Taimako na Clinical Neurophysiology Support. El Paso, TX. Chiropractor, Dokta Alexander Jimenez ya tattauna neurophysiology na asibiti. Dokta Jimenez zai bincika mahimmancin asibiti da ayyukan aiki na ƙwayoyin jijiya na gefe, kashin baya, kwakwalwa, da kwakwalwa a cikin mahallin visceral da ƙwayoyin cuta. Marasa lafiya za su sami ci gaba da fahimta game da ilimin halittar jiki, kwayoyin halitta, biochemistry, da ilimin halittar jiki na jin zafi dangane da cututtukan cututtuka daban-daban. Za'a haɗa nau'ikan halittu masu gina jiki masu alaƙa da nociception da zafi. Kuma za a jaddada aiwatar da wannan bayanin a cikin shirye-shiryen jiyya.
Ƙungiyarmu tana alfahari da kawo danginmu da majinyata da suka ji rauni kawai ingantattun ka'idojin magani. Ta hanyar koyar da cikakkiyar lafiya a matsayin salon rayuwa, muna kuma canza ba kawai rayuwar majiyyatan mu ba har ma da danginsu. Muna yin haka ne domin mu isa ga El Pasoans da yawa waɗanda suke buƙatar mu, komai lamurra masu araha. Don amsoshin tambayoyin da za ku iya samu don Allah a kira Dr. Jimenez a 915-850-0900.
"Sharuɗɗan yanke shawara na asibiti, rarrabuwa na kashin baya da kuma tsinkayar sakamakon magani: Tattaunawa na rahotannin kwanan nan a cikin wallafe-wallafen gyarawa"
Abstract
Dokokin yanke shawara na asibiti zama na kowa a cikin wallafe-wallafen halittu kuma suna wakiltar dabarun haɓaka yanke shawara na asibiti don haɓaka inganci da ingancin isar da lafiya. A cikin mahallin bincike na gyaran gyare-gyare, ƙa'idodin yanke shawara na asibiti sun fi dacewa don rarraba marasa lafiya ta hanyar tsinkayar maganin su ga takamaiman hanyoyin kwantar da hankali. A al'ada, shawarwarin don haɓaka ƙa'idodin yanke shawara na asibiti suna ba da shawarar tsari mai yawa (samuwa, tabbatarwa, nazarin tasiri) ta amfani da ƙayyadaddun hanyoyin. Ƙoƙarin bincike da nufin haɓaka ƙa'idar yanke shawara ta asibiti ya tashi daga wannan al'ada. Littattafai na baya-bayan nan a cikin wannan layin bincike sun yi amfani da gyare-gyaren ƙamus na tushen jagorar yanke shawara na asibiti. Canje-canje ga kalmomi da hanyoyin da ke kewaye da ka'idojin yanke shawara na asibiti na iya sa ya fi wuya ga likitocin likita su gane matakin shaidar da ke hade da ka'idar yanke shawara kuma su fahimci yadda ya kamata a aiwatar da wannan shaida don sanar da kulawar haƙuri. Muna ba da taƙaitaccen taƙaitaccen bayani game da ci gaban ƙa'idar yanke shawara na asibiti a cikin mahallin wallafe-wallafen gyare-gyare da kuma takamaiman takaddun takaddun guda biyu da aka buga kwanan nan a Chiropractic da Manual Therapies.
Dokokin Hasashen asibiti
Kiwon lafiya ya sami babban canji mai mahimmanci zuwa aikin tushen shaida. Hanyar tunani don haɓaka yanke shawara na asibiti ta hanyar haɗa mafi kyawun shaidar da ake samu tare da ƙwarewar asibiti da zaɓin marasa lafiya.
A ƙarshe, makasudin aikin tushen shaida shine haɓaka isar da lafiya. Koyaya, fassarar shaidar kimiyya cikin aiki ta tabbatar da ƙalubale.
Dokokin yanke shawara na asibiti (CDRs), kuma aka sani da ka'idodin tsinkaya na asibiti, suna ƙara zama gama gari a cikin wallafe-wallafen gyarawa.
Waɗannan kayan aikin ne waɗanda aka ƙera don sanar da yanke shawara na asibiti ta hanyar gano yuwuwar masu hasashen sakamakon gwaji, tsinkaye, ko amsawar warkewa.
A cikin wallafe-wallafen gyaran gyare-gyare, ana amfani da CDRs mafi yawan amfani da su don hango ko hasashen martanin mai haƙuri ga jiyya. An ba da shawarar su don gano ƙungiyoyin da suka dace da asibiti na marasa lafiya waɗanda ke gabatar da wasu cututtuka daban-daban kamar wuyan wuyansa ko ƙasa. ciwon baya, wanda shine mahangar da muka yi niyyar mayar da hankali a kai.
Dokokin Hasashen asibiti
An ba da damar iya rarrabawa ko ƙungiyoyi marasa lafiya tare da cututtuka daban-daban irin su ciwo na kashin baya a matsayin fifiko na bincike kuma, saboda haka, mayar da hankali ga ƙoƙarin bincike mai yawa. Ƙaunar irin waɗannan hanyoyin rarrabuwa shine yuwuwar su don ingantaccen ingantaccen magani da inganci ta hanyar daidaita marasa lafiya tare da ingantattun hanyoyin kwantar da hankali. A baya, rarrabuwar majiyyaci ya dogara ga fayyace hanyoyin da aka kafa a al'ada ko kuma abubuwan lura marasa tsari. Yin amfani da CDRs don sanar da rarrabuwa shine ƙoƙari ɗaya don ƙarin hanyar da ta fi dacewa da shaida, ƙasa da dogaro da ka'idar mara tushe.
CDRs an haɓaka su a cikin matakai masu yawa da suka haɗa da nazarin ƙaddamarwa, tabbatarwa, da kuma nazarin tasiri, tare da kowanne yana da ƙayyadaddun manufa da ma'auni. Kamar yadda yake tare da duk nau'ikan shaidar da aka yi amfani da su don yanke shawara game da marasa lafiya, kulawa ga tsarin binciken da ya dace yana da mahimmanci don tantance yiwuwar amfani da aiwatarwa.
Amfanin Dokokin Hasashen Clinical
Yana iya ɗaukar abubuwa da yawa fiye da yadda kwakwalwar ɗan adam za ta iya la'akari da su
Samfurin CDR/CPR koyaushe zai ba da sakamako iri ɗaya (daidaitan lissafin)
Zai iya zama daidai fiye da hukuncin asibiti.
Amfanin Clinical na Dokokin Hasashen Clinical
Ganewa � Yiwuwar tantancewa
Hasashen � Yi hasashen haɗarin sakamakon cututtuka
A ƙarshe, amfanin CDR ba tare da daidaito ba amma tare da ikonsa na inganta sakamakon asibiti da haɓaka ingantaccen kulawa.[15] Ko da lokacin da CDR ya nuna ingantaccen inganci, wannan baya tabbatar da cewa zai canza yanke shawara na asibiti ko kuma canje-canjen da yake samarwa zai haifar da kyakkyawar kulawa.
Canje-canjen da yake samarwa zai haifar da kulawa mai kyau. McGinn et al.[2] gano bayanai guda uku na gazawar CDR a wannan matakin. Na farko, idan hukuncin likitan ya kasance daidai kamar shawarar da aka sanar da CDR, babu wani fa'ida ga amfani da shi. Na biyu, aikace-aikacen CDR na iya haɗawa da ƙididdige ƙididdiga ko hanyoyin da ke hana likitocin yin amfani da CDR. Na uku, yin amfani da CDR maiyuwa baya yiwuwa a kowane yanayi ko yanayi. Bugu da ƙari, za mu haɗa da gaskiyar cewa binciken gwaji na iya haɗawa da marasa lafiya waɗanda ba su da cikakken wakilci na waɗanda aka gani a cikin kulawa na yau da kullum kuma wannan zai iya ƙayyade ainihin ƙimar CDR. Sabili da haka, don fahimtar cikakken amfani da CDR da ikonsa na inganta isar da kiwon lafiya, ya zama dole a gudanar da bincike na zahiri game da yuwuwar sa da tasirin sa lokacin da aka yi amfani da shi a cikin yanayin da ke nuna aikin gaske na duniya. Ana iya yin wannan tare da ƙira daban-daban na nazari kamar gwaje-gwaje bazuwar, gwajin bazuwar tari, ko wasu hanyoyin kamar nazarin tasirin CDR kafin da bayan aiwatar da shi.
Yaduwar hanyoyin rarrabawa ga marasa lafiya tare da raunin lumbar ta amfani da cututtukan McKenzie, yanayin zafi, magudi, da kuma tabbatar da ka'idojin tsinkaya na asibiti.
Manufofin sun kasance (1) don ƙayyade adadin marasa lafiya da raunin lumbar waɗanda za a iya rarraba su a lokacin cin abinci ta hanyar McKenzie Syndrome (McK) da kuma nau'in nau'i na ciwo (PPCs) ta amfani da Mechanical Diagnosis and Therapy (MDT) hanyoyin kimantawa, magudi, da kuma tabbatar da tsinkayar asibiti. Dokokin (CPRs) da (2) na kowane Man CPR ko Stab CPR category, ƙayyade ƙimar yaɗuwar rarrabuwa ta amfani da McK da PPC.
CPRs sune ƙayyadaddun ƙima da ƙididdiga masu ƙima inda ƙungiyoyin halayen haƙuri da aka gano da alamun asibiti da alamomi suna da alaƙa da ƙididdiga masu ma'ana na sakamakon haƙuri.
Masu bincike sun haɓaka CPR guda biyu daban-daban don gano marasa lafiya waɗanda zasu amsa da kyau ga magudi.33,34 Flynn et al. ɓullo da ainihin magudi CPR ta amfani da ma'auni biyar, watau, babu alamun bayyanar da ke ƙasa da gwiwa, kwanan nan na bayyanar cututtuka (<16 days), ƙananan tambayoyin imani da tsoro-nauyi36 don aiki (<19), hypomobility na lumbar kashin baya, da hip ciki. rotation ROM (> 35 don akalla kwatangwalo daya).33
Fritz et al ya gyara Flynn's CPR daga baya. zuwa sharuɗɗa guda biyu, waɗanda ba su haɗa da alamun bayyanar da ke ƙasa da gwiwa da kwanan nan na bayyanar cututtuka (<16 days), a matsayin madaidaicin madaidaicin don rage nauyin likitancin don gano marasa lafiya a cikin kulawa na farko wanda zai iya amsawa ga magudin motsa jiki.34 tabbatacce.
"Potentia.l Matsalolin Dokokin Hasashen Clinical"
Menene Dokokin Hasashen Clinical?
Dokar tsinkayar asibiti (CPR) ita ce haɗuwa da binciken binciken asibiti wanda ya nuna ƙididdiga mai ma'ana don ƙayyade yanayin da aka zaɓa ko tsinkaye na mai haƙuri wanda aka ba da wani magani na musamman 1,2. An ƙirƙiri CPRs ta amfani da hanyoyin ƙididdiga masu yawa daban-daban, an tsara su don bincika ikon tsinkaya na ƙungiyoyin da aka zaɓa na masu canji na asibiti3,4, kuma an yi nufin su taimaka wa likitocin yin yanke shawara mai sauri waɗanda galibi ke kasancewa ƙarƙashin rashin son rai5. Dokokin algorithmic ne a cikin yanayi kuma sun haɗa da taƙaitaccen bayani wanda ke gano mafi ƙarancin adadin alamun ƙididdiga zuwa yanayin da aka yi niyya6.
Gabaɗaya ana haɓaka ƙa'idodin tsinkayar asibiti ta amfani da hanya 3-mataki14. Na farko, CPRs sun samo mana gaba-gaba-
Haɓaka hanyoyin ƙididdiga masu yawa don bincika ikon tsinkaya na ƙungiyoyin da aka zaɓa na masu canjin asibiti3. Mataki na biyu ya haɗa da tabbatar da CPR a cikin gwajin sarrafawa bazuwar don rage haɗarin cewa abubuwan tsinkaya da suka samo asali yayin lokacin haɓakawa an zaɓi su ta hanyar kwatsam14. Mataki na uku ya ƙunshi gudanar da bincike na tasiri don sanin yadda CPR ke inganta kulawa, rage farashi, da ma'anar maƙasudin manufa14 daidai.
Ko da yake akwai ƙananan muhawara waɗanda aka gina a hankali CPRs na iya inganta aikin asibiti, a sani na, babu wasu jagororin da suka ƙayyade hanyoyin da ake bukata don CPRs don jiko a cikin duk yanayin aikin asibiti. An ƙirƙiri jagorori don inganta ƙaƙƙarfan ƙira da bayar da rahoto. Edita mai zuwa yana fayyace yuwuwar hatsabiban dabara a cikin CPRs waɗanda zasu iya raunana canja wurin algorithm. A cikin fagen gyaran gyare-gyare, yawancin CPRs an tsara su; don haka, maganganuna a nan suna nuna alamun CPRs.
Matsalolin Hanyar
An tsara CPRs don ƙididdige saitin halaye masu kama da juna daga yawan jama'a dabam-dabam na marasa lafiya da aka zaɓe a jere5,15. Yawanci, sakamakon abin da ya shafi yawan jama'a ƙaramin yanki ne na babban samfuri kuma yana iya wakiltar ƙaramin kaso na ainihin adadin yau da kullun na likitan. Saitin da wurin da ya fi girma samfurin ya kamata ya zama cikakke15,16, kuma nazarin ingantaccen aiki na gaba yana buƙatar kima na CPR a cikin ƙungiyoyin marasa lafiya daban-daban, a cikin yanayi daban-daban, kuma tare da ƙungiyar marasa lafiya da aka gani ta hanyar yawancin likitoci16. Saboda yawancin CPRs an haɓaka su ne bisa ƙayyadaddun ƙungiyar da ƙila ko ba za ta iya nuna yawan adadin marasa lafiya ba, jigilar bakan17 na yawancin algorithms CPR na yanzu na iya iyakance.
Dokokin tsinkaya na asibiti suna amfani da matakan sakamako don sanin tasirin sa baki. Matakan sakamako dole ne su kasance da ma'anar aiki guda ɗaya5 kuma suna buƙatar isashen amsa don kama canjin da ya dace a cikin yanayin14 da gaske; Bugu da kari, ya kamata wadannan matakan su kasance da ingantattun maki 16,18 kuma wani makafi ya tattara su15. A halin yanzu ana muhawara game da zaɓin maki mai dacewa don auna ainihin canji19-20. Yawancin matakan sakamako suna amfani da tambayoyin tushen tunawa da haƙuri kamar ƙimar canjin canji na duniya (GroC), wanda ya dace idan aka yi amfani da shi a cikin ɗan gajeren lokaci amma yana fama da ƙiyayyar tunawa lokacin da aka yi amfani da shi a cikin dogon nazari19-21.
Wata yuwuwar koma baya ga CPRs shine gazawar kula da ingancin gwaje-gwaje da matakan da aka yi amfani da su azaman tsinkaya a cikin algorithm. Don haka, gwajin hangen nesa da matakan ya kamata su kasance masu zaman kansu daga juna yayin yin samfuri16; kowanne ya kamata a yi shi cikin ma'ana, karbabbe4; likitoci ko masu kula da bayanai yakamata a makantar da su ga matakan sakamakon majiyyaci da yanayin22.
Sources
Matsaloli masu yuwuwar Dokokin Hasashen Clinical; Jaridar Manual & Manipulative Therapy Juzu'i na 16 Lamba Biyu [69]
Jeffrey J Hebert da Julie M Fritz; Sharuɗɗan yanke shawara na asibiti, rarrabuwa na kashin baya da kuma tsinkayar sakamakon jiyya: Tattaunawar rahotannin kwanan nan a cikin wallafe-wallafen gyarawa
Bacin rai yana ɗaya daga cikin al'amuran kiwon lafiyar kwakwalwa da aka fi sani a Amurka. Bincike na yanzu yana nuna cewa baƙin ciki yana samuwa ne daga haɗakar abubuwan halitta, ilimin halitta, muhalli, da kuma tunani. Bacin rai babban cuta ce ta tabin hankali a duk duniya tare da tabarbarewar tattalin arziki da tunani akan al'umma. Abin farin ciki, baƙin ciki, har ma da mafi tsanani lokuta, za a iya magance su. Tun da farko da magani zai iya farawa, mafi inganci shine.
A sakamakon haka, duk da haka, akwai buƙatu masu ƙarfi na biomarkers waɗanda za su taimaka wajen haɓaka ganewar asali don haɓaka tsarin gano magunguna da/ko hanyoyin gano magunguna ga kowane majiyyaci mai cutar. Waɗannan haƙiƙa ne, alamomin ilimin lissafi na gefe waɗanda za a iya amfani da kasancewar kasancewarsu don hasashen yuwuwar farawa ko wanzuwar baƙin ciki, daidaitawa gwargwadon tsananin ko alamun bayyanar cututtuka, suna nuna tsinkaya da tsinkaya ko saka idanu kan martanin hanyoyin warkewa. Manufar labarin mai zuwa shine don nuna hangen nesa na baya-bayan nan, ƙalubalen da ake fuskanta da kuma abubuwan da ke gaba game da gano abubuwa iri-iri. biomarkers don damuwa da kuma yadda waɗannan zasu iya taimakawa wajen inganta ganewar asali da magani.
Alamar Halittu don Bacin rai: Hassoshin Kwanan nan, Kalubale na Yanzu da Halayen Gaba
Abstract
Yawancin bincike ya haifar da ɗaruruwan masu satar kwayoyin halitta don ɓacin rai, amma har yanzu ba su yi cikakken bayanin rawar da suke takawa a cikin rashin lafiya ba ko kafa abin da ba shi da kyau wanda marasa lafiya da yadda za a iya amfani da bayanan ilimin halitta don haɓaka ganewar asali, jiyya da tsinkaye. Wannan rashin ci gaba wani ɓangare ne saboda yanayin yanayi da nau'in ciwon ciki, tare da haɗin kai tare da nau'in nau'i na hanyoyin da ke cikin wallafe-wallafen bincike da kuma manyan nau'o'in kwayoyin halitta tare da yuwuwar, bayyanar da sau da yawa ya bambanta bisa ga dalilai da yawa. Muna yin nazarin wallafe-wallafen da ake samuwa, wanda ke nuna cewa alamomin da ke cikin kumburi, neurotrophic da matakai na rayuwa, da kuma abubuwan da ke tattare da tsarin neurotransmitter da neuroendocrine, suna wakiltar 'yan takara masu ban sha'awa. Ana iya auna waɗannan ta hanyar kwayoyin halitta da epigenetic, transcriptomic da proteomic, metabolomic da ƙididdigar neuroimaging. Yin amfani da sababbin hanyoyin da shirye-shiryen bincike na yau da kullum ana buƙatar don sanin ko, kuma wanda, za a iya amfani da masu amfani da kwayoyin halitta don tsinkayar mayar da martani ga jiyya, ƙaddamar da marasa lafiya zuwa takamaiman jiyya da kuma haɓaka maƙasudai don sababbin ayyukan. Mun kammala da cewa akwai alƙawura da yawa don rage nauyin baƙin ciki ta hanyar haɓakawa da faɗaɗa waɗannan hanyoyin bincike.
Kalubale a cikin Lafiyar Hankali da Cututtukan yanayi
Ko da yake ilimin hauka yana da nauyin da ke da alaƙa da cututtuka fiye da kowane nau'in bincike na likita guda ɗaya, 1 rashin daidaituwa na mutunci har yanzu yana bayyana a tsakanin lafiyar jiki da ta hankali a cikin bangarori da yawa ciki har da kudade na bincike2 da bugawa.3 Daga cikin matsalolin da lafiyar kwakwalwa ke fuskanta shine rashin lafiya. na yarjejeniya game da rarrabuwa, ganewar asali da magani wanda ya samo asali daga rashin cikakkiyar fahimtar hanyoyin da ke tattare da waɗannan cututtuka. Wannan yana bayyana sosai a cikin rikice-rikice na yanayi, nau'in wanda ya ƙunshi nauyi ɗaya mafi girma a cikin lafiyar hankali.3 Mafi yawan yanayin yanayi, babban rashin damuwa (MDD), cuta ce mai rikitarwa, rashin lafiya mai ban sha'awa wanda har zuwa 60% na marasa lafiya zasu iya fuskanta. wani mataki na juriya na jiyya wanda ke tsawaitawa kuma yana kara tsananta yanayi.4 Don cututtukan yanayi, da kuma fa'idar lafiyar hankali, za a iya inganta sakamakon jiyya ta hanyar gano ƙaƙƙarfan ƙaƙƙarfan nau'ikan nau'ikan nau'ikan nau'ikan nau'ikan bincike (da kuma a cikin duka) waɗanda ke yin jiyya. za a iya stratified. Don gane da wannan, shirye-shiryen duniya don tantance nau'ikan nau'ikan nau'ikan aiki yanzu suna ci gaba, kamar ka'idodin yanki na bincike.5 An nuna cewa alamomin halittu sune 'yan takara masu fifiko don ƙaddamar da cututtukan tunani.6
Inganta Amsa Magani don Bacin rai
Duk da ɗimbin zaɓuɓɓukan jiyya don babban bakin ciki, kusan kashi ɗaya bisa uku na marasa lafiya tare da MDD sun sami gafara ko da lokacin da ake samun ingantaccen maganin rage damuwa bisa ga ƙa'idodin yarjejeniya da kuma yin amfani da kulawa ta tushen ma'auni, kuma ƙimar amsawar jiyya ya bayyana ya faɗi tare da kowane sabon magani. .7 Bugu da ƙari kuma, damuwa mai jurewa jiyya (TRD) yana haɗuwa da ƙara yawan rashin aiki na aiki, mace-mace, cututtuka da kuma sake dawowa ko lokuta na yau da kullum a cikin dogon lokaci.8,9 Don haka, samun cigaba a cikin amsawar jiyya a kowane mataki na asibiti zai ba da fa'ida ga fa'ida ga sakamakon gaba ɗaya cikin ciki. Duk da babban nauyi da ake dangantawa ga TRD, bincike a wannan yanki ya yi kadan. Ma'anar TRD ba a daidaita su ba, duk da ƙoƙarin da aka yi a baya: 4 wasu sharuɗɗa suna buƙatar gwajin jiyya ɗaya kawai wanda ya kasa cimma nasarar rage alamar 50% (daga ingantacciyar ma'auni na tsananin baƙin ciki), yayin da wasu ke buƙatar rashin samun cikakkiyar gafara. ko rashin amsawa ga akalla biyu isassun magungunan antidepressants na nau'o'i daban-daban a cikin wani lamari da za a yi la'akari da shi TRD.4,10 Bugu da ƙari kuma, ƙaddamarwa da tsinkaya na juriya na jiyya an inganta ta hanyar ƙara mahimmin sifofin asibiti na tsanani da na yau da kullum zuwa adadin jiyya na kasawa. .9,11 Duk da haka, wannan rashin daidaituwa a cikin ma'anar yana sanya fassarar wallafe-wallafen bincike akan TRD wani aiki mai rikitarwa.
Domin inganta martani ga jiyya, yana da taimako a fili don gano abubuwan haɗari na tsinkaya na rashin amsawa. Wasu masu tsinkaya na gaba ɗaya na TRD an kwatanta su, ciki har da rashin cikakkiyar gafara bayan abubuwan da suka faru a baya, damuwa da damuwa, suicidality da farkon farawa na ciki, da kuma hali (musamman ƙananan haɓaka, ƙananan ladaran dogara da babban neuroticism) da kwayoyin halitta.12 An tabbatar da waɗannan binciken ta hanyar sake dubawa da ke haɗa shaida daban don maganin pharmacolojic13 da psychopsychological14 don baƙin ciki. Magungunan antidepressants da fahimi-halayen hanyoyin kwantar da hankali suna nuna kwatankwacin inganci,15 amma saboda bambancin hanyoyin aiwatar da su ana iya sa ran samun masu hasashen martani daban-daban. Yayin da raunin da ya faru a farkon rayuwa ya dade yana da alaƙa da rashin sakamako na asibiti da kuma rage martani ga jiyya, 16 alamun farko sun nuna cewa mutanen da ke da tarihin raunin yara na iya amsawa da kyau ga ilimin halin mutum fiye da magungunan magunguna.17 Duk da haka, rashin tabbas yana ci gaba da kasancewa da ƙananan keɓancewa ko keɓancewa ko keɓancewa. stratification na magani ya kai ga aikin asibiti.18
Wannan bita yana mai da hankali kan shaidun da ke tallafawa masu amfani da ƙwayoyin halitta azaman kayan aikin asibiti masu amfani don haɓaka amsawar jiyya don baƙin ciki.
Biomarkers: Tsari da Tushen
Biomarkers suna ba da wata manufa mai mahimmanci don gano masu tsinkaya game da mayar da martani ga wasu ayyuka daban-daban.19 Shaidar zuwa yau ta nuna cewa alamun da ke nuna ayyukan masu kumburi, neurotransmitter, neurotrophic, neuroendocrine da tsarin rayuwa na iya iya yin la'akari da sakamakon tunanin mutum da lafiyar jiki a cikin mutanen da ke fama da damuwa a halin yanzu. , amma akwai rashin daidaituwa da yawa tsakanin binciken.20 A cikin wannan bita, mun mai da hankali kan waɗannan tsarin halittu guda biyar.
Don samun cikakkiyar fahimtar hanyoyin ƙwayoyin cuta da gudummawar da suke bayarwa a cikin cututtukan tabin hankali, yanzu ana ɗaukar mahimmanci don tantance matakan ilimin halitta da yawa, a cikin abin da aka fi sani da tsarin ilimin kimiyya.21 Hoto na 1 yana ba da kwatance daban-daban. matakan nazarin halittu wanda za'a iya tantance kowane tsarin guda biyar, da yuwuwar tushen alamomin da za'a iya gudanar da waɗannan kima. Koyaya, lura cewa yayin da ana iya bincika kowane tsarin a kowane matakin omics, madaidaitan ma'aunin ma'auni ya bambanta a sarari a kowane matakin. Misali, neuroimaging yana ba da dandamali don kimanta tsarin kwakwalwa ko aiki kai tsaye, yayin da gwajin furotin a cikin jini ke tantance alamomi kai tsaye. Transcriptomics22 da metabolomics23 suna ƙara shahara, suna ba da ƙima na ƙima mai yawa na alamomi, kuma Human Microbiome Project yanzu yana ƙoƙarin gano duk ƙananan ƙwayoyin cuta da tsarin halittarsu a cikin ɗan adam. ; alal misali, ana iya tantance hormones irin su cortisol a gashi ko farce (yana ba da nuni na yau da kullun) ko gumi (samar da ci gaba da aunawa), 24 da kuma cikin jini, ruwan cerebrospinal, fitsari da miya.
Idan aka yi la'akari da adadin maɓuɓɓuka, matakan da tsarin da ke cikin ciki, ba abin mamaki ba ne cewa ma'auni na masu nazarin halittu tare da yuwuwar fassarar yana da yawa. Musamman ma, lokacin da aka yi la'akari da hulɗar tsakanin alamomi, yana yiwuwa ba zai yuwu yin nazarin alamun halittu guda ɗaya a ware ba zai haifar da sakamako mai amfani don inganta aikin asibiti. Schmidt et al26 ya ba da shawarar yin amfani da sassan biomarker kuma, daga baya, Brand et al27 ya zayyana wani daftarin kwamiti wanda ya dogara da bayanan asibiti na farko da na farko ga MDD, yana gano maƙasudin 16 mai ƙarfi, kowane ɗayansu da wuya alama ɗaya ce. Sun ƙunshi rage girman ƙwayar launin toka (a cikin hippocampal, prefrontal cortex da basal ganglia yankuna), canje-canje na sake zagayowar circadian, hypercortisolism da sauran wakilcin hypothalamic pituitary adrenal (HPA) axis hyperactivation, thyroid dysfunction, rage dopamine, noradrenaline ko 5-hydroxyindoleacetic acidic acid. , ƙãra glutamate, ƙara superoxide dismutase da lipid peroxidation, attenuated cyclic adenosine 3?,5?-monophosphate da mitogen-activated protein kinase hanya hanya, ƙara proinflammatory cytokines, gyare-gyare ga tryptophan, kynurenine, insulin da takamaiman kwayoyin polymorphisms. Waɗannan alamomin ba a yarda da su ta hanyar yarjejeniya ba kuma ana iya auna su ta hanyoyi daban-daban; a bayyane yake cewa aikin mai da hankali da tsari dole ne ya magance wannan babban aiki don tabbatar da fa'idodin su na asibiti.
Manufar wannan Bita
A matsayin bita mai faɗi da gangan, wannan labarin yana neman tantance buƙatun gabaɗayan bincike na biomarker a cikin ɓacin rai da kuma iyakar abin da masu nazarin halittu ke riƙe da ƙarfin fassarar gaske don haɓaka martani ga jiyya. Za mu fara da tattauna mafi mahimmanci kuma mafi ban sha'awa sakamakon a cikin wannan filin kuma mu jagoranci mai karatu zuwa ƙarin takamaiman bita da suka shafi alamomi da kwatance. Mun zayyana ƙalubalen da ake fuskanta a halin yanzu dangane da shaidar, tare da buƙatun rage nauyin baƙin ciki. A ƙarshe, muna sa ido ga mahimman hanyoyin bincike don saduwa da ƙalubalen da ke faruwa a yanzu da abubuwan da suka shafi aikin asibiti.
Fahimtar Kwanan nan
Binciken masu amfani da kwayoyin halitta na asibiti ga mutanen da ke da damuwa ya haifar da bincike mai zurfi a cikin rabin karni na karshe. An yi amfani da jiyya da aka fi amfani da su daga ka'idar monoamine na ciki; daga baya, neuroendocrine hypotheses sami yawa da hankali. A cikin 'yan shekarun nan, binciken da ya fi dacewa ya kewaye ra'ayi mai kumburi na ciki. Koyaya, babban adadin abubuwan bita masu dacewa sun mayar da hankali kan duk tsarin guda biyar; duba Tebu 1 da ƙasa don tarin bayanai na baya-bayan nan a cikin tsarin biomarker. Yayin da aka auna a matakan da yawa, an yi nazarin sunadaran da aka samo daga jini da yawa kuma suna samar da tushen kwayoyin halitta wanda ya dace, mai tsada kuma yana iya zama kusa da yiwuwar fassarar fiye da sauran tushe; don haka, an ba da ƙarin dalla-dalla ga masu siyar da kwayoyin halitta da ke yawo cikin jini.
A cikin bita na tsari na kwanan nan, Jani et al20 sun yi nazarin abubuwan da ke tushen jini don baƙin ciki a cikin haɗin gwiwa tare da sakamakon jiyya. Daga cikin binciken 14 kawai da aka haɗa (an bincika har zuwa farkon 2013), an yi nazarin masu nazarin halittu na 36 waɗanda 12 sun kasance masu tsinkaya mahimmancin alamun amsawar tunani ko ta jiki a cikin aƙalla bincike ɗaya. Wadanda aka gano a matsayin yiwuwar wakiltar abubuwan haɗari don rashin amsawa sun haɗa da sunadaran masu kumburi: ƙananan interleukin (IL) -12p70, rabo na lymphocyte zuwa ƙididdigar monocyte; alamomin neuroendocrine (dexamethasone rashin ragewa na cortisol, babban cortisol mai yawo, rage yawan hormone mai motsa jiki); alamun neurotransmitter (ƙananan serotonin da noradrenaline); na rayuwa (ƙananan babban adadin lipoprotein cholesterol) da abubuwan neurotrophic (rage S100 mai ɗaure furotin B). Bugu da ƙari ga wannan, wasu sake dubawa sun ba da rahoto game da ƙungiyoyi tsakanin ƙarin masu nazarin halittu da sakamakon jiyya.19,28�30 An taƙaita taƙaitaccen bayanin alamomin sakawa a cikin kowane tsarin a cikin sassan da ke gaba kuma a cikin Table 2.
Abubuwan da aka gano masu kumburi a cikin Bacin rai
Tun lokacin da Smith's seminal takarda da ke bayyana ma'anar macrophage, 31 wannan wallafe-wallafen da aka kafa ya samo matakan da yawa na alamomin proinflammatory daban-daban a cikin marasa lafiya masu tawayar, waɗanda aka yi nazari sosai. kula da jama’a.32�37
IL-6 (P <0.001 a cikin duk meta-analyses; 31 binciken da aka haɗa) da kuma CRP (P <0.001; 20 nazarin) ya bayyana akai-akai kuma an dogara da shi a cikin ciki. (P <40), 0.001 amma babban nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'i ya sanya wannan ba shi da mahimmanci lokacin da aka yi la'akari da binciken da aka yi kwanan nan (nazarin 38).31 IL-40? Har ila yau yana da alaƙa da rashin daidaituwa tare da ciki, tare da nazarin meta-bincike da ke nuna matakan girma a cikin ciki (P=1),0.03 matakan girma kawai a cikin nazarin Turai41 ko babu bambanci daga sarrafawa. 42?,40 yana goyan bayan wani tasiri mai mahimmanci na haɓakar IL-1? ribonucleic acid yana tsinkayar rashin amsawa ga masu rage damuwa; 44 wasu binciken da ke sama sun shafi cytokines da aka samo daga jini. Chemokine monocyte chemoattractant protein-1 ya nuna haɓakawa a cikin mahalarta masu rauni a cikin meta-bincike guda ɗaya. matakin meta-analytic, amma duk da haka sun nuna yuwuwar dangane da canzawa tare da jiyya: IL-45 an ba da rahoton haɓakawa a cikin waɗanda ke da matsanancin baƙin ciki mai yiwuwa kuma a gefe, 1 nau'ikan canji daban-daban na IL-39 da interferon gamma yayin jiyya. sun faru tsakanin masu amsawa na farko da masu ba da amsa, 2 yayin da IL-4 da IL-8 sun ragu a cikin layi tare da alamar cututtuka. 10 da CRP.8 Bugu da ƙari, TNF? na iya ragewa kawai tare da jiyya a cikin masu amsawa, kuma ma'auni mai alamar alama na iya nuna ƙarar kumburi a cikin marasa lafiya waɗanda ba su amsa magani ba. . Don haka, aƙalla wasu sauye-sauye masu kumburi a lokacin jiyya ana iya danganta su ga antidepressants. Ba a riga an kafa madaidaicin tasirin kumburi na antidepressants daban-daban ba, amma shaidar ta amfani da matakan CRP na nuna mutane suna amsa daban-daban ga takamaiman jiyya dangane da kumburi na asali: Harley et al46 sun ba da rahoton haɓakar pretreatment CRP yana annabta mummunan martani ga ilimin halayyar ɗan adam (fahimi �halaye ko tsaka-tsaki). psychotherapy), amma kyakkyawar amsa ga nortriptyline ko fluoxetine; Uher et al10 sun kwafi wannan binciken don nortriptyline kuma sun gano kishiyar tasirin escitalopram. Ya bambanta, Chang et al47 sun sami CRP mafi girma a farkon masu amsawa zuwa fluoxetine ko venlafaxine fiye da masu ba da amsa. Bugu da ƙari kuma, marasa lafiya tare da TRD da babban CRP sun amsa mafi kyau ga TNF? antagonist infliximab fiye da waɗanda ke da matakan da ke cikin kewayon al'ada.4
Tare, shaidun sun nuna cewa ko da lokacin da ake sarrafa abubuwa irin su ma'auni na jiki (BMI) da shekaru, amsawar ƙwayar cuta ta bayyana a cikin kusan kashi ɗaya bisa uku na marasa lafiya da ciki. akwai alamomin halittu masu yawa da ke wakiltar bangarori daban-daban na wannan tsarin. Kwanan nan, ƙarin sabon cytokines da chemokines sun ba da shaida na rashin daidaituwa a cikin ciki. Waɗannan sun haɗa da: furotin inhibitory macrophage 55,56a, IL-1a, IL-1, IL-7p12, IL-70, IL-13, eotaxin, granulocyte macrophage colony-stimulating factor,15 IL-57 IL-5,58 IL- 16,59 monocyte chemoattractant protein-17,60 thymus da kunnawa-kayyade chemokine,4,61 eotaxin-62, TNFb,3 interferon gamma-induced protein 63 serum amyloid A,10,64 mai narkewa cikin intracellular adhesion molecule65 da adhesioncule sel sel adhesion.
Abubuwan Ci gaban Ci Gaba a cikin Bacin rai
Dangane da yuwuwar mahimmancin abubuwan haɓakar cututtukan da ba na neurotrophic ba (kamar waɗanda ke da alaƙa da angiogenesis), muna magana ne akan ma'anar halittun neurogenic a ƙarƙashin ma'anar abubuwan haɓaka.
Factor neurotrophic-wanda aka samu na ƙwaƙwalwa (BDNF) shine mafi yawan binciken waɗannan. Matsakaicin meta-bincike yana nuna raguwar furotin BDNF a cikin jini, wanda ya bayyana yana ƙaruwa tare da maganin antidepressant. ƙara yawan matakan wannan furotin ko da idan babu remission na asibiti .68 proBDNF ba a yi nazari sosai ba fiye da nau'i mai girma na BDNF, amma biyun sun bayyana sun bambanta da aiki (dangane da tasirin su akan masu karɓar tyrosine receptor kinase B) da kuma kwanan nan. shaidu sun nuna cewa yayin da BDNF mai girma za a iya ragewa a cikin ciki, proBDNF na iya karuwa. mafi yawan raguwa a cikin marasa lafiya da ke da matsanancin damuwa.71 An ba da rahoton irin wannan binciken a cikin nazarin meta-nau'i na glial cell.abin da ake samu a layi na neurotrophic.70
Matsakaicin ci gaban endothelial na jijiyoyi (VEGF) yana da muhimmiyar rawa wajen inganta angiogenesis da neurogenesis tare da sauran membobin dangin VEGF (misali, VEGF-C, VEGF-D) kuma yana da alƙawarin yin baƙin ciki. kwanan nan an nuna girman VEGF a cikin jini na marasa lafiya marasa lafiya idan aka kwatanta da sarrafawa (a cikin binciken 75; P<16) .0.001 Duk da haka, an gano ƙananan VEGF a cikin TRD76,77 kuma matakan da suka fi girma sun annabta rashin amsawa ga maganin antidepressant.78 Ba a fahimta ba. dalilin da yasa matakan furotin VEGF za a haɓaka, amma yana iya kasancewa wani ɓangare na aikin haɓakawa da / ko karuwa a cikin shingen shinge na jini a cikin jihohin da ke fama da damuwa wanda ke haifar da raguwar magana a cikin ruwan cerebrospinal.79 Alakar da ke tsakanin VEGF da amsa magani ba ta da tabbas. ; wani binciken da aka yi a baya-bayan nan bai sami dangantaka tsakanin ko dai maganin VEGF ko BDNF tare da amsawa ko rashin tausayi ba, duk da raguwa tare da maganin antidepressant.80 Insulin-like girma factor-81 wani ƙarin factor ne tare da ayyukan neurogenic wanda zai iya karuwa a cikin ciki, yana nuna rashin daidaituwa a ciki. Hanyoyin neurotrophic.1 Basic fibroblast girma factor (ko FGF-82,83) shi ne memba na fibroblast girma factor iyali kuma ya bayyana mafi girma a cikin tawayar fiye da iko kungiyoyin.2 Duk da haka, rahotanni ba daidai ba; wanda ya gano cewa wannan furotin ya kasance ƙasa a cikin MDD fiye da kulawar lafiya, amma an rage gaba tare da maganin damuwa.84
Ƙarin abubuwan haɓaka waɗanda ba a bincika su sosai a cikin ciki sun haɗa da tyrosine kinase 2 da fms-kamar tyrosine kinase-1 (wanda ake kira sVEGFR-1) wanda ke aiki tare da VEGF, da masu karɓar tyrosine kinase (wanda ke ɗaure BDNF) na iya ragewa. a cikin ɓacin rai.86 Fa'idodin girma na Placental shima wani ɓangare ne na dangin VEGF, amma ba a yi nazarinsa ba a cikin samfurori masu tawayar hankali ga iliminmu.
Neman Metabolic Biomarker a cikin Bacin rai
Babban abubuwan da ke tattare da cututtukan rayuwa sun haɗa da leptin, adiponectin, ghrelin, triglycerides, high-density lipoprotein (HDL), glucose, insulin da albumin.87 An sake nazarin ƙungiyoyin da ke tsakanin yawancin waɗannan da damuwa: leptin88 da ghrelin89 sun bayyana ƙasa a cikin ciki. fiye da sarrafawa a cikin kewaye kuma yana iya karuwa tare da maganin rage damuwa ko gafara. Ana iya ƙara juriya na insulin a cikin baƙin ciki, ko da kaɗan. hyperglycemia90 da hypoalbuminemia91 a cikin ciki an ba da rahoton a cikin bita.
Binciken gabaɗayan jihohin rayuwa na rayuwa yana ƙara zama akai-akai ta amfani da sassan metabolomics na ƙananan ƙwayoyin cuta tare da begen samun ingantaccen sa hannun sinadarai na ƙwayoyin cuta don cututtukan hauka. A cikin binciken baya-bayan nan ta hanyar yin amfani da ƙirar ƙira ta wucin gadi, saitin metabolites waɗanda ke kwatanta ƙarar siginar glucose-lipid ya kasance tsinkaya sosai game da ganowar MDD,94 yana goyan bayan binciken da ya gabata.95
Binciken Neurotransmitter a cikin Bacin rai
Yayin da kulawar da aka ba wa monoamines a cikin ɓacin rai ya haifar da ingantacciyar jiyya mai nasara, ba a gano ingantattun alamun neurotransmitter don inganta jiyya dangane da zaɓin maƙasudin monoamine na antidepressants. Ayyukan da aka yi kwanan nan zuwa ga mai karɓa na serotonin (5-hydroxytryptamine) 1A mai karɓa a matsayin mai yiwuwa mai mahimmanci ga duka ganewar asali da kuma tsinkaye na ciki, jiran sababbin kwayoyin halitta da fasaha na hoto.96 Akwai sababbin hanyoyin da za a iya magance 5-hydroxytryptamine; alal misali, ta yin amfani da tsarin jinkirin jinkirin 5-hydroxytryptophan.97 Ƙara yawan watsawa na dopamine yana hulɗa tare da sauran masu amfani da kwayoyin halitta don inganta sakamakon fahimta irin su yanke shawara da motsawa. a matsayin wani ɓangare na amsa damuwa mai alaƙa; Wannan na iya rage samar da 98-hydroxytryptamine ta hanyar ambaliya. Wani bita na baya-bayan nan ya fitar da wannan ka'idar kuma ya nuna cewa a cikin TRD, wannan za'a iya canzawa (kuma 5-HT ya sake dawowa) ta hanyar maganin multimodal da aka yi niyya ga yawancin neurotransmitters.5 Abin sha'awa, karuwa a cikin serotonin ba koyaushe yana faruwa tare tare da fa'idodin antidepressant na warkewa.99 Duk da wannan. , neurotransmitter metabolites irin su 100-methoxy-3-hydroxyphenylglycol, na noradrenaline, ko homovanillic acid, na dopamine, sau da yawa an samo su don karuwa tare da raguwa a cikin ciki tare da maganin antidepressant4 ko ƙananan matakan waɗannan metabolites suna hasashen mafi kyawun amsa ga Maganin SSRI.101,102
Neuroendocrine Nemo a cikin Bacin rai
Cortisol shine mafi yawan na kowa axis biomarker na HPA da aka yi nazari a cikin ciki. Reviews masu yawa sun mayar da hankali kan kimantawa daban-daban na ayyukan HPA; gabaɗaya, waɗannan suna ba da shawarar cewa baƙin ciki yana da alaƙa da hypercortisolemia kuma ana rage martanin farkawa na cortisol. a matsayin rashin tsoro.104,105 Bugu da ƙari kuma, musamman, haɓakar matakan cortisol na iya yin tsinkaya maras kyau ga mayar da martani ga tunanin mutum106 da antidepressant107. A tarihi, mafi kyawun alamar neuroendocrine na amsawar jiyya shine gwajin murkushewar dexamethasone, inda rashin jin daɗin cortisol bayan gudanarwar dexamethasone yana da alaƙa da ƙarancin yuwuwar gafara na gaba. Koyaya, wannan sabon abu ba a yi la'akari da isasshen ƙarfi don aikace-aikacen asibiti ba. Alamun da ke da alaƙa da corticotrophin-releasing hormone da adrenocorticotropin hormone da kuma vasopressin an samo su ba tare da daidaituwa ba a cikin damuwa kuma an gano dehydroepiandrosterone da za a rage; Ana iya haɓaka rabon cortisol zuwa dehydroepiandrosterone a matsayin alamar kwanciyar hankali a cikin TRD, dagewa bayan gafara.108 Neuroendocrine dysfunctions na hormone dysfunctions sun dade suna hade da ciki, kuma hypothyroidism na iya taka rawa a cikin yanayin damuwa.109 Bugu da ƙari kuma, thyroid martani zai iya. daidaita tare da samun nasarar maganin bacin rai.110
A cikin abin da ke sama, yana da mahimmanci kuma muyi la'akari da hanyoyin sigina a fadin tsarin, irin su glycogen synthase kinase-3, protein kinase mai kunna mitogen da cyclic adenosine 3?,5?-monophosphate, wanda ke cikin synaptic plasticity112 kuma an gyara shi ta hanyar antidepressants.113 Bugu da ƙari. Ana iya auna ƙwararrun ƴan takarar masu alamar halittu waɗanda ke kan tsarin ilimin halitta musamman ta amfani da neuroimaging ko kwayoyin halitta. Dangane da rashin bambance-bambance masu ƙarfi da ma'ana na genomic tsakanin mutane masu tawayar rai da waɗanda ba su da bakin ciki, 114 sabbin hanyoyin kwayoyin halitta kamar su polygenic scores115 ko telomere length116,117 na iya tabbatar da ƙarin amfani. Ƙarin alamomin halittu da ke samun shahara suna nazarin zagayowar circadian ko alamomin halittu na chronobiology ta amfani da tushe daban-daban. Ayyukan aiki na iya ba da ƙima na haƙiƙa game da ayyukan barci da farkawa da hutawa ta na'urar accelerometer, kuma na'urorin aiki na iya ƙara auna ƙarin abubuwa kamar fallasa haske. Wannan na iya zama mafi amfani don ganowa fiye da yadda aka saba amfani da rahotanni na ainihi na marasa lafiya kuma zai iya ba da labari game da amsawar jiyya.118 Tambayar abin da masu nazarin halittu suka fi dacewa don amfani da fassarar ita ce kalubale, wanda aka fadada a ƙasa.
Matsaloli na yau
Ga kowane ɗayan waɗannan tsarin neurobiological guda biyar da aka bita, shaidar tana biye da irin wannan labari: akwai alamomin halittu da yawa waɗanda ke da alaƙa da wasu fannoni tare da baƙin ciki. Waɗannan alamomin suna yawan alaƙa da juna a cikin hadadden tsari, mai wuyar ƙira. Shaidar ba ta dace ba, kuma yana iya yiwuwa wasu su ne epiphenomena na wasu dalilai kuma wasu suna da mahimmanci a cikin ƙananan marasa lafiya kawai. Mai yiyuwa ne masu amfani da kwayoyin halitta su kasance masu amfani ta hanyoyi daban-daban (misali, waɗanda ke yin hasashen martani na gaba ga jiyya, waɗanda ke nuna ƙayyadaddun jiyya kamar yadda ake iya yin tasiri ko waɗanda ke canzawa tare da tsoma baki ba tare da la’akari da haɓakar asibiti ba). Ana buƙatar hanyoyin sabbin abubuwa don haɓaka daidaito da kuma aiki na asibiti na kimar halittu a cikin yawan masu tabin hankali.
Canjin biomarker
Bambance-bambancen alamomin halittu na tsawon lokaci da cikin yanayi sun shafi wasu nau'ikan (misali, proteomics) fiye da wasu (genomics). Madaidaitan ƙa'idodi don da yawa ba su wanzu ko kuma ba a yarda da su ba. Lallai, tasirin abubuwan muhalli akan alamomi akai-akai ya dogara ne akan abun da ke tattare da kwayoyin halitta da sauran bambance-bambancen ilimin lissafi tsakanin mutane wadanda ba za a iya lissafta su duka ba. Wannan yana sa kimanta ayyukan biomarker, da gano abubuwan da ba su dace ba, da wahalar fassarawa. Saboda adadin masu iya gano kwayoyin halitta, da yawa ba a auna su ba ko a cikin cikakken panel tare da sauran alamomi masu dacewa.
An ba da rahoton abubuwa da yawa don canza matakan furotin a cikin tsarin nazarin halittu a cikin marasa lafiya da ke da cututtuka masu tasiri. Tare da abubuwan da suka danganci bincike kamar tsawon lokaci da yanayin ajiya (wanda zai iya haifar da lalacewa na wasu mahadi), waɗannan sun haɗa da lokacin da aka auna rana, kabilanci, motsa jiki, abinci na 119 (misali, aikin microbiome, musamman ma idan yawancin nazarin halittu na jini ya yi. ba ya buƙatar samfurin azumi), 120 shan taba da amfani da abubuwa, 121 da kuma abubuwan kiwon lafiya (irin su ciwon kumburi, zuciya da jijiyoyin jini ko wasu cututtuka na jiki). Misali, ko da yake ana samun karuwar kumburi a cikin masu tawayar zuciya amma in ba haka ba mutane masu lafiya idan aka kwatanta da kungiyoyin da ba su damu ba, masu tawayar wadanda kuma ke da cututtukan da ke da alaka da garkuwar jiki akai-akai suna da ma fi girma matakan cytokines fiye da ko dai wadanda ba su da ciki ko rashin lafiya.122 Wasu manyan dalilai tare da yiwuwar shiga cikin alakar da ke tsakanin masu nazarin halittu, damuwa da amsawar jiyya an tsara su a ƙasa.
Danniya. Dukansu amsawar endocrine da na rigakafi suna da sanannun rawar da ake takawa wajen mayar da martani ga danniya (physiologic ko na tunani), kuma danniya na wucin gadi a lokacin tarin samfuran halittu ba a cika auna shi ba a cikin binciken bincike duk da bambancin wannan lamari tsakanin mutane wanda zai iya ƙarfafawa ta halin yanzu. bayyanar cututtuka na depressive. Dukansu mawuyacin halin da ake ciki da kuma na yau da kullum suna aiki a matsayin kalubale na rigakafi, suna ƙarfafa amsawar ƙwayar cuta a cikin gajeren lokaci da tsawo. wani babba .123,124 A lokacin ƙuruciyar ƙuruciyar ƙuruciyar yara, an kuma ba da rahoton ƙumburi mai tsanani kawai a cikin yara waɗanda ke fama da damuwa a halin yanzu.125,126 Akasin haka, mutanen da ke fama da rashin tausayi da tarihin raunin yara na iya ɓatar da amsawar cortisol ga danniya, idan aka kwatanta da wadanda ke da damuwa da damuwa. ba a farkon rayuwa ba.127 Canje-canjen da ke haifar da damuwa na HPA axis sun bayyana alaƙa tare da aikin fahimi,128 da kuma nau'in damuwa ko bambancin jinsin da ke da alaka da HPA. Hanyoyi.129 Ba a fayyace daidai yadda raunin yara ke shafar alamomin halitta a cikin balagagge ba s, amma yana yiwuwa danniya na farkon rayuwa ya sa wasu mutane su jure halayen damuwa a lokacin girma waɗanda aka haɓaka ta hankali da/ko ta ilimin halitta.
Ayyukan fahimi. Rashin ta'addanci yana faruwa akai-akai a cikin mutanen da ke da rikitarwa MDD.133 neurobiolically juriya, da neurotrophic tsarin a wannan dangantakar. Neurotransmitters noradrenaline da dopamine mai yiwuwa suna da mahimmanci ga matakai masu hankali kamar ilmantarwa da ƙwaƙwalwar ajiya.134 An haɗu da amsawar haɓakar haɓakar haɓakawa tare da raguwar fahimi, kuma mai yiwuwa ya shafi aikin fahimi a cikin ɓangarori masu ɓarna, 129 kuma a cikin gafara, ta hanyar hanyoyi daban-daban.135 Lalle ne, Krogh et al136 ya ba da shawarar cewa CRP yana da alaƙa da alaƙa da fahimi fiye da ainihin alamun rashin ciki.
Shekaru, jinsi da BMI. Rashi ko kasancewar, da jagorancin bambance-bambancen ilimin halitta tsakanin maza da mata ya kasance mai bambanta musamman a cikin shaida har yau. Bambancin hormone Neuroendocrine tsakanin maza da mata suna hulɗa tare da rashin tausayi na ciki.140 Binciken nazarin ƙumburi ya ruwaito cewa kula da shekaru da jinsi ba su shafi bambance-bambancen kulawa da haƙuri a cikin cytokines masu kumburi ba (ko da yake ƙungiyar tsakanin IL-6 da damuwa sun ragu yayin da shekaru suka karu, wanda ya dace da ka'idodin cewa kumburi gabaɗaya yana ƙaruwa tare da shekaru) 41,141 VEGF bambance-bambance tsakanin marasa lafiya da sarrafawa sun fi girma a cikin binciken da ke tantance ƙananan samfurori, yayin da jinsi, BMI da abubuwan asibiti ba su shafi waɗannan kwatancen a matakin meta-analytic.77 Duk da haka, rashin daidaitawa ga BMI a cikin gwaje-gwajen da suka gabata na kumburi da ɓacin rai ya bayyana yana damun bambance-bambance masu mahimmanci da aka ruwaito a tsakanin waɗannan kungiyoyi.41 An nuna ƙaddamar da ƙwayar adipose mai mahimmanci don ƙarfafa samar da cytokine da kuma kasancewa mai dangantaka da alamar cututtuka.142 Saboda magungunan psychotropic. ana iya danganta shi da wei ght riba da BMI mafi girma, kuma waɗannan an haɗa su da juriya na jiyya a cikin damuwa, wannan yanki ne mai mahimmanci don bincika.
Magunguna. Yawancin nazarin halittu masu rai a cikin ciki (duka na giciye da kuma na tsaye) sun tattara samfurori na asali a cikin mahalarta marasa magani don rage nau'in nau'i. Koyaya, yawancin waɗannan ƙididdiga ana ɗaukar su bayan lokacin wankewa daga magani, wanda ke barin babban abin da zai iya ruɗewa na saura canje-canje a cikin ilimin lissafi, wanda ya tsananta da yawancin jiyya da ake samu waɗanda wataƙila sun sami tasiri daban-daban akan kumburi. Wasu nazarin sun cire psychotropic, amma ba sauran amfani da magani ba: musamman, ana ba da izinin maganin maganin maganin maganin maganin maganin maganin maganin maganin maganin maganin maganin maganin maganin maganin maganin maganin maganin maganin maganin maganin maganin maganin maganin maganin maganin maganin maganin maganin maganin maganin maganin maganin maganin maganin maganin maganin maganin maganin rigakafi. magunguna suna da tasiri akan amsawar kumburi, 143,144�34,43,49,145 HPA-axis,147 neurotransmitter,108 da neurotrophic148 aiki. Koyaya, yawancin yuwuwar jiyya don ɓacin rai suna da kaddarorin magunguna daban-daban kuma masu rikitarwa, suna ba da shawarar cewa za'a iya samun takamaiman tasirin ilimin halitta na zaɓuɓɓukan jiyya daban-daban, waɗanda bayanan yanzu ke goyan bayan. An yi la'akari da cewa ban da tasirin monoamine, takamaiman magungunan maganin maganin serotonin (watau SSRIs) suna iya kaiwa ga canje-canje na Th149 a cikin kumburi, da kuma noradrenergic antidepressants (misali, SNRIs) tasiri a Th2 shift.1 Har yanzu bai yiwu ba. Ƙayyade tasirin magungunan mutum ko haɗin gwiwa akan masu alamar halitta. Wadannan suna iya yin sulhu ta hanyar wasu dalilai ciki har da tsawon jiyya ('yan gwaje-gwaje sun tantance amfani da magani na dogon lokaci), samfurin nau'i na nau'i da kuma rashin ƙaddamar da mahalarta ta hanyar mayar da martani ga jiyya.
Bambance-bambance
Hanyar hanya. Kamar yadda aka ambata a sama, bambance-bambance (tsakanin da tsakanin karatu) dangane da abin da jiyya (da haɗuwa) mahalarta ke ɗauka kuma sun ɗauka a baya an ɗaure su gabatar da nau'i-nau'i a cikin binciken bincike, musamman a cikin binciken biomarker. Baya ga wannan, yawancin ƙirar ƙira da samfuran samfuri sun bambanta a cikin karatun, don haka yana ƙara wahala tare da fassara da ba da sakamakon binciken. Waɗannan sun haɗa da ma'aunin ma'aunin halitta (misali, kits na tantancewa) da hanyoyin tattarawa, adanawa, sarrafawa da kuma nazarin alamomi a cikin ɓacin rai. Hiles et al141 yayi nazarin wasu hanyoyin rashin daidaituwa a cikin wallafe-wallafen akan kumburi kuma sun gano cewa daidaiton ganewar asali na ciki, BMI da cututtukan cututtuka sun kasance mafi mahimmanci don yin la'akari da ƙumburi na gefe tsakanin ƙungiyoyi masu tawayarwa da marasa tausayi.
Na asibiti. Bambance-bambancen bambancin al'ummomin da ke cikin baƙin ciki an rubuta su sosai151 kuma yana da mahimmanci mai ba da gudummawa ga bambance-bambancen binciken a cikin wallafe-wallafen bincike. Mai yiyuwa ne cewa ko da a cikin bincike-bincike, ƙayyadaddun bayanan ilimin halitta marasa al'ada sun keɓe ga ƙungiyoyin mutane waɗanda ƙila ba za su tsaya a kan lokaci ba. Ƙungiyoyin haɗin gwiwa na mutanen da ke fama da baƙin ciki za a iya gano su ta hanyar haɗin kai da abubuwan halitta. A ƙasa, mun zayyana yuwuwar binciko ƙungiyoyin ƙasa don saduwa da ƙalubalen da bambance-bambancen biomarker da iri-iri ke haifarwa.
Subtypes a cikin Bacin rai
Ya zuwa yanzu, babu wasu ƙungiyoyi masu kama da juna a cikin ɓangarori na ɓarna ko rashin lafiya da suka iya dogara da gaske don bambance tsakanin marasa lafiya bisa ga bayyanar cututtuka ko amsawar jiyya.152 Kasancewar rukunin rukuni wanda abubuwan da ke tattare da ilimin halitta sun fi bayyanawa zai taimaka wajen bayyana bambancin dake tsakanin binciken da ya gabata da kuma zai iya karkatar da hanyar zuwa ga madaidaicin magani. Kungi et Al153 ya gabatar da saitin subtypes hudu dangane da tsarin da suka dace da manchicypical, wadanda ke da karfin da suka shafi melanchial, wadanda ke da karfi da ke da alaƙa da marasa lafiyar da zasu iya gabatar da musamman tare da anhedonia (kuma zai iya ba da amsa da kyau, misali, aripiprazole) da wani nau'in kumburi wanda ke da haɓakar kumburi. Yawancin labaran da ke mayar da hankali kan kumburi sun ƙayyade yanayin wanzuwar wani nau'i mai kumburi a cikin ciki.55,56,154,155 Abubuwan da suka dace na asibiti mai girma har yanzu ba a tantance ba kuma an yi yunƙurin kai tsaye don gano ko wane mahalarta zasu iya haɗa da wannan ƙungiya. An ba da shawarar cewa mutanen da ke fama da rashin tausayi na iya samun matakan kumburi fiye da nau'in melancholic, 156 wanda watakila ba ya dace da binciken game da axis na HPA a cikin melancholic da atypical subtypes na ciki. TRD37 ko ɓacin rai tare da manyan alamun somatic157 kuma an nuna su azaman mai yuwuwar ƙwayar cuta, amma neurovegetative (barci, ci, asarar libido), yanayi (ciki har da ƙarancin yanayi, suicidality da irritability) da alamun fahimi (ciki har da raɗaɗi da laifi) 158 duka. bayyana masu alaƙa da bayanan halitta. Ƙarin ƙwararrun 'yan takara don ƙananan nau'in kumburi sun haɗa da ƙwarewar halayen rashin lafiya-kamar bayyanar cututtuka159,160 ko ciwo na rayuwa.158
Ƙaunar zuwa (hypo) mania na iya bambanta ilimin halitta tsakanin marasa lafiya da ke fama da damuwa. Shaidu yanzu sun nuna cewa cututtuka na bipolar rukuni ne masu yawa na rikice-rikice na yanayi, tare da cututtukan cututtuka na subsyndromal da aka samu fiye da yadda aka gane a baya. matsakaicin lokaci don gyara ganewar asali akai-akai fiye da shekaru goma161 kuma wannan jinkiri yana haifar da tsanani da tsadar rashin lafiya. Abubuwan da za su iya bambanta tsakanin unipolar da ciwon ciki na biyu yana da tasiri mai mahimmanci.162 Ƙirar ƙwayar cuta mai yiwuwa ba a gano su ba a wasu binciken binciken biomarker na MDD na baya, kuma smatterings na shaida sun nuna bambanci na aikin axis na HPA163 ko kumburi164 tsakanin bipolar da unipolar depr. esion. Koyaya, waɗannan kwatancen ba su da yawa, suna da ƙananan nau'ikan samfura, gano abubuwan da ba su da mahimmanci ko yawan waɗanda aka ɗauka waɗanda ba su da siffa ta asali. Waɗannan binciken kuma ba sa yin nazarin rawar amsawar jiyya a cikin waɗannan alaƙa.
Dukansu cututtukan guda biyu167 da juriya na jiyya168 ba ginshiƙai ba ne kuma suna kwance akan ci gaba, wanda ke ƙara ƙalubalantar gano nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in iri. Baya ga subtyping, yana da kyau a lura cewa yawancin abubuwan da suka shafi ilimin halitta da aka gani a cikin baƙin ciki ana samun su a cikin marasa lafiya tare da wasu cututtukan. Don haka, gwaje-gwajen transdiagnostic suma suna da mahimmanci.
Kalubalen Auna Halitta
Zaɓin biomarker. Yawancin masu amfani da kwayoyin halitta masu amfani suna ba da ƙalubale ga ilimin halin dan Adam wajen tantance waɗanne alamomin da aka haɗa ta wace hanya kuma ga wane. Don haɓaka ƙalubalen, kaɗan daga cikin waɗannan alamomin halittu sun sami isasshen bincike a cikin baƙin ciki, kuma ga mafi yawan, ba a fahimci ainihin matsayinsu a cikin ƙoshin lafiya da yawan jama'a na asibiti ba. Duk da wannan, an yi ƙoƙari da yawa don ba da shawarar fa'idodi masu alamar halitta. Bugu da ƙari ga Brand et al 16 na alamomi tare da ƙarfin ƙarfi, 27 Lopresti et al yana ba da ƙarin ƙarin saiti na alamomin damuwa na oxidative tare da yuwuwar inganta amsawar jiyya. tsarin ilimin halitta (BDNF, cortisol, mai narkewa TNF? nau'in mai karɓa na II, alpha28 antitrypsin, apolipoprotein CIII, haɓakar girma na epidermal, myeloperoxidase, prolactin da resistin) a cikin inganci da samfurori tare da MDD. Da zarar an haɗa su, ma'auni mai mahimmanci na waɗannan matakan ya iya bambanta tsakanin MDD da ƙungiyoyi masu kulawa tare da 1% ~ 80% daidai.90 Muna ba da shawara cewa ko da waɗannan ba su shafi duk masu neman takara a wannan filin ba; duba Tebu 169 don ƙayyadaddun ƙayyadaddun ƙididdiga na masu binciken halittu tare da yuwuwar ɓacin rai, wanda ya ƙunshi duka waɗanda ke da tushe mai tushe da alamar alamar labari.
Technology. Saboda ci gaban fasaha, yanzu yana yiwuwa (hakika, dacewa) don auna ɗimbin ɗimbin samfuran halittu lokaci guda a farashi mai arha kuma tare da hankali fiye da yadda aka saba a baya. A halin yanzu, wannan damar don auna ma'auni masu yawa yana gaba da ikonmu na yin nazari da fassara yadda ya kamata, 170 wani abu da zai ci gaba da haɓakawa a cikin tsararrun kwayoyin halitta da sababbin alamomi irin su metabolomics. Wannan ya samo asali ne saboda rashin fahimta game da madaidaicin matsayin da kuma alaƙar da ke tsakanin alamomi, da rashin fahimtar yadda alamomin da ke da alaƙa ke haɗuwa a cikin matakan ilimin halitta daban-daban (misali, kwayoyin halitta, rubutun, furotin) a ciki da tsakanin daidaikun mutane. Manyan bayanai ta amfani da sabbin hanyoyin nazari da ka'idoji za su taimaka wajen magance wannan, kuma ana ba da shawarar sabbin hanyoyin; misali ɗaya shine haɓaka tsarin ƙididdiga wanda aka kafa a cikin bincike na tushen juzu'i don gano sabbin alamomin rayuwa masu yuwuwa dangane da halayensu tsakanin cibiyoyin sadarwa da haɗa maganganun kwayoyin halitta tare da bayanan metabolite.171 An riga an yi amfani da dabarun koyan na'ura kuma za su taimaka tare da ƙira ta amfani da biomarker. bayanai don hasashen sakamakon jiyya a cikin nazari tare da manyan bayanai.172
Haɗa alamun halittu. Yin nazarin tsararrun na'urorin halitta a lokaci guda shine madadin bincika keɓaɓɓen alamomi waɗanda za su iya ba da madaidaicin ra'ayi a cikin hadadden gidan yanar gizo na tsarin ilimin halitta ko hanyoyin sadarwa.26 Har ila yau, don taimakawa tare da kawar da bambance-bambancen shaida a cikin wannan wallafe-wallafen har zuwa yau (musamman, inda cibiyoyin sadarwar biomarker). kuma ana fahimtar hulɗar da kyau), bayanan biomarker za'a iya haɗawa ko ƙididdige su. Kalubale ɗaya shine gano mafi kyawun hanyar gudanar da wannan, kuma yana iya buƙatar haɓakawa a cikin fasaha da/ko dabarun nazari na zamani (duba sashin �Babban bayanai�). A tarihi, ma'auni tsakanin nau'ikan nau'ikan halittu guda biyu sun haifar da bincike mai ban sha'awa.109,173 An yi yunƙuri kaɗan don tara bayanan biomarker akan sikelin da ya fi girma, kamar waɗanda ke amfani da mahimman abubuwan bincike na cibiyoyin sadarwa na cytokine na proinflammatory. an canza shi zuwa ma'auni mai girman tasiri guda ɗaya don kowane binciken, kuma gabaɗaya ya nuna ƙonawa sosai kafin maganin antidepressant, yana tsinkayar rashin amsawa na gaba a cikin karatun marasa lafiya. Haɗin bangarorin biomarder dukansu ne da dama don bincike na gaba don gano ingantattun abubuwan da ake buƙata, zaɓi wani ɓangare na heterogostas na yau da kullun (na zaɓi wani ɓangare na heterogostas na yau da kullun (na mai kumburi, mai kumburi, HPA axis da tsarin rayuwa) wanda aka nuna don bambanta tsakanin masu rauni da masu sarrafawa a cikin binciken da ya gabata kuma sun haɗa waɗannan a cikin haɗarin haɗari wanda ya bambanta a cikin samfurori masu zaman kansu guda biyu da ƙungiyar kulawa tare da> 174% hankali da ƙayyadaddun .43
Babban bayanai. Yin amfani da manyan bayanai mai yiwuwa ya zama dole don magance ƙalubalen da ke faruwa a halin yanzu da aka zayyana kewaye da bambancin halitta, bambancin halittu, gano mafi kyawun alamomi da kawo filin zuwa fassarar, bincike mai amfani a cikin ciki. Duk da haka, kamar yadda aka bayyana a sama, wannan yana kawo kalubale na fasaha da na kimiyya.175 Kwanan nan ne kimiyyar kiwon lafiya ta fara amfani da manyan nazarin bayanai, shekaru goma ko fiye da haka a fannin kasuwanci. Duk da haka, karatu irin su iSPOT-D152 da haɗin gwiwa irin su Ƙungiyar Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararru ta 176 ta fahimtar hanyoyin nazarin halittu a cikin ilimin halin kwakwalwa. Algorithms na ilmantarwa na na'ura sun kasance, a cikin ƙananan binciken, an fara amfani da su ga masu nazarin halittu don damuwa: binciken da aka yi kwanan nan ya tattara bayanai daga> mahalarta 5,000 na 250 biomarkers; bayan ƙididdige bayanai da yawa, an gudanar da haɓaka karatun na'ura, wanda ke nuna alamun 21 masu yiwuwa. Bayan ƙarin nazarin koma-baya, an zaɓi masu alamar halitta guda uku a matsayin masu alaƙa da ƙarfi tare da alamun damuwa (girman kwayar jinin jini mai saurin canzawa, glucose jini da matakan bilirubin). Marubutan sun kammala cewa za a iya amfani da manyan bayanai da kyau don samar da hasashe.177 Manyan ayyukan phenotyping na biomarker yanzu suna gudana kuma zasu taimaka wajen ci gaba da tafiya zuwa gaba na neurobiology na ciki.
Makasudin gaba
Ƙididdigar Ƙungiyar Ƙwararrun Halitta
Abubuwan da aka samo a cikin wallafe-wallafen har zuwa yau suna buƙatar maimaitawa a cikin manyan binciken. Wannan gaskiya ne musamman ga masu binciken halittu masu rai, irin su chemokine thymus da chemokine mai kunnawa da haɓakar haɓakar tyrosine kinase 2 wanda, ga iliminmu, ba a bincika ba a cikin ɓacin rai na asibiti da samfuran kulawa lafiya. Babban karatun bayanai dole ne a tantance cikakkun fa'idodin nazarin halittu kuma su yi amfani da ƙwararrun dabarun bincike don tabbatar da cikakkiyar alaƙa tsakanin alamomi da waɗancan abubuwan da ke gyara su a cikin jama'ar asibiti da marasa lafiya. Bugu da ƙari, babban fa'ida na babban binciken abubuwan da ke tattare da shi na iya kafa ƙungiyoyi masu alaƙar halittu kuma suna iya ba da sanarwar amfani da �composites� a cikin ilimin halin mahaukata, wanda zai iya haɓaka kamanni na binciken nan gaba.
Gano Nau'o'in Ƙirar Ƙarya
Game da zaɓin mai alamar halitta, ana iya buƙatar fanatoci da yawa don yuwuwar hanyoyi daban-daban waɗanda bincike zai iya haifarwa. Idan aka haɗu, shaidun na yanzu suna nuna cewa bayanan martaba na biomarker tabbas ne, amma ba a canza su ba a cikin yawan mutanen da ke fama da baƙin ciki a halin yanzu. Ana iya kafa wannan a cikin ko a cikin nau'ikan bincike, wanda zai haifar da rashin daidaituwa na binciken da za a iya gani a cikin wannan wallafe-wallafen. Ƙididdiga ƙungiyar ƙananan ƙungiyoyin halittu (ko ƙungiyoyin ƙasa) na iya samun sauƙin sauƙaƙe ta hanyar babban bincike na rukunonin cibiyoyin sadarwa na biomarker a cikin bakin ciki. Wannan zai nuna bambancin tsakanin yawan jama'a; Binciken aji na latent zai iya nuna halaye daban-daban na asibiti bisa, misali, kumburi.
Takamaiman Tasirin Magani akan Kumburi da Amsa
Dukkanin jiyya da aka saba wajabta don baƙin ciki yakamata a tantance su gabaɗaya don takamaiman tasirinsu na ilimin halitta, kuma yana lissafin tasirin gwajin jiyya. Wannan na iya ba da damar ginin gine-ginen da suka shafi masu alamar halitta da gabatarwar alamomi don hasashen sakamako zuwa nau'ikan jiyya na maganin damuwa a cikin salon da ya fi keɓanta, kuma yana iya yiwuwa a mahallin duka biyun unipolar da baƙin ciki na bipolar. Wannan yana yiwuwa ya zama da amfani ga sababbin hanyoyin jiyya da kuma jiyya da aka nuna a halin yanzu.
Ƙaddamar da Ƙaddamar da Amsar Jiyya
Yin amfani da dabarun da ke sama na iya haifar da ingantacciyar damar yin hasashen juriyar jiyya nan gaba. Ingantattun ingantattun matakan dagewa (misali, dogon lokaci) matakan amsa jiyya na iya ba da gudummawa ga wannan. Ƙididdigar wasu ingantattun matakan jin daɗin haƙuri (kamar ingancin rayuwa da aiki na yau da kullun) na iya ba da cikakkiyar ƙima game da sakamakon jiyya wanda zai iya haɗawa da kusanci da masu biomarkers. Yayin da aikin ilimin halitta kaɗai ba zai iya bambance masu amsa jiyya daga masu ba da amsa ba, ana iya haɗa ma'aunin ma'aunin halittu tare da ma'aunin yanayin zamantakewar al'umma ko na alƙaluma tare da bayanan mai ƙididdiga don haɓaka ƙirar tsinkaya na rashin isassun amsa magani. Idan an samar da ingantaccen samfuri don tsinkayar martani (ko dai don yawan baƙin ciki ko yawan jama'a) kuma an inganta shi a baya, ƙirar fassarar na iya kafa fa'idarsa a cikin babban gwaji mai sarrafawa.
Zuwa Dabarar Jiyya
A halin yanzu, marasa lafiya da ke da baƙin ciki ba a ba su umarni bisa tsari don karɓar ingantaccen shirin shiga tsakani. Idan an inganta shi, za a iya amfani da ƙayyadaddun ƙirar gwaji don gwada samfurin don hasashen rashin amsawa da/ko don tantance inda majiyyaci ke buƙatar tantancewa a cikin ƙirar kulawa. Wannan zai iya zama da amfani a cikin daidaitattun saitunan jiyya na dabi'a, a cikin nau'ikan sa baki daban-daban. Daga qarshe, za a iya samar da wani tsari na asibiti don samar wa daidaikun mutane magani mafi dacewa, don gane waɗanda ke da yuwuwar haɓaka baƙin ciki da ba da ingantaccen kulawa da kulawa ga waɗannan majiyyatan. Marasa lafiya da aka gano suna cikin haɗari don juriya na jiyya ana iya ba da izini ta hanyar ilimin halin ɗan adam da magunguna ko haɗin gwiwar magunguna. A matsayin misali na hasashe, mahalarta ba tare da haɓakar cytokine na proinflammatory ba za a iya nuna su don karɓar ilimin tunani maimakon ilimin likitanci, yayin da wani ɓangaren marasa lafiya da ke da kumburi musamman zai iya karɓar wakili mai kumburi a cikin haɓaka zuwa daidaitattun magani. Mai kama da ƙira, dabarun zaɓin jiyya na keɓaɓɓu na iya yiwuwa a nan gaba. Misali, wani mutum mai rauni na iya samun babban TNF mai girma? matakan, amma babu wani rashin daidaituwa na ilimin halitta, kuma zai iya amfana daga jiyya na gajeren lokaci tare da TNF? antagonist.54 Keɓaɓɓen jiyya na iya haifar da sa ido kan bayyanar cututtuka yayin jiyya don sanar da yiwuwar sauye-sauyen shiga tsakani, tsawon ci gaba da jiyya da ake buƙata ko don gano alamun koma baya.
Manufofin Magani Novel
Akwai adadi mai yawa na yuwuwar jiyya waɗanda za su iya yin tasiri ga baƙin ciki, waɗanda ba a tantance su sosai ba, gami da sabon labari ko sake fasalin sasanninta daga wasu fannonin likitanci. Wasu daga cikin mashahuran da aka fi sani da su sun kasance a cikin magungunan anti-inflammatory irin su celecoxib (da sauran masu hana cyclooxygenase-2), TNF? antagonists etanercept da infliximab, minocycline ko aspirin. Wadannan sun bayyana alamar 178 Antiglucocorticoid mahadi, ciki har da ketoconazole179 da kuma metyrapone, 180 an bincikar su don rashin tausayi, amma duka biyu suna da matsala tare da tasirin tasirin su kuma yiwuwar asibiti na metyrapone ba shi da tabbas. Mifepristone181 da corticosteroids fludrocortisone da spironolactone,182 da dexamethasone da hydrocortisone183 na iya zama tasiri wajen magance bakin ciki a cikin gajeren lokaci. Targeting glutamate N-methyl-d-aspartate antagonists antagonists, ciki har da ketamine, na iya wakiltar ingantattun jiyya a cikin ciki.184 Omega-3 polyunsaturated fatty acids rinjayar kumburi da aiki na rayuwa kuma ya bayyana ya nuna wasu tasiri ga ciki. suna da tasirin maganin bacin rai185 ta hanyar hanyoyin neurobiological masu dacewa.186
Ta wannan hanyar, an yi amfani da illolin biochemical na maganin rashin jin daɗi (duba sashin magani) don fa'idodin asibiti a wasu fannoni: musamman gastroenterological, neurologic da cututtukan cututtukan da ba na musamman ba. wadannan fa'idodin. Hakanan an ba da shawarar lithium don rage kumburi, mai mahimmanci ta hanyar hanyoyin glycogen synthase kinase-188 Mai da hankali kan waɗannan tasirin zai iya tabbatar da bayyani ga sa hannu na biomarker na ciki kuma, bi da bi, masu binciken halittu na iya wakiltar alamomin maye don haɓakar magunguna.
Dr. Alex Jimenez's Insight
Bacin rai cuta ce ta tabin hankali da ke tattare da mummunan alamu waɗanda ke shafar yanayi, gami da asarar sha'awar ayyuka. Binciken bincike na baya-bayan nan, duk da haka, ya gano cewa yana iya yiwuwa a iya gano bakin ciki ta amfani da fiye da kawai alamun halayen haƙuri. A cewar masu binciken, gano abubuwan da ake iya samu cikin sauƙi waɗanda za su iya gano bakin ciki daidai gwargwado yana da mahimmanci wajen inganta lafiyar majiyyaci da lafiyarsa gaba ɗaya. Alal misali, binciken asibiti ya nuna cewa mutanen da ke da babbar matsalar damuwa, ko MDD, suna da ƙananan matakan kwayoyin acetyl-L-carnitine, ko LAC, a cikin jininsu fiye da kulawar lafiya. Ƙarshe, kafa magungunan ƙwayoyin cuta don ɓacin rai na iya taimakawa mafi kyawun sanin wanda ke cikin haɗarin haɓaka cutar tare da taimakawa masu sana'a na kiwon lafiya su ƙayyade mafi kyawun zaɓi na jiyya ga mai haƙuri da bakin ciki.
Kammalawa
Littattafan sun nuna cewa kusan kashi biyu bisa uku na marasa lafiya da ke fama da baƙin ciki ba sa samun gafara ga jiyya na farko kuma cewa yiwuwar rashin amsawa yana ƙaruwa tare da adadin jiyya da aka gwada. Samar da hanyoyin kwantar da hankali marasa inganci yana da sakamako mai ma'ana ga mutum ɗaya da na al'umma, gami da ci gaba da damuwa da rashin jin daɗi, haɗarin kashe kansa, asarar haɓakawa da ɓarnatar albarkatun kula da lafiya. Littattafai masu yawa a cikin ɓacin rai suna nuna adadi mai yawa na biomarkers tare da yuwuwar inganta jiyya ga mutanen da ke fama da baƙin ciki. Bugu da ƙari ga alamomin neurotransmitter da alamomin neuroendocrine waɗanda ke ƙarƙashin binciken yaduwa tsawon shekarun da suka gabata, abubuwan da suka faru na baya-bayan nan suna nuna alamun kumburi (da tsarin rigakafi gabaɗaya), abubuwan haɓaka da haɓaka kamar yadda suke da mahimmanci a cikin baƙin ciki. Duk da haka, shaidun da suka wuce kima suna nuna cewa akwai ƙalubalen da ake buƙatar magance kafin a iya amfani da binciken biomarker don inganta gudanarwa da kula da mutanen da ke da damuwa. Saboda tsantsar sarkakkiyar tsarin ilimin halitta, gwaje-gwaje na lokaci guda na cikakken kewayon alamomi a cikin manyan samfura suna da fa'ida sosai wajen gano hulɗar tsakanin ilimin halitta da yanayin tunani a tsakanin mutane. Ƙirƙirar ma'auni na duka sigogin neurobiological da matakan asibiti na ciki yana iya sauƙaƙe fahimtar fahimta. Wannan bita kuma yana nuna mahimmancin nazarin abubuwan da za su iya gyaggyarawa (kamar rashin lafiya, shekaru, fahimta da magani) a cikin tattara madaidaicin fahimtar ilimin halitta na bakin ciki da hanyoyin juriya na jiyya. Wataƙila wasu alamomi za su nuna mafi yawan alƙawura don tsinkayar amsawar jiyya ko juriya ga takamaiman jiyya a cikin rukunin marasa lafiya, kuma ma'auni na lokaci guda na ilimin halittu da bayanan tunani na iya haɓaka ikon iya gano waɗanda ke cikin haɗari ga sakamakon rashin kulawa. Ƙaddamar da kwamitin nazarin halittu yana da tasiri don haɓaka daidaiton ganewar asali da tsinkaye, da kuma don keɓance jiyya a farkon matakin da za a iya amfani da shi na rashin jin daɗi da haɓaka ingantattun dabarun jiyya. Ana iya keɓance waɗannan abubuwan ga ƙungiyoyin marasa lafiya masu tawayar zuciya. Hanyoyin da za a iya kaiwa ga waɗannan damar sun dace da dabarun bincike na baya-bayan nan don danganta cututtuka na asibiti mafi kusa da ƙananan ƙwayoyin cuta na neurobiological.6 Baya ga rage yawan nau'in halitta, wannan na iya sauƙaƙe sauƙaƙawa zuwa daidaito na daraja tsakanin lafiyar jiki da ta hankali. A bayyane yake cewa ko da yake ana buƙatar aiki da yawa, ƙaddamar da dangantaka tsakanin masu amfani da kwayoyin halitta da kuma rashin tausayi yana da tasiri mai mahimmanci don rage nauyin damuwa a matakin mutum da al'umma.
Acknowledgments
Wannan rahoton yana wakiltar bincike mai zaman kansa wanda Cibiyar Nazarin Kiwon Lafiya ta Kasa (NIHR) Cibiyar Bincike ta Biomedical a Kudancin London da Maudsley NHS Foundation Trust da King's College London suka bayar. Ra'ayoyin da aka bayyana na marubuta ne kuma ba lallai ba ne na NHS, NIHR ko Sashen Lafiya.
Bayanan kalmomi
Bayarwa. AHY a cikin shekaru 3 da suka gabata ya sami karramawa don magana daga Astra Zeneca (AZ), Lundbeck, Eli Lilly, Sunovion; girmamawa don shawarwari daga Allergan, Livanova da Lundbeck, Sunovion, Janssen; da tallafin bincike daga Janssen da hukumomin bayar da tallafi na Burtaniya (NIHR, MRC, Wellcome Trust). AJC a cikin shekaru 3 da suka gabata ta sami karramawa don yin magana daga Astra Zeneca (AZ), girmamawa don tuntuɓar Allergan, Livanova da Lundbeck, da tallafin bincike daga Lundbeck da hukumomin ba da tallafi na Burtaniya (NIHR, MRC, Wellcome Trust).
Marubutan ba su bayar da rahoton wasu rikice-rikice na sha'awa a cikin wannan aikin ba.
A ƙarshe,�Yayin da yawancin binciken bincike ya gano ɗaruruwan masu binciken halittu don baƙin ciki, ba da yawa ba ne suka kafa rawar da suke takawa a cikin rashin damuwa ko kuma yadda za a iya amfani da ainihin bayanan ilimin halitta don haɓaka ganewar asali, jiyya da tsinkaye. Duk da haka, labarin da ke sama yana nazarin wallafe-wallafen da ake samuwa a kan abubuwan da ke tattare da kwayoyin halitta a yayin wasu matakai kuma ya kwatanta binciken asibiti zuwa na ciki. Bugu da ƙari kuma, sababbin abubuwan da aka gano a kan masu amfani da kwayoyin halitta don damuwa na iya taimakawa mafi kyawun gano ciwon ciki don bi da magani mafi kyau. Bayanin da aka ambata daga Cibiyar Nazarin Kimiyyar Halittu ta Ƙasa (NCBI) �Irin bayanin mu yana iyakance ga chiropractic da kuma raunin da ya faru da kashin baya. Don tattauna batun, da fatan za a ji daɗin tambayar Dr. Jimenez ko tuntuɓe mu a�915-850-0900 .
Dr. Alex Jimenez ne ya shirya shi
Ƙarin Maudu'i: Ciwon Baya
Binciken baya yana daya daga cikin abubuwan da ke haifar da nakasa da kuma rashin kwanakin aiki a duniya. A gaskiya ma, an danganta ciwon baya a matsayin dalili na biyu mafi yawan lokuta na ziyartar ofisoshin likitoci, wanda ya fi girma kawai ta hanyar cututtuka na sama. Kusan 80 bisa dari na yawan jama'a za su fuskanci wani nau'i na ciwon baya a kalla sau ɗaya a rayuwarsu. Kashin baya wani tsari ne mai rikitarwa wanda ya kunshi kasusuwa, gidajen abinci, jijiya da tsokoki, a tsakanin sauran kyallen takarda masu laushi. Saboda wannan, raunin da / ko yanayin da ya tsananta, kamar 'yan kwalliya, a ƙarshe na iya haifar da alamun ciwon baya. Raunin wasanni ko raunin haɗari na mota sau da yawa shine mafi yawan dalilin ciwon baya, duk da haka, wani lokacin mafi sauƙi na motsi na iya samun sakamako mai raɗaɗi. Abin farin ciki, madadin zaɓuɓɓukan magani, irin su kulawar chiropractic, na iya taimakawa wajen sauƙaƙe ciwon baya ta hanyar yin amfani da gyare-gyare na kashin baya da kuma manipulations na hannu, a ƙarshe inganta jin zafi.
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amosanin gabbai zafi wani abu ne mai rikitarwa wanda ya haɗa da tsarin aikin neurophysiological mai rikitarwa a duk matakan hanyar jin zafi. Zaɓuɓɓukan jiyya da ke akwai don rage ciwon haɗin gwiwa suna da iyakacin iyaka, kuma yawancin marasa lafiya na arthritis suna ba da rahoton kawai jin zafi mai sauƙi tare da jiyya na yanzu. Kyakkyawan fahimtar hanyoyin jijiyoyi da ke da alhakin ciwo na musculoskeletal da kuma gano sababbin maƙasudi zai taimaka wajen bunkasa hanyoyin kwantar da hankali na gaba. Wannan labarin ya sake nazarin wasu sababbin bincike a cikin abubuwan da ke taimakawa ga ciwon haɗin gwiwa da kuma rufe wurare irin su cannabinoids, furotin-activated receptors, sodium tashoshi, cytokines, da kuma wucin gadi m tashoshin. An kuma tattauna hasashen da ke fitowa cewa osteoarthritis na iya samun ɓangaren neuropathic.
Gabatarwa
Kungiyar lafiya ta duniya ta ba da matsayi na cututtukan musculoskeletal a matsayin mafi yawan sanadin nakasa a wannan zamani, wanda ke shafar daya cikin uku manya [1]. Wani abin da ya fi daure kai shi ne, yawaitar ire-iren wadannan cututtuka na karuwa yayin da sanin mu na musabbabin su ya zama na asali.
Hoto 1 Siffar da ke nuna wasu maƙasudin da aka sani don daidaita ciwon haɗin gwiwa. Za a iya sakin masu amfani da neuromodulators daga tashoshi na jijiyoyi da kuma ƙwayoyin mast da macrophages don musanya kayan aiki mai ban sha'awa. Endovanilloids, acid, da zafi mai zafi na iya kunna tashoshi na nau'in nau'in vanilloid na 1 (TRPV1) wanda ke haifar da sakin algogenic abu P (SP), wanda daga baya ya ɗaure zuwa masu karɓar neurokinin-1 (NK1). Proteases na iya tsinkewa da ta da masu karɓar protease-activated (PARs). Ya zuwa yanzu, an nuna PAR2 da PAR4 don fadakar da abubuwan haɗin gwiwa na farko. Ana samar da endocannabinoid anandamide (AE) akan buƙata kuma an haɗa shi daga N-arachidonoyl phosphatidylethanolamine (NAPE) a ƙarƙashin aikin enzymatic na phospholipases. Wani ɓangare na AE sannan ya ɗaure zuwa masu karɓa na cannabinoid-1 (CB1) wanda ke haifar da rashin jin daɗi na neuronal. Anandamide membrane transporter (AMT) wanda ba a ɗaure shi ba yana ɗauka da sauri kafin fatty acid amide hydrolase (FAAH) ya rushe shi cikin ethanolamine (Et) da arachidonic acid (AA). Cytokines tumor necrosis factor-?(TNF-?), interleukin-6 (IL-6) da kuma interleukin1-beta (IL-1?) Za su iya ɗaure ga masu karɓan su don haɓaka jin zafi. A ƙarshe, tetrodotoxin (TTX) -tashoshin sodium mai jurewa (Nav1.8) suna shiga cikin haɓakar neuronal.
Marasa lafiya suna sha'awar su kullum zafi a bace; duk da haka, a halin yanzu magungunan analgesics da aka tsara ba su da tasiri sosai kuma suna tare da nau'ikan illolin da ba a so. Don haka, miliyoyin mutane a duk duniya suna fama da lahani na ciwon haɗin gwiwa, wanda babu gamsasshen magani [2].
Fiye da nau'o'in arthritis daban-daban 100 suna da osteoarthritis (OA) wanda ya fi kowa. OA shine ciwon haɗin gwiwa na ci gaba da lalacewa wanda ke haifar da ciwo mai tsanani da asarar aiki. Yawanci, OA shine rashin iyawar haɗin gwiwa don gyara lalacewa yadda ya kamata don mayar da martani ga wuce gona da iri da aka sanya a kai. Abubuwan da ke tattare da ilimin halitta da na zamantakewar zamantakewar da ke tattare da ciwo na OA na yau da kullum ba a fahimta sosai ba, kodayake bincike mai gudana yana bayyana yanayin hadaddun alamun cututtuka [2]. Magunguna na yau da kullum, irin su magungunan anti-inflammatory marasa steroidal (NSAIDs), suna ba da taimako na alamun bayyanar cututtuka, rage zafi na ɗan gajeren lokaci, amma ba sa rage zafi a tsawon rayuwar mai haƙuri. Bugu da ƙari kuma, ba za a iya ɗaukar magungunan NSAID masu yawa akai-akai ba fiye da shekaru masu yawa, saboda wannan zai iya haifar da guba na koda da zubar jini na ciki.
A al'adance, binciken maganin arthritis ya fi mayar da hankali kan guringuntsi na articular a matsayin manufa ta farko don ci gaban warkewa na novel OA kwayoyi don gyare-gyaren cututtuka. Wannan mayar da hankali na chondrogenic ya ba da sabon haske a kan rikitattun kwayoyin halitta da kuma abubuwan da ke haifar da kwayoyin halitta wanda ke rinjayar halayen chondrocyte a cikin gidajen abinci masu cututtuka. Duk da haka, kamar yadda guringuntsi na articular ya kasance aneural da jijiyoyin jini, wannan nama ba zai yiwu ya zama tushen ciwon OA ba. Wannan gaskiyar, tare da binciken da aka gano cewa babu wani dangantaka tsakanin lalacewa na guringuntsi da ciwo a cikin marasa lafiya na OA [3,4] ko samfurori na asali na OA [5], ya haifar da canji a mayar da hankali ga ci gaba da kwayoyi don tasiri mai tasiri na ciwo. . Wannan labarin zai sake nazarin sabon binciken da aka samu a cikin bincike na ciwo na haɗin gwiwa kuma ya nuna wasu abubuwan da suka samo asali wanda zai iya zama makomar ciwon maganin arthritis (wanda aka taƙaita a cikin Fig. 1).
Cytokines
Ayyukan cytokines daban-daban a cikin nazarin neurophysiology na haɗin gwiwa sun fito sosai kwanan nan. Interleukin-6 (IL-6), alal misali, cytokine ne wanda yawanci ke ɗaure ga mai karɓar IL-6 mai ɗaure (IL-6R). IL-6 kuma na iya yin sigina ta hanyar ɗaure tare da mai narkewa IL-6R (SIL-6R) don samar da hadaddun IL-6/sIL-6R. Wannan hadaddun IL-6 / sIL-6R na gaba yana lybinds zuwa transmembrane glycoprotein subunit 130 (gp130), don haka ba da damar IL-6 don sigina a cikin sel waɗanda ba sa bayyana madaidaicin IL-6R [25,26]. IL-6 da SIL-6R sune manyan 'yan wasa a cikin kumburi na tsarin da arthritis, kamar yadda aka sami haɓakar duka biyu a cikin maganin marasa lafiya na RA da ruwan synovial. [27,29]. Kwanan nan, Vazquez et al. lura cewa haɗin gwiwar IL-6 / sIL-6R a cikin gwiwoyi na bera ya haifar da ciwo mai kumburi, kamar yadda aka bayyana ta hanyar karuwa a cikin amsawar ƙananan ƙaho na dorsal na kashin baya zuwa motsa jiki na gwiwa da sauran sassa. na gaba [30]. An kuma gani hyperexcitability na kashin baya lokacin da aka yi amfani da IL-6 / sIL-6R a gida zuwa ga kashin baya. Aikace-aikacen kashin baya na gp130 mai soluble (wanda zai lalata IL-6/sIL-6R complexes, don haka rage siginar trans-signing) ya hana IL-6 / sIL-6R-induced fahimtar tsakiya. Duk da haka, aikace-aikace mai mahimmanci na gp130 mai soluble kadai bai rage martanin neuronal zuwa kumburin haɗin gwiwa da aka riga aka kafa ba.
Tashoshin mai karɓa na wucin gadi (TRP) tashoshi ne waɗanda ba zaɓaɓɓun tashoshi ba waɗanda ke aiki azaman masu haɗa nau'ikan hanyoyin physiological da pathophysiological iri-iri. Baya ga thermosensation, chemosensation, da mechanosensation, tashoshi na TRP suna shiga cikin daidaitawar zafi da kumburi. Alal misali, TRP vanilloid-1 (TRPV1) tashoshi ion an nuna su don taimakawa ga ciwon kumburi na haɗin gwiwa kamar yadda hyperalgesia na thermal ba zai iya fitowa ba a cikin TRPV1 mono arthritic mice [31]. Hakazalika, tashoshi na TRP ankyrin-1 (TRPA1) suna da hannu a cikin mechano hypersensitivity na arthritic a matsayin toshewar mai karɓa tare da masu zaɓaɓɓen antagonists da ke rage ciwo na inji a cikin Freunds cikakke samfurin kumburi [32,33]. Ƙarin shaida cewa TRPV1 na iya shiga cikin neurotransmission na OA zafi ya fito ne daga binciken da neuronal TRPV1 magana aka daukaka a cikin sodium monoiodoacetate model na OA [34]. Bugu da ƙari, tsarin tsarin gudanarwa na TRPV1 antagonist A-889425 ya rage aikin da aka yi da kuma ba tare da bata lokaci ba na kashin baya-bayani mai mahimmanci da ƙananan ƙwayoyin cuta a cikin tsarin monoiodoacetate [35]. Wadannan bayanan sun nuna cewa endovanilloids na iya shiga cikin tsarin kulawa na tsakiya da ke hade da ciwon OA.
A halin yanzu an san su zama aƙalla polymorphisms guda huɗu a cikin kwayar halittar da ke ɓoye TRPV1, wanda ke haifar da canji a cikin tsarin tashar tashar ion da rashin aiki. Ɗaya daga cikin nau'in polymorphism (rs8065080) yana canza hankalin TRPV1 zuwa capsaicin, kuma mutanen da ke dauke da wannan polymorphism ba su da mahimmanci ga hyperalgesia na thermal [36]. Wani binciken da aka yi kwanan nan ya bincika ko marasa lafiya na OA tare da rs8065080 polymorphism sun sami canjin ra'ayi na jin zafi dangane da wannan dabi'ar kwayoyin halitta. Ƙungiyar binciken ta gano cewa marasa lafiya da ke da asymptomatic gwiwa OA sun fi iya ɗaukar kwayoyin rs8065080 fiye da marasa lafiya da ke fama da ciwo mai zafi. [37] Wannan lura yana nuna cewa marasa lafiya na OA tare da aiki na yau da kullun; Tashoshi na TRPV1 suna da haɗarin haɗari na haɗin gwiwa da kuma sake tabbatar da yiwuwar shigar da TRPV1 a cikin fahimtar jin zafi na OA.
Kammalawa
Yayin da matsala ta magance ciwon arthritis ya kasance da kyau, ana yin babban tsalle a cikin fahimtarmu game da hanyoyin neurophysiological da ke da alhakin samar da ciwon haɗin gwiwa. Ana ci gaba da gano sabbin maƙasudi, yayin da ake ƙara fayyace hanyoyin da aka sani da kuma inganta su. Yin niyya ɗaya takamaiman mai karɓa ko tashar ion ba shi yiwuwa ya zama mafita don daidaita ciwon haɗin gwiwa, amma a maimakon haka ana nuna tsarin polypharmacy wanda ake amfani da masu shiga tsakani daban-daban a hade yayin takamaiman matakan cutar. Ƙaddamar da kewayawar aiki a kowane mataki na hanyar ciwo zai kuma inganta ilimin mu game da yadda ake haifar da ciwon haɗin gwiwa. Alal misali, gano masu tsaka-tsakin tsaka-tsaki na haɗin gwiwa na haɗin gwiwa zai ba mu damar sarrafa nociception a cikin haɗin gwiwa kuma mai yiwuwa mu guje wa tasirin tsakiya na tsarin sarrafa magunguna.
CIWON FACETOGENIC
FACET SYNDROME & FACETOGENIC PIN
Facet ciwo wata cuta ce ta articular da ke da alaƙa da haɗin gwiwa na facet na lumbar da kuma abubuwan da ke ciki kuma suna haifar da ciwo na gida da radiating facetogenic.
Juyawa mai yawa, tsawo, ko jujjuyawar kashin baya (maimaita yawan amfani) na iya haifar da canje-canje na lalacewa ga guringuntsi na haɗin gwiwa. Bugu da ƙari, itt na iya haɗawa da canje-canje na degenerative zuwa wasu sifofi, ciki har da diski na intervertebral.
CIWON FUSKAR MAHAIFA & CIWON FUSKA
Ciwon wuyan axial (da wuya yana haskakawa a bayan kafadu), mafi yawan gama gari.
Ciwo tare da / ko iyakancewa na tsawo da juyawa
Tausayi akan palpation
Radiating facetogenic zafi a gida ko cikin kafadu ko babba baya, kuma da wuya yana haskakawa a gaba ko ƙasa hannu ko cikin yatsu kamar diski mai rauni.
LUMBAR FACET SYNDROME & FACETOGENIC PIN
Jin zafi ko taushi a cikin ƙananan baya.
Tausayi / taurin gida tare da kashin baya a cikin ƙananan baya.
Ciwo, tauri, ko wahala tare da wasu motsi (kamar miƙewa tsaye ko tashi daga kujera.
Pain a kan hyperextension
Ciwon da aka ambata daga haɗin gwiwa na facet na lumbar zai iya shiga cikin gefe, hip, da cinya na gefe.
Ciwon da aka ambata daga ƙananan haɗin gwiwa na lumbar zai iya shiga zurfi cikin cinya, a gefe da / ko a baya.
L4-L5 da L5-S1 facet haɗin gwiwa na iya komawa zuwa jin zafi da ke tashi zuwa cikin ƙafar gefe mai nisa, kuma a lokuta da yawa, zuwa ƙafa.
MAGANIN SHAIDA
Maganin Ciwo na Ciwo na tushen shaida bisa ga Binciken Clinical
12. Ciwon da ya samo asali daga Lumbar Facet Joints
Abstract
Kodayake kasancewar ciwon facet ya daɗe ana tambayarsa, yanzu gabaɗaya an yarda dashi azaman mahallin asibiti. Dangane da ka'idodin bincike, haɗin gwiwar zygapophysial suna lissafin tsakanin 5% da 15% na lokuta na ciwo mai tsanani, axial low ciwon baya. Mafi yawan gaske, facetogenic zafi yana haifar da damuwa mai maimaitawa da / ko tarawa ƙananan ƙananan rauni, wanda ke haifar da kumburi da kuma shimfiɗa haɗin haɗin gwiwa. Mafi yawan ƙarar ƙararrawa shine ƙananan ciwon baya na axial tare da jin zafi da aka sani a cikin gefe, hip, da cinya. Babu wani binciken bincike na jiki da ya zama pathognomonic don ganewar asali. Mafi ƙarfi mai nuna alama don ciwon facetogenic na lumbar shine rage jin zafi bayan ɓangarorin maganin sa barci na mediales rami (reshen tsaka-tsaki) na rami dorsales waɗanda ke shiga cikin mahaɗin facet. Saboda rashin gaskiya da, maiyuwa, sakamako mara kyau na iya faruwa, dole ne a fassara sakamakon a hankali. A cikin marasa lafiya tare da ciwon haɗin gwiwa na zygapophysial da aka tabbatar da allura, za a iya aiwatar da tsarin aiki a cikin mahallin nau'i-nau'i na multidisciplinary, tsarin kulawa na yau da kullum wanda ya hada da maganin pharmacotherapy, farfadowa na jiki, da motsa jiki na yau da kullum, kuma, idan an nuna, psychotherapy. A halin yanzu, ma'auni na zinariya don magance ciwon facetogenic shine maganin mitar rediyo (1 B+). Shaidar da ke goyan bayan intra-articular corticosteroids ta iyakance; Don haka, ya kamata a keɓe wannan ga waɗanda ba su amsa maganin mitar rediyo (2 B1).
Facetogenic Pain da ke fitowa daga sassan lumbar facet haɗin gwiwa shine dalilin da ya sa ƙananan ciwon baya a cikin yawan mutane. Goldthwaite shine farkon wanda ya bayyana ciwon a cikin 1911, kuma Ghormley gabaɗaya ana la'akari da ƙirƙirar kalmar facet syndrome a cikin 1933. Facetogenic zafi ana bayyana shi azaman zafi wanda ke tasowa daga kowane tsarin da ke cikin sassan facet, gami da capsule na fibrous. , synovial membrane, hyaline guringuntsi, da kashi.35
Fiye da haka, shine sakamakon maimaita damuwa da/ko tara ƙananan rauni. Wannan yana haifar da kumburi, wanda zai iya haifar da haɗin gwiwa na facet ya cika da ruwa da kuma kumbura, wanda ya haifar da ƙaddamar da capsule na haɗin gwiwa da kuma jin zafi na gaba.27 Canje-canje masu kumburi a kusa da haɗin gwiwa na facet kuma zai iya fusatar da jijiyar kashin baya ta hanyar raguwa mai zurfi, yana haifar da sciatica. Bugu da ƙari, Igarashi et al.28 sun gano cewa cytokines masu kumburi da aka saki ta hanyar haɗin gwiwa na haɗin gwiwa a cikin marasa lafiya tare da ciwon haɗin gwiwa na zygapophysial na iya zama wani ɓangare na alhakin bayyanar cututtuka na neuropathic a cikin mutanen da ke da kashin baya. Abubuwan da ke da alaƙa don ciwon haɗin gwiwa na zygapophysial sun haɗa da spondylolisthesis / lysis, cututtukan diski na degenerative, da tsufa.5
IC KARIN GWAJI
Yawan adadin sauye-sauyen cututtuka a cikin sassan facet akan jarrabawar rediyo ya dogara ne akan ma'anar shekarun batutuwa, fasahar rediyo da aka yi amfani da su, da ma'anar rashin daidaituwa. Za a iya gani da kyau ga mahaɗan facet masu lalacewa ta hanyar jarrabawar lissafi (CT)..49
CIWON NEUROPATHIC
An fara jin zafi ko haifar da rauni na farko ko rashin aiki a cikin tsarin jijiya na somatosensory.
Neuropathic zafi yawanci yakan zama na yau da kullun, yana da wuyar magani, kuma sau da yawa yana juriya ga daidaitaccen maganin analgesic.
Abstract
Ciwon neuropathic yana haifar da rauni ko cuta na tsarin somatosensory, ciki har da filaye na gefe (A?, A? da C fibers) da ƙananan ƙananan ƙwayoyin cuta, kuma yana rinjayar 7-10% na yawan jama'a. An bayyana dalilai da yawa na ciwon neuropathic. Mai yuwuwa lamarin ya karu saboda yawan tsufa a duniya, da karuwar ciwon suga, da kuma inganta rayuwa daga cutar kansa bayan ilimin chemotherapy. Lalle ne, rashin daidaituwa tsakanin sigina na somatosensory mai ban sha'awa da inhibitory, sauye-sauye a cikin tashoshi na ion, da kuma bambancin yadda ake daidaita saƙonnin zafi a cikin tsarin kulawa na tsakiya duk sun kasance cikin ciwon neuropathic. Bugu da ƙari kuma, nauyin ciwon ciwon neuropathic na yau da kullum yana da alaƙa da rikitarwa na alamun neuropathic, sakamako mara kyau, da kuma yanke shawara mai wuyar magani. Mahimmanci, ingancin rayuwa yana da lahani a cikin marasa lafiya da ciwon neuropathic saboda ƙara yawan takardun magani da ziyartar ma'aikatan kiwon lafiya da kuma cututtuka daga ciwo da kanta da cutar da ke haifar da cutar. Duk da kalubale, ci gaba a fahimtar ilimin pathophysiology na ciwon neuropathic yana haifar da ci gaba da sababbin hanyoyin bincike da kuma abubuwan da suka dace, wanda ya jaddada buƙatar tsarin kulawa da yawa don kula da ciwon neuropathic.
MAGANIN CIWON NEUROPATHIC
MKANANIYYA
Bayan raunin jijiya na gefe, neurons sun zama masu hankali kuma suna haɓaka tashin hankali mara kyau da haɓakar hankali ga haɓakawa.
Ana kiran wannan da…Hanyar Hannu!
MECHANISS NA TSAKIYA
Sakamakon ci gaba da ayyukan da ba zato ba tsammani a cikin kewayen, ƙwayoyin jijiya suna haɓaka haɓaka aikin baya, faɗaɗa filayen karɓa, da ƙarin martani ga abubuwan motsa jiki, gami da abubuwan motsa jiki na yau da kullun. Wannan ana kiransa da…Mai Hakuri na Tsakiya!
Ciwon neuropathic na yau da kullum ya fi yawa a cikin mata (8% a cikin 5.7% a cikin maza) kuma a cikin marasa lafiya> 50 shekaru (8.9% da 5.6% a cikin wadanda <49 shekaru), kuma yawanci yana rinjayar ƙananan baya da ƙananan gaɓɓai. , wuya da babba24. Lumbar da radiculopathies mai raɗaɗi mai raɗaɗi mai yiwuwa shine mafi yawan sanadin ciwon neuropathic na yau da kullun. Daidai da waɗannan bayanan, binciken da aka yi na> 12,000 marasa lafiya tare da ciwo mai tsanani tare da nau'in ciwon nociceptive da neuropathic, wanda ake magana a kai ga ƙwararrun masu jin zafi a Jamus, ya nuna cewa 40% na duk marasa lafiya sun sami akalla wasu halaye na ciwon neuropathic (irin su ƙonawa, konewa). numbness, tingling; marasa lafiya da ciwon baya na baya da radiculopathy sun shafi musamman25.
Gudunmawar neurophysiology na asibiti don fahimtar hanyoyin tashin hankali-nau'in ciwon kai.
Abstract
Ya zuwa yanzu, an gudanar da nazarin ilimin neurophysiological na asibiti game da ciwon kai na nau'in tashin hankali (TTH) tare da manyan dalilai guda biyu: (1) don tabbatar da ko wasu sigogi na neurophysiological na iya aiki a matsayin alamomi na TTH, da (2) don bincikar ilimin lissafi na TTH. Game da batu na farko, sakamakon da aka samu yana da ban sha'awa tun lokacin da wasu rashin daidaituwa da aka samu a cikin marasa lafiya na TTH na iya kasancewa akai-akai a cikin migraineurs. A gefe guda, neurophysiology na asibiti ya taka muhimmiyar rawa a cikin muhawara game da pathogenesis na TTH. Nazari a kan ɓarkewar ɓacin rai na ƙanƙancewar tsoka na ɗan lokaci ya gano tabarbarewar haɓakawar kwakwalwar kwakwalwa da sarrafa suprasegmental. An cimma irin wannan ƙaddamarwa ta hanyar amfani da ƙwayoyin cuta na trigeminocervical, wanda rashin daidaituwa a cikin TTH ya ba da shawarar rage yawan ayyukan hanawa na kwakwalwar kwakwalwar kwakwalwa, wanda ke nuna hanyoyin sarrafa ciwo mai tsanani. Abin sha'awa shine, rashin daidaituwa na jijiyoyi a cikin TTH da alama ya zama babban al'amari, ba'a iyakance ga gundumomi na cranial ba. Haƙiƙa an tabbatar da ingantattun hanyoyin kamar DNIC a cikin gundumomi na somatic ta hanyar nazarin flexion reflex nociceptive. Abin takaici, yawancin nazarin neurophysiological akan TTH sun lalace ta hanyar kuskuren hanyoyi masu tsanani, wanda ya kamata a kauce masa a cikin bincike na gaba don bayyana hanyoyin TTH mafi kyau.
References:
Neurophysiology na ciwon arthritis. McDougall JJ1 Linton P.
Ciwon da ya samo asali daga mahaɗin facet na lumbar. van Kleef M1,Vanlderen P,Cohen SP,Lataster A,Van Zundert J,Mekhail N.
Neuropathic zafiLuana Colloca,1Taylor Ludman,1Didier Bouhassira,2Ralf Baron,3Anthony H. Dickenson,4David Yarnitsky,5Roy Freeman,6Andrea Truini,7Nadine Attal, Nanna B. Finnerup,9Christopher Eccleston,10,11Iya Kalso,12David L. Bennett,13Robert H. Dworkin,14da kuma Srinivasa N. Raja15
Gudunmawar neurophysiology na asibiti don fahimtar hanyoyin tashin hankali-nau'in ciwon kai. Rossi P1, Vollono C, Valeriani M, Sandrini G.
Likitoci sun ayyana ciwo mai tsanani, kamar kowane ciwo da ya wuce watanni 3 zuwa 6 ko fiye. The zafi yana tasiri lafiyar tunanin mutum da rayuwar yau da kullun. Ciwo yana fitowa daga jerin saƙon da ke gudana ta tsarin jin tsoro. Damuwa da alama yana biye da zafi. Yana haifar da cututtuka masu tsanani waɗanda ke shafar yadda mutum yake ji, tunani, da yadda ake tafiyar da ayyukan yau da kullun, watau barci, cin abinci da aiki. Chiropractor, Dokta Alex Jimenez ya shiga cikin masu amfani da kwayoyin halitta wanda zai iya taimakawa wajen ganowa da kuma magance tushen abubuwan da ke haifar da ciwo da ciwo mai tsanani.
Mataki na farko a cikin nasarar sarrafa ciwo shine cikakken kima na biopsychosocial.
Matsakaicin ilimin cututtuka na kwayoyin halitta bazai iya nunawa daidai ba a cikin jin zafi.
Ana iya amfani da kima na farko don gano wuraren da ke buƙatar ƙarin ƙima mai zurfi.
Yawancin ingantattun kayan aikin kai-kai suna samuwa don tantance tasirin ciwo na yau da kullun.
Ƙimar Marasa lafiya Masu Ciwon Jiki
Jin zafi na yau da kullun shine damuwa da lafiyar jama'a da ke shafar kashi 20 zuwa 30% na yawan mutanen ƙasashen Yamma. Ko da yake akwai ci gaban kimiyya da yawa a cikin fahimtar ilimin neurophysiology na ciwo, daidaitaccen kimantawa da kuma gano matsalar ciwo mai tsanani na mai haƙuri ba daidai ba ne ko ma'anarsa. Yadda za a yi la'akari da ciwo na kullum yana rinjayar yadda ake kimanta ciwo da kuma abubuwan da aka yi la'akari da lokacin da ake yin ganewar asali na ciwo mai tsanani. Babu wata alaƙa tsakanin mutum-da-daya tsakanin adadin ko nau'in ilimin halittar jiki da tsananin zafi, amma a maimakon haka, Kwarewar jin zafi na yau da kullun yana da siffa ta ɗimbin ilimin halittu, psychosocial (misali imanin marasa lafiya, tsammanin, da yanayi), da halayen halayen (misali mahallin, martani ta wasu manyan mutane). Yin la'akari da kowane ɗayan waɗannan yankuna guda uku ta hanyar ƙima mai mahimmanci ga mutumin da ke fama da ciwo mai tsanani yana da mahimmanci don yanke shawara na jiyya da kuma sauƙaƙe sakamako mafi kyau. Wannan kimantawa yakamata ya haɗa da cikakken tarihin majiyyaci da kima na likita da ɗan taƙaitaccen hirar dubawa inda za'a iya lura da halayen majiyyaci. Ƙarin ƙima don magance tambayoyin da aka gano yayin ƙimar farko zai jagoranci yanke shawara game da ƙarin ƙarin ƙima, idan akwai, na iya dacewa. Daidaitaccen kayan aikin da aka ba da rahoton kai don kimanta tsananin zafin mai haƙuri, iyawar aiki, imani da tsammanin, da damuwa na zuciya suna samuwa, kuma ana iya gudanar da su ta hanyar likita, ko kuma za a iya ba da shawara don kimantawa mai zurfi don taimakawa wajen tsara tsarin jiyya.
Pain alama ce ta yaɗu sosai. An kiyasta ciwon na yau da kullum zai shafi kashi 30% na manya na Amurka, sama da manya miliyan 100
Duk da hauhawar farashin maganin mutanen da ke fama da ciwo mai tsanani, taimako ga mutane da yawa ya kasance mai wuyar gaske kuma cikakken kawar da ciwo yana da wuya. Kodayake an sami ci gaba mai mahimmanci a cikin ilimin neurophysiology na jin zafi, tare da haɓaka magungunan analgesic masu ƙarfi da sauran sabbin hanyoyin aikin likita da na tiyata, a matsakaicin adadin raguwar raɗaɗi ta hanyoyin da ake samu shine 30 ~ 40% kuma wannan yana faruwa a cikin kasa da rabin majinyatan da aka yi musu magani.
Hanyar da muke tunani game da ciwo yana rinjayar hanyar da muke zuwa kimanta ciwo. Ana farawa da tantancewa da tarihi da gwajin jiki, sannan ta hanyar gwaje-gwajen dakin gwaje-gwaje da hanyoyin tantancewa a cikin yunƙurin ganowa da/ko tabbatar da kasancewar duk wani nau'in cututtukan da ke haifar da alamar/s ko zafi janareta.
Idan babu alamun cututtukan cututtukan ƙwayoyin cuta, mai ba da lafiya na iya ɗauka cewa rahoton alamun ya samo asali ne daga abubuwan tunani kuma yana iya buƙatar kimantawa na tunani don gano abubuwan da ke tattare da tunanin da ke ƙarƙashin rahoton mai haƙuri. Akwai duality inda aka danganta rahoton alamun zuwa ko dai somatic or hanyoyin psychogenic.
A matsayin misali, tushen kwayoyin halitta don wasu na yau da kullun da masu maimaitawa (misali ciwon kai)3 da na yau da kullun [misali. ciwon baya, Fibromyalgia (FM)] matsalolin zafi ba a san su ba, 4,5 yayin da a gefe guda, mutanen asymptomatic na iya samun rashin daidaituwa na tsari irin su diski na herniated wanda zai bayyana ciwo idan ya kasance.6,7�Akwai ƙarancin isassun bayanai ga marasa lafiya waɗanda ba su da alamun cututtukan ƙwayoyin cuta waɗanda ke ba da rahoton raɗaɗi mai ƙarfi da mutane marasa jin zafi tare da mahimmanci, ilimin cututtukan haƙiƙa.
Ciwo na yau da kullun yana shafar fiye da majinyacin mutum, har ma da wasu manyansa (abokan tarayya, dangi, ma'aikata da abokan aiki da abokai.), yin maganin da ya dace yana da mahimmanci. Magani mai gamsarwa zai iya fitowa ne kawai daga cikakkiyar kima na ilimin ilimin ilimin halitta na jin zafi tare da takamaiman yanayin halayyar haƙuri da yanayin halin haƙuri, gami da yanayin motsin su (misali damuwa, damuwa, da fushi), fahimta da fahimtar alamun bayyanar cututtuka, da halayen halayen waɗancan. bayyanar cututtuka ta wasu mahimmanci.8,9 Mahimmin mahimmanci shine cewa abubuwa masu yawa suna rinjayar alamun bayyanar cututtuka da iyakokin aiki na mutanen da ke da ciwo mai tsanani. Sabili da haka, ana buƙatar ƙima mai mahimmanci wanda ke magance yanayin ilimin halitta, psychosocial, da kuma halaye, kamar yadda kowannensu ke ba da gudummawa ga ciwo mai tsanani da nakasa.10,11
Ƙimar Ƙimar Mutum Mai Ciwon Jiki
Turk da Meichenbaum12 sun ba da shawarar cewa tambayoyin tsakiya guda uku ya kamata su jagoranci kimanta mutanen da ke ba da rahoton ciwo:
Menene girman cutar ko raunin majiyyaci (lalacewar jiki)?
Menene girman rashin lafiyar? Wato, har yaya majiyyaci ke shan wahala, naƙasassu, kuma ba za su iya jin daɗin ayyukan da suka saba ba?
Shin halin mutum yana da kama da ya dace da cutar ko rauni, ko akwai wata shaida ta ƙara alamar alama ga kowane nau'ikan dalilai na tunani ko zamantakewa (misali fa'idodi kamar kyakkyawar kulawa, magunguna masu canza yanayi, ramuwar kuɗi)?
Don amsa waɗannan tambayoyin, ya kamata a tattara bayanai daga majiyyaci ta tarihi da jarrabawar jiki, a hade tare da hira na asibiti, da kuma ta hanyar daidaitattun kayan aiki. Ma'aikatan kiwon lafiya suna buƙatar neman kowane dalili (s) na ciwo ta hanyar gwajin jiki da gwaje-gwajen bincike yayin da suke kimanta yanayin haƙuri, tsoro, tsammanin, ƙoƙarin magancewa, albarkatu, martani na wasu masu mahimmanci, da kuma tasirin ciwo ga marasa lafiya. rayuwa.11 A takaice, ma'aikacin kiwon lafiya dole ne ya kimanta dukkan mutum ba kawai zafi ba.
Maƙasudin gabaɗaya na tarihi da kimantawar likita sune:
(i) ƙayyade wajibcin ƙarin gwajin gwaji
(ii) tantance idan bayanan likita na iya bayyana alamun majiyyaci, tsananin alamun, da iyakokin aiki
(iii) yin bincike na likita
(iv) kimanta samuwan maganin da ya dace
(v) kafa manufofin jiyya
(vi) ƙayyade hanyar da ta dace don sarrafa alamun idan cikakkiyar magani ba zai yiwu ba.
Mahimman lambobi na marasa lafiya waɗanda ke ba da rahoton ciwo mai tsanani ba su nuna alamun cututtuka na jiki ta hanyar amfani da radiyo a fili, ƙididdigar axial tomography scans, ko electromyography. (ana samun ɗimbin ɗimbin ɗimbin ɗimbin ɗimbin ɗimbin ɗimbin ɗimbin ɗimbin ɗimbin ɗimbin ɗimbin ɗimbin ɗimbin yawa akan kima na jiki, hanyoyin tantancewa na rediyo da na gwaje-gwaje don tantance tushen jin zafi), 17 yin madaidaicin ƙwayar cuta mai wahala ko ba zai yiwu ba.
Duk da waɗannan iyakoki, tarihin majiyyaci da gwajin lafiyar jiki sun kasance ginshiƙan ganowar likita, na iya ba da kariya daga binciken fiye da kima daga hoton binciken da ke da tabbaci sosai, kuma ana iya amfani da shi don jagorantar jagorar ƙoƙarin ƙima.
Bugu da ƙari, marasa lafiya da matsalolin ciwo na kullum sukan cinye magunguna iri-iri.18 Yana da mahimmanci a tattauna magungunan majiyyaci na yanzu a yayin hira, kamar yadda yawancin magungunan zafi suna haɗuwa da lahani na gefe wanda zai iya haifar da damuwa ko damuwa.19 Ma'aikatan kiwon lafiya ya kamata ba kawai su saba da magungunan da ake amfani da su don ciwo mai tsanani ba, amma har ma tare da sakamako masu illa daga waɗannan magungunan da ke haifar da gajiya, matsalolin barci, da canje-canjen yanayi don kauce wa kuskuren rashin fahimta na ciki.
An yi imani da yin amfani da liary na yau da kullun ya fi daidai saboda sun dogara ne akan ainihin lokaci maimakon tunawa. Ana iya tambayar marasa lafiya don kula da diaries na yau da kullum na tsananin zafi tare da ƙididdiga da aka rubuta sau da yawa kowace rana (misali abinci da lokacin kwanta barci) na kwanaki da yawa ko makonni kuma za a iya ƙididdige ƙimar zafi da yawa a tsawon lokaci.
Wata matsala da aka lura tare da yin amfani da littattafan rubutu-da-fensir ita ce cewa marasa lafiya na iya ƙi bin umarnin don ba da ƙima a ƙayyadaddun tazara. Maimakon haka, majiyyata na iya kammala littatafai a gaba (�cika gaba�) ko kuma jim kaɗan kafin ganin likitan (�cika baya�),24 yana lalata ingancin littafin rubutu. Littattafan lantarki sun sami karɓuwa a wasu binciken bincike don guje wa waɗannan matsalolin.
Bincike ya nuna muhimmancin yin la'akari da lafiyar lafiyar lafiyar lafiyar jiki (HRQOL) a cikin marasa lafiya na ciwo mai tsanani ban da aiki .31,32 Akwai adadin da aka kafa da kyau, matakan HRQOL da psychometrically goyon bayan [Nazarin Harkokin Kiwon Lafiyar Jama'a (SF-36)], 33 ma'auni na gaba ɗaya na aikin jiki [misali Pain Disability Index (PDI)],34 da takamaiman matakan cututtuka [misali Western Ontario MacMaster Osteoarthritis Index (WOMAC); 35 Roland-Morris Back Pain Disability Questionnaire (RDQ) )] 36 don tantance aiki da ingancin rayuwa.
An tsara ƙayyadaddun matakan cututtuka don kimanta tasirin wani yanayi na musamman (misali ciwo da taurin kai a cikin mutanen da ke fama da osteoarthritis), yayin da ma'auni na yau da kullum ya sa ya yiwu a kwatanta aikin jiki da ke hade da rashin lafiya da aka ba da magani tare da na wasu yanayi daban-daban. Ƙila ba za a iya gano takamaiman tasirin rashin lafiya lokacin amfani da ma'auni ba; don haka, ƙayyadaddun ƙayyadaddun cututtuka na iya zama mafi kusantar bayyana ingantaccen ingantaccen asibiti ko tabarbarewar ayyuka na musamman sakamakon jiyya. Gabaɗaya matakan aiki na iya zama da amfani don kwatanta marasa lafiya tare da bambancin yanayi mai raɗaɗi. Haɗin yin amfani da ƙayyadaddun ƙayyadaddun cututtuka da matakan ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun buƙatun biyu ke sauƙaƙe cimma burin biyun.
Kasancewar damuwa na tunani a cikin mutanen da ke fama da ciwo mai tsanani yana ba da ƙalubale yayin tantance alamun bayyanar cututtuka irin su gajiya, rage yawan matakin aiki, rage libido, canjin ci, damuwa barci, karuwar nauyi ko hasara, da ƙwaƙwalwar ajiya da ƙaddamarwa, kamar yadda waɗannan alamun zasu iya zama sakamakon ciwo, damuwa na tunani, ko magungunan magani da aka tsara don sarrafa ciwo.
An ƙera kayan aiki na musamman don masu fama da ciwo don tantance matsalolin tunani, tasirin raɗaɗi a kan rayuwar marasa lafiya, jin dadi, halin da ake ciki, da kuma halaye game da cututtuka, ciwo, da masu ba da lafiya.17
Misali, Inventory Beck Depression Inventory (BDI) 39 da Profile of Mood States (POMS) 40 suna da kyau a hankali don tantance alamun tawayar yanayi, damuwa da damuwa, kuma an ba da shawarar a yi amfani da su a cikin duk gwajin gwaji na asibiti. ciwo mai tsanani; 41 duk da haka, dole ne a fassara ma'auni tare da taka tsantsan kuma ma'auni na matakan damuwa na motsin rai na iya buƙatar gyara don hana halayen ƙarya.42
Lab Biomarkers Don Ciwo
Alamar halitta halaye ne na halitta waɗanda za a iya amfani da su don nuna lafiya ko cuta. Wannan takarda ta sake nazarin binciken akan masu nazarin halittu na ƙananan ciwon baya (LBP) a cikin batutuwa na mutum. LBP shine babban abin da ke haifar da nakasa, wanda ya haifar da cututtuka daban-daban na kashin baya, ciki har da lalata intervertebral disc degeneration, disc herniation, spinal stenosis, da facet arthritis. Mayar da hankali ga waɗannan karatun shine masu shiga tsakani, saboda ƙumburi yana taimakawa wajen haifar da lalacewar diski da kuma hanyoyin haɗin gwiwa. Bugu da ƙari, nazarin ya nuna cewa kasancewar masu shiga tsakani na kumburi za a iya auna su cikin jini. Waɗannan masu alamar halitta na iya zama sabbin kayan aikin don jagorantar kulawar haƙuri. A halin yanzu, amsawar haƙuri ga jiyya ba shi da tabbas tare da mahimmancin sake dawowa, kuma, yayin da jiyya na tiyata na iya samar da gyaran jiki da jin zafi, sun kasance masu haɗari da tsada. Binciken ya ƙunshi nazarin da aka yi akan yawan jama'a tare da takamaiman bincike da asalin LBP da ba a bayyana ba. Tun da tarihin halitta na LBP yana ci gaba da ci gaba, yanayin ɗan lokaci na nazarin yana rarraba ta tsawon lokacin bayyanar cututtuka / cuta. Hakanan ana yin nazarin binciken da ke da alaƙa akan canje-canje a cikin masu alamar halitta tare da jiyya. Ƙarshe, masu binciken kwayoyin halitta na LBP da kuma lalatawar kashin baya suna da damar yin kiwon wani zamani na maganin kashin baya don keɓaɓɓen hanyoyin kwantar da hankali a cikin jiyya na LBP.
Alamar Halittu Don Ciwon Neuropathic na Zamani & Aikace-aikace Mai yuwuwa A cikin Ƙarfafa Ƙwararrun Ƙwararru
Wannan bita ya mayar da hankali kan fahimtar abin da abubuwan da ke cikin jikin mutum ke karuwa da raguwa tare da karuwar ciwon neuropathic. Mun sake nazarin karatu daban-daban, kuma mun ga alaƙa tsakanin ciwon neuropathic da sassan tsarin rigakafi (wannan tsarin yana kare jiki daga cututtuka da cututtuka). Sakamakonmu zai zama da amfani musamman don fahimtar hanyoyin da za a rage ko kawar da rashin jin daɗi, ciwon neuropathic na kullum yana kawowa. Hanyar motsa jiki ta kashin baya (SCS) ɗaya ce daga cikin ƴan ingantattun hanyoyin magance jin zafi. Binciken na gaba zai yi amfani da bincikenmu daga wannan bita zuwa SCS, don fahimtar tsarin, da kuma ƙara inganta inganci.
Cytokines masu kumburi irin su IL-1?, IL-6, IL-2, IL-33, CCL3, CXCL1, CCR5, da TNF-?, an samo su suna taka muhimmiyar rawa wajen haɓaka jihohin ciwo na kullum.
Bayan nazarin nazarin daban-daban da suka shafi masu ciwon daji, mun gano cewa matakan jini na cytokines da chemokines pro-inflammatory, irin su IL-1?, IL-6, IL-2, IL-33, CCL3, CXCL1, CCR5, da TNF -?, An inganta su sosai a lokacin jin zafi na yau da kullum. A gefe guda, an gano cytokines masu kumburi irin su IL-10 da IL-4 don nuna ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun lokaci a lokacin ciwo mai tsanani.
Biomarkers Don Bacin rai
Yawancin bincike ya haifar da ɗaruruwan masu satar kwayoyin halitta don ɓacin rai, amma har yanzu ba su yi cikakken bayanin rawar da suke takawa a cikin rashin lafiya ba ko kafa abin da ba shi da kyau wanda marasa lafiya da yadda za a iya amfani da bayanan ilimin halitta don haɓaka ganewar asali, jiyya da tsinkaye. Wannan rashin ci gaba a wani bangare ne saboda yanayi da nau'ikan nau'ikan baƙin ciki, tare da haɗin kai tare da nau'ikan nau'ikan hanyoyin a cikin wallafe-wallafen bincike da kuma manyan abubuwan da ke tattare da kwayoyin halitta tare da yuwuwar, maganganun wanda sau da yawa ya bambanta bisa ga dalilai da yawa. Muna yin nazarin wallafe-wallafen da ake samuwa, wanda ke nuna cewa alamomin da ke cikin kumburi, neurotrophic da matakai na rayuwa, da kuma abubuwan da ke tattare da tsarin neurotransmitter da neuroendocrine, suna wakiltar 'yan takara masu ban sha'awa. Ana iya auna waɗannan ta hanyar kwayoyin halitta da epigenetic, transcriptomic da proteomic, metabolomic da ƙididdigar neuroimaging. Yin amfani da sababbin hanyoyin da shirye-shiryen bincike na yau da kullum ana buƙatar don sanin ko, kuma wanda, masu nazarin halittu za a iya amfani da su don tsinkayar amsa ga magani, ware marasa lafiya zuwa takamaiman jiyya da haɓaka maƙasudai don sabbin saɓani. Mun kammala da cewa akwai alƙawura da yawa don rage nauyin baƙin ciki ta hanyar haɓakawa da faɗaɗa waɗannan hanyoyin bincike.
References:
Kimanta majinyata masu fama da ciwo mai tsanani�EJ Dansiet da DC Turk*t�
Alamar Halitta don Ciwon Neuropathic na Zamani da Aikace-aikacensu Mai yuwuwar Su a cikin Ƙarfafa Ƙwararrun Ƙwararru: Bita
Chibueze D. Nwagwu, 1 Christina Sarris, MD, 3 Yuan-Xiang Tao, Ph.D., MD, 2 da Antonios Mammis, MD1,2
Biomarkers don ɓacin rai: hangen nesa na baya-bayan nan, ƙalubalen da ake fuskanta da kuma abubuwan da ke gaba. Strawbridge R1, Matashi AH1,2, Cleare AJ1,2.
Jin zafi shine yanayin yanayin jikin ɗan adam ga rauni ko rashin lafiya, kuma galibi gargaɗi ne cewa wani abu ba daidai ba ne. Da zarar matsalar ta warke, gabaɗaya mun daina fuskantar wannan alamun masu zafi, duk da haka, menene zai faru lokacin da ciwon ya ci gaba da daɗe bayan abin ya tafi? kullum ciwo an ayyana a likitance azaman ciwon dagewa wanda ke ɗaukar watanni 3 zuwa 6 ko fiye. Jin zafi na yau da kullun tabbas yanayin ƙalubale ne don rayuwa tare da shi, yana shafar komai daga matakan ayyukan mutum da ikon su na yin aiki gami da alaƙar su da yanayin tunani. Amma, kuna sane da cewa ciwo na yau da kullun na iya shafar tsarin da aikin kwakwalwar ku? Ya zama cewa waɗannan canje-canjen kwakwalwa na iya haifar da rashin fahimta da na tunani.
Jin zafi na yau da kullun ba wai kawai yana tasiri ga yanki ɗaya na hankali ba, a zahiri, yana iya haifar da canje-canje zuwa ɓangarorin da yawa masu mahimmanci na ƙwaƙwalwa, galibi waɗanda ke da hannu cikin matakai da ayyuka da yawa. Nazarin bincike daban-daban a cikin shekarun da suka gabata sun sami sauye-sauye ga hippocampus, tare da raguwa a cikin launin toka daga dorsolateral prefrontal cortex, amygdala, kwakwalwar kwakwalwa da kuma madaidaiciyar cortex na dama, don suna wasu, hade da ciwo mai tsanani. Rushewar wasu ƙananan tsarin waɗannan yankuna da ayyukan da suka danganci su na iya taimakawa wajen sanya waɗannan canje-canjen kwakwalwa a cikin mahallin, ga mutane da yawa masu fama da ciwo mai tsanani. Manufar labarin mai zuwa shine don nunawa da kuma tattauna sauye-sauyen tsarin tsarin da aikin kwakwalwa da ke hade da ciwo mai tsanani, musamman ma a cikin yanayin da waɗanda ke yin tunani mai yiwuwa ba lalacewa ko atrophy ba.
Harshen jin zafi yana bayyana da alaƙa da rage matsalar toka a cikin wuraren da ba zai yiwu ba ga isar da ciwo. Hanyoyin da ke tattare da waɗannan canje-canjen tsarin, mai yiwuwa sun biyo bayan gyare-gyaren aiki da kuma filastik ta tsakiya a cikin kwakwalwa, ba su da tabbas. Jin zafi a cikin osteoarthritis na hip yana daya daga cikin ƴan ciwon ciwo mai tsanani waɗanda ake iya warkewa. Mun bincika marasa lafiya 20 tare da ciwo na kullum saboda coxarthrosis na unilateral (ma'anar shekaru 63.25�9.46 (SD) shekaru, 10 mace) kafin hip hadin gwiwa endoprosthetic tiyata (jin zafi jihar) da kuma kula da kwakwalwa tsarin canje-canje har zuwa 1 shekara bayan tiyata: 6 �8 makonni , 12�18 makonni da wata 10�14 ba tare da jin zafi gaba ɗaya ba. Marasa lafiya da ke fama da ciwo mai tsanani saboda coxarthrosis na unilateral suna da ƙarancin launin toka sosai idan aka kwatanta da sarrafawa a cikin cortex na cingulate na baya (ACC), cortex na insular da operculum, dorsolateral prefrontal cortex (DLPFC) da kuma orbitofrontal cortex. Wadannan yankuna suna aiki a matsayin tsarin haɗin kai da yawa a lokacin kwarewa da kuma tsammanin jin zafi. Lokacin da marasa lafiya ba su da zafi bayan sun dawo daga aikin tiyata na endoprosthetic, an sami karuwar ƙwayar launin toka a kusan wurare iri ɗaya. Mun kuma sami haɓakar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar cuta (SMA). Mun ƙaddamar da cewa rashin daidaituwa na launin toka a cikin ciwo mai tsanani ba shine dalilin ba, amma na biyu zuwa cutar kuma aƙalla a cikin wani ɓangare saboda canje-canje a cikin aikin motsa jiki da haɗin kai na jiki.
Gabatarwa
Shaidar aikin da tsarin sake tsarawa a cikin marasa lafiya na ciwo na kullum suna goyon bayan ra'ayin cewa ciwo mai tsanani bai kamata a yi la'akari da shi kawai a matsayin yanayin aiki mai canzawa ba, amma har ma saboda sakamakon aikin kwakwalwa da kuma tsarin kwakwalwa [1], [2], [3]. [4], [5], [6]. A cikin shekaru shida na ƙarshe, an buga fiye da nazarin 20 da ke nuna sauye-sauyen tsarin kwakwalwa a cikin 14 na ciwo mai tsanani. Babban fasalin duk waɗannan karatun shine gaskiyar cewa canje-canjen al'amuran launin toka ba a rarraba su ba da gangan, amma suna faruwa a cikin ƙayyadaddun takamaiman wuraren kwakwalwa waɗanda ke aiki sosai - wato, sa hannu a cikin sarrafa supraspinal nociceptive. Abubuwan da aka fi sani da su sun bambanta ga kowane ciwo mai zafi, amma sun mamaye cikin cortex na cingulate, cortex orbitofrontal, insula da dorsal pons [4]. Ƙarin sifofi sun haɗa da thalamus, dorsolateral prefrontal cortex, basal ganglia da yankin hippocampal. Ana tattauna waɗannan binciken sau da yawa azaman atrophy na salula, ƙarfafa ra'ayin lalacewa ko asarar kwayoyin launin toka [7], [8], [9]. A gaskiya ma, masu bincike sun sami alaƙa tsakanin ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar kuma da kuma tsawon lokacin jin zafi [6], [10]. Amma tsawon lokacin zafi kuma yana da alaƙa da shekarun haƙuri, da shekarun da suka dogara da duniya, amma kuma ƙayyadaddun ƙayyadaddun yanayin launin toka yana da rubuce sosai [11]. A gefe guda, waɗannan sauye-sauyen tsarin na iya zama raguwa a cikin girman tantanin halitta, ruwan sha na waje, synaptogenesis, angiogenesis ko ma saboda canjin girman jini [4], [12], [13]. Duk abin da tushen yake, don fassarar irin wannan binciken yana da mahimmanci don ganin waɗannan binciken binciken kwayoyin halitta a cikin hasken ɗimbin ilimin ilimin halittar jiki a cikin motsa jiki na dogara da filastik, wanda aka ba da cewa an nuna canje-canjen kwakwalwa na musamman na yanki akai-akai bayan fahimi da motsa jiki na jiki [ 14].
Ba a fahimci dalilin da ya sa kawai ƙananan ƙananan mutane ke ci gaba da ciwo mai tsanani ba, la'akari da cewa ciwo shine kwarewa ta duniya. Tambayar ta taso ko a cikin wasu mutane bambance-bambancen tsari a cikin tsarin watsawa na tsakiya na iya zama diathesis don ciwo mai tsanani. Halin launin toka yana canzawa a cikin zafin fata saboda yankewa [15] da raunin kashin baya [3] yana nuna cewa sauye-sauye na kwakwalwa na kwakwalwa shine, aƙalla a wani ɓangare, sakamakon ciwo mai tsanani. Duk da haka, jin zafi a cikin osteoarthritis na hip (OA) yana ɗaya daga cikin ƙananan ciwon ciwo mai tsanani wanda ke da mahimmanci, kamar yadda 88% na waɗannan marasa lafiya ba su da ciwo a kai a kai bayan jimlar maye gurbin hip (THR) [16]. A cikin binciken matukin jirgi mun bincika marasa lafiya goma masu fama da hip OA kafin da kuma jim kadan bayan tiyata. Mun sami raguwar abubuwa masu launin toka a cikin cortex na baya (ACC) da insula a lokacin ciwo mai tsanani kafin aikin tiyata na THR kuma mun sami karuwar kwayoyin launin toka a cikin sassan kwakwalwa masu dacewa a cikin yanayin rashin jin daɗi bayan tiyata [17]. Mayar da hankali kan wannan sakamakon, yanzu mun faɗaɗa karatunmu game da ƙarin marasa lafiya (n?=?20) bayan nasarar THR da lura da canje-canjen tsarin kwakwalwa a cikin tazarar lokaci huɗu, har zuwa shekara guda bayan tiyata. Don sarrafa canje-canjen al'amuran launin toka saboda haɓaka mota ko ɓacin rai mun kuma gudanar da tambayoyin tambayoyin da ke nufin haɓaka aikin motsa jiki da lafiyar hankali.
Kaya da matakai
Masu aikin agaji
Marasa lafiya da aka ruwaito a nan rukuni ne na marasa lafiya na 20 daga cikin marasa lafiya 32 da aka buga kwanan nan waɗanda aka kwatanta da shekaru-da kuma jinsi-daidaita ƙungiyar kula da lafiya [17] amma sun shiga cikin ƙarin bincike na shekara guda. Bayan tiyata 12 marasa lafiya sun daina fita saboda aikin tiyata na biyu na endoprosthetic (n?=?2), rashin lafiya mai tsanani (n?=?2) da kuma janye yarda (n?=?8). Wannan ya bar rukunin marasa lafiya ashirin tare da OA na farko na farko (yana nufin shekaru 63.25�9.46 (SD) shekaru, mata 10) waɗanda aka bincika sau huɗu: kafin tiyata (jin zafi) da kuma 6�8 da 12�18 makonni da 10 �watanni 14 bayan tiyatar endoprosthetic, lokacin da babu ciwo gaba ɗaya. Duk marasa lafiya tare da OA na farko suna da tarihin ciwo fiye da watanni 12, daga 1 zuwa 33 shekaru (ma'anar 7.35 shekaru) da kuma ma'anar ciwo na 65.5 (daga 40 zuwa 90) akan sikelin analog na gani (VAS) wanda ya fito daga 0 (babu zafi) zuwa 100 (mafi munin zafin da ake iya tunanin). Mun ƙididdige duk wani abin da ya faru na ƙananan ciwo, ciki har da hakori-, kunne- da ciwon kai har zuwa makonni 4 kafin binciken. Mun kuma zaɓi bayanan ba da gangan ba daga jima'i 20- kuma shekaru sun dace da kulawar lafiya (ma'anar shekaru 60,95�8,52 (SD) shekaru, mace 10) na 32 na binciken matukin jirgi da aka ambata a sama [17]. Babu wani daga cikin marasa lafiya 20 ko na 20 jima'i- da shekaru da suka dace da masu aikin sa kai masu lafiya da ke da tarihin jijiya ko na ciki. Kwamitin da'a na gida ya ba da izinin binciken kuma an sami izini a rubuce daga duk mahalarta binciken kafin jarrabawa.
Bayanan Hali
Mun tattara bayanai game da ciki, somatization, damuwa, zafi da lafiyar jiki da tunani a cikin duk marasa lafiya da duk maki hudu ta amfani da tambayoyin daidaitattun daidaitattun masu zuwa: Beck Depression Inventory (BDI) [18], Brief Symptom Inventory (BSI) [19], Schmerzempfindungs-Skala (SES?=?jin rashin jin daɗi sikelin) [20] da Binciken Kiwon lafiya 36-Gajeren Form (SF-36) [21] da Bayanan Bayanan Lafiya na Nottingham (NHP). Mun gudanar da maimaita matakan ANOVA kuma mun haɗa t-Tests masu wutsiya guda biyu don nazarin bayanan ɗabi'a na tsaye ta amfani da SPSS 13.0 don Windows (SPSS Inc., Chicago, IL), kuma mun yi amfani da gyaran Greenhouse Geisser idan an keta zato na sphericity. An saita matakin mahimmanci a p<0.05.
VBM - Samun Bayanai
Samun hoto. An yi sikanin MR mai ƙima akan tsarin 3T MRI (Siemens Trio) tare da madaidaicin madaurin kai na tashoshi 12. Ga kowane maki huɗun, duba I (tsakanin rana ta 1 zuwa wata 3 kafin aikin tiyata), duba II (makonni 6 zuwa 8 bayan tiyata), duba III (makonni 12 zuwa 18 bayan tiyata) da duba IV (10�14) watanni bayan tiyata), an samo MRI na T1 mai nauyi ga kowane mai haƙuri ta amfani da jerin 3D-FLASH (TR 15 ms, TE 4.9 ms, kusurwa 25, 1 mm yanka, FOV 256�256, girman voxel 1�1�) 1 mm).
Gudanar da Hoto da Ƙididdiga na Ƙididdiga
An yi su da bincike na farko tare da masu bincike da SPM2 (Sashen Sashen Sashen Gasology, London, Sherbornet ya dogara ne akan babban ƙuduri na 3D MR hotuna kuma yana ba da damar yin amfani da kididdigar hikimar voxel don gano bambance-bambancen yanki a cikin ƙwayar launin toka ko girma [22], [23]. A taƙaice, riga-kafi ya ƙunshi daidaitawar sararin samaniya, rarrabuwar al'amuran launin toka da santsin sararin samaniya mm 10 tare da kernel Gaussian. Don matakan aiwatarwa, mun yi amfani da ingantacciyar yarjejeniya [22], [23] da samfurin na'urar daukar hotan takardu da takamaiman samfurin launin toka [17]. Mun yi amfani da SPM2 maimakon SPM5 ko SPM8 don yin wannan bincike kwatankwacin binciken mu na matukin jirgi [17]. kamar yadda yake ba da damar ingantaccen daidaitawa da rarrabuwa na bayanan tsaye. Koyaya, yayin da ƙarin sabuntawar kwanan nan na VBM (VBM8) ya sami samuwa kwanan nan (dbm.neuro.uni-jena.de/vbm/), mun kuma yi amfani da VBM8.
Tsara-Sectional Analysis
Mun yi amfani da samfurin t-gwajin guda biyu don gano bambance-bambancen yanki a cikin kwakwalwar launin toka tsakanin kungiyoyi (marasa lafiya a lokaci-lokaci scan I (cututtuka na yau da kullum) da kuma kula da lafiya). Mun yi amfani da kofa na p <0.001 (ba a daidaita ba) a duk faɗin kwakwalwa saboda ƙarfin mu mai mahimmanci, wanda ya dogara ne akan nazarin 9 masu zaman kansu da ƙungiyoyin da ke nuna raguwa a cikin launin toka a cikin marasa lafiya na ciwo na kullum [7], [8], 9], [15], [24], [25], [26], [27], [28], cewa ƙwayar launin toka yana ƙaruwa zai bayyana a cikin yankuna guda (don sarrafa ciwo mai dacewa) kamar yadda a cikin binciken mu na matukin jirgi (17). ). An daidaita ƙungiyoyi don shekaru da jima'i ba tare da wani bambanci tsakanin ƙungiyoyi ba. Don bincika ko bambance-bambancen da ke tsakanin ƙungiyoyi sun canza bayan shekara guda, mun kuma kwatanta marasa lafiya a lokaci-lokaci scan IV (ba tare da raɗaɗi ba, bin shekara guda) zuwa ƙungiyar kulawar lafiyar mu.
Tsawon Tsayi
Don gano bambance-bambance tsakanin maki lokaci (Scan I�IV) mun kwatanta sikanin kafin tiyata (jin zafi) da kuma 6-8 da 12�18 makonni da watanni 10 zuwa 14 bayan aikin tiyata na endoprosthetic (kyauta) kamar maimaita ma'aunin ANOVA. Saboda kowane kwakwalwa yana canzawa saboda ciwo mai tsanani na iya buƙatar ɗan lokaci don komawa bayan aiki da kuma dakatar da ciwo kuma saboda ciwon bayan tiyata da marasa lafiya suka ruwaito, mun kwatanta a cikin bincike na tsawon lokaci I da II tare da scan III da IV. Don gano canje-canjen da ba su da alaƙa da zafi, mun kuma nemi canje-canje masu ci gaba a kowane lokaci. Mun jujjuya kwakwalwar marasa lafiya tare da OA na hip na hagu (n? =? 7) don daidaitawa ga gefen jin zafi na duka biyu, kwatancen rukuni da bincike na tsayi, amma da farko an bincika bayanan da ba a kwance ba. Mun yi amfani da maki BDI azaman covariate a cikin ƙirar.
results
Bayanan ƙira
Duk marasa lafiya sun ba da rahoton ciwon hanji na yau da kullum kafin tiyata kuma ba su da zafi (game da wannan ciwo mai tsanani) nan da nan bayan tiyata, amma sun ruwaito wani ciwo mai tsanani bayan tiyata akan scan II wanda ya bambanta da zafi saboda osteoarthritis. Makin lafiyar hankali na SF-36 (F(1.925/17.322)?=?0.352, p?=?0.7) da makin BSI na duniya GSI (F(1.706/27.302)?=?3.189, p?=?0.064 ) ba ya nuna canje-canje a tsawon lokaci kuma babu rashin lafiyar kwakwalwa. Babu wani daga cikin abubuwan sarrafawa da ya ba da rahoton wani ciwo mai tsanani ko na yau da kullum kuma babu wanda ya nuna alamun damuwa ko nakasa ta jiki / hankali.
Kafin aikin tiyata, wasu marasa lafiya sun nuna alamun rashin ƙarfi zuwa matsakaici a cikin ƙimar BDI waɗanda suka ragu sosai akan scan III (t(17)?=?2.317, p?=?0.033) da IV (t(16)?=?2.132, p? =?0.049). Bugu da ƙari, ƙimar SES (rashin jin daɗi) na duk marasa lafiya sun inganta sosai daga duba I (kafin tiyata) don duba II (t (16)?=?4.676, p<0.001), scan III (t (14)?=? 4.760, p <0.001) da kuma duba IV (t (14)?=? 4.981, p <0.001, 1 shekara bayan tiyata) kamar yadda rashin jin daɗi ya ragu tare da zafi mai tsanani. Ƙididdigar zafi a kan sikanin 1 da 2 sun kasance tabbatacce, ƙimar guda ɗaya a ranar 3 da 4 mara kyau. SES kawai yana kwatanta ingancin jin zafi. Saboda haka yana da kyau a ranar 1 da 2 (ma'anar 19.6 a ranar 1 da 13.5 a ranar 2) da kuma mummunan (na) a ranar 3 & 4. Duk da haka, wasu marasa lafiya ba su fahimci wannan hanya ba kuma sun yi amfani da SES a matsayin ingancin duniya. na rayuwa�. Wannan shine dalilin da ya sa aka tambayi duk marasa lafiya a rana guda ɗaya ɗaya kuma ta mutum ɗaya game da abin da ya faru na ciwo.
A cikin ɗan gajeren binciken kiwon lafiya (SF-36), wanda ya ƙunshi ma'auni na taƙaitaccen ma'auni na Kiwon Lafiyar Jiki da Sakamakon Kiwon Lafiyar Ƙwararru [29], marasa lafiya sun inganta sosai a cikin Kiwon Lafiyar Jiki daga scan I zuwa duba II (t (t) 17) =??4.266, p?=?0.001), scan III (t(16)?=??8.584, p<0.001) da kuma IV (t(12)?=??7.148, p<0.001), amma ba a cikin Makin Lafiyar Hankali ba. Sakamakon NHP sun kasance iri ɗaya, a cikin ƙananan ƙananan �pain� (juyawar polarity) mun lura da babban canji daga duba I zuwa duba II (t(14)?=??5.674, p <0.001, scan III (t(12) ?? (t(7.040)??=??0.001, p?=?10) da kuma duba IV (t(3.258)??=??0.009, p?=?12) Babu wani gagarumin canji tsakanin scan I da scan II( makonni shida bayan tiyata).
Bayanan Tsari
Tsare-tsare bincike. Mun haɗa shekaru azaman haɗin kai a cikin ƙirar madaidaiciyar gabaɗaya kuma ba mu sami rikicewar shekaru ba. Idan aka kwatanta da jima'i da abubuwan da suka dace da shekarun da suka dace, marasa lafiya tare da OA na farko (n?=?20) sun nuna pre-operatively (Scan I) rage launin toka a cikin cortex na gaba na cingulate (ACC), cortex insular, operculum, dorsolateral prefrontal cortex ( DLPFC), sandar dama na ɗan lokaci da cerebellum (Table 1 da Figure 1). Sai dai madaidaicin putamen (x?=?31, y?=??14, z?=??1; p<0.001, t?=?3.32) ba a sami wani gagarumin karuwa a yawan launin toka ba a cikin marasa lafiya da OA idan aka kwatanta da su. zuwa lafiya controls. Kwatanta marasa lafiya a lokaci-lokaci scan IV tare da sarrafawa masu dacewa, an sami sakamako iri ɗaya kamar yadda aka yi a cikin bincike na giciye ta amfani da scan I idan aka kwatanta da sarrafawa.
Hoto 1: Taswirar ƙididdiga na ƙididdiga waɗanda ke nuna bambance-bambancen tsarin a cikin launin toka a cikin marasa lafiya da ciwo mai tsanani saboda na farko na OA idan aka kwatanta da sarrafawa da kuma tsayin daka idan aka kwatanta da kansu a tsawon lokaci. Ana nuna mahimman canje-canjen al'amuran launin toka sama da launi, bayanan giciye ana nuna su cikin ja da bayanan tsayi cikin rawaya. Jirgin axial: gefen hagu na hoton shine gefen hagu na kwakwalwa. saman: Yankunan raguwa mai mahimmanci na launin toka tsakanin marasa lafiya da ciwo mai tsanani saboda na farko na hip OA da kuma abubuwan da ba su da tasiri. p<0.001 kasa da ba a gyara ba: Halin launin toka ya karu a cikin marasa lafiya na 20 marasa ciwo a lokaci na uku da na hudu bayan jimlar maye gurbin hip, idan aka kwatanta da na farko (preoperative) da na biyu (6�8 makonni bayan tiyata) duba. p<0.001 Matsalolin da ba a gyara ba: Ƙididdiga ta bambanta da 90% tazarar amincewa, tasirin sha'awa, raka'a na sabani. x-axis: ya bambanta ga wuraren lokutan 4, y-axis: ƙiyasin bambanci a ?3, 50, 2 don ACC da ƙimar bambanci a 36, 39, 3 don insula.
Juya bayanan marasa lafiya tare da hagu hip OA (n?=?7) da kwatanta su tare da kulawar lafiya bai canza sakamakon ba sosai, amma don raguwar thalamus (x?=?10, y?=??20, z?= =
Tsayi nazari. A cikin bincike na tsawon lokaci, an gano karuwa mai yawa (p<.001 ba a gyara ba) na launin toka ta hanyar kwatanta na farko da na biyu (ciwo na yau da kullum / ciwon tiyata) tare da na uku da na hudu (ba tare da jin zafi ba) a cikin ACC, Insular cortex, cerebellum da pars orbitalis a cikin marasa lafiya tare da OA (Table 2 da Figure 1). Halin launin toka ya ragu a tsawon lokaci (p <.001 cikakken bincike na kwakwalwa ba a gyara ba) a cikin na biyu na somatosensory cortex, hippocampus, midcingulate cortex, thalamus da caudate nucleus a cikin marasa lafiya tare da OA (Figure 2).
Hoto 2: a) Mahimman haɓakawa a cikin kwayoyin launin toka na kwakwalwa bayan nasarar aiki. Ra'ayin axial na gagarumin raguwar ƙwayar launin toka a cikin marasa lafiya da ciwo mai tsanani saboda na farko na hip OA idan aka kwatanta da batutuwa masu sarrafawa. p<0.001 ba a gyara ba (binciken giciye), b) Tsawon tsayin abu mai launin toka akan lokaci a cikin kwatancen rawaya I&IIscan III>scan IV) a cikin marasa lafiya tare da OA. p<0.001 ba a gyara ba (binciken dogon lokaci). Gefen hagu na hoton shine gefen hagu na kwakwalwa.
Juya bayanan marasa lafiya tare da OA na hagu na hagu (n?=?7) bai canza sakamakon da muhimmanci ba, amma don raguwar kwayoyin launin toka a cikin Heschl's Gyrus (x?=??41, y?=?? 21, z?=?10, p<0.001, t?=?3.69) da Precuneus (x?=?15, y?=??36, z?=?3, p<0.001, t?=?4.60) .
Ta hanyar kwatanta sikanin farko (presurgery) tare da sikanin 3 + 4 (bayan tiyata), mun sami karuwar ƙwayar launin toka a cikin cortex na gaba da ƙwayar motar (p <0.001 ba a gyara ba). Mun lura cewa wannan bambanci ba shi da ƙarfi kamar yadda muke da yanzu ƙananan sikanin kowane yanayi (ciwo vs. mara zafi). Lokacin da muka rage ƙofa muna maimaita abin da muka samo ta amfani da bambanci na 1+2 vs. 3+4.
Ta hanyar neman wuraren da ke ƙaruwa a duk tsawon lokaci, mun sami canje-canje na ƙwayar cuta a cikin wuraren motsa jiki (yanki 6) a cikin marasa lafiya sau ɗaya (yanki)dbm.neuro.uni-jena.de/vbm/) za mu iya maimaita wannan binciken a cikin gaba da tsakiyar cingulate cortex da kuma duka insulae na gaba.
Mun ƙididdige girman tasirin sakamako da bincike-binciken ɓangarori (marasa lafiya vs. controls) sun ba da Cohen�sd na 1.78751 a cikin ƙaramar voxel na ACC (x?=??12, y?=?25, z?=?? 16). Mun kuma ƙididdige Cohen�sd don bincike mai tsayi (sakanin sikanin 1+2 vs. scan 3+4). Wannan ya haifar da Cohen�sd na 1.1158 a cikin ACC (x?=??3, y?=?50, z?=?2). Game da insula (x?=??33, y?=?21, z?=?13) da kuma alaka da wannan sabanin, Cohen�sd shine 1.0949. Bugu da ƙari, mun ƙididdige ma'anar ƙimar voxel maras sifili na taswirar Cohen�sd a cikin ROI (wanda ya ƙunshi ɓangaren baya na cingulate gyrus da subcallosal cortex, wanda aka samo daga Harvard-Oxford Cortical Structural Atlas): 1.251223.
Dr. Alex Jimenez's Insight
Marasa lafiya na yau da kullun suna iya fuskantar al'amuran kiwon lafiya iri-iri a tsawon lokaci, ban da alamun da suka rigaya sun lalace. Alal misali, mutane da yawa za su fuskanci matsalolin barci a sakamakon ciwon su, amma mafi mahimmanci, ciwo mai tsanani zai iya haifar da matsalolin kiwon lafiya daban-daban, ciki har da damuwa da damuwa. Sakamakon da ciwo zai iya haifar da kwakwalwa na iya zama kamar maɗaukaki ne amma shaidu masu girma sun nuna cewa waɗannan canje-canjen kwakwalwa ba su da dindindin kuma za'a iya canzawa lokacin da marasa lafiya masu ciwo na kullum suka sami maganin da ya dace don al'amuran kiwon lafiyar su. Bisa ga labarin, abubuwan da ba su da kyau na launin toka da aka samu a cikin ciwo mai tsanani ba su nuna lalacewar kwakwalwa ba, amma, suna da sakamakon da zai iya canzawa wanda ya daidaita lokacin da jin zafi ya dace. Abin farin ciki, akwai hanyoyi daban-daban na magani don taimakawa wajen sauƙaƙa alamun ciwo mai tsanani da kuma mayar da tsari da aikin kwakwalwa.
tattaunawa
Sa ido kan tsarin kwakwalwa gabaɗayan lokaci, muna tabbatarwa da faɗaɗa bayanan matukin mu da aka buga kwanan nan [17]. Mun sami canje-canje a cikin kwayoyin launin toka a cikin marasa lafiya tare da osteoarthritis na farko a cikin yanayin ciwo na kullum, wanda ya juya wani ɓangare lokacin da waɗannan marasa lafiya ba su da zafi, bayan aikin tiyata na endoprosthetic haɗin gwiwa. Ƙaruwa a ɓangaren ƙwayar launin toka bayan tiyata ya kusan kusan a cikin wuraren da aka ga raguwar ƙwayar launin toka kafin tiyata. Juya bayanan marasa lafiya tare da OA na hagu na hagu (saboda haka daidaitawa ga gefen zafi) yana da ɗan tasiri kaɗan akan sakamakon amma kuma ya nuna raguwar ƙwayar launin toka a cikin gyrus na Heschl da Precuneus wanda ba za mu iya bayyanawa cikin sauƙi ba kuma, kamar yadda babu wani hasashe mai mahimmanci, la'akari da taka tsantsan. Koyaya, bambance-bambancen da aka gani tsakanin marasa lafiya da kulawar lafiya a scan Na kasance har yanzu ana iya gani a cikin binciken giciye a scan IV. Dangantakar haɓakar ƙwayar launin toka a kan lokaci yana da dabara, watau bai isa ya bambanta ba don yin tasiri a kan bincike na ɓangaren giciye, binciken da aka riga aka nuna a cikin binciken binciken gwaninta na dogaro da filastik [30], [31]. Mun lura cewa gaskiyar cewa muna nuna wasu sassa na kwakwalwa-canji saboda ciwo mai tsanani don zama mai canzawa ba ya ware cewa wasu sassa na waɗannan canje-canje ba za su iya canzawa ba.
Abin sha'awa, mun lura cewa ƙwayar launin toka ta ragu a cikin ACC a cikin marasa lafiya na ciwo na kullum kafin tiyata yana ci gaba da ci gaba da makonni 6 bayan tiyata (scan II) kuma kawai yana ƙaruwa zuwa scan III da IV, mai yiwuwa saboda ciwon bayan tiyata, ko ragewa a cikin mota. aiki. Wannan yana cikin layi tare da bayanan halayen halayen motsi na jiki wanda aka haɗa a cikin NHP, wanda bayan aikin ba ya nuna wani canji mai mahimmanci a lokacin II amma ya karu sosai zuwa scan III da IV. Na bayanin kula, marasa lafiyarmu sun ba da rahoton wani ciwo a cikin hip bayan tiyata, amma sun sami ciwon bayan tiyata a cikin tsokoki da fata da ke kewaye da su wanda marasa lafiya suka gane da bambanci. Duk da haka, kamar yadda marasa lafiya har yanzu sun ba da rahoton wasu jin zafi a scan II, mun kuma bambanta da na farko scan (pre-fitat) tare da sikanin III + IV (bayan tiyata), yana nuna karuwar ƙwayar launin toka a cikin cortex na gaba da kuma motar motsa jiki. Mun lura cewa wannan bambanci ba shi da ƙarfi saboda ƙananan sikanin kowane yanayi (ciwo vs. mara zafi). Lokacin da muka saukar da ƙofa muna maimaita abin da muka samo ta amfani da bambanci na I+II vs. III+IV.
Bayananmu yana ba da shawarar cewa sauye-sauyen launin toka a cikin marasa lafiya na ciwo mai tsanani, wanda yawanci ana samuwa a cikin yankunan da ke cikin aikin nociceptive na supraspinal [4] ba saboda rashin lafiyar neuronal ko lalacewar kwakwalwa ba. Gaskiyar cewa waɗannan canje-canjen da aka gani a cikin yanayin ciwo mai tsanani ba su juyo gaba ɗaya ba za a iya bayyana su tare da ɗan gajeren lokaci na kallo (shekara ɗaya bayan aiki tare da ma'anar shekaru bakwai na ciwo mai tsanani kafin aikin). Canje-canjen kwakwalwar neuroplastic wanda wataƙila ya haɓaka sama da shekaru da yawa (sakamakon shigarwar nociceptive akai-akai) yana buƙatar mai yiwuwa ƙarin lokaci don juyawa gaba ɗaya. Wata yuwuwar dalilin da ya sa za a iya gano ƙarar ƙwayar launin toka kawai a cikin bayanan dogon lokaci amma ba a cikin bayanan giciye (watau tsakanin ƙungiyoyi a lokaci IV) shine adadin marasa lafiya (n?=?20) yayi ƙanƙanta. Ya kamata a yi nuni da cewa bambance-bambancen da ke tsakanin kwakwalwar mutane da yawa yana da girma sosai kuma bayanan na tsaye suna da fa'ida cewa bambance-bambancen yana da ƙanƙanta kamar yadda ake duba kwakwalwar sau da yawa. Saboda haka, za a iya gano sauye-sauye masu sauƙi a cikin bayanan dogon lokaci [30], [31], [32]. Tabbas ba za mu iya ware cewa waɗannan canje-canje aƙalla ba za su iya jurewa ba duk da cewa hakan ba zai yuwu ba, idan aka ba da sakamakon binciken ƙayyadaddun ƙayyadaddun ƙayyadaddun filastik da sake tsarawa [4], [12], [30], [33], [34]. Don amsa wannan tambayar, bincike na gaba yana buƙatar bincika marasa lafiya akai-akai na tsawon lokaci, maiyuwa shekaru.
Mun lura cewa kawai za mu iya yin iyakacin iyaka game da canjin yanayin kwakwalwar da ke canzawa cikin lokaci. Dalili kuwa shi ne, lokacin da muka tsara wannan binciken a shekarar 2007 kuma aka duba a 2008 da 2009, ba a san ko sauye-sauyen tsarin za su faru ba kwata-kwata kuma saboda dalilai na yuwuwar mun zabi kwanakin da aka yi amfani da su da kuma lokutan binciken kamar yadda aka bayyana a nan. Mutum zai iya yin jayayya cewa al'amarin launin toka yana canzawa a lokaci, wanda muka kwatanta ga ƙungiyar masu haƙuri, zai iya faruwa a cikin ƙungiyar kulawa kuma (sakamakon lokaci). Koyaya, duk wani canje-canje saboda tsufa, idan ya kasance, ana tsammanin zai zama raguwar girma. Idan aka ba da ma'anar mu na farko, dangane da nazarin 9 masu zaman kansu da ƙungiyoyin da ke nuna raguwa a cikin launin toka a cikin marasa lafiya na ciwo na kullum [7], [8], [9], [15], [24], [25], [26], [27], [28]. Abin lura, ba za mu iya yin watsi da cewa ƙwayar launin toka tana raguwa cikin lokaci da muka samu a rukunin majinyatan mu na iya zama saboda tasirin lokaci, kamar yadda ba mu bincika ƙungiyar mu ba a cikin lokaci guda. Idan aka ba da binciken, binciken da za a yi a nan gaba ya kamata ya yi niyya a cikin ɗan gajeren lokaci, wanda aka ba da cewa motsa jiki da ke dogara da kwakwalwar kwakwalwa na iya faruwa da sauri kamar bayan mako 1 [32], [33].
Bugu da ƙari ga tasirin yanayin nociceptive na ciwo a kan kwayoyin launin toka na kwakwalwa [17], [34] mun lura cewa canje-canje a cikin aikin motar mai yiwuwa ma yana taimakawa ga canje-canjen tsarin. Mun sami wuraren motsa jiki da premotor (yanki 6) don haɓaka akan kowane tazara (Hoto 3). Haƙiƙa wannan yana iya kasancewa saboda haɓaka aikin motar a kan lokaci yayin da marasa lafiya ba su da ƙarin ƙuntatawa a rayuwa ta al'ada. Musamman ba mu mai da hankali kan aikin motsa jiki ba amma haɓakawa a cikin ƙwarewar jin zafi, da aka ba mu na asali don bincika ko raguwar da aka sani a cikin ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar cuta ta fi dacewa ta sake komawa. Saboda haka, ba mu yi amfani da takamaiman kayan aiki don bincika aikin mota ba. Duk da haka, (aiki) gyaran gyaran gyare-gyare na motsa jiki a cikin marasa lafiya da ciwon ciwo yana da kyau a rubuce [35], [36], [37], [38]. Bugu da ƙari, ƙwayar motar motar ita ce manufa ɗaya a cikin hanyoyin warkewa a cikin marasa lafiya marasa lafiya marasa lafiya ta hanyar amfani da kwakwalwar kwakwalwa ta kai tsaye [39], [40], motsa jiki kai tsaye na halin yanzu [41], da kuma maimaitawar haɓakar haɓakar haɓakar magnetic [42], [43]. Mahimman hanyoyin irin wannan gyare-gyaren (saukarwa vs. hanawa, ko kuma kawai tsangwama a cikin cibiyoyin sadarwar da ke da ciwo) ba a bayyana ba tukuna [40]. Wani bincike na baya-bayan nan ya nuna cewa takamaiman ƙwarewar motsa jiki na iya canza tsarin kwakwalwa [13]. Synaptogenesis, sake tsara wakilcin motsi da angiogenesis a cikin bawo na motsi na iya faruwa tare da buƙatun musamman na aikin motar. Tsawo et al. ya nuna sake tsarawa a cikin motar motsa jiki na marasa lafiya tare da ciwon baya na baya-bayan nan wanda ke da alama yana da takamaiman ciwon baya [44] da Puri et al. an lura da raguwa a cikin ƙarin ƙarin motsi na hagu na al'amarin launin toka a cikin masu fama da fibromyalgia [45]. Ba a tsara nazarin mu don warware matsalolin daban-daban waɗanda zasu iya canza kwakwalwa a cikin ciwo mai tsanani amma muna fassara bayanan mu game da canjin launin toka wanda ba sa kama da sakamakon da aka samu na ci gaba da shigarwar nociceptive. A gaskiya ma, wani binciken da aka yi kwanan nan a cikin marasa lafiya na ciwon neuropathic ya nuna rashin daidaituwa a cikin yankunan kwakwalwa da ke tattare da tunanin mutum, mai zaman kansa, da jin zafi, yana nuna cewa suna taka muhimmiyar rawa a cikin hoton asibiti na duniya na ciwo mai tsanani [28].
Hoto na 3: Taswirar sigar ƙididdiga suna nuna mahimmancin ƙwayoyin kwakwalwa a cikin wuraren motoci (yanki 6) a cikin marasa lafiya kafin idan aka kwatanta da na ƙarshe (na zamani), duba ni Ƙimar kwatanta a x?=?19, y?=??12, z?=?70.
Nazarin matukin jirgi guda biyu na baya-bayan nan sun mayar da hankali kan maganin maye gurbin hip a cikin marasa lafiya na osteoarthritis, kawai ciwo mai raɗaɗi na yau da kullun wanda ke iya warkewa tare da jimlar maye gurbin hip [17], [46] kuma waɗannan bayanan suna da alaƙa da wani binciken da aka yi kwanan nan a cikin marasa lafiya marasa lafiya marasa lafiya [47] 30]. Ana buƙatar ganin waɗannan karatun a cikin hasken binciken da yawa na dogon lokaci da ke bincikar ƙwarewar ƙwararrun ƙwayar cuta a cikin ɗan adam akan matakin tsari [31], [34] da kuma wani binciken da aka yi kwanan nan game da canje-canjen kwakwalwar tsarin a cikin masu sa kai masu lafiya waɗanda ke fama da maimaitawa mai raɗaɗi [6] . Mahimmin saƙo na duk waɗannan karatun shine cewa babban bambanci a cikin tsarin kwakwalwa tsakanin masu fama da ciwo da sarrafawa na iya komawa baya lokacin da ciwon ya warke. Duk da haka, dole ne a la'akari da cewa ba a bayyane ba ko canje-canje a cikin marasa lafiya na ciwo na kullum sun kasance kawai saboda shigarwar nociceptive ko kuma sakamakon sakamakon ciwo ko duka biyu. Ya fi yuwuwar canje-canjen ɗabi'a, kamar rashi ko haɓaka hulɗar zamantakewa, ƙarfin hali, horo na jiki da sauye-sauyen salon rayuwa sun isa su tsara kwakwalwa [12], [28], [48], [XNUMX]. Musamman baƙin ciki a matsayin haɗin gwiwa ko sakamakon ciwo shine babban ɗan takara don bayyana bambance-bambance tsakanin marasa lafiya da sarrafawa. Ƙananan rukunin marasa lafiyar mu tare da OA sun nuna alamun rashin tausayi masu sauƙi zuwa matsakaici waɗanda suka canza tare da lokaci. Ba mu sami gyare-gyaren tsarin ba don yin tasiri sosai tare da BDI-maki amma tambayar ta taso nawa wasu canje-canje na hali saboda rashin ciwo da haɓaka mota na iya taimakawa ga sakamakon da kuma yadda suke yi. Wadannan sauye-sauye na hali na iya yin tasiri ga raguwar ƙwayar launin toka a cikin ciwo na kullum da kuma ƙarar launin toka lokacin da ciwo ya tafi.
Wani muhimmin al'amari wanda zai iya ɓata fassarar mu game da sakamakon shine gaskiyar cewa kusan dukkanin marasa lafiya da ke fama da ciwo mai tsanani sun dauki magunguna don ciwo, wanda suka tsaya lokacin da ba su da zafi. Mutum zai iya jayayya cewa NSAIDs irin su diclofenac ko ibuprofen suna da wasu tasiri akan tsarin jijiyoyi kuma iri ɗaya yana da gaskiya ga opioids, antiepileptics da antidepressants, magungunan da ake amfani dasu akai-akai a cikin maganin ciwo na kullum. Tasirin masu kashe ciwo da sauran magunguna akan binciken morphometric na iya zama mahimmanci (48). Babu wani binciken da ya zuwa yanzu ya nuna tasirin maganin jin zafi a kan ilimin halittar kwakwalwa amma wasu takardu da yawa sun gano cewa canje-canje a cikin tsarin kwakwalwa a cikin marasa lafiya na ciwo mai tsanani ba a bayyana su kawai ta hanyar rashin aiki na ciwo [15], ko kuma ta hanyar jin zafi [7], [9]. [49] Duk da haka, ƙayyadaddun karatu ba su da yawa. Ƙarin bincike ya kamata ya mayar da hankali ga canje-canje masu dogara da kwarewa a cikin cortical plasticity, wanda zai iya samun babban tasiri na asibiti don maganin ciwo mai tsanani.
Mun kuma sami raguwar abubuwa masu launin toka a cikin bincike na tsayi, mai yiwuwa saboda tsarin sake tsarawa wanda ke tare da canje-canje a cikin aikin mota da jin zafi. Akwai ƙananan bayanai game da canje-canje na tsayin daka a cikin kwayoyin launin toka a cikin yanayin zafi, saboda wannan dalili ba mu da hasashe don raguwar ƙwayar launin toka a waɗannan wuraren bayan aikin. Teutsch et al. [25] Sun gano karuwar kwayar cutar kwakwalwa a cikin Satattox a cikin masu ba da agaji mai lafiya wadanda suka dandana mai zafi a cikin kwanaki takwas na jere. Binciken ƙwayar launin toka yana ƙaruwa bayan shigarwar nociceptive na gwaji ya mamaye jiki zuwa wani mataki tare da raguwar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar cuta a cikin wannan binciken a cikin marasa lafiya da aka warkar da su na dogon lokaci. Wannan yana nuna cewa shigarwar nociceptive a cikin masu aikin sa kai masu lafiya suna haifar da motsa jiki masu dogara da sauye-sauye na tsarin, kamar yadda zai yiwu a cikin marasa lafiya da ciwo mai tsanani, kuma waɗannan canje-canjen sun juya cikin masu sa kai masu lafiya lokacin da shigarwar nociceptive ya tsaya. Sakamakon haka, raguwar ƙwayar launin toka a cikin waɗannan wuraren da aka gani a cikin marasa lafiya tare da OA za a iya fassara su don bin tsari guda ɗaya: dogara da motsa jiki yana canza canje-canjen kwakwalwa [50]. A matsayin hanya mara cin zarafi, MR Morphometry shine kayan aiki mai kyau don nema don nemo nau'ikan kwayoyin halitta na cututtuka, zurfafa fahimtar dangantakar da ke tsakanin tsarin kwakwalwa da aiki, har ma don saka idanu kan hanyoyin warkewa. Ɗaya daga cikin manyan kalubale a nan gaba shi ne daidaita wannan kayan aiki mai karfi don gwaje-gwaje masu yawa da kuma maganin warkewa na ciwo mai tsanani.
Iyakar wannan Nazarin
Ko da yake wannan binciken shine tsawo na bincikenmu na baya yana fadada bayanan da aka biyo baya zuwa watanni 12 da kuma bincikar ƙarin marasa lafiya, ka'idarmu ta gano cewa kwakwalwar kwakwalwar kwakwalwa ta canza a cikin ciwo mai tsanani yana canzawa yana da hankali. Girman tasirin suna ƙanana (duba sama) kuma tasirin yana haifar da ƙarin raguwar ƙarar ƙwayar ƙwayar ƙwayar ƙwayar cuta ta yanki a lokacin-lokacin binciken 2. Lokacin da muka ware bayanan daga sikanin 2 (kai tsaye bayan aikin) kawai mahimmanci Yana ƙaruwa a cikin kwakwalwar launin toka don ƙwayoyin cuta da na gaba na baya da ke gaban cortex tsira daga bakin p <0.001 wanda ba a sani ba (Table 3).
Kammalawa
Ba zai yiwu a bambanta har zuwa wane irin gyare-gyaren tsarin da muka lura ba saboda canje-canje a cikin shigarwar nociceptive, canje-canje a cikin aikin mota ko shan magani ko canje-canje a cikin jin dadi kamar haka. Rufe bambance-bambancen rukunin farko da na ƙarshe tare da juna ya nuna ƙarancin bambance-bambance fiye da yadda ake tsammani. Mai yiwuwa, sauye-sauyen kwakwalwa saboda ciwo mai tsanani tare da duk sakamakon yana tasowa na dogon lokaci kuma yana iya buƙatar ɗan lokaci don komawa. Duk da haka, waɗannan sakamakon suna bayyana hanyoyin sake tsarawa, suna ba da shawara mai ƙarfi cewa shigarwar nociceptive na yau da kullun da nakasar motsa jiki a cikin waɗannan marasa lafiya suna haifar da sauye-sauyen aiki a cikin yankuna na cortical kuma saboda haka canje-canjen tsarin kwakwalwa waɗanda ke cikin ka'ida mai canzawa.
Acknowledgments
Muna gode wa duk masu sa kai don shiga cikin wannan binciken da ƙungiyar Physics da Hanyoyi a NeuroImage Nord a Hamburg. Kwamitin da'a na gida ya ba da izinin binciken kuma an sami izini a rubuce daga duk mahalarta binciken kafin jarrabawa.
Bayanin Kudin Kuɗi
An tallafa wa wannan aikin ta hanyar tallafi daga DFG (Gidan Bincike na Jamusanci) (MA 1862 / 2-3) da BMBF (Ma'aikatar Ilimi da Bincike ta Tarayya) (371 57 01 da NeuroImage Nord). Masu ba da kuɗaɗen ba su da wata rawa wajen ƙirƙira bincike, tattara bayanai da bincike, yanke shawarar bugawa, ko shirya rubutun.
Tsarin Endocannabinoid: Mahimman Tsarin da Baku taɓa Ji ba
Idan ba ku ji labarin tsarin endocannabinoid, ko ECS ba, babu buƙatar jin kunya. A baya cikin shekarun 1960, masu binciken da suka zama masu sha'awar bioactivity na Cannabis a ƙarshe sun ware yawancin sinadarai masu aiki. Ya ɗauki wasu shekaru 30, duk da haka, don masu binciken da ke nazarin ƙirar dabba don nemo mai karɓar waɗannan sinadarai na ECS a cikin kwakwalwar rodents, wani binciken da ya buɗe dukan duniya na bincike game da wanzuwar masu karɓar ECS da kuma menene manufar ilimin halittarsu.
Yanzu mun san cewa yawancin dabbobi, daga kifaye zuwa tsuntsaye zuwa dabbobi masu shayarwa, suna da endocannabinoid, kuma mun san cewa mutane ba kawai suna yin nasu cannabinoids wanda ke hulɗa da wannan tsarin ba, amma muna samar da wasu mahadi masu hulɗa tare da ECS, na waɗanda ake lura da su a cikin tsire-tsire da abinci daban-daban, fiye da nau'in Cannabis.
A matsayin tsarin jikin mutum, ECS ba wani dandamali bane keɓe kamar tsarin jijiya ko tsarin zuciya. Madadin haka, ECS wani tsari ne na masu karɓa wanda aka rarraba a ko'ina cikin jiki waɗanda aka kunna ta hanyar saitin ligands da muka sani tare da endocannabinoids, ko cannabinoids endogenous. Duk masu karɓa da aka tabbatar ana kiran su CB1 da CB2, kodayake akwai wasu waɗanda aka gabatar. Tashoshin PPAR da TRP suma suna daidaita wasu ayyuka. Hakanan, zaku sami endocannabinoids masu kyau guda biyu kawai: anadamide da 2-arachidonoyl glycerol, ko 2-AG.
Bugu da ƙari, mahimmanci ga tsarin endocannabinoid shine enzymes wanda ke haɗawa da rushe endocannabinoids. An yi imanin endocannabinoids an haɗa su a cikin tushe kamar yadda ake buƙata. Enzymes na farko da ke ciki sune diacylglycerol lipase da N-acyl-phosphatidylethanolamine-phospholipase D, wanda ya hada da 2-AG da anandamide. Manyan enzymes masu lalata su ne fatty acid amide hydrolase, ko FAAH, wanda ke rushe anandamide, da monoacylglycerol lipase, ko MAGL, wanda ya rushe 2-AG. Tsarin waɗannan enzymes guda biyu na iya ƙarawa ko rage daidaitawar ECS.
Menene Aiki na ECS?
ECS shine babban tsarin kulawa na gida na jiki. Ana iya kallonsa da sauri azaman tsarin daidaita yanayin jiki, koyaushe yana aiki don kiyaye ma'auni na ayyuka iri-iri. Endocannabinoids suna aiki sosai azaman neuromodulators kuma, don haka, suna tsara nau'ikan tafiyar matakai na jiki, daga haihuwa zuwa zafi. Wasu daga cikin sanannun ayyuka daga ECS sune kamar haka:
m System
Daga tsarin kulawa na tsakiya, ko CNS, haɓakawa na gaba ɗaya na masu karɓar CB1 zai hana sakin glutamate da GABA. A cikin CNS, ECS yana taka rawa a cikin samuwar ƙwaƙwalwar ajiya da ilmantarwa, yana haɓaka neurogenesis a cikin hippocampus, kuma yana daidaita haɓakar neuronal. Har ila yau, ECS yana taka rawa a cikin hanyar da kwakwalwa za ta yi don rauni da kumburi. Daga kashin baya, ECS yana daidaita siginar ciwo kuma yana ƙarfafa analgesia na halitta. A cikin tsarin juyayi na gefe, wanda masu karɓa na CB2 ke sarrafawa, ECS yana aiki da farko a cikin tsarin juyayi mai juyayi don tsara ayyuka na hanji, urinary, da hanyoyin haihuwa.
Damuwa da yanayi
ECS yana da tasiri da yawa akan halayen danniya da ka'idojin motsin rai, kamar ƙaddamar da wannan amsawar jiki ga matsanancin damuwa da daidaitawa akan lokaci zuwa ƙarin motsin rai na dogon lokaci, kamar tsoro da damuwa. Tsarin endocannabinoid mai aiki mai lafiya yana da mahimmanci ga yadda mutane ke daidaitawa tsakanin matakan gamsarwa mai gamsarwa idan aka kwatanta da matakin da ya wuce kima da rashin jin daɗi. ECS kuma yana taka rawa a cikin samuwar ƙwaƙwalwar ajiya kuma maiyuwa ne musamman ta hanyar da kwakwalwa ke buga abubuwan tunawa daga damuwa ko rauni. Saboda ECS yana daidaita sakin dopamine, noradrenaline, serotonin, da cortisol, kuma yana iya rinjayar martanin motsin rai da halaye.
narkewa kamar tsarin
Wurin narkewa yana cike da duka CB1 da CB2 masu karɓa waɗanda ke daidaita yawancin mahimman abubuwan kiwon lafiyar GI. Ana tunanin cewa ECS na iya zama "haɗin da ya ɓace" a cikin kwatanta haɗin gwiwar gut-brain-immune wanda ke taka muhimmiyar rawa a cikin aikin lafiyar tsarin narkewa. ECS shine mai kula da rigakafi na gut, watakila ta hanyar iyakance tsarin rigakafi daga lalata tsire-tsire masu lafiya, kuma ta hanyar daidaitawar siginar cytokine. ECS yana daidaita amsawar ƙwayar cuta ta dabi'a a cikin tsarin narkewa, wanda ke da mahimmanci ga al'amuran kiwon lafiya da yawa. Motsin ciki da na GI na gabaɗaya shima ya bayyana a wani yanki na ECS ke sarrafa shi.
Ci abinci da Metabolism
ECS, musamman masu karɓar CB1, suna taka rawa a cikin sha'awar ci, metabolism, da daidaita kitsen jiki. Ƙarfafa masu karɓar CB1 yana haɓaka halayen neman abinci, haɓaka wayewar wari, kuma yana daidaita daidaiton kuzari. Dukansu dabbobi da mutanen da ke da kiba suna da dysregulation na ECS wanda zai iya haifar da wannan tsarin ya zama hyperactive, wanda ke ba da gudummawa ga duka yawan cin abinci da rage kashe kuzari. An nuna matakan kewayawa na anandamide da 2-AG don haɓaka cikin kiba, wanda zai iya zama wani ɓangare saboda rage samar da enzyme na lalata FAAH.
Lafiyar rigakafi da Amsar kumburi
Kwayoyin da gabobin tsarin rigakafi suna da wadata tare da masu karɓar endocannabinoid. Ana bayyana masu karɓa na Cannabinoid a cikin glandar thymus, splin, tonsils, da marrow kashi, da kuma akan T- da B-lymphocytes, macrophages, kwayoyin mast, neutrophils, da kwayoyin kisa na halitta. Ana ɗaukar ECS a matsayin direba na farko na daidaita tsarin rigakafi da homeostasis. Ko da yake ba a fahimci duk ayyukan ECS daga tsarin rigakafi ba, ECS ya bayyana yana tsara tsarin samar da cytokine kuma yana da tasiri wajen hana yawan aiki a cikin tsarin rigakafi. Kumburi wani bangare ne na dabi'a na amsawar rigakafi, kuma yana taka rawar al'ada sosai a cikin mummunan zagi ga jiki, ciki har da rauni da cututtuka; duk da haka, lokacin da ba a kiyaye shi ba zai iya zama na dindindin kuma yana taimakawa wajen haifar da mummunar matsalolin lafiya, kamar ciwo mai tsanani. Ta hanyar kiyaye amsawar rigakafi a cikin rajistan, ECS yana taimakawa wajen kula da ma'auni mai mahimmanci ta hanyar jiki.
Sauran wuraren kiwon lafiya da ECS ke tsarawa:
Kashi lafiya
Haihuwa
Lafiya na fata
Lafiyar jijiya da numfashi
Barci da zaren circadian
Yadda za a fi dacewa da goyan bayan ECS mai lafiya shine tambaya da yawancin masu bincike ke ƙoƙarin amsawa. Ku kasance da mu domin samun karin bayani kan wannan batu da ya kunno kai.
A ƙarshe,�An haɗa zafi na yau da kullun tare da sauye-sauyen ƙwaƙwalwa, gami da rage ƙwayar launin toka. Duk da haka, labarin da ke sama ya nuna cewa ciwo mai tsanani zai iya canza tsarin gaba ɗaya da aikin kwakwalwa. Ko da yake ciwo mai tsanani zai iya haifar da waɗannan, a tsakanin sauran al'amurran kiwon lafiya, maganin da ya dace na alamun bayyanar cututtuka na marasa lafiya zai iya canza canje-canje na kwakwalwa da kuma daidaita al'amuran launin toka. Bugu da ƙari kuma, ƙarin binciken bincike ya fito a bayan mahimmancin tsarin endocannabinoid kuma yana aiki a cikin sarrafawa da kuma kula da ciwo mai tsanani da sauran al'amurran kiwon lafiya. Bayanin da aka ambata daga Cibiyar Nazarin Kimiyyar Halittu ta Ƙasa (NCBI) �Irin bayanin mu yana iyakance ga chiropractic da kuma raunin da ya faru da kashin baya. Don tattauna batun, da fatan za a iya tambayar Dr. Jimenez ko tuntuɓe mu a�915-850-0900 .
Dr. Alex Jimenez ne ya shirya shi
Ƙarin Maudu'i: Ciwon Baya
Binciken baya yana daya daga cikin abubuwan da ke haifar da nakasa da kuma rashin kwanakin aiki a duniya. A gaskiya ma, an danganta ciwon baya a matsayin dalili na biyu mafi yawan lokuta na ziyartar ofisoshin likitoci, wanda ya fi girma kawai ta hanyar cututtuka na sama. Kusan 80 bisa dari na yawan jama'a za su fuskanci wani nau'i na ciwon baya a kalla sau ɗaya a rayuwarsu. Kashin baya wani tsari ne mai rikitarwa wanda ya kunshi kasusuwa, gidajen abinci, jijiya da tsokoki, a tsakanin sauran kyallen takarda masu laushi. Saboda wannan, raunin da / ko yanayin da ya tsananta, kamar 'yan kwalliya, a ƙarshe na iya haifar da alamun ciwon baya. Raunin wasanni ko raunin haɗari na mota sau da yawa shine mafi yawan dalilin ciwon baya, duk da haka, wani lokacin mafi sauƙi na motsi na iya samun sakamako mai raɗaɗi. Abin farin ciki, madadin zaɓuɓɓukan magani, irin su kulawar chiropractic, na iya taimakawa wajen sauƙaƙe ciwon baya ta hanyar yin amfani da gyare-gyare na kashin baya da kuma manipulations na hannu, a ƙarshe inganta jin zafi.
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Biochemistry na Pain:�Dukkan ciwon ciwo suna da bayanin kumburi. Bayanan kumburi na iya bambanta daga mutum zuwa mutum kuma yana iya bambanta a cikin mutum ɗaya a lokuta daban-daban. Maganin ciwon ciwo shine fahimtar wannan bayanin kumburi. Ana kula da ciwon ciwo ta hanyar magani, tiyata ko duka biyun. Manufar ita ce hanawa / hana samar da masu shiga tsakani. Kuma sakamako mai nasara shine wanda ke haifar da ƙananan kumburi kuma ba shakka rashin ciwo.
Biochemistry na Pain
Manufofin:
Wanene manyan 'yan wasa
Menene hanyoyin sinadarai na sinadarai?
Menene sakamakon?
Binciken Kumburi:
key Players
Me Yasa Kafada Na Ke Ciki? Bita na Tushen Neuroanatomical & Biochemical Tushen Ciwon Kafada
ABDRACT
Idan majiyyaci ya tambaya �me yasa kafada na ke ciwo? Sau da yawa, likitan likitancin ya fahimci iyakokin tushen kimiyya na bayanin su, yana nuna rashin cikar fahimtar mu game da yanayin ciwon kafada. Wannan bita yana ɗaukar tsarin tsari don taimakawa wajen amsa tambayoyi masu mahimmanci da suka shafi ciwon kafada, tare da ra'ayi don samar da basira game da bincike na gaba da kuma sababbin hanyoyin da za a magance ciwon kafada. Za mu bincika matsayin (1) masu karɓa na gefe, (2) sarrafa ciwo na gefe ko �nociception�, (3) kashin baya, (4) kwakwalwa, (5) wurin masu karɓa a cikin kafada da (6) ) jijiya jijiya na kafada. Har ila yau, muna la'akari da yadda waɗannan abubuwan zasu iya taimakawa wajen bambanta a cikin gabatarwar asibiti, ganewar asali da kuma maganin ciwon kafada. Ta wannan hanyar muna nufin samar da wani bayyani na sassan sassan tsarin gano ciwo na gefe da kuma hanyoyin sarrafa ciwo na tsakiya a cikin ciwon kafada wanda ke hulɗar don haifar da ciwo na asibiti.
GABATARWA: TAKAITACCEN TARIHIN KIMIYYAR CIWON KIMIYYA MAI MUHIMMAN GA MASU LIKITA.
Halin ciwo, a gaba ɗaya, ya kasance batun rikici da yawa a cikin karni na baya. A cikin karni na 17 Descartes ka'idar1 ya ba da shawarar cewa tsananin zafi yana da alaƙa kai tsaye da adadin raunin nama mai alaƙa kuma an sarrafa zafi ta hanya ɗaya ta musamman. Yawancin ka'idodin da suka gabata sun dogara da wannan abin da ake kira �dualist� falsafar Descartian, ganin zafi sakamakon haɓakar wani takamaiman mai karɓar raɗaɗi a cikin kwakwalwa. A cikin karni na 20 an yi yakin kimiyya tsakanin ka'idoji guda biyu masu gaba da juna, wato ka'idar ka'ida da ka'idar tsari. Ka'idar ta musamman ta Descartian ta ga zafi a matsayin takamaiman tsarin shigar da hankali tare da na'urarta, yayin da ka'idar ka'idar ta ji cewa zafi ya samo asali ne daga tsananin kuzari na masu karɓa na musamman.2 A cikin 1965, Wall da Melzacks 3. ka'idar ƙofa na ciwo ya ba da shaida ga samfurin wanda aka daidaita fahimtar jin zafi ta hanyar ra'ayi mai mahimmanci da kuma tsarin kulawa na tsakiya. Wani babban ci gaba a ka'idar jin zafi a kusa da lokaci guda ya ga gano takamaiman yanayin ayyuka na opioids.4 Daga baya, ci gaba na kwanan nan a cikin neuroimaging da maganin kwayoyin halitta sun fadada fahimtarmu gaba daya game da ciwo.
To yaya wannan yake da alaƙa da ciwon kafaɗa?�Ciwon kafada matsala ce ta gama gari, da ƙaƙƙarfan fahimtar hanyar da jiki ke sarrafa ciwo yana da mahimmanci don mafi kyawun ganowa da magance ciwon mara lafiya. Ci gaba a cikin iliminmu game da maganin jin zafi ya yi alkawarin bayyana rashin daidaituwa tsakanin ilimin cututtuka da kuma fahimtar ciwo, suna iya taimaka mana mu bayyana dalilin da yasa wasu marasa lafiya suka kasa amsawa ga wasu jiyya.
TUSHEN GININ GINDI NA CIWON
Masu karɓa na zahiri: mechanoreceptor da �nociceptor�
Akwai nau'ikan nau'ikan masu karɓa na zahiri da yawa waɗanda ke cikin tsarin tsokar ɗan adam. 5 Za a iya rarraba su dangane da ayyukansu (kamar injiniyoyi, thermoreceptors ko nociceptors) ko ilimin halittar jiki (nau'in jijiyoyi masu kyauta ko nau'ikan masu karɓa daban-daban). kasancewar wasu alamomin sinadarai. Akwai mahimman cikowa tsakanin nau'o'in aiki daban-daban na mai karɓa, misali
Gudanar da Ciwon Jiki: �Nociception�
Raunin nama ya ƙunshi nau'ikan masu shiga tsakani masu kumburi waɗanda aka sake su ta hanyar lalata ƙwayoyin cuta ciki har da bradykinin, histamine, 5-hydroxytryptamine, ATP, nitric oxide da wasu ions (K+ da H+). Kunna hanyar arachidonic acid yana haifar da samar da prostaglandins, thromboxanes da leuko-trienes. Cytokines, ciki har da interleukins da tumor necrosis factor?, da kuma neurotrophins, irin su jijiya girma factor (NGF), kuma an sake su kuma suna da hannu sosai a cikin sauƙaƙe kumburi.15 Sauran abubuwa irin su amino acid mai ban sha'awa (glutamate) da opioids ( endothelin-1) kuma an haɗa su a cikin mummunar amsawar ƙwayar cuta.16 17 Wasu daga cikin waɗannan wakilai na iya kunna nociceptors kai tsaye, yayin da wasu suka kawo aikin daukar nauyin wasu kwayoyin halitta wanda ya sake sakin ƙarin masu taimakawa. na nociceptive neurons zuwa shigarsu na yau da kullun da/ko ɗaukar martani ga abubuwan da aka saba amfani da su na ƙasa ana kiransu �halayen yanayi
NGF da mai karɓa na wucin gadi m tashar tashar tashar tashar tashar tashar V memba na 1 (TRPV1) mai karɓa yana da alaƙar alaƙa idan ya zo ga kumburi da ƙwarewar nociceptor. Cytokines da aka samar a cikin nama mai kumburi yana haifar da karuwa a cikin samar da NGF.19 NGF yana ƙarfafa sakin histamine da serotonin (5-HT3) ta hanyar kwayoyin mast, kuma yana da hankali ga nociceptors, mai yiwuwa ya canza kaddarorin A? zaruruwa kamar yadda mafi girma rabo zama nociceptive. Mai karɓa na TRPV1 yana cikin ƙananan ƙananan filaye na filaye na farko kuma ana kunna shi ta capsaicin, zafi da protons. Mai karɓa na TRPV1 an haɗa shi a cikin jikin kwayar halitta na filaye mai banƙyama, kuma an kai shi zuwa duka biyu na gefe da na tsakiya, inda yake ba da gudummawa ga ƙwarewar nociceptive afferents. Sakamakon kumburi a cikin samar da NGF a gefe wanda sannan ya ɗaure zuwa nau'in mai karɓa na tyrosine kinase mai karɓa na 1 a kan tashar nociceptor, NGF kuma an kai shi zuwa jikin tantanin halitta inda ya haifar da tsari na rubutun TRPV1 kuma sakamakon haka ya karu nociceptor sensitivity.19 20 NGF da sauran masu shiga tsakani masu kumburi kuma suna wayar da kan TRPV1 ta hanyoyi daban-daban na hanyoyin manzo na biyu. Yawancin sauran masu karɓa da suka haɗa da masu karɓa na cholinergic, ?-aminobutyric acid (GABA) masu karɓa da kuma masu karɓa na somatostatin ana tunanin suna da hannu a cikin hankali na nociceptor na gefe.
Yawancin masu shiga tsakani masu kumburi an haɗa su musamman a cikin ciwon kafada da cututtukan rotator cuff. Waɗannan canje-canjen na iya zama farkon fassarar bayan fassarorin ko jinkirta rubutawa. Misalai na farko sune canje-canje a cikin mai karɓa na TRPV21 ko a cikin tashoshi masu ƙarfin lantarki wanda ya samo asali daga phosphorylation na sunadaran da ke ɗaure membrane. Misalai na ƙarshe sun haɗa da haɓakar haɓakar NGF a cikin samar da tashar tashoshi TRV25 da ƙaddamar da ƙwayoyin calcium na abubuwan da ke cikin rubutun cikin salula.
Hanyoyin Molecular Na Nociception
Jin zafi yana faɗakar da mu ga ainihin ko rauni mai zuwa kuma yana haifar da martanin kariya masu dacewa. Abin takaici, ciwo sau da yawa yakan wuce amfaninsa a matsayin tsarin gargadi kuma a maimakon haka ya zama na yau da kullum da rashin ƙarfi. Wannan sauyi zuwa wani lokaci na yau da kullum ya ƙunshi canje-canje a cikin kashin baya da kwakwalwa, amma akwai kuma wani yanayi mai ban mamaki inda aka fara saƙon ciwo � a matakin farko na neuron. Ƙoƙarin ƙayyadaddun yadda waɗannan ƙwayoyin cuta ke gano abubuwan da ke haifar da ciwo na yanayin zafi, inji ko sinadarai sun bayyana sababbin hanyoyin sigina kuma sun kawo mu kusa da fahimtar abubuwan da ke faruwa na kwayoyin halitta wanda ke sauƙaƙe sauyawa daga matsananciyar zafi zuwa ciwo mai tsanani.
Neurochemistry na Nociceptors
Glutamate shine mafi rinjayen neurotransmitter mai ban sha'awa a cikin duk nociceptors. Nazarin histochemical na manya DRG, duk da haka, ya bayyana manyan nau'ikan nau'ikan fiber C guda biyu marasa lafiya.
Masu Fassara Sinadarai Don Sa Ciwon Ya Muni
Kamar yadda aka bayyana a sama, rauni yana ƙaruwa da jin daɗin jin daɗinmu ta hanyar haɓaka ƙwarewar nociceptors zuwa duka thermal da na inji. Wannan al'amari yana haifar da, a wani ɓangare, daga samarwa da saki na masu shiga tsakani na sinadarai daga maɗaukaki na farko da kuma daga ƙwayoyin da ba na jijiyoyi ba (misali, fibroblasts, ƙwayoyin mast, neutrophils da platelets) a cikin yanayi36 (Fig. 3). Wasu sassa na miya mai kumburi (misali, protons, ATP, serotonin ko lipids) na iya canza haɓakar neuronal kai tsaye ta hanyar yin hulɗa tare da tashoshi ion akan farfajiyar nociceptor, yayin da wasu (misali, bradykinin da NGF) suna ɗaure ga masu karɓar metabotropic daidaita tasirin su ta hanyar siginar manzo na biyu cascades11. An sami babban ci gaba wajen fahimtar tushen kimiyyar halittu na irin waɗannan hanyoyin daidaitawa.
Extracellular Protons & Tissue Acidosis
Acidosis na nama na gida alama ce ta ilimin lissafin jiki ga rauni, kuma matakin jin zafi ko rashin jin daɗi yana da alaƙa da girman acidification37. Aikace-aikacen acid (pH 5) zuwa fata yana haifar da ci gaba mai dorewa a cikin kashi uku ko fiye na nociceptors na polymodal waɗanda ke mamaye filin karɓar 20.
Hannun Hannun Halitta & Kwayoyin Halitta Na Pain
Abstract
Tsarin jijiyoyi yana ganowa da fassara nau'ikan abubuwan motsa jiki na thermal da injiniyoyi da muhalli da abubuwan da ke haifar da haɓakar sinadarai. Lokacin da mai tsanani, waɗannan abubuwan da ke haifar da ciwo mai tsanani suna haifar da ciwo mai tsanani, kuma a cikin yanayin raunin da ya faru, duka biyu na gefe da na tsakiya na tsarin tsarin jin zafi na hanyar watsawa suna nuna babban filastik, haɓaka siginar ciwo da kuma haifar da haɓaka. Lokacin da filastik ke sauƙaƙe matakan kariya, zai iya zama da amfani, amma lokacin da canje-canjen ya ci gaba, yanayin ciwo na kullum zai iya haifar da. Halittar kwayoyin halitta, electrophysiological, da nazarin ilimin likitanci suna bayyana hanyoyin kwayoyin da ke haifar da ganowa, ƙididdigewa, da gyare-gyaren abubuwan da ke haifar da ciwo.
Gabatarwa: Mummunan Ciwon Ciki Mai Ciki
Hoto 5. Ƙwararrun Ƙwararrun Ƙwararru (Tsakiya).
Glutamate/NMDA-matsakaicin fahimtar mai karɓa.�Bayan matsananciyar kuzari ko rauni mai tsayi, kunna C da A? nociceptors suna sakin nau'ikan ƙwayoyin cuta iri-iri ciki har da dlutamate, abu P, peptide mai alaƙa da calcitonin-gene (CGRP), da ATP, akan fitattun ƙwayoyin cuta a cikin lamina I na ƙaho na dorsal na sama (ja). Sakamakon haka, masu karɓa na NMDA glutamate na yau da kullun da ke cikin neuron postsynaptic na iya yanzu sigina, haɓaka calcium na ciki, da kunna rundunonin hanyoyin siginar da ke dogaro da calcium da manzanni na biyu ciki har da mitogen-activated protein kinase (MAPK), protein kinase C (PKC) , protein kinase A (PKA) da Src. Wannan cascade na abubuwan da suka faru za su kara yawan jin dadi na fitarwa na neuron da kuma sauƙaƙe watsa sakonnin zafi zuwa kwakwalwa.
Rashin hanawa.A karkashin yanayi na al'ada, interneurons masu hanawa (blue) suna ci gaba da sakin GABA da / ko glycine (Gly) don rage jin dadi na lamina I fitarwa neurons da kuma daidaita yanayin watsawa (sautin hanawa). Duk da haka, a cikin yanayin raunin da ya faru, wannan hanawa zai iya ɓacewa, yana haifar da hyperalgesia. Bugu da ƙari, hanawa na iya ba da damar marasa lafiya da ke fama da myelinated A? abubuwan da suka fi dacewa don shiga da'awar watsa jin zafi kamar yadda aka saba ganin abubuwan da ba su da lahani a yanzu suna jin zafi. Wannan yana faruwa, a wani ɓangare, ta hanyar hana PKC excitatory? bayyana interneurons a cikin lamina II.
Kunna Microglial.Raunin jijiya na gefe yana haɓaka sakin ATP da chemokine fractalkine wanda zai ta da ƙwayoyin microglial. Musamman, kunna purinergic, CX3CR1, da Toll-like receptors akan microglia (purple) yana haifar da sakin ƙwayar neurotrophic da aka samu ta kwakwalwa (BDNF), wanda ta hanyar kunna masu karɓar TrkB da aka bayyana ta lamina I fitarwa neurons, yana haɓaka haɓaka haɓakawa inganta jin zafi a mayar da martani ga duka m da kuma m stimulating (wato hyperalgesia da allodynia). Microglia da aka kunna kuma yana sakin ɗimbin cytokines, irin su ƙari necrosis factor? (TNF?), interleukin-1? da 6 (IL-1?, IL-6), da sauran abubuwan da ke taimakawa ga fahimtar tsakiya.
Chemical Milieu Na Kumburi
Hankali na gefe ya fi yawanci sakamakon canje-canje masu alaƙa da kumburi a cikin yanayin sinadarai na fiber jijiya (McMahon et al., 2008). Don haka, lalacewar nama sau da yawa yana tare da tarin abubuwan da ke tattare da kwayoyin halitta da aka saki daga nociceptors da aka kunna ko ƙwayoyin da ba na jijiyoyi ba waɗanda ke zaune a ciki ko shiga cikin yankin da aka ji rauni (ciki har da kwayoyin mast, basophils, platelets, macrophages, neutrophils, endothelial sel, keratinocytes, da dai sauransu). fibroblasts). Gaba ɗaya. Wadannan abubuwan, da ake magana a kai a matsayin miya mai kumburi, suna wakiltar nau'ikan kwayoyin sigina, ciki har da masu rarrabawa, peptides (abu P, CGRP, bradykinin), eicosinoids da lipids masu dangantaka (prostaglandins, thromboxanes, leukotrienes, endocannabinoids), neurotrophins, cytotropic. , da chemokines, da kuma proteases na extracellular da protons. Abin sha'awa, nociceptors suna bayyana ɗaya ko fiye da masu karɓa na sel waɗanda ke iya ganewa da amsawa ga kowane ɗayan waɗannan pro-inflammatory ko pro-algesic agents (Hoto 4). Irin wannan mu'amala yana haɓaka haɓakar fiber jijiya, ta haka yana ƙara azama ga zafin jiki ko taɓawa.
Babu shakka hanyar da ta fi dacewa don rage ciwon kumburi ya haɗa da hana haɗuwa ko tara abubuwan da ke cikin miya mai kumburi. Wannan ya fi dacewa da misalan magungunan ƙwayoyin cuta marasa amfani, irin su aspirin ko ibuprofen, wanda ke rage ciwo mai zafi da hyperalgesia ta hanyar hana cyclooxygenases (Cox-1 da Cox-2) da ke cikin haɗin gwiwar prostaglandin. Hanya ta biyu ita ce ta toshe ayyukan masu kumburi a nociceptor. Anan, muna haskaka misalan da ke ba da sabon haske game da hanyoyin salon salula na haɓakawa na gefe, ko waɗanda ke zama tushen sabbin dabarun warkewa don magance ciwon kumburi.
NGF watakila an fi saninsa da matsayinsa a matsayin abin da ake buƙata na neurotrophic da ake buƙata don rayuwa da ci gaba da ƙananan ƙwayoyin jijiya a lokacin embryogenesis, amma a cikin balagagge, NGF kuma ana samar da shi a cikin saitin raunin nama kuma ya zama wani muhimmin sashi na miya mai kumburi (Ritner et). al., 2009). Daga cikin maƙasudin salon salula da yawa, NGF yana aiki kai tsaye akan peptidergic C fiber nociceptors, wanda ke bayyana babban alaƙar NGF mai karɓar mai karɓar tyrosine kinase, TrkA, da ƙarancin mai karɓar mai karɓar neurotrophin, p75 (Chao, 2003; Snider da McMahon, 1998). NGF yana haifar da haɓaka mai zurfi ga zafi da abubuwan motsa jiki ta hanyar hanyoyi guda biyu na ɗan lokaci. Da farko, hulɗar NGF-TrkA tana kunna hanyoyin sigina na ƙasa, ciki har da phospholipase C (PLC), protein kinase mai kunna mitogen (MAPK), da phosphoinotide 3-kinase (PI3K). Wannan yana haifar da ƙarfin aiki na furotin da aka yi niyya a tashar nociceptor na gefe, musamman TRPV1, wanda ke haifar da saurin canji a cikin salon salula da yanayin zafi mai zafi (Chuang et al., 2001).
Ba tare da la'akari da hanyoyin su na pro-nociceptive ba, tsoma baki tare da neurotrophin ko siginar cytokine ya zama babbar dabara don sarrafa cututtukan cututtuka ko haifar da ciwo. Babban tsarin ya ƙunshi toshe NGF ko TNF-? aiki tare da antibody neutralizing. A cikin yanayin TNF-?, wannan yana da tasiri sosai a cikin maganin cututtuka masu yawa na autoimmune, ciki har da cututtukan cututtuka na rheumatoid, wanda ke haifar da raguwa mai ban mamaki a cikin lalata nama da kuma tare da hyperalgesia (Atzeni et al., 2005). Saboda manyan ayyuka na NGF akan nociceptor mai girma yana faruwa a cikin saitin kumburi, amfani da wannan hanyar ita ce hyperalgesia zai ragu ba tare da tasiri ba. fahimtar jin zafi na al'ada. Lalle ne, ƙwayoyin rigakafi na anti-NGF a halin yanzu suna cikin gwaji na asibiti don maganin cututtuka na ciwo mai zafi (Hefti et al., 2006).
Glutamate/NMDA Mai karɓa-Matsakaicin Hankali
Ana nuna ciwo mai tsanani ta hanyar sakin glutamate daga tsakiyar tsakiya na nociceptors, yana haifar da motsin motsi na post-synaptic (EPSCs) a cikin tsari na biyu na ƙahonin ƙaho. Wannan yana faruwa da farko ta hanyar kunna postsynaptik AMPA da nau'ikan kainate na masu karɓar ionotropic glutamate. Ƙaddamar da ƙananan ƙananan EPSCs a cikin neuron postsynaptic zai haifar da yiwuwar harbe-harbe da watsa saƙon zafi zuwa mafi girman tsari.
Sauran nazarin sun nuna cewa canje-canje a cikin tsinkayar neuron, kanta, yana ba da gudummawa ga tsarin hanawa. Alal misali, raunin jijiya na gefe ya yi ƙasa sosai-yana daidaita K +- Cl-co-transporter KCC2, wanda ke da mahimmanci don kiyaye K+ da Cl-gradients na al'ada a fadin ƙwayar plasma (Coull et al., 2003). Ƙaddamar da KCC2, wanda aka bayyana a cikin lamina I tsinkaya neurons, yana haifar da canji a cikin Cl-gradient, irin wannan kunnawa na GABA-A masu karɓa suna raguwa, maimakon hyperpolarize da lamina I tsinkaya neurons. Wannan zai, bi da bi, inganta tashin hankali da kuma ƙara zafi watsa. Lallai, toshewar magunguna ko sirna-matsakaicin tsakani na KCC2 a cikin bera yana haifar da allodynia na inji.
Raba Ebook
Sources:
Me yasa kafada ta ke ciwo? Bita na tushen neuroanatomical da biochemical na ciwon kafada
Benjamin John Floyd Dean, Stephen Edward Gwilym, Andrew Jonathan Carr
Hanyoyin Hannun Halitta da Kwayoyin Halitta na Pain
Allan I. Basbaum1, Diana M. Bautista2, Gre?gory Scherrer1, da David Julius3
1 Sashen Anatomy, Jami'ar California, San Francisco 94158
2 Sashen Kwayoyin Halitta da Halittun Halitta, Jami'ar California, Berkeley CA 94720 3 Sashen Nazarin Halitta, Jami'ar California, San Francisco 94158
Hanyoyin kwayoyin halitta na nociception
David Julius* & Allan I. Basbaum�
* Sashen Ilimin Magungunan Kwayoyin Halitta da Kwayoyin Halitta, da Sashen Anatomy da Physiology da Cibiyar Gidauniyar WM Keck don Integrative Neuroscience, Jami'ar California San Francisco, San Francisco, California 94143, Amurka (e-mail: julius@socrates.ucsf.edu)
Neurogenic kumburi, ko NI, shine tsarin ilimin lissafin jiki inda ake fitar da masu shiga tsakani kai tsaye daga jijiyoyi na fata don fara amsa mai kumburi. Wannan yana haifar da ƙirƙirar halayen kumburi na gida ciki har da, erythema, kumburi, yawan zafin jiki, taushi, da zafi. Fine mai kyau unmyelinated afferent somatic C-fibers, waɗanda ke amsawa ga ƙananan ƙarfin injina da kuzarin sinadarai, sune ke da alhakin sakin waɗannan matsakaitan kumburi.
Lokacin da aka motsa su, waɗannan hanyoyin jijiyoyi a cikin jijiyoyi na fata suna saki neuropeptides masu kuzari, ko abu P da calcitonin gene related peptide (CGRP), da sauri a cikin microenvironment, yana haifar da jerin amsa mai kumburi. Akwai bambanci mai mahimmanci a cikin kumburi na immunogenic, wannan shine farkon kariya da mayar da martani da tsarin rigakafi ya yi lokacin da kwayar cutar ta shiga cikin jiki, yayin da kumburin neurogenic ya ƙunshi haɗin kai tsaye tsakanin tsarin juyayi da amsa mai kumburi. Ko da yake kumburin neurogenic da kumburi na rigakafi na iya kasancewa a lokaci guda, ba za a iya bambanta su a asibiti ba. Manufar labarin da ke ƙasa shine don tattauna tsarin ƙumburi na neurogenic da kuma tsarin tsarin jin dadi na gefe a cikin tsaro na tsaro da immunopathology.
Kumburi na Neurogenic � Tsarin Jijiya na Haɓaka Matsayin Matsayin Tsaro Mai Runduna da Immunopathology
Abstract
A al'adance ana tunanin tsarin juyayi da na rigakafi azaman ayyuka daban-daban. Wannan layin, duk da haka, yana ƙara ɓarnawa ta hanyar sabbin fahimta game da kumburin neurogenic. Nociceptor neurons suna da yawancin hanyoyin gane kwayoyin halitta iri ɗaya don haɗari kamar ƙwayoyin rigakafi kuma a cikin martani ga haɗari, tsarin juyayi na gefe kai tsaye yana sadarwa tare da tsarin rigakafi, yana samar da ingantaccen tsarin kariya. Cibiyoyin sadarwar innervation mai yawa na filaye masu azanci da masu cin gashin kansu a cikin kyallen jikin bango da kuma babban saurin jigilar jijiya yana ba da damar haɓakar ƙwayoyin cuta na gida da na tsarin neurogenic cikin sauri. Ƙwayoyin jijiyoyi kuma suna bayyana suna taka muhimmiyar rawa wajen rashin aikin rigakafi a cikin cututtukan autoimmune da rashin lafiyan. Sabili da haka, fahimtar haɗin gwiwar haɗin kai na ƙananan ƙwayoyin cuta tare da ƙwayoyin rigakafi na iya haɓaka hanyoyin warkewa don ƙara yawan tsaro da kuma kawar da immunopathology.
Gabatarwa
Shekaru dubu biyu da suka gabata, Celsus ya ayyana kumburi kamar yadda ya ƙunshi alamomin zuciya huɗu: Dolor (ciwo), Calor (zafi), Rubor (jawa), da Tumor (ƙumburi), lura da ke nuna cewa an gane kunnawar tsarin jijiya a matsayin haɗin gwiwa. kumburi. Duk da haka, an fi tunanin jin zafi tun lokacin, kawai a matsayin alama, kuma ba mai shiga cikin tsararrun kumburi ba. A cikin wannan hangen nesa, mun nuna cewa tsarin jin tsoro na gefe yana taka rawa kai tsaye kuma mai aiki a cikin daidaita tsarin rigakafi da kuma daidaitawa, kamar yadda tsarin rigakafi da juyayi na iya samun aikin kariya na gama gari a cikin tsaro na rundunar tsaro da kuma mayar da martani ga raunin nama, mai rikitarwa. hulɗa wanda kuma zai iya haifar da ilimin cututtuka a cikin rashin lafiyar jiki da cututtuka na autoimmune.
Rayuwar kwayoyin halitta ya dogara sosai kan iyawar da za ta iya hawa kariya daga yuwuwar cutarwa daga lalacewar nama da kamuwa da cuta. Kare mai watsa shiri ya haɗa da halayen gujewa duka biyu don cire hulɗa tare da yanayi mai haɗari (m) (aikin jijiyoyi), da kuma kawar da ƙwayoyin cuta (aiki na rigakafi). A al'adance, rawar da tsarin garkuwar jiki ke yi don yaƙar cututtuka masu cutarwa da kuma gyara raunin nama an yi la'akari da su sosai da na tsarin jin tsoro, wanda ke haifar da lalatawar yanayi da siginar ciki zuwa aikin lantarki don samar da jin dadi da jin dadi (Fig. 1). Muna ba da shawarar cewa waɗannan tsare-tsare guda biyu haƙiƙanin ɓangarorin ingantacciyar hanyar tsaro ce. An sanya tsarin jijiya na somatosensory don gano haɗari. Da fari dai, duk kyallen jikin da aka fallasa sosai ga yanayin waje, kamar su saman epithelial na fata, huhu, urinary da fili na narkewa, suna da ƙarfi ta hanyar nociceptors, babban kofa mai haifar da zaruruwa na azanci. Na biyu, musanya abubuwan kara kuzari na waje yana kusan nan take, umarni masu girma da sauri fiye da tattara tsarin garkuwar jiki, sabili da haka yana iya zama mai amsawa na farko a cikin tsaron gida.
Hoto 1: Mummunan abubuwan motsa rai, ƙananan ƙwayoyin cuta da hanyoyin gane kumburi suna haifar da kunna tsarin juyayi na gefe. Ƙwararrun ƙwayoyin jijiya sun mallaki hanyoyi da yawa na gano gaban abubuwa masu cutarwa/ cutarwa. 1) Masu karɓar siginar haɗari, ciki har da tashoshin TRP, tashoshi na P2X, da haɗari masu alaƙa da tsarin kwayoyin halitta (DAMP) masu karɓa sun gane siginar da ke fitowa daga yanayi (misali zafi, acidity, sunadarai) ko alamun haɗari masu haɗari da aka saki a lokacin rauni / rauni na nama (misali ATP, uric acid, hydroxynonenal. 2) Masu karɓa na ƙididdiga (PRRs) irin su Toll-like receptors (TLRs) da Nod-like receptors (NLRs) sun gane Pathogen hade tsarin kwayoyin halitta (PAMPs) wanda aka zubar ta hanyar mamaye kwayoyin cuta ko ƙwayoyin cuta yayin kamuwa da cuta. 3) Masu karɓa na Cytokine sun gane abubuwan da aka ɓoye ta ƙwayoyin rigakafi (misali IL-1beta, TNF-alpha, NGF), wanda ke kunna kinases taswira da sauran hanyoyin sigina don ƙara haɓakar membrane.
Baya ga abubuwan shigar da orthodromic zuwa ga kashin baya da kwakwalwa daga kewayen, ana iya daukar matakan aiki a cikin nociceptor neurons kuma ana iya yada su ta antidromically a wuraren reshe na baya zuwa ga gefen, axon reflex. Wadannan tare da ci gaba da depolarizations na gida suna haifar da saurin saki na gida na masu shiga tsakani na jijiyoyi daga duka axon na gefe da kuma tashoshi (Fig. 2) 1. Gwaje-gwajen gargajiya ta Goltz (a cikin 1874) da Bayliss (a cikin 1901) sun nuna cewa tushen wutar lantarki yana ƙarfafa tushen dorsal. yana haifar da vasodilation na fata, wanda ya haifar da manufar kumburin neurogenic, mai zaman kanta daga abin da tsarin rigakafi ya samar (Fig. 3).
Hoto 2: Abubuwan da ke haifar da jijiya da aka saki daga nociceptor jijiya neurons kai tsaye suna fitar da chemotaxis leukocyte, hemodynamics na jijiyoyin jini da amsawar rigakafi. Lokacin da abubuwa masu banƙyama suna kunna sigina masu banƙyama a cikin jijiyoyi masu hankali, ana haifar da reflexes na antidromic axon wanda ke haifar da sakin neuropeptides a wuraren da ke kusa da neurons. Wadannan matsakaitan kwayoyin halitta suna da ayyuka masu kumburi da yawa: 1) Chemotaxis da kunna neutrophils, macrophages da lymphocytes zuwa wurin rauni, da lalata ƙwayoyin mast. 2) Sigina ga ƙwayoyin jijiyoyi na jijiyoyi don ƙara yawan jini, zubar jini da edema. Wannan kuma yana ba da damar sauƙin ɗaukar leukocytes masu kumburi. 3) Ƙaddamar da ƙwayoyin dendritic don fitar da bambancin Taimakon Taimako na gaba zuwa Th2 ko Th17 subtypes.
Hoto 3: Tsarin lokaci na ci gaba a fahimtar abubuwan neurogenic na kumburi daga Celsus har zuwa yau.
Neurogenic kumburi yana shiga tsakani ta hanyar sakin neuropeptides calcitonin gene related peptide (CGRP) da abu P (SP) daga nociceptors, wanda ke aiki kai tsaye akan endothelial na jijiyoyin jini da santsin ƙwayoyin tsoka 2�5. CGRP yana haifar da tasirin vasodilation 2, 3, yayin da SP yana haɓaka haɓakar capillary wanda ke haifar da ƙari na plasma da edema 4, 5, yana ba da gudummawa ga rubor, calor da ƙari na Celsus. Duk da haka, nociceptors sun saki ƙarin ƙarin neuropeptides (bayanin kan layi: www.neuropeptides.nl/), ciki har da Adrenomedullin, Neurokinins A da B, Vasoactive intestinal peptide (VIP), neuropeptide (NPY), da kuma gastrin releasing peptide (GRP), da kuma sauran kwayoyin matsakanci irin su glutamate, nitric oxide (NO) da cytokines irin su eotaxin. 6.
Yanzu mun yaba da cewa masu shiga tsakani da aka saki daga jijiyoyi masu hankali a cikin ɓangarorin ba wai kawai suna aiki akan vasculature ba, har ma suna jawo hankalin kai tsaye da kunna ƙwayoyin rigakafi na asali (mast cells, dendritic cells), da ƙwayoyin rigakafi masu dacewa (T lymphocytes) 7�12. A cikin mummunan yanayin lalacewar nama, muna tsammanin cewa kumburin neurogenic yana da kariya, yana sauƙaƙe warkar da raunuka na jiki da kuma kare kariya daga ƙwayoyin cuta ta hanyar kunnawa da ɗaukar ƙwayoyin rigakafi. Duk da haka, irin waɗannan hanyoyin sadarwar neuro-immune suma suna iya taka rawa sosai a cikin ilimin halittar jiki na rashin lafiyan da cututtukan autoimmune ta hanyar haɓaka martanin rigakafi ko rashin lafiya. A cikin dabbobin dabbobi na rheumatoid amosanin gabbai misali, Levine da abokan aiki sun nuna cewa denervation na haɗin gwiwa yana haifar da raguwa mai mahimmanci a cikin kumburi, wanda ya dogara da maganganun jijiyoyi na abu P 13, 14. A cikin 'yan nazarin kwanan nan na rashin lafiyar iska mai kumburi, colitis da psoriasis, ƙananan ƙananan ƙwayoyin jijiya suna taka muhimmiyar rawa wajen farawa da haɓaka haɓakar rigakafi da haɓakawa 15�17.
Mun ba da shawara saboda haka, cewa na gefe m tsarin ba kawai taka m rawa a rundunar tsaro (gane da m stimuli da farawa da kaucewa hali), amma kuma wani aiki rawa a concert tare da na rigakafi da tsarin a modulating da martani ga da kuma fama da cutarwa. motsa jiki, rawar da za a iya jujjuya don taimakawa ga cututtuka.
Rarraba Hannun Gane Hatsari a cikin Na'urorin Jijiya da Tsarin Immune Innate
An daidaita jijiyoyi masu jiwuwa na gefe don gane haɗari ga kwayoyin halitta ta hanyar halayensu ga matsananciyar injiniyoyi, zafi da kuzari (Fig. 1). Tashoshin ion masu karɓa na wucin gadi (TRP) sune mafi yawan binciken masu shiga tsakani na ƙwayoyin cuta na nociception, suna gudanar da shigar da ba zaɓaɓɓu na cations akan kunnawa ta hanyoyi daban-daban masu muni ba. Ana kunna TRPV1 ta yanayin zafi mai zafi, ƙananan pH da capsaicin, ɓangaren vallinoid mai ban sha'awa na barkono barkono 18. TRPA1 yana ƙaddamar da ganewar sinadarai masu amsawa ciki har da abubuwan da suka shafi muhalli kamar gas mai hawaye da isothiocyanates masana'antu 19, amma mafi mahimmanci, ana kunna shi a lokacin nama. rauni ta siginar kwayoyin halitta ciki har da 4-hydroxynonenal da prostaglandins 20, 21.
Abin sha'awa shine, jijiyoyi masu hankali suna raba yawancin ƙwayoyin cuta iri ɗaya da kuma haɗarin hanyoyin gano ƙwayoyin ƙwayoyin cuta kamar ƙwayoyin rigakafi na asali, waɗanda ke ba su damar gano ƙwayoyin cuta (Fig. 1). A cikin tsarin garkuwar jiki, ana gano ƙwayoyin cuta na ƙwayoyin cuta ta hanyar germline encoded pattern gane receptors (PRRs), waɗanda ke gane fa'idodin ƙwayoyin cuta masu alaƙa da ƙwayoyin cuta (PAMPs). PRRs na farko da aka gano su ne membobin dangi mai karɓar kuɗi (TLR), waɗanda ke ɗaure da yisti, abubuwan da ke tattare da bangon tantanin halitta da ƙwayoyin cuta da ƙwayoyin cuta na RNA 22. Bayan kunna PRR, ana kunna hanyoyin siginar ƙasa wanda ke haifar da samar da cytokine da kunnawa. na rigakafi na daidaitawa. Bugu da ƙari ga TLRs, ƙwayoyin rigakafi na asali suna kunna yayin rauni na nama ta hanyar siginar haɗari da aka samo asali, wanda kuma aka sani da lalacewar kwayoyin halitta (DAMPs) ko ƙararrawa 23, 24. Waɗannan siginar haɗari sun haɗa da HMGB1, uric acid, da sunadaran zafi da aka saki. ta sel masu mutuwa a lokacin necrosis, kunna ƙwayoyin rigakafi a yayin amsawar kumburi mara cututtuka.
PRRs ciki har da TLRs 3, 4, 7, da 9 ana bayyana su ta hanyar nociceptor neurons, kuma ƙarfafawa ta hanyar haɗin gwiwar TLR yana haifar da shigar da igiyoyin ciki da kuma fahimtar nociceptors zuwa wasu abubuwan motsa jiki 25�27. Bugu da ƙari kuma, kunna ƙananan ƙwayoyin cuta ta hanyar TLR7 ligand imiquimod yana haifar da kunnawa ta hanyar ƙayyadaddun ƙayyadaddun ƙayyadaddun hanyoyi 25. Wadannan sakamakon sun nuna cewa ciwon da ke hade da kamuwa da cuta da ƙaiƙayi na iya zama wani ɓangare saboda kunnawa kai tsaye na neurons ta hanyar abubuwan da suka samo asali, wanda hakan ya biyo baya. kunna ƙwayoyin rigakafi ta hanyar sakin kwayoyin siginar neuronal.
Babban DAMP / ƙararrawa da aka saki yayin raunin salula shine ATP, wanda masu karɓa na purinergic ke gane su akan duka nociceptor neurons da ƙwayoyin rigakafi 28�30. Masu karɓa na purinergic sun ƙunshi iyalai biyu: masu karɓa na P2X, tashoshin ligand-gated cation, da P2Y masu karɓa, G-protein masu karɓa. A cikin nociceptor neurons, ganewar ATP yana faruwa ta hanyar P2X3, wanda ke haifar da hanzari da sauri da kuma jin zafi 28, 30 (Fig. 1), yayin da masu karɓa na P2Y suna taimakawa wajen kunna nociceptor ta hanyar fahimtar TRP da tashoshi na sodium-gated. A cikin macrophages, ATP daure zuwa P2X7 masu karɓa yana haifar da hyperpolarization, da kuma kunnawa na ƙasa na ƙumburi, wani hadadden kwayoyin halitta mai mahimmanci a cikin tsararrun IL-1beta da IL-18 29. Saboda haka, ATP alama ce mai haɗari mai haɗari wanda ke kunna duka ƙananan ƙwayoyin cuta da kuma na asali. rigakafi a lokacin rauni, kuma wasu shaidun ma sun nuna cewa neurons suna bayyana sassan injunan ƙwayoyin cuta masu kumburi 31.
Matsakaicin siginar haɗari a cikin nociceptors shine rawar tashoshi na TRP a cikin kunna ƙwayoyin rigakafi. TRPV2, wani homologue na TRPV1 da aka kunna ta zafi mai zafi, an bayyana shi a cikin manyan matakan da ke cikin ƙwayoyin rigakafi na halitta 32. Ƙwararren kwayoyin halitta na TRPV2 ya haifar da lahani a cikin macrophage phagocytosis da kuma kawar da cututtuka na kwayan cuta 32. Mast Kwayoyin kuma suna bayyana tashoshi na TRPV, wanda zai iya shiga tsakani kai tsaye. Mutuwar su 33. Ya rage don a tantance ko siginonin haɗari masu haɗari suna kunna ƙwayoyin rigakafi kamar yadda nociceptors.
Maɓalli na hanyar sadarwa tsakanin ƙwayoyin rigakafi da nociceptor neurons sune ta hanyar cytokines. Bayan kunna masu karɓa na cytokine, ana kunna hanyoyin siginar siginar a cikin jijiyoyi masu jiji da ke haifar da ƙananan phosphorylation na sunadarai na membrane ciki har da TRP da tashoshin wutar lantarki (Fig. 1). Sakamakon farfadowa na nociceptors yana nufin cewa kullun rashin lahani na inji da zafi zai iya kunna nociceptors. Interleukin 1 beta da TNF-alpha sune mahimman cytokines guda biyu waɗanda sel na rigakafi suka saki yayin kumburi. IL-1beta da TNF-alpha ana fahimtar su kai tsaye ta hanyar nociceptors waɗanda ke bayyana masu karɓa na cognate, haifar da kunna kinases na taswirar p38 wanda ke haifar da haɓaka haɓakar membrane 34 ~ 36. Mahimmin haɓakar jijiya (NGF) da prostaglandin E (2) suma manyan masu shiga tsakani ne masu kumburi waɗanda aka saki daga ƙwayoyin rigakafi waɗanda ke aiki kai tsaye akan jijiyoyi masu jijiyoyi don haifar da hankali. Wani muhimmin tasiri na nociceptor hankali ta hanyar abubuwan rigakafi shine ƙara yawan sakin neuropeptides a tashoshi na gefe wanda ke kara kunna ƙwayoyin rigakafi, ta haka yana haifar da madaidaicin ra'ayi mai mahimmanci wanda ke motsawa da sauƙaƙe kumburi.
Tsarin Jijiya na Jijiya Sarrafa Ƙwarewar Innate da Daidaitacce
A farkon matakai na kumburi, siginar siginar siginar siginar nama zuwa ƙwayoyin mast ɗin mazaunin nama da sel dendritic, waɗanda ke da mahimmancin ƙwayoyin rigakafi waɗanda ke da mahimmanci wajen fara amsawar rigakafi (Fig. 2). Nazarin anatomical sun nuna yarda da kai tsaye na tashoshi tare da kwayoyin mast, da kuma tare da kwayoyin dendritic, da kuma neuropeptides da aka saki daga nociceptors na iya haifar da lalata ko cytokine a cikin waɗannan kwayoyin halitta 7, 9, 37. Wannan hulɗar yana taka muhimmiyar rawa a cikin hanyar iska mai rashin lafiya. kumburi da dermatitis 10�12.
A lokacin lokacin sakamako na kumburi, ƙwayoyin rigakafi suna buƙatar samun hanyar zuwa takamaiman wurin rauni. Yawancin masu shiga tsakani da aka saki daga ƙananan ƙwayoyin cuta, neuropeptides, chemokines, da glutamate, sune chemotactic ga neutrophils, eosinophils, macrophages, da kuma T-cell, kuma suna haɓaka endothelial adhesion wanda ke taimakawa 6, 38�41 homing na rigakafi (Fig. 2). Bugu da ƙari kuma, wasu shaidun suna nuna cewa neurons na iya shiga kai tsaye a cikin lokaci mai tasiri, kamar yadda neuropeptides da kansu na iya samun ayyukan antimicrobial kai tsaye 42.
Kwayoyin siginar da aka samu daga jijiyoyi kuma na iya jagorantar nau'in kumburi, ta hanyar ba da gudummawa ga bambance-bambance ko ƙayyadaddun nau'ikan ƙwayoyin T na rigakafi daban-daban. Antigen ana yin phagocytosed kuma ana sarrafa su ta sel na rigakafi na asali, wanda sannan yayi ƙaura zuwa kumburin lymph mafi kusa kuma ya gabatar da peptide na antigenic zuwa ƙwayoyin T. Dangane da nau'in antigen, kwayoyin costimulatory akan kwayar halitta na rigakafi, da kuma haɗuwa da takamaiman cytokines, ƙwayoyin T na T sun girma cikin takamaiman nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'in antigen). Kwayoyin CD4 T, ko ƙwayoyin T helper (Th), za a iya raba su zuwa ƙungiyoyi hudu, Th1, Th2, Th17, da T regulatory cells (Treg). Kwayoyin Th1 sun fi shiga cikin daidaita matakan rigakafi ga ƙwayoyin cuta na ciki da ƙwayoyin cuta na musamman na jiki; Th2 suna da mahimmanci don rigakafi da ƙwayoyin cuta na waje, irin su helminths, kuma suna da alhakin rashin lafiyar cututtuka masu kumburi; Kwayoyin Th17 suna taka muhimmiyar rawa wajen kariya daga ƙalubalen ƙananan ƙwayoyin cuta, irin su ƙwayoyin cuta da fungi; Kwayoyin Treg suna da hannu wajen kiyaye juriyar kai da daidaita martanin rigakafi. Wannan tsari na maturation na tantanin T yana bayyana yana tasiri sosai daga masu shiga tsakani na jijiya. Neuropeptides, irin su CGRP da VIP, na iya nuna son kai ga sel dendritic zuwa wani nau'in rigakafi na Th2 da kuma rage nau'in rigakafi na Th1 ta hanyar inganta samar da wasu cytokines da hana wasu, da kuma ta hanyar rage ko haɓaka ƙaurawar dendritic cell zuwa ƙananan ƙwayoyin lymph na gida 8. , 10, 43. Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwaƙwalwa na Ƙwaƙwalwa na Ɗauka na Ɗaya ) na Ƙaƙwalwa na Ɗauka na Ɗauka na Ɗaukaka na Ɗaya 2. Baya ga daidaitawa Th17 da Th1 Kwayoyin, wasu neuropeptides, irin su SP da Hemokinin-2, na iya fitar da amsawar kumburi fiye da Th1 ko Treg. 17, 44, wanda ke nufin cewa neurons kuma na iya shiga cikin daidaita ƙudurin kumburi. A cikin cututtukan cututtuka irin su colitis da psoriasis, toshewar masu shiga tsakani na neuronal kamar abu P na iya rage girman T cell da lalacewa ta hanyar rigakafi 45�15, kodayake ƙin yarda da matsakanci ɗaya na iya da kansa kawai yana da iyakacin tasiri akan kumburin neurogenic.
Idan akai la'akari da cewa siginar kwayoyin da aka saki daga filayen jijiya na gefe suna tsara ba kawai ƙananan jini ba, har ma da chemotaxis, homing, maturation, da kunna ƙwayoyin rigakafi, ya bayyana a fili cewa hulɗar neuro-immune ya fi rikitarwa fiye da yadda ake tunani a baya (Figure). . 2). Bugu da ƙari kuma, yana da kyawawa cewa ba masu shiga tsakani na ɗaiɗaikun jijiyoyi ba ne amma takamaiman haɗaɗɗun ƙwayoyin sigina waɗanda aka saki daga nociceptors waɗanda ke tasiri matakai daban-daban da nau'ikan martanin rigakafi.
Gudanar da Reflex mai sarrafa kansa na rigakafi
Rawar da ke tattare da tsarin jijiya mai cin gashin kansa na cholinergic �reflex� da'irar a cikin tsari na martanin rigakafi na gefe shima ya bayyana sananne 46. Vagus shine babban jijiyar parasympathetic wanda ke haɗa tushen kwakwalwa tare da gabobin visceral. Aiki na Kevin Tracey da sauransu suna nuni zuwa ga ingantacciyar amsawar gabaɗayan anti-mai kumburi a cikin girgizar septic da endotoxemia, wanda ya haifar da wani aikin jijiya na vagal wanda ke haifar da danne macrophages na gefe 47-49. The vagus kunna na gefe adrenergic celiac ganglion neurons innervating da saifa, haifar da downstream saki na acetylcholine, wanda ɗaure zuwa alpha-7 nicotinic receptors a kan macrophages a cikin saifa da gastrointestinal fili. Wannan yana haifar da kunnawa ta hanyar siginar JAK2 / STAT3 SOCS3, wanda ke da ƙarfi ya hana fassarar TNF-alpha 47. Adrenergic Celiac ganglion kuma yana sadarwa kai tsaye tare da wani yanki na acetylcholine wanda ke samar da ƙwaƙwalwar ajiya T Kwayoyin, wanda ke hana kumburi macrophages 48.
Kwayoyin Killer T masu banƙyama (iNKT) ƙwararrun sel T ne waɗanda ke gane ƙwayoyin lipids a cikin mahallin CD1d maimakon peptide antigens. Kwayoyin NKT sune maɓalli na yawan ƙwayar lymphocyte da ke da hannu a cikin yaƙar ƙwayoyin cuta da kuma daidaita tsarin rigakafi. Kwayoyin NKT suna zaune kuma suna zirga-zirga ta hanyar vasculature da sinusoids na saifa da hanta. Jijiyoyin beta-adrenergic masu tausayi a cikin hanta kai tsaye sigina don daidaita ayyukan NKT cell 50. A yayin samfurin linzamin kwamfuta na bugun jini (MCAO), alal misali, hanta NKT cell motsi ya kasance a bayyane, wanda aka juya ta hanyar jinƙai mai tausayi ko beta-adrenergic antagonists. Bugu da ƙari kuma, wannan aikin immunosuppressive na noradrenergic neurons a kan kwayoyin NKT ya haifar da karuwa a cikin kamuwa da cuta da cutar huhu. Sabili da haka, siginonin da ke fitowa daga neurons masu cin gashin kansu na iya yin sulhu mai ƙarfi na rigakafi.
Dr. Alex Jimenez's Insight
Neurogenic kumburi shine amsawar kumburi na gida wanda tsarin jin tsoro ya haifar. An yi imani da cewa yana taka muhimmiyar rawa a cikin pathogenesis na al'amurran kiwon lafiya iri-iri, ciki har da, migraine, psoriasis, asma, fibromyalgia, eczema, rosacea, dystonia da kuma yawan ilimin sunadarai. Kodayake ƙumburi na neurogenic da ke hade da tsarin juyayi na gefe an yi bincike sosai, manufar ƙumburi neurogenic a cikin tsarin kulawa na tsakiya har yanzu yana buƙatar ƙarin bincike. Dangane da binciken bincike da yawa, duk da haka, an yi imanin cewa rashin magnesium shine babban dalilin kumburin neurogenic. Labarin da ke gaba yana nuna bayyani game da hanyoyin ƙumburi na neurogenic a cikin tsarin juyayi, wanda zai iya taimakawa masu sana'a na kiwon lafiya su ƙayyade mafi kyawun tsarin kulawa don kula da al'amurran kiwon lafiya da dama da ke hade da tsarin jin tsoro.
karshe
Menene takamaiman ayyuka na musamman na somatosensory da tsarin juyayi masu zaman kansu a cikin daidaita kumburi da tsarin rigakafi (Fig. 4)? Kunna nociceptors yana haifar da reflexes na axon na gida, waɗanda ke ɗaukar aiki a cikin gida da kunna ƙwayoyin rigakafi kuma saboda haka, galibi pro-mai kumburi ne kuma an tsare shi a sarari. Sabanin haka, haɓakawar kai-da-kai yana haifar da tsarin rigakafi ta hanyar cutar da wuraren tafki na ƙwayoyin rigakafi a cikin hanta da safiya. Hanyoyin sigina masu banƙyama a cikin kewayen da ke haifar da farawar ƙwayar cuta ta vagal cholinergic reflex ba a fahimta da kyau ba. Koyaya, kashi 80 zuwa 90% na filayen vagal sune filaye na zahiri na farko, sabili da haka sigina daga viscera, yawancin yuwuwar sel na rigakafi, na iya haifar da kunna interneurons a cikin kwakwalwar kwakwalwa kuma ta hanyar su zuwa fitarwa a cikin filaye na vagal 46.
Hoto 4: Hannun hankali da tsarin juyayi masu zaman kansu suna daidaita martanin rigakafi na gida da na tsarin bi da bi. Nociceptors innervating epithelial saman (misali fata da huhu) suna haifar da martanin kumburin gida, kunna ƙwayoyin mast da sel dendritic. A cikin rashin lafiyar kumburin iska, dermatitis da rheumatoid arthritis, nociceptor neurons suna taka rawa wajen motsa kumburi. Sabanin haka, da'irori masu cin gashin kansu da ke shigar da gabobin visceral (misali saifa da hanta) suna daidaita tsarin rigakafi ta hanyar toshe macrophage da kunna tantanin halitta NKT. A cikin bugun jini da kuma septic endotoxemia, waɗannan neurons suna taka rawar rigakafi.
Yawanci, tsarin lokaci da yanayin kumburi, ko a lokacin kamuwa da cuta, halayen rashin lafiyan, ko cututtukan cututtukan auto-immune, ana bayyana su ta nau'ikan ƙwayoyin rigakafi da ke ciki. Zai zama mahimmanci a san abin da nau'ikan ƙwayoyin rigakafi daban-daban ke daidaita su ta hanyar sigina na hankali da masu zaman kansu. Ƙididdiga na yau da kullum na abin da masu shiga tsakani za a iya saki daga nociceptors da autonomic neurons da kuma bayyanar da masu karɓa don waɗannan ta hanyar daban-daban na kwayoyin halitta da na rigakafi na iya taimakawa wajen magance wannan tambaya.
A lokacin juyin halitta, hanyoyin gano haɗari makamantan hanyoyin ƙwayoyin cuta sun haɓaka don rigakafi na asali da kuma nociception duk da cewa sel suna da mabanbanta zuriyar ci gaba. Yayin da ake nazarin PRRs da tashoshi na ligand-gated ion daban-daban ta hanyar immunologists da neurobiologists, layin da ke tsakanin waɗannan filayen biyu yana ƙara ɓarna. A lokacin lalacewar nama da kamuwa da cuta mai saurin kamuwa da cuta, sakin siginonin haɗari na iya haifar da haɗaɗɗiyar kunnawa na ƙwayoyin jijiya na gefe da ƙwayoyin rigakafi tare da hadaddun sadarwar bidirectional, da kuma haɗaɗɗen tsaro na rundunar. Matsayin jiki na nociceptors a cikin mu'amala tare da yanayi, saurin watsawar jijiyoyi da ikon su don sakin manyan cocktails na masu shiga tsakani na rigakafi suna ba da damar tsarin juyayi na gefe don daidaita yanayin amsawar rigakafi na asali da daidaita rigakafin daidaitawa na ƙasa. Sabanin haka, nociceptors suna da matukar damuwa ga masu shiga tsakani na rigakafi, waɗanda ke kunnawa da kuma wayar da kan jijiyoyi. Neurogenic da kumburi mai shiga tsakani ba, sabili da haka, ƙungiyoyi masu zaman kansu amma suna aiki tare azaman na'urorin faɗakarwa da wuri. Duk da haka, tsarin juyayi na gefe kuma yana taka muhimmiyar rawa a cikin ilimin cututtuka, kuma watakila ilimin kimiyya, na yawancin cututtuka na rigakafi kamar asma, psoriasis, ko colitis saboda ikonsa na kunna tsarin rigakafi na iya haɓaka kumburi na pathological 15�17. Jiyya don cututtuka na rigakafi na iya buƙatar haɗawa, sabili da haka, ƙaddamar da nociceptors da kuma ƙwayoyin rigakafi.
Godiya
Mun gode wa NIH don tallafi (2R37NS039518).
A ƙarshe,Fahimtar rawar kumburin neurogenic lokacin da yazo ga rundunar tsaro da immunopathology yana da mahimmanci don tantance tsarin kulawa da ya dace don al'amuran lafiya da yawa na tsarin juyayi. Ta hanyar kallon hulɗar ƙananan ƙwayoyin cuta tare da ƙwayoyin rigakafi, masu sana'a na kiwon lafiya na iya ci gaba da hanyoyin warkewa don ƙara taimakawa wajen ƙara yawan tsaro da kuma kawar da immunopathology. Manufar labarin da ke sama shine don taimakawa marasa lafiya su fahimci ilimin likitancin likitancin neuropathy, a tsakanin sauran batutuwan kiwon lafiya na jijiyoyi. Bayanin da aka ambata daga Cibiyar Bayanan Kimiyyar Halittu ta Ƙasa (NCBI). Matsakaicin bayanin mu yana iyakance ga chiropractic da kuma raunin kashin baya da yanayi. Don tattauna batun, da fatan za a ji daɗin tambayar Dr. Jimenez ko tuntuɓe mu a�915-850-0900 .
Dr. Alex Jimenez ne ya shirya shi
Ƙarin Maudu'i: Ciwon Baya
Binciken baya yana daya daga cikin abubuwan da ke haifar da nakasa da kuma rashin kwanakin aiki a duniya. A gaskiya ma, an danganta ciwon baya a matsayin dalili na biyu mafi yawan lokuta na ziyartar ofisoshin likitoci, wanda ya fi girma kawai ta hanyar cututtuka na sama. Kusan 80 bisa dari na yawan jama'a za su fuskanci wani nau'i na ciwon baya a kalla sau ɗaya a rayuwarsu. Kashin baya wani tsari ne mai rikitarwa wanda ya kunshi kasusuwa, gidajen abinci, jijiya da tsokoki, a tsakanin sauran kyallen takarda masu laushi. Saboda wannan, raunin da / ko yanayin da ya tsananta, kamar 'yan kwalliya, a ƙarshe na iya haifar da alamun ciwon baya. Raunin wasanni ko raunin haɗari na mota sau da yawa shine mafi yawan dalilin ciwon baya, duk da haka, wani lokacin mafi sauƙi na motsi na iya samun sakamako mai raɗaɗi. Abin farin ciki, madadin zaɓuɓɓukan magani, irin su kulawar chiropractic, na iya taimakawa wajen sauƙaƙe ciwon baya ta hanyar yin amfani da gyare-gyare na kashin baya da kuma manipulations na hannu, a ƙarshe inganta jin zafi.
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Abstract
References:
Me Yasa Kafada Na Ke Ciki? Bita na Tushen Neuroanatomical & Biochemical Tushen Ciwon Kafada
NGF da mai karɓa na wucin gadi m tashar tashar tashar tashar tashar tashar V memba na 1 (TRPV1) mai karɓa yana da alaƙar alaƙa idan ya zo ga kumburi da ƙwarewar nociceptor. Cytokines da aka samar a cikin nama mai kumburi yana haifar da karuwa a cikin samar da NGF.19 NGF yana ƙarfafa sakin histamine da serotonin (5-HT3) ta hanyar kwayoyin mast, kuma yana da hankali ga nociceptors, mai yiwuwa ya canza kaddarorin A? zaruruwa kamar yadda mafi girma rabo zama nociceptive. Mai karɓa na TRPV1 yana cikin ƙananan ƙananan filaye na filaye na farko kuma ana kunna shi ta capsaicin, zafi da protons. Mai karɓa na TRPV1 an haɗa shi a cikin jikin kwayar halitta na filaye mai banƙyama, kuma an kai shi zuwa duka biyu na gefe da na tsakiya, inda yake ba da gudummawa ga ƙwarewar nociceptive afferents. Sakamakon kumburi a cikin samar da NGF a gefe wanda sannan ya ɗaure zuwa nau'in mai karɓa na tyrosine kinase mai karɓa na 1 a kan tashar nociceptor, NGF kuma an kai shi zuwa jikin tantanin halitta inda ya haifar da tsari na rubutun TRPV1 kuma sakamakon haka ya karu nociceptor sensitivity.19 20 NGF da sauran masu shiga tsakani masu kumburi kuma suna wayar da kan TRPV1 ta hanyoyi daban-daban na hanyoyin manzo na biyu. Yawancin sauran masu karɓa da suka haɗa da masu karɓa na cholinergic, ?-aminobutyric acid (GABA) masu karɓa da kuma masu karɓa na somatostatin ana tunanin suna da hannu a cikin hankali na nociceptor na gefe.
Neurochemistry na Nociceptors
Hannun Hannun Halitta & Kwayoyin Halitta Na Pain
Hoto 5. Ƙwararrun Ƙwararrun Ƙwararru (Tsakiya).
