CO_2激光治疗的时序选择对尖锐湿疣疗效的影响
|
摘要
目的探讨在尖锐湿疣(CA)综合治疗中,二氧化碳(CO_2)激光治疗的时序选择对其疗效的影响。方法将90例CA患者随机分为先激光组及后激光组,每组45例。(1)两组初次就诊时开始服用相同的免疫调节治疗药物,即复方环磷酰胺片(1mg/kg qd×7d,停用3d,此10d为一疗程,共3疗程)联合胸腺肽肠溶片(30mg bid×90d),先激光组第一次就诊时予以CO_2激光清除可见疣体。两组每月复诊1次,共3个月,如有新发疣体即用激光清除。(2)治疗结束后两组再随访6个月,观察疣体新发情况。结果 (1)每月疣体的新发率:治疗1个月后先激光组疣体新发率大于后激光组,且两组之间的差异具有统计学意义(P<0.01),在治疗第2个月及第3个月两组疣体新发率之间的差异不具有统计学意义。(2)治疗期间两组激光次数:先激光组激光次数多于后激光组,且两组之间的差异具有统计学意义(秩和检验,P<0.01)。(3)治疗结束后随访6个月的临床治愈率:先激光组和后激光组分别为95.1%、92.9%(P>0.05)。(4)后激光组治疗1个月后疣体完全消退有12例(28.6%)。结论在CA综合治疗中,待机体细胞免疫功能提高后再行物理祛疣治疗有利于综合治疗的优化。
Objective To explore the effect of time sequence of carbon dioxide laser on the curative effect of comprehensive treatment of condyloma acuminatum(CA).Methods Patients with CA were randomly divided into pre-carbon dioxide laser group and post-carbon dioxide laser group,45 cases in each group.At the first time to see a doctor,all the patients began to take the same medication,cyclophosphamide tablets(1 mg/kg qd×7 days,stopped for 3 days,these 10 days are a course of treatment,and a total of 3 courses were used)combined with thymosin enteric-coated tablets(30 mg bid×90 days).Patients from pre-carbon dioxide laser group received carbon dioxide laser treatment at the first visit.Subsequent monthly visits were requested to all patients during the three months of treatment.Carbon dioxide laser would be used for patients when new warts were found.Follow-up of six months was performed to observe whether there were new warts after 3-month treatment period.Results In the first month,the incidence rates of new warts were 39.0%and 2.4%in pre-carbon dioxide laser group and postcarbon dioxide laser group,the differences between the two groups were statistically significant.In the second and third months,the difference of the incidence rate of new warts between the two groups was not statistically significant.The frequency of CO_2 laser treatment in pre-carbon dioxide laser group was higher than that in post-carbon dioxide laser group,and the difference between the two groups was statistically significant(Mann-Whitney test,P<0.05).The clinical cure rates were 95.1% and92.9%in pre-carbon dioxide laser group and post-carbon dioxide laser group,respectively(P>0.05),the difference was not statistically significant.In post-carbon dioxide laser group,warts in 12 cases(28.6%)disappeared completely after 1-month treatment.Conclusion In the comprehensive treatment of CA,physical therapy after improvement of cellular immune function of the body to eliminate wart is beneficial to the optimization of comprehensive treatment.
Objective To explore the effect of time sequence of carbon dioxide laser on the curative effect of comprehensive treatment of condyloma acuminatum(CA).Methods Patients with CA were randomly divided into pre-carbon dioxide laser group and post-carbon dioxide laser group,45 cases in each group.At the first time to see a doctor,all the patients began to take the same medication,cyclophosphamide tablets(1 mg/kg qd×7 days,stopped for 3 days,these 10 days are a course of treatment,and a total of 3 courses were used)combined with thymosin enteric-coated tablets(30 mg bid×90 days).Patients from pre-carbon dioxide laser group received carbon dioxide laser treatment at the first visit.Subsequent monthly visits were requested to all patients during the three months of treatment.Carbon dioxide laser would be used for patients when new warts were found.Follow-up of six months was performed to observe whether there were new warts after 3-month treatment period.Results In the first month,the incidence rates of new warts were 39.0%and 2.4%in pre-carbon dioxide laser group and postcarbon dioxide laser group,the differences between the two groups were statistically significant.In the second and third months,the difference of the incidence rate of new warts between the two groups was not statistically significant.The frequency of CO_2 laser treatment in pre-carbon dioxide laser group was higher than that in post-carbon dioxide laser group,and the difference between the two groups was statistically significant(Mann-Whitney test,P<0.05).The clinical cure rates were 95.1% and92.9%in pre-carbon dioxide laser group and post-carbon dioxide laser group,respectively(P>0.05),the difference was not statistically significant.In post-carbon dioxide laser group,warts in 12 cases(28.6%)disappeared completely after 1-month treatment.Conclusion In the comprehensive treatment of CA,physical therapy after improvement of cellular immune function of the body to eliminate wart is beneficial to the optimization of comprehensive treatment.
引文
[1]Evander M,Frazer I H,Payne E,et al.Identification of the alpha6integrin as a candidate receptor for papillomaviruses[J].J Virol,1997,71(3):2449-2456.
[2]Yoon C,Kim K,Park S,et al.α6integrin is the main receptor of human papillomavirus type 16 VLP[J].Biochem Biophys Res Commun,2001,283(3):668-673.
[3]任荣鑫,郑和义.尖锐湿疣局部免疫功能抑制及其机制的研究进展[J].中国皮肤性病学杂志,2014,28(2):200-201.
[4]Cao Y,Zhao J,Yang Z,et al.CD4+FOXP3+regulatory T cell depletion by low-dose cyclophosphamide prevents recurrence in patients with large condylomata acuminata after laser therapy[J].Clin Immunol,2010,136(1):21-29.
[5]Zhao J,Zeng W,Cao Y,et al.Immunotherapy of HPV infection-caused genital warts using low dose cyclophosphamide[J].Expert Rev Clin Immunol,2014,10(6):791-799.
[6]Cao Y,Zhao J,Lei Z,et al.Local accumulation of FOXP3+regulatory T cells:evidence for an immune evasion mechanism in patients with large condylomata acuminata[J].J Immunol,2008,180(11):7681-7686.
[7]Zhao J,Cao Y,Lei Z,et al.Selective depletion of CD4+CD25+Foxp3+regulatory T cells by low-dose cyclophosphamide is explained by reduced intracellular ATP levels[J].Cancer Res,2010,70(12):4850-4858.
[8]Zhang P,Chan J,Dragoi A M,et al.Activation of IKK by thymosin alpha1requires the TRAF6signalling pathway[J].EMBO Rep,2005,6(6):531-537.
[9]Chandratilleke D,Marsh J A.The effect of thymulin on avian IL-2receptor expression[J].Int J Immunopharmacol,2000,22(11):887-896.
[10]杨玲媛,谢青梅,毕英佐.胸腺肽研究进展[J].动物医学进展,2008,29(10):57-60.
[11]Egawa N,Doorbar J.The low-risk papillomaviruses[J].Virus Res,2017,231:119-127.
[12]Bordignon V,Di Domenico E G,Trento E,et al.How human papillomavirus replication and immune evasion strategies take advantage of the host DNA damage repair machinery[J].Viruses,2017,9(12):390.
[13]中华医学会皮肤性病学分会性病学组.尖锐湿疣诊疗指南(2014)[J].中华皮肤科杂志,2014,47(8):598-599.
[14]Zhang Y,Duan Y,Zhao J,et al.Low-dose oral cyclophosphamide therapy is effective for condylomata acuminata[J].Chin Med J(Engl),2013,126(16):3198-3199.
[2]Yoon C,Kim K,Park S,et al.α6integrin is the main receptor of human papillomavirus type 16 VLP[J].Biochem Biophys Res Commun,2001,283(3):668-673.
[3]任荣鑫,郑和义.尖锐湿疣局部免疫功能抑制及其机制的研究进展[J].中国皮肤性病学杂志,2014,28(2):200-201.
[4]Cao Y,Zhao J,Yang Z,et al.CD4+FOXP3+regulatory T cell depletion by low-dose cyclophosphamide prevents recurrence in patients with large condylomata acuminata after laser therapy[J].Clin Immunol,2010,136(1):21-29.
[5]Zhao J,Zeng W,Cao Y,et al.Immunotherapy of HPV infection-caused genital warts using low dose cyclophosphamide[J].Expert Rev Clin Immunol,2014,10(6):791-799.
[6]Cao Y,Zhao J,Lei Z,et al.Local accumulation of FOXP3+regulatory T cells:evidence for an immune evasion mechanism in patients with large condylomata acuminata[J].J Immunol,2008,180(11):7681-7686.
[7]Zhao J,Cao Y,Lei Z,et al.Selective depletion of CD4+CD25+Foxp3+regulatory T cells by low-dose cyclophosphamide is explained by reduced intracellular ATP levels[J].Cancer Res,2010,70(12):4850-4858.
[8]Zhang P,Chan J,Dragoi A M,et al.Activation of IKK by thymosin alpha1requires the TRAF6signalling pathway[J].EMBO Rep,2005,6(6):531-537.
[9]Chandratilleke D,Marsh J A.The effect of thymulin on avian IL-2receptor expression[J].Int J Immunopharmacol,2000,22(11):887-896.
[10]杨玲媛,谢青梅,毕英佐.胸腺肽研究进展[J].动物医学进展,2008,29(10):57-60.
[11]Egawa N,Doorbar J.The low-risk papillomaviruses[J].Virus Res,2017,231:119-127.
[12]Bordignon V,Di Domenico E G,Trento E,et al.How human papillomavirus replication and immune evasion strategies take advantage of the host DNA damage repair machinery[J].Viruses,2017,9(12):390.
[13]中华医学会皮肤性病学分会性病学组.尖锐湿疣诊疗指南(2014)[J].中华皮肤科杂志,2014,47(8):598-599.
[14]Zhang Y,Duan Y,Zhao J,et al.Low-dose oral cyclophosphamide therapy is effective for condylomata acuminata[J].Chin Med J(Engl),2013,126(16):3198-3199.