CAJ | 학술논문

目的系统评价他克莫司及吡美莫司软膏外用治疗白癜风的疗效与安全性.方法计算机检索MEDLINE(1966～2008.6)、Cochrane临床对照试验资料库(Cochrane图书馆2008年第4期)、EMbase(1980～2008.6)、CBM(1978～2008.6)、CNKI(1979～2008.6),手工检索相关会议文献,文种限于中文和英文.根据纳入和排除标准筛选文献,收集所有相关随机对照试验(RCT),提取资料和进行质量评价,采用Rev Man 4.2软件对数据进行Meta分析.结果共纳入14个RCT,其中11个自身对照研究共414例,其余3个研究共182例.他克莫司+准分子光治疗引起75%以上色素恢复率优于单独准分子光照射[RR=-2.28,95%CI(1.02,5.1 0)];显效率及有效率亦显著高于单独照射治疗[显效率:RR=1.24,95%CI(1.13,1.37);有效率:RR=5.40,95%CI(1.82,16.09)].吡美莫司+准分子光照射引起最初色素恢复的照光次数明显少于单独准分子光照射[WMD=-3.00,95%CI(-3.22,-2.78)],且对面部皮损复色率显著高于单独准分子光照射.他克莫司+复方卡力孜然酊外用显效率及有效率均显著优于复方卡力孜然酊单独外用[显效率:RR=1.83,95%CI(1.14,2.94);有效率:RR=1.31,95%CI(1.01,1.71)].与对照组相比,他克莫司+NB-UVB照射、他克莫司或吡美莫司软膏单独外用疗效无明显优势.他克莫司或吡美莫司软膏外用不良反应轻微且可耐受.结论有限证据表明,他克莫司软膏+准分子光照射或复方卡力孜然酊外用可提高白斑消退的显效率或有效率;吡美莫司软膏+准分子光照射可减少引起最初色素恢复的照光次数,且对于面部皮损复色率显著优于单独准分子光照射.
목적 계통평개타극막사급필미막사연고외용치료백전풍적료효여안전성.방법 계산궤검색MEDLINE(1966～2008.6)、Cochrane림상대조시험자료고(Cochrane도서관2008년제4기)、EMbase(1980～2008.6)、CBM(1978～2008.6)、CNKI(1979～2008.6),수공검색상관회의문헌,문충한우중문화영문.근거납입화배제표준사선문헌,수집소유상관수궤대조시험(RCT),제취자료화진행질량평개,채용Rev Man 4.2연건대수거진행Meta분석.결과 공납입14개RCT,기중11개자신대조연구공414례,기여3개연구공182례.타극막사+준분자광치료인기75%이상색소회복솔우우단독준분자광조사[RR=-2.28,95%CI(1.02,5.1 0)];현효솔급유효솔역현저고우단독조사치료[현효솔:RR=1.24,95%CI(1.13,1.37);유효솔:RR=5.40,95%CI(1.82,16.09)].필미막사+준분자광조사인기최초색소회복적조광차수명현소우단독준분자광조사[WMD=-3.00,95%CI(-3.22,-2.78)],차대면부피손복색솔현저고우단독준분자광조사.타극막사+복방잡력자연정외용현효솔급유효솔균현저우우복방잡력자연정단독외용[현효솔:RR=1.83,95%CI(1.14,2.94);유효솔:RR=1.31,95%CI(1.01,1.71)].여대조조상비,타극막사+NB-UVB조사、타극막사혹필미막사연고단독외용료효무명현우세.타극막사혹필미막사연고외용불량반응경미차가내수.결론 유한증거표명,타극막사연고+준분자광조사혹복방잡력자연정외용가제고백반소퇴적현효솔혹유효솔;필미막사연고+준분자광조사가감소인기최초색소회복적조광차수,차대우면부피손복색솔현저우우단독준분자광조사.
Objective To assess the efficacy and safety of tacrolimus and pimecrolimus ointment for treating Vitiligo. Methods We searched the MEDLINE (1966 to June 2008), Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4, 2008), OVID (1978 to June 2008), EMbase (1980 to June 2008), CBM (1978 to June 2008), and CNKI (1979 to June 2008) to collect randomized controlled trials (RCTs). We also handsearched relevant journals and conference proceedings. The language was confined to English and Chinese. We screened the retrieved studies according to the predefined indusion and exdusion criteria, evaluated the quality of included studies, and performed meta-analyses using the Cochrane Collaboration's RevMan 4.2 software. Results Fourteen trials involving 414 patients in 11 self-control trials and 182 patients in other 3 trials were included and assessed. The rate of 75% repigmentation induced by combination of topical tacrolimus with monochromatic excimer light was higher than that of control [RR= -2.28, 95%CI (1.02, 5.10)]. The efficacy rate of combination treatment was also obviously higher than that of control [RR= 1.24, 95%CI (1.13, 1.37)]. The irradiation number of initial repigmentation induced by combination of topical pimecrolimus with monochromatic excimer light was less than that of control [WMD=-3.00, 95%CI (-3.22,-2.78)], and the repigmentationrate of facial lesions in the combination group was higher than that of control. The efficacy rate of topical tacrolimus combination with Fufang Kaliziran Ding was significantly higher than that of control [RR= 1.83, 95% (1.14, 2.94)]. No significant difference was seen between topical tacrolimus combination with the NB-UVB groupand the control group, or between the topical tacrolimus or pimecrolimus alone group with the control group. The side effects were limited and brief. Conclusion The limited evidence indicats that the combination of topical tacrolimus with monochromatic excimer light or Fufang Kaliziran Ding could improve the efficacy rate of treating vitiligo leukoplakia. The combination of topical pimecrolimuswith monochromatic excimer light shortens the irradiation number of initial repigmentation and works better on facial lesions.