Isifo sikaRustitzky-Kahler noma i-myeloma yisifo esihlasela isistimu yokujikeleza. Isici sokwempilo ukuthi ngenxa yesisu esibi egazini, inani lamaplasmocytes (amangqamuzana akhiqiza i-immunoglobulins) landa, okuqala ukukhiqiza i-immunoglobulin ye-pathological (paraprotein) enkulu.
I-myeloma eminingi - yini emagama alula?
I-myeloma eminingi ingenye yefomu le-myeloma. I-plasmocyte-ehlabayo isifo sofuba lesi sifo sitholakala emnothweni wethambo. Ngokwe-statistically, i-myeloma yamathambo omgogodla, i-skull, i-pelvis, izimbambo, i-thorax, futhi, ngokungajwayelekile, amathambo omzimba womzimba, ajwayelekile. Izakhiwo ezimbi (i-plasmacytomas) ene-myeloma eminingi ithatha amathambo amaningana futhi ifinyelele ubukhulu buka-10-12 cm ububanzi.
Ama-plasmocyte ayingxenye yesistimu yomzimba yomzimba. Bakha ama-antibodies ethize avikela isifo esithile (okuyinto i-immunoglobulin okufanele ikhiqizwe "ngokugqugquzela" amangqamuzana okukhumbula inkumbulo). Amangqamuzana e-plasma aphethwe yisisu (i-plasmomyeloma cells) umkhiqizo ongalawuleki umkhiqizo ongakalungi (okulimazayo) ongakwazi ukuwuvikela umzimba, kodwa uqoqe kwezinye izitho futhi uphazamise umsebenzi wabo. Ngaphezu kwalokho, i-plasmacytoma ibangela:
- ukwehla kwenani lama-erythrocytes, amaplatelet nama-leukocyte;
- ukwanda kwe-immunodeficiency nokukhushulwa okwenyuka kwezifo ezehlukene;
- i-hematopoiesis negazi le-viscosity landa;
- ukwephula amaminerali kanye namaprotheni umzimba;
- ukubonakala kokungena kwezinye izitho, ikakhulukazi ezintsheni;
- Izinguquko zesifo samathambo esifundeni se-tumor - ithambo lincipha futhi libhujiswa, futhi lapho i-tumor ihluma kuyo, ifinyelela kuzicubu ezithambile.
Izimbangela ze-myeloma
Ukugula kukaRustitskiy-Kahler kuye kwafundiswa odokotela, kodwa akukho ukuvumelanisa ngezizathu zokuthi kwenzeke emibuthanweni yezokwelapha. Kutholakale ukuthi emzimbeni womuntu ogulayo, amagciwane e-lymphatic of T noma B uhlobo ngokuvamile akhona, futhi njengoba amangqamuzana e-plasma enza ama-B-lymphocyte, noma yikuphi ukuphulwa kwalenqubo kuholela ekuhlulekeni nasekuqaleni kokubunjwa kwama-pathoplasmocytes.
Ngaphezu kwenguqulo yegciwane, kukhona ubufakazi bokuthi i-myeloma nayo ingabangela ukuvezwa kwemisebe. Odokotela bafunda abantu abathintekayo eHiroshima naseNagasaki, endaweni yokuqhuma e-Chernobyl. Kutholakale ukuthi phakathi kwalabo abathola umthamo omkhulu wemisebe, iphesenti lamacala e-myeloma nezinye izifo ezithinta igazi ne-lymphatic system liphakeme.
Phakathi kwezici ezimbi ezandisa ingozi yokuthola i-myeloma, odokotela bayabiza:
- Ukubhema - isikhathi eside sokubhema komuntu obhemayo kanye nenani likagwayi elibhema, kuphakama ingozi;
- ukuzivivinya umzimba;
- umthelela emzimbeni wezinto ezinobuthi;
- izakhi zofuzo.
I-Myeloma - izimpawu
I-Myeloma ivela kakhulu ekugugeni, echaphazela kokubili abesifazane nabesilisa. Lesi sifo uRustitskogo-Kahler - izimpawu kanye nesithombe somtholampilo, esibonwe ezigulini:
- ukunqotshwa kwe-hemopoietic ne-bone systems;
- ukwephulwa kwezinqubo zokuxuba;
- izinguquko zesifo se-urinary system.
Izimpawu eziningi ze-myeloma:
- izimpawu zokuqala ze-myeloma zibuhlungu emathanjeni (emthanjeni, emathunzini, emathanjeni e-skull), ama-fractures okuzenzekelayo, ukuguqulwa kwamathambo kanye nokuba khona kwama-tumor formations;
- i-pneumonia njalo nezinye izifo, ezibangelwa ukuwa kokuzivikela nokuvinjelwa kokunyakaza kokuphefumula okubangelwa izinguquko emathanjeni esifubeni;
- izinguquko ezinama-dystrophic emisipha yenhliziyo, ukwehluleka kwenhliziyo;
- ukwanda kwesibindi nesibindi;
- i-myeloma nephropathy - isifo esisezinso kanye nokwanda komzimba kuma-protein emcimbini, okuguqula ukungabi namandla okweqile;
- i-normochromic anemia - ukwehla kwenani lama-erythrocytes ne-hemoglobin level;
- i-hypercalcemia - inani elengeziwe le-calcium e-plasma nasemcinini, lesi simo sinengozi kakhulu, izimpawu zalo - ukuhlanza, ukucabangela, ukulala, ukuphazamiseka kwezixhobo zamathambo, ukuphazamiseka kwengqondo;
- ukwehla ezingeni le-immunoglobulin evamile;
- i-hemopoiesis ukuphazamiseka - ukuphuma kwezinambuzane ezimangcwabeni, ukulimaza, ukuphazamiseka kwezimbangela ze-arteries phalanges, i-diathesis eyingozi;
- i-paresthesia ("i-creepy"), ikhanda, ukulala, ukuguquka, ukuxubana, isizungu, ukungazithulu, i-dyspnea;
- ezigabeni zokugcina - ukulahlekelwa isisindo, umkhuhlane, i-anemia enkulu.
Amafomu we-myeloma
Ngokwezigaba zokwelashwa kwe-clinic, i-myeloma ingamafomu alandelayo:
- i-myeloma yodwa - ngesifo esisodwa esitheni noma lymph node;
- multiple (generalized) myeloma - ngokubunjwa kwezilonda eziningana zesisu.
Ngaphezu kwalokho, i-myeloma eminingi ingaba:
- ukusabalalisa - ngalesi simo ngokwemvelo ukubunjwa okungekho imingcele, kodwa ngokugcwele isakhiwo somnyosa wethambo;
- okugxilwe ngokuphindaphindiwe - i-plasmacytoma yethambo ithuthuka ezindaweni ezinqunyelwe, futhi ngaphezu kwalokho, izicubu zingase zenzeke ku-lymph nodes, i-spleen.
- isakaza kakhulu - ukuhlanganisa izimpawu zokwahlukana nokuningi.
Izifo ze-Myeloma - izigaba
Odokotela bahlukanisa izigaba ezintathu ze-myeloma eningi, isigaba sesibili siphezulu, lapho ama-indices ephakeme kuneyokuqala, kodwa ephansi kuneyesithathu (esimbi kakhulu):
- Isigaba sokuqala sibonakala nge-hemoglobin yehlelwa ku-100 g / l, izinga le-calcium evamile, ukuxilongwa okuphansi kwe-paraproteins kanye ne-Bens-Jones amaprotheni, okugxilwe kwe-0.6 kg / m², okungekho i-osteoporosis, i-bone deformation.
- Isigaba sesithathu sibonakala sithengiswa ku-85 g / l kanye ne-hemoglobin ephansi, ukuhlushwa kwe-calcium egazini elingaphezu kuka-12 mg nge-100 ml, izicubu eziningi, ukuhlushwa okukhulu kwama-paraprotein kanye namaprotheni e-Bens-Jones, isisindo esiphezulu se-1.2 kg / m² noma ngaphezulu, izimpawu ze-osteoporosis.
Izinkinga ze-myeloma
Nge-myeloma eminingi, izinkinga ezihlobene nomsebenzi owonakalisa we-tumor ziyisici:
- ubuhlungu obukhulu nokuphulwa kwamathambo (ama-fractures);
- ukwehluleka kwenqunu ngesidingo se- hemodialysis ;
- izifo ezithathelwanayo eziphikisanayo;
- i-anemia esiteji esibucayi, efuna ukumpontshelwa igazi.
I-Myeloma - ukuxilongwa
Uma kutholakala ukuthi i-myeloma ixilongwa, ukuhlukunyezwa ngokungafani kuyinkimbinkimbi, ikakhulukazi ezimweni lapho kungekho khona i-tumor foci ecacile. Isiguli sihlolwe yi-hematologist osolwa ngokuxilongwa nge-myeloma, oqala ukuhlola futhi athole ukuthi kunezibonakaliso ezinjengezinhlungu zethambo, ukuphuma kwegazi, izifo ezithathelwanayo njalo. Ngaphezu kwalokho, kwenziwa ucwaningo olwengeziwe lokucacisa ukuxilongwa, ukuma nokukala:
- ukuhlaziywa okujwayelekile kwegazi nomchamo;
- isifuba ne-x-ray yamathambo;
- i-tomography ehlanganisiwe;
- ukuhlola igazi kwegazi ;
- i-coagulogram ;
- ukutadisha inani lama-paraprotein egazini nasemcimbini;
- i-bone marrow biopsy;
- funda ngendlela kaMancini ngencazelo ye-immunoglobulins.
I-Myeloma - ukuhlolwa kwegazi
Uma kutholakala ukuthi ukuxilongwa kwe-myeloma, udokotela ubeka ukuhlolwa kwegazi jikelele kanye negazi. Izinkomba ezilandelayo zijwayelekile kule sifo:
- i-hemoglobin - engaphansi kuka-100 g / l;
- I-erythrocytes - engaphansi kuka-3.7 t / l (abesifazane), ngaphansi kuka-4.0 t / l (owesilisa);
- amaplatelet - ngaphansi kuka-180 g / l;
- i-leukocyte - engaphansi kwe-4,0 g / l;
- I-ESR - engaphezu kwama-60 mm ngehora;
- amaprotheni - 90 g / l nangaphezulu;
- i-albin - 35 g / l nangaphansi;
- urea - 6.4 mmol / L futhi ngaphezulu;
- i-calcium - 2.65 mmol / l nangaphezulu.
I-Myeloma - X-ray
Isigaba esibaluleke kakhulu sesifundo ne-myeloma yi-X-ray. Ukuxilongwa kokuxilongwa kwe-myeloma amaningi usebenzisa i-rayography kungaqinisekisa ngokugcwele noma kushiye ngokungabaza. Amathumba e-ray-ray abonakala ngokucacile, futhi ngaphezu kwalokho - udokotela uyakwazi ukuhlola ubuningi bomonakalo nokuguqulwa kwamathanga amathambo. Izilonda ezinzima kwi-X-ray zembula okunzima kakhulu, ngakho udokotela angadinga izindlela ezengeziwe.
Ukugula kwe-Myeloma - ukwelashwa
Njengamanje, ekwelapheni i-myeloma, indlela edidiyelwe isetshenziselwa, ngokusetshenziswa okuyisisekelo kwezidakamizwa ezinhlanganisweni ezihlukahlukene. Ukwelashwa okudingekayo kuyadingeka ukulungisa ama-vertebrae ngenxa yokubhujiswa kwawo. Imithi eminingi ye-myeloma - izidakamizwa ihlanganisa:
- Ukwelashwa okuhlosiwe , okuvuselela ama-protein, okuhola ukulwa nama-paraproteins;
- i-chemotherapy, ukuvimbela ukukhula kwamangqamuzana omdlavuza nokuwabulala;
- Ukwelashwa kwe-immune okuhloswe ukugqugquzela ukuzivikela komzimba wakhe;
- ukwelashwa kwe-corticosteroid, okuthuthukisa ukwelashwa okuyisisekelo;
- ukuphathwa nge- bisphosphonates eqinisa izicubu zamathambo;
- ukwelashwa kwezifo ezihlose ukuhlobulula ubuhlungu be-syndrome.
I-Myeloma - izincomo zomtholampilo
Ngeshwa, akunakwenzeka ukuba alulame ngokuphelele e-myeloma, ukwelashwa kuhloswe ukukhulisa impilo. Ukuze wenze lokhu, kufanele ulandele imithetho ethile. Ukuxilongwa kwe-myeloma - izincomo zodokotela:
- Qaphela ngokucophelela ukwelashwa okushiwo udokotela.
- Qinisekisa ukuzivikela komzimba hhayi kuphela ngemithi, kodwa nangokuhamba ngezinyawo, izinqubo zamanzi, ukushisa ilanga (ukusebenzisa i-sunscreen kanye nomsebenzi omncane welanga - ekuseni nakusihlwa).
- Ukuvikela kusuka ekutheleleni - gcina imithetho yokuhlanzeka komuntu siqu, ugweme izindawo ezigcwele, ugeze izandla ngaphambi kokuthatha imithi ngaphambi kokudla.
- Ungahambi ngezicathulo, ngoba ukunqotshwa kwezinzwa zomzimba kulula ukulimala futhi ungaboni.
- Hlola izinga lokushukela ekudleni, njengoba ezinye izidakamizwa zinikeza ekuthuthukiseni isifo sikashukela.
- Gcina isimo sengqondo esihle, ngoba imizwa emihle ibaluleke kakhulu kulolu hlelo.
I-Chemotherapy ye-myeloma eminingi
I-Chemotherapy ye-myeloma ingenziwa ngomuthi owodwa noma ngaphezulu. Le ndlela yokwelashwa ivumela ukufezwa okuphelele kumacala angu-40%, okuyingxenye - ku-50%, noma kunjalo, ukubuyela emuva kwesifo kufaneke kaningi, njengoba lesi sifo sithinta izitho eziningi kanye nezicubu. I-Plasmacytoma - ukwelashwa nge-chemotherapy:
- Esigabeni sokuqala sokwelashwa, i-chemotherapy enqunywe udokotela ngendlela yamathebulethi noma amajojo kuthathwe ngokuya kwesimiso.
- Esigabeni sesibili, uma i-chemotherapy iphumelela, i-bone marrow stem cells isuke isetshenziselwa - thatha i- puncture , ikhiphe ama-stem cells bese uwanamathisela.
- Phakathi kwezifundo ze-chemotherapy, izifundo zokwelashwa ngezidakamizwa ze-interferon-alpha zenziwa - ukwandisa ukuxolelwa.
I-myeloma eminingi - ukubikezela
Ngeshwa, uma kutholakala i-myeloma, ukubikezela kuyadumaza - odokotela bakwazi kuphela ukukhulisa isikhathi sokuxolelwa. Ngokuvamile iziguli ezine-myeloma ziyafa ngenxa yempneumonia, ukuphuma kwegazi okubangelwa ukuhlukunyezwa kwegazi, ukwehlukana, ukwehluleka kwezinso, thromboembolism. Isici esihle sokuqagela singumncane futhi isigaba sokuqala sesifo, isifo esibi kunabo bonke abantu asebekhulile kunama-65 abanezifo ezihambisana nezifo nezinso nezinye izitho, izicubu eziningi.
I-myeloma eminingi - isikhathi sokuphila:
- Iminyaka engu-1-2 - ngaphandle kokwelapha;
- kuze kube yiminyaka engu-5 - i-myeloma yokuphila okulinganiselwe kubantu abawelashwa;
- kuze kube yiminyaka eyi-10 - isikhathi sokuphila nokuphendula okuhle kumakhemikhali kanye nezifo endaweni elula;
- iminyaka engaphezu kwengu-10 ingahlala kuphela iziguli ezinokugxila okukodwa, ezisuswe ngempumelelo odokotela.