Platelet rich fibrin is not a barrier membrane!Or is it?

Platelet-rich fibrin(PRF)is widely used in dentistry and other fields of medicine,and its use has become popular in dental implantology.In several published studies,PRF has been used as a barrier membrane.A barrier membrane is a sheet of a certain material that acts as a biological and mechanical barrier against the invasion of cells that are not involved in bone formation,such as epithelial cells.Among the basic requirements of a'barrier membrane,occlusivity,stiffness,and space maintenance are the criteria that PRF primarily lacks;therefore,it does not fall under the category of barrier membranes.However,there is evidence that PRF membranes are useful in significantly improving wound healing.Does the PRF membrane act as a barrier?Should we think of adding or subtracting some points from the ideal requirements of a barrier membrane,or should we coin a new term or concept for PRF that will incorporate some features of a barrier membrane and be a combination of tissue engineering and biotechnology?This review is aimed at answering the basic question of whether the PRF membrane should be considered a barrier membrane or whether it is something more beyond the boundaries of a barrier membrane.

The Role of Leukocyte and Platelet-Rich Fibrin in Enhancing the Healing of Extraction Sockets: An Overview of the Literature

Introduction: Leukocyte and platelet-rich fibrin (L-PRF) is an emerging material in dentistry, however, there are controversies surrounding its effectiveness. Despite the amount of literature available, debates regarding its effect continue. This review aims to summarize and clarify the data surrounding the use of L-PRF in promoting the healing of extraction sockets, which may offer a better outcome for future treatments. Purpose: The purpose of this review is to evaluate the current literature on the use of L-PRF in promoting the healing of extraction sockets, and to provide a comprehensive overview of the available evidence. Methods: A comprehensive computer-based search of databases such as PubMed, Medline, and Cochrane Library was conducted. Results: The results of this review suggest that L-PRF has shown promise in promoting early healing of extraction sockets, but the evidence for its effectiveness over a longer period is limited. Conclusion: Although L-PRF has shown promising results in the early healing periods, its effectiveness over a longer healing period cannot be confirmed based on the available data. More clinical trials with standardized protocols and consistent measurement methods are needed to establish the role of L-PRF in enhancing the healing of extraction sockets.

Evaluating the Benefits of Platelet Rich-Fibrin in Periodontal Regeneration: A Literature Review

Introduction: Platelet Rich-Fibrin (PRF) is a biological matrix derived from a patient’s own blood, rich in growth factors and platelets. Its use in various periodontal and non-periodontal procedures is gaining recognition due to its potential in promoting tissue regeneration. The purpose of this review was to evaluate the benefits of using PRF in intra-bony defect regeneration, guided-bone regeneration, and sinus floor elevation. Methods: The study searched PubMed for manuscripts published between 2017 and 2022 to better understand the clinical and radiological effects of PRF. The manuscripts were divided into the following sections: intra-bony defect regeneration, guided-bone regeneration, and sinus floor elevation. Results: In intra-bony defects, PRF improved clinical and radiological parameters when compared with OFD alone, with a significant difference in wound healing at 7 days. In GBR, a CBCT evaluation shows no statistical difference between the PRF-autogenous bone complex group and the bovine bone-collagen membrane complex regarding volume change of the augmented bone with a 16% rate of bone loss following a 6-month healing period. Also, a slight increase in bone thickness has been seen when liquid PRF is used. In sinus floor elevation, results revealed no differences in graft volume between PRF group and control group at any of the evaluated time points. Although higher implant stability immediately postoperatively, higher new bone formation, the lesser amount of residual graft and earlier implant placement. Conclusion: Platelet Rich-Fibrin is widely accepted for use in periodontal surgery and dentistry due to its minimally invasive nature and low risk of adverse effects, with positive results in tissue regeneration. There is evidence that PRF leads to improved and faster healing, as well as cost-effective regenerative procedures compared to other treatments.

Platelet-rich fibrin-induced bone marrow mesenchymal stem cell differentiation into osteoblast-like cells and neural cells

Bone marrow mesenchymal stem cells were allowed to develop for 14 days in a platelet-rich fibrin environment.Results demonstrated that platelet-rich fibrin significantly promoted bone marrow mesenchymal stem cell proliferation.In addition,there was a dose-dependent increase in Runt-related transcription factor-2 and bone morphogenetic protein-2 mRNA expression,as well as neuron-specific enolase and glial acidic protein.Results showed that platelet-rich fibrin promoted bone marrow mesenchymal stem cell proliferation and differentiation of osteoblast-like cells and neural cells in a dose-dependent manner.

Flapless immediate implant placement into fresh molar extraction socket using platelet-rich fibrin: A case report

BACKGROUND There are some challenges concerning immediate implant placement in the molar region.Platelet-rich fibrin(PRF),an autologous biomaterial,has been used widely for periodontal intra-bony defects,sinus augmentation,socket preservation,and gingival recession.However,the literature remains scarce for reports on immediate implants with PRF,particularly in the case of fresh molar extraction socket.CASE SUMMARY The patient was a 43-year-old woman with maxillary molar vertical crown-root fracture.She underwent flapless immediate implant placement into the fresh molar socket with PRF.At the follow-up visit 15 d post procedure,the vascularization of soft tissue was visible.There was no swelling or pain after the surgery.Six months postoperatively,the regeneration of bone and soft tissues was visible.Subsequently,the definitive restoration was placed.The patient was satisfied with the aesthetic outcomes.CONCLUSION The flapless immediate implant placement into the fresh molar socket with PRF is a feasible procedure.This case report demonstrates that PRF promotes bone and soft tissue regeneration apart from having an enhanced anti-inflammatory ability.Furthermore,the procedure involves a minimally invasive technique,thus reducing the surgical complexity.

Early therapeutic effect of platelet-rich fibrin combined with allogeneic bone marrow-derived stem cells on rats’ critical-sized mandibular defects

BACKGROUND Critically sized bone defects represent a significant challenge to orthopaedic surgeons worldwide.These defects generally result from severe trauma or resection of a whole large tumour.Autologous bone grafts are the current gold standard for the reconstruction of such defects.However,due to increased patient morbidity and the need for a second operative site,other lines of treatment should be introduced.To find alternative unconventional therapies to manage such defects,bone tissue engineering using a combination of suitable bioactive factors,cells,and biocompatible scaffolds offers a promising new approach for bone regeneration.AIM To evaluate the healing capacity of platelet-rich fibrin(PRF)membranes seeded with allogeneic mesenchymal bone marrow-derived stem cells(BMSCs)on critically sized mandibular defects in a rat model.METHODS Sixty-three Sprague Dawley rats were subjected to bilateral bone defects of critical size in the mandibles created by a 5-mm diameter trephine bur.Rats were allocated to three equal groups of 21 rats each.Group I bone defects were irrigated with normal saline and designed as negative controls.Defects of group II were grafted with PRF membranes and served as positive controls,while defects of group III were grafted with PRF membranes seeded with allogeneic BMSCs.Seven rats from each group were killed at 1,2 and 4 wk.The mandibles were dissected and prepared for routine haematoxylin and eosin(HE)staining,Masson's trichrome staining and CD68 immunohistochemical staining.RESULTS Four weeks postoperatively,the percentage area of newly formed bone was significantly higher in group III(0.88±0.02)than in groups I(0.02±0.00)and II(0.60±0.02).The amount of granulation tissue formation was lower in group III(0.12±0.02)than in groups I(0.20±0.02)and II(0.40±0.02).The number of inflammatory cells was lower in group III(0.29±0.03)than in groups I(4.82±0.08)and II(3.09±0.07).CONCLUSION Bone regenerative quality of critically sized mandibular bone defects in rats was better promoted by PRF membranes seeded with BMSCs than with PRF membranes alone.

Autologous Adipose-Derived Mesenchymal Stem Cells Embedded in Platelet-Rich Fibrin in Diabetic Foot Ulcers

Context and Aim: Mesenchymal stem cells (MSCs) and platelet-rich fibrin (PRF) have emerged as ideal candidates for advanced therapies of various therapeutically-challenging diseases;however, their regenerative potential in diabetic foot ulcers (DFU) has not been well determined. In this study, we reviewed our clinical experience in mitigating chronic ulcer complications of diabetic foot through a conventional treatment of autologous adipose-derived MSCs embedded in PRF with pure PRF injections. Materials and Methods: The present study was carried out in 10 patients with an open DFU wound selected over a period of 1 year starting from April 2019. Patients were either injected with PRF alone (Group A) or injected with MSCs derived from adipose tissue (ADMSC) embedded in (PRF (Group B). Results: Patients in Group B had a better healing index when compared to Group A. Conclusion: Use of ADMSC embedded in PRF showed promising results to treat DFU.

富血小板纤维蛋白对难愈合创面炎症反应的影响

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。

自体富白细胞-血小板纤维蛋白凝胶与腘绳肌腱修复创伤性髌骨脱位

背景:临床上创伤性髌骨脱位合并内侧髌股韧带股骨止点或体部撕裂多采用内侧髌股韧带重建手术,为促进内侧髌股韧带重建术后的腱骨愈合,研究者采用了包括生长因子、干细胞、富血小板血浆在内的多种生物治疗技术。目的:探讨自体富白细胞-血小板纤维蛋白凝胶联合腘绳肌腱重建内侧髌股韧带修复创伤性髌骨脱位的临床疗效。方法:选择2019年2月至2021年2月秦皇岛市第一医院诊治的创伤性髌骨脱位患者37例,采用随机数字表法分为试验组(n=18)与对照组(n=19),试验组接受自体富白细胞-血小板纤维蛋白凝胶联合自体腘绳肌腱重建内侧髌股韧带手术,对照组接受单纯自体绳肌腱重建内侧髌股韧带手术。两组患者术后随访12个月,通过目测类比评分、Lysholm评分、Kujala髌股关节评分及膝关节活动度评估患者膝关节疼痛及功能状态,通过MRI及CT片测量髌股关节髌骨倾斜角、髌骨适合角及髌骨外移率,评估髌股关节的稳定性及改善情况。结果与结论:①两组术后6,12个月的目测类比评分均低于术前(P<0.05),术后6,12个月的Lysholm评分、Kujala髌股关节评分均高于术前(P<0.05);试验组术后6个月的Lysholm评分、Kujala髌股关节评分高于对照组(P<0.05),两组间术后12个月的目测类比评分、Lysholm评分、Kujala髌股关节评分比较差异无显著性意义(P>0.05);②两组术后12个月的髌股关节髌骨倾斜角、髌骨适合角、髌骨外移率及关节活动度测量值均较术前明显改善(P<0.05);试验组术后12个月的髌骨倾斜角小于对照组(P<0.05),两组间术后12个月的髌骨适合角、髌骨外移率及关节活动度及MRI评分比较差异无显著性意义(P>0.05);③结果表明,自体富白细胞-血小板纤维蛋白凝胶联合腘绳肌腱重建内侧髌股韧带能有效治疗创伤性髌骨脱位,改善膝关节功能,恢复髌骨的运动轨迹。

自体脂肪颗粒联合PRF移植填充矫治面部凹陷的效果及PRF对移植脂肪成活率的影响

目的:研究自体脂肪颗粒联合富血小板纤维蛋白(Platelet-rich fibrin,PRF)移植填充矫治面部凹陷的效果及PRF对移植脂肪成活率的影响。方法:选取2019年3月-2021年12月在笔者医院择期行脂肪颗粒移植填充手术的120例面部凹陷女性就医者,按照随机分组原则分为观察组和对照组,每组60例。两组均采取脂肪颗粒移植手术,观察组在移植自体脂肪颗手术基础上联合富血小板纤维蛋白治疗。术后6个月,比较两组移植脂肪的成活率及治疗效果。结果:观察组移植成活率显著高于对照组(P<0.05),且观察组治疗效果显著优于对照组(P<0.05);两组血肿情况、局部感染情况、坏死、脂肪液化、破溃、纤维囊肿发生情况比较,差异无统计学意义(P>0.05)。结论:自体脂肪颗粒移植联合PRF在面部凹陷填充中疗效确切,不仅提升了脂肪移植成活率,而且改善了面部凹陷情况,值得临床推广应用。

血浆基质在牙髓根尖周病治疗中的应用

血浆基质作为一种自体血液离心产物,具有再生修复的功能,已被广泛应用于口腔颌面部软硬组织再生修复、皮肤美容等领域,并取得了较好的效果。目前,牙髓再生治疗和根尖手术已成为保存牙髓以及保存患牙的主要方法,生物活性材料的应用至关重要,血浆基质作为一种自体生物活性材料,较易获取,可塑性强,具有天然优势。血浆基质可应用于以下情况:①无法刺激根尖出血的根尖孔未闭合年轻恒牙的牙髓血运重建术;②存在骨缺损的根尖屏障术及大面积穿孔髓室底或根侧壁修补术;③大面积根尖病变,伴或不伴随牙周疾病患牙的根尖手术。因血浆基质为自身血液来源制品,使用方面无明显禁忌。虽然已有系统综述表明,相比传统血凝块,血浆基质作为天然再生支架,可有效促进牙髓根尖周病的再生性修复。然而,由于血浆基质的特性受不同制备方式的影响,其适用范围有所差异。此外,目前尚缺乏血浆基质长期的临床研究结果,且组织学证据较难获取,仍然需要大量的体内外研究进一步探索。本文将对不同血浆基质在牙髓再生、根尖手术中的骨组织再生等方面的应用进行阐述,以期为临床医生在适应证选择及预后评估时提供参考。

“改良”上颌窦底提升

上颌后牙缺失时,由于缺乏牙的功能性刺激以及上颌窦气化作用导致种植所需的剩余骨高度不足,剩余骨量无法保证种植体的初始稳定性时,需要采取上颌窦底提升增加上颌后牙区骨量。“改良”上颌窦底内提升是通过使用富血小板纤维蛋白(platelet-rich fibrin,PRF),在内镜(endoscope)辅助下实现同期植入种植体(simultaneous implants placement)的一种改良的、微创的牙槽嵴入路上颌窦底提升(sinus floor elevation),简称“PESS”。“PESS”在一定程度上优化了上颌窦底提升,减小了手术创伤。本文阐述了“PESS”的原理、适应证、临床操作流程及注意事项,以期为“PESS”在临床中的应用提供技术支持。

A-PRF促进兔膝关节骨软骨损伤愈合的观察

目的·探讨改良型富血小板纤维蛋白(advanced platelet-rich fibrin,A-PRF)在骨软骨再生中的作用。方法·获取新西兰兔骨髓间充质干细胞(bone-marrow mesenchymal stem cells,BMSCs)和膝关节软骨细胞;通过低速离心兔心脏血液获得A-PRF。采用光学显微镜观察A-PRF的组织学结构;ELISA法检测A-PRF中生长因子,包括血小板衍生生长因子、转化生长因子-β、胰岛素样生长因子、血管内皮生长因子、表皮生长因子和成纤维细胞生长因子的释放;采用活/死细胞双染法及MTT法检测A-PRF对兔BMSCs细胞毒性及增殖情况的影响;采用实时荧光定量聚合酶链反应(qRT-PCR)检测A-PRF对兔BMSCsⅡ型胶原蛋白、聚集蛋白聚糖、碱性磷酸酶(ALP)和骨钙素(OCN)基因表达的影响;使用transwell小室测定A-PRF对于兔BMSCs以及软骨细胞迁移能力的影响。建立兔膝关节骨软骨缺损模型,将18只兔随机分为3组:A-PRF组(n=6)在缺损处植入A-PRF;A-PRF+BMSCs组(n=6)植入接种兔BMSCs的A-PRF;对照组(n=6)不进行植入操作。术后12周处死兔,采用苏木精-伊红(H-E)、甲苯胺蓝和番红O-固绿染色进行膝关节标本的组织学观察,并根据膝关节的表面形态学与组织学情况,采用国际软骨修复协会(International Cartilage Repair Society,ICRS)评分系统进行宏观与组织学评分。结果·A-PRF具有松散的网络结构,可以缓慢释放生长因子。加入A-PRF后,未观察到其对兔BMSCs具有细胞毒性;在加入A-PRF后24、48和72 h,BMSCs的增殖能力均明显升高(均P<0.05),成软骨相关基因Ⅱ型胶原蛋白、聚集蛋白聚糖,以及成骨相关基因ALP和OCN均显著上调(均P<0.05)。加入A-PRF后,兔BMSCs与软骨细胞的迁移能力均显著增强(均P<0.05),且兔BMSCs的迁移能力显著高于软骨细胞(P=0.025)。在兔膝关节缺损模型中,观察关节表面形态,可见A-PRF组和A-PRF+BMSCs组缺损均基本恢复,而对照组仅有软组织覆盖。在ICRS宏观评分方面,A-PRF组与A-PRF+BMSCs组的差异无统计学意义,但2组评分均显著高于对照组(均P<0.05)。组织学观察显示,A-PRF组和A-PRF+BMSCs组均产生骨软骨修复,但A-PRF组软骨更加成熟,对照组则形成纤维修复。在ICRS组织学评分方面,A-PRF组与A-PRF+BMSCs组的差异无统计学意义,但2组评分均显著高于对照组(均P<0.05)。结论·自体A-PRF具有良好的生物相容性和促进BMSCs增殖的能力,在体外和体内均可促进软骨和软骨下骨的修复。

自体牙本质颗粒联合PRF在拔牙位点保存术中的应用1例

报告1例利用未脱矿的自体牙本质颗粒(UADP)联合自体血液浓缩物富血小板纤维蛋白(PRF),为左下颌第二磨牙进行拔牙位点保存术,术后3、 9、 24个月的CBCT显示骨量维持效果明显。组织学切片可见牙本质颗粒周围有大量新生骨形成。

改良型富血小板纤维蛋白促进脂肪移植存活的最适混合比例实验研究

目的探索改良型富血小板纤维蛋白(A-PRF)促进脂肪移植存活的最适混合比例。方法酶消化法分离脂肪干细胞并培养,传代至第三代,抽取健康患者静脉血一次性制备A-PRF,以1:6、1:8、1:10、1:12、1:14五种混合比例分别与脂肪干细胞混合。取6周龄SPF级雌性裸鼠60只,随机分为5组,每组12只,分别将A-PRF以体积比1:6、1:8、1:10、1:12、1:14五种混合比例分别与人脂肪颗粒混合后注射至5组裸鼠背部,分别记为1:6、1:8、1:10、1:12、1:14组。于移植后4、8、12周以断颈法处死裸鼠,比较脂肪标本体积及质量变化;HE染色观察脂肪标本的血管密度及分布;分析囊腔/空泡占比、炎症反应程度、间质化纤维程度;免疫组化测定CD31蛋白含量。结果第24小时,5组迁移变化均不明显,在第48小时及72小时1:12组的细胞迁移程度明显高于其他组,差异具有统计学意义(P<0.05)。在第4、8及12周,1:12组的脂肪质量组织体积及质量的保留率最高,差异具有统计学意义(P<0.05)。HE染色结果显示,1:12组的囊腔/空泡占比、间质化纤维程度均为最低并伴有大量新生毛细血管,5组在第4周时炎性反应程度均较严重,在第8及第12周的炎性反应程度均较轻且差异不明显。CD31染色结果显示,1:12组的CD31蛋白含量较其他组明显升高,差异具有统计学意义(P<0.05)。结论改良型富血小板纤维蛋白促进脂肪移植存活的最适混合比例是1:12。

自体富血小板纤维蛋白应用于根尖周炎磨牙即刻种植1例报告及文献复习

目的:将自体富血小板纤维蛋白(PRF)单独应用于根尖周炎磨牙即刻种植,观察其临床疗效并探讨其作用机制,以拓宽其临床应用并为其临床实践提供指导。方法:收集1例将PRF单独应用于根尖周炎磨牙即刻种植患者的临床资料,采用锥形束CT(CBCT)和口腔扫描数据三维重建的方法对种植体周围组织改变量进行评估,并结合相关文献分析PRF的治疗方法和治疗效果。结果:采用微创拔除患者46患牙行即刻种植的治疗方法。术前取患者自体血液30 mL(3管),将血液置于不含抗凝剂的10 mL玻璃涂层塑料管中,采用3000 r·min-1离心10 min的方法制备3枚PRF,并将其作为唯一材料充填跳跃间隙。治疗后采用CBCT和口腔扫描三维重建对比分析,术后6个月时,种植体周围骨组织增加203.19 mm^(3),颊侧骨高度增加5.83 mm,且颊侧骨组织增加量大于1 mm;术后12个月时,种植体周软硬组织基本保持稳定。结论:将自体PRF单独应用于根尖周炎磨牙即刻种植,获得了良好的治疗效果,种植体周骨组织再生且种植体周软硬组织基本保持稳定。

富血小板纤维蛋白联合羟基磷灰石治疗牙周骨内缺损的Meta分析

目的:从临床指标方面系统评价富血小板纤维蛋白(PRF)与羟基磷灰石(HA)联用治疗牙周骨内缺损的疗效。方法:计算机检索PubMed、the Cochrane Library、Web of Science、维普、万方数据库、中国知网,检索关于PRF和HA联合治疗与PRF或HA单独治疗牙周骨内缺损的随机对照实验(RCT),检索时限从建库至2023年6月。结果:最终纳入9个RCT,354个牙周骨内缺损位点。Meta分析显示,PRF与HA联合应用组与PRF组和HA组的探诊深度(PD)、临床附着丧失(CAL)、菌斑指数(PI)、牙龈指数(GI)的改变量差异均有统计学意义(P<0.05)。结论:目前的研究证据表明,PRP与HA联合应用治疗牙周骨内缺损均优于单用PRF或HA,由于纳入研究数量及质量的限制,还亟待更多高质量文献的证明。

黏性骨在口腔临床治疗中的应用研究进展

在口腔医学领域中,黏性骨(sticky bone)一般指由第二代血浆基质制品可注射型富血小板纤维蛋白(injectable platelet rich fibrin,i-PRF)与一定质量的骨增量材料(bone grafting materials)混合制备而成的凝胶团块状骨移植物。黏性骨既富含血浆基质所提供的生长因子和纤维蛋白支架等组织再生所需基本要素,又具备一定的可塑性,在骨增量、上颌窦底提升和牙槽嵴保存等临床治疗中有着广阔的应用前景。本文总结临床经验和相关研究,对黏性骨的基本情况和目前在临床治疗中应用作一介绍,以期为后续研究提供参考。

即刻种植联合富血小板纤维蛋白固定种植体在前牙缺失治疗中的疗效及对患者龈沟液骨桥蛋白的影响

目的:探究即刻种植联合使用患者富血小板纤维蛋白(PRF)固定种植体在前牙缺失治疗中的疗效及对患者龈沟液骨桥蛋白(OPN)水平的影响。方法:选择前牙缺失患者82例,依照随机数字表法分为两组各41例,对照组即刻种植,观察组在对照组基础上联合PRF。对比两组总有效、OPN、碱性磷酸酶(ALP)、骨保护素(OPG)、软垢指数、龈沟出血指数、菌斑指数、种植体周围骨密度、唇腭向骨厚度、唇腭向骨高度。结果:观察组总有效率高于对照组(P<0.05)。术前,两组OPN、ALP、OPG比较,无统计学差异(均P>0.05);术后30d,观察组OPN、ALP水平及软垢、龈沟出血、菌斑指数较对照组降低,而OPG高于对照组(均P<0.05)。在术后6、12周,观察组种植体周围骨密度、唇腭向骨厚度、唇腭向骨高度高于对照组(均P<0.05)。结论:即刻种植联合使用PRF在前牙缺失即刻种植中具有较为理想疗效,有利于改善骨代谢。

血清SPARC及SERPIND1与鼻咽癌患者放疗敏感性及预后的相关性

目的研究鼻咽癌(NPC)患者血清富含半胱氨酸的酸性分泌蛋白(SPARC)、纤维蛋白活化因子抑制蛋白(SERPIND1)表达与放疗敏感性及预后的关系。方法收集2017年1月—2019年1月南京大学医学院附属盐城第一医院肿瘤放疗科诊治NPC患者98例为NPC组,选取同期体检的健康人群60例为健康对照组。酶联免疫吸附试验检测血清SPARC、SERPIND1水平。根据NPC患者放疗反应性将NPC患者分为放疗敏感亚组(n=68)和放疗抵抗亚组(n=30)。比较不同临床病理特征、放疗反应的NPC患者血清SPARC、SERPIND1水平差异。绘制Kaplan-Meier曲线,Log-Rank检验比较不同SPARC、SERPIND1表达患者生存预后的差异。采用Cox回归分析NPC预后的影响因素。结果放疗前NPC组患者血清SPARC、SERPIND1水平高于健康对照组(t=37.535、48.522,P均<0.001)。放疗前放疗抵抗亚组NPC患者血清SPARC、SERPIND1水平明显高于放疗敏感亚组(t/P=14.034/<0.001、7.772/<0.001),放疗后2亚组血清SPARC、SERPIND1水平均降低,且放疗敏感亚组低于放疗抵抗亚组(t/P=22.974/<0.001、18.137/<0.001)。肿瘤TNM分期Ⅲ~Ⅳ期、有淋巴结转移NPC患者放疗前血清SPARC、SERPIND1水平高于TNM分期Ⅰ~Ⅱ期、无淋巴结转移者(t/P=16.539/<0.001、16.799/<0.001、15.756/<0.001、15.015/<0.001)。血清SPARC高表达和低表达患者3年总生存率分别为50.00%(24/48)、92.00%(46/50)。血清SERPIND1高表达和低表达患者3年总生存率分别为53.19%(25/47),88.24%(45/51),血清SPARC、SERPIND1高表达NPC患者3年累积生存率明显低于血清SPARC、SERPIND1低表达患者(Log-rankχ^(2)=21.500、14.790,P均<0.001)。TNM分期Ⅲ~Ⅳ期、淋巴结转移、SPARC高表达、SERPIND1高表达是影响NPC预后的独立危险因素[HR(95%CI)=1.608(1.225~2.112)、1.917(1.319~2.799)、1.839(1.228~2.753)、1.738(1.246~2.426)]。结论NPC患者血清SPARC、SERPIND1水平上调,与NPC患者不良临床病理特征及放疗敏感性有关,是评估NPC患者预后的血清肿瘤标志物。