Ululu wa Neuropathic umatanthawuza kugwira ntchito kwachilendo, kumva kupweteka komanso kupweteka kodzidzimutsa chifukwa cha kuvulala kapena matenda a somatic sensory nervous system.Ambiri a iwo akadali limodzi ndi ululu lolingana innervated m`dera pambuyo kuchotsa chovulala zinthu, amene akuwonetseredwa mowiriza ululu, hyperalgesia, hyperalgesia ndi matenda kutengeka.Pakali pano, mankhwala ochepetsa ululu wa neuropathic akuphatikizapo tricyclic antidepressants, 5-hydroxytryptamine norepinephrine reuptake inhibitors, anticonvulsants gabapentin ndi pregabalin, ndi opioids.Komabe, zotsatira za mankhwala ozunguza bongo nthawi zambiri zimakhala zochepa, zomwe zimafuna njira zochizira ma multimodal monga masewero olimbitsa thupi, malamulo a neural ndi opaleshoni.Kupweteka kosalekeza ndi kuchepa kwa magwiridwe antchito kudzachepetsa kutenga nawo gawo kwa odwala ndikupangitsa kuti odwala azivutika kwambiri m'maganizo ndi zachuma.
Platelet rich plasma (PRP) ndi mankhwala a plasma okhala ndi mapulateleti oyeretsedwa kwambiri omwe amatengedwa ndi centrifuging autologous blood.Mu 1954, KINGSLEY adagwiritsa ntchito mawu oti azachipatala PRP.Kupyolera mu kafukufuku ndi chitukuko m'zaka zaposachedwapa, PRP yakhala ikugwiritsidwa ntchito kwambiri pa opaleshoni ya mafupa ndi mafupa, opaleshoni ya msana, dermatology, kukonzanso ndi madipatimenti ena, ndipo imakhala ndi gawo lofunika kwambiri pa ntchito yokonza zomangamanga.
Mfundo yaikulu ya chithandizo cha PRP ndikulowetsa mapulateleti okhazikika pamalo ovulala ndikuyamba kukonzanso minofu mwa kutulutsa zinthu zosiyanasiyana za bioactive (zinthu za kukula, cytokines, lysosomes) ndi mapuloteni omatira.Izi bioactive zinthu ndi udindo poyambitsa hemostatic cascade reaction, kaphatikizidwe wa minyewa yatsopano yolumikizana ndi kukonzanso mitsempha.
Gulu ndi matenda a neuropathic ululu Bungwe la World Health Organization linatulutsa 11th revised version of the International Classification of Pain mu 2018, kugawanitsa ululu wa neuropathic pakati pa ululu wa neuropathic ndi zotumphukira za neuropathic.
Zopweteka za neuropathic zimagawidwa malinga ndi etiology:
1) Matenda / kutupa: postherpetic neuralgia, khate lopweteka, chindoko / HIV peripheral neuropathy
2) Kupanikizika kwa mitsempha: matenda a carpal tunnel syndrome, kupweteka kwa msana kumachepetsa kwambiri
3) Kupwetekedwa mtima: kupwetekedwa mtima / kutentha / post-operative / post radiotherapy neuropathic ululu
4) Ischemia/metabolism: matenda a shuga amtundu wa neuropathic ululu
5) Mankhwala: zotumphukira neuropathy chifukwa cha mankhwala (monga chemotherapy)
6) Zina: kupweteka kwa khansa, trigeminal neuralgia, glossopharyngeal neuralgia, Morton's neuroma.
Magulu ndi njira zokonzekera za PRP amakhulupirira kuti kuchuluka kwa mapulateleti mu PRP ndi kuwirikiza kanayi kapena kasanu kuposa magazi athunthu, koma pakhala kusowa kwa zizindikiro za kuchuluka.Mu 2001, Marx adatanthauzira kuti PRP ili ndi mapulateleti osachepera 1 miliyoni pa microliter ya plasma, yomwe ndi chizindikiro cha kuchuluka kwa PRP.Dohan et al.PRP yagawidwa m'magulu anayi: PRP yoyera, leukocyte rich PRP, pure platelet rich fibrin, ndi leukocyte rich platelet fibrin yotengera zomwe zili mu platelet, leukocyte, ndi fibrin mu PRP.Pokhapokha ngati tafotokozedwa mwanjira ina, PRP nthawi zambiri imatanthawuza ma cell oyera olemera a PRP.
Njira ya PRP pochiza Ululu wa Neuropathic Pambuyo pa kuvulazidwa, zoyambitsa zosiyanasiyana zowonongeka ndi zakunja zidzalimbikitsa kutsegulira kwa mapulateleti α- Ma granules amakumana ndi degranulation reaction, kutulutsa zinthu zambiri za kukula, fibrinogen, cathepsin ndi hydrolase.Zomwe zimatulutsidwa zimamangirira kunja kwa nembanemba ya cell ya chandamale kudzera pa ma transmembrane receptors pa cell membrane.Ma transmembrane receptors nawonso amathandizira ndikuyambitsa mapuloteni ozindikiritsa amkati, ndikuyambitsanso mthenga wachiwiri muselo, zomwe zimapangitsa kuchulukana kwa maselo, mapangidwe a matrix, kaphatikizidwe ka mapuloteni a collagen ndi mawonekedwe ena amtundu wa intracellular.Pali umboni wosonyeza kuti ma cytokines otulutsidwa ndi mapulateleti ndi ma transmitters ena amathandiza kwambiri kuchepetsa / kuthetsa ululu wosaneneka wa neuropathic.Njira zenizeni zimatha kugawidwa m'machitidwe ozungulira ndi njira zapakati.
Njira ya platelet rich plasma (PRP) pochiza ululu wa neuropathic
Njira zotumphukira: anti-inflammatory effect, neuroprotection ndikulimbikitsa kusinthika kwa axon, chitetezo chamthupi, analgesic effect.
Makina apakati: kufooketsa ndi kubweza kulimbikitsa kwapakati ndikuletsa kuyambitsa kwa ma cell a glial
Anti-kutupa Zotsatira
Peripheral sensitization imakhala ndi gawo lofunikira pakuwonekera kwa zizindikiro za ululu wa neuropathic pambuyo povulala kwa mitsempha.Maselo osiyanasiyana otupa, monga neutrophils, macrophages ndi mast cell, adalowetsedwa m'malo ovulaza mitsempha.Kuchulukana kwakukulu kwa maselo otupa kumapanga maziko a chisangalalo chochuluka ndi kutulutsa kosalekeza kwa mitsempha ya mitsempha.Kutupa kumatulutsa chiwerengero chachikulu cha oyimira pakati pa mankhwala, monga cytokines, chemokines ndi lipid mediators, kupanga ma nociceptors kukhala okhudzidwa ndi okondwa, ndikupangitsa kusintha kwa chilengedwe cha mankhwala.Mapulateleti ali ndi mphamvu zolimbitsa thupi komanso zotsutsana ndi kutupa.Poyang'anira ndi kubisa zinthu zosiyanasiyana zotetezera chitetezo cha mthupi, zinthu za angiogenic ndi zakudya zowonjezera, zimatha kuchepetsa kuwonongeka kwa chitetezo cha mthupi ndi kutupa, ndikukonza zowonongeka zosiyanasiyana m'madera osiyanasiyana.PRP ikhoza kugwira ntchito yotsutsa-kutupa kudzera m'njira zosiyanasiyana.Ikhoza kulepheretsa kutulutsidwa kwa ma cytokines oyambitsa kutupa kuchokera ku maselo a Schwann, macrophages, neutrophils ndi maselo a mast, ndikuletsa kuwonetsera kwa jini ya pro-inflammatory factor receptors mwa kulimbikitsa kusintha kwa minyewa yowonongeka kuchokera ku dziko lopweteka kupita ku dziko loletsa kutupa.Ngakhale mapulateleti samatulutsa interleukin 10, mapulateleti amachepetsa kupanga kwa interleukin 10 yambiri poyambitsa maselo osakhwima a dendritic γ - Kupanga kwa interferon kumagwira ntchito yotsutsa-kutupa.
Analgesic Effect
Mapulateleti oyambitsidwa amatulutsa ma neurotransmitters ambiri oyambitsa kutupa komanso odana ndi kutupa, omwe angayambitse ululu, komanso amachepetsa kutupa ndi kupweteka.Mapulateleti okonzedwa kumene amakhala mu PRP.Pambuyo poyendetsedwa mwachindunji kapena m'njira zina, morphology ya platelet imasintha ndikulimbikitsa kuphatikizika kwa mapulateleti, kutulutsa ma α-Dense particles ndi tinthu tating'onoting'ono ta 5-hydroxytryptamine, yomwe imakhala ndi zotsatira zowawa.Pakadali pano, ma 5-hydroxytryptamine receptors amapezeka kwambiri m'mitsempha yozungulira.5-hydroxytryptamine ingakhudze kutumiza kwa nociceptive m'magulu ozungulira kudzera mu 5-hydroxytryptamine 1, 5-hydroxytryptamine 2, 5-hydroxytryptamine 3, 5-hydroxytryptamine 4 ndi 5-hydroxytryptamine 7 receptors.
Kuletsa kwa Glial Cell Activation
Maselo a Glial amakhala pafupifupi 70% ya ma cell apakati amanjenje, omwe amatha kugawidwa m'mitundu itatu: astrocytes, oligodendrocytes ndi microglia.Microglia idatsegulidwa mkati mwa maola a 24 pambuyo pa kuvulala kwa mitsempha, ndipo astrocyte adatsegulidwa atangovulala kwa mitsempha, ndipo kuyambitsako kunatenga masabata a 12.Astrocytes ndi microglia ndiye amamasula ma cytokines ndi kuyambitsa mndandanda wa mayankho a ma cell, monga kukweza kwa glucocorticoid ndi glutamate receptors, zomwe zimayambitsa kusintha kwa msana wa msana ndi neural plasticity, zomwe zimagwirizana kwambiri ndi zochitika za ululu wa neuropathic.
Zomwe zimakhudzidwa pakuchepetsa kapena kuthetsa ululu wa neuropathic mu plasma wolemera wa platelet
1) Angiopoietin:
kuyambitsa angiogenesis;Kulimbikitsa kusuntha kwa endothelial cell ndi kuchulukana;Kuthandizira ndi kukhazikika kwa chitukuko cha mitsempha yamagazi polemba ma pericytes
2) Kukula kwa minofu yolumikizana:
Kulimbikitsa kusamuka kwa leukocyte;kulimbikitsa angiogenesis;Imayendetsa myofibroblast ndikulimbikitsa kuyika kwa matrix a extracellular ndi kukonzanso
3) Epidermal kukula factor:
Limbikitsani machiritso a zilonda ndi kuyambitsa angiogenesis mwa kulimbikitsa kuchulukana, kusamuka ndi kusiyanitsa macrophages ndi fibroblasts;Limbikitsani ma fibroblasts kuti atulutse collagenase ndikuwononga matrix a extracellular pakukonzanso mabala;Limbikitsani kuchuluka kwa keratinocytes ndi fibroblasts, zomwe zimatsogolera ku repithelization.
4) Fibroblast kukula factor:
Kupangitsa chemotaxis ya macrophages, fibroblasts ndi endothelial cell;kuyambitsa angiogenesis;Ikhoza kuyambitsa granulation ndi kukonzanso minofu ndi kutenga nawo mbali pakupanga mabala.
5) Kukula kwa hepatocyte:
Kuwongolera kukula kwa maselo ndi kayendedwe ka epithelial / endothelial cell;Kulimbikitsa kukonza epithelial ndi angiogenesis.
6) Insulin ngati kukula kwake:
Sonkhanitsani pamodzi ma cell a fiber kuti mulimbikitse kaphatikizidwe ka mapuloteni.
7) Kukula kwa Platelet:
Kulimbikitsa chemotaxis wa neutrophils, macrophages ndi fibroblasts, ndi kulimbikitsa kuchuluka kwa macrophages ndi fibroblasts pa nthawi yomweyo;Zimathandizira kuwonongeka kwa collagen yakale ndikuwongolera kufotokozera kwa matrix metalloproteinases, zomwe zimayambitsa kutupa, mapangidwe a minofu ya granulation, epithelial proliferation, kupanga matrix a extracellular ndi kukonzanso minofu;Ikhoza kulimbikitsa kuchuluka kwa maselo amtundu wa adipose omwe amachokera ku anthu ndikuthandizira kuti azitha kukonzanso mitsempha.
8) Stromal cell yochokera ku chinthu:
Itanani ma CD34+ kuti muwapangitse kukhala kwawo, kuchulukira ndi kusiyanitsa kukhala ma cell a endothelial progenitor, ndikulimbikitsa angiogenesis;Sungani maselo amtundu wa mesenchymal ndi leukocyte.
9) Kusintha kukula kwa chinthu β:
Poyamba, zimakhala ndi zotsatira zolimbikitsa kutupa, koma zimatha kulimbikitsanso kusintha kwa gawo lovulala ku dziko loletsa kutupa;Ikhoza kupititsa patsogolo chemotaxis ya fibroblasts ndi maselo osalala a minofu;Sinthani mawonekedwe a collagen ndi collagenase, ndikulimbikitsa angiogenesis.
10) Vascular endothelial kukula factor:
Thandizani ndikulimbikitsa kukula kwa ulusi wosinthika wa mitsempha mwa kuphatikiza angiogenesis, neurotrophic ndi neuroprotection, kuti abwezeretse ntchito ya mitsempha.
11) Kukula kwa mitsempha:
Imagwira ntchito ya neuroprotective polimbikitsa kukula kwa ma axon komanso kukonza ndi kupulumuka kwa ma neuron.
12) Glial yochokera ku neurotrophic factor:
Imatha kusintha bwino ndikusinthiratu mapuloteni a neuroogenic ndikuchita gawo la neuroprotective.
Mapeto
1) Platelet olemera a plasma ali ndi mikhalidwe yolimbikitsa machiritso ndi anti kutupa.Iwo sangakhoze kokha kukonza kuonongeka minyewa zimakhala, komanso mogwira kuthetsa ululu.Ndi njira yofunikira yothandizira kupweteka kwa neuropathic ndipo imakhala ndi chiyembekezo chowala;
2) Njira yokonzekera mapulateleti olemera a plasma akadali mkangano, kuyitanitsa kukhazikitsidwa kwa njira yokonzekera yokhazikika komanso muyezo wowunika wagawo;
3) Pali maphunziro ambiri pa mapulateleti olemera a plasma mu ululu wa neuropathic chifukwa cha kuvulala kwa msana, kuvulala kwa mitsempha yotumphukira ndi kupsinjika kwa mitsempha.Njira ndi mphamvu yachipatala ya plasma yolemera ya platelet mu mitundu ina ya ululu wa neuropathic iyenera kuphunziridwa mowonjezereka.
Ululu wa Neuropathic ndi dzina la gulu lalikulu la matenda azachipatala, omwe amapezeka kwambiri m'machitidwe azachipatala.Komabe, palibe njira yeniyeni yothandizira pakalipano, ndipo ululuwo umakhala kwa zaka zingapo kapena ngakhale moyo wonse pambuyo pa matenda, zomwe zimayambitsa kulemetsa kwakukulu kwa odwala, mabanja ndi anthu.Chithandizo chamankhwala ndi njira yoyambira yothandizira ululu wa neuropathic.Chifukwa chofuna mankhwala okhalitsa, kutsata kwa odwala sikwabwino.Kumwa mankhwalawa kwa nthawi yayitali kumawonjezera zovuta za mankhwala ndikuwononga kwambiri thupi ndi malingaliro kwa odwala.Kuyesera koyenera kofunikira ndi maphunziro achipatala atsimikizira kuti PRP ikhoza kugwiritsidwa ntchito pochiza ululu wa neuropathic, ndipo PRP imachokera kwa wodwalayo mwiniyo, popanda kuchitapo kanthu.Njira yochiritsira ndiyosavuta, imakhala ndi zovuta zochepa.PRP ingagwiritsidwenso ntchito pamodzi ndi maselo amtundu, omwe ali ndi mphamvu zolimba za kukonzanso mitsempha ndi kusinthika kwa minofu, ndipo adzakhala ndi chiyembekezo chogwiritsa ntchito pochiza ululu wa neuropathic m'tsogolomu.
(Zomwe zili m'nkhaniyi zidasindikizidwanso, ndipo sitikupereka chitsimikizo chotsimikizika kapena chotsimikizika pakulondola, kudalirika kapena kukwanira kwa zomwe zili m'nkhaniyi, ndipo sitili ndi udindo pamalingaliro ankhaniyi, chonde mvetsetsani.）
Nthawi yotumiza: Dec-20-2022