發(fā)布時間：2018-07-04 10:18

  本文選題：痤瘡 + 光動力療法��； 參考：《中國人民解放軍醫(yī)學院》2015年碩士論文

【摘要】：目的：通過對比光動力療法(photodynamic therapy, PDT)聯(lián)合米諾環(huán)素和單用米諾環(huán)素治療中重度痤瘡的臨床療效及對患者生活質量影響,探討PDT在痤瘡治療中的臨床價值,評價PDT治療痤瘡的安全性及有效性。方法：將門診收集的符合入選條件的78例中重度痤瘡患者隨機分為兩組,PDT聯(lián)合米諾環(huán)素治療組39例,米諾環(huán)素對照組39例。PDT聯(lián)合米諾環(huán)素治療組：配制5%5-氨基酮戊酸(5-aminolevulinic acid,5-ALA)凝膠,涂抹于皮損部位,保鮮膜封閉,避光封包1.5h,用LED光動力治療儀紅光照射全臉,照射劑量(90-100)J/cm2,照光距離10cm,照光20min,每周照光1次,治療4次；同時口服鹽酸米諾環(huán)素膠囊(玫滿),100mg/次,2次/日,口服4周。米諾環(huán)素治療組：口服鹽酸米諾環(huán)素膠囊(玫滿),100mg/次,2次/日,口服4周。所有患者在治療前及開始治療后第2、4、8周應用痤瘡綜合分級系統(tǒng)(Global Acne Grading System, GAGS)和痤瘡特異性生活質量調查表(Acne Quality of Life, Acne-QOL)進行療效觀察和患者生活質量評估。記錄患者治療過程中出現(xiàn)的不良反應。結果：兩組患者年齡、男女比例、病程、GAGS評分和Acne-QOL評分等基線資料均無統(tǒng)計學差異。PDT聯(lián)合米諾環(huán)素治療組患者治療2周、4周及8周時GAGS評分均顯著低于米諾環(huán)素組,差異均有統(tǒng)計學意義(P均0.01)。PDT聯(lián)合米諾環(huán)素治療組患者治療第2、4、8周有效率分別為：29.7%、64.9%和94.6%；治療顯效率分別為：13.5%、40.5%和78.4%；米諾環(huán)素治療組患者治療第2、4、8周有效率分別為：26.3%、57.9%和89.5%；治療顯效率分別為：10.5%、26.3%和55.3%。治療后第2、4、8周PDT聯(lián)合米諾環(huán)素組皮損有效率高于米諾環(huán)素組,但差異無統(tǒng)計學意義(P0.05)；治療后第2、4周兩組皮損顯效率不同,但無統(tǒng)計學差異(P0.05),治療第8周PDT聯(lián)合米諾環(huán)素組皮損顯效率(78.4%)顯著高于米諾環(huán)素組(55.3%),差異有統(tǒng)計學意義。Acne-QOL評分與GAGS評分呈顯著負相關(相關系數(shù)r=-0.741,P0.01),即痤瘡越嚴重,患者生活質量越差。PDT聯(lián)合米諾環(huán)素組患者治療2周后生活質量輕度下降,隨后生活質量顯著提高,治療8周時,PDT聯(lián)合米諾環(huán)素組患者Acne-QOL評分(81.5±18.1)高于米諾環(huán)素治療組(71.7±16.7),差異有統(tǒng)計學意義(P0.01),PDT治療能夠顯著提高患者生活質量。PDT治療痤瘡,不良反應主要表現(xiàn)為紅斑、灼熱、腫痛和瘙癢等,表現(xiàn)程度輕微,患者能夠耐受,PDT治療結束可很快自行消退,無后遺癥狀。結論：PDT聯(lián)合米諾環(huán)素、單用米諾環(huán)素治療中重度痤瘡均有顯著療效。PDT聯(lián)合米諾環(huán)素治療中重度痤瘡無明顯不良反應,患者耐受性好,安全性高；PDT聯(lián)合米諾環(huán)素治療痤瘡療效較單用米諾環(huán)素更好,能顯著提高患者治療顯效率。PDT聯(lián)合米諾環(huán)素治療后患者生活質量有短暫降低,主要與照光后不適反應有關,患者長期生活質量高于單用米諾環(huán)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 鹵18.1) was significantly higher than that in minocycline group (71.7 鹵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.
【學位授予單位】：中國人民解放軍醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R758.733

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本文編號：2095744