Inqaku
Imethylene blue nesifo samathumbu esinokudumba: uphando xa luthelekiswa nokufaka umbala ngenjongo yoxilongo
Iinkqubo ezimbini zisebenzisa imolekyuli eluhlaza enye, kodwa phantse azinanto yimbi zifana ngayo. Kwenye, abaphandi banika imethylene blue kwiimpuku ezineekholoni ezonzakaliswe yikhemikhali baze balinganise ukuba ukudumba kuyehla na. Kwenye, ingcali ye-endoscopy itshiza idayi eluhlaza exutywe kakhulu kumaleko wangaphakathi wamathumbu womntu onokudumba kwekholoni okunezilonda okanye ukudumba kwekholoni okubangelwa sisifo sikaCrohn, ukuze ibone iindawo ezikrokrisayo ngokucacileyo ngakumbi. Eyokuqala ibuza ukuba le khompawundi iyasitshintsha na isifo. Eyesibini ibuza ukuba umbala uyasiveza na. Abafundi abafuna ubungqina ngemethylene blue nokudumba kwekholoni okunezilonda kufuneka bawagcine ahlukene la mabali mabini, kuba ukuwaxuba kuguqula isixhobo sokunceda ukubona sibe lunyango olungekhoyo.
Uvavanyo olwazama ukutshintsha ukudumba
Umzamo wonyango luphando luka-2015 ngeempuku olwenziwa nguDinc noogxa bakhe, olwapapashwa njengo imethylene blue ithintela inkqubo yokudumba kwekholoni okubangelwe yi-acetic acid. Yayiluvavanyo lwangaphambi kolingo lwezonyango, olunolwabiwo olungakhethiyo, ingelulo ulingo kwizigulana. Iimpuku ezingamaduna zohlobo lweSprague-Dawley ezingamashumi asibhozo zahlulwa zaba ngamaqela amane anamashumi amabini ngalinye: iqela lolawulo elisempilweni, izilwanyana ezisempilweni ezanikwa idayi, iqela elinokudumba kwekholoni elinganyangwanga, neqela elinokudumba kwekholoni elanyangwayo. Ukudumba kwekholoni kwabangelwa nge-acetic acid, kwaye izilwanyana ezikumaqela anyangwayo zafumana i-2 mL yesisombululo se-1% semethylene blue. Emva kweentsuku ezintathu iqela labaphandi lahlola icandelo le-8 cm lendawo esezantsi yekholoni.
Imilinganiselo yeziphumo yaquka iinkalo ezininzi zomonzakalo: amanqaku omonakalo obonakalayo nobonwa ngemikroskopu, ukugqithisa kodonga lwamathumbu izinto, ukusebenza kweeneutrophil okulinganiswa ngemyeloperoxidase, ukonakaliswa kwamafutha yi-oxidation okulinganiswa ngemalondialdehyde, ii-enzyme ezikhusela kwi-oxidation ezibizwa ngokuba yisuperoxide dismutase necatalase, iicytokine i-TNF-alpha, i-IL-1beta ne-IL-6, kunye nemilinganiselo yendlela yenitric oxide equka initrite/nitrate iyonke nokusebenza kwenitric oxide synthase.
I-acetic acid yabangela umonzakalo owawulindelekile, kwaye xa kuthelekiswa noko, iimpuku ezinokudumba kwekholoni ezanyangwa ngedayi zabonisa umonakalo omncinane obonakala ngeliso nobonwa ngemikroskopu, ukuphucuka kokugqithisa kodonga lwamathumbu izinto, ukwehla kwemyeloperoxidase nemalondialdehyde, ukubuyela kwamanqanaba esuperoxide dismutase necatalase, nokwehla kweecytokine, kwenitrite/nitrate nokusebenza kwesynthase. Ababhali bacebisa ukuba ukuthintelwa kokuveliswa ngokugqithisileyo kwenitric oxide yeyona ndlela iphambili yokusebenza, kuncediswa kukuncipha koxinzelelo lwe-oxidation nolwenitrosation. Le yingqikelelo ehambelanayo kule modeli, kwaye uhlolo olubanzi lobungqina ngokudumba luyibeka phakathi kwezinye iziphumo zaselabhoratri kunokuba luyithathe njengobungqina bonyango kwizigulana.
Oko uphando lungakwenzanga kubaluleke ngakumbi. Lwaqhutywa iintsuku ezintathu, lwasebenzisa amaduna kuphela, lwavavanya inkqubo enye emiselweyo ngaphandle kokuhlola indlela iziphumo ezitshintsha ngayo ngokomthamo, aluzange luquke iyeza eliqhelekileyo le-IBD lokuthelekisa, kwaye lwalinganisa izalathi zezicubu nezekhemistri yezinto eziphilayo endaweni yokuthomalala kwesifo, ukubuyela kwaso, okanye nasiphi na isiphumo kwisigulana. Ukuza kuthi ga kuSeptemba 2026 akukho lingo lipapashiweyo ebantwini elivavanya imethylene blue njengonyango lokudumba kwekholoni okunezilonda okanye imethylene blue kwisifo sikaCrohn lisebenzisa imilinganiselo yeziphumo zonyango. Isiphumo kwiimpuku sisiqalo sophando, asisosiseko sezigqibo zomntu ngomthamo aza kuwusebenzisa.
Isizathu sokuba ukutsha yikhemikhali kungayimeli kakuhle i-IBD
Ukudumba kwekholoni okubangelwa yi-acetic acid yimodeli yomonzakalo, akusiyo imodeli yesifo ngendlela esenzeka ngayo ebantwini. Isisombululo sekhemikhali sitshisa umaleko wangaphakathi wendawo esezantsi yekholoni, iineutrophil zingxamele kuloo ndawo, kuvele izilonda, size isilwanyana sihlolwe kwisithuba seentsuku. Ukudumba kwekholoni okunezilonda ebantwini yimeko engapheliyo, ebuyela rhoqo, elawulwa yinkqubo yokhuselo lomzimba kwaye ichatshazelwa yimfuza, zii-microbiota, nalukhuselo lomzimba olufundwayo nolwendalo, ineziqendu zokuvutha nokuthomalala ekuhambeni kweminyaka. Le modeli iphinda ibonise ezinye iimpawu zesakhiwo sendawo esezantsi yekholoni nemilinganiselo yokudumba, kodwa phantse ayibonisi konke ukuqalisa, ukuqhubeka nokubuyela kwesifo.
Kwisifo sikaCrohn lo mahluko uba mkhulu ngakumbi. Umonzakalo obangelwa yi-acetic acid ukwindawo esezantsi yekholoni kwaye upheleliselwe kumaleko wangaphakathi nakumaleko ongaphantsi kwawo. Isifo sikaCrohn sinokuchaphazela naliphi na icandelo lendlela yokwetyisa, sibe neendawo ezonzakeleyo ezohlulwe ziindawo ezingachaphazelekanga, sidlule kuyo yonke imaleko yodonga lwamathumbu, size siguqule izicubu zibe ziindawo ezimxinwa neefistula. Ngoko imibuzo ngemethylene blue nesifo sikaCrohn ayinakuphendulwa kukutsha kwendawo esezantsi yekholoni kwiimpuku kangangeentsuku ezintathu. Uphando olunxulumeneyo ngezilwanyana oluphathelele amaqela eentsholongwane kufuneka luqondwe ngokwemeko yalo, echazwe kwisikhokelo sophando lwemicrobiome yamathumbu kwiimpuku.
Umgaqo osebenzisekayo ulula. Xa ibango licaphula imodeli yokudumba kwekholoni okwenziwe ngabom, buza ukuba kusetyenziswe yiphi ikhemikhali, loluphi uhlobo lwesilwanyana nesini saso, uvavanyo luthathe ixesha elingakanani, ukuba unyango oluqhelekileyo lusetyenziselwe ukuthelekisa, nokuba imilinganiselo yeziphumo ibizizalathi zezicubu okanye iziphumo zonyango kwizigulana. Imodeli ephendula ukuba ikholoni yempuku ibibonakala idumbe kangakanani ngosuku lwesithathu ayinakuphendula ukuba umntu usahlala ekuthomalaleni kwesifo kwinyanga yeshumi elinesibini.
Uphando olwalujonga kuphela
Iphepha lesibini limalunga nombono owahlukileyo. UMarion noogxa bakhe baqhuba uphando lokubeka iliso kwidysplasia olujonga phambili kubantu abali-102 ababenokudumba kwekholoni ixesha elide, abangama-79 benokudumba kwekholoni okunezilonda nabangama-23 benokudumba kwekholoni okubangelwa sisifo sikaCrohn, olwaxelwa njengo iisampulu zezicubu ezithathwa ngokujolisa ngechromoendoscopy zingcono kunokubeka iliso okuqhelekileyo. Isigulana ngasinye sasiliqela laso lokuthelekisa kuhlolo olunye apho ikholonoskopu yayidlula kabini. Iqela lathelekisa ukuthathwa kweesampulu zezicubu ngokungakhethiyo ngendlela eqhelekileyo, ukuthathwa kweesampulu ezijoliswe kwiindawo ezingaqhelekanga ezibonwe ngokukhanya okumhlophe okuqhelekileyo, nokuthathwa kweesampulu ezijolisweyo emva kokutshizwa kwekholoni yonke ngemethylene blue eyi-0.01%. Ingcali enye yezifo zendlela yokwetyisa yahlola iisampulu ingazi ukuba zithathwe ngayiphi indlela.
Ukujolisa kuncediswa yidayi kwafumana idysplasia kwizigulana ezili-17 xa kuthelekiswa nezi-3 ngokuthathwa kweesampulu ngokungakhethiyo, umahluko obalulekileyo ngokwezibalo, naxa kuthelekiswa nezi-9 ngokujolisa ngokukhanya okumhlophe kuphela, ukwanda kwenani okungazange kufikelele kwinqanaba eliqhelekileyo lokubaluleka ngokwezibalo. Iindlela zokujolisa ezidityanisiweyo zafumana idysplasia kwizigulana ezingama-20 xa kuthelekiswa nezi-3 ngokuthathwa kweesampulu ngokungakhethiyo. Akukho ziganeko zibi ezaxelwayo.
Akukho nto apha yavavanya unyango. Idayi yayisisixhobo sokwahlula ngokubonakala esasifakwa phezu kwezicubu, esenza ukuba iinguqu ezingaqhelekanga kwipateni yemingxuma emincinane zibonakale lula kwaye kuthathwe iisampulu zazo. Ayizange ilinganise iimpawu, ukusebenza kwesifo, amanqanaba eecytokine, ukuthomalala kwesifo, okanye ukubuyela kwaso, kwaye ayinakucaphulwa njengobungqina ebantwini bokuba imethylene blue inyanga i-IBD. Ukufunyanwa kweenguqu ngumlinganiselo wesiphumo, kwaye oko kuhambelana nesikhokelo se-endoscopy yendlela yokwetyisa ne-chromoendoscopy, esichaza ukufaka umbala kwizicubu eziphilayo, uhlobo lwepilisi yeLumeblue ethathwa ngomlomo, nesizathu sokuba ukufumana iindawo ezonzakeleyo kungabi kukuzinyanga.
Ungenelelo xa luthelekiswa nokwenza izinto zibonakale: itheyibhile yobungqina
| Dinc 2015: ungenelelo lovavanyo | Marion 2008: ukwenza izinto zibonakale ngenjongo yoxilongo | |
|---|---|---|
| Indima yedayi | Into evavanyelwa ukukwazi ukuthomalalisa ukudumba | Idayi efakwa phezu kwezicubu ukuze zahluke ngokubonakala |
| Umbuzo obuziweyo | Ingaba imethylene blue iyawunciphisa umonzakalo wokudumba kwekholoni kwiimpuku | Ingaba ukutshiza idayi kuphucula ukufunyanwa kwedysplasia ebantwini |
| Abathathe inxaxheba | Iimpuku ezingamaduna ezingama-80, ukudumba kwekholoni okubukhali okubangelwa yi-acetic acid, umgangatho wesiphumo kwiintsuku ezi-3 | Izigulana ezili-102 ezibekwa iliso, ezingama-79 ezinokudumba kwekholoni okunezilonda nezingama-23 ezinokudumba kwekholoni okubangelwa sisifo sikaCrohn |
| Inkqubo yokusebenzisa | I-2 mL yesisombululo se-1%, inkqubo enye emiselweyo | Ukutshiza nge-0.01% ngexesha lekholonoskopi, ifunxwe ikhutshelwe ngaphandle emva kokuthathwa kwayo zizicubu |
| Imilinganiselo yeziphumo | Amanqaku omonakalo, ukugqithisa kodonga izinto, MPO, MDA, SOD, catalase, iicytokine, ukusebenza kwe-NOS | Izigulana ezinedysplasia eqinisekiswe ngohlolo lwezicubu ngokwendlela nganye yokuthatha iisampulu |
| Isiphumo esiphambili | Iimpuku ezinokudumba kwekholoni ezanyangwayo zabonisa ukuphucuka kwizalathi zohlolo lwezicubu nezekhemistri yezinto eziphilayo | Ukujolisa ngedayi kwafumana idysplasia kwi-17 xa kuthelekiswa ne-3 ngokungakhethiyo, P 0.001; kwi-17 xa kuthelekiswa ne-9 ngokujolisa ngokukhanya okumhlophe, P 0.057 |
| Oko kungakubonisiyo | Akukho bungqina bokusebenza ebantwini, akukho datha yokuthomalala kwesifo, akukho sikhokelo semithamo | Akukho siphumo sonyango ekudumbeni, kwiimpawu, okanye kwindlela isifo esiqhubeka ngayo |
Indlela yokufunda ibango elilandelayo nge-IBD
Phatha ibango ngalinye njengomsebenzi omncinane wokwahlula ngokweendidi. Okokuqala, chonga indima: ingaba idayi inikwa ukuze itshintshe ukusebenza komzimba okanye ifakwa ukuze kuhlolwe izicubu. Okwesibini, chonga isifo: ukudumba kwekholoni okunezilonda okupheleliselwe kwikholoni akusiso isifo sikaCrohn esineendawo ezonzakeleyo ezohlukahlukeneyo kunye neengxaki ezidlula kuyo yonke imaleko yodonga lwamathumbu, kwaye isiphumo kwesinye asidluliselwa kwesinye. Okwesithathu, chonga inqanaba: imodeli yeempuku ebangelwe yikhemikhali, uphando lokufumanisa iinguqu ebantwini, nolingo lonyango ebantwini ziphendula imibuzo eyahlukileyo kwaye azinakuthatha indawo enye kwenye. Okwesine, hlola imilinganiselo yeziphumo: izalathi zezicubu namanani ezinto ezifunyenweyo yimilinganiselo esetyenziswa endaweni yeziphumo eziphambili, ngoxa ukuthomalala kwesifo, ukubuyela kwaso, ukulaliswa esibhedlele notyando ziziphumo ezichaphazela ubomi bezigulana ngokuthe ngqo. Ibango eliphumelela kuzo zone ezi mvavanyo lifanele ukuqwalaselwa. Elo liboleka amanani okufumanisa iinguqu kuphando lukaMarion ukuze lixhase isigqibo sonyango liyasilela kuvavanyo lokuqala kwaye kufuneka libekelwe bucala.
Oko kufanele ukukhunjulwe
Gcina iibhokisi ezimbini kwaye ungaze uvumele okuqulathwe kuzo kuxubane. Ibhokisi yokuqala iqulethe uvavanyo olufutshane ngeempuku apho imethylene blue yanciphisa izalathi zomonzakalo wekholoni obangelwe yikhemikhali, indlela yenitric oxide iyeyona ikrokrelwa njengendlela yokusebenza, kuquka yonke imida yokusebenzisa iimodeli zomonzakalo obukhali ukuqonda okwenzeka ebantwini. Ibhokisi yesibini iqulethe uphando lokubeka iliso ebantwini apho idayi eluhlaza yanceda iingcali ze-endoscopy ukufumana idysplasia ekwakufanele kuthathwe iisampulu zezicubu kuyo, kungekho lwazi konke konke ngonyango lwesifo samathumbu. Ukuze uqonde ukusetyenziswa okugunyazisiweyo nokokuvavanywa, jonga isishwankathelo semethylene blue kwezamayeza. Ingqokelela yophando ngemethylene blue idwelisa izifundo ezixhasa lo mahluko.