梅花针叩刺增强氨基酮戊酸光动力治疗光线性角化病、基底细胞癌、鳞状细胞癌的研究

目的 探讨梅花针叩刺预处理对氨基酮戊酸光动力（ALA-PDT）治疗光线性角化病、基底细胞癌、鳞状细胞癌的疗效影响，以及梅花针叩刺预处理的安全性。 方法 通过病例对照研究，对6例光线性角化病，3例结节型基底细胞癌，3例原位鳞状细胞癌进行梅花针叩刺 ＋ ALA-PDT治疗，同时选取皮损类型及分期类似的患者仅单纯ALA-PDT治疗作为对照组。 结果 梅花针叩刺 ＋ ALA-PDT治疗组单次治疗对光线性角化病的完全缓解率明显高于单纯ALA-PDT组［1级皮损12/12比10/14，2级皮损79.5%（31/39）比57.9%（22/38），3级皮损36.6%（15/41）比17.0%（7/41），均P ＜ 0.05］。梅花针叩刺 ＋ ALA-PDT治疗组中光线性角化病获得完全缓解所需的治疗次数有所减少，3级皮损平均治疗1.9次获得完全缓解；单纯ALA-PDT组3级皮损平均2.6次获得完全缓解。梅花针叩刺 ＋ ALA-PDT治疗原位皮肤鳞状细胞癌（皮损厚度超过0.3 mm），获得完全缓解治疗次数少于单纯ALA-PDT组。结节型基底细胞癌在增加梅花针叩刺后治疗效果亦增强。梅花针叩刺患者疼痛无明显增加。 结论 梅花针叩刺可增强ALA-PDT治疗光线性角化病，基底细胞癌，鳞状细胞癌的疗效，而不增加不良反应。

Plum-blossom needle tapping enhances the efficacy of aminolevulinic acid-based photodynamic therapy for actinic keratosis,basal cell carcinoma and squamous cell carcinoma

Wang Peiru, Zhang Linglin, Zhou Zhongxia, Wei Minglei, Shi Lei, Ji Jie, Yang Degang, Zhang Guolong, Wang Xiuli. Shanghai Skin Disease Hospital, Shanghai 200443, China Corresponding author: Wang Xiuli, Email: xlwang2001@aliyun.com 【Abstract】 Objective To investigate the effect of plum-blossom needle tapping on the efficacy of aminolevulinic acid-based photodynamic therapy （ALA-PDT） for actinic keratosis, basal cell carcinoma and squamous cell carcinoma, and to evaluate the safety of plum-blossom needle tapping. Methods Twenty-four patients, including 12 patients with actinic keratosis, 6 patients with nodular basal cell carcinoma and 6 patients with squamous cell carcinoma in situ, were enrolled into this study and classified into two groups, i.e., combination group and control group, with the number of patients with actinic keratosis, nodular basal cell carcinoma and squamous cell carcinoma in situ being equal between the two groups. The patients in the combination group were pretreated with plum-blossom needle tapping followed by ALA-PDT, and the control group by ALA-PDT alone. Results The complete remission rate of actinic keratosis after the first session of treatment was significantly higher in the combination group than in the control group （grade 1 lesions, 12/12 vs. 10/14; grade 2 lesions, 79.5% （31/39） vs. 57.9% （22/38）; grade 3 lesions, 36.6% （15/41） vs. 17.0% （7/41）, all P < 0.05）. The number of treatment sessions required for the complete remission of actinic keratosis and squamous cell carcinoma in situ lesions measuring more than 0.3 mm in thickness was significantly reduced in the combination group compared with the control group. On average, 1.9 sessions of treatment were required for the complete remission of grade 3 lesions of actinic keratosis in the combination group, compared to 2.6 sessions in the control group. Plum-blossom needle tapping also enhanced the efficacy of ALA-PDT for nodular basal cell carcinoma. Further more, plum-blossom needle tapping did not aggravate pain in patients during the treatment. Conclusion Plum-blossom needle tapping can enhance the efficacy of ALA-PDT for actinic keratosis, basal cell carcinoma and squamous cell carcinoma, with no increase in adverse reactions.