崔 晓　赵仓焕　综述　程 飚　审校

[关键词]浓缩血小板;富血小板血浆;纤维蛋白原;君臣佐使思想;理论探讨

[中图分类号]R331.1+43    [文献标志码]A    [文章编号]1008-6455（2021）12-0174-04

The View of"Emperor，Minister，Assistant and Envoy"Composing Principle in Platelet Concentrate Therapy

CUI Xiao1，ZHAO Cang-huan2，CHENG Biao3

（1.Department of Physiotherapy，Guangdong Provincial Hospital of Chinese Medicine，Guangzhou 510120，Gangdong，China;2.Department of Acupuncture，Guangzhou Overseas Chinese Hospital，Guangzhou 510630，Gangdong，China;3.Department of Burn and Plastic Surgery，General Hospital of Southern Theater Command，PLA，Guangzhou 510030，Gangdong，China）

Abstract： Platelet concentrate （PC） has been widely used in many clinical disciplines in recent years and has achieved good results due to its diverse components and extensive functions. With the deepening of the research， our understanding of PC has increased from the simple functions of hemostasis， fibrinolysis and repair to the functions of immunity， sterilization and regeneration. The gradual increase in therapeutic function has raised higher requirements for the precise use of PC， which requires a guiding principle to coordinate with the formulation of clinical treatment plans. The "emperor， minister， assistant and envoy" composition principle of herbal prescriptions is in accord with this demand. This theory is ingenious and unique in the pursuit of streamlined drug array and precise breakthrough， which can well guide the clinical application of platelet concentrate.

Key words： platelet concentrate; platelet-rich plasma; fibrinogen; bcomposition principle of herbal prescriptions; theoretical discussion

浓缩血小板（Platelet concentrate，PC）是通过离心的方法，从血液中分离出的血小板浓缩液[1]，主要组成成分为血小板、纤维蛋白、白细胞、纤维连接蛋白、血栓黏合素、骨连接蛋白、玻连蛋白等其他成分。其中血小板激活后又可以释放多种超生理浓度的生长因子和其他各种生物活性物质，而且这些生物活性物质间完美协作，可在一定程度上弥补传统单一生长因子修复效果不佳的缺憾。从上世纪50年代富小板血浆（Platelet-rich plasma，PRP）概念的提出，到如今如火如荼的临床应用，短短几十年的发展，浓缩血小板治疗技术已遍布多个临床学科[2]，涉及的有骨科和运动医学[3-4]、口腔颌面科[5]、整形美容科[6-9]、眼科[10]、耳鼻喉[11]、皮肤科[12]、泌尿外科[13]以及妇产科等[14]。浓缩血小板使用起来较为灵活，可通过局部注射或涂抹等多种方式发挥良好效果。随着浓缩血小板在临床的广泛应用，逐渐制备出多种不同性状的浓缩血小板产品，从而出现了大量不同的浓缩血小板命名或相关衍生物应用[15]。其分类方法较多，如以优势成分分类有PRP、富含生长因子的血浆（Plasma rich in growth factors，PRGF）、富血小板纤维蛋白（Plasma rich fibrin，RGF）、浓缩生长因子（Concentrated growth factors，CGF）;根据制备形态分为PRP浓缩液和PRP凝胶;根据白细胞含量分为富白细胞PRP（Leukocyte- platelet-rich plasma，L-PRP）和贫白细胞PRP（Pure-platelet-rich plasma，P-PRP）;根据PRP是否激活分为激活PRP和非激活PRP等。

虽然浓缩血小板命名及种类繁多，但所有这些分类都离不开一个关键词--血小板，所有涉及的治疗一定是立足于血小板来发挥作用。……