Ukutsala i-vasculitis

I-Necrotizing vasculitis liqela leengxaki ezibandakanya ukudumba kweendonga zemithambo yegazi. Ubungakanani bemithambo yegazi echaphazelekayo inceda ukumisela amagama ezi meko kunye nendlela isifo esisibangela ngayo isifo.

I-Necrotizing vasculitis inokuba yeyona meko iphambili njenge-polyarteritis nodosa okanye i-granulomatosis ene-polyangiitis (eyayibizwa ngokuba yi-Wegener granulomatosis). Ngamanye amaxesha, i-vasculitis inokwenzeka njengenxalenye yesinye isifo, njenge-systemic lupus erythematosus okanye i-hepatitis C.

Unobangela wokudumba awaziwa. Kusenokwenzeka ukuba inxulumene nezinto ezizimeleyo. Udonga lomthambo wegazi lunokukrala kwaye lutshise okanye lufe (lube necrotic). Umthambo wegazi ungavala, uphazamise ukuhamba kwegazi kwizicubu ezinikezelayo. Ukungabikho kokuhamba kwegazi kuya kubangela ukuba izicubu zife. Ngamanye amaxesha isitya segazi sinokuqhekeka kwaye sopha (ukuqhekeka).

I-Necrotizing vasculitis inokuchaphazela imithambo yegazi kulo naliphi na ilungu lomzimba. Ke ngoko, inokubangela iingxaki kulusu, kwingqondo, kwimiphunga, emathunjini, kwizintso, kwingqondo, kumalungu okanye kulo naliphi na elinye ilungu.

Umkhuhlane, Ukugodola, ukudinwa, isifo samathambo, okanye ukwehla kobunzima inokuba kuphela kwempawu zokuqala. Nangona kunjalo, iimpawu zinokuba phantse kulo naliphi na ilungu lomzimba.

Ulusu:

• Amaqhuma abomvu okanye mfusa anemilenze, izandla okanye amanye amalungu omzimba
• Umbala oluhlaza okwesibhakabhaka kwiminwe neenzwane
• Iimpawu zokufa kweethishu ngenxa yokunqongophala kweoksijini njengentlungu, ukuba bomvu kunye nezilonda ezingapholiyo

Imisipha namalungu:

• Intlungu edibeneyo
• Intlungu yomlenze
• Ubuthathaka bemisipha

Ubungqina kunye nenkqubo ye-nervous:

• Ubuhlungu, ukuba ndindisholo, ukubetha ngengalo, emlenzeni, okanye kwenye indawo yomzimba
• Ubuthathaka bengalo, umlenze, okanye enye indawo yomzimba
• Abafundi abahlukeneyo ngobukhulu
• Ukujongwa kweenkophe
• Ukuginya ubunzima
• Ukonakala kwentetho
• Ubunzima bokuhamba

Imiphunga kunye neendlela zokuphefumla:

• Khohlela
• Ukuqhawukelwa ngumphefumlo
• Ukuxinana kweSinus kunye neentlungu
• Ukukhohlela igazi okanye ukopha empumlweni

Ezinye iimpawu zibandakanya:

• Intlungu zesisu
• Igazi kumchamo okanye ilindle
• Ukugquma okanye ukutshintsha kwelizwi
• Intlungu yesifuba ekonakaleni kwemithambo ebonelela ngentliziyo (yemithambo yegazi)

Umboneleli wezempilo uya kwenza uvavanyo olupheleleyo lomzimba. Inkqubo yeemvakalelo (yemithambo-luvo) inokubonisa iimpawu zomonakalo wemithambo-luvo.

Uvavanyo olunokwenziwa lunokubandakanya:

• Gcwalisa ubalo lwegazi, ipaneli yekhemistri ebanzi, kunye novavanyo lokuchama
• I-x-ray yesifuba
• Uvavanyo lweprotheni esebenzayo yeC
• Inqanaba lentlenga
• Uvavanyo lwegazi lwe-hepatitis
• Uvavanyo lwegazi kwii-antibodies ezichasene nee-neutrophils (ii-antibodies ze-ANCA) okanye ii-antigen zenyukliya (ANA)
• Uvavanyo lwegazi kwii-cryoglobulins
• Uvavanyo lwegazi ngokwamanqanaba okuxhasa
  
• Ukulinganisa izifundo ezinje nge-angiogram, ultrasound, scan computed tomography (CT), okanye imaging resonance imaging (MRI)
• I-Biopsy yolusu, umsipha, amalungu omzimba, okanye imithambo-luvo

ICorticosteroids inikwa kwiimeko ezininzi. Idosi iya kuxhomekeka ekubeni imeko imbi kangakanani.

Amanye amachiza athintela amajoni omzimba anokunciphisa ukudumba kwemithambo yegazi. Oku kubandakanya i-azathioprine, i-methotrexate, kunye ne-mycophenolate. La mayeza ahlala esetyenziswa kunye ne-corticosteroids. Le indibaniselwano yenza ukuba kube lula ukulawula isifo kunye nedosi esezantsi ye-corticosteroids.

Kwisifo esibi, i-cyclophosphamide (iCytoxan) sele isetyenziswe iminyaka emininzi. Nangona kunjalo, i-rituximab (i-Rituxan) isebenza ngokulinganayo kwaye ayinabungozi.

Kutshanje, i-tocilizumab (Actemra) ibonakalisiwe ukuba iyasebenza kwi-arteritis enkulu yeseli ukuze i-corticosteroids yedosi incitshiswe.

I-Necrotizing vasculitis inokuba sisifo esibi kwaye sisongela ubomi. Isiphumo sixhomekeke kwindawo ye-vasculitis kunye nobukhulu bomonakalo wethishu. Iingxaki zinokubakho kwesi sifo nakumayeza. Uninzi lweefom ze-necrotizing vasculitis zifuna ukulandelelwa kunye nokunyangwa ixesha elide.

Iingxaki zinokubandakanya:

• Umonakalo ongapheliyo kulwakhiwo okanye umsebenzi wommandla ochaphazelekayo
• Usulelo lwesibini lwezicubu ze-necrotic
• Iziphumo ebezingalindelekanga ezivela kumayeza asetyenzisiweyo

Tsalela umnikezeli wakho ukuba uneempawu zokuqunjelwa kwe-vasculitis.

Iimpawu ezingxamisekileyo zibandakanya:

• Iingxaki ngaphezulu kwenxalenye enye yomzimba enjengokubetha, isifo samathambo, irhashalala lolusu, iintlungu zesisu okanye ukukhohlela igazi
• Utshintsho kubungakanani bomfundi
• Ukuphulukana nokusebenza kwengalo, umlenze, okanye elinye ilungu lomzimba
• Iingxaki zentetho
• Ukuginya ubunzima
• Ubuthathaka
• Iintlungu ezinzima zesisu
  

Akukho ndlela yaziwayo yokuthintela esi sifo.

• Inkqubo yokujikeleza

UJennette JC, uFalk RJ. Izintso kunye ne-vasculitis yenkqubo. Ku: Feehally J, Floege J, Tonelli M, Johnson RJ, ii-eds. I-Clinical Nephrology epheleleyo. Umhla wesi-6. IPhiladelphia, PA: Elsevier; I-2019: isahluko 25.

UJennette JC, Weimer ET, Kidd J.Vasculitis. Ku: McPherson RA, Pincus MR, ii-eds. Ukuchongwa kweKlinikhi kaHenry kunye noLawulo ngeendlela zeLebhu. Umhla wama-23. ISt Louis, MO: Elsevier; Ngo-2017: isahluko 53.

URhee RL, uHogan SL, uPoulton CJ, et al. Imikhwa kwiziphumo zexesha elide phakathi kwezigulana ezine-antineutrophil cytoplasmic antibody-ehambelana ne-vasculitis enesifo sezintso. Isifo samathambo Rheumatol. Ngo-2016; 68 (7): 1711-1720. IINKCUKACHA: 26814428 www.ncbi.nlm.nih.gov/pubmed/26814428.

Iindidi U, Merkel PA, Seo P, et al. Ukusebenza kweerejimeni zokungenisa uxolelo kwi-vasculitis enxulumene ne-ANCA. N Engl J Med. Ngo-2013; 369 (5): 417-427. IINKCUKACHA: 23902481 www.ncbi.nlm.nih.gov/pubmed/23902481.

Ilitye JH, uKlearman M, uCollinson N. Uvavanyo lwe-tocilizumab kwi-giant-cell arteritis. N Engl J Med. Ngo-2017; 377 (15): 1494-1495. IINKCUKACHA: 29020600 www.ncbi.nlm.nih.gov/pubmed/29020600.