点阵CO_(2)激光联合其他非手术方式治疗痤疮瘢痕有效性的网状荟萃分析  

Effectiveness of fractional carbon dioxide laser combined with other non-surgical therapy in treating acne scars:a network meta-analysis

作　　者：蒋敏 刘馨竹 李大伟[1] 冯柏塨 申传安[1] Jiang Min;Liu Xinzhu;Li Dawei;Feng Baigong;Shen Chuan′an(Senior Department of Burns and Plastic Surgery,the Fourth Medical Center of PLA General Hospital,Beijing 100048,China)

机构地区：[1]解放军总医院第四医学中心烧伤整形医学部,北京100048

出　　处：《中华损伤与修复杂志（电子版）》2024年第5期427-437,共11页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

基　　金：国家自然科学基金(82272279、82072169)。

摘　　要：目的系统评价点阵CO_(2)激光联合其他非手术方式治疗痤疮瘢痕的有效性。方法系统检索PubMed、Embase、Cochrane Library、中国知网及万方数据库中关于点阵CO_(2)激光和点阵CO_(2)激光联合其他非手术方式治疗痤疮瘢痕有效性的随机对照试验(RCT),检索时限均为建库至2023年6月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险,采用Stata 16.0软件进行网状荟萃分析。结果共纳入65项RCT,包括5282例患者。网状荟萃分析结果显示,在主要评价指标临床效果评分方面,与单用点阵CO_(2)激光相比,点阵CO_(2)激光联合其他非手术治疗方式明显提高了痤疮瘢痕的临床效果评分(P<0.05),其中点阵CO_(2)激光联合硅酮凝胶提高痤疮瘢痕临床效果评分最显著(MD=0.59,95%CI:0.47~0.71,P<0.05);在次要评价指标痤疮瘢痕权重(ECCA)评分方面,与单用点阵CO_(2)激光相比,点阵CO_(2)激光联合表皮生长因子凝胶(MD=-0.30,95%CI:-0.45~-0.14,P<0.05)、点阵CO_(2)激光联合重组碱性成纤维细胞生长因子(MD=-0.21,95%CI:-0.39~-0.03,P<0.05)和点阵CO_(2)激光联合微针(MD=-0.22,95%CI:-0.38~-0.05,P<0.05)明显降低了痤疮瘢痕的ECCA评分;在次要评价指标皮肤含水量方面,与单用点阵CO_(2)激光相比,点阵CO_(2)激光联合表皮生长因子凝胶显著提高了痤疮瘢痕的皮肤含水量(MD=0.24,95%CI:0.07~0.40,P<0.05)。结论当前证据显示,点阵CO_(2)激光联合硅酮凝胶是改善痤疮瘢痕最有效的联合治疗方式;同时,点阵CO_(2)激光联合表皮生长因子凝胶在增加皮肤含水量方面具有显著优势。Objective To systematically review the effectiveness of fractional carbon dioxide laser combined with other non-surgical therapy in treating acne scars.Methods PubMed,Embase,Cochrane Library,CNKI and WanFang Database were systematically searched to collect randomized controlled trial(RCT)on the effectiveness of fractional carbon dioxide laser and fractional carbon dioxide laser combined with other non-surgical therapy in treating acne scars from inception to June 2023.Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies.The network meta-analysis was then performed using Stata 16.0 software.Results A total of 65 RCTs involving 5282 patients were included.The results of network meta-analysis showed that in terms of clinical effect score,the main evaluation indicator,fractional carbon dioxide laser combined with other non-surgical therapy was more effective than fractional carbon dioxide laser alone(P<0.05).Among them,fractional carbon dioxide laser combined with silicone gel was the most effective(MD=0.59,95%CI:0.47-0.71,P<0.05).In terms oféchelle d'évaluation clinique des cicatrices d'acné(ECCA),one of the second evaluation indicators,fractional carbon dioxide laser combined with epidermal growth factor dressing(MD=-0.30,95%CI:-0.45--0.14,P<0.05),fractional carbon dioxide laser combined with recombinant basic fibroblast growth factor(MD=-0.21,95%CI:-0.39--0.03,P<0.05)and fractional carbon dioxide laser combined with microneedling(MD=-0.22,95%CI:-0.38--0.05,P<0.05)showed more significant improvements than fractional carbon dioxide laser alone.Additionally,in terms of skin hydration,one of the second evaluation indicators,fractional carbon dioxide laser combined with epidermal growth factor dressing(MD=0.24,95%CI:0.07-0.40,P<0.05)was more effective than fractional carbon dioxide laser alone.Conclusion The current evidence shows that fractional carbon dioxide laser combined with silicone gel is the most effective among combined therapies in treating acne

关 键 词：痤疮瘢痕 点阵CO_(2)激光 有效性 网状荟萃分析 

分 类 号：R75[医药卫生—皮肤病学与性病学]