Xanuunka neerfaha waxaa loola jeedaa shaqada dareenka aan caadiga ahayn, dareenka xanuunka iyo xanuunka kediska ah ee uu keeno dhaawaca ama cudurka habdhiska dareenka somatic.Inta badan oo iyaga ka mid ah ayaa weli la socon kara xanuunka aagga u dhigma innervated ka dib markii la baabi'iyo arrimo dhaawac, taas oo u muuqataa sida xanuun lama filaan ah, hyperalgesia, hyperalgesia iyo dareen aan caadi ahayn.Waqtigan xaadirka ah, daawooyinka lagu yareeyo xanuunka neuropathic waxaa ka mid ah tricyclic antidepressants, 5-hydroxytryptamine norepinephrine reuptake inhibitors, anticonvulsants gabapentin iyo pregabalin, iyo opioids.Si kastaba ha ahaatee, saamaynta daawaynta maandooriyaha ayaa inta badan xaddidan, taas oo u baahan qorshayaal daaweyneed oo kala duwan sida daaweynta jireed, nidaaminta neerfaha iyo faragelinta qalliinka.Xanuunka daba-dheeraada iyo xaddidaadda shaqeyntu waxay yareyn doontaa ka-qaybgalka bulshada ee bukaan-socodka waxayna keeni doontaa culeys maskaxeed iyo mid dhaqaale oo culus bukaanka.
Plasma qani ah (PRP) waa badeeco balasma ah oo leh platelet daahirnimo sare leh oo lagu helo centrifuging dhiiga iswada.Sannadkii 1954kii, KINGSLEY waxay markii ugu horreysay adeegsatay ereyga caafimaadka ee PRP.Iyada oo loo marayo cilmi baarista iyo horumarinta sanadihii la soo dhaafay, PRP ayaa si weyn loogu isticmaalay qalliinka lafaha iyo wadajirka, qalliinka laf-dhabarka, maqaarka, baxnaaninta iyo waaxaha kale, waxayna door muhiim ah ka ciyaartaa qaybta dayactirka injineernimada unugyada.
Mabda'a aasaasiga ah ee daawaynta PRP waa in la isku duro platelets ee goobta dhaawacan oo la bilaabo hagaajinta nudaha iyada oo la sii daayo arrimo kala duwan oo bioactive ah (waxyaabaha koritaanka, cytokines, lysosomes) iyo borotiinnada adhesion.Walxahan noole noolaha ah ayaa mas'uul ka ah bilaabista falcelinta cascade hemostatic, isku dhafka unugyo cusub oo isku xiran iyo dib u dhiska xididdada dhiigga.
Kala-soocidda iyo cudur-sidaha xanuunka neerfaha Ururka Caafimaadka Adduunka ayaa sii daayay nooca 11-aad ee dib-u-eegis lagu sameeyay ee Kala-soocidda Caalamiga ah ee Xanuunka ee 2018, taas oo u qaybisa xanuunka neuropathic xanuunka dhexe ee neuropathic xanuunka iyo xanuunka neuropathic peripheral.
Xanuunka neuropathic xanuunka waxaa loo kala saaraa iyadoo loo eegayo etiology:
1) Caabuq/barar: neuralgia postherpetic, baras xanuun badan, waraabow/HIV oo qaba neuropathy peripheral
2) Cadaadiska neerfaha: xanuunka carpal tunnel syndrome, xanuunka radicular degenerative spinal
3) Dhaawaca: dhaawac / gubasho / qalliin ka dib / daaweynta shucaaca ka dib xanuunka neuropathic xanuunka
4) Ischemia/metabolism: xanuunka neuropathic ee ku yaala sokorowga
5) Daawooyinka: neuropathy peripheral neuropathy oo ay sababto daroogo (sida kiimoterabiga)
6) Kuwa kale: xanuunka kansarka, neuralgia trigeminal, glossopharyngeal neuralgia, Morton's neuroma
Hababka kala soocida iyo diyaarinta PRP guud ahaan waxay aaminsan yihiin in fiirsashada platelet ee PRP ay afar ama shan jeer ka badan tahay dhiigga oo dhan, laakiin waxaa jiray la'aanta tilmaamayaasha tirada.Sannadkii 2001, Marx waxa uu qeexay in PRP ay ka kooban tahay ugu yaraan 1 milyan oo platelets halkii microliter ee balaasmaha, taas oo ah tilmaanta tirada ee heerka PRP.Dohan iyo al.PRP oo loo kala saaray afar qaybood: PRP saafi ah, leukocyte qani ah PRP, fibrin qani ah oo platelet ah, iyo leukocyte fibrin taajir ah oo ku salaysan waxyaabaha kala duwan ee platelet, leukocyte, iyo fibrin ee PRP.Haddii aan si kale loo cayimin, PRP badanaa waxa ay tixraacdaa PRP hodanka ah unugga cad.
Farsamaynta PRP ee Daaweynta Xanuunka Neuropathic Dhaawaca ka dib, firfircoonayaasha kala duwan ee endogenous iyo exogenous waxay kor u qaadi doonaan firfircoonida platelet α- Granules waxay maraan falcelin deg-deg ah, oo sii daaya tiro badan oo ah arrimaha koritaanka, fibrinogen, cathepsin iyo hydrolase.Qodobbada koritaanka ee la sii daayay waxay ku xiran yihiin dusha sare ee xuubka unugyada ee unugga bartilmaameedka iyada oo loo marayo soo-dhoweynta transmembrane ee xuubka unugyada.Qaboojiyayaasha transmembrane-ku waxay markooda kiciyaan oo ay dhaqaajiyaan borotiinnada calaamadaha endogenous, iyagoo sii kicinaya farriinta labaad ee unugga, taas oo keenta kororka unugyada, samaynta matrixka, isku-darka borotiinka kolajka iyo muujinta hidda-wadaha kale ee unugyada.Waxaa jira caddayn ah in cytokines ay sii daayaan platelets iyo gudbiyeyaasha kale ay door muhiim ah ka ciyaaraan yaraynta / baabi'inta xanuunka neuropathic ee daba-dheeraada.Hababka gaarka ah waxaa loo qaybin karaa hababka durugsan iyo hababka dhexe.
Mechanism of plazma hodanka ah ee platelet (PRP) ee daaweynta xanuunka neuropathic
Hababka durugsan: saamaynta anti-bararka, neuroprotection iyo kor u qaadida dib-u-soo-nooleynta axon, xakamaynta difaaca, saamaynta xanuunka
Habka dhexe: daciifinta iyo dib u noqoshada dareenka dhexe iyo joojinta firfircoonida unugyada glial
Saamaynta Ka-hortagga caabuqa
Dareenka durugsan wuxuu door muhiim ah ka ciyaaraa dhacdooyinka calaamadaha xanuunka neuropathic ka dib dhaawaca dareemayaasha.Unugyo kala duwan oo barar ah, sida neutrophils, macrophages iyo unugyada mastarada, ayaa la dhex geliyay goobta dhaawaca dareemayaasha.Ururinta xad-dhaafka ah ee unugyada bararka waxay aasaas u yihiin kicinta xad-dhaafka ah iyo dheecaanka joogtada ah ee fiilooyinka dareemayaasha.Caabuqa ayaa siidaaya tiro badan oo dhexdhexaadiyeyaasha kiimikaad ah, sida cytokines, chemokines iyo dhexdhexaadiyeyaasha dufanka leh, taasoo ka dhigaysa nociceptors xasaasi ah oo faraxsan, oo keenaya isbeddel ku yimaada deegaanka kiimikada deegaanka.Platelets waxay leeyihiin difaac difaac adag iyo saameyn bararka.Nidaaminta iyo qarsoodiga arrimo kala duwan oo xakameynaya difaaca jirka, arrimaha angiogenic iyo arrimaha nafaqada, waxay yareyn karaan falcelinta difaaca waxyeellada leh iyo bararka, waxayna hagaajin karaan dhaawaca unugyada kala duwan ee microevironments kala duwan.PRP waxay ciyaari kartaa doorka ka hortagga bararka iyada oo loo marayo habab kala duwan.Waxay xannibi kartaa sii-deynta cytokines pro-bararka ee unugyada Schwann, macrophages, neutrophils iyo unugyada mastarada, waxayna joojinayaan muujinta hidda-wadaha ee soo-dhoweynta fayraska pro-inflammatory iyadoo kor u qaadeysa isbeddelka unugyada dhaawacan ee ka yimaada xaalad barar ah una gudubta xaalad ka-hortagga caabuqa.In kasta oo platelets aysan sii deynin interleukin 10, platelets waxay yareeyaan soo saarista xaddi badan oo interleukin 10 ah iyagoo kicinaya unugyada dendritic-ka ee aan qaan-gaarin
Saamaynta xanuunka
Platelets-ka firfircooni waxay sii daayaan neurotransmitters badan oo u ololeeya iyo ka hortagga bararka, kuwaas oo keeni kara xanuunka, laakiin sidoo kale waxay yareeyaan bararka iyo xanuunka.Platelets-ka cusub ee la diyaariyey waxay ku hurdaan PRP.Ka dib markii si toos ah ama si aan toos ahayn loo hawlgeliyo, qaab-dhismeedka platelet-ka ayaa isbeddela oo kor u qaada isku-darka platelet, sii daaya unugyada α-Cunanka gudaha iyo qaybaha dareenka ayaa kicin doona sii deynta 5-hydroxytryptamine, kaas oo leh saameyn xakameynaya xanuunka.Waqtigan xaadirka ah, 5-hydroxytryptamine reseptors ayaa inta badan laga helaa dareemayaasha durugsan.5-hydroxytryptamine waxay saameyn kartaa gudbinta nociceptive ee unugyada ku wareegsan iyada oo loo marayo 5-hydroxytryptamine 1, 5-hydroxytryptamine 2, 5-hydroxytryptamine 3, 5-hydroxytryptamine 4 iyo 5-hydroxytryptamine 7 reseptors.
Joojinta Dhaqdhaqaaqa Unugyada Glial
Unugyada Glial waxay ku xisaabtamaan 70% unugyada habdhiska dhexe ee neerfayaasha, kuwaas oo loo qaybin karo saddex nooc: astrocytes, oligodendrocytes iyo microglia.Microglia ayaa la hawlgeliyay 24 saacadood gudahood ka dib dhaawaca neerfaha, iyo astrocytes ayaa la hawlgeliyay wax yar ka dib dhaawaca neerfaha, iyo firfircoonidu waxay socotay toddobaadyo 12.Astrocytes iyo microglia ayaa markaa sii daaya cytokines waxayna keenaan taxane jawaab celin ah oo unug ah, sida kor u qaadista glucocorticoid iyo glutamate reseptors, taasoo keentay isbeddel ku yimaada kicinta laf-dhabarka iyo balaastigga neerfaha, kaas oo si dhow ula xiriira xanuunka neuropathic.
Waxyaabaha ku lug leh yaraynta ama baabi'inta xanuunka neuropathic ee plazma qani ah ee platelet
1) Angiopoietin:
In ay keento angiogenesis;Kicin guuritaanka unugyada endothelial iyo badinta;Taageer oo deji horumarinta xididdada dhiigga adoo qoraya pericytes
2) Qodobka koritaanka unugyada isku xidhan:
Kicin socdaalka leukocyte;Kor u qaad angiogenesis;Wuxuu kiciyaa myofibroblast wuxuuna kiciyaa kaydinta unugyada unugyada unugyada iyo dib-u-qaabaynta
3) Qodobka koritaanka Epidermal:
Kor u qaadida bogsashada dhaawaca iyo kicinta angiogenesis adoo kor u qaadaya fidinta, guuritaanka iyo kala duwanaanta makrophages iyo fibroblasts;Kicin fibroblasts si ay u qariso collagenase oo ay hoos u dhigto matrix ka baxsan unugyada inta lagu jiro dib-u-qaabaynta boogaha;Kor u qaadida fidinta keratinocytes iyo fibroblasts, taasoo horseedaysa dib-u-celinta epitheliation.
4) Qodobka koritaanka Fibroblast:
Si loo kiciyo chemotaxis ee macrophages, fibroblasts iyo unugyada endothelial;In ay keento angiogenesis;Waxay keeni kartaa granulation iyo unugyada dib u habeynta waxayna ka qayb qaadan kartaa foosha nabarrada.
5) Qodobka koritaanka hepatocyte:
Habeeya korriinka unugyada iyo dhaqdhaqaaqa unugyada epithelial/endothelial;Kor u hagaajinta epithelial iyo angiogenesis.
6) Insulinka sida koritaanka factor:
Isku soo wada duub unugyada fiber-ka si ay u kiciyaan isku-dhafka borotiinka.
7) Qodobka koritaanka ee Platelet:
Kicin chemotaxis ee neutrophils, macrophages iyo fibroblasts, iyo kicin fidinta macrophages iyo fibroblasts isku mar;Waxay ka caawisaa in ay burburiso kolajkii hore iyo kor u habeynta muujinta matrix metalloproteinases, taasoo keentay caabuq, samaynta unugyada granulation, faafinta epithelial, soo saarida matrix ka baxsan unugyada iyo dib u habeynta unugyada;Waxay kor u qaadi kartaa kororka unugyada tarma ee adipose-ka bini'aadamka waxayna gacan ka geysataa doorka dib u soo kabashada dareemayaasha.
8) Unugyada stromal ka soo jeeda:
Wac CD34+unugyada si aad u kiciso homing-kooda, badintooda iyo kala soocidooda unugyada horraanta endothelial, una kiciyaan angiogenesis;Ururi unugyada stem mesenchymal iyo leukocytes.
9) Wax ka beddelka qodobka koritaanka β：
Marka ugu horeysa, waxay leedahay saameynta kor u qaadista caabuqa, laakiin waxay sidoo kale kor u qaadi kartaa isbeddelka qaybta dhaawaca ah ee gobolka ka hortagga caabuqa;Waxay kor u qaadi kartaa chemotaxis ee fibroblasts iyo unugyada muruqa siman;Habbee muujinta collagen iyo collagenase, oo kor u qaad angiogenesis.
10) Qodobka koritaanka xididada xididada xididada:
Taageer iyo kor u qaadida korriinka fiilooyinka dareemayaasha ee dib loo soo nooleeyay iyadoo la isku darayo angiogenesis, neurotrophic iyo neuroprotection, si loo soo celiyo shaqada dareemayaasha.
11) Qodobka koritaanka neerfaha:
Waxay ka ciyaartaa doorka neuroprotective iyadoo kor u qaadaysa koritaanka axon iyo dayactirka iyo badbaadada neerfayaasha.
12) Glial oo ka soo jeeda neurotrophic factor:
Waxay si guul leh u rogi kartaa oo ay caadi u noqon kartaa borotiinnada neurogenic waxayna ciyaaraan doorka neuroprotective.
Gabagabo
1) Balasma qani ku ah Platelet waxay leedahay sifooyin kor u qaadida bogsashada iyo ka hortagga caabuqa.Kaliya ma hagaajin karto unugyada dareemayaasha ee dhaawacan, laakiin sidoo kale si wax ku ool ah u nafiso xanuunka.Waa habka daaweynta muhiimka ah ee xanuunka neuropathic wuxuuna leeyahay rajooyin dhalaalaya;
2) Habka diyaarinta ee balasmaha qaniga ah ee platelet weli waa muran ka taagan yahay, isaga oo ku baaqaya in la sameeyo hab diyaargarow oo heersare ah iyo heerka qiimaynta qayb midaysan;
3) Waxaa jira daraasado badan oo ku saabsan Plasma hodanka ah ee platelet ee xanuunka neuropathic ee uu keeno dhaawaca laf dhabarta, dhaawaca dareemaha durugsan iyo cadaadiska dareemayaasha.Habka iyo waxtarka bukaan-socodka ee plazma qani ah ee platelet ee noocyada kale ee xanuunka neuropathic waxay u baahan yihiin in la sii darso.
Xanuunka neerfaha waa magaca guud ee fasalka weyn ee cudurrada kiliinikada, kaas oo aad ugu badan dhaqanka bukaan-socodka.Si kastaba ha ahaatee, ma jiro hab daaweyn gaar ah hadda, oo xanuunku wuxuu socdaa dhowr sano ama xitaa nolosha ka dib jirrada, taasoo keenta culeys halis ah bukaanka, qoysaska iyo bulshada.Daaweynta maandooriyaha ayaa ah qorshaha daaweynta aasaasiga ah ee xanuunka neuropathic.Baahida dawooyinka muddada dheer awgeed, u hoggaansanaanta bukaanku ma fiicna.Daawaynta muddada dheer waxay kordhin doontaa falcelinta daroogada waxayna dhaawac weyn u geysataa jirka iyo maskaxda bukaanka.Tijaabooyin aasaasi ah oo ku habboon iyo daraasadaha kiliinikada ayaa caddeeyey in PRP loo isticmaali karo in lagu daweeyo xanuunka neuropathic, PRP waxay ka timaaddaa bukaanka laftiisa, iyada oo aan lahayn fal-celinta difaaca jirka.Habka daawaynta waa mid fudud, oo leh falcelin xun.PRP waxa kale oo loo isticmaali karaa unugyada asliga ah, kuwaas oo awood xooggan u leh hagaajinta dareemayaasha iyo dib-u-soo-nooleynta unugyada, waxayna yeelan doonaan rajooyin ballaadhan oo ku saabsan daaweynta xanuunka neuropathic mustaqbalka.
(Qoddobada maqaalkan dib ayaa loo daabacay, mana bixinno dammaanad cad ama dammaanad dhab ah oo sax ah, isku halaynta ama dhammaystirnaanta waxa ku jira maqaalkan, mas'uulna kama aha fikradaha maqaalkan, fadlan fahan.)
Waqtiga boostada: Dec-20-2022