结构化心理干预对寻常型银屑病患者生活质量影响的证据整合

Evidence Integration on the Impact of Structured Psychological Intervention on the Quality of Life of Patients with Psoriasis Vulgaris

摘要: 背景：寻常型银屑病的心身交互作用显著损害患者生活质量，心理干预是打破这一恶性循环的关键，但其近五年基于随机对照试验的高质量证据有待系统整合。目的：系统评价近五年结构化心理干预对寻常型银屑病患者生活质量的改善效果及证据异质性。方法：遵循PRISMA指南，检索中英文数据库，纳入比较结构化心理干预与常规护理的随机对照试验。采用Cochrane RoB 2工具评估偏倚风险，并进行主题整合分析。结果：共纳入7项RCT，579例患者。干预模式涵盖沟通导向、认知行为团体、健康教育及协同护理。方法学质量中等，主要局限在于随机化与盲法实施报告不充分。整合分析发现，6项研究报告干预后皮肤病生活质量指数评分较对照组显著降低，组间差值范围约2.1~6.8分，效应主要通过缓解焦虑抑郁、减轻病耻感及提升自我管理能力介导。然而，研究在干预时长、强度及对照措施活性上异质性显著，且心理干预对客观皮损的改善作用不一致。结论：近五年证据支持结构化心理干预作为改善患者生活质量的有效组成部分。未来需开展方法学更严谨、方案标准化、并包含长期随访及神经免疫机制探索的试验，以明确最佳实践，推动银屑病“生物-心理-社会”整合照护模式的标准化实施。

Abstract: Background: The psychosomatic interaction in psoriasis vulgaris significantly impairs patients’ quality of life. Psychological intervention is the key to breaking this vicious cycle, but high-quality evidence based on randomized controlled trials (RCTs) in the past five years needs to be systematically integrated. Objective: This paper aims to systematically evaluate the effect of structured psychological intervention on the quality of life of patients with psoriasis vulgaris in the past five years and the heterogeneity of the evidence. Methods: Following the PRISMA guidelines, Chinese and English databases were searched, and RCTs comparing structured psychological intervention with routine care were included. The Cochrane RoB 2 tool was used to assess the risk of bias, and a thematic integration analysis was conducted. Results: A total of 7 RCTs and 579 patients were included. The intervention models covered communication-oriented, cognitive-behavioral group, health education, and collaborative care. The methodological quality was moderate, with the main limitation being insufficient reporting of randomization and blinding. The integration analysis found that 6 studies reported a significant reduction in the Dermatology Life Quality Index score after intervention compared with the control group, with an intergroup difference range of approximately 2.1~6.8 points. The effect was mainly mediated by alleviating anxiety and depression, reducing stigma, and enhancing self-management ability. However, there was significant heterogeneity in intervention duration, intensity, and the activity of control measures, and the improvement effect of psychological intervention on objective skin lesions was inconsistent. Conclusion: The evidence in the past five years supports structured psychological intervention as an effective component in improving patients’ quality of life. Future studies need to be more methodologically rigorous, standardized in protocols, and include long-term follow-up and exploration of neuroimmune mechanisms to clarify best practices and promote the standardized implementation of the “biopsychosocial” integrated care model for psoriasis.