中华皮肤科杂志

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光动力疗法治疗尿道尖锐湿疣的临床研究

王秀丽1, 王宏伟1, 过明霞1, Herbert Stepp2, Reinhold Baumgartner2   

  1. 1. 上海市皮肤病性病医院 200050;
    2. 慕尼黑大学激光研究所
  • 收稿日期:2006-02-20 出版日期:2006-04-15 发布日期:2006-04-15
  • 基金资助:
    上海市卫生局科技发展基金(044028)

A clinical study of photodynamic therapy with topical application of 5-aminolevulinic acid in ure-thral warts

WANG Xiu-li1, WANG Hong-wei1, GUO Ming-xia1, Herbert Stepp2, Reinhold Baumgartner2   

  1. Shanghai Skin Diseases and STD Hospital, Shanghai 200050, China
  • Received:2006-02-20 Online:2006-04-15 Published:2006-04-15

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摘要： 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HPVDNA.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HPVDNA.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.

关键词: 尖锐湿疣, 氨基酮戊酸, 原卟啉类, 光化学疗法

Abstract: Objective To find out the optimal 5-aminolevulinic acid (ALA) concentration and duration of topical use in ALA-photodynamic therapy (ALA-PDT) for urethral warts.Methods Sixty patients with urethral warts were recruited into the study.ALA solution was applied to warty lesions in concentrations of 0.5%,1%,3%,5% and 10%,for 1,3,5 and 7 h before biopsy.The fluorescence pattern of ALA induced protoporphyrinⅨ(PPⅨ) was quantified by fluorescence microscopy and digital image analysis in cryosections.The presence of low-or high-risk types of HPV was tested by FDA approved Hybrid Capture 2 HPV DNA assay.Results ALA-induced PPⅨ fluorescence was found in the epidermis in almost all of patients after application of 5-ALA,but hardly found in dermis.The intensity of PPIX fluorescence became strong at 3 h after application,reached peak at 5 h,and gradually declined afterwards.The equal intensity was identified between 3 h and 7 h after application.The intensity of PPⅨfluorescence increased gradually in epidermis along with the increasing of ALA concentrations,which was stronger with 5% and 10% compared to as compared that with 0.5%,1% and 3% ALA solution (P<0.05).Low-risk types were identified in all patients while high-risk types in 18.3% (11/60) simultaneously.Conclusions The results strongly suggest that ALA-PDT with 5% and 10% ALA applied for 3-5 hours is optimal for the treatment of urethral warts.

Key words: Condylomata acuminata, Aminolevulinic acid, Protoporphyrins, Photochemotherapy