Vulva-vaginal atrophy (VVA) ke e 'ngoe ea litlamorao tse tloaelehileng tsa khaello ea estrogen, haholo kamora ho khaotsa ho ilela khoeli.Liphuputso tse 'maloa li hlahlobile liphello tsa hyaluronic acid (HA) matšoao a' mele le a thobalano a amanang le VVA 'me li fihletse liphello tse tšepisang.Leha ho le joalo, boholo ba liphuputso tsena li tsepamisitse maikutlo tlhahlobong e ikemetseng ea karabelo ea matšoao ho li-topical formulations.Leha ho le joalo, HA ke molek'hule e sa feleng, 'me hoa utloahala hore e sebetsa hantle ha e kenngoa ka har'a epithelium e ka holimo.Desirial® ke hyaluronic acid ea pele e amanang le sefapano e tsamaisoang ka ente ea mucosal ea botšehali.Sepheo sa thuto ena e ne e le ho batlisisa phello ea liente tse ngata tsa intravaginal intravaginal intravaginal intervaginal hyaluronic acid (DESIRIAL®, Laboratoires VIVACY) liphellong tse 'maloa tsa mantlha tsa kliniki le tse tlalehiloeng ke mokuli.
Sehlopha sa litsi tse peli tsa thuto ea lifofane.Liphetho tse khethiloeng li ne li kenyelletsa liphetoho tsa botenya ba botšehali ba botšehali, li-biomarkers tsa collagen formation, limela tsa botšehali, pH ea botšehali, index ea bophelo bo botle ba botšehali, matšoao a vulvovaginal atrophy le ts'ebetso ea thobalano libeke tsa 8 ka mor'a ente ea Desirial®.Maikutlo a mokuli ka kakaretso a ntlafatso (PGI-I) sekala se ile sa boela sa sebelisoa ho hlahloba khotsofalo ea mokuli.
Kakaretso ea bankakarolo ba 20 ba ile ba thaothoa ho tloha ka la 19/06/2017 ho isa la 05/07/2018.Qetellong ea thuto, ho ne ho se na phapang pakeng tsa botenya bohle ba botšehali ba botšehali kapa procollagen I, III, kapa Ki67 fluorescence.Leha ho le joalo, polelo ea liphatsa tsa lefutso tsa COL1A1 le COL3A1 e eketsehile haholo ka lipalo (p = 0.0002 le p = 0.0010, ka ho latellana).Dyspareunia e tlalehiloeng, ho omella ka botšehaling, ho hlohlona ha litho tsa botona le botšehali, le makhopho ka botšehaling le tsona li fokotsehile haholo, 'me litekanyo tsohle tsa index ea ts'ebetso ea thobalano ea basali li ile tsa ntlafatsoa haholo.Ho itšetlehile ka PGI-I, bakuli ba 19 (95%) ba tlalehile litekanyetso tse sa tšoaneng tsa ntlafatso, tseo 4 (20%) li ileng tsa ikutloa li le betere hanyenyane;7 (35%) e ne e le betere, mme 8 (40%) e ne e le betere.
Multi-point intravaginal injection ea Desirial® (HA e amanang le sefapano) e ne e amahanngoa haholo le polelo ea CoL1A1 le CoL3A1, e bontšang hore ho thehoa ha collagen ho ile ha tsosoa.Ho phaella moo, matšoao a VVA a fokotsehile haholo, 'me khotsofalo ea mokuli le lintlha tsa mosebetsi oa thobalano li ile tsa ntlafatsoa haholo.Leha ho le joalo, botenya bohle ba mucosa ea botšehali ha boa ka ba fetoha haholo.
Vulva-vaginal atrophy (VVA) ke e 'ngoe ea liphello tse tloaelehileng tsa khaello ea estrogen, haholo-holo ka mor'a ho khaotsa ho ilela khoeli [1,2,3,4].Li-syndromes tse 'maloa tsa kliniki li amahanngoa le VVA, ho kenyelletsa ho omella, ho teneha, ho hlohlona, dyspareunia, le tšoaetso ea khafetsa ea moroto, e ka bang le phello e mpe haholo ho boleng ba bophelo ba basali [5].Leha ho le joalo, ho qala ha matšoao ana ho ka ’na ha e-ba bonolo ’me butle-butle, ’me a qala ho bonahala ka mor’a hore matšoao a mang a ho khaotsa ho ilela khoeli a kokobele.Ho ea ka litlaleho, ho fihlela ho 55%, 41%, le 15% ea basali ba postmenopausal ba na le bothata ba ho omella ha botšehali, dyspareunia, le mafu a mangata a ho ntša metsi, ka ho latellana [6,7,8,9].Leha ho le joalo, batho ba bang ba lumela hore ho ata ha mathata ana ho phahame, empa basali ba bangata ha ba batle thuso ea bongaka ka lebaka la matšoao [6].
Likahare tsa mantlha tsa taolo ea VVA ke kalafo ea matšoao, ho kenyeletsoa le liphetoho tsa mokhoa oa bophelo, tse senang lihomone (joalo ka litlolo tsa botšehali kapa li-moisturizer le kalafo ea laser) le mananeo a kalafo ea lihomone.Lisebelisoa tsa botšehali li sebelisoa haholo-holo ho imolla ho omella ha botšehali nakong ea thobalano, kahoo li ke ke tsa fana ka tharollo e sebetsang ho sa foleng le ho rarahana ha matšoao a VVA.Ho fapana le hoo, ho tlalehoa hore moisturizer ea botšehali ke mofuta oa "bioadhesive" sehlahisoa se ka khothalletsang ho boloka metsi, 'me tšebeliso ea kamehla e ka ntlafatsa ho teneha ha botšehali le dyspareunia [10].Leha ho le joalo, sena ha se amane letho le ntlafatso ea kakaretso ea "vaginal epithelial maturity index" [11].Lilemong tsa morao tjena, ho 'nile ha e-ba le lipolelo tse ngata tsa ho sebelisa radiofrequency le laser ho phekola matšoao a botšehali ba menopausal [12,13,14,15].Leha ho le joalo, FDA e fane ka litemoso ho bakuli, e hatisa hore tšebeliso ea mekhoa e joalo e ka lebisa liketsahalong tse mpe tse tebileng, 'me ha e e-s'o etse qeto ea polokeho le katleho ea lisebelisoa tse thehiloeng matla ho phekola mafu ana [16].Bopaki bo tsoang ho meta-analysis ea lithuto tse 'maloa tse sa reroang li tšehetsa katleho ea phekolo ea li-hormone ea lihlooho le tsa tsamaiso ho fokotsa matšoao a amanang le VVA [17,18,19].Leha ho le joalo, palo e fokolang ea liphuputso e hlahlobile liphello tse tsitsitseng tsa phekolo e joalo ka mor'a likhoeli tse 6 tsa phekolo.Ntle le moo, li-contraindication tsa bona le khetho ea bona ke lintlha tse fokotsang ts'ebeliso e atileng le ea nako e telele ea likhetho tsena tsa kalafo.Ka hona, ho ntse ho hlokahala tharollo e sireletsehileng le e sebetsang ea ho laola matšoao a amanang le VVA.
Hyaluronic acid (HA) ke molek'hule ea bohlokoa ea matrix ea extracellular, e fumanehang ka har'a lisele tse fapaneng ho kenyelletsa le mucosa ea botšehali.Ke polysaccharide e tsoang lelapeng la glycosaminoglycan, e phethang karolo ea bohlokoa ho boloka ho leka-lekana ha metsi le ho laola ho ruruha, karabelo ea 'mele ea ho itšireletsa mafung, ho thehoa ha lebali le angiogenesis [20, 21].Litokisetso tsa HA Synthetic li fanoa ka mokhoa oa li-gel tsa lihlooho 'me li na le boemo ba "lisebelisoa tsa bongaka".Liphuputso tse 'maloa li hlahlobile phello ea HA matšoao a' mele le a thobalano a amanang le VVA 'me a fihletse liphello tse tšepisang [22,23,24,25].Leha ho le joalo, boholo ba liphuputso tsena li tsepamisitse maikutlo tlhahlobong e ikemetseng ea karabelo ea matšoao ho li-topical formulations.Leha ho le joalo, HA ke molek'hule e sa feleng, 'me hoa utloahala hore e sebetsa hantle ha e kenngoa ka har'a epithelium e ka holimo.Desirial® ke hyaluronic acid ea pele e amanang le sefapano e tsamaisoang ka ente ea mucosal ea botšehali.
Sepheo sa boithuto bona bo lebelletsoeng ba ho etsa liteko tse peli ke ho lekola phello ea liente tsa intravaginal intravaginal tse ngata tse amanang le hyaluronic acid (DESIRIAL®, Laboratoires VIVACY) liphethong tsa mantlha tsa litlaleho tse 'maloa tsa bongaka le tsa mokuli, le ho lekola. ho khoneha ha tlhahlobo ea tlhahlobo Ho kopanela liphate liphetho tsena.Liphetho tse felletseng tse khethiloeng bakeng sa phuputso ena li ne li kenyelletsa liphetoho botenya ba mahlaku a botšehali, li-biomarker tsa ho nchafatsoa ha lisele, limela tsa botšehali, pH ea botšehali le index ea bophelo bo botle ba botšehali libeke tse 8 ka mor'a ente ea Desirial®.Re ile ra lekanya liphetho tse tlalehiloeng ke bakuli ba 'maloa, ho kenyelletsa le liphetoho mosebetsing oa thobalano le tekanyo ea tlaleho ea matšoao a amanang le VVA ka nako e le' ngoe ka nako.Qetellong ea thuto, maikutlo a mokuli a ntlafatso (PGI-I) ka kakaretso a sebelisitsoe ho hlahloba khotsofalo ea mokuli.
Palo ea thuto e ne e le ea basali ba postmenopausal (lilemo tse 2 ho isa ho tse 10 ka mor'a ho khaotsa ho ilela khoeli) ba ileng ba isoa tleliniking ea ho khaotsa ho ilela khoeli ba nang le matšoao a bothata ba botšehali le/kapa dyspareunia ea bobeli ho omella ha botšehali.Basali ba tlameha ho ba ≥ lilemo tse 18 le <70 le ho ba le BMI <35.Barupeluoa ba ne ba tsoa ho e 'ngoe ea lihlopha tsa 2 tse kopanelang (Centre Hospitaler Régional Universitaire, Nîmes (CHRU), Fora le Karis Medical Center (KMC), Perpignan, Fora).Basali ba nkoa ba tšoaneleha haeba e le karolo ea morero oa inshorense ea bophelo bo botle kapa ba rua molemo morerong oa inshorense ea bophelo bo botle, 'me baa tseba hore ba ka kenya letsoho nakong ea tlhahlobo e reriloeng ea libeke tse 8.Basali ba neng ba kenya letsoho lithutong tse ling ka nako eo ba ne ba sa tšoanelehe ho ngolisoa.≥ Mothati oa 2 oa "apical pelvic organ prolapse", khatello ea maikutlo ea ho incontinence, vaginismus, vulvovaginal kapa ts'oaetso ea mokokotlo, maqeba a mali kapa a neoplastic, lihlahala tse itšetlehileng ka lihomone, ho tsoa mali a litho tsa botona kapa botšehali ka lebaka le sa tsejoeng, porphyria e iphetang, lefu la sethoathoa se sa laoleheng, angina pectoris , rheumatic fever, opereishene ea nakong e fetileng ea vulvovaginal kapa urogynecological, mafu a hemostatic, le tšekamelo ea ho theha maqeba a hypertrophic li ne li nkoa e le mekhoa ea ho qheleloa ka thōko.Basali ba noang li-antihypertensive, steroidal le non-steroidal anti-inflammatory drugs, li-anticoagulants, li-antidepressants tse kholo kapa aspirin, le li-anesthetics tse tsejoang tsa sebakeng seo tse amanang le HA, mannitol, betadine, lidocaine, amide kapa Basali ba nang le alejiki ho efe kapa efe ea li-excipients tsa moriana ona. e nkoa e sa tšoanelehe bakeng sa phuputso ena.
Qalong, basali ba ile ba kōptjoa hore ba tlatse Index ea Basali ba Ho Kopanela Liphate (FSFI) [26] 'me ba sebelise 0-10 visual analog scale (VAS) ho bokella lintlha tse amanang le matšoao a VA (dyspareunia, ho omella ha botšehali, maqeba a botšehali le ho hlohlona ha litho tsa botona kapa botšehali). ) boitsebiso.Tlhahlobo ea pele ho ts'ebetso e kenyelelitse ho hlahloba pH ea botšehali, ho sebelisa Bachmann Vaginal Health Index (VHI) [27] bakeng sa tlhahlobo ea bongaka ea botšehali, Pap smear ho hlahloba limela tsa botšehali, le biopsy ea mucosal ea botšehali.Lekanya pH ea botšehali haufi le sebaka se reriloeng sa ente le ka har'a botšehali ba fornix.Bakeng sa limela tsa botšehali, lintlha tsa Nugent [28, 29] li fana ka sesebelisoa sa ho lekanya tikoloho ea botšehali, moo lintlha tsa 0-3, 4-6 le 7-10 li emelang limela tse tloaelehileng, limela tse bohareng le vaginosis, ka ho latellana.Litlhahlobo tsohle tsa limela tsa botšehali li etsoa Lefapheng la Bacteriology la CHRU ka Nimes.Sebelisa mekhoa e tloaelehileng bakeng sa biopsy ea mucosal ea botšehali.Etsa "punch biopsy" ea 6-8 mm sebakeng sa sebaka sa ente se reriloeng.Ho ea ka botenya ba lera la basal, lera le bohareng le lera le ka holimo, mucosal biopsy e ile ea hlahlojoa histologically.Biopsy e boetse e sebelisetsoa ho lekanya COL1A1 le COL3A1 mRNA, ho sebelisoa RT-PCR le procollagen I le III immunotissue fluorescence e le sebaka sa ho hlahisa collagen expression, le fluorescence ea proliferation marker Ki67 e le moemeli oa ts'ebetso ea mucosal mitotic.Teko ea liphatsa tsa lefutso e etsoa ke laboratori ea BioAlternatives, 1bis rue des Plantes, 86160 GENCAY, France (tumellano e teng ka kopo).
Hang ha lisampole tsa motheo le litekanyo li phethiloe, HA (Desirial®) e kopantsoeng ka sefapano e kenngoa ke e mong oa litsebi tse koetlisitsoeng tsa 2 ho ea ka protocol e tloaelehileng.Desirial® [NaHa (sodium hyaluronate) IPN-Like 19 mg/g + mannitol (antioxidant)] ke gel e nang le ente ea HA ea tlhaho e seng ea phoofolo, bakeng sa tšebeliso e le 'ngoe le ho phutheloa ka Seringe e pakiloeng pele (2 × 1 ml. ).Ke sesebelisoa sa bongaka sa Sehlopha sa III (CE 0499), se sebelisetsoang ente ea intramucosal ho basali, e sebelisetsoang biostimulation le rehydration ea mucosal surface ea sebaka sa genital (Laboratoires Vivacy, 252 rue Douglas Engelbart-Archamps Technopole, 74160 Archamps, France).Hoo e ka bang liente tse 10, e 'ngoe le e' ngoe ea 70-100 µl (0.5-1 ml ka kakaretso), e etsoa ka mela e 3-4 e otlolohileng sebakeng se khutlo-tharo sa lebota la ka morao la botšehali, leo motheo oa lona o leng boemong ba botšehali ba ka morao. lerako, le tlhōrō ka 2 cm ka holimo (setšoantšo sa 1).
Tlhahlobo ea ho qetela ea thuto e reretsoe libeke tse 8 ka mor'a ho ngolisoa.Litekanyetso tsa tlhahlobo bakeng sa basali li tšoana le tsa qalong.Ho phaella moo, bakuli ba boetse ba hlokoa hore ba phethe Sekala sa Khotsofalo sa Kakaretso ea Boipheliso (PGI-I) [30].
Ka lebaka la khaello ea data ea pele le mofuta oa teko oa lipatlisiso, ha ho khonehe ho etsa lipalo tsa boholo ba sampole pele.Ka hona, boholo ba sampuli e loketseng ea kakaretso ea bakuli ba 20 bo khethiloe ho latela bokhoni ba lihlopha tse peli tse kopanelang 'me bo ne bo lekane ho fumana tekanyo e utloahalang ea litekanyetso tsa sephetho se reriloeng.Tlhahlobo ea lipalo-palo e ile ea etsoa ho sebelisoa software ea SAS (9.4; SAS Inc., Cary NC), 'me boemo ba bohlokoa bo behiloe ho 5%.Teko ea boemo bo saenneng ea Wilcoxon e ile ea sebelisoa bakeng sa mefuta-futa e tsoelang pele 'me teko ea McNemar e ile ea sebelisoa bakeng sa mefuta-futa ea lihlopha ho hlahloba liphetoho libeke tse 8.
Patlisiso e amohetsoe ke Comité d'ethique du CHU Carémeau de Nimes (ID-RCB: 2016-A00124-47, protocol code: LOCAL/2016/PM-001).Batsayakarolo botlhe ba thutopatlisiso ba saenetse foromo e e maleba e e kwadilweng ya tumello.Bakeng sa maeto a 2 a boithuto le li-biopsies tse 2, bakuli ba ka fumana matšeliso a fihlang ho 200 Euros.
Kakaretso ea barupeluoa ba 20 ba ile ba thaothoa ho tloha ka 19/06/2017 ho isa 05/07/2018 (bakuli ba 8 ba tsoang CHRU le bakuli ba 12 ba KMC).Ha ho na tumellano e tlolang mokhoa oa ho kenyeletsoa oa pele/ho khaotsoa.Mekhoa eohle ea ho entoa e ne e bolokehile ebile e utloahala 'me e phethiloe nakong ea metsotso e 20.Litšobotsi tsa palo ea batho le tsa motheo tsa barupeluoa ba phuputso li bonts'itsoe ho Lethathamo la 1. Qalong, basali ba 12 ho ba 20 (60%) ba sebelisitse phekolo bakeng sa matšoao a bona (6 hormonal le 6 non-hormonal), ha ka beke 8 ke bakuli ba 2 feela. (10%) ba ne ba ntse ba tšoaroa tjena (p = 0.002).
Liphetho tsa liphetho tsa tlaleho ea kliniki le ea mokuli li bontšoa ho Lethathamo la 2 le la 3. Mokuli a le mong o ile a hana tlhahlobo ea W8 ea botšehali;mokuli e mong o ile a hana tlhahlobo ea W8 ea botšehali.Ka hona, barupeluoa ba 19/20 ba ka fumana lintlha tse felletseng tsa tlhahlobo ea nalane le liphatsa tsa lefutso.Ha ho bapisoa le D0, ho ne ho se na phapang pakeng tsa botenya bo bohareng ba mucosa ea botšehali ka beke ea 8. Leha ho le joalo, botenya ba basal layer bo ile ba eketseha ho tloha ho 70.28 ho ea ho 83.25 microns, empa keketseho ena e ne e se ea bohlokoa ka lipalo (p = 0.8596).Ho ne ho se na phapang ea lipalo ho fluorescence ea procollagen I, III kapa Ki67 pele le ka mor'a phekolo.Leha ho le joalo, COL1A1 le COL3A1 liphatsa tsa lefutso li eketsehile haholo ka lipalo (p = 0.0002 le p = 0.0010, ka ho latellana).Ho ne ho se na phetoho e kholo ea lipalo-palo, empa e thusitse ho ntlafatsa mokhoa oa limela tsa botšehali ka mor'a ente ea Desirial® (n = 11, p = 0.1250).Ka ho tšoanang, haufi le sebaka sa ente (n = 17) le fornix ea botšehali (n = 19), boleng ba pH ea botšehali le bona bo ne bo atisa ho fokotseha, empa phapang ena e ne e se ea bohlokoa ka lipalo (p = p = 0.0574 le 0.0955) (Letlapa la 2) .
Batsayakarolo botlhe ba thutopatlisiso ba na le phitlhelelo ya dipoelo tse di begilweng ke molwetse.Ho ea ka PGI-I, morupeluoa a le mong (5%) o ile a tlaleha hore ha ho phetoho ka mor'a ente, ha bakuli ba setseng ba 19 (95%) ba tlaleha maemo a fapaneng a ntlafatso, ao 4 (20%) a ileng a ikutloa a le betere hanyenyane;7 (35%) e betere, 8 (40%) e betere.Dyspareunia e tlalehiloeng, ho omella ka botšehaling, ho hlohlona ha setho sa botona le botšehali, ho ruruha ka botšehaling, le lintlha tse felletseng tsa FSFI hammoho le takatso ea bona, ho tlotsa, ho khotsofala le litekanyo tsa bohloko le tsona li fokotsehile haholo (Letlapa la 3).
Khopolo-taba e tšehetsang thuto ena ke hore liente tse ngata tsa Desirial® leboteng le ka morao la botšehali li tla kokobetsa mucosa ea botšehali, pH ea botšehali e ka tlaase, e ntlafatse limela tsa botšehali, e susumetse sebōpeho sa collagen le ho ntlafatsa matšoao a VA.Re khonne ho bontša hore bakuli bohle ba tlalehile lintlafatso tse kholo, ho kenyelletsa dyspareunia, ho omella ha botšehali, maqeba a botšehali, le ho hlohlona ha litho tsa botona kapa botšehali.VHI le FSFI le tsona li ’nile tsa ntlafatsoa haholo, ’me palo ea basali ba hlokang mekhoa e meng ea phekolo ho laola matšoao a bona le eona e fokotsehile haholo.Ka tsela e ts'oanang, hoa khoneha ho bokella tlhahisoleseling mabapi le liphetho tsohle tse boletsoeng qalong, 'me ho khonehe ho fana ka litšebelisano bakeng sa bankakarolo bohle ba thutopatlisiso.Ho phaella moo, 75% ea barupeluoa ba thuto e tlalehile hore matšoao a bona a ntlafetse kapa a ne a le betere haholo qetellong ea thuto.
Leha ho le joalo, ho sa tsotellehe keketseho e fokolang ea botenya bo tloaelehileng ba lesela la basal, re ne re ke ke ra paka phello e kholo ho boima ba kakaretso ea mucosa ea botšehali.Le hoja thuto ea rona e sa khone ho hlahloba katleho ea Desirial® ho ntlafatsa botenya ba mucosal ea botšehali, re lumela hore liphello li bohlokoa hobane polelo ea matšoao a CoL1A1 le CoL3A1 e ile ea eketseha haholo ka lipalo ho W8 ha e bapisoa le D0.E bolela ho susumetsa collagen.Leha ho le joalo, ho na le lintlha tse ling tse lokelang ho nahanoa pele u nahana ka tšebeliso ea eona lipatlisisong tse tlang.Ntlha ea pele, na nako ea ho latela libeke tse 8 e khutšoanyane haholo ho paka ntlafatso ea botenya bohle ba mucosal?Haeba nako ea ho latela e le telele, liphetoho tse khetholloang karolong ea motheo li ka 'na tsa sebelisoa likarolong tse ling.Taba ea bobeli, na botenya ba histological ba lera la mucosal bo bonts'a nchafatso ea lisele?Tlhahlobo ea histological ea botenya ba botšehali ba botšehali ha e hlile ha e nahane ka lera la basal, le kenyeletsang lesela le tsosolositsoeng le kopanang le lesela le ka tlas'a motsoako.
Re utloisisa hore palo e nyane ea barupeluoa le ho hloka sampole ea semmuso ke mefokolo ea lipatlisiso tsa rona;leha ho le joalo, ka bobeli ke likarolo tse tloaelehileng tsa thuto ea teko.Ke ka lebaka lena re qobang ho fetisetsa seo re se fumaneng ho litletlebo tsa ho nepahala kapa ho se sebetse hantle ha kliniki.Leha ho le joalo, e 'ngoe ea melemo e ka sehloohong ea mosebetsi oa rona ke hore e re lumella ho hlahisa lintlha bakeng sa liphetho tse' maloa, tse tla re thusa ho bala boholo ba sampuli ea molao bakeng sa lipatlisiso tsa nakong e tlang.Ho feta moo, mofofisi oa sefofane o re lumella ho lekola leano la rona la ho hira, sekhahla sa churn, monyetla oa ho bokella lisampole le tlhahlobo ea sephetho, e tla fana ka leseli bakeng sa mosebetsi ofe kapa ofe o amanang le ona.Qetellong, letoto la liphetho tseo re li hlahlobileng, ho kenyeletsoa sephetho sa sepheo sa kliniki, li-biomarker, le liphetho tse tlalehiloeng ke mokuli tse hlahlobiloeng ho sebelisoa mehato e netefalitsoeng, ke matla a mantlha a lipatlisiso tsa rona.
Desirial® ke hyaluronic acid ea pele e amanang le sefapano e tsamaisoang ka ente ea mucosal ea botšehali.E le ho fana ka sehlahisoa ka tsela ena, sehlahisoa se tlameha ho ba le mokelikeli o lekaneng e le hore se ka kenngoa habonolo ka har'a lisele tse khethehileng tse kopanetsoeng ha li ntse li boloka hygroscopicity ea eona.Sena se finyelloa ka ho ntlafatsa boholo ba limolek'hule tsa gel le boemo ba gel cross-linking ho netefatsa hore mahloriso a mangata a gel ha a ntse a boloka viscosity e tlaase le elasticity.
Liphuputso tse 'maloa li hlahlobile liphello tse molemo tsa HA, tseo boholo ba tsona e leng li-RCT tse seng tlaase, ho bapisa HA le mefuta e meng ea phekolo (haholo-holo li-hormone) [22,23,24,25].The HA lithutong tsena e ne e tsamaisoa sebakeng sa heno.HA ke molek'hule ea tlhaho e khetholloang ka bokhoni ba eona ba bohlokoa haholo ba ho lokisa le ho tsamaisa metsi.Ha lilemo li ntse li feta, palo ea endogenous hyaluronic acid ka har'a mucosa ea botšehali e fokotseha haholo, 'me botenya ba eona le vascularization le tsona lia fokotseha, ka tsela eo li fokotsa ho tsoa ha plasma le lubrication.Phuputsong ena, re bontšitse hore ente ea Desirial® e amahanngoa le ntlafatso e kholo matšoao 'ohle a amanang le VVA.Liphuputso tsena li lumellana le phuputso e fetileng e entsoeng ke Berni et al.E le karolo ea tumello ea taolo ea Desirial® (lintlha tse sa boleloang-tlatsetso) (Faele e Ekelitsoeng 1).Le hoja e le khopolo-taba feela, hoa utloahala hore ntlafatso ena ke ea bobeli ho monyetla oa ho tsosolosa phetisetso ea plasma sebakeng sa botšehali sa epithelial.
Gel ea HA e kopantsoeng le sefapano e boetse e bontšitsoe ho eketsa motsoako oa mofuta oa I collagen le elastin, kahoo e eketsa botenya ba lisele tse potolohileng [31, 32].Thutong ea rona, ha rea ka ra paka hore fluorescence ea procollagen I le III e fapane haholo ka mor'a phekolo.Leha ho le joalo, COL1A1 le COL3A1 liphatsa tsa lefutso li eketsehile haholo ka lipalo.Ka hona, Desirial® e ka 'na ea e-ba le phello e susumetsang ho thehoa ha collagen ka har'a botšehali, empa lithuto tse khōloanyane tse nang le ho latela nako e telele li hlokahala ho tiisa kapa ho hanyetsa monyetla ona.
Phuputso ena e fana ka lintlha tsa motheo le boholo ba phello e ka bang teng bakeng sa liphetho tse 'maloa, tse tla thusa lipalo tsa boholo ba sampole nakong e tlang.Ho feta moo, boithuto bo bonts'itse monyetla oa ho bokella liphetho tse fapaneng.Leha ho le joalo, e boetse e totobatsa lintlha tse ’maloa tse lokelang ho nahanoa ka hloko ha ho raloa lipatlisiso tsa nako e tlang sebakeng sena.Le hoja Desirial® e bonahala e ntlafatsa haholo matšoao a VVA le ts'ebetso ea thobalano, mokhoa oa eona oa ketso ha o hlaka.Joalokaha ho ka bonoa ho tsoa polelong ea bohlokoa ea CoL1A1 le CoL3A1, ho bonahala ho na le bopaki ba pele ba hore e susumetsa ho thehoa ha collagen.Leha ho le joalo, procollagen 1, procollagen 3 le Ki67 ha lia ka tsa fumana litlamorao tse tšoanang.Ka hona, matšoao a tlatsetso a histological le biological a tlameha ho hlahlojoa lipatlisisong tse tlang.
Multi-point intravaginal injection ea Desirial® (HA e amanang le sefapano) e ne e amahanngoa haholo le polelo ea CoL1A1 le CoL3A1, e bontšang hore e susumetsa sebopeho sa collagen, e fokotsa haholo matšoao a VVA, 'me e sebelisa mekhoa e meng ea phekolo.Ho phaella moo, ho itšetlehile ka lintlha tsa PGI-I le FSFI, khotsofalo ea mokuli le ts'ebetso ea thobalano e ntlafetse haholo.Leha ho le joalo, botenya bohle ba mucosa ea botšehali ha boa ka ba fetoha haholo.
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Nako ea poso: Oct-26-2021