Gwajin maganin hana ɗaukar jini na lupus (LA) muhimmin ɓangare ne na gwajin dakin gwaje-gwaje don maganin rigakafi na antiphospholipid kuma an ba da shawarar amfani da shi a yanayi daban-daban na asibiti, kamar gano cutar antiphospholipid syndrome (APS) da systemic lupus erythematosus (SLE), kimanta haɗarin thromboembolism na venous thromboembolism (VTE), da kuma bayanin lokacin thromboplastin mai aiki ba tare da wani bayani ba (APTT). Wannan labarin zai taimaka muku sanin menene cutar antiphospholipid (APS).
Ciwon Antiphospholipid (APS) cuta ce ta jiki wadda ke da alaƙa da sake dawowar jijiyoyin jini, sake dawowar zubar da ciki, thrombocytopenia, da sauransu a matsayin manyan bayyanar cututtuka, tare da matsakaicin matsakaici da babban titer positive antiphospholipid antibody spectrum (aPLs). Yawanci ana raba ta zuwa primary APS da secondary APS, wanda na ƙarshe galibi yana da alaƙa da cututtukan haɗin gwiwa kamar systemic lupus erythematosus (SLE) da Sjögren's syndrome. Bayyanar cututtuka na APS suna da rikitarwa kuma daban-daban, kuma dukkan tsarin jiki na iya shafar, tare da mafi bayyanar bayyanar ita ce thrombosis na jijiyoyin jini. Dalilin APS shine cewa aPL yana yawo yana ɗaurewa da phospholipids na saman tantanin halitta da furotin masu ɗaure phospholipid, yana kunna ƙwayoyin endothelial, PLTs da wBc, wanda ke haifar da abubuwan da suka faru na thrombosis na jijiyoyin jini da rikitarwa na haihuwa, da kuma haɓaka faruwar wasu rikitarwa na autoimmune da kumburi. Kodayake aPL yana da illa, thrombosis yana faruwa ne kawai lokaci-lokaci, yana nuna cewa "yajin aiki na biyu" na ɗan gajeren lokaci kamar kamuwa da cuta, kumburi, tiyata, ciki da sauran abubuwan da ke haifar da thrombosis suna da mahimmanci a cikin tsarin thrombosis.
A gaskiya ma, APS ba sabon abu ba ne. Bincike ya nuna cewa kashi 25% na marasa lafiya da ke fama da bugun jini wanda ba a bayyana ba a ƙasa da shekaru 45 suna da alamun aPL, kashi 14% na marasa lafiya da ke fama da cututtukan thrombosis na jijiyoyin jini masu maimaitawa suna da alamun aPL, kuma kashi 15% zuwa 20% na mata marasa lafiya da ke fama da rashin juna biyu masu maimaitawa suna da alamun aPL. Saboda rashin fahimtar wannan nau'in cutar daga likitoci, matsakaicin lokacin da aka jinkirta ganewar APS shine kimanin shekaru 2.9. APS yawanci ya fi yawa a cikin mata, tare da rabon maza na mace: 9:1, kuma ya fi yawa a cikin matasa da tsofaffi, amma kashi 12.7% na marasa lafiya sun fi shekaru 50 girma.
1. Abubuwan da ke faruwa a cikin Thrombotic
Bayyanar cutar thrombosis ta jijiyoyin jini a cikin APS ya dogara da nau'in, wurin da girman jijiyoyin jini da abin ya shafa, kuma ana iya bayyana su a matsayin jijiyoyin jini guda ɗaya ko da yawa da ke da hannu. Ciwon thromboembolism na jijiyoyin jini (VTE) ya fi yawa a cikin APS, galibi a cikin zurfin jijiyoyin ƙananan gaɓoɓi. Hakanan yana iya shafar sinuses na jijiyoyin jini na intracranial, retina, subclavian, hanta, koda, da kuma mafi girma da na baya na vena cava. Ciwon thrombosis na jijiyoyin jini na APS (AT) ya fi yawa a cikin jijiyoyin jini na intracranial, kuma yana iya shafar jijiyoyin koda, jijiyoyin zuciya, jijiyoyin jini na mesenteric, da sauransu. Bugu da ƙari, marasa lafiya na APS na iya samun thrombosis na microvascular a cikin fata, idanu, zuciya, huhu, koda da sauran gabobin jiki. Meta-bincike ya gano cewa tasirin lupus anticoagulant (LA) yana da haɗarin thromboembolism fiye da antibodies na antiphospholipid (acL); Nazarin asibiti ya nuna cewa marasa lafiya na APS masu aPL mai kyau [watau, LA, aCL, glycoprotein I antibodies (αβGPI) positivity] suna nuna babban haɗarin thrombosis, gami da ƙimar thrombosis na 44.2% cikin shekaru 10.
2. Ciki mai cututtuka
Ilimin cututtuka na bayyanar APS a lokacin daukar ciki yana da sarkakiya kuma yana iya bambanta dangane da matakin daukar ciki, wanda ke haifar da bambancin siffofin asibiti da aka lura. Kumburi, kunna kari, da kuma thrombosis na mahaifa duk ana daukar su a matsayin abubuwan da ke haifar da cutar APS a lokacin daukar ciki. Ciki mai cututtuka da APS ke haifarwa yana daya daga cikin kadan daga cikin abubuwan da za a iya hanawa da magance su, kuma kulawa mai kyau na iya inganta sakamakon daukar ciki yadda ya kamata. Wani bincike da aka buga a shekarar 2009 ya gano cewa kasancewar LA da aCL yana da alaka sosai da mutuwar tayi a sama da makonni 10 na daukar ciki; wani bita da nazari mai tsari da aka yi kwanan nan sun gano cewa tasirin LA yana da alaka sosai da mutuwar tayi. A cikin marasa lafiya da aka sani suna da APS, hadarin mutuwar tayi har yanzu yana da girma har zuwa kashi 10% zuwa 12% koda kuwa ana amfani da maganin heparin da aspirin mai ƙarancin allurai. Ga marasa lafiya na APS masu tsananin alamun preeclampsia ko rashin isasshen mahaifa, kasancewar LA da aCL yana da alaka sosai da preeclampsia; sake zubar da ciki da wuri (kasa da makonni 10 na daukar ciki) matsala ce ta haihuwa wadda galibi tana la'akari da yiwuwar APS.
1. Thrombocytopenia
Thrombocytopenia yana ɗaya daga cikin alamun asibiti da aka saba gani a cikin marasa lafiya da APS, tare da faruwar kashi 20% zuwa 53%. Yawanci, SLE secondary APS ya fi saurin kamuwa da thrombocytopenia fiye da primary APS. Matsayin thrombocytopenia a cikin marasa lafiya da APS sau da yawa yana da sauƙi ko matsakaici. Abubuwan da ka iya haifar da cutar sun haɗa da aPLs waɗanda ke ɗaure kai tsaye zuwa platelets don kunna da tara platelets, shan thrombotic microangiopathy, shan ɗimbin thrombosis, ƙaruwar riƙewa a cikin saifa, da kuma mummunan halayen da suka shafi magungunan hana ɗaukar jini da heparin ke wakilta. Saboda thrombocytopenia na iya ƙara haɗarin zubar jini, likitoci suna da wasu damuwa game da amfani da maganin hana zubar jini a cikin marasa lafiya da APS da ke da thrombocytopenia, har ma sun yi imani da kuskure cewa APS thrombocytopenia na iya rage haɗarin sake dawowar abubuwan da ke faruwa a cikin marasa lafiya. A gaskiya ma, akasin haka, bincike ya nuna cewa haɗarin sake dawowar abubuwan da ke faruwa a cikin marasa lafiya da APS da ke da thrombocytopenia yana ƙaruwa sosai, don haka ya kamata a yi masa magani sosai.
2. CAPS wata cuta ce mai matuƙar hatsari, wadda ke da alaƙa da yawan embolisms na jijiyoyin jini (≥3) a cikin ƙaramin adadin marasa lafiya na APS cikin ɗan gajeren lokaci (≤ kwana 7), yawanci tana da yawan titers, tana shafar ƙananan jijiyoyin jini, da kuma tabbatar da cutar thrombosis a cikin ƙananan jijiyoyin jini. APL positive yana ci gaba cikin makonni 12, yana haifar da gazawar gabobin jiki da dama da kuma haɗarin mutuwa, wanda aka sani da catastrophic antiphospholipid syndrome. Yawan kamuwa da cutar ya kai kusan 1.0%, amma adadin mace-macen yana da yawa har zuwa 50% ~ 70%, sau da yawa saboda bugun jini, encephalopathy, zubar jini, kamuwa da cuta, da sauransu. Wataƙila cutar da ke haifar da ita ita ce samuwar thrombotic storm da kumburi storm cikin ɗan gajeren lokaci.
aPLs kalma ce ta gabaɗaya ga ƙungiyar antibodies masu ɗauke da phospholipids da/ko sunadaran da ke ɗaure phospholipid a matsayin antigens masu manufa. Ana samun aPLs galibi a cikin marasa lafiya da ke ɗauke da cututtukan autoimmune kamar APS, SLE, da Sjögren's syndrome. Su ne alamomin dakin gwaje-gwaje mafi halayya na APS kuma manyan abubuwan da ke hasashen haɗarin faruwar thrombosis da kuma ciki a cikin marasa lafiya da ke ɗauke da cutar APS. Daga cikinsu, an yi amfani da anticoagulant na lupus (LA), antibodies na anticardiolipin (aCL), da antibodies na anti-β-glycoprotein I (αβGPⅠ), a matsayin alamun dakin gwaje-gwaje a cikin ma'aunin rarrabuwa na APS, a matsayin manyan alamun dakin gwaje-gwaje a cikin aikin asibiti kuma sun zama ɗaya daga cikin gwaje-gwajen autoantibody da aka fi sani a cikin dakunan gwaje-gwaje na asibiti.
Idan aka kwatanta da aCL da antibodies na anti-βGPⅠ, LA tana da alaƙa mai ƙarfi da thrombosis da ciki mai cututtuka. LA tana da haɗarin thrombosis fiye da acL. Kuma tana da alaƙa da zubar jini a cikin ciki sama da makonni 10. A takaice, LA mai ci gaba da kasancewa mai kyau ita ce mafi inganci wajen hasashen haɗarin thrombosis da kuma cututtukan ciki.
Gwaji ne na aiki wanda ke tantance ko jiki yana da LA bisa ga gaskiyar cewa LA na iya tsawaita lokacin coagulation na hanyoyi daban-daban da suka dogara da phospholipid a cikin vitro. Hanyoyin gano LA sun haɗa da:
1. Gwajin tantancewa: gami da lokacin gubar maciji mai narkewa (dRVVT), lokacin thromboplastin mai aiki (APTT), hanyar lokacin coagulation na silica, lokacin coagulation na maciji mai girma da lokacin enzyme na jijiyar maciji. A halin yanzu, jagororin gano aPLs na duniya kamar Ƙungiyar Duniya kan Thrombosis da Haemostasis (ISTH) da Cibiyar Kula da Ka'idojin Dakunan gwaje-gwaje ta Asibiti (CLSI) sun ba da shawarar a gano LA ta hanyoyi guda biyu daban-daban na coagulation. Daga cikinsu, dRVVT da APTT sune hanyoyin ganowa da aka fi amfani da su a duniya. Yawanci ana amfani da dRVVT a matsayin hanyar farko ta zaɓi, kuma ana amfani da APTT mai laushi (ƙananan phospholipids ko silica a matsayin mai kunnawa) a matsayin hanya ta biyu.
2. Gwajin haɗa jini: Ana haɗa jinin majiyyaci da jinin lafiya (1:1) don tabbatar da cewa tsawon lokacin da aka ɗauka ba ya faruwa ne saboda rashin abubuwan da ke haifar da zubar jini ba.
3. Gwajin Tabbatarwa: Ana canza yawan sinadarin phospholipids ko abun da ke ciki don tabbatar da kasancewar LA.
Ya kamata a lura cewa samfurin da ya dace don LA ya kamata a tattara shi daga marasa lafiya waɗanda ba a yi musu maganin hana zubar jini ba, domin marasa lafiya da aka yi musu magani da warfarin, heparin, da sabbin magungunan hana zubar jini na baki (kamar rivaroxaban) na iya samun sakamakon gwajin LA mara kyau; saboda haka, ya kamata a fassara sakamakon gwajin LA na marasa lafiya da suka karɓi maganin hana zubar jini da taka tsantsan. Bugu da ƙari, ya kamata a fassara gwajin LA da taka tsantsan a yanayin asibiti mai tsanani, saboda ƙaruwar matakan furotin na C-reactive na iya tsoma baki ga sakamakon gwajin.
APS cuta ce ta garkuwar jiki wadda ke da abubuwan da ke faruwa na toshewar jijiyoyin jini, zubar da ciki ba zato ba tsammani, toshewar jijiyoyin jini, da sauransu a matsayin manyan alamun asibiti, tare da matsakaicin adadin aPLs masu yawa.
APS yana ɗaya daga cikin ƙalilan abubuwan da ke haifar da ciki da za a iya magancewa. Kula da APS yadda ya kamata zai iya inganta sakamakon ciki yadda ya kamata.
A cikin aikin asibiti, APS ya kamata ya haɗa da marasa lafiya da ke da alamun asibiti masu alaƙa da aPLs kamar livedo reticularis, thrombocytopenia, da cututtukan zuciya, da kuma waɗanda suka cika sharuɗɗan rarrabuwa na asibiti kuma suna da ƙarancin adadin aPLs akai-akai. Irin waɗannan marasa lafiya kuma suna da haɗarin faruwar thrombosis da kuma ɗaukar ciki.
Manufofin maganin APS sun haɗa da hana thrombosis da kuma guje wa gazawar ciki.
Nassoshi
[1] Zhao Jiuliang, Shen Haili, Chai Kexia, da sauransu. Jagororin Ganewa da Maganin Ciwon Antiphospholipid[J]. Mujallar Magungunan Cikin Gida ta Sin
[2] Bu Jin, Liu Yuhong. Ci gaba a cikin ganewar asali da maganin cutar antiphospholipid[J]. Mujallar Magungunan Ciki na Asibiti
[3] JAGORANCIN BSH Jagororin bincike da kuma kula da cutar antiphospholipid.
[4] Kwamitin Thrombosis da Hemostasis na Ƙungiyar Asibitocin Bincike ta ƙasar Sin. Yarjejeniyar amincewa kan daidaita gano da bayar da rahoton maganin hana kumburi na lupus [J].
Katin kasuwanci
WeChat na kasar Sin