PRP(高濃度血小板)治療退化性關節炎是否會受白血球的影響?
 
knee  
 
於2015年4月29日發表於美國運動醫學期刊的文章﹕
 
一般常見用於治療退化性關節炎的PRP(高濃度血小板血漿)有分成所謂LP-PRP(不含白血球的)和LR-PRP(含白血球的),
針對治療退化性關節炎是否會有差異, 以往是眾說分云。
 
所以有學者就比較了:
1. 關節注射 含有白血球的PRP(LR-PRP),
2. 關節注射 不含白血球的PRP(LP-PRP),
3. 玻尿酸關節注射;
4. 安慰劑;
 
然後整合多篇期刊的結論(其中包含6篇高證據等級的隨機雙盲測試), 含有白血球的PRP, 和不含白血球的PRP, 在治療退化性關節炎安全性都是差不多的, 其造成副作用的機率都高於玻尿酸的關節注射(主要是局部的腫脹和疼痛)。
但是無論是 含有白血球的PRP, 或是不含白血球的PRP, 在治療效果上都是優於玻尿酸的關節注射, 和安慰劑的, 其中不含白血球的PRP的效果又是當中最為優異的。
 
測試效果的指標是退化性關節炎常用的 WOMAC score (Western Ontario and McMaster Universities Osteoarthritis Index)
 
其它有關PRP治療退化性關節炎的內容請參考: PRP(高濃度血小板血漿)治療關節疾患 
 
 
原文摘要請參考: 
 
Am J Sports Med. 2015 Apr 29. pii: 0363546515580787.

Effect of Leukocyte Concentration on the Efficacy of Platelet-Rich Plasma in the Treatment of Knee Osteoarthritis.

Abstract

BACKGROUND:

Leukocyte-poor platelet-rich plasma (LP-PRP) is hypothesized to be more suitable for intra-articular injection than leukocyte-rich PRP (LR-PRP) in the treatment of knee osteoarthritis.

PURPOSE:

To compare clinical outcomes and rates of adverse reactions between LP-PRP and LR-PRP for this application.

STUDY DESIGN:

Meta-analysis.

METHODS:

The MEDLINE, EMBASE, and Cochrane databases were reviewed. The primary outcome was the incidence of local adverse reactions. Secondary outcomes were the changes in International Knee Documentation Committee (IKDC) subjective score and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score between baseline and final follow-up measurements. A Bayesian network meta-analysis was performed, with a post hoc meta-regression to correct for baseline differences in WOMAC scores. Treatment rankings were based on surface under the cumulative ranking (SUCRA) probabilities.

RESULTS:

Included in the analysis were 6 randomized controlled trials (evidence level 1) and 3 prospective comparative studies (evidence level 2) with a total of 1055 patients. Injection of LP-PRP resulted in significantly better WOMAC scores than did injection of hyaluronic acid (mean difference, -21.14; 95% CI, -39.63 to -2.65) or placebo (mean difference, -17.84; 95% CI, -34.95 to -0.73). No such difference was observed with LR-PRP (mean difference, -14.28; 95% CI, -44.80 to 16.25). All treatment groups resulted in equivalent IKDC subjective scores. The SUCRA analysis showed that LP-PRP was the highest ranked treatment for both measures of clinical efficacy (WOMAC and IKDC). Finally, PRP injections resulted in a higher incidence of adverse reactions than hyaluronic acid (odds ratio, 5.63; 95% CI, 1.38-22.90), but there was no difference between LR-PRP and LP-PRP (odds ratio, 0.78; 95% CI, 0.05-11.93). These reactions were nearly always local swelling and pain, with a single study reporting medical side effects including syncope, dizziness, headache, gastritis, and tachycardia (17/1055 total patients).

CONCLUSION:

LP-PRP results in improved functional outcome scores compared with hyaluronic acid and placebo when used for treatment of knee osteoarthritis. LP-PRP and LR-PRP have similar safety profiles, although both induce more transient reactions than does hyaluronic acid. Adverse reactions to PRP may not be directly related to leukocyte concentration.

© 2015 The Author(s).

KEYWORDS:

injection; knee osteoarthritis; leukocyte; platelet-rich plasma; white blood cell

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