Efficacy And Safety Of Platelet-rich Plasma Combined With Fractional CO₂ Laser In The Treatment Of Atrophic Acne Scar:A Systematic Evaluation And Meta Analysis

Objective:China's latest acne guideline reports that more than 95%of people will have different degrees of acne,and 3%-7%of acne patients will leave scars.Atrophic acne scars are common in acne scars.Acne and acne scars are disfiguring,which can affect the quality of life and hurt the patient's self-esteem.At present,exfoliative laser is themost effective method to treat atrophic acne scar,but the adverse reactions such as erythema and edema caused by operation limit its clinical application.In recent years,there are some studies that combine platelet rich plasma with fractional CO₂ laser to treat atrophic acne scar,and reduce the adverse reactions after laser operation.The purpose of this meta-analysis is to evaluate the efficacy and safety of platelet-rich plasma combined with fractional CO₂ laser in the treatment of atrophic acne scars on the face,and to provide evidence-based evidence for clinical application.Methods:We searched from the electronic databases Cochrane Library,EMBASE,MEDLINE,CNKI,Wanfang and VIP database.The search time was from the establishment to July 2019.English search terms were:acne,acne vulgaris,scar,cicatrix,platelet rich plasma,PRP,etc;Chinese search terms were:acne,acne vulgaris,acne scar,PRP,platelet rich plasma.To search the randomized controlled trials?RCTs?of platelet rich plasma combined with fractional CO₂ laser in the treatment of atrophic acne scars on the face,and to screen the literatures that meet the requirements and evaluate the quality of the literatures according to the Cochrane bias risk assessment method.Two researchers independently evaluated the quality of RCTs that meet the inclusion criteria.The intervention measures,treatment course,total effective rate,adverse reactions,pain score,patient satisfaction and other data were extracted.Finally,the data of the included studies were analysed.We used Revman 5.3software for statistical analysis.For the counting data,the Odds Ratio?OR?and its 95%confidence interval?95%CI?were used.For the measurement data,the standardized mean difference?SMD?and its 95%confidence interval were used.Results:According to the retrieval method,185 literatures were retrieved,and 5 English literatures were included.All of them were half-face control studies,including 120 patients.Meta analysis showed that:?1?the total effective rate and cure rate of combined therapy were higher than that of single laser group:the total effective rate OR=4.21,95%CI?1.45,12.25?,p=0.008;the cure rate OR=5.06,95%CI?2.15,11.86?,p=0.0002;?2?there was no statistical difference in the duration of erythema and edema between combined therapy and single laser group:the duration of erythema SMD=-0.64,95%CI?-1.65,0.36?,p=0.21;the duration of edema SMD=-0.60,95%CI?-1.87,0.67?,p=0.35;the crusting duration SMD=-1.04,95%CI?-1.56,-0.52?,p<0.0001,combined therapy has a shorter crusting duration than laser alone.More clinical trials are needed to verify the pain scores of the two groups.?3?There was no significant difference in the satisfaction of patients with combined therapy and laser alone:patient satisfaction OR=2.15,95%CI?0.96,4.80?,p=0.06.Conclusion:The total effective rate and cure rate of platelet rich plasma combined with fractional CO₂ laser in the treatment of acne scars were better than that in the laser group alone,and the duration of crusting in the combined treatment was shorter than that in the laser group alone,but there was no significant difference in erythema,edema duration and satisfaction between the two groups.This meta-analysis included 5 English literatures,most of which did not mention specific random methods,all of which did not describe assignment concealment and blind method for subjects,so the quality of the literatures included was generally not high.More rigorous,standardized and high-quality large-scale RCTs are still needed to get more reliable research results to better guide clinical application.