刮痧法治疗黄褐斑的Meta分析及试验序贯分析

姚松领 闫小宁 付海鹏 李张军 闫隽

[摘要]目的：利用Meta分析系統性评价刮痧法治疗黄褐斑的临床疗效，为后续临床治疗及研究提供循证参考。方法：计算机检索中国期刊全文数据库（CNKI）、万方数据库（WanFang）、维普（VIP）、Cochrane Library和PubMed等数据库，检索时间选为建库至2019年11月30日，搜集各大数据库收录的相关RCT试验文献，根据相关纳入和排除标准进行筛选，再利用Cochrane干预措施系统评价手册中的风险偏倚评估工具进行评估，利用Revman5.3 软件对刮痧法治疗黄褐斑的临床总有效率、颜色评分、面积评分和临床兼证总积分进行分析，并根据试验组不同平均年龄段进行亚组分析，最后采用TSA 0.9软件进行试验序贯分析。结果：Meta分析显示刮痧法在治疗黄褐斑总有效率、面积评分、颜色评分等方面均有着不错的疗效，临床效果均高于对照组，而临床兼证总积分方面无统计学意义。TSA分析结果显示，实际样本量远低于期望样本量，且累计Z值并未达到TSA界值，表明本次Meta分析中可能存在假阳性的结论，需要纳入更多的试验以确证疗效。结论：刮痧法治疗黄褐斑的临床疗效明显优于非刮痧疗法，且安全性较好，无明显不良反应。但因纳入研究的文献有限，结论仍需更大、更完整样本的高质量研究来验证。

[关键词]黄褐斑;刮痧;Meta分析;随机对照试验;序贯分析

[中图分类号]R758.4+2    [文献标志码]A    [文章编号]1008-6455（2020）09-0100-06

Meta Analysis and Sequential Analysis of Scraping Therapy for Chloasma

YAO Song-ling1， YAN Xiao-ning2，FU Hai-peng1，LI Zhang-jun2，YAN jun2

（1.First Clinical Medical College of Shaanxi University of Traditional Chinese Medicine， Xianyang 712046， Shaanxi，China; 2.Department of Dermatology，Shaanxi Provincial Hospital of Traditional Chinese Medicine， Xian 710003， Shaanxi，China）

Abstract：Objective To systematically evaluate the clinical effect of scraping therapy on Chloasma by meta analysis， so as to provide evidence-based reference for the follow-up clinical treatment and research. Methods The databases of CNKI， Wanfang， VIP， Cochrane Library and PubMed were searched by computer. The retrieval time is from the establishment of database to November 30， 2019. The relevant RCT test literature collected in each database is screened according to the relevant inclusion and exclusion criteria.Then，the risk bias assessment tool in Cochrane intervention system assessment manual is used for assessment.Revman 5.3 software was used to analyze the clinical efficiency，color score， area score and total clinical syndrome score of scraping therapy for chloasma， Finally， TSA 0.9 software was used for sequential analysis. Results Meta analysis showed that scraping therapy had a good effect in treating chloasma， such as total effective rate， area score，color score， etc. The clinical effect was higher than that of the control group， However， there was no statistical significance in clinical total syndrome score.The results of TSA analysis show that the actual sample size is far lower than the expected sample size，and the accumulated Z value does not reach the TSA boundary value， which indicates that there may be false-positive conclusions in this meta-analysis， and more tests need to be included to confirm the efficacy. Conclusion The clinical effect of scraping therapy on chloasma is better than that of non scraping therapy， and the safety is better without obvious adverse reactions. However， due to the limited literature， the conclusions still need to be verified by a larger and more complete sample of high-quality research.

Key words： chloasma; scraping; Meta analysis; randomized controlled trial ;sequential analysis

黄褐斑是一种常见的色素增加性皮肤病。其主要表现为面部黄褐色色素沉着，因多对称分布于面颊两侧，形如蝴蝶，故又称为蝴蝶斑，中医称之为“黧黑斑”[1]。……