外用咪喹莫特预防尖锐湿疣复发的疗效及其机制

Clinical Observation on Externally Used Imiquimod Cream 5% in Preventing Recurrence of Condyloma Acuminate and Its Pathogenesis

目的:评价外用咪喹莫特预防尖锐湿疣复发的疗效并探讨其机制。方法:将62例尖锐湿疣患者分为3组:(1)二氧化碳(CO2)激光治疗组(A组)16例;(2)CO2激光加明欣利迪外用组(B组)27例,以CO2激光去除疣体,等创面愈合后,再外用5%咪喹莫特乳膏(明欣利迪),每周3次,最长连用16周;(3)明欣利迪外用组(C组)19例,患者仅外用明欣利迪,每周3次,最长连用16周。患者均随访6个月。同时用酶联免疫吸附试验(ELISA)方法检测37例患者的血清中细胞因子肿瘤坏死因子-α(TNF-α)、白介素-3(IL-3)、白介素-6(IL-6)、白介素-8(IL-8)和白介素-10(IL-10)的水平。结果:A组清除率为31.25%,复发率为68.75%;B组清除率为66.67%,复发率为33.33%;C组为清除率为47.37%,复发率为52.63%。B组复发率明显低于A组(P=0.024),A组与B组、B组与C组无显著差异。在B组、C组的46例患者中,仅少部分患者出现的主要不良反应为用药局部的刺激反应,患者都能忍受,经简单处理后都能坚持治疗。37例患者血清中细胞因子TNF-α、IL-3、IL-6、IL-8和IL-10的水平,治疗前后均在正常范围,并且与正常人对照组相比均无显著差异。结论:CO2激光结合外用5%咪喹莫特乳膏(明欣利迪)能明显降低尖锐湿疣的复发率,且不良反应少。明欣利迪外用不能改变患者血清中细胞因子TNF-α、IL-3、IL-6、IL-8和IL-10的水平。

Objective：To evaluate the efficacy of externally used imiquimod cream 5% in treating and preventing the recurrence of condyloma acuminate（CA）.Methods： A total of 62 cases of CA were divided into 3 groups（group A： 16 cases,B： 27 cases and C： 19 cases）.Group A was treated with CO2 laser therapy only,Group B was externally used imiquimod cream 5% three times per week less than 16 weeks（Imquimod cream 5% provided by SiChuan MinXin pharmaceutically Co.LTD,China） after CO2 laser therapy,and Group C was locally used imiquimod cream 5% three times each week less than 16 weeks.All cases were followed-up for 6 months.Simultaneously the levels of these cytokines tumor necrosis factor-alpha（TNF-α）,interleukin-3（IL-3）,interleukin-6（IL-6）,interleukin-8（IL-8） and interleukin-10（IL-10） in serum in 37 patients were detected by ELISA.Results： The results showed that the recurrence rates of Group A,B and C were 68.75%,33.33% and 52.63% respectively,and the elimination rates were 31.25%,66.67% and 47.37% respectively 6 months after commencement of the therapy.After all that the recurrence rate of the externally used imiquimod cream 5% combined with CO2 laser therapy in group B was significant lower than that of group A（P=0.024）.There was no significant difference between recurrence rates of Group A and Group C,Group B and GroupC.There was no significant difference among the levels of these cytokines TNF-α,IL-3,IL-6,IL-8 and IL-10 in serum of group A,group B and group C.Conclusions： Imiquimod cream 5% was more effective by externally used combined with CO2 laser than the therapies by CO2 laser only and externally used only.It＇s also favourable for the prevention of recurrence of CA with little side effect,and can＇t modulate the levels of cytokines TNF-α,IL-3,IL-6,IL-8 and IL-10 in serum.