同种异体富血小板对糖尿病足创面的愈合再生情况分析

Efficacy of allogeneic platelet-rich on healing and regeneration of diabetic foot wounds

目的探讨同种异体富血小板对糖尿病足创面的愈合再生情况的影响。方法选择2019年1月~2020年6月在本院接受治疗的糖尿病足溃疡患者86例进行研究。以随机数字表法将患者分为2组,每组各43例。对照组参照《中国糖尿病足诊治指南》均给予常规治疗,观察组在此基础上加以同种异体血库浓缩血小板富血小板凝胶(APG)治疗。比较2组患者临床疗效、一般情况、创面情况、炎症因子、血清中转化生长因子-β1(TGF-β1)、血管内皮生长因子(VEGF)、透明质酸(HA)水平。结果观察组患者总有效率为93.02%,高于对照组的76.73%(P<0.05)。观察组患者创面愈合时间(15.08±3.19 vs 17.38±4.02)d及住院时间(16.12±4.03 vs 18.27±5.11)d均较对照组更短(P<0.05)。治疗前两组hs-CRP(4.25±0.39 vs 4.10±0.41)mg/L、TNF-α(5.70±1.29 vs 5.81±1.33)μg/L、IL-6(96.38±24.02 vs 99.64±25.17)mg/L差异均无统计学意义(P>0.05),治疗后观察组hs-CRP(2.35±0.50 vs 2.83±0.44)mg/L、TNF-α(3.15±0.82 vs 4.02±1.07)μg/L、IL-6(50.82±18.54 vs 72.93±20.25)mg/L均低于对照组(P<0.05)。治疗前两组患者TGF-β1(5.66±1.25 vs 5.81±1.31)ng/L、VEGF(11.03±3.62 vs 10.83±3.72)μg/L及HA(71.19±20.84 vs 70.82±21.03)mg/L差异均无统计学意义(P>0.05)。治疗后观察组患者TGF-β1(17.29±4.09 vs 14.03±3.72)ng/L、VEGF(43.03±14.17 vs 37.04±11.05)及HA(177.96±39.08 vs 151.94±36.17)水平均高于对照组(P<0.05)。结论常规治疗基础上以同种异体血库浓缩血小板APG较单独使用常规治疗可有效提高糖尿病足创面疗效,缩短创面愈合时间及住院时间,其机制可能与降低炎症因子水平并提高TGF-β1、VEGF及HA有关。

Objective To investigate the effect of allogeneic platelet-rich on the healing and regeneration of diabetic foot wounds. Methods A total of 86 patients with diabetic foot ulcer treated in our hospital from January 2019 to June 2020 were selected for this study. They were divided into 2 groups by the random number table method, with 43 patients in each group. The control group was given conventional treatment according to the Guidelines for the Diagnosis and Treatment of Diabetic Foot in China, and the observation group was further treated with platelet-rich gel(APG) from the allogeneic blood bank.The clinical efficacy, general conditions, wound conditions, inflammatory factors, serum levels of transforming growth factor-β1(TGF-β1), vascular endothelial growth factor(VEGF) and hyaluronic acid(HA) were compared between the two groups. Results The total effective rate of patients in the observation group was 93.02%, higher than 76.73% in the control group(P<0.05). The wound healing time(15.08±3.19 vs 17.38±4.02) d and hospitalization time(16.12±4.03 vs 18.27±5.11) d in the observation group were shorter than those in the control group(P<0.05). Before treatment, there were no significant differences in hsCRP(4.25±0.39 vs 4.10±0.41) mg/L, TNF-α(5.70±1.29 vs 5.81±1.33) μ g/L and IL-6(96.38±24.02 vs 99.64±25.17) mg/L between the two groups(P>0.05). After treatment, hsCRP(2.35±0.50 vs 2.83±0.44) mg/L, TNF-α(3.15±0.82 vs 4.02±1.07) μ g/L and IL-6(50.82±18.54 vs 72.93±20.25) mg/L in the observation group were lower than those in the control group(P < 0.05). Before treatment, there were no significant differences in TGF-β 1(5.66±1.25 vs 5.81±1.31) ng/L, VEGF(11.03±3.62 vs 10.83±3.72) μ g/L and ha(71.19±20.84 vs 70.82±21.03) mg/L between the two groups(P>0.05). After treatment, the levels of TGF-β 1(17.29±4.09 vs 14.03±3.72) ng/L, VEGF(43.03±14.17 vs 37.04±11.05) and ha(177.96±39.08 vs 151.94±36.17) in the observation group were higher than those in the control group(P<0.05). Conclusion On the basis of conventional treatment, allogeneic blood bank concentrated platelet APG can effectively improve the curative effect of diabetic foot wound and shorten the wound healing time and hospitalization time. The mechanism may be related to reducing the level of inflammatory factors and increasing TGF-β 1, VEGF and HA.