氨甲环酸皮内注射对黄褐斑疗效的meta分析

Meta-analysis of Tranexamic Acid Intradermal Injection in the Treatment of Melasma

目的评价氨甲环酸(tranexamic acid,TXA)皮内注射对黄褐斑的疗效和安全性。方法计算机检索中国知网、万方数据库、维普期刊网和PubMed,检索时间建库起至2019-12月,纳入含有TXA皮内注射治疗黄褐斑的研究。根据Cochrane协作网推荐的偏倚风险评估文献质量,所有统计分析采用RevMan 5.3软件。以有效率、黄褐斑面积及严重程度指数(melasma area severity index,MASI)、黑色素指数(melanin index,MI)、红斑指数(erythema index,MI)为效应指标。结果纳入14项研究,其中随机对照试验12项,病例研究2项。结果表明TXA皮内注射治疗黄褐斑有效,可使MASI和MI进一步降低,EI变化无统计学意义[有效率OR=2.96,95%CI(1.70,5.14),P<0.01;MASI前后变化SMD=-1.40;95%CI(-2.04,-0.75),P<0.0001;MI前后变化SMD=-0.7;95%CI(-1.12,-0.78),P=0.001]。结论TXA皮内注射治疗黄褐斑安全有效。

Objective To evaluate the efficacy and safety of intradermal injection of tranexamic acid(TXA)in the treatment of patients with melasma.Methods The databases such as China National Knowledge Infrastructure,Wanfang Database,VIP Database and PubMed were searched to collect the studies of intradermal injection of TXA in the treatment of patients with melasma from the establishment of the database to December 2019.The quality of the literatures were assessed using bias risk according to the Cochrane collaboration.All data were analyzed using RevMan 5.3 software.Efficiency,melasma area severity index(MASI),melanin index(MI)and erythema index(EI)were used as the effect indexes.Results A total of 14 studies were included,including 12 randomized controlled trials and 2 case series studies.TXA intradermal injection was effective in the treatment of melasma,which could further reduce the MASI and MI,but the change of EI was not statistically significant[Efficiency OR=2.96,95%CI(1.70,5.14),P<0.01;MASI before-after SMD=-1.40;95%CI(-2.04,-0.75),P<0.0001;MI before-after SMD=-0.7;95%CI(-1.12,-0.78),P=0.001].Conclusion TXA intradermal injection is an effective and safe way for melasma.