光动力疗法治疗尿道尖锐湿疣的临床研究

目的探讨5-氨基酮戊酸光动力疗法(ALA-PDT)治疗尿道尖锐湿疣的最适ALA浓度和最佳敷药时间。方法将60例尿道尖锐湿疣患者分为0.5%、1%、3%、5%和10%ALA五组,分别在敷药1、3、5、7h时取材,进行原位定量原卟啉Ⅸ检测、常规组织病理检查和杂交捕获试验检测高危型、低危型HPV DNA。结果经不同浓度和时间的ALA湿敷后,皮损局部的表皮内均有不同程度的原卟啉Ⅸ砖红色荧光,荧光基本上分布于表皮全层,而真皮几乎见不到原卟啉Ⅸ荧光。原位定量原卟啉Ⅸ荧光强度在敷药3h时已经明显升高,在5h时到达最高峰,7h时再次下降为3h时的水平。随着ALA浓度的增高,其组织中原卟啉Ⅸ的荧光强度逐渐增高。经统计学分析,5%和10%ALA组原卟啉Ⅸ荧光强度显著高于其他组(P<0.05)。HPV DNA杂交捕获试验结果显示,尿道尖锐湿疣患者的临床标本中低危型HPV DNA 100% (60/60)阳性,18.3%(11/60)病例同时检测出高危型HPV DNA。结论ALA-PDT治疗尿道尖锐湿疣的最佳ALA浓度为5%或10%,最佳敷药时间为3-5h。

5-氨基酮戊酸光动力疗法治疗寻常痤疮临床应用研究

目的探索5-氨基酮戊酸光动力疗法（ALA—PDT）治疗寻常痤疮的ALA最适浓度和最佳敷药时间。方法将30例中、重度寻常痤疮患者随机分为两组，第一组15例，给以10％ALA乳膏外敷，分别在不同时间点（1、2、3、4、5h）和不同皮损进行原卟啉IX（PpIX）荧光光动力诊断和皮损组织PpIX荧光采集与定量分析；第二组15例，在每例患者的右侧面颊、左侧面颊、前额的痤疮皮损上分别给以3％、5％、10％ALA乳膏外敷3h后进行PpIX荧光光动力诊断和荧光定量研究；同时对该组患者不同部位采用不同浓度ALA—PDT的疗效和不良反应进行临床研究。结果第一组痤疮患者经10％ALA乳膏外敷，暗室环境下采用激发光源照射皮损后发现，炎性丘疹、脓疱和囊肿均显示PpIX强砖红色荧光；粉刺、炎性丘疹、脓疱和囊肿的PpIX荧光强度分别为1．3、4.3，5．1和5．8校准单位，PpIX荧光强度随着皮损严重程度的增加而增强；同时，随着外敷时间的延长，PpIX荧光强度逐渐增强，敷药3h、4h、5h时PpIX荧光强度明显高于1h和2h（P〈0．05）。第二组患者不同部位采用3％、5％、10％ALA封包3h，其相同皮损内PpIX荧光强度差异无统计学意义（P〉0．05）；分别以3％、5％、10％ALA乳膏外涂于15例患者右侧面颊、左侧面颊、前额部位，经过两次ALA—PDT治疗后，痊愈5例、显效6例，总有效率为73％；每例患者的不同部位皮损之间，疗效改善情况无明显差异。副作用表现为轻至中度的红斑、肿胀，严重时少许渗出，仅2例出现暂时陛色素沉着，所有病例均未出现溃疡和瘢痕等严重不良反应。结论ALA—PDT适用于以炎性丘疹、脓疱和囊肿为主要表现的寻常痤疮治疗，宜采用3％ALA浓度和3h敷药时间。

Research and developments of laser assisted methods for translation into clinical application

Biophotonics and laser medicine are very dynamic and continuously increasing fields ecologically as well as economically. Direct communication with medical doctors is necessary to identify specific requests and unmet needs. Information on innovative, new or renewed techniques is necessary to design medical devices for introduction into clinical application and finally to become established after positive clinical trials as well as medical approval. The long-term endurance in developing light based innovative clinical concepts and devices are described based on the Munich experience. Fluorescence technologies for laboratory medicine to improve non- invasive diagnosis or for online monitoring are described according with new approaches in improving photody- namic therapeutic aspects related to immunology. Regard- ing clinically related thermal laser applications, the introduction of new laser wavelengths and laser parameters showed potential in the treatment of varicose veins as well as in lithotripsy. Such directly linked research and development are possible when researchers and medical doctors perform their daily work in immediate vicinity, thus have the possibility to share their ideas in meetings by day.