Graft tiv thaiv tus kab mob (GvHD), yog ib qho kev phiv uas tuaj yeem tshwm sim tom qab ib qho Allogeneic hloov pauv.
Dab tsi yog graft tiv thaiv tus kab mob (GvHD)?
Graft tiv thaiv tus kab mob (GvHD) yog ib qho teeb meem tshwm sim ntawm kev hloov pauv ntawm cov qia cell. Nws tshwm sim thaum T-hlwb ntawm lub cev tiv thaiv kab mob tshiab, lees paub tus neeg txais lub hlwb li txawv teb chaws, thiab tawm tsam lawv. Qhov no ua rau muaj kev tsov rog ntawm 'graft' thiab 'tus tswv'.
Nws yog hu ua graft piv rau tus tswv tsev, vim tias 'graft' yog lub cev tiv thaiv kab mob pub dawb, thiab 'tus tswv tsev' yog tus neeg mob tau txais cov hlwb pub dawb.
GvHD yog ib qho teeb meem uas tsuas yog tshwm sim hauv kev hloov pauv allogeneic. Ib qho kev hloov pauv allogenic suav nrog cov qia hlwb uas pub dawb rau tus neeg mob tau txais.
Thaum ib tug neeg muaj kev hloov pauv uas lawv tau txais lawv tus kheej qia hlwb, qhov no yog hu ua autologous hloov. GvHD tsis yog ib qho teeb meem uas tuaj yeem tshwm sim hauv cov neeg uas tau txais kev rov ua kom rov ua rau lawv lub hlwb.
Tus kws kho mob yuav soj ntsuam cov neeg mob rau GvHD tsis tu ncua raws li ib feem ntawm kev saib xyuas tom qab ib qho kev hloov pauv allogeneic. Rau txhua qhov ntawm lub cev cuam tshuam los ntawm tus mob GvHD, qhov qhab nia nruab nrab ntawm 0 (tsis muaj kev cuam tshuam) thiab 3 (qhov cuam tshuam hnyav) tau muab. Qhov qhab nia yog nyob ntawm qhov cuam tshuam cov tsos mob muaj nyob rau hauv lub neej niaj hnub thiab qhov no pab cov kws kho mob txiav txim siab txog kev kho mob zoo tshaj plaws rau tus neeg mob.
Hom graft tiv thaiv tus kab mob (GvHD)
GvHD tau muab faib ua 'mob' lossis 'hloov' nyob ntawm seb tus neeg mob tau ntsib nws thiab cov tsos mob thiab cov tsos mob ntawm GvHD.
Mob graft tiv thaiv tus kab mob
- Pib hauv thawj 100 hnub tom qab hloov pauv
- Ntau tshaj 50% ntawm cov neeg mob uas muaj kev hloov pauv hauv allogenic, paub txog qhov no
- Feem ntau tshwm sim li 2 mus rau 3 lub lis piam tom qab hloov pauv. Lub 2 – 3 lub lim tiam no yog thaum cov qia hlwb tshiab pib los ua haujlwm ntawm lub cev tiv thaiv kab mob thiab ua cov qe ntshav tshiab.
- Mob GvHD tuaj yeem tshwm sim sab nraud ntawm 100 hnub, qhov no feem ntau tsuas yog cov xwm txheej hauv cov neeg mob uas tau txo qis kev siv tshuaj ua ntej hloov pauv.
- Nyob rau hauv mob GvHD, lub graft yog tsis lees paub nws tus tswv, tsis yog tus tswv tsev tsis lees txais qhov graft. Thaum lub hauv paus ntsiab lus no zoo ib yam nyob rau hauv ob qho tib si mob thiab mob ntev GvHD, cov yam ntxwv ntawm mob GvHD txawv ntawm cov mob ntev.
Qhov hnyav ntawm GvHD yog qib los ntawm theem I (mob heev) mus rau theem IV (qhov hnyav), qhov kev muab qhab nia no pab cov kws kho mob txiav txim siab txog kev kho mob. Feem ntau cov chaw ntawm mob GvHD yog:
Kab mob plab: ua rau raws plab uas tuaj yeem ua rau dej los yog ntshav. Kev xeev siab thiab ntuav ua ke nrog mob plab, poob phaus thiab tsis qab los noj mov.
Daim tawv nqaij: ua rau pob khaus khaus thiab khaus. Nws feem ntau pib ntawm tes, taw, pob ntseg thiab hauv siab, tab sis tuaj yeem kis tau thoob plaws lub cev.
Lub siab: ua rau mob daj ntseg uas yog tsim los ntawm 'bilirubin' (ib yam khoom muaj feem cuam tshuam rau hauv lub siab ua haujlwm) uas hloov cov xim dawb ntawm lub qhov muag daj thiab tawv nqaij daj.
Pab neeg kho mob yuav tsum ntsuas tus neeg mob rau GvHD tsis tu ncua ua ib feem ntawm kev saib xyuas tom qab.
Chronic graft versus host kab mob
- Chronic GvHD tshwm sim ntau dua 100 hnub tom qab hloov pauv.
- Thaum nws tuaj yeem tshwm sim ntawm txhua qhov chaw tom qab hloov pauv, nws feem ntau pom hauv thawj xyoo.
- Cov neeg mob uas tau mob GvHD muaj kev pheej hmoo siab ntawm kev tsim GvHD ntev.
- Kwv yees li ntawm 50% ntawm cov neeg mob uas tau mob GvHD yuav mus rau qhov mob GvHD.
- Nws tuaj yeem cuam tshuam rau leej twg tom qab hloov cov qia cell.
Chronic GvHD feem ntau cuam tshuam rau:
- Qhov ncauj: ua rau lub qhov ncauj qhuav thiab mob
- Daim tawv nqaij: pob khaus, tawv nqaij ua flaky thiab khaus, zawm ntawm daim tawv nqaij thiab hloov mus rau nws cov xim thiab lub suab
- Gastrointestinal: indigestion, raws plab, xeev siab, ntuav thiab tsis piav qhia qhov hnyav
- Daim siab: feem ntau tshwm sim nrog cov tsos mob zoo li tus kab mob siab viral
Tus kab mob GvHD tuaj yeem cuam tshuam rau lwm qhov chaw, xws li qhov muag, pob qij txha, ntsws thiab qhov chaw mos.
Cov tsos mob thiab cov tsos mob ntawm graft tiv thaiv tus kab mob (GvHD)
- Cov pob khaus, nrog rau kub hnyiab thiab liab ntawm daim tawv nqaij. Cov pob khaus no feem ntau tshwm sim ntawm ob txhais tes thiab ob txhais taw. Nws tuaj yeem cuam tshuam lub cev thiab lwm yam extremities.
- xeev siab, ntuav, raws plab, mob plab thiab tsis qab los noj mov tuaj yeem hu nkauj ntawm plab hnyuv GvHD.
- Yellowing ntawm daim tawv nqaij thiab qhov muag (qhov no yog hu ua jaundice) tuaj yeem yog ib qho cim ntawm GvHD ntawm daim siab. Lub siab ua haujlwm tsis zoo kuj tuaj yeem pom ntawm qee qhov kev kuaj ntshav.
- Ncauj:
- qhov ncauj qhuav
- Ua kom qhov ncauj rhiab heev (kub, txias, fizz, ntsim zaub mov thiab lwm yam)
- Nyuaj noj
- Cov kab mob ntawm cov pos hniav thiab cov hniav lwj
- Daim tawv nqaij:
- Qhib
- Qhuav, nruj, khaus tawv nqaij
- Thickening thiab zawm ntawm daim tawv nqaij uas yuav ua rau muaj kev txwv tsis pub txav mus los
- Cov tawv nqaij hloov xim
- Intolerance rau qhov kub thiab txias hloov, vim yog puas hws qog
- Rau tes:
- Hloov ntawm tus ntsia thawv kev ntxhib los mos
- tawv, brittle rau tes
- Nail poob
- Gastrointestinal kab mob:
- Poob tsis qab los noj mov
- Unexplained poob phaus
- Ntuav
- Zawv plab
- Mob plab heev
- Lub ntsws:
- Txog siav ua tsis taus pa
- hnoos uas tsis ploj mus
- Hawb pob
- Nplooj siab:
- Mob plab o
- Yellow discoloration ntawm daim tawv nqaij / qhov muag (jaundice)
- Lub siab ua haujlwm txawv txav
- Cov leeg thiab pob qij txha:
- Cov leeg tsis muaj zog thiab cramping
- Joint stiffness, nruj thiab nyuaj ncua
- Genitalia:
- Poj niam:
- Qhov chaw mos dryness, khaus thiab mob
- Vaginal ulcerations thiab caws pliav
- Txoj kev nqaim ntawm qhov chaw mos
- Kev sib deev nyuaj / mob
- Txiv neej:
- Narrowing thiab caws pliav ntawm urethra
- Khawb thiab caws pliav ntawm scrotum thiab noov
- Kab mob ntawm noov
- Poj niam:
Kev kho mob graft tiv thaiv tus kab mob (GvHD)
- Txhim kho cov tshuaj tiv thaiv kab mob
- Kev tswj hwm ntawm corticosteroids xws li Prednisolone thiab Dexamethasone
- Rau qee cov tawv nqaij qis GvHD, cov tshuaj pleev steroid tuaj yeem siv
Rau kev kho mob ntawm GvHD uas tsis teb rau corticosteroids:
- Ibrutinib
- Ruxolitinib
- Mycophenolate mofetil
- Sirolimus
- Tacrolimus thiab Cyclosporin
- Cov kab mob monoclonal
- Antithymocyte Globulin (ATG)
