Uruhare rwa platine mu kwifuza amagufwa
PRP na bone marrow aspiration concentrate (BMAC) irakoreshwa muburyo butandukanye bwo kuvura kwa muganga mubiro byo mu biro no kubaga kubera inyungu zabo zisubirana muri MSK n'indwara z'umugongo, gucunga ububabare budakira no kwerekana ibimenyetso byoroshye.PRP ntabwo igenga gusa kwimuka kwakagari no gukwirakwira kwingirabuzimafatizo, ahubwo inagira uruhare muri angiogenezi na ECM kuvugurura kugirango habeho ibidukikije byiza kandi bitezimbere gusana no kuvugurura.
Igikorwa cyo gusana BMAC
BMACs ni selile itandukanye igizwe na BMMSCs, bigatuma iba isoko ya endogenous selile yo kuvura imiti mishya.Bagira uruhare mukugabanya apoptose selile, fibrosis no gutwika;Kandi kora reaction ya cascade iganisha ku gukwirakwiza selile.Byongeye kandi, BMMSCs ifite ubushobozi bwo gutandukanya imirongo itandukanye ya selile, harimo osteoblasts, adipocytes, myoblasts, epithelial selile na neuron.Bateza imbere kandi angiogenez binyuze muri paracrine na autocrine inzira.Ni ngombwa kandi ko BMMSC igira uruhare mu kugenga ubudahangarwa butagengwa na selile yihariye y’umubiri, igira uruhare mu gutwika ibikomere.Byongeye kandi, BMMSCs ishyigikira iyinjizwa rya selile ahantu hashya bivura angiogenezi kugirango byihute kwiyubaka kwamaraso.Jin n'abandi.Byaragaragaye ko mugihe hatabayeho scafolds ihagije, igipimo cyo kubaho cya BMMSC nubushobozi bwo kuyisana no gutandukanya guteza imbere gukira byangiritse.Nubwo gukusanya ibice, gutegura ingero hamwe nuburyo bwibikorwa bya PRP na BMAC bitandukanye, ubushakashatsi bwerekana ko bushobora kuzuzanya.Mubyukuri, guhuza PRP na BMAC mubicuruzwa byibinyabuzima bishobora kugira inyungu zinyongera.
Guhuza PRP na BMAC
Nk’ubushakashatsi bumwe butazwi, ihame shingiro ryo guhuza PRP na BMAC rishingiye ku nyubako nyinshi.Ubwa mbere, PRP irashobora gutanga microen ibidukikije ikwiye aho BMSC ishobora kongera ikwirakwizwa ryimikorere no gutandukanya no kongera angiogenez.Icya kabiri, PRP yakoreshejwe nka scafold kuri selile hamwe na BMAC.Ibinyuranye, guhuza PRP na BMAC birashobora kuba igikoresho gikomeye cyibinyabuzima gikurura abaturage ba BMMSC.Uruganda rwa PRP-BMAC rwakoreshejwe mu kuvura tendinose, ibikomere, ibikomere by'umugongo, disiki ya degenerative intervertebral hamwe nudusembwa twa osteochondral dufite imbaraga nyinshi zo kuvugurura.Kubwamahirwe, nubwo ibice bigize selile selile igizwe na platine, raporo nkeya zivuga ubunini bwa platine mumitsi yakuwe hamwe na BMAC nyuma yo kuvurwa, ariko birashobora gukurwa muburyo bukwiye bwo kwifuza.Ubundi bushakashatsi burakenewe kugirango wumve niba insimburangingo ya platine ikeneye gukoreshwa hamwe na BMAC.Kugeza ubu, nta makuru yerekana igipimo cyiza cya platine na selile ya MSC (cyangwa izindi selile zo mu magufa), bigira ingaruka nziza muburyo bwimirire ya MSC mugusana ingirangingo.Byiza cyane, ibikoresho byo gukusanya amagufwa hamwe nikoranabuhanga birashobora gutezimbere kugirango bikuremo amagufwa ahagije.
PRP ikura ningaruka zimirire ya BMAC
Gukura kwa PRP platelet ni proteine yingenzi igira uruhare mubikorwa byo gusana BMAC.Ubwinshi bwa PGF nizindi cytokine zigira uruhare mubikorwa byimirire ya BMAC zirashobora gutangiza gusana ingirabuzimafatizo zigabanya apoptose selile, anabolisme ningaruka zo kurwanya inflammatory, no gukora ikwirakwizwa ryingirabuzimafatizo, gutandukanya na angiogenezi binyuze mumihanda ya paracrine na autocrine.
Iterambere rikomoka kuri platel hamwe nibice byinshi bya granule bigaragara ko bigira uruhare mubikorwa byimirire ya BMAC kandi bigashyigikira gusana no kuvugurura ingirabuzimafatizo byatewe na MSC.Amagambo ahinnye: MSC: mesenchymal stem selile, HSC: hematopoietic stem selile.
Ikigaragara ni uko mu kuvura OA, PDGF igira uruhare runini mu kuvugurura karitsiye no kubungabunga homeostasis binyuze mu gukwirakwiza MSC no kubuza IL-1 iterwa na chondrocyte apoptose no gutwika.Byongeye kandi, TGF- β Ubwoko butatu bugira uruhare mu gukurura karitsiye no kubuza gucana, kandi byerekana ubushobozi bwo guteza imbere ingirabuzima fatizo zifitanye isano na MSC binyuze mu mikoranire hagati y’imitsi.Ingaruka yimirire ya MSC ifitanye isano nibikorwa bya PGF hamwe no gusohora cytokine.Byaba byiza, iyi cytokine yose igomba kuba iri mumacupa yo kuvura BMAC hanyuma ikajyanwa ahakomeretse ingirangingo kugirango habeho gukira neza kwa MSC kuvura indwara.
Mu bushakashatsi bwakozwe na OA, Mui ñ os-L ó pez n'abandi.Irerekana ko MSC ikomoka kumubiri wa synovial yahinduye imikorere, bikaviramo gutakaza ubushobozi bwayo bwo gukira.Igishimishije, gutera PRP mu magufwa yo mu bwoko bwa osteoarthritis byatumye MSC igabanuka mu mazi ya synovial, byerekana ko ivuriro ryateye imbere.Ingaruka zo kuvura zahujwe no kugabanya uburyo bwo gutwika mumazi ya synovial fluid abarwayi ba OA.
Hano hari amakuru make ahari kubijyanye na PGF muri BMAC cyangwa igipimo cyiza gisabwa kugirango dushyigikire imikorere yimirire ya BMMSC.Bamwe mu bavuzi bahuza cyane PRP hamwe na BMAC kugirango babone ibihangano bikora biologiya, bikaba byitezwe ko bizahindura ibisubizo byubuvuzi bushya.Nyamara, hari amakuru make yumutekano no gukora neza, byerekana ko guhuza PRP yibanze hamwe na BMAC aribwo buryo bwiza bwo kuvura.Kubwibyo, twizera ko bidashoboka gukoresha BMMSC mugukoresha hamwe na platine yibanze kuri iki cyiciro.
Imikoranire ya platine hamwe nibiyobyabwenge bya antiplatelet na NSAIDs
PRP ikubiyemo ibintu byinshi bigize ibanga kandi bigizwe nibitangazamakuru byinshi biologiya.Ingaruka zo kuvura PRP yitirirwa aba bahuza.Nubwo abunzi bavura muri platine bazwi cyane, uburyo bwiza bwo gukora hamwe na kinetics yiyi miti ya anabolike na catabolike ntabwo isobanutse neza.Imwe mu mbogamizi nyamukuru zogushikira uburyo bwo kuvura ni ugutsinda itandukaniro ryaba bahuza ibinyabuzima hagamijwe kurwanya ingaruka zagenzuwe neza zihora zisubirwamo kandi zikagira akamaro mubuvuzi.Kubera iyo mpamvu, ibiyobyabwenge (nk'imiti itari steroidal anti-inflammatory (NSAIDs)) bishobora kugira ingaruka ku irekurwa ry’amatsinda y’ibanga rya platine.Mu bushakashatsi buherutse gufungura-label ikurikirana-ikurikiranye, gufata buri munsi mg 81 za aspirine (ASA) byagabanije imvugo y'abunzi b'ingenzi, nka TGF- β 1. PDGF na VEGF.
Izi ngaruka ziterwa no kubuza bidasubirwaho cyclooxygenase-1 (COX-1) hamwe no kubuza guhinduranya cyclooxygenase-2 (COX-2), iyo ikaba ari enzymes ebyiri zisabwa kugirango umuntu yandurwe na platine.Ubushakashatsi buherutse gukorwa bwerekanye ko imiti igabanya ubukana ishobora kugabanya imikurire yo gukura mu buryo bwa COX-1 na COX-2, kandi 8 kuri 15 y’ubushakashatsi 15 yasanze ibintu bikura byagabanutse.
Ibiyobyabwenge (urugero NSAIDs) bikoreshwa mugukuraho ububabare no kugabanya uburibwe buterwa n'indwara ya MSK.Uburyo bwa NSAIDs ni ukubuza gukora platelet muguhuza bidasubirwaho na enzyme ya COX no kugenzura inzira ya acide arachidonic.Kubwibyo, imikorere ya platine izahinduka mugihe cyubuzima bwose bwa platine, bityo birinde ibimenyetso bya PGF.NSAIDs ibuza umusaruro wa cytokine (urugero, PDGF, FGF, VEGF, na IL-1 β ， IL-6, na IL-8), mugihe uzamura TNF- α。 Icyakora, hari amakuru make ku ngaruka za molekile ziterwa na NSAIDs kuri PRP.Nta bwumvikane ku gihe cyiza cyo gutegura no kuyobora PRP ku barwayi bakoresha NSAIDs.Mannava na bagenzi be bagereranije ibintu biologiya ya anabolike na catabolike muri PRP ikungahaye kuri leucocyte PRP y'abakorerabushake bazima bafata naproxen.Basanze nyuma yo gukoresha naproxen icyumweru kimwe, urwego rwa PDGF-AA na PDGF-AB (mitogen nziza yo guteza imbere angiogenez) yagabanutse cyane.Nyuma yicyumweru kimwe, urwego rwibintu byakuze rwagarutse hafi yurwego rwibanze.Nyuma yo gukoresha naproxen icyumweru kimwe, urwego LR-PRP rwa proinflammatory na catabolique IL-6 narwo rwaragabanutse, hanyuma rusubira kurwego rwibanze nyuma yicyumweru kimwe.Kugeza ubu, nta bushakashatsi bw’ubuvuzi bwerekana ko abarwayi bafite naproxen nyuma yo kuvurwa PRP bafite ingaruka mbi;Ariko, birasabwa gusuzuma igihe cyo gukaraba icyumweru kimwe kugirango ugarure indangagaciro za PDGF-AA, PDGF-BB na IL-6 kurwego rwibanze kugirango tunoze ibikorwa byibinyabuzima.Ubushakashatsi burakenewe cyane kugirango wumve neza ingaruka za antiplatelet na NSAID kumatsinda ya PRP isohora hamwe nintego zayo zo hasi.
Huza ikoreshwa rya plasma ikungahaye kuri plasma hamwe no gusubiza mu buzima busanzwe
Nubwo ubushakashatsi bwibanze bwa siyansi bwerekana ko ubuvuzi bwumubiri nuburemere bwimashini bifite uruhare rugaragara mugusubirana imiterere ya tendon nyuma yo guterwa PRP, nta bwumvikane kuri gahunda nziza yo gusubiza mu buzima busanzwe indwara ya MSK nyuma yo kuvurwa PRP.
Ubuvuzi bwa PRP burimo gutera inshinge za platine yibanze mubidukikije kugirango bigabanye ububabare no guteza imbere gusana ingirangingo.Ibimenyetso bikomeye byamavuriro bibaho mumavi OA.Ariko, gukoresha PRP mukuvura tendinose yibimenyetso ntibivugwaho rumwe, kandi ibisubizo byatangajwe biratandukanye.Ubushakashatsi bwibikoko mubisanzwe byerekana iterambere ryamateka ya tendinose nyuma yo kwinjira muri PRP.Ubu bushakashatsi bwerekana ko umutwaro wubukanishi ushobora kubyara imitsi, kandi umutwaro hamwe ninshinge za PRP bikorana kugirango biteze imbere gukira.Itandukaniro mu myiteguro ya PRP, imyiteguro y’ibinyabuzima, imyiteguro, gahunda yo gutera inshinge hamwe nubwoko bwimvune ya tendon bishobora gutera itandukaniro mubisubizo byubuvuzi.Byongeye kandi, nubwo ibimenyetso bya siyansi bishyigikira inyungu za gahunda yo gusubiza mu buzima busanzwe, iperereza ryakozwe ku mavuriro ryagerageje gucunga no guhuza gahunda zihamye zo gusubiza mu buzima busanzwe nyuma ya PRP.
Vuba aha, Onishi n'abandi.Uruhare rwumutwaro wimashini ningaruka za biologiya PRP mu ndwara ya Achilles tendon rwasuzumwe.Basuzumye icyiciro cya mbere n’icyiciro cya II cy’ubuvuzi bw’indwara ya Achilles tendon ivurwa na PRP, bibanda kuri gahunda yo gusubiza mu buzima busanzwe nyuma yo guterwa PRP.Gahunda igenzurwa na gahunda yo gusubiza mu buzima busanzwe isa naho itezimbere kubahiriza imyitozo no kunoza ibisubizo nubushobozi bwo gukurikirana igipimo cyimyitozo ngororamubiri.Ibigeragezo byinshi byateguwe neza Achilles tendon PRP igerageza kuvura nyuma ya PRP hamwe na gahunda yo gusubiza mu buzima busanzwe imashini nkibice bigize ingamba zo kuvugurura.
Icyerekezo cy'ejo hazaza n'imyanzuro
Iterambere rya tekiniki ryibikoresho bya PRP nuburyo bwo gutegura byerekana ibisubizo by’abarwayi bitanga umusaruro, nubwo ibisobanuro by’ibinyabuzima bitandukanye bya PRP nibiranga biologiya bijyanye nibicuruzwa byanyuma bitarangizwa.Mubyongeyeho, ubushobozi bwuzuye bwerekana PRP nibisabwa ntabwo byamenyekanye.Kugeza vuba aha, PRP yagurishijwe mubucuruzi nkigicuruzwa gikomoka ku maraso gikomoka ku maraso, gishobora guha abaganga ubushobozi bwo gukoresha tekinoroji yo gukura ya autologique ya platologiya mu buryo bwihariye bw’indwara n’indwara.Ubwa mbere, igipimo cyonyine cyo gukoresha neza PRP ikunze kuvugwa ni icyitegererezo cyateguwe, icyerekezo cya platine kiri hejuru yagaciro kamaraso yose.Uyu munsi, kubwamahirwe, abimenyereza basobanukiwe neza imikorere ya PRP.
Muri iri suzuma, twemera ko hakiri ikibazo cyo kutagira ubuziranenge no gushyira mu byiciro tekinoloji yo gutegura;Kubwibyo, nta bwumvikane ku miterere y’ibinyabuzima ya PRP muri iki gihe, nubwo ubuvanganzo bwinshi bwumvikanye ku buryo bwiza bwo gukwirakwiza ibipimo bya platine bisabwa kugira ngo biteze imbere (bishya).Hano, twatangije muri make ibikorwa bya PGFs, ariko cyane cyane twagaragaje uburyo bwihariye bwa platine n'ingaruka za selile yamaraso yera na MSCs, ndetse nubusabane bwakurikiyeho.By'umwihariko, kuba selile yamaraso yera mumyiteguro ya PRP itanga gusobanukirwa byimbitse ingaruka mbi cyangwa nziza.Uruhare rugaragara rwa platine n'imikoranire yabyo hamwe na sisitemu yo kwirinda indwara.Byongeye kandi, hakenewe ubushakashatsi buhagije kandi bwanditse neza kugirango hamenyekane ingaruka zose hamwe nubuvuzi bwa PRP mubimenyetso bitandukanye.
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: Werurwe-01-2023