Xiong Yongqing, Gong Cheng, Peng Xumiao, Liu Xianlei, Su Xinda, Tao Xi, Li Ying, Wen Youliang, Li Wei
Gannan Medical University, Ganzhou, Jiangxi, China.
Front Med (Lausanne). 2023 Jun 27;10:1204144. doi: 10.3389/fmed.2023.1204144. eCollection 2023.
In recent years, platelet-rich plasma (PRP) injections for osteoarthritis (OA) have been widely promoted in clinical practice, but their effectiveness is controversial. Therefore, we conducted a meta-analysis of relevant randomized controlled trials (RCTs) to determine the efficacy and safety of PRP injections for the treatment of OA.
We searched databases including Embase, Web of Science, Medline, PubMed, and the Cochrane Library for relevant studies. Two researchers (YQX and CG) performed literature screening, baseline data extraction, literature quality assessment, and heterogeneity analysis of RCTs from the retrieved studies. Based on the magnitude of heterogeneity , random-effects or fixed-effects models were selected for the meta-analysis.
We included 24 RCTs comprising 1344 patients with OA who met the inclusion criteria, with the main types of morbidity being knee osteoarthritis (KOA), hip osteoarthritis (HOA), ankle osteoarthritis (AOA), and temporomandibular joint osteoarthritis (TMJOA). Our results indicate that PRP injections were effective in improving Visual Analog Scale (VAS) pain scores in patients with KOA, HOA, and AOA compared to controls (AOA, MD = -1.15, CI = 95% [-1.74, -0.56], = 40%, < 0.05; KOA, MD = -1.03, CI = 95% [-1.16, -0.9], = 87%, < 0.05; TMJOA, MD = -1.35, CI = 95% [-1.74, -0.97], = 92%, < 0.05) but showed no significant efficacy in patients with HOA (MD = -0.27, CI = 95% [-0.8, 0.26], = 56%, >0.05). Compared to controls, PRP injections were effective in improving Knee Injury and Osteoarthritis Outcome Score (KOOS), including the patient's pain symptoms, activities of daily living (ADL), and adhesion symptomatology, but not for that of sports function (KOOS-pain, MD = 2.77, CI = 95% [0, 5.53], = 0%, < 0.05; KOOS-symptoms, MD = 3.73, CI = 95% [0.76, 6.71], = 0%, < 0.05; KOOS-ADL, MD = 3.61, CI = 95% [0.79, 6.43], = 0%, < 0.05; KOOS-QOL, MD = 4.66, CI = 95% [0.98, 8.35], = 29%, < 0.05, KOOS-sport, MD = 0.48, CI = 95% [-3.02, 3.98], = 0%, > 0.05). PRP injections were effective in improving Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores, including pain, stiffness, and functional joint motion, in patients with OA compared with the control group (WOMAC-pain, MD = -1.08, CI = 95% [-1.62, -0.53], = 87%, < 0.05; WOMAC-stiffness, MD = -1.17, CI = 88% [-1.72, -0.63], = 87%, < 0.05; WOMAC-function, MD = -1.12, CI = 95% [-1.65, -0.58], = 87%, < 0.05). In addition, subgroup analysis showed that leukocyte-poor (LP) PRP injections were more effective than leukocyte-rich (LR) PRP injections in improving pain symptoms in patients with OA (VAS, LR-PRP, MD = -0.81, CI = 95% [-1.65, -0.03], = 83%, = 0.06 > 0.05; LP-PRP, MD = -1.62, CI = 95% [-2.36, -0.88], = 92%, < 0.05). A subgroup analysis based on injection sites showed that no statistical difference in efficacy between intra-articular (IA) combined with intra-osseous (IO) simultaneous PRP injections. IA PRP injections only improved VAS pain scores in patients with OA (IA+IO PRP injections, MD = -0.74, CI =95% [-1.29, -0.18], = 61%, < 0.05; IA PRP injections, MD = -1.43, CI = 95% [-2.18, -0.68], = 87%, < 0.05, test for subgroup differences, > 0.05, = 52.7%).
PRP injection therapy can safely and effectively improve functional activity in patients with OA and produce positive analgesic effects in patients with KOA, TMJOA, and AOA. However, PRP injection therapy did not significantly reduce pain symptoms in patients with HOA. In addition, the analgesic effect of LP-PRP was greater than that of LR-PRP.
https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022362066.
近年来，富血小板血浆（PRP）注射治疗骨关节炎（OA）在临床实践中得到广泛推广，但其疗效存在争议。因此，我们对相关随机对照试验（RCT）进行了荟萃分析，以确定PRP注射治疗OA的疗效和安全性。
我们检索了Embase、Web of Science、Medline、PubMed和Cochrane图书馆等数据库中的相关研究。两名研究人员（YQX和CG）对检索到的研究中的RCT进行文献筛选、基线数据提取、文献质量评估和异质性分析。根据异质性大小，选择随机效应或固定效应模型进行荟萃分析。
我们纳入了24项RCT，共1344例符合纳入标准的OA患者，主要发病类型为膝关节骨关节炎（KOA）、髋关节骨关节炎（HOA）、踝关节骨关节炎（AOA）和颞下颌关节骨关节炎（TMJOA）。我们的结果表明，与对照组相比，PRP注射在改善KOA、HOA和AOA患者的视觉模拟评分（VAS）疼痛评分方面有效（AOA，MD = -1.15，CI = 95%[-1.74，-0.56]，I² = 40%，P < 0.05；KOA，MD = -1.03，CI = 95%[-1.16，-0.9]，I² = 87%，P < 0.05；TMJOA，MD = -1.35，CI = 95%[-1.74，-0.97]，I² = 92%，P < 0.05），但对HOA患者无显著疗效（MD = -0.27，CI = 95%[-0.8，0.26]，I² = 56%，P>0.05）。与对照组相比，PRP注射在改善膝关节损伤和骨关节炎疗效评分（KOOS）方面有效，包括患者的疼痛症状、日常生活活动（ADL）和粘连症状，但对运动功能无效（KOOS-疼痛，MD = 2.77，CI = 95%[0，5.53]，I² = 0%，P < 0.05；KOOS-症状，MD = 3.73，CI = 95%[0.76，6.71]，I² = 0%，P < 0.05；KOOS-ADL，MD = 3.61，CI = 95%[0.79，6.43]，I² = 0%，P < 0.05；KOOS-QOL，MD = 4.66，CI = 95%[0.98，8.35]，I² = 29%，P < 0.05，KOOS-运动，MD = 0.48，CI = 95%[-3.02，3.98]，I² = 0%，P > 0.05）。与对照组相比，PRP注射在改善OA患者的西安大略和麦克马斯特大学骨关节炎指数（WOMAC）评分方面有效，包括疼痛、僵硬和关节功能运动（WOMAC-疼痛，MD = -1.08，CI = 95%[-1.62，-0.53]，I² = 87%，P < 0.05；WOMAC-僵硬，MD = -1.17，CI = 88%[-1.72，-0.63]，I² = 87%，P < 0.05；WOMAC-功能，MD = -1.12，CI = 95%[-1.65，-0.58]，I² = 87%，P < 0.05）。此外，亚组分析表明，低白细胞（LP）PRP注射在改善OA患者疼痛症状方面比高白细胞（LR）PRP注射更有效（VAS，LR-PRP，MD = -0.81，CI = 95%[-
