目的：评估氨甲环酸巴布剂联合大光斑低能量Q开关Nd:YAG激光治疗黄褐斑的疗效及安全性。 方法：选取面部黄褐斑患者180例, 根据不同治疗方法将纳入患者分为A组和B组, 各90例。A组给予大光斑低能量Q开关Nd:YAG激光治疗, B组给予氨甲环酸巴布剂联合大光斑低能量Q开关Nd:YAG激光治疗。观察比较2组治疗后黄褐斑总积分下降指数、总有效率、皮肤病生活质量指数(DLQI)、黄褐斑生活质量评分(MELASQOL)及不良反应。对2组患者进行6个月随访, 观察比较2组患者复发情况。结果： ①2组患者治疗前黄褐斑总积分无统计学差异(P＞0.05), 治疗后均有明显下降(P＜0.05), 但2组治疗后黄褐斑总积分和下降指数比较, 差异均有统计学意义(P＜0.05)。②A组治疗总有效率为61%(55/90), B组治疗总有效率为80%(72/90), B组治疗总有效率明显高于A组(P＜0.05)。③2组治疗前DLQI及MELASQOL评分无统计学差异(P＞0.05), 2组治疗后DLQI及MELASQOL评分均明显降低(P＜0.05), 但B组改善程度大于A组(P＜0.05)。④所有患者在治疗过程中均未出现严重不良反应。两组不良反应发生率无统计学差异(P＞0.05)。6个月随访期间B组复发率(5.6%)低于A组(11.1%), 差异比较有统计学意义(P＜0.05)。结论：氨甲环酸巴布剂联合大光斑低能量Q开关Nd:YAG激光治疗黄褐斑的疗效显著, 患者满意度高,复发率低, 不良反应轻, 值得临床推广应用。

Objective: to assess the efficacy and safety of tranexamic acid cataplasm combined with large spot low energy Q switch Nd :YAG laser for melasma. Methods: Selected 180 patients with facial melasma as the research object, according to different treatment methods, the included patients were divided into group A and group B, with 90 cases each. Group A was treated by large spot low energy Q switch Nd :YAG laser, and Group B was treated by tranexamic acid cataplasm combined with large spot low energy Q switch Nd :YAG laser. The total melasma score decline index, total effective rate, dermatology life quality index (DLQI), melasma quality of life scale(MELASQOL) and adverse reactions of chloasma were observed and compared between the two groups after treatment. The patients in the two groups were followed up for 6 months to observe and compare the recurrence of patients in the two groups. Results: ①There was no statistically significant difference in total chloasma score before treatment (P>0.05)between the two groups, and decreased after treatment (P<0.05), but the difference in total chloasma score and decline index between the two groups after treatment were statistically significant (P<0.05).②The total effective rate of group A was 61%(55/90), and that of group B was 80%(72/90). The total effective rate of group B was significantly higher than that of group A (P<0.05).③There was no statistical difference in DLQI and MELASQOL scores between the two groups before treatment (P>0.05), and DLQI and MELASQOL scores were significantly reduced after treatment in the two groups (P<0.05), but the improvement degree in group B was greater than that in group A (P<0.05).④No serious adverse reactions occurred in all patients during the treatment.There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05).During the 6-month follow-up, the recurrence rate of group B (5.6%) was lower than that of group A (11.1%), and the difference was statistically significant (P<0.05). Conclusion The efficacy of tranexamic acid cataplasm combined with large spot low energy Q switch Nd :YAG laser for melasma is significant, has high patient satisfaction, low recurrence rate and mild adverse reactions, which is worthy of clinical application.