Engraftment syndrome is complication iyo inogona kuitika mushure mekufa kwemafuro ekunyora, iyo nzira inonziwo hematopoietic stem cell transplant (HSCT). Iyo engraftment syndrome inoonekwa sechiremera chechimiro, uye inoratidzwa neiyi inotevera:
- Huru uye kusakurumidza kwete nekuda kwehutachiona
- Kuwedzera kwemvura mumapapu kwete nekuda kwechinetso chemwoyo
- Kusiyana zvimwe zviratidzo nezvitsva
Chirwere chinotanga kusvika mazuva manomwe kusvika kwegumi nemashure mushure mekutengesa, munguva yeNeutrophil kupora . Zviratidzo zvinowanzova zvinyoro, asi zvinogona kutarisa kune mamwe maitiro uye kutyisa mafomu. Iyo chirwere chinogona kukonzera dambudziko kufema kufema, fivhiri ≥100.9˚F, rash reddish iyo yakave yakadzika uye yakasimudza nzvimbo dzeganda, kuwedzera kuwedzera, kupera kweropa regijeni, nekuwedzerwa kwemvura mumapapu asina kukonzerwa nechinetso chemwoyo.
Mune maitiro ayo akaipisisa, izwi rokuti "aseptic shock" syndrome rave richishandiswa, zvinoreva kuti kune kuora kwehutachiona uye kusagadzikana kwezvikwata zvakawanda.
Iyo engraftment syndrome yave ichinzi inenge ichiitika pashure pemhando mbiri miviri yeHSCT: autologous (kutemwa kubva kune mumwe) uye allogeneic (kubva kune imwe, kazhinji anowirirana anowirirana).
Ukama kune Zvimwe Zvimwe
Engraftment inoreva masero anenge achangobva kuendeswa "achitora midzi uye achibereka," ndiko kuti, apo masero akawedzerwa akawana niche mumapfupa eropa ndokutanga nzira yekuita masero matsvuku eropa, masero eropa, uye maplatelets.
Ukama hwe engraftment syndrome kune dzimwe post-transplant zviitiko zvine zvimwe zvakafanana zvinokakavadzana. Izvi zviitiko zvinotevera mushure mekunyora zvinosanganisira mamiriro akadai seyakanyanyisa kufanana nemauto ane chirwere (GVHD) , pre-engraftment syndrome (PES), mazairo emishonga uye zvinodhaka zvinokonzerwa nehutachiona uye zvirwere, oga kana kuti pamwe.
Pre-engraftment syndrome uye peri-engraftment syndrome mamwe mazwi ayo masayendisiti akashandisa kurondedzera iyi yezviratidzo zvingasimuka munguva ye engraftment. Engraftment syndrome yakatumidzwawo kuti "capillary leak syndrome," iyo inoreva chimwe chezvinhu zvinoita kuti zvirwere zvechirwere-zvichireva, zvichienderana nemasaini esirivha asina kuenzana, mito miduku midzi yeropa, makapilari, anowanikwa kupfuura zvinowanzoitika, zvichiguma nekusina kujairika, kuwedzera kwemvura inoshandiswa mumativi akasiyana-siyana emuviri. Apo izvi zvinowanikwa mumapapu, inonzi pulmonary edema. Kunyanya kunyanya, iri mumvura mumapapu kwete nekuda kwedambudziko remwoyo, saka izwi iri "noncardiogenic pulmonary edema."
Chii Chinokonzera Engraftment Syndrome?
Chikonzero chaiicho che engraftment syndrome hachizivikanwi, asi zvinofungidzirwa kuti kudarika kweproproductive ye pro-inflammatory cell signals uye kushamwaridzana kwemasero kunogona kuita basa guru.
Iyo inonaya mumapapu inofungidzirwa inokonzerwa nemasikirini emagetsi anoita kuti miviri miviri yemaviri isvike. Izvi zvinodhaka zvakanyanya zvinonzi pulmonary edema , kana kana zvichionekwa pazviitiko zvekufungidzira, zvinogona kutaurwa pamusoro pekushandiswa kwepfungwa. Mumamiriro ezvinhu apo mvura inopisa mumapapu yakadzidzwa, dzimwe nguva inowana nhamba dzakawanda dzeeutrophils, rudzi rwechichena cheropa.
Muvarwere vaviri vaiva nemapapu avo akashongedzwa, vakawanawo kukanganisa kwe-alveoli-mapapiro emhepo emapapu-ayo akaparadzirwa zvakasiyana.
Vatsvakurudzi vanofunga kuti, nokuti engraftment syndrome inoonekwa mushure mekusiyana kwemhando dzevatsigiri vekutsvaga uye marudzi akasiyana emashiripiti, uye sezvo chirwere chinogona kunge chakasiyana neGVH uye chinopindirana nekugadziriswa kwemasero machena anozivikanwa se granulocytes, kuti inogona kunge yakarongedzwa nemhepo yakacheneswa masero eropa uye proinflammatory cell signals. Iko kusanganiswa kwemasero esero uye kuwirirana kunogona kukonzera kuora kwepachiviriro, chirwere chisingaiti uye zviratidzo zvakadai sefivha.
Inozivikanwa Sei?
Dr. Spitzer, keriniki anotsvakurudza paT Bone Marrow Transplant Program paMassachusetts General Hospital muBoston, MA, akabudisa pepa reminiti ye engraftment syndrome zvakare muna 2001.
Zvinonzi Spitzer Zvirongwa zve engraftment syndrome zvinotevera:
Maitiro makuru:
- Kupisa kukura kudarika kana kuenzana ne 38.3 ° C pasina chinokonzera chinokonzera chinokonzera
- Kurwiswa kwakatsvuka kunosanganisira> 25 muzana yemuviri nzvimbo uye kwete kunokonzerwa nemishonga
- Rash kana kupfurikidza kwemvura mumapapu asina kubatwa nechinetso chemwoyo, sekuonekwa pamagetsi ekufungidzira, uye pasi yakadzika muropa
Minor criteria:
- Chiropa chisina kushanda nemamwe maparamende (bilirubin ≥2 mg / dL kana transaminase ≥2 nguva dzinowanikwa)
- Ipi isingakwanisi (serum creatinine ≥ 2x baseline)
- Kuwedzera kwehuwandu (≥2,5 muzana yehutano hwepamuviri hwekutanga)
- Kushungurudzika kwekanguva / uropi husina kunaka hunotsanangurwa nezvimwe zvinokonzera
Kuongororwa kunoda zvose zvitatu zvakakosha zvidzidzo kana maviri mazano makuru uye imwe kana zvishoma zvishoma mukati maawa 96 engraftment.
Pane dzimwe nzira dzinoshandiswa kuongorora engraftment syndrome, zvakare. Semuenzaniso, chirongwa cheMayolino chakatangwa muna 2004. Nyanzvi dzakasiyana dzinoratidzika dzakasiyana-siyana dzekuziva engraftment syndrome, uye zviratidzo zvinoputika zvinogona kuita kuti dambudziko iri rive. Muna 2015, Dr Spitzer akabudisa zvimwe zviitiko zvaive "zvakaenderana" uye "zvisingaenderani ne" engraftment syndrome:
Inopesana ne engraftment syndrome: Noninfectious fever; mapundu; zviratidzo zvehutachiona hwemaaky (masimba ekuderedzwa kweropa, kuwedzera kwekuremera, kuzvimba, mvura inenge mudumbu, mumvura mumapapu asina kukonzerwa nemamiriro emwoyo); itsvo, chiropa, kana uropi hunooma; uye chirwere chisina chimwe chikonzero.
Hazvienderani ne engraftment syndrome: Chikonzero chinopararira chefivha; kukwikwidza nebiopsy zvinowanikwa zvinoreva GVHD munyaya yekugadziriswa kubva kune munhu asiri wezvipo; congestive heart failure; nhengo dzisina kukodzera nemhaka yechimwe chikonzero, (somuenzaniso, calcineurin inhibitor nephrotoxicity kana chiropa GVHD); chirwere chinokonzerwa nechimwe chikonzero (somuenzaniso, utachiona, chemo toxicity, kana GVHD).
Iko Kunraftment Syndrome Inotungamirirwa Sei?
Maererano nemushumo weDkt. Spitzer, mune imwe yechitatu yevarwere, engraftment syndrome inogona kuzvisarudzira pachayo, uye inoda kusarapwa. Kana kurapa kuchidikanwa, engraftment syndrome inoratidzika kuva yakagadzirisa kurticostosteroid maitiro anopiwa chero bedzi zviratidzo zvinoramba zvichiitika, kazhinji zvishoma pasi pevhiki. Chido chekurapa chinoratidzirwa nekushisa kwe> 39 ° C pasina chikonzero chinozivikanwa chinokonzera kutapukira uye zviratidzo zvemuviri zvinoshamisa zvemvura yakadzika, kunyanya kuwedzera kwemvura mumapapu.
Chimwe Chinozivikanwa Nezve Engraftment Syndrome?
Pane mitemo yakasiyana-siyana inoshandiswa pakutsvaga engraftment syndrome, uye izvi zvinogona kutora nhamba yakawanda yezvinyorwa pamusoro penyaya yekuzivikanwa kwechirwere chinosvika mumapoka akasiyana-siyana evarwere vanogamuchira stem cell transplants. Dr Spitzer ave achidzidza chirwere kubva muna 2001, uye mabhuku uye kuongororwa kwezvinyorwa zvezvinyorwa zvakapfupikiswa munguva ichangopfuura muna 2015:
- Engraftment syndrome mushure mokunge hematopoietic cell transplantation (HCT) inowedzera kuongororwa.
- Zviratidzo zvakasiyana-siyana zvinoshandiswa, uye zvichida nhoroondo yepamusoro (7-90 kubva muzana) yakawanda inorondedzerwa.
- Kunyange zvazvo kliniki zviratidzo zve engraftment syndrome zvingave zvakafanana kune zveGVHD yakaoma, engraftment syndrome zvakare yakatsanangurwa zvakajeka kune varwere vasina GVHD yakajeka.
- Hazvizivikanwe kana chirwere chacho chinotungamirira kukufa kwepamusoro uye kupona kwakaipisisa mushure meHCT; zvidzidzo zvakaitwa, asi data inopesana.
- Engraftment syndrome inowanzogadzirisa pachayo, asi, kufanana neGVHD yakaoma, inopindura corticosteroids.
- Nokuti engraftment syndrome uye GVHD yakaoma ingangodaro inobatanidza zvinhu uye kugadzirisa kurapwa, zvirwere izvi zvirwere zvingasava zviitiko zvakasiyana.
- Zviratidzo zve engraftment syndrome zvinogona kuwirirana neaya emishonga-uye inonzi radiation-induced toxicities uye utachiona.
Shoko Rinobva:
Izvi zvinowanzosangana sei nehutachiona, uye ndeipi mikana murwere chaiye achawedzera zviratidzo zvayo? Zvakanaka, sezvo pasina kubvumirana pane tsanangudzo yakajeka, kuchipatara, zvikamu zvakakura zvezviitiko zvakataurwa mumabhuku, kubva pasi zvakadarika se7 kubva kune imwe kusvika kune yakakwirira se 90 muzana mumotokari yepototransplants (kuwedzerwa kubva kune munhu seupi mubatsiri). Mazinga akakwirira akave ataurwa mushure me autotransplant ye lymphomas kunze kweHodgkin lymphoma . Chirwere chinogona kuchinja vana nevakuru pamatanho akafanana, asi iyo inogona kuva yakakura kune vana maererano nehutano husingawirirani nekudzokazve kwekenza.
Izvo zviyero zve engraftment syndrome zvinoita sezvishoma muvanhu vanogamuchira kuchinja kubva kune vasiri vatsigiri. Iyi inzvimbo yakaoma yekutsvakurudza, zvisinei, sezvo chirwere chinogona kutarisa seGVHD yakaoma. Mune rumwe ruzivo, kusarudzwa kwakakwana kwe engraftment syndrome kwakaitika muzana gumi chete yezvidzidzo izvo zvisina kuzotevera GVHD yakajeka.
> Sources:
> Franquet T, Müller NL, Lee KS, et al. High-resolution CT uye pathologic zvakagadziriswa zvekusagadziriswa kwepummonic complications pashure pehematopoietic stem cell transplantation. AJR Am J Roentgenol . 2005; 184 (2): 629-37.
> Lee YH, Rah WJ. Pre-engraftment syndrome: kliniki inokosha uye pathophysiology. Ropa Res . 2016; 51 (3): 152-154.
> Omer AK, Kim HT, Yalamarti B, McAfee S, Dey BR, Ballen KK et al. Engraftment syndrome mushure meallogeneic hematopoietic cell transplantation kuvanhu vakuru. Am J Hematol 2014; 89: 698-705.
> Spitzer, TR. Engraftment syndrome: inopinza-yakapinza munondo we hematopoietic cell transplants. Bone Marrow Kubika. 2015; 50 (4): 469-75.