富血小板血浆治疗膝骨关节炎疗效及安全性的系统评价

Effect and safety of platelet-rich plasma in treatment of knee osteoarthritis:a systematic review

目的评价富血小板血浆(PRP)治疗膝骨关节炎(OA)疗效。方法计算机检索MEDLINE、EMBASE、Cochrane图书馆临床对照试验注册中心、中国生物医学文献数据库、中国期刊全文数据库、数字化期刊全文数据库,并手工检索相关领域其他杂志,全面检索PRP治疗膝OA的临床随机对照试验、前瞻性对照研究、准试验研究。检索不受语种限制,时间截止至2014年7月。以膝OA患者为研究对象,比较PRP与透明质酸(HA)或生理盐水治疗膝OA的疗效,评价纳入研究的质量,并用Rev Man5.1软件进行Meta分析,并采用JADAD和Newcastle-Ottawa量表评价证据质量。结果纳入6项随机对照研究,5项准试验研究,7项单组前瞻性研究。治疗后WOMAC评分较对照组提高19.28,治疗后WOMAC评分较治疗前基线提高23.50,PRP治疗后1月WOMAC评分提高最为显著,以后随随访时间延长评分逐渐下降,但仍高于治疗前基线水平。治疗后IKDC评分较对照组降低8.28,治疗后IKDC评分较治疗前基线降低15.77。治疗后视觉模拟评分(VAS)较治疗前基线下降2.81。PRP治疗不良反应主要为注射后轻微的膝关节疼痛,其次为肿胀。证据总体质量评级为低质量,推荐强度为弱推荐。结论 PRP能显著改善膝OA患者膝关节功能,减轻疼痛,效果较HA更好、更持久,且安全性好。

Objective To explore the efficacy and safety of platelet-rich plasma（PRP） in the treatment of knee osteoarthritis（OA）.Methods MEDLINE,EMBASE,the Cochrane registration center,the Chinese Biomedical Literature on disc,China academic journal database,and digitized journals full-text databases were searched for clinical randomized controlled trials（RCTs）,prospective controlled study,and quasi-experimental study on PRP treatment of knee OA published from inception to July 2014 with no language restriction.The literatures of relevant fields of other magazines were also manually retrieved.The efficacy of PRP was compared with hyaluronic acid（HA） or saline in the treatment for knee OA.Two reviewers independently screened studies according to the exclusion and inclusion criteria,extracted data,and assessed the methodological quality using JADAD and Newcastle-Ottawa scale.Meta analysis was performed using Rev Man 5.1 software.Results Six RCTs,five quasi-experimental studies and seven prospective studies were included.The WOMAC scores increased 23.50 from the baseline in the experimental group and was 19.28 higher than the control group.The WOMAC scores increased and reached to its highest one month after the PRP treatment,then declined with the follow-up but still above the baseline.After the treatment with PRP,the IKDC scores decreased 15.77 from the baseline and it was8.28 lower than the control group.The visual analog scores（VAS） also decreased 2.81 from the baseline after the PRP treatment.The main adverse reaction of PRP treatment was mild knee pain after the injection,and the joint swelling was also reported.The overall quality of the evidence was low quality with weak recommendation strength.Conclusion PRP can significantly improve the knee function in the patients with knee OA,relieve the pain with better efficacy,durability and safety compared with HA.