2019 年第 7 期 第 14 卷

光动力疗法治疗Bowen病的Meta分析

Efficacy and safety of photodynamic therapy in treatment of cutaneous Bowen disease: a meta-analysis

作者：王晓阳孙立元褚小玲

英文作者：

单位：100029首都医科大学附属北京安贞医院皮肤科

英文单位：

关键词：Bowen病；光动力疗法；Meta分析

英文关键词：

• 摘要：

• 【摘要】目的    系统评价光动力疗法（PDT）治疗Bowen病的临床效果及安全性。方法    检索关于PDT治疗Bowen病的随机对照临床试验。检索数据库包括PubMed、Ovid数据库、万方数据、中国知网、维普数据库，发表时间为2000年1月至2018年12月，检索语种限中、英文。由两名研究人员独立检索文献，对纳入的研究进行质量评价，观察组采用PDT单独或联合其他治疗，主要结局指标包括治愈率、美容效果评价和复发率。结果    最终纳入6篇随机对照试验文献，方法学质量评价均为中等偏倚。涉及皮损共540处，其中观察组262处、对照组278处。PDT组治愈率高于5-氟尿嘧啶外用治疗组(P=0.014)；2组复发率比较差异无统计学意义（P=0.153）。治疗3、12个月后PDT组治愈率高于安慰剂组(均P<0.05)，复发率低于安慰剂组(P<0.05)；治疗12个月后，PDT组治愈率高于冷冻治疗组（P=0.046）。红光PDT治愈率显著高于绿光PDT，复发率低于绿光PDT组(均P<0.05)。PDT两次光照方案与单次治疗方案的治愈率和美容效果评价比较差异均无统计学意义（均P>0.05）。铒钇铝石榴石联合PDT组治疗3个月后治愈率高于单纯PDT组(P=0.05)，治疗12个月后复发率低于单纯PDT组(P=0.05)，2组美容效果评估比较差异无统计学意义（P=0.843）。PDT治疗的不良反应包括不同程度的疼痛、局部感觉异常、局部炎症反应、色素沉着、结痂。结论    PDT治疗Bowen病的临床疗效优于对照组；红光光源PDT的疗效优于绿光光源；两次光照治疗方案与单次光照治疗的疗效无明显差异，但前者疼痛明显；Er:YAG联合PDT组疗效优于单纯PDT组，美容效果评估差异不明显。

• 【Abstract】Objective    To assess the efficacy and safety of photodynamic therapy(PDT) for Bowen disease. Methods    Domestic and English randomized controlled trials(RCTs) of PDT treating Bowen disease were searched in electronic databases from January 2000 to December 2018, such as PubMed, Ovid, Wanfang Data, China National Knowledge Infrastructure(CNKI) and VIP database. RCTs were screened by 2 reviewers independently according to predefined inclusion criteria. Quality of literatures was evaluated. Patients in the observation group were treated with PDT with or without routine therapy. Main outcome indexes included cure rate, cosmetic effect and recurrence rate. Results    Six RCTs involving 540 skin lesions were included in meta analysis; there were 262 lesions in observation group and 278 lesions in control group. Evaluation results of methodological quality was moderate bias. Meta-analysis showed that cure rate of PDT was higher than that of 5-fluorouracil for external application(P=0.014); recurrence rate showed no significant difference between them(P=0.153). After 3, 12 months of treatment, cure rate of PDT was higher and recurrence rate was lower than those of placebo group(both P<0.05). The 12-month cure rate of PDT was higher than that of cryotherapy（P=0.046）. Cure rate of PDT with red light source was significantly higher and recurrence rate was lower than that of green light(both P<0.05). There was no significant difference of cure rate and cosmetic outcomes between double and single scheme of PDT（both P>0.05）. The 3-month cure rate of PDT combined with Er:YAG was higher than that of PDT(P=0.05); the 12-month recurrence rate of PDT combined with Er:YAG was lower than that of PDT(P=0.05). There was no significant difference of cosmetic outcomes between Er:YAG＋PDT group and PDT group（P=0.843）. Main adverse reactions of PDT included pain, cacesthesia, inflammation, hyperpigmentation and crusting. Conclusions    PDT shows a good curative effect on Bowen disease. Clinical efficacy of PDT with red light source is superior to that of PDT with green light source. Double illumination scheme and single illumination scheme have similar efficacy; double illumination scheme may induce obvious pain. Er:YAG＋PDT shows better efficacy and similar cosmetic outcome compared to PDT.