IPL/激光联合氨甲环酸治疗黄褐斑疗效的系统评价

Systematic Evaluation of the Therapeutic Effect of IPL/Laser Combined with Tranexamic Acid on Chloasma

目的:系统评价IPL/激光联合氨甲环酸治疗黄褐斑的效果。方法:对6个在线数据库(PubMed、Web of science、Embase、Cochrane图书馆、CNKI、万方)进行全面的文献检索。检索文献在2020年3月前发表,于2020年3月完成建库。纳入以亚洲FitzpatrickⅢ、Ⅳ、Ⅴ皮肤类型黄褐斑患者为研究对象,比较IPL/激光联合氨甲环酸与单用IPL/激光或氨甲环酸的治疗效果。使用Newcastle-Ottawa量表(The newcastle-ottawa scale,NOS)评估纳入研究的质量,使用RevMan 5.0软件对MASI值进行Meta分析。结果:共纳入8个病例对照研究,包括599例黄褐斑患者的642例面部皮肤(其中43例患者为自身对照),试验组278例,对照组364例。经Meta分析,韩国和泰国的研究:联合应用与单用对改善m MASI值无差异[OR=-0.30,95%CI(-0.65,0.05),P=0.09]和[OR=-0.13,95%CI(-0.58,0.32),P=0.58];中国的研究:IPL/激光联合氨甲环酸与单用IPL/激光改善m MASI值有明显差异,前者较后者疗效更佳[OR=-2.31,95%CI(-3.75,-0.87),P=0.002];IPL/激光联合口服氨甲环酸与口服氨甲环酸对改善m MASI值有明显差异,前者优于后者[OR=-1.03,95%CI(-1.14,-0.92),P<0.00001]。结论:研究对象为中国黄褐斑患者IPL/激光联合氨甲环酸较单用IPL/激光或氨甲环酸更能有效改善m MASI值,研究对象为韩国、泰国黄褐斑患者的研究两种治疗无统计学差异。受纳入研究质量和数量的限制,上述结论尚需大量高质量的随机对照试验验证。

Objective Systematic evaluation of the therapeutic effect of IPL/laser combined with tranexamic acid on chloasma.Methods Comprehensive literature retrieval of six online databases(PubMed,web of science,EMBASE,Cochrane Library,CNKI,Wanfang).All included literature will be published before March 2020.To compare the therapeutic effect of IPL/laser combined with tranexamic acid with that of IPL/laser alone or tranexamic acid alone in Asian FitzpatrickⅢ,ⅣandⅤskin type chloasma patients.The Newcastle Ottawa scale(NOS)was used to evaluate the quality of the study,and Revman 5.0 software was used to conduct a meta-analysis of the Masi value.Results Eight case-control studies were included,including 599 chloasma patients(278 in the experimental group and 364 in the control group,including 43 in the self-control group).According to the Meta-analysis,there was no difference between the combined application and the single application in improving the mMASI value[ OR=-0.30,95%CI(-0.65,0.05),P=0.09]and[OR=-0.13,95%CI(-0.58,0.32,P=0.58).The Chinese study showed that there was significant difference between IPL/laser combined with tranexamic acid and IPL/laser alone in improving mMASI,the former was better than the latter[OR=-2.31,95%CI(-3.75,-0.87),P=0.002].There was a significant difference in the improvement of mMASI between the combination of IPL/laser and oral tranexamic acid[OR=-1.03,95%CI(-1.14,-0.92),P<0.00001].Conclusion The subjects of this study were Chinese chloasma patients with IPL/laser combined with tranexamic acid,which could improve the mmasi value more effectively than IPL/laser alone or tranexamic acid alone.The subjects of this study were Korean and Thai chloasma patients with no statistical difference between the two treatments.Limited by the quality and quantity of the included studies,the above conclusions need to be verified by a large number of high-quality randomized controlled trials.