两步照射法与口服普瑞巴林对光动力疗法治疗中重度痤疮疼痛及疗效影响

Effects of two-step irradiation schedule versus single-dose pregabalin on pain control and clini efficacy of photodynamic therapy for moderate to severe acne

目的:比较两步照射法与口服普瑞巴林对氨基酮戊酸光动力疗法(ALA-PDT)治疗中重度痤疮患者疼痛及疗效的影响。方法:将首次PDT治疗中疼痛程度数字评估量表(NRS)最高>6分的患者随机分为两步照射法组和普瑞巴林组。两步照射法组予以起始功率密度40 mW/cm^(2),照射8 min,继以功率密度65 mW/cm^(2),照射15 min,总能量密度为78 J/cm^(2);普瑞巴林组予照射前1 h口服普瑞巴林75 mg,联合常规方案照射,总能量密度为78 J/cm^(2)。记录并比较2组患者第2次及第3次PDT治疗过程中各个时间点的NRS评分、治疗结束后1个月的临床疗效以及不良反应。结果:第2次及第3次PDT治疗过程中,照光开始后5 min及10 min时,两步照射法组疼痛评分均低于普瑞巴林组,差异均有统计学意义(P<0.05);照光15 min及20 min时,两组疼痛评分比较差异均无统计学意义(P>0.05);照光25、30、50及120 min时,普瑞巴林组疼痛评分均低于两步照射法组,差异均有统计学意义(P<0.05)。两次治疗过程中2组NRS评分最高值均于20 min时出现,且分别比较2组第2次治疗与第3次治疗中NRS评分最高值差异均无统计学意义(P>0.05)。治疗后2组患者临床疗效比较,差异无统计学意义(P>0.05)。两步照射法组患者红斑和水肿发生率低于普瑞巴林组,差异有统计学意义(P<0.05);而干燥脱屑、反应性痤疮及色素沉着发生率比较,2组差异均无统计学意义(P>0.05)。结论:两步照射法在治疗初期能有效镇痛,口服普瑞巴林在治疗后期及术后镇痛效果显著,二者结合将有可能为接受PDT治疗的中重度痤疮患者提供一种新的联合镇痛方案。

Objective:To compare the effects of two-step irradiation schedule and single-dose oral pregabalin on pain control and clinical efficacy in the treatment of moderate to severe acne with 5-aminolevulinic acid photodynamic therapy(ALA-PDT).Methods:Numeric rating scale(NRS)was used to assess the pain scores of moderate to severe acne patients treated with ALA-PDT.Patients with the highest pain score>6 from initial PDT were randomly divided into the two-step irradiation group and the pregabalin group.Two-step iradiation was given to the two-step iradiation group,and single-dose oral pregabalin was given to the pregabalin group,respectively,during the second and third PDT.The two-step iradiation group received an initial power density of 40mW/cm^(2) for 8 min,followed by 65 mW/cm^(2) for 15 min.The total energy density was 78 J/cm^(2).In the pregabalin group,75 mg pregabalin capsule was orally taken one hour before irradiation,and the total energy density was also 78 J/cm^(2).The pain scores of the two groups at each time point were recorded and compared;clinical efficacy was evaluated one month after the treatment;and adverse reactions during or after the treatment were observed.Results:At 5 and 10 minutes after irradiation,the pain scores of the two step irradiation group were significantly lower than those of the pregabalin group(P<0.05);at 15 and 20 minutes,there was no significant difference in the pain scores between the two groups(P>0.05);at 25,30,50 and 120 minutes after the start of irradiation,the pain scores of pregabalin group were significantly lower than those of the two-step irradiation group(P<0.05).The highest mean NRS scores in both groups occurred at 20 min during both treatments,and there was no statistically significant difference between the highest NRS scores in the 2nd and 3rd treatments in both groups(P>0.05).There was no significant difference in clinical efficacy between the two groups.The incidence of erythema and edema in the two-step irradiation group was lower than that in the pregabalin group(P<0.05);there was no significant difference in the incidence of skin dryness,reactive acne and pigmentation between the two groups.Conclusion:The two-step irradiation schedule can effectively relieve pain at the initial stage of PDT,and oral pregabalin can exert a significant analgesic effect at the later stage of PDT as well as post operation.The combination of the two methods may provide a new combined analgesic scheme for patients with moderate to severe acne receiving PDT.