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光生物调节治疗口腔扁平苔藓与局部皮质类固醇疗效的比较:系统评价、荟萃分析及基于 GRADE 的证据确定性评估。

Efficacy of photobiomodulation in the management of oral Lichen Planus in comparison to topical corticosteroids: Systematic review, meta-analysis, and GRADE-based assessment of certainty of evidence.

机构信息

PhD Scholar, Dental Institute, Rajendra Institute of Medical Sciences (RIMS), Bariatu, Ranchi 834009, India.

Associate Professor, Oral Medicine and Radiology, Dental Institute, Rajendra Institute of Medical Sciences (RIMS), Bariatu, Ranchi 834009, India.

出版信息

J Stomatol Oral Maxillofac Surg. 2024 Oct;125(5S2):101798. doi: 10.1016/j.jormas.2024.101798. Epub 2024 Feb 21.

Abstract

BACKGROUND

There is an urgent need to update the evidence available on the efficacy of photobiomodulation (PBM) in comparison to topical corticosteroids in the management of Oral Lichen Planus (OLP).

METHODS

Cochrane Oral Health's Trials Register, Cochrane Central Register of Controlled Trials in the Cochrane Library, MEDLINE Pubmed, SCOPUS, Lilacs and Google Scholar were searched. Other sources included US National Institutes of Health Ongoing Trials Register, World Health Organization International Clinical Trials Registry Platform and Clinical Trial Registry - India were searched using variations of the keywords "Laser" and "Oral Lichen Planus". Randomized controlled trials comparing PBM and topical corticosteroids in the resolution of pain among OLP patients were included. The studies were assessed using the Cochrane Risk-of-Bias assessment tool. Publication bias was assessed using a funnel plot, and the certainty of evidence was evaluated according to the GRADE guidelines.

RESULTS

Ten studies were included for qualitative assessment and of these eight were included in the meta-analysis. The included studies used laser parameters of varying strengths and duration. Meta-analysis favoured PBM (n = 274, MD =-0.48, CI -0.66- -0.30) for pain score. No adverse effects were reported for laser therapy. There was high heterogeneity and moderate certainty of evidence, and most studies had a high risk of bias.

CONCLUSION

There is improvement in the clinical parameters of OLP when treated with PBM in comparison to topical corticosteroids. However, the strength of the evidence for these findings in limited. It is recommended to conduct better long-term trials with large sample size.

摘要

背景

迫切需要更新光生物调节(PBM)与局部皮质类固醇治疗口腔扁平苔藓(OLP)相比的疗效证据。

方法

检索了 Cochrane 口腔健康试验注册库、Cochrane 图书馆对照试验中心注册库、MEDLINE Pubmed、SCOPUS、Lilacs 和 Google Scholar。其他来源包括美国国立卫生研究院正在进行的试验注册库、世界卫生组织国际临床试验注册平台和临床试验注册-印度,使用“激光”和“口腔扁平苔藓”的关键词变体进行搜索。纳入了比较 PBM 和局部皮质类固醇治疗 OLP 患者疼痛缓解的随机对照试验。使用 Cochrane 偏倚风险评估工具评估了这些研究。使用漏斗图评估发表偏倚,并根据 GRADE 指南评估证据的确定性。

结果

纳入了 10 项研究进行定性评估,其中 8 项纳入了荟萃分析。纳入的研究使用了不同强度和持续时间的激光参数。荟萃分析支持 PBM(n = 274,MD =-0.48,CI -0.66- -0.30)在疼痛评分方面的效果。激光治疗未报告不良反应。存在高度异质性和中等确定性证据,且大多数研究存在高偏倚风险。

结论

与局部皮质类固醇相比,PBM 治疗 OLP 可改善临床参数。然而,这些发现的证据强度有限。建议进行更好的长期试验,样本量更大。

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