Kukurukurirana kwechipiri uye yechitatu-line-therapy
Kunyange zvazvo vazhinji vevana uye nhamba shomanana yevanhu vakuru vane immune thrombocytopenia (ITP) vanoenderera mberi kuti vave netsika yakawanda yeplatelet, vamwe vanozoenderera mberi kuti vave nekusingaperi. Pfungwa yekuve isina kuitika ITP inogona kutyisa, saka ngationgororei zvinorevei apa.
Chokutanga, ITP inogona kuiswa se:
- Primary: Primary Primary ITP inokonzerwa nega autoimmune platelet destruction. Muvana, huwandu hwemhosva ndeyekutanga ITP.
- Sekondari: Sekondari ITP inosanganiswa nemamwe mamiriro ezvinhu akadai se lupus , HIV , hepatitis C , kana chronic lymphocytic leukemia .
Kunyange zvazvo kurapwa kugadzirisa kubuda ropa kwekutanga uye yechipiri ITP kunogona kunge yakafanana, kurapwa kwechipiri cheItP kunotarisa kune chinangwa chekurapa. Kurapa kwakanakisisa kwechikonzero chekurapa chinogona kuvandudza thrombocytopenia.
Primary Primary ITP inogona kuwedzera kugoverwa ku:
- Zvichigere kuongororwa: Kuongororwa kwemwedzi mitatu.
- Kuramba: ITP inopfuurira kwemwedzi inopfuura mitatu.
- Chisingarapiki: Kana ichiramba ichipfuura mwedzi gumi nemaviri, inonzi yakashata.
- Kuratidzira: Iri izwi rinowanzoshandiswa kurondedzera ITP inoda kurapwa (murwere ane zviratidzo zvekubuda ropa) izvo zvinopesana nemutambo wekutanga-steroid (steroids, IVIG, WinRho) kana splenectomy .
Pasinei nekuti vazhinji vevanhu vakuru vanorwara nehukuru hweTP vacharamba vachivandudza mararamiro asingaverengeki, vazhinji vanozochengetedza tsvina, yakachengeteka platelet count (inowanzoreva masero 20 000 nema microliters), uko kubuda kwepachivande kusingabviri.
Vachiremba vanogona kunge vachida dzimwe nguva mapeji emishonga. Imwe muenzaniso ndeyekuvhiyiwa, apo platelet yakawanda inowanzoda kuva yakakwirira kudzivirira kubuda ropa panguva yekuita.
Yechipiri-Mushonga Mushonga
Dambudziko nderokuti avo varwere vanoramba vachibuda ropa pasinei nekurapa kwekutanga.
Mumakore apfuura, splenectomy yainzi inowanzoita remishonga yechipiri-line. Splenectomy inoshanda nenzira mbiri. Chokutanga, inobvisa nzvimbo yeplatelet kuparadzwa. Chechipiri, iyo inobvisa mamwe lymphocytes anogadzira anti-platelet antibodies anogara mu spleen. Kubviswa kweizvi lymphocytes kunogona kuwedzera hupenyu hweplatelets.
Splenectomy ine ruzivo rwunozivikanwa nevanopfuura 85 muzana yevarwere vanopindura, huwandu hwakawanda nehurongwa hweplatelet zvinyorwa. Pasinei nehuwandu hwekubudirira uku, splenectomy haisi mungozi dzaro, kunyanya kutyisa kwoupenyu hwose hwehutachiona hwehutachiona hwehutachiona.
Nemhaka yezvipingamupinyi izvi, vamwe vanachiremba vanofunga rituximab yechipiri-line therapy. Rituximab is antibody inosungiririra kuB lymphocytes (imwe yemasero machena anoita zvirwere), zvichiita kuti vaparadzwe. Zvine anti-platelet anti-platelet inoshandiswa kubva kuB bymphocyte, maplatelets haazoparadzwi . Rituximab inowanzopiwa seA IV inokonzerwa kamwechete kwevhiki kwevhiki ina, asi dzimwe nguva vhiki shoma dzinogona kupiwa. Mhinduro kune rituximab inowanzosiyana pane splenectomy, pamwe nevamwe varwere vane mhinduro dzisingagumi asi vamwe vachidzoka zvakare.
Dhiyabhorosi Kutapwa
Nenzira yakanaka, ikozvino kune mishonga yemitambo yechitatu inowanikwa yeItP.
Kwemakore mazhinji, zvakatendwa kuti muIITP, maplatelet aiitwa kazhinji mumapfupa emapfupa asi akaparadzwa paakasunungurwa kuti apararire. Nyanzvi dzinozivikanwa iye zvino kuti platelet work haina kukwana. Idzi ruzivo rwakaguma mukugadzirwa kwemishonga inonzi thrombopoietin (TPO) receptor agonists.
Parizvino pane maEXO receptor agonist anowanikwa muU.S., elthrombopag uye romiplostim. Elthrombopag inorapwa mishonga inotorwa zuva roga roga uye romiplostim inopiwa kamwe chete nevhiki semusana wechirwere. Kunyange zvazvo elthrombopag inogona kuonekwa seye kurapa nyore nokuti inotorwa nemuromo, hapana zvokudya zvine calcium zvinogona kudyiwa kwemaawa akawanda isati yasvika uye pashure payo.
Pane imwe nguva chirongwa chekugadzirisa chinotsanangurwa, vanhu vakuru vanogona kudzidza kudzidzisa romiplostim pamba.
TPO receptor agonists inonzi inogara isingagadziriswa mishonga inoshandiswa kuchengetedza platelet yakawanda zvakakwana kuti irege kudzivirira ropa. Iyi mishonga inogona kushandiswa mune zvose vana nevakuru vane chisingagumi ITP.
Sezvo nemishonga yakawanda yemishonga, urongwa hwekutanga, rwechipiri, nehutatu hutano hunosiyana hunoenderana nehutano hwemunhu mumwe. Kana uine mibvunzo kana zvinetseka pamusoro pekurapa kwako, unofanira kuzvikurukura nechiremba wako.
Sources:
Bussel JB. ITP muvana: Kutungamirirwa kweHIV DHW. Mu: UpToDate, Post TW (Ed), UpToDate, Waltham, MA.
George JN naArold DM. ITP muVakuru: Chipiri-Mutsara uye Inotevera Kurapa. Mu: UpToDate, Post TW (Ed), UpToDate, Waltham, MA.