豆舒乾 杨一飞 苗晓燕 邓正涛 李浩闯 刘英琦 常谨

[摘要]目的：通过对纳入文献的数据进行网状荟萃分析（Network Meta-analysis，NMA），系统评价八种方法治疗腋臭（Axillary osmidrosis）的有效率。方法：按照Cochrane系统评价的方法，在计算机上检索Cochrane Library、PubMed数据库、中国知网（CNKI）、维普（VIP）、万方（WanFang）全文数据库有关腋臭治疗的病例对照研究及队列研究。检索时间为自建库至2020年6月5日，按预先制定的纳入、排除标准进行资料提取，并对纳入文献的质量进行评价。运用STATA 15.1和RevMan 5.3软件对纳入的数据进行网状荟萃分析和偏倚风险评估。结果：本文共纳入25篇相关文献，涉及8种治疗方式，共3011例腋臭患者。网状荟萃分析显示：治疗腋臭有效率的排序为：皮肤梭形切除>小切口剪切法>射頻微针>皮下搔刮术>负压抽吸术>肉毒毒素皮下注射>Nd：YAG激光>CO2激光。结论：目前治疗腋臭最可靠的方法为皮肤梭形切除术，其次为小切口剪切法，手术治疗较非手术治疗的效果普遍更佳，而非手术治疗中射频微针治疗效果最确切。

[关键词]腋臭;网状荟萃分析;小切口剪切法;肉毒毒素注射;激光疗法

[中图分类号]R758.74+1    [文献标志码]A    [文章编号]1008-6455（2021）06-0017-06

Efficacy of Eight Methods in the Treatment of Axillary Osmidrosis： a Network Meta-analysis

DOU Shu-qian1，YANG Yi-fei1，MIAO Xiao-yan2，DENG Zheng-tao1，LI Hao-chuang1，

LIU Ying-qi2，CHANG Jin2

（1.School of Clinical Medicine，Hebei University of Engineering，Handan 056038，Hebei，China;2.Department of Plastic Surgery，Affiliated Hospital of Hebei University of Engineering，Handan 056002，Hebei，China）

Abstract：  Objective  A Network Meta-analysis was conducted on the data in the included literature to systematically evaluate the efficacy of eight methods in the treatment of axillary osmidrosis. Methods  According to the method of Cochrane systematic evaluation， we searched Cochrane Library， PubMed database， CNKI， VIP and Wanfang for case-control studies and cohort studies on the treatment of axillary osmidrosis. The retrieval time was from the establishment of the database to June 5， 2020. The data were extracted according to the pre-set inclusion and exclusion criteria， and the quality of the included literature was evaluated. Stata 15.1 and Revman 5.3 software were used to conduct a network Meta-analysis and bias risk assessment on the included data. Results  In this paper， a total of 25 related literatures were included， involving 8 treatment methods， and a total of 3 011 cases of patients with axillary osmidrosis were included. Network Meta-analysis showed that the effective rate of treatment for axillary osmidrosis was： fusiform skin resection>the small-incision shear method>radiofrequency microneedle>subcutaneous curettage>negative pressure suction>subcutaneous injection of botulinum toxin A>Nd：YAG laser>CO2 laser. Conclusion  The results showed that the most reliable method for the treatment of axillary osmidrosis was fusiform skin resection， followed by small incision shear method， and the surgical treatment was generally more effective than the non-surgical treatment， while the radiofrequency microneedles were the most effective in the non-surgical treatment.

Key words： axillary osmidrosis; network Meta-analysis; small incision shear method; botulinum toxin A injection; laser therapy

腋臭俗称“狐臭”，又称“多汗症”，是临床上较常见的疾病之一，有研究报道国人患病率为4.56%[1]。其发病机制较为复杂，与种族、性别、环境、情绪、生理状态等多种因素相关[2]。目前普遍较认可的理论认为，腋窝区存在小汗腺、顶泌汗腺（大汗腺）及大小汗腺三种汗腺。小汗腺分泌大量清澈、无味的汗液，顶泌汗腺分泌少量乳白色浓稠汗液[3]，其主要成分有脂肪酸、蛋白质、类固醇等……