Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, No. 107 West Wenhua Road, Jinan, Shandong 250012, China.
Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, No. 107 West Wenhua Road, Jinan, Shandong 250012, China; Key Laboratory of Gynecologic Oncology of Shandong Province, China.
Photodiagnosis Photodyn Ther. 2022 Sep;39:103009. doi: 10.1016/j.pdpdt.2022.103009. Epub 2022 Jul 10.
To analyze the efficacy and safety of photodynamic therapy (PDT) on postmenopausal women with persistent human papillomavirus (HPV) infection with or without low-grade cervical and vaginal intraepithelial neoplasia (CIN1 and VaIN1).
The clinicopathological and follow-up data of 86 postmenopausal women with HPV infection (35 cases with chronic cervicitis and 51 cases with CIN1/VaIN1) were collected. All the women in this group met these criteria: menopausal time ≥ 1 year, HPV infection time ≥ 2 years, colposcopy and pathological diagnosis of biopsy ≤ CIN1/VaIN1 before PDT treatment, and 5-aminolaevulinic acid (5-ALA) as photosensitizer treating for 6 times with a week interval. The above patients were followed up 6 months and 12 months after PDT treatment, and the follow-up contents included HPV typing, cytology, colposcopy and pathological examinations. HPV negative conversion rate and lesion remission rate are the evaluation indicators of treatment efficacy. In addition, we also assessed the safety of PDT treatment.
At 12-month follow-up, the overall HPV clearance rate was 60% (45/75), of which the negative conversion rate of 16/18 HPV was 41.38% (12/29), and non-16/18 HPV was 71.74% (33/46) (p = 0.009). In patients without lesions, the HPV clearance rate was 51.72% (15/29), while in patients with CIN1/VaIN1 (n = 46), the HPV complete remission rate and lesion regression rate were 65.22% (30/46) and 89.13% (41/46), respectively. In addition, the clearance rate of HPV in lesion regression group was significantly higher than that in lesion persistence/progression group (0.00% vs. 73.17%, p = 0.003). The adverse reactions after PDT treatment were mild, mainly manifested as increased vaginal secretions or burning/tingling.
Photodynamic therapy can significantly enhance the elimination rate of persistent HPV infection in postmenopausal women and reduce the progression of CIN1/VaIN1. It could be an effective conservative treatment for persistent HPV infection and CIN1/VaIN1 in postmenopausal women.
分析光动力疗法（PDT）治疗绝经后持续性人乳头瘤病毒（HPV）感染伴或不伴低级别宫颈和阴道上皮内瘤变（CIN1 和 VaIN1）的疗效和安全性。
收集了 86 例 HPV 感染绝经后妇女（35 例慢性宫颈炎，51 例 CIN1/VaIN1）的临床病理及随访资料。所有患者均符合以下标准：绝经时间≥1 年，HPV 感染时间≥2 年，PDT 治疗前阴道镜和活检病理诊断为 CIN1/VaIN1 以下，5-氨基酮戊酸（5-ALA）作为光敏剂，每 1 周治疗 1 次，共 6 次。PDT 治疗后 6 个月和 12 个月对上述患者进行随访，随访内容包括 HPV 分型、细胞学、阴道镜和病理检查。HPV 阴性转化率和病变缓解率是评估治疗效果的指标。此外，我们还评估了 PDT 治疗的安全性。
12 个月随访时，HPV 总清除率为 60%（45/75），其中 HPV16/18 阴性转化率为 41.38%（12/29），非 HPV16/18 阴性转化率为 71.74%（33/46）（p=0.009）。无病变患者 HPV 清除率为 51.72%（15/29），而 CIN1/VaIN1 患者（n=46）HPV 完全缓解率和病变消退率分别为 65.22%（30/46）和 89.13%（41/46）。此外，病变消退组 HPV 清除率明显高于病变持续/进展组（0.00% vs. 73.17%，p=0.003）。PDT 治疗后不良反应较轻，主要表现为阴道分泌物增多或烧灼感/刺痛感。
光动力疗法可显著提高绝经后妇女持续性 HPV 感染的清除率，降低 CIN1/VaIN1 的进展。对于绝经后持续性 HPV 感染和 CIN1/VaIN1，它可能是一种有效的保守治疗方法。
