中国组织工程研究

中国组织工程研究 ›› 2018, Vol. 22 ›› Issue (20): 3263-3266.doi: 10.3969/j.issn.2095-4344.0806

• 组织构建综述 tissue construction review • 上一篇    下一篇

自体脂肪移植中应用的血小板浓缩制品：尚无量化评估及应用指南

张天嘉，代杰文，王旭东   

  1. 上海交通大学医学院附属第九人民医院口腔颅颌面科，上海市口腔医学重点实验室，上海市  200011
  • 收稿日期:2017-11-15 出版日期:2018-07-18 发布日期:2018-07-18
  • 通讯作者: 王旭东，博士，博士生导师，教授，主任医师，上海交通大学医学院附属第九人民医院口腔颅颌面科，上海市口腔医学重点实验室，上海市 200011
  • 作者简介:张天嘉，男，1992年生，浙江省绍兴市人，汉族，上海交通大学口腔医学院在读硕士，主要从事口腔颌面畸形的临床与基础研究。
  • 基金资助:

    上海市促进市级医院临床技能与临床创新能力三年行动计划(16CR3019A)；上海交通大学医学院附属第九人民医院临床研究助推计划(JYLJ006)；2017年上海交通大学“医工交叉基金”(YG2017ZD03)

Application of concentrated platelet products in autologous fat grafting: lack of quantitative indicators and application guidelines

Zhang Tian-jia, Dai Jie-wen, Wang Xu-dong   

  1. Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai 200011, China
  • Received:2017-11-15 Online:2018-07-18 Published:2018-07-18
  • Contact: Wang Xu-dong, M.D., Doctoral supervisor, Professor, Chief physician, Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai 200011, China
  • About author:Zhang Tian-jia, Studying for master’s degree, Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai 200011, China
  • Supported by:

    the Shanghai Three-Year Action Plan of Promoting the Clinical Skill and Innovation Abilities of Municipal Hospitals, No. 16CR3019A; the Plan for Promoting Clinical Research of Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, No. JYLJ006; the Medical-Engineering Cross Foundation of Shanghai Jiao Tong University in 2017, No. YG2017ZD03

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摘要：

文章快速阅读：
文题释义：
血小板浓缩制品：血小板作为一种多功能细胞，激活后可释放多种生物活性物质，经梯度离心浓缩的血小板制品在局部软组织及骨组织愈合中可起到重要促进作用。
自体脂肪移植：吸出自身腰、腹、大腿等部位多余脂肪，经离心、提纯、净化处理后，将完整的脂肪细胞颗粒注射至面颊或身体其余部位修复缺陷或畸形。
摘要
背景：面部脂肪移植技术已十分成熟，但依然存在远期效果不稳定、容易吸收等不足。血小板浓缩制品可以促进脂肪生长，减少术后反应，与脂肪细胞混合后可以提高自体脂肪移植的远期临床效果。
目的：综述富血小板血浆、富血小板纤维蛋白和浓缩生长因子3种血小板浓缩制品的活性成分、性能、基础研究与临床应用进展。
方法：计算机检索建库至2017年CNKI，万方，PubMed及Medline 数据库关于血小板浓缩制品与自体脂肪移植的文献，检索词分别为“富血小板血浆；富血小板纤维蛋白；浓缩生长因子；脂肪移植；生存率”和“platelet-rich plasma；platelet-rich fibrin；concentrated growth factor；fat graft；survival”。最初共检索到940篇文献，按纳入和排除标准对文献进行筛选，共纳入54篇文献进一步总结分析。
结果与结论：①富血小板血浆作为较早制备的血小板浓缩产品，通过激活各种生长因子提高脂肪移植的存活率，但实验结果评估相对主观，富血小板血浆在脂肪移植中的作用尚有较多的争议；②富血小板纤维蛋白作为富血小板血浆的替代产品，因其在制作中无需添加任何外源物质，在简便性及安全性上拥有较为明显的优势，其中富血小板纤维蛋白特有的抗炎因子、纤维蛋白成分以及生长因子的缓释性，在促脂肪移植中具有更好的效果；③最新的血小板浓缩产品浓缩生长因子，相比富血小板纤维蛋白提供了独有的CD34+干细胞，且拥有更多的纤维蛋白，提供了立体的纤维蛋白支架结构，使其在促进脂肪移植的效果上有了更好的保证。除此之外，浓缩生长因子可以制备为凝胶或者液体形态，在临床上具有更广泛的应用前景；④但是目前的研究结果大多数采用主观评分表，还应引入CT和MRI等客观影像学评价方法。此外，需要开展随机对照临床试验，最终建立血小板浓缩制品的临床应用指南，以促进其在脂肪移植领域的发展。

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
ORCID: 0000-0002-3559-6102(张天嘉)

关键词: 组织构建, 富血小板血浆, 富血小板纤维蛋白, 浓缩生长因子, 自体脂肪移植, 量化评估, 临床应用

Abstract:

BACKGROUND: Autologous fat grafting is a mature treatment for soft tissue reconstruction, but some disadvantages such as unpredictable results and variable reabsorption still exist. Concentrated platelet products have been shown to promote adipogenesis, reduce postoperative adverse reactions, and enhance fat graft survival combined with adipocytes.
OBJECTIVE: To review the compositions, properties, research progress and clinical application of platelet-rich plasma, platelet-rich fibrin and concentrated growth factor.
METHODS: A computer-based retrieval of CNKI, WanFang, PubMed and Medline databases was performed for the articles concerning concentrated platelet products and autologous fat grafting published before 2017. The keywords were “platelet-rich plasma, platelet-rich fibrin, concentrated growth factor, fat graft, survival” in English and Chinese, respectively. Initially 940 articles were retrieved, and finally 54 eligible articles were included according to the inclusion and exclusion criteria.
RESULTS AND CONCLUSION: Platelet-rich plasma, the first generation of concentrated platelet products, has been reported to promote fat graft survival by activating various factors. However, its roles still remain controversial because of a subjective but not objective assessment. As the substitute of platelet-rich plasma, platelet-rich fibrin possesses overt advantages in manufacturing process and safety. Moreover, its unique anti-inflammatory cytokines, fibrin and sustained-release nerve growth factor achieve satisfactory effects in fat grafting. Compared with platelet-rich fibrin, the newly emerged concentrated growth factor holds CD34+ stem cells and more fibrin, and provides a three-dimensional fibrin graft, ensuring a better outcome in fat transplantation. Importantly, the newly developed concentrated growth factors gel and liquid will be extensively applied in fat transplantation. Nevertheless, assessment methods need to be improved, and CT, MRI and other radiological methods should be adopted. Additionally, more clinical controlled trials are needed to lay down a clinical guidance, so as to enhance the development of concentrated platelet products in fat transplantation.

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

Key words: Platelet-Rich Plasma, Fibrin, Tissue Engineering

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