Nhengo yekugadziriswa kwemuviri inenge iri pangozi yakawanda yezvipembenene uye osteoporosis
Chirwere chepfupa mushure mechirongwa chekugadziriswa chinetso chinowanzova chinowanzoitika pakugadziriswa kwevatapi kupfuura varwere vakawanda vanoziva. Icho, zvisinei, chimwe chinhu chinofanira kunzwisiswa, zvichida musati waenda kune imwe nhengo yekugadzirisa, kuitira kuti matanho ekudzivirira anogona kutorwa. Pachinyanya kukosha, chirwere chepfupa mumamiriro ezvinhu akadaro chinogona kukonzera marwadzo emapfupa, asi mumamiriro ezvinhu akaipisisa angatungamirira kumarara.
Zviri pachena kuti izvozvo zvingakonzera hutano hwehupenyu hwevarwere, uye zvinogona kuwedzera njodzi yekufa zvakare.
Ndeupi Muviri Wemapapiro Anotungamirira KuNengozi Yakawanda Yezvirwere Zvepfupa?
Pasinei neiyo itsvo 'inobata mapfupa, haisi kungova varwere vane upvo kukanganisa (vanogamuchira kuwedzerwa kwepvo) avo vane ngozi yakawanda yepfupa zvirwere uye fractures. Nhengo dzakawanda dzekugadzira varwere (kusanganisira vanogamuchira mafungiro, mwoyo, mapapu, chiropa, uye marrow transplants) zvinogona kukurira zvinetso zvinosanganisira fractures, kurwadziwa kwepfupa, osteoporosis, nezvimwe zvakadaro, zviitiko zvinogona kuchinja zvichienderana nhengo inobatanidzwa. Semuenzaniso, kuwandisa kwezvipembenene mumagetsi ekutengesa kwepimpinyi kunogona kuva chero ipi zvayo kubva pa6 kubva pamapfumbamwe kusvika ku45 muzana, zvichipesana 22 kusvika 42 muzana kune vanogamuchira moyo, mapapu, kana chiropa chinoputika.
Kukuru Kwakaita Ngozi Yezvirwere Zvemapfupa Mushure mekunge Muviri Wakafuridzirwa?
Sezvataurwa pamusoro apa, chiitiko chichasiyana nechimiro chakaiswa.
A retrospective chidzidzo chevarwere vane 86 vakagamuchira mafungiro epiyo akawana kuti vaigamuchirwa vakanga vawedzera kuwedzera kashanu mumatambudziko ekuparara mumakore gumi ekutanga mushure mekugamuchira mafungiro, kusiyana nemunhu akawandisa. Kunyangwe mushure memakore gumi ekutevera, dambudziko racho rakanga richiri mbiri. Izvi zvinoratidza kuti kuwedzera kwengozi yekuputsika kunopfuurira kwenguva refu mushure mekufunga kwepvo.
Zvisinei, kuputika, asi, inongova muenzaniso mumwe chete wepfupa chirwere mushure mekugadzirwa kwomuviri. Osteoporosis inowanzoonekwawo. Tinoona izvi pamhando dzakasiyana-siyana dzechirwere chinokonzerwa nekusiyana-siyana kwepfungwa (88 muzana), mwoyo (20 muzana), chiropa (37 muzana), mapapu (73 muzana), uye marora emafuta (29 muzana yevanogadziriswa).
Zvinotora Nguva Yakadii Kuti Ive Nemafu Matambudziko Mushure mekushandura?
Chimwe chinhu chinoshamisa pazvinosvika pakugadzirisa-kutapudza mapfupa kurasikirwa ndekukurumidza sei varwere vanorasikirwa nefupa ravo. Mwenje, hono, mwoyo, uye chiropa chekugadzirisa chiropa chinogona kurasikirwa ne4 kusvika ku10 muzana yemapfupa emaminetsi emadhora (BMD) mukati memwedzi yekutanga kusvika ku12 mushure mekugadzirwa kwemuviri. Kuti unzwisise zviri nani izvi, fanisa nhamba iyi kune chiyero chekurasikirwa kwefupa mune imwe postmenopausal osteoporotic mukadzi, inongova 1 kusvika 2 muzana pagore!
Chii Chinokonzera Kurasikirwa Kwemapfupa uye Kuparara Muvanhu Avo Vanogamuchira Organ Transplants?
Kutarisa pazviri kubva pakufungidzira, kurasikirwa kwefupa kune vanhu vanogamuchira chimiro chechirwere kunokonzerwa nezvikonzero zviripo isati yasvika kugoverwa kwechirongwa , pamwe nekurasikirwa kwepfupa kwakakurumidza kunoitika mushure mekugadzirwa kwechirongwa .
Zvose zvinokonzera ngozi zvinowedzera kurasikirwa kwetema zvinoshandiswa kune munhu wese akaisvonaka, zviri pachena kuti zvakakosha pano zvakare.
Izvi zvinosanganisira:
- Vitamin D kukwana
- Kusvuta
- Chirwere cheshuga
- Nguva yakwegura
Asi, ngatitarirei zvimwe zvipingamupinyi zvinokonzerwa nechikwata chakakanganisika:
Pre-transplant Risk Factors
Zvinokonzera njodzi muvarwere vane zvirwere zvepfungwa zvinosanganisira:
- Vitamin D kukwana
- Kakawanda kushandisa steroid ( iyo inokonzera kurasikirwa kwenyama ), sekurapa kwezvirwere zvakasiyana-siyana zvepfungwa
- High acid mazinga muropa, anonzi metabolic acidosis
- Kuwanda kwemahara hormone parathyroid muropa (inonzi secondary hyperparathyroidism ), iyo inotungamirira kukurumidza kupera calcium kurasikirwa kubva pfupa
Zvinokonzera ngozi kune varwere vane chirwere chechiropa zvinosanganisira:
- Kusadya zvokudya zvakakwana, kazhinji kunoonekwa muchiropa kukanganisa varwere
- Cholestasis
- Tete testersterone mazinga kana hypogonadism
Zvinokonzera njodzi muvarwere vane chirwere chemapapu zvinosanganisira:
- Kushandisa nguva dzose steroids, kurapa zvirwere zvepapu, kufanana neCOPD kana asthma
- Kusvuta, chinhu chakanyanya ngozi kune osteoporosis uye kurasikirwa kwefupa
- High acid mazinga, nemhaka yekodhi dioxide kuchengetedza muropa
Zvinokonzera njodzi muvarwere vane chirwere chemwoyo zvinosanganisira:
- Kushandiswa kwenguva refu kwemishonga yemvura, kana kuti diuretics, izvo zvinogona kukonzera kuparara kwekasium kubva pfupa. Mienzaniso inosanganisira mishonga sefurosemide uye torsemide.
- Kuderedza basa remuviri, chinowanzoonekwa kune varwere vane chirwere chepfungwa
Post-transplant Risk Factors
Pre-transplant risk factors zvinokonzera kurasikirwa kwepfupa kunowanzoenderera kune imwe nguva kunyange mushure mekugadzirwa kwemuviri. Zvisinei, zvimwe zvinhu zvitsva zvinokonzera ngozi zvinowanikwa mushure mekunge murwere ane chirwere chisina kukwana anowana imwe nhengo yekugadzira. Izvi zvinosanganisira:
- Steroid inoshandiswa : Mushure mekunge varwere vagamuchira chirongwa chekugadzira, vanodikanwa mishonga yekudzivirira maitiro avo emagetsi kubva "kuramba" nhengo itsva. Steroid inoitika kuva imwe yemishonga iyi. Zvinosuruvarisa kuti, steroids inoderedza mutsva pfupa maitiro kuburikidza nekudzivisa rudzi rwupi rwefupa rinonzi "osteoblast." Vanowedzerawo kurasikirwa kwefupa kuburikidza nekukurudzira imwe rudzi rwekero rinonzi "osteoclast." Mune mamwe mazwi, kana uri pane steroid, uri kupisa mwenje pamativi ose maviri. Kune dzimwe nzira dzinoshandiswa steroid, izvo zvisingasviki pakukura kwechikamu chino (chimwe chinhu chinonzi chichiwedzera-murau weReceptor Activator yeNuclear Factor kappa-B) iyo inokonzera kuparara kwemapfupa.
- Calcineurin inhibitor inoshandisa : Sezvakaita steroids, izvi ndezvimwe zvikamu zvinowanzoshandiswa zvemishonga inoshandiswa mukudzivirira kupfuudzwa kwemuviri kurambwa. Iyi mishonga inosanganisira cyclosporine, tacrolimus, nezvimwe. Izvi zvinogona kukonzera kurasikirwa kwefupa, asi kazhinji zvinopindirawo neitsvo 'kukwanisa kuchinja vitamin D kuti ishandiswe (izvo zvinokosha pakugadzira mapfupa), chimwe chinhu chinonzi kushandiswa.
Unosangana Sei Nezvirwere Zvemapfupa Muvarwere Ndiani Anogamuchira Muviri Wemutsipa?
Iyo "yegoridhe yepamusoro" kuedza kuongorora kuvepo kwefupa zvirwere mukugadziriswa kwevafambisi ifupa remapfupa, iro rinosanganisira kunamatira tsono mumapfupa, uye kuitarisa pasi pe microscope kuti iongororwe. Sezvo varwere vakawanda vasiri mavheti makuru ekunamatira masero akadzika mumapfupa avo, maitiro asina-invasive anoshandiswa pakuongorora kwekutanga. Kunyange zvazvo chizikanwi chakazivikanwa cheDXA scan (chinoshandiswa kuongorora mabheji emagetsi) chirwere chakajairika chinoshandiswa kuongorora hutano hwepafu muhuwandu hwehuwandu hwevanhu, kukwanisa kufanotaura kuti njodzi dzezviputi muhutano hwekugadzira vanhu hazviratidzi. Kubva pane maonero anobatsira, muedzo unoramba uchinyorwa uye unorudzirwa nesangano guru rakafanana neAmerican Society of Transplantation neKDIGO.
Zvimwe zviyero zvinotsigira kana zvinyorwa zvinosanganisira kuongororwa kwemavara emapfupa ekutora se serum osteocalcin uye bone zvakanyanya alkaline phosphatase mazinga. Kufanana neDVDA scan, hapana chimwe chezvizvi chakave chichidzidza mukukwanisa kwavo kufanotaura ngozi yekuputsika mukutakura varwere.
Kurapa Mafupa Emapfupa Muhutano Hwekutakura Mushonga
Zvose zvinoshandiswa zvinoshandiswa kune vanhu vakawanda, zvakanyanya kufanana nevari kumubatsiri wekutora. Izvi zvinosanganisira kuenzanisa muviri, kuvhara kusvuta, kutungamirirwa kwezvokudya uye calcium uye vitamini D supplementation.
Matanho chaiwo anotarisana nehuwandu hunokonzerwa nehutachiwana hunogadziriswa uye hunosanganisira:
- Kudzivisa steroidhi, kana zvichibvira, sechikamu chekudya kwezvinodhaka zvinoshandiswa kudzivirira kupfuudzwa kwechirongwa chemuviri. Zvisinei, izvi zvinoda kuyerwa nehuwandu hwehutano hwekuregwa kwemuviri.
- Chikamu chakajairika chemishonga inowanzokurudzirwa nokuda kwedambudziko iri chinonzi " bisphosphonates ," iyo inoshandiswa pakudzivirira nekurapa steroid-induced bone loss muvanhu vakawanda. Kunyange zvazvo dzimwe dzidzo dzakaratidza mishonga iyi kuti ibudirire pakudzivirira nekurapa mushure-kudengisa kurasikirwa kwefupa, hapana imwe yenhoroondo yakaratidza kuti bisphosphonates ine kukwanisa kuderedza dambudziko rezvipuka zvechokwadi.
> Sources
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> Shane E, Papadopoulos A, Staron RB, et al. Kurasikirwa kwepfupa uye kuputsika mushure mokuputika kwemapapu. Transplantation. 1999; 68 (2): 220-227
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