Neuropathic mob yog hais txog qhov txawv txav ntawm kev hnov mob, mob rhiab heev thiab mob tshwm sim los ntawm kev raug mob lossis kab mob ntawm lub paj hlwb somatic.Feem ntau ntawm lawv tseem tuaj yeem nrog qhov mob ntawm qhov sib thooj innervated cheeb tsam tom qab tshem tawm ntawm qhov raug mob, uas yog tshwm sim raws li qhov mob tshwm sim, hyperalgesia, hyperalgesia thiab txawv txav.Tam sim no, cov tshuaj rau kev txo cov mob neuropathic suav nrog tricyclic antidepressants, 5-hydroxytryptamine norepinephrine reuptake inhibitors, anticonvulsants gabapentin thiab pregabalin, thiab opioids.Txawm li cas los xij, cov txiaj ntsig ntawm kev kho tshuaj feem ntau txwv, uas yuav tsum tau siv ntau hom kev kho mob xws li kev kho lub cev, kev tswj hwm ntawm neural thiab kev cuam tshuam kev phais.Kev mob ntev thiab kev ua haujlwm tsis zoo yuav txo qis kev koom tes ntawm cov neeg mob thiab ua rau muaj kev puas siab puas ntsws thiab nyiaj txiag hnyav rau cov neeg mob.
Platelet nplua nuj plasma (PRP) yog cov khoom siv plasma nrog cov ntshav purity siab uas tau txais los ntawm cov ntshav centrifuging autologous.Xyoo 1954, KINGSLEY thawj zaug siv lo lus kho mob PRP.Los ntawm kev tshawb fawb thiab kev loj hlob nyob rau hauv xyoo tas los no, PRP tau siv dav hauv kev phais pob txha thiab kev sib koom tes, kev phais mob txha caj qaum, dermatology, kho dua tshiab thiab lwm lub tuam tsev, thiab ua lub luag haujlwm tseem ceeb hauv kev kho cov ntaub so ntswg engineering.
Lub hauv paus ntsiab lus ntawm PRP kev kho mob yog txhaj tshuaj muaj zog platelets ntawm qhov chaw raug mob thiab pib kho cov ntaub so ntswg los ntawm kev tso tawm ntau yam bioactive yam (txog kev loj hlob, cytokines, lysosomes) thiab adhesion proteins.Cov tshuaj bioactive no yog lub luag haujlwm rau kev pib cov tshuaj tiv thaiv hemostatic cascade, cov synthesis ntawm cov ntaub so ntswg tshiab thiab vascular reconstruction.
Kev faib tawm thiab pathogenesis ntawm mob neuropathic Lub Koom Haum Ntiaj Teb Kev Noj Qab Haus Huv tau tshaj tawm 11th hloov kho tshiab ntawm International Classification of Pain hauv 2018, faib cov mob neuropathic rau hauv nruab nrab cov mob neuropathic thiab peripheral neuropathic mob.
Peripheral neuropathic mob yog cais raws li etiology:
1) Kab mob / mob: postherpetic neuralgia, mob mob ruas, mob syphilis/HIV mob peripheral neuropathy
2) Nerve compression: carpal tunnel syndrome, spinal degenerative radicular mob
3) Kev raug mob: raug mob / hlawv / tom qab ua haujlwm / tom qab siv hluav taws xob kho mob neuropathic mob
4) ischemia / metabolism: mob ntshav qab zib peripheral neuropathic mob
5) Tshuaj: peripheral neuropathy tshwm sim los ntawm cov tshuaj (xws li kws khomob)
6) Lwm yam: mob qog noj ntshav, trigeminal neuralgia, glossopharyngeal neuralgia, Morton's neuroma
Kev faib tawm thiab kev npaj ntawm PRP feem ntau ntseeg tias platelet concentration hauv PRP yog plaub lossis tsib npaug ntawm cov ntshav tag nrho, tab sis muaj qhov tsis muaj qhov ntsuas ntau.Hauv xyoo 2001, Marx tau txhais tias PRP muaj tsawg kawg yog 1 lab platelets ib microliter ntawm cov ntshav ntshav, uas yog qhov ntsuas ntau ntawm tus qauv ntawm PRP.Dohan et al.cais PRP ua plaub pawg: ntshiab PRP, leukocyte nplua nuj PRP, ntshiab platelet nplua nuj fibrin, thiab leukocyte nplua nuj platelet fibrin raws li cov ntsiab lus sib txawv ntawm platelet, leukocyte, thiab fibrin hauv PRP.Tshwj tsis yog tias tau teev tseg, PRP feem ntau yog hais txog dawb cell nplua nuj PRP.
Mechanism ntawm PRP nyob rau hauv kev kho mob ntawm Neuropathic Mob Tom qab raug mob, ntau yam endogenous thiab exogenous activators yuav txhawb platelet activation α- Cov granules undergo degranulation cov tshuaj tiv thaiv, tso ib tug loj tus naj npawb ntawm kev loj hlob yam, fibrinogen, cathepsin thiab hydrolase.Cov txiaj ntsig kev loj hlob tso tawm khi rau sab nrauv ntawm lub cell membrane ntawm lub hom phiaj ntawm tes los ntawm transmembrane receptors ntawm lub cell membrane.Cov transmembrane receptors nyob rau hauv lem induce thiab qhib endogenous signaling proteins, ntxiv activating tus thib ob messenger nyob rau hauv lub cell, uas induces cell proliferation, matrix tsim, synthesis ntawm collagen protein thiab lwm yam intracellular gene qhia.Muaj pov thawj tias cytokines tso tawm los ntawm platelets thiab lwm yam transmitters ua lub luag haujlwm tseem ceeb hauv kev txo / tshem tawm cov mob neuropathic mob ntev.Cov txheej txheem tshwj xeeb tuaj yeem muab faib ua peripheral mechanisms thiab central mechanisms.
Mechanism ntawm platelet nplua nuj plasma (PRP) hauv kev kho mob neuropathic
Peripheral mechanisms: anti-inflammatory nyhuv, neuroprotection thiab txhawb nqa axon regeneration, tiv thaiv kab mob, analgesic nyhuv
Central mechanism: tsis muaj zog thiab thim rov qab hauv nruab nrab rhiab heev thiab inhibiting glial cell activation
Anti-inflammatory nyhuv
Peripheral sensitization plays lub luag haujlwm tseem ceeb hauv qhov tshwm sim ntawm cov tsos mob neuropathic mob tom qab raug mob paj hlwb.Ntau yam kab mob inflammatory, xws li neutrophils, macrophages thiab mast hlwb, tau nkag mus rau hauv cov hlab ntsha raug mob.Cov tsub zuj zuj ntawm cov kab mob inflammatory ntau dhau los ua lub hauv paus ntawm kev excitation ntau dhau thiab ua rau cov hlab ntsha tsis tu ncua.Kev mob tshwm sim tso tawm ntau cov tshuaj lom neeg, xws li cytokines, chemokines thiab lipid mediators, ua rau cov nociceptors rhiab heev, thiab ua rau muaj kev hloov pauv hauv cheeb tsam tshuaj lom neeg.Platelets muaj zog tiv thaiv kab mob thiab tiv thaiv kab mob.Los ntawm kev tswj hwm thiab zais ntau yam kev tiv thaiv kev tiv thaiv kab mob, cov yam ntxwv angiogenic thiab cov khoom noj khoom haus, lawv tuaj yeem txo cov kab mob tiv thaiv kab mob thiab kev mob, thiab kho cov ntaub so ntswg sib txawv hauv cov microenvironments.PRP tuaj yeem ua lub luag haujlwm tiv thaiv kab mob los ntawm ntau yam txheej txheem.Nws tuaj yeem thaiv kev tso tawm ntawm cov kab mob pro-inflammatory cytokines los ntawm Schwann hlwb, macrophages, neutrophils thiab mast hlwb, thiab inhibit cov noob qhia ntawm pro-inflammatory factor receptors los ntawm kev txhawb kev hloov ntawm cov ntaub so ntswg puas los ntawm lub xeev inflammatory mus rau lub xeev anti-inflammatory.Txawm hais tias platelets tsis tso tawm interleukin 10, platelets txo cov khoom loj ntawm interleukin 10 los ntawm inducing cov hlwb tsis paub tab dendritic γ- Kev tsim cov interferon plays lub luag haujlwm tiv thaiv.
Cov nyhuv analgesic
Activated platelets tso tawm ntau yam pro-inflammatory thiab anti-inflammatory neurotransmitters, uas tuaj yeem ua rau mob, tab sis kuj txo qhov mob thiab mob.Cov platelets npaj tshiab yog dormant hauv PRP.Tom qab tau ncaj qha los yog tsis ncaj ncees, platelet morphology hloov pauv thiab txhawb nqa nws cov khoom siv ntom ntom nti thiab muaj nuj nqis rau kev tso tawm ntawm 5-hydroetized cov lus, uas muaj qhov mob kev cai cuam tshuam.Tam sim no, 5-hydroxytryptamine receptors feem ntau kuaj pom hauv cov hlab ntsha peripheral.5-hydroxytryptamine tuaj yeem cuam tshuam qhov kev sib kis nociceptive hauv cov ntaub so ntswg ib puag ncig los ntawm 5-hydroxytryptamine 1, 5-hydroxytryptamine 2, 5-hydroxytryptamine 3, 5-hydroxytryptamine 4 thiab 5-hydroxytryptamine 7 receptors.
Inhibition ntawm Glial Cell Activation
Glial hlwb suav txog li 70% ntawm lub hauv paus paj hlwb hlwb, uas tuaj yeem muab faib ua peb hom: astrocytes, oligodendrocytes thiab microglia.Microglia tau qhib rau hauv 24 teev tom qab cov hlab ntsha raug mob, thiab astrocytes tau qhib sai sai tom qab cov hlab ntsha raug mob, thiab qhov ua kom tau siv sijhawm li 12 lub lis piam.Astrocytes thiab microglia tom qab ntawd tso tawm cytokines thiab ua rau muaj ntau cov lus teb ntawm tes, xws li kev tswj hwm ntawm glucocorticoid thiab glutamate receptors, ua rau muaj kev hloov pauv ntawm tus txha caj qaum excitation thiab neural plasticity, uas yog ze ze rau qhov tshwm sim ntawm qhov mob neuropathic.
Cov xwm txheej cuam tshuam los yog tshem tawm cov mob neuropathic hauv platelet nplua nuj plasma
1) Angiopoietin:
Induce angiogenesis;Txhawb nqa endothelial cell migration thiab proliferation;Txhawb nqa thiab txhim kho cov hlab ntsha los ntawm kev nrhiav cov pericytes
2) Connective cov ntaub so ntswg loj hlob yam:
Txhawb nqa leukocyte tsiv teb tsaws;Txhawb nqa angiogenesis;Activates myofibroblast thiab stimulates extracellular matrix deposition thiab remodeling
3) Epidermal loj hlob yam:
Txhawb kev kho qhov txhab thiab induce angiogenesis los ntawm kev txhawb nqa kev loj hlob, kev tsiv teb tsaws thiab kev sib txawv ntawm macrophages thiab fibroblasts;Txhawb nqa fibroblasts kom zais collagenase thiab degrade extracellular matrix thaum kho qhov txhab;Txhawb txoj kev loj hlob ntawm keratinocytes thiab fibroblasts, ua rau rov ua dua epithelium.
4) Fibroblast loj hlob yam:
Txhawm rau induce chemotaxis ntawm macrophages, fibroblasts thiab endothelial hlwb;Induce angiogenesis;Nws tuaj yeem ua rau granulation thiab kho cov ntaub so ntswg thiab koom nrog hauv qhov txhab mob.
5) Hepatocyte loj hlob yam:
Tswj kev loj hlob ntawm tes thiab txav ntawm epithelial / endothelial hlwb;Txhawb kev kho epithelial thiab angiogenesis.
6) Cov tshuaj insulin zoo li kev loj hlob zoo:
Sib sau ua ke cov hlwb fiber ntau los txhawb cov protein synthesis.
7) Platelet derived kev loj hlob yam:
Txhawb cov chemotaxis ntawm neutrophils, macrophages thiab fibroblasts, thiab txhawb kev loj hlob ntawm macrophages thiab fibroblasts tib lub sijhawm;Nws pab kom decompose qub collagen thiab nce tswj kev qhia ntawm matrix metalloproteinases, ua rau o, granulation ntaub so ntswg tsim, epithelial proliferation, zus tau tej cov extracellular matrix thiab cov ntaub so ntswg remodeling;Nws tuaj yeem txhawb kev loj hlob ntawm tib neeg adipose derived qia hlwb thiab pab ua lub luag haujlwm hauv paj hlwb.
8) Stromal cell derived yam:
Hu rau CD34 + cell los txhawb lawv lub hom phiaj, kev loj hlob thiab kev sib txawv rau hauv endothelial progenitor cells, thiab txhawb nqa angiogenesis;Sau mesenchymal qia hlwb thiab leukocytes.
9) Kev hloov pauv kev loj hlob β:
Thaum xub thawj, nws muaj cov txiaj ntsig ntawm kev txhawb kev mob, tab sis nws kuj tuaj yeem txhawb kev hloov pauv ntawm qhov raug mob mus rau lub xeev anti-inflammatory;Nws tuaj yeem txhim kho cov chemotaxis ntawm fibroblasts thiab cov leeg nqaij du;Kev tswj cov kev qhia ntawm collagen thiab collagenase, thiab txhawb nqa angiogenesis.
10) Vascular endothelial kev loj hlob yam:
Txhawb nqa thiab txhawb kev loj hlob ntawm cov paj hlwb regenerated los ntawm kev sib txuas ntawm angiogenesis, neurotrophic thiab neuroprotection, thiaj li los kho cov paj hlwb.
11) Nerve growth factor:
Nws ua lub luag haujlwm tiv thaiv kab mob los ntawm kev txhawb nqa kev loj hlob ntawm axons thiab kev saib xyuas thiab ciaj sia ntawm neurons.
12) Glial derived neurotrophic yam:
Nws tuaj yeem ua tiav rov qab thiab normalize cov proteins neurogenic thiab ua lub luag haujlwm tiv thaiv neuroprotective.
Xaus
1) Platelet nplua nuj plasma muaj cov yam ntxwv ntawm kev txhawb kev kho thiab tiv thaiv kev mob.Nws tuaj yeem kho tsis tau tsuas yog kho cov paj hlwb puas, tab sis kuj zoo txo qhov mob.Nws yog ib qho tseem ceeb ntawm txoj kev kho mob rau cov mob neuropathic thiab muaj qhov ci ntsa iab;
2) Txoj kev npaj ntawm platelet nplua nuj plasma tseem muaj kev tsis sib haum xeeb, hu rau kev tsim cov txheej txheem kev npaj thiab kev sib koom ua ke kev soj ntsuam tus qauv;
3) Muaj ntau ntau cov kev tshawb fawb ntawm platelet nplua nuj plasma nyob rau hauv cov mob neuropathic tshwm sim los ntawm tus txha caj qaum raug mob, peripheral paj raug mob thiab paj hlwb compression.Cov txheej txheem thiab kev kho mob ua tau zoo ntawm platelet nplua nuj plasma hauv lwm hom mob neuropathic yuav tsum tau kawm ntxiv.
Neuropathic mob yog lub npe dav dav ntawm chav kho mob loj, uas muaj ntau heev hauv kev kho mob.Txawm li cas los xij, tsis muaj ib txoj kev kho mob tshwj xeeb tam sim no, thiab qhov mob yuav kav ntev li ob peb xyoos lossis txawm tias lub neej tom qab muaj mob, ua rau lub nra hnyav rau cov neeg mob, tsev neeg thiab zej zog.Kev kho tshuaj yog qhov kev kho mob yooj yim rau kev mob neuropathic.Vim qhov kev xav tau ntawm cov tshuaj mus sij hawm ntev, cov neeg mob kev ua raws cai tsis zoo.Kev siv tshuaj ntev ntev yuav ua rau muaj kev phiv tshuaj tsis zoo thiab ua rau muaj kev puas tsuaj rau lub cev thiab lub hlwb rau cov neeg mob.Cov kev sim cuam tshuam thiab kev tshawb fawb soj ntsuam tau ua pov thawj tias PRP tuaj yeem siv los kho cov mob neuropathic, thiab PRP los ntawm tus neeg mob nws tus kheej, tsis muaj tshuaj tiv thaiv autoimmune.Cov txheej txheem kev kho mob yog qhov yooj yim, nrog ob peb yam tsis zoo.PRP kuj tseem tuaj yeem siv ua ke nrog cov qia hlwb, uas muaj peev xwm kho cov paj hlwb thiab cov ntaub so ntswg, thiab yuav muaj cov ntawv thov dav dav hauv kev kho mob neuropathic yav tom ntej.
(Cov ntsiab lus ntawm tsab xov xwm no tau luam tawm dua, thiab peb tsis muab ib qho kev qhia lossis kev lees paub rau qhov raug, kev ntseeg tau lossis ua tiav ntawm cov ntsiab lus muaj nyob rau hauv tsab xov xwm no, thiab tsis muaj lub luag haujlwm rau cov kev xav ntawm tsab xov xwm no, thov nkag siab.)
Post lub sij hawm: Dec-20-2022