本文選題：尋常痤瘡 + 光動(dòng)力療法��； 參考：《重慶醫(yī)科大學(xué)》2017年碩士論文

【摘要】：背景:痤瘡是皮膚科常見(jiàn)病之一,是累及毛囊皮脂腺的慢性炎癥性疾病[1]。中重度痤瘡?fù)ǔ０l(fā)生于青少年,部分病人皮損常持續(xù)到成年時(shí)期,若治療不當(dāng)往往會(huì)留色素沉著、瘢痕等[2]。當(dāng)發(fā)生于顏面部時(shí)嚴(yán)重影響外觀,使患者產(chǎn)生消極、負(fù)面情緒,部分病人甚至有抑郁、自殺傾向。由于人們對(duì)常規(guī)傳統(tǒng)療法的抵制及耐藥,使其治療效果不佳,且容易反復(fù)發(fā)作。近年來(lái),已有較多實(shí)踐表明光動(dòng)力療法(photodynamic therepy,PDT)治療中重度痤瘡效果較好,但缺乏較明確的循證醫(yī)學(xué)證據(jù)。目的:綜合分析、評(píng)價(jià)PDT治療中重度痤瘡療效與安全性,為PDT治療中重度痤瘡提供循證醫(yī)學(xué)依據(jù)。方法:電子檢索數(shù)據(jù)庫(kù):Pubmed、EMbase、the Cochrane Library、中國(guó)知網(wǎng)(CNKI)、維普數(shù)據(jù)庫(kù)(VIP)、萬(wàn)方數(shù)據(jù)庫(kù)等,按照納入標(biāo)準(zhǔn)納入有關(guān)PDT治療中重度痤瘡的隨機(jī)對(duì)照試驗(yàn)(randomized controlled trial,RCT),檢索日期為各數(shù)據(jù)庫(kù)建庫(kù)日期-2017年2月。依據(jù)Cochrane偏倚評(píng)價(jià)工具推薦的質(zhì)量評(píng)價(jià)標(biāo)準(zhǔn),對(duì)納入試驗(yàn)進(jìn)行評(píng)價(jià),并采用RevMan 5.3軟件進(jìn)行統(tǒng)計(jì)學(xué)分析、處理。由兩名研究者獨(dú)自篩選、提取資料、質(zhì)量評(píng)價(jià),如果有爭(zhēng)議,則雙方共同討論,必要時(shí)交由第三方仲裁。結(jié)果:根據(jù)納入、排除標(biāo)準(zhǔn),共納入23篇RCT,病人總數(shù)為1515人。meta分析結(jié)果顯示:PDT在治療中重度痤瘡中有效率及痊愈率均優(yōu)于單用紅光組、紅藍(lán)光組及強(qiáng)脈沖光(Intense Pulsed Light,IPL)組;與口服異維A酸組療效相當(dāng),但較其更安全,無(wú)明顯系統(tǒng)性反應(yīng),且復(fù)發(fā)率較低。PDT常見(jiàn)不良反應(yīng)有灼熱、刺痛、紅斑等,患者多能耐受,經(jīng)對(duì)癥處理后均可緩解。結(jié)論:PDT治療中重度痤瘡起效快,有效率及痊愈率高,復(fù)發(fā)率低,無(wú)嚴(yán)重不良反應(yīng)。但受納入研究質(zhì)量限制,本結(jié)論尚需要更多大樣本、多中心、高質(zhì)量的RCT進(jìn)行驗(yàn)證。
[Abstract]:Background: acne is one of the common diseases in dermatology. It is a chronic inflammatory disease involving hair follicle sebaceous gland. Moderate and severe acne usually occurs in adolescents, and some of the patients' skin lesions continue into adulthood. Pigmentation, scar and so on are often left if treated improperly [2]. When it occurs in the face, it seriously affects the appearance of the patients, causing negative and negative emotions, and some patients even have depression and suicidal tendency. Because of resistance and resistance to conventional traditional therapy, it has poor therapeutic effect and is prone to relapse. In recent years, many practices have shown that photodynamic therapy (PDT) is effective in the treatment of moderate and severe acne, but there is no clear evidence of evidence-based medicine. Objective: to evaluate the efficacy and safety of PDT in the treatment of moderate and severe acne and to provide evidence-based medical evidence for the treatment of moderate and severe acne by PDT. Methods: the electronic retrieval database: Pubmedus Embase was Cochrane Library, CNKI, Weip, Wanfang, et al. According to the inclusion criteria, the randomized controlled trial of PDT in the treatment of moderate and severe acne was conducted. The date of retrieval was the date of the establishment of each database from February 2017 to February 2017.Methods: a randomized controlled trial on the treatment of moderate and severe acne with PDT was carried out according to the inclusion criteria. The date of retrieval was the date of establishment of each database from February 2017 to February 2017. According to the quality evaluation standard recommended by Cochrane bias evaluation tool, the inclusion test was evaluated and analyzed statistically with RevMan 5.3 software. The two researchers independently sift the data, extract the data, evaluate the quality, and, if there is a dispute, discuss it together and submit it to a third party for arbitration if necessary. Results: according to the inclusion and exclusion criteria, 23 RCTs were included. The total number of patients was 1515. The results of meta analysis showed that the effective rate and cure rate of the treatment of moderate and severe acne were better than those of the red light group, the red blue light group and the strong pulse Pulsed light group. The curative effect was similar to that of oral isotinic acid group, but it was safer than that of oral isoretinoic acid group, and had no obvious systemic reaction, and the recurrence rate of PDT was lower. The common adverse reactions of PDT were burning, prickly pain, erythema and so on. The patients were tolerant and could be alleviated after symptomatic treatment. Conclusion: the treatment of moderate and severe acne with 1% PDT has rapid onset, high effective rate and cure rate, low recurrence rate and no serious adverse reactions. However, due to the limited quality of the study, more large samples, multicenter and high quality RCT are needed to verify this conclusion.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R758.733

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