基于网络Meta分析的瘢痕药物预防及治疗评价

Prevention and treatment of scar drugs based on Meta analysis

目的通过网络Meta分析方法,评价现行瘢痕治疗药物在瘢痕防治中的作用。方法通过检索PubMed,Blackwell,Cochrane Central,Web of Science,Ovid及Scopus等数据库及国内中国生物医学文献数据库、万方数据库和中国期刊全文数据库等,检索瘢痕药物治疗及预防的相关文献,将文献提供的相关数据录入到Excel电子表格中,再将电子表格导入到R(2.15.1版)软件(http://www.r-project.org/)中,利用Meta软件包及Q检验等进行分析。结果通过数据库检索,本研究总计纳入35篇文献,汇总分析,药物对瘢痕治疗的总体有效率为(80.0±3.0)%,总体复发率为(28.0±3.0)%。瘢痕治疗作用的大小顺序大致为:激素类、博来霉素、5-氟尿嘧啶、丝裂霉素C、维拉帕米及胶原酶。其中胶原酶治疗效应的相对危险性值(OR)小于1,提示该药物对瘢痕的治疗不仅无效,而且可能有害;而5-氟尿嘧啶的OR区间包含1,其治疗作用也有待进一步的证实。药物辅助治疗对瘢痕复发作用的大小依次为:博来霉素、5-氟尿嘧啶、维拉帕米、激素类、咪喹莫特、秋水仙碱、他莫昔芬,其中可信区间包含50%的有咪喹莫特、他莫昔芬及维拉帕米。瘢痕药物治疗总体有效率之间的相互比较,汇总后I^2=95.6%,Q检验显示P<0.0001。而对瘢痕药物辅助治疗复发率的分析中,激素类药物及咪喹莫特对瘢痕复发的效果明显优于其他几种药物,而他莫昔芬对瘢痕复发的预防作用最低。结论用于瘢痕治疗的药物可以选择激素类、博来霉素、丝裂霉素C、维拉帕米等;而用于预防术后复发可选激素类,其他药物的作用尚有待证实。

Objective To evaluate existing drugs for the treatment and prevention of scars and keloids through network meta-analysis methods. Methods By searching the Pub Med,Blackwell,Cochrane Central,Web of Science,Ovid,and Scopus database and the domestic Chinese Biomedical Literature Database,Wanfang database and the Chinese Journal Full-text Database database,literatures were retrieved relevant to the scar medication and prevention research,the data provided by the relevant documents into the Excel spreadsheet,and then import the spreadsheet into the R( 2. 15. 1 version) software( http://www. rproject. org/),the use of Meta software package and Q test for analysis. Results A total of 35 studies were included in the research which contained 28 literatures in English and 7 literatures in Chinese by database searches. Pooled analysis indicated that the drug's effect on keloids treatment of the overall response rate was( 80. 0 ± 3. 0) %. The overall recurrence rate was( 28. 0 ± 3. 0) %. The effect size of the keloid treatment roughly in the order: steroids,bleomycin,5-fluorouracil,mitomycin C,verapamil and collagenase. The OR for collagenase was less than 1,suggesting that it was ineffective and potentially harmful,and 95% CI of OR for 5-fluorouracil covered 1,thus its therapeutic effect had yet to be further confirmed. The recurrence ORs for adjuvant treatment of the drugs for keloids were: bleomycin,5-fluorouracil,verapamil,hormone,imiquimod colchicine and tamoxifen. The drugs which confidence interval exceeds 50% were imiquimod,tamoxifen and verapamil. The comparison between the drugs for the treatment of keloid was not significant.As for the keloid adjuvant therapy,steroids and imiquimod were superior to other drugs in term of the recurrence rate whereas tamoxifen had the highest recurrence rate. Conclusions Options of drugs for keloid treatment: steroids,bleomycin,mitomycin C,and verapamil,while for the prevention of recurrence was steroids,the role of other drugs had yet to be confirmed.