国内富血小板血浆与透明质酸对膝关节骨性关节炎临床疗效差异的Meta分析

Clinical efficacy between platelet-rich plasma and hyaluronic acid in the treatment of knee osteoarthritis:meta-analysis of the published clinical trails

目的通过Meta分析比较国内使用富血小板血浆(PRP)与透明质酸(HA)关节腔内注射在治疗膝关节骨性关节炎上的临床疗效是否存在差异。方法检索并收集2019年3月31日前公开发表于PubMed和中国知网(CNKI)上研究关节腔内注射PRP与HA治疗膝关节骨性关节炎临床疗效差异的随机对照研究文献,制定并严格按照排除与纳入标准进行文献收集,所纳入研究的所在医院为中国地区内,使用Review Manager5.3软件对纳入文献中的数据进行Meta分析。结果共纳入11篇随机对照研究文献,总计784例标本接受关节腔内药物治疗,其中PRP组共393例,HA组391例。与HA组对比,PRP组治疗KOA后1个月无明显差异(WOMCA:MD=-1.33,P>0.05;VAS:MD=-0.39,P>0.05);PRP组治疗3个月后VAS评分与HA组无明显差异, WOMAC评分结果优于HA组,其差异具有显著统计学意义(WOMCA:MD=-3.51,P<0.01;VAS:MD=-0.30,P>0.05);PRP组治疗6个月后,所有评分结果均明显优于HA组,其差异具有显著统计学意义(WOMCA:MD=-8.03,P<0.01;VAS:MD=-1.70,P<0.05);8项研究对HA与PRP治疗KOA后产生的不良反应进行了统计,合并分析结果显示PRP治疗KOA与HA相比并不存在额外风险,两者不良反应发生情况间的差异无统计学意义(OR=1.56,P>0.05)。结论使用PRP关节腔内注射治疗KOA的远期疗效比HA更好,两者间不良反应发生情况并无差异,可在临床上大力推广。

Objective To compare the clinical efficacy of intra-articular injection of platelet-rich plasma(PRP)and hyaluronic acid(HA)in the treatment of knee osteoarthritis by meta-analysis.Methods Randomised trials of the joint cavity injection of PRP versus HA in the treatment of knee osteoarthritis in domestic hospitals before March 31,2019,available at PubMed and CNKI,were retrieved and formulated strictly according to the exclusion and inclusion criteria of literature collection.The data included was studied with Meta analysis using Review Manager 5.3 software.Results A total of 11 randomized controlled trails were included,involving 784 patients receiving intra-articular drug therapy,including 393 in the PRP group and 391 in the HA group.There was no significant difference between the PRP group and the HA group after 1 month of KOA treatment(WOMCA:MD=-1.33,P>0.05;VAS,MD=0.39,P>0.05);VAS score in PRP group was not significantly different from HA group after 3 months of treatment,and WOMAC score was better than HA group,with statistically significant difference(WOMCA:MD=-3.51,P<0.05;VAS,MD=0.30,P>0.05);after 6 months of treatment,all scores in the PRP group were significantly better than those in the HA group,(WOMCA:MD=-8.03,P<<0.05;VAS,MD=1.70,P<0.05);8 studies analyzed the adverse reactions caused by treatment of KOA with HA and PRP.The results of combined analysis showed that there was no additional risk in the treatment of KOA with PRP in comparision of HA,and there was no statistical difference in the occurrence of adverse reactions between the two treatments(OR=1.56,P>0.05).Conclusion The long-term efficacy of PRP intra-articular injection on KOA is better than HA and there is no difference in the occurrence of adverse reactions between the two treatments.PRP used for the treatment of KOA,therefore,deserves promotion in clinical practice.