甲氨蝶呤和阿维A治疗银屑病效果比较的Meta分析.docVIP

甲氨蝶呤和阿维A治疗银屑病效果比较的Meta分析 　　[摘要] 目的 系统评价甲氨蝶呤和阿维A治疗银屑病的有效性和安全性。 方法 计算机检索Medline、Cochrane图书馆、EMbase、维普、中国期刊和万方数字化期刊全文数据库，纳入甲氨蝶呤对比阿维A治疗银屑病的随机对照试验，采用RevMan 5.1软件进行Meta分析。 结果 共纳入12篇随机对照试验，包括共877例患者。Meta分析显示：甲氨蝶呤组6周的疗效与阿维A组比较，差异无统计学意义（OR = 1.21，95%CI：0.51～2.87，P = 0.66）；治疗8周时，甲氨蝶呤组疗效低于阿维A组（OR = 0.17，95%CI：0.04～0.72，P = 0.02）；治疗12周时，甲氨蝶呤组疗效明显高于阿维A组（OR = 3.20，95%CI：1.93～5.31，P 0.000 01）。甲氨蝶呤组不良反应明显低于阿维A组（OR = 0.14，95%CI：0.04～0.52，P = 0.004）。甲氨蝶呤组与阿维A组治疗银屑病的复发率比较差异无统计学意义（OR = 1.23，95%CI：0.17～8.98，P = 0.84）。 结论 甲氨蝶呤长期治疗银屑病的效果优于阿维A，甲氨蝶呤不良反应明显低于阿维A，二者复发率差异不明显。上述结论尚需要更多高质量的随机对照试验验证。 　　[关键词] 甲氨蝶呤；阿维A；银屑病；Meta分析；随机对照试验 　　[中图分类号] R758.63 [文献标识码] A [文章编号] 1673-7210（2016）10（b）-0136-04 　　[Abstract] Objective To evaluate the efficacy and security of Methotrexate and Acitretin for psoriasis systematically. Methods The randomized controlled trials （RCTs） of Methotrexate and Acitretin for psoriasis from the Medline， the Cochrane library， EMbase， VIP， CNKI and Wanfang data were collected. The Cochrane Collaboration RevMan 5.1 software was used for Meta analysis. Results There were 12 randomized controlled trials involving 877 patients. The Meta analysis showed that the efficacies of Methotrexate and Acitretin at the end of the 6th week had no statistic difference respectively （OR = 1.21， 95%CI： 0.51-2.87， P = 0.66）； but for the 8th week， the Methotrexate group was slightly lower than the Acitretin group （OR = 0.17， 95%CI： 0.04-0.72， P = 0.02）； for the 12th week， the efficacy of the Methotrexate group was obviously higher than that of the Acitretin group （OR = 3.20， 95%CI： 1.93-5.31， P 0.000 01）. It also revealed that the incidence of adverse effects of the Methotrexate group was obviously lower than that of the Acitretin group （OR = 0.14， 95%CI： 0.04-0.52， P = 0.004）， but there was no difference of the recurrence incidence between the two groups （OR = 1.23， 95%CI： 0.17-8.98， P = 0.84）. Conclusion Methotrexate is more efficient than Acitretin in the long term therapy， the incidence