目的 探讨不同制备方法自体富血小板凝胶（APG）对糖尿病足伤口愈合及体外抑菌的疗效。 方法 伤口愈合试验：将云南省第三人民医院2024—2025年收治的80例糖尿病足溃疡患者随机分为一次离心法APG组、二次离心法APG组、机采法APG组及清创胶对照组（各20例），比较4组治疗前后的空腹血糖（FBG）、血沉（ESR）、白细胞介素-6（IL-6）、降钙素原（PCT）、C反应蛋白（CRP）、抗凝血酶Ⅲ（AT-Ⅲ）、肿瘤坏死因子-α（TNF-α）、同型半胱氨酸（Hcy）、溃疡面积缩小率。体外抑菌试验：另纳入20例糖尿病患者，以3种方法制备APG为试验组，设PPP组及SALINE SOLUTION对照组，观察对金黄色葡萄球菌、大肠埃希杆菌、产酶大肠埃希杆菌及铜绿假单胞菌的抑菌作用。 结果 治疗后4组实验室指标差异有统计学意义（P < 0.05）；两两比较显示，3组试验组AT-Ⅲ高于对照组，其余7项指标低于对照组（P < 0.05）。3次换药后，4组在第1次换药、第3次换药溃疡面积及溃疡面积缩小率、最终疗效上差异有统计学意义（P < 0.05），对照组效果均差于试验组；对照组各时间点溃疡面积缩小率均显著低于3组试验组（P < 0.001），试验组间差异无统计学意义（P > 0.05）；溃疡面积缩小率随时间显著上升 （P < 0.001），组间时间变化模式不同，对照组各时间点愈合率均低于试验组；治疗分组、基线溃疡面积及上述多项实验室指标组间分布（P < 0.05）。对于更严重的Wagner 3级溃疡，APG治疗能带来确切的、优于常规治疗的临床改善。多因素logistic显示3组试验组均为疗效显效的强预测因素 （P < 0.05），其余基线溃疡面积、空腹血糖等指标对显效结局无统计学显著影响（P 均> 0.05）。3组试验组4 ~ 12 h对大肠杆菌、金黄色葡萄球菌抑菌活性显著，且各实验组组间分布水平十分接近；5组对产酶大肠杆菌、铜绿假单胞菌均无抑菌作用，PPP组、对照组对所有菌株均无效；所有组的抑菌活性均随时间延长而减弱，24 h基本消失。 结论 3种制备方法APG均能有效地降低糖尿病足患者血糖水平、改善临床指标、促进创面愈合，且富血小板凝胶具有特定的抑菌谱，且对不同菌属的抑菌作用具有时效性。

Objective To investigate the efficacy of autologous platelet-rich gel （APG） prepared by different methods on diabetic foot wound healing and antibacterial activity in vitro. Methods In the wound healing trial， 80 patients with diabetic foot ulcers admitted to The Third People's Hospital of Yunnan Province from 2024 to 2025 were randomly divided into four groups （n=20 each）： Single centrifugation APG group， double centrifugation APG group， machine-harvested APG group， and debridement gel control group. fasting blood glucose （FBG）， erythrocyte sedimentation rate （ESR）， interleukin-6 （IL-6）， procalcitonin （PCT）， C-reactive protein （CRP）， antithrombin Ⅲ（AT-III）， tumor necrosis factor-α （TNF-α）， homocysteine （Hcy）， and ulcer area reduction rate were compared before and after treatment. In the in vitro antibacterial test， 20 diabetic patients were additionally enrolled. Three types of APG were used as experimental groups， with platelet-poor plasma （PPP） group and saline solution as controls. Antibacterial effects against Staphylococcus aureus， Escherichia coli， extended-spectrum β-lactamase-producing Escherichia coli， and Pseudomonas aeruginosa were observed. Results After treatment， significant differences were found in laboratory parameters among the four groups （P < 0.05）. Pairwise comparisons showed that AT-Ⅲ was higher in the three experimental groups than in the control group， while the other seven indicators were lower （P < 0.05）. After the first and third dressings， significant differences were observed in ulcer area， ulcer area reduction rate， and final efficacy among the four groups （P < 0.05）； the control group was inferior to the experimental groups. The ulcer area reduction rate was significantly lower in the control group than in the three experimental groups at each time point （P < 0.001）， with no significant difference among experimental groups （P > 0.05）. The ulcer area reduction rate increased significantly over time （P < 0.001）， with different temporal patterns between groups； the control group had lower healing rates than experimental groups at all time points. Treatment group， baseline ulcer area， and the aforementioned laboratory parameters were significantly different among groups （P < 0.05）. For more severe Wagner grade 3 ulcers， APG treatment provided definite clinical improvement superior to conventional therapy. Multivariate logistic regression showed that all three experimental groups were strong predictors of marked efficacy （P < 0.05）， whereas baseline ulcer area， fasting blood glucose， and other indicators had no significant effect （all P > 0.05）. All three experimental groups exhibited significant antibacterial activity against Escherichia coli and Staphylococcus aureus at 4 ? 12 hours， with similar levels among groups. None of the five groups showed antibacterial activity against extended-spectrum β-lactamase-producing Escherichia coli or Pseudomonas aeruginosa； the PPP group and control group had no effect on any strain. Antibacterial activity decreased over time and was almost absent at 24 hours. Conclusions APG prepared by the three methods effectively reduces blood glucose， improves clinical parameters， and promotes wound healing in diabetic foot patients. Autologous platelet-rich gel displays a specific antibacterial spectrum， and its antibacterial effect against different bacterial genera is time-dependent.