2026 年第 10 期 第 21 卷

光动力疗法治疗外阴硬化性苔藓的临床效果分析及皮肤CT的应用

Clinical efficacy analysis of photodynamic therapy in the treatment of vulvar lichen sclerosus and the application of skin CT

作者：刘晗黎1林晓蕾1王希波2

英文作者：Liu Hanli1 Lin Xiaolei1 Wang Xibo2

单位：1山东第二医科大学临床医学院，潍坊261053；2山东第二医科大学第一附属医院（山东省潍坊市人民医院）妇科一区，潍坊261041

英文单位：1School of Clinical Medicine Shandong Second Medical University Weifang 261053 China; 2The First Ward of Department of Gynecology The First Affiliated Hospital of Shandong Second Medical University (Weifang People′s Hospital Shandong Province) Weifang 261041 China

关键词：外阴硬化性苔藓；5-氨基酮戊酸光动力疗法；皮肤CT

英文关键词：Vulvarlichensclerosus;5-aminolevulinicacidphotodynamictherapy;SkinCT

• 摘要：

• 目的  应用Cattaneo评分及皮肤CT影像学特征，评价5-氨基酮戊酸光动力疗法（ALA-PDT）对外阴硬化性苔藓（VLS）的临床效果及影像学变化。方法 选取2024年10月至2025年8月就诊于山东省潍坊市人民医院的80例VLS患者作为研究对象。采用随机数字表法将患者分为ALA-PDT组和糠酸莫米松组，各40例。在治疗前、治疗中期、治疗后，对所有患者的临床症状、体征、皮肤CT影像学特征进行评价。对所得数据进行评价分析。结果 2组患者主要临床症状（瘙痒程度）、体征（皮肤弹性、皮肤颜色、病变范围）、皮肤CT影像学特征（真皮浅层炎细胞浸润、真皮浅层毛细血管扩张）在治疗中期得到明显改善，治疗后进一步改善，ALA-PDT组较糠酸莫米松组改善更为明显，差异均有统计学意义（均P＜0.05）。而皮肤CT影像学特征（表真皮界限不清、基底细胞环缺失）仅在治疗后得到改善，且ALA-PDT组较糠酸莫米松组改善更为明显，差异均有统计学意义（均P＜0.05）。ALA-PDT组治疗有效率高于糠酸莫米松组［95.0%（38/40）比90.0%（36/40）］（χ2＝0.180，P＜0.001）。治疗过程中ALA-PDT组患者多出现不同程度疼痛，经冷敷等处理后可耐受；治疗后ALA-PDT组患者持续性不良反应发生率低于糠酸莫米松组［15.0%（6/40）比37.5%（15/40）］，差异有统计学意义（χ2＝5.230，P＝0.022）。结论 ALA-PDT对于VLS是安全有效的。皮肤CT可从细胞层面评估肉眼不可见的细微变化，而这些变化可用于评估ALA-PDT对于VLS的有效性。

• Objective To evaluate the clinical efficacy and imaging changes of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) in the treatment of vulvar lichen sclerosus (VLS) using Cattaneo score and imaging features of skin CT. Methods A total of 80 patients diagnosed with VLS who were treated at Weifang People′s Hospital, Shandong Province from October 2024 to August 2025 were enrolled in this study. Patients were randomly divided into the ALA-PDT group and the mometasone furoate group via random number table method, with 40 cases in each group. Clinical symptoms, physical signs and skin CT imaging manifestations of all patients were assessed before treatment, during treatment and after treatment, and the obtained data were statistically analyzed. Results The main clinical symptoms (pruritus severity), physical signs (skin elasticity, skin color, lesion scope) and skin CT imaging features (inflammatory cell infiltration in superficial dermis, telangiectasia of superficial dermal capillaries) were significantly improved in both groups at the mid-term of treatment and further relieved after treatment, with more remarkable improvements observed in the ALA-PDT group than in the mometasone furoate group (all P＜0.05). The skin CT imaging manifestations including indistinct dermoepidermal junction and disappearance of basal cell layer were only improved after treatment, and the improvement degree was significantly superior in the ALA-PDT group compared with the mometasone furoate group (all P＜0.05). The effective rate in the ALA-PDT group was higher than that in the mometasone furoate group ［95.0%(38/40) vs 90.0%(36/40)］(χ2＝0.180, P＜0.001). Most patients in the ALA-PDT group experienced varying degrees of pain during treatment, which was tolerable after cold compress and other symptomatic management. The incidence of persistent adverse reactions in the ALA-PDT group was lower than that in the mometasone furoate group after treatment ［15.0%(6/40) vs 37.5%(15/40)］(χ2＝5.230, P＝0.022). Conclusion ALA-PDT is safe and effective for the treatment of VLS. Skin CT can evaluate subtle invisible lesions at the cellular level, which can be used to assess the therapeutic efficacy of ALA-PDT for VLS.