羊膜移植与角膜缘上皮移植治疗翼状胬肉的Meta分析  

Meta-Analysis of Limbal Autograft and Amniotic Membrane Transplantation for Pterygium

作　　者：张月梅[1] 刘永琦[2] 吴建军[2] 王宏[1] 田曼男[1] 魏志诚[1] 黎小军[1] 拜正刚[3] 

机构地区：[1]兰州大学第一医院,兰州730000 [2]甘肃中医学院,兰州730000 [3]兰州大学循证医学中心,兰州730000

出　　处：《循证医学》2009年第6期368-372,377,共6页The Journal of Evidence-Based Medicine

摘　　要：目的比较角膜缘上皮移植与羊膜移植治疗翼状胬肉的有效性和安全性。方法计算机检索MEDLINE(1996年至2008年6月)、中国期刊全文数据库(1994年至2008年6月)、中国科技期刊全文数据库(1989年至2008年6月)等数据库。纳入比较自体角膜缘上皮移植和羊膜移植治疗翼状胬肉的随机对照试验,由两名评价者独立检索、评价、提取资料并进行交叉核对。数据统计分析采用Cochrane协作网提供的RevMan4.2.10软件。结果共纳入41项研究,有41项研究报告了术后翼状胬肉的复发率,共4148只眼;14项研究报告了术后睑球粘连发生率,共1475只眼。Meta分析结果显示,自体角膜缘上皮移植组翼状胬肉复发率为5.03%,羊膜移植组翼状胬肉复发率为10.60%,两组差异有统计学意义(比值比0.45,95%可信区间0.36～0.58,Z=6.42,P<0.00001);自体角膜缘上皮移植组术后睑球粘连发生率为0.26%,羊膜移植组术后睑球粘连发生率为1.73%,两组差异有统计学意义(比值比0.21,95%可信区间0.07～0.68,Z=2.60,P=0.009)。结论自体角膜缘上皮移植术在预防翼状胬肉复发及术后睑球粘连的发生方面优于羊膜移植术。Objective To evaluate the safety and effectiveness of amniotic membrane grafting and limbal autograft in the treatment of pterygium. Methods We searched MEDLINE （1996-2008.6）,EMBASE（1974-2008.6）,CBMdisc （1996-2008.6） ,CNKI（ 1990-2008.6）and VIP（1990-2008.6）. Only randomized controlled trials（RCTs） were identified. Two reviewers indenpendently searched, assessed the quality of the included trials and then crossed checked the results. We assessed the effect of therapeutic and adverse effect by doing meta-analysis with The Cochrane Collaboration＇s Review Manager 4.2.10 software. Results 41 RCTs evaluated the pterygium recurrent rate after grafting including 4 148 eyes and the incidence rate including 1 475 eyes. The recurrent rates of pterygium were 5.03% of limbal autograft group, and 10.60% of amniotie membrane grafting group, and the difference was significant between the groups [OR 0.45,95%CI （0.36,0.58）, Z=6.42, P〈0.000 01 ] ; the incidence of symblepharon was 0.26% of limbal autograft group, and 1.73% of amniotic membrane grafting group, and the difference was significant between the groups too [OR 0.21,95%Cl（0.07,0.68）,Z=2.60,P=0.009]. Conclusion Current evidence indicates that limbal autograft is superior to amniotic membrane grafting in reducing the recurrent rate of pterygium and the incidence of symblepharon.

关 键 词：翼状胬肉 角膜缘 羊膜 移植 META分析 

分 类 号：R779.6[医药卫生—眼科]