光动力疗法与脉冲染料激光治疗鲜红斑痣的临床比较

目的 探讨光动力疗法（PDT）和脉冲染料激光（PDL）治疗鲜红斑痣的疗效差异，并比较两种疗法不良反应发生情况。方法 将45例鲜红斑痣患者的自身皮损随机分成PDT治疗区和PDL治疗区。PDT区治疗区在避强光条件下静脉输注5 mg/kg血卟啉注射液，10 min后开始532 nm连续波激光照射，照射20 min后结束，照射功率密度80 ~ 100 mW/cm2，光斑直径7 cm；PDL治疗区采用595 nm脉冲染料激光照射，光斑7 mm，脉冲宽度10 ms，能量密度10 ~ 12 J/cm2。两种治疗之间至少间隔2个月。单次治疗后第4天、8周时随访，记录不良反应，并根据治疗前后临床照片对皮损消退情况进行分析。结果 45例患者PDT治疗区基愈10例（22.22%），显效22例（48.89%），有效9例（20.00%），无效4例（8.89%）；PDL治疗区基愈6例（13.33%），显效16例（35.56%），有效18例（40.00%），无效5例（11.11%），PDT单次治疗的疗效明显优于PDL（Z = 2.48，P < 0.05）。PDT和PDL治疗组不良反应发生率分别为24.44%和15.56%，差异无统计学意义（Z = 1.26，P > 0.05），主要为治疗后色素沉着，3 ～ 6个月内自行消退。结论 PDT、PDL疗法治疗鲜红斑痣有效、安全，PDT单次治疗的疗效明显优于PDL单次治疗。

Clinical comparison between photodynamic therapy and pulsed dye laser for the treatment of port wine stains

Wu Qiuju, Zhou Zhanchao, Lin Tong, Rong Huizhen, Jia Gaorong Hospital of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing 210042, China （the current affiliation of the second author was Zhanchao BeauCare Clinic） Corresponding author: Wu Qiuju, Email: wqj0528@163.com 【Abstract】 Objective To compare the clinical efficacy and adverse effects of photodynamic therapy （PDT） versus pulsed dye laser （PDL） for the treatment of port wine stains （PWS）. Methods Forty?five patients with PWS were enrolled in this study. The PWS lesions in each patient were randomly divided into PDT and PDL areas. Hematoporphyrin monomethyl ether of 5 mg/kg was injected intravenously into the PDT area protected from light, followed by 20?minute irradiation with a 532?nm, solid?state, continuous?wave laser （power density: 80 - 100 mw/cm2; spot diameter: 7 cm） 10 minutes later. The PDL area was treated with a single session of 595?nm pulsed dye laser radiation （spot diameter: 7 mm; pulse width: 10 ms; energy density: 10 - 12 J/cm2）. The interval between PDT and PDL treatment was no shorter than two months. Follow up visits were scheduled on day 4 and week 8 after each treatment. Adverse reactions were recorded, and photographs were taken before and 8 weeks after the treatment for evaluation of lesion regression. Results In the case of PDT area, 10 cases （22.22%） were nearly cured, 22 （48.89%） achieved marked improvement, 9 （20.00%） improvement, 4 （8.89%） no improvement. As far as the PDL area is concerned, 6 cases （13.33%） were nearly cured, 16 （35.56%） achieved marked improvement, 18 （40.00%） improvement, and 5 （11.11%） no improvement. The response rate was significantly higher in the PDT area than in the PDL area （Z = 2.48, P＜0.05）. Hyperpigmentation, which spontaneously subsided within 3 to 6 months, was the main adverse reaction. No significant difference was found in the incidence rate of adverse reactions between the PDL and PDT areas （24.44% vs. 15.56%, Z = 1.26, P > 0.05）. Conclusion For the treatment of PWS, both PDT and PDL are effective and safe, and single?session PDT appears to be superior to single?session PDL.