摘要目的 研究A型肉毒毒素治疗眉间纹引起的皮肤及其下肌层的厚度改变.方法 收集北京协和医院2017年8月至2018年2月注射A型肉毒毒素治疗的26例中重度眉间纹受试者,于注射前及注射后4周、16周,采用50 MHz高频超声检测注射部位皮肤的真皮层厚度,20 MHz高频超声检测皮肤全层和肌层厚度.采用单组重复测量资料的方差分析、配对t检验及Bonferroni法比较受试者注射治疗前后3个时间点超声检测的组织厚度.结果 注射前,真皮层、皮肤全层和肌层厚度分别为(2.01±0.48)、(4.32±0.73)、(4.51±0.67) mm.注射前、注射后4及16周真皮层厚度差异无统计学意义(F=1.94,P=0.199),而皮肤全层厚度、肌层厚度差异均有统计学意义(F=6.28、24.19,P=0.020、＜0.001).与注射前相比,注射后4周皮肤全层厚度显著增加[(4.88±0.93) mm,t=3.72,P=0.004],而肌层厚度显著降低[(3.82±0.79) mm,t=4.65,P=0.001].与注射前和注射后4周相比,注射后16周时皮肤全层厚度(4.61±0.73) mm和肌层厚度(4.38±0.90) mm差异均无统计学意义(均P＞ 0.016 7).结论 注射A型肉毒毒素可改变皮下组织和肌层厚度,高频超声可用于A型肉毒毒素注射治疗眉间纹的疗效评价及随访.

abstractsObjective To investigate changes in thickness of the skin and muscular layer during the treatment with botulinum toxin A injections in patients with glabellar lines.Methods Twenty-six subjects with moderate to severe glabellar lines were enrolled into this study,who received botulinum toxin A injections in Peking Union Medical College Hospital from August 2017 to February 2018.Before the injections,4 and 16 weeks after the injections,thickness of the dermis at the injection site was measured by using 50 MHz high-frequency ultrasound,and full thickness of the skin and thickness of the muscular layer were measured with 20 MHz high-frequency ultrasound.Repeated measures analysis of variance,paired ttest and Bonferroni method were used to compare the pretreatment and posttreatment tissue thicknesses measured by using high-frequency ultrasound.Results Before the injections,the thickness of the dermis,full thickness of the skin,thickness of the muscular layer were 2.01 ± 0.48,4.32 ± 0.73 and 4.51 ± 0.67 mm respectively.No significant difference was observed among the pretreatment,4-and 16-week posttreatment thickness of the dermis (F =1.94,P =0.199),while there were significant differences among the pretreatment,4-and 16-week posttreatment full thickness of the skin and thickness of the muscular layer (F =6.28,24.19,P =0.020,＜ 0.001 respectively).Four weeks after the injections,the full thickness of the skin significantly increased (4.88 ± 0.93 mm,t =3.72,P =0.004),while the thickness of the muscular layer significantly decreased (3.82 ± 0.79 mm,t =4.65,P =0.001)compared with the pretreatment thicknesses.Sixteen weeks after the injections,the full thickness of the skin (4.61 ± 0.73 mm) and thickness of the muscular layer (4.38 ± 0.90 mm) did not significantly differ from those before and 4 weeks after the injections (all P ＞ 0.016 7).Conclusions Botulinum toxin A injections can change the thickness of the subcutaneous tissue and muscular layer.High-frequency ultrasound can be applied to the evaluation of efficacy and to follow-up after the treatment of glabellar lines with botulinum toxin A injections.