改良型PRF與普通型PRF在脂肪移植應用中的實驗對比研究

柳芳 趙宇 馬莉

[摘要]目的：探索改良型富血小板纖維蛋白（advance platetel-rich fribin，A-PRF）與普通型富血小板纖維蛋白（platetel-rich fribin，PRF）在脂肪移植中的應用效果，進而為臨床應用提供指導。方法：將18只實驗兔隨機分成三組，實驗組（A-PRF組）：取兔背部脂肪組織，將2ml A-PRF+1ml顆粒脂肪移植到兔耳分離好的區域;陽性對照組（PRF組）：兔耳移植區移入2ml PRF+1ml顆粒脂肪;陰性對照組（NS組）：兔耳移植區移入2ml生理鹽水+1ml顆粒脂肪。分別于4周、8周、12周取材進行大體觀察、稱重、HE染色與免疫染色來比較三組間脂肪成活差異。結果：各時間點，A-PRF組的脂肪存活率及新生毛細血管密度明顯優于其他兩組，PRF組結果優于NS組，且三組間比較差異有統計學意義（P<0.05）。結論：A-PRF在增加脂肪細胞成活率、減輕炎癥反應及促進毛細血管新生方面優于普通型PRF，這為A-PRF的臨床使用提供參考。

[關鍵詞]A-PRF;PRF;顆粒脂肪移植;脂肪細胞成活率;VEGF;細胞因子

[中圖分類號]R622 ? ?[文獻標志碼]A ? ?[文章編號]1008-6455（2019）11-0082-04

Abstract： Objective ?To explore the application of advanced platelet-rich fibrin （A-PRF） and common platelet-rich fibrin （PRF） in fat transplantation in rabbit. Provide guidance for clinical applications. Methods ?Eighteen experimental rabbits were divided into three groups randdomly. The experimental group（A-PRF group）： adipose tissue was taken， and 2ml A-PRF+1ml granule fat was transplanted into the isolated area of rabbit ears. The positive control group（PRF group）： 2ml PRF+1ml granule fat was transferred into the transplantation area. The negative control group（NS group）： 2ml physiological saline +1ml granular fat was transplanted. Gross observation， weighing， HE staining and immunostaining were performed at 4 weeks， 8 weeks， and 12 weeks to compare the survival of fat between the three groups. Results ?At each observation time， the fat survival rate and neonatal capillary density of the A-PRF group were significantly better than the other two groups. The positive control group was superior to the negative control group， and the difference was statistically significant （P<0.05）. Conclusion ?A-PRF is superior to common PRF in increasing the survival rate of adipocytes， reducing inflammation and promoting capillary angiogenesis， which provides a reference for the use of A-PRF in clinic.

Key words： A-PRF; PRF; granular fat transplantation; adipocyte survival rate; VEGF; cytokines

自體顆粒脂肪移植是整形學科常規項目，常用于軟組織缺損修復，原因如下：①自身脂肪移植避免了移植后的免疫排斥，組織相容性好;②脂肪來源廣泛，供區提供脂肪的同時可局部塑形;③移植后的脂肪細胞可部分存活，有效地保持了受區的體積。然而脂肪移植后伴隨而來的壞死、液化、鈣化、囊腫形成等限制了其臨床應用。臨床上通過各種方法來提升移植脂肪的存活率，如脂肪干細胞與基質血管成分（stromal vascular fraction，SVF）聯合脂肪細胞移植、各種生長因子及后來的富血小板血漿（platelet-rich plasma，PRP）[1]與富血小板纖維蛋白（platetel-rich fribin，PRF）[2]、抗氧化劑添加、促進血管生成藥物使用、獲取過程減少脂肪細胞的損傷、注射方法的改進等。……