Ubuhlungu be-neuropathic bubhekisela ekusebenzeni okungavamile kwezinzwa, ukuzwela ubuhlungu nobuhlungu obuzenzakalelayo obubangelwa ukulimala noma isifo sesimiso sezinzwa ze-somatic.Iningi labo lisengakwazi ukuhambisana nobuhlungu endaweni ehambisanayo engenalutho ngemva kokuqedwa kwezinto ezilimazayo, ezibonakala njengobuhlungu obuzenzakalelayo, i-hyperalgesia, i-hyperalgesia kanye nokuzwa okungavamile.Njengamanje, izidakamizwa zokuqeda ubuhlungu be-neuropathic zihlanganisa ama-tricyclic antidepressants, i-5-hydroxytryptamine norepinephrine reuptake inhibitors, i-anticonvulsants i-gabapentin ne-pregabalin, nama-opioid.Kodwa-ke, umphumela wokwelashwa kwezidakamizwa uvame ukulinganiselwa, okudinga izikimu zokwelapha ze-multimodal ezifana nokwelapha ngokomzimba, ukulawulwa kwezinzwa nokungenelela kokuhlinzwa.Ubuhlungu obungapheli kanye nomkhawulo wokusebenza kuzonciphisa ukubamba iqhaza komphakathi kweziguli futhi kubangele umthwalo omkhulu ongokwengqondo nezomnotho ezigulini.
I-Platelet rich plasma (PRP) iwumkhiqizo we-plasma one-high purity platelet etholakala nge-centrifuging autologous blood.Ngo-1954, i-KINGSLEY yaqala ukusebenzisa igama lezokwelapha elithi PRP.Ngokucwaninga nokuthuthukiswa eminyakeni yamuva, i-PRP isetshenziswe kabanzi ekuhlinzeni amathambo namalungu, ukuhlinzwa komgogodla, i-dermatology, ukuvuselelwa kanye neminye iminyango, futhi idlala indima ebalulekile emkhakheni wokulungisa ubunjiniyela bezicubu.
Isimiso esiyisisekelo sokwelashwa kwe-PRP ukujova ama-platelet agxilile endaweni elimele futhi uqale ukulungiswa kwezicubu ngokukhulula izici ezihlukahlukene ze-bioactive (izici zokukhula, ama-cytokines, ama-lysosomes) namaprotheni okunamathela.Lezi zinto ze-bioactive zinesibopho sokuqala ukusabela kwe-hemostatic cascade, ukuhlanganiswa kwezicubu ezintsha ezixhumeneyo nokwakhiwa kabusha kwemithambo.
Ukuhlukaniswa kanye ne-pathogenesis yobuhlungu be-neuropathic I-World Health Organization ikhiphe inguqulo ye-11 ebuyekeziwe ye-International Classification of Pain ku-2018, ehlukanisa ubuhlungu be-neuropathic phakathi kobuhlungu be-neuropathic kanye nobuhlungu be-peripheral neuropathic.
Ubuhlungu be-peripheral neuropathic buhlukaniswa ngokwe-etiology:
1) Ukutheleleka/ukuvuvukala: i-postherpetic neuralgia, uchoko olubuhlungu, ugcunsula/i-peripheral neuropathy ethelelekile nge-HIV
I-2) Ukucindezelwa kwemizwa: i-carpal tunnel syndrome, ubuhlungu be-radicular obunzima bomgogodla
I-3) Ukuhlukumezeka: ukuhlukumezeka / ukushisa / ngemuva kokuhlinzwa / i-post radiotherapy ubuhlungu be-neuropathic
I-4) I-Ischemia / i-metabolism: isifo sikashukela se-peripheral neuropathic pain
5) Izidakamizwa: i-peripheral neuropathy ebangelwa izidakamizwa (ezifana ne-chemotherapy)
6) Abanye: ubuhlungu bomdlavuza, i-neuralgia ye-trigeminal, i-glossopharyngeal neuralgia, i-neuroma ka-Morton
Izindlela zokuhlukanisa nezindlela zokulungiselela ze-PRP ngokuvamile zikholelwa ukuthi ukuhlushwa kwe-platelet ku-PRP kuphindwe kane noma kahlanu kunegazi eliphelele, kodwa kube nokuntuleka kwezinkomba zobuningi.Ku-2001, uMarx wachaza ukuthi i-PRP iqukethe okungenani ama-platelet ayizigidi ezingu-1 nge-microliter ye-plasma, okuyinkomba yobuningi bezinga le-PRP.U-Dohan et al.i-PRP ihlukanise ngezigaba ezine: i-PRP ehlanzekile, i-PRP ecebile ye-leukocyte, i-fibrin ecebile ye-platelet ehlanzekile, ne-leukocyte ecebile ye-platelet fibrin esekelwe kokuqukethwe okuhlukene kwe-platelet, i-leukocyte, ne-fibrin ku-PRP.Ngaphandle kwalapho kucaciswe ngenye indlela, i-PRP ivamise ukusho i-PRP ecebile yamaseli amhlophe.
Indlela ye-PRP Ekwelapheni Ubuhlungu Be-Neuropathic Ngemva kokulimala, ama-activator ahlukahlukene angapheli kanye ne-exogenous azokhuthaza ukusebenza kweplatelet α- Ama-granules athola ukusabela kwe-degranulation, ekhulula inani elikhulu lezici zokukhula, i-fibrinogen, i-cathepsin ne-hydrolase.Izici zokukhula ezikhishiwe zibophezela endaweni engaphandle yolwelwesi lweseli lweseli eliqondiwe ngama-transmembrane receptors kulwelwesi lweseli.Lawa ma-receptors e-transmembrane nawo abangela futhi asebenze amaprotheni okubonisa angapheli, aqhubeke nokusebenzisa isithunywa sesibili esitokisini, esikhuthaza ukwanda kwamaseli, ukwakheka kwe-matrix, ukuhlanganiswa kwephrotheni ye-collagen nokunye ukubonakaliswa kofuzo kwe-intracellular.Kunobufakazi bokuthi ama-cytokines akhishwe ama-platelet namanye ama-transmitter adlala indima ebalulekile ekunciphiseni / ekuqedeni ubuhlungu obungapheli be-neuropathic.Izindlela eziqondile zingahlukaniswa zibe izindlela ezizungezile kanye nezinqubo ezimaphakathi.
I-Mechanism ye-platelet ecebile ye-plasma (PRP) ekwelapheni ubuhlungu be-neuropathic
Izindlela ze-Peripheral: umphumela wokulwa nokuvuvukala, i-neuroprotection kanye nokukhuthaza ukuvuselelwa kwe-axon, ukulawulwa kwamasosha omzimba, umphumela we-analgesic
Indlela emaphakathi: yenza buthaka futhi ihlehlise ukuzwela okumaphakathi kanye nokuvimbela ukwenziwa kusebenze kweseli ye-glial
Umphumela Wokuqeda Ukuvuvukala
Ukuzwela kwe-peripheral kudlala indima ebalulekile ekuveleni kwezimpawu zobuhlungu be-neuropathic ngemva kokulimala kwenzwa.Izinhlobonhlobo zamangqamuzana okuvuvukala, njengama-neutrophils, ama-macrophages nama-mast cells, angeniswa endaweni yokulimala kwezinzwa.Ukuqoqwa ngokweqile kwamangqamuzana okuvuvukala kwakha isisekelo sokuthakazelisa ngokweqile kanye nokukhishwa okuqhubekayo kwezintambo zezinzwa.Ukuvuvukala kukhipha inani elikhulu labalamuli bamakhemikhali, njengama-cytokines, ama-chemokines kanye nabaxhumanisi be-lipid, okwenza ama-nociceptors azwele futhi ajabule, futhi abangele izinguquko endaweni yamakhemikhali wendawo.Ama-platelet anemiphumela eqinile ye-immunosuppressive kanye ne-anti-inflammatory.Ngokulawula nokufihla izici ezihlukahlukene zokulawula amasosha omzimba, izici ze-angiogenic kanye nezici zokudla okunomsoco, zinganciphisa ukusabela okulimazayo kwamasosha omzimba nokuvuvukala, futhi zilungise ukulimala kwezicubu ezihlukene ezindaweni ezincane ezihlukene.I-PRP ingadlala indima ephikisana nokuvuvukala ngokusebenzisa izindlela ezihlukahlukene.Ingavimbela ukukhululwa kwama-cytokines ane-pro-inflammatory kusuka kumaseli e-Schwann, ama-macrophages, ama-neutrophils nama-mast cells, futhi ivimbele ukubonakaliswa kofuzo lwe-pro-inflammatory factor receptors ngokukhuthaza ukuguqulwa kwezicubu ezonakalisiwe kusukela esimweni sokuvuvukala kuya esimweni esiphikisana nokuvuvukala.Nakuba ama-platelet awakhiphi i-interleukin 10, ama-platelet anciphisa ukukhiqizwa kwenani elikhulu le-interleukin 10 ngokufaka amangqamuzana e-dendritic angavuthiwe γ- Ukukhiqizwa kwe-interferon kudlala indima ephikisana nokuvuvukala.
Umphumela we-analgesic
Ama-platelet acushiwe akhulula ama-neurotransmitters amaningi ane-pro-inflammatory and anti-inflammatory, angabangela ubuhlungu, kodwa futhi anciphise ukuvuvukala nobuhlungu.Ama-platelet asanda kulungiswa alele ku-PRP.Ngemva kokusebenza ngokuqondile noma ngokungaqondile, i-morphology ye-platelet iyashintsha futhi ikhuthaze ukuhlanganiswa kweplatelet, ikhiphe izinhlayiya zayo ze-α-Dense ze-intracellular kanye nezinhlayiya ezizwelayo zizogqugquzela ukukhululwa kwe-5-hydroxytryptamine, enomphumela wokulawula ubuhlungu.Njengamanje, ama-5-hydroxytryptamine receptors atholakala kakhulu emithanjeni ye-peripheral.I-5-hydroxytryptamine ingathinta ukudluliswa kwe-nociceptive ezicutshini ezizungezile ngokusebenzisa i-5-hydroxytryptamine 1, i-5-hydroxytryptamine 2, i-5-hydroxytryptamine 3, i-5-hydroxytryptamine 4 kanye ne-5-hydroxytryptamine 7 receptors.
Ukuvinjwa Kokusebenza Kweseli Ye-Glial
Amaseli e-Glial athatha cishe u-70% wamangqamuzana esistimu yezinzwa emaphakathi, angahlukaniswa abe izinhlobo ezintathu: ama-astrocyte, ama-oligodendrocyte kanye nama-microglia.I-Microglia yenziwe yasebenza phakathi namahora angu-24 ngemva kokulimala kwezinzwa, futhi ama-astrocyte aqalwa ngokushesha ngemva kokulimala kwezinzwa, futhi ukusebenza kwathatha amasonto angu-12.I-Astrocyte kanye ne-microglia bese ikhulula ama-cytokines futhi ibangele uchungechunge lwezimpendulo zamaselula, njengokwenyuka kwe-glucocorticoid kanye ne-glutamate receptors, okuholela ekushintsheni kokuthakazelisa komgogodla kanye ne-neural plasticity, ehlobene eduze nokuvela kobuhlungu be-neuropathic.
Izinto ezihilelekile ekudambiseni noma ekuqedeni ubuhlungu be-neuropathic ku-plasma ecebile ye-platelet
1) Angiopoietin:
Ithuthukisa i-angiogenesis;Khuthaza ukufuduka kwamangqamuzana e-endothelial nokwanda;Sekela futhi uzinzise ukuthuthukiswa kwemithambo yegazi ngokuqasha ama-pericyte
2) Isici sokukhula kwezicubu ezixhumeneyo:
Khuthaza ukufuduka kwe-leukocyte;Ukuthuthukisa i-angiogenesis;Yenza kusebenze i-myofibroblast futhi ikhuthaze ukufakwa kwe-matrix engaphandle kweselula nokulungisa kabusha
3) Isici sokukhula kwe-epidermal:
Khuthaza ukuphulukiswa kwesilonda futhi wenze i-angiogenesis ngokukhuthaza ukwanda, ukufuduka kanye nokuhlukaniswa kwama-macrophages nama-fibroblasts;Khuthaza ama-fibroblasts ukuze akhiphe i-collagenase futhi alulaze i-matrix ye-extracellular ngesikhathi sokulungiswa kabusha kwesilonda;Khuthaza ukwanda kwama-keratinocyte nama-fibroblasts, okuholela ekuvuseleleni kabusha i-epithelization.
4) Isici sokukhula se-Fibroblast:
Ukunxenxa i-chemotaxis yama-macrophages, ama-fibroblasts namaseli e-endothelial;Ithuthukisa i-angiogenesis;Ingaheha imbudumbudu kanye nokulungiswa kabusha kwezicubu futhi ibambe iqhaza ekufinyezweni kwenxeba.
5) Isici sokukhula kwe-Hepatocyte:
Ukulawula ukukhula kwamangqamuzana nokunyakaza kwamaseli e-epithelial/endothelial;Khuthaza ukulungiswa kwe-epithelial kanye ne-angiogenesis.
6) I-insulin efana nesici sokukhula:
Hlanganisa ndawonye amangqamuzana e-fiber ukuze ukhuthaze ukwakheka kwamaprotheni.
7) I-Platelet derived growth factor:
Khuthaza i-chemotaxis ye-neutrophils, i-macrophages ne-fibroblasts, futhi ikhuthaze ukwanda kwama-macrophages nama-fibroblasts ngesikhathi esifanayo;Kuyasiza ukubola i-collagen endala futhi phezulu kulawula ukubonakaliswa kwe-matrix metalloproteinases, okuholela ekuvuvukeni, ukwakheka kwezicubu ze-granulation, ukwanda kwe-epithelial, ukukhiqizwa kwe-matrix ye-extracellular kanye nokuvuselelwa kwezicubu;Ingakhuthaza ukwanda kwamaseli e-stem asuselwa ku-adipose yomuntu futhi isize ukudlala indima ekuvuseleleni izinzwa.
8) Isici esithathwe yi-Stromal cell:
Shayela amaseli e-CD34+ ukuze ulethe indawo yawo yokuhlala, ukwanda nokuhlukaniswa kwawo abe amaseli e-endothelial progenitor, futhi ashukumise i-angiogenesis;Qoqa amaseli we-mesenchymal stem nama-leukocyte.
9) Ukuguqula isici sokukhula β:
Ekuqaleni, inomphumela wokugqugquzela ukuvuvukala, kodwa ingaphinde ikhuthaze ukuguqulwa kwengxenye elimele esimweni sokulwa nokuvuvukala;Ingathuthukisa i-chemotaxis ye-fibroblasts namaseli emisipha ebushelelezi;Lawula ukubonakaliswa kwe-collagen ne-collagenase, futhi ukhuthaze i-angiogenesis.
10) Isici sokukhula kwe-Vascular endothelial:
Sekela futhi ukhuthaze ukukhula kwemicu yezinzwa evuselelwe ngokuhlanganisa i-angiogenesis, neurotrophic kanye neuroprotection, ukuze kubuyiselwe ukusebenza kwezinzwa.
11) Isici sokukhula kwemizwa:
Idlala indima ye-neuroprotective ngokukhuthaza ukukhula kwama-axon kanye nokugcinwa nokusinda kwama-neurons.
12) I-Glial derived neurotrophic factor:
Ingakwazi ukubuyisela emuva ngempumelelo futhi ijwayele amaprotheni e-neurogenic futhi idlale indima ye-neuroprotective.
Isiphetho
I-1) I-Platelet ecebile ye-plasma inezici zokugqugquzela ukuphulukiswa nokulwa nokuvuvukala.Ayikwazi ukulungisa kuphela izicubu zezinzwa ezilimele, kodwa futhi ikhulule ngempumelelo ubuhlungu.Kuyindlela yokwelapha ebalulekile yobuhlungu be-neuropathic futhi inamathemba aqhakazile;
2) Indlela yokulungiselela i-plasma ecebile ye-platelet iseyimpikiswano, idinga ukusungulwa kwendlela yokulungiselela esezingeni kanye nezinga elihlanganisiwe lokuhlola ingxenye;
I-3) Kunezifundo eziningi nge-plasma ecebile ye-platelet ebuhlungu be-neuropathic obubangelwa ukulimala komgogodla, ukulimala kwenzwa ye-peripheral kanye nokucindezelwa kwezinzwa.Indlela yokusebenza nokusebenza komtholampilo kwe-plasma ecebile ye-platelet kwezinye izinhlobo zobuhlungu be-neuropathic kudingeka kuqhutshekwe kufundwe.
Ubuhlungu be-neuropathic yigama elijwayelekile lesigaba esikhulu sezifo zomtholampilo, ezivame kakhulu ekusebenzeni komtholampilo.Kodwa-ke, ayikho indlela yokwelapha ethize okwamanje, futhi ubuhlungu buhlala iminyaka eminingana noma ngisho nokuphila ngemva kokugula, kubangela umthwalo omkhulu ezigulini, emindenini nasemphakathini.Ukwelashwa kwezidakamizwa kuwuhlelo oluyisisekelo lokwelapha ubuhlungu be-neuropathic.Ngenxa yesidingo semithi yesikhathi eside, ukuthobela kweziguli akulungile.Imithi yesikhathi eside izokwandisa ukusabela okubi kwezidakamizwa futhi ibangele ukulimala okukhulu ngokomzimba nangokwengqondo ezigulini.Ukuhlolwa okuyisisekelo okufanelekile kanye nezifundo zomtholampilo ziye zafakazela ukuthi i-PRP ingasetshenziswa ukwelapha ubuhlungu be-neuropathic, futhi i-PRP ivela esigulini ngokwayo, ngaphandle kokusabela okuzenzakalelayo.Inqubo yokwelapha ilula ngokuqhathaniswa, inokusabela okubi okumbalwa.I-PRP ingasetshenziswa kanye nama-stem cells, anekhono eliqinile lokulungiswa kwezinzwa nokuvuselelwa kwezicubu, futhi azoba nethuba elibanzi lokufaka isicelo ekwelapheni ubuhlungu be-neuropathic esikhathini esizayo.
(Okuqukethwe yile ndatshana kuphrintwe kabusha, futhi asinikezeli nganoma yisiphi isiqinisekiso esicacile noma esishiwoyo sokunemba, ukwethembeka noma ukuphelela kokuqukethwe okuqukethwe kulesi sihloko, futhi asinasibopho ngemibono yalesi sihloko, sicela uqonde.)
Isikhathi sokuthumela: Dec-20-2022