Isibindi Fibrosis

-Delile

• Ziyini izigaba zesibindi se-fibrosis?
• Ziyini izimpawu zesibindi se-fibrosis?
• Ziyini izimbangela zesibindi se-fibrosis?
• Izinketho zokwelashwa
• Ukuxilongwa
• I-biopsy yesibindi
• I-elastography yesikhashana
• Ukuhlolwa kwe-Nonsurgical
• Izinkinga
• Umbono

Ukubuka konke

Isibindi fibrosis senzeka lapho izicubu ezinempilo zesibindi sakho ziba nezibazi ngakho-ke azikwazi ukusebenza kahle. I-Fibrosis yisigaba sokuqala sokusha kwesibindi. Kamuva, uma isibindi esiningi siba nezibazi, saziwa njenge-cirrhosis yesibindi.

Ngenkathi ezinye izifundo zezilwane zikhombisile ukuthi kungenzeka ukuthi isibindi sizivuselele noma sizelaphe, uma ukulimala kwesibindi sekwenziwe kubantu, isibindi asivamisile ukuphola. Kodwa-ke, imishanguzo kanye nokushintsha kwendlela yokuphila kungasiza ekugcineni i-fibrosis ingabi kubi.

Ziyini izigaba zesibindi se-fibrosis?

Kunezilinganiso ezahlukahlukene zesiteji sesibindi se-fibrosis, lapho udokotela enquma izinga lokulimala kwesibindi. Njengoba ukufakwa kwesiteji kungazithoba, isilinganiso ngasinye sinemikhawulo yaso. Omunye udokotela angacabanga ukuthi isibindi sinezibazi kancane kunomunye. Kodwa-ke, odokotela bavame ukwabela isigaba i-fibrosis yesibindi ngoba isiza isiguli nabanye odokotela ukuthi baqonde izinga lapho kuthinteka khona isibindi somuntu.

Olunye lwezinhlelo ezithandwa kakhulu zokufaka amagoli uhlelo lokufaka amagoli le-METAVIR. Lolu hlelo lubeka amaphuzu “womsebenzi” noma ukubikezela ukuthi i-fibrosis iqhubeka kanjani, kanye nezinga le-fibrosis uqobo. Odokotela imvamisa bangabeka leli phuzu kuphela ngemuva kokuthatha isampula le-biopsy noma izicubu zengcezu yesibindi. Amabanga womsebenzi asukela ku-A0 kuye ku-A3:

• A0: awukho umsebenzi
• I-A1: umsebenzi omnene
• I-A2: umsebenzi olinganiselayo
• I-A3: umsebenzi onzima

Izigaba ze-fibrosis zisukela ku-F0 ziye ku-F4:

• I-F0: ayikho i-fibrosis
• I-F1: i-portal fibrosis ngaphandle kwe-septa
• I-F2: i-portal fibrosis ene-septa embalwa
• I-F3: i-septa eminingi ngaphandle kwe-cirrhosis
• F4: ukuqina kwesibindi

Ngakho-ke, umuntu onesifo esibi kakhulu angaba nesilinganiso se-A3, F4 METAVIR.

Olunye uhlelo lokushaya amagoli yiBatts neLudwig, ebanga i-fibrosis esikalini sebanga loku-1 kuye ebangeni lesi-4, kuthi ibanga lesi-4 libe elinzima kakhulu. I-International Association of the Study of the Liver (IASL) nayo inesistimu yokufaka amagoli enezigaba ezine ezisukela kwesifo sokusha kwesibindi kohlobo esingapheli kuya kwesifo esibi esibi esingapheli.

Ziyini izimpawu zesibindi se-fibrosis?

Odokotela abavami ukuxilonga i-fibrosis yesibindi ngezigaba zayo eziphakathi neziphakathi. Lokhu kungenxa yokuthi i-fibrosis yesibindi ayivame ukudala izimpawu kuze kube yilapho iningi lesibindi lilimala.

Lapho umuntu eqhubeka nesifo sakhe sesibindi, angathola izimpawu ezibandakanya:

• ukulahlekelwa isifiso sokudla
• kunzima ukucabanga kahle
• ukwanda ketshezi emilenzeni noma esiswini
• i-jaundice (lapho isikhumba namehlo avela ephuzi)
• isicanucanu
• ukuncipha kwesisindo okungaqondakali
• ubuthakathaka

Ngokusho kuka-a, kulinganiselwa ukuthi amaphesenti angama-6 kuya kwayi-7 omhlaba wonke ane-fibrosis yesibindi futhi angayazi ngoba awanawo izimpawu.

Ziyini izimbangela zesibindi se-fibrosis?

Isibindi fibrosis senzeka ngemuva kokuthi umuntu ezwe ukulimala noma ukuvuvukala esibindini. Amaseli wesibindi akhuthaza ukwelashwa kwesilonda. Ngesikhathi sokuphulukiswa kwesilonda, amaprotheni amaningi ngokweqile njenge-collagen nama-glycoprotein akha esibindini. Ekugcineni, ngemuva kwezimo eziningi zokulungiswa, amaseli wesibindi (aziwa ngokuthi ama-hepatocyte) awasakwazi ukuzilungisa. Amaprotheni amaningi enza izicubu ezibomvu noma i-fibrosis.

Izinhlobo eziningi zezifo zesibindi zikhona ezingadala i-fibrosis. Lokhu kufaka phakathi:

• i-hepatitis ezenzakalelayo
• ukuvimbela i-biliary
• insimbi egcwele ngokweqile
• isifo sesibindi esingenawo utshwala, okubandakanya isibindi esinamafutha angenalo utshwala (NAFL) kanye ne-nonalcoholic steatohepatitis (NASH)
• isifo sokusha kwesibindi kohlobo B no-C
• isifo sesibindi sotshwala

Ngokusho, imbangela evame kakhulu yesibindi i-fibrosis yisifo sesibindi esinamafutha (i-NAFLD), kanti esesibili yisifo sesibindi sokuphuza ngokweqile ngenxa yokuphuza ngokweqile isikhathi eside.

Izinketho zokwelashwa

Izinketho zokwelashwa kwe-fibrosis yesibindi imvamisa zincike kumbangela oyimbangela ye-fibrosis. Udokotela uzokwelapha ukugula okuyisisekelo, uma kungenzeka, ukunciphisa imiphumela yesifo sesibindi. Isibonelo, uma umuntu ephuza utshwala ngokweqile, udokotela angancoma uhlelo lokwelashwa oluzomsiza ayeke ukuphuza. Uma umuntu ene-NAFLD, udokotela angancoma ukuthi enze ushintsho ekudleni ukuze anciphise isisindo futhi athathe imishanguzo yokukhuthaza ukulawula ushukela wegazi kangcono. Ukuvivinya umzimba nokunciphisa umzimba kungasiza futhi ekunciphiseni ukuqhubeka kwesifo.

Udokotela angahle anikeze nemithi eyaziwa ngokuthi i-antifibrotics, ekhonjisiwe ukunciphisa amathuba okuthi isibazi sesibindi senzeke. I-antifibrotic enqunyiwe imvamisa incike esimweni sezempilo esingaphansi. Izibonelo zalezi zindlela zokwelapha zifaka:

• izifo ezingapheli zesibindi: Ama-ACE inhibitors, afana ne-benazepril, i-Lisinopril ne-ramipril
• igciwane le-hepatitis C: a-Tocopherol noma i-interferon-alpha
• i-steatohepatitis engeyona utshwala: I-PPAR-alpha agonist

Ngenkathi abacwaningi benza izivivinyo eziningi ukuzama ukuthola imishanguzo engaguqula imiphumela ye-fibrosis yesibindi, ayikho imishanguzo engakufeza lokhu njengamanje.

Uma i-fibrosis yesibindi yomuntu iqhubekela lapho isibindi sayo sinesibazi kakhulu futhi ingasebenzi, ukwelashwa komuntu okuvame ukuthola ukufakelwa kwesibindi. Kodwa-ke, uhlu lokulinda lude kulezi zinhlobo zokufakelwa futhi hhayi wonke umuntu ungumuntu ozobhapathizwa.

Ukuxilongwa

I-biopsy yesibindi

Ngokwesiko, odokotela babecabanga ukuthatha i-biopsy yesibindi "indinganiso yegolide" yokuhlolelwa i-fibrosis yesibindi. Le yinqubo yokuhlinzwa lapho udokotela ethatha khona isampula lezicubu. Isazi esaziwa njenge-pathologist sizohlola izicubu ukuba khona kwesibazi noma i-fibrosis.

I-elastography yesikhashana

Enye indlela ukuhlolwa kwe-imaging okwaziwa njenge-elastography yesikhashana. Lesi isivivinyo esikala ukuthi isibindi siqinile kanjani. Lapho umuntu ene-fibrosis yesibindi, amangqamuzana anezibazi enza isibindi siqine. Lokhu kuhlolwa kusebenzisa amaza omsindo wemvamisa ephansi ukukala ukuthi izicubu zesibindi ziqinile kanjani. Kodwa-ke, kungenzeka ukuthi ube nezindawo ezingamanga lapho izicubu zesibindi zingabonakala ziqinile, kepha i-biopsy ayikhombisi isibazi sesibindi.

Ukuhlolwa kwe-Nonsurgical

Kodwa-ke, odokotela bakwazile ukusebenzisa ezinye izivivinyo ezingadingi ukuhlinzwa ukuthola ukuthi umuntu angaba ne-fibrosis yesibindi yini. Lokhu kuhlolwa kwegazi kuvame ukubekelwa labo abanezifo ezaziwayo ezingapheli zesifo sokusha kwesibindi kohlobo C abasengozini yokuba nesibindi fibrosis ngenxa yesifo sabo. Izibonelo zifaka i-serum hyaluronate, i-matrix metalloproteinase-1 (MMP), kanye ne-tissue inhibitor ye-matrix metalloproteinase-1 (TIMP-1).

Odokotela bangaphinda basebenzise izivivinyo ezidinga ukubalwa, njenge-aminotransferase-to-platelet ratio (i-APRI) noma ukuhlolwa kwegazi okubizwa nge-FibroSURE elikala izimpawu eziyisithupha ezihlukene zesibindi bese lizibeka ku-algorithm ngaphambi kokunikeza amaphuzu. Kodwa-ke, udokotela akakwazi ngokuvamile ukunquma isigaba se-fibrosis yesibindi ngokusekelwe kulezi zivivinyo.

Ngokufanelekile, udokotela uzoxilonga umuntu onesibindi se-fibrosis ekuqaleni lapho isimo siyelapheka kakhulu. Kodwa-ke, ngoba lesi simo asivame ukudala izimpawu ezigabeni zakuqala, odokotela abajwayele ukuxilonga isimo ekuqaleni.

Izinkinga

Inkinga ebaluleke kakhulu yesibindi i-fibrosis kungaba isibindi i-cirrhosis, noma isibazi esinzima esenza isibindi sonakaliswe kakhulu umuntu uzogula. Imvamisa, lokhu kuthatha isikhathi eside ukwenzeka, njengokuphela kweshumi noma amabili eminyaka.

Umuntu udinga isibindi sakhe ukuze aphile ngoba isibindi sinesibopho sokuhlunga izinto eziyingozi egazini nokwenza eminye imisebenzi eminingi ebalulekile emzimbeni. Ekugcineni, uma i-fibrosis yomuntu iqhubekela ku-cirrhosis nokuhluleka kwesibindi, bangaba nezinkinga ezinjengalezi:

• ama-ascites (ukwakheka okunzima ketshezi esiswini)
• i-hepatic encephalopathy (inqwaba yemikhiqizo kadoti ebangela ukudideka)
• isifo se-hepatorenal
• umfutho wegazi ophezulu wengosi
• ukuphuma kwegazi

Ngayinye yalezi zimo ingaba yingozi kumuntu onesifo sesibindi.

Umbono

Ngokusho, isibindi i-cirrhosis ingenye yezimbangela eziholela ekufeni emhlabeni wonke. Ngakho-ke, kubalulekile ukuthi umuntu atholakale futhi alashelwe i-fibrosis yesibindi ngokushesha okukhulu ngaphambi kokuba iqhubekele esibindi sokuqina kwesibindi. Ngenxa yokuthi i-fibrosis yesibindi ayibangeli izimpawu njalo, lokhu kunzima ukukwenza. Kwesinye isikhathi odokotela kufanele bacabangele izinto eziyingozi zomuntu, njengokukhuluphala ngokweqile noma ukuphuza ngokweqile, ekutholeni i-fibrosis nokuncoma ukwelashwa.