羟氯喹治疗玫瑰痤疮的疗效和安全性系统评价

Efficacy and Safety of Hydroxychloroquine for Acne Rosacea:A Systematic Review

目的:系统评价羟氯喹(Hydroxychloroquine,HCQ)治疗玫瑰痤疮的有效性与安全性。方法:计算机检索Pub Med,The Cochrane Library,Embase,CNKI,万方数据库,筛选HCQ治疗玫瑰痤疮的随机对照试验(Randomized controlled trials,RCTs),使用Cochrane RevMan5.4进行数据分析。结果:纳入18项研究,共1397例患者。与四环素类药物比较,HCQ治疗有效率[OR=0.94,95%CI(0.74,1.19),P=0.60]差异无统计学意义。HCQ的治疗有效率低于HCQ联合激光光疗组、联合外用药组、联合中医药组以及联合四环素组[RR=0.68,95%CI(0.57,0.80),P<0.01;RR=0.70,95%CI(0.57,0.86),P<0.01;RR=0.70,95%CI(0.54,0.90),P<0.01;RR=0.73,95%CI(0.62,0.85),P<0.01]。单用HCQ的治疗后疗效低于激光单独治疗组,HCQ联合四环素组,联合激光光疗组以及联合外用药组,差异有统计学意义[MD=1.50,95%CI(1.04,1.96),P<0.01;MD=2.59,95%CI(2.24,2.94),P<0.01;MD=0.63,95%CI(0.27,0.99),P<0.01;MD=0.84,95%CI(0.65,1.02),P<0.01]。HCQ联合激光、外用皮肤修复剂在红斑、毛细血管扩张的缓解上有更好的疗效[MD=1.70,95%CI(0.06,3.34),P<0.05;MD=0.47,95%CI(0.37,0.56),P<0.01;MD=0.39,95%CI(0.15,0.63),P<0.01];HCQ联合激光治疗对瘙痒的缓解也有较好的疗效MD=0.75,95%CI(0.42,1.07),P<0.01,但是对丘疹脓疱的治疗并不优于HCQ组[MD=-1.20,95%CI(-4.19,1.79),P=0.43]。单独治疗与联合治疗间的不良反应差异无统计学意义[RR=1.25,95%CI(0.94,1.66),P=0.12]。结论:HCQ是否比四环素更有效还有待确定,但HCQ联合四环素、激光光疗、中医药、外用修复剂及血管收缩剂治疗玫瑰痤疮更有效,且不良反应并未增加。

Objective To systematically review the efficacy and safety of hydroxychloroquine(HCQ)for rosacea.Methods Pub Med,The Cochrane Library,Embase,CNKI and WanFang database were electronically searched to collect randomized controlled trials(RCTs)of HCQ for rosacea.The data were analyzed by using Revman5.4 software provided by Cochrane collaboration.Results A total of 18 studies involving 1397 patients were included.Compared with tetracycline,the efficiency of HCQ was not statistically significant[OR=0.94,95%CI(0.74,1.19),P=0.60].The efficiency of HCQ was lower than that of HCQ combined with laser and phototherapy,external medication,Traditional Chinese medicine and tetracycline[RR=0.68,95%CI(0.57,0.80),P<0.01;RR=0.70,95%CI(0.57,0.86),P<0.01;RR=0.70,95%CI(0.54,0.90),P<0.01;RR=0.73,95%CI(0.62,0.85),P<0.01].After treatment,the efficacy score of HCQ was lower than that of laser alone,HCQ combined with tetracycline,laser and phototherapy,and external medication,the difference was statistically significant[MD=1.50,95%CI(1.04,1.96),P<0.01;MD=2.59,95%CI(2.24,2.94),P<0.01;MD=0.63,95%CI(0.27,0.99),P<0.01;MD=0.84,95%CI(0.65,1.02),P<0.01].For the treatment of HCQ alone,HCQ combined with laser and topical skin repair agent had better efficacy in the remission of erythema and telangiectasis[MD=1.70,95%CI(0.06,3.34),P<0.05;MD=0.47,95%CI(0.37,0.56),P<0.01;MD=0.39,95%CI(0.15,0.63),P<0.01].HCQ combined with laser therapy also showed good efficacy in pruritus relief[MD=0.75,95%CI(0.42,1.07)],but the treatment of papules and pustules was not better than that of HCQ group[MD=-1.20,95%CI(-4.19,1.79),P=0.43].There was no statistical significance in the adverse reactions between single therapy and combination therapy[RR=1.25,95%CI(0.94,1.66),P=0.12].Conclusion Whether HCQ is more effective than tetracycline remains to be determined,but HCQ combined with tetracycline,laser and phototherapy,Traditional Chinese medicine and topical repair agent and vasoconstrictor are more effective for rosacea,and the adverse reactions don’t increase.