Vulva-vaginal atrophy (VVA) bụ otu n'ime ihe na-esikarị na erughi estrogen pụta, ọkachasị mgbe nsọpụchara.Ọtụtụ nchọpụta enyochala mmetụta nke hyaluronic acid (HA) na mgbaàmà anụ ahụ na nke mmekọahụ metụtara VVA ma nweta nsonaazụ na-ekwe nkwa.Otú ọ dị, ọtụtụ n'ime ọmụmụ ihe ndị a lekwasịrị anya na ntule nke onwe nke nzaghachi mgbaàmà na usoro isiokwu.Ka o sina dị, HA bụ molecule endogenous, ọ bụkwa ihe ezi uche dị na ya na ọ na-arụ ọrụ kacha mma ma ọ bụrụ na etinye ya n'ime epithelium elu.Desirial® bụ hyaluronic acid nke mbụ jikọtara ya na ya nke a na-enye site na ntụtụ mucosal nke ikpu.Ebumnuche nke ọmụmụ a bụ iji nyochaa mmetụta nke intravaginal intramucosal injections nke hyaluronic acid kpọmkwem (DESIRIAL®, Laboratoires VIVACY) na ọtụtụ isi ụlọ ọgwụ na onye ọrịa na-akọ.
Otu ọmụmụ pilot nke etiti abụọ.Nsonaazụ ahọpụtara gụnyere mgbanwe na ọkpụrụkpụ mucosal ikpu, collagen formation biomarkers, flora vaginal, vaginal pH, vaginal health index, ihe mgbaàmà nke atrophy vulvovaginal na ọrụ mmekọahụ 8 izu mgbe injection Desirial®.A na-ejikwa nleba anya n'ozuzu nke onye ọrịa ahụ maka mmụba (PGI-I) iji chọpụta afọ ojuju onye ọrịa.
Ngụkọta ndị sonyere 20 ka ewetere site na 19/06/2017 ruo 05/07/2018.N'ọgwụgwụ ọmụmụ ihe ahụ, ọ nweghị ihe dị iche n'etiti oke mucosa ikpu nke etiti ma ọ bụ procollagen I, III, ma ọ bụ Ki67 fluorescence.Otú ọ dị, okwu mkpụrụ ndụ COL1A1 na COL3A1 mụbara nke ọma (p = 0.0002 na p = 0.0010, n'otu n'otu).Dyspareunia a kọrọ, nkụchi nke ikpu, itching genital, na abrasions nke ikpu na-ebelata nke ukwuu, na akụkụ niile nke ọrụ mmekọahụ na-akawanye mma.Dabere na PGI-I, ndị ọrịa 19 (95%) kọrọ ọkwa dị iche iche nke nkwalite, nke 4 (20%) chere ntakịrị mma;7 (35%) ka mma, yana 8 (40%) ka mma.
Intravaginal injection Multi-point nke Desirial® (a cross-linked HA) jikọtara ya na nkwupụta nke CoL1A1 na CoL3A1, na-egosi na a kpalitere nhazi collagen.Na mgbakwunye, akara ngosi VVA belatara nke ukwuu, afọ ojuju ndị ọrịa na ọnụ ọgụgụ ọrụ mmekọahụ na-abawanye nke ọma.Otú ọ dị, ngụkọta ọkpụrụkpụ nke mucosa ikpu agbanwebeghị nke ọma.
Vulva-vaginal atrophy (VVA) bụ otu n'ime ihe na-esikarị na ụkọ estrogen pụta, karịsịa mgbe menopause gasịrị [1,2,3,4].A na-ejikọta ọtụtụ ọrịa ụlọ ọgwụ na VVA, gụnyere nkụ, mgbakasị ahụ, itching, dyspareunia, na ọrịa urinary na-emekarị, nke nwere ike inwe mmetụta dị njọ na ndụ ụmụ nwanyị [5].Otú ọ dị, mmalite nke mgbaàmà ndị a nwere ike ịdị nwayọọ na nke nta nke nta, wee malite ịpụta mgbe mgbaàmà ndị ọzọ nke menopausal kwụsịrị.Dị ka akụkọ si kwuo, ihe ruru 55%, 41%, na 15% nke ụmụ nwanyị postmenopausal na-ata ahụhụ site na nkụchi akwara, dyspareunia, na ọrịa urinary ugboro ugboro, n'otu n'otu [6,7,8,9].Ka o sina dị, ụfọdụ ndị kwenyere na ọnụ ọgụgụ nke nsogbu ndị a ka ukwuu, mana ọtụtụ ụmụ nwanyị anaghị achọ enyemaka ahụike n'ihi mgbaàmà [6].
Isi ọdịnaya nke njikwa VVA bụ ọgwụgwọ mgbaàmà, gụnyere mgbanwe ndụ, na-abụghị nke homonụ (dị ka mmanu mmanu ma ọ bụ moisturizers na ọgwụgwọ laser) na mmemme ọgwụgwọ homonụ.A na-ejikarị mmanu mmanu eme ihe iji belata nkụchi nke ikpu n'oge mmekọahụ, yabụ na ha enweghị ike inye ngwọta dị mma maka ogologo oge na mgbagwoju anya nke mgbaàmà VVA.N'ụzọ megidere nke ahụ, a na-akọ na moisturizer ikpu bụ ụdị ngwaahịa "bioadhesive" nke nwere ike ịkwalite njide mmiri, na iji ya eme ihe mgbe niile nwere ike ime ka iwe iwe na dyspareunia dị mma [10].Ka o sina dị, nke a enweghị ihe jikọrọ ya na mmụba nke mkpokọta ntozu oke nke epithelial ikpu [11].N'ime afọ ndị na-adịbeghị anya, enweela ọtụtụ ebubo iji rediofrequency na laser na-agwọ mgbaàmà menopausal nke ikpu [12,13,14,15].Ka o sina dị, FDA enyela ndị ọrịa ịdọ aka ná ntị aka na ntị, na-ekwusi ike na iji usoro ndị dị otú ahụ nwere ike ịkpata ajọ ihe ọjọọ, ma ekpebibeghị nchekwa na ịdị irè nke ngwaọrụ ndị dabeere na ume na ọgwụgwọ ọrịa ndị a [16].Ihe akaebe sitere na meta-analysis nke ọtụtụ ọmụmụ ihe na-akwadoghị ịdị irè nke usoro ọgwụgwọ homonụ na sistemu na-ebelata mgbaàmà metụtara VVA [17,18,19].Otú ọ dị, ọnụ ọgụgụ dị nta nke ọmụmụ enyochala mmetụta na-adịgide adịgide nke ọgwụgwọ ndị dị otú ahụ mgbe ọnwa 6 gasịrị.Na mgbakwunye, contraindications ha na nhọrọ onwe ha bụ ihe na-egbochi oke maka ojiji zuru oke na ogologo oge nke nhọrọ ọgwụgwọ ndị a.Ya mere, a ka nwere mkpa maka ngwọta dị mma ma dị irè iji jikwaa mgbaàmà metụtara VVA.
Hyaluronic acid (HA) bụ molekul bụ isi nke matrix extracellular, nke dị na anụ ahụ dị iche iche gụnyere mucosa ikpu.Ọ bụ polysaccharide sitere na ezinụlọ glycosaminoglycan, nke na-arụ ọrụ dị mkpa n'ịkwado nguzozi mmiri na ịchịkwa mbufụt, nzaghachi mgbochi ọrịa, ọkpụkpụ na angiogenesis [20, 21].A na-enye nkwadebe HA sịntetik n'ụdị gels ma nwee ọnọdụ nke "ngwaọrụ ahụike".Ọtụtụ ọmụmụ enyochala mmetụta HA na mgbaàmà anụ ahụ na nke mmekọahụ metụtara VVA ma nweta nsonaazụ na-ekwe nkwa [22,23,24,25].Otú ọ dị, ọtụtụ n'ime ọmụmụ ihe ndị a lekwasịrị anya na ntule nke onwe nke nzaghachi mgbaàmà na usoro isiokwu.Ka o sina dị, HA bụ molecule endogenous, ọ bụkwa ihe ezi uche dị na ya na ọ na-arụ ọrụ kacha mma ma ọ bụrụ na etinye ya n'ime epithelium elu.Desirial® bụ hyaluronic acid nke mbụ jikọtara ya na ya nke a na-enye site na ntụtụ mucosal nke ikpu.
Ebumnuche nke ọmụmụ pilot a na-atụ anya n'etiti etiti abụọ bụ ịchọpụta mmetụta nke injections intravaginal intravaginal multi-point nke hyaluronic acid kpọmkwem (DESIRIAL®, Laboratoires VIVACY) na isi nsonaazụ nke ọtụtụ akụkọ gbasara ụlọ ọgwụ na onye ọrịa, yana nyocha. ohere nke nyocha nyocha Mmekọahụ nsonaazụ ndị a.Nsonaazụ zuru oke nke ahọpụtara maka ọmụmụ ihe a gụnyere mgbanwe na oke mucosal nke ikpu, ndị na-ahụ maka mmepụta anụ ahụ, flora vaginal, pH vaginal na index health vaginal 8 izu mgbe ịgbanye Desirial®.Anyị tụlere nsonaazụ nke ọtụtụ ndị ọrịa kwuru, gụnyere mgbanwe na ọrụ mmekọahụ na ọnụ ọgụgụ akụkọ nke mgbaàmà metụtara VVA n'otu oge ahụ.Na njedebe nke ọmụmụ ihe, a na-eji nleba anya n'ozuzu nke onye ọrịa ahụ maka mmụba (PGI-I) iji chọpụta afọ ojuju onye ọrịa.
Ọnụ ọgụgụ ọmụmụ ahụ gụnyere ụmụ nwanyị postmenopausal (2 ruo 10 afọ mgbe menopause gasịrị) bụ ndị a na-ezigara na ụlọ ọgwụ menopause nwere ihe mgbaàmà nke ahụ erughị ala na / ma ọ bụ dyspareunia nke abụọ na nkụchi akwara.Ụmụ nwanyị ga-abụrịrị ≥ 18 afọ na <70 afọ ma nwee BMI <35.Ndị sonyere sitere na otu n'ime ngalaba 2 na-ekere òkè (Centre Hospitalier Régional Universitaire, Nîmes (CHRU), France na Karis Medical Center (KMC), Perpignan, France).A na-ewere ụmụ nwanyị na ha ruru eru ma ọ bụrụ na ha bụ akụkụ nke atụmatụ mkpuchi ahụike ma ọ bụ na-erite uru na atụmatụ mkpuchi ahụike, ma ha maara na ha nwere ike isonye na oge nleba anya nke izu 8.Ụmụ nwanyị ndị na-ekere òkè na ọmụmụ ihe ndị ọzọ n'oge ahụ erughị eru ka e were ha n'ọrụ.≥ Nkeji 2 apical pelvic akụkụ prolapse, nchekasị urinary incontinence, vaginismus, vulvovaginal ma ọ bụ urinary tract ọrịa, hemorrhagic ma ọ bụ neoplastic Genital ọnya, hormone na-adabere na ya, ọbara ọgbụgba na-amaghị etiology, ugboro ugboro porphyria, Akwụkwụ na-achịkwaghị achịkwa, ọrịa obi recurrent, , ahụ ọkụ rheumatic, ịwa ahụ vulvovaginal ma ọ bụ urogynecological gara aga, ọrịa hemostatic, na ọchịchọ ịmepụta hypertrophic scars ka a na-ewere dị ka njirisi mwepụ.Ụmụ nwanyị na-aṅụ ọgwụ antihypertensive, steroidal na ndị na-abụghị steroidal anti-inflammatory, anticoagulants, isi antidepressants ma ọ bụ aspirin, na ihe anestetiiki mpaghara amaara jikọtara HA, mannitol, betadine, lidocaine, amide ma ọ bụ Women ndị nwere ihe nfụkasị nke onye ọ bụla n'ime ndị na-enye ọgwụ a. a na-ewere na ọ gaghị eru eru maka ọmụmụ ihe a.
Na mbido, a gwara ụmụ nwanyị ka ha mezue Index Ọrụ Mmekọahụ nwanyị (FSFI) [26] wee jiri 0-10 visual analog scale (VAS) na-anakọta ozi metụtara akara VA (dyspareunia, nkụchi akwara, abrasions ikpu, na itching genital. ) ozi.Nyocha tupu itinye aka gụnyere ịlele pH ikpu, iji Bachmann Vaginal Health Index (VHI) [27] maka nyocha ụlọ ọgwụ nke ikpu, Pap smear iji nyochaa flora ikpu, na biopsy mucosal nke ikpu.Tule pH nke ikpu n'akụkụ ebe a na-agba ọgwụ na-eme atụmatụ yana na fornix ikpu.Maka mkpụrụ osisi ikpu, akara Nugent [28,29] na-enye ngwa ọrụ iji chọpụta gburugburu ebe obibi nke ikpu, ebe isi 0-3, 4-6 na 7-10 na-anọchi anya ahịhịa nkịtị, ahịhịa etiti na vaginosis, n'otu n'otu.A na-eme nyocha niile nke osisi ikpu na ngalaba Bacteriology nke CHRU na Nimes.Jiri usoro ahaziri ahazi maka biopsy mucosal nke ikpu.Mee 6-8 mm punch biopsy site na mpaghara ebe a na-eme atụmatụ ịgba ọgwụ.Dị ka ọkpụrụkpụ nke basal oyi akwa, etiti oyi akwa na elu elu oyi akwa, mucosal biopsy na-enyocha akụkọ ihe mere eme.A na-ejikwa biopsy tụọ COL1A1 na COL3A1 mRNA, na-eji RT-PCR na procollagen I na III immunotissue fluorescence dị ka ihe nnọchi maka okwu collagen, yana fluorescence nke akara mmụba Ki67 dị ka onye nnọchi maka ọrụ mitotic mucosal.A na-eme nnwale mkpụrụ ndụ ihe nketa site na ụlọ nyocha BioAlternatives, 1bis rue des Plantes, 86160 GENCAY, France (nkwekọrịta dị mgbe a rịọrọ ya).
Ozugbo emechara ihe nlele ntọala na nha, otu n'ime ndị ọkachamara 2 zụrụ azụ na-agbanye njikọ cross-linked HA (Desirial®) dịka ụkpụrụ ọkọlọtọ siri dị.Desirial® [NaHa (sodium hyaluronate) IPN jikọtara cross-dị ka 19 mg/g + mannitol (antioxidant)] bụ gel injectable HA gel nke na-abụghị anụmanụ, maka otu ojiji na ngwugwu na tupu ngwugwu Syringe (2 × 1 ml). ).Ọ bụ ngwaọrụ ahụike nke Klas III (CE 0499), nke a na-eji maka ịgba ọgwụ intramucosal na ụmụ nwanyị, nke a na-eji maka biostimulation na rehydration nke elu mucosal nke akụkụ genital (Laboratoires Vivacy, 252 rue Douglas Engelbart-Archamps Technopole, 74160 Archamps, France).A na-eme ihe dị ka injections 10, nke ọ bụla 70-100 µl (0.5-1 ml na mkpokọta), na ahịrị 3-4 kwụ ọtọ na mpaghara triangular nke mgbidi ikpu azụ, isi ya dị na ọkwa nke ikpu azụ. Mgbidi, na ọnụ ọnụ na 2 cm n'elu (ọnụọgụ 1).
A na-ahazi nlebanya ngwụcha nke ọmụmụ maka izu 8 ka edebanye aha ya.Usoro nleba anya maka ụmụ nwanyị bụ otu ihe ahụ dị na ntọala.Tụkwasị na nke a, a chọkwara ndị ọrịa ka ha mechaa Mmetụta Mmezi N'ozuzu (PGI-I) Scale Satisfaction Scale [30].
N'ihi enweghị data nke mbụ na ọdịdị pilot nke nyocha ahụ, ọ gaghị ekwe omume ịme nhazi nhazi nhazi nke mbụ.Ya mere, a na-ahọrọ ihe nlele dị mma nke ngụkọta nke ndị ọrịa 20 dabere na ike nke nkeji abụọ na-ekere òkè ma zuru ezu iji nweta atụmatụ ezi uche dị na ya nke njirimara nsonaazụ a tụrụ aro.A na-eme nyocha ndekọ ọnụ ọgụgụ site na iji ngwanrọ SAS (9.4; SAS Inc., Cary NC), na ọkwa dị mkpa ka edobere na 5%.A na-eji ule ọkwa Wilcoxon bịanyere aka na ya maka mgbanwe na-aga n'ihu na nyocha McNemar maka ụdị mgbanwe dị iche iche iji nwalee mgbanwe na izu 8.
Comité d'ethique du CHU Carémeau de Nimes kwadoro nyocha a (ID-RCB: 2016-A00124-47, koodu protocol: LOCAL/2016/PM-001).Ndị niile sonyere n'ọmụmụ ihe binyere aka n'akwụkwọ nkwenye ederede dị mma.Maka nleta ọmụmụ 2 na biopsies 2, ndị ọrịa nwere ike ịnweta ụgwọ ruru 200 Euro.
Ngụkọta ndị sonyere 20 sitere na 19/06/2017 ruo 05/07/2018 (ndị ọrịa 8 sitere na CHRU na ndị ọrịa 12 sitere na KMC).Enweghị nkwekọrịta na-emebi ụkpụrụ nsonye/mwepu nke priori.Usoro ịgba ntụtụ niile dị mma ma dịkwa mma ma mechaa n'ime nkeji iri abụọ.E gosipụtara njirimara mmadụ na njirimara nke ndị na-amụ ihe na Tebụl 1. N'oge mmalite, 12 n'ime ụmụ nwanyị 20 (60%) jiri ọgwụgwọ ahụ mee ihe maka mgbaàmà ha (6 hormonal na 6 na-abụghị hormonal), ebe n'izu 8 naanị ndị ọrịa 2. A ka na-emeso (10%) dị ka nke a (p = 0.002).
E gosipụtara nsonaazụ nke ụlọ ọgwụ na nke onye ọrịa na Tebụl 2 na Tebụl 3. Otu onye ọrịa jụrụ W8 biopsy vaginal;onye ọrịa nke ọzọ jụrụ nyocha biopsy ikpu W8.Ya mere, ndị sonyere 19/20 nwere ike nweta data nyocha akụkọ ihe mere eme na mkpụrụ ndụ ihe nketa.E jiri ya tụnyere D0, ọ dịghị ihe dị iche n'etiti etiti ngụkọta nke mucosa ikpu n'izu 8. Otú ọ dị, ọkpụkpụ basal basal na-abawanye site na 70.28 ruo 83.25 microns, ma mmụba a abụghị ihe ndekọ ọnụ ọgụgụ (p = 0.8596).Enweghị ihe dị iche na ndekọ ọnụ ọgụgụ na fluorescence nke procollagen I, III ma ọ bụ Ki67 tupu na mgbe ọgwụgwọ gasịrị.Ka o sina dị, okwu mkpụrụ ndụ COL1A1 na COL3A1 mụbara n'ụzọ dị ukwuu (p = 0.0002 na p = 0.0010, n'otu n'otu).Enweghị mgbanwe ọ bụla dị ịrịba ama, mana ọ nyere aka melite ọnọdụ nke osisi ikpu mgbe injection Desirial® (n = 11, p = 0.1250).N'otu aka ahụ, n'akụkụ ebe a na-agba ọgwụ (n = 17) na fornix vaginal (n = 19), uru pH na-adịghị mma na-achọkwa ibelata, ma ọdịiche a abụghị ihe dị mkpa (p = p = 0.0574 na 0.0955) (Table 2). .
Ndị niile sonyere n'ọmụmụ ihe nwere ohere ịnweta nsonaazụ onye ọrịa kọrọ.Dị ka PGI-I si kwuo, otu onye so na ya (5%) kọrọ na ọ dịghị mgbanwe ọ bụla mgbe ịgbanye ọgwụ, ebe ndị ọrịa 19 fọdụrụnụ (95%) kọrọ ọkwa dị iche iche nke mmelite, nke 4 (20%) chere na ọ dịtụ mma;7 (35%) ka mma, 8 (40%) ka mma.Dyspareunia a kọrọ, nkụchi akwara, itching genital, abrasions vaginal, na FSFI ngụkọta ọnụ yana ọchịchọ ha, mmanye, afọ ojuju, na akụkụ mgbu belatara nke ukwuu (Table 3).
Echiche na-akwado ọmụmụ ihe a bụ na ọtụtụ injections Desirial® na mgbidi dị n'azụ nke ikpu ga-eme ka mucosa nke ikpu sie ike, pH dị ala nke ikpu, melite flora ikpu, na-ebute mmepụta collagen ma melite akara ngosi VA.Anyị nwere ike igosi na ndị ọrịa niile gosipụtara mmụba dị ịrịba ama, gụnyere dyspareunia, nkụchi akwara, abrasions ikpu, na itching genital.VHI na FSFI emeela ka ọ dịkwuo mma, yana ọnụ ọgụgụ ụmụ nwanyị ndị chọrọ ọgwụgwọ ọzọ iji chịkwaa mgbaàmà ha belatakwara nke ukwuu.N'otu aka ahụ, ọ ga-ekwe omume ịnakọta ozi gbasara nsonaazụ niile kpebisiri ike na mmalite ma nwee ike ịnye ntinye aka maka ndị niile na-amụ ihe.Tụkwasị na nke ahụ, 75% nke ndị na-amụ ihe na-akọ na mgbaàmà ha ka mma ma ọ bụ dị mma na njedebe nke ọmụmụ ahụ.
Otú ọ dị, n'agbanyeghị ntakịrị mmụba na nkezi ọkpụrụkpụ nke basal oyi akwa, anyị enweghị ike igosi mmetụta dị ịrịba ama na ngụkọta ọkpụrụkpụ nke mucosa ikpu.Ọ bụ ezie na ọmụmụ ihe anyị enweghị ike ịtụle ịdị irè nke Desirial® n'ịkwalite ọkpụkpụ mucosal vaginal, anyị kwenyere na nsonaazụ ya dị mkpa n'ihi na okwu nke akara CoL1A1 na CoL3A1 na-abawanye nke ọma na W8 ma e jiri ya tụnyere D0.Pụtara mkpali collagen.Otú ọ dị, e nwere ụfọdụ okwu ị ga-atụle tupu ị tụlee iji ya mee nchọpụta n'ọdịnihu.Nke mbụ, oge nleba anya nke izu 8 ọ dị mkpụmkpụ iji gosipụta mmụba na mkpokọta mucosal niile?Ọ bụrụ na oge nsochi ahụ dị ogologo, mgbanwe ndị achọpụtara na oyi akwa isi nwere ike ịbụ na etinyere ya na ọkwa ndị ọzọ.Nke abuo, ọkpụrụkpụ akụkọ ihe mere eme nke oyi akwa mucosal ọ na-egosipụta mmegharị anụ ahụ?Nyocha akụkọ ihe mere eme nke oke mucosal vaginal adịghị echebara oyi akwa basal, nke gụnyere anụ ahụ emegharịrị na kọntaktị na anụ ahụ njikọ dị n'okpuru.
Anyị na-aghọta na ọnụ ọgụgụ dị nta nke ndị sonyere na enweghị nke preri formal sample size bụ njedebe nke nyocha anyị;ka o sina dị, ha abụọ bụ njirimara ọkọlọtọ nke ọmụmụ ihe pilot.Ọ bụ ya mere anyị ji ezere ịgbatị nchoputa anyị na nkwupụta nke nkwado ụlọ ọgwụ ma ọ bụ ezighi ezi.Otú ọ dị, otu n'ime uru ndị bụ isi nke ọrụ anyị bụ na ọ na-enye anyị ohere ịmepụta data maka nsonaazụ dị iche iche, nke ga-enyere anyị aka gbakọọ nha nha maka nyocha nke deterministic n'ọdịnihu.Tụkwasị na nke ahụ, onye na-anya ụgbọelu na-enye anyị ohere ịnwale atụmatụ ọrụ anyị, ọnụ ọgụgụ churn, ike nke nchịkọta nlele na nyocha nsonaazụ, nke ga-enye ozi maka ọrụ ọ bụla metụtara ya.N'ikpeazụ, usoro nsonaazụ anyị tụlere, gụnyere ebumnuche ụlọ ọgwụ, ndị na-ahụ maka biomarkers, na nsonaazụ onye ọrịa gosipụtara site na iji usoro akwadoro, bụ isi ike nke nyocha anyị.
Desirial® bụ hyaluronic acid nke mbụ jikọtara ya na ya nke a na-enye site na ntụtụ mucosal nke ikpu.Iji wepụta ngwaahịa ahụ site na ụzọ a, ngwaahịa ahụ ga-enwerịrị mmiri mmiri zuru oke ka ọ wee nwee ike ịgbanye ya ngwa ngwa n'ime anụ ahụ jikọtara ọnụ pụrụ iche ma na-edobe hygroscopicity ya.A na-enweta nke a site n'ịkwalite nha nke mkpụrụ ndụ gel na ọkwa nke njikọ njikọ gel iji hụ na ntinye gel dị elu ka ị na-ejigide viscosity dị ala na elasticity.
Ọtụtụ ọmụmụ enyochala mmetụta bara uru nke HA, ọtụtụ n'ime ha bụ RCT na-adịghị ala ala, na-atụnyere HA na ụdị ọgwụgwọ ndị ọzọ (karịsịa hormones) [22,23,24,25].A na-elekọta HA na ọmụmụ ihe ndị a na mpaghara.HA bụ molekul endogenous nke e ji ike ya dị oke mkpa idozi na ibugharị mmiri.N'ime afọ, ọnụọgụ hyaluronic acid endogenous na mucosa ikpu na-ebelata nke ọma, na ọkpụrụkpụ ya na vaskụla ya na-ebelata, si otú a na-ebelata mmịpụta na mmanu plasma.N'ime ọmụmụ ihe a, anyị egosila na a na-ejikọta injection Desirial® na mmụba dị ịrịba ama na mgbaàmà niile metụtara VVA.Nchọpụta ndị a kwekọrọ na nyocha gara aga nke Berni et al mere.Dị ka akụkụ nke nkwado iwu Desirial® (ozi agbakwunyere anaghị ekpughe) (Faịlụ mgbakwunye 1).Ọ bụ ezie na ọ bụ naanị ịkọ nkọ, ọ bụ ihe ezi uche dị na ya na ọganihu a bụ nke abụọ na ohere nke iweghachi nnyefe nke plasma na elu epithelial ikpu.
A na-egosipụtakwa njikọ HA gel na-ejikọta ya na-eme ka njikọ nke ụdị m collagen na elastin dịkwuo elu, si otú ahụ na-amụba ọkpụkpụ nke anụ ahụ gbara ya gburugburu [31, 32].N'ime ọmụmụ ihe anyị, anyị egosighị na fluorescence nke procollagen I na III dị nnọọ iche mgbe ọgwụgwọ gasịrị.Ka o sina dị, okwu mkpụrụ ndụ COL1A1 na COL3A1 mụbara nke ọma.Ya mere, Desirial® nwere ike inwe mmetụta na-akpali akpali na nhazi nke collagen na ikpu, ma ọ dị mkpa ka ọmụmụ ihe buru ibu nwere ogologo oge iji kwado ma ọ bụ gbaghaa ohere a.
Ọmụmụ ihe a na-enye data ndabere na nha mmetụta nwere ike ime ọtụtụ nsonaazụ, nke ga-enyere aka ịgbakọ nha nha nha n'ọdịnihu.Na mgbakwunye, ọmụmụ ihe ahụ gosipụtara na ọ ga-ekwe omume ịnakọta nsonaazụ dị iche iche.Otú ọ dị, ọ na-egosipụtakwa ọtụtụ okwu ndị e kwesịrị iji nlezianya tụlee mgbe ị na-eme atụmatụ nyocha n'ọdịnihu na mpaghara a.Ọ bụ ezie na Desirial® yiri ka ọ na-emeziwanye akara ngosi VVA na ọrụ mmekọahụ, usoro ya adịghị edozi.Dị ka enwere ike ịhụ site na ngosipụta dị ịrịba ama nke CoL1A1 na CoL3A1, ọ dị ka enwere ihe akaebe mbụ na ọ na-akpali mmepụta nke collagen.Ka o sina dị, procollagen 1, procollagen 3 na Ki67 enwetaghị mmetụta yiri nke ahụ.Ya mere, a ga-enyochakwu ihe nrịbama akụkọ ihe mere eme na ndu na nyocha n'ọdịnihu.
Multi-point intravaginal injection of Desirial® (a cross-linked HA) jikọtara ya na nkwupụta nke CoL1A1 na CoL3A1, na-egosi na ọ na-akpali mmepụta nke collagen, na-ebelata akara VVA nke ọma, ma na-eji ọgwụgwọ ọzọ.Na mgbakwunye, dabere na akara PGI-I na FSFI, afọ ojuju ndị ọrịa na ọrụ mmekọahụ ka mma.Otú ọ dị, ngụkọta ọkpụrụkpụ nke mucosa ikpu agbanwebeghị nke ọma.
Enwere ike nweta data ejiri na/ma ọ bụ nyochaa n'oge ọmụmụ ihe ugbu a site n'aka onye edemede kwekọrọ na arịrịọ ezi uche dị na ya.
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