长脉宽Nd:YAG 1064 nm激光治疗远端侧位甲下型甲真菌病的疗效观察及对真菌超微结构的影响

摘要/Abstract

摘要：

目的探讨长脉宽Nd：YAG 1064 nm激光治疗远端侧位甲下型甲真菌病的疗效，观察其对真菌超微结构的影响。方法收集临床具有甲真菌病典型临床表现且真菌真接镜检阳性的远端侧位甲下型甲真菌病病例，给予长脉宽Nd：YAG 1064 nm激光治疗12周，计算临床有效率、真菌学清除率，记录不良反应。采用扫描电镜观察长脉宽Nd：YAG 1064 nm激光对红色毛癣菌、趾/指间毛癣菌、白念珠菌临床菌株超微结构的影响。结果入选远端侧位甲下型甲真菌病患者30例，共计病甲58个，其中22个累积甲母质。疗后半年临床有效率为58.62%。治疗结束未累积与累积甲母质病甲临床有效率分别为61.11%、9.09%，疗后半年两组临床有效率分别为80.56%、22.73%，差异均有显著的统计学意义（χ²=15.234、18.825，P<0.001、0.001）。疗后半年真菌学清除率为58.62%。治疗结束时及疗后半年未累积与累积甲母质病甲真菌学清除率差异均有显著的统计学意义（χ²=21.795、23.895，P<0.001、0.001）。激光照射后的临床菌株，在扫描电镜下显示菌体被破坏。结论长脉宽Nd：YAG1064 nm激光是治疗未累积甲母质的远端侧位甲下型甲真菌病的一种安全有效的方法，其可以改变菌体的超微结构。

关键词: 激光治疗, 甲真菌病, 超微结构

Abstract:

Objective To evaluate the efficacy of long pulsed Nd:YAG 1064nm laser for the treatment of distal lateral subungual onychomycosis and to observe the effect on the ultrastructural changes of fungi. Methods Distal lateral subungual onychomycosis cases with typical clinical manifestations and positive fungal microscopy examination were enrolled into this study, and treated with long pulsed Nd:YAG 1064 nm laser for 12 weeks. Clinical efficacy and mycological clearance were evaluated. The ultrastructural changes of long pulsed Nd:YAG 1064 nm laser in Trichophyton rubrum, Trichophyton interdigitale and Candida albicans were exhibited by scanning electron micrograph(SEM). Results Totally, 30 patients with distal lateral subungual onychomycosis (58 nails) were enrolled. There were 22 nails with nail matrix involvement. The clinical effective rate was 58.62% at 6 months after treatment. At the end of the treatment, the clinical effective rates of the nails without and with nail matrix involvement were 61.11%、9.09%,respectively. At 6 months after treatment, those were 80.56%、22.73%, respectively. There were significant differences,respectively(χ²=15.234、18.825,P<0.001、0.001). The mycological clearance rate was 58.62% at 6 months after treatment. At the end of treatment and 6 months after treatment, there was significant difference in the mycological clearance rate between the nails without and with nail matrix involvement(χ²=21.795、23.895,P<0.001、0.001). The results of SEM exhibited that the ultrastructure of the three strains after laser irradiation was damaged. Conclusion Long pulsed Nd:YAG 1064 nm laser was a safe and effective method for the treatment of distal lateral subungual onychomycosis without nail matrix involvement, and the laser could change the cellular ultrastructure of fungi.

Key words: laser therapy, onychomycosis, ultrastructure

中图分类号:

R756.4

王玲, 景东云, 王学军, 刘俊, 曹月清. 长脉宽Nd:YAG 1064 nm激光治疗远端侧位甲下型甲真菌病的疗效观察及对真菌超微结构的影响[J]. 中国真菌学杂志, 2020, 15(5): 268-273.

WANG Ling, JING Dong-yun, WANG Xue-jun, LIU Jun, CAO Yue-qing. Efficacy of long pulsed Nd:YAG 1064nm laser for the treatment of distal lateral subungual onychomycosis and effect on the ultrastructural changes of fungi[J]. Chinese Journal of Mycology, 2020, 15(5): 268-273.

参考文献 18

[1]	赵辨.中国临床皮肤病学[M].第4版.南京:江苏科学技术出版社,2010:557.
[2]	Kim HJ, Park HJ, Suh DH,et al. Clinical factors influencing outcomes of 1064 nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser treatment for onychomycosis[J].Ann Dermatol,2018,30(4):493-495.
[3]	do Espírito Santo RB, Deps PD.Case study of onychomycosis patients treated with 1,064-nm Nd:YAG laser[J].Case Rep Dermatol,2018,10(2):216-225.
[4]	许阳,马仁燕,Juliandri,等.长脉宽Nd:YAG激光和口服特比奈芬联合疗法与单一治疗甲真菌病临床疗效比较研究[J].中国美容医学,2016,25(12):60-63.
[5]	中华医学会皮肤性病学分会真菌学组.甲真菌病诊治指南(2008年版)[J].中华皮肤科杂志,2008,41(12):844-845.
[6]	中华医学会皮肤性病学分会,中国中西医结合学会皮肤性病专业委员会,中国医师协会皮肤科医师分会.中国甲真菌病诊疗指南(2015年版)[J].中国真菌学杂志,2015,10(2):118-125.
[7]	Gupta AK, Simpson F.Newly approved laser systems for onychomycosis[J].J Am Podiatr Med Assoc,2012,102(5):428-430.
[8]	黄荷,周炳荣,许阳,等.物理治疗在甲真菌病中的应用[J].国际皮肤性病学杂志,2015,41(6):370-373.
[9]	张蕊娜,禚风麟,王东坤,等.不同激光设备不同方案治疗甲真菌病的疗效评估[J].临床皮肤科杂志,2016,45(1):15-19.
[10]	刘艳,周俊,李蕊联,等.长脉宽1064 nm Nd:YAG激光治疗甲真菌病[J].中国麻风皮肤病杂志,2017,33(9):541-543.
[11]	刘红芳,黄莉宁,陈勇军,等.不同疗程长脉宽Nd:YAG 1064 nm激光治疗甲真菌病的疗效观察[J].皮肤性病诊疗学杂志,2015,22(3):185-188.
[12]	Gupta AK, Paquet M.A retrospective chart review of the clinical efficacy of Nd:YAG 1064-nm laser for toenail onychomycosis[J].J Dermatolog Treat,2015,26(4):376-378.
[13]	杨烨玫,周思彤,胡永轩,等.长脉宽1064 nm Nd:YAG激光治疗趾甲真菌病的疗效及安全性[J].南方医科大学学报,2016,36(5):693-696.
[14]	杨阳,刘涵,杨蓉娅,等.超脉冲CO2点阵激光治疗甲真菌病疗效观察[J].中华皮肤科杂志,2015,8(48):526-530.
[15]	邹彦芬,叶庭路,钟绮丽,等.长脉宽Nd:YAG激光1064 nm治疗甲真菌病33例临床观察[J].中国皮肤性病学杂志,2014,28(6):581-583.
[16]	陆晟,张振,费烨,等.长脉宽Nd:YAG激光治疗甲真菌病疗效观察[J].中华皮肤科杂志,2013,46(2):105-108.
[17]	陈梅,张敬东,董正邦.长脉宽Nd:YAG 1064 nm激光联合水杨酸封包治疗甲真菌病的疗效评价[J].中国麻风皮肤病杂志,2015,31(11):685-688.
[18]	曹艳云,孙盈翡,徐徉,等.长脉冲1064 nm激光联合酮康唑软膏封包病甲治疗甲真菌病的临床疗效观察[J].中国真菌学杂志,2019,14(3):154-158.