Chinese Journal of Tissue Engineering Research ›› 2023, Vol. 27 ›› Issue (35): 5734-5740.doi: 10.12307/2023.841
Song Li, Lu Mao, Tang Yi, Liu Yanlin
Received:
2022-10-17
Accepted:
2022-11-21
Online:
2023-12-18
Published:
2023-06-05
Contact:
Song Li, Department of Dermatology, First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, Sichuan Province, China
About author:
Song Li, Master, Associate chief physician, Department of Dermatology, First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, Sichuan Province, China
Supported by:
CLC Number:
Song Li, Lu Mao, Tang Yi, Liu Yanlin. A systemic review of the effectiveness and safety of fractional CO2 laser combined with platelet-rich plasma in the treatment of atrophic acne scars[J]. Chinese Journal of Tissue Engineering Research, 2023, 27(35): 5734-5740.
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2.3.1 随机方法 纳入的13个研究中[12-24],均为随机对照试验。其中7个研究为半脸自身对照[12-18],另外6个研究纳入不同的患者作为对照组[19-24]。6个研究描述了随机方法[16-17,19-21,24],分别为掷硬币、抽签、随机数字表、信封法。所有研究都未采取分配隐藏。 2.3.2 盲法 5个研究为观察者及受试者双盲[12-14,17-18],1个研究为观察者单盲[15],7个研究没有采取盲法[16,19-24]。 2.3.3 基线一致 7个研究为半脸自身对照[12-18],另外6个研究纳入不同的患者作为对照组[19-24]。所有研究描述了试验组与对照组的基线情况,均具有可比性。 2.3.4 随访情况 全部研究进行了随访,随访时间最长为6个月。2个研究有患者失访[15,18],失访率分别为7.4%[15],24.2%[18],都采取将失访患者排除结果统计。 2.4 纳入临床试验偏倚分析 偏倚风险评价结果表明,纳入的13个研究中[12-24],只有6个研究描述了随机方法[16-17,19-21,24],全部没有采用分配隐藏,其中5个采用了双盲[12-14,17-18],1个采用了单盲,没有研究采用三盲。2个研究有一定比例的失访[15,18],均将失访案例排除试验数据统计。所有研究都清楚的报告了研究结果,见图3。"
2.5 Meta分析结果 2.5.1 主要指标(总有效率) 采取治疗前后拍摄患者面部照片的方法,将瘢痕的改善程度采用四分法分类:0分,无效;1分,< 25%,改善不佳;2分,≥25%,但< 50%,稍微改善;3分,≥50%,但< 75%,有效改善;4分,≥75%,显著改善。统计有效及显著改善人数,计算总有效率。7个研究通过计算有效人数统计了总有效率[13-14,16,19-22],其中6个研究为点阵CO2激光联合富血小板血浆组与点阵CO2激光组相比[13,14,16,19-21],研究间无临床异质性,无统计学异质性[Chi2=1.67,df=5(P=0.89),I2=0%],采用固定效应模式进行Meta分析,结果显示点阵CO2激光联合富血小板血浆组总有效率高于点阵CO2激光组,差异有显著性意义(OR=3.95,95%CI=2.23-7.00,P < 0.000 01),见图4。另外1个研究对照组为富血小板血浆,故没有纳入数据合并[22]。"
(3)疼痛评分:5个研究报道了患者对疼痛的评价[13,17-18,20,23],均采用视觉模拟量表评分,但只有3个研究分别报道了治疗组及对照组疼痛评分分数[13,20,23]。3个研究均为点阵CO2激光联合富血小板血浆组与点阵CO2激光组相比,研究间无临床异质性,有统计学异质性[Tau2=1.46,Chi2=135.80,df=2(P < 0.000 01),I2=99%],采用随机效应模式进行Meta分析。结果显示点阵CO2激光联合富血小板血浆组疼痛评分稍高于点阵CO2激光组,但差异无显著性意义(MD=1.18,95%CI=-0.21至2.57,P=0.10),见图7。异质性检验结果显示 I2=99%,表示存在较高异质性。"
为了探究异质性的来源,采用了敏感性分析的方法,发现去除GAWDAT等[13]后,总的效应量变为MD=-0.13,95%CI=-0.25至-0.01,P=0.04,且 I2=0%,与未去除前相比异质性变化较大,表明GAWDAT等[13]这篇研究可能是异质性的来源。 (4)红斑、水肿、渗出持续时间:6个研究报道了治疗后红斑持续时间[12-14,16,21,23] ,其中5个研究报道了治疗组与对照组的红斑持续天数[12-14,21,23]。6个研究报道了治疗后水肿持续时间[12-14,16,21,23] ,其中5个研究报道了治疗组与对照组的水肿持续天数[12-14,21,23]。5个研究报道了治疗后渗出或结痂时间[12-13,16,21,23],其中4个研究报道了治疗组与对照组的渗出或结痂持续天数[12-13,21,23]。研究均为点阵CO2激光联合富血小板血浆组与点阵CO2激光组相比。 针对红斑的研究间无临床异质性,无统计学异质性[Chi2=7.33,df=4(P=0.12),I2=45%],采用固定效应模式进行Meta分析。针对水肿的研究间无临床异质性,有统计学异质性[Tau2=0.14,Chi2=11.14,df=4(P=0.03),I2=64%],采用随机效应模式进行Meta分析。针对渗出的研究间无临床异质性,有统计学异质性[Tau2=0.55,Chi2=18.62,df=3(P=0.000 3),I2=84%],采用随机效应模式进行Meta分析。结果显示点阵CO2激光联合富血小板血浆组术后红斑、水肿持续时间均短于点阵CO2激光组,差异均有显著性意义(MD=-0.98,95%CI=-1.19至-0.77,P < 0.000 01,MD=-0.92,95%CI=-1.36至-0.48,P < 0.000 1);点阵CO2激光联合富血小板血浆组术后渗出持续时间稍短于点阵CO2激光组,但差异无显著性意义(MD=-0.53,95%CI=-1.33至0.27,P=0.20),分别见图8-10。"
关于渗出及结痂时间的4个研究异质性检验结果显示 I2=84%,表示存在较高异质性[12-13,21,23]。为了探究异质性的来源,采用了敏感性分析的方法,发现去除LEE等[12]后,总的效应量变为MD=-0.94,95%CI=-1.28至-0.59,P < 0.000 1,且 I2= 0%,与未去除前相比异质性变化较大,表明LEE等[12]这篇研究可能是异质性的来源。 (5)术后色素沉着发生率:4个研究分别报道了治疗组及对照组术后色素沉着发生率[13,19-20,23],均为点阵CO2激光联合富血小板血浆组与点阵CO2激光组相比,研究间无临床异质性,无统计学异质性[Chi2=0.39,df=3(P=0.94),I2=0%],采用固定效应模式进行Meta分析。结果显示点阵CO2激光联合富血小板血浆组术后色素沉着发生率低于点阵CO2激光组,差异有显著性意义(OR=0.21,95%CI=0.06-0.70,P=0.01),见图11。"
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