< Обратно

 

У многих врачей отношение к ауто-гемотерапии  скептическое, доходящий до обвинения  в в шарлатанстве (quakery,.

Мой скепсис был  не столь категоричен. Методика существует и работает ли реально, за счет чего и насколько эффективно и ее место в современное время . Захотелось слегка прояснить для себя.

Малая аутогемотерапия в англоязычной литературе упоминается как autologous blood injection.

Официально она уже рекомендована для лечения местных проблем и вошла в некоторые из из гайделайнов NICE 2013

 

Autologous blood injection for tendinopathy

http://www.nice.org.uk/guidance/ipg438/resources/guidance-autologous-blood-injection-for-tendinopathy-pdf

Применяется для лечения эпикондилита (локоть теннисиста, тендинита ахиллова сухожилия

Эффект в некоторых исследованиях был даже выше чем иньекции гидрокортизона.

2.3.1

In a randomised controlled trial (RCT) of 150 patients with tennis elbow, 70 were treated by autologous blood injection and 80 were treated by platelet-rich plasma injection. Technical success was defined as an improvement in patient-rated tennis elbow evaluation score of 25 points at final analysis; measured on a scale of 0–100, with a higher score indicating more pain and functional disability. Of those patients followed up at 6 months, technical success was reported in 72% (43/60) of patients treated by autologous blood injection and 66% (46/70) treated by platelet-rich plasma injection (p=0.59).

2.3.2

In an RCT of 100 patients with tennis elbow, 51 were treated by platelet-rich plasma injection and 49 were treated by corticosteroid injection. Successful treatment was defined as a reduction of 25% on the visual analogue scale pain score (measured on a scale of 0–100, with a higher score indicating more pain) and no reintervention after 2 years. At 2-year follow-up, successful treatment was achieved in 76% (39/51) of patients treated by platelet-rich plasma injection and 43% (21/49) treated by corticosteroid injection (p<0.0001).

2.3.3

In an RCT of 54 patients with Achilles tendinopathy, 27 were treated by platelet-rich plasma injection and 27 were treated by placebo injection. The mean difference on the Victorian Institute of Sports assessment – Achilles (VISA-A) scale (assessing the severity of Achilles tendinopathy on a scale of 0–100, with a lower score indicating higher severity) was not significant (6 points [95% confidence interval (CI) −5 to 16]) at 1-year follow-up (p value not reported).

2.3.4

In the RCT of 100 patients with tennis elbow, 12% (6/51) of patients treated by platelet-rich plasma injection and 29% (14/49) of patients treated by corticosteroid injection needed further intervention within 2–14 months. Of those treated by platelet-rich plasma injection, 6% (3/51) had subsequent corticosteroid injections. Of those treated by corticosteroid injection, 16% (8/49) had subsequent corticosteroid or platelet-rich plasma injections.

2.3.5

In the RCT of 54 patients with Achilles tendinopathy, 57% of the platelet-rich plasma group and 42% of the placebo group returned to their previous level of sporting activity (absolute figures not reported). The adjusted between-group difference for return to sports was 2% (95% CI −25 to 28) at 1-year follow-up. This difference was not significant (p=0.89).

2.3.6

The Specialist Advisers listed key efficacy outcomes as pain relief and improved function.привычные вывихи височночелюстного чучтава

Autologous blood injection for plantar fasciitis

https://www.nice.org.uk/guidance/IPG437

A randomised controlled trial of 64 patients treated by autologous blood injection or corticosteroid injection reported that mean pain scores decreased from 7.3 and 6.9 at baseline to 3.6 and 2.4 respectively at 6 month follow-up (p<0.0001 for both groups; measured on a visual analogue scale from 0–10, with 0 indicating no pain and 10 the worst imaginable pain). The proportion of patients with no change in score was 10% in both groups (3/30 and 3/31 respectively). The mean tenderness threshold improved from 3.1 kg/cm2 at baseline to 6.5 kg/cm2 in the autologous blood injection group and from 3.7 kg/cm2 to 8.6 kg/cm2 in the corticosteroid group at 6 month follow-up (p<0.0001 for both groups).

2.3.2

A randomised controlled trial of 45 patients treated by autologous blood injection, corticosteroid injection or peppering alone reported that mean pain scores reduced from 7.6, 7.3 and 6.4 at baseline to 2.4, 2.6 and 2.0 respectively at 6 month follow-up (p<0.001 for all groups; measured on a visual analogue scale from 0–10). The Rearfoot scores (scale 0–100 with higher scores indicating less pain and better function) improved from 72, 66 and 64 at baseline to 81, 80 and 78 respectively at 6 month follow-up (p=0.025, 0.030 and 0.018 respectively). There were no statistically significant differences between the groups.

2.3.3

A non-randomised comparative trial of 100 patients treated by autologous blood injection, local anaesthetic with peppering, corticosteroid injection or corticosteroid injection with peppering reported an 'excellent' or 'good' outcome in 60% (15/25), 52% (13/25), 80% (20/25) and 88% (22/25) of patients respectively at 6 month follow-up (measured using a modified Roles and Maudsley scale, which measures pain and limitation of activity). There was a statistically significant difference between corticosteroid injection and autologous blood injection and local anaesthetic with peppering, with more successful outcomes in the corticosteroid groups (p<0.05).

2.3.4

The randomised controlled trial of 45 patients treated by autologous blood injection, corticosteroid injection or peppering alone reported that 67% (10/15), 0% (0/14) and 47% (7/15) of patients respectively needed a third injection.

Известная и сложная процедура -PRP(platelet-rich plasma) https://www.youtube.com/watch?v=k1aM5q-cjWs  относительно которой существенно больше информации до последнего времени активно использовалась спортивными врачами, ортопедами-травматологами, но широкая медицинская общественность   рассматривала эту практику с налетом недоверия и подозрением в псевдонаучности. 

Эту же методику использовали и при других локализациях тендинитов и артритах.

Как оказалось эффективность  PRP и ABI не очень сильно различаются, хотя вторая методика значительно проще и значительно легче может быть внедрена в практику. 

Effect of Platelet-Rich Plasma (PRP) versus Autologous Whole Blood on Pain and Function Improvement in Tennis Elbow: A Randomized Clinical trial://www.hindawi.com/journals/prt/2014/191525/

Необходимо сказать, что существует  технология пролотерапии (местного обкалывание) с применением гипертонического раствора декстрозы.

Посмотрев на процедуру https://www.youtube.com/watch?v=eXl3cJQQKUA можно предположить , что повреждающее действие множественных уколов-микроповреждений приводит к сходному механизму (раздражающий фактор -локальное воспаление + микрокровотечения в ткани)

Инфузии крови использовали с успехом для лечения хронического подвывиха челюстно-лицевого сустава 

The effect of chronic temporomandibular joint dislocation: frequency on the success of autologous blood injection. 

http://www.ncbi.nlm.nih.gov/pubmed/24431880 

Большая травма вызывает огромное количество физиологических реакций в том числе иммунных реакций они зависят от размера

Immune Response and Its Modulation

http://www.hindawi.com/journals/mi/2012/731563/

Кровоилияние в ткани закономерно должно вызывать местную рекцию с поступлением в ткани цельных элементов крови эритроцитов, тромбоцитов итд, что вполне должно спровоцировать как местную регенеративную, так и общую системную адаптационную реакцию с вероятными системными последствиями.

Initial immune reaction and angiogenesis in bone healing

http://onlinelibrary.wiley.com/doi/10.1002/term.1505/abstract

Аутогемотерапию используют в ветеринарии, где казалось бы плацебо эффект может быть только у ветеринара.

Journal of Immunology and Immunopathology

Year : 2013, Volume : 15, Issue : 1

First page : ( 123) Last page : ( 123) 

Print ISSN : 0972-0561. Online ISSN : 0973-9149. 

Therapeutic Management of Bovine Papillomaosis by Autohemotherapy – A Reviw of 3 Cases

Ramakrishnan V, Sundaravinayaki M

Veterinary College and Research Institute (TANUVAS), Tirunelveli, Tamil Nadu, India

Bovine papillomatosis is a contagious disease of cattle occurring as warts or papilloma on skin and mucosa, caused by BPV types 1 to 10. Infection by BPV occurs as a result of multiplication of the virus in basal cells, leading to wart formation, however, most warts are benign and do no proliferate indefinitely.Three cross bred cows were presented during the year of 2012 to the Veterinary Dispensary, south gate Madurai, with the history of warts in udder as well as teats (two cases) and numerous cauliflower like growth on the left side of neck region, lower abdomen (one case). The diagnosis of bovine papillomatosis was arrived at on the basis of presented clinical signs, since the structure of the papillomas on the skin was easily observed and identified and the animal was subjected to autohemotherapy, 30 ml blood was collected from jugular vein puncture, 15 ml was given intramuscularly and another 15 ml was given subcutaneously in two different sites. The treatment was repeated at 5 days interval and animal recovered after five injections.More research may help to know the actual reason behind the cure of the disease.

Аутогемотерапия упомянута в европейских Guidelines for treatment of atopic eczema (atopic dermatitis) Part II http://ga2p2.org/documents/AE%20Guideline2.pdf и американских  гайделайнах дерматологов по лечению атопического дерматита 

Guidelines of care for the management of atopic dermatitis 

https://www.aad.org/File%20Library/Global%20navigation/Education%20and%20quality%20care/AD-part-4.pdf

Хотя уровень доказательства B и стандартно назначать не рекомендуют тем не менее отмечен положительный эффект при лечении в ряде случаев

We located one RCT comparing the reinjection of 1–3 ml autolo- gous blood over 5 weeks to the injection of the equivalent amount of sterile saline solution.131 Patients were recruited via press adver- tisement and finally 30 subjects participated. Over a 9 weeks period, eczema severity as measured by SASSAD dropped signifi- cantly in the verum group from 23.2 to 10.4 and did not change in the placebo group (21.0–22.5). Significant differences were not observed in health related quality of life and the subjective assess- ment of pruritus skin appearance and sleep quality. The data sug- gest a beneficial effect of autologous blood therapy with respect to the severity score. This finding should be confirmed in larger trials and different settings.

Связывают этот эффект в т.ч. с  выработкой антиидиотипических антител к тучным клеткам, что способствует  развитию толерантности к антигенам 

Autologous serum therapy in chronic urticaria: A promising complement to antihistamines

www.e-ijd.org/article.asp?issn=0019-5154;year=2014;volume=59;issue=4;spage=375;epage=382;aulast=Debbarman

Насколько она выражена и достаточна ли для коррекции вероятных фоновых болезней, которые планируется лечить остается вопросом.

Тем не менее исходя из теоретических и практического прошлого опыта применения рациональные зерна в аутогемотерапии нужно признать, все таки присутствуют и требуют переоценки с современной точки зрения, тем более что мы нередко видим «пере-открытие старых технологий».

Отдельная тема - большая аутогемотерапия, часто упоминается применением ультрафиолетого , лазерного облучения, обработке озоном.