富血小板纤维蛋白对难愈合创面炎症反应的影响

Effect of Platelet-Rich Fibrin on Inflammatory Response in Refractory Wounds

目的:研究富血小板纤维蛋白(Platelet-Rich Fibrin,PRF)对难愈合创面炎症反应的影响。方法:将2020年9月至2022年12月承德医学院附属医院烧伤整形科确诊的难愈合创面患者,完全随机分为PRF组、对照组,每组各20例,入院后均进行创面清创碘伏消毒,PRF组创面外敷PRF,隔日换药;对照组无菌敷料包扎换药治疗。于治疗前、治疗后第7天和第14天留取创面组织,进行HE染色来观察创面病理学变化;抽取静脉血分别检测白细胞(White Blood Cell,WBC)、C反应蛋白(C-Reac-tive Protein,CRP)和降钙素原(Procalcitonin,PCT)水平变化;创面组织进行CD34免疫组织化学染色,观察治疗前后创面血管化情况;通过流式细胞术比较治疗前与治疗后第7天患者血液中CD4^(+)T细胞与CD8^(+)T细胞水平变化以及CD4^(+)T/CD8^(+)T比值。结果:两组患者在性别、年龄和入院前病程的比较,差异均无统计学意义(P>0.05)。HE染色显示,在治疗前,两组患者创面均可见大量炎症细胞浸润,可见少量血管;治疗后第7天,PRF组的炎性细胞浸润减少,血管新生,治疗后第14天,PRF组炎性细胞明显减少,上皮增生,出现新生的皮肤附属器。WBC、CRP、PCT水平,治疗前差异无统计学意义(P>0.05),在治疗后的第7天和第14天时,炎症指标均下降,并且两组差异有统计学意义(P<0.05)。在治疗后第7、14天,PRF组CD34阳性表达细胞多于对照组,新生血管较多,创面上皮化出现也早于对照组。治疗前两组患者CD4^(+)T细胞、CD8^(+)T细胞和CD4^(+)/CD8^(+)比值无统计学意义(P>0.05);在治疗后第7天,两组患者的CD4^(+)T和CD4^(+)/CD8^(+)比值细胞均有上升,CD8^(+)T细胞均有下降,两组患者CD4^(+)T细胞、CD8^(+)T细胞及CD4^(+)/CD8^(+)比值比较具有统计学差异(P<0.05)。结论:PRF应用于难愈合创面,能减轻创面炎症反应,改善创面血液循环和免疫功能。

Objective:To investigate the effect of platelet-rich fibrin(PRF)on inflammatory response in refractory wounds.Methods:From September 2020 to December 2022,40 patients with refractory wounds diagnosed in the Department of Burns and Plastic Surgery of the Affiliated Hospital of Chengde Medical Uni-versity were randomly divided into the PRF group and the control group,with 20 cases in each group.After admission,all patients underwent wound debridement and iodine disinfection.The PRF group was treated with PRF on the wound surface,and the dressing was changed every other day.The control group was treated with sterile dressing change.Wound tissue was collected before treatment,on the 7th and 14th day after treatment for HE staining to observe the pathological changes of the wound.Venous blood was drawn to detect the chan-ges of white blood cell(WBC),C-reactive protein(CRP),and procalcitonin(PCT)levels.Immunohisto-chemical staining of CD34 was performed on the wound tissue to observe the vascularization of the wound be-fore and after treatment.Flow cytometry was used to compare the changes of CD4^(+)T cells and CD8^(+)T cells in the blood of patients before and on the 7th day after treatment,as well as the CD4^(+)T/CD8^(+)T ratio.Results:There was no statistically significant difference in gender,age and course of disease before admission between the two groups(P>0.05).HE staining showed that before treatment,there was a large number of inflammato-ry cell infiltration and a small number of vessels in the wounds of both groups.On the 7th day after treatment,the inflammatory cell infiltration in the PRF group was reduced,and new vessels were formed.On the 14th day after treatment,the inflammatory cells in the PRF group were significantly reduced,the epithelium prolif-erated,and new skin appendages appeared.There was no statistically significant difference in WBC,CRP,and PCT levels before treatment(P>0.05).On the 7th and 14th day after treatment,the inflammatory indi-cators all decreased,and the differences between the two groups were statistically significant(P<0.05).On the 7th and 14th day after treatment,the number of CD34 positive cells in the PRF group was more than that in the control group,and the number of new vessels was more.The epithelialization of the wound also ap-peared earlier than that in the control group.There was no statistically significant difference in CD4^(+)T cells,CD8^(+)T cells,and CD4^(+)/CD8^(+)ratio between the two groups before treatment(P>0.05).On the 7th day after treatment,the CD4^(+)T and CD4^(+)/CD8^(+)ratio cells in both groups increased,and the CD8^(+)T cells decreased.There were statistically significant differences in CD4^(+)T cells,CD8^(+)T cells,and CD4^(+)/CD8^(+)ratio between the two groups(P<0.05).Conclusion:PRF can reduce inflammatory response,improve blood circulation and immune function in refractory wounds.