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Agnieszka Owczarczyk-Saczonek, Natalia Zdanowska, Ewa Wygonowska, Waldemar Placek Dhipatimendi reDermatology, Zvirwere Zvepabonde uye Clinical Immunology, Warmia neMazury Universities muOlsztyn, Poland Newsletter: Agnieszka Chirwere cheDhipatimendi reDermatology uye Immunology yeDhipatimendi reTransmix Warmia uye Mazury University, Olsztyn, Poland.Wojska Polskiego 30, Olsztyn, 10-229, PolishTel +48 89 6786670 Fax +48 89 6786641 Email [email protected] Abstract: Hyaluronic acid (HA) is glycosaminoglycan, a natural component of the extracellular matrix.Mamiriro akafanana emorekuru mune zvese zvipenyu ndiwo mukana waro mukuru nekuti ine mukana mudiki wekushandurwa kuita immunogenicity.Naizvozvo, nekuda kweiyo biocompatibility uye kugadzikana panzvimbo yekuisirwa, ndiyo iri padhuze yakanakira kuumbwa kuti ishandiswe sekuzadza.Ichi chinyorwa chinosanganisira nhaurirano yepasi peiyo HA's yakashata immune system, pamwe nemaitiro ekupindura mushure mekudzivirira kurwisa SARS-CoV-2.Sekureva kwemabhuku, takaedza kuronga iyo yakashata immune immune ne systemic kuratidzwa muHA.Kuitika kwemaitiro asingatarisirwi kune hyaluronic acid kunoratidza kuti vangave vasina kutorwa sevakarerekera kana kwete-allergenic.Kuchinja kweHA makemikari maitiro, additives, uye maitiro ega ega muvarwere angave ari chikonzero chekusagadzikana kusingatarisirwi, zvichiita kuti pave nemigumisiro yakakomba yehutano.Kugadzirira kusingazivikanwe kwakabva, kucheneswa kwakashata, kana kuti ine bhakitiriya DNA ine ngozi zvakanyanya.Nokudaro, kutevera kwenguva refu kwevarwere uye kusarudzwa kweFDA kana EMA gadziriro dzakabvumirwa zvakakosha zvikuru.Varwere kazhinji havazivi mhedzisiro yekuvhiyiwa kwakachipa kunoitwa nevanhu vasina ruzivo rwakakwana vachishandisa zvigadzirwa zvisina kunyoreswa, saka veruzhinji vanofanirwa kudzidziswa uye mitemo nemirairo inofanirwa kuunzwa.Keywords: Hyaluronic acid, fillers, kunonoka kuzvimba, autoimmune / auto-inflammatory adjuvant-induced syndrome, SARS-CoV-2
Hyaluronic acid (HA) inonzi glycosaminoglycan, chikamu chepanyama che extracellular matrix.Iyo inogadzirwa nedermal fibroblasts, synovial masero, endothelial masero, akatsetseka mhasuru masero, adventitia masero uye oocytes uye anoburitswa munzvimbo yakapoteredza extracellular space.1,2 Chimiro chakafanana chema molecules mune zvipenyu zvose ndiyo inonyanya kukosha, iyo inosanganiswa nekadiki kadiki ke immunogenicity.Iyo biocompatibility uye kugadzikana kweiyo saiti yekuisirwa inoita kuti ive sarudzo yakanakira iyo yese yekuzadza nhevedzano.Nekuda kwekuwedzera kwemuchina kwetishu mushure mejekiseni uye kunotevera activation yeganda fibroblasts, ine yakakosha mukana wekukwanisa kukurudzira kugadzirwa kwecollagen nyowani.2-4 Hyaluronic acid yakanyanya hydrophilic, ine hunhu hwakakosha hwekusunga mamorekuru emvura (kupfuura ka1000 uremu hwayo), uye inoumba conformation yakatambanudzwa ine vhoriyamu yakakura zvichienzaniswa nehuremu.Inogonawo kugadzira condensation kunyange pakadzika zvakanyanya.glue.Inokonzera kuti matushu kukurumidza hydrate uye kuwedzera huwandu hweganda.3,5,6 Mukuwedzera, kunyorova kweganda uye simba re antioxidant re hyaluronic acid rinogona kukurudzira kugadzirwa kwemasero eganda uye kukurudzira kugadzirwa kwe collagen.5
Kwemakore, zvakaonekwa kuti kufarirwa kwemaitiro ezvizoro achishandisa zvinhu zvakadai seHA zvakaramba zvichiwedzera.Zvinoenderana nedata kubva kuInternational Society of Aesthetic Plastic Surgery (ISAPS), zvinopfuura 4.3 miriyoni zvizoro nzira zvakaitwa pachishandiswa HA muna 2019, kuwedzera kwe15.7% zvichienzaniswa ne2018. The American Society of Dermatology (ASDS) inoshuma kuti dermatologists vakaita 2.7 miriyoni yedermal filler jekiseni muna 2019. 8 Kuitwa kwemaitirwo akadaro kuri kuita nzira inobatsira kwazvo yebasa rakabhadharwa.Naizvozvo, nekuda kwekushaikwa kwemitemo nemirau munyika / matunhu mazhinji, vanhu vazhinji vanopa masevhisi akadaro, kazhinji vasina kudzidziswa kwakakwana kana zvikwaniriso.Mukuwedzera, kune makwikwi ekugadzirisa pamusika.Dzinogona kunge dzakachipa, dzemhando yakaderera, uye hadzina kubvumidzwa neFDA kana EMA, inova iri njodzi yekuvandudza mhando nyowani dzemaitiro akashata.Sekureva kweongororo yakaitwa muBelgium, mazhinji emasampuli gumi nemana anofungidzirwa kuti asiri pamutemo akaedzwa aive nezvigadzirwa zvishoma pane zvakatsanangurwa papakeji.9 Nyika dzakawanda dzine nzvimbo dzakachena dzezvizoro zvisiri pamutemo.Pamusoro pezvo, maitiro aya haana kunyoreswa uye hapana mutero unobhadharwa unobhadharwa.
Nokudaro, kune mishumo yakawanda yezviitiko zvakashata mumabhuku.Zviitiko izvi zvakashata zvinowanzo tungamira mukuongororwa kwakanyanya uye matambudziko ekurapa uye nemhedzisiro isingatarisike kune varwere.7,8 Hypersensitivity kune hyaluronic acid inonyanya kukosha.Iyo pathogenesis yemamwe maitiro haisati yanyatsojekeswa, saka izwi muzvinyorwa harisi yunifomu, uye kubvumirana kwakawanda pamusoro pekutarisira kwematambudziko hakusati kwasanganisira maitiro akadaro.10,11
Ichi chinyorwa chinosanganisira data kubva muongororo yezvinyorwa.Ziva zvinyorwa zvekuongorora nekutsvaga PubMed uchishandisa mitsara inotevera: hyaluronic acid, mafirita, uye mhedzisiro.Kutsvaga kunoenderera mberi kusvika Kurume 30, 2021. Takawana zvinyorwa 105 uye takaongorora makumi mana nemaviri acho.
Hyaluronic acid haisi nhengo kana zvisikwa zvakananga, saka zvinogona kufungidzirwa kuti hazvikonzeri maitiro emagetsi.12 Zvisinei, zvakakosha kuyeuka kuti chigadzirwa chejekiseni chinosanganisirawo zvinowedzera, uye hyaluronic acid inowanikwa kuburikidza nebhakitiriya biosynthesis.
Izvo zvakaratidzwawo kuti maitiro ega ega anogona kutungamira kune njodzi yekunonoka, immune-mediated yakashata maitiro anoenderana nedermal fillers muvarwere vanotakura HLA-B * 08 uye DR1 * 03 haplotypes.Uku kusanganiswa kweHLA subtypes kwakabatana nekuwedzera kwakapetwa kane mukana wekuita kwakashata (OR 3.79).13
Hyaluronic acid iripo muchimiro chemultiparticulates, dhizaini yayo iri nyore, asi ine multifunctional biomolecule.Ukuru hweHA hunokanganisa maitiro anopesana: inogona kuva ne-pro-inflammatory kana anti-inflammatory properties, inosimudzira kana kudzivisa kutama kwemasero, uye shandisa kana kumisa kupatsanurwa kwesero uye kusiyanisa.14-16 Nehurombo, hapana kubvumirana pane kupatsanurwa kweHA.Izwi rekuti molecular size.14,16,17
Paunenge uchishandisa zvigadzirwa zveHMW-HA, zvakakosha kuyeuka kuti hyaluronidase yechisikigo inokonzera kuora kwayo uye inokurudzira kuumbwa kweLMW-HA.HYAL2 (yakamisikidzwa pasero membrane) inotsemura yakakwira molecular uremu HA (> 1 MDa) kuita 20 kDa zvidimbu.Mukuwedzera, kana HA hypersensitivity inotanga, kuzvimba kuchasimudzira kuderera kwayo (Mufananidzo 1).
Panyaya yezvigadzirwa zveHA, panogona kunge paine misiyano mune tsananguro yehukuru hwemamorekuru.Semuenzaniso, kune boka reJuvederm zvigadzirwa (Allergan), mamorekuru> 500 kDa anoonekwa seLMW-HA, uye> 5000 kDa - HMW-HA.Ichakanganisa kuvandudzwa kwekuchengetedzwa kwechigadzirwa.18
Mune zvimwe zviitiko, low molecular weight (LMW) HA inogona kukonzera hypersensitivity 14 (Mufananidzo 2).Inoonekwa sepro-inflammatory molecule.Inowanikwa zvakanyanya munzvimbo dzinoshanda catabolism, semuenzaniso, mushure mekukuvara, inokonzera kuzvimba nekukanganisa Toll-like receptors (TLR2, TLR4).14-16,19 Nenzira iyi, LMW-HA inokurudzira kushandiswa nekukura kwemasero e-dendritic (DC), uye inokurudzira marudzi akasiyana-siyana emasero kuti abudise pro-inflammatory cytokines, yakadai seIL-1β, IL-6, IL-12 , TNF-α uye TGF-β, inodzora kutaura kwechemokines uye kutama kwemasero.14,17,20 LMW-HA inogona kuita seyakatarisana nengozi-yakabatana molecular model (DAMP) kuti itange maitiro ekudzivirira emuviri, akafanana nemapuroteni ebhakitiriya kana mapuroteni ekupisa.14,21 CD44 inoshanda sechimiro chekugamuchira maitiro ekuzivikanwa kweLMW-HA.Inowanikwa pamusoro pemasero ese emunhu uye inogona kudyidzana nemamwe ma ligand akadai se osteopontin, collagen, uye matrix metalloproteinases (MMP).14,16,17.
Mushure mekunge kuzvimba kwadzikira uye zvakasara zvenyama yakakuvadzwa zvabviswa nemacrophages, iyo LMW-HA molecule inobviswa neCD44-inotsamira endocytosis.Kusiyana neizvi, kuzvimba kusingaperi kwakabatana nekuwedzera kwehuwandu hweLMW-HA, saka vanogona kutorwa semasikirwo echisikigo biosensor echimiro chetishu yekutendeseka.14,20,22,23 Basa reCD44 receptor yeHA rakaratidzwa mune zvidzidzo pamusoro pekugadzirisa kwekuvhiringidza pasi pemamiriro ehupenyu.Mune mbeva mhando dzeatopic dermatitis, anti-CD44 kurapwa inotadzisa kuvandudzwa kwemamiriro ezvinhu senge collagen-induced arthritis kana kukuvara kweganda.makumi maviri nemana
Yakakwira molecular uremu (HMW) HA inowanzoitika mumatishu asina kusimba.Inodzivisa kugadzirwa kwevamiririri vepro-inflammatory (IL-1β, IL-8, IL-17, TNF-α, metalloproteinases), inoderedza kutaura kweTLR uye inogadzirisa angiogenesis.14,19 HMW-HA inokanganisawo basa remacrophages rinotarisirwa kugadzirisa nekukurudzira basa ravo rinopesana nekuputika kuti rivandudze kuzvimba kwenzvimbo.15,24,25
Nhamba yose ye hyaluronic acid mumunhu anoyera 70 kg inenge magiramu gumi nemashanu, uye muvhareji wayo wekutengesa magiramu mashanu pazuva.Inenge 50% ye hyaluronic acid iri mumuviri wemunhu yakanyura muganda.Hhafu yehupenyu hwayo ndeye 24-48 maawa.22,26 Nokudaro, hafu yehupenyu hweha husina kugadziriswa husati hwave huchikurumidza kuvharwa ne hyaluronidase, ma enzymes emasikirwo emasikirwo uye maitiro eokisijeni anoshanda anenge maawa gumi nemaviri chete.27,28 Iketani yeHA yakagadzirwa kuti iwedzere kugadzikana kwayo uye ibudise mamorekuru akakura uye akagadzikana, ane nguva yakareba yekugara munyama (inenge mwedzi yakati wandei), uye ine yakafanana biocompatibility uye viscoelastic kuzadza zvivakwa.28 Crosslinking inosanganisira chikamu chepamusoro chekubatana kweHA ine yakaderera molecular weight molecules uye yakaderera chikamu chepamusoro molecular weight HA.Uku kugadziridzwa kunoshandura kuumbwa kwechisikigo kweiyo HA molecule uye inogona kukanganisa immunogenicity yayo.18
Cross-linking inonyanya kusanganisira kuyambuka-kubatanidza kwemapolymers kuti aumbe covalent bond, kunyanya kusanganisira (-COOH) uye/kana hydroxyl (-OH) skeletons.Mimwe mishonga inogona kukurudzira kuyambuka, zvakadai se1,4-butanediol diglycidyl ether (BDDE) (Juvederm, Restylane, Princess), divinyl sulfone (Captique, Hylaform, Prevelle) kana diepoxy octane (Puragen).29 Zvisinei, mapoka epoxy eBDDE haagadziriswi mushure mokuita neHA, saka chete tsvaga huwandu hweBDDE isina kubatwa (<2 zvikamu pamiriyoni) inogona kuwanikwa muchigadzirwa.26 Cross-linked ha hydrogel chinhu chinogadziriswa zvikuru chinogona kutungamirira pakuumbwa kwezvivako zve 3D zvine maitiro akasiyana (rheology, degradation, applicability).Aya maficha anokurudzira kugoverwa kuri nyore kwechigadzirwa uye panguva imwechete inosimudzira kugadzirwa kwemamorekuru eiyo extracellular matrix.30,31<>
Kuti kuwedzere hydrophilicity yechigadzirwa, vamwe vanogadzira vanowedzera mamwe macompound, akadai sedextran kana mannitol.Chimwe nechimwe chezvinowedzera izvi chinogona kuva antigen iyo inomutsa mhinduro yezvirwere zvemuviri.
Parizvino, gadziriro dzeHA dzinogadzirwa kubva kune dzakanangana dzeStreptococcus kuburikidza nekuvirisa kwebhakitiriya.(Streptococcus equi kana Streptococcus zooepidemicus).Kuenzaniswa neyakashandiswa kare yakagadziriswa yakagadzirwa nemhuka, inoderedza dambudziko rekudzivirira muviri, asi haigoni kubvisa kusvibiswa kweprotein molecules, bhakitiriya nucleic acids uye stabilizers.Anogona kuve maantigen uye anomutsa mhinduro yemuviri wemuridzi, senge hypersensitivity kune HA zvigadzirwa.Naizvozvo, matekinoroji ekugadzira mafiller (akadai seRestylane) anotarisa pakudzikisa kusvibiswa kwechigadzirwa.32
Maererano neimwe fungidziro, maitiro ekudzivirira emuviri kune HA anokonzerwa nekuzvimba kunokonzerwa nebhakitiriya biofilm zvikamu, izvo zvinotamirwa kune tishu kana chigadzirwa chichibaiwa.33,34 Biofilm inoumbwa nebhakitiriya, kudya kwavo uye metabolites.Zvinonyanya zvinosanganisira chikuru kwete-pathogenic mabhakitiriya kuti colonize utano ganda kana mucous membranes (somuenzaniso, Dermatobacterium acnes, Streptococcus oralis, Staphylococcus epidermidis).Aya Madhiri akasimbiswa ne polymerase chain reaction test.33-35
Nekuda kwehunhu hwavo hwakasiyana-siyana hunokura zvishoma nezvishoma uye zvakasiyana-siyana zvinonzi makoroni madiki, kazhinji zvinonetsa kuziva utachiona mutsika.Mukuwedzera, metabolism yavo mubiofilm inogona kuderedzwa, iyo inobatsira kudzivisa migumisiro yemishonga inorwisa mabhakitiriya.35,36 Uyezve, kukwanisa kugadzira matrix e-extracellular polysaccharides (kusanganisira HA) chinhu chinodzivirira chephagocytosis.Aya mabhakitiriya anogona kugara akarara kwemakore mazhinji, obva aitwa nekunze zvinhu uye kukonzeresa maitiro.35-37 macrophages uye masero makuru anowanzo kuwanikwa munharaunda yezvipembenene izvi.Vanogona kukurumidza kushandiswa uye kukurudzira mhinduro yekuzvimba.38 Zvimwe zvinhu, zvakaita sehutachiona hwehutachiona hune hutachiona hwemhando dzakafanana mukuumbwa kune biofilms, dzinogona kufambisa tupukanana tusina kurara kuburikidza nekutevedzera nzira.Activation inogona kunge iri nekuda kwekukuvara kwakakonzerwa neimwe dermal filler maitiro.38
Zvakaoma kusiyanisa pakati pekuzvimba uye kunonoka hypersensitivity kunokonzerwa nebhakitiriya biofilms.Kana red sclerotic lesion inoonekwa chero nguva mushure mekuvhiyiwa, pasinei nekufamba kwenguva, biofilm inofanira kufungidzirwa pakarepo.38 Inogona kunge iine asymmetrical uye symmetrical, uye dzimwe nguva inogona kukanganisa nzvimbo dzose apo HA inoitwa panguva yekuvhiyiwa.Kunyange kana mugumisiro wetsika usina kunaka, mishonga inorwisa mabhakitiriya yakakura ine kupinda mukati meganda inofanira kushandiswa.Kana paine fibrous nodules nekuwedzera kupikisa, inogona kunge iri yekunze muviri granuloma.
HA inogonawo kukurudzira kuzvimba kuburikidza nemaitiro e superantigens.Iyi mhinduro haidi matanho ekutanga ekuzvimba.12,39 Superantigens inokonzera 40% yemasero ekutanga eT uye zvichida NKT clonal activation.Kushandiswa kweiyi lymphocytes kunotungamirira kune dutu re cytokine, iyo inoratidzirwa nekusunungurwa kwehuwandu hwepro-inflammatory cytokines, dzakadai se IL-1β, IL-2, IL-6 uye TNF-α40.
Mabayo akanyanya, kazhinji achiperekedzwa nekutadza kufema kwakanyanya, muenzaniso wepathological mhinduro kune bhakitiriya superantigen (staphylococcal enterotoxin B), iyo inowedzera LMW-HA inogadzirwa nefibroblasts mumapapu tishu.HA inokurudzira kugadzirwa kweIL-8 uye IP-10 chemokines, iyo inoita basa rinokosha mukutsvaga masero ekuputika kumapapu.40,41 Nzira dzakafanana dzakaonekwa munguva yeasthma, chirwere chisingaperi chinodzivirira pulmonary uye pneumonia.Kuwedzera kugadzirwa kweCCIDID-19.41 LMW-HA kunotungamira mukuwedzeredza kweCD44 uye kuburitswa kwepro-inflammatory cytokines uye chemokines.40 Iyi nzira inogonawo kuonekwa mukuzvimba kunokonzerwa nezvikamu zvebiofilm.
Kana tekinoroji yekugadzira yekuzadza isina kunyatsojeka muna 1999, njodzi yekunonoka kuita mushure mejekiseni reHA yakatemwa kuve 0.7%.Mushure mekuiswa kwezvigadzirwa zvepamusoro-soro, chiitiko chezviitiko zvakashata zvakadaro zvakadonha kusvika ku0.02%.3,42,43 Zvisinei, kuiswa kweHA fillers iyo inobatanidza yakakwirira uye yakaderera HA cheni yakakonzera kuwedzera kweAE muzana.44
Yekutanga data pamabatiro akadai akaonekwa mumushumo wekushandiswa kweNASHA.Iyi ndiyo erythema uye edema reaction, nekupinda uye edema munzvimbo yakapoteredza inogara kusvika kumazuva gumi nemashanu.Kuita uku kwakaonekwa mu1 wevarwere ve1400.3 Vamwe vanyori vakashuma kwenguva refu yekuzvimba nodules, inoitika mu 0.8% yevarwere.45 Vakasimbisa etiology ine chekuita nekusvibiswa kweprotein kunokonzerwa nekuvirisa kwebhakitiriya.Maererano nezvinyorwa, kuwanda kwemaitiro akashata ndeye 0.15-0.42%.3,6,43
Panyaya yekushandisa iyo nguva yakajairwa, kune dzakawanda kuedza kurongedza yakashata mhedzisiro yeHA.46
Bitterman-Deutsch et al.yakarongedza zvikonzero zvekukanganisa uye matambudziko mushure mekuvhiyiwa ne hyaluronic acid-based preparations.Dzinosanganisira
Boka renyanzvi rakaedza kutsanangura mhinduro kune hyaluronic acid zvichienderana nenguva yekuonekwa mushure mekuvhiyiwa: "kutanga" (<14 mazuva), "kunonoka" (> 14 mazuva kusvika 1 gore) kana "kunonoka" (> 1 gore).47-49 Vamwe vanyori vakakamura mhinduro mukutanga (kusvika vhiki imwe), yepakati (nguva: vhiki imwe kusvika kumwedzi mumwe), uye kunonoka (kupfuura mwedzi mumwe).50 Parizvino, kunonoka uye kunonoka mhinduro dzinoonekwa sechinhu chimwe, chinonzi kunonoka kuputika mhinduro (DIR), nokuti zvikonzero zvavo zvinowanzosanyatsotsanangurwa uye marapirwo haana chokuita nechikonzero.42 Kurongeka kwemaitiro aya kunogona kutsanangurwa zvichibva pane zvinyorwa (Mufananidzo 3).
Kupfupika edema panzvimbo yejekiseni pakarepo mushure mekuvhiyiwa kunogona kunge kuri nekuda kweiyo histamine yekuburitsa nzira muvarwere vane mhando yekutanga allergic reaction, kunyanya avo vane nhoroondo yezvirwere zveganda.51 Angori maminetsi mashoma mushure mekutonga kuti mast cell anokuvadzwa nemuchina uye anoburitsa pro-inflammatory mediators kuti akonzerese edema yetishu uye kuumbwa kwemhepo.Kana mhinduro inosanganisira mast cells ikaitika, nzira ye antihistamine therapy inowanzokwana.51
Iyo yakakura kukuvadzwa kweganda kunokonzerwa nekuvhiyiwa kwekushongedza, iyo yakakura edema, iyo inogona kutofambira mberi kusvika 10-50%.52 Zvinoenderana nerandomized kaviri-mapofu multicenter murwere diaries, kuwanda kwe edema mushure mejekiseni reRestylane inofungidzirwa kuva 87% yechidzidzo 52,53.
Nzvimbo dziri pachiso dzinoita sedzinonyanya kukonzerwa ne edema ndiyo miromo, periorbital uye matama.52 Kuti uderedze njodzi, zvinokurudzirwa kudzivisa kushandiswa kwehuwandu hwakawanda hwekuzadza, infiltration anesthesia, kushingaira massage uye yakanyanya hygroscopic kugadzirira.Zvinowedzera (mannitol, dextran).52
Edema panzvimbo yejekiseni inogara maminetsi akati wandei kusvika kumazuva 2-3 inogona kukonzerwa neiyo hygroscopicity yeHA.Izvi zvinowanzoonekwa munzvimbo yeperilip uye periorbital.49,54 haifaniri kukanganisa nokuda kwe edema inokonzerwa nemaitiro asingawanzoitiki ekukurumidza allergic reaction (angioedema).49
Mushure mejekiseni reRestylane (NASHA) mumuromo wepamusoro, nyaya ye hypersensitivity kune angioedema yakatsanangurwa.Nekudaro, murwere akatorawo 2% lidocaine, iyo inogona zvakare kukonzeresa mhando I hypersensitivity reaction.Systemic administration yecorticosteroids yakaita kuti edema ipere mukati memazuva mana.32
Iko kukurumidza kubuda kwekuita kunogona kunge kuri nekuda kwe hypersensitivity kune mapuroteni akasara kusvibiswa kweHA synthesizing mabhakitiriya.Kudyidzana pakati peiyo injected HA uye masero emasero akasara mumucheka ndeimwe nzira yekujekesa chiitiko chekukurumidza kupindura.Iyo CD44 receptor iri pamusoro pemast cells ndiyo inotambira HA, uye kusangana uku kungave kwakakosha pakufamba kwavo.32,55
Kurapa kunosanganisira kukurumidza kupihwa antihistamines, systemic GCS, kana epinephrine.46
Chirevo chekutanga, chakabudiswa naTurkmani et al., Akatsanangura vakadzi vane makore 22-65 vakanga vavhiyiwa HA yakagadzirwa nemakambani akasiyana.39 Zvironda zveganda zvinoratidzwa ne erythema uye edema inorwadza panzvimbo yejekiseni rekuzadza pachiso.Muzviitiko zvese, mhinduro inotanga 3-5 mazuva mushure mekurwara kwefuruwenza (fivha, musoro, kurwadziwa kwehuro, kukosora, uye kuneta).Mukuwedzera, varwere vose vakanga vagamuchira HA kutungamirirwa (2 kusvika ku6 nguva) mumakore e4 zviratidzo zvisati zvaonekwa pane zvikamu zvakasiyana zvechiso.39
Mharidzo yekiriniki yezvakatsanangurwa maitiro (erythema uye edema kana urticaria-kufanana nekuputika nemaitiro ehurongwa) yakafanana nemhando III maitiro-a pseudoserum sickness reaction.Zvinosuruvarisa, hapana mishumo mumabhuku inosimbisa iyi hypothesis.Nyaya yenyaya inotsanangura murwere ane kuputika-kufanana nekuputika panguva yeSweet syndrome, iyo chiratidzo chechirwere chinoratidzika 24-48 maawa mushure meHA nzvimbo yekutonga.56
Vamwe vanyori vanotenda kuti maitiro ekuita anokonzerwa nemhando IV hypersensitivity.Iyo yapfuura HA jekiseni yakakurudzira kuumbwa kwendangariro lymphocytes, uye kutungamira kwakatevera kwegadziriro kwakakurumidza kukonzera mhinduro yeCD4 + masero uye macrophages.39
Murwere akagamuchira oral prednisolone 20-30 mg kana methylprednisolone 16-24 mg zuva nezuva kwemazuva mashanu.Zvadaro dose yakaderedzwa kwemamwe mazuva mashanu.Mushure memavhiki maviri, zviratidzo zvevarwere gumi vakagamuchira oral steroids zvakanyangarika zvachose.Varwere vana vakasara vakaramba vaine edema nyoro.Hyaluronidase inoshandiswa kwemwedzi mumwe mushure mekutanga kwezviratidzo.39
Maererano nemabhuku, matambudziko akawanda anononoka anogona kuitika mushure mejojo ye hyaluronic acid.Nekudaro, munyori wega wega akazvironga zvichienderana neruzivo rwekiriniki.Izwi rakabatana kana kupatsanurwa hakuna kugadzirwa kutsanangura maitiro akashata akadaro.Izwi rokuti continuous intermittent delayed kuzvimba (PIDS) rakatsanangurwa neBrazilian dermatologists muna 2017. 57 Beleznay et al.yakaunza rimwe izwi kutsanangura chirwere ichi muna 2015: kunonoka kutanga nodule 15,58 uye Snozzi et al.: advanced inflammatory response syndrome (LI).58 Muna 2020, imwe nguva yakatsanangurwa: kunonoka kuzvimba Reaction (DIR).48
Chung et al.akasimbisa kuti DIR inosanganisira maitiro mana ekuita: 1) DTH maitiro (yakarurama inonzi: kunonoka rudzi IV hypersensitivity reaction);2) mutorwa muviri granuloma reaction;3) biofilm;4) hutachiona hwehutachiona.DTH reaction inononoka masero ekudzivirira immune kuzvimba, inova mhinduro kune allergenic.59
Maererano nezvinyorwa zvakasiyana, zvinogona kutaurwa kuti kuwanda kwekuita uku kunosiyana.Nguva pfupi yadarika yakabudiswa bepa rakanyorwa nevaongorori veIsrael.Vakaongorora huwandu hwezviitiko zvakashata nenzira yeDIR zvichibva pamubvunzo.Gwaro remibvunzo rakapedzwa navanachiremba 334 vakapa majekiseni eHA.Zvigumisiro zvakaratidza kuti inenge hafu yevanhu vakanga vasina kuonekwa kuti vane DIR, uye 11.4% vakapindura kuti vakanga vaona kuita uku kanopfuura ka5.48 Mukuyedzwa kwekunyoresa kuongorora kuchengetedzwa, maitiro anokonzerwa nezvigadzirwa zvinogadzirwa neAllergan akanyorwa zvakanaka.Mushure mekutora Juvederm Voluma® kwemwedzi makumi maviri nemana, ingangoita 1% yevarwere ve103 vakatariswa vakashuma maitiro akafanana.60 Munguva yemwedzi ye68 yekudzokorora kwekuongorora kwemaitiro e4702, mhinduro yakafanana yakaonekwa mu 0.5% yevarwere.Juvederm Voluma® yakashandiswa muvarwere ve2342.15 Chikamu chepamusoro chakaonekwa apo zvigadzirwa zveJuvederm Volbella® zvakashandiswa munzvimbo yemisodzi uye nzvimbo yemuromo.Mushure meavhareji yevhiki dze8, 4.25% (n = 17) yakanga ine kudzokorora kwakatora kusvika kumwedzi ye11 (avhareji 3.17 episodes).42 Ongororo ichangoburwa yevarwere vanopfuura chiuru vari kurapwa Vycross ye2-gore yekutevera nemafillers yakaratidza kuti chiitiko chekunonoka manodule yaive 1%.57 Chung et al.'s mhinduro frequency kumushumo yakakosha zvikuru.Zvinoenderana nekuverenga kwezvichaitwa zvidzidzo, chiitiko chekunonoka kwekuzvimba mhinduro yaive 1.1% pagore, nepo muzvidzidzo zvekare, yaive isingasviki 1% panguva ye1 kusvika kumakore 5.5.Haasi ese akataurwa nyaya ari chaiwo DIR nekuti hapana tsananguro chaiyo.59
Kunonoka kuzvimba mhinduro (DIR) yechipiri kune kutungamira kwetishu filler kunoitika kanenge 2-4 mavhiki kana gare gare mushure mejekiseni reHA.42 Makiriniki ezviratidzo ari muchimiro chezvikamu zvinowanzoitika zveedema yemunharaunda yakasimba, inofambidzana ne erythema uye unyoro, kana subcutaneous nodules panzvimbo yeHA injection site.42,48 Madundundu anogona kunge achidziya kana akabatwa, uye ganda rakatenderedza rinogona kunge riri repepuru kana shava.Varwere vazhinji vane maitiro muzvikamu zvese panguva imwe chete.Muchiitiko chekushandisa HA kare, pasinei nerudzi rwekuzadza kana nhamba yejekiseni, chinhu chinokosha chinoratidza zviratidzo zvekliniki.15,39 Zvironda zveganda zvinowanzoitika kune vanhu vakambobaya majekiseni akawanda eHA.43 Mukuwedzera, edema inofambidzana inonyatsooneka mushure mokumuka, uye inovandudza zvishoma zuva rose.42,44,57 Vamwe varwere (~ 40%) vane concomitant systemic furuwenza-sekuratidzwa.15
Aya maitiro anogona kunge ane chekuita nekusvibiswa kweDNA, mapuroteni, uye bhakitiriya endotoxin, kunyangwe kana iyo yakadzikira zvakanyanya kupfuura yeHA.15 Zvisineyi, LMW-HA inogonawo kunge iripo muvanhu vanobatwa nemajini zvakananga kana kuburikidza nemamorekuru ane utachiona (biofilms).15,44 Zvisinei, kuonekwa kwezvipembenene zvinoputika pane imwe chinhambwe kubva panzvimbo yejekiseni, kuramba kwechirwere kusvika pakurapa kwenguva refu kwemishonga inorwisa mabhakitiriya uye kusabatanidzwa kwezvirwere zvinotapukira (tsika uye PCR kuongororwa)) zvinomutsa fungidziro pamusoro pebasa rebiofilms. .Mukuwedzera, kushanda kwehyaluronidase kurapwa uye kuvimba neHA dose inoratidza nzira yekunonoka hypersensitivity.42,44
Mhinduro inokonzerwa nehutachiona kana kukuvara inogona kutungamirira kuwedzera kweserum interferon, iyo inogona kuwedzera kupisa kusati kwavapo.15,57,61 Mukuwedzera, LMW-HA inokurudzira CD44 kana TLR4 receptors pamusoro pemacrophages uye dendritic masero.Iyo inovaita uye inoendesa masaini emutengo kune T masero.15,19,24 Inflammatory nodules inobatanidza neDIR inoitika mukati memwedzi mitatu kusvika ku5 mushure mejekiseni reHMW-HA filler (ine anti-inflammatory properties), iyo inobva yaora uye inoshandura kuva LMW- ine pro-inflammatory properties HA.15
Kutanga kwekuita kunowanzokonzerwa neimwe nzira yehutachiona (sinusitis, urinary tract infection, chirwere chekufema, chirwere chezino), kukuvara kwechiso, uye kuvhiyiwa kwemazino.57 Kuita uku kwakakonzerwawo nekubayiwa nhomba uye kwakadzoka zvakare nekuda kwekubuda ropa kwekutevera.15, 57 Chikamu chega chega chinogona kukonzerwa nezvinokonzeresa zvinotapukira.
Vamwe vanyori vakatsanangurawo genetic predisposition yevanhu vane subtypes inotevera kuti vapindure: HLA B * 08 kana DRB1 * 03.4 (kana kuwedzera kwengozi).13,62
Zvipembenene zvine chokuita neDIR zvinoratidzwa nemanodule ekuputika.Anofanira kusiyaniswa kubva kumapfumbu, maabscesses (kunyorova, kushanduka), uye granulomatous reactions (zvakaoma kuzvimba ma nodule) anokonzerwa ne biofilms.58
Chung et al.kurudzira kushandisa HA zvigadzirwa zvekuongororwa kweganda pamberi pemaitiro akarongwa, kunyangwe nguva inodiwa yekududzira mhinduro yebvunzo inogona kunge iri 3-4 mavhiki.59 Ivo vanonyatsokurudzira bvunzo dzakadaro muvanhu vakave nezviitiko zvakashata.Ndakamboona.Kana bvunzo iri yakanaka, murwere haafanire kurapwa zvakare neiyo HA filler.Zvisinei, inogona kusabvisa maitiro ose nokuti anowanzokonzerwa nezvinokonzera, zvakadai sezvirwere zvinosangana zvinogona kuitika chero nguva.59
Nguva yekutumira: Sep-28-2021