高浓度血小板血浆

高浓度血小板血浆(英语:Platelet-rich plasma)(PRP),又称富血小板血浆,是取全血离心移除红血球,成为富含血小板血浆蛋白浓缩液。截至2016年,支持其益处的证据很少[1][2]。截至2019年,(在美国)每次注射的费用通常为500至2,000美元[3]

高浓度血小板血浆
高浓度血小板血浆注射手部
MeSHD053657

医学用途

高浓度血小板血浆已用在慢性肌腱炎[4]骨关节炎[5]、或口腔颌面外科[6]整形外科[7]研究治疗的领域中,但截至2016年,支持其益处的证据很少[1][2]

研究未发现高浓度血小板血浆能有效治疗旋转袖疾病[8]。初步证据支持其可用于骨关节炎[9][10]

2009年的综述文章表示少有随机对照试验能充分评估高浓度血小板血浆治疗的安全性和有效性,其结论认为高浓度血小板血浆用于关节肌腱韧带肌肉等损伤是一种有潜力但尚未得到证实的治疗选择[11]。与其他免手术骨科疾病的保守治疗(例如足底筋膜炎类固醇注射)相比,研究证据不支持高浓度血小板血浆作为保守治疗[12]。2018年的综述发现高浓度血小板血浆仍缺乏证据能有效治疗跟腱病变[13]

2010年考科蓝综述未发现高浓度血小板血浆能有益于植牙过程的鼻窦增高术[6]。2013年的综述指出需要更多证据才能确认高浓度血小板血浆对毛发再生是否有效[14]

2014年考科蓝综述表示舒缓肌肉骨骼损伤短期疼痛的证据非常薄弱,对短期、中期、长期的身体功能均无助益。有薄弱的证据显示比对已治疗和未治疗的病患,高浓度血小板血浆治疗造成伤害的发生率低[2]。2017年的综述探讨治疗皮肤移植捐赠部位的疼痛,证据显示获益不佳[15]

研究未显示高浓度血小板血浆有益于骨骼愈合[16]。2016年的综述回顾其应用于骨移植,发现只有一篇报告有骨质增大效果,但有四篇研究发现没有差异[17]

一种名为“性高潮射击”(英语:Orgasm shot)的作法将高浓度血小板血浆注射于阴道,声称可改善性高潮[18],但没有证据支持这些主张[18][19]

不良反应

迄今为止尚无可靠文献证明有与高浓度血小板血浆治疗相关的不良反应,这可能是因为研究方法不良和不一致[20]。2019年加拿大卫生部表示大多数自体细胞疗法缺乏证据支持其有效,并且可能带来风险,比如如果设备未妥善消毒,可引起人与人的交叉感染或潜在危险的免疫反应[21],他们正设法停止加拿大诊所提供这类服务[22]

成分

 
两阶段离心前,将全血置于离心机中

根据白血球纤维蛋白含量的不同,制备的高浓度血小板血浆一般分为四类:高浓度白血球血小板血浆(L-PRP)、减白血球高浓度血小板血浆(P-PRP)、高浓度白血球血小板纤维蛋白、纯高浓度血小板纤维蛋白英语Platelet-rich fibrin[23][24]

生长因子对各种损伤的疗效与高浓度血小板血浆的生长因子浓度是高浓度血小板血浆能否用于组织修复的理论基础[25]。添加凝血酶氯化钙可活化中收集到的血小板,从而使血小板α颗粒英语Platelet alpha-granule释放生长因子。高浓度血小板血浆含有下列生长因子和细胞激素[25][26]

制作

高浓度血小板血浆的制作是先从人体取血,再经两阶段离心,以便将高浓度血小板血浆分离出来,留下红血球与其他血浆。通常是由提供治疗的诊所使用商业套件和设备来完成[27]。制品品质因病人而异,也因设备而异,因此不易研究确认其作为特定用途时的安全性和有效性[27][28]

社会与文化

在美国,高浓度血小板血浆治疗的自付费用开价1000美元,因为健康保险通常不给付[29]。由于运动员的使用,高浓度血小板血浆已引起大众媒体关注[30][31][32][29]美国食品药品监督管理局未认可在办公室环境(非运动环境)使用高浓度血小板血浆[33]

2010年代在名人代言推动下,以“吸血鬼面部调理”为名销售具有争议的美容方式,着重使用高浓度血小板血浆,通常(但不必然)采用微针胶原蛋白导入治疗英语Collagen induction therapy[34][35]

体育禁药

高浓度血小板血浆治疗是否违反体育禁药规定,早期曾有疑虑[25]。2010年尚不清楚局部注射高浓度血小板血浆是否会对血液循环中的细胞激素浓度产生影响,因而影响禁药检测,以及是否具有全身性同化作用或影响体育表现[25]。2011年1月世界反运动禁药机构确认缺乏证据显示其能增进体育表现,故取消肌肉注射高浓度血小板血浆的禁令[36]

参见

参考文献

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