光动力疗法治疗皮肤鲍温病的系统评价

目的系统评价光动力疗法（photodynamic therapy,PDT）治疗皮肤鲍温病的疗效与安全性。方法计算机检索PubMed、OVID、Cochrane图书馆临床对照试验库、CBM和CNKI等电子数据库,纳入PDT治疗皮肤鲍温病的随机对照试验（RCT）。检索时间从1966年1月至2010年3月。检索语种限中、英文。对纳入RCT进行质量评价,提取有效数据,采用RevMan 5.0.23版软件进行Meta分析。结果共纳入5个RCT,共354例患者,496处皮损,其中试验组皮损237处,对照组皮损259处。Meta分析结果显示：PDT组的治愈率高于安慰剂组[RR=4.16,95%CI（1.69,10.25）]或外用氟尿嘧啶软膏治疗组[RR=1.38,95%CI（1.12,1.71）],而与冷冻治疗组无显著差别;PDT组的美容效果评价优于冷冻组[RR=1.48,95%CI（1.18,1.87）]或外用氟尿嘧啶软膏治疗组[RR=1.51,95%CI（1.05,2.15）];PDT组的复发率低于安慰剂治疗组[RR=0.29,95%CI（0.10,0.86）],但与冷冻组或外用氟尿嘧啶软膏组无显著差异。以红光为光源的PDT组治愈率高于绿光光源组的PDT[RR=1.29,95%CI（1.02,1.65）],复发率低于后者[RR=0.20,95%CI（0.05,0.87）]。两次光照治疗方案与单次光照治疗方案的治愈率及美容效果评价无显著差异。PDT治疗的不良反应包括不同程度的疼痛、局部感觉异常、局部炎症反应、色素沉着、结痂。结论现有有限证据表明,PDT治疗皮肤鲍温病的疗效优于安慰剂、冷冻或外用氟尿嘧啶软膏等对照治疗,复发率低于安慰剂,不良反应与对照组相似;红光-PDT治疗疗效优于绿光-PDT,复发率低,而不良反应两者相似;两次光照治疗方案与单次光照治疗的疗效无明显差异,但前者疼痛明显。

Efficacy and Safety of Photodynamic Therapy on Cutaneous Bowen Disease:A Systematic Review

Objective To assess the effcacy and safety of photodynamic therapy（PDT） for cutaneous bowen disease.Methods We electronically searched PubMed,OVID,Cochrane Central Register of Controlled Trials,CBM,and CNKI databases from January,1966 to March,2010.The language was con ned to English and Chinese.We screened the retrieved randomized controlled trials（RCTs） according to the prede ned inclusion criteria,evaluated the quality of the included studies,and performed meta-analysis with RevMan 5.0.23 software.Results Five RCTs were included;among all 496 skin lei-sions on 354 patients,237 were in trial group while the other 259 were in control group.The healing rate of PDT was higher than that of both placebo（RR=4.16,95%CI 1.69 to 10.25） and topical uorouracil（RR=1.38,95%CI 1.12 to 1.71）,and was similar to that of cryotherapy.The cosmetic outcome evaluation of PDT was better than that of both cryotherapy（RR=1.48,95%CI 1.18 to 1.87） and topical uorouracil treatment（RR=1.51,95%CI 1.05 to 2.15）.The recurrence rate of PDT was lower than that of placebo（RR=0.29,95%CI 0.10 to 0.86）,and was similar with cryotherapy or topical uorouracil treatment re-spectively.The healing rate of PDT with red light source was higher than that of PDT with green light（RR=1.29,95%CI 1.02 to 1.65）,and the recurrence rate of the former was lower than that of the latter（RR=0.20,95%CI 0.05 to 0.87）.There was no di erence between 2-fold illumination scheme and single illumination scheme in the healing rate or the cosmetic outcome evaluation.The adverse effects include pain,cacesthesia,in ammatory reaction,hyperpigmentation,and crusting.Conclu-sion The limited evidence indicates that the effcacy of PDT is better than those of placebo,cryotherapy or topical uoro-uracil treatment,the recurrence rate of PDT is lower than that of placebo,and the adverse effects are similar comparing to control groups.The PDT with red light source is superior to PDT with green light source for having better effectiveness,less recurrence and similar adverse effects.The 2-fold illumination scheme and single illumination scheme have similar effcacy,but the former is more painful.