Amavi y'ibanze osteoarthritis (OA) akomeje kuba indwara idashobora gucungwa.Hamwe no kwiyongera kuramba hamwe nicyorezo cy'umubyibuho ukabije, OA itera umutwaro wiyongera mubukungu numubiri.Amavi OA nindwara idakira yimitsi ishobora gukenera kubagwa.Kubwibyo, abarwayi bakomeje gushakisha uburyo bushobora kuvurwa butari kubagwa, nko gutera plasma ikungahaye kuri platine (PRP) mu ivi ryanduye.
Ku bwa Jayaram n'abandi, PRP ni imiti igaragara kuri OA.Nyamara, ibimenyetso byamavuriro byerekana ko bikora neza biracyabura, kandi uburyo bwibikorwa ntibizwi.Nubwo ibisubizo bitanga icyizere byatangajwe kubyerekeye ikoreshwa rya PRP mu ivi OA, ibibazo byingenzi nkibimenyetso simusiga bijyanye ningaruka zabyo, dosiye zisanzwe, hamwe nubuhanga bwiza bwo gutegura ntiburamenyekana.
Bivugwa ko Knee OA yibasira abantu barenga 10% ku isi yose, bafite ibyago byo kubaho 45%.Amabwiriza yiki gihe arasaba ubuvuzi budasanzwe (urugero, imyitozo ngororamubiri) hamwe nubuvuzi bwa farumasi, nkimiti yo mu kanwa idafite imiti igabanya ubukana (NSAIDs).Nyamara, ubwo buvuzi busanzwe bufite inyungu zigihe gito gusa.Byongeye kandi, gukoresha ibiyobyabwenge ku barwayi bafite ibibazo ni bike kubera ibyago byo guhura n'ingaruka.
Indwara ya corticosteroide yimbere ikoreshwa muburyo bwo kugabanya ububabare bwigihe gito kuko inyungu zayo zigarukira kumyumweru mike, kandi inshinge nyinshi byagaragaye ko bifitanye isano no gutakaza karitsiye.Bamwe mu banditsi bavuga ko gukoresha aside hyaluronike (HA) bitavugwaho rumwe.Ariko, abandi banditsi bavuze ko ububabare bwatewe nyuma yo guterwa inshuro 3 kugeza kuri 5 buri cyumweru HA mu byumweru 5 kugeza 13 (rimwe na rimwe bigera ku mwaka 1).
Iyo ubundi buryo bwavuzwe haruguru bwananiranye, arthroplasty yuzuye ivi (TKA) irasabwa kenshi nkumuti mwiza.Ariko, birazimvye kandi birashobora kuba bikubiyemo ingaruka mbi zubuvuzi na nyuma yibikorwa.Kubwibyo, ni ngombwa kumenya ubundi buryo bwizewe kandi bwiza bwo kuvura ivi OA.
Ubuvuzi bwibinyabuzima nka PRP, buherutse gukorwaho iperereza kugirango bivure ivi OA.PRP nigicuruzwa cyamaraso autologique hamwe na platine nyinshi.Imikorere ya PRP ikekwa kuba ifitanye isano no kurekura ibintu bikura hamwe nizindi molekile, harimo niterambere ryikura rya platine (PDGF), guhindura ibintu bikura (TGF) -beta, insuline imeze nkubwoko bwa I (IGF-I) , hamwe no gukura kw'imitsi ya endoteliyale (VEGF).
Ibitabo byinshi byerekana ko PRP ishobora gutanga ikizere cyo kuvura ivi OA.Nyamara, benshi ntibavuga rumwe kuburyo bwiza, kandi hariho imbogamizi nyinshi zigabanya isesengura ryiza ryibisubizo byabo, hashobora kubaho kubogama.Itandukaniro ryuburyo bwo gutegura no gutera inshinge zikoreshwa mubushakashatsi bwatangajwe ni imbogamizi mugusobanura sisitemu nziza ya PRP.Byongeye kandi, ibigeragezo byinshi byakoreshaga HA nkugereranya, bitavugwaho rumwe ubwabyo.Ibigeragezo bimwe byagereranije PRP na placebo kandi byagaragaje neza ibimenyetso byiza kuruta saline mumezi 6 na 12.Nyamara, ibigeragezo bifite inenge zuburyo butandukanye, harimo no kutabona neza, byerekana ko inyungu zabo zishobora kugereranywa.
Ibyiza bya PRP mukuvura ivi OA nibi bikurikira: biroroshye rwose gukoresha kubera kwitegura byihuse no gutera bike;ni tekinike ihendutse cyane bitewe no gukoresha inzego za serivisi zubuzima rusange zihari;kandi birashoboka ko ari umutekano, kuko nibicuruzwa byikora.Ibisohokayandikiro byabanje byatangaje gusa ingorane zoroheje nigihe gito.
Intego yiyi ngingo ni ugusubiramo uburyo bwimikorere ya molekulire yimikorere ya PRP hamwe ningaruka zingirakamaro zo gutera inshinge zo mu nda zatewe na PRP ku barwayi bafite ivi OA.
Uburyo bwa molekulari yibikorwa bya plasma ikungahaye kuri plasma
Isomero rya Cochrane na PubMed (MEDLINE) gushakisha ubushakashatsi bujyanye na PRI mu ivi OA byasesenguwe.Igihe cyo gushakisha ni kuva moteri yubushakashatsi yatangira kugeza 15 Ukuboza 2021. Gusa ubushakashatsi bwa PRP mumavi OA abanditsi babonaga ko bushimishije cyane harimo.PubMed yasanze ingingo 454, muri zo 80 zatoranijwe.Ingingo yabonetse mu isomero rya Cochrane, naryo ryerekanwe, hamwe hamwe 80.
Ubushakashatsi bwasohotse mu 2011 bwerekanye ko gukoresha ibintu bikura (abanyamuryango ba TGF-β birenze urugero, umuryango wa fibroblast ukura, IGF-I na PDGF) mu micungire ya OA bigaragara ko bitanga icyizere.
Muri 2014, Sandman n'abandi.yatangaje ko kuvura PRP kuvura ingirangingo za OA byatumye igabanuka rya catabolism;icyakora, PRP yatumye igabanuka rikomeye rya matrix metalloproteinase 13, kwiyongera kwa synthase ya hyaluronan 2 muri selile synovial, no kwiyongera mubikorwa bya synthesis ya karitsiye.Ibyavuye muri ubu bushakashatsi byerekana ko PRP itera umusaruro wa HA endogenous HA kandi igabanya catabolisme ya karitsiye.PRP yabujije kandi kwibanda ku bunzi batera umuriro no kwerekana imiterere ya gene muri synovial na chondrocytes.
Muri 2015, ubushakashatsi bwakorewe muri laboratoire bwerekanye ko PRP yashishikarije cyane ikwirakwizwa ry'uturemangingo no gusohora poroteyine zo hejuru mu ivi ry'abantu no mu ngirabuzimafatizo.Izi nyigisho zifasha gusobanura uburyo bwibinyabuzima bujyanye nibikorwa bya PRP mukuvura ivi OA.
Muri modine ya murine ya OA (igenzurwa na laboratoire) yatangajwe na Khatab n'abandi.Muri 2018, inshinge nyinshi za PRP zirekura zagabanije ububabare nubunini bwa synovial, birashoboka ko byahujwe na macrophage subtypes.Rero, izo nshinge zisa nkigabanya ububabare nubushuhe bwa synovial, kandi birashobora kubuza iterambere rya OA kubarwayi bafite OA yo hambere.
Muri 2018, isubiramo ryibitabo byububiko bwa PubMed byanzuye ko PRP ivura OA isa nkaho igira ingaruka ku nzira ya Wnt / β-catenin, ishobora kuba ingenzi mu kugera ku ngaruka zayo z’amavuriro.
Muri 2019, Liu n'abandi.yakoze iperereza kuri molekuline ikoreshwa na PRP ikomoka kuri exosomes igira uruhare mukugabanya OA.Ni ngombwa kwerekana ko exosomes igira uruhare runini mu itumanaho hagati.Muri ubu bushakashatsi, chondrocytes y'urukwavu rwibanze rwarahawe akato kandi ruvurwa na interleukin (IL) -1β kugirango hashyizweho urugero rwa vitro ya OA.Gukwirakwiza, kwimuka, hamwe na apoptose byapimwe kandi bigereranywa hagati ya PRP ikomoka kuri PRP hamwe na PRP ikora kugirango isuzume ingaruka zo kuvura kuri OA.Inzira zagize uruhare muri Wnt / β-catenin yerekana inzira yakozwe nisesengura ryiburengerazuba.Exosomes ikomoka kuri PRP wasangaga ifite ingaruka zisa cyangwa nziza zo kuvura kuri OA kuruta PRP ikora muri vitro no muri vivo.
Muburyo bwimbeba ya posttraumatic OA yavuzwe muri 2020, Jayaram nabandi.tekereza ko ingaruka za PRP ku iterambere rya OA hamwe na hyperalgesia iterwa n'indwara zishobora guterwa na leukocyte.Bavuze kandi ko PRP (LP-PRP) ikennye na leukocyte ikennye na PRP (LR-PRP) ikungahaye kuri leukocyte ikumira ubwinshi no gutakaza ubuso.
Ibyavuye mu bushakashatsi byatangajwe na Yang n'abandi.Ubushakashatsi bwakozwe mu 2021 bwerekanye ko PRP byibuze yongereye igice cya IL-1β iterwa na chondrocyte apoptose no gutwikwa hirindwa hypoxia-inducable factor 2α.
Muburyo bwimbeba ya OA ukoresheje PRP, Izuba nibindi.microRNA-337 na microRNA-375 wasangaga bidindiza iterambere rya OA bigira ingaruka kumuriro na apoptose.
Nk’uko Sheean n'abandi babivuga, ibikorwa by’ibinyabuzima bya PRP bifite impande nyinshi: platine alpha granules itera irekurwa ry’ibintu bitandukanye bikura, harimo VEGF na TGF-beta, kandi gutwika bigengwa no guhagarika ibintu bya kirimbuzi-κB inzira
Hakozwe ubushakashatsi ku bintu bisetsa muri PRP byateguwe kuva ku bikoresho byombi ndetse n'ingaruka ziterwa no gusetsa kuri macrophage phenotype.Basanze itandukaniro mubice bigize selile hamwe nibitekerezo byurwenya hagati ya PRP yeza ikoresheje ibikoresho bibiri.Autologous protein solution LR-PRP kit ifite ubunini bwinshi bwa M1 na M2 macrophage.Kwiyongera kwa PRP ndengakamere mumico ya macrophage ikomoka kuri monocyte na macrophage M1 yerekanaga ko PRP yabujije M1 macrophage polarisation kandi iteza imbere M2 macrophage polarisation.
Muri 2021, Szwedowski n'abandi.Impamvu zo gukura zasohotse mu mavi ya OA nyuma yo guterwa PRP zasobanuwe: ibintu bya kanseri ya niyose (TNF), IGF-1, TGF, VEGF, gutandukana, hamwe na metalloproteinase hamwe na moteri ya trombospondine, interleukins, matrix metalloproteinase, ibintu bikura byindwara ya hepatocyte, fibroblast ibintu byo gukura, keratinocyte yo gukura nibintu bya platel 4.
1. PDGF
PDGF yavumbuwe bwa mbere muri platine.Nibirwanya ubushyuhe, birwanya aside, polypeptide ya cationic byoroshye hydrolyz na trypsin.Nibimwe mubintu byambere bikura bigaragara kurubuga rwacitse.Igaragarira cyane mu mitsi yo mu magufwa, itera osteoblasts chemotactique kandi ikagwira, ikongerera ubushobozi bwa synthesis ya kolagen, kandi igatera kwinjiza osteoclasts, bityo bigatuma amagufwa akora.Byongeye kandi, PDGF irashobora kandi guteza imbere ikwirakwizwa no gutandukanya fibroblast no guteza imbere ingirabuzimafatizo.
2. TGF-B
TGF-B ni polypeptide igizwe n'iminyururu 2, ikora kuri fibroblast na pre-osteoblasts muburyo bwa paracrine na / cyangwa autocrine, itera ikwirakwizwa rya osteoblasts na pre-osteoblasts hamwe na synthesis ya fibre ya kolagen, nka chemokine, osteoprogenitor ingirabuzimafatizo zinjira mu ngingo zamagufwa yakomeretse, kandi gukora no kwinjiza osteoclasts birabujijwe.TGF-B igenga kandi synthesis ya ECM (matrice idasanzwe), igira ingaruka za chimotactique kuri neutrophile na monocytes, ikanahuza ibisubizo byumuriro.
3. VEGF
VEGF ni glycoproteine ya dimeric, ihuza reseptors hejuru ya selile endoteliyale yimitsi ikoresheje autocrine cyangwa paracrine, igatera ikwirakwizwa ry'uturemangingo twa endoteliyale, itera gushiraho no gushiraho imiyoboro mishya y'amaraso, itanga ogisijeni kugeza kumeneka, igatanga intungamubiri, kandi ikanatwara imyanda ya metabolike. ., gutanga microen ibidukikije nziza ya metabolism mugace kavugurura amagufwa.Noneho, mugikorwa cya VEGF, ibikorwa bya alkaline fosifata yo gutandukanya osteoblast byongerewe imbaraga, kandi umunyu wa calcium waho urabikwa kugirango uteze imbere kuvunika.Byongeye kandi, VEGF iteza imbere gusana ingirangingo zoroheje mu kunoza itangwa ryamaraso yumubiri woroshye ukikije kuvunika, kandi bigatera gukira kuvunika, kandi bigira ingaruka zo kuzamura hamwe na PDGF.
4. EGF
EGF ni igabana rikomeye ritera imbaraga zo gutera amacakubiri no gukwirakwizwa kwubwoko butandukanye bwingirabuzimafatizo mu mubiri, mugihe biteza imbere synthesis ya matrix no kubitsa, bigatera imiterere ya fibrous tissue, kandi bigakomeza guhinduka amagufwa kugirango bisimbuze imitsi yamagufwa.Ikindi kintu EGF igira uruhare mu gusana kuvunika ni uko ishobora gukora fosifolipase A, bityo igateza imbere irekurwa rya aside arachidonic iva mu ngirabuzimafatizo ya epiteliyale, ikanateza imbere synthesis ya prostaglandine igenga ibikorwa bya cyclooxygenase na lipoxygenase.Uruhare rwa resorption hanyuma nyuma yo gukora amagufwa.Birashobora kugaragara ko EGF igira uruhare mugukiza kuvunika kandi irashobora kwihutisha gukira kuvunika.Byongeye kandi, EGF irashobora guteza imbere ikwirakwizwa rya selile epidermal selile na endothelia selile, kandi igatera selile endoteliyale kwimukira hejuru y igikomere.
5. IGF
IGF-1 ni polypeptide yumunyururu umwe ihuza reseptors mu magufa kandi igakora protease ya tirozine nyuma ya reseptor autophosphorylation, iteza fosifora ya insuline ya insuline, bityo bikagenga imikurire ya selile, ikwirakwizwa na metabolism.Irashobora gukangura Osteoblasts na pre-osteoblasts, igatera karitsiye hamwe na matrix.Byongeye kandi, igira uruhare runini muguhuza kuvugurura amagufwa muguhuza itandukaniro no gushiraho osteoblasts na osteoclasts nibikorwa byabo.Mubyongeyeho, IGF nayo nikimwe mubintu byingenzi mugusana ibikomere.Nibintu biteza imbere kwinjiza fibroblast mumuzunguruko kandi bigatera itandukaniro hamwe na synthesis ya fibroblast.
PRP ni autologique yibanda kuri platine nibintu bikura bikomoka kumaraso ya centrifuged.Hariho ubundi bwoko bubiri bwibibumbano bya platine: fibrine ikungahaye kuri platine hamwe niterambere rya plasma.PRP irashobora kuboneka gusa mumaraso y'amazi;ntibishoboka kubona PRP muri serumu cyangwa maraso yuzuye.
Hariho uburyo butandukanye bwubucuruzi bwo gukusanya amaraso no kubona PRP.Itandukaniro hagati yabo ririmo ubwinshi bwamaraso agomba gukurwa kumurwayi;tekinike yo kwigunga;umuvuduko wa centrifugation;umubare wo kwibanda ku majwi nyuma ya centrifugation;igihe cyo gutunganya;
Uburyo butandukanye bwamaraso centrifugation bwagiye bugira ingaruka kumibare ya leukocyte.Umubare wa platel muri 1 μL yamaraso yabantu bafite ubuzima bwiza uri hagati ya 150.000 na 300.000.Amashanyarazi ashinzwe guhagarika kuva amaraso.
Alpha granules ya platine irimo ubwoko butandukanye bwa poroteyine nkibintu bikura (urugero: guhindura ibintu bikura beta, insuline imeze nkikura, icyorezo cya epidermal), chemokine, coagulants, anticoagulants, proteine fibrinolytique, proteine adhesion, proteine integral membrane, mediators mediates , ibintu bya angiogenic na inhibitor, hamwe na proteyine za bagiteri.
Uburyo nyabwo bwibikorwa bya PRP ntiburamenyekana.PRP isa nkaho itera chondrocytes kugirango ivugurure karitsiye hamwe na biosynthesis ya kolagen na proteoglycans.Yakoreshejwe mubuvuzi butandukanye nko kubaga umunwa na maxillofacial kubaga (harimo na OA by'agateganyo), dermatology, ophthalmology, cardiothoracic kubaga no kubaga plastique.
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 cyo kohereza: Nyakanga-27-2022