Isihloko
I-methylene blue nesifo sokuvuvukala kwamathumbu: ucwaningo uma luqhathaniswa nokufaka umbala kokuxilonga
Izinqubo ezimbili zisebenzisa i-molecule efanayo eluhlaza okwesibhakabhaka, kodwa cishe azifani kokunye. Kweyokuqala, abacwaningi banikeza i-methylene blue amagundane anamakholoni alinyazwe ngamakhemikhali bese bekala ukuthi ukuvuvukala kuyehla yini. Kweyesibili, uchwepheshe we-endoscopy ufafaza udayi oluhlaza okwesibhakabhaka ohlanjululiwe olwelwesini lwamathumbu omuntu one-colitis enezilonda noma i-colitis yesifo sika-Crohn ukuze abone ngokucacile izindawo ezisolisayo. Eyokuqala ibuza ukuthi le nhlanganisela iyasiguqula yini isifo. Eyesibili ibuza ukuthi umbala uyasiveza yini. Abafundi abafuna ubufakazi nge-methylene blue ne-colitis enezilonda kudingeka bagcine lezi zindaba ezimbili zihlukene, ngoba ukuzihlanganisa kuguqula insiza yokubona ibe ukwelashwa okucatshangwayo.
Ukuhlola okwazama ukushintsha ukuvuvukala
Umzamo wokwelapha uvela ocwaningweni lwamagundane lwango-2015 olwenziwa uDinc nozakwabo, olwashicilelwa ngesihloko esithi i-methylene blue ivimbela inqubo yokuvuvukala ku-colitis ebangelwa yi-acetic acid. Kwakuwukuhlola kwangaphambi kwezivivinyo zabantu, okwabiwa amaqembu ngokungahleliwe, hhayi isivivinyo seziguli. Amagundane angamaduna angamashumi ayisishiyagalombili ohlobo lwe-Sprague-Dawley ahlukaniswa aba amaqembu amane anamagundane angamashumi amabili ngalinye: izilwane eziphilile zokuqhathanisa, izilwane eziphilile ezanikezwa udayi, ezine-colitis ezingelashwanga, nezine-colitis ezelashwa. I-colitis yabangelwa nge-acetic acid, futhi izilwane ezisemaqenjini elashwayo zanikezwa u-2 mL wesisombululo se-methylene blue esingu-1%. Ngemva kwezinsuku ezintathu, ithimba lahlola ingxenye engu-8 cm yekholoni eseduze nesiphetho.
Imiphumela eyakalwa yahlanganisa amazinga amaningana okulimala: amaphuzu okulimala okubonakala ngamehlo nangesibonakhulu, ukuvumela kodonga lwamathumbu izinto ukuba zidlule, ukusebenza kwama-neutrophil okukalwa nge-myeloperoxidase, ukulimala kwama-lipid ngenxa yokusabela ne-oksijini okukalwa nge-malondialdehyde, ama-enzyme avikela ekulimazeni kwe-oksijini i-superoxide dismutase ne-catalase, ama-cytokine i-TNF-alpha, i-IL-1beta ne-IL-6, kanye nezilinganiso zendlela ye-nitric oxide ezihlanganisa inani eliphelele le-nitrite/nitrate nokusebenza kwe-nitric oxide synthase.
I-acetic acid yabangela ukulimala okwakulindelwe. Kulezo zimo, amagundane ane-colitis ayelashwe ngodayi abonisa ukulimala okuncane okubonakala ngamehlo nangesibonakhulu, ukuvumela kwezinto ukuba zidlule okungcono, amazinga aphansi e-myeloperoxidase ne-malondialdehyde, ukubuyiselwa kwe-superoxide dismutase ne-catalase, kanye namazinga aphansi ama-cytokine, i-nitrite/nitrate nokusebenza kwe-synthase. Ababhali baphakamisa ukuthi ukuvinjelwa kokukhiqizwa ngokweqile kwe-nitric oxide kwakuyindlela eyinhloko yokusebenza, kusizwa ukuncipha kwengcindezi ebangelwa ukusabela kwe-oksijini nezinhlanganisela ze-nitrogen. Lokho kuwumbono ohambisanayo kule modeli, futhi ukubuyekezwa okubanzi kobufakazi ngokuvuvukala kuwubeka phakathi kokunye okutholwe elabhorethri, hhayi njengobufakazi bezivivinyo zabantu.
Okungazange kwenziwe ucwaningo kubaluleke kakhulu. Lwaqhubeka izinsuku ezintathu, lwasebenzisa amaduna kuphela, lwahlola uhlelo olulodwa olungaguquki ngaphandle kokuhlola ukusabela kwemithamo ehlukahlukene, aluzange lufake umuthi ojwayelekile we-IBD ukuze kuqhathaniswe, futhi lwakala izinkomba zezicubu nezamakhemikhali omzimba esikhundleni sokudamba kwesifo, ukubuya kwaso, noma yimuphi umphumela ezigulini. Kusukela ngoSepthemba 2026, akukho sivivinyo sabantu esishicilelwe esihlola i-methylene blue njengokwelashwa kwe-colitis enezilonda noma i-methylene blue yesifo sika-Crohn ngemiphumela yokwelapha. Umphumela wamagundane uyisiqalo socwaningo, hhayi isisekelo sezinqumo zomuntu siqu ngemithamo.
Kungani ukusha ngamakhemikhali kungayimeleli kahle i-IBD
I-colitis ebangelwa yi-acetic acid iyimodeli yokulimala, hhayi imodeli yesifo ngomqondo wesifo somuntu. Isixazululo samakhemikhali sishisa ulwelwesi lwangaphakathi lwengxenye yekholoni eseduze nesiphetho, ama-neutrophil angena ngokushesha, kwakheke izilonda, bese isilwane sihlolwa ezinsukwini ezimbalwa. I-colitis enezilonda kubantu iyisimo esingamahlalakhona, esibuya siphinde sidambe, esibangelwa ukusebenza kwamasosha omzimba futhi esithonywa izakhi zofuzo, amagciwane ahlala emzimbeni, namasosha omzimba azalwa nawo nafunda ukubhekana nezinto ezithile, ngokuba nezikhathi zokubhebhetheka nokudamba phakathi neminyaka. Le modeli ilingisa ezinye izinguquko zesakhiwo sengxenye yekholoni eseduze nesiphetho nezilinganiso zokuvuvukala, kodwa cishe ayibonisi nhlobo ukuqala, ukuqhubeka nokubuya kwesifo.
Esifweni sika-Crohn, umehluko uba mkhulu nakakhulu. Ukulimala kwe-acetic acid kusengxenyeni yekholoni eseduze nesiphetho futhi kugcina olwelwesini lwangaphakathi nasezingqimbeni ezingaphansi kwalo. Isifo sika-Crohn singathinta noma iyiphi ingxenye yomgudu wokugaya ukudla, sishiye izindawo ezingathintekile phakathi kwezindawo ezilimele, sidlule kuzo zonke izingqimba zodonga lwamathumbu, futhi siguqule izicubu zakhe izingxenye ezincishisiwe nemigudu engajwayelekile exhumanisa izitho. Ngakho imibuzo nge-methylene blue nesifo sika-Crohn ayikwazi ukuphendulwa ngokusha kwezinsuku ezintathu kwengxenye yekholoni eseduze nesiphetho emagundaneni. Ucwaningo oluhlobene olwenziwa ezilwaneni mayelana nemiphakathi yamagciwane ludinga umongo walo, oxoxwa kumhlahlandlela wocwaningo lwamagundane ngamagciwane asemathunjini.
Umthetho ongawusebenzisa ulula. Uma isimangalo sicaphuna imodeli ye-colitis ebangelwe ngenhloso, buza ukuthi kusetshenziswe liphi ikhemikhali, luphi uhlobo lwezilwane nobulili bazo, ukuhlola kuqhubeke isikhathi esingakanani, ukwelashwa okujwayelekile kusetshenzisiwe yini ukuqhathanisa, nokuthi imiphumela eyakalwa ibiyizinkomba zezicubu noma imiphumela yeziguli. Imodeli ephendula ukuthi ikholoni legundane lalibukeka livuvukele kangakanani ngosuku lwesithathu ayikwazi ukuphendula ukuthi isifo somuntu sihlala sidambile yini ngenyanga yeshumi nambili.
Ucwaningo olwabheka kuphela
Iphepha lesibili liphathelene nombono ohlukile. UMarion nozakwabo benza ucwaningo lokuqapha i-dysplasia olulandela abantu kusukela ekuqaleni ukuya phambili, kubantu abangu-102 ababene-colitis isikhathi eside, abangu-79 bene-colitis enezilonda nabangu-23 bene-colitis yesifo sika-Crohn. Lwabikwa ngesihloko esithi ukuthathwa kwamasampula ezicubu okuqondiswe nge-chromoendoscopy kungcono kunokuqapha okujwayelekile. Isiguli ngasinye saqhathaniswa naso uqobo ngesikhathi sokuhlolwa okukodwa lapho i-colonoscope yadluliswa khona kabili. Ithimba laqhathanisa ukuthathwa kwamasampula ezicubu ngokungahleliwe okujwayelekile, ukuthathwa kwamasampula ezindaweni ezingajwayelekile ezibonakala ngaphansi kokukhanya okumhlophe okuvamile, nokuthathwa kwamasampula okuqondisiwe ngemva kokufafaza yonke ikholoni nge-methylene blue engu-0.01%. Uchwepheshe oyedwa wezifo zomgudu wokugaya ukudla wahlola amasampula engazi ukuthi athathwe ngayiphi indlela.
Ukuqondisa okusizwa udayi kwathola i-dysplasia ezigulini ezingu-17 uma kuqhathaniswa nezingu-3 lapho amasampula ethathwa ngokungahleliwe, umehluko owawubalulekile ngokwezibalo. Uma kuqhathaniswa nezingu-9 lapho ukuqondisa kwenziwa ngokukhanya okumhlophe kuphela, kwakuwukwanda kwenani okungafinyelelanga ezingeni elivamile lokubaluleka ngokwezibalo. Ukuhlanganiswa kwezindlela eziqondisiwe kwathola i-dysplasia ezigulini ezingu-20 uma kuqhathaniswa nezingu-3 lapho amasampula ethathwa ngokungahleliwe. Akukho zehlakalo ezingathandeki ezabikwa.
Akukho kulokhu okwahlola ukwelashwa. Udayi wawuyinto yokugqamisa efakwa ebusweni bezicubu eyayenza kube lula ukubona nokuthatha amasampula ezindaweni ezinamaphethini emigodi engajwayelekile. Akuzange kukalwe izimpawu, ukusebenza kwesifo, amazinga ama-cytokine, ukudamba kwesifo, noma ukubuya kwaso, futhi lokhu akukwazi ukucashunwa njengobufakazi kubantu bokuthi i-methylene blue yelapha i-IBD. Ukuthola yikho okwalinganiswa, futhi ukuthola kuhambisana nomhlahlandlela we-endoscopy yomgudu wokugaya ukudla ne-chromoendoscopy, ochaza ukufaka umbala ezicutshini eziphilayo, ukwakheka kwethebhulethi ye-Lumeblue ephuzwa ngomlomo, nokuthi kungani ukuthola izindawo ezilimele kungekhona ukuzelapha.
Ukungenelela uma kuqhathaniswa nokwenza kubonakale: ithebula lobufakazi
| Dinc 2015: ukungenelela kokuhlola | Marion 2008: ukwenza kubonakale ukuze kuxilongwe | |
|---|---|---|
| Indima kadayi | Into engase isetshenziselwe ukunciphisa ukuvuvukala | Udayi wokugqamisa ofakwa ebusweni bezicubu |
| Umbuzo obuzwayo | Ingabe i-methylene blue inciphisa ukulimala kwe-colitis emagundaneni | Ingabe ukufafaza udayi kuthuthukisa ukutholwa kwe-dysplasia kubantu |
| Abahlolwayo | Amagundane angamaduna angu-80, i-colitis yesikhashana ebangelwa yi-acetic acid, imiphumela ikalwa ngemva kwezinsuku ezingu-3 | Iziguli ezingu-102 eziqaphwayo, ezingu-79 ezine-colitis enezilonda nezingu-23 ezine-colitis yesifo sika-Crohn |
| Uhlelo lokusetshenziswa | U-2 mL wesisombululo esingu-1%, uhlelo olulodwa olungaguquki | Ukufafaza ngo-0.01% ngesikhathi se-colonoscopy, bese kumuncwa ngemva kokumuncwa yizicubu |
| Imiphumela ekalwayo | Amaphuzu okulimala, ukuvumela kwezinto ukuba zidlule, MPO, MDA, SOD, catalase, ama-cytokine, ukusebenza kwe-NOS | Iziguli ezine-dysplasia eqinisekiswe ngokuhlolwa kwezicubu, ngendlela ngayinye yokuthatha amasampula |
| Umphumela oyinhloko | Amagundane ane-colitis ayelashwe abonisa ukuthuthuka ezinkombeni zezicubu nezamakhemikhali omzimba | Ukuqondisa ngodayi kwathola i-dysplasia kwabangu-17 uma kuqhathaniswa nabangu-3 ngokuthatha amasampula ngokungahleliwe, P 0.001; abangu-17 uma kuqhathaniswa nabangu-9 ngokuqondisa ngokukhanya okumhlophe, P 0.057 |
| Okungakubonisi | Abukho ubufakazi bokusebenza kubantu, akukho datha yokudamba kwesifo, akukho siqondiso semithamo | Awukho umphumela wokwelapha ekuvuvukaleni, ezimpawini, noma endleleni isifo esiqhubeka ngayo |
Indlela yokufunda isimangalo esilandelayo nge-IBD
Bheka isimangalo ngasinye njengomsebenzi omncane wokuhlukanisa. Okokuqala, thola indima: ingabe udayi unikezwa ukuze uguqule ukusebenza komzimba noma ufakwa ukuze kuhlolwe izicubu. Okwesibili, thola isifo: i-colitis enezilonda egcina ekholoni ayisona isifo sika-Crohn esinezindawo ezilimele ezihlukaniswe yizindawo ezingathintekile nezinkinga ezithinta zonke izingqimba zodonga lwamathumbu, futhi umphumela kwesinye awudluliselwa kwesinye. Okwesithathu, thola izinga: imodeli yegundane ebangelwe ngamakhemikhali, ucwaningo lokuthola kubantu, nesivivinyo sokwelapha kubantu kuphendula imibuzo ehlukene futhi akunakuthatha indawo yokunye. Okwesine, hlola imiphumela ekalwayo: izinkomba zezicubu nezibalo zokutholakele ziyizilinganiso ezimele imiphumela, kanti ukudamba kwesifo, ukubuya kwaso, ukulaliswa esibhedlela nokuhlinzwa kuyimiphumela ethinta iziguli ngqo. Isimangalo esidlula konke lokhu kuhlola okune sifanele ukunakwa. Esisebenzisa izibalo zokuthola zikaMarion ukusekela isinqumo sokwelapha siyehluleka ekuhlolweni kokuqala futhi kufanele sibekwe eceleni.
Okufanele ukukhumbule
Gcina amabhokisi amabili futhi ungavumeli okuqukethwe kwawo kuhlangane. Ibhokisi lokuqala liqukethe ukuhlola okufushane kwamagundane lapho i-methylene blue yanciphisa khona izinkomba zokulimala kwekholoni okubangelwe ngamakhemikhali, indlela ye-nitric oxide kuyiyona eyayicatshangwa kakhulu ukuthi ichaza ukusebenza kwayo, kanye nayo yonke imikhawulo yokudlulisela imiphumela yamamodeli ezimo zesikhashana kubantu. Ibhokisi lesibili liqukethe ucwaningo lokuqapha kubantu lapho udayi oluhlaza okwesibhakabhaka wasiza ochwepheshe be-endoscopy ukuthola i-dysplasia okwakufanele kuthathwe kuyo amasampula ezicubu, ngaphandle kwanoma yiluphi ulwazi ngokwelapha isifo samathumbu. Ukuze uqonde ukusetshenziswa okugunyaziwe nokusahlolwa, bheka ukubuka konke kwe-methylene blue kwezokwelapha. Irekhodi eliqoqiwe locwaningo lwe-methylene blue libala izifundo ezisekela lokhu kwehlukanisa.