Ukubeka iliso kwimiphumo emibi kunokufuneka xa uthabatha amayeza athile
Umgqirha wakho we-IBD uza kululeka uvavanyo oluthile ukujonga umsebenzi wesifo endleleni, kodwa nokuvavanya indlela amayeza asebenza ngayo kwaye ukuba unayo nayiphi na imiphumo emibi kwezinye izitho okanye iinkqubo zomzimba. Abantu abanezifo zesibindi esivuthayo (IBD) baphathwa ngeendlela ezahlukeneyo zonyango, ezininzi zazo zineendlela ezahlukeneyo zokwenza umzimba.
Kwiimeko ezininzi, imiphumo emibi ayinqabile, kodwa inokubanjwa kwangaphambili ngoko kulungile ukwenza iimvavanyo ukuqinisekisa ukuba unyango luhamba kakuhle.
Izikhokelo zokuvavanya ngaphambi kokuba uqalise iindlela ezithile zonyango zilandelayo: izikhokelo. Wonke ogqirha kunye ne-IBD ziza kwenza izinto ngokwahlukileyo. Nangona kunjalo, kubalulekile ukuba abantu abahlala ne-IBD babe nesicatshulwa santoni ukuba ingaba yintoni inqanaba lokhathalelo xa uqala amachiza athile. Oku kuyinyani ngakumbi xa kungabonakali kwiziko le-IBD okanye ukuba unonophelo olujongene nelinye ilungu leqela (njengomqeqeshi we-internist okanye ugqirha wezonyango lokuqala).
Abantu abanesifo sikaCrohn okanye i- ulcerative colitis abanemibuzo malunga nomsebenzi webhu kunye nezinye iimvavanyo ezicetyiswayo xa kuthatha imithi ye-IBD kufuneka idibane noogqirha babo.
Xa uthatha i-Azulfidine (iSulfasalazine)
I-Azulfidine iyisistim esisisiseko sulfa esine-5-aminosalicylic acid (5-ASA) kunye ne-sulfapyridine.
Isetyenziselwa ukunyanga i-ulcerative colitis kunye nezinye izimo ezivuthayo ezifana ne- rheumatoid arthritis kunye ne- spondylitis e-ankylosing .
Esi sigqirha sinomlando omdala wokusetyenziswa ngokukhuselekileyo kwe-ulcerative colitis, kodwa ngoku isetyenziswe kangangoko nje ngezilwanyana ezintsha ezisebenzayo kwaye zineempembelelo ezimbalwa (izikhwebu kunye neentlanzi) ziphuhliswa.
Ngokubanzi, iimvavanyo zokuvavanya ngaphandle kwe- CBC count azicetyiswa ngoxa zifumana le mveliso.
Gcwalisa i-Blood Cell Count (CBC)
Olu vavanyo lwegazi lunokwenziwa ngaphambi kokuqala unyango kunye neAzulfidine kwaye kwakhona kwakhona nganye ngeveki okanye ngenyanga nganye kwiiveki ezintandathu zokuqala ukuya kwiinyanga ezintathu. Emva koko, uvavanyo luya kucetyiswa nyangazonke kwiinyanga ezintathu kwaye emva kweenyanga ezintathu zisele kwintsalela yeAzulfidine ithathwa.
Oku kukujonga ezinye iziphumo ezinqabileyo ezingathandekiyo ezifana nokuncipha kweseli yamhlophe yegazi (imeko ibizwa ngokuba yi-agranulocytosis). Iimeko ezininzi ze-agranulocytosis zenzeka kwiinyanga ezintathu zokuqala zonyango.
Xa uthatha iCorticosteroids
Ukusetyenziswa kwexesha elide le-steroids ezifana ne- prednisone iyancipha njengonyango lwe-IBD, kodwa isasetyenziswa kwiimeko ezithile okanye kunye nezinye iyeza. Enye yeengqwalasela eziphambili kunye nokusetyenziswa rhoqo kwe-prednisone ingozi yokulahlekelwa kwethambo.
I- Absorptiometry ye-X-Ray ye -Double-Energy (DEXA)
I- DEXA yokukhangela inganconywa ngaphambi kokuqala unyango lwe-corticosteroid. Emva koko, unokwenziwa kwakhona emva kweminyaka emibili ukuya kwimithathu, okanye kungekudala kubantu abane- osteoporosis okanye ababenomnye umonakalo wokulimala kwethambo, njengokwahlukana.
Ukuba iziphumo ze-DEXA zibonisa ukuba kukho ukulahleka kwethambo, unyango lunokuqaliswa kwaye ezinye iimvavanyo zenziwa.
Xa uthatha i-Cyclosporine
I-Cyclosporine luhlobo lwe-immunosuppressant drug elidambisa isistim somzimba. Ngamanye amaxesha kusetyenziswa isifo se-ulcerative kunye nesifo sikaCrohn, kodwa nokukhusela ukulahlwa komzimba emva kokutshintshwa kunye nezinye iimeko ezivuthayo ezifana ne-lupus, i-rheumatoid arthritis kunye ne-psoriasis. Iimvavanyo ezimbalwa zinokuyalelwa ngexesha lo unyango.
I-Cyclosporine Level Level
Ukuze kuqinisekiswe ukuba okwaneleyo kwilisi kumzimba ukuba kusebenze, okanye ukuba amanqanaba eziyobisi aphezulu kwaye angabangela iziphumo ezimbi, amanqanaba emichiza angadinga ukulinganiswa ngokuhlolwa kwegazi.
Imizimba yabantu isabela ngokungafaniyo kunye neyeza kunye namanqanaba egazini inokuchaphazeleka yimiba emininzi.
Ekuqaleni kwonyango nge-cyclosporine, ukuvavanywa kungenziwa rhoqo rhoqo imihla ngemihla de ifikeleleke. Emva koko, uvavanyo luya kwenziwa ngeveki, ngenyanga okanye ngaphezulu. Inokuphinda ikhuphe kwakhona xa kukho utshintsho, njengokuba impawu ziba zibi okanye esinye isidakamizwa sidinga kwaye sichaphazela inqanaba le-cyclosporin.
Ukubala kweCBC
Ubume belo vavanyo lwegazi luyahlukahluka ngokusetyenzwa ngunyango, kodwa ngokubanzi, isibalo segazi esimhlophe, isibalo sesibomvu segazi, i-hemoglobin, kunye ne-hematocrit ziya kuhlolwa rhoqo ngexesha.
Urinalysis
Izigulane zinokucelwa ukuba ziqoke umchamo ukuze zenze i- urinalysis . Iziphumo zolu vavanyo zinokukunceda ukubeka iliso kwiingxaki ezinezintso kunye nesibindi. Inokuthi ilandelwe rhoqo rhoqo xa ithatha i-cyclosporine ukuqinisekisa ukuba iziyobisi azikho naziphi na iziphumo ezimbi kulawo malungu.
Ezinye iimvavanyo zeGazi
Ukuqinisekisa ukuba i-cyclosporin ayibangeli imiphumo emibi yonyango, ugqirha unokuyalela ezinye iimvavanyo ukujonga umsebenzi wezintso kunye nesibindi, kubandakanywa amanqanaba egazi urea nitrogen (BUN) , i-bilirubin, i-magnesium, i-potassium uric acid, i-lipids kunye ne- enzyme yesibindi .
Xa uthatha i-Imuran (Azathioprin)
I-Imuran (azathioprine) iyisistim e-immunosuppressive antimetabolite esinqunyelwe ukuphatha i-IBD kunye nezinye izimo ezivuthayo ezifana ne-rheumatoid arthritis. Imuran ingasetyenziselwa yona ngokwawo okanye ngexesha elifanayo njengamanye amayeza (njengama-corticosteroids) ukwenzela ukuba uncede loo mayeza asebenze ngempumelelo. Ngexa befumana i-Imuran, izigulane ziza kujongwa ngokuthe ngqo kwimiphumo emibi.
Ukubala kweCBC
Ngenyanga yokuqala, olu vavanyo lwegazi luya kwenziwa ngeveki, lulandelwa yilo lonke iiveki ngexesha leyesibini neyesithathu, emva koko emva kwenyanga. Ukuba kukho utshintsho lweeritha, inkqubo yeveki kunye nezinye iiveki inokuqalisa kwakhona.
I-Thiopurine Methyltransferase (TPMT)
Olu vavanyo lunokwenziwa ngaphambi kokufumana naziphi na iziyobisi ze-thiopurine, eziquka i-Imuran, mercaptopurine (6-MP) , kunye ne-thioguanine. Inqanaba le-enzyme ye-TPMT ngokuqhelekileyo ihlolwe ngokuhlolwa kwegazi, kodwa ukuba kuphela uvavanyo lofuzo luya kwenziwa ngokugqitywa kwezinye iiseli eziphuma ngaphakathi kwesitye.
Kubalulekile ukuba lo vavanyo lwenziwa ngaphambi kokuba uthathe imithi ukuze ufumane ukunyaniseka kwenyaniso ye-TPMT enzyme level. Olu vavanyo lwenziwa ngenxa yokuba i-TPMT yi-enzyme emzimbeni owehla i-Imuran kunye neminye imichiza efanayo. Ukuba izinga le-TPMT emzimbeni liphantsi kakhulu (elenzeka malunga nama-10 ekhulwini labantu) okanye kakhulu kakhulu (okwenzeka malunga neepesenti ezingama-0.3 zabantu), ukuthatha isicirho se thiopurine njenge-Imuran kunokubangela iziphumo ezibi kakhulu.
Xa uthatha i-Mesalamine kunye nezinye i-ASA izidakamizwa
Kukho amalungiselelo amaninzi ahlukeneyo e- mesalamine asetyenziselwa ukunyanga i-ulcerative colitis, kwaye le nkunkuma ingafumaneka ngomlomo okanye kwi-enema. I-Mesalamine yi-5-ASA yeziyobisi ehambelana nemiphumo embalwa ngaphandle kweAzulfidine kuba ayinayo isakhi sulfa.
Inani le-CBC kunye novavanyo lomsebenzi wesibindi lingagqitywa ngaphambi kokuba uqale le nkunkuma ukuze ufumane isiseko esisezantsi. Nangona kunjalo, akukho ziphakamiso zokuqhubeka nokuvavanywa ngexesha lonyango. Uvavanyo olulodwa olunokuthi luyenze ngokuphindaphindiweyo luyinqanaba lomdali.
Levelininine
I-Mesalamine yonyango lokulondolozwa rhoqo lithathwa ixesha elide. Inqanaba lomdali lingahle lenziwe ngaphambi kokuba liqalise le nkunkuma, kwiiveki ezintandathu, ezintandathu ezintandathu, ngonyaka, kwaye ngonyaka.
Inqanaba lomdali lisetyenziselwa ukunyamekela umonakalo ongenabunqabileyo apho izintso zitshisa, ezibizwa ngokuba yi-nephritis yangaphakathi. Ukuba i-nephritis ye-interstiti iyangqatshulwa, unyango nge-mesalamine luya kumiswa.
Xa uthatha iMethotrexate
I-Methotrexate iyisisulu se-antinoplastic esisetyenziselwa ukuphatha isifo sika-Crohn, isifo esicacisayo se-spondylitis, i-rheumatoid arthritis, ne-psoriasis. Kuye kwaboniswa ukuba kubangele ukungabikho komntwana kwaye ngenxa yoko akufanele kuthathwe ngabafazi abakhulelweyo okanye abafuna ukukhulelwa. Kubalulekile ukuxoxa ngeendlela zokulawula ukuzalwa ngaphambi kokuba uqale lesi sidakamizwa.
Uvavanyo lokukhulelwa
Ngaphambi kokuqala i-methotrexate, uvavanyo lokukhulelwa lunokuyalelwa ukuba luqinisekise ukuba lukhuselekile ukuthatha isiza. Esi sidakamizwa sinokubangela ukukhulelwa kwesisu kunye nokukhubazeka kokuzalwa. I-Methotrexate iphinda idlule ubisi lwebele, ngoko ayikhuthazwa ukuba isetyenziswe ngabahlengikazi. Iimvavanyo zokukhulelwa zingenziwa kwakhona kusetyenzisweni lweziyobisi ukuba kuyimfuneko.
I-X-Ray kunye ne / okanye i-Function Test Test
I-Methotrexate inokuchaphazela imiphunga kwaye ngoko phambi kokuqala unyango, iimvavanyo zokuvavanya umsebenzi wamaphaphu zinokuyalelwa. Oku kungabandakanya i-carbon monoxide kunye ne-test function ye-pulmonary ukuqinisekisa ukuba akukho miphunga yemiphunga engabonakaliyo, ingakumbi kubantu abatshitshisiyo okanye ababeshushu.
Ukubala kweCBC
Inani legazi liya kwenziwa ngaphambi kokuqala i-methotrexate yonyango, kwaye ke inokuyalelwa kwakhona emva kweveki enye kunye neeiveki ezisibhozo kunye neveki ezili-12 emva koko. I- white white cell cell counts while taking methotrexate ayizange iboniswe kwizigulane ezine-IBD, kodwa zenzeke kwizigulane ezine-arthritis ye-rheumatoid.
I-Panel Metabolic Panel
Olu vavanyo lungaquka i-BUN, i-carbon dioxide (CO2), i-creatinine, i-glucose, i-cholesterol, i-albin, i-electrolyte, i-enzyme yesibindi, namazinga e-hormone ye-thyroid. Oku kukubukela nayiphina imiphumo emibi kwisibindi kunye neentso. Olu vavanyo lunokwenziwa rhoqo emva kweenyanga ezintathu xa i-methotrexate ithathwa.
Isibilini seBil
Ukuba umsebenzi wesibindi ubonakala uchaphazelekayo ngokusekelwe kwiziphumo zesiphakamiso sesiseko sokuqala okanye ezinye iimpawu okanye iimpawu, i-biopsy yesibindi ingenziwa. Kwabantu abane-arthritis okanye i-psoriasis, i-biopsy yesibindi ingenziwa kuphela xa kufikelelwe umthamo othile we-methotrexate, kodwa okwangoku, i-biopsy yesibindi ehleliweyo njengaleyo kubantu abane-IBD ayikhuthazwa.
ILizwi
Njengamaxesha onke, i-gastroenterologist yindlela efanelekileyo yokuxubusha malunga naluphi uhlobo lokubeka iliso olufunekayo xa kuthatha imithi ye-IBD. Kwiimeko ezininzi, umsebenzi webhabhi oqhelekileyo kunye nokuvavanywa kwenzelwa ukwenzela ukubamba nayiphi na ingxaki kusasa kwaye uphathwe ngokukhawuleza.
Kwimeko ezininzi iziphumo ezimbi ziyabonakala kodwa zingagwenywa ngezinye iimvavanyo ezilula, kungenxa yoko kungathi ngathi umsebenzi wegazi wenza njalo. Kukho izikhokelo zokunceda oogqirha banqume indlela engcono yokunyamekela izigulane, kodwa zonke izigulane ezine-IBD ziyahlukileyo kwaye ngoko ke akukho kuphela unyango oluzimeleyo, kodwa kunjalo novavanyo oluqhelekileyo lwenziwe.
> Imithombo:
> Abegunde AT, Muhammad BH, Ali T. Amanyathelo okukhusela okukhuselekileyo kwizifo zesibindi sokuvuvukala. Ihlabathi J Gastroenterol. 2016; 22: 7625-7644. i-doi: 10.3748 / wjg.v22.i34.7625.
> [Akukho ababhali abalwe] "Uvavanyo lwe-TPMT phambi kweyeza le-azathioprine?" I- Drug Ther Bull . 2009 Jan; 47 (1): 9-12.
> I-Cunliffe RN, uScott BB. Ukubeka iliso kwizonyango ezichaphazela izidakamizwa kwisifo sofuba. I-Pharmacology & Therapeutics. 2002; 16: 647-662. i-doi: 10.1046 / j.1365-2036.2002.01216.x
> Jacobson IM, uKelsey PB, uBlyden GT, iDirjian ZN, Isselbacher KJ. I-Sulfasalazine-yenze i-agranulocytosis. Am J Gastroenterol. 1985; 80: 118-121.
> Al-Shakarchi I, uLobão B, uHenriques C, et al. "AB0230 I-pre-methotrexate i-lung screening ye-interstitial disease-is a x-ray isifuba esaneleyo?" Ama-Annal of the Rheumatic Diseases 2013; 72 >: A857 >.