Manufar da aka sani a yau da PRP ta fara bayyana a fagen ilimin jini a cikin 1970s.Masanan ilimin halittar jini sun kirkiro kalmar PRP shekaru da yawa da suka gabata a yunƙurin bayyana plasma da aka samu daga adadin platelet sama da ƙimar basal a cikin jini na gefe.Fiye da shekaru goma bayan haka, an yi amfani da PRP a cikin tiyata na maxillofacial a matsayin nau'i na fibrin mai arzikin platelet (PRF).Abubuwan da ke cikin fibrin a cikin wannan abin da aka samo na PRP yana da ƙima mai yawa don abubuwan da ke ɗaure su da kayan gida, yayin da PRP yana da kaddarorin anti-mai kumburi da kuma ƙarfafa haɓakar ƙwayoyin cuta.A ƙarshe, a kusa da 1990s, PRP ya zama sananne, kuma a ƙarshe, an canza fasahar zuwa wasu wuraren kiwon lafiya.Tun daga wannan lokacin, an yi nazarin wannan ingantaccen ilimin halitta kuma an yi amfani da shi don magance raunin tsoka da yawa a cikin ƙwararrun 'yan wasa, yana ƙara ba da gudummawa ga yaduwar watsa labarai.Bugu da ƙari, kasancewa mai tasiri a cikin magungunan kasusuwa da magungunan wasanni, ana amfani da PRP a cikin ilimin ophthalmology, gynecology, urology da cardiology, pediatrics da filastik tiyata.A cikin 'yan shekarun nan, PRP ya kuma sami yabo daga masu ilimin fata don yuwuwar ta don magance gyambon fata, sake fasalin tabo, sabunta nama, sabunta fata har ma da asarar gashi.
Yin la'akari da gaskiyar cewa an san PRP don yin amfani da magani kai tsaye da hanyoyin kumburi, dole ne a gabatar da cascade na warkaswa azaman tunani.An raba tsarin warkarwa zuwa matakai hudu masu zuwa: hemostasis;kumburi;haɓakar salon salula da matrix, kuma a ƙarshe gyara raunuka.
1. Warkar da Nama
An kunna cascade mai warkarwa na nama, tsarin da ke haifar da tarawar platelet, samuwar jini, da haɓaka matrix na wucin gadi na wucin gadi (ECM. Platelets sa'an nan kuma suna manne wa fallasa ƙwayoyin collagen da ECM, suna haifar da kasancewar α-granules a cikin Sakin. Bioactive Molecules.Platelets sun ƙunshi nau'o'in kwayoyin halitta iri-iri, ciki har da abubuwan haɓaka, chemokines, da cytokines, da kuma masu shiga tsakani masu tasowa irin su prostaglandins, prostatic cyclin, histamine, thromboxane, serotonin, da bradykinin.
Mataki na ƙarshe na aikin warkaswa ya dogara da sake fasalin rauni.An tsara gyaran gyare-gyaren nama sosai don tabbatar da daidaituwa tsakanin amsawar anabolic da catabolic.A wannan lokaci, nau'in haɓakar haɓakar platelet (PDGF), haɓaka haɓakar haɓaka (TGF-β) da fibronectin suna haɓaka haɓakawa da ƙaura na fibroblasts, da kuma haɗakar abubuwan ECM.Duk da haka, lokacin balagaggen rauni ya dogara ne akan tsananin rauni, halaye na mutum, da takamaiman ƙarfin warkarwa na nama da aka ji rauni, da wasu abubuwan pathophysiological da na rayuwa na iya shafar tsarin warkarwa, kamar ischemia nama, hypoxia, kamuwa da cuta. , Rashin daidaituwar haɓakar haɓaka, har ma da cututtukan da ke da alaƙa da cututtukan rayuwa.
Wani microenvironment mai kumburi wanda ke tsangwama tare da tsarin warkarwa.Don rikitar da al'amura, akwai kuma babban aikin protease wanda ke hana aikin yanayin girma (GF).Baya ga samun mitogenic, angiogenic, da kaddarorin chemotactic, PRP kuma shine tushen wadataccen abubuwan haɓaka da yawa, biomolecules waɗanda zasu iya magance illa mai lalacewa a cikin kyallen takarda ta hanyar sarrafa kumburi mai ƙarfi da kafa abubuwan motsa jiki na anabolic.Idan aka ba da waɗannan kaddarorin, Masu bincike na iya samun babban yuwuwar magance raunuka daban-daban.
2. Cytokine
Cytokines a cikin PRP suna taka muhimmiyar rawa wajen sarrafa hanyoyin gyaran nama da daidaita lalacewar kumburi.Cytokines na anti-kumburi wani nau'i ne mai fadi na kwayoyin halittu masu rai waɗanda ke daidaita martanin cytokine masu kumburi, galibi suna haifar da macrophages da aka kunna.Cytokines masu kumburi suna hulɗa tare da takamaiman masu hana cytokine da masu karɓar cytokine masu narkewa don daidaita kumburi.Interleukin (IL) -1 antagonists masu karɓa, IL-4, IL-10, IL-11 da IL-13 an rarraba su azaman babban cytokines anti-mai kumburi.Dangane da nau'in rauni, wasu cytokines, irin su interferon, ƙwayar cutar sankarar bargo, TGF-β da IL-6, na iya nuna alamun pro- ko anti-mai kumburi.TNF-a, IL1 da IL-18 suna da wasu masu karɓar cytokine waɗanda zasu iya hana tasirin pro-inflammatory na sauran sunadaran [37].IL-10 yana daya daga cikin cytokines masu kumburi masu ƙarfi, yana iya saukar da tsarin cytokines masu kumburi kamar IL-1, IL-6 da TNF-a, da haɓaka cytokines anti-mai kumburi.Wadannan hanyoyin daidaitawa suna taka muhimmiyar rawa wajen samarwa da aikin cytokines masu kumburi.Bugu da ƙari, wasu cytokines na iya haifar da takamaiman amsawar siginar da ke motsa fibroblasts, waɗanda ke da mahimmanci don gyaran nama.Cytokines mai kumburi TGFβ1, IL-1β, IL-6, IL-13, da IL-33 suna ƙarfafa fibroblasts don bambanta cikin myofibroblasts da haɓaka ECM [38].Bi da bi, fibroblasts suna ɓoye cytokines TGF-β, IL-1β, IL-33, CXC, da CC chemokines, waɗanda ke haɓaka martani mai kumburi ta hanyar kunnawa da ɗaukar ƙwayoyin rigakafi kamar macrophages.Wadannan sel masu kumburi suna da matsayi da yawa a wurin rauni, da farko ta hanyar haɓaka raunin rauni - da kuma biosynthesis na chemokines, metabolites da abubuwan haɓaka, waɗanda ke da mahimmanci don sake fasalin sabon nama.Don haka, cytokines da ke cikin PRP suna taka muhimmiyar rawa wajen haɓaka nau'in ƙwayoyin cuta na ƙwayoyin cuta, suna haifar da ƙuduri na lokaci mai kumburi.A gaskiya ma, wasu masu bincike sun ba da suna wannan tsari "ƙumburi na farfadowa," yana nuna cewa lokaci mai kumburi, duk da rashin jin daɗin haƙuri, mataki ne mai mahimmanci da ake bukata don tsarin gyaran nama don cimma nasara mai nasara, da aka ba da hanyoyin epigenetic ta hanyar siginar ƙwayar cuta ta inganta salon salula. filastik.
3. Fibrin
Platelets suna ɗaukar abubuwa da yawa masu alaƙa da tsarin fibrinolytic wanda zai iya daidaitawa ko rage daidaita martanin fibrinolytic.Dangantakar ɗan lokaci da gudummawar dangi na abubuwan haɗin jini da aikin platelet a cikin zubar jini ya kasance batun da ya cancanci tattaunawa mai yawa a cikin al'umma.Littattafan sun gabatar da karatu da yawa da ke mai da hankali kan platelet kawai, waɗanda aka san su da ikon yin tasiri akan tsarin warkarwa.Duk da ƙwararrun ƙwararrun ƙwararrun ƙwararrun ƙwararrun ƙwararrun ƙwararrun ƙwararrun ƙwararrun jini, irin su abubuwan haɗin gwiwa da tsarin fibrinolytic, an kuma gano su don ba da gudummawa mai mahimmanci don ingantaccen gyara rauni.Ta hanyar ma'anar, fibrinolysis shine tsarin ilimin halitta mai rikitarwa wanda ya dogara da kunna wasu enzymes don sauƙaƙe lalata fibrin.An ba da shawarar amsawar fibrinolytic da wasu marubutan cewa samfuran lalata fibrin (fdp) na iya zama ainihin ƙwayoyin ƙwayoyin cuta da ke da alhakin haɓaka gyaran nama, jerin mahimman abubuwan da suka faru na rayuwa kafin ƙaddamar da fibrin da cirewa daga angiogenesis, wanda ya zama dole don warkar da rauni.Samar da gudan jini bayan rauni yana aiki azaman kariya mai kariya wanda ke kare nama daga asarar jini, mamayewa ta hanyar ƙwayoyin cuta, kuma yana ba da matrix na ɗan lokaci ta hanyar da sel zasu iya yin ƙaura yayin gyarawa.Ciwon jini ya faru ne saboda tsagewar fibrinogen ta hanyar sinadarai masu sinadarai da kuma adadin platelets a cikin hanyar sadarwar fibrin fibrous mai haɗe-haɗe.Wannan halayen yana fara yin polymerization na fibrin monomers, babban abin da ya faru a cikin samuwar jini.Clots kuma na iya aiki azaman tafki don cytokines da abubuwan girma, waɗanda aka saki akan lalatawar platelet ɗin da aka kunna.An tsara tsarin fibrinolytic ta hanyar plasmin kuma yana taka muhimmiyar rawa wajen inganta ƙaurawar tantanin halitta, haɓakar haɓakar ƙwayoyin cuta, da kuma daidaita sauran tsarin protease da ke cikin kumburi na nama da farfadowa.Mahimman abubuwan da ke cikin fibrinolysis, irin su urokinase plasminogen activator receptor (uPAR) da plasminogen activator inhibitor-1 (PAI-1) an san su da za a bayyana su a cikin ƙwayoyin cuta na mesenchymal (MSCs), nau'in kwayar halitta na musamman da ake bukata don samun nasarar warkar da raunuka.
4. Hijira ta Cell
Kunna plasminogen ta ƙungiyar uPA-uPAR wani tsari ne wanda ke inganta ƙaura mai kumburi yayin da yake haɓaka proteolysis na waje.Tunda uPAR ba ta da sassan transmembrane da na cikin salula, sunadaran suna buƙatar masu karɓar haɗin gwiwa kamar integrins da vitreins don daidaita ƙaura ta tantanin halitta.Bugu da ari, ɗaurin uPA-uPAR ya haifar da haɓakar alaƙar uPAR don haɗin gwiwar vitreous da integrins, haɓaka mannewar tantanin halitta.Plasminogen activator inhibitor-1 (PAI-1) bi da bi yana watsar da sel, yana lalata upar-vitrein da integrin- lokacin da ya ɗaure zuwa uPA na hadaddun uPA-upar-integrin akan farfajiyar tantanin halitta Interaction na gilashin voxels.
A cikin yanayin maganin farfadowa, ƙwayoyin ƙwayoyin cuta na mesenchymal suna motsa jiki daga kasusuwan kasusuwa a cikin yanayin lalacewar kwayoyin halitta mai tsanani kuma saboda haka za'a iya samuwa a cikin wurare dabam dabam na marasa lafiya tare da raguwa da yawa.Duk da haka, a wasu yanayi, kamar gazawar renal na ƙarshen mataki, gazawar hanta na ƙarshe, ko lokacin farkon ƙin yarda bayan dashen zuciya, waɗannan ƙwayoyin cuta na iya ƙila ba za a iya gano su a cikin jini ba [66].Abin sha'awa shine, waɗannan ƙwayoyin ƙasusuwan ƙasusuwan da aka samu mesenchymal (stromal) ba za a iya gano su a cikin jinin mutane masu lafiya ba [67].An kuma ba da shawarar rawar da za a yi don uPAR a cikin ƙwayar kasusuwa mesenchymal cell mobilization a baya, kama da abin da ke faruwa a cikin tattarawar kwayar cutar hematopoietic (HSC).Varabaneni et al.Sakamakon ya nuna cewa yin amfani da granulocyte colony-stimulating factor a cikin rashi na berayen uPAR ya haifar da gazawar MSCs, kuma ya sake ƙarfafa aikin tallafi na tsarin fibrinolytic a cikin ƙaura ta cell.Har ila yau, ƙarin nazarin ya nuna cewa glycosylphosylphosphatidylinositol-anchored uPA receptors suna daidaita mannewa, ƙaura, haɓakawa, da bambanci ta hanyar kunna wasu hanyoyin siginar siginar ciki, kamar haka: pro-survival phosphatidylinositol 4,5-bissphate 3-kinase / Akt da ERK1 , da adhesion kinase (FAK).
MSCs sun nuna ƙarin mahimmanci a cikin mahallin warkar da rauni.Alal misali, ƙananan ƙwayoyin plasminogen sun nuna jinkiri mai tsanani a cikin abubuwan da ke warkar da raunuka, suna nuna cewa plasmin yana da mahimmanci a cikin wannan tsari.A cikin mutane, asarar plasmin kuma na iya haifar da rikitarwa na warkar da rauni.Rushewar jini yana iya hana haɓakar nama sosai, wanda ya bayyana dalilin da yasa waɗannan hanyoyin haɓakawa suka fi ƙalubalanci a cikin masu ciwon sukari.
5. Monocytes da Tsarin Sabuntawa
Bisa ga wallafe-wallafen, akwai tattaunawa mai yawa game da rawar da monocytes ke takawa wajen warkar da raunuka.Macrophages an samo su ne daga monocytes na jini kuma suna taka muhimmiyar rawa wajen maganin farfadowa [81].Tun da neutrophils suna ɓoye IL-4, IL-1, IL-6 da TNF-[alpha], waɗannan ƙwayoyin suna shiga cikin wurin rauni kamar 24-48 hours bayan rauni.Platelets sun saki thrombin da kuma platelet factor 4 (PF4), chemokines guda biyu waɗanda ke inganta ɗaukar monocytes da bambancin su zuwa macrophages da sel dendritic.Wani mahimmin fasalin macrophages shine filastik ɗin su, watau ikon su na canza nau'ikan halitta da canzawa zuwa wasu nau'ikan tantanin halitta kamar ƙwayoyin endothelial, waɗanda daga baya suna nuna ayyuka daban-daban don amsawa daban-daban na ƙwayoyin ƙwayoyin cuta a cikin microenvironment na rauni.Kwayoyin kumburi suna bayyana manyan abubuwa biyu, M1 ko M2, dangane da siginar kwayoyin halitta na gida wanda shine tushen abin kara kuzari.M1 macrophages ana haifar da su ta hanyar ƙananan ƙwayoyin cuta kuma don haka suna da ƙarin tasiri mai kumburi.Sabanin haka, M2 macrophages yawanci ana haifar da su ta hanyar amsawar nau'in 2 kuma suna da kaddarorin anti-mai kumburi, waɗanda galibi ana nuna su ta haɓaka a cikin IL-4, IL-5, IL-9, da IL-13.Har ila yau, yana shiga cikin gyaran nama ta hanyar samar da abubuwan girma.Sauye-sauye daga M1 zuwa M2 isoforms an fi mayar da shi ta hanyar matakai na baya na warkar da rauni, inda M1 macrophages ke haifar da neutrophil apoptosis da fara kawar da waɗannan kwayoyin halitta).Phagocytosis ta neutrophils yana kunna jerin abubuwan da suka faru a cikin abin da aka kashe samar da cytokine, polarizing macrophages da sakewa TGF-β1.Wannan haɓakar haɓaka shine babban mai sarrafa bambance-bambancen myofibroblast da raunin rauni, yana ba da damar ƙudurin kumburi da farawa lokacin haɓakawa a cikin cascade waraka [57].Wani sunadaran da ke da alaƙa da ke cikin tsarin salula shine serine (SG).An gano wannan granulan sirri na hematopoietic don zama dole don adana sunadaran da aka ɓoye a cikin takamaiman ƙwayoyin rigakafi, kamar ƙwayoyin mast, neutrophils, da cytotoxic T lymphocytes.Duk da yake yawancin ƙwayoyin da ba na hematopoietic ba kuma suna haɗar serotonin, duk ƙwayoyin kumburi suna samar da adadi mai yawa na wannan furotin kuma suna adana shi a cikin granules don ƙarin hulɗa tare da sauran masu shiga tsakani, ciki har da proteases, cytokines, chemokines, da kuma girma factor.Sarƙoƙin glycosaminoglycan (GAG) da aka caje mara kyau a cikin SG sun bayyana suna da mahimmanci ga sirriyar granule homeostasis, saboda suna iya ɗaurewa da sauƙaƙe ma'ajin abubuwan da aka caje granule a cikin takamaiman tantanin halitta-, furotin-, da takamaiman sarkar GAG.Game da shigar da su a cikin PRP, Woulfe da abokan aiki sun nuna a baya cewa rashi SG yana da alaƙa da sauye-sauyen ilimin halittar jini;lahani a cikin nau'in platelet 4, beta-thromglobulin, da PDGF ajiya a cikin platelets;rashin haɓakar platelet da ɓarna a cikin vitro da thrombosis a cikin nau'in lahani.Saboda haka masu binciken sun kammala cewa wannan proteoglycan ya bayyana a matsayin babban mai kula da thrombosis.
Ana iya samun samfuran da ke da arziƙin platelet ta hanyar tattarawa da tara jinin mutum gaba ɗaya, a ware cakuɗaɗen zuwa yadudduka daban-daban masu ɗauke da plasma, platelets, leukocytes, da leukocytes.Lokacin da adadin platelet ya fi kimar basal girma, ana iya haɓaka haɓakar ƙashi da nama mai laushi tare da ƙarancin illa.Aikace-aikacen samfuran PRP na autologous sabon ilimin kimiyyar halittu ne wanda ke ci gaba da nuna sakamako masu ban sha'awa a cikin haɓakawa da haɓakar warkar da raunuka daban-daban.Ana iya danganta tasirin wannan madadin hanyoyin warkewa zuwa ga isar da wuri na nau'ikan abubuwan haɓaka da furotin, yin kwaikwayi da goyan bayan raunin raunin jiki da hanyoyin gyaran nama.Bugu da ƙari kuma, tsarin fibrinolytic a fili yana da tasiri mai mahimmanci akan gyaran nama gaba ɗaya.Bugu da ƙari ga ikonsa na canza salon daukar ma'aikata na ƙwayoyin kumburi da ƙananan ƙwayoyin cuta, yana daidaita ayyukan proteolytic a wuraren warkar da raunuka da kuma lokacin sake farfadowa da kyallen takarda da suka hada da kashi, guringuntsi da tsoka, sabili da haka yana da mahimmanci a bangaren magungunan musculoskeletal.
Haɓaka warkarwa shine burin da ƙwararru da yawa ke nema a fagen kiwon lafiya, kuma PRP tana wakiltar ingantaccen kayan aikin ilimin halitta wanda ke ci gaba da ba da ci gaba mai ban sha'awa a cikin haɓakawa da ingantaccen haɗin kai na abubuwan haɓakawa.Koyaya, yayin da wannan kayan aikin warkewa ya kasance mai rikitarwa, musamman tunda yana fitar da ɗimbin abubuwan da ke haifar da rayuwa da hanyoyin hulɗarsu da tasirin sigina, ana buƙatar ƙarin karatu.
(Ana sake buga abubuwan da ke cikin wannan labarin, kuma ba mu bayar da garantin bayyananne ko bayyananniyar garanti don daidaito, amintacce ko cikar abubuwan da ke cikin wannan labarin ba, kuma ba mu da alhakin ra'ayoyin wannan labarin, da fatan za a fahimta.)
Lokacin aikawa: Jul-19-2022