| Background and ObjectivesCondyloma (condyloma acuminatum. CA) is a common sexually transmitted diseases (sexually transmitted disease, STD)which is caused by a human papilloma virus (HPV).The data of epidemiological infection indicate that CA is the second sexually transmitted diseases, and have an increasing trend. in some cases, CA may turned into cancer, So it is importance to deal with this diseases. The traditional treatment:freezing,laser,electrocautery and applied externally cytotoxic drugs have some effect but various methods of treatment have side effects and higher recurrence rate,on account of the lack of tissue specificity and failure to remove the sub-clinical infection.5-ALA-PDT is increasingly applied in recent years and have a wide range, A research have proved that the lesions caused by HPV select to absorb ALA.It shows that the treatment has cleared not only the role of CA wart, but also latent lesions.In this study we will observe the distinct an external 5-ALA-PDT with traditional cryotherapy treatment to condyloma acuminatum and have a dynamic observation of 5-ALA-PDT treatment to local reactions.we will want to provide valuable clinical information for a better future application of 5-ALA-PDT treatment to condylomata acuminate.The occurrence and development of CA have some relation with the patient's immune function and proliferation abnormalities condyloma.The study indicate that the specific immune is mainly cellular immunity in the body of the CA, Langerhans cells (LC), is an important antigen presenting cells (antigen presenting cell, APC), the skin is the only antibody which binded with the CD-la cells; Ki-67 is associated with cell cycle proliferation cell nuclear protein and can more accurately reflect the cell proliferation activity.In this study,we will detect the expression of Ki-67, CD-la protein in CA, to study their roles in the occurrence and development of CA; Observing the clinical effect of 5-ALA-PDT combined with cryotherapy on treating in the patients of CA;analysis the effect of Ki-67, CD-1a in the clinical efficacy of 5-ALA-PDT for CA, suggesting the role of two indicators in the CAMethods1,A total of 108 patiens with CA were colleced in dermatology department of the Second Hospital of Shandong University from January 2007 to December 2008 the patiens were randomly divided into two groups:A (78 cases), B (30 cases).20 cases of normal foreskin as control group.2,Group A were treated with 5-ALA-PDT(XD-635AB-based photodynamic laser treatment instrument,10% ALA solution, group B were received cryotherapy treatment, the patients were followed up 7 to 10 days time once time and were treated for 3 times.3,The expression of Ki-67, CD-la was detected by immunohistochemical method and contrast the expression in 20 normal foreskin.4,We detailly recorded the clinical datas of each patient by questionnaire.Every patient was asked to regularly return visit and closely observe the changes in patients's lesion.After treatment, we followed up all patients by telephone5,All datas were analyzed by using the statistical sofeware(SPSS13.0).Results1,With 5-ALA-PDT therapy for 3 times of Group A,61(78.2%) cases were cured.For the first time,16(20.51%) cases were cured; the second time,28(35.9%) cases were cured; the last time,17(21.79%) cases were cured.15 cases recrudesced and the recurrence rate was19.23%. the patients relapsed were treated by 5-ALA-PDT and ultimatly cured. Group B were treated by cryotherapy for 3 times, 16(53.3%) cases were recoverd, For the first time,3 (10%) cases were cured, the second time,5 (16.6%)cases were cured, the last time,8 (26.67%) cases were cured,12(40%) patients relapsed. Difference between the two groups has statistically significant (P<0.05).2,28 (35.9%)cases in group A had low expression in Ki-67and 50 cases (64.1%) had high expression; 13(65%) cases in normal foreskin tissue had low expression in Ki-67 and 7 (35%)cases are high expression in Ki-67, The high expression in Ki-67 of two groups has significant differences (P<0.05); 45(57.7%) cases in group A are low expression in CD-la and 33 (42.3%)cases are high expression in CD-la, normal foreskin tissues with low expression of CD-la are 6 (30%) cases and14(70%) cases are high expression in CD-la, the low expression in CD-la has significantly different (P<0.05).3,With low expression in Ki-67 of group A who are treated by 5-ALA-PDT,26 (92.86%)cases are cured,2 (7.14%)cases recurrensed, With high expression in Ki-67,35 (70%) cases are cured,13 (26%)patients are relapsed, the cure rate between the two was significant difference (P<0.05); With low expression in CD-la,31 (68.89%)cases were cured,13 (28.89%)patients were recurrent, With high expression in CD-la,30 (90.91%) cases cured,2 (6.06%)cases were recurrent, the cure rate between the two was significant difference (P<0.05)Conclusions1,5-ALA-PDT for CA in comparison with traditional cryotherapy has higher cure rate and lower recurrence. It is a selective, trauma, effect approach.2,Compared to foreskin tissue, The expression of Ki-67 in CA is higher and the expression of CD-la is lower,which shows that the two indexs may have some relevance. with the occurrence and development of CA.3,The expression of Ki-67,CD-la proteins may be related to 5-ALA-PDT in the threatment of CA. |
PDF Full Text Request