Xiao Yi, Zhang Xingyu, Luo Dan, Kuang Yehong, Zhu Wu, Chen Xiang, Shen Minxue
Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China,
Hunan Engineering Research Center of Skin Health and Disease, Central South University, Changsha, China,
Psychol Res Behav Manag. 2019 Feb 7;12:97-106. doi: 10.2147/PRBM.S195181. eCollection 2019.
Previous observational studies have shown comorbidity between psoriasis and psychological disorders. However, the evidence of the efficacy of psychological interventions, including cognitive behavioral therapy (CBT) and other treatments, on psoriasis is still debated.
The aim of this study was to systematically review the psychological interventions used in the treatment of psoriasis and to meta-analyze the efficacy of psychological interventions on psoriasis with respect to area and severity reduction.
A systematic review and meta-analysis were conducted. PubMed, Web of Science, EMbase, and major Chinese academic journal databases were searched for articles published before January 2018. Studies of randomized controlled trials (RCTs) that applied psychological interventions in the treatment of psoriasis and used area and severity as the outcome measures were meta-analyzed. The pooled mean difference between groups was estimated using either fixed-effects models or random-effects models in the presence of heterogeneity. Subgroup analysis was performed by method of intervention and severity of psoriasis.
Out of the 4,152 potentially relevant studies, 8 RCTs were included. The pooled mean difference was -1.36 (95% CI: -2.52 to -0.19; =0.02). The pooled estimate was -1.80 (95% CI: -2.57 to -1.03; <0.001) for CBT intervention and was -0.70 (95% CI: -2.39 to 0.99; =0.42) for non-CBT intervention. The pooled estimates for mild and moderate-to-severe psoriasis were -1.95 (95% CI: -3.91 to 0.00; =0.05) and -0.61 (95% CI: -1.61 to 0.38; =0.23), respectively.
CBT is effective in the treatment of psoriasis in terms of area and severity reduction. Systemic treatment does not further enhance the efficacy of CBT. The effect of the psychological intervention is stronger in patients with moderate-to-severe psoriasis.
既往观察性研究显示银屑病与心理障碍之间存在共病现象。然而，包括认知行为疗法（CBT）及其他治疗在内的心理干预对银屑病疗效的证据仍存在争议。
本研究旨在系统评价用于治疗银屑病的心理干预措施，并对心理干预在减少银屑病面积和严重程度方面的疗效进行荟萃分析。
进行了一项系统评价和荟萃分析。检索了PubMed、科学网、EMbase以及中国主要学术期刊数据库中2018年1月以前发表的文章。对应用心理干预治疗银屑病且将面积和严重程度作为结局指标的随机对照试验（RCT）进行荟萃分析。在存在异质性的情况下，使用固定效应模型或随机效应模型估计组间合并平均差。按干预方法和银屑病严重程度进行亚组分析。
在4152项可能相关的研究中，纳入了8项RCT。合并平均差为-1.36（95%CI：-2.52至-0.19；P=0.02）。CBT干预的合并估计值为-1.80（95%CI：-2.57至-1.03；P<0.001），非CBT干预的合并估计值为-0.70（95%CI：-2.39至0.99；P=0.42）。轻度和中度至重度银屑病的合并估计值分别为-1.95（95%CI：-3.91至0.00；P=0.05）和-0.61（95%CI：-1.61至0.38；P=0.23）。
CBT在减少银屑病面积和严重程度方面对治疗银屑病有效。全身治疗不会进一步提高CBT的疗效。心理干预对中度至重度银屑病患者的效果更强。
