Abamkeli be-Transplant bangakwazi ukuhlakulela isifo sikashukela njengenkcenkceshelo yokutshintshwa kwezinto
Sibanzi
Nangona i-diabetes mellitus isifo esiqhelekileyo nesiqondwa kakuhle, bambalwa abantu bayazi ukuba isifo sikashukela sinokukhula njengento entsha yokuzibandakanya ezintle kwizigulane ezifumana ukutshintshwa kweengtso . Nabani na ongenasifo sezintso ekuqwalaseleni ukutshintshwa kwezintso njengengonyango yesifo seengtso kufuneka baqaphele lo mngcipheko, owaziwa ngokutsha njengesifo seswekile emva kokutshintshwa (i-NODAT).
Nangona kubakho umngcipheko, kubalulekile ukuqaphela ukuba akusiyo wonke umntu usemngciphekweni, kwaye abo baneendlela zokonyango kufuneka i-diabetes post-kidney transplantation ithuthuke.
Isiganeko
I-NODAT yinkxalabo ebonakalayo kwinani elikhulu lezigulane ezifumana ukutshintshwa kwezintso. Nangona kunjalo, iinkcukacha ezicacileyo kule nombolo azifumaneki. Oku kungenxa yokuba akukho ncazelo ecacileyo yeNODAT ixesha elide, de kube ngu-2003. Ngenxa yoko, kuxhomekeke kwindlela ochaza ngayo i-NODAT, iziganeko ziyahluka.
Olunye uphando lubonakala lubonisa ukuba malunga nama-30 ekhulwini alabo abangenayo isifo sikashukela ngaphambi kokufumana ukutshintshwa kweengtso kunokuhlakulela ukuphakama okuqhubekayo kumanqanaba eshukela egazini ekuphakamiseni i-NODAT ngeenyanga ezintandathu emva kokutshintshwa kwezintso zabo. Oku kucacileyo inani elibalulekileyo, ebonisa ukuba iingcebiso malunga neNODAT kufuneka ziyinxalenye ebalulekileyo yokunyamekela izigulane zokungaphumeleli kweentso ezinomdla wokufumana ukutshintshwa kwezintso.
Impact
Isifo sikashukela esitsha esasandul 'ukutsha emva kokufumana ukutshintshwa kweengtso kunemiphumo ebanzi, ezinye zazo zibonwa kumntu oqhelekileyo onesifo sikashukela. Ngako oko, aba bantu banokukwazi ukuphuhlisa iingxaki ezithile. Imizekelo embalwa ibandakanya:
- I-Ketoacidosis : i-ketone eyandisiweyo kunye namazinga e-asidi kwigazi elibonwe kwizigulane ezingenakho ukungena kwe-insulin, engakhokelela ekuphazamiseni okukhulu kunye nokuphazamiseka kwe-electrolyte, kunye nefuthe ephezulu yegazi. Isigulane esichaphazelekayo sidla ngokugula kakhulu.
- I-neuropathy: ukuba "izikhonkwane kunye neenaliti" ukuvakalelwa kwezandla kunye neenyawo ezixhatshazwa ngesifo sikashukela esilawulekileyo.
- Umngcipheko ophezulu wokusuleleka ukususela kwishukela ephezulu yegazi yimbangela eyaziwayo yokunciphisa umzimba. Oku kungabonakalisa njengamaxesha amaninzi okwanda kwezifo, izifo zesikhumba, izifo zentlungu, njl njl.
- Ngokukodwa, i-NODAT iya kuba nempembelelo embi ekungagcini nje kwimeko yokuphila komgulane kunye nobungozi bokufa, kodwa nokuphila kwimpso etshayelwe. Ukukubeka ngamanye amagama, ummkeli we-intsi ephinda uguqulele i-NODAT unokuba nexesha elifutshane lokuphila kwaye abone ukuba iimpilwane ehlonyelweyo iphumelela ngokukhawuleza.
Ziyimpembelelo enkulu kangakanani? Ewe, njengokwakhe isifundo kwiYunivesithi yaseNew York, ngelixa isaphila kwizigulane ezingenaso iswekile kwisithuba seminyaka emihlanu emva kokufakelwa kweengso ngamaphesenti angama-92, kwakungekho ngaphantsi kwama-87 ekhulwini kwabamkeli abaye bavelisa i-NODAT. Ngokufanayo, kukho ubungqina obuvela kwizifundo ezibonisa ukuba ukusinda kwengane ehlonyelwe kufutshane, ukuba ummkeli ahlakulele isifo sikashukela emva kokufumana i-kidney transplantation.
Izinto zobungozi
Nangona impembelelo ibalulekile, phawula ukuba akusiyo yonke intsholongwane yezintso ezifumene isifo esicatshulwayo esenza isifo sikashukela njengengxaki yokupasa.
Amanye amayeza kunye nezinye izinto ezinobungozi zandisa amathuba okuba nesigulane esenza i-NODAT. Ezinye zezi ziquka:
- Amachiza: oku kubandakanya i-glucocorticoids (umzekelo, i-prednisone) kunye nezinye iziyobisi esisisebenzisayo ukukhusela isistim somzimba sommkeli wokufakelwa ukukhusela i-kidney yokutsalwa (ekubeni isistim somzimba sommkeli sibona ukuba iinjongo "njengeziko langaphandle") . Imizekelo yale myeza ifaka iklasi yezilwanyana ezibizwa ngokuthi "calcinurin inhibitors" (umzekelo i-tacrolimus kunye ne-cyclosporine, eyakuba yinto enokubangela isifo sikashukela), kunye ne-sirolimus. Nceda uqaphele ukuba akuyiyo yonke imveliso yokulahla i-prophylaxis imithi ekwandisa umngcipheko we-NODAT (ezi ziquka ezinye iindawo eziqhelekileyo zokutshintshwa kweempawu zokuguquka kwamagciwane njenge-mycophenolate mofetil, eyaziwa ngokuba yi-CellCept).
- Izifo ziyaziwayo. Ezi ziquka igciwane lesifo se-Hepatitis C (i-HCV), isifo se-cytomegalovirus (CMV).
- Ukongezelela kwezi zixhobo ezichazwe ngamachiza / izifo ezithintela isifo, uhlanga lwase-Afrika kunye ne-American, ukunyamezeka, kunye nentsapho ye-diabetes yandisa ingozi yeNODAT.
Ukulinganisa ingozi yokuLawulwa ngengozi yeNODAT
Njengoko kubonakala ngokucacileyo kwingxoxo ekhankanywe ngasentla, imichiza efanayo esisetyenziswayo ukugcina inqanaba elaneleyo lokunciphisa isistim somzimba sokufumana umzimba (ukwenzela ukuba bangalilahli intso entsha entsha), kwandisa ingozi yesifo sikashukela. Ngamanye amazwi, ngaba unokubeka umngcipheko ekugatheni inqanda, okanye ngaba unokubeka ingozi ekuhlaleni isifo sikashukela? Ngayiphi na indlela, unokuba uzive ngathi ubeka impilo yengqondo yakho yokufakelwa, intsha yakho yokuqeshisa ubomi, engozini. Ukulinganisela oku kubaluleka kubaluleke kakhulu, ngoko uhlangabezana njani na?
Nantsi ithatha umyalezo wekhaya: Ukugatywa kweentso ezifakelwayo kuseyona nto ebaluleke kakhulu ekunqumeni ukukwazi ukusinda nokusebenza kwisigulane, nangaphezulu kwengozi yesifo sikashukela esandul 'intsha .
Ngenxa yoko, ezininzi izikhokelo zibonisa ukubeka phambili ukunyuswa kwamanyathelo okunciphisa ukukhutshwa, nangona kuthetha ukwanda kwengozi yommkeli wokufakelwa ukuphuhlisa i-NODAT.
Ukuxilongwa
Ekubeni sineengqiqo ezifanelekileyo ezinobungozi obangela umngcipheko we-NODAT, ukubeka iliso kwizigulane ezinobungozi obuphezulu kunconywa kakhulu. Isiko esihle sokupakisha siya kukucebisa ngomngcipheko we-NODAT nangaphambi kokuba bafumane iinjongo ukuze wenze isinqumo esinolwazi.
Nangona kunjalo, xa uhlolisiswa emva kokufumana iinjongo ezifakelwayo, ezi ngcaciso zilandelayo ziya kusebenza ukwenzela ukufumanisa ukusukela kwintsholongwane entsha yesifo sikashukela emva kokufakelwa kwesantya. Ezi ngcaciso zichazwe yiphaneli yeengcali zamazwe ngamazwe:
- Iimpawu zesifo sikashukela ngaphezu kwe-plasma ye-glucose level ezingaphezu kwe-200 mg / dL
- Ukuzila ukutya kweplasma i-glucose enkulu okanye ilingana no-126 mg / dL
- Iyure ye-2 ye-plasma i-glucose enkulu okanye ilingana no-200 mg / dL ngexesha lovavanyo lomlomo lwe-glucose ukunyamezela
- Unokuthi uqhelane novavanyo oluqhelekileyo olubizwa ngokuba yi- hemoglobin A1c ye-glycosylated , esisebenzisa ngayo ukuxilongwa kwesifo sikashukela kubemi bonke. Ukusetyenziswa kwayo njengethuluzi lokuxilonga akukhuthazwa kwiinyanga ezintathu zokuqala emva kokufakelwa kweengtso. Nangona kunjalo, emva koko, incazelo efanayo yokuxilongwa kwesifo sikashukela njengoko isetyenziswe kubemi jikelele iyasebenza. Oku kuya kuba ngama-hemoglobin A1c amazinga aphezulu kunokuba alingana no-6.5 ngaphambili ukuze ahlolisise i-NODAT.
Lawulo
Ulawulo lokuQala loLondolozo
Ngaba ufanele uhlakulele i-NODAT (ngokukodwa ekusetyenzisweni kwezinto ezichazwe ngentla apha ngasentla), indlela yokulondolozwa kokuqala isungulwa ukwenzela ukuba uphathe iishukela eziphezulu zegazi. Nazi ezinye izinto ozaziyo:
- Ukuqwalasela ngokunyanisekileyo kwi-NODAT ngokucacileyo kuyinxalenye yokunyamekela okuqhelekileyo kwamukeli wezintso zokuguqula izintso. Isetyhu egazini lilinganiswa rhoqo ngokuphindwe ngeveki ubuncinane ngenyanga yokuqala, nangona uvavanyo lwexesha lokuhlola lunokuncitshiswa kamva.
- Enye yeendlela zokunciphisa umngcipheko we-NODAT, kunye nokunciphisa ubunzima bawo xa sele sele iqhubekile, kukujolisa ukunciphisa umthamo we-steroids (enye yeelppins yokulahla imithi ye-prophylaxis). Nangona kunjalo, ekubeni umngcipheko wokugatya ilungu elitshintshiwe lenyuka kakhulu ukuba i-steroids imisiwe ngokupheleleyo, ukuphela kokuphelisa ngokuqhelekileyo akunakucetyiswa.
- Ngokufanayo, umthamo we-tacrolimus (esinye isicatshulwa esifanelekileyo sokunyuswa kwe-immunosuppression drug), njengoko kuvunyelwe ngumngcipheko wokulahlwa, kunokucatshangelwa ukunciphisa. Ukuba konke okuhlulekayo kunye nesigulane sineminye impawu / iimpawu zeNODAT, utshintsho kumyeza ofanayo obizwa ngokuba yi-cyclosporine inokuba yimfuneko.
Uncedo lwezoNyango
Ukuba ngaba ulawulo olungasentla oluchazwe ngasentla aluncedi kwaye isifo sikashukela siyaqhubeka nokuphucula emva kokutshintshwa kweengso, ummkeli wokutshintshwa kwesifo sikashukela esandul 'utsha angadinga ukuphathwa okuthethekileyo ngemishanguzo yeswekile. Kanye njengawo nawuphi na umntu onesifo sikashukela, ngokuqhelekileyo siqala ngemithi yomlomo.
Imimiselo eqhelekileyo ibandakanya izilwanyana ezibizwa ngokuthi i-glipizide (ngamanye amaxesha zikhethwa ngenxa yokuba ukuphuma kwayo emzimbeni akuxhomekekanga kakhulu kwiintso '; ukuba oko kwakungenjalo, imithi yesifo sikashukela ikwazi ukuqokelela kumazinga aphezulu kwizigulane zezifo zengqondo kwaye ibangele ingozi phantsi amazinga eshukela egazi). Ukuba elinye unyango alinelisekile, amanye amayeza ayongezwa kude kube yilapho ekugqibeleni, ii-insulin zangaphantsi kwee-insulin zingabakho mfuneko yokulawula amanqanaba eshukela egazini ngokufanelekileyo.
Thintelo
Ukwazi umngcipheko, mhlawumbi uyazibuza nokuba kukho nantoni na ongayenza ukuze uyinciphise. Njengengxelo yecala, amanye amaziko atyalela i-pancreas (iqumrhu apho i-insulin iveliswa kwaye ukungaqhelekanga kungabangela isifo sikashukela) kanyekanye neentliziyo kwizigulane ezinezifo zesifo sesifo sesifo sikashukela. Zizifundo ezithile ezibonisa ukuba inkqubo enjalo ibangela ukuphucula nokuphila ixesha elide.
Oku kudibene kwindlela enkulu yokuphucula ukulawulwa kohlobo lwesifo sikashukela (uhlobo olusondele kwiminyaka ephantse kwi-"cure" epheleleyo yesifo ngenxa yesigxina se-pancreas), kodwa akakho na matyala enkqubo eye yazama kwimeko ye-NODAT, ngenxa yesizathu esicacileyo sokuba ngengcaciso, isigulane se-NODAT asiyi kuba nesifo sikashukela ngaphambi kokutshintshwa.
ILizwi
Ngokubanzi, umngcipheko wokuphuhlisa i-NODAT unokuba nzima ukuwamkela kwaye ungakhokelela ukungathandabuzeki malunga nokuba ufanele uhambe ngenkqubo. Qinisekisa ukukhupha uze uxubushe ngeengxaki zakho kunye nogqirha wakho. Uya kukunceda wenze isigqibo esinqununu kuwe. Izihlandlo ezininzi, zinikwe iinketho zokulawula ukuba isifo sikashukela siphuhlisiwe, umgangatho wobomi emva kokufakelwa ungadlulisa umngcipheko weNODAT.
> Imithombo:
> Isifo sikashukela esitsha emva kokutshintshwa (NODAT): ukuhlaziywa kweenkcazo kwizilingo zesilingo. UMongameli wokuqala, et al. Ukutshintshwa kwezityalo. 2013.
> Isifo seswekile esitsha emva kokutshintshwa (NODAT): ukujonga ngokubanzi. Phuong-Thu T Pham. Isifo sikashukela seMetab Syndr Obes. 2011.
> Isifo sikashukela esitsha ngokusasazwa emva kokutshintshwa kweeNtshi: Izinto zobungozi. Emilio Rodrigo. Umbhalo we-American Society of Nephrology. 2006.