Efficacy and safety of intra-articular injection of platelet-rich plasma combined with intermittent hypoxic training in the treatment of early knee osteoarthritis

doi:10.11958/20253164

Abstract

Abstract:

Objective To observe the efficacy and safety of intra-articular injection of platelet-rich plasma (PRP) combined with intermittent hypoxic training in the treatment of early knee osteoarthritis (KOA). Methods A total of 220 patients with early KOA were enrolled and equally divided into four groups using a random number table. The low oxygen group received intermittent hypoxic training alone, the sodium hyaluronate+low oxygen group received intra-articular injection of sodium hyaluronate combined with intermittent hypoxic training, the PRP group received intra-articular injection of PRP alone and the PRP+low oxygen group received intra-articular injection of PRP combined with intermittent hypoxic training. Patients of all groups were treated continuously for 6 weeks. The numerical pain rating scale (NPRS) score, inflammatory pain mediators [C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-17 (IL-17), 5-hydroxytryptamine (5-HT) and substance P], oxidative stress indicators [superoxide dismutase (SOD), malondialdehyde (MDA)], the knee injury and osteoarthritis outcome scores (KOOS), timed up and go test (TUG) results, and adverse reactions were compared between the four groups. Results After treatment, NPRS scores, CRP, TNF-α, IL-17, 5-HT, substance P and MDA levels were decreased in order in the low oxygen group, the PRP group, the sodium hyaluronate+low oxygen group and the PRP+low oxygen group. SOD levels, the scores for pain, knee-related quality of life, symptoms, exercise and recreation, activities of daily living and total KOOS scores were increased in order in these groups, while the TUG time decreased in order (all P<0.05). There was no significant difference in the incidence of adverse reactions between the four groups (P>0.05). Conclusion Applying intra-articular injection of PRP combined with intermittent hypoxic training to treat early KOA can effectively improve the expression levels of inflammatory pain mediators and oxidative stress level, alleviate pain and enhance knee function and balance ability of patients, with high safety.

Key words: osteoarthritis, knee, platelet-rich plasma, hypoxia, injection, intra-articular, sodium hyaluronate, intermittent hypoxic training

CLC Number:

R684.3

Figures/Tables 7

References 26

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组别		性别（男/女）			年龄/岁			体质量指数/（kg/m²）
低氧组		27/28			58.29±10.76			24.14±2.67
PRP组		23/32			55.53±10.30			23.66±2.07
玻璃酸钠+低氧组		24/31			57.95±11.26			23.91±2.45
PRP+低氧组		26/29			58.58±9.60			23.10±2.55
χ²或F		0.733			0.974			1.849
组别	K-L分级					病变侧			病程/月
组别	I		II	III		左侧	右侧		病程/月
低氧组	18		25	12		26	29		22.67±4.16
PRP组	15		29	11		30	25		20.60±4.15
玻璃酸钠+低氧组	17		28	10		28	27		21.44±4.52
PRP+低氧组	15		27	13		31	24		22.25±5.14
χ²或F	1.171					1.075			2.276

组别		性别（男/女）			年龄/岁			体质量指数/（kg/m²）
低氧组		27/28			58.29±10.76			24.14±2.67
PRP组		23/32			55.53±10.30			23.66±2.07
玻璃酸钠+低氧组		24/31			57.95±11.26			23.91±2.45
PRP+低氧组		26/29			58.58±9.60			23.10±2.55
χ²或F		0.733			0.974			1.849
组别	K-L分级					病变侧			病程/月
组别	I		II	III		左侧	右侧		病程/月
低氧组	18		25	12		26	29		22.67±4.16
PRP组	15		29	11		30	25		20.60±4.15
玻璃酸钠+低氧组	17		28	10		28	27		21.44±4.52
PRP+低氧组	15		27	13		31	24		22.25±5.14
χ²或F	1.171					1.075			2.276

组别	治疗前	治疗后
低氧组	5.78±0.96	4.85±0.73	5.886^＊＊
PRP组	5.65±0.75	4.38±0.59^a	9.918^＊＊
玻璃酸钠+低氧组	5.89±1.08	3.78±0.74^ab	12.442^＊＊
PRP+低氧组	6.09±1.13	2.96±0.58^abc	16.703^＊＊
F	1.971	83.157^＊＊

组别	治疗前	治疗后
低氧组	5.78±0.96	4.85±0.73	5.886^＊＊
PRP组	5.65±0.75	4.38±0.59^a	9.918^＊＊
玻璃酸钠+低氧组	5.89±1.08	3.78±0.74^ab	12.442^＊＊
PRP+低氧组	6.09±1.13	2.96±0.58^abc	16.703^＊＊
F	1.971	83.157^＊＊

组别		CRP/（mg/L）				TNF-α/（μg/L）						IL-17/（ng/L）
组别		治疗前	治疗后		t	治疗前		治疗后		t		治疗前	治疗后		t
低氧组		28.88±5.71	11.25±1.94		20.836^＊＊	16.51±2.81		13.76±2.53		8.261^＊＊		6.67±1.26	5.92±1.14		4.962^＊＊
PRP组		28.74±6.62	9.89±1.75^a		19.343^＊＊	15.60±2.83		12.73±1.99^a		6.571^＊＊		6.64±1.35	5.26±1.26^a		7.116^＊＊
玻璃酸钠+低氧组		30.33±5.68	8.30±1.44^ab		27.031^＊＊	15.83±2.98		11.64±2.62^ab		8.132^＊＊		6.38±1.40	4.66±1.05^ab		7.614^＊＊
PRP+低氧组		30.30±4.65	6.86±1.40^abc		38.218^＊＊	15.82±2.40		10.16±1.25^abc		14.631^＊＊		6.47±1.41	3.93±0.87^abc		11.796^＊＊
F		1.279	73.623^＊＊			1.113		27.842^＊＊				0.589	33.311^＊＊
组别	5-HT/（μg/L）								P物质/（nmol/L）
组别	治疗前			治疗后			t		治疗前		治疗后			t
低氧组	876.42±115.70			669.47±112.18			9.344^＊＊		4.43±0.84		3.41±0.57			7.406^＊＊
PRP组	847.00±121.53			589.23±110.17^a			11.870^＊＊		4.67±0.95		2.93±0.43^a			13.168^＊＊
玻璃酸钠+低氧组	865.40±118.07			534.70±84.88^ab			15.987^＊＊		4.40±0.84		2.36±0.47^ab			16.944^＊＊
PRP+低氧组	875.48±129.59			486.11±75.32^abc			19.779^＊＊		4.49±0.77		1.84±0.35^abc			22.318^＊＊
F	0.697			36.176^＊＊					1.082		120.561^＊＊