Kuongororwa kwemigumisiro inogona kudiwa kana uchida mamwe mishonga
Chiremba wako weBD anowanzorayira zvimwe zviedzo kuti aongorore chirwere chinenge chiri munzira, asiwo kuti aongorore kuti mishonga inoshanda sei uye kana iri kuve nemigumisiro yakaipa pane dzimwe nhengo kana zvirongwa zvemuviri. Vanhu vane chirwere chechirwere chinokonzera chirwere (IBD) vanobatwa nemhando dzakasiyana dzemishonga, dzakawanda dzazvo dzine nzira dzakasiyana dzekuita pamuviri.
Mune zviitiko zvakawanda, zvinetso zvakaipa zvinowanika, asi zvinogona kutorwa zvakatanga saka zvakakosha kuita zvidzidzo kuitira kuti chirwere chiende zvakanaka.
Mirayiridzo yekuedza usati watanga mamwe maitiro ndeokuti: mirayiridzo. Chiremba wega wega neBDI centre ichaita zvinhu zvakasiyana. Zvisinei, zvakakosha kuti vanhu vanorarama neBD vave nehuwandu hwezvinhu zvinogona kuva mukana wekutarisira pavanotanga mamwe mishonga. Izvi zvinonyanya kuitika kana kusingaonekwi paBD centre kana kana kutarisirwa kwakawanda kuri kutarisirwa neumwe nhengo yeboka (zvakadai somudzidzi wepamusoro kana kuti chiremba wokurapa).
Vanhu vane Crohn's disease kana ulcerative colitis vane mibvunzo pamusoro pebasa rebasa uye nedzimwe mimwe miedzo inorumbidzwa pavanotora mishonga yeBDI vanofanira kubvunza vanachiremba vavo.
Apo Kutora Azulfidine (Sulfasalazine)
Azulfidine is sulfa based drug containing 5-aminosalicylic acid (5-ASA) uye sulfapyridine.
Iyo inoshandiswa kurapa chironda chekurara uye zvimwe zvinokonzera kupisa sezvakaita rheumatoid arthritis uye ankylosing spondylitis .
Ichi chemishonga ine nhoroondo yakareba yekuchengetedzwa kwakachengeteka kwekuonda kwehutachiona, asi ikozvino iko kushandiswa kudarika kazhinji semishonga mitsva iyo inoshanda uye ine zvishoma zvinokonzerwa nemusoro (misoro uye nausea) inogadzirwa.
Pakati pese, kuongororwa miedzo kunze kweCBC count hakuwanzokurudzirwa panguva yekugamuchira ichi chirwere.
Complete Blood Cell Count (CBC)
Iyi kuongorora ropa kunogona kuitwa musati watanga kurapwa naAzulfidine uye zvakare zvakare mamwe masvondo kana mwedzi kwemavhiki matanhatu ekutanga kusvika kumwedzi mitatu. Mushure meizvozvo, kuedzwa kunogona kukurudzirwa mwedzi mitatu uye ipapo mwedzi mitatu yega yega yakasara yenguva iyo Azulfidine iri kutorwa.
Izvi ndezvekutarisa zvimwe zviitiko zvisingaoneki zvakashata zvakadai sokuderera kweropa rekuyera masero (iyo inonzi inonzi agranulocytosis). Kazhinji zviitiko zveagranulocytosis zvinoitika mukati memwedzi mitatu yekutanga yekurapa.
Paunotora Corticosteroids
Kushandiswa kwenguva yakareba steroid yakadai sa prednisone iri pamakumbo sekurapa kweBD, asi inoshandiswa mune zvimwe zviitiko kana pamwe nemimwe mishonga. Chimwe chezvinyanya kufunga nezvekushandisa nguva dzose ye prednisone ndiyo ngozi yekurasikirwa kwefupa.
Dual-Energy X-Ray Absorptiometry (DEXA)
A DEXA scan inogona kukurudzirwa usati yatanga chirwere cheticticosteroid. Mushure meizvozvo, zvinogona kuitwa zvakare mushure memakore maviri kusvika matatu, kana kukurumidza kune vanhu vane osteoporosis kana kuti vane imwe chiratidzo chepfupa rinokuvadza, sekuputsika.
Kana zviitiko zveDEXA zvinoratidza kuti kune rimwe kurasikirwa kwemapfupa, kurapwa kunogona kutanga uye mamwe maedzo anogona kuitwa.
Pakutora Cyclosporine
Cyclosporine rudzi rwemumunosuppressant zvinodhaka izvo zvinoparadza maitiro ezvirwere zvemuviri. Iko dzimwe nguva inoshandiswa kuonda kwehutachiona uye chirwere cheCrohn, asiwo kuchengetedza nhengo kurambwa mushure mekutsvaira uye kune mamwe mamiriro ekuvhiringidza akadai se lupus, rheumatoid arthritis, uye psoriasis. Miedzo shomanana inogona kurairwa panguva ino.
Cyclosporine Level Test
Kuti kuve nechokwadi chokuti zvakakwana zvechirwere chiri mumuviri kuti zvive zvakanaka, kana kuti mishonga yemishonga haina kukwirira uye ichikonzera migumisiro yakaipa, zvinodhaka zvinodhaka zvingada kuyerwa kuburikidza neropa rekuongorora.
Mitumbi yevanhu inoita zvakasiyana nemishonga uye mazinga muropa inogona kuchinjwa nehuwandu hwezvinhu.
Pakutanga kwerapi ne cyclosporine, kuedza kunogona kuitwa kakawanda sezuva nezuva kusvikira kuenzanisa kwakakwana kuchiwanikwa. Mushure meizvozvo, kuedza kunogona kuitwa vhiki nevhiki, mwedzi mumwe nomumwe, kana kupfuura zvishoma. Zvinogona kukanganiswa zvakare kana pane kuchinja, zvakadai sokuti zviratidzo zvinowedzera kana kuti mumwe mushonga unoda uye unobata chirwere che cyclosporin.
CBC Count
Kakawanda kwekuongororwa kweropa iri kuchasiyana kubva kune chiremba anofanirwa, asi kazhinji, ropa rekuyera masero, ropa rekuyera ropa, hemoglobin, uye hematocrit zvichaongororwa nguva nenguva.
Urinalysis
Varwere vanogona kubvunzwa kuti vatore urine nokuda kwekuita urinalysis . Migumisiro yechiratidzo ichi inogona kubatsira kutarisa matambudziko aneinso uye chiropa. Inogona kurairwa nguva dzose paunenge uchitora cyclosporine kuti uone kuti mushonga wacho hausi kutungamirira kune chero njodzi dzinosvibisa kune nhengo idzi.
Mimwe Miedzo Yeropa
Kuti ave nechokwadi chokuti cyclosporin haisi kukanganisa migumisiro yakaipa, chiremba anogona kuraira zvimwe zviedzo kuti aongorore mafungiro uye chiropa chinoshanda, kusanganisira maitiro eropa urea nitrogen (BUN) , bilirubin, magnesium, potasium uric acid, lipids, uye enzyme yeropa .
Apo Kutora Imuran (Azathioprin)
Imuran (azathioprine) ine immunosuppressive antimetabolite mishonga inorayirwa kuti irarame IBD nedzimwe mamiriro ekuvhiringidza akadai se rheumatoid arthritis. Imuran inogona kushandiswa pachayo pachayo kana panguva yakafanana nemimwe mishonga (yakadai seye corticosteroids) kuitira kubatsira iyo mishonga inoshanda zvakanyanya. Paanenge achigamuchira Imuran, varwere vacharongedzwa zvakanyanya pamigumisiro yemigumisiro.
CBC Count
Kwemwedzi wokutanga, kuongororwa kweropa uku kunogona kuitwa vhiki nevhiki, kuteverwa nemamwe vhiki imwe neimwe mumwedzi wechipiri nemwedzi wechitatu, uye pashure pemwedzi mushure mazvo. Kana paine kuchinja kwemaji, basa revhiki nevhiki uye rimwe nerimwe vhiki rinogona kutanga zvakare.
Thiopurine Methyltransferase (TPMT) Nhamba
Uyu muedzo unogona kuitwa musati wagamuchira chero ipi zvayo yemishonga ye thiopurine, inosanganisira Imuran, mercaptopurine (6-MP) , uye thioguanine. Nhamba ye enzyme ye TPMT inowanzoongororwa kuburikidza nekuongororwa kweropa, asi kana kuongororwa kwemajini kunenge kuchiitwa kuedzwa kunogona kuzadzikiswa nokuputira mamwe masero kubva mukati me cheek.
Zvakakosha kuti chiyero ichi chiitwa musati watora mishonga kuitira kuti uwane mumiririri wechokwadi wematendi e TPMT. Uyu muedzo unoitwa nokuti TPMT ndiyo enzyme mumuviri inoputsa Imuran nemamwe mishonga yakafanana. Kana uwandu hweTTMT mumuviri huri pasi pfupi (hunoitika munenge 10 muzana yevanhu) kana hutsika kwazvo (iyo inowanikwa munenge 0.3 muzana yevanhu), kutora chirwere che thiopurine seImuran chinogona kukonzera kukanganisika kwemigumisiro.
Apo Kutora Mesalamine uye Zvimwe 5-ASA Zvinodhaka
Kune maitiro akasiyana-siyana akasiyana-siyana emamamineine akashandiswa kurapa chironda chekuonda, uye izvi zvinodhaka zvinogona kupiwa mumuromo kana muEema. Mesalamine ibhidhiyo 5-ASA iyo inobatanidza nehuwandu hwemigumisiro kupfuura Azulfidine nokuti haina sulfa chikamu.
A CBC count uye chiedza chekushanda chinogona kupera musati watanga ichi chinodhaka kuitira kuti uwane nheyo yekutanga. Zvisinei, hapana mazano anokurudzira kuenderera kuongororwa panguva yekurapa. Chimwe chiyero chinogona kuitwa kakawanda chiyero chekusika.
Creatinine Level
Mesalamine chirongwa chekuchengetedza chinowanzotorwa kwenguva refu. Izwi re creatinine rinogona kurairwa usati watanga ichi chemishonga, pamasvondo matanhatu, pamwedzi mitanhatu, gore rimwechete, uye gore negore.
A creatinine level inoshandiswa kubatsira kutarisa kwechiitiko chisingawanzovhiringidzi chinosvibiswa apo itsvo dzinopisa, dzinonzi interstitial nephritis. Kana kuparadzaniswa nephritis kunofungidzirwa, kurapwa ne mesalamine kuchavharwa.
Pakutora Methotrexate
Methotrexate inonzi antiineoplastic drug inoshandiswa kurapa Crohn's disease, ankylosing spondylitis, rheumatoid arthritis, uye psoriasis. Yakave yakaratidza kuti inokonzera kusakwana kwemafupa uye saka haifaniri kutorwa nevakadzi vane pamuviri kana vari kutsvaka kuve nemimba. Zvakakosha kukurukura maitiro ekuzvidzivirira kwekuberekwa musati watanga iyi mishonga.
Kuberekwa Test
Usati watanga methotrexate, kuongororwa pamuviri kunogona kurairwa kuve nechokwadi kuti zvakachengeteka kutora mishonga. Ichi chinodhaka chinogona kukonzera kusununguka kwemasimba pamwe nekuberekwa kwekuberekwa. Methotrexate inopindawo mumukaka wemukaka, naizvozvo hazvikurudzirwi kuti ishandiswe navanaamai vanoyamwisa. Mimba yekudzivirira inogonawo kuitika mukushandiswa kwemishonga kana zvichidiwa.
Chifu X-Ray uye / kana Mhemberero Yemabasa Miedzo
Methotrexate inogona kukanganisa mapapu saka saka usati watanga chirwere, miedzo yekuongorora mapapu inogona kurayirwa. Izvi zvinogonawo kusanganisira carbon monoxide transfer factor uye test pulmonary function kuti uone kuti hapana mapapu emapapu asina kumboonekwa, kunyanya kune vanhu vanoputa kana avo vambove vachema.
CBC Count
Kuverenga ropa kunofanira kuitwa musati watanga methotrexate therapy, uye zvino inogona kurairwa zvakare mushure mevhiki imwe uye pakati pevhiki masere uye masvondo gumi nemaviri pashure. Serosi yakachena yeropa inotarisa panguva iyo inotora methotrexate haina kuonekwa kune varwere vane IBD, asi yakaitika kune varwere vane rheumatoid arthritis.
Basic Metabolic Panel
Uyu muedzo unogona kusanganisira BUN, carbon dioxide (CO2), creatinine, glucose, cholesterol, albumin, electrolyte, enzyme yeropa, uye utachiona hwehomoni. Izvi ndezvekutarisa chero zvipi zvacho zvinotambudza pane chiropa uye neitsvo. Uyu muedzo unogona kuitwa mwedzi mitatu yese apo methotrexate iri kutorwa.
Chiropa Chirwere
Kana chiropa chinenge chichiita sechinokanganisa zvichienderana nemigumisiro yejecha rekutanga remagetsi kana zvimwe zviratidzo kana zviratidzo, chiropa chinonzi chiropa chinogona kuitwa. Kune vanhu vane rheumatoid arthritis kana psoriasis, chiropa chinokonzera chiropa chinogona kuitika kamwe kana imwe dose ye methotrexate yasvika, asi ikozvino, chirongwa chechiropa chinorongwa seyizvi kune vanhu vane IBD hachina kukurudzirwa.
Shoko Rinobva
Sezvenguva dzose, gastroenterologist ndiyo yakanakisisa yekushandisa kukurukura kuti ndeapi maitiro ekuongororwa anodiwa paanotora mishonga yeBDD. Muzviitiko zvakawanda, chiito chebasa rebasa uye mamwe maedzo anoitwa kuitira kuti abate matambudziko chero ipi zvayo nekutanga kuvabata pakarepo.
Muzviitiko zvizhinji zvinokonzerwa nemigumisiro yakashata asi inogona kudziviswa nezvimwe zviedzo zvakaoma, ndicho chikonzero nei zvingaita sokuti basa reropa riri kuitwa kakawanda. Mirayiridzo iripo kuti ibatsire vanachiremba kusarudza kuti zvakanakisisa sei kutarisira varwere, asi murwere wese ane IBD akasiyana uye naizvozvo kwete chete chirwere chinoparadzaniswa zvakasiyana, asi ndizvo zvakaitawo kuongorora kunowanzoitwa.
> Sources:
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> [Hapana vanyori vakarondedzera] "TPMT kuongorora pamberi peAzathioprine therapy?" Drug Ther Bull 2009.; Jan (47): 9-12. Ini: 10.1136 / dtb.2008.12.0033.
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