点阵CO_(2)激光联合富血小板血浆治疗萎缩性痤疮瘢痕的系统评价  

A systemic review of the effectiveness and safety of fractional CO_(2) laser combined with platelet-rich plasma in the treatment of atrophic acne scars

作　　者：宋黎[1] 陆茂[1] 唐懿[1] 刘彦麟[1] Song Li;Lu Mao;Tang Yi;Liu Yanlin(Department of Dermatology,First Affiliated Hospital of Chengdu Medical College,Chengdu 610500,Sichuan Province,China)

机构地区：[1]成都医学院第一附属医院皮肤性病科,四川省成都市610500

出　　处：《中国组织工程研究》2023年第35期5734-5740,共7页Chinese Journal of Tissue Engineering Research

基　　金：四川省卫生和计划委员会资助课题(120480),课题负责人:宋黎。

摘　　要：目的:萎缩性瘢痕是痤疮最常见的并发症,对患者的心理及生活质量造成很大影响。点阵CO_(2)激光联合富血小板血浆展示了良好的治疗前景。文章拟采用Meta分析方法评价点阵CO_(2)激光联合富血小板血浆治疗萎缩性痤疮瘢痕的有效性及安全性。方法:计算机检索截至2022年9月的The Cochrane Library、PubMed、Web of Science、EMbase、中国知网(CNKI)、万方数据库、维普中文科技期刊全文数据库、中国生物医学文献数据库中关于点阵CO_(2)激光联合富血小板血浆治疗萎缩性痤疮瘢痕的临床试验,手工检索补全资料。经2名研究人员筛选出纳入的研究并进行文献质量评价,最后对纳入研究采用Revman 5.3软件进行Meta分析,不能Meta分析的资料采用描述性分析。结果:共纳入13个研究,包括642例患者。Meta分析结果显示:①点阵CO_(2)激光联合富血小板血浆组治疗萎缩性痤疮瘢痕总有效率高于点阵CO_(2)激光组(OR=3.95,95%CI=2.23-7.00,P<0.00001);②点阵CO_(2)激光联合富血小板血浆组患者满意度高于点阵CO_(2)激光组(OR=4.19,95%CI=1.05-16.76,P=0.04);③点阵CO_(2)激光联合富血小板血浆组术后红斑、水肿时间均短于点阵CO_(2)激光组(MD=-0.98,95%CI=-1.19至-0.77,P<0.00001;MD=-0.92,95%CI=-1.36至-0.48,P<0.0001),色素沉着发生率低于点阵CO_(2)激光组(OR=0.21,95%CI=0.06-0.70,P=0.01);④点阵CO_(2)激光联合富血小板血浆组术后愈合时间及停工时间均短于点阵CO_(2)激光组(MD=-2.79,95%CI=-3.28至-2.30,P<0.00001;MD=-2.68,95%CI=-3.15至-2.21,P<0.00001)。结论:目前证据显示点阵CO_(2)激光联合富血小板血浆治疗萎缩性痤疮瘢痕效果优于单独使用点阵CO_(2)激光,且术后愈合更快,红斑、水肿及色素沉着等不良反应更少。OBJECTIVE:Atrophic scar is the most common complication of acne,which has a great impact on patients'psychology and quality of life.Fractional CO_(2) laser combined with platelet-rich plasma shows promising therapeutic prospects.This study systematically evaluated the effectiveness and safety of fractional CO_(2) laser combined with platelet-rich plasma in the treatment of atrophic acne scars.METHODS:The Cochrane Library,PubMed,Web of Science,EMbase,CNKI,WanFang,VIP and Chinese Biomedical Literature Database were searched for literature related to clinical trials on fractional CO_(2) laser combined with platelet-rich plasma for the treatment of atrophic acne scar up to September 2022.Manual retrieval was conducted to complete the data.The included studies were screened and evaluated for literature quality by two researchers,and finally Meta-analysis was performed using Revman 5.3 software for the included studies,and descriptive analysis was used for data that could not be Meta-analyzed.RESULTS:A total of 13 studies involving 642 patients were included.Meta-analysis results showed that compared with the fractional CO_(2) laser alone group,the fractional CO_(2) laser combined with platelet-rich plasma group had significantly better overall response rate(odds ratio(OR)=3.95,95%confidence interval(CI)=2.23 to 7.00,P<0.00001),better patient satisfaction(OR=4.19,95%CI=1.05 to 16.76,P=0.04),shorter duration of erythema and edema(mean difference(MD)=-0.98,95%CI=-1.19 to-0.77,P<0.00001;MD=-0.92,95%CI=-1.36 to-0.48,P<0.0001 respectively),less post-inflammatory hyperpigmentation(OR=0.21,95%CI=0.06 to 0.70,P=0.01),and shorter recovery time and total downtime(MD=-2.79,95%CI=-3.28 to-2.30,P<0.00001;MD=-2.68,95%CI=-3.15 to-2.21,P<0.00001,respectively).CONCLUSION:Fractional CO_(2) laser combined with platelet-rich plasma is more effective than fractional CO_(2) laser alone,with faster post-operative recovery and less adverse reactions such as erythema,edema and hyperpigmentation.

关 键 词：点阵CO_(2)激光 富血小板血浆 萎缩性痤疮瘢痕 系统评价 Meta分析 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R751.05