Caabuqa neerfaha, ama NI, waa habka jireed ee dhexdhexaadiyeyaasha si toos ah looga saaro dareemayaasha maqaarka si ay u bilaabaan jawaab celin barar ah. Tani waxay keenaysaa abuurista falcelinta bararka maxalliga ah oo ay ku jiraan, erythema, barar, heerkulka korodhka, jilicsanaanta, iyo xanuunka. Finnada C-fibers-ka afferent-ka ah ee aan miir-beelka lahayn, kuwaas oo ka jawaabaya kicinta makaanikada iyo kiimikada xoogga hoose, ayaa inta badan mas'uul ka ah sii deynta dhexdhexaadiyeyaashan bararka.

 

Marka la kiciyo, dariiqyadan neerfaha ee dareemayaasha maqaarka ayaa sii daaya neuropeptides tamar leh, ama walaxda P iyo calcitonin ee peptide (CGRP), si degdeg ah u galay microenvironment, taasoo kicinaysa jawaab celin isdaba-joog ah. Waxaa jira farqi weyn oo u dhexeeya caabuqa immunogenic, taasi waa jawaabta ugu horreysa ee ka hortagga iyo dib-u-celinta ee habka difaaca jirka marka cudur-sidaha uu galo jirka, halka caabuqa neurogenic uu ku lug leeyahay xiriir toos ah oo ka dhexeeya habdhiska dareenka iyo jawaabaha bararka. Inkasta oo caabuqa neurogenic iyo caabuqa difaaca jirka ay si isku mid ah u jiri karaan, labaduba maaha kuwo kiliinik ahaan aan la kala saari karin. Ujeedada maqaalka hoose waa in laga hadlo habka caabuqa neurogenic iyo doorka habdhiska dareenka ee difaaca martida iyo difaaca jirka.

 

Caabuqa neerfaha � Nidaamka Dareemaha Dareemaha ee Kaalinta ee Difaaca martida loo yahay iyo Immunopathology

 

aan la taaban karin

 

Hababka neerfayaasha iyo habdhiska difaaca ayaa dhaqan ahaan loo haystaa inay u adeegaan hawlo kala duwan. Si kastaba ha ahaatee, khadkani waa, si kastaba ha ahaatee, wuxuu noqonayaa mid si sii kordheysa u jahwareersan fikradaha cusub ee caabuqa neerfaha. Nociceptor neurons waxay leeyihiin qaar badan oo ka mid ah dariiqyada aqoonsiga molecular ee khatarta ah sida unugyada difaaca jirka iyo ka jawaabista khatarta, habka dareemayaasha ee durugsan wuxuu si toos ah ula xiriiraa habka difaaca, samaynta hannaan ilaalin isku dhafan. Shabakadda innervation cufan ee dareenka iyo fiilooyinka iswada ee unugyada durugsan iyo xawaaraha sare ee gudbinta neerfaha waxay u oggolaanaysaa is-beddelka degdega ah ee neurogenic ee gudaha iyo nidaamka nidaamka difaaca. Neurons-ka durugsan waxay sidoo kale u muuqdaan inay door weyn ka ciyaaraan shaqada difaaca ee difaaca jirka iyo cudurrada xasaasiyadda. Sidaa darteed, fahamka isdhexgalka isku-dhafka ah ee neerfayaasha durugsan ee unugyada difaaca ayaa laga yaabaa inay horumariyaan hababka daweynta si loo kordhiyo difaaca martida iyo in la xakameeyo immunopathology.

 

Hordhac

 

Laba kun oo sano ka hor, Celsus waxay ku qeexday caabuqa inuu ku lug leeyahay afar calaamadood oo wadnaha ah - Dolor (xanuun), Calor (kuleyl), Rubor (casaan), iyo Tumor (barar), indho-indheyn muujinaysa in dhaqdhaqaaqa habdhiska dareenka loo aqoonsaday inuu yahay mid muhiim u ah barar. Si kastaba ha ahaatee, xanuunka ayaa inta badan loo maleynayay tan iyo markaas, kaliya sida calaamad, oo aan ka qaybqaatay jiilka caabuqa. Marka la eego aragtidan, waxaan ku tusineynaa in habdhiska dareenka ee durugsan uu ka ciyaaro door toos ah oo firfircoon si loo beddelo difaaca gudaha iyo la qabsiga, sida habka difaaca jirka iyo habdhiska dareenka ayaa laga yaabaa in ay leeyihiin shaqo ilaalin isku dhafan oo wadajir ah oo difaaca martida iyo jawaabta dhaawaca unugyada, oo ah mid adag. isdhexgalka kaas oo sidoo kale u horseedi kara pathology ee cudurada xasaasiyadda iyo difaaca jirka.

 

Badbaadinta nooluhu waxay si aad ah ugu xidhan tahay awoodda ay iskaga difaacayaan waxyeelada ka iman karta dhaawaca unugyada iyo caabuqa. Difaaca martida loo yahay waxay ku lug leedahay labadaba dabeecad ka fogaansho si meesha looga saaro xidhiidhka deegaanka khatarta ah (shaqada neerfaha), iyo dhexdhexaadinta firfircoon ee cudur-sideyaasha (shaqo difaac). Dhaqan ahaan, doorka habka difaaca jirka ee la dagaallanka wakiilada caabuqa iyo hagaajinta dhaawaca unugyada ayaa loo arkaa mid aad uga duwan kan habka dareemayaasha, kaas oo u beddela calaamadaha deegaanka iyo gudaha waxyeellada leh ee dhaqdhaqaaqa korantada si ay u soo saaraan dareemo iyo falcelin (Jaantus 1). Waxaan soo jeedineynaa in labadan nidaam ay dhab ahaantii yihiin qaybo ka mid ah habka difaaca midaysan. Nidaamka neerfayaasha somatosensory ayaa ku habboon in la ogaado khatarta. Marka hore, dhammaan unugyada aadka u soo gaadhay deegaanka dibadda, sida maqaarka epithelial ee maqaarka, sambabada, kaadi mareenka iyo habka dheef-shiidka, waxaa si cufan u galgala nociceptors, xad sare oo xanuun soo saara fiilooyinka dareenka. Marka labaad, gudbinta kicinta dibadda ee xun waxay ku dhowdahay isla markiiba, amarada baaxadda way ka dhaqso badan yihiin abaabulka habka difaaca jidhka, sidaas awgeed waxa laga yaabaa inay noqoto jawaab-bixiyaha ugu horreeya ee difaaca martida loo yahay.

 

 

Marka lagu daro agabyada lafaha ee laf-dhabarta iyo maskaxda ee ka soo durugsan durugsan, awoodaha waxqabadka ee nociceptor neurons sidoo kale waxaa lagu kala qaadaa antidromically meelaha laanta dib ugu soo noqda durugsan, axon reflex. Kuwaas oo ay weheliyaan depolarizations maxalli ah oo joogto ah waxay horseedaan sii-dayn degdeg ah oo maxalli ah oo dhexdhexaadiyayaal neerfaha ah oo ka imanaya axonnada durugsan iyo marinnada (Jaantus. 2) 1. Tijaabooyin qadiimi ah oo Goltz (1874) iyo Bayliss (1901) waxay muujiyeen in koronto ahaan kicinaya xididdada dhabarka Waxay keentaa vasodilation maqaarka, taasoo keentay fikradda caabuqa neurogenic, oo ka madax bannaan kan uu soo saaro habka difaaca jirka (Jaantus. 3).

 

 

 

Caabuqa neerfaha waxaa dhexdhexaadiya sii-deynta neuropeptides calcitonin gene-ka laxiriira peptide (CGRP) iyo walaxda P (SP) ee nociceptors, kuwaas oo si toos ah ugu dhaqma unugyada endothelial vascular iyo unugyada muruqa siman 2�5. CGRP waxay soo saartaa saameynaha vasodilation 2, 3, halka SP ay kordhiso qulqulka xididada taasoo keenta balaasmaha dheeraadka ah iyo bararka 4, 5, oo gacan ka geysta burooyinka, calor iyo burada Celsus. Si kastaba ha ahaatee, nociceptors waxay sii daayaan neuropeptides badan oo dheeraad ah (database online: www.neuropeptides.nl/), oo ay ku jiraan Adrenomedullin, Neurokinins A iyo B, Vasoactive intestinal peptide (VIP), neuropeptide (NPY), iyo gastrin sii daayo peptide (GRP), iyo sidoo kale dhexdhexaadiyeyaasha kale ee molecular sida glutamate, nitric oxide (NO) iyo cytokines sida eotaxin 6.

 

Waxaan hadda ka mahadcelineynaa in dhexdhexaadiyeyaasha laga sii daayo neerfayaasha dareemayaasha ee ku yaala xayndaabka aysan ku dhaqmin oo kaliya vasculature, laakiin sidoo kale waxay si toos ah u soo jiidanayaan oo ay hawlgeliyaan unugyada difaaca jirka (unugyada mast, unugyada dendritic), iyo unugyada difaaca la qabsiga (T lymphocytes) 7�12. Goobta ba'an ee dhaawaca nudaha, waxaan ku qiyaaseynaa in caabuqa neurogenic uu yahay mid ilaalinaya, fududeynaya bogsashada nabarrada jireed iyo difaaca difaaca jirrooyinka iyada oo la hawlgelinayo lana qorayo unugyada difaaca. Si kastaba ha ahaatee, isgaadhsiinta neuro-immune ee noocan oo kale ah waxay sidoo kale u badan tahay inay door weyn ka ciyaaraan pathophysiology ee cudurada xasaasiyadda iyo difaaca jirka iyadoo la kordhinayo jawaabaha difaaca jireed ama aan fiicnayn. Noocyada xayawaanka ee rheumatoid arthritis-ka tusaale ahaan, Levine iyo asxaabtiisuba waxay muujiyeen in denervation ee isku-dhafka ay keenayso hoos u dhac ku yimaada bararka, taas oo ku xiran tahay muujinta neerfaha ee walaxda P 13, 14. Daraasadihii ugu dambeeyay ee caabuqa hawo-mareenka xasaasiyadda, colitis iyo cudurka psoriasis, dareemayaasha dareemayaasha aasaasiga ah ayaa kaalin dhexe ka ciyaara bilaabista iyo kordhinta firfircoonida difaaca gudaha iyo la qabsiga 15�17.

 

Sidaa darteed, waxaanu soo jeedinaynaa, in habka dareemayaasha ee durugsan uusan kaliya ka ciyaarin door aan fiicneyn oo ku saabsan difaaca martida loo yahay (ogaanshaha kicinta xun iyo bilaabista dhaqanka ka fogaanshaha), laakiin sidoo kale door firfircoon oo la xidhiidha habka difaaca jirka ee habaynta jawaabaha iyo la dagaallanka waxyeellada. Kiciyeyaasha, door la leexin karo si ay cudur uga qayb qaataan.

 

Dariiqooyinka Aqoonsiga Khatarta La Wadaago ee Nidaamka Dareenka Dareenka ee Dareenka

 

Dareenka dareemayaasha ee ku wareegsan waxa loo habeeyey si ay u gartaan khatarta noolaha iyada oo loo eegayo dareenka ay u leeyihiin kicinta kiimikada, kulaylka iyo xanaaqa (Jaantus. 1). Awoodda soo dhawaynta ku-meel-gaadhka ah (TRP) ion channels waa dhexdhexaadiyeyaasha molecular ee ugu badan ee la bartay ee nociception, samaynta gelitaanka aan la dooran ee cations marka ay dhaqaajiyaan kicinta xunxun ee kala duwan. TRPV1 waxaa ku shaqeeya heerkulka sare, pH hooseeya iyo capsaicin, qaybta vallinoid irritant ee basbaaska chili dhaawaca calaamadaha molecular ee endogenous oo ay ku jiraan 18-hydroxynonenal iyo prostaglandins 1, 19.

 

Waxa xiisaha lihi leh, neerfayaasha dareemayaasha waxay wadaagaan qaar badan oo ka mid ah cudur-sidaha isku midka ah iyo dariiqyada aqoonsiga molecular ee khatarta ah sida unugyada difaaca jirka, kuwaas oo awood u siinaya inay sidoo kale ogaadaan cudurada (Jaantus. 1). Nidaamka difaaca jirka, cudur-sidaha microbial-ka waxaa lagu ogaadaa germline encoded design receptors (PRRs), kuwaas oo aqoonsada qaababka molecular-ka ee si ballaaran loo ilaaliyo (PAMPs). PRR-yadii ugu horreeyay ee la aqoonsaday waxay ahaayeen xubno ka tirsan qoyska receptor-u eg (TLR), kuwaas oo ku xidha khamiirka, qaybaha gidaarka-unugga ee bakteeriyada ka soo jeeda iyo fayraska RNA 22. Ka dib firfircoonida PRR, dariiqyada calaamadaynta hoose ayaa loo rogay taas oo keenta soo saarista cytokine iyo firfircoonida. difaaca la qabsiga. Marka lagu daro TLR-yada, unugyada difaaca jirka ayaa hawlgeliya inta lagu jiro dhaawaca nudaha iyadoo la adeegsanayo calaamadaha khatarta ah ee laga soo qaatay, sidoo kale loo yaqaan qaababka molecular-ka ee burburka leh (DAMPs) ama alaarminada 23, 24. Calaamadaha khatarta ah waxaa ka mid ah HMGB1, uric acid, iyo borotiinnada shoogga kulaylka oo la sii daayo by unugyada dhimanaya inta lagu guda jiro necrosis, firfircoonida unugyada difaaca inta lagu guda jiro jawaabaha caabuqa aan faafa.

 

PRRs oo ay ku jiraan TLRs 3, 4, 7, iyo 9 waxaa lagu muujiyaa nociceptor neurons, iyo kicinta TLR ligands waxay keenaysaa soo-gelinta qulqulka gudaha iyo dareenka nociceptors ee kicinta kale ee xanuunka 25�27. Waxaa intaa dheer, firfircoonida dareemayaasha dareemayaasha ee TLR7 ligand imiquimod waxay keenaysaa kicinta cuncunka dariiqa dareenka gaarka ah ee 25. Natiijooyinkani waxay muujinayaan in xanuunka iyo cuncunka la xidhiidha caabuqa ay qayb ahaan sabab u tahay firfircoonida tooska ah ee neerfayaasha by arrimo pathogen-derived, taas oo markeeda. firfircooni unugyada difaaca iyada oo loo marayo sii daynta durugsan ee unugyada dareemayaasha calaamadaha.

 

DAMP / alaarmin weyn oo la sii daayay inta lagu jiro dhaawaca gacanta waa ATP, kaas oo lagu aqoonsanayo daaweeyayaasha purinergic ee labadaba nociceptor neurons iyo unugyada difaaca 28�30. Reseptors Purinergic waxay ka kooban yihiin laba qoys: P2X reseptors, kanaalada ligand-gated cation, iyo P2Y reseptors, G-protein-ku-xidhayayaasha. Nociceptor neurons, aqoonsiga ATP wuxuu ku dhacaa iyada oo loo marayo P2X3, taasoo keentay in si degdeg ah loo xakameeyo qulqulka qulqulka iyo xanuunka 28, 30 (Jaantus. 1), halka P2Y reseptors ay gacan ka geystaan ​​firfircoonida nociceptor by dareenka TRP iyo kanaalka sodium-gated. Makrophages-ka, ATP oo ku xiran P2X7 reseptors waxay keenaysaa hyperpolarization, iyo firfircoonida hoose ee bararka, iskudhafka molecular ee muhiimka ah ee jiilka IL-1beta iyo IL-18 29. Sidaa darteed, ATP waa calaamad khatar ah oo awood leh oo dhaqaajisa labadaba neerfayaasha durugsan iyo kuwa gudaha ah. xasaanadda inta lagu jiro dhaawaca, iyo caddaymaha qaarkood xitaa waxay soo jeedinayaan in neerfayaasha ay muujiyaan qaybo ka mid ah mashiinnada molecular 31.

 

Dhinaca kale ee calaamadaha khatarta ah ee nociceptors waa doorka kanaalada TRP ee firfircoonida unugyada difaaca. TRPV2, homologue of TRPV1 firfircoon kulayl xun, ayaa lagu muujiyay heerar sare oo unugyada difaaca gudaha 32. Ablation genetic of TRPV2 waxay keentay cilladaha macrophage phagocytosis iyo nadiifinta caabuqyada bakteeriyada 32. Waa in la go'aamiyo in calaamadaha khatarta ah ee khatarta ah ay u dhaq-dhaqaaqaan unugyada difaaca si la mid ah sida nociceptors.

 

Habka muhiimka ah ee xidhiidhka ka dhexeeya unugyada difaaca jirka iyo neerfayaasha nociceptor waa iyada oo loo marayo cytokines. Marka la dhaqaajiyo reseptors cytokine, dariiqyada gudbinta calaamadaha ayaa lagu hawlgeliyaa neerfaha dareemayaasha taasoo horseedaysa fosforyaalka hoose ee borotiinnada xuubka oo ay ku jiraan TRP iyo kanaalka korantada-gated (Jaantus 1). Dareenka ka dhalanaya ee nociceptors macnaheedu waa in sida caadiga ah kicinta makaanikada iyo kulaylka aan dhib lahayn ay hadda kicin karaan nociceptors. Interleukin 1 beta iyo TNF-alpha waa laba cytokines oo muhiim ah oo ay sii daayaan unugyada difaaca jirka inta lagu jiro caabuqa. IL-1beta iyo TNF-alpha waxaa si toos ah u dareema nociceptors kuwaas oo muujinaya soo-dhoweeyayaasha cognate, oo keena firfircoonida khariidadda p38 kinases taasoo horseedaysa kororka xajinta 34-36. Qodobka koritaanka neerfaha (NGF) iyo prostaglandin E (2) ayaa sidoo kale ah dhexdhexaadiyeyaasha bararka waaweyn ee laga sii daayo unugyada difaaca kuwaas oo si toos ah ugu shaqeeya dareemayaasha dareemayaasha dareemayaasha si ay u keenaan dareenka. Saamaynta muhiimka ah ee dareenka nociceptor ee arrimaha difaaca ayaa ah sii-deynta sii-deynta neuropeptides ee marinnada durugsan ee sii kicinaya unugyada difaaca jirka, taas oo keenaysa jawaab celin wanaagsan oo kicinaysa oo fududaysa caabuqa.

 

Dareemayaasha Nidaamka Xakamaynta Xasaanadda Dhallaanka iyo La-qabsiga

 

Wajiyada hore ee caabuqa, dareemayaasha dareemayaasha ayaa calaamad u ah unugyada mastarada ee unugyada iyo unugyada dendritic, kuwaas oo ah unugyada difaaca jirka ee muhiimka u ah bilaabista jawaabta difaaca (Jaantus. 2). Daraasadaha anatomical ayaa muujiyay in si toos ah loogu talagalay terminal leh unugyada mastarada, iyo sidoo kale unugyada dendritic, iyo neuropeptides oo laga sii daayo nociceptors waxay keeni karaan degranulation ama wax soo saarka cytokine ee unugyadaas 7, 9, 37. Isdhexgalkaani wuxuu door muhiim ah ka ciyaaraa marinka hawada ee xasaasiyadda. caabuq iyo dermatitis 10�12.

 

Inta lagu jiro marxaladda saameynaha caabuqa, unugyada difaaca waxay u baahan yihiin inay helaan dariiqa ay u maraan goobta gaarka ah ee dhaawaca. Dhexdhexaadiyayaal badan oo laga sii daayo dareemayaasha dareemayaasha, neuropeptides, chemokines, iyo glutamate, ayaa ah kiimiko ee neutrophils, eosinophils, macrophages, iyo T-unugyada, waxayna kor u qaadaan adhesion endothelial kaas oo fududeeya homing unugyada difaaca 6, 38�41 (Jaantus 2). Intaa waxaa dheer, caddaynta qaar ayaa tilmaamaya in neerfayaasha ay si toos ah uga qayb qaadan karaan marxaladda saameynaha, sida neuropeptides laftoodu waxay yeelan karaan hawlo toos ah oo antimicrobial 42.

 

Unugyada calaamadaha neerfaha ka soo jeeda waxay sidoo kale hagi karaan nooca caabuqa, iyagoo gacan ka geysanaya kala soocida ama qeexidda noocyada kala duwan ee unugyada difaaca jirka ee T. Antigen-ku waa phagocytosed oo ay farsameeyaan unugyo difaac oo dhalanteed, ka dibna u guura qanjidhada u dhow oo soo bandhiga peptide-ka antigenic ilaa unugyada T unugyada. Iyada oo ku xidhan nooca antigen-ka, molecules costimulatory ee unugyada difaaca gudaha, iyo isku-darka cytokines gaar ah, unugyada T-yada waxay u koraan noocyo-hoosaadyo gaar ah oo sida ugu wanaagsan ugu adeega dadaalka bararka si loo nadiifiyo kicinta cudur-sidaha. Unugyada CD4 T, ama unugyada T caawiyaha (Th), waxaa loo qaybin karaa afar kooxood oo mabda'a ah, Th1, Th2, Th17, iyo T unugyo nidaamiya (Treg). Unugyada Th1 waxay inta badan ku lug leeyihiin habaynta jawaabaha difaaca ee microorganisms intracellular iyo cudurrada difaaca jirka ee gaarka ah; Th2 waxay muhiim u tahay kahortagga cudurada unugyada unugyada ka baxsan, sida helminths, waxayna mas'uul ka yihiin cudurrada bararka xasaasiyadda; Unugyada Th17 waxay door dhexe ka ciyaaraan ilaalinta caqabadaha microbial, sida bakteeriyada ka baxsan unugyada iyo fungi; Unugyada Treg waxay ku lug leeyihiin ilaalinta dulqaadka iyo habaynta jawaabaha difaaca. Habka korriinka unugyada T-ga ayaa u muuqda mid si weyn u saameeya dhexdhexaadiyeyaasha dareemayaasha dareemayaasha. Neuropeptides, sida CGRP iyo VIP, waxay u xaglin karaan unugyada dendritic xagga difaaca nooca Th2 waxayna yareeyaan difaaca nooca Th1 iyagoo kor u qaadaya wax soo saarka cytokines qaarkood iyo xannibaadda kuwa kale, iyo sidoo kale hoos u dhigista ama kor u qaadista u guuritaanka unugyada dendritic ee qanjidhada maxalliga ah 8 , 10, 43. Dareemaha dareemayaasha ayaa sidoo kale si weyn uga qaybqaata xasaasiyadda (inta badan Th2 wadista) caabuqa 17. Marka lagu daro nidaaminta unugyada Th1 iyo Th2, neuropeptides kale, sida SP iyo Hemokinin-1, waxay u wadi karaan jawaabta bararka si aad u badan Th17 ama Treg 44, 45, taas oo macnaheedu yahay in neerfayaasha ay sidoo kale ku lug yeelan karaan nidaaminta xallinta bararka. Cudurada difaaca jirka sida colitis iyo psoriasis, xannibaadda dhexdhexaadiyeyaasha neerfaha sida walaxda P ayaa si weyn u dhimi karta T-unugga iyo dhaawaca dhexdhexaadiyaha ah ee 15, in kasta oo ka soo horjeeda hal dhexdhexaadiye laftiisa kaliya ayaa saameyn xaddidan ku yeelan kara caabuqa neurogenic.

 

Iyadoo la tixgelinayo in unugyada calaamadaha ah ee laga sii daayo fiilooyinka dareemayaasha dareenka ee durugsan ay nidaamiyaan ma aha oo kaliya xididdada dhiigga yar yar, laakiin sidoo kale chemotaxis-ka, homing, korriinka, iyo firfircoonida unugyada difaaca, waxaa caddaatay in isdhexgalka neuro-immune uu aad uga sii adag yahay sidii hore loo maleynayay (Sawir). .2). Intaa waxaa dheer, waa wax la qiyaasi karo in aysan ahayn dhexdhexaadiyeyaasha neerfaha ee shakhsi ahaaneed, laakiin waa isku-dhafka gaarka ah ee molecules calaamadaha laga sii daayo nociceptors kuwaas oo saameeya heerarka kala duwan iyo noocyada jawaabaha difaaca.

 

Xakamaynta falcelinta iswada leh ee difaaca

 

Doorka habdhiska neerfaha ee iskeed u madaxbannaanida reflex� wareegga habaynta jawaabaha difaaca durugsan ayaa sidoo kale u muuqda mid caan ah. Shaqada Kevin Tracey iyo kuwa kale waxay tilmaamayaan jawaabaha guud ee ka hortagga bararka ee shoogga septic iyo endotoxemia, oo uu kiciyay firfircoonida neerfaha vagal ee u horseedaya xakamaynta macrophages durugsan 46-47. Vagus-ku waxa uu kiciyaa adrenergic celiac ganglion neurons innervating xuubka beeryarada, taasoo keenta sii daynta hoose ee acetylcholine, kaas oo ku xidhan alfa-49 nicotinic reseptors on macrophages ee beeryarada iyo mareenka caloosha iyo mindhicirka. Tani waxay kicisaa firfircoonida JAK7 / STAT2 SOCS3 dariiqa calaamadaynta, taas oo si xoog leh u xakameynaysa qoraalka TNF-alpha 3. Ganglion adrenergic celiac ganglion sidoo kale waxay si toos ah ula xiriirtaa qayb ka mid ah acetylcholine soo saarta xusuusta T unugyada, kaas oo xakameynaya macrophages bararka 47.

 

Unugyada Killer T ee dabiiciga ah ee aan kala sooc lahayn (iNKT) waa qayb gaar ah oo ka mid ah unugyada T kuwaas oo aqoonsada dufanka microbial ee macnaha CD1d halkii ay ka ahaan lahaayeen antigens peptide. Unugyada NKT waa dad muhiim ah oo ku lug leh dagaalka ka dhanka ah cudurada faafa iyo nidaaminta difaaca nidaamka. Unugyada NKT way degan yihiin waxayna inta badan dhex maraan vasculature iyo sinusoids ee beeryarada iyo beerka. Dareemaha beta-adrenergic ee beerka ayaa si toos ah u calaamadeynaya inay beddelaan dhaqdhaqaaqa NKT unugyada 50. Inta lagu jiro qaabka jiirka ee istaroogga (MCAO), tusaale ahaan, dhaqdhaqaaqa unugyada beerka ee NKT ayaa si muuqata loo xakameeyey, taas oo lagu beddelay denervation naxariiseed ama beta-adrenergic antagonists. Intaa waxaa dheer, hawshan difaaca jirka ee neerfayaasha noradrenergic ee unugyada NKT waxay keentay kororka caabuqa nidaamka iyo dhaawaca sambabada. Sidaa darteed, calaamadaha muuqda ee ka imanaya neurons-ka iswada ayaa dhexdhexaadin kara difaac-xakameyn xooggan.

 

Dr. Alex Jimenez's Insight

Caabuqa neerfaha waa jawaab-celin barar ah oo uu keeno habdhiska dareenka. Waxaa la rumeysan yahay in ay door aasaasi ah ka ciyaareyso pathogenesis ee arrimo caafimaad oo kala duwan, oo ay ku jiraan, madax xanuunka dhanjafka, psoriasis, neefta, fibromyalgia, cambaarta, rosacea, dystonia iyo dareenka kiimikaad badan. Inkasta oo bararka neerfaha ee la xidhiidha habdhiska dareenka durugsan si weyn loo baaray, fikradda caabuqa neerfaha ee ku dhex jira habka dhexe ee dareenka ayaa weli u baahan cilmi-baaris dheeraad ah. Sida laga soo xigtay cilmi-baaris dhowr ah, si kastaba ha ahaatee, cilladaha magnesium ayaa la rumeysan yahay inay tahay sababta ugu weyn ee caabuqa neerfaha. Maqaalka soo socdaa wuxuu muujinayaa dulmar guud oo ku saabsan hababka caabuqa neurogenic ee nidaamka dareenka, taas oo laga yaabo inay ka caawiso xirfadlayaasha daryeelka caafimaadku inay go'aamiyaan habka daaweynta ugu fiican ee lagu daryeelayo arrimo caafimaad oo kala duwan oo la xidhiidha habdhiska dareenka.

 

Gabagabada

 

Waa maxay doorarka gaarka ah ee ay u kala leeyihiin somatosensory iyo habdhiska dareenka iskeed isu-tagga ee nidaaminta caabuqa iyo habka difaaca jirka (Jaantus. 4)? Firfircoonida nociceptors waxay keentaa reflexes axon maxalli ah, kuwaas oo maxalli ah qora oo hawlgeliya unugyada difaaca sidaas darteed, inta badan pro-bararka iyo meelo xaddidan. Taas bedelkeeda, kicinta iskeed u madax-bannaanidu waxay keentaa difaac-is-daba-marin habaysan oo saameeya barkadaha unugyada difaaca ee beerka iyo beeryarada. Hababka calaamadaynta afferent ee ku yaal durugsan ee u horseedaya kicinta wareegga reflex vagal cholinergic immunosuppressive ayaa si liidata loo fahmay. Si kastaba ha noqotee, 80-90% fiilooyinka vagal waa fiilooyinka dareenka afferent ee asaasiga ah, sidaas darteed calaamadaha ka yimaada viscera, oo badan oo suurtagal ah oo ay wadaan unugyada difaaca, waxay u horseedi karaan firfircoonida interneurons ee jirridda maskaxda iyo iyaga oo soo saaraya fiilooyinka vagal 46.

 

 

Caadi ahaan, waqtiga koorsada iyo dabeecadda caabuqa, ha ahaato inta lagu jiro caabuqa, falcelinta xasaasiyadda, ama cudurada difaaca jirka, waxaa lagu qeexaa qaybaha unugyada difaaca ee ku lug leh. Waxay noqon doontaa muhiim in la ogaado noocyada kala duwan ee unugyada difaaca ee lagu xakameynayo calaamadaha dareenka iyo kuwa iskood u taagan. Qiimayn nidaamsan oo ku saabsan waxa dhexdhexaadiyeyaasha laga sii deyn karo nociceptors iyo autonomic neurons iyo muujinta receptors kuwaas oo ah unugyo difaac oo kala duwan oo gudaha ah iyo kuwa la qabsiga ayaa laga yaabaa inay wax ka qabtaan su'aashan.

 

Intii lagu guda jiray korriinka, dariiqyada ogaanshaha khatarta ah ee isku midka ah ayaa u horumaray difaaca gudaha iyo nociception labadaba inkasta oo unugyadu ay gebi ahaanba kala duwan yihiin nalalka korriinka. Iyadoo PRRs iyo kanaalada ligand-gated ion-ka ee waxyeellada leh ay si gaar ah u baaraan dhakhaatiirta difaaca jirka iyo dhakhaatiirta neerfayaasha, khadka u dhexeeya labadan goobood ayaa si isa soo taraysa u mugdi sii galaya. Inta lagu jiro dhaawaca nudaha iyo caabuqa cudur-sidaha, sii daynta calaamadaha khatarta ah waxay u badan tahay inay horseedaan firfircoonaan isku dubaridan oo ah neerfayaasha durugsan iyo unugyada difaaca oo leh isgaarsiin laba jiho ah oo adag, iyo difaac isku dhafan oo martida loo yahay. Meelaynta anatomical ee nociceptors ee isdhexgalka deegaanka, xawaaraha gudbinta neerfaha iyo awooda ay u leeyihiin inay sii daayaan cocktails xooggan ee dhexdhexaadiyeyaasha difaaca jirka waxay u oggolaaneysaa habdhiska dareemayaasha in ay si firfircoon u habeeyaan jawaabta difaaca gudaha iyo iskudubarid difaac la qabsiga hoose. Taa bedelkeeda, nociceptors waxay aad ugu nugul yihiin dhexdhexaadiyeyaasha difaaca jirka, kuwaas oo dhaqaajiya oo baraya neerfaha. Caabuqa neerfaha iyo is-difaaca-dhexdhexaadinta maaha, sidaas darteed, hay'ado madaxbannaan laakiin waxay u wada dhaqmaan sidii qalab digniin hore ah. Si kastaba ha ahaatee, habka dareemayaasha durugsan ayaa sidoo kale door muhiim ah ka ciyaara pathophysiology, iyo laga yaabee etiology, cuduro badan oo difaaca sida neefta, psoriasis, ama colitis sababtoo ah awooddeeda si ay u dhaqaajiso habka difaaca jirka waxay kordhin kartaa caabuqa pathological 15-17. Daawaynta ciladaha difaaca ayaa laga yaabaa inay u baahdaan inay ku jiraan, sidaa darteed, beegsiga nociceptors iyo sidoo kale unugyada difaaca.

 

Mahadnaq

 

Waxaan uga mahadcelineynaa NIH taageerada (2R37NS039518).

 

Gabagabadii,Fahamka doorka caabuqa neurogenic marka ay timaado difaaca martida loo yahay iyo immunopathology waa lama huraan xagga go'aaminta habka daaweynta habboon ee arrimaha caafimaadka habdhiska dareenka ee kala duwan. Markaad eegto isdhexgalka neurons-ka durugsan ee unugyada difaaca jirka, xirfadlayaasha daryeelka caafimaadku waxay horumarin karaan hababka daweynta si ay u sii caawiyaan kordhinta difaaca martida iyo sidoo kale xakamaynta immunopathology. Ujeedada maqaalka kor ku xusan waa in lagu caawiyo bukaanada inay fahmaan neurophysiology kiliinikada ee neuropathy, oo ay ka mid yihiin arrimaha kale ee caafimaadka dhaawaca dareemayaasha. Macluumaadka laga soo xigtay Xarunta Qaranka ee Macluumaadka Bayoolaji (NCBI). Baaxadda macluumaadkayadu waxay ku kooban tahay xanuunka loo yaqaan 'chiropractic' iyo sidoo kale dhaawacyada laf dhabarta iyo xaaladaha. Si aad ugala hadasho mawduuca, fadlan xor u noqo inaad waydiiso Dr. Jimenez ama nagala soo xidhiidh at�915-850-0900 .

 

Waxaa soo saaray Dr. Alex Jimenez

 

 

Mawduucyo Dheeraad ah: Xanuunka Dhabarka

 

Xanuunka dhabarka waa mid ka mid ah sababaha ugu badan ee naafanimada iyo maalmaha shaqada laga waayo adduunka oo dhan. Sida xaqiiqda ah, xanuunka dhabarka ayaa loo aaneynayaa inuu yahay sababta labaad ee ugu badan ee booqashooyinka xafiiska dhakhtarka, oo ka badan kaliya caabuqyada neef-mareenka sare. Qiyaastii 80 boqolkiiba dadku waxay la kulmi doonaan nooc ka mid ah xanuunka dhabarka ugu yaraan hal mar noloshooda oo dhan. Laf-dhabarta waa qaab dhismeed kakan oo ka kooban lafo, kala-goysyo, seedaha iyo murqaha, iyo unugyo kale oo jilicsan. Taas awgeed, dhaawacyada iyo/ama xaaladaha sii xumeeyay, sida maqaarka herniated, ugu dambeyntii waxay keeni kartaa calaamadaha xanuunka dhabarka. Dhaawacyada isboortiga ama dhaawacyada shilalka baabuurta ayaa inta badan ah sababta ugu badan ee xanuunka dhabarka, si kastaba ha ahaatee, mararka qaarkood dhaqdhaqaaqa ugu fudud ayaa keeni kara natiijooyin xanuun leh. Nasiib wanaag, xulashooyinka daaweynta kale, sida daryeelka xanuunka loo yaqaan 'chiropractic care', ayaa kaa caawin kara yareynta xanuunka dhabarka iyada oo loo marayo isticmaalka isbeddelka laf-dhabarka iyo manfacyada gacanta, ugu dambeyntii hagaajinta xanuunka.

 

 

 

 

MAWDUUC DHEERAAD AH OO MUHIIM AH: Maareynta Xanuunka Dhabarka Hoose

 

Mawduucyo intaa ka badan: DHEERAAD AH: Xanuun & Daawayn Raaag ah