Primary knee osteoarthritis (OA) e ntse e le lefu le fokolisang le sa laoleheng.Ka ho eketseha ha nako ea bophelo le seoa sa botenya, OA e baka moroalo o ntseng o hola oa moruo le oa 'mele.Knee OA ke lefu le sa foleng la musculoskeletal leo qetellong le ka hlokang ho buuoa.Ka hona, bakuli ba tsoela pele ho batla mekhoa ea phekolo e ka 'nang ea se ke ea buuoa, e kang ente ea platelet-rich plasma (PRP) ka har'a lenonyeletso la lengole le amehileng.
Ho ea ka Jayaram et al., PRP ke phekolo e hlahang bakeng sa OA.Leha ho le joalo, bopaki ba kliniki ba katleho ea eona bo ntse bo haella, 'me mokhoa oa eona oa ho sebetsa ha o tsejoe hantle.Le hoja liphello tse tšepisang li tlalehiloe mabapi le tšebeliso ea PRP ho OA ea lengole, lipotso tsa bohlokoa tse kang bopaki bo tiileng mabapi le katleho ea eona, litekanyetso tse tloaelehileng, le mekhoa e metle ea ho lokisetsa li ntse li sa tsejoe.
Knee OA e hakanngoa hore e ama batho ba fetang 10% lefatšeng ka bophara, ka kotsi ea bophelo bohle ba 45%.Litaelo tsa sejoale-joale li khothaletsa liphekolo tse seng tsa meriana (mohlala, boikoetliso) le liphekolo tsa meriana, joalo ka li-nonsteroidal anti-inflammatory drugs (NSAIDs).Leha ho le joalo, hangata liphekolo tsena li na le melemo ea nakoana feela.Ho feta moo, tšebeliso ea lithethefatsi ho bakuli ba nang le li-comorbidities e lekanyelitsoe ka lebaka la kotsi ea mathata.
Hangata li-corticosteroids tsa intra-articular li sebelisoa feela bakeng sa phomolo ea nakoana e khutšoanyane hobane molemo oa bona o lekanyelitsoe libeke tse 'maloa,' me liente tse pheta-phetoang li bontšitsoe hore li amahanngoa le ho eketseha ha lefu la lefufuru.Bangoli ba bang ba bolela hore tšebeliso ea hyaluronic acid (HA) e na le likhang.Leha ho le joalo, bangoli ba bang ba tlalehile ho imolla bohloko ka mor'a 3 ho liente tsa beke le beke tsa 5 tsa HA bakeng sa 5 ho libeke tsa 13 (ka linako tse ling ho fihlela selemo sa 1).
Ha mekhoa e meng e ka holimo e hlōleha, hangata lengole la arthroplasty (TKA) le buelloa e le phekolo e sebetsang.Leha ho le joalo, e bitsa chelete e ngata ’me e ka ’na ea akarelletsa liphello tse mpe tsa bongaka le tsa ka mor’a ho buuoa.Ka hona, ho bohlokoa ho tseba mekhoa e meng e sireletsehileng le e sebetsang bakeng sa OA ea lengole.
Litlhare tsa likokoana-hloko, tse kang PRP, li sa tsoa etsoa lipatlisiso bakeng sa phekolo ea OA ea lengole.PRP ke sehlahisoa sa mali se ikemetseng se nang le li-platelet tse ngata.Ho nahanoa hore katleho ea PRP e amana le ho lokolloa ha lintlha tsa kholo le limolek'hule tse ling, ho kenyelletsa le platelet-derived growth factor (PDGF), e fetolang kholo ea kholo (TGF) -beta, insulin-like growth factor type I (IGF-I) , le vascular endothelial growth factor (VEGF).
Lingoliloeng tse 'maloa li bontša hore PRP e ka' na ea tšepisa bakeng sa phekolo ea lengole OA.Leha ho le joalo, ba bangata ha ba lumellane ka mokhoa o molemo ka ho fetisisa, 'me ho na le mefokolo e mengata e fokotsang tlhahlobo e nepahetseng ea liphello tsa bona, kotsing ea ho ba leeme.Ho fapana ha mekhoa ea ho lokisa le ea ente e sebelisitsoeng lithutong tse tlalehiloeng ke moeli oa ho hlalosa mokhoa o nepahetseng oa PRP.Ho feta moo, liteko tse ngata li sebelisitse HA e le papiso, e leng likhang ka boeona.Liteko tse ling li ile tsa bapisa PRP le placebo 'me tsa bontša ntlafatso e ntle haholo ea matšoao ho feta saline likhoeling tse 6 le 12.Leha ho le joalo, liteko tsena li na le mefokolo e mengata ea mokhoa, ho kenyelletsa le khaello ea ho foufatsa ka nepo, ho fana ka maikutlo a hore melemo ea bona e kanna ea lekanyetsoa.
Melemo ea PRP bakeng sa phekolo ea OA ea lengole ke e latelang: e bonolo haholo ho e sebelisa ka lebaka la ho itokisa ka potlako le ho hlasela ho fokolang;ke mokhoa o batlang o le theko e tlase ka lebaka la tšebeliso ea meaho le lisebelisoa tsa litšebeletso tsa bophelo bo botle ba sechaba;'me ho ka etsahala hore e sireletsehe, hobane ke sehlahisoa sa autologous.Lingoliloeng tse fetileng li tlalehile feela mathata a manyenyane le a nakoana.
Sepheo sa sehlooho sena ke ho hlahloba mokhoa oa hona joale oa limolek'hule oa ts'ebetso ea PRP le tekanyo ea katleho ea ente ea intra-articular ea PRP ho bakuli ba nang le lengole la OA.
Mokhoa oa limolek'hule oa ts'ebetso ea plasma e ruileng ea platelet
Laebrari ea Cochrane le PubMed (MEDLINE) e batla lithuto tse amanang le PRI ho OA ea lengole li ile tsa hlahlojoa.Nako ea ho batla ke ho tloha qalong ea mochine oa ho batla ho fihlela ka December 15, 2021. Liphuputso feela tsa PRP ho OA ea lengole tseo bangoli ba neng ba li nka e le tsa thahasello e kholo li kenyelelitsoe.PubMed e fumane lingoliloeng tse 454, tse 80 tsa tsona li khethiloe.Sengoloa se fumanoe Laeboraring ea Cochrane, eo le eona e thathamisitsoeng, e nang le litšupiso tse 80 kaofela.
Phuputso e hatisitsoeng ka 2011 e bontšitse hore tšebeliso ea lintlha tsa kgolo (litho tsa TGF-β superfamily, fibroblast growth factor family, IGF-I le PDGF) tsamaisong ea OA e bonahala e tšepisa.
Ka 2014, Sandman et al.e tlalehile hore phekolo ea PRP ea motsoako oa OA e ile ea fella ka ho fokotseha ha catabolism;leha ho le joalo, PRP e ile ea fella ka ho fokotseha ho hoholo ha matrix metalloproteinase 13, ho eketseha ha polelo ea hyaluronan synthase 2 liseleng tsa synovial, le keketseho ea ts'ebetso ea cartilage synthesis.Liphello tsa thuto ena li fana ka maikutlo a hore PRP e susumetsa tlhahiso ea HA e sa feleng le ho fokotsa catabolism ea lefuba.PRP e ile ea boela ea thibela mahloriso a bahlaseli ba ho ruruha le liphatsa tsa bona tsa lefutso ho synovial le chondrocyte.
Ka 2015, phuputso ea laboratori e laoloang e bontšitse hore PRP e ile ea susumetsa haholo ho ata ha lisele le ho hlahisa liprotheine holim'a lefufuru la lengole la motho le lisele tsa synovial.Litlhahlobo tsena li thusa ho hlalosa mekhoa ea lik'hemik'hale tse amanang le katleho ea PRP ho phekola OA ea lengole.
Ka mohlala oa murine OA (thuto ea laboratori e laoloang) e tlalehiloeng ke Khatab et al.Ka 2018, liente tse ngata tsa PRP tse lokollang bohloko li ile tsa fokotsa bohloko le botenya ba synovial, mohlomong bo kopanngoeng ke macrophage subtypes.Kahoo, liente tsena li bonahala li fokotsa bohloko le ho ruruha ha synovial, 'me li ka thibela tsoelo-pele ea OA ho bakuli ba nang le OA ea pele.
Ka 2018, tlhahlobo ea lingoliloeng tsa database tsa PubMed e ile ea etsa qeto ea hore phekolo ea PRP ea OA e bonahala e na le phello ea ho fetola tsela ea Wnt / β-catenin, e ka 'nang ea e-ba ea bohlokoa bakeng sa ho finyella liphello tsa eona tse molemo tsa kliniki.
Ka 2019, Liu et al.e ile ea batlisisa mokhoa oa limolek'hule oo li-exosome tse tsoang ho PRP li amehang ho fokotsa OA.Ho bohlokoa ho totobatsa hore li-exosome li bapala karolo ea bohlokoa puisanong ea li-intercellular.Phuputsong ena, li-chondrocyte tse ka sehloohong tsa mmutla li ne li khethiloe 'me li tšoaroa ka interleukin (IL) -1β ho theha in vitro model ea OA.Ho ata, ho falla, le liteko tsa apoptosis li ile tsa lekanngoa le ho bapisoa pakeng tsa li-exosomes tse nkiloeng ho PRP le PRP e entsoeng ho hlahloba phello ea phekolo ho OA.Mekhoa e amehang tseleng ea pontšo ea Wnt/β-catenin e ile ea fuputsoa ka tlhahlobo ea blot ea bophirimela.Li-exosomes tse nkiloeng ho PRP li fumanoe li na le litlamorao tse tšoanang kapa tse betere tsa kalafo ho OA ho feta tse kentsoeng PRP in vitro le in vivo.
Ka mohlala oa toeba oa posttraumatic OA e tlalehiloeng ka 2020, Jayaram et al.fana ka maikutlo a hore liphello tsa PRP mabapi le tsoelo-pele ea OA le hyperalgesia e bakoang ke maloetse e ka 'na ea e-ba e itšetlehileng ka leukocyte.Ba ile ba boela ba bolela hore leukocyte-futsane PRP (LP-PRP) le palo e nyenyane ea PRP (LR-PRP) e nang le leukocyte e ngata e thibela molumo le tahlehelo ea holim'a metsi.
Liphuputso tse tlalehiloeng ke Yang et al.Phuputso ea 2021 e bontšitse hore PRP bonyane e fokolisitsoe ka mokhoa o itseng oa IL-1β-induced chondrocyte apoptosis le ho ruruha ka ho thibela hypoxia-inducible factor 2α.
Ka mohlala oa rat oa OA o sebelisang PRP, Sun et al.microRNA-337 le microRNA-375 li fumanoe li liehisa tsoelo-pele ea OA ka ho ama ho ruruha le apoptosis.
Ho ea ka Sheean et al., mesebetsi ea likokoana-hloko ea PRP e na le mefuta e mengata: platelet alpha granules e khothalletsa ho lokolloa ha lintlha tse sa tšoaneng tsa kgolo, ho akarelletsa le VEGF le TGF-beta, 'me ho ruruha ho laoloa ka ho thibela tsela ea nyutlelie-κB.
Ho ile ha batlisisoa maikutlo a lintlha tsa humoral ho PRP tse lokiselitsoeng ho tloha ho li-kits ka bobeli le litlamorao tsa lintlha tsa humoral ho phenotype ea macrophage.Ba fumane ho se tšoane ha likarolo tsa cellular le li-humoral factor concentrations lipakeng tsa PRP e hloekisitsoeng ho sebelisoa lisebelisoa tse peli.The autologous protein solution LR-PRP kit e na le lintlha tse phahameng tsa M1 le M2 tse amanang le macrophage.Ho phaella ha PRP supernatant ho setso sa macrophages e entsoeng ka monocyte le M1 polarized macrophages e bontšitse hore PRP e thibela M1 macrophage polarization le ho khothalletsa polarization ea M2 macrophage.
Ka 2021, Szwedowski et al.Mabaka a khōlo a lokolloang ka mahlahahlaha a mangole a OA ka mor'a ho kenngoa ha PRP a hlalosoa: tumor necrosis factor (TNF), IGF-1, TGF, VEGF, disaggregate, le metalloproteinases e nang le thrombospondin motifs, interleukins, matrix metalloproteinases , epidermal growth factor, kholo ea hepatocyte, fibroblast. ntlha ea kholo, keratinocyte kgolo ea keratinocyte le platelet factor 4.
1. PDGF
PDGF e ile ea fumanoa ka lekhetlo la pele liplateleteng.Ke cationic polypeptide e thibelang mocheso, e thibelang asiti, e nang le trypsin habonolo.Ke e 'ngoe ea lintlha tsa pele tsa kholo tse hlahang libakeng tsa fracture.E hlalosoa haholo ka lisele tse bohloko tsa masapo, tse etsang hore osteoblasts chemotactic le ho ata, e eketsa bokhoni ba collagen synthesis, 'me e khothalletsa ho kenngoa ha li-osteoclasts, kahoo ho khothalletsa ho thehoa ha masapo.Ho feta moo, PDGF e ka boela ea khothalletsa ho ata le ho arohana ha fibroblasts le ho khothalletsa ho tsosolosoa ha lisele.
2. TGF-B
TGF-B ke polypeptide e entsoeng ka liketane tsa 2, tse sebetsang ho fibroblasts le pre-osteoblasts ka mokhoa oa paracrine le / kapa autocrine, e leng se susumetsang ho ata ha li-osteoblasts le li-pre-osteoblasts le ho qaptjoa ha collagen fibers, e le chemokine, osteoprogenitor. lisele li kenngoa ka har'a lisele tse lemetseng tsa masapo, 'me ho thehoa le ho monya ha li-osteoclasts hoa thibeloa.TGF-B e boetse e laola ECM (extracellular matrix) synthesis, e na le liphello tsa chemotactic ho li-neutrophils le monocyte, 'me e buisana le likarabo tsa ho ruruha sebakeng seo.
3. VEGF
VEGF ke dimeric glycoprotein, e tlamang ho li-receptor ka holim'a lisele tsa vascular endothelial ka autocrine kapa paracrine, e khothalletsa ho ata ha lisele tsa endothelial, e susumetsa ho thehoa le ho thehoa ha methapo e mecha ea mali, e fana ka oksijene ho ea qetellong ea ho robeha, e fana ka limatlafatsi, 'me e tsamaisa litšila tsa metabolic. ., ho fana ka microenvironment e ntle bakeng sa metabolism sebakeng sa sebaka sa ho tsosolosoa ha masapo.Ebe, tlasa ts'ebetso ea VEGF, ts'ebetso ea alkaline phosphatase ea phapang ea osteoblast ea ntlafatsoa, 'me matsoai a lehae a calcium a kenngoa ho khothaletsa pholiso ea fracture.Ntle le moo, VEGF e khothalletsa ho lokisoa ha lisele tse bonolo ka ho ntlafatsa phepelo ea mali ea lisele tse bonolo tse pota-potileng leqeba, 'me e khothalletsa pholiso ea ho robeha,' me e na le tšusumetso e kopanetsoeng le PDGF.
4. EGF
EGF ke karolo e matla e khothalletsang karohano ea lisele e susumetsang karohano le ho ata ha mefuta e fapaneng ea lisele tsa lisele tsa 'mele, ha e ntse e khothalletsa matrix synthesis le deposition, e khothalletsang ho thehoa ha lisele tsa fibrous, le ho tsoela pele ho fetoha lesapo ho nka sebaka sa ho thehoa ha lisele tsa masapo.Ntho e 'ngoe eo EGF e nkang karolo ho lokisoeng ha fracture ke hore e ka etsa hore phospholipase A e sebetse, kahoo e khothalletsa ho lokolloa ha arachidonic liseleng tsa epithelial, le ho khothalletsa tlhahiso ea prostaglandin ka ho laola mesebetsi ea cyclooxygenase le lipoxygenase.Karolo ea resorption le ho theha masapo hamorao.Ho ka bonoa hore EGF e nka karolo ts'ebetsong ea pholiso ea fractures mme e ka potlakisa pholiso ea fracture.Ho phaella moo, EGF e ka khothalletsa ho ata ha lisele tsa epidermal le lisele tsa endothelial, le ho etsa hore lisele tsa endothelial li fallele holim'a leqeba.
5. IGF
IGF-1 ke polypeptide e nang le ketane e le 'ngoe e tlamang ho li-receptors ka lesapo le ho kenya tšebetsong tyrosine protease ka mor'a receptor autophosphorylation, e khothalletsang phosphorylation ea insulin receptor substrates, kahoo e laola ho hōla ha lisele, ho ata le metabolism.E ka tsosa li-Osteoblasts le pre-osteoblasts, ea khothalletsa lefufuru le ho thehoa ha masapo.Ho phaella moo, e phetha karolo ea bohlokoa ho kopantseng ho tsosolosoa ha masapo ka ho kopanya phapang le ho thehoa ha li-osteoblasts le li-osteoclasts le mesebetsi ea tsona e sebetsang.Ho feta moo, IGF e boetse ke e 'ngoe ea lintlha tsa bohlokoa ho lokisoeng ha maqeba.Ke ntho e khothalletsang ho kena ha fibroblasts ka har'a potoloho ea lisele le ho hlohlelletsa phapang le motsoako oa fibroblasts.
PRP ke mohopolo oa autologous oa liplatelete le lintlha tsa kholo tse tsoang mali a centrifuged.Ho na le mefuta e meng e 'meli ea platelet concentrate: platelet-rich fibrin le plasma-rich growth factor.PRP e ka fumanoa feela maling a metsi;ha ho khonehe ho fumana PRP ho tsoa ho serum kapa mali a clotted.
Ho na le mekhoa e fapaneng ea khoebo ea ho bokella mali le ho fumana PRP.Liphapang pakeng tsa bona li kenyelletsa tekanyo ea mali a lokelang ho nkoa ho tsoa ho mokuli;mokhoa oa ho itšehla thajana;lebelo la centrifugation;tekanyo ea ho tsepamisa mohopolo ka mor'a centrifugation;nako ea ho sebetsa;
Mekhoa e fapaneng ea centrifugation ea mali e tlalehiloe hore e ama karo-karolelano ea leukocyte.Linomoro tsa liplatelete ho 1 μL ea mali ho tsoa ho batho ba phetseng hantle li tloha ho 150,000 ho isa ho 300,000.Li-platelet li na le boikarabelo ba ho emisa ho tsoa mali.
Li-alpha granules tsa liplatelete li na le mefuta e fapaneng ea liprotheine joalo ka lintlha tsa kholo (mohlala, phetoho ea kholo ea beta, insulin-like growth factor, epidermal growth factor), chemokines, coagulants, anticoagulants, fibrinolytic proteins, adhesion proteins, Integral membrane proteins, bakena-lipakeng ba ho itšireletsa mafung. , lintlha tsa angiogenic le li-inhibitors, le liprotheine tsa bactericidal.
Mokhoa o nepahetseng oa ts'ebetso ea PRP o ntse o sa tsejoe.PRP e bonahala e susumetsa li-chondrocyte ho lokisa lefuba le biosynthesis ea collagen le proteoglycans.E 'nile ea sebelisoa litabeng tse fapaneng tsa bongaka tse kang ho buuoa ka molomo le maxillofacial (ho kenyeletsoa temporomandibular OA), dermatology, ophthalmology, cardiothoracic opereishene le polasetiki ea polasetiki.
(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: Jul-27-2022