富血小板血浆促进骨修复的机制及应用

背景：目前普遍认为富血小板血浆具有促进骨修复的作用,但其具体机制尚未完全阐明,富血小板的最佳应用方式仍不明确。 目的：综述近期富血小板血浆促进骨修复机制及应用的研究进展。 方法：由第一作者检索1995/2011 PubMed与CNKI数据库有关富血小板血浆促进骨修复机制及应用的相关文献,排除与研究目的相关性差及内容陈旧、重复的文献。中文关键词为“富血小板血浆,生长因子,骨修复”,英文关键词为“Platelet-rich plasma,Growth factor,Bone repair”。共纳入25篇符合标准的文献进行综述。 结果与结论：富血小板血浆含有多种高浓度生长因子,普遍的观点认为聚合过程中血小板脱颗粒释放多种生长因子联合作用加速了骨修复的过程。单独应用富血小板血浆对骨修复的治疗效果不如与其他物质复合使用效果明显。     

富血小板血浆在深度烧伤创面治疗中的应用进展

富血小板血浆(PRP)是一种从自体静脉血提取的富含高浓度血小板的血浆,其被激活后可释放大量生长因子参与创面修复过程。该技术作为一种促进组织修复的新型治疗手段,已在糖尿病足、静脉性溃疡等慢性创面的治疗中被广泛应用,而且在深度烧伤创面中的应用也逐渐增多。本文将对PRP影响深度烧伤创面愈合的机制、目前PRP在深度烧伤创面中应用的具体实践和效果展开综述,以期为PRP技术应用于烧伤创面提供理论支持,并指导烧伤专科医师的临床实践。     

富血小板血浆修复重建退变腰椎间盘组织的基础与临床研究进展

腰椎间盘退变及其诱发的下腰痛是中老年人群的常见疾病,给患者和社会带来了沉重的医疗和经济负担,目前临床上尚无有效的根治方法。富血小板血浆(platelet-rich plasma,PRP)是自体全血经离心后得到的血小板浓缩物,因其独特的生物学活性,已用于多种慢性疼痛、骨骼与软组织损伤性疾病的临床替代疗法。既往研究显示,富血小板血浆释放的多种生长因子及细胞因子能有效抑制退变椎间盘的细胞凋亡并抑制细胞外基质降解,尤其在退变早期发挥重要作用,有望从根本上阻遏甚至逆转退变进程,从而减轻疼痛和促进修复。我国这一领域研究较少,相关临床证据尤其不足。本文主要对国内外PRP促进退变椎间盘修复的动物实验和临床研究进展进行综述。     

自体富血小板血浆在糖尿病足治疗中的应用进展

糖尿病足引发的慢性难愈性创面是目前社会所面临的重要健康问题之一。目前,糖尿病足有越来越多先进的治疗方案,包括组织工程人工皮肤替代物法、高压氧治疗法、应用负压敷料等,然而,仍缺少十分有效的治疗手段。自体富血小板血浆(PRP)富含血小板、白细胞、生长因子等多种成分,具有促进创面修复,减轻创面疼痛,封闭保护创面,抑制局部细菌生长等特点,在糖尿病足治疗的应用中有确实的疗效。随着PRP技术日趋成熟,PRP可能成为糖尿病足领域最有发展前景的治疗方式之一。     

富血小板血浆临床应用及其生物材料性能

背景：富血小板血浆的制备方法、设备及应用手段等方面有了长足发展,但是相对于国内临床工作者而言富血小板血浆技术仍是一项相对较新的生物技术。 目的：对富血小板血浆分类等相关概念和存在问题加以说明和论述,使其制备和应用技术等更加清晰和明确。 方法：以“platelet rich plasma,preparation,富血小板血浆,制备”为检索词,检索PubMed数据库及维普数据库1995-09/ 2010-09相关文章。 结果与结论：根据所含白细胞的多少可以将富血小板血浆分为贫白细胞的富血小板血浆和富白细胞的富血小板血浆;根据应用形式又可以分为未激活富血小板血浆和激活的富血小板血浆,后者又可以分为富血小板血浆凝胶和富血小板血浆释放物。被视为第二代血小板浓缩物的富血小板纤维蛋白与富血小板血浆都含有高浓度的血小板,但两者在制备方法,凝胶形成方式等方面有根本的区别。由于其安全性和易于制备,富血小板血浆在医学领域的应用将会越来越多,但临床应用还要保持谨慎,因为富血小板血浆在多个方面还缺乏相关研究。     

富血小板血浆(PRP)治疗慢性难愈合伤口的初步经验

目的观察自体富血小板血浆对慢性难愈合伤口创面的修复作用。方法12个创面中，糖尿病性溃疡4例，创伤性溃疡3例，压迫性溃疡3例，神经性溃疡2例。创面清创后用PRP凝胶修复，然后定期比较PRP与全血中的血小板计数，观察创面愈合情况。结果PRP的血小板计数约为全血的5～8倍。用PRP修复的12例中，创面完全愈合7例，部分愈合3例，皮瓣转移后愈合2例。结论PRP凝胶对慢性难愈合伤口有明显的修复作用，且应用安全，无痛苦。     

骨转化标志物评价富血小板血浆辅助治疗胫骨骨折手术后的不愈合

背景:富血小板血浆凭借其超强的促进愈合作用在临床上逐渐得到应用,但目前缺少高质量临床对比研究来明确其对骨折不愈合的作用及作用机制.目的:比较富血小板血浆联合手术治疗与单纯手术治疗胫骨干骨折术后不愈合的效果,分析相应骨折修复实验室指标.方法:收集2017年1月至2020年1月青岛大学附属威海市中心医院连续收入的胫骨干骨折...     

自体浓缩生长因子在创面修复中的应用前景

多种生长因子协同参与创面的修复过程,目前临床上仍缺乏强效的生长因子生物制剂。自体浓缩生长因子(CGF)含有浓缩的生长因子及纤维蛋白,能改善和增强组织再生能力,具有促进创面愈合的作用。与富血小板血浆和富血小板纤维蛋白相比,CGF中生长因子含量及纤维蛋白的黏合度和拉伸强度均高于富血小板血浆和富血小板纤维蛋白。作为新一代血小板浓缩物,CGF具有更加优越的临床和生物技术应用潜力,在创面修复中具有潜在的临床应用前景,本文综述了这方面的研究现状及存在问题。     

自体单采富血小板血浆凝胶临床制作与应用

目的介绍利用全自动血液成分分离机制备自体富血小板血浆凝胶技术及其临床应用,总结其在各类创面修复中的应用方法及效果,并与传统制作方法进行比较,为临床修复各类创面提供新方案及治疗建议。方法 2013年1月至2016年3月,笔者科室使用全自动血液成分分离机制备自体富血小板血浆凝胶技术,治疗各类创面92例。创面处理前,先使用全自动血液采集装置采集血小板,后二次离心浓缩,制成富血小板血浆;术中创面行彻底清创后,将富血小板血浆注入窦道或涂于创面,通过激活剂激活形成凝胶,术后经负压吸引治疗,定期更换辅料,部分创面可换药愈合,部分可通过自体皮移植修复。结果使用全自动血液成分分离机制备自体富血小板血浆凝胶技术治疗各类急慢性创面92例,创面肉芽增生满意,窦道封闭良好,抗感染能力强,特别对于骨质、肌腱外露创面,肉芽覆盖速度快,对于窦道封闭效果好,术后复查无死腔。结论全自动血液成分分离机制备自体富血小板血浆凝胶技术治疗各类急慢性创面,较以往换药、负压、手术清创、皮瓣(肌皮瓣)等修复方式有较大优势,同时与自体全血离心技术采集富血小板血浆凝胶比较,优势明显;该治疗技术简单易行,损伤小,治疗时间短,不易复发,安全可靠。     

富血小板血浆在风湿性疾病中的研究进展

富血小板血浆(PRP)富含大量生长因子，趋化因子，细胞因子及血浆蛋白，不仅可控制炎症，更有促进组织修复的作用。PRP逐渐成为风湿性疾病治疗的新热点。本文综述了PRP在骨关节炎、类风湿关节炎、干燥综合征、系统性硬化症、结缔组织病相关顽固性皮肤溃疡等疾病中的研究进展。未来需要更多学者积极尝试PRP在其他风湿性疾病中的疗效，同时，PRP联合间充质干细胞治疗在难治性风湿病中具有巨大应用前景。     

Platelet and growth factor concentrations in activated platelet-rich plasma: a comparison of seven commercial separation systems

Platelet-rich plasma (PRP) is blood plasma that has been enriched with platelets. It holds promise for clinical use in areas such as wound healing and regenerative medicine, including bone regeneration. This study characterized the composition of PRP produced by seven commercially available separation systems (JP200, GLO PRP, Magellan Autologous Platelet Separator System, KYOCERA Medical PRP Kit, SELPHYL, MyCells, and Dr. Shin’s System THROMBO KIT) to evaluate the platelet, white blood cell, red blood cell, and growth factor concentrations, as well as platelet-derived growth factor-AB (PDGF-AB), transforming growth factor beta-1 (TGF-β1), and vascular endothelial growth factor (VEGF) concentrations. PRP prepared using the Magellan Autologous Platelet Separator System and the KYOCERA Medical PRP Kit contained the highest platelet concentrations. The mean PDGF-AB concentration of activated PRP was the highest from JP200, followed by the KYOCERA Medical PRP Kit, Magellan Autologous Platelet Separator System, MyCells, and GLO PRP. TGF-β1 and VEGF concentrations varied greatly among individual samples, and there was almost no significant difference among the different systems, unlike for PDGF. The SELPHYL system produced PRP with low concentrations of both platelets and growth factors. Commercial PRP separation systems vary widely, and familiarity with their individual advantages is important to extend their clinical application to a wide variety of conditions.     

The biology of platelet-rich plasma and its application in oral surgery: literature review

Platelet-rich plasma (PRP) is a new approach in tissue regeneration and a developing area for clinicians and researchers. It is used in various surgical fields, including oral and maxillofacial surgery. PRP is prepared from the patient's own blood and contains growth factors that influence wound healing. Of these growth factors, platelet-derived growth factor, transforming growth factor, insulin-like growth factor, and epidermal growth factor play a pivotal role in tissue repair mechanisms. Although the growth factors and mechanisms involved are still poorly understood, the easy application of PRP in the clinic and its possible beneficial outcome, including reduction of bleeding, rapid soft tissue healing, and bone regeneration, hold promise for new treatment approaches. However, animal studies and human trials demonstrate conflicting results regarding the application of PRP. Therefore the aim of this literature review is to evaluate the scientific evidence regarding the use of PRP in dentistry, to describe the different bioactive substances included in PRP and their participation in the healing process, to elucidate the different techniques and available technology for PRP preparation, to review animal and human studies, to clarify risks, and to provide guidance for future research.     

Platelet biology in regenerative medicine of skeletal muscle

Platelet‐based applications such as platelet‐rich plasma (PRP) and platelet releasate have gained unprecedented attention in regenerative medicine across a variety of tissues as of late. The rationale behind utilizing PRP originates in the delivery of key cytokines and growth factors from α‐granules to the targeted area, which in turn act as cell cycle regulators and promote the healing process across a variety of tissues. The aim of the present review is to assimilate current experimental evidence on the role of platelets as biomaterials in tissue regeneration, particularly in skeletal muscle, by integrating findings from human, animal and cell studies. This review is composed of 3 parts: firstly, we review key aspects of platelet biology that precede the preparation and use of platelet‐related applications for tissue regeneration. Secondly, we critically discuss relevant evidence on platelet‐mediated regeneration in skeletal muscle focusing on findings from (i) clinical trials, (ii) experimental animal studies and (iii) cell culture studies; and thirdly, we discuss the application of platelets in the regeneration of several other tissues including tendon, bone, liver, vessels and nerve. Finally, we review key technical variations in platelet preparation that may account for the large discrepancy in outcomes from different studies. This review provides an up‐to‐date reference tool for biomedical and clinical scientists involved in platelet‐mediated tissue regenerative applications.     

Platelet-rich plasma: quantification of growth factor levels and the effect on growth and differentiation of rat bone marrow cells

Platelet-rich plasma (PRP) is a new application of tissue engineering and a developing area for clinicians and researchers. It is a storage vehicle of growth factors (GFs) such as platelet-derived growth factor (PDGF)- AA, -BB, -AB; transforming growth factor (TGF)-beta1 and -2; platelet-derived epidermal growth factor (PDEGF); platelet-derived angiogenesis factor (PDAF); insulin growth factor-1 (IGF-1); and platelet factor- 4 (PF-4), which are known to influence bone regeneration. However, animal and clinical studies reveal different results with the use of PRP and its effect on bone healing. This could be due to the differences between species, that is, differences between species in GF concentrations or variation in presence of GFs between the various PRPs. In this study, rat bone marrow cells were cultured in PRP-coated wells or in uncoated wells for 16 days in osteogenic medium, and analyzed on cell growth (DNA content) and cell differentiation (alkaline phosphatase [ALP] activity, calcium content, scanning electron microscopy, and QPCR). The concentrations of TGF-beta1, PDGF-AA, PDGF-AB, and PDGF-BB in rat, goat, and human PRP were subsequently determined. The results showed that PRP stimulated initial cell growth and had no effect on ALP activity. The calcium measurements showed a significant increase in calcium at days 8, 12, and 16. The real-time PCR results showed that PRP upregulated osteocalcin at day 1 and collagen type I at day 8. Overall, the immunoassays revealed that human PRP contained higher concentrations of growth factors per platelet compared to rat and goat PRP. Goat PRP showed higher concentrations of growth factors per platelet as compared to rat PRP except for PDGF-BB, which had a higher concentration in rat PRP. TGF-beta1 was the most abundant growth factor in all 3 PRPs. On the basis of our results, we conclude that platelet-rich plasma contains osteo-inductive growth factors, which are probably species related. However, we cannot generalize the results because of large intraspecies variations. Further, we conclude that rat PRP gel stimulates initial growth and differentiation of rat bone marrow cells in vitro.     

Positive effect on bone fusion by the combination of platelet-rich plasma and a gelatin β-tricalcium phosphate sponge: a study using a posterolateral fusion model of lumbar vertebrae in rats

We developed a novel method for bone fusion by combining platelet-rich plasma (PRP) and a gelatin β-tricalcium phosphate (β-TCP) sponge. The PRP is an autologous concentration of platelets that includes several growth factors. The gelatin β-TCP sponge comprises gelatin and β-TCP, thus enabling the sustained release of growth factors and osteoconduction. To evaluate this method, we generated a posterolateral fusion model of lumbar vertebrae in rats and divided it into five groups by implanting the following materials between transverse processes of vertebrae, (1) the gelatin β-TCP sponge with PRP (PRP sponge), (2) the gelatin β-TCP sponge with platelet-poor plasma, (3) gelatin hydrogel with PRP, (4) autologous iliac bone (autograft), and (5) no material was implanted as a control. The assessment of bone fusion by a radiographic assessment, a biomechanical test, microcomputed tomography, and histological evaluations demonstrated that there were no significant differences between the PRP sponge and the autograft groups regarding the osteogenic effect. Subsequent examinations revealed that no significant differences existed between the PRP sponge and the autograft groups in either biomechanical stiffness or the bone volume over time; whereas the radiographic and histological composition underwent similar changes in the fusion process. These results indicate that the PRP sponge could, therefore, be potentially useful as an attractive and less invasive method for bone fusion.     

自体富血小板血浆修复慢性难愈性创面的作用：回顾性研究和文献检索证据分析

文题释义： 慢性难愈性创面：通常把各种内外因作用下创面不能通过正常的创面愈合过程而达到愈合,呈现病理性炎症反应状态,从而导致创面经久难愈的称为慢性难愈性创面。 富血小板血浆：是通过离心自体血而提取出的含有高浓度血小板的血浆,除血小板外,其中含有多种高浓度的生长因子及纤维蛋白。 背景：自体富血小板血浆对难愈性创面有一定修复效果,可加快软组织愈合速度。而富血小板血浆凝胶可以防止血小板的流失,使血小板在局部长时间存活并分泌生长因子,更有利于创面愈合。 目的：观察自体富血小板血浆凝胶对慢性难愈性创面的修复作用,并分析其研究现状。 方法：①收集慢性难愈性创面病例22例,其中糖尿病性溃疡8例,创伤性溃疡3例,创伤后骨不连3例,电烧伤后骨外露2例,放射性溃疡6例,创面行清创手术后用富血小板血浆凝胶外用,定期换药并更换富血小板血浆凝胶,观察创面愈合情况;②由第一作者检索万方数据库近10年的有关自体富血小板血浆凝胶治疗慢性难愈性创面的相关文献,并分析研究现状。 结果与结论：①回顾性分析结果表明,富血小板血浆修复的22例慢性难愈性创面病例,创面完全愈合11例,创面缩小后经皮瓣转移后愈合5例,行游离植皮治疗获得愈合6例,患者均无疾病传播及免疫排斥反应,结果证实富血小板血浆凝胶对慢性难愈合伤口有明显的修复作用,安全有效;②文献检索结果显示,纳入文献32篇,其中2016年到2018年对自体富血小板血浆在慢性难愈性创面的研究发文量逐年升高,但现有证据尚缺乏说服力,缺乏大规模、多中心、前瞻性随机对照研究,如何规范富血小板血浆的制备及使用过程以保证疗效的稳定性还有待进行更多的探索。 ORCID: 0000-0002-2480-5159(李万同) 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

富血小板血浆在骨愈合治疗中的作用

背景：富血小板血浆可明显促进各种组织的修复和愈合。临床上运用其治疗骨软骨以及软组织缺损等骨科疾病方面已取得了很多成果。 目的：简要综述近年来富血小板血浆相关研究,总结其在骨科基础研究与临床应用中的进展。 方法：以“platelet-rich plasma, bone formation, tissue engineering”为检索词,检索Pubmed数据库(1999-01/2011-01),以“富血小板血浆,骨缺损,组织工程”为检索词,检索中国期刊全文数据库(1999-01/2011-01)。纳入与干细胞以及干细胞在骨科应用方面的基础和临床研究,排除不相关及重复研究。计算机初检得到301篇文献,根据纳入排除标准,最终纳入62篇。 结果与结论：尽管目前还存在争论,但富血小板血浆仍是一种非常有潜力的技术,尤其是作为细胞支架在组织工程中的应用如能被进一步研究证实有效,将对骨组织工程乃至其他各种组织工程研究产生重大的影响。因此除了规范研究在循证医学方面的要求之外,这应该是富血小板血浆今后研究的有一个重要方向。     

Incorporating platelet-rich plasma into electrospun scaffolds for tissue engineering applications

Platelet-rich plasma (PRP) therapy has seen a recent spike in clinical interest due to the potential that the highly concentrated platelet solutions hold for stimulating tissue repair and regeneration. The aim of this study was to incorporate PRP into a number of electrospun materials to determine how growth factors are eluted from the structures, and what effect the presence of these factors has on enhancing electrospun scaffold bioactivity. PRP underwent a freeze-thaw-freeze process to lyse platelets, followed by lyophilization to create a powdered preparation rich in growth factors (PRGF), which was subsequently added to the electrospinning process. Release of protein from scaffolds over time was quantified, along with the quantification of human macrophage and adipose-derived stem cell (ADSC) chemotaxis and proliferation. Protein assays demonstrated a sustained release of protein from PRGF-containing scaffolds at up to 35 days in culture. Scaffold bioactivity was enhanced as ADSCs demonstrated increased proliferation in the presence of PRGF, whereas macrophages demonstrated increased chemotaxis to PRGF. In conclusion, the work performed in this study demonstrated that the incorporation of PRGF into electrospun structures has a significant positive influence on the bioactivity of the scaffolds, and may prove beneficial in a number of tissue engineering applications.