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安全性.方法陆军军医大学(第三军医大学)第一附属医院整形外科通过检索Pubmed、Embase、Cochrane Library、Wanfang Data和CNKI数据库,搜索有关点阵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安全性的随机对照试验(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后,采用Stata 16.0软件进行网状Meta分析.结果共纳入55个RCT,包括4779例患者.网状Meta分析结果显示,在色素沉着发生率方面,最佳累积概率排序为:点阵CO_(2)激光+富血小板血浆(platelet-rich plasma,PRP;79.9%)>点阵CO_(2)激光+表皮生长因子凝胶(70.2%)>点阵CO_(2)激光+硅酮凝胶(64.3%)>点阵CO_(2)激光+胶原贴敷料(58.0%)>点阵CO_(2)激光+透明质酸敷料(56.6%)>点阵CO_(2)激光+重组碱性成纤维细胞生长因子(55.6%)>点阵CO_(2)激光+积雪苷霜(51.8%)>点阵CO_(2)激光+果酸(38.8%)>点阵CO_(2)激光+微针(23.4%)>点阵CO_(2)激光(1.3%).在误工时间方面,最佳累积概率排序为:点阵CO_(2)激光+PRP(97.0%)>点阵CO_(2)激光+表皮生长因子凝胶(72.8%)>点阵CO_(2)激光+硅酮凝胶(68.7%)>点阵CO_(2)激光+积雪苷霜(40.7%)>点阵CO_(2)激光+胶原贴敷料(20.7%)>点阵CO_(2)激光(0).在水肿发生率方面,最佳累积概率排序为:点阵CO_(2)激光+PRP(73.5%)>点阵CO_(2)激光+表皮生长因子凝胶(70.4%)>点阵CO_(2)激光+胶原贴敷料(68.8%)>点阵CO_(2)激光+透明质酸敷料(63.8%)>点阵CO_(2)激光+果酸(51.0%)>点阵CO_(2)激光+硅酮凝胶(36.0%)>点阵CO_(2)激光(19.9%)>点阵CO_(2)激光+重组碱性成纤维细胞生长因子(16.4%).在感染发生率方面,最佳累积概率排序为:点阵CO_(2)激光+PRP(75.6%)>点阵CO_(2)激光+表皮生长因子凝胶(71.7%)>点阵CO_(2)激光(33.3%)>点阵CO_(2)激光+微针(19.4%).结论点阵CO_(2)激光联合PRP可能是点阵CO_(2)激光联合其他非手术方式治疗痤疮瘢痕中最安全的治疗方式,可以有效降低单用点阵CO_(2)激光治疗痤疮瘢痕过程中的色素沉着发生率、误工时间、水肿和感染发生率,增加患者的依从性.
Objective To systematically review the safety of carbon dioxide fractional laser combined with other non-surgical treatments on patients with acne scars.Methods PubMed,EMbase,the Cochrane Library,WanFang Data and CNKI databases were electronically searched to collect randomized controlled trials(RCTs)on the safety of carbon dioxide fractional laser and carbon dioxide fractional laser combined with other non-surgical treatments on patients with acne scars from inception to June 2023.Two reviewers inde-pendently screened the literature,extracted data and assessed the risk of bias in included studies.The network meta-analysis was then performed using Stata 16.0 software.Results A total of 55 RCTs involving 4779 patients were included.The results of network meta-analysis showed that the probability order of the treatments on pigmentation incidence was:fractional CO2 laser+platelet-rich plasma(PRP;79.9%)>fractional CO2 laser+epidermal growth factor dressing(70.2%)>fractional CO2 laser+silicone gel(64.3%)>fractional CO2 laser+collagen dressing(58.0%)>fractional CO2 laser+hyaluronic acid dressing(56.6%)>fractional CO2 laser+recombinant basic fi-broblast growth factor(55.6%)>fractional CO2 laser+asiaticoside cream ointment(51.8%)>fractional CO2 laser+fruit acid(38.8%)>frac-tional CO2 laser+microneedling(23.4%)>fractional CO2 laser(1.3%).In terms of lost time,the probability order of the treatments was:fractional CO2 laser+PRP(97.0%)>fractional CO2 laser+epidermal growth factor dressing(72.8%)>fractional CO2 laser+silicone gel(68.7%)>fractional CO2 laser+asiaticoside cream ointment(40.7%)>fractional CO2 laser+collagen dressing(20.7%)>fractional CO2 laser(0).In the term of edema incidence,the probability order of the treatments was:fractional CO2 laser+PRP(73.5%)>fractional CO2 laser+epidermal growth factor dressing(70.4%)>fractional CO2 laser+collagen dressing(68.8%)>fractional CO2 laser+hyaluronic acid dressing(63.8%)>fractional CO2 laser+fruit acid(51.0%)>fractional CO2 laser+silicone gel(36.0%)>fractional CO2 laser(19.9%)>fractional CO2 laser+recombinant basic fibroblast growth factor(16.4%).In terms of infection incidence,the probability order of the treatments was:frac-tional CO2 laser+PRP(75.6%)>fractional CO2 laser+epidermal growth factor dressing(71.7%)>fractional CO2 laser(33.3%)>fractional CO2 laser+microneedling(19.4%).Conclusion The current evidence shows that carbon dioxide fractional laser combined with PRP is the safest treatment among carbon dioxide fractional laser combined with other non-surgical treatments,which effectively reduces pigmen-tation incidence,lost time,edema incidence,and infection incidence induced by fractional CO2 laser in patients with acne scars,as well as improve patient compliance.
作者
蒋敏
夏录凡
张警泓
陈煦
刘骆家
张泽
刘小强
武潮
江旭品
陈颖
张家平
JIANG Min;XIA Lufan;ZHANG Jinghong;CHEN Xu;LIU Luojia;ZHANG Ze;LIU Xiaoqiang;WU Chao;JIANG Xupin;CHEN Ying;ZHANG Jiaping(Department of Plastic Surgery,State Key Laboratory of Trauma and Chemical Poisoning,the First Afiliated Hospital of Army Medical University,the Third Military Medical University,Chongqing 400038,China)
出处
《中国美容整形外科杂志》
CAS
2024年第8期465-470,I0006,I0007,共8页
Chinese Journal of Aesthetic and Plastic Surgery
基金
国家自然科学基金(82272285)。
