他克莫司对口腔扁平苔藓疗效和安全性的系统评价

›› 2017, Vol. 37 ›› Issue (1): 38-45.

他克莫司对口腔扁平苔藓疗效和安全性的系统评价

李莎¹,孙玉亮²,牛颖慧¹,赵今³

1. 新疆医科大学第一附属医院牙体牙髓科
2. 新疆医科大学第一附属医院口腔科
3. 新疆口腔医学研究所

收稿日期:2016-08-08 修回日期:2016-09-29 出版日期:2017-01-28 发布日期:2017-01-17
通讯作者: 赵今 E-mail:781552544@qq.com
基金资助:
国家自然科学基金

Curative effects and security of tacrolimus on oral lichen planus：A systematic review

Received:2016-08-08 Revised:2016-09-29 Online:2017-01-28 Published:2017-01-17

摘要/Abstract

摘要： 目的　系统评价他克莫司治疗口腔扁平苔癣患者（OLP）的有效性和安全性，以期为临床合理使用该制剂和预防不良反应发生提供决策依据。方法　计算机联合手工检索PubMed、 Web of Science、The Cochrane Library、MEDLINE、中国生物医学、中国知网、维普和万方数据库，搜集中英文全文发表的他克莫司对比OLP一线治疗药物糖皮质激素的相关随机对照试验(RCT)，检索时限均从建库至2016年6月。根据Cochrane系统评价方法，综合分析最终纳入的15篇文献进行系统评价及Meta分析，结局指标为总有效率、不良反应发生率和复发率。结果　最终纳入15篇文章，合计894例患者。Meta分析结果发现：他克莫司组疗效优于曲安奈德组(RR=1.55，95％CI(1.27，1.89)，P＜0.000 1），卤米松组(RR=1.27，95％CI(1.16，1.39)，P＜0.000 01），和氟轻松组（RR=1.33，95％CI(1.05，1.69)，P=0.02），与丙酸氯倍他索组疗效差异无统计学意义（RR=1.04，95％CI(0.95，1.14)，P=0.44）。停药后复发率（RR=0.72，95％CI(0.48，1.09)，P=0.12）与对照组相比无统计学差异，治疗期间不良反应发生率（RR=0.70，95％CI(0.49，1.00),P=0.05）与对照组相比有统计学差异。结论　目前临床证据表明局部外用他克莫司治疗口腔扁平苔藓是一种短期临床疗效较佳的治疗方案。本系统评价纳入的文献中通过病理检查明确诊断的文献较少，结果出现选择性偏倚的可能性增大。受纳入数量和质量影响，将来还需更多更高质量RCT来验证此药物疗效和安全的可靠性。

关键词: 关键词他克莫司, 口腔扁平苔癣, 治疗, 糖皮质激素, 系统评价

Abstract: Abstract Objective To systematically evaluate the efficacy and safety of tacrolimus and glucocorticoid for oral lichen planus(OLP)， in order to provide strong basis for clinical rational use of drugs and prevention of adverse reactions.Methods The Cochrane review’s method was adopted manual and computer—based retrieval was performed on The PubMed ,Cochrane Library, MEDLINE，EMbase，CBM，VIP， CNKI and WanFang Data (from their establishment toJune 2016)to collect randomized controlled trials comparing the clinical efficacy of tacrolimus in treating OLP with that of glucocorticoid．The study was selected according to Cochrane system evaluation method． Fifteen literature is recommended by Cochrane was used to complete the Meta analysis of total effective rate ，recurrence rate and rate of adverse reaction. Results Fifteen trials involving 894 patients were included． The results of meta-analyses showed that the total effective rate of tacrolimus was higher than that of triamcinolone acetonide (RR=1．55，95％CI(1．27，1．89)，P＜0.0001) ，mometasone （RR=1．27，95％CI(1．16，1．39)，P＜0.00001) ，and fluorine relaxed (RR=1．33，95％CI(1．05，1．69)，P=0.02)，but there was no significant difference between the tacrolimus group and the propionate group(RR=1．04，95％CI(0.95，1．14)，P=0.44). However,there was no significant difference between the tacrolimus group and the glucocorticoid group in adverse events(RR=0．66，95％CI(0．38，1．15),P=0.14) , there was a significant difference between the experience group and the control group in recurrence rate(RR=0．70，95％CI(0．49，1．00),P=0.05) during the treatment session. Conclusion Current evidence shows that, tacrolimus treated oral lichen planus is a short-term clinical curative effect of better treatment plan. While the diagnosis of pathological examination by pathological examination was less,Due to the limited quality of included studies ,the possibility of selective migration increased.it still needs to be verified by more high quality studies to increase the efficacy and safety of the medicine.

Key words: Key words Tacrolimus, Oral lichen planus, Therapy, Glucocorticoid, Systematic review

中图分类号:

R781.59

李莎孙玉亮牛颖慧赵今. 他克莫司对口腔扁平苔藓疗效和安全性的系统评价[J]. , 2017, 37(1): 38-45.

[1]	邱秋王雨晨姜成惠汪彬昺李盛江宏兵施星辉. 电子鼻咽镜下正常成人发音与鼓气状态下腭咽闭合功能的比较研究[J]. , 2019, 39(6): 530-534.
[2]	叶强高雪彬王晓王小萌李静雅黄洋. 牛牙样牙文献回顾[J]. , 2019, 39(5): 464-467.
[3]	王雯王鹏来谢妮娜吴翠刘宗响. 不同器械预备根管对隐裂性牙髓炎临床治疗效果的影响[J]. , 2019, 39(5): 427-431.
[4]	何小桐王琼吴亚平王东苗王琰玲程杰. 口腔颌面颈部Castleman病：6例临床病例报告和文献复习[J]. , 2019, 39(3): 246-249.
[5]	宋璐王娜娜杨梦馨陈莉丽丁佩惠. 1例根管治疗过程中异物误吞病例报告[J]. , 2019, 39(2): 158-160.
[6]	田陶然. 种植修复大于1年，碟形骨吸收至种植体平台下3 mm时，应选择翻瓣植骨[J]. , 2019, 39(2): 161-163.
[7]	郑旭甘姗灵郭竹玲. 牙周基础治疗调节2型糖尿病患者代谢的研究进展[J]. , 2019, 39(2): 183-187.
[8]	杨丕山宋爱梅. TNF-α/ NF-κB信号通路对牙周炎发展和牙周再生的影响及其干预[J]. , 2019, 39(1): 1-5.
[9]	于雯雯孙红霞卢晓峰. 精准医学之于阻塞性睡眠呼吸暂停的思考[J]. , 2019, 39(1): 81-88.
[10]	连宁朱洪光王晓钰孙晨雨梁椿怡白建文. 三种镍钛再治疗锉去除根充物操作时间及清除率的比较研究[J]. , 2019, 39(1): 40-43.
[11]	操亚波傅露郁雯科王硕李伯休陈丹鹏. 数字化排牙试验在正畸病例拔牙与否判断中的应用[J]. , 2019, 39(1): 44-47.
[12]	宋文静葛少华. Ⅱ型糖尿病牙周炎及牙周基础治疗对其影响的现状研究[J]. , 2018, 35(9): 839-843.
[13]	邵佳琪汪淑华. 非创伤性修复与乳牙龋病治疗的研究现状[J]. , 2018, 38(8): 765-768.
[14]	赵奇韬周如玉梅予锋王娟. 过氧化氢银离子消毒剂控制微生物污染的效果检测[J]. , 2018, 38(8): 694-698.
[15]	王晓琨赵忠琪彭慧敏王小晋梁家迪刘畅. 低水平激光治疗促进正畸牙齿移动的研究进展[J]. , 2018, 38(8): 756-760.