富血小板血浆对宫腔粘连患者疗效的meta分析

Meta-analysis of platelet-rich plasma for the treatment of intrauterine adhesion.

目的:系统评价富血小板血浆(PRP)对宫腔粘连(IUA)患者的治疗效果。方法:检索PubMed、Scopus、Web of Science、Cochrane Central Register of Controlled Trials(CENTRAL)和Google Scholar,检索时间截至2023年3月。纳入关于PRP宫腔灌注治疗IUA患者的所有随机对照研究和队列研究,随机对照研究采用Cochrane偏倚风险评估工具,队列研究运用纽卡斯尔-渥太华量表(NOS)系统评价文献质量,使用RevMan5.4.1软件进行meta分析。结果:共纳入5篇随机对照研究,3篇队列研究,共677例。与对照组相比,PRP组宫腔镜二探粘连严重程度(RR=1.21,95%CI为1.11~1.79,P<0.001)、术后妊娠率(RR=1.53,95%CI为1.12~2.10,P=0.008)、月经持续时间(MD=1.12,95%CI为0.84~1.39,P<0.001)和月经量(MD=2.96,95%CI为2.30~3.61,P<0.001)的差异均有统计学意义。结论:PRP宫腔治疗具有改善IUA严重程度、妊娠率和月经模式的临床效果,对于IUA患者是一种安全、有效的治疗方法。

Objective:To conduct a systematic review and meta-analysis to assess efficacy of platelet rich plasma(PRP)in the treatment of intrauterine adhesion(IUA).Methods:PubMed,Scopus,Web of Science,Cochrane Central Register of Controlled Trials(CENTRAL)and Google Scholar were screened from inception till March 2023.Risk of bias of included randomized controlled trials was evaluated according to the Cochrane's Collaboration tool,and the quality of cohort studies was evaluated according to the Newcastle Ottawa Scale(NOS).The data analysis was performed by RevMan 5.4.1.Results:Five randomized controlled trials and three cohort studies met the inclusion criteria,with a total of 677 patients(325 and 352 patients were allocated to PRP and control groups,respectively).After intervention,compared with the control group,the PRP group had a statistically significant higher rate of patients with IUAs gradeⅠ~Ⅱafter intervention(RR=1.21,95%CI 1.11~1.79,P<0.001),higher pregnancy rate(RR=1.53,95%CI 1.12~2.10,P=0.008),improved menstrual pattern:higher duration of menstrual menses(MD=1.12,95%CI 0.84~1.39,P<0.001)and higher amount of menstrual menses(MD=2.96,95%CI 2.30~3.61,P<0.001).Conclusions:PRP treatment after hysteroscopic adhesiolysis is effective in decreasing the IUA grade,improving pregnancy rate,the duration and amount of menstrual menses.