环孢素A、甲氨蝶呤、阿维A治疗泛发性脓疱型银屑病的Meta分析

A meta-analysis of the efficacy of cyclosporine A,methotrexate and acitretin in the treatment of generalized pustular psoriasis

目的 Meta分析评价环孢素A(cyclosporine A)、甲氨蝶呤(Methotrexate,MTX)及阿维A(acitretin)治疗泛发性脓疱型银屑病(generalized pustularpsoriasis,GPP)疗效及安全性。方法电子检索Pubmed、Cochrane Library、EMbase、中国知网(CNKI)、万方及维普电子数据库2004年1月1日至2014年12月31日发表的有关环孢素A、MTX及阿维A治疗GPP的文献,采用严格的文献筛选及质量评价标准,并提取有效数据进行分析,分别对三种药物治疗GPP患者总有效率及不良反应发生率进行Meta分析,并采用χ~2检验分析三种药物治疗GPP的疗效及不良反应发生率的差异。结果共有17篇文献纳入Meta分析模型,三种药物均可显著改善GPP患者症状,环孢素A,MTX及阿维A治疗GPP有效率分别为85.75%[Z=7.30,P<0.00001,RR(95%CI)=6.76(4.05,11.29)],78.95%[Z=8.62,P<0.00001,RR(95%CI)=4.27(3.07,5.94)]及76.11%[Z=9.50,P<0.00001,RR(95%CI)=4.07(3.05,5.44)],不良反应率分别为59.04%[Z=6.70,P<0.00001,RR(95%CI)=2.38(1.85,3.07)],58.97%[Z=2.17,P=0.03,RR(95%CI)=1.96(1.07,3.58)]及80.45%[Z=2.29,P=0.02,RR(95%CI)=9.45(1.38,64.50)],三种药物治疗GPP的疗效无统计学差异(P=0.104),环孢素A与MTX治疗后不良反应率相近,阿维A治疗不良反应率显著高于前两者,但不良反应症状轻于前两者,结果有统计学意义(P<0.001)。结论对于一般的GPP患者,应首选维甲酸类药物进行治疗,如阿维A,对于阿维A治疗无效的GPP患者,可以选择免疫抑制剂进行治疗,环孢素A与MTX疗效及不良反应率无明显差异。

Objective：To evaluate the efficacy and safety of cyclosporine A,Methotrexate（MTX） and acitretin in the treatment of Generalized pustularpsoriasis（GPP） by Meta-analysis.Methods：Electronic retrieval of literature of the cyclomedin A,MTX,and Avita A Treatment GPP published by Pubmed,brary,EMbase,CNKI,Wanfang,and VIP Electronic Database from January 1,2004 to December 31,2014.Strict literature screening and quality evaluation criteria,and extracting valid data were adopted for analysis,and a meta-analysis of the total efficacy and incidence of adverse reactions in three drug treatment GPP patients were conducted,and the efficacy and adverse reaction rate of three drugs were analyzed using χ~2 Difference.RESULTS：A total of 17 articles were included in the meta-analysis model.All three drugs significantly improved the symptoms of GPP patients.The effective rates of GPP treatment for cyclosporine A,MTX and acitretin were85.75%[Z=7.30,P0.00001,RR（95% CI）=6.76（4.05,11.29）],78.95%[Z=8.62,P0.00001,RR（95%CI）=4.27（3.07,5.94） ] and 76.11%[Z=9.50,P0.00001,RR（95% CI）=4.07（3.05,5.44） ],The adverse reaction rates were 59.04%[Z=6.70,P0.00001,RR（95% CI）=2.38（1.85,3.07） ],58.97% [Z=2.17,P=0.03,RR（95% CI）=1.96（1.07,3.58） ]and 80.45% [Z=2.29,P=0.02,RR（95% CI）=9.45（1.38,64.50） ].There was no statistical difference in the efficacy of the three drugs for GPP（P=0.104）.The adverse reaction rate after treatment with A and MTX was similar,and the adverse reaction rate of acitretin A was significantly higher than that of the former two,but the adverse reaction symptoms were milder than the former two,and the results were statistically significant（P0.001）.Conclusions：For general GPP patients,retinoids should be the first choice for treatment,such as acitretin A.For patients with GPP who are refractory to acitretin treatment,immunosuppressants can be selected for treatment.The efficacy and adverse effects of cyclosporine A and MTX are not satisfactory.There is no significant difference in response rate.