University of Liverpool, Liverpool, UK.
University of Oxford, Oxford, UK.
Lancet. 2015 Feb 26;385 Suppl 1:S19. doi: 10.1016/S0140-6736(15)60334-8.
Platelet-rich plasma (PRP), an autologous derivative of whole blood that contains a supraphysiological concentration of platelets, is thought to invoke an earlier and improved tissue healing response. This notion has been supported by in-vitro and animal studies in bone, cartilage, tendon, and muscle. To our knowledge no published study exists of the effects of PRP in human tissues in vivo. The aim of our study was to investigate the response of ruptured Achilles tendon treated with PRP.
Tendon tissue biopsy samples were obtained from 20 patients with ruptured Achilles tendon by means of ultrasound-guided needle biopsies from the healing area of the Achilles tendon 6 weeks after treatment with PRP or placebo controls (10 patients each). All samples were embedded in paraffin wax, sectioned, and stained with haematoxylin and eosin and alcian blue. Immunohistochemistry markers were used to identify collagen I and III, lymphocytes (CD45), proliferation (KI67), and blood vessels (CD34). All images were masked and analysed with Image J software.
Cellularity and glycosaminoglycans content were significantly higher in PRP-treated tendons than in controls (p=0·01 and p<0·001, respectively). Fibre structure of the tissue was significantly better in the PRP group than in the control tissue (p<0·001). Although both groups showed high collagen I staining, content of collagen I was significantly higher in PRP-treated tendons than in control tendons (p=0·0079), whereas collagen III content was not different (p=1·0). The ratio of collagen III to collagen I was significantly lower in PRP samples (p=0·007). There was no significant difference in CD45 expression (p=0·33). However, PRP samples had fewer blood vessels than did control samples (p=0·023). The overall modified Bonar score was significantly lower in PRP samples, which indicates improved early tendon healing.
This is the first study, to our knowledge, to report the immunohistochemical response of ruptured human Achilles tendon to PRP. The findings reveal that locally applied PRP enhanced the maturity of the healing tendon tissues by promoting better collagen I deposition, decreased cellularity, less vascularity, and higher glycosaminoglycan content when compared with control samples. Further work is required to determine the longer term effects of the use of PRP in musculoskeletal diseases.
National Institute for Health Research.
富含血小板的血浆（PRP）是一种自体衍生的全血衍生物，其中含有超生理浓度的血小板，被认为能引发更早和改善的组织愈合反应。这一观点得到了骨、软骨、肌腱和肌肉的体外和动物研究的支持。据我们所知，目前还没有关于 PRP 在人类体内组织中的影响的已发表研究。我们的研究目的是调查 PRP 治疗后破裂的跟腱的反应。
通过超声引导的跟腱愈合区的针活检，从接受 PRP 或安慰剂对照治疗（每组 10 例）的 20 例跟腱断裂患者中获得跟腱组织活检样本。所有样本均用石蜡包埋、切片、用苏木精和伊红以及阿尔辛蓝染色。免疫组织化学标志物用于鉴定胶原 I 和 III、淋巴细胞（CD45）、增殖（KI67）和血管（CD34）。所有图像均经过掩蔽并使用 Image J 软件进行分析。
与对照组相比，PRP 治疗的肌腱中的细胞数量和糖胺聚糖含量显著更高（p=0.01 和 p<0.001）。PRP 组的组织纤维结构明显优于对照组（p<0.001）。尽管两组的胶原 I 染色均较高，但 PRP 治疗的肌腱中的胶原 I 含量明显高于对照组（p=0.0079），而胶原 III 含量无差异（p=1.0）。PRP 样本中的胶原 III 与胶原 I 的比值明显较低（p=0.007）。CD45 表达无显著差异（p=0.33）。然而，PRP 样本中的血管数量少于对照组（p=0.023）。PRP 样本的改良 Bonar 评分整体较低，表明早期跟腱愈合得到改善。
据我们所知，这是第一项报告富含血小板的血浆对破裂的人类跟腱的免疫组织化学反应的研究。研究结果表明，与对照组相比，局部应用 PRP 通过促进更好的胶原 I 沉积、降低细胞数量、减少血管生成和增加糖胺聚糖含量，增强了愈合的肌腱组织的成熟度。需要进一步研究确定 PRP 在肌肉骨骼疾病中的长期应用效果。
国家卫生研究院。
