以低能量氦氖雷射治療分節型尋常性白斑之成效評估及其對皮膚微循環影響之研究

The Study of Effectiveness of Low-energy Helium-Neon Laser Treatment in Segmental-type Vitiligo and its Effect on Cutaneous Microcirculation

吳介山(Chieh-Shan Wu)

指導教授 ： 余幸司

高雄醫學大學/醫學院/醫學研究所/碩士(2003年)

摘要

Koga將尋常性白斑依其臨床及生理學上的表現簡單區分成兩種病型，非分節型白斑與自體免疫性疾病有關；分節型白斑則與病灶部位之交感神經功能異常有關。為了詳細了解此二型白斑的差異，本論文第一章應用雷射都卜勒血流測定及離子導入等方法，評估病灶部位之皮膚微循環及交感神經接受器反應，發現分節型白斑患者病灶部位之皮膚血流量顯著上升，而且其病灶部位皮膚之α與β型交感神經接受器反應，有明顯亢進的現象。所以我們進一步證實分節型白斑病灶部位交感神經功能異常之理論，並確信其在分節型白斑致病機轉中，扮演相當重要的角色。
分節型白斑的頑固治療反應是皮膚科醫師最頭痛的問題，低能量氦氖雷射在臨床上已被廣泛運用治療許多疾病，其中包括白斑治療與神經損害的修復在內。本論文第二章以低能量氦氖雷射治療分節型白斑並評估其療效，在持續接受治療的患者有60%可以觀察到有顯著效果，同時在規則治療的患者發現病灶的皮膚血流量及交感神經接受器功能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，其對於病灶部位受損的交感神經機能可能也有相當程度的修復或調控的作用。

關鍵字

低能量氦氖雷射 ； 分節型白斑 ； 皮膚微循環

並列摘要

It has been proposed that two types of vitiligo exist from the physiological and clinical points of view. Nonsegmental-type vitiligo（NSV） is associated with autoimmune diseases. Segmental-type vitiligo（SV） results from the dysfunction of sympathetic nerves in the affected area. For further exploring the differences between these two types of vitiligo, we used laser Doppler flowmetry and iontophoresis for cutaneous microcirculation and adrenoceptor responses assessments in chapter 1. Obviously increased cutaneous blood flow and significant hyperfunction in cutaneousα- and β-adrenoceptor in SV lesions were noticed. Our findings further suggest that a dysfunction of the sympathetic nerves exists in the affected skin and plays a role in the pathogenesis of SV.
The recalcitrant treatment response of SV is indeed an arduous challenge for all dermatologists. Low-energy helium-neon laser（He-Ne laser）（632.8 nm）has been employed in a variety of clinical treatments including vitiligo management and repair of nerve injury. In chapter 2, we utilized He-Ne laser to treat SV and evaluated its effectiveness on repigmentation and cutaneous microcirculation. Marked repigmentation （＞50%）was observed in 60% of patients with successive treatments. Tendency of gradually normalizing cutaneous blood flow and adrenoceptor responses were found. So we concluded that He-Ne laser could effectively treat SV and have some repairing effect on damaged sympathetic nerves.

並列關鍵字

low-energy helium-neon laser ； segmental-type vitiligo ； cutaneous microcirculation

參考文獻

第一章

Al’Abadie MSK, Senior HJ, Bleehen SS, Gawkrodger DJ: Neuropeptide and neuronal marker studies in vitiligo. Br J Dermatol 131: 160-165, 1994.

Al’Abadie M, Gawkrodger D, Senior H et al.: Neuro-ultrastructural and neuropeptide studies in vitiligo. Clin Exp Dermatol 15: 284, 1992.

Al’Abadie MS, Warren MA, Beehen SS.: Morphologic observation on the dermal nerves in vitiligo: an ultrastructural study. Int J Dermatol 34: 837-840, 1995.

Breathnach A, Bor S, Wyllie L: Electron microscope of peripheral nerve terminals and marginal melanocytes in vitiligo. J Invest Dermatol 47: 125-140, 1966.