5-氨基酮戊酸光动力治疗16型或(和)18型人乳头状瘤病毒宫颈持续感染合并宫颈低级别上皮内瘤样病变疗效观察

Efficacy analysis of 5-aminolevulinic acid photodynamic therapy for treatment of HPV16 or(and)18 cervical persistent infection with low-grade cervical intraepithelial neoplasia

目的探讨5-氨基酮戊酸光动力疗法(5-aminolevulinic acid photodynamic therapy,ALA-PDT)治疗16型或(和)18型人乳头状瘤病毒(human papillomavirus,HPV)宫颈持续感染合并宫颈低级别上皮内瘤样病变(low-grade cervical intraepithelial neoplasia,LSIL)的疗效。方法选取自2016年6月至2019年9月广东省第二人民医院收治的110例宫颈持续感染16型或(和)18型HPV(>1年)且宫颈细胞学检查和阴道镜下活检病理确诊为LSIL的患者作为研究对象,随机将入组患者分为空白对照组(21例)、干扰素治疗组(41例)和光动力治疗组(48例)。空白对照组不做处理,干扰素治疗组给予重组人干扰素α-2b凝胶治疗,光动力治疗组行ALA-PDT治疗。治疗后第3、9个月行HPV基因分型检测和阴道镜下病理活检,观察HPV转阴和LSIL逆转情况。结果治疗后第3、9个月,干扰素治疗组HPV转阴率、LSIL逆转率和双清除率与空白对照组比较,差异均无统计学意义(P>0.05)。治疗后第3、9个月,光动力治疗组HPV转阴率分别为:68.75%、79.17%,LSIL逆转率分别为:66.67%、81.25%,双清除率分别为54.17%、77.08%。光动力治疗组HPV转阴率、LSIL逆转率和双清除率均高于空白对照组和干扰素治疗组,差异有统计学意义(P<0.05)。结论ALA-PDT疗法是治疗16型或(和)18型HPV宫颈持续感染合并LSIL的有效手段,安全性较好,对降低癌变风险和改善预后具有显著意义。

Objective To analyze the efficacy of 5-aminolevulinic acid photodynamic therapy(ALA-PDT)for treatment of HPV16 or(and)18 cervical persistent infection with low-grade cervical intraepithelial neoplasia(LSIL).Methods A study was performed on 110 patients with HPV16 or Thinprep cytology test(TCT)and biopsy,who were admitted from June 2016 to September 2019 in Guangdong Second Provincial General Hospital.They were divided into three groups randomly,the blank control group including 21 cases,the interferon therapy group including 41 cases and the photodynamic therapy group including 48 cases.The patients in the interferon therapy group were treated with recombinant human interferonα-2b gel,while those in the photodynamic therapy group were treated with ALA-PDT,the blank control group without any treatment.HPV genotyping detection and biopsy were performed 3 and 9 months after the treatment to compare the HPV negative conversion rate and the LSIL reversal rate of the three groups.Results There were no statistically significant difference(P>0.05)when comparing the HPV negative conversion rates,LSIL reversal rates and double clearance rates between the interferon treatment group and the blank control group 3 and 9 months after the treatment.The HPV negative conversion rates(68.75%、79.17%),LSIL reversal rates(66.67%、81.25%)and double clearance rates(54.17%、77.08%)of the photodynamic therapy group were higher than those of the interferon treatment group and the blank control group,which revealed a significantly statistical difference(P<0.05),3 and 9 months after the treatment.Conclusions ALA-PDT is an effective and safe method for the treatment of HPV16 or(and)18 cervical persistent infection with LSIL,which has significance to lower the risk of cancer and improve the prognosis of patients.