改良间充质干细胞、富含血小板血浆和透明质酸联合关节镜下关节内注射治疗早期骨关节炎：系统评价、荟萃分析和荟萃回归研究

Modified Mesenchymal stem cell, platelet-rich plasma, and hyaluronic acid intervention in early stage osteoarthritis: A systematic review, meta-analysis, and meta-regression of arthroscopic-guided intra-articular approaches.

机构信息

Department of Medicine, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia.

Kariadi General Hospital, Semarang, Indonesia.

出版信息

PLoS One. 2024 Mar 8;19(3):e0295876. doi: 10.1371/journal.pone.0295876. eCollection 2024.

BACKGROUND

Mesenchymal stem cells (MSCs) hold promise for osteoarthritis (OA) treatment, potentially enhanced by combining them with platelet-rich plasma (PRP) and hyaluronic acid (HA). This study aimed to assess the synergy of MSCs, PRP, and varying HA doses, and determine optimal MSC sources to treat early-stage OA in the perspective of Lysholm score, VAS Score, KSS score, and WOMAC score.

METHOD

Original articles from 2013 to 2023 were screened from four databases, focusing on clinical trials and randomized controlled trials. The Risk of Bias in Non-randomized Studies-of Interventions (ROB-2) tool evaluated bias, and a PICOS criteria table guided result construction. Revman 5.4 analyzed outcomes such as Lysholm score, VAS score, KSS, WOMAC score, cartilage volume, and defect size using MRI. This systematic review adhered to PRISMA guidelines.

RESULT

Nine studies met the final inclusion criteria. Meta-analysis revealed a significant improvement in Lysholm score (MD: 17.89; 95% CI: 16.01, 19.77; I2 = 0%, P = 0.56), a notable reduction in VAS score (MD: -2.62; 95% CI: -2.83, -2.41; I2 = 99%, P < 0.00001), elevated KSS (MD: 29.59; 95% CI: 27.66, 31.52; I2 = 95%, P < 0.0001), and reduced WOMAC score (MD: -12.38; 95% CI: -13.75, -11.01; I2 = 99%, P < 0.0001).

CONCLUSIONS

Arthroscopic guided high-dose subchondral application of primary cultured synovial MSCs in popliteal PRP media with HA effectively regenerates cartilage defects and improves clinical outcomes in early-stage osteoarthritis. Clarification of MSC sources and quantities enhances the understanding of this promising treatment modality.

背景

间充质干细胞（MSCs）在治疗骨关节炎（OA）方面具有潜力，通过与富血小板血浆（PRP）和透明质酸（HA）结合，可能会增强其效果。本研究旨在评估 MSC、PRP 和不同 HA 剂量的协同作用，并从 Lysholm 评分、VAS 评分、KSS 评分和 WOMAC 评分的角度确定最佳 MSC 来源来治疗早期 OA。

方法

从四个数据库中筛选出 2013 年至 2023 年的原始文章，重点关注临床试验和随机对照试验。非随机干预研究的偏倚风险（ROB-2）工具评估偏倚，PICOS 标准表指导结果构建。Revman 5.4 分析了 Lysholm 评分、VAS 评分、KSS、WOMAC 评分、软骨体积和 MRI 评估的缺陷大小等结果。本系统评价遵循 PRISMA 指南。

结果

符合最终纳入标准的有 9 项研究。Meta 分析显示 Lysholm 评分显著改善（MD：17.89；95%CI：16.01，19.77；I2=0%，P=0.56），VAS 评分显著降低（MD：-2.62；95%CI：-2.83，-2.41；I2=99%，P<0.00001），KSS 升高（MD：29.59；95%CI：27.66，31.52；I2=95%，P<0.0001），WOMAC 评分降低（MD：-12.38；95%CI：-13.75，-11.01；I2=99%，P<0.0001）。