外用维A酸治疗寻常痤疮的疗效和安全性的系统评价  

Topical Retinoids for Acne Vulgaris: Efficacy and Safety: a Systematic Review

作　　者：李玲[1] 冉玉平[1] 李静[2] 熊琳[1] 周光平[1] 张幼嘉[3] 付远忠[3] 蒋献[1] 李芳[3] 

机构地区：[1]四川大学华西医院皮肤性病科,成都610041 [2]四川大学华西医院临床流行病学教研室,成都610041 [3]成都市第一人民医院

出　　处：《中华皮肤科杂志》2005年第4期214-216,共3页Chinese Journal of Dermatology

摘　　要：目的评价外用维A酸治疗寻常痤疮的疗效和安全性,并与外用硫磺制剂、过氧苯甲酰、抗生素比较。方法用Cochrane协作网系统评价方法,选择有随机对照的临床试验做系统评价。结果截止2002年,纳入15个临床试验2439例患者。有4个临床试验示外用维A酸疗效明显优于安慰剂[RR(相对危险度)=1.87,95%CI(可信区间)为1.13￣3.11],尤其对非炎性皮损(RR=12.70,95%CI为4.09￣39.40)。有3个临床试验示维A酸疗效优于硫磺制剂(RR=1.75,95%CI为1.42￣2.16)。与过氧苯甲酰对照的7个临床试验以及与抗生素对照的3个临床试验尚不能下结论。所有临床试验示外用维A酸制剂后,可出现红斑、脱屑等局部不良反应,虽无证据显示其系统不良反应,但对孕妇须非常谨慎。结论外用维A酸治疗寻常痤疮有效,并优于硫磺制剂,但尚无证据表明优于过氧苯甲酰或外用抗生素。有局部不良反应。需进行更多质量高、大样本的随机对照试验,以证实外用维A酸治疗寻常痤疮的作用和地位。Objective To evaluate the efficacy and safety of topical retinoids in the treatment of acne vulgaris compared with placebo, antibiotics, benzoyl peroxide and sulfur preparation. Methods According to the Cochrane reviewer′s handbook, randomized controlled clinical trials were selected for the systematic review. Results Up to 2002, 15 clinical trials (2,439 patients) that met the inclusion criteria were selected. There were four clinical trials which showed that topical retinoids were more effective than that of placebo (RR=1.87, and 95% CI: 1.13 ~ 3.11),especially for noninflammatory lesions (RR=12.70,and 95% CI : 4.09 ~ 39.40). There were 3 clinical trials which showed that topical retinoids had better efficacy than that of sulfur preparations (RR=1.75, and 95% CI: 1.42 ~ 2.16). For 7 clinical trials of retinoids compared with benzoyl peroxide, and 3 clinical trials of retinoids compared with antibiotics, no conclusion could be drawn. All the clinical trials showed that there were local side effects, including erythema, and scaling etc in the patients using topical retinoids, but no systematic side effects were observed, however, pregnant women had to be very cautious. Conclusions Topical retinoids are effective for acne vulgaris, and has better efficacy than sulfur preparation does, but there is not enough evidence to clarify that the efficacy of topical retinoids is better than that of benzoyl peroxide and antibiotics.

关 键 词：寻常痤疮 安全性 疗效 治疗 COCHRANE协作网 局部不良反应 过氧苯甲酰 临床试验 外用硫磺制剂 系统评价方法 随机对照试验 2002年 相对危险度 维A酸制剂 抗生素 可信区间 炎性皮损 安慰剂 大样本 证据 

分 类 号：R758.733[医药卫生—皮肤病学与性病学] R4[医药卫生—临床医学]