中华皮肤科杂志 ›› 2009, Vol. 42 ›› Issue (8): 563-565.

• 论著 • 上一篇    下一篇

5-氨基酮戊酸光动力疗法治疗寻常痤疮临床应用研究

王秀丽1,王宏伟1,苏丽娜1,张玲琳1,过明霞1,Herbert Stepp2   

  1. 1. 上海市皮肤病性病医院
    2. 德国慕尼黑大学激光研究所
  • 收稿日期:2008-09-01 修回日期:2009-02-25 出版日期:2009-08-15 发布日期:2009-08-10
  • 通讯作者: 王秀丽

Topical photodynamic therapy with 5-aminolevulinic acid for acne vulgaris

  • Received:2008-09-01 Revised:2009-02-25 Online:2009-08-15 Published:2009-08-10

PDF (PC)

182

赞

摘要：

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、5 h）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3 h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3 h、4 h、5 h时PpIX荧光强度明显高于1 h和2 h（P < 0.05）。第二组患者不同部位采用3%、5%、10% ALA封包3 h，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例出现暂时性色素沉着，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3 h敷药时间。

关键词: 5-氨基酮戊酸;光动力诊断;光动力治疗;痤疮;原卟啉IX（PpIX）

Abstract:

Objective To investigate the optimal concentration and incubation time of 5-aminolevulinic acid （ALA） in photodynamic therapy of acne vulgaris. Methods Thirty patients with facial acne vulgaris were equally divided into two groups. In group 1, ALA （10%）cream was applied to acne lesions and protoporphyrin IX （PpIX） fluorescence was examined visually and spectroscopically at 1, 2, 3, 4 and 5 hours. In group 2, ALA cream of 3%, 5% and 10% was applied to lesions in the right cheek, left cheek, and forehead, respectively, of the same patient and incubated for 3 hours followed by photodynamic diagnosis and quantification of fluorescence intensity; clinical outcome and side effects were analyzed. Results Strong brick red PpIX fluorescence was observed in inflammatory papules, pustules, and cysts after application of 10% ALA cream and irradiation with excitation light. The relative intensity of PpIX fluorescence was 1.3, 4.3, 5.1 and 5.8 in comedones, inflammatory papules, pustules and cysts, respectively, and it increased with the severity of lesions. A higher intensity of PpIX fluorescence was noted in patients with longer incubation period （3, 4 or 5 hours） compared with those with shorter incubation period （1 or 2 hours）, and the difference was significant （P < 0.05）. However, there was no significant difference in PpIX fluorescence intensity among lesions receiving ALA of different concentrations （P > 0.05）. The overall clearance rate was 73% （11/15） after two courses of ALA-photodynamic therapy （PDT） in group 2. Side effects mainly included mild to moderate erythema, swelling and little exudation （occasionally）. A transient pigmentation was observed in 2 patients. Neither ulceration nor scarring was noted. Conclusions ALA-PDT is suitable for the management of acne vulgaris mainly characterized by inflammatory papules, pustules and cysts. The results strongly suggest that 3% and 3 hours are the optimal concentration and incubation time of ALA in PDT of acne vulgaris.