微针、分束 CO2 激光与冷冻疗法联合 5-氨基酮戊酸光动力疗法治疗光化性角化病的疗效和安全性：一项多中心前瞻性随机对照研究。

Efficacy and safety of microneedling, fractional CO laser, and cryotherapy combined with 5-aminolevulinic acid photodynamic therapy in the treatment of actinic keratosis: A multicenter prospective randomized controlled study.

机构信息

Department of Dermatology, The Affiliated Hospital of Xuzhou Medical University, 99 West Huai Hai Road, Xuzhou, Jiangsu 221002, People's Republic of China; Department of Dermatology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Department of Dermatology, The Affiliated Hospital of Xuzhou Medical University, 99 West Huai Hai Road, Xuzhou, Jiangsu 221002, People's Republic of China.

出版信息

Photodiagnosis Photodyn Ther. 2023 Sep;43:103700. doi: 10.1016/j.pdpdt.2023.103700. Epub 2023 Jul 8.

DOI:10.1016/j.pdpdt.2023.103700

PMID:37429461

Abstract

BACKGROUND

Photodynamic therapy (PDT) for actinic keratosis (AK) is limited by the depth of treatment. Microneedling or fractional CO laser can facilitate the penetration of photosensitizer, while cryotherapy can treat deeper tissues but is not suitable for field cancerization.

OBJECTIVE

To investigate the efficacy of microneedling, fractional CO laser, and cryotherapy in combination with PDT for AK.

METHODS

Patients with AK were randomized into 4 groups, including group A with microneedling + PDT, group B with fractional CO laser + PDT, group C with cryotherapy + PDT, and group D with PDT. After 12 weeks, the clinical, dermoscopic, and reflectance confocal microscopy (RCM) outcomes were assessed.

RESULTS

A total of 129 patients were included in this study, with 31, 30, 35, and 31 patients in each group, yielding clinical response rates of 90.3%, 93.3%, 97.1%, and 74.2%, respectively (P=0.026). The RCM response rates were 71.0%, 80.0%, 85.7%, and 54.8%, respectively (P=0.030). The dermoscopic response rates were 77.4%, 83.3%, 88.6%, and 60.0%, respectively (P=0.039). Group C showed the best efficacy in terms of clinical, dermoscopic, and RCM outcomes.

CONCLUSIONS

All three treatments improved the efficacy of PDT and were well tolerated, with cryotherapy + PDT showing the best efficacy.

摘要

背景

光动力疗法（PDT）治疗光化性角化病（AK）的疗效受限于治疗深度。微针或分束 CO2 激光可以促进光敏剂的渗透，而冷冻疗法可以治疗更深层的组织，但不适合用于癌前病变。

目的

探讨微针、分束 CO2 激光和冷冻疗法联合 PDT 治疗 AK 的疗效。

方法

将 AK 患者随机分为 4 组，分别为微针+PDT 组（A 组）、分束 CO2 激光+PDT 组（B 组）、冷冻疗法+PDT 组（C 组）和 PDT 组（D 组）。治疗 12 周后，评估临床、皮肤镜和反射共聚焦显微镜（RCM）的疗效。

结果

本研究共纳入 129 例患者，每组 31、30、35 和 31 例，临床有效率分别为 90.3%、93.3%、97.1%和 74.2%（P=0.026）。RCM 有效率分别为 71.0%、80.0%、85.7%和 54.8%（P=0.030）。皮肤镜有效率分别为 77.4%、83.3%、88.6%和 60.0%（P=0.039）。C 组在临床、皮肤镜和 RCM 疗效方面均表现最佳。