Ciwon suturar ƙwayar cuta shine rikitarwa wanda zai iya faruwa bayan sashi na kasusuwan ɓarke, hanyar da aka sani da shirar sautin cell cell hematopoietic (HSCT). An lasafta ciwo na nakasassu kamar yanayin ƙin jini, kuma yana halin da ke biyowa:
- Fushi da raguwa ba saboda kamuwa da cuta
- Ruwa mai yawa a cikin huhu ba saboda matsalar zuciya ba
- Sauran wasu bayyanar cututtuka da binciken
Ciwon ciwon yana ci gaba da tsawon kwanaki 7 zuwa 11 bayan da aka dasa shi, a yayin da aka dawo da tsaka-tsaki . Magungunan cututtukan ƙwayar cuta yawanci suna da sauƙi, amma suna iya ɗaukar nauyin siffofi da kuma barazanar rayuwa. Rashin ciwo zai iya haifar da numfashi na numfashi, zazzabi ≥100.9˚F, raguwa mai tsabta wadda ke da lakabi da kuma tasowa fata, karbar gwargwadon ƙwayar jini, da kuma yawan ruwa a cikin huhu wanda ba saboda matsalar zuciya ba.
A cikin matsananciyar siffar, an yi amfani da kalmar "maye gurbin" ciwo, yana nufin cewa rushewar tsarin siginar da ɓarna-nau'in mahaifa.
An bayar da rahoton cewa cutar ciwon ya faru ne bayan duka manyan HSCT: autologous (dashi daga kai) da kuma allogeneic (daga sauran, mai ba da gudummawa da yawa).
Saduwa da wasu Yanayi
Fassara yana nufin 'yan kwayoyin sabbin kwayoyin halitta da suke "samo tushen da samarwa," wato, lokacin da kwayoyin da aka sassaukar sun gano ninkinsu a cikin kututtukan kasusuwa kuma su fara aiwatar da sababbin jini, jini da jini.
Halin dangantaka da cututtuka zuwa wasu abubuwan da suka faru a bayan bayanan da suke da siffofin irin wannan yana da rikici. Wadannan abubuwan da suka faru a baya bayanan sun hada da yanayi irin su gwaninta mai mahimmanci tare da cutar mai kwakwalwa (GVHD) , cututtuka na farko (PES), radiation- da kuma maganin cututtukan kwayoyi da cututtuka, kadai ko a hade.
Ƙunƙwasacciyar ciwon zuciya da cututtuka da ƙwayar cututtuka wasu kalmomi ne waɗanda masana kimiyya suka yi amfani da su don bayyana wannan sigina na bayyanar cututtuka waɗanda zasu iya tashi a lokacin lokacin rubutu. Har ila yau an kira ciwon sikila "ciwon sikila mai launi," wanda yake nufin daya daga cikin mawuyacin hanyoyin da za'a iya haifar da ciwo - wato, saboda siginonin tantancewa wanda ba su da ma'auni, ƙananan jini na jini, capillaries, ya zama ƙari. fiye da al'ada, wanda ya haifar da mahaukaci, haɓakar ruwa mai gina jiki a sassa daban-daban na jiki. Lokacin da wannan ya faru a cikin huhu, yana da harshe na huhu. Mafi mahimmanci, yana da ruwa a cikin huhu ba saboda matsalar zuciya ba, saboda haka kalman nan "noncardiogenic pulmonary edema" ne.
Abin da ke haifar da ciwo na injiniya?
Dalili na ainihin cututtuka ba a san shi ba, amma ana tunanin cewa maye gurbin siginar ƙwayoyin ƙwayoyin ƙwayoyin cuta da ƙwayoyin salula na iya zama muhimmiyar rawa.
Rashin ruwa a cikin huhu yana zaton ana haifar dashi ne ta hanyar siginonin tantance jiki wanda zai haifar da ƙananan ƙananan murfin jikin. Wannan nauyin haɗari yana kiransa huhu ne , ko kuma idan aka gani akan nazarin ilimin lissafi, ana iya ambaton alamu. A lokuta inda aka bincike cikin ruwa a cikin huhu, wani lokaci sukan sami babban lambobi na neutrophils, irin nau'in jini.
A cikin marasa lafiya biyu da suka kamu da kwayar cutar, sun kuma sami lalacewa ga alvaoli-jakar iska a cikin iska - wanda aka yadu da bambanci.
Masu bincike sunyi la'akari da cewa, saboda an gano cututtuka bayan daban-daban na masu ba da gudummawa da nau'o'in kayan aiki, kuma tun da ciwo zai iya bambanta daga GVHD kuma yayi daidai da dawo da fararen fararen jikinsu da ake kira granulocytes, wanda zai iya yin rikici ta hanyar farin ciki Kwayoyin jini da kuma siginar kwayoyin proinflammatory. Wannan jigon siginar salula da hulɗa zai iya haifar da tsarin siginar ƙwayar cuta, dysfunction da kwayoyin cuta kamar su zazzaɓi.
Yaya aka gano shi?
Dokta Spitzer, wani masanin binciken asibitin a Bone Marrow Transplant Program, a Massachusetts General Hospital a Boston, MA, ya wallafa takardun seminal a kan nakasasshen ciwo a shekara ta 2001.
Sakamakon Spitzer don ciwon haɗin gwargwado kamar haka:
Manyan mahimmanci:
- Tsawancin zafi fiye da ko daidai da 38.3 ° C ba tare da wani mawuyacin matsalar cutar ba
- Raƙuman raƙuman wuta sun shafi> kashi 25 cikin dari na jiki kuma ba'a iya haifar da magani
- Rash ko wuce haddi a cikin huhu ba lalacewa ta hanyar matsalolin zuciya ba, kamar yadda aka gani akan bidiyon hoto, da rashin isashshen oxygen cikin jini
Ƙananan ma'auni:
- Dysfunction na haɓaka tare da wasu sigogi (bilirubin ≥2 MG / dL ko transaminase ≥2 sau al'ada)
- Ingancin rashin inganci (magani na creatinine ≥ 2x)
- Amfanin nauyi (≥2.5 bisa dari na nauyin nauyi na jiki)
- Abubuwa masu rikicewa da kwanciyar hankali na yau da kullum da wasu ƙananan haddasawa ba su samuwa ba
Binciken ganewa yana buƙatar dukkanin manyan sharuddan guda uku ko manyan sharuddan guda biyu kuma daya ko mafi qarancin ƙarami a cikin sa'o'i 96 na haruffa.
Akwai wasu ka'idoji don amfani da su don tantance cututtuka, kamar yadda ya kamata. Alal misali, an gabatar da ka'idoji Maiolino a shekara ta 2004. Masana sun bambanta suna da matakai daban daban don gano cutar ciwo, kuma alamu da ke rufewa zasu iya taimakawa wajen wannan matsala. A shekara ta 2015, Dr Spitzer ya wallafa wasu halaye da suke "daidai da" da "ba daidai da" ciwon suturar rubutu ba:
Daidaita da ciwowar ƙwayar cuta: Ciwon daji marasa ciwon; rash; alamun bala'i na ƙananan jini (ƙananan jini, riba mai kyau, kumburi, ruwa cikin ciki, ruwa a cikin huhu ba lalacewa ta hanyar zuciya); koda, hanta, ko ƙwaƙwalwar kwakwalwa; da kuma zawo ba tare da wani dalili ba.
Ba daidaituwa da ciwon suturawa: Ciwon zazzaɓi na zazzabi; rash tare da binciken biopsy wanda ya bada shawara ga GVHD a cikin yanayin sauko daga mai bayarwa; ƙwaƙwalwar zuciya ta rikici; dysfunction ta jiki saboda wani dalili, (alal misali, mai ƙwayar lissafin nephrotoxicity ko hanta GVHD); zawo saboda wani dalili (alal misali, kamuwa da cuta, maye gurbin chemo, ko GVHD).
Ta Yaya An Yi Ginar Ciwo Guda?
A cewar rahoton Dr Spitzer, game da kashi daya bisa uku na marasa lafiya, cutar ciwo zai iya warware kansa, kuma baya buƙatar magani. Lokacin da magani ya wajaba, cutar ciwo ya zama mai karɓa sosai ga maganin corticosteroid da aka ba dasu idan dai bayyanar cututtuka ta ci gaba, yawanci kasa da mako guda. Ana buƙatar mahimmanci don jiyya ta hanyar zafin jiki na> 39 ° C ba tare da wata sanadiyar cututtuka da kuma alamun asibiti mai mahimmanci ba, wanda yafi yawa a cikin huhu.
Mene ne Yaya Sananne Game da Cutar Gashi?
Akwai ka'idoji daban-daban don amfani da maganin ciwon haɗin gwiwar, kuma wannan yana iya ƙididdiga yawan adadin kididdigar game da yadda al'amuran ciwo ke tasowa a sassa daban-daban na marasa lafiya waɗanda suka karbi sassan cell transplants. Dr. Spitzer yana nazarin ciwo tun daga shekara ta 2001, kuma an wallafa littattafai da kuma nazarin ilimin lissafin halittu a kwanan nan a 2015:
- Ciwon sikila bayan ƙwayar cututtuka (Hematopoietic cell transplantation) (HCT) an ƙara ganowa sosai.
- Tsarin bincike na daban yana amfani da shi, kuma wataƙila akwai asusun ajiyar fannoni (kashi 7-90) na sharuddan da aka ruwaito.
- Kodayake bayyanuwar cututtuka na cututtuka na iya zama kamanni ga wadanda ke cikin GVHD mai tsanani, an kuma bayyana magungunan cututtuka a marasa lafiya ba tare da GVHD ba.
- Ba a san ko ciwo yana haifar da mummunar rayuwa ta mace da kuma mummunan rayuwa bayan HCT; an gudanar da bincike, amma bayanai sunyi rikici.
- Ciwon sikila yana iya magance kansa, amma, kamar GVHD mai mahimmanci, yana amsawa ga corticosteroids.
- Saboda ciwon haɗin gwaninta da kuma GVHD mai tsanani na iya samun siffofi masu mahimmanci da kuma maganin farfadowa, waɗannan ƙwayoyin cuta na iya zama sau da yawa ba abubuwan ban mamaki ba.
- Hanyoyin cututtuka na iya haɗuwa da wadanda ke fama da kwayoyi da radiation-induced toxicities da kamuwa da cuta.
Kalma Daga:
Yaya yawan wannan ciwo ya saba, kuma menene chances wani mai haƙuri zai ci gaba da bayyanar cututtuka? To, tun da babu wata yarjejeniya a kan ainihin ma'anar, a cikin asibiti, an ba da labari a cikin littattafai, a cikin asibiti, daga kashi 7 cikin dari zuwa kashi 90 cikin dari a cikin autotransplants (dashi daga kansa a matsayin mai bayarwa). An bayar da rahotanni mafi girma bayan autotransplants don lymphomas banda Hodgkin lymphoma . Wannan ciwo zai iya shafar yara da manya a irin wannan nau'i, amma tasiri zai iya zama mafi girma a cikin yara game da mace-mace da ba shi da dangantaka da sake dawowa da ciwon daji.
Yawan nauyin cututtuka ya bayyana ya zama ƙasa a cikin mutanen da suka karbi sutura daga masu ba da gudummawar kansu. Wannan wani wuri mai wuya don bincike, duk da haka, tun da ciwo zai iya kama da babbar GVHD. A cikin nazarin daya, kammala ƙaddamar da ciwowar ƙwayar cuta ya faru ne kawai a kashi 10 cikin 100 na batutuwa waɗanda basu ƙara girma GVHD ba.
> Sources:
> Franquet T, Müller NL, Lee KS, et al. CT mai mahimmanci da kuma binciken pathologic na rikitarwa na huhu ba tare da cututtuka ba bayan tsirrai da ƙwayar sautin cell. AJR Am J Roentgenol . 2005; 184 (2): 629-37.
> Lee YH, Rah WJ. Ƙunƙwasawa na ciwon ciki: ƙwarewar asibiti da kuma pathophysiology. Ruwan jini . 2016, 51 (3): 152-154.
> Omer AK, Kim HT, Yalamarti B, McAfee S, Dey BR, Ballen KK et al. Ciwon sikila bayan ƙwayar daji a cikin tsofaffin yara. Am J Hematol 2014; 89: 698-705.
> Spitzer, TR. Ƙunƙarar motsa jiki: ɗan takobi biyu na takobi na hematopoietic cell transplants. Bone Marrow Transplant. 2015; 50 (4): 469-75.