Astaamaha, MRI, iyo Xakamaynta Lumbar si loo baaro PML
Cudurka 'vertical leukoencephalopathy' (PML) waa cudur halis ah oo ay keento fayraska JC . Fayrasku caadi ahaan ma keeno wax calaamado ah markuu qofku ku dhaco, ugu danbeynna jiifto jidhkooda. Laakiin marka nidaamka difaaca qofku uu daciif yahay (sida AIDS-ka, lupus, ama kansarrada qaarkood), fayrasku waxa uu dib-u-dhaqaajin karaa, isagoo ku faafaya unugyada sameeya maskaxda (daboolka dareemayaasha) -yani waa bayoolajiga ka dambeeya PML.
Muhiimadda PML ee MS waa in ay tahay saameyn naadir ah oo ka mid ah daweynaha isbeddel-ku-beddelidda , ugu badnaan, Tysabri (natalizumab).
Waxaa sidoo kale jira laba qof oo ka mid ah xaaladaha PML ee dadka qaba MS ee qaatay Gilenya (fingolimod), Tecfidera (dimetetum fumarate), ama Ocrevus (ocrelizumab).
Ciladeynta cudurkan halista ah wuxuu u baahan yahay qiimeyn degdeg ah oo deg deg ah dhakhtar oo ay ku jiraan taariikh faahfaahsan iyo baaritaan jireed, MRI maskaxda, iyo boogaha lumbar .
Tijaabinta Jirrada JCC ee Xajka Cerebrospinal
Si loo cadeeyo PML, dhakhtarku wuxuu qaban doonaa mandheerta lumbar si uu u falanqeeyo dheecaanka maskaxda ee ' cerebrospinal fluid' (CSF) sababtoo ah joogitaanka faayraska JC. Tani waxaa lagu sameeyaa iyada oo la samaynayo baaritaanka falgalka silsilad ee polymerase (PCR) ee CSF si loo arko haddii DNA-ga fayruska JC uu joogo.
Natiijooyinka baaritaanka PCR-da si loo eego fayruska JC ee dareeraha maskaxda ayaa la geyn doonaa natiijooyinka baaritaanka (calaamadaha PML) iyo natiijooyinka MRI si ay u yimaadaan baaritaan.
MRI si loo baaro PML
Baadhitaanka sawirka maskaxda (MRI) ee maskaxda ayaa la amri doonaa. Marka la eego MRI, PML waxay caadi ahaan u muuqataa sida ugu yar ee yar yar, dhaawacyada kala duwan T2 . Waxay ugu dambeyntii ku biiri karaan si ay u sameeyaan hal boogo waaweyn.
Astaamahaaga si aad u ogaato PML
Dhakhtarkaagu wuxuu rabi doonaa inuu ogaado sida aad u dareemeysid iyo marka calaamadaha cusub bilaabay.
Waxaa muhiim ah in la qeexo oo faahfaahin laguu sharaxo. Calaamadaha PML way kala duwan yihiin laakiin waxaa ku jiri kara isbeddel ku yimaada fekerka iyo shakhsiyadda, luminta isuduwidda, dhibaatooyinka aragtida, ka sii darista daciifnimada gacmaha ama lugaha, madax xanuun, ama suuxdinta.
Mararka qaarkood waxay noqon kartaa mid caqabad ku ah in la ogaado calaamadaha soo noqoshada MSL ee ka imanaya PML. Hal calaamad, sida laga soo xigtay daraasaddan 2009 ee Archives of Neurology, waa in qofka qaba xanuunka MS dib u dhaco hal calaamadaha asaasiga ah, halka dadka qaba PML ay u muuqdaan kuwo calaamado badan ah.
Xinjirta Biopsy si loo ogaado PML
Haddii uu qofku ku jiro Tysabri, baaritaan ku sameeya fayruska JC-ga ee tijaabada PCR CSF, wuxuu muujiyaa calaamadaha PML, oo leh MRI scan oo leh natiijooyin la mid ah PML, waxay u badan tahay in dhakhtarku u daaweyn doono PML. Mararka qaarkood, xitaa, waxaa la sameeyaa cad ka-qaadista maskaxda.
Cad ka-qaadista maskaxdu waa ka saarista qaybo yaryar oo ah unugyada maskaxda si ay ugu adeegsadaan baadhitaanka PML. Noocyada unugyada waxaa lagu baarayaa fayraska JC.
Cad ka-qaadista maskaxdu waa "heerka dahabka" ee baadhitaanka ogaanshaha ee PML. Si kastaba ha noqotee, waxay qaadataa halis, oo ay ku jirto dhimashada. Intaa waxaa dheer, dhaawacyada PML waxaa laga yaabaa in aysan suurtagal ahayn in la gaarsiiyo saamiga biopsy. Wali maaha in la yiraahdo, tani ma aha nidaam loo yaqaan bukaanka ama dhakhaatiirta, ama mid aan loo isticmaalin marka laga reebo xaaladaha ugu daran, si loo ciribtiro cudurrada kale.
Marka laga hadlayo qof qaba MS ee ku jira Tysabri, tani way ka yar tahay arrin ka badan qof qaba HIV / AIDS, sida tirada cudurada u keeni kara PML (toxoplasmosis, cryptococcal meningitis, ama AIDS) dhici karta
Ereyga
Haddii aad bilowdo inaad yeelatid calaamado aan caadi ahayn ama sii xumaanaya marka la joogo Tysabri (ama daaweyn kale oo MS-ku-beddelid daaweyn) la xiriir dhakhtarkaaga isla markiiba. Ha u qaadan in ay tahay "kaliya dib-u-soo-noqoshada MS" ama calaamadaha walax-maskaxda. Iska hubi sida ugu dhakhsaha badan. Si dhakhso ah daaweynta PML ayaa la billaabay, fursadahaaga aad u sii wadi karto.
> Ilo:
> Boster A et al. Dhiig-bax badan oo dheellitiran oo laf-dhabarka ah iyo dib-u-soo-ceshad-qabashada sclerosis multiple: daraasad isbarbardhig ah. Arch Neurol. 2009 May; 66 (5): 593-9.
> Clifford DB et al. Natalizumab-xiriir la leh leukoensphalopathy ee horumarinta multifocal ee bukaanada qaba sclerosis multiple: casharrada 28 kiis. Lancet Neurol . 2010 Apr; 9 (4): 438-46.
> Ururka Shaqaalaha Qaranka (2015). Xaaladda PML ee lagu soo warramey Qofka Geenya Gaar ah: UPDATED. iyo > Kiiska PML ee lagu wargaliyay Qofka Qaadashada Tecfidera.
> Ururka MS MS Society (2017). Xaaladda PML ee Warbixinta lagu soo bandhigay Qofka helaya Dhabarka Daaweynta MS.
> Wareegga PML. Xirfadlayaasha Caafimaadka: Maxay tahay PML?