夏卉 赵莉

[摘要]目的：探讨异维A酸联合光动力治疗（Photodynamic therapy，PDT）重度痤疮的临床效果。方法：选取2017年2月-2019年4月笔者医院皮肤科收治的80例重度痤疮患者，随机分为对照组和研究组，每组40例，其中对照组采用光动力疗法，研究组在对照组基础上采用异维A酸进行治疗，两组均治疗4周，随访3个月，比较两组治疗后3个月的临床疗效;对比两组治疗前、治疗后3个月的皮损情况、痤疮综合分级系统（Global acne grading system，GAGS）评分及血清白细胞介素-17（Interleukin-17，IL-17）、白细胞介素-18（Interleukin-18，IL-18）、γ-干扰素（Interferon-γ，IFN-γ）水平;统计两组随访期间的不良反应发生率。结果：研究组痊愈率52.50%，高于对照组的30.00%（P<0.05）;与治疗前比较，治疗后3个月，两组皮损数量和GAGS评分均下降，且研究组均低于对照组（P<0.05）;两组血清IL-17、IL-18水平均下降，且研究组血清IL-17、IL-18水平均低于對照组（P<0.05），两组血清IFN-γ水平均升高，且研究组血清IFN-γ水平高于对照组（P<0.05）;研究组发生皮肤干燥和色素沉着的比例分别为60.00%、5.00%，均低于对照组的82.50%、22.50%（P<0.05）。结论：异维A酸联合光动力治疗重度痤疮患者疗效确切，能够明显改善患者痤疮症状，降低血清IL-17、IL-18水平，减轻炎症反应并降低患者不良反应发生率。

[关键词]异维A酸;光动力疗法;重度痤疮;白细胞介素;干扰素

[中图分类号]R758.73+3    [文献标志码]A    [文章编号]1008-6455（2021）05-0086-04

Analysis of Clinical Effect of Oral Isotretinoin Combined with Photodynamic Therapy on Severe Acne Patients

XIA Hui，ZHAO Li

（Department of Dermatology and Venereology，Drum Tower Hospital Affiliated to Nanjing University School of Medicine，Nanjing 210008，Jiangsu，China）

Abstract：Objective  To observe the clinical effect of oral isotretinoin combined with photodynamic therapy on severe acne patients. Methods 80 patients with severe acne admitted to our dermatology department from February 2017 to April 2019 were selected and randomly divided into the control group and the study group， each with 40 cases. The control group used photodynamic therapy， and the study group was in the control group. Based on the treatment， isotretinoin was used for treatment. Both groups were treated for 4 weeks and followed up for 3 months. The clinical efficacy in the two groups after 3 months of treatment was compared; the skin lesions before and after treatment 3 months， the global acne grading system （GAGS） score and the serum interleukin-17 （Interleukin-17， IL-17）， Interleukin-18 （Interleukin-18， IL-18）， γ-interferon （Interferon-γ， IFN-γ） levels were compared.The incidence of adverse reactions during the follow-up of the two groups were counted. Results The cure rate in the study group was 52.50%， higher than the control group （30.00%， P<0.05）. Compared with before treatment， After treatment 3 mouths， the skin lesions and the scores of GAGS in the two groups were decreased， and the study group were lower than the control group （P<0.05）. The levels of serum IL-17， IL-18 decreased in both groups， and the levels of serum IL-17， IL-18 in the study group were lower the control group （P<0.05）， the level of serum IFN-γ increased in both groups， and the level of serum IFN-γ in the study group was higher than the control group （P<0.05）. The proportion of skin dryness and pigmentation in the study group were 60.00%， 5.00%， lower than those in the control group （82.50%， 22.50%） （P<0.05）. Conclusion  Isotretinoin combined with photodynamic therapy for severe acne has a definite curative effect， which can obviously improve the symptoms of acne， reduce the levels of IL-17 and IL-18， reduce the inflammatory response and reduce the incidence of adverse reactions.

Key words： isotretinoin; photodynamic therapy; severe acne; interleukin; interferon

痤疮是临床上常见的一种慢性炎症性皮肤病，好发于青少年，其临床特征主要表现为面部粉刺、丘疹、脓疱及结节等多形性皮损[1-2]，严重影响患者的外观形象及身心健康。轻度患者往往在青春期自行痊愈，对于中重度患者临床上常采用内外用疗法、物理疗法等[3]。研究发现[4]，光动力疗法作为一种物理疗法，在临床上用于治疗重度痤疮，可在一定程度上改善患者痤疮症状，但该疗法单用疗效不佳。有学者指出[5]，内服药异维A酸软胶囊在治疗重度痤疮方面具有较好的临床效果，但目前临床上将异维A酸和光动力联合应用于治疗重度痤疮的研究尚少。故本研究致力于通过探讨异维A酸联合光动力治疗重度痤疮患者的临床疗效，旨在为临床治疗该病提供科学依据。……