Immunogenicity da sakamakon hyaluronic acid fillers

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Agnieszka Owczarczyk-Saczonek, Natalia Zdanowska, Ewa Wygonowska, Waldemar Placek Department of Dermatology, Jima'i da Cututtuka da Clinical Immunology, Warmia da Mazury Jami'o'i a Olsztyn, Poland Newsletter: Agnieszka Owczarekzyk, Transmatology da Sashen Digiri, Dermatology Warmia da Jami'ar Mazury, Olsztyn, Poland.Wojska Polskiego 30.Irin tsarin kwayoyin halitta a cikin dukkan kwayoyin halitta shine babban fa'idarsa domin yana da mafi karancin yiwuwar rikidewa zuwa rigakafi.Sabili da haka, saboda daidaituwar yanayin halitta da kwanciyar hankali a wurin dasawa, shine mafi kusancin tsarin da za a yi amfani da shi azaman filler.Wannan labarin ya haɗa da tattaunawa game da tushen tsarin rashin amsawar rigakafi na HA, da kuma hanyar mayar da martani bayan rigakafin cutar SARS-CoV-2.Bisa ga wallafe-wallafen, mun yi ƙoƙarin tsara tsarin rigakafi mara kyau tare da bayyanar cututtuka a cikin HA.Abin da ya faru na halayen da ba a iya ganewa ba ga hyaluronic acid yana nuna cewa ƙila ba za a yi la'akari da su tsaka-tsaki ko rashin lafiyan jiki ba.Canje-canje a cikin tsarin sinadarai na HA, additives, da halayen mutum a cikin marasa lafiya na iya zama sanadin halayen da ba a iya ganewa ba, yana haifar da mummunar sakamakon lafiya.Shirye-shiryen da ba a san asalinsu ba, rashin tsarkakewa, ko ɗauke da DNA na kwayan cuta suna da haɗari musamman.Sabili da haka, bin dogon lokaci na marasa lafiya da zaɓin shirye-shiryen da aka yarda da FDA ko EMA suna da mahimmanci.Sau da yawa marasa lafiya ba su san illar ayyukan rahusa da mutane ke yi ba tare da sanin ya kamata ba ta amfani da kayayyakin da ba a yi wa rajista ba, don haka ya kamata a wayar da kan jama’a tare da bullo da dokoki da ka’idoji.Mahimman kalmomi: Hyaluronic acid, fillers, jinkirta kumburi, autoimmune/auto-inflammatory adjuvant-induced syndrome, SARS-CoV-2
Hyaluronic acid (HA) shine glycosaminoglycan, wani yanki na halitta na matrix extracellular.Ana samar da shi ta hanyar fibroblasts dermal, sel synovial, sel endothelial, ƙwayoyin tsoka mai santsi, ƙwayoyin adventitia da oocytes kuma an sake su cikin sararin sararin samaniya.1,2 Irin wannan tsarin kwayoyin halitta a cikin dukkanin kwayoyin halitta shine babban amfaninsa, wanda ke hade da ƙananan haɗari na rigakafi.Kwayoyin halitta da kwanciyar hankali na wurin dasawa sun sa ya zama kusan kyakkyawan zaɓi don duk jerin filler.Saboda fadada inji na nama bayan allura da kuma kunna fibroblasts na fata na gaba, yana da fa'ida mai mahimmanci na samun damar haɓaka samar da sabon collagen.2-4 Hyaluronic acid ne sosai hydrophilic, yana da musamman halaye na dauri ruwa kwayoyin (fiye da 1000 sau nasa nauyi), da kuma Forms wani Extended conformation tare da babban girma idan aka kwatanta da nauyi.Yana kuma iya samar da magudanar ruwa ko da a cikin ƙananan yawa.manne.Yana haifar da kyallen takarda don yin sauri da sauri da kuma ƙara ƙarar fata.3,5,6 Bugu da ƙari, m fata da kuma yiwuwar antioxidant na hyaluronic acid na iya inganta farfadowar fata na fata kuma yana ƙarfafa samar da collagen.5
A cikin shekaru, an lura cewa shaharar hanyoyin kwaskwarima ta amfani da abubuwa irin su HA ya ci gaba da karuwa.Dangane da bayanai daga aikin tiyata na duniya (ITPAPS), sama da matakai miliyan 4.7% aka yi amfani da su ta hanyar 2018, da suka karu da rahotannin da ke tsakanin shekarar 2018. miliyan dermal filler injections in 2019. 8 Aiwatar da irin waɗannan hanyoyin yana zama nau'i mai fa'ida mai fa'ida na ayyukan biya.Don haka, saboda rashin dokoki da ƙa'idodi a ƙasashe/yankuna da yawa, mutane da yawa suna ba da irin waɗannan ayyuka, yawanci ba tare da isasshen horo ko cancanta ba.Bugu da kari, akwai m formulations a kasuwa.Suna iya zama mai rahusa, mafi ƙarancin inganci, kuma FDA ko EMA ba su amince da su ba, wanda shine haɗarin haɓaka sabbin nau'ikan halayen mara kyau.A cewar wani bincike da aka gudanar a Belgium, akasarin samfura 14 da ake zargin ba bisa ka'ida ba da aka gwada sun ƙunshe da ƙananan kayayyaki fiye da ƙayyadaddun marufi.9 Kasashe da yawa suna da launin toka na hanyoyin kwaskwarima ba bisa ka'ida ba.Bugu da ƙari, waɗannan hanyoyin ba su da rajista kuma ba a biya harajin da za a biya.
Saboda haka, akwai rahotanni da yawa na abubuwan da ba su da kyau a cikin wallafe-wallafen.Wadannan mummunan al'amuran yawanci suna haifar da babban ganewar asali da matsalolin jiyya da sakamakon da ba a iya tsammani ga marasa lafiya.7,8 Hypersensitivity zuwa hyaluronic acid yana da mahimmanci musamman.Ba a ba da cikakken bayani game da cututtukan wasu halayen ba, don haka kalmomi a cikin wallafe-wallafen ba daidai ba ne, kuma yawancin ra'ayi game da gudanar da rikice-rikice ba su haɗa da irin wannan halayen ba.10,11
Wannan labarin ya ƙunshi bayanai daga nazarin adabi.Gano labaran ƙima ta hanyar bincika PubMed ta amfani da waɗannan kalmomi masu zuwa: hyaluronic acid, filler, da illa.Ana ci gaba da binciken har zuwa ranar 30 ga Maris, 2021. An samo labarai guda 105 kuma an bincika 42 daga cikinsu.
Hyaluronic acid ba gabobin jiki ba ne ko takamaiman nau'in, don haka ana iya ɗauka cewa baya haifar da rashin lafiyan halayen.12 Duk da haka, yana da mahimmanci a tuna cewa samfurin da aka yi masa allura ya haɗa da ƙari, kuma ana samun hyaluronic acid ta hanyar biosynthesis na ƙwayoyin cuta.
Hakanan an nuna cewa halayen mutum na iya haifar da haɗarin jinkiri, halayen rashin daidaituwa na rigakafi da ke hade da dermal fillers a cikin marasa lafiya ɗauke da HLA-B * 08 da DR1 * 03 haplotypes.Wannan haɗin nau'ikan nau'ikan HLA yana da alaƙa da haɓaka kusan ninki huɗu a cikin yuwuwar mummunan halayen (OR 3.79).13
Hyaluronic acid ya wanzu a cikin nau'i na multiparticulates, ƙirar sa yana da sauƙi, amma yana da biomolecule multifunctional.Girman HA yana rinjayar kishiyar sakamako: yana iya samun pro-inflammatory ko anti-mai kumburi Properties, inganta ko hana cell hijirarsa, da kuma kunna ko dakatar da rarraba cell da bambanci.14-16 Abin baƙin ciki, babu yarjejeniya akan rabewar HA.Kalmar girman kwayoyin halitta.14,16,17
Lokacin amfani da samfuran HMW-HA, yana da mahimmanci a tuna cewa hyaluronidase na halitta yana haifar da lalacewa kuma yana haɓaka samuwar LMW-HA.HYAL2 (wanda aka rataye akan membrane na tantanin halitta) yana raba babban nauyin kwayoyin HA (> 1 MDa) zuwa gutsuttsura kDa 20.Bugu da ƙari, idan HA hypersensitivity ya fara, kumburi zai inganta ci gaba da lalacewa (Figure 1).
A cikin yanayin samfuran HA, ana iya samun wasu bambance-bambance a cikin ma'anar girman kwayoyin halitta.Misali, ga rukunin samfuran Juvederm (Allergan), ƙwayoyin cuta> 500 kDa ana ɗaukar su LMW-HA, da> 5000 kDa - HMW-HA.Zai shafi inganta amincin samfur.18
A wasu lokuta, ƙananan nauyin kwayoyin halitta (LMW) HA na iya haifar da hypersensitivity 14 (Hoto 2).Ana la'akari da kwayar cutar mai kumburi.Yana da yawa a cikin wuraren catabolism na nama mai aiki, alal misali, bayan rauni, yana haifar da kumburi ta hanyar rinjayar masu karɓa na Toll-like (TLR2, TLR4).14-16,19 Ta wannan hanyar, LMW-HA yana haɓaka kunnawa da maturation na ƙwayoyin dendritic (DC), kuma yana ƙarfafa nau'ikan sel daban-daban don samar da cytokines masu kumburi, kamar IL-1β, IL-6, IL-12 , TNF-a da TGF-β, suna sarrafa maganganun chemokines da ƙaurawar tantanin halitta.14,17,20 LMW-HA na iya yin aiki azaman ƙirar ƙwayoyin cuta mai alaƙa da haɗari (DAMP) don ƙaddamar da ingantattun hanyoyin rigakafi, kama da sunadaran ƙwayoyin cuta ko sunadarai masu girgiza zafi.14,21 CD44 yana aiki azaman nau'i na ƙirar ƙirar mai karɓa don LMW-HA.Yana wanzu a saman dukkan ƙwayoyin ɗan adam kuma yana iya yin hulɗa tare da sauran haɗin gwiwa kamar osteopontin, collagen, da matrix metalloproteinases (MMP).14,16,17.
Bayan kumburi ya ragu kuma an kawar da ragowar nama mai lalacewa ta hanyar macrophages, an cire kwayoyin LMW-HA ta hanyar endocytosis mai dogara da CD44.Sabanin haka, kumburi na yau da kullun yana da alaƙa da haɓakar adadin LMW-HA, don haka ana iya ɗaukar su azaman biosensors na halitta na matsayin amincin nama.14,20,22,23 Matsayin mai karɓar CD44 na HA an nuna shi a cikin binciken akan ka'idojin kumburi a ƙarƙashin yanayin vivo.A cikin nau'ikan linzamin kwamfuta na atopic dermatitis, maganin anti-CD44 yana hana ci gaban yanayi irin su cututtukan fata da ke haifar da collagen ko lalacewar fata.ashirin da hudu
Babban nauyin kwayoyin halitta (HMW) HA ya zama ruwan dare a cikin kyallen takarda.Yana hana samar da masu shiga tsakani (IL-1β, IL-8, IL-17, TNF-α, metalloproteinases), yana rage maganganun TLR kuma yana daidaita tsarin angiogenesis.14,19 HMW-HA kuma yana rinjayar aikin macrophages da ke da alhakin tsarawa ta hanyar ƙarfafa aikin su na anti-mai kumburi don inganta kumburi na gida.15,24,25
Jimlar adadin hyaluronic acid a cikin mutum mai nauyin kilogiram 70 ya kai kimanin gram 15, kuma matsakaicin adadinsa shine gram 5 kowace rana.Kimanin kashi 50% na hyaluronic acid a jikin mutum yana cikin fata.Rabin rayuwarsa shine sa'o'i 24-48.22,26 Sabili da haka, rabin rabin rayuwa na halitta HA ba a canza shi ba kafin a rushe shi da sauri ta hyaluronidase, enzymes nama na halitta da nau'in oxygen mai amsawa shine kawai 12 hours.27,28 An haɓaka sarkar HA don tsawaita kwanciyar hankali da kuma samar da manyan ƙwayoyin cuta masu ƙarfi, tare da tsawon lokacin zama a cikin nama (kimanin watanni da yawa), kuma tare da kwatankwacin kwatankwacin halittu da abubuwan cikewar viscoelastic.28 Crosslinking ya ƙunshi mafi girma rabo na haɗe HA tare da ƙananan kwayoyin nauyin kwayoyin halitta da ƙananan nauyin nauyin nauyin kwayoyin HA.Wannan gyare-gyaren yana canza yanayin yanayin kwayoyin HA kuma yana iya rinjayar immunogenicity.18
Haɗin giciye ya ƙunshi haɗin haɗin gwiwa na polymers don samar da haɗin kai, galibi gami da (-COOH) da/ko kwarangwal na hydroxyl (-OH).Wasu mahadi na iya inganta haɗin kai, irin su 1,4-butanediol diglycidyl ether (BDDE) (Juvederm, Restylane, Princess), divinyl sulfone (Captique, Hylaform, Prevelle) ko diepoxy octane (Puragen).29 Koyaya, ƙungiyoyin epoxy na BDDE an kawar da su bayan amsawa tare da HA, don haka kawai ana iya samun adadin BDDE da ba a amsa ba (<2 sassa a kowace miliyan) a cikin samfurin.26 Cross-linked ha hydrogel abu ne mai daidaitawa wanda zai iya haifar da samuwar sifofin 3D tare da kaddarorin na musamman (rheology, lalata, zartarwa).Waɗannan fasalulluka suna haɓaka sauƙin rarraba samfurin kuma a lokaci guda suna haɓaka samar da abubuwan haɗin ƙwayoyin ƙwayoyin cuta na matrix extracellular.30,31<>
Domin ƙara yawan hydrophilicity na samfurin, wasu masana'antun suna ƙara wasu mahadi, kamar dextran ko mannitol.Kowane ɗayan waɗannan abubuwan ƙari na iya zama antigen wanda ke motsa amsawar rigakafi.
A halin yanzu, ana samar da shirye-shiryen HA daga takamaiman nau'ikan Streptococcus ta hanyar fermentation na kwayan cuta.(Streptococcus equi ko Streptococcus zooepidemicus).Idan aka kwatanta da shirye-shiryen da aka samo daga dabba da aka yi amfani da su a baya, yana rage haɗarin immunogenicity, amma ba zai iya kawar da gurɓataccen ƙwayoyin furotin ba, kwayoyin nucleic acid da stabilizers.Suna iya zama antigens kuma suna motsa martanin rigakafi na mai watsa shiri, irin su rashin hankali ga samfuran HA.Don haka, fasahar samar da filler (kamar Restylane) suna mai da hankali kan rage gurɓataccen samfur.32
A cewar wani hasashe, amsawar rigakafi ga HA yana haifar da kumburi ta hanyar ƙwayoyin ƙwayoyin cuta na ƙwayoyin cuta, waɗanda aka canjawa wuri zuwa kyallen takarda lokacin da aka allurar samfurin.33,34 Biofilm yana kunshe da kwayoyin cuta, abubuwan gina jiki da kuma metabolites.Ya ƙunshi manyan ƙwayoyin cuta waɗanda ba su da cutarwa waɗanda ke mamaye fata mai lafiya ko ƙwayoyin mucous (misali Dermatobacterium acnes, Streptococcus oralis, Staphylococcus epidermidis).Waɗannan An tabbatar da nau'in ta hanyar gwajin sarkar polymerase.33-35
Saboda halayensu na musamman na sannu-sannu da bambance-bambancen su da ake kira ƙananan yankuna, sau da yawa yana da wuya a gano ƙwayoyin cuta a cikin al'ada.Bugu da ƙari, ƙwayar su a cikin biofilm na iya raguwa, wanda ke taimakawa wajen kauce wa tasirin maganin rigakafi.35,36 Bugu da ƙari, ikon samar da matrix extracellular na extracellular polysaccharides (ciki har da HA) wani abu ne mai kariya ga phagocytosis.Waɗannan ƙwayoyin cuta na iya zama a kwance na shekaru masu yawa, sannan a kunna su ta hanyar abubuwan waje kuma su haifar da amsa.35-37 Macrophages da giant sel yawanci ana samun su a kusa da waɗannan ƙananan ƙwayoyin cuta.Za a iya kunna su da sauri kuma su haifar da amsa mai kumburi.38 Wasu dalilai, irin su cututtukan ƙwayoyin cuta tare da nau'ikan ƙwayoyin cuta waɗanda suke kama da abun da ke ciki zuwa biofilms, na iya kunna ƙwayoyin cuta marasa ƙarfi ta hanyar ƙirar ƙima.Kunnawa na iya zama saboda lalacewa ta hanyar wani hanyar filler dermal.38
Yana da wuya a bambanta tsakanin kumburi da jinkirin jinkirin da ke haifar da ƙwayoyin ƙwayoyin cuta.Idan raunin ja na sclerotic ya bayyana a kowane lokaci bayan tiyata, ba tare da la'akari da tsawon lokaci ba, ya kamata a yi zargin biofilm nan da nan.38 Yana iya zama asymmetrical da m, kuma wani lokaci yana iya shafar duk wuraren da ake gudanar da HA yayin tiyata.Ko da sakamakon al'ada ba shi da kyau, ya kamata a yi amfani da maganin rigakafi mai faɗi tare da shigar da kyau cikin fata.Idan akwai nodules fibrous tare da haɓaka juriya, yana yiwuwa ya zama granuloma na jikin waje.
HA kuma na iya tayar da kumburi ta hanyar tsarin superantigens.Wannan amsa baya buƙatar matakan farko na kumburi.12,39 Superantigens suna haifar da 40% na farkon ƙwayoyin T da yuwuwar kunna NKT clonal.Ƙaddamar da waɗannan ƙwayoyin lymphocytes suna haifar da hadari na cytokine, wanda aka kwatanta da sakin adadi mai yawa na cytokines masu kumburi, irin su IL-1β, IL-2, IL-6 da TNF-α40.
Mummunan ciwon huhu, sau da yawa tare da matsanancin gazawar numfashi, misali ne na amsawar cututtuka ga ƙwayoyin cuta na superantigen (staphylococcal enterotoxin B), wanda ke ƙara LMW-HA wanda fibroblasts ya haifar a cikin nama na huhu.HA yana ƙarfafa samar da IL-8 da kuma IP-10 chemokines, wanda ke taka muhimmiyar rawa wajen ɗaukar ƙwayoyin kumburi zuwa huhu.40,41 An lura da irin wannan hanyoyin a cikin yanayin asma, cututtukan huhu na huhu da ciwon huhu.Ƙarfafa samar da COVID-19.41 LMW-HA yana haifar da wuce gona da iri na CD44 da sakin cytokines masu kumburi da chemokines.40 Hakanan ana iya lura da wannan tsarin a cikin kumburi da abubuwan da ke haifar da biofilm.
Lokacin da fasahar samar da filler ba ta yi daidai ba a cikin 1999, haɗarin jinkirin amsawa bayan allurar HA an ƙaddara ya zama 0.7%.Bayan gabatar da samfurori masu tsabta, abubuwan da suka faru na irin wannan mummunan lamari ya ragu zuwa 0.02%.3,42,43 Duk da haka, ƙaddamar da masu cika HA waɗanda ke haɗuwa da sarƙoƙi masu girma da ƙananan HA sun haifar da ƙimar AE mafi girma.44
Bayanan farko game da irin waɗannan halayen sun bayyana a cikin rahoto game da amfani da NASHA.Wannan wani nau'i ne na erythema da edema, tare da kutsawa da edema a cikin yankin da ke kewaye da shi har zuwa kwanaki 15.An lura da wannan dauki a cikin 1 na marasa lafiya 1400.3 Wasu mawallafa sun ba da rahoton nodules mai kumburi na dindindin, wanda ke faruwa a cikin 0.8% na marasa lafiya.45 Sun jaddada ilimin etiology da ke da alaƙa da gurɓataccen furotin da ke haifar da fermentation na ƙwayoyin cuta.Dangane da wallafe-wallafen, yawan halayen halayen halayen shine 0.15-0.42%.3,6,43
A cikin yanayin amfani da ma'auni na lokaci, akwai ƙoƙari da yawa don rarraba mummunan tasirin HA.46
Bitterman-Deutsch et al.An rarraba abubuwan da ke haifar da mummunan halayen da rikitarwa bayan tiyata tare da shirye-shiryen tushen hyaluronic acid.Sun hada da
Ƙwararrun ƙwararrun sun yi ƙoƙari su bayyana martani ga hyaluronic acid dangane da lokacin bayyanar bayan tiyata: "farkon" (<14 days), "marigayi" (> 14 kwanaki zuwa 1 shekara) ko "jinkiri" (> 1 shekara).47-49 Wasu marubuta sun raba martanin zuwa farkon (har zuwa mako guda), matsakaici (lokaci: mako ɗaya zuwa wata ɗaya), da kuma marigayi (fiye da wata ɗaya).50 A halin yanzu, jinkiri da jinkirin martani ana ɗaukarsu azaman mahalli ɗaya, wanda ake kira jinkirin amsawar kumburi (DIR), saboda galibi ba a bayyana abubuwan da ke haifar da su ba kuma jiyya ba su da alaƙa da sanadin.42 Ana iya ba da shawarar rarraba waɗannan halayen bisa ga wallafe-wallafe (Figure 3).
Edema na wucin gadi a wurin allurar nan da nan bayan tiyata na iya zama saboda tsarin sakin histamine a cikin marasa lafiya masu saurin kamuwa da cutar rashin lafiyar 1, musamman waɗanda ke da tarihin cututtukan fata.51 Bayan 'yan mintoci kaɗan bayan gudanarwar ƙwayoyin mast ɗin sun lalace ta hanyar injiniya kuma suna sakin masu shiga tsakani don haifar da kumburin nama da haɓakar iska.Idan martanin da ya haɗa da ƙwayoyin mast ɗin ya faru, tsarin maganin antihistamine yawanci ya isa.51
Mafi girman lalacewar fata ta hanyar tiyata na kwaskwarima, mafi girma edema, wanda zai iya ci gaba zuwa 10-50%.52 Dangane da bazuwar littafan majinyata masu yawan makafi da yawa, yawan edema bayan allurar Restylane an kiyasta shine 87% na binciken 52,53
Wuraren da ke fuskar da ke da alama suna da saurin kamuwa da edema su ne lebe, sassan gefe da kuma kunci.52 Don rage haɗarin, ana bada shawara don kauce wa yin amfani da adadi mai yawa, maganin sa barci, tausa mai aiki da kuma shirye-shiryen hygroscopic sosai.Additives (mannitol, dextran).52
Edema a wurin allurar na tsawon mintuna da yawa zuwa kwanaki 2-3 na iya haifar da hygroscopicity na HA.Yawancin lokaci ana ganin wannan halayen a cikin ɓarna da yanki na periorbital.49,54 bai kamata a yi kuskure ba don edema da ke haifar da wani nau'i mai wuyar gaske na rashin lafiyan gaggawa (angioedema).49
Bayan allurar Restylane (NASHA) a cikin lebe na sama, an bayyana wani lamari na hypersensitivity zuwa angioedema.Duk da haka, majiyyaci kuma ya ɗauki 2% lidocaine, wanda kuma zai iya haifar da nau'in halayen rashin hankali na I.Gudanar da tsarin corticosteroids ya sa edema ya ragu a cikin kwanaki 4.32
Halin da ke faruwa da sauri yana iya zama saboda rashin jin daɗi ga gurɓataccen gurɓataccen furotin na ƙwayoyin cuta masu haɗin HA.Ma'amala tsakanin allurar HA da sauran ƙwayoyin mast a cikin nama wata hanya ce don fayyace abin da ya faru nan take.Mai karɓar CD44 akan saman sel mast shine mai karɓar HA, kuma wannan hulɗar na iya zama mahimmanci ga ƙaura.32,55
Jiyya ya haɗa da gudanarwa nan da nan na maganin antihistamines, tsarin GCS, ko epinephrine.46
Rahoton na farko, wanda Turkmani et al ya wallafa, ya bayyana mata masu shekaru 22-65 da aka yi wa tiyatar HA da kamfanoni daban-daban suka yi.39 Raunin fata yana bayyana ta erythema da kumburi mai raɗaɗi a wurin allurar filler akan fuska.A kowane hali, amsa yana farawa kwanaki 3-5 bayan rashin lafiya kamar mura (zazzabi, ciwon kai, ciwon makogwaro, tari, da gajiya).Bugu da ƙari, duk marasa lafiya sun sami gwamnatin HA (2 zuwa 6 sau) a cikin shekaru 4 kafin bayyanar cututtuka sun bayyana a sassa daban-daban na fuska.39
Gabatarwar asibiti na amsawar da aka bayyana (erythema da edema ko urticaria-kamar kurji tare da bayyanar tsarin tsarin) yayi kama da nau'in amsawar III-a yanayin rashin lafiya na pseudoserum.Abin takaici, babu rahotanni a cikin wallafe-wallafen da suka tabbatar da wannan hasashe.Rahoton shari'ar ya kwatanta majiyyaci tare da raunin da ya faru a lokacin ciwo mai dadi, wanda shine alamar cututtuka da ke bayyana 24-48 hours bayan wurin gudanarwa na HA.56
Wasu mawallafa sun yi imanin cewa tsarin da aka yi shi ne saboda nau'in hypersensitivity na IV.Allurar HA da ta gabata ta haifar da samuwar ƙwayoyin lymphocytes na ƙwaƙwalwar ajiya, kuma gudanar da shirye-shiryen na gaba da sauri ya haifar da amsawar ƙwayoyin CD4 + da macrophages.39
Mai haƙuri ya karɓi prednisolone na baka 20-30 MG ko methylprednisolone 16-24 MG kowace rana don kwanaki 5.Sa'an nan kuma an rage adadin na tsawon kwanaki 5.Bayan makonni 2, alamun marasa lafiya 10 da suka karbi maganin steroids gaba daya sun ɓace.Sauran marasa lafiya huɗu sun ci gaba da samun ƙarancin edema.Ana amfani da Hyaluronidase na tsawon wata daya bayan bayyanar cututtuka.39
Bisa ga wallafe-wallafen, yawancin matsalolin da aka jinkirta na iya faruwa bayan allurar hyaluronic acid.Koyaya, kowane marubuci ya rarraba su bisa ga kwarewar asibiti.Ba a ƙirƙira wata kalma ɗaya ko rarrabuwa don bayyana irin wannan mummunan halayen ba.Kalmar ci gaba da jinkirta jinkirin kumburi (PIDS) an bayyana shi ta hanyar likitocin fata na Brazil a cikin 2017. 57 Beleznay et al.gabatar da wani lokaci don bayyana wannan ilimin cututtuka a cikin 2015: jinkirta farawa nodule 15,58 da Snozzi et al .: ci gaba da ciwo mai kumburi (LI).58 A cikin 2020, an ba da shawarar wani lokaci: jinkirin amsawar kumburi (DIR).48
Chung et al.ya jaddada cewa DIR ya ƙunshi nau'i nau'i nau'i hudu: 1) DTH dauki (wanda ake kira daidai: jinkirta nau'in IV hypersensitivity dauki);2) halayen granuloma na jikin waje;3) biofilm;4) kamuwa da cuta mai yawan gaske.Halin DTH shine jinkirin kumburin rigakafi na salula, wanda shine martani ga allergens.59
A cewar majiyoyi daban-daban, ana iya cewa yawan wannan martanin yana canzawa.Kwanan nan ne aka buga takarda da masu binciken Isra’ila suka rubuta.Sun ƙididdige adadin abubuwan da ba su dace ba a cikin nau'in DIR bisa ga takardar tambayoyin.Likitoci 334 ne suka cika takardar tambayoyin da suka ba da alluran HA.Sakamakon ya nuna cewa kusan rabin mutanen ba su kamu da cutar ta DIR ba, kuma 11.4% sun amsa cewa sun lura da wannan yanayin fiye da sau 5.48 A cikin gwajin rajista don tantance aminci, halayen da samfuran da Allergan suka haifar an rubuta su da kyau.Bayan shan Juvederm Voluma® na tsawon watanni 24, kusan 1% na marasa lafiya 103 da aka sa ido sun ba da rahoton irin wannan halayen.60 A cikin watanni na 68 na sake dubawa na hanyoyin 4702, an lura da irin wannan yanayin amsawa a cikin 0.5% na marasa lafiya.An yi amfani da Juvederm Voluma® a cikin marasa lafiya 2342.15 An lura da kashi mafi girma lokacin da aka yi amfani da samfuran Juvederm Volbella® a cikin tsagewar tsage da leɓe.Bayan matsakaita na makonni 8, 4.25% (n=17) sun sami sake dawowa wanda ya dade har zuwa watanni 11 (matsakaicin sassan 3.17).42 Binciken baya-bayan nan na marasa lafiya fiye da dubu ɗaya da ke jurewa magani na Vycross don bin diddigin shekaru 2 tare da filler ya nuna cewa abin da ya faru na nodules na jinkirta shine 1%.Mitar amsa ta Chung et al ga rahoton yana da matukar muhimmanci.Bisa ga ƙididdiga na bincike mai yiwuwa, abubuwan da suka faru na jinkirin amsawar kumburi shine 1.1% a kowace shekara, yayin da a cikin binciken da aka yi a baya, ya kasance kasa da 1% a cikin shekarun 1 zuwa 5.5.Ba duk shari'o'in da aka ruwaito su ne ainihin DIR ba saboda babu takamaiman ma'anar.59
Jinkirin amsawar kumburi (DIR) na biyu zuwa gudanar da filler nama yana faruwa aƙalla makonni 2-4 ko kuma daga baya bayan allurar HA.42 Bayanan asibiti suna cikin nau'i na maimaitawa na ƙaƙƙarfan ƙaƙƙarfan ƙaƙƙarfan gida, tare da erythema da taushi, ko nodules na subcutaneous a wurin allurar HA.42,48 Nodules na iya zama dumi don taɓawa, kuma fatar da ke kewaye tana iya zama shunayya ko launin ruwan kasa.Yawancin marasa lafiya suna da halayen a duk sassa a lokaci guda.A cikin yanayin yin amfani da HA a baya, ba tare da la'akari da nau'in filler ko adadin injections ba, yana da mahimmancin mahimmanci wanda ke nuna alamun asibiti.Raunin fata 15,39 sun fi zama ruwan dare a cikin mutanen da suka yi allura mai yawa na HA a baya.43 Bugu da ƙari, edema mai rakiyar ya fi fitowa fili bayan farkawa, kuma yana inganta kadan a cikin yini.42,44,57 Wasu marasa lafiya (~ 40%) suna da bayyanar cututtuka kamar mura.15
Wadannan halayen na iya kasancewa da alaƙa da gurɓataccen DNA, furotin, da endotoxin na kwayan cuta, koda kuwa ƙaddamarwa ya fi ƙasa da na HA.15 Duk da haka, LMW-HA na iya kasancewa a cikin mutane masu saurin kamuwa da kwayoyin halitta kai tsaye ko ta hanyar ƙwayoyin cuta masu alaƙa (biofilms).15,44 Duk da haka, bayyanar nodules mai kumburi a wani nisa daga wurin allurar, juriya na cutar zuwa maganin rigakafi na dogon lokaci da kuma kawar da cututtuka masu cututtuka (al'ada da gwajin PCR)) yana haifar da zato game da rawar biofilms. .Bugu da ƙari, tasirin maganin hyaluronidase da kuma dogara ga kashi na HA yana nuna tsarin jinkirin jinkiri.42,44
Amsa saboda kamuwa da cuta ko rauni zai iya haifar da karuwa a cikin maganin interferon, wanda zai iya haifar da kumburi da aka rigaya.15,57,61 Bugu da ƙari, LMW-HA yana ƙarfafa CD44 ko TLR4 masu karɓa a kan macrophages da kwayoyin dendritic.Yana kunna su kuma yana ba da sigina na farashi zuwa ƙwayoyin T.15,19,24 nodules masu kumburi da ke hade da DIR suna faruwa a cikin watanni 3 zuwa 5 bayan allurar HMW-HA filler (tare da kaddarorin anti-mai kumburi), wanda sannan ya bazu kuma ya canza zuwa LMW- tare da kaddarorin masu kumburi HA.15
Sau da yawa ana haifar da cutar ta hanyar wani tsari na kamuwa da cuta (sinusitis, urinary tract infection, infection na numfashi, ciwon hakori), raunin fuska, da tiyatar hakori.57 Shima wannan maganin alurar riga kafi ne kuma ya sake faruwa saboda jinin haila.15, 57 Kowane lamari na iya haifar da abubuwan da ke haifar da cututtuka.
Wasu marubutan sun kuma bayyana irin tunanin mutane tare da abubuwan da zasu biyo baya don amsa: Hla B * 08 ko drb1 * 03.4 (karuwar hawa hudu cikin hadari).13,62
Raunin da ke da alaƙa da DIR yana da alaƙa da nodules mai kumburi.Ya kamata a bambanta su daga nodules, abscesses (laushi, sauye-sauye), da halayen granulomatous (hard inflammatory nodules) wanda biofilms ya haifar.58
Chung et al.ba da shawarar yin amfani da samfuran HA don gwajin fata kafin tsarin da aka tsara, kodayake lokacin da ake buƙata don fassara sakamakon gwajin na iya zama makonni 3-4.59 Suna ba da shawarar irin waɗannan gwaje-gwaje musamman a cikin mutanen da suka sami mummunan al'amura.Na lura a baya.Idan gwajin ya tabbata, bai kamata a sake jinyar mara lafiya da filler HA iri ɗaya ba.Duk da haka, bazai kawar da duk halayen ba saboda yawanci ana haifar da su ta hanyar abubuwan da ke haifar da su, kamar cututtuka masu haɗuwa waɗanda zasu iya faruwa a kowane lokaci.59


Lokacin aikawa: Satumba-28-2021