富血小板血浆与透明质酸治疗膝骨性关节炎的荟萃分析△

Platelet-rich plasma versus hyaluronic acid for treatment of knee osteoarthritis: a meta-analysis

摘要:

[目的]比较关节腔内注射富血小板血浆(platelet-rich plasma , PRP)和透明质酸(hyaluronic acid, HA)治疗膝关节骨性关节炎 (knee osteoarthritis, KOA) 的临床疗效。[方法] 系统检索 Cochrane、PubMed 和 Embase 数据库中截至 2020 年 12 月所有关节腔内注射 PRP 和 HA 治疗 KOA 临床疗效的随机对照试验。对文献进行质量评估及数据提取。使用 Review manager 5.3 软件进行数据的荟萃分析。[结果] 纳入 13 项研究，共 1 259 例患者，PRP 组 644 例；HA 组 615 例，随访 12 个月。荟萃分析表明：PRP 组 WOMAC 总分评分 (MD=-16.57，95% CI=-23.34~-9.79，P＜0.001)，WOMAC 功能评分 (SMD=-1.47，95% CI=-2.34~-0.59，P＜0.001)，WOMAC 疼痛评分 (SMD=-1.02，95% CI=-1.69~-0.34，P=0.002) 和 VAS 评分 (SMD=-2.75， 95% CI=-4.93~-0.57，P=0.013) 均显著优于 HA 组。两组间不良反应发生率差异无统计学意义 (RR=1.07，95%CI=0.80~1.42， P=0.100)。[结论]PRP 治疗 KOA 在减轻疼痛和功能恢复方面优于 HA，但两者安全性无差异。

Abstract:

[Objective] To compare the clinical outcomes of platelet-rich plasma (PRP) versus hyaluronic acid (HA) intraarticularly for treatment of knee osteoarthritis (KOA) . [Methods] All randomized controlled trials on the clinical efficacy of intraarticularly PRP and HA in the treatment of KOA were systematically searched from Cochrane, PubMed and Embase databases as of December 2020. After quality assessment, the data were extracted from the literature, and then a meta-analysis of data was performed using Review Manager 5.3 software. [Results] A total of 13 studies were enrolled into this study involving 1 259 patients, including 644 patients in the PRP group and 615 pa- tients in the HA group, with a followed-up period of 12 months. As results of this meta-analysis, the PRP group proved significantly superi- or to the HA group in terms of overall WOMAC scores (MD=-16.57, 95%CI=-23.34~-9.79, P＜0.001) , WOMAC function score (SMD=- 1.47, 95%CI=-2.34~-0.59, P＜0.001) , WOMAC pain score (SMD=-1.02, 95%CI=-1.69 ~-0.34, P=0.002) , and VAS score (SMD=-2.75, 95%CI=-4.93~-0.57, P=0.013) . However, there was no a significant difference in the incidence of adverse reactions between the two groups (RR=1.07, 95%CI= 0.80~1.42, P=0.100) . [Conclusion] The PRP is superior to the HA in alleviating pain and functional recovery for treatment of KOA, but there is no difference in safety between the two therapies.