δ-氨基酮戊酸光动力疗法治疗尖锐湿疣的机理探讨

Study of the Mechanism of δ-Aminolevulinic Acid-Induced Photodynamic Therapy on Patients with Condyloma Accuminata

目的 探讨δ-氨基酮戊酸光动力疗法（ALA-PDT）治疗尖锐湿疣（ＣＡ）的作用机理。方法 对 １５例 ＣＡ患者进行ALA-PDT治疗，分别在治疗前及治疗后１、３、５h取标本，共５５份，其中，４０份进行常规组织病理学观察，１５份进行透射电镜检查。结果（1）治疗前表皮角质形成细胞增生活跃，可见较多空泡细胞。（２）治疗后１h真皮水肿，有较多的嗜酸性粒细胞及个性粒细胞浸润，且少量中性粒细胞浸润表皮；线粒体一端肿胀、嵴断裂、消失。（３）治疗后３ｈ表皮内可见大量中性粒细胞浸润，角质形成细胞间及细胞内水肿明显，并可见角质形成细胞变性和坏死；电镜下可见角质形成细胞凋亡特征，如染色质异常聚集呈花环状、新月状等。（４）治疗后 5ｈ表皮明显变薄，大量角质形成细胞变性、坏死。结论ALA-PDT可以通过细胞调亡和坏死两条途径选择性的杀伤 ＣＡ病变区域内的角质形成细胞。

Objective To explore the mechanismofδ-aminolevulinic acid-induced photodynamic therapy( ALA-PDT) on patients with condyloma accuminata(CA). Methods 15 patients with CA were treated by the ALA-PDT. The 55 samples were taken before and 1,3, 5h after treatment, respectively, forty ones out of them for light microscopic examination and fifteen ones out of them for transmission electron microscopic(TEM) examination. Results 1. Before the treatment with ALA-PDT, the keratinocytes(KCs) in the epidermis of CA proliferated actively with a lot of vacuolar cells. 2. lh after ALA-PDT, the dermis was edema, many eosinophilic leukocytes and neutrophilic leukocytes appeared in the dermis and some neutrophilic leukocytes in the epidermis. Mitochondrion in KCs swelled at one side and the cristae were decreased and broken. 3. 3h after ALA-PDT, a lot of neutrophilic leukocytes appeared in the epidermis. The intercellular and intracellular edema between KCs could be observed. Both degeneration and necrosis in KCs oc curred. The characters of apoptosis in KCs were obvious with TEM. For example, the chromatin appeared as flower 1oops, a new moon and so on. 4. After 5h of treatment, the epidermis became much thinner. A lot of KCs degenerated and nectosized. Conclusion The KCs in involved tissue with CA can be selectively destroyed by ALA-PDT via apoptosis and necrosis.