局部使用苯妥英钠对皮肤伤口愈合影响的Meta分析

Meta-analysis of Clinical Effects of Topical Administration of Phenytoin on Wound Healing

目的:评价局部使用苯妥英钠对各种类型皮肤伤口的临床疗效。方法:计算机检索Pub Med和Cochrane图书馆临床对照试验资料库,检索时间均从建库至2016年5月,收集所有皮肤伤口愈合与局部使用苯妥英钠有关的临床对照研究文献。采用Rev Man 5及Stata 12.0软件进行Meta分析。结果:共纳入15项符合要求的研究,合计1 048例受试者。Meta分析显示,局部使用苯妥英钠与伤口愈合率(OR=3.28,95%CI:1.23~8.75,P=0.02)、与健康肉芽组织生成率(OR=2.18,95%CI:1.33~3.59,P=0.002)、平均伤口表面积百分率减少(SMD=1.77,95%CI:0.53~3.02,P<0.000 01)均显著相关。但伤口愈合率的研究间以及伤口平均表面积百分率减少的研究间均存在异质性。Meta回归结果显示,伤口类型与伤口愈合率的研究间异质性显著相关(P=0.02),治疗时间也与其有一定的相关性(P=0.08);平均年龄与伤口平均表面积百分率减少的研究间异质性有一定相关性(P=0.07)。结论:局部使用苯妥英钠对多种皮肤伤口愈合有积极作用,但由于研究间存在异质性,该结论在临床实践中需要谨慎使用。

Objective： To evaluate the clinical effects of topical administration of phenytoin （PHT） on wound heal!ng. Methods： The clinical trials on PHT topically used for wound healing were collected from Cocharne Library and PubMed （ from database establish -ment to May, 2016. Meta-analysis was performed using RevMan 5.0 software and Stata 12.0 software. Results： A total of 15 stud- ies involving 1 048 patients were included. Topical PHT treatment was significantly associated with complete healing rate （ OR = 3.28, 95% CI： 1.23-8.75, P =0.02）, production rate of health granulation tissue （ OR =2.18,95% CI： 1.33-3.59, P =0.002） and aver- age percentage reduction of wound surface size （ SMD = 1.77, 95% CI： 0. 53-3.02, P 〈 0. 000 01 ）. However, heterogeneity existed in complete healing rate and average percentage reduction of wound surface size among the studies. Meta-regression analysis showed that wound types （ P = 0.02） and treatment periods （ P = 0.08 ） were associated with the heterogeneity of complete healing rate outcomes, and mean age was associated with the heterogeneity of average percentage reduction of wound surface size （ P = 0.07 ）. Conclusion ： Meta-analysis suggests that topical PHT treatment has significant positive clinical effect on wound healing. There is heterogeneity among the studies, so topical PHT treatment still should be applied in clinical practice prudently.