Kodi nthawi zina mumamva kutentha kosatha m'manja ndi m'mapazi anu popanda chifukwa? Kapena mumamva kutopa kwambiri komanso kusatuluka thukuta, komanso kukhala ndi madontho ofiira ang'onoang'ono pakhungu lanu? Mungaganize kuti izi ndi zinthu zachilendo. Koma izi zitha kukhalanso zizindikiro za matenda osowa a majini otchedwa Fabry Disease , omwe sitinamvepo zambiri. Musadandaule, tidzakambirana za dzinali, chifukwa chake limachitika, zizindikiro zake ndi ziti, komanso ngati pali chithandizo, m'nkhaniyi lero.
Kodi matenda a Fabry ndi chiyani kwenikweni?
Mwachidule, matenda a Fabry ndi vuto lomwe limayamba chifukwa cha vuto la majini m'thupi lathu. Chomwe chimachitika ndichakuti kupanga kwa enzyme yofunika m'thupi lathu kumachepa kapena kusakhalapo konse. Dzina la enzyme iyi ndi alpha-galactosidase A , kapena `(alpha-GAL)` mwachidule.
Tangoganizani kuti matupi athu ali ndi dongosolo lomwe lili ngati kampani yotaya zinyalala. Enzyme iyi yotchedwa `alpha-GAL` ndi wantchito wanzeru kwambiri mu kampaniyi. Ntchito yake ndikuyeretsa bwino ndikuphwanya ma sphingolipids, mtundu wa mafuta (kwenikweni, chinthu chonga mafuta) chomwe chimapangidwa mkati mwa maselo athu.
Tsopano, m'thupi la munthu amene ali ndi matenda a Fabry, wantchito wanzeru uyu, enzyme ya `alpha-GAL`, sali okwanira. Ndiye chimachitika ndi chiyani? Mafuta ofanana ndi zinyalala otchedwa `sphingolipids` amayamba kusonkhana m'thupi. Monga momwe mulu wa zinyalala umaunjikira m'nyumba ngati zinyalala sizichotsedwa. Mtundu uwu wa mafuta umasonkhana makamaka m'mitsempha yathu yamagazi, mtima, impso, ubongo, dongosolo lamanjenje ndi khungu. Mafuta akamasonkhana motere pakapita nthawi, ziwalo zimenezo zimayamba kuwonongeka. Izi ndi za gulu la matenda otchedwa lysosomal storage disorders .
Kodi mitundu ikuluikulu ya matendawa ndi iti?
Matenda a Fabry akhoza kugawidwa m'magulu awiri akuluakulu, kutengera zaka zomwe zizindikiro zimayamba kuwonekera.
| Mtundu wa matenda | Kufotokozera |
|---|---|
| Mtundu wakale | Zizindikiro za matendawa zimayamba kuonekera ali mwana kapena ali wachinyamata. Nthawi zina, kutentha kosapiririka m'manja ndi m'mapazi kumatha kuchitika ali ndi zaka ziwiri. Zizindikiro zimawonjezeka pang'onopang'ono pakapita nthawi. |
| Mtundu wochedwa/wosazolowereka | Mu mtundu uwu, palibe zizindikiro zomwe zimaonekera mpaka munthu atakwanitsa zaka 30 kapena kupitirira apo. Matendawa angayambe kupezeka pambuyo poti matenda aakulu monga kulephera kwa impso kapena matenda a mtima ayamba. |
Kodi matendawa ndi ofala? Ndani amadwala?
Matenda a Fabry ndi matenda osowa kwambiri. Malinga ndi ziwerengero, matenda akale amapezeka mwa amuna m'modzi mwa 40,000. Komabe, matendawa amayamba mochedwa kwambiri. Amatha kugwira amuna m'modzi mwa 1,500 ndi 4,000.
N'zovuta kunena momwe matendawa alili pakati pa akazi, chifukwa akazi ena alibe zizindikiro konse, kapena zizindikiro zochepa chabe, motero amakhala osapezeka ndi matendawa.
Umu ndi momwe zimakhalira kuyambira mibadwomibadwo.
Uwu ndi matenda a majini, zomwe zikutanthauza kuti amapatsiridwa kuchokera kwa makolo kupita kwa ana. Jini lolakwika lomwe limayambitsa izi lili pa chromosome yathu ya X. Tiyeni tiwone momwe izi zimachitikira m'mabanja.
- Ngati bambo ali ndi matendawa: Bambo amene ali ndi matenda a Fabry amapereka chromosome yake ya X kwa ana ake onse aakazi . Izi zikutanthauza kuti ana ake aakazi onse adzalandira kusintha kwa majini chifukwa cha matendawa. Koma ana aamuna sali pachiwopsezo . Izi zili choncho chifukwa ana aamuna amalandira chromosome ya Y kuchokera kwa abambo awo, osati chromosome ya X.
- Ngati mayi ali ndi matendawa: Mayi amene ali ndi matenda a Fabry ali ndi mwayi wa 50% wopatsira mwana wake aliyense chromosome ya X yolakwika (kaya mwana wamkazi kapena wamwamuna) . Zili ngati kuponya ndalama. Mwana mmodzi akhoza kutenga matendawa, ndipo winayo sangalandire.
Kodi zizindikiro za matenda a Fabry ndi ziti?
Zizindikiro zimatha kusiyana kwambiri kuchokera kwa munthu ndi munthu. Anthu ena amakhala ndi zizindikiro zochepa kwambiri, pomwe ena amakhala ndi zizindikiro zoopsa. Amuna nthawi zambiri amakhala ndi zizindikiro zoopsa kwambiri kuposa akazi.
Izi ndi zina mwa zizindikiro zomwe zimaonekera kwambiri:
- Ululu m'manja ndi m'mapazi: Manja ndi m'mapazi amatha kumva dzanzi, kunjenjemera, kapena kutentha. Ululuwu ukhoza kukulirakulira panthawi yochita masewera olimbitsa thupi.
- Kusamva kutentha: Kulephera kupirira kutentha kwambiri kapena kuzizira kwambiri.
- Kuchepa kwa thukuta: Anthu ena amatuluka thukuta pang'ono (hypohidrosis) . Ena satuluka thukuta konse (anhidrosis) .
- Kusintha kwa khungu: Madontho ang'onoang'ono, okwezeka, ofiira kapena ofiirira amaonekera m'malo monga pachifuwa, kumbuyo, ndi m'malo oberekera. Izi zimatchedwa angiokeratoma .
- Kusintha kwa maso: Kapangidwe kapadera kamakula pa cornea ya diso. Izi zimatchedwa cornea verticillata . Komabe, izi sizimakhudza masomphenya mwanjira iliyonse. Dokotala yekha ndi amene angaone izi ndi chipangizo chapadera (lampu yodulidwa).
- Mavuto a m'mimba: Mavuto monga kupweteka m'mimba, kudzimbidwa, kutsegula m'mimba, kapena kudzimbidwa nthawi zambiri kumachitika.
- Zizindikiro zodziwika bwino: Kutopa, chizungulire, malungo, ndi kupweteka kwa thupi (monga chimfine) kungachitike.
- Mavuto akumva: Kutaya kumva kapena kulira m'makutu (tinnitus) kungachitike.
- Zotsatira pa impso: Kuchuluka kwa mapuloteni mu mkodzo (proteinuria) .
- Kutupa: Miyendo, akakolo, ndi mapazi zimatupa (edema) .
Kodi ndi mavuto otani oopsa omwe angabwere chifukwa cha matendawa?
Kwa zaka zambiri, mafuta amenewa otchedwa `sphingolipids' amasonkhana m'thupi angawononge kwambiri mitsempha yamagazi ndi ziwalo. Izi zingayambitse mavuto omwe angakhale oopsa kwa moyo.
Popeza matenda amenewa ndi opitirira muyeso, kuwazindikira msanga ndi kuchiza kungathandize kwambiri kupewa mavuto aakuluwa.
Mavuto akulu ndi awa:
- Matenda a mtima: Matenda monga kusakhazikika kwa mtima (arrhythmia) , matenda a mtima, kukula kwa mtima, ndi kulephera kwa mtima .
- Kulephera kwa impso: Kuwonongeka kwa impso kungayambitse kutayika kwathunthu kwa ntchito yawo.
- Mavuto a mitsempha: Kuwonongeka kwa mitsempha ya m'mphepete mwa thupi (peripheral neuropathy) kungayambitse kupweteka kwambiri ndi dzanzi m'miyendo.
- Kutsekeka kwa mitsempha yamagazi kupita ku ubongo kungayambitse ziwalo kapena kuukira kwa ischemic kwa nthawi yochepa (TIA) .
Kodi mungazindikire bwanji matendawa? (Kuzindikira)
Ngati dokotala wanu akukayikira kuti ali ndi matenda a Fabry, adzalamula mayeso angapo kuti atsimikizire matendawa.
- Kuyesa kwa enzyme:Uku ndi kuyezetsa magazi. Izi zimayesa kuchuluka kwa enzyme ya `alpha-GAL` m'magazi mwanu. Ngati kuchuluka kumeneku kuli kochepera 1%, matendawa akukayikiridwa. Komabe, kuyezetsa kumeneku ndi kodalirika kwa amuna okha. Izi sizoyenera akazi, chifukwa kuchuluka kwa enzyme yawo kumatha kusinthasintha nthawi zonse.
- Kuyesa majini: Iyi ndiyo njira yabwino kwambiri yotsimikizira matendawa. Ukadaulo wofufuza DNA ukhoza kuzindikira molondola ngati pali kusintha, kapena cholakwika, mu jini ya GLA , yomwe imaphunzitsa kupanga enzyme ya `alpha-GAL`.
- Kuyezetsa ana obadwa kumene: M'mayiko ena, ana obadwa kumene amayezetsa matenda amenewa.
Kodi mankhwala a matenda a Fabry ndi ati?
Palibe mankhwala a matenda a Fabry. Komabe, pali mankhwala othandiza omwe angathandize kuchepetsa zizindikiro ndikuchepetsa kuchulukana kwa mafuta owopsa m'thupi. Cholinga chachikulu cha mankhwala awa ndikupewa matenda a mtima, matenda a impso, ndi mavuto ena akuluakulu.
| Njira yochizira | Kodi chimachitika ndi chiyani? |
|---|---|
| Chithandizo Chosintha Ma Enzyme (ERT) | Izi zimaphatikizapo kupatsa thupi mtundu wopangidwa wa enzyme ya `alpha-GAL` yomwe ikusowa, enzyme yopangidwa mu labotale, kudzera mu IV infusion milungu iwiri iliyonse. Mwachitsanzo, mankhwala monga agalsidase beta (Fabrazyme®) ndi pegunigalsidase alfa (Elfabrio®) amagwiritsidwa ntchito. Pamene enzyme yopangidwayi ilowa m'thupi, imatenga ntchito ya enzyme yomwe ikusowa ndikuletsa mafuta kuti asasonkhanitsidwe. |
| Chithandizo cha Wotsogolera Pakamwa | Iyi ndi piritsi yomwe mumamwa tsiku lililonse. Mapiritsiwa amagwira ntchito "pokonza" enzyme ya `alpha-GAL` yolakwika m'thupi. Kenako enzyme yokonzedwayo imatha kuswa mafuta. migalastat (Galafold®)Uwu ndi mtundu wa mankhwala. Koma chithandizochi sichigwira ntchito kwa aliyense. Kaya ichi ndi choyenera kapena ayi zimadalira mtundu wa kusintha kwa majini anu. |
Kuwonjezera pa mankhwala akuluakulu awa, mankhwala osiyana amaperekedwa pa ululu ndi mavuto am'mimba. Asayansi akupanganso mankhwala atsopano pogwiritsa ntchito ukadaulo wa majini.
Kodi moyo udzakhala bwanji ndi matendawa? (Outlook)
Matenda a Fabry ndi matenda omwe amapitirira. Izi zikutanthauza kuti chiopsezo cha zizindikiro ndi zovuta zimawonjezeka ndi ukalamba. Matendawa amatha kuchepetsa nthawi yomwe munthu amakhala. Pa avareji, amuna omwe ali ndi mawonekedwe akale amakhala ndi moyo mpaka kumapeto kwa zaka za m'ma 50 ndipo akazi amakhala ndi moyo mpaka zaka za m'ma 70.
Koma chofunika kwambiri ndichakuti mukalandira chithandizo choyenera, makamaka posamalira thanzi la mtima ndi impso, mutha kuwonjezera zaka zambiri pa moyo wanu.
Kodi matendawa angaletsedwe kuti asafalikire kwa achibale?
Popeza iyi ndi matenda a majini, ngati wina m'banja mwanu ali ndi kusintha kwa majini kokhudzana ndi matendawa, pali chiopsezo choti ana anu adzalandira matendawa. Chifukwa chake, ngati inu kapena wina m'banja mwanu ali ndi matendawa, ndikofunikira kwambiri kukumana ndi katswiri wa majini .
Katswiri wotereyu angafotokoze kuthekera kwakuti ana anu adzalandira jini. Angakambiranenso za njira zomwe zilipo kwa inu ngati mukukonzekera kukhala ndi ana. Mwachitsanzo, pali njira yotchedwa Preimplantation Genetic Diagnosis (PGD) . Njirayi imayesa mazira asanasamutsidwe kwa mayi panthawi ya In Vitro Fertilization (IVF) kuti asankhe mazira athanzi omwe alibe jini lolakwika.
Nthawi yomwe muyenera kupita kwa dokotala nthawi yomweyo
Ngati mwapezeka ndi matenda a Fabry ndipo mukukumana ndi zizindikiro zotsatirazi, pitani kwa dokotala nthawi yomweyo kapena pitani ku chipatala chapafupi cha Emergency Department (ETU).
- Kupweteka pachifuwa, kugunda kwa mtima kosakhazikika, kupuma movutikira (izi zitha kukhala zizindikiro za matenda a mtima).
- Kutupa kwambiri kapena kusunga madzi m'thupi.
- Chizungulire chachikulu, mavuto a masomphenya, kusintha kwa mawu (izi zitha kukhala zizindikiro za sitiroko).
- Kutaya mwadzidzidzi kumva.
- Kupweteka kwambiri m'mimba kapena kutsegula m'mimba.
Mafunso ofunikira oti mufunse dokotala wanu
Mukapezeka ndi matendawa, ndi zachilendo kukhala ndi mafunso ambiri. Musaiwale kufunsa mafunso awa mukapita kwa dokotala wanu.
- Kodi ndinapeza bwanji matenda a Fabry?
- Kodi ndi matenda amtundu wanji a Fabry omwe ndili nawo?
- Ndi chithandizo chiti chomwe chili chabwino kwa ine?
- Kodi zoopsa ndi zotsatirapo zake ndi ziti?
- Kodi banja langa lili pachiwopsezo chotenga matendawa? Kodi tiyenera kuyezetsa majini?
- Ndi mankhwala ndi mayeso ati omwe ndiyenera kupitiriza kulandira?
- Ndi zizindikiro ziti za mavuto zomwe ndiyenera kuda nkhawa nazo kwambiri?
Ndizachibadwa kumva chisoni komanso nkhawa mukapezeka ndi matenda a Fabry. Mutha kuda nkhawa ndi tsogolo lanu komanso ana anu. Koma kumbukirani, tsopano pali mankhwala othandiza kwambiri othana ndi matendawa. Ndipo pali kafukufuku wambiri womwe ukupitilira womwe umatipatsa chiyembekezo cha mtsogolo. Mwa kutsatira dongosolo lanu la chithandizo mosamala komanso kugwira ntchito limodzi ndi dokotala wanu, mutha kuthana ndi zizindikiro zanu, kupewa kuwonongeka kwa nthawi yayitali, ndikukhala ndi moyo wopambana.
Uthenga Wopita Nawo Kunyumba
- Matenda a Fabry ndi vuto losowa lomwe limayamba chifukwa cha vuto la majini lomwe limapangitsa kuti thupi lipange enzyme yochepa yomwe imaphwanya mtundu wina wa mafuta.
- Zizindikiro monga kutentha m'miyendo, kusatuluka thukuta, ziphuphu pakhungu, komanso kuvutika m'mimba zingachitike.
- Kuzindikira matendawa msanga kungalepheretse kuwonongeka kwakukulu kwa mtima, impso, ndi ubongo.
- Tsopano pali mankhwala othandiza kwambiri obwezeretsa ma enzyme (ERT) ndi mankhwala ena ochizira matendawa.
- Popeza uwu ndi matenda obadwa nawo, ndikofunikira kufunafuna upangiri wa majini kuti mudziwe za chiopsezo chomwe chingakhalepo m'banjamo.
- Nthawi zonse tsatirani malangizo a dokotala wanu ndipo mupeze mayeso ndi chithandizo chofunikira.











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