I-methylene blue ye-lichen planus yomlomo: ubufakazi besivivinyo sokwelapha nge-photodynamic

Iziguli ezimbili zifunda umphumela ofanayo kodwa zizwe izithembiso ezihlukene. Esinye sizwa ukuthi izilonda zipholile, ngakho isifo sesiphelile. Esinye sizwa ukuthi ubuhlungu behlile, ngakho izilonda kufanele ukuthi zipholile. Umfundi wesithathu ubona izinga eliphansi lokubuyela kwesimo bese ecabanga ukuthi lisebenza kuwo wonke umuntu owaqala ukwelashwa. Indlela ngayinye yokufunda ididanisa umqondo othile nomunye. Lokhu kubuyekezwa kuyayehlukanisa.

Isihloko siwukwelapha nge-methylene blue photodynamic okwenziwa uchwepheshe wezempilo, okuvame ukubizwa ngokuthi MB-PDT, kwe-lichen planus yomlomo enezilonda esixilongiwe, evame ukubizwa ngokuthi OLP. Ubufakazi lapha buvela esivivinyweni esisodwa sokwelapha nge-photodynamic kanye ne-corticosteroid egcotshwayo se-lichen planus yomlomo enezilonda, lapho iziguli zabelwa amaqembu ngokungahleliwe, esashicilelwa ngo-2026, esineziguli ezingu-74 ezabelwa amaqembu ngokungahleliwe. Sihlola i-MB-PDT njengesengezo ku-steroid, hhayi njengento ethatha indawo yayo futhi hhayi njengokwelashwa kwasekhaya. Abafundi abafuna kuqala ulwazi ngento eyenza izicubu zisabele ekukhanyeni kufanele baqale ngokuthi i-methylene blue isebenza kanjani njengento enjalo, kanti abafundi abaqhathanisa ukwelashwa okukhethwa kuqala kufanele bafunde ngama-corticosteroid agcotshwayo ezilondeni zomlomo kanye naleli khasi.

Imiqondo emibili esekela lokhu kwelashwa

I-OLP yisimo esingamahlalakhona solwelwesi lwamafinyila lomlomo esibangelwa ukusebenza kwamasosha omzimba. I-OLP enezilonda, okuwuhlobo olukulesi sivivinyo, isho ukuqhekeka okubuhlungu kolwelwesi, okuvame ukuba solwelwesini lwangaphakathi kwezihlathi, okuphola bese kubuya. Isici esiyinhloko salesi sifo ukubuyela kwaso. Ukuphola esikhathini esifushane akusho ukulawuleka kwesikhathi eside, ngakho noma iyiphi incazelo ethembekile kufanele ilandelele ukuphola, izimpawu nokubuyela kwesimo njengemiphumela ehlukene.

I-MB-PDT ingumqondo onezingxenye ezintathu: into eyenza izicubu zisabele ekukhanyeni kanye nokukhanya okunobude begagasi obumuncwayo kanye nomoya-mpilo. Uma kususwa noma iyiphi ingxenye, lo mqondo awusebenzi. I-methylene blue imunca ukukhanya okubomvu eduze kuka-660 nm, idayi esesimweni samandla aphakeme idlulisa amandla noma ama-electron ngezindlela ezincike emoyeni-mpilo, bese izinhlobo zamakhemikhali ezisebenza ngamandla ezivelayo zilimaza izicubu eziqondiwe kuleyo ndawo. Idayi efanayo ngaphandle kokukhanya iwumqondo ohlukile, yingakho ukwelapha nge-methylene blue photodynamic ezimweni zesikhumba kuveza ngokucacile umuthi, ukukhanya, umthamo nesikhawu sokusebenzisa ngakunye. Uma kusetshenziswa emlonyeni, inqubo kufanele yenziwe ochwepheshe bezempilo, indawo ibonakala ngokuqondile, isilonda somisiwe futhi sihlukanisiwe ngaphambi kokuchayeka ekukhanyeni.

Okwenziwa yisivivinyo empeleni

Isivivinyo senziwa esibhedlela esisodwa eShanghai, sabhalisa abantu abadala abane-OLP enezilonda eqinisekiswe ngokuhlolwa kwesampula yezicubu, izilonda zinkulu kuno-5 mm oyisikwele ngokwemigomo ye-WHO ka-2003 eguquliwe, futhi sabela iziguli ezingu-37 ngokungahleliwe ku-MB-PDT kanye nenhlama ye-triamcinolone acetonide engu-0.1 wamaphesenti, nezingu-37 enhlameni kuphela. Inhlama yayigcotshwa kathathu ngosuku kuwo womabili amaqembu phakathi namasonto amane okwelashwa. Iqembu le-PDT lathola nokuchayeka ekukhanyeni okungu-660 nm masonto onke, ngo-13.2 J nge-cm ngayinye eyisikwele, imizuzwana engu-60 ngesikhathi ngasinye, ngemva kokugcotshwa kwe-methylene blue engu-0.1 mg nge-mL, kuze kube yizikhathi ezine. Umhloli ozimele owayengazi ukwabiwa kwamaqembu walinganisa imiphumela. Iziguli nabachwepheshe ababezelapha babekwazi ukuthi yiliphi iqembu lokwelashwa, okuyinto evamile enqubweni yokukhanya kodwa eshiya imibiko yezimpawu isengathonywa yilokho okulindelwe. Isingeniso sezindlela zalolu hlobo lokuklanywa kwesivivinyo siqoqwe encazelweni yokufunda imibiko yezivivinyo ze-photodynamic.

Ukuhlaziywa kwesikhathi esifushane kuze kube yisonto 4 kwasebenzisa indlela yokuhlaziya ngokwamaqembu iziguli ezabelwa wona ekuqaleni, kwagcwaliswa idatha engekho ngamanani alinganisiwe. Ukulandelela kwesikhathi eside emavikini 8 no-12 kwalandela kuphela iziguli ezazisabele ekwelashweni, okuyinto ebaluleke kakhulu ekubuyeleni kwesimo, njengoba kukhonjiswa ngezansi. Imibuzo evamile ngokuhlelwa kwenqubo emtholampilo nokuqapha ukuphepha iphendulwa emibuzweni evame ukubuzwa ngokwelapha umlomo nge-photodynamic.

Ithebula lokuqhathanisa lesivivinyo

Ukuphola, ubuhlungu, ukubuyela kwesimo nempilo yansuku zonke kwashintsha ngokwehlukana

Ukuphola esontweni 4 kwaba ngcono eqenjini elathola inhlanganisela. Ukusebenza kokwelashwa ngokomtholampilo kwafinyelela ezigulini ezingu-35 kwezingu-37 (94.6 wamaphesenti) nge-MB-PDT kanye ne-steroid, uma kuqhathaniswa nezingu-26 kwezingu-37 (70.3 wamaphesenti) nge-steroid kuphela, igebe elingu-24.3 lamaphuzu wamaphesenti, i-P ilingana no-0.006. Ukuvaleka okuphelele kwaba yingxenye enkulu yalowo mehluko, abangu-27 kwabangu-37 uma kuqhathaniswa nabangu-21 kwabangu-37. Izinga lokuncipha kobukhulu besilonda laba likhulu ngokubalulekile ngokwezibalo eqenjini lenhlanganisela esontweni 4, lowo mehluko walahlekelwa ukubaluleka ngokwezibalo esontweni 8, waphinde wakuthola esontweni 12. Isilinganiso esibanzi sobunzima besimo se-REU sathuthuka kuwo womabili amaqembu ngaphandle komehluko obalulekile ngokwezibalo phakathi kwawo kunoma yisiphi isikhathi, okuyisikhumbuzo sokuthi isilonda esikhulu kunazo zonke asiwona umlomo wonke.

Ubuhlungu balandela indlela ehamba kancane. Ukwehla okumaphakathi esikalini sezinombolo esontweni 4 kwakungamaphuzu angu-3.97 ngenhlanganisela uma kuqhathaniswa no-2.62 nge-steroid kuphela, i-P ilingana no-0.004. Amaqembu awazange ahluke emasontweni amabili okuqala. Umehluko wavela esontweni 3 futhi waqhubeka emavikini 8 no-12. Leyo ndlela ihambisana nesengezo esidinga izikhathi eziphindaphindwayo kunokudambisa ngokushesha, futhi ixwayisa ngokwahlulela inqubo ngemva kokuvakasha okukodwa.

Ekubuyeleni kwesimo, isisekelo sokubala yiso esinquma incazelo. Irekhodi lesivivinyo salolu cwaningo lwe-OLP enezilonda lichaza ukubuyela kwesimo phakathi kweziguli eziphole, futhi izinani zibonisa ukuthi eziphole kwakushiwo ezisabele ngokuphelele: abangu-27 uma kuqhathaniswa nabangu-21 esontweni 8, kwehla kwaba abangu-26 uma kuqhathaniswa nabangu-20 esontweni 12. Esontweni 8 ukubuyela kwesimo kwaba kwabangu-2 kwabangu-27 (7.4 wamaphesenti) uma kuqhathaniswa nabangu-5 kwabangu-21 (23.8 wamaphesenti), umehluko ungabalulekile ngokwezibalo. Esontweni 12 kwaba kwabangu-3 kwabangu-26 (11.5 wamaphesenti) uma kuqhathaniswa nabangu-8 kwabangu-20 (40.0 wamaphesenti), i-P ilingana no-0.038. Lowo umphumela weqembu elincane labasabele ekwelashweni, hhayi umphumela wokuhlaziya ngokwamaqembu iziguli ezabelwa wona ekuqaleni, ngoba iziguli ezazingapholile zaphuma ekuhlaziyweni kokubuyela kwesimo ukuze zithole okunye ukwelashwa. Umbhali obika u-11.5 uma kuqhathaniswa no-40.0 wamaphesenti ngaphandle kokusho isisekelo sokubala esingu-26 uma kuqhathaniswa no-20 uphinda iphutha elivame kakhulu emibikweni yabanye ngaleli phepha.

Izinga lempilo nesimo semizwa kwabonisa indlela efanayo yemiphumela ehlukene. Izinga lempilo elihlobene nomlomo ku-OHIP-14 lathuthuka kakhulu ngenhlanganisela, i-P ilingana no-0.002, nokukhathazeka ku-GAD-7 kwathuthuka kakhulu, i-P ilingana no-0.007. Ukucindezeleka kwengqondo ku-PHQ-9 akuzange kuhluke. Izilinganiso zokukhathazeka nokucindezeleka kwengqondo ekuqaleni zaziphansi, ngakho lezi zikali zilinganisa ushintsho oluncane eqenjini elithinteke kancane kunokwelashwa kokukhathazeka noma ukucindezeleka kwengqondo okufinyelela ezingeni lokuxilongwa emtholampilo.

Imikhawulo okufanele umfundi ocophelelayo ayikhumbule

Ubukhulu beqembu locwaningo bungumkhawulo wokuqala. Isibalo sokuhlela sathatha ukusebenza kokwelashwa okungu-37 uma kuqhathaniswa no-79 wamaphesenti, sabeka amandla ezibalo angu-80 wamaphesenti omphumela oyinhloko wesonto 4, futhi sakhiqiza isamba seziguli ezingu-74. Lobo bukhulu abukwazi ukusekela izimangalo eziqinile ngamaqembu amancane okubuyela kwesimo angu-26 uma kuqhathaniswa no-20, izikali zezinga lempilo, noma ukulimala okungavamile. Ukungabi bikho kwezehlakalo ezingezinhle ezigulini ezingu-74 emasontweni angu-12 kubonisa ukuthi ukulimala okuvamile akwenzekanga, kodwa kusho okuncane ngezehlakalo ezingavamile, futhi izindlela zocwaningo zabuza ngokuqondile ngobuhlungu bomlomo, ukuvuvukala kolwelwesi lwamafinyila nokushintsha kokunambitha ngokwemigomo ejwayelekile yokulimala ngenxa yokwelashwa.

Ukulandelela kungumkhawulo wesibili. Amasonto ayishumi nambili kusukela ekwabelweni kwamaqembu ngokungahleliwe acishe abe amasonto ayisishiyagalombili ngemva kwesikhathi sokugcina sokukhanya. I-OLP ibuyela phakathi kwezinyanga neminyaka, ngakho ukuqhathanisa ukubuyela kwesimo emasontweni angu-12 kuwubufakazi bokuqala, hhayi isimangalo sokuhlala komphumela isikhathi eside. Ukuklanywa kocwaningo olwenziwa esikhungweni esisodwa kungumkhawulo wesithathu. Ithimba elilodwa, umshini owodwa, uhlelo olulodwa lwe-steroid, neqembu lapho abesifazane babengaphezu kuka-80 wamaphesenti futhi iminyaka yobudala isondele ku-59 kuchaza lowo mtholampilo kahle, kodwa ezinye izindawo akuzichazi kahle kangako.

Amaphutha amabili okubika kufanele aqashelwe ukuze ababhali bangawakopishi. Iphepha linamathisela ibanga lokuqiniseka elisuka ku-7.9 kuya ku-40.7 wamaphesenti, elivezwe ngamaphuzu wamaphesenti, esilinganisweni sobungozi esingu-1.35, kodwa lelo banga lihambisana nomehluko ophelele wamaphuzu angu-24.3, hhayi nesilinganiso. Futhi ingxoxo ithi umehluko obalulekile wamaphuzu angu-10 owawunqunywe kusengaphambili awutholakalanga, nakuba igebe elibikiwe lokusebenza kokwelashwa lidlula amaphuzu angu-10. Alikho kulawa maphutha elishintsha izinani zangempela, okungamaqiniso azinzile: abangu-35 kwabangu-37 uma kuqhathaniswa nabangu-26 kwabangu-37 ekusebenzeni kokwelashwa, kanye nabangu-3 kwabangu-26 uma kuqhathaniswa nabangu-8 kwabangu-20 ekubuyeleni kwesimo esontweni 12 phakathi kwabasabele ngokuphelele.

Isiphetho sigcina imingcele yaso icacile, okuyiwona mandla aso. Kubantu abadala abane-OLP enezilonda eqinisekiswe ngokuhlolwa kwesampula yezicubu, ukwengeza izikhathi ezine noma ngaphansi zamasonto onke emtholampilo zokwelapha nge-methylene blue PDT ku-triamcinolone egcotshwayo kwathuthukisa ukuphola nokuncipha kobuhlungu esontweni 4, kwaba nesibonakaliso sokuncipha kokubuyela kwesimo esontweni 12 esasigcina kwabasabele ngokuphelele kuphela, kanye nenzuzo yezinga lempilo ezilinganisweni zomthelela womlomo nokukhathazeka. Akusivivinyi idayi iyodwa, imishini yasekhaya, obunye ubude bamagagasi, noma ukulawuleka kwesikhathi eside. Iziguli ezicabanga ngakho kufanele zibuze uchwepheshe wazo wezempilo ngokuqinisekiswa kokuxilongwa, inani lezikhathi zokwelashwa, indlela okulindeleke ukuthi ubuhlungu bushintshe ngayo emasontweni amathathu kuya kwamane, nokuthi ukubuyela kwesimo kuzolandelwa kanjani ngemva kwesizini yokuqala.