Basa remaplatelet mubhonzo aspiration concentrate
PRP uye bone marrow aspiration concentrate (BMAC) iri kushandiswa kune dzakatevedzana marapirwo ekiriniki munzvimbo yehofisi uye kuvhiyiwa nekuda kwekubatsira kwavo patsva muMSK uye zvirwere zvemuzongoza, kusingaperi marwadzo ekudzora uye zvinyoro zvinyoro zviratidzo.PRP haingogadziri kutama kwesero uye kuwedzera kwesero, asi inobatsirawo kune angiogenesis uye ECM remodeling kugadzira yakanaka microenvironment uye kukurudzira kugadziriswa kwematishu nekuvandudzwa.
BMAC kugadzirisa maitiro
BMACs ari heterogeneous maseru ekuumbwa ane BMMSCs, achiaita endogenous sero sosi ye regenerative mushonga kugadzirisa kurapwa.Ivo vanoita basa nekudzikisa sero apoptosis, fibrosis uye kuzvimba;Uye shandisa iyo cascade reaction inotungamira mukuwanda kwesero.Mukuwedzera, maBMMSC ane mukana wekusiyanisa mumhando dzakasiyana-siyana dzemasero, kusanganisira osteoblasts, adipocytes, myoblasts, epithelial cells uye neurons.Vanosimudzirawo angiogenesis kuburikidza neparacrine uye autocrine nzira.Izvo zvakakoshawo kuti BMMSC inogovera kune immune regulation yakazvimirira kubva kune immune chaiyo maseru, ayo anotora chikamu muchikamu chekuzvimba chekugadzirisa maronda.Pamusoro pezvo, maBMMSC anotsigira kutorwa kwemasero kunzvimbo itsva dzekurapa angiogenesis kukurumidza kuvakwazve kwekuyerera kweropa.Jin et al.Zvakaratidzwa kuti mukushayikwa kwemakafu akakwana, mwero wekupona kweBMMSC uye kugadzirisa kwayo nekusiyanisa kugona kusimudzira kuporeswa kwakakuvadzwa.Kunyangwe kuunganidzwa kwematishu, gadziriro yemuenzaniso uye maitiro ekuita kwePRP neBMAC akasiyana, zvidzidzo zvinoratidza kuti vanogona kutsigirana.Muchokwadi, kusanganisa PRP neBMAC kuita biological chigadzirwa kunogona kuve nekuwedzera mabhenefiti.
Kubatanidza PRP uye BMAC
Zvinoenderana nekumwe kusingazivikanwe tsvagiridzo, musimboti wekutanga wekubatanidza PRP neBMAC wakavakirwa pane akati wandei nzvimbo.Kutanga, PRP inogona kupa yakakodzera microenvironment umo BMSC inogona kuwedzera kupararira kwesero uye kusiyanisa uye kuwedzera angiogenesis.Kechipiri, PRP yakashandiswa sechikafu chemasero aya pamwe neBMAC.Kusiyana neizvi, musanganiswa wePRP neBMAC unogona kuve chishandiso chine simba chebiological kukwezva huwandu hweBMMSC.PRP-BMAC compound yakashandiswa kurapa tendinosis, maronda, kukuvara kwemusana, degenerative intervertebral discs uye osteochondral defects ine simba guru rekuzvarwa patsva.Nehurombo, kunyangwe heterogeneous bhonzo maseru maseru zvikamu zvinosanganisira maplatelet, mishumo mishoma inotaura nezvehuwandu hwemaplatelet mumwongo wakabviswa uye mushure mekurapa kweBMAC, asi anogona kutorwa nenzira dzakakodzera dzekushuvira.Kumwe kutsvagurudza kunodiwa kuti unzwisise kana mamwe maplatelet anotarisisa anoda kushandiswa musanganiswa neBMAC.Parizvino, hapana dhata pamusoro peyero yakakwana yeplatelet kune MSC (kana mamwe masero emapfupa) masero, ayo ane maitiro akanaka pane zvinovaka muviri zveMSC mukugadziriswa kwematishu.Sezvineiwo, bhonzo marongo ekuunganidza midziyo uye tekinoroji inogona kuvandudzwa kuti ibudise akakwana mwongo maplatelet.
PRP kukura chinhu uye BMAC inovaka muviri
PRP platelet kukura chinhu ipuroteni yakakosha inobatanidzwa mukugadzirisa maitiro eBMAC.Kusiyana kwePGF uye mamwe ma cytokines anobatanidzwa muhutano hweBMAC inogona kutanga kugadziriswa kwetishu kuburikidza nekuderedza cell apoptosis, anabolism uye anti-inflammatory effects, uye activating cell proliferation, kusiyanisa uye angiogenesis kuburikidza neparacrine uye autocrine nzira.
Platelet-derived growth factor uye dense granule zvikamu zviri pachena kuti zvinobatanidzwa muhutano hweBMAC uye kutsigira kugadziriswa kwetishu uye kuvandudzwa kunokonzerwa neMSC.Mhedziso: MSC: mesenchymal stem masero, HSC: hematopoietic stem masero.
Zviripachena, mukurapwa kweOA, PDGF inoita basa rakananga mukuvandudzwa kwecartilage uye kuchengetedza homeostasis kuburikidza neMSC kuwanda uye inhibition yeIL-1-induced chondrocyte apoptosis uye kuzvimba.Mukuwedzera, zvitatu zveTGF- β The subtypes zviri kushingaira mukukurudzira kuumbwa kwecartilage uye kuvharidzira kuzvimba, uye vanoratidza kukwanisa kukurudzira MSC-inoenderana nehutachiona hwekuporesa kuburikidza nekubatana kwe intermolecular.Iyo inovaka muviri mhedzisiro yeMSC ine chekuita nebasa rePGF uye secretion yekugadzirisa cytokines.Sezvineiwo, ese aya ma cytokines anofanirwa kunge aripo muBMAC bhodhoro rekurapa uye kutakurwa kuenda kunzvimbo yekukuvara kwetishu kusimudzira yakanakisa MSC-inoenderana nerapeutic tishu kuporesa.
Muchidzidzo cheOA chakabatana, Mui ñ os-L ó pez et al.Zvinoratidza kuti MSC yakabva ku synovial tissue yakachinja basa, zvichikonzera kurasikirwa kwekugona kwayo kupora.Sezvineiwo, jekiseni yakananga yePRP mu subchondral bone ye osteoarthritis yakaguma nekuderedzwa kweMSC mu synovial fluid, zvichiratidza kuvandudzwa kwekiriniki.Therapeutic effect inopindirana nekuderedza maitiro ekuputika mu synovial fluid yeOA varwere.
Pane ruzivo rushoma rwuripo pamusoro pekuvapo kana kusungwa kwePGF muBMAC kana chiyero chakanaka chinodiwa kutsigira basa rekudya kweBMMSC.Vamwe varapi vanosanganisa yakakwira PRP yekumisikidza neBMAC kuti vawane mamwe biologically anoshanda magrafti, ayo anotarisirwa kukwirisa mhedzisiro yekurapa yemushonga wekuvandudza.Nekudaro, kune mashoma aripo ekuchengetedza uye efficacy data, zvichiratidza kuti kusanganisa yakakwira PRP kusungwa neBMAC inzira inoshanda yekurapa.Naizvozvo, isu tinotenda kuti zvingave zvisina kukodzera kushandisa BMMSC nekuvamisa nepamusoro peplatelet concentration panguva ino.
Kudyidzana kwemaplatelet ane antiplatelet zvinodhaka uye NSAIDs
PRP ine huwandu hwakawanda hwezvikamu zvepachivande uye inoumbwa nezvakawanda zvebiological media.Kurapa kwePRP kunonzi kune varevereri ava.Kunyangwe varevereri vekurapa mumaplatelet vachinyatsozivikanwa, iyo yakanyanya kuumbwa uye kinetics yeaya anabolic uye catabolic mishonga haina kunyatsojeka.Chimwe chemipimo mikuru yekuwana marapirwo maumbirwo ndiko kukunda kusiyanisa kwevayananisi vebhayoloji iyi kuitira kunanga zvakadzika-dzika zvakadzika mhedzisiro inogara ichidzokororwa uye nekiriniki inobatsira.Nokuda kwechikonzero ichi, zvinodhaka (zvakadai se-non-steroidal anti-inflammatory drugs (NSAIDs)) zvinogona kukanganisa kusunungurwa kweplatelet secretory mapoka.Mune ichangobva kuvhurwa-label yakagadziriswa-sequence yekudzidza, kudya kwezuva nezuva kwe81 mg ye aspirin (ASA) kwakaderedza kutaura kwevarevereri vanokosha, vakadai seTGF- β 1. PDGF uye VEGF.
Izvi zvinokonzerwa nekudzivirirwa kusingadzoreki kwe cyclooxygenase-1 (COX-1) uye inogadziriswa inhibition ye cyclooxygenase-2 (COX-2), ari ma enzymes maviri anodiwa kuzasi kweplatelet degranulation.Ongororo yazvino yakarongeka yakawana kuti antiplatelet mishonga inogona kuderedza kukura kwechinhu kuburitsa curve mune COX-1 uye COX-2 inotsamira nzira, uye 8 yezvidzidzo gumi neshanu zvakaona kuti kukura kwakadzikira.
Mishonga (eg NSAIDs) inowanzoshandiswa kuderedza marwadzo uye kuderedza kuzvimba kunokonzerwa nechirwere cheMSK.Nzira yeNSAID ndeyekudzivisa kushandiswa kweplatelet nekusunga zvisingachinjiki neCOX enzyme uye kugadzirisa arachidonic acid nzira.Naizvozvo, basa remaplatelet richachinja mukati mehupenyu hwese kutenderera kwemaplatelet, nokudaro kudzivirira PGF chiratidzo kutapurirana.NSAIDs inhibit cytokine production (eg, PDGF, FGF, VEGF, uye IL-1 β, IL-6, uye IL-8), apo ichiwedzera TNF- α. Zvisinei, pane zvishoma zvinyorwa pamusoro pemakemikari eNSAID paPRP.Hapana kubvumirana pane nguva yakanakisisa yekugadzirira uye kutungamirirwa kwePRP kune varwere vanoshandisa NSAIDs.Mannava nevamwe vaaishanda navo vakaverengera anabolic uye catabolic biological factor muleucocyte-rich PRP yevanozvipira vane hutano vanotora naproxen.Vakaona kuti mushure mekushandisa naproxen kwevhiki imwe, mazinga ePDGF-AA uye PDGF-AB (mitogen inoshanda yekusimudzira angiogenesis) yakaderedzwa zvakanyanya.Mushure mevhiki imwe chete, chiyero chekukura chakadzokera kusvika padyo nedanho rekutanga.Mushure mekushandisa naproxen kwevhiki imwe chete, iyo LR-PRP level yeproinflammatory uye catabolic factor IL-6 yakadererawo, uye yakadzokera kunheyo yekutanga mushure mevhiki imwe chete yekuregererwa.Parizvino, hapana chidzidzo chekliniki kuratidza kuti varwere vane naproxen mushure mekurapa kwePRP vane migumisiro yakaipa;Zvisinei, zvinokurudzirwa kufunga nezvenguva yekugeza kwevhiki imwe chete kuti udzorere PDGF-AA, PDGF-BB uye IL-6 tsika kusvika padanho rekutanga kuti vavandudze basa ravo rehupenyu.Kutsvakurudza kwakawanda kunodiwa kuti unzwisise zvizere zvinokonzerwa ne antiplatelet uye NSAID paPRP secretion group uye zvinangwa zvayo pasi.
Sanganisa kushandiswa kweplatelet-rich plasma nekugadzirisa
Kunyange zvazvo tsvakurudzo yesayenzi inokosha inoratidza kuti kurapa kwepanyama uye mechanical load ine basa rakajeka mukudzorerwa kwemaitiro etendon mushure mejekiseni rePRP, hapana kubvumirana pane zvakanakisisa chirongwa chekugadzirisa chirwere cheMSK mushure mekurapa kwePRP.
Kurapa kwePRP kunosanganisira jekiseni remaplatelet akaiswa munzvimbo yemuno matishu kudzora marwadzo uye kukurudzira kugadziriswa kwetishu.Uchapupu hwakasimba hwekiriniki huripo mumabvi OA.Zvisinei, kushandiswa kwePRP mukurapa kwechiratidzo tendinosis kunokakavadzana, uye migumisiro yakataurwa yakasiyana.Zvidzidzo zvemhuka zvinowanzoratidza histological kunatsiridza tendinosis mushure mePRP kupinda.Izvi zvidzidzo zvinoratidza kuti mechanical load inogona kudzorera matendon, uye mutoro uye PRP jekiseni zvinoshanda pamwe chete kukurudzira kuporesa tendon.Kusiyana mukugadzirira kwePRP, kugadzirira kwehupenyu, kugadzirira, zvirongwa zvejekiseni uye tendon kukuvara subtypes zvinogona kutungamirira kune kusiyana kwemigumisiro yekliniki.Mukuwedzera, kunyange zvazvo uchapupu hwezvesayenzi hunotsigira zvikomborero zvezvirongwa zvekugadzirisa, zvishomanana zvakadhindwa tsvakurudzo dzekliniki dzinoedza kugadzirisa nekubatanidza zvirongwa zvekugadzirisa mushure mePRP.
Munguva pfupi yapfuura, Onishi et al.Basa rema mechanical load uye PRP biological effect muAchilles tendon chirwere chakaongororwa.Vakaongorora chikamu I uye chikamu chechipiri chekliniki zvidzidzo zveAchilles tendon chirwere chakabatwa nePRP, vachitarisa paurongwa hwekugadzirisa mushure mejojo yePRP.Mapurogiramu ekudzoreredza anotariswa anoita seanonatsiridza kutevedzera maekisesaizi uye kuvandudza mhedzisiro uye kugona kutarisa maekisesaizi dose.Miedzo yakawanda yakagadzirwa neAchilles tendon PRP yakasanganiswa mushure mePRP kurapwa ne mechanical load rehabilitation plan sechikamu chakakosha chekugadzirisa nzira.
Maonero eramangwana nemhedziso
Kufambira mberi kwehunyanzvi hwemidziyo yePRP uye nzira dzekugadzirira kunoratidza kuvimbisa mhedzisiro yevarwere, kunyangwe tsananguro yezvakasiyana PRP biological agents uye yakakodzera biological maitiro echigadzirwa chekupedzisira zvichiri kusanzwisisika.Mukuwedzera, iyo yakazara mikana yePRP zviratidzo uye zvikumbiro hazvina kutsanangurwa.Kusvika nguva pfupi yadarika, PRP yave ichitengeswa seautologous blood derivative product, iyo inogona kupa vanachiremba kugona kushandisa autologous platelet kukura factor tekinoroji mune chaiyo yakaratidza pathology uye zvirwere.Pakutanga, mucherechedzo chete wekubudirira kwekushandiswa kwePRP iyo inowanzotaurwa ndiyo yakagadziriswa sampu, iyo iyo platelet concentration yakakwira kupfuura kukosha kweropa rose.Nhasi, nerufaro, vashandi vane kunzwisisa kwakawanda kwekushanda kwePRP.
Muongororo iyi, tinobvuma kuti pachine kushaikwa kwekumisikidza uye kurongedza muhunyanzvi hwekugadzirira;Nokudaro, hapana kubvumirana pamusoro pePRP biological agents panguva ino, kunyange zvazvo mamwe mabhuku asvika kubvumirana pamusoro pehutano hweplatelet dose hunodiwa hunodiwa kukurudzira (itsva) angiogenesis.Pano, takasuma muchidimbu chiitiko chePGFs, asi zvakanyanya kuratidza iyo chaiyo platelet mashandiro uye mhedzisiro mhedzisiro yemasero machena eropa uye MSCs, pamwe nekuzotevera kupindirana kwesero-sero.Kunyanya, kuvapo kwemasero machena eropa mukugadzirira kwePRP kunopa kunzwisisa kwakadzama kwekukuvadza kana kunobatsira.Basa rakajeka remaplatelet uye kudyidzana kwavo neakaberekwa uye anogadzirisa immune system akakurukurwa.Mukuwedzera, zvakakwana uye zvakanyatsonyorwa zvidzidzo zvekliniki zvinodikanwa kuti zvione kukwanisa kwakakwana uye kurapa kwePRP mune zviratidzo zvakasiyana-siyana.
(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: Mar-01-2023