他克莫司治療口腔扁平苔癬的系統評價_《中國循證醫學雜志》

作者：

吳伯海 ¹ , 李成章 ¹ ,  郭毅 ²

1. 武漢大學口腔醫學院（武漢?430079）；2. 武漢大學公共衛生學院流行病學教研室（武漢?430071）;

關鍵詞：

口腔扁平苔癬他克莫司糖皮質激素系統評價

DOI：

10.7507/1672-2531.20110123

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目的　系統評價他克莫司與糖皮質激素比較治療口腔扁平苔癬（OLP）的療效和安全性。
方法　采用Cochrane系統評價方法，計算機檢索Cochrane Library、MEDLINE、EMbase、CBM、CNKI中從建庫至2010年11月收錄的關于比較他克莫司和糖皮質激素治療OLP療效的隨機對照試驗（RCT）。按照納入與排除標準選擇文獻、提取資料和評價納入研究的方法學質量后，采用RevMan 5.0.25軟件進行Meta分析。
結果　最終納入4個RCT，共164例患者。2個研究結果顯示，他克莫司能有效減少OLP患者的病損面積和疼痛。Meta分析發現：他克莫司治療OLP的總有效率并不優于糖皮質激素［OR=4.38，95%CI （0.67，28.73）］，其治療期間的不良反應發生率亦與糖皮質激素無統計學差異［OR=3.49，95%CI （0.49，24.84）］。兩組藥物治療OLP停藥后的復發率差異無統計學意義［OR=0.82，95%CI （0.27，2.46）］。
結論　局部外用他克莫司在改善OLP患者體征（病損面積）和癥狀（疼痛）方面效果顯著，與未納入本系統評價的其他非RCT研究報告的結論一致。目前證據表明，他克莫司治療OLP的總有效率、治療期間局部不良反應發生率及停藥后復發率均與糖皮質激素相當。由于本系統評價納入試驗對某些療效評價指標的評估方法不盡相同，今后需要更多高質量、多中心、療效評價指標及其相應評估方法均統一的RCT，以獲得更可靠的證據。

引用本文： 吳伯海,李成章,郭毅. 他克莫司治療口腔扁平苔癬的系統評價. 中國循證醫學雜志, 2011, 11(6): 706-710. doi: 10.7507/1672-2531.20110123 復制

1.	1 Setterfield JF, Black MM, Challacombe SJ. The management of oral lichen planus. Clin Exp Dermatol , 2000, 25(3): 176-182.
2.	2 Dissemond J. Oral lichen planus: an overview. J Dermatolog Treat , 2004, 15(3): 136-140.
3.	4 López-Jornet P, Camacho-Alonso F, Salazar-Sanchez N. Topical tacrolimus and pimecrolimus in the treatment of oral lichen planus: an update. J Oral Pathol Med , 2010, 39(3): 201-205.
4.	7 Corrocher G, Di Lorenzo G, Martinelli N, et al . Comparative effect of tacrolimus 0.1% ointment and clobetasol 0.05% ointment in patients with oral lichen planus. J Clin Periodontol , 2008, 35(3): 244-249.
5.	8 Radfar L, Wild RC, Suresh L. A comparative treatment study of topical tacrolimus and clobetasol in oral lichen planus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod , 2008, 105(2): 187-193.
6.	9 Laeijendecker R, Tank B, Dekker SK, et al . A comparison of treatment of oral lichen planus with topical tacrolimus and triamcinolone acetonide ointment. Acta Derm Venereol , 2006, 86(3): 227-229.
7.	10 Vente C, Reich K, Rupprecht R, et al . Erosive mucosal lichen planus: response to topical treatment with tacrolimus. Br J Dermatol , 1999, 140(2): 338-342.
8.	11 Rozycki TW, Rogers RS 3rd, Pittelkow MR, et al . Topical tacrolimus in the treatment of symptomatic oral lichen planus: a series of 13 patients. J Am Acad Dermatol , 2002, 46(1): 27-34.
9.	12 Kaliakatsou F, Hodgson TA, Lewsey JD, et al . Management of recalcitrant ulcerative oral lichen planus with topical tacrolimus. J Am Acad Dermatol , 2002, 46(1): 35-41.
10.	13 Olivier V, Lacour JP, Mousnier A, et al . Treatment of chronic erosive oral lichen planus with low concentrations of topical tacrolimus: an open prospective study. Arch Dermatol , 2002, 138(10): 1335-1338.
11.	14 Morrison L, Kratochvil FJ 3rd, Gorman A. An open trial of topical tacrolimus for erosive oral lichen planus. J Am Acad Dermatol , 2002, 47(4): 617-620.
12.	15 Byrd JA, Davis MD, Bruce AJ, et al . Response of oral lichen planus to topical tacrolimus in 37 patients. Arch Dermatol , 2004, 140(12): 1508-1512.
13.	16 Hodgson TA, Sahni N, Kaliakatsou F, et al . Long-term efficacy and safety of topical tacrolimus in the management of ulcerative/erosive oral lichen planus. Eur J Dermatol , 2003, 13(5): 466-470.
14.	17 Eckardt A, Volker B, Starke O, et al . Topical tacrolimus in erosive oral lichen planus: an e?ective treatment approach. Oral Biosci Med , 2005, 4: 235-240.
15.	18 Thomson MA, Hamburger J, Stewart DG, et al . Treatment of erosive oral lichen planus with topical tacrolimus. J Dermatolog Treat , 2004, 15(5): 308-314.
16.	19 Fricain JC, Sibaud V, Campana F, et al . Mucosal pigmentation after oral lichen planus treatment with topical tacrolimus. Dermatology , 2005, 210(3): 229-232.
17.	20 Lozada-Nur FI, Sroussi HY. Tacrolimus powder in Orabase 0.1% for the treatment of oral lichen planus and oral lichenoid lesions: an open clinical trial. Oral Surg Oral Med Oral Pathol Oral Radiol Endod , 2006, 102(6): 744-749.
18.	21 Niwa Y, Terashima T, Sumi H. Topical application of the immunosuppressant tacrolimus accelerates carcinogenesis in mouse skin. Br J Dermatol , 2003, 149(5): 960-967.
19.	22 Spergel JM, Leung DY. Safety of topical calcineurin inhibitors in atopic dermatitis: evaluation of the evidence. Curr Allergy Asthma Rep , 2006, 6(4): 270-274.
20.	孫玉亮, 趙今, 吳泰相, 等. 口腔扁平苔蘚治療的系統評價. 中國循證醫學雜志, 2009, 9(3): 323-330.
21.	蘇士文, 程喆, 閆俊杰. 他克莫司軟膏治療糜爛型口腔扁平苔蘚的效果觀察. 海峽藥學, 2010, 22(3): 153-154.
22.	楊衛平, 楊建強. 他克莫司軟膏治療口腔糜爛型扁平苔蘚的療效觀察. 實用口腔醫學雜志, 2010, 26(1): 108-109.

1. 1 Setterfield JF, Black MM, Challacombe SJ. The management of oral lichen planus. Clin Exp Dermatol , 2000, 25(3): 176-182.
2. 2 Dissemond J. Oral lichen planus: an overview. J Dermatolog Treat , 2004, 15(3): 136-140.
3. 4 López-Jornet P, Camacho-Alonso F, Salazar-Sanchez N. Topical tacrolimus and pimecrolimus in the treatment of oral lichen planus: an update. J Oral Pathol Med , 2010, 39(3): 201-205.
4. 7 Corrocher G, Di Lorenzo G, Martinelli N, et al . Comparative effect of tacrolimus 0.1% ointment and clobetasol 0.05% ointment in patients with oral lichen planus. J Clin Periodontol , 2008, 35(3): 244-249.
5. 8 Radfar L, Wild RC, Suresh L. A comparative treatment study of topical tacrolimus and clobetasol in oral lichen planus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod , 2008, 105(2): 187-193.
6. 9 Laeijendecker R, Tank B, Dekker SK, et al . A comparison of treatment of oral lichen planus with topical tacrolimus and triamcinolone acetonide ointment. Acta Derm Venereol , 2006, 86(3): 227-229.
7. 10 Vente C, Reich K, Rupprecht R, et al . Erosive mucosal lichen planus: response to topical treatment with tacrolimus. Br J Dermatol , 1999, 140(2): 338-342.
8. 11 Rozycki TW, Rogers RS 3rd, Pittelkow MR, et al . Topical tacrolimus in the treatment of symptomatic oral lichen planus: a series of 13 patients. J Am Acad Dermatol , 2002, 46(1): 27-34.
9. 12 Kaliakatsou F, Hodgson TA, Lewsey JD, et al . Management of recalcitrant ulcerative oral lichen planus with topical tacrolimus. J Am Acad Dermatol , 2002, 46(1): 35-41.
10. 13 Olivier V, Lacour JP, Mousnier A, et al . Treatment of chronic erosive oral lichen planus with low concentrations of topical tacrolimus: an open prospective study. Arch Dermatol , 2002, 138(10): 1335-1338.
11. 14 Morrison L, Kratochvil FJ 3rd, Gorman A. An open trial of topical tacrolimus for erosive oral lichen planus. J Am Acad Dermatol , 2002, 47(4): 617-620.
12. 15 Byrd JA, Davis MD, Bruce AJ, et al . Response of oral lichen planus to topical tacrolimus in 37 patients. Arch Dermatol , 2004, 140(12): 1508-1512.
13. 16 Hodgson TA, Sahni N, Kaliakatsou F, et al . Long-term efficacy and safety of topical tacrolimus in the management of ulcerative/erosive oral lichen planus. Eur J Dermatol , 2003, 13(5): 466-470.
14. 17 Eckardt A, Volker B, Starke O, et al . Topical tacrolimus in erosive oral lichen planus: an e?ective treatment approach. Oral Biosci Med , 2005, 4: 235-240.
15. 18 Thomson MA, Hamburger J, Stewart DG, et al . Treatment of erosive oral lichen planus with topical tacrolimus. J Dermatolog Treat , 2004, 15(5): 308-314.
16. 19 Fricain JC, Sibaud V, Campana F, et al . Mucosal pigmentation after oral lichen planus treatment with topical tacrolimus. Dermatology , 2005, 210(3): 229-232.
17. 20 Lozada-Nur FI, Sroussi HY. Tacrolimus powder in Orabase 0.1% for the treatment of oral lichen planus and oral lichenoid lesions: an open clinical trial. Oral Surg Oral Med Oral Pathol Oral Radiol Endod , 2006, 102(6): 744-749.
18. 21 Niwa Y, Terashima T, Sumi H. Topical application of the immunosuppressant tacrolimus accelerates carcinogenesis in mouse skin. Br J Dermatol , 2003, 149(5): 960-967.
19. 22 Spergel JM, Leung DY. Safety of topical calcineurin inhibitors in atopic dermatitis: evaluation of the evidence. Curr Allergy Asthma Rep , 2006, 6(4): 270-274.
20. 孫玉亮, 趙今, 吳泰相, 等. 口腔扁平苔蘚治療的系統評價. 中國循證醫學雜志, 2009, 9(3): 323-330.
21. 蘇士文, 程喆, 閆俊杰. 他克莫司軟膏治療糜爛型口腔扁平苔蘚的效果觀察. 海峽藥學, 2010, 22(3): 153-154.
22. 楊衛平, 楊建強. 他克莫司軟膏治療口腔糜爛型扁平苔蘚的療效觀察. 實用口腔醫學雜志, 2010, 26(1): 108-109.

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他克莫司治療口腔扁平苔癬的系統評價

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《中國循證醫學雜志》

他克莫司治療口腔扁平苔癬的系統評價

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