低剂量环磷酰胺辅助治疗复发性尖锐湿疣的疗效及其对辅助型T17细胞的影响

Auxiliary Effects of Low-dose Cyclophosphamide for Recurrent Condyloma Acuminatum and the Influence on Th17 Cells

目的观察低剂量环磷酰胺辅助治疗复发性尖锐湿疣的疗效及其对辅助型T17细胞的影响。方法 80例患者随机分为对照组和观察组,各40例,对照组予CO_2激光联合5-氨基酮戊酸光动力疗法治疗,每周1次,连续4周;观察组加用环磷酰胺50 mg口服,连用7 d,停药3 d,再连用7 d。比较患者复发情况、HPV基因型分布;流式细胞仪检测外周血中Th17细胞比例,ELISA法检测IL-17和IL-23蛋白含量,RT-PCR检测IL-17和IL-23 m RNA表达情况;记录不良反应。结果观察组治疗后3,6,9,12个月时的复发率分别为5.0%,10.0%,15.0%和17.5%,均低于对照组的20.0%,32.5%,40.0%和47.5%(P<0.05);Th17细胞比例、IL-17、IL-23蛋白及m RNA含量均较对照组明显降低;80例患者共检出9种HPV基因型,观察组HPV清除率(90.0%)显著高于对照组(70.0%,P<0.05);2组不良反应发生率相近。结论低剂量环磷酰胺联合5-氨基酮戊酸光动力、CO_2激光,对复发性尖锐湿疣具有良好治疗作用,且安全性良好。

OBJECTIVE To observe the auxiliary effects of low-dose cyclophosphamide on the patients with recurrent condyloma acuminatum （CA） and its influence on Th17 cells. METHODS Eighty cases of patients were randomly divided into control group and study group （40 cases each group）. The control group was treated with CO2 laser and 5-aminolevulinic acid photodynamic （ALA-PDT）, once a week for 4 weeks continuously. The study group received cyclophosphamide 50 mg orally; a treatment course lasted for 7 d, and received 2 treatment courses with 3 days＇ interval. The recurrence of CA and HPV genotypes were compared. The subgroups of Th17 cells were investigated by flow eytometry; the protein content and mRNA expression of cytokines （IL-17 and IL-23） in peripheral blood were determined by ELISA and RT-PCR, respectively. The adverse reactions were recorded. RESULTS After treatment, the recurrence rate of 3, 6, 9 and 12 months of study group was 5.0%, 10.0%, 15.0% and 17.5%, respectively; were all lower than that of control group of 20.0%, 32.5%, 40.0% and 47.5% （P〈0.05）. The ratio of Th 17 cells, the protein content and mRNA expression of IL-17and IL-23 were lower than those of control group. There were 9 kinds of HPV genotypes in the 80 cases, the clearance rate of HPV in study group was 90.0%, which was higher than that in control group of 70.0% （P〈0.05）. The incidence of adverse reaction rate was similar between the two groups. CONCLUSION Low-dose cyclophosphamide combined with CO2 laser and ALA-PDT is effective and safe for recurrent CA.