【作者】 吴楠；

【导师】 丛宪玲；

【作者基本信息】 吉林大学 ， 皮肤病与性病学（专业学位）， 2020， 硕士

【摘要】 目的:痤疮是一种常见的好发于青春期男女的毛囊皮脂腺的慢性炎症性疾病,而痤疮后遗留瘢痕是痤疮患者的常见愈后,不仅造成患者的外貌损害,也对其心理健康和日常生活造成一定影响。二氧化碳点阵激光（Ablative Fractional carbon dioxide laser systems,CO₂ AFL）已证实是治疗痤疮瘢痕的一种有效方法,近年有文献研究CO₂ AFL联合自体富血小板血浆（Autologous platelet-rich plasma,PRP）与单用CO₂ AFL治疗痤疮瘢痕的疗效与安全性对比。本系统评价通过对相关文献的检索与收集,分析CO₂ AFL联合PRP治疗痤疮瘢痕的有效性及安全性,以进一步指导痤疮瘢痕患者的治疗。方法:计算机检索Web of Science、PubMed、Embase、万方数据库、中国知网、维普数据库,时间为建库至2019年11月。检索关于CO₂ AFL联合PRP与CO₂ AFL治疗痤疮瘢痕的所有随机对照试验与非随机对照研究,并检索已经纳入研究的参考文献进行筛选,以防止漏选。根据预设的纳入排除标准筛选文献,对最终纳入文献进行方法质量评价和数据提取,应用Revman5.3系统评价软件对数据进行Meta分析。结果:本Meta分析最终纳入9篇文献,其中有随机对照试验8篇,非随机对照试验1篇,共357例患者,试验组（CO₂ AFL+PRP）255例,对照组（CO₂ AFL）237例。结果如下:1.临床改善评分:共6个研究,试验组临床改善评分显著高于对照组,统计学有显著差异（MD=0.51,95%CI[0.32,0.70],P<0.000001）。2.临床改善率>75%:共4个研究,试验组临床改善率大于75%的患者显著高于对照组,统计学有显著差异（OR=4.12,95%[1.93,8.79],P=0.0003）;临床改善率>50%:共5个研究,试验组临床改善率大于50%的患者显著高于对照组,统计学有显著差异（OR=2.77,95%CI[1.62,4.71],P=0.0002）;临床改善率>25%:共4个研究,试验组临床改善率大于25%的患者显著高于对照组,统计有显著差异（OR=2.77,95%CI[1.32,5.82],P=0.007）。3.患者满意度:共7个研究,试验组治疗满意的患者例数显著高于对照组,差异有统计学意义（OR=3.61,95%CI[2.26,5.75],P<0.00001）。4.治疗后结痂期:共包含2个研究,试验组患者结痂时间显著短于对照组,差异有统计学意义（MD=-1.04,95%CI[-1.56,-0.52],P<0.0001）。5.不良反应发生例数:共5个文献研究记录了治疗后色素沉着的发生例数,Meta分析结果显示试验组色素沉着的发生例数显著少于对照组,差异有统计学意义（OR=0.27,95%CI[0.11,0.66],P=0.004）;共3个文献研究记录了红斑的发生例数,meta分析结果显示试验组红斑的发生例数显著少于对照组,差异有统计学意义（OR=0.27,95%CI[0.10,0.71],P=0.008）;共2个文献研究记录了水肿的发生例数,结果显示试验组水肿的发生例数显著少于对照组,差异有统计学意义（OR=0.21,95%CI[0.05,0.80],P=0.02）;痤疮爆发:共有2个文献研究记录了痤疮爆发的例数,试验组与对照组无显著差异（OR=0.36,95%CI[0.12,1.10],P=0.07）。6.不良反应持续时间:共3个研究记录了治疗后红斑持续时间,试验组与对照组无显著差异（MD=-1.07,95%CI[-2.39,0.25],P=0.11）;共3个研究记录了水肿持续时间,试验组与对照组无显著差异（MD=-0.53,95%CI[-1.73,0.67],P=0.39）。7.疼痛评分:共3个研究记录了患者治疗后的疼痛评分,试验组与对照组无显著差异（MD=1.03,95%CI[-1.58,3.64],P=0.44）。结论:本Meta分析结果表明应用CO₂ AFL联合PRP治疗痤疮瘢痕较单用CO₂ AFL疗效更好,且安全性更高。1.CO₂ AFL联合PRP治疗组的患者较单用CO₂ AFL组临床改善程度更高,患者满意度更高。2.CO₂ AFL联合PRP治疗组的患者红斑、水肿、色素沉着等不良反应发生率较单用CO₂ AFL组低,治疗后结痂期更短。更多还原

【Abstract】 Object: Acne is a common chronic inflammatory disease of hair follicles and sebaceous glands in adolescent men and women.However,acne scar after acne is a common disease in acne patients,which not only affects the appearance of patients but also affects the psychological and life of patients.Ablative Fractional carbon dioxide laser systems（CO₂ AFL）has been proved to be an effective method for the treatment of acne scars.In recent years,the efficacy and safety of CO₂ AFL combined with Autologous platelet-rich plasma（PRP）and CO₂ AFL alone have been compared.This system evaluated the effectiveness and safety of CO₂ AFL combined with PRP in the treatment of acne scar through the retrieval and collection of relevant literature,to further guide the treatment of patients with acne scar.Methods: Computer retrieval of Web of Science,Pub Med,EMBASE,Vip database,Chinese National Knowledge Infrastructure（CNKI）and Wanfang database was conducted until November 2019.All randomized controlled and nonrandomized controlled studies of CO₂ AFL combined with PRP and CO₂ AFL in the treatment of acne scar were searched,and references that had been included in the study were searched for screening to prevent omission.Literature was screened according to the preset inclusion and exclusion criteria,method quality evaluation and data extraction were conducted for the final included literature,and meta-analysis was conducted for the data with Revman5.3 system evaluation software.Results: Nine studies were included in this meta-analysis,including 8 randomized controlled trials and 1 non-randomized controlled trial,with a total of 357 patients.The results are as follows:1.Clinical improvement score: in a total of 6 studies,the clinical improvement score is significantly higher in the experimental group than in the control group,with a statistically significant difference（MD=0.51,95%CI [0.32,0.70],P< 0.000001）.2.Clinical improvement rate >75%: in a total of 4 studies,patients with clinical improvement rate greater than 75% were significantly higher in the experimental group than in the control group,with statistically significant difference（OR=4.12,95%CI [1.93,8.79],P=0.0003）;Clinical improvement rate > 50%: in a total of 5 studies,patients with clinical improvement rate greater than 50% in the experimental group were significantly higher than those in the control group,with statistically significant difference（OR=2.77,95%CI [1.62,4.71],P=0.0002）.Clinical improvement rate > 25%: a total of 4 studies showed that patients with a clinical improvement rate greater than 25% were significantly higher in the experimental group than in the control group,with statistically significant differences（OR=2.77,95%CI [1.32,5.82],P=0.007）.3.Patient satisfaction: in a total of 7 studies,the number of patients satisfied with treatment was significantly higher in the experimental group than in the control group,with a statistically significant difference（OR=3.61,95%CI [2.26,5.75],P< 0.00001）.4.Scab stage after treatment: there were two studies,and the scab time was significantly shorter in the experimental group than in the control group,with a statistically significant difference（MD=-1.04,95%CI [-1.56,-0.52],P< 0.0001）.5.Incidence of adverse reactions: a total of 5 studies recorded the incidence of pigmentation after treatment.The results of the metaanalysis showed that the incidence of pigmentation was significantly lower in the experimental group than in the control group,with a statistically significant difference（OR=0.27,95%CI [0.11,0.66],P=0.004）.A total of three studies recorded the incidence of erythema.The results of the meta-analysis showed that the incidence of erythema was significantly lower in the experimental group than in the control group,with a statistically significant difference（OR=0.27,95%CI [0.10,0.71],P=0.008）.A total of 2 studies recorded the number of cases of edema.The results showed that the number of cases of edema was significantly lower in the test group than in the control group,with a statistically significant difference（OR=0.21,95%CI [0.05,0.80],P=0.02）.Acne outbreak: two studies recorded the number of cases of acne outbreak,with no significant difference between the two groups（OR=0.36,95%CI [0.12,1.10],P=0.07）.6.Duration of adverse reactions: a total of 3 studies recorded the duration of erythema after treatment,and there was no significant difference between the two groups（MD=-1.07,95%CI [-2.39,0.25],P=0.11）.The duration of edema was recorded in three studies,with no significant difference between two groups（MD=-0.53,95%CI [-1.73,0.67],P=0.39）.7.Pain score: three studies recorded the pain score of patients after treatment,and there was no significant difference between the two groups（MD=1.03,95%CI [-1.58,3.64],P=0.44）.Conclusions: The results of this meta-analysis showed that CO₂ AFL combined with PRP was more effective and safer than CO₂ AFL alone in the treatment of acne scars.1.Patients in the CO₂ AFL combined with the PRP treatment group showed higher clinical improvement and higher patient satisfaction than those in the CO₂ AFL group alone.2.The incidence of erythema,edema,pigmentation and other adverse reactions in patients treated with CO₂ AFL combined with PRP was lower than those treated with CO₂ AFL alone,and the crusting stage was shorter after treatment.更多还原