本文選題：疣 + 化學(xué)療法��； 參考：《揚(yáng)州大學(xué)》2014年碩士論文

【摘要】：背景病毒疣是臨床上常見的一種良性白限性疾病。疣是表皮感染人乳頭瘤病毒(HPV)而導(dǎo)致細(xì)胞增殖和增厚,形成丘疹樣突起。人體的任何部位都可以感染,但最常見的是手足部的感染,生殖器的感染也越來(lái)越常見,但本研究著重于非生殖器疣的治療。目前關(guān)于病毒疣的可靠流行病學(xué)數(shù)據(jù)較少,但統(tǒng)計(jì)不同年齡,不同人群和時(shí)間,發(fā)現(xiàn)最高發(fā)病率是兒童和青年,分別為0.84%和12.9%。疣是由HPV感染引起的,但HPV的分型有70多種。外傷或者皮膚破損是最常見的感染方式。在免疫正常的人群中,非生殖器疣對(duì)健康的影響不大,一般在數(shù)月到數(shù)年內(nèi)消退。這種變化和很多因素有關(guān),包括宿主的免疫力,年齡,HPV類型和大小部位等。研究表明,65%的疣在2年內(nèi)自然消退。 目的系統(tǒng)評(píng)價(jià)局部治療非生殖器疣的臨床療效及安全性 方法計(jì)算機(jī)檢索Cochorane Library、Pubmed、Medline.Springlink、EMbase、CNKI、CBM、VIP等數(shù)據(jù)庫(kù),檢索的最近日期至2013年12月。收集所有局部治療非生殖器疣的臨床隨機(jī)對(duì)照試驗(yàn)(RCT),對(duì)其進(jìn)行系統(tǒng)評(píng)價(jià)。 結(jié)果最終102篇中英文文獻(xiàn)納入標(biāo)準(zhǔn)。①水楊酸或5-FU及其制劑、博來(lái)霉素、激光、干擾素、二硝基氯苯、溫?zé)岑煼�、ALA-PDT在局部治療疣時(shí),其效果明顯優(yōu)于安慰劑。②液氮冷凍治療疣的療效優(yōu)于水楊酸及其制劑(RR=0.90,95%CI0.78to1.03),但其療效次于激光治療(RR=1.28,95%CI1.20to1.36)。③液氮冷凍治療疣時(shí)間隔2周一次的療效優(yōu)于間隔3周(](RR=1.14,95%CI1.04to1.26),冷凍深的治療療效優(yōu)于溫和的治療(RR=1.54,95%CI1.26to1.87)。但冷凍療效次于局部二硝基氯苯、博來(lái)霉素、80%苯酚、DCP等治療。④ALA-PDT治療尋常疣的療效優(yōu)于常規(guī)治療如微波、冷凍、激光等(RR=1.23,95%CI1.12to1.36),且不良反應(yīng)較(RR=0.43,95%CI0.26to0.71)。⑤不同濃度的博來(lái)霉素、5-氟尿嘧啶局部治療治愈率無(wú)明顯差異,但5-氟尿嘧啶的聯(lián)合治療療效優(yōu)于單獨(dú)的治療。⑥膠帶療法、咪喹莫特和維甲酸類藥物的聯(lián)合治療療效優(yōu)于其單獨(dú)治療。⑦激光較冷凍治療療效好,不良反應(yīng)、(RR=0.23,95%CI0.11to0.46)。激光聯(lián)合其他治療療效優(yōu)于單獨(dú)激光治療,且不同激光(C02激光和Q激光)治愈率無(wú)明顯差異。 結(jié)論局部外用水楊酸或5-FU及其制劑、博來(lái)霉素、二硝基氯苯、干擾素、溫?zé)岑煼�、咪喹莫特、維甲酸等是安全有效的療法。冷凍治療的療效與具體的治療方式如冷凍的時(shí)間、冷凍的深度、冷凍的間隔時(shí)間等有關(guān)。激光和ALA-PDT療法治療非生殖器疣疣治愈率高復(fù)發(fā)率低,局部不良反應(yīng)輕微,患者依從性較好,是較安全高效的治療方法。多種治療方式的聯(lián)合治療療效優(yōu)于單獨(dú)治療。
[Abstract]:Background virus verruca is a common benign leukoconstriction disease. Verruca is an epidermal infection of human papillomavirus (HPV), resulting in cell proliferation and thickening, forming papular processes. Any part of the human body can be infected, but the most common infection is the hand and foot, genital infection is also more and more common, but this study focuses on the treatment of non-genital warts. At present, there are few reliable epidemiological data about virus warts, but according to different age, different population and time, the highest incidence is children and young people (0.84% and 12.9%, respectively). Warts are caused by HPV infection, but there are more than 70 types of HPV. Trauma or skin damage is the most common form of infection. Non-genital warts have little effect on health in the immune population and usually fade within months to years. This change is related to a number of factors, including host immunity, type and size of HPV. Studies have shown that 65% of warts naturally recede within 2 years. Objective to evaluate the clinical efficacy and safety of local treatment of non-genital warts Methods Cochorane Library Pubmedus Medline.Spring Linkage EMbase (CNKI) CBM VIP and other databases were searched by computer, and the most recent date of retrieval was until December, 2013. All clinical randomized controlled trials of local treatment of non-genital verruca were collected and evaluated systematically. Results Standard .1 salicylic acid or 5-FU and its preparation, bleomycin, laser, interferon, dinitrochlorobenzene, thermotherapy and ALA-PDT were included in the local treatment of verruca. The therapeutic effect of liquid nitrogen cryotherapy was better than that of salicylic acid and its preparation RRN 0.90 ~ 95CI0.78to1.03C, but the curative effect was better than that of laser treatment of verruca (RRN 1.2895CI1.20to1.36.3) every 2 weeks (] RRN 1.1495CI1.04to1.26m. The curative effect of deep treatment was better than that of mild treatment. However, the therapeutic effect of cryotherapy is inferior to that of local dinitrochlorobenzene, bleomycin 80% phenol and DCP in treating verruca vulgaris. 4ALA-PDT is superior to conventional therapy such as microwave, cryopreservation, etc. There was no significant difference in the cure rate of local treatment with different concentrations of bleomycin 5-fluorouracil, but the curative effect of combined treatment of 5-fluorouracil was better than that of the treatment of 6 tape alone, and the adverse reaction was higher than that of RRX 0.43 to 0.71. 5 in local treatment of bleomycin 5-fluorouracil, but the curative effect of 5-fluorouracil was better than that of RRX 0.43 to 0.71%, but the curative effect of combined therapy of 5-fluorouracil was better than that of treatment with adhesive tape alone. The therapeutic effect of Imiquimod combined with retinoic acid was better than that of laser alone, and the adverse reaction was 0.2395 CI 0.11 to 0.46%. The curative effect of laser combined with other laser therapy was better than that of single laser therapy, and there was no significant difference in cure rate between different laser CO 2 laser and Q laser. Conclusion topical use of salicylic acid or 5-FU and its preparations, bleomycin, dinitrochlorobenzene, interferon, thermotherapy, imiquimod and retinoic acid are safe and effective therapies. The curative effect of cryotherapy is related to the time of freezing, depth of freezing, interval of freezing and so on. Laser and ALA-PDT therapy is a safe and effective method for the treatment of non-genital warts. The cure rate is high, the recurrence rate is low, the local adverse reaction is slight, and the compliance of patients is good. The combined treatment of multiple treatments is better than that of single treatment.
【學(xué)位授予單位】：揚(yáng)州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R752.5

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