I-ICP ikhonjiswe kanjani futhi iphathwa kanjani?
I-cholestasis ye-intrahepatic yokukhulelwa (i-ICP) yimbangela yesibili evamile ye-jaundice ekukhulelwe. Kungase futhi kuthiwa yi-cholestasis ye-obstetric. Lesi simo sihilela ukwakheka kwe-bile acids egazini nasesikhumba okubangela ukuchichima okukhulu. Kucatshangwa ukuthi kubangelwa ukuhlanganiswa kwezimo ze-hormonal, izakhi zofuzo, nezendalo, futhi ngokuvamile, kwenzeka ku-trimester yesithathu yokukhulelwa.
Ukuvama
Ukusabalala kwe-ICP kuyahluka kakhulu ezweni lonke. E-United States, eSwitzerland naseFrance I-ICP livela cishe ku-1 ku-100 ukuya ku-1 ku-1000 ukukhulelwa. Nokho, kuvame kakhulu kubantu bezizwe ezithile. Esikhathini sabantu baseChilean, lesi sigameko singamaphesenti angu-16, kodwa singamaphesenti angu-28 phakathi kwamaNdiya ase-Aracucanos. Okungajwayelekile kunaseChile, isimo sivame kakhulu eSouth Asia, ezinye izingxenye zaseNingizimu Melika, namazwe aseScandinavia kunase-United States.
Ukubukeka
Isibonakaliso esivame kakhulu se-intrahepatic cholestasis yokukhulelwa siwukuthi sivame ukukhula ku-trimester yesithathu yokukhulelwa. Ukuvuthwa, ngokuvamile okubi kakhulu futhi kubi kakhulu ebusuku, kuvame ukuqala ezintendeni nasezintabeni, bese usakazeka kuwo wonke umzimba. Ukuqhuma kwe-ICP kubangelwa ukukhwabanisa isikhumba esibucayi kakhulu.
I-jaundice, ukuchithwa okuphuzi kwesikhumba kanye nabamhlophe bamehlo kubangelwa ngamaphesenti angu-10 kuya ku-15 amaphesenti abesifazane abenele sifo.
Ukuvuthwa kuvame ukubonakala amasonto amabili kuya kwamane emva kokuqala kokubamba. Ngemuva kokubeletha, kokubili ukushaywa kanye ne-jaundice ukuxazulula ngokuzenzekelayo.
Ngemuva kokuba owesifazane ekhulise i-ICP ngesikhathi sokukhulelwa okulodwa, ithuba lokuthi lizophinde likhulelwe ngokukhulelwa okulandelayo kungama-45 kuya ku-70%.
Izimpawu ezihambisana nezibonakaliso ezihambisanayo
Ngaphezu kokushaywa okukhulu, izimpawu nezimpawu ze-cholestasis ye-intrahepatic yokukhulelwa zingabandakanya:
- I-Jaundice
- I-Rash ngenxa yokukhipha (ukukopiswa)
- Ukulahlekelwa kwesifiso (i-anorexia)
- Ukukhathala
- Izitshalo ezikhanyayo nezigcoba ezihambayo (i-steatorrhea)
- Umchamo omnyama
- Ubuhlungu ku-quadrant engenhla engenhla nasesifundazwe esisodwa sesisu
- Ukucindezeleka
- I-nausea
Izimbangela
I-cholestasis ye-intrahepatic yokukhulelwa kucatshangwa ukuthi iyimbangela yokuhlanganiswa kwezimo ze-hormonal, ezemvelo, kanye nezakhi zofuzo.
I-hormonally, amazinga e-estrogen aphezulu ahlobene nokukhulelwa yimbangela eyodwa ebalulekile. I-cholestasis ye-intrahepatic yokukhulelwa ibangelwa ukukhubazeka kwesibindi se-bindi esibindi. Ama-Hormone akhiqizwa ekukhulelweni kuthinta i-gallbladder (isibonelo, ingozi ye-gallstones yanda ngokukhulelwa.) Umsebenzi we-gallbladder ukwenza njengendlu yokugcina i-bile eyenziwa esibindi. Bile, futhi, isetshenziselwa ukwephula amafutha egatsheni lokugaya. Lapho i-bile duct ivinjiwe, i-bile acids isiphakamise esibindi. Njengoba izinga le-bile elisesibindi landa, liya phezulu egazini. Yilezi zinsimbi ze-bile ezifaka igazi futhi zifakwa esikhumbeni ezibangela ukugwinya okukhulu. I-Estrogen iphazamisa ukuhlanzwa kwe-bile ebusweni ne-progesterone kuphazamisa ukuvunyelwa kwe-estrogen kwesibindi.
Amazinga e-hormone afana ne-estrogen ne-progesterone cishe izikhathi ezingu-1000 eziphakeme ngesikhathi sokukhulelwa kunokuba owesifazane engakhulelwe.
Izimbangela zegciwane zidlala indima, kanti lesi sifo sivame ukugijima emindenini. Ezinye izakhi zokuguqula izakhi nazo zihlobene nengozi eyanda. Amaphesenti angu-15 abesifazane abano-ICP abonakala sengathi ashintsho (ngempela imishintshi ehlukahlukene) e-adenosine triphosphate ebopha ikhasethi, umndeni wase-B, ilungu le-4 (ABCB4 / abcb4) (elibizwa nangokuthi i-protein 3 anti-drug resistant (MDR3).
Izimo zemvelo nazo zibonakala zinendima ethile, kanti isimo sivame kakhulu ebusika futhi sihambisana nokuntuleka kwe-selenium yamaminerali.
Izingozi Zezingozi
Kunezimo eziningana eziphakamisa ingozi yokuthuthukisa i-ICP. Kubalulekile ukuqaphela ukuthi lezi azibangeli ngempela, kodwa zihlobene kuphela nengozi ephezulu ukuthi isimo sizokwenzeka. Ezinye izici zengozi zihlanganisa:
- Umlando womuntu siqu we-ICP (njengoba kuphawuliwe ekuqaleni, isimo sibuyele ekukhulelweni okulandelayo cishe isigamu sesikhathi)
- Umlando womndeni we-ICP (abesifazane abanomama noma udade oye waba ne-ICP basengozini enkulu yokuthuthukisa isimo
- Umlando womndeni wokuthuthukiswa kwe-gallstone ngenkathi uthatha isisu somlomo
- Isizinda sobuzwe - Njengoba kuphawuliwe ekuqaleni, isimo sivame kakhulu kwezinye izingxenye zomhlaba, njengeChile
- Ubudala bomama obudala
- I-Multiparity (enezingane eziningi)
- Iziqu eziningi - I-ICP iphindwe kasikhombisa ngokuphindaphindiwe kwamawele amabili kunokukhulelwa kwezingane ezingabodwa
- Umlando wangaphambi kokusetshenziswa kokubeletha ngomlomo
- Abesifazane abanomzwelo ku-estrogen (njengalabo ababenenkinga yokuthatha izisu zomlomo esikhathini esidlule) kubonakala sengathi bayingozi
- I-ICP ivame kakhulu ezinyangeni zasebusika
Ukuxilongwa
Ukuxilongwa kwe-ICP kuvame ukusekelwe emlandweni oqaphileko nangokwenyama, kanye nokuhlolwa kwegazi okubonisa izinga eliphakeme lama-salts we-bile kanye nama-enzyme ethile yesibindi (ukuhlolwa komsebenzi wesibindi). Ukuba khona kokubamba ngaphandle kokukhwabanisa okuyinhloko nakho kusiza ukuqinisekisa ukuxilongwa. I-biopsy yesibindi noma i-ultrasound ayidingi isidingo sokuthola ukuxilongwa. Ngokuvamile, i-ICP ngokuyinhloko ixilongwa ngokukhishwa (ngaphandle kokunye okubangelwa izifo ze-jaundice nokushaywa ngesikhatsi sokukhulelwa.)
Uma ubheka izivivinyo ezithile ze-lab, i-serum bile acids ivame kakhulu kunamaphesenti angu-10 (futhi ingaba ngaphezulu kuka-40.) Ukuhlolwa kokusebenza kwesibindi kuvame ukuphakanyiswa kakhulu. I-serum bilirubin ivame ukuphakama, kepha ngokuvamile ingaphansi kwamahlanu. Ama-Labs futhi angabonisa izinga elengeziwe le-cholic acid, i-chenoeoxycholic acid, ne-alkaline phosphatase.
Ezinye Izimbangela Ze-Jaundice Ekukhulelweni
I-ICP ngokuyinhloko isifo sokuxilongwa-okusho ukuthi ukuxilongwa kuyingxenye eyenziwe ngokungabandakanyi ezinye izimbangela ze-jaundice nokubamba. Ezinye izimo ezingalingisa ezinye zezimpawu ze-ICP zihlanganisa:
- I-fatty acute fox yokukhulelwa
- Isifo se-HEELP nesifo se-pre-eclamptic yesibindi
- Ezinye izifo zesikhumba zokukhulelwa (okungabangela ukuqhuma nokushaya kodwa hhayi ukuhlolwa okungavamile kwesibindi noma i-jaundice)
- Ama-gallstones
- Izimo zesibindi ezingahlobene nokukhulelwa zihlanganisa nesifo sofuba esibandayo, isifo sofuba esibhedlela, nesifo sesibindi esingapheli.
Izinkinga kuMama
Izinkinga ze-ICP, ngaphandle kokubamba okungenzeka kube nzima kakhulu, ngokuvamile zibi kakhulu kakhulu kunomama. Ukutheleleka kwamagciwane e-Urinary kuvame kakhulu kwabesifazane abane-ICP kunabesifazane abakhulelwe abangenalutho. Ngaphezu kwalokho, ukulahlekelwa kwe-vitamin K kungabangela ngemuva kweklasi elide le-ICP, elingase liholele nezinkinga zokugaya.
Izinkinga zomntwana
I-ICP ingaba yingozi kakhulu emntwaneni, okuholela ekufeni kokubeletha kanye nokufa kwe-intrauterine (izinsana ezisanda kuzalwa.) Ngiyabonga ukuthi ukwelashwa okusha kwabamama abane-ICP nokuqapha ngokucophelela kwezingane kuye kwaholela ezinkingeni ezincane ezinganeni kunakuqala.
Isibindi se-fetus enempilo sinamandla okulinganiselwe ukususa i-bile acids egazini. I-fetus ivame ukuthembela esibindi sesibindi ukwenza lo msebenzi. Ngakho-ke, amazinga aphakanyisiwe we-bile bangela ukucindezeleka esibindi sesibindi. Ukuphathwa kwalezi zingozi kuxoxwa ngezansi.
I-cholestasis ye-intrahepatic yokukhulelwa yandisa ingozi kumntwana we-meconium staining ngesikhathi sokubeletha, ukuhanjiswa kwangaphambi kwesikhathi, nokufa kwe-intrauterine . Abesifazane abane-ICP kufanele bahlolwe ngokucophelela, futhi kufanele kucatshangelwe ngokujulile ekunciphiseni abasebenzi ngokushesha nje lapho kukhula ukukhulelwa kwesisu.
Ukwelapha
Ngenxa yezinkinga ezingase zibe zengane, ukwelashwa kwe-ICP kufanele kuqale ngokushesha ngemuva kokuba lesi sifo sifinyelelwe. Izindlela zokwelashwa zifaka kokubili lezo zenzelwe ukuqeda i-bile acids nezindlela zokusekela ukulawula izimpawu. Ngaphezu kwalokho, ukuqapha okuqakathekile kwengane kubalulekile.
Ukwelashwa okungcono kakhulu futhi "izinga lokunakekelwa" kwe-cholestasis ye-intrahepatic yokukhulelwa yi- ursodeoxycholic acid noma i-UDCA . Le mithi ivame ukuqala ngokushesha futhi iqhubekele ngokudiliva. Ngokungafani nemithi yangaphambilini, i-UDCS ibonakala iyithuthukisa kakhulu imiphumela yomama nomntwana nge-ICP. Akuqiniseki kahle ukuthi le mithi isebenza kanjani.
Ngokusetshenziswa kwe-UDCA, ukuhlunga kuyathuthukisa kubafazi abathathu kwabayisishiyagalombili futhi kungabangela ukunyamalala ngokuphelele kweso simo ngamaphesenti angama-25. Njengoba omama bevame ukhathazeka kakhulu ngomntwana wabo kunabo, imiphumela ngokusetshenziswa kwalokhu ukwelashwa ingaqinisa. Abesifazane abakhulelwe baphathwa nge-UDCA banokuzalwa okuncane kokubeletha , izingane zingenakuthola ukucindezeleka okungumntwana noma ukucindezeleka kokuphefumula , futhi cishe ngeke zidingeke ukuba zivunyelwe ekamelweni lokunakekelwa kwezingane ezincane. Amantombazane omama abaphathwa ngayo ne-UDCA nabo bavame ukuzalwa kamuva-esikhathini esihamba phambili sokubeletha kunabantwana abanomama abangaphathwa.
Eminye imithi esetshenzisiwe ngenxa yemiphumela yabo ekusithekeni kwe-bile, nakuba ingasebenzi kahle, faka i-S-adenosylmethionine (SAMe) ne-cholestyramine. I-Cholestyramine, ikakhulukazi, ibonakala ingasebenzi, futhi ingase ibe yingozi nakakhulu amazinga aphansi e-vitamin K atholakalayo. Ama-steroids omlomo ophakeme ofana ne-dexamethasone nawo angase abe ukwelashwa kwe-ICP.
Ukushaywa kwe-ICP kungaphathwa nge-emollients, antihistamines, okugeza okuphunga, ama-primrose nama-anti-itching imikhiqizo efana ne-Sarna. Nazi ezinye amathiphu wokuthi ungabeka kanjani ukumisa, kepha labo abangabhekene nalesi sifo kufanele baqaphele ukuthi ukushaywa okubangelwa kuleso simo akuyona into ejwayelekile yokubamba. Abanye abantu baye bathi bangcono kakhulu ukubhekana nobuhlungu kunalolu hlobo lokubamba, futhi abanye abantu baye bazicabangela ukuzibulala. Uma othandekayo wakho ehlangabezana ne-ICP, umsekele nganoma iyiphi indlela ongayenza.
Ukuphatha ukukhulelwa
Ingxenye ebaluleke kunazo zonke yokuphatha umntwana onomama ono-ICP ukuhlela ukulethwa ngokushesha lapho ukuvuthwa kwamaphaphu e-fetal kubhalwe phansi. Ngokomlando, lesi sikhathi sesicatshangelwe amasonto angu-37, kodwa ngokutholakala kwamanje kwe-UDCA, ukukhulelwa okuthile kuye kwavunyelwa ukuba kuqhubeke isikhathi eside kunalokhu.
Ngaphambi kokubeletha, kunconywa ukuthi omama babe nokuhlolwa kokubili kokungapheli kabili ngesisu . Ukuzwa ngengozi yokubeletha kungase kube ukukhathazeka ngokuphelele kwabesifazane ababhekana nalesi simo. Ngokujabulisayo, bangathatha isiqiniseko ekuthi ukufa kokuzalwa komntwana okuhlobene ne-ICP akuvamile ngaphambi kwamasonto angu-36 ukubeletha.
Kwezinye izifundo, ukukhubazeka kwe- meconium ekwenzeni ngesikhathi sokubeletha kuye kwaphakanyiswa, ngakho ukudiliva kufanele kwenzeke endaweni lapho isithifiketi sikwazi ukufinyeleleka khona kunoma iyiphi into angayidinga ukuvimbela isifiso (gcina umntwana ekungeneni i-meconium) engakwazi imbangela ye-meconium aspiration syndrome.
I-ICP ne-Hepatitis C
Ososayensi abaqiniseki ngokubaluleka okuqondile, kodwa abesifazane abanesifo esingenasifo esibelethwe yi-hepatitis C banamathuba amaningi okuthuthukisa i-ICP, futhi abesifazane abaye bahlangabezana ne-ICP cishe banokutholakala ukuthi banezifo ezingapheli ze-hepatitis C. Labo abathola i-ICP bangase bafise ukukhuluma nodokotela babo ngokuhlolwa kwe-hepatitis C.
Ukuphila Nge-ICP
Uma uthola ukuthi une-ICP kungenzeka ukwesaba-kokubili ngenxa yakho nangokwakho. Ngokujabulisayo, ukwelashwa kwalesi simo kuye kwathuthuka ngokuphawulekayo, kunciphisa izingozi kokubili umama nengane. Ngaphezu kwalokho, ukuqapha ngokucophelela kwezinsana kuye kwehlisa ingozi yokucindezeleka okunzima njengokufana nokuzalwa komntwana, ngo-2016 isifundo singatholi lutho oluthile phakathi kweqembu labesifazane abaphathwayo futhi beqashwe ngokucophelela ngemuva kokuthola ukuxilongwa.
Ukwelashwa kwenza nokwenzeka ukubambezeleka kwezidingo kuze kube yilapho ingane ingase ikhule kuze kube iphuzu lapho ukucindezeleka okuphefumulayo kungakhathazeki khona.
Noma kunjalo, khumbula ukuthi noma yikuphi ukucindezeleka kokukhulelwa kuyingozi kakhulu. Cela futhi wamukele usizo. Abanye abantu bakuthola kuwusizo ukufinyelela amaqembu okusekela futhi bakhulume nabanye besifazane abaye bahlala nesimo. Igama lokuqapha lihlelekile uma wenza lokhu, noma kunjalo. Impumelelo enkulu yamuva kanye nokuthuthuka kokwelapha yamuva kakhulu-futhi labo ongase uxoxe nabo ababhekana nalesi sifo ngisho nonyaka noma odlule kungenzeka ukuthi babhekana nemiphumela ehluke kakhulu.
Imithombo:
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