中华皮肤科杂志 ›› 2019, Vol. 52 ›› Issue (12): 923-927.doi: 10.35541/cjd.20180737

• 药物与临床 • 上一篇    下一篇

海姆泊芬光动力治疗鲜红斑痣的临床疗效及声像学变化研究

盛珉旻1    王芳1    张汝芝1    王冲2    肖丽1    杨玉花1    李艳1    徐春兴1    刘小明1   

  1. 1苏州大学附属第三医院  常州市第一人民医院皮肤科，江苏常州  213000；2苏州大学附属第三医院  常州市第一人民医院超声影像科，江苏常州  213000
  • 收稿日期:2018-09-06 修回日期:2018-10-22 发布日期:2019-12-02
  • 通讯作者: 刘小明 E-mail:xiaomingliu2012@163.com
  • 基金资助:
    江苏省“六大人才高峰”高层次人才选拔培养资助项目（KY2017134）；江苏省科教强卫工程青年人才培养项目（QNRC2016291）；常州市高层次卫生人才培养项目（2016CZBJ034）

Clinical efficacy of hematoporphyrin monomethyl ether-based photodynamic therapy for the treatment of port-wine stain and its sonographic changes

Sheng Minmin1, Wang Fang1, Zhang Ruzhi1, Wang Chong2, Xiao Li1, Yang Yuhua1, Li Yan1, Xu Chunxing1, Liu Xiaoming1   

  1. 1Department of Dermatology, The Third Affiliated Hospital of Soochow University, The First People′s Hospital of Changzhou, Changzhou 213000, Jiangsu, China; 2Department of Ultrasonography, The Third Affiliated Hospital of Soochow University, The First People′s Hospital of Changzhou, Changzhou 213000, Jiangsu, China
  • Received:2018-09-06 Revised:2018-10-22 Published:2019-12-02
  • Contact: Liu Xiaoming E-mail:xiaomingliu2012@163.com
  • Supported by:
    Six Talent Peaks Project of Jiangsu Province （KY2017134）; Science and Education Qiangwei Engineering Youth Talent Training Project of Jiangsu Province （QNRC2016291）; Changzhou High-Level Medical Talents Training Project （2016CZBJ034）

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摘要： 【摘要】 目的 探索海姆泊芬光动力治疗鲜红斑痣的临床疗效及声像学变化。方法 收集2017年3月至2018年6月苏州大学附属第三医院皮肤科门诊确诊的鲜红斑痣患者45例，其中粉红型5例，紫红型39例，增厚型1例，均接受3次海姆泊芬光动力治疗。采用高频超声评价治疗前后皮肤厚度及密度。等级资料采用非参数检验，计量资料以x[±]s表示，采用单因素方差分析，组间两两比较采用SNK-q检验。P < 0.05为差异有统计学意义。结果 45例完成治疗并随访的鲜红斑痣患者中，痊愈10例，显效21例，有效13例，无效1例，总有效率97.78%，粉红型的疗效优于紫红型（U = 12.50，P < 0.001）。痊愈、显效、有效患者的皮损治疗前后皮肤厚度差值［（0.65 ± 0.21）、（0.56 ± 0.88）、（0.37 ± 0.12） mm］、皮肤密度差值［（-8.65 ± 2.19）、（-6.86 ± 2.79）、（-4.92 ± 2.91） g/cm3］差异均有统计学意义（F = 14.528、5.428，P < 0.001），痊愈组皮肤厚度、皮肤密度差值均大于有效组（q = 5.82、4.63，P < 0.05）。23例颧面颊部、6例额颞部患者治疗结束后在光照部位出现不同程度红肿，1周左右可逐渐消退。35例患者光照部位出现淡褐色结痂，约3周左右自行脱落，4例出现光照部位炎症后色素沉着，随访2个月后逐渐消退。结论 海姆泊芬光动力治疗鲜红斑痣疗效确切，安全性高，不良反应少。高频超声监测可客观评价临床疗效。

关键词: 葡萄酒色痣, 血卟啉光照疗法, 超声检查

Abstract: 【Abstract】 Objective To evaluate the clinical efficacy of hematoporphyrin monomethyl ether-based photodynamic （HMME-PDT） therapy for the treatment of port-wine stain （PWS） and its sonographic changes. Methods A total of 45 patients with confirmed PWS were enrolled from the Department of Dermatology, Third Affiliated Hospital of Soochow University from March 2017 to June 2018, including 5 with pink PWS, 39 with purplish red PWS and 1 with thickened PWS. All the patients received 3 sessions of HMME-PDT therapy. The skin thickness and density were compared before and after the treatment by using high-frequency ultrasound. Ranked data were analyzed by using nonparametric test. Measurement data were expressed as mean ± standard deviation, and analyzed using ony-way analysis of variance. Multiple comparisons were performed using Student-Newman-Keuls-q （SNK-q） test. The results were considered to be statistically significant if P < 0.05. Results Among the 45 patients with PWS who completed the treatment and follow-up, 10 were cured, 21 received marked improvement, 12 received improvement, and 1 showed no response. The total response rate was 97.78%, and the response rate in the patients with pink PWS was higher than that in the patients with purplish red PWS （U = 12.50, P < 0.001）. The difference value of the skin thickness or skin density before and after the treatment significantly differed among the cured patients, patients receiving marked improvement and those receiving improvement （skin thickness: 0.65 ± 0.21, 0.56 ± 0.88, 0.37 ± 0.12 mm respectively; skin density: -8.65 ± 2.19, -6.86 ± 2.79, -4.92 ± 2.91 g/cm3 respectively; F = 14.528, 5.428 respectively, both P < 0.001）, and the difference values of the skin thickness and density were significantly higher in the cured patients than in those receiving improvement （q = 5.82, 4.63, both P < 0.05）. Erythematous swelling to different extents occurred at the laser-exposed sites in the zygomatic and cheek region in 23 patients with PWS and in the frontal-zygomatic region in 6 with PWS after the HMME-PDT therapy, but gradually regressed about 1 week later. Pale brown crusts were observed at the laser-exposed sites in 35 patients, and shed spontaneously about 3 weeks later. Post-inflammatory hyperpigmentation at the laser-exposed sites was observed in 4 patients, and gradually regressed after 2-month follow-up. Conclusions HMME-PDT therapy is effective for the treatment of PWS, with high safety and few adverse reactions. High-frequency ultrasound can be used for objectively evaluating the clinical efficacy of HMME-PDT therapy.

Key words: Port-wine stain, Hematoporphyrin photoradiation, Ultrasonography 

引用本文

盛珉旻 王芳 张汝芝 王冲 肖丽 杨玉花 李艳 徐春兴 刘小明. 海姆泊芬光动力治疗鲜红斑痣的临床疗效及声像学变化研究[J]. 中华皮肤科杂志, 2019,52(12):923-927. doi:10.35541/cjd.20180737

Sheng Minmin, Wang Fang, Zhang Ruzhi, Wang Chong, Xiao Li, Yang Yuhua, Li Yan, Xu Chunxing, Liu Xiaoming. Clinical efficacy of hematoporphyrin monomethyl ether-based photodynamic therapy for the treatment of port-wine stain and its sonographic changes[J]. Chinese Journal of Dermatology, 2019, 52(12): 923-927.doi:10.35541/cjd.20180737