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[同种异体脱细胞真皮基质治疗糖尿病足溃疡临床疗效的Meta分析]

[Meta-analysis on the clinical effects of allogenic acellular dermal matrix treatment for diabetic foot ulcer].

作者信息

Xue C L, Hu Z C, Yang Z X, Li X J

机构信息

The First Clinical Medical School of Ji'nan University, Guangzhou 510630, China.

出版信息

Zhonghua Shao Shang Za Zhi. 2016 Dec 20;32(12):725-729. doi: 10.3760/cma.j.issn.1009-2587.2016.12.005.

Abstract

To analyze the clinical effects of allogenic acellular dermal matrix (ADM) treatment for diabetic foot ulcer (DFU) with meta-analysis. Databases including and were searched using key words " diabetic foot, diabetic ulcer, diabetic wound, acellular dermal matrix, acellular dermal regenerative tissue matrix, acellular regenerative tissue matrix, AlloDerm, SureDerm, KaroDerm, Graftjacket, Hyalomatrix PA, and Hyalograft 3D" , and - and were searched using key words in Chinese version ",,," to obtain the published trials of allogenic ADM treatment for DFU from January 1990 to July 2015, and then meta-analysis was used to analyze the trials. The measurement indexes were wound contraction rate, wound healing rate, complete epithelization time of wound, and complication rate. Meta-analysis was conducted by RevMan 5.2 statistical software. A total of 5 trials involving 426 DFU patients were included, with 224 patients in group ADM who received allogenic ADM treatment and 202 patients in conventional treatment group (CT) who received conventional moist treatment. There was no statistically significant difference between group ADM and group CT in wound contraction rate, with mean difference 20.34 (with 95% confidence interval -25.27-65.94, =0.38). The wound healing rate of patients in group ADM was higher than that in group CT, with relative risk (RR) 1.90 (with 95% confidence interval 1.29-2.80, <0.01). There was no statistically significant difference between group ADM and group CT in complete epithelization time of wound, with mean difference 1.20 (with 95% confidence interval -2.93-0.52, =0.17). The complication rate of patients in group ADM was lower than that in group CT, RR=0.54 (with 95% confidence interval 0.38-0.76, <0.001). Publication bias might exist in wound contraction rate, wound healing rate, complete epithelization time of wound, and complication rate. Compared with conventional moist treatment, allogenic ADM treatment can accelerate wound healing and reduce complication rate in patients with DFU.

摘要

采用Meta分析方法分析同种异体脱细胞真皮基质(ADM)治疗糖尿病足溃疡(DFU)的临床效果。使用关键词“糖尿病足、糖尿病溃疡、糖尿病伤口、脱细胞真皮基质、脱细胞真皮再生组织基质、脱细胞再生组织基质、AlloDerm、SureDerm、KaroDerm、Graftjacket、Hyalomatrix PA、Hyalograft 3D”检索包括[具体数据库名称1]和[具体数据库名称2]在内的数据库,并使用中文关键词“[具体中文关键词1]、[具体中文关键词2]、[具体中文关键词3]”检索[具体数据库名称3]和[具体数据库名称4],以获取1990年1月至2015年7月间关于同种异体ADM治疗DFU的已发表试验,然后采用Meta分析方法对这些试验进行分析。测量指标为伤口收缩率、伤口愈合率、伤口完全上皮化时间和并发症发生率。采用RevMan 5.2统计软件进行Meta分析。共纳入5项试验,涉及426例DFU患者,其中ADM组224例患者接受同种异体ADM治疗,常规治疗组(CT)202例患者接受常规湿性治疗。ADM组与CT组在伤口收缩率方面差异无统计学意义,平均差值为20.34(95%置信区间为-25.27至65.94,P=0.38)。ADM组患者的伤口愈合率高于CT组,相对危险度(RR)为1.90(95%置信区间为1.29至2.80,P<0.01)。ADM组与CT组在伤口完全上皮化时间方面差异无统计学意义,平均差值为1.20(95%置信区间为-2.93至0.52,P=0.17)。ADM组患者的并发症发生率低于CT组,RR=0.54(95%置信区间为0.38至0.76,P<0.001)。在伤口收缩率、伤口愈合率、伤口完全上皮化时间和并发症发生率方面可能存在发表偏倚。与常规湿性治疗相比,同种异体ADM治疗可加速DFU患者伤口愈合并降低并发症发生率。

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