Myeloma ndi myeloma zambiri ndi maina osiyana ndi khansa yomweyo. Mawu angapo ndi okhutira ndipo amatanthauza zivundi zambiri zomwe zimapezeka m'mafupa a anthu omwe ali ndi matendawa.
Myeloma, khansa ya m'magazi, ndi lymphoma ndi mitundu itatu yaikulu ya khansa yamagazi kapena malungo a hematologic. Pa zitatuzi, myeloma ndi yosavomerezeka kwambiri. Mwayi wokhala ndi myeloma akuwonjezeka ndi ukalamba ndipo anthu ambiri amene amapezeka kuti ali ndi zaka 60 kapena kuposa. Ngakhale zikhoza kuchitika kwa achinyamata akuluakulu, osachepera mmodzi pa anthu 100 aliwonse ali ndi zaka zosakwana 35.
Kodi Myeloma Ndi Chiyani?
Myeloma ndi khansa yomwe imayamba m'mafupa . Pakati pa anthu okalamba, mafupa ndi mafupa omwe amatha kukhala m'matumba ena. Kumeneku, nthawi zonse zimapanga ndi kutulutsa maselo ofiira atsopano a magazi ndi maselo oyera a mitundu yonse, kutsimikizira kuti muli ndi magazi okwanira.
Komabe, myeloma ndi kansa makamaka ya selo ya plasma s-mtundu wapadera kwambiri wa selo loyera la magazi. Ntchito yaikulu ya maselo a plasma ndiyo kupanga mapuloteni, mapuloteni ochepa kwambiri omwe amatsutsa anthu achilendo omwe amatha kuwononga chitetezo cha mthupi.
Nthenda yambiri yamagazi a plasma imayambitsa ma antibodies osiyanasiyana kuti iwononge nyongolosi imodzi. Mu myeloma, pali 'chingwe' cha maselo a plasma ovuta-makope ambiri a selo la plasma lomwelo mumphuno la fupa amapanga mapuloteni ofanana (mapuloteni a monoclonal kapena M protein ) omwe ali osowa. Chidutswa choopsa cha maselo a plasma sichimayembekezera kuti nyongolotsi ipite; imapanga mapuloteni a M mosalekeza komanso owonjezera.
Momwemo selo labwino la plasma limakhala ndi khansa silinamadziwidwe kwathunthu, koma asayansi akupeza malo. Chofunika kwambiri, tsopano ndikumvetsetsa kuti myeloma ndi ya banja la matenda osiyanitsa maselo a m'magazi. Anthu ambiri omwe ali ndi matenda a maselo a m'magazi am'tsogolo amapanga multipleeloma angapo.
Zizindikiro
Sikuti aliyense amene ali ndi myeloma ali ndi zizindikiro poyamba, kotero kutenga myeloma kumayambiriro kwake kuli kovuta. Zizindikiro zoyenera kuzifufuza zikuphatikizapo zotsatirazi:
- Kupweteka kwa mafupa, makamaka mu msana kapena pachifuwa
- Kutopa
- Kutayika kosayembekezereka
- Matenda opatsirana
- Kusuta, kudzimbidwa, ndi / kapena kusowa kwa njala
- Kukumva ludzu kwambiri
- Chisokonezo kapena ubongo wa ubongo
- Kuvala kapena kufooka m'milingo
Kawirikawiri zizindikiro za myeloma zimagwirizana ndi zotsatira za matenda oopsa komanso / kapena mapuloteni omwe amapanga. Mwachitsanzo:
- Monga maselo osadziwika m'kati mwa mafupa amamanga, kupweteka kwa mafupa, kufooka kwa mafupa ndi kuphwanyidwa n'kotheka, zomwe zingathe kuwonongeka kwa mitsempha.
- Maselo a myeloma atayamba kuyendetsa maselo opanga magazi, anthu amatha kukhala ndi chiwerengero chochepa cha maselo. Chiwerengero chochepa cha maselo ofiira a magazi, kapena kuchepa kwa magazi m'thupi , chingapereke zizindikiro za kufooka ndi chizungulire. Kuperewera kwa maselo oyera a magazi kungakupangitseni kuti mukhale ndi kachilombo ka HIV. Ndipo kufooka kwaplateti kungayambitse vuto la magazi kuchokera kuvulala zomwe sizikanakhala zochepa kwambiri.
- Maselo a Myeloma angawonetse kuti maselo ena amathyola fupa, kutulutsa calcium yomwe ingafike poopsa m'magazi. Amadziwika kuti hypercalcemia, kuchuluka kwa magazi mu calcium kumabwera ndi zizindikiro zake, kuphatikizapo ludzu loopsa / kukodza kwambiri, kusokonezeka, kudzimbidwa kwakukulu, kupweteka kwa mimba, ndi kusowa kwa njala.
- Nthawi zina maselo a myeloma amapanga mapuloteni omwe amawononga impso ndi misempha. Izi zingachititse matenda a impso kapena, ngati zimakhala ndi mitsempha yowopsya, kupweteka, kupweteka kapena kufooka. Kuwongolera koteroko ndi kupweteka mmanja, mikono, mapazi, ndi miyendo zimadziwika kuti ziwalo za m'mimba.
- Kupanga mapuloteni a myeloma kungachititsenso kuphulika kwa magazi-pafupifupi ngati kuwonjezera ufa wochulukirapo wa batter. Izi zimatchedwa hyperviscosity. Ikhoza kuchepetsa kuthamanga kwa magazi kupita ku ubongo ndikuyambitsa chisokonezo, chizungulire, ndi zizindikiro zina.
Kodi Pali Preel-Myeloma?
Matenda oyambirira a myeloma ndi ovuta chifukwa zizindikiro sizikhoza kuwonekera mpaka mtsogolo. Nthawi zina, pakhoza kukhala zizindikiro zosadziwika zomwe poyamba zimayambitsidwa ndi matenda ena. Komabe, asayansi apeza banja la mitundu yosiyana ya maselo a m'magazi, ena mwa iwo angathe kutulukira ku myeloma, monga zotsatirazi:
- Makhalidwe Osaoneka Osakanikirana (MGUS)
- Plasmacytoma, kapena plasmacytoma yokha.
MGUS
Mukakhala ndi makope ambiri a antibody yemweyo, izi zimadziwika kuti monoclonal gammopathy kapena MG. Anthu omwe ali ndi myeloma akhoza kukhala ndi MG, koma osati onse omwe ali ndi MG ali ndi myeloma. Ndipotu, pali mndandanda wautali wa matenda okhudzana ndi kukhalapo kwa MG ndipo ambiri mwa iwo si khansa.
Pamene munthu ali ndi MG koma palibe zifukwa zowonjezera, zimadziwika ngati MG wa chiwerengero chosadziwika kapena MGUS. Sikuti aliyense amene ali ndi MGUS adzapitirizabe kupanga myeloma, koma ena akhoza, chifukwa chake kufufuza chaka ndi chaka n'kofunika.
Ngakhale kuti ndi matenda osokoneza bongo, MGUS imaika chiopsezo chotchedwa myeloma pafupifupi pafupifupi 1.5 peresenti pachaka. Zovuta zimakhala ndi ma selo ambiri a plasma omwe amapezeka m'mphuno la mafupa komanso amakhala ndi mapuloteni apamwamba m'magazi. MGUS nthawi zambiri amaziyang'anitsitsa koma sachitidwa.
Plasmacytoma
Nthawi zina pali umboni umodzi wokha wa chotupa chimodzi cha maselo a plasma. Izi zikachitika, zimatchedwa plasmacytoma kapena plasmacytoma yamtundu wokha, m'malo mwa myeloma.
Pulogalamu ya plasmacytoma ingakhalenso kunja kwa fupa m'thupi lina. Pankhaniyi, amatchedwa extramedullary plasmacytoma. Anthu ambiri omwe ali ndi plasmacytoma okhawo amapitiriza kukhala ndi maulendo angapo a myeloma, kuyang'ana pafupi kwa zizindikiro za myeloma ndikofunikira.
Kodi Chimachitika Chiti ku Myeloma?
Ganizirani za mafupa anu ngati stadium ya mpira yodzala ndi mafani. Wosakaniza aliyense ndi selo ndipo pali mitundu yambiri ya selo. M'sitediyamu iyi, maselo a plasma ndiwo mafani omwe anapatsidwa mbendera kuti azungulira pawonetsere ya halftime. Ndipo selo iliyonse / piritsi ya plasma ili ndi mbendera yosiyana, yomwe ikuyimira wodwala wodwalayo womwe umapanga.
Mu thanzi labwino, mafupa ena amaposa maselo a plasma. Choncho, m'bwalo lathu, ambiri mafani alibe mbendera zakuda. Komabe, pali mafanizi okwanira ndi mbendera zapamwamba kuti azisunga masewerawo pafupi ndi mthunzi uliwonse wa mtundu uliwonse-mitundu yosiyanasiyana ya ma antibodies.
Tsopano taganizirani kuti selo imodzi ya plasma yokhala ndi imvi imatuluka ndipo imatha kudzimangiriza, imakhala mafanizi ofanana, omwe ali ndi mbendera yoyera. Kenaka awiri amakhala anai, anai amodzi, ndiponse-onse akukhala ndi zigoba zakuda. Potsirizira pake, pali njira zowonjezera zazizindikiro zazikulu kuposa zoyenera. Mankhwala a imvi amaimira mapuloteni ambiri omwe amapanga mapuloteni okhaokha kapena mapuloteni amtundu wa M - chifukwa amachokera ku chinthu chimodzi chomwe chimayambitsa maselo. Kuchuluka kwa mapuloteni a monoclonal m'magazi kapena mkodzo ndi chinthu chomwe chingapezeke mu mayesero a labu.
Tsopano talingalirani kuti selo limodzi kuchokera ku nthendayi yoipa imabwera kukagula zakumwa, koma kenako kubwerera kumalo osayenera, ndikupitirizabe kudzimangiriza. Nkhumba imayambira mu gawo latsopano, ndipo kachiwiri zimakhala zinayi, zinayi zimakhala zisanu ndi zitatu, ndi zina zotero.
Maselo oopsa a maselo a plasma angayambe kutenga masewerawo. Amagwiritsa ntchito mipando ndi magawo omwe ankakhala ndi maselo abwino, monga omwe amapanga maselo ofiira, maselo oyera, maplatelet, komanso maselo ena a plasma okhala ndi mbendera za mtundu. Choncho, pamene chiwerengero cha majalu a imvi akuwonjezeka, chiwerengero cha zigoba zachilendo, zopangidwa ndi polyclonal zimatha kuchepa.
Ndipo magulu oopsa angakhudze maselo ena oyandikana nawo pabwalo. Maselo a plasma akhoza kumasula amithenga amachimake omwe amachititsa "mafani" pafupi kuti azichita molakwika. Zina mwa izo (osteoclasts) ziyamba kuyendetsa mu simenti ya masewera ( fupa resorption ), kumasula mitambo ya phulusa (calcium) yomwe imafalikira ponseponse pamasewu ndi kumbali (mwazi).
Mitundu
Pamene myeloma ikukula, ikhoza kutulukira ndikufutukula mosiyana mwa anthu osiyanasiyana. Ena mwa mawu omwe amagwiritsidwa ntchito polemba myeloma ndi awa:
- Asymptomatic Myeloma
- Smoldering Myeloma
- Chizindikiro kapena Active Myeloma
- Mzere Wowala Myeloma
- Nonsecretory Myeloma
- Myelomas ya mitundu yosiyanasiyana ya mitundu yosiyanasiyana ya majini
Asymptomatic vs. Smoldering vs. Ogwira Ntchito / Chidziwitso Myeloma
Kwa anthu ena, pali "pakati" gawo la matenda-mkhalidwe pakati pa MGUS ndi yogwira myeloma, ndiko. Izi zikachitika, zimatchedwa kuti myeloma ndipo nthawi zina, pali zizindikiro zochepa za matenda omwe amagwira ntchito kapena myeloma ndi yolimba.
Pakumanga myeloma, mafupa amadzaza ndi maselo ena a plasma. Pafupifupi 10 peresenti kapena kuposa ma selo a marrow akhoza kukhala ochokera ku myeloma clone ndi / kapena M mapuloteni amakhala aakulu kuposa 30 g / L. Komabe, pakamwa fungo langa, pakadalibe kuchepa kwa magazi, kusagwedezeka kwa impso, kutsika kwa kashiamu m'magazi, ndipo palibe malo ophwanyika a fupa. Smoldering myeloma kawirikawiri amawonedwa koma samachiritsidwa; Komabe, ochita kafukufuku akuyang'anitsitsa phindu loperekera kuchipatala nthawi zina.
Chizindikiro kapena chithandizo cha myeloma chiyenera kuchiritsidwa. Pali mapuloteni a M m'magazi kapena mkodzo komanso kuchuluka kwa maselo a m'magazi mumphuno. Mawanga owoneka amatha kuoneka m'magawo ena, kufooketsa mafupa, kuwapweteka, ndi kuonjezera chiopsezo cha zophulika. Ndipo, zinthu zomwe ziripo pofotokoza kufota myeloma kuchokera pamwamba zingakhale zogwira ntchito mu myeloma yogwira ntchito.
Mapuloteni Athandizira Kuyika Myeloma
Mitundu ya mapuloteni maselo a myeloma amathandizanso kudziwa mtundu wa myeloma. Ma antibodies ndi mapuloteni akuluakulu omwe ali ndi zigawo zosiyana kapena maunyolo. Mbali zolemera, kapena unyolo wolemera, ndi mbali zochepa, kapena mitsempha yofewa, onse amasonkhana pamodzi kuti apange wodwala wodwala umodzi.
Pogwiritsa ntchito anti-antibody kapena immunoglobulin, unyolo wolemetsa amadziwa kalata yomwe imabwera pambuyo pa immunoglobulin (Ig). Kotero, mwachitsanzo, gawo lolemetsa kwambiri lomwe limapezeka mu mapuloteni a myeloma ndi IgG, lomwe limaimira pafupifupi 60 mpaka 70 peresenti ya milandu ya myeloma. Chotsatira ndi IgA. Kawirikawiri, IgD kapena IgE zingakhudzidwe.
Nthawi zina, maselo a myeloma amatha kupanga ma antibodies okhaokha kapena amatha kusungunula mitsempha yochepa chabe. Izi zimatchedwa mapuloteni a Bence-Jones ndipo ndi ochepa kwambiri moti nthawi zambiri amadutsa impso mumtsinje. Pafupifupi 20 peresenti ya milandu yonse ya myeloma imatulutsa mitsempha yochepa chabe.
Pafupifupi theka la magulu onse a myeloma samatulutsa mapuloteni okwanira A kapena mapuloteni omwe amatha kuwoneka. M'mayeserowa, mayesero ovuta kwambiri amagwiritsidwa ntchito kapena zizindikiro za myeloma komanso kupeza kwa maselo osadziwika a plasma mumtsinje kumayambitsa matenda.
Mitundu Yachibadwa
Pali mitundu yosiyana ya majini yomwe imayambitsidwa ndi myeloma. Zotsatira za DNA zakhala zikuwerengedwa kotero kuti zimadziwika, kuti, kuti kukhala ndi chimodzi mwa izi zowonongeka kwa majini kungakhudze kapena kulosera momwe matenda anu angayankhire ndi mankhwala . Ochita kafukufuku akuyembekeza kuti kufotokozera kwa mitundu imeneyi kudzapitiriza kuthandizira patsogolo pa mankhwala a myeloma.
Zimayambitsa
Nthaŵi zambiri, asayansi samadziwa bwino momwe myeloma imayambira . Mitengo imasiyana mosiyana-mtundu wa Afirika-Achimerika oposa Caucasian-Achimerika ndi Caucasian-Achimerika oposa Achimwenye-Amwenye-koma zifukwa sizidziwika. Zina mwa kusintha kwa majini m'maselo a plasma azindikiritsidwa, koma chomwe chimapangitsa kusintha kumeneku kumakhala kosavuta nthawi zonse.
DNA imatulutsidwa mu DNA, yomwe imaphatikizidwa mu mitundu iwiri ya ma chromosomes. Mu maselo a myeloma ena, mbali ya chromosome nambala 13 ikusowa, yotchedwa kuchotsedwa. Zotsalirazi zikuwoneka kuti mankhwalawa ndi osagwiritsidwa ntchito kwambiri.
Pafupifupi 50 peresenti ya anthu omwe ali ndi myeloma, khungu lachilomboli limakhala ndi chromosome ndi chimene chimatchedwa translocation-gawo limodzi la chromosome lasintha ndi gawo la chromosome m'maselo a myeloma. Pamene kukonzanso kotereku kumayambitsa matenda aakulu, imatha kulimbikitsa kuvulaza.
Ochita kafukufuku amakhulupirira kuti zovuta zina m'maselo ena zimatha kugwira ntchito mu myeloma. Mwachitsanzo, maselo ena oteteza ku chitetezo omwe amatchedwa maselo a dendritic akhoza kupanga zizindikiro zamagetsi zomwe zimayambitsa maselo abwino a m'magazi kukula. Choncho, kufotokoza mopitirira malire ndi maselo a dendritic kungathandize kuti chitukuko cha myeloma chikule.
Kudziwa
Ngati zizindikiro zikutsutsana ndi myeloma, mayeso a ma laboni okhudza magazi ndi / kapena mkodzo, malingaliro a mafupa, ndi mafupa a mafupa amachitidwa.
Mayesero a Magazi
- Complete Blood Count (CBC): Izi zimaphatikizapo kuwerengetsa maselo a magazi osiyanasiyana osiyanasiyana kuti mudziwe ngati nambala yanu imakhala mkati mwachibadwa kapena chachilendo. Maselo a myeloma akafalikira m'mafupa, zina mwazigawo za magazi zimakhala zochepa. Kuchuluka kwa maselo ofiira a m'magazi ndiwowonjezera.
- Mankhwala a Immunoglobulins (Ig) Quantification: Kulemba kwag kugwiritsidwa ntchito kuti tiwone ngati pali mitundu yambiri ya ma antibodies, omwe ali owonjezeka kwambiri-IgA, IgD, IgE, IgG, ndi IgM. Mu myeloma, imodzi mwa izi zikhoza kukhala zapamwamba ndipo zina zingakhale zochepa kuposa zachibadwa. Njira zina ndizotheka.
- SPEP ndi UPEP: Izi zikutanthauza seramu protein electrophoresis ndi mkodzo wamapuloteni electrophoresis. Mayeserowa angathe kudziwa ngati pali puloteni yokhala ndi pulogalamu yamagetsi yokha kapena yogwiritsidwa ntchito.
- Mipanga Yoyera Yam'manja: Mayesowa amachititsa chiwerengero cha mitsempha yofewa m'magazi. Izi zikhoza kuchitika, mwachitsanzo, mwa wodwalayo ndi myeloma yemwe palibe Puloteni Yomwe imapezeka ndi SPEP.
Matenda a Marrow Amayesa ndi Ziopsezo
Anthu omwe ali ndi myeloma amakhala ndi maselo ambiri a m'magazi mumtambo wawo. Choncho, fupa la mafupa ndi zokhumba zimapangidwira kuti aone zomwe zilipo ndikupeza zitsanzo. Zitha kuchitidwa ku ofesi ya dokotala kapena kuchipatala. Zitsanzo zamakono zimayang'aniridwa ndi munthu wodwala matenda odwala matendawa ndipo amayamba kuyesa ma laboratory.
Kuyeza kwa Mafupa a Khansa
Kuyezetsa magazi kumachitika kawirikawiri pa maselo osadziwika ngati gawo la kufufuza ndi kuunika kwa myeloma. Kusanthula kwa Cytogenic kumatanthawuza mayesero omwe amayang'ana kusintha kwa ma chromosomes a maselo a myeloma.
Zosinthika zina ndi zina zowonongeka kwa majeremusi zimathandizanso madokotala kulongosola momwe matenda amatha kukhalira. Zoyezetsa zosiyanasiyana zosiyana zimapezeka ndipo zimagwiritsidwa ntchito pofufuza kansa ya munthu kamodzi pamene maselo amapezeka.
Chimake cha Amyloid
Maseŵera apamwamba a mapuloteni oteteza kachilomboka amachititsa odwala a myeloma pangozi yoti apange amyloidosis. Amyloid ndi chinthu chomwe chingamange mu minofu iliyonse ndi biopsy kumathandiza kupeza matendawa. Kawirikawiri, izi zimaphatikizapo kugwiritsa ntchito singano kuchotsa mafuta ena amimba.
Kujambula ndi Kujambula
Maselo a Myeloma amadziwika kuti amatha kupanga zinthu zotchedwa lytic zilonda m'mafupa. Amatha kulandira maselo ena otchedwa osteoclasts kuti awononge fupa kapena kuchititsa malo ofewa m'malo ochepa a fupa.
Nthawi zambiri mafupa a x-ray omwe amaphatikizapo mafupa ambiri amatha. Poganizira za mtundu umenewu, amadziwika ngati kufufuza mafupa kapena mafupa. Mitundu ina ya malingaliro ingakhale yothandiza makamaka pazinthu zina, monga kupeza plasmacytomas yomwe silingakhoze kuwonedwa pa x-ray.
Nthawi Yomwe Muwone Dokotala
Ganizirani kupanga nthawi ndi dokotala ngati muli ndi zizindikiro zomwe zikukudetsani. Zizindikiro za myeloma zikhoza kukhala zosavuta komanso zopanda pake.
Ngati mwapezeka kuti muli ndi MGUS kapena muli plasmacytoma okha, nkofunika kuti inu ndi dokotala mupitirize kuyang'ana pa zinthu monga matenda a maselo a plasma angathe kupita ku myeloma. Nthawi zonse funsani dokotala mafunso omwe mungakhale nawo ponena za chikhalidwe chanu.
Mawu Ochokera
Ngati inu kapena wokondedwa wanu mwamsanga mwapezeka ndi myeloma, ndi zachilendo kumva chisokonezo, kukwiya, kukhumudwa, kapena zonsezi. Kuyeza khansa ndiko kusintha kwa moyo m'njira zambiri . Zingathandize kumva nkhani za anthu ena. Maphunziro otha kupulumuka, misonkhano, komanso mafilimu ndi njira zabwino kwambiri zogwirizanirana ndi ena omwe angagawane zovuta zanu kapena kukhala ndi zofanana ndi zomwe mukuzidziwa.
> Zotsatira:
> Hengeveld PJ, Kersten MJ. B-cell activating factor mu matenda a myeloma angapo: cholinga cha mankhwala? Magazi a Magazi a Magazi. 2015; 5 (2): e282-.
> Sonneveld P, A. A. Kuchiza kwa kubwereranso ndi kutsutsa multiple myeloma. Haematologica. 2016; 101 (4): 396-406.
> Palumbo A, Anderson K. Multiple myeloma. N Engl J Med. 2011; 364 (11): 1046-1060.