Vakagamuchira zvidimbu vanogona kukura chirwere cheshuga sechinhu chinokonzerwa nekugadziriswa
Overview
Kunyange zvazvo chirwere cheshuga chinokanganisa uye chinonzwisiswa zvirwere, vashomanana vanoziva kuti chirwere cheshuga chinogona kukura sechinhu chitsva chinokonzera kusangana nevarwere vanogamuchira kuchinja kwepvo . Chero ani zvake ane kupererwa kwetsvo achiona kupora kwepuropi semushonga wezvirwere zvepfungwa zvinofanira kuziva nezvenjodzi iyi, inonyatsozivikanwa seyo itsva-inotanga chirwere cheshuga mushure mekutengesa (NODAT).
Kunyange zvazvo njodzi iripo, zvakakosha kuziva kuti havasi munhu wese ari pangozi, uye avo vane maitiro ekurapa anofanira kupararira chirwere cheshuga chinonzi post-kidney transplantation.
Incidence
NODAT inetso inonzwisisika mune nhamba yakawanda yevarwere vanogamuchira kuchinja kwepvo. Zvisinei, nhamba dzakajeka dzehamba iyi hazviwaniki. Ichi ndechokuti kwakanga kusina tsananguro yakaenzana yeNODAT kwenguva yakareba, kusvika muna 2003. Nokudaro, zvichienderana nekuti iwe unotsanangura sei NODAT, chiitiko chacho chinogona kusiyana.
Zvimwe zvidzidzo zvinoita sezviri kuratidza kuti vanenge makumi matatu kubva muzana yeavo vasina chirwere cheshuga vasati vagamuchira kuchinja kwepvo kunogona kukura kukwirira kunoramba kuchiwedzera muhuga hweropa rinokurudzira kweNODAT mwedzi mitanhatu mushure mekugadziriswa kwepvo. Izvi zvakajeka nhamba inokosha, zvichiratidza kuti kupa mazano pamusoro peNODAT kunofanira kuva chikamu chinokosha chekuchengetwa kweiyo mafungiro kusakatika avo vanofarira kuwana kushaya kwepvo.
Impact
Chirwere cheshuga chitsva mushure mekugamuchira kugadzirwa kwetsvo ine migumisiro yakawanda, dzimwe dzadzo dzinoonekwawo kune munhu ane chirwere cheshuga. Saka, vanhu ava vanogona kukudziridza mamwe matambudziko. Mienzaniso mishoma inosanganisira:
- Ketoacidosis : yakawedzera ketone uye mazinga eropa muropa rakaonekwa nevarwere vane urombo hwekushaya insulini, izvo zvinogona kukonzera kukanganisika kwakanyanya uye kusvibiswa kwe electrolyte, uye kuwedzerwa kwemashuga eropa. Murwere anorwara anowanzorwara zvikuru.
- Neuropathy: iyo "mapini nemasero" kunzwa mune maoko nemakumbo anotambura nechirwere cheshuga chisina kunaka.
- Ngozi yakakwirira yehutachiona kubva yakasviba shuga yeropa ndiyo inozivikanwa chikonzero chekubviswa kwemasimba ezvirwere. Izvi zvinogona kuratidza sekuwedzera kwehuwandu hwehutachiona hwehutachiona, zvirwere zveganda, zvirwere zvemapapu, nezvimwewo.
- Kunyanya kunyanya, NODAT ichava nemigumisiro yakaipisisa kwete kungoita mararamiro emurwere uye njodzi yekufa, asiwo kupona kwepfungwa dzakapfuudzwa. Kuti uise mune mamwe mazwi, mupiki wekupora mupiro uyo anoumba NODAT angave ane upenyu hupfupi uye anoona mafungiro akawedzerwa akangokundikana nokukurumidza zvakare.
Izvi zvakakura zvakadini? Zvakanaka, maererano nekudzidza kubva kuUnited University yeNew York, apo kuponeswa kwevarwere vasina chirwere cheshuga pakupera kwemakore mashanu mushure mekutsvaira kwepvo yaiva 92 kubva muzana, yaive yakawanda kusvika 87 muzana kune avo vakagadzira NODAT. Saizvozvowo, kune humwe uchapupu hunobva kune zvidzidzo zvinoratidza kuti kupona kweiyo mafungiro akafukidzirwa kunopfupiswa, kana mupiro wacho aine chirwere cheshuga mushure mekugamuchira mafungiro ekuchinja.
Risk Factors
Kunyange zvazvo hurumende yakakosha, nyora kuti haisi yepfungwa dzose dzakakundikana murwere uyo akawana mafungiro akawedzerwa anova nechirwere cheshuga semushure-kutengesa kusangana.
Mimwe mishonga pamwe nezvimwe zvinokonzera ngozi zvinowedzera mikana yemumwe murwere anogadzira NODAT. Zvimwe zvezvi zvinosanganisira:
- Mishonga: izvi zvinosanganisira glucocorticoids (semuenzaniso, prednisone) nemimwe mishonga yatinoshandisa kudzivisa masimba ezvirwere zvemuviri wekugadziriswa kuitira kuti tidzivise kurambwa kwepfungwa yakabikwa (sezvo mupi wemuviri wemuviri anoona kuti itsvo se "sangano rekune imwe nyika") . Mienzaniso yemishonga iyi inosanganisira boka remishonga inonzi "calcineurin inhibitors" (somuenzaniso tacrolimus uye cyclosporine, iyo yaimbova yakanyanya kukonzera chirwere cheshuga), uye sirolimus. Ndapota cherechedza kuti hazvirevi kutapurirwa kwemishonga yekurapa prophylaxis kunowedzera kuisa njodzi yeNODAT (izvi zvinosanganisira zvimwe zvinowanikwa mushure mekugadzirwa kwemishonga inoshandiswa mumasikirwo akadai sa mycophenolate mofetil, inozivikanwa seClusCept).
- Zvirwere ndezvikonzero zvinozivikanwa. Izvi zvinosanganisira utachiona hweHepatitis C (HCV), utachiona hweCytomegalovirus (CMV).
- Mukuwedzera kune zvakataurwa pamusoro apa nezvemishonga / hutachiwana hunokonzerwa nehutachiona, hutambo hweAfrica -America, kuneta, uye mhuri yehutachiona cheshuga inowedzera ngozi yeNODAT.
Kuenzanisa Nengozi Yokurambwa Nengozi yeNODAT
Sezvo zvingave zviri pachena kubva mukukurukurirana pamusoro apa, mishonga imwechete yatinoshandisa kuchengetedza zvakakwana kuderedza kudzvinyirirwa kwemupi wemuviri wezvirwere (kuitira kuti vasarambe mafungiro matsva akawedzerwa), uyewo kuwedzera ngozi yechirwere cheshuga. Mune mamwe mazwi, iwe ungasarudza kuisa pangozi kuramba nhengo here, kana iwe unogona kuisa njodzi yekurasikirwa nechirwere cheshuga? Chero nzira, unganzwa sokuti iwe uri kuisa hutano hwepfungwa yako yekuchera, yako yekutsvaga hupenyu hwehupenyu, pangozi. Kuenzanisa izvi zviviri zvakakwikwidzana zvinonyanya kukosha, saka unozviita sei?
Heano mutezo wekutora kumusha: Kurambwa kwepfungwa yakaputika ichiri chinhu chikuru chikuru chinogadza kukwanisa kwaro kurarama nekushanda mumurwere, kunyanya kudarika ngozi yechirwere cheshuga chitsva .
Nokudaro, mazano akawanda anongoronga kuisa maitiro ekudzivirira mafungiro akakwana ekudzivisa kurambwa, kunyange kana zvichireva kuwedzerwa pangozi yomubatsiri wekucheka achigadzira NODAT.
Kuziva
Sezvo tine kunzwisisa kwakanaka kwezvipingamupinyi zvinowedzera dambudziko reNODAT, kutarisa vanhu vane ngozi yakawanda inokurudzirwa zvikuru. A good transplant centre ichakupa zano pamusoro pengozi yeNODAT kunyange vasati vagamuchira itsvo kuitira kuti mugone kuita chisarudzo chakanaka.
Zvisinei, kana iwe uri kuongororwa mushure mokugamuchira mafungiro akawedzerwa, tsanangudzo dzinotevera dzichashandiswa kuitira kuti uongorore chirwere cheshuga chetachiona mushure mokunge tashandurwa. Tsanangudzo idzi dzakagadzwa nedzimwe nyanzvi yenyanzvi dzenyika:
- Zviratidzo zvechirwere cheshuga kuwedzera kune purogiramu yeplasma glucose yakakura kupfuura 200 mg / dL
- Kutsanya plasma glucose kupfuura kupfuura kana kuenzana na 126 mg / dL
- 2-hour plasma glucose yakakura kudarika kana yakaenzana ne 200 mg / dL munguva yekutaura glucose kuvhiringidzika
- Iwe unogonawo kuziva ruzivo rwakafanana runonzi glycosylated hemoglobin A1c , iyo yatinoshandisa kuti tiongorore chirwere cheshuga muhuwandu hwevanhu. Kushandiswa kwaro sechigoni chekuongorora hakukurudzirwi mumwedzi mitatu yokutanga mushure mekugadziriswa kwepvo. Zvisinei, mushure meizvozvo, tsanangudzo imwechete yekuongorora chirwere cheshuga sezvinoshandiswa muhuwandu hwevanhu inoshanda. Izvi zvingava hemoglobin A1c mazinga makuru kupfuura kana akaenzana ne 6.5 precent kuitira kuti aongorore NODAT.
Management
Pakutanga Conservative Management
Iwe unofanirwa here kukura NODAT (zvikurukuru mumamiriro ezvinhu anotaurwa pamusoro pezvipingamupinyi), nzira yekuchengetedza inotanga kuiswa kuitira kubata chirwere chakakosha cheropa. Heano zvimwe zvinhu zvokuziva:
- Kurongedza kushandiswa kweNODAT zviri pachena kuti chikamu chekuchengetedzwa kwakakwana kwemupi wekupora mupiro. Ropa shuga rinoyera kakawanda se kamwechete pavhiki kunyangwe mumwedzi wokutanga, kunyange zvazvo nguva yakawanda yekuedza inogona kuderedzwa gare gare.
- Imwe yenzira dzekudzivirira njodzi yeNODAT, pamwe nekuderedza kuoma kwayo kana yave yatotanga, ndeyekuita kuti kuderedzwa kwerosi ye steroid (imwe yeinchpins rejection prophylaxis mishonga). Zvisinei, kubva pangozi yekuramba chimiro chekuendeswa chinokwira zvakanyanya kana steroid inomiswa zvachose, kupera kwakakwana hakuwanzobvumirwi.
- Saizvozvowo, chirwere che tacrolimus (chimwe chiitiko chinowanzozivikanwa nezvekudzivirira muviri), sezvinobvumirwa nehupenyu hunopesana, inogona kuonekwa sekuderedza. Kana zvimwe zvose zvisingakwanisi uye murwere ane zvimwe zviratidzo / zviratidzo zveNODAT, kuchinja kune mishonga yakafanana inonzi cyclosporine inogona kudiwa.
Definitive Medical Therapy
Kana zviri pamusoro apa zvinorondedzerwa kushandiswa kwekutarisira hakubatsiri uye chirwere cheshuga chinoramba chichikura uye chakaipa shure kwekutsvaira kwepvo, mupiki wekucheka ane chirwere cheshuga chitsva angangoda hutano hwakanaka nehutachiona hwehuga. Kungofanana nemumwe munhu wese ane chirwere cheshuga, tinowanzozotanga nemishonga inonzwika.
Mienzaniso yakajairika inosanganisira mishonga inonzi glipizide (dzimwe nguva inoshandiswa nokuti yakasununguka kubva mumuviri hairevi zvakanyanya pamafongo 'basa; kana izvo zvisirizvo, mishonga yechirwere cheshuga inogona kuwedzera kusvika kumazinga akakwirira muzvirwere zvepfungwa zvepfungwa uye zvinokonzera ngozi ropa rinosanganiswa neropa). Kana imwe mishonga isingakwani, mimwe mishonga inowedzerwa kusvikira pakupedzisira, subcutaneous insulin injection inogona kuva yakakosha kudzora mazinga ega shuga zvakakwana.
Kudzivirira
Kuziva njodzi, iwe unogona kunge uchifungawo kuti kune chero chii chaunogona kuita kuti udzivise. Sezvinyorwa zvemashure, mamwe masangano anotora pancreas (iyo nhengo iyo insulin inobudiswa uye ine kusagadzikana kunogona kukonzera chirwere cheshuga) panguva imwechete neinso kune varwere vane chirwere cheshuga chekushaya chirwere cheshuga. Idzo dzimwe dzidzo dzinoratidza kuti nzira yakadaro inoguma mune hupenyu huri nani uye hurefu.
Izvi zvakabatana nenzira huru yekuvandudza kutonga kwechirwere cheshuga chechirwere cheshuga (icho chinopera nepamusoro pe "chirwere" chakakwana chechirwere semugumisiro wepascreas yakashandurwa), asi hapasati paine maitiro ekuti nzira yakamboedzwa iyo nyaya yeNODAT, nokuda kwechikonzero chakajeka icho nechirevo, murwere weNODAT haazove nechirwere cheshuga chisati chagadzirwa.
Shoko Rinobva
Zvose, njodzi yekukudziridza NODAT inogona kuva yakaoma kugamuchira uye inogona kukanda kusava nechokwadi pamusoro pekuti iwe unofanira kufambisa nzira yacho. Iva nechokwadi chekusimudza uye kurukura zvekunetsa kwako nachiremba wako. Iye achakubatsira iwe kuita sarudzo yakanakisisa kwauri. Kazhinji, kupa hutungamiri sarudzo kana chirwere cheshuga chichigadziridzwa, hutano hwehupenyu shure kwekugadzirwa hunogona kupfuudza dambudziko reNODAT.
> Sources:
> Zvitsva-zvekare chirwere cheshuga mushure mekushandura (NODAT): kuongororwa kwemashoko mumatambudziko ekurapa. Kutanga MR, et al. Transplantation. 2013.
> Nyaya itsva yechirwere cheshuga mushure mekushandura (NODAT): muongorororwo. Phuong-Thu T Pham. Diabetes Metab Syndr Obes. 2011.
> New-Onset Chirwere cheshuga mushure meDenney Transplantation: Risk Factors. Emilio Rodrigo. Nyaya yeAmerican Society yeNehrology. 2006.