Marka qofku qabo istaroog, daaweynta ugu fiican (daaweynta dabiiciga ah, iyo daaweynta si looga hortago istaroog kale) waxay kuxirantahay waxa keena istaroogga . Sidaas daraadeed waa muhiim in dhakhaatiirtu ay hoos u dhigaan sababaha asaasiga ah ee istaroogga.
Nasiib darro, illaa boqolkiiba 40 dadka Maraykanku leeyahay istaroogga ayaa ku dambeynaya kala-soocista qaylo-dhafka , taas oo macnaheedu yahay in xitaa ka dib marka la sameeyo qiimeyn caafimaad oo dhamaystiran sababta keentay walaac ay wali la'yahay.
Iyadoo aan ogaanin sababta, daaweynta ugu wanaagsan ee istaroogga waxay ku saleysnaan kartaa qiyaasta.
Muddo sanado ah cilmi baarayaashu waxay isku dayayeen in ay fahmaan xaaladaha caafimaad ee ay u badan tahay in ay keenaan istaroogga iyaga oo aan ka tegin xayndaab cad, taas oo ah, xaaladaha caafimaad ee ay u badan tahay in ay soo saaraan stroke cryptogenic. Labada suxufi ee soo jiidashada ugu muhiimsan waa patent foramen ovale (PFO) iyo fibrillada atrial . Go'aaminta in PFO ay u badan tahay inay sabab u tahay istaroog lagu shubo qalooca cryptogenic ayaa cadeeyay inay adag tahay oo muran ka taagan tahay.
Khilaaf khilaafku ka yaryahay waa khatarta uu keeno fibrillada atrial. Stroke, dhibaatada ugu ba'an ee fibrillada atrial, ayaa ah mid aad u badan bukaannada qaba arrintia this. Oo hadda waxay u muuqataa in fayruska atrial-ka uu noqon karo sabab u sii badan ee keena qulqulatada cryptogenic-ka intii aan hore u ogaanay.
Foosha 'Fibrillation' iyo 'Cryptogenic Stroke'
Inkastoo ay badanaa keento astaamo muhiim ah (sida isbaarada iyo lulmoodka), dhacdooyinka fibrillada atrial ayaa sidoo kale dhici karta iyada oo aan wax calaamado ah wax soo saarin. Xaaladahaan, bukaanku ama dhakhtarku malaha wax fikrad ah in fayraska atrial-ka uu dhacayo. Hadda waxay noqoneysaa mid sii cakirsan in dhacdooyinka noocaas ah ee "subclinical" (taas oo ah, aan la aqoonsaneyn) fibrillada atrial waa fure muhiim ah oo ku yimaada istaroogga qufaca.
Daraasada CRYSTAL-AF, oo isku dayday in ay cabirto inta jeer ee fayrasku ku dhaco qallafsanaanta maskaxda ee laga yaabo inay mas'uul ka noqoto qufaca cryptogenic, waxay eegtey 414 qof oo horey u jirey cryptogenic. Baarayaashu waxay kashaqeeyaan kormeerka wadnaha oo yar yar, qalabka is-qabadsiinta-aaladda (Medtronic, Inc.) - iyaga oo kormeeri kara garaaca wadnaha qofka ilaa saddex sano.
Dhamaadka daraasaddan, 30 boqolkiiba bukaanka qaba laf-dhabarka wadnaha ayaa u soo jeestay in ay qabaan dhacdooyin hore oo aan loo baahnayn ee fayrasta. Marka la barbardhigo, koox ka kooban 220 oo bukaan ah kuwaas oo istiraatiijiga cryptogenic lagu qiimeeyay iyada oo aan la socon kormeerka wadnaha oo muddo dheer soconaya, qaybo ka mid ah fibrillada atrial ayaa lagu qeexay in ka yar laba boqolkiiba.
Tani waxay soo jeedineysaa laba waxyaabood oo cusub oo ku saabsan xuubka hurgunka iyo qallalka qufaca. Ugu horeyn, fibrillada hoose ee maskaxda ayaa laga yaabaa in ay masuul ka tahay xaalado badan oo maskax-bararro qoyan (cryptogenic stroke) marka loo eego tan hore. Iyo labaad, kormeer joogta ah oo muddo dheer ah ayaa lagama maarmaan u ah in la ogaado bukaanada qaba dhibaatadan. (Celceliska waqtiga kormeerka la-ogeysiin karo ayaa ku jiray daraasaddan kahor intaan la ogaanin fibrillada atrial waa 84 maalmood.)
Daraasadani ma xaqiijineyso in fibrillada atrial-ka ay mas'uul ka tahay qufaca qulqulka ee dhammaan bukaanadaan, mana caddayn in isticmaalka daroogada ladaga xoojiyo ay sii wanaajin doonto natiijooyinkooda.
Dhibaatooyinka waqtiga dheer ee la kala soocay ayaa lagama maarmaan u ah inay si cad u muujiyaan waxyaalahan. Laakiin waxaan ognahay in dadka qaba qoorgooyaha qufaca ay leeyihiin khatar aad u sareysa ee istaraatijiyeynta soo noqnoqda, in fibrillada atrial-ka ah ay si weyn u kordhiso khatarta istaroogga, iyo daaweynta ka hortagga xinjirta si weyn u yareyneysa khatarta istaroogga ee fibrillada atrial. Iyadoo xaqiiqooyinkaas maskaxda ku hayaan, 97 boqolkiiba bukaanada ku jira baaritaanka CRYSTAL-AF ee loo aqoonsaday in ay qabaan qallal-celin xummo oo hooseeya ayaa lagu dhajiyay daawooyinka ka hortagga xinjirta dhakhtarkooda.
Kormeer Wadnaha ah oo waqti dheer ah
Iyadoo lagu saleynayo waxa aan ognahay maanta, kormeerka wadnaha ee muddada-dheer waa in ugu yaraan lagu tixgeliyo bukaanada soo maray qaylo-dhaf (Cryptogenic stroke), gaar ahaan haddii dhakhaatiirtooda ay bedelaan talo-bixintooda daaweynta iyada oo ku saleysan natiijada kormeerka.
Kormeer joogta ah oo muddo dheer ah ayaa ah mid suurtogal ah in lagu sameeyo dhaqtarka caadiga ah. Kontoroolayaasha wadnaha ee xidhan ayaa hadda loo isticmaali karaa illaa 30 cisho, muddada kormeerka ee lagu muujiyay in la aqoonsado qayb weyn oo bukaan ah oo leh qallal-celin xeeldheer. Daawooyinka wadnaha oo muddo dheer ah - kuwa loo isticmaalo daraasadda CRYSTAL-AF iyo sidoo kale qaabab aad u yar "jiilka xiga" - ayaa loo heli karaa isticmaalka kiliinikada.
Haddii adiga ama qof aad jeceshahay uu ku dhacay qalalaaso cryptogenic ah, oo haddii dhakhtarkaagu bedeli karo daweyntaada iyadoo ku xiran haddii lagu ogaanayo iyo in kale, waa in dhakhtarka la hadashaa suurtogalnimada in kormeerka wadnaha lagu sameeyo muddo dheer.
Ilaha:
Natiijooyinka imtixaanka CRYSTAL-AF. Shirka Caalamiga ah ee Dhimista (ISC) 2014. Abstract LB11. Soo bandhigay Febraayo 14, 2014.
Liao J, Khalid Z, Scallan C, iyo al. Kormeer la'aanta wadnaha oo lagu ogaanayo qalooc-xummo-xummad isdaba-joog ah ama goynta ka-daba-galka ah ka-dib marka uu jiro is-dabadheeraad diidmo ah: dib-u-eegis nidaamsan. Stroke 2007; 38: 2935.
Hylek EM, Go AS, Chang Y, iyo al. Saamaynta xoogga ah ee xinjirowga afka laga qaato ee ku saabsan darnaanta madax-dhiigfuranka iyo dhimashada ee fiyuuska atrial. N Engl J Med 2003; 349: 1019.