环孢素A在防止翼状胬肉术后复发中作用的meta分析  

Meta analysis of the topical administration of cyclosporine A in the prevention of pterygium recurrence

作　　者：潘建兵 冯一帆[2] 

机构地区：[1]浙江省温岭市第四人民医院眼科,317511 [2]复旦大学附属中山医院眼科,上海200032

出　　处：《中华实验眼科杂志》2013年第11期1069-1073,共5页Chinese Journal Of Experimental Ophthalmology

摘　　要：背景翼状胬肉是常见的眼表疾病，目前主要采取手术行翼状胬肉切除治疗，然而术后复发率较高。近年来有研究提出术后局部应用环孢素A（CsA）能有效降低其术后复发概率，但尚缺乏循证医学评价的证据。目的为CsA在翼状胬肉切除术中临床疗效的评价寻求循证依据。方法采用检索策略并选择关联检索词对数据库建库至2012年10月已发表有关比较翼状胬肉术后是否使用CsA滴眼剂的随机对照试验（RCT）和前瞻性队列研究（Cohort）进行检索，检索的数据库包括MEDLINE、EMBASE、Cochrane图书馆、中国期刊全文数据库（CNKI）、万方数据库和维普数据库（VIP），由2名研究者独立提取资料，对符合纳入标准的文献进行meta分析。Meta分析中纳入的关联结局指标包括术后复发率、Schirmer试验I（sIt）及术后并发症发生率。采用RevMan5．0软件进行统计分析，若纳入的各研究无异质性（P≥0．1，异质性检验，2〈50％），对计数指标的相对危险度（RR）和计量指标的加权均数差（WMD）采用固定效应模型进行分析，反之则采用随机效应模型，计算各指标95％可信区间（CI）。结果共检索到符合纳入标准的相关文献6篇，包括RCT4篇和Cohort研究2篇，1篇RCT的Jadad量表评分为5分，另3篇均为2分；2篇Cohort研究的纽卡斯尔一渥太华量表（NOS）评分为6～7分，共纳入309例366眼。6篇文献发表时间为2008--2012年。Meta分析显示，CsA组术后翼状胬肉的复发率和并发症的发生率均明显低于对照组，差异均有统计学意义（RR：0．39；95％CI：0．24～0．64，P=0．0002；RR=0．24；95％CI：0．13—0．44，P〈0．00001）。CsA组术眼术后sIt较术前的提高值明显高于对照组，差异有统计学意义（WMD=2．47，95％CI：1．59～3．35，P〈0．00001）。亚组分析结果与合并结果吻合。结论翼状胬肉切除术中使用CsA滴眼剂能有�Background Pterygium is a common ocular surface disease and its treatment is surgical excision. But recurrence rate of pterygium is high after operation. Recently, some studies showed that the postoperatively topical administration of cyclosporine A （CsA） reduce the recurrence of pterygium, but this conclusion needs basis of evidence-based medicine. Objective This systematic review was to investigate the efficacy and safety of postoperatively topical usage of CsA in preventing the recurrence of primary pterygium. Methods A systematic literature retrieval was conducted and the relative articals were searched from MEDLINE, EMBASE, Cochrane Library, CNKI, Wanfang and VIP databases up to October 2012 according to searching strategy and correlated words. Randomized controlled trial （RCT） and prospective Cohort studies data were extracted by two researchers separately. The outcome parameters, such as the rate of recurrence, Schirmer I test （ S I t） and complications were analyzed. The statistical analysis of the relative risk （RR） or weighted mean difference （WMD） was performed using a RevMan 5.0 software. Fixed-effect model was used for the inhomogeneity multiple studies （ P≥0. 1 ,homogeneity test 12 〈 50% ）, and random-effect model was used for the homogeneity study. Results Six prospective studies involving 366 eyes of 309 participants were identified, including 4 RCT and 2 non-RCT. The literature was published in 2008-2012 with the Jadad 5 scores in 1 paper and 2 scores in 3 papers for RCT and 6-7 NOS （The Newcastle-Ottawa Scale） scores in 2 papers for Cohort studies. Meta-analysis showed that the recurrence and complication rates were significantly lower in the CsA group than those of the control group （RR = 0. 39,95% CI： 0.24-0. 64, P = 0. 0002 and RR = 0.24,95% CI： O. 13 - 0. 44, P 〈 0. 000 01 ） respectively. The postoperatively increased value of S I t in the CsA group was significantly higher than that of the control group （ WMD = 2.47,95% CI：1. 59- 3.35, P 〈 0.

关 键 词：翼状胬肉 环孢素A 复发 泪液分泌试验I META分析 

分 类 号：R777.33[医药卫生—眼科]