摘要 ：背景：已有多个安慰剂对照研究评估了局部外用硝酸盐药物在雷诺现象中的疗效。

目的：这项荟萃分析的目的是评估局部外用硝酸盐药物对原发性及继发性雷诺现象患者的疗效，其研究终点为指端血流及临床严重程度。

方法：通过MEDLINE、Embase和Cochrane搜索文献。仅纳入比较局部外用硝酸盐药物和安慰剂作为对照的研究。两位独立评价者对偏倚进行了评价。

结果：该荟萃分析共纳入7个安慰剂对照试验，包括346名患者。其中4项试验用了硝酸甘油软膏，2项试验用了MQX-503，1项试验用了复合亚硝酸盐。Meta分析结果提示硝酸盐类药物对雷诺现象有中等至强的疗效，其标准化平均差(SMD)为0.70(0.35-1.05, p<0.0001)。亚组分析提示对于继发性雷诺现象，其疗效更强，SMD为0.95 (0.25 to 1.65, p=0.008)，对于原发性雷诺现象，其疗效中等，SMD为0.45 (0.05 to 0.85, p=0.03)。

局限性：包括纳入多种局部硝酸盐制剂、不同结果评估的整合。

结论：局部外用硝酸盐药物治疗原发性及继发性雷诺现象有效。

附原文：AbstractBACKGROUND:Multiple placebo controlled trials have assessed locally applied topicalnitrate preparations in treating Raynaud's phenomenon (RP).OBJECTIVES: The objective of thismeta-analysis was to assess the effects of local topical nitrates in primaryand secondary RP with respect to a combined endpoint integrating parameters ofdigital blood flow and clinical severity.METHODS: A systematic review wasperformed using MEDLINE, Embase and the Cochrane library. Only trials comparinglocally applied topical nitrates to placebo comparators were included. Studieswere appraised for bias by two independent reviewers.RESULTS: Seven placebocontrolled trials including 346 patients were used in meta-analysis. Fourtrials used nitroglycerin ointments, two used MQX-503 and one used compoundednitrite. Meta-analysis results support a moderate to large treatment effect in Raynaud's phenomenon,standardized mean difference (SMD)=0.70, (0.35 to 1.05, p<0.0001). Subgroupanalyses showed a large treatment effect in secondary RP, SMD=0.95 (0.25 to1.65, p=0.008) and moderate effect in primary RP, SMD=0.45 (0.05 to 0.85,p=0.03).LIMITATIONS: Limitations include the inclusion of multiple topicalnitrate preparations and integration of different outcomesassessments.CONCLUSION: Local topical nitrates have significant efficacy in thetreatment of both primary and secondary Raynaud'sphenomenon.

引自：Curtiss P,SchwagerZ,CobosG, et al.A Systematic Review and Meta-Analysis of theEffects of Topical Nitrates in the Treatment of Primary and Secondary Raynaud's Phenomenon.J Am AcadDermatol.2018Feb 2. pii:S0190-9622(18)30172-5. doi: 10.1016/j.jaad.2018.01.043.[Epub ahead of print]