I-Engraftment syndrome iyinkimbinkimbi engenzeka ngemva kokufakelwa komnyosi we-bone, inqubo eyaziwa ngokuthi i-hematopoietic stem cell transplant (HSCT). I-engraftment syndrome ibhekwa njengesimo sokuvuvukala, futhi sibonakala ngalokhu okulandelayo:
- Ukushisa nokushisa hhayi ngenxa yokutheleleka
- Uketshezi okwedlulele emaphashini hhayi ngenxa yenkinga yenhliziyo
- Ezinye izimpawu nezimpawu eziningi
I-syndrome iqala cishe izinsuku ezingu-7 kuya kwezingu-11 emva kokutshala, ngesikhathi sokuthola i-neutrophil . Izimpawu ngokuvamile ziba buthakathaka, kodwa zingakwazi ukufaka amafomu amaningi okusongela nokuphila. I-syndrome ingabangela ukuphefumula ukuphefumula, umkhuhlane ≥100.9˚F, ukushisa okubomvu okubili okuphambene nokuphakamisa izindawo zesikhumba, inzuzo yesisindo, amazinga aphansi e-oksijeni wegazi, nokukhuphuka ngokweqile emaphashini okungengenxa yenkinga yenhliziyo.
Esimweni sayo esibi kakhulu, igama elithi "aseptic shock" syndrome lisetshenziswe, okusho ukuthi kukhona ukuwa kwehlelo lokujikeleza nokuhluleka kwamalungu amaningi.
I-engraftment syndrome ibike ukuthi iyenzeka ngemuva kokubili izinhlobo eziyinhloko ze-HSCT: i-autologous (ukufakelwa kusuka ku-self) ne-allogeneic (evela kwezinye, abaxhasi abahlobene njalo).
Ubuhlobo Kwezinye Izimo
I-engraftment ibhekisela kumaseli amasha asetshenziswe "ethatha izimpande futhi akhiqize," okungukuthi, lapho amangqamuzana asetshenziswe athola i-niche yawo emnothweni wamathambo futhi aqale inqubo yokwenza amangqamuzana egazi abomvu amasha, amangqamuzana amhlophe wegazi namaplatelet.
Ubuhlobo be-engraftment syndrome nakwezinye izenzakalo zokuthutha ezithuthukayo ezinezici ezifanayo ziphikisana. Lezi zenzakalo ze-post-transplant zifaka izimo ezinjenge-acute graft versus host host (GVHD) , i-pre-engraftment syndrome (i-PES), i-pre-engraftment syndrome (i-PES), izidakamizwa ezibangelwa izidakamizwa kanye nezifo, zodwa noma zihlangene.
I-pre-engraftment syndrome kanye ne-peri-engraftment syndrome yizinye izinqubo ososayensi abasetshenziselwe ukuchaza le setha yezimpawu ezingase ziphakame ngesikhathi se-engraftment. I-Engraftment syndrome nayo ibizwe ngokuthi "i-capillary leak syndrome," ekhuluma ngenye yezindlela ezingase zibe ngaphansi kwe-syndrome-okungukuthi, ngenxa yezibonakaliso zeselula ezingekho ibhalansi, imithwalo yegazi encane kunazo zonke, i-capillaries, iba ngaphezulu kakhulu kunokuvamile, okuholela ekungajwayelekile, ukwedlulele ngokweqile ekwakheni izingxenye ezihlukahlukene zomzimba. Uma lokhu kwenzeka emaphashini, i-edema ye-pulmonary. Ngokuqondile, liwuketshezi emaphashini hhayi ngenxa yenkinga yenhliziyo, ngakho leli gama "liyi-edema ye-pulmonary noncardiogenic."
Yini Ebangela Ukuxhunyaniswa Kwe-Syndrome?
Isizathu esiqondile se-engraftment syndrome asiyazi, kodwa kucatshangwa ukuthi ukukhiqizwa ngokweqile kwamasignali eselula okuvuthayo nokusebenzisana kwamaselula kungaba nendima enkulu.
I-fluid emaphashini kucatshangwa ukuthi ibangelwa amasignali weselula abangela ukuthi ama-capillaire amancane omzimba ahlasele. Le fluid ngokweqile ibizwa ngokuthi i -edema ye-pulmonary , noma uma iboniswa kwizifundo ze-imaging, kungase kukhulunywe ngezingqinamba zesikhalazo. Ezimweni lapho umthamo wamaphaphu ufundwe khona, ngezinye izikhathi bathola izinombolo eziphezulu ze-neutrophils, uhlobo lwe-white cell cell.
Ezigulini ezimbili ezaziphethe amaphaphu abo, zathola umonakalo ku-alveoli-amasaka omoya wephaphu-owasakazwa kabanzi.
Abacwaningi bacabanga ukuthi, ngoba i-engraftment syndrome ibonakala ngemuva kwezinhlobo ezahlukene zabanikeli bokufakelwa kanye nezinhlobo ezahlukene ze-graft, futhi njengoba i-syndrome ingahle ihluke ku-GVHD futhi ihambelana nokubuyiselwa kwamangqamuzana amhlophe awaziwa ngokuthi ama-granulocyte, okungenzeka abe nomlamuli owenziwa umhlophe amangqamuzana egazi kanye namasignali eselula asebenzayo. Lokhu kuhlanganiswa kwamasignali weselula kanye nokusebenzisana kungabangela uhlelo olujikelezayo lokujikeleza, ukungasebenzi komzimba kanye nezimpawu ezifana nomkhuhlane.
Utholakala kanjani?
UDkt. Spitzer, umcwaningi wemitholampilo ohlelweni lwe-Bone Marrow Transplant Programme eMassachusetts General Hospital eBoston, MA, washicilela iphepha lokulonda nge-engraftment syndrome emuva ngo-2001.
Izimpawu zeSpitzer ze-engraftment syndrome zilandelayo:
Izindlela ezinkulu:
- Ukushisa kunkulu noma kuqhathaniswa no-38.3 ° C kungabikho imbangela efakazelayo ehambisanayo
- Ukuqhuma okubomvu okubandakanya> amaphesenti angu-25 omzimba womzimba futhi kungabonakali imithi
- Rash noma uketshezi okweqile emaphashini angabangelwa inkinga yenhliziyo, njengoba kubonwe ku-scing scans, ne-oxygen ephansi egazini
Indlela encane:
- Ukungasebenzi kwesibindi nemingcele ethile (i-bilirubin ≥2 mg / dL noma i-transaminase ≥ izikhathi ezingu-2 evamile)
- Ukungakwazi ukusebenza kwezinso (serum creatinine ≥ 2x isisekelo)
- Inzuzo yesisindo (amaphesenti angu-2,5 wesisindo somzimba esisisekelo)
- Ukudideka okwesikhashana / ukungaqondakali kobuchopho okungaqondakali ezinye izimbangela
Ukuxilonga kudinga zonke izindlela ezintathu ezinkulu noma izindlela ezimbili ezinkulu kanye nomgomo owodwa noma ngaphezulu okungakapheli amahora angu-96 we-engraftment.
Kunezinye izindlela ezisetshenziswayo ukuze uhlolisise i-engraftment syndrome, futhi. Isibonelo, ukuhlolwa kwe-Maiolino kwafakwa ngo-2004. Ochwepheshe abahlukahlukene babonakala benemingcele ehlukene yokuthola ingxube ye-engraftment, futhi izimpawu ezingaphezulu zingabangela le nkinga. Ngo-2015, uDkt Spitzer ushicilele ezinye izici "ezihambisana" futhi "ezingahambisani" ne-engraftment syndrome:
Ngokuhambisana ne-engraftment syndrome: Umkhuhlane ongasetshenzisiwe; ukuqhuma; izibonakaliso zamaphilisi aphuzi (ukucindezela kwegazi okuphansi, ukuzuza isisindo, ukuvuvukala, uketshezi esiswini, uketshezi emaphashini angabangelwa isimo senhliziyo); izinso, isibindi, noma ukukhubazeka kobuchopho; kanye nesifo sohudo ngaphandle kwesinye isizathu.
Akuhambisani ne-engraftment syndrome: Isizathu esithathelwanayo somkhuhlane; ukushayela okutholakala nge-biopsy okukhombisa ukuthi i-GVHD uma kwenzeka ukufakelwa kusuka kumuntu ongeyena ozimele; ukuhluleka kwenhliziyo ngokukhululekile; isisindo somzimba ngenxa yenye imbangela, (isibonelo, i-calcineurin inhibitor nephrotoxicity noma i-GVHD yesibindi); isifo sohudo ngenxa yesinye isizathu (isibonelo, ukutheleleka, isifo se-chemo, noma i-GVHD).
Ukuphathwa Kwama-Syndrome Ukuphathwa Kanjani?
Ngokombiko kaDkt. Spitzer, cishe kwesiguli sesiguli, i-engraftment syndrome ingase ixazulule yodwa, futhi ingadingi ukwelashwa. Uma ukwelashwa kuyadingeka, i-engraftment syndrome ibonakala iyamukeleka kakhulu ekwelashweni kwe-corticosteroid uma nje kuphela izimpawu ziqhubeka, ngokuvamile zingaphansi kweviki. Isidingo sokwelashwa siboniswa ukushisa kwe> 39 ° C ngaphandle kwesizathu esibonakalayo esithathelwanayo kanye nezibonakaliso ezibalulekile emitholampilo, ikakhulukazi uketshezi okweqile emaphashini.
Yini Eyaziwa Ngayo Nge-Engraftment Syndrome?
Kunemigomo ehlukene ekusetshenzisweni kokuxilongwa kwe-engraftment syndrome, futhi lokhu kungase kube ne-akhawunti yezinhlobo eziningi zezibalo esihlokweni sokuthi i-syndrome ivela kanjani ezigabeni ezehlukene zeziguli ezithola ukuguqulwa kwe-stem cell. UDkt. Spitzer usufunde isifo kusukela ngo-2001, futhi izincwadi kanye nokubuyekezwa kwezincwadi zezinto eziphilayo zifingqiwe maduzane ngo-2015:
- I-engraftment syndrome ngemuva kokufakelwa kwesitembu se-hematopoietic (HCT) isanda kutholakala.
- Izinqubo ezihlukahlukene zokuxilonga ziyasetshenziswa, futhi kungenzeka ukuthi i-akhawunti yokubanzi (amaphesenti angu-790) wezinto ezibikiwe.
- Yize ukubonakaliswa kwemitholampilo ye-engraftment syndrome kungase kufane nalawo we-GVHD enamandla, i-engraftment syndrome iphinde ichazwe kahle ezigulini ngaphandle kwe-GVHD eqondile.
- Ayaziwa ukuthi ngabe isifo siholela ekufeni kwabantu abaphezulu futhi basinda kakhulu emva kweHCT; Ucwaningo lwenziwe, kodwa idatha iyaphikisana.
- I-Engraftment syndrome ijwayele ukuxazululwa yedwa, kodwa, njenge-GVHD enamandla, iyaphendula ku-corticosteroids.
- Ngenxa yokuthi i-engraftment syndrome kanye ne-GVHD enamandla ingaba nezimpawu eziqhamukayo nezimpendulo zokwelashwa, lezi zinqubo zesifo ngokuvamile ngeke zibe yimicimbi ehlukile.
- Izici ze-engraftment syndrome zingase zihlangane nalabo abasebenzisa izidakamizwa nezidakamizwa ezibangelwa imishanguzo kanye nokutheleleka.
Izwi elivela:
Kuvamile kangakanani le syndrome, futhi yiziphi amathuba ukuthi isiguli esithile zizothuthukisa izimpawu zayo? Yebo, njengoba kungekho ukuvumelanisa ngencazelo eqondile, emitholampilo, izigaba eziningi zezinto ezenzekayo ziye zabikwa ezincwadini, kusukela ngaphansi kwamaphesenti angu-7 kuya phezulu kunamaphesenti angama-90 kuma-autotransplants (ukufakelwa kusuka kubuntu njengabaxhasi). Amanani aphakeme abike ngemuva kwama-autotransplants for lymphomas ngaphandle kwe- Hodgkin lymphoma . I-syndrome ingathinta izingane nabantu abadala ngamazinga afanayo, kodwa umthelela ungase ube mkhulu ezinganeni ngokuphathelene nokufa okungahlobene nokubuyela emuva komdlavuza.
Amazinga we-engraftment syndrome abonakala ephansi kubantu abamukela ukuguquka kusuka kwabangewona abanikelayo. Lokhu kuyindawo enzima yokucwaninga, noma kunjalo, ngoba isifo singabonakala njenge-GVHD enzima. Kwesinye isifundo, ukulungiswa okuphelele kwe-engraftment syndrome kwenzeka kuphela kumaphesenti angu-10 kuphela zezifundo ezingazange zenze i-GVHD elula kamuva.
> Imithombo:
> Franquet T, Müller NL, Lee KS, et al. Ukuthola izixazululo eziphezulu ze-CT kanye nezibalo zezinkinga ezingenayo i-pulmary pulmonary emva kwe-hematopoietic stem cell transplantation. I-AJR Am J Roentgenol . 2005; 184 (2): 629-37.
> Lee YH, Rah WJ. I-pre-engraftment syndrome: ukubaluleka komtholampilo kanye ne-pathophysiology. I-Blood Res . 2016; 51 (3): 152-154.
> Omer AK, Kim HT, Yalamarti B, McAfee S, Dey BR, Ballen KK et al. I-engraftment syndrome ngemuva kokufakelwa kwesitembu se-allogeneic hematopoietic kubantu abadala. Am J Hematol 2014; 89: 698-705.
> Spitzer, TR. I-Engraftment syndrome: inkemba ehlangene kabili ye-hematopoietic cell transplants. Ukufakelwa kwe-Bone Marrow. 2015; 50 (4): 469-75.