A型肉毒毒素对动物模型皮瓣手术的影响:系统评价和meta分析  

Effect of botulinum toxin type A on flap surgery in animal models:a systematic review and meta-analysis

作　　者：施舒鹏 费鲁菁 林涛 王强[1] 方泓 余刚 赵李平 Shi Shupeng;Fei Lujing;Lin Tao;Wang Qiang;Fang Hong;Yu Gang;Zhao Liping(Department of Plastic Surgery,First Affiliated Hospital,University of Science and Technology of China,Anhui Provincial Hospital,Hefei 230001,China;Xiangya School of Medicine,Central South University,Changsha 410031,China)

机构地区：[1]中国科学技术大学附属第一医院,安徽省立医院整形外科,合肥230001 [2]中南大学湘雅医学院,长沙410031

出　　处：《中华整形外科杂志》2023年第5期502-513,共12页Chinese Journal of Plastic Surgery

摘　　要：目的评估A型肉毒毒素(BTXA)对动物模型皮瓣手术的影响。方法检索1979年1月至2022年3月PubMed、Cochrane图书馆、Ovid、Web of Science、Embase、Scopus、中国生物医学文献数据库、中国知网及万方9个数据库已发表的比较使用BTXA(BTXA组)与使用生理盐水或不做处理(对照组)对动物模型皮瓣手术影响的文献,按照纳入、排除标准筛选并提取文献。观察指标包括手术后皮瓣存活率、血流量和血管内皮生长因子(VEGF)表达水平,并根据干预时间分为皮瓣手术前注射组(预处理组)和皮瓣手术中注射组、根据皮瓣类型分为随意皮瓣组和轴型皮瓣组分别进行亚组分析。使用Review Manager(RevMan) 5.3软件和Stata 15.1软件进行meta分析和系统评价。结果经过严格的纳入和排除筛选,共纳入19项研究(603只动物)。与对照组相比,BTXA组具有更高的皮瓣成活率[均数差(MD)=15.65%,95%CI:13.11%~18.19%,Z=12.08,P<0.001]、血流量[标准化均数差(SMD)=1.96,95%CI:1.39~2.54,Z=6.71,P<0.001]和VEGF表达(mRNA水平:SMD=6.01,95%CI:0.89~11.13,Z=2.30,P=0.020;蛋白质水平:SMD=3.44,95%CI:2.44~4.43,Z=6.73,P<0.001)。亚组分析显示,预处理组(MD=21.54%,95%CI:16.07%~27.01%,Z=7.71,P<0.001)的皮瓣成活率显著高于术中注射组(MD=9.40%,95%CI:6.79%~12.00%,Z=7.07,P<0.001)。随意皮瓣组(MD=20.87%,95%CI:16.67%~25.07%,Z=9.73,P<0.001)的皮瓣成活率显著高于轴型皮瓣组(MD=13.11%,95%CI:8.91%~17.31%,Z=6.12,P<0.001)。结论在动物模型中,BTXA辅助皮瓣手术可能对提高皮瓣组织成活率、皮瓣血流量以及VEGF表达有正向影响。此外,注射时机和皮瓣类型也可能是BTXA对皮瓣手术产生效应的重要因素。Objective To evaluate the effect of botulinum toxin type A(BTXA)on flap surgery in animal models.Methods Nine databases(PubMed,Cochrane Library,Ovid,Web of Science,Embase,Scopus,CBM,CNKI,and WANFANG database)were searched for published literature comparing the effects of BTXA(BTXA group)versus saline or no treatment(control group)on flap operation in animal models from January 1979 to March 2022.The literature was screened according to inclusion and exclusion criteria.Indicators included flap survival rate,blood flow and vascular endothelial growth factor(VEGF)expression level after surgery.The subjects were divided into pre-operation injection group and intraoperation injection group according to the intervention timing,and were divided into random flap group and axial flap group according to the type of flaps,and subgroup analysis was conducted respectively.Review Manager(RevMan)5.3 software and Stata 15.1 software were used for all statistical analysis.Results A total of 603 animals from 19 studies were included after rigorous inclusion and exclusion screening.Compared with control group,BTXA group revealed a significantly higher flap survival rate[mean difference(MD)=15.65%,95%CI:13.11%-18.19%,Z=12.08,P<0.001],blood flow[standardized mean difference(SMD)=1.96,95%CI:1.39-2.54,Z=6.71,P<0.001]and VEGF expression(at mRNA level:SMD=6.01,95%CI:0.89-11.13,Z=2.30,P=0.020;at protein level:SMD=3.44,95%CI:2.44-4.43,Z=6.73,P<0.001).Subgroup analysis showed that the flap survival rate of the pre-operation injection group(MD=21.54%,95%CI:16.07%-27.01%,Z=7.71,P<0.001)was significantly higher than that of the intraoperative injection group(MD=9.40%,95%CI:6.79%-12.00%,Z=7.07,P<0.001).The flap survival rate of the random flap group(MD=20.87%,95%CI:16.67%-25.07%,Z=9.73,P<0.001)was significantly higher than that of the axial flap group(MD=13.11%,95%CI:8.91%-17.31%,Z=6.12,P<0.001).Conclusion BTXA assisted flap surgery may have positive effects on the survival rate,blood flow and VEGF expression in animal models.In addition,inject

关 键 词：肉毒毒素类 A型肉毒毒素 皮瓣手术 META分析 动物模型 

分 类 号：R622[医药卫生—整形外科] R-332[医药卫生—外科学]