I-AIDS kanye ne-High-Dose Steroids Kungabangela Ukuzivivinya Kwama-Immunosuppression
Muva nje, ngenxa yokwethulwa kwezidakamizwa ezintsha ze-immunosuppressant kanye nokwanda kwenani lezingxenyana zomzimba, sibonile abantu abaningi abangenakuzivikela noma abaphila nengculazi engakhubazekile.
Amasosha omzimba ukuqoqwa kwazo zonke amaseli, izicubu, nezitho ezisiza umzimba ukuba ugweme ukutheleleka. Ngaphandle kwesimiso sokuzivikela esiqinile, umuntu uwela inyamazane ezweni langaphandle.
Nokho, imishanguzo emithi eminingi yokuzivivinya umzimba imane iyisinye sezizathu ezenza abantu bangabi namagciwane noma bavikeleke. Ngokuqinisekile, ezinye izinto ezimbi zingaphazamisa isimiso somzimba sokuzivikela, futhi, kuhlanganise ne- AIDS kanye nezifo ezizuzwe njengefa.
Uyini Umzimba Wokuzivikela Emzimbeni?
Amasosha omzimba wakho akhona ukuze avimbele noma ahlasele isifo. Amaseli nezindlela zomzimba omzimba ziyinkimbinkimbi futhi ziyahlukahluka futhi zihlupha zonke izingxenye zomzimba.
Nazi izingxenye ezahlukene zesistimu yomzimba:
- Umnkantsha wamathambo yilapho konke okujabulisayo kuqala khona. Umnkantsha wamathambo unama-stem cells aqhubekela phambili abe amajoni omzimba ahlukahlukene (amaseli B, ama-T, ama-lymphocyte, njalonjalo).
- Akuyona kuphela isikhumba sokuqala sokuzivikela ekuhlaselweni okuvela ezweni elingaphandle, kodwa izingxenye ezithile zesikhumba (njenge-dermis) nazo zicebile amangqamuzana omzimba omzimba. Ngaphezu kwalokho, isikhumba sikhiqiza amaprotheni anesigciwane.
- Kunezinqwaba zamasosha omzimba omzimba egazini. Empeleni, ukuhlolwa kwegazi kusetshenziselwa ukuqapha ukuzivikela.
- Uhlelo lymphatic lugcwele amangqamuzana omzimba omzimba. I-lymphatic system ihlanganisa i-bloodstream ngezicubu ezitholakala kuwo wonke umzimba futhi isebenza njengomgwaqo omkhulu wokuthutha amasosha omzimba. Lezi zamasosha omzimba ziguqulwa ema-lymph nodes. Ngaphakathi kwama-lymph nodes, ukuphendula kwamagciwane kuyasebenza lapho kutholakala ama-microbes.
- Uhlobo lwe-immune cell oluvumela ukuthi sivumelane nezinsongo ezibangelwa ukutheleleka yi-T-cell. Nakuba ama-T-cells eqala ukukhiqizwa emnothweni wamathambo, aqhubeka nokuvuthwa kwi-thymus.
- Abantu baphila ngaphandle kwe-spleens (i-asplenia iyinhloko yezokwelapha ngenxa yokungabi nesipere noma umsebenzi we-splenic). Noma kunjalo, i- spleen iyasiza ukulungiselela umzimba ukutheleleka, futhi abantu abangenawo ama-spleens bajwayele ukuthuthukisa ukutheleleka ngezifo ezithile ezifana ne-meningococci (cabanga ngamadoda), i- Streptococcus pneumoniae (cabanga nge-pneumonia) neHaemophilus influenzae , noma i- H influenza . Sicela uqaphele ukuthi naphezu kwegama layo, i- H. influenza ayibangeli uketshezi futhi esikhundleni salokho ibangela ukutheleleka kokuphefumula ezinganeni. I-spleen yenza njengesihlungi somzimba, kanye nama-patches amangqamuzana omzimba emzimbeni wokulonda igazi ngenxa yezibonakaliso zokutheleleka. Uma ukutheleleka kukhona, i-spleen isebenza impendulo yomzimba.
- Njengesikhumba, izicubu ze-mucosal, ezinjengalezo ezitholakale zihlanganisa amapheshana omzimba kanye nokuphefumula, iyindlela yokuzivikela yokuqala evimbela amagciwane ukungena emzimbeni. Ngakho-ke, izicubu ze-mucosal zigcwele amangqamuzana omzimba omzimba.
I-Net State Immunosuppression
Ukususwa kwesimiso sokuzivikela komzimba kuncike ezintweni eziningana. Kuhlangene, isimo somuntu siqu sokuzivivinya umzimba sithathwa emva kokucubungula okuguquguqukayo okulandelayo:
- uhlobo lwe-immunosuppression (eyesibili kumithi noma ukugula)
- ubude bokuzikhumbuza umzimba
- ukuqina kwe-immunosuppression
- umthamo kanye nezinhlobo zama-immunosuppressant agents noma izidakamizwa
- ama-immunodefaces angenasifo (izifo ezizuzwe njengefa ezigcwala umzimba)
- izici ze-anatomic eziholela ekuqhekekeni (njengokungcoliswa kwamanzi lymphatic okuyiwona owodwa okuhlinzekwa ukuhlinzwa noma imisebe)
- ukutheleleka (cabanga nge-HIV noma i-CMV)
Ukuguqulwa komzimba okubangelwa yimithi
Imithi eminingi isinciphisa isimiso somzimba sokuzivikela. Lezi zidakamizwa zokuzivikela zingaphazamisa izingxenye ezimbalwa zempendulo yegciwane lesandulela ngculazi noma izinjongo zamanye amasosha omzimba omzimba.
Nazi imithi emi-3 engaphazamisa isimiso somzimba sokuzivikela:
- Corticosteroids . Le mithi inqunywe ngezimo ezihlukahlukene zokuzimela, izifo ezibangelwa ukungezwani komzimba nezimo ezivuvukalayo, njenge-arthritis ye-rheumatoid, isifo sofuba esibulalayo, isifo se-asthma, ne-atopy. Ngesikhathi esifushane, le mithi iphazamisa ukusebenza komzimba wamasosha omzimba. Ngokuqondile, i-corticosteroids inqwaba izinombolo zama- lymphocyte nama-monocyte kanye nokucindezela ukufuduka kwe-phagocyte nokusebenza. Imithelela yesikhathi eside yale mithi ihlanganisa isikhumba esincane futhi sikhathele ukukhanda izicubu zomzimba, kokubili okungaqhubeka nokwandisa ukukhulelwa komzimba. Abantu abasesimweni esiphezulu se-steroids basengozini yokutheleleka ezinhlobonhlobo zezinto eziphilayo, njenge- Pneumocystis jirovecii , okubangela ukubola kwe- Pneumocystis pneumonia , kanye no- Strongyloides , okungase kube nokubulala futhi okubangelwa yizimbungu. Ukwengeza, abantu abanesisindo sokuzivikela ezibuthakathaka okuyisisindo esiphakeme ekusebenziseni i-steroid basengozini yokuvuselelwa kwesifo sofuba noma ezinye izifo ezitholakalayo.
Rituximab. Le anti-monoglonal anti-CD20 isetshenziselwa ukwelapha i-non-Hodgkin lymphoma, i-rthumicid arthritis, ne-lymphocytic leukemia engavamile. Ngesikhathi sokuhlolwa kwe-clinical, i-rituximab yayingaxhunyiwe engozini yokukhulelwa. Kusukela lapho i-rituximab isiye emakethe, kunjalo-ke kuye kwaba nemibiko yomuntu ngamunye (i-anecdotal) exhumanisa ukuphathwa kwe-rituximab kulezi zifo ezingavamile njenge-letifencephalopathy eningi eqhubekayo, ebangelwa igciwane le-JC, ne-red cell aplasia ehlanzekile, ehlobene nokutheleleka kwe-parvovirus . Ngaphezu kwalokho, ukuguqulwa kwamagciwane okwesikhashana kuya ekulawulweni kwe-rutiximab kungaholela ekwenzeni kabusha ukutheleleka kwe-hepatitis B.
I-Tumor Necrosis Factor-Alpha (TNF-α) Inhibitors. Le mithi yilezi zinkinga; ama-cytokines ngokuvamile akhiqizwa ngamaseli omzimba. I-TNF-α inhibitors ihlanganisa izidakamizwa ezifana ne-infliximab, i-certolizumab pegol, nama-antibodies omzimba futhi zisetshenziselwa ukuphatha izimo ezizenzakalelayo ezifana ne-rheumatoid arthritis nesifo sikaCrohn. Ngokuphawula, ukuvimbela ukukhulelwa komzimba okubangelwa ukuphathwa kwezidakamizwa kuvulwa umnyango wokutheleleka noListeria monocytogenes , i-pathogen yokudla okungabangela ukufa kwabasifazane abakhulelwe.
Ukuguqulwa kwe-Immunosuppression kusuka ku-Asplenia
Ukususwa kokupheka kwesipula kubizwa ngokuthi "i-splenectomy." Kunezizathu eziningi zokuthi kungani umuntu angasuswa isilwane sakhe, kuhlanganise nomdlavuza, ukuhlukunyezwa, kanye nokuphazamiseka kwegazi (njenge-refractory idiopathic thrombotic purpura). Igama lezokwelapha elithi "asplenia" alibheki kuphela ekususweni kwephethini nge-splenectomy kodwa futhi nokulahlekelwa umsebenzi we-splenic ngokuhambisana nezimo ezifana ne-sickle cell anemia.
Abantu abane-asplenia bangengozi enkulu yokutheleleka ngezilwane ezifakiwe, njengeStptococcus pneumoniae , i- Haemophilus influenzae , nezinye izinhlobo ze- Neisseria meningitides . Kulaba bantu, ukutheleleka okubulalayo kungasheshe kugxile - ikakhulukazi uma kwenzeka i-sepsis noma ukutheleleka kwegazi. I-Sepsis ivame kakhulu kubantu abanesifo se-splenectomy esesimweni somdlavuza (ukulimala) kunabantu abangenawo ama-spleens ngemuva kwengozi (ukuhlukumezeka). Okuphawulayo, ingozi yokutheleleka ngezinto ezifakiwe zikhulu kunazo zonke phakathi neminyaka embalwa yokuqala kulandela i-splenectomy.
Ukuguquka Kwangaphandle Ngemva Kokufakelwa
Kunezinhlobo ezimbili zokuguqula: ukuguqulwa kwe-stem cell kanye nokuguquka komzimba okuqinile. Zombili lezi zinhlobo zokuguqula zibangelwa ukuguqulwa kwe-immunosuppression.
Ukuguquka kwe-stem cell kuye kwabizwa ngokuthi ukuguqulwa komnkantsha wamathambo ngoba amangqamuzana ama-stem, noma amaseli angenalutho angakwazi ukukhiqiza zonke izinhlobo zamangqamuzana egazi, ayekade evunwa kuphela emsakeni wethambo. Ngenxa yentuthuko yezokwelapha, manje sesiyakwazi ukuhlunga amaseli avela egazini. Ukufakelwa kwe-cell stem kwenziwa njengokwelashwa kwezinhlobo ezithile ze-khansa yegazi, kuhlanganise ne-acute leukemia ye-lymphocytic, Ngokuvamile, abantu abanezifo sebevele bevezwe ukwelashwa okunzulu komdlavuza ngakho-ke sebevele bengavunyelwe ukuzivivinya.
Ukuguqula izitho eziqinile kubhekisela ekudluleni kwezitho ezinjengezinhliziyo, izinso, noma isibindi. Abantu abathola izidakamizwa eziqinile njalo badinga ukwelashwa kwansuku zonke ngemishanguzo ye-immunosuppressant ukunciphisa ingozi yokulahlwa.
Phakathi nenyanga yokuqala yokutakula kusuka ekufakweni komzimba, umamukeli wokufakelwa usengozini enkulu yokutheleleka ehlobene nokuhlinzwa ngokwayo. Ukutheleleka okuvamile phakathi nalesi sikhathi kubandakanya ukutheleleka kwe-urinary tract, izifo zesikhumba, kanye nokutheleleka. Phakathi kwezinyanga ezimbili no-6 emva kokuhlinzwa, abafakiwe ukufaka izitshalo basengozini yokutheleleka ngezifo kanye nokuvuselelwa kwegciwane le-herpes noma ezinye izifo ezitholakalayo. Ezinyangeni eziyisithupha emva kokufakelwa futhi ngaphesheya, abamukeli basengozini yokuthola izifo ezinjengomphakathi ezibangelwa izidalwa ezifakiwe (cabanga ngeStreptococcus pneumoniae neHaemophilus influenzae ).
Ukuguqulwa Kwama-immunosuppression Okubangelwa I-innate Immunodeficiency
Ngezinye izikhathi abantu badla izifo zofuzo eziholela ekutheni amasosha omzimba abuthakathaka. Amaningi kulawa ma-immunodefacial primary ayinqamule futhi athola ukuthi usemncane, njengokwelashwa okunamandla okuhlangene kanye nesifo esingapheliyo se-granulomatous. Kodwa-ke, ukuguquguquka kwama-immunodeficiency okuvamile (CVID) kuvame kakhulu futhi kuveza ekukhuleni nasekukhuleni okuncane.
Nge-CVID, amasosha omzimba ahluleki ukukhiqiza ama-immunoglobulin adingekayo ukuze akhuphule impendulo yomzimba. Ngenxa yalokho, abantu abanesifo se-CVID banamathuba amaningi okuba nezifo zokuphefumula kanye nokutheleleka kwamathambo njengoGiardia lamblia .
Ukwelashwa kwe-CVID kuyinkimbinkimbi futhi kudinga ukunakekelwa kwabachwepheshe ngokwengxenye ngoba abantu abanezimo abaphenduli ukugoma futhi kunalokho badinga ukumnika i-immunoglobulin esimweni sesibhedlela.
Ukuguquka komzimba okubangelwa ukutheleleka
Ukugonywa kwe-immunosuppression kungabangeli nje ingozi eyengeziwe yokutheleleka kodwa kungabangelwa nezifo ezithile. Isibonelo, i-cytomegalovirus (i-CMV), evame ukuphumela kungenazo izimpawu noma izimpawu ze-mononucleosis-uhlobo lwabantu abanamasosha omzimba ajwayelekile, kungaphazamisa isimiso somzimba sokuvikela omzimba kulabo abasesimweni sokuzivikela. Ngokuqondile, imiyalezo ye-CMV ngamathambo e-T, afaka iqhaza ekuziphenduleleni kwamagciwane.
Olunye uhlobo lokutheleleka okungaba nomphumela wokuzivikela ekugululeni i-HIV (i-immunodeficiency virus). Ukuqhubeka kwegciwane lesandulela ngculaza nengculazi kubhalwe ngokuzikhukhumeza okukhulu . Lokhu kungagculiseki kwenzeka uma i-HIV ibulala inqwaba yamaseli omsizi T - i-CD4 namaseli e-CD8 - okudingekayo ukukhuphula impendulo yomzimba. Uma nje lokhu okwanele kulawa maseli bebulewe, umuntu uthola izifo eziningana eziyingozi, okufaka okulandelayo:
- Candidiasis
- Coccidioidomycosis
- Cryptococcosis
- Isifo se-Cytomegalovirus
- I-encephalopathy, okuhlobene ne-HIV
- I-Herpes simplex
- Histoplasmosis
- I-sarcoma yeKapa
- Isifo sofuba
- I-Pneumocystis carinii pneumonia
- I-toxoplasmosis yobuchopho
Sicela uqonde ukuthi akubona bonke abantu abanesandulela ngculazi abangenakuzivikela, noma bane-AIDS. Ngenhlanhla, intuthuko emithi yenze ukwelashwa kwe-HIV kuphumelele kakhulu. Namuhla, abantu abazinikela ngobuqotho ekwelashweni kwama-antiretroviral bangaphila impilo ende ngaphandle kokuthuthukisa i-AIDS.
Isifingqo
Ngokwezinga elikhulu, ukuvama kwamandla okugonywa komzimba phakathi kwabantu baseMelika kuyisibonakaliso senqubekela phambili. Ngenxa yentuthuko emcwaningweni, manje sinezidakamizwa ezingcono zokuzivikela ezingakwazi ukuphatha izinombolo ezihlukahlukene kakhulu. Ngaphezu kwalokho, senza okwezinye izingxenye zomzimba eziholela ekuziphatheni komzimba.
Ngakolunye uhlangothi, ukuthuthuka kwezokwelapha nakho kunethuba lokunciphisa imvamisa yokuguquka kwamagciwane phakathi kwamalungu omphakathi jikelele. Ngokucacile, abantu abanesandulela ngculaza abahambisana ngokuqinile emiphakathini yabo ye-antiretroviral bangaphila ukuphila okude futhi bejabule bengenakho ukuzivikela. Ngeshwa, nokho, naphezu kwentuthuko ekwelashweni kwe-HIV, kuphela abantu abangu-3 kuphela baseMelika abanesandulela ngculaza.
Imithombo:
UHammond SP, uBaden LR. Isahluko 198. Izifo ze-Host Immunocompromised. Ku: McKean SC, Ross JJ, Dressler DD, Brotman DJ, Ginsberg JS. ama-eds. Izimiso Nemikhuba Yezokwelapha Isibhedlela . ENew York, NY: McGraw-Hill; 2012. Kufinyelelwe ngo-Ephreli 12, 2016.
U-Nayeri U, Thung S. Isahluko 15. Izifo ezithathelwanayo ze-Fetal Infenital. Ku: DeCherney AH, Nathan L, Laufer N, Roman AS. ama-eds. Ukutholakala Kokuqala Nokuphathwa Kwesifo: I-Obstetrics & Gynecology, 11e . ENew York, NY: McGraw-Hill; 2013. Kufinyelelwe ngo-Ephreli 13, 2016.