Mtundu wa Hepatitis C: Mafunso Anu Ayankhidwa

Zamkati

• Kodi hepatitis C genotypes ndi chiyani?
• Hepatitis C ili ndi mitundu yosiyanasiyana. Kodi izi zikutanthauza chiyani?
• Kodi pali kusiyana kotani pakati pa genotypes ya hepatitis C?
• Kodi kafukufuku waposachedwa bwanji wama genotypes ndi chithandizo chamtundu uliwonse?
• Kodi genotype imaneneratu kuyankha kwamankhwala a DAA monga momwe anachitira ndi mankhwala a interferon?
• Genotype nthawi zambiri imasankha mtundu wa chithandizo chomwe munthu amalandira. Kodi pali zinthu zina zomwe zimakhudza chithandizo?
• Kodi mtundu wanga wamtunduwu umakhudza mwayi woti ndikadwala khansa kapena chiwindi?
• Za dokotala

Zithunzi za Getty

Hepatitis C ndi matenda omwe amayambitsa kutupa kwa chiwindi. Tizilomboti timafalikira kudzera m'magazi ndipo nthawi zambiri timagonana.

Pali mitundu yambiri ya kachilombo ka hepatitis C. Koma mitundu yonse ya hepatitis C imagwirizana mofanana.

Mukalandira matenda a hepatitis C, dokotala wanu adzagwira ntchito kuti adziwe mtundu womwe muli nawo kuti mulandire chithandizo chabwino.

Dziwani za kusiyanasiyana kwamitundu ya hepatitis C. Mayankho a akatswiri amaperekedwa ndi Dr. Kenneth Hirsch, yemwe amachita zambiri zamankhwala akugwira ntchito ndi anthu omwe ali ndi chiwindi cha hepatitis C.

Kodi hepatitis C genotypes ndi chiyani?

Chosinthika kwa iwo omwe ali ndi kachirombo kosatha ka hepatitis C (HCV) ndi "genotype," kapena mtundu wa kachilomboka pamene adatenga matenda. Genotype imatsimikiziridwa ndi kuyesa magazi.

Genotype sikuti imathandizira pakukula kwa kachilomboka, koma ngati chinthu chofunikira posankha mankhwala oyenera ochiritsira.

Malinga ndi a, mitundu isanu ndi iwiri yapadera ya HCV, ndi yoposa, yadziwika.

Mitundu yosiyanasiyana ya HCV ndi ma subtypes ali ndi magawo osiyanasiyana padziko lonse lapansi.

Genotypes 1, 2, ndi 3 amapezeka padziko lonse lapansi. Genotype 4 imapezeka ku Middle East, Egypt, ndi Central Africa.

Genotype 5 imapezeka ku South Africa kokha. Genotype 6 imawoneka ku Southeast Asia. Genotype 7 yakhala ikudziwika ku Democratic Republic of Congo.

Hepatitis C ili ndi mitundu yosiyanasiyana. Kodi izi zikutanthauza chiyani?

HCV ndi kachilombo ka RNA kamodzi. Izi zikutanthauza kuti chibadwa cha kachilombo kalikonse kamakhala mkati mwa gawo limodzi la nucleic acid RNA.

Chingwe chilichonse cha nucleic acid (RNA kapena DNA) chimapangidwa ndi unyolo wazomangira. Dongosolo la midadada imeneyi limatsimikizira mapuloteni omwe thupi limafuna, kaya ndi kachilombo, chomera, kapena chinyama.

Mosiyana ndi HCV, chibadwa cha anthu chimanyamulidwa ndi DNA yokhala ndi zingwe ziwiri. Ma code amtundu wa anthu amawerengedwanso mosadukiza pokonzanso DNA.

Kusintha kosasintha (kusintha) ku chibadwa chaumunthu kumachitika pamtengo wotsika. Izi ndichifukwa choti zolakwitsa zambiri pakubwereza kwa DNA zimadziwika ndikuwongoleredwa.

Mosiyana ndi izi, ma code a HCV samayesedwa akawunikiridwa. Kusintha kosasintha kumachitika ndikukhala munkhokwe.

HCV imabereka mwachangu kwambiri - mpaka 1 trilioni yatsopano patsiku. Chifukwa chake, magawo ena amtundu wa HCV amakhala osiyanasiyana ndipo amasintha pafupipafupi, ngakhale mwa munthu m'modzi yemwe ali ndi matenda.

Ma genotypes amagwiritsidwa ntchito kuzindikira mitundu ina ya HCV. Zimachokera ku kusiyana kwa madera ena amtundu wa ma virus. Pali magulu ena a nthambi mkati mwa genotype. Amaphatikizapo ma subtype ndi quasispecies.

Kodi pali kusiyana kotani pakati pa genotypes ya hepatitis C?

Monga tanenera, mitundu yosiyanasiyana ya HCV genotypes ndi ma subtypes ali ndi magawo osiyanasiyana padziko lonse lapansi.

Genotype 1 ndiye mtundu wofala kwambiri wa HCV ku United States. Amapezeka pafupifupi 75 peresenti ya matenda onse a HCV mdziko muno.

Ambiri mwa anthu otsala ku United States omwe ali ndi matenda a HCV amakhala ndi mitundu iwiri kapena itatu.

HCV genotype siyokhudzana kwenikweni ndi kuchuluka kwa kuwonongeka kwa chiwindi, kapena mwayi woti pamapeto pake ungadwale chiwindi. Komabe, zitha kuthandiza kuneneratu zotsatira zamankhwala.

Ma genotype amatha kuthandiza kuneneratu zotsatira za anti-HCV mankhwala okhala ndi mankhwala amtundu wa interferon. Genotype yathandizanso kudziwa chithandizo chamankhwala.

M'magawo ena, milingo ya ribavirin ndi pegylated interferon (PEG) ndi ya anthu omwe ali ndi mitundu ina ya HCV.

Kodi kafukufuku waposachedwa bwanji wama genotypes ndi chithandizo chamtundu uliwonse?

Mankhwala ogwiritsira ntchito kwambiri a HCV, PEG / ribavirin, sakulimbana ndi kachilombo komweko. Mankhwalawa amakhudza kwambiri chitetezo chamthupi cha munthu. Cholinga chake ndikulimbikitsa chitetezo cha mthupi kuti chizindikire ndikuchotsa maselo omwe ali ndi HCV.

Komabe, kusiyanasiyana kwa HCV mwa munthu m'modzi sikungakhale "kofanana" ndi chitetezo cha mthupi. Ichi ndi chimodzi mwazifukwa zomwe matenda a HCV amapitilira ndikukhala matenda opatsirana.

Ngakhale ndizosiyanasiyana zamtunduwu, ofufuza apeza mapuloteni omwe amafunikira kuti HCV ibereke m'thupi. Mapuloteniwa amapezeka pamitundu yonse ya HCV.

Mankhwala atsopano a HCV amalimbikitsa mapuloteniwa. Izi zikutanthauza kuti amalimbana ndi kachilomboka. Thandizo la Direct-antiviral (DAA) limagwiritsa ntchito mamolekyulu ang'onoang'ono opangidwa kuti ateteze mapuloteni amtunduwu.

Mankhwala ambiri a DAA akhala akupangidwa mzaka khumi zapitazi. Mankhwala aliwonse amalimbana ndi ochepa mwa mapuloteni ofunikira a HCV.

Mankhwala awiri oyamba a DAA, boceprevir ndi telaprevir, adalandira chilolezo choti azigwiritsidwa ntchito ku United States mu 2011. Zonsezi zimalanda mtundu wina wa enzyme ya HCV yotchedwa protease. Mankhwalawa amagwiritsidwa ntchito limodzi ndi msomali / ribavirin.

Mankhwala onse atsopanowa ndi othandiza kwambiri pa genotype ya HCV 1. Amagwira bwino ntchito genotype 2, ndipo siyothandiza pa genotype 3.

Poyamba, adangovomerezedwa kuti azigwiritsidwa ntchito mwa anthu omwe ali ndi genotype 1 HCV kuphatikiza ndi PEG / ribavirin.

Mankhwala owonjezera a DAA avomerezedwa kuti agwiritsidwe ntchito limodzi ndi PEG / ribavirin. Mankhwala atsopanowa amalimbana ndi ma protein angapo a HCV. Imodzi mwa mankhwalawa ndi sofosbuvir.

Ndi chithandizo cha PEG / ribavirin chokha, genotype 1 HCV imagwiritsa ntchito chithandizo chotalika kwambiri popanda mwayi wopambana. Ndi sofosbuvir, genotype 1 tsopano imachiritsidwa mwa anthu opitilira 95 peresenti omwe amathandizidwa kwamasabata 12 okha.

Sofosbuvir ali ndi mphamvu yayikulu kwambiri yopondereza kubwereza kwa ma virus, mosasamala kanthu za genotype (pakati pa omwe adaphunzira). Chifukwa chakupambana kwa mankhwalawa, Europe posachedwa yasintha malangizo ake azithandizo.

Tsopano ikulimbikitsa chithandizo chamasabata 12 kwa anthu onse omwe ali ndi HCV yosavuta omwe sanalandiridweko kale.

Ndi sofosbuvir, a FDA [Food and Drug Administration] adavomerezanso njira yoyamba yophatikizira yopanda interferon (sofosbuvir kuphatikiza ribavirin). Mankhwalawa amagwiritsidwa ntchito kwa milungu 12 mwa anthu omwe ali ndi genotype 2, kapena milungu 24 mwa anthu omwe ali ndi genotype 3.

Kodi genotype imaneneratu kuyankha kwamankhwala a DAA monga momwe anachitira ndi mankhwala a interferon?

Mwina… mwina ayi.

Mapuloteni onse ofunikira a HCV amagwira ntchito chimodzimodzi, mosasamala kanthu za genotype. Mapuloteni ofunikirawa atha kukhala osiyana malinga ndi kusintha kwakanthawi.

Chifukwa ndizofunikira pakazunguliridwe ka moyo wa HCV, kapangidwe ka malo awo ogwira ntchito mwina sikangasinthe chifukwa chosintha mosasintha.

Chifukwa tsamba logwira ntchito la protein limakhala lofananira pakati pa mitundu yosiyanasiyana ya majini, momwe wothandizila wa DAA amagwirira ntchito amakhudzidwa ndi komwe amamangiriza pa protein yomwe akufuna.

Kuchita bwino kwa othandizira omwe amamangiriza makamaka kumalo omwe ali ndi mapuloteniwo sangakhudzidwe ndi mtundu wama virus.

Mankhwala onse a DAA amaletsa kubwereza kwa HCV kosalekeza, koma samachotsa kachilomboka m'manja mwake. Sachotsanso maselo omwe ali ndi kachilomboka. Ntchitoyi imasiyidwa m'thupi la munthu.

Kuchita mosiyanasiyana kwa chithandizo cha interferon kumawonetsa kuti chitetezo chamthupi chimatha kuchotsa bwino ma cell omwe ali ndi ma genotypes ena kuposa omwe ali ndi ena.

Genotype nthawi zambiri imasankha mtundu wa chithandizo chomwe munthu amalandira. Kodi pali zinthu zina zomwe zimakhudza chithandizo?

Kupatula pa genotype, pali mitundu yambiri yomwe ingakhudze mwayi wopambana. Zina mwazofunikira kwambiri ndi izi:

• kuchuluka kwa kachilombo ka HCV m'magazi anu
• kuopsa kwa chiwindi kuwonongeka asanalandire chithandizo
• momwe chitetezo chanu cha mthupi chimatetezera (kutenga kachilombo ka HIV, chithandizo cha corticosteroids, kapena kukhala ndi chiwalo china kumatha kuchepetsa chitetezo chanu)
• zaka
• mpikisano
• kumwa mowa mopitirira muyeso
• kuyankha kwamankhwala am'mbuyomu

Mitundu ina yamunthu imatha kuneneratu momwe chithandizo chithandizire kugwira ntchito. Chibadwa cha munthu chotchedwa Zamgululi ndi m'modzi mwamanenedwe olimba amomwe angayankhire PEG / ribavirin chithandizo mwa anthu omwe ali ndi mtundu wa HCV 1.

Anthu ali ndi chimodzi mwazinthu zitatu zomwe zingachitike Zamgululi:

• CC
• CT
• TT

Anthu omwe ali ndi kasinthidwe ka CC amalabadira bwino chithandizo cha PEG / ribavirin. M'malo mwake, ali ndi mwayi wopitilira kawiri kapena katatu kuposa omwe ali ndi mawonekedwe ena oti athe kuyankha kwathunthu kuchipatala.

Kudziwa Zamgululi kasinthidwe ndikofunikira pakusankha kochiza ndi msomali / ribavirin. Komabe, anthu omwe ali ndi genotypes 2 ndi 3 amatha kuchiritsidwa ndi PEG / ribavirin ngakhale atakhala kuti alibe CC.

Izi ndichifukwa choti PEG / ribavirin imagwira bwino ntchito motsutsana ndi mitundu iyi. Kotero, Zamgululi kasinthidwe sikusintha mwayi wothandizidwa moyenera.

Kodi mtundu wanga wamtunduwu umakhudza mwayi woti ndikadwala khansa kapena chiwindi?

Mwina. Ena amati anthu omwe ali ndi kachilombo ka HCV genotype 1 (makamaka omwe ali ndi kachilombo 1b) amakhala ndi vuto la matenda enaake kuposa omwe ali ndi matenda amtundu wina.

Mosasamala kanthu kuti izi ndizowona, dongosolo loyendetsera bwino lomwe silikusintha silisintha kwenikweni.

Kukula kwa chiwindi kumachedwa. Nthawi zambiri zimachitika kwazaka zambiri. Chifukwa chake, aliyense amene angopezeka ndi HCV ayenera kuyesedwa kuti awononge chiwindi. Kuwonongeka kwa chiwindi ndi chisonyezo cha mankhwala.

Kuopsa kokhala ndi khansa ya chiwindi sikuwoneka kuti kukugwirizana ndi mtundu wa HCV. Mu matenda opatsirana a HCV, hepatocellular carcinoma (khansa ya chiwindi) imangoyamba kamodzi kokha kukhazikika kwa khansa kukakhazikika.

Ngati munthu yemwe ali ndi kachilombo ka HCV amachiritsidwa bwino asanayambe kudwala matenda a chiwindi, ndiye kuti kachilombo koyambitsa matenda kameneka si kofunika.

Komabe, mwa anthu omwe adayamba kale kudwala matenda enaake, akuti akuwonjezera kuti genotypes 1b kapena 3 itha kukulitsa chiopsezo cha khansa.

Kuyezetsa khansa ya chiwindi kumalimbikitsa aliyense amene ali ndi HCV ndi matenda enaake. Madokotala ena amalimbikitsa kuwunika pafupipafupi kwa omwe ali ndi genotypes 1 ndi 3.

Za dokotala

Dr. Kenneth Hirsch adalandira dokotala ku University of Washington ku St. Louis, Missouri. Adachita maphunziro omaliza zamankhwala amkati ndi hepatology ku University of California, San Francisco (UCSF). Adachita maphunziro owonjezera ku National Institutes of Health pazowopsa ndi chitetezo chamthupi. Dr. Hirsch analinso mkulu wa zamatenda a hepatology ku Washington, D.C., VA Medical Center. A Hirsch adasungitsa oyang'anira masukulu azachipatala a Georgetown ndi George Washington University.

Dr. Hirsch ali ndi machitidwe azachipatala othandizira odwala omwe ali ndi kachilombo ka hepatitis C. Alinso ndi zaka zambiri pakufufuza zamankhwala. Adatumikira m'mabungwe olangiza makampani, mabungwe azachipatala mdziko lonse, komanso mabungwe oyang'anira.