富血小板血浆与糖皮质激素治疗肱骨外上髁炎有效性的Meta分析

Efficacy of platelet-rich plasma versus glucocorticoid for lateral humeral epicondylitis: a meta-analysis

背景:肱骨外上髁炎是常见的手肘部疾病,糖皮质激素是其常用的治疗方法之一,但其远期疗效并不理想。近年来,富血小板血浆作为一种新的方法常用于骨和关节慢性炎症的治疗,因而有必要对2种方法的治疗效果进行系统评价和分析。目的:采用Meta分析的方法评价富血小板血浆与糖皮质激素治疗肱骨外上髁炎的临床疗效。方法:计算机检索PubMed、EMbase、theCochraneLibrary、CNKI、VIP、CBM和WangFangData等数据库中有关富血小板血浆与糖皮质激素治疗肱骨外上髁炎的随机对照试验,检索时限从建库至2018年5月;由2位评价员按照纳入和排除标准独立筛选文献、提取数据并评价纳入研究的偏倚风险后采用Review Manger 5.3软件进行Meta分析。结果与结论:(1)最终纳入10个随机对照试验,包括661例患者;(2)Meta分析结果显示,在疼痛缓解方面,2-4周时糖皮质激素优于富血小板血浆(SMD=0.75,P=0.01),6-8周和12周时2组差异无显著性意义(6-8周:SMD=0.38,P=0.25;12周:SMD=-0.16,P=0.33),在6个月和1年时富血小板血浆优于糖皮质激素(6个月:SMD=-0.95,P <0.000 01;1年:SMD=-0.83,P <0.000 01);(3)在关节功能改善方面,2-4周和6-8周时糖皮质激素优于富血小板血浆(2-4周:SMD=0.74,P <0.000 01;6-8周:SMD=0.46,P=0.000 5),在12周时2组差异无显著性意义(SMD=-0.24,P=0.22),在6个月和1年时富血小板血浆优于糖皮质激素(6个月:SMD=-0.65,P=0.03;1年:SMD=-0.53,P=0.001);(4)结果证实,在治疗肱骨外上髁炎时,糖皮质激素可以在短期内缓解疼痛(2-4周)、改善关节功能(2-8周),而富血小板血浆在长期的疼痛缓解和关节功能改善(6个月-1年)方面显示出更优良的效果;考虑到富血小板血浆的长期治疗效果,推荐采用富血小板血浆治疗肱骨外上髁炎。鉴于纳入研究的质量限制,上述结论需更多高质量的研究予以验证。

BACKGROUND:Lateral epicondylitis,a common elbow disease,is often treated with glucocorticoid,but its long-term efficacy is not ideal.Platelet-rich plasma has been used as a new method for the treatment of bone and chronic inflammation,so it is necessary to systematically evaluate and analyze the therapeutic effects of the two methods.OBJECTIVE:To systematically review the effectiveness of platelet-rich plasma versus steroid for lateral humeral epicondylitis.METHODS:Related randomized controlled trials about platelet-rich plasma versus glucocorticoid for epicondylitis were searched in the databases of PubMed,EMbase,the Cochrane Library,CNKI,VIP,CBM and WanFang before May 2018.Two reviewers independently screened literature,extracted data,and assessed the risk of bias of the included studies.Then meta-analysis was performed on RevMan 5.3 software.RESULTS AND CONCLUSION:(1)Ten randomized controlled trials involving 661 patients were included.(2)The meta-analysis results showed that,in pain relief,glucocorticoids were superior to platelet-rich plasma at 2-4 weeks(SMD=0.75,P=0.01);there was no significant difference between two groups at 6-8 weeks and 12 weeks(6-8 weeks:SMD=0.38,P=0.25;12 weeks:SMD=-0.16,P=0.33).Platelet-rich plasma was better than glucocorticoids at 6 months and 1 year(6 months:SMD=-0.95,P<0.000 01;1 year:SMD=-0.83,P<0.000 01).(3)In improving joint function,glucocorticoids were superior to platelet-rich plasma at 2-4 weeks and 6-8 weeks(2-4 weeks:SMD=0.74,P<0.000 01;6-8 weeks:SMD=0.46,P=0.000 5);there was no significant difference between two groups at 12 weeks(SMD=-0.24,P=0.22);platelet-rich plasma was better than glucocorticoids at 6 months and 1 year(6 months:SMD=-0.65,P=0.03;1 year:SMD=-0.53,P=0.001).(4)These results imply that in the treatment of lateral epicondylitis,glucocorticoids can relieve pain(2-4 weeks)and improve joint function(2-8 weeks),platelet-rich plasma appears to be more effective in relieving pain and improving function in the long term(6 months to 1 year).Considering the long-term therapeutic effect of platelet-rich plasma,we recommend platelet-rich plasma as the preferred option for lateral humeral epicondylitis.Due to the limited quality of included studies,more high quality studies are needed to verify the above conclusion.