Isifo sikaRustitzky-Kahler okanye i-myeloma sisifo se-ecological of circulatory system. Isici esichaphazelekayo sisifo kukuba ngenxa yesifo esibi esigazini, inani lamaplasmocytes (iiseli ezivelisa i-immunoglobulins) landa, eliqala ukuvelisa inani elikhulu le-immunoglobulin (paraprotein).
I-myeloma yamaninzi - yintoni ngamazwi alula?
I-myeloma yamanye yenye yeifom ye-myeloma. Ixilongo le-Plasmocyte-elihlabayo esi sifo senzeke emnzini wethambo. Isitatisti, i-myeloma yamathambo omgudu, isikhala, i-pelvis, iimbambo, i-thorax, kwaye, ngokungaqhelekanga, amathambo amathumba omzimba, aqhelekileyo. Izakhiwo ezinobungozi (plasmacytomas) kunye ne-myeloma ezininzi zithatha amathambo amaninzi kwaye zifikelela ubukhulu be-10-12 cm ububanzi.
I-Plasmocyte yindawo efanelekileyo yomzimba womzimba. Zivelisa izixhobo ezikhuselekileyo ezikhusela kwisifo esithile (apho i-immunoglobulin kufuneka iveliswe "ngokukhuthaza" iistim zeememori ezikhethekileyo). Amaseli e-plasma aphethwe yi-tumor (iiselmomyeloma zeeseli) iimveliso ezingalawulwayo ezingalunganga (ezilinakele) iimpawu zokungakhuseli umzimba, kodwa zihlangene kwezinye izitho kwaye ziphazamise umsebenzi wazo. Ukongeza, i-plasmacytoma ibangela:
- kuncipha kwinani le-erythrocyte, iiplatelet kunye ne-leukocytes;
- ukwanda kwe-immunodeficiency kunye nokwanda kwengozi kwiintsholongwane ezahlukeneyo;
- i-hematopoiesis kunye ne-blood viscosity yanda;
- ukuphulwa kwamaminerali kunye neprothem metabolism;
- ukubonakala kokungena kwezinye iimbutho, ngokukodwa ngokuqhelekileyo ezintsheni;
- utshintsho lwezifo kwiithambo zethambo kwisithili se-tumor - ithambo lincinci kwaye litshabalalise, kwaye xa i-tumor ikhula kuyo, ingena kwiifomthi ezithambileyo.
Izizathu ze-myeloma
Ukugula kukaRustitskiy-Kahler kuye kwafundiswa oogqirha, kodwa akukho mvumelwano malunga nezizathu zokuvela kwayo kwizonyango zonyango. Kwafunyaniswa ukuba emzimbeni womntu ogulayo, iintsholongwane ze-lymphatic ze-T okanye ze-B zihlala zikhona, kwaye ekubeni iiseli ze-plasma zivela kwi-B-lymphocytes, nayiphi na ukuphulwa kwalo mgaqo kubangela ukungaphumeleli kunye nokuqala kokwenziwa kwe-pathoplasmocytes.
Ukongeza kwinguqu ye-viral, kukho ubungqina bokuba i-myeloma inokubangela ukunyanzeliswa kwemitha. Oogqirha bafunda abantu abachaphazelekayo e-Hiroshima naseNagasaki, kwindawo yokuqhuma kwiChernobyl. Kwafunyaniswa ukuba phakathi kwalabo bafumene umthamo ophezulu wemitha, ipesenteji yamatyala e-myeloma kunye nezinye izifo ezichaphazela igazi ne-lymphatic system ziphezulu.
Phakathi kwezinto ezinobangela ukwanda komngcipheko we-myeloma, oogqirha bathi:
- Ukutshaya - kungekudala amava okutshaya kwaye ngakumbi inani lokubhema i-cigarettes, iphakamileyo ingozi;
- i-immunodeficiency;
- ifuthe kumzimba wezinto ezinobuthi;
- imfuza.
Iimpawu zeMyeloma
U-Myeloma ngokuyinhloko uvela ekuguga, echaphazela abafazi kunye namadoda. Isifo uRustitskogo-Kahler - iimpawu kunye nomfanekiso wekliniki, eziphawuliweyo kwizigulane:
- ukunqotshwa kweemvelo kunye neethambo;
- ukuphulwa kweenkqubo zeempawu;
- utshintsho lwezifo kwi-urinary system.
Izimpawu ezininzi ze-myeloma:
- iimpawu zokuqala ze-myeloma zintlungu emathanjeni (emlanjeni, emathunjini, emathambo enkkull), i-fracture spontaneous, i-deformation yamathambo kunye nobukho be-tumor formations;
- i-pneumonia rhoqo kunye nezinye izifo, echukunyiswa kukuwa kwe-immunity kunye nokuthintela ukunyakaza okuphefumulayo okubangelwa utshintsho emathanjeni esifubeni;
- utshintsho oluthile kwiintliziyo zentliziyo, ukungaphumeleli kwentliziyo;
- ukwanda kwentengane nesibindi;
- i-myeloma nephropathy - ingxaki ezintsheni kunye nokwanda kwezinto ezibonakalayo kwiiprotheni zomlambo, eziguqulela ekungenakutshatyalaliswa komzimba;
- i-normochromic anemia - ukuncipha kwinani le-erythrocytes kunye ne-hemoglobin level;
- i-hypercalcemia - inani elongezelelweyo le-calcium kwiplasma kunye nomchamo, le meko iyingozi kakhulu, iimpawu zayo - ukuhlanza, isisonguluko, ukulala, ukuphazamiseka kwezixhobo zokuphazamiseka, ukuphazamiseka kwengqondo;
- kuncipha kwinqanaba le-immunoglobulin;
- ukuphazamiseka kwe-hemopoiesis - ukuphuma kweembrane, ukutyumza, ukuphazamiseka kwemithambo ye-phalanges, i-diathesis eyingozi;
- i-paresthesia ("ephazamisayo"), intloko, ukulala, ukuguquka, ukuxubha, ukuxakeka, ukungazizithulu, i-dyspnea;
- kwiinqanaba zokugqibela - ukulahleka kwesisindo, umkhuhlane, i-anemia enkulu.
Iifom ze-myeloma
Ngokwezigaba ze-klinikhi-anatomiki, i-myeloma yile fom elandelayo:
- i-myeloma yedwa - kunye ne-tumor enye kwithambo okanye i-lymph node;
- ezininzi (jikelele) i-myeloma - kunye nokwakhiwa kwezilonda ezininzi zesisu.
Ukongezelela, i-myeloma eninzi ingaba:
- ekwahlukileyo - kule meko ngokusesikweni i-formations ayinayo imida, kodwa iphela isakhiwo sonke somongo wethambo;
- i-plasmacytoma yethambo ikhula kwiindawo ezincinci, kwaye ngaphezu koko, izicubu zinokuvela kwi-lymph nodes, ipleen.
- idibanisa i-focal - ukudibanisa iimpawu zokutshatyalaliswa kunye nokuphindaphindiweyo.
Izifo ze-Myeloma - izigaba
Oogqirha bahlula izigaba ezintathu ze-myeloma, isigaba sesibini sitshintshi, xa ama-indices ephakamileyo kunokuba ngowokuqala, kodwa ngaphantsi kweyesithathu (yeyona nto ibaluleke kakhulu):
- Isigaba sokuqala sibonakala nge-hemoglobin yehlelwa kwi-100 g / l, izinga le-calcium eliqhelekileyo, ukuxinwa kwe-paraproteins ephantsi kunye ne-Bens-Jones iprotheni, ukugxila kwe-0.6 kg / m², akukho-osteoporosis, i-bone deformation.
- Isigaba sesithathu sibonakaliswe ngokunyuka ukuya kuma-85 g / l kunye ne-hemoglobin ephantsi, i-calcium concentration egazini elingaphezu kwe-12 mg nganye nge-100 ml, iifomors ezininzi, ukuxinwa okuphezulu kwama-paraproteins kunye neprothetheni ye-Bens-Jones, ubuninzi be-kg kg / m² okanye ngaphezulu, iimpawu ze-osteoporosis.
Iingxaki ze-myeloma
Kwi-myeloma ezininzi, iingxaki ezinxulumene nomsebenzi owonakalisayo we-tumor ziphawu:
- intlungu ebuhlungu kunye nokuphuka kwamathambo (i-fractures);
- ukungaphumeleli komntu kunye nesidingo se- hemodialysis ;
- izifo ezithintekayo;
- i-anemia kwinqanaba elincinci, efuna ukudluliselwa.
I-Myeloma
Xa ukuxilongwa kwe-myeloma, ukuxilongwa ngokungafaniyo kunzima, ingakumbi kwiimeko apho kungekho sikhomba esicacileyo. Isigulane sihlolwe yi-hematologist esityholisa ukuxilongwa kwe-myeloma, oqala ukuqhuba uphando kwaye ufumanisa ukuba kukho impawu ezinjengeentlungu zethambo, ukuphuma kwamagciwane, izifo ezithintekayo rhoqo. Ukongezelela, kwenziwe uphando olongezelelweyo ukucacisa ukuxilongwa, ubunzima kunye nobukhulu:
- Ukuhlalutya ngokubanzi kwegazi kunye nomchamo;
- isifuba kunye ne-x-ray;
- tomography;
- vavanyo lwegazi ;
- coagulogram ;
- ukufundisisa inani lemapaprotin egazini kunye nomchamo;
- umongo wethambo;
- ukufundisisa ngendlela yeMancini kwintetho ye-immunoglobulins.
I-Myeloma - ukuhlolwa kwegazi
Ukuba ukuxilongwa kwe-myeloma kukhankanywa, ugqirha umisela ukuhlolwa kwegazi jikelele kunye ne-biochemical. Ezi zilandelayo zibonakaliso zezifo:
- i-hemoglobin - ngaphantsi kwe-100 g / l;
- I-erythrocyte - ngaphantsi kwe-3.7 t / l (abafazi), ngaphantsi kwe-4.0 t / l (owesilisa);
- iplatelet - ngaphantsi kwe-180 g / l;
- i-leukocytes - ngaphantsi kwe-4,0 g / l;
- ESR - ngaphezu kwama-60 mm ngeyure;
- protein-90 g / l nangaphezulu;
- i-albin-35 g / l kunye nezantsi;
- urea - 6.4 mmol / L kwaye ngaphezulu;
- i-calcium - 2.65 mmol / l kunye naphezulu.
I-Myeloma - X-ray
Ibakala elibaluleke kakhulu lokufunda kunye ne-myeloma yi-X-ray. Ukuxilongwa koxilongo lwe-myeloma ezininzi usebenzisa i-rayography ingakwazi ukuqinisekisa okanye ukushiya ngokungathandabuzekiyo. Ukuqhuma kwi-x-ray kubonakala ngokucacileyo, kwaye ngaphezu koko - ugqirha uyakwazi ukuvavanya ubuninzi bomonakalo kunye nokuchithwa kweethambo zamathambo. Izilonda ezingafaniyo kwi-X-ray zibonisa nzima, ngoko ugqirha unokufuna iindlela ezongeziweyo.
Ugula lwe-Myeloma - unyango
Njengamanje, kunyango lwe-myeloma, indlela edibeneyo isetyenzisiweyo, kunye nokusetyenziswa okuphambili kweziyobisi kwiintlobo ezahlukeneyo. Unyango oluphandwayo luyadingeka ukulungisa i-vertebrae ngenxa yokutshatyalaliswa kwabo. Unyango lwama-myeloma - unyango lwamanzi luquka:
- Ulwaphulo olujoliswe kuko , olukhuthaza ukuhlanganiswa kwamaprotheni, olukhokelela ekulwa neparaproteins;
- i-chemotherapy, ukuvimbela ukukhula kweeseli zomhlaza kunye nokubulala;
- Ulwaphulo lwe-immune lujolise ekuvuseleleni umzimba wakhe;
- i-corticosteroid yonyango, ephakamisa unyango olusisiseko;
- unyango kunye ne- bisphosphonates ezomeleza izicubu zethambo;
- unyango lwe-anesthetic olujoliswe ekunciphiseni i-syndrome yesifo.
I-Myeloma - iingcebiso zeklinikhi
Ngelishwa, akunakwenzeka ukuba aphinde abuyele kwi-myeloma, unyango lujoliswe ekunciphiseni ubomi. Ukwenza oku, kufuneka ulandele imithetho ethile. Ukuxilongwa kwe-myeloma - iingcebiso zoogqirha:
- Qaphela ngokunyameko unyango oluchazwe ngugqirha.
- Qinisekisa ukukhuseleka kungekhona kuphela ngamayeza, kodwa kunye nokuhamba, iindlela zokuhambisa amanzi (sunbathing) (usebenzisa i-sunscreen kunye nexesha eliphantsi lokusebenza kwelanga - ekuseni nakusihlwa).
- Ukukhusela kwintsholongwane - gcina imithetho yokucoceka, khusela iindawo ezininzi, uhlambe izandla ngaphambi kokuthatha amayeza, ngaphambi kokutya.
- Musa ukuhamba ngeengubo, ngenxa yokutshatyalaliswa kweentlungu zomzimba kulula ukulimaza kwaye ungayiqapheli.
- Ukubeka esweni iswekile ekudleni, njengoko ezinye iziyobisi zifaka isandla ekuphuhlisweni kwesifo sikashukela.
- Gcina isimo sengqondo esifanelekileyo, kuba iimvakalelo ezintle zibaluleke kakhulu kwixesha le sifo.
I-Chemotherapy kwi-myeloma yamaninzi
I-Chemotherapy ye-myeloma inokwenziwa ngeyodwa okanye ngaphezulu kweziyobisi. Le ndlela yonyango ivumela ukufezekiswa ngokupheleleyo kwiimeko ezimalunga nama-40% amacala, inxenye - kwi-50%, nangona kunjalo, ukubuyela kwakhona kwesi sifo kubakho rhoqo, njengoko isifo sichaphazela amaninzi amaninzi kunye nezicubu. I-Plasmacytoma unyango kunye ne-chemotherapy:
- Kwinqanaba lokuqala lonyango, i-chemotherapy egqitywe ngugqirha ngendlela yamacwecwe okanye iilenki ithathwa ngokwecwangciso.
- Kwinqanaba lesibini, ukuba i-chemotherapy iyasebenza, i-bone marrow cell stem ishintshiwe - thatha ikhefu , yikhuphe iiseli ze-stem kwaye uyihlanganise nabo.
- Phakathi kwezifundo ze-chemotherapy, iikhosi zonyango kunye nezidakamizwa ze-interferon-alpha zenziwa - ukukhulisa ukuxolelwa.
I-myeloma yamanqaku amaninzi
Ngelishwa, ngokuxilongwa kwe-myeloma, ukugxekwa kukudakisayo - oogqirha banako ukunyusa ixesha lokuxolelwa. Ngokuqhelekileyo izigulane ze-myeloma ziyafa ngenxa yempumoniya, ukuphuma kwegazi okubangelwa ukuphulwa kwegazi, ukuhlukana, ukuhluleka kwezintso, i-thromboembolism. Isilungiso esilungileyo sincinci kunye nesigaba sokuqala sesi sifo, ukugqithiswa kakubi kunabantu abangaphantsi kwama-65 abanezifo ezihambelana neentso kunye nezinye izitho, izicubu ezininzi.
I-myeloma yamaninzi - ixesha lokuphila:
- 1-2 iminyaka - ngaphandle kokonyango;
- ukuya kwiminyaka emi-5 - umyinge wokuphila wam we-myeloma kubantu abaphantsi kweyeza;
- ukuya kwiminyaka eyi-10 - ukulindela ubomi kunye nokuphendula kakuhle kwi-chemotherapy kunye nezifo kwisigaba esilula;
- ngaphezu kweminyaka eyi-10 kuphela kuphela abahlala kwizigulane ezineengxaki ezixhamlayo, ezikhutshwe ngempumelelo ngogqirha.