刺络放血治疗寻常型银屑病疗效及安全性Meta分析

Systematic evaluation of the efficacy and safety of blood-letting puncture in the treatment of psoriasis vulgaris

目的:系统评价刺络放血治疗寻常型银屑病的效果与安全性。方法:检索建库以来应用刺络放血疗法治疗寻常型银屑病的随机对照试验(RCT),由2名研究者分别独立进行文献筛选和资料提取、并评价偏倚风险后,利用Rev Man 5.4软件合并分析。主要评价指标为:总有效率、银屑病面积与严重性指数(PASI评分)、红斑、鳞屑、浸润、瘙痒等皮损症状、银屑病患者生活质量(PQOLS评分)、复发率、不良反应发生率等。结果:共纳入12个RCT,共计997例患者。本系统评价结果显示联用刺络放血疗法较其他治疗方式在提高临床有效率[RR=1.15,95%CI(1.09,1.21),P<0.00001]、降低PASI评分[MD=-0.96,95%CI(-1.09,-0.82),P<0.00001]、改善红斑、鳞屑症状[红斑:MD=-0.65,95%CI(-1.15,-0.15),P=0.01;鳞屑:MD=-0.47,95%CI(-0.74,-0.20),P=0.0007]、减少不良反应[RR=0.49,95%CI(0.24,0.98),P=0.04]、减少复发[RR=0.41,95%CI(0.22,0.76),P=0.005]、提高生活质量[MD=-1.78,95%CI(-2.48,-1.08),P<0.00001]方面差异显著,具有统计学意义。但在浸润[MD=-0.33,95%CI(-0.91,0.25),P=0.26]和瘙痒症状[MD=-0.79,95%CI(-1.64,0.06),P=0.07]两方面并无统计学意义。结论:刺络放血疗法治疗寻常型银屑病有效率高、安全性好、复发率小。但本研究纳入文献数据质量偏低,样本量不足,今后亟需开展大样本、高质量研究对刺络放血疗法的疗效优势进一步科学验证。

Objective:To systematically evaluate the efficacy and safety of pricking collaterals and bloodletting in the treatment of psoriasis vulgaris.Methods:Randomized controlled trials(RCTs)of pricking blood therapy in the treatment of psoriasis vulgaris since the establishment of the database were retrieved.Two researchers independently conducted literature screening and data extraction,and evaluated the risk of bias.Rev Man 5.4 software was used for combined analysis.The main evaluation indexes were:the total effective rate,psoriasis area and severity index(PASI score),erythema,scales,infiltration,itching and other skin lesions,quality of life in patients with psoriasis(PQOLS score),recurrence rate,incidence of adverse reactions,etc.Results:A total of 12 RCTs with a total of 997 patients were included.The results of this systematic review show that the combined use of pricking and bloodletting therapy compared with other treatments can improve the clinical effective rate[RR=1.15,95%CI(1.09,1.21),P<0.00001]and reduce the PASI score[MD=-0.96,95%CI(-1.09,-0.82),P<0.00001],improved erythema,scaling symptoms[erythema:MD=-0.65,95%CI(-1.15,-0.15),P=0.01;scaling:MD=-0.47,95%CI(-0.74,-0.20),P=0.0007],reduction in adverse effects[RR=0.49,95%CI(0.24,0.98),P=0.04],reduction in recurrence[RR=0.41,95%CI(0.22,0.76),P=0.005],and improved quality of life[MD=-1.78,95%CI(-2.48,-1.08),P<0.00001],the difference was significant and statistically significant.However,there were no statistics for infiltration[MD=-0.33,95%CI(-0.91,0.25),P=0.26]and pruritus symptoms[MD=-0.79,95%CI(-1.64,0.06),P=0.07]study meaning.Conclusion:Bloodletting therapy for pricking collaterals has high efficacy,good safety and low recurrence rate in the treatment of psoriasis vulgaris.However,the quality of the literature data included in this study is low.In the future,it is urgent to carry out large-sample and high-quality research to further scientifically verify the therapeutic advantages of bloodletting therapy.