Necrotizing vasculitis

Necrotizing vasculitis ke sehlopha sa mathata a amanang le ho ruruha ha marako a methapo ea mali. Boholo ba methapo ea mali e amehileng bo thusa ho tseba mabitso a maemo ana le hore na lefu lena le baka mafu joang.

Necrotizing vasculitis e kanna ea ba boemo bo ka sehloohong bo kang polyarteritis nodosa kapa granulomatosis le polyangiitis (eo pele e neng e bitsoa Wegener granulomatosis). Maemong a mang, vasculitis e ka hlaha e le karolo ea lefu le leng, joalo ka systemic lupus erythematosus kapa hepatitis C.

Lebaka la ho ruruha ha le tsejoe. Mohlomong e amana le lintlha tse ikemetseng. Lerako la methapo ea mali le ka 'na la hlaba le ho hola kapa la shoa (la fetoha necrotic). Mothapo oa mali o ka koala, oa sitisa phallo ea mali ho ea liseleng tseo o li fang. Ho haella ha phallo ea mali ho tla etsa hore lisele li shoe. Ka linako tse ling methapo ea mali e ka robeha le ho tsoa mali.

Necrotizing vasculitis e ka ama methapo ea mali karolong efe kapa efe ea 'mele. Ka hona, e ka baka mathata letlalong, bokong, matšoafo, mala, liphio, boko, manonyello kapa setho sefe kapa sefe.

Feberu, ho hatsela, mokhathala, ramatiki kapa ho theola boima ba 'mele e kanna ea ba matšoao feela qalong. Leha ho le joalo, matšoao a ka ba hoo e ka bang karolong efe kapa efe ea 'mele.

Letlalo:

• Makukuno a khubelu kapa a pherese maotong, matsohong kapa likarolong tse ling tsa 'mele
• Mmala o boputsoa ho menoana le menoana ea maoto
• Matšoao a lefu la lisele ka lebaka la khaello ea oksijene joalo ka bohloko, bofubelu le liso tse sa foleng

Mesifa le manonyeletso:

• Bohloko bo kopaneng
• Bohloko ba maoto
• Bofokoli ba mesifa

Sistimi ea boko le methapo:

• Bohloko, ho ba shohlo, ho hlohlona letsohong, leoto kapa sebakeng se seng sa mmele
• Bofokoli ba letsoho, leoto kapa karolo e 'ngoe ea' mele
• Barutoana ba boholo bo fapaneng
• Mahlo a theoha
• Ho metsa bothata
• Ho senyeha ha puo
• Bothata ba motsamao

Matšoafo le pampitšana ea ho hema:

• Khohlela
• Phefumoloho e khutšoanyane
• Pherekano ea Sinus le bohloko
• Ho kgohlola madi kapa ho tsoa madi ka dinko

Matšoao a mang a kenyelletsa:

• Bohloko ba mpeng
• Madi ka moroto kapa mantle
• Ho honotha kapa ho fetola lentsoe
• Bohloko ba sefuba bo bakoang ke tšenyo ea methapo e fanang ka pelo (methapo ea mali)

Mofani oa tlhokomelo ea bophelo o tla etsa tlhahlobo e felletseng ea 'mele. Tlhahlobo ea methapo ea methapo e ka bontša matšoao a tšenyo ea methapo.

Liteko tse ka etsoang li kenyelletsa:

• Palo e felletseng ea mali, phanele e akaretsang ea chemistry, le urinalysis
• X-ray sefubeng
• Teko ea protheine ea C-e sebetsang
• Sekhahla sa sedimentation
• Teko ea mali ea hepatitis
• Teko ea mali bakeng sa lithibela-mafu khahlanong le li-neutrophils (li-antibodies tsa ANCA) kapa li-antigen tsa nyutlelie (ANA)
• Teko ea mali bakeng sa cryoglobulins
• Teko ea mali bakeng sa maemo a tlatsetsang
  
• Ho etsa lithuto tsa ho etsa litšoantšo tse kang angiogram, ultrasound, scan computed tomography (CT), kapa imaging resonance imaging (MRI)
• Biopsy ea letlalo, mesifa, lisele tsa setho, kapa methapo

Corticosteroids e fanoa maemong a mangata. Tekanyo e tla itšetleha ka hore na boemo bo bobe hakae.

Lithethefatsi tse ling tse hatellang sesole sa 'mele li ka fokotsa ho ruruha ha methapo ea mali. Tsena li kenyelletsa azathioprine, methotrexate, le mycophenolate. Meriana ena hangata e sebelisoa hammoho le corticosteroids. Kopano ena e nolofalletsa ho laola lefu lena ka tekanyo e tlase ea corticosteroids.

Bakeng sa lefu le matla, cyclophosphamide (Cytoxan) e sebelisitsoe ka lilemo tse ngata. Leha ho le joalo, rituximab (Rituxan) e sebetsa ka tsela e tšoanang ebile ha e na chefo e ngata.

Haufinyane, tocilizumab (Actemra) e bonts'itsoe hore e sebetsa bakeng sa giant cell arteritis kahoo lethal dose corticosteroids le ka fokotsoa.

Necrotizing vasculitis e ka ba lefu le tebileng le le sokelang bophelo. Phello e latela sebaka sa vasculitis le boima ba tšenyo ea lisele. Mathata a ka hlaha ho tsoa ho lefu lena le meriana. Mefuta e mengata ea "necrotizing vasculitis" e hloka ho latela le kalafo ka nako e telele.

Mathata a ka kenyelletsa:

• Tšenyo e sa feleng moahong kapa ts'ebetsong ea sebaka se amehileng
• Matšoao a bobeli a lisele tsa necrotic
• Litla-morao tsa meriana e sebelisitsoeng

Bitsa mofani oa hau haeba u na le matšoao a necrotizing vasculitis.

Matšoao a tšohanyetso a kenyelletsa:

• Mathata likarolong tse fetang e le 'ngoe tsa' mele tse kang stroke, ramatiki, ho phatloha ho hoholo ha letlalo, bohloko ba mpeng kapa ho khohlela mali
• Liphetoho ka boholo ba moithuti
• Ho lahleheloa ke ts'ebetso ea letsoho, leoto, kapa setho se seng sa mmele
• Mathata a puo
• Ho metsa bothata
• Bofokoli
• Bohloko bo bohloko ba mpeng
  

Ha ho na mokhoa o tsebahalang oa ho thibela lefu lena.

• Tsamaiso ea potoloho ea mali

Jennette JC, Falk RJ. Renal le systemic vasculitis. Ho: Feehally J, Floege J, Tonelli M, Johnson RJ, bangoli. Kakaretso ea Nephrology ea Kliniki. La 6th. Philadelphia, PA: Elsevier; 2019: khaolo ea 25.

Jennette JC, Weimer ET, Kidd J. Vasculitis. Ka: McPherson RA, Pincus MR, bahlophisi. Henry's Clinical Diagnosis le Tsamaiso ka Mekhoa ea Laboraro. 23th ed. St Louis, MO: Elsevier; 2017: khaolo ea 53.

Rhee RL, Hogan SL, Poulton CJ, le al. Mekhoa ea sephetho sa nako e telele har'a bakuli ba nang le antineutrophil cytoplasmic anti-vasculitis e amanang le lefu la renal. Ramatiki Rheumatol. 2016; 68 (7): 1711-1720. PMID: 26814428 www.ncbi.nlm.nih.gov/pubmed/26814428. (Lebokose)

Mefuta ea U, Merkel PA, Seo P, et al. Ts'ebetso e nepahetseng ea mekhoa ea ho hlakola-induction bakeng sa vasculitis e amanang le ANCA. N Engl J Med. 2013; 369 (5): 417-427. PMID: 23902481 www.ncbi.nlm.nih.gov/pubmed/23902481.

Lejoe JH, Klearman M, Collinson N. Teko ea tocilizumab ho giant-cell arteritis. N Engl J Med. 2017; 377 (15): 1494-1495. PMID: 29020600 www.ncbi.nlm.nih.gov/pubmed/29020600.