Systematic Review Of The Efficacy And Safety Of Q-switched Nd:YAG 1064nm Laser Combined With Oral Tranexamic Acid In The Treatment Of Melasma

Objectives:To evaluate the efficacy and safety of Q-switched Nd:YAG 1064nm laser combined with oral tranexamic acid(TA)in the treatment of melasma.Methods:Computer retrieval China Biology Medicine disc,China National Knowledge Infrastructure,WanFang Database,VIP China Science and Technology Journal Database,Pubmed,Embase,the Cochrane Library,Web of science,Chinese Clinical Trial Registry and United States registry of clinical trials of Q-switched Nd:YAG 1064 nm laser combined oral TA randomized controlled trials for the treatment of melasma,literature retrieval time range for the self-built database Library to December 2019,according to include and exclude the screening of the literature of the inspection standard,Using Cochrane bias risk assessment tools to evaluate quality of literature,to extract the relevant data,using Revman5.3 software for statistical data analysis,binary classification variables data using relative risk(relative risk,RR)and 95%Confidence Interval(the Confidence Interval,CI)expression,continuous variable data using standardized mean differences(standardized mean difference,SMD)and 95%CI.Results:A total of 10 literatures were included,with 991 patients,including 497 patients in the test group(Q-switched Nd:YAG 1064nm laser combined with oral TA)and 494 patients in the control group(Q-switched Nd:YAG 1064nm laser alone).The analysis results were as follows:1.Efficiency analysis:Quantitative analysis of data:?The total effective rate of the experimental group was higher than that of the control group,with statistically significant differences[RR=1.64,95%CI(1.36,1.98),Z=5.18,P<0.05].?The reduction of MASI score in the experimental group before and after treatment was better than that in the control group,with statistically significant differences[SMD=-1.02,95%CI(-1.47,-0.56),Z=4.36,P<0.05].?The recurrence rate of the experimental group was lower than that of the control group,with statistically significant differences[RR=0.27,95%CI(0.11,0.68),Z=2.78,P<0.05].Qualitative analysis of data:Since the data of melanin index outcome index do not meet the requirements of quantitative analysis,only descriptive qualitative analysis was conducted.The decrease of melanin index in the experimental group before and after treatment was better than that in the control group,and the difference was statistically significant(P<0.05).2.safety analysis:Quantitative analysis of data:The incidence of pigmentation in the experimental group was lower than that in the control group,with statistically significant differences[RR=0.16,95%CI(0.07,0.35),Z=4.63,P<0.05].Qualitative analysis of data:?Most of the patients in the test group and the control group had facial erythema or mild edema immediately after laser treatment,which could be relieved or disappeared in a short time after ice compress or cold spray.?In the experimental group,the incidence of gastrointestinal reactions(nausea,abdominal pain,abdominal distension)after oral administration of TA was 2%?12.5%,and the incidence of decreased menstruation was 4%?13.3%.Conclusion:Q-switched Nd:YAG 1064nm laser combined with oral TA in the treatment of melasma has better efficacy,lower recurrence rate and less risk of pigmentation than Q-switched Nd:YAG 1064nm laser alone,which is worthy of clinical application.