Methylene blue palichen planus yemumuromo: humbowo hweyedzo yekurapa nechiedza

Varwere vaviri vanoverenga mhedzisiro imwe chete asi vonzwa zvipikirwa zvakasiyana. Mumwe anonzwa kuti maronda akapora, saka chirwere chapera. Mumwe anonzwa kuti kurwadziwa kwakaderera, saka maronda anofanira kunge akapora. Muverengi wechitatu anoona mwero wakaderera wekudzoka kwechirwere ofunga kuti unoshanda kumunhu wese akatanga kurapwa. Kuverenga kumwe nokumwe uku kunovhiringidza pfungwa imwe neimwe. Ongororo iyi inodziparadzanisa.

Nyaya iri pano ndeyekurapa nemethylene blue nechiedza kunoitwa nenyanzvi yezveutano, kunowanzonzi MB-PDT, kwevanhu vakaonekwa kuti vane lichen planus yemumuromo ine maronda, inowanzonzi OLP. Humbowo huri pano hunobva muyedzo yakagovera varwere mumapoka zvisina kurongwa yekurapa nechiedza pamwe necorticosteroid inozorwa palichen planus yemumuromo ine maronda, yakabudiswa muna 2026, iine varwere 74 vakagoverwa mumapoka zvisina kurongwa. Inoedza MB-PDT sechinowedzerwa kusteroid, kwete sechinotsiva steroid uye kwete sekurapa kumba. Vaverengi vanoda kutanga vanzwisisa chinhu chinonzwa chiedza vanofanira kutanga nenyaya yekuti methylene blue inoshanda sei sechinhu chinonzwa chiedza, uye vaverengi vari kuenzanisa kurapa kunotanga kushandiswa vanofanira kuverenga nezvecorticosteroid dzinozorwa pamaronda emumuromo pamwe chete nepeji iri.

Pfungwa mbiri dziri shure kwekurapa uku

OLP chirwere chinogara kwenguva refu cheganda remukati memuromo, chinokonzerwa nezvinoitwa nemasoja emuviri. OLP ine maronda, rudzi rwakaedzwa muyedzo iyi, inoreva kubvaruka kunorwadza kweganda remukati memuromo, kazhinji mukati mematama, kunopora kwodzoka. Chinonyanya kuratidza chirwere ichi kudzoka kwacho. Kupora kwenguva pfupi hakurevi kudzora chirwere kwenguva refu, saka tsananguro ipi zvayo yakatendeseka inofanira kutevera kupora, zviratidzo, uye kudzoka kwechirwere sezvinhu zvakasiyana.

MB-PDT ine zvikamu zvitatu: chinhu chinonzwa chiedza pamwe nechiedza chine kureba kwemafungu kunotorwa nechinhu ichocho pamwe neokisijeni. Kana chimwe chikamu chikabviswa, nzira iyi haishandi. Methylene blue inotora chiedza chitsvuku chine mafungu ari pedyo ne660 nm, dhayi yamutswa nechiedza inoendesa simba kana maerekitironi nenzira dzinoda okisijeni, uye zvinhu zvinobuda zvinokurumidza kuita mabasa emakemikari zvinokuvadza nyama yakanangwa panzvimbo iyoyo. Dhayi imwe chete iyi isina chiedza inzira yakasiyana, ndokusaka nyaya yekurapa nemethylene blue nechiedza pazvirwere zveganda ichiratidza mushonga, chiedza, huwandu hunoshandiswa, uye nguva iri pakati pezvikamu pakushandiswa kwega kwega. Kana ichishandiswa mumuromo, nzira iyi inofanira kuitwa nenyanzvi munzvimbo yezveutano, dzichiona ronda zvakananga, ronda raomeswa uye raparadzaniswa nezvarakapoteredzwa nazvo risati ravhenekerwa.

Zvakaitwa chaizvo muyedzo

Yedzo yakaitwa pachipatara chimwe muShanghai, ikapinza vanhu vakuru vaiva neOLP ine maronda yakasimbiswa nekuongorora chidimbu chenyama, maronda ari makuru kupfuura 5 mm squared maererano nemaitiro eWHO a2003 akagadziridzwa, uye ikagovera varwere 37 kuMB-PDT pamwe nepesiti ye0.1 percent triamcinolone acetonide ne37 kupesiti chete. Pesiti yaizorwa katatu pazuva mumapoka ose ari maviri mukati memavhiki mana ekurapa. Boka rePDT rakawedzerwa kuvhenekerwa vhiki nevhiki nechiedza che660 nm pa13.2 J per square cm kwemasekonzi 60 pachikamu, mushure mekuzorwa methylene blue ye0.1 mg per mL, kusvika kuzvikamu zvina. Muongorori akazvimirira aisaziva kuti murwere aiva muboka ripi ndiye akayera mhedzisiro. Varwere nenyanzvi dzaivarapa vaiziva mapoka acho, zvinova zvakajairika pakurapa nechiedza asi zvichisiya mishumo yezviratidzo ichigona kukanganiswa nezvavaitarisira. Nhanganyaya yenzira dzerudzi urwu rweyedzo iri munyaya yekuverenga mishumo yeyedzo dzekurapa nechiedza.

Ongororo dzenguva pfupi kusvika pavhiki 4 dzakashandisa nzira yekuongorora varwere vose mumapoka avakagoverwa pakutanga, nemaitiro ekuzadza mashoko aishayikwa. Kutevera kwenguva yakareba pavhiki 8 ne12 kwakatevera chete varwere vakanga vapindura kurapwa, izvo zvakakosha zvikuru pakudzoka kwechirwere, sezvinoratidzwa pazasi. Mibvunzo inowanzobvunzwa nezvekurongwa kwekurapa mukiriniki uye kuongorora kuchengeteka inopindurwa mumibvunzo inowanzobvunzwa nezvekurapa kwemumuromo nechiedza.

Tafura yekuenzanisa muyedzo

Kupora, kurwadziwa, kudzoka kwechirwere, uye upenyu hwezuva nezuva zvakachinja zvakasiyana

Kupora pavhiki 4 kwaiva nani neboka rakagamuchira nzira dzose dziri mbiri. Kushanda kwekurapa kwakasvika pavarwere 35 pa37 (94.6 percent) neMB-PDT pamwe nesteroid zvichienzaniswa ne26 pa37 (70.3 percent) nesteroid chete, musiyano wemapoinzi 24.3 uye P yakaenzana ne0.006. Kuvharika kwakakwana kwemaronda kwakaita chikamu chikuru chemusiyano iwoyo, 27 pa37 zvichienzaniswa ne21 pa37. Mwero wekudzikira kwenzvimbo yeronda wakava mukuru zvine kukosha pahuwandu muboka renzira dzose dziri mbiri pavhiki 4, kukosha ikoko kukanyangarika pavhiki 8, ndokudzoka pavhiki 12. Chibodzwa cheREU chinoyera kukura kwechirwere munzvimbo dzakawanda chakavandudzika mumapoka ose ari maviri pasina musiyano une kukosha pahuwandu pakati pemapoka panguva ipi zvayo, chichiyeuchidza kuti ronda guru harimiriri muromo wose.

Kurwadziwa kwakachinja zvishoma nezvishoma. Avhareji yekudzikira kwechibodzwa chenhamba pavhiki 4 yaiva mapoinzi 3.97 neboka renzira dzose dziri mbiri zvichienzaniswa ne2.62 nesteroid chete, P yakaenzana ne0.004. Mapoka haana kusiyana mukati memavhiki maviri okutanga. Musiyano wakaonekwa pavhiki 3 uye wakaramba uripo pavhiki 8 ne12. Maitiro iwayo anoenderana nekurapa kunowedzerwa kunoda zvikamu zvinodzokororwa pane kuderedza kurwadziwa pakarepo, uye anoyambira nezvekutonga nzira iyi mushure mekushanya kamwe chete.

Pakudzoka kwechirwere, huwandu hunoshandiswa pakuverenga ndihwo hunosarudza zvinorehwa nemhedzisiro. Chinyorwa cheyedzo yeOLP ine maronda iyi chinotsanangura kudzoka kwechirwere pakati pevarwere vakapora, uye nhamba dzinoratidza kuti kupora kwaireva kupindura kwakakwana: 27 zvichienzaniswa ne21 pavhiki 8, zvichidzika ku26 zvichienzaniswa ne20 pavhiki 12. Pavhiki 8 kudzoka kwechirwere kwaiva 2 pa27 (7.4 percent) zvichienzaniswa ne5 pa21 (23.8 percent), musiyano usina kukosha pahuwandu. Pavhiki 12 kwaiva 3 pa26 (11.5 percent) zvichienzaniswa ne8 pa20 (40.0 percent), P yakaenzana ne0.038. Iyi imhedzisiro yeboka duku revakapindura kurapwa, kwete mhedzisiro yekuongorora vose mumapoka avakagoverwa pakutanga, nokuti varwere vasina kupora vakabva muongororo yekudzoka kwechirwere kuti vawane kumwe kurapa. Munyori anotaura 11.5 zvichienzaniswa ne40.0 percent asingatauri huwandu hwe26 zvichienzaniswa ne20 hunoshandiswa pakuverenga anodzokorora chikanganiso chinowanzoitwa mumishumo inotsanangura bepa iri.

Kunaka kweupenyu nemanzwiro zvakaratidzawo kupatsanuka kumwe chete. Kunaka kweupenyu maererano nehutano hwemumuromo pachiyero cheOHIP-14 kwakavandudzika zvakanyanya neboka renzira dzose dziri mbiri, P yakaenzana ne0.002, uye kuzvidya mwoyo pachiyero cheGAD-7 kwakavandudzika zvakanyanya, P yakaenzana ne0.007. Kuora mwoyo pachiyero chePHQ-9 hakuna kusiyana. Zvibodzwa zvekuzvidya mwoyo nekuora mwoyo pakutanga zvaiva zvakaderera, saka zviyero izvi zvinoyera shanduko duku muboka rakanga rakanganiswa zvishoma pane kuyera kurapwa kwechirwere chekuzvidya mwoyo kana chekuora mwoyo.

Miganhu inofanira kurangarirwa nemuverengi anongwarira

Huwandu hwevarwere ndiwo muganhu wokutanga. Kuverenga kwacho kwakafungidzira kushanda kwekurapa kwe37 zvichienzaniswa ne79 percent, kukaisa simba rekuona musiyano pa80 percent pamhedzisiro huru yepavhiki 4, uye kukabudisa varwere 74 pamwe chete. Huwandu ihwohwo hahugoni kutsigira zvirevo zvakasimba pamusoro pemapoka maduku ekudzoka kwechirwere e26 zvichienzaniswa ne20, zviyero zvekunaka kweupenyu, kana kukuvara kusingawanzoitiki. Kusava nezviitiko zvinokuvadza muvarwere 74 mukati memavhiki 12 kunobvisa fungidziro yekukuvara kunowanzoitika asi kunotaura zvishoma nezvezviitiko zvisingawanzoitiki, uye nzira dzeongororo dzakanyatsobvunza nezvekurwadziwa mumuromo, kuzvimba kweganda remukati memuromo, uye kuchinja kwekunzwa kuravira maererano nemaitiro akajairwa ekuyera kukuvadza kwemushonga.

Kutevera varwere ndiwo muganhu wechipiri. Mavhiki gumi nemaviri kubva pakugoverwa mumapoka anenge mavhiki masere mushure mechikamu chokupedzisira chechiedza. OLP inodzoka mumwedzi nemakore, saka kuenzanisa kudzoka kwechirwere kwemavhiki 12 humbowo hwekutanga, kwete chirevo chekuti mhedzisiro inogara kwenguva refu. Kuitirwa panzvimbo imwe chete ndiwo muganhu wechitatu. Chikwata chimwe, mudziyo mumwe, purogiramu imwe yesteroid, uye boka raiva nevakadzi vanopfuura 80 percent vaiva pedyo nezera re59 zvinotsanangura kiriniki iyoyo zvakanaka asi zvisinganyatsotsananguri dzimwe nzvimbo.

Kukanganisa kuviri pakutaura mhedzisiro kunofanira kucherechedzwa kuitira kuti vanyori vasakutevedzera. Bepa rinobatanidza muganhu wekuvimba wemapoinzi epercent we7.9 kusvika 40.7 percent nereshiyo yengozi ye1.35, asi muganhu iwoyo unoenderana nemusiyano wakananga wemapoinzi 24.3, kwete nereshiyo. Uye chikamu chinokurukura mhedzisiro chinoti musiyano unokosha wemapoinzi 10 wakanga watsanangurwa kare hauna kuwanikwa, kunyange zvazvo musiyano wekushanda kwekurapa wakataurwa uchipfuura mapoinzi 10. Hapana chimwe chekukanganisa uku chinoshandura nhamba chaidzo, idzo dzinoramba dziri chokwadi chakatsiga: 35 pa37 zvichienzaniswa ne26 pa37 pakushanda kwekurapa, uye 3 pa26 zvichienzaniswa ne8 pa20 pakudzoka kwechirwere pavhiki 12 pakati pevakapindura zvakakwana.

Mhedziso inoramba iine muganhu wakamanikana, uye ndiwo musimboti wesimba rayo. Kuvanhu vakuru vane OLP ine maronda yakasimbiswa nekuongorora chidimbu chenyama, kuwedzera zvikamu zvina kana zvishoma zvekurapa nemethylene blue PDT mukiriniki vhiki nevhiki kutriamcinolone inozorwa kwakavandudza kupora nekudzikira kwekurwadziwa pavhiki 4, paine chiratidzo chemusiyano mukudzoka kwechirwere pavhiki 12 chinongobata vakapindura zvakakwana uye mukana pakunaka kweupenyu pazviyero zvekukanganiswa nehutano hwemumuromo nekuzvidya mwoyo. Yedzo iyi haiedzi dhayi yoga, midziyo yekumba, humwe hurefu hwemafungu echiedza, kana kudzora chirwere kwenguva refu. Varwere vari kufunga nezvayo vanofanira kubvunza nyanzvi yavo yezveutano nezvekusimbisa kuongororwa kwechirwere, huwandu hwezvikamu, maitiro ekurwadziwa anotarisirwa mumavhiki matatu kusvika mana, uye kuti kudzoka kwechirwere kuchatevedzerwa sei mushure memwaka wokutanga.