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相關文獻
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題名 | Low-Energy Helium-Neon Laser Therapy Induces Repigmentation and Improves the Abnormalities of Cutaneous Microcirculation in Segmental-Type Vitiligo Lesions=低能量氦氖雷射可促使分節型白斑病灶色素恢復並改善其交感神經機能異常 |
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作者姓名(中文) | 吳介山; 胡楚松; 藍政哲; 陳國熏; 卓玟禾; 余幸司; | 書刊名 | The Kaohsiung Journal of Medical Sciences |
卷期 | 24:4 2008.04[民97.04] |
頁次 | 頁180-189 |
分類號 | 415.754 |
關鍵詞 | 皮膚微循環; 低能量氦氖雷射; 分節型白斑; 交感神經腎上腺接受器; Cutaneous microcirculation; He-Ne laser; Segmental-type vitiligo; Sympathetic adrenoceptor response; |
語文 | 英文(English) |
中文摘要 | 分節型白斑是一種特殊型的白斑,其病灶分布於單側的神經節段上,目前的研究認為是由於病灶交感神經機能異常所致,我們過去的研究發現分節型白斑病灶有皮膚血流量上升及交感神經腎上腺接受器亢進的異常表現。臨床上其頑固的治療反應對皮膚科醫師而言是一項艱鉅的挑戰。低能量氦氖雷射 (波長 632.8 nm) 在臨床上已被廣泛運用於治療許多疾病,其中包括白斑治療與神經損害的修復在內。本研究之目的在評估以低能量氦氖雷射治療分節型白斑的療效與安全性,並進一步探討其對病灶交感神經機能異常的修復作用。我們選取 40 位病灶位於頭頸部的穩定期分節型白斑患者,低能量氦氖雷射以點治療的模式 (3.0 J/cm2) 每週治療 1-2 次;另外在 6 位經氦氖雷射治療後有明顯色素回復的分節型白斑患者以雷射都卜勒血流測定儀測定病灶治療前後皮膚血流量的差異,並以離子電泳導入擬交感神經藥劑觀察病灶皮膚血流量的變化,藉以評估其交感神經腎上腺接受器機能在治療前後的變化,所有檢查均同時監測正常側對稱部位作為比較。平均在 17 次治療後,即可發現病灶開始出現色素恢復的現象,而在持續接受治療的患者中 60% 可以觀察到有顯著的治療效果 (色素恢復 > 50%),而且所有接受治療者完全沒有任何不適反應或副作用出現;同時在 6 位規則治療的分節型白斑患者發現治療前異常上升的病灶皮膚血流量已恢復正常,而交感神經腎上腺素接受器對於 clonidine 的異常反應亦有逐漸恢復正常的趨勢。由以上的結果我們相信:低能量氦氖雷射不僅可以有效地治療分節型白斑,其對於病灶部位異常的交感神經機能亦可能有相當程度的修復或調控的作用。 |
英文摘要 | Segmental vitiligo (SV) is a special form of vitiligo occurring in a dermatomal distribution, and an abnormality involving the sympathetic nerves supplying the affected dermatome is known to underlie this disorder. Previously, we have shown that SV is associated with an abnormal increase in cutaneous blood flow and adrenoceptor responses in the affected areas. Since SV is resistant to conventional forms of therapy, its management represents a challenge for dermatologists. Low energy helium-neon lasers (He-Ne laser, wavelength 632.8 nm) have been employed as a therapeutic instrument in many clinical situations, including vitiligo management and repair of nerve injury. The purpose of this study was to evaluate the effectiveness and safety of He-Ne lasers in treating SV, and determine their effects on the repair of sympathetic nerve dysfunction. Forty patients with stable-stage SV on the head and/or neck were enrolled in this study. He-Ne laser irradiation was administered locally at 3.0 J/cm2 with point stimulation once or twice weekly. Cutaneous microcirculatory assessments in six SV patients were performed using a laser Doppler flowmeter. The sympathetic adrenoceptor response of cutaneous microcirculation was determined by measuring cutaneous blood flow before, during and after iontophoresis with sympathomimetic drugs (phenylephrine, clonidine and propranolol). All measurements of microcirculation obtained at SV lesions were simultaneously compared with contralateral normal skin, both before and after He-Ne laser treatment. After an average of 17 treatment sessions, initial repigmentation was noticed in the majority of patients. Marked repigmentation (> 50%) was observed in 60% of patients with successive treatments. Cutaneous blood flow was significantly higher at SV lesions compared with contralateral skin, but this was normalized after He-Ne laser treatment. In addition, the abnormal decrease in cutaneous blood flow in response to clonidine was improved by He-Ne laser therapy. Our study showed that He-Ne laser therapy is an effective treatment for SV by normalizing dysfunctions of cutaneous blood flow and adrenoceptor responses in SV patients. Thus, the beneficial effects of He-Ne laser therapy may be mediated in part by a reparative effect on sympathetic nerve dysfunction. |
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