海姆泊芬光动力治疗成人鲜红斑痣的疗效及其影响因素分析:一项回顾性研究

Efficacy and influencing factors of hematoporphyrin monomethyl ether-mediated photodynamic therapy in the treatment of adult patients with port-wine stains:a retrospective study

目的分析海姆泊芬光动力疗法(HMME-PDT)治疗中国成人鲜红斑痣的疗效及影响疗效的因素。方法回顾四川大学华西医院皮肤科2017年2月至2023年10月行HMME-PDT治疗的265例成年鲜红斑痣患者资料。患者静脉注射5~6.5 mg/kg海姆泊芬后,采用532 nm LED绿光照射,能量密度为100~130 J/cm^(2)(功率密度85~100 mW/cm^(2)),照射时间19~25 min。患者每2~6个月治疗1次。观察治疗区域每次治疗后的反应,最后1次治疗后至少2个月,评估临床疗效。采用卡方检验分析组间疗效差异。结果265例成人鲜红斑痣患者中,男女比例90∶175,18~56(26.48±6.88)岁,治疗1~8(2.67±1.33)次。102例(38.4%)基愈,74例(27.9%)显效,59例(22.2%)好转,30例(11.3%)无效,总有效率88.7%。在146例无增厚的皮损中,69例(47.3%)基愈,有效率92.5%;102例轻微增厚的皮损中,32例(31.4%)基愈,有效率87.3%;17例明显增厚的皮损中,1例基愈,11例有效。50例治疗次数>3次,28例基愈(56%),有效率100%;45例单次治疗,5例(11.1%)基愈,有效率68.9%。232例不伴随软组织增生的皮损,95例(40.9%)基愈,有效率88.8%;33例伴随软组织增生的皮损,7例(21.2%)基愈,有效率87.9%。不同皮损厚度、治疗次数以及是否伴随软组织增生的患者疗效差异有统计学意义(均P<0.05)。不同性别、年龄、皮损颜色患者之间以及皮损是否出现结节患者之间和是否有既往治疗史的患者之间疗效差异均无统计学意义(P>0.05)。治疗过程中和治疗后,患者有不同程度的肿胀、烧灼感、疼痛和瘙痒,经一般处理后均可缓解;10例(3.8%)出现瘢痕,予对症治疗;治疗过程中未见药物过敏、肝肾功能损害等系统性不良反应。结论HMME-PDT治疗成人鲜红斑痣安全有效,皮损增厚和软组织增生与治疗效果相关,随着治疗次数增多疗效更好。

Objective To evaluate the efficacy of hematoporphyrin monomethyl ether-mediated photodynamic therapy(HMME-PDT)in the treatment of adult patients with port-wine stains(PWS)in China,and to analyze factors influencing the efficacy.Methods A retrospective study was conducted on the data from 265 adult patients with PWS who underwent HMME-PDT at the Department of Dermatology,West China Hospital,Sichuan University from February 2017 to October 2023.Patients were intravenously injected with hemoporfin at doses of 5-6.5 mg/kg,followed by irradiation with a 532-nm green light-emitting diode at the energy density of 100-130 J/cm^(2)(power density,85-100 mW/cm^(2))for 19-25 minutes.Treatments were conducted every 2-6 months.The treatment response in the treated area was observed after each treatment,and the clinical efficacy was assessed at least two months after the last treatment.Chi-square test was used to analyze the differences in efficacy between groups.Results Among the 265 adult patients with PWS,the male to female ratio was 90∶175,the patients'age ranged from 18 to 56 years(26.48±6.88 years),and they underwent 1 to 8 treatment sessions(2.67±1.33 sessions).After treatment,102(38.4%)patients achieved complete remission,74(27.9%)achieved marked improvement,59(22.2%)had moderate improvement,and 30(11.3%)showed no response,resulting in an overall response rate of 88.7%.Among 146 patients without hypertrophic lesions,69(47.3%)achieved complete remission,with a response rate of 92.5%;among 102 with slightly thickened lesions,32(31.4%)achieved complete remission,with a response rate of 87.3%;among 17 with markedly thickened lesions,only 1 achieved complete remission,and 11 achieved marked improvement.Among 50 patients who received more than 3 treatment sessions,28(56%)had complete remission,with a response rate of 100%;among 45 who received only one session of treatment,5(11.1%)achieved complete remission,with a response rate of 68.9%.Among 232 patients without soft tissue hyperplasia,95(40.9%)achieved complete remission,with a response rate of 88.8%;among 33 with soft tissue hyperplasia,7(21.2%)achieved complete remission,with a response rate of 87.9%.The therapeutic effects significantly differed among patients with different lesion thicknesses,among those with different treatment sessions,as well as between patients with soft tissue hyperplasia and those without(all P<0.05).There were no significant differences in the therapeutic effect among patients of different genders,different ages,with different lesion colors,as well as between patients with nodules and those without,and between patients with treatment history and those without(all P>0.05).During and after the treatment,patients experienced varying degrees of swelling,burning sensation,pain,and itching,all of which could be relieved by common treatment;scars occurred in 10(3.8%)patients,and were managed by symptomatic treatment;no systemic adverse reactions,such as drug allergies or impairment of liver and kidney function,were observed during the treatment.Conclusions HMME-PDT is safe and effective in the treatment of adult patient with PWS.The therapeutic effect of HMME-PDT was associated with lesion thickening and soft tissue hyperplasia,and increased with the increase in treatment sessions.