AIDS uye High-Dose Steroids inogona kukonzera Immunosuppression
Munguva pfupi yapfuura, nekuda kwekuiswa kwemishonga inoshandiswa kwema immunosuppressant pamwe nekuwedzera kwehuwandu hwehupenyu hunoputika, takaona vanhu vakawanda vasina zvirwere zvekuzvidzivirira kana kurarama vasina kukwana.
Mune maitiro ezvirwere zvezvirwere zvezvirwere zvezvirwere zvezvirwere zvinokonzerwa nemasero ose, masukisi, uye nhengo dzinobatsira muviri kuvhara utachiona. Pasina kunyatsodzivirira zvirwere, munhu anowira mhuka kune dzimwe nyika.
Zvimwe zvirwere zvekudzivirira zvirwere zvinoshandiswa nemishonga, asi, ndicho chikonzero chimwe chete chinoita kuti vanhu vasapindwa mumuviri kana kuti vasina kudzivirirwa. Zvechokwadi, zvimwe zvinhu zvakaipa zvinogona kuvhiringidza masimba ezvirwere zvezvirwere, zvakare, kusanganisira AIDS uye nezvirwere zvakagara nhaka.
Chii Chinonzi Immune System?
Zvirwere zvemuviri wako zviripo kudzivirira kana kuparadza utachiona. Masero uye nzira dzomuviri wechirwere chekuzvidzivirira muviri dzakaoma uye dzakasiyana uye dzinopisa zvikamu zvose zvemuviri.
Heano pane zvakasiyana-siyana zvemuviri wemuviri:
- Pfupa remafupa ndiko kunofara kunotanga. Pfupa remapfupa rine masero emadzimai anoenderera mberi kuti ave masero ezvirwere zvakasiyana-siyana (B masero, T cells, lymphocytes, nezvakadaro).
- Kwete ganda rekutanga rekuzvidzivirira pakushorwa kunobva kunze kwenyika, asi zvimwe zvikamu zveganda (semvura inonzi dermis) zvinowedzerawo mumasero emumunwe. Uyezve, ganda rinoberekawo majekiseni antimicrobial.
- Iko mazhinji emasero emuviri muropa. Ichokwadi, kuongororwa kweropa kunoshandiswa kutarisa utachiona.
- I-lymphatic system yakazara nemasero emuviri. I-lymphatic system inokwidza ropa iro nemisumbu iri mumuviri wose uye inoshanda semugwagwa mukuru wekutakura masero emumunwe. Aya maune immune masero anoshandura mune lymph nodes. Mukati memakirini node, zvirwere zvemuviri zvinoshandiswa kana michina inowanikwa.
- Chirwere chemuviri chema immune chinotibvumira kuti tifanane nekutyisidzira kunokonzerwa nehutachiona ndiko T-cell. Kunyange zvazvo T-masero inotanga kubudiswa mumasese emapfupa, vanoramba vachikura mumutsara.
- Vanhu vanorarama vasina mahwanda (asplenia ndiyo chirwere chekurapa nokuda kwekushayikwa kwepleen kana splenic basa). Kunyange zvakadaro, chirwere chinobatsira kugadzirira muviri kuti utapukwe, uye vanhu vasina tsvina vanowanzokwanisa kukudziridza hutachiona nezvimwe zvirwere zvakadai semaminococci (funga meningitis), Streptococcus pneumoniae (funga pneumonia) uye Haemophilus influenzae , kana HH influenza . Ndapota cherechedza kuti pasinei nezita rayo, H influenza haina kukonzera chirwere ichi uye panzvimbo iyo inokonzera kupemha chirwere muvana. Tsvina inoshanda semuviri wemuviri, uye mapepa emasero emumunini mu spleen kuongorora ropa nokuda kwezviratidzo zvehutachiona. Kana utachiona huripo, spleen inobata mhinduro dzomuviri.
- Kufanana neganda, mucosal tissue, yakafanana neyo yakawana kuvhara matumbo uye mapfupa emapfupa, ndiyowo mutsara wekutanga wezvidziviriro zvinodzivirira utachiona kubva pakupinda mumuviri. Sezvo zvakadaro, mucosal tissue yakafuma mumasero emunodzi.
Net State of Immunosuppression
Kuregererwa kwemuviri wemuviri kunobva pane zvimwe zvinhu. Pakati pese, hupfumi hwemunhu hwekudzivirira muviri hunoratidzwa mushure mekutarisa zvinotevera zvinotevera:
- rudzi rwezvirwere (immunosuppression) (yechipiri kune mishonga kana kurwara)
- nguva yekudzivirira muviri
- kusimba kwekudzivirira muviri
- miviri uye mapepa emunosuppressant agents kana madhiragi
- innate immunodeficiencies (nhaka yezvirwere zvinoshambadza nemuviri wemuviri)
- matomic zvinhu zvinotungamirira pakuparara (zvakadai sekushaya simba lymphatic drainage yechipiri kune kuvhiyiwa kana kupiswa kwezuva)
- utachiona (funga HIV kana CMV)
Immunosuppression Kubvisa kubva Mishonga
Mishonga yakawanda inorambidza muviri wechirwere chemuviri. Izvi zvinodhaka zvinodhaka zvinogona kuvhiringidza huwandu hwezvidziviriro zvemuviri wezvirwere zvemuviri kana kuti zvinotarisirwa nemhando dzemajeri emunodzivirira.
Heano mishonga 3 inogona kuvhiringidza zvirwere zvemuviri:
- Corticosteroids . Iyi mishonga inorayirwa kune zvakasiyana-siyana zvekudzivirira muviri, zvirwere, uye zvinoputika, zvakadai se rheumatoid arthritis, chirwere chinoputira chirwere, chirwere cheputi, uye inopy. Munguva pfupi pfupi, mishonga iyi inopindira maune immune cell function. Kunyanya, corticosteroids inoderedza nhamba ye lymphocytes uye monocytes pamwe chete nekudzivisa phagocyte kufamba uye basa. Nguva yakareba yemigumisiro yemishonga iyi inosanganisira ganda rakapfava uye risina simba rakagadziriswa mishonga yekugadzirisa, iyo yose inogona kuwedzera kukura kwekudzivirira muviri. Vanhu vari muhotera yakakura ye steroid inowanzosangana nehutachiona nemhando dzakasiyana-siyana dzehupenyu, zvakadai sePneumocystis jirovecii , inokonzera kuuraya Pneumocystis pneumonia , uyewo Strongyloides , iyo inogonawo kuuraya uye inokonzerwa nehupombwe. Uyezve, vanhu vane simba rakasimba rekudzivirirwa nemasikirini echipiri kune steroid vanoshandiswa vari pangozi yekugadziriswa kwechirwere chetachiona kana zvimwe zvirwere zvishoma.
Rituximab. Iyi monoclonal antibody kune CD20 inoshandiswa kurapa kwete Hodgkin lymphoma, rheumatoid arthritis, uye chronic lymphocytic leukemia. Pakati pekuongororwa kwekliniki, rituximab yakanga isina kubatana nehuwandu hwehutachiona. Kubva pakatanga rituximab kune pamusika, zvakadaro, pane imwe munhu (anecdotal) nhepfenyuro dzinobatanidza rituximab kutungamirira kune zvirwere zvisingawanzoonekwa seinopfuurira multifocal leukoencephalopathy, iyo inokonzerwa neJC virus, uye yakachena red cell aplasia, inosanganiswa nehutachiona hweparvovirus . Uyezve, kuzvidzivirira kwechipiri kune rutiximab hutungamiri kunogona kutungamirira pakugadzirisa kwehutachiona hweH hepatitis B.
Tumor Necrosis Factor-Alpha (TNF-α) Inhibitors. Iyi mishonga inonzi cytokines; magytokine anowanzobudiswa nemasero emuviri. TNF-α inhibitors inosanganisira mishonga yakadai se infliximab, certolizumab pegol, uye monoclonal antibodies uye inoshandiswa kurapa mamiriro ekudzivirira anonzi rheumatoid arthritis uye chirwere cheCrohn. Izvozvi, kusagadziriswa kwepachiviriro kunokonzerwa nekutungamirirwa kwemishonga iyi kunovhura mukova wekutapukirwa naListeria monocytogenes , chirwere chinokonzera kudya chinogona kukonzera kufa kwekufa muvakadzi vane pamuviri.
Immunosuppression Kubva kuAsplenia
Kugadzirwa kushandiswa kwepleen kunonzi "splenectomy." Pane zvikonzero zvakawanda nei munhu angave akadzingwa nemucheka wake, kusanganisira kenza, kushungurudzika, uye kukanganiswa kweropa (kufanana nekodhiyo idiopathic thrombotic purpura). Izwi rechiremba rokuti "asplenia" rinongoreva chete kubviswa kwepleen nenzira ye splenectomy asiwo kurasikirwa kweplenic function zvichienderana nemamiriro ezvinhu se sickle cell anemia.
Vanhu vane asplenia vari pangozi yakawanda yehutachiona nemararamiro akachengetwa, zvakadai saStptococcus pneumoniae , Haemophilus influenzae , uye mamwe maNeisseria meningitides . Muvanhu ava, chirwere chinouraya chinogona kugadziriswa nekukurumidzira - kunyanya panyaya yekushungurudza kana kutapura ropa. Sepsis inowanzozivikanwa pakati pevanhu vane splenectomy yechipiri kune kenza (kusanganisa) kupfuura iyo iri pakati pevanhu avo vakadzingwa kana vabuda nengozi (tsvina). Nhoroondo, njodzi yehutachiona nemararamiro akachengetedzeka ndiyo yakakura mumakore mashomanana ekutanga mushure me splenectomy.
Immunosuppression Pashure Kokushandura
Kune marudzi maviri ekutenderera: stem cell transplants uye chimiro chakasimba chemuviri. Zvose izvi zvinyorwa zvekufambisa zvinokonzera kusunungura.
Simba rekushandiswa kwemasero akambodanwa sefupa remapfupa rinoputika nokuti masero emadziro, kana masero asina kukodzera anokwanisa kubudisa marudzi ose emasero eropa, akambohwehwa chete kubva mumuti wemafuta. Nemhaka yekufambira mberi mune zvemishonga, isu tava kukwanisa kuchenesa masero emasero kubva muropa. Simba rekushandiswa kwemasero rinoshandiswa sehutano hwemamwe marudzi evanhu vane zvirwere zvekenza, kusanganisira acute lymphocytic leukemia, Kazhinji, vanhu vane zvirwere izvi vatove vaine zvirwere zvakanyanya zvekenza uye saka vagara vasati vashandurwa.
Nhengo dzakasimba dzakaputika dzinoreva kutenderera kwezviviri zvakaita mwoyo, impso, kana chiropa. Vanhu vanogamuchira nhengo yakasimba yekutenderera vanowanzodikanwa kurapwa kwemazuva ese nemishonga inofanirwa kugadzirisa zvirwere zvekudzivirira kukanganisa dambudziko rekuramba.
Mumwedzi wokutanga wekudzikinura kubva kunhengo yekugadzira, mupiki wekufambisa anonyanya kutarirwa nehutachiona hunoenderana nekuvhiyiwa pachako. Zvirwere zvinowanikwa panguva ino zvinosanganisira zvirwere zvekuvhiringidza, zvirwere zveganda, uye zvirwere. Pakati pemwedzi 2 ne6 mushure mekuvhiyiwa, vanogadziriswa vanogadziriswa vari pangozi yezvirwere zvisingabatsiri pamwe nekugadziriswa kwemaronda ehepe kana zvimwe zvirwere zvishoma. Mwedzi mitanhatu mushure mokusimuka nekupfuura, vaparidzi vanonyanya kunetseka nehutachiona hunowanikwa munharaunda yakafanana neavo hunokonzerwa nezvipenyu zvakagadziriswa (funga Streptococcus pneumoniae uye Haemophilus influenzae ).
Immunosuppression Inokonzerwa neNewate Immunodeficiency
Dzimwe nguva vanhu vanogara nhaka yezvirwere zvepabonde zvinokonzera kuti simba rekudzivirirwa mumuviri risina simba. Zvakawanda zvezvipembenene zvisingatauriki zvezvirwere hazvina kuwanikwa uye zvinowanikwa mucheche, zvakadai sechisimba chakabatanidza immunodeficiency uye chirwere chisingaperi chisinganyanyisi. Zvisinei, huwandu hunowanzosiyana hwemagetsi (CVID) hwakawanda uye hunoita mukuyaruka uye huduku huri muduku.
NeCVID, masero ezvirwere zvemusununguko anokundikana kubereka immunoglobulins inokodzera kuvhara mhinduro dzekuzvidzivirira. Somugumisiro, vanhu vane CVID vangangodaro vanotambura kubva kuhutachiona hwehutachiona uye zvirwere zvemukati seGiardia lamblia .
Kurapa kweCVID kwakaoma uye kunoda kutarisirwa kwevadzidzi mune chimwe chikamu nokuti vanhu vane chirwere ichi havatauri kunorapwa uye pane zvinoda kuvharirwa kwema immunoglobulin muchipatara.
Immunosuppression Inokonzerwa Nehutachiona
Kuzvidzivirira kwezvirwere hakusi kungoguma nehuwandu hwehutachiona asi hunogona kukonzerwa nedzimwe zvirwere. Semuenzaniso, cytomegalovirus (CMV), iyo inowanzokonzera kusina zviratidzo kana mononucleosis-zviratidzo zvemarudzi kune vanhu vane maitiro ezvirwere zvekudzivirirwa kwezvirwere, zvinogona kukanganisa hutachiona hwemajeri kune avo vatove vasina kudzivirirwa. Kunyanya, CMV miviri nemasero eT, ayo anoshanda zvakasimba mumuviri wekuzvidzivirira.
Imwe rudzi rwehutachiona hunogona kuguma mukudzivirira mafungiro eHIV (human immunodeficiency virus). Kufambira mberi kweHIV neAIDS kunoratidzirwa nehutachiona husingaenzaniswi . Iyi immunocompromise inoitika apo HIV inouraya huwandu hwakawanda hwemasero anobatsira T - CD4 uye CD8 masero - izvo zvinodiwa kukwira mhinduro dzekuzvidzivirira. Pane imwe nguva yakakwana yemasero aya akaurayiwa, munhu anowanzosangana nehuwandu hunotyisa hwezvirwere, kusanganisira zvinotevera:
- Candidiasis
- Coccidioidomycosis
- Cryptococcosis
- Cytomegalovirus chirwere
- Encephalopathy, hukama hweHIV
- Herpes simplex
- Histoplasmosis
- Kaposi's sarcoma
- Tuberculosis
- Pneumocystis carinii pneumonia
- Toxoplasmosis yeuropi
Ndapota zivai kuti havasi vanhu vose vane HIV vane zvirwere zvisina kuchena, kana vane AIDS. Nenzira yakanaka, kufambira mberi mumishonga kwakaita kuti kurapwa kweHIV kuve kwakanyanya. Mazuva ano, vanhu vanozvipira nesimba kumishonga inorwisa mabhakitiriya vanogona kurarama hupenyu hurefu pasina hutachiwana AIDS.
Summary
Kumwero mukuru, kuwedzerwa kwemaitiro ekudzivirira mafungiro pakati pevanhu veAmerica chiratidzo chekufambira mberi. Kutenda kubudirira mune tsvakurudzo, isu iye zvino tine zvirwere zvisingabatsiri zvinodhaka zvinogona kubata nhamba inowedzera yakasiyana yemamiriro ezvinhu. Uyezve, tiri kuitawo zvimwe zvikamu zvekugadzirisa zvinokonzerwa nekudzivirira mafungiro.
Kusiyana naizvozvo, kufambira mberi mune zvemishonga kunewo zvingaita kuti kuderedza kuwandisa kwekudzivirira mafungiro pakati pemapoka evanhu vakawanda. Kunyanya, vanhu vane HIV vanotsigira zvakasimba kumishonga yavo ye antiretroviral vanogona kurarama kwenguva yakareba uye vachifara upenyu vasina ununosuppression. Zvinosuruvarisa, zvisinei, pasinei nekufambira mberi kwekurapa kweHIV, vanhu 3 chete veAmerica vane HIV yavo inotungamirirwa.
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