氨乙酰丙酸介导的光动力疗法对宫颈人乳头瘤病毒感染合并宫颈上皮内瘤变的疗效影响

Effect of 5-aminolaevulinic acid-based photodynamic therapy for cervical HPV infection patients with cervical intraepithelial neoplasia

目的研究氨乙酰丙酸介导的光动力疗法(ALA-PDT)对宫颈人乳头瘤病毒(HPV)感染合并宫颈上皮内瘤变(CIN)的疗效影响。方法选择本院就诊的100经阴道镜和病理组织检查确诊为宫颈上皮内瘤样病变患者作为研究对象。将患者随机分为安慰剂组、5%ALA治疗组、10%ALA治疗组和20%ALA治疗组,每组25例,分别给予安慰剂、5%、10%与20%的新鲜的ALA温敏凝胶治疗。治疗后3、6个月时,通过组织学和细胞学显示的结果对患者宫颈情况进行检查,比较DNA转阴率,同时对患者的不良反情况进行分析。结果治疗3、6个月后,安慰剂组与5%ALA组、10%ALA组和20%ALA组治疗CINⅠ患者的治疗有效率比较无显著差异(P>0.05)。治疗3、6个月后,安慰剂组中CINⅡ期患者的有效率显著低于20%ALA治疗组中的CINⅡ患者,差异有统计学意义(P<0.05)。20%ALA组CINⅡ期患者在治疗6个月后HPV16/18阴转率显著高于其他3组患者,差异有统计学意义(P<0.05)。结论浓度为20%ALA治疗CINⅡ期患者有较高的有效率及HR-HPV转阴率,对合并HR-HPV感染的CIN患者的治疗方面应用前景良好。

Objective To study the effect of 5-aminolaevulinic acid-based photodynamic therapy (ALA-PDT) for human papillomavirus (HPV) infection combined with cervical intraepithelial neoplasia (CIN). Methods A total of 100 patients with cervical intraepithelial neoplasia diagnosed by colposcopy and pathological examination were selected as the study subjects, and were randomly divided into placebo group, 5% ALA treatment group, 10% ALA treatment group, and 20% ALA treatment group, with 25 in each group, given placebo, ALA thermosensitive gel in concentration s of 5%, 10% and 20%, respectively. At 3 and 6 months after treatment, the cervical condition of the patients was examined by the results of histology and cytology, and the negative rate of DNA was compared. At the same time, the adverse reactions of the patients were recorded and analyzed. Results After 3, 6 months of treatment, there were no significant differences in the efficacy between placebo group and 5% ALA group, 10% ALA group and 20% ALA group ( P > 0.05). After 3 months of treatment, the effective rate of CINⅡ patients in placebo group was significantly lower than that in 20% ALA group, difference was found in two groups ( P <0.05). The negative conversion rate of HPV16/18 in 20% ALA group was significantly higher than that in placebo group, 5% ALA group and 10% ALA group after 6 months of treatment ( P <0.05). Conclusion 20% ALA has higher efficiency and negative conversion rate in the treatment of CINⅡ patients, which has a good prospect in the treatment of CIN patients with HR-HPV infection.