Objective: To explore the clinical effects of concentrated growth factor (CGF) combined with plasma albumin gel (PAG) in treating facial depressed scar. Methods: From January 2018 to June 2019, 14 patients in the First Affiliated Hospital of Zhengzhou University and 10 patients in Henan NO.3 Provincial People's Hospital with facial depressed scar who met the inclusion criteria were admitted, and their clinical data were retrospectively analyzed by the method of case-control study. Based on the method of treatment, 8 patients (4 males and 4 females) aged 28.50 (25.50, 31.50) years were enrolled in CGF alone group, 8 patients (3 males and 5 females) aged 32.00 (28.50, 35.00) years were enrolled in PAG alone group, and 8 patients (5 males and 3 females) aged 33.50 (29.00, 35.75) years were enrolled in CGF+ PAG group. Suitable amount of CGF, PAG, and CGF+ PAG (mixed at a ratio of 1.0∶1.0-1.0∶1.5) prepared from autologous blood were injected subcutaneously via a single or multiple entrance (s) into the depressed scar of patients in CGF alone, PAG alone, and CGF+ PAG groups respectively to fill up the concavity, once every 4 weeks for a total of 3 times. Before the first treatment (hereinafter referred to as before treatment) and 3 months after the last treatment (hereinafter referred to as after treatment), the Goodman & Baron Acne Scar Grading System was used for scar grading, and the difference was calculated; the Anxiety Self-Rating Scale was used to score anxiety, and the difference was calculated. The Visual Analogue Score was used to score pain immediately after the first treatment. By one, two, and three months after treatment, the patients' satisfaction to scar treatment was scored, and the Global Aesthetic Improvement Scale was used to score the scar improvement. Adverse reaction of patients after treatment was monitored. Data were statistically analyzed with Fisher's exact probability test, Kruskal-Wallis H test, Mann-Whitney U test, Bonferroni correction, and Wilcoxon signed rank sum test. Results: (1) The scars of patients in the three groups were all graded 4.00 (4.00, 4.00) before treatment (χ(2)<0.001, P>0.05). By three months after treatment, compared with 2.00 (1.25, 2.00) of CGF alone group, the scar grades of patients in PAG alone group and CGF+ PAG group (3.00 (2.00, 3.00) and 1.00 (1.00, 1.00), respectively) had no significant change (Z=2.199, 2.003, P>0.05). The scar grade of patients in CGF+ PAG group was significantly lower than that in PAG alone group (Z=3.229, P<0.01). Compared with those before treatment, the scar grades of patients in CGF alone group, PAG alone group, and CGF+ PAG group were significantly reduced three months after treatment (Z=2.588, 2.598, 2.640, P<0.05 or P<0.01). The difference in scar grade before and after the treatment was significantly higher in CGF+ PAG group than in PAG alone group (Z=3.229, P<0.01). (2) The anxiety scores of patients in the three groups were similar before treatment and 3 months after (χ(2)=2.551, 2.768, P>0.05). Compared with those before treatment, the anxiety scores of patients in CGF alone group, PAG alone group, and CGF+ PAG group were significantly reduced three months after treatment (Z=2.395, 2.527, 2.533, P<0.05). The differences in anxiety score before and after the treatment were similar among the three groups (χ(2)=1.796, P>0.05). (3) The pain scores of patients in the three groups were similar immediately after the first treatment (χ(2)=0.400, P>0.05). (4) By one and two month (s) after treatment, the patients' satisfaction scores to scar treatment in the three groups were similar (χ(2)=2.688, 5.989, P>0.05). By three months after treatment, the patients' satisfaction score to scar treatment in CGF+ PAG group was significantly higher than that in PAG alone group (Z=2.922, P<0.01). Compared with those one month after treatment within the same group, the patients' satisfaction scores to scar treatment in CGF alone group, PAG alone group, and CGF+ PAG group were significantly increased two and three months after treatment (Z=1.121, 2.392, 2.000, 2.828, 2.449, 2.598, P<0.05 or P<0.01). Compared with those two months after treatment within the same group, the patients' satisfaction scores to scar treatment in CGF alone group, PAG alone group, and CGF+ PAG group were significantly increased three months after treatment (Z=2.271, 2.000, 2.646, P<0.05 or P<0.01). (5) One month after treatment, the scar improvement scores of patients in the three groups were similar (χ(2)=4.438, P>0.05). Two months after treatment, the scar improvement scores of patients in CGF alone group and CGF+ PAG group were 2.00 (2.00, 2.75) and 2.00 (2.00, 2.00) points, respectively, which were significantly higher than 1.00 (1.00, 1.00) point of PAG alone group (Z=3.303, 3.771, P<0.01). Three months after treatment, the scar improvement score of patients in CGF+ PAG group was 3.00 (3.00, 3.00) points, which was significantly higher than 2.00 (2.00, 2.75) points of CGF alone group and 1.00 (1.00, 2.00) points of PAG alone group (Z=2.450, 3.427, P<0.05 or P<0.01). Compared with those one month after treatment within the same group, the scar improvement scores of patients were significantly higher in CGF alone group and CGF+ PAG group two and three months after treatment and in PAG alone group three months after treatment (Z=2.828, 2.828, 2.530, 2.640, 2.121, P<0.05 or P<0.01). Compared with that two months after treatment within the same group, the scar improvement score of patients in CGF+ PAG group was significantly higher three months after treatment (Z=2.449, P<0.05). (6) After injection, all patients in the three groups had slight redness and swelling at the needle prick point and no other adverse reactions. Conclusions: CGF combined with PAG can reduce the scar grading, anxiety of patients, and enhance patients' satisfaction and scar improvement in the treatment of patients with facial depressed scar. The combined CGF+ PAG injection, without significant adverse reactions, is better than single component injection and is worthy of clinical application.
目的： 探讨浓缩生长因子(CGF)联合血浆蛋白凝胶(PAG)治疗面部凹陷瘢痕的临床效果。 方法： 2018年1月—2019年6月，郑州大学第一附属医院收治14例、河南省直第三人民医院收治10例符合入选标准的面部凹陷瘢痕患者，以病例对照研究的方法回顾性分析其临床资料。按采取的治疗方法分组，8例患者纳入单纯CGF组，其中男4例、女4例，年龄28.50(25.50，31.50)岁；8例患者纳入单纯PAG组，其中男3例、女5例，年龄32.00(28.50，35.00)岁；8例患者纳入CGF＋PAG组，其中男5例、女3例，年龄33.50(29.00，35.75)岁。单纯CGF组、单纯PAG组、CGF＋PAG组患者凹陷瘢痕皮下分别单点或多点注射适量自体血液制备的CGF、PAG、CGF＋PAG(比例为1.0∶1.0～1.0∶1.5)，以填满凹陷为度，4周1次，共3次。首次治疗前(下称治疗前)及末次治疗后(下称治疗后)3个月，采用Goodman & Baron痤疮瘢痕分级系统进行瘢痕分级并计算差值，采用焦虑自评量表进行焦虑评分并计算差值；首次治疗结束即刻，采用视觉模拟评分法进行疼痛评分；治疗后1、2、3个月，进行患者瘢痕治疗满意度评分，采用全球审美改善量表进行瘢痕改善程度评分。观察患者治疗后是否有不良反应。对数据行Fisher确切概率法检验、Kruskal－Wallis H检验、Mann－Whitney U检验、Bonferroni校正、Wilcoxon符号秩和检验。 结果： (1)治疗前，3组患者瘢痕分级均为4.00(4.00，4.00)级(χ(2)<0.001，P>0.05)。治疗后3个月，与单纯CGF组的2.00(1.25，2.00)级比较，单纯PAG组、CGF＋PAG组患者瘢痕分级没有明显变化[3.00(2.00，3.00)、1.00(1.00，1.00)级，Z＝2.199、2.003，P>0.05]；CGF＋PAG组患者瘢痕分级明显低于单纯PAG组(Z＝3.229，P<0.01)。与治疗前比较，单纯CGF组、单纯PAG组、CGF＋PAG组患者治疗后3个月瘢痕分级均明显降低(Z＝2.588、2.598、2.640，P<0.05或P<0.01)。CGF＋PAG组患者治疗前后瘢痕分级差值明显高于单纯PAG组(Z＝3.229，P<0.01)。(2)治疗前、治疗后3个月，3组患者焦虑评分均相近(χ(2)＝2.551、2.768，P>0.05)。与治疗前比较，单纯CGF组、单纯PAG组、CGF＋PAG组患者治疗后3个月焦虑评分均明显降低(Z＝2.395、2.527、2.533，P<0.05)。3组患者治疗前后焦虑评分差值相近(χ(2)＝1.796，P>0.05)。(3)3组患者首次治疗结束即刻疼痛评分相近(χ(2)＝0.400，P>0.05)。(4)治疗后1、2个月，3组患者瘢痕治疗满意度评分均相近(χ(2)＝2.688、5.989，P>0.05)。治疗后3个月，CGF＋PAG组患者瘢痕治疗满意度评分明显高于单纯PAG组(Z＝2.922，P<0.01)。与组内治疗后1个月比较，单纯CGF组、单纯PAG组、CGF＋PAG组患者治疗后2、3个月瘢痕治疗满意度评分均明显升高(Z＝1.121、2.392，2.000、2.828，2.449、2.598，P<0.05或P<0.01)。与组内治疗后2个月比较，单纯CGF组、单纯PAG组、CGF＋PAG组患者治疗后3个月瘢痕治疗满意度评分均明显升高(Z＝2.271、2.000、2.646，P<0.05或P<0.01)。(5)治疗后1个月，3组患者瘢痕改善程度评分相近(χ(2)＝4.438，P>0.05)。治疗后2个月，单纯CGF组、CGF＋PAG组患者瘢痕改善程度评分分别为2.00(2.00，2.75)、2.00(2.00，2.00)分，均明显高于单纯PAG组的1.00(1.00，1.00)分(Z＝3.303、3.771，P<0.01)。治疗后3个月，CGF＋PAG组患者瘢痕改善程度评分为3.00(3.00，3.00)分，明显高于单纯CGF组的2.00(2.00，2.75)分和单纯PAG组的1.00(1.00，2.00)分(Z＝2.450、3.427，P<0.05或P<0.01)。与组内治疗后1个月比较，单纯CGF组与CGF＋PAG组患者治疗后2、3个月和单纯PAG组患者治疗后3个月瘢痕改善程度评分均明显升高(Z＝2.828、2.828，2.530、2.640，2.121，P<0.05或P<0.01)。与组内治疗后2个月比较，CGF＋PAG组患者治疗后3个月瘢痕改善程度评分明显升高(Z＝2.449，P<0.05)。(6)3组患者注射后进针口均有轻微红肿，无其他不良反应。 结论： CGF联合PAG治疗患者面部凹陷瘢痕后，患者瘢痕分级降低、焦虑程度减轻、治疗满意度增加、瘢痕改善程度增加，无明显不良反应，较单一成分注射效果好，值得临床推广。.
Keywords: Blood platelets; Cicatrix; Concentrated growth factor; Face; Plasma albumin gel.