A型肉毒毒素联合类固醇激素与单独类固醇激素治疗病理性瘢痕的系统评价  

Botulinum Toxin Type A Combined with Steroids Versus Steroids Alone for the Effects of Pathological Scars:A Systematic Review

作　　者：张淼 周虹 赵霞 王一枝 杨璐珊 郭杏 ZHANG Miao;ZHOU Hong;ZHAO Xia;WANG Yizhi;YANG Lushan;GUO Xing(Department of Plastic and Burn Surgery,Affi liated Hospital of Southwest Medical University,Luzhou 646000,Sichuan,China)

机构地区：[1]西南医科大学附属医院整形烧伤外科,四川泸州646000

出　　处：《中国美容医学》2023年第1期26-32,共7页Chinese Journal of Aesthetic Medicine

基　　金：四川省教育厅项目(编号:18ZB0639)。

摘　　要：目的:采用Meta分析比较A型肉毒毒素联合类固醇激素与单独类固醇激素治疗病理性瘢痕的疗效及安全性。方法:计算机检索截止2021年3月的Pubmed、EMbase、Cochrane Central Register of controlled Trail、中国知网、万方、维普以及中国生物医学文献数据库中公开发表的关于A型肉毒毒素联合类固醇激素与单独类固醇激素治疗病理性瘢痕的临床对照实验。由2名研究员根据纳入及排除标准独立筛选文献、提取资料及质量评价。使用RevMan 5.3和Stata 14.0统计软件,对结局指标进行Meta分析。结果:共纳入11项研究,包括8项随机对照试验,3项病例-队列研究,试验组采用A型肉毒毒素联合类固醇激素局灶内注射,对照组采用类固醇激素局灶内注射,纳入文献总体质量较高。Meta分析结果表明,试验组在目测类比评分[WMD=-2.26,95%CI(-3.07,-1.46),P<0.00001]、瘢痕厚度[WMD=-0.94,95%CI(-1.82,-0.06),P=0.04]、满意度评分[WMD=1.51,95%CI(1.21,1.81),P<0.00001]、有效率[RR=1.30,95%CI(1.17,1.43),P<0.00001]、复发率[RR=0.23,95%CI(0.11,0.49),P=0.0002]、不良反应发生率[RR=0.65,95%CI(0.42,0.99),P=0.04]等指标均优于对照组,而治疗后两组间瘢痕长度无显著性差异[SMD=-4.30,95%CI(-11.56,2.96),P=0.25]。结论:A型肉毒毒素联合类固醇激素治疗病理性瘢痕的疗效及安全性均优于单独使用类固醇激素。Objective This paper adopts meta-analysis to compare the effectiveness and safety of treating pathological scars with steroids alone and treating that with botulinum toxin type A combined with steroids.Methods The authors have retrieved published articles as of March 2021 of controlled clinical trials regarding treating pathological scars with steroids alone and of treating that with botulinum toxin type A combined with steroids from Pubmed,EMbase,Cochrane Central Register of Controlled Trail,CNKI,Wanfang Data,VIP,and CBMdisc.Based on the inclusion and exclusion criteria,two researchers chose literature,selected resources,and evaluated its qualities.RevMan 5.3 and Stata 14.0 were used to conduct a meta-analysis for the outcomes.Results Eleven research studies were incorporated,including eight randomized controlled trials and three casecohort studies.The experimental group was intralesional injected with botulinum toxin type A combined with steroids;the control group was intralesional injected only with steroids.Overall,the chosen literature has a high quality.The Meta-analysis results showed that the outcome indicators of the experimental group were better than the control group in terms of visual analog scale[WMD=-2.26,95%CI(-3.07,-1.46),P<0.00001],scar thickness[WMD=-0.94,95%CI(-1.82,-0.06),P=0.04],patient satisfaction score[WMD=1.51,95%CI(1.21,1.81),P<0.00001],efficacy rate[RR=1.30,95%CI(1.17,1.43),P<0.00001],relapse rate[RR=0.23,95%CI(0.11,0.49),P=0.0002],rate of adverse drug reactions[RR=0.65,95%CI(0.42,0.99),P=0.04].Nevertheless,the scar length of the two groups demonstrated no significant differences after the treatment[SMD=-4.30,95%CI(-11.56,2.96),P=0.25].Conclusion Both the effectiveness and the safety of treating pathological scars with botulinum toxin type A combined with steroids are better than that with steroids alone.

关 键 词：A型肉毒毒素 类固醇激素 病理性瘢痕 瘢痕疙瘩 目测类比评分 系统评价 Meta分析 

分 类 号：R619.6[医药卫生—外科学]