光动力单独或联合其他传统方法治疗尖锐湿疣复发因素的探讨

Discussion on the Factors of Recurrence of Condyloma Acuminatum Treated by ALA-PDT Alone or Combined with Other Traditional Methods

目的探讨光动力(ALA-PDT)单独或联合其他传统方法治疗尖锐湿疣(condy-loma acuminata, CA)后可能的复发因素,为临床防治工作提供可行性建议。方法收集本院150例自2019年1月-2020年6月临床和/或病理确诊为CA,并依据皮疹大小及发病部位不同使用ALA-PDT或ALA-PDT+液氮冷冻或ALA-PDT+微波治疗的CA患者临床资料,治疗后随访6个月,根据CA是否复发分为未复发组和复发组,统计患者一般资料、人乳头瘤病毒(human papillomavirus, HPV)感染情况及其他可能的危险因素(生活习惯、皮损情况等),分析影响CA复发的危险因素。结果实际纳入CA患者147例,65例完成HPV基因分型检测,62例阳性,3例阴性。Logistics多因素结果分析显示:治疗及随访期间有熬夜史(P=0.024,OR=17.931)、合并肛门和/或生殖器区域糜烂(P=0.009,OR=61.754)、有性生活史(P=0.015,OR=36.144)、性伴侣个数≥2(P=0.045,OR=11.952)、性伴侣HPV感染(P=0.014,OR=66.520)、合并其他性传播疾病或免疫系统相关疾病(P=0.021,OR=19.164)均是影响CA治疗后复发的独立危险因素(P<0.05,OR>1)。性生活时佩戴安全套(P=0.003,OR=0.003)是CA治疗后复发的保护因素(P<0.05,OR<1)。结论 CA患者治疗及随访期间有熬夜史、合并肛门和/或生殖器区域糜烂、有性生活史或与多个性伴侣有不洁性行为、性伴侣HPV感染、合并其他性传播疾病或免疫系统相关疾病时更容易引起治疗后CA复发,而性生活时佩戴安全套可有效降低CA复发风险。

Objective To explore the potential recurrence factors of photodynamic(ALA-PDT) alone or its combination with other traditional methods for the treatment of condyloma acuminata(CA), and provide feasible suggestions for clinical prevention and treatment.Methods Clinical data from 150 patients who were clinically and/or pathologically diagnosed as CA, and treated with ALA-PDT or ALA-PDT+liquid nitrogen freezing or ALA-PDT+microwave according to the rash size and location from January 2019 to June 2020 were collected. Based on the follow-up for 6 months after treatment, it was divided into non-relapsed group and relapsed group according to whether CA recurrence.Patients′ general information, human papillomavirus(HPV) infection and other potential risk factors(life habits, skin damage, etc.) were included, and the risk factors affecting the recurrence of CA were analyzed.Results There were 147 patients with CA finally included, 65 cases were conducted the HPV genotyping test, and the results showed that 62 cases were positive and 3 cases were negative.Multivariate analysis of Logistics regression showed that patients with a history of staying up late during treatment and follow-up period(P=0.024, OR=17.931), combined with anal and/or genital area erosion(P=0.009, OR=61.754), with a history of sexual life(P= 0.015, OR=36.144), the number of sexual partners ≥ 2(P=0.045, OR=11.952), sexual partners with HPV infection(P=0.014, OR=66.520), combined with other sexually transmitted diseases or immune system related diseases(P =0.021, OR=19.164) were independent risk factors for the CA recurrence after treatment(P<0.05, OR>1), while wearing a condom during sexual life(P=0.003, OR=0.003) was a protective factor for CA recurrence after treatment(P<0.05, OR<1).Conclusion Patients with CA who have a history of staying up late during treatment and follow-up period, combined with anal and/or genital area erosions, have a history of sexual life, or have unclean sexual life with multiple sexual partners, sexual partners are with HPV infection, combined with other sexually transmitted diseases or immune system related diseases are more likely to cause CA recurrence after treatment, while wearing a condom during sexual life can effectively reduce the risk of CA recurrence.