摘要
背景:增生性瘢痕因成纤维细胞增殖、生长失控、胶原过度沉积导致真皮纤维化,光动力疗法和咪喹莫特均可以抑制纤维增生,同时咪喹莫特还可以通过激活免疫应答系统增加细胞凋亡,降低纤维细胞增殖活性。目的:观察咪喹莫特联合光动力疗法对增生性瘢痕免疫应答与预后的影响。方法:选择石家庄市人民医院于2017年12月至2020年3月收治的增生性瘢痕患者110例,随机分为2组,每组55例;对照组患者给予光动力疗法(隔10 d治疗一次,连续4次),观察组在对照组的基础上外用咪喹莫特乳膏(1次/d,连续3个月)。治疗结束后第2天采用温哥华瘢痕量表对瘢痕的变化进行评价;评估两组的患者临床疗效;分别于治疗前、治疗后(治疗结束后第2天)采用酶联免疫吸附法测定两组患者血清中γ-干扰素、肿瘤坏死因子α、白细胞介素2和白细胞介素6水平;采用免疫比浊法测定两组患者血清中IgA、IgG和IgM水平;并记录不良反应发生情况。结果与结论:①治疗前,两组患者瘢痕的柔软度、厚度、血管分布和色泽评分组间比较差异均无显著性意义(P>0.05);治疗后,研究组和对照组瘢痕的柔软度、厚度、血管分布和色泽评分均较治疗前显著降低,且研究组上述评分显著低于对照组(P<0.001);②治疗后,研究组患者临床治疗有效率为96%,显著高于对照组的78%(P<0.05);③治疗前,两组患者血清中γ-干扰素、肿瘤坏死因子α、白细胞介素2和白细胞介素6水平组间比较差异无显著性意义(P>0.05);治疗后,研究组和对照组血清中γ-干扰素、肿瘤坏死因子α、白细胞介素2和白细胞介素6水平均较治疗前显著降低,且研究组上述参数水平显著低于对照组(P<0.001);④治疗前,两组患者血清中IgA、IgG和IgM水平比较差异无显著性意义(P>0.05);治疗后,研究组和对照组患者血清中IgA、IgG和IgM水平均较治疗前显著增加,且研究组患者血清中IgA、IgG和IgM水平显著高于对照组(P<0.05);⑤对照组患者总不良反应发生率为13%,显著高于研究组的2%(P<0.05);⑥提示咪喹莫特联合光动力疗法治疗增生性瘢痕效果良好,可以显著减轻患者炎性反应,提高免疫功能,且不良反应较少。
BACKGROUND:Hyperplasia scar is caused by dermal fibrosis due to fibroblast proliferation,uncontrolled growth and excessive collagen deposition.Both photodynamic therapy and imiquimod can inhibit fibroplasia.Imiquimod can further increase cell apoptosis and reduce the proliferation activity of fibroblasts by activating the immune response system.OBJECTIVE:To study the effect of imiquimod combined with photodynamic therapy on the immune response and prognosis of patients with hypertrophic scars.METHODS:A total of 110 patients with hypertrophic scars admitted to Shijiazhuang People’s Hospital from December 2017 to March 2020 were enrolled and randomly divided into a control group and a study group,with 55 patients in each group.Patients in the control group were given photodynamic therapy(every 10 days,four times in total)and those in the study group were treated with imiquimod cream(once a day for continuous 3 months)based on photodynamic therapy.The Vancouver Scar Scale was used to evaluate scar changes on day 2 after treatment.Clinical efficacy was evaluated and compared between the two groups of patients.The serum levels of interferon-γ,tumor necrosis factor-α,interleukin-2 and interleukin-6 were determined by enzyme-linked immunosorbent assay before and after treatment.The immunoturbidimetric method was used to determine the serum levels of IgA,IgG,and IgM in the two groups of patients.The occurrence of adverse reactions was recorded in the two groups.RESULTS AND CONCLUSION:(1)Before treatment,there was no significant difference in softness,thickness,blood vessel distribution,and color score between the two groups(P>0.05).After treatment,the softness,thickness,blood vessel distribution and color scores of the two groups were significantly reduced,and the above-mentioned scores in the study group were significantly lower than those in the control group(P<0.001).(2)The clinical response rate of the study group was 96%,which was significantly higher than that of the control group(78%;P<0.05).(3)Before treatment,there were no significant differences in the serum levels of interferon-γ,tumor necrosis factor-α,interleukin-2 and interleukin-6 between the two groups(P>0.05).After treatment,the serum levels of interferon-γ,tumor necrosis factor-α,interleukin-2 and interleukin-6 were significantly reduced in the two groups,and the levels of the above-mentioned indicators in the study group were significantly lower than those in the control group(P<0.001).(4)Before treatment,there was no significant difference in serum IgA,IgG and IgM levels between the two groups(P>0.05).After treatment,the serum levels of IgA,IgG and IgM increased significantly in the two groups,and the serum levels of IgA,IgG and IgM in the study group were significantly higher than those in the control group(P<0.05).(5)The total adverse reaction rate in the control group was 13%,which was significantly higher than that of the study group(2%;P<0.05).(6)To conclude,imiquimod combined with photodynamic therapy has a good effect in the treatment of hypertrophic scars,which can significantly reduce inflammatory responses,improve immune function,and have fewer adverse reactions in such patients.
作者
卢会秀
曹海育
娄丹
李建英
刘宏远
孙静
Lu Huixiu;Cao Haiyu;Lou Dan;Li Jianying;Liu Hongyuan;Sun Jing(Shijiazhuang People’s Hospital,Shijiazhuang 050000,Hebei Province,China)
出处
《中国组织工程研究》
CAS
北大核心
2023年第5期690-694,共5页
Chinese Journal of Tissue Engineering Research
基金
河北省医学科学研究课题计划项目(20191464),项目负责人:卢会秀。
关键词
咪喹莫特
光动力疗法
增生性瘢痕
炎性反应
免疫功能
免疫应答
imiquimod
photodynamic therapy
hypertrophic scar
inflammatory response
immune function
immune response
