Mgbu Neuropathic na-ezo aka na ọrụ mmetụta uche na-adịghị mma, mmetụta mgbu na mgbu na-enweghị isi nke mmerụ ahụ ma ọ bụ ọrịa nke usoro nhụjuanya nke anụ ahụ somatic kpatara.Ọtụtụ n'ime ha ka nwere ike na-esonyere mgbu na mpaghara innervated kwekọrọ na njedebe nke ihe ndị na-emerụ ahụ, nke gosipụtara dị ka ihe mgbu na-enweghị isi, hyperalgesia, hyperalgesia na mmetụta na-adịghị mma.Ka ọ dị ugbu a, ọgwụ maka ibelata mgbu neuropathic gụnyere tricyclic antidepressants, 5-hydroxytryptamine norepinephrine reuptake inhibitors, anticonvulsants gabapentin na pregabalin, na opioids.Otú ọ dị, mmetụta nke ọgwụgwọ ọgwụ na-adịkarị ntakịrị, nke na-achọ usoro ọgwụgwọ multimodal dị ka ọgwụgwọ anụ ahụ, nchịkwa akwara na ntinye aka.Ihe mgbu na-adịghị ala ala na njedebe ọrụ ga-ebelata òkè mmekọrịta nke ndị ọrịa ma mee ka ndị ọrịa nwee nsogbu uche na akụ na ụba siri ike.
Plasma bara ụba (PRP) bụ ngwaahịa plasma nwere platelet dị ọcha dị elu enwetara site na centrifuging ọbara autologous.Na 1954, KINGSLEY bu ụzọ jiri okwu ahụike PRP mee ihe.Site na nyocha na mmepe n'ime afọ ndị na-adịbeghị anya, a na-eji PRP mee ihe n'ọtụtụ ebe na ọkpụkpụ na nkwonkwo ịwa ahụ, ịwa ahụ ọkpụkpụ, dermatology, nhazigharị na ngalaba ndị ọzọ, ma na-arụ ọrụ dị mkpa n'ọhịa nke nrụzi anụ ahụ.
Ụkpụrụ bụ isi nke ọgwụgwọ PRP bụ ịgbanye platelet gbanyere mkpọrọgwụ na saịtị ahụ merụrụ ahụ wee malite nrụzi anụ ahụ site n'ịhapụ ọtụtụ ihe ndị na-emepụta ihe (ihe na-eto eto, cytokines, lysosomes) na protein adhesion.Ihe ndị a na-ahụ maka ihe ndị na-emepụta ihe na-ahụ maka ịmalite mmeghachi omume hemostatic cascade, njikọ nke anụ ahụ njikọ ọhụrụ na nhazigharị vaskụla.
Nhazi na pathogenesis nke mgbu neuropathic Healthtù Ahụ Ike Worldwa wepụtara 11th revised version of International Classification of Pain na 2018, na-ekewa mgbu neuropathic n'ime mgbu neuropathic nke etiti na mgbu neuropathic mpụta.
A na-ekewa mgbu neuropathic nke akụkụ dị ka etiology si dị:
1) Ọrịa / mbufụt: postherpetic neuralgia, ekpenta na-egbu mgbu, syphilis/HIV bu ọrịa neuropathy peripheral.
2) Mkpịsị akwara: ọrịa ọwara carpal, mgbu radicular degenerative spinal
3) Trauma: trauma / ọkụ / post-operative / post radiotherapy mgbu neuropathic mgbu
4) Ischemia/metabolism: ọrịa shuga peripheral neuropathic mgbu
5) Ọgwụ: neuropathy mpụta nke ọgwụ (dị ka chemotherapy) kpatara.
6) Ndị ọzọ: mgbu cancer, trigeminal neuralgia, glossopharyngeal neuralgia, Morton's neuroma.
Usoro nhazi na nkwadebe nke PRP n'ozuzu kwenyere na ntinye platelet na PRP ji okpukpu anọ ma ọ bụ ise karịa nke ọbara dum, mana enweghi ihe ngosi ọnụọgụ.N'afọ 2001, Marx kọwara na PRP nwere opekata mpe 1 nde platelet kwa microliter nke plasma, nke bụ akara ọnụọgụ nke ọkọlọtọ PRP.Dohan et al.Nkewa PRP na ngalaba anọ: PRP dị ọcha, ọgaranya leukocyte PRP, fibrin dị ọcha platelet, na leukocyte ọgaranya platelet fibrin dabere na ọdịnaya dị iche iche nke platelet, leukocyte, na fibrin na PRP.Ọ gwụla ma akọwapụtara ya ọzọ, PRP na-ezokarị aka na cell ọgaranya PRP.
Mechanism nke PRP na ọgwụgwọ nke Neuropathic Pain Mgbe mmerụ ahụ gasịrị, ndị na-eme ihe dị iche iche na-arụ ọrụ endogenous na exogenous ga-akwalite ọrụ platelet α- The granules na-enweta mmeghachi omume mmebi, na-ahapụ ọtụtụ ihe na-eto eto, fibrinogen, cathepsin na hydrolase.Ihe ndị na-eto eto a tọhapụrụ na-ejikọta na elu elu nke cell membrane nke cell ezubere iche site na ndị na-anabata transmembrane na akpụkpọ ahụ cell.Ndị na-anabata transmembrane ndị a na-ebute ma na-arụ ọrụ protein na-egosi endogenous, na-eme ka onye ozi nke abụọ na-arụ ọrụ na cell, nke na-ebute mmụba cell, nhazi nke matrix, njikọ nke protein collagen na okwu mkpụrụ ndụ intracellular ndị ọzọ.Enwere ihe akaebe na cytokines wepụtara site na platelet na ndị na-ebufe ndị ọzọ na-arụ ọrụ dị mkpa n'ibelata / iwepụ mgbu neuropathic na-adịghị ala ala.Enwere ike kewaa usoro ndị a kapịrị ọnụ n'ime usoro mpụta na usoro etiti.
Mechanism nke platelet ọgaranya plasma (PRP) na ọgwụgwọ nke mgbu neuropathic
Usoro dị n'akụkụ: mmetụta mgbochi mkpali, neuroprotection na nkwalite nke axon regeneration, usoro mgbochi, mmetụta analgesic.
Usoro etiti: na-ebelata ma na-atụgharị uche etiti yana igbochi glial cell ịgbalite
Mmetụta mgbochi mkpali
Mmetụta dị n'akụkụ na-arụ ọrụ dị mkpa n'ihe omume nke mgbaàmà mgbu neuropathic mgbe mmerụ ahụ akwara gasịrị.Ụdị mkpụrụ ndụ dị iche iche, dị ka neutrophils, macrophages na sel mast, na-abanye n'ime ebe mmerụ ahụ akwara.Nnukwu mkpokọta mkpụrụ ndụ mkpali na-etolite ndabere nke oke mkpali na mwepu nke eriri akwara na-aga n'ihu.Mbufụt na-ewepụta ọnụ ọgụgụ dị ukwuu nke ndị mgbasa ozi kemịkalụ, dị ka cytokines, chemokines na ndị ogbugbo egbugbere ọnụ, na-eme ka nociceptors nwee mmetụta na obi ụtọ, na-eme mgbanwe na gburugburu kemịkalụ mpaghara.Platelet nwere mmetụta immunosuppressive siri ike yana mgbochi mkpali.Site na ịhazi na izobe ihe dị iche iche na-achịkwa usoro mgbochi ọrịa, ihe angiogenic na ihe oriri na-edozi ahụ, ha nwere ike ibelata mmeghachi omume na-emerụ ahụ na mbufụt, ma mezie mmebi anụ ahụ dị iche iche na microenvironments dị iche iche.PRP nwere ike ịrụ ọrụ mgbochi mkpali site na usoro dị iche iche.Ọ nwere ike igbochi ntọhapụ nke cytokines pro-inflammatory sitere na mkpụrụ ndụ Schwann, macrophages, neutrophils na mast cell, ma gbochie okwu mkpụrụ ndụ ihe nketa nke ndị na-anabata ihe na-emepụta ihe site n'ịkwalite mgbanwe nke anụ ahụ mebiri emebi site na ọnọdụ mkpali gaa na steeti mgbochi.Ọ bụ ezie na platelet adịghị ahapụ interleukin 10, platelet na-ebelata mmepụta nke nnukwu interleukin 10 site n'ime ka mkpụrụ ndụ dendritic na-akabeghị aka γ-Mmepụta interferon na-arụ ọrụ mgbochi mkpali.
Mmetụta analgesic
platelet arụ ọrụ na-ahapụ ọtụtụ neurotransmitters pro-inflammatory na mgbochi mkpali, nke nwere ike ịkpata mgbu, ma belata mbufụt na mgbu.platelet ndị a kwadebere ọhụrụ na-ehi ụra na PRP.Mgbe emechara ya ozugbo ma ọ bụ na-apụtaghị ìhè, morphology platelet na-agbanwe ma na-akwalite nchịkọta platelet, na-ahapụ ya intracellular α-Dense particles na ihe mmetụta uche ga-akpali ntọhapụ nke 5-hydroxytryptamine, nke nwere mmetụta mgbu.Ka ọ dị ugbu a, a na-achọpụtakarị ndị na-anabata 5-hydroxytryptamine na irighiri akwara.5-hydroxytryptamine nwere ike imetụta nnyefe nociceptive na anụ ahụ gbara ya gburugburu site na 5-hydroxytryptamine 1, 5-hydroxytryptamine 2, 5-hydroxytryptamine 3, 5-hydroxytryptamine 4 na 5-hydroxytryptamine 7.
Mgbochi nke Glial Cell ịgbalite
Mkpụrụ ndụ Glial bụ ihe dị ka 70% nke mkpụrụ ndụ sistemu ụjọ nke etiti, nke enwere ike kewaa ụzọ atọ: astrocytes, oligondrocytes na microglia.A na-arụ ọrụ Microglia n'ime awa 24 mgbe mmerụ ahụ merụrụ ahụ, na astrocytes na-arụ ọrụ n'oge na-adịghị anya mgbe mmerụ ahụ gasịrị, ọrụ ahụ na-adịgide maka izu 12.Astrocytes na microglia wee hapụ cytokines ma mee ka usoro nzaghachi cellular, dị ka ngbanwe nke glucocorticoid na ndị na-anabata glutamate, na-eduga ná mgbanwe na mkpali akwara azụ na plasticity neural, nke nwere njikọ chiri anya na ihe omume nke mgbu neuropathic.
Ihe ndị na-etinye aka na ibelata ma ọ bụ wepụ ihe mgbu neuropathic na plasma bara ụba nke platelet
1) Angiopoietin:
mee ka angiogenesis pụta;Na-akpali ịkwaga cell endothelial na mmụba;Kwado ma mee ka mmepe nke arịa ọbara guzosie ike site n'iweta pericytes
2) Ihe na-akpata uto anụ ahụ jikọtara:
Na-akpali ịkwaga leukocyte;Na-akwalite angiogenesis;Na-arụ ọrụ myofibroblast ma na-akpali ntinye matriks nke extracellular na nhazigharị
3) Ihe na-akpata uto Epidermal:
Na-akwalite ọgwụgwọ ọnya ma na-ebute angiogenesis site n'ịkwalite mgbasawanye, ịkwaga na ọdịiche nke macrophages na fibroblasts;Na-akpali fibroblasts iji zoo collagenase na imebi matrix extracellular n'oge imegharị ọnya;Na-akwalite mmụba nke keratinocytes na fibroblasts, na-eduga na re epitheliization.
4) Ihe na-eto eto fibroblast:
ime ka chemotaxis nke macrophages, fibroblasts na sel endothelial;mee ka angiogenesis pụta;Ọ nwere ike ime ka granulation na nhazi anụ ahụ na-ekere òkè na nkwụsị ọnya.
5) Ihe na-akpata ịba ụba hepatocyte:
Mezie uto cell na mmegharị nke sel epithelial / endothelial;Na-akwalite mmezi epithelial na angiogenesis.
6) Insulin dị ka ihe na-eto eto:
Kpọkọtanụ mkpụrụ ndụ fiber iji kpalite njikọ protein.
7) Ihe na-ebute uto platelet:
Na-akpali chemotaxis nke neutrophils, macrophages na fibroblasts, ma kpalie mmụba nke macrophages na fibroblasts n'otu oge ahụ;Ọ na-enyere aka decompose ochie collagen na elu mezie okwu nke matrix metalloproteinases, na-eduga na mbufụt, granulation anụ ahụ e guzobere, epithelial proliferation, mmepụta nke extracellular matrix na anụ ahụ remodeling;Ọ nwere ike ịkwalite mmụba nke mkpụrụ ndụ sel adipose ewepụtara ma nyere aka na-ekere òkè na mmeghari akwara.
8) Ihe enwetara mkpụrụ ndụ Stromal:
Kpọọ sel CD34 + ka ha mee ka homing ha, mmụba na ọdịiche dị n'ime sel progenitor endothelial, ma kpalie angiogenesis;Na-anakọta mkpụrụ ndụ sel mesenchymal na leukocytes.
9) Ihe na-agbanwe uto uto β:
Na mbụ, ọ nwere mmetụta nke ịkwalite mbufụt, ma ọ nwekwara ike ịkwalite mgbanwe nke akụkụ ahụ merụrụ ahụ na steeti mgbochi mkpali;Ọ nwere ike ịkwalite chemotaxis nke fibroblasts na mkpụrụ ndụ akwara dị nro;Mezie okwu nke collagen na collagenase, ma kwalite angiogenesis.
10) Ihe na-akpata uto vascular endothelial:
Kwado ma kwalite uto nke akwara akwara eweghachite site na ijikọta angiogenesis, neurotrophic na neuroprotection, ka iweghachi ọrụ akwara.
11) Ihe na-akpata uto akwara:
Ọ na-arụ ọrụ neuroprotective site n'ịkwalite uto nke axon na mmezi na nlanarị nke neurons.
12) Ihe na-akpata neurotrophic nke Glial nwetara:
Ọ nwere ike ịtụgharị nke ọma na normalize protein neurogenic ma rụọ ọrụ neuroprotective.
Mmechi
1) Platelet bara ụba plasma nwere njirimara nke ịkwalite ọgwụgwọ na mgbochi mbufụt.Ọ bụghị naanị na ọ nwere ike ịrụzi anụ ahụ akwara mebiri emebi, kamakwa na-ebelata ihe mgbu nke ọma.Ọ bụ usoro ọgwụgwọ dị mkpa maka mgbu neuropathic ma nwee atụmanya na-egbuke egbuke;
2) Usoro nkwadebe nke plasma bara ụba nke platelet ka na-arụrịta ụka, na-akpọ ka e guzobe usoro nkwadebe ahaziri ahazi yana ọkọlọtọ nyocha akụrụngwa jikọtara ọnụ;
3) Enwere ọtụtụ ọmụmụ na platelet bara ụba plasma na mgbu neuropathic nke kpatara mmerụ ahụ azụ, mmerụ ahụ akwara na mkpakọ akwara.Usoro na nrụpụta ụlọ ọgwụ nke plasma bara ụba nke platelet na ụdị mgbu neuropathic ndị ọzọ kwesịrị ka a mụọkwuo ya.
Mgbu Neuropathic bụ aha n'ozuzu nke nnukwu klas nke ọrịa ụlọ ọgwụ, bụ nke a na-ahụkarị na usoro ọgwụgwọ.Otú ọ dị, ọ dịghị usoro ọgwụgwọ a kapịrị ọnụ ugbu a, na ihe mgbu na-adịru ọtụtụ afọ ma ọ bụ ọbụna maka ndụ mgbe ọrịa ahụ gasịrị, na-ebute oke ibu nye ndị ọrịa, ezinụlọ na ọha mmadụ.Ọgwụgwọ ọgwụ bụ isi atụmatụ ọgwụgwọ maka mgbu neuropathic.N'ihi mkpa ọgwụ ogologo oge, nnabata ndị ọrịa adịghị mma.Ọgwụ ogologo oge ga-abawanye mmeghachi omume ọgwụ ọjọọ ma kpatara nnukwu mmebi anụ ahụ na nke uche nye ndị ọrịa.Nnwale ndị dị mkpa na nyocha ụlọ ọgwụ egosila na enwere ike iji PRP na-agwọ mgbu neuropathic, na PRP na-abịa site na onye ọrịa n'onwe ya, na-enweghị mmeghachi omume autoimmune.Usoro ọgwụgwọ ahụ dịtụ mfe, yana mmeghachi omume ọjọọ ole na ole.PRP nwekwara ike iji ya na sel sel, nke nwere ikike siri ike nke nrụzi akwara na imegharị anụ ahụ, ma ga-enwe atụmanya ngwa ngwa na ọgwụgwọ nke mgbu neuropathic n'ọdịnihu.
(A na-ebipụtaghachi ọdịnaya nke isiokwu a, ma anyị anaghị enye nkwa ọ bụla ma ọ bụ nkwenye doro anya maka izi ezi, ntụkwasị obi ma ọ bụ izu oke nke ọdịnaya dị n'ime edemede a, ọ bụghịkwa maka echiche nke isiokwu a, biko ghọta.)
Oge nzipu: Dec-20-2022