目的 探讨体重指数(BMI)对单采富血小板血浆(PRP)治疗膝骨关节炎(KOA)患者的疗效及其对关节功能恢复的影响。方法 回顾性分析2023-01至2024-10在解放军总医院第一医学中心接受单采PRP治疗的120例KOA患者的临床资料。根据BMI将患者分为正常体重组(BMI 18.5～23.9 kg/m2)、超重组(BMI 24.0～27.9 kg/m2)和肥胖组(BMI ≥28.0 kg/m2),每组40例。所有患者均接受3次超声引导下PRP关节腔注射,间隔2周。于治疗前、治疗后3个月、6个月和12个月评估视觉模拟疼痛评分(VAS)、膝关节骨关节炎结果评分(KOOS)、骨关节炎指数(WOMAC)、关节活动度(ROM)和MRI T2-mapping值变化。结果 治疗后12个月,三组VAS评分均较基线显著降低(P＜0.001),但肥胖组(3.25±0.94)降幅明显小于超重组(2.37±0.82)和正常体重组(1.68±0.71)(F=17.362,P＜0.001)。KOOS总分改善幅度在正常体重组(33.48±7.21)显著高于超重组(24.57±6.35)和肥胖组(15.69±5.82)(F=20.475,P＜0.001)。WOMAC总分降低幅度呈现类似趋势,正常体重组(25.36±5.47)优于超重组(18.93±4.86)和肥胖组(12.57±4.32)(F=18.734,P＜0.001)。关节活动度改善幅度正常体重组(19.73±5.42)°显著优于超重组(13.42±4.68)°和肥胖组(7.95±3.76)°(F=16.537,P＜0.001)。内侧胫骨平台软骨MRI T2-mapping值减少幅度正常体重组(6.37±1.84)ms显著大于超重组(4.25±1.63)ms和肥胖组(2.16±1.28)ms(F=19.654,P＜0.001)。多元回归分析显示,BMI(β=0.612,P＜0.001)和年龄(β=0.386,P=0.008)是PRP治疗效果的独立预测因素。结论 BMI是影响单采PRP治疗KOA疗效的重要因素,正常体重患者获得了更显著的疼痛缓解和功能改善,而肥胖患者疗效相对有限,提示临床应根据BMI制定个体化治疗方案。
Abstract
Objective To investigate the effect of body mass index(BMI) on the efficacy of single-collected platelet-rich plasma (PRP) in the treatment of patients with knee osteoarthritis (KOA) and the recovery of joint function. Methods A retrospective analysis was conducted on 120 KOA patients who received single-collected PRP treatment at the First Medical Center of PLA General Hospital from January 2023 to October 2024. The patients were divided into a normal weight group(BMI 18.5-23.9 kg/m2, n=40), an overweight group(BMI 24.0-27.9 kg/m2, n=40), and an obese group (BMI≥28.0 kg/m2, n=40) according to BMI. All patients received 3 ultrasound-guided PRP joint cavity injections, with an interval of 2 weeks. Visual Analogue Scale (VAS), Knee Injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), range of motion (ROM), and MRI T2-mapping values were evaluated before treatment, 3 months, 6 months, and 12 months after treatment. Results At 12 months after treatment, VAS scores in all the three groups decreased significantly from baseline (P<0.001), but the reduction in the obese group (3.25±0.94) was significantly less than that in the overweight group (2.37±0.82) and normal weight group (1.68±0.71) (F=17.362, P<0.001). The improvement in the total KOOS score was significantly higher in the normal weight group (33.48±7.21) than in the overweight group (24.57±6.35) and obese group (15.69±5.82) (F=20.475, P<0.001). The reduction in the total WOMAC score showed a similar trend,, with the normal weight group (25.36±5.47) better than the overweight group (18.93±4.86) and obese group (12.57±4.32) (F=18.734, P<0.001). The improvement in joint ROM was significantly greater in the normal weight group (19.73±5.42)° than in the overweight group (13.42±4.68) °and obese group (7.95±3.76)°(F=16.537, P<0. 001). The reduction in the MRI T2-mapping value of the medial tibial plateau was significantly greater in the normal weight group (6.37±1.84) ms than in the overweight group (4.25±1.63) ms and the obese group (2.16±1.28) ms (F=19.654, P<0.001). Multivariate regression analysis showed that BMI (β=0.612, P<0.001) and age (β=0.386, P=0.008) were independent predictors of the efficacy of PRP treatment. Conclusions BMI is an important factor affecting the efficacy of single-collected PRP in treating KOA. Normal-weight patients can achieve more significant pain relief and functional improvement, while obese patients have relatively limited efficacy, suggesting that individualized treatment plans should be developed based on BMI in clinical practice.
关键词
体重指数 /
富血小板血浆 /
膝骨关节炎 /
关节功能 /
磁共振成像
Key words
body mass index /
platelet-rich plasma /
knee osteoarthritis /
joint function /
magnetic resonance imaging
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 王养发,刘 军,潘建科,等. 富血小板血浆与透明质酸治疗膝骨关节炎疗效对比的Meta分析[J]. 中国组织工程研究,2020,24(27):4421-4428.
[2] Allen K D, Thoma L M, Golightly Y M. Epidemiology of osteoarthritis[J]. Osteoarthr Cartilag, 2022, 30(2): 184-195.
[3] Li S, Xing F, Yan T, et al. Multiple injections of platelet-rich plasma versus hyaluronic acid for knee osteoarthritis: a systematic review and meta-analysis of current evidence in randomized controlled trials[J]. J Personalized Med, 2023, 13(3): 429.
[4] Rodríguez-Merchán E C. Intra-articular platelet-rich plasma injections in knee osteoarthritis: a review of their current molecular mechanisms of action and their degree of efficacy[J]. Int J Mol Sci, 2022, 23(3): 1301.
[5] Xiong Y, Gong C, Peng X, et al. Efficacy and safety of platelet-rich plasma injections for the treatment of osteoarthritis: a systematic review and meta-analysis of randomized controlled trials[J]. Front Med, 2023, 10:1204144.
[6] 房 昕,郭金铭,刘品端. 不同浓度富血小板血浆修复兔膝骨关节炎软骨缺损的比较[J]. 中国组织工程研究,2021,25(35):5588-5593.
[7] Belk J W, Kraeutler M J, Houck D A, et al. Platelet-rich plasma versus hyaluronic acid for knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials[J]. Am J Sport Med,2021, 49(1): 249-260.
[8] Saraf A, Hussain A, Singhal A, et al. Do age, gender, BMI and disease duration influence the clinical outcomes in patients of knee osteoarthritis treated with serial injections of autologous platelet rich plasma?[J]. J Clin Orthop Trauma, 2023, 43:102226.
[9] Annaniemi J A, Pere J, Giordano S. The efficacy of platelet-rich plasma injection therapy in obese versus non-obese patients with knee osteoarthritis: a comparative study[J]. J Clin Med, 2024, 13(9):2590.
[10] Li T, Li Y, Li W, et al. Impact of autologous platelet-rich plasma therapy vs. hyaluronic acid on synovial fluid biomarkers in knee osteoarthritis: a randomized controlled clinical trial[J]. Front Med, 2023, 10: 1258727.
[11] Hohmann E, Tetsworth K, Glatt V. Is platelet-rich plasma effective for the treatment of knee osteoarthritis? A systematic review and meta-analysis of level 1 and 2 randomized controlled trials[J]. Eur J Orthop Surg Tr, 2020, 30(6): 955-967.
[12] Hurley E T, Sherman S L, Stokes D J, et al. Experts achieve consensus on a majority of statements regarding platelet-rich plasma treatments for treatment of musculoskeletal pathology[J]. Arthroscopy, 2024, 40(2):470-77.
[13] Economou A, Mallia I, Fioravanti A, et al. The role of adipokines between genders in the pathogenesis of osteoarthritis[J]. Int J Mol Sci, 2024, 25(19): 10865.
[14] Pereira Herrera B, Emanuel K, Emans P J, et al. Infrapatellar fat pad as a source of biomarkers and therapeutic target for knee osteoarthritis[J]. Arthritis Res Ther, 2025, 27(1): 81.
[15] Huffman K F, Ambrose K R, Nelson A E, et al. The critical role of physical activity and weight management in knee and hip osteoarthritis: a narrative review[J]. J Rheumatol, 2024, 51(3): 224-233.
[16] Messier S P, Beavers D P, Queen K, et al. Effect of diet and exercise on knee pain in patients with osteoarthritis and overweight or obesity: a randomized clinical trial[J]. JAMA, 2022, 328(22): 2242-2251.
[17] Dias I E, Cardoso D F, Soares C S, et al. Clinical application of mesenchymal stem cells therapy in musculoskeletal injuries in dogs-A review of the scientific literature[J]. Open Vet J, 2021, 11(2): 188-202.
[18] Costa L A V, Lenza M, Irrgang J J, et al. How does platelet-rich plasma compare clinically to other therapies in the treatment of knee osteoarthritis? A systematic review and meta-analysis[J]. Am J Sports Med, 2023, 51(4):1074-1086.
[19] Annaniemi J A, Pere J, Giordano S. The efficacy of platelet-rich plasma injection therapy in obese versus non-obese patients with knee osteoarthritis: a comparative study[J]. J Clin Med, 2024, 13(9):2590.
[20] Cao Y. Update on the use of platelet-rich plasma in the treatment of osteoarthritis: new supporting evidence[J]. Bio Res Thera, 2024, 11(7):6556-6564.
[21] Emanuel K S, Kellner L J, Peters M J M, et al. The relation between the biochemical composition of knee articular cartilage and quantitative MRI: a systematic review and meta-analysis[J]. Osteoarthr Cartilag, 2022, 30(5): 650-662.
[22] Emanuel K S, Kellner L J, Peters M J M, et al. The relation between the biochemical composition of knee articular cartilage and quantitative MRI: a systematic review and meta-analysis[J]. Osteoarthritis Cartilage, 2022, 30(5):650-662.
[23] Mende E, Love R J, Young J L. A Comprehensive summary of the meta-analyses and systematic reviews on platelet-rich plasma therapies for knee osteoarthritis[J]. Mil Med, 2024, 189(11-12):e2347-e2356.
[24] Oeding J F, Varady N H, Fearington F W, et al. Platelet-rich plasma versus alternative injections for osteoarthritis of the knee: a systematic review and statistical fragility index-based meta-analysis of randomized controlled trials[J]. Am J Sports Med, 2024, 52(8):2119-2130.
[25] Messier S P, Beavers D P, Queen K, et al. Effect of diet and exercise on knee pain in patients with osteoarthritis and overweight or obesity: a randomized clinical trial[J]. JAMA, 2022, 328(22):2242-2251.
PDF(998 KB)
