Chinyorwa
Methylene blue nechirwere chekuzvimba kweura: tsvakurudzo ichienzaniswa nekuisa ruvara pakuongorora chirwere
Nzira mbiri dzinoshandisa molekyuru imwe chete yebhuruu asi hadzina zvimwe zvakawanda zvadzinofanana. Mune imwe, vatsvakurudzi vanopa methylene blue kumakonzo ane ura hukuru hwakakuvadzwa nekemikari, voyeresa kana kuzvimba kuchiderera. Mune imwe, chiremba anoshandisa endoscope anomwaya dhayi yebhuruu yakasanganiswa nemvura paruvara rwemukati meura hwemunhu ane colitis ine maronda kana colitis yaCrohn kuti aone zvakajeka nzvimbo dzinofungirwa kuti dzine dambudziko. Yekutanga inobvunza kana mushonga wacho uchichinja chirwere. Yechipiri inobvunza kana ruvara ruchibatsira kuchiona. Vaverengi vari kutsvaga humbowo hwemethylene blue mucolitis ine maronda vanofanira kusiyanisa nyaya idzi mbiri, nokuti kudzibatanidza kunoshandura chinhu chinobatsira kuona kuita kurapa kwekufungidzira.
Kuedza kwakatsvaga kuchinja kuzvimba
Kuedza kurapa uku kuri muongororo yemakonzo yakaitwa naDinc nevamwe muna 2015, yakabudiswa ichinzi methylene blue inodzivisa muitiro wekuzvimba mucolitis yakakonzerwa neacetic acid. Kwaiva kuedza kusati kwasvika kuvarwere, uko mapoka akasarudzwa nenzira isina kurerekera, kwete kuedza kurapa varwere. Makonzo echirume eSprague-Dawley makumi masere akakamurwa kuita mapoka mana ane makumi maviri rimwe nerimwe: makonzo ane utano ekufananidza nawo, makonzo ane utano akapiwa dhayi, makonzo ane colitis asina kurapwa, uye makonzo ane colitis akarapwa. Colitis yakakonzerwa neacetic acid, uye makonzo mumapoka akarapwa akapiwa 2 mL yemusanganiswa we1% methylene blue. Mushure memazuva matatu boka racho rakaongorora chikamu che8 cm chekumagumo kweura hukuru.
Zvakayerwa zvaisanganisira marudzi akawanda ekukuvadzwa: zviyero zvekukuvadzwa kunooneka neziso uye nemaikorosikopu, kupindika kwezvinhu nepamadziro eura, kushanda kweneutrophils kuburikidza nemyeloperoxidase, kuora kwemafuta kunokonzerwa neoxidation kuburikidza nemalondialdehyde, maenzayimu anodzivisa oxidation anoti superoxide dismutase necatalase, macytokine anoti TNF-alpha, IL-1beta neIL-6, uye zviyero zvemuitiro wenitric oxide zvaisanganisira huwandu hwese hwenitrite/nitrate nekushanda kwenitric oxide synthase.
Acetic acid yakakonzera kukuvara kwaitarisirwa, uye mumamiriro iwayo makonzo ane colitis akarapwa nedhayi akaratidza kukuvara kushoma kunooneka neziso uye nemaikorosikopu, kupindika kuri nani kwezvinhu nepamadziro eura, myeloperoxidase nemalondialdehyde zvakaderera, superoxide dismutase necatalase zvakadzorerwa, uye macytokine, nitrite/nitrate nekushanda kwesynthase zvakaderera. Vanyori vakafungidzira kuti kudzivisa kugadzirwa kwakawandisa kwenitric oxide ndiyo nzira huru yakaita kuti izvi zviitike, zvichibatsirwawo nekuderedzwa kwekushushikana kwetishu kunokonzerwa neoxidation nenitrosation. Iyi ipfungwa ine musoro pamuenzaniso uyu, uye ongororo yakafara yehumbowo pamusoro pekuzvimba inoiisa pakati pezvimwe zvakawanikwa murabhoritari, kwete sehumbowo hwekurapa varwere.
Zvisina kuitwa neongororo iyi ndizvo zvinotonyanya kukosha. Yakatora mazuva matatu, yakashandisa makonzo echirume chete, yakaedza chirongwa chimwe chakatarwa isingaongorori shanduko dzinobva pahuwandu hwakasiyana, haina kushandisa mushonga unowanzoitwa weIBD pakuenzanisa, uye yakayera zviratidzo zvetishu nezvemakemikari emuviri zvinomirira migumisiro, pane kuyera kudzikama kwechirwere, kudzoka kwacho, kana mumwe mugumisiro kuvarwere. Kusvika muna Gunyana 2026, hapana kuedza kwakabudiswa kwakaitwa pavanhu kuchiongorora methylene blue sekurapa colitis ine maronda kana methylene blue pachirwere chaCrohn kuchiyera migumisiro yekurapa. Zvakawanikwa pamakonzo izvi inzvimbo yekutangira tsvakurudzo, kwete hwaro hwekuzvisarudzira huwandu hwekushandisa.
Nei kupiswa nekemikari kusiri muenzaniso wakasimba weIBD
Colitis inokonzerwa neacetic acid muenzaniso wekukuvara, kwete wechirwere sezvachinoitika muvanhu. Musanganiswa wekemikari unopisa rukoko rwemukati mechikamu chekumagumo kweura hukuru, neutrophils dzinomhanyira ipapo, maronda anoumbwa, uye mhuka inoongororwa mukati memazuva mashoma. Colitis ine maronda muvanhu chirwere chinogara kwenguva refu, chinodzoka-dzoka, uye chinokonzerwa nekushanda kwemasoja emuviri. Chinoumbwa nemajini, tupukanana tunogara mumuviri, uye masoja emuviri anodzidza kurwisa pamwe neanongovapo kubva pakuzvarwa, chiine nguva dzekuwedzera nekudzikama kwemakore. Muenzaniso uyu unodzokorora chimwe chimiro chechikamu chekumagumo kweura hukuru nezvimwe zviyero zvekuzvimba, asi unopotsa zvinenge zvese zvekutanga kwechirwere, kuramba chiripo, nekudzoka kwacho.
Pachirwere chaCrohn kusafanana uku kunowedzera. Ronda rinokonzerwa neacetic acid riri muchikamu chekumagumo kweura hukuru uye rinongobata rukoko rwemukati kusvika parukoko rwuri pasi parwo. Chirwere chaCrohn chinogona kubata chero chikamu chenzira yekugaya chikafu, chichisiya nzvimbo dzisina kukuvadzwa pakati pemaronda. Chinopinda mukukora kwese kwemadziro eura, uye chinoshandura tishu zvichikonzera kutetepa kwemigero nemigero isina kujairika inobatanidza nhengo. Naizvozvo mibvunzo pamusoro pemethylene blue nechirwere chaCrohn haigoni kupindurwa nekupiswa kwemazuva matatu kwechikamu chekumagumo kweura hukuru mumakonzo. Imwe tsvakurudzo yemhuka yakabatana neiyi pamusoro pemapoka etupukanana inofanira kunzwisiswa mumamiriro ayo, anotsanangurwa mugwaro reongororo yemakonzo pamusoro petupukanana twemuura.
Mutemo wekushandisa uri nyore. Kana chirevo chichinongedzera kumuenzaniso wecolitis yakakonzerwa nemaune, bvunza kuti ikemikari ipi yakashandiswa, rudzii rwemhuka uye dzaive hadzi kana hono, kuedza kwakatora nguva yakareba sei, kana kurapa kunowanzoitwa kwakashandiswa pakuenzanisa, uye kana zvakayerwa zvaiva zviratidzo zvetishu kana migumisiro kuvarwere. Muenzaniso unopindura kuti ura hukuru hwegonzo hwakaratidzika hwakazvimba zvakadii pazuva rechitatu haugoni kupindura kuti munhu anoramba aine chirwere chakadzikama here pamwedzi wechigumi nemiviri.
Ong ororo yakangotarisa chete
Gwaro rechipiri rine chinangwa chakasiyana. Marion nevamwe vakaita ongororo yakatevera varwere ichitsvaga dysplasia muvanhu 102 vaiva necolitis kwenguva refu, 79 vaine colitis ine maronda uye 23 vaine colitis yaCrohn. Yakabudiswa ichinzi kutora tishu munzvimbo dzakanangwa nechromoendoscopy kuri nani pane kuongorora kunowanzoitwa. Murwere mumwe nemumwe akashandiswa kuzvienzanisa naye pachake pakuongororwa kumwe chete uko colonoscope yakapfuura kaviri. Boka racho rakaenzanisa kutora tishu munzvimbo dzisina kusarudzwa kunowanzoitwa, kutora tishu munzvimbo dzakanangwa nekuda kwezvisina kujairika zvakaonekwa nechiedza chichena chakajairika, uye kutora tishu munzvimbo dzakanangwa mushure mekumwaya 0.01% methylene blue muura hukuru hwese. Nyanzvi imwe chete yekuongorora tishu dzenzira yekugaya chikafu yakaongorora masampuli isingazivi nzira yaakashandiswa kuatora.
Kunangisa nzvimbo uchibatsirwa nedhayi kwakawana dysplasia muvarwere 17, zvichienzaniswa ne3 pakutora tishu munzvimbo dzisina kusarudzwa; mutsauko uyu waiva wakakosha maererano nenhamba dzeongororo. Kwakaiwanawo mu17 zvichienzaniswa ne9 pakunangisa nechiedza chichena chete, kuwedzera kwenhamba kusina kusvika pachiyero chinowanzoitwa chekukosha kwenhamba. Kubatanidza nzira dzekunangisa kwakawana dysplasia muvarwere 20, zvichienzaniswa ne3 pakutora masampuli munzvimbo dzisina kusarudzwa. Hapana zviitiko zvinokuvadza zvakashumwa.
Hapana apa chakaedza kurapa. Dhayi yaiva chinhu chaiiswa pamusoro petishu kuti chisimbise musiyano wezvinoonekwa, zvichiita kuti maumbirwo asina kujairika emakomba madiki etishu ave nyore kuona nekutorera sampuli. Ong ororo iyi haina kuyera zviratidzo zvinonzwiwa nemurwere, kushanda kwechirwere, mazinga emacytokine, kudzikama kwechirwere, kana kudzoka kwacho, uye haigoni kutaurwa sehumbowo hwevanhu hwekuti methylene blue inorapa IBD. Kuwana nzvimbo dzine dambudziko ndiko kwakayerwa, uye izvi zvinofambirana negwaro reendoscopy nechromoendoscopy yenzira yekugaya chikafu, rinotsanangura kuisa ruvara pamatishu mapenyu, chimiro chepiritsi reLumeblue rinomedzwa, uye nei kuwana maronda kusiri kuarapa.
Kupindira kuchienzaniswa nekuita kuti zvionekwe: tafura yehumbowo
| Dinc 2015: kupindira kwekuedza | Marion 2008: kuita kuti zvionekwe pakuongorora chirwere | |
|---|---|---|
| Basa redhayi | Chinhu chiri kuongororwa kuti chingaderedza kuzvimba here | Ruvara runoiswa pamusoro petishu kuratidza musiyano |
| Mubvunzo wakabvunzwa | Methylene blue inoderedza kukuvara kwecolitis mumakonzo here | Kumwaya dhayi kunovandudza kuwanikwa kwedysplasia muvanhu here |
| Vakaongororwa | Makonzo echirume 80, colitis yeacetic acid inokurumidza kuitika, kuyerwa mushure memazuva 3 | Varwere 102 vaiongororwa nguva nenguva, 79 vane colitis ine maronda uye 23 vane colitis yaCrohn |
| Chirongwa chekushandisa | 2 mL yemusanganiswa we1%, chirongwa chimwe chakatarwa | Kumwaya 0.01% panguva yecolonoscopy, yozosvetwa mushure mekunge yatorwa netishu |
| Zvakayerwa | Zviyero zvekukuvadzwa, kupindika kwezvinhu nepamadziro, MPO, MDA, SOD, catalase, macytokine, kushanda kweNOS | Varwere vane dysplasia yakasimbiswa nekuongorora tishu panzira imwe neimwe yekutora sampuli |
| Mugumisiro mukuru | Makonzo ane colitis akarapwa akavandudzika pazviratidzo zvechimiro chetishu nezvemakemikari emuviri | Kunangisa nedhayi kwakawana dysplasia mu17 zvichienzaniswa ne3 pakutora sampuli munzvimbo dzisina kusarudzwa, P 0.001; 17 zvichienzaniswa ne9 pakunangisa nechiedza chichena, P 0.057 |
| Zvazvisingaratidzi | Hapana humbowo hwekushanda muvanhu, hapana ruzivo rwekudzikama kwechirwere, hapana gwara rehuwandu hwekushandisa | Hapana mugumisiro wekurapa pakuzvimba, zviratidzo zvinonzwiwa nemurwere, kana mafambiro echirwere |
Maitiro ekuverenga chirevo chinotevera cheIBD
Tora chirevo chimwe nechimwe sebasa diki rekuisa zvinhu mumapoka. Chekutanga, ziva basa racho: dhayi iri kupiwa kuti ichinje mashandiro emuviri here kana kuti iri kuiswa kuti tishu dziongororwe? Chechipiri, ziva chirwere: colitis ine maronda inongobata ura hukuru haisi chirwere chaCrohn chine maronda akaparadzana nematambudziko anobata kukora kwese kwemadziro eura, uye mugumisiro mune chimwe hauiti kuti zvive zvimwe chete mune chimwe. Chechitatu, ziva danho reongororo: muenzaniso wemakonzo wakakonzerwa nekemikari, ongororo yekuwana dambudziko muvanhu, uye kuedza kurapa vanhu zvinopindura mibvunzo yakasiyana uye hazvigoni kutsivana. Chechina, tarisa zvakayerwa: zviratidzo zvetishu nenhamba dzezvawanikwa zvinomirira migumisiro, asi kudzikama kwechirwere, kudzoka kwacho, kupinzwa muchipatara, nekuvhiyiwa ndizvo migumisiro inobata varwere. Chirevo chinopfuura kuongororwa pazvinhu zvese izvi zvina chakakodzera kutariswa. Chinokwereta nhamba dzekuwana dysplasia kubva kuna Marion kuti chitsigire sarudzo yekurapa chinokundikana pakuongororwa kwekutanga uye chinofanira kusiiwa.
Zvaunofanira kuyeuka
Chengeta mabhokisi maviri uye usamborega zviri mukati mawo zvichisanganiswa. Bhokisi rekutanga rine kuedza kupfupi kwemakonzo umo methylene blue yakaderedza zviratidzo zvekukuvadzwa kweura hukuru kwakakonzerwa nekemikari. Muitiro wenitric oxide ndiwo unonyanya kufungidzirwa kutsanangura zvakaitika, asi zvipingamupinyi zvese zvekushandisa zvinobva mumienzaniso yekukuvara kunokurumidza kuitika kuvanhu zvinoramba zviripo. Bhokisi rechipiri rine ongororo yekutevera vanhu umo dhayi yebhuruu yakabatsira vanachiremba vanoshandisa endoscope kuwana dysplasia yakakodzera kutorerwa sampuli, pasina kana ruzivo rwekurapa chirwere cheura. Kuti unzwisise kushandiswa kwakabvumirwa nekuchiri kuedzwa, ona pfupiso yekushandiswa kwemethylene blue mukurapa. Muunganidzwa wezvinyorwa zvetsvakurudzo yemethylene blue unoronga ongororo dzinotsigira misiyano iyi.