Osteoarthritis na farko na gwiwa (OA) ya kasance cuta mai lalacewa da ba za a iya sarrafa ta ba.Tare da haɓaka tsammanin rayuwa da kuma annobar kiba, OA yana haifar da nauyi na tattalin arziki da na jiki.Knee OA cuta ce ta musculoskeletal na yau da kullun wacce ƙila a ƙarshe na buƙatar sa hannun tiyata.Sabili da haka, marasa lafiya suna ci gaba da neman hanyoyin da ba za a iya amfani da su ba, kamar allurar plasma mai arzikin platelet (PRP) a cikin haɗin gwiwa da ya shafa.
A cewar Jayaram et al., PRP magani ne mai tasowa don OA.Duk da haka, shaidar asibiti game da tasirinta har yanzu ba a samu ba, kuma tsarin aikinsa ba shi da tabbas.Kodayake an ba da rahoton sakamako masu ban sha'awa game da amfani da PRP a gwiwa OA, tambayoyi masu mahimmanci irin su tabbataccen shaida game da tasirin sa, daidaitattun allurai, da dabarun shirye-shirye masu kyau sun kasance ba a sani ba.
An kiyasta Knee OA zai shafi fiye da 10% na yawan al'ummar duniya, tare da hadarin rayuwa na 45%.Jagororin zamani suna ba da shawarar duka marasa magani (misali, motsa jiki) da jiyya na magunguna, irin su magungunan hana kumburin ciki na baka (NSAIDs).Koyaya, waɗannan jiyya yawanci suna da fa'idodi na ɗan gajeren lokaci kawai.Bugu da ƙari kuma, yin amfani da miyagun ƙwayoyi a cikin marasa lafiya tare da cututtuka yana iyakance saboda haɗarin rikitarwa.
Intra-articular corticosteroids yawanci ana amfani da su ne kawai don rage jin zafi na ɗan gajeren lokaci saboda amfanin su yana iyakance ga 'yan makonni, kuma an nuna maimaita alluran da za a hade tare da ƙara yawan asarar guringuntsi.Wasu mawallafa sun bayyana cewa amfani da hyaluronic acid (HA) yana da rikici.Duk da haka, wasu marubuta sun ba da rahoton jin zafi bayan 3 zuwa 5 injections na mako-mako na HA don 5 zuwa 13 makonni (wani lokaci har zuwa 1 shekara).
Lokacin da hanyoyin da ke sama suka gaza, ana ba da shawarar jimlar ƙwanƙwasa gwiwa (TKA) a matsayin magani mai inganci.Koyaya, yana da tsada kuma yana iya haɗawa da illar likita da bayan tiyata.Don haka, yana da mahimmanci a gano madadin amintattun jiyya masu inganci don OA gwiwa.
Kwanan nan an bincika hanyoyin kwantar da hankali, irin su PRP, don maganin OA gwiwa.PRP samfur ne na jini mai sarrafa kansa tare da babban taro na platelet.Ana tsammanin tasirin PRP yana da alaƙa da sakin abubuwan haɓakawa da sauran ƙwayoyin cuta, gami da nau'in haɓakar haɓakar platelet (PDGF), factor factor factor (TGF) -beta, nau'in nau'in haɓakar insulin-kamar I (IGF-I) , da kuma jijiyoyi masu girma na endothelial (VEGF).
Yawancin wallafe-wallafe sun nuna cewa PRP na iya yin alƙawari don maganin OA gwiwa.Duk da haka, yawancin basu yarda da hanya mafi kyau ba, kuma akwai iyakoki da yawa waɗanda ke iyakance ingantaccen bincike na sakamakon su, cikin haɗarin rashin son zuciya.Bambance-bambancen shirye-shiryen da hanyoyin allura da aka yi amfani da su a cikin binciken da aka ruwaito shine iyakancewa wajen ayyana ingantaccen tsarin PRP.Bugu da ƙari kuma, yawancin gwaje-gwaje sun yi amfani da HA a matsayin mai kwatanta, wanda ke da rikici a kanta.Wasu gwaje-gwajen da aka kwatanta PRP zuwa placebo kuma sun nuna ingantaccen ingantaccen alamar alama fiye da saline a watanni 6 da 12.Duk da haka, waɗannan gwaje-gwajen suna da lahani masu yawa, ciki har da rashin makanta mai kyau, yana nuna cewa za a iya ƙididdige amfanin su.
Abubuwan da ake amfani da su na PRP don maganin OA gwiwa sune kamar haka: yana da kyau don amfani da shi saboda saurin shirye-shiryensa da ƙananan cin zarafi;wata dabara ce mai araha saboda amfani da sifofi da kayan aiki na kiwon lafiyar jama'a;kuma yana iya zama lafiya, saboda samfur ne mai sarrafa kansa.Littattafan da suka gabata sun ba da rahoton ƙananan matsaloli da na ɗan lokaci kawai.
Manufar wannan labarin shine don sake nazarin tsarin kwayoyin halitta na halin yanzu na aikin PRP da girman ingancin allurar intra-articular na PRP a cikin marasa lafiya tare da gwiwa OA.
Tsarin kwayoyin halitta na aikin plasma mai arzikin platelet
Laburaren Cochrane da PubMed (MEDLINE) sun bincika binciken da suka danganci PRI a gwiwa OA.Lokacin binciken yana daga farkon injin bincike zuwa Disamba 15, 2021. Nazarin PRP kawai a gwiwa OA wanda marubutan suka yi la'akari da mafi girman sha'awa an haɗa su.PubMed ta samo labarai 454, daga cikinsu an zaɓi 80.An samo labarin a cikin Laburaren Cochrane, wanda kuma aka yi maƙalar, tare da jimillar nassoshi 80.
Wani binciken da aka buga a cikin 2011 ya nuna cewa yin amfani da abubuwan haɓaka (mambobi ne na TGF-β superfamily, fibroblast girma factor iyali, IGF-I da PDGF) a cikin gudanar da OA ya bayyana mai ban sha'awa.
A cikin 2014, Sandman et al.ya ruwaito cewa maganin PRP na haɗin gwiwa na OA ya haifar da raguwa a cikin catabolism;duk da haka, PRP ya haifar da raguwa mai yawa a cikin matrix metalloproteinase 13, karuwa a cikin hyaluronan synthase 2 magana a cikin kwayoyin synovial, da karuwa a cikin aikin haɗin gwiwar guringuntsi.Sakamakon wannan binciken ya nuna cewa PRP yana ƙarfafa samar da HA na endogenous kuma yana rage catabolism na guringuntsi.PRP kuma ta hana ƙaddamar da masu shiga tsakani masu kumburi da maganganun su a cikin synovial da chondrocytes.
A cikin 2015, binciken dakin gwaje-gwajen da aka sarrafa ya nuna cewa PRP yana haɓaka haɓakar ƙwayoyin sel da haɓakar furotin na sama a cikin guringuntsin gwiwa na ɗan adam da ƙwayoyin synovial.Waɗannan abubuwan lura suna taimakawa wajen bayyana hanyoyin sinadarai masu alaƙa da tasirin PRP a cikin maganin gwiwa OA.
A cikin samfurin OA murine (binciken dakin gwaje-gwajen sarrafawa) wanda Khatab et al ya ruwaito.A cikin 2018, yawancin alluran sakewa na PRP sun rage zafi da kauri na synovial, mai yuwuwa matsakaita ta hanyar macrophage subtypes.Don haka, waɗannan alluran suna bayyana don rage zafi da kumburi na synovial, kuma suna iya hana ci gaban OA a cikin marasa lafiya tare da matakin farko na OA.
A cikin 2018, nazarin wallafe-wallafen PubMed ya kammala cewa PRP magani na OA ya bayyana yana yin tasiri mai mahimmanci akan hanyar Wnt / β-catenin, wanda zai iya zama mahimmanci don cimma tasirin tasirinsa na asibiti.
A cikin 2019, Liu et al.ya binciki tsarin kwayoyin halitta wanda PRP-samu exosomes ke da hannu wajen rage OA.Yana da mahimmanci a nuna cewa exosomes suna taka muhimmiyar rawa a cikin sadarwar salula.A cikin wannan binciken, an ware chondrocytes na zomo na farko kuma an bi da su tare da interleukin (IL) -1β don kafa samfurin in vitro na OA.An auna haɓakawa, ƙaura, da ƙididdigar apoptosis kuma idan aka kwatanta tsakanin PRP da aka samu exosomes da PRP da aka kunna don tantance tasirin warkewa akan OA.Hanyoyin da ke cikin hanyar siginar Wnt/β-catenin an bincika su ta hanyar bincike na lalata na yamma.An samo exosomes da aka samu PRP suna da irin wannan ko mafi kyawun tasirin warkewa akan OA fiye da kunna PRP a cikin vitro da a vivo.
A cikin ƙirar linzamin kwamfuta na posttraumatic OA da aka ruwaito a cikin 2020, Jayaram et al.bayar da shawarar cewa tasirin PRP akan ci gaban OA da cututtukan da ke haifar da hyperalgesia na iya zama masu dogaro da leukocyte.Har ila yau, sun ambaci cewa leukocyte-poor PRP (LP-PRP) da ƙananan adadin leukocyte-rich PRP (LR-PRP) suna hana girma da hasara.
Sakamakon binciken da Yang et al.Nazarin 2021 ya nuna cewa PRP aƙalla an rage IL-1β-induced chondrocyte apoptosis da kumburi ta hanyar hana hypoxia-inducible factor 2α.
A cikin ƙirar bera na OA ta amfani da PRP, Sun et al.microRNA-337 da microRNA-375 an samo su don jinkirta ci gaban OA ta hanyar shafar kumburi da apoptosis.
A cewar Sheean et al., Ayyukan nazarin halittu na PRP suna da yawa: platelet alpha granules suna inganta sakin abubuwan haɓaka daban-daban, ciki har da VEGF da TGF-beta, kuma ana sarrafa kumburi ta hanyar hana hanyar hanyar nukiliya-κB.
An bincika abubuwan abubuwan ban dariya a cikin PRP waɗanda aka shirya daga duka kayan aiki da tasirin abubuwan ban dariya akan macrophage phenotype.Sun sami bambance-bambance a cikin sassan salula da kuma abubuwan ban dariya tsakanin PRP da aka tsarkake ta amfani da kayan biyun.Maganin furotin mai sarrafa kansa LR-PRP kit yana da mafi girman ƙima na abubuwan da ke da alaƙa da macrophage M1 da M2.Ƙara na PRP supernatant zuwa al'ada matsakaici na monocyte-samu macrophages da M1 polarized macrophages nuna cewa PRP hana M1 macrophage polarization da kuma inganta M2 macrophage polarization.
A cikin 2021, Szwedowski et al.Abubuwan haɓakar haɓakar da aka saki a cikin haɗin gwiwa na OA bayan allurar PRP an bayyana su: ƙwayar necrosis factor (TNF), IGF-1, TGF, VEGF, rarrabawa, da metalloproteinases tare da motifs na thrombospondin, interleukins, matrix metalloproteinases, matrix metalloproteinases, factor factor girma na epidermal, hepatocyte girma factor, fibroblast factor. ma'aunin girma, keratinocyte girma factor da platelet factor 4.
1. PDGF
An fara gano PDGF a cikin platelets.Yana da juriya mai zafi, mai jurewa acid, cationic polypeptide wanda trypsin ke iya sanyawa cikin sauƙi.Yana ɗaya daga cikin abubuwan haɓaka na farko waɗanda ke bayyana a wuraren karaya.An bayyana shi sosai a cikin nama mai rauni mai rauni, wanda ke sa osteoblasts chemotactic da haɓakawa, yana haɓaka ikon haɓakar collagen, kuma yana haɓaka haɓakar osteoclasts, ta haka yana haɓaka haɓakar ƙashi.Bugu da ƙari, PDGF kuma na iya inganta haɓakawa da bambance-bambancen fibroblasts da inganta gyaran nama.
2. TGF-B
TGF-B wani polypeptide ne wanda ya ƙunshi sarƙoƙi na 2, wanda ke aiki akan fibroblasts da pre-osteoblasts a cikin nau'in paracrine da / ko autocrine, yana haɓaka haɓakar osteoblasts da pre-osteoblasts da haɓakar fiber na collagen, azaman chemokine, osteoproge Kwayoyin suna shiga cikin nama na kashin da suka ji rauni, kuma an hana samuwar da kuma sha na osteoclasts.TGF-B kuma yana daidaita tsarin ECM (extracellular matrix), yana da tasirin chemotactic akan neutrophils da monocytes, kuma yana daidaita martanin kumburi na gida.
3. VEGF
VEGF wani dimeric glycoprotein ne, wanda ke ɗaure ga masu karɓa a saman sel endothelial na jijiyoyin jini ta hanyar autocrine ko paracrine, yana haɓaka haɓakar ƙwayoyin sel, haifar da samuwar da kafa sabbin hanyoyin jini, yana ba da iskar oxygen zuwa ƙarewar karaya, samar da abinci mai gina jiki, da jigilar abubuwan sharar gida. ., samar da microenvironment mai kyau don haɓakawa a cikin yanki na farfadowa na gida.Sa'an nan, a karkashin aikin VEGF, aikin alkaline phosphatase na bambance-bambancen osteoblast yana inganta, kuma ana ajiye salts na calcium na gida don inganta waraka.Bugu da ƙari, VEGF yana inganta gyaran gyare-gyare mai laushi ta hanyar inganta samar da jini na nama mai laushi a kusa da raguwa, kuma yana inganta warkar da raunuka, kuma yana da tasiri na haɓaka tare da PDGF.
4. EGF
EGF wani nau'i ne mai ƙarfi na haɓakar ƙwayoyin sel wanda ke haɓaka rarrabuwa da haɓaka nau'ikan nau'ikan ƙwayoyin nama a cikin jiki, yayin haɓaka haɓakar matrix da ƙididdigewa, haɓaka haɓakar ƙwayoyin fibrous, da ci gaba da canzawa zuwa kashi don maye gurbin nama na nama.Wani abu da EGF ke shiga cikin gyaran karaya shi ne cewa zai iya kunna phospholipase A, don haka inganta sakin arachidonic acid daga sel epithelial, da kuma inganta kira na prostaglandins ta hanyar daidaita ayyukan cyclooxygenase da lipoxygenase.Matsayin resorption da kuma samuwar kashi daga baya.Ana iya ganin cewa EGF yana shiga cikin tsarin warkar da raunuka kuma yana iya hanzarta warkar da raunuka.Bugu da ƙari, EGF na iya inganta haɓakar ƙwayoyin epidermal da ƙwayoyin endothelial, da kuma haifar da kwayoyin halitta don yin ƙaura zuwa ga rauni.
5. IGF
IGF-1 shine nau'in sarkar polypeptide guda ɗaya wanda ke ɗaure ga masu karɓa a cikin kashi kuma yana kunna protease na tyrosine bayan autophosphorylation mai karɓa, wanda ke inganta phosphorylation na insulin receptor substrates, ta haka ne ke daidaita girman cell, yaduwa da metabolism.Yana iya ta da Osteoblasts da pre-osteoblasts, inganta guringuntsi da kuma kasusuwa matrix samuwar.Bugu da ƙari, yana taka muhimmiyar rawa wajen haɗuwa da gyaran gyare-gyaren kashi ta hanyar daidaitawa da bambance-bambance da samuwar osteoblasts da osteoclasts da ayyukan aikin su.Bugu da ƙari, IGF kuma yana ɗaya daga cikin mahimman abubuwan da ke gyara rauni.Wani abu ne wanda ke inganta shigar da fibroblasts a cikin tsarin tantanin halitta kuma yana haifar da bambance-bambance da haɗuwa da fibroblasts.
PRP wani abu ne mai sarrafa kansa na platelet da abubuwan girma wanda aka samo daga jini mai tatsuniyoyi.Akwai nau'ikan nau'ikan nau'ikan nau'ikan platelet guda biyu: fibrin mai wadatar platelet da abubuwan haɓaka mai wadatar plasma.Ana iya samun PRP daga jinin ruwa kawai;ba zai yiwu a sami PRP daga jini ko zubar jini ba.
Akwai dabarun kasuwanci daban-daban don tattara jini da samun PRP.Bambance-bambancen da ke tsakanin su sun haɗa da adadin jinin da ake buƙatar cirewa daga majiyyaci;dabarar warewa;gudun centrifugation;adadin don maida hankali ƙarar bayan centrifugation;lokacin aiki;
Daban-daban dabarun centrifugation jini an bayar da rahoton su shafi leukocyte rabo.Lambobin platelet a cikin 1 μL na jini daga mutane masu lafiya suna daga 150,000 zuwa 300,000.Platelets ne ke da alhakin dakatar da zubar jini.
Alfa granules na platelets sun ƙunshi nau'ikan sunadarai daban-daban kamar abubuwan haɓaka (misali canza factor factor beta, insulin-kamar girma factor, epidermal girma factor), chemokines, coagulants, anticoagulants, fibrinolytic sunadaran, manne sunadarai, Integral membrane proteins, rigakafi matsakanci. , abubuwan angiogenic da masu hanawa, da sunadaran ƙwayoyin cuta.
Ba a san ainihin tsarin aikin PRP ba.PRP ya bayyana yana motsa chondrocytes don sake gyara guringuntsi da biosynthesis na collagen da proteoglycans.An yi amfani da shi a fannonin kiwon lafiya daban-daban kamar tiyata na baka da na maxillofacial (ciki har da temporomandibular OA), ilimin fata, ilimin ido, tiyatar zuciya da kuma tiyatar filastik.
(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: Yuli-27-2022