Myeloma - zviratidzo uye kufungidzira kwezvikamu zvose zvechirwere

Chirwere chaRustitzky-Kahler kana kuti myeloma chirwere chisingaoneki chechirwere chekufamba. Chimwe chinhu chinoratidzwa nechirwere ndechekuti nekuda kwechirwere chinouraya muropa, nhamba ye plasmocytes (masero anogadzira immunoglobulins) inowedzera, iyo inotanga kubudisa yakawanda yezvirwere zvekudzivirira immunoglobulin (paraprotein).

Multiple myeloma - chii chiri mumashoko mashoma?

Multiple myeloma imwe yemhando dze myeloma. Chirwere cheplasmocyte-chinokonzera murwere ichi chinowanikwa mumapfupa emapfupa. Muchidimbu, myeloma yemapfupa emusana, skull, pelvis, nenyundo, thorax, uye, kazhinji kazhinji, mapfupa emuviri wemumuviri, anowanzoonekwa. Zviratidzo zvinosvibisa (plasmacytomas) ine myeloma yakawanda inobata mapfupa akawanda uye inosvika kukura kwema 10-12 masendimita.

Plasmocytes ndeimwe chikamu chemuviri wemuviri wemuviri. Izvo zvinogadzira zvirwere zvakasimba zvinodzivirira pane chirwere chakasiyana (izvo immunoglobulin inofanira kubudiswa ne "kukurudzira" zvakakanganwa masero memasero). Masero eplasma anokonzerwa nechirwere (plasmomyeloma masero) maitiro asina kudzora anorasika (asina kuodzwa) immunoglobulins asingagoni kudzivirira muviri, asi kuunganidza mune dzimwe nhengo uye kuvhiringidza basa ravo. Mukuwedzera, plasmacytoma inokonzera:

• kuderera kwehuwandu hwe erythrocytes, platelets uye leukocytes;
• kuwedzera immunodeficiency uye kuwedzera kukuvadzwa kune zvirwere zvakasiyana-siyana;
• hematopoiesis uye ropa visikiti zvinowedzera;
• kukanganisa kwemaminera uye mapuroteni metabolism;
• kuonekwa kwekupinda mune dzimwe nhengo, kunyanya kazhinji muitsvo;
• pathological kuchinja mu bone tissue mumugumisiro yechipfuva - bone rinotapudzwa uye rinoparadzwa, uye apo bundu racho rinowedzera kuburikidza naro, rinopinda mumatumbu akaoma.

Zvinokonzera myeloma

Chirwere cheRustitskiy-Kahler chave chichidzidzwa navanachiremba, asi hapana kubvumirana pamusoro pezvikonzero zvekuitika kwaro mune zvechiremba. Yakawanikwa kuti mumuviri wemunhu anorwara, majekiseni e-lymphatic eT kana B anowanzovapo, uye sezvo masero eplasma achiumba kubva kuB-lymphocytes, chero kukanganisa kupi kweiitiro kunounza kukanganisa uye kutanga kwekugadzirwa kwepathoplasmocytes.

Mukuwedzera kune viral version, kune uchapupu hwokuti myeloma inogonawo kukonzerwa nehuwandu hwemhepo. Vanachiremba vakadzidza vanhu vakagadziriswa muHiroshima neNagasaki, munzvimbo inoputika paChernobyl nuclear power plant. Yakawanikwa kuti pakati peavo vakagamuchira mizinga yakareba yehutachiona, huwandu hwemakumbo e myeloma nezvimwe zvirwere zvine chokuita neropa uye lymphatic system yakakwirira.

Pakati pezvinhu zvisingaiti zvinowedzera mukana wekutengesa myeloma, vanachiremba vanoti:

• Kusvuta - iyo yakareba iyo inosangana nevanoputa uye kunyanya nhamba yefodya yakasvuta, inowedzera ngozi;
• immunodeficiency;
• kukanganisa pamuviri wezvinhu zvinotyisa;
• genetic predisposition.

Myeloma - zviratidzo

Myeloma zvikurukuru inowanikwa mukukwegura, inosanganisira vakadzi nevakadzi. Chirwere ichi Rustitskogo-Kahler - zviratidzo uye chirwere chechipatara, zvakaonekwa kune varwere:

• kukunda hemopoietic uye bone systems;
• kukanganisa kwemagetsi ekugadzirisa;
• pathological changes mu urinary system.

Multiple myeloma zviratidzo:

• mavambo epakutanga emamapfupa (mumupfupa, chifuva, mapfupa egehenya), kuputika kwepakati, kushanduka kwemapfupa uye kuvapo kwemaitiro emumarara;
• kazhinji pneumonia nedzimwe zvirwere, zvinokonzerwa nekuwa kwekudzivirirwa nekudzivirira kwekufema kunokonzerwa nekuchinja mumapfupa echipfuva;
• dystrophic inoshanduka mumisungo yemwoyo, mwoyo kusakundikana;
• kuwedzera spleen nechiropa;
• myeloma nephropathy - chirwere chiri muitsvo nehuwandu hwekuwedzera mune mapuroteni mumuguta, unoshandura pakuita kuti urege kukwana;
• normochromic anemia - kuderera kwechiverengero che erythrocytes uye hemoglobin level;
• hypercalcemia - kuwedzera kwechircium mu plasma uye mumuguta, ichi chiitiko chinotyisa, zviratidzo zvaro - kurutsa, kusuruvara, kurara, zvipfeko zvemaziso zvinokanganisa, zvirwere zvepfungwa;
• kuderera muhutano hwemazuva ano immunoglobulin;
• hemopoiesis marwadzo - kubuda ropa mumuchu membrane, kuputika, marwadzo emakemikari phalanges, hemorrhagic diathesis;
• paresthesia ("chinotyisa"), misoro, kusvodzwa, kutendeuka, kuputika, chizivo, matsi, dyspnea;
• pamatanho ekupedzisira - kurasikirwa kwemazivi, fivha, kuora muviri kwakanyanya.

Forms of myeloma

Maererano nekliniki-anatomical classification, myeloma ndeyezvipi zvinotevera:

• ndoga myeloma - neine tumarara mune bone kana lymph node;
• multiple (generalized) myeloma - nekuumbwa kwezvipembenene zvakasiyana-siyana zvechirwere.

Mukuwedzera, multiple myeloma inogona kuva:

• kupararira - munyaya iyi pathologically maumbirwo haana mitsara, asi inotenderera chimiro chose chepafupa;
• Multi-focal - plasmacytoma yemapfupa inokura munzvimbo dzisinganyanyi, uyezve, zviremara zvinogona kuitika muine lymph nodes, spleen.
• diffuse focal - kuunganidza zviratidzo zvekupararira uye yakawanda.

Myeloma chirwere - zvikamu

Vanachiremba vanoparadzanisa zvikamu zvitatu zve multipleel myeloma, chikamu chechipiri ndechekutsvaga, apo nhamba dzakareba kupfuura dzekutanga, asi dzakadarika pane yechitatu (yakanyanya kupfuura):

1. Nharaunda yekutanga inoratidzwa ne hemoglobin inoderedzwa kusvika ku100 g / l, yakakwana calcium level, yakadzika midzi yeparaproteins uye Bens-Jones protein, imwe gumbo rinotarisa 0.6 kg / m², hapana osteoporosis, mapfupa ekusafukura.
2. Chikamu chechitatu chinoratidzwa nechinoderedzwa kusvika ku 85 g / l uye pasi ye hemoglobin, mukana we calcium muropa rinopfuura 12 mg pa 100 ml, mishonga yakasiyana-siyana, yakakura yemapaprotini uye mapuroteni eBens-Jones, chiremera chakakura che 1.2 kg / m² kana kupfuura, zviratidzo zveansteoporosis.

Zvinetso zve myeloma

Kune multipleel myeloma, zvinetso zvinosanganiswa nebasa rinoparadza romuviri wacho zvinoratidza:

• kurwadziwa kukuru uye kuputsika kwemapfupa (fractures);
• kukundikana kwechirwere pamwe nekudiwa kwe hemodialysis ;
• zvirwere zvinopfuurira zvinopararira;
• anemia mune imwe nguva yakakura, inoda kuwedzerwa ropa.

Myeloma - diagnostic

Nekuongororwa kwemaeloma, kusiyana kwekutsanangurira kwakaoma, kunyanya mumamiriro ezvinhu apo hapana chimiro chakaoneka. Murwere anotsvakurudzwa nehematologist anofungidzira kuti anonzi myeloma, uyo anotanga kuongorora tsvaga uye anoona kana pane zviratidzo zvakadai sekurwadziwa kwemapfupa, kubuda ropa, zvirwere zvinopararira zvinowanzoitika. Uyezve, zvimwe zvidzidzo zvakaitwa kuti zvijekese kuongororwa, chimiro chayo nekukura kwayo:

• kazhinji kuongorora ropa neropa;
• chifuva uye skeletal x-ray;
• computed tomography;
• biochemical blood test ;
• coagulogram ;
• chidzidzo chehuwandu hweparaprotein muropa uye murini;
• bone marrow biopsy;
• kudzidza pamusoro penzira yeMancini pane tsanangudzo yemununoglobulin.

Myeloma - kuongorora ropa

Kana kuongororwa kwemaeloma kunofungidzirwa, chiremba anongorongedza huwandu uye huwandu hwekuongorora ropa. Izvi zvinotevera zviratidzo ndezvechirwere ichi:

• hemoglobin - pasi pe100 g / l;
• erythrocytes - pasi pe 3.7 t / l (vakadzi), pasi pe 4.0 t / l (varume);
• maplatelet - pasi pe 180 g / l;
• leukocyte - pasi pe4 g / l;
• ESR - inopfuura 60 mm neawa;
• protein - 90 g / l uye pamusoro;
• albumin - 35 g / l uye pasi;
• urea - 6.4 mmol / L uye yakakwirira;
• calcium - 2.65 mmol / l uye yakakwirira.

Myeloma - X-ray

Chikamu chinonyanya kukosha chekudzidza na myeloma ndi X-ray. Kuongororwa kwe multiple myeloma diagnosis using radiography inogona kusimbisa kana kuti kusiya mubvunzo. Mishonga mu x-ray inooneka zvakajeka, uyezve - chiremba anokwanisa kuongorora huwandu hwekuparara uye kushandiswa kwemapfupa emapfupa. Zvirwere zvakasiyana-siyana pa X-ray zvinoratidza zvakaoma zvikuru, saka chiremba angada dzimwe nzira dzakawedzerwa.

Myeloma chirwere - kurapwa

Pari zvino, pakushandiswa kweyangueloma, nzira yakabatanidzwa inoshandiswa, uye inoshandiswa kushandiswa kwezvinodhaka mumakwikwi akasiyana-siyana. Kurapa kunobatanidzwa kunodiwa kugadzirisa vertebrae nekuda kwekuparadzwa kwavo. Multiple myeloma - mishonga yemishonga inosanganisira:

• Targeted therapy , kukurudzira kufanana kwepuroteni, kutungamirira kurwisana neparaproteins;
• chemotherapy, inhibiting kukura kwekenza masero nekuvauraya;
• Immune therapy inoshandiswa pakukurudzira muviri wake;
• corticosteroid therapy, iyo inosimudzira kurapwa kwekutanga;
• kurapwa ne- bisphosphonates inosimbisa mapfupa emapfupa;
• anesthetic therapy inoshandiswa pakudzivirira kurwadziwa chirwere.

Myeloma - kliniki mazano

Zvinosuruvarisa, hazvibviri kupora zvachose kubva ku myeloma, kurapwa kunonongedza kuwedzera upenyu. Kuti uite izvi, unofanira kutevera mamwe mitemo. Kuongororwa kwe myeloma - kukurudzira kwechiremba:

1. Chenjerera kuchengeta kurapwa kwakagadzirirwa nachiremba.
2. Simbisa utachiona kwete nemishonga chete, asiwo nekufamba, mvura nzira, sunbathing (kushandisa suncreen uye panguva inenge isina basa yezuva - mangwanani uye manheru).
3. Kudzivirira kubva kune hutachiona - chengetedza mitemo yehutsanana, kudzivisa nzvimbo dzakazara, kushambidza maoko usati watora mishonga, usati wadya.
4. Usafamba usina shangu, nekuda kwekukundwa kwemitsipa yeropa iri nyore kuti uzvikuvadze uye usazviona.
5. Chengeta uwandu hwehuga muzvokudya, semamwe mishonga inobatsira pakuvandudzika kwechirwere cheshuga.
6. Ramba uine mafungiro akanaka, nokuti mafungiro akanaka anonyanya kukoshesa kwenguva yechirwere.

Chemotherapy for multiple myeloma

Chemotherapy ye myeloma inogona kuitwa nemumwe kana kupfuura mishonga. Iyi nzira yekurapa inobvumira kuzadzikisa zvakakwana mumasangano makumi mana ezana, zvisarudzo - muna 50%, zvisinei, kudzoka kwechirwere ichi kunowanzoitika kakawanda, sezvo chirwere ichi chinokanganisa nhengo dzakawanda nemaviri. Plasmacytoma - kurapa nemakemikrasi:

1. Pakutanga kwekutanga kurapwa, chemotherapy inorayirwa nachiremba mune mahwendefa kana majekesiti anotorwa maererano nesarudzo.
2. Muchikamu chechipiri, kana chemotherapy ichibudirira, mapfupa emashizha emasero anosvibirirwa - kutora chivharo , kubvisa masero emadziro uye kuvatanidza zvakare.
3. Pakati pemapoka e chemotherapy, mafundo ekurapa ne interferon-alpha madhiragi anoitwa - kuwedzera kuregererwa.

Multiple myeloma - kufungidzira

Zvinosuruvarisa, nekuongororwa kwemaeloma, kufungidzira kunonyadzisa - vanachiremba vanongokwanisa kukwanisa nguva yekuregererwa. Kazhinji varwere vane myeloma vanorwara nemapneumonia, kuuraya kunouraya kunokonzerwa nokuputsika kwekuvhara ropa, kuputsika, hosha kusagadzikana, thromboembolism. Chirevo chakanaka chiri chidiki uye chikamu chekutanga chechirwere, chirevo chakaipisisa chiri kuvanhu vakwegura kupfuura 65 vane zvirwere zvinobatanidza zveputsvo nedzimwe nhengo, zvirwere zvakawanda.

Multiple myeloma - tarisiro yeupenyu:

• 1-2 makore - asina kurapwa;
• kusvika kumakore mashanu - avhareji yemararamiro emararamiro e myeloma kune vanhu vanorapwa;
• kusvika kumakore gumi - kutarisira hupenyu nemhinduro yakanaka kumakemikrasi uye zvirwere muchero iri nyore;
• makore anodarika gumi anongogona kurarama varwere vane chiremera chimwe chete chinotarisa, kubudirira zvakabviswa navanachiremba.