光动力疗法与脉冲染料激光治疗鲜红斑痣的临床比较  

Clinical comparison between photodynamic therapy and pulsed dye laser for the treatment of port wine stains

作　　者：吴秋菊[1] 周展超[1] 林彤[1] 戎惠珍[1] 贾高蓉[1] 

机构地区：[1]中国医学科学院 北京协和医学院 皮肤病医院激光科,南京210042

出　　处：《中华皮肤科杂志》2016年第8期587-590,共4页Chinese Journal of Dermatology

摘　　要：目的：探讨光动力疗法（PDT）和脉冲染料激光（PDL）治疗鲜红斑痣的疗效差异，并比较两种疗法不良反应发生情况。方法将45例鲜红斑痣患者的自身皮损随机分成PDT治疗区和PDL治疗区。PDT区治疗区在避强光条件下静脉输注5 mg/kg血卟啉注射液，10 min后开始532 nm连续波激光照射，照射20 min后结束，照射功率密度80～100 mW/cm^2，光斑直径7 cm；PDL治疗区采用595 nm脉冲染料激光照射，光斑7 mm，脉冲宽度10 ms，能量密度10～12 J/cm^2。两种治疗之间至少间隔2个月。单次治疗后第4天、8周时随访，记录不良反应，并根据治疗前后临床照片对皮损消退情况进行分析。结果45例患者PDT治疗区基愈10例（22.22%），显效22例（48.89%），有效9例（20.00%），无效4例（8.89%）；PDL治疗区基愈6例（13.33%），显效16例（35.56%），有效18例（40.00%），无效5例（11.11%），PDT单次治疗的疗效明显优于PDL（Z=2.48，P〈0.05）。PDT和PDL治疗组不良反应发生率分别为24.44%和15.56%，差异无统计学意义（Z=1.26，P〉0.05），主要为治疗后色素沉着，3～6个月内自行消退。结论 PDT、PDL疗法治疗鲜红斑痣有效、安全，PDT单次治疗的疗效明显优于PDL单次治疗。Objective To compare the clinical efficacy and adverse effects of photodynamic therapy （PDT） versus pulsed dye laser（PDL）for the treatment of port wine stains（PWS）. Methods Forty-five patients with PWS were enrolled in this study. The PWS lesions in each patient were randomly divided into PDT and PDL areas. Hematoporphyrin monomethyl ether of 5 mg/kg was injected intravenously into the PDT area protected from light, followed by 20-minute irradiation with a 532-nm, solid-state, continuous-wave laser（power density：80-100 mw/cm^2;spot diameter： 7 cm）10 minutes later. The PDL area was treated with a single session of 595-nm pulsed dye laser radiation（spot diameter：7 mm;pulse width：10 ms;energy density：10-12 J/cm^2）. The interval between PDT and PDL treatment was no shorter than two months. Follow up visits were scheduled on day 4 and week 8 after each treatment. Adverse reactions were recorded, and photographs were taken before and 8 weeks after the treatment for evaluation of lesion regression. Results In the case of PDT area, 10 cases（22.22%）were nearly cured, 22（48.89%）achieved marked improvement, 9（20.00%）improvement, 4（8.89%）no improvement. As far as the PDL area is concerned, 6 cases（13.33%）were nearly cured, 16（35.56%）achieved marked improvement, 18（40.00%）improvement, and 5 （11.11%）no improvement. The response rate was significantly higher in the PDT area than in the PDL area（Z=2.48, P〈0.05）. Hyperpigmentation, which spontaneously subsided within 3 to 6 months, was the main adverse reaction. No significant difference was found in the incidence rate of adverse reactions between the PDL and PDT areas（24.44%vs. 15.56%, Z=1.26, P〉0.05）. Conclusion For the treatment of PWS, both PDT and PDL are effective and safe, and single-session PDT appears to be superior to single-session PDL.

关 键 词：葡萄酒色痣 光疗法 血卟啉光照疗法 

分 类 号：R758.51[医药卫生—皮肤病学与性病学]