Ingabe isibindi sakho sinamafutha kakhulu? Ake sifunde ngegama elisha lesifo sesibindi esinamafutha (i-Steatotic Liver Disease)!

“O, dokotela, nginama-fat deposits esibindini sami…” Uke wezwa into efana nale? Noma nawe unalesi simo? Ungakhathazeki. Namuhla sikhuluma ngalesi sifo sokunama-fat deposits esibindini, noma ngamanye amazwi, i-Steatotic Liver Disease. Esikhathini esidlule, sasibiza lesi “sibindi esinamafutha.” Kuyini ngempela lokhu? Kungani sanikwa igama elisha? Ake sixoxe ngakho konke lokhu kalula.

Kungani igama elithi "Fatty Liver" lashintsha?

Sasivame ukubiza lesi simo ngokuthi “isifo sesibindi esinamafutha.” Kodwa ngo-2023, ochwepheshe bezokwelapha banquma ukushintsha igama libe “isifo sesibindi esinamafutha amaningi.” Kunezizathu ezimbili eziyinhloko zalokhu. Esinye ukuthi igama elisha lichaza ngokunembile izimbangela zalesi simo. Isibonelo, ngenkathi ukukhuluphala kuyimbangela eyodwa, kunezinye izici eziyingozi ezingahlobene nesisindo. Esinye isizathu ukuthi igama elithi “isibindi esinamafutha” ngezinye izikhathi lingaba namahloni futhi lihlazise abantu abanalesi simo, ngakho ukushintsha igama kwasiza ekunciphiseni lokho. Kalula nje, elithi “steatosis” igama elisetshenziswa odokotela ukuchaza ukunqwabelana kwamafutha esithweni (ngokuvamile isibindi). Isibindi esinempilo nesisebenza kahle siqukethe inani elincane lamafutha. Lokhu kunqwabelana kwamafutha kuba yinkinga uma kudlula u-5% wesisindo sesibindi.

Yiziphi izinhlobo zesifo sesibindi esinamafutha (i-SLD)?

Odokotela bahlukanisa i-SLD ngokwezimbangela zayo kanye nezimo ezihlobene nayo. Ake sibheke izinhlobo eziyinhloko.

1. Isifo sesibindi esihlobene notshwala (ALD)

Okwenzekayo ukuthi uma uphuza utshwala obuningi, amafutha ayanqwabelana esibindini sakho. Cabanga ngakho, uma uphuza utshwala, isibindi sakho yisona esiluhlungayo. Phakathi naleso sikhathi, amanye amangqamuzana esibindi ayafa. Ngokuvamile, isibindi singakha amangqamuzana amasha ukuze sithathe indawo yalawo alahlekile. Kodwa uma uqhubeka nokuphuza utshwala obuningi, isibindi asikwazi ukwenza lo msebenzi ngendlela efanele. Yilapho amafutha eqala khona ukunqwabelana esibindini sakho, isimo esibizwa ngokuthi i-steatosis .

2. Isifo sesibindi esihambisana nokungasebenzi kahle kwe-metabolic (MASLD)

Lokhu kwakubizwa ngaphambilini ngokuthi isifo sesibindi esinamafutha esingenalo utshwala (i-NAFLD). Lokhu kungenxa yokuthi amafutha esibindini awabangelwa ukuphuza utshwala ngokweqile. Igama elisha lithi izici eziyinhloko ezifaka isandla ekuthuthukisweni kwesibindi esinamafutha yizici eziyingozi zenhliziyo nemithambo yegazi . Kalula nje, kubangelwa izimo ezithile nezici ezithinta impilo yenhliziyo yakho.

Izici eziyinhloko zengozi yokuthuthukisa i-MASLD yilezi:

• Ukukhuluphala ngokweqile
• Isifo Sikashukela Sohlobo 2
• Umfutho wegazi ophakeme
• Ukungalingani kwamafutha egazini - Lokhu ukungalingani kwezinhlobo zamafutha egazini lakho, njenge-cholesterol kanye ne-triglycerides.

Ngisho noma uphuza utshwala obuncane ngesonto, okungukuthi, ngaphansi kwamagremu angu-140 ngesonto kwabesifazane kanye nangaphansi kwamagremu angu-210 ngesonto kwabesilisa, usengabhekwa njenge-MASLD. (Isibonelo, e-United States, ithini likabhiya elivamile elingama-ounce angu-12 liqukethe cishe amagremu angu-14 otshwala.)

3. Ukugcwala kwamafutha kanye nokuvuvukala esibindini ngenxa yokungasebenzi kahle kwe-metabolic (i-steatohepatitis ehlobene ne-metabolic - MASH)

I-MASH uhlobo olubi kakhulu lwe-MASLD. Kulesi simo, isibindi siyavuvukala futhi sivuvuke ngenxa yokuqongelela kwamafutha esibindini. Ngemuva kwalokho, izicubu zesibindi ziyalimala bese ziqala ukuba nezibazi (fibrosis) . Ngaphambilini, lokhu kwakubizwa ngokuthi i-steatohepatitis engeyona eyotshwala (NASH).

4. I-MASLD kanye nokusetshenziswa kotshwala ngokweqile (i-MetalALD)

Uma une-MetalALD, kusho ukuthi kokubili izici eziyingozi ze-metabolic kanye nokusetshenziswa kotshwala kube nomthelela ekuqongeleleni kwamafutha esibindini sakho. Kulesi simo, unezici eziyingozi zenhliziyo nemithambo yegazi, futhi uphuza amagremu angaphezu kuka-140 otshwala ngesonto kwabesifazane kanye namagremu angaphezu kuka-210 kwabesilisa.

Ukuthi utshwala noma izici eziyingozi ze-metabolic cishe zinegalelo ekuqongeleleni kwamafutha esibindini kungahluka kumuntu nomuntu.

5. Ezinye izinhlobo ze-SLD

I-SLD ingenzeka ngaphandle kokusebenzisa utshwala noma izici eziyingozi ze-metabolic. Isibonelo, eminye imithi nezinye izifo zingabangela ukwakheka kwamafutha esibindini. Ngezinye izikhathi odokotela abakwazi ukuthola imbangela ecacile. I-SLD engenambangela ecacile ibizwa ngokuthi i-cryptogenic SLD .

Ingabe isifo sesibindi esinamafutha (SLD) siyinkinga enkulu?

Ezimweni eziningi, ukugcinwa kwamafutha esibindini akubangeli izinkinga ezinkulu noma kuphazamise ukusebenza kahle kwesibindi. Kodwa-ke, ngezinye izikhathi lesi simo singaba sibi kancane kancane futhi sibe yisifo sesibindi. Lokhu kuvame ukwenzeka ngezigaba eziningana:

• I-Hepatitis : Isibindi, esiqala sigcwele amafutha, siyavuvukala futhi sivuvuke. Lokhu kuvuvukala konakalisa izicubu zesibindi. Lesi simo sibizwa ngokuthi i-steatohepatitis. Isibonelo, i-MASLD iba yi-MASH kanje.
• I-Fibrosis: Izicubu zezibazi ziqala ukwakheka ezindaweni ezinomonakalo wesibindi obangelwa ukuvuvukala. Lokhu kubangela ukuthi isibindi siqine kancane. Le nqubo ibizwa ngokuthi i-fibrosis .
• I-Cirrhosis yesibindi: Lokhu kwenzeka lapho izicubu zesibindi ezinempilo zithathelwa indawo yinqwaba yezicubu zesibazi. Lokhu kulapho sikubiza khona ngokuthi i-cirrhosis yesibindi . Uma ingelashwa kahle, i-cirrhosis ingaholela ezimweni ezisongela ukuphila njengokwehluleka kwesibindi kanye nomdlavuza wesibindi. Isibonelo, cishe abantu abangu-90% abathola i-hepatocellular carcinoma (HCC) , uhlobo lomdlavuza wesibindi, bane-cirrhosis.

Ziyini izimpawu zesifo sesibindi esinamafutha (i-SLD)?

Akuwona wonke umuntu one-SLD ozobhekana nezimpawu. Ngezinye izikhathi, uma kuvela izimpawu, zingase zihlanganise:

• Ubuhlungu besisu noma umuzwa wokugcwala engxenyeni engenhla kwesokudla yesisu.
• Ukuzizwa ukhathele kakhulu noma ubuthakathaka (ukukhathala).

Kodwa-ke, abantu abaningi baqaphela izimpawu kuphela ngemva kokuba i-SLD isiphenduke isifo sokuqina kwesibindi . Lapho isifo sokuqina kwesibindi siqala, izimpawu ezifana nalezi:

• Isicanucanu.
• Ukudla akunambitheki.
• Ukuba mncane ngaphandle kwesizathu.
• Ukuphuzi kwesikhumba kanye nokumhlophe kwamehlo (i-jaundice).
• Ama-Ascites - Lokhu kusho ukuthi isisu sigcwele uketshezi.
• Ukuvuvukala (ukuvuvukala) kwemilenze, izingalo, noma amaqakala.
• Ukopha (udokotela angase akubone lokhu emqaleni wakho, esiswini, noma endukwini).

Yiziphi izimbangela zesifo sesibindi esinamafutha (i-SLD)?

Kunezizathu eziningana zokuthi kungani i-SLD ingakhula. Kodwa-ke, uma unezici eziyingozi zenhliziyo nemithambo yegazi , uma usebenzisa utshwala ngendlela engaphilile, noma uma unazo zombili, kungenzeka kakhulu ukuthi ube ne-SLD.

Usengozini enkulu yokuthola i-SLD uma unalezi zinto:

• Inkinga yokusebenzisa utshwala – okungukuthi, ukuphuza utshwala njalo noma ngokweqile.
• I-Metabolic syndrome - Lokhu kuhlanganisa ukumelana ne-insulin, umfutho wegazi ophakeme, i-cholesterol ephezulu, kanye namazinga aphezulu e-triglyceride.
• Isifo sikashukela sohlobo lwesibili.
• Ukukhuluphala ngokweqile – Lokhu kusho ukuthi inkomba yakho yesisindo somzimba (i-BMI) iphakathi kuka-25 no-29.9 kg/m2.
• Ukukhuluphala ngokweqile – I-BMI ingu-30 kg/m2 noma ngaphezulu.
• I-Polycystic ovary syndrome (i-PCOS).
• Ukuphefumula okuvimbelayo kokulala.
• I-Hypothyroidism.
• Ukwehla kwamazinga e-hormone ye-pituitary (i-Hypopituitarism).
• Ukwehla kwama-hormone ocansi (i-Hypogonadism).
• Ukuqhubeka nokuphuza imithi ethile. Isibonelo, i-Amiodarone (Amiodarone – Cordarone®), i-Diltiazem (Diltiazem – Cardizem®), i-Tamoxifen (Tamoxifen – Nolvadex®) noma ama-steroid. (Eminye imithi ingabangela ukwakheka kwamafutha esibindini njengomphumela ongemuhle.)

Yiziphi izinkinga ezingaba khona ze-SLD?

Uma ingelashwa, isibindi esinama-steatotic singaqhubekela ekubeni yi -cirrhosis , okungaholela ekuhlulekeni kwesibindi, umdlavuza wesibindi, kanye neminye imidlavuza engaphandle kwesibindi. Abantu abane-MASLD basengozini enkulu yesifo senhliziyo. Kubalulekile ukukhumbula ukuthi isifo senhliziyo, hhayi isifo sesibindi, yisona esibangela ukufa phakathi kwabantu abane-MASLD.

Isifo sesibindi esinamafutha (i-SLD) sitholakala kanjani?

Ngenxa yokuthi i-SLD ngokuvamile ayinazo izimpawu, udokotela wakho angaba ngowokuqala ukuqaphela inkinga. Uma ama-enzyme esibindi sakho ephakanyisiwe ngesikhathi sokuhlolwa kwegazi kwezinye izimo, kungaba uphawu oluyisixwayiso. Ama-enzyme esibindi aphezulu angasho ukuthi isibindi sakho sonakele.

Ukuze axilonge, udokotela wakho angenza okulandelayo:

• Umlando wezokwelapha: Ukubuza ngezimo zakho zezokwelapha, ukuthi uphuza utshwala obungakanani, nokuthi usebenzisa mithi mini.
• Ukuhlolwa komzimba: Hlola izimpawu zesifo sokuqina kwesibindi, njengokukhula kwesibindi kanye ne-jaundice .
• Izinqubo zokuthwebula izithombe: Ukuhlolwa okufana ne-ultrasound , i-CT scan (i-Computed Tomography scan) , noma i-MRI (i-Magnetic Resonance Imaging) kusetshenziselwa ukubheka ukuvuvukala kanye nezibazi esibindini. Ukuhlolwa okukhethekile kwe-ultrasound okubizwa nge -FibroScan® kungasetshenziswa ukuthola inani lamafutha kanye nezibazi esibindini.
• Ukuhlolwa kwesibindi: Lokhu kuhlolwa kwenziwa ukuze kutholakale ukuthi isifo sesibindi sithuthuke kangakanani. Okuwukuphela kwendlela yokuhlukanisa ngokunembile phakathi kwe-MASLD ne-MASH ukwenza ukuhlolwa kwesibindi .

Isifo sesibindi esinamafutha (i-SLD) selashwa kanjani?

Akukho ukwelashwa noma imithi ethile yalesi simo. Kunalokho, odokotela bagxila ekukusizeni ukulawula izici eziyingozi ezibangela lesi simo. Lokhu kuhlanganisa nokwenza izinguquko endleleni yokuphila ezingathuthukisa impilo yakho.

Udokotela wakho angase akuncome okulandelayo:

• Yeka ukuphuza utshwala ngokuphelele: Ngisho noma i-SLD yakho ingabangelwanga ukusetshenziswa kotshwala, gwema utshwala ngokuphelele.
• Ukwehlisa isisindo: Ukuzivocavoca umzimba, izinguquko zokudla ngaphansi kokuqondisa kochwepheshe bezokudla, kanye neminye imithi, njenge- GLP-1RA, ingakusiza ukwehlisa isisindo. Ungase ucabangele nokuhlinzwa kokunciphisa isisindo.(ukuhlinzwa kwe-Bariatric) nakho kungafaneleka.
• Thatha imithi yokulawula izimo ze-metabolic: Thatha imithi oyinikezwe ngudokotela ukuze ulawule isifo sikashukela, i-cholesterol, namafutha egazini (ama-triglycerides). Kwezinye izimo, kungadingeka futhi ukuthi uthathe i-vitamin E kanye ne -thiazolidinediones (imithi yesifo sikashukela efana ne -Actos® kanye ne -Avandia® ).
• Gomela i-Hepatitis A kanye ne-Hepatitis B : Lezi zifo ezibangelwa amagciwane ziyingozi kakhulu uma usuvele unesifo sesibindi.

Uma umuthi owusebenzisayo ubangela ukwakheka kwamafutha esibindini sakho, udokotela wakho angase ashintshe umuthi wakho kadokotela.

Ungakuvimbela kanjani isifo sesibindi esinamafutha (i-SLD)?

Indlela engcono kakhulu yokugwema i-SLD ukugcina impilo yakho iyonke:

• Vivinya umzimba njalo.
• Nciphisa ukuphuza kwakho utshwala.
• Gcina isisindo sakho siphilile.
• Uma unesifo sikashukela sohlobo lwesibili noma i-metabolic syndrome, thatha imithi oyinikezwe udokotela njengoba nje uyalelwe.

Ingabe isifo sesibindi esinamafutha (i-SLD) siyalapheka?

Kuye ngokuthi isimo sakho sibucayi kangakanani, i-SLD ingabuyiselwa emuva futhi ezinye izibazi zingalungiswa. Isibindi sakho sinekhono elimangalisayo lokuzelapha. Uma ulandela uhlelo lokwelashwa lukadokotela wakho ngqo, unganciphisa inani lamafutha nokuvuvukala esibindini sakho. Ungavimbela umonakalo ukuthi ube mubi kakhulu, futhi kwezinye izimo, ngisho nokubuyisela emuva umonakalo wesibindi kusenesikhathi.

Ingabe i-SLD ingadala ukufa?

Kwabaningi abantu, i-SLD ayibangeli izinkinga ezinkulu ngaphandle kokuthi iqhubekele ekubeni yi-cirrhosis ethuthukile . Abantu abaningi abane-SLD baphila isikhathi esijwayelekile sokuphila.

Kodwa-ke, i-cirrhosis yesibindi engalashwanga ingagcina iholele ekuhlulekeni kwesibindi noma umdlavuza wesibindi. Isibindi siyisitho esibalulekile kuwe. Yingakho kubaluleke kakhulu ukuvikela isibindi sakho uma uthola ukuthi une-SLD.

Kuyini ukudla okuhle komuntu one-SLD?

Uma i-SLD yakho ihlotshaniswa nokukhuluphala, landela ukudla okulinganiselayo ukuze wehlise isisindo kancane kancane kodwa kancane kancane. Odokotela bavame ukuncoma ukugwema ukudla okunoshukela. Baphinde batuse ukuzama ukudla kwaseMedithera . Kucebile ngemifino, izithelo, namafutha amahle. Futhi, izinto ezinjengamantongomane, ubhontshisi, okusanhlamvu okuphelele, inhlanzi, nenkukhu ziyizinketho ezinhle zokudla kubantu abane-SLD. Kubaluleke kakhulu futhi ukugwema ukudla inyama ebomvu kakhulu nokuphuza iziphuzo ezinoshukela.

Imibuzo Evame Ukubuzwa (Imibuzo Evame Ukubuzwa)

Umbuzo: Ungakanani umonakalo owenziwe esibindini sami?

Impendulo: Udokotela wakho angakutshela ngokuqinisekile. Uzokwenza ukuhlolwa kwegazi, ama-scan (i-Ultrasound, i-FibroScan) ukuhlola ukuthi kunamafutha angakanani esibindini sakho nokuthi kukhona yini izibazi. Ngemuva kwalokho uzokuchazela isimo.

Umbuzo: Kuthatha isikhathi esingakanani ukuthi umonakalo wesibindi ululame?

Impendulo:Kuncike kakhulu esimweni sakho kanye nemizamo yakho. Uma kusesigabeni sokuqala, uma ulawula ukudla kwakho futhi wehlisa isisindo, ungabona ushintsho oluhle ezinyangeni ezimbalwa. Uma kukubi kakhulu, njenge-cirrhosis, kunzima ukukwelapha ngokuphelele, kodwa ungayivimba ukuthi ingabi yimbi kakhulu.

Umbuzo: Ingabe imithi engiyithathayo iyayithinta i-SLD?

Impendulo: Yebo, ingakwenza lokho. Eminye imithi, isibonelo, i-Amiodarone ne-Diltiazem, ingathinta isibindi. Yingakho kufanele utshele udokotela wakho ngayo yonke imithi oyithathayo. Uzobe esehlola ukuthi ikhona yini inkinga ngaleyo mithi.

Umbuzo: Siyini isisindo esinempilo kimi?

Impendulo: Kuncike ekuphakameni kwakho kanye nobudala bakho. Ngokuvamile kungcono ukugcina i-BMI yakho ingaphansi kwama-25. Kodwa into engcono kakhulu ongayenza ukubuza udokotela wakho noma isazi sokudla ngesisindo esifanele wena. Ngisho nokwehlisa isisindo esincane kungaba impumuzo enkulu esibindini sakho.

Umbuzo: Ngingahlangana nochwepheshe wezokudla ukuze ngifunde ngokudla okunempilo?

Impendulo: Impela! Yilokho okungcono kakhulu ongakwenza. Uchwepheshe wezokudla angakusiza ukuthi udale uhlu lokudla olufanele wena. Bangakutshela ngezinto ezifana nokudla kwaseMedithera kanye nokudla okulula ukukulungisa. Uma ubuza udokotela wakho, angakuthumela.

Umbuzo: Ngingaluthola kanjani ukwelashwa kwenkinga yokusebenzisa utshwala?

Impendulo: Uma unenkinga yokuyeka ukuphuza utshwala, ungabi namahloni. Kuyinto evamile. Into engcono kakhulu ongayenza ukukhuluma nodokotela wakho ngakho. Angakusiza, futhi uma kudingeka, akuthumele enkonzweni yokwelulekwa noma kuchwepheshe. Khumbula, ukuyeka utshwala kubalulekile ukuze usindise isibindi sakho.