目的:糖尿病足溃疡(DFU)是糖尿病最严重的并发症之一。富含白细胞和血小板的纤维蛋白(L-PRF)是第二代自体富含血小板的血浆。本研究旨在探讨L-PRF在实际临床实践中对糖尿病患者的临床效果。
方法:纳入2018年至2019年在同济医院接受L-PRF治疗和标准护理(SOC)的DFU患者。包括患者特征在内的临床信息,伤口评估(面积,严重程度,感染,血液供应),DFU的SOC,对溃疡的图像进行回顾性提取和分析。每7±2天进行L-PRF治疗,直到溃疡表现出完全上皮化或总体积百分比减少(PVR)大于80%。疗效,包括整体PVR以及整体和每周的治愈率,进行了评估。
结果:完全,纳入26例DFU患者,他们的溃疡持续时间为47.0(35.0,72.3)天。溃疡的严重程度和感染各不相同,如网站所示,缺血,神经病,细菌感染,深度(SINBAD)评分为2-6,瓦格纳评分为1-4,灌注,程度,深度,感染和感觉(PEDIS)评分2-4。L-PRF治疗前的初始溃疡体积为4.94(1.50,13.83)cm3,最终溃疡体积为0.35(0.03,1.76)cm3。L-PRF剂量的中位数为3(2,5)。共有11例患者在治疗第五周后达到完全上皮化,和19例患者在第七周后实现了至少80%的体积减少。整体伤口愈合率为1.47(0.63,3.29)cm3/周,前2周的愈合速度快于其余周。同时治疗未改变完全上皮形成或愈合率的百分比。
结论:将L-PRF加入SOC可显著改善DFU患者的伤口愈合,而与踝肱指数无关。SINBAD得分,或者瓦格纳等级,表明该方法适用于不同临床条件下的DFU治疗。
OBJECTIVE: Diabetic foot ulcer (DFU) is one of the most serious complications of diabetes. Leukocyte- and platelet-rich fibrin (L-PRF) is a second-generation autologous platelet-rich plasma. This study aims to investigate the clinical effects of L-PRF in patients with diabetes in real clinical practice.
METHODS: Patients with DFU who received L-PRF treatment and standard of care (SOC) from 2018 to 2019 in Tongji Hospital were enrolled. The clinical information including patient characteristics, wound evaluation (area, severity, infection, blood supply), SOC of DFU, and images of ulcers was retrospectively extracted and analyzed. L-PRF treatment was performed every 7±2 days until the ulcer exhibited complete epithelialization or an overall percent volume reduction (PVR) greater than 80%. Therapeutic effectiveness, including overall PVR and the overall and weekly healing rates, was evaluated.
RESULTS: Totally, 26 patients with DFU were enrolled, and they had an ulcer duration of 47.0 (35.0, 72.3) days. The severity and infection of ulcers varied, as indicated by the Site, Ischemia, Neuropathy, Bacterial Infection, and Depth (SINBAD) scores of 2-6, Wagner grades of 1-4, and the Perfusion, Extent, Depth, Infection and Sensation (PEDIS) scores of 2-4. The initial ulcer volume before L-PRF treatment was 4.94 (1.50, 13.83) cm3, and the final ulcer volume was 0.35 (0.03, 1.76) cm3. The median number of L-PRF doses was 3 (2, 5). A total of 11 patients achieved complete epithelialization after the fifth week of treatment, and 19 patients achieved at least an 80% volume reduction after the seventh week. The overall wound-healing rate was 1.47 (0.63, 3.29) cm3/week, and the healing rate was faster in the first 2 weeks than in the remaining weeks. Concurrent treatment did not change the percentage of complete epithelialization or healing rate.
CONCLUSIONS: Adding L-PRF to SOC significantly improved wound healing in patients with DFU independent of the ankle brachial index, SINBAD score, or Wagner grade, indicating that this method is appropriate for DFU treatment under different clinical conditions.