中国组织工程研究

中国组织工程研究 ›› 2026, Vol. 30 ›› Issue (30): 7954-7962.doi: 10.12307/2026.930

• 组织构建临床实践 clinical practice in tissue construction • 上一篇    下一篇

二氧化碳点阵激光联合复方倍他米松注射液治疗烧伤后增生性瘢痕的时机对比

李  妍1，陶  凯2，唐亦复1，姬生波1，林  麟1，胥学冰1   

  1. 1武警辽宁总队医院烧伤科，辽宁省沈阳市  110034；2中国医科大学附属第四医院，辽宁省沈阳市  110032
  • 收稿日期:2026-04-22 修回日期:2026-05-15 出版日期:2026-10-28 发布日期:2026-09-14
  • 通讯作者: 胥学冰，硕士，主任医师，武警辽宁总队医院烧伤科，辽宁省沈阳市 110034
  • 作者简介:李妍，女，1987年生，辽宁省沈阳市人，满族，2020年中国医科大学毕业，硕士，主治医师，主要从事烧伤整形方面的研究。

Comparison of therapeutic timing of fractional carbon dioxide laser combined with compound betamethasone injection for post-burn hypertrophic scars

Li Yan1, Tao Kai2, Tang Yifu1, Ji Shengbo1, Lin Lin1, Xu Xuebing1   

  1. 1Department of Burns, Hospital of the Liaoning Provincial Armed Police Corps, Shenyang 110034, Liaoning Province, China; 2The Fourth Affiliated Hospital of China Medical University, Shenyang 110032, Liaoning Province, China
  • Received:2026-04-22 Revised:2026-05-15 Online:2026-10-28 Published:2026-09-14
  • Contact: Xu Xuebing, MS, Chief physician, Department of Burns, Hospital of the Liaoning Provincial Armed Police Corps, Shenyang 110034, Liaoning Province
  • About author:Li Yan, MS, Attending physician, Department of Burns, Hospital of the Liaoning Provincial Armed Police Corps, Shenyang 110034, Liaoning Province, China

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摘要：



文题释义：
增生性瘢痕：烧伤后增生性瘢痕是深部真皮损伤愈合过程中，成纤维细胞过度增殖、胶原纤维异常沉积所形成的高出皮面、质硬、呈红色或暗红色的病理性组织。此次研究中纳入的增生性瘢痕均符合以下量化标准：瘢痕形成时间1-12个月，温哥华瘢痕量表评分≥5分，厚度≥2 mm，且经至少2名主治及以上医师独立诊断为活动性增生性瘢痕。组织学上以真皮内大量Ⅲ型胶原结节状排列、α-平滑肌肌动蛋白阳性肌成纤维细胞增多为特征。与瘢痕疙瘩不同，增生性瘢痕范围不超过原始烧伤边界，且在6-12个月后可能自然进入减退期，这为研究不同治疗时机的干预效果提供了时间窗口。
治疗时机：此次研究中“治疗时机”特指烧伤创面上皮化完全后至首次接受联合治疗的时间间隔，并以6个月为界划分为“早期治疗”(≤6个月)和“晚期治疗”(> 6个月)。该界值基于增生性瘢痕的自然病程：半年内瘢痕处于快速增生期，成纤维细胞增殖活跃(此次研究中早期治疗组治疗前增殖细胞核抗原表达量为138-223 H-score)；半年后部分瘢痕可能进入减退期或稳定期。研究通过析因设计，比较两个时间窗启动二氧化碳点阵激光联合复方倍他米松注射的疗效差异，旨在回答临床实践中“何时开始治疗能获得最佳瘢痕改善”这一核心问题，为制定个体化瘢痕治疗策略提供循证依据。

背景：烧伤后增生性瘢痕的激光联合激素治疗已初步显示疗效，但最佳启动时机(瘢痕形成半年内与半年后)是否影响远期效果尚缺乏前瞻性临床证据。
目的：探讨二氧化碳点阵激光联合复方倍他米松注射液在不同治疗时机(半年内与半年以后)对烧伤后增生性瘢痕的疗效及安全性。  
方法：选择2022年1月至2025年8月于武警辽宁总队医院烧伤科接受治疗的烧伤后增生性瘢痕患者120例，按治疗方案分为4组，每组30例。A、B组分别于瘢痕形成半年内、半年以后接受复方倍他米松注射液注射治疗；C组在A组基础上联合二氧化碳点阵激光治疗；D组在B组基础上联合二氧化碳点阵激光治疗。在统计分析时，将A组与C组合并为早期治疗组，B组与D组合并为晚期治疗组。所有患者均计划接受5次治疗，每次治疗间隔4周。分别于治疗前、治疗后6个月采用温哥华瘢痕量表评估患者的瘢痕程度，应用观察者瘢痕评估量表评分、患者瘢痕评估量表评分评估瘢痕疗效，并采用武警辽宁总队医院自制满意度调查问卷评估患者满意度，比较治疗前、治疗后6个月瘢痕组织中增殖细胞核抗原蛋白的表达水平；同时记录两组治疗期间出现的不良反应及复发率。  
结果与结论：①治疗后6个月A组与C组的温哥华瘢痕量表评分、观察者瘢痕评估量表评分和患者瘢痕评估量表评分均低于B组与D组(P < 0.05)；C组温哥华瘢痕量表评分、观察者瘢痕评估量表评分和患者瘢痕评估量表评分均显著低于其他治疗组(P < 0.05)；②早期治疗组患者的满意度高于晚期治疗组(P < 0.05)；③治疗后6个月，各组增殖细胞核抗原表达水平均较治疗前显著下降，其中C组增殖细胞核抗原表达水平显著低于其余各组(P < 0.05)；A组和D组增殖细胞核抗原表达水平均显著低于B组(P < 0.05)；A组与D组之间差异无显著性意义(P > 0.05)；④4组间复发率比较差异无显著性意义(χ2=4.205，P=0.240)，但C组仅1例复发，复发率最低；⑤治疗后随访1年，对各组患者再次进行温哥华瘢痕量表、观察者瘢痕评估量表及患者瘢痕评估量表评估，结果显示早期治疗优势持续存在，早期联合治疗组改善最为显著，与其余组比较差异有显著性意义(P < 0.05)。提示二氧化碳点阵激光联合复方倍他米松注射液治疗烧伤后增生性瘢痕，疗效优于单纯激素治疗，并且早期治疗(瘢痕形成半年内)的疗效优于晚期治疗(瘢痕形成半年以后)，且安全性高。
https://orcid.org/0009-0003-7241-2047(李妍)


中国组织工程研究杂志出版内容重点：干细胞；骨髓干细胞；造血干细胞；脂肪干细胞；肿瘤干细胞；胚胎干细胞；脐带脐血干细胞；干细胞诱导；干细胞分化；组织工程

关键词: 二氧化碳点阵激光, 复方倍他米松注射液, 烧伤, 增生性瘢痕, 治疗时机, 疗效对比

Abstract: BACKGROUND: Although the combination of laser and corticosteroid therapy has shown preliminary efficacy for post-burn hypertrophic scars, whether the optimal timing of initiation (within 6 months versus after 6 months of scar formation) affects long-term outcomes remains unclear due to a lack of prospective clinical evidence. 
OBJECTIVE: To investigate the efficacy and safety of fractional carbon dioxide laser combined with diprospan in the treatment of post-burn hypertrophic scars at different treatment timings (within 6 months and after 6 months of scar formation). 
METHODS: A total of 120 patients with post-burn hypertrophic scars who received treatment in the Department of Burn and Plastic Surgery of the Hospital of the Liaoning Provincial Armed Police Corps from January 2022 to August 2025 were selected. They were randomly divided into four groups, with 30 patients in each group. Groups A and B were given diprospan injection within 6 months of scar formation and after 6 months of scar formation. Group C received treatment within 6 months of scar formation using fractional carbon dioxide laser combined with diprospan injection. Group D received treatment after 6 months of scar formation using fractional carbon dioxide laser combined with diprospan injection. For statistical analysis, group A and group C were combined into the early-treatment group, and group B and group D were combined into the late-treatment group. The Vancouver Scar Scale was used to evaluate the degree of scarring before treatment and 6 months after treatment. The Observer Scar Assessment Scale and the Patient Scar Assessment Scale were used to assess the efficacy of scar treatment. A self-made satisfaction questionnaire from the Hospital of the Liaoning Provincial Armed Police Corps was used to evaluate patient satisfaction. The expression level of proliferating cell nuclear antigen protein in scar tissue before and after treatment was compared. Additionally, adverse reactions and recurrence rates during the treatment period in the two groups were recorded. 
RESULTS AND CONCLUSION: (1) Six months after treatment, the scores on the Vancouver Scar Scale, the Observer Scar Assessment Scale and the Patient Scar Assessment Scale in groups A and C were lower than those in groups B and D (P < 0.05), while the scores in group C were significantly lower than those in the other treatment groups (P < 0.05). (2) Patient satisfaction in the early‑treatment group was higher than that in the late‑treatment group (P < 0.05). (3) Six months after treatment, the expression levels of proliferating cell nuclear antigen protein in all groups decreased significantly compared with baseline. Among them, the expression level of proliferating cell nuclear antigen protein in group C was significantly lower than those in the other groups (P < 0.05). The expression levels of proliferating cell nuclear antigen protein in groups A and D were both significantly lower than that in group B (P < 0.05). There was no statistically significant difference between groups A and D (P > 0.05). (4) The difference in recurrence rates among the four groups was not statistically significant (χ2=4.205, P=0.240), but group C had only one case of relapse, with the lowest recurrence rate. At the 1‑year follow‑up, the scores on the Vancouver Scar Scale, the Observer Scar Assessment Scale and the Patient Scar Assessment Scale were reassessed in all groups. The results showed that the advantages of early treatment persisted, and the combination treatment group showed the most significant improvement at the early stage, with statistically significant differences compared with the other groups (P < 0.05). These findings indicate that fractional carbon dioxide laser combined with compound betamethasone injection is more effective than corticosteroid monotherapy for post‑burn hypertrophic scars, and early treatment (within 6 months of scar formation) is superior to late treatment (after 6 months of scar formation), and has high safety.

Key words: fractional carbon dioxide laser, diprospan, burn, hypertrophic scar, therapeutic timing, efficacy comparison

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