5-氨基酮戊酸光动力疗法治疗外阴硬化性苔藓的疗效分析

Topical Photodynamic Therapy with 5-aminolevulinic Acid for Vulvar Lichen Sclerosus

目的：探讨5-氨基酮戊酸光动力疗法（ALA-PDT）治疗外阴硬化性苔藓（VLS）的可行性和有效性。方法：将60例经病理检查确诊为VLS的患者随机分为两组,每组30例。实验组采用浓度为20%的ALA-PDT治疗6次,治疗间隔时间为2~3周;对照组局部涂抹卤米松乳膏,第1月2次/天,第2~3月1次/天,第4~6月2次/周。治疗结束后随访6月比较临床疗效,并观察ALA-PDT治疗前后白斑范围及病理检查变化。结果：实验组总有效率达96.67%（29/30）,对照组为73.33%（7/30）,实验组总有效率明显高于对照组（2=6.41,P〈0.05）。实验组ALA-PDT治疗前后白斑范围对比差异有统计学意义（t=19.02,P〈0.01）,治疗后病理检查结果显示表皮及真皮层组织结构均恢复正常。治疗过程中,除疼痛以外无其他不良反应。结论：20%ALA-PDT治疗VLS安全、有效,可作为治疗VLS的新方法。

Objective： To explore the efficacy of 5-aminolevulinic acid photodynamic therapy （ALA-PDT） in vulvar lichen selerosus （VLS）. Methods：The total 60 patients with vulvar lichen sclerosus definitely diagnosed by pathological examination were randomly divided into 2 groups. 30 patients in experimental group were treated with ALA-PDT （20%）. The total treatments are 6 times, the interval treatment time was 2 to 3 weeks. The other 30 patients in control group were treated with halometasone cream in any on-spot treatments： 2 times per day at first month, 1 time per day from the second month to the third month, 2 times per week from the fourth month to the sixth month. The total treatments are 6 times. The symptoms, signs and the structure of skin tissue were observed with or without ALA-PDT treatment. Results： After treated with 20% ALA-PDT, The ratio of total efficiently was 96.67% （29/30）, which was higher than that in control group （73.33%） , X2 =6. 41, P 〈0. 05. The scope of the original spot in experiment group was statisti- cally significant decrease compared with the control group （ t = 19.02 ,P 〈 0.01 ）. Pathological ex- amination showed that the structure of skin and dermis tissues recovered to normal with ALA-PDT treatment. There were seldom adverse reactions except for pain during the treatment. Conclusion： ALA-PDT, an effective and safety method, might be applied to treat with VLS.