阿维A治疗重症银屑病的系统评价

目的系统评价阿维A治疗重症银屑病的有效性与安全性。方法计算机检索MEDLINE、Cochrane图书馆、EM-base、CBM、CNKI和万方数字化期刊全文数据库，语种限于英、中文，根据纳入与排除标准筛选文献，纳入阿维A治疗重症银屑病的随机对照试验（Randomized Controlled Trial，RCT）。采用RevMan5．0软件进行Meta分析。结果共纳入6个RCT，包括497例患者，其中试验组338例，对照组159例。总体Meta分析结果显示常规剂量阿维A口服（≥30mg／d）与对照组疗效无统计学差异（RR=2．15，95％ci（o．72，6．42）]，P〉0．05）。亚组分析结果提示无论常规量阿维A单独口服或联合其它药物疗效均与对照组无统计学差异；阿维A单独口服10mg／d及25mg／d时，其疗效均差于依曲替酯口服（RR=0．62，95％CI（O．43，0．89）]，P〈0．05及RR=0．50，95％CI（0．33，0．77）]，P〈0．05）；阿维A联合中波紫外线治疗疗效优于安慰剂对照组（RR=2．24，95％CI（1．44，3．48）]，P〈0．05）。阿维A治疗最常见不良反应为唇炎、皮肤干燥、脱屑、脱发、甲脆，还包括一过性的血脂升高、肝功能异常。结论阿维A单独口服或联合其它药物治疗重症银屑病的疗效不确定，阿维A联合中波紫外线治疗重症银屑病可能有效。阿维A治疗不良反应轻微。由于本系统评价存在局限性，结论尚需高质量、大规模、多中心、大样本的RCT加以证实．

A systematic review of the efficacy and safety of acitretin in severe psoriasis

Objective To systematically review the efficacy and safety of acitretin in severe psoriasis. Methods The data was lectronically searched in MEDLINE, Cochrane library, EMbase, CBM, CNKI and Wan Fang digital journal full-text database. The language limited to English and Chinese. According to the including and excluding criteria, randomized controlled trials （RCTs） about the acitre- tin on severe psoriasis were included and RevMan50 software was used for Meta-analysis. Results Six RCTs involved 497 patients, which include 338 cases and 159 controls. The results of total meta-analyses have shown that the efficacy of routine acitretin administra- tion（~〉30mg/d） had no statistical sinificance compared with control group（ RR = 2. 15, 95% CI（0. 72, 6. 42）], P〉0.05 ）. The re- sults of subgroup analyses have shown that whether singly routine acitretin administration or combined with other drugs, there were no sta- tistical significance compared with control group on efficacy; the efficacy of single acitretin administrstion of 10mg/d or 25rag/d, was worse than etretinate administration RR = 0. 62, 95 % CI （0.43, 0. 89）, P〈0. 05 and （ IRT 0760） ） RR = 0. 50, 95 % CI （0. 33, 0. 77 ）, P〈0.05 ） ] ; the efficacy of routine acitretin administration plus ultraviolet combination treatment was better than placebo control （ RR = 2. 24, 95% CI（ 1.44, 3.48） ], P〈0. 05） ]. The common side effects of atrecitin were chelitis, dry skin, scaling, hairloss, nail fragile, temporary elevated blood lipids, abnormal liver function. Conclusion Limited evidence indicates the efficacy of single acitretin adminis- tration or combined with orther drugs is uncertain. Acitretin administration combination with ultraviolet treatment in severe psoriasis may be effective. The side effects are mild. Due to the limitation of the systematic evaluation, the conclusions should be verified by more high quality, large-scale, muhicenter and large specimen RCTs.