卡介苗多糖核酸联合ALA-PDT及CO2激光对尖锐湿疣患者血清相关因子和免疫功能的影响

Joint Effect of BCG Polysaccharide Nucleic Acid Plus ALA-PDT and CO-Switched Laser on Immune Functions and Serum Related Factors of Patients with Condyloma Acuminatum

目的探讨卡介苗多糖核酸联合5-氨基酮戊酸(5-aminoketovaleric acid,ALA)-光动力(photodynamic,PDT)及CO2激光治疗尖锐湿疣的临床疗效,并分析其对患者免疫功能及血清P物质(serum substance P,SP)、神经生长因子(nerve growth factor,NGF)、粒细胞-巨噬细胞克隆刺激因子(granulocyte-macrophage cloning stimulating factor,GM-CSF)水平的影响。方法选择2016年1月到2018年6月,尖锐湿疣患者105例,随机数字表法分为对照组和观察组。对照组患者52例,采用ALA-PDT和CO2激光治疗;观察组患者53例,给予卡介苗多糖核酸联合ALA-PDT、CO2激光治疗,激光治疗1次后连续用药4~6周。治疗后1年进行临床疗效评价,比较两组治疗前后的血清SP、NGF、GM-CSF水平及外周血CD3+、CD4+、CD8+及CD4+/CD8+水平,比较两组治疗后的复发率和治疗中治疗后的不良反应发生率。结果观察组和对照组临床总有效率分别为90.6%、71.2%,差异具有统计学意义(P<0.05)。两组治疗后1年外周血CD3+、CD4+水平及CD4+/CD8+均明显高于治疗前(P<0.05),CD8+水平均明显低于治疗前(P<0.05);观察组治疗后1年外周血CD3+、CD4+、CD4+/CD8+高于对照组(P<0.05),CD8+低于对照组(P<0.05)。两组治疗后1年血清SP、NGF、GM-CSF水平均明显低于治疗前(P<0.05);观察组治疗后1年血清SP、NGF、GM-CSF水平均明显低于对照组(P<0.05)。观察组治疗后1年复发率低于对照组(P<0.05)。治疗中,观察组和对照组不良反应发生率分别为13.2%、7.69%,差异无统计学意义(P>0.05);治疗后1年观察组和对照组不良反应发生率分别为13.2%、11.5%,差异无统计学意义(P>0.05)。结论卡介苗多糖核酸联合ALA-PDT及CO2激光治疗尖锐湿疣的临床疗效显著,能够提高机体免疫功能,降低血清SP、NGF、GM-CSF水平,且复发率和不良反应发生率较低。

Objective To investigate the joint clinical effect of BCG polysaccharide nucleic acid plus 5-aminoketovaleric acid(ALA)photodynamic treatment(PDT)and CO2 laser in treating condyloma acuminatum,and to analyze its effect on the immune function levels of serum substance P(SP),nerve growth factor(NGF),and granulocyte-macrophage cloning stimulating factor(GM-CSF)of the patients.Methods Totally 105 patients with condyloma acuminatum from Jan.2016 to Jun.2018 were selected and divided randomiy into a control group(52 cases)and observation group(53 cases).The patients in the control group were treated with ALA-PDT and CO2 laser,and those in the observation group with BCG polysaccharide nucleic acid in addition.After the laser treatment,all the patients in both groups were given drug treatment for 4-6 weeks.Their clinical curative effect was evaluated 1 year after the treatment.The serum levels of SP,NGF,GM-CSF and peripheral blood levels of CD3+,CD4+,CD8+and CD4+/CD8+of both groups before and after the treatment were compared respectively.The recurrence rate after the treatment and adverse reaction rate during and after the treatment of both groups were compared respectively.Results The total effective rate of the observation group and control group was 90.6%(48/53)and 71.2%(37/52)respectively,and the difference was statistically significant(P<0.05).After the treatment,the peripheral blood levels of CD3+,CD4+and CD4+/CD8+of the two groups rose dramatically(P<0.05),but the level of CD8+dropped remarkably(P<0.05).At the same time,the improvement of peripheral blood CD3+,CD4+and CD4+/CD8+were more obvius in the observation group than in the control group(P<0.05),and the level of CD8+dropped more obvious in the observation group than in the control group(P<0.05).The serum levels of SP,NGF and gm-csf in the group dropped significantly after the treatment(P<0.05).Meanwhile,the serum levels of SP,NGF and GM-CSF in the observation group after the treatment were significantly lower than those in the control group(P<0.05).After the treatment,the recurrence rate of the observation group was significantly lower than that of the control group(P<0.05).The adverse reaction rate of the observation group and control group was 13.2%(7/53)and 7.69%(4/52)respectively,and the difference was not singificant(P>0.05).After the treatment,the incidence of adverse reactions was 13.2%(7/53)in the observation group and 11.5%(6/52)in the control group,and there was no significant difference between the two groups(P>0.05).Conclusions The combination of BCG polysaccharide nucleic acid with ALA-PDT and CO2 laser is highly effective in treating condyloma acuminatum.Moreover,featuring low rates of recurrence and adverse reactions,it will improve immune functions and reduce the serum levels of SP,NGF and GM-CSF.