Meta-Analys Of Autologous Platelet-Rich Gel In The Treatment Of Diabetic Foot

Objective To assess the clinical efficacy of autologous platelet-rich gel (APG) in the treatment of diabetic foot (DF).Methods According to the search strategy, we searched PubMed, EMbase, the Cochrane Library, CNKI, the Chinese VIP database, CBM, Wanfang database and so on. We also searched relevant meeting records, references and dissertations, and when necessary, we contacted the author to obtain relevant data. According to the inclusion and exclusion criteria, two reviewers independently screened the literature and included literature which was about using APG to treat DF into randomized controlled trial. We evaluated the quality of the included studies and extracted data according to the quality assessment standards which was recommended by the Cochrane Collaboration. Then, we made the decision by cross-checking, when there were disagreements, the decision was made by discussion or by a third party. RevMan 5.3 software was used for Meta-analysis.Results We collected 15 articles, which were in accordance with the inclusion and exclusion criteria and involved 722 patients. Meta-analysis showed that:1. Compared with the conventional treatment, the treatment of DF by APG improved the rate of ulcer healing (P<0.00001).2. The rate of ulcer healing at different Wagner stages by Subgroup analysis were as follows:compared with the conventional treatment, using APG to treat Wagner 1 ulcer, there were no significant difference in the ulcer healing rate (P=0.13), while using APG to treat Wagner 2 or 3 ulcer, the ulcer healing rate was significantly increased (P= 0.01 in Wagner 2, P=0.003 in Wagner 3).3. Compared with the conventional treatment, the treatment of DF by APG significantly reduced the ulcer healing time (P< 0.00001).4. The ulcer healing time at different Wagner stages by Subgroup analysis were as follows:compared with the conventional treatment, using APG to treat Wagner 1, Wagner 2 or Wagner 3 ulcer, the ulcer healing time was significantly shortened (P< 0.00001).5. The ulcer area reduction by APG treatment was better than that by the conventional therapy.6. The adverse reactions and complications about APG therapy were not found.7. The cost of treatment by APG was less than that of the conventional treatment. However, more large-scale clinical studies were needed to confirm the results.Conclusion Compared with the conventional treatment, APG treatment for DF can improve the ulcer healing rate, shorten the ulcer healing time, and reduce the hospitalization expenses. APG is a new, safe and effective method of DF treatment, but there was no significant difference for Wagner 1 ulcer healing rate compared with the conventional therapy.