富血小板血浆与透明质酸治疗膝骨关节炎疗效对比的Meta分析

Therapeutic effects of platelet-rich plasma versus hyaluronic acid for knee osteoarthritis: a meta-analysis

背景:透明质酸是治疗膝骨关节炎的常用药物,富血小板血浆治疗膝骨关节炎则是近年来的研究热点,对于这两者之间的有效性和安全性的比较尚存在争议。目的:系统评价富血小板血浆与透明质酸治疗膝骨关节炎的有效性及安全性。方法:按照Cochrane系统评价的方法,应用计算机检索CNKI、维普网、万方数据知识服务平台、中国生物医学文献数据库(CBM)、Pub Med、Cochrane Library、Embase等数据库,检索有关富血小板血浆与透明质酸治疗膝骨关节炎的随机对照试验,文献发表时间为建库至2020年1月。对所有符合纳入标准的文献进行质量评价,采用Revman 5.3软件对其WOMAC评分、IKDC评分、目测类比评分、Lequesne指数及不良事件进行Meta分析。结果与结论:(1)纳入21篇文献,共1872例患膝,其中富血小板血浆组963例,透明质酸组909例;(2)Meta分析结果显示,富血小板血浆组治疗后3,6,12个月的WOMAC评分明显低于透明质酸组[MD=-5.84,95%CI(-10.11,-1.57),P=0.007;MD=-9.48,95%CI(-13.02,-5.95),P<0.00001;MD=-10.47,95%CI(-13.95,-7.00),P<0.00001],治疗后6,12个月的目测类比评分低于透明质酸组[MD=-5.02,95%CI(-8.87,-1.18),P=0.01;MD=-3.33,95%CI(-4.89,-1.76),P<0.0001],治疗后3,6,12个月的IKDC评分高于透明质酸组[MD=7.10,95%CI(3.88,10.32),P<0.0001;MD=7.88,95%CI(5.12,10.65),P<0.00001;MD=6.85,95%CI(2.50,11.19),P=0.002],治疗后6,12个月的Lequesne指数低于透明质酸组[MD=-0.82,95%CI(-1.31,-0.32),P=0.001;MD=-2.37,95%CI(-2.93,-1.81),P<0.00001];两组不良事件发生率比较差异无显著性意义[OR=1.46,95%CI(0.94,2.24),P=0.09];(3)结果表明相较于透明质酸,富血小板血浆治疗膝骨关节炎更能缓解疼痛、改善功能、提高患者生活质量,疗效更持久。

BACKGROUND: Hyaluronic acid is a commonly used drug in the treatment of knee osteoarthritis, and platelet-rich plasma is a research hotspot in recent years. There is still controversy on the comparison of the effectiveness and safety between them. OBJECTIVE: To systematically assess the efficacy and safety of platelet-rich plasma and hyaluronic acid for knee osteoarthritis through a meta-analysis. METHODS: The authors systematically retrieved the databases of CNKI, VIP, Wanfang, CBM, Pub Med, EMBase and Cochrane Library for randomized controlled trials regarding platelet-rich plasma versus hyaluronic acid for knee osteoarthritis published from inception to January 2020. Quality assessment was conducted on eligible randomized controlled trials. A meta-analysis was performed in WOMAC score, IKDC score, visual analogue scale score, Lequesne index and adverse events using Rev Man 5.3 software. RESULTS AND CONCLUSION:(1) Totally 21 randomized controlled trials were eventually included,involving 1 872 knees including 963 patients in the platelet-rich plasma group and 909 patients in the hyaluronic acid group.(2) Meta-analysis results showed that WOMAC scores were significantly lower in the platelet-rich plasma group than in the hyaluronic acid group at 3, 6 and 12 months after treatment [MD=-5.84, 95%CI(-10.11,-1.57), P=0.007;MD=-9.48, 95%CI(-13.02,-5.95), P < 0.000 01;MD=-10.47, 95%CI(-13.95,-7.00), P < 0.000 01]. Visual analogue scale scores were lower in the platelet-rich plasma group than in the hyaluronic acid group at 6 and 12 months after treatment [MD=-5.02, 95%CI(-8.87,-1.18), P=0.01;MD=-3.33, 95%CI(-4.89,-1.76), P < 0.000 1]. IKDC scores were higher in the platelet-rich plasma group than in the hyaluronic acid group at 3, 6, and 12 months after treatment [MD=7.10, 95%CI(3.88, 10.32), P < 0.000 1;MD=7.88, 95%CI(5.12, 10.65), P < 0.000 01;MD=6.85, 95%CI(2.50, 11.19), P=0.002]. Lequesne Index scores were lower in the platelet-rich plasma group than in the hyaluronic acid group at 6 and 12 months after treatment [MD=-0.82, 95%CI(-1.31,-0.32), P=0.001;MD=-2.37, 95%CI(-2.93,-1.81), P < 0.000 01]. No significant difference was found in adverse event rates between the two groups [OR=1.46, 95%CI(0.94, 2.24), P=0.09].(3) The results show that compared with hyaluronic acid, platelet-rich plasma can relieve pain, improve function, improve the quality of life of patients with knee osteoarthritis, and the effect is more lasting.