富含自体血小板血浆凝胶在老年糖尿病足溃疡护理中的应用潜力：一项系统评价与荟萃分析
The Potential of Autologous Platelet-Rich Plasma Gel for Diabetic Foot Ulcer Care Among Older Adults: A Systematic Review and Meta-Analysis.
作者信息
Platini Hesti, Adammayanti Keyzha Amartya, Maulana Sidik, Putri Putu Moradha Kharisma, Layuk Welly Grivin, Lele Juan Alessandro Jeremis Maruli Nura, Haroen Hartiah, Pratiwi Sri Hartati, Musthofa Faizal, Mago Arpit
机构信息
Department of Medical-Surgical Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, West Java, Indonesia.
Clinical Clerkship Program, Faculty of Medicine, Universitas Kristen Indonesia (UKI), UKI Hospital East Jakarta, Special Capital Region, Indonesia.
出版信息
Ther Clin Risk Manag. 2024 Jan 25;20:21-37. doi: 10.2147/TCRM.S433033. eCollection 2024.
INTRODUCTION
Poorly controlled diabetes mellitus can lead to the development of diabetic foot ulcers (DFU), which is a frequent complication in patients. However, several diabetes management guidelines for older adults do not mention the occurrence of DFUs. Nowadays, Autologous Platelet-Rich Gel (APG) is being used for treating diabetic ulcers. APG is an innovative platelet-derived product with many advantages, such as being low-cost, easy to produce, and readily available materials. Additionally, it does not lead to any rejection reaction.
OBJECTIVE
This study aims to assess the safety and efficacy of APG as a novel treatment of DFU compared with standard treatment in older adult patients.
METHODS
Randomized Controlled Trials (RCTs) were searched using PubMed, Cochrane, Google Scholar, Wiley, and PlosOne. The keywords have been arranged using the Boolean operator, including autologous platelet-rich gel, DFU, and elderly. The data was screened by inclusion and exclusion criteria. The final inclusion study was analyzed and synthesized by tabulation, clusterization, contextual and thematic approach, and assessed for risk of bias using ROB 2.0. Meta-analysis was conducted by using Review Manager 5.4 and the Mantel Haenszel method.
RESULTS
Eight RCTs with 598 patients were eligible for the present analysis. Compared with standard care/conventional treatment, APG could significantly improve the healing wound in patients with diabetic foot ulcers (Relative risk (RR) 1.32, 95% confidence interval (CI) 1.22-1.57, p < 0.0001), shortened the healing time (Mean difference [MD] -16.97 days (95% CI: -32.64 to -1.29; p < 0.00001), shortened the length of hospital stay (MD= -20.11, 95% CI: -38.02, -2.20; = 0.03), and amputation rate (MD= 0.36, 95% CI: 0.16, 0.84; p = 0.02).
CONCLUSION
APG treatment can better treat DFU in terms of duration of healing, wound healing, length of hospital stay, and amputation prevention than the standard treatment.
引言
糖尿病控制不佳会导致糖尿病足溃疡（DFU）的发生，这是患者中常见的并发症。然而，一些针对老年人的糖尿病管理指南并未提及DFU的发生情况。如今，自体富血小板凝胶（APG）正被用于治疗糖尿病溃疡。APG是一种创新的血小板衍生产品，具有许多优点，如成本低、易于制备且材料容易获取。此外，它不会引起任何排斥反应。
目的
本研究旨在评估与标准治疗相比，APG作为一种新型治疗方法对老年患者DFU的安全性和有效性。
方法
使用PubMed、Cochrane、谷歌学术、Wiley和PlosOne检索随机对照试验（RCT）。使用布尔运算符排列关键词，包括自体富血小板凝胶、DFU和老年人。根据纳入和排除标准筛选数据。对最终纳入的研究采用列表、聚类、背景和主题方法进行分析和综合，并使用ROB 2.0评估偏倚风险。使用Review Manager 5.4和Mantel Haenszel方法进行荟萃分析。
结果
八项RCT（共598例患者）符合本分析的要求。与标准护理/传统治疗相比，APG能显著改善糖尿病足溃疡患者的伤口愈合情况（相对风险（RR）1.32，95%置信区间（CI）1.22 - 1.57，p < 0.0001），缩短愈合时间（平均差[MD] -16.97天（95% CI：-32.64至-1.29；p < 0.00001），缩短住院时间（MD = -20.11，95% CI：-38.02，-2.20；p = 0.03），以及降低截肢率（MD = 0.36，95% CI：0.16，0.84；p = 0.02）。
结论
在愈合持续时间、伤口愈合、住院时间和预防截肢方面，APG治疗比标准治疗能更好地治疗DFU。
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