中华实验眼科杂志
中華實驗眼科雜誌
중화실험안과잡지
CHINESE JOURNAL OF EXPERIMENTAL OPHTHALMOLOGY
2013年
11期
1069-1073
,共5页
翼状胬肉%环孢素A%复发%泪液分泌试验Ⅰ%Meta分析
翼狀胬肉%環孢素A%複髮%淚液分泌試驗Ⅰ%Meta分析
익상노육%배포소A%복발%루액분비시험Ⅰ%Meta분석
Pterygium%Cyclosporine A%Recurrence%Schirmer Ⅰ test%Meta-analysis
背景 翼状胬肉是常见的眼表疾病,目前主要采取手术行翼状胬肉切除治疗,然而术后复发率较高.近年来有研究提出术后局部应用环孢素A(CsA)能有效降低其术后复发概率,但尚缺乏循证医学评价的证据. 目的 为CsA在翼状胬肉切除术中临床疗效的评价寻求循证依据. 方法 采用检索策略并选择关联检索词对数据库建库至2012年10月已发表有关比较翼状胬肉术后是否使用CsA滴眼剂的随机对照试验(RCT)和前瞻性队列研究(Cohort)进行检索,检索的数据库包括MEDLINE、EMBASE、Cochrane图书馆、中国期刊全文数据库(CNKI)、万方数据库和维普数据库(VIP),由2名研究者独立提取资料,对符合纳入标准的文献进行meta分析.Meta分析中纳入的关联结局指标包括术后复发率、Schirmer试验Ⅰ(SⅠt)及术后并发症发生率.采用RevMan5.0软件进行统计分析,若纳入的各研究无异质性(P≥0.1,异质性检验Ⅰ2＜50％),对计数指标的相对危险度(RR)和计量指标的加权均数差(WMD)采用固定效应模型进行分析,反之则采用随机效应模型,计算各指标95％可信区间(CI).结果 共检索到符合纳入标准的相关文献6篇,包括RCT 4篇和Cohort研究2篇,1篇RCT的Jadad量表评分为5分,另3篇均为2分；2篇Cohort研究的纽卡斯尔-渥太华量表(NOS)评分为6～7分,共纳入309例366眼.6篇文献发表时间为2008-2012年.Meta分析显示,CsA组术后翼状胬肉的复发率和并发症的发生率均明显低于对照组,差异均有统计学意义(RR=0.39;95％ CI:0.24～ 0.64,P=0.0002;RR=0.24;95％ CI:0.13 ～0.44,P＜0.00001).CsA组术眼术后SⅠt较术前的提高值明显高于对照组,差异有统计学意义(WMD=2.47,95％CI:1.59～3.35,P＜0.00001).亚组分析结果与合并结果吻合. 结论 翼状胬肉切除术中使用CsA滴眼剂能有效降低术后复发率及术后并发症的发生率.
揹景 翼狀胬肉是常見的眼錶疾病,目前主要採取手術行翼狀胬肉切除治療,然而術後複髮率較高.近年來有研究提齣術後跼部應用環孢素A(CsA)能有效降低其術後複髮概率,但尚缺乏循證醫學評價的證據. 目的 為CsA在翼狀胬肉切除術中臨床療效的評價尋求循證依據. 方法 採用檢索策略併選擇關聯檢索詞對數據庫建庫至2012年10月已髮錶有關比較翼狀胬肉術後是否使用CsA滴眼劑的隨機對照試驗(RCT)和前瞻性隊列研究(Cohort)進行檢索,檢索的數據庫包括MEDLINE、EMBASE、Cochrane圖書館、中國期刊全文數據庫(CNKI)、萬方數據庫和維普數據庫(VIP),由2名研究者獨立提取資料,對符閤納入標準的文獻進行meta分析.Meta分析中納入的關聯結跼指標包括術後複髮率、Schirmer試驗Ⅰ(SⅠt)及術後併髮癥髮生率.採用RevMan5.0軟件進行統計分析,若納入的各研究無異質性(P≥0.1,異質性檢驗Ⅰ2＜50％),對計數指標的相對危險度(RR)和計量指標的加權均數差(WMD)採用固定效應模型進行分析,反之則採用隨機效應模型,計算各指標95％可信區間(CI).結果 共檢索到符閤納入標準的相關文獻6篇,包括RCT 4篇和Cohort研究2篇,1篇RCT的Jadad量錶評分為5分,另3篇均為2分；2篇Cohort研究的紐卡斯爾-渥太華量錶(NOS)評分為6～7分,共納入309例366眼.6篇文獻髮錶時間為2008-2012年.Meta分析顯示,CsA組術後翼狀胬肉的複髮率和併髮癥的髮生率均明顯低于對照組,差異均有統計學意義(RR=0.39;95％ CI:0.24～ 0.64,P=0.0002;RR=0.24;95％ CI:0.13 ～0.44,P＜0.00001).CsA組術眼術後SⅠt較術前的提高值明顯高于對照組,差異有統計學意義(WMD=2.47,95％CI:1.59～3.35,P＜0.00001).亞組分析結果與閤併結果吻閤. 結論 翼狀胬肉切除術中使用CsA滴眼劑能有效降低術後複髮率及術後併髮癥的髮生率.
배경 익상노육시상견적안표질병,목전주요채취수술행익상노육절제치료,연이술후복발솔교고.근년래유연구제출술후국부응용배포소A(CsA)능유효강저기술후복발개솔,단상결핍순증의학평개적증거. 목적 위CsA재익상노육절제술중림상료효적평개심구순증의거. 방법 채용검색책략병선택관련검색사대수거고건고지2012년10월이발표유관비교익상노육술후시부사용CsA적안제적수궤대조시험(RCT)화전첨성대렬연구(Cohort)진행검색,검색적수거고포괄MEDLINE、EMBASE、Cochrane도서관、중국기간전문수거고(CNKI)、만방수거고화유보수거고(VIP),유2명연구자독립제취자료,대부합납입표준적문헌진행meta분석.Meta분석중납입적관련결국지표포괄술후복발솔、Schirmer시험Ⅰ(SⅠt)급술후병발증발생솔.채용RevMan5.0연건진행통계분석,약납입적각연구무이질성(P≥0.1,이질성검험Ⅰ2＜50％),대계수지표적상대위험도(RR)화계량지표적가권균수차(WMD)채용고정효응모형진행분석,반지칙채용수궤효응모형,계산각지표95％가신구간(CI).결과 공검색도부합납입표준적상관문헌6편,포괄RCT 4편화Cohort연구2편,1편RCT적Jadad량표평분위5분,령3편균위2분；2편Cohort연구적뉴잡사이-악태화량표(NOS)평분위6～7분,공납입309례366안.6편문헌발표시간위2008-2012년.Meta분석현시,CsA조술후익상노육적복발솔화병발증적발생솔균명현저우대조조,차이균유통계학의의(RR=0.39;95％ CI:0.24～ 0.64,P=0.0002;RR=0.24;95％ CI:0.13 ～0.44,P＜0.00001).CsA조술안술후SⅠt교술전적제고치명현고우대조조,차이유통계학의의(WMD=2.47,95％CI:1.59～3.35,P＜0.00001).아조분석결과여합병결과문합. 결론 익상노육절제술중사용CsA적안제능유효강저술후복발솔급술후병발증적발생솔.
Background Pterygium is a common ocular surface disease and its treatment is surgical excision.But recurrence rate of pterygium is high after operation.Recently,some studies showed that the postoperatively topical administration of cyclosporine A (CsA) reduce the recurrence of pterygium,but this conclusion needs basis of evidence-based medicine.Objective This systematic review was to investigate the efficacy and safety of postoperatively topical usage of CsA in preventing the recurrence of primary pterygium.Methods A systematic literature retrieval was conducted and the relative articals were searched from MEDLINE,EMBASE,Cochrane Library,CNKI,Wanfang and VIP databases up to October 2012 according to searching strategy and correlated words.Randomized controlled trial (RCT) and prospective Cohort studies data were extracted by two researchers separately.The outcome parameters,such as the rate of recurrence,Schirmer Ⅰ test (S Ⅰ t) and complications were analyzed.The statistical analysis of the relative risk (RR) or weighted mean difference (WMD) was performed using a RevMan 5.0 software.Fixed-effect model was used for the inhomogeneity multiple studies (P≥0.1,homogeneity test I2 ＜ 50％),and random-effect model was used for the homogeneity study.Results Six prospective studies involving 366 eyes of 309 participants were identified,including 4 RCT and 2 non-RCT.The literature was published in 2008-2012 with the Jadad 5 scores in 1 paper and 2 scores in 3 papers for RCT and 6-7NOS (The Newcastle-Ottawa Scale) scores in 2 papers for Cohort studies.Meta-analysis showed that the recurrence and complication rates were significantly lower in the CsA group than those of the control group (RR =0.39,95 ％ CI:0.24-0.64,P =0.0002 and RR =0.24,95％ CI:0.13-0.44,P ＜ 0.00001) respectively.The postoperatively increased value of S Ⅰ t in the CsA group was significantly higher than that of the control group (WMD =2.47,95％CI:1.59-3.35,P ＜ 0.00001).Subgroups analyses suggested that the results were comparatively reliable.Conclusions Postoperative application of CsA can be effective for preventing recurrences and reducing complications after primary pterygium surgery.
