Cieslik-Bielecka Agata, Skowroński Rafał, Jędrusik-Pawłowska Magdalena, Pierchała Marcin
Department of Emergency Care, Medical University of Silesia, Sosnowiec, Poland.
Department and Clinic of Orthopaedics, Medical University of Białystok, Białystok, Poland.
Adv Med Sci. 2018 Mar;63(1):140-146. doi: 10.1016/j.advms.2017.10.002. Epub 2017 Nov 6.
Nonhealing wounds or skin ulcerations are the result of insufficient repair and destruction of a local healing potential. Opportunistic infections which cause a lot of ulcer complications influence the worsening general condition of patients with AIDS, ultimately leading to death. The chronicity of the condition and poor results of conventional therapy have prompted the search for new methods of treatment.
We have examined venous or arteriovenous insufficiency-related extensive crural ulcers in AIDS patients. Crural ulcer healing processes were evaluated with clinical observations and histopathological, immunohistochemical and molecular examinations of tissue samples harvested from the wound edges before and on day 10 after L-PRP cover dressing.
Clinical observations showed positive effects of L-PRP in all patients. However, complete wound closure was noted in 60% of cases. Statistical analysis of histological examination showed increased epidermal processes between samples, but the difference was nonsignificant. However, immunohistochemical investigations showed an increased healing process with strong statistical significance. The mean VEGF level before L-PRP usage was 114.3 vessels/mm and on day 10 118.9 (p=0.001523). The mean FLK level was 103.2 and 109.9 respectively (p=0.008241). The biggest differences were observed for CD34, with values of 68.2 on day 0 and 100.8 on day 10 (p=0.006982). Molecular analysis generally showed decreased gene expression and confirmed vascular formation and reepithelialization processes.
In our opinion, L-PRP may be used to eradicate microorganisms from wounds, to induce neovascularization, and in unhealed cases prepare the base and edge of the ulcer for skin grafting and tissue expansion procedures.
难愈合伤口或皮肤溃疡是局部愈合潜力修复不足和破坏的结果。导致许多溃疡并发症的机会性感染会影响艾滋病患者的整体状况恶化，最终导致死亡。病情的慢性化和传统治疗效果不佳促使人们寻找新的治疗方法。
我们检查了艾滋病患者中与静脉或动静脉功能不全相关的广泛小腿溃疡。通过临床观察以及对伤口边缘在使用L-PRP覆盖敷料前和第10天采集的组织样本进行组织病理学、免疫组织化学和分子检查，评估小腿溃疡的愈合过程。
临床观察显示L-PRP对所有患者均有积极作用。然而，60%的病例实现了伤口完全闭合。组织学检查的统计分析显示样本间表皮过程增加，但差异不显著。然而，免疫组织化学研究显示愈合过程增强，具有很强的统计学意义。使用L-PRP前VEGF的平均水平为114.3个血管/mm，第10天为118.9（p=0.001523）。FLK的平均水平分别为103.和109.9（p=0.008241）。CD34的差异最为显著，第0天的值为68.2，第10天为100.8（p=0.006982）。分子分析总体显示基因表达降低，并证实了血管形成和再上皮化过程。
我们认为，L-PRP可用于清除伤口中的微生物、诱导新血管形成，在伤口未愈合的情况下为皮肤移植和组织扩张手术准备溃疡的基底和边缘。
