Isibindi seFibrosis

Umxholo

• Ngawaphi amanqanaba e-fibrosis yesibindi?
• Zithini iimpawu zesibindi fibrosis?
• Yintoni unobangela wesibindi sefibrosis?
• Izinketho zonyango
• Uxilongo
• Isibindi se-biopsy
• Elastography yethutyana
• Uvavanyo lwe-Nonsurgical
• Iingxaki
• Imbonakalo

Ushwankathelo

I-fibrosis yesibindi yenzeka xa izicwili ezisempilweni zesibindi sakho ziba namabala kwaye ke azikwazi kusebenza nazo. I-Fibrosis yinqanaba lokuqala lokuqhaqha kwesibindi. Emva kwexesha, ukuba uninzi lwesibindi luba namanxeba, yaziwa ngokuba sisibindi sokuqina kwesibindi.

Ngelixa ezinye izifundo zezilwanyana zibonise ukubakho kwesibindi sokuzivuselela okanye ukuziphilisa, sakuba umonakalo wesibindi wenziwe ebantwini, isibindi asihlali siphola. Nangona kunjalo, amayeza kunye notshintsho kwindlela yokuphila kunokunceda ukugcina i-fibrosis ekubeni mandundu.

Ngawaphi amanqanaba e-fibrosis yesibindi?

Kukho amanqanaba ahlukeneyo esiteji se-fibrosis, apho ugqirha emisela inqanaba lokonakala kwesibindi. Kuba ukulinganisa kunokuba yinto yokuthobela, inqanaba ngalinye linomda walo. Omnye ugqirha unokucinga ukuba isibindi sinesikrelemnqa kancinci kunomnye. Nangona kunjalo, oogqirha baya kuhlala babela inqanaba kwi-fibrosis yesibindi kuba iyanceda isigulana kunye nabanye oogqirha baqonde inqanaba apho isibindi somntu sichaphazeleka khona.

Enye yeenkqubo zokufumana amanqaku ezaziwayo yinkqubo yokufumana amanqaku ye-METAVIR. Le nkqubo inika amanqaku “omsebenzi” okanye uqikelelo lokuba i-fibrosis iqhubeka njani, kunye nenqanaba le-fibrosis ngokwalo. Oogqirha banokuhlala benikezela eli nqaku kuphela emva kokuthatha isampulu ye-biopsy okanye yeethishu yesiqwengana sesibindi. Amanqanaba omsebenzi asusela ku-A0 ukuya ku-A3:

• A0: akukho msebenzi
• I-A1: umsebenzi omnene
• I-A2: umsebenzi ophakathi
• I-A3: umsebenzi onzima

Amanqanaba e-fibrosis aqala ukusuka kwi-F0 ukuya kwi-F4:

• F0: akukho fibrosis
• I-F1: i-portal fibrosis ngaphandle kwe-septa
• I-F2: i-portal fibrosis ene-septa ezimbalwa
• I-F3: uninzi lwe-septa ngaphandle kwesibindi
• F4: ukuqina kwesibindi

Ke ngoko, umntu onesona sifo sinzima uya kuba nenqaku le-A3, F4 METAVIR.

Enye inkqubo yokufumana amanqaku yiBatts kunye neLudwig, ethi ibanga i-fibrosis kwinqanaba le-1 ukuya kwiBanga lesi-4, ibanga lesi-4 libe lelona linzima. Umbutho wamanye amazwe woFundo lweSibindi (IASL) ikwanenkqubo yokufumana amanqaku aneendidi ezine ezisusela kwisifo sokudumba kwesibindi esinganyangekiyo ukuya kwisifo sesibindi esingapheliyo.

Zithini iimpawu zesibindi fibrosis?

Oogqirha abasoloko bechonga i-fibrosis yesibindi kumanqanaba aso aphakathi ukuya phakathi. Kungenxa yokuba i-fibrosis yesibindi ayisoloko ibangela iimpawu kude kube ngakumbi kwesibindi esonakeleyo.

Xa umntu esenza inkqubela phambili kwisifo sesibindi, banokufumana iimpawu ezibandakanya:

• ukungabi namdla wokutya
• ubunzima bokucinga ngokucacileyo
• ulwelo olwakhiweyo emilenzeni okanye esiswini
• i-jaundice (apho ulusu namehlo avela emthubi)
• isicaphucaphu
• ukwehla kobunzima obungachazwanga
• ubuthathaka

Ngokuka-a, kuqikelelwa kwi-6 ukuya kwi-7 ipesenti yabemi behlabathi abanesibindi se-fibrosis kwaye abayazi kuba abanazimpawu.

Yintoni unobangela wesibindi sefibrosis?

I-fibrosis yesibindi yenzeka emva kokuba umntu eye wenzakala okanye ukudumba esibindini. Iiseli zesibindi zikhuthaza ukuphola kwenxeba. Ngexesha lokuphiliswa kwenxeba, iiproteni ezigqithileyo ezinje ngeclagen kunye neeglycoprotein zakha esibindini. Ekugqibeleni, emva kokulungiswa okuninzi, iiseli zesibindi (ezaziwa ngokuba zii-hepatocytes) azisakwazi ukuzilungisa. Iiproteni ezigqithisileyo zenza izicwili ezibomvu okanye i-fibrosis.

Zininzi iintlobo zezifo zesibindi ezinokubangela i-fibrosis. Oku kubandakanya:

• hepatitis yomzimba
• isithintelo se-biliary
• ukugcwala kwentsimbi
• isifo sesibindi esinamafutha esinganxili, esinokubandakanya isibindi esinamafutha (i-NAFL) kunye ne-nonalcoholic steatohepatitis (NASH)
• intsholongwane hepatitis B no-C
• isifo sesibindi esinxilisayo

Ngokutsho, esona sizathu siqhelekileyo sesibindi i-fibrosis sisifo sesibindi esinamafutha (i-NAFLD), ngelixa esi sibini sisifo sesibindi esinxilisayo ngenxa yokusela kakhulu ixesha elide.

Izinketho zonyango

Ukhetho kunyango lwe-fibrosis yesibindi zihlala zixhomekeke kwisizathu esisisiseko se-fibrosis. Ugqirha uya kunyanga isigulo esisisiseko, ukuba kunokwenzeka, ukunciphisa iziphumo zesifo sesibindi. Umzekelo, ukuba umntu usela utywala kakhulu, ugqirha unokucebisa ngenkqubo yonyango yokumnceda ayeke ukusela. Ukuba umntu unayo i-NAFLD, ugqirha unokucebisa ukuba enze utshintsho ekutyeni ukunciphisa umzimba kunye nokuthatha amayeza ukukhuthaza ulawulo lweswekile lwegazi. Ukuzilolonga kunye nokunciphisa umzimba kunokunceda ekunciphiseni ukuqhubela phambili kwesi sifo.

Ugqirha unokuyalela amayeza abizwa ngokuba zi-antifibrotics, eziye zaboniswa ukunciphisa amathuba okuba isibindi senzeke. I-antifibrotic emiselweyo ihlala ixhomekeke kwimeko yezonyango engaphantsi. Imizekelo yonyango ibandakanya:

• isifo sesibindi esinganyangekiyo: I-ACE inhibitors, ezinje nge-benazepril, i-Lisinopril, kunye ne-ramipril
• intsholongwane hepatitis C: a-Tocopherol okanye i-interferon-alpha
• ukunganyangeki steatohepatitis: I-agonist ye-PPAR-alpha

Ngelixa abaphandi beqhuba iimvavanyo ezininzi ukuzama ukufumana amayeza anokuguqula iimpembelelo zesibindi fibrosis, akukho naliphi na iyeza elinokukwenza oku okwangoku.

Ukuba isibindi somntu somntu siqhubela phambili apho isibindi sinenxeba kwaye singasebenzi, unyango lomntu kuphela luhlala lufumana ukufakelwa kwesibindi. Nangona kunjalo, uluhlu lokulinda lude kwezi ntlobo zokufakelwa kwaye ayinguye wonke umntu ongumgqatswa wotyando.

Uxilongo

Isibindi se-biopsy

Ngokwesiko, oogqirha babecinga ukuthatha i-biopsy yesibindi "umgangatho wegolide" wokuvavanyelwa i-fibrosis yesibindi. Le yinkqubo yotyando apho ugqirha angathatha khona isampulu yethishu. Ingcali eyaziwa ngokuba yi-pathologist iya kuvavanya izicubu kubukho besiqholo okanye i-fibrosis.

Elastography yethutyana

Olunye ukhetho luvavanyo lokucinga olwaziwa njengelastography yexeshana. Olu luvavanyo olulinganisa indlela esiqina ngayo isibindi. Xa umntu ene-fibrosis yesibindi, iiseli ezinqabileyo zenza isibindi siqine. Olu vavanyo lusebenzisa amaza esandi asezantsi ukulinganisa ukuba ziqinile njani izicubu zesibindi. Nangona kunjalo, kunokwenzeka ukuba ube neemposiso ezingezizo apho izicwili zesibindi zinokubonakala ziqinile, kodwa i-biopsy ayibonisi ukonakala kwesibindi.

Uvavanyo lwe-Nonsurgical

Nangona kunjalo, oogqirha baye bakwazi ukusebenzisa ezinye iimvavanyo ezingadingi utyando ukufumanisa ukuba umntu unokuba nesibindi se-fibrosis. Olu vavanyo lwegazi luhlala lubekelwe abo banesifo esosulelayo sesifo se-hepatitis C abasengozini yokuba ne-fibrosis yesibindi ngenxa yesifo sabo. Imizekelo ibandakanya i-serum hyaluronate, i-matrix metalloproteinase-1 (MMP), kunye ne-tissue inhibitor ye-matrix metalloproteinase-1 (TIMP-1).

Oogqirha banokusebenzisa iimvavanyo ezifuna ukubalwa, ezinje nge-aminotransferase-to-platelet ratio (APRI) okanye uvavanyo lwegazi olubizwa ngokuba yiFibroSURE olinganisa amanqaku amathandathu ahlukeneyo esibindi kwaye uwafaka kwialgorithm ngaphambi kokumisela amanqaku. Nangona kunjalo, ugqirha akanakudinga ukumisela inqanaba le-fibrosis yesibindi esekwe kwezi mvavanyo.

Ngokufanelekileyo, ugqirha uya kufumanisa umntu onesibindi se-fibrosis kwinqanaba lokuqala xa imeko inyangeka ngakumbi. Nangona kunjalo, ngenxa yokuba imeko ingahlali ibangela iimpawu kumanqanaba okuqala, oogqirha abaqhelekanga ukuxilonga imeko kwangoko.

Iingxaki

Eyona nto ibaluleke kakhulu kwisibindi i-fibrosis inokuba sisibindi sokuqina kwesibindi, okanye inxeba elomeleleyo elenza ukuba isibindi sonakalise umntu uya kugula. Ngokwesiqhelo, oku kuthatha ixesha elide ukuba kwenzeke, njengokuhamba kwexesha elinye okanye amabini eminyaka.

Umntu ufuna isibindi sakhe ukuze aphile kuba isibindi sinoxanduva lokuhluza izinto eziyingozi egazini kunye nokwenza eminye imisebenzi ebalulekileyo emzimbeni. Ekugqibeleni, ukuba i-fibrosis yomntu iqhubela phambili kwi-cirrhosis kunye nokusilela kwesibindi, banokuba neengxaki ezinje:

• i-ascites (ulwakhiwo olunamandla lwesisu esiswini)
• i-hepatic encephalopathy (ukwanda kweemveliso zenkunkuma ezibangela ukudideka)
• isifo hepatorenal
• Uxinzelelo lwe-portal
• ukopha kwe-variceal

Imeko nganye kwezi inokubulala umntu onesifo sesibindi.

Imbonakalo

Ngoku ka, i-cirrhosis yesibindi sesinye sezizathu eziphambili zokufa kwabantu kwihlabathi liphela. Ke, kubalulekile ukuba umntu afunyaniswe kwaye anyangwe i-fibrosis yesibindi kwangoko ngaphambi kokuba iqhubele kwisibindi sokuqina kwesibindi. Ngenxa yokuba i-fibrosis yesibindi ayisoloko ibangela iimpawu, oku kunzima ukwenza. Ngamanye amaxesha oogqirha kufuneka bathathele ingqalelo ubungozi bomntu, njengokutyeba kakhulu okanye ukusela kakhulu, ekufumaneni isifo se-fibrosis kunye nokucebisa unyango.