Inqaku
Imethylene blue kusulelo lweCandida emlonyeni: oko kuboniswa zizifundo zekliniki ze-photodynamic
Isigulana sijonga esipilini, sibone ukuba amabala amhlophe aphelile, size sigqibe ekubeni ukungunda kuphelile. Eso sigqibo sibonakala sisengqiqweni. Kwizilingo zemethylene blue evuselelwa kukukhanya kunyango losulelo lokungunda emlonyeni, sikwasesona sigqibo sibangela ukubhideka okukhulu.
Olu nyango lunamacandelo amathathu, yaye icandelo ngalinye lenza umsebenzi owahlukileyo. Imethylene blue igquma isilonda, ukukhanya okubomvu kuvuselela idayi, ize idayi evuselelweyo idlulisele amandla kwioksijini ukuze kuvele amasuntswana asebenza ngokwekhemikhali aphila ixesha elifutshane nawonakalisa iiseli zeentsholongwane ezikufutshane. Iinkcukacha zendlela imethylene blue esebenza ngayo njengento evuselelwa kukukhanya zibalulekile, kuba ngaphandle kokukhanya le dayi inye iba buthathaka kakhulu ekulweni neentsholongwane. Umbuzo wekliniki uthe ngqo ngakumbi: xa le nkqubo isetyenziswa kwicandidiasis yomlomo, yintoni ephucukayo, yinkangeleko yomlomo okanye ziziphumo zokukhuliswa kokungunda elebhu, yaye olo phuculo luhlala ixesha elingakanani?
Lo mahluko ulungelelanisa konke okulandelayo. Impendulo ngokweempawu ithetha ukuba zimbalwa izilonda ezibonakalayo, kunciphe ukuba bomvu okanye umaleko ofana nenwebu, kunciphe neentlungu okanye ukutshisa. Impendulo ngokokungunda ithetha ukuba zincinane iiyunithi ezenza iikholoni xa ukungunda kukhuliswa elebhu, okanye kungafumaneki ukungunda konke konke. Umlomo unokuyifezekisa ingcaciso yokuqala kodwa ungayifezekisi eyesibini.
Oko kwavavanywa zizilingo ezibini eziphambili
Esona silingo sihambelana ngqo nalo mba kubantu abadala abanecandidiasis yomlomo ehamba nokuba bomvu sahlula abathathi-nxaxheba abangama-41 ngokungakhethiyo phakathi konyango lwe-photodynamic ngemethylene blue nolwelo lwenystatin, kwabakho iiseshoni zeveki nganye ukuya kuthi ga kwiiveki ezine kwiqela lonyango lokukhanya. Uxinano lwedayi lwaluyi-0.1 percent, ishiywa ichukumisa izicubu imizuzu eyi-15, kuze kulandele ukukhanya kwelaser okuyi-660 nm ngamandla ayi-4 joules kwindawo nganye kangangemizuzwana eyi-40 kwindawo nganye, inani leendawo limiselwa bubungakanani bezilonda. Unyango lokuthelekisa yayilulwelo lwenystatin lomlomo oluyi-100,000 IU olwalusetyenziswa ukuhlamba umlomo yonke imihla kangangeentsuku ezimalunga nama-21. Uhlolo lokulandelela lwalusenziwa veki nganye ngexesha lonyango, kungaxelwanga isigaba esandisiweyo sokujonga ukubuya kosulelo. Isishwankathelo esipapashiweyo sixela ukuphela ngokupheleleyo kwezilonda kwiimeko eziyi-16 kwezili-17 ezavavanywayo kwiqela lenystatin, nakwiimeko eziyi-16 kwezili-19 ezavavanywayo kwiqela le-photodynamic. Elo nani lilonke lisetyenziswa ukubala iziphumo lifanele ukuqatshelwa kuba lahlukile kwi-18 nakuma-23 abahlulwa ngokungakhethiyo, yaye isilingo asifumananga ukuba iqela lonyango lokukhanya lingcono. Izilonda ezinzima zazingafane ziphele nakweliphi na iqela. Amanani okungunda ehla emva kweseshoni yokuqala yokukhanya, kodwa ingxelo ixhasa ukuncipha kwangoko kunokuba iqinisekise ukupheliswa ngokupheleleyo. Ingxelo epheleleyo iyafumaneka kwisilingo esahlula abathathi-nxaxheba ngokungakhethiyo sonyango lwe-photodynamic kwicandidiasis ehamba nokuba bomvu.
Isilingo sesibini esiphambili luvavanyo oluncinane lokuqala oluphononongayo noluwubeka ngokucacileyo umahluko phakathi kwempendulo ngokweempawu nempendulo ngokokungunda. Abantu abadala abalishumi elinesibhozo abanecandidiasis yomlomo eqinisekiswe ngokuhlolwa kweempawu nangovavanyo lokungunda bahlulwa ngokungakhethiyo kusetyenziswa iibhloko, baba yi-9 kwiqela ngalinye, kwaza kwagqiba abali-16. Abantu abanesifo seswekile, abanxiba amazinyo emboleko, abakhe basebenzisa amayeza okubulala iibhaktheriya, okanye abanococeko olubi babenokubhalisa, kodwa abo baqinisekiswe ukuba baneHIV babengafakwa. Iqela lonyango lokukhanya lasebenzisa uxinano lwedayi oluphantsi kakhulu, oluyi-0.1 mg nge-mL, idayi ishiywa ichukumisa izicubu umzuzu oyi-1, nokukhanya kwediode okuyi-660 nm ngamandla ayi-1.2 ukuya kwi-3.3 joules nge-cm2 kangangemizuzwana emalunga nama-60 kwindawo nganye, kwiiseshoni ezintandathu kwiiveki ezimbini. Unyango lokuthelekisa yayiziipilisi zenystatin ezinyibilikiswa emlonyeni ezaziyi-500,000 IU kathathu ngemini kangangeentsuku ezili-14. Uhlolo lokulandelela lwaphela ngosuku lwe-14, kungakhange kuphinde kujongwe ukubuya kosulelo emva koko. Impendulo ngokweempawu yafikelela kwi-6 kwaba-9 ngonyango lwe-photodynamic, xa kuthelekiswa naba-8 kwaba-9 ngenystatin. Impendulo ngokokungunda yaba yi-5 kwaba-9 xa kuthelekiswa naba-8 kwaba-9, yaye ukupheliswa ngokupheleleyo kokungunda kwaba yi-4 kwaba-9 xa kuthelekiswa naba-8 kwaba-9. Akukho mahluko wafikelela ekubalulekeni ngokweenkcukacha-manani, nto leyo elindelekileyo kwisampulu encinane kangaka. Isiphumo esiluncedo ngumsantsa phakathi kweziphumo zeqela lonyango lokukhanya ngokwalo: impendulo ngokweempawu eyi-66.7 percent xa ithelekiswa nokupheliswa ngokupheleleyo okuyi-44.4 percent. Izilonda zaziphucuka rhoqo ngakumbi kunokungafumaneki kokungunda xa kukhuliswa elebhu. Akukho ziganeko zibi zinzulu zenzekayo. Uyilo namanani achazwe kuvavanyo lokuqala lokuba unyango lwecandidiasis yomlomo lunokwenziwa na kwindawo yonyango lwamazinyo.
Abafundi abakhangela imethylene blue yosulelo lokungunda emlonyeni bafanele bawugcine engqondweni lo msantsa ngaphambi kokufunda naliphi na izinga lokuphiliswa elibhalwe kwisihloko. Umlinganiselo wokuphiliswa odibanisa iimpawu neziphumo zokukhuliswa kokungunda elebhu ufihla kanye ulwazi olufunwa sisigulana esineempawu ezibuyayo.
Iziphumo ngokweempawu xa zithelekiswa neziphumo ngokokungunda
| Isilingo neqela labantu | Uyilo, unyango lokuthelekisa, uhlolo lokulandelela | Iziphumo zezilonda ngokweempawu | Iziphumo ngokokungunda | Imida ephambili |
|---|---|---|---|---|
| Medeiros 2023, abantu abadala abanecandidiasis yomlomo ehamba nokuba bomvu, kwahlalutywa abangama-41 | Ukwahlulwa ngokungakhethiyo, ulwelo lwenystatin oluyi-100,000 IU lokuhlamba umlomo yonke imihla kangangeentsuku ezimalunga nama-21, uhlolo lokulandelela lweveki nganye ukuya kwiiveki ezi-4 | Ukuphela ngokupheleleyo malunga ne-84 percent ngonyango lokukhanya xa kuthelekiswa ne-94 percent ngenystatin, akubonakalanga ukuba olunye lungcono | Amanani eCandida ehla emva kweseshoni yokuqala, ukupheliswa ngokupheleleyo akuzange kuqinisekiswe | Isampulu encinane, uhlolo lokulandelela olufutshane, amanani asetyenziswa ukubala ukuphela kwezilonda awahambelani namanani ewonke abahlulwa ngokungakhethiyo, izilonda ezinzima zazimbalwa phakathi kwezo zaphelayo |
| Zhou 2026, abantu abadala abanecandidiasis yomlomo eqinisekisiweyo, abali-18 bahlulwa ngokungakhethiyo | Uvavanyo lokuqala ngokwahlulwa ngokungakhethiyo, iipilisi zenystatin ezinyibilikiswa emlonyeni eziyi-500,000 IU kathathu ngemini kangangeentsuku ezili-14, uhlolo lokulandelela ukuya kusuku lwe-14 | Impendulo kwi-6 kwaba-9 xa kuthelekiswa naba-8 kwaba-9, p ilingana ne-0.576 | Ukupheliswa ngokupheleleyo kwi-4 kwaba-9 xa kuthelekiswa naba-8 kwaba-9, p ilingana ne-0.131 | n ilingana ne-18 kungakhange kubalwe amandla ovavanyo ngokweenkcukacha-manani, akukho sigaba sokujonga ukubuya kosulelo, idosi neshedyuli azikalungiselelwa ukufumana eyona ndlela ifanelekileyo |
| Isilingo secandidiasis enxulumene neHIV, izigulana ezingama-21 ezimalunga ne-7 kwiqela ngalinye | Amaqela amathathu ngokwahlulwa ngokungakhethiyo, ifluconazole eyi-100 mg yonke imihla kangangeentsuku ezili-14 kunye neqela lokukhanya kuphela, uhlolo lokulandelela ukuya kusuku lwama-30 | Ababhali baxela ukuba usulelo alubuyanga kwiqela lokukhanya ukuya kusuku lwama-30 xa kuthelekiswa nokubuya kwalo ngexesha elifutshane ngefluconazole | Ababhali baxela ukuba ukupheliswa kweekholoni emva konyango lokukhanya kwaqhubeka ukuya kusuku lwama-30 | Amanani amancinci kakhulu kwiqela ngalinye, ukuxelwa kweziganeko zibi kwinqanaba lesishwankathelo kuphela, inkqubo yeseshoni enye inciphisa ukusetyenziswa kweziphumo ngokubanzi |
| Ukudumba komlomo okunxulumene namazinyo emboleko kohlobo II, abathathi-nxaxheba abangama-40 | Ukwahlulwa ngokungakhethiyo, ijeli yemiconazole kane ngemini kangangeentsuku ezili-15, ukujonga ukubuya kosulelo malunga nosuku lwama-30 | Ukuphela okudityanisiweyo kweempawu neentsholongwane kuyi-40 percent ngokukhanya kunye nelaser yamandla asezantsi xa kuthelekiswa ne-80 percent ngemiconazole | Kwaxelwa njengomlinganiselo odityanisiweyo, kungahlulwanga ngokucacileyo | Iseshoni enye ye-photodynamic kunye neeseshoni zelaser, umlinganiselo odityanisiweyo uthintela ukwahlulwa kweziphumo zezilonda kwiziphumo zokukhuliswa kokungunda elebhu |
Itheyibhile ibonisa indlela ezi ziphumo ezihamba ngayo. Apho izilingo zahlula le milinganiselo mibini, ukuphucuka kwezilonda kwenzeka ngakumbi kunokungafumaneki kokungunda xa kukhuliswa elebhu. Apho ziyidibanisa khona, umfundi akanakwazi ukuba yeyiphi eqhube isiphumo. Oko kulawulwa yidosi yokukhanya okubomvu kuchaza inxalenye yomahluko, kuba uxinano, ixesha lokushiya idayi ichukumisa izicubu, ubude bamaza, amandla ngommandla ngamnye, nenani leeseshoni zahlukile kumqolo ngamnye.
Kutheni iinkqubo zahluke kangaka
Uxinano luqala kwi-0.01 ukuya kwi-0.1 percent kwizilingo eziphambili zomlomo. Ixesha lokushiya idayi ichukumisa izicubu liqala kumzuzu oyi-1 ukuya kwimizuzu eli-15. Ezinye iinkqubo zinyanga kube kanye, ezinye zinyanga izihlandlo ezithandathu kwiiveki ezimbini. Idosi yokukhanya, inani leendawo ezikhanyiswayo, nokuba amazinyo emboleko ngokwawo ayakhanyiswa na, zonke zitshintsha amandla afikayo. Oku kwahluka kuthetha ukuba akukho dosi inye yemethylene blue yeCandida enokushwankathelwa. Naliphi na inani elidityanisiweyo lingaxuba unyango olwahlukeneyo phantsi kwegama elinye.
Umahluko phakathi kwamaqela abantu wongeza elinye inqanaba. Icandidiasis ehamba nokuba bomvu, isifo esinomaleko ofana nenwebu, ukudumba komlomo okunxulumene namazinyo emboleko, necandidiasis enxulumene neHIV ziziphatha ngokwahlukileyo kwaye zibuya ngenxa yezizathu ezahlukeneyo. Abanxiba amazinyo emboleko basengozini yokuphinda kuhlale ukungunda okuvela kumphezulu wawo. Abantu abanomlomo owomileyo, abanesifo seswekile, abasebenzisa amayeza esteroid aphefumlelwayo, okanye abasandul' ukusebenzisa amayeza okubulala iibhaktheriya bajongene neemeko ezahlukeneyo ezibangela ukubuya kosulelo. Isiphumo kwelinye iqela asidluleli ngokuzenzekelayo kwelinye, yaye akukho nasinye kwezi zilingo zomlomo esivavanya amabango ngeCandida echaphazela umzimba wonke okanye amathumbu.
Indlela yokufunda isilingo sosulelo lokungunda emlonyeni ngemizuzu emibini
Okokuqala, jonga isivakalisi esichaza iqela labantu. Abantu abadala abanxiba amazinyo emboleko, abantu abaneHIV, namaqela abantu abanecandidiasis yomlomo ngokubanzi baphendula imibuzo eyahlukileyo. Okwesibini, bhala phantsi unyango lokuthelekisa nobungakanani besampulu. Ulwelo lwenystatin, iipilisi zenystatin ezinyibilikiswa emlonyeni, ijeli yemiconazole, nefluconazole azizonyango zokuthelekisa ezinokutshintshaniswa, yaye izilingo ezinabathathi-nxaxheba abayi-7 ukuya kuma-23 kwiqela ngalinye zinokuxhasa kuphela izigqibo zokuba indlela inokwenziwa na. Okwesithathu, fumana umhla wohlolo lokulandelela. Umlinganiselo wosuku lwe-14 okanye wosuku lwama-30 ulinganisa impendulo yexesha elifutshane, kungekhona ukuthintelwa kokubuya kosulelo. Okwesine, funa amanani ahlukeneyo ezilonda naweziphumo zokukhuliswa kokungunda elebhu. Ukuba iphepha lixela kuphela umlinganiselo wokuphiliswa odityanisiweyo, lithathe njengobungqina obungaphelelanga kumbuzo wokungunda.
Ukuxelwa kokhuseleko kwezi zilingo kunqabile kodwa kuyakhuthaza koko kuqukunjelweyo. Uvavanyo lokuqala lwaxela imeko enye yokuba bomvu kweentsini neentlungu eyagwetywa njengenganxulumananga nonyango emva kokufunyanwa kwesifo samazinyo, kunye nokurhoxa komntu omnye ngenxa yencasa nokucaphuka kwinystatin, nokurhoxa komnye ngenxa yokucinga ukuba unyango lokukhanya alunampembelelo. Imibuzo ebanzi malunga nokunyamezelwa konyango yinwebu yangaphakathi yomlomo ifanele kujongwana nayo kusetyenziswa iinkcukacha zokhuseleko lokusetyenziswa kuyo, kungekhona ngeetheyibhile zempumelelo yonyango.
Oko kuthethwa koku kwizigulana nakubasebenzi bezonyango
Kwisifo esinxulumene namazinyo emboleko, amazinyo emboleko kufuneka alawulwe kunye nenwebu yangaphakathi yomlomo. Yiyo loo nto indlela yokulawula icandidiasis enxulumene namazinyo emboleko isisigqibo esahlukileyo kukhetho lweyeza lokulwa nokungunda okanye lwenkqubo yokukhanya. Kusulelo lokungunda emlonyeni olubuya rhoqo, isicwangciso esijonga kokubini inkangeleko esipilini neziphumo zokukhuliswa kokungunda elebhu sisengqiqweni ngakumbi kunokujonga enye kuphela. Iimpawu nenqanaba lobuzaza bezilonda zikhokela ukulawulwa kwentuthuzelo nokusebenza komlomo. Ukuphinda kukhuliswa ukungunda elebhu okanye kubalwe iikholoni kukhokela ekwazini ukuba ukungunda kusekho na emva kokuphela kwezilonda.
Isishwankathelo esithembekileyo semeko yangoku sesi silandelayo. Unyango lwe-photodynamic ngemethylene blue lunokunciphisa izilonda namanani okungunda kwicandidiasis yomlomo kwiintsuku ukuya kwiiveki. Ukungafumaneki ngokupheleleyo nangexesha elide kokungunda xa kukhuliswa elebhu akuboniswa ngokungaguquguqukiyo, yaye uthelekiso oluthe ngqo nenystatin okanye imiconazole luncinane kakhulu kwaye lufutshane kakhulu ukuba luxhase amabango okulingana. Uhlalutyo olubanzi lwango-2025 lwezilingo ezili-16 ze-photodynamic ezisebenzisa izinto ezahlukeneyo ezivuselelwa kukukhanya alufumananga mahluko ubalulekileyo uwonke xa kuthelekiswa namayeza okulwa nokungunda kwimpendulo iyonke, kodwa kukho ukwahluka okukhulu neenkxalabo zokuthambekela kweziphumo kwicala elithile. Oko kunika umxholo kunokuba kube luqikelelo olukhethekileyo lwemethylene blue.
Olo luphawu olulinganiselweyo kodwa lokwenene. Luxhasa uphando olungakumbi olunemilinganiselo emiselweyo yedayi nokukhanya, imilinganiselo yeziphumo eyahluliweyo, nohlolo lokulandelela ukubuya kosulelo. Aluxhasi izigqibo ngokusetyenziswa ekhaya, yaye olu hlaziyo aludluleli kumathumbu okanye egazini. Abafundi abafuna umbono obanzi wezifundo zeedayi ezivuselelwa kukukhanya banokusebenzisa isishwankathelo seemeko zomlomo ezifundwe ngeedayi ezivuselelwa kukukhanya kunye nezilingo ezibini eziphambili ezidityaniswe ngasentla.