压力疗法治疗增生性瘢痕患者有效性的荟萃分析

田凌云; 李映兰; 吴英; 张莹

doi:10.3760/cma.j.issn.1009-2587.2019.09.005

压力疗法治疗增生性瘢痕患者有效性的荟萃分析

doi: 10.3760/cma.j.issn.1009-2587.2019.09.005

1. 中南大学湘雅护理学院,长沙 410013(现在安徽中医药大学护理学院,合肥 230012);
2. 中南大学湘雅医院护理部,长沙 410008;
3. 中南大学湘雅医院烧伤科,长沙 410008;
4. 中南大学湘雅医院感染控制中心,长沙 410008

基金项目:

湖南省发改委资助项目（湘财企指[2016]65号）

湖南省自然科学基金面上项目（2019JJ40527）

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出版历程
- 收稿日期: 2018-07-20
- 网络出版日期: 2021-10-28
- 刊出日期: 2019-09-20

Meta-analysis of efficacy of pressure therapy in treating patients with hypertrophic scars

1. Xiangya Nursing School, Central South University, Changsha 410013, China (Tian Lingyun is working at Nursing School of Anhui University of Chinese Medicine, Hefei 230012, China);
2. Nursing Department, Xiangya Hospital, Central South University, Changsha 410008, China;
3. Department of Burns, Xiangya Hospital, Central South University, Changsha 410008, China;
4. Control Center of Infection, Xiangya Hospital, Central South University, Changsha 410008, China

摘要

摘要: 目的应用荟萃分析方法系统评价压力疗法治疗增生性瘢痕患者的有效性。方法以"hypertrophic scar、hyperplastic scar、HTS、pressure therapy、pressure treatment"为检索词检索《PubMed》《Embase》《Web of Science》《Cochrane Library》数据库，以"增生性瘢痕、瘢痕增生、肥厚性瘢痕、压力治疗、压力疗法"为检索词检索《中国期刊全文数据库》，检索各数据库自建库起至2017年7月公开发表的有关压力疗法治疗增生性瘢痕患者的随机对照试验。结局指标为有效比例、温哥华瘢痕量表(VSS)评分、瘢痕血管分布、瘢痕柔软度、瘢痕色泽、瘢痕厚度、瘢痕颜色的亮度和红色与黄色值。采用RevMan 5.3及Stata 12.0统计软件对符合标准的研究进行荟萃分析。结果共纳入11篇文献667例增生性瘢痕患者，包括接受压力治疗的压力疗法组患者362例和未进行任何治疗的未治疗组患者305例。纳入的11项研究偏倚风险均不确定。与未治疗组相比，压力疗法组患者有效比例显著升高，相对危险度＝5.98(95%置信区间＝1.83～19.46，P<0.01)；VSS评分和瘢痕血管分布均明显降低，加权均数差＝－2.24、－0.66(95%置信区间＝－4.16～－0.33、－1.21～－0.12，P<0.05)；瘢痕柔软度、瘢痕色泽、瘢痕厚度、瘢痕颜色的亮度和红色与黄色值均无明显变化(P≥0.05)。有效比例、VSS评分、瘢痕血管分布、瘢痕柔软度、瘢痕色泽、瘢痕厚度纳入研究间存在明显异质性，P<0.01，I²＝90%、87%、80%、93%、86%、94%。压力范围可能是有效比例异质性来源，压力衣联合压力垫疗法可能是VSS评分异质性来源。敏感性分析结果显示，有效比例、瘢痕色泽合并效应量结果稳定性好，VSS评分、瘢痕厚度、瘢痕柔软度、瘢痕血管分布合并效应量结果稳定性不好。有效比例、VSS评分、瘢痕柔软度、瘢痕色泽及瘢痕血管分布不存在发表偏倚(P>0.1)，瘢痕厚度存在发表偏倚(95%置信区间＝－19.77～－3.30，P<0.1)。结论相较于未治疗患者，压力疗法治疗增生性瘢痕可明显提高有效比例，降低VSS评分，减少瘢痕血管分布，但不能明显改善瘢痕柔软度、瘢痕色泽、瘢痕厚度、瘢痕颜色的亮度和红色与黄色值。
- 瘢痕 /
- 有效性研究 /
- 压力疗法 /
- 荟萃分析
Abstract: Objective To systematically evaluate the efficacy of pressure therapy in treating patients with hypertrophic scars by meta-analysis. Methods Databases including PubMed, Embase, Web of Science, and Cochrane Library were retrieved with the search terms"hypertrophic scar, hyperplastic scar, HTS, pressure therapy, pressure treatment, and the Chinese Journals Full-text Database was retrieved with the search terms in Chinese version"增生性瘢痕,瘢痕增生,肥厚性瘢痕,压力治疗,压力疗法"to obtain the publicly published randomized controlled trials about pressure therapy in the treatment of patients with hypertrophic scar from the establishment of each database to July 2017. The measurement indexes included the effective ratio, Vancouver Scar Scale (VSS) score, scar vascularity, scar hardness, scar pigment, scar thickness, and value of scar color (brightness, red, and yellow). RevMan 5.3 and Stata 12.0 statistical software were used to conduct a meta-analysis of eligible studies. Results A total of 667 hypertrophic scar patients were enrolled in 11 articles, including 362 patients in pressure therapy group who received pressure treatment and 305 patients in untreated group who received no treatment. The bias risks of the 11 studies included were uncertain. Compared with those of untreated group, the effective ratio of patients in pressure therapy group was significantly increased, with the relative risk of 5.98 (95% confidence interval=1.83-19.46, P<0.01); the VSS score and scar vascularity of patients in pressure therapy group were obviously decreased, with weighted mean differences of -2.24 and -0.66 respectively (95% confidence interval=-4.16--0.33, -1.21--0.12, P<0.05); the scar hardness, scar pigment, scar thickness, and value of scar color (brightness, red, and yellow) of patients in pressure therapy group were not changed obviously (P≥0.05). Significant heterogeneity existed in the included studies of the effective ratio, VSS score, scar vascularity, scar hardness, scar pigment, and scar thickness, P<0.01, I²=90%, 87%, 80%, 93%, 86%, 94%. Pressure range might be the heterogeneity source of effective ratio, and pressure clothing combined with pressure pad therapy might be a heterogeneous source of VSS score. Sensitivity analysis showed that the combined effect size results were stable in the effective ratio and scar pigment, but not stable in the VSS score, scar thickness, scar hardness, and scar vascularity. There was no publication bias in the effective ratio, VSS score, scar hardness, scar pigment, and scar vascularity (P>0.1), while there was publication bias in the scar thickness (95% confidence interval=-19.77--3.30, P<0.1). Conclusions Compared with patients without treatment, in the treatment of hypertrophic scars, pressure therapy can obviously increase the effective ratio, reduce the VSS score and scar vascularity, but can not obviously improve the scar hardness, scar pigment, scar thickness, and value of scar color (brightness, red, and yellow).
- Cicatrix /
- Validation studies /
- Pressure therapy /
- Meta-analysis