Dib u Eegida Calaamadaha, Ciladda, iyo Daaweynta Cudurrada Hypereosinophilic Syndromes
Guudmarka
Cudurka hypereosinophilic (HES) waa koox ka mid ah cudurrada dhifta ah ee lagu yaqaano eosinophils (eosinophilia) taas oo keenta dhaawac jidhka ah (maqaarka, sanbabada, wadnaha, caloosha mindhicirka). Dadka intooda badani waxay da'doodu ka weyn tahay 20 jir marka la baarayo laakiin waxay ku dhici kartaa carruurta. Inta badan HES waxaa loo tixgeliyaa xaalado xun (aan kansar ahayn), laakiin qayb hoosaad ah ayaa loo tixgeliyaa neoplasiferative neoplasms kaas oo ku dhici kara kansar.
Qeexitaan
Hypereosinophilia waxaa lagu qeexay tiro dhan eosinophil in ka badan 1500 unugyada / mikroliter laba dhiig oo buuxa (CBC) laba jeer oo kala duwan oo ay kala tagaan ugu yaraan hal bil iyo / ama xaqiijinta unugyada hypereosinophilia oo ku saabsan biopsy. Hypereosinophilia ee unugyada ayaa lagu qeexay meelihii biopsiga. Dhinaca lafaha lafaha, hypereosinophilia waxaa lagu qeexaa marka ka badan 20 boqolkiiba unugyada nucleated eosinophils. Nudaha kale, waxaa lagu qeexay "fara badan" fara badan eosinophils ku soo galay unugyada ra'yiga ay ka bixiyeen farsamoyaqaan (dhakhtarka dib u eegista xoqitaanka).
Xaalado dhowr ah ayaa keeni kara eosinophilia, laakiin kuwan marar dhif ah ayaa sababi kara dhaawaca unugyada ee lagu arko HES. Eosinophilia waxaa loo kala qaadi karaa saddex qaybood: mid fudud (500 ilaa 1500 eosinophils / microliter), dhexdhexaad ah (1500 illaa 5000 eosinophils / microliter), iyo daran (ka weyn 5000 eosinophils / microliter.
Noocyada
HES waxa loo qaybin karaa saddex qaybood oo waaweyn: koowaad (ama neoplastic), labaad (ama reactive), iyo idiopathic. Idiopathic HES waa ogaanshaha ka-saaris la'aan, taasoo macnaheedu yahay in wax kale oo keena eosinophilia la ogaan karo. HES ee asaasiga ah, isbedelka hidda-socodka ayaa kicin doona dhuux lafo si loo dedejiyo wax soo saarka eosinophil oo la mid ah fayraska polycythemia ama trombocythemia muhiim ah .
HES-da labaad, xaalad hoos-yimaada (infekshanka parasite, lymfoma, iwm) waxay soo saartaa borotiinka (oo loo yaqaan cytokines) kuwaas oo kiciya wax soo saarka eosinophil.
Astaamaha
Calaamadaha HES waxay ku salaysan yihiin aagga ay saameeyeen waxayna ku jiri karaan:
- Maqaarka: Cambaarta, dhicinta maqaarka, finan,
- Sambabada: qufac, neefsasho gaaban, hinraagid
- Wadnaha: xanuunka feedhaha, neefta oo adkaata,
- Cudurka Neurologic
- Dhiigxinjirta (dhiig-xinjirowga)
- Indhaha: aragti qallafsan
- Miyir beelka (GI): miisaan lumis, xanuun caloosha ah, matag, shuban
Ciladeynta
Sida kor ku xusan, eosinophils waa mid ka mid ah shanta nooc ee unugyada dhiigga cad (nutrophils, lymphocytes, monocytes, eosinophils iyo basophils). Imtixaanka ogaanshaha baaritaanka bilowga waa dhiig buuxa oo buuxa. Tirada eosinophil ee ka weyn 1500 unug / microliter 2 jeer oo lagu caddeeyo baaritaan dheeraad ah Marka hore, sababaha ugu badan ee eosinophilia waa in la tirtiraa.
Marka HAA laga shakiyo, qiimeeynta ayaa diirada saaraya raadinta xubinta xubnaha. Qiimeynta wadnaha waxaa ku jiri kara garaacis (ECG) iyo echocardiogram (ultrasound of the heart). Baaritaanka shaqada sambabada waa in la sameeyaa. Baadhitaanka la xarriiqay (CT) ayaa loo isticmaali doonaa si loo eego calaamadaha HES ee sanbabada ama caloosha.
Baaritaannada dheeraadka ah waxaa lagu falanqeyn doonaa go'aaminta haddii ay jiraan wax caddayn ah neoplasmap neoplasm. Tani waxay ku jiri doontaa shaqada dhiigga iyo astaamaha lafaha / dheecaanka laf dhabarta . Nudaha lafaha lafta waxaa lagu baari doonaa isbeddelada hidda ee la xiriira HES. Haddii ay jirto tiro kordheysa unugyada mastarka, baaritaanka waxaa loo diri doonaa si loo eego mastooseoska (nidaam kale oo ah myeloproliferative neoplasm).
Daaweynta
Daaweyntaada ayaa lagu go'aamiyaa nooca cudurka hypereosinophilic syndrome iyo ciladda calaamadahaaga. Waa wax aan caadi ahayn in loo baahdo daaweyn sax ah marka la ogaanayo, laakiin HES aad ayay u yartahay daaweyn degdeg ah.
- Steroids: Steroids sida prednisone iyo methylprednisolone ayaa loo isticmaali karaa.
- Imatinib: Imatinib waa dawo afka laga qaato oo lagu daaweeyo kansarka loo yaqaan 'tyrosine kinase inhibitor'.
- Vincristine: Vincristine waa kiimiko (IV) kiimiko (IV) oo loo isticmaali karo. Haddii aad ka jawaabto, tiradaada eosinophil waxay hoos u dhigi kartaa saacadaha gudahooda ee maamulka.
- Hydrogxurea: Hydroxyurea waa dawo kiimiko ah oo afka ah. Waxay qaadan kartaa ilaa 2 toddobaad si loo arko jawaabta daawadan.
Haddii ay jiraan waxyaabo ka mid ah neoplasmallka myeloprermis (heerarka fitamiin B12 oo sareeya, beeryaro ballaaran, eosinophils atypical, iwm), daaweynta bilowga waa imatinib. Haddii uu jiro kaadida wadnaha, steroids ayaa lagu daraa. Haddii imatinib aysan waxtar lahayn, waxaa jira dhowr daawo oo la mid ah oo la isticmaali karo. Inta badan dadka qaba HES uma baahna daaweyn laakiin waxay u baahan yihiin kormeer taxadar leh dhaawaca xubnaha, horumarinta xinjirta dhiigga (thrombosis), iyo horumarinta cudurka. Haddii ay jirto ka qayb qaadashada xubinta taranka, steroids waa daaweynta ugu horeysa. Sababtoo ah isticmaalka steroid-ka muddo dheer wuxuu la xiriiraa waxyeelo badan, marka calaamadaha la xakameynayo, waxaa laguu bedeli karaa daawooyin kale sida hydroxyurea, alpha interferon, ama methotrexate daaweynta socota.
Sida korka loo arko, steroids waa daaweyn muhiim ah. Ka hor inta aan la bilaabin steroids waxaa muhiim ah in la go'aamiyo haddii aad halis u tahay cudurka influwanka loo yaqaan Strongyloides. Steroidsku waxay ka sii dari karaan infekshanka Strongyloides si aad ah. Haddii aad u baahan tahay daaweyn deg-deg ah oo ay jiraan wax walaac ah oo aad qabtid infekshanka Strongyloides, waxaa lagugu daaweyn doonaa infekshanka (daaweynta afka ilaa 2 maalmood).
Ereyga
Barashada aad qabtid cudurka hypereosinophilic waxay noqon kartaa cabsi. Nasiib wanaag, inta badan dadka heysata HES uma baahna daaweyn. Kuwa kuwa sameeya, waxaa jira ikhtiyaaro dhowr ah iyo xitaa in badan oo hadda la baranayo.
> Isha
> Roufosse F, Klion AD, Weller PF. Xanuunada hypereosinophilic: Calaamadaha kiliiniga, xanuunka nafsiga, iyo cilad-sheegidda iyo astaamaha hypereosinophilic: Daaweynta. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. (Lasoo gooyey July 5, 2016.)