Objective: To compare the efficacy and safety of triamcinolone acetonide (TA) alone and in combination with 5-fluorouracil (5-FU) for treating keloids using meta-analysis. Methods: Databases including PubMed, Embase, and Cochrane Library were retrieved with the search terms of " triamcinolone acetonide, 5-fluorouracil, glucocorticoid, fluorouracil, keloid, scar, TAC, 5-FU, hypertrophic scar " and databases including Chinese Journal Full-Text Database, Chinese Biomedical Database, and Wanfang Data were retrieved with the search terms of ",, 5-,," in Chinese to obtain the publicly published randomized controlled trials about the effects of TA alone and in combination with 5-fluorouracil for treating keloids from the establishment of each database to august 2019. The outcome indexes included effective proportion of treatment, incidence proportion of adverse reactions, and recurrence proportion of keloids. RevMan 5.3 and Stata 14.0 statistical software were used to conduct a meta-analysis of eligible studies. Results: A total of 1 326 patients with keloids were included in 14 studies, including 668 patients in TA+ 5-fluorouracil group whose keloids were injected with TA and 5-fluorouracil and 658 patients in TA alone group whose keloids were injected with TA alone. A total of 7 articles achieved 1 to 3 points in modified Jadad score, while 7 articles achieved 4 to 7 points in modified Jadad score. Patients in TA+ 5-fluorouracil group had a higher effective proportion of treatment than that of TA alone group (relative risk=1.28, 95% confidence interval=1.16-1.41, P<0.01). Subgroup analysis showed that the quality of the included literature and ethnic factors might be the source of heterogeneity in effective proportion of treatment. Patients in TA+ 5-fluorouracil group had a lower incidence proportion of adverse reactions than that of TA alone group (relative risk=0.44, 95% confidence interval=0.25-0.75, P<0.01). Patients in TA+ 5-fluorouracil group had a lower recurrence proportion of keloids than that of TA alone group (relative risk=0.25, 95% confidence interval=0.14-0.44, P<0.01). There was no publication bias in incidence proportion of adverse reactions (P>0.05), while the effective proportion of treatment and recurrence proportion of keloids had publication bias (P<0.05). Conclusions: TA combined with 5-fluorouracil is more effective than TA alone for treating keloids, with less incidence of adverse reactions and recurrence.
目的： 应用荟萃分析方法比较曲安奈德联合5-氟尿嘧啶与单独曲安奈德治疗瘢痕疙瘩的有效性和安全性。 方法： 以"曲安奈德、瘢痕疙瘩、5-氟尿嘧啶、糖皮质激素、增生性瘢痕"为检索词检索《中国期刊全文数据库》《中国生物医学文献数据库》《万方数据库》，以"triamcinolone acetonide、5-fluorouracil、glucocorticoid、fluorouracil、keloid、scar、TAC、5-FU、hypertrophic scar"为检索词检索《PubMed》《Embase》《Cochrane Library》数据库。检索各数据库自建库至2019年8月公开发表的比较曲安奈德联合5-氟尿嘧啶和单独曲安奈德治疗瘢痕疙瘩的随机对照试验。结局指标包括治疗有效比例、不良反应发生比例、瘢痕疙瘩复发比例。采用RevMan 5.3和Stata 14.0统计软件对符合入选标准的研究进行荟萃分析。 结果： 共纳入14篇文献1 326例瘢痕疙瘩患者，包括采用曲安奈德联合5-氟尿嘧啶瘢痕疙瘩内注射的曲安奈德＋5-氟尿嘧啶组患者668例，仅采用曲安奈德瘢痕疙瘩内注射的单纯曲安奈德组患者658例。改良Jadad评分1～3分的文献7篇、4～7分的文献7篇。曲安奈德＋5-氟尿嘧啶组患者的治疗有效比例明显高于单纯曲安奈德组[相对危险度(RR)＝1.28，95%置信区间＝1.16～1.41，P<0.01]。亚组分析显示，纳入文献质量高低和人种因素可能是治疗有效比例的异质性来源。曲安奈德＋5-氟尿嘧啶组患者的不良反应发生比例明显低于单纯曲安奈德组(RR＝0.44，95%置信区间＝0.25～0.75，P<0.01)。曲安奈德＋5-氟尿嘧啶组患者的瘢痕疙瘩复发比例明显低于单纯曲安奈德组(RR＝0.25，95%置信区间＝0.14～0.44，P<0.01)。不良反应发生比例不存在发表偏倚(P>0.05)，治疗有效比例、瘢痕疙瘩复发比例存在发表偏倚(P<0.05)。 结论： 曲安奈德联合5-氟尿嘧啶皮下注射治疗瘢痕疙瘩的疗效优于单独应用曲安奈德，且不良反应和复发更少。.
Keywords: Fluorouracil; Glucocorticoids; Keloid; Meta-analysis; Triamcinolone acetonide.