I-Engraftment syndrome yinkcenkcesha engenzeka emva kokutsalwa komnxeba wethambo, inkqubo eyaziwa ngokuba yi-hematopoietic stem cell transplant (HSCT). I-engraftment syndrome ithathwa njengesimo sokuvuvukala, kwaye ibonakala ngolu hlobo lulandelayo:
- Umkhuhlane kunye nokukhawuleza kungekhona ngenxa yesifo
- Ukugqithisa okweqile kwimiphaphu kungekhona ngenxa yengxaki yenhliziyo
- Ezinye iimpawu kunye neziphumo
I-syndrome ikhula malunga neentsuku ezi-7 ukuya kwe-11 emva kokutsalwa, ngexesha lokubuyiswa kwe-neutrophil . Iimpawu zisoloko ziba buthathaka, kodwa ziyakwazi ukufikelela kwiifom ezitshatyalaliswayo kunye nezingozi zokuphila. Isifo singabangela ukuphefumula, ingqungquthela ≥100.9˚F, ukugqithisa okubomvu kokubili kwiplani kunye nokuphakamisa iindawo zesikhumba, ukufumana ubunzima, iqondo eliphantsi le-oksijeni yegazi, kunye nokusetyenziswa kwamanzi emiphakeni engekho ngenxa yengxaki yenhliziyo.
Ngendlela ephezulu kakhulu, igama elithi "aseptic shock" syndrome lisetyenziswe, oku kuthetha ukuba kukho ukuwa kweprogram yokujikeleza kunye nokuhluleka kwamalungu amaninzi.
I-engraftment syndrome ibikwe ukuba yenzeke emva kokubini iindidi eziphambili ze-HSCT: i-autologous (ukutyala ukusuka kwedwa) kunye ne-allogeneic (ukusuka kwenye, umxhasi onxulumene naye rhoqo).
Ulwalamano kwezinye iimeko
I-engraftment ibhekisele kwiiseli ezitsha zitshintshwe "zithatha iingcambu kwaye zivelise," oko kukuthi, xa iiseli ezifakelwayo zifumana i-niche emnzini wethambo kwaye ziqalise inkqubo yokwenza iiseli zegazi ezibomvu, iiseli zegazi ezimhlophe kunye neeplatelet.
Ulwalamano lwe-engraftment syndrome ukuya kwezinye iindwendwe ezithatha emva kokutshintshela ezinempawu ezifanayo ziphikisana. Ezi zenzeko zenzeke iziganeko ezinjenge-acute graft versus host host (GVHD) , i-pre-engraftment syndrome (i-PES), i-toxicity etyetyment and infections.
I-pre-engraftment syndrome kunye ne-peri-engraftment syndrome yimiqathango eyenziwa yizenzululwazi ukuchaza le setethi yeempawu ezingase zivele malunga nexesha le-engraftment. I-Engraftment syndrome iye yabizwa ngokuba yi "capillary leak syndrome," ebhekisela kwelinye leendlela ezisetyenziswayo zesifo-oko kukuthi, ngenxa yempawu zecala ezingekho emzimbeni, imithwalo yegazi encinci yegazi, i-capillaries, ibe ngakumbi ngaphezu kwesigqirha, okubangelwa kukungaqhelekanga, ukongezwa kwamanzi amaninzi kwiindawo ezahlukeneyo zomzimba. Xa oku kwenzeka emiphakeni, i-edema ye-pulmonary. Ngokukodwa, i-fluid kwimiphunga engekho ngenxa yengxaki yentliziyo, ngoko igama elithi "i-edema ye-pulmary pulema".
Yintoni Ebangelwa Ngama-Syndrome?
Isizathu esicacileyo se-engraftment syndrome asiyazi, kodwa kucatshangelwa ukuba ukuchithwa kwama-cell-inflammatory cell signals kunye nokusebenzisana kwamaseli kunokuba nenendima enkulu.
Umngcipheko emiphakeni kucatshangelwa ukuba kubangelwa izibonakaliso zeseli ezibangela ukuba ama-capillary amancinci omzimba ahlambe. Lo mkhuhlane ogqithisileyo ubizwa ngokuba yi -edema ye-pulmonary , okanye xa uboniswa kwizifundo zengcamango, kunokubhekwa ngokuchithwa kwesigxina. Kwiimeko apho i-fluid emaphaphini ifundwe, ngamanye amaxesha bayifumana amaninzi aphezulu e-neutrophils, uhlobo lweseli legazi elimhlophe.
Kwizigulane ezimbini ezaziphethe imiphunga yazo, zafumanisa umonakalo kwi-alveoli-i-pulp air air bags-eyasasazeka ngokubanzi.
Abaphandi baqiqa ukuba, ngenxa ye-engraftment syndrome ibonakala emva kweentlobo ezahlukeneyo zabaxhasi beentlobo kunye neentlobo ezahlukeneyo zeengqungquthela, kwaye ekubeni i-syndrome ingabonakali kwi-GVHD kwaye ihambelane nokubuyiswa kweeseli ezimhlophe ezibizwa ngokuba yi-granulocytes, ukuba inokuthi ilandelelwe ngumhlophe iiseli zegazi kunye nezibonakaliso zeselfowm. Lo mxube weempawu zeseli kunye nokusebenzisana kunokubangela inkqubo ejikelezayo yokujikeleza, inkunkuma yokungasebenzi kunye neempawu ezifana nomkhuhlane.
Kuchongwa njani?
UDkt. Spitzer, umphandi wekliniki kwiNkqubo yeMathambo yokuThuthukiswa kweMarrow eMassachusetts General Hospital eBoston, MA, wapapasha iphepha lokulonda kwi-engraftment syndrome emva ko-2001.
I-Spitzer Imigqaliselo ye-engraftment syndrome yile ndlela ilandelayo:
Imigaqo ephakamileyo:
- Ubungakanani bokushisa obukhulu okanye obalingana no-38.3 ° C ngaphandle kwesizathu esibangela ukusuleleka
- Ukugqithisa okubomvu okubandakanya> iipesenti ezingama-25 zommandla womhlaba kwaye kungabonakali kwiyeza
- Rash okanye umthamo ogqithiseleyo kwimiphunga engabangelwa yingxaki yenhliziyo, njengoko kubonwe kumatshini okucinga, kunye ne-oksijini ephantsi egazini
Imilinganiselo encinci:
- Ubunzima bebindi kunye neerameters ezithile (bilirubin ≥2 mg / dL okanye i-transaminase ≥2 izihlandlo eziqhelekileyo)
- Ukungasebenzi (i-serum creatinine ≥ 2x isiseko)
- Uzuzo lwesisindo (≥2,5 ekhulwini lesisindo somzimba esisiseko)
- Ukudideka kwesikhashana / ingqondo engafanelekiyo ngezinye izizathu
Ukufumanisa i-diagnosti kudinga zonke iinkqubo ezintathu eziphambili okanye iikhrayitheriya ezimbini eziphambili kunye nemigangatho emininzi engaphantsi kweeyure ezingama-96 ze-engraftment.
Kukho ezinye iimpawu ezisetyenziswayo ukufumanisa i-engraftment syndrome, ngokunjalo. Ngokomzekelo, imilinganiselo ye-Maiolino yasungulwa ngo-2004. Iingcali ezahlukeneyo zibonakala zinemingcele eyahlukileyo yokuchonga i-engraftment syndrome, kwaye iimpawu ezigqithisileyo zingabangela ukuba kule ngxaki. Ngo-2015, uDkt. Spitzer wakhicilela ezinye iimpawu "ezihambelana" kwaye "ezingahambelani ne" engraftment syndrome:
Ukuhambelana nesifo se-engraftment: I- fever non-fever; ukukhawuleza; imiqondiso yamaplasilla ahlambulukileyo (uxinzelelo oluphantsi lwegazi, inzuzo yesisindo, ukuvuvukala, ukuphuma kwamanzi emzimbeni, umkhuhlane kwimiphunga engabangelwa yintliziyo yesimo); izintso, isibindi, okanye ingqondo engasebenzi; kunye nehudo ngaphandle kwesinye isizathu.
Awuhambisani nesifo se-engraftment: Isifo esibangelwa ngumkhuhlane; ukukhawuleza ngeziphumo ze-biopsy ezibonisa i-GVHD kwimeko yokufakelwa komntu ongeyena ngokwakhe; ukungaphumeleli kwentliziyo; i-organ dysfunction ngenxa yesinye isizathu, (umzekelo, i-calcinurin inhibitor nephrotoxicity okanye i-GVHD yesibindi); isifo sohudo ngenxa yesinye isizathu (umzekelo, usulelo, utyhefu, okanye i-GVHD).
I-Engraftment Syndrome ilawulwa njani?
Ngokweengxelo kaDkt. Spitzer, malunga nesithathu kwisigulane, i-engraftment syndrome inokusombulula ngokwayo, kwaye ayifuni unyango. Xa unyango luyimfuneko, i-engraftment syndrome ibonakala iyayiphendula kakhulu kunyango ye-corticosteroid xa nje iimpawu ziqhubeka, ngokuqhelekileyo zingaphantsi kweveki. Imfuno yonyango iboniswa ngubusika> 39 ° C ngaphandle kwesizathu esichaphazelayo esibangela sisifo kunye nezibonakaliso eziphawulekayo zamapilisi ahlambulukileyo, ngokukodwa ukwanda kwamanzi kwimiphunga.
Yintoni Eyaziwa Ngakumbi Nge-Engraftment Syndrome?
Kukho iindlela ezahlukeneyo zokusetyenziswa kwezifo zesifo se-engraftment, kwaye oku kungenza i-akhawunti yoluhlu olubanzi lweenkcukacha ngokubhekiselele kwindlela eqhelekileyo ngayo i-syndrome ivela kwiindidi ezahlukahlukeneyo zezigulane ezitholayo izicwangciso ze-stem cell transplants. UDkt. Spitzer uye wafunda i-syndrome ukususela ngo-2001, kwaye iimpapasho kunye nokuhlaziywa kweencwadi eziphilayo zatshintshiswe kutshanje ngo-2015:
- I-engraftment syndrome emva kokuba i-hematopoietic cell transplantation (HCT) iqhutyelwa ngakumbi.
- Imigaqo yokuxilonga eyahlukeneyo isetyenziswa, kwaye mhlawumbi ilandele i-intanethi (i-7-
- Nangona izibonakaliso zekliniki zesifo se-engraftment zingalingana nezo zi-GVHD eziqhelekileyo, i-engraftment syndrome sele ichazwe kakuhle kwizigulane ezingenayo i-GVHD eqatha.
- Ayaziwa ukuba i-syndrome iholele ekufeni okuphezulu kunye nokuphila okungakumbi emva kweHCT; Izifundo zenziwe, kodwa idatha iyaphikisana.
- I-Engraftment syndrome ihlala isombululo ngokwayo, kodwa, njenge-GVHD enzima, iyaphendula kwi-corticosteroids.
- Ngenxa yokuba i-engraftment syndrome kunye ne-GVHD enobuchule inokuba neenkalo ezigqithisileyo kunye nokuphendula kwonyango, ezi nkqubo zingasayi kuba yiziganeko ezahlukileyo.
- Izixhobo ze-engraftment syndrome zinokuthi zenzeke kunye nezobisi kunye ne-radiation-induced andxication.
ILizwi Ku:
Kufana kangakanani le syndrome, kwaye yintoni amathuba okuba isigulane esithile siza kuvelisa iimpawu zayo? Ekubeni, kungabikho mvumelwano malunga nenkcazo echanekileyo, kwiinkonzo ezininzi, kuye kwavakaliswa iziganeko ezininzi kwiincwadi, ukususela ngaphantsi kweepesenti ezi-7 ukuya kuma-90 ekhulwini kuma-autotransplants (ukutshintshwa ukusuka kumntu njengomniki-mali). Amazinga aphakamileyo sele abiwe emva kwe-autotransplants ze-lymphomas ngaphandle kweHodgkin lymphoma . Isifo sinokuchaphazela abantwana kunye nabantu abadala kumazinga afanayo, kodwa impembelelo ingaba ngakumbi kubantwana ngokubhekiselele ekufeni okungahambelani nokubuyela kwakhona komhlaza.
Iirhafu ze-engraftment syndrome zibonakala zingezantsi kubantu abafumana ukugqithiswa kwabanikeli abangabanikeli. Le ndawo inzima ukuphanda, nangona kunjalo, ekubeni i-syndrome ibonakala ngathi i-GVHD enzima. Kwisifundo esinye, ukugqiba isigqibo se-engraftment syndrome kwenzeka kwiipesenti ezili-10 kuphela zezifundo ezingakhange zihlakulele i-GVHD enzima.
> Imithombo:
> Franquet T, uMüller NL, Lee KS, et al. Iziphumo ze-CT ezichanekileyo kunye neziphumo zokufumana iingxaki ze-pulmatical non-infectious pulmonary complications emva kwe-hematopoietic stem cell transplantation. AJR Am J Roentgenol . 2005; 184 (2): 629-37.
> Lee YH, Rah WJ. I-pre-engraftment syndrome: ukubaluleka kwekliniki kunye ne-pathophysiology. IGazi Res . 2016; 51 (3): 152-154.
> Omer AK, Kim HT, Yalamarti B, McAfee S, Dey BR, iBalen KK et al. I-engraftment syndrome emva kwe-allogeneic i-hematopoietic cell transplantation kubantu abadala. U-J Hematol 2014; 89: 698-705.
> Spitzer, TR. I-Engraftment syndrome: ikrele elijikelezileyo elinama-hematopoietic cell transplants. I-Bone Marrow Transplant. 2015; 50 (4): 469-75.