Geriatric Diseases Institute of Chengdu, Department of Endocrine and Metabolism, Chengdu Fifth People's Hospital(The Second Clinical Medical College, Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, China.
Department of Nephrology, Chengdu Third People's hospital, Chengdu, China.
Front Endocrinol (Lausanne). 2024 Sep 23;15:1452192. doi: 10.3389/fendo.2024.1452192. eCollection 2024.
Through a network meta-analysis, we compared different treatment measures for patients with diabetic foot ulcers (DFU), assessing their impact on the healing of DFU and ranking them accordingly.
We searched the PubMed, the China National Knowledge Infrastructure (CNKI), Embase, the WanFang and the WeiPu database. The retrieval time was from database establishment to January 2024, and retrieval entailed subject and free words. Randomized controlled trials (RCTs) with different treatment measures for DFU were included. Data extraction and evaluation were based on the PRISMA guidelines. Meta-analyses using pairwise and network methods were employed to compare and rank the effectiveness of different treatments for DFU.
Ultimately, we included 57 RCTs involving a total of 4,826 patients with DFU. When it comes to ulcer healing rates, compared to standard of care(SOC),platelet-rich plasma(PRP), hyperbaric oxygen therapy(HBOT), topical oxygen therapy(TOT), acellular dermal matrix(ADM), and stem cells(SCs) in both direct meta-analysis(DMA) and network meta-analysis(NMA) can effectively increase the complete healing rate. For Scs+PRP, a statistically significant improvement was only observed in the NMA. Moreover, when compared to the negative pressure wound therapy(NPWT) group, the PRP+NPWT group was more effective in promoting the complete healing of ulcers. In terms of promoting the reduction of ulcer area, no statistical differences were observed among various treatment measures. When it comes to ulcer healing time, both PRP and NPWT can effectively shorten the healing time compared to SOC. Furthermore, when compared to the NPWT group, the combined treatment of PRP and ultrasonic debridement(UD) with NPWT is more effective in reducing healing time. In terms of amputation rates and adverse reactions, the PRP group effectively reduced the amputation rate and adverse reactions for patients with DFU. Additionally, compared to the NPWT group, the combined treatment of PRP and UD with NPWT reduced the incidence of adverse reactions. However, no significant differences were observed among other treatment measures in terms of amputation rates and adverse reactions. The ranking results showed that the efficacy of PRP+NPWT and UD+NPWT in promoting ulcer healing, reducing ulcer area, shortening healing time, decreasing amputation rates and adverse reactions is superior to that of the alone PRP group, NPWT group, and UD group. Conversely, the SOC group demonstrates the least effective performance in all aspects.
Due to the particularity of the wound of DFU, the standard of care is not effective, but the new treatment scheme has a remarkable effect in many aspects. And the treatment of DFU is not a single choice, combined with a variety of methods often achieve better efficacy, and will not bring more adverse reactions.
通过网络荟萃分析，我们比较了不同治疗方法对糖尿病足溃疡（DFU）患者的影响，评估了它们对 DFU 愈合的影响，并对其进行了相应的排序。
我们检索了 PubMed、中国知网（CNKI）、Embase、万方和维普数据库。检索时间为数据库建立至 2024 年 1 月，检索采用主题词和自由词。纳入了比较不同治疗措施对 DFU 患者的疗效的随机对照试验（RCT）。基于 PRISMA 指南进行数据提取和评估。使用直接和网络荟萃分析比较和排序不同治疗措施对 DFU 的疗效。
最终，我们纳入了 57 项 RCT，共涉及 4826 例 DFU 患者。在溃疡愈合率方面，与标准治疗（SOC）相比，富血小板血浆（PRP）、高压氧治疗（HBOT）、局部氧疗（TOT）、脱细胞真皮基质（ADM）和干细胞（SCs）在直接荟萃分析（DMA）和网络荟萃分析（NMA）中均能有效提高完全愈合率。对于 Scs+PRP，仅在 NMA 中观察到统计学意义上的改善。此外，与负压伤口治疗（NPWT）组相比，PRP+NPWT 组在促进溃疡完全愈合方面更有效。在促进溃疡面积缩小方面，各种治疗措施之间无统计学差异。在溃疡愈合时间方面，PRP 和 NPWT 均能有效缩短 SOC 愈合时间。此外，与 NPWT 组相比，PRP 和超声清创（UD）联合 NPWT 的联合治疗更能有效缩短愈合时间。在截肢率和不良反应方面，PRP 组能有效降低 DFU 患者的截肢率和不良反应。此外，与 NPWT 组相比，PRP 和 UD 联合 NPWT 的联合治疗可降低不良反应发生率。然而，在截肢率和不良反应方面，其他治疗措施之间无显著差异。排序结果表明，PRP+NPWT 和 UD+NPWT 在促进溃疡愈合、缩小溃疡面积、缩短愈合时间、降低截肢率和不良反应方面的疗效优于单独 PRP 组、NPWT 组和 UD 组。相反，SOC 组在各方面的表现都最差。
由于 DFU 伤口的特殊性，标准治疗并不有效，但新的治疗方案在许多方面都有显著效果。DFU 的治疗不是单一选择，结合多种方法往往能取得更好的疗效，且不会带来更多的不良反应。
