Abamkeli be-transplant organ (Organic transplant recepents) basengozini ephezulu yeentambo kunye ne-osteoporosis
Isifo seThambo emva kokufakelwa kwesigxina yinkinga eqhelekileyo ekukhutsheni abafumanayo kunezona zigulane ziyazi. Kodwa ke, into ekufuneka iqondwe, ngokukhethekileyo ngaphambi kokuba umntu aqalise ukufakelwa kwesigqeba, ukuze amanyathelo okuthintela athathwe. Kwizona zifo ezincinci, izifo zethambo kwiimeko ezinjalo zingabangela iintlungu zethambo, kodwa kwiimeko ezinzima zingakhokelela kwiziqhekeza.
Kucacile, oko kuya kuba nefuthe kakhulu kumgangatho wobomi wobomi, kwaye kunokunyusa ingozi yokufa.
Ziziphi iinguqu ezihamba phambili ezikhokelela kwengozi yokugula yezifo?
Nangona iinjongo zeentso kwi-bone formation, akuzona nje izigulane ezinokuphelelwa kweengtso (ezifumana ukutshintshwa kweengtso) ezinobungozi obuphezulu kwizifo zethambo kunye neziqhekeza. Uninzi lwezigulana zokuguqula izidumbu (kubandakanywa nabamkeli beentliziyo, intliziyo, imiphunga, isibindi, kunye nokuguquka komongo weethambo) kunokuhlakulela iingxaki ezinjengeziqhekeza, iintlungu zethambo, i-osteoporosis, njl. Nangona kunjalo, ingozi ingahluka ngokusekelwe kwiziko elichaphazelekayo. Ngokomzekelo, ukuphindaphindwa kwezizahlulo ezifunyanwa ngabamkeli bezintso zingabakho ukusuka kuma-6 ukuya kuma-45 eepesenti, ngokuchasene nama-22 ukuya kuma-42 ekhulwini kubantu abafumana intliziyo, imiphunga, okanye izibindi zesibindi.
Ubunzima Kangakanani Ubungozi Bokugula Kwamathambo Emva Kokufakelwa Kwemveliso?
Njengoko kukhankanywe ngasentla, iziganeko ziya kuhluka ngohlobo olufakelwayo.
Ucwaningo oluthabathelweyo lwezigulane ezingama-86 ezifumene iintlobo zeengtso zifumene ukuba abafumanayo banokunyuka kwamaxesha angamahlanu emngciphekweni wezahlulo kwiminyaka yokuqala eyi-10 emva kokufumana iinjongo, ngokuchasene nomntu ophakathi. Nangona emva kweminyaka eyi-10 yokulandelelana, umngcipheko wawusabini. Oku kuphakamisa ukuba ingozi eyandayo yokuphuka iyaqhubeka ixesha elide emva kokutsalwa kweengso.
Noko ke, i-Fractures, ngumzekelo omnye obalaseleyo wesifo seethambo emva kokufakelwa komzimba. I-osteoporosis yinto eqhelekileyo kunye. Siyabona oku kwiindidi ezahlukileyo zeengxowa zemizimba kunye neentsholongwane zentsholongwane (iipesenti ezingama-88), intliziyo (iipesenti ezingama-20), isibindi (ama-37 ekhulwini), imiphunga (iipesenti ezingama-73), kunye nomnatha wethambo (iipesenti ezingama-29 zokufumana izifaki).
Kuthatha ixesha elide ukuthini ukuphuhlisa iingxaki zeengxaki emva kokutshalisa?
Enye into emangalisayo xa kuthethwa ukutshatyalaliswa kwethambo ukulahleka kweso sihlandlo ngokukhawuleza izigulane zilahlekelwa ngumzimba. I-lung, i-kidney, intliziyo, kunye nabamkeli be-fop-plant (sopies plant) bangakwazi ukulahlekelwa yi-4 ukuya kwi-10 ekhulwini ze-bone minerals (BMD) kwiinyanga ezi-6 ukuya kwezi-12 emva kokufakelwa komzimba. Ukuze uqonde ngakumbi oku, qhathanisa le statistic kwinqanaba lokulahlekelwa kwethambo kwindoda ye-osteoporotic postmenopausal, eyi-1 ukuya kwi-2 ekhulwini ngonyaka!
Yintoni Ebangelwa Ukulahlekelwa Kwamathambo kunye Neziqhwala kubantu Abantu abafumana i-Organ Transplants?
Ukujonge kwindlela elula, ukulahleka kwethambo kubantu abafumana ukuguqulwa komzimba ngenxa yezinto ezikhoyo phambi kokutsalwa komzimba , kunye nokulahleka kwethambo ngokukhawuleza okuvela emva kokufakelwa komzimba .
Izinto ezinobungozi zowenu jikelele ezandisa ukonakala kwethambo ezisebenza kumntu omhle kakhulu, ngokucacileyo zichaphazeleka apha nakhona.
Ezi ziquka:
- Ubunzima be-Vitamin D
- Ukutshaya
- Sikashukela
- Ubudala
Kodwa, makhe sijonge ezinye izinto ezinobungozi ezisekelwe kwisaphulo seqela:
Ukufakelwa kwangaphambili kwezinto zobungozi
Iziganeko zobungozi kwizigulane ezinezifo zezintso eziphambili zibandakanya:
- Ubunzima be-Vitamin D
- Ukusetyenziswa rhoqo kwe-steroids ( okubangela ukulahleka kwethambo ), njengonyango lweengxaki ezihlukahlukeneyo zesifo
- Amanqanaba aphezulu egazini, ebizwa ngokuba yi-acidosis
- Amanqanaba aphezulu e-hormone ye-parathyroid egazini (ebizwa ngokuba yi- hyperparathyroidism yesibini ), ekhokelela ekulahlekeni kwe-calcium kwi-bone
Iziganeko zobungozi kwizigulane ezinezifo zesibindi ziquka:
- Ukungondleki, kubonakala kubonakala kwizigulane zokuhluleka kwesibindi
- Cholestasis
- Izinga eliphantsi le testosterone okanye u-hypogonadism
Iziganeko zobungozi kwizigulane ezinezifo zemiphunga ziquka:
- Ukusetyenziswa rhoqo kwe-steroids, ukunyanga izifo zomphunga, njengeCOPD okanye i-asthma
- Ukubhema, ingozi enkulu ye-osteoporosis kunye nokulahleka kwethambo
- Amanqanaba aphezulu ase-acid, ngenxa yokugcinwa kwe-carbon dioxide egazini
Izinto ezinobungozi kwizigulane ezinesifo senhliziyo zibandakanya:
- Ukusetyenziswa rhoqo kweepilisi zamanzi, okanye i-diuretics, engabangela ukulahleka kwe-calcium kwithambo. Imizekelo ibandakanya imithi efana ne-furosemide ne-torsemide.
- Ukunciphisa umsebenzi owenziweyo, into eqhelekileyo kwizigulane ezinesifo senhliziyo
I-Post-transplant Factors Risk
Izinto ezibangelwa ukutshatyalaliswa kweengozi ezenza ukuba ukulahleka kwethambo kudla ngokuqhubekayo kwinqanaba elithile nangemva kokufakelwa komzimba. Nangona kunjalo, ezinye izinto ezinobungozi ezenzekayo emva kokuba isigulane esinokungaphumeleli komzimba sithatha utshintsho olutsha. Ezi zinto ziquka:
- Ukusetyenziswa kweSteroid : Emva kokuba izigulane zitholwe ukufakelwa komzimba, zidinga imishanguzo yokukhusela isistim sokuzivikela kwisistim sokuzivikela kwi "ukugatya" ilungu elitsha. I-Steroids iyenzeka enye yeziyobisi. Ngelishwa, i-steroids inciphisa i-bone entsha eyenziwe ngokukhusela uhlobo oluthile lwethambo lesithambo elithi "i-osteoblast." Bakwandisa ukulahleka kwethambo ngokuvuselela olunye uhlobo lweselingo olubizwa ngokuthi "i-osteoclast." Ngamanye amagama, xa ukhona kwi-steroids, utshisa ikhandlela kuzo zombini iziphelo. Kukho ezinye iindlela ezithonya i-steroids, ezingaphaya kwelo nqaku (into ebizwa ngokuba yonyuka-ukulawulwa kwe-Receiver Activator ye-Nuclear Factor kappa-B) eya kubangela ukulahleka kwethambo.
- Ukusetyenziswa kwe-calcinurin inhibitor : Njenge-steroids, le yinye inqanaba eliqhelekileyo lonyango elisebenzisayo ekuthintela ukutshatyalaliswa komzimba. Ezi zonyango ziquka i-cyclosporine, i-tacrolimus, njl. Le nto ingabangela ukulahleka kwethambo, kodwa ngokuqhelekileyo iya kubaphazamisa neentso 'zokuguqula i-vitamin D kwifom esebenzisekayo (ebalulekileyo ekubunjweni kwethambo), into ebizwa ngokuba yi-activation.
Uyazijonga njani izifo zeThambo kwizigulane ezifumana ukutsalwa komzimba?
Uvavanyo lwe "golide standard" ukuvavanya ubukho besifo seethambo ekufakeni izitshixo kwithefu le-bone, elibandakanya ukubethela inaliti kwisithambo, kwaye lijonge ngaphantsi kwe-microscope ukuze ixilongwe. Ngenxa yokuba ezininzi izigulane azizona ezinkulu abalandeli abanamathele enaliti emathanjeni abo, iimvavanyo ezingekho-invasive zisetyenziselwa uvavanyo lokuqala. Nangona i-DEXA eyaziwayo (esetyenziselwa ukuvavanya isisitye samaminerali) yinto eqhelekileyo yokuvavanya isetyenziselwa ukuvavanya impilo yeethambo kubemi bemihlali, kunakho ukuqikelela ukuba ingozi yokuphulwa komzimba kwindawo yokufakelwa komzimba ayibonakali. Ukususela kumbono osebenzayo, uvavanyo lusemiselwe kwaye lukhuthazwa ngumbutho omkhulu onjenge-American Society of Transplantation kunye ne-KDIGO.
Ezinye iimvavanyo ezisekelayo okanye ezincedisayo zibandakanya iimvavanyo zokumakishwa kweethambo njenge-serum osteocalcin kunye nethambo elithile lamanqanaba e-alkaline phosphatase. Njenga-scan ye-DEXA, akukho nanye kulaba baye bafundiswa ngokukwazi kwabo ukuqikelela ingozi yokuphulwa komzimba ekutshaleni izigulane.
Ukunyanga izifo zeThambo kwizigulana zokuTyhulwa komzimba
Amanyathelo aqhelekileyo ayasebenza kubemi bemihlali, njengokuba kunjalo kummkeli wokufakelwa. Ezi zibandakanya ukuzivocavoca umzimba, ukuyeka ukutshaya, ukukhokela okunomsoco kunye ne-calcium kunye ne-vitamin D.
Amanyathelo athile ajoliswe kumngcipheko othe ngqo kubamkeli bezithuthi kunye nokuquka:
- Ukukhusela i-steroids, ukuba kunokwenzeka, njengenxalenye ye-cocktail yezilwanyana ezisetyenziselwa ukuthintela ukutshitshiswa kwelilungu. Nangona kunjalo, oku kufuneka kulinganiswe nomngcipheko ophezulu wokugatywa komzimba.
- Uhlobo oluqhelekileyo lwemithi edlalwa ngcebiso kule nkalo yinto ethiwa " bisphosphonates ," ezisetyenziselwa ukuthintela nokunyanga ukulahlekelwa kwethambo kwenzalo yabantu. Nangona uphando oluthile lubonise la mayeza ukuba asebenze ekukhuseleni nasekuphatheni ukulahlekelwa kwethambo ekuphumeni kwethambo, akukho nanye yedatha eye yabonisa ukuba i-bisphosphonates inokukwazi ukunciphisa umngcipheko wee-fractures zangempela.
> Imithombo
> Cohen A, iSambrook P, Shane E. Ulawulo lokulahlekelwa kwethambo emva kokutsalwa komzimba. J Bone Miner Res. 2004; 19 (12): 1919-1932
> Leidig-Brukner G, Hosch S, Dodidou P, et al. Ukuphindaphinda kunye nokuqatshelwa kwee-osteoporotic fractures emva kokufakelwa komzimba okanye ukufakelwa kwesibindi: isifundo esilandelayo. Lancet. 2001; 357 (9253): 342-347
> Shane E, Papadopoulos A, Staron RB, et al. Ukulahleka kwethambo kunye nokuphuka emva kokufakelwa kwemiphunga. Ukutshintshwa kwezityalo. 1999; 68 (2): 220-227
> Ukuxhaphaza i-SM, Josephson MA. Isifo seThambo emva kokutshintsha kweengso.Semin Nephrol. 2004; 24 (1): 82-90
> Vantour LM, uMelton LJ 3, u-Clarke BL, u-Achenbach SJ, u-Oberg AL, uMcCarthy JT. Ingozi yexesha elide lokutshatyalaliswa kwentshukumo emva kokutshintshwa kweengqungquthela: isifundo esisekelwe ngabantu. Osteoporos Int. 2004; 15 (2): 160-167