Kuzindikira Matenda a Autoimmune
Matenda a autoimmune ndi gulu la matenda omwe chitetezo chamthupi—chomwe chimayenera kuteteza thupi ku matenda—m'malo mwake chimaukira minofu ya thupi. Izi zimapangitsa kutupa kosatha komwe kungakhudze pafupifupi chiwalo chilichonse: khungu, mafupa, magazi, tiziwalo ta m'mimba, mapapo, impso, komanso dongosolo lamanjenje. Zitsanzo zodziwika bwino za matenda a autoimmune ndi monga systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), autoimmune thyroid disease (Graves' and Hashimoto's), mtundu 1 wa shuga mellitus, multiple sclerosis, psoriasis, celiac disease, ndi matenda otupa m'matumbo monga Crohn's ndi ulcerative colitis. Popeza zizindikiro nthawi zambiri sizimadziwika bwino ndipo zimatha kutsanzira matenda kapena matenda ena, kuzindikira matenda a autoimmune kumafuna njira yosamala komanso yokhazikika, komanso kusankha mayeso oyenera othandizira.
Chifukwa chiyani matenda a autoimmune nthawi zambiri amakhala ovuta?
Vuto lalikulu ndi kusiyanasiyana kwa zizindikiro komanso kusinthasintha kwa matendawa (kutupa ndi kupumula). Wodwala m'modzi akhoza kukhala ndi kutopa kosalekeza komanso kupweteka pang'ono kwa mafupa, pomwe wina akhoza kukhala ndi ziphuphu pakhungu, malungo, kuchepa thupi, kapena kulephera kugwira ntchito bwino kwa ziwalo monga nephritis. Kuphatikiza apo, matenda ena a autoimmune ali ndi zizindikiro zofanana; mwachitsanzo, matenda a Sjögren amatha kukhala ndi SLE kapena scleroderma. Odwala ena alinso ndi ma autoantibodies abwino opanda zizindikiro zoonekeratu, kotero zomwe zapezeka m'ma laboratori ziyenera kufotokozedwa nthawi zonse malinga ndi momwe wodwalayo alili.
Gawo loyamba: anamnesis yolunjika
Kuzindikira matenda nthawi zambiri kumayamba ndi mbiri yakale. Dokotala ayenera kufufuza zomwe zimayambitsa vuto lalikulu, nthawi yomwe matendawa amatenga, momwe matendawa amabwereranso, zinthu zomwe zimayambitsa matendawa, komanso momwe zochita za tsiku ndi tsiku zimakhudzira thupi. Kutopa kwambiri komwe sikuchira mukapuma, kutentha thupi pang'ono, komanso kuchepa thupi kosazolowereka ndi zizindikiro zofunika kuziganizira.
Zizindikiro za ziwalo zina zimathandiza kuwongolera kukayikira. Kupweteka kwa mafupa m'manja mofanana komanso kuuma kwa m'mawa komwe kumatha mphindi zoposa 30-60 kungasonyeze RA. Ziphuphu pankhope zomwe zimakula kwambiri atakhala padzuwa, zilonda zam'kamwa zomwe zimabwerezabwereza, kutayika kwa tsitsi, ndi kupweteka kwa mafupa kungakhale kokayikitsa kwa SLE. Maso ndi pakamwa pouma nthawi zonse zitha kusonyeza matenda a Sjögren. Kutsegula m'mimba kosalekeza kapena kupweteka kwa m'mimba kosalekeza kungayambitse matenda otupa m'matumbo. Madandaulo a dzanzi, kufooka kwa miyendo, kapena kusokonezeka kwa maso nthawi zina kuyenera kuyambitsa funso la matenda a autoimmune amitsempha monga multiple sclerosis.
Mbiri ya banja nayonso ndi yofunika, chifukwa majini amatenga nawo mbali pa matenda ambiri a chitetezo chamthupi. Kuphatikiza apo, mbiri ya matenda enaake, kugwiritsa ntchito mankhwala osokoneza bongo, kusuta fodya, kupsinjika maganizo, kuvutika maganizo pambuyo pobereka, komanso mavuto a mahomoni zitha kugwirizanitsidwa ndi kuyamba kapena kuipiraipira kwa matenda a chitetezo chamthupi mwa odwala ena.
Kuwunika thupi: kuyang'ana zizindikiro za kutupa ndi kulowerera kwa ziwalo
Kuwunika thupi cholinga chake ndi kupeza umboni wa kutupa, kuwunika momwe ziwalo zimagwirira ntchito, ndikuchotsa matenda osiyanasiyana. Dokotala adzawunika zizindikiro zofunika kwambiri (malungo, kuthamanga kwa magazi), kuyang'ana ziphuphu (monga ziphuphu zomwe zimatuluka mu photosensitivity, purpura), zilonda pakamwa, ma lymph nodes okulirapo, ndi zizindikiro za kuchepa kwa magazi m'thupi monga khungu lofiirira.
Mu minofu ndi mafupa, kufufuza kuuma kwa mafupa, kutupa kwa mafupa, kuyenda kochepa, kupunduka, kapena ma nodule a rheumatoid kumathandiza kusiyanitsa kutupa kwa mafupa ndi kupweteka kwa makina. Mu chithokomiro, kukula, kunjenjemera, kapena bradycardia kungasonyeze matenda a chithokomiro chodziyimira pawokha. Kufufuza m'mapapo, mtima, ndi m'mimba ndikofunikira chifukwa matenda a autoimmune angayambitse pleural effusion, pericarditis, hepatosplenomegaly, kapena kupweteka kwa m'mimba kotupa. Kuwunika kwa mitsempha kumayesa mphamvu, kusinthasintha, kumva, ndi kugwirizana, makamaka ngati pali zizindikiro za mitsempha.
Mayeso oyambira a labotale: kuwunika kutupa ndi momwe kumakhudzira
Akangoganizira za vuto la autoimmune, mayeso oyamba a labotale nthawi zambiri amaphatikizapo kuyezetsa magazi, erythrocyte sedimentation rate (ESR) kapena C-reactive protein (CRP), mayeso a impso ndi chiwindi, kuyesa mkodzo, ndi kagayidwe kachakudya. Kuchepa kwa magazi m'thupi, leukopenia, kapena thrombocytopenia kungakhalepo mu SLE kapena matenda ena a autoimmune hematologic. Kukwera kwa ESR/CRP kungasonyeze kutupa, ngakhale kuti matenda ena a autoimmune angakhale ndi CRP yokwera pang'ono ngakhale kuti akugwira ntchito mwakhama.
Kusanthula mkodzo ndikofunikira kwambiri kuti mudziwe kuchuluka kwa proteinuria kapena hematuria komwe kungasonyeze kukhudzidwa kwa impso, monga lupus nephritis. Kuyesa kwa protein/creatinine mkodzo kapena kusonkhanitsa mkodzo kwa maola 24 kungakhale kofunikira kuti mudziwe kuchuluka kwa proteinuria.
Ma Autoantibodies ndi mayeso a chitetezo chamthupi: chinsinsi koma osati chokhacho
Kuyesa kwa ma antibodies a autoimmune ndi gawo lofunika kwambiri pakupeza matenda, koma zofooka zake ziyenera kumvedwa. Ma antibodies a antinuclear (ANA) nthawi zambiri amagwiritsidwa ntchito ngati mayeso owunikira ma SLE omwe akukayikiridwa, matenda a Sjögren, matenda osakanikirana a minofu, ndi scleroderma. ANA yabwino sikutanthauza matenda a autoimmune okha, chifukwa amapezeka mwa anthu ena athanzi, makamaka omwe ali ndi ma titer otsika. Mosiyana ndi zimenezi, ANA yoipa imapangitsa kuti matenda ena, monga SLE, asachitike, ngakhale kuti sizikutanthauza kuti n'zotheka.
Ma autoantibodies enaake amathandiza kutsimikizira matendawa, monga anti-dsDNA ndi anti-Sm mu SLE; anti-CCP ndi rheumatoid factor mu RA; anti-Ro/SSA ndi anti-La/SSB mu Sjögren's; anti-centromere kapena anti-Scl-70 mu scleroderma; ndi ANCA mu vasculitis ina. Kuyesa kowonjezera (C3, C4) ndikofunikanso, makamaka mu SLE, chifukwa kumatha kuchepa panthawi ya matenda.
Komabe, kutanthauzira kuyenera kuganizira zizindikiro, zomwe zapezeka pakuwunika thupi, ndi zina zomwe zapezeka. Ma antibodies a autoimmune angakhale "chizindikiro," koma kuzindikira sikuyenera kutengera zotsatira imodzi.
Mayeso ojambula zithunzi ndi njira zapadera
Kujambula zithunzi kumathandiza kuwona kuwonongeka kwa ziwalo ndikusiyanitsa kutupa ndi matenda ena. Ma X-ray, ma ultrasound a mafupa, kapena MRI amatha kuwona synovitis, kukokoloka kwa mafupa, ndi kukhudzidwa kwa minofu yofewa mu nyamakazi yotupa. Pakukhudzidwa kwa mapapo, CT scan pachifuwa imatha kuwona matenda a m'mapapo amkati, omwe angachitike mu scleroderma, RA, kapena myositis. Echocardiography ingakhale yofunikira ngati mukukayikira kuti pericarditis kapena pulmonary hypertension.
Nthawi zina amafunika biopsy kuti atsimikizire matenda kapena kuwona kuchuluka kwa kuwonongeka, monga biopsy ya impso mu lupus nephritis yomwe ikukayikiridwa, biopsy ya khungu mu vasculitis kapena cutaneous lupus, ndi biopsy ya m'matumbo mu matenda a celiac kapena matenda otupa m'matumbo. Njirazi ndizofunikira chifukwa zotsatira zake zimatha kudziwa njira zamankhwala ndi zomwe zingachitike.
Njira zowerengera ndi kuzindikira kosiyana
Pa matenda ena, pali njira zowerengera matenda padziko lonse lapansi (monga ACR/EULAR) zomwe zimathandiza kuti pakhale kukhazikika kwa matendawa, makamaka mu kafukufuku ndi machitidwe azachipatala. Ngakhale kuti si "chida chodziwira matenda" chimodzi chokha, njirazi zitha kutsogolera madokotala poyesa kuphatikiza zizindikiro, kufufuza thupi, ma antibodies a autoimmune, ndi zotsatira zothandizira.
Matenda osiyanasiyana ayenera kuganiziridwa nthawi zonse. Matenda osatha (chifuwa chachikulu, chiwindi, HIV), khansa ya m'magazi, zotsatira za mankhwala, matenda a endocrine, komanso fibromyalgia zimatha kutsanzira zizindikiro za autoimmune. Chifukwa chithandizo cha autoimmune nthawi zambiri chimagwiritsa ntchito mankhwala oletsa chitetezo chamthupi, kuchotsa matenda opatsirana ndi matenda ena omwe angaipe kwambiri ndi kutsekeka kwa chitetezo chamthupi ndikofunikira.
Dziwani momwe matenda amagwirira ntchito komanso momwe ziwalo zimagwirira ntchito
Kuwonjezera pa kudziwa mtundu wa matenda, madokotala nthawi zambiri amawunika kuchuluka kwa ntchito ndi ziwalo zomwe zikuphatikizidwa. Izi zimakhudza kufunikira ndi mphamvu ya chithandizo. Mwachitsanzo, nyamakazi yofatsa mu SLE imachiritsidwa mosiyana ndi lupus nephritis kapena kukhudzidwa kwa dongosolo la mitsempha. Kuwunika ntchito kungagwiritse ntchito ziwerengero zinazake (monga, za SLE kapena RA), pamodzi ndi magawo a labotale monga complement, anti-dsDNA, CRP, ndi zomwe zapezeka kuchipatala.
Udindo wa mgwirizano ndi kutsatira
Kuzindikira matenda a autoimmune nthawi zambiri kumafuna mgwirizano pakati pa akatswiri osiyanasiyana: mankhwala amkati—rheumatology, dermatology, neurology, nephrology, gastroenterology, ndi hematology. Sizachilendo kuti matendawa adziwike bwino pokhapokha atayang'aniridwa nthawi zonse, chifukwa odwala ena poyamba amawonetsa zizindikiro zochepa. Chifukwa chake, kutsatira bwino, kulemba zizindikiro, ndi kuwunikanso mayeso a labotale kungakhale gawo la njira yodziwira matenda.
Kutseka
Kuzindikira matenda a autoimmune ndi njira yosiyana siyana yomwe imaphatikiza mbiri yakale, kufufuza mwatsatanetsatane, kuwunika koyambira kwa labotale, kuyesa kwa autoantibody, ndi kujambula ndi biopsy ngati pakufunika kutero. Mavuto akuluakulu ali mu mawonekedwe osadziwika bwino a zizindikiro, kusintha kwa matenda, komanso kuyanjana pakati pa matenda. Makiyi opambana ndi kutanthauzira zotsatira za mayeso aliwonse mkati mwa matenda a wodwalayo, kuchotsa matenda osiyanasiyana omwe angakhale oopsa, ndikutsatira kwa nthawi yayitali. Ndi matenda olondola, chithandizo chingapangidwe kuti chichepetse kutupa, kupewa kuwonongeka kwa ziwalo, ndikukweza moyo wa wodwalayo.
