[摘要]目的：評价火针联合艾拉光动力治疗难治性痤疮的临床疗效。方法：选择2017年5月-2019年1月笔者医院就诊的难治性痤疮患者，共300例，采用随机数字法分为三组，即对照组、火针组和联合组，每组100例。对照组：采用口服抗生素和异维A酸治疗;火针组：采用火针治疗，1周1次;联合组：采用火针联合艾拉光动力治疗。疗程均为4周。采用中医证候积分定量评估病情严重程度、治疗前后积分变化以及临床疗效和并发症，疗程结束后继续随访4周，比较复发率。结果：三组治疗后中医症候积分均较前降低，且联合组积分绝对值显著低于火针组，对照组最高，而降低百分比显著高于火针组，对照组最低（P<0.05）。疗程结束后，联合组总有效率显著高于火针组，对照组最低（P<0.05）。联合组和火针组均未出现严重不良反应，均能坚持完成规定疗程。随访发现，联合组复发率显著低于火针组，对照组最高（P<0.05）。结论：针对难治性痤疮患者可选择火针联合艾拉光动力治疗，能够显著改善临床症状，提高临床疗效，降低复发率，同时不增加不良反应，有较好的安全性。

[关键词]火针;艾拉光动力;难治性痤疮;中医症候积分;并发症;复发率

[中图分类号]R758.73+3    [文献标志码]A     [文章编号]1008-6455（2020）01-0145-03

Fire Needle Combined with 5-Aminolevulinicacid Photodynamic Therapy for Acne

WANG  Wen-juan

（Department of Dermatology，the First People's Hospital of Chenzhou City， Chenzhou 423000， Hunan， China）

Abstract： Objective  The study aimed to evaluate clinical effect of fire needle combined with 5-aminolevulinicacid photodynamic therapy（5-ALA-PDT） for refractory acne patients. Methods  A total of 300 patients with refractory acne from May 2017 to January 2019 were enrolled and divided randomly into three groups，they were control group，fire needle group and combined group（fire needle combined with 5-ALA-PDT），each of 100 cases，they in control group got oral antibiotics and isotretinoin，the course was four weeks.Then we compared severity of disease，TCM syndrome score before and after treatment，clinical efficacy and complications，the recurrence rate 4 weeks after the end of treatment course. Results  The TCM syndrome scores in the three groups after treatment were all lower than before，and the integral absolute value in combined group was significantly less than fire needle group，control group the most，whats more，the percentage of reduction in combined group was more than  fire needle group，control group the least（P<0.05）. Furtherly，the total effective rate in combined group after course was more higher than fire needle group，control group the lowest（P<0.05）.There were no serious adverse reactions in combined group and fire needle group，the prescribed course of treatment could be completed.The recurrence rate after follow-up in combined group was less than fire needle group，control group the most（P<0.05）. Conclusion  For patients with refractory acne， fire needle combined with 5-ALA-PDT can significantly relieve clinical symptoms，improve clinical efficacy and reduce recurrence rate， while not increasing adverse reactions， with better safety.

Key words： fire needle;5-aminolevulinicacid photodynamic therapy;refractory acne;TCM syndrome score;complication;

recurrence rate

痤疮中医又称“粉刺”、“面疮”，主要发生于青少年和中年群体[1]。好发于颜面部和颈背部，严重者可形成瘢痕，治疗效果较差，影响美容[2]。西醫治疗推荐口服抗生素和异维A酸，临床观察总有效率为30%～70%[3]。中医治法有火针、中药内服及外敷等，火针治疗痤疮的历史较长，主要发挥以热治热，促进气血运行，排脓扶正之功效，操作简便、取材简单、费用低廉、可重复操作、创伤小、安全性高及效果明确[4]。艾拉光动力疗法在肿瘤、疣、血管瘤及痣等多种疾病中发挥较好的疗效[5-6]，具有高效、低毒及绿色的优点[7]。难治性痤疮患者往往具有病程长、病情复杂、治疗方式多样、效果差及易反复等特点，该研究主要选择难治性痤疮患者，采用火针联合艾拉光动力治疗并观察临床效果，现将结果报道如下。……