Myeloma uye multiple myeloma mazita akasiyana nemukenza mumwe chete. Izwi rokuti multiple rinosarudzo uye rinoreva maitiro akawanda anowedzera mumapfupa evanhu vane chirwere ichi.
Myeloma, leukemia, uye lymphoma ndiyo mitatu mikuru yekenza yeropa kana hematologic malignancy. Pakati pavatatu, myeloma ndiyo yakanyanya kufanana. Mikana yekuvandudza myeloma inowedzera nezera uye vanhu vakawanda vanoonekwa kuti vari mumakore avo makumi matanhatu kana kupfuura. Kunyange zvazvo zvinogona kuitika kuvakuru vaduku, pasi pezana kubva muzana yematambudziko ari kune avo vari pasi pemakore makumi matatu.
Chii chinonzi Myeloma?
Myeloma ndikenza inotanga mufupa . Muvanhu vakuru vane hutano, marora mararamiro mhuka dzinorarama dzakapinda mumapango emukati mune mamwe mapfupa. Iko, inoramba ichiita uye ichibudisa masero matsvuku eropa uye masero machena emarudzi ose, kuve nechokwadi kuti iwe unogara uchipa muropa rako.
Zvisinei, myeloma ndiyo kenza yakananga yekasepa re plasma s-rudzi rwakanyatsonaka rwemasero eropa rega. Basa guru remaserema eplasma nderokuita zvirwere zvinopesana, mapuroteni ane microscopic anongedza vatorwa vekune dzimwe nyika kuti varware kuparadzwa.
Chirwere cheutachiona chemalasma chinovanza nzvimbo yose yezvirwere zvakasiyana-siyana kurwisa imwe gciwane. Mune myeloma, pane 'clone' yemasero ema plasma-zvinonetsa-mazana emapepa akafanana e plasma mumapfupa emapfupa anobudisa puroteni yakafanana (a monoclonal protein kana M protini ) isingawanzoitiki. Izvi zvinoshungurudza masero eplasma hazvimiriri kuti germi iparadze; inobereka P protein nguva dzose uye inopfuura.
Kunyatsoziva kuti kero yepa plasma ine utano inenge isingazivi here, asi masayendisiti ari kuwana nzvimbo. Zvinokosha, zvino zvinonzwisisika kuti myeloma ndeyemhuri yezvirwere zvakasiyana-siyana zveplasma. Vanhu vazhinji vane zvimwe zvirwere zveplasma zvekare zvinopedzisira vava nekuwedzera myeloma yakawanda.
Zviratidzo
Haasi munhu wose ane myeloma ane zviratidzo pakutanga, saka kubata myeloma pakutanga kwaro kunonetsa. Zviratidzo zvekutarisa zvinosanganisira zvinotevera:
- Kutambura kwepfupa, kunyanya mumutsana kana muchifuva
- Kuneta
- Unintentional kurasikirwa kwekurema
- Vanowanzorwara zvirwere
- Nausea, kuvimbiswa, uye / kana kusava nenzara
- Kunzwa zvakanyanya nyota
- Kushungurudzika kana uropi hwehuropi
- Unhu kana kushaya simba mumakumbo
Kazhinji zviratidzo zve myeloma zvakabatana nemigumisiro inokonzerwa nemakwenzi anouraya uye / kana antian-protein anogadzira. Semuyenzaniso:
- Sezvo masero asina kukwana mukati memapfupa anovaka, kurwadziwa kwepfupa, kusimba kwemapfupa uye kuputika kunogona kuitika, zvichida nehutano hwekushaya.
- Apo magetsi e-myeloma anotanga kubuda kunze kwemasero emuviri-akagadzira ropa, vanhu vanogona kukura pasi masero ekuverenga. Nhamba yakaderedzwa yemasero matsvuku eropa, kana chirwere chepemhenga , inogona kuunza zviratidzo zvekushaya simba uye chirwere chezhezi. Kushayikwa kwemasero machena eropa kunogona kukuita kuti utapukirwe. Uye kushayikwa kweplatelet kunogona kutungamirira kumatambudziko anopa ropa kubva pakukuvadzwa kunenge kusinganyanyi kuoma.
- Myeloma masero anogona kuratidza mamwe masero kuti aparadze bone, achibudisa calcium inogona kusvika pangozi yakakwirira muropa. Anozivikanwa se hypercalcemia, ichi chakawedzerwa muropa re calcium chinouya nemararamiro ayo, zvinosanganisira nyota yakanyanya / kunyanya kudhonza, kusanganiswa, kuvhiringidzwa kwakasimba, kurwadziwa kwepamuviri, uye kurasikirwa kwechido.
- Dzimwe nguva masero e-myeloma anounza mapuroteni anokuvadza maitsvo uye nerve. Izvi zvinogona kubudisa zvirwere zvepfungwa kana, mune mutsara unobatwa nehutachiona, kupera, kumira kana kushaya simba. Kutinhira kwakadaro uye kurwadziwa mumaoko, maoko, tsoka, uye makumbo zvinonzi seuropheral neuropathy.
- Iko kuvaka-myeloma mapuroteni kunogonawo kukonzera kuwedzera kweropa-zvakadai sokuwedzera huwandu hweupfu hwepascake batter. Izvi zvinonzi "hyperviscosity". Inogona kuderedza ropa richiyerera kusvika muuropi uye inokonzera kuvhiringidzika, chirungu, uye zvimwe zviratidzo.
Kune Hwe Pre-Myeloma Here?
Kutanga kufungidzirwa kwemaeloma kunonetsa sezvo zviratidzo zvisingasviki kusvikira zvishoma. Dzimwe nguva, pangave nezviratidzo zvisinganzwisisiki izvo pakutanga zvinonzi kune dzimwe zvirwere. Zvisinei, masayendisiti akacherechedza mhuri yezvirwere zvakasiyana-siyana zveplasma, dzimwe dzingaguma dzichienda ku myeloma, dzakadai seiyo inotevera:
- Monoclonal Gammopathy yeUndetermined Significance (MGUS)
- Plasmacytoma, kana kuti plasmacytoma ari oga.
MGUS
Paunenge uine makopi akawanda kwazvo evanhu vanomwe, iyo inozivikanwa se monoclonal gammopathy kana MG. Vanhu vane myeloma vanogona kunge vane MG, asi kwete vose vane MG vane myeloma. Muzvokwadi, pane rurefu rwezvirwere zvinosangana nekuvapo kweMG uye vazhinji vavo havasi kanzira.
Apo munhu ane MG asi hapana mazano ekuti chii chinokonzera, inozivikanwa seMG yezvisingatauriki zvakakosha kana MGUS. Haasi munhu wose ane MGUS achaenderera mberi kukura myeloma, asi vamwe vangave, ndicho chikonzero kuongorora gore negore kunokosha.
Kunyange zvazvo iri chirwere chekushaya simba, MGUS inotakura dambudziko rekuve myeloma pamwero we5,5% pagore. Izvozvo zvinokwira nehuwandu hwemajini asingazivikanwi e plasma mumapfupa emapfupa uyewo nepamusoro mazinga eprotini muropa. MGUS inowanzoongororwa asi isingarapwa.
Plasmacytoma
Dzimwe nguva kune humwe humwe uchapupu hwomukoma mumwechete weplasma chesaundi. Kana izvi zvichiitika, inonzi plasmacytoma kana kuti plasmacytoma yakasara yemapfupa, panzvimbo peyo myeloma.
Iga plasmacytoma imwechete inogonawo kukura kunze kwefupa remafu mune imwe nhengo. Muchiitiko ichi, inonzi "extramedullary plasmacytoma". Vanhu vazhinji vane plasmacytoma vari voga vacharamba vachikudziridza myeloma yakawanda, saka kuongorora kwakanyanya kwezviratidzo zve myeloma zvakakosha.
Chii Chinoitika muMyeloma?
Funga nezvemapfupa ako samatambo sebhokisi rebhola rakazara nevhuni. Mumwe nomumwe fan is cell uye kune dzakawanda masero masero. Munhandare iyi, masero eplasma ndiwo mavheti akapiwa mureza kuti atsike pahafu yetime show. Uye imwe sendima yeplasma / fan inogadzirwa nemarudzi akasiyana-siyana, anomiririra munhu anonyanya kushandiswa.
Mune marara ane hutano hwakanaka, mamwe masero evanhu anopfuura masero e plasma. Saka, munhandare yedu, vese vese havana mavara ane mavara. Kunyange zvakadaro, pane vateveri vakakwana uye mavara-mavara kuti vazadze nhandare nepamusoro pemumvuri wose wemarudzi ose-zvinoshamisa zvakasiyana-siyana zvezvirwere.
Iye zvino chimbofungidzira kuti rimwe sero re plasma rakabata grey mureza rinotenderera uye rinogona kuzvisunga, richiva mafani maviri akafanana, mumwe nomumwe ane grey mureza. Zvadaro vaviri vanova mana, mana anova masere, uye zvichiri--vose vakabata mazai avo mawere. Pakupedzisira, kune nzira yakawanda yemafuta emapfupa kupfuura zvinotarisirwa. Iyo majee mawere anomiririra makopi akawanda eproteiniti imwechete-protechenal monoclonal kana M protini - nokuti inobva kune chimwe chinetso chinotambudza chemasero. Iyi yakawandisa yemaprotheni muropa kana mumurini chimwe chinhu chinogona kuonekwa muongororo yebazi.
Iye zvino fungidzira kuti rimwe sero kubva kumagetsi anonyangadza anomuka kuti atenge kunwa, asi anodzokera kune chikamu chisina kunaka chekugara, achiri kuramba achizvibatanidza. Ikoko inotanga muchikamu chitsva, uye zvakare maviri anova mana, mana anova masere, nezvimwe zvakadaro.
Aya majekoni esero eplasma anotadza anogona kutanga kutora nhandare. Vanotarisa kunze kwemitsara uye zvikamu zvezvigaro zvaimbova semafuta emafuta ane utano, akafanana neaya anoita kuti iwe upe masero matsvuku, masera masero, maplatelets, uye kunyange mamwe masero eplasma ane mavara ehondo. Nokudaro, sezvo nhamba yejera miregi inowedzera, nhamba yezvakagadzirwa, mapurogiramu anovaraidza mavara anokwanisa kuderera.
Uye majekoni akaipa anokwanisawo kukanganisa mamwe masero ari pedyo munhandare. Plasma cell clones inogona kusunungura nhume dzemakemikari dzinokonzera pedo "venzi" kuti vaite zvisina kunaka. Mamwe acho (osteoclasts) anotanga kukanda mu simiti yemutambo ( bone resorption ), kusunungura makore eguruva (calcium) yakapararira munhandare uye kunze (ropa iro).
Aina
Apo myeloma inokura, inogona kubuda uye kuparadzaniswa zvakasiyana nevanhu vakasiyana. Mamwe emashoko anoshandiswa kuisa myeloma anosanganisira:
- Asymptomatic Myeloma
- Smoldering Myeloma
- Symptomatic or Active Myeloma
- Chiedza Chakanaka Myeloma
- Nonsecretory Myeloma
- Myelomas yemhando dzakasiyana-siyana dzemashoko
Asymptomatic vs. Smoldering vs. Active / Symptomatic Myeloma
Mune vamwe vanhu, kune "pakati-" chikamu chechirwere-chiitiko chiri pakati peMGUS uye inoshanda myeloma, ndiko kuti. Apo izvi zvinenge zvichiitika, inonzi inymptomatic myeloma uye, mumamiriro ezvinhu akadaro, pane zviratidzo zvishomanana zvechirwere chinoshanda kana myeloma yakasimba.
Mukuputika myeloma, marora emapfupa anozadza nemamwe masero eplasma. Vamwe 10 kubva muzana kana kupfuura mamwe marore masero anogona kunge ari kubva ku myeloma clone uye / kana M mapuroteni mazinga ave makuru kupfuura 30 g / L. Zvisinei, pakuputika myeloma, hapasisina anemia, kusakanganiswa kwepvo, hapana kukwidziridzwa kwe calcium muropa, uye hapana kuora kunokonzera nzvimbo yefupa. Kushungurudza myeloma kunowanzoonekwa asi kusati kwarapwa; zvisinei, vatsvakurudzi vari kutarisa kune zvingabatsirika zvekurapwa kwekutanga mune dzimwe mamiriro ezvinhu.
Chiratidzo kana chimiro chinonzi myeloma chinoda kurapwa. Iko maProtein muropa kana mumurini uye kuwedzerwa kwemajeri e plasma mumapfupa emapfupa. Nzvimbo dzakaderera dzinogona kuonekwa mune zvikamu zvefupa, kuonda simba, zvichikonzera marwadzo, uye kuwedzera njodzi yezviputi. Uye, izvo zvinhu zvisiripo mukutsanangurwa kwekunyorera myeloma kubva kumusoro zvinogona kusvika pakugadzirisa mukushanda kwangu myeloma.
Mapuroteni Anobatsira Sarudza Myeloma
Mhando yeprotini yemasero e-myeloma inobereka inobatsirawo kuziva kuti ndeypi yeyellemoma. Zvirwere zvepamuviri mapuroteni makuru ane zvikamu zvakasiyana kana zviketani. Zvikamu zvakakura, kana zviketani zvakasimba, uye zvikamu zviduku, kana zviketani zvitsvuku, zvose zvinoungana kuti zvive nhengo imwechete yevanhu vanorwisa.
Mukudanwa kwechirwere chechirwere kana immunoglobulin, maketani ane simba anonzwisisa tsamba ipi inouya mushure mokunge immunoglobulin (Ig). Saka, somuenzaniso, chikamu chinowanzosema chinowanikwa mu myeloma M mapurotini ndi IgG, iyo inokwana 60 kusvika ku70 muzana yemhosva dzangu. Icho chinotevera IgA. Kazhinji, IgD kana IgE inogona kubatanidzwa.
Mune zvimwe zviitiko, myeloma masero angangobereka chete mauto asingagumi kana kuti anogona kuvhara maketani chete. Izvi zvinonzi Bence-Jones maprotestine uye zviduku zvikuru zvokuti dzinowanzopfuura kubva paitsvo mumuguta. Anenge makumi maviri kubva muzana yematambudziko ose e myeloma secrete chete maketani.
Inenge imwechete yezana yezviitiko zvose zve myeloma hazvizivikanise zvakakwana M mapuroteni kana maketani akachena kuti aoneke zvachose. Muzviitiko izvi, kuongororwa kwakaoma kunoshandiswa kana zviratidzo zve myeloma pamwe nekuwana kwemasero asina kujairika emu plasma mumusana unoita kuti uongororwe.
Genetic Sub-Types
Kune marudzi akasiyana-siyana ehutachiona hunokonzerwa ne myeloma. Kuenzaniswa kweDNA kwakadzidzwa kuitira kuti zvizivikanwe, somuenzaniso, kuti kuva nechimwe chezvinhu izvi zvinokonzera maitiro zvinogona kuchinja kana kufanotaura kuti chirwere chako chichapindura sei kurapwa . Vatsvakurudzi vanotarisira kuti kufanirwa kwezvekuberekwa kwakadaro kuchange kuchienderera kubatsira kutungamirira mberi kubudirira mune zveraeloma.
Zvinokonzera
Muzviitiko zvakawanda, masayendisiti haazive kunyatsoziva kuti myeloma inotanga sei . Mitengo yakasiyana nedzinza-VaAfrica-MaAmerica makuru kudarika Caucasian -America neCaucasian -America makuru kudarika Asia-America-asi zvikonzero zvisingazivikanwi. Mamwe mazai ezvemagetsi mumasero epa plasma ave akaonekwa, asi chii chinokonzera kuchinja uku munzvimbo yekutanga hakusi kujekesa nguva dzose.
Zvitema zvakanyorwa muDNA, iyo yakaiswa mu 23 mapaundi emakromosomes. Mune mamwe masero evanhu, myeloma nhamba yechiromosome nhamba 13 inoshaikwa, inozivikanwa sekubviswa. Izvi zvinoratidzika zvichiita kuti myeloma iwedzere kurapwa.
Munenge inenge 50 kubva muzana yevanhu vane myeloma, clone inouraya ine chromosome ine izvo zvinonzi translocation-chikamu chechromosome chakashandura nechikamu cheimwe chromosome mumasero e myeloma. Apo kugadziriswa kwakadaro kunoshandura maitiro ekudzivirira kana kuvhara, inogona kukurudzira kuipa.
Vatsvakurudzi vanotendawowo kuti kusakosha mune mamwe masero mumapfupa emapfupa kunogona kuitawo basa mu myeloma. Semuenzaniso, mamwe masero emuviri anonzi dendritic masero anokwanisa kuita zviratidzo zvemakemikari zvinokonzera masero epa plasma ane hutano kukura. Nokudaro, kuiswa kwakanyanya kwemasero e-dendritic kunogona kuita kuti kuve kwemaeloma.
Kuziva
Kana zviratidzo zvichinyanyisa maeloma, maongororo emaropa uye / kana urini, kufungidzira kwemapfupa, uye mapfupa emapfupa anowanzoitwa.
Dambudziko reRopa
- Complete Blood Count (CBC): Izvi zvinosanganisira kuverenga masero eropa emhando dzakasiyana-siyana kuti uone kana nhamba yako inowira mukati mehutano hwakanaka kana husina kunaka. Apo masero e-myeloma akapararira mukati mefupa, mamwe echitema cheropa anenge ari pasi. Iko tsvuku tsvuku yesero yeropa inowanzowanikwa.
- Immunoglobulins (Ig) Quantification: Ig quantification inogadzirwa kuona kuti, kana iripo, yemarudzi mashanu akasiyana ezvirwere, anowedzera-IgA, IgD, IgE, IgG, uye IgM. Mune myeloma, imwe yeiyi inogona kunge yakareba uye imwe inogona kunge yakaderera pane yakasikwa. Mamwe maitiro anokwanisa.
- SPEP na UPEP: Izvi zvinoreva serum protein electrophoresis uye urine protein electrophoresis. Iyi miedzo inogona kuziva kana kune monoclonal protein buildup kana spike inobatanidzwa.
- Zviedza Zvitsva Zvitsva: Muedzo uyu unoyera nhamba yemaketani akachena muropa. Izvi zvinogona kuitwa, somuenzaniso, mune murwere neyamieloma uyo pasina mProtini inowanikwa neSPEP.
Bone Bone Marrow Test and Biopsies
Vanhu vane myeloma vane masero akawanda eplasma mumapfupa emapfupa avo. Nokudaro, marora emapfupa ane chido uye chido chinowanikwa kuti uongorore huwandu uye uwane samples. Inogona kuitwa kana kuhofisi yechiremba kana kuchipatara. Zvinyorwa zvitsva zvinozoongororwa nechirwere chechirwere uye zvinowedzera kuongororwa kwema laboratory.
Genetic Testing of Cancerous Cells
Maitiro eGenetic anowanzoitwa pamasero asina kukwana sechikamu chekuongororwa uye kuongororwa kwe myeloma. Cytogenic tsananguro inoreva zviedzo zvinongorora kuchinja kwekromosomes yemasero e myeloma.
Zvimwe zvinoshanduka uye mararamiro ekugadzirisa zvekare zvinobatsirawo vanachiremba kufanotaura kuti kuuraya kungaita sei. Zvimwe zvakasiyana-siyana zvakasiyana-siyana zvinoedzwa uye zvinoshandiswa kuongorora kenza yemunhu inoshandiswa kamwe chete kana masero akawanikwa.
Amyloid Biopsy
Kuwanda kwemaitiro asina kukodzera anorifomeni mapuroteni akaisa myeloma varwere vari panjodzi yekuvandudza amyloidosis. Amyloid ibasa rinogona kuvaka mumhando ipi zvayo uye bhiopsy inobatsira kuziva chirwere ichi. Kazhinji kazhinji, ichi chinosanganisira kushandura nenyuchi kubvisa zvimwe dumbu remafuta.
Scans uye Imaging
Myeloma masero anozivikanwa nokuda kwekugona kwavo kuita izvo zvinonzi lytic zvipembenene mumapfupa. Vanogona kutora mamwe masero anonzi osteoclasts kuti aparadze bone kana kuti aite nzvimbo dzakanaka munzvimbo dzakasiyana dzefupa.
Kakawanda ru-x-ray runosanganisira mapfupa mazhinji anoitwa. Apo rudzi urwu rwekufungidzira runoitwa, runozivikanwa sepfupa rekuongorora kana skeletal survey. Dzimwe mhando dzekufungidzira dzinogona kubatsira zvikuru mune zvimwe zviitiko, zvakadai sekuwana plasmacytomas isingagoni kuonekwa pa-ray-ray.
Nguva Yokuona Chiremba
Funga kugadzirira kusangana nachiremba wako kana uine zviratidzo zvinoramba zvichiramba zvichikushungurudza. Zviratidzo zve myeloma zvinogona kuva zvisinganzwisisiki uye zvisingaiti.
Kana iwe uine chirwere cheMGUS kana kuti uri oga plasmacytoma, zvakakosha kuti iwe nachiremba wako rambai makatarisa zvinhu sezvo idzi zvirwere zveplasma sezvirwere zvinogona kufambira mberi ku myeloma. Nguva dzose bvunza chiremba wako chero mibvunzo yaunogona kuva nayo maererano nemamiriro ako ezvinhu.
Shoko Rinobva
Kana iwe kana mudiwa wako munguva pfupi yapfuura uongororwa ne myeloma, zvinowanzoita kuti uchinetseke, wakatsamwa, uchinetseka, kana zvose zvataurwa pamusoro apa. Kenza kuongororwa kwehupenyu ndiko kuchinja hupenyu nenzira dzakasiyana siyana . Inogona kubatsira kunzwa nhau dzevamwe vanhu. Kudzivirira kupedza mazano, misangano, uye kunyange nhepfenyuro yevanhu ndeye nzira dzakanakisisa dzekubatana nevamwe vanogona kugoverana nematambudziko ako kana kuva nezvakaitika zvakafanana nemanzwisisiro.
> Sources:
> Hengeveld PJ, Kersten MJ. B-cell activating factor muzvirwere zvepathophysiology ye multiple myeloma: chinangwa cherapi? Blood Cancer Journal. 2015; 5 (2): e282-.
> Sonneveld P, Broijl A. Kurapa kwekudzokorora uye kuratidzira multiple myeloma. Haematologica. 2016; 101 (4): 396-406.
> Palumbo A, Anderson K. Multiple myeloma. N Engl J Med. 2011; 364 (11): 1046-1060.