杨丽英 罗鹏 陈玲

[摘要]目的：探讨富血小板血浆联合混合换药对难治性皮肤溃疡的治疗效果及其对肉芽组织中TGF-β1及EGF表达的影响。方法：选择68例难治性皮肤溃疡患者，随机分为对照组和观察组，每组34例。两组患者均给予混合换药治疗，观察组另给予富血小板血浆凝胶治疗。治疗12周后评估两组患者临床疗效、创面愈合时间、创面愈合美学满意度;PRP治疗前及治疗后第7天、第14天比较两组患者创面肉芽组织中转化生长因子β1（Transforming growth factor，TGF-β1）及表皮生长因子（Epidermal growth factor，EGF）表达水平。结果：观察组临床有效率为97.1%（33/34），对照组为73.5%（25/34），差异有统计学意义（P<0.05）。观察组创面愈合时间为（25.6±4.6）d短于对照组的（32.7±5.1）d，差异有统计学意义（P<0.05）。观察组创面愈合美容满意度为91.2%（31/34）高于对照组的67.6%（23/34），差异有统计学意义（P<0.05）。PRP治疗前两组肉芽组織中TGF-β1及EGF表达水平比较差异无统计学意义（P>0.05）;治疗后第7天、第14天两组患者创面肉芽组织中TGF-β1及EGF表达水平均升高，且观察组高于对照组，差异有统计学意义（P<0.05）。结论：富血小板血浆联合混合换药能够提高难治性皮肤溃疡临床治疗效果，改善美学外观，其可能同上调肉芽组织中TGF-β1及EGF的表达有关。

[关键词]富血小板血浆;难治性皮肤溃疡创面;创面修复;转化生长因子β1;表皮生长因子

[中图分类号]R622    [文献标志码]A    [文章编号]1008-6455（2021）05-0048-03

Effect of Platelet-rich Plasma on Wound Healing and Expression of TGF-β1 and EGF in Granulation Tissue of Refractory Skin Ulcer

YANG Li-ying1，LUO Peng2，CHEN Ling3

（1.Department of Burn and Plastic Surgery;2.Department of Radiology;3.Department of Gastroenterology，the First People's Hospital of Ziyang，Ziyang 641300，Sichuan，China）

Abstract： Objective  To investigate the clinical effect of platelet-rich plasma combined with dressing change on refractory skin ulcer and its effect on the expression of TGF-β1 and EGF in granulation tissue. Methods  68 patients with refractory skin ulcers were randomly divided into the control group and the observation group， 34 cases in each group. Two groups of patients were given mixed dressing treatment. The observation group was treated with platelet rich plasma gel treatment. After 12 weeks treatment， the clinical efficacy， wound healing time， esthetic satisfaction of wound healing of two groups were evaluated. The expression levels of TGF-β1 and EGF in granulation tissue were compared before PRP treatment and on the 7th and 14th day after PRP treatment. Results  The clinical effective rate of the observation group was 97.1%（33/34）， and that of the control group was 73.5%（25/34）， the difference was statistically significant（P<0.05）. The wound healing time of the observation group was （25.6±4.6）d， which was shorter than that of the control group[（32.7±5.1）d， P<0.05]. The satisfaction of the observation group was 91.2%（31/34）， which was higher than that of the control group[67.6%（23/34）， P<0.05]. There was no significant difference in the expression of TGF-β1 and EGF between the two groups before PRP treatment（P>0.05）. The expression levels of TGF-β1 and EGF in granulation tissue of two groups were increased on the 7th and 14th day after treatment， and the observation group was higher than that of the control group（P<0.05）. Conclusion  Platelet-rich plasma combined with dressing change can improve the clinical therapeutic effect and aesthetic appearance of refractory skin ulcer， which may be related to the up-regulation of the expression of TGF-β1 and EGF in granulation tissue.

Key words： platelet-rich plasma（PRP）; refractory skin ulcer wound; wound healing; TGF-β1; EGF

难治性皮肤溃疡在临床较为常见，多由于静脉病变、皮肤受压、创伤等原因引起，溃疡往往较深、组织活力差，临床治疗效果差，迁延不愈[1]。影响局部功能及外观，甚至导致患者的活动能力下降，降低患者生活质量。虽然临床上难治性皮肤溃疡的治疗方法较多，但临床治疗效果往往不满意，创面愈合缓慢，甚至不愈合[2-3]。富血小板血浆（Platelet-rich plasma，PRP）是血液分离物，含有丰富的血小板源性生长因子，能够诱导组织的生长[4-5]。近年来在组织修复过程中具有较好的效果，笔者医院在难治性皮肤溃疡创面治疗中采用PRP联合混合换药，取得了……