5-氨基酮戊酸光动力在尖锐湿疣诊断中的应用

5-Aminolevulinic add-mediated photodynamic diagnosis for condylomata acnminata

目的探讨5-氨基酮戊酸光动力诊断（ALA—PDD）在人乳头瘤病毒（HPV）相关性疾病中应用及其临床意义。方法将20％ALA乳膏应用于36例临床诊断为尖锐湿疣患者的皮损及其周围2cm区域，2h后进行荧光光动力诊断。同时对患者皮损、亚临床皮损、皮损周围0．5cm和2cm处分别进行醋酸白试验、取材进行组织病理检查及基因芯片技术检测HPVDNA。结果36例患者经组织病理确诊为尖锐湿疣者30例、鲍恩样丘疹病5例、脂溢性角化病1例（剔除病例）。30例尖锐湿疣和5例鲍恩样丘疹病患者皮损出现PpIX砖红色荧光；28例患者亚临床皮损也呈现砖红色荧光。17例皮损周围0．5cm和5例2cm处HPV潜伏感染部位也出现PpIX荧光。黏膜部位、炎症浸润和组织糜烂部位易产生非特异性荧光。结论ALA—PDD对尖锐湿疣、鲍恩样丘疹病皮损和亚临床皮损诊断及HPV潜伏感染的定位诊断中有一定的应用价值，而黏膜部位、炎症浸润和组织糜烂部位不适宜进行荧光诊断。

Objective To evaluate the usefulness of protoporphyrin IX （PpIX） fluorescence diagnosis after topical application of 5-aminolevulinic acid （ALA） in human papillomavirus （HPV） related diseases. Methods Photodynamic diagnosis （PDD） was conducted in 36 patients clinically diagnosed as genital condylomata acuminata. PpIX fluorescence was observed 2 hours following the application of 5-aminolevulinic acid 20% cream on the lesions and subclinical lesions of these patients. Biopsy samples were resected from the lesions, subclinical lesions, and normal skin area （0.5 cm and 2 cm around the lesions） of the patients, and subjected to histopathological examination and microarray analysis for HPV DNA. Acetowhitening test was also performed at the four skin areas. Results Of the 36 patients, 30 were diagnosed as condylomata acuminata, 5 as bowenoid papulosis, and 1 as kemtosis seborrheica by histopathological examination. Brick-red fluorescence of PpIX was observed in both lesions and subclinical lesions of all patients with condylomata acuminata and those with bowenoid papulosis, in subclinical lesions of 28 patients, at the area 0.5 cm around the lesions of 17 patients, and at the area 2 cm around the lesions of 5 patients. Acetowhitening and HPV DNA were also positive in lesions and subclinical lesions of patients with condylomata acuminata and those with bowenoid papulosis. Mucosa, inflammatory infiltration area and erosion tissue were prone to develop nonspecific PpIX fluorescence. Conclusions ALA-PpIX-mediated PDD can be used for the diagnosis of clinical and subclinical HPV infection, as well as the location of latent HPV infection, however, it＇s not recommended to be used in mucosa, inflammatory infiltration area or erosion tissue.