Autologous platelet-rich gel treatment for diabetic chronic cutaneous ulcers: A meta-analysis of randomized controlled trials
自体富血小板凝胶治疗糖尿病慢性皮肤溃疡:随机对照试验的meta分析
Abstract
enBackground
In recent years, many studies have reported that autologous platelet-rich gel (APG) is an effective adjuvant treatment for chronic cutaneous ulcers in diabetics. The aim of this study was to explore the efficacy and safety of APG for the topical treatment of diabetic chronic cutaneous ulcers.
Methods
The China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), VIP Database for Chinese Technical Periodicals (VIP), Chinese Wanfang database, PubMed, EMBASE, EBSCOhost, and Cochrane Library were systematically searched for relevant studies published up to 18 October 2017. Fixed- and random-effects models were used to calculate risk ratios (RR), odds ratios (ORs), and mean difference (MD) with 95% confidence intervals (95% CI). Subgroup analyses were conducted according to the Diabetic Foot Wagner Classification.
Results
Fifteen randomized control trials (RCTs) with 829 patients were eligible for inclusion in this analysis. Compared with standard care or conventional treatment, APG significantly improved the healing rate (RR 1.39; 95% CI 1.29, 1.50; P < 0.00001), shortened the healing time (MD -9.18; 95% CI −11.32, −7.05; P < 0.00001), and reduced the incidence of infection (OR 0.34; 95% CI 0.15, 0.77; P = 0.009).
Conclusions
Current evidence suggests that APG is effective and safe, and is feasible for use as an adjuvant treatment for diabetic ulcers, especially chronic refractory ulcers. However, more RCTs with a good design and of a high quality are needed before the use of APG can be implemented widely.
Abstract
zh摘要
背景
近年来，许多研究报道了自体血小板凝胶(autologous platelet-rich gel，APG)是治疗糖尿病慢性皮肤溃疡的有效辅助方法之一。本研究旨在探讨APG局部治疗糖尿病慢性皮肤溃疡的有效性和安全性。
方法
系统检索中国生物医学文献数据库，中国学术期刊数据库，维普中文期刊数据库，万方学术论文数据库，PubMed，EMBASE，EBSCOhost和Cochrane library数据库，时间截止至2017年10月18日，以获取相关研究。Meta分析采用固定效应模型和随机效应模型计算相对危险度(risk ratios，RR)、比值比(odds ratios，OR)、均差(mean difference，MD)及相应的95%置信区间(95% confidence intervals，95%CI)等统计学指标，并依据糖尿病足瓦格纳分级进行亚组分析。
结果
最终共15个随机对照试验包括829例患者符合条件并被纳入分析。Meta分析结果表明:与标准治疗或常规治疗相比，APG显著提高了治愈率(RR 1.39；95% CI 1.29，1.50；P < 0.00001)，缩短了治愈时间(MD -9.18；95% CI -11.32，-7.05；P < 0.00001)，降低了感染发生率(OR 0.34；95% CI 0.15，0.77；P = 0.009)。
结论
目前的研究结果表明
APG安全、有效，可将其作为糖尿病皮肤溃疡，尤其是慢性难治性糖尿病皮肤溃疡的辅助治疗方法之一。但在APG被广泛应用前，尚需要更多设计良好、质量高的随机对照试验以进一步验证。
