五种方法治疗顽固性跖疣的疗效和安全性比较

Comparison of the Efficacy and Safety of Five Therapeutic Regimens for Intractable Plantar Warts

目的评价5种方法治疗顽固性跖疣的临床疗效和安全性。方法将入选的250例顽固性跖疣随机分为5组,各50例。A组予局部注射重组人IL-2联合CO2激光治疗,B组予CO2激光治疗,C组予冷冻治疗,D组予氟尿嘧啶软膏外搽,E组予局部注射重组人IL-2。5组患者的疗程均为1个月。结果治疗结束后1个月时A组有效率(82.00%)显著高于B组、C组、D组和E组(依次为64.00%,40.00%,10.00%和32.00%),治疗结束后2个月时A组有效率(94.00%)也显著高于B组、C组、D组和E组(依次为78.00%,56.00%,32.00%和44.00%),而且各组有效率组内比较结果显示治疗结束后2个月时均优于治疗结束后1个月时;随访6个月时,A组复发率(4.26%)分别低于B组、C组、D组和E组(依次为20.51%,42.86%,62.50%和31.82%)。以上差异均有统计学意义(P均<0.05)。A组皮损平均愈合时间均明显少于其他4组,差异均有统计学意义(t=5.726,11.354,17.876,9.687,P均<0.05)。各组治疗不良反应主要有术中术后疼痛、伤口出血、感染等,A组不良反应明显少于B组、C组和E组,D组无明显不良反应。结论局部注射重组人IL-2联合CO2激光治疗顽固性跖疣时患者的皮损消失快,伤口愈合早,治愈率高,复发率低,不良反应少。其他组别有效率由高到低依次为CO2激光、液氮冷冻、局部注射IL-2及外用5%氟尿嘧啶软膏。

Objective To compare the efficacy and safety of five therapeutic regimens for intractable plantar waits. Meth- ods A total of 250 patients with intractable plantar warts were randomly divided into five groups,50 cases/ group. Group A were given local injection of recombinant human IL-2 plus CO2 laser treatment, while group B were treated with CO2 laser alone. Cryotherapy was given to group C ; group D were treated with topical fluorouracil ointment; group E were given local injection of recombinant human IL-2 alone. All patients were treated for one month. Results One month after the treatment,the total effective rate in group A （82.00%） was significantly higher than that in other four groups （64.00% for group B,40.00% for group C,10.00% for group D and 32.00% for group E）. Likewise 2 months after the treatment, the total effective rate in group A （94.00%） was also significantly higher than that in the other four groups （78.00% for Group B,56.00% % for Group C,32.00% for group D and 44.00% for group E）. In contrast,after 6-month follow-up,the recurrence rate in group A （4.26%） was significantly lower than that in other 4 groups （20.51% for group B, 42.86% for group C,62.50% for group D and 31.82% for group E,P 〈 0.05） . The cure time was signifi- cantly shorter in for group A than the other four groups （ t = 5. 726,11. 354,17. 876,9.687 ,P 〈 0.05 ） . While major adverse reactions in all groups included intraoperative and postoperative pain,wound bleeding,and infection, the incidence in group A was significantly less than that in the other four groups. Conclusion Local in- jection of recombinant human IL- 2 combined with CO2 laser is effective and safe for intractable plantar warts with a lower recurrence rate and less adverse reactions. Among the other treatments, CO2 laser shows the highest effective rate, followed by liquid nitrogen freezing,local injection of IL-2 and topical 5% fluorouracil ointment.