Neuropathic tiga e faasino i le faaletonu o le gaioiga o lagona, lagona tiga ma tiga faʻafuaseʻi e mafua mai i manuʻa poʻo faʻamaʻi o le somatic sensory nervous system.O le tele oi latou e mafai lava ona faʻatasi ma le tiga i totonu o le vaega innervated talafeagai pe a uma le faʻaumatiaina o mea manuʻa, lea e faʻaalia e pei o tiga faʻafuaseʻi, hyperalgesia, hyperalgesia ma lagona le masani.I le taimi nei, o vailaʻau mo le faʻamalolo o tiga neuropathic e aofia ai tricyclic antidepressants, 5-hydroxytryptamine norepinephrine reuptake inhibitors, anticonvulsants gabapentin ma pregabalin, ma opioids.Ae ui i lea, o le aʻafiaga o vailaʻau faʻamaʻi e masani ona faʻatapulaʻaina, lea e manaʻomia ai togafitiga faʻapitoa e pei o togafitiga faʻale-tino, tulafono faatonutonu o le neural ma le taotoga.O tiga masani ma le faʻatapulaʻaina o galuega o le a faʻaitiitia ai le auai o tagata gasegase ma mafua ai le mamafa o le mafaufau ma le tamaoaiga i tagata mamaʻi.
Platelet rich plasma (PRP) o se oloa plasma e maualuga le mama platelets maua mai i le centrifuging toto autologous.I le 1954, na faʻaaoga muamua e KINGSLEY le upu faʻafomaʻi PRP.E ala i suʻesuʻega ma atinaʻe i tausaga talu ai nei, ua faʻaaogaina lautele le PRP i ponaivi ma taotoga faʻatasi, taotoga o le tui, dermatology, toe faʻaleleia ma isi matagaluega, ma e iai sona sao taua i le tulaga o le toe faʻaleleia o masini.
O le mataupu faavae o le PRP togafitiga o le tui o platelets concentrated i luga o le nofoaga manua ma amata le toe faaleleia o aano e ala i le faamatuu atu o le tele o mea bioactive (tupu tuputupu ae, cytokines, lysosomes) ma adhesion proteins.O nei mea olaola e nafa ma le amataina o le hemostatic cascade reaction, le faʻapipiʻiina o mea fesoʻotaʻi fou ma le toe fausia o vascular.
Faʻavasegaina ma le pathogenesis o tiga neuropathic Na faʻasalalau e le Faalapotopotoga o le Soifua Maloloina a le Lalolagi le 11th toe faʻafouina lomiga o le Faʻavasegaina Faʻavaomalo o Tiga i le 2018, vaevaeina tiga o le neuropathic i le ogatotonu o le neuropathic tiga ma le peripheral neuropathic tiga.
O tiga o le neuropathic peripheral ua faʻavasegaina e tusa ai ma mafuaʻaga:
1) Fa'ama'i/fu'a: neuralgia pe a uma le ma'i, lepela tiga, syphilis/fa'ama'i HIV neuropathy peripheral
2) Faʻalavelave faʻalavelave: faʻamaʻi o le tunnel carpal, tiga faʻamaʻi faʻamaʻi faʻamaʻi
3) Manu'a: manu'a/mu/post-operative/post radiotherapy tiga neuropathic
4) Ischemia/metabolism: ma'i suka peripheral neuropathic tiga
5) Fualaau: neuropathy lautele e mafua mai fualaau (e pei o le chemotherapy)
6) O isi: tiga o le kanesa, trigeminal neuralgia, glossopharyngeal neuralgia, Morton's neuroma
O le faʻavasegaina ma le sauniuniga o metotia o le PRP e masani ona talitonu o le faʻaogaina o platelet i le PRP e fa pe lima taimi o le toto atoa, ae o loʻo i ai le leai o ni faʻailoga faʻatusatusa.I le 2001, na faʻamatalaina e Marx o le PRP o loʻo i ai le itiiti ifo i le 1 miliona platelets i le microliter o le plasma, o se faʻailoga faʻatusatusa o le tulaga o le PRP.Dohan et al.fa'avasegaina PRP i ni vaega se fa: PRP mama, leukocyte mauoa PRP, platelet mauoa fibrin, ma leukocyte mauoa platelet fibrin e fa'avae i mea eseese o platelet, leukocyte, ma fibrin i le PRP.Se'i vagana ua fa'amaoti mai, e masani lava ona fa'asino le PRP i le PRP e maua ai sela pa'epa'e.
Mechanism of PRP in the Treatment of Neuropathic Pain A maeʻa le manuʻa, o le tele o mea e faʻaogaina ai le endogenous ma exogenous activators o le a faʻalauteleina le faʻagaioiina o platelet α- O le granules e maua ai le faʻaleagaina, faʻasaʻo le tele o mea faʻatupulaia, fibrinogen, cathepsin ma hydrolase.O mea fa'atupu fa'amatu'u fa'amatu'u e fusifusia i le pito i fafo o le pa'u sela o le sela fa'atatau e ala i le fa'aogaina o le transmembrane i luga o le membrane cell.O nei transmembrane e faʻafeiloaʻi e faʻaosoina ma faʻagaoioia protein faʻailoga, faʻamalosia atili le avefeʻau lona lua i totonu o le sela, lea e faʻaosofia ai le faʻateleina o le cell, matrix formation, synthesis of collagen protein ma isi faʻamatalaga o gene intracellular.O loʻo i ai faʻamaoniga o cytokines na tuʻuina atu e platelets ma isi transmitters e taua tele i le faʻaitiitia / faʻaitiitia o tiga masani o le neuropathic.O masini faʻapitoa e mafai ona vaevaeina i masini faʻapitoa ma masini tutotonu.
Mechanism of platelet rich plasma (PRP) i le togafitiga o tiga neuropathic
Faiga fa'apitonu'u: a'afiaga anti-inflammatory, neuroprotection ma le fa'aleleia o le toe fa'afouina o le axon, fa'atonuga fa'aletonu, a'afiaga analgesic.
Faiga tutotonu: faʻavaivaia ma fesuiaʻi le faʻaogaina tutotonu ma faʻalavelaveina le faʻagaioiina o le glial cell
Aafiaga Anti-inflammatory
O le faʻaogaina o le peripheral e iai se sao taua i le tupu mai o faʻamaoniga o le tiga o le neuropathic pe a maeʻa manuʻa neura.O le tele o sela inflammatory, e pei o neutrophils, macrophages ma mast cell, na ofi i totonu o le nofoaga o manuʻa neura.O le faʻaputuina tele o sela faʻamaʻi e fai ma faʻavae o le faʻafefe tele ma le faʻaauauina o alava o neura.O le fulafula e faʻasaʻolotoina ai le tele o faʻasalalauga vailaʻau, e pei o cytokines, chemokines ma lipid mediators, faʻafefe ma faʻafiafiaina nociceptors, ma mafua ai suiga i le siosiomaga vailaʻau faʻapitonuʻu.O platelets e iai ni a'afiaga malosi o le immunosuppressive ma le anti-inflammatory.E ala i le fa'atonutonuina ma le fa'alilolilo o mea fa'aletulafono fa'aletulafono eseese, mea angiogenic ma mea tau mea'ai, e mafai ona fa'aitiitia ai fa'alavelave fa'aleagaina ma le mumū, ma toe fa'aleleia ai mea fa'aleagaina eseese i microenvironments eseese.E mafai e le PRP ona faia se sao anti-inflammatory e ala i auala eseese.E mafai ona poloka le tuʻuina atu o cytokines pro-inflammatory mai sela Schwann, macrophages, neutrophils ma mast cell, ma faʻalavelaveina le faʻaalia o le kenera o faʻamaʻi faʻamaʻi faʻamaʻi e ala i le faʻalauiloaina o le suiga o mea faʻaleagaina mai se tulaga inflammatory i se tulaga anti-inflammatory.E ui lava e le tatalaina e platelets interleukin 10, o platelets e faʻaitiitia ai le gaosiga o le tele o le interleukin 10 e ala i le faʻaosoina o sela dendritic e le o matua γ- O le gaosiga o le interferon e faia se matafaioi e tetee ai i le mumū.
Aafiaga fa'ama'i
O platelets ua faʻagaoioia e faʻasaʻo ai le tele o neurotransmitters pro-inflammatory ma anti-inflammatory, lea e mafai ona faʻaosoina ai le tiga, ae faʻaitiitia ai foi le mumū ma le tiga.O platelets faatoa saunia o lo'o moe ile PRP.A maeʻa ona faʻagaoioia tuusaʻo pe le tuusaʻo, o le platelet morphology e suia ma faʻalauteleina le faʻapipiʻiina o platelet, faʻamatuʻu atu ona intracellular α- O mea faʻapipiʻi ma maaleale o le a faʻaosofia ai le tuʻuina atu o le 5-hydroxytryptamine, lea e iai le faʻatonuga o tiga.I le taimi nei, 5-hydroxytryptamine receptors e tele lava ina iloa i neura peripheral.O le 5-hydroxytryptamine e mafai ona a'afia ai le felauaiga nociceptive i totonu o masini si'osi'omaga e ala i le 5-hydroxytryptamine 1, 5-hydroxytryptamine 2, 5-hydroxytryptamine 3, 5-hydroxytryptamine 4 ma le 5-hydroxytryptamine 7 receptors.
Taofi ole Glial Cell Activation
O sela glial e tusa ma le 70% o sela tutotonu o le tino, lea e mafai ona vaevaeina i ni ituaiga se tolu: astrocytes, oligodendrocytes ma microglia.Microglia na faʻagaoioia i totonu ole 24 itula ina ua maeʻa le manua o le neura, ma o astrocytes na faʻagaoioia i se taimi vave ina ua maeʻa manuʻa namu, ma o le faʻagaioiga na tumau mo 12 vaiaso.Astrocytes ma microglia ona tuʻuina atu lea o cytokines ma faʻaosoina se faasologa o tali feaveaʻi, e pei o le faʻaleleia o le glucocorticoid ma le glutamate receptors, e oʻo atu ai i suiga i le faʻalavelave faʻalavelave ma le palasitika neural, lea e vavalalata vavalalata ma le tupuga o tiga neuropathic.
O a'afiaga e a'afia i le fa'amāmā po'o le fa'aitiitia o le tiga ole neuropathic ile platelet rich plasma
1) Angiopoietin:
fa'aoso le angiogenesis;Faʻaosofia le femalagaiga o sela endothelial ma le faʻateleina;Lagolago ma faʻamautu le atinaʻeina o vaʻa toto e ala i le suʻeina o pericytes
2) Fa'atatau i le tuputupu a'e o le aano feso'ota'iga:
Fa'aosofia le femalaga'iga o leukocyte;Faʻateleina le angiogenesis;Fa'agaoioia le myofibroblast ma fa'aosofia ai le fa'aputuina ma le toe fa'afouina o le matrix extracellular
3) Epidermal tulaga tuputupu aʻe:
Faʻaleleia le faʻamalolo o manuʻa ma faʻaosoina le angiogenesis e ala i le faʻalauteleina o le faʻateleina, femalagaiga ma le eseesega o macrophages ma fibroblasts;Fa'aosofia fibroblasts e fa'amama ai le collagenase ma fa'aleagaina matrix extracellular i le taimi o le toe fa'aleleia o manu'a;Faʻateleina le faʻateleina o keratinocytes ma fibroblasts, e taʻitaʻia ai le toe faʻaleleia.
4) Fibroblast tulaga tuputupu aʻe:
E faʻaosofia le chemotaxis o macrophages, fibroblasts ma sela endothelial;fa'aoso le angiogenesis;E mafai ona fa'aosoina le fa'atosinaina ma le toe fa'aleleia o a'ano ma auai i fa'ama'i manu'a.
5) Vaega tuputupu aʻe Hepatocyte:
Faʻatonutonu le tuputupu aʻe o sela ma feʻaveaʻi o sela epithelial/endothelial;Faʻaleleia le faʻaleleia o le epithelial ma le angiogenesis.
6) Insulin pei o le tuputupu aʻe:
Faʻapotopoto faʻatasi sela alava e faʻaosofia ai le faʻapipiʻiina o polotini.
7) Platelet maua mai le tuputupu aʻe:
Faʻaosofia le chemotaxis o neutrophils, macrophages ma fibroblasts, ma faʻaosofia le faʻateleina o macrophages ma fibroblasts i le taimi e tasi;E fesoasoani i le faʻaleagaina o le collagen tuai ma faʻatonutonu le faʻaalia o matrix metalloproteinases, e oʻo atu ai i le mumū, faʻapipiʻiina o mea faʻapipiʻi, faʻateleina o le epithelial, gaosiga o le matrix extracellular ma le toe faʻaleleia o mea;E mafai ona fa'alauteleina le fa'atuputeleina o sela e maua mai i le tino ma fesoasoani e fai se sao i le toe fa'afouina o neura.
8) Stromal cell mea e maua mai:
Valaau CD34 + sela e faʻaosofia ai lo latou faʻafeiloaʻi, faʻateleina ma le eseesega i totonu o sela endothelial progenitor, ma faʻaosofia le angiogenesis;Aoina mai sela o le mesenchymal stem ma leukocytes.
9) Suia le tulaga tuputupu ae β：
I le taimi muamua, o loʻo i ai le aʻafiaga o le faʻalauiloaina o le mumū, ae e mafai foi ona faʻaleleia le suiga o le vaega manuʻa i le tulaga anti-inflammatory;E mafai ona faʻaleleia le chemotaxis o fibroblasts ma sela maso lamolemole;Faʻatonutonu le faʻaaliga o collagen ma collagenase, ma faʻaleleia le angiogenesis.
10) Vascular endothelial tuputupu aʻe vaega:
Lagolago ma faʻaleleia le tuputupu aʻe o alava neura toe faʻafouina e ala i le tuʻufaʻatasia o le angiogenesis, neurotrophic ma le neuroprotection, ina ia toe faʻafoʻisia galuega a le neura.
11) Vaega tuputupu aʻe neura:
E faia se matafaioi neuroprotective e ala i le faʻalauiloaina o le tuputupu aʻe o axons ma le tausiga ma le ola o neurons.
12) Fa'ailoga neurotrophic e maua mai i le Glial:
E mafai ona faʻafeiloaʻi manuia ma faʻasaʻo polotini neurogenic ma taʻalo se matafaioi neuroprotective.
Fa'ai'uga
1) Platelet rich plasma o loʻo i ai uiga o le faʻaleleia o le faʻamalolo ma le faʻamaʻi.E le gata e mafai ona toe faʻaleleia aano o neura ua faʻaleagaina, ae faʻamalolo lelei foi le tiga.O se auala taua togafitiga mo tiga o le neuropathic ma e iai ni faʻamoemoega susulu;
2) O le auala sauniuni o le platelet rich plasma o loʻo finau pea, e manaʻomia le faʻavaeina o se metotia sauniuni faʻapitoa ma se tulaga faʻavasega iloiloga tuʻufaʻatasia;
3) E tele suʻesuʻega ile platelet rich plasma ile neuropathic tiga e mafua mai i le faʻamaʻi faʻamaʻi, manuʻa o le nerve peripheral ma le faʻalavelave neura.Ole masini ma le aoga ole platelet rich plasma i isi ituaiga o tiga neuropathic e manaʻomia ona suʻesuʻeina atili.
O le tiga o le neuropathic o le igoa lautele o se vasega tele o faʻamaʻi faʻamaʻi, lea e masani ona masani ai ile falemaʻi.Ae ui i lea, e leai se auala faʻapitoa mo togafitiga i le taimi nei, ma o le tiga e tumau mo ni nai tausaga pe oʻo lava i le olaga pe a maeʻa le maʻi, e mafua ai se avega mamafa i gasegase, aiga ma sosaiete.Togafitiga o vailaʻau o le fuafuaga faʻavae togafitiga mo tiga o le neuropathic.Ona o le manaʻomia o vailaʻau umi, e leʻo lelei le tausisia o tagata mamaʻi.O vaila'au umi o le a fa'atuputeleina ai fa'afitauli leaga ma fa'aleagaina ai le tino ma le mafaufau i gasegase.O suʻesuʻega faʻavae talafeagai ma suʻesuʻega faʻapitoa ua faʻamaonia ai e mafai ona faʻaogaina le PRP e togafitia ai le tiga o le neuropathic, ma o le PRP e sau mai le tagata maʻi lava ia, e aunoa ma se faʻalavelave autoimmune.O le fa'agasologa o togafitiga e fai si faigofie, ma ni nai fa'alavelave leaga.E mafai fo'i ona fa'aogaina le PRP fa'atasi ma sela fa'a'au, lea e malosi le malosi o le toe fa'aleleia o neura ma le toe fa'afouina o le tino, ma o le ai ai le avanoa lautele mo le fa'aogaina o le tiga o le neuropathic i le lumana'i.
(O mea o loʻo i totonu o lenei tusiga ua toe lolomiina, ma matou te le tuʻuina atu se faʻamaoniga manino pe faʻamaonia mo le saʻo, faʻamaoni poʻo le atoatoa o mea o loʻo i totonu o lenei tusiga, ma e le nafa ma manatu o lenei tusiga, faamolemole ia malamalama.)
Taimi meli: Tes-20-2022