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研究生:柯淑華
研究生(外文):Shu-Hua Ko
論文名稱:非藥物介入措施對處置乾癬之成效:系統性回顧暨統合分析之隨機對照試驗
論文名稱(外文):Nonpharmacological Interventions for Managing Psoriasis:A Systematic Review and Meta-Analysis of RCT
指導教授:葉美玲 博士
指導教授(外文):Mei-Ling Yeh, Ph.D.
口試委員:鍾玉珠紀景琪
口試委員(外文):YU-CHU CHUNGCHING-CHI CHI
口試日期:2014-07-28
學位類別:碩士
校院名稱:國立臺北護理健康大學
系所名稱:護理研究所
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2014
畢業學年度:102
語文別:中文
論文頁數:94
中文關鍵詞:乾癬乾癬面積暨嚴重度身體質量指標生活品質統合分析
外文關鍵詞:PsoriasisPsoriasis Area and Severity Index (PASI)Body mass index (BMI)Dermatology Life Quality Index (DLQI)Meta-analysis
相關次數:
  • 被引用被引用:1
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  • 下載下載:80
  • 收藏至我的研究室書目清單書目收藏:3
背景:乾癬屬於一種非傳染性但終身性之慢性發炎皮膚疾病,已被證實會併發多種慢性病。非藥物介入對於改善乾癬的成效尚待定論。
目的:本研究旨在運用系統性回顧暨統合分析,分析隨機試驗中,非藥物介入措施如飲食、運動、生活型態、輔助與另類醫學法對乾癬病人在嚴重度、身體質量指數及生活品質的成效。
研究方法:搜尋至2014年2月發表於MEDLINE、PudMed、Cochrane Library、EBSCO(CINAHL plus with Full Text)、華藝線上圖書館、全國臺灣博碩士論文加值系統資料庫等共6個電子資料庫,選取乾癬病人非藥物介入措施相關文獻符合標準。測量變項為乾癬面積暨嚴重度、身體質量指標或皮膚生活品質。
資料分析:符合納入及排除條件之文章,以Jadad量表、偏差風險評估作為評讀研究文章品質,採用RevMan5.2系統評估其偏差風險,並以CMA Version2統計軟體分析非藥物介入措施之成效。
結果:共納入分析35篇研究樣本,顯示低熱量飲食對改善乾癬病人之嚴重度統合分析有成效,其綜合效量為0.118 (95%CI 0.051~0.271, p=0.000)。魚油對改善乾癬病人之嚴重度指標文獻回顧分析研究具顯著性。研究發現運動介入措施對乾癬病人的嚴重度及身體質量指數達顯著,但對生活品質文獻回顧分析研究未具顯著性。檢索未搜尋到戒菸、戒酒生活型態改變對乾癬病人之嚴重度、身體質量指數、生活品質影響之相關研究。輔助與另類醫學中,穴位刺激對改善乾癬病人之嚴重度統合分析研究未具顯著性,身心療法對改善乾癬病人之嚴重度指標、生活品質文獻回顧分析研究具顯著性。教育對改善乾癬病人之嚴重度指標、生活品質文獻回顧分析研究具顯著性。外用乳液對改善乾癬病人之嚴重度指標文獻回顧分析研究未具顯著性。
結論:現有證據支持低熱量飲食、運動、魚油、身心療法介入對乾癬病人之嚴重度具有療效,其它非藥物介入則缺乏證據支持其療效。本研究結果可提供醫護人員及病人現有之最佳證據,用於選擇乾癬之非藥物介入措施的參考。

Background:Psoriasis is a non-contagious chronic inflammatory skin disease with no proven cure. Psoriasis has been associated with a variety of chronic diseases.There has be a large body of literature on the pharmacological treatments for psoriasis, but whether nonpharmacological interventions are effective in managing psoriasis remains largely unclear.
Purpose: To assess the effects of nonpharmacological interventions in improving the severity of psoriasis, body mass index (BMI), and dermatology life quality index (DLQI).
Methods: Search strategy: databases including the MEDLINE (OVID)、PudMed、Cochrane Library、EBSCO (CINAHL plus with Full Text) and two Chinese databases (Airiti Library and National Digital Library of Theses and Dissertations in Taiwan) in February 2012 for randomized controlled trials on nonpharmacological interventions for managing psoriasis.
Data analysis: Met the inclusion and exclusion criteria of article .We used the Jadad score in the critical appraisal of the quality of the included studies, used the Cochrance Risk of Bias Tool to assess their risk of bias, and used the CMA Version2 statistical software to analyze the pooled intervention effects.
Results: This study included 35 randomized controlled trials.Low-calorie diet improved weight measures. Effect size were 0.118 (95%CI 0.051~0.271, p<0.00). Fish oil interventions significantly improved the severity of psoriasis and patients’ by a literature review. Exercise interventions significantly improved the severity of psoriasis and body mass index, but did not significantly change the quality of life by a literature review.No trials on smoking cessation and alcohol abstinence were found. As to complementary and alternative medicine, acupuncture points stimulation did not significantly improve the severity of psoriasis. Mental therapy interventions significantly improved the severity of psoriasis and quality of life, but did not significantly change the body mass index by a literature review. Education interventions significantly improved the severity of psoriasis and quality of life by a literature review. Topical emulsion for improving psoriasis severity literature retrospective analysis of patients was no significant by a literature review.
Conclusions: The current evidence supports the efficacy of low-calorie diet, exercise, fish oil, mental and physical therapy in managing psoriasis, but does not support the use of other nonpharmacological interventions. Our study results will provide a useful reference for healthcare professionals and patients in making decision in the use of effective nonpharmacological interventions for managing psoriasis, and avoiding use of ineffective interventions.

目 次
摘 要 i
第一章 緒論 - 1 -
第一節 研究動機及重要性 - 1 -
第二節 研究目的 - 4 -
第三節 研究問題 - 5 -
第四節 名詞解釋 - 7 -
第二章 文獻查證 - 10 -
第一節 乾癬介紹 - 10 -
第二節 乾癬的藥物治療 - 12 -
第三節 非藥物療法 - 15 -
第四節 乾癬療效指標 - 21 -
第三章 研究設計與方法 - 24 -
第一節 研究過程 - 24 -
第二節 資料的搜尋與篩選 - 26 -
第三節 研究工具與資料登錄 - 31 -
第四節 研究品質評估 - 33 -
第五節 資料分析 - 35 -
第四章 研究結果 - 38 -
第一節 搜尋結果與研究的篩選流程 - 39 -
第二節 研究樣本特徵 - 41 -
第三節 研究品質評量結果 46
第四節 飲食療法療效評估 51
第五節 運動療效評估 55
第六節 生活型態改變療效評估 56
第五章 討論 62
第一節 研究樣本特性 63
第二節 飲食療法於改善乾癬之乾癬皮膚面積暨嚴重度、身體質量指數及皮膚生活品質之效益 64
第三節 運動於改善乾癬之乾癬皮膚面積暨嚴重度、身體質量指數及皮膚生活品質之成效 66
第四節 生活型態改善乾癬之乾癬皮膚面積暨嚴重度、身體質量指數及皮膚生活品質之成效 67
第五節 輔助與另類醫學於改善乾癬之乾癬皮膚面積暨嚴重度、身體質量指數及皮膚生活品質之效益 68
第六章 結論與限制 70
第一節 對於臨床實務上的意義 71
第二節 對於未來研究上意義 72
第三節 對護理的貢獻 73
第四節 研究限制 74
參考文獻 75
英文文獻 78
編碼及納入研究樣本文獻 88

表次
表1-1 非藥物介入措施應用於乾癬病人的PICO - 5 -
表1-2 乾癬面積(Area)計算方式 - 7 -
表1-3 乾癬嚴重度(Severity)計算方式 - 8 -
表3-1 MeSH  Datebase - 29 -
表4-1 針對飲食、運動、生活型態的文章出處彙總表 - 42 -
表4-2 針對輔助與另類醫學(CAM)的文章出處彙總表 - 43 -
表4-3 研究測量變項彙總表 - 44 -

圖次
圖3-1 研究流程圖 - 25 -
圖4-1 研究篩選流程圖 - 40 -
圖4-2 研究品質判斷結果 49
圖4-3 納入研究百分比 50
圖4-4 低熱量飲食與乾癬面積暨嚴重度(PASI)之統合分析 51
圖4-5 穴位介入與乾癬面積暨嚴重度(PASI)之統合分析 57
圖4-6 穴位介入與乾癬面積暨嚴重度(PASI)之出版偏差 58
圖4-7 穴位介入與乾癬面積暨嚴重度(PASI)之統合分析 58


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編碼及納入研究樣本文獻
A1 Jensen 2013
Jensen, P., Zachariae, C., Christensen, R., Geiker, N.R., Schaadt, B.K., Stender, S., Hansen, P.R., Astrup, A., & Skov, L. (2013). Effect of weight loss on the severity of psoriasis: a randomized clinical study. JAMA Dermatol, 149 (7), 795-801.
doi:10.1001/jamadermatol.2013.722.
A2 Kimball 2012
Kimball, A. B., Alavian, C., Alora-Palli, M., & Bagel, J. (2012). Weight loss in obese patients with psoriasis can be successfully achieved during a course of phototherapy. Journal of the European Academy of Dermatology and Venereology, 26 (12), 1582-1584. doi: 10.1111/j.1468-3083.2011.04361.x.
A3 Del-Giglio 2012
Del, Giglio. M., Gisondi, P., Tessari, G., & Girolomoni, G. (2012).Weight reduction alone may not be sufficient to maintain disease remission in obese patients with psoriasis: a randomized, investigator-blinded study. The Journal of Dermatology, 224 (1), 31-37. doi:10.1159/000335566.
A4 Naldi 2014
Naldi, L., Conti, A., Cazzaniga, S., Patrizi, A., Pazzaglia, M., Lanzoni, A., Veneziano, L., & Pellacani, G. (2014). Diet and physical exercise in psoriasis: a randomized controlled trial. The British Journal of Dermatology, 170 (1), 634-642.
A5 Gisondi 2008
Gisondi, P., Del, Giglio. M., Di, Francesco. V., Zamboni, M., & Girolomoni, G.
(2008). Effect of dietary supplementation patients with moderate-to-severe chronic plaque psoriasis to low-dose cyclosporine therapy: a randomized, controlled, investigator-blinded clinical trial. The American journal of clinical nutrition, 88(5), 1242-1247.
B1 Gupta 1989
Gupta, A. K., Ellis, C.N., Tellner, D. C., Anderson, T, F., &Voorhees, J. J. (1989). Double-blind, placebo-controlled study to evaluate the efficacy of fish oil and low-dose UVB in the treatment of psoriasis. The British Journal of Dermatology, 120 (6), 801-807.
B2 Collier 1993
Collier, P. M., Ursell, A., Zaremba, K., Payne, C. M., Staughton, R. C., & Sanders, T. (1993). Effect of regular consumption of oily fish compared with white fish on chronic plaque psoriasis. Europuan Journal of Clinical Nutrition, 224(1), 31-37. doi:10.1159/000335566
B3 Bjørneboe 1998
Bjørneboe, A., Smith, A. K., Bjørneboe, G. E., Thune, P. O., & Drevon, C. A.
(1998). Effect of dietary supplementation with n-3 fatty acids on clinical manifestations of psoriasis. The British Journal of Dermatology, 118(1), 77-83.
B4 Søyland 1993
Søyland, E., Funk, J., Rajka, G., Sandberg, M., Thune, P., Rustad, L., Helland, S., Middelfart, K., Odu, S., & Falk, E. S. (1993). Effect of dietary supplementation with very-long-chain n-3 fatty acids in patients with psoriasis. The New England Journal of Medicine, 328(25), 1812-1816.
B5 Bittiner 1988
Bittiner, S. B., Tucker, W. F., Cartwright, I., & Bleehen, S. S. (1988). A double-blind, randomised, placebo-controlled trial of fish oil in psoriasis. The Journal of Lancet, 20(1), 378-380.

B6 Gupta 1990
Gupta, A. K., Ellis, C. N., Goldfarb, M. T., Hamilton, T. A., & Voorhees, J. J.
(1990). The role of fish oil in psoriasis. A randomized, double-blind, placebo-controlled study to evaluate the effect of fish oil and topical corticosteroid therapy in psoriasis. International Journal of Dermatology, 29(8), 591-595.
B7 Escobar 1992
Escobar, S. O., Achenbach, R., Iannantuono, R., & Torem, V. (1992). Topical fish oil in psoriasis--a controlled and blind study. Clinical and Experimental Dermatology, 17(3), 159-162.
B8 Grimminger 1993
Grimminger, F., Mayser, P., Papavassilis, C., Thomas, M., Schlotzer, E., Heuer, K. U., Führer, D., Hinsch, K. D., Walmrath, D., & Schill, W. B. (1993). A double-blind, randomized, placebo-controlled trial of n-3 fatty acid based lipid infusion in acute, extended guttate psoriasis. Rapid improvement of clinical manifestations and changes in neutrophil leukotriene profile. The Clinical investigator, 71(8), 634-643.
B9 Danno & Sugie 1998
Danno, K., & Sugie, N. (1998). Combination therapy with low-dose etretinate and eicosapentaenoic acid for psoriasis vulgaris. The journal of Dermatology, 25(11), 703-705.
B10 Mayser 1998
Mayser, P., Mrowietz, U., Arenberger, P., Bartak, P., Buchvald, J., Christophers, E., Jablonska, S., Salmhofer, W., Schill, W. B., Krämer, H. J., Schlotzer, E., Mayer, K., Seeger, W., & Grimminger, F. (1998). Omega-3 fatty acid-based lipid infusion in patients with chronic plaque psoriasis: results of a double-blind, randomized, placebo-controlled, multicenter trial. Journal of The American Academy of Dermatology, 38(4), 539-547.
B11 Oliwiecki & Burton 1994
Oliwiecki, S., & Burton, J. L. (1994). Evening primrose oil and marine oil in the treatment of psoriasis. Clinical and experimental dermatology, 19(2), 127-129.
C1 Jerrner 1997
Jerner, B., Skogh, M., & Vahlquist, A. (1997). A controlled trial of acupuncture in psoriasis: no convincing effect. Acta Dermato-Venercologica, 77(2), 154-156.
C2 Lu 2012
Lu, C. J., Xiang, Y., Xie, X. L., Xuan, M. L., & He, Z. H. (2012). A randomized controlled single-blind clinical trial on 84 outpatients with psoriasis vulgaris by auricular therapy combined with optimized Yinxieling Formula. Chinese Journal of Integrative Medicine, 18(3), 186-191.
C3 Qing 2009
Qing, H., Tian, Y. S., Fan, J. M., Tang, B. Y., Niu, H. Q., & Lu, J. Y. (2009). Meridian three-combined therapy for treatment of ordinary psoriasis: a multi-center randomized controlled study. Chinese acupuncture & moxibustion , 29(3), 181-184.
C4 Zhang 2000
Zhang, Changlong. (2000). Observation of the effect of treating 36 cases of psoriasis with reflexotherapy plus acupoint blocking. China Reflexology Journal, 2(9), 9-11.
C5 Wu & Gu 2011
Wu, J. P., & Gu, S. Z. (2011). Randomized controlled trials for treatment of 30 cases of ordinary psoriasis by acupuncture and moxibustion. Acupuncture Research, 36(1), 62-65.

D1 Tausk 1999
Tausk, F., & Whitmore, S. E. (1999). A pilot study of hypnosis in the treatment of patients with psoriasis. Psychother Psychosom, 68(4), 221-225.
D2 Vedhara 2007
Vedhara, K., Morris, R. M., Booth, R., Horgan, M., Lawrence, M., & Birchall, N. (2007). Changes in mood predict disease activity and quality of life in patients with psoriasis following emotional disclosure. Journal of Psychosomatic research, , 62(6), 611-619.
D3 Paradisi 2010
Paradisi, A., Abeni, D., Finore, E., Di, Pietro. C., Sampogna, F., Mazzanti, C., Pilla, M. A., & Tabolli, S. (2010). Effect of written emotional disclosure interventions in persons with psoriasis undergoing narrow band ultraviolet B phototherapy. European journal of dermatology, 20(5), 599-605. doi: 10.1684/ejd.2010.1018.
D4 Zachariae 1996
Zachariae, R., Oster, H., Bjerring, P., & Kragballe, K. (1996). Effects of psychologic intervention on psoriasis: a preliminary report. Journal of the American Academy of Dermatology, 34(6), 1008-1015.
D5 Leibovici 2009
Leibovici, V., Magora, F., Cohen, S., & Ingber, A. (2009). Effects of virtual reality immersion and audiovisual distraction techniques for patients with pruritus.The journal of the Canadian Pain Society, 14(4), 283-286.
D6 Tabolli 2012
Tabolli, S., Naldi, L., Pagliarello, C., Sampogna, F., di Pietro C, Spagnoli A, Abeni D; Italian Writing Exercise Study Group. (2012). Evaluation of the impact of writing exercises interventions on quality of life in patients with psoriasis undergoing systemic treatment. The British Journal of dermatology, 167(6), 1254-1264. doi:10.1111/j.1365-2133.2012.11147.x.
D7 Kabat-Zinn 1998
Kabat, Zinn. J., Wheeler, E., Light, T., Skillings, A., Scharf, M. J., Cropley, T. G., Hosmer, D., & Bernhard, J.D. (1998). Influence of a mindfulness meditation-based stress reduction intervention on rates of skin clearing in patients with moderate to severe psoriasis undergoing phototherapy (UVB) and photochemotherapy (PUVA).Psychosom Medicine, 60(5), 625-632.
D8 Keinan 1995
Keinan, G., Segal, A., Gal, U., & Brenner, S. (1995). Stress management for psoriasis patients: The effectiveness of biofeedback and relaxation techniques. Stress Medicine, 11(1), 235-241.
D9 Fortune 2004
Fortune, D. G., Richards, H. L., Griffiths, C. E., & Main, C.J. (2004). Targeting cognitive-behaviour therapy to patients' implicit model of psoriasis : results from a patient preference controlled trial. The British journal of clinical psychology, 43(Pt 1), 65-82.
D10 Gaston 1991
Gaston, L., Crombez, J. C., Lassonde, M., Bernier-Buzzanga, J., & Hodgins S. (1991). Psychological stress and psoriasis: experimental and prospective correlational studies. Acta Dermato-Venereologica Supplementum (Stockh). 156, 37-43.
E1 Bostoen 2012
Bostoen, J., Bracke, S., De, Keyser. S., & Lambert, J. (2012). An educational programme for patients with psoriasis and atopic dermatitis: a prospective randomized controlled trial. The British Journal of dermatology, 167(5), 1025-1031. doi: 10.1111/j.1365-2133.2012.11113.x.

E2 Balato 2013
Balato, N., Megna, M., Di, Costanzo. L., Balato, A., & Ayala, F. (2013). Educational and motivational support service: a pilot study for obile-phone-based interventions in patients with psoriasis. The British Journal of dermatology, 168(1), 201-205. doi:10.1111/j.1365-2133.2012.11205.x.
F1 Brown 2005
Brown, A. C., Koett, J., Johnson, D. W., Semaskvich, N. M ., Holck, P., Lally, D., Cruz, L., Young, R., Higa, B., & Lo, S. (2005). Effectiveness of kukui nut oil as a topical treatment for psoriasis. Internation journal of dermatology, 44(8), 684-687.
F2 Stucker 2001
Stücker, M., Memmel, U., Hoffmann, M., Hartung, J., & Altmeyer, P. (2001). Vitamin B(12) cream containing avocado oil in the therapy of plaque psoriasis. Journal of Dermatology, 203(2), 141-147.


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