20%5-氨基酮戊酸光动力联合液氮冷冻治疗尖锐湿疣

20% 5-aminolevulinic acid photochemotherapy combined with liquid nitrogen frozen therapy in treatment of condyloma acuminatum patients

目的探讨20%5-氨基酮戊酸光动力联合液氮冷冻治疗尖锐湿疣的疗效和安全性,并分析尖锐湿疣患者人类乳头瘤病毒(HPV)基因型感染分布情况。方法尖锐湿疣患者108例随机分为两组,治疗组56例,对照组52例。治疗组患者采用20%5-氨基酮戊酸光动力联合液氮冷冻治疗,每周1次,连续3次。对照组先外用0.5%鬼臼毒素酊,再根据皮肤情况选择CO2激光或冷冻治疗,连续治疗3周。两组治疗结束后均随访6个月。两组患者在治疗前后均使用PCR膜杂交法检测21种HPV基因型分布情况,并对检测结果进行分析。结果治疗组与对照组3次治疗后的疣体清除率分别为97.1%和78.4%,治愈率分别为96.4%和76.9%,组间比较均具有显著差异(P<0.01);两组复发率和不良反应发生率比较亦有显著差异(P<0.01、P<0.05)。HPV基因型检测结果:108例尖锐湿疣患者共检出16种基因型,治疗组的HPV清除率明显优于对照组,尤其是针对伴有高、中危型和混合型感染时疗效更为显著(P<0.01)。结论 20%5-氨基酮戊酸光动力联合液氮冷冻治疗尖锐湿疣疗效显著,疣体清除率及临床治愈率高,复发率低,不良反应轻微,在尖锐湿疣治疗中尤其是对伴有高危型HPV及混合型感染患者值得临床进一步广泛推广应用。

AIM To investigate the curative effect and the safety of 20% 5- aminolevulinic acid photochemotherapy combined with liquid nitrogen frozen therapy in the treatment of condyloma acuminatum （CA） and analyze the distribution of human papilloma virus （HPV） genotypes in CA patients. METHODS One hundred and eight patients with CA were randomly divided into treatment group （n = 56） and control group （n = 52）. The treatment group was treated with 20% 5-aminolevulinic acid photodynamic combined with liquid nitrogen frozen therapy. The frequency of the treatment was one time a week for 3 weeks continuously. The control group was treated with 0.5% ghost mortar toxin tincture and CO2 laser or liquid nitrogen frozen therapy in the second or third week according to the skin condition. Patients were followed up for 6 months after all treatment. The distribution of 21 kinds of HPV genotypes in both groups before and after treatment was detected by PCR hybridization method and the testing results were analyzed. RESULTS There were signifieam differences between in the treatment group and the control group in wart clearance rate （97.1% vs. 78.4%, P 〈 0.01）, the cure rate （96.4% vs. 76.9%, P 〈 0.01）, the overall recurrence rate （P 〈 0.01）, and the adverse reactions （P 〈 0.05）. The results of HPV genotyping： there were 16 kinds of genotypes in the 108 CA cases, the clearance rate of HPV in the treatment group was much superior to the control group especially for the high-risk and low-risk HPV and mixed infection （P 〈 0.01 ）. CONCLUSION 20% 5- aminolevulinic acid photochemo- therapy with liquid nitrogen frozen therapy is effective in the treatment of CA especially in the high-risk HPV and mixed infection patients with higher clearance rate of warts, low recurrence rate and less adverse reaction, which is worthy of further application in clinic.