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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Adverse Reactions and Clinical Outcomes for Leukocyte-Poor Versus Leukocyte-Rich Platelet-Rich Plasma in Knee Osteoarthritis: A Systematic Review and Meta-analysis
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Adverse Reactions and Clinical Outcomes for Leukocyte-Poor Versus Leukocyte-Rich Platelet-Rich Plasma in Knee Osteoarthritis: A Systematic Review and Meta-analysis

机译：白细胞贫瘠的不良反应和临床结果与膝关节骨关节炎中白细胞丰富的富含片白细胞的富含血浆：系统审查和荟萃分析

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Background: Platelet-rich plasma (PRP) has gained attention as a therapeutic option for knee osteoarthritis; however, its efficacy varies widely. Leukocytes in PRP raise the concern of aggravating proinflammatory activity. To date, PRP has rarely been investigated with regard to leukocyte concentration. Purpose: To provide clinical evidence of the intra-articular injection of PRPs containing different leukocyte concentrations. Study Design: Systematic review; Level of evidence, 4. Methods: We systematically searched the MEDLINE, Embase, Cochrane Library, CINAHL, and Scopus databases. PRP was classified into leukocyte-poor (LP-PRP) and leukocyte-rich (LR-PRP). Clinical outcomes including Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analog scale (VAS) for pain score, International Knee Documentation Committee (IKDC) subjective score, and adverse reactions were evaluated. The Methodological Index for Non-Randomized Studies criteria were used for quality assessment. Results: Included were 32 studies with an evidence level between 1 and 4. Both LP-PRP and LR-PRP showed improvements above the minimal clinically important difference (MCID) in VAS pain score. No significant intergroup difference was seen at 3, 6, or 12 months of follow-up. Regarding function, both LP-PRP and LR-PRP showed improvements above the MCID in the WOMAC and IKDC scores, with no significant difference between the groups. Adverse reactions for pain were significantly higher in LR-PRP than in LP-PRP (odds ratio, 1.64; 95% confidence interval, 1.29-2.10; P = .01). After intra-articular PRP injection, LR-PRP showed a significantly higher rate of swelling than LP-PRP (odds ratio, 1.56; 95% confidence interval, 1.22-1.99; P = .02). The mean Methodological Index for Non-Randomized Studies score of the included studies was 18.6 (range, 10-24). Conclusion: Intra-articular PRP injection resulted in improvements above the MCID in terms of pain and function in patients with knee osteoarthritis up to 12 months. The risk of local adverse reactions appeared to be increased after LR-PRP compared with LP-PRP injection. The findings of this review can support the potential use of intra-articular PRP injection for the treatment of knee osteoarthritis. In clinical application, clinicians need to consider selecting a specific type of PRP for knee osteoarthritis.
机译：背景：富含血小板的血浆（PRP）作为膝关节骨关节炎治疗选择的注意力;然而，它的功效广泛变化。 PRP中的白细胞提高了加重促炎活动的关注。迄今为止，PRP很少已经考虑了白细胞浓度。目的：提供含有不同白细胞浓度的关节内注射PRP的临床证据。研究设计：系统评论;证据级别，4.方法：我们系统地搜索了Medline，Embase，Cochrane库，Cinahl和Scopus数据库。 PRP分为白细胞贫乏（LP-PRP）和富含白细胞（LR-PRP）。在包括西部安大略省和麦克马斯特大学骨关节炎指数（WOWAC），视觉模拟规模（VAS）的临床结果，评估了国际膝关节委员会（IKDC）主观评分和不良反应。非随机研究标准的方法论指标用于质量评估。结果：包括32项研究，证据水平在1和4之间.LP-PRP和LR-PRP均显示出高于VAS疼痛评分中最小临床重要差异（MCID）的改善。在3,6或12个月后，没有显着的互动差异。关于功能，LP-PRP和LR-PRP都显示出于WOWAC和IKDC分数的MCID上方的改进，而组织之间没有显着差异。 LR-PRP的疼痛不良反应显着高于LP-PRP（差距比，1.64; 95％置信区间，1.29-2.10; p = .01）。在关节内PRP注射后，LR-PRP显示出比LP-PRP的显着更高的肿胀速率（大量比，1.56; 95％置信区间，1.22-1.99; p = .02）。非随机研究的平均方法结果包括18.6（范围，10-24）。结论：关节内的PRP注射导致膝关节骨关节炎患者疼痛和功能高于MCID的改善，高达12个月。与LP-PRP注射液相比，LR-PRP后局部不良反应的风险似乎增加。本综述的调查结果可以支持潜在使用关节内PRP喷射，以治疗膝关节骨关节炎。在临床应用中，临床医生需要考虑选择特定类型的PRP用于膝关节骨关节炎。

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