Kuongororwa kwezvirwere zveAutoimmune
Zvirwere zve autoimmune iboka rezvirwere umo masoja emuviri—anonzi anodzivirira muviri kubva kuhutachiona—panzvimbo pezvo anorwisa nhengo dzemuviri. Izvi zvinoguma nekuzvimba kusingaperi kunogona kukanganisa chero nhengo: ganda, majoini, ropa, magland, mapapu, itsvo, uye kunyange sisitimu yetsinga. Mienzaniso inozivikanwa yezvirwere zve autoimmune inosanganisira systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), autoimmune thyroid disease (Graves' naHashimoto's), type 1 diabetes mellitus, multiple sclerosis, psoriasis, celiac disease, uye zvirwere zve inflammatory bowel zvakaita seCrohn's neulcerative colitis. Nekuti zviratidzo zvinowanzova zvisina kujeka uye zvinogona kutevedzera hutachiona kana zvimwe zvirwere, kuongororwa kwezvirwere zve autoimmune kunoda nzira yekungwarira, yakarongeka, uye kusarudzwa kweongororo dzakakodzera dzinotsigira.
Sei kuongororwa kwezvirwere zvemuviri zvichiwanzonetsa?
Dambudziko guru nderekusiyana kwezviratidzo uye kuchinja-chinja kwechirwere (kuputika nekubuda kweropa). Mumwe murwere anogona kuratidza kuneta kunogara kwenguva refu uye kurwadziwa kudiki kwemajoini, nepo mumwe anogona kuona mapundu eganda, fivha, kudzikira kwehuremu, kana kusashanda zvakanaka kwenhengo dzakadai senephritis. Uyezve, zvimwe zvirwere zve autoimmune zvine zviratidzo zvakafanana; semuenzaniso, chirwere cheSjögren chinogona kuratidza SLE kana scleroderma. Vamwe varwere vanewo ma autoantibodies akanaka asina zviratidzo zvakajeka, saka zvakawanikwa murabhoritari zvinofanira kugara zvichitsanangurwa zvichienderana nemamiriro ezvinhu ekiriniki.
Matanho ekutanga: anamnesis yakatungamirirwa
Kuongororwa kwechirwere kunowanzo tanga nenhoroondo yakakwana. Chiremba achafanira kuongorora kunyunyuta kukuru, nguva, maitiro ekudzoka kwechirwere, zvinhu zvinokonzera chirwere, uye kukanganisa mabasa ezuva nezuva. Kuneta kwakanyanya kusingavandudzike nekuzorora, fivha yakaderera inoramba ichidzoka, uye kudzikira kwehuremu kusingatsananguriki zviratidzo zvemuviri zvinofanirwa kucherechedzwa.
Zviratidzo zvenhengo dzakasiyana zvinobatsira kutungamira kufungira. Marwadzo akafanana mumajoini mumaoko uye kuomarara kwemangwanani kunotora maminetsi anopfuura 30-60 kunogona kuratidza RA. Mapundu pachiso anokura zvakanyanya mushure mekupiswa nezuva, maronda emuromo anodzokororwa, kurasikirwa nebvudzi, uye kurwadziwa kwemajoini zvinogona kunge zvichifungidzirwa kune SLE. Maziso nemuromo zvakaoma nguva dzose zvinogona kuratidza chirwere cheSjögren. Manyoka anobuda ropa nguva dzose kana kurwadziwa mudumbu nguva dzose zvinogona kuratidza chirwere chekuzvimba kwemudumbu. Kunyunyuta kwechiveve, kushaya simba mumakumbo, kana matambudziko ekuona nguva nenguva kunofanira kumutsa mubvunzo wechirwere chetsinga chemuviri senge multiple sclerosis.
Nhoroondo yemhuri inokoshawo, sezvo majini achikonzera zvirwere zvakawanda zvemuviri. Uyezve, nhoroondo yezvirwere zvakasiyana-siyana, kushandisa zvinodhaka, kusvuta, kushushikana, kuora mwoyo mushure mekusununguka, uye mamiriro ezvinhu emahormone zvinogona kusanganiswa nekutanga kana kuwedzera kwezvirwere zvemuviri mune vamwe varwere.
Kuongororwa kwemuviri: kutsvaga zviratidzo zvekuzvimba uye kupindira kwenhengo dzemuviri
Kuongororwa kwemuviri kunovavarira kuona humbowo hwekuzvimba, kuongorora kupindira kwenhengo dzemuviri, uye kubvisa zviratidzo zvakasiyana. Chiremba achaongorora zviratidzo zvinokosha (fivha, BP), kutsvaga mapundu (semuenzaniso, mapundu ane photosensitivity, purpura), maronda emuromo, lymph nodes dzakakura, uye zviratidzo zveanemia zvakaita sepallor.
Muhurongwa hwemapfupa nemapfupa, kuongorora kupfava, kuzvimba kwemajoini, mafambiro mashoma, kuremara, kana maronda erheumatoid kunobatsira kusiyanisa kuzvimba kwemajoini nekurwadziwa kwemuviri. Mugland rethyroid, kukura, kudedera, kana bradycardia zvinogona kuratidza chirwere chethyroid che autoimmune. Kuongororwa kwemapupa, mwoyo, uye dumbu kunodiwa nekuti zvirwere zve autoimmune zvinogona kukonzera pleural effusion, pericarditis, hepatosplenomegaly, kana kurwadziwa kwedumbu. Kuongororwa kwetsinga kunoongorora simba, mafungiro, kunzwa, uye kubatana, kunyanya kana paine zviratidzo zvetsinga.
Miedzo yekutanga yerabhoritari: ongorora kuzvimba uye mhedzisiro yako
Kana chirwere che autoimmune chikafungidzirwa, bvunzo dzekutanga dzemurabhoritari dzinowanzo sanganisira kuongororwa kweropa, erythrocyte sedimentation rate (ESR) kana C-reactive protein (CRP), bvunzo dzekushanda kweitsvo nechiropa, weti, uye metabolic profile. Anemia, leukopenia, kana thrombocytopenia zvinogona kunge zviripo muSLE kana mamwe matambudziko e autoimmune hematologic. ESR/CRP yakakwira inogona kuratidza kuzvimba, kunyangwe mamwe mamiriro e autoimmune angave neCRP yakakwira zvishoma pasinei nekushanda nesimba.
Kuongororwa kweweti kwakakosha pakuona proteinuria kana hematuria zvinogona kuratidza kubatanidzwa kweitsvo, zvakaita se lupus nephritis. Kuongororwa kweprotein/creatinine weti kana kuunganidzwa kweweti kwemaawa makumi maviri nemana kunogona kudiwa kuti kuonekwe huwandu hweproteinuria.
Kuongororwa kweAutoantibodies uye immune system: chinhu chakakosha asi kwete chega
Kuongororwa kweautoantibodies chinhu chakakosha pakuongorora chirwere, asi miganhu yacho inofanira kunzwisiswa. Antinuclear antibodies (ANA) dzinowanzo shandiswa seongororo yekuongorora chirwere chinofungidzirwa kuti chine SLE, chirwere cheSjögren, chirwere chemisanganiswa yekubatanidza tissue, uye scleroderma. ANA yakanaka hairevi chirwere che autoimmune, sezvo ichiwanikwa mune vamwe vanhu vane hutano hwakanaka, kunyanya vari padanho rakaderera. Kusiyana neizvi, ANA isina kunaka inoita kuti zvimwe zvirwere, zvakaita seSLE, zvisanyanya kuipa, kunyange zvazvo zvisingabvisi mukana wekuti zviitike.
MaAutoantibodies chaiwo anobatsira kusimbisa kuongororwa, akadai seAnti-dsDNA uye Anti-Sm muSLE; Anti-CCP uye Rheumatoid Factor muRA; Anti-Ro/SSA uye Anti-La/SSB muSjögren's; Anti-centromere kana Anti-Scl-70 muScleroderma; uye ANCA mune mamwe mavasculitis. Kuongororwa kwakawedzerwa (C3, C4) kunobatsirawo, kunyanya muSLE, sezvo inogona kudzikira panguva yechirwere chinoshanda.
Zvisinei, dudziro inofanira kugara ichitarisa zviratidzo, zvakawanikwa pakuongorora muviri, nezvimwe zvakawanikwa zvinotsigira. MaAutoantibodies anogona kunge ari "chiratidzo," asi kuongororwa hakufanirwe kuenderana nemhedzisiro imwe chete.
Miedzo yekufungidzira uye maitiro akakosha
Mifananidzo inobatsira kuongorora kukuvara kwenhengo uye kusiyanisa kuzvimba nezvimwe zvirwere. X-ray, joint ultrasound, kana MRI zvinogona kuongorora synovitis, mapfupa akaora, uye kubatanidzwa kwenyama yakapfava muarthritis inorwisa kuzvimba. Kana paine kubatanidzwa kwemapapu, chest CT scan inogona kuongorora chirwere chemukati memapapu, chinogona kuitika mu scleroderma, RA, kana myositis. Echocardiography inogona kudiwa kana paine fungidziro yekuti pericarditis kana pulmonary hypertension.
Dzimwe nyaya dzinoda biopsy kuti zvionekwe kana kuti zvionekwe kuti chirwere chacho chakanyanya sei, zvakaita se biopsy yeitsvo kana paine chirwere chinonzi lupus nephritis, biopsy yeganda kana vasculitis kana cutaneous lupus, uye biopsy yemudumbu kana chirwere checeliac kana chirwere chemudumbu chinozvimba. Maitiro aya akakosha nekuti mhedzisiro yacho inogona kusarudza nzira dzekurapa uye fungidziro.
Maitiro ekupatsanura uye kuongororwa kwakasiyana
Kune zvimwe zvirwere, zvinodiwa pasi rose zvekuisa muzvikamu (semuenzaniso, ACR/EULAR) zviripo kuti zvive nyore kuisa muzvikamu, kunyanya mukutsvaga uye mukurapa. Kunyange zvazvo zvisiri "chishandiso chimwe chete chekuongorora," zvinodiwa izvi zvinogona kutungamira vanachiremba mukuongorora musanganiswa wezviratidzo, kuongororwa kwemuviri, autoantibodies, uye zvinotsigira zvakawanikwa.
Kuongororwa kwakasiyana-siyana kunofanira kugara kuchifungwa nezvako. Utachiona husingaperi (chirwere cheTB, hepatitis, HIV), kenza yeropa, maitiro emishonga, zvirwere zve endocrine, uye kunyange fibromyalgia zvinogona kutevedzera zviratidzo zve autoimmune. Nekuti kurapwa kwe autoimmune kunowanzo shandisa mishonga inodzvinyirira immune, kubvisa hutachiona hunoshanda nezvimwe zvirwere zvinogona kuipa nekudzvinyirirwa kwe immune system kwakakosha.
Sarudza mashandiro echirwere uye kupindira kwenhengo dzemuviri
Pamusoro pekuona rudzi rwechirwere, vanachiremba vanowanzoongorora mwero webasa uye nhengo dzipi dziripo. Izvi zvinopesvedzera kukurumidza uye kusimba kwekurapa. Semuenzaniso, arthritis isina kusimba muSLE inorapwa zvakasiyana ne lupus nephritis kana kubatanidzwa kwesystem yetsinga. Kuongororwa kwemabasa kunogona kushandisa mamakisi chaiwo (semuenzaniso, eSLE kana RA), pamwe chete nezviratidzo zverabhoritari zvakaita se complement, anti-dsDNA, CRP, uye zvakawanikwa mukiriniki.
Basa rekushandira pamwe nekutevera
Kuongororwa kwezvirwere zvemuviri zvinowanzoda kushandira pamwe pakati pemakiriniki: mishonga yemukati—rheumatology, dermatology, neurology, nephrology, gastroenterology, uye hematology. Hazvishamisi kuti kuongororwa kunonyatsojeka mushure mekuongororwa nguva dzose, sezvo vamwe varwere pakutanga vachiratidza zviratidzo zvishoma. Saka, kuteverwa kwakarongeka, kunyora zviratidzo, uye kuongororwazve kwemiedzo yerabhoritari zvinogona kunge zviri chikamu chekuongorora.
Penutup
Kuongororwa kwechirwere che autoimmune muchipatara inzira inotora matanho akawanda inosanganisa nhoroondo yakatarisana, kuongororwa kwakadzama kwemuviri, kuongororwa kwekutanga murabhoritari, kuongororwa kwe autoantibodies, uye kufungidzira uye biopsy kana zvichidikanwa. Matambudziko makuru ari mukusarongeka kwezviratidzo, kuchinja kwemaitiro echirwere, uye kusangana pakati pezviratidzo. Kiyi dzekubudirira ndeyekududzira mhedzisiro yega yega yebvunzo mukati memamiriro ekurapa emurwere, kubvisa kuongororwa kwakasiyana kunogona kukuvadza, uye kuita kuteverwa kwenguva refu. Nekuongororwa kwakakodzera, kurapwa kunogona kugadzirwa kudzvinyirira kuzvimba, kudzivirira kukuvara kwenhengo, uye kuvandudza hupenyu hwemurwere.
