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浓缩生长因子联合血浆白蛋白凝胶治疗面部凹陷性瘢痕的临床效果

[Clinical effects of concentrated growth factor combined with plasma albumin gel in treating facial depressed scar].

作者信息

Sun J L, Wang J J, Cui Z J, Meng Q N, Liu X J, Wang X, Yu Z G

机构信息

Department of Burns and Repair Reconstruction, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China.

Department of Plastic Surgery, Henan NO.3 Provincial People's Hospital, Zhengzhou 450000, China.

出版信息

Zhonghua Shao Shang Za Zhi. 2020 Mar 20;36(3):210-218. doi: 10.3760/cma.j.cn501120-20190930-00389.

DOI:10.3760/cma.j.cn501120-20190930-00389
PMID:32241047
Abstract

To explore the clinical effects of concentrated growth factor (CGF) combined with plasma albumin gel (PAG) in treating facial depressed scar. From January 2018 to June 2019, 14 patients in the First Affiliated Hospital of Zhengzhou University and 10 patients in Henan NO.3 Provincial People's Hospital with facial depressed scar who met the inclusion criteria were admitted, and their clinical data were retrospectively analyzed by the method of case-control study. Based on the method of treatment, 8 patients (4 males and 4 females) aged 28.50 (25.50, 31.50) years were enrolled in CGF alone group, 8 patients (3 males and 5 females) aged 32.00 (28.50, 35.00) years were enrolled in PAG alone group, and 8 patients (5 males and 3 females) aged 33.50 (29.00, 35.75) years were enrolled in CGF+ PAG group. Suitable amount of CGF, PAG, and CGF+ PAG (mixed at a ratio of 1.0∶1.0-1.0∶1.5) prepared from autologous blood were injected subcutaneously via a single or multiple entrance (s) into the depressed scar of patients in CGF alone, PAG alone, and CGF+ PAG groups respectively to fill up the concavity, once every 4 weeks for a total of 3 times. Before the first treatment (hereinafter referred to as before treatment) and 3 months after the last treatment (hereinafter referred to as after treatment), the Goodman & Baron Acne Scar Grading System was used for scar grading, and the difference was calculated; the Anxiety Self-Rating Scale was used to score anxiety, and the difference was calculated. The Visual Analogue Score was used to score pain immediately after the first treatment. By one, two, and three months after treatment, the patients' satisfaction to scar treatment was scored, and the Global Aesthetic Improvement Scale was used to score the scar improvement. Adverse reaction of patients after treatment was monitored. Data were statistically analyzed with Fisher's exact probability test, Kruskal-Wallis test, Mann-Whitney test, Bonferroni correction, and Wilcoxon signed rank sum test. (1) The scars of patients in the three groups were all graded 4.00 (4.00, 4.00) before treatment ((2)<0.001, >0.05). By three months after treatment, compared with 2.00 (1.25, 2.00) of CGF alone group, the scar grades of patients in PAG alone group and CGF+ PAG group (3.00 (2.00, 3.00) and 1.00 (1.00, 1.00), respectively) had no significant change (=2.199, 2.003, >0.05). The scar grade of patients in CGF+ PAG group was significantly lower than that in PAG alone group (=3.229, <0.01). Compared with those before treatment, the scar grades of patients in CGF alone group, PAG alone group, and CGF+ PAG group were significantly reduced three months after treatment (=2.588, 2.598, 2.640, <0.05 or <0.01). The difference in scar grade before and after the treatment was significantly higher in CGF+ PAG group than in PAG alone group (=3.229, <0.01). (2) The anxiety scores of patients in the three groups were similar before treatment and 3 months after ((2)=2.551, 2.768, >0.05). Compared with those before treatment, the anxiety scores of patients in CGF alone group, PAG alone group, and CGF+ PAG group were significantly reduced three months after treatment (=2.395, 2.527, 2.533, <0.05). The differences in anxiety score before and after the treatment were similar among the three groups ((2)=1.796, >0.05). (3) The pain scores of patients in the three groups were similar immediately after the first treatment ((2)=0.400, >0.05). (4) By one and two month (s) after treatment, the patients' satisfaction scores to scar treatment in the three groups were similar ((2)=2.688, 5.989, >0.05). By three months after treatment, the patients' satisfaction score to scar treatment in CGF+ PAG group was significantly higher than that in PAG alone group (=2.922, <0.01). Compared with those one month after treatment within the same group, the patients' satisfaction scores to scar treatment in CGF alone group, PAG alone group, and CGF+ PAG group were significantly increased two and three months after treatment (=1.121, 2.392, 2.000, 2.828, 2.449, 2.598, <0.05 or <0.01). Compared with those two months after treatment within the same group, the patients' satisfaction scores to scar treatment in CGF alone group, PAG alone group, and CGF+ PAG group were significantly increased three months after treatment (=2.271, 2.000, 2.646, <0.05 or <0.01). (5) One month after treatment, the scar improvement scores of patients in the three groups were similar ((2)=4.438, >0.05). Two months after treatment, the scar improvement scores of patients in CGF alone group and CGF+ PAG group were 2.00 (2.00, 2.75) and 2.00 (2.00, 2.00) points, respectively, which were significantly higher than 1.00 (1.00, 1.00) point of PAG alone group (=3.303, 3.771, <0.01). Three months after treatment, the scar improvement score of patients in CGF+ PAG group was 3.00 (3.00, 3.00) points, which was significantly higher than 2.00 (2.00, 2.75) points of CGF alone group and 1.00 (1.00, 2.00) points of PAG alone group (=2.450, 3.427, <0.05 or <0.01). Compared with those one month after treatment within the same group, the scar improvement scores of patients were significantly higher in CGF alone group and CGF+ PAG group two and three months after treatment and in PAG alone group three months after treatment (=2.828, 2.828, 2.530, 2.640, 2.121, <0.05 or <0.01). Compared with that two months after treatment within the same group, the scar improvement score of patients in CGF+ PAG group was significantly higher three months after treatment (=2.449, <0.05). (6) After injection, all patients in the three groups had slight redness and swelling at the needle prick point and no other adverse reactions. CGF combined with PAG can reduce the scar grading, anxiety of patients, and enhance patients' satisfaction and scar improvement in the treatment of patients with facial depressed scar. The combined CGF+ PAG injection, without significant adverse reactions, is better than single component injection and is worthy of clinical application.

摘要

探讨浓缩生长因子(CGF)联合血浆白蛋白凝胶(PAG)治疗面部凹陷性瘢痕的临床效果。选取2018年1月至2019年6月郑州大学第一附属医院的14例及河南省人民医院的10例符合纳入标准的面部凹陷性瘢痕患者,采用病例对照研究方法对其临床资料进行回顾性分析。根据治疗方法,将年龄为28.50(25.50,31.50)岁的8例患者(男4例,女4例)纳入单纯CGF组,将年龄为32.00(28.50,35.00)岁的8例患者(男3例,女5例)纳入单纯PAG组,将年龄为33.50(29.00,35.75)岁的8例患者(男5例,女3例)纳入CGF+PAG组。分别从自体血制备适量的CGF、PAG以及CGF+PAG(按1.0∶1.0 - 1.0∶1.5的比例混合),经单处或多处进针分别皮下注射至单纯CGF组、单纯PAG组和CGF+PAG组患者的凹陷性瘢痕内以填充凹陷,每4周注射1次,共注射3次。在首次治疗前(以下简称治疗前)及末次治疗后3个月(以下简称治疗后),采用古德曼和巴伦痤疮瘢痕分级系统进行瘢痕分级并计算差值;采用焦虑自评量表进行焦虑评分并计算差值。在首次治疗后即刻采用视觉模拟评分法进行疼痛评分。在治疗后1、2、3个月,对患者瘢痕治疗满意度进行评分,并采用整体美学改善量表对瘢痕改善情况进行评分。监测患者治疗后的不良反应。采用Fisher确切概率检验、Kruskal - Wallis检验、Mann - Whitney检验、Bonferroni校正及Wilcoxon符号秩和检验进行统计学分析。(1)三组患者治疗前瘢痕均分级为4.00(4.00,4.00)((2)<0.001,>0.05)。治疗后3个月,单纯PAG组和CGF+PAG组患者瘢痕分级分别为3.00(2.00,3.00)和1.00(1.00,1.00),与单纯CGF组的2.00(1.25,2.00)相比,差异无统计学意义(=2.199,2.003,>0.05)。CGF+PAG组患者瘢痕分级显著低于单纯PAG组(=3.229,<0.01)。与治疗前相比,单纯CGF组、单纯PAG组和CGF+PAG组患者治疗后3个月瘢痕分级均显著降低(=2.588,2.598,2.640,<0.05或<0.01)。CGF+PAG组治疗前后瘢痕分级差值显著高于单纯PAG组(=3.229,<0.01)。(2)三组患者治疗前及治疗后3个月焦虑评分相近((2)=2.551,2.768,>0.05)。与治疗前相比,单纯CGF组、单纯PAG组和CGF+PAG组患者治疗后3个月焦虑评分均显著降低(=2.395,2.527,2.533,<0.05)。三组治疗前后焦虑评分差值相近((2)=1.796,>0.05)。(3)三组患者首次治疗后即刻疼痛评分相近((2)=0.400,>0.05)。(4)治疗后1、2个月,三组患者瘢痕治疗满意度评分相近((2)=2.688,5.989,>0.05)。治疗后3个月,CGF+PAG组患者瘢痕治疗满意度评分显著高于单纯PAG组(=2.922,<0.01)。与同组治疗后1个月相比,单纯CGF组、单纯PAG组和CGF+PAG组患者治疗后2、3个月瘢痕治疗满意度评分均显著升高(=1.121,2.392,2.000,2.828,2.449,2.598,<0.05或<0.01)。与同组治疗后2个月相比,单纯CGF组、单纯PAG组和CGF+PAG组患者治疗后3个月瘢痕治疗满意度评分均显著升高(=2.271,2.000,2.646,<0.05或<0.01)。(5)治疗后1个月,三组患者瘢痕改善评分相近((2)=4.438,>0.05)。治疗后2个月,单纯CGF组和CGF+PAG组患者瘢痕改善评分分别为2.00(2.00,2.75)和2.00(2.00,2.00)分,显著高于单纯PAG组的1.00(1.00,1.00)分(=3.303,3.771,<0.01)。治疗后3个月,CGF+PAG组患者瘢痕改善评分为3.00(3.00,3.00)分,显著高于单纯CGF组的2.00(2.00,2.75)分和单纯PAG组的1.00(1.00,2.00)分(=2.450,3.427,<0.05或<0.01)。与同组治疗后1个月相比,单纯CGF组和CGF+PAG组患者治疗后2、3个月瘢痕改善评分及单纯PAG组治疗后3个月瘢痕改善评分均显著升高(=2.828,2.828,2.530,2.640,2.121,<0.05或<0.01)。与同组治疗后2个月相比,CGF+PAG组患者治疗后3个月瘢痕改善评分显著升高(=2.449,<0.05)。(6)注射后,三组所有患者针刺点均有轻微红肿,无其他不良反应。CGF联合PAG可降低面部凹陷性瘢痕患者的瘢痕分级、焦虑程度,提高患者满意度及瘢痕改善情况。CGF+PAG联合注射无明显不良反应,优于单组分注射,值得临床应用。

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