PRP联合β受体阻滞剂治疗糖尿病足溃疡疗效及对血管新生、炎症反应的影响

Effect of PRP combined withβreceptor blockers on diabetes foot ulcer and its influence on angiogenesis and inflammatory reaction

目的:研究自体富血小板血浆(Plate rich plasm,PRP)联合β受体阻滞剂治疗糖尿病足溃疡疗效。方法:选取2020年3月至2022年9月我院收治的96例糖尿病足溃疡患者,采用随机数字表法分为对照组和联合组(n=48)。对照组给予PRP治疗(氯化钙溶液溶解凝血酶散与PRP依照1:10的比例混合,形成凝胶覆盖创面,每7 d更换1次,共治疗4 w);联合组采用PRP联合噻吗洛尔(每平方厘米的创面滴1滴噻吗洛尔滴眼液,共治疗4 w)治疗。治疗前、治疗4 w后以彩色多普勒超声诊断仪测定两组足背动脉血流指标,以酶联免疫吸附法测定血清肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)、白细胞介素-6(Interleukin-6,IL-6)、S100钙结合蛋白A8(S100 calcium binding protein A8,S100A8)、Toll样受体9(Toll like receptor 9,TLR9),以及血清碱性成纤维生长因子(Basic fibroblast growth factor,bFGF)、血管内皮生长因子(Vascular endothelial growth factor,VEGF)、内皮抑素(Endostatin,ES)水平,同时记录并比较两组临床疗效、创面愈合情况。结果:联合组临床总有效率明显高于对照组(P<0.05);联合组创面愈合时间短于对照组(P<0.05);治疗后联合组TNF-α、ES、IL-6、S100A8、TLR9水平较对照组低,bFGF、VEGF水平、足背动脉血流指标较对照组高(P<0.05)。结论:PRP联合β受体阻滞剂治疗糖尿病足溃疡疗效显著,可减轻局部炎症反应,促进血管新生,改善足背血流供应,加速溃疡愈合。

Objective:To study the effect of the combination of autologous platelet-rich plasma(PRP)andβreceptor blockers on a diabetic foot ulcer.Methods:A total of 96 patients with diabetic foot ulcers admitted to our hospital from March 2020 to September 2022 were selected and randomly divided into the control group and the combined group(n=48).The control group was treated with PRP(calcium chloride solution dissolved thrombin powder was mixed with PRP in a ratio of 1:10 to form a gel to cover the wound,which was replaced every 7 days for 4 weeks).The combined group was treated with PRP combined with timolol(1 drop of timolol eye drops per square centimeter of the wound surface,for 4 weeks).The blood flow index of the dorsalis pedis artery of the two groups was measured by color Doppler ultrasound before and after treatment,and the serum inflammatory mediator levels,including tumor necrosis factor-α(TNF-α),Interleukin-6(IL-6),S100 calcium-binding protein A8(S100A8),Toll-like receptor 9(TLR9),and serum angiogenesis-related indicators,such as basic fibroblast growth factor(bFGF),vascular endothelial growth factor(VEGF),and endostatin(ES)were measured by enzyme-linked immunosorbent assay.Meanwhile,the clinical efficacy and wound healing of the two groups were recorded and compared.Results:The total clinical effective rate of the combined group was notably higher than that of the control group(P<0.05).The wound healing time of the combined group was shorter than that of the control group.Post-treatment,the levels of TNF-α,ES,IL-6,S100A8,and TLR9 in the combined group were lower than those in the control group,while the levels of bFGF,VEGF,and blood flow index of dorsal foot artery were higher than those in the control group(P<0.05).Conclusion:PRP combination withβreceptor blockers are effective in the treatment of diabetic foot ulcers,which can reduce the local inflammatory reaction,promote angiogenesis,improve the blood supply of the foot dorsum,and accelerate ulcer healing.