富血小板血浆治疗黄褐斑系统评价和单臂meta分析  

The application of platelet-rich plasma in melasma:a system review and single-arm meta-analysis

作　　者：陈伟权 祝瑶 张锐柠 韦汝静 李芳谷 蔡川川 CHEN Weiquan;ZHU Yao;ZHANG Ruining;WEI Rujing;LI Fanggu;CAI Chuanchuan(Department of Dermatology and Cosmetology,Dongguan Maternity&Child Healthcare Hospital,Dongguan 523000,)

机构地区：[1]广东省东莞市妇幼保健院皮肤医学美容科,东莞523000 [2]广东医科大学附属医院皮肤性病科

出　　处：《实用皮肤病学杂志》2024年第3期139-145,166,共8页Journal of Practical Dermatology

摘　　要：目的系统评价富血小板血浆(PRP)在黄褐斑应用中的临床疗效及安全性。方法计算机检索中国知网、万方数据、SinoMed、PubMed、Embase、Webofscience、Cochrane library数据库,以及中国临床试验注册中心和ClinicalTrials.gov自建库起至2023年1月收录的相关研究。使用MINORS工具对文献进行质量评价,采用Stata14.0进行单臂meta分析。结果共纳入19项研究,550例黄褐斑患者接受PRP治疗前后的数据。随机效应模型meta分析示PRP疗效显著,黄褐斑面积和严重度指数(MASI)下降6.82分(95%CI:-9.77,-3.87);改良MASI(mMASI)下降5.62分(95%CI:-7.79,-3.45);显效率为55.3%(95%CI:42.2%,68.1%)有效率为88.8%(95%CI:77.7%,96.7%);总体满意率为93.0%(95%CI:79.0%,100.0%)。meta回归分析显示:①联合治疗显效率高于单独PRP治疗(72.7%vs41.7%,P=0.011);②采用微针或水光注射等方式导入PRP的显效率高于浅表微注射(70.7%vs39.0%,P=0.011);③更长治疗或观察期的显效率高于较短期研究(71.9%vs 38.2%,P-=0.01)。结论PRP对黄褐斑疗效良好,不良反应轻,无明显长期不良事件。当联合治疗、采用微针或水光注射导入、采取更长治疗周期时,皮损可获得更显著的改善。Objective To systematically evaluate the efficacy and safety of platelet-rich plasma(PRP)in melasma treatment.Methods The relevant studies up to January 2023 were collected from multiple databases,including CNKI,WanFang,SinoMed,PubMed,Embase,Web of Science,Cochrane library,Chinese Clinical Trial Registry Platform,and ClinicalTrials.gov.The study quality was evaluated using the MINORS software and the single-arm meta-analysis was performed using the Stata 14.0.Results A total of 19 studies were included in the meta-analysis,comprising pre-and post-treatment data from 550 patients with melasma.The random-effect model of meta-analysis showed that PRP significantly improved melasma,resulting in the decrease of melasma area and scoring index(MASI)scores[-6.82,(95%CI:-9.77,-3.87)]and the modified-MASI scores(mMASI)[-5.62,(95%CI:-7.79,-3.45)].In addition,the remission rate(improved score≥50%),response rate(improved score≥25%),and patient satisfaction rate were 55.3%(95%CI:42.2%,68.1%),88.8%(95%CI:77.7%,96.7%),and 93.0%(95%CI:79.0%,100%),respectively.In terms of remission rate,meta-regression revealed that combined treatment outperformed single treatment of PRP(72.7%vs.41.7%,P-0.011),that the microneedle or water light injections(a kind of mesotherapy)of PRP outperformed superficial microinjection(70.7%vs.39.0%,P-0.011),and that longer treatment or longer follow-up periods outperformed short-term studies(71.9%vs.38.2%,P-0.01).Conclusion PRP has promising efficacy in treating melasma,with mild adverse effects and rare profound adverse events.The improvement of melasma may be more significant using these therapeutic approaches associated with PRP,such as combined treatment,microneedle or water light injections and longer periods of treatment.

关 键 词：黄褐斑 富血小板血浆 黄褐斑面积和严重度指数 META分析 

分 类 号：R758.42[医药卫生—皮肤病学与性病学]