Nyob rau hauv cov xwm txheej niaj hnub no ntawm ib puag ncig kev puas tsuaj, lo lus txaus ntshai - oncology - tau hnov ntau dua. Ntawm txhua hom mob qog noj ntshav, ntau yam myeloma nyob hauv ib qho chaw tshwj xeeb. Lub etiology ntawm tus kab mob no tseem tsa cov lus nug ntau dua li cov lus teb. Nws yog dab tsi - ntau yam myeloma, vim li cas nws tshwm sim, leej twg muaj kev pheej hmoo - kab lus no yog hais txog qhov no.
Ntau lub npe, ib qho tseem ceeb
Myeloma (los ntawm Greek myelos - lub hlwb) yog ib qho kab mob ntawm lub cev cuam tshuam nrog cov hlwb ntawm cov kab mob hematopoietic - precursors ntawm B-lymphocytes, uas muaj peev xwm sib txawv rau hauv cov ntshav plasma. Raws li International Classification of Diseases, nws muaj tus lej C.90 - C.93, hais txog cov kab mob leukocytic leukemia. Hauv ntau qhov chaw, ntau yam myeloma hu ua myeloma, Rustitzky-Kahler kab mob, ntau yam myeloma, generalized plasmacytoma. Tab sis txawm nws yog hu ua, nws yog ib tug malignant tsim ntawm plasma hlwb, nyob rau hauv lub feem ntau ntawm cov pob txha pob txha. Feem ntau, cov pob txha pob txha tsim ib qho nyiajplasma hlwb. Nrog rau kev loj hlob ntawm tus kab mob, lawv cov lej nce, thiab tsim cov qe ntshav ib txwm (leukocytes, erythrocytes) txo qis. Hloov cov tshuaj tiv thaiv kab mob uas muaj lub luag haujlwm rau kev tiv thaiv kab mob, cov proteins uas raug tsim tawm.
Txheeb cais thiab laj thawj
Ntawm cov neoplasms ntawm cov ntshav plasma, myeloma yog qhov tshwm sim tshaj plaws thiab suav txog li 10% ntawm tag nrho cov kab mob ntshav siab. Feem ntau ntawm cov neeg mob yog cov txiv neej hnub nyoog tshaj 45 xyoos. Lub ncov tseem ceeb ntawm ntau yam myeloma poob rau hauv qeb ntawm cov neeg mob hnub nyoog 65 txog 70 xyoo. Cov kab mob no tsis raug kuaj pom hauv menyuam yaus.
Tus kab mob etiology tseem tsis meej. Kev soj ntsuam ntawm tus neeg mob keeb kwm tsis qhia txog cov tshuaj lom thiab cov tshuaj tiv thaiv kab mob.
txheej txheem microbiology
Plasma cells (plasmocytes) yog cov hlwb uas muab kev tiv thaiv peb. Lawv tsim cov tshuaj tiv thaiv - cov proteins tseem ceeb ntawm lub cev tiv thaiv kab mob. Lawv yog tsim los ntawm cov precursors ntawm B-lymphocytes, thiab qhov no tshwm sim nyob rau hauv cov pob txha pob txha, lymph nodes thiab txoj hnyuv. Hauv ib tus neeg noj qab haus huv, plasma hlwb tsim 5% ntawm cov hlwb uas muaj nyob hauv cov pob txha. Yog tias lawv tus lej dhau los ua ntau dua 10%, lawv tham txog kev txhim kho ntau yam myeloma (duab hauv qab no - plasma hlwb raug pleev xim rau hauv cov xim tsaus).
Cov txheej txheem ntawm kev tsim cov plasma hlwb muaj rau theem, thiab tsuas yog nyob rau theem kawg ntawm kev sib txawv, lymphocytoplasmic cells tau txais lub peev xwm los zais cov tshuaj tiv thaiv kab mob (immunoglobulins) uas tuaj yeem ua tau.tiv thaiv ntau yam kab mob (cov kab mob thiab kab mob). Yog li, ib txwm plasma cell yog ib leeg-hlwb caj pas ntawm lub cev tiv thaiv kab mob uas zais ntau pua cov tshuaj tiv thaiv ib ob.
How myeloma develops
Ib qho ntawm rau theem ntawm kev tsim cov ntshav plasma yuav ua tsis tiav, thiab hloov mus rau myeloma cell nrog cov khoom tsis zoo, uas muaj nyob rau hauv nws qhov kev faib ua ntu zus, yog tsim. Kev sib sau ntawm cov hlwb no, tsim los ntawm kev faib cov thawj, hu ua plasmacytoma. Nws hlob mus rau hauv cov pob txha lossis cov leeg, tuaj yeem ua ib leeg lossis ntau yam. Myeloma hlwb lawv tus kheej tsis nkag mus rau hauv cov hlab ntsha, tab sis lawv secrete ntau paraprotein - pathological immunoglobulin. Nws tsis ua lub luag haujlwm hauv cov txheej txheem ntawm kev tiv thaiv kab mob, tab sis tso rau hauv cov ntaub so ntswg. Nws yog tus uas pom nyob rau hauv kev kuaj ntshav.
Ntxiv rau cov tshuaj paraproteins, cov plasma hlwb tso cov protein tshwj xeeb - cytokines. Cov tshuaj protein no txhawb txoj kev loj hlob ntawm kev ua kom lub cev tsis muaj zog - ua kom cov ntshav tawg, ua kom muaj zog ntshav thiab ua kom puas tsuaj rau cov ntshav, ua kom cov protein metabolism, uas ua rau muaj cov protein metabolism, uas ua rau muaj kev puas tsuaj rau lub raum thiab lub siab. Nyob rau hauv cov pob txha cov ntaub so ntswg, myeloma plasma hlwb provoke kev puas tsuaj ntawm pob txha mos thiab pob txha cov ntaub so ntswg, voids nyob rau hauv nws.
Kev faib tawm
Tus kab mob no yog mob qog noj ntshav ntawm cov ntshav ntshav, uas ua rau lub cev tsis muaj peev xwm tiv thaiv kab mob thiab teeb meem nrog cov hlab ntshav. Raws li qhov tshwm sim ntawm kev sib kis ntawm cov qog hauvnyob rau hauv cov pob txha pob txha, diffuse, diffuse-nodular thiab ntau-nodular daim ntawv ntawm tus kab mob yog cais. Raws li cov cellular muaj pes tsawg leeg, myelomas yog plasmacytic, plasmablastic, polymorphic-cellular, me-celled. Nyob ntawm seb hom paraproteins secreted los ntawm myeloma plasma cells, muaj cov kab mob hauv qab no: non-secreting myelomas, dyclonal, Bence-Jones myeloma thiab G, A, M myelomas.
Risk pawg
Qhov ua rau muaj ntau yam myeloma tsis paub, tab sis muaj qee yam uas ua rau muaj tus kabmob:
- txiv neej tshaj 40. Nws ntseeg tau tias nrog kev txo qis hauv qib ntawm cov tshuaj hormones poj niam txiv neej, qhov kev pheej hmoo ntawm myeloma nce. Cov poj niam mob tsawg heev.
- YGenetic predisposition. 15% ntawm cov neeg mob muaj cov txheeb ze uas muaj tus kab mob no.
- Ntau tshaj. Cov kab mob metabolic hauv kev rog rog txo lub cev tiv thaiv kab mob thiab tsim cov xwm txheej rau kev loj hlob ntawm cov hlwb malignant.
- Radiation thiab toxins. Cov neeg uas tau txais kev kho hluav taws xob, cov neeg ua dej num ntawm Chernobyl kev huam yuaj thiab cov neeg uas raug cov asbestos mus sij hawm ntev, arsenic feem ntau yuav hloov B-lymphocytes. Qee qhov kev tshawb fawb muab cov ntaub ntawv hais txog cov txiaj ntsig zoo sib xws ntawm nicotine thiab cawv.
- Cov neeg tsis muaj zog tiv thaiv kab mob HIV thiab noj tshuaj tiv thaiv kab mob.
- Cov neeg tawv nqaij tawv tawv muaj ob npaug yuav muaj mob xws li Caucasians thiab Asians.
Cov tsos mob ntawm ntau tus kab mob myeloma
Nyob zootsis muaj ntau cov hlwb myelin, tus kab mob tuaj yeem ua asymptomatic. Raws li lawv cov naj npawb nce, lawv hloov cov hlwb qub hauv cov pob txha, thiab ntau thiab ntau cov tshuaj paraproteins nkag mus rau hauv cov hlab ntsha. Nrog ntau yam myeloma, cov tsos mob tshwm sim feem ntau los ntawm cov pob txha, ob lub raum thiab lub cev tiv thaiv kab mob. Hauv qhov no, daim duab kho mob nyob ntawm theem ntawm kev loj hlob ntawm qog thiab tus nqi ntawm paraproteins hauv cov ntshav. Hauv 10% ntawm cov neeg mob, cov hlwb txawv txav tsis tsim cov proteins uas tsis zoo, thiab tus kab mob ua rau tsis muaj tsos mob. Daim duab kho mob ntawm ntau yam myeloma ntawm cov ntshav yog dominated los ntawm:
- Kev qaug zog thiab qaug zog tas li.
- Kev poob phaus.
- Mob pob txha thiab cov leeg. Mob taub hau.
- Pathological pob txha tawg.
- Immune status disorders, nquag kis kab mob.
- nce ntshav viscosity thiab siab ESR nyob rau lub sijhawm ntev.
- Cov kab mob trophic ntawm qis qis, tsis cuam tshuam nrog varicose leeg.
- Sclera hemorrhage, pos hniav los ntshav, subcutaneous hemorrhage thiab bruising.
- Kidney puas.
Yuav ua li cas rau pob txha
Nyob rau hauv kev kho mob feem ntau, axillary resorption ntawm cov pob txha cov ntaub so ntswg nrog tsim cov kab noj hniav yog pom. Qee zaum muaj cov ntaub so ntswg du lossis lacunar resorption. Nrog rau kev puas tsuaj ntawm cov pob txha nyob rau hauv ob lub raum, lub ntsws thiab cov hlab ntsha, phosphorus-lime pawg tau muab tso rau raws li hom metastasis. Hauv thaj chaw ntawm microfractures, focal neoplasms tuaj yeem tsim.pob txha tshuaj - osteosclerosis.
Ua ke nrog cov pob txha hauv cov qog nqaij hlav, tonsils, spleen thiab siab, focal lossis diffuse infiltrates pom. Nyob rau hauv cov xwm txheej hnyav, muaj infiltration ntawm cov kabmob no, lawv nce, nodular loj hlob. Xws li kev tshwm sim ntawm myeloma ua rau nws tshwm sim los ze zog rau cov kab mob leukemia hnyav thiab kev kho mob nyuaj, ua rau muaj kev pheej hmoo ntawm tus kab mob.
Khiab theem ntawm tus kab mob
Nws ntseeg tau tias mus txog 15 xyoo dhau los txij li lub sijhawm tsim cov qog thawj zaug mus txog thaum pib cov tsos mob ntawm tus kabmob. Muaj ob theem ntawm myeloma:
- theem zoo. Nws yog tus cwj pwm los ntawm kev them nyiaj somatic, qeeb qeeb ntawm cov pob txha pathology, txo qis cov ntshav suav, khaws cia immunoglobulin titer, thiab qeeb nce qib ntawm paraproteins. Kev kwv yees ntawm kev kho mob nyob rau lub sijhawm no feem ntau yog qhov zoo.
- Terminal theem. Qhov no yog ib lub sij hawm ntawm mob inhibition ntawm ib txwm hematopoiesis, cov tsos ntawm anemia, leukemia, thrombocytopenia. Qib ntawm cov tshuaj tiv thaiv ib txwm poob qis, mus txog rau lawv qhov kev hloov pauv nrog cov tshuaj paraproteins. Metastasis nrog kev tsim ntawm cov nodes nyob rau hauv ntau yam kabmob nrog ib tug feature ntawm aggression loj hlob ntawm cov qog qhia txog kev hloov ntawm tus kab mob mus rau malignant sarcoma. Kev kwv yees ntawm tus kab mob no tsis zoo.
Tus kws kho mob hu rau
Kev kuaj mob ntau yam myeloma yog ua los ntawm tus kws kho mob hematologist. Cov lus txhais feem ntau nyuaj vim qhov dav dav ntawm tus neeg mob qhov kev tsis txaus siab thiab qhov tsis muaj cov tsos mob hauv thawj theem. Qhia meej txog kev kuaj mobRaws li kev tshawb fawb ntxiv:
- kuaj ntshav kuaj. Ntau tus myeloma yog tus cwj pwm los ntawm kev nce hauv viscosity thiab erythrocyte sedimentation tus nqi (ESR), txo qis ntawm cov platelets thiab erythrocytes, thiab cov ntsiab lus qis ntawm hemoglobin.
- kuaj ntshav rau electrolytes. Nrog rau ntau yam myeloma, cov kev ntsuam xyuas pom tias muaj calcium ntau ntxiv. Cov ntshav biochemistry yog tus cwj pwm los ntawm cov ntsiab lus ntxiv ntawm tag nrho cov protein, ntau ntawm urea thiab creatinine.
- Kev tshuaj ntsuam cov ntshav ntawm cov tshuaj paraproteins lossis cov tshuaj tiv thaiv tsis zoo.
- Kev kuaj zis qhia pom cov kab mob immunoglobulin txawv txav (Bence-Jones proteins).
- X-ray ntawm cov pob txha pom cov kab noj hniav zoo ib yam nrog myeloma. Kev suav tomography, MRI, PET scan yuav qhia tib yam kev puas tsuaj.
- Txoj kev txhim khu kev qha tshaj plaws los kuaj mob ntau yam myeloma yog qhov sternal puncture ntawm cov pob txha pob txha. Nws raug coj los ntawm cov pob txha sternum lossis pelvic pob txha, tshuaj xyuas hauv lub tshuab ntsuas kab mob los txiav txim siab myeloma plasma cells.
Kev kho mob nyuaj thiab ntev
Tom qab kuaj pom ntau yam myeloma, kev kho mob tau ua hauv tsev kho mob. Kev kho tshuaj nyuaj yog siv, suav nrog:
- Tim phiaj kho mob nrog cov tshuaj uas cuam tshuam rau cov protein synthesis thiab ua rau cov ntshav plasma tuag (piv txwv li, tshuaj "Carfilzomib").
- Kev kho mob lom neeg yog txhawm rau txhawb lub cev tiv thaiv kab mob (xws li Thalidomide lossis Lenalidomide).
- Tshuaj kho mobtsom rau inhibition ntawm qog loj hlob thiab tuag ntawm cov kab mob pathological ("Cyclophosphan" thiab "Melphalan").
- Corticosteroid kho yog siv los ua ib qho ntxiv.
- Bisphosphonates ("Pamidronate") raug tshuaj los ua kom cov ntaub so ntswg ceev.
- Tshaj tawm yog siv thaum tsim nyog los txo qhov mob.
Kev cuam tshuam phais yog tsim nyog. Piv txwv li, yog tias tsim nyog kho lub vertebrae, thaum kuaj pom pob txha puas lawm.
pob txha pob txha hloov tau. Nyob rau hauv rooj plaub no, stem cell transplantation ntawm tus neeg mob tus kheej cov pob txha pob txha yog siv ntau dua.
Nws yog ib qho tseem ceeb uas yuav tsum ua raws li txhua tus kws kho mob cov lus txib thiab ua raws li lub sijhawm kuaj xyuas. Tom qab ntawd qhov kev cia siab ntawm ntau yam myeloma tuaj yeem ua tau zoo.
Txoj Kev Nyuaj Siab
Raws li txhua yam kab mob hauv lub cev, qhov no, cov teeb meem tuaj yeem ua tau raws li hauv qab no:
- mob hnyav heev uas yuav tsum tau siv tshuaj loog zoo.
- Lub raum tsis ua haujlwm, mus txog qhov xav tau hemodialysis.
- Cov kab mob sib kis tau ntev thiab ntev.
- Pathological fractures vim pob txha thinning.
- Anemia yuav tsum tau txhaj ntshav.
Myeloma thiab prognosis
Meloma kev saib xyuas yog qhov zoo tshaj plaws niaj hnub no ntau dua li 20 xyoo dhau los. Qhov nruab nrab, tawm ntawm 100 tus neeg mob, 77 yuav nyob lwm xyoo, thiab 23 yuav nyob tsawg kawg yog 10 xyoo. Qhov hu ua "smoldering" myeloma,uas tsis muaj kev vam meej thiab yuav luag asymptomatic rau ntau xyoo, yuav tsum tau kuaj xyuas tsis tu ncua los ntawm kws kho mob thiab tswj kev txhim kho ntawm tus kab mob. Kev kuaj mob ntxov ntawm kev ua kom cov pob txha puas tsuaj thiab kev kho kom zoo ua rau qhov kev pom zoo tshaj plaws.
Kev tuag feem ntau tshwm sim los ntawm kev kis kab mob, cov ntshav poob qis, lub raum tsis ua haujlwm hnyav thiab pulmonary embolism.
Myeloma yog qhov tsis paub tseeb thiab tsis txaus ntseeg. Yog li ntawd, tsis muaj kev tiv thaiv tshwj xeeb. Muaj cov kev tshawb fawb uas qhia txog kev sib raug zoo ntawm kev noj qab haus huv thiab kev ua neej nyob hauv lub hnub nyoog laus thiab txo kev pheej hmoo ntawm tus kab mob. Nyob rau hauv thawj theem ntawm kev loj hlob ntawm tus kab mob, cov neeg mob raug qhia kom ua raws li tej yam kev cai noj haus, uas yog:
- Tsis suav cov zaub mov kaus poom thiab ua tiav los ntawm kev noj haus.
- Nqe zaub mov muaj hlau ntau - tswb kua txob, nqaij liab, zaub paj, papaya, txiv nkhaus taw.
- Nrog ntau txiv hmab txiv ntoo thiab zaub hauv koj cov zaub mov.
- Txo cov protein ntau, suav nrog mis nyuj thiab khoom noj siv mis, qe, taum, txiv ntseej.
Muaj kev tshawb fawb txog cov txiaj ntsig zoo ntawm oriental txuj lom turmeric. Nws muaj cov tshuaj tua kab mob antioxidant curcumin, uas muaj cov tshuaj tiv thaiv kab mob thiab pab txo qis kev loj hlob ntawm cov qog hlwb, nrog rau tiv thaiv cov tshuaj tiv thaiv kab mob.
Yam tshuaj tshuaj dab tsi tawm tswv yim
Kev kho neeg mob rau tus kab mobmuab faib ua ob pawg:
- Kev kho raws li kev noj cov tshuaj lom ntawm cov nroj tsuag tshuaj lom (hemlock, ya agaric, celandine), uas yog tsom rau kev ua kom qeeb ntawm cov qog. Cov nroj tsuag no muaj cov alkaloids zoo ib yam li cov tshuaj tua kab mob. Kev noj cov nyiaj zoo li no yuav tsum tau ceev faj heev - qhov ntau npaum li cas tuaj yeem ua rau muaj mob hnyav thiab tuag taus. Kev noj tshuaj yog qhov zoo tshaj plaws nrog koj tus kws kho mob tham.
- Kev txais cov tshuaj infusions txhawm rau txhim kho kev tiv thaiv kab mob thiab cov xwm txheej ntawm tus neeg mob. Siv infusions raws li marsh cinquefoil, tshuaj qab zib clover, tshuaj veronica, meadowsweet, comfrey, milkweed. Cov nyiaj no yuav tsis muaj peev xwm kov yeej tus kab mob no, tab sis lawv tuaj yeem txhim kho lub neej zoo thiab kev noj qab haus huv ntawm tus neeg mob.
Nws yog ntshaw kom siv cov txhais tau tias ntawm thawj thiab thib ob pawg nyob rau hauv ib tug complex yam. Nyob rau tib lub sijhawm, cov nyiaj raws li cov nroj tsuag tshuaj lom yog siv rau hauv cov kev kawm uas yuav tsum tau so. Thiab ib qho kev kho mob yuav tsum tsis txhob siv ntau tshaj ib hlis, txhawm rau kom tsis txhob muaj kev quav yeeb quav tshuaj ntawm lub cev thiab tsis muaj txiaj ntsig zoo. Txawm li cas los xij, ua ntej siv cov tshuaj pej xeem, koj yuav tsum sab laj nrog koj tus kws kho mob. Cov tshuaj niaj hnub no nyob deb ntawm kev saib xyuas raws li peb tau xav thiab npaj los txiav txim siab txhua yam kev xaiv rau kev pom zoo ntawm ntau yam myeloma.
