UGawulayo kunye ne-High-Dose Steroids Inokubangela ukuba i-Immunosuppression
Kungekudala, ngenxa yokuqaliswa kwezidakamizwa ezintsha ze-immunosuppressant kunye nokunyuka kwenani lezinto ezihambayo, siye sabona abantu abaninzi abangenakuxilongwa okanye abangenakukhubazeka.
Umzimba womzimba kukuqokelelwa kwazo zonke iiseli, izicubu, kunye nezitho ezenza umzimba uphuse isifo. Ngaphandle kwesistim somzimba esilungileyo, umntu uhlaselwa kwilizwe langaphandle.
Noko ke, izigulana zamachiza amaninzi ezithintekayo zokugonywa kweempawu zonyango, zizathu esinye sezizathu zokubangela ukuba abantu bangabi namagxininiso okanye baxhomekeke kwi-immunocompromised. Ewe, ezinye izinto ezimbi zingaphazamisa isistim somzimba, kwakhona, kuquka i- AIDS kunye nezifo ezizuze njengefa.
Yisiphi i-Immune System?
I-immune system yakho ikhona ukukhusela okanye ukusuleleka. Iiseli kunye neendlela zendlela yokuzivikela omzimba ziyinkimbinkimbi kwaye zihluke kwaye zihlupha zonke iinxalenye zomzimba.
Nazi izixhobo ezihlukeneyo zesistim somzimba:
- Umnatha wethambo apho yonke into emnandi iqala khona. Umongo wethambo uqulethe iiseli ezinokuthi ziya kuba ziindidi ze-immune (iiseli ze-B, iiseli ze-T, i-lymphocytes, njalo njalo).
- Akukuphela nje kwesikhumba umzila wokuqala wokuzikhusela ukuhlambalaza kwihlabathi langaphandle, kodwa iindawo ezithile zesikhumba (njenge-dermis) nazo zizityebi kwiiseli zomzimba. Ukongezelela, ulusu luvelisa iiprotheyini ezinamagciwane.
- Kukho amajoni omzimba amaninzi kwigazi. Enyanisweni, iimvavanyo zegazi zisetyenziselwa ukubeka i-immunity.
- I-lymphatic system izaliswe ngamaseli omzimba. I-lymphatic system iyakhupha igazi kunye nezicubu ezisemzimbeni wonke kwaye isebenza njengomgwaqo omkhulu wokuthuthwa kwamaseli omzimba. La maseli omzimba aguquka kwii-lymph nodes. Ngaphakathi kwe-lymph nodes, ukuphendula komzimba kusebenze xa i-microbes ifunyanwa.
- Uhlobo olusisiseko lwe-immune type oluvumela ukuba sivumelane neengongelo ezibangelwa usulelo nguT-cell. Nangona i-T-seli iqala ukuveliswa kwintsipho yethambo, iyaqhubeka ikhula kwi-thymus.
- Abantu baphila ngaphandle kwe-spleens (asplenia yintetho yezokwelapha ngenxa yokungahambi kweseyile okanye umsebenzi we-splenic). Nangona kunjalo, i- spleen inceda ukulungiselela umzimba ukusuleleka, kunye nabantu abangenawo utyholongwane banako ukuhlakulela ukusuleleka kwiintsholongwane ezithile ezifana ne-meningococci (cinga ngeminitisitis), iStreptococcus pneumoniae (cinga i-pneumonia) kunye ne- Haemophilus influenzae , okanye iH influenza . Nceda uqaphele ukuba ngaphandle kwegama layo, iH influenza ayibangeli umkhuhlane kwaye endaweni yoko ibangela ukusuleleka kwintsholongwane yokuphefumula kubantwana. I-spleen isebenza njengecilisi yomzimba, kunye neengqambela zamaseli omzimba kwi-spleen ukubeka iliso kwigazi ngempawu zentsholongwane. Ukuba usulelo lukhona, i-spleen isebenza ukuphendula ngomzimba.
- Njengekhumba, izicubu ze-mucosal, ezinjengezo zifunyenwe kumacandelo omzimba kunye nokuphefumula, yinto yokuqala yokukhusela ekhusela iintsholongwane ukuba zingene emzimbeni. Ngaloo ndlela, izicubu ze-mucosal zizityebi kwiiseli zomzimba.
I-State State Immunosuppression
Ukuncitshiswa kwe-immune system kuxhomekeke kwizinto eziliqela. Ngokubanzi, umgangatho womntu womnxeba wokuzifakela umzimba ulandelwa emva kokuqwalasela ezi zilandelayo:
- uhlobo lwe-immunosuppression (okwesibini kumachiza okanye ukugula)
- ixesha lokuxilongwa kwe-immunosuppression
- ubunzulu be-immunosuppression
- umlinganiselo kunye neentlobo zee-immunosuppressant agents okanye iziyobisi
- ama-immunodeographical innate (izifo ezizuze njengefa ezixhatshazwayo ngamajoni omzimba omzimba)
- izinto ezibangelwa ukuphazamiseka (njengemithombo engafanelekiyo ye-lymphatic eyesiqhelo kwindlela yokuhlinzwa okanye i-radiation)
- sulelo (cinga i-HIV okanye i-CMV)
Ukunyuswa kwe-Immunosuppression Ukusuka kwiMida
Uninzi lwamachiza lugxotha umzimba. Ezi ziyobisi zingasiphazamisa iindlela ezininzi zokuphendula ngamagciwane okanye ukujoliswa kweentlobo zamaseli omzimba omzimba.
Nazi iyeza ezi-3 ezingaphazamisa isistim somzimba:
- Corticosteroids . Ezi zonyango zimiselwe iintlobo ezahlukeneyo zokuzimela, izifo ezinobungozi kunye nezimo ezivuthayo, ezifana ne-rheumatoid arthritis, izifo zesibindi sokuvuvukala, isifo se-asthma kunye ne-atopy. Ngexesha elifutshane, la mayeza aphazamisa umsebenzi weseli omzimba. Ngokukodwa, i-corticosteroids iyanciphisa inani leemilphocyte kunye ne-monocytes kunye nokukhutshwa kwe-phagocytes migration kunye nomsebenzi. Imiphumo emide yale mizuzu iquka ukunqanda kwesikhumba kunye nokukhubazeka kokulungisa izicubu zomzimba, zombini ezo ziyakwandisa ukwanda kwe-immunosuppression. Abantu abakwii-dosage eziphezulu ze-steroids banokusuleleka kwiintsholongwane zezinto eziphilayo, ezifana ne- Pneumocystis jirovecii , ebangela ukuba i- Pneumocystis pneumonia , kunye ne- Strongyloides , eyingozi kwaye ibangelwa yimivungu. Ukongezelela, abantu abaneendlela zokuzivikela ezibuthathaka kwi-steroid ezisetyenziswayo basengozini yokuvuselelwa kwesifo sofuba okanye ezinye izifo ezithintekayo.
Rituximab. I-anti-monoglonal antibody kwi-CD20 isetyenziselwa ukuphatha i-non-Hodgkin lymphoma, i-rheumatoid arthritis, kunye ne-lymphocytic leukemia engapheliyo. Ngexesha lovavanyo lweeklinikhi, i-rituximab yayinganyaniseki kwengozi yokwanda kwesulelo. Nangona kunjalo ukususela ekubeni i-rituximab sele isemakethe, kunjalo ke kukho iingxelo zomntu (i-anecdotal) ezidibanisa i-rituximab ukulawulwa kwezifo ezinqabileyo ezinjenge-letifencephalopathy, enokubangelwa yi-JC, kunye ne-aplasia ebomvu ecocekileyo, edibene ne-parvovirus . Ukongezelela, ukunyanzelwa kwe-immunosuppression kwinqanaba lokulawula i-rutiximab kungakhokelela ekusebenzeni kwakhona ukusuleleka kwe-hepatitis B.
I-Norrosis Factor-Alpha (TNF-α) Inhibitors. Ezi zonyango ziyi-cytokines; ii-cytokines zivame ukuveliswa ngamaseli omzimba. I-TNF-α inhibitors ziquka izidakamizwa ezinjenge-infliximab, i-certolizumab pegol, kunye ne-antibodies ze-monoclonal kwaye zisetyenziselwa ukunyanga iimeko ezizimeleyo njenge-rheumatoid arthritis kunye nesifo se-Crohn. Ingqalelo, ukukhutshwa komzimba okubangelwa ukulawulwa kwezi zonyango kuvulwa umnyango wokusuleleka ku- Listeria monocytogenes , i-pathogen yokutya engabangela ukufa kwabantwana abakhulelweyo.
Ukunyuswa kwama-immunosuppression Ukusuka kwi-Asplenia
Ukutshatyalaliswa kokutshitshiswa kwepeni kuthiwa "u-splenectomy." Kukho izizathu ezininzi zokuba umntu angashenxiswa yipeni, kuquka nomhlaza, ukuxhwaleka, kunye nokuphazamiseka kwegazi (njenge-purpura ye-idiopathic thrombotic purpura). Igama lonyango elithi "asplenia" alubhekiseli kuphela ekususweni kwetyeni ngokusebenzisa i-splenectomy kodwa kunye nokulahleka komsebenzi we-splenic kwimiqathango efana ne-antenia ye-sickle cell.
Abantu abane-asplenia banomngcipheko ophezulu wokusuleleka kwintsholongwane efana ne- Streptococcus pneumoniae , i- Haemophilus influenzae , kunye neendlela ezithile ze- Neisseria meningitides . Kula bantu, isifo esichengayo singasetha ngokukhawuleza - ngakumbi xa kuthengiswa i-sepsis okanye isifo segazi. I-Sepsis ixhaphake kakhulu kubantu abane-splenectomy esecaleni kumdlavuza (ukungcolisa) kunokuba kubantu abaye baphulwa emva kweengozi (ingozi). Ingqalelo, umngcipheko wokusuleleka kwimizimba ekhutshweyo yinto enkulu kuninzi kwiminyaka embalwa yokuqala emva kwe-splenectomy.
Ukunyuswa kwamanyathelo emva kokutshintshwa
Kukho iintlobo ezi-2 zokuguquka: ukuguqulwa kwesitampu se-stem kunye nokuguqulwa kwamalungu. Zombini ezi ntlobo zokuguquka zibangelwa ukunyuswa kwe-immunosuppression.
Ukutshintshwa kweesitembile zesitampu bekuye kwabizwa ngokuba yi-bone marrow transplants kuba amangqamuzana angama-stem, okanye iiseli ezingenakuchaphazeleka ukuvelisa zonke iindidi zegazi zegazi, zakuba zivunwa kuphela kumnatha wethambo. Ngenxa yentuthuko yezokwelapha, ngoku siyakwazi ukucoca iiseli ezinokuphuma kwigazi. Ukutshintshwa kweseli yentsholongwane yenziwa njengonyango lweentlobo ezithile zeengqimba zegazi, kuquka i-lemonemic i-lymphocytic i-leukemia, ngokuqhelekileyo, abantu abanezifo sele bevelele kwizonyango ezinzulu zonyango kwaye sele sele bengenakuxilongwa.
Ukuguqulwa komzimba ngokubhekiselele kubhekisela kwiziganeko ezinjengeentliziyo, izintso, okanye isibindi. Abantu abafumana ukuguqulwa kwamalungu amaninzi badinga ukunyanga ngonaphakade ngamachiza omzimba wokunciphisa umngcipheko wokulahlwa.
Ngethuba lwenyanga yokuqala yokubuyiselwa kwisilwanyana sokufakelwa komzimba, ummkeli wokutshintshisa unomdla kakhulu osuleleke kwisifo soqhagamshelwano. Izifo eziqhelekileyo ngeli xesha zibandakanya izifo zokungena emanzini, izifo zesikhumba, kunye nokusuleleka. Phakathi kweenyanga 2 no-6 emva kokuhlinzwa, abafakiweyo abathintelayo basengozini yokufumana iintsholongwane kunye ne-reactivation of herpes virus okanye ezinye izifo ezithintekayo. Emva kweenyanga ezintandathu emva kokutshintshwa nokugqithisa, abafumanayo banokungenelwa yizifo ezifana nezo zibangelwa zizidalwa ezifihliweyo (cinga iStreptococcus pneumoniae kunye neHaemophilus influenzae ).
Ukunyuswa kwama-immunosuppression okubangelwa yi-Innate Immunodeficiency
Ngamanye amaxesha abantu badla izifo zofuzo ezibangelwa sisifo se-immune. Uninzi lwezi zixhobo ezingundoqo ze-immunodeographical are rare and diagnostic in the early age, efana nokuxilongwa kwe-immunodeficiency kunye nokugula okungapheliyo. Nangona kunjalo, i-variable-immunodeficiency (i-CVID) eqhelekileyo ixhaphake kwaye ivelisa ebusheni kunye nabantu abadala.
Nge-CVID, amaseli omzimba ahluleki ukuvelisa i-immunoglobulins eyimfuneko ukukhupha impendulo yomzimba. Ngenxa yoko, abantu abaneCVID banokuthi bafumane ubunzima bokusuleleka kwizifo zokuphefumula kunye nokusuleleka kumathumbu njengoGiardia lamblia .
Unyango lweCVID luyinkimbinkimbi kwaye lufuna unonophelo lwengcali ngenxalenye yokuba abantu abanalo mqathango abaphenduli ukugonywa kwaye kunokuba badinga ukunyuswa kwe-immunoglobulin kwisilwanyana esibhedlele.
Ukunyuswa kwama-immunosuppression okubangelwa yi-Infection
Ukunyanzelwa kwe-immunosuppression kungekudala nje kubangele ingozi yokusuleleka kwintsholongwane kodwa kunokubangelwa nezifo ezithile. Ngokomzekelo, i-cytomegalovirus (i-CMV), edla ngokubangela ukuba akukho zibonakaliso okanye iimpawu ze-mononucleosis-zihlobo kubantu abanamasosha omzimba aqhelekileyo, banokuphazamisa isimiso somzimba-mzimba kulabo abasesigxina. Ngokukodwa, i-CMV imiyalezo kunye neeseli ze-T, ezibandakanyeka ngokuthe ngqo kwiimpendulo zomzimba.
Olunye uhlobo lokusuleleka oluya kubangela ukunyanzelwa kwe-immunosuppression (HIV) (i-virus immunodeficiency virus). Ukuqhubela phambili kwe-HIV kunye noGawulayo kuphawulwe yi-immunocompromise . Le ngxaki yokuzikhusela i-immunocompromise iyenzeka xa i-HIV ibulala inani elikhulu lamaseli e-T - ii-CD4 kunye ne-CD8 zeeseli-eziyimfuneko ukukhupha impendulo yomzimba. Xa sele sele ngokwaneleyo kwezi iiseli ziye zabulawa, umntu uhlaselwa yintsholongwane enomdla, kuquka oku kulandelayo:
- Candidiasis
- Coccidioidomycosis
- Cryptococcosis
- Isifo se-Cytomegalovirus
- Incephalopathy, inxulumene neHIV
- Herpes simplex
- Histoplasmosis
- Sarcoma Kaposi
- Isifo sofuba
- Pneumocystis carinii pneumonia
- I-Toxoplasmosis yengqondo
Nceda uqonde ukuba akubona bonke abantu abane-HIV abangaxilwanga, okanye abane-AIDS. Ngethamsanqa, ukuqhubela phambili kwiyeza kwenza ukuba unyango lwe-HIV luphumelele ngakumbi. Namhlanje, abantu abenza ngokunyanisekileyo kwi-antiretroviral therapy bangaphila ubomi obude ngaphandle kokuhlawula i-AIDS.
Isishwankathelo
Ngokomlinganiselo omkhulu, ukunyuka kwamaxesha amaninzi okuxilongwa kwe-immunosuppression phakathi kwabantu baseMerika kukubonakalisa inkqubela. Siyabulela kwimpumelelo yophando, ngoku sinezixhobo ezinonophelo zokuzikhusela eziphathekayo ezinokuthi zingaphathe iindidi ezahlukileyo zeemeko. Ukongezelela, senza ezinye izakhi zokuguqula eziza kubangela ukuguquka kwamagciwane.
Ngokuchasene, ukuphucula phambili kwimiziza kunakho ukunciphisa ukuphindaphindwa kwamalungu omzimba jikelele. Ngokukodwa, abantu abanentsholongwane kaGawulayo abambelela ngokunyanisekileyo kwimimiselo yabo ye-antiretroviral bangaphila ubomi obude kunye novuyo olungapheliyo. Ngelishwa ke, nangona kunjalo, nangona uphuhliso lwentsholongwane kaGawulayo, abantu aba-3 kuphela kwabaseMerika abanesifo se-HIV.
Imithombo:
UHammond SP, iBaden LR. Isahluko 198. Izifo zoMbutho we-Immunocompromised Host. Ku: McKean SC, Ross JJ, Dressler DD, Brotman DJ, Ginsberg JS. eds. Imigaqo kunye nokuSebenza kweMithi yoBhedlele . New York, NY: McGraw-Hill; 2012. Kufumaneka ngo-Ephreli 12, 2016.
U-Nayeri U, Thung S. Isahluko 15. Izifo ezithintekayo zentsholongwane. Ku: DeCherney AH, Nathan L, Laufer N, Roman AS. eds. UKUHLAZIWA KUNYE NESICWANGCISO Nonyango: I-Obstetrics & Gynecology, 11e . New York, NY: McGraw-Hill; 2013. Kufumaneka ngo-Apreli 13, 2016.