向全英　罗丹　陈伟　左颖　李利

[摘要]目的：系统评价相同波长皮秒与纳秒激光治疗色素增加性疾病的临床疗效和安全性。方法：计算机检索PubMed、EMbase、Web of Science、The Cochrane Library、万方、知网、维普数据库及中国生物医学文献数据库，搜集相同波长皮秒激光对比纳秒激光治疗皮肤色素增加性疾病的随机对照试验，进行Meta分析。结果：共纳入8个RCT，其中6个为自身对照研究。皮损清除有效率、优异清除率由于异质性高，采取亚组分析，分为表皮组、真皮组及文身组。Meta分析结果显示，皮损清除有效率各组均无统计学差异;优异清除率真皮组、文身组皮秒优于纳秒激光，有显著性差异，表皮组无统计学差异;患者满意率无统计学差异，患者非常满意率皮秒激光优于纳秒激光，有显著性差异。长期不良反应皮秒低于纳秒激光，有统计学差异。结论：现有证据表明，真皮色素增加性疾病，如：太田痣、颧部褐青色痣，皮秒激光治疗效果优于纳秒激光;表皮色素增加性疾病（如：雀斑、日光性黑子）两者疗效相当;文身治疗中，皮秒激光獲得优异清除率较纳秒激光可能性更高，皮秒激光副作用少于纳秒激光。皮秒激光是否优于纳秒激光需要更多的高质量研究予以验证。

[关键词]皮秒;纳秒;激光;Meta分析;色素增加性疾病;随机对照试验

[中图分类号]R364.2+3    [文献标志码]A    [文章编号]1008-6455（2021）09-0079-06

Picosecond Laser for Pigmentary Disorders：A Meta-analysis

XIANG Quan-ying1，LUO Dan2，CHEN Wei3，ZUO Ying1，LI Li1

（1.Department of Dermatology and Venereology，West China Hospital，Sichuan University，Chengdu 610041， Sichuan，China;

2.Department of Dermatology，Pengan County People's Hospital，Nanchong 637800，Sichuan，China; 3.Department of Medical Cosmetology，Chengdu Second People's Hospital，Chengdu 610017， Sichuan，China）

Abstract： Objective  To assess clinical efficacy and complications between picosecond laser and nanosecond laser with same wavelength on pigmentary disorders. Methods  PubMed， Embase， Web of Science， The Cochrane Library， WanFang，CNKI， VIP，CBM database were searched to collect randomized controlled trials （RCTs） on picosecond laser and nanosecond laser for pigmentary disorders. Meta-analysis was performed. Results  A total of 8 RCTS were included ，6 of which were self-controlled design .According to heterogeneity，the effective rate and the excellent rate of pigment clearance was analysised in subgroup and divided into epidermis group，dermis group，tattoo group.The effective rate of pigment clearance in each group showed no significant difference.The excellent rate of pigment clearance in dermis group and tattoo group showed significant difference，picosecond laser is better than nanosecond laser ，but there was no significant difference in epidermis group.Besides，there was significant difference in the rate of patients very satisfaction， picosecond laser is better than nanosecond laser .The rate of patients satisfaction showed no statistically significant difference. Picosecond laser has fewer long-term adverse reactions than nanosecond laser，with statistically significance. Conclusion  Current evidence indicates that picosecond laser is better than nanosecond laser for dermal pigmentary disorders， such as nevus of Ota and nevus fuscocaeruleus zygomaticus. Picosecond laser is equivalent to nanosecond laser in epidermal pigmentary disorders （such as freckles， solar lentigines） treatment . In tattoo treatment， picosecond laser are more likely to achieve excellent clearance than nanosecond laser. The picosecond laser has fewer adverse effects than the nanosecond laser. Whether picosecond laser is better than nanosecond laser requires more high-quality studys to prove.

Key words：picosecond;nanosecond;laser;meta-analysis;pigmentary disorders;RCT

近20年来，Q开关纳秒激光已成为去除文身和色素增加性疾病的主力激光器，但仍然存在着色素脱失、色素沉着及瘢痕形成等风险，具有一定的局限性，尤其在深肤色人群，部分文身、色素性疾病清除效果差，治疗次数多，治疗周期长。……