序贯疗法治疗结节囊肿型痤疮的疗效观察

Clinical efficacy of sequential therapy for nodular cystic acne

目的探讨序贯疗法治疗结节囊肿型痤疮的安全性和有效性。方法将43例结节囊肿型痤疮患者随机分为序贯组和对照组。序贯组22例,接受三阶段“序贯疗法”,第一阶段3次5-氨基酮戊酸光动力疗法(ALA-PDT),每2周治疗1次,联合抗生素口服;第二阶段3次化学换肤,每2周治疗1次,联合异维A酸口服;第三阶段继续口服异维A酸。对照组21例,口服异维A酸治疗。均治疗持续16周为研究终点。每次治疗后对两组患者进行疗效评价。随访半年,比较两组复发率及不良反应发生情况。结果经第一阶段2、3次治疗后,序贯组有效率分别为9.09%、22.73%,对照组有效率为0、4.76%,两组差异无统计学意义(均P>0.05)。经第二阶段1、2、3次治疗后,序贯组有效率分别为50.00%、90.90%、100%,对照组为23.81%、42.86%、66.67%,其中第二阶段2、3次治疗后序贯组疗效优于对照组,差异有统计学意义(均P<0.05)。经第三阶段治疗后,序贯组有效率保持100%,对照组为85.71%,序贯组疗效高于对照组,差异有统计学意义(均P<0.05)。随访半年,序贯组未复发或明显改善者占比为100%,对照组占比为73.33%。序贯组复发率低于对照组,差异有统计学意义(χ^(2)=5.46,P<0.05)。结论序贯疗法治疗结节囊肿型痤疮起效快、疗效好、不良反应少、复发率低。

Objective To assess the clinical efficacy and safety of sequential therapy for nodular cystic acne.Methods Forty three patients with nodular cystic acne were divided into sequential and control groups.In the sequential group,22 patients were treated with ALA-PDT every two weeks for 3 times,and oral antibiotics in the first stage,followed by chemical peeling once every two weeks for 3 times,and oral isotretinoin in the second stage.Finally,oral isotretinoin alone was given in the last stage.While 21 patients in the control group were treated with isotretinoin alone.The treatments lasted for 16 weeks.After each treatment course,the efficacy and adverse effect were compared between the two therapies.The patients in both groups were followed up for 6 months,and the relapse rate and adverse reactions were recorded.Results In the first stage of treatment,effective rates after the second and the third treatment course were 9.09% and 22.73%,respectively,in the sequential group,and 0 and 4.76%,respectively,in the controls.In the second stage,the effective rates after each treatment course were higher in sequential groups than in the controls(1^(st) treatment course:50.00%vs.23.81%;2^(nd) treatment course:90.90%vs.42.86%,and the 3^(rd) treatment course:100%vs.66.67%.P<0.05 for 2^(rd) and 3^(rd) treatment).After the third stage of treatment,the effective rate in the sequential and control groups were 100% and 85.71%,respectively(P<0.05).The rates of no relapse and marked improvement were significantly higher in the sequential group than in the controls(100%vs.73.33%,P<0.05).Conclusion Sequential therapy is effective and safe for nodular cystic acne,with fewer adverse reactions and lower relapse rate.