光动力疗法治疗鲜红斑痣疗效和安全性的Meta分析

Efficacy and safety of photodynamic therapy for port-wine stains:a meta analysis

目的系统评价光动力疗法(PDT)治疗鲜红斑痣的有效性与安全性。方法2022年3月到2023年3月,江苏大学附属医院皮肤科经计算机检索PubMed、Cochrane Library、CNKI、万方数据库中筛选PDT治疗鲜红斑痣的随机对照试验,用Cochrane协作网提供的RevMan 5.4进行数据分析。结果共纳入9项研究,1190例患者。2项研究将PDT与安慰剂比较,PDT治疗总有效率较高(OR=24.81,95%CI:14.68~41.93,P<0.01);4项研究将PDT与激光[脉冲染料激光(PDL)、CO_(2)激光]比较,PDT的治疗有效率高于激光(OR=3.43,95%CI:1.79~6.58,P<0.01)。2项研究将PDT与PDT+PDL联合治疗相比,PDT总体治疗有效率低于PDT+PDL(OR=0.19,95%CI:0.08~0.45,P<0.01)。PDT的治疗反应高于安慰剂组,尤其是疼痛、烧灼、瘙痒、肿胀以及结痂(OR=49.99,95%CI:23.95~104.35,P<0.01;OR=5.22,95%CI:3.40~8.02,P<0.01;OR=8.68,95%CI:4.75~15.87,P<0.01;OR=62.04,95%CI:23.92~160.90,P<0.01;OR=203.14,95%CI:28.91~1427.34,P<0.01);水疱的发生率不高于安慰剂组(OR=2.62,95%CI:0.88~7.85,P=0.08)。PDT与安慰剂相比,远期不良反应增加,尤其是色素沉着(OR=65.62,95%CI:4.06~1061.30,P<0.01)。PDT与PDL相比,均有治疗反应,常见色素沉着并未增加(OR=1.04,95%CI:0.59~1.82,P=0.89)。PDT与PDT+PDL联合治疗相比,色素沉着发生率差异无统计学意义(OR=1.69,95%CI:0.40~7.23,P=0.48)。结论PDT治疗鲜红斑痣有效,虽然治疗反应较大,但远期常见不良反应色素沉着未增加,且PDT联合PDL是提高治疗有效率的新方向。

ObjectiveTo systematically evaluate the efficacy and safety of photodynamic therapy(PDT)in the treatment of port-wine stains(PWS).MethodsPubMed,Cochrane Library,CNKI,Wanfang database were electronically searched to collect randomized controlled trials(RCTs)of PDT for PWS and data was analyzed using RevMan 5.4 provided by Cochrane Collaboration from March 2022 to March 2023 in the Department of Dermatology,Affiliated Hospital of Jiangsu University.ResultsA total of 9 studies involving 1190 patients were included.Two studies compared PDT with placebo,the total efficiency rate of PDT was increased(OR=24.81,95%CI:14.68-41.93,P<0.01).Four studies compared PDT with laser[pulsed dye laser(PDL),CO_(2) laser]and showed that PDT had a higher therapeutic efficiency(OR=3.43,95%CI:1.79-6.58,P<0.01).The efficiency rate of PDT was lower than PDT+PDL in two studies(OR=0.19,95%CI:0.08-0.45,P<0.01).The treatment reaction of PDT group was higher than that of placebo group,especially pain,burning,pruritus,swelling and scab(OR=49.99,95% CI:23.95-104.35,P<0.01;OR=5.22,95% CI:3.40-8.02,P<0.01;OR=8.68,95%CI:4.75-15.87,P<0.01;OR=62.04,95% CI:23.92-160.9,P<0.01;OR=203.14,95% CI:28.91-1427.34,P<0.01),the incidence of blister was not higher than that of placebo group(OR=2.62,95% CI:0.88-7.85,P=0.08).Compared with placebo,long-term adverse reactions were increased,especially hyperpigmentation(OR=65.62,95% CI:4.06-1061.30,P<0.01).Both PDT and PDL showed treatment response,but the most common long-term adverse reaction hyperpigmentation did not increase(OR=1.04,95% CI:0.59-1.82,P=0.89).There was no significant difference in the incidence of long-term adverse reaction hyperpigmentation between PDT and PDT+PDL groups(OR=1.69,95% CI:0.40-7.23,P=0.48).ConclusionsPDT is effective in the treatment of PWS,and has a better effect than the current treatment.Although the treatment reaction is higher,the most common long-term adverse reaction hyperpigmentation does not increase,and PDT combined with PDL is a new direction to improve the efficiency rate.