An Observation Of Efficacy Of Photodynamic Therapy With 5-aminolevulinic Acid On Condyloma Acuminatum And An Exploration Of Mechanism Related To Immune Regulation

Objective:This study is intended to comprehensively evaluate the curative effects,safety,adverse reactions,and relapse that might ensue after photodynamic therapy(PDT)with 5-aminolevulinic acid(ALA)as photosensitizer on condyloma acuminatum,(CA)and to investigate the mechanism of local immune regulation.The results are based on the record of clinical curative effects before and after treatment,the check-up of localized lesions on histopathology,immunohistochemistry,human papilloma virus DNA,the comparative analysis of clinical efficacy and immunity of localized lesions and their surrounding,combined with patients' dermatology life quality index before and after treatment.Method: 1.Clinical observation:Visiting our dermatology department to receive PDT on CA during February,2015 through February,2016,with a course of 2 weeks to 3 months,a total of 67 outpatients were selected,49 males and 18 females.They were treated once a week,3 times in a raw for a course of treatment.A comparison was made in clinical efficacy before and after treatment;a record was kept of degree of pain,adverse reactions,patients' satisfaction,and dermatology life quality index.In a comprehensive analysis,the PDT on CA was evaluated.2.Laboratory examination:The skin lesions collected before the treatment and after each of 3 treatments with 5-ALA on CA were closely examined in relation to histopathology,immunohistochemistry,and human papilloma virus DNA so as to observe the changes that occurred to 19 patients in histopathology and Immunohistochemistry respectively,and the changes,to 67 patients with human papilloma virus DNA,and thus to explore the curative effects of PDT with 5-ALA on CA and the mechanism related to immune regulation.Results: 1.Clinical observation:The effective rate of subsided reaction to the skin lesions was as high as 100% in a total of 67 cases of CA;the cure rate,88.06%;the wart clearance rate,96.84%;the total relapse rate,11.86%.High-risk human papilloma virus(HPV)could reduce the efficacy of photodynamic therapy;the difference was statistically significant(P<0.05).Such factors as high-risk HPV,smoking,and drinking could increase the recurrence rate of patients;the difference was statistically significant(P<0.05).After PDT,high-risk HPV infection could be alleviated or eliminated;the difference was also statistically significant(P<0.05).PDT could upgrade the life quality of patients;the difference was statistically significant.2.Laboratory examination:After PDT,73.68% of patients,as histopathology suggested,showed normal skin tissue without vacuolar cells,providing a reliable basis for the clinical efficacy of ALA-PDT in treating CA.As histopathology also suggested,suspicious atypical vacuolated cells were found in 26.32% of patients,giving a hint of follow-up treatment.The immunohistochemical expressions of CD4,CD8,CD4\CD8,CD68,CD-1? were clearly on the rise,but the expression of Ki-67 was clearly on the decrease after PDT.The difference was statistically significant(P<0.05).After the treatment,the intensity of positive reaction was getting low for the expression of Ki-67.The difference was statistically significant(P<0.05).The relapse rate was correlated with greater intensity of positive reaction for the expression of Ki-67(P<0.05),but it had nothing to do with the variation of the expression of Ki-67 before and after the therapy(P>0.05).Further,the relapse was related to the variation of the expression of CD-1? before and after the therapy.Lower variation induced relapse.The difference was statistically significant(P<0.05).Conclusion:The photodynamic therapy(PDT)is a proper way of treating condyloma acuminatum,(CA)for its good curative effects,safety,low relapse rate,and less invasion.In the reaction process of PDT on CA,many immune cells,like CD4 T cells,CD8 T cells,and CD68 macrophage,got involved in the local immune response and regulation.The occurrence and development of CA was correlated with the variation of local immune function.In the PDT on CA,the expressions of Ki-67 and CD-1?also had a close correlation with the relapse.