富血小板血浆治疗下肢静脉溃疡疗效及安全性的Meta分析

Meta-analysis of the efficacy and safety of platelet rich plasma for venous leg ulcers

目的系统评价富血小板血浆(PRP)治疗下肢静脉溃疡(VLU)的疗效和安全性。方法检索Cochrane Library、Medline、Embase、护理及卫生相关文献累积索引(CINAHL)、中国知网数据库、万方数据库、中国生物医学文献数据库(CBM)和维普中文科技期刊数据库等,并通过手工检索获取相关的文献,收集关于PRP治疗VLU的相关临床研究。检索时限为建库至2022年5月,由2名研究者独立筛选文献、提取数据并对纳入的文献进行质量评价,采用RevMan 5.3软件进行Meta分析。结果共纳入16篇文献,其中,随机对照试验(RCT)13篇,非随机对照干预性研究2篇,病例对照研究1篇。Meta分析结果显示,PRP组患者的溃疡愈合率、溃疡面积缩小率均明显高于对照组患者,溃疡面积明显小于对照组患者,差异均有统计学意义(P﹤0.01);两组患者的视觉模拟评分法(VAS)评分比较,差异无统计学意义(P﹥0.05)。PRP组患者的不良反应发生率明显高于对照组患者(P﹤0.01),主要表现为创面瘙痒和溃疡面积扩大。结论PRP治疗VLU具有一定的疗效,但不良反应的发生风险较高,其风险获益有待进一步研究。

Objective To systemically review the efficacy and safety of platelet rich plasma(PRP)in the healing of venous leg ulcers(VLU).Method The Cochrane Library,Medline,Embase,cumulative index to nursing and allied health literature(CINAHL),China National Knowledge Internet,Wan Fang Database,China biology medicine database(CBM)and VIP were searched,and the references of included literatures were retrieved manually to collect related clinical studies on the treatment of VLU by PRP.The search period was from the establishment of the database to May 2022.Two researchers independently screened literatures,extracted data,and evaluated the quality of the included literatures.Meta-analysis was performed using RevMan 5.3 software.Result A total of 16 literatures were included,including 13 randomized controlled trials(RCT),2 non-randomized controlled intervention studies,and 1 case-control study.Metaanalysis showed that the healing rate and the area reduction rate of the ulcers in PRP group were significantly higher than those in control group,the area of ulcers was significantly lower than that in control group(P<0.01).There was no significant difference for the visual analogue scale(VAS)scores in two groups(P>0.05).The incidence rate of adverse reactions in the PRP group was significantly higher than that in the control group(P<0.01),manifesting as enlarged itching and ulcer area.Conclusion PRP is effective for VLU,but there is a risk of adverse reactions,and the risk and benefit need to be further analyzed.