他克莫司治疗口腔扁平苔癣的系统评价_《中国循证医学杂志》

作者：

吴伯海 ¹ , 李成章 ¹ ,  郭毅 ²

1. 武汉大学口腔医学院（武汉?430079）；2. 武汉大学公共卫生学院流行病学教研室（武汉?430071）;

关键词：

口腔扁平苔癣他克莫司糖皮质激素系统评价

DOI：

10.7507/1672-2531.20110123

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　系统评价他克莫司与糖皮质激素比较治疗口腔扁平苔癣（OLP）的疗效和安全性。
方法　采用Cochrane系统评价方法，计算机检索Cochrane Library、MEDLINE、EMbase、CBM、CNKI中从建库至2010年11月收录的关于比较他克莫司和糖皮质激素治疗OLP疗效的随机对照试验（RCT）。按照纳入与排除标准选择文献、提取资料和评价纳入研究的方法学质量后，采用RevMan 5.0.25软件进行Meta分析。
结果　最终纳入4个RCT，共164例患者。2个研究结果显示，他克莫司能有效减少OLP患者的病损面积和疼痛。Meta分析发现：他克莫司治疗OLP的总有效率并不优于糖皮质激素［OR=4.38，95%CI （0.67，28.73）］，其治疗期间的不良反应发生率亦与糖皮质激素无统计学差异［OR=3.49，95%CI （0.49，24.84）］。两组药物治疗OLP停药后的复发率差异无统计学意义［OR=0.82，95%CI （0.27，2.46）］。
结论　局部外用他克莫司在改善OLP患者体征（病损面积）和症状（疼痛）方面效果显著，与未纳入本系统评价的其他非RCT研究报告的结论一致。目前证据表明，他克莫司治疗OLP的总有效率、治疗期间局部不良反应发生率及停药后复发率均与糖皮质激素相当。由于本系统评价纳入试验对某些疗效评价指标的评估方法不尽相同，今后需要更多高质量、多中心、疗效评价指标及其相应评估方法均统一的RCT，以获得更可靠的证据。

引用本文： 吴伯海,李成章,郭毅. 他克莫司治疗口腔扁平苔癣的系统评价. 中国循证医学杂志, 2011, 11(6): 706-710. doi: 10.7507/1672-2531.20110123 复制

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 eﬀective 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.	孙玉亮, 赵今, 吴泰相, 等. 口腔扁平苔藓治疗的系统评价. 中国循证医学杂志, 2009, 9(3): 323-330.
21.	苏士文, 程喆, 闫俊杰. 他克莫司软膏治疗糜烂型口腔扁平苔藓的效果观察. 海峡药学, 2010, 22(3): 153-154.
22.	杨卫平, 杨建强. 他克莫司软膏治疗口腔糜烂型扁平苔藓的疗效观察. 实用口腔医学杂志, 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 eﬀective 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. 孙玉亮, 赵今, 吴泰相, 等. 口腔扁平苔藓治疗的系统评价. 中国循证医学杂志, 2009, 9(3): 323-330.
21. 苏士文, 程喆, 闫俊杰. 他克莫司软膏治疗糜烂型口腔扁平苔藓的效果观察. 海峡药学, 2010, 22(3): 153-154.
22. 杨卫平, 杨建强. 他克莫司软膏治疗口腔糜烂型扁平苔藓的疗效观察. 实用口腔医学杂志, 2010, 26(1): 108-109.

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他克莫司治疗口腔扁平苔癣的系统评价

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《中国循证医学杂志》

他克莫司治疗口腔扁平苔癣的系统评价

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