自体富血小板凝胶治疗对糖尿病足溃疡患者修复效果及生活质量的影响
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摘要
目的分析自体富血小板凝胶(APG)治疗对糖尿病足溃疡(DFU)患者修复效果及生活质量的影响。方法将我院自2013年7月-2017月11月间收治的64例糖尿病足患者按区化随机化分为APG组(n=32)及对照组(n=32),对照组清创后给予重组牛碱性成纤维细胞生长因子凝胶,APG组则给予自体富血小板凝胶,对比两组溃疡创面愈合率、创面修复效果、创面愈合时长及生活质量。结果两组总体溃疡面积、表浅溃疡面积、窦道溃疡体积、Wagner2级溃疡及Wagner3级溃疡面积比较差异均无统计学意义(P>0.05);治疗1周后,APG组总体溃疡、表浅溃疡、窦道溃疡、Wagner2级及Wagner3级溃疡愈合率均显著高于对照组(P<0.05);8周时APG组总体溃疡、窦道溃疡、Wagner3及溃疡愈合率仍显著高于对照组(P<0.05);且APG组肉芽组织覆盖率、肉芽组织生长厚度、创面细菌清除率均显著高于对照组(P<0.001),总体溃疡、表浅溃疡、窦道溃疡、Wagner2级、Wagner3级溃疡面积/体积修复时长均较对照组短(P<0.001);糖尿病生存质量特异性分数量表中生理功能、心理或精神维度、社会关系、治疗影响等维度分值亦低于对照组(P<0.05)。结论于DFU患者,自体富血小板凝胶治疗或能取得更佳的创面愈合及修复获益,对生活质量的改善作用亦更显著。
Objective To analyze the repair effect of autologous platelet-rich gel( APG) on diabetic foot ulcer( DFU)and the effect on quality of life. Methods Sixty-four patients with diabetic foot problems admitted to the hospital between July2013 and November 2017 were randomly divided into APG group( n = 32) and control group( n = 32). The control group was treated with recombinant bovine basic fibroblast growth factor gel after debridement,while the APG group was treated with APG.The ulcer healing rate,wound repair effect,wound healing time and quality of life were compared between the two groups.Results There was no significant difference in the total ulcer area,superficial ulcer area,sinus tract ulcer volume,Wagner 2 ulcer or Wagner 3 ulcer area between the two groups( P>0.05). The healing rates of total ulcers,superficial ulcers,sinus tract ulcers,Wagner 2 ulcers and Wagner 3 ulcers in APG group were significantly higher than those in the control group after one week of treatment( P<0.05). The healing rates of total ulcers,sinus tract ulcers and Wagner 3 ulcers in APG group after eight weeks of treatment were still significantly higher than those in the control group( P<0.05). The granulation tissue coverage rate,granulation tissue growth thickness and wound bacterial clearance rate in APG group were significantly higher than those in the control group( P<0.001). The duration of repair for overall ulcers,superficial ulcers,sinus tract ulcers,Wagner 2 and Wagner 3 ulcers in APG was shorter than that in the control group( P<0.001). Scores of dimensions of quality of life,such as physical function,psychological or spiritual dimension,social relationships,and treatment effect in APG group were lower than those in the control group( P<0.05). Conclusion For patients with DFU,APG can help wound healing and repair. It can also significantly improve the quality of life of patients.
Objective To analyze the repair effect of autologous platelet-rich gel( APG) on diabetic foot ulcer( DFU)and the effect on quality of life. Methods Sixty-four patients with diabetic foot problems admitted to the hospital between July2013 and November 2017 were randomly divided into APG group( n = 32) and control group( n = 32). The control group was treated with recombinant bovine basic fibroblast growth factor gel after debridement,while the APG group was treated with APG.The ulcer healing rate,wound repair effect,wound healing time and quality of life were compared between the two groups.Results There was no significant difference in the total ulcer area,superficial ulcer area,sinus tract ulcer volume,Wagner 2 ulcer or Wagner 3 ulcer area between the two groups( P>0.05). The healing rates of total ulcers,superficial ulcers,sinus tract ulcers,Wagner 2 ulcers and Wagner 3 ulcers in APG group were significantly higher than those in the control group after one week of treatment( P<0.05). The healing rates of total ulcers,sinus tract ulcers and Wagner 3 ulcers in APG group after eight weeks of treatment were still significantly higher than those in the control group( P<0.05). The granulation tissue coverage rate,granulation tissue growth thickness and wound bacterial clearance rate in APG group were significantly higher than those in the control group( P<0.001). The duration of repair for overall ulcers,superficial ulcers,sinus tract ulcers,Wagner 2 and Wagner 3 ulcers in APG was shorter than that in the control group( P<0.001). Scores of dimensions of quality of life,such as physical function,psychological or spiritual dimension,social relationships,and treatment effect in APG group were lower than those in the control group( P<0.05). Conclusion For patients with DFU,APG can help wound healing and repair. It can also significantly improve the quality of life of patients.
引文
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[9]陈婕,白玉.糖尿病足溃疡临床特点及愈合的影响因素分析[J].现代仪器与医疗,2017,23(6):41.
[10]张杉杉,赵连礼,何泱,等.常见不同细菌感染对糖尿病足溃疡患者病情和短期预后的影响[J].中华内分泌代谢杂志,2017,33(1):11.
[11]刘风.自体富血小板凝胶治疗糖尿病皮肤慢性难愈合创面的机制及临床应用进展[J].重庆医学,2017,46(6):848.
[12]刘玉梅,邓本强.RFC-1基因多态性与急性脑梗塞的相关性研究[J].医学分子生物学杂志,2017,14(2):91.
[2]阚全娥,杨慧慧,李全忠.糖尿病足溃疡不同程度感染的影响因素分析[J].中华医院感染学杂志,2014,24(24):6151.
[3]王冰洋,牛广明,杜华,等.不同敷料在糖尿病足溃疡伤口治疗中的研究与应用[J].中国组织工程研究,2016,20(34):5155.
[4]班绎娟,王爱红,许樟荣.富血小板凝胶治疗难愈性糖尿病足溃疡的随机对照研究[J].中国糖尿病杂志,2015,7(5):306.
[5]国际血管联盟中国分会糖尿病足专业委员会.糖尿病足诊治指南[J].介入放射学杂志,2013,22(9):705.
[6]方积乾.生存质量测定方法及应用[M].北京.北京医科大学出版社,2000:304.
[7]颜文婷,徐海燕,魏忠诚,等.老年冠心病患者血清VEGF、NT-pro BNP、c Tn T与冠状动脉病变程度的相关性[J].医学分子生物学杂志,2017,14(2):96.
[8]DUBSK(Y)M,JIRKOVSKA A,BEM R,等.糖尿病足溃疡复发的危险因素:对Eurodiale研究亚组的前瞻性随访分析[J].中国糖尿病杂志,2014,6(8):628.
[9]陈婕,白玉.糖尿病足溃疡临床特点及愈合的影响因素分析[J].现代仪器与医疗,2017,23(6):41.
[10]张杉杉,赵连礼,何泱,等.常见不同细菌感染对糖尿病足溃疡患者病情和短期预后的影响[J].中华内分泌代谢杂志,2017,33(1):11.
[11]刘风.自体富血小板凝胶治疗糖尿病皮肤慢性难愈合创面的机制及临床应用进展[J].重庆医学,2017,46(6):848.
[12]刘玉梅,邓本强.RFC-1基因多态性与急性脑梗塞的相关性研究[J].医学分子生物学杂志,2017,14(2):91.