富血小板血浆治疗膝骨关节炎的系统评价和Meta分析

A systematic review and meta-analysis for platelet-rich plasma in treatment of knee osteoarthritis

目的:系统评价富血小板血浆(PRP)对膝骨关节炎(KOA)患者的有效性和安全性。方法:计算机检索2005年~2020年5月之间公开发表在PUBMED、EMBASE、MEDLINE、Cochrane图书馆中的所有关于PRP治疗KOA的双盲随机对照研究。由两位研究员独立进行文献筛选、数据提取,按Cochrane协作网标准对纳入的随机对照试验逐个进行质量评价,对符合纳入标准的研究用RevMan5.3进行Meta统计分析。结果:(1)最终纳入7篇双盲随机对照试验,其中试验(PRP)组250例,对照(无PRP)组230例;(2)Meta分析结果显示:在6、12个月的随访中,PRP组与无PRP组的WOMAC评分(MD=9.63,95%CI:3.29~15.96,P=0.003)、(MD=3.85,95%CI:2.66~5.04,P<0.00001)差异有统计学意义(P<0.05);在随访6个月KOOS功能评分的比较中,PRP组改善膝关节功能评分超过无PRP组(MD=8.63,95%CI:0.85~16.42,P=0.03)(P<0.05)。在随访3、6个月的KOA患者中,注射PRP比未注射PRP组能更有效地减轻疼痛,VAS疼痛评分差异有统计学意义(SMD=0.88,95%CI:0.13~1.62,P=0.02);(SMD=0.85,95%CI:0.11~1.59,P=0.002)(P<0.05)。然而,两组不良事件(AEs)差异均无统计学意义(RR=0.96,95%CI:0.65~1.40,P=0.82)(P>0.05)。结论:在精心设计的双盲随机对照试验的长期随访中,在改善膝关节功能和减轻疼痛方面,PRP相比于其他非手术治疗有更显著的优势。由于质量和数据有限,后期仍需大量高质量的多中心随机对照研究提供更充足的证据。

Objective:Knee osteoarthritis(KOA)is a common chronic joint disease that usually occurs in older people,and injuries articular cartilage and cartilage proliferation.Studies have shown that platelet-rich plasma(PRP),as one of non-surgical treatments,is used to alleviate the symptoms of patients with KOA,becoming popular with doctors.In this study,the purpose was to investigate the effects of platelet-rich plasma on the level of pain and function in patients with KOA.Methods:The Pubmed,Cochrane Library,Embase,and Medline were investigated from 2005 through May 2020.All randomized double-blind controlled trials on the effect of PRP injections for KOA were included.Outcome indicators included the Western Ontario and McMaster Universities Arthritis Index(WOMAC)and the Knee Osteoarthritis Outcome Score(KOOS)for function,the visual analogue scale(VAS)for pain,and adverse events(AEs).Review Manager 5.3 was used to calculate these outcome indicators.Results:In this study,(1)Seven studies met the eligibility criteria,including 250 patients in the experiment(PRP)group and 230 patients in the control(no PRP)group.(2)Meta-analysis results showed that the WOMAC scores were differed significantly between the PRP and no PRP groups at the 6 months follow-up(MD=9.63,95%CI:3.29 to 15.96,P=0.003),and 12 months follow-up(MD=3.85,95%CI:2.66 to 5.04,P<0.00001)(P<0.05).In a comparison of KOOS function scores at the 6 months follow-up,PRP improved knee function scores more than no PRP(MD=8.63,95%CI:0.85 to 16.42,P=0.03)(P<0.05).PRP injections reduced pain more effectively than no PRP injections in patients with KOA at 3,6 months of follow-up,and the VAS pain score showed a significant difference(SMD=0.88,95%CI:0.13 to 1.62,P=0.02)(SMD=0.85,95%CI:0.11 to 1.59,P=0.002)(P<0.05).However,adverse events(AEs)were all not significantly different(RR=0.96,95%CI:0.65 to 1.40,P=0.82)(P>0.05).(3)Results showed that PRP has significant advantages in pain relief and functional improvement.Conclusion:In improving knee function and relieving pain,PRP showed superiority to other non-surgical treatments in long-term follow-up from well-designed double-blind trials.Due to the limited quality and data,more high-quality multi-center studies are required.