內(nèi)容血小板簡介及其功能濃縮血小板及其應(yīng)用人群的選擇濃縮血小板的制備方法及分類濃縮血小板的激活及使用方法濃縮血小板在創(chuàng)面修復中的作用目前研究中存在的問題血小板簡介及功能血小板是血細胞中的一種，它是從骨髓巨核細胞的細胞質(zhì)脫落的的具有生物活性的小塊胞質(zhì)，體積小，無細胞核，呈雙面微凸的圓盤狀。生理特性：粘附、聚集、釋放、收縮基本功能：止血凝血、維持血管內(nèi)皮的完整性Plateletultrastructure.[1]3濃縮血小板濃縮血小板（PlateletsConcentrate）根據(jù)其臨床用途可分為兩類：第一類：體內(nèi)，是外科常用的成分輸血制品，濃縮血小板一般用于血小板減少，失血癥狀明顯而又需手術(shù)者。第二類：體外，常用于局部軟組織和骨組織的修復，主要是應(yīng)用血小板內(nèi)還有豐富的細胞因子，它們在參與創(chuàng)面的修復過程中發(fā)揮重要的作用。目前文獻中常見的有四種濃縮血小板類型，也可稱為Platelet-RichPreparation應(yīng)用人群的選擇明確有傳染病的患者，如乙肝、梅毒、艾滋等；腫瘤患者；服用血小板抑制劑的或血小板功能存在障礙的患者；如口服阿司匹林、氯吡格雷等；血小板減少的患者；制備臨床上常用的濃縮血小板主要通過兩種方法制備商業(yè)的血小板分離系統(tǒng)手工分離制備過程中的影響因素眾多，主要包括以下幾方面：患者之間的個體差異血液的采集：無菌原則、抗凝劑的選擇（ACD-A/CPD）、抗凝劑和血液的比例（1:10）離心次數(shù)：單次離心和二次離心轉(zhuǎn)速/離心力：HardandSoftcentrifugation離心時間離心溫度

商業(yè)分離系統(tǒng)CommercialSystemBloodVol(ml)Centrifugation(No.ofSpins)PRPVol(ml)PlateletConcentrationActivator(+/-)Activator:PRPLeukocytes(+/-)Cascade?9-1814-91-1.5×CaCl21:10-GPSⅢ601109.3×Trombin1:10+ACP?9132-3×None1:10-SmartPRP2?20-12023-204-6×Trombin1:10+PRGF?9-7214-322-3×CaCl21:10-Magellan?30-60263-9×CaCl21:10+Angel?40241-18×None1:10+/-GenesisCS?30-6014-109×CaCl21:10NSSequire?50251.6×TrombinBovine1:10NSPlatelex?5024-6NSBatroxobin1:10+SymphonyⅡPCS?55-1101NS3-6×Thrombin1:10NSJP2000?20215-9×CaCl2andThrombin1:10+GLOPRP?8.520.65-6×CaCl2andThrombin1:10+KYOCERA?20227-8×CaCl21:10+Selphyl?8120.5×CaCl21:10+MyCells?10114-5×CaCl2andThrombin1:10+Dr.Shin’sSystem?8.5113-4×CaCl2andThrombin1:10+PCCS?Curasan?手工分離

FlowchartdescribingpreparationofPRP.[2]濃縮血小板分類9PRP.Classicalmanualplatelet-richplasma(PRP)protocolusingatwo-stepcentrifugationprocedure.[3]10PRGFCommonlydescribedprotocolforAnitua’sPRGF.[3]PPGF:plasmapooringrowthfactorsPRGF:plasmarichingrowthfactors11PRFChoukroun’splatelet-richfibrin(PRF)method.[3]12Structural

DifferencesSchematicillustrationofthematrixandcellarchitectureofthefourcategoriesofplateletconcentrates.[3]ActivatedversusNonactivated濃縮血小板的激活14

Activated濃縮血小板的激活方式應(yīng)該考慮以下三個方面：血小板激活劑的種類

牛凝血酶、人凝血酶、鈣劑、凝血酶受體激活肽（TRAP）、膠原、類凝血酶-巴曲酶、反復凍融、殼聚糖、納秒脈沖電場（nsPEF）

；激活劑的濃度的選擇激活劑和濃縮血小板的比例影響細胞因子的釋放時間影響細胞因子的釋放量15納秒脈沖電場（NanosecondPulseElectricField，nsPEF）Activator16Non-activatedDiabeticmousefull-thicknesswoundhealing.[5]17Non-activatedEffectsofplatelettreatmentonfibroblastcultures.[5]Non-activated

Invitrothree-dimensionaltissuedefectassay.[5]19ActivatedversusNonactivatedSchematicdepictionoftheeffectofphysiologicandunspecificactivationofplateletsonwoundhealing.[4]20在創(chuàng)面修復中的作用Cytokines/ChemokineIL-6IL-8PF-4MIP-1αRANTESFractalkineNAP2GRO-αENA-78sCD40LSDF-1αGrowthFactorPlateletDerivedGrowthFactor,PDGF-AB/BBTransformingGrowthFactor-beta,TGF-β1/2VascularEndothelialGrowthFactor,VEGFEpidermalGrowthFactor,EGFBasicFibroblastGrowthFactor,bFGFInsulinlikeGrowthFactor(IGF1and2)ConnectiveTissueGrowthFactor(CTGF)KeratinocyteGrowthFactor(KGF)HepatocyteGrowthFactor(HGF)PlateletDerivedEndothelialGrowthFactor(PDEGF)PlateletDerivedAngiogenicFactor(PDAF)生長因子在創(chuàng)面修復中的作用SchematicillustrationoftheroleofGFsduringthedifferentstagesofthewoundhealingprocess.[6]22細胞因子在創(chuàng)面修復中的作用ThisistrueforbacterialikeMSSA,GroupAStreptococcus,andNeisseriagonorrhoeaeaswell.[7].目前存在的問題缺乏統(tǒng)一的濃縮血小板的制備標準臨床應(yīng)用時能否激活仍存在爭議，若激活，激活劑種類、濃度及其與濃縮血小板的比例如何確定無法確定有臨床療效的濃縮血小板中最適的血小板的濃度參考文獻[1].YeamanMR.Theroleofplateletsinantimicrobialhostdefense.ClinInfectDis199725(5):951-968;quiz969-970[2].DhuratRSukeshM.PrinciplesandMethodsofPreparationofPlatelet-RichPlasma:AReviewandAuthor'sPerspective.JCutanAesthetSurg20147(4):189-197[3].DohanEhrenfestDM,RasmussonLAlbrektssonT.Classificationofplateletconcentrates:frompureplatelet-richplasma(P-PRP)toleucocyte-andplatelet-richfibrin(L-PRF).TrendsBiotechnol200927(3):158-167[4].SchererSS,TobalemM,VigatoEetal.

Nonactivatedversusthrombin-activatedplateletsonwoundhealingandfibroblast-to-myofibroblastdifferentiationinvivoandinvitro.PlastReconstrSurg2012129(1):46e-54e[5].FrelingerIiiAL,TorresAS,CaiafaAetal.

Platelet-richplasmastimulatedbypulseelectricfields:Plateletactivation,procoagulantmarkers,growthfactorreleaseandcellproliferation.Platelets20151-8[6].EvertsPA,KnapeJT,WeibrichGetal.

Platelet-richplasmaandplateletgel: