I-Necrotizing vasculitis

I-Necrotizing vasculitis yiqembu lezinkinga ezibandakanya ukuvuvukala kwezindonga zomthambo wegazi. Usayizi wemithambo yegazi ethintekile kusiza ukunquma amagama alezi zimo nokuthi lesi sifo sibangela kanjani izifo.

I-Necrotizing vasculitis ingaba yisimo esiyinhloko njenge-polyarteritis nodosa noma i-granulomatosis ene-polyangiitis (eyayibizwa nge-Wegener granulomatosis). Kwezinye izimo, i-vasculitis ingenzeka njengengxenye yesinye isifo, njenge-systemic lupus erythematosus noma i-hepatitis C.

Isizathu sokuvuvukala asikaziwa. Kungenzeka ukuthi ihlobene nezici ezizimele. Udonga lomthambo wegazi lungaba nesibazi futhi lishise noma lufe (lube necrotic). Umthambo wegazi ungavala, uphazamise ukugeleza kwegazi kuya ezicutshini ezinikezayo. Ukuntuleka kokugeleza kwegazi kuzodala ukuthi izicubu zife. Kwesinye isikhathi umthambo wegazi ungaphuka futhi wophe (uqhekeke).

I-Necrotizing vasculitis ingathinta imithambo yegazi kunoma iyiphi ingxenye yomzimba. Ngakho-ke, kungadala izinkinga esikhunjeni, ebuchosheni, emaphashini, emathunjini, ezinso, ebuchosheni, emalungeni noma kwesinye isitho.

Imfiva, ukugodola, ukukhathala, isifo samathambo noma ukuncipha kungaba yizo kuphela izimpawu ekuqaleni. Kodwa-ke, izimpawu zingaba cishe kunoma iyiphi ingxenye yomzimba.

Isikhumba:

• Amaqhubu anombala obomvu noma onsomi emilenzeni, ezandleni noma kwezinye izitho zomzimba
• Umbala oluhlaza okwesibhakabhaka eminweni nasezinzwaneni
• Izimpawu zokufa kwezicubu ngenxa yokushoda komoya-mpilo njengobuhlungu, ukubomvu, nezilonda ezingapholi

Imisipha namalunga:

• Ubuhlungu obuhlangene
• Ubuhlungu bomlenze
• Ubuthakathaka bemisipha

Ubuchopho nesistimu yezinzwa:

• Ubuhlungu, ukuba ndikindiki, ukuncinza engalweni, emlenzeni, noma kwenye indawo yomzimba
• Ukubuthakathaka kwengalo, umlenze, noma enye indawo yomzimba
• Abafundi abanobukhulu obuhlukile
• Ijwabu lehla
• Ukugwinya ubunzima
• Ukukhubazeka kwenkulumo
• Ubunzima bokuhamba

Amaphaphu nomgudu wokuphefumula:

• Khwehlela
• Ukuphelelwa umoya
• Ukuminyana kwesinus nobuhlungu
• Ukukhwehlela igazi noma ukopha ngamakhala

Ezinye izimpawu zifaka:

• Ubuhlungu besisu
• Igazi emchameni noma ezindle
• Ukubola noma ukushintsha kwezwi
• Ubuhlungu besifuba obuvela ekulimaleni kwemithambo eletha inhliziyo (imithambo yegazi)

Umhlinzeki wezokunakekelwa kwempilo uzokwenza ukuhlolwa okuphelele ngokomzimba. Ukuhlolwa kwesistimu yezinzwa (i-neurological) kungakhombisa izimpawu zokulimala kwemizwa.

Ukuhlolwa okungenziwa kufaka phakathi:

• Qedela ukubalwa kwegazi, iphaneli ephelele yamakhemikhali, kanye nokuhlolwa komchamo
• I-x-ray yesifuba
• Ukuhlolwa kwamaprotheni asebenzayo ngo-C
• Izinga le-sedimentation
• Ukuhlolwa kwegazi le-hepatitis
• Ukuhlolwa kwegazi kwama-antibodies alwa nama-neutrophils (amasosha omzimba we-ANCA) noma ama-antigen enuzi (ANA)
• Ukuhlolwa kwegazi kwama-cryoglobulins
• Ukuhlolwa kwegazi kwamazinga wokugcwalisa
  
• Ukucwaninga izifundo ezifana ne-angiogram, ultrasound, scan computed tomography (CT), noma imaging resonance imaging (MRI)
• I-biopsy yesikhumba, imisipha, izicubu zomzimba, noma imizwa

Ama-Corticosteroids anikezwa ezimweni eziningi. Umthamo uzoncika ekutheni isimo sibi kangakanani.

Eminye imithi ecindezela amasosha omzimba inganciphisa ukuvuvukala kwemithambo yegazi. Lokhu kufaka phakathi i-azathioprine, i-methotrexate, ne-mycophenolate. Le mithi ivame ukusetshenziswa kanye ne-corticosteroids. Le nhlanganisela yenza kube lula ukulawula lesi sifo ngomthamo ophansi wama-corticosteroids.

Ngesifo esibi, i-cyclophosphamide (Cytoxan) isetshenziswe iminyaka eminingi. Kodwa-ke, i-rituximab (i-Rituxan) isebenza ngokulinganayo futhi ayinabuthi kangako.

Muva nje, i-tocilizumab (Actemra) ikhonjiswe ukuthi iyasebenza kwi-giant cell arteritis ngakho-ke umthamo we-corticosteroids ungancishiswa.

I-necrotizing vasculitis ingaba yisifo esibi futhi esisongela impilo. Umphumela uncike lapho kutholakala khona i-vasculitis nobukhulu bokulimala kwezicubu. Izinkinga zingavela kulesi sifo nasemithini. Izinhlobo eziningi ze-necrotizing vasculitis zidinga ukulandelwa nokwelashwa kwesikhathi eside.

Izinkinga zingafaka:

• Ukulimala unomphela kwesakhiwo noma kokusebenza kwendawo ethintekile
• Ukutheleleka kwesibili kwezicubu ze-necrotic
• Imiphumela emibi evela emithini esetshenzisiwe

Shayela umhlinzeki wakho uma unezimpawu ze-necrotizing vasculitis.

Izimpawu zezimo eziphuthumayo zifaka:

• Izinkinga ezingxenyeni ezingaphezu kweyodwa zomzimba njengokushaywa unhlangothi, isifo samathambo, ukuqubuka okukhulu kwesikhumba, ubuhlungu besisu noma ukukhwehlela igazi
• Izinguquko kusayizi womfundi
• Ukulahleka kokusebenza kwengalo, umlenze, noma enye ingxenye yomzimba
• Izinkinga zokukhuluma
• Ukugwinya ubunzima
• Ubuthakathaka
• Ubuhlungu obukhulu besisu
  

Ayikho indlela eyaziwayo yokuvimbela lesi sifo.

• Uhlelo lokujikeleza kwegazi

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UJennette JC, Weimer ET, uKidd J. Vasculitis. Ku: McPherson RA, Pincus MR, abahleli. UHenry’s Clinical Diagnosis and Management by Laboratory Methods. Umhla ka-23. ISt Louis, MO: Elsevier; I-2017: isahluko 53.

URhee RL, uHogan SL, uPoulton CJ, et al. Amathrendi emiphumeleni yesikhathi eside phakathi kweziguli ezine-antineutrophil cytoplasmic antibody-ehambisana ne-vasculitis enesifo sezinso. I-Arthritis Rheumatol. 2016; 68 (7): 1711-1720. I-PMID: 26814428 www.ncbi.nlm.nih.gov/pubmed/26814428.

I-Specks U, Merkel PA, Seo P, et al. Ukusebenza kwemigomo yokuxolelwa yokungeniswa kwe-vasculitis ehlobene ne-ANCA. N Engl J Med. 2013; 369 (5): 417-427. I-PMID: 23902481 www.ncbi.nlm.nih.gov/pubmed/23902481.

I-Stone JH, uKlearman M, uCollinson N. Isivivinyo se-tocilizumab ku-giant-cell arteritis. N Engl J Med. 2017; 377 (15): 1494-1495. I-PMID: 29020600 www.ncbi.nlm.nih.gov/pubmed/29020600.