反射式共聚焦显微镜在海姆泊芬光动力疗法治疗紫红型鲜红斑痣疗效评估中的应用

Application of reflectance confocal microscopy in the evaluation of clinical efficacy of hemoporfin-mediated photodynamic therapy for purple-type port-wine stain

目的探讨反射式共聚焦显微镜(RCM)在评估海姆泊芬光动力疗法治疗鲜红斑痣临床疗效中的应用价值。方法2018年4月至2020年1月在武汉市第一医院皮肤科收集面中部紫红型鲜红斑痣患者39例,采用海姆泊芬光动力疗法治疗3次。首次治疗前及海姆泊芬光动力疗法治疗3次后3~6个月皮损拍照后,使用RCM检测皮损内100μm深度血管直径和血管密度。根据临床照片评估临床疗效,并计算1 mm^(2)范围内血管平均直径和血管平均密度。各组间计量资料比较采用单因素方差分析,两两比较采用LSD检验,治疗前后比较采用配对t检验。结果海姆泊芬光动力疗法治疗3次后,39例患者中基愈1例(2.56%),显效16例(41.03%),有效20例(51.28%),无效2例(5.13%)。显效组和有效组患者治疗后血管平均直径和密度较治疗前均显著降低,差异均有统计学意义(P<0.05),而无效组患者治疗前后差异无统计学意义(P>0.05)。显效组治疗前后血管平均直径差值为(48.56±17.87)μm,高于有效组[(31.15±21.09)μm]和无效组[(12.00±2.83)μm],均P<0.05。显效组、有效组和无效组治疗前后血管平均密度差值分别为(7.13±3.44)支/mm2、(5.00±2.22)支/mm2和(-0.50±3.54)支/mm2,各组间两两比较差异有统计学意义(均P<0.05)。结论RCM可用于观察海姆泊芬光动力疗法治疗前后鲜红斑痣皮损处血管平均直径、密度情况,有助于定量评估海姆泊芬光动力疗法的效果。

Objective To assess the application value of reflectance confocal microscopy(RCM)in evaluating clinical efficacy of hemoporfin-mediated photodynamic therapy for purple-type port-wine stain.Methods From April 2018 to January 2020,a total of 39 patients with centrofacial purple-type port-wine stains were enrolled from Department of Dermatology,Wuhan No.1 Hospital,and received 3 sessions of hemoporfin-mediated photodynamic therapy.Before the first treatment,and 3-6 months after 3 sessions of hemoporfin-mediated photodynamic therapy,skin lesions were photographed,and RCM was conducted to measure the diameter and density of blood vessels at a depth of 100μm in the lesions.Clinical efficacy was evaluated based on the clinical photos,and the average diameter of blood vessels and density of blood vessels per square millimeter of lesion area were calculated.Measurement data were compared among different groups by using one-way analysis of variance,multiple comparisons were performed using least significant difference test,and comparisons of parameters before and after treatment were conducted by using paired t test.Results After 3 sessions of hemoporfin-mediated photodynamic therapy,1(2.56%)patient was nearly completely cured,16(41.03%)received marked improvement,20(51.28%)received improvement,and 2(5.13%)showed no response to the treatment.In the patients receiving marked improvement or improvement,the average diameter and density of blood vessels significantly decreased after treatment compared with those before treatment(all P<0.05),while no significant difference was observed before and after treatment in the patients with no response(both P>0.05).The average difference in the blood vessel diameter before and after treatment was significantly higher in the patients receiving marked improvement(48.56±17.87μm)than in those receiving improvement(31.15±21.09μm,P<0.05)and those with no response(12.00±2.83μm,P<0.05).The average difference in the blood vessel density before and after treatment was 7.13±3.44,5.00±2.22 and-0.50±3.54 vessels/mm2,respectively,in the patients receiving marked improvement,improvement and those with no response,and pairwise comparisons between the 3 groups all showed significant differences(all P<0.05).Conclusion RCM can be used to assess the average diameter and density of blood vessels in the port-wine stain lesions before and after hemoporfin-mediated photodynamic therapy,and is helpful in quantitatively evaluating the therapeutic effect of hemoporfin-mediated photodynamic therapy.