A型肉毒毒素注射治疗瘢痕的有效性：一项随机对照试验的系统评价和荟萃分析。
Effectiveness of Botulinum Toxin Type A Injection on Scars: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
机构信息
From the Department of Surgery, School of Medicine, College of Medicine, and Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University; the Department of Management of Technology, National Chiao Tung University; SurgMate Company; and the Graduate Institute of Data Science and Research Center of Biostatistics Center, College of Management, the Biostatistics Center, Wan Fang Hospital, the School of Public Health, College of Public Health and Nutrition, the Department of Pharmacy and Research Center for Pharmacoeconomics, College of Pharmacy, the Department of Public Health, School of Medicine, College of Medicine, Cochrane Taiwan, and the Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University.
出版信息
Plast Reconstr Surg. 2022 Dec 1;150(6):1249e-1258e. doi: 10.1097/PRS.0000000000009742. Epub 2022 Sep 19.
BACKGROUND
Scars can cause pain, long-term physical dysfunction, and psychological harm. Botulinum toxin type A (BoNT-A) is one treatment choice for scars, but further evidence is needed to confirm its efficacy.
METHODS
This systematic review included randomized controlled trials that investigated the effectiveness of BoNT-A on scars. The mean and standard deviation for the Vancouver Scar Scale, Stony Brook Scar Evaluation Scale, visual analog scale for appearance evaluation, visual analog scale for scar pain evaluation, and scar width were extracted for subgroup analysis.
RESULTS
Twenty-one randomized controlled trials were included. The BoNT-A group had a lower Vancouver Scar Scale score than the saline group (standardized mean difference, -0.73; 95 percent CI, -1.12 to -0.35; p = 0.0002) but a higher score than the steroid group (standardized mean difference, 0.85; 95 percent CI, 0.27 to 1.43; p = 0.004). The BoNT-A group exhibited a higher Stony Brook Scar Evaluation Scale grade than the saline group (standardized mean difference, 1.42; 95 percent CI, 0.83 to 2.00; p < 0.00001). The visual analog scale for appearance evaluation revealed higher scores in the BoNT-A group than in the saline group (standardized mean difference, 1.14; 95 percent CI, 0.69 to 1.60; p < 0.00001). As for pain evaluation, the BoNT-A group had a lower visual analog scale score than the steroid group (standardized mean difference, -2.57; 95 percent CI, -4.40 to -0.74; p = 0.006). Furthermore, scar width was significantly shorter in the BoNT-A group than in the control group (standardized mean difference, -1.11; 95 percent CI, -1.38 to -0.83; p < 0.00001).
CONCLUSIONS
BoNT-A is more effective in treating scars than saline, although steroids may exhibit higher potency. Therefore, it can be considered an alternative in patients not amenable to steroid treatment.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
背景
疤痕可导致疼痛、长期身体功能障碍和心理伤害。肉毒毒素 A 型（BoNT-A）是一种治疗疤痕的选择，但需要更多证据来证实其疗效。
方法
本系统评价纳入了研究 BoNT-A 对疤痕疗效的随机对照试验。温哥华疤痕量表、石溪疤痕评估量表、外观评估视觉模拟评分、疤痕疼痛评估视觉模拟评分和疤痕宽度的平均值和标准差用于亚组分析。
结果
纳入 21 项随机对照试验。BoNT-A 组温哥华疤痕量表评分低于盐水组（标准化均数差，-0.73；95%置信区间，-1.12 至 -0.35；p = 0.0002），但高于皮质类固醇组（标准化均数差，0.85；95%置信区间，0.27 至 1.43；p = 0.004）。BoNT-A 组石溪疤痕评估量表等级高于盐水组（标准化均数差，1.42；95%置信区间，0.83 至 2.00；p < 0.00001）。外观评估视觉模拟评分显示 BoNT-A 组评分高于盐水组（标准化均数差，1.14；95%置信区间，0.69 至 1.60；p < 0.00001）。至于疼痛评估，BoNT-A 组视觉模拟评分低于皮质类固醇组（标准化均数差，-2.57；95%置信区间，-4.40 至 -0.74；p = 0.006）。此外，BoNT-A 组疤痕宽度明显短于对照组（标准化均数差，-1.11；95%置信区间，-1.38 至 -0.83；p < 0.00001）。
结论
BoNT-A 治疗疤痕的效果优于盐水，尽管皮质类固醇可能具有更高的疗效。因此，对于不能接受皮质类固醇治疗的患者，可以考虑使用 BoNT-A。
临床问题/证据水平：治疗性，II 级。
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