年轻年龄和富血小板血浆特征影响膝骨关节炎短期结局，但独立效应仍不确定：一项安慰剂对照随机试验的系统综述与荟萃分析及荟萃回归
简介
该研究对20项随机安慰剂对照试验（PRP组1774例、安慰剂组1518例）进行荟萃分析及荟萃回归，评估PRP成分与注射特征对膝骨关节炎临床疗效的影响。结果显示关节内注射PRP在6及12个月时改善疼痛与功能优于安慰剂，但其证据确定性极低；年轻年龄、血小板浓缩倍数高、白细胞富集型PRP及CaCl₂激活与6个月更佳疗效相关，因各因素相互关联，独立贡献尚难判定，结论…
英文摘要
PURPOSE: The goal of this systematic review with meta-regression was to investigate the influence of different platelet-rich plasma (PRP) composition and administration characteristics on the clinical results of intra-articular PRP injections in patients with knee osteoarthritis (KOA) as compared to placebo. METHODS: Three databases were searched until 25 May 2025, to identify randomised placebo-controlled trials of PRP injections in KOA. Population, PRP composition and administration characteristics and clinical scores data were collected. Clinical data were categorised into functional and pain scores and recorded at 6- and 12-month follow-up. Meta-analysis comparing PRP to placebo was conducted using random-effects model and summarised as standardised mean differences and 95% confidence intervals. Meta-regression was conducted using patient-related and PRP-specific covariates. RESULTS: Twenty studies including 26 unique groups of PRP (n = 1774) and 20 groups of placebo (n = 1518). The PRP group showed statistically significant improved knee function and pain at 6 months and at 12 months (large effect, very low certainty). Higher platelet increase factor and activation with CaCl2 were significantly associated with superior PRP results in knee function and pain at 6 months. Younger age and leucocyte-rich PRP were significantly associated with improved knee function. However, PRP type and concentration factor were significantly correlated. No other moderator explained the superior PRP results at 6 months, and none at the 12-month follow-up. CONCLUSIONS: Younger age, higher platelet increase factor, LR-PRP and CaCl2 activation were associated with greater short-term improvements in meta-regression analyses. Intra-articular PRP injections appeared to be more effective than placebo in reducing pain and improving knee function at 6 and 12 months. However, the certainty of evidence was very low and due to interrelated PRP characteristics and limited reporting across studies, the independent contribution of individual factors remains uncertain, and these findings are still hypothesis-generating rather than definitive evidence supporting specific PRP formulations. LEVEL OF EVIDENCE: Level I.