Lingaliro lomwe masiku ano limadziwika kuti PRP lidawonekera koyamba mu gawo la hematology m'ma 1970.Akatswiri a Hematologists adapanga mawu akuti PRP zaka makumi angapo zapitazo poyesa kufotokoza plasma yotengedwa kuchokera ku mapulateleti owerengera pamwamba pa milingo yoyambira m'magazi am'mphepete.Zaka zoposa khumi pambuyo pake, PRP idagwiritsidwa ntchito pa opaleshoni ya maxillofacial ngati mawonekedwe a platelet-rich fibrin (PRF).Zomwe zili mu fibrin zomwe zimachokera ku PRP ndizofunika kwambiri chifukwa cha zomatira ndi homeostatic katundu, pamene PRP imakhala ndi zotsutsana ndi zotupa zomwe zimapitirizabe ndipo zimalimbikitsa kukula kwa maselo.Pomaliza, chakumapeto kwa zaka za m'ma 1990, PRP inakhala yotchuka, ndipo pamapeto pake, lusoli linasamutsidwa kumadera ena azachipatala.Kuyambira nthawi imeneyo, biology yabwinoyi yakhala ikuphunziridwa mozama ndikugwiritsidwa ntchito pochiza kuvulala kosiyanasiyana kwa minofu ndi mafupa mwa akatswiri othamanga, zomwe zikuthandizira kuti anthu ambiri azimvetsera.Kuphatikiza pa kukhala othandiza pamankhwala a mafupa ndi masewera, PRP imagwiritsidwa ntchito mu ophthalmology, gynecology, urology ndi cardiology, ana ndi opaleshoni ya pulasitiki.M'zaka zaposachedwapa, PRP yayamikiridwanso ndi dermatologists chifukwa cha kuthekera kwake kuchiza zilonda zapakhungu, kukonzanso zipsera, kusinthika kwa minofu, kubwezeretsa khungu komanso ngakhale tsitsi.
Poganizira kuti PRP imadziwika kuti imayendetsa mwachindunji machiritso ndi njira zotupa, machiritso a machiritso ayenera kuyambitsidwa ngati zofotokozera.Njira yochiritsira imagawidwa m'magawo anayi otsatirawa: hemostasis;kutupa;kuchuluka kwa ma cell ndi matrix, ndipo pamapeto pake kukonzanso mabala.
1. Machiritso a Minofu
Kuphulika kwa machiritso a minofu kumayambitsidwa, njira yomwe imatsogolera ku kuphatikizika kwa mapulateleti, kupangika kwa magazi, ndi chitukuko cha matrix osakhalitsa a extracellular (ECM. Platelets kenaka amamatira ku mapuloteni oonekera a collagen ndi ECM, zomwe zimayambitsa kupezeka kwa α-granules mu Kutulutsidwa kwa Mapulateleti ali ndi mamolekyu osiyanasiyana a bioactive, kuphatikizapo kukula, ma chemokines, ndi ma cytokines, komanso oyimira pakati oyambitsa kutupa monga prostaglandins, prostatic cyclin, histamine, thromboxane, serotonin, ndi bradykinin.
Gawo lomaliza la kuchira limadalira kukonzanso kwa bala.Kukonzanso minofu kumayendetsedwa mwamphamvu kuti pakhale mgwirizano pakati pa mayankho a anabolic ndi catabolic.Panthawi imeneyi, kukula kwa platelet-derived growth factor (PDGF), kusintha kukula kwa chinthu (TGF-β) ndi fibronectin kumalimbikitsa kufalikira ndi kusamuka kwa fibroblasts, komanso kaphatikizidwe ka zigawo za ECM.Komabe, nthawi yakukhwima kwa bala imadalira kuuma kwa bala, mikhalidwe ya munthu payekha, komanso kuchiritsa kwenikweni kwa minofu yovulalayo, ndipo zinthu zina za pathophysiological ndi metabolism zimatha kukhudza machiritso, monga ischemia, hypoxia, matenda. , Kusalinganika kwa kukula kwa zinthu, komanso matenda okhudzana ndi metabolic syndrome.
Pro-inflammatory microenvironment yomwe imasokoneza machiritso.Pofuna kusokoneza zinthu, palinso ntchito yayikulu ya protease yomwe imalepheretsa zochitika zachilengedwe za kukula kwa chinthu (GF).Kuphatikiza pa kukhala ndi mitogenic, angiogenic, ndi chemotactic properties, PRP imakhalanso gwero lolemera la zinthu zambiri za kukula, ma biomolecules omwe amatha kuthana ndi zotsatira zowonongeka m'matenda otupa mwa kulamulira kutupa kowonjezereka ndi kukhazikitsa anabolic stimus.Chifukwa cha zinthu izi, Ofufuza angapeze mwayi waukulu wochiza kuvulala kosiyanasiyana.
2. Cytokine
Ma Cytokines mu PRP amagwira ntchito yofunika kwambiri pakuwongolera njira zokonzanso minofu ndikuwongolera kuwonongeka kotupa.Ma cytokines odana ndi kutupa ndi mitundu yambiri ya mamolekyu a biochemical omwe amayankhira mayankho a pro-inflammatory cytokine, makamaka oyambitsidwa ndi ma macrophages.Ma cytokine odana ndi kutupa amalumikizana ndi ma cytokine inhibitors ndi ma soluble cytokine receptors kuti achepetse kutupa.Interleukin (IL) -1 receptor antagonists, IL-4, IL-10, IL-11 ndi IL-13 amatchulidwa ngati ma cytokines akuluakulu odana ndi kutupa.Malingana ndi mtundu wa bala, ma cytokines ena, monga interferon, leukemia inhibitory factor, TGF-β ndi IL-6, akhoza kusonyeza zotsatira zotsutsana ndi zotupa.TNF-α, IL1 ndi IL-18 ali ndi zolandilira zina za cytokine zomwe zingalepheretse zoyambitsa zotupa za mapuloteni ena [37].IL-10 ndi imodzi mwa ma cytokines amphamvu kwambiri oletsa kutupa, amatha kuchepetsa-kuwongolera ma cytokines oyambitsa kutupa monga IL-1, IL-6 ndi TNF-α, ndikuwongolera ma cytokines odana ndi kutupa.Njira zotsutsana ndi izi zimagwira ntchito yofunika kwambiri pakupanga ndi kugwira ntchito kwa ma cytokines oteteza kutupa.Kuphatikiza apo, ma cytokines ena angayambitse mayankho ozindikiritsa omwe amalimbikitsa ma fibroblasts, omwe ndi ofunikira pakukonzanso minofu.Ma cytokines otupa TGFβ1, IL-1β, IL-6, IL-13, ndi IL-33 amathandizira ma fibroblasts kusiyanitsa myofibroblasts ndikuwongolera ECM [38].Komanso, ma fibroblasts amatulutsa ma cytokines TGF-β, IL-1β, IL-33, CXC, ndi CC chemokines, omwe amalimbikitsa mayankho okhudzana ndi kutupa mwa kuyambitsa ndi kulemba maselo a chitetezo cha mthupi monga macrophages.Maselo otupawa ali ndi maudindo angapo pa malo a bala, makamaka polimbikitsa kuchotsedwa kwa mabala - komanso biosynthesis ya chemokines, metabolites ndi kukula kwa zinthu, zomwe ndizofunikira pa kukonzanso minofu yatsopano.Chifukwa chake, ma cytokines omwe amapezeka mu PRP amagwira ntchito yofunika kwambiri polimbikitsa mayankho a chitetezo chamthupi amtundu wa cell, ndikuwongolera gawo lotupa.Ndipotu, ochita kafukufuku ena adatcha ndondomekoyi "kutupa koyambitsa matenda," kutanthauza kuti gawo lotupa, ngakhale kuti odwala ali ndi nkhawa, ndi sitepe yofunika kwambiri kuti ndondomeko yokonza minofu ifike pamapeto opambana, chifukwa cha njira za epigenetic zomwe zizindikiro zotupa zimalimbikitsa ma cell. pulasitiki.
3. Fibrin
Mapulateleti amanyamula zinthu zingapo zokhudzana ndi dongosolo la fibrinolytic zomwe zimatha kukweza kapena kutsitsa kuyankha kwa fibrinolytic.Ubale wanthawi yochepa komanso kuthandizira kwapang'onopang'ono kwa zigawo za hematological ndi ntchito ya mapulateleti pakuwonongeka kwa magazi ndi nkhani yoyenera kukambirana mozama m'deralo.Zolembazi zimapereka maphunziro ambiri omwe akungoyang'ana mapulateleti okha, omwe amadziwika kuti amatha kukhudza machiritso.Ngakhale kuti pali maphunziro ambiri apamwamba, zigawo zina za hematological, monga coagulation factor ndi fibrinolytic system, zapezeka kuti zikuthandizira kwambiri kukonza mabala.Mwa kutanthauzira, fibrinolysis ndi njira yovuta yachilengedwe yomwe imadalira kuyambitsa kwa ma enzymes kuti athandizire kuwonongeka kwa fibrin.Mayankho a fibrinolytic adanenedwa ndi olemba ena kuti zinthu zowononga ma fibrin (fdp) zitha kukhala ma molekyulu omwe amathandizira kukonza minofu, kutsatizana kwa zochitika zofunika kwambiri zamoyo zomwe fibrin isanakhazikike ndikuchotsedwa ku angiogenesis, yomwe ndiyofunikira pakuchiritsa mabala.Mapangidwe a chiwombankhanga pambuyo povulazidwa amakhala ngati chitetezo chotetezera chomwe chimateteza minofu kutayika kwa magazi, kugwidwa ndi tizilombo toyambitsa matenda, komanso imapereka matrix osakhalitsa omwe maselo amatha kusamuka panthawi yokonza.Kutsekeka kwa magazi kumachitika chifukwa cha kung'ambika kwa fibrinogen ndi serine proteases ndi mapulateleti ophatikizana mu network ya fibrin fibrous network.Izi amayambitsa polymerization wa fibrin monomers, chochitika chachikulu magazi kuundana.Ziphuphu zimathanso kukhala ngati nkhokwe za ma cytokines ndi zinthu zakukulira, zomwe zimatulutsidwa pakuwonongeka kwa mapulateleti otsegulidwa.Dongosolo la fibrinolytic limayendetsedwa mwamphamvu ndi plasmin ndipo limagwira ntchito yofunika kwambiri polimbikitsa kusamuka kwa maselo, kukula kwa bioavailability, komanso kuwongolera machitidwe ena a protease omwe amakhudzidwa ndi kutupa ndi kusinthika kwa minofu.Zigawo zazikulu za fibrinolysis, monga urokinase plasminogen activator receptor (uPAR) ndi plasminogen activator inhibitor-1 (PAI-1) zimadziwika kuti zimawonetsedwa m'maselo a mesenchymal stem cell (MSCs), mtundu wapadera wa selo wofunikira kuti chilonda chichiritse bwino.
4. Kusamuka kwa Maselo
Kutsegula kwa plasminogen kudzera mu mgwirizano wa uPA-uPAR ndi njira yomwe imalimbikitsa kusamuka kwa maselo otupa chifukwa kumawonjezera ma proteolysis owonjezera.Popeza uPAR ilibe ma transmembrane ndi ma intracellular domains, mapuloteni amafunikira ma co-receptors monga ma integrins ndi ma vitreins kuti azitha kuyendetsa ma cell.Kupitilira apo, kumanga kwa uPA-uPAR kudapangitsa kuti pakhale kuyanjana kwa uPAR kwa ma vitreous connexins ndi ma integrins, kulimbikitsa kumamatira kwa ma cell.Plasminogen activator inhibitor-1 (PAI-1) nayenso imachotsa ma cell, kuwononga upar-vitrein ndi integrin- ikamangiriza ku UPA ya uPA-upar-integrin complex pa cell surface Kulumikizana kwa ma voxels agalasi.
Pankhani ya mankhwala obwezeretsanso, maselo amtundu wa mesenchymal amasonkhanitsidwa kuchokera ku fupa la fupa pokhudzana ndi kuwonongeka kwakukulu kwa chiwalo ndipo motero angapezeke pakuyenda kwa odwala omwe ali ndi fractures angapo.Komabe, nthawi zina, monga kulephera kwa aimpso kumapeto, kulephera kwa chiwindi, kapena kuyambika kwa kukanidwa pambuyo pa kuikidwa kwa mtima, maselowa sangawonekere m'magazi [66].Chochititsa chidwi n'chakuti, maselo amtundu wa mesenchymal (stromal) omwe amachokera ku mafupa aumunthu sangathe kudziwika m'magazi a anthu athanzi [67].Udindo wa uPAR pakuphatikiza ma cell a mafupa a mesenchymal stem cell adanenedwanso kale, zofanana ndi zomwe zimachitika polimbikitsa hematopoietic stem cell (HSC).Varabaneni et al.Zotsatira zake zidawonetsa kuti kugwiritsa ntchito granulocyte colony-stimulating factor mu mbewa zoperewera za uPAR kudapangitsa kuti ma MSC alephere, ndikulimbitsanso gawo lothandizira la fibrinolytic system pakusuntha kwa ma cell.Kafukufuku wina wasonyezanso kuti glycosylphosphatidylinositol-anchored uPA receptors imayang'anira kumamatira, kusamuka, kuchulukana, ndi kusiyanitsa mwa kuyambitsa njira zina zowonetsera zamkati mwa cell, motere: pro-survival phosphatidylinositol 4,5-bisphosphate 3-kinase / Akt 2 njira ndi ERK2 , ndi adhesion kinase (FAK).
Ma MSC awonetsa kufunikira kwina pakuchiritsa mabala.Mwachitsanzo, mbewa zopanda plasminogen zimasonyeza kuchedwa kwakukulu pazochitika zochiritsa mabala, kutanthauza kuti plasmin ikukhudzidwa kwambiri ndi izi.Mwa anthu, kutayika kwa plasmin kungayambitsenso zovuta za kuchira kwa bala.Kusokonezeka kwa magazi kungalepheretse kwambiri kusinthika kwa minofu, zomwe zimalongosola chifukwa chake njira zowonongekazi zimakhala zovuta kwambiri kwa odwala matenda a shuga.
5. Monocytes ndi Regeneration Systems
Malinga ndi mabukuwa, pali zokambirana zambiri za ntchito ya monocytes mu machiritso a bala.Macrophages makamaka amachokera ku magazi a monocyte ndipo amagwira ntchito yofunika kwambiri pamankhwala obwezeretsa [81].Popeza ma neutrophils amatulutsa IL-4, IL-1, IL-6 ndi TNF-α, maselowa amalowa pabalaza pafupifupi maola 24-48 atavulala.Mapulateleti amatulutsa thrombin ndi platelet factor 4 (PF4), ma chemokines awiri omwe amalimbikitsa kulembedwa kwa ma monocyte ndi kuwasiyanitsa kukhala ma macrophages ndi ma dendritic cell.Chochititsa chidwi kwambiri ndi ma macrophages ndi mapulasitiki awo, mwachitsanzo, amatha kusintha ma phenotypes ndi transdifferentiate kukhala ma cell ena monga ma endothelial cell, omwe pambuyo pake amawonetsa ntchito zosiyanasiyana potengera kukhudzidwa kwamitundu yosiyanasiyana yazachilengedwe m'malo ang'onoang'ono a bala.Maselo otupa amasonyeza ma phenotypes awiri akuluakulu, M1 kapena M2, malingana ndi chizindikiro cha maselo am'deralo chomwe chili gwero la chilimbikitso.Ma macrophages a M1 amapangidwa ndi tizilombo toyambitsa matenda ndipo motero amakhala ndi zotsatira zowononga kwambiri.Mosiyana ndi izi, ma macrophages a M2 nthawi zambiri amapangidwa ndi mayankho amtundu wa 2 ndipo amakhala ndi anti-inflammatory properties, zomwe zimadziwika ndi kuwonjezeka kwa IL-4, IL-5, IL-9, ndi IL-13.Zimakhudzidwanso ndi kukonza minofu mwa kupanga zinthu za kukula.Kusintha kuchokera ku M1 kupita ku M2 isoforms kumayendetsedwa makamaka ndi magawo amtsogolo a machiritso a bala, pomwe ma macrophages a M1 amayambitsa neutrophil apoptosis ndikuyambitsa kuchotsedwa kwa maselowa).Phagocytosis ndi neutrophils imayendetsa zochitika zambiri zomwe kupanga cytokine kuzimitsidwa, polarizing macrophages ndikutulutsa TGF-β1.Kukula kumeneku ndikuwongolera kwakukulu kwa kusiyanitsa kwa myofibroblast ndi kutsika kwa bala, kulola kuthetsa kutupa ndi kuyambitsa gawo lochulukira mu machiritso a machiritso [57].Puloteni ina yokhudzana kwambiri ndi ma cell ndi serine (SG).Granulan yopangidwa ndi maselo a hematopoietic yapezeka kuti ndiyofunika kusungirako mapuloteni obisika m'maselo enieni a chitetezo chamthupi, monga ma mast cell, neutrophils, ndi cytotoxic T lymphocytes.Ngakhale kuti maselo ambiri omwe sali a hematopoietic amapanganso serotonin, maselo onse otupa amatulutsa mapuloteni ochuluka kwambiri ndipo amawasunga mu granules kuti apitirize kuyanjana ndi oyimira pakati otupa, kuphatikizapo ma proteases, cytokines, chemokines, ndi kukula kwake.Unyolo wa glycosaminoglycan (GAG) wokhala ndi ma charger olakwika mu SG umawoneka ngati wofunikira kwambiri pa granule homeostasis, chifukwa amatha kumangirira ndikuthandizira kusungidwa kwa zigawo za granule zochajitsidwa kwambiri mu cell-, protein-, ndi GAG chain chain.Ponena za kukhudzidwa kwawo ku PRP, Woulfe ndi anzake adawonetsa kale kuti kusowa kwa SG kumagwirizanitsidwa kwambiri ndi kusintha kwa mapulaneti a mapulaneti;zolakwika mu platelet factor 4, beta-thromblobulin, ndi kusunga PDGF m'mapulateleti;kusanjika bwino kwa mapulateleti ndi katulutsidwe ka m'galasi ndi thrombosis mu vivo mawonekedwe opunduka.Chifukwa chake ofufuzawo adatsimikiza kuti proteoglycan iyi ikuwoneka ngati yowongolera bwino kwambiri ya thrombosis.
Zinthu zokhala ndi mapulateleti zimatha kupezeka posonkhanitsa ndi kuyika magazi athunthu amunthu, kuwalekanitsa m'magulu osiyanasiyana okhala ndi plasma, mapulateleti, leukocyte, ndi leukocyte.Pamene kuchuluka kwa mapulateleti ndipamwamba kuposa ma basal, kukula kwa mafupa ndi minofu yofewa kumatha kufulumizitsidwa ndi zotsatira zochepa.Kugwiritsa ntchito mankhwala a autologous PRP ndi sayansi yatsopano yazachilengedwe yomwe ikupitilizabe kuwonetsa zotsatira zolimbikitsa pakukondoweza komanso kuchiritsa kuvulala kwamitundu yosiyanasiyana.Kuchita bwino kwa njira yochiritsira yosiyanayi kungabwere chifukwa cha kuperekedwa kwapamutu kwa zinthu zosiyanasiyana zakukulira ndi zomanga thupi, kutsanzira ndikuthandizira kuchiritsa mabala amthupi ndi kukonza minofu.Kuphatikiza apo, dongosolo la fibrinolytic momveka bwino limakhudza kwambiri kukonza minofu yonse.Kuphatikiza pa kuthekera kwake kusintha ma cell opangira ma cell otupa ndi ma cell tsinde a mesenchymal, imathandizira ntchito ya proteolytic m'malo ochiritsa mabala komanso panthawi yosinthika kwa minofu ya mesodermal kuphatikiza mafupa, cartilage ndi minofu, motero ndizofunikira kwambiri pagawo lamankhwala aminoskeletal.
Kufulumizitsa machiritso ndi cholinga chofunidwa kwambiri ndi akatswiri ambiri azachipatala, ndipo PRP imayimira chida chabwino chachilengedwe chomwe chikupitilizabe kupititsa patsogolo chitukuko cholimbikitsa komanso chogwirizana bwino cha zochitika zakubadwanso.Komabe, popeza chida ichi chochiritsira chimakhalabe chovuta, makamaka popeza chimatulutsa zinthu zambirimbiri za bioactive ndi njira zawo zosiyanasiyana zolumikizirana ndi zizindikiro, maphunziro ena amafunikira.
(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: Jul-19-2022