Engraftment syndrome ndi vuto lomwe lingakhoze kuchitika pambuyo poika mafupa a mafupa, njira yomwe imatchedwanso kuti hematopoietic cell stem cell (HSCT). Matenda a engraftment amaonedwa ngati kutupa, ndipo amadziwika ndi zotsatirazi:
- Kutentha komanso kuthamanga osati chifukwa cha matenda
- Kuthamanga kwa madzi okwanira m'mapapu osati chifukwa cha vuto la mtima
- Zizindikiro zina ndi zofufuza
Matendawa amayamba masiku 7 mpaka 11 mutatha kuwatsitsa, panthawi ya neutrophil . Zizindikiro kawirikawiri zimakhala zofewa, koma zimatha kuwonongera mafomu osiyanasiyana. Matendawa angayambitse kupweteka, malungo ≥100.9˚F, mpweya wofiira womwe umakhala wolimba kwambiri ndipo umapangitsa malo a khungu, phindu, kuchepa kwa magazi, ndi madzi owonjezera m'mapapo omwe sali chifukwa cha vuto la mtima.
Mu mawonekedwe ake opambana kwambiri, mawu akuti "aseptic shock" syndrome akhala akugwiritsidwa ntchito, kutanthauza kuti kugwa kwa kayendedwe ka kayendetsedwe ka magazi ndi zolepheretsa ziwalo zambiri.
Matenda a engraftment awonetsedwa kuti adzachitika pambuyo pa mitundu ikuluikulu ya HSCT: autologous (kutulutsa kuchokera kwa mwini) ndi allogeneic (kuchokera kwa ena, omwe amapereka chithandizo).
Kugwirizana ndi Zina
Mipangidwe yowonjezera imatanthawuza za maselo atsopano opangidwa "akuzika mizu ndi kubereka," ndiko kuti, pamene maselo opatsiridwawo amapeza niche mu fupa ndikuyamba njira yopanga maselo ofiira atsopano, maselo oyera, ndi mapuloletsiti.
Chiyanjano cha engraftment syndrome ku zochitika zina zomwe zimachitika pambuyo pake zotsalira zomwe zimakhala zofanana ndizo zotsutsana. Zochitika zina zomwe zimachitika pambuyo pake, zimaphatikizapo zinthu monga matenda oopsa omwe amagwira ntchito (GVHD) , pre-engraftment syndrome (PES), poizoni ndi mankhwala osokoneza bongo, okha kapena ophatikizana.
Matenda a Pre-engraftment ndi matenda a peri-engraftment ndi ena omwe asayansi agwiritsira ntchito kufotokoza izi zizindikiro zomwe zingayambe panthaŵi ya engraftment. Mankhwala otchedwa Engraftment syndrome amatchedwanso "capillary leak syndrome," yomwe imatchula njira imodzi yomwe ingatheke kuyambitsa matendawa-ndiko kuti, chifukwa cha zizindikiro zosagwirizana ndi thupi, mitsempha yaing'ono kwambiri ya thupi, ma capillaries, amakhala ovomerezeka kwambiri kuposa zachizolowezi, zomwe zimapangitsa kuti thupi likhale losawonongeka, kumakhala ndi madzi ambiri. Pamene izi zimachitika m'mapapu, ndi mapulitsi a edema. Makamaka, ndikumadzimadzi m'mapapu osati chifukwa cha vuto la mtima, motero mawuwa ndi "oscardiogenic pulmonary edema."
Kodi N'chiyani Chimayambitsa Kusokonezeka Kwambiri?
Chifukwa chenicheni cha engraftment syndrome sichikudziwika, koma akuganiza kuti kupitirira muyeso kwa mawonekedwe a pro-inflammatory cell ndi machitidwe a magulu angakhale ndi mbali yaikulu.
Madzi m'mapapu amalingalira kuti amayamba chifukwa cha maselo omwe amachititsa kuti tizirombo ta thupi tinyenyeke. Madzi oterewa amatchedwa pulmonary edema , kapena ngati amawonedwa pa zojambula zojambula, pangakhale kutchulidwa kwachisembwere. Zikakhala kuti madzimadzi m'mapapo awerengedwa, nthawi zina amapeza nambala ya neutrophils, mtundu wa selo loyera la magazi.
Odwala awiri omwe anali ndi mapapu awo, anapeza kuwonongeka kwa alveoli-mapepala a mpweya wamapapu-omwe anafalikira mochuluka.
Ochita kafukufuku akuganiza kuti, chifukwa engraftment syndrome imawonekera pambuyo pa mitundu yosiyanasiyana ya opereka ndalama ndi mitundu yosiyanasiyana ya ma grafts, ndipo popeza matendawa angakhale osiyana ndi GVHD ndipo amagwirizana ndi kupulumuka kwa maselo oyera omwe amadziwika kuti granulocytes, mwinamwake amathera pakati pa oyera maselo a magazi ndi zizindikiro zosungira maselo. Kusakaniza kwa maselo ndi kusakanikirana kungayambitse kayendedwe kake kakuyendayenda, chiwalo chosagwira ntchito ndi zizindikiro monga fever.
Kodi Zimapezeka Bwanji?
Dr. Spitzer, wofufuza kafukufuku wa pachipatala cha Bone Marrow Transplant Programme ku Massachusetts General Hospital ku Boston, MA, adafalitsa pepala lamasinema pa engraftment syndrome mmbuyo mu 2001.
Zolinga za Spitzer za engraftment syndrome ndi izi:
Miyezo yambiri:
- Kutentha kwakukulu kuposa kapena kufanana ndi 38.3 ° C popanda chifukwa chodziwika chowopsa
- Kuthamanga kofiira> 25 peresenti ya thupi pamtunda ndipo osati chifukwa cha mankhwala
- Msuzi kapena madzi owonjezera m'mapapu osayambitsidwa ndi vuto la mtima, monga momwe amawonera zithunzi zojambula, ndi mpweya wotsika m'magazi
Njira zochepa:
- Kulephera kwa chiwindi ndi magawo ena (bilirubin ≥2 mg / dL kapena transaminase ≥2 nthawi zonse zachibadwa)
- Kulephera kwa impso (serum creatinine ≥ 2x baseline)
- Phindu lolemera (≥2,5 peresenti ya kulemera kwa thupi loyambirira)
- Chisokonezo cha nthawi / ubongo wosadziwika wosadziwika ndi zifukwa zina
Kuzindikira kumafuna zonse zitatu zazikuluzikulu kapena zikuluzikulu zikuluzikulu ziwiri ndi chimodzi kapena zingapo zing'onozing'ono mkati mwa maola 96 a engraftment.
Palinso njira zina zomwe zimagwiritsidwa ntchito pofufuza matenda a engraftment, komanso. Mwachitsanzo, mayendedwe a Maiolino adayambitsidwa mu 2004. Akatswiri osiyana akuoneka kuti ali ndi malo osiyana siyana kuti adziwitse engraftment syndrome, ndipo zizindikiro zowonjezereka zingabweretse vutoli. Mu 2015, Dr Spitzer adasindikiza zina zomwe zinali "zofanana" ndi "zosagwirizana ndi" engraftment syndrome:
Mogwirizana ndi engraftment syndrome: Matenda osagwiritsidwa ntchito; mphukira; Zizindikiro za mavitamini otsika (kutsika kwa magazi, kulemera kwa thupi, kutupa, madzimadzi m'mimba, madzi m'mapapu osati chifukwa cha mtima wa mtima); impso, chiwindi, kapena kuwonongeka kwa ubongo; ndi kutsekula m'mimba popanda chifukwa china.
Osagwirizana ndi engraftment syndrome: Matenda owopsa chifukwa cha malungo; Kuthamanga ndi zovuta zokhudzana ndi chidziwitso chomwe chimapereka GVHD ngati chotsekera kuchokera kwa wosadzipereka yekha; kupweteka mtima kwa mtima; kupweteka kwa thupi chifukwa cha chifukwa china, (mwachitsanzo, calcineurin inhibitor nephrotoxicity kapena GVHD ya chiwindi); Kutsegula m'mimba chifukwa cha chifukwa china (mwachitsanzo, matenda, chemo poizoni, kapena GVHD).
Kodi Kutengera Kwambiri Kwambiri Kumakhala Motani?
Malinga ndi lipoti la Dr. Spitzer, pafupifupi pafupifupi theka la odwala, engraftment syndrome ingasankhe yekha, ndipo safuna chithandizo. Pamene chithandizo chili chofunikira, engraftment syndrome ikuwoneka kuti ikugwirizana kwambiri ndi mankhwala ochizira odwala omwe amaperekedwa malinga ngati zizindikiro zikupitirira, kawirikawiri pasanathe sabata. Kufunika kwa chithandizo kumasonyezedwa ndi kutentha kwa> 39 ° C popanda chidziwitso chowopsa chodziwika ndi zizindikiro zazikulu za ma capillaries othawa, makamaka madzi owonjezera m'mapapo.
Kodi Ndi Zina Zodziwika Zotani Zokhudza Engraftment Syndrome?
Pali njira zosiyanasiyana zogwiritsira ntchito matendawa, ndipo izi zikhoza kufotokozera ziwerengero zambiri za momwe matendawa amayambira m'magulu osiyanasiyana a odwala omwe amalandira maselo osakanikirana. Dr. Spitzer wakhala akuphunzira matenda kuyambira 2001, ndipo zofalitsa ndi ndemanga za zolemba zamakono zakhala zikufotokozedwa mwachidule mu 2015:
- Matenda otchedwa Engraftment syndrome pambuyo poti maselo a hematopoietic transplantation (HCT) amapezeka kwambiri.
- Njira zosiyana siyana zogwiritsiridwa ntchito zimagwiritsidwa ntchito, ndipo mwachidziwikire zimakhala zowerengera zambiri (zopitirira 7 mpaka 90 peresenti) zomwe zakhala zikuchitika.
- Ngakhale mawonetseredwe a kliniki a engraftment syndrome angakhale ofanana ndi a GVHD yovuta, engraftment syndrome inanenedwa bwino kwa odwala popanda GVHD yovuta.
- Sidziwika ngati matendawa amatsogolera ku imfa yapamwamba komanso kupulumuka koopsa pambuyo pa HCT; Maphunziro achitika, koma deta ikutsutsana.
- Matenda otchedwa Engraftment syndrome amawongolera okha, koma, ngati a GVHD ovuta, amavomereza corticosteroids.
- Chifukwa chakuti engraftment syndrome ndi GVHD yovuta ikhoza kukhala ndi maonekedwe ophatikizana ndi kuyankhidwa kwa mankhwala, njirazi zimakhala zosiyana kwambiri.
- Zizindikiro za engraftment syndrome zikhoza kukhala zofanana ndi za mankhwala ndi mankhwala omwe amachititsa poizoni ndi matenda.
Mawu Ochokera:
Kodi matendawa ndi otani, ndipo ndi mwayi wotani wodwalayo amene angakhale ndi zizindikiro zake? Eya, popeza palibe mgwirizanowu pazinthu zenizeni, m'zipatala, ziwerengero zazikulu za zochitikazo zafotokozedwa m'mabuku, kuyambira pansi pa 7 peresenti mpaka kufika 90 peresenti mu autotransplants (kuzipangira kuchokera kwa mwini monga wopereka). Mapiri apamwamba awonetsedwa pambuyo pa autotransplants kwa malimymasi osati Hodgkin lymphoma . Matendawa angakhudze ana ndi akulu omwe ali ndi chiwerengero chomwecho, koma zotsatira zake zingakhale zazikulu kwa ana ponena za imfa zomwe sizigwirizana ndi kubwerera kwa khansa.
Miyeso ya engraftment syndrome ikuoneka kuti ndi yochepa mwa anthu omwe amalandira kusintha kuchokera kwa osapereka okha. Iyi ndi malo ovuta kufufuza, komabe, chifukwa matendawa angawoneke ngati GVHD yovuta. Mu phunziro limodzi, kuthetsa kwathunthu kwa engraftment syndrome kunachitika mwa anthu 10 peresenti ya maphunziro omwe sanakhalenso ndi GVHD yovuta.
> Zotsatira:
> Franquet T, Müller NL, Lee KS, ndi al. Zotsatira zake zapamwamba za CT komanso zizindikiro za matenda osapatsirana pogwiritsa ntchito mankhwala osokoneza bongo. AJR Am J Roentgenol . 2005; 184 (2): 629-37.
Lee YH, Rah WJ. Pre-engraftment syndrome: chithandizo chamankhwala ndi matenda opatsirana. Magazi Res . 2016; 51 (3): 152-154.
> Omer AK, Kim HT, Yalamarti B, McAfee S, Dey BR, Ballen KK ndi al. Matenda otsekemera pambuyo poti maselo amtundu wa maselo amtundu wa anthemenietiki amatha kufalikira anthu akuluakulu. Am J Hematol 2014; 89: 698-705.
> Spitzer, TR. Engraftment syndrome: lupanga lakuthwa konsekonse la maselo a hematopoietic transplants. Kugwidwa kwa mafupa a mafupa. 2015; 50 (4): 469-75.