Chinachake chimene anthu okhala ndi lymphoma ndi mitundu ina ya khansa ya magazi nthawi zambiri amagwira nawo, kaya ndi mbali ya matenda awo kapena ngati mankhwala othandizira, amachepetsa chitetezo cha mthupi komanso kutenga kachilombo ka HIV. Nthawi zina anthu omwe ali ndi khansa ya magazi ali ndi magawo osadziwika a tizilombo toyambitsa matenda pamene ena ali ndi magulu angapo okhudzidwa (IgA ndi IgG ndi magulu awiri a ma antibodies opangidwa ndi maselo ena a maselo oyera a thupi ; IgM ndi kalasi yachitatu).
Kodi zotsatira za izi zimakhala zovuta bwanji, ndipo angachiritsidwe bwanji?
Matendawa Angathe Kukhala ndi Mavuto Osalongosoka
Matenda opatsirana, makamaka matenda opatsirana, amapezeka kwa odwala omwe ali ndi Waldenström , mtundu wa non-Hodgkin lymphoma , ndipo angakhale okhudzana ndi kukhalapo kwa ma antibodies-koma zimadalira.
Ponena za anthu omwe ali osowa mu IgA (yomwe ili ndi mbali mu thupi lomwe lili ndi ziwalo zamkati, monga kukwera kwa airways), chiyanjano cha matenda opatsirana kawirikawiri sichiwoneka kukhala cholimba. Ndipotu, anthu omwe ali osowa m'gulu lino la anti antibody okha nthawi zambiri alibe zizindikiro.
Madokotala nthawi zambiri amayesa ma ARV . Mwachitsanzo, Jennifer Killam, yemwe anapulumuka ku Waldenström, wapuma pantchito ya Air Force Major, adanena kuti payekha nambala ya antibody yake inali yovuta. "Madokotala anga amafunika kufufuza nthawi zonse pamagulu anga a antibody-IgA, IgG, ndi IgM.
Miyendo yanga ya IgM ikulamulidwa, koma sindiri kukhululukidwa, "adatero Killam.
Mu mtundu wa Major Killam wa lymphoma, ndi mitundu yambiri ya khansa ya magazi, maselo odwala amachititsa kuchuluka kwa mapuloteni a antibody omwe amalowa m'magazi; M'malo mwake, ndi mankhwala ochuluka kwambiri a anti-IgM.
Chimodzi mwa mankhwala ake akuyesetsa kubweretsa magawowa kuti akhale oyenera. Ngakhale kuti mbali zake za IgM zili pansi pano komanso ali ndi thanzi labwino, maginito ake a IgG ndi otsika kwambiri-ndipo IgG ndiwopambana ndi anti-antibody.
Miyendo yachibadwa ya IgG ili pamwamba pa 800 mg / dL. Madontho akulu a Killam mpaka 200 mg / dl, omwe amachititsa kuti akhale ndi matenda ambiri. Kotero, masabata asanu ndi limodzi amapita ku City of Hope Medical Center kwa maola anayi kapena asanu kuti apeze magulu ake a IgG. Amalandira mankhwala otsekemera otchedwa IVIG.
Mankhwala a IVIG
IVIG kwenikweni ndi mankhwala omwe akhalapo kwa zaka makumi ambiri ndipo amagwiritsidwa ntchito kuchiza odwala okhala ndi mitundu yosiyanasiyana ya matenda. Vuto la IV limayimirira ndipo IG imayimira immunoglobulin (dzina la sayansi la mapuloteni oteteza thupi).
IVIG inayamba kuwonetseredwa kuti ikugwira ntchito mu matenda otchedwa autoimmune idiopathic thrombocytopenic purpura (ITP) mu 1981. Kuyambira apo, mndandanda wautali wa matenda omwe akuwoneka kuti akuyankhidwa bwino ndi IVIG wakhala ukukula. Chimodzi mwa ntchito zazikuluzikulu za IVIG ndikutengera mawonekedwe a antibody, koma izi ndizochepa chabe.
Mankhwalawa ndi mankhwala omwe angapachike mu thumba kuti athetse madzi m'mitsempha. Amapangidwa kuchokera ku pulasitiki yaumunthu, yomwe imatanthauza matumbawa ali ndi ma antibodies a IgG ochokera kwa anthu osiyanasiyana, opereka chithandizo chamitundu zosiyanasiyana, komanso mankhwalawa ali ndi zopitirira 95 peresenti zosagwirizana ndi IgG, ndipo amangowerengera ma immunoglobulin A (IgA) kapena immunoglobulin M ( IgM).
Kusonkhanitsa kwa matenda omwe amachitirana ndi IVIG ndiwodabwitsa ndipo mndandanda mwina umasonyeza kufunika kokhala ndi thanzi labwino m'thupi la mitundu yonse.
Zochita za mankhwala a IVIG
Nazi chitsanzo cha ntchito za IVIG.
Kuchulukitsa thupi: Izi zimaphatikizapo zinthu zomwe anthu amabadwa nazo komanso matenda omwe amachititsa kuti chitetezo cha mthupi chitengeke ngati chronic lymphocytic leukemia (CLL) ndi multipleeloma. Zina mwazi ndizo zimbudzi zomwe zimapanga malinga ndi ndondomeko pamene mankhwala amachiza thupi.
Matenda: Nthawi zina, nthawi zina munthu amakhala ndi matenda opatsirana kawirikawiri kapena amodzimodzi omwe angapindule ndi IVIG.
Matenda ena a mavairasi, monga matenda aakulu a parvovirus ovuta ndi kuchepa kwa magazi, amapezeka m'gulu ili.
Zinthu Zomwe Zimapangitsa Munthu Kugonjetsa / Kutupa Kwambiri: Kuphatikiza pa kudzipangira mtundu wa idiopathic thrombocytopenic purpura, umene IVIG inayamba kuwonetsa bwino mu 1981, zizindikiro zina monga matenda a Guillain-Barré, matenda a Kawasaki, ndi matenda opatsirana pogonana a mitsempha akuphatikizidwa m'gulu lino.
Zochitika Zina: Matenda ena omwe amachititsa mitsempha, yotchedwa matenda aakulu a neuropathies, amatha kusintha bwino ndi IVIG. Zomwe zimawotchedwa ndi kutulutsa thupi komanso zotsitsimutsa ziwalozo zimagwiranso ntchitoyi.
Kukhala ndi Waldenström's, Kuchita ndi Malonda a Zamalonda
Major Killam adanena kuti, panthawiyi, matenda ake ndi okhazikika. Mankhwala ake amubweretsa magawo a IgM pansi kotero kuti sayenera kudandaula zambiri za mavuto ena omwe amakhala nawo chifukwa chokhala ndi IgM yambiri.
Pamene puloteni yambiri imalowa m'magazi, madokotala amada nkhaŵa ndi chinachake chomwe chimatchedwa hyperviscosity syndrome, kapena HVS. Zizindikiro za HVS zimaphatikizapo zinthu zitatu: kutuluka mwazi mu mucosa, kapena kuyala kwa ziwalo zosiyanasiyana, kusintha kwa maonekedwe, ndi zizindikiro zomwe zimapangitsa dongosolo la mitsempha kukhala gwero lawo. Zizindikiro zambiri za thupi kuphatikizapo kutopa, kutaya thupi kapena kutentha thupi kungakhaleponso.
Mankhwala ochiritsira matenda a lymphoma amakhalanso opanda zotsatira zake. Zina mwa mankhwala atsopano am'mamwa zimakhudza kapangidwe kakang'ono ka m'mimba, ndi kutsegula m'mimba kapena kudzimbidwa.
Pankhani ya Killam yayikulu, sikuti amachititsa kuti azipita yekha koma amatha kukhala ndi regimen, ndipo amachokera ku mitundu yosiyanasiyana ya mankhwala, kuphatikizapo mankhwala ochiritsira, kuchiritsa, kuchira, kuchira, ndi yoga.
"Zonse zandithandiza pa thanzi langa-komanso moyo wanga. O, kuseka-kuseka kumathandiza kwambiri. Choncho nthawi zina ndimangoyang'ana pagalasi ndikuseka. "
> Zotsatira:
> Hunter ZR, Manning RJ, Hanzis C, et al. IgA ndi IgG hypogammaglobulinemia mu macroglobulinemia ya Waldenström. Haematologica . 2010; 95 (3): 470-475.
> Gelfand EW.Intravenous immune globulin mu matenda omwe amachititsa kuti munthu azidwala matendawa. N Engl J Med . 2012 Nov 367 (21): 2015-25.