I-methylene blue kwi-lichen planus yomlomo: ubungqina bolingo lonyango lwe-photodynamic

Izigulana ezibini zifunda isiphumo esinye kodwa zive izithembiso ezahlukeneyo. Esinye siva ukuba izilonda ziphilile, ngoko isifo siphelile. Esinye siva ukuba iintlungu zehlile, ngoko izilonda zimele ukuba ziphilile. Umfundi wesithathu ubona izinga elisezantsi lokubuya kwesifo aze acinge ukuba lisebenza kuye wonke umntu oqale unyango. Indlela nganye yokufunda idibanisa ingcamango enye nenye. Olu phononongo luyazahlula.

Umxholo lunyango lwe-photodynamic nge-methylene blue olwenziwa yingcali yezonyango, oludla ngokubizwa ngokuba yi-MB-PDT, kwi-lichen planus yomlomo enezilonda evunyiweyo ngoxilongo, edla ngokubizwa ngokuba yi-OLP. Ubungqina obusetyenzisiweyo apha buvela kulingo olunokwabiwa ngokungakhethiyo lonyango lwe-photodynamic kunye ne-corticosteroid efakwa kwindawo echaphazelekayo kwi-lichen planus yomlomo enezilonda, olwapapashwa ngo-2026, olunezigulana ezingama-74 ezabelwe amaqela ngokungakhethiyo. Luvavanya i-MB-PDT njengonyango olongezwa kwi-steroid, hayi njengento ethatha indawo yayo okanye njengonyango lwasekhaya. Abafundi abafuna kuqala ukuqonda into eyenza izicubu zibe novakalelo ekukhanyeni mabafunde indlela i-methylene blue esebenza ngayo njengaloo nto, kanti abo bathelekisa unyango lokuqala mabafunde ngee-corticosteroid ezifakwa kwizilonda zomlomo kunye neli phepha.

Iingcamango ezimbini ezisisiseko solu nyango

I-OLP yimeko engapheliyo yenwebu yangaphakathi yomlomo, ebangelwa ziinkqubo zamajoni omzimba. I-OLP enezilonda, eluhlobo oluvavanywe kolu lingo, ithetha ukuqhawuka okubuhlungu kwenwebu, ngokufuthi kwicala langaphakathi lezidlele, okuphilayo kuze kubuye. Uphawu oluphambili lwendlela esi sifo esisebenza ngayo kukuphinda sibuye. Ukuphiliswa kwezilonda ngexesha elifutshane akuthethi ukulawulwa kwesifo ixesha elide, ngoko nayiphi na ingxelo ethembekileyo imele ilandele ukuphiliswa kwezilonda, iimpawu nokubuya kwesifo njengezinto ezahlukileyo.

I-MB-PDT yingcamango enamacandelo amathathu: into eyenza izicubu zibe novakalelo ekukhanyeni kunye nokukhanya okunobude bamaza obufunxwayo kunye neoksijini. Xa kususwa naliphi na kula macandelo, le ndlela ayisebenzi. I-methylene blue ifunxa ukukhanya okubomvu kufutshane ne-660 nm, idayi ekwimeko evuselelweyo idlulisa amandla okanye ii-electron ngeendlela ezixhomekeke kwioksijini, zize iintlobo zeekhemikhali ezisebenzayo ezivelayo zonakalise izicubu ekujoliswe kuzo kuloo ndawo. Le dayi inye xa ingasetyenziswa nokukhanya iyenye ingcamango, yiyo loo nto unyango lwe-photodynamic nge-methylene blue kwiimeko zolusu lubonisa ngokucacileyo iyeza, ukukhanya, idosi nesithuba phakathi kweeseshoni kusetyenziso ngalunye. Xa lusetyenziswa emlonyeni, olu nyango lumele lwenziwe yingcali yezonyango, ibona indawo ngokuthe ngqo, emva kokomisa nokwahlula isilonda ngaphambi kokusikhanyisela.

Okwenziwa lulingo ngokwenene

Ulingo lwenziwa kwisibhedlele esinye eShanghai, lwabhalisa abantu abadala abane-OLP enezilonda eqinisekiswe ngovavanyo lwesampulu yezicubu, enendawo engaphezu kwe-5 mm esisikwere ngokwemiqathango ye-WHO ka-2003 ehlengahlengisiweyo, lwaza lwabela ngokungakhethiyo izigulana ezingama-37 kwi-MB-PDT kunye nentlama ye-triamcinolone acetonide eyi-0.1 epesenti, nezingama-37 kwintlama kuphela. Intlama yayifakwa kathathu ngemini kuwo omabini amaqela ngexesha leeveki ezine zonyango. Iqela le-PDT longezwa ukukhanyiselwa rhoqo ngeveki nge-660 nm nge-13.2 J nge-cm esisikwere, kangangemizuzwana engama-60 kwiseshoni nganye, emva kokufakwa kwe-methylene blue eyi-0.1 mg nge-mL kwindawo echaphazelekayo, ukuya kutsho kwiiseshoni ezine. Umvavanyi ozimeleyo owayengazazi izabelo zamaqela walinganisa iziphumo. Izigulana neengcali ezazinyanga zazizazi izabelo zamaqela, nto leyo eqhelekileyo kunyango lokukhanya kodwa ishiya iingxelo zeempawu zinokuphenjelelwa zizinto ezilindelwe ngabantu. Isingeniso seendlela zophando kolu hlobo loyilo sifumaneka kwingcaciso yendlela yokufunda iingxelo zolingo lwe-photodynamic.

Uhlalutyo lwexesha elifutshane ukuya kwiveki 4 lwasebenzisa indlela yokuhlalutya zonke izigulana ngokwamaqela ezabelwe wona ekuqaleni, kuqikelelwa idatha engekhoyo. Ukulandelelwa kwexesha elide kwiiveki 8 no-12 kwalandela kuphela izigulana ezaziphendule kunyango, nto leyo ebaluleke kakhulu xa kuthethwa ngokubuya kwesifo, njengoko kubonisiwe ngezantsi. Imibuzo eqhelekileyo malunga nokulungiselelwa konyango ekliniki nokubekwa esweni kokhuseleko iphendulwa kwimibuzo ebuzwa rhoqo ngonyango lwe-photodynamic lomlomo.

Itheyibhile yokuthelekisa amaqela olingo

Ukuphiliswa kwezilonda, iintlungu, ukubuya kwesifo nobomi bemihla ngemihla zatshintsha ngokwahlukeneyo

Ukuphiliswa kwezilonda kwiveki 4 kwabangcono kunyango oludityanisiweyo. Ukusebenza konyango ngokwezonyango kwafikelela kwizigulana ezingama-35 kwezingama-37 (94.6 epesenti) nge-MB-PDT kunye ne-steroid, xa kuthelekiswa nezingama-26 kwezingama-37 (70.3 epesenti) nge-steroid kuphela, umahluko wamanqaku angama-24.3 apho u-P wayelingana no-0.006. Ukuvaleka ngokupheleleyo kwezilonda kwaba ngunobangela wenxalenye enkulu yaloo mahluko, abangama-27 kwezingama-37 xa kuthelekiswa nabangama-21 kwezingama-37. Izinga lokuncipha kwendawo yesilonda laba likhulu ngakumbi ngokubaluleka ngokwezibalo kwiqela lonyango oludityanisiweyo kwiveki 4, loo mahluko waphulukana nokubaluleka ngokwezibalo kwiveki 8, waza wakufumana kwakhona kwiveki 12. Amanqaku e-REU avavanya ubuzaza ngokubanzi aphucuka kuwo omabini amaqela ngaphandle komahluko obalulekileyo ngokwezibalo phakathi kwawo nakweliphi na ixesha, nto leyo ekhumbuza ukuba esona silonda sikhulu asimeli umlomo uphela.

Iintlungu zalandela indlela ecothayo. Umyinge wokwehla kwamanqaku kwisikali samanani kwiveki 4 wawungamanqaku ayi-3.97 ngonyango oludityanisiweyo xa kuthelekiswa nawayi-2.62 nge-steroid kuphela, u-P elingana no-0.004. Amaqela awazange ahluke kwiiveki ezimbini zokuqala. Umahluko wavela kwiveki 3 waza waqhubeka kwiiveki 8 no-12. Loo ndlela ihambelana nonyango olongeziweyo olufuna iiseshoni eziphindaphindiweyo kunokuba lunike isiqabu kwangoko, kwaye ilumkisa ngokugweba olu nyango emva kotyelelo olunye kuphela.

Ekubuyeni kwesifo, linani elisisiseko sokubala elichaza intsingiselo. Ingxelo yolingo yolu phando lwe-OLP enezilonda ichaza ukubuya kwesifo phakathi kwezigulana eziphilileyo, kwaye amanani abonisa ukuba ukuphila kwakuthetha ukuphendula ngokupheleleyo: abangama-27 xa kuthelekiswa nabangama-21 kwiveki 8, behla baya kuma-26 xa kuthelekiswa nabangama-20 kwiveki 12. Kwiveki 8 isifo sabuya kwaba-2 kwabangama-27 (7.4 epesenti) xa kuthelekiswa naba-5 kwabangama-21 (23.8 epesenti), kungekho mahluko ubalulekileyo ngokwezibalo. Kwiveki 12 saba ngaba-3 kwabangama-26 (11.5 epesenti) xa kuthelekiswa naba-8 kwabangama-20 (40.0 epesenti), u-P elingana no-0.038. Eso sisiphumo seqela elincinane labaphendule kunyango, hayi isiphumo sohlalutyo lwezigulana zonke ngokwamaqela ezabelwe wona ekuqaleni, kuba izigulana ezazingaphilanga zaphuma kuhlalutyo lokubuya kwesifo zaya kolunye unyango. Umbhali oxela i-11.5 xa kuthelekiswa ne-40.0 epesenti ngaphandle kokuchaza amanani asisiseko angama-26 xa kuthelekiswa nama-20 uphinda eyona mpazamo ixhaphakileyo kwiingxelo zabanye ngeli phepha.

Umgangatho wobomi nesimo sengqondo zabonisa ukwahlukana okufanayo. Umgangatho wobomi onxulumene nempilo yomlomo kwi-OHIP-14 waphucuka ngakumbi ngonyango oludityanisiweyo, u-P elingana no-0.002, nexhala kwi-GAD-7 laphucuka ngakumbi, u-P elingana no-0.007. Udandatheko kwi-PHQ-9 aluzange lwahluke. Amanqaku exhala nodandatheko ekuqaleni ayephantsi, ngoko ezi zikali zilinganisa utshintsho oluncinane kwisampulu echaphazeleke kancinane kunokuba zibonise unyango lwexhala okanye udandatheko olufunyaniswe ngokwezonyango.

Imida ekufuneka umfundi ononophelo ayikhumbule

Ubungakanani besampulu ngumda wokuqala. Ubalo lwaluthatha ukuba ukusebenza konyango kuza kuba yi-37 xa kuthelekiswa ne-79 epesenti, lwabeka amandla ovavanyo ezibalo kwi-80 epesenti kwisiphumo esiphambili seveki 4, lwaza lwavelisa izigulana ezingama-74 zizonke. Obo bungakanani abunakuxhasa izigqibo eziqinileyo ngamaqela amancinane okuvavanya ukubuya kwesifo angama-26 xa kuthelekiswa nama-20, ngezikali zomgangatho wobomi, okanye ngemiphumo eyingozi enqabileyo. Ukungabikho kweziganeko ezingathandekiyo kwizigulana ezingama-74 kwiiveki ezili-12 kunciphisa inkxalabo ngemiphumo eyingozi exhaphakileyo kodwa akuthethi lukhulu ngeziganeko ezinqabileyo, kwaye iindlela zophando zazibuza ngokukhethekileyo ngeentlungu zomlomo, ukudumba kwenwebu yomlomo nokutshintsha kwencasa ngokwemiqathango eqhelekileyo yetyhefu.

Ukulandelelwa ngumda wesibini. Iiveki ezilishumi elinesibini ukusuka ekwabelweni kwamaqela ngokungakhethiyo zimalunga neeveki ezisibhozo emva kweseshoni yokugqibela yokukhanya. I-OLP iphinda ibuye kwiinyanga nakwiminyaka, ngoko uthelekiso lokubuya kwesifo kwiiveki ezili-12 bubungqina bokuqala, hayi ibango lokuhlala kwempembelelo yonyango ixesha elide. Uyilo olukwiziko elinye ngumda wesithathu. Iqela elinye, isixhobo esinye, inkqubo enye ye-steroid, nesampulu apho ngaphezu kwe-80 epesenti yayingabasetyhini abaneminyaka ekufutshane nama-59 ichaza loo kliniki kakuhle, kodwa ezinye iindawo ingazichazi kangako.

Iimpazamo ezimbini ekunikeni ingxelo zimele ziqatshelwe ukuze ababhali bangazikopi. Iphepha linxulumanisa isithuba sokuzithemba samanqaku epesenti esisuka ku-7.9 ukuya ku-40.7 epesenti nomlinganiselo womngcipheko oyi-1.35, kodwa eso sithuba sihambelana nomahluko opheleleyo wamanqaku angama-24.3, hayi nomlinganiselo. Kanti ingxoxo ithi umahluko obalulekileyo wamanqaku ali-10 owawumiselwe kwangaphambili awufumanekanga, nangona umahluko oxeliweyo wokusebenza konyango ungaphezu kwamanqaku ali-10. Akukho nanye kwezi mpazamo etshintsha amanani okuqala, ayinyaniso ezinzileyo: abangama-35 kwabangama-37 xa kuthelekiswa nabangama-26 kwabangama-37 ekusebenzeni konyango, naba-3 kwabangama-26 xa kuthelekiswa naba-8 kwabangama-20 ekubuyeni kwesifo kwiveki 12 phakathi kwabaphendule ngokupheleleyo.

Isigqibo sihlala sinomda ocacileyo, nto leyo engamandla aso. Kubantu abadala abane-OLP enezilonda eqinisekiswe ngovavanyo lwesampulu yezicubu, ukongeza iiseshoni zekliniki ezine okanye ezimbalwa ezenziwa rhoqo ngeveki ze-PDT nge-methylene blue kwi-triamcinolone efakwa kwindawo echaphazelekayo kwaphucula ukuphiliswa kwezilonda nokuncipha kweentlungu kwiveki 4, kukho uphawu lomahluko ekubuyeni kwesifo kwiveki 12 oluphelele kwabaphendule ngokupheleleyo, kunye nenzuzo kumgangatho wobomi ngokwemilinganiselo yefuthe lempilo yomlomo nexhala. Olu lingo aluvavanyi idayi iyodwa, izixhobo zasekhaya, obunye ubude bamaza, okanye ukulawulwa kwesifo ixesha elide. Izigulana ezicinga ngolu nyango zimele zibuze ingcali yazo yezonyango ngokuqinisekiswa koxilongo, inani leeseshoni, indlela ekulindeleke ukuba iintlungu zitshintshe ngayo kwiiveki ezintathu ukuya kwezine, nangendlela ukubuya kwesifo okuya kubekwa esweni ngayo emva kwexesha lokuqala lonyaka.