Effect Of 5-aminolevulinic Acid Photodynamic Therapy Research Articles

Observation of the effect of 5-aminolevulinic acid-photodynamic therapy combined with liquid nitrogen cryotherapy in the treatment of patients with facial stubborn flat warts

目的 观察5-氨基酮戊酸光动力疗法联合液氮冷冻治疗颜面部顽固性扁平疣的临床疗效。 方法 选择运城市中心医院2016年1月至2017年6月收治的符合入组标准的面部顽固性扁平疣患者70例为研究对象，采用随机数字表法分为对照组35例和观察组35例，对照组采用单纯液氮冷冻治疗；观察组先给予5-氨基酮戊酸光动力疗法治疗，随后再进行液氮冷冻治疗。治疗结束后10 d、20 d、30 d进行扁平疣综合临床疗效评估及瘢痕愈合质量评估，记录治疗期间不良反应发生情况，统计随访6个月的复发情况。 结果 观察组治疗后10 d、20 d、30 d的总有效率分别为68.57%、82.86%、91.43%，对照组分别为34.29%、48.57%、65.71%，观察组有效率均明显高于对照组(χ2＝9.010、9.353、8.173，均P<0.05)。观察组治疗后10 d、20 d、30 d瘢痕愈合质量均明显优于对照组(χ2＝58.209、91.369、59.917，均P<0.05)。随访6个月，观察组复发率为5.71%(2/35)，明显低于对照组的22.86%(8/35)，两组差异有统计学意义(χ2＝4.200，P<0.05)。 结论 5-氨基酮戊酸光动力疗法联合液氮冷冻治疗颜面部顽固性扁平疣能够有效提高综合临床疗效及瘢痕愈合质量，降低复发率。

Influence of 5-Aminolevulinic Acid and Red Light on Collagen Metabolism of Human Dermal Fibroblasts

Patients with localized scleroderma receiving topical photodynamic therapy with 5-aminolevulinic acid show a reduction in skin tightness, suggesting that this therapy reduces skin sclerosis. To investigate potential mechanisms, the effects of 5-aminolevulinic acid and light on collagen metabolism were studied in vitro. Normal and scleroderma fibroblasts were treated with sublethal doses of 5-aminolevulinic acid and red light and transferred to three-dimensional collagen lattices. Cell supernatants were taken 6-72 h after photodynamic therapy to determine protein levels of the matrix metalloproteinases 1, 2, and 3, and of their inhibitors, tissue inhibitor of metalloproteinase 1 and 2 by enzyme-linked immunosorbent assay. Cellular mRNA expression of these proteins and of collagen type I and III was measured by quantitative real-time polymerase chain reaction. A significant, time-dependent induction of matrix metalloproteinase 1 (up to 2.4-fold after 48 h) and matrix metalloproteinase 3 (up to 4.3-fold after 48 h) protein levels was seen after 5-aminolevulinic acid-photodynamic therapy. Irradiation with ultraviolet A light, used as a positive control, showed a similar induction of matrix metalloproteinase 1 (2.3-fold after 48 h). The mRNA levels of matrix metalloproteinase 1 and matrix metalloproteinase 3 were significantly increased 12 h after irradiation, whereas collagen type I mRNA was strongly decreased already 6 h following irradiation. Collagen type III, tissue inhibitor of metalloproteinase 1, and matrix metalloproteinase 2 did not change after photodynamic therapy. Addition of nontoxic concentrations of sodium azide, a singlet-oxygen quencher, significantly inhibited induction of matrix metalloproteinase 1 by 5-aminolevulinic acid and light. These data show that 5-aminolevulinic acid and light induce matrix metalloproteinase 1 and matrix metalloproteinase 3 expression in normal and scleroderma fibroblasts in a singlet oxygen-dependent way while reducing collagen type I mRNA expression. Induction of collagen-degrading enzymes together with reduction of collagen production might be responsible for the anti-sclerotic effects of 5-aminolevulinic acid-photodynamic therapy observed in vivo.