Observation On The Curative Effect Of Aminolevulinic Acid-photodynamic Therapy Combined With Imiquimod Cream In The Treatment Of Condyloma Acuminatum

Genital warts(condyloma acuminate,CA)is a common sexually transmitted d isease(STD),also called genital warts,which has characteristics of strong infectivi ty,high incidence and high recurrence rate.Its clinical manifestations are mainly verrucous hyperplasia such as chicken crown and cauliflower on genital skin or m ucosal surface.The pathogen of CA is human papilloma virus(HPV).Currently,more than 200 genotypes of HPV have been found.According to the carcinogenic risk,they are classified as high risk HPV(HR HPV)and low risk HPV(LR-HP V).Long-term existence of HR HPV infection may lead to cancer,while the LRHPV infection can produce warts,45 of which are related to perianal and genital warts.There are many treatment methods for CA,including carbon dioxide laser t reatment,liquid nitrogen freezing and microwave therapy,which have good remov al effect for visible warts.Whoever there are disadvantages such as poor cleanran ce effect for HPV subclinical infection and latent infection.So the recurrence rate of traditional treatment is higher.Amino ketones pentanoic acid photodynamic the rapy(ALA-PDT)is also called ALA photodynamic therapy.As a kind of external use photosensitizer combined with laser irradiation at 630 nm,it can selectively destroy the hypertrophic active or abnormal hyperplasia lesions,and clear the subc linical and latent infection of HPV.Therefore,it can reduce the recurrence rate.H owever,the cost of photodynamic therapy is relatively expensive,and some patients are not able to afford the cost of multiple treatments.Therefore,in order to re duce the economic burden of patients,we used ALA-PDT combined with the topi cal treatment of imiquimod cream to treat subclinical and latent infection.We obs erved the recurrence rate of CA and HPV clearance rate of different photodynami c treatment times combined with imiquimod cream topical treatment,and provided a reasonable treatment scheme for clinical treatment of CA.Objective:To observe the effect of different times of ALA-PDT combined with imiquim od cream in the treatment of CA.To evaluate the clinical efficacy of ALA-PDT c ombined with imiquimod cream in the treatment of CA by observing the recurrenc e rate of CA,the clearance rate of LR-HPV and the clearance rate of HR-HPV a fter treatment.To analyzed the high risk factors related to CA recurrence by evalu ating the related factors of CA recurrence.Methods:Patients with CA who attended the STD clinic of the First Affiliated Hospital of Dalian Medical University from October 2017 to June 2018 participated in thi s study.After removing visible warts through liquid nitrogen frozen therapy,CA p atients were randomly divided into 3 groups: 3 times of ALA-PDT combined wit h topical imiquimod cream,1 time of ALA-PDT combined with topical imiquimo d cream and only topical imiquimod cream.The recurrence was observed in 1,2,3 and 6 months after treatment.HPV typing detection was performed before treat ment and after the last treatment.The number of patients whose detection of HPV turned negative was recorded and the clearance rates of LR-HPV and HR-HPV were calculated.And seven factors related to the recurrence of CA,including sex,age,duration of disease,HPV genotype,location of warts,number of warts,hist ory of recurrence or reinfection,were collected for statistical analysis.Results:1.There was no statistically significant difference in the recurrence rate amon g the 3 treatment groups: 3 times of ALA-PDT combined with imiquimod cream,1 time ALA-PDT combined with imiquimod cream and imiquimod cream(P=0.282).2.There was no statistically significant difference in HPV clearance rate amo ng the 3 treatment groups: 3 times of ALA-PDT combined with imiquimod crea m),1 time of ALA-PDT combined with imiquimod cream and imiquimod cream(P=1.000).3.The HR-HPV clearance rate of 3 times of ALA-PDT combined with imiqu imod cream was higher than that of 1 time of ALA-PDT combined with imiquim od cream,and the difference was statistically significant(P=0.014).The HR-HPV clearance rate of 3 times of ALA-PDT combined with imiquimod cream was high er than that of imiquimod cream,and the difference was statistically significant(P=0.038).There was no statistically significant difference in HR-HPV clearance rate between the two groups: 1 time of ALA-PDT combined with imiquimod cream a nd only imiquimod cream(P=0.698).4.Female(OR=3.762,P=0.003),special wart site(OR=1.340,P=0.000)and p revious CA history(OR=9.248,P=0.044)were risk factors for CA recurrence,with statistical significance.Conclusion:1.The treatment regimen of 3 times of ALA-PDT combined with imiquimod cream can reduce the recurrence rate and improve the HR-HPV clearance rate in CA patients with HR-HPV/LR-HPV co-infection,which is an effective treatment re gimen.2.CA patients with single LR-HPV infection can choose 1 time of ALA-PDT combined with imiquimod cream or only imiquimod cream as an alternative tre atment.There is no statistical difference in the recurrence rate and HPV clearance rate between the above-mentioned treatments and the treatment of 3 times of AL A-PDT combined with imiquimod cream.3.The risk factors of CA recurrence are female,specific wart site and previo us CA history.Therefore,the female patients with previous CA history who had warts located in special sites are the high-risk group of CA recurrence.