| BACKGROUNDUrticaria is a kind of limited edema due to the expansion of small blood vessels of skin and mucous membrane and to the increase of permeability, which is characterized by different size of the wheals with itching, and may be associated with angioedema. Chronic spontaneous urticaria(CSU), also known as chronic urticaria(CU) refers to the lesions were repeated over 6 weeks. Because of its complex etiology, increasing incidence and recurrence rate, and poor clinical treatment effect, which seriously affect the quality of life of patients, and lead to patients and clinicians be in trouble. There is no doubt that the pathogenesis research and treatment regime of CSU is needed. In recent years, the incidence of chronic spontaneous urticaria not only includes histamine, but also includes the abnormal expression of chemokines, Th1-Th2 immune imbalance, etc. Now, the first line treatment for chronic spontaneous urticaria is H1 anti-histamine. But there are still some patients are not sensitive to the treatment, thus forcing the clinic to find a more effective treatment strategy. The existing reports suggest that NB-UVB combined with antihistamine drugs in the treatment of chronic spontaneous urticaria has a certain therapeutic effect, but is its efficacy and safety reliable? Is it worth recommending? Up to now, there is no systematic review of relevant literature. OBJECTIVEAccording to a meta-analysis, the study systematically reviewed NB-UVB combined with antihistamine for CSU to estimate the efficacy and safety of this therapy in the treatment of CSU. To examine serum level of Monocyte Chemoattractant Protein-3(MCP-3) and Regulated on Activation Normal T cell Expressed and Secreted(RANTES) in chronic spontaneous urticaria’ patients and to further discuss the immune pathogenesis of chronic urticarial.METHODECNKI, PubMed, CBM, EMBASE, CNKI, Web of Science and Cochrane Library were all used to retrieve randomized controlled trials(RCT) of NB-UVB combined with antihistamine versus H1 anti-histamine single in patients with CSU to estimate the efficiency and safety of this treatment, but not limited language. In addition, we also manual retrieve relevant literature. Based on strictly Cochrane system evaluation methods, the primary outcome measures were efficacy and urticaria activity score(UAS), and adverse events was the secondary outcome.MCP-3 and RANTES serum concentration of 20 cases of patients with chronic spontaneous urticaria and 50 cases of healthy controls were detected by ELISA method, and at the same time, IgG, IgM and IgA were tested by Rate Nephelometic immunoassay. Then, statistical analysis was analyzed by SPSS18.0. RESULTSFour RCT studies about 341 patients were included in meta-analysis of NB-UVB combined with antihistamine. Our study demonstrated that this treatment seemed to show more clinical efficacy rate [OR=9.60,95%CI(4.45,20.74),p<0.00001] than H1 anti-histamine single. Urticaria activity score(UAS) in only one study is used to determine efficacy, which demonstrated that the treatment group compared with control group in decline of USA was statistically significant(P<0.05), and the treatment group’s three times average down were more obvious. At 3 months of follow-up, the average UAS of the treatment group continued to fall, 15.7, while the control group rose to 31.2. In adverse reactions, 3 of the 4 included studies reported mild adverse events, including mild diffuse erythema, burning, itching, and so on.The concentrations of MCP-3 and RANTES in experimental group were higher than those in healthy control group(P<0.05), the difference was statistically significant. Compared with healthy people, the discrete degree of MCP-3 and RANTES in CSU were relatively large. The concentrations of IgA in the experimental group were higher than those in the healthy control group(P=0.025), and the concentration of IgG was lower than that of healthy controls(P=0.044), the difference was statistically significant. While the concentration of IgM in the experimental group was lower than that in healthy control group(P=0.080), the difference was not statistically significant. Compared with healthy people, the discrete degree of IgG was relatively large, while the level of IgA and IgM in serum was relatively small. CONCLUSIONSThe clinical efficacy of NB-UVB combined with antihistamine is better than antihistamine single for CSU patients. However, due to the confined amount and the low quality of the included studies, the conclusion should be treated with caution. Therefore, it is necessary for more rigorous randomized, double blind, and controlled trials to verify this conclusion.The abnormal expression of CC chemokine, like RANTES, MCP-3 and so on, in sera of patients with CSU may be relevant to the dominant response of Th2 and its pathogenesis. |
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