富血小板纤维蛋白在治疗难治性溃疡中的研究

发布时间：2018-07-06 14:25

本文选题：PRF + 富血小板纤维蛋白　；参考：《安徽医科大学》2017年硕士论文

【摘要】：目的内源性表皮生长因子的缺乏可导致创面不愈合,自体富血小板纤维蛋白(PRF)含有多种生长因子。本实验观察富血小板纤维蛋白对糖尿病溃疡创面的治疗作用。通过制造兔糖尿病溃疡的动物模型,将富血小板纤维蛋白应用到动物糖尿病溃疡创面中并分析比较其疗效;后期将富血小板纤维蛋白应用于临床难治性溃疡创面的换药修复中。从而分析探讨富血小板纤维蛋白治疗临床难治性溃疡的临床效果与可行性。方法(1)动物实验研究将20只大白兔随机分为空白对照组(4只)、糖尿病模型组(4只)、重组人表皮生长因子凝胶(rh EGF)组(4只),PRF组(8只),将糖尿病模型组、rh EGF组、PRF组建立糖尿病动物创面模型,4组动物创面分别予以1%碘伏清创、1%碘伏清创、rh EGF外敷、PRF外敷。观察各组创面面积及容积变化情况,标本予以HE染色观察创面组织生长情况,免疫组化标记血管内皮生长因子(VEGF)蛋白,计算VEGF平均光密度。(2)富血小板纤维蛋白的临床应用收集2015年12月至2017年1月安徽医科大学第一附属医院18例难治性溃疡创面住院患者,按治疗方法分为PRF组和传统治疗组,比较两组病例治疗前的一般情况以及治疗后在愈合时间、抗生素使用时间、住院日、换药次数、治愈率以及复发率方面的差别。结果(1)动物实验:干预后3、7 d显示,rh EGF组、PRF组创面面积和容积缩小的速度高于空白对照组及糖尿病模型组(P0.05)。第2、3周末大体病理观察rh EGF组、PRF组创面组织表皮覆盖完全,真皮结构致密,皮肤结构基本恢复正常,有大量毛细血管存在。第2、3周末标本VEGF平均光密度蛋白含量,rh EGF组、PRF组显著高于空白对照组、糖尿病模型组(P0.05)。(2)PRF组与传统治疗组患者在溃疡愈合时间、抗生素使用时间、住院日、换药次数等项目上统计结果存在差异,均有统计学意义(P0.05);在溃疡复发率方面,PRF组低于传统治疗组,统计结果有统计学意义(P0.05)。但在溃疡治愈率方面,两组数据无统计学意义(P0.05)。结论PRF可显著促进糖尿病皮肤溃疡创面的愈合,相对于传统换药治疗能有效缩短治疗时间,取材方便、安全、经济,为今后临床治疗难治性溃疡提供了新思路和新方法。
[Abstract]:Objective the absence of endogenous epidermal growth factor (EGF) may lead to wound nonunion and autogenous platelet-rich fibrin (PRF) contains multiple growth factors. To observe the therapeutic effect of platelet rich fibrin on diabetic ulcer wound. The platelet-rich fibrin was applied to the wound of diabetic ulcer in rabbits and the therapeutic effect was analyzed and compared by making the animal model of diabetic ulcer in rabbits, and the platelet rich fibrin was applied in the dressing repair of the wound of refractory ulcer in the later stage. The clinical effect and feasibility of platelet-rich fibrin in the treatment of refractory ulcer were analyzed and discussed. Methods (1) Twenty rabbits were randomly divided into control group (n = 4), diabetic model group (n = 4), recombinant human epidermal growth factor gel (rh EGF) group (n = 4) and PRF group (n = 8). Rats in 4 groups were treated with 1% Iodophor debridement and 1% Iodophor debridement with Rh EGF and PRF respectively. The changes of wound area and volume in each group were observed. The growth of wound tissue was observed by HE staining. Vascular endothelial growth factor (VEGF) protein was labeled by immunohistochemistry. The mean optical density of VEGF was calculated. (2) from December 2015 to January 2017, 18 hospitalized patients with refractory ulcer wounds in the first affiliated Hospital of Anhui Medical University were collected and divided into PRF group and traditional treatment group. The general conditions before treatment and the differences in healing time, antibiotic use time, hospitalization days, times of dressing change, cure rate and recurrence rate were compared between the two groups. Results (1) Animal experiment: the reduction rate of wound area and volume in PRF group was higher than that in blank control group and diabetic model group 3 days after intervention (P0.05). At the end of the 2nd week, the histopathological observation showed that in the rh EGF group, the wound tissue was completely covered by epidermis, the dermis structure was compact, the skin structure returned to normal, and a large number of capillaries were found in the rh EGF group. At the end of the 2nd week, the average optical density protein content in the Rh EGF group was significantly higher than that in the blank control group. The healing time of ulcer, the time of antibiotic use and the days of hospitalization in the diabetic model group (P0.05). (2) and the traditional treatment group were significantly higher than those in the control group. Changes in the number of items on the statistical results were statistically significant (P0.05); in the recurrence rate of ulcer in PRF group is lower than the traditional treatment group, the statistical results were statistically significant (P0.05). But in the ulcer cure rate, the two groups data have no statistical significance (P0.05). Conclusion PRF can significantly promote the healing of diabetic skin ulcer wound. Compared with traditional dressing change treatment, PRF can effectively shorten the treatment time, obtain materials conveniently, safely and economically, and provide a new way of thinking and new method for clinical treatment of refractory ulcer in the future.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R632.1

【参考文献】