Tlhahlobo ea Matšoao, Tlhahlobo le Tlhahlobo ea Hypereosinophilic Syndromes
Kakaretso
Li-syndromes tsa Hypereosinophilic (HES) ke sehlopha sa mathata a sa tloaelehang a khetholloang ke likarolo tse phahameng tsa eosinophils (eosinophilia) e bakang tšenyo ea litho (letlalo, matšoafo, pelo, matšoao a masapo). Boholo ba batho ba ka holimo ho lilemo tse 20 ha ba hlahlojoa empa e ka ba teng ho bana. Boholo ba HES bo nkoa e le boemong bo botle (eseng ba kankere) empa karoloana e nkoa e le myeloproliferative neoplasms e ka fetoha kankere.
Tlhaloso
Hypereosinophilia e hlalosoa e le tekanyo e feletseng ea eosinophil e kholo ho feta 1500 lisele / microliter tse peli tse feletseng tsa mali (CBC) ka makhetlo a mabeli a fapaneng a arohanngoa bonyane khoeli e le 'ngoe le / kapa bopaki ba li-tissu tsa hypereosinophilia holim'a biopsy. Hypereosinophilia likarolong tsena li hlalosoa ho latela sebaka sa biopsy. Ha mokotla oa masapo o ntse o lemala, hypereosinophilia e hlalosoa ha karolo ea 20 lekholong ea lisele tsa nucleated eosinophils. Lihlahisoa tse ling, e hlalosoa e le "ho pharaletseng" ho kenngoa ha li-eosinophil ho liphatsa tsa lefutso ka maikutlo a setsebi sa mafu (ngaka e hlahlobang bothata).
Maemo a 'maloa a ka etsa hore ho be le li-eosinophilia empa hangata li baka tšenyo ea lisele tse hlahang HES. Eosinophilia e ka aroloa ka mekhahlelo e meraro: e bonolo (500 ho ea ho 1500 eosinophils / microliter), e nyenyane (1500 ho ea ho 5000 eosinophils / microliter), le matla (a fetang 5000 eosinophils / microliter.
Mefuta
HES e ka aroloa ka likarolo tse tharo tse kholo: tse ka sehloohong (kapa tsa methapo ea methapo), ea bobeli (kapa ea ts'oaetsanoang) le ea idiopathic. Idiopathic HES ke ho fumanoa hore ha ho na mohloli o mong oa li-eosinophilia. Ha e le HES e ka sehloohong, phetoho ea liphatsa tsa lefutso e etsa hore 'mele oa bone o potlakise tlhahiso ea eosinophil e tšoanang le polycythemia vera kapa thrombocythemia ea bohlokoa .
Ho HES ea bobeli, boemo bo boima (tšoaetso ea likokoana-hloko, lymphoma, joalo-joalo) e hlahisa liprotheine (tse bitsoang li-cytokines) tse hlahisang tlhahiso ea eosinophil.
Matšoao
Matšoao a HES a thehiloe sebakeng seo a amehileng mme a kenyeletsa:
- Letlalo: khanya ea letsatsi, botenya ba letlalo, ming'ae,
- Lithako: khohlela, phefumoloho e khutšoanyane, ho phalla
- Pelo: bohloko ba sefuba, ho hema ho thata,
- Maloetse a kelello
- Li-blood clots (thrombosis)
- Mahlo: Pono e foufalitsoeng
- Tšoaetso ea mafu a motsoako (GI): tahlehelo ea boima ba 'mele, bohloko ba mpeng, ho hlatsa, letšollo
Tsejoa
Joalokaha ho boletsoe ka holimo, li-eosinophil ke e 'ngoe ea mefuta e mehlano ea lisele tse tšoeu tsa mali (neutrophils, lymphocytes, monocytes, eosinophils le basophils). Teko ea pele ea ho hlahloba ke palo e feletseng ea mali. Tlhahlobo ea eosinophil e fetang lisele tse 1500 / microliter ka makhetlo a mabeli e fana ka bopaki bo eketsehileng ba ho hlahlojoa Qalong, lisosa tse tloaelehileng tsa li-eosinophilia li lokela ho felisoa.
Hang ha HES e belaelloa, tlhahlobo e lebisitsoe ho batla ho kenya letsoho ha litho. Ho hlahloba pelo ho tla kenyeletsa electrocardiogram (ECG) le echocardiogram (ultrasound of heart). Mokhoa oa ho hlahloba mosebetsi o lokela ho etsoa. Computed tomography (CT) e tla sebelisoa ho sheba lipontšo leha e le life tsa HES matšoafong kapa mpa.
Litlhahlobo tse eketsehileng li tla tsepamisoa mohoong oa ho bona hore na ho na le bopaki bo bong le bo bong ba myeloproliferative neoplasm. Sena se kenyeletsa mosebetsi oa mali le aspirate ea mofu / biopsy . Lisele tsa motsoako o tla hlahlojoa bakeng sa liphetoho tsa liphatsa tsa lefutso tse amanang le HES. Haeba ho na le palo e ntseng e eketseha ea lisele tsa mast, tlhahlobo e tla romeloa ho ea batla mastocytosis (mokhoa o mong oa moriana oa myeloproliferative neoplasm).
Phekolo
Kalafo ea hau e tla etsoa ka mofuta oa hypereosinophilic syndrome le matla a matšoao a hau. Ho tloaelehile hore u hloke phekolo ha u elelloa, empa HES e sa tloaelehang haholo e ka hloka phekolo ea kapele.
- Steroids: Li-steroids tse kang prednisone le methylprednisolone li ka sebelisoa.
- Imatinib: Imatinib ke moriana oa molomo o sebelisoang ho tšoara kankere e bitsoang tyrosine kinase inhibitor.
- Vincristine: Vincristine ke chemotherapy ea intravenous (IV) e ka sebelisoang. Haeba u arabela, palo ea hau ea eosinophil e ka fokotseha pele ho nako ea tsamaiso.
- Hydroyxurea: Hydroxyurea ke meriana ea oral chemotherapy. Ho ka 'na ha nka libeke tse 2 ho bona karabo ea meriana ena.
Haeba ho na le likarolo tsa myeloproliferative neoplasm (maemong a phahameng a vithamine B12, spleen e hōlileng, li-eosinophils tsa mahlaseli, joalo-joalo), phekolo ea pele ke imatinib. Haeba ho na le karolo ea pelo, li-steroid li kenngoa. Haeba imatinib e sa atlehe, ho na le meriana e mengata e tšoanang e ka sebelisoang. Bongata ba batho ba nang le HES ha ba hloke phekolo empa ba hloka tlhokomelo e hlokolosi bakeng sa tšenyo ea 'mele, ntshetsopele ea liphallelo tsa mali (thrombosis), le tsoelo-pele ea mafu. Haeba ho na le tšebetso ea litho, li-steroids ke eona ea pele ea phekolo. Hobane ts'ebeliso ea nako e telele ea steroid e amana le litla-morao tse ngata, hang ha matšoao a laoloa, u ka fetisetsoa meriana e meng e kang hydroxyurea, alpha interferon, kapa methotrexate bakeng sa phekolo e tsoelang pele.
Joalokaha ho boletsoe ka holimo, li-steroids ke tsona tse ka sehloohong tsa phekolo. Pele o qala li-steroids ke habohlokoa haholo ho fumana hore na u kotsing ea tšoaetso ea likokoana-hloko e bitsoang Strongyloides. Li-steroids li ka mpefatsa tšoaetso ea Strongyloides haholo. Haeba o hloka phekolo e potlakileng 'me ho na le ho ameha hoba u na le tšoaetso ea Strongyloides, u tla phekoloa bakeng sa tšoaetso (meriana ea molomo ka matsatsi a 2).
Lentsoe le Tsoang ho
Ho ithuta hore u na le hypereosinophilic syndrome ho ka tšosa. Ka lehlohonolo, boholo ba batho ba nang le HES ba ke ke ba hloka phekolo. Bakeng sa ba etsang joalo, ho na le dikgetho tse 'maloa mme le ho feta ba ntse ba ithuta hona joale.
> Mohloli
> Roufosse F, Klion AD, Weller PF. Syndromes ea Hypereosinophilic: Lipontšo tsa meriana, mafu a likokoana-hloko, le ho hlahlojoa le li-syndromes tsa Hypereosinophilic: Kalafo. Ka ho: UpToDate, TW Post (Ed), UpToDate, Waltham, MA. (E fihliloe ka la 5 July, 2016.)