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Agnieszka Owczarczyk-Saczonek, Natalia Zdanowska, Ewa Wygonowska, Waldemar Placek Department of Dermatology, Sexually Transmitted Diseases and Clinical Immunology, Warmia and Mazury Universities ku Olsztyn, Poland Newsletter: Agnieszka Dermatology Department, Transmitted Diseases, Transmitted Clinic, Immunology, Immunology Warmia ndi Mazury University, Olsztyn, Poland.Wojska Polskiego 30, Olsztyn, 10-229, PolishTel +48 89 6786670 Fax +48 89 6786641 Imelo [email protected] Abstract: Hyaluronic acid (HA) ndi glycosaminoglycan, gawo lachilengedwe la matrix owonjezera.Mapangidwe omwewo a molekyulu mu zamoyo zonse ndi mwayi wake waukulu chifukwa ali ndi mwayi wochepa wosandulika kukhala immunogenicity.Chifukwa chake, chifukwa cha biocompatibility yake komanso kukhazikika pamalo oyikapo, ndiye njira yabwino kwambiri yogwiritsidwira ntchito ngati chodzaza.Nkhaniyi ikuphatikiza kukambirana za momwe mayankhidwe amthupi a HA amathandizira, komanso momwe angayankhire atalandira katemera wa SARS-CoV-2.Malinga ndi zolembedwazo, tidayesa kukonza njira yoyipa ya chitetezo chamthupi ndi mawonetsedwe amtundu wa HA.Kupezeka kwa zochitika zosayembekezereka ku hyaluronic acid kumasonyeza kuti iwo sangaganizidwe kuti salowerera ndale kapena osakhala allergenic.Kusintha kwa kapangidwe ka mankhwala a HA, zowonjezera, ndi chizolowezi cha munthu aliyense mwa odwala kungakhale chifukwa cha zochitika zosayembekezereka, zomwe zimayambitsa zotsatira za thanzi.Kukonzekera kosadziwika bwino, kusayeretsedwa bwino, kapena kukhala ndi DNA ya bakiteriya ndikoopsa kwambiri.Chifukwa chake, kutsata kwanthawi yayitali kwa odwala ndi kusankha kwa FDA kapena EMA kukonzekera kovomerezeka ndikofunikira kwambiri.Odwala nthawi zambiri sadziwa zotsatira za ntchito zotsika mtengo zomwe anthu amachita popanda chidziwitso choyenera pogwiritsa ntchito mankhwala osalembetsa, choncho anthu ayenera kuphunzitsidwa ndipo malamulo ndi malamulo ayenera kukhazikitsidwa.Mawu osakira: Hyaluronic acid, zodzaza, kuchedwa kutupa, autoimmune / auto-inflammatory adjuvant-induced syndrome, SARS-CoV-2
Hyaluronic acid (HA) ndi glycosaminoglycan, gawo lachilengedwe la matrix a extracellular.Amapangidwa ndi dermal fibroblasts, ma synovial cell, endothelial cell, maselo osalala a minofu, ma cell adventitia ndi oocyte ndikumasulidwa kumalo ozungulira.1,2 Mapangidwe omwewo a mamolekyu mu zamoyo zonse ndizopindulitsa zake zazikulu, zomwe zimagwirizanitsidwa ndi chiopsezo chochepa kwambiri cha immunogenicity.Kukhazikika kwa biocompatibility ndi kukhazikika kwa malo oyikapo kumapangitsa kukhala chisankho choyenera pamndandanda wonse wazodzaza.Chifukwa chakukula kwamakina kwa minofu pambuyo pa jekeseni ndikuyambitsanso ma fibroblasts a khungu, ili ndi mwayi waukulu wokhoza kulimbikitsa kupanga kolajeni yatsopano.2-4 asidi Hyaluronic kwambiri hydrophilic, ali ndi makhalidwe apadera a kumanga mamolekyu madzi (kuposa 1000 nthawi kulemera kwake), ndipo amapanga conformation yaitali ndi buku lalikulu poyerekeza kulemera.Ikhozanso kupanga condensation ngakhale pamagulu otsika kwambiri.guluu.Zimapangitsa kuti minyewa ikhale ndi madzi mwachangu ndikuwonjezera kuchuluka kwa khungu.3,5,6 Kuwonjezera apo, kusungunuka kwa khungu ndi mphamvu ya antioxidant ya asidi ya hyaluronic ikhoza kulimbikitsa kusinthika kwa maselo a khungu ndikulimbikitsa kupanga kolajeni.5
Kwa zaka zambiri, zakhala zikudziwika kuti kutchuka kwa njira zodzikongoletsera pogwiritsa ntchito zinthu monga HA kukupitirirabe.Malinga ndi kafukufuku wochokera ku International Society of Aesthetic Plastic Surgery (ISAPS), njira zodzikongoletsera zopitilira 4.3 miliyoni zidachitidwa pogwiritsa ntchito HA mu 2019, zomwe zidakwera 15.7% poyerekeza ndi 2018. The American Society of Dermatology (ASDS) inanena kuti akatswiri akhungu anachita 2.7 miliyoni dermal filler jakisoni mu 2019. 8 Kukhazikitsa njira zotere kukukhala njira yopindulitsa kwambiri yolipira.Choncho, chifukwa cha kusowa kwa malamulo ndi malamulo m'mayiko / zigawo zambiri, anthu ambiri amapereka ntchito zoterezi, nthawi zambiri popanda maphunziro oyenerera kapena ziyeneretso.Kuphatikiza apo, pali zopangira zopikisana pamsika.Zitha kukhala zotsika mtengo, zotsika mtengo, ndipo sizinavomerezedwe ndi FDA kapena EMA, zomwe ndizowopsa pakupanga mitundu yatsopano ya zoyipa.Malinga ndi kafukufuku yemwe adachitika ku Belgium, ambiri mwa zitsanzo 14 zomwe akuganiza kuti ndi zosaloledwa ndi boma zomwe adayesedwa anali ndi zinthu zochepa kwambiri kuposa zomwe zafotokozedwa pamapaketi.9 Mayiko ambiri ali ndi njira zosavomerezeka zodzikongoletsera.Kuphatikiza apo, njirazi sizinalembetsedwe ndipo palibe msonkho womwe umalipiridwa.
Choncho, m'mabuku muli malipoti ambiri okhudza zochitika zovuta.Zochitika zoyipa izi nthawi zambiri zimabweretsa zovuta za matenda ndi chithandizo komanso zotsatira zosayembekezereka kwa odwala.7,8 Hypersensitivity kwa hyaluronic acid ndiyofunikira kwambiri.Zomwe zimayambitsa zochitika zina sizinafotokozedwe bwino, kotero kuti mawu omwe ali m'mabuku sali ofanana, ndipo mgwirizano wambiri pa kayendetsedwe ka zovuta sizinaphatikizepo machitidwe otere.10, 11
Nkhaniyi ili ndi zomwe zalembedwa muzolemba.Dziwani zolemba zowunikira pofufuza PubMed pogwiritsa ntchito mawu otsatirawa: hyaluronic acid, fillers, and side effects.Kusakaku kupitilira mpaka pa Marichi 30, 2021. Tinapeza zolemba 105 ndikusanthula 42 mwazo.
Asidi hyaluronic si chiwalo kapena mitundu yeniyeni, choncho tingaganize kuti si chifukwa thupi lawo siligwirizana.12 Komabe, ndikofunikira kukumbukira kuti jekeseni imaphatikizanso zowonjezera, ndipo asidi a hyaluronic amapezeka kudzera mu bakiteriya biosynthesis.
Zasonyezedwanso kuti chibadwa cha munthu chikhoza kuchititsa chiopsezo chochedwa, chotsutsana ndi chitetezo cha mthupi chokhudzana ndi dermal fillers kwa odwala omwe ali ndi HLA-B * 08 ndi DR1 * 03 haplotypes.Kuphatikizika kwa ma subtypes a HLA kumalumikizidwa ndi kuwonjezereka kwapang'onopang'ono kanayi pakutheka kwa zoyipa (OR 3.79).13
Asidi Hyaluronic alipo mu mawonekedwe a multiparticulates, kapangidwe ake n'zosavuta, koma ndi multifunctional biomolecule.Kukula kwa HA kumakhudza zotsatira zosiyana: zingakhale ndi zotsutsana ndi zotupa kapena zowonongeka, kulimbikitsa kapena kulepheretsa kusamuka kwa maselo, ndikuyambitsa kapena kuyimitsa magawano a maselo ndi kusiyanitsa.14-16 Zachisoni, palibe mgwirizano pakugawanika kwa HA.Mawu akuti kukula kwa maselo.14,16,17
Mukamagwiritsa ntchito mankhwala a HMW-HA, ndi bwino kukumbukira kuti hyaluronidase yachilengedwe imayambitsa kuwonongeka kwake ndikulimbikitsa mapangidwe a LMW-HA.HYAL2 (yozikika pa cell membrane) imadula molekyulu yolemera kwambiri HA (> 1 MDa) kukhala zidutswa za 20 kDa.Kuonjezera apo, ngati HA hypersensitivity iyamba, kutupa kudzalimbikitsa kuwonongeka kwake (Chithunzi 1).
Pankhani ya zinthu za HA, pakhoza kukhala kusiyana pakati pa tanthauzo la kukula kwa maselo.Mwachitsanzo, gulu la zinthu za Juvederm (Allergan), mamolekyu> 500 kDa amaonedwa kuti ndi LMW-HA, ndi> 5000 kDa - HMW-HA.Zidzakhudza kusintha kwa chitetezo cha mankhwala.18
Nthawi zina, kulemera kochepa kwa maselo (LMW) HA kungayambitse hypersensitivity 14 (Chithunzi 2).Imatengedwa ngati molekyulu ya pro-inflammatory.Imapezeka kwambiri m'malo okhudzidwa ndi minofu, mwachitsanzo, ikavulala, imayambitsa kutupa pokhudza ma receptor ngati Toll (TLR2, TLR4).14-16,19 Mwa njira iyi, LMW-HA imalimbikitsa kuyambitsa ndi kusasitsa kwa maselo a dendritic (DC), ndipo imayambitsa mitundu yosiyanasiyana ya maselo kuti apange ma cytokines oletsa kutupa, monga IL-1β, IL-6, IL-12 , TNF-α ndi TGF-β, imayendetsa kufotokozera kwa chemokines ndi kusamuka kwa maselo.14,17,20 LMW-HA ikhoza kukhala ngati mamolekyu okhudzana ndi ngozi (DAMP) kuti ayambe njira zodzitetezera zachibadwa, zofanana ndi mapuloteni a bakiteriya kapena mapuloteni otenthetsa kutentha.14,21 CD44 imagwira ntchito ngati mawonekedwe a receptor pateni ya LMW-HA.Imakhala pamwamba pa maselo onse aumunthu ndipo imatha kuyanjana ndi mitsempha ina monga osteopontin, collagen, ndi matrix metalloproteinases (MMP).14,16,17.
Kutupa kukatha ndipo zotsalira za minofu yowonongeka zimachotsedwa ndi macrophages, molekyulu ya LMW-HA imachotsedwa ndi CD44-dependent endocytosis.Mosiyana ndi izi, kutupa kosatha kumalumikizidwa ndi kuchuluka kwa LMW-HA, kotero amatha kuwonedwa ngati ma biosensor achilengedwe a mawonekedwe a umphumphu wa minofu.14,20,22,23 Ntchito ya CD44 receptor ya HA yawonetsedwa mu maphunziro okhudza kutupa pansi pa mikhalidwe ya vivo.M'mitundu ya mbewa ya atopic dermatitis, chithandizo cha anti-CD44 chimalepheretsa kukula kwa zinthu monga nyamakazi yopangidwa ndi collagen kapena kuwonongeka kwa khungu.makumi awiri ndi mphambu zinayi
Kulemera kwa mamolekyulu (HMW) HA kumakhala kofala m'magulu osasinthika.Zimalepheretsa kupanga oyimira pakati (IL-1β, IL-8, IL-17, TNF-α, metalloproteinases), amachepetsa mawu a TLR ndikuwongolera angiogenesis.14,19 HMW-HA imakhudzanso ntchito ya macrophages omwe ali ndi udindo wolamulira mwa kulimbikitsa ntchito yawo yotsutsa-kutupa kuti apititse patsogolo kutupa kwanuko.15,24,25
Kuchuluka kwa asidi hyaluronic mwa munthu wolemera makilogalamu 70 ndi pafupifupi 15 magalamu, ndipo pafupifupi chiwongola dzanja chake ndi magalamu 5 patsiku.Pafupifupi 50% ya asidi a hyaluronic m'thupi la munthu amakhazikika pakhungu.Theka la moyo wake ndi maola 24-48.22,26 Choncho, theka la moyo wa HA wosasinthika wachilengedwe usanadulidwe mofulumira ndi hyaluronidase, ma enzymes achilengedwe ndi mitundu yowonjezereka ya okosijeni ndi pafupifupi maola 12 okha.27,28 Unyolo wa HA udapangidwa kuti uwonjezere kukhazikika kwake ndikupanga mamolekyu akuluakulu komanso okhazikika, okhala ndi nthawi yayitali yokhala mu minofu (pafupifupi miyezi ingapo), komanso kukhala ndi biocompatibility yofananira ndi kudzaza kwa viscoelastic.28 Crosslinking imaphatikizapo gawo lalikulu la HA lophatikizidwa ndi mamolekyu otsika kwambiri a molekyulu ndi gawo lochepa la molekyulu yolemera kwambiri HA.Kusintha kumeneku kumasintha kusinthika kwachilengedwe kwa molekyulu ya HA ndipo kungakhudze immunogenicity yake.18
Kulumikizana kwakukulu kumakhudzanso kulumikizana kwa ma polima kuti apange ma covalent bond, makamaka kuphatikiza (-COOH) ndi/kapena mafupa a hydroxyl (-OH).Mankhwala ena amatha kulimbikitsa kuphatikizika, monga 1,4-butanediol diglycidyl ether (BDDE) (Juvederm, Restylane, Princess), divinyl sulfone (Captique, Hylaform, Prevelle) kapena diepoxy octane (Puragen).29 Komabe, magulu a epoxy a BDDE sakhala opanda mphamvu atatha kuchitapo kanthu ndi HA, kotero kuti mumangotsatira kuchuluka kwa BDDE (<2 magawo pa milioni) kungapezeke mu mankhwala.26 Cross-linked ha hydrogel ndi chinthu chosinthika kwambiri chomwe chingapangitse kupanga mapangidwe a 3D okhala ndi zinthu zapadera (rheology, degradation, applicability).Zinthuzi zimalimbikitsa kugawa kosavuta kwa mankhwalawa ndipo nthawi yomweyo zimalimbikitsa kupanga zigawo za maselo a extracellular matrix.30.31 <>
Pofuna kuonjezera hydrophilicity ya mankhwala, opanga ena amawonjezera mankhwala ena, monga dextran kapena mannitol.Zina mwazowonjezerazi zimatha kukhala antigen yomwe imapangitsa kuti chitetezo cha mthupi chiyankhidwe.
Pakadali pano, kukonzekera kwa HA kumapangidwa kuchokera ku mitundu ina ya Streptococcus kudzera mu nayonso mphamvu ya bakiteriya.(Streptococcus equi kapena Streptococcus zooepidemicus).Poyerekeza ndi zokonzekera zogwiritsidwa ntchito kale ndi zinyama, zimachepetsa chiopsezo cha immunogenicity, koma sichikhoza kuthetsa kuipitsidwa kwa mamolekyu a mapuloteni, mabakiteriya nucleic acids ndi stabilizers.Atha kukhala ma antigen ndikupangitsa kuti chitetezo cha mthupi chitetezeke, monga hypersensitivity ku zinthu za HA.Chifukwa chake, matekinoloje opanga ma filler (monga Restylane) amayang'ana kwambiri kuchepetsa kuipitsidwa kwazinthu.32
Malinga ndi lingaliro lina, kuyankha kwa chitetezo cha m'thupi ku HA kumayambitsidwa ndi kutupa komwe kumayambitsidwa ndi zigawo za bakiteriya za biofilm, zomwe zimasamutsidwa ku minofu pamene mankhwala amabayidwa.33,34 Biofilm imapangidwa ndi mabakiteriya, zakudya zawo ndi metabolites.Zimaphatikizapo mabakiteriya akuluakulu omwe samayambitsa matenda omwe amakhala pakhungu lathanzi kapena mucous nembanemba (mwachitsanzo, Dermatobacterium acnes, Streptococcus oralis, Staphylococcus epidermidis).Izi Zovuta zatsimikiziridwa ndi mayeso a polymerase chain reaction.33-35
Chifukwa cha mawonekedwe awo apadera omwe amakula pang'onopang'ono ndi mitundu yawo yotchedwa midzi yaying'ono, nthawi zambiri zimakhala zovuta kuzindikira tizilombo toyambitsa matenda mu chikhalidwe.Kuonjezera apo, kagayidwe kawo mu biofilm akhoza kuchepetsedwa, zomwe zimathandiza kupewa zotsatira za maantibayotiki.35,36 Kuphatikiza apo, kuthekera kopanga matrix a extracellular polysaccharides (kuphatikiza HA) ndizomwe zimalepheretsa phagocytosis.Mabakiteriyawa amatha kukhala ogona kwa zaka zambiri, kenako amayambitsidwa ndi zinthu zakunja ndikuyambitsa kuchitapo kanthu.35-37 macrophages ndi maselo akuluakulu amapezeka pafupi ndi tizilombo toyambitsa matenda.Zitha kutsegulidwa mwachangu ndikuyambitsa kuyankha kotupa.38 Zinthu zina, monga matenda a bakiteriya okhala ndi mitundu ya mabakiteriya omwe amafanana ndi ma biofilms, amatha kuyambitsa tizilombo tating'onoting'ono pogwiritsa ntchito njira zotsanzira.Kutsegula kungakhale chifukwa cha kuwonongeka koyambitsidwa ndi njira ina ya dermal filler.38
Ndizovuta kusiyanitsa pakati pa kutupa ndi kuchedwa kwa hypersensitivity chifukwa cha biofilms ya bakiteriya.Ngati chotupa chofiira cha sclerotic chikuwonekera nthawi iliyonse pambuyo pa opaleshoni, mosasamala kanthu za nthawi yayitali, biofilm iyenera kuganiziridwa nthawi yomweyo.38 Ikhoza kukhala yosakanikirana ndi yofanana, ndipo nthawi zina imatha kukhudza malo onse omwe HA amaperekedwa panthawi ya opaleshoni.Ngakhale zotsatira za chikhalidwe ndi zoipa, mankhwala opha tizilombo toyambitsa matenda omwe amatha kulowa bwino pakhungu ayenera kugwiritsidwa ntchito.Ngati pali tinatake tozungulira fibrous ndi kukana kuchulukirachulukira, mwina ndi yachilendo thupi granuloma.
HA imathanso kuyambitsa kutupa kudzera munjira ya ma superantigens.Kuyankha uku sikufuna magawo oyamba a kutupa.12,39 Superantigens imayambitsa 40% ya maselo oyambirira a T ndipo mwinamwake NKT clonal activation.Kutsegula kwa ma lymphocytewa kumabweretsa mphepo yamkuntho ya cytokine, yomwe imadziwika ndi kutulutsidwa kwa ma cytokines ochuluka omwe amachititsa kutupa, monga IL-1β, IL-2, IL-6 ndi TNF-α40.
Chibayo chachikulu, nthawi zambiri limodzi ndi kwambiri kupuma kulephera, ndi chitsanzo cha pathological poyankha bakiteriya superantigen (staphylococcal enterotoxin B), amene kumawonjezera LMW-HA opangidwa ndi fibroblasts mu m`mapapo minofu.HA imalimbikitsa kupanga IL-8 ndi IP-10 chemokines, yomwe imagwira ntchito yofunika kwambiri polemba maselo otupa m'mapapo.40,41 Njira zofananira zakhala zikuwonetsedwa pa nthawi ya mphumu, matenda osokoneza bongo komanso chibayo.Kuchulukirachulukira kwa COVID-19.41 LMW-HA kumabweretsa kukondoweza kwambiri kwa CD44 komanso kutulutsidwa kwa ma cytokines oyambitsa kutupa ndi ma chemokines.40 Makinawa amathanso kuwonedwa mu kutupa komwe kumayambitsidwa ndi zigawo za biofilm.
Pamene ukadaulo wopanga ma filler sunali wolondola mu 1999, chiwopsezo cha kuchedwa kuchitapo kanthu pambuyo jekeseni wa HA chidatsimikizika kukhala 0.7%.Pambuyo pa kukhazikitsidwa kwa zinthu zoyera kwambiri, zochitika zowawa zoterezi zidatsika mpaka 0,02%.3,42,43 Komabe, kuyambitsidwa kwa HA fillers yomwe imaphatikiza unyolo wapamwamba ndi wochepa wa HA kunapangitsa kuti maperesenti apamwamba a AE.44
Deta yoyamba pazotsatira zotere idawonekera mu lipoti la kugwiritsa ntchito NASHA.Ichi ndi edema ndi edema reaction, ndi kulowa ndi edema m'madera ozungulira kumatenga masiku 15.Izi zidawonedwa mwa odwala 1 mwa 1400.3 Olemba ena adanenanso za zotupa zokhalitsa, zomwe zimachitika mu 0.8% ya odwala.45 Iwo anagogomezera etiology yokhudzana ndi kuipitsidwa kwa mapuloteni chifukwa cha kuwira kwa mabakiteriya.Malinga ndi zolembedwa, kuchuluka kwa zoyipa ndi 0.15-0.42%.3,6,43
Pankhani yogwiritsira ntchito nthawi, pali zoyesayesa zambiri zoyika zotsatira zoyipa za HA.46
Bitterman-Deutsch et al.m'gulu zimayambitsa chokhwima zimachitikira ndi mavuto pambuyo opaleshoni ndi hyaluronic asidi ofotokoza kukonzekera.Iwo akuphatikizapo
Gulu la akatswiri linayesa kufotokozera yankho la hyaluronic acid pogwiritsa ntchito nthawi yowonekera pambuyo pa opaleshoni: "oyambirira" (<14 masiku), "mochedwa" (> 14 masiku mpaka 1 chaka) kapena "kuchedwa" (> 1 chaka).47-49 Olemba ena adagawa mayankhowo kumayambiriro (mpaka sabata imodzi), apakatikati (nthawi: sabata imodzi mpaka mwezi umodzi), komanso mochedwa (kuposa mwezi umodzi).50 Pakalipano, mayankho ochedwa ndi ochedwa amatengedwa ngati chinthu chimodzi, chotchedwa delayed inflammatory response (DIR), chifukwa zomwe zimayambitsa nthawi zambiri sizidziwika bwino ndipo chithandizo sichikugwirizana ndi zomwe zimayambitsa.42 Gulu la machitidwewa likhoza kuperekedwa kutengera zolemba (Chithunzi 3).
Kutupa kwapang'onopang'ono pamalo opangira jekeseni pambuyo pa opaleshoni kungakhale chifukwa cha kutulutsa kwa histamine kwa odwala omwe ali ndi vuto lamtundu wa 1, makamaka omwe ali ndi mbiri ya matenda a khungu.51 Pangopita mphindi zochepa kuchokera pomwe ma cell a mast amawonongeka ndi makina ndipo amamasula oyimira pakati omwe amayambitsa kutupa kwa minofu ndi mapangidwe amphepo.Ngati kuyankhidwa kwa mast cell kumachitika, njira ya antihistamine nthawi zambiri imakhala yokwanira.51
Kuwonongeka kwakukulu kwa khungu komwe kumachitika chifukwa cha opaleshoni yodzikongoletsera, ndikokulirapo kwa edema, komwe kumatha mpaka 10-50%.52 Malinga ndi zolemba za odwala omwe ali ndi akhungu amitundu iwiri, kuchuluka kwa edema pambuyo pa jekeseni wa Restylane akuti ndi 87% ya kafukufukuyu 52,53.
Madera omwe ali pankhope omwe amawoneka kuti ndi ovuta kwambiri ndi edema ndi milomo, periorbital ndi masaya.52 Pofuna kuchepetsa chiopsezo, tikulimbikitsidwa kuti tipewe kugwiritsa ntchito zodzaza zambiri, anesthesia yolowera, kutikita minofu yogwira ntchito komanso kukonzekera kwa hygroscopic.Zowonjezera (mannitol, dextran).52
Edema pamalo opangira jakisoni yomwe imatha mphindi zingapo mpaka masiku 2-3 imatha chifukwa cha hygroscopicity ya HA.Izi zimachitika kawirikawiri m'dera la perilip ndi periorbital.49,54 sayenera kulakwitsa chifukwa cha edema yomwe imayambitsidwa ndi njira yosowa kwambiri yanthawi yomweyo ziwengo (angioedema).49
Pambuyo pa jekeseni wa Restylane (NASHA) pamlomo wapamwamba, nkhani ya hypersensitivity kwa angioedema inafotokozedwa.Komabe, wodwalayo adatenganso 2% ya lidocaine, yomwe ingayambitsenso mtundu wa I hypersensitivity zimachitikira.Kuwongolera mwadongosolo kwa corticosteroids kunapangitsa kuti edema ichepetse mkati mwa masiku 4.32
Zomwe zikukula mwachangu zitha kukhala chifukwa cha hypersensitivity ku zotsalira za mapuloteni a HA synthesizing mabakiteriya.Kuyanjana pakati pa jekeseni ya HA ndi maselo otsala a mast mu minofu ndi njira ina yofotokozera zomwe zimachitika mwamsanga.Cholandira cha CD44 pamwamba pa mast cell ndi cholandirira cha HA, ndipo kuyanjana kumeneku kungakhale kofunikira pa kusamuka kwawo.32,55
Chithandizo chimaphatikizapo kupatsidwa mankhwala oletsa antihistamine, systemic GCS, kapena epinephrine.46
Lipoti loyamba, lofalitsidwa ndi Turkmani et al., Anafotokoza amayi azaka za 22-65 omwe adachitidwa opaleshoni ya HA yopangidwa ndi makampani osiyanasiyana.39 Zilonda zapakhungu zimawonekera ndi erythema ndi edema yowawa pamalo opangira jakisoni pankhope.Nthawi zonse, kuyankha kumayamba patatha masiku 3-5 pambuyo pa matenda a chimfine (malungo, mutu, zilonda zapakhosi, chifuwa, ndi kutopa).Kuphatikiza apo, odwala onse adalandira chithandizo cha HA (2 mpaka 6 nthawi) zaka 4 zizindikiro zisanawonekere mbali zosiyanasiyana za nkhope.39
Kuwonetsedwa kwachipatala kwa zomwe zafotokozedwa (erythema ndi edema kapena urticaria-ngati zidzolo zowoneka mwadongosolo) ndizofanana ndi machitidwe amtundu wa III - kudwala kwa pseudoserum.Tsoka ilo, palibe malipoti m'mabuku omwe amatsimikizira lingaliro ili.Lipoti lamilandu limafotokoza za wodwala yemwe ali ndi zotupa ngati zotupa pa nthawi ya Sweet Syndrome, yomwe ndi chizindikiro cha pathological chomwe chikuwoneka maola 24-48 pambuyo pa malo olamulira a HA.56
Olemba ena amakhulupirira kuti limagwirira zomwe zimachitika chifukwa cha mtundu wa IV hypersensitivity.Yapita HA jekeseni analimbikitsa mapangidwe lymphocytes kukumbukira, ndi wotsatira makonzedwe a kukonzekera mwamsanga zinayambitsa kuyankha kwa CD4 + maselo ndi macrophages.39
Wodwalayo analandira oral prednisolone 20-30 mg kapena methylprednisolone 16-24 mg tsiku lililonse kwa masiku asanu.Kenako mlingo unachepetsedwa kwa masiku asanu.Pambuyo pa milungu iwiri, zizindikiro za odwala 10 omwe adalandira oral steroids adazimiririka.Odwala anayi otsalawo anapitirizabe kukhala ndi edema yochepa.Hyaluronidase amagwiritsidwa ntchito kwa mwezi umodzi pambuyo poyambira.39
Malinga ndi mabuku, ambiri anachedwa mavuto angayambe pambuyo jekeseni wa asidi hyaluronic.Komabe, wolemba aliyense adawaika m'magulu malinga ndi zochitika zachipatala.Liwu logwirizana kapena gulu silinapangidwe kuti lifotokoze zovuta zotere.Mawu akuti continuous intermittent delayed kutupa (PIDS) amatanthauzidwa ndi dermatologists ku Brazil mu 2017. 57 Beleznay et al.adayambitsa mawu ena ofotokoza za matendawa mu 2015: kuchedwa kuyambika kwa nodule 15,58 ndi Snozzi et al.: advanced inflammatory response syndrome (LI).58 Mu 2020, mawu ena adanenedwa: kuchedwa kutupa Reaction (DIR).48
Chung et al.anatsindika kuti DIR imaphatikizapo mitundu inayi ya machitidwe: 1) DTH reaction (yotchedwa molondola: kuchedwa kwa mtundu wa IV hypersensitivity reaction);2) yachilendo thupi granuloma anachita;3) biofilm;4) matenda atypical.Kuchita kwa DTH ndikuchedwa kutukusira kwa chitetezo cham'thupi, komwe ndi kuyankha kwa ma allergen.59
Malinga ndi magwero osiyanasiyana, tinganene kuti pafupipafupi zomwe zimachitikazi zimasinthasintha.Posachedwapa pepala lolembedwa ndi ofufuza a Israeli.Iwo adawunika kuchuluka kwa zochitika zoyipa mu mawonekedwe a DIR kutengera mafunso.Mafunsowo adamalizidwa ndi madokotala 334 omwe adapereka jakisoni wa HA.Zotsatira zake zidawonetsa kuti pafupifupi theka la anthu sanapezeke ndi DIR, ndipo 11.4% adayankha kuti adawonapo izi kuposa kasanu.48 Mu mayeso olembetsa kuti awone chitetezo, zomwe zimayambitsidwa ndi zinthu zopangidwa ndi Allergan zalembedwa bwino.Atatha kumwa Juvederm Voluma® kwa miyezi 24, pafupifupi 1% mwa odwala 103 omwe adayang'anitsitsa adanenanso zomwezo.60 Pakafukufuku wobwerezabwereza wa miyezi ya 68 ya njira za 4702, njira yoyankhira yofananayo inawonedwa mu 0.5% ya odwala.Juvederm Voluma® idagwiritsidwa ntchito mwa odwala 2342.15 Kuchuluka kwakukulu kunawonedwa pamene mankhwala a Juvederm Volbella® ankagwiritsidwa ntchito pa misozi ndi malo a milomo.Pambuyo pa masabata a 8, 4.25% (n = 17) anali ndi zobwereza zomwe zinatha mpaka miyezi 11 (chiwerengero cha 3.17 episodes).42 Kuwunika kwaposachedwa kwa odwala opitilira chikwi chimodzi omwe amalandila chithandizo cha Vycross kwazaka 2 zotsatiridwa ndi zodzaza zidawonetsa kuti kuchuluka kwa ma nodule ochedwa kunali 1%.57 Kuyankha kwa Chung et al. ku lipotili ndizovuta kwambiri.Malingana ndi mawerengedwe a maphunziro omwe akuyembekezeka, chiwerengero cha kuchedwa kuyankha kwa kutupa chinali 1.1% pachaka, pamene m'maphunziro obwerezabwereza, chinali chochepera 1% pazaka 1 mpaka 5.5.Sikuti milandu yonse yomwe yanenedwa ilidi DIR chifukwa palibe tanthauzo lenileni.59
Kuchedwetsa kuyankha kwa kutupa (DIR) yachiwiri pakuwongolera kwa minofu filler kumachitika osachepera masabata 2-4 kapena pambuyo pake jekeseni wa HA.42 Mawonetseredwe azachipatala ali mu mawonekedwe obwerezabwereza a edema olimba a m'deralo, pamodzi ndi erythema ndi chifundo, kapena ma subcutaneous nodules pa malo a jekeseni wa HA.42,48 Mitsempha imatha kukhala yotentha pokhudza, ndipo khungu lozungulira likhoza kukhala lofiirira kapena lofiirira.Odwala ambiri amakhudzidwa mbali zonse panthawi imodzi.Pankhani yogwiritsa ntchito HA kale, mosasamala kanthu za mtundu wa zodzaza kapena kuchuluka kwa jakisoni, ndizofunikira kwambiri zomwe zikuwonetsa mawonetseredwe azachipatala.15,39 Zilonda zapakhungu ndizofala kwambiri mwa anthu omwe adabayapo kale jekeseni wambiri wa HA.43 Kuonjezera apo, edema yotsatizana ndi yowonekera kwambiri pambuyo podzuka, ndipo imakhala bwino pang'ono tsiku lonse.42,44,57 Odwala ena (~ 40%) amakhala ndi mawonekedwe ofanana ndi chimfine.15
Zochita izi zikhoza kukhala zokhudzana ndi kuipitsidwa kwa DNA, mapuloteni, ndi endotoxin ya bakiteriya, ngakhale kuti chiwerengerocho ndi chochepa kwambiri kuposa cha HA.15 Komabe, LMW-HA ikhoza kupezekanso mwa anthu omwe ali ndi vuto la majini mwachindunji kapena kudzera mu mamolekyu opatsirana (biofilms).15,44 Komabe, maonekedwe a zotupa zotupa pamtunda wina kuchokera kumalo opangira jekeseni, kukana kwa matendawa ku chithandizo cha nthawi yaitali cha maantibayotiki komanso kuchotseratu tizilombo toyambitsa matenda (chikhalidwe ndi PCR kuyezetsa)) kumayambitsa kukayikira za ntchito ya biofilms. .Komanso mphamvu ya mankhwala hyaluronidase ndi kudalira HA mlingo zimasonyeza limagwirira a kuchedwa hypersensitivity.42,44
Kuyankha chifukwa cha matenda kapena kuvulala kungayambitse kuwonjezeka kwa seramu interferon, zomwe zingapangitse kutupa komwe kunalipo kale.15,57,61 Kuwonjezera apo, LMW-HA imayambitsa ma CD44 kapena TLR4 receptors pamwamba pa macrophages ndi maselo a dendritic.Imawayambitsa ndikupereka ma sign a costimulatory kuma T cell.15,19,24 Mitsempha yotupa yomwe imagwirizanitsidwa ndi DIR imachitika mkati mwa 3 mpaka miyezi 5 pambuyo pa jekeseni wa HMW-HA filler (yokhala ndi anti-inflammatory properties), yomwe imawonongeka ndikusintha kukhala LMW- yokhala ndi pro-inflammatory properties HA.15
Zomwe zimachitika nthawi zambiri zimayambitsidwa ndi matenda ena (sinusitis, matenda a mkodzo, matenda a kupuma, matenda a mano), kuvulala kumaso, ndi opaleshoni ya mano.57 Izi zidayambanso chifukwa cha katemera ndipo zidachitikanso chifukwa chotaya magazi msambo.15, 57 Chigawo chilichonse chikhoza kuyambitsidwa ndi zoyambitsa matenda.
Olemba ena afotokozanso za chibadwa cha anthu omwe ali ndi ma subtypes otsatirawa kuti ayankhe: HLA B * 08 kapena DRB1 * 03.4 (kuwonjezeka kwachiwopsezo kanayi).13,62
Zotupa zokhudzana ndi DIR zimadziwika ndi zotupa zotupa.Ayenera kusiyanitsidwa ndi tinatake tozungulira, ma abscesses (kufewetsa, kusinthasintha), ndi ma granulomatous (zotupa zolimba zotupa) zomwe zimayambitsidwa ndi biofilms.58
Chung et al.lingalirani kugwiritsa ntchito mankhwala a HA poyezetsa khungu musanakonzekere, ngakhale kuti nthawi yofunikira kutanthauzira zotsatira zake zitha kukhala masabata 3-4.59 Iwo amalimbikitsa mwatsatanetsatane mayeso otere mwa anthu omwe adakumana ndi zovuta.Ndazindikira kale.Ngati mayeso ali abwino, wodwalayo sayenera kuthandizidwanso ndi HA filler yomweyo.Komabe, sizingathetse zochitika zonse chifukwa nthawi zambiri zimayambitsidwa ndi zoyambitsa, monga matenda opatsirana omwe amatha kuchitika nthawi iliyonse.59
Nthawi yotumiza: Sep-28-2021