自体富血小板血浆/凝胶联合负压封闭引流术治疗糖尿病足溃疡的荟萃分析  

Autologous platelet-rich plasma/gel combined with negative pr essure sealed drainage for treatment of diabetic foot ulcers:A Meta-analysis

作　　者：张艺 王思雨 杨晴 刘春华[1] ZHANG Yi;WANG Si-yu;YANG Qing;LIU Chun-hua(Department of Cardiology,The Second Affiliated Hospital of Hunan University of Chinese Medicine,Changsha 410005,Hunan,China)

机构地区：[1]湖南中医药大学第二附属医院心血管内科,湖南长沙410005

出　　处：《生物医学工程与临床》2024年第3期389-397,共9页Biomedical Engineering and Clinical Medicine

基　　金：湖南省教育厅科研项目(22A0269);湖南中医药大学校级科研项目(2022CX165)。

摘　　要：目的评估联合运用自体富血小板血浆/凝胶(PRP/APG)和负压封闭引流技术(VSD)治疗糖尿病足溃疡的效果及安全性。方法应用计算机检索PubMed、EMbase、The Cochrane Library、中国知网(CNKI)、维普、万方数据库,检索应用PRP/APG联合VSD治疗糖尿病足溃疡的随机对照研究,检索时限设为建库至2022年4月。由2名研究人员独立进行文献筛选、数据提取、评估偏倚风险,随后采用RevMan 5.3软件对数据进行荟萃分析并进行总结。结果纳入17篇随机对照研究,涵盖1338例患者,其中观察组(PRP/APG联合VSD)668例,对照组(常规治疗或VSD)670例。Meta分析结果显示,观察组治疗有效率高于对照组[比值比(OR)=7.35,95%可信区间(CI)5.04~10.70,P<0.00001];溃疡愈合时间短于对照组[均数差(MD)=-9.32,95%CI-10.63~-8.01,P<0.00001];住院时间少于对照组(MD=-13.51,95%CI-14.09~-12.92,P<0.00001);并发症发生率低于对照组(OR=0.16,95%CI 0.07~0.38,P<0.00001);对照组血管内皮生长因子(VEGF)浓度低于观察组(MD=4.57,95%CI 3.84~5.31,P<0.00001);观察组碱性成纤维细胞生长因子(bFGF)浓度高于对照组(OR=2.86,95%CI 2.36~3.36,P<0.00001)。结论PRP/APG联合VSD可以有效提高糖尿病足溃疡愈合率,减少愈合时间、住院时间、并发症,并可提高VEGF、bFGF浓度促进溃疡愈合,具有较好的临床疗效。Objective To evaluate the effectiveness and safeties of autologous platelet-rich gel(APG)/platelet-rich plasma(PRP)combined with vacuum sealing drain(VSD)in treatment of diabetic foot ulcers.Methods A comprehensive computer search was conducted across databases including PubMed,EMbase,The Cochrane Library,China National Knowledge Infrastructure(CNKI),and VIP databases.The randomized controlled trials of PRP/APG combined with VSD in treatment diabetic foot ulcers were searched from inception to April 2022.Two researchers screened literature,extracted data,and assessed the risk of bias,independently.RevMan 5.3 software was used for Meta-analysis and summary of the data.Results A total of 17randomized controlled trials involving 1338 patients were enrolled,which included 668 patients in observation group(PRP/APG combined with VSD)and 670 in control group(conventional treatment or VSD).The results of Meta-analysis showed that treatment effective rate in observation group was higher than that in control group[odds ratio(OR)=7.35,95%confidence interval(CI)5.04-10.70,P<0.00001];ulcer healing time in observation group was shorter than that in control group[mean diviation(MD)=-9.32,95%CI-10.63--8.01,P<0.00001];hospitalization time in observation group was less than that in control group(MD=-13.51,95%CI-14.09--12.92,P<0.00001);complication rates in observation group was lower than that in control group(OR=0.16,95%CI 0.07-0.38,P<0.00001);concentration of vascular endothelial growth factor(VEGF)in control group was lower than that in observation group(MD=4.57,95%CI 3.84-5.31,P<0.00001);concentration of basic fibroblast growth factor(bFGF)in observation group was higher than that in control group(OR=2.86,95%CI 2.36-3.36,P<0.00001].Conclusion It is demonstrated that PRP/APG combined with VSD could effectively improve healing rate of diabetic foot ulcers,reduce healing time,hospitalization time and complications,and increase the concentration of VEGF and bFGF to promote ulcer healing,which showed good clinical efficacy.

关 键 词：自体富血小板血浆 自体富血小板凝胶 Meta分析 糖尿病足 负压封闭引流 糖尿病足溃疡 

分 类 号：R587.2[医药卫生—内分泌]