Neuropathic pain inoreva kusajairika kwekunzwa basa, kurwadziwa kunzwisiswa uye kurwadziwa kunongoerekana kwaitika kunokonzerwa nekukuvadzwa kana chirwere chesomatic sensory nervous system.Vazhinji vavo vanogona kuramba vachiperekedzwa nemarwadzo munzvimbo inoenderana innervated mushure mekubviswa kwezvinhu zvinokuvadza, izvo zvinoratidzwa sekurwadziwa kwepamuviri, hyperalgesia, hyperalgesia uye kusagadzikana kwekunzwa.Parizvino, mishonga yekubvisa kurwadziwa kweuropathic inosanganisira tricyclic antidepressants, 5-hydroxytryptamine norepinephrine reuptake inhibitors, anticonvulsants gabapentin uye pregabalin, uye opioid.Nekudaro, mhedzisiro yekurapa zvinodhaka kazhinji inogumira, izvo zvinoda multimodal kurapwa zvirongwa senge kurapa kwemuviri, neural regulation uye kupindira kwekuvhiya.Kurwadziswa kusingagumi uye kuderedzwa kwekushanda kunoderedza kugarisana kwevarwere uye kukonzera mutoro wakakomba wepfungwa uye wehupfumi kuvarwere.
Platelet rich plasma (PRP) chigadzirwa cheplasma chine kuchena kwakanyanya kunowanikwa ne centrifuging autologous ropa.Muna 1954, KINGSLEY akatanga kushandisa izwi rezvokurapa PRP.Kuburikidza nekutsvakurudza uye kubudirira mumakore achangopfuura, PRP yakashandiswa zvakanyanya mukuvhiyiwa kwemapfupa uye majoini, kuvhiyiwa kwemusana, dermatology, kudzorera uye mamwe madhipatimendi, uye inoita basa rinokosha mumunda wekugadzira engineering.
Nheyo yekutanga yePRP kurapwa ndeyekupinza maplatelet akaiswa panzvimbo yakakuvara uye kutanga kugadziriswa kwetishu nekusunungura zvakasiyana-siyana zvebioactive zvinhu (kukura kwezvinhu, cytokines, lysosomes) uye mapuroteni ekunamatira.Izvi bioactive zvinhu zvine basa rekutanga hemostatic cascade reaction, iyo synthesis yezvitsva zvinobatanidza tishu uye vascular reconstruction.
Kurongeka uye pathogenesis yemarwadzo europathic World Health Organization yakabudisa 11th yakadzokororwa shanduro yeInternational Classification of Pain muna 2018, inoparadzanisa marwadzo europathic mukurwadziwa kwepakati neuropathic uye peripheral neuropathic pain.
Peripheral neuropathic kurwadziwa kunorongwa maererano ne etiology:
1) Utachiona/kuzvimba: postherpetic neuralgia, maperembudzi anorwadza, njovhera/HIV ine peripheral neuropathy
2) Nerve compression: carpal tunnel syndrome, musana unopera simba radicular kurwadziwa
3) Kushungurudzika: kushungurudzika / kupisa / post-operative / post radiotherapy neuropathic kurwadziwa
4) Ischemia / metabolism: chirwere cheshuga peripheral neuropathic kurwadziwa
5) Zvinodhaka: peripheral neuropathy inokonzerwa nemishonga (yakadai sechemotherapy)
6) Vamwe: kurwadziwa kwekenza, trigeminal neuralgia, glossopharyngeal neuralgia, Morton's neuroma.
Kurongeka uye nzira dzekugadzirira dzePRP dzinowanzotenda kuti kuwanda kweplatelet muPRP kakapetwa kana kana kashanu kweropa rose, asi pakave nekushaikwa kwehuwandu hwezviratidzo.Muna 2001, Marx akatsanangura kuti PRP ine zvishoma 1 mamiriyoni eplatelet per microliter ye plasma, iyo inoratidzira huwandu hwehuwandu hwePRP.Dohan et al.yakakamurwa PRP muzvikamu zvina: pure PRP, leukocyte rich PRP, pure platelet rich fibrin, uye leukocyte rich platelet fibrin inobva pane zvakasiyana-siyana zveplatelet, leukocyte, uye fibrin muPRP.Kunze kwekunge zvatsanangurwa neimwe nzira, PRP inowanzo reva white cell rich PRP.
Mechanism yePRP muKurapwa kweNeuropathic Pain Mushure mekukuvadzwa, zvakasiyana-siyana zvekupedzisira uye exogenous activators zvichakurudzira platelet activation α- The granules inopinda degranulation reaction, kusunungura nhamba huru yekukura kwezvinhu, fibrinogen, cathepsin uye hydrolase.Izvo zvakaburitswa zvekukura zvinhu zvinosunga kune yekunze pamusoro pesero membrane yerinotariswa sero kuburikidza ne transmembrane receptors pane cell membrane.Aya ma-transmembrane receptors anozoita kuti uye aite endogenous signing mapuroteni, achiwedzera kuita mutumwa wechipiri muchitokisi, izvo zvinoita kuti masero awedzere, kuumbwa kwematrix, synthesis ye collagen protein uye imwe intracellular gene expression.Pane humbowo hwekuti ma cytokines anoburitswa nemaplatelet uye mamwe ma transmitters anoita basa rakakosha mukuderedza/kubvisa marwadzo asingaperi europathic.Iyo chaiyo nzira inogona kukamurwa kuita peripheral mechanisms uye central mechanisms.
Mechanism yeplatelet rich plasma (PRP) mukurapa kwemarwadzo europathic
Peripheral nzira: anti-inflammatory effect, neuroprotection uye kukurudzirwa kweaxon regeneration, immune regulation, analgesic effect.
Pakati pemashini: kunetesa uye kudzoreredza yepakati sensitization uye inhibiting glial cell activation
Anti-inflammatory Effect
Peripheral sensitization inoita basa rakakosha pakuitika kwezviratidzo zvekurwadziwa kweuropathic mushure mekukuvara kwetsinga.Masero akasiyana-siyana ekuputika, akadai neutrophils, macrophages uye mast cells, akapinzwa munzvimbo yekukuvara kwetsinga.Kuwedzera kuunganidza kwemasero ekuputika kunoumba hwaro hwekunyanya kufadza uye kuenderera mberi kwekubuda kwetsinga fibers.Kuvhiringidza kunobudisa nhamba yakawanda yemakemikari anopindirana, akadai se cytokines, chemokines uye lipid mediators, zvichiita kuti nociceptors zvive nehanya uye kufara, uye zvichikonzera kuchinja munharaunda yemakemikari emunharaunda.Platelets ane simba rekudzivirira muviri uye anti-inflammatory effects.Nekudzora uye nekuvanza zvakasiyana-siyana immune regulatory zvinhu, angiogenic zvinhu uye zvinovaka muviri, zvinogona kuderedza zvinokuvadza immune system uye kuzvimba, uye kugadzirisa kwakasiyana kukuvara kwetishu munzvimbo dzakasiyana siyana.PRP inogona kuita basa rinopesana nekuputika kuburikidza nemhando dzakasiyana-siyana.Inogona kuvharidzira kusunungurwa kwepro-inflammatory cytokines kubva kuSchwann masero, macrophages, neutrophils uye mast masero, uye inhibit gene expression ye pro-inflammatory factor receptors nekusimudzira kuchinjwa kwezvinyama zvakakanganisika kubva kune imwe nyika inoputika kusvika kune imwe nyika inopesana nekuputika.Kunyange zvazvo maplatelet asingasununguri interleukin 10, maplatelet anoderedza kugadzirwa kwehuwandu hweinterleukin 10 kuburikidza nekuita masero edendritic maduku γ- Kugadzirwa kwe interferon kunobata basa rinopesana nekuputika.
Analgesic Effect
Activated maplatelet anoburitsa akawanda e-pro-inflammatory uye anti-inflammatory neurotransmitters, ayo anogona kukonzera marwadzo, asi zvakare kuderedza kuzvimba uye kurwadziwa.Iwo maplatelet achangogadzirwa akarara muPRP.Mushure mokunge yashandiswa zvakananga kana kuti zvisina kurongeka, morphology yeplatelet inoshanduka uye inokurudzira platelet aggregation, ichibudisa intracellular α-Dense particles uye zvipembenene zvinokurudzira zvichakurudzira kusunungurwa kwe5-hydroxytryptamine, iyo ine marwadzo ekugadzirisa maitiro.Parizvino, 5-hydroxytryptamine receptors inowanzoonekwa mune peripheral nerves.5-hydroxytryptamine inogona kukanganisa kuendeswa kwenociceptive mumasumbu akapoteredza kuburikidza ne5-hydroxytryptamine 1, 5-hydroxytryptamine 2, 5-hydroxytryptamine 3, 5-hydroxytryptamine 4 uye 5-hydroxytryptamine 7 receptors.
Kudziviswa kweGlial Cell Activation
Maseru eGlial anoverengera makumi manomwe muzana emasero epakati tsinga, ayo anogona kukamurwa kuva marudzi matatu: astrocytes, oligodendrocytes uye microglia.Microglia yakashandiswa mukati meawa 24 mushure mekukuvara kwetsinga, uye astrocytes yakagadziriswa nguva pfupi mushure mekukuvara kwetsinga, uye kushandiswa kwakagara kwevhiki dze12.Astrocytes uye microglia zvino inobudisa ma cytokines uye inokonzera mutsara wemhinduro dzemasero, zvakadai sekukwidziridzwa kweglucocorticoid uye glutamate receptors, zvichiita kuti kuchinja kwemutsara wepinini uye neural plasticity, iyo inonyatsoenderana nekuitika kwemarwadzo europathic.
Zvinhu zvinobatanidzwa mukubvisa kana kubvisa marwadzo europathic muplatelet rich plasma
1) Angiopoietin:
Kukurudzira angiogenesis;Kukurudzira endothelial cell migration uye kuwedzera;Tsigira uye kudzikamisa kukura kwemidziyo yeropa nekutsvaga ma pericytes
2) Connective tishu kukura chinhu:
Kukurudzira kutama kweleukocyte;kukurudzira angiogenesis;Inomutsa myofibroblast uye inomutsa extracellular matrix deposition uye kugadzirisa
3) Epidermal kukura chinhu:
Kurudzira kuporeswa kwemaronda uye kuunza angiogenesis nekusimudzira kupararira, kutama uye kusiyanisa kwema macrophages uye fibroblasts;Kurudzira fibroblasts kuburitsa collagenase uye kushatisa extracellular matrix panguva yekugadziridza maronda;Kurudzira kuwanda kwe keratinocytes uye fibroblasts, zvichiita kuti repithelization.
4) Fibroblast kukura chinhu:
Kukurudzira chemotaxis ye macrophages, fibroblasts uye endothelial masero;Kukurudzira angiogenesis;Inogona kukonzera granulation uye kugadziridzwa kwetishu uye kutora chikamu mukudonha kweronda.
5) Hepatocyte kukura chinhu:
Kugadzirisa sero kukura uye kufamba kwe epithelial / endothelial masero;Kurudzira kugadzirisa epithelial uye angiogenesis.
6) Insulin yakafanana nekukura chinhu:
Unganidza pamwe chete fiber masero kuti akurudzire mapuroteni synthesis.
7) Platelet yakabva kukura chinhu:
Kurudzira chemotaxis ye neutrophils, macrophages uye fibroblasts, uye inokurudzira kupararira kwemacrophages uye fibroblasts panguva imwe chete;Inobatsira kuora collagen yekare uye kumusoro inogadzirisa kutaura kwematrix metalloproteinases, inotungamirira kukuputika, granulation tissue formation, epithelial proliferation, kugadzirwa kwe extracellular matrix uye kugadziriswa kwetishu;Inogona kukurudzira kuwanda kweadipose inotorwa stem maseru uye kubatsira kuita basa mukuvandudza tsinga.
8) Stromal cell derived factor:
Dana maCD34+ masero kuti ape imba yavo, kuwanda uye kupatsanurwa kuita endothelial progenitor masero, uye kukurudzira angiogenesis;Unganidza mesenchymal stem masero uye leukocytes.
9) Kushandura kukura chinhu β:
Pakutanga, ine mhedzisiro yekusimudzira kuputika, asi inogonawo kukurudzira kushandurwa kwechikamu chakakuvara kune chinopesana nekuputika;Inogona kuwedzera chemotaxis ye fibroblasts uye yakatsetseka mhasuru masero;Dzora kutaura kwe collagen uye collagenase, uye kukurudzira angiogenesis.
10) Vascular endothelial kukura chinhu:
Tsigira uye kusimudzira kukura kweiyo regenerated nerve fibers nekubatanidza angiogenesis, neurotrophic uye neuroprotection, kuitira kudzoreredza basa retsinga.
11) Nerve growth factor:
Inotamba neuroprotective basa nekusimudzira kukura kwemaaxon uye kuchengetedza uye kupona kwema neurons.
12) Glial inotorwa neurotrophic factor:
Inogona kubudirira kudzosera kumashure uye kuenzanisa neurogenic mapuroteni uye kutamba neuroprotective basa.
Mhedziso
1) Platelet yakapfuma plasma ine hunhu hwekusimudzira kuporeswa uye anti kuzvimba.Haikwanise kugadzirisa chete kukuvara kwetsinga tishu, asiwo zvinobudirira kubvisa marwadzo.Iyo yakakosha nzira yekurapa yekurwadziwa kweuropathic uye ine tarisiro yakajeka;
2) Nzira yekugadzirira yeplatelet rich plasma ichiri kukakavara, inodaidzira kugadzwa kweyakagadziriswa nzira yekugadzirira uye yakabatana chikamu chekuongorora chiyero;
3) Kune dzakawanda zvidzidzo zveplatelet rakapfuma plasma mukurwadziwa kweuropathic kunokonzerwa nekukuvara kwemusana, kukuvara kwetsinga uye kudzvanywa kwetsinga.Iyo nzira uye kliniki inoshanda yeplatelet yakawanda yeplasma mune mamwe marudzi ekurwadziwa kweuropathic inoda kuenderera mberi ichidzidzwa.
Neuropathic pain ndiro zita rakawanda rekirasi hombe yezvirwere zvekiriniki, iyo yakajairika mukurapa kwekiriniki.Zvisinei, hapana nzira chaiyo yekurapa panguva ino, uye kurwadziwa kunogara kwemakore anoverengeka kana kunyange kwehupenyu mushure mekurwara, zvichikonzera mutoro wakakomba kuvarwere, mhuri uye nzanga.Kurapa zvinodhaka ndicho chirongwa chekutanga chekurapa kwekurwadziwa kweuropathic.Nekuda kwekuda kwemishonga yenguva refu, kutevedzera kwevarwere hakuna kunaka.Mushonga wenguva refu unowedzera kukanganiswa kwezvinodhaka uye kukonzera kukuvara kukuru kwemuviri nepfungwa kuvarwere.Zvidzidzo zvekutanga zvakakosha uye zvidzidzo zvekiriniki zvakaratidza kuti PRP inogona kushandiswa kurapa marwadzo europathic, uye PRP inobva kumurwere pachake, pasina autoimmune reaction.Nzira yekurapa iri nyore, ine maitiro mashoma asina kunaka.PRP inogonawo kushandiswa pamwe chete ne stem cell, iyo ine simba rakasimba rekugadzirisa tsinga uye kuvandudzwa kwetishu, uye ichava netarisiro yakafara yekushandiswa mukurapa kweuropathic marwadzo mune ramangwana.
(Zviri muchinyorwa ichi zvakadhindwa patsva, uye isu hatipe chero vimbiso yechokwadi, kuvimbika kana kuzara kwezviri muchinyorwa chino, uye hatina mhosva yemafungiro echinyorwa ichi, ndapota nzwisisa.)
Nguva yekutumira: Zvita-20-2022