5-氨基酮戊酸介导的光动力疗法可有效改善人乳头瘤病毒感染的宫颈上皮内瘤变。
5-aminolevulinic acid-mediated photodynamic therapy effectively ameliorates HPV-infected cervical intraepithelial neoplasia.
作者信息
Chen Yi, Xu Ying, Zhang Zhengrong, Xiong Zhenhong, Wu Dan
机构信息
Cervical Center of The International Peace Maternity & Child Health Hospital of China Welfare Institute Shanghai 200030, China.
出版信息
Am J Transl Res. 2022 Apr 15;14(4):2443-2451. eCollection 2022.
OBJECTIVE
To determine the efficacy and safety of 5-aminolevulinic acid-mediated photodynamic therapy (ALA-PDT) in cervical intraepithelial neoplasia (CIN) infected by HPV.
METHODS
The clinical data of 115 patients with HPV-Infected CIN admitted to our hospital were selected for this retrospective analysis. They were divided into a control group (n=53) and an experimental group (n=62) according to different treatment methods. Patients in the control group were treated by laser therapy, while those in the experimental group were treated by ALA-PDT. The two cohorts of patients were compared with respect to clinical efficacy, LSIL cure rate, adverse reactions, and complications. Patients were followed up for 3 months and 6 months, and their clinical outcomes were compared based on HPV persistence and residual/recurrent low-grade squamous intraepithelial lesion (LSIL). In the experimental group, the negative conversion rate of HPV and the degree of squamous epithelial lesions in patients with different HPV infection types and various visible degrees of transformation zones (TZs) were compared 6 months after surgery.
RESULTS
After 6 months of follow-up, the HPV clearance rate and LSIL reversal rate in the control group were 62.3% and 64.2%, respectively, while those in the experimental group were 79.0% and 80.6%, respectively, with significant differences between the two groups (P<0.05). There was no significant difference between the two groups in terms of the LSIL cure rate of lesions located in cervicovaginal region and cervicovaginal region + cervical canal (P>0.05). Neither were there any significant differences in HPV negative conversion rate and LSIL residual/recurrence rate in patients with HPV 16/18 and non-HPV 16/18 between the control group and the experimental group (P>0.05). However, the HPV negative conversion rate in partially visible TZs was lower than that in completely visible TZs, and the LSIL residual/recurrence rate in the completely visible TZs in the control group was higher than that in the experimental group (P<0.05). The incidence of adverse reactions was not significantly different between the two groups (P>0.05), but the incidence of complications in the control group was higher than that in the experimental group (P<0.05). Neither the experimental group nor the control group had any cases of pathologic escalation to high-grade squamous intraepithelial lesion (HSIL).
CONCLUSION
ALA-PDT can effectively treat HPV-infected CIN and promote HPV clearance.
目的
确定5-氨基酮戊酸介导的光动力疗法（ALA-PDT）治疗人乳头瘤病毒（HPV）感染的宫颈上皮内瘤变（CIN）的疗效和安全性。
方法
选取我院收治的115例HPV感染的CIN患者的临床资料进行回顾性分析。根据不同治疗方法将其分为对照组（n = 53）和试验组（n = 62）。对照组患者接受激光治疗，试验组患者接受ALA-PDT治疗。比较两组患者的临床疗效、低度鳞状上皮内病变（LSIL）治愈率、不良反应及并发症。对患者进行3个月和6个月的随访，根据HPV持续存在情况以及残余/复发性低度鳞状上皮内病变（LSIL）比较其临床结局。在试验组中，比较术后6个月不同HPV感染类型及不同可见程度转化区（TZ）患者的HPV转阴率和鳞状上皮病变程度。
结果
随访6个月后，对照组的HPV清除率和LSIL逆转率分别为62.3%和64.2%，而试验组分别为79.0%和80.6%，两组间差异有统计学意义（P<0.05）。位于宫颈阴道区域和宫颈阴道区域+宫颈管的病变的LSIL治愈率在两组间差异无统计学意义（P>0.05）。对照组和试验组中HPV 16/18型和非HPV 16/18型患者的HPV转阴率及LSIL残余/复发率差异均无统计学意义（P>0.05）。然而，部分可见TZ的HPV转阴率低于完全可见TZ，对照组完全可见TZ的LSIL残余/复发率高于试验组（P<0.05）。两组间不良反应发生率差异无统计学意义（P>0.05），但对照组并发症发生率高于试验组（P<0.05）。试验组和对照组均无病理升级为高级别鳞状上皮内病变（HSIL）的病例。
结论
ALA-PDT可有效治疗HPV感染的CIN并促进HPV清除。
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