He maʻi degenerative hiki ʻole ke hoʻokele ʻia.Me ka hoʻonui ʻana i ka manaʻolana o ke ola a me ka maʻi maʻi obesity, ke kumu nei ʻo OA i ke kaumaha o ke kino a me ka hoʻokele waiwai.ʻO Knee OA kahi maʻi musculoskeletal mau loa e koi ai i ke kaʻina hana.No laila, hoʻomau ka poʻe maʻi i ka ʻimi ʻana i nā lāʻau lapaʻau ʻole, e like me ka hoʻokomo ʻana i ka platelet-rich plasma (PRP) i loko o ka hui kuli i hoʻopilikia ʻia.
Wahi a Jayaram et al., ʻO PRP kahi lāʻau lapaʻau e kū nei no ka OA.Eia nō naʻe, ʻaʻole naʻe nā hōʻike lapaʻau o kona pono, a ʻaʻole maopopo ke ʻano o kāna hana.ʻOiai ua hōʻike ʻia nā hopena hoʻohiki e pili ana i ka hoʻohana ʻana i ka PRP ma ke kuli OA, nā nīnau koʻikoʻi e like me nā hōʻike paʻa e pili ana i kona pono, nā ʻano maʻamau, a me nā ʻenehana hoʻomākaukau maikaʻi e ʻike ʻole ʻia.
Ua manaʻo ʻia ʻo Knee OA e pili ana ma mua o 10% o ka heluna kanaka o ka honua, me ka pilikia o ke ola o 45%.Paipai nā alakaʻi o kēia manawa i nā lāʻau lapaʻau nonpharmacological (e laʻa, hoʻoikaika kino) a me nā lāʻau lapaʻau, e like me nā lāʻau anti-inflammatory oral nonsteroidal (NSAIDs).Eia nō naʻe, ʻo kēia mau lāʻau lapaʻau he mau pōmaikaʻi pōkole wale nō.Eia kekahi, ua kaupalena ʻia ka hoʻohana ʻana i ka lāʻau lapaʻau i nā maʻi me nā comorbidities ma muli o ka pilikia o nā pilikia.
Hoʻohana pinepine ʻia nā corticosteroids intra-articular no ka hoʻomaha ʻana i ka ʻeha no ka manawa pōkole no ka mea ua kaupalena ʻia ko lākou pōmaikaʻi i kekahi mau pule, a ua hōʻike ʻia nā hoʻopiʻi hou ʻana e pili ana i ka hoʻonui ʻana o ka cartilage.Ua ʻōlelo kekahi mau mea kākau he mea hoʻopaʻapaʻa ka hoʻohana ʻana i ka waikawa hyaluronic (HA).Eia naʻe, ua hōʻike nā mea kākau ʻē aʻe i ka hōʻoluʻolu ʻeha ma hope o ka 3 a hiki i ka 5 pule hebedoma o HA no 5 a 13 mau pule (i kekahi manawa a hiki i 1 makahiki).
Ke hāʻule nā mea ʻē aʻe i luna, ʻōlelo pinepine ʻia ka nui o ka arthroplasty kuli (TKA) ma ke ʻano he lapaʻau maikaʻi.Eia nō naʻe, he kumu kūʻai ia a hiki ke komo i nā hopena koʻikoʻi o ka lāʻau lapaʻau a me ka postoperative.No laila, he mea nui e ʻike i nā lāʻau lapaʻau palekana a maikaʻi hoʻi no ka OA kuli.
Ua noiʻi ʻia nā lāʻau lapaʻau olaola, e like me PRP, no ka mālama ʻana i ke kuli OA.ʻO PRP kahi huahana koko autologous me kahi kiʻekiʻe o nā platelets.Manaʻo ʻia ka maikaʻi o ka PRP e pili ana i ka hoʻokuʻu ʻana i nā mea ulu a me nā molekala ʻē aʻe, me ka platelet-derived growth factor (PDGF), transforming growth factor (TGF) -beta, insulin-like growth factor type I (IGF-I) , a me ka vascular endothelial growth factor (VEGF).
Hōʻike kekahi mau paʻi ʻana e hoʻohiki paha ʻo PRP no ka mālama ʻana i ke kuli OA.Eia nō naʻe, ʻaʻole ʻae ka hapa nui i ke ala maikaʻi loa, a he nui nā palena e kaupalena ana i ka nānā pono ʻana i kā lākou hopena, me ka pilikia o ke ʻano.ʻO ka heterogeneity o ka hoʻomākaukau a me nā ʻano hana injection i hoʻohana ʻia i nā haʻawina i hōʻike ʻia he palena i ka wehewehe ʻana i kahi ʻōnaehana PRP kūpono.Eia kekahi, ʻo ka hapa nui o nā hoʻāʻo i hoʻohana iā HA ma ke ʻano he mea hoʻohālikelike, he mea hoʻopaʻapaʻa iā ia iho.Ua hoʻohālikelike kekahi mau ho'āʻo iā PRP i kahi placebo a hōʻike i ka hoʻomaikaʻi maikaʻi ʻana o nā hōʻailona ma mua o ka paʻakai ma 6 a me 12 mau mahina.Eia naʻe, he nui nā hemahema o kēia mau hoʻāʻo ʻana, me ka nele o ka makapō kūpono, e hōʻike ana e hoʻonui ʻia paha kā lākou mau pono.
ʻO nā mea maikaʻi o PRP no ka mālama ʻana i ke kuli OA penei: maʻalahi ka hoʻohana ʻana ma muli o kāna hoʻomākaukau wikiwiki a me ka liʻiliʻi o ka invasiveness;He ʻenehana kūpono loa ia ma muli o ka hoʻohana ʻana i nā hale lawelawe olakino lehulehu a me nā lako;a palekana paha ia, no ka mea, he huahana autologous ia.Ua hōʻike ʻia nā paʻi mua i nā pilikia liʻiliʻi a pōkole wale nō.
ʻO ke kumu o kēia ʻatikala ʻo ia ka nānā ʻana i ke ʻano molekala o kēia manawa o ka PRP a me ka nui o ka pono o ka intra-articular injection o PRP i nā maʻi me ke kuli OA.
ʻO ka hana molekula o ka plasma waiwai nui platelet
Ua ʻimi ʻia ka Cochrane Library a me PubMed (MEDLINE) i nā haʻawina pili PRI ma ke kuli OA.ʻO ka manawa huli mai ka hoʻomaka ʻana o ka ʻenekini ʻimi a hiki i Dekemaba 15, 2021. ʻO nā haʻawina wale nō o PRP ma nā kuli OA i manaʻo ʻia e nā mea kākau he mea hoihoi loa.Ua loaʻa iā PubMed he 454 mau ʻatikala, a he 80 i koho ʻia.Ua loaʻa kekahi ʻatikala ma ka Hale Waihona Puke ʻo Cochrane, kahi i kuhikuhi ʻia, me ka huina o 80 mau kuhikuhi.
Ua hōʻike ʻia kahi haʻawina i paʻi ʻia ma 2011 i ka hoʻohana ʻana i nā kumu ulu (nā lālā o ka TGF-β superfamily, fibroblast growth factor family, IGF-I a me PDGF) i ka mālama ʻana i ka OA.
Ma 2014, Sandman et al.ua hōʻike ʻia ʻo ka mālama ʻana o PRP i ka ʻiʻo hui o OA i ka emi ʻana o ka catabolism;akā naʻe, ua hoʻonui nui ʻia ka PRP i ka matrix metalloproteinase 13, ka hoʻonui ʻana o ka hyaluronan synthase 2 i loko o nā pūnaewele synovial, a me ka hoʻonui ʻana i ka hana cartilage synthesis.Hōʻike nā hopena o kēia haʻawina e hoʻoulu ka PRP i ka hana o ka endogenous HA a hoʻemi i ka catabolism cartilage.Ua kāohi pū ʻo PRP i ka ʻike ʻana o nā mea hoʻolaha inflammatory a me kā lākou hōʻike gen i nā synovial a me nā chondrocytes.
I ka makahiki 2015, ua hōʻike ʻia kahi noiʻi hoʻokolohua i hoʻopaʻa ʻia i ka PRP i hoʻoikaika nui i ka hoʻonui ʻana o ka cell a me ka huna ʻana o ka protein i loko o ka cartilage kuli kanaka a me nā cell synovial.Kōkua kēia mau ʻike i ka wehewehe ʻana i nā hana biochemical e pili ana i ka pono o ka PRP i ka mālama ʻana i ke kuli OA.
I loko o kahi kumu hoʻohālike murine OA (ka hoʻopaʻa ʻana i ke keʻena hoʻokolohua) i hōʻike ʻia e Khatab et al.I ka makahiki 2018, ua hoʻemi ʻia ka ʻeha a me ka mānoanoa o ka synovial, hiki ke hoʻopili ʻia e nā subtypes macrophage.No laila, ʻike ʻia kēia mau injections e hōʻemi i ka ʻeha a me ka ʻeha synovial, a hiki ke kāohi i ka ulu ʻana o OA i nā maʻi me ka OA mua.
I ka makahiki 2018, ua hoʻoholo ka loiloi o ka puke waihona waihona PubMed ua ʻike ʻia ka mālama ʻana o PRP o OA i kahi hopena modulating ma ke ala Wnt/β-catenin, he mea nui paha ia no ka hoʻokō ʻana i kāna mau hopena lapaʻau pono.
Ma 2019, Liu et al.ua noiʻi ʻo ia i ke ʻano molekala kahi e komo ai nā exosome i loaʻa i ka PRP i ka hoʻohaʻahaʻa ʻana i ka OA.He mea nui ia e hoʻohālikelike i ka hana koʻikoʻi o nā exosome i ke kamaʻilio intercellular.I loko o kēia haʻawina, ua hoʻokaʻawale ʻia nā chondrocytes rabbit mua a mālama ʻia me interleukin (IL) -1β e hoʻokumu i kahi ʻano hoʻohālike in vitro o OA.Ua ana ʻia a hoʻohālikelike ʻia ka proliferation, migration, a me apoptosis assays ma waena o nā exosomes i loaʻa mai i ka PRP a me ka PRP hoʻāla e loiloi i ka hopena therapeutic ma OA.Ua noiʻi ʻia nā hana i komo i ke ala hōʻailona Wnt/β-catenin e ka nānā ʻana o ke komohana blot.Ua ʻike ʻia nā exosome i loaʻa mai i ka PRP e like a ʻoi aku ka maikaʻi o nā hopena therapeutic ma OA ma mua o ka PRP i hoʻāla ʻia i loko o ka vitro a me ka vivo.
Ma kahi hoʻohālike ʻiole o posttraumatic OA i hōʻike ʻia ma 2020, Jayaram et al.manaʻo e pili ana i ka leukocyte nā hopena o ka PRP i ka holomua o OA a me ka hyperalgesia i hoʻokomo ʻia i ka maʻi.Ua ʻōlelo pū lākou ʻo ka leukocyte-poor PRP (LP-PRP) a me ka liʻiliʻi o ka leukocyte-rich PRP (LR-PRP) e pale i ka nui a me ka nalowale o ka ʻili.
ʻO nā ʻike i hōʻike ʻia e Yang et al.Ua hōʻike ʻia ka haʻawina 2021 i ka PRP ma kahi liʻiliʻi i hoʻemi ʻia i ka IL-1β-induced chondrocyte apoptosis a me ka mumū ma ke kāohi ʻana i ka hypoxia-inducible factor 2α.
Ma kahi ʻano ʻiole o OA me ka hoʻohana ʻana iā PRP, Sun et al.Ua ʻike ʻia ka microRNA-337 a me ka microRNA-375 e hoʻopaneʻe i ka holomua OA ma o ka hoʻopili ʻana i ka mumū a me ka apoptosis.
Wahi a Sheean et al., ʻO nā hana koʻikoʻi o PRP he multifaceted: platelet alpha granules e hoʻoikaika i ka hoʻokuʻu ʻana i nā mea ulu like ʻole, me VEGF a me TGF-beta, a ua hoʻoponopono ʻia ka mumū ma ke kāohi ʻana i ke ala nuclear factor-κB.
Ua noiʻi ʻia nā ʻano kumu hoʻokalakupua i PRP i hoʻomākaukau ʻia mai nā pahu ʻelua a me nā hopena o nā kumu hoʻohenehene ma ka macrophage phenotype.Ua ʻike lākou i nā ʻokoʻa i loko o nā ʻāpana kelepona a me nā kumu kumu hoʻohenehene ma waena o PRP i hoʻomaʻemaʻe ʻia me ka hoʻohana ʻana i nā pahu ʻelua.ʻO ka ʻōnaehana protein autologous LR-PRP kit he kiʻekiʻe kiʻekiʻe o nā mea pili macrophage M1 a me M2.ʻO ka hoʻohui ʻana o ka PRP supernatant i ka moʻomeheu moʻomeheu o nā macrophages i loaʻa i ka monocyte a me nā macrophages polarized M1 i hōʻike ʻia ua pale ʻo PRP i ka M1 macrophage polarization a hāpai i ka M2 macrophage polarization.
Ma 2021, Szwedowski et al.Hōʻike ʻia nā mea ulu i hoʻokuʻu ʻia i nā hui kuli OA ma hope o ka hoʻokomo ʻia ʻana o PRP: tumor necrosis factor (TNF), IGF-1, TGF, VEGF, disaggregate, a me metalloproteinases me nā kumu thrombospondin, interleukins, matrix metalloproteinases, epidermal growth factor, hepatocyte growth factor, fibroblast kumu ulu, kumu ulu keratinocyte a me platelet factor 4.
1. PDGF
Ua ʻike mua ʻia ka PDGF i nā platelets.He polypeptide cationic hiki ke hoʻoheheʻe ʻia e trypsin.ʻO ia kekahi o nā kumu ulu mua loa i ʻike ʻia ma nā wahi haʻihaʻi.Ua hōʻike nui ʻia i loko o ka ʻiʻo o ka iwi traumatic, ka mea e hana ai i ka osteoblasts chemotactic a proliferates, hoʻonui i ka hiki o ka collagen synthesis, a hoʻoikaika i ka absorption o nā osteoclast, a laila hoʻoikaika i ka hoʻokumu ʻana o ka iwi.Eia kekahi, hiki i ka PDGF ke hoʻoikaika i ka hoʻonui a me ka hoʻokaʻawale ʻana o nā fibroblasts a hoʻoikaika i ka hoʻoponopono hou ʻana o nā kiko.
2. TGF-B
ʻO TGF-B kahi polypeptide i hoʻokumu ʻia i nā kaulahao 2, e hana ana i nā fibroblasts a me nā pre-osteoblasts i loko o kahi ʻano paracrine a / a autocrine, e hoʻoulu i ka hoʻonui ʻana o nā osteoblasts a me nā pre-osteoblasts a me ka synthesis o nā fibers collagen, ma ke ʻano he chemokine, ka osteoprogenitor. Hoʻokomo ʻia nā cell i loko o ka ʻiʻo iwi ʻeha, a ke kāohi ʻia ke kūkulu ʻana a me ka absorption o nā osteoclast.Hoʻoponopono pū ʻo TGF-B i ka ECM (extracellular matrix) synthesis, loaʻa nā hopena chemotactic ma nā neutrophils a me nā monocytes, a hoʻoponopono i nā pane inflammatory kūloko.
3. VEGF
ʻO ka VEGF he glycoprotein dimeric, kahi e hoʻopaʻa ai i nā mea loaʻa ma ka ʻili o nā cell endothelial vascular ma o ka autocrine a i ʻole paracrine, e hoʻoikaika i ka hoʻonui ʻana o ka endothelial cell, hoʻoulu i ka hoʻokumu ʻana a me ka hoʻokumu ʻana i nā kīʻaha koko hou, hāʻawi i ka oxygen i nā hopena haʻihaʻi, hāʻawi i nā meaʻai, a lawe i nā ʻōpala metabolic. ., e hāʻawi ana i kahi microenvironment maikaʻi no ka metabolism i loko o ka wahi hoʻolaʻa iwi kūloko.A laila, ma lalo o ka hana a VEGF, hoʻonui ʻia ka hana alkaline phosphatase o ka ʻokoʻa osteoblast, a waiho ʻia nā paʻakai calcium kūloko e hāpai i ka ho'ōla ʻana.Eia kekahi, hoʻoikaika ka VEGF i ka hoʻoponopono ʻana i ka ʻiʻo palupalu ma o ka hoʻomaikaʻi ʻana i ke koko o ka ʻiʻo palupalu a puni ka haʻihaʻi, a hoʻoikaika i ka ho'ōla ʻana o ka haʻihaʻi, a loaʻa ka hopena hoʻolaha like me PDGF.
4. EGF
ʻO ka EGF he mea hoʻoikaika ikaika e hoʻoikaika i ka māhele a me ka hoʻonui ʻana i nā ʻano ʻano o nā ʻiʻo i loko o ke kino, ʻoiai e hāpai ana i ka synthesis matrix a me ka waiho ʻana, e hoʻoikaika ana i ka hoʻokumu ʻana o ka ʻiʻo fibrous, a hoʻomau i ka hoʻololi ʻana i iwi e pani ai i ka hoʻokumu ʻana o ka iwi.ʻO kekahi kumu ʻē aʻe e komo ai ka EGF i ka hoʻoponopono ʻana i ka haʻihaʻi ʻana, ʻo ia ka hiki ke hoʻāla i ka phospholipase A, a laila e hoʻoikaika ai i ka hoʻokuʻu ʻana o ka waika arachidonic mai nā cell epithelial, a me ka hoʻoikaika ʻana i ka synthesis o prostaglandins ma o ka hoʻoponopono ʻana i nā hana o cyclooxygenase a me lipoxygenase.ʻO ke kuleana o ka resorption a me ka hoʻokumu ʻana o ka iwi ma hope.Hiki ke ʻike ʻia ke komo ʻana o EGF i ke kaʻina hana hoʻōla o nā haʻihaʻi a hiki ke hoʻolalelale i ka hoʻōla ʻana o ka haʻihaʻi.Eia hou, hiki i ka EGF ke hoʻoikaika i ka hoʻonuiʻana o nā pūnaewele epidermal a me nā pūnaewele endothelial, a hoʻoulu i nā pūnaewele endothelial e neʻe i kaʻili o kaʻeha.
5. IGF
ʻO IGF-1 kahi polypeptide kaulahao hoʻokahi e hoʻopaʻa ai i nā mea hoʻokipa i ka iwi a hoʻāla i ka tyrosine protease ma hope o ka autophosphorylation receptor, e hāpai ana i ka phosphorylation o nā substrates receptor insulin, a laila e hoʻoponopono ai i ka ulu ʻana o ka cell, proliferation a me ka metabolism.Hiki iā ia ke hoʻoulu i nā Osteoblasts a me nā pre-osteoblasts, e hoʻoikaika i ka cartilage a me ka hoʻokumu ʻana o ka iwi matrix.Eia kekahi, he hana koʻikoʻi ia i ka hui ʻana o ka hoʻoponopono hou ʻana o ka iwi ma o ka hoʻokaʻawale ʻana i ka ʻokoʻa a me ka hoʻokumu ʻana o nā osteoblasts a me nā osteoclast a me kā lākou hana hana.Eia kekahi, ʻo IGF kekahi o nā mea nui i ka hoʻoponopono ʻana i ka ʻeha.He mea ia e hoʻoikaika ai i ke komo ʻana o nā fibroblasts i loko o ka pōʻai cell a hoʻoulu i ka ʻokoʻa a me ka synthesis o nā fibroblasts.
ʻO ka PRP kahi ʻokoʻa autologous o nā platelets a me nā kumu ulu i loaʻa mai ke koko centrifuged.ʻElua ʻano ʻano platelet concentrates: platelet-rich fibrin a me plasma-rich growth factor.Hiki ke loaʻa iā PRP mai ke koko wai wale nō;ʻAʻole hiki ke loaʻa iā PRP mai ka serum a i ʻole ke koko i hoʻopaʻa ʻia.
Loaʻa nā ʻenehana kālepa like ʻole e hōʻiliʻili i ke koko a loaʻa iā PRP.ʻO nā ʻokoʻa ma waena o lākou ka nui o ke koko e pono e huki ʻia mai ka mea maʻi;ʻenehana kaʻawale;ka wikiwiki centrifugation;ka nui o ka nui o ka nui ma hope o ka centrifugation;manawa hana;
Ua hōʻike ʻia nā ʻano hana centrifugation like ʻole e pili ana i ka ratio leukocyte.ʻO nā helu platelet i 1 μL o ke koko mai nā kānaka olakino mai 150,000 a 300,000.ʻO nā platelets ke kuleana no ka hoʻopau ʻana i ke koko.
Aia i loko o ka alpha granules o nā platelets nā ʻano protein like ʻole e like me nā kumu ulu (eg transforming growth factor beta, insulin-like growth factor, epidermal growth factor), chemokines, coagulants, anticoagulants, fibrinolytic proteins, adhesion proteins, Integral membrane proteins, immune mediators. , nā kumu angiogenic a me nā mea paʻa, a me nā protein bactericidal.
ʻAʻole ʻike ʻia ka hana pololei o ka hana PRP.ʻIke ʻia ka PRP e hoʻoulu i nā chondrocytes e hoʻoponopono hou i ka cartilage a me ka biosynthesis o collagen a me proteoglycans.Ua hoʻohana ʻia i nā ʻano lāʻau lapaʻau like ʻole e like me ke ʻoki waha a me ka maxillofacial (me ka temporomandibular OA), dermatology, ophthalmology, cardiothoracic surgery and plastic surgery.
（Paʻi hou ʻia nā mea o kēia ʻatikala, ʻaʻole mākou e hāʻawi i ka hōʻoiaʻiʻo a i ʻole ka hōʻoia ʻana no ka pololei, hilinaʻi a i ʻole ka piha o nā mea i loko o kēia ʻatikala, a ʻaʻole kuleana no nā manaʻo o kēia ʻatikala, e ʻoluʻolu e hoʻomaopopo.)
Ka manawa hoʻouna: Iulai-27-2022