光動力聯合異維A酸及阿奇霉素治療重度痤瘡療效研究

顧麗群 朱周 任祺

[摘要]目的：觀察光動力聯合異維A酸及阿奇霉素治療重度痤瘡的臨床療效。方法：選取筆者醫院2015年1月-2017年1月就診的80例重度痤瘡患者，每組40例。對照組使用異維A酸膠丸口服治療，治療組在對照組基礎上聯合阿奇霉素及ALA光動力治療。結果：對治療后兩組患者進行4周隨訪，治療組有效率（75.00%）高于對照組（52.50%）;治療后8周隨訪，治療組有效率（92.50%）高于對照組（70.00%），差異均具有統計學意義。隨訪6個月，治療組4例復發，復發率為11.43%;對照組12例復發，復發率為26.67%，差異有統計學意義（P<0.05）;兩組不良反應發生率比較，無統計學差異（P>0.05）。結果顯示治療組血清睪酮（T）以及局部痤瘡處雄激素受體（AR）水平均優于對照組，差異有統計學意義（P<0.001）。結論：光動力聯合異維A酸及阿奇霉素治療重度痤瘡患者，起效快、有效率顯著高于傳統口服藥物治療，且復發率低，值得臨床推廣應用。

[關鍵詞]光動力;異維A酸;重度痤瘡;血清睪酮;雄激素受體;療效;不良反應

[中圖分類號]R758.73+3 ? ?[文獻標志碼]A ? ?[文章編號]1008-6455（2019）09-0047-03

Abstract： Objective ?To observe the effect of photodynamic therapy combined with isotretinoin and azithromycin on severe acne. Methods ?The 80 patients with severe acne treated in our hospital from January 2015 to January 2017 were selected for the study. The efficacy and adverse reactions were observed in a one-year follow-up. There were 40 patients in the treatment group and 40 patients in the control group. The control group was treated with isotretinoin pellets orally， and the treatment group was treated with azithromycin combined with ALA photodynamic therapy on the basis of the control group. Results ?The patients in the two groups were followed up for 4 weeks after treatment. The response rates of the treatment group （75.00%） were higher than those of the control group （52.50%）. After 8 week follow-up， there was a statistically significant difference in the effective rate between the treatment group and the control group， and the effective rate in the treatment group （92.50%） was higher than that in the control group （70.00%）. Four patients in the treatment group were followed up for 6 months， with a recurrence rate of 11.43%. The recurrence rate of 12 patients in the control group was 26.67%. The difference between the two groups was statistically significant （P<0.05）. There was no significant difference in the incidence of adverse reactions between the treatment group and the control group （P>0.05）. In addition， the serum testosterone （T） and androgen receptor （AR） levels of the treatment group were significantly higher than those of the control group （P<0.001）. Conclusion ?Photodynamic therapy for severe acne has a quick onset， a significantly higher effective rate than traditional oral drug therapy， and a low recurrence rate， which is worthy of clinical promotion.

Key words： photodynamic; sotretinoic acid; severe acne; serum testosterone; androgen receptor;therapeutic effect; adverse reaction

痤瘡是遺傳與環境因素等眾多因子作用下出現的一種炎癥性皮膚病，表現為毛囊皮脂腺的慢性炎癥，在青春期人群中發病率最高，約90%的青少年均會出現不同程度的痤瘡樣癥狀，且具有病程長及易復發等特征[1-2]。隨著相關領域技術的不斷發展更新，對于痤瘡患者來說，特別是對于藥物治療不耐受以及不愿接受藥物治療的患者，物理治療方法成為一種較好的可選項目。5-氨基酮戊酸光動力療法（5-Aminolevulinic acid-photodynamic therapy， ALA-PDT）通過光毒性反應來誘導細胞的凋亡，同時刺激巨噬細胞釋放相關細胞因子，達到促進皮損自愈的目標，完成了對痤瘡治療的全過程[3-5]。……