中国组织工程研究

中国组织工程研究 ›› 2020, Vol. 24 ›› Issue (27): 4421-4428.doi: 10.3969/j.issn.2095-4344.2771

• 骨与关节循证医学 evidence-based medicine of the bone and joint • 上一篇    

富血小板血浆与透明质酸治疗膝骨关节炎疗效对比的Meta分析

王养发1，刘  军1，潘建科1，高世华2，黄俊翰1，李慧文1，何祥忠1，陈海云1   

  1. 1广州中医药大学第二附属医院，广东省广州市  510120；2广州中医药大学第二临床医学院，广东省广州市  510405
  • 收稿日期:2019-12-11 修回日期:2019-12-14 接受日期:2020-01-20 出版日期:2020-09-28 发布日期:2020-09-10
  • 通讯作者: 陈海云，主任医师，广州中医药大学第二附属医院，广东省广州市 510120
  • 作者简介:王养发，男，1995年生，江西省吉安市人，汉族，广州中医药大学在读硕士，主要从事骨科创伤及关节方向的研究。
  • 基金资助:
    广东省财政厅项目([2014]157号，[2018]8号)； 广东省中医院中医药科学技术研究专项(YN2019ML08，YN2015MS15，YK2013B2N19)

Therapeutic effects of platelet-rich plasma versus hyaluronic acid for knee osteoarthritis: a meta-analysis

Wang Yangfa1, Liu Jun1, Pan Jianke1, Gao Shihua2, Huang Junhan1, Li Huiwen1, He Xiangzhong1, Chen Haiyun1   

  1. 1Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, Guangdong Province, China; 2Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
  • Received:2019-12-11 Revised:2019-12-14 Accepted:2020-01-20 Online:2020-09-28 Published:2020-09-10
  • Contact: Chen Haiyun, Chief physician, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, Guangdong Province, China
  • About author:Wang Yangfa, Master candidate, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, Guangdong Province, China
  • Supported by:
    the Project of Guangdong Provincial Department of Finance, No. [2014]157, [2018]8; the Science and Technology Research Project of Traditional Chinese Medicine of Guangdong Hospital of Traditional Chinese Medicine, No. YN2019ML08, YN2015MS15, YK2013B2N19

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摘要：

文题释义：

透明质酸：是细胞外基质的主要成分，是一种由氨基葡萄糖组成的多糖，主要分布于关节软骨、滑液、皮肤和房水中，具有调节生物化学过程、提供支持和润滑的功效，在维持关节的正常功能方面具有重要的作用。

富血小板血浆：是自体外周血经离心后得到的血制品，对于自身无免疫排斥反应，含有大量生长因子，如血小板源性生长因子、血管内皮生长因子、转化生长因子等，这些因子能够刺激软骨细胞的增殖分化，诱导血管生成，对软组织损伤修复起着积极的作用。

背景：透明质酸是治疗膝骨关节炎的常用药物，富血小板血浆治疗膝骨关节炎则是近年来的研究热点，对于这两者之间的有效性和安全性的比较尚存在争议。

目的：系统评价富血小板血浆与透明质酸治疗膝骨关节炎的有效性及安全性。

方法：按照Cochrane系统评价的方法，应用计算机检索CNKI、维普网、万方数据知识服务平台、中国生物医学文献数据库(CBM)、PubMed、Cochrane Library、Embase等数据库，检索有关富血小板血浆与透明质酸治疗膝骨关节炎的随机对照试验，文献发表时间为建库至2020年1月。对所有符合纳入标准的文献进行质量评价，采用Revman 5.3软件对其WOMAC评分、IKDC评分、目测类比评分、Lequesne指数及不良事件进行Meta分析。

结果与结论：①纳入21篇文献，共1 872例患膝，其中富血小板血浆组963例，透明质酸组909例；②Meta分析结果显示，富血小板血浆组治疗后3，6，12个月的WOMAC评分明显低于透明质酸组[MD=-5.84，95%CI(-10.11，-1.57)，P=0.007；MD=-9.48，95%CI(-13.02，-5.95)，P < 0.000 01；MD=-10.47，95%CI(-13.95，-7.00)，P < 0.000 01]，治疗后6，12个月的目测类比评分低于透明质酸组[MD=-5.02，95%CI(-8.87，-1.18)，P=0.01；MD=-3.33，95%CI(-4.89，-1.76)，P< 0.000 1]，治疗后3，6，12个月的IKDC评分高于透明质酸组[MD=7.10，95%CI(3.88，10.32)，P < 0.000 1；MD=7.88，95%CI(5.12，10.65)，P < 0.000 01；MD=6.85，95%CI(2.50，11.19)，P=0.002]，治疗后6，12个月的Lequesne指数低于透明质酸组[MD=-0.82，95%CI(-1.31，-0.32)，P=0.001；MD=-2.37，95%CI(-2.93，-1.81)，P < 0.000 01]；两组不良事件发生率比较差异无显著性意义[OR=1.46，95%CI(0.94，2.24)，P=0.09]；③结果表明相较于透明质酸，富血小板血浆治疗膝骨关节炎更能缓解疼痛、改善功能、提高患者生活质量，疗效更持久。

ORCID: 0000-0003-4045-0340(王养发)

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 富血小板血浆, 透明质酸, 膝骨关节炎, 膝关节骨性关节炎, 膝关节, 骨性关节炎, Meta分析, 荟萃分析

Abstract:

BACKGROUND: Hyaluronic acid is a commonly used drug in the treatment of knee osteoarthritis, and platelet-rich plasma is a research hotspot in recent years. There is still controversy on the comparison of the effectiveness and safety between them.

OBJECTIVE: To systematically assess the efficacy and safety of platelet-rich plasma and hyaluronic acid for knee osteoarthritis through a meta-analysis.

METHODS: The authors systematically retrieved the databases of CNKI, VIP, Wanfang, CBM, PubMed, EMBase and Cochrane Library for randomized controlled trials regarding platelet-rich plasma versus hyaluronic acid for knee osteoarthritis published from inception to January 2020. Quality assessment was conducted on eligible randomized controlled trials. A meta-analysis was performed in WOMAC score, IKDC score, visual analogue scale score, Lequesne index and adverse events using RevMan 5.3 software.

RESULTS AND CONCLUSION: (1) Totally 21 randomized controlled trials were eventually included，involving 1 872 knees including 963 patients in the platelet-rich plasma group and 909 patients in the hyaluronic acid group. (2) Meta-analysis results showed that WOMAC scores were significantly lower in the platelet-rich plasma group than in the hyaluronic acid group at 3, 6 and 12 months after treatment [MD=-5.84, 95%CI(-10.11, -1.57), P=0.007; MD=-9.48, 95%CI(-13.02, -5.95), P < 0.000 01; MD=-10.47, 95%CI(-13.95, -7.00), P < 0.000 01]. Visual analogue scale scores were lower in the platelet-rich plasma group than in the hyaluronic acid group at 6 and 12 months after treatment [MD=-5.02, 95%CI(-8.87, -1.18), P=0.01; MD=-3.33, 95%CI(-4.89, -1.76), P < 0.000 1]. IKDC scores were higher in the platelet-rich plasma group than in the hyaluronic acid group at 3, 6, and 12 months after treatment [MD=7.10, 95%CI(3.88, 10.32), P < 0.000 1; MD=7.88, 95%CI(5.12, 10.65), P < 0.000 01; MD=6.85, 95%CI(2.50, 11.19), P=0.002]. Lequesne Index scores were lower in the platelet-rich plasma group than in the hyaluronic acid group at 6 and 12 months after treatment [MD=-0.82, 95%CI(-1.31, -0.32), P=0.001; MD=-2.37, 95%CI(-2.93, -1.81), P < 0.000 01]. No significant difference was found in adverse event rates between the two groups [OR=1.46, 95%CI(0.94, 2.24), P=0.09]. (3) The results show that compared with hyaluronic acid, platelet-rich plasma can relieve pain, improve function, improve the quality of life of patients with knee osteoarthritis, and the effect is more lasting. 

Key words: platelet-rich plasma, hyaluronic acid, knee osteoarthritis, knee joint, osteoarthritis, meta-analysis

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