电离子联合光动力对肛管尖锐湿疣的治疗效果及血清iNOS和HIF-1α水平的影响

Clinical Effect of Electro-Ionization Combined Photodynamic Therapy on Anal Condyloma Acuminatum and Its Influence on Serum Levels of iNOS and HIF-1α

目的:探讨电离子联合光动力治疗对肛管尖锐湿疣(CA)患者的治疗效果及血清诱导型一氧化氮合酶(iNOS)、缺氧诱导因子-1α(HIF-1α)水平的影响。方法:将90例肛管CA患者随机均分为电离子治疗组、光动力治疗组及联合治疗组,电离子治疗组采用单纯高频电离子灼烧治疗,光动力治疗组采用单纯5-氨基酮戊酸光动力(ALA-PDT)治疗,联合治疗组采用两种方案联合治疗;比较3组患者治疗后6个月时的疣体清除率及复发率,比较治疗前、治疗后6个月时3组患者血清iNOS及HIF-1α水平。结果:治疗后6个月时,联合治疗组患者疣体清除率显著高于电离子组及光动力组(χ~2=7. 081,P=0. 029),联合治疗组患者疣体复发率显著低于电离子组及光动力组(χ~2=8. 444,P=0. 015);治疗后6个月时,3组患者血清iNOS及HIF-1α水平较治疗前显著降低(P <0. 05),联合治疗组血清iNOS及HIF-1α水平显著低于电离子组及光动力组(P <0. 05)。结论:电离子联合ALA-PDT治疗肛管CA效果优于单纯使用高频电离子或ALA-PDT治疗,其机制可能与降低血液iNOS及HIF-1α水平有关。

Objective:To investigate the clinical effect of electro-ion combined photodynamic therapy on anal condyloma acuminatum and the serum iNOS and HIF-1a levels.Methods:90 diagnosed patients with perianal condyloma acuminatum were randomly divided into three groups with equal number:electro-ion therapy group,photodynamic therapy group and combined therapy group;each group adopted single high frequency electric ion cauterization treatment,single 5-aminolevulinic acid photodynamic therapy(ALA-PDT)and combined therapy respectively.Comparing the clearance rate of warts and the recurrence rate 6 months after treatment of three groups;the serum levels of iNOS and HIF-1a were compared among the three groups 6 months after treatment.Results:Half a year after treatment,the clearance rate and recurrence rate of warts in-combined group were significantly higher than those of electrotherapy and photodynamic therapy group(χ^2=7.081,P=0.029;χ^2=7.081,P=0.029).The levels of iNOS and HIF-1 in serum were significantly lowered in all groups 6 months after treatment(P<0.05).The levels of iNOS and HIF-1 in serum of combined group were significantly lower than other two groups(P<0.05).Conclusion:Electro-ion combined with rod-5-aminolevulinic acid photodynamic therapy(ALA-PDT)has a better effect on condyloma acuminatum,which is superior to the single use of high frequency electric ion or photodynamic therapy for condyloma acuminatum in anal canal.The mechanism might be relevant with the lowered serum level of iNOS and HIF-1.