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1、BURN&PLASTIC SURGERY HOSPITAL OF PLA GENERAL HOSPITAL BURNS INSTITUTE OF PLA BURN&PLASTIC SURGERY HOSPITAL OF PLA GENERAL HOSPITAL BURNS INSTITUTE OF PLA 浓缩血小板的研究进展血小板简介及功能血小板血小板是血细胞中的一种，它是从骨髓巨核细胞的细胞质脱落的的具有生物活性的小块胞质，体积小，无细胞核，呈双面微凸的圆盘状。生理特性：粘附、聚集、释放、收缩粘附、聚集、释放、收缩基本功能：止血凝血、维持血管内皮的完整性止血凝血、维持血管内皮的完整性Pla
2、teletultrastructure.13浓缩血小板浓缩血小板（浓缩血小板（Platelets ConcentratePlatelets Concentrate）根据其临床用途可分为两类：两类：第一类第一类：体内，是外科常用的成分输血制品，浓缩血小板一般用于血小板减少，失血症状明显而又需手术者。第二类第二类：体外，常用于局部软组织和骨组织的修复，主要是应用血小板内还有丰富的细胞因子，它们在参与创面的修复过程中发挥重要的作用。目前文献中常见的有四种浓缩血小板类型，也可称为Platelet-RichPreparation应用人群的选择 明确有传染病的患者，如乙肝、梅毒、艾滋等；肿瘤患者；服用血小
3、板抑制剂的或血小板功能存在障碍的患者；如口服阿司匹 林、氯吡格雷等；血小板减少的患者；制备临床上常用的浓缩血小板主要通过两种两种方法制备商业的血小板分离系统商业的血小板分离系统手工分离手工分离制备过程中的影响因素众多，主要包括以下几方面：患者之间的个体差异患者之间的个体差异血液的采集血液的采集：无菌原则、抗凝剂的选择（ACD-A/CPD）、抗凝剂和血液的比例（1:10）离心次数离心次数：单次离心和二次离心转速转速/离心力离心力：Hard and Soft centrifugation 离心时间离心时间离心温度离心温度 商业分离系统CommercialSystemBloodVol(ml)Cent
4、rifugation(No.ofSpins)PRPVol(ml)PlateletConcentrationActivator(+/-)Activator:PRPLeukocytes(+/-)Cascade 9-1814-91-1.5CaCl21:10-GPS 601109.3Trombin1:10+ACP9132-3None1:10-Smart PRP220-12023-204-6Trombin1:10+PRGF9-7214-322-3CaCl21:10-Magellan30-60263-9CaCl21:10+Angel40241-18None1:10+/-Genesis CS30-6014-
5、109CaCl21:10NSSequire50251.6TrombinBovine1:10NSPlatelex5024-6NSBatroxobin1:10+Symphony PCS55-1101NS3-6Thrombin1:10NSJP200020215-9CaCl2andThrombin1:10+GLO PRP8.520.65-6CaCl2andThrombin1:10+KYOCERA20227-8CaCl21:10+Selphyl8120.5CaCl21:10+MyCells10114-5CaCl2andThrombin1:10+Dr.Shins System8.5113-4CaCl2an
6、dThrombin1:10+PCCSCurasan手工分离 FlowchartdescribingpreparationofPRP.2浓缩血小板分类 L-PRP PRP P-PRP 浓缩血小板类型 PRGF L-PRF PRF R-PRF9PRPPRP.Classicalmanualplatelet-richplasma(PRP)protocolusingatwo-stepcentrifugationprocedure.310PRGFPRGFCommonlydescribedprotocolforAnituasPRGF.3PPGF:plasmapooringrowthfactorsPRGF:p
7、lasmarichingrowthfactors11PRFPRFChoukrounsplatelet-richfibrin(PRF)method.312StructuralDifferencesSchematicillustrationofthematrixandcellarchitectureofthefourcategoriesofplateletconcentrates.3Activated versus Nonactivated浓缩血小板的激活14 Activated浓缩血小板的激活方式应该考虑以下三个三个方面：l血小板激活剂血小板激活剂的种类 牛凝血酶、人凝血酶、钙剂、凝血酶受体激活
8、肽（TRAP）、胶原、类凝血酶-巴曲酶、反复冻融、壳聚糖、纳秒脉冲电场（nsPEF）；l激活剂的浓度的选择l激活剂和浓缩血小板的比例影响细胞因子的释放时间影响细胞因子的释放时间影响细胞因子的释放量影响细胞因子的释放量15纳秒脉冲电场（纳秒脉冲电场（Nanosecond Pulse Electric Field，nsPEF）ActivatorRepresentative voltage and currenttracingforpulseelectricfieldconditionused to activatePRP.Electricalsignalsweremeasuredona2mm cu
9、vette containing PRP andstimulatedwithpulseelectricfieldforPRP activation.Each sample wasexposedtofivepulses,ofapproximately500nanosecondspulsewidth,4 kV peak voltage and morethan300Apeakcurrentperpulse.416Non-activatedDiabeticmousefull-thicknesswoundhealing.517Non-activatedEffectsofplatelettreatmen
10、tonfibroblastcultures.5Non-activatedInvitrothree-dimensionaltissuedefectassay.519Activated versus NonactivatedSchematicdepictionoftheeffectofphysiologicandunspecificactivationofplateletsonwoundhealing.420在创面修复中的作用Cytokines/ChemokineIL-6IL-8PF-4MIP-1RANTESFractalkineNAP2GRO-ENA-78sCD40LSDF-1Growth Fa
11、ctorPlateletDerivedGrowthFactor,PDGF-AB/BBTransformingGrowthFactor-beta,TGF-1/2VascularEndothelialGrowthFactor,VEGFEpidermalGrowthFactor,EGFBasicFibroblastGrowthFactor,bFGFInsulinlikeGrowthFactor(IGF1and2)ConnectiveTissueGrowthFactor(CTGF)KeratinocyteGrowthFactor(KGF)HepatocyteGrowthFactor(HGF)Plate
12、letDerivedEndothelialGrowthFactor(PDEGF)PlateletDerivedAngiogenicFactor(PDAF)生长因子在创面修复中的作用Schematicillustrationof the role of GFsduring the differentstages of the woundhealingprocess.622细胞因子在创面修复中的作用ThisistrueforbacterialikeMSSA,GroupAStreptococcus,and Neisseria gonorrhoeae aswell.7.目前存在的问题缺乏统一的浓缩血小
13、板的制备标准临床应用时能否激活仍存在争议，若激活，激活剂种类、浓度及其与浓缩血小板的比例如何确定无法确定有临床疗效的浓缩血小板中最适的血小板的浓度参考文献1.YeamanMR.The role of platelets in antimicrobial host defense.ClinInfectDis199725(5):951-968;quiz969-9702.DhuratRSukeshM.Principles and Methods of Preparation of Platelet-Rich Plasma:A Review and Authors Perspective.JCutan
14、AesthetSurg20147(4):189-1973.DohanEhrenfestDM,RasmussonLAlbrektssonT.Classification of platelet concentrates:from pure platelet-rich plasma(P-PRP)to leucocyte-and platelet-rich fibrin(L-PRF).TrendsBiotechnol200927(3):158-1674.SchererSS,TobalemM,VigatoE et al.Nonactivated versus thrombin-activated pl
15、atelets on wound healing and fibroblast-to-myofibroblast differentiation in vivo and in vitro.PlastReconstrSurg2012129(1):46e-54e5.FrelingerIiiAL,TorresAS,CaiafaA et al.Platelet-rich plasma stimulated by pulse electric fields:Platelet activation,procoagulant markers,growth factor release and cell pr
16、oliferation.Platelets20151-86.EvertsPA,KnapeJT,WeibrichG et al.Platelet-rich plasma and platelet gel:a review.JExtraCorporTechnol200638(2):174-1877.LiHLiB.PRP as a new approach to prevent infection:preparation and in vitro antimicrobial properties of PRP,(2013).The EndThe End Thanks For Your AttentionThanks For Your AttentionBURN&PLASTIC SURGERY HOSPITAL OF PLA GENERAL HOSPITAL BURNS INSTITUTE OF PLA BURN&PLASTIC SURGERY HOSPITAL OF PLA GENERAL HOSPITAL BURNS INSTITUTE OF PLA 此课件下载可自行编辑修改，仅供参考！此课件下载可自行编辑修改，仅供参考！感谢您的支持，我们努力做得更好！谢谢感谢您的支持，我们努力做得更好！谢谢