Nkhani
Methylene blue pa MCAS ndi kusalolera histamine: zomwe umboni ukusonyeza
Methylene blue si chithandizo chotsimikiziridwa cha vuto lotseguka kwa maselo a mast (MCAS) kapena kusalolera histamine. Zolemba za kafukufuku zomwe zinapezeka pokonzekera nkhaniyi sizinali ndi mayesero a odwala okhala ndi gulu loyerekezera omwe anasonyeza phindu lopitirira kwa vuto lililonse mwa awiriwa. Zomwe zilipo zikuphatikiza mayesero a m'labotale ndi lipoti la wodwala pa nthawi yozungulira opaleshoni, zomwe zimayankha mafunso ocheperapo.
Kusiyanitsa kumeneku n'kofunika chifukwa “kuchepetsa kutupa,” “kukhazikitsa maselo a mast kuti asatulutse zinthu,” ndi “kuchotsa histamine” zimafotokoza zotsatira zosiyana. Umboni wa chimodzi sungangogwiritsidwa ntchito kutsimikizira zinazo.
Mawu atatu omwe ayenera kukhalabe osiyana
MCAS imakhudza zochitika zobwerezabwereza zomwe maselo a mast amatulutsa zinthu zonyamula mauthenga n'kukhudza thupi lonse. Histamine ndi chimodzi mwa zinthu zimenezi, koma maselo a mast amapanganso zinthu zina zotumiza mauthenga. American Academy of Allergy, Asthma & Immunology imafotokoza mmene MCAS imawunikidwira pogwirizanitsa zochitika zokhala ndi zizindikiro zake, kuwonjezeka kwa zinthu zonyamula mauthenga zoyenera pamene zizindikiro zilipo poyerekeza ndi mlingo wamba, komanso kuyankha ku chithandizo cholunjika pa zinthu zimenezo. Kungokhala ndi zizindikiro zingapo sikutsimikizira kuti munthu ali ndi vutoli.
Ziwengo zapompopompo zoyendetsedwa ndi IgE zimachitika pamene chitetezo cha m'thupi chimayankha ku chinthu chinachake choyambitsa ziwengo. Chinthu choyambitsa ziwengo chikamangirira ku IgE pa maselo a mast, chingayambitse kutulutsidwa kwa zinthu zonyamula mauthenga. Njira yodziwika imeneyi ya ziwengo ingakhudze maselo a mast popanda kutanthauza kuti munthu aliyense wa ziwengo ali ndi MCAS yosadziwika chifukwa chake. Mawu akuti “ziwengo” amaphatikizanso njira zina kupatula njira yapompopompo imeneyi.
Kusalolera histamine nthawi zambiri ndi mawu ofotokoza mavuto amene akuganiziridwa kuti amayambitsidwa ndi histamine ya m'chakudya. Sikuti ndi chinthu chimodzi ndi ziwengo za chakudya kapena MCAS. Malangizo a 2021 opangidwa ndi mabungwe angapo okhudza histamine yodyedwa amafotokoza kuti umboni wogwirizanitsa kudya histamine ndi zizindikiro zomwe zimabwereza pakayesedwanso ndi wochepa komanso wotsutsana, ndipo amachenjeza kuti kuyeza diamine oxidase m'gawo lamadzimadzi la magazi sikungatsimikizire vutoli. Mawuwa amafotokoza lingaliro la chimene chingayambitse zizindikiro; vuto lotsatira kudya chakudya palokha silitsimikizira kuti histamine sikuphwanyidwa mokwanira.
Zomwe mayesero a maselo a mast anayeza kwenikweni
Zotsatira zachindunji za mayesero sizichirikiza mfundo yosavuta yakuti methylene blue imaletsa mosadalirika kutulutsa zinthu kuchokera m'maselo a mast.
Mu kafukufuku wa Kimura ndi anzake wa 1999 wokhudza kayendedwe ka magazi m'mitsempha yaing'ono ya makoswe, ofufuza anaona maselo a mast pafupi ndi mitsempha yaing'ono yobwezera magazi kuchokera ku minofu yolumikiza matumbo, pogwiritsa ntchito makina oonera zinthu zazing'ono m'thupi lamoyo. Kuyendetsa madzi okhala ndi methylene blue wa 50 micromolar pamwamba pa minofuyo kunayambitsa kutulutsidwa kwa zinthu zomwe zinali m'matumba aang'ono a maselowo. Maselo oyera a magazi anamamatiranso kwambiri ku khoma la mkati la mtsempha ndipo ankagubuduka pang'onopang'ono kwambiri. Kupereka ketotifen pasadakhale kunaletsa kutulutsidwa kwa zinthu kuchokera m'matumbawo. Uku kunali kuyesa nyama kofufuza kutumizirana mauthenga kokhudzana ndi nitric oxide, osati kupereka chithandizo chomwedwa kwa anthu a MCAS.
Kafukufuku wa 2001 wa maselo a basophil a anthu ndi maselo a mast a m'chigawo chozungulira ziwalo za m'mimba mwa makoswe anayeza kutulutsidwa kwa histamine mwachindunji. Methylene blue sinasinthe kutulutsidwa kwa histamine komwe kumachitika mwachibadwa kapena komwe kunayambitsidwa ndi chitetezo cha m'thupi m'maselo a basophil a anthu pansi pa mikhalidwe yoyesedwayo. Maselo a basophil ndi maselo a chitetezo cha m'thupi ofanana ndi maselo a mast, koma sangayesedwe ngati kuti ndi maselo a mast a m'minofu.
Mayesero ena ogwiritsa ntchito mzere wa maselo a makoswe wa RBL-2H3 sanapeze kusintha kulikonse kochititsidwa ndi methylene blue pa kutulutsidwa kwa histamine komwe kumachitika mwachibadwa kapena koyambitsidwa ndi L-arginine. Mzere wa maselo, maselo opatukana, ndi maselo a mast omwe ali m'mitsempha yaing'ono ya nyama yamoyo zimasiyana pa mauthenga owazungulira komanso zinthu zimene amakumana nazo m'mayesero. Kusapeza kusintha, kapena kupeza kutulutsidwa kwa zinthu za m'matumba a maselo m'mayesero amenewa, sikulosera mmene munthu aliyense angayankhire. Pamodzi, zotsatirazi zimapangitsa kuti zikhale zovuta kutsimikizira kunena mosasiyanitsa kuti methylene blue “imakhazikitsa maselo a mast kuti asatulutse zinthu.”
Miyeso ya kutupa mwachisawawa ili kutali kwambiri ndi funso la chithandizo cha odwala. Kusintha kwa cytokine kapena puloteni yotumiza mauthenga sikungatsimikizire kuchepa kwa kutulutsidwa kwa zinthu za m'matumba a maselo a mast pokhapokha ngati kutulutsidwa kumeneku kunayesedwa. Ngakhale kuchepa kwa kutulutsidwa kwa zinthu zonyamula mauthenga kutasonyezedwa, pangafunikirebe umboni wa odwala wotsimikizira kuchepa kwa zochitika za vutoli kapena kuyenda bwino kwa moyo watsiku ndi tsiku. Kusiyana pakati pa mauthenga okhudza kutupa ndi zotsatira pa thanzi kumagwiranso ntchito pano.
Nkhani ya wodwala m'chipatala imayankha funso lina
Lipoti la 2017 la wodwala amene anachitidwa opaleshoni yochotsa magazi oundana m'mitsempha ya m'mapapo limafotokoza wodwala amene mwina anali ndi vuto la maselo a mast ndipo pambuyo pa opaleshoni anadwala shock chifukwa cha kutambasuka kwa mitsempha ya magazi. Wodwalayo analandira mankhwala oletsa zochita pa H1 ndi H2, mankhwala a steroid, ndi methylene blue, ndipo kayendedwe ka magazi kanasintha kukhala bwino.
Umenewo ndi umboni woona zomwe zinachitika pa wodwala, koma chotsatira chake chinali kubwezeretsa kayendedwe ka magazi pa mikhalidwe yovuta ya opaleshoni. Anaperekedwa zithandizo zingapo, panalibe gulu loyerekezera, ndipo matenda ake sanali otsimikizika. Lipotili silingapatule gawo lomwe methylene blue inathandizira, kusonyeza kuti inaletsa kutulutsidwa kwa zinthu zonyamula mauthenga, kapena kutsimikizira kuti kuigwiritsa ntchito mobwerezabwereza kumachepetsa mavuto a nthawi yaitali ochitika chifukwa cha chakudya. Kukonza mavuto a kuthamanga kwa magazi omwe amabwera pambuyo pa chochitika cha vutoli ndi kupewa chochitikacho ndi zolinga ziwiri zosiyana za chithandizo.
Kuyerekezera vuto ndi chotsatira choyezedwa
Gwiritsani ntchito kuyerekezera kumeneku kuti mudziwe zomwe zingafunike kutsimikizira phindu lomwe likunenedwa. Zofunikira za umboni zomwe zili m'munsizi ndi kaphatikizidwe koyambirira ka kusiyana kwa kuzindikira matenda ndi mayesero komwe kwafotokozedwa pamwambapa, osati chida chotsimikiziridwa chozindikira matenda.
| Zotsatira zomwe zikunenedwa | Vuto kapena njira yokhudzidwa | Umboni womwe ungazichirikize | Zomwe zingakhalebe zosatsimikiziridwa |
|---|---|---|---|
| Kumaletsa kutseguka kwa maselo a mast | Kutulutsidwa kwa zinthu zonyamula mauthenga kuchokera m'maselo a mast mu njira yoyesera yofotokozedwa bwino | Miyeso yoyendetsedwa bwino ya kutulutsidwa kwa zinthu za m'matumba a maselo ndi zinthu zonyamula mauthenga zoyenera, yokhala ndi miyeso yotsimikizira kuti maselo akadali amoyo | Phindu kwa anthu amene MCAS yawo yatsimikiziridwa |
| Kumawongolera MCAS | Zochitika zobwerezabwereza zokhudza thupi lonse zomwe zafotokozedwa bwino mwa njira zachipatala | Zotsatira za odwala zoyerekezedwa ndi gulu lina, monga kuchuluka kwa zochitika, kuopsa kwake, kuthekera kochita ntchito, ndi zotsatira zosafunika, limodzi ndi kuwunika koyenera kwa zinthu zonyamula mauthenga | Kuti phindu limachokera ku kuphwanyidwa mofulumira kwa histamine |
| Kumachepetsa mavuto a histamine okhudzana ndi chakudya | Zizindikiro zobwerezanso zomwe zikugwirizana ndi histamine yodyedwa pambuyo powunika zifukwa zina | Kuyerekezera zizindikiro pansi pa mikhalidwe yofanana, koyang'aniridwa ndiponso kobisa kuti ndani akulandira chiyani | Kusowa kwa DAO komwe kuli maziko a vutolo kapena phindu pa ziwengo zoyendetsedwa ndi IgE |
| Kumafulumizitsa kuchotsedwa kwa histamine | Kusinthidwa kwa histamine ndi thupi | Miyeso yotsimikiziridwa ya mmene thupi limagwirira ntchito ndi histamine pansi pa kulandira histamine koyendetsedwa bwino, limodzi ndi umboni wokhudza enzayimu yeniyeni | Kuchepa kwa zizindikiro kapena kwa zochitika zoyambitsidwa ndi maselo a mast |
| Kumachepetsa shock kapena kutupa mwachisawawa | Kulephera kwa kayendedwe ka magazi kapena njira inayake ya kutupa | Zotsatira za kayendedwe ka magazi kapena chotsatira chenicheni choyezedwa cha kutupa, zoyerekezedwa ndi gulu loyenera | Kupewa ziwengo, zochitika za MCAS, kapena kusalolera chakudya |
Kuphwanya histamine si kuletsa MAO
Histamine ili ndi njira ziwiri zazikulu zosinthidwa ndi thupi zomwe zimakhudza diamine oxidase (DAO) ndi histamine N-methyltransferase (HNMT). Ma enzayimu amenewa ndi osiyana ndi monoamine oxidase A (MAO-A). Chithunzi cha pachikuto chimasiyanitsa kutulutsidwa kwa zinthu zonyamula mauthenga ndi njira zimenezi zopwanya histamine; maina a ma enzayimu omwe ali pachithunzicho amatchula njira, osati zinthu zopangidwa kuchokera ku histamine.
Ramsay ndi anzake anasonyeza kuti methylene blue imaletsa MAO-A, zomwe ndi zofunika pa kuopsa kochitika chifukwa cha serotonin. Kuletsa MAO-A si umboni wakuti ntchito ya DAO kapena HNMT imawonjezeka, ndipo sikusonyeza kuchotsedwa mofulumira kwa histamine. Kufanana kwa maina a ma enzayimu sikutsimikizira kuti ali ndi phindu lofanana pa chithandizo.
Palinso kusiyana kwa kafukufuku komwe munthu angaphonye mosavuta. Kafukufuku wa 2020 wa kuyeza DAO wokhudza odwala 22 ndi anthu 22 oyerekezera unapanga methylene blue ngati chinthu chautoto chochokera ku kusintha kwa zinthu m'labotale komwe kunkagwiritsidwa ntchito kuyerekezera ntchito ya enzayimu. Anthu omwe anatenga nawo mbali sanali kulandira chithandizo cha methylene blue. Choncho, kupeza mawu onse awiriwa m'nkhani ya kafukufuku sikutanthauza nthawi zonse kuti nkhaniyo ikufufuza chithandizo.
Chifukwa chake kusintha kwa zizindikiro sikungatsimikizire njira imene zinthu zikugwirira ntchito
Zokambirana pa malo ochezera zomwe zinayambitsa funso limeneli zikuphatikiza zonena za kugayika bwino kwa chakudya ndi kuchepa kwa kufuna kukodza mwachangu pambuyo pogwiritsa ntchito methylene blue. Zonena zimenezo zimafotokoza kusintha komwe anthuwo anaona kapena kumva. Sizikuyeza kuchuluka kwa histamine, kutsimikizira MCAS, kapena kusonyeza kuti minofu ya chikhodzodzo inayamba kukana zotsatira za histamine.
Zizindikiro zingasinthe pamene chakudya, caffeine, kuchuluka kwa madzi m'thupi, mankhwala, ndi zinthu zina zomwe munthu amakumana nazo zikusintha. Zomwe munthu waona zingakhale zoona ngakhale kuti chifukwa chimene akuganiza sichili cholondola. Kufunika kokodza mwachangu kumafunikanso kuwunikidwa payokha: zizindikiro za chikhodzodzo ndi matenda otsimikiziridwa a njira ya mkodzo ndi zinthu zosiyana. Kuchepa kwa zizindikiro kokha sikungatsimikizire kuti matenda kapena ntchito ya maselo a mast ndi zomwe zayambitsa vutolo.
Kuyankha mopitirira kwa chitetezo cha m'thupi kukadali kofunika
Methylene blue yokha ingayambitse kuyankha mopitirira kwa chitetezo cha m'thupi. Malangizo operekera PROVAYBLUE kudzera mumtsempha wa magazi amafotokoza anaphylaxis ndipo amaletsa kugwiritsa ntchito mankhwalawa kwa munthu amene anali ndi kuyankha koopsa kwa chitetezo cha m'thupi ku chinthu cha gulu la methylene blue. Amachenjezanso za serotonin syndrome ikagwiritsidwa ntchito ndi mankhwala ena omwe amalumikizana nayo, ndipo amaletsa kugwiritsa ntchito kwa anthu osowa G6PD. Malangizo amenewa amatsimikizira zoopsa zofunika; safotokoza kuchuluka kwa chiopsezo chilichonse cha chinthu chomwedwa chomwe sichinafufuzidwe.
Umboni sulungamitsa kusintha mankhwala a antihistamine olembedwa ndi dokotala kapena chithandizo china chotsimikiziridwa n'kugwiritsa ntchito methylene blue m'malo mwake. Kuvutika kupuma, kutupa pakhosi, kapena kukomoka kumafunika thandizo lachipatala la mwadzidzidzi, osati kuyesa chinthu cha utoto. Pokonzekera kukambirana ndi katswiri wa zachipatala, bweretsani zomwe zikunenedwa zenizeni, chinthu chomwe mukufuna kugwiritsa ntchito, mankhwala omwe mukumwa panopa, ndi mbiri ya zizindikiro zanu, pogwiritsa ntchito mafunso awa okhudza methylene blue. Funso lofunika ndi lakuti chithandizocho chikufuna kuthana ndi matenda ati ndi kukwaniritsa chotsatira chiti, komanso ngati pali umboni wa kugwiritsa ntchito kumeneko.