Gomez Paul T, Andrews Karen L, Arthurs Jennifer R, Bruce Alison J, Wyles Saranya P
At Mayo Clinic, Rochester, Minnesota, United States, Paul T. Gomez, BS, is Summer Research Fellow, Regenerative Sciences Track, Mayo Clinic Graduate School of Biomedical Sciences; Saranya P. Wyles, MD, PhD, is Consultant, Department of Dermatology; and Karen L. Andrews, MD, is Director, Vascular Ulcer and Wound Healing Clinic/Gonda Vascular Center, and Consultant, Department of Physical Medicine and Rehabilitation. At Mayo Clinic, Jacksonville, Florida, Jennifer R. Arthurs is APRN, Center for Regenerative Medicine; and Alison J. Bruce, MB, ChB, is Consultant, Department of Dermatology.
Adv Skin Wound Care. 2024;37(11&12):608-615. doi: 10.1097/ASW.0000000000000229.
BACKGROUND: Chronic nonhealing neuropathic foot ulcers affect approximately 15% to 30% of patients with diabetes mellitus and are associated with significant morbidity and mortality. Although current strategies to address these chronic wounds include a multifactorial approach, clinical outcomes remain poor and warrant improvement. Platelet-rich plasma (PRP), derived from autologous or allogeneic blood, is an emerging regenerative product that aims to serve as an adjuvant to standard diabetic foot ulcer (DFU) treatment. OBJECTIVE: To examine controlled clinical trials investigating the efficacy of platelet-rich therapies in promoting healing of chronic DFUs. DATA SOURCES: The PubMed/MEDLINE database. STUDY SELECTION: Researchers selected 11 controlled clinical trials published between 2011 and 2021 that investigated the efficacy of PRP treatments for chronic DFUs. DATA EXTRACTION: Extracted data included study type and size, participant sex and age, duration of diabetes, glycated hemoglobin levels, baseline ulcer area, wound duration, healing parameters, PRP preparation approach, and application type. DATA SYNTHESIS: Randomized prospective studies (n = 8), prospective controlled studies (n = 2), and a double-blind, randomized controlled study (n = 1) were included in the review. In general, PRP plus standard of care provided superior wound healing, in both percentage of wound closure and healing rate, compared with standard of care alone. CONCLUSIONS: Use of PRP as an adjuvant for healing chronic DFUs appears to improve wound healing. Further research on optimizing PRP preparation and exploring combinatorial approaches will be important in advancing this avenue for chronic wound healing.
背景:慢性不愈合神经性足部溃疡影响约15%至30%的糖尿病患者,与显著的发病率和死亡率相关。尽管目前处理这些慢性伤口的策略包括多因素方法,但临床结果仍然不佳,需要改进。富含血小板血浆(PRP),源自自体或异体血液,是一种新兴的再生产品,旨在作为标准糖尿病足溃疡(DFU)治疗的辅助手段。 目的:研究探讨富含血小板疗法促进慢性DFU愈合疗效的对照临床试验。 数据来源:PubMed/MEDLINE数据库。 研究选择:研究人员选取了2011年至2021年间发表的11项对照临床试验,这些试验研究了PRP治疗慢性DFU的疗效。 数据提取:提取的数据包括研究类型和规模、参与者的性别和年龄、糖尿病病程、糖化血红蛋白水平、基线溃疡面积、伤口持续时间、愈合参数、PRP制备方法和应用类型。 数据综合:综述纳入了随机前瞻性研究(n = 8)、前瞻性对照研究(n = 2)和一项双盲随机对照研究(n = 1)。总体而言,与单纯标准治疗相比,PRP加标准治疗在伤口闭合百分比和愈合率方面均能提供更好的伤口愈合效果。 结论:使用PRP作为辅助治疗慢性DFU似乎能改善伤口愈合。进一步研究优化PRP制备和探索联合方法对于推进慢性伤口愈合的这一途径将具有重要意义。
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