背景:冷冻疗法是治疗肛门生殖器疣(AGW)的最常用治疗方式之一,但是这种待遇在最近的国际建议中没有明确确立。
目的:比较冷冻疗法与其他AGW疗法的疗效和安全性。
方法:通过对12个电子数据库的系统搜索,我们确定了11项随机对照试验,从数据库开始至2016年10月进行筛选,符合纳入标准(包括1个对照组中接受冷冻治疗的免疫功能正常的AGW成人).主要终点是AGW的完全清除。偏见风险评估基于Cochrane手册的建议。Meta分析使用ReviewManagerv5.3软件。
结果:冷冻疗法的疗效似乎与三氯乙酸的疗效没有差异,鬼臼,或者咪喹莫特.与冷冻疗法相比,电手术与AGW清除率的相关性较弱(风险比[RR]0.80,95%置信区间[CI]0.65-0.99)。冷冻疗法与更直接的低水平不良事件(红斑,刺痛,或刺激;RR3.02,95%CI1.38-6.61)和需要口服镇痛药的即时疼痛(RR2.11,95%CI1.07-4.17),但糜烂较少(RR0.57,95%CI0.36-0.90)。
结论:除1项随机对照试验外,所有试验均有较高的偏倚风险。
结论:证据质量低,冷冻疗法是治疗AGW的可接受的一线疗法.
BACKGROUND: Cryotherapy is one of the most commonly used therapeutic modalities to treat anogenital warts (AGWs), but this treatment was not clearly established in the recent international recommendations.
OBJECTIVE: To compare the efficacy and safety of cryotherapy versus other AGW treatments.
METHODS: Through a systematic search of 12 electronic databases, we identified 11 randomized controlled trials, screened from database inception through October 2016, that met the inclusion criteria (including immunocompetent adults with AGWs receiving cryotherapy in 1 of the comparison groups). Primary endpoint was complete clearance of AGW. Risk-for-bias assessment was based on Cochrane Handbook recommendations. Meta-analyses used
Review Manager v5.3 software.
RESULTS: Cryotherapy efficacy did not appear to differ from that of trichloroacetic acid, podophyllin, or imiquimod. Electrosurgery was weakly associated with better AGW clearance than cryotherapy (risk ratio [RR] 0.80, 95% confidence interval [CI] 0.65-0.99). Cryotherapy was associated with more immediate low-level adverse events (erythema, stinging, or irritation; RR 3.02, 95% CI 1.38-6.61) and immediate pain requiring oral analgesics (RR 2.11, 95% CI 1.07-4.17) but fewer erosions (RR 0.57, 95% CI 0.36-0.90).
CONCLUSIONS: All but 1 randomized-controlled trial had a high risk for bias.
CONCLUSIONS: With low-level quality of the evidence, cryotherapy is an acceptable first-line therapy to treat AGWs.