CAJ | 학술논문

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.
목적 탐색5-안기동무산광동력요법(ALA-PDT)치료심상좌창적ALA최괄농도화최가부약시간.방법 장30례중、중도심상좌창환자수궤분위량조,제일조15례,급이10%ALA유고외부,분별재불동시간점(1、2、3、4、5 h)화불동피손진행원계람Ⅸ(PpⅨ)형광광동력진단화피손조직PpⅨ형광채집여정량분석;제이조15례,재매례환자적우측면협、좌측면협、전액적좌창피손상분별급이3%、5%、10%ALA유고외부3 h후진행PpⅨ형광광동력진단화형광정량연구;동시대해조환자불동부위채용불동농도ALA-PDT적료효화불량반응진행림상연구.결과 제일조좌창환자경10%ALA유고외부,암실배경하채용격발광원조사피손후발현,염성구진、농포화낭종균현시PpⅨ강전홍색형광;분자、염성구진、농포화낭종적PpⅨ형광강도분별위1.3、4.3,5.1화5.8교준단위,PpⅨ형광강도수착피손엄중정도적증가이증강;동시,수착외부시간적연장,PpⅨ형광강도축점증강,부약3 h,4 h、5 h시PpⅨ형광강도명현고우1 h화2 h(P<0.05).제이조환자불동부위채용3%、5%、10%ALA봉포3 h,기상동피손내PpⅨ형광강도차이무통계학의의(P>0.05);분별이3%、5%、10%ALA유고외도우15례환자우측면협、좌측면협、전액부위,경과량차ALA-PDT치료후,전유5례、현효6례,총유효솔위73%;매례환자적불동부위피손지간,료효개선정황무명현차이.부작용표현위경지중도적홍반、종창,엄중시소허삼출,부2례출현잠시성색소침착,소유병례균미출현궤양화반흔등엄중불량반응.결론 ALA-PDT괄용우이염성구진、농포화낭종위주요표현적심상좌창치료,의채용3%ALA농도화3 h부약시간.
Objective To investigate the optimal concentration and incubation time of 5-aminole-vulinic 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 photodynamie 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 alter applica-tion 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 incu-bation 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 manage-ment 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.