Amangqamuzana omgogodla afakwe kwizinto ezibizwa ngokuthi i-myelin. I-Myelin iyasiza izimpendulo zikagesi zihamba ngezinzwa. I-Multiple Sclerosis (MS) yinkinga yokudonswa komzimba lapho umzimba uhlasele khona ama-myelin emathanjeni obuchopho nomgogodla obangela iziguli ezine-MS ukuba zithole ukuphazanyiswa okubukwayo, ubunzima be-muscle, izinkinga zokucabanga, njalonjalo.
Njengezifo eziningi, kukholelwa ukuthi i-MS ithonywe yizinto eziphilayo nezendalo.
Ngo-December 2017 ukubuyekezwa okuhlelekile okubizwa ngokuthi "Ukutholakala kwezidakamizwa kanye nobungozi be-multiple sclerosis," u-Yong nababhali bezincwadi bahlola ukuthi ngabe izidakamizwa ezidakamizwa-indawo engokwemvelo-zingathonya ingozi ye-MS. Kulesi sifundo, abacwaningi baveza izifundo eziphakeme ezingu-13 zokuhlaziywa. Lezi zifundo ezingu-13 zahlola izigaba eziyisikhombisa zemithi. Ake sibheke ithonya leklasi ngayinye yezidakamizwa ku-MS.
Amiloride
I-Amiloride (i-Midamor) i-potassium-egcina i-diuretic esebenzisa ukwelapha umfutho wegazi ophakeme noma umfutho wegazi ophakeme. Ngokuqondile, i-Midamor inqabela isiteshi se-i-ion-sensing 1 (ASIC-1). Ezilwaneni zezilwane ze-MS, i-ASIC-1 iphakanyisiwe, okusho ukuthi kunokunyuka kwamaselula ku-ASIC-1. Lokhu kwenyuka kwamaselula kutholakala ezifundeni zesimiso sezinzwa eziphakathi kwezinto ezimele (ie, plaques). Kulezi zilwane, ukuvinjelwa kwe-ASIC-1 kuboniswa ukunciphisa ukwenziwa kwe-neurodengeneration, inqubo ehambisana nokukhubazeka okwedlulele kuziguli ezine-MS.
Naphezu kokuphumelela ekunciphiseni ukudilizwa kwezidakamizwa ezilwaneni, u-Yong nosebenza nabo bathola ukuthi akukho mhlangano phakathi kokusetshenziswa kweMidamor kanye nemvamisa ye-MS esampula saseDenmark. (IDenmark ibamba izincwadi eziningi ezisekelwe kubantu, okwenza kube lula ukwenza izifundo ezisekelwe emphakathini ezihlola impilo yomphakathi.) Ngokuphawulekayo, lesi sampula saseDanishi sasihlanganisa abantu abaye baqala ukuphuma kwe-MS, abacwaningi abachazayo njenge-MS eyakhiwe kulabo abaneminyaka engama-60 ubudala noma Okuningi.
Ukuhamba kwesikhathi esilandelayo MS kuphela kuthinta amaphesenti angu-5 abantu abane-MS; Ngakho-ke, kungenzeka ukuthi lezi zithole azisebenzi kumuntu omkhulu we-MS. Ngamanye amazwi, aziwa ukuthi i-Midamor ithonya yini i-pathogenesis ye-MS kubantu abane-MS kepha hhayi ngokuya kwesikhathi se-MS.
Encwadini ehlobene nalokhu, abacwaningi abatholanga nethonya lama-thiazide diuretics, afana ne-Midamor asetshenziselwa ukuphatha umfutho wegazi ophezulu, ku-MS.
I-Valproic Acid
I-Valproic acid (i-Valproic) imithi e-anticonvulsant esetshenziselwa ukwelapha isithuthwane . "I-Valproic acid ivimbela i-histone deacetylase engabangela ukuguqulwa kwamaprotheni athile okubandakanya ukufaka amaselula nokukhanda kwe-myelin," bhala u-Yong nabalobi bezobambiswano. Noma kunjalo, ngokususelwa ekuhlaziyweni kwedatha yaseDanish, abacwaningi abatholanga ukuhlangana phakathi kukaValproic no-MS.
TNF Inhibitors
Ngokusho kwe-American College of Rheumatology, "i-TNF inhibitors yindlela yokusetshenziswa kwezidakamizwa emhlabeni jikelele ukuphatha izimo zokuvuvukala njenge-arthritis ye-rheumatoid (RA), i-psoriatic arthritis, i-arthritis yezingane, izifo zesifo sofuba (Crohn's and ulcerative colitis), i-ankylosing spondylitis, futhi i-psoriasis. Benza ukunciphisa ukuvuvukala nokuyeka ukuqhuma kwesifo ngokubhekisa into ekhangela ukuvuvukala okuthiwa i-Tumor Necrosis Factor (TNF). "
U-Yong nababhali bezobambiswano baphinde babukela izifundo ezivela eDanishi ukuze bathole ukuthi ngabe kukhona ubudlelwane phakathi kwe-TNF inhibitors kanye ne-MS. Zombili lezi zifundo ezihlolwe kwakuyizinkolelo zokubheka kanye nokubandakanyeka noma ama-sampuli esabantu abalandelwa ngokuhamba kwesikhathi.
U-Yong nozakwethu bathola ukuthi kukhona ukuhlangana phakathi kokwelashwa nge-TNF inhibitors yesifo sofuba esifubeni kanye nokuthuthukiswa kwe-MS. Ngokucacile, nakuba kwakukhona ukwanda okwemine engozini yokuthuthukisa i-MS kulabo abasebenzisa i-TNF inhibitors yezifo zesibindi sokuvuvukala, lokhu kuphakama kwakungefani nengozi emine yokuthi abantu abanezifo zesifo sofuba sebevele babonakalise ukuxoshwa kwemicimbi efana ne-MS.
Kodwa-ke, abacwaningi bathola ukuthi amadoda athola i-TNF inhibitors ye-arthritis kanye nabesilisa nabesifazane abathola i-TNF inhibitors ye-anondlosing spondylitis babenengozini enkulu ye-MS ngemuva kokuqala ukwelashwa. Inothi, i-spondylitis e-ankylosing ivame kakhulu emadodeni.
Omunye umkhawulo wezifundo zaseDanishi ezihlolwe ukuthi akukacaci ukuthi yiziphi izinhlobo ze-TNF inhibitors ezisetshenzisiwe, kanti izinhlobo ezahlukene ze-TNF inhibitors zithinta ukuvuvukala ngezindlela ezahlukene.
Ngokusho kwabakwa-Yong nabambhali abambisene nabo: "Ukuhlanganiswa, ukubonwa kokuqala kuphakamisa ukukhathazeka ngokuphepha kwe-anti-TNFα [TNF inhibitors] ngokuphathelene nomngcipheko we-MS, kodwa umsebenzi obalulekile uyadingeka. Kungaba nokubaluleka kokuqinisekisa ukuthi ngabe yimiphi imiphumela kukhona umkhiqizo othize noma obonakalayo ekilasini lonke lokwelapha. "
Ama-antibiotics
Ucwaningo lwezinkinga ezimbili-olulodwa e-UK nolunye eDenmark-luhlolisisa inhlangano phakathi kokusetshenziswa kwamagciwane nama-MS. Ucwaningo lwe-case-control luqhathanisa neziguli ezinomphumela noma izifo (ie, amacala) nalabo abangenalo (okusho, izilawuli). Ngesifundo sokulawula icala, abacwaningi babukeka emuva ngokuphindaphindiwe ukuze banqume ukuvezwa kwezici zobungozi. Ezifundweni zase-UK naseDanish, amacala ayebandakanya iziguli ezazitholwa ukuthi zinama-MS, futhi isisindo esiyingozi sentshisekelo kwakuwukusetshenziswa kwezidakamizwa.
Esifundweni sase-UK, iziguli ezingu-163 ezine-MS zifaniswe nabantu abangu-1523 ngaphandle kwe-MS ngokususelwa eminyakeni yobudala, ubulili, nezinye izinto. Abacwaningi bathola ukuthi ukusetshenziswa kwama-antibiotic jikelele akuhlobene no-MS. Noma kunjalo, ukusebenzisa i-penicillin isikhathi esingaphezu kwamasonto amabili noma ukusetshenziswa kwe-tetracycline isikhathi esingaphezu kwesonto elilodwa kuhlanganiswe namaphesenti ama-50 anciphisa ingozi ye-MS.
Abacwaningi baseDanishi bazama ukuphinda baphendule lokho okufunyenwe ngabacwaningi base-UK basebenzisa ubukhulu besampuli (3259 amacala). Kuyathakazelisa ukuthi abacwaningi baseDenmark bathola ukuthi izinhlobo eziningi zokusebenzisa ama-antibiotic zazihlotshaniswa nengozi ephakeme ye-MS-ngisho neziguli ezithatha inkambo eyodwa yama-antibiotic izinsuku ezingu-7. Ukuthi ububanzi obubanzi bokusebenzisa ama-antibiotic buhlotshaniswa ne-MS bubonakala bubonisa ukuthi ukutheleleka kwangempela ngokwayo-hhayi imithi elwa namagciwane ngokwayo-kuhlobene nokuthuthukiswa kwe-MS.
Ngokuvamile, kubonakala sengathi ama-antibiotics awahlotshaniswa ne-MS ekuhlaziyeni okuningi, kepha ucwaningo oluningi luzodingeka lwenziwe.
Kufakwe ama-agonist alamukeli abamukelekayo abambalwa beta2-adrenergic
I-fenoterol yezidakamizwa (i-Berotec N) ne-salbutamol (i-ProAir HFA) zombili zihanjiswe nge-short-acting beta2-adrenergic receptor agonists ezisetshenziselwa ukwelapha isifo se-asthma nesifo esingavamile se-pulmonary pulmonary. Emcwaningweni wokulawulwa kwamacala e-population, abacwaningi baseTaiwan bahlola ukuthi ngabe lezi zidakamizwa zithonya ingozi ye-MS. Bathola ukuthi nakuba kwakukhona ingozi encane ye-MS kulabo abathatha i-Berotec N, ingozi yokuthuthukisa i-MS ayihlanganisiwe neProAir HFA.
Abacwaningi baseTaiwan basikisela ukuthi i-Berotec N ingase ibe nomthelela wokuvikela ngoba ikhono layo eliphakeme lokuvimbela isizukulwane se-superoxide nesi-degranulation. Kubonakala sengathi, i-ProAir HFA ayifanele ukwenza lezi zinto; ngakho-ke, ayinamandla okuvikela.
Ngaphezu kwalokho, uma sicabanga nge-classic-adrenergic receptor agonists njengeklasi, i-Yong kanye nabalobi ababambisene nabo babika lokhu okulandelayo: "Ama-agonists abambalwa abenza ama-beta2 ama-brontialist avimbela i-interleukin-12, i-cytokine eyenza i-T cell ihlukaniswe I-proinflammatory T isisindo amangqamuzana angu-1. "Ngokweqile, ochwepheshe basikisela ukuthi amaseli e-T (uhlobo lomzimba wegazi elimhlophe) adlala indima ebalulekile emonakalweni wezingqimba ze-myelin eziholela ku-MS.
Ama-antihistamine
Ukusebenzisa umklamo wokulawulwa kwamacala, abacwaningi base-UK bahlola ukuthi ama-antihistamine asetshenziselwa ukuguqulwa nokungahlali ahlobene nokuthuthukiswa kwe-MS. Izinto ezifana nesifo sofuba (isb., I-asthma, i-eczema, ne-fever fever) nokubhema kulungiselelwe. Abacwaningi bathola ukuthi nakuba ama-antihistamine angewona ahlala phansi ayengavumelani nengozi ye-MS, ukulwa nama-antihistamine kwakuhlobene nama-80% okunciphisa ingozi yokuthuthukisa i-MS.
Abacwaningi basikisela ukuthi isizathu sokuthi ama-antihistamine asetshenziselwa ukuguqula ngandlela-thile ayenomphumela wokuzivikela yilokho-ngokungafani nama-antihistamine angewona ahlala phansi-lezi zidakamizwa ziwela umkhawulo wegazi-ubuchopho futhi zenze umphumela ongathí sina ebuchosheni nasendlini yomgogodla.
Ukukhulelwa komlomo
U-Yong nozakwabo bahlaziya izifundo ezinhlanu ezazifuna ubudlelwane phakathi kokusetshenziswa kwezibeletha zomlomo nezingozi ze-MS. Ngokubanzi, kwakungekho nhlobo phakathi kwalezi zinhlobo ezimbili.
Ulwazi Olwengeziwe Nge-Multiple Sclerosis
I-multiple sclerosis ibonakala ngokubhujiswa okukhethiwe kwe-myelin emangqamuzaneni omzimba we-system central negazi (ubuchopho nentambo yomgogodla). Akuthinti amangqamuzana egeyimu esesimweni sezinzwa zomzimba (ie, izinzwa ne-ganglia esingaphandle kobuchopho nomgogodla). Lesi sifo sizenzekelayo, okusho ukuthi umzimba uhlasela ngokwawo.
Ngaphandle kwezidakamizwa zemithi, eziye zaqashelwa nje nje ngokuthi yi-etiologic factor, ezinye izici zokucabangela ziye zathinteka kwi-pathogenesis ye-MS kuhlanganise nalokhu okulandelayo:
- Isikhathi sokuchayeka
- Ukubhema
- Ukucindezeleka
- Izifo ezithinta igciwane njenge- Epstein-Barr Virus
- Ukucindezeleka
- Ukunciphisa ukukhanya kwelanga
- Amazinga aphansi e-vitamin D
Emhlabeni wonke, i-MS ithinta abantu abayizigidi ezingu-2.5, futhi e-United States, abantu abangaphezu kuka-400 000 banesifo.
Ukuqala kwe-MS kungase kube ngokuphuthumayo noma kancane kancane. Izimpawu zokuqala zingase zihlakaniphe kangangokuthi umuntu onama-MS angeke azibone ngisho nezinyanga noma iminyaka. Nazi ezinye izimpawu ze-MS:
- Ukungabi namandla
- Izimpawu ezibonakalayo
- Ukuphazanyiswa okubonakalayo
- Izinkinga ezihambisana nokuzibandakanya
- Ukuphuthuma kwe-Urinary
- Imvamisa ye-Urinary
- Ukukhathala
- Izinkinga zezimoto
Lezi zimpawu zingaxhuma futhi zishaye, ngokuhlaselwa okuphindaphindiwe okuhlala amasonto noma izinyanga kulandela izinga lokutakula. Izimpawu zingenziwa zimbi ngokushisa, ukukhathala, ukuzivocavoca noma ukucindezeleka.
Ekugcineni, i-MS ixilongwa ngokuxoshwa, okusho ukuthi itholakale kuphela ngemva kwezifo ezikhona, ezifana nezicubu zomgogodla noma i-encephalomyelitis (eseceleni kokutheleleka). Lapho ukuhlonza i-MS, umlando kanye nokuhlolwa okubonakalayo ngokomzimba kanye nokutholakala kwe-MRI kuyasiza. Izinguquko kuma-biomarkers ku-cerebrospinal fluid nazo ziyabonakala.
Ngeshwa, akekho ukwelashwa kwe-MS. Kodwa-ke, kunezindlela zokwelashwa ezitholakalayo, kuhlanganise ne-corticosteroids kanye nokushintshaniswa kwe-plasma yokwelashwa kwama-flare-ups, kanye nezinqubo eziningana zokuguqula izifo ezifana ne-beta interferons zokuvimbela izilonda ezintsha ze-MS.
Izwi elivela
Khumbula ukuthi lokhu kubuyekezwa okuhlelekile yi-Yong nabobhali bezinkampani kuqala ukuhlola ithonya lemithi ehlukahlukene ku-MS. Imiphumela yalokhu kubuyekezwa okuhlelekile kuhloswe ukukhanyisa i-pathogenesis ye-MS-isifo esingaziqondi izimbangela.
Kuleli qophelo, akekho umtholampilo ongasebenzisa lezi zithole ukuqondisa ukwelashwa. Noma yiluphi ulwazi oluvela kulobu buchwepheshe obuhlelekile lufanele luqinisekiswe futhi luphindwe. Uma uthatha noma iyiphi yale mithi futhi ukhathazekile ngokuthi ithonya kanjani i-MS engozini, zizwe ukhululekile ukuxoxa ngalokho okufundile ngodokotela wakho odokotela. Kodwa-ke, ungayeki (noma uqale ukuthatha) imithi ngokusekelwe kulokho okufundayo kulesi sihloko-futhi ngaphandle kokufaka okuvela kudokotela wakho.
> Imithombo:
> Multiple Sclerosis. Ku: Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson J, Loscalzo J. eds. I-Manual yezokwelapha yakwaHarrison, e- New York, NY: McGraw-Hill.
> Multiple Sclerosis. I-MedlinePlus.
> TNF Inhibitors. I-American College of Rheumatology.
> Yong HY et al. Ukutholakala kwezidakamizwa kanye nengozi ye-multiple sclerosis: Ukubuyekezwa okuhlelekile. Pharmacoepidemiol Drug Saf. 2017; 1-7.