普萘洛尔联合噻吗洛尔治疗婴幼儿血管瘤的疗效及安全性Meta分析

Meta-analysis of Efficacy and Safety of Propranolol Combined with Timolol in the Treatment of Infantile Hemangioma

目的 将普萘洛尔联合噻吗洛尔与其他治疗措施进行对比,对其疗效及安全性进行系统评价,为临床治疗、用药决策提供循证依据。方法 遵循prisma指南,应用计算机检索中国知网数据库(CNKI)、维普数据库(VIP)、万方数据库(WanFang Data)、PubMed、Cochrance library、Embase,搜索运用普萘洛尔联合噻吗洛尔治疗婴幼儿血管瘤的随机对照实验,检索时限设置为建库至2020年2月,不设定语言限制;主要结局指标为有效率及不良反应发生率,所得文献由两名独立研究人员筛选后,使用Cochrane系统评价员手册5.1.0版随机对照试验偏倚风险评估工具对文献进行质量评价。采用RevMan 5.3软件进行Meta分析。结果 共纳入9篇文献及569例患儿。Meta分析结果显示:(1)对于婴幼儿血管瘤,普萘洛尔联合噻吗洛尔的效果明显高于单独使用普萘洛尔,差异有统计学意义[RR=1.28,95%CI(1.15,1.43),P<0.001],不良反应与单独应用普萘洛尔的差异无统计学意义[RR=0.87,95%CI(0.45,1.70),P=0.69];(2)普萘洛尔联合噻吗洛尔与单纯外用噻吗洛尔的有效率差异有统计学意义[RR=1.45,95%CI(1.22,1.88),P<0.05]。结论基于当前数据分析,普萘洛尔联合噻吗洛尔治疗婴幼儿血管瘤的临床疗效显著,且危险性未见提高。

Objective To systematically evaluate the efficacy and safety of propranolol combined with timolol compared with other therapeutic measures, so as to provide an evidence-based basis for clinical treatment and medication decision. Methods Following the guidelines of prisma, computer search was performed on CNKI, VIP, WanFang Data, PubMed, Cochrance library, and Embase. To search for randomized controlled trials of propranolol combined with timolol in the treatment of infantile hemangiomas. The retrieval time limit was set to February 2020 when the database was established, and no language restrictions were set. The main outcome measures were the response rate and the incidence of adverse reactions. After the literature was screened by two independent researchers, the quality of the literature was evaluated using the Cochrane Manual of Systematic Reviewers version 5.1.0 risk assessment tool for randomized controlled trials. Meta-analysis was performed using RevMan 5.3software. Results A total of 9 articles and 569 patients were included. Meta-analysis results showed ∶ 1.for infantile hemangioma, the effect of propranolol combined with timolol was significantly higher than that of propranolol alone, the difference was statistically significant[RR=1.28,95%CI(1.15,1.43),P<0.001], there was no statistically significant difference in adverse reactions between propranolol and propranolol alone [RR=0.87,95%CI(0.45, 1.70),P=0.69];2. propranolol combined with timolol and the difference in the effective rate of topical timolol alone was statistically significant [RR=1.45,95%CI(1.22,1.88),P<0.05].Conclusion Based on the current data analysis, the clinical efficacy of propranolol combined with timolol in the treatment of infantile hemangioma is significant, and the risk is not increased.