胡丽,皮银珍,胡韵婷,王环君,赵晋晋
HU Li,PI Yinzhen,HU Yunting,WANG Huanjun,ZHAO Jinjin

• 1:长沙市第一医院内分泌代谢科

摘要(Abstract)：

目的:探讨自体富血小板凝胶(APRG)治疗难治性糖尿病足溃疡的疗效及其作用机制。方法:90例难治性糖尿病足溃疡患者随机均分为对照组(常规创面治疗,n=45)和观察组(常规创面联合APRG治疗,n=45),均治疗28 d;收集2组患者入院时基础资料和血液常规生化指标;于治疗前和治疗28 d后分别抽取2组患者空腹静脉血5 m L,采用酶联免疫吸附测定(ELISA)法测定血清肿瘤坏死因子-α(TNF-α)、白细胞介素-1(IL-1)、血管内皮生长因子(VEGF)、表皮生长因子(EGF)水平;采用中国糖尿病足防治指南(2019版)标准评价2组患者治疗结束时的治疗效果。结果:2组患者治疗后血清TNF-α和IL-1水平均分别低于治疗前,且观察组低于对照组(P <0. 05); 2组患者治疗后血清VEGF和EGF水平均分别高于治疗前,且观察组高于对照组(P <0. 05);观察组患者治疗后总有效率(88. 89%)高于对照组(71. 11%),差异有统计学意义(χ~2=4. 444,P=0. 035)。结论:APRG可有效治疗难治性糖尿病足溃疡,其治疗机制可能与降低炎症因子水平、促进表皮生长有关。
Objective: To investigate the efficacy and mechanism of autologous platelet rich gel( APRG) in the treatment of refractory diabetic foot ulcers. Methods: Ninety patients with refractory diabetic foot ulcers were randomly divided into the control group( conventional wound therapy,n =45) and the observation group( conventional wound treatment combined with APRG,n = 45). Both groups were treated for 28 d. The basic data and clinical routine biochemical indexes were collected.Before and 28 d after treatment,5 m L of fasting venous blood was collected from the two groups,and the levels of TNF-α,IL-1,VEGF,and EGF were measured by enzyme-linked immunosorbent assay( ELISA). The curative effect of the two therapies in the end of treatment was evaluated by the Chinese Diabetes Foot Prevention and Treatment Guidelines( 2019). Results: After treatment,the serum TNF-α and IL-1 levels in the two groups were lower than those before treatment,and those in the observation group were lower than those in the control group( P < 0. 05); And the serum VEGF and EGF levels in the two groups were higher than those before treatment,and those in the observation group were higher than those in the control group( P < 0. 05); The total effective rate of the observation group after treatment( 88. 89%) was higher than that in the control group( 71. 11%),and the difference was statistically significant( χ~2= 4. 444,P = 0. 035). Conclusion: APRG can effectively treat refractory diabetic foot ulcers,and its mechanism is related to reducing inflammatory factors and promoting epidermal growth.

关键词(KeyWords)： 糖尿病;足溃疡;表皮生长因子;难治性;自体富血小板凝胶;炎症因子;作用机制
diabetes mellitus;foot ulcer;epidermal growth factor(EGF);refractory;autologous platelet rich gel(APRG);inflammatory factors;mechanism of action

Abstract:

Keywords:

基金项目(Foundation): 湖南省卫生计生委科研计划课题项目(B2016158);; 长沙市科技计划项目(kq1907017)

作者(Author): 胡丽,皮银珍,胡韵婷,王环君,赵晋晋
HU Li,PI Yinzhen,HU Yunting,WANG Huanjun,ZHAO Jinjin

DOI: 10.19367/j.cnki.2096-8388.2020.12.019

参考文献(References)：

• [1]宋渊，刘涛，何志军，等．糖尿病足溃疡治疗研究进展[J]．中国老年学杂志，2019,39(18):4612-4616.
• [2] EVERETT E,MATHIOUDAKIS N. Update on management of diabetic foot ulcers[J]. Annals of the New york Academy of Sciences,2018,1411(1):153-165.
• [3]程玉霞，赵凤卉，朱平，等．复发性糖尿病足溃疡的危险因素分析[J]．北京医学，2019,41(11):1024-1027.
• [4]LI Y,GAO Y Y,GAO Y,et al. Autologous platelet-rich gel treatment for diabetic chronic cutaneous ulcers:a meta-analysis of randomized controlled trials[J]. Journal of Diabetes,2019,11(5):359-369.
• [5]李炳辉，邹利军，李恭驰，等．2018年糖尿病足基础及临床研究进展[J]．感染、炎症、修复，2019,20(1):27-31.
• [6]李学靖，晏利姣，张小艳，等．加拿大安大略护士协会2013年第2版《糖尿病足部溃疡患者的评估与管理》指南解读[J]．中华现代护理杂志，2018,24(27):3228-3232.
• [7]杨景军，陈航，魏子人，等．自体富血小板凝胶在老年烧伤患者整复治疗中对创面愈合及肉芽组织特异性蛋白表达的影响[J]．中国美容医学，2019,28(12):83-87.
• [8]王富军．中国糖尿病足防治指南(2019版)解读[J]．河北医科大学学报，2019,40(11):1241-1245,1250.
• [9]邱锦媚．Wagner分级糖尿病足的护理研究进展[J]．护理实践与研究，2019,16(22):49-51.
• [10]万仁辉，鲁瑾．2型糖尿病大血管并发症的影响因素[J]．第二军医大学学报，2020,41(1):75-80.
• [11]SEMADI N I. The role of VEGF and TNF-Alpha on epithelialization of diabetic foot ulcers after hyperbaric oxygen therapy[J]. Open Access Macedonian Journal of Medical Science,2019,7(19):3177-3183.
• [12]BOLTON L. Managing patients with diabetic foot ulcers[J]. Wounds,2018,30(12):380-381.
• [13]胡艳红，沈世琴，向勤，等．糖尿病足溃疡感染诊断与局部治疗的研究进展[J]．中华全科医师杂志，2016,15(5):395-398.
• [14]PICCIN A,DIPIERRO A M,CANZIAN L,et al. Platelet gel:a new therapeutic tool with great potential[J]. Blood Transfusion,2017,15(4):333-340.
• [15]修一平，张丽艳，钱学义，等．自体富血小板血浆修复慢性难愈性创面的作用:回顾性研究和文献检索证据分析[J]．中国组织工程研究，2020,24(8):1231-1237.
• [16]赖青孙，李锦华，王承辉．自体富血小板凝胶对糖尿病足溃疡创面愈合、疼痛及瘙痒的影响[J]．贵州医药，2018,42(6):703-705.
• [17]FEDYAKOVA E,PINO A,KOGAN L,et al. An autologous protein gel for soft tissue augmentation:in vitro characterization and clinical evaluation[J]. Journal of Cosmetic Dermatology,2019,18(3):762-772.
• [18]RAINVS D,CEPAS A,DAMBRAUSKAITE K,et al. Effectiveness of autologous platelet-rich plasma gel in the treatment of hard-to-heal leg ulcers:a randomised control trial[J]. Journal of Wound Care,2019,28(10):658-667.
• [19]刘风．自体富血小板凝胶治疗糖尿病皮肤慢性难愈合创面的机制及临床应用进展[J]．重庆医学，2017,46(6):848-850,864.
• [20]卫东，杜丽萍，张家建．封闭负压引流联合生物敷料对糖尿病足溃疡创面植皮后血管新生、炎症反应的影响[J]．海南医学院学报，2017,23(15):2071-2074.
• [21]汪涛，赵珺，于敏，等．负压吸引疗法通过减轻炎症反应促进糖尿病足溃疡愈合[J]．上海交通大学学报(医学版)，2016,36(8):1159-1164.
• [22]CHANG N J,ERDENEKHUYAG Y,CHOU P H,et al.Therapeutic effects of the addition of platelet-rich plasma to bioimplants and early rehabilitation exercise on articular cartilage repair[J]. American Journal of Sports Medicine,2018,46(9):2232-2241.
• [23]吴曼．自体富血小板凝胶治疗难治性糖尿病皮肤溃疡的疗效及对血清炎症因子的影响[J]．实用临床医药杂志，2018,22(5):6-28,31.
• [24]邬佳敏，王达利，贺钧，等．难愈创面局部注射自体富血小板血浆临床观察[J]．贵州医药，2019,43(5):749-750.
• [25]方颖，曹东升，谢娟，等．富血小板凝胶在兔糖尿病溃疡模型中的研究[J]．安徽医科大学学报，2019,54(11):1831-1834.
• [26]周丽华，陈清华，陈宗存，等．自体富血小板凝胶联合封闭式负压引流术治疗糖尿病足溃疡的效果观察[J]．中国医学前沿杂志(电子版)，2017,9(6):131-134.
• [27]袁园，张潇，邵菊，等．富血小板血浆对小鼠下肢缺血血管生成的作用研究[J]．重庆医学，2019,48(2):24-27.
• [28]杨思思，肖承志．自体富血小板血浆对烧伤创面治疗影响的研究进展[J]．中华烧伤杂志，2018,34(12):910-913.
• [29]阴彩琴，王敏．自体富血小板凝胶治疗难治性糖尿病足60例临床研究[J]．中国药物与临床，2019,19(18):3154-3155.
• [30]付鹏，冯佳丽，苗婷，等．自体富血小板凝胶治疗对糖尿病足溃疡患者修复效果及生活质量的影响[J]．解放军预防医学杂志，2018,36(7):858-861.
• [31]刘贯英，邓晓龙，王敏哲，等．自体富血小板凝胶在糖尿病足中的作用机制与应用[J]．医学研究杂志，2015,44(9):4-6,56.

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