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Agnieszka Owczarczyk-Saczonek, Natalia Zdanowska, Ewa Wygonowska, Waldemar Placek Lefapha la Dermatology, Mafu a Fetisoang ka Thobalano le Clinical Immunology, Liunivesithi tsa Warmia le Mazury ho la Olsztyn, Poland Newsletter: Agnieszka Lefapha la Dermatology, Setsi sa Mafu a Transczarczy, Setsi sa Mafu a Agnieszka, Setsi sa Mafu a Transmax Univesithi ea Warmia le Mazury, Olsztyn, Poland.Wojska Polskiego 30, Olsztyn, 10-229, PolishTel +48 89 6786670 Fax +48 89 6786641 Email [email protected] Abstract: Hyaluronic acid (HA) ke glycosaminoglycan, motsoako oa tlhaho oa extracellular matrix.Sebopeho se tšoanang sa molek'hule linthong tsohle tse phelang ke molemo oa eona o ka sehloohong hobane o na le monyetla o monyenyane oa ho fetoloa ho immunogenicity.Ka hona, ka lebaka la biocompatibility ea eona le botsitso sebakeng sa ho kengoa, ke mokhoa o haufi ka ho fetisisa o loketseng ho sebelisoa e le setlatsi.Sengoliloeng sena se kenyelletsa puisano ea mokhoa o ka tlase oa karabelo e mpe ea 'mele ea ho itšireletsa mafung ea HA, hammoho le mokhoa oa karabelo kamora ho entoa khahlanong le SARS-CoV-2.Ho ea ka lingoliloeng, re lekile ho hlophisa karabelo e mpe ea 'mele ea ho itšireletsa mafung ka lipontšo tsa systemic ho HA.Ho hlaha ha liketso tse sa lebelloang ho hyaluronic acid ho bontša hore li ka 'na tsa se ke tsa nkoa li sa nke lehlakore kapa li se na allergenic.Liphetoho tsa sebopeho sa lik'hemik'hale tsa HA, li-additives, le tšekamelo ea motho ka mong ho bakuli e ka 'na ea e-ba sesosa sa liketso tse sa lebelloang, tse lebisang liphellong tse tebileng tsa bophelo bo botle.Litokisetso tsa tšimoloho e sa tsejoeng, tlhoekiso e fosahetseng, kapa tse nang le DNA ea baktheria li kotsi haholo.Ka hona, tlhahlobo ea nako e telele ea bakuli le khetho ea FDA kapa EMA litokisetso tse amohelehang li bohlokoa haholo.Hangata bakuli ha ba tsebe liphello tsa ts'ebetso e theko e tlaase e etsoang ke batho ba se nang tsebo e nepahetseng ba sebelisa lihlahisoa tse sa ngolisoang, kahoo sechaba se lokela ho rutoa le melao le melaoana e lokela ho hlahisoa.Mantsoe a bohlokoa: Hyaluronic acid, li-filler, ho ruruha ho liehang, autoimmune / auto-inflammatory adjuvant-induced syndrome, SARS-CoV-2
Hyaluronic acid (HA) ke glycosaminoglycan, karolo ea tlhaho ea matrix a extracellular.E hlahisoa ke dermal fibroblasts, lisele tsa synovial, lisele tsa endothelial, lisele tse boreleli tsa mesifa, lisele tsa adventitia le oocyte 'me li lokolloa sebakeng se potolohileng extracellular.1,2 Sebopeho se tšoanang sa limolek'hule linthong tsohle tse phelang ke molemo oa eona o ka sehloohong, o amanang le kotsi e nyenyane ka ho fetisisa ea immunogenicity.Biocompatibility le botsitso ba sebaka sa ho kengoa se etsa hore e be khetho e nepahetseng bakeng sa letoto lohle la li-filler.Ka lebaka la ho atolosoa ha mochini oa lisele ka mor'a ente le ts'ebetso e latelang ea li-fibroblasts tsa letlalo, e na le molemo o moholo oa ho khona ho susumetsa tlhahiso ea collagen e ncha.2-4 Hyaluronic acid e na le hydrophilic haholo, e na le litšobotsi tse khethehileng tsa ho tlama limolek'hule tsa metsi (ka makhetlo a fetang 1000 boima ba eona), 'me e etsa conformation e atolositsoeng e nang le molumo o moholo ha o bapisoa le boima.E ka boela ea theha condensation esita le maemong a tlaase haholo.sekgomaretsi.E etsa hore lisele li phalle kapele 'me li eketse molumo oa letlalo.3,5,6 Ho phaella moo, ho nosetsa letlalo le matla a antioxidant a hyaluronic acid a ka khothalletsa ho tsosolosoa ha lisele tsa letlalo le ho susumetsa tlhahiso ea collagen.5
Ho theosa le lilemo, ho 'nile ha hlokomeloa hore ho tsebahala ha mekhoa ea litlolo ho sebelisa lintho tse kang HA ho tsoetse pele ho eketseha.Ho latela lintlha tse tsoang ho Mokhatlo oa Machaba oa Aesthetic Plastic Surgery (ISAPS), ho entsoe mekhoa ea litlolo e fetang limilione tse 4.3 ho sebelisoa HA ka 2019, keketseho ea 15.7% ha e bapisoa le 2018. Mokhatlo oa Amerika oa Dermatology (ASDS) o tlaleha hore lingaka tsa letlalo li entse 2.7 milione dermal filler ente ka selemo sa 2019. 8 Ts'ebetsong ea lits'ebetso tse joalo e fetoha mokhoa o nang le phaello e ngata haholo oa ts'ebetso e lefuoang.Ka hona, ka lebaka la khaello ea melao le melaoana linaheng/litikolohong tse ngata, batho ba bangata ba fana ka litšebeletso tse joalo, hangata ba se na koetliso e lekaneng kapa mangolo a thuto.Ho phaella moo, ho na le mekhoa ea tlhōlisano 'marakeng.E ka 'na ea e-ba theko e tlaase, ea boleng bo tlaase,' me ha e e-s'o amoheloe ke FDA kapa EMA, e leng kotsi ea ho hlahisa mefuta e mecha ea liketso tse mpe.Ho latela phuputso e entsoeng Belgium, boholo ba lisampole tse 14 tseo ho belaelloang hore ha li molaong tse hlahlobiloeng li ne li na le lihlahisoa tse nyane haholo ho feta tse boletsoeng ka har'a sephutheloana.9 Linaha tse ngata li na le libaka tse thoko tsa mekhoa ea litlolo e seng molaong.Ho feta moo, lits'ebetso tsena ha lia ngolisoa 'me ha ho lekhetho le lefuoang.
Ka hona, ho na le litlaleho tse ngata tsa liketsahalo tse mpe ka har'a lingoliloeng.Liketsahalo tsena tse mpe hangata li lebisa ho mathata a mangata a tlhahlobo le kalafo le litlamorao tse sa lebelloang ho bakuli.7,8 Hypersensitivity ho hyaluronic acid e bohlokoa haholo.Pathogenesis ea liketso tse ling ha e e-s'o hlalosoe ka botlalo, kahoo mantsoe a hlahang libukeng ha a tšoane, 'me litumellano tse ngata mabapi le tsamaiso ea mathata ha li e-s'o kenyelle maikutlo a joalo.10,11
Sengoliloeng sena se kenyelletsa lintlha tsa tlhahlobo ea lingoliloeng.Hlalosa lingoloa tsa tlhahlobo ka ho batla PubMed u sebelisa mantsoe a latelang: hyaluronic acid, li-fillers, le litlamorao.Patlo e ntse e tsoela pele ho fihlela la 30 Hlakubele 2021. Ho fumanoe lingoliloeng tse 105 mme ho hlahlobisisa tse 42 tsa tsona.
Hyaluronic acid ha se setho sa 'mele kapa mefuta e ikhethileng, kahoo ho ka nahanoa hore ha e bake maikutlo a ho kula.12 Leha ho le joalo, ke habohlokoa ho hopola hore sehlahisoa se kentsoeng se boetse se kenyelletsa li-additives, 'me hyaluronic acid e fumanoa ka baktheria biosynthesis.
Ho boetse ho bonts'itsoe hore mekhoa ea motho ka mong e ka lebisa kotsing ea ho lieha, ho ba le mekhoa e mebe e amanang le 'mele ea ho itšireletsa mafung e amanang le dermal fillers ho bakuli ba nang le HLA-B * 08 le DR1 * 03 haplotypes.Motsoako ona oa li-subtypes tsa HLA o amahanngoa le keketseho e batlang e imena habeli menyetla ea karabelo e mpe (OR 3.79).13
Hyaluronic acid e teng ka mokhoa oa li-multiparticulate, moralo oa eona o bonolo, empa ke biomolecule e sebetsang ka bongata.Boholo ba HA bo ama phello e fapaneng: e ka 'na ea e-ba le lintho tse thibelang ho ruruha kapa tse khahlanong le ho ruruha, ho khothalletsa kapa ho thibela ho falla ha lisele, le ho kenya tšebetsong kapa ho emisa karohano ea lisele le phapang.14-16 Ka masoabi, ha ho na tumellano mabapi le karohano ea HA.Lentsoe la boholo ba molek'hule.14,16,17
Ha u sebelisa lihlahisoa tsa HMW-HA, ke habohlokoa ho hopola hore hyaluronidase ea tlhaho e baka ho senyeha ha eona le ho khothalletsa ho thehoa ha LMW-HA.HYAL2 (e khomaretsoeng ka lera la sele) e arola boima ba molek'hule e phahameng HA (> 1 MDa) ka likhechana tsa 20 kDa.Ho phaella moo, haeba HA hypersensitivity e qala, ho ruruha ho tla khothalletsa ho senyeha ho eketsehileng (Setšoantšo sa 1).
Tabeng ea lihlahisoa tsa HA, ho ka 'na ha e-ba le phapang e itseng tlhaloso ea boholo ba limolek'hule.Ka mohlala, bakeng sa sehlopha sa lihlahisoa tsa Juvederm (Allergan), limolek'hule> 500 kDa li nkoa e le LMW-HA, le> 5000 kDa - HMW-HA.E tla ama ntlafatso ea polokeho ea sehlahisoa.18
Maemong a mang, boima bo tlaase ba molek'hule (LMW) HA bo ka baka hypersensitivity 14 (Setšoantšo sa 2).E nkoa e le molek'hule ea pro-inflammatory.E fumaneha haholo libakeng tse sebetsang tsa catabolism, mohlala, ka mor'a kotsi, e baka ho ruruha ka ho ama li-receptors tsa Toll-like (TLR2, TLR4).14-16,19 Ka tsela ena, LMW-HA e khothalletsa ts'ebetso le kholo ea lisele tsa dendritic (DC), 'me e susumetsa mefuta e sa tšoaneng ea lisele ho hlahisa li-cytokine tse nang le pro-inflammatory, tse kang IL-1β, IL-6, IL-12 , TNF-α le TGF-β, e laola polelo ea li-chemokine le ho falla ha lisele.14,17,20 LMW-HA e ka sebetsa e le mohlala oa molek'hule o amanang le kotsi (DAMP) ho qala mekhoa ea tlhaho ea ho itšireletsa mafung, e tšoanang le liprotheine tsa baktheria kapa liprotheine tsa mocheso oa mocheso.14,21 CD44 e sebetsa e le mokhoa oa ho amohela mokhoa oa ho amohela LMW-HA.E teng ka holim'a lisele tsohle tsa motho 'me e ka sebelisana le li-ligand tse ling tse kang osteopontin, collagen, le matrix metalloproteinases (MMP).14,16,17.
Ka mor'a hore ho ruruha ho fokotsehe 'me masala a lisele tse senyehileng a felisoe ke macrophages, molek'hule ea LMW-HA e tlosoa ke endocytosis e itšetlehileng ka CD44.Ka lehlakoreng le leng, ho ruruha ho sa foleng ho amahanngoa le keketseho ea palo ea LMW-HA, kahoo li ka nkoa e le li-biosensor tsa tlhaho tsa boemo ba botšepehi ba lisele.14,20,22,23 Karolo ea CD44 receptor ea HA e bontšitsoe lithutong tsa taolo ea ho ruruha tlas'a maemo a vivo.Mehlala ea litoeba tsa atopic dermatitis, kalafo ea anti-CD44 e thibela nts'etsopele ea maemo a kang ramatiki e bakoang ke collagen kapa tšenyo ea letlalo.mashome a mabeli le metso e mene
Boima bo phahameng ba molek'hule (HMW) HA e tloaelehile ka har'a lisele tse sa fetoheng.E thibela tlhahiso ea li-pro-inflammatory mediators (IL-1β, IL-8, IL-17, TNF-α, metalloproteinases), e fokotsa polelo ea TLR le ho laola angiogenesis.14,19 HMW-HA e boetse e ama mosebetsi oa macrophages o ikarabellang bakeng sa taolo ka ho susumetsa mosebetsi oa bona o khahlanong le ho ruruha ho ntlafatsa ho ruruha ha sebaka.15,24,25
Kakaretso ea asiti ea hyaluronic ho motho ea boima ba lik'hilograma tse 70 e ka ba ligrama tse 15, 'me tekanyo ea eona ea kakaretso ke ligrama tse 5 ka letsatsi.Hoo e ka bang 50% ea asiti ea hyaluronic 'meleng oa motho e kenelletse letlalong.Halofo ea bophelo ba eona ke lihora tse 24-48.22,26 Ka hona, halofo ea bophelo ea HA ea tlhaho e sa fetotsoeng pele e phunyeletsoa ka potlako ke hyaluronidase, li-enzyme tsa tlhaho tsa tlhaho le mefuta e sebetsang ea oksijene e ka bang lihora tsa 12 feela.27,28 Ketane ea HA e ile ea ntlafatsoa ho atolosa botsitso ba eona le ho hlahisa limolek'hule tse kholoanyane le tse tsitsitseng haholoanyane, tse nang le nako e telele ea ho lula ka har'a lisele (hoo e ka bang likhoeli tse 'maloa), le ka thepa e tšoanang ea biocompatibility le viscoelastic filling.28 Crosslinking e kenyelletsa karolo e phahameng ea HA e kopantsoeng le limolek'hule tse tlaase tsa boima ba limolek'hule le karolo e tlaase ea boima bo phahameng ba molek'hule HA.Phetoho ena e fetola sebopeho sa tlhaho sa molek'hule ea HA mme e ka ama immunogenicity ea eona.18
Cross-linking haholo-holo e kenyelletsa ho hokahanya ha li-polymers ho etsa li-covalent bond, haholo-holo tse kenyeletsang (-COOH) le / kapa hydroxyl (-OH) skeletons.Metsoako e meng e ka khothalletsa crosslinking, joalo ka 1,4-butanediol diglycidyl ether (BDDE) (Juvederm, Restylane, Princess), divinyl sulfone (Captique, Hylaform, Prevelle) kapa diepoxy octane (Puragen).29 Leha ho le joalo, lihlopha tsa epoxy tsa BDDE ha li fokotsehe ka mor'a hore li sebetsane le HA, kahoo ho ka fumanoa feela palo ea BDDE e sa sebetseng (<2 likarolo ka milione) e ka fumanoang sehlahisoa.26 Cross-linked ha hydrogel ke thepa e feto-fetohang haholo e ka lebisang ho thehoeng ha mehaho ea 3D e nang le thepa e ikhethang (rheology, degradation, applicability).Likarolo tsena li khothalletsa ho ajoa habonolo ha sehlahisoa 'me ka nako e ts'oanang li susumetsa tlhahiso ea likarolo tsa limolek'hule tsa matrix a extracellular.30,31 <>
E le ho eketsa hydrophilicity ea sehlahisoa, bahlahisi ba bang ba eketsa metsoako e meng, e kang dextran kapa mannitol.E 'ngoe le e' ngoe ea li-additives tsena e ka fetoha antigen e susumetsang karabelo ea 'mele ea ho itšireletsa mafung.
Hona joale, litokisetso tsa HA li hlahisoa ka mefuta e itseng ea Streptococcus ka ho belisoa ha baktheria.(Streptococcus equi kapa Streptococcus zooepidemicus).Ha e bapisoa le litokisetso tse entsoeng ka liphoofolo tse neng li sebelisoa pele, e fokotsa kotsi ea ho itšireletsa mafung, empa e ke ke ea felisa tšilafalo ea limolek'hule tsa protheine, li-nucleic acid tsa baktheria le li-stabilizers.Li ka fetoha li-antigen 'me tsa susumetsa karabelo ea 'mele ea ho itšireletsa mafung, joalo ka hypersensitivity ho lihlahisoa tsa HA.Ka hona, mahlale a tlhahiso ea li-filler (joalo ka Restylane) a shebana le ho fokotsa tšilafalo ea sehlahisoa.32
Ho ea ka khopolo-taba e 'ngoe, karabo ea' mele ea ho itšireletsa mafung ho HA e bakoa ke ho ruruha ho bakoang ke likaroloana tsa baktheria tsa biofilm, tse fetisetsoang liseleng ha sehlahisoa se kenngoa.33,34 Biofilm e entsoe ka libaktheria, limatlafatsi tsa tsona le metabolites.Haholo-holo e kenyelletsa libaktheria tse ka sehloohong tse seng tsa pathogenic tse bokellang letlalo le phetseng hantle kapa lera la mucous (mohlala, Dermatobacterium acnes, Streptococcus oralis, Staphylococcus epidermidis).Tsena Mathata a netefalitsoe ke tlhahlobo ea polymerase chain reaction.33-35
Ka lebaka la litšobotsi tse ikhethang tsa ho hōla butle le mefuta ea tsona e bitsoang likolone tse nyenyane, hangata ho thata ho khetholla likokoana-hloko setso.Ho phaella moo, metabolism ea bona ka biofilm e ka 'na ea fokotseha, e thusang ho qoba liphello tsa lithibela-mafu.35,36 Ho phaella moo, bokhoni ba ho theha matrix a extracellular polysaccharides (ho akarelletsa le HA) ke ntho e thibelang phagocytosis.Libaktheria tsena li ka 'na tsa lula li robetse ka lilemo tse ngata, ebe li kenngoa ts'ebetsong ke mabaka a ka ntle' me li baka karabelo.35-37 Macrophages le lisele tse kholo li atisa ho fumanoa haufi le likokoana-hloko tsena.Li ka 'na tsa kenngoa ka potlako' me tsa baka karabelo ea ho ruruha.38 Lintlha tse ling, joalo ka ts'oaetso ea baktheria e nang le mefuta ea baktheria e ts'oanang ka sebopeho le biofilm, e ka kenya tšebetsong likokoana-hloko tse robetseng ka mekhoa ea ho etsisa.Ts'ebetso e kanna ea bakoa ke tšenyo e bakiloeng ke ts'ebetso e 'ngoe ea dermal filler.38
Ho thata ho khetholla pakeng tsa ho ruruha le ho lieha ha hypersensitivity e bakoang ke likokoana-hloko tsa baktheria.Haeba leqeba le khubelu la sclerotic le hlaha ka nako leha e le efe ka mor'a ho buuoa, ho sa tsotellehe nako e telele, biofilm e lokela ho belaelloa hang-hang.38 E ka 'na ea e-ba asymmetrical le symmetrical,' me ka linako tse ling e ka 'na ea ama libaka tsohle moo HA e tsamaisoang nakong ea ho buuoa.Esita le haeba phello ea setso e le mpe, lithibela-mafu tse pharaletseng tse nang le ho kenella hantle letlalong li lokela ho sebelisoa.Haeba ho na le li-nodule tsa fibrous tse nang le khanyetso e ntseng e eketseha, ho ka etsahala hore e be granuloma ea 'mele osele.
HA e ka boela ea susumetsa ho ruruha ka mochine oa superantigens.Karabelo ena ha e hloke mehato ea pele ea ho ruruha.12,39 Superantigens e baka 40% ea lisele tsa T tsa pele mme mohlomong NKT clonal activation.Ts'ebetso ea li-lymphocyte tsena e lebisa ho sefefo sa cytokine, se khetholloang ka ho lokolloa ha li-cytokine tse ngata tse nang le pro-inflammatory, tse kang IL-1β, IL-2, IL-6 le TNF-α40.
Pneumonia e matla, hangata e tsamaeang le ho hloleha ho matla ha phefumoloho, ke mohlala oa karabelo ea pathological ho bacterial superantigen (staphylococcal enterotoxin B), e eketsang LMW-HA e hlahisoang ke fibroblasts liseleng tsa matšoafo.HA e susumetsa tlhahiso ea lik'hemik'hale tsa IL-8 le IP-10, tse bapalang karolo ea bohlokoa ho bokella lisele tsa ho ruruha matšoafong.40,41 Mekhoa e tšoanang e 'nile ea hlokomeloa nakong ea asthma, lefu le sa foleng le thibelang mafu a matšoafo le pneumonia.Tlhahiso e ntseng e eketseha ea COVID-19.41 LMW-HA e lebisa ho tsosoloseng ho feteletseng ha CD44 le ho lokolloa ha li-cytokine tse thibelang ho ruruha le chemokine.40 Mokhoa ona o ka boela oa hlokomeloa ka ho ruruha ho bakoang ke likarolo tsa biofilm.
Ha theknoloji ea tlhahiso ea li-filler e ne e sa nepahala hakaalo ka 1999, kotsi ea ho lieha ho arabela ka mor'a ente ea HA e ne e le 0.7%.Ka mor'a ho hlahisoa ha lihlahisoa tse phahameng tsa bohloeki, liketsahalo tsa liketsahalo tse joalo tse mpe li ile tsa theohela ho 0,02%.3,42,43 Leha ho le joalo, ho kenngoa ha li-fillers tsa HA tse kopanyang liketane tse phahameng le tse tlaase tsa HA li entse hore ho be le liphesente tse phahameng tsa AE.44
Lintlha tsa pele mabapi le karabelo e joalo li hlahile tlalehong ea ts'ebeliso ea NASHA.Ena ke karabelo ea erythema le edema, ka ho kenella le edema sebakeng se potolohileng ho nka matsatsi a 15.Karabelo ena e ile ea bonoa ho 1 ho bakuli ba 1400.3 Bangoli ba bang ba tlalehile li-nodule tsa nako e telele tsa ho ruruha, tse hlahang ho 0.8% ea bakuli.45 Ba ile ba totobatsa semelo se amanang le tšilafalo ea protheine e bakoang ke ho belisoa ha baktheria.Ho ea ka lingoliloeng, khafetsa ea liketso tse mpe ke 0.15-0.42%.3,6,43
Tabeng ea ho sebelisa tekanyetso ea nako, ho na le liteko tse ngata tsa ho arola liphello tse mpe tsa HA.46
Bitterman-Deutsch et al.classified lisosa tse mpe le mathata a ka mor'a ho buuoa ka hyaluronic acid e thehiloeng litokisetso.Li kenyeletsa
Sehlopha sa litsebi se ile sa leka ho hlalosa karabelo ho hyaluronic acid ho latela nako ea ponahalo ka mor'a ho buuoa: "pele" (
Edema ea nakoana sebakeng sa ente hang ka mor'a ho buuoa e ka 'na ea e-ba ka lebaka la mochine oa ho lokolla histamine ho bakuli ba atisang ho tšoaroa ke mofuta oa 1, haholo-holo ba nang le histori ea mafu a letlalo.51 Ke metsotsoana e seng mekae feela ka mor'a tsamaiso moo lisele tsa mast li senyehang ka mochine 'me li lokolla li-pro-inflammatory mediators ho baka edema ea lithane le ho thehoa ha moea.Haeba karabelo e amanang le lisele tsa mast e etsahala, mokhoa oa phekolo ea antihistamine hangata o lekane.51
E kholoanyane tšenyo ea letlalo e bakoang ke ho buuoa ka litlolo, ho na le edema e kholoanyane, e ka 'nang ea tsoela pele ho fihlela ho 10-50%.52 Ho ea ka li-diaries tse peli tse foufetseng tse nang le bokooa ba batho ba bangata, khafetsa ea edema ka mor'a ente ea Restylane e hakanngoa hore ke 87% ea thuto ea 52,53.
Libaka tse sefahlehong tse bonahalang eka li na le edema ka ho khetheha ke melomo, libaka tsa periorbital le marameng.52 E le ho fokotsa kotsi, ho kgothaletswa ho qoba ho sebelisoa ha li-fillers tse ngata, anesthesia ea ho kenella, ho silila ka mafolofolo le litokisetso tse ngata tsa hygroscopic.Li-additives (mannitol, dextran).52
Edema sebakeng sa ente e nkang metsotso e mengata ho isa ho matsatsi a 2-3 e ka bakoa ke hygroscopicity ea HA.Karabelo ena hangata e bonoa sebakeng sa perilip le periorbital.49,54 ha ea lokela ho fosoa ka edema e bakoang ke mokhoa o sa tloaelehang haholo oa ho itšoara ka potlako (angioedema).49
Ka mor'a ho kenngoa ha Restylane (NASHA) molomong o ka holimo, ho ile ha hlalosoa nyeoe ea hypersensitivity ho angioedema.Leha ho le joalo, mokuli o ile a boela a nka 2% ea lidocaine, e ka 'nang ea tsosa karabelo ea hypersensitivity ea mofuta oa I.Tsamaiso ea tsamaiso ea corticosteroids e entse hore edema e fokotsehe ka hare ho matsatsi a 4.32
Boitšoaro bo ntseng bo fetoha ka potlako bo ka bakoa ke hypersensitivity ho tšilafalo ea masalla a protheine ea libaktheria tsa HA synthesizing.Tšebelisano pakeng tsa HA e kentsoeng le lisele tse setseng tsa mast ka har'a lisele ke mokhoa o mong oa ho hlakisa ts'ebetso ea hang-hang ea karabo.Mokelikeli oa CD44 o holim'a lisele tsa mast ke receptor bakeng sa HA, 'me tšebelisano ena e ka ba ea bohlokoa bakeng sa ho falla ha tsona.32,55
Kalafo e kenyelletsa tsamaiso ea hang-hang ea li-antihistamine, systemic GCS, kapa epinephrine.46
Tlaleho ea pele, e hatisitsoeng ke Turkmani et al., E hlalositse basali ba lilemo li 22-65 ba ileng ba etsoa opereishene ea HA e hlahisoang ke lik'hamphani tse fapaneng.39 Maqeba a letlalo a bonahatsoa ke erythema le edema e bohloko sebakeng sa ente ea filler sefahlehong.Maemong 'ohle, karabelo e qala matsatsi a 3-5 ka mor'a ho kula ho kang ntaramane (feberu, hlooho e bohloko, 'metso, khohlela le mokhathala).Ho phaella moo, bakuli bohle ba ne ba fumane tsamaiso ea HA (linako tse 2 ho isa ho tse 6) lilemong tsa 4 pele matšoao a hlaha likarolong tse fapaneng tsa sefahleho.39
Ponahalo ea tleliniki ea karabelo e hlalositsoeng (erythema le edema kapa lekhopho le kang urticaria e nang le lipontšo tsa systemic) e ts'oana le karabelo ea mofuta oa III - karabelo ea bokuli ba pseudoserum.Ka bomalimabe, ha ho na litlaleho libukeng tse tiisang khopolo ena.Tlaleho ea nyeoe e hlalosa mokuli ea nang le leqeba le kang lekhopho nakong ea Sweet syndrome, e leng letšoao la pathological le hlahang lihora tse 24-48 ka mor'a sebaka sa tsamaiso ea HA.56
Bangoli ba bang ba lumela hore mokhoa oa karabelo o bakoa ke mofuta oa IV hypersensitivity.Ente e fetileng ea HA e ile ea etsa hore ho thehoe li-lymphocyte tsa memori, 'me tsamaiso e latelang ea litokisetso e ile ea etsa hore ho be le karabelo ea lisele tsa CD4 + le macrophages.39
Mokuli o ile a fuoa molomo prednisolone 20-30 mg kapa methylprednisolone 16-24 mg letsatsi le letsatsi bakeng sa matsatsi a 5.Joale lethal dose le fokotsehile bakeng sa matsatsi a mang a 5.Ka mor'a libeke tse 2, matšoao a bakuli ba 10 ba amohetseng li-steroids tsa molomo a ile a nyamela ka ho feletseng.Bakuli ba bane ba setseng ba ile ba tsoela pele ho ba le edema e bonolo.Hyaluronidase e sebelisoa khoeli e le 'ngoe ka mor'a ho qala ha matšoao.39
Ho ea ka lingoliloeng, mathata a mangata a liehang a ka hlaha ka mor'a ente ea hyaluronic acid.Leha ho le joalo, sengoli se seng le se seng se li khethile ho latela boiphihlelo ba bongaka.Lentsoe le kopaneng ha le so hlahisoe ho hlalosa maikutlo a mabe joalo.Lentsoe "continuous intermittent delayed swelling" (PIDS) le hlalositsoe ke lingaka tsa letlalo tsa Brazil ka 2017. 57 Beleznay et al.e hlahisitse lentsoe le leng ho hlalosa lefu lena ka 2015: ho lieha ho qala nodule 15,58 le Snozzi et al.: lefu le tsoetseng pele la ho ruruha (LI).58 Ka 2020, polelo e 'ngoe e ile ea hlahisoa: ho lieha ho ruruha Reaction (DIR).48
Chung et al.a hatisa hore DIR e kenyelletsa mefuta e mene ea liketso: 1) DTH reaction (e bitsoang ka nepo: mofuta o liehang oa IV hypersensitivity reaction);2) karabelo ea granuloma ea 'mele osele;3) biofilm;4) tšoaetso ea atypical.Karabelo ea DTH ke ho lieha ho ruruha ha lisele tsa 'mele, e leng karabelo ho li-allergen.59
Ho ea ka mehloli e fapaneng, ho ka boleloa hore khafetsa ea karabelo ena ea fetoha.Haufinyane tjena ho hatisitsoe pampiri e ngotsoeng ke bafuputsi ba Isiraele.Ba ile ba lekola palo ea liketsahalo tse mpe ka mokhoa oa DIR ho latela lethathamo la lipotso.Lenane la lipotso le ile la phethoa ke lingaka tse 334 tse faneng ka liente tsa HA.Liphello li bontšitse hore hoo e batlang e le halofo ea batho ba ne ba sa fumanoa ba e-na le DIR, 'me 11.4% ba arabetse hore ba bone karabelo ena ho feta makhetlo a 5.48 Tekong ea ngoliso ea ho lekola polokeho, karabelo e hlahisitsoeng ke lihlahisoa tse hlahisoang ke Allergan li ngotsoe hantle.Kamora ho nka Juvederm Voluma® bakeng sa likhoeli tse 24, hoo e ka bang 1% ea bakuli ba 103 ba neng ba beiloe leihlo ba tlalehile maikutlo a tšoanang.60 Nakong ea tlhahlobo ea morao-rao ea likhoeli tsa 68 ea mekhoa ea 4702, mokhoa o tšoanang oa ho arabela o ile oa hlokomeloa ho 0.5% ea bakuli.Juvederm Voluma® e sebelisitsoe ho bakuli ba 2342.15 Liphesente tse holimo li ile tsa bonoa ha lihlahisoa tsa Juvederm Volbella® li ne li sebelisoa sebakeng sa meokho le sebaka sa molomo.Ka mor'a karolelano ea libeke tsa 8, 4.25% (n = 17) e ne e e-na le liketsahalo tse ling tse ileng tsa nka likhoeli tse 11 (karolelano ea liketsahalo tsa 3.17).42 Tlhahlobo ea morao-rao ea bakuli ba fetang sekete ba tšoaroang ke Vycross bakeng sa ho latela lilemo tse 2 ka li-fillers e bontšitse hore liketsahalo tsa li-nodule tse liehang li ne li le 1%.57 Phetoho ea karabelo ea Chung et al ho tlaleho e bohlokoa haholo.Ho ea ka lipalo tsa lithuto tse neng li tla etsahala, liketsahalo tsa ho lieha ho arabela ho ruruha e ne e le 1.1% ka selemo, ha liphuputsong tsa morao-rao, li ne li le ka tlase ho 1% nakong ea 1 ho lilemo tse 5.5.Ha se linyeoe tsohle tse tlalehiloeng e hlileng e leng DIR hobane ha ho na tlhaloso e nepahetseng.59
Karabelo e liehang ea ho ruruha (DIR) ea bobeli ho tsamaiso ea li-tissue filler e etsahala bonyane libeke tse 2-4 kapa hamorao ka mor'a ente ea HA.42 Lits'oants'o tsa kliniki li na le mokhoa oa ho pheta-pheta ha edema e tiileng ea sebakeng seo, e tsamaeang le erythema le bonolo, kapa li-nodule tse nang le subcutaneous sebakeng sa ente ea HA.42,48 Maqhutsu a ka 'na a futhumala ha a ama,' me letlalo le potolohileng e ka ba pherese kapa sootho.Bakuli ba bangata ba na le maikutlo likarolong tsohle ka nako e le 'ngoe.Tabeng ea ho sebelisa HA pele, ho sa tsotellehe mofuta oa ho tlatsa kapa palo ea liente, ke ntlha ea bohlokoa e bontšang lipontšo tsa kliniki.15,39 Maqeba a letlalo a tloaelehile haholo ho batho ba kileng ba kenya chelete e ngata ea HA.43 Ho phaella moo, edema e tsamaeang le eona e totobetse haholo ka mor'a ho tsoha, 'me e ntlafala hanyenyane ho pholletsa le letsatsi.42,44,57 Bakuli ba bang (~ 40%) ba na le lipontšo tse tšoanang le tsa ntaramane ea tsamaiso.15
Liphetoho tsena li ka 'na tsa amana le tšilafalo ea DNA, protheine, le endotoxin ea baktheria, le haeba mahloriso a le tlase haholo ho feta a HA.15 Leha ho le joalo, LMW-HA e kanna ea ba teng ho batho ba tšoaelitsoeng ke lefutso ka kotloloho kapa ka limolek'hule tse tšoaetsanoang tse amanang le tsona (biofilms).15,44 Leha ho le joalo, ponahalo ea li-nodule tsa ho ruruha sebakeng se itseng ho tloha sebakeng sa ente, ho hanyetsa lefu lena ho phekolo ea nako e telele ea lithibela-mafu le ho tlosoa ha likokoana-hloko tse tšoaetsanoang (setso le tlhahlobo ea PCR) li hlahisa lipelaelo mabapi le karolo ea biofilms. .Ntle le moo, katleho ea kalafo ea hyaluronidase le ho itšetleha ka lethal dose ea HA ho bonts'a mokhoa oa ho lieha ha hypersensitivity.42,44
Karabelo ka lebaka la tšoaetso kapa kotsi e ka lebisa ho eketseha ha serum interferon, e ka 'nang ea mpefatsa ho ruruha ho neng ho le teng pele.15,57,61 Ho phaella moo, LMW-HA e susumetsa li-receptor tsa CD44 kapa TLR4 holim'a macrophages le lisele tsa dendritic.E li kenya tšebetsong ebe e fana ka matšoao a theko ho lisele tsa T.15,19,24 Li-nodule tsa ho ruruha tse amanang le DIR li etsahala nakong ea likhoeli tse 3 ho isa ho tse 5 ka mor'a ho kenngoa ha HMW-HA filler (e nang le thepa e khahlanong le ho ruruha), e ntan'o senyeha ebe e fetoha LMW- e nang le pro-inflammatory properties HA.15
Ho qala ha karabelo hangata ho hlohlelletsoa ke ts'ebetso e 'ngoe ea ts'oaetso (sinusitis, tšoaetso ea moroto, tšoaetso ea phefumoloho, tšoaetso ea leino), kotsi ea sefahleho, le opereishene ea meno.57 Maikutlo ana a boetse a bakoa ke ho entoa 'me a khutla hape ka lebaka la ho tsoa ha khoeli.15, 57 Ketsahalo e 'ngoe le e' ngoe e ka bakoa ke lintho tse bakang tšoaetso.
Bangoli ba bang ba boetse ba hlalositse liphatsa tsa lefutso tsa batho ba nang le li-subtypes tse latelang ho arabela: HLA B * 08 kapa DRB1 * 03.4 (keketseho ea kotsi ka makhetlo a mane).13,62
Maqeba a amanang le DIR a khetholloa ke li-nodule tsa ho ruruha.Li lokela ho khetholloa ho tloha ho li-nodule, li-abscesses (ho nolofatsa, ho feto-fetoha ha maemo), le liketso tsa granulomatous (li-nodule tse thata tsa ho ruruha) tse bakoang ke biofilms.58
Chung et al.etsa tlhahiso ea ho sebelisa lihlahisoa tsa HA bakeng sa tlhahlobo ea letlalo pele ho ts'ebetso e reriloeng, le hoja nako e hlokahalang ho hlalosa liphello tsa liteko e ka ba libeke tse 3-4.59 Ba khothaletsa liteko tse joalo ka ho khetheha ho batho ba bileng le liketsahalo tse mpe.Ke hlokometse pele.Haeba tlhahlobo e le ntle, mokuli ha aa lokela ho phekoloa hape ka HA filler e tšoanang.Leha ho le joalo, e ka 'na ea se ke ea felisa liketso tsohle hobane hangata li bakoa ke lintho tse susumetsang, tse kang mafu a tšoaetsanoang a ka 'nang a hlaha neng kapa neng.59
Nako ea poso: Sep-28-2021