Igitekerezo kizwi muri iki gihe nka PRP cyagaragaye bwa mbere mu bijyanye na hematologiya mu myaka ya za 70.Abahanga mu kuvura indwara z’imiti bahimbye ijambo PRP mu myaka ibarirwa muri za mirongo bagerageza gusobanura plasma yakuwe mu mibare ya platel iri hejuru y’agaciro k’ibanze mu maraso ya peripheri.Nyuma yimyaka irenga icumi, PRP yakoreshejwe mugubaga maxillofacial nkuburyo bwa fibrine ikungahaye kuri platine (PRF).Ibirimo bya fibrin biri muri iyi nkomoko ya PRP bifite agaciro gakomeye kubintu bifata hamwe na homeostatike, mugihe PRP ifite imiti igabanya ubukana kandi igatera ikwirakwizwa ry'uturemangingo.Amaherezo, ahagana mu myaka ya za 90, PRP yaramamaye, amaherezo, ikoranabuhanga ryimurirwa mu zindi nzego z'ubuvuzi.Kuva icyo gihe, ibinyabuzima byiza byizwe cyane kandi bishyirwa mu bikorwa kugira ngo bivure ibikomere bitandukanye by’imitsi ku bakinnyi babigize umwuga, bikomeza kugira uruhare mu itangazamakuru.Usibye kuba ingirakamaro mu magufa no mu buvuzi bwa siporo, PRP ikoreshwa mu kuvura amaso, indwara z'abagore, urologiya na kardiologiya, ubuvuzi bw'abana no kubaga plastique.Mu myaka yashize, PRP yashimiwe kandi naba dermatologiste kubushobozi ifite bwo kuvura ibisebe byuruhu, kuvugurura inkovu, kuvugurura ingirabuzimafatizo, kuvugurura uruhu ndetse no guta umusatsi.
Urebye ko PRP izwiho gukoresha mu buryo butaziguye uburyo bwo gukiza no gutwika, casade ikiza igomba gutangizwa nkibisobanuro.Inzira yo gukira igabanijwemo ibyiciro bine bikurikira: hemostasis;gutwika;selile na matrix ikwirakwizwa, hanyuma amaherezo yo gukomeretsa.
1. Gukiza imyenda
Cascade ikiza tissue irakorwa, inzira iganisha ku guteranya platine, kwibumbira hamwe, no guteza imbere matrice idasanzwe yigihe gito (ECM. Platelets noneho ikurikiza poroteyine za kolagen na ECM zagaragaye, bigatuma habaho α-granules mu Kurekura kwa Bioactive Molecules. Platelet irimo molekile zitandukanye za bioaktike, zirimo ibintu bikura, chemokine, na cytokine, hamwe nabunzi batera indwara nka prostaglandine, prostine cyclin, histamine, tromboxane, serotonine, na bradykinin.
Icyiciro cyanyuma cyibikorwa byo gukira biterwa no guhindura igikomere.Kuvugurura imyenda bigengwa cyane kugirango habeho kuringaniza ibisubizo bya anabolike na catabolika.Muri iki cyiciro, ibintu bikura bikomoka kuri platine (PDGF), bihindura ibintu bikura (TGF-β) na fibronectine bitera gukwirakwira no kwimuka kwa fibroblast, hamwe no guhuza ibice bya ECM.Nyamara, igihe cyo gukura kw'ibikomere ahanini giterwa n'uburemere bw'igikomere, ibiranga umuntu ku giti cye, hamwe n'ubushobozi bwihariye bwo gukiza bw'imitsi yakomeretse, kandi ibintu bimwe na bimwe bya patrophysiologique na metabolike bishobora kugira ingaruka ku gukira, nka ischemia tissue, hypoxia, infection , Gukura ibintu kutaringaniza, ndetse n'indwara ziterwa na metabolike.
Ibidukikije byangiza ibidukikije bibangamira inzira yo gukira.Kugora ibintu, hariho kandi ibikorwa byinshi bya protease bibuza ibikorwa bisanzwe byikura (GF).Usibye kugira mitogenic, angiogenic, na chemotactique, PRP nisoko ikomeye yibintu byinshi bikura, biomolecules ishobora kurwanya ingaruka zifatika mumyanya yaka umuriro mugukumira umuriro ukabije no gushyiraho anabolike.Urebye iyi miterere, abashakashatsi barashobora kubona imbaraga nyinshi mukuvura ibikomere bitandukanye bigoye.
2. Cytokine
Cytokine muri PRP igira uruhare runini mugukoresha uburyo bwo gusana ingirabuzimafatizo no kugenzura ibyangiritse.Cytokine irwanya inflammatory ni igice kinini cya molekile ya biohimiki ihuza ibisubizo bya cytokine itera cyane, biterwa na macrophage ikora.Cytokine irwanya inflammatory ikorana na inhibitor ya cytokine yihariye hamwe na reseptor ya cytokine ikora kugirango ihindure umuriro.Interleukin (IL) -1 antagonist antagonist, IL-4, IL-10, IL-11 na IL-13 bashyizwe mubikorwa nka cytokine nyamukuru irwanya inflammatory.Ukurikije ubwoko bw igikomere, cytokine zimwe na zimwe, nka interferon, leukemia inhibitory factor, TGF-β na IL-6, irashobora kwerekana ingaruka ziterwa no kurwanya indwara.TNF-α, IL1 na IL-18 bifite reseptor zimwe na zimwe za cytokine zishobora kubuza ingaruka ziterwa na poroteyine [37].IL-10 ni imwe mu mbaraga zikomeye za anti-inflammatory cytokine, irashobora kugabanya-kugenzura cytokine itera inflammatory nka IL-1, IL-6 na TNF-α, kandi ikanagenzura cytokine irwanya inflammatory.Ubu buryo bwo kurwanya-kugenzura bugira uruhare runini mu gukora no mu mikorere ya cytokine.Byongeye kandi, cytokine zimwe zishobora gukurura ibimenyetso byerekana ibimenyetso bitera fibroblast, zikomeye mugusana ingirangingo.Cytokine ikongora TGFβ1, IL-1β, IL-6, IL-13, na IL-33 itera fibroblast gutandukanya myofibroblast no kunoza ECM [38].Na none, fibroblast isohora cytokine TGF-β, IL-1β, IL-33, CXC, na CC chemokine, iteza imbere ibisubizo bitera imbaraga mugukora no kwinjiza ingirabuzimafatizo nka macrophage.Izi ngirabuzimafatizo zifite uruhare runini ahakomeretse, cyane cyane mugutezimbere ibikomere - kimwe na biosynthesis ya chemokine, metabolite nibintu bikura, byingenzi muguhindura ingirangingo nshya.Rero, cytokine iboneka muri PRP igira uruhare runini mugukangura ubwoko bwimikorere-selile yubudahangarwa bw'umubiri, bigatera gukemura icyiciro cya inflammatory.Nkako, abashakashatsi bamwebamwe bavuze ko ubu buryo bwitwa “regenerative inflammation,” bavuga ko icyiciro c'umuriro, naho umurwayi adahungabanye, ari intambwe ikomeye ikenewe kugira ngo inzira yo gusana ingirangingo igere ku mwanzuro ugenda neza, urebye uburyo bwa epigenetike bwerekana ibimenyetso bitanga umuriro bitera selile plastike.
3. Fibrin
Platelets itwara ibintu byinshi bijyanye na sisitemu ya fibrinolytike ishobora kugenzura cyangwa kugabanya igisubizo cya fibrinolytike.Umubano wigihe gito nintererano igereranijwe yibigize hematologiya nibikorwa bya platel mugutesha agaciro imyenda iracyari ikibazo gikwiye kuganirwaho mubaturage.Ubuvanganzo butanga ubushakashatsi bwinshi bwibanda kuri platine gusa, izwiho ubushobozi bwo guhindura inzira yo gukira.Nubwo ubushakashatsi bwinshi bwibanze, ibindi bice byamaraso, nkibintu bya coagulation na sisitemu ya fibrinolytike, nabyo byagaragaye ko bigira uruhare runini mugusana ibikomere neza.Mubisobanuro, fibrinolysis ninzira igoye yibinyabuzima ishingiye kumikorere ya enzymes zimwe na zimwe kugirango byorohereze fibrin.Igisubizo cya fibrinolytike cyatanzwe nabandi banditsi ko ibicuruzwa byangiza fibrin (fdp) mubyukuri bishobora kuba ibintu bya molekuline bishinzwe gukangura isanwa ryimitsi, urukurikirane rwibintu byingenzi byibinyabuzima mbere yo gushira fibrin no kuvana muri angiogenez, bikenewe mugukiza ibikomere.Ihinduka ryimyenda nyuma yimvune ikora nkurwego rukingira urinda ingirangingo gutakaza amaraso, kwibasirwa na mikorobe, kandi ikanatanga matrise yigihe gito inyama zishobora kwimuka mugihe cyo gusana.Imyenda iterwa no gukuramo fibrinogen na proteine serine hamwe na platine yegeranya mumurongo wa fibrin fibrous.Iyi reaction itangiza polymerisation ya fibrin monomers, ikintu nyamukuru mugukora amaraso.Imyenda irashobora kandi gukora nk'ibigega bya cytokine hamwe nibintu bikura, birekurwa nyuma yo kwangirika kwa platine ikora.Sisitemu ya fibrinolytike igenzurwa cyane na plasmin kandi ikagira uruhare runini mugutezimbere kwimuka kwingirabuzimafatizo, ibintu bikura bioavailability, no kugenzura izindi sisitemu za protease zigira uruhare mu gutwika no kuvuka.Ibice byingenzi muri fibrinolysis, nka reseptor ya urokinase plasminogen (uPAR) hamwe na plasminogen activator inhibitor-1 (PAI-1) bizwi ko bigaragarira mu ngirabuzimafatizo ya Mesenchymal (MSCs), ubwoko bw’akagari kabuhariwe bukenewe mu gukira neza ibikomere.
4. Kwimuka kwakagari
Gukora plasminogen binyuze mumuryango uPA-uPAR ninzira iteza imbere kwimuka kwimuka kuko byongera proteolysis idasanzwe.Kubera ko uPAR idafite transembrane na domaine internacellular domaine, poroteyine isaba kwakirwa hamwe nka integin na vitamine kugirango bigabanye kwimuka kwakagari.Byongeye kandi, uPA-uPAR guhuza byatumye habaho kwiyongera kwa uPAR kuri vitreous connexine na integin, biteza imbere ingirabuzimafatizo.Plasminogen activator inhibitor-1 (PAI-1) nayo ihagarika ingirabuzimafatizo, isenya upar-vitrein na integrin- iyo ihujwe na uPA yikigo cya uPA-upar-integrin hejuru yubuso Imikoranire yijwi ryibirahure.
Mu rwego rwubuvuzi bushya, ingirangingo ngengabuzima ya mesenchymal ikangurwa kuva mu magufa mu rwego rwo kwangirika kw’ingingo bityo bikaba bishobora kuboneka mu kuzenguruka kw’abarwayi bafite imvune nyinshi.Ariko rero, mubihe bimwe bimwe, nko kunanirwa kwimpyiko zanyuma, kunanirwa kwumwijima wanyuma, cyangwa mugihe cyo gutangira kwangwa nyuma yo guterwa umutima, utugingo ngengabuzima ntidushobora kuboneka mumaraso [66].Igishimishije, utugingo ngengabuzima twa magenchymal (tromal) progenitor ntishobora kuboneka mumaraso yabantu bafite ubuzima bwiza [67].Uruhare rwa uPAR mugukangurira amagufwa ya mesenchymal stem selile na none rwasabwe mbere, bisa nibibera muri mobilisation stem hematopoietic stem selile (HSC).Varabaneni n'abandi.Ibisubizo byerekanye ko ikoreshwa rya granulocyte colony-itera imbaraga mu mbeba zabuze uPAR zateye kunanirwa kwa MSCs, byongera gushimangira uruhare rushyigikira sisitemu ya fibrinolytike mu kwimuka kwakagari.Ubundi bushakashatsi bwerekanye kandi ko reseptor ya glycosylphosphatidylinositol-anchored uPA igenga guhuza, kwimuka, gukwirakwizwa, no gutandukana mugukoresha inzira zimwe na zimwe zerekana ibimenyetso, nkuko bikurikira: pro-kubaho fosifatiidylinositol 4,5-bisphosifate 3-kinase / Akt na ERK1 / 2 byerekana inzira , hamwe na adhesion kinase (FAK).
MSCs yerekanye akamaro kanini murwego rwo gukira ibikomere.Kurugero, imbeba zabuze plasminogene zagaragaje gutinda cyane mubikorwa byo gukiza ibikomere, byerekana ko plasmin igira uruhare runini muriki gikorwa.Mu bantu, gutakaza plasmin birashobora kandi gutera ingorane zo gukira ibikomere.Guhagarika umuvuduko wamaraso birashobora kubuza cyane kuvugurura ingirabuzima fatizo, bisobanura impamvu izi nzira zo kuvugurura bigoye cyane kubarwayi ba diyabete.
5. Monocytes na sisitemu yo kuvugurura
Ukurikije ibitabo, haribiganiro byinshi kubyerekeye uruhare rwa monocytes mugukiza ibikomere.Makrophage ikomoka ahanini ku maraso monocytes kandi igira uruhare runini mu buvuzi bushya [81].Kubera ko neutrophile isohora IL-4, IL-1, IL-6 na TNF- [alpha], utugingo ngengabuzima twinjira mu gikomere nyuma y'amasaha 24-48 nyuma yo gukomereka.Platelets irekura trombine na platelet factor 4 (PF4), chemokine ebyiri ziteza imbere kwinjiza monocytes no gutandukana kwayo muri macrophage na selile dendritic.Ikintu gitangaje cya macrophage ni plastike yabo, ni ukuvuga ubushobozi bwabo bwo guhindura fenotipi no guhinduranya ubundi bwoko bwimikorere nka selile endoteliyale, hanyuma ikagaragaza imikorere itandukanye mugusubiza ibinyabuzima bitandukanye bikomoka kubinyabuzima bikomeretsa ibidukikije.Ingirabuzimafatizo zerekana ibintu bibiri by'ingenzi, M1 cyangwa M2, bitewe n'ibimenyetso bya molekile byaho aribyo soko yo gukangura.M1 macrophage iterwa na mikorobe bityo ikagira ingaruka nyinshi zo gutwika.Ibinyuranye, macrophage ya M2 mubisanzwe itangwa nubwoko bwa 2 kandi ifite imiti igabanya ubukana, ubusanzwe irangwa no kwiyongera kwa IL-4, IL-5, IL-9, na IL-13.Ifite kandi uruhare mu gusana imyenda binyuze mu gutanga ibintu bikura.Guhinduka kuva M1 kugera kuri M2 isoforms ahanini biterwa nicyiciro cya nyuma cyo gukira ibikomere, aho M1 macrophage itera neutrophil apoptose kandi igatangira gukuraho izo selile).Phagocytose na neutrophile ikora urunigi rwibintu aho cytokine yazimye, ikabika macrophage ikarekura TGF-β1.Iki kintu cyo gukura nikintu cyingenzi kigenga itandukaniro rya myofibroblast no kugabanya ibikomere, bituma hakemurwa umuriro no gutangiza icyiciro cyo gukwirakwira muri kasake ikiza [57].Iyindi poroteyine ifitanye isano cyane na selile ni serine (SG).Iyi granulan ya hematopoietic isohora granulan byagaragaye ko ari nkenerwa mu kubika poroteyine zasohotse mu ngirabuzimafatizo zihariye z'umubiri, nka selile ya mast, neutrophile, na lymphocytes T cytotoxic T.Mugihe ingirabuzimafatizo nyinshi zitari hematopoietic nazo zikora serotonine, selile zose zitera umuriro zitanga proteine nyinshi kandi zikabikwa muri granules kugirango zirusheho gukorana nabandi bahuza umuriro, harimo protease, cytokine, chemokine, nimpamvu zikura.Iminyururu itemewe ya glycosaminoglycan (GAG) muri SG isa nkaho ari ingenzi cyane kuri granule homeostasis yibanga, kuko ishobora guhuza no koroshya kubika ibice bya granule byishyurwa cyane muri selile-, proteyine-, na GAG muburyo bwihariye.Ku bijyanye n'uruhare rwabo muri PRP, Woulfe na bagenzi be bagaragaje mbere ko kubura SG bifitanye isano cyane na morphologie yahinduwe;inenge mubintu bya platel 4, beta-thromglobuline, nububiko bwa PDGF muri platine;gukusanya nabi kwa platelet no gusohora muri vitro na trombose muburyo bwa vivo.Abashakashatsi rero banzuye bavuga ko iyi proteoglycan isa nkaho igenzura neza trombose.
Ibicuruzwa bikungahaye kuri platel birashobora kuboneka mugukusanya no kwinjiza amaraso yumuntu ku giti cye, gutandukanya imvange mubice bitandukanye birimo plasma, platine, leukocytes, na leukocytes.Iyo kwibumbira hamwe kwa platel birenze agaciro kibanze, gukura kwamagufwa no koroshya ingirangingo birashobora kwihuta hamwe ningaruka nkeya.Gukoresha ibicuruzwa bya PRP autologique ni biotehnologiya nshya ikomeje kwerekana ibisubizo bitanga umusaruro mukubyutsa no gukira gukomeye kwimvune zitandukanye.Ingaruka zubu buryo bwo kuvura zishobora guterwa no gutanga ibintu byinshi byikura hamwe na poroteyine, kwigana no gushyigikira ibikomere bya physiologique hamwe no gusana ingirangingo.Byongeye kandi, sisitemu ya fibrinolytike biragaragara ko igira ingaruka zikomeye mugusana ingirabuzimafatizo muri rusange.Usibye ubushobozi bwayo bwo guhindura uburyo bwo kwinjiza ingirabuzimafatizo hamwe na selile stem selile, ihindura ibikorwa bya proteolyique ahantu hakira ibikomere ndetse no mugihe cyo kuvugurura ingirabuzimafatizo zirimo amagufwa, karitsiye n'imitsi, bityo rero ni ingenzi mubice bigize imiti ya musculoskeletal.
Kwihutisha gukira nintego ishakishwa cyane ninzobere nyinshi mubuvuzi, kandi PRP igereranya igikoresho cyiza cyibinyabuzima gikomeje gutanga iterambere ryiza mubyutsa no guhuza neza ibintu bishya.Nyamara, nkuko iki gikoresho cyo kuvura gikomeza kuba ingorabahizi, cyane cyane ko gisohora ibintu byinshi bitagira bioaktike hamwe nuburyo butandukanye bwimikoranire hamwe ningaruka zerekana ibimenyetso, birakenewe ubundi bushakashatsi.
Ibiri muri iyi ngingo byongeye gusubirwamo, kandi ntidutanga ingwate iyo ari yo yose cyangwa yerekana ko ari ukuri, kwiringirwa cyangwa kuzuza ibikubiye muri iyi ngingo, kandi ntabwo dushinzwe ibitekerezo by'iyi ngingo, nyamuneka ubyumve.）
Igihe cyoherejwe: Nyakanga-19-2022