积雪苷联合二氧化碳点阵激光治疗病理性瘢痕疗效及安全性Meta分析

A Meta-Analysis of the Efficacy and Safety of Asiaticoside Combined with Carbon Dioxide Fractional Laser for the Treatment of Pathological Scar

目的:应用Meta分析方法评价积雪苷联合二氧化碳点阵激光治疗病理性瘢痕的临床效果。方法:通过计算机检索中国知网(CNKI)、万方数据知识服务平台、维普中文科技期刊数据库(VIP)、中国生物医学文献数据库(CBM)、PubMed、Web of Science、Cochrane数据库从建库至2022年3月公开发表的有关积雪苷联合二氧化碳点阵激光治疗病理性瘢痕的文献。以总有效率、温哥华瘢痕量表(VSS)、瘢痕去除权重评分(ECCA)、瘢痕厚度、柔软度、不良反应等为结局指标,应用RevMan 5.4软件进行Meta分析。结果:共纳入11篇文献,共772例患者,其中试验组388例,对照组384例。积雪苷联合二氧化碳点阵激光在治疗瘢痕方面可以提高总有效率[RR=1.26,95%CI:(1.15,1.37)]、改善ECCA评分[MD=-4.37,95%CI:(-7.23,-1.50)]、减少瘢痕厚度[MD=-0.31,95%CI:(-0.49,-0.12)]、改善瘢痕柔软度[MD=-0.33,95%CI:(-0.49,-0.17)]、改善血管分布[MD=-0.22,95%CI:(-0.35,-0.08)]、减少色素沉着[RR=0.22,95%CI:(0.10,0.52)],差异有统计学意义(P<0.05)。而对VSS评分[MD=1.94,95%CI:(-3.85,-0.02)]、感染性脓症[RR=0.38,95%CI:(0.14,0.98)]、疼痛评分[RR=0.57,95%CI:(0.17,1.92)],差异无统计学意义(P>0.05)。结论:积雪苷联合二氧化碳点阵激光在治疗病理性瘢痕方面有较好的疗效及安全性,且不会增加其不良反应的发生,但仍需要更多高质量的大样本研究进一步验证。

Objective:To evaluate the clinical effect of asiaticoside combined with carbon dioxide fractional laser in the treatment of pathological scar by applying Meta-analysis method.Methods:Computer search of the literature on asiaticosid combined with carbon dioxide fractional laser for pathological scar treatment in China Knowledge Network(CNKI),Wanfang Data Knowledge Service Platform,VIP Chinese Science and Technology Journal Database(VIP),Chinese Biomedical Literature Database(CBM),and PubMed built up to March 2022 was conducted.The total effective rate,VSS,ECCA score,scar thickness,tenderness,and adverse effects were used as outcome indicators,and Meta-analysis was performed by applying RevMan 5.4 software.Results:A total of 11 literature articles with 772 patients were included,including 388 cases in the trial group and 384 cases in the control group.Asiaticoside combined with carbon dioxide fractional laser in the treatment of keloid scars improved total efficiency rate[RR=1.26,95%CI:(1.15,1.37)],reduced ECCA score[MD=-4.37,95%CI:(-7.23,-1.50)],reduced scar thickness[MD=-0.31,95%CI:(-0.49,-0.12)],improved scar softness[MD=-0.33,95%CI:(-0.49,-0.17)],improved vascular distribution[MD=-0.22,95%CI:(-0.35,-0.08)],and reduced hyperpigmentation[RR=0.22,95%CI:(0.10,0.52)],all with statistically significant differences(P<0.05).And there was no statistical significance for VSS score[MD=-1.94,95%CI:(-3.85,-0.02)],infected pustules[RR=0.38,95%CI:(0.14,0.98)],and pain score[RR=0.57,95%CI:(0.17,1.92)].Conclusion:Asiaticoside combined with carbon dioxide fractional laser has better efficacy and safety in the treatment of pathological scar without increasing its adverse effects,but more high-quality large sample studies are needed for further validation.