Abamukeli be-transplant ye-organism basengozini enkulu yokuhlukana nokuhlukunyezwa kwegazi
Isifo se-bone emva kokufakelwa kwesitho somzimba kuyinkinga evamile kakhulu ekufakweni kwabamukeli kunokuba iziguli eziningi ziqaphele. Kodwa-ke, into okufanele iqondwe, mhlawumbe ngaphambi kokuba umuntu avule ukufakelwa komzimba, ukuze izinyathelo zokuzivikela zingathathwa. Esikhathini esincane kakhulu, isifo samathambo ezimweni ezinjalo singabangela ubuhlungu be-bone, kodwa ezimweni ezimbi kakhulu kungaholela ekuqhekekeni.
Ngokusobala, lokho kungathinta kakhulu izinga lomgulane wokuphila, futhi kungandisa ingozi yokufa.
Iziphi Izingxenyana Zomzimba Eziholela Engozini Yokukhula Yezifo Zezifo?
Naphezu kwezinso zezinso ezitholakala emathambo, akuzona nje iziguli ezinokuhluleka kwezinso (ezithola ukufakelwa kwezinso) ezibeka engozini enkulu yezinsana zethambo kanye nokwehlukana. Iziguli eziningi zokufakelwa komzimba (kubandakanya abamukeli bezinso, inhliziyo, amaphaphu, isibindi, kanye nokuguqulwa kwamathambo) kungase kube nezinkinga ezibandakanya ukuhlukunyezwa, ubuhlungu be-bone, i-osteoporosis, njll. Nokho, izingozi zingase zihluke ngokusekelwe enhlanganweni ehilelekile. Isibonelo, imvamisa yezinsalela ezitholwa abamukeli bezinso kungenzeka ukuthi ivela kumaphesenti angu-6 kuya ku-45 amaphesenti, ngokuphambene namaphesenti angu-22 kuya kwangu-42 kulabo abamukeli be-heart, amaphaphu, noma ukufakelwa kwesibindi.
Indlela Ekulu Ngayo Ingozi Yezifo Zezifuba Ngemva Kokufakelwa Kwemvelo?
Njengoba kuphawuliwe ngenhla, lesi sigameko sizohluka ngesitho esitshalwe kabusha.
Ucwaningo olunzulu lweziguli ezingu-86 oluthola ukuguquka kwezinso lwathola ukuthi abamukeli babe nokwanda okuphindwe kabili engozini yokuhlukumeza eminyakeni eyishumi yokuqala ngemva kokuthola izinso, ngokuphambene nomuntu ovamile. Ngisho nangemva kweminyaka eyi-10 yokulandelela, ingozi yayisembili. Lokhu kuphakamisa ukuthi ingozi ekhulayo yokuphuka iqhubeka isikhathi eside emva kokufakelwa kwezinso.
Kodwa-ke, ama-fractures ayingxenye eyodwa kuphela yezifo zamathambo emva kokufakelwa komzimba. I-osteoporosis iyisici esivamile. Sibona lokhu ezinhlotsheni ezihlukahlukene zokufakelwa komzimba ngezimpikane ezinamavolumu (amaphesenti angu-88), inhliziyo (ngamaphesenti angu-20), isibindi (amaphesenti angu-37), amaphaphu (amaphesenti angu-73), kanye nomnkantsha wamathambo (amaphesenti angama-29 omamukeli wokufakelwa).
Kuthatha isikhathi eside kangakanani ukuthuthukisa izinkinga ze-Bone Ngemuva kokutshala?
Esinye isici esimangalisa uma kuziwa ekuthunjweni kwethambo lokulahlekelwa yilapho iziguli ngokushesha zilahlekelwa yi-bone mass. Amapulangwe, izinso, inhliziyo kanye nokufakelwa kwesibindi bangathola amaphesenti angu-4 kuya kwangu-10 emithini yamaminerali abo (BMD) phakathi nezinyanga zokuqala eziyisithupha kuya kwezingu-12 emva kokufakelwa komzimba. Ukuze uqonde kangcono lokhu, qhathanisa lezi zibalo ngesilinganiso sokulahlekelwa kwethambo kumfazi we-postmenopausal osteoporotic, okuyi-1 kuya kwangu-2 amaphesenti ngonyaka!
Yini Ebangelwa Ukulahlekelwa Kwamathambo Nokuhlukunyezwa Kwabantu Abathola I-Organ Transplants?
Uma uyibuka ngombono olula, ukulahlekelwa amathambo kubantu abathola ukuguqulwa komzimba kungenxa yezici ezikhona ngaphambi kokufakelwa komzimba , kanye nokulahleka kwethambo okusheshayo okwenzeka emva kokufakelwa komzimba .
Izinto eziyingozi ezivame ukwandisa ukulahleka kwethambo ezisebenza kumuntu omncane kakhulu, kusobala ukuthi ziyasebenza lapha.
Lokhu kufaka:
- Ukuntuleka kwe-Vitamin D
- Ukubhema
- Isifo sikashukela
- Ubudala obudala
Kodwa, ake sibheke ezinye izinto ezibeka ingozi ezisekelwe ekuhlulekeni komzimba okuhilelekile:
Pre-ukufakelwa Izingozi Risk
Izici ezinobungozi ezigulini ezinesifo sezinso eziphambili zihlanganisa:
- Ukuntuleka kwe-Vitamin D
- Ukusetshenziswa njalo kwe-steroids ( okubangela ukulahlekelwa kwethambo ), njengokwelashwa kwezifo ezihlukahlukene zezinso
- Amazinga aphakeme e-asidi egazini, okuthiwa i-metabolic acidosis
- Amazinga aphezulu e-hormone ephathekayo egazini (ebizwa ngokuthi i- secondary hyperparathyroidism ), okuholela ekulahlekelweni kwe-calcium esheshayo esitheni
Izici eziyingozi ezigulini ezinezifo zesibindi zihlanganisa:
- Ukungondleki, okuvame ukubonakala ezigulini zokuhluleka kwesibindi
- I-Cholestasis
- Amazinga aphansi we-testosterone noma i-hypogonadism
Izici ezinobungozi ezigulini ezinezifo zamaphaphu zihlanganisa:
- Ukusetshenziswa njalo kwe-steroids, ukuphatha izifo zamaphaphu, njenge-COPD noma i-asthma
- Ukubhema, isici esiyinhloko engozini yokuphuza i-osteoporosis kanye nokulahlekelwa amathambo
- Amazinga aphezulu e-acid, ngenxa yokugcinwa kwe-carbon dioxide egazini
Izici ezinobungozi ezigulini ezinesifo senhliziyo zihlanganisa:
- Ukusebenzisa njalo amaphilisi amanzi, noma izidakamizwa, ezingabangela ukulahleka kwe-calcium ethangeni. Izibonelo zihlanganisa imithi efana ne-furosemide ne-torsemide.
- Ukunciphisa umsebenzi owenziwe ngokomzimba, isici esivamile ezigulini ezinesifo senhliziyo
Izindleko zokuthutha emva kokufakelwa
Izinto zokuqala zokufakelwa ingozi ezibangelwa ukulahleka kwethambo ziyoqhubeka ziqhubeka ngokwezinga elithile ngisho nangemva kokufakelwa komzimba. Kodwa-ke, kunezici ezithile ezingozini ezithinta ingozi ngemuva kokuba isiguli esinehluleka komzimba sithola ukufakelwa komzimba okusha. Lezi zici zihlanganisa:
- Ukusetshenziswa kwe-steroid : Ngemva kokuba iziguli zithole ukufakelwa komzimba, zidinga imithi yokuvimbela amasosha omzimba "ekulahleni" isitho esisha. I-steroids ibonakala ingenye yalezi zidakamizwa. Ngeshwa, ama-steroid anciphisa amathambo amasha okwakhiwa ngokuvimbela uhlobo oluthile lwesithambo elithi "i-osteoblast." Futhi zandisa ukulahleka kwethambo ngokugqugquzela olunye uhlobo lweseli olubizwa ngokuthi "i-osteoclast." Ngamanye amazwi, uma usu-steroids, ushisa lelikhandlela kuzo zombili iziphetho. Kunezinye izindlela ezithonya i-steroid, ezingaphezu kwaleso sihloko (into ebizwa ngokuthi ikhuphuke phezulu-isimiso seReceptor Activator of Nuclear Factor kappa-B) okuzobangela ukulahleka kwethambo.
- Ukusetshenziswa kwe-Calcineurin inhibitor : Njenge-steroids, lokhu kuyinye isigaba esivamile semithi esetshenziselwa ukuvimbela ukuguqulwa kwesitho somzimba. Le mithi ihlanganisa i-cyclosporine, i-tacrolimus, njll. Lokhu kungabangela ukulahlekelwa kwethambo, kepha ngokuvamile kuzophazamisa izinso 'zokukwazi ukuguqula i-vitamin D ifomu elisebenzisekayo (okubalulekile ekwenzeni amathambo), into ebizwa ngokuthi ukusebenza.
Ungayibona kanjani Izifo Zamathambo Ezigulini Obani Abawuthola Ukutshala Umzimba?
Ukuhlola okujwayelekile "kwegolide" ukuhlola ukutholakala kwesifo samathambo ekufakweni kwezitshalo kuyisifo se-bone, okuhlanganisa ukufaka inaliti emthanjeni, nokuyibuka ngaphansi kwe-microscope ukuze uhlolwe. Njengoba iziguli eziningi zingekho abalandeli abakhulu bokunamathela izinaliti ezinzima emathanjeni abo, ukuhlolwa okungenasidingo kusetshenziselwa ukuhlola kokuqala. Nakuba i-DEXA eyaziwa kahle (esetshenziselwa ukuhlola amathambo amaminerali) isifo esivamile esetshenziswa ukuhlola impilo yethambo emphakathini jikelele, ikhono lokubikezela ingozi yezinsalela kubantu bokufakelwa komzimba akubonakali. Ngokombono osebenzayo, ukuhlolwa kusalokhu kunqunywe futhi kunconywa inhlangano enkulu efana ne-American Society of Transplantation ne-KDIGO.
Ezinye izivivinyo ezixhasayo noma ezisekelayo zifaka ukuhlolwa kwamaketenti okuthola amathambo njenge-serum osteocalcin namazinga athile e-alkaline phosphatase. Njenge-scan ye-DEXA, akekho kulaba asebefundwe ekukhoneni kwabo ukubikezela ingozi yokuhlukumeza ekufakeni iziguli.
Ukwelapha Izifo Zamathambo Ezigulini Zokutshala Umzimba
Izinyathelo ezijwayelekile zisebenza kubantu abaningi, njengoba nje zikhona kumamukeli wokufakelwa. Lokhu kufaka ukuzivocavoca umzimba, ukuyeka ukubhema, isiqondiso sokudla okunomsoco nge-calcium ne-vitamin D eyengeziwe.
Izinyathelo eziqondile ezibhekene nezinhlekelele eziqondene nabamukeli bezitho zomzimba futhi zibandakanya:
- Ukugwema i-steroids, uma kungenzeka, njengengxenye yokudla kwezidakamizwa ezisetshenziselwa ukuvimbela ukukhishwa kwesitho somzimba. Kodwa-ke, lokhu kudinga ukulinganiswa nengozi eyengeziwe yokwenqatshwa komzimba.
- Isigaba esivamile semithi evame ukuphakanyiswa kule nkinga into okuthiwa "i- bisphosphonates ," esetshenziselwa ukuvimbela nokwelapha ukulahleka kwethambo le-steroid kubantu abaningi. Nakuba ezinye izifundo zibonise ukuthi le mithi iphumelela ekuvimbeleni nasekuphatheni ukulahlekelwa kwe-bone post-transplant, ayikho idatha efakazele ukuthi i-bisphosphonates inamandla okunciphisa ingozi yezingqinamba zangempela.
> Imithombo
> Cohen A, Sambrook P, Shane E. Ukuphathwa kokulahlekelwa amathambo emva kokufakelwa komzimba. I-Bone Bone Miner Res. 2004; 19 (12): 1919-1932
> Leidig-Brukner G, u-Hosch S, u-Dodidou P, et al. Ukuphindaphindiwe nokuqapheliswa kwama-osteoporotic fractures emva kokufakelwa kwesifo senhliziyo noma kwesibindi: isifundo sokulandela. I-Lancet. 2001; 357 (9253): 342-347
> Shane E, Papadopoulos A, Staron RB, et al. Ukulahleka kwegazi nokuphuka emva kokufakelwa kwamaphaphu. Ukufakelwa kwezitshalo. 1999; 68 (2): 220-227
> Ukuphambanisa SM, Josephson MA. Isifo se-Bone ngemva kokufakelwa kwezinso.Semin Nephrol. 2004; 24 (1): 82-90
> Vantour LM, Melton LJ 3rd, Clarke BL, Achenbach SJ, Oberg AL, McCarthy JT. Ingozi yesikhathi eside yokuphulwa komzimba ngokulandela ukufakelwa kabusha kwe-renal: isifundo esisekelwe kubantu. Ama-osteoporos Int. 2004; 15 (2): 160-167