Izinsiza - Ukuxilongwa
Izinga
Okokuqala, iphethini yezimpawu. Izimpawu kufanele ziphindaphindeke futhi zibe yi-episodic, futhi kufanele zibandakanye amasistimu wezitho ezimbili noma ngaphezulu. Izinhlanganisela ezijwayelekile zihlanganisa isikhumba esinamathumbu, noma inhliziyo nemithambo yokuphefumula. Inkinga evalelwe ohlelweni olulodwa, noma leyo engaguquki kunokuguquguquka, ayilingani.
Okwesibili, ubufakazi obuhlosiwe bokukhululwa komlamuleli we-mast cell. Lokhu kusho isilinganiso seselabhorethri - ngokuvamile ukwenyuka kwe-serum tryptase phakathi nesiqephu uma kuqhathaniswa nesisekelo esingenazimpawu zesiguli, noma ama-metabolite aphakeme angumlamuli emchameni. Umkhawulo we-tryptase osetshenziswa okuvamile uwukukhuphuka okungenani okungu-20% ngaphezu kwesisekelo kanye no-2 ng/mL eyengeziwe.
Okwesithathu, impendulo yokwelashwa eqondiswe kuma-mast cells. Ukuthuthukiswa kwama-antihistamine e-H1 ne-H2, iziqinisi zeseli ye-mast, noma ama-ejenti ahlobene asekela ukuxilongwa. Lo mbandela unesisindo sangempela ekusebenzeni, ikakhulukazi lapho ukuhlolwa komlamuli bekungahlangani.
Eceleni kwalokhu, ezinye izimo ezikwazi ukukhiqiza isithombe esifanayo kufanele zingafakwa - okuhlanganisa i-mastocytosis, ehilela ukweqisa kwangempela kwamaseli ensika futhi iphenywa ngendlela ehlukile. Qaphela ukuthi ukuhlukahluka kwalolu hlaka kukhona futhi ochwepheshe bayehluka ngokuthi bawusebenzisa ngokuqinile kanjani umbandela wesibili; indlela kadokotela ingase yehluke ngokunengqondo kulokho okuchazwe lapha.
Zontathu izindlela, ndawonye. Owesibili - ubufakazi obuhlosiwe - yilapho uhambo oluningi lokuxilonga luhlala khona, futhi ngokuvamile ngenxa yezizathu zobuchwepheshe kunokuba ngoba isiguli asinaso isimo.
I-serum tryptase umaka osungulwe kakhulu. Kudinga izilinganiso ezimbili ukuze zichazeke: esisodwa esithathwe ngesikhathi noma ngokushesha ngemva kokusabela, futhi esisodwa esithathwe ekuqaleni lapho izimpawu zithulile. Inani elilodwa elihlukanisiwe kunzima ukwenza ngalo, ngoba okubalulekile wushintsho olusuka kusisekelo somuntu esikhundleni senombolo ephelele. Isampula ebukhali kufanele zidwetshwe cishe phakathi nehora elilodwa kuya kwamane kusukela kuqale ukusabela, kanye nesampula eyisisekelo okungenani emahoreni angama-24 ngemva kokuqeda izimpawu.
Ukuqoqwa komchamo wamahora angu-24 linganisa ama-metabolites omlamuli - ngokuvamile i-N-methylhistamine, i-prostaglandin D2 noma i-metabolite yayo engu-11-beta-prostaglandin F2-alpha, ne-leukotriene E4. Lokhu kuthwebula iwindi elide kunokudonsa igazi okukodwa futhi kungathola ukwenziwa kusebenze okungaphuthelwa yisithombe esifushane. Kufanele ziqalwe ngesikhathi esinezimpawu.
Izidingo zokuphatha ziqinile, futhi ziyisizathu esivame kakhulu ukuthi imiphumela ibuye ingelona iqiniso. Abaningana balaba balamuli abazinzile ezingeni lokushisa legumbi. Amasampuli ngokuvamile adinga ukupholiswa ngokushesha, agcinwe ebanda ngesikhathi eqoqwa, futhi acutshungulwe ngokushesha. Amasampula e-Prostaglandin antekenteke kakhulu. Isifanekiso esishiywe kukhawunta, noma esithunyelwe izinto zokuhamba ezijwayelekile, singaveza umphumela ojwayelekile ovela esigulini ebesisabela ngokweqiniso.
Ngenxa yalokhu, kufanelekile ukuqinisekisa iphrothokholi yokuphatha nodokotela o-oda kanye nelabhorethri ngaphambili iqoqo kunokuba ngemva komphumela ongalindelekile. Akuwona wonke amalabhorethri ajwayelekile asebenzisa lezi zivivinyo, futhi akuwona wonke amakhithi eqoqo afika anemiyalelo eyanele.
Ngaphambi Kokuhlola
Ukutolika
Ukuhlola kukala amakhemikhali anesigamu sokuphila esifushane. I-Tryptase ifinyelela isiqongo phakathi namahora ambalwa okusabela bese iwe; ama-metabolites omchamo aphikelela isikhathi eside kodwa asabonisa iwindi elilinganiselwe. Uma isampuli ithathwa phakathi kweziqephu, kungase kungabi khona lutho oluphakeme olungatholwa - hhayi ngoba ukuqalisa akukaze kwenzeke, kodwa ngoba akusalinganiseki.
Ukuhlolwa komlamuleli ongemuhle akukhiphi i-MCAS ngokwayo - nokuqonda ukuthi kungani kuvimbela ukudumazeka okuningi okungadingekile.
Ukuhlola kukala amakhemikhali anesigamu sokuphila esifushane. I-Tryptase ifinyelela isiqongo phakathi namahora ambalwa okusabela bese iwe; ama-metabolites omchamo aphikelela isikhathi eside kodwa asabonisa iwindi elilinganiselwe. Uma isampuli ithathwa phakathi kweziqephu, kungase kungabi khona lutho oluphakeme olungatholwa - hhayi ngoba ukuqalisa akukaze kwenzeke, kodwa ngoba akusalinganiseki.
Izinkinga zokusingatha ezichazwe ngenhla zihlanganisa lokhu. Phakathi kokuqoqwa kwesikhathi esingafanele namasampuli awonakele, ingxenye enkulu yemiphumela engemihle ezincwadini nasema-akhawuntini esiguli ukwehluleka kwezobuchwepheshe kunokungabikho kwesifo kwangempela.
Akukho kulokhu okusho ukuthi ukuhlolwa kufanele kweqiwe. Ubufakazi obuhlosiwe buqinisa ukuxilongwa kakhulu, buvula ukufinyelela ekwelashweni, kanye nezindaba zomshwalense kanye nezindawo zokuhlala. Kusho ukuthi umphumela ojwayelekile kufanele udale ingxoxo mayelana nesikhathi nokusingatha - futhi mhlawumbe umzamo wokuphinda ngesikhathi sokusabela - kunokuvala umbuzo.
Letha umlando wezimpawu obhaliwe ohleliwe ngohlelo lwesitho esikhundleni sokulandelana kwezenzakalo. Ukufaka kuhlu isikhumba, amathumbu, inhliziyo nemithambo yegazi, izimpawu zokuphefumula, kanye nezinzwa njengamaqembu kwenza iphethini yesistimu eningi ibonakale ngokushesha, lapho i-akhawunti elandisayo ivame ukuyifihla.
Letha idayari yakho yokuqalisa uma uyigcinile - bheka Izicupha lokho ongakuqopha. Documented episodes with timing and severity give a clinician something concrete to work from, and help establish the episodic pattern the first criterion requires.
Letha imiphumela yokuhlolwa kwangaphambilini, okuhlanganisa nethi negative. Normal allergy panels, unremarkable endoscopies, and clear cardiac workups are informative: they are part of the exclusion process, and they spare repetition of tests already done.
Buza ngokuqondile mayelana nesikhathi sokuhlola umlamuli kanye nokuphathwa kwesampula. Umbuzo ophusile, ukhombisa ukuthi uyayiqonda inqubo, futhi uthuthukisa ngokubonakalayo ithuba lomphumela osebenzisekayo.
Letha imiphumela yokuhlolwa kwangaphambilini, okuhlanganisa nethi negative. Amaphaneli ajwayelekile okungezwani komzimba nezinto ezithile, ama-endoscopies angaphawuleki, kanye nokusebenza okucacile kwenhliziyo kuyafundisa: ayingxenye yenqubo yokukhishwa, futhi asindisa ukuphindaphindwa kokuhlolwa osekwenziwe.