光动力联合米诺环素治疗中重度痤疮疗效观察及患者生活质量影响

发布时间：2018-07-04 10:18

本文选题：痤疮 + 光动力疗法　；参考：《中国人民解放军医学院》2015年硕士论文

【摘要】：目的：通过对比光动力疗法(photodynamic therapy, PDT)联合米诺环素和单用米诺环素治疗中重度痤疮的临床疗效及对患者生活质量影响,探讨PDT在痤疮治疗中的临床价值,评价PDT治疗痤疮的安全性及有效性。方法：将门诊收集的符合入选条件的78例中重度痤疮患者随机分为两组,PDT联合米诺环素治疗组39例,米诺环素对照组39例。PDT联合米诺环素治疗组：配制5%5-氨基酮戊酸(5-aminolevulinic acid,5-ALA)凝胶,涂抹于皮损部位,保鲜膜封闭,避光封包1.5h,用LED光动力治疗仪红光照射全脸,照射剂量(90-100)J/cm2,照光距离10cm,照光20min,每周照光1次,治疗4次；同时口服盐酸米诺环素胶囊(玫满),100mg/次,2次/日,口服4周。米诺环素治疗组：口服盐酸米诺环素胶囊(玫满),100mg/次,2次/日,口服4周。所有患者在治疗前及开始治疗后第2、4、8周应用痤疮综合分级系统(Global Acne Grading System, GAGS)和痤疮特异性生活质量调查表(Acne Quality of Life, Acne-QOL)进行疗效观察和患者生活质量评估。记录患者治疗过程中出现的不良反应。结果：两组患者年龄、男女比例、病程、GAGS评分和Acne-QOL评分等基线资料均无统计学差异。PDT联合米诺环素治疗组患者治疗2周、4周及8周时GAGS评分均显著低于米诺环素组,差异均有统计学意义(P均0.01)。PDT联合米诺环素治疗组患者治疗第2、4、8周有效率分别为：29.7%、64.9%和94.6%；治疗显效率分别为：13.5%、40.5%和78.4%；米诺环素治疗组患者治疗第2、4、8周有效率分别为：26.3%、57.9%和89.5%；治疗显效率分别为：10.5%、26.3%和55.3%。治疗后第2、4、8周PDT联合米诺环素组皮损有效率高于米诺环素组,但差异无统计学意义(P0.05)；治疗后第2、4周两组皮损显效率不同,但无统计学差异(P0.05),治疗第8周PDT联合米诺环素组皮损显效率(78.4%)显著高于米诺环素组(55.3%),差异有统计学意义。Acne-QOL评分与GAGS评分呈显著负相关(相关系数r=-0.741,P0.01),即痤疮越严重,患者生活质量越差。PDT联合米诺环素组患者治疗2周后生活质量轻度下降,随后生活质量显著提高,治疗8周时,PDT联合米诺环素组患者Acne-QOL评分(81.5±18.1)高于米诺环素治疗组(71.7±16.7),差异有统计学意义(P0.01),PDT治疗能够显著提高患者生活质量。PDT治疗痤疮,不良反应主要表现为红斑、灼热、肿痛和瘙痒等,表现程度轻微,患者能够耐受,PDT治疗结束可很快自行消退,无后遗症状。结论：PDT联合米诺环素、单用米诺环素治疗中重度痤疮均有显著疗效。PDT联合米诺环素治疗中重度痤疮无明显不良反应,患者耐受性好,安全性高；PDT联合米诺环素治疗痤疮疗效较单用米诺环素更好,能显著提高患者治疗显效率。PDT联合米诺环素治疗后患者生活质量有短暂降低,主要与照光后不适反应有关,患者长期生活质量高于单用米诺环素。
[Abstract]:Objective: to investigate the clinical value of (photodynamic therapy, combined with minocycline and minocycline alone in the treatment of moderate and severe acne. To evaluate the safety and efficacy of PDT in the treatment of acne. Methods: Seventy-eight patients with moderate and severe acne were randomly divided into two groups: control group (n = 39) and minocycline control group (n = 39): 5-aminolevulinic acidine 5-ALA gel was prepared. The skin was smeared on the lesion, the preservation film was closed, the envelope was sealed for 1.5 hours, the whole face was irradiated with red light of LED photodynamic therapy instrument. The irradiation dose was (90-100) J / cm ~ (2), the distance of irradiation was 10 cm, the irradiation time was 20 min, once a week, 4 times a week. Minocycline hydrochloride capsules (Meiman) were taken orally twice a day for 4 weeks. Minocycline treatment group: minocycline hydrochloride capsule (Meiman) 100 mg / d twice a day for 4 weeks. All patients were treated with the Global Acne grading system (Gags) and the Acne quality of Life (Acne-QOL) before and after treatment for 8 weeks. Adverse reactions during treatment were recorded. Results: there was no significant difference in baseline data such as age, sex ratio, course of disease, GAGS score and Acne-QOL score between the two groups. The GAGS scores in the PDT combined with minocycline group were significantly lower than those in the minocycline group at 2 weeks, 4 weeks and 8 weeks, respectively. The difference was statistically significant (P0.01). The effective rates of PDT combined with minocycline were 64.9% and 94.60.The effective rates of treatment were 40.5% and 78.4%, respectively, and the effective rates of minocycline treatment group were 57.9% and 89.50.5% in the 24th week of minocycline treatment, 57.9% and 89.5m in the group of minocycline treated with minocycline, respectively. The effective rate of treatment was 26.3% and 55.3%, respectively. The effective rate of skin lesion in PDT combined with minocycline group was higher than that in minocycline group at 8 weeks after treatment, but the difference was not statistically significant (P0.05). However, there was no statistical difference (P0.05). At the 8th week of treatment, the marked effective rate of skin lesions in the PDT combined with minocycline group (78.4%) was significantly higher than that in the minocycline group (55.3%). The difference was significantly negative correlation between the acne-QOL score and the GAGS score (r = 0.741P0.01). The worse the quality of life. PDT combined with minocycline group, 2 weeks after treatment, the quality of life decreased slightly, then the quality of life improved significantly. The Acne-QOL score of patients in PDT combined with minocycline group (81.5 卤18.1) was significantly higher than that in minocycline group (71.7 卤16.7) at 8 weeks after treatment. The difference was statistically significant (P0.01) that PDT treatment could significantly improve the quality of life of patients with acne. The main adverse reactions were erythema and burning heat. Swelling, pain and pruritus are mild, the patient can tolerate PDT treatment end can quickly self-regression, no sequelae. Conclusion the effect of minocycline combined with minocycline and minocycline alone in the treatment of moderate and severe acne is significant. PDT combined with minocycline has no significant adverse effects on moderate and severe acne patients with good tolerance and high safety. The curative effect of PDT combined with minocycline on acne was better than that of minocycline alone. The long-term quality of life of patients was higher than that of minocycline alone.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R758.733

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