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目的 比较长脉宽Nd∶YAG 1 064nm激光不同治疗参数(能量密度、光斑直径、脉宽及治疗次数)治疗由红色毛癣菌感染引起的甲真菌病的疗效及安全性,探索影响该激光治疗甲真菌病疗效的主要因素.方法 利用不同能量密度(35J/cm2,40J/cm2,45J/cm2),光斑直径(3mm,4mm,5mm),脉宽(25ms,30ms,35ms)及治疗次数(3次,4次,5次)等治疗参数正交设计A～I共9组治疗方案,将177例甲真菌病患者511个病甲随机分为9组,分别接受A～I组方案治疗,并于治疗结束后6个月及12个月进行随访,观察临床有效率、真菌学有效率及复发情况,记录观察治疗过程及随访中的不良反应.结果 A～I组患者接受不同方案治疗,治疗结束后各组患者的病甲有明显改善,各组的临床有效率与治疗结束时相比,各组病甲均有明显改善;多因素回归分析表明,治疗的能量密度越高(6个月Wald=5.129,P=0.024;12个月Wald=10.471,P=0.001),次数越多(6个月Wald=4.529,P=0.033;12个月Wald=4.021,P=0.045),其临床有效率及真菌学有效率越高.结论 长脉宽Nd∶YAG 1 064nm激光是治疗红色毛癣菌感染引起的甲真菌病的一种安全有效的方法;在患者能够耐受的情况下,高能量密度、多次治疗可提高临床疗效.“,”Objective To compare the efficacy and safety of long-pulsed Nd∶YAG 1 064nm laser for the treatment of onychomycosis caused by Trichophyton rubrum with different parameters (energy density,spot size,pulsewidth and treatment times),and to investigate the main factors that affected the efficacy of the long-pulsed Nd∶YAG 1 064nm laser for the treatment of onychomycosis.Methods Group A ～ I were orthogonally designed according to various energy density (35J/cm2,40J/cm2,45J/cm2),spot size (3mm,4mm,5mm),pulse-width (25ms,30ms,35ms) and treatment times (3times,4times,5times).The 511 destroyed nails of 177 patients with onychomycosis were enrolled and accept different treatment.Follow-up was made in 6 months and 12 months after completion of treatment.Clinical efficacy and mycological clearance were also evaluated.Adverse reactions to laser treatment were recorded.Results All the patients in group A ～ I were improved after various treatments.All destroyed nails improved significantly at 6 months and 12 months after completion of treatment.The results of multivariate analysis showed that the clinical efficacy and mycological clearance were related with energy density (6 months Wald =5.129,P =0.024;12 months Wald=10.471,P =0.001) and treatment times(6 months Wald =4.529,P =0.033;12 months Wald =4.021,P =0.045).Conclusion Long-pulsed Nd ∶YAG 1 046nm laser is effective and safe in the treatment of onychomycosis caused by Trichophyton rubrum,and higher clinical effects and mycological clearance were made by improving the energy density and treatment times under the patients' tolerance.