Osteoarthritis ikpere nke mbụ (OA) ka bụ ọrịa degenerative na-enweghị nchịkwa.Site na atụmanya ndụ na-abawanye ụba na ọrịa oke ibu, OA na-ebute ibu arọ akụ na ụba na nke anụ ahụ na-eto eto.Knee OA bụ ọrịa musculoskeletal na-adịghị ala ala nke nwere ike chọọ enyemaka ịwa ahụ n'ikpeazụ.Ya mere, ndị ọrịa na-aga n'ihu na-achọ ọgwụgwọ ndị na-abụghị nke ịwa ahụ, dị ka ịgbanye plasma-rich platelet (PRP) n'ime nkwonkwo ikpere metụtara.
Dị ka Jayaram et al., PRP bụ ọgwụgwọ na-apụta maka OA.Otú ọ dị, ihe àmà ụlọ ọgwụ na-egosi ịdị irè ya ka na-adịkwaghị, na usoro ihe omume ya ejighị n'aka.Ọ bụ ezie na a kọwapụtala nsonaazụ na-ekwe nkwa gbasara iji PRP na ikpere OA, ajụjụ ndị dị mkpa dị ka ihe akaebe zuru oke gbasara ịdị irè ya, usoro doses, na usoro nkwadebe dị mma ka amabeghị.
A na-eche na Knee OA ga-emetụta ihe karịrị 10% nke ndị bi n'ụwa, yana ihe ize ndụ ndụ nke 45%.Ntuziaka nke oge a na-akwado ma ndị na-abụghị ọgwụ (dịka ọmụmaatụ, mmega ahụ) na ọgwụgwọ ọgwụ, dị ka ọgwụ mgbochi mkpali na-abụghị steroidal (NSAIDs).Agbanyeghị, ọgwụgwọ ndị a na-enwekarị naanị uru dị mkpụmkpụ.Ọzọkwa, iji ọgwụ ọjọọ eme ihe na ndị ọrịa na-arịa ọrịa nwere oke n'ihi ihe ize ndụ nke nsogbu.
A na-ejikarị corticosteroids intra-articular eme ihe maka enyemaka mgbu dị mkpirikpi n'ihi na uru ha na-ejedebe na izu ole na ole, na ntinye ugboro ugboro ka egosipụtara na-ejikọta ya na ụba cartilage.Ụfọdụ ndị edemede na-ekwu na iji hyaluronic acid (HA) na-arụ ụka.Otú ọ dị, ndị edemede ndị ọzọ kọrọ ihe mgbu mgbe 3 ruo 5 injections kwa izu nke HA maka 5 ruo 13 izu (mgbe ụfọdụ ruo 1 afọ).
Mgbe usoro ndị ọzọ dị n'elu dara, a na-atụkarị aro ka a na-atụ aro mkpokọta nkwonkwo ikpere (TKA) dị ka ọgwụgwọ dị irè.Otú ọ dị, ọ na-efu ọnụ ma nwee ike ịgụnye mmetụta ọjọọ nke ahụike na mgbe ịwachara ahụ.Ya mere, ọ dị oke mkpa ịchọpụta ọgwụgwọ ọzọ dị mma ma dị irè maka ikpere OA.
A na-enyocha usoro ọgwụgwọ ndu, dị ka PRP, n'oge na-adịbeghị anya maka ọgwụgwọ ikpere OA.PRP bụ ngwaahịa ọbara na-emepụta ihe nke nwere nnukwu mkpokọta platelet.A na-eche na ịdị irè nke PRP nwere njikọ na mwepụta nke ihe ndị na-eto eto na ụmụ irighiri ihe ndị ọzọ, gụnyere platelet-derived growth factor (PDGF), na-agbanwe uto uto (TGF) -beta, insulin-like growth factor I (IGF-I) , na vascular endothelial growth factor (VEGF).
Ọtụtụ akwụkwọ na-egosi na PRP nwere ike na-ekwe nkwa maka ọgwụgwọ ikpere OA.Otú ọ dị, ihe ka ọtụtụ n'ime ha ekwenyeghị na usoro kachasị mma, ma enwere ọtụtụ njedebe na-amachi nyocha nke ọma nke nsonaazụ ha, n'ihe ize ndụ nke enweghị isi.Ihe dị iche iche nke nkwadebe na ụzọ injection na-arụ ọrụ na ọmụmụ ihe a kọrọ bụ njedebe na ịkọwapụta usoro PRP dị mma.Ọzọkwa, ọtụtụ ule na-eji HA dị ka ihe atụ, nke na-arụrịta ụka n'onwe ya.Ụfọdụ ule tụnyere PRP na placebo ma gosipụta ọganihu dị mma karịa saline na ọnwa 6 na 12.Otú ọ dị, ọnwụnwa ndị a nwere nnukwu ntụpọ usoro, gụnyere enweghị nke ọma kpuru ìsì, na-atụ aro na uru ha nwere ike ịfefe.
Uru nke PRP maka ọgwụgwọ ikpere OA bụ ndị a: ọ dị mma iji ya mee ihe n'ihi nkwadebe ngwa ngwa na ntanarị ntanye;ọ bụ usoro dị ọnụ ala n'ihi iji ihe owuwu na akụrụngwa ọrụ ahụike ọha dị adị;na o yikarịrị ka ọ ga-adị mma, n'ihi na ọ bụ ngwaahịa akpaaka.Akwụkwọ ndị gara aga akọpụtala naanị obere nsogbu na nwa oge.
Ebumnuche nke isiokwu a bụ iji nyochaa usoro ihe omimi nke ugbu a nke PRP na oke arụmọrụ nke intra-articular injection PRP na ndị ọrịa nwere ikpere OA.
Usoro molekul na-arụ ọrụ nke plasma nwere ụbara platelet
A na-enyocha ọbá akwụkwọ Cochrane na PubMed (MEDLINE) maka ọmụmụ ihe metụtara PRI na ikpere OA.Oge nchọta sitere na mmalite nke search engine ruo Disemba 15, 2021. Naanị ihe ọmụmụ nke PRP na ikpere OA nke ndị edemede weere dị ka ihe kacha amasị ka agụnyere.PubMed chọtara akụkọ 454, nke ahọpụtara 80 n'ime ha.A chọtara otu isiokwu n'ọ́bá akwụkwọ Cochrane, bụ́ nke e dekwara aha ya, nke nwere ngụkọta nke ntụaka 80.
Nnyocha e bipụtara na 2011 gosiri na iji ihe ndị na-eto eto (ndị òtù TGF-β superfamily, fibroblast growth factor family, IGF-I na PDGF) na njikwa nke OA na-egosi nkwa.
Na 2014, Sandman et al.kọrọ na ọgwụgwọ PRP nke anụ ahụ nkwonkwo OA mere ka mbelata catabolism;Otú ọ dị, PRP mere ka mbelata dị ukwuu na matrix metalloproteinase 13, mmụba nke hyaluronan synthase 2 okwu n'ime mkpụrụ ndụ synovial, na mmụba nke ọrụ njikọ cartilage.Nsonaazụ nke ọmụmụ a na-egosi na PRP na-akpali mmepụta nke endogenous HA ma belata catabolism cartilage.PRP mechibidokwara ntinye nke ndị mgbasa ozi mkpali na okwu mkpụrụ ndụ ha na synovial na chondrocytes.
N'afọ 2015, nchọpụta ụlọ nyocha a na-achịkwa gosiri na PRP kpalitere mmụba nke cell na nzuzo protein n'elu na cartilage ikpere mmadụ na sel synovial.Nleba anya ndị a na-enyere aka ịkọwa usoro biochemical metụtara ịdị irè nke PRP na ọgwụgwọ ikpere OA.
N'ime ụdị murine OA (ọmụmụ ụlọ nyocha a na-achịkwa) nke Khatab et al kọrọ.Na 2018, ọtụtụ injections na-ahapụ PRP belatara mgbu na ọkpụrụkpụ synovial, ikekwe site na subtypes macrophage na-atụgharị ya.Ya mere, injections ndị a na-egosi na ọ na-ebelata mgbu na mbufụt synovial, ma nwee ike igbochi mmepe OA na ndị ọrịa nwere OA mmalite.
Na 2018, nyocha nke akwụkwọ nchekwa data PubMed kwubiri na ọgwụgwọ PRP nke OA na-egosi na ọ na-eme mgbanwe mgbanwe na ụzọ Wnt / β-catenin, nke nwere ike dị mkpa iji nweta mmetụta ọgwụgwọ ya bara uru.
Na 2019, Liu et al.nyochara usoro ihe omimi nke exosomes sitere na PRP na-etinye aka na ibelata OA.Ọ dị mkpa ịkọwapụta na exosomes na-arụ ọrụ dị mkpa na nkwurịta okwu intercellular.N'ime ọmụmụ ihe a, a na-ekewa chondrocytes nke oke bekee ma jiri interleukin (IL) -1β mee ihe iji guzobe ụdị in vitro nke OA.A tụlere mmụba, mbugharị, na nyocha apoptosis ma jiri ya tụnyere PRP-enwetara exosomes na PRP na-arụ ọrụ iji chọpụta mmetụta ọgwụgwọ na OA.A na-enyocha usoro ndị dị na ụzọ akara Wnt/β-catenin site na nyocha nke ọdịda anyanwụ.Achọpụtara exosomes sitere na PRP nwere mmetụta ọgwụgwọ yiri ya ma ọ bụ ka mma na OA karịa PRP arụ ọrụ na vitro na vivo.
N'ụdị òké nke posttraumatic OA kọrọ na 2020, Jayaram et al.na-atụ aro na mmetụta nke PRP na ọganihu OA na ọrịa hyperalgesia kpatara ọrịa nwere ike ịdabere na leukocyte.Ha kwukwara na leukocyte-poor PRP (LP-PRP) na obere ego nke leukocyte-rich PRP (LR-PRP) na-egbochi olu na nkwụsị elu.
Ihe nchoputa nke Yang et al.Ọmụmụ 2021 gosiri na PRP opekata mpe belatara IL-1β-induced chondrocyte apoptosis na mbufụt site na igbochi hypoxia-inducible factor 2α.
Na ụdị oke nke OA na-eji PRP, Sun et al.Achọpụtara microRNA-337 na microRNA-375 na-egbu oge na-aga n'ihu OA site na-emetụta mbufụt na apoptosis.
Dị ka Sheean et al., ọrụ ndu nke PRP nwere ọtụtụ akụkụ: platelet alpha granules na-akwalite ntọhapụ nke ihe dị iche iche na-eto eto, gụnyere VEGF na TGF-beta, na mbufụt na-achịkwa site n'igbochi ụzọ nuklia-κB.
Achọpụtara nleba anya nke ihe ọchị na PRP akwadoro site na ngwa abụọ yana mmetụta nke ihe ọchị na macrophage phenotype.Ha chọtara ọdịiche dị na ihe ndị dị na cellular yana ihe na-atọ ọchị n'etiti PRP dị ọcha site na iji ngwa abụọ ahụ.Ngwọta protein autologous LR-PRP kit nwere nnukwu mkpokọta M1 na M2 metụtara macrophage.Mgbakwunye nke PRP supernatant na omenala omenala nke monocyte na-enweta macrophages na M1 polarized macrophages gosiri na PRP gbochiri M1 macrophage polarization ma kwalite M2 macrophage polarization.
Na 2021, Szwedowski et al.Ihe uto ewepụtara na nkwonkwo ikpere OA mgbe ịgba ọgwụ PRP kọwapụtara: ụbụrụ necrosis factor (TNF), IGF-1, TGF, VEGF, disaggregate, na metalloproteinases na thrombospondin motifs, interleukins, matrix metalloproteinases , epidermal growth factor, hepatocyte growth factor, fibroblast factor. ihe na-eto eto, ihe na-eto eto keratinocyte na ihe platelet 4.
1. PDGF
Achọpụtara PDGF na mbụ na platelet.Ọ bụ ihe na-eguzogide okpomọkụ, acid na-eguzogide, cationic polypeptide nke na-adị mfe hydrolyzed site trypsin.Ọ bụ otu n'ime ihe ndị mbụ na-eto eto na-apụta na saịtị mgbawa.A na-egosipụta ya nke ọma na anụ ahụ ọkpụkpụ traumatic, nke na-eme ka osteoblasts chemotactic ma na-amụba, na-eme ka ikike nke njikọ collagen dịkwuo elu, na-akwalite mmịkọ nke osteoclasts, si otú ahụ na-akwalite ọkpụkpụ ọkpụkpụ.Tụkwasị na nke ahụ, PDGF nwekwara ike ịkwalite mmụba na ọdịiche nke fibroblasts ma kwalite nhazi anụ ahụ.
2. TGF-B
TGF-B bụ polypeptide nke mejupụtara agbụ 2, nke na-eme na fibroblasts na pre-osteoblasts na paracrine na / ma ọ bụ autocrine, na-akpali mgbasawanye nke osteoblasts na pre-osteoblasts na njikọ nke collagen fibers, dị ka chemokine, osteoproge. mkpụrụ ndụ na-abanye n'ime anụ ahụ merụrụ ahụ, a na-egbochikwa nhazi na ntinye nke osteoclasts.TGF-B na-achịkwa njikọ ECM (extracellular matrix), nwere mmetụta chemotactic na neutrophils na monocytes, ma na-emezi nzaghachi mkpali mpaghara.
3. VEGF
VEGF bụ dimeric glycoprotein, nke na-ejikọta na ndị na-anabata ya n'elu sel endothelial vaskụla site na autocrine ma ọ bụ paracrine, na-akwalite mgbasa nke cell endothelial, na-eme ka e guzobe na nguzobe nke arịa ọbara ọhụrụ, na-enye oxygen na njedebe mgbawa, na-enye nri na-edozi ahụ, na-ebufe ihe mkpofu nke metabolic. ., na-enye microenvironment dị mma maka metabolism na mpaghara mmeghari ọkpụkpụ mpaghara.Mgbe ahụ, n'okpuru ọrụ VEGF, a na-eme ka ọrụ alkaline phosphatase dị iche iche nke osteoblast dịkwuo mma, a na-echekwa salts calcium mpaghara iji kwalite ọgwụgwọ mgbawa.Tụkwasị na nke ahụ, VEGF na-akwalite nrụzi nke anụ ahụ dị nro site na imeziwanye ọbara nke anụ ahụ dị nro na gburugburu mgbawa ahụ, ma na-akwalite ọgwụgwọ nke mgbawa, ma nwee mmetụta nkwalite mmekọrịta na PDGF.
4. EGF
EGF bụ akụkụ dị ike nke cell na-akwalite ihe na-akpali nkewa na mmụba nke ụdị mkpụrụ ndụ anụ ahụ dị iche iche n'ime ahụ, ebe ọ na-akwalite njikọ na ntinye nke matrix, na-akwalite nhazi anụ ahụ fibrous, na-aga n'ihu na-agbanwe ghọọ ọkpụkpụ iji dochie ọkpụkpụ ọkpụkpụ.Ihe ọzọ EGF na-ekere òkè na nrụzi mgbaji bụ na ọ nwere ike ime ka phospholipase A rụọ ọrụ, si otú ahụ na-akwalite ntọhapụ nke arachidonic acid site na sel epithelial, na ịkwalite njikọ nke prostaglandins site n'ịhazi ọrụ nke cyclooxygenase na lipoxygenase.Ọrụ nke resorption na emesịa ọkpụkpụ ọkpụkpụ.Enwere ike ịhụ na EGF na-ekere òkè na usoro ọgwụgwọ nke mgbaji ma nwee ike mee ka ọgwụgwọ mgbawa dị ngwa ngwa.Na mgbakwunye, EGF nwere ike ịkwalite mmụba nke mkpụrụ ndụ epidermal na sel endothelial, ma mee ka mkpụrụ ndụ endothelial kwaga n'elu ọnya ahụ.
5. IGF
IGF-1 bụ otu polypeptide nke nwere otu agbụ nke na-ejikọta ya na ndị na-anabata ya na ọkpụkpụ ma na-eme ka tyrosine protease na-arụ ọrụ mgbe autophosphorylation na-anabata ya, nke na-akwalite phosphorylation nke insulin receptor substrates, si otú ahụ na-achịkwa uto cell, mmụba na metabolism.Ọ nwere ike kpalie Osteoblasts na pre-osteoblasts, na-akwalite nhazi cartilage na ọkpụkpụ ọkpụkpụ.Tụkwasị na nke ahụ, ọ na-arụ ọrụ dị mkpa na njikọ nke nhazi ọkpụkpụ site n'ịgbazite ọdịiche na nhazi nke osteoblasts na osteoclasts na ọrụ ha na-arụ.Na mgbakwunye, IGF bụkwa otu n'ime ihe ndị dị mkpa na nrụzi ọnya.Ọ bụ ihe na-akwalite ntinye nke fibroblasts n'ime okirikiri cell ma na-akpali ọdịiche na njikọ nke fibroblasts.
PRP bụ ntinye uche nke platelet na ihe uto sitere na ọbara centrifuged.E nwere ụdị abụọ ọzọ nke platelet concentrates: platelet-rich fibrin na plasma-ọgaranya uto ihe.Enwere ike nweta PRP naanị site na ọbara mmiri mmiri;ọ gaghị ekwe omume ịnweta PRP site na serum ma ọ bụ ọbara mkpụkọ.
Enwere usoro azụmahịa dị iche iche iji nakọta ọbara wee nweta PRP.Ọdịiche dị n'etiti ha na-agụnye ọnụọgụ ọbara dị mkpa ka a na-enweta n'aka onye ọrịa;Usoro iche iche;ọsọ centrifugation;ego itinye uche na olu mgbe centrifugation;oge nhazi;
A kọwo usoro ịgbatị ọbara dị iche iche na-emetụta oke leukocyte.Ọnụọgụ platelet dị na 1 μL ọbara sitere na ndị nwere ahụike sitere na 150,000 ruo 300,000.Platelet na-ahụ maka ịkwụsị ọbara ọgbụgba.
Alfa granules nke platelet nwere ụdị protein dị iche iche dị ka ihe na-eto eto (dịka ọmụmaatụ na-agbanwe ihe na-eto eto beta, insulin-like growth factor, epidermal growth factor), chemokines, coagulants, anticoagulants, protein fibrinolytic, protein adhesion, Integral membrane proteins, dịghịzi mediators. , ihe angiogenic na ihe mgbochi, na protein bactericidal.
Usoro ihe omume PRP ka amabeghị.PRP na-egosi na ọ na-akpali chondrocytes iji megharịa cartilage na biosynthesis nke collagen na proteoglycans.Ejirila ya n'ọpụrụiche ahụike dị iche iche dịka ịwa ahụ ọnụ na maxillofacial (gụnyere temporomandibular OA), dermatology, ophthalmology, ịwa ahụ cardiothoracic na ịwa ahụ rọba.
(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: Jul-27-2022