Bohloko ba Neuropathic bo bolela ts'ebetso e sa tloaelehang ea kutlo, kutlo ea bohloko le bohloko bo itlelang feela bo bakoang ke kotsi kapa lefu la tsamaiso ea methapo ea kutlo ea somatic.Boholo ba bona bo ntse bo ka tsamaea le bohloko bo sebakeng se ts'oanang le sa innervated ka mor'a hore ho felisoe lintlha tsa kotsi, tse bonahalang e le bohloko bo itlelang feela, hyperalgesia, hyperalgesia le maikutlo a sa tloaelehang.Hajoale, meriana ea ho kokobetsa bohloko ba neuropathic e kenyelletsa tricyclic antidepressants, 5-hydroxytryptamine norepinephrine reuptake inhibitors, anticonvulsants gabapentin le pregabalin, le opioids.Leha ho le joalo, phello ea phekolo ea lithethefatsi hangata e lekanyelitsoe, e hlokang mekhoa ea phekolo ea mefuta e mengata e kang phekolo ea 'mele, tsamaiso ea methapo ea kutlo le ho kenella ha ho buuoa.Bohloko bo sa foleng le ho fokotsa ts'ebetso ho tla fokotsa ho kenya letsoho sechabeng sa bakuli le ho baka moroalo o tebileng oa kelello le moruo ho bakuli.
Platelet rich plasma (PRP) ke sehlahisoa sa plasma se nang le liplatelete tse phahameng tsa bohloeki tse fumanoang ke centrifuging autologous blood.Ka 1954, KINGSLEY o ile a qala ho sebelisa lentsoe la bongaka PRP.Ka lipatlisiso le nts'etsopele lilemong tsa morao tjena, PRP e 'nile ea sebelisoa haholo ho buuoa ka masapo le manonyeletso, ho buuoa ka mokokotlo, dermatology, tsosoloso le mafapha a mang,' me e phetha karolo ea bohlokoa tšimong ea ho lokisa boenjiniere ba lisele.
Molao-motheo oa motheo oa phekolo ea PRP ke ho kenya liplatelete tse tsepamisitsoeng sebakeng se lemetseng le ho qala ho lokisoa ha lisele ka ho lokolla mefuta e sa tšoaneng ea lintho tse phelang (lintho tse hōlang, li-cytokine, li-lysosomes) le liprotheine tsa ho khomarela.Lintho tsena tsa bioactive li ikarabella bakeng sa ho qala karabelo ea hemostatic cascade, motsoako oa lisele tse ncha tse hokahantsoeng le kaho e ncha ea methapo.
Tlhaloso le pathogenesis ea bohloko ba neuropathic Mokhatlo oa Lefatše oa Bophelo o ile oa lokolla phetolelo e ntlafalitsoeng ea 11 ea International Classification of Pain ka 2018, e arola bohloko ba neuropathic ho bohloko bo bohareng ba neuropathic le bohloko ba peripheral neuropathic.
Peripheral neuropathic pain e arotsoe ho latela etiology:
1) Tšoaetso / ho ruruha: neuralgia ea postherpetic, lepera le bohloko, syphilis / HIV peripheral neuropathy
2) Khatello ea methapo: lefu la carpal tunnel syndrome, bohloko ba mokokotlo oa mokokotlo oa mokokotlo
3) Tlhekefetso: ho tsieleha / ho chesa / ka mor'a ho sebetsa / post radiotherapy bohloko ba neuropathic
4) Ischemia / metabolism: lefu la tsoekere peripheral neuropathic bohloko
5) Lithethefatsi: peripheral neuropathy e bakoang ke lithethefatsi (tse kang chemotherapy)
6) Tse ling: bohloko ba mofets'e, trigeminal neuralgia, glossopharyngeal neuralgia, Morton's neuroma.
Mekhoa ea ho hlophisa le ho lokisa ea PRP ka kakaretso e lumela hore palo ea liplatelete ho PRP e mena ka makhetlo a mane kapa a mahlano ho feta mali kaofela, empa ho bile le khaello ea matšoao a bongata.Ka 2001, Marx e hlalositse hore PRP e na le bonyane liplatelete tse limilione tse 1 ka microliter ea plasma, e leng pontšo ea palo ea tekanyo ea PRP.Dohan et al.PRP e arotsoe ka mekhahlelo e mene: PRP e hloekileng, leukocyte rich PRP, pure platelet rich fibrin, le leukocyte rich platelet fibrin e thehiloeng ho litaba tse fapaneng tsa platelet, leukocyte le fibrin ho PRP.Ntle le ha ho boletsoe ka tsela e 'ngoe, PRP hangata e bua ka white cell rich PRP.
Mokhoa oa PRP ka Phekolo ea Bohloko ba Neuropathic Ka mor'a ho tsoa kotsi, li-activator tse sa tšoaneng tsa endogenous le exogenous li tla khothalletsa ts'ebetso ea platelet α- The granules e kenella karabelo ea degranulation, e lokolla palo e kholo ea lintlha tsa kgolo, fibrinogen, cathepsin le hydrolase.Mabaka a kholo a lokollotsoeng a tlama bokaholimo ba sele ea sele e lebeletsoeng ka li-receptor tsa transmembrane ho membrane ea sele.Li-receptor tsena tsa transmembrane li kenya tšebetsong le ho kenya tšebetsong liprotheine tsa lipontšo tsa endogenous, ho tsoela pele ho kenya lenģosa la bobeli ka seleng, e leng se susumetsang ho ata ha lisele, ho thehoa ha matrix, motsoako oa protheine ea collagen le tse ling tsa liphatsa tsa lefutso tsa intracellular.Ho na le bopaki ba hore li-cytokine tse lokolloang ke li-platelet le li-transmitters tse ling li phetha karolo ea bohlokoa ho fokotsa / ho felisa bohloko bo sa foleng ba neuropathic.Mekhoa e khethehileng e ka aroloa ka mekhoa ea peripheral le mekhoa e bohareng.
Mechanism ea platelet rich plasma (PRP) ho phekola bohloko ba neuropathic
Mekhoa ea peripheral: phello e khahlanong le ho ruruha, ts'ireletso ea neuroprotection le nts'etsopele ea nchafatso ea axon, taolo ea 'mele ea ho itšireletsa mafung, phello ea analgesic.
Mochine o bohareng: ho fokolisa le ho khutlisetsa morao ts'usumetso e bohareng le ho thibela ts'ebetso ea lisele tsa glial
Phello e khahlanong le ho ruruha
Peripheral sensitization e phetha karolo ea bohlokoa ketsahalong ea matšoao a bohloko ba neuropathic ka mor'a kotsi ea methapo.Lisele tse fapaneng tsa ho ruruha, tse kang li-neutrophils, macrophages le mast cell, li ile tsa kenngoa sebakeng sa kotsi ea methapo.Ho bokellana ho feteletseng ha lisele tsa ho ruruha ho theha motheo oa ho tsosoa ho feteletseng le ho tsoa ho tsoelang pele ha methapo ea kutlo.Ho ruruha ho lokolla palo e kholo ea baemeli ba lik'hemik'hale, tse kang li-cytokines, chemokines le lipid mediators, ho etsa hore li-nociceptors li be le boikutlo bo botle le ho thaba, 'me li baka liphetoho tikolohong ea lik'hemik'hale tsa sebaka seo.Liplatelete li na le litlamorao tse matla tsa immunosuppressive le anti-inflammatory.Ka ho laola le ho pata lintlha tse fapaneng tsa taolo ea 'mele ea ho itšireletsa mafung, lintlha tsa angiogenic le lintlha tsa phepo e nepahetseng, li ka fokotsa ts'ebetso e kotsi ea' mele ea ho itšireletsa mafung le ho ruruha, le ho lokisa tšenyo ea lisele tse fapaneng tikolohong e fapaneng.PRP e ka bapala karolo e khahlanong le ho ruruha ka mekhoa e sa tšoaneng.E ka thibela ho lokolloa ha li-cytokine tsa pro-inflammatory ho tloha lisele tsa Schwann, macrophages, neutrophils le mast cell, le ho thibela tlhahiso ea liphatsa tsa lefutso tsa pro-inflammatory factor receptors ka ho khothalletsa phetoho ea lisele tse senyehileng ho tloha boemong ba ho ruruha ho ea boemong bo khahlanong le ho ruruha.Le hoja liplatelete li sa lokolle interleukin 10, liplatelete li fokotsa tlhahiso ea li-interleukin 10 tse ngata ka ho etsa hore lisele tsa dendritic li se ke tsa e-ba teng γ- Tlhahiso ea interferon e phetha karolo e khahlanong le ho ruruha.
Phello ea Analgesic
Li-platelet tse sebetsang li lokolla li-neurotransmitters tse ngata tse thibelang ho ruruha le tse thibelang ho ruruha, tse ka bakang bohloko, empa hape li fokotsa ho ruruha le bohloko.Li-platelet tse sa tsoa lokisoa li robetse PRP.Ka mor'a hore e sebelisoe ka ho toba kapa ka tsela e sa tobang, morphology ea platelet e fetoha 'me e khothalletsa platelet aggregation, e lokolla likaroloana tsa eona tsa intracellular α-Dense le likaroloana tse hlabollotsoeng li tla susumelletsa ho lokolloa ha 5-hydroxytryptamine, e nang le phello ea taolo ea bohloko.Hajoale, li-receptor tsa 5-hydroxytryptamine li fumanoa haholo methapong ea peripheral.5-hydroxytryptamine e ka ama phetisetso ea nociceptive meleng e potolohileng ka 5-hydroxytryptamine 1, 5-hydroxytryptamine 2, 5-hydroxytryptamine 3, 5-hydroxytryptamine 4 le 5-hydroxytryptamine 7 receptors.
Thibelo ea Ts'ebetso ea Glial Cell
Lisele tsa Glial li etsa hoo e ka bang 70% ea lisele tsa methapo ea bohareng, tse ka aroloang ka mefuta e meraro: astrocyte, oligodendrocytes le microglia.Microglia e ile ea sebelisoa nakong ea lihora tsa 24 ka mor'a kotsi ea methapo, 'me li-astrocyte li ile tsa kenngoa hang ka mor'a kotsi ea methapo,' me ts'ebetso e ile ea nka libeke tsa 12.Joale li-astrocyte le microglia li lokolla li-cytokine 'me li etsa hore ho be le letoto la likarabo tsa cellular, tse kang ho phahama ha li-glucocorticoid le li-receptor tsa glutamate, tse lebisang liphetohong tsa mokokotlo oa mokokotlo le polasetiki ea methapo, e amanang haufi-ufi le ho etsahala ha bohloko ba neuropathic.
Lintlha tse amehang ho imollang kapa ho felisa bohloko ba neuropathic ho plasma e ruileng ea platelet
1) Angiopoietin:
Hlohlelletsa angiogenesis;Ho susumetsa ho falla ha lisele tsa endothelial le ho ata;Ts'ehetsa le ho tsitsisa nts'etsopele ea methapo ea mali ka ho hira li-pericyte
2) Ntho e amanang le kholo ea lisele:
Hlohlelletsa ho falla ha leukocyte;Ntlafatsa angiogenesis;E kenya tšebetsong myofibroblast mme e hlohlelletse ho beoa ha matrix a kantle ho sele le ho nchafatsa
3) Epidermal growth factor:
Ho khothalletsa pholiso ea maqeba le ho kenya angiogenesis ka ho khothalletsa ho ata, ho falla le ho khetholla ha macrophages le fibroblasts;Ho susumetsa li-fibroblasts ho hlahisa collagenase le ho senya matrix a extracellular nakong ea ho nchafatsa maqeba;Khothalletsa ho ata ha keratinocyte le fibroblasts, e lebisang ho epithelization.
4) Ntho ea kholo ea Fibroblast:
Ho kenyelletsa chemotaxis ea macrophages, fibroblasts le lisele tsa endothelial;Hlohlelletsa angiogenesis;E ka susumetsa granulation le ho nchafatsa lisele le ho kenya letsoho ho honyeng ha leqeba.
5) Ntho ea kholo ea Hepatocyte:
Ho laola kholo ea lisele le ho tsamaea ha lisele tsa epithelial / endothelial;Khothalletsa tokiso ea epithelial le angiogenesis.
6) Insulin joalo ka ntlha ea kholo:
Bokella hammoho lisele tsa fiber ho susumetsa protheine synthesis.
7) Platelet derived growth factor:
Ho susumetsa chemotaxis ea neutrophils, macrophages le fibroblasts, le ho susumetsa ho ata ha macrophages le fibroblasts ka nako e le 'ngoe;E thusa ho senya collagen ea khale le holimo ho laola polelo ea matrix metalloproteinases, e lebisang ho ruruha, ho thehoa ha lisele tsa granulation, ho ata ha epithelial, tlhahiso ea matrix a extracellular le ho tsosolosoa ha lisele;E ka khothaletsa ho ata ha lisele tsa stem tse tsoang ho adipose le ho thusa ho phetha karolo ea ho nchafatsa methapo.
8) Ntho e nkiloeng ke lisele tsa Stromal:
Letsetsa lisele tsa CD34+ ho susumetsa homing, ho ata le ho arola ka har'a lisele tsa endothelial progenitor, le ho susumetsa angiogenesis;Bokella lisele tsa stem tsa mesenchymal le leukocyte.
9) Ho fetola ntlha ea kholo β:
Qalong, e na le phello ea ho khothalletsa ho ruruha, empa e ka boela ea khothalletsa phetoho ea karolo e lemetseng ho ea boemong bo khahlanong le ho ruruha;E ka ntlafatsa chemotaxis ea fibroblasts le lisele tse boreleli tsa mesifa;Laola polelo ea collagen le collagenase, le ho khothaletsa angiogenesis.
10) Vascular endothelial growth factor:
Ts'ehetsa le ho khothaletsa kholo ea methapo ea kutlo e nchafalitsoeng ka ho kopanya angiogenesis, neurotrophic le neuroprotection, e le ho khutlisetsa ts'ebetso ea methapo.
11) Ntho ea kholo ea methapo:
E bapala karolo ea ts'ireletso ea methapo ka ho khothaletsa kholo ea li-axon le tlhokomelo le ho phela ha li-neurone.
12) Glial derived neurotrophic factor:
E ka atleha ho khutlisetsa morao le ho etsa hore liprotheine tsa neuroogenic li tloaelehe 'me tsa bapala karolo ea neuroprotective.
Qetello
1) Platelet e ruileng ea plasma e na le litšobotsi tsa ho khothalletsa pholiso le ho thibela ho ruruha.E ke ke ea lokisa feela methapo ea kutlo e senyehileng, empa e boetse e kokobetsa bohloko.Ke mokhoa oa bohlokoa oa phekolo bakeng sa bohloko ba neuropathic mme o na le litebello tse khanyang;
2) Mokhoa oa ho lokisa oa plasma e ngata ea platelet e ntse e phehisana khang, e batla hore ho thehoe mokhoa o tloaelehileng oa ho itokisa le tekanyetso e kopaneng ea tlhahlobo ea likarolo;
3) Ho na le lithuto tse ngata ka plasma e ruileng ea platelet ka bohloko ba neuropathic bo bakoang ke lesapo la mokokotlo, kotsi ea methapo ea kutlo le khatello ea methapo.Mokhoa le katleho ea kliniki ea plasma e ruileng ea platelet mefuteng e meng ea bohloko ba neuropathic e hloka ho tsoela pele ho ithutoa.
Bohloko ba Neuropathic ke lebitso le akaretsang la sehlopha se seholo sa mafu a kliniki, a atileng haholo ts'ebetsong ea bongaka.Leha ho le joalo, ha ho na mokhoa o tobileng oa phekolo hona joale, 'me bohloko bo nka lilemo tse' maloa kapa esita le bophelo bohle ka mor'a ho kula, ho baka moroalo o tebileng ho bakuli, malapa le sechaba.Kalafo ea lithethefatsi ke moralo oa motheo oa phekolo bakeng sa bohloko ba neuropathic.Ka lebaka la tlhokahalo ea meriana ea nako e telele, ho latela melao ea bakuli ha ho molemo.Litlhare tsa nako e telele li tla eketsa litlamorao tse mpe tsa lithethefatsi le ho baka tšenyo e kholo 'meleng le kelellong ho bakuli.Liteko tsa motheo tse amehang le lithuto tsa kliniki li pakile hore PRP e ka sebelisoa ho phekola bohloko ba neuropathic, 'me PRP e tsoa ho mokuli ka boeena, ntle le ho itšoara ka mokhoa o ikemetseng.Mokhoa oa phekolo o batla o le bonolo, 'me o na le liphello tse fokolang tse fokolang.PRP e ka boela ea sebelisoa hammoho le lisele tsa stem, tse nang le bokhoni bo matla ba ho lokisoa ha methapo le ho tsosolosoa ha lisele, 'me li tla ba le menyetla e pharaletseng ea kopo ea ho phekola bohloko ba neuropathic nakong e tlang.
(Likahare tsa sengoloa sena li hatisitsoe hape, 'me ha re fane ka tiisetso efe kapa efe e hlakileng kapa e boletsoeng bakeng sa ho nepahala, ho ts'epahala kapa botlalo ba litaba tse teng sengolong sena,' me ha re ikarabelle bakeng sa maikutlo a sengoloa sena, ka kopo utloisisa.)
Nako ea poso: Dec-20-2022