4种系统治疗史蒂文斯–约翰逊综合征和中毒性表皮坏死松解症的网状Meta分析

Network Meta-Analysis of 4 Systemic Treatments for Stevenson-Johnson Syndrome and Toxic Epidermal Necrolysis

摘要: 目的：运用网状Meta比较4种系统治疗和支持性治疗史蒂文斯–约翰逊综合征和中毒性表皮坏死松解症的疗效。方法：检索Pubmed、Embase和Cochrane数据库，时间设定为1994年至2019年7月。根据纳入排除标准完成文献筛选、数据提取及质量评价，使用R软件和STATA 14.0进行分析。结果：数据库共检索到12,278篇文章，最终纳入17篇文献，共541名患者。在减少完全再上皮化时间方面：环孢素优于激素，差异有统计学意义(P < 0.05)。SUCRA排序结果前三名依次为环孢素、IVIG联合激素、支持性治疗。在减少平均住院日方面：环孢素优于单用IVIG，结果有统计学意义(P < 0.05)。SUCRA排序结果前三名依次为环孢素、IVIG联合激素、支持性治疗。结论：本次网状Meta分析结果为临床应用环孢素治疗SJS/TEN提供了依据。

Abstract: Objective: A network meta-analysis was used to compare the efficacy of four systemic and support-ive treatments for Stevenson-Johnson syndrome and toxic epidermal necrolysis. Methods: Pubmed, Embase and Cochrane databases were retrieved from 1994 to July 2019. Literature screening, data extraction and quality evaluation were completed according to inclusion and exclusion criteria, and R software and STATA 14.0 were used for analysis. A total of 12,278 articles were retrieved from the database and 17 articles were eventually included, totaling 541 patients. In terms of reducing the time of complete reepithelialization, cyclosporine was superior to glucocorticoid, and the difference was statistically significant (P < 0.05). The top three results of SUCRA sequencing were cyclosporine, IVIG combined with glucocorticoid and supportive therapy. Cyclosporine was superior to IVIG alone in reducing average hospital stay, and the results were statistically significant (P < 0.05). The top three results of SUCRA sequencing were cyclosporine, IVIG combined hormone and supportive therapy. Conclusion: The results of this network meta-analysis provide a basis for the clinical application of cyclosporine in the treatment of SJS/TEN.