富血小板血浆治疗糖尿病足溃疡:疗效及安全性的Meta分析  

Efficacy and safety of platelet-rich plasma in the treatment of diabetic foot ulcer:a meta-analysis

作　　者：牛彩丽 黄锐娜 徐滋琪 卢咏梅[1] 黄永明[3] 曾秀云[3] Niu Caili;Huang Ruina;Xu Ziqi;Lu Yongmei;Huang Yongming;Zeng Xiuyun(School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China;the Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China;Department of Orthopedics, University Hospital of Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou 510000, Guangdong Province, China)

机构地区：[1]广州中医药大学护理学院,广东省广州市510000 [2]广州中医药大学第二临床医学院,广东省广州市510000 [3]广东省中医院大学城医院骨科,广东省广州市510000

出　　处：《中国组织工程研究》2019年第14期2285-2291,共7页Chinese Journal of Tissue Engineering Research

基　　金：广东省自然科学基金项目(2018A030313643);项目负责人:黄永明~~

摘　　要：背景:目前富血小板血浆已被应用于骨科、烧伤整形科等领域创面的治疗,并取得了良好疗效,但其在糖尿病足溃疡中的治疗效果尚存在争议。目的:系统评价富血小板血浆应用于糖尿病足溃疡的有效性和安全性。方法:应用计算机检索PubMed、EMbase、The Cochrane Library、CBM、CNKI和VIP数据库,检索应用富血小板血浆治疗糖尿病足溃疡的随机对照研究,检索时限设为建库至2018年9月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果与结论:①共纳入16个随机对照研究,包括925例患者,试验组可单独进行富血小板血浆治疗或富血小板血浆联合常规治疗(清创、负压封闭引流术、敷料覆盖等),对照组进行常规治疗、空白对照或安慰剂治疗;②Meta分析结果显示,试验组愈合率高于对照组[OR=3.05,95%CI(2.25,4.13),P <0.000 01],治疗有效率高于对照组[OR=3.84,95%CI(2.44,6.06),P <0.000 01],溃疡愈合时间短于对照组[MD=-11.39,95%CI(-13.45,-9.34),P <0.000 01],治疗费用低于对照组[MD=-5 927.76,95%CI (-10 413.04,-1 442.49),P=0.010],住院时间少于对照组[MD=-14.77,95%CI(-18.82,-10.73),P <0.000 01;③4个研究报告了不良反应情况,但不良反应与富血小板血浆本身治疗无关; ④结果表明,富血小板血浆在促进糖尿病足溃疡愈合上具有较好的临床疗效,且无不良反应,受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。BACKGROUND: Platelet-rich plasma has been used in the treatment of wounds in orthopedics, burn and plastic surgery, and has achieved good results. But its therapeutic effect in diabetic foot ulcers is still controversial. OBJECTIVE: To systematically evaluate the efficacy and safety of platelet-rich plasma in diabetic foot ulcer. METHODS: PubMed, EMbase, The Cochrane Library, CBM, CNKI, and VIP databases were searched for a randomized controlled trial of platelet-rich plasma for treating diabetic foot ulcers published before September 2018. Meta-analysis was performed using RevMan 5.3 software after two investigators independently screened the literature, extracted the data, and assessed the risk of bias in the included studies. RESULTS AND CONCLUSION:(1) Sixteen randomized controlled trials were included, including 925 patients. The trial group was treated with platelet-rich plasma alone or platelet-rich plasma combined with conventional therapy (debridement, vacuum sealing drainage, or dressing coverage). The control group received routine treatment, blank control or placebo treatment.(2) Meta-analysis showed that the healing rate in the trial group was higher than that in the control group [OR=3.05, 95%CI (2.25, 4.13), P < 0.000 01];effective rate was higher than that in the control group [OR=3.84, 95%CI (2.44, 6.06), P < 0.000 01];the ulcer healing time was shorter than that in the control group [MD=-11.39, 95%CI (-13.45,-9.34), P < 0.000 01];the cost of treatment was lower than that in the control group [MD=-5 927.76, 95%CI (-10 413.04,-1 442.49), P=0.010];and the hospitalization time was less than that in the control group [MD=-14.77, 95%CI (-18.82,-10.73), P < 0.000 01].(3) Four studies reported adverse reactions, but adverse reactions were not associated with platelet-rich plasma.(4) These results suggest that platelet-rich plasma has a good clinical effect in promoting the healing of diabetic foot ulcers, and no adverse reactions occur. Due to limitations in the quantity and quality of the studies, the a

关 键 词：富血小板血浆 糖尿病足 糖尿病足溃疡 META分析 创面愈合 足溃疡 组织工程 

分 类 号：R459.9[医药卫生—治疗学] R318.08[医药卫生—临床医学]