关节腔内注射富血小板血浆与透明质酸治疗膝骨关节炎疗效与安全性评价  

Efficacy and safety evaluation of intra-articular injection of platelet rich plasma and hyaluronic acid in the treatment of knee osteoarthritis

作　　者：张军锋 季世昌 宋飞超 陈荣荣 黄曦 刘慕淳 刘冰洁 郝慧琴 Zhang Junfeng;Ji Shichang;Song Feichao;Chen Rongrong;Huang Xi;Liu Muchun;Liu Bingjie;Hao Huiqin(School of Basic Medicine,Shanxi University of Chinese Medicine,Jinzhong 030619,China;Graduate School,Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西中医药大学基础医学院,晋中030619 [2]山西医科大学研究生学院,太原030001 [3]山西省医疗卫生机构综合服务中心(山西省血液中心),030006

出　　处：《中华风湿病学杂志》2022年第11期730-736,I0003,共8页Chinese Journal of Rheumatology

基　　金：国家自然科学基金(81573245,81102198);"四个一批"科技兴医创新计划重大科技攻关专项(2022XM11);山西省卫生健康委员会科研项目(2020021);山西省重点研发计划(201803D31207);山西省卫生健康委员会公共卫生专项科研项目(2018GW09)。

摘　　要：目的比较关节腔内注射富血小板血浆与透明质酸治疗膝骨关节炎的临床疗效与安全性差异。方法检索2010年1月至2021年12月间发表的有关于关节腔内注射富血小板血浆与透明质酸治疗膝骨关节炎随机对照研究的相关文献,采用Revman 5.3软件对纳入研究文献进行偏倚风险评估,采用Stata 16.0软件进行数据的处理与分析。疗效指标差异计算加权均数差(WMD),差异比较行t检验;安全性指标差异计算优势比(OR),差异比较行t检验。结果①共计纳入研究文献10篇,全部为英文文献。②共计纳入研究患者总量为921例,其中479例患者采用关节腔内注射富血小板血浆进行治疗,442例患者采用关节腔内注射透明质酸进行治疗。③注射富血小板血浆与注射透明质酸的VAS评分结果比较,注射治疗6、12个月后,注射富血小板血浆患者的VAS评分均明显低于注射透明质酸患者相应的VAS评分,差异具有统计学意义[WMD(95%CI)=-0.66(-1.25,-0.77),P=0.029;WMD(95%CI)=-0.90(-1.51,-0.29),P=0.004]。④注射富血小板血浆与注射透明质酸的美国西安大略省和麦克马斯特大学骨关节炎指数评分(WOMAC评分)结果比较,注射治疗6、12个月后注射富血小板血浆患者WOMAC疼痛评分均显著低于注射透明质酸患者,差异具有统计学意义[WMD(95%CI)=-0.76(-1.06,0.45),P<0.001;WMD(95%CI)=-1.35(-2.05,-0.65),P<0.001];注射治疗3、6、12个月后,注射富血小板血浆患者的WOMAC僵硬评分均显著低于注射透明质酸的患者,差异具有统计学意义[WMD(95%CI)=-0.37(-0.66,-0.08),P=0.011;WMD(95%CI)=-0.30(-0.57,-0.04),P=0.023;WMD(95%CI)=-0.62(0.92,-0.33),P<0.001];注射治疗3、6、12个月后,注射富血小板血浆患者的WOMAC功能评分均显著低于注射透明质酸的患者,差异具有统计学意义[WMD(95%CI)=-1.90(-2.53,-1.27),P<0.001;WMD(95%CI)=-5.77(-9.20,-2.34),P=0.001;WMD(95%CI)=-5.72(-8.62,-2.82),P<0.001]。⑤2种关节腔内注射治疗方法的不良反应事Objective To compare the clinical efficacy and safety of intra-articular injection of platelet rich plasma and hyaluronic acid in the treatment of knee osteoarthritis.Methods The relevant literatures including the randomized control study of intra-articular injection of platelet rich plasma and hyaluronic acid in the treatment of knee osteoarthritis published from January 2010 to December 2021 were searched.The bias risk of the included literatures was evaluated by Revman 5.3 software,and the data were processed and analyzed by Stata 16.0 software.The weighted mean difference(WMD)was calculated for the difference ofefficacy indexes,and the difference was compared by t-test.The odds ratio(OR)was calculated for the difference of safety index,and the difference was compared by t-test.Results①A total of 10 literatures were included,all of which were in English.②A total of 921 patients were included in the study,of which 479 patients were treated with intra-articular injection of platelet rich plasma and 442 patients were treated with intra-articular injection of hyaluronic acid.③Comparing the VAS scores of platelet rich plasma injection and hyaluronic acid injection,the visual analogue scale(VAS)scores of platelet rich plasma injection patients were significantly lower than those of hyaluronic acid injection patients after 6 and 12 months of injection treatment,and the difference was statistically significant[WMD(95%CI)=-0.66(-1.25,-0.77),P=0.029;WMD(95%CI)=-0.90(-1.51,-0.29),P=0.004].④The specific performance was that the Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)pain score of patients injected with platelet rich plasma after 6 and 12 months of injection treatment was significantly lower than that of patients injected with hyaluronic acid[WMD(95%CI)=-0.76(-1.06,0.45),P<0.001;WMD(95%CI)=-1.35(-2.05,-0.65),P<0.01];After 3,6 and 12 months of injection treatment,the WOMAC stiffness score of patients injected with platelet rich plasma was significantly lower than that of patients inject

关 键 词：骨关节炎 膝 富血小板血浆 透明质酸 系统评价 

分 类 号：R684.3[医药卫生—骨科学]