Ukusebenzisa i-Marsh Scores ukuze ufumane i-Celiac Disease

by Nancy Lapid; Uhlolwe nguEmmy Ludwig, MD

Iimpawu zeMarh zilinganisa umonakalo wamathumbu emzimbeni we-celiac

Ukuba uhlolwe isifo se-celiac , ugqirha wakho uya kwenza i-endoscopy kunye ne-biopsy ukubona ukuba intlungu yakho encinci ibonakaliswe yi- gluten , iprotheni efunyenwe ngqolowa, i-hareyi kunye ne-rye. Ugqirha wakho uya kusebenzisa isixhobo sezokwelapha, esibizwa ngokuthi i-endoscope, kunye nekhamera encinane ukujonga ngqo kwinkqubo yakho yokutya, kwaye uza kuthatha iisampuli ezincinci zamathambo ukusuka kwimbombo yesisu sakho esincinci.

Ukulandela i-endoscopy yakho, i-pathologist iza kujonga iisampuli zakho zenyama ukuze ubone ukuba kukho umonakalo onxulumene ne-gluten. Loo pathologist uza kuhlawula imeko yeesampuli esekelwe kwinkqubo yokulinganisa ebizwa ngokuba yi-Marsh Score. Umlinganiselo wakho we-Marsh uya kugqiba ukuba ngaba ufumene ukuba unesifo se-celiac, kunye nendlela ephakame ngayo imeko yakho.

Isifo seCeliac asiyodwa yimeko enokubangela ezinye zezi tshintsho, yingakho i-biopsy yodwa yeemvavanyo zokuxilongwa ezicetyiswayo kwizifo eziphethwe yi-celiac-nangona i-biopsy ithathwa ngokuba "ngumgangatho wegolide" wokuxilongwa. Iziphumo zeemvavanyo zegazi ze- celiac kunye nokuphendula komntu ngokugqithiseleyo kukutya okungekho-gluten nako kunokukunceda ekufumaneni i-diagnostic.

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Isigaba 0

Isayensi yeZithombe / Iifoto zeGetty

Le nto ifoto ithathwe ngexesha lokuphela kwe-endoscopy, ebonisa intlungu encinci emathunjini eneempilo eziphilileyo. Ekubeni i-intestinal lining ityhila ngokuqhelekileyo, akunakwenzeka ukuba umntu unesifo se-celiac.

Kule meko, isampula ye-biopsy iya kubalwa njenge-Marsh Stage 0, eyaziwa ngokuba yi-"pre-infiltrative stage". kubizwa ngokuba "kwangaphambi kokungena ngaphakathi" kuba i-lymphocytes ayifakalanga ukunyuka, okanye "ukungena ngaphakathi," emathunjini emathumbu.

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Amanqanaba 1 no-2

Isitampu sesisu esiswini - I-Marsh Score 1. © Ludvigsson et al, 2009

Isigaba soku-1 se-Marsh sithetha iiseli ebusweni bamathumbu emathumbu emathunjini, ezaziwa ngokuba ngama-epithelial cells, zinama-lymphocytes angaphezulu, iiseli zegazi ezimhlophe, phakathi kwazo kuneziqhelo.

Kwi-intestine eqhelekileyo encinci, akumele kubekho i-lymphocyte engama-30 ngama-cell epithelial angama-30, kodwa kwiimeko ezithathwa njengesigaba se-1, zikho ngaphezu koko. Ukuba unayo isigaba soku-1, ingxelo yakho ye-pathology iyakwazi ukufunda "ukwandisa i-lymphocyte ye-intraepithelial".

Isifo seCeliac asiyodwa yimeko enokubangela ukwanda kwe-lymphocyte yezifo. Unokuba ne-lymphocytes eninzi xa unesifo sokuguga, isifo sikaSjogren, kunye nokunye ukungabikho kokutya. Usulelo lwebhakteria olubizwa ngokuba yi- Helicobacter pylori (edibaniswa nezilonda), kunye nokusetyenziswa kweentlungu ezingaphezu kwe-counter killings ezifana ne-aspirin kunye ne-ibuprofen, nayo ingabangela oku.

Abantu abanezifo ezingenasifo esilandelayo , abalandeli beentsapho ezingenabungozi, kunye nabantu abane- dermatitis herpetiformis , ukugqithisa okugqithiseleyo okubhekisiwe njengokonakala kwesikhumba se-celiac disease, banokuba ne-1 Marsh Inqaku.

Ngecandelo 2, ubona i-lymphocyte ngaphezulu kunezinye eziqhelekileyo kunye nokudlwengulwa okukhulu kunesiqhelo phakathi kwe-intestinal villi. Ezi zibizo zibizwa ngokuthi "i-crypts," kunye ne-crypts ezikhudlwana-eziqhelekileyo zibizwa ngokuthi "i-hyperplastic," ngoko ukuba ingxelo yakho yokukhubazeka ilandele i-biopsy ithi unokuthi "i-crypts hyperplastic" okanye "crypt hyperplasia," ithetha ukuphanga okubonakalayo kwi-biopsy yakho zinkulu kunokuba ziza kuba zizinzi zesisu zomzimba.

Isigaba sesi-2 sinqabile-singabonakali kubantu abano-dermatitis herpetiformis.

_{Le photomicrograph ivela kuMfanekiso 1b weLudvigsson et al.} _{BMC Gastroenterology 2009 9:19.} _{I-doi: 10.1186 / 1471-230X-9-19.} _{Iiphotomicrographs zifunyenwe kuProf. Åke Öst, owayenguSihlalo wangaphambili weSweden National Steering Group kwi-Patesty ye-Intestinal Pathology).}

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Isigaba 3

Oku kubonakalisa intsimbi ye-intestinal kwi-Marsh I-Score 3. © Ludvigsson et al, 2009

Uninzi lwagqirha aluyi kuhlola i-celiac isifo kuze kube yilapho isisu sakho samathumbu sesisu sifike kwisigaba 3. Kule nqanaba, utshintsho lwesigaba 2 lukhona - i-lymphocytes engaphezulu kunezinto eziqhelekileyo nezikhudlwana kunezinye izinto eziqhelekileyo - kunye nokuhlahlala , yintoni eyaziwa ngokuba yi-atrophy.

Isigaba sesi-3 sineendawo ezintathu:

I-atrophy (inqanaba lesi-3a) elincinci: I-intestinal villi yakho ikhona, kodwa incinci
I-atrophy (i-Stage 3b): I-intestinal villi yakho inqabile kakhulu
I-atrophy eyiyo yonke (i-Stage 3c): Ubumba bakho bomzimba luhlala lufulekileyo kwaye kungekho-intestinal villi esele

Uninzi lwabantu abafunyaniswa ukuba banezifo ze-celiac banomgangatho we-3 Marsh.

_{Le photomicrograph ivela kuMfanekiso 1c weLudvigsson et al.} _{BMC Gastroenterology 2009 9:19.} _{I-doi: 10.1186 / 1471-230X-9-19.} _{Iiphotomicrographs zithe zafunyanwa kuProfesa Åke Öst, owayengumongameli weSweden National Steering Group kwi-Patestyle encinci ye-Intestinal.}

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Isigaba 4

Isigaba sesi-4 sisona sigaba esiphambili kakhulu kwaye inqabileyo ayibonakali yonke into. Kwinqanaba le-4, i- villi yakho igqityiwe ngokupheleleyo (i-atrophied) i-depressions phakathi kwabo (i-crypts) iyanqanyulwa.

Isigaba sesi-4 siqhelekileyo phakathi kwabantu abakhulileyo abanesifo esiqhekezayo. Ukuba umlinganiselo wakho we-Marsh isigaba se-4, unokuba nomngcipheko ophezulu weengxaki zeliliac, kuquka i-lymphoma.

Ukwazisa:

_{Le photomicrograph ivela kuMfanekiso 1d weLudvigsson et al.} _{BMC Gastroenterology 2009 9:19.} _{I-doi: 10.1186 / 1471-230X-9-19.} _{Iiphotomicrographs zithe zafunyanwa kuProfesa Åke Öst, owayengumongameli weSweden National Steering Group kwi-Patestyle encinci ye-Intestinal.}

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ILizwi

I-Gastroenterologists isebenzisa amanqaku e-Marsh ukulinganisa umonakalo wakho kumathumbu amancinci emathunjini ukusuka kwisifo se-celiac. Umlinganiselo wakho we-Marsh uza kugqiba ukuba unayo isifo se-celiac, kwaye ingaba yonakalise kangakanani i-intestinal villi yakho.

Esi sikhokelo kumanqaku omgangatho we-Marsh sinokukunceda ukutolika ingxelo evela kwi-biopsy yakho yamathumbu. Nangona kunjalo, ukuba unengxaki yokuyiqonda, ungesabi ukuthetha nodokotela wakho malunga noko kuthetha. Yaye ukhumbule: xa uqala ukutya okungenayo i-gluten, umonakalo ombi wamathumbu kufuneka uqale ukuphilisa.

> Imithombo:

> Ludvigsson JF et al. Ukuqinisekiswa kokuqinisekiswa kwe-atrophy ekhohlakeleyo kunye nokuvutha kwamathambo amancinci kwizirejista ze-biopsy zesiSweden. BMC Gastroenterology . 2009; 9: 19.

> Snyder CL, INTSHA ENTSHA, iGreen PHR, Taylor AK. GeneReviews: Izifo zeCeliac. 2009.

> ID Hill kunye al. Isikhokelo sokuxilongwa kunye nokunyangwa kwesifo se-celiac kubantwana: iingcebiso zeNorth American Society ye-Pediatric Gastroenterology, i-Hepatology kunye neZondlo. Umbhalo we-Gastroenterology kunye neZondlo. 2005; 40: 1-19.

> I-Stanford Medicine yokuThengiswa kwePathologia Iimpawu: Izifo zeCeliac.

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