AIDS-ka iyo Qaadashada Qalabka-sare ee Steroids Maxay Sababta Loogu Dhaqan Yahay?
Dhawaan, sababtoo ah hordhaca daawooyinka cusub ee difaaca jirka iyo sidoo kale kororka tirada xubinta taranka, waxaan aragney dad badan oo la tallaalay ama la noolaansho la'aanta difaaca jirka.
Nidaamka difaaca ayaa ah ururinta dhammaan unugyada, unugyada, iyo xubnaha jirka ka caawiya jiritaanka caabuqa. Iyadoo aan lahayn nidaam difaaca oo aan joogto ahayn, qofku wuxuu ku dhacaa ugaadhsiga dunida.
Si kastaba ha noqotee, daweyno daaweyn ah oo xooggan oo xooggan, ayaa ah hal sabab oo kaliya sababta ay dadku u noqdaan kuwo difaaca jidhka ama difaaca jirka. Dhab ahaan, waxyaabo kale oo xun ayaa carqaladayn kara nidaamka difaaca jirka, sidoo kale, oo ay ku jiraan AIDS-ka iyo cudurada dhaxalka leh.
Waa maxay Nidaamka Isku-xirka?
Nidaamkaaga difaaca ayaa jiraya si looga hortago ama loo yareeyo cudurka. Unugyada iyo waddooyinka habka difaaca jirka ayaa ah kuwo adag oo kala duwan oo ku filan dhammaan qaybaha jirka.
Waa kuwan qaybaha kala duwan ee habka difaaca jirka:
- Dhaqtarka lafuhu waa halka ugu fiican ee madadaalo la bilaabo. Dharka lafuhu wuxuu ka kooban yahay unugyo dabiici ah oo u socda si ay u noqdaan unugyo kala duwan oo unugyada difaaca (unugyada B, T unugyada, lymphocytes, iyo waxyaabo kale).
- Maaha oo kaliya maqaarka ugu horeeya ee difaaca ee ka soo horjeeda adduunka ka baxsan, laakiin lakabka qaarkiis (sida maqaarka) ayaa sidoo kale hodan ku ah unugyada difaaca. Waxaa intaa dheer, maqaarka ayaa sidoo kale soo saara borotiinka antimicrobial.
- Waxaa jira unugyo difaac ah oo badan oo ku jira dhiigga. Dhab ahaan, tijaabooyinka dhiigga waxaa loo isticmaalaa si loo ilaaliyo difaacidda.
- Nidaamka lymphatic wuxuu ku dhejiyaa unugyada difaaca. Nidaamka qanjirada ayaa xirxiraya dhiigga oo leh unugyo ku yaalla guud ahaan jidhka waxayna u adeegtaa dariiqa weyn ee gaadiidka unugyada difaaca. Unugyada difaaca jirka waxay kudhowaan qanjirada. Xididada qanjirada, jawaab celinta difaaca ayaa la dhaqaajiyaa marka la baaro microbes.
- Nooca unugyada difaaca jirka oo noo oggolaanaya inaan la qabsano hanjabaadaha ay keenaan infekshanku waa T-cell. Inkasta oo unugyada T-da la soo saaro marka hore lafaha laf dhabarta, waxay sii wadaan inay ku dhacaan thymus.
- Dadku waxay ku nool yihiin iyadoo aan lahayn xakameyn (asplenia waa jargon caafimaad sabab la'aan maqaayad ama faleyn yar). Si kastaba ha ahaatee, beeryaradu waxay caawimaan jirka u diyaarinta jeermis, iyo dadka aan lahayn xakameyntu waxay u nugul yahiin inay qaadaan infakshanka cudurada sida meningococci (fekerka meningococci), Streptococcus pneumoniae (feker pneumonia) iyo influenza Haemophilus , ama H. influenza . Fadlan la soco in kastoo magaceeda, H. hargabku uusan keenin hargabka isla markaana wuxuu keenaa infekshin xagga neefsiga ee carruurta. Boogaha waxay u dhaqmaan sida shahwada jidhka, iyo boogaha unugyada difaaca ee ku dhaca daloolka dhiigga oo fiiriya calaamadaha caabuqa. Haddii infekshanku jiro, beeralayku waxay hawlgalaan jawaab difaac ah.
- Sida maqaarka, nudaha unugyada, sida soo helitaanka xuubka mindhicirka iyo neef-mareenka, ayaa sidoo kale ah safka ugu horeeya ee difaaca oo ka hortagaya jeermiska inuu galo galitaanka jirka. Sidan oo kale, unugyada dheecaanka ah ayaa hodan ku ah unugyada difaaca.
Dawlad Goboleed ee Immunosuppression
Diidmada nidaamka difaaca waxay ku xiran tahay dhowr arrimood. Wadar ahaan, xaalad saafi ah ee qofku leeyahay ee loo yaqaan 'immunosuppression' ayaa lagu qiimeeyaa ka dib marka la tixgeliyo isbeddellada soo socda:
- Nooca difaaca jirka (oo ka sarreeya daawo ama jirro)
- muddada difaaca jirka
- xoojinta difaaca jirka
- qiyaasta iyo noocyada immunosuppressant ama daroogooyinka
- dhalashada jirka (cudurada dhaxalka leh ee la xariira nidaamka difaaca)
- waxyaalaha asaarta ah ee keena burburinta (sida dheecaanka lenfiga ee daciifka ah ee labaad ee qalliin ama shucaac)
- infakshanka (ka fikir HIV ama CMV)
Immunosuppression Resulting from Daawooyinka
Daawooyin farabadan ayaa wiiqaya nidaamka difaaca. Daawooyinkan difaaca jirka ayaa waxyeeleyn kara dhowr lakab oo ah jawaab celin difaac ama bartilmaameed noocyada unugyada difaaca jirka.
Halkan waxaa ku yaala 3 dawo oo burburin kara habka difaaca jirka:
- Corticosteroids . Daawooyinkan waxaa loo qoraa noocyo kala duwan oo ah oogada, xasaasiyad, iyo xaalado bararka, sida rheumatoid arthritis, cudurada caabuqa neefta, neefta, iyo hareeraha. Inta lagu jiro muddada gaaban, daawooyinkani waxay farageliyaan hawlgalka difaaca jirka. Gaar ahaan, corticosteroids waxay tirtirtaa tirooyinka lymphocytes iyo monocytes iyo sidoo kale xakamaynta guuritaanka fagos iyo shaqeynta. Saameynta muddada dheer ee daawooyinkan waxaa ka mid ah maqaarka khafiifinta iyo hagaajinta unugyada jilicsan, oo labadoodaba ka sii dari kara tallaalka jirka. Dadka ku jira qadarka sare ee steroids waxay u nugul yahiin cuduro kala duwan oo kala duwan, sida Pneumocystis jirovecii , kaas oo sababa Pneumocystis Pneumonia , iyo sidoo kale Strongyloides , taas oo sidoo kale dhiman karta oo ay sababtay wareegga wareegga. Waxaa intaa dheer, dadka qaba difaaca jidhka ee daciifka ah ee isticmaala steroid waxay halis ugu jiraan inay soo noqnoqdaan cudurka qaaxada ama infekshannada kale ee qarsoon.
Rituximab. Unugyada monokloral ee CD20 waxaa loo adeegsadaa in lagu daaweeyo non-Hodgkin lymphoma, rheumatoid arthritis, iyo lymphocytic leukemia. Intii lagu jirey tijaabooyin caafimaad, rituximab kuma xirna khatarta sii kordheysa ee cudurka. Si kastaba ha ahaatee, rituximab wuxuu ku jiray suuqa, si kastaba ha ahaatee, waxaa jiray warbixinno shakhsi ah oo la xidhiidha maamulka rituximab ee cudurada dhifka ah ee loo yaqaan 'leukoencephalopathy', taas oo ay keento fayruska JCB, iyo unugyada casriga ah ee casaanka ah, oo la xiriira infekshanka parvovirus . Waxaa intaa dheer, tallaalka immunosuppression-ka ee maamulka rutiximab waxay keeni kartaa in uu soo celiyo infakshanka cagaarshow B.
Tumor Necrosis Factor-Alpha (TNF-a) Ka hortagga. Daawooyinkani waa cytokines; cytokines waxaa badanaa lagu soo saaraa unugyada difaaca. Daawooyinka TNF-α waxaa ka mid ah daroogada sida inflmaximab, certolizumab pegol, iyo monoclonal monoklonal waxaana loo isticmaalaa in lagu daaweeyo xaaladaha dabiiciga ah sida rheumatoid arthritis iyo cudurka Crohn. Xasuusta, xakameyn la'aanta ka timaadda maamulka daawooyinkan waxay albaabka u qaadaan infekshanka Listeria monocytogenes , waa cudur raashin ah oo keeni kara dhimasho uurjiifka dumarka uurka leh.
Immunosuppression Natiijada ka soo Asplenia
Qalitaanka cirridka ee beeryarada waxaa loo yaqaan "splenectomy." Waxaa jira sababo badan oo uu qofku u yeelan karo beertiisa, oo ay ka mid yihiin kansarka, dhaawacyada, iyo jirrooyinka dhiigga (sida daaweynta idiopathic thrombotic purpura). Ereyga caafimaad ee "asplenia" ma aha oo kaliya waxa looga jeedaa ka saarista beeryarada iyadoo la isticmaalayo splenectomy, laakiin sidoo kale luminta falcelinta hargabka caadiga ah ee ku dhaca xaaladaha sida cudurka anemia ee sickle cell.
Dadka qaba asphenia waxay halis u yihiin infekshankooda noolaha, sida Streptococcus pneumoniae , influenzae Haemophilus , iyo qaababka noocyada Neisseria meningitides . Dadkaas, infekshanka dilaaga ah ayaa si deg-deg ah u dhigi kara - gaar ahaan haddii uu ku dhaco sepsis ama infekshinka dhiigga. Sepsis wuxuu ku badan yahay dadka qaba laf-dhabarka (splinectomy secondary) ee kansarka (malignancy) marka loo eego dadka ay hayso laf-dhabarkooda kadib markii ay shil ka dhacaan. Xasuusnow, khatarta caabuqa ee la socota noolaha noolaanshaha ayaa ah kan ugu weyn sanadaha ugu horreeya kadib marka la eego splenektomy.
Immunosuppression-ka Dib Qalitaanka
Waxaa jira 2 nooc oo ah isu-tallaalid: unugyada unugyada unugyada unugyada unugyada jirka iyo xubnaha jirka ee adag. Labadaba noocyada noocyada kala duwan ee loo yaqaan 'transplants' ayaa keena difaaca jirka.
Qalabka unugyada unugyada unugyada unugyada qanjirada 'stem cell transplant' ayaa markii hore loo yaqaan 'transplant lactones' sababta oo ah unugyada dabiiciga ah, ama unugyo aan kala go 'lahayn oo awood u leh inay soo saaraan dhammaan noocyada unugyada dhiigga, ayaa markii hore laga goostay dhuuxa lafta. Sababtoo ah horumarinta daawada, waxaan hadda awoodnaa inaan ka nadiifino unugyada unugyada dhiiga. Qalinka unugyada stem ayaa loo sameeyaa sida daaweynta noocyada kansarka dhiigga qaarkood, oo ay ka mid yihiin leukemocytic leukemia, Caadi ahaan, dadka qaba cudurradani mar hore ayay u qaadeen daaweynta kansarka degdega ah isla markaana sidaas darteed horeyba waa loo tallaalay.
Qalabka bedelka jirka ee jirka oo dhan wuxuu tixraacayaa xubnaha unugyada sida wadnaha, kalyaha, ama beerka. Dadka qaata xubno jidheed oo adag waxay badanaa u baahan yihiin daaweyn joogto ah daawooyinka difaaca jirka si loo yareeyo halista diidmada.
Inta lagu jiro bilaha ugu horeeya ee ka soo kabashada xubinta taranka jirka, qofka qaada ee xubinta taranka ah ayaa ugu nugul cudurka infekshanka laftiisa. Caabuqyada caadiga ah inta lagu jiro mudadaas waxaa ka mid ah infekshinka kaadimareenka, caabuqyada maqaarka, iyo infekshannada. Intii u dhaxaysa bilaha 2aad iyo 6aad qalliinka ka dib, dadka qaata ee ku-meelgaarka ah ayaa halis u ah infakshanka fursadaha iyo sidoo kale dib u soo noqoshada fayraska herpes ama infekshannada kale ee qarsoon. Lix bilood ka dib qaliinka iyo wixii ka baxsan, dadka qaata waxay ugu nugul yihiin infakshannada beesha ee la midka ah kuwaas oo ay sababeen bacrimiyeyaal jidheed (oo u maleynaya inay yihiin Streptococcus pneumoniae iyo influenza Haemophilus ).
Immunosuppression oo ay sababtay Innat Immune Deficiency
Mararka qaarkood dadku waxay dhaxlaan cudurada hidda-socodka ee keena hab difaaca jirka oo daciif ah. Qaar badan oo ka mid ah tallaaladan asaasiga ah ayaa ah kuwo dhif ah oo laga helaa da 'da yar, sida tallaalka infalawansada daran iyo cudurrada granulomatous ee joogtada ah. Si kastaba ha noqotee, isbedellada isbeddelka guud (CVID) ayaa ah mid aad u badan oo keena dhalinyarada iyo qaangaarnimada dhalinyarada.
CVID, unugyada difaaca waxay ku fashileen inay soo saaraan tallaalka immunoglobulin ee lagama maarmaanka u ah in lagu dhajiyo jawaab difaac ah. Sidaa awgeed, dadka qaba CVID waxay u badan tahay inay ku dhacaan caabuqyada neef-mareenka iyo sidoo kale infekshannada mindhicirka sida Giardia Lamblia .
Daaweynta CVID way adagtahay oo waxay u baahan tahay daryeel takhasus gaar ah sababta oo ah dadka qaba xaaladdan kama jawaab celinayaan tallaalkana waxay u baahan yihiin faleebo immunoglobulin ah ee isbitaal.
Immunosuppression oo ay sababtay Caabuqa
Immunosuppression ma aha oo kaliya natiijooyinka khatarta sii kordheysa, hase yeeshee waxaa sababi kara infekshannada qaarkood. Tusaale ahaan, cytomegalovirus (CMV), taas oo badanaa keenta calaamadaha ama calaamadaha mononucleosis ee dadka qaba nidaamyada difaaca jirka ee caadiga ah, waxay sii wiiqi karaan nidaamka difaaca ee kuwa horeyba loo xakameynayey. Gaar ahaan, CMV ayaa ku qulqulaya unugyada T, kuwaas oo si firfircoon uga qaybqaata jawaab celinta difaaca jirka.
Nooca kale ee caabuqa ee keeni kara difaacu waa HIV (fayruska difaaca jirka ee bini'aadamka). Horumarka HIV-ga ee AIDS-ka waxaa lagu calaamadeeyaa tallaalka infalawansada daran . Tallaalkan tallaalku wuxuu dhacaa marka HIV uu dilo tiro badan oo caawiye ah T - unugyada CD4 iyo unugyada CD8 - kuwaas oo lagama maarmaan u ah in lagu dhajiyo jawaab difaac ah. Marka ay ku filan tahay unugyadaas ayaa la diley, qofku wuxu noqdaa mid u nugul calaamadaha infakshanka cirridka ah, oo ay ku jiraan kuwa soo socda:
- Candidiasis
- Coccidioidomycosis
- Cryptococcosis
- Cudurada Cytomegalovirus
- Encephalopathy, HIV-ku xiran
- Herpes simplex
- Histoplasmosis
- Kaposi's sarcoma
- Qaaxada
- Pneumocystis carinii pneumonia
- Toxoplasmosis ee maskaxda
Fadlan faham in dhammaan dadka qaba HIV ay yihiin kuwo aan la tallaalin, ama ay qabaan AIDS. Nasiib wanaag, horumarinta daawada ayaa ka dhigtay daaweynta infekshanka HIV waxtar badan. Maalmahan, dadka kufsiga qaba daaweyn antiretrovoviral ayaa ku noolaan karaan nolol dheer iyada oo aan la qaadin AIDS.
Soo koobid
Si aad u badan, kororka joogtada ah ee difaaca jirka ee dadka Maraykanka waa calaamad horumareed. Thanks to horumarinta cilmi baarista, hadda waxaan leenahay daawooyin immunosuppressant ka fiican oo daaweyn kara xaalado kala duwan oo sii kordhaya. Waxaa intaa dheer, waxaanu sidoo kale samaynaynaa xubin ka mid ah xubno jirka ka mid ah oo sidoo kale keena difaaca jirka.
Taa bedelkeeda, horumarka daawada ayaa sidoo kale leh awood yar si loo yareeyo inta jeer ee isdaba-joogga ka dhexjirta xubnaha dadweynaha. Gaar ahaan, dadka HIV qaba oo u hoggaansamaya hab-dhaqameedkooda antiretroviral waxay ku noolaan karaan nolol dheer oo farxad ku haboon difaaca jirka. Nasiib daro, si kastaba ha ahaatee, inkastoo horumarka daaweynta HIV, kaliya 3 ka mid ah 10kii qof ee Maraykanka ah ayaa qaba HIV-ga la xakameeyay.
Ilaha:
Hammond SP, Baden LR. Cutubka 198aad. Caabuqyada difaaca difaaca jirka. In: McKean SC, Ross JJ, Dressler DD, Brotman DJ, Ginsberg JS. eds. Mabaadi'da iyo Tababarka Daawada Isbitaalka . New York, NY: McGraw-Hill; 2012. Helitaanka Abriil 12, 2016.
Nayeri U, Thung S. Qeybta 15. Caabuqyada Cudurka Wadnaha ee Kuuriya. In: DeCherney AH, Nathan L, Laufer N, Roman AS. eds. CUDURKA CUDURKA & Daaweynta: Dhaqtarka & Ginecology, 11e . New York, NY: McGraw-Hill; 2013. Abaabulay Abriil 13, 2016.