Lefu la Rustitzky-Kahler kapa myeloma ke boloetse ba tlhaho ba tlhaho ea tsamaiso ea potoloho. Tšobotsi ea tšobotsi ea lefu lena ke hore ka lebaka la hlahala e kotsi maling, palo ea li-plasmocyte (lisele tse hlahisang immunoglobulin) lia eketseha, e leng ho qala ho hlahisa immunoglobulin e ngata (paraprotein).
Manyeloma e mengata - ke eng ka mantsoe a bonolo?
Myeloma e ngata ke e 'ngoe ea mefuta ea myeloma. Mokokotlo o bolaeang plasmocyte boloetse bona o hlaha mokong oa masapo. Ha e le hantle, myeloma ea masapo a mokokotlo, lehata, pelvis, likhopo, thorax, 'me, hangata haholo, masapo a mafura a' mele, a tloaelehile. Mefuta e kotsi (plasmacytomas) e nang le myeloma e mengata e tšoara masapo a 'maloa' me e fihla boholo ba 10-12 cm bophara.
Plasmocyte ke karolo ea sesole sa 'mele sa' mele. Li hlahisa li-antibodies tse khethehileng tse sireletsang khahlanong le lefu le itseng (e leng immunoglobulin e lokelang ho hlahisoa ka "ho susumelletsa" lisele tse khethehileng tsa memori). Lisele tsa 'mele tse tšoaelitsoeng ke hlahala (lisele tsa plasmomyeloma) lihlahisoa tse sa laoleheng li hlahisa li-immunoglobulin tse sa khone ho sireletsa' mele, empa li bokella lithong tse ling le ho senya mosebetsi oa tsona. Ho feta moo, plasmacytoma e baka:
- fokotseha ka palo ea erythrocyte, platelet le leukocyte;
- ho eketseha ha immunodeficiency le ho eketseha kotsing ea mafu a sa tšoaneng;
- hematopoiesis le mali a viscosity a eketseha;
- tlōlo ea diminerale le protheine metabolism;
- ponahalo ea ho kenella lithong tse ling, haholo-holo hangata liphio;
- liphetoho tsa mafu a lesapo la masapo sebakeng sa hlahala - lesapo le fokotsehile mme le senyeha, 'me ha hlahala e hlaha ka eona, e kenella ka lithong tse bonolo.
Mabaka a myeloma
Ho kula ha Rustitskiy-Kahler ho ithutiloe ke lingaka, empa ha ho lumellane ka mabaka a hore na ho etsahala'ng ka meriana ea bongaka. E fumanoe hore 'meleng oa motho ea kulang, likokoana-hloko tsa lymphatic tsa mofuta oa T kapa B li atisa ho ba teng,' me kaha lisele tsa plasma li theha ho tloha ho li-lymphocyte tsa B, tlōlo leha e le efe ea ts'ebetso ena e lebisa tlholehong le ho qala ho thehoa ha li-pathoplasmocytes.
Ntle le ts'ebetso ea kokoana-hloko, ho na le bopaki ba hore myeloma e ka boela ea bakoa ke ho pepeseha ha mahlaseli. Lingaka li ile tsa ithuta batho ba ileng ba ameha Hiroshima le Nagasaki, sebakeng seo ho phatlohang ho sona sehlahisoa sa matla sa nyutlelie sa Chernobyl. Ho fumanoe hore har'a ba fumaneng mahlaseli a phahameng, karolo ea likarolo tsa myeloma le mafu a mang a amanang le mali le lymphatic system e phahameng.
Har'a lintho tse mpe tse eketsang kotsi ea ho tšoara myeloma, lingaka li re:
- Ho tsuba - ha nako e telele ho tsuba ho tsuba le ha sesekere e tsuba haholoanyane, e beha kotsi;
- immunodeficiency;
- tšusumetso ho 'mele oa lintho tse chefo;
- liphatsa tsa lefutso.
Myeloma - matšoao
Myeloma haholo-holo o hlaha botsofaling, ho ama basali le banna. Lefu lena Rustitskogo-Kahler - matšoao le setšoantšo sa bongaka, se hlokomelitsoeng ho bakuli:
- ho hlōloa haemopoietic le bone;
- ho tlōla mekhoa ea metsolic;
- liphetoho tsa lefu lena tsamaisong ea ho ntša metsi.
Matšoao a mangata a myeloma:
- matšoao a pele a myeloma ke mahlaba masapong (ka mokokotlo, sefubeng, masapo a mangole), ho fapana ka makhetlo a mangata, ho senyeha ha masapo le boteng ba mahlaseli;
- pneumonia khafetsa le maloetse a mang, a tsosoa ke ho oa ha tšireletso le ho thibela mehato ea ho hema ho bakoa ke liphetoho masapong a sefubeng;
- liphetoho tse tsitsitseng ka har'a mesifa ea pelo, ho hloleha ha pelo;
- spleen e eketsehileng le sebete;
- myeloma nephropathy - boloetse bo liphio ka ho eketseha ha liprotheine ka metsing, e leng ho fetoha ho se nang letho;
- normochromic anemia - ho fokotsa palo ea erythrocytes le hemoglobin;
- hypercalcemia - kakaretso e eketsehileng ea khalsiamo ka lero la mali le mmele, boemo bona bo kotsi haholo, matšoao a eona - ho hlatsa, ho nyeheloa ke pelo, ho otsela, ho tsieleha ha lisebelisoa tsa mahlaseli, matšoao a kelello;
- fokotseha boemong ba tloaelehileng ea immunoglobulin;
- Mathata a hemopoiesis - ho tsoa mali a mongobo, ho longoa, ho ba le methapo ea methapo ea phalanges, ho fokotsa lefu la diathesis;
- paresthesia ("e tsosang"), hlooho, ho otsela, ho fetoha sekoti, ho ferekana, ho ba le botsoa, ho se utloe, dyspnea;
- mekhahlelo ea ho qetela - ho lahleheloa ke boima ba 'mele, feberu, khaello e matla ea mali.
Mefuta ea myeloma
Ho ea ka likarolo tsa tlhokomelo ea litsebi tsa bophelo, myeloma ke ea mefuta e latelang:
- myeloma e le mong - e nang le hlahala e le 'ngoe kapa lesapo la lymph;
- mefuta e mengata (e tloaelehileng) myeloma - ka ho thehoa ha likokoana-hloko tse 'maloa.
Ho phaella moo, myeloma e mengata e ka ba:
- ho fapana - tabeng ena botsofali bo hlophisitsoeng ha bo na meeli, empa ka ho feletseng sebopeho sa masapo;
- ho tsepamisa makhetlo a mararo - plasmacytoma ea lesapo le hlaha libakeng tse fokolang, 'me ho phaella moo, lihlahala li ka etsahala lymph nodes, spleen.
- ho fapanyetsana haholo - ho kopanya matšoao a ho fapana le a mangata.
Matšoao a Myeloma - mekhahlelo
Lingaka li arola mekhahlelo e meraro ea myeloma e mengata, mohato oa bobeli ke oa nakoana, ha li-indices li phahame ho feta tsa pele, empa li tlase ho feta tsa boraro (tse boima ka ho fetisisa):
- Karolo ea pele e na le hemoglobin e theohelang ho 100 g / l, tekanyo ea khalsiamo e tloaelehileng, mahlaseli a tlaase a li-paraprotein le liprotheine tsa Bens-Jones, e leng lehlakoreng le leng la 0,6 lik'hilograma / mmera, ha ho na lefu la osteoporosis, lesapo la bone.
- Karolo ea boraro e theoleloa ho 85 g / l le hemoglobin e tlaase, mahlaseli a khalsiamo maling a fetang 12 mg ka 100 ml, li-tumor tse ngata, mahlaseli a mangata a paraprotein le protheine ea Bens-Jones, totor e kholo ea 1.2 kg / mm kapa ho feta, matšoao a lefu la ho fokola ha masapo.
Mathata a myeloma
Bakeng sa myeloma e mengata, mathata a amanang le mosebetsi o senyang oa hlahala ke litšoaneleho:
- bohloko bo boholo le ho robeha ha masapo (fractures);
- ho hlōleha ha renal le tlhokahalo ea hemodialysis ;
- maloetse a tšoaetsanoang a tsitsitseng;
- lefu la phokolo ea mali sebakeng se tebileng, le hlokang ho tšeloa mali.
Myeloma - ho hlahlojoa
Ka ho hlahlojoa ha myeloma, bothata ba ho khetholla ho thata bo thata, haholo-holo maemong ao ho seng ho bonahalang eka ho na le likokoana-hloko tse hlakileng. Mokuli o hlahlojoa ke setsebi sa mafu a tšoaetso ea mafu a tšoaetsanoang ke myeloma, ea qalang ho etsa lipatlisiso mme o fumana hore na ho na le lipontšo tse kang bohloko ba masapo, ho tsoa mali, mafu a mangata a tšoaetsanoang. Ho feta moo, liphuputso tse eketsehileng li etsoa ho hlakisa ho hlahlojoa, sebōpeho le boholo ba tsona:
- tlhahlobo e tloaelehileng ea mali le moroto;
- sefuba le masapo a x-ray;
- computed tomography;
- tlhahlobo ea mali ea mali ;
- coagulogram ;
- ho ithuta ka bongata ba paraproteins maling le morong;
- 'moho oa masapo;
- ho ithuta ka mokhoa oa Mancini mabapi le tlhaloso ea li-immunoglobulin.
Myeloma - tlhahlobo ea mali
Haeba ho nahanoa hore lefu la myeloma le nahanngoa, ngaka e fana ka tlhahlobo ea mali e akaretsang le ea phekolo ea mali. Lintlha tse latelang li tloaelehile bakeng sa lefu lena:
- hemoglobin - tlase ho 100 g / l;
- erythrocyte - tlase ho 3.7 t / l (basali), tlase ho 4.0 t / l (banna);
- liplatelete - tlase ho 180 g / l;
- likocyte - tse ka tlaase ho 4,0 g / l;
- ESR - tse fetang 60 mm ka hora;
- protheine - 90 g / l le holimo;
- albumin - 35 g / l le ka tlase;
- urea - 6.4 mmol / L le ho feta;
- khalsiamo - 2.65 mmol / l le ho feta.
Myeloma - X-ray
Ntho ea bohlokoa ka ho fetisisa ea thuto le myeloma ke X-ray. Ho fumanoa ha lingaka tse ngata tsa myeloma ka lebaka la ho hlahlojoa ke radiography ho ka tiisa kapa ho tlohela lipelaelo ka botlalo. Mahlaseli a x-ray a bonahala ka ho hlaka, 'me ho phaella moo - ngaka e khona ho lekanya boholo ba tšenyo le ho fetoha ha mesifa ea masapo. Lisosa tse sa tšoaneng tse hlahisang X-ray li senola ho le thata, kahoo ngaka e ka 'na ea hloka mekhoa e meng.
Boloetse ba Myeloma - phekolo
Hona joale, bakeng sa phekolo ea myeloma, mokhoa o kopanetsoeng o sebelisoa, le tšebeliso e ka sehloohong ea lithethefatsi tse fapaneng. Ho hlokahala phekolo ea ho buoa bakeng sa ho lokisa li-vertebrae ka lebaka la ho timetsoa. Mefuta e mengata ea myeloma - kalafo ea lithethefatsi e akarelletsa:
- Ho phekoloa kalafo , ho susumelletsa ho qaptjoa ha liprotheine, ho lebisa ntoeng le paraproteins;
- chemotherapy, ho thibela ho hōla ha lisele tsa kankere le ho li bolaea;
- Meriana ea 'mele ea ho itšireletsa mafung e ikemiselitse ho itšireletsa mafung;
- phekolo ea corticosteroid, e ntlafatsang phekolo ea motheo;
- ho phekoloa ka li- bisphosphonate tse matlafatsang mesifa ea bone;
- phekolo ea meriana e thibelang lefu lena.
Myeloma - litlhahiso tsa kliniki
Ka bomalimabe, ho ke ke ha khoneha ho hlaphoheloa ka ho feletseng ho myeloma, phekolo e ikemiselitse ho lelefatsa bophelo. Ho etsa sena, o tlameha ho latela melao e itseng. Tlhahlobo ea myeloma - litlhahiso tsa lingaka:
- Hlokomela ka hloko phekolo e boletsoeng ke ngaka.
- Matlafatsa ho itšireletsa mafung, empa le ka ho tsamaea, mekhoa ea metsi, sunbathing (ho sebelisa seplase sa letsatsi le nakong ea mosebetsi o fokolang oa letsatsi - hoseng le ka shoalane).
- Ho itšireletsa ho tsoaetsing - hlokomela melao ea bohloeki, qoba libaka tse ngata, hlatsoa matsoho pele u noa meriana pele u ja.
- U se ke ua tsamaea u sa roala lieta, ka lebaka la ho hlōloa ha methapo ea meriana ho bonolo hore u utloise bohloko 'me u se ke ua e hlokomela.
- Hlahloba boemo ba tsoekere lijong, joalo ka ha lithethefatsi tse ling li tlatsetsa ho nts'etsong ea lefu la tsoekere.
- Lula u e-na le boikutlo bo botle, hobane maikutlo a nepahetseng ke a bohlokoa haholo bakeng sa lefu lena.
Chemotherapy bakeng sa myeloma e mengata
Chemotherapy bakeng sa myeloma e ka etsoa ka meriana e le 'ngoe kapa ho feta. Mokhoa ona oa phekolo o lumella ho finyelloa ka ho feletseng ka 40% ea linyeoe, ka karolo ea 50%, leha ho le joalo, ho khutlela ha lefu lena hangata hangata, kaha lefu lena le ama litho tse ngata le lisele tse ngata. Plasmacytoma - phekolo ea chemotherapy:
- Karolong ea pele ea phekolo, chemotherapy e laetsoeng ke ngaka ka matlapa kapa liente e nkiloe ho latela morero.
- Karolong ea bobeli, haeba chemotherapy e sebetsa hantle, masapo a bakoang ke mofu o fetisetsoa - a nke nako, a ntše masela a bakoang 'me a li khomarele.
- Pakeng tsa li-chemotherapy, lithupelo tsa lipilisi tse nang le lithethefatsi tsa alpha-lipere li etsoa - ho eketsa ts'oarelo.
Mefuta e mengata ea myeloma - prognosis
Ka bomalimabe, ka ho hlahlojoa ha myeloma, ho phatloha hoa nyahamisa - lingaka li khona feela ho lelefatsa nako ea ho phomola. Hangata bakuli ba myeloma ba bolaoa ke pneumonia, ho tsoa mali ho bolaeang ho bakoang ke ho tlōla ha mali, ho robeha ha liphio, ho hloleha ha liphio, thromboembolism. Ntho e nepahetseng ea ho fana ka bopaki ke bocha ebile e le mohato oa pele oa lefu lena, ho tsebahala ho hobe ho feta batho ba fetang 65 ba nang le maloetse a khotsofatsang a liphio le litho tse ling, lihlahala tse ngata.
Manyeloma e mengata - tebello ea bophelo:
- Lilemo tse 1-2 - ntle le phekolo;
- ho fihlela ho lilemo tse 5 - tekanyo ea bophelo ea myeloma bakeng sa batho ba phekoloang;
- ho fihlela ho lilemo tse 10 - tebello ea bophelo le phekolo e ntle ho chemotherapy le maloetse boemong bo bonolo;
- lilemo tse fetang 10 li ka phela feela bakuli ba nang le hlahala e le 'ngoe feela, ba tlosoa ka katleho ke lingaka.