白癜风的非手术复色疗法。文献的荟萃分析。

Nonsurgical repigmentation therapies in vitiligo. Meta-analysis of the literature.

作者信息

Njoo M D, Spuls P I, Bos J D, Westerhof W, Bossuyt P M

机构信息

Netherlands Institute for Pigmentary Disorders, University of Amsterdam, The Netherlands.

出版信息

Arch Dermatol. 1998 Dec;134(12):1532-40. doi: 10.1001/archderm.134.12.1532.

DOI:10.1001/archderm.134.12.1532

PMID:9875190

Abstract

OBJECTIVE

To assess the effectiveness and safety of nonsurgical repigmentation therapies in localized and generalized vitiligo by means of a meta-analysis.

DATA SOURCES

Computerized searches of bibliographic databases, a complementary manual literature search, and contacts with researchers and pharmaceutical firms.

STUDY SELECTION

Predefined selection criteria were applied to both randomized and nonrandomized controlled trials.

DATA EXTRACTION

Two investigators independently assessed the articles for inclusion. When there was a disagreement, a third investigator was consulted.

DATA SYNTHESIS

Sixty-three studies were found on therapies for localized vitiligo. Of these, 10 of 11 randomized controlled trials and 29 of 110 patient series were included. One hundred seventeen studies on therapies for generalized vitiligo were found. Of these, 10 of 22 randomized controlled trials and 46 of 231 patient series were included. Among randomized controlled trials on localized vitiligo, the pooled odds ratio vs placebo was significant for topical class 3 corticosteroids (14.32; 95% confidence interval [CI], 2.45-83.72). In the patient series, topical class 3 and class 4 corticosteroids carried the highest mean success rates (56% [95% CI, 50%-62%] and 55% [95% CI, 49%-61%], respectively). Side effects were reported mostly with topical psoralen and intralesional and class 4 corticosteroids. In the randomized controlled trials on generalized vitiligo, the odds ratio vs placebo was significant for oral methoxsalen plus sunlight (23.37; 95% CI, 1.33-409.93), oral psoralen plus sunlight (19.87; 95% CI, 2.37-166.32), and oral trioxsalen plus sunlight (3.75; 95% CI, 1.24-11.29). In the series, the highest mean success rates were achieved with narrowband UV-B (63%; 95% CI, 50%-76%), broadband UV-B (57%; 95% CI, 29%-82%), and oral methoxsalen plus UV-A therapy (51%; 95% CI, 46%-56%). Oral methoxsalen plus UV-A was associated with the highest rates of side effects. No side effects were reported with UV-B therapy.

CONCLUSIONS

Class 3 corticosteroids and UV-B therapy are the most effective and safest therapies for localized and for generalized vitiligo, respectively.

摘要

目的

通过荟萃分析评估非手术复色疗法治疗局限性和泛发性白癜风的有效性和安全性。

数据来源

对书目数据库进行计算机检索、辅助手工文献检索，并与研究人员及制药公司联系。

研究选择

将预定义的选择标准应用于随机对照试验和非随机对照试验。

数据提取

两名研究人员独立评估纳入的文章。出现分歧时，咨询第三名研究人员。

数据综合

共找到63项关于局限性白癜风治疗的研究。其中，11项随机对照试验中的10项以及110个患者系列中的29项被纳入。共找到117项关于泛发性白癜风治疗的研究。其中，22项随机对照试验中的10项以及231个患者系列中的46项被纳入。在局限性白癜风的随机对照试验中，外用3级皮质类固醇与安慰剂相比的合并比值比具有统计学意义（14.32；95%置信区间[CI]，2.45 - 83.72）。在患者系列中，外用3级和4级皮质类固醇的平均成功率最高（分别为56%[95%CI，50% - 62%]和55%[95%CI，49% - 61%]）。副作用主要报告于外用补骨脂素、皮损内注射和4级皮质类固醇治疗。在泛发性白癜风的随机对照试验中，口服甲氧沙林加阳光照射（23.37；95%CI，1.33 - 409.93）、口服补骨脂素加阳光照射（19.87；95%CI，2.37 - 166.32）以及口服三甲沙林加阳光照射（3.75；95%CI，1.24 - 11.29）与安慰剂相比的比值比具有统计学意义。在患者系列中，窄带UV - B（63%；95%CI，50% - 76%）、宽带UV - B（57%；95%CI，29% - 82%）以及口服甲氧沙林加UV - A疗法（51%；95%CI，46% - 56%）的平均成功率最高。口服甲氧沙林加UV - A的副作用发生率最高。UV - B疗法未报告副作用。