Methylene blue pa lichen planus ya m’kamwa: umboni wa mayesero a chithandizo cha photodynamic

Odwala awiri amawerenga zotsatira zomwezo koma amamvamo malonjezo osiyana. Wina amamva kuti zilondazo zachira, choncho matendawo atha. Winayo amamva kuti ululu wachepa, choncho zilondazo ziyenera kuti zachira. Wowerenga wachitatu amaona kuti chiwerengero cha kubwereranso kwa zilonda chatsika ndipo amaganiza kuti chimakhudza aliyense amene anayamba chithandizo. Kutanthauzira kulikonse kumeneku kumasokoneza mfundo imodzi ndi ina. Kuwunikaku kumazisiyanitsa.

Nkhaniyi ikunena za chithandizo cha methylene blue photodynamic choperekedwa ndi akatswiri azachipatala, chomwe nthawi zambiri chimatchedwa MB-PDT, pa lichen planus ya m’kamwa yokhala ndi zilonda yomwe yatsimikizidwa, yomwe nthawi zambiri imatchedwa OLP. Umboni pano ndi mayesero ogawa odwala mwachisawawa a chithandizo cha photodynamic chowonjezeredwa pa corticosteroid yopaka pa lichen planus ya m’kamwa yokhala ndi zilonda, ofalitsidwa mu 2026, okhala ndi odwala 74 ogawidwa mwachisawawa. Amayesa MB-PDT monga chowonjezera pa steroid, osati cholowa m’malo mwake kapena chithandizo chochitira kunyumba. Owerenga amene akufuna kudziwa kaye za mankhwala amene amayambitsidwa kugwira ntchito ndi kuwala ayenera kuyamba ndi mmene methylene blue imagwirira ntchito ngati mankhwala oyambitsidwa ndi kuwala, ndipo amene akuyerekezera chithandizo choyamba kuperekedwa ayenera kuwerenga za corticosteroid zopaka pa zilonda za m’kamwa limodzi ndi tsambali.

Mfundo ziwiri zimene chithandizochi chimadalira

OLP ndi matenda okhalitsa a nembanemba ya m’kamwa amene amakhudzana ndi chitetezo cha m’thupi. OLP yokhala ndi zilonda, mtundu womwe unayesedwa pano, imatanthauza mabala opweteka pa nembanembayo, nthawi zambiri mkati mwa masaya, amene amachira n’kubweranso. Chikhalidwe chachikulu cha matendawa ndi kubwereranso. Kuchira kwa kanthawi sikutanthauza kuti matendawa alamuliridwa kwa nthawi yaitali, choncho kufotokoza kulikonse koona kuyenera kutsatira kuchira, zizindikiro, ndi kubwereranso kwa zilonda monga zinthu zosiyana.

MB-PDT imadalira zinthu zitatu: mankhwala oyambitsidwa ndi kuwala, kuwala kwa utali wa mafunde umene mankhwalawo amayamwa, ndi oxygen. Chotsani chilichonse mwa izi ndipo njira imeneyi sigwira ntchito. Methylene blue imayamwa kuwala kofiira pafupi ndi 660 nm; utotowo ukalandira mphamvu umasamutsa mphamvu kapena ma electron kudzera m’njira zodalira oxygen, ndipo zinthu zomwe zimapangidwa zomwe zimachita mwamphamvu ndi zinthu zina zimawononga minofu yolunjikidwa pamalopo. Utoto womwewo wopanda kuwala ndi njira ina, n’chifukwa chake chithandizo cha methylene blue photodynamic pa mavuto a khungu chimafotokoza momveka mankhwala, kuwala, kuchuluka koperekedwa, ndi nthawi pakati pa magawo a chithandizo pa ntchito iliyonse. Pogwiritsa ntchito m’kamwa, njirayi iyenera kuchitidwa ndi akatswiri azachipatala omwe akuona chilondacho mwachindunji, ndipo chilondacho chiumitsidwe ndi kupatulidwa ku malo ozungulira chisanawalitsidwe.

Zimene mayeserowo anachita kwenikweni

Mayeserowo anachitikira pachipatala chimodzi ku Shanghai, ndipo analembetsa anthu akuluakulu okhala ndi OLP yokhala ndi zilonda yotsimikizidwa pofufuza chidutswa cha minofu, yokhala ndi dera lalikulu kuposa 5 mm squared malinga ndi miyezo yosinthidwa ya WHO ya 2003. Odwala 37 anagawidwa mwachisawawa kulandira MB-PDT limodzi ndi phala la triamcinolone acetonide la 0.1 percent, ndipo 37 analandira phalalo lokha. M’magulu onse awiri, phalalo linkapakidwa katatu patsiku pa nthawi ya chithandizo ya masabata anayi. Gulu la PDT linawonjezera kuwalitsidwa kwa 660 nm mlungu uliwonse pa 13.2 J pa square cm kwa masekondi 60 pa gawo lililonse, atapaka methylene blue ya 0.1 mg pa mL, mpaka magawo anayi. Wowunika wodziyimira pawokha amene sankadziwa mmene odwala anagawidwira m’magulu anayeza zotsatira. Odwala ndi akatswiri amene ankapereka chithandizo ankadziwa chithandizo choperekedwa, zomwe zimachitika kawirikawiri pa njira yogwiritsa ntchito kuwala, koma zimasiya mwayi wakuti zomwe odwala amanena pa zizindikiro zawo zikhudzidwe ndi zomwe akuyembekezera. Chiyambi chofotokoza njira za kafukufuku wa mtundu umenewu chili mu mmene mungawerengere malipoti a mayesero a photodynamic.

Kusanthula kwa nthawi yochepa mpaka sabata 4 kunaphatikiza aliyense malinga ndi gulu limene anapatsidwa poyamba, ndipo kunagwiritsa ntchito kuyerekeza zinthu zomwe zinalibe deta. Kutsatira kwa nthawi yaitali pa masabata 8 ndi 12 kunangotsatira odwala amene anali atayankha ku chithandizo, zomwe n’zofunika kwambiri pa kubwereranso kwa zilonda, monga taonera pansipa. Mafunso ofala okhudza kukonzekera chithandizo kuchipatala ndi kuyang’anira chitetezo ayankhidwa mu mafunso ofunsidwa kawirikawiri okhudza chithandizo cha photodynamic cha m’kamwa.

Tebulo loyerekezera mayesero

Kuchira, ululu, kubwereranso kwa zilonda, ndi moyo watsiku ndi tsiku zinasintha mosiyana

Kuchira pa sabata 4 kunali kwabwino kwambiri m’gulu lolandira chithandizo chophatikiza. Chithandizo chinachita bwino kwa odwala 35 mwa 37 (94.6 percent) omwe analandira MB-PDT limodzi ndi steroid, poyerekeza ndi 26 mwa 37 (70.3 percent) omwe analandira steroid yokha, kusiyana kwa mfundo za peresenti 24.3 ndipo P inali 0.006. Kutsekeka kwathunthu kwa zilonda kunapangitsa mbali yaikulu ya kusiyana kumeneku, 27 mwa 37 poyerekeza ndi 21 mwa 37. Mlingo wa kuchepa kwa dera la chilonda unakhala wokulirapo mokhala ndi kusiyana kofunika mwa ziwerengero m’gulu la chithandizo chophatikiza pa sabata 4, kusiyanako sikunakhalenso kofunika pa sabata 8, ndipo kunakhalanso kofunika pa sabata 12. Chiwerengero cha REU choyeza kuopsa m’malo ambiri chinakhala bwino m’magulu onse awiri, popanda kusiyana kofunika mwa ziwerengero pakati pa magulu nthawi iliyonse. Izi zimatikumbutsa kuti chilonda chachikulu kwambiri sichikuimira mkamwa monse.

Ululu unasintha pang’onopang’ono. Kuchepa kwapakati pa sikelo ya manambala pa sabata 4 kunali mfundo 3.97 ndi chithandizo chophatikiza poyerekeza ndi 2.62 ndi steroid yokha, ndipo P inali 0.004. Maguluwo sanasiyane m’masabata awiri oyambirira. Kusiyana kunaonekera pa sabata 3 ndipo kunapitirira pa masabata 8 ndi 12. Mmene zinthu zinasinthira zikugwirizana ndi chithandizo chowonjezera chomwe chimafuna magawo obwerezabwereza, osati mpumulo wapompopompo, ndipo zimatichenjeza kuti tisaweruze njirayi pambuyo popita kuchipatala kamodzi kokha.

Pa kubwereranso kwa zilonda, chiwerengero choyambira powerengera ndicho chimasankha tanthauzo. Mbiri ya mayesero a kafukufuku wa OLP yokhala ndi zilonda imeneyi imatanthauzira kubwereranso kwa zilonda mwa odwala ochira, ndipo ziwerengero zikusonyeza kuti ochira amatanthauza oyankha kwathunthu: 27 poyerekeza ndi 21 pa sabata 8, kutsika mpaka 26 poyerekeza ndi 20 pa sabata 12. Pa sabata 8, zilonda zinabwereranso mwa 2 mwa 27 (7.4 percent) poyerekeza ndi 5 mwa 21 (23.8 percent), kusiyana kosafika pa kufunika mwa ziwerengero. Pa sabata 12, zinali 3 mwa 26 (11.5 percent) poyerekeza ndi 8 mwa 20 (40.0 percent), ndipo P inali 0.038. Izi ndi zotsatira za kagulu ka anthu oyankha ku chithandizo, osati zotsatira zophatikiza aliyense malinga ndi gulu lake loyambirira, chifukwa odwala osachira anachoka pa kusanthula kubwereranso kwa zilonda kuti alandire chithandizo china. Wolemba amene amanena 11.5 poyerekeza ndi 40.0 percent popanda kunena chiwerengero choyambira cha 26 poyerekeza ndi 20 amabwereza cholakwika chofala kwambiri m’nkhani zofotokoza kafukufukuyu.

Moyo watsiku ndi tsiku ndi mmene anthu ankamvera zinasonyeza kusiyana komweko. Moyo wokhudzana ndi thanzi la m’kamwa woyezedwa ndi OHIP-14 unakhala bwino kwambiri ndi chithandizo chophatikiza, ndipo P inali 0.002; nkhawa zoyezedwa ndi GAD-7 zinachepanso kwambiri, ndipo P inali 0.007. Kukhumudwa koyezedwa ndi PHQ-9 sikunasiyane. Ziwerengero za nkhawa ndi kukhumudwa poyambira zinali zotsika, choncho masikelowa amayesa kusintha kochepa mwa anthu amene ankakhudzidwa pang’ono, osati kuchiza matenda a nkhawa kapena kukhumudwa.

Malire amene wowerenga mosamala ayenera kukumbukira

Kukula kwa gulu la kafukufuku ndi malire oyamba. Kuwerengera kunaganizira kuchita bwino kwa 37 poyerekeza ndi 79 percent, kunaika mphamvu ya 80 percent yozindikira kusiyana pa zotsatira zazikulu za sabata 4, ndipo kunapereka odwala 74 onse. Kukula kumeneku sikungachirikize zonena zotsimikiza za kubwereranso kwa zilonda m’timagulu ta 26 poyerekeza ndi 20, masikelo a moyo watsiku ndi tsiku, kapena kuvulazidwa kosowa. Kusakhala ndi zochitika zoipa mwa odwala 74 pa masabata 12 kumatsutsa kuvulazidwa kofala, koma sikutiuza zambiri za zochitika zosowa. Njira za kafukufukuyu zinafunsa mwachindunji za ululu wa m’kamwa, kutupa kwa nembanemba ya m’kamwa, ndi kusintha kwa kamvedwe ka kukoma, pogwiritsa ntchito miyezo yokhazikika ya poizoni.

Nthawi yotsatira odwala ndi malire achiwiri. Masabata khumi ndi awiri kuchokera pogawa odwala mwachisawawa ndi pafupifupi masabata asanu ndi atatu pambuyo pa gawo lomaliza la kuwala. OLP imabwereranso m’miyezi ndi zaka, choncho kuyerekezera kubwereranso kwa zilonda kwa masabata 12 ndi umboni woyambirira, osati umboni wakuti zotsatira zimakhalitsa. Kuchitikira pa malo amodzi ndi malire achitatu. Gulu limodzi la ogwira ntchito, chipangizo chimodzi, ndondomeko imodzi ya steroid, ndi gulu la odwala lomwe oposa 80 percent anali akazi azaka pafupifupi 59 zimafotokoza bwino chipatala chimenecho, koma sizifotokoza bwino malo ena.

Zolakwika ziwiri za kufotokoza ziyenera kuzindikiridwa kuti olemba asazikopere. Lipotilo limalumikiza malire a chidaliro a mfundo za peresenti a 7.9 mpaka 40.7 percent ndi chiŵerengero choyerekezera chiopsezo cha 1.35, koma malirewo akugwirizana ndi kusiyana kwenikweni kwa mfundo 24.3, osati chiŵerengerocho. Ndipo gawo lokambirana limanena kuti kusiyana kofunika kwa mfundo 10 komwe kunakhazikitsidwa pasadakhale sikunapezeke, ngakhale kusiyana kwa kuchita bwino komwe kunanenedwa kunaposa mfundo 10. Palibe mwa zolakwika ziwirizi chomwe chimasintha ziwerengero zenizeni, zomwe ndi mfundo zokhazikika: 35 mwa 37 poyerekeza ndi 26 mwa 37 pa kuchita bwino, ndi 3 mwa 26 poyerekeza ndi 8 mwa 20 pa kubwereranso kwa zilonda pa sabata 12 mwa oyankha kwathunthu.

Mfundo yomaliza imakhalabe ndi malire, ndipo zimenezi ndi mphamvu yake. Kwa anthu akuluakulu omwe OLP yawo yokhala ndi zilonda inatsimikizidwa pofufuza chidutswa cha minofu, kuwonjezera magawo anayi kapena ocheperapo a methylene blue PDT a mlungu uliwonse kuchipatala pa triamcinolone yopaka kunathandiza kuchira ndi kuchepa kwa ululu pa sabata 4. Pa sabata 12 panali chizindikiro cha kuchepa kwa kubwereranso kwa zilonda mwa oyankha kwathunthu okha, komanso ubwino wa moyo watsiku ndi tsiku pa miyeso ya mmene thanzi la m’kamwa limakhudzira moyo ndi ya nkhawa. Kafukufukuyu sayesa utoto wokha, zipangizo za kunyumba, utali wina wa mafunde, kapena kulamulira matendawa kwa nthawi yaitali. Odwala amene akuganizira chithandizochi ayenera kufunsa katswiri wawo wa zachipatala za kutsimikizira matenda, kuchuluka kwa magawo a chithandizo, mmene ululu ukuyembekezeredwa kusintha pa masabata atatu mpaka anayi, ndi mmene kubwereranso kwa zilonda kudzayang’aniridwire pambuyo pa nyengo yoyamba.