浓缩生长因子和表皮生长因子在口颌面部软硬组织损伤修复领域的应用

Application of concentrated growth factor and epidermal growth factor in the field of oral and maxillofacial soft and hard tissue injury repair

背景:口颌面部为外形美的敏感部位,其损伤常同时累及软硬组织。浓缩生长因子及重组人表皮生长因子因能促进机体局部软硬组织损伤的修复与再生,成为近年来新兴的研究热点。目的:综述浓缩生长因子及重组人表皮生长因子在口颌面部软硬组织损伤修复领域的研究及应用进展,探讨目前研究的局限性以及将来二者联合应用的可能性。方法:以“CGF,concentrated growth factor,rhEGF,recombinant human epidermal growth factor,tissue regeneration”为英文检索词,以“浓缩生长因子、表皮生长因子、组织工程、组织再生、口颌面部”为中文检索词,在中国知网和PubMed数据库检索有关于浓缩生长因子、重组人表皮生长因子的相关文献,检索时限为2011-2021年。最终选用文献63篇进行分析。结果与结论:①文章对浓缩生长因子及重组人表皮生长因子各自的生物学特性及来源进行简要介绍,着重总结了二者分别促进与口颌面部软硬组织再生相关干细胞增殖分化的研究进展及临床应用现状,讨论了现阶段研究的局限性和未来可能的应用方向。②浓缩生长因子含有多种生长因子和CD34+细胞,可促进多种组织细胞,尤其是干细胞的生长、增殖、迁移和分化等生物学行为,在组织损伤修复中具有重要作用。③浓缩生长因子在种植手术、自体牙移植、颌骨囊肿切除术、膜龈手术、清创缝合术中有广泛应用,能缓解疼痛、减轻炎症、改善术后骨再生效果及美学效果。④重组人表皮生长因子在软组织、神经再生方面有很大发展空间,已证实重组人表皮生长因子可促进多种干细胞分化为神经元样细胞,也可诱导脂肪细胞分化为表皮细胞;多数临床研究提示重组人表皮生长因子可促进口腔溃疡愈合,减少瘢痕形成。⑤“浓缩生长因子+重组人表皮生长因子”联合脂肪干细胞等易于获取的干细胞,有定向形成口颌面部软硬组织的可能,未来或可填补因创伤、肿瘤切除手术等造成的深在口颌面部组织缺损,并促进损伤的神经修复、再生。⑥因此,尝试将“浓缩生长因子+重组人表皮生长因子”用于难治性口腔溃疡、牙周手术、牙种植术及口颌面部外伤手术的治疗也是改善口颌面部功能及外形美的新思路。胶原海绵、壳聚糖膜等或可作为“浓缩生长因子+重组人表皮生长因子”的运载体,便于塑形,并可延长该复合材料的作用时限。

BACKGROUND:Oral and maxillofacial region is a sensitive part of beauty in appearance,and its damage often involves both soft and hard tissues.Concentrated growth factor and recombinant human epidermal growth factor can promote the repair and regeneration of local soft and hard tissue injury,which has become a new research hotspot in recent years.OBJECTIVE:To review the research progress and application of concentrated growth factor and recombinant human epidermal growth factor in the repair of soft and hard tissue injury in oral and maxillofacial region,and discuss the limitations of current research and the possibility of their combined application in the future.METHODS:The English search terms were“CGF,concentrated growth factor,rhEGF,recombinant human epidermal growth factor,tissue regeneration”and the Chinese search terms were“concentrated growth factor,epidermal growth factor,tissue engineering,tissue regeneration,oral and maxillofacial region”.Relevant articles about concentrated growth factor and recombinant human epidermal growth factor were searched in CNKI and PubMed databases.The retrieval time was from 2011 to 2021.Finally,63 articles were selected.RESULTS AND CONCLUSION:(1)In this paper,the biological characteristics and sources of concentrated growth factor and recombinant human epidermal growth factor were briefly introduced.The research progress and clinical application status of concentrated growth factor and recombinant human epidermal growth factor in promoting the proliferation and differentiation of stem cells related to the regeneration of soft and hard tissues in oral and maxillofacial regions were emphatically summarized.The limitations of current research and possible application directions in the future were discussed.(2)Concentrated growth factor contains a variety of growth factors and CD34+cells,which can promote the growth,proliferation,migration and differentiation of a variety of tissue cells,especially stem cells,and play an important role in tissue injury repair.(3)Concentrated growth factor is widely used in implant surgery,autologous tooth transplantation,jaw cyst resection,gingival surgery,debridement and suture,which can relieve pain,reduce inflammation,and improve postoperative bone regeneration effect and aesthetic effect.(4)Recombinant human epidermal growth factor has a great development space in soft tissue and nerve regeneration.It has been proven that recombinant human epidermal growth factor can promote a variety of stem cells to differentiate into neuron-like cells,and also induce adipocytes to differentiate into epidermal cells.Most clinical studies suggest that recombinant human epidermal growth factor can promote healing of oral ulcers and reduce scar formation.(5)“Concentrated growth factor+recombinant human epidermal growth factor”combined with adipose-derived stem cells and other stem cells that can be easily obtained have the possibility of directional formation of oral and maxillofacial soft and hard tissue.In the future,it may fill the deep oral and maxillofacial tissue defects caused by trauma,tumor resection,and promote the repair and regeneration of damaged nerves.(6)Trying to use“concentrated growth factor+recombinant human epidermal growth factor”for refractory oral ulcers,periodontal surgery,dental implants,oral and maxillofacial trauma surgery is also a new way to improve oral and maxillofacial function and appearance.Collagen sponge and chitosan membrane may be used as carriers of“concentrated growth factor+recombinant human epidermal growth factor”to facilitate shaping and prolong the action time of the composite.