背景:透明质酸酶仍然是治疗透明质酸(HA)皮肤填充物后血管阻塞引起的皮肤坏死的主要方法。在施用透明质酸酶的方案中存在广泛的可变性。大多数协议,然而,缺乏关于透明质酸酶剂量的有力证据。
方法:我们进行了系统评价和试点荟萃分析,检索从成立至2023年12月的4个国际数据库,收集2名或2名以上接受透明质酸酶治疗后皮肤坏死患者的临床研究.进行随机效应(DerSimonian和Laird)荟萃分析。主要结果是完全瘢痕消退的合并比例。我们使用JoannaBriggs研究所检查表对研究中的偏倚风险进行了评估,并使用GRADE方法评估了证据的确定性。
结果:我们纳入了15项研究,共223例患者。透明质酸酶给药后完全瘢痕消退的合并比例为77.8%(95%-CI:65.5%至86.6%,pegger=0.093,低确定性)。与低剂量(500IU或更低)治疗的患者相比,高剂量透明质酸酶(>500国际单位[IU])的患者的分辨率较低,为69.6%(95%-CI:41.2%至88.3%),分辨率为88.1%(95%-CI:86.0%至96.2%)。虽然没有统计学意义(p=0.18)。使用辅助疗法对结果没有统计学意义。
结论:与接受高剂量(69.7%)的患者相比,接受低剂量(500IU或更低)的患者的瘢痕完全消退比例更高(88.1%),虽然没有统计学意义(p=0.18)。未来的研究应提供有关其方案的更详细的细节,以有利于将来制定循证指南。
方法:本期刊要求作者为每篇文章分配一定程度的证据。对于这些循证医学评级的完整描述,请参阅目录或在线作者说明www。springer.com/00266.
背景:CRD42024538661。
BACKGROUND: Hyaluronidase remains the mainstay treatment for skin necrosis due to vascular occlusion after hyaluronic acid (HA) dermal
fillers. There is wide variability in protocols for the administration of hyaluronidase. Most protocols, however, lack strong evidence regarding hyaluronidase dosages.
METHODS: We conducted a systematic review and pilot meta-analysis, searching four international databases from inception until December 2023 for clinical studies reporting on two or more patients receiving hyaluronidase for skin necrosis after hyaluronic acid
fillers. Random-effects (DerSimonian and Laird) meta-analyses were conducted. The primary outcome was the pooled proportion of complete scar resolution. We rated intra-study risk of bias using the Joanna Briggs Institute checklists and assessed the certainty of evidence using the GRADE approach.
RESULTS: We included 15 studies totaling 223 patients. The pooled proportion of complete scar resolution after hyaluronidase administration was 77.8% (95%-CI: 65.5% to 86.6%, pegger = 0.093, low certainty). Patients treated with high doses of hyaluronidase (>500 international units [IUs]) had lower rates of resolution of 69.6% (95%-CI: 41.2% to 88.3%) compared to those treated with low doses (500IU or less) that had 88.1% rate of resolution (95%-CI: 86.0% to 96.2%), though not statistically significant (p= 0.18). The use of adjunct therapies did not have a statistically significant effect on outcomes.
CONCLUSIONS: A higher proportion of patients receiving low doses (500IU or less) (88.1%) had complete scar resolution compared to patients receiving high doses (69.7%), though not statistically significant (p=0.18). Future studies should provide more granular details on their protocols to benefit the formulation of evidence-based guidelines in future.
METHODS: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
BACKGROUND: CRD42024538661.