Methylene blue ndi matenda otupa matumbo: kafukufuku poyerekeza ndi kugwiritsa ntchito utoto pozindikira matenda

Njira ziwiri zimagwiritsa ntchito molekyulu yomweyo yabuluu, koma pafupifupi palibe china chomwe zimafanana. Mu imodzi, ofufuza amapatsa methylene blue makoswe amene matumbo awo aakulu avulazidwa ndi mankhwala, n'kuyeza ngati kutupa kwachepa. Mu inayo, katswiri woyang'ana m'kati mwa thupi ndi chida cha endoscope amapopera utoto wabuluu wochepetsedwa mphamvu pa nembanemba ya m'matumbo mwa munthu amene ali ndi ulcerative colitis kapena Crohn's colitis, kuti aone bwino madera okayikitsa. Yoyamba imafunsa ngati mankhwalawo amasintha matenda. Yachiwiri imafunsa ngati mtunduwo umathandiza kuwaona. Owerenga ofunafuna umboni wokhudza methylene blue ndi ulcerative colitis ayenera kusiyanitsa nkhani ziwirizi, chifukwa kuzisakaniza kumasandutsa chothandiza kuona kukhala chithandizo chongoganiziridwa.

Kuyesa komwe kunafuna kusintha kutupa

Kuyesa kwa chithandizoku ndi kafukufuku wa makoswe wa mu 2015 wochitidwa ndi Dinc ndi anzake, wofalitsidwa ndi mutu wakuti methylene blue imalepheretsa njira ya kutupa kwa matumbo oyambitsidwa ndi acetic acid. Anali mayeso a kafukufuku woyambirira asanayese mwa anthu, okhala ndi magulu osankhidwa mwamwayi, osati mayeso ochitikira odwala. Makoswe aamuna a mtundu wa Sprague-Dawley makumi asanu ndi atatu anagawidwa m'magulu anayi, gulu lililonse lili ndi makumi awiri: athanzi oyerekezera nawo, athanzi opatsidwa utoto, amene anali ndi kutupa kwa matumbo osapatsidwa chithandizo, ndi amene anali ndi kutupa kwa matumbo opatsidwa chithandizo. Kutupa kwa matumbo kunayambitsidwa ndi acetic acid, ndipo nyama za m'magulu opatsidwa chithandizo zinalandira 2 mL ya madzi a methylene blue a 1%. Patapita masiku atatu, gululo linafufuza gawo la 8 cm la kumapeto kwa matumbo aakulu.

Zinthu zomwe anayeza zinakhudza mbali zingapo za kuvulalako: mavoti a kuwonongeka kooneka ndi maso ndi kooneka ndi maikulosikopu, mmene zinthu zimadutsira khoma la matumbo, kugwira ntchito kwa maselo a neutrophil kudzera mu myeloperoxidase, kuwonongeka kwa mafuta ndi okosijeni kudzera mu malondialdehyde, ma enzyme oteteza ku kuwonongeka ndi okosijeni a superoxide dismutase ndi catalase, ma cytokine a TNF-alpha, IL-1beta ndi IL-6, komanso miyeso ya njira ya nitric oxide, kuphatikizapo nitrite/nitrate yonse ndi kugwira ntchito kwa nitric oxide synthase.

Acetic acid inayambitsa kuvulala komwe ankayembekezera. Poyerekeza ndi zimenezi, makoswe okhala ndi kutupa kwa matumbo amene anapatsidwa utoto anasonyeza kuwonongeka kochepa kooneka ndi maso komanso ndi maikulosikopu, kudutsa kwa zinthu m'khoma la matumbo kwabwinoko, myeloperoxidase ndi malondialdehyde zochepa, superoxide dismutase ndi catalase zobwerera pa mulingo wabwino, komanso kuchepa kwa ma cytokine, nitrite/nitrate ndi kugwira ntchito kwa synthase. Olembawo ananena kuti njira yaikulu ingakhale kuletsa kupanga nitric oxide yochuluka kwambiri, mothandizidwa ndi kuchepa kwa kuwonongeka koyambitsidwa ndi zinthu zogwira ntchito za okosijeni ndi nayitrojeni. Limeneli ndi lingaliro lomveka pa chitsanzo chimenechi, ndipo kuunika kwa umboni wokhudza kutupa kumaliika pamodzi ndi zomwe zapezeka m'ma labotale ena, osati ngati umboni wa chithandizo mwa odwala.

Zomwe kafukufukuyu sanachite n'zofunika kwambiri kuposa zimene anachita. Anachitika kwa masiku atatu, anagwiritsa ntchito makoswe aamuna okha, anayesa dongosolo limodzi lokhazikika popanda kufufuza mmene zotsatira zimasinthira ndi kuchuluka kwa mankhwala, sanaphatikize mankhwala ovomerezeka a IBD oyerekezera nawo, ndipo anayeza minofu ndi zizindikiro za kusintha kwa mankhwala m'thupi m'malo moyeza kuchepa kapena kutha kwa zizindikiro za matenda, kubwereranso kwa matenda, kapena zotsatira zilizonse mwa odwala. Pofika mu September 2026, palibe mayeso ofalitsidwa ochitikira anthu omwe amayesa methylene blue ngati chithandizo cha ulcerative colitis kapena methylene blue pa matenda a Crohn ndi miyeso ya zotsatira za chithandizo. Zotsatira za makoswe ndi poyambira kafukufuku, osati maziko opangira munthu payekha chisankho cha kuchuluka kwa mankhwala oti agwiritse ntchito.

Chifukwa chake kuvulala ndi mankhwala sikuyimira bwino IBD

Kutupa kwa matumbo koyambitsidwa ndi acetic acid ndi chitsanzo cha kuvulala, osati chitsanzo cha matenda monga momwe amakhalira mwa anthu. Madzi a mankhwala amawotcha nembanemba ya kumapeto kwa matumbo aakulu, maselo a neutrophil amathamangira kumeneko, zilonda zimapangika, ndipo nyamayo imafufuzidwa pasanathe masiku ambiri. Ulcerative colitis mwa anthu ndi matenda osatha obwererabwerera, okhudzana ndi chitetezo cha m'thupi, omwe amakhudzidwa ndi majini, tizilombo tokhala m'thupi, komanso chitetezo chophunzira kuzindikira zinthu ndi chitetezo chobadwa nacho. Matendawa amakula kenako n'kuchepa m'zaka zambiri. Chitsanzochi chimabwereza mbali zina za kaonekedwe ka kumapeto kwa matumbo aakulu ndi miyeso ya kutupa, koma pafupifupi sichimasonyeza mmene matendawa amayambira, amapitiririra, kapena amabwereranso.

Pa matenda a Crohn, kusiyana kumeneku kumakulirakulira. Kuvulala kwa acetic acid kumakhala kumapeto kwa matumbo aakulu ndipo kumangokhudza nembanemba yamkati ndi minofu ya pansi pake. Matenda a Crohn angakhudze gawo lililonse la njira ya chakudya, m'madera osalumikizana okhala ndi minofu yabwinobwino pakati pawo; amalowa m'khoma lonse la matumbo, ndipo amasintha minofu n'kuyambitsa kupapatiza kwa matumbo ndi njira zosazolowereka zolumikiza ziwalo. Choncho, mafunso okhudza methylene blue ndi matenda a Crohn sangayankhidwe ndi kuvulala kwa kumapeto kwa matumbo aakulu mwa makoswe komwe kwafufuzidwa kwa masiku atatu. Kafukufuku wina wa nyama wokhudza magulu a tizilombo uyenera kuwonedwa m'nkhani yake, monga tafotokozera mu kalozera wa kafukufuku wa tizilombo ta m'matumbo mwa mbewa.

Lamulo lothandiza n'losavuta. Ngati mawu ena otanthauza zotsatira akutchula chitsanzo cha kutupa kwa matumbo koyambitsidwa mwadala, funsani kuti ndi mankhwala ati, nyama za mtundu wanji ndi zaimuna kapena zazikazi, mayesowo anatenga nthawi yaitali bwanji, ngati anagwiritsa ntchito chithandizo chodziwika bwino poyerekezera, komanso ngati anayeza zizindikiro za minofu kapena zotsatira mwa odwala. Chitsanzo chomwe chimayankha kuti matumbo aakulu a khoswe anaoneka otupa motani pa tsiku lachitatu sichingayankhe ngati munthu amakhalabe ndi zizindikiro zochepa kapena zopanda zizindikiro pa mwezi wa khumi ndi chiwiri.

Kafukufuku amene ankangoyang'ana

Nkhani yachiwiriyi ili ndi cholinga china. Marion ndi anzake anachita kafukufuku wotsatira anthu m'tsogolo kuti apeze kukula kosazolowereka kwa maselo, kotchedwa dysplasia, mwa anthu 102 amene anakhala ndi kutupa kwa matumbo kwa nthawi yaitali: 79 anali ndi ulcerative colitis ndipo 23 anali ndi Crohn's colitis. Kafukufukuyu anafalitsidwa ndi mutu wakuti kutenga tizidutswa ta minofu molunjika m'madera ooneka ndi chromoendoscopy n'kwabwino kuposa kuyang'anira mwachizolowezi. Wodwala aliyense anayerekezera njira zosiyanasiyana pa thupi lake lomwelo pa kufufuza kumodzi, pomwe chida choyang'anira matumbo aakulu chinadutsa kawiri. Gululo linayerekezera kutenga tizidutswa ta minofu mwachizolowezi m'malo osankhidwa mwamwayi, kutenga tizidutswa molunjika m'madera osazolowereka ooneka ndi kuwala koyera kwanthawi zonse, ndi kutenga tizidutswa molunjika atapopera methylene blue ya 0.01% m'matumbo aakulu onse. Katswiri mmodzi wofufuza matenda a njira ya chakudya m'minofu anawunika tizidutswato osadziwa njira yomwe idagwiritsidwa ntchito pozitenga.

Kutenga tizidutswa molunjika mothandizidwa ndi utoto kunapeza dysplasia mwa odwala 17 poyerekeza ndi 3 pa kutenga tizidutswa mwamwayi, kusiyana kofunika malinga ndi ziwerengero. Poyerekeza ndi kutenga tizidutswa molunjika mothandizidwa ndi kuwala koyera kokha, komwe kunapeza dysplasia mwa odwala 9, chiwerengerocho chinawonjezeka koma sichinafike pa malire omwe amagwiritsidwa ntchito nthawi zambiri potsimikizira kufunika kwa kusiyana. Njira zolunjika ziwirizi zitaphatikizidwa, zinapeza dysplasia mwa odwala 20 poyerekeza ndi 3 pa kutenga tizidutswa mwamwayi. Palibe zochitika zosafunika zomwe zinanenedwa.

Palibe apa pomwe panayesedwa chithandizo. Utotowo unali woyikidwa pamwamba pa minofu kuti usonyeze kusiyana, n'kupangitsa kuti kusazolowereka kwa kaonekedwe ka timabowo pa nembanemba kuoneke mosavuta ndi kuti tizidutswa ta minofu titengedwe kumeneko. Kafukufukuyu sanayeze zizindikiro za matenda, mmene matenda akugwirira ntchito, milingo ya ma cytokine, kuchepa kapena kutha kwa zizindikiro, kapena kubwereranso kwa matenda. Sangatchulidwe ngati umboni wa anthu woti methylene blue imachiza IBD. Kupeza madera osazolowereka ndiko kunali cholinga choyezedwa, ndipo nkhani ya kupezayi ili mu kalozera wa endoscopy ya njira ya chakudya ndi chromoendoscopy, womwe umafotokoza kuyika utoto pa minofu yamoyo, mtundu wa piritsi la Lumeblue lomezedwa, komanso chifukwa chake kupeza madera ovulala sikutanthauza kuwachiza.

Kusintha matenda poyerekeza ndi kuwasonyeza: tebulo la umboni

Mmene mungawerengere mawu otsatira onena za IBD

Onani mawu aliwonse ngati ntchito yaing'ono yosiyanitsa zinthu m'magulu. Choyamba, dziwani ntchito yake: kodi utotowo umaperekedwa kuti usinthe mmene thupi limagwirira ntchito, kapena umayikidwa kuti minofu ifufuzidwe? Chachiwiri, dziwani matenda ake: ulcerative colitis yomwe imangokhudza matumbo aakulu si matenda a Crohn omwe amakhala ndi madera osalumikizana ovulala ndi mavuto okhudza khoma lonse la matumbo; zotsatira za matenda amodzi sizimangogwiranso ntchito pa enawo. Chachitatu, dziwani mulingo wa kafukufukuyo: chitsanzo cha makoswe choyambitsidwa ndi mankhwala, kafukufuku wa kupeza madera osazolowereka mwa anthu, ndi mayeso a chithandizo mwa anthu zimayankha mafunso osiyanasiyana ndipo sizingalowe m'malo mwa zina. Chachinayi, onani zomwe zinayesedwa: zizindikiro za minofu ndi chiwerengero cha madera opezeka zimangoimira zinthu zina, pamene kuchepa kapena kutha kwa zizindikiro, kubwereranso kwa matenda, kugonekedwa m'chipatala, ndi opaleshoni ndi zotsatira zomwe odwala amakumana nazo. Mawu amene amakwaniritsa zonse zinayi ayenera kuwaganizira. Mawu amene amatenga ziwerengero za kupeza dysplasia za Marion kuti athandize chisankho cha chithandizo amalephera pa kufufuza koyamba ndipo ayenera kuikidwa pambali.

Mfundo zofunika kukumbukira

Khalani ndi mabokosi awiri ndipo musalole zomwe zili mmenemo kusakanikirana. Bokosi loyamba lili ndi mayeso achidule a makoswe momwe methylene blue inachepetsa zizindikiro za kuvulala kwa matumbo aakulu koyambitsidwa ndi mankhwala. Njira ya nitric oxide ndiyo inaganiziridwa kwambiri kuti ikufotokoza mmene zimenezi zinachitikira, koma malire onse a kugwiritsa ntchito zotsatira za zitsanzo za kuvulala kwadzidzidzi pa anthu akadali pomwepo. Bokosi lachiwiri lili ndi kafukufuku woyang'anira anthu momwe utoto wabuluu unathandiza akatswiri a endoscopy kupeza dysplasia yoyenera kutengeramo tizidutswa ta minofu, koma osapereka chidziwitso chilichonse chokhudza kuchiza matenda a matumbo. Kuti mudziwe mwachidule ntchito zovomerezeka ndi zoyesedwa, onani chidule cha ntchito za methylene blue m'zachipatala. Zolemba zosonkhanitsidwa za kafukufuku wa methylene blue zimatchula kafukufuku amene ali maziko a kusiyana kumeneku.