自体血小板凝胶对人类急性皮肤伤口的愈合作用。

The healing effects of autologous platelet gel on acute human skin wounds.

作者信息

Hom David B, Linzie Bradley M, Huang Trevor C

机构信息

Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Minnesota School of Medicine, MN, and Hennepin County Medical Center, USA.

出版信息

Arch Facial Plast Surg. 2007 May-Jun;9(3):174-83. doi: 10.1001/archfaci.9.3.174.

DOI:10.1001/archfaci.9.3.174

PMID:17519207

Abstract

OBJECTIVE

To compare the healing of full-thickness skin punch wounds treated with topical autologous platelet gel (APG) vs conventional therapy (antibiotic ointment and/or occlusive dressings) in healthy volunteers.

METHODS

A prospective, single-blind, pilot study comprising 80 full-thickness skin punch wounds (4 mm diameter) was conducted on the thighs of 8 healthy volunteers. With each subject serving as his or her own control (5 punch sites per leg), APG was applied topically on one thigh, and an antibiotic ointment and/or a semiocclusive dressing was applied on the other thigh. Healing was monitored for spontaneous wound closure by clinical assessment and by digital photographs over 6 months. Over 35 days, 64 serial dermal biopsy specimens (6 mm diameter) were analyzed (using hematoxylin-eosin, Mason trichrome, CD-34, and Ki-67 stains) to measure differences between treated and control sites for cellularity, granulation formation, vascularity, epithelialization, and cellular replication.

RESULTS

Over a 42-day period, the APG-treated sites had statistically increased wound closure compared with controls by visual clinical assessment and by digital planimetry photographic measurements (P<or=.02). On day 17, the percentage of closure was 81.1% +/- 2.5% (mean +/- SE) for the APG-treated sites and 57.2% +/- 5.9% for the control sites. Also, the APG wound closure velocities were significantly faster than those of the controls (P = .001). Histologically, over time, the APG-treated sites had similar cellularity, cellular replication, granulation tissue, vascularity, and epithelialization compared with controls. However, when the platelet count in the gel was more than 6 times the baseline intravascular platelet count in some subjects, epithelialization and granulation formation appeared 3 days earlier in the APG-treated group. Furthermore, in vitro testing of supplemental APG showed increased endothelial cell proliferation compared with controls (P<.04).

CONCLUSION

This pilot study provides preliminary evidence that topical APG may hasten wound closure in full-thickness dermal wounds in healthy individuals.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT00199992.

摘要

目的

比较在健康志愿者中，局部应用自体血小板凝胶（APG）与传统疗法（抗生素软膏和/或封闭性敷料）治疗全层皮肤穿刺伤口的愈合情况。

方法

对8名健康志愿者的大腿进行了一项前瞻性、单盲、试点研究，共纳入80个全层皮肤穿刺伤口（直径4毫米）。以每名受试者自身作为对照（每条腿5个穿刺部位），在一侧大腿局部应用APG，另一侧大腿应用抗生素软膏和/或半封闭性敷料。通过临床评估和数码照片监测6个月内伤口的自然闭合情况。在35天内，分析64份连续的真皮活检标本（直径6毫米）（使用苏木精-伊红染色、梅森三色染色、CD-34染色和Ki-67染色），以测量治疗部位和对照部位在细胞密度、肉芽组织形成、血管生成、上皮化和细胞增殖方面的差异。

结果

在42天的时间里，通过视觉临床评估和数码平面摄影测量，与对照组相比，APG治疗部位的伤口闭合在统计学上有显著增加（P≤0.02）。在第17天，APG治疗部位的闭合百分比为81.1%±2.5%（平均值±标准误），对照部位为57.2%±5.9%。此外，APG伤口闭合速度明显快于对照组（P = 0.001）。组织学上，随着时间的推移，与对照组相比，APG治疗部位在细胞密度、细胞增殖、肉芽组织、血管生成和上皮化方面相似。然而，当凝胶中的血小板计数在某些受试者中超过基线血管内血小板计数的6倍时，APG治疗组的上皮化和肉芽组织形成提前3天出现。此外，补充APG的体外试验显示，与对照组相比，内皮细胞增殖增加（P<0.04）。