| BACKGROUND:In recent decades,people’s material level has been improved,medical security has been implemented,and people’s average life span is getting longer and longer.Diabetes has quietly evolved from a rare disease to the current epidemic in various countries,and the prevalence of diabetic foot has also risen steadily,leaping to become the primary cause of chronic refractory wounds.It is characterized by complex pathogenesis,difficult treatment,long hospitalization time,expensive hospitalization cost and high mortality and disability rate.It has caused great troubles to patients and their families,and has also brought great challenges to the whole society and the health care system around the world.Because of this,it is particularly important to find a way to heal the wound of diabetic foot ulcer,which is of no delay.Growth factor is a kind of new therapy which can accelerate wound healing.Although there are many clinical reports that EGF therapy can promote the complete healing of diabetic foot ulcers and shorten the healing time of the wound.However,there has been no comprehensive and systematic evaluation of clinical evidence regarding the efficacy and safety of EGF in the treatment of diabetic foot ulcers.AIM:To conduct a meta-analysis of the clinical efficacy and safety of EGF in the medical practice of treating diabetic foot ulcers,in order to help clinicians make medical decisions,identify areas that need further research,and provide them with strong evidence from evidence-based medicine.METHODS:Through computer access to the library of Nanchang University to search the domestic and foreign major Chinese and English literature databases(such as CNKI,VIP,Wanfang,Chinese Biomedical Literature Service System,Pub Med,Embase,Cochrane and other databases)and manually search the major professional journals and related literature references.The retrieval time is from the major database construction to October 2020.According to the preset inclusion and exclusion criteria,the literatures that meet the requirements were screened out and the data were extracted for statistical analysis.By two peers in the case of not communicate each other again screening studies,extract information and evaluation in the risk of bias,the final end index for rate of diabetic foot ulcer wound healed completely,time needed for wound healed completely,wound efficiently,smaller wounds ulcer area difference,the wound granulation tissue began to appear time and adverse events.Meta-analysis of outcome indicators was all performed on Review Manager5.3 and Stata 16.RESULTS:Finally,a total of 29 randomized controlled studies(including 9 English literatures and 20 Chinese literatures)that met the inclusion and exclusion criteria were collected.The results of Meta-analysis showed that the EGF group had a significant increase in the complete healing rate of diabetic foot ulcer compared with the control group,which were 60.44%(492/814)and 39.17%(284/725)[RR=1.52,95%CI=(1.38,1.68),Z=8.25,P<0.00001] had significant clinical differences;The treatment period of EGF treatment group was shorter than that of the control group [MD=-12.16,95%CI=(-19.59,-4.74),Z=3.21,P=0.001].The wound effectiveness was also significantly improved by 92.63%(352/380)and 72.51%(269/371)[RR=1.26,95%CI=(1.18,1.35,Z=6.64),P<0.00001]In terms of the difference of wound area before and after treatment,the difference of wound area in the EGF treatment group was statistically larger [MD=2.48,95%CI=(2.15,2.80),Z=14.83,P<0.00001];Granulation tissue appeared earlier in EGF group [MD=-3.20,95%CI=(-5.86,-0.53),Z=2.35,P=0.02].However,the EGF group had a higher frequency of shivering [RR=3.76,95%CI=(1.44,9.82),Z=2.71,P=0.007].CONCLUSION:On the basis of standard treatment,EGF therapy can improve the complete healing rate of diabetic foot ulcer wounds,shorten the healing time of wounds,reduce the ulcer area,and make the granulation tissue appear earlier than the control group,and the difference of adverse reactions(mainly shivering)is small,and the degree of adverse reactions is mild.It has been proved to be a kind of adjuvant therapy for diabetic foot ulcer with good clinical efficacy and high safety. |
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