非生殖器疣局部治疗方法的系统评价

发布时间：2018-06-05 05:47

本文选题：疣 + 化学疗法　；参考：《扬州大学》2014年硕士论文

【摘要】：背景病毒疣是临床上常见的一种良性白限性疾病。疣是表皮感染人乳头瘤病毒(HPV)而导致细胞增殖和增厚,形成丘疹样突起。人体的任何部位都可以感染,但最常见的是手足部的感染,生殖器的感染也越来越常见,但本研究着重于非生殖器疣的治疗。目前关于病毒疣的可靠流行病学数据较少,但统计不同年龄,不同人群和时间,发现最高发病率是儿童和青年,分别为0.84%和12.9%。疣是由HPV感染引起的,但HPV的分型有70多种。外伤或者皮肤破损是最常见的感染方式。在免疫正常的人群中,非生殖器疣对健康的影响不大,一般在数月到数年内消退。这种变化和很多因素有关,包括宿主的免疫力,年龄,HPV类型和大小部位等。研究表明,65%的疣在2年内自然消退。目的系统评价局部治疗非生殖器疣的临床疗效及安全性方法计算机检索Cochorane Library、Pubmed、Medline.Springlink、EMbase、CNKI、CBM、VIP等数据库,检索的最近日期至2013年12月。收集所有局部治疗非生殖器疣的临床随机对照试验(RCT),对其进行系统评价。结果最终102篇中英文文献纳入标准。①水杨酸或5-FU及其制剂、博来霉素、激光、干扰素、二硝基氯苯、温热疗法、ALA-PDT在局部治疗疣时,其效果明显优于安慰剂。②液氮冷冻治疗疣的疗效优于水杨酸及其制剂(RR=0.90,95%CI0.78to1.03),但其疗效次于激光治疗(RR=1.28,95%CI1.20to1.36)。③液氮冷冻治疗疣时间隔2周一次的疗效优于间隔3周(](RR=1.14,95%CI1.04to1.26),冷冻深的治疗疗效优于温和的治疗(RR=1.54,95%CI1.26to1.87)。但冷冻疗效次于局部二硝基氯苯、博来霉素、80%苯酚、DCP等治疗。④ALA-PDT治疗寻常疣的疗效优于常规治疗如微波、冷冻、激光等(RR=1.23,95%CI1.12to1.36),且不良反应较(RR=0.43,95%CI0.26to0.71)。⑤不同浓度的博来霉素、5-氟尿嘧啶局部治疗治愈率无明显差异,但5-氟尿嘧啶的联合治疗疗效优于单独的治疗。⑥胶带疗法、咪喹莫特和维甲酸类药物的联合治疗疗效优于其单独治疗。⑦激光较冷冻治疗疗效好,不良反应、(RR=0.23,95%CI0.11to0.46)。激光联合其他治疗疗效优于单独激光治疗,且不同激光(C02激光和Q激光)治愈率无明显差异。结论局部外用水杨酸或5-FU及其制剂、博来霉素、二硝基氯苯、干扰素、温热疗法、咪喹莫特、维甲酸等是安全有效的疗法。冷冻治疗的疗效与具体的治疗方式如冷冻的时间、冷冻的深度、冷冻的间隔时间等有关。激光和ALA-PDT疗法治疗非生殖器疣疣治愈率高复发率低,局部不良反应轻微,患者依从性较好,是较安全高效的治疗方法。多种治疗方式的联合治疗疗效优于单独治疗。
[Abstract]:Background virus verruca is a common benign leukoconstriction disease. Verruca is an epidermal infection of human papillomavirus (HPV), resulting in cell proliferation and thickening, forming papular processes. Any part of the human body can be infected, but the most common infection is the hand and foot, genital infection is also more and more common, but this study focuses on the treatment of non-genital warts. At present, there are few reliable epidemiological data about virus warts, but according to different age, different population and time, the highest incidence is children and young people (0.84% and 12.9%, respectively). Warts are caused by HPV infection, but there are more than 70 types of HPV. Trauma or skin damage is the most common form of infection. Non-genital warts have little effect on health in the immune population and usually fade within months to years. This change is related to a number of factors, including host immunity, type and size of HPV. Studies have shown that 65% of warts naturally recede within 2 years. Objective to evaluate the clinical efficacy and safety of local treatment of non-genital warts Methods Cochorane Library Pubmedus Medline.Spring Linkage EMbase (CNKI) CBM VIP and other databases were searched by computer, and the most recent date of retrieval was until December, 2013. All clinical randomized controlled trials of local treatment of non-genital verruca were collected and evaluated systematically. Results Standard .1 salicylic acid or 5-FU and its preparation, bleomycin, laser, interferon, dinitrochlorobenzene, thermotherapy and ALA-PDT were included in the local treatment of verruca. The therapeutic effect of liquid nitrogen cryotherapy was better than that of salicylic acid and its preparation RRN 0.90 ~ 95CI0.78to1.03C, but the curative effect was better than that of laser treatment of verruca (RRN 1.2895CI1.20to1.36.3) every 2 weeks (] RRN 1.1495CI1.04to1.26m. The curative effect of deep treatment was better than that of mild treatment. However, the therapeutic effect of cryotherapy is inferior to that of local dinitrochlorobenzene, bleomycin 80% phenol and DCP in treating verruca vulgaris. 4ALA-PDT is superior to conventional therapy such as microwave, cryopreservation, etc. There was no significant difference in the cure rate of local treatment with different concentrations of bleomycin 5-fluorouracil, but the curative effect of combined treatment of 5-fluorouracil was better than that of the treatment of 6 tape alone, and the adverse reaction was higher than that of RRX 0.43 to 0.71. 5 in local treatment of bleomycin 5-fluorouracil, but the curative effect of 5-fluorouracil was better than that of RRX 0.43 to 0.71%, but the curative effect of combined therapy of 5-fluorouracil was better than that of treatment with adhesive tape alone. The therapeutic effect of Imiquimod combined with retinoic acid was better than that of laser alone, and the adverse reaction was 0.2395 CI 0.11 to 0.46%. The curative effect of laser combined with other laser therapy was better than that of single laser therapy, and there was no significant difference in cure rate between different laser CO 2 laser and Q laser. Conclusion topical use of salicylic acid or 5-FU and its preparations, bleomycin, dinitrochlorobenzene, interferon, thermotherapy, imiquimod and retinoic acid are safe and effective therapies. The curative effect of cryotherapy is related to the time of freezing, depth of freezing, interval of freezing and so on. Laser and ALA-PDT therapy is a safe and effective method for the treatment of non-genital warts. The cure rate is high, the recurrence rate is low, the local adverse reaction is slight, and the compliance of patients is good. The combined treatment of multiple treatments is better than that of single treatment.
【学位授予单位】：扬州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R752.5

【参考文献】