5-氨基酮戊酸光动力疗法（5-ALA-PDT）与宫颈环形电切术（LEEP）治疗育龄期高危型人乳头瘤病毒感染的宫颈鳞状上皮内瘤变（CIN2）的比较：一项非随机对照多中心研究
Comparison of 5-ALA-PDT and LEEP of cervical squamous intraepithelial neoplasia (CIN2) with high-risk human papillomavirus infection in childbearing age women: A non-randomized controlled polit study.
作者信息
Wang Lili, Liu Xiaoli, Zhang Junhua, Song Min, Liu Hongli, Xu Ying, Meng Lihua, Zhang Youzhong, Jia Lin
机构信息
Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, No. 107 West Wenhua Road, Jinan, Shandong 250012, PR China.
Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, No. 107 West Wenhua Road, Jinan, Shandong 250012, PR China; Key Laboratory of Gynecologic Oncology of Shandong Province, PR China.
出版信息
Photodiagnosis Photodyn Ther. 2024 Apr;46:104044. doi: 10.1016/j.pdpdt.2024.104044. Epub 2024 Mar 11.
BACKGROUND
5-Aminolevulinic acid-mediated photodynamic therapy (5-ALA-PDT) is a possible minimally-invasive treatment for high-grade cervical intraepithelial neoplasia (HSIL). The present study was carried out to assess the effect of 5-ALA-PDT and loop electrosurgical excision procedure (LEEP) in cervical squamous intraepithelial neoplasia (CIN2) combined with high-risk human papillomavirus (HR-HPV) infection.
METHODS
In this study, 190 patients with CIN2 and HR-HPV infection were finally included. They were divided into the LEEP Group (n = 116) and PDT Group (n = 74) according to gynecologist's recommendation and patient's willingness. All patients were followed up at 4-6 months and 12 months after treatment, including HPV testing, cytology, and colposcopy examination.
RESULTS
(1) 4-6 months after treatment, the pathological regression rate was 97.30 % (72/74) in the PDT group and 98.28 % (114/116) in the LEEP group (P = 0.952). The HPV clearance rate was 81.08 % (60/74) in the PDT group and 80.17 % (93/116)in the LEEP group (P = 0.877). (2) 12 months after treatment, the pathological regression rate was 93.24 % (69/74) in the PDT group and 96.55 % (112/116) in the LEEP group (P = 0.486). The recurrence rate of CIN2 was 4.05 % (3/74) in the PDT group and 1.72 % (2/116) in the LEEP group (P = 0.608). The HPV clearance rate was 90.54 % (67/74) in the PDT group and 89.66 % (104/116)in the LEEP group (P = 0.843). The reinfection rate of HR-HPV was 5.41 % (4/74) in the PDT group and 1.72 % (2/116) in the LEEP group (P = 0.322). (3) The adverse reactions in the PDT Group were slightly lower than that in the LEEP Group (P = 0.4956), but the incidence of vaginal bleeding in the PDT group was lower than that in the LEEP group during follow-up.
CONCLUSIONS
The effectiveness of 5-ALA-PDT is similar to LEEP for CIN2 with less side effects. Therefore, 5-ALA-PDT, a non-invasive treatment, may be an effective method for CIN2 patients of childbearing age.
背景
5-氨基酮戊酸介导的光动力疗法（5-ALA-PDT）是一种治疗高级别宫颈上皮内瘤变（HSIL）的微创治疗方法。本研究旨在评估5-ALA-PDT和环形电切术（LEEP）治疗宫颈鳞状上皮内瘤变（CIN2）合并高危型人乳头瘤病毒（HR-HPV）感染的效果。
方法
本研究最终纳入190例CIN2合并HR-HPV感染患者。根据妇科医生的建议和患者意愿，将其分为LEEP组（n = 116）和PDT组（n = 74）。所有患者在治疗后4 - 6个月和12个月进行随访，包括HPV检测、细胞学检查和阴道镜检查。
结果
（1）治疗后4 - 6个月，PDT组病理缓解率为97.30%（72/74），LEEP组为98.28%（114/116）（P = 0.952）。PDT组HPV清除率为81.08%（60/74），LEEP组为80.17%（93/116）（P = 0.877）。（2）治疗后12个月，PDT组病理缓解率为93.24%（69/74），LEEP组为96.55%（112/116）（P = 0.486）。PDT组CIN2复发率为4.05%（3/74），LEEP组为1.72%（2/116）（P = 0.608）。PDT组HPV清除率为90.54%（67/74），LEEP组为89.66%（104/116）（P = 0.843）。PDT组HR-HPV再感染率为5.41%（4/74），LEEP组为1.72%（2/116）（P = 0.322）。（3）PDT组不良反应略低于LEEP组（P = 0.4956），但随访期间PDT组阴道出血发生率低于LEEP组。
结论
5-ALA-PDT治疗CIN2的疗效与LEEP相似，但副作用较少。因此，5-ALA-PDT这种非侵入性治疗方法可能是育龄期CIN2患者的有效治疗方法。
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