海姆泊芬光动力治疗鲜红斑痣的临床疗效及声像学变化研究

Clinical efficacy of hematoporphyrin monomethyl ether-based photodynamic therapy for the treatment of port-wine stain and its sonographic changes

目的探索海姆泊芬光动力治疗鲜红斑痣的临床疗效及声像学变化。方法收集2017年3月至2018年6月苏州大学附属第三医院皮肤科门诊确诊的鲜红斑痣患者45例,其中粉红型5例,紫红型39例,增厚型1例,均接受3次海姆泊芬光动力治疗。采用高频超声评价治疗前后皮肤厚度及密度。等级资料采用非参数检验,计量资料以±s表示,采用单因素方差分析,组间两两比较采用SNK-q检验。P<0.05为差异有统计学意义。结果45例完成治疗并随访的鲜红斑痣患者中,痊愈10例,显效21例,有效13例,无效1例,总有效率97.78%,粉红型的疗效优于紫红型(U=12.50,P<0.001)。痊愈、显效、有效患者的皮损治疗前后皮肤厚度差值[(0.65±0.21)、(0.56±0.88)、(0.37±0.12)mm]、皮肤密度差值[(-8.65±2.19)、(-6.86±2.79)、(-4.92±2.91)g/cm^3]差异均有统计学意义(F=14.528、5.428,P<0.001),痊愈组皮肤厚度、皮肤密度差值均大于有效组(q=5.82、4.63,P<0.05)。23例颧面颊部、6例额颞部患者治疗结束后在光照部位出现不同程度红肿,1周左右可逐渐消退。35例患者光照部位出现淡褐色结痂,约3周左右自行脱落,4例出现光照部位炎症后色素沉着,随访2个月后逐渐消退。结论海姆泊芬光动力治疗鲜红斑痣疗效确切,安全性高,不良反应少。高频超声监测可客观评价临床疗效。

Objective To evaluate the clinical efficacy of hematoporphyrin monomethyl ether-based photodynamic(HMME-PDT)therapy for the treatment of port-wine stain(PWS)and its sonographic changes.Methods A total of 45 patients with confirmed PWS were enrolled from the Department of Dermatology,Third Affiliated Hospital of Soochow University from March 2017 to June 2018,including 5 with pink PWS,39 with purplish red PWS and 1 with thickened PWS.All the patients received 3 sessions of HMME-PDT therapy.The skin thickness and density were compared before and after the treatment by using high-frequency ultrasound.Ranked data were analyzed by using nonparametric test.Measurement data were expressed as mean±standard deviation,and analyzed using ony-way analysis of variance.Multiple comparisons were performed using Student-Newman-Keuls-q(SNK-q)test.The results were considered to be statistically significant if P<0.05.Results Among the 45 patients with PWS who completed the treatment and follow-up,10 were cured,21 received marked improvement,12 received improvement,and 1 showed no response.The total response rate was 97.78%,and the response rate in the patients with pink PWS was higher than that in the patients with purplish red PWS(U=12.50,P<0.001).The difference value of the skin thickness or skin density before and after the treatment significantly differed among the cured patients,patients receiving marked improvement and those receiving improvement(skin thickness:0.65±0.21,0.56±0.88,0.37±0.12 mm respectively;skin density:-8.65±2.19,-6.86±2.79,-4.92±2.91 g/cm3 respectively;F=14.528,5.428 respectively,both P<0.001),and the difference values of the skin thickness and density were significantly higher in the cured patients than in those receiving improvement(q=5.82,4.63,both P<0.05).Erythematous swelling to different extents occurred at the laser-exposed sites in the zygomatic and cheek region in 23 patients with PWS and in the frontal-zygomatic region in 6 with PWS after the HMME-PDT therapy,but gradually regressed about 1 week later.Pale brown crusts were observed at the laser-exposed sites in 35 patients,and shed spontaneously about 3 weeks later.Post-inflammatory hyperpigmentation at the laser-exposed sites was observed in 4 patients,and gradually regressed after 2-month follow-up.Conclusions HMME-PDT therapy is effective for the treatment of PWS,with high safety and few adverse reactions.High-frequency ultrasound can be used for objectively evaluating the clinical efficacy of HMME-PDT therapy.