Txoj kev kho nws tus kheej yog tsim los txhawm rau tiv thaiv lub cev tiv thaiv kab mob tsis txaus siab rau stimuli.
Ntau zaus cov cuab yeej no siv los tshem tawm cov kab mob autoimmune - cov no yog cov kab mob uas lub cev tiv thaiv kab mob raug kev txom nyem heev, lub cev raug tawm tsam thiab nws lub cev raug puas tsuaj. Nyeem ntxiv txog lub ntsiab lus ntawm kev tiv thaiv kab mob thiab kev tiv thaiv kab mob hauv cov kab mob rheumatological thiab kab mob raum - ntxiv.
Qhov no yog dab tsi?
Koj tuaj yeem hnov tias thaum lub sijhawm hloov pauv, siv cov tshuaj tiv thaiv kab mob, nws yog qhov tsim nyog los tiv thaiv kev tawm tsam ntawm kev tsis lees paub ntawm lub cev uas tau hloov pauv los ntawm lwm yam kabmob. Nws kuj yog siv dav tom qab hloov pob txha pob txha. Xws li kev kho mob tseem ceeb heev kom ua tiav kev tiv thaiv kab mob, nrog rau lub sijhawm mob hnyav.
Kev nyuaj siab
muaj thiabCov tshuaj tiv thaiv kab mob ntev ntev rau tus tswv tsev tshiab, txwv tsis pub hu ua teeb meem ntawm kev tiv thaiv kab mob rau glomerulonephritis. Qhov no yog vim qhov tseeb tias nws yog tus neeg pub dawb uas pib ua rau tsis zoo rau tus neeg mob lub cev. Hmoov tsis zoo, kev siv tshuaj tiv thaiv kab mob ua rau muaj qhov tshwm sim tsis zoo, ua rau muaj kev pheej hmoo ntawm tus kab mob sib kis, uas yog vim li cas cov txheej txheem no yuav tsum tau ua ke nrog lwm yam kev ntsuas uas tau tsim los txo qhov kev pheej hmoo ntawm kev kis kab mob.
Kev kho mob
Kev kho mob tshwj xeeb muaj nyob ntawm nws cov pov tseg cytostatics, glucocorticoids. Cov tshuaj no yog theem nrab, xws li Sirolimus, Tacrolimus thiab lwm yam. Nyob rau hauv parallel, lwm yam txhais tau tias yog siv, xws li monoclonal antibodies. Lawv tau tsim los kom tshem tawm cov kev cuam tshuam tsis zoo ntawm qee qib cellular hauv lub cev tiv thaiv kab mob.
Kev tiv thaiv kab mob
Muaj ntau cov lus qhia rau kev tiv thaiv kab mob hauv glomerulonephritis. Tab sis qhov tseem ceeb tshaj plaws yog cov hauv qab no: cov txheej txheem no yuav tsum ua kom lub neej ntev tshaj plaws nrog kev hloov pauv uas tau muab tso rau hauv tib neeg lub cev. Thiab qhov no, nyob rau hauv lem, yog ib tug txiav txim siab thiab, nyob rau tib lub sij hawm, txaus tsub kom kev tiv thaiv ntawm lub sij hawm ntawm kev pheej hmoo. Ua li no, cov kev mob tshwm sim tsawg kawg nkaus.
Ib txheej txheem tuaj yeem muab faib ua ob peb lub sijhawm, 2 tau tso cai:
- Thawj yog mus txog ib xyoos tom qab tus txheej txheemsuav tias yog kev txhawb nqa ntxov. Thaum lub sij hawm lub sij hawm no, maj mam txo cov koob tshuaj tiv thaiv kab mob tshwm sim.
- Lub sijhawm thib ob yog ncua ntev dua, ua tiav ib xyoos tom qab kev ua haujlwm ntawm lub raum hloov pauv lossis lwm yam kabmob txuas ntxiv mus. Thiab lub sijhawm thaum kev txhaj tshuaj tiv thaiv kab mob ua kom ruaj khov thiab txaus ntxiv rau nruab nrab, qhov kev pheej hmoo ntawm cov teeb meem tshwm sim.
Kev xaiv tshuaj
Raws li tag nrho cov txheej txheem niaj hnub no uas cuam tshuam nrog kev kho mob, mycophenolate kuj tau siv rau qhov txiaj ntsig zoo. Piv nrog rau lwm yam siv tau azathioprines, tsis muaj qhov tshwm sim ntawm kev tsis lees paub, lawv yog qhov kev txiav txim siab me dua. Raws li cov kev soj ntsuam no, nws pom tseeb tias qhov ciaj sia taus tom qab hloov pauv tau nce.
Nyob ntawm tus neeg mob thiab lawv cov kev pheej hmoo tshwj xeeb, cov tshuaj tiv thaiv kab mob tiv thaiv tus kheej raug txheeb xyuas. Hom kev xaiv no yog suav tias yog qhov yuav tsum tau ua, uas tsis muaj qhov tsis tuaj yeem tsis quav ntsej. Kev hloov pauv tau raug sau tseg rau cov qauv tshuaj, thiab qhov no yog qhov kev daws teeb meem zoo tshaj plaws nyob rau hauv cov xwm txheej tsis zoo ntawm ib lossis lwm qhov kev xaiv tshuaj.
Nws tsis yog qhov tsis tshua muaj ntshav qab zib tshwm sim tom qab hloov lub cev. Qhov no tuaj yeem tshwm sim los ntawm cov tshuaj steroids hauv cov neeg mob uas txhim kho cov piam thaj tsis zoo, txhim kho ntshav qab zib mellitus, vim tias nws raug nquahu kom txo cov koob tshuaj lossis txawm tias tsis noj cov tshuaj steroid tag nrho. Tab sisQee zaum muaj xwm txheej uas qhov ntsuas no tsis pab, yog li yuav tsum tau saib lwm txoj kev kho mob.
Kev hloov pauv tsis txaus
Kev xav tsis zoo yog qhov qhia tias lub cev tiv thaiv kab mob tau muab nws cov lus teb rov tshwm sim, uas yog npaj rau tus neeg pub dawb antigens. Yog tias qhov xwm txheej zoo li no tshwm sim, qhov no qhia tau tias muaj kev pheej hmoo siab ntawm kev nce hauv creatinine. Thiab, yog li ntawd, tso zis dhau los ua qhov kev txiav txim siab qis dua thiab qhov mob thiab induration tshwm sim hauv cheeb tsam thauj.
Cov tsos mob uas tau nthuav tawm yog qhov rhiab heev, muaj lawv tus kheej cov cim tshwj xeeb thiab cov yam ntxwv, uas cuam tshuam rau kev tiv thaiv kab mob. Yog li ntawd, nyob rau hauv thawj theem ntawm kev kho mob nws yog tsim nyog los tshem tawm ib tug thib ob ua hauj lwm ntawm dysfunction. Thiab txhawm rau txhawm rau txheeb xyuas qhov tsis txaus ntseeg ntawm qhov hloov pauv, nws yog ib qho tsim nyog yuav tsum tau ua ib qho biopsy ntawm lub cev hloov pauv. Nws yuav tsum tau muab sau tseg tias, feem ntau, ib tug biopsy yog ib tug zoo tagnrho kev kuaj tom qab xws li ib tug txawv txawv kev kho mob. Qhov no yog txhawm rau tiv thaiv kev kuaj mob ntau dhau ntawm kev tsis lees paub tom qab lub sijhawm luv luv tau dhau mus tom qab hloov pauv.
Yuav ua li cas tom qab thawj ntu ntawm kev swb?
Lub sijhawm thaum thawj qhov exacerbation tshwm sim, uas, dhau los, nqa cov yam ntxwv ntawm kev tsis lees paub ntawm tes thiab ua rau muaj kev nkag siab zoo, cov kws kho mob pom zoo.siv pulse therapy raws li kev kho mob. Nws tso cai, hauv paus, tiv thaiv kev tsis lees paub. Txhawm rau ua qhov kev tshwm sim no, "Methylprednisolone" yog siv. Kev ua tau zoo ntawm cov txheej txheem no yog ntsuas 48 lossis 72 teev tom qab kho. Thiab cov dynamics ntawm qib ntawm creatinine yog coj mus rau hauv tus account. Cov kws tshaj lij tau sau tseg qhov tseeb uas twb muaj nyob rau hnub 5 tom qab kev kho mob pib, qib creatinine rov qab mus rau lawv txoj haujlwm qub.
Muaj cov xwm txheej uas lawv nyob rau tag nrho lub sijhawm ntawm kev tsis lees paub. Tab sis tib lub sij hawm raws li txoj kev kho yuav tsum tau ua, nws yog ib qho tsim nyog yuav tsum tau ua kom paub tseeb tias cov concentration yog nyob rau hauv qhov kev pom zoo. Hais txog qhov koob tshuaj "Mycophenolates", tsis muaj teeb meem nws yuav tsum qis dua qhov pom zoo. Yog tias tsis muaj qhov tsis lees paub qhov mob tshwm sim, txawm tias khaws cia zoo lossis tsis ua, yuav tsum hloov pauv mus rau tacrolimus.
Raws li kev kho cov mem tes, nws tsuas yog ua haujlwm rau qhov tsis lees paub, tab sis nws yuav tsum tau coj mus rau hauv tus account tias txoj kev no siv tsis pub ntau tshaj ob zaug. Hmoov tsis zoo, lub sijhawm thib ob ntawm kev tsis lees paub yuav tsum muaj qhov hnyav steroid. Nws yog ib qho tsim nyog yuav tau sau cov tshuaj uas yuav tawm tsam cov tshuaj tiv thaiv.
Cov kws tshawb fawb uas tshawb xyuas qhov teeb meem no pom zoo pib kho cov tshuaj tiv thaiv tam sim tom qab pib kho mem tes. Tab sis muaj lwm tus neeg txhawb nqa ntawm txoj kev xav no, lawv hais tias nws yuav tsum tau tos ob peb hnub tom qab kev kho mob thiab tsuas yog tom qab ntawd siv cov tshuaj steroids. Tab sisYog tias lub cev uas tau teeb tsa hauv lub cev pib ua haujlwm tsis zoo, qhov no qhia tau tias nws yuav tsum tau hloov cov kev kho mob.
kho kom raug thaum raug mob chronic graft
Yog tias qhov kev hloov pauv maj mam pib ua tsis tiav nws txoj haujlwm, qhov no qhia tau tias kev sib txawv ntawm cov qauv tau tshwm sim lossis fibrosis tau tshwm sim, kev tsis lees paub ntev ua rau nws tus kheej xav.
Yuav kom tau txais txiaj ntsig zoo tom qab hloov pauv, nws yog qhov tsim nyog yuav tsum tau siv txhua yam kev muaj peev xwm niaj hnub no, siv cov tshuaj tiv thaiv kab mob, thiab siv cov txheej txheem kho mob nyuaj. Ua kev kuaj mob raws sij hawm, saib xyuas, thiab ua kev tiv thaiv kev kho mob. Rau qee cov txheej txheem, nws raug nquahu kom siv tshuaj pleev thaiv hnub. Thiab kev kho tshuaj tiv thaiv kab mob hauv qhov no yuav ua tau zoo dua.
Raws li lwm yam, cov tshuaj tiv thaiv kab mob muaj kev phiv. Txhua leej txhua tus paub zoo tias kev noj tshuaj txhua yam tuaj yeem ua rau muaj qhov tshwm sim tsis zoo hauv lub cev, uas koj yuav tsum xub kawm txog thiab npaj tawm tsam.
Thaum siv cov tshuaj npaj rau kev kho mob, kev saib xyuas tshwj xeeb yog them rau arterial hypertension. Kuv xav kom nco ntsoov qhov tseeb tias nyob rau hauv cov ntaub ntawv ntawm kev kho mob mus sij hawm ntev, ntshav siab nce ntau zaus, qhov no tshwm sim nyob rau hauv yuav luag 50% ntawm cov neeg mob.
Cov tshuaj tiv thaiv kab mob tshiab tau tsim muaj tsawg duatus naj npawb ntawm cov kev mob tshwm sim, tab sis, hmoov tsis, qee zaum lawv cov txiaj ntsig ntawm lub cev ua rau tus neeg mob muaj kev puas siab puas ntsws.
Azathioprine
Hauv kev tiv thaiv kab mob rau glomerulonephritis, cov tshuaj no tau siv rau 20 xyoo, uas yuav tsum tau coj mus rau hauv tus account. Nws inhibits cov synthesis ntawm DNA thiab RNA. Raws li qhov tshwm sim ntawm kev ua haujlwm, muaj kev ua txhaum thaum lub sijhawm faib cov lymphocytes paub tab.
Y"Cyclosporin"
Cov khoom siv tshuaj no yog peptide ntawm cov nroj tsuag keeb kwm. Nws yog tau los ntawm fungi. Cov tshuaj no koom nrog qhov tseeb tias nws cuam tshuam cov synthesis thiab thaiv kev puas tsuaj ntawm lymphocytes thiab lawv cov kev faib tawm hauv lub cev.
Tacrolimus
Tshuaj ntawm cov kab mob fungal. Qhov tseeb, nws ua tau zoo ib yam ntawm kev ua raws li cov kev kho mob yav dhau los, tab sis, hmoov tsis, vim kev siv cov tshuaj no, kev pheej hmoo ntawm ntshav qab zib mellitus nce ntxiv. Hmoov tsis zoo, cov tshuaj no tsis tshua muaj txiaj ntsig thaum lub sijhawm rov qab los tom qab hloov daim siab. Tab sis tib lub sijhawm, cov tshuaj no tau raug sau tseg thaum lub raum hloov pauv thiab nws nyob rau theem ntawm kev tsis lees paub.
Sirolimus
Cov tshuaj no, zoo li ob qho dhau los, yog cov kab mob fungal, tab sis nws muaj qhov sib txawv ntawm kev ua haujlwm ntawm tib neeg lub cev. Qhov nws ua yog rhuav tshem kev loj hlob.
Kev txiav txim los ntawm kev tshuaj xyuas zoo liob tus neeg mob thiab kws kho mob, nws tau paub tias kev siv tshuaj raws sijhawm thaum lub sijhawm hloov pauv yog qhov lees paub tias txoj hauv kev muaj sia nyob ntawm cov kabmob hloov pauv tau nce ntxiv thiab ua rau muaj peev xwm ua rau nws tsis lees paub yog tiv thaiv.
Rau thawj lub sijhawm, tus neeg mob nyob rau hauv kev saib xyuas ze ntawm cov kws tshaj lij, lawv niaj hnub saib xyuas tus neeg mob lub xeev kev noj qab haus huv, sau ntau yam kev cuam tshuam rau qee qhov stimuli, txhua yam yog qhov tsim nyog kom nyob rau hauv cov xwm txheej ntawm thawj cov cim ntawm kev tsis lees txais lub cev hloov pauv, sim yuav tsum tau ua kom tiv thaiv nws.
