自体富血小板凝胶联合负压封闭引流术治疗糖尿病足溃疡的临床研究

Autologous Platelet-rich Gel Combined with Vacuum Sealing Drainage in the Treatment of Diabetic Foot Ulcers

目的探究自体富血小板凝胶(APG)联合负压封闭引流术(VSD)应用于糖尿病足溃疡的有效性及安全性。方法选取2014年5月~2016年7月冀中能源邢台矿业集团有限责任公司总医院住院治疗的98例糖尿病足溃疡患者,按照随机数表法分为对照组和观察组,每组各49例。两组均进行糖尿病足的基础治疗,对照组加用VSD治疗,观察组采用VSD联合APG治疗。对比两组临床疗效、溃疡愈合时间及肉芽组织内血管内皮生长因子(VEGF)、碱性成纤维细胞生长因子(bFGF)等的表达水平;记录两组治疗过程中的不良反应发生情况。结果观察组的治疗有效率高于对照组(P<0.05);观察组溃疡愈合时间比对照组短(P<0.001);两组治疗前创面肉芽组织VEGF、bFGF水平比较差异无统计学意义(P>0.05);治疗后各时间段两组VEGF、bFGF水平均明显升高,且观察组高于对照组(P<0.001);观察组并发症发生率低于对照组(P<0.05)。结论APG联合VSD治疗糖尿病足溃疡,临床效果明确,可促进肉芽组织及新血管的生成,减少愈合时间,安全可靠。

Objective To investigate the efficacy and safety of autologous platelet-rich gel( APG) combined with vacuum sealing drainage( VSD) in the treatment of diabetic foot ulcers. Methods 98 patients with diabetic foot ulcers were selected in General Hospital of Xingtai Mining Group Co.,Ltd of Jizhong Energy from May 2014 to July 2016. The patients were randomly divided into the control group and the observation group according to the random number table,49 cases in each group. All patients received conventional treatment for diabetic foot. The control group was additionally treated with VSD. The observation group was additionally treated with VSD and APG. The clinical efficacy,ulcer healing time and the levels of vascular endothelial growth factor( VEGF) and basic fibroblast growth factor( b FGF) in granulation tissue were compared between the two groups. The adverse reactions during treatment were recorded. Results The overall response rate in the observation group was significantly higher than that in the control group( P < 0. 05). The ulcer healing time in the observation group was significantly shorter than that in the control group( P < 0. 001).There were no significant differences in the levels of VEGF and b FGF in granulation tissue between the two groups before treatment( P > 0. 05). The levels of VEGF and b FGF were significantly increased in the two groups after treatment,and were significantly higher in the observation group than those in the control group( P < 0. 001). The incidence of complications was significantly lower in the observation group than that in the control group( P < 0. 05). Conclusion APG combined with VSD might be effective and safe in the treatment of diabetic foot ulcers. It can promote the formation of granulation tissue and new blood vessels,and reduce healing time.