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目的探讨20%5-氨基酮戊酸光动力联合液氮冷冻治疗尖锐湿疣的疗效和安全性,并分析尖锐湿疣患者人类乳头瘤病毒(HPV)基因型感染分布情况。方法尖锐湿疣患者108例随机分为两组,治疗组56例,对照组52例。治疗组患者采用20%5-氨基酮戊酸光动力联合液氮冷冻治疗,每周1次,连续3次。对照组先外用0.5%鬼臼毒素酊,再根据皮肤情况选择CO2激光或冷冻治疗,连续治疗3周。两组治疗结束后均随访6个月。两组患者在治疗前后均使用PCR膜杂交法检测21种HPV基因型分布情况,并对检测结果进行分析。结果治疗组与对照组3次治疗后的疣体清除率分别为97.1%和78.4%,治愈率分别为96.4%和76.9%,组间比较均具有显著差异(P<0.01);两组复发率和不良反应发生率比较亦有显著差异(P<0.01、P<0.05)。HPV基因型检测结果:108例尖锐湿疣患者共检出16种基因型,治疗组的HPV清除率明显优于对照组,尤其是针对伴有高、中危型和混合型感染时疗效更为显著(P<0.01)。结论 20%5-氨基酮戊酸光动力联合液氮冷冻治疗尖锐湿疣疗效显著,疣体清除率及临床治愈率高,复发率低,不良反应轻微,在尖锐湿疣治疗中尤其是对伴有高危型HPV及混合型感染患者值得临床进一步广泛推广应用。
Objective To investigate the efficacy and safety of 20% 5-aminolevulinic acid photodynamic therapy combined with liquid nitrogen freezing in the treatment of condyloma acuminatum and analyze the distribution of human papillomavirus (HPV) genotypes in patients with condyloma acuminatum. Methods 108 patients with condyloma acuminatum were randomly divided into two groups, 56 cases in the treatment group and 52 cases in the control group. Patients in the treatment group were treated with 20% 5-aminolevulinic acid photodynamic combined with liquid nitrogen cryotherapy once a week for 3 consecutive times. Control group first with 0.5% podophyllotoxin tincture, and then select the CO2 laser skin or frozen treatment, continuous treatment for 3 weeks. Both groups were followed up for 6 months after treatment. The distribution of 21 HPV genotypes in both groups were detected by PCR membrane hybridization before and after treatment, and the test results were analyzed. Results The wart clearance rates of the three treatment groups were 97.1% and 78.4%, respectively, and the cure rates were 96.4% and 76.9% respectively, with significant difference between the two groups (P <0.01). The recurrence rate There was also a significant difference in the incidence of adverse reactions (P <0.01, P <0.05). HPV genotype test results: A total of 16 genotypes were detected in 108 patients with condyloma acuminatum, the HPV clearance rate of the treatment group was significantly better than that of the control group, especially for patients with high, medium risk and mixed infection (P <0.01). Conclusion 20% 5-aminolevulinic acid photodynamic therapy combined with liquid nitrogen freezing treatment of condyloma acuminata significant effect, wart body clearance rate and clinical cure rate, low recurrence rate, mild adverse reactions, especially in the treatment of condyloma acuminatum associated with high risk Type HPV and mixed infections worth further widespread clinical application.