他卡西醇及卡泊三醇治疗白癜风的系统评价

目的系统评价他卡西醇及卡泊三醇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，文种限于中英文。收集所有关于他卡西醇及卡泊三醇治疗白癜风的随机对照试验，根据纳入和排除标准筛选文献、提取资料，并采用Cochrane协作网推荐的方法评价纳入研究的方法学质量，采用RevMan4．2软件进行Meta分析。结果共纳入15个RCT，其中5个为自身对照研究，共包括120例患者，其余10个RCT共包括793例患者。Meta分析结果显示，他卡西醇联合窄普中波紫外线（NB—UVB）照射使治疗反应性很好者和治疗反应性一般者皮肤出现色素恢复的时间均明显短于对照组WMD=-75，95％CI（～93．93，-56．07）；WMD=-48，95％CI（-76．36，-19．64）]。他卡西醇联合准分子光引起最初色素恢复的平均照光次数明显少于对照组WMD=-0．78，95％CI（-1．02，-0．54）]；且引起最初色素恢复的光累积量亦明显低于对照组WMD=-1．06，95％CI（-1．36，-0．76）]。卡泊三醇联合补骨脂素紫外线（PUVA）治疗引起最初色素恢复及完全色素恢复的平均照光次数均明显少于对照组WMD=-2．67，95％CI（-3．06．-2．28）；WMD=-2．67，95％CI（-3．42，-1．92）]；且联合治疗组最初色素恢复及完全色素恢复的PUVA累计量亦明显低于对照组WMD=-25．68，95％CI（-29．44，-21．92）；WMD=-27．14，95％CI（-34．80，-19．48）]。卡泊三醇联合糖皮质激素组平均色素恢复时间明显短于对照组WMD=-3．87，95％CI（-5．45，-2．29）]。结论现有的有限证据表明，他卡西醇软膏联合NB—UVB，准分子光或卡泊三醇联合PUVA、糖皮质激素可缩短色素恢复时间、减少光照累积量：他卡西醇或卡泊三醇单用或联合治疗不良反应轻微，对于色紊恢复程度作用不明显。

Efficacy and Safety of Tacalcitol and Calcitriol on Vitiligo: A Systematic Review

Objective To assess the efficacy and safety of tacalcitol and calcitriol on 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）, CNKI （1979 to June 2008） to collect randomized controlled trials （RCTs）. We also hand searched relevant journals and conference proceedings. The language was confined to English and Chinese. We screened the retrieved studies according to the predefined inclusion and exclusion criteria, evaluated the quality of included studies, and performed meta-analyses by using the Cochrane Collaboration＇s RevMan 4.2 software. Results Ffiteen trials involving 120 patients in 5 self-control trials and 793 patients in other 10 randomized controlled trials were included and assessed. The time of repigmentation onset of good responders and normal responders in the side treated with a combination of topical talcitol and NB-UVB was shorter than that in the control group WMD=-75, 95%CI （-93.93, -56.07）; WMD= -48, 95%CI （-76.36, -19.64）]. The mean number and cumulative dose of excimer light exposures for initial repigmentation in the side treated with tacalcitol and 308-nm monochromatic excimer light were less than those in the control group WMD= -0.78, 95%CI （-1.02, -0.54; WMD=-1.06, 95%CI （-1.36, -0.76）]. The mean number of UVA exposures for initial repigmentation and complete repigmentation in the side treated with calcipotriol and PUVA were less than those in the control group WMD= -2.67, 95%CI （-3.06, -2.28）; WMD= -2.67, 95%CI （-3.42, -1.92）], and the cumulative UVA dose for iniitial and complete repigmentation in the combination group were also lower than those in the control group WMD=-25.68, 95%CI （-29.44,-21.92）; WMD=-27.14, 95%CI （-34.80, -19.48）]. The mean time of initial pigmentation was much shorter in the group treated with calcipotriol and corticosteroid was shorter than that in the control group WMD= -3.87, 95%CI （-5.45, -2.29）]. Conclusion The limited evidence indicated that combination of topical tacalcitol with NB-UVB or monochromatic excimer light, or the combination of topical calcipotriol with PUVA or corticosteroid shortened the time of repigmentation and decreased the cumulative irradiation dose. The side effects were limited. No obvious effect was seen on re-pigmentation degree.