点阵激光联合曲安奈德治疗增生性瘢痕疗效与安全性的荟萃分析

Efficacy and safety of fractional laser therapy combined with triamcinolone acetonide in the treatment of hypertrophic scar:a meta-analysis

目的利用荟萃分析比较点阵激光联合曲安奈德与单独曲安奈德治疗增生性瘢痕的有效性和安全性。方法自2022年2月至2022年6月,解放军总医院第四医学中心烧伤整形医学部以“激光”“曲安奈德”“增生性瘢痕”“laser”“triamcinolone acetate”“glucocorticoid”“hypertrophic scar”等为检索词检索中国期刊全文数据库、中国生物医学文献数据库、万方数据库、PubMed、Embase数据库自建库以来至2022年6月公开发表的比较点阵激光联合曲安奈德与单独曲安奈德治疗增生性瘢痕的随机对照实验(randomized controlled trial,RCT)。结局指标为治疗有效比例、不良反应、复发比例、温哥华瘢痕量表(vancouver scar scale,VSS)评分、视觉模拟疼痛量表(visual analogue scale,VAS)评分。采用RevMan 5.4和Stata 16.0统计软件对符合标准的研究进行荟萃分析。结果共纳入14篇文献,926例患者,包括点阵激光+曲安奈德治疗组(联合组)459例,单纯曲安奈德治疗组(对照组)467例。与对照组相比,联合组患者有效比例显著升高,相对危险度(RR)=1.28,95%置信区间(CI)(1.20,1.36),P<0.01。联合组发生不良反应比例明显低于对照组[RR=0.46,95%CI(0.27,0.77),P<0.01]。联合组复发比例与对照组间比较,差异无统计学意义[RR=0.75,95%CI(0.34,1.66),P=0.39]。联合组VSS评分、VAS评分显著低于对照组,加权数均差(WMD)=-1.83、-0.55,95%CI(-1.98,-1.68)、(-0.70,-0.40),P均<0.01)。敏感性分析结果显示,所有结局指标结果稳定性好。治疗有效比例存在发表偏倚(P=0.002),不良反应比例、VAS评分、VSS评分不存在发表偏倚(P=0.636、0.358、0.089)。结论较于单纯曲安奈德治疗,点阵激光联合曲安奈德治疗增生性瘢痕可明显提高有效比例,且患者不良反应更少、VSS评分和VAS评分更低。

Objective To compare the efficacy and safety of triamcinolone acetonide(TA)alone and in combination with fractional laser(FL)therapy in the treatment of hypertrophic scar using meta-analysis.Methods From February 2022 to June 2022,Senior Department of Burns and Plastic Surgery,the Fourth Medical Center of PLA General Hospital databases including Pubmed,Embase,Chinese Journal Full Text Database,Chinese Biomedical Database,and Wanfang Date were retrieved with the search terms"laser,triamcinolone acetate,glucocorticoid,hypertrophic scar""激光,曲安奈德,增生性瘢痕"respectively to obtain the publicly published randomized controlled trials about TA alone and in combination with FL therapy for treating hypertrophic scar from the establishment of each database to June 2022.The outcome indexes included the effective proportion of treatment,incidence proportion of adverse reactions,recurrence rate,vancouver scar scale(VSS)score and visual analogue scale(VAS)score.RevMan 5.4 and Stata 16.0 statistical software were used to conduct a meta-analysis of eligible studies.Results A total of 926 patients were included in 14 studies,including 459 patients in the TA+FL group(combination group)and 467 patients in the TA alone group(control group).Patients in the combination therapy group had a higher effective proportion of treatment than those in the control group.[relative risk(RR)=1.28,95%confidence interval(CI)(1.20,1.36),P<0.01].The incidence proportion of adverse reactions in the combined group was significantly lower than that in the control group[RR=0.46,95%CI(0.27,0.77),P<0.01].There was no statistical difference in the recurrence rate between the combined group and the control group[RR=0.75,95%CI(0.34,1.66),P=0.39].The VSS score and VAS score of patients in the combination group were significantly decreased,with weighted mean differences(WMD)of-1.83 and-0.55 respectively[95%CI(-1.98,-1.68)、(-0.70,-0.40),P<0.01].Sensitivity analysis showed that the results were stable in all outcome indexes.There was no publication bias in the incidence proportion of adverse reactions,VAS score and VSS score(P=0.636,0.358,0.089),while the effective proportion of treatment had publication bias(P=0.002).Conclusion FL combined with TA is more effective than TA alone for treating the hypertrophic scar,with a higher effective proportion and lower incidence proportion of adverse reactions,VSS score and VAS score.