外用抗真菌剂治疗头皮脂溢性皮炎及头皮屑的Meta分析

Efficacy of topical antifungal agents for scalp seborrheic dermatitis and dandruff:meta analysis

目的:评价外用抗真菌剂治疗头皮脂溢性皮炎及头皮屑的临床疗效及安全性。方法:通过计算机检索Cochrane Library、Pubmed、MEDLINE、CBM和CNKI等数据库,并辅以手工检索,收集所有外用抗真菌剂治疗头皮脂溢性皮炎及头皮屑的临床安慰剂对照试验(RCT)。对纳入研究按照Cochrane协作网推荐标准进行质量评估,并使用RevMan 5.2对结果进行Meta分析。结果:共纳入11个符合标准的RCT研究(酮康唑6个和环吡酮胺5个)。结果显示,酮康唑疗效明显优于安慰剂[RR合并=2.60,95%CI(2.14,3.15),P<0.000 01],环吡酮胺也较对照组有效[RR合并=1.81,95%CI(1.58,2.06),P<0.00001],有统计学意义。常见的不良反应类型包括烧灼感和瘙痒等,试验组和对照组相比差异无统计学意义。结论:酮康唑和环吡酮胺治疗头皮脂溢性皮炎及头皮屑效果优于安慰剂。目前临床上外用环吡酮胺和酮康唑是安全的,可以作为头皮脂溢性皮炎及头皮屑的替代治疗方法。

Objective： To assess the therapeutic efficacy of topical antifungal agents of scalp seborrheic dermatitis and dandruff. Methods： The literatures were retrieved from the Cochrane Library, Pubmed, MEDLINE, CBM and CNKI. All relevant randomized vehicle-controlled trials of topical antifungal agents for scalp seborrheic dermatitis treatment were retrieved. The quality of the enrolled studies were evaluated by the criteria recommended by Cochrane Collaboration, and meta analyses were performed using RevMan 5.2 software. Results： Eleven randomized controlled trials were included. Six reports studied the efficacy for ketoconazole and five for ciclopirox. The results of meta analyses showed that ketoconazole was more effective than that of the vehicle [PRR=2.60, 95%CI（2.14, 3.15）, P〈0.00001], as was ciclopirox [PRR=I.81, 95%CI（1.58, 2.06）, P〈0.00001]. No significant adverse reactions were reported except burning sensation and puritus, while there was no significant difference between the two groups. Conclusion： Ketoconazole and ciclopirox demonstrate strong evidence of therapeutic efficacy of seborrheic dermatitis and dandruff. Up to the present they are safe, and could be used as alternatives for the treatment of seborrheic dermatitis and dandruff.