| Part I Th1/Th2 cytokines in CD4+T cells in peripheral blood and natural killer in lesions of condyloma acuminatumObjective To investigate the role of Th1/Th2 cytokines in CD4+T cells in peripheral blood and natural killers in lesions in the pathogenesis of condyloma acuminatum. Methods The levels of Th1/Th2 cytokines (IL-2, IL-12 ,and IL-4) in CD4+T cells in peripheral blood of 40 cases of condyloma acuminatum and 20 cases of normal controls were tested by flow cytometry and ICCS. At the same time, the expression of CD4, CD8, CD16, CD57 molecules in condyloma acuminatum leisions and normal prepuce was detected by immunohistochemistry. Results The percentage of IL-2+, IL-12+, IFN-γ+-CD4+T cells in peripheral blood of condyloma acuminatum was significantly lower than that in normal controls (P<0.01). The percentage of Il-4+-CD4+ T cells in peripheral blood of condyloma acuminatum was not significantly higher than that in normal controls. The ratio of Th1/Th2 was remarkedly lower in peripheral blood of the patients with condyloma acunimatum than in the controls. The expression of CD4 and CD8 in lesions of condyloma acunimatum was higher than that in normal controls, but the ratio of CD4/CD8 was lower in condyloma acunimatum. The expression of CD16 and CD57 was significantly lower than that in normal controls. It was suggested that the number of natural killers was less in lesions of condyloma acunimatum than that in controls. Conclusion Th1/Th2 is imbalance in condyloma acuminatum. Th1 type cytokines are inhibited, and Th2 type cytokines are relatively enhanced, so Th1/Th2 shifts to Th2. The shift of Th1 to Th2 and the suppression of cell-mediated immunity may be the pathogens of condyloma acuminata. Part II Fas expression and apoptosis of keratinocyte in condyloma acuminatumObjective To investigate the correlation between keratinocyte Fas expression and apoptosis in condyloma acuminatum. Methods The expression of keratinocyte Fas antigen and apoptosis in 28 ases of CA and 20 normal controls was detected respectively with immunohistochemical staining (SP method) and terminal deoxynucleotidyl transferase-mediated dUTP nick endlabeling. Results The keratinocyte Fas index in CA was significantly higher than that in normal controls, and the keratinocyte apoptosis index in CA was not significantly different from that in normal controls. Conclusion There is Fas over-expression in CA epithelium, which doesn't cause the increase in cell apoptosis. Part III 5-aminolevulinic acid photodynamic therapy for condyloma acuminatumObjective To investigate the effect of photodynamic therapy (PDT) with topical 5-aminolaevulinic acid (ALA) on condylomata acuminata(CA). Methods 60 patients with CA were randomly divided into two groups. One group was treated with 10% ALA solution under occlusive dressing followed by irradiation with He-Ne laser at 100mW. The other group was treated with CO2 laser. Results ALA-PDT achieved completed response in 22 of 30 patients (73.33%) after 1～4 times treatment.In 5 patients (16.67%) complete response was found after one ALA-PDT treatment, 8 patients (26.67%) required two treatments, 6 (20.00%) needed three and 3 (10.00%) needed four treatments before the lesions disappered completely. The complete remission was 30 of 30 (100.00%) for CO2 laser treatment. After 6 months of follow-up, recurrence rate was 23.33% and 63.33% for ALA-PDT and CO2 laser, respectively. No scar formed. Conclusion The cure rate with CO2 laser was higher than that with ALA-PDT. However, the recurrence rate with ALA-PDT was lower than that with CO2 laser and ALA-PDT was much better than CO2 laser on side effects. Compared with conventional therapies, topical ALA-PDT is a simple, effective, safe and well-tolerated treatment for condylomata acuminata that is associated with a low recurrence rate. It is expected that ALA-PDT could be a better therapy methods for CA. |
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