| Objective:1.Analyze the results of efficacy between different groups of patients with condyl oma acuminatum in privileged sites.2.To evaluate the ratio of potency between ALA photodynamic therapy and Paiteling to provide a reference for clinical treatment.Objects and methods:Clinical case-control study was used to identify patients with condyloma acuminatum who came to the Shandong Provincial Hospital of Dermatology and Gynecology clinics,combined with clinical symptoms and test results to identify patients that meet clinical diagnostic criteria and divide them into cervical infections and anal warts.In this comparative study,the patients were randomly divided into ALA photodynamic therapy group and Paiteling group,according to the treatment order and their own willingness.1.ObjectsThis study selected 357 patients from the Department of Dermatology and Gynecology at the Shandong Provincial Hospital between March 2015 and November 2017.The diagnosis of the patients was in accordance with the?The standard of ministry of health in condyloma acuminatum diagnosis and management(WS235-2003)?.2.MethodsThe screened patients were randomly divided into two groups,one group was treated with Paiteling and the other was treated with ALA photodynamic therapy.After four to eight courses of treatment,follow-up observations were performed every four weeks to compare efficacy results.If necessary,samples of cervical secretions or interface were taken and HPV DNA was detected again.A followed up of six months for the recovered patients was performed to compare and evaluate the recurrence and the cost-effectiveness of the two treatments.The comparison project included the following aspects:(1)General data analysis(2)Analysis of the two treatment methods(3)Cost-effectiveness(4)Adverse reactions.SPSS21.0 statistical software was used to analyze the research data.Measured data are expressed as mean ± standard deviation(x±s),using the t test;count data expressed as a rate(%),using x2 test.P<0.05 indicates that the difference was statistically significant.Results:Through comparative analysis of the two treatment methods,the following conclusions were drawn:(1)There were 357 patients,the oldest being 65 years old and the youngest being 19 years old;165 males and 192 females;the longest duration was fifteen months,and the shortest was one week.Both groups are comparable in terms of age,gender and course of illness.(2)Of the 207 patients in the Paiteling treatment group,there were 57 patients with cervical dominant warts,40 with high-risk positive patients,10 patients with CINI??and 100 patients with anal warts.As for 150 patients in the photodynamic therapy group,52 with cervical dominant warts,30 with high-risk positivity,5 with CINI??and 68 with genital warts in the anal area.(3)Ten anal wart patients with HIV positive in the Paiteling treatment group and ten cervical wart patients with immune system diseases in the ALA photodynamic therapy group were additionally observed in our research.(4)In the eighth week,the cured rate in Paiteling group was 92.8%(192/207)and the effective rate was 96.1%(199/207);the cured rate in ALA photodynamic therapy group was 78%(117/150),the effective rate is 90%(135/150).The total recovered rate of the two groups was compared with x2=16.268,P<0.01.The Short-term efficacy of Paiteling was significantly better than that of ALA photodynamic therapy.(5)The recovered patients after six months showed that 43 cases of cumulative recurrences occurred in the Paiteling group with recurrence rate 22.4%.The cumulative number of relapse cases in the ALA photodynamic therapy group was 12 with the recurrence rate 10.2%.The total recurrence rate of the two groups was compared with x2=7.322,P<0.01.ALA photodynamic therapy is better than Paitiling in preventing recurrence.(6)The average time of each treatment in the Paiteling group was 3.85± 1.66 hours,and the average of ALA photodynamic therapy group was 4.72±0.65 hours.The average course of treatment for Paiteling group was 37.34±5.82 days,and the average course in the ALA PDT group was 46.93±7.73 days.The average cost in Paiteling group was 1,050.47±1,734.62 dollars;the ALA photodynamic therapy group was 21230±4247.16 dollars.Paiteling group were superior to ALA photodynamic therapy group in terms of time,course of treatment and cost(P<0.01).(7)The ratio of potency in the Paiteling group was 0.984;the ratio of potency in the ALA PDT group was 0.449.The difference between the two groups was statistically significant(P<0.05).The ratio of potency in the Paiteling group was significantly higher than that of the ALA photodynamic therapy.(8)The incidence of adverse reactions was 22.22%(46/207)in the Paiteling group;the incidence of adverse reactions in the ALA PDT group was 16.0%(16/150).There was no statistical difference in the incidence of adverse reactions between the two groups.Conclusions:ALA photodynamic therapy and Paiteling both have a significant efficacy in treatment of genital warts in cervix and anus area.ALA photodynamic therapy and Paiteling are effective in the treatment and prevent recurrence of subclinical and latent cervical infections and also patients with immune system diseases.For patients with certain requirements in terms of efficacy and economic costs,it is recommended that Paiteling can be used to remove surface warts first then followed up by ALA photodynamic therapy to effectively prevent recurrence.The two treatments in this study have the advantage of high selectivity,low recurrence,safe and harmless,noninvasive scar and repeatable.They can be used as alternatives to traditional therapies in patients with immune system diseases and worthy of clinical application. |
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