自体富血小板凝胶治疗糖尿病皮肤溃疡效果及对创面基质金属蛋白酶影响  

Effect of platelet rich gel on diabetic skin ulcer and its effect on matrix metalloproteinases in wounds

作　　者：李伟[1] 徐杰[1] 白小岗[1] 朱亚莉[1] Li Wei;Xu Jie;Bai Xiaogang(Department of Endocrine Metabolism,Affiliated Hospital of Yan’an University,Yan'an 716000,China)

机构地区：[1]延安大学附属医院内分泌代谢科,716000

出　　处：《中华保健医学杂志》2022年第4期308-310,共3页Chinese Journal of Health Care and Medicine

基　　金：陕西省卫生健康科研基金项目(2018C013)。

摘　　要：目的观察自体富血小板凝胶(autologous platelet-rich gel,APG)治疗糖尿病皮肤溃疡的效果及对创面基质金属蛋白酶(matrix metalloproteinase,MMP)-9和基质金属蛋白酶抑制因子(tissueinhibitor of metalloproteinase,TIMP)-1的影响。方法选取2020年4月~2021年10月于延安大学附属医院住院治疗的糖尿病皮肤溃疡患者60例,随机数表法分为APG组和常规治疗组,每组各30例。APG组根据依据溃疡面积采集自体静脉血制备凝胶喷洒在创面表面并注入窦道深部。常规治疗组使用阴离子藻酸盐敷料。观察12周,比较两组的有效率、溃疡愈合时间、窦道闭合率。于治疗前,治疗3、6、10、14 d,采用ELISA法检测溃疡面MMP-9和TIMP-1。结果常规治疗组有效率73.33%低于APG组的97.67%,差异有统计学意义(P<0.05)。常规治疗组16例溃疡愈合患者愈合平均时间(34.7±16.5)d,APG组28例溃疡愈合患者平均时间(29.6±14.3)d,两组比较差异无统计学意义(t=1.076,P=0.288)。常规治疗组窦道封闭率30.76%(4/13),APG组窦道封闭率91.66%(11/12),两组比较,差异有统计学意义(χ^(2)=9.642,P=0.002)。两组均无明显不良反应。治疗前,两组MMP-9、TIMP-1水平及MMP-9/TIMP-1比值差异均无统计学意义(P>0.05)。APG组治疗3和14 d的MMP-9低于常规组,6和10 d的TIMP-1高于常规组,各时点的MMP-9/TIMP-1比值均低于常规组,差异有统计学意义(P<0.05)。结论自体富血小板凝胶治疗糖尿病皮肤溃疡安全有效,其机制可能与降低创面MMP-9水平,提高TIMP-1水平,改善MMP-TIMP平衡有关。Objective To observe the effect of autologous platelet-rich gel(APG)on diabetic skin ulcers and its effects on matrix metalloproteinase(MMP)-9 and matrix metalloproteinase inhibitor(tissueinhibitor of metalloproteinase).Methods 60hospitalized diabetic skin ulcer patients were screened.They were randomly divided into APG group and routine treatment group,with30 cases in each group.In group APG,gel was sprayed on the wound surface and injected into the deep part of the sinus according to the area of ulcer.The conventional treatment group was treated with anionic alginate dressing.The effective rate,ulcer healing time and sinus closure rate were compared between the two groups.Before treatment,3,6,10 and 14 days after treatment,matrix metalloproteinase-9(MMP-9)and matrix metalloproteinase inhibitor-1(TIMP-1)were detected by ELISA.Results The effective rate of routine treatment group was 73.33%,which was lower than that of APG group 97.67%,the difference was statistically significant(P<0.05).The average healing time of 16 patients with ulcer healing in the routine treatment group was(34.7±16.5)d,and that of 28patients with ulcer healing in the APG group was(29.6±14.3)d.There was no significant difference between the two groups(t=1.076,P=0.288).The sinus closure rate in the routine treatment group was 30.76%(4/13)and that in the APG group was 91.66%(11/12).There was significant difference between the two groups(χ^(2)=9.642,P=0.002).There were no obvious adverse reactions in both groups.Before treatment,there was no significant difference in the levels of MMP-9,TIMP-1 and the ratio of MMP-9/TIMP-1between the two groups(P>0.05).MMP-9 in APG group was lower than that in routine group on days 3 and 14,TIMP-1 on days 6and 10 was higher than that in routine group,and the ratio of MMP-9/TIMP-1 at each time point was lower than that in routine group,the difference was statistically significant(P<0.05).Conclusion Autologous platelet rich gel is effective and safe in the treatment of diabetic skin ulcers,and its mechanism ma

关 键 词：富血小板凝胶 糖尿病 皮肤溃疡 基质金属蛋白酶-9 基质金属蛋白酶抑制因子-1 

分 类 号：R746[医药卫生—神经病学与精神病学]