Necrotizing vasculitis

Necrotizing vasculitis ndi gulu la zovuta zomwe zimakhudzana ndi kutupa kwa makoma amitsempha yamagazi. Kukula kwa mitsempha yamagazi yomwe ikukhudzidwa kumathandizira kudziwa mayina azomwezi komanso momwe matendawa amayambitsira matenda.

Necrotizing vasculitis ikhoza kukhala vuto lalikulu monga polyarteritis nodosa kapena granulomatosis ndi polyangiitis (yomwe kale idatchedwa Wegener granulomatosis). Nthawi zina, vasculitis imatha kupezeka ngati gawo la vuto lina, monga systemic lupus erythematosus kapena hepatitis C.

Zomwe zimayambitsa kutupa sizidziwika. Zitha kukhala zokhudzana ndi zinthu zodziyimira zokha. Khoma la mtsempha wamagazi limatha kutuluka ndi kufota kapena kufa (kukhala necrotic). Mitsempha yamagazi imatha kutseka, kusokoneza magazi kupita kumatumba omwe amapereka. Kuperewera kwa magazi kumapangitsa kuti matendawo afe. Nthawi zina chotengera chamagazi chitha kuthyoka ndikutuluka magazi.

Necrotizing vasculitis ingakhudze mitsempha yamagazi mbali iliyonse ya thupi. Chifukwa chake, zimatha kubweretsa mavuto pakhungu, ubongo, mapapo, matumbo, impso, ubongo, mafupa kapena chiwalo china chilichonse.

Malungo, kuzizira, kutopa, nyamakazi, kapena kuwonda zitha kukhala zizindikilo zokha poyamba. Komabe, zizindikilo zimatha kukhala pafupifupi m'chigawo chilichonse cha thupi.

Khungu:

• Ziphuphu zofiira kapena zofiirira pamapazi, manja kapena ziwalo zina za thupi
• Mtundu wabuluu ku zala ndi zala zakumapazi
• Zizindikiro zakufa kwa minofu chifukwa chosowa mpweya monga kupweteka, kufiira, ndi zilonda zomwe sizichira

Minofu ndi zimfundo:

• Ululu wophatikizana
• Kupweteka kwa mwendo
• Minofu kufooka

Ubongo ndi dongosolo lamanjenje:

• Ululu, dzanzi, kumva kulasalasa mu mkono, mwendo, kapena mbali ina ya thupi
• Kufooka kwa mkono, mwendo, kapena malo ena thupi
• Ophunzira omwe ndi osiyana kukula kwake
• Eyelid akugwera
• Kumeza vuto
• Kuwonongeka kwamalankhulidwe
• Zovuta zoyenda

Mapapu ndi njira zopumira:

• Tsokomola
• Kupuma pang'ono
• Matenda a Sinus ndi ululu
• Kutsokomola magazi kapena kutuluka magazi m'mphuno

Zizindikiro zina ndizo:

• Kupweteka m'mimba
• Magazi mkodzo kapena ndowe
• Kuwopsya kapena kusintha mawu
• Kupweteka pachifuwa kuwonongeka kwa mitsempha yomwe imapereka mtima (mitsempha yamtendere)

Wothandizira zaumoyo adzayesa kwathunthu. Kuyesa kwamanjenje (kwamitsempha) kumatha kuwonetsa zizindikiritso zamitsempha.

Mayeso omwe angachitike ndi awa:

• Kuwerengera kwathunthu kwamagazi, gulu lonse la chemistry, ndi kukodza kwamitsempha
• X-ray pachifuwa
• Mayeso othandizira mapuloteni a C
• Mlingo wamatsenga
• Kuyezetsa magazi kwa chiwindi
• Kuyesa magazi kwa ma antibodies motsutsana ndi neutrophils (ma antibodies a ANCA) kapena ma antigen a nyukiliya (ANA)
• Kuyesa magazi kwama cryoglobulins
• Kuyezetsa magazi kwamagulu owonjezera
  
• Kujambula maphunziro monga angiogram, ultrasound, computed tomography (CT) scan, kapena magnetic resonance imaging (MRI)
• Chikopa cha khungu, minofu, ziwalo, kapena mitsempha

Corticosteroids amaperekedwa nthawi zambiri. Mlingowo umadalira kukula kwa vutoli.

Mankhwala ena omwe amaletsa chitetezo cha mthupi amatha kuchepetsa kutupa kwa mitsempha yamagazi. Izi zikuphatikizapo azathioprine, methotrexate, ndi mycophenolate. Mankhwalawa nthawi zambiri amagwiritsidwa ntchito limodzi ndi corticosteroids. Kuphatikizaku kumapangitsa kuti matendawa athe kupezeka ndi mlingo wochepa wa corticosteroids.

Pa matenda akulu, cyclophosphamide (Cytoxan) yakhala ikugwiritsidwa ntchito kwazaka zambiri. Komabe, rituximab (Rituxan) imagwiranso ntchito ndipo siyowopsa.

Posachedwa, tocilizumab (Actemra) idawonetsedwa kuti ndiyothandiza kwa chimphona cha arteritis kotero kuti corticosteroids imatha kuchepetsedwa.

Necrotizing vasculitis ikhoza kukhala matenda owopsa komanso owopsa. Zotsatira zake zimadalira komwe kuli vasculitis komanso kuopsa kwa kuwonongeka kwa minofu. Zovuta zimatha kubwera chifukwa cha matendawa komanso mankhwala. Mitundu yambiri ya necrotizing vasculitis imafuna kutsatira ndi chithandizo kwa nthawi yayitali.

Zovuta zingaphatikizepo:

• Kuwonongeka kwamuyaya pamapangidwe kapena ntchito ya dera lomwe lakhudzidwa
• Matenda achiwiri amisempha ya necrotic
• Zotsatira zoyipa za mankhwala omwe agwiritsidwa ntchito

Itanani omwe akukuthandizani ngati muli ndi vuto la necrotizing vasculitis.

Zizindikiro zadzidzidzi ndizo:

• Mavuto opitilira gawo limodzi la thupi monga sitiroko, nyamakazi, zotupa pakhungu, kupweteka m'mimba kapena kutsokomola magazi
• Zosintha pakukula kwa wophunzira
• Kutaya ntchito kwa mkono, mwendo, kapena gawo lina la thupi
• Mavuto olankhula
• Kumeza vuto
• Kufooka
• Kupweteka kwambiri m'mimba
  

Palibe njira yodziwika yothetsera vutoli.

• Njira yoyendera

Jennette JC, Falk RJ. Aimpso ndi systemic vasculitis. Mu: Feehally J, Floege J, Tonelli M, Johnson RJ, olemba. Chachikulu Chachipatala Nephrology. Lachisanu ndi chimodzi. Philadelphia, PA: Elsevier; 2019: chap 25.

Jennette JC, Weimer ET, Kidd J. Vasculitis. Mu: McPherson RA, Pincus MR, olemba., Eds. Henry's Clinical Diagnosis and Management by Laboratory Methods. Wachitatu. St Louis, MO: Elsevier; 2017: mutu 53.

Rhee RL, Hogan SL, Poulton CJ, ndi al. Zochitika pazotsatira zazitali pakati pa odwala omwe ali ndi antineutrophil cytoplasmic anti-anti-vasculitis yokhudzana ndi matenda a impso. Nyamakazi Rheumatol. 2016; 68 (7): 1711-1720. PMID: 26814428 www.ncbi.nlm.nih.gov/pubmed/26814428. (Adasankhidwa)

Malingaliro U, Merkel PA, Seo P, et al. Kuchita bwino kwa njira zotsitsimula zochotsa mavitamini a ANCA. N Engl J Med. 2013; 369 (5): 417-427. PMID: 23902481 www.ncbi.nlm.nih.gov/pubmed/23902481.

Mwala JH, Klearman M, Collinson N. Kuyesedwa kwa tocilizumab mu chimphona-cell arteritis. N Engl J Med. 2017; 377 (15): 1494-1495. (Adasankhidwa) PMID: 29020600 www.ncbi.nlm.nih.gov/pubmed/29020600.