复发性尖锐湿疣患者光动力联合二氧化碳激光治疗效果及其对患者外周血中T细胞亚群和调节性T细胞的影响

The clinical efficacy and the effect on T lymphocyte subsets and regulatory T cells in peripheral blood of photodynamic therapy combined with carbon dioxide laser therapy for recurrentcondylomata acuminate

目的:评价应用光动力联合二氧化碳激光治疗复发性尖锐湿疣的效果,以及对患者外周血中T细胞亚群和调节性T细胞的影响。方法:选择2015年3月至2016年3月来鄂东医疗集团黄石市中心医院就诊的复发性尖锐湿疣患者78例,将其随机分为光动力组、激光组和联合治疗组,并选择26例年龄配对的健康体检者作为对照组,比较光动力组、激光组和联合治疗组的临床疗效、治疗相关并发症和3个月、6个月及1年的复发率,比较治疗前后患者外周血中T细胞亚群(CD4^+/CD8^+和Th1/Th2比值)和调节性T细胞(T-reg的百分比)的分布情况。结果:光动力组、激光组和联合治疗组的总有效率分别为69.23%,65.38%和92.31%,联合治疗组显著高于光动力足和激光组。联合治疗组的治疗相关并发症和复发率的效果显著高于光动力足和激光组。治疗前,尖锐湿疣患者的CD4^+/CD8^+比值、Th1/Th2比值和T-reg的百分比与健康对照组存在明显差异;治疗后,联合治疗组的改善效果最为明显,与光动力组和激光组相比,其差异均有统计学意义(均P<0.05)。结论:在复发性尖锐湿疣患者中应用光动力联合二氧化碳激光治疗效果安全确切,可以显著降低复发风险,调节患者免疫功能,值得在临床中推广。

Objective： To observe the clinical efficacy and the effect on T lymphocyte subsets and regulatory T cells（ T-reg） in peripheral blood of photodynamic therapy（ PDT） combined with carbon dioxide laser therapy for recurrent condylomata acuminate（ CA）. Methods： From March 2015 to March 2016,78 recurrent CA patients with clinical follow-up for 12 months were divided into PDT group,laser group and combination group（ 26 cases in each group）. Another 26 age-matched health control were selected as control group. The clinical efficacy,complications,recurrence rate,CD4^＋/CD8^＋ratio and T-reg percentage of peripheral blood were comparatively analyzed.Results： The total effective rate in PDT group,laser group and combination group were 69. 23%,65. 38% and92. 31% respectively（ P〈0. 05）. The complication rate and recurrence rate in combination group was significantly lower than PDT group and laser group（ P〈0. 05）. There were significant differences in T lymphocyte subsets between CA patients and health control before treatment. The improvement in CD4^＋/CD8^＋ratio,Th1/Th2 ratio and T-reg percentage in combination group were significantly higher than PDT group and laser group（ P〈0. 05）.Conclusions： Photodynamic therapy combined with carbon dioxide laser therapy is effective and safe for recurrent CA,which can significantly reduce the recurrence risk and adjust the immune function of CA patients.