308nm准分子激光治疗白癜风随机对照试验的系统评价

目的评价308nm准分子激光治疗白癜风的疗效和安全性。方法用计算机检索Medline(1966-2010),Embase(1984-2010)、中国生物医学文献数据库(CBM 1978-2010)。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),提取资料进行质量评价,采用RevMan5.1软件对数据进行Meta分析。结果共纳入10个RCT,包括411例患者。308nm准分子激光联合0.03%～0.1%他克莫司软膏、胸腺肽注射液治疗的无效率均小于单纯308nm准分子激光治疗RR他合并=0.20,95%CI(0.08,0.51)],RR胸合并=0.62,95%CI(0.41,0.93)];308nm准分子激光联合0.1%他克莫司软膏、他卡西醇软膏治疗的75%以上色素恢复率均优于单纯308nm准分子激光照射RR=3.48,95%CI(1.39,8.70)],OR=5.71,95%CI(1.13,28.75)];308nm准分子激光联合表皮移植治疗的75%以上色素恢复率优于单独表皮移植治疗RR=0.14,95%CI(0.01,2.63)];308nm准分子激光治疗的75%以上色素恢复率优于NB-UVB照射RR=6.00,95%CI(0.81,44.35)]。所有研究均未发现严重不良反应。结论 308nm准分子激光联合0.03%～0.1%他克莫司软膏、胸腺肽注射液能降低白斑消退的无效率,308nm准分子激光联合0.1%他克莫司软膏、卡泊三醇软膏能提高75%以上色素恢复率。

Efficacy and Safety of 308-nm Excimer Laser on Vitiligo: A Systematic Review

Objective To assess the efficacy and safety of 308-nm excimer laser for treating vitiligo. Methods Electronic database Medline (1966 - 2010) ,Embase(1984 - 2010) and CBM( 1978 - 2010) were searched to collect Randomized Controlled Trials ( RCTs) . And,relevant articles of journals and conference were hand searched. The language was confined in English and Chinese. Collecting RCT,screening,retrieving of studies and evaluating the quality of the studies were based on the criteria of predefined inclusion and exclusion. Meta-analyse were conducted by RevMan 5. 1. Results Ten RCTs which involving 411 patients were included. The combination of 308-nm excimer laser therapy with either 0. 03% ～ 0. 1% tacrolimus ointment or thymosin injection had less invalid treatment rate compare to 308-nm excimer laser monotherapy RR = 0. 20,95% CI( 0. 08,0. 51) ]. The combination of 308-nm excimer laser therapy with either 0. 1% tacrolimus ointment or tacalcitol ointment were superior to 308-nm excimer laser monotherapy in terms of achieving the rate of 75% repigmentation or moreRR = 3. 48,95% CI( 1. 39,8. 70) ],OR = 5. 71,95% CI( 1. 13, 28. 75) ]. The combination of 308-nm excimer laser therapy and skin graft obtained a higher repigmentation rate of 75% or more than split skin graft aloneRR = 0. 14,95% CI( 0. 01,2. 63) ],while 308-nm excimer laser therapy achieved higher repigmentation rate of 75% or more than NB-UVB treatment RR = 6. 00,95% CI( 0. 81,44. 35) ]. No severe adverse effect was identified. Conclusion Limited evidence indicates that the combination of 308-nm excimer laser with 0. 03% ～ 0. 1% tacrolimus ointment or with thymosin injection can decrease the invalid rate of treating vitiligo leukoplakia. And,the combination of 308-nm excimer laser with 0. 1% tacrolimus or with tacalcitol ointment can improve the rate 75% repigmentation and more.