Mubvunzo: Apheresis KwaLDL Cholesterol
Muzukuru wangu ane makore gumi nemaviri ane cholesterol yakakura kwazvo, iyo yavanotaura inokonzerwa nekuzvarwa. Nhamba yake yakakwirira kwazvo zvokuti vanachiremba vari kurumbidza kuti anotanga kurapa inonzi "apheresis." Kubva pane zvishoma ndinoziva nezvazvo, izvi zvinonzwika zvakanyanya kwandiri. Unogona kundiudza nezve apheresis, uye kana iri pfungwa yakanaka kune mwana?
Mhinduro: Kune mhando dzakawanda dzenhaka dzakagara nhaka yeLDL cholesterol . Yakawanda pane iyi ndeyemhuri hypercholesterolemia (FH). Vanhu vane FH, kunyanya avo vane maitiro akaoma zvikuru ehutano, vane ngozi yakawanda yekuwedzera nguva isati yasvika yemwoyo. Iyo yakakwirira yeLDL cholesterol mahara mumamiriro ezvinhu aya aripo kubva pakuberekwa, uye anotanga kukuvadza mhepo yehutano muhuduku - saka vanhu vane mhuri ye hypercholesterolemia vanoda kubatwa kunyange pavanenge vari vana.
Mutsara wekurapa kwe FH ndiyo kushandiswa kwemishonga yemagetsi. Muvanhu vakawanda vane chirwere ichi, mitemo ichaderedza LDL cholesterol mazinga zvikuru. Asi kune avo vane maitiro akakomba emurairo wezvirwere vanokundikana kushanda zvakanaka zvakakwana, uye ngozi yemoyo inogara yakanyanya. Vanhu ava vanonzi vane "mishonga inopikisa hypercholesterolemia."
Kune nzira dzakasiyana-siyana dzokurapa varwere vane mishonga isingagadzirwi hypercholesterolemia; hapana chimwe chazvo chiri nyore kana chinonakidza. Pakati pemitoo inowanika, iyo yakave yakanyanya kuedzwa is apheresis.
Apheresis
Mune apheresis, ropa rekutsvaira rega rega rinoputirwa kubva muropa remvura, uye rinoshandiswa nenzira inobvisa mapuroteni (anonzi lipoproteins) ane LDL-cholesterol.
Pakupedzisira, iyo yakaderedzwa-cholesterol ropa inodzorerwa kumurwere. (Izvi zvinenge zvakafanana ne hemodialysis inoshandiswa kune varwere vane hono kusakona.)
Apheresis inogadzirisa LDL cholesterol mazinga nekusvika 75%. Zvisinei, nokuti chiropa mune izvi varwere chiri kukonzera zvakawanda zveLDL cholesterol, mazinga eLDL anodzoka mumazuva mashomanana. Saka apheresis inowanzofanira kuitwa kamwechete pavhiki, uye dzimwe nguva kaviri pavhiki.
Kutanga apheresis therapy, zviri pachena, kuzvipira kukuru munguva uye kusagadzikana, uye zvinodhura zvikuru. Mukuwedzera, inogona kubudisa mitambo yakawanda yakawanda yakawanda, kusanganisira kuderera kweropa, anemia , uye musoro. Pakupedzisira, sezvakadai kune varwere vane hemodialysis, avo vane apheresis vanowanzodikanwa kuti vaite chirongwa chekuvhiya kuti vaite fistula yepamusoro (kusangana nekubatanidza ariti uye mvere pasi peganda), izvo zvinowedzera nyore kuwana mikana yeropa inoshandiswa ne apheresis .
Kubudirira kweapheresis mune vana vane chirwere chakakura chekutsvalaira kwakadzidzwa. Heino izvo UpToDate , magwaro ekutaura kwechiremba nevarwere, inofanira kutaura pamusoro pemigumisiro yeapheresis muvana:
Kuchengetedzwa nekubudirira kweLDL-apheresis yakareba kwenguva refu yakaongororwa mukuongorora kwevana gumi vane vane maitiro anorema anonzi hypercholesterolemia (kusanganisira vana vane homozygous FH) avo vakatapwa kwemakore maviri kusvika ku17. Kwakange kusina kufa kwepfungwa, kusina kuuraya myocardial infarctions, kana coronary revascularization nzira. Kudzvinyirira kwechigadziriso chegoni reyeri, pamwe nekudzivirira kwekuvandudzwa kwezvitsva zvitsva uye marononi, zvakaratidzwa.Mune mamwe mazwi, pasinei nezvipingamupinyi zveapheresis, zvidzidzo chimwe chete zvinoratidzika kuratidza kuti maitiro aya ekurapa - muvana, zvisingaiti - kwete kungoderedza LDL cholesterol mazinga, asiwo zvinoita seinoita kuderedza zvakanyanya dambudziko rekuvandudza nguva isati yasvika yemwoyo . Nokudaro pasinei nematambudziko aro ose, apheresis chimwe chinhu chinofanirwa kuonekwa kune vana vane maitiro akakomba e hypercholesterolemia asingateereri kumitemo.
The Long Term
Nenzira yakanaka, ikozvino inoonekwa kuti apheresis ingasave kuzvipira kwoupenyu hwose. Kuvonga nekuvandudzwa kwezvinoitika mukutsvakurudza pamusoro pevanhu, zvipembenene zvitsva zvakawanda zvinokurudzirwa zvirikudziridzwa, zvinotarirwa kune zvakasiyana-siyana zvinokonzera maitiro zvinogadzira FH. Iyi mishonga pasi pekugadzirwa ine mukana wakanaka kwazvo wekugadzirisa zvakakwana LDL cholesterol kusvika kune zvinongororwa. Zvichida zvakarurama kuti uone apheresis mune vana vane FH sechimiro chekuedza - senzira yekuchengeta mishonga yeropa "yakachena" apo isu takamirira kunyatsotsanangura, uye zviri nyore kwazvo, kurapa kurapwa.
Unoda kudzidza zvakawanda here? Ona UpToDate nenyaya, "Familial Hypercholesterolemia" yezvezvekuwedzera-ruzivo rwehutano.
Sources:
Rosenson RS, de Ferranti SD, Durrington P. Kurapa kwezvinodhaka zvinorwisa hypercholesterolemia. Kusvika pari zvino. Yakasvika, muna July 2012.