【目的】 观察火针联合 5-氨基酮戊酸光动力疗法（ALA-PDT）治疗中重度寻常型痤疮的临床疗效。【方法】 选取 2021年 2 月至2023年2月安康市中医医院皮肤科门诊收治的112例明确诊断为寻常型痤疮的患者为研究对象。按随机数字表将患者 随机分为观察组和对照组，每组各56例。对照组给予ALA-PDT治疗，观察组在对照组治疗的基础上，给予火针治疗，每周 治疗1次，共治疗4周。治疗后，评价2组临床疗效。观察2组患者治疗前后皮损症状评分和痤疮综合分级系统（GAGS）评分 的变化情况，以及皮肤屏障功能的情况。比较2组患者治疗前后血清脱氢表雄酮（DHEA）、胰岛素样生长因子1（IGF-1）水平 的变化情况。并随访复发情况，评价 2 组的安全性及不良反应的发生情况。【结果】（1）治疗后，2 组患者皮损症状评分、 GAGS评分均明显改善（P＜0.05），且观察组在改善皮损症状评分、GAGS评分方面明显优于对照组，差异有统计学意义（P＜ 0.05）。（2）治疗后，2组患者的面部皮肤角质层含水量、TEWL、表皮pH值明显改善（P＜0.05），且观察组在改善面部皮肤角 质层含水量、TEWL、表皮pH值方面明显优于对照组，差异有统计学意义（P＜0.05）。（3）治疗后，2组患者的DHEA、IGF-1 水平明显改善（P＜0.05），且观察组在改善DHEA、IGF-1水平方面明显优于对照组，差异有统计学意义（P＜0.05）。（4）观察 组总有效率为89.29%（50/56），对照组为73.21%（41/56）。观察组疗效优于对照组，差异有统计学意义（P＜0.05）。（5）治疗后 8、12 周，观察组复发率分别为 10.00%（5/50）、16.00%（8/50），对照组分别为 34.14%（14/41）、46.34%（19/41）。观察组复 发率优于对照组，差异有统计学意义（P＜0.05）。（6）观察组不良反应发生率为16.07%（9/56），对照组为10.71%（6/56）；观察 组与对照组的不良反应发生率比较，差异无统计学意义（P＞0.05）。【结论】 火针联合ALA-PDT治疗中重度寻常型痤疮，可有 效促进皮损修复，缓解患者的临床症状，修复皮肤屏障功能，降低复发率，疗效显著，其机制可能与调节血清DHEA、IGF-1 有关。

Objective To observe the clinical efficacy of fire needle combined with 5-aminolevulinic acid photodynamic therapy （ALA-PDT） in the treatment of moderate to severe acne vulgaris. Methods A total of 112 patients diagnosed with acne vulgaris in the dermatology outpatient department of Ankang Hospital of Traditional Chinese Medicine from February 2021 to February 2023 were selected as the study subjects. The patients were randomly divided into an observation group and a control group using a random number table，with 56 cases in each group. The control group was treated with ALA-PDT，while the observation group received fire needle treatment in addition to the control group’s treatment，once a week for a total of 4 weeks. After treatment， the clinical efficacy of the two groups was evaluated. Changes in lesion symptom scores and the Global Acne Grading System （GAGS） scores were observed before and after treatment，as well as the skin barrier function. The serum levels of dehydroepiandrosterone （DHEA） and insulin-like growth factor-1（IGF-1） were compared before and after treatment. The recurrence rate was followed up，and the safety and incidence of adverse reactions in the two groups were evaluated. Results （1） After treatment， the lesion symptom scores and GAGS scores of both groups were significantly improved （P＜0.05），and the observation group showed significantly better improvement in lesion symptom scores and GAGS scores compared to the control group，with a statistically significant difference （P＜0.05）.（2） After treatment， the stratum corneum hydration， transepidermal water loss （TEWL）， and epidermal pH of facial skin in both groups were significantly improved （P＜0.05）， and the observation group showed significantly better improvement in these parameters compared to the control group， with a statistically significant difference （P＜0.05）.（3） After treatment，the serum levels of DHEA and IGF-1 in both groups were significantly improved （P＜0.05），and the observation group showed significantly better improvement in DHEA and IGF-1 levels compared to the control group，with a statistically significant difference （P＜0.05）.（4） The total effective rate in the observation group was 89.29% （50/56），while it was 73.21% （41/56） in the control group. The efficacy of the observation group was superior to that of the control group，with a statistically significant difference （P＜0.05）.（5） At 8 and 12 weeks after treatment，the recurrence rates in the observation group were 10.00% （5/50） and 16.00%（8/50），respectively，while they were 34.14%（14/41） and 46.34%（19/41） in the control group. The recurrence rate in the observation group was lower than that in the control group，with a statistically significant difference （P＜0.05）.（6） The incidence of adverse reactions in the observation group was 16.07%（9/ 56）， while it was 10.71%（6/56） in the control group. There was no statistically significant difference in the incidence of adverse reactions between the two groups （P＞0.05）. Conclusion Fire needle combined with ALAPDT in the treatment of moderate to severe acne vulgaris can effectively promote lesion repair，alleviate clinical symptoms， restore skin barrier function， and reduce the recurrence rate， with significant efficacy. The mechanism may be related to the regulation of serum DHEA and IGF-1 levels.

R246.9

陕西省重点研发计划资助项目（编号：2019ZD-SF-055）