Zhao Kun, Liu Yan-Shan, Nie Liu-Yan, Qian Lin-Na, Nie Nan-Fang, Leptihn Sebastian, Bunpetch Varitsara, Xu Jia-Qi, Zou Xiao-Hui, Ouyang Hongwei
Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China.
Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China.
J Orthop Translat. 2019 Nov 15;22:34-42. doi: 10.1016/j.jot.2019.10.002. eCollection 2020 May.
The magnitude of the therapeutic effects of intra-articular injection of platelet-rich plasma (PRP) on osteoarthritis (OA) is still under debate. The goal of this study that was a systematic review of randomised controlled trials of PRP injections for the treatment of OA was to elucidate the therapeutic efficacy of PRP.
Electronic databases of PubMed, CENTRAL, EMBASE, EBSCO, ClinicalTrials.gov, and International Clinical Trials Registry Platform were searched from inception to June 2018 for RCTs that compared PRP injections to controls in patients with OA. A random-effects approach was used to compile data and subgroups according to trial size (large trials versus small trials), patient profile (age and gender), and PRP preparation method was performed.
Thirty trials met the inclusion criteria and were analysed. All results had unexplained statistical heterogeneity. Patients treated with PRP compared with control showed statistically relevant pain relief and function improvement at short term (standardised mean difference [SMD] = -0.62, 95% confidence interval [CI]: -0.98 to -0.27, = 0.0006, SMD = -0.74, 95% CI: -1.11 to 0.36, = 0.0001, respectively), medium term (SMD = -0.53, 95% CI: -0.83 to -0.23, = 0.0006, SMD = -0.50, 95% CI: -0.75 to -0.25, = 0.0006), and long term (SMD = -0.69, 95% CI: -1.08 to -0.30, = 0.0006, SMD = -0.68, 95% CI: -0.1.09 to -0.27, = 0.001, respectively). A subgroup analysis of the data from large trials and from trials composed of less than 50% female patients revealed that therapeutic effects of the treatment are insignificant.
According to the currently available data, PRP injections are beneficial for pain relief and function improvement in patients with OA. This meta-analysis, however, demonstrated that the efficacy of PRP is related to sample size and gender composition. Thus, more randomised controlled trials of high quality and larger patient size, also including gender aspects, are required to understand this phenomenon.
The translation potential of this meta-analysis is that provided another perspective to analyse the treatment effect of PRP for OA. In future research, phenotypes subpopulation and gender difference of OA patient should be considered for PRP treatment.
关节腔内注射富血小板血浆（PRP）对骨关节炎（OA）的治疗效果大小仍存在争议。本研究旨在对PRP注射治疗OA的随机对照试验进行系统评价，以阐明PRP的治疗效果。
检索PubMed、CENTRAL、EMBASE、EBSCO、ClinicalTrials.gov和国际临床试验注册平台等电子数据库，检索时间从数据库建立至2018年6月，查找比较PRP注射与对照组治疗OA患者的随机对照试验。采用随机效应方法根据试验规模（大型试验与小型试验）、患者特征（年龄和性别）对数据和亚组进行汇总，并对PRP制备方法进行分析。
30项试验符合纳入标准并进行了分析。所有结果均存在无法解释的统计学异质性。与对照组相比，接受PRP治疗的患者在短期（标准化均数差[SMD]= -0.62，95%置信区间[CI]：-0.98至-0.27，P = 0.0006；SMD = -0.74，95% CI：-1.11至-0.36，P = 0.0001）、中期（SMD = -0.53，95% CI：-0.83至-0.23，P = 0.0006；SMD = -0.50，95% CI：-0.75至-0.25，P = 0.0006）和长期（SMD = -0.69，95% CI：-1.08至-0.30，P = 0.0006；SMD = -0.68，95% CI：-1.09至-0.27，P = 0.001）均显示出有统计学意义的疼痛缓解和功能改善。对大型试验和女性患者比例低于50%的试验数据进行亚组分析发现，该治疗的效果不显著。
根据现有数据，PRP注射对OA患者的疼痛缓解和功能改善有益。然而，这项荟萃分析表明，PRP的疗效与样本量和性别构成有关。因此，需要更多高质量、更大患者规模且包括性别因素的随机对照试验来了解这一现象。
这项荟萃分析的转化潜力在于为分析PRP治疗OA的效果提供了另一个视角。在未来的研究中，PRP治疗OA患者时应考虑其表型亚群和性别差异。
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