中华损伤与修复杂志（电子版）
中華損傷與脩複雜誌（電子版）
중화손상여수복잡지（전자판）
Chinese Journal of Injury Repair and Wound Healing
2012年
2期
44-48
,共5页
丁伟佳%胡检%罗莞超%江乐文%陈茵
丁偉佳%鬍檢%囉莞超%江樂文%陳茵
정위가%호검%라완초%강악문%진인
富血小板血浆%静脉曲张溃疡%细胞因子类
富血小闆血漿%靜脈麯張潰瘍%細胞因子類
부혈소판혈장%정맥곡장궤양%세포인자류
Platelet-rich plama%Varicose ulcer%Cytokine
目的 评价自制自体富血小板凝胶(APG)局部治疗静脉性溃疡的临床疗效并初步探讨其作用机制.方法 筛选深圳市龙岗中心医院及协作单位收治的静脉性溃疡患者76例,入院经标准化治疗2周后随机分为两组,治疗组40例,对照组36例,两组患者的年龄、性别和病程比较差异均无统计学意义(P＞0.05).治疗组每2周于溃疡创面局部使用以自体外周静脉血制备的APG,传统方法换药；两组均观察至创面愈合.自治疗开始后每周1次测量创面面积,连续5周,并计算溃疡创面愈合率；对照组单纯按照传统方法换药.记录两组创面愈合时间；测定创面组织液中转化生长因子-βl、血小板源性生长因子-BB、表皮生长因子水平；在测量创面面积同时做溃疡组织活检,以histopathological criteria评分行组织病理学分析.结果治疗组创面愈合时间为(38.69±5.72)d,较对照组的(50.17±4.94)d明显缩短(P=0.0339).治疗组与对照组在第1、2、3、4、5周时间点创面愈合率相比明显增加[分别为(64.61±2.31)％ vs(40.24±1.73)％.P=0.0179;(77.24±2.16)％ vs(50.84±1.71)％,P=0.0108；(84.24±1.98)％vs(63.74±1.28)％,P=0.0217;(91.38±1.74)％vs(76.24±1.81)％,P=0.0029；(98.45±1.21)％ vs(82.35±1.78)％,P=0.0205].治疗组组织病理学评分亦明显高于对照组,创面组织中除表皮生长因子外,血小板源性生长因子-BB及转化生长因子-β1水平均明显高于对照组.结论APG能明显促进静脉性溃疡创面愈合,其机制可能与APG增加创面局部生长因子水平,调控创面细胞的增殖、分化以及炎症的消退相关.
目的 評價自製自體富血小闆凝膠(APG)跼部治療靜脈性潰瘍的臨床療效併初步探討其作用機製.方法 篩選深圳市龍崗中心醫院及協作單位收治的靜脈性潰瘍患者76例,入院經標準化治療2週後隨機分為兩組,治療組40例,對照組36例,兩組患者的年齡、性彆和病程比較差異均無統計學意義(P＞0.05).治療組每2週于潰瘍創麵跼部使用以自體外週靜脈血製備的APG,傳統方法換藥；兩組均觀察至創麵愈閤.自治療開始後每週1次測量創麵麵積,連續5週,併計算潰瘍創麵愈閤率；對照組單純按照傳統方法換藥.記錄兩組創麵愈閤時間；測定創麵組織液中轉化生長因子-βl、血小闆源性生長因子-BB、錶皮生長因子水平；在測量創麵麵積同時做潰瘍組織活檢,以histopathological criteria評分行組織病理學分析.結果治療組創麵愈閤時間為(38.69±5.72)d,較對照組的(50.17±4.94)d明顯縮短(P=0.0339).治療組與對照組在第1、2、3、4、5週時間點創麵愈閤率相比明顯增加[分彆為(64.61±2.31)％ vs(40.24±1.73)％.P=0.0179;(77.24±2.16)％ vs(50.84±1.71)％,P=0.0108；(84.24±1.98)％vs(63.74±1.28)％,P=0.0217;(91.38±1.74)％vs(76.24±1.81)％,P=0.0029；(98.45±1.21)％ vs(82.35±1.78)％,P=0.0205].治療組組織病理學評分亦明顯高于對照組,創麵組織中除錶皮生長因子外,血小闆源性生長因子-BB及轉化生長因子-β1水平均明顯高于對照組.結論APG能明顯促進靜脈性潰瘍創麵愈閤,其機製可能與APG增加創麵跼部生長因子水平,調控創麵細胞的增殖、分化以及炎癥的消退相關.
목적 평개자제자체부혈소판응효(APG)국부치료정맥성궤양적림상료효병초보탐토기작용궤제.방법 사선심수시룡강중심의원급협작단위수치적정맥성궤양환자76례,입원경표준화치료2주후수궤분위량조,치료조40례,대조조36례,량조환자적년령、성별화병정비교차이균무통계학의의(P＞0.05).치료조매2주우궤양창면국부사용이자체외주정맥혈제비적APG,전통방법환약；량조균관찰지창면유합.자치료개시후매주1차측량창면면적,련속5주,병계산궤양창면유합솔；대조조단순안조전통방법환약.기록량조창면유합시간；측정창면조직액중전화생장인자-βl、혈소판원성생장인자-BB、표피생장인자수평；재측량창면면적동시주궤양조직활검,이histopathological criteria평분행조직병이학분석.결과치료조창면유합시간위(38.69±5.72)d,교대조조적(50.17±4.94)d명현축단(P=0.0339).치료조여대조조재제1、2、3、4、5주시간점창면유합솔상비명현증가[분별위(64.61±2.31)％ vs(40.24±1.73)％.P=0.0179;(77.24±2.16)％ vs(50.84±1.71)％,P=0.0108；(84.24±1.98)％vs(63.74±1.28)％,P=0.0217;(91.38±1.74)％vs(76.24±1.81)％,P=0.0029；(98.45±1.21)％ vs(82.35±1.78)％,P=0.0205].치료조조직병이학평분역명현고우대조조,창면조직중제표피생장인자외,혈소판원성생장인자-BB급전화생장인자-β1수평균명현고우대조조.결론APG능명현촉진정맥성궤양창면유합,기궤제가능여APG증가창면국부생장인자수평,조공창면세포적증식、분화이급염증적소퇴상관.
Objective To evaluate the clinical effects of local treatment of autologous platelet-rich gel (APG) for venous ulcers and to explore its mechanism of actions.Methods Seventy-six patients with venous ulcers screened out in the authors' hospital and other cooperative units were randomly divided into a treatment group of 40 cases and a control group of 36 cases after two weeks of standard hospitalized treatment,with no significant difference in age,gender or course of disease between them.APG made from peripheral venous blood was administered on local ulcers of the treatment group biweekly whereas traditional dressing was applied to the control group until the ulcers were healed in both groups.The ulcer areas were measured,their healing rates were calculated,their healing time was recorded,and the levels of transforming growth factor -β1,latelet-derived growth factor and epidermal growth factor in the ulcer fluid were measured weekly from the start of the treatment for five consecutive weeks.Ulcer biopsy was made on all patients while their ulcer areas being measured for pathological analysis by the score lines of the histopathological criteria.Results The healing time in treatment group was (38 ± 5.72) days,and was significantly shorter than that in control group,which was (50 ± 4.94) days ( P =0.0339).Compared with those in control group,the healing rates of ulcers in treatment group were increased greatly at each time point of the 1 st,2nd,3rd,4th and5thweek [(64.61 ±2.31)％ vs (40.24±1.73)％,P=0.0179; (77.24±2.16)％ vs (50.84±1.71)％,P=0.0108; (84.24 ±1.98) vs (63.74 ±1.28)％,P=0.0217; (91.38 ±1.74) vs (76.24 ±1.81 ) ％,P =0.0029 ; (98.45 ± 1.21 ) ％ vs ( 82.35 ± 1.78 ) ％,P =0.0205 ].In addition to epidermal growth factor,the levels of platelet-derived growth factor-BB and transforming growth factor-β1 and the histopathological scores were also significantly higher than those of the control group.Conclusions APG can significantly promote the healing of venous ulcers,the mechanism of which may be relevant to APG' s increase of local growth factors and its control of cell proliferation and differentiation and inflammation subsiding in ulcers.
