Intlungu ye-neuropathic ibhekisela ekusebenzeni okungaqhelekanga kweentlungu, uvakalelo lweentlungu kunye neentlungu ezizenzekelayo ezibangelwa ukwenzakala okanye isifo se-somatic sensory system.Uninzi lwazo lusenokuhamba kunye nentlungu kwindawo ehambelanayo engabonakaliyo emva kokupheliswa kwezinto zokulimala, ezibonakaliswa njengentlungu ezenzekelayo, i-hyperalgesia, i-hyperalgesia kunye nokuziva okungaqhelekanga.Okwangoku, amayeza okuphelisa intlungu ye-neuropathic aquka i-tricyclic antidepressants, i-5-hydroxytryptamine norepinephrine reuptake inhibitors, i-anticonvulsants i-gabapentin kunye ne-pregabalin, kunye ne-opioids.Nangona kunjalo, isiphumo sonyango lweziyobisi luhlala lulinganiselwe, olufuna izikimu zonyango lwe-multimodal ezifana nonyango lomzimba, ukulawulwa kwe-neural kunye nongenelelo lotyando.Intlungu engapheliyo kunye nokunciphisa ukusebenza kuya kunciphisa inxaxheba kwintlalo yezigulane kwaye kubangele umthwalo onzima wengqondo kunye noqoqosho kwizigulane.
I-Platelet rich plasma (PRP) yimveliso ye-plasma eneeplatelet ezicocekileyo ezifunyenwe nge-centrifuging autologous blood.Kwi-1954, i-KINGSLEY yaqala ukusebenzisa igama lezonyango elithi PRP.Ngophando kunye nophuhliso kwiminyaka yamuva nje, i-PRP isetyenziswe ngokubanzi kwithambo kunye nokuhlinzwa ngokudibeneyo, utyando lomgudu, i-dermatology, ukuvuselelwa kunye namanye amasebe, kwaye idlala indima ebalulekileyo kwinkalo yokulungiswa kobunjineli bezicubu.
Umgaqo osisiseko wonyango lwe-PRP kukujova iiplatelet ezigxininisiweyo kwindawo yokulimala kwaye uqale ukulungiswa kwezicubu ngokukhupha izinto ezahlukeneyo ze-bioactive (izinto zokukhula, i-cytokines, i-lysosomes) kunye neeprotheni zokubambelela.Ezi zinto ze-bioactive zinoxanduva lokuqalisa i-hemostatic cascade reaction, i-synthesis yezicubu ezintsha ezidibeneyo kunye nokwakhiwa kwakhona kwe-vascular.
Ukwahlula kunye ne-pathogenesis yeentlungu ze-neuropathic I-World Health Organization ikhuphe i-11th ehlaziyiweyo inguqu ye-International Classification of Pain kwi-2018, ukwahlula intlungu ye-neuropathic kwintlungu ephakathi kwe-neuropathic kunye ne-peripheral neuropathic pain.
Iintlungu ze-peripheral neuropathic zihlelwa ngokwe-etiology:
1) Usulelo/ukudumba: i-neuralgia yasemva kwe-postherpetic, iqhenqa elibuhlungu, igcushuwa/neuropathy esulelwe yi-HIV
I-2) Ukunyanzeliswa kwe-nerve: i-carpal tunnel syndrome, i-spinal degenerative radicular pain
I-3) Ukuxhatshazwa: ukuxhatshazwa / ukutshisa / emva kokusebenza / emva kwe-radiotherapy intlungu ye-neuropathic
I-4) I-Ischemia / i-metabolism: isifo sikashukela se-peripheral neuropathic pain
5) Iziyobisi: i-peripheral neuropathy ebangelwa ngamachiza (njenge-chemotherapy)
6) Abanye: iintlungu zomhlaza, i-neuralgia ye-trigeminal, i-glossopharyngeal neuralgia, i-neuroma ka-Morton.
Ukuhlelwa kunye neendlela zokulungiselela i-PRP ngokubanzi zikholelwa ukuba i-concentration ye-platelet kwi-PRP iphindwe kane okanye kahlanu kwigazi elipheleleyo, kodwa kukho ukungabikho kwezikhombisi zobungakanani.Kwi-2001, uMarx wachaza ukuba i-PRP iqulethe ubuncinane i-1 yezigidi zeeplatelet kwi-microliter ye-plasma, eyisalathisi sobungakanani bomgangatho we-PRP.UDohan et al.i-PRP ehlelwe kwiindidi ezine: i-PRP ecocekileyo, i-leukocyte ecebileyo ye-PRP, i-purelet platelet rich fibrin, kunye ne-leukocyte ecebileyo yeplatelet fibrin esekelwe kwimixholo eyahlukeneyo yeplatelet, i-leukocyte, kunye ne-fibrin kwi-PRP.Ngaphandle kokuba kuchazwe ngenye indlela, i-PRP idla ngokubhekisa kwi-PRP etyebileyo yeseli emhlophe.
I-Mechanism ye-PRP kuNyango lwe-Neuropathic Pain Emva kokulimala, i-activators ezahlukeneyo ezingapheliyo kunye ne-exogenous ziya kukhuthaza ukusebenza kweplatelet α- I-granules ifumana i-degranulation reaction, ikhulula inani elikhulu lezinto zokukhula, i-fibrinogen, i-cathepsin kunye ne-hydrolase.Izinto ezikhutshiweyo zokukhula zibophelela kumphezulu ongaphandle wenwebu yeseli yeseli ekujoliswe kuyo ngokusebenzisa ii-receptors ze-transmembrane kwinwebu yeseli.Ezi receptor ze-transmembrane zijika zikhuthaze kwaye zisebenze iiprotheyini zomqondiso we-endogenous, ziqhubekisela phambili umthunywa wesibini kwiseli, ebangela ukwanda kweeseli, ukubunjwa kwe-matrix, i-synthesis ye-collagen protein kunye nezinye i-intracellular gene expression.Kukho ubungqina bokuba i-cytokines ekhutshwe ngamaplatelet kunye nezinye ii-transmitter zidlala indima ebalulekileyo ekunciphiseni / ekupheliseni intlungu engapheliyo ye-neuropathic.Iindlela ezikhethekileyo zinokwahlulwa zibe ziinkqubo ze-peripheral kunye ne-central mechanisms.
I-Mechanism ye-platelet ecebileyo ye-plasma (PRP) kunyango lweentlungu ze-neuropathic
Iindlela zeperipheral: impembelelo yokuchasa ukudumba, ukhuseleko lwe-neuroprotection kunye nokukhuthaza ukuvuselelwa kwe-axon, ukulawulwa komzimba, isiphumo se-analgesic
Indlela esembindini: ukwenza buthathaka kunye nokubuyisela umva uvakaliso oluphakathi kunye nokuthintela ukusebenza kweseli yeglial
I-Anti-inflammatory Effect
I-peripheral sensitization idlala indima ebalulekileyo ekuveleni kweempawu zentlungu ye-neuropathic emva kokulimala kwe-nerve.Iintlobo ezahlukeneyo zeeseli ezivuthayo, ezifana ne-neutrophils, i-macrophages kunye neeseli ze-mast, zangeniswa kwindawo yokulimala kwe-nerve.Ukuqokelela ngokugqithiseleyo kweeseli ezivuthayo zenza isiseko sokutshatyalaliswa ngokugqithiseleyo kunye nokukhutshwa okuqhubekayo kweentambo ze-nerve.Ukuvuvukala kukhulula inani elikhulu labalamli beekhemikhali, ezifana ne-cytokines, i-chemokines kunye ne-lipid mediators, okwenza i-nociceptors ibe novelwano kwaye ivuyiswe, kwaye ibangele utshintsho kwindawo yamachiza yendawo.IiPlatelets zineempembelelo ezinamandla ze-immunosuppressive kunye ne-anti-inflammatory.Ngokulawula kunye nokufihla izinto ezahlukeneyo zokulawula i-immune, izinto ze-angiogenic kunye nesondlo, zinokunciphisa ukusabela okunobungozi bokuzivikela kunye nokuvutha, kunye nokulungisa umonakalo wezicubu ezahlukeneyo kwiindawo ezincinci.I-PRP inokudlala indima echasene nokuvuvukala ngeendlela ezahlukeneyo.Inokuthintela ukukhululwa kwe-cytokines e-pro-inflammatory kwiiseli ze-Schwann, i-macrophages, i-neutrophils kunye neeseli ze-mast, kwaye inqanda ukubonakaliswa kwemfuza ye-pro-inflammatory factor receptors ngokukhuthaza ukuguqulwa kwezicubu ezonakalisiweyo ukusuka kwimeko evuthayo ukuya kwimeko echasayo.Nangona iiplatelet zingayikhuphi i-interleukin 10, iiplatelet zinciphisa ukuveliswa kweemali ezininzi ze-interleukin 10 ngokubangela iiseli ze-dendritic ezingavuthiwe γ- Ukuveliswa kwe-interferon kudlala indima echasayo.
Impembelelo ye-Analgesic
Iiplatelets ezisebenzayo zikhupha ii-neurotransmitters ezininzi ezi-pro-ukudumba kunye ne-anti-inflammatory, ezinokubangela iintlungu, kodwa zinciphise ukudumba kunye neentlungu.Iiplatelet ezisanda kulungiswa zilele kwi-PRP.Emva kokusebenza ngokuthe ngqo okanye ngokungathanga ngqo, i-platelet morphology iyatshintsha kwaye ikhuthaze ukuhlanganiswa kweplatelet, ukukhulula i-intracellular α-Dense particles kunye ne-sensitized particles iya kukhuthaza ukukhululwa kwe-5-hydroxytryptamine, enefuthe lokulawula intlungu.Okwangoku, ii-receptors ze-5-hydroxytryptamine zifunyenwe kakhulu kwi-peripheral nerves.I-5-hydroxytryptamine inokuchaphazela ukuhanjiswa kwe-nociceptive kwizicubu ezijikelezayo nge-5-hydroxytryptamine 1, i-5-hydroxytryptamine 2, i-5-hydroxytryptamine 3, i-5-hydroxytryptamine 4 kunye ne-5-hydroxytryptamine 7 receptors.
Ukuthintelwa kokuSebenzisa iiseli zeGlial
Iiseli zeGlial zithatha malunga ne-70% yeeseli ze-nervous central, ezinokuthi zohlulwe zibe ziintlobo ezintathu: i-astrocytes, i-oligodendrocytes kunye ne-microglia.I-Microglia yenziwe yasebenza kwiiyure ze-24 emva kokulimala kwe-nerve, kwaye i-astrocytes yasebenza ngokukhawuleza emva kokulimala kwe-nerve, kwaye ukusetyenziswa kwahlala kwiiveki ze-12.I-Astrocytes kunye ne-microglia emva koko ikhupha i-cytokines kwaye ibangele uchungechunge lweempendulo zeselula, ezifana nokunyuswa kwe-glucocorticoid kunye ne-glutamate receptors, ekhokelela ekutshintsheni kwi-spinal cord excitation kunye ne-neural plasticity, ehambelana ngokusondeleyo nokuvela kweentlungu ze-neuropathic.
Izinto ezibandakanyekayo ekupheliseni okanye ekupheliseni intlungu ye-neuropathic kwi-platelet ecebileyo ye-plasma
1) Angiopoietin:
Ukukhuthaza i-angiogenesis;Ukuvuselela ukufuduka kweeseli ze-endothelial kunye nokwanda;Ukuxhasa kunye nokuzinzisa ukuphuhliswa kwemithambo yegazi ngokugaya i-pericytes
2) Ukukhula kwezicubu eziqhagamshelayo:
Ukuvuselela ukufuduka kwe-leukocyte;Ukukhuthaza i-angiogenesis;Yenza i-myofibroblast isebenze kwaye ivuselele i-extracellular matrix deposition kunye nokulungiswa kwakhona
3) Ukukhula kwe-Epidermal factor:
Ukukhuthaza ukuphulukiswa kwesilonda kunye nokukhupha i-angiogenesis ngokukhuthaza ukwanda, ukufuduka kunye nokwahlulahlula kwe-macrophages kunye ne-fibroblasts;Ukuvuselela i-fibroblasts ukukhupha i-collagenase kunye nokunciphisa i-matrix ye-extracellular ngexesha lokulungiswa kwenxeba;Ukukhuthaza ukwanda kwe-keratinocytes kunye ne-fibroblasts, ekhokelela kwi-re epithelization.
4) Ukukhula kweFibroblast:
Ukukhupha i-chemotaxis ye-macrophages, i-fibroblasts kunye neeseli ze-endothelial;Ukukhuthaza i-angiogenesis;Inokubangela i-granulation kunye nokuguqulwa kwezicubu kunye nokuthatha inxaxheba ekunciphiseni inxeba.
5) Ukukhula kweHepatocyte:
Ukulawula ukukhula kweeseli kunye nokuhamba kweeseli ze-epithelial / endothelial;Ukukhuthaza ukulungiswa kwe-epithelial kunye ne-angiogenesis.
6) I-insulin ifana nemeko yokukhula:
Hlanganisa kunye iiseli zefiber ukuvuselela iprotein synthesis.
7) I-Platelet ephuma kwinto yokukhula:
Ukuvuselela i-chemotaxis ye-neutrophils, i-macrophages kunye ne-fibroblasts, kwaye ikhuthaze ukwanda kwe-macrophages kunye ne-fibroblasts ngexesha elifanayo;Inceda ukubola i-collagen endala kwaye iphezulu ilawula ukubonakaliswa kwe-matrix metalloproteinases, ekhokelela ekuvukeni, ukubunjwa kwezicubu ze-granulation, ukwanda kwe-epithelial, ukuveliswa kwe-matrix ye-extracellular kunye nokuhlaziywa kwezicubu;Inokukhuthaza ukwanda kweeseli ze-stem eziphuma kwi-adipose yomntu kwaye incede ukudlala indima ekuvuseleleni i-nerve.
8) I-Stromal cell derived factor:
Biza iiseli ze-CD34 + ukuba zikhuthaze ukuhlala kwazo, ukwanda kunye nokwahlula kwiiseli ze-endothelial progenitor, kunye nokuvuselela i-angiogenesis;Ukuqokelela iiseli ze-mesenchymal stem kunye ne-leukocytes.
9) Ukutshintsha imeko yokukhula β:
Ekuqaleni, inomphumo wokukhuthaza ukuvuvukala, kodwa kunokukhuthaza ukuguqulwa kwecandelo elimeleyo kwisimo esichasayo;Inokuphucula i-chemotaxis ye-fibroblasts kunye neeseli ze-muscle ezigudileyo;Ukulawula ukubonakaliswa kwe-collagen kunye ne-collagenase, kwaye ukhuthaze i-angiogenesis.
10) Ukukhula kweVascular endothelial factor:
Ukuxhasa kunye nokukhuthaza ukukhula kwe-nerve fibers ehlaziyiweyo ngokudibanisa i-angiogenesis, i-neurotrophic kunye ne-neuroprotection, ukwenzela ukubuyisela ukusebenza kwe-nerve.
11) Ukukhula kweNerve:
Idlala indima ye-neuroprotective ngokukhuthaza ukukhula kwee-axons kunye nokugcinwa kunye nokusinda kwee-neurons.
12) I-Glial evela kwi-neurotrophic factor:
Iyakwazi ukubuyisela umva ngempumelelo kunye nokulungelelanisa iiprotheni ze-neurogenic kwaye idlale indima ye-neuroprotective.
Ukuqukumbela
I-1) I-Platelet ecebileyo ye-plasma ineempawu zokukhuthaza ukuphilisa kunye nokuchasana nokuvutha.Ayinakulungisa kuphela izicubu zemithambo-luvo ezonakalisiweyo, kodwa iphinde ikhulule iintlungu ngempumelelo.Yindlela yonyango ebalulekileyo yentlungu ye-neuropathic kwaye inamathuba aqaqambileyo;
I-2) Indlela yokulungiselela i-platelet ecebileyo ye-plasma isaphikisana, ibiza ukusekwa kwendlela yokulungiswa okusemgangathweni kunye nomgangatho wokuvavanya icandelo elidibeneyo;
I-3) Kukho izifundo ezininzi kwi-platelet ecebileyo ye-plasma kwiintlungu ze-neuropathic ezibangelwa ukulimala kwentambo yomgogodla, ukulimala kwe-nerve ye-peripheral kunye noxinzelelo lwe-nerve.Inkqubo kunye nokusebenza kweklinikhi ye-platelet ecebileyo ye-plasma kwezinye iintlobo zentlungu ye-neuropathic kufuneka ifundwe ngakumbi.
Intlungu ye-neuropathic ligama eliqhelekileyo leklasi enkulu yezifo zeklinikhi, eziqhelekileyo kakhulu kwiikliniki.Nangona kunjalo, akukho ndlela yonyango ecacileyo ngoku, kwaye intlungu ihlala iminyaka emininzi okanye ubomi emva kokugula, kubangela umthwalo onzima kwizigulane, iintsapho kunye noluntu.Unyango lweziyobisi luyisiseko sonyango lwentlungu ye-neuropathic.Ngenxa yesidingo samayeza exesha elide, ukuthotyelwa kwezigulane akulunganga.Amayeza exesha elide aya kwandisa ukusabela kakubi kweziyobisi kwaye abangele umonakalo omkhulu emzimbeni nasengqondweni kwizigulana.Iimvavanyo ezisisiseko ezifanelekileyo kunye nezifundo zeklinikhi ziye zabonisa ukuba i-PRP ingasetyenziselwa ukunyanga intlungu ye-neuropathic, kwaye i-PRP ivela kwisigulane ngokwayo, ngaphandle kokuphendula ngokuzenzekelayo.Inkqubo yonyango ilula, kunye neempendulo ezimbi ezimbalwa.I-PRP ingasetyenziselwa kunye kunye neeseli ze-stem, ezinekhono eliqinileyo lokulungiswa kwe-nerve kunye nokuvuselelwa kwezicubu, kwaye ziya kuba nethemba elibanzi lesicelo kunyango lwentlungu ye-neuropathic kwixesha elizayo.
(Imixholo yeli nqaku ishicilelwe, kwaye asiboneleli nasiphi na isiqinisekiso esicacileyo okanye esichaziweyo sokuchaneka, ukuthembeka okanye ukugqibelela kokuqulathwe kweli nqaku, kwaye abanaxanduva ngezimvo zeli nqaku, nceda uqonde.)
Ixesha lokuposa: Dec-20-2022