5-氨基酮戊酸光动力治疗尿道尖锐湿疣临床与实验研究

The study of 5-ALA photodynamic therapy for the treatment of urethral condylomat a acuminata

目的: 探讨5-氨基酮戊酸光动力疗法(5-Aminolevulinic acid - photodynamic therapy, ALA-PDT)治疗尿道尖锐湿疣的临床疗效,并对治疗后皮损的组织病理学变化进行研究。方法:对164 例尿道尖锐湿疣患者进行了ALA-PDT治疗;并对11例外生殖器尖锐湿疣ALA-PDT治疗后的16个皮损进行了组织病理和超微研究。结果:164例患者经ALA-PDT治疗后,156例疣体完全消失,治愈率高达95.12%,而复发率仅5.13%(8/156);无感染、溃疡、疤痕和尿道狭窄等副作用。治疗后1、3 h时表皮浅层角质形成细胞变性坏死,5 h时表皮全层角质形成细胞坏死;电镜下发现治疗后1、3 h时线粒体一端肿胀、嵴断裂、内质网膜结构断裂、角质形成细胞变性和坏死、典型的细胞凋亡小体,5 h时大量角质形成细胞变性、坏死。结论:ALA-PDT是治疗尿道尖锐湿疣的简单、安全、有效、低复发率、耐受性好、无明显副作用的一种新疗法。ALA-PDT对尖锐湿疣的治疗作用是通过细胞凋亡和坏死两种途径实现的。

Objective: To investigate the effect of ph ot odynamic therapy (PDT) with topical 5-aminolevulinic acid (ALA) on urethral cond ylomata acuminata and to examine the histological changes in lesions of condylom ata acuminata after ALA-PDT. Methods: One hundred and sixty-four urethral condyl omata patients were given topical ALA followed by intraurethral PDT through a cy lindrical fiber. Among the cases, 16 penile and vulval condylomata lesions in 11 patients were treated with topical ALA-PDT at same time. After the treatment, b iopsy specimens were collected from the 16 penile and vulval lesions. The histol ogical changes were then evaluated by light microscope and electron microscope. Results: The complete response rate for urethral condylomata by topical ALA-PDT was 95.12% and the recurrence rate was 5.13% after 6 to 24 months follow-up. Ker atinocytes in middle and upper layers of the epidermis with marked vacuolation a nd some necrocytosis were detected one and three hours after PDT and necrosis in all layers of the epidermis were noted five hours after PDT by microscopy. In e lectron microscopy of kerationcytes, distinct ultrastructural abnormalities of m itochondrion, endoplasmic reticulum and membrane damage were observed. Apoptotic bodies were detected three hours after PDT and a large number of the keratinocy tes exhibited necrosis five hours after PDT by electron microscope. Conclusions: Results suggests that topical ALA-PDT is a simple, effective, relatively safe, less recurrent and well tolerated treatment for urethral condylomata acuminata. The mechanisms might be that ALA-PDT could trigger apoptotic process and the cyt otoxicity which cause cellular apoptosis and necrosis in the HPV infected kerati nocytes.