Hirase Takashi, Ruff Eric, Surani Salim, Ratnani Iqbal
Department of Orthopaedic Surgery, Houston Methodist Hospital, Houston, TX 77030, United States.
Department of Plastic and Reconstructive Surgery, University of Texas Medical Branch, Galveston, TX 77555, United States.
World J Diabetes. 2018 Oct 15;9(10):172-179. doi: 10.4239/wjd.v9.i10.172.
To determine if topical application of platelet-rich plasma (PRP) to diabetic foot ulcers (DFUs) results in superior healing rates.
A systematic review was registered with PROSPERO and performed using PRISMA guidelines. Level I-IV investigations of topical PRP application in DFUs were sought in multiple databases including: MEDLINE, Web of Science, and Cochrane Central Register of Controlled Trials. The search terms used were "platelet rich plasma", "diabetes", "ulcers", and "wound". The Modified Coleman Methodology Score (MCMS) was used to analyze study methodological quality. Study heterogeneity and a mostly non-comparative nature of evidence precluded meta-analysis. Only the outcome measurements used by more than 50% of the studies were included in the data synthesis to increase power of the measurement over that of individual studies. A weighted mean of healing rate per week between PRP group controls were compared using two-sample -tests using -value of less than 0.05 for significance.
One thousand two hundred and seventeen articles were screened. Eleven articles (322 PRP subjects, 126 controls, PRP subject mean age 58.4 ± 7.2 years, control mean age 58.7 ± 5.9 years) were analyzed. Six articles were level II evidence, four were level III, and one article was level IV. The mean MCMS was 61.8 ± 7.3. Healing rate was significantly faster with PRP application compared to controls (0.68 ± 0.56 cm/wk 0.39 ± 0.09 cm/wk; < 0.001). Mean heal time to > 90% of the original ulcer area was 7.8 ± 2.7 wk and 8.3 ± 3.7 wk for patients in the PRP group and control groups, respectively ( = 0.115). There were significantly lower adverse effects reported with PRP application compared to controls (7 wound infections, 1 contact dermatitis 14 wound infections, 1 maceration; < 0.001).
The topical application of PRP for DFUs results in statistically superior healing rates and lower complication rates compared to controls.
确定向糖尿病足溃疡（DFU）局部应用富血小板血浆（PRP）是否能带来更高的愈合率。
在国际前瞻性系统评价注册库（PROSPERO）登记了一项系统评价，并按照系统评价和Meta分析的首选报告项目（PRISMA）指南进行。在多个数据库中检索关于DFU局部应用PRP的I - IV级研究，包括：医学主题词表（MEDLINE）、科学引文索引（Web of Science）和考克兰对照试验中心注册库。使用的检索词为“富血小板血浆”“糖尿病”“溃疡”和“伤口”。采用改良科尔曼方法学评分（MCMS）分析研究方法学质量。研究的异质性以及证据大多为非对照性质使得无法进行Meta分析。仅将超过50%的研究使用的结局测量指标纳入数据综合分析，以提高测量结果相对于单个研究的效力。使用双样本t检验比较PRP组和对照组每周的愈合率加权平均值，P值小于0.05为有统计学意义。
筛选了1217篇文章。分析了11篇文章（322例PRP受试者，126例对照，PRP组受试者平均年龄58.4±7.2岁，对照组平均年龄58.7±5.9岁）。6篇文章为II级证据，4篇为III级，1篇为IV级。平均MCMS为61.8±7.3。与对照组相比，应用PRP后的愈合速度明显更快（0.68±0.56厘米/周对0.39±0.09厘米/周；P<0.001）。PRP组和对照组患者溃疡面积愈合至超过原始溃疡面积90%的平均愈合时间分别为7.8±2.7周和8.3±3.7周（P = 0.115）。与对照组相比，应用PRP后报告的不良反应明显更少（7例伤口感染，1例接触性皮炎对14例伤口感染，1例浸渍；P<0.001）。
与对照组相比，DFU局部应用PRP在统计学上能带来更高的愈合率和更低的并发症发生率。
