Ukuqapha imiphumela emibi kungadingeka ngenkathi kuthatha imithi ethile
Udokotela wakho we-IBD uzolungisa izivivinyo ezithile ukuqapha umsebenzi wesifo endleleni, kodwa futhi nokuhlola ukuthi imithi isebenza kanjani futhi uma kunemiphumela emibi kwezinye izitho zakho noma izinhlelo zomzimba. Abantu abanezifo zesifo sofuba (IBD) baphathwa ngezindlela ezihlukahlukene zemithi, eziningi zazo zinezindlela ezahlukene zokwenza umzimba.
Ezimweni eziningi, imiphumela emibi ayivamile, kodwa ingabanjwa ekuseni ngakho kufanelekile ukwenza izivivinyo ukuqinisekisa ukuthi ukwelashwa kuyahamba kahle.
Imihlahlandlela yokuhlola ngaphambi kokuqala imithi ethile yokwelashwa yilezo kuphela: imihlahlandlela. Wonke odokotela kanye ne-IBD isikhungo bazokwenza izinto ngokuhlukile. Kodwa-ke, kubalulekile ukuthi abantu abahlala ne-IBD bahlolisise ukuthi yini engaba yizinga lokunakekelwa lapho beqala imithi ethile. Lokhu kuyiqiniso ikakhulukazi uma kungabonakali esikhungweni se-IBD noma uma ukunakekelwa okuningi kunakekelwa elinye ilungu lethimba (njengokuthi i-internist noma udokotela oyinhloko).
Abantu abane- Crohn's disease noma i- ulcerative colitis abanemibuzo mayelana nomsebenzi webhu kanye nezinye izivivinyo eziphakanyisiwe ngenkathi bethatha imithi ye-IBD kufanele baxoxe nodokotela babo.
Lapho Kuthatha i-Azulfidine (i-Sulfasalazine)
I-Azulfidine yisidakamizwa esisekelwe sulfa esine-5-aminosalicylic acid (5-ASA) ne-sulfapyridine.
Isetshenziselwa ukwelapha isifo sochungechunge kanye nezinye izimo zokuvuvukala njenge- arthritis ye-rheumatoid kanye ne- ankylosing spondylitis .
Lesi sidakamizwa sinomlando omude wokusetshenziswa okuphephile kwe-ulcerative colitis, kodwa manje sekusetshenziselwa kancane kancane njengezidakamizwa ezintsha ezisebenza kahle futhi zibe nemiphumela emibi kakhulu (izinwele kanye nesicucu).
Ngokuvamile, ukuhlolwa kokuqapha ngaphandle kokubalwa kwe- CBC akuvunyelwanga ngokujwayelekile ngenkathi kuthola lesi sidakamizwa.
Gcwalisa i-Blood Cell Count (CBC)
Lokhu kuhlola kwegazi kungenziwa ngaphambi kokuqala ukwelapha nge-Azulfidine bese uphinda njalo njalo ngesonto noma ngenyanga ngenyanga yamaviki ayisithupha okuqala kuya ezinyangeni ezintathu. Ngemuva kwalokho, ukuhlolwa kunganconywa njalo inyanga izinyanga ezintathu bese kuthi njalo emva kwezinyanga ezintathu kuleso sikhathi i-Azulfidine ithathwa.
Lokhu ukuhlola imiphumela eminye engavamile engavamile njengokunciphisa isibalo segazi elimhlophe (isimo sibizwa nge-agranulocytosis). Amacala amaningi e-agranulocytosis ayenzeka ezinyangeni ezintathu zokuqala zokwelapha.
Lapho uthatha i-Corticosteroids
Ukusetshenziswa kwesikhathi eside kwe-steroids njenge- prednisone kuwukuphela kokwelashwa kwe-IBD, kodwa kusetshenziswe kwezinye izimo noma kanye neminye imithi. Esinye sezici eziyinhloko nokusetshenziswa okuvamile kwe-prednisone kuyingozi yokulahlekelwa amathambo.
I- Absorptiometry ye- Dual-Energy ye- X-Ray (DEXA)
Ukukhishwa kwe- DEXA kunganconywa ngaphambi kokuqala ukwelashwa kwe-corticosteroid. Emva kwalokho, kungenziwa futhi emva kweminyaka emibili kuya kweyithathu, noma ngokushesha kubantu abane- osteoporosis noma ababenomunye umonakalo wamathambo, njengokuphuka.
Uma imiphumela ye-DEXA ibonisa ukuthi kukhona ukulahleka kwamathambo, ukwelashwa kungase kuqalwe futhi ezinye izivivinyo zingenziwa.
Lapho uthatha i-Cyclosporine
I-Cyclosporine uhlobo lomuthi wokuzivikela omzimba ovimbela isimiso somzimba sokuzivikela. Ngezinye izikhathi lisetshenziselwa ulcerative colitis nesifo sikaCrohn, kodwa futhi nokuvimbela ukulahlwa komzimba emva kokufakelwa kanye nezinye izimo ezivuthayo ezifana ne-lupus, i-rheumatoid arthritis, ne-psoriasis. Ukuhlolwa okumbalwa kungahle kulandwe ngale ndlela yokwelapha.
Isivivinyo sezinga le-Cyclosporine
Ukuze kuqinisekiswe ukuthi okwanele kwezidakamizwa emzimbeni ukuze kusebenze, noma ukuthi amazinga ezidakamizwa awaphakamisi kakhulu futhi abangela imiphumela emibi, amazinga emithi angadinga ukuba alinganiswe ngokuhlolwa kwegazi.
Imizimba yabantu isabela ngokungafani nemithi kanye namazinga egazini angathinteka yizici eziningi.
Ekuqaleni kokwelapha nge-cyclosporine, ukuhlolwa kungenziwa njalo njalo nsuku zonke kuze kube yilapho isilinganiso esifanele sitholakale. Emva kwalokho, ukuhlolwa kungenziwa ngeviki, ngenyanga, noma ngaphezulu njalo. Kungase kuphinde ibuyele emuva uma kukhona ushintsho, njengokuthi izimpawu ziba zimbi noma esinye isidakamizwa sidingeka futhi sithinta izinga le-cyclosporin.
Ukubalwa kwe-CBC
Ukuvama kwalesi sivivinyo segazi kuzohluka ngokusekelwe kudokotela okhethwayo, kodwa ngokujwayelekile, isibalo segazi esimhlophe, isibalo segazi elibomvu, inani le-hemoglobin, ne-hematocrit lizohlolwa ngezikhathi ezithile.
Ukuzihlola
Iziguli zingase ziceliwe ukuthi ziqoqe umchamo ngenxa ye- urinalysis . Imiphumela yalesi sivivinyo ingasiza ukuqapha izinkinga ezinezinso nesibindi. Kungase kulandwe njalo njalo ngenkathi kuthatha i-cyclosporine ukuqinisekisa ukuthi izidakamizwa azikho emiphumeleni emibi kulawo malungu.
Ezinye izivivinyo zegazi
Ukuze uqinisekise ukuthi i-cyclosporin ayibangeli imiphumela emibi, udokotela angase ahlele ezinye izivivinyo ukuhlola umsebenzi wezinso nesibindi, kuhlanganise namazinga wegazi urea nitrogen (BUN) , i-bilirubin, i-magnesium, i-potassium uric acid, i-lipids, ne- enzyme yesibindi .
Lapho Kuthatha Imuran (Azathioprine)
I-Imuran (azathioprine) iyisidakamizwa se-immunosuppressive antimetabolite esinqunyiwe ukuphatha i-IBD nezinye izimo ezivuthayo ezifana nesifo samathambo. I-Imuran ingase isetshenziswe yodwa noma ngesikhathi esifanayo nezinye imithi (njenge-corticosteroids) ukuze kusize lezo mithi zisebenze ngokuphumelelayo. Ngesikhathi esithola i-Imuran, iziguli zizobekwa ngokucophelela ngemiphumela emibi.
Ukubalwa kwe-CBC
Ngenyanga yokuqala, lokhu kuhlola kwegazi kungenziwa njalo ngeviki, kulandelwa yiwo onke amanye amasonto phakathi nenyanga yesibili nesithathu, bese kuthi njalo ngenyanga emva kwalokho. Uma kunokuguqulwa kwesilinganiso, inqubo yeviki njalo njalo ngesonto ingahle iqale futhi.
Izinga le-Thiopurine Methyltransferase (TPMT)
Lokhu kuhlolwa kungenziwa ngaphambi kokuthola noma yimiphi imithi ye-thiopurine, efaka i-Imuran, mercaptopurine (6-MP) , ne-thioguanine. Izinga le-enzyme le-TPMT livame ukuhlolwa ngokuhlolwa kwegazi, kodwa uma kuphela ukuhlolwa kofuzo kwenziwa kuphela ukuhlolwa kungagcwaliswa ngokuthinta amanye amangqamuzana avela ngaphakathi esihlathini.
Kubalulekile ukuthi lokhu kuhlolwa kwenziwe ngaphambi kokuthatha imithi ukuze uthole ukumelwa kweqiniso kwezinga le-enzyme ye-TPMT. Lokhu kuhlolwa kwenziwa ngoba i-TPMT yi-enzyme emzimbeni owehla i-Imuran neminye imithi efanayo. Uma izinga le-TPMT emzimbeni liphansi kakhulu (okwenzeka ngamaphesenti angu-10 abantu) noma eliphansi kakhulu (okwenzeka cishe ngamaphesenti angu-0.3 abantu), ukuthatha imithi ye-thiopurine njengo-Imuran kungabangela imiphumela emibi kakhulu.
Lapho Kuthatha I-Mesalamine Nezinye 5-ASA Izidakamizwa
Kukhona amalungiselelo amaningana ahlukene e- mesalamine asetshenziselwa ukwelapha i-ulcerative colitis, futhi lesi sidakamizwa singanikwa ngomlomo noma nge-enema. I-Mesalamine imithi e-5-ASA ehlotshaniswa nemiphumela emibi kakhulu kune-Azulfidine ngoba ayiqukethe ingxenye ye-sulfa.
Ukubalwa kwe-CBC kanye nokuhlolwa komsebenzi wesibindi kungaqedwa ngaphambi kokuqala lesi sidakamizwa ukuze uthole izinga eliyisisekelo. Noma kunjalo, azikho izincomo zokuqhubeka nokuhlolwa ngesikhathi sokwelapha. Isivivinyo esisodwa esingase senziwe kaningi kangcono ezingeni le-creatinine.
Izinga le-Creatinine
I-Mesalamine iyindlela yokwelapha evame ukwenziwa isikhathi eside. Izinga lomdali lingalaywa ngaphambi kokuqala lesi sidakamizwa, emavikini ayisithupha, ezinyangeni eziyisithupha, ngonyaka owodwa, bese kuthi ngonyaka.
Izinga le-creatinine lisetshenziselwa ukusiza ukuqapha umphumela omubi ongavamile lapho izinso ziba khona, okuthiwa i-nephritis yangaphakathi. Uma ngabe i-nephritis yezinhlangothi ezisobala, ukwelashwa nge-mesalamine kuyomiswa.
Lapho Kuthatha Methotrexate
I-Methotrexate iyisidakamizwa esiphathelene nesifo sofuba esisetshenziselwa ukwelapha isifo sikaCrohn, i-ankylosing spondylitis, i-rhumatoid arthritis, ne-psoriasis. Kuye kwaboniswa ukuthi kubangela ukungalingani kwe-fetus ngakho-ke akufanele kuthathwe ngabesifazane abakhulelwe noma abafuna ukukhulelwa. Kubalulekile ukuxoxa ngezindlela zokulawula ukubeletha ngaphambi kokuqala lesi sidakamizwa.
Isivivinyo sokukhulelwa
Ngaphambi kokuqala i-methotrexate, ukuhlolwa kokukhulelwa kungahle kulandelwe ukuqinisekisa ukuthi kuphephile ukuthatha isidakamizwa. Lesi sidakamizwa singabangela ukukhulelwa kwesisu kanye nokukhubazeka kokuzalwa. I-methotrexate iphinda idlule ubisi lwebele, ngakho-ke akukhuthazwa ukuthi kusetshenziswe omama abahlengikazi. Ukuhlolwa kokukhulelwa kungenziwa futhi kulo lonke ukusetshenziswa kwezidakamizwa uma kudingekile.
I-X-Ray ye-Chest kanye / noma izivivinyo zomsebenzi we-Lung
I-Methotrexate ingathinta amaphaphu ngakho-ke ngaphambi kokuqala ukwelashwa, ukuhlola ukuhlola umsebenzi wamaphaphu kungalawulwa. Lokhu kungabandakanya nokudluliswa kwe-carbon monoxide kanye nokuhlolwa komsebenzi we-pulmonary ukuqinisekisa ukuthi ayikho izinkinga zamaphaphu ezingabonakali, ikakhulukazi kubantu ababhema noma ababhemayo ngaphambili.
Ukubalwa kwe-CBC
Ukubalwa kwegazi kuzokwenziwa ngaphambi kokuqala ukwelashwa kwe-methotrexate, bese kungalawulwa ngemuva kwesonto elilodwa naphakathi kwamasonto ayisishiyagalombili namasonto angu-12 ngemuva kwalokho. I- white white cell cell ibala ngenkathi ithatha methotrexate ayizange iboniswe kuziguli ezine-IBD, kodwa zenzeke kuziguli ezine-arthritis ye-rheumatoid.
I-Panel Basic Metabolic
Lokhu kuhlolwa kungabandakanya i-BUN, i-carbon dioxide (CO2), i-creatinine, i-glucose, i-cholesterol, i-albin, i-electrolyte, ama-enzyme yesibindi, namazinga we-hormone ye-thyroid. Lokhu ukubuka noma yimiphi imiphumela emibi esibindi nesibindi. Lokhu kuhlolwa kungenziwa njalo ezinyangeni ezintathu ngenkathi i-methotrexate ithathwa.
Ukuphika kwesibindi
Uma umsebenzi wesibindi ubonakala uphathwe ngokusekelwe emiphakathini yephaneli eyisisekelo yamandla noma ezinye izimpawu noma izimpawu, i-biopsy yesibindi ingenziwa. Kubantu abane-arthritis ye-rheumatoid noma i-psoriasis, i-biopsy yesibindi ingenziwa uma umthamo othize we-methotrexate ufinyelelwa, kodwa okwamanje, i-biopsy yesibindi ehleliwe njengaleyo kubantu abane-IBD ayinconywa.
Izwi elivela
Njengoba njalo, i-gastroenterologist iyisisetshenziswa esihle kakhulu sokuxoxa ngezinhlobo zokuqapha ezidingekayo ngenkathi kuthatha imithi ye-IBD. Ezimweni eziningi, umsebenzi webhulethi kanye nezinye ukuhlolwa kwenziwa ukuze ubambe izinkinga kusenesikhathi futhi uphathe ngokushesha.
Ezimweni eziningi imiphumela emibi ayidlangalaleni kodwa ingagwenywa ngezinye izivivinyo ezilula, yingakho kungase kubonakale sengathi umsebenzi wegazi wenza kaningi. Kukhona izinkombandlela zokusiza odokotela banquma ukuthi kungcono kanjani ukunakekelwa iziguli, kodwa zonke iziguli ezine-IBD zihlukile futhi ngakho-ke akuyona nje kuphela ukwelashwa okuzimele ngokweqile, kodwa futhi ukuhlolwa okujwayelekile kwenziwa.
> Imithombo:
> Abegunde AT, Muhammad BH, Ali T. Izinyathelo zokuvimbela ezempilo ezithombeni zesifo sofuba. I-World J Gastroenterol. 2016; 22: 7625-7644. doi: 10.3748 / wjg.v22.i34.7625.
> [Ayikho abalobi ababalwe] "Ukuhlolwa kwe-TPMT ngaphambi kwe-azathioprin therapy?" I- Drug Ther Bull . 2009 Jan; 47 (1): 9-12.
> Cunliffe RN, Scott BB. Ukuqapha izidakamizwa ezithinta izidakamizwa ezithombeni zesifo sofuba. I-Pharmaceutical Pharmacy & Therapeutics. 2002; 16: 647-662. i-doi: 10.1046 / j.1365-2036.2002.01216.x
> Jacobson IM, Kelsey PB, Blyden GT, Demirjian ZN, Isselbacher KJ. I-agranulocytosis i-Sulfasalazine. Am J Gastroenterol. 1985; 80: 118-121.
> Al-Shakarchi Mina, uLobão B, Henriques C, et al. "AB0230 Pre-methotrexate ukuhlolwa kwesifo samaphaphu-isifo se-x-ray esanele?" Ama-Annal of the Rheumatic Diseases 2013; 72 >: A857 >.