背景:血卟啉单甲醚介导的光动力疗法(HMME-PDT)已成为葡萄酒色斑(PWS)的替代方法,主要用脉冲染料激光(PDL)处理。本研究旨在评价HMME-PDT治疗PWS的有效性和安全性,并探讨影响其疗效的因素。
方法:共纳入254例患者。患者接受5mg/kg的HMME静脉注射。用532-nm的光照射损伤区域20-25分钟。根据病变消退评估疗效,并分级为优秀(≥90%)。良好(60%-89%),公平(20%-59%),或较差(<20%)。记录不良事件。分析临床数据,包括性别,年龄,病变亚型,病变位置和治疗次数。
结果:总体而言,72.4%的患者取得了有效的反应,27.6%的人表现出优异的疗效,24.8%显示良好疗效,20.1%显示相当疗效。只有27.6%的患者表现出较差的疗效。18岁以下的患者获得了比成人更好的疗效。面部病变的治疗效果优于颈部或躯干和四肢。与结节性增厚型相比,粉红色型的反应更有效。多种HMME-PDT治疗可以改善临床反应。病变位置,病变亚型,治疗次数是影响疗效的独立因素。不良事件包括水肿,水泡,地壳,色素沉着减退,色素沉着过度,疼痛,瘙痒和灼烧感。没有观察到严重的系统性副作用。
结论:HMME-PDT治疗PWS有效,患者安全且耐受性良好。更多来自中国不同地区医疗机构的患者的有效性和安全性值得进一步研究。在PWS的临床治疗中,仍在探索最佳治疗参数和治疗方案。
BACKGROUND: Hematoporphyrin monomethyl ether mediated photodynamic therapy (HMME-PDT) has emerged as an alternative approach for port-wine stain (PWS), which was primarily treated with pulsed dye laser (PDL). This study was aimed to evaluate the efficacy and safety of HMME-PDT for PWS and to explore influential factors on the efficacy.
METHODS: A total of 254 patients were enrolled. Patients received an intravenous injection of HMME at 5 mg/kg. Lesion areas were irradiated with 532-nm light for 20-25 min. Efficacy was assessed according to fading of lesions and graded as excellent (≥90 %), good (60 %-89 %), fair (20 %-59 %), or poor (<20 %). Adverse events were recorded. Clinical data were analyzed including gender, age, lesion sub-type, lesion location and number of treatments.
RESULTS: Overall, 72.4 % of patients achieved an effective response, with 27.6% showing excellent efficacy, 24.8 % showing good efficacy and 20.1 % showing fair efficacy. Only 27.6 % showed poor efficacy. Patients under the age of 18 obtained a better efficacy than adults. Lesions in face showed a better therapeutic outcome than those in neck or trunk and extremities. A more effective response was seen in pink type compared with nodular thickening type. Multiple HMME-PDT treatments could improve the clinical response. Lesion location, lesion sub-type, number of treatments were independent influential factors on efficacy. Adverse events included edema, blister, crust, hypopigmentation, hyperpigmentation, pain, itch and burning sensation. No severe systemic side events were observed.
CONCLUSIONS: HMME-PDT was effective for treating PWS and was safe and well-tolerated by patients. It is worth further investigation in efficacy and safety involving more patients from medical institutions in different regions in China. The optimal treatment parameters and treatment protocols are still being explored in the clinical treatment for PWS.