AIDS ndi High -oseose Steroids Zingayambitse Kugonjetsedwa kwa Mthupi
Posachedwapa, chifukwa cha mankhwala osokoneza bongo atsopano komanso kuwonjezeka kwa chiwerengero cha ziwalo za thupi, tawona anthu ochulukirapo omwe ali ndi matenda osatetezeka komanso osatetezeka.
Chitetezo cha mthupi ndi mndandanda wa maselo onse, matenda, ndi ziwalo zomwe zimathandiza thupi kupeleka matenda. Popanda chitetezo chamthupi choyipa, munthu amagwera kunyanja kudziko lakunja.
Mankhwala owonjezera omwe amachititsa kuti munthu asagwiritsidwe ntchito ndi mankhwala, ndiye chifukwa chimodzi chomwe chimachititsa kuti anthu asamasokonezedwe kapena asamangodzimva mosavuta. Zoonadi, zinthu zina zoipa zingasokoneze chitetezo cha mthupi, komanso, kuphatikizapo Edzi komanso matenda obadwa nawo.
Kodi Chitetezo cha M'thupi N'chiyani?
Chitetezo cha mthupi chanu chiripo kuti chiteteze kapena kutaya matenda. Maselo ndi njira za chitetezo cha mthupi zimakhala zovuta komanso zosiyana siyana ndipo zimayambitsa ziwalo zonse za thupi.
Nazi zigawo zikuluzikulu za chitetezo cha mthupi:
- Mfupa ndi kumene kusangalatsa konse kumayambira. Mfupa uli ndi maselo ofunika omwe amapitirira kukhala maselo osiyanasiyana (B maselo, T, ma lymphocytes, ndi zina zotero).
- Khungu silokhalo loyamba kutetezera kunyoza kuchokera kunja kwa dziko lapansi, koma zigawo zina za khungu (monga dermis) zili ndi maselo ochulukirapo. Komanso, khungu limatulutsa mapuloteni opha tizilombo toyambitsa matenda.
- Pali maselo ochuluka a chitetezo cha m'magazi m'magazi. Ndipotu, kuyesera magazi kumagwiritsidwa ntchito poyang'anira chitetezo.
- Maselo am'mimba amadzaza ndi maselo a m'thupi. Mmene thupi limagwirira ntchito m'magazi ndipo limakhala ngati msewu waukulu wopititsa maselo a chitetezo. Maselo otetezedwa m'maguluwa amatembenukira mu ma lymph nodes. M'kati mwa maselo a mitsempha, chitetezo cha mthupi chimatulutsidwa pamene tizilombo toyambitsa matenda timapezeka.
- Chinthu chachikulu cha maselo omwe amatithandiza kuti tithe kuyanjana ndi zoopseza zomwe zimayambitsa matenda ndi T-cell. Ngakhale kuti T-maselo amayamba kupangidwa m'mafupa, amayamba kukula mumthambo.
- Anthu amakhala mosasunthika (asplenia ndi chida chachipatala chifukwa cha kusowa kwa ntchentche kapena ntchito ya splenic). Komabe, nthendayi imathandiza kukonzekera thupi kuti likhale ndi matenda, ndipo anthu omwe alibe matendawa amatha kukhala ndi tizilombo toyambitsa matenda monga meningococci (kuganiza kwa meningitis), Streptococcus pneumoniae (kuganiza chibayo) ndi Haemophilus influenzae , kapena Hfenza . Chonde dziwani kuti ngakhale dzina lake, H fluenza sizimayambitsa matenda a chimfine ndipo m'malo mwake zimayambitsa matenda opuma. Nkhumba imakhala ngati fyuluta ya thupi, ndi mazenera a maselo a chitetezo cha mthupi mu mpeni kuwunika magazi chifukwa cha zizindikiro za matenda. Ngati kachilombo kamakhalapo, nthendayi imayambitsa chitetezo cha mthupi.
- Monga khungu, minofu ya mucosal, yomwe imapezeka kuti imayika m'mimba ndi mapepala a kupuma, ndiyo njira yoyamba yotetezera yomwe imathandiza kuti majeremusi asalowe m'thupi. Momwemonso, mucosal minofu ali ndi maselo ochulukira mthupi.
Nthendayi yoteteza thupi
Kuchepetsa chitetezo cha mthupi kumadalira zifukwa zingapo. Pafupipafupi, chiwerengero cha anthu omwe ali ndi kachilombo koyambitsa matendawa kamasankhidwa ataganizira zochitika izi:
- mtundu wa mankhwala osokoneza bongo (wachiwiri kwa mankhwala kapena matenda)
- nthawi yokhala ndi kachilombo ka HIV
- mphamvu ya kuteteza thupi
- mlingo ndi mitundu ya ma immunosuppressant agents kapena mankhwala
- matenda aumphawi (matenda obadwa nawo omwe amasokonezeka ndi chitetezo cha mthupi)
- zinthu za anatomic zomwe zimayambitsa kuwonongeka (monga zofooka zamadzimadzi zomwe zimaphatikizapo opaleshoni kapena ma radiation)
- matenda (ganizirani HIV kapena CMV)
Kugonjetsedwa kwa Mthupi Chifukwa Chotsatira Mankhwala
Mankhwala ambiri amachititsa kuti chitetezo cha mthupi chitetezeke. Mankhwalawa amatha kusokoneza magulu angapo a chitetezo cha mthupi kapena kugwiritsira ntchito mitundu yosiyanasiyana ya maselo a m'thupi.
Nazi mankhwala 3 omwe angasokoneze chitetezo cha mthupi:
- Corticosteroids . Mankhwalawa amalembedwa kwa mitundu yosiyanasiyana ya zozizwitsa, zozizira, ndi zotupa, monga nyamakazi ya nyamakazi, matenda opweteka, matenda a mphumu, ndi atopy. Panthaŵi yochepa, mankhwalawa amachititsa kuti maselo a chitetezo cha m'thupi asatengeke. Makamaka, corticosteroids imachepetsa kuchuluka kwa ma lymphocytes ndi monocytes komanso kupondereza phagocyte kusamuka ndi ntchito. Zotsatira za mankhwalawa zimaphatikizapo kupukuta kwa khungu ndi kufooka kwa minofu yofewa, zonsezi zomwe zingapangitse kuti thupi liziyenda bwino. Anthu omwe ali ndi mitsempha yambiri ya steroid amatha kukhala ndi matenda osiyanasiyana, monga Pneumocystis jirovecii , omwe amachititsa kuti Pneumocystis chibayo , komanso Strongyloides , omwe ndi oopsa komanso owopsa. Kuwonjezera apo, anthu omwe ali ndi mphamvu zochepa zoteteza thupi lachilendo kuwonjezera pa steroid ali pachiopsezo chobwezeretsa chifuwa chachikulu kapena matenda ena omwe amatha.
Chikondi. Mankhwala otchedwa monoclonal a CD20 amagwiritsidwa ntchito pochizira matenda osagwiritsidwa ntchito ngati a Hodgkin, nyamakazi, komanso matenda a khansa ya m'magazi. Pakati pa mayesero a chipatala, rituximab sinali yogwirizana ndi chiopsezo chowonjezereka cha matenda. Kuyambira pamene rituximab wakhala pa msika, komabe pakhala pali mauthenga aumwini (osakayikira) omwe akugwirizanitsa rituximab administration ku matenda osadziwika monga maulendo ambiri a leukoencephalopathy, omwe amayambitsa matenda a JC, komanso red cell aplasia, yomwe imakhudzana ndi matenda a parvovirus . Kuwonjezera apo, kuteteza thupi kwachilombo koyambitsa matendawa kungachititse kuti kachilombo ka HIV kachiritsidwe kachiwiri.
Nthenda ya Necrosis Factor-Alpha (TNF-α) Inhibitors. Mankhwalawa ndi ma cytokini; ma cytokines amadziwika ndi maselo a chitetezo. TNF-α inhibitors ndi mankhwala monga infliximab, certolizumab pegol, ndi maselo a monoclonal ndipo amagwiritsidwa ntchito pochiza matenda omwe ali ndi matenda a nyamakazi ndi matenda a Crohn. Zindikirani kuti, kutetezedwa chifukwa cha kuyendetsa mankhwalawa kumatsegula chitseko cha matendawa ndi Listeria monocytogenes , tizilombo toyambitsa matenda zomwe zingayambitse amayi omwe ali ndi pakati.
Kugonjetseratu Maganizo Kuchokera ku Asplenia
Kuchotsa opaleshoniyo kumatchedwa "splenectomy." Pali zifukwa zambiri zomwe munthu angathenso kuchotsa nthenda yake, kuphatikizapo khansara, kupwetekedwa mtima, ndi matenda a magazi (monga momwe amawonetsetsera idiopathic thrombotic purpura). Dzina lachipatala "asplenia" limangotanthauza kuchotsa mpeni kudzera mwa splenectomy komanso kutayika kwa splenic ntchito yowonjezereka ndi zinthu monga sickle cell anemia.
Anthu omwe ali ndi asplenia ali ndi chiopsezo chowonjezereka cha matenda omwe ali nawo, monga Streptococcus pneumoniae , Haemophilus influenzae , ndi mitundu ina ya Neisseria meningitides . Mwa anthuwa, matenda owopsa amatha msanga makamaka makamaka pa vuto la sepsis kapena matenda a magazi. Sepsis ndi wamba kwambiri pakati pa anthu omwe ali ndi splenectomy yachiwiri ndi khansa (malinkhulidwe) kuposa momwe aliri pakati pa anthu amene amachotsedwa pambuyo pangozi (zoopsa). Zindikirani, chiopsezo chotenga kachilombo koyambitsa matenda ndi zofunikira kwambiri m'zaka zochepa zoyambirira pambuyo pa splenectomy.
Kusamalidwa Kwachilomboka Pakatha Kusamba
Pali mitundu iwiri yokhalapo: zowonjezera maselo ndi maselo olimbitsa thupi. Mitundu yonseyi imayambitsa kusamalitsa.
Maselo opangira maselo amtunduwu ankatchedwanso kuti mafupa osakanikirana, kapena maselo osayanjanitsika omwe angathe kupanga mitundu yonse ya maselo a magazi, anali atangokolola kokha m'mafupa. Chifukwa cha kupita patsogolo kwa zamankhwala, tsopano tatha kufotokoza maselo otsika m'magazi. Kulowetsa maselo a tsinde amachitidwa ngati chithandizo cha mitundu ina ya khansa ya magazi, kuphatikizapo matenda oopsa a khansa ya m'magazi, Kawirikawiri, anthu omwe ali ndi matendawa ali kale ndi matenda oopsa a khansa ndipo motero amakhala osatetezedwa.
Ziwalo zolimba zokhudzana ndi ziwalo zimatanthawuza zizindikiro za ziwalo monga mtima, impso, kapena chiwindi. Anthu omwe amatenga thupi lawo amafunika kuchitidwa chithandizo chamoyo nthawi zonse ndi mankhwala osokoneza bongo kuti athetse chiopsezo cha kukanidwa.
Patsiku loyamba la kuchira kuchokera kuchidutswa cha thupi, wothandizira ena amatha kutenga matenda okhudzana ndi opaleshoniyo. Matendawa nthawi zambiri amaphatikizapo matenda opatsirana pakhungu, matenda a khungu, komanso matenda. Pakapakati pa miyezi 2 ndi 6 mutatha opaleshoni, opaleshoni yoikapo ali pangozi ya matenda opatsirana komanso kutsegula kachilombo ka herpes kapena matenda ena omwe amatha. Patatha miyezi isanu ndi umodzi mutapatsa ndi kupitirira, ozilandirira amatha kutenga kachilombo koyambitsa matenda monga anthu omwe amachitidwa ndi tizilombo toyambitsa matenda (kuganizira Streptococcus pneumoniae ndi Haemophilus influenzae ).
Kugonana kwa Magetsi Kumayambitsa Kachilombo ka Immunodeficiency
Nthawi zina anthu amadwala matenda a majeremusi omwe amachititsa kuti chitetezo cha mthupi chitetezeke. Ambiri mwa mavitamini oyambirirawa amapezeka mosavuta ndipo amapezeka kuti ali aang'ono, monga matenda okhudzana ndi kuteteza thupi komanso matenda aakulu. Komabe, mavitamini omwe amatha kusintha kwambiri (CVID) amavomerezeka komanso amakhalanso achikulire komanso achinyamata.
Ndi CVID, maselo a chitetezo cha m'thupi samalephera kutulutsa ma immunoglobulins oyenera kuti athe kutulutsa mayankho a chitetezo cha mthupi. Chifukwa chake, anthu omwe ali ndi CVID amavutika kwambiri ndi matenda opatsirana komanso matenda a m'matumbo monga Giardia lamblia .
Mankhwala a CVID ndi ovuta ndipo amafunikira chisamaliro chapadera chifukwa chakuti anthu omwe ali ndi vutoli samayankha katemera ndipo m'malo mwake amafunika kulowetsedwa kwa immunoglobulin kuchipatala.
Matenda Omwe Amasamalidwa Chifukwa cha Matenda
Kugonana kwa thupi sikungowonjezera chiwopsezo cha matenda koma kungayambitsenso matenda ena. Mwachitsanzo, cytomegalovirus (CMV), yomwe nthawi zambiri imakhala ndi zizindikiro kapena zizindikiro za mtundu wa munthu zomwe zimakhala ndi mphamvu zowonongeka, zingasokoneze chitetezo cha mthupi mwa iwo omwe ali kale osatetezedwa. Mwachindunji, maselo a CMV ali ndi maselo T, omwe amagwira nawo ntchito yoteteza mthupi.
Mtundu wina wa matenda omwe angabweretse chiopsezo choteteza kachilombo ka HIV ndi HIV (kachilombo ka HIV). Kupititsa patsogolo kwa HIV kwa Edzi kumadziwika ndi matenda aakulu . Izi zimachitika ngati HIV imapha ma cell ambiri othandizira T - CD4 ndi CD8 maselo - zomwe ndizofunika kuti zitha kuyankhira. Maselowa ataphedwa, munthu amakhala ndi matenda osiyanasiyana omwe amawoneka oopsa, kuphatikizapo zotsatirazi:
- Candidiasis
- Coccidioidomycosis
- Cryptococcosis
- Matenda a Cytomegalovirus
- Kuchulukanso, kachilombo ka HIV
- Herpes simplex
- Histoplasmosis
- Kaposi sarcoma
- Chifuwa chachikulu
- Pneumocystis carinii chibayo
- Toxoplasmosis ya ubongo
Chonde dziwani kuti si anthu onse omwe ali ndi kachilombo ka HIV omwe alibe HIV, kapena ali ndi AIDS. Mwamwayi, kupita patsogolo kwa mankhwala kwapangitsa kuti kachilombo ka HIV katengeke kwambiri. Masiku ano, anthu omwe amadzipereka molimba mtima ku mankhwala opatsirana pogonana akhoza kukhala ndi moyo wautali popanda kukhala ndi Edzi.
Chidule
Kuwonjezereka kwakukulu, kuchulukitsa kwa kuchuluka kwa chiopsezo cha thupi pakati pa anthu a ku America ndi chizindikiro cha kupita patsogolo. Chifukwa cha kupita patsogolo kwa kafukufuku, tsopano tili ndi mankhwala osokoneza bongo omwe amatha kusamalira zinthu zosiyanasiyana. Kuwonjezera pamenepo, tikuchitanso zowonjezera zowonjezera zomwe zimayambitsa kusamalitsa.
Mosiyana ndi zimenezi, kupita patsogolo kwa mankhwala kumatha kuchepetsa kuchuluka kwa chiopsezo pakati pa anthu ambiri. Makamaka, anthu omwe ali ndi kachilombo ka HIV omwe amatsatira mwamphamvu ma antiretroviral awo akhoza kukhala ndi moyo wautali komanso wosangalala opanda chitetezo. Koma mwatsoka, ngakhale kuti chithandizo cha HIV chikupita patsogolo, anthu atatu okha ku America ali ndi kachilombo ka HIV.
Zotsatira:
Hammond SP, Baden LR. Chaputala 198. Matenda a Mtsogoleri Wosamalidwa ndi Immunocompromised. Mu: McKean SC, Ross JJ, Dressler DD, Brotman DJ, Ginsberg JS. eds. Malamulo ndi Zochita za Chipatala . New York, NY: Hill ya McGraw; 2012. Kufikira pa April 12, 2016.
Nayeri U, Thung S. Mutu 15. Kuchuluka kwa Fetal Infections. Mu: DeCherney AH, Nathan L, Laufer N, Roman AS. eds. Kufufuza Koyamba ndi Kuchiza: Zovala Mimba ndi Gynecology, 11e . New York, NY: Hill ya McGraw; 2013. Kufikira pa April 13, 2016.