A Meta-analysis Of The Efficacy And Safety Of Autologous Platelet-rich Plasma In The Treatment Of Diabetic Foot Ulcers

Objective:The meta-analysis was used to systematically evaluate the efficacy and safety of Autologous platelet-rich plasma(Au-PRP)in the treatment of Diabetic foot ulcer(DFU),which is intend to provide a higher level of evidence-based medicine support for the clinical application of Au-PRP in the treatment of DFU.Method:Using the strategy of "subject words and free words" combined with manual reference retrieval,we searched the literatures on clinical randomized controlled trials of Au-PRP in the treatment of DFU from January 1990 to March 2021 in Pub Med,Web of Science,Cochrane Library,Embase,VIP,Wanfang and CNKI and other databases of domestic and foreign.The two authors strictly screened the literature,downloaded and read the full text carefully,and strictly evaluated the quality of the literature and collected relevant data.The software of Rev Man 5.4 and Stata16.0 were used for statistical analysis of the data and chart drawing.Results:According to the screening rules based on literature,20 articles of RCTs published in Chinese and English were included,involving a total of 1224 patients.Among of them,there are 559 patients in the experiental group and 565 patients in the control group.The quantitative analysis results of various research outcome indicators in this Meta-analysis were as follows:1.Au-PRP could significantly increase the healing rate of DFU compared with conventional therapy:(1)Au-PRP could improve the overall healing rate of DFU[RR=1.45,95%CI(1.24,1.69),p<0.00001],but also obviously increase the healing rate of chronic refractory DFU [RR=1.40,95%CI(1.24,1.58),p<0.00001];(2)AuPRP could increase the healing rate of Wagner grade I ulcers [RR=1.17,95% CI(1.01,1.36),p=0.04],Wagner grade II ulcer [RR=1.36,95%CI(1.12,1.66),p=0.002],Wagner grade III ulcer [RR=2.43,95% CI(1.483.99),p=0.0004] and sinus wound[RR= 3.27,95% CI(1.84,5.79),p = 0.0001].2.Au-PRP could shorten the healing time of DFU compared with typical therapy alone :(1)Au-PRP could apparently diminish the healing time of DFU [MD=-13.79,95%CI(-19.56,-8.01),p<0.00001].(2)Au-PRP could reduce the healing time of Wagner grade I ulcer [MD=-7.00,95%CI(-8.00,-5.99),p < 0.00001],Wagner grade II ulcer [MD=-7.86,95%CI(-8.66,-7.07),p<0.00001],Wagner grade III ulcer[MD=-12.06,95%CI(-13.19,-10.93),p<0.00001]and sinus ulcer [MD=-21.19,95%CI(-35.66,-6.72),p=0.004].3.Au-PRP could promote the growth of granulation tissue compared with simple traditional therapy: Au-PRP could increase the thickness of granulation tissue[MD=2.05,95%CI(1.75,2.35),p<0.00001] and the coverage rate of granulation tissue [MD=14.36,95%CI(4.96,,23.76),p=0.003]4.Au-PRP could accelerate the reduction of DFU area compared with conventional therapy [MD=0.83,95%CI(0.55,1.11),p<0.0001],and minimize the hospitalization time of patients [MD=-17.25,95%CI(-30.29,-4.21),p=0.001].5.Au-PRP reduced the amputation rate of DFU of patients compared with simple conventional therapy [RR=0.36,95%CI(0.16,0.84),p=0.02].But it had no obviously advantage in reducing the recurrence rate of ulcers [RR=1.31,95%CI(0.49,3.56),p=0.59].6.Au-PRP would not increase the rate of adverse reactions during the treatment compared with simple conventional therapy [RR=1.06,95%CI(0.71,1.58),p=0.78].Conclusion:Au-PRP could promote the growth of DFU granulation tissue,accelerate the speed of wound contraction,increase the healing rate of ulcer,effectively shorten the healing time of the wound and reduce the patient’s hospital stay.In addition,it also reduces the patient’s amputation(toe)rate,but there was no obvious advantage in reducing ulcer recurrence.Moreover,Au-PRP would not increase the incidence of adverse reactions.In general,Au-PRP has reliable efficacy and strong safety in treatment of DFU,and it is worthy popularizing in clinical.