Methylene blue kuri lichen planus yo mu kanwa: ibimenyetso byo mu igerageza ry'ubuvuzi bukoresha urumuri

Abarwayi babiri basoma igisubizo kimwe bakumva amasezerano atandukanye. Umwe yumva ko ibisebe byakize, akumva rero ko indwara yashize. Undi yumva ko ububabare bwagabanutse, akumva rero ko ibisebe bigomba kuba byarakize. Umusomyi wa gatatu abona ko igipimo cyo kongera kugaruka kw'indwara kiri hasi, akibwira ko kireba abantu bose batangiye kuvurwa. Buri buryo bwo kubisoma bwitiranya igitekerezo kimwe n'ikindi. Iri sesengura rirabitandukanya.

Ingingo ivugwaho ni ubuvuzi bukoresha methylene blue n'urumuri butangwa n'umuganga, bukunze kwitwa MB-PDT, kuri lichen planus yo mu kanwa itera ibisebe yasuzumwe ikemezwa, ikunze kwitwa OLP. Ibimenyetso biri hano biva mu igerageza ry'ubuvuzi bukoresha urumuri bwongewe kuri korutikositeroyide isigwa kuri lichen planus yo mu kanwa itera ibisebe, aho abarwayi bashyizwe mu matsinda ku buryo bwa tombola, ryasohotse mu 2026, ririmo abarwayi 74 bashyizwe mu matsinda ku buryo bwa tombola. Rigerageza MB-PDT nk'inyongera kuri siteroyide, si nk'igisimbura cyayo kandi si nk'ubuvuzi bukorerwa mu rugo. Abasomyi bashaka kubanza kumenya ibijyanye n'ikinyabutabire gikora iyo kimurikiwe bagomba guhera ku buryo methylene blue ikora nk'ikinyabutabire gikangurwa n'urumuri, naho abagereranya ubuvuzi bubanza gukoreshwa bagasoma ibijyanye na korutikositeroyide zisigwa ku bisebe byo mu kanwa hamwe n'uru rupapuro.

Ibitekerezo bibiri ubuvuzi bushingiraho

OLP ni indwara idakira yo ku gahu gatwikiriye imbere mu kanwa, iterwa n'imikorere y'ubudahangarwa bw'umubiri. OLP itera ibisebe, ari yo yageragejwe muri ubu bushakashatsi, irangwa n'ibisebe bibabaza ku gahu k'imbere mu kanwa, akenshi imbere ku matama, bikira hanyuma bikagaruka. Ikiranga imigendekere y'iyi ndwara ni ukongera kugaruka. Gukira mu gihe gito ntibivuze ko indwara igenzurwa mu gihe kirekire, bityo ibisobanuro byose byizewe bigomba gukurikirana gukira, ibimenyetso n'ukongera kugaruka kw'indwara nk'ibintu bitandukanye.

MB-PDT ishingiye ku bintu bitatu: ikinyabutabire gikangurwa n'urumuri, urumuri rufite uburebure bw'umuraba icyo kinyabutabire cyakira, na ogisijeni. Iyo kimwe muri byo kivanywemo, ubwo buryo ntibukora. Methylene blue yakira urumuri rutukura rufite uburebure bw'umuraba hafi ya 660 nm; icyo kinyabutabire cy'ibara kimaze gukangurwa gihererekanya ingufu cyangwa elegitoroni binyuze mu nzira zikeneye ogisijeni, maze ibinyabutabire bikora cyane bivuyemo bikangiza inyama z'umubiri zigenewe kuvurwa aho byakoreshejwe. Gukoresha icyo kinyabutabire cy'ibara nta rumuri ni ubundi buryo butandukanye, ari yo mpamvu ubuvuzi bukoresha methylene blue n'urumuri ku ndwara z'uruhu bugaragaza umuti, urumuri, ingano ikoreshwa n'intera hagati y'ibikorwa kuri buri mikoreshereze. Iyo bukoreshwa mu kanwa, bugomba gukorwa n'abaganga babona neza ahavurwa, igisebe cyumishijwe kandi gitandukanyijwe n'ahagikikije mbere yo kukimurikiraho.

Ibyakozwe mu igerageza

Igerageza ryakorewe mu bitaro bimwe byo muri Shanghai. Ryakiriye abantu bakuru bafite OLP itera ibisebe yemejwe no gusuzuma agace k'inyama kakuwe mu kanwa, ibisebe birengeje 5 mm kare, hakurikijwe ibipimo bya WHO byo mu 2003 byahinduwe. Abarwayi 37 bashyizwe ku buryo bwa tombola mu itsinda rya MB-PDT hamwe n'umuti wa triamcinolone acetonide wa 0.1 ku ijana usigwa umeze nk'umutsima, naho abandi 37 bahabwa uwo muti usigwa wonyine. Mu matsinda yombi, uwo muti wasigwaga inshuro eshatu ku munsi mu byumweru bine by'ubuvuzi. Itsinda rya PDT ryongeyeho kumurikirwa buri cyumweru n'urumuri rwa 660 nm, kuri 13.2 J kuri cm kare, mu masegonda 60 kuri buri gikorwa, nyuma yo gusigwa methylene blue ya 0.1 mg kuri mL, kugeza ku bikorwa bine. Umusuzumyi wigenga utari azi itsinda buri murwayi yashyizwemo yapimye ibyavuyemo. Abarwayi n'abaganga babavuraga bari bazi amatsinda barimo, bikaba bisanzwe ku buvuzi bukoresha urumuri, ariko ibyo bigatuma ibyo abarwayi bavuga ku bimenyetso byabo bishobora guterwa n'ibyo biteze. Ibisobanuro by'ibanze ku buryo ubushakashatsi nk'ubu bukorwa biri mu buryo bwo gusoma raporo z'igerageza ry'ubuvuzi bukoresha urumuri.

Isesengura ry'igihe gito kugeza ku cyumweru cya 4 ryakoresheje uburyo bwo gusesengura abarwayi bose hakurikijwe amatsinda bashyizwemo mu ntangiriro, hakagereranywa indangagaciro z'amakuru yaburaga. Gukurikirana mu gihe cyakurikiyeho, ku byumweru bya 8 na 12, byarebye gusa abarwayi bari bagize igisubizo ku buvuzi. Ibyo bifite akamaro kanini ku kongera kugaruka kw'indwara, nk'uko bigaragara hepfo. Ibibazo bikunze kubazwa ku mitegurire y'ubuvuzi ku ivuriro no ku gukurikirana umutekano bisubizwa mu bibazo bikunze kubazwa ku buvuzi bwo mu kanwa bukoresha urumuri.

Imbonerahamwe igereranya amatsinda y'igerageza

Gukira, ububabare, kongera kugaruka kw'indwara n'imibereho ya buri munsi byahindutse mu buryo butandukanye

Gukira ku cyumweru cya 4 kwari kwiza kurushaho mu bahuje ubuvuzi bwombi. Igipimo cy'ubushobozi bw'ubuvuzi cyageze ku barwayi 35 muri 37 (94.6 ku ijana) bahawe MB-PDT hamwe na siteroyide, ugereranyije na 26 muri 37 (70.3 ku ijana) bahawe siteroyide yonyine. Ikinyuranyo cyari amanota 24.3 ku gipimo cy'ijanisha, P ingana na 0.006. Gufunga burundu kw'ibisebe ni byo byagize uruhare runini muri icyo kinyuranyo: 27 muri 37 ugereranyije na 21 muri 37. Igipimo cyo kugabanuka k'ubuso bw'igisebe cyabaye kinini ku buryo bufite ubusobanuro mu mibare mu itsinda ryahuje ubuvuzi bwombi ku cyumweru cya 4; icyo kinyuranyo nticyari kigifite ubusobanuro mu mibare ku cyumweru cya 8, ariko cyongeye kubugira ku cyumweru cya 12. Amanota ya REU apima uburemere bw'indwara mu buryo bwagutse yarushijeho kuba meza mu matsinda yombi, nta kinyuranyo gifite ubusobanuro mu mibare hagati y'amatsinda mu gihe icyo ari cyo cyose. Ibyo bitwibutsa ko igisebe kinini kurusha ibindi kitagaragaza uko akanwa kose kameze.

Ububabare bwagabanutse buhoro kurushaho. Ku cyumweru cya 4, impuzandengo yo kugabanuka ku gipimo cy'imibare yari amanota 3.97 mu bahuje ubuvuzi bwombi, ugereranyije na 2.62 mu bahawe siteroyide yonyine, P ingana na 0.004. Amatsinda ntiyatandukaniye mu byumweru bibiri bya mbere. Ikinyuranyo cyagaragaye ku cyumweru cya 3 kandi gikomeza ku byumweru bya 8 na 12. Iyo migendekere ihuye n'ubuvuzi bw'inyongera bukenera ibikorwa bisubirwamo aho gutanga ihumure ako kanya, kandi yerekana ko umuntu atagomba guca urubanza kuri ubwo buvuzi nyuma yo kujya ku ivuriro rimwe gusa.

Ku kongera kugaruka kw'indwara, umubare shingiro ni wo ugena icyo igisubizo gisobanura. Inyandiko y'igerageza ry'ubu bushakashatsi kuri OLP itera ibisebe isobanura kongera kugaruka kw'indwara mu barwayi bakize. Imibare yerekana ko abakize bari abagize igisubizo cyuzuye: 27 ugereranyije na 21 ku cyumweru cya 8, bagabanuka bakaba 26 ugereranyije na 20 ku cyumweru cya 12. Ku cyumweru cya 8, indwara yongeye kugaruka kuri 2 muri 27 (7.4 ku ijana) ugereranyije na 5 muri 21 (23.8 ku ijana), ikinyuranyo kidafite ubusobanuro mu mibare. Ku cyumweru cya 12, yari 3 muri 26 (11.5 ku ijana) ugereranyije na 8 muri 20 (40.0 ku ijana), P ingana na 0.038. Icyo ni igisubizo cyo mu itsinda rito ry'abagize igisubizo ku buvuzi, si igisubizo cy'isesengura ry'abashyizwe mu matsinda bose, kuko abarwayi batakize bavuye mu isesengura ryo kongera kugaruka kw'indwara bagahabwa ubundi buvuzi. Umwanditsi utangaza 11.5 ugereranyije na 40.0 ku ijana atavuze imibare shingiro ya 26 ugereranyije na 20 asubiramo ikosa rikunze kuboneka cyane mu nyandiko zisobanura iyi raporo.

Imibereho myiza n'uko umuntu yiyumva na byo byagaragaje iyo migendekere itandukanye. Imibereho myiza ijyanye n'ubuzima bwo mu kanwa yapimwe na OHIP-14 yarushijeho kuba myiza mu bahuje ubuvuzi bwombi, P ingana na 0.002, kandi guhangayika kwapimwe na GAD-7 kwagabanutse kurushaho, P ingana na 0.007. Kwiheba kwapimwe na PHQ-9 ntikwatandukaniye mu matsinda. Amanota yo guhangayika no kwiheba yari make mu ntangiriro, bityo ibyo bipimo bigaragaza impinduka nto mu itsinda ryari rifite ibyo bibazo ku rugero ruto, aho kugaragaza kuvura guhangayika cyangwa kwiheba byemejwe n'isuzuma rya muganga.

Imbogamizi umusomyi witonda agomba kuzirikana

Umubare w'abitabiriye ni yo mbogamizi ya mbere. Mu kubara uwo mubare, ubushakashatsi bwafashe ko igipimo cy'ubushobozi bw'ubuvuzi cyaba 37 ugereranyije na 79 ku ijana, bushyiraho ubushobozi bw'ibarurishamibare bwa 80 ku ijana bwo gutahura ikinyuranyo ku gisubizo nyamukuru cyo ku cyumweru cya 4, maze haboneka abarwayi 74 bose hamwe. Uwo mubare ntushobora gushyigikira imyanzuro ihamye ku kongera kugaruka kw'indwara mu matsinda mato ya 26 ugereranyije na 20, ku bipimo by'imibereho myiza, cyangwa ku ngaruka mbi ziboneka gake. Kutabona ingaruka mbi n'imwe mu barwayi 74 mu byumweru 12 bigaragaza ko ingaruka mbi zikunze kubaho zitagaragaye, ariko ntibitanga amakuru menshi ku ngaruka zidapfa kuboneka. Uburyo ubushakashatsi bwakoresheje bwabajije by'umwihariko ku bubabare bwo mu kanwa, kubyimba no kwangirika kw'agahu ko mu kanwa, no guhinduka k'uburyohe, hakurikijwe ibipimo bisanzwe by'uburozi.

Igihe cyo gukurikirana ni yo mbogamizi ya kabiri. Ibyumweru cumi na bibiri uhereye igihe abarwayi bashyiriwe mu matsinda ku buryo bwa tombola ni hafi ibyumweru umunani nyuma y'igikorwa cya nyuma cyo kumurikirwa. OLP yongera kugaruka mu mezi no mu myaka, bityo kugereranya kongera kugaruka kwayo mu byumweru 12 ni ibimenyetso by'ibanze, si ukwemeza ko inyungu ziramba. Kuba ubushakashatsi bwarakorewe ahantu hamwe ni yo mbogamizi ya gatatu. Itsinda rimwe ry'abaganga, igikoresho kimwe, gahunda imwe ya siteroyide, n'abitabiriye bari barengeje 80 ku ijana ari abagore bari hafi y'imyaka 59, bisobanura neza iryo vuriro ariko ntibihagararira neza ahandi.

Amakosa abiri yo gutanga amakuru akwiriye kwitabwaho kugira ngo abanditsi batayasubiramo. Raporo ihuza intera y'icyizere ya 7.9 kugeza kuri 40.7 ku ijana, igaragazwa mu manota y'ijanisha, n'ikigereranyo cy'ibyago cya 1.35, ariko iyo ntera ihuye n'ikinyuranyo nyacyo cy'amanota 24.3, si icyo kigereranyo. Kandi igice cyo kuganira ku bisubizo kivuga ko ikinyuranyo cy'ingenzi cy'amanota 10 cyari cyaragenwe mbere kitagezweho, nubwo ikinyuranyo cy'ubushobozi bw'ubuvuzi cyatangajwe kirengeje amanota 10. Nta na rimwe muri ayo makosa rihindura imibare yabonetse, ari yo makuru adahinduka: 35 muri 37 ugereranyije na 26 muri 37 ku bushobozi bw'ubuvuzi, na 3 muri 26 ugereranyije na 8 muri 20 ku kongera kugaruka kw'indwara ku cyumweru cya 12 mu bagize igisubizo cyuzuye.

Umwanzuro uguma ku byo ubushakashatsi bwagaragaje gusa, kandi ni byo biwuha imbaraga. Ku bantu bakuru bafite OLP itera ibisebe yemejwe no gusuzuma agace k'inyama, kongera ibikorwa bine cyangwa munsi yabyo bya PDT ikoresha methylene blue, bikorerwa ku ivuriro buri cyumweru, kuri triamcinolone isigwa byarushijeho kunoza gukira no kugabanya ububabare ku cyumweru cya 4. Ku cyumweru cya 12, ibimenyetso by'ikinyuranyo mu kongera kugaruka kw'indwara byagaragaye gusa mu bagize igisubizo cyuzuye, kandi habonetse inyungu ku mibereho myiza mu bipimo by'ingaruka z'ubuzima bwo mu kanwa no guhangayika. Igerageza ntirisuzuma ikinyabutabire cy'ibara cyonyine, ibikoresho byo mu rugo, ubundi burebure bw'imiraba, cyangwa kugenzura indwara mu gihe kirekire. Abarwayi batekereza gukoresha ubwo buvuzi bagomba kubaza umuganga wabo uko isuzuma ryemezwa, umubare w'ibikorwa, uko ububabare bwitezwe guhinduka mu byumweru bitatu kugeza kuri bine, n'uko kongera kugaruka kw'indwara bizakurikiranwa nyuma y'amezi atatu ya mbere.