5-氨基酮戊酸光动力治疗尿道尖锐湿疣的疗效分析

目的：探讨5-氨基酮戊酸光动力疗法（ALA-PDT）治疗尿道尖锐湿疣（UCA）的疗效和安全性.方法：试验组采用ALA-PDT对80例UCA进行治疗,每周治疗1次,共 1-3次;对照组采用CO2激光对63例UCA进行治疗.两组治疗后第3周判定临床疗效,随访时间均为3个月.结果：试验组皮损清除率为98.96%,复发率11.39%（9/79）;对照组皮损清除率为100%,复发率30.16%（19/63）.经统计学处理,两组皮损清除率差异无统计学意义（P〉0.01）,复发率对照组明显高于试验组（P〈0.01）.试验组仅少许患者出现轻度水肿、刺痛,对照组几乎所有患者均出现不同程度的疼痛、糜烂和浅表溃疡,但二者均未出现疤痕及尿道狭窄等较严重副作用.结论：ALA-PDT具有疗效好、复发率低、副作用小等优势,可作为UCA的治疗选择之一.     

5-氨基酮戊酸光动力疗法治疗痤疮

目的 探索5-氨基酮戊酸光动力疗法（ALA-PDT）治疗中、重度痤疮的安全性及有效性。方法 将70例中、重度痤疮患者随机分为两组。治疗组35例,给予ALA-PDT治疗,每2周治疗1次,共治疗1 ~ 3次;对照组35例,口服异维A酸胶囊治疗,共服用6周。在治疗第2、4、6周对两组患者进行疗效判断和比较。结果 35例接受ALA-PDT治疗的患者经过1 ~ 3次治疗后（第2、4、6周）,总有效率达97.1%;对照组于6周时总有效率为80.0%,治疗组疗效明显优于对照组（P < 0.05）。另外,ALA-PDT组复发程度明显轻于对照组,且病情控制时间明显延长。ALA-PDT组有个别患者局部出现暂时性色素沉着,但无瘢痕发生。结论 ALA-PDT是一种简单、高效、不良反应轻微的治疗中、重度痤疮的新疗法。     

不同浓度氨基酮戊酸光动力治疗中重度痤疮疗效观察

目的 探讨不同浓度氨基酮戊酸光动力疗法（ALA-PDT）治疗中重度痤疮的有效性及安全性。方法 采用随机、自身对照的方法将180例患者分为5％、10%、15%、20% ALA 4个治疗组,患者一侧面部外敷ALA,另一侧面部外敷安慰剂。均采用相同剂量的红光进行照射,每周1次,共4次。在治疗结束后第2周、1个月、3个月、6个月分别进行随访,记录皮损消退情况及不良反应。结果 治疗结束后随访,各治疗组皮损改善情况与对照组相比,差异均有统计学意义（P < 0.05）。至第6个月随访,试验侧有效率5% ALA组为79.55％,10% ALA组为88.37％,15% ALA组为95.24％,20% ALA组为97.73％,疗效均明显优于对照侧,差异有统计学意义（P < 0.05）。试验侧各浓度组间比较,随浓度增加,有效率明显增加,差异有统计学意义（P < 0.05）。从不良反应看,ALA浓度越高,红肿及色素沉着等不良反应的发生率越高,但无瘢痕形成。结论 ALA-PDT治疗中重度痤疮疗效明显优于单用红光治疗,结合临床有效率和安全性,10%和15% ALA-PDT治疗能达到较满意的疗效。     

皮肤光动力疗法的研究进展

随着皮肤光动力治疗（PDT）技术的发展和不断成熟,光动力三要素中光敏剂、光源方面都有了新的发展,研发了透皮性更好的氨基酮戊酸（ALA）凝胶和贴片制剂;光源上除了传统的激光或二极管红光,“日光PDT”因其光谱的可行性和便捷的治疗方式在欧美国家得到普遍关注;PDT疗法的适应证也有新的拓展,如部分皮肤肿瘤及皮肤区域癌化（field cancerization）的防治等。PDT与其他物理方法的联合也取得了较为满意的疗效……     

5-氨基酮戊酸光动力疗法治疗中、重度痤疮护理体会

目的探讨临床护理在5-氨基酮戊酸光动力疗法(ALA-PDT)治疗中、重度痤疮患者中的作用。方法在入选的35例中、重度痤疮患者进行ALA-PDT治疗的过程中,对痤疮发病原因、光动力原理及疗中、疗后可能出现的情况施以充分的的宣教,并观察护理对临床疗效的影响。结果经过充分的临床护理,患者的依从性好,临床疗效随着治疗次数的增加逐渐提高,35例中、重度痤疮患者经ALA-PDT治疗1～3次后,痊愈28例、显效6例、进步1例,有效率为97.1%。结论通过对痤疮及光动力知识的宣教,使患者接受和配合治疗,有助于提高ALA-PDT的临床疗效。     

Influence of topical photodynamic therapy with 5-aminolevulinic acid on porphyrin metabolism

Photodynamic therapy (PDT) with topically applied 5-aminolaevulinic acid (5-ALA) is increasingly used for treating tumours. The efficacy of topical PDT is limited to superficial and initial tumours. The topically applied doses of 5-ALA vary from 0.02 to 7.0 g per session according to the type of lesion. There are no studies on the influence of topically applied 5-ALA on the systemic accumulation of porphyrins or porphyrin precursors. A group of 20 patients with actinic keratoses (AK) and basal cell carcinomas (BCC) were treated by topical PDT with 5-ALA. Prior to and 6 and 24 h after PDT, 5-ALA and total porphyrin concentrations were determined in red blood cells and plasma, respectively. In addition, before and after 5-ALA treatment, 24-h urine samples were collected and porphyrins and porphyrin precursors were measured. There was no significant alteration in porphyrin metabolism. In some patients, a slight but insignificant increase in erythrocyte and plasma porphyrins was found 6 h after 5-ALA PDT. This investigation confirms clearly the safety of this treatment modality and demonstrates that 5-ALA application (up to 7 g) in the course of PDT has no influence on the concentrations of porphyrins and porphyrin precursors measured in various compartments.     

Immunosuppressive effects of photodynamic therapy by topical aminolevulinic acid

Photodynamic therapy (PDT) has been used for inflammatory skin disorders as well as superficial skin cancers such as solar keratosis and Bowen's disease. Whether PDT with topical application of aminolevulinic acid (ALA) and exposure to visible light has a similar immunosuppressive action to ultraviolet phototherapy was investigated using a murine contact hypersensitivity (CHS) model. The number of epidermal Langerhans cells (LC) was decreased with their morphological changes 1 day after PDT with the minimal level at 5 days and gradual recovery thereafter. Conversely, the number of CD11c(+) I-A(+) cells was significantly increased in the draining lymph nodes after PDT. This suggests that LC moved from PDT-treated skin, resulting in the decrement of epidermal LC and migration to lymph nodes. CHS response to DNFB applied on the PDT-treated skin with 20% ALA and 40 J/cm(2) visible light was significantly suppressed (local immunosuppression). When mice were treated with 80 J/cm(2) of PDT, CHS response to the antigen applied on untreated distant skin was also significantly suppressed (systemic immunosuppression). The locally or systemically immunosuppressed mice by PDT were attempted to sensitize again with DNFB on non-treated skin, but elicitation responses were significantly suppressed. However, these mice were able to be sensitized with another hapten, oxasolone. Thus, a hapten-specific immunological unresponsiveness (tolerance) was induced in mice by topical ALA-PDT. These findings suggest that PDT has a potential immunological contribution to clinical efficacy for inflammatory diseases identical to ultraviolet phototherapies.     

Lack of selectivity of protoporphyrin IX fluorescence for basal cell carcinoma after topical application of 5-aminolevulinic acid: implications for photodynamic treatment

Clinical trials of topical ALA in photodynamic therapy (PDT) of basal cell carcinoma (BCC) show significant recurrence rates. Exogenous 5-aminolevulinic acid (ALA) is converted by intracellular enzymes to photoactive protoporphyrin IX (PpIX) in human tissues. PpIX generates cytotoxic singlet oxygen when irradiated with visible light in the 400–640 nm range. To evaluate variability and heterogeneity in PpIX production by tumors in such trials, and to assess the usefulness of PpIX for marking skin tumors, we measured PpIX fluorescence distribution in BCC after topical application of 20% ALA cream. ALA cream was applied under occlusion for periods ranging from 3 to 18 h (average 6.9 h, SD 4 h) to 16 BCCs. ALA conversion to PpIX in the BCCs was assessed by in vivo photography, ex vivo video fluorescence imaging, and fluorescence microscopy. External macroscopic PpIX fluorescence, as assessed by in vivo and ex vivo imaging, correlated with the clinical presence of BCC. Examination by a digital imaging fluorescence microscope revealed inter- and intratumor fluorescence variability and heterogeneity. PpIX fluorescence corresponding to full tomor thickness was found in six superficial and four nodular tumors, and partial-thickness fluorescence was observed in five nodular tumors, but no PpIX fluorescence was observed in some areas of superficial, nodular and infiltrating tumors. In a significant number of nodular and infiltrating BCCs, topical ALA appeared to provide little or no PpIX in deep tumor lobules. In addition, no selectivity for tumor tissue versus normal epidermis was seen. The grossly brighter external PpIX fluorescence over tumors may be due, therefore, to enhanced penetration through tumor-reactive stratum corneum and to the tumor thickness. The absence of reproducible fluorescence marking of nodular and infiltrating BCC suggests that topical ALA, at least under the present delivery protocols, may not be a reliable regimen for photodynamic treatment of these BCCs.     

Photodynamic therapy for acne vulgaris: a randomized, controlled, split-face clinical trial of topical aminolevulinic acid and pulsed dye laser therapy

Background  There remains the need for more effective therapeutic options to treat acne vulgaris. Interest in light-based acne treatments has increased, but few randomized, controlled clinical trials assessing the value of photodynamic therapy (PDT) for acne have been reported.
Aims  We sought to examine the efficacy of PDT using 5-aminolevulinic acid (ALA) and pulsed dye laser therapy in the treatment of acne.
Patients/methods  We conducted a randomized, controlled, split-face, single-blind clinical trial of 44 patients with facial acne. Patients were randomized to receive three pulsed dye laser treatments to one side of the face after a 60–90 min ALA application time, while the contralateral side remained untreated and served as a control. Serial blinded lesion counts and global acne severity ratings were performed.
Results  Global acne severity ratings improved bilaterally with the improvement noted to be statistically significantly greater in treated skin than in untreated skin. Erythematous macules (remnants of previously active inflammatory lesions) decreased in number in treated skin when compared with control skin and there was a transient but significant decrease in inflammatory papules in treated skin when compared with untreated skin. There were no other statistically significant differences between treated and untreated sides of the face in terms of counts of any subtype of acne lesion. Thirty percent of patients were deemed responders to this treatment with respect to improvement in their inflammatory lesion counts, while only 7% of patients responded in terms of noninflammatory lesion counts.
Conclusions  PDT with the treatment regimen employed here may be beneficial for a subgroup of patients with inflammatory acne.     

光动力疗法联合果酸治疗面部中重度痤疮临床疗效观察

目的观察5-氨基酮戊酸光动力疗法(ALA-PDT)联合果酸治疗面部中重度痤疮的有效性及安全性。方法 52例面部中重度痤疮患者随机分为两组,试验组25例,先给予ALA-PDT治疗,每周1次,共2次,2周后行果酸治疗,每2周1次,共2次。对照组27例,仅给予ALA-PDT治疗,每周1次,共2次。在治疗结束后2、4、8周进行疗效判断及不良反应记录。结果治疗后2、4周试验组与对照组疗效相比,差异无统计学意义(P0.05);治疗后8周试验组疗效明显优于对照组(P0.05)。结论 ALA-PDT联合果酸治疗面部中重度痤疮是一种安全、有效的治疗方法。     

5-氨基酮戊酸光动力学疗法在皮肤科的应用进展

探讨5-氨基酮戊酸（ALA）光动力学疗法（PDT）治疗皮肤病的作用原理及应用范围,为临床合理使用ALA—PDT提供参考依据。对近lO余年来文献报道的有关PDT研究进展及其临床应用的文献进行总结和分析,综述ALA．PDT治疗各类皮肤病的作用原理和机制,以及ALA．PDT治疗皮肤病的范围,所引起的不良反应。PDT对皮肤肿瘤、红斑鳞屑性皮肤病、人乳头瘤病毒（HPV）感染性皮肤病、痤疮、鲜红斑痣等均有良好的临床效果,不良反应相对较小,在皮肤科有很大的应用前景。     

氨基酮戊酸光动力治疗尖锐湿疣局部免疫反应的研究

目的 探讨氨基酮戊酸光动力(ALA-PDT)治疗尖锐湿疣的局部免疫反应.方法 分别采用体外细胞共培养体系和在体免疫组化方法进行研究.将前期建立的稳定表达人乳头瘤病毒16E7蛋白HaCaT细胞株即HPV 16E7/HaCaT细胞作为HPV感染角质形成细胞模型,将ALA-PDT处理后的HPV 16E7/HaCaT细胞与外周血单一核细胞(PBMC)经Transwell小室共培养,3h后观察PBMC的趋化情况;同时采用免疫组化方法研究10例尖锐湿疣患者光动力前及光动力后1、2、3、48 h时,皮损中CD4+T细胞、CD8+T细胞、CD68+巨噬细胞的数量及CD4+/CD8+T细胞数比值变化情况.结果 与ALA-PDT处理后的HPV 16E7/HaCaT细胞共培养3h后,PBMC有明显趋化现象.临床标本免疫组化结果显示,48 h时CD4+T细胞、CD8+T细胞数量及其比值明显升高(P＜0.05),而CD68+巨噬细胞在3h及48 h均升高(P＜0.05).结论 ALA-PDT治疗尖锐湿疣的过程中,可诱导机体产生局部抗病毒免疫反应.     

氨基酮戊酸光动力疗法皮肤科临床应用指南（2021版）

【摘要】 近年来氨基酮戊酸光动力疗法（ALA-PDT）在中国皮肤科应用广泛且发展迅速。为进一步规范、指导、推动ALA-PDT在皮肤科临床上的应用,2020年中华医学会皮肤性病学分会、中国康复医学会皮肤病康复专业委员会联合中国医学装备协会皮肤病与皮肤美容分会光医学治疗装备学组再次组织从事ALA-PDT研究的相关专家在首版《氨基酮戊酸光动力疗法临床应用专家共识》的基础上进行修订、更新,制定了该版指南,供中国皮肤科医师参考。     

Photodynamic therapy of acne vulgaris using 5‐aminolevulinic acid 0.5% liposomal spray and intense pulsed light in combination with topical keratolytic agents

Background Increasing antibiotic resistance of Propionibacterium acnes and growing awareness on the side effects of topical and systemic drugs in the treatment of acne vulgaris by physicians and patients have paved the way for a search into new efficacious and safe treatment modalities such as photodynamic therapy (PDT). Although the efficacy of PDT using 20% 5‐aminolevulinic acid (ALA) cream has been established, phototoxic side effects limit its use. The 5‐ALA concentration can be lowered by a factor of 40 by changing the vehicle of 5‐ALA from a moisturizing cream to liposome encapsulation. Objectives Assessment of the efficacy and the safety of PDT using 5‐ALA 0.5% in liposomal spray and intense pulsed light (IPL) in combination with topical peeling agents (Li‐PDT‐PC) in acne vulgaris. Materials and Methods 32 patients suffering from acne participated in this randomized, prospective, single blind study. All patients were treated with Li‐PDT‐PC. During the study nine patients were additionally treated with topical or systemic antibiotics (Li‐PDT‐PC‐AT). These patients were removed from the study although their results were recorded. Results After a mean period of 7.8 months and a mean number of 5.7 treatments the mean total number of lesions dropped from 34.6 lesions to 11.0 lesions, resulting in a mean improvement of 68.2%. Side effects were minimal. Additionally, an intention to treat analysis was conducted. Conclusion Photodynamic therapy of acne vulgaris using 5‐ALA 0.5% liposomal spray and IPL in combination with topical peeling agents is safe and efficacious, even in patients with acne recalcitrant to standard therapy.     

5-氨基酮戊酸光动力疗法对尖锐湿疣疗效预后的影响因素分析

目的：探讨5-氨基酮戊酸（5-Aminolevulinic acid,5-ALA）光动力（Photodynamic therapy,PDT）疗法对尖锐湿疣（Condyloma acuminatum,CA）疗效预后的影响因素,为改善患者的预后提出指导建议。方法：选取我院2011年3月至2013年3月收治的97例CA患者,均采取5-ALA PDT疗法治疗,按照患者预后情况分为痊愈组及未痊愈组,对比两组患者一般资料,分析其影响因素。结果：经4周治疗后,CA患者痊愈66例,显效17例,进步11例,无效3例,痊愈率68.0%;97例患者均获得有效随访,其中痊愈组复发3例,复发率4.5%,未痊愈组复发6例,复发率19.4%,痊愈组复发率显著低于未痊愈组;多因素回归分析发现,非生殖器部位皮损、疣体面积≥1.5cm^2、疣体高度≥0.5mm、性伙伴个数≥3及存在PDT照射停顿是影响CA患者痊愈率的独立危险因素（P〈0.05）。结论：存在上述因素的CA患者多具有更差的治疗效果及更高的复发率,应采取心理干预、健康宣教等护理措施,并注重治疗的连续性,以保证治疗效果,改善患者预后。     

提高氨基酮戊酸透皮能力的方法

氨基酮戊酸光动力治疗在皮肤科领域应用广泛,由于氨基酮戊酸透皮能力低,限制氨基酮戊酸光动力治疗的疗效。氨基酮戊酸衍生物,微针、激光、离子导入和运输载体技术相继被应用于提高氨基酮戊酸的透皮能力,并且取得了一定的效果。它们可通过不同的机制提高氨基酮戊酸透皮的深度和透皮的量,使氨基酮戊酸光动力治疗能更有效地应用于皮肤科领域。     

Photodynamic therapy of actinic keratoses with topical aminolevulinic acid hydrochloride and fluorescent blue light.

BACKGROUND: Aminolevulinic acid hydrochloride (ALA, Levulan) applied topically to actinic keratoses (AKs) leads to accumulation of the photosensitizer protoporphyrin IX, which, when activated by exposure to light, eradicates AKs. OBJECTIVE: We examined the safety and efficacy of photodynamic therapy using topical 20% ALA in a solution formulation and varying blue light doses to treat multiple AKs on the face and scalp. METHOD: This is a multicenter, investigator-blinded, randomized, vehicle-controlled study. RESULTS: Thirty-six patients with clinically typical AKs were treated with 20% ALA; 14 to 18 hours later, they were irradiated with a nonlaser fluorescent blue light source. With the optimal light dose of 10 J/cm(2), 88% of the AKs completely cleared 8 weeks after a single photodynamic treatment, compared with 6% after treatment with vehicle and light. CONCLUSION: Topical ALA PDT using a nonlaser, blue light source is an effective treatment for multiple AKs.     

ALA-PDT治疗囊肿性痤疮22例疗效观察

目的采用随机对照研究评价3%5-氨基酮戊酸光动力疗法(ALA-PDT)治疗囊肿性痤疮的疗效。方法治疗组22例接受1～3次ALA-PDT,对照组17例口服异维A酸胶丸20mg/d。皮损消退>90%或治疗持续6周为研究终点。结果治疗组第2,4,6周囊肿数目较对照组明显减少(P<0.01);治疗组第2,4,6周有效率分别为9.09%,40.91%,100%,而对照组分别为0,11.76%,58.82%,差异有统计学意义(P均<0.05);B超显示ALA-PDT治疗后囊肿较治疗前缩小或消失(P<0.01)。研究结束时,治疗组患者满意度较对照组高(P<0.05);治疗组复发率较对照组明显降低(P<0.05),且首次复发时间较对照组延长(P<0.05)。结论 ALA-PDT能够安全快速治愈囊肿性痤疮,同时延迟复发。     

5-氨基酮戊酸光动力疗法治疗中、重度痤疮临床观察

目的观察5-氨基酮戊酸光动力疗法(ALA-PDT)治疗中、重度痤疮的临床疗效。方法治疗组26例,予ALA-PDT照射20min,1次/周;对照组20例,予蓝光照射20min,1次/周,同时予口服维胺酯胶囊25mg和外擦克林霉素软膏,2次/d。两组疗程均为4周,并于治疗前及治疗第2,4和6周时判定疗效。结果治疗第4周时,治疗组中、重度痤疮患者的有效率(89.47%和71.43%)分别高于对照组(60.00%和0),差异均有统计学意义(P均<0.05);治疗第6周时,治疗组痊愈率(42.31%)和有效率(92.31%)明显优于对照组(10.00%和55.00%)。结论 ALA-PDT是一种安全、高效和不良反应轻微的治疗中、重度痤疮的新方法。