Matenda a Rustitzky-Kahler kapena myeloma ndi matenda opatsirana a mthupi. Chizindikiro cha matendawa ndi chakuti chifukwa cha chotupa choopsa m'magazi, chiwerengero cha plasmocytes (maselo omwe amabweretsa ma immunoglobulins) chikuwonjezeka, zomwe zimayambitsa kuchuluka kwa matenda a immunoglobulin (paraprotein).
Myeloma yambiri - ndi chiyani m'mawu osavuta?
Myeloma yambiri ndi imodzi mwa mitundu ya myeloma. Matenda a plasmocyte opweteka matendawa amapezeka m'mafupa. Momwemonso, myeloma ya mafupa a msana, fuga, pelvis, nthiti, thorax, ndipo, kawirikawiri, mafupa ophwanya thupi, ndi ofala kwambiri. Maonekedwe oopsa (plasmacytomas) ndi myeloma angapo amatenga mafupa angapo ndikufika kukula kwa masentimita 10-12 masentimita.
Plasmocytes ndi mbali imodzi ya chitetezo cha thupi. Amapanga ma antibodies omwe amateteza ku matenda ena (omwe immunoglobulin ayenera kupangidwa ndi "kuchititsa" maselo apadera a kukumbukira). Maselo a plasma omwe ali ndi chotupa (maselo a plasmomyeloma) mavitamini osayendetsa osadziwika (omwe amawonongeka) omwe sangathe kuteteza thupi, koma amaunjikana ndi ziwalo zina ndi kusokoneza ntchito yawo. Komanso, plasmacytoma imayambitsa:
- kuchepetsa chiwerengero cha erythrocytes, platelets ndi leukocytes;
- kuwonjezereka kwa thupi ndi kutentha kwa matenda osiyanasiyana;
- hematopoiesis ndi magazi a viscosity akuwonjezeka;
- kuphwanya mchere ndi mapuloteni;
- maonekedwe ena amalowa m'ziwalo zina, makamaka pa impso;
- Mafupa amatha kuphulika m'magazi a mfupa - fupa limapukuta ndi kuonongeka, ndipo pamene chotupacho chikumera, chimalowa m'ziwalo zofewa.
Zifukwa za myeloma
Matenda a Rustitskiy-Kahler adayesedwa ndi madokotala, koma palibe mgwirizano pa zifukwa zomwe zimachitikira m'magulu a zamankhwala. Zinaoneka kuti m'thupi la munthu wodwala, mavairasi a lymphatic a mtundu wa T kapena B amakhalapo, ndipo popeza maselo a plasma amapangidwa kuchokera ku B-lymphocytes, kuphwanya kulikonse kumeneku kumabweretsa kulephera ndi kuyambira kwa mapangidwe a tizilombo toyambitsa matenda.
Kuphatikiza pa mavitamini, pali umboni wakuti myeloma ikhozanso kuyambitsidwa ndi kutuluka kwa dzuwa. Madokotala anaphunzira anthu amene anakhudzidwa ndi Hiroshima ndi Nagasaki, pamalo ophulika omwe anafika ku Chernobyl. Zinapezeka kuti pakati pa omwe adalandira mazira akuluakulu, chiwerengero cha matenda a myeloma ndi matenda ena okhudzana ndi magazi ndi ma lymphatic ndi apamwamba.
Zina mwa zovuta zomwe zimawonjezera chiopsezo chotenga myeloma, madokotala amachitcha kuti:
- Kusuta - ndikovuta kwa wosuta fodya komanso kuchuluka kwa fodya kusuta, kumakhala koopsa;
- chithunzi;
- zimakhudza thupi la poizoni;
- chibadwa.
Myeloma - zizindikiro
Myeloma makamaka amapezeka mu ukalamba, zomwe zimakhudza amai ndi abambo onse. Matendawa Rustitskogo-Kahler - zizindikiro ndi chithunzithunzi cha mankhwala, owonedwa ndi odwala:
- kugonjetsa mankhwala ndi mafupa;
- kuphwanya njira zamagetsi;
- Kusintha kwa matenda m'thupi.
Zizindikiro zambiri za myeloma:
- zizindikiro zoyambirira za myeloma zimamva kupweteka m'mapfupa (mumsana, m'fuwa, mafupa a magazi), kupweteka kwapadera, kusokonezeka kwa mafupa komanso kukhalapo kwa mapulusa;
- matenda a chibayo komanso matenda ena, omwe amachititsa kuti thupi likhale lopeweratu komanso likhale loletsedwa chifukwa cha kusintha kwa mafupa a chifuwa;
- kusinthasintha kwamasinthasintha mu minofu ya mtima, mtima kulephera;
- nthenda yochuluka ndi chiwindi;
- myeloma nephropathy - matenda mu impso ndi kuwonjezeka kwa mapuloteni mu mkodzo, womwe umatanthawuza kukhala wosakwanira;
- normochromic anemia - kuchepa kwa chiwerengero cha erythrocytes ndi hemoglobin level;
- Mankhwala a hypercalcemia - kuchuluka kwa kashiamu mu plasma ndi mkodzo, matendawa ndi owopsa kwambiri, zizindikiro zake - kusanza, kunyowa, kugona, kusokoneza zipangizo zamagetsi;
- Kutsika kwa mlingo wa immunoglobulin;
- Matenda a hemopoiesis - kutuluka magazi kwa mitsempha, kupweteka, mitsempha ya mitsempha phalanges, hemorrhagic diathesis;
- paresthesia ("zokwawa"), kupweteka mutu, kugona, kutembenuka, kupweteka, chizungulire, wogontha, dyspnea;
- pamagulu omaliza - kutaya thupi, malungo, kuchepa kwa magazi m'thupi.
Mafomu a myeloma
Malingana ndi kafukufuku wa chipatala, myeloma ndi ya mitundu iyi:
- myeloma yandekha - ndi chotupa chimodzi mu fupa kapena minofu;
- multiple (generalized) myeloma - ndi kupanga mapangidwe angapo a zotupa.
Komanso, multipleeloma angakhale:
- kufalikira - pakadali pano mchitidwewo ulibe malire, koma mthupi lonse la mafupa;
- Zambiri - plasmacytoma ya fupa imakula m'madera ochepa, komanso kuwonjezera apo, zotupa zimatha kupezeka m'matumbo, ntchentche.
- kufotokozera kwambiri - kuphatikiza zizindikiro za kusiyana ndi zochepa.
Matenda a Myeloma - magawo
Madokotala amagawanitsa magawo atatu a myeloma angapo, gawo lachiwiri ndilokusintha, pamene zizindikirozo ndi zazikulu kuposa zoyamba, koma zochepa kuposa zachitatu (zovuta kwambiri):
- Gawo loyamba limakhala ndi hemoglobini yomwe inachepetsedwa kufika 100 g / l, mlingo wa kalisium wamba, mapuloteni ambiri a Bens-Jones, chimodzimodzi chotupa cha 0,6 makilogalamu / mamita, osataya mitsempha.
- Gawo lachitatu ndiloperewera kwa 85 g / l ndi hemoglobin yapamtunda, magazi a m'magazi opitirira 12 mg pa 100 ml, mapulogalamu ambiri, mapuloteni ambiri a Bens-Jones, chiwerengero cha chotupa cha 1.2 makilogalamu / mamita kapena kuposa, zizindikiro za matenda a mitsempha.
Mavuto a myeloma
Kwa myeloma yambiri, zovuta zokhudzana ndi ntchito yowononga ya chotupa ndizo:
- kupweteka kwambiri ndi kupasuka kwa mafupa (fractures);
- kulephera kwa renal ndi kufunikira kwa hemodialysis ;
- matenda opatsirana opitirira;
- kuperewera kwa magazi m'thupi lalikulu, kumafuna kuikidwa magazi.
Myeloma - matenda
Ndili ndi matenda a myeloma, kusiyana kwa matendawa ndi kovuta, makamaka nthawi yomwe palibe chotupa chodziwika bwino. Wodwala akuyang'anitsidwa ndi katswiri wa zamagazi amene akukayikira kuti a myeloma amadziwa kuti ndi ndani, yemwe amayamba kafukufuku ndikupeza ngati pali zizindikiro monga kupweteka kwa mafupa, kutuluka magazi, matenda opatsirana kawirikawiri. Kuonjezerapo, maphunziro owonjezereka amapangidwa kuti afotokoze za matenda, mawonekedwe ake ndi kukula kwake:
- kusanthula kwakukulu kwa magazi ndi mkodzo;
- chifuwa ndi chigoba x-ray;
- chiwerengero;
- kuyesa magazi ;
- coagulogram ;
- kuphunzira za kuchuluka kwa paraproteins m'magazi ndi mkodzo;
- fupa la fupa;
- Phunzirani njira ya Mancini pa tanthauzo la immunoglobulins.
Myeloma - kuyesa magazi
Ngati akuganiza kuti myeloma ikudziwika, adokotala akuyesa kuyesa magazi ndi kachirombo ka magazi. Zizindikiro zotsatirazi ndizofanana ndi matendawa:
- hemoglobin - zosakwana 100 g / l;
- erythrocyte - osachepera 3.7 t / l (akazi), osachepera 4.0 t / l (amuna);
- mapulogalamu - osakwana 180 g / l;
- leukocyte - zosakwana 4,0 g / l;
- ESR - zoposa 60 mm pa ora;
- mapuloteni - 90 g / l ndi pamwamba;
- albumin - 35 g / l ndi pansipa;
- urea - 6.4 mmol / L ndi apamwamba;
- calcium - 2.65 mmol / l ndi apamwamba.
Myeloma - X-ray
Gawo lofunika kwambiri la phunziro ndi myeloma ndi X-ray. Kutulukira kwa matenda osiyanasiyana a myeloma pogwiritsa ntchito radiography kungatsimikizire kapena kusiya kukayikira. Ziphuphu mu x-ray zikuwonekeratu, ndipo kuwonjezera - dokotala amatha kuwona kuchuluka kwa kuwonongeka ndi kusokonezeka kwa minofu ya mafupa. Zilonda zosautsa pa X-ray zimapangitsa zovuta kwambiri, choncho adokotala angafunike njira zina.
Matenda a Myeloma - mankhwala
Pakalipano, pofuna chithandizo cha myeloma, njira yogwirizanitsa imagwiritsidwa ntchito, ndi kugwiritsa ntchito mankhwala osokoneza bongo mosiyanasiyana. Mankhwala opanga opaleshoni amafunika kuwongolera vertebrae chifukwa cha kuwonongedwa. Mankhwala ambiri a myeloma akuphatikizapo:
- Kuchiza mankhwala , kulimbikitsa kaphatikizidwe ka mapuloteni, kutsogolera nkhondo ndi paraproteins;
- chemotherapy, kulepheretsa kukula kwa maselo a khansa ndi kuwapha;
- Mankhwalawa amathandiza kuti thupi lanu liziyenda bwino;
- mankhwala a corticosteroid, omwe amachititsa chithandizo chamankhwala;
- mankhwala ndi bisphosphonates zomwe zimalimbitsa minofu ya mafupa;
- mankhwala othandizira kuchepetsa matenda opweteka.
Myeloma - malingaliro othandizira
Mwatsoka, sikutheka kuti ndithetsere kachilombo ka myeloma, chithandizochi chikufuna kupititsa patsogolo moyo. Kuti muchite izi, muyenera kutsatira malamulo ena. Kuzindikira kwa a myeloma - madokotala a madandaulo:
- Samalani mosamala chithandizo chimene adokotala adanena.
- Pitirizani kuteteza thupi lanu osati mankhwala okha, komanso kuyenda, njira zamadzi, dzuwa (kugwiritsa ntchito mawindo a dzuwa ndi nthawi yochepetsera dzuwa - m'mawa ndi madzulo).
- Kuteteza ku matenda - onetsetsani malamulo a ukhondo, kupewa malo odzaza, asambe m'manja musanayambe kumwa mankhwala, musadye.
- Musayende wopanda nsapato, chifukwa cha kugonjetsedwa kwa mitsempha ya palimodzi ndi zophweka kuvulazidwa koma osazindikira.
- Onetsetsani mlingo wa shuga mu zakudya, monga mankhwala ena amathandizira kuti chitukuko chikule.
- Khalani ndi malingaliro abwino, chifukwa malingaliro abwino ndi ofunikira kwambiri pa matendawa.
Chemotherapy kwa multipleeloma angapo
Chemotherapy ya myeloma ikhoza kuchitidwa ndi mankhwala amodzi kapena angapo. Njira yamachiritso imapereka kukwaniritsa kwathunthu pafupifupi 40 peresenti ya milandu, pang'onopang'ono - mu 50%, komabe, kubwereza kwa matendaku kumachitika nthawi zambiri, chifukwa matendawa amakhudza ziwalo zambiri ndi ziphuphu zambiri. Plasmacytoma - mankhwala ndi chemotherapy:
- Pa gawo loyamba la chithandizo, chemotherapy yomwe adapatsidwa ndi adokotala mwa mapiritsi kapena jekeseni amachotsedwa malinga ndi dongosolo.
- Pachigawo chachiwiri, ngati mankhwala a chemotherapy ndi othandiza, maselo osungunuka a mafupa amatengedwa - atenge nthawi, achotseni maselo osungunula ndi kuwagwirizanitsa.
- Pakati pa maphunziro a chemotherapy, njira zamachiritsira ndi mankhwala a interferon-alpha akuchitidwa - kuonjezera kukhululukidwa.
Ambiri a myeloma - kufotokozera
Mwamwayi, ndi matenda a myeloma, zizindikiro ndizokhumudwitsa - madokotala amangokhalira kupitiliza nthawi ya kukhululukidwa. Kawirikawiri odwala a myeloma amafa chifukwa cha chibayo, kutaya magazi kumayambitsa kuphulika kwa magazi, kupasuka, impso, kupweteka. Chinthu chabwino chofotokozera ndichinyamata komanso gawo loyamba la matendawa, anthu okalamba ndi oposa 65 omwe ali ndi matenda a impso ndi impso zina.
Myeloma yambiri - kuyembekezera moyo:
- 1-2 zaka - popanda chithandizo;
- mpaka zaka zisanu - adiresi ya moyo wanga wa maeloma kwa anthu omwe akudwala;
- mpaka zaka 10 - nthawi yokhala ndi moyo ndi mankhwala abwino ku chemotherapy ndi matenda mosavuta;
- Zaka zoposa 10 zitha kukhala ndi odwala okha omwe ali ndi chotupa chimodzi, atachotsedwa bwino ndi madokotala.