Ubufakazi Busekela Ukusebenzisa Ukubuyela kabusha kweSteroid-Resistant
A. Ukushintshaniswa kwePlasma, okubizwa nangokuthi "i-plasmapheresis," kutuswa yi-American Academy of Neurology (AAN) ukuphatha ukuphindaphinda okunzima kubantu abane-relapsing-remitting multiple sclerosis (RRMS), njengoba kuthathwa ngokuthi "mhlawumbe isebenzayo."
Kodwa-ke, ukushintshaniswa kwe-plasma kunconywa njengendlela yokwelashwa kwemigqa yesibili yokuphindaphinda engaphenduli esikoleni sikaSolu-Medrol - hhayi esikhundleni seSolu-Medrol.
Ukugunyazwa okuvela ku-AAN ekwelapheni kokubuyela emuva ku-RRMS kwenziwa ngoJanuwari 2011 futhi kuyishintsha emibhalweni kusukela ngo-1996, lapho inqubo ibizwa "njengokuthembisayo" futhi "kungenzeka ukuthi iyasiza."
Kumele kuqashelwe ukuthi ukushintshaniswa kwe-plasma akukhulunywanga yi-AAN ukuphatha ukwelashwa okubili okuqhubekayo noma okuqala okuqhubekayo kwezifo eziningi.
Kungani Ukushintshaniswa Kwe-Plasma Exchange kuzobuyela emuva?
Ukushintshaniswa kwe-plasma kususa izinto eziyingozi ezihamba engxenyeni yamanzi (i-plasma) yegazi. Endabeni ye-MS, lokhu cishe ngamagciwane okulwa neprotheyini eyenza i- myelin , kanye namaseli e-T kanye namanye amangqamuzana omzimba angase ahlose i-myelin.
Kucatshangwa ukuthi ukususa la maseli ngesikhathi sokubuyela emuva kunganciphisa ubude bokubuyela emuva kanye nomonakalo obangelwa ukuvuvukala. Kodwa-ke, uma lezi antibodies zigcinwe noma zifakwa ezilonda , ukushintshaniswa kwe-plasma ngeke kusakwazi ukususa futhi cishe ngeke kube nenzuzo yokwelapha.
Iyini Ubufakazi bePlasma Exchange ye-RRMS Ukubuyiselwa?
Esivivinyweni esisodwa se-crossover, abantu abangu-22 abane-RRMS noma ezinye izifo ezibulalayo ezibulalayo (i-myelitis eguquguqukayo, i-neuromyelitis optica) ebangela izimpawu ezinzima zifakiwe ekuhlolisweni kwe-plasma exchange. Bonke abantu behlulekile ukuphendula inkambo yeSolu-Medrol kanti amaphuzu aphakathi kwe- EDSS ayengu- 7.5 lapho beqala ukwelashwa.
Iziguli eziyisishiyagalolunye "zaphawulwa" ekuthuthukiseni "ukulungiswa" ngemuva kokushintshaniswa kwe-plasma. Ezinhlanu zazo zaqhubeka zithola ukuthuthukiswa iminyaka engaba ngu-3.
Kwelinye iqembu elincane lamacala, abantu abane abane-RRMS babuye babuye babuyele eSolu-Medrol. Ngamunye wanikwa imijikelezo emihlanu ye-plasma exchange. Umuntu oyedwa "wabonakalisa" ukutakula, abantu ababili babebuyele "ukulinganisela" kokuthola (nakuba omunye wabo efuna ukuthi ukwelashwa komjikelezo ka-5 kwenziwe kabili), futhi umuntu oyedwa "wayenomusa" wokutakula.
Ngaphansi
Uma ubuyela emuva obunzima obungaphenduli uSolu-Medrol, udokotela wakho angase abonise kahle ukushintshaniswa kwe-plasma. Ukushintshaniswa kwe-plasma kuyinkambiso ephephile kakhulu engeyona engavamile futhi ayibangeli ukukhathazeka okuningi.QAPHELA: Ukushintshaniswa kwe-Plasma kusetshenziselwa abantu abane-multiple sclerosis abatholwe benesifo se-leukoencephalopathy (i-PML) ehambisana ne-Tysabri ehambisana ne-multifocal. Kuvame ukusetshenziselwa ngokuhambisana nemithi. (Ukuze ufunde kabanzi: Q. Iyiphi imithi yokwelashwa kwe-PML ehlobene ne-Tysabri? )
Ukuze uthole ukubuyekezwa kwenqubo yokushintshaniswa kwe-plasma, funda: I-Plasma Exchange (i-Plasmapheresis) ye-MS nezinye izifo ze-neurological
Imithombo:
Cortese I, Chaudhry V, So YT, Cantor F, Cornblath DR, Rae-Grant A. Ukubuyekezwa okusekelwe ebukhosini: I-Plasmapheresis enkingeni ye-neurologic: Umbiko we-Therapeutics and Technology Assessment Committee ye-American Academy of Neurology. I-Neurology. 2011 Jan 18; 76 (3): 294-300.
Habek M, Barun B, Puretic Z, Brinar VV. Ukwelashwa kwe-steroid okungaphenduliyo kubuya nokushintshaniswa kwe-plasma ku-multiple sclerosis. Ther Apher Dial. 2010 Jun; 14 (3): 298-302.
Lehmann HC, Hartung HP, Hetzel GR, Stuve O, Kieseier BC. Ukushintshaniswa kwe-plasma ku-Neuroimmunological Disorders, Ingxenye 1: Ukulinganisa nokwelashwa kwezimo ezivuthayo zoHlelo lweNervous System. Arch Neurol. 2006; 63: 930-935.
Ukuxoshwa kweBG, O'Brien PC, Petterson TM, et al. Isivivinyo esingenangqondo sokushintshaniswa kwe-plasma ohlelweni oluyinhloko lwezinzwa zesifo sokuvuvukala kwesifo somzimba. Ann Neurol. 1999; 46: 878-886.