Ingabe isibindi sakho naso sinamafutha? Ake sixoxe nge-Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)

Wake wacabanga ukuthi isisindo esengeziwe osithwele noma isimo esifana nesifo sikashukela onaso singathinta nesibindi sakho? Ngezinye izikhathi, singazi siqala ukuqongelela amafutha esibindini sethu. Leso ngesinye sezimo esizokhuluma ngazo namuhla, esibizwa ngokuthi i-MASLD. Ungakhathazeki, ake sikuqonde kalula lokhu.

Iyini le MASLD?

Kalula nje, i-MASLD (Metabolic Dysfunction-Associated Steatotic Liver Disease) yisifo sesibindi esibangelwa ukunqwabelana ngokweqile kwamafutha ngaphakathi kwamaseli esibindi sakho. Sibizwa nangokuthi isifo sesibindi se-steatotic (fatty) (SLD) . Ngaphambilini sasibizwa ngokuthi i-NAFLD (Nonalcoholic Fatty Liver Disease), okusho ukuthi amafutha anqwabelana esibindini ngezizathu *hhayi* ngenxa yokuphuza utshwala. Kodwa manje leli gama selishintshiwe laba yi-MASLD, ngoba kutholakale ukuthi lihlobene ngqo nokuphazamiseka okuthile ekusebenzeni komzimba wethu.

Njengoba nje kunqwabelana udoti emakhaya ethu, lapho amafutha eqoqana esibindini, ngokuhamba kwesikhathi kungabangela i-hepatitis, okuwukuvuvukala kwesibindi. Lesi simo singesinye sezifo zesibindi ezingamahlalakhona ezivame kakhulu emhlabeni. Sivame kakhulu kubantu abanokukhuluphala kanye nesifo sikashukela sohlobo 2. Njengoba lezi zimo zanda, ochwepheshe balinganisela ukuthi abantu abangaphezu kuka-30% emhlabeni bangaba ne-MASLD. Uma ingelashwa, i-MASLD ingaholela ezifweni zesibindi ezingathi sína. Ngakho-ke, ukutholakala kusenesikhathi kanye nokwelashwa kungavimbela lesi simo ukuba sibi kakhulu.

Ziyini izimpawu ze-MASLD?

Ngokuvamile, lesi simo esibizwa ngokuthi i-MASLD singakhula iminyaka eminingi ngaphandle kokubonisa izimpawu ezigabeni zokuqala. Lokhu kusho ukuthi lesi sifo singaba khona emzimbeni wakho ngaphandle kokuthi uzizwe umehluko. Cabanga ngaso njengenkinga ekhula ngokungabonakali.

Kodwa-ke, ezinye izimpawu ziqala ukuvela lapho lesi simo sifinyelela esigabeni esibi kakhulu esibizwa ngokuthi i-MASH (Metabolic Dysfunction-Associated Steatohepatitis). I-MASH yilapho amafutha eqoqana esibindini bese eqala ukulimaza isibindi kanye nokuvuvukala. Lokhu kungaholela ezimweni ezifana ne-liver fibrosis, okuwukwakheka kwezicubu zesibazi, noma i-cirrhosis. Uma lokhu kwenzeka, ungase ube nezimpawu ezifana nalezi:

• Unezinhlungu noma ukungakhululeki engxenyeni engenhla kwesokudla yesisu sakho, lapho isibindi sakho sitholakala khona .
• Ukuzizwa ukhathele ngendlela engakholeki futhi ungenampilo.
• Ukudla akunambitheki.
• Ukuzizwa sengathi isisu sakho sivuvukele.
• Ukuba mncane ngaphandle kwesizathu.
• Isikhumba sakho kanye namehlo akho amhlophe aphenduka aphuzi (njenge-jaundice, odokotela babiza lokhu ngokuthi i-scleral icterus ).

Uma unesinye noma ngaphezulu salezi zimpawu, kubalulekile ukufuna iseluleko sezokwelapha.

Yiziphi izimbangela ze-MASLD?

Isizathu esiyinhloko sokuthuthukisa i-MASLD ukuvela kokungajwayelekile okuthile enkambisweni yokuguqulwa kwe-metabolic emzimbeni wakho. Lokhu kuguqulwa kwe-metabolism yinqubo lapho ukudla esikudlayo kuguqulwa khona kube amandla. Uma kukhona inkinga kule nqubo, i-MASLD ingenzeka. Nazi ezinye zezinto eziyinhloko ezithinta lokhu:

• I-Dyslipidemia: Lokhu kwenzeka lapho amazinga amafutha egazini lakho, ikakhulukazi amafutha anjenge-cholesterol, ephakeme kunokuvamile.
• Ukukhuluphala: Uma i-Body Mass Index (BMI) yakho ingu-30 noma ngaphezulu, ubhekwa njengokhuluphele. Abantu abanamafutha amaningi, ikakhulukazi eduze kwesisu, basengozini enkulu yokuthola i-MASLD.
• Ukumelana ne-insulin: I-insulin iyi-hormone elawula izinga likashukela (i-glucose) egazini lethu. Ukumelana ne-insulin kusho ukuthi imisipha yakho, amaseli amafutha, kanye namaseli esibindi awasabeli kahle ku-insulin. Lokhu kwenza kube nzima ukulawula amazinga kashukela egazini.
• Isifo sikashukela sohlobo 2: Lesi futhi yisimo sesikhathi eside. Okwenzekayo lapha ukuthi amazinga kashukela egazini ahlala ephezulu (i-hyperglycemia).

Ngaphezu kwalezi zici, ucwaningo luthole ukuthi ukuhlukahluka okuthile kwezakhi zofuzo kungandisa nengozi yokuthola i-MASLD.

Yiziphi izinkinga ezingaba khona ze-MASLD?

Sesikhulume kakade ngendlela abanye abantu abane-MASLD abangahlakulela ngayo isimo esibizwa ngokuthi i-MASH. Uma lesi simo se-MASH siba sibi kakhulu, kungavela izinkinga ezilandelayo:

• I-MASH ene-fibrosis yesibindi: I-Fibrosis ukwakheka kwezicubu zesibazi esibindini. Lokhu kubanga kwenzeka lapho amangqamuzana esibindi onakele futhi ezama ukuzilungisa.
• I-cirrhosis ehlobene ne-MASH: I-cirrhosis yisimo lapho isibindi sonakala kakhulu futhi silahlekelwa amandla aso okusebenza. Lokhu kuyingozi kakhulu futhi kungaba yingozi empilweni.
• I-carcinoma yesibindi: Lolu uhlobo lomdlavuza wesibindi olungabangelwa yi-MASH.

I-MASLD ayikwazi nje kuphela ukubangela lezi zinkinga ezihlobene nesibindi, kodwa futhi ingandisa ingozi yezinye izifo ezinkulu. Isibonelo:

• Umdlavuza: Izinhlobo zomdlavuza ezifana nomdlavuza webele kanye nomdlavuza we-colorectal.
• Isifo senhliziyo: Izifo ezihlobene nenhliziyo nemithambo yegazi.
• Isifo Sikashukela: Abantu abangenaso isifo sikashukela njengamanje bangaba nesifo sikashukela esisha.

I-MASLD itholakala kanjani?

Ukuze bathole ngokuqinisekile ukuthi une-MASLD, odokotela bavame ukwenza izivivinyo eziningana zegazi kanye nokuhlolwa kwezithombe. Ngezinye izikhathi, kungadingeka bathathe ingxenye encane yesibindi ukuze ihlolwe (i-biopsy yesibindi).

Ukuhlolwa kwegazi

Udokotela angenza ukuhlolwa kwegazi okuningana, okufana nalokhu:

• Ukuhlolwa kwe-A1C: Lokhu kulinganisa amazinga akho ajwayelekile kashukela egazini ezinyangeni ezimbili kuya kwezintathu ezedlule.
• Ukubalwa Kwegazi Okuphelele (i-CBC): Lokhu kuhlola inani kanye nezici zezinhlobo ezahlukene zamaseli egazini lakho.
• Iphaneli Ephelele Ye-Metabolic (CMP): Lokhu kuhlola amazinga ezinto ezingaba ngu-14 egazini lakho, njengeprotheni nama-electrolyte.
• Iphaneli ye-lipid: Lokhu ukuhlolwa kwesifo senhliziyo. Kukala amazinga ezinhlayiya zamafutha (i-cholesterol, ama-triglycerides) egazini lakho.
• Ukuhlolwa kokusebenza kwesibindi: Lokhu kuhlolwa kwegazi kulinganisa izinto ezahlukahlukene (ama-enzyme, amaprotheni) akhiqizwa yisibindi ukuze kunikezwe umbono wempilo yesibindi.

Ukuhlolwa kwezithombe

Udokotela wakho angenza amaskeni anjengalawa ukuhlola izimpawu ze-MASLD esibindini sakho:

• I-FibroScan®: Lokhu kuskena kungakunikeza umbono wenani lamafutha abekwe esibindini sakho kanye nobukhulu be-fibrosis.
• I-Magnetic Resonance Elastography kanye ne-Proton Density Fat Fraction (MRE-PDFF): Lolu futhi uhlobo olukhethekile lokuskena. Lungalinganisa ngokunembile iphesenti lamafutha esibindini kanye nezinga le-fibrosis.

Ukuhlolwa kwebhayoloji

Akuvamile kakhulu, uma udokotela wakho esola ukuthi izimpawu zakho zibangelwa okunye okungeyona i-MASLD, noma uma edinga ulwazi olwengeziwe ngemuva kokuhlolwa okufana ne-fibroscan, angase athathe ingxenye encane yezicubu esibindini sakho (i-biopsy yesibindi) ayihlole ngaphansi kwe-microscope.

Iphathwa kanjani i-MASLD?

Lapho welapha i-MASLD, ukugxila kokuqala kulele ekunciphiseni isisindo . Ngaphezu kwalokho, izimo eziyisisekelo ezibangele i-MASLD, njengesifo sikashukela, i-cholesterol ephezulu, kanye nomfutho wegazi ophakeme, nazo ziyalashwa.

Eqinisweni, ukwehlisa isisindo kungenza umehluko omkhulu empilweni yesibindi sakho. Ukunciphisa amafutha amaningi esibindini kungasiza ekulawuleni ukuvuvukala okungaholela ezimweni ezifana ne-cirrhosis. Udokotela wakho angase ancome uhlelo lokudla olukhethekile, njengokudla kwaseMedithera noma ukudla kwe-DASH. Sizoxoxa ngalezi zindlela zokudla esihlokweni esihlukile.

Ukuzivocavoca okulingene okungenani imizuzu engama-30 ngosuku, izinsuku ezintathu ngesonto, kungakusiza ukwehlisa isisindo. Udokotela wakho angakutshela ukuthi unciphise isisindo somzimba wakho ngo-10% noma ngaphezulu. Kodwa-ke, ngisho nokunciphisa isisindo somzimba wakho ngo-3% kuya ku-5% kungenza umehluko omkhulu .

Imithi yokwehlisa isisindo

Uma unesifo sikashukela kanye/noma ukukhuluphala ngokweqile, udokotela wakho angase akunike imithi yokwehlisa isisindo, njenge-GLP-1 agonists. Le mithi yehlisa amazinga kashukela egazini lakho futhi ikusize unciphise isisindo. Ezinye izibonelo yilezi:

• I-Semaglutide (i-Ozempic® noma i-Wegovy®)
• I-Liraglutide (i-Liraglutide - i-Victoza® noma i-Saxenda®)
• I-Tirzepatide (i-Mounjaro® noma i-Zepbound®)

Ukuhlinzwa kwe-Bariatric

Ngezinye izikhathi udokotela wakho angase akhulume nawe ngokuhlinzwa kwe-bariatric. Uma kutholakala ukuthi une-MASLD ngaphambi kokuba i-cirrhosis iqale, lokhu kuhlinzwa kokunciphisa isisindo kungasiguqula lesi simo.

Ingabe isimo se-MASLD singaguqulwa?

Yebo, kungenziwa! Kodwa kuya ngesimo sakho. Ngokuvamile, uma ungenayo i-cirrhosis ehlobene ne-MASH, ukwelashwa kungaguqula i-MASLD.

Kubalulekile ukuthola lesi sifo kusenesikhathi . Lokhu kungasiza ekulawuleni umonakalo wesibindi ngaphambi kokuba sibe sibi kakhulu. Ukwehlisa isisindo nokwenza izinguquko endleleni yokuphila kungasiza ekubuyiseleni umonakalo wesibindi obangelwa yi-MASLD. Kodwa-ke, lokhu kuncike empilweni yakho iyonke. Ngakho-ke, buza udokotela wakho ukuthi ukwehlisa isisindo kungasibuyisela yini isimo sakho.

Ingabe i-MASLD ingavinjelwa?

Lesi simo sivame ukuthinta abantu abakhuluphele kakhulu futhi abanesifo sikashukela sohlobo 2. Kungase kungenzeki ukuvimbela ngokuphelele lezi zimo ukuthi zingabi khona. Kodwa-ke, ukutholakala kusenesikhathi kanye nokushintsha kwendlela yokuphila kungasiza ekuvimbeleni noma ekulawuleni ukuthuthukiswa kwe-MASLD.

Uma ukhuluphele noma unesifo sikashukela sohlobo lwesibili, udokotela wakho angase akuncome ukuhlolwa kwegazi kanye nokuskena ukuze kuhlolwe izimpawu zalesi simo. Uma utholakala kusenesikhathi, ungenza izinguquko endleleni yokuphila ukuze unciphise ingozi yakho.

Ungaphila isikhathi esingakanani ne-MASLD?

Ucwaningo lubonisa ukuthi ukuba ne-MASLD kungathinta impilo yakho. Isibonelo, olunye ucwaningo luthole ukuthi abantu abane-MASLD bangase baphile iminyaka engu-2.8 ngaphansi kwalabo abangenayo leso simo.

Kodwa-ke, kunezici eziningi ezithinta ukuthi uzophila isikhathi esingakanani ne-MASLD. Isimo sakho singase sihluke kwesabanye. Ngakho-ke, udokotela wakho ungumthombo ongcono kakhulu wolwazi ngalokho ongakulindela.

Ngizinakekela kanjani?

Uma une-MASLD, indlela engcono kakhulu yokuzinakekela ukusebenzisana nodokotela bakho ukulawula izimo ezibangele i-MASLD, njengesisindo esiningi, ukukhuluphala ngokweqile, nesifo sikashukela sohlobo 2. Ukwehlisa isisindo nokuhlala usebenza kungasiza ekunciphiseni, futhi mhlawumbe ekubuyiseleni emuva, ukulimala kwesibindi.Nazi ezinye iziphakamiso:

• Qaphela impilo yakho iyonke. I-MASLD yandisa ingozi yakho yokuthola isifo sikashukela, isifo senhliziyo, kanye nezinye izinhlobo zomdlavuza. Ngakho-ke, buza udokotela wakho womndeni ukuthi yiziphi izivivinyo ongayenza ukuze unciphise ingozi yakho.
• Yakha imikhuba emihle esibindini sakho. Yeka ukubhema nokuphuza utshwala. Ukubhema notshwala kubeka ingcindezi eyengeziwe esibindini sakho. Buza nodokotela wakho mayelana nokugonyelwa i-hepatitis A kanye ne-hepatitis B.
• Ungayeki, qhubeka uzama.

Ukwehlisa isisindo kuthatha isikhathi. Ungase ungaboni umehluko omkhulu ngokushesha, kodwa uzobona imiphumela kancane kancane. Futhi, ukuzivocavoca njalo kuyisibopho. Uma uzizwa ukhathele noma unesithukuthezi phakathi nalolu hambo, khuluma nodokotela wakho ngakho.

Kufanele ngimbone nini udokotela?

Uma ubona noma yiziphi izinguquko emzimbeni wakho, njengokuzizwa ukhathele kakhulu kunokujwayelekile noma ukuba nobuhlungu ohlangothini oluphezulu kwesokudla lwesisu sakho, qiniseka ukuthi ubona udokotela wakho . Lezi zinguquko zingase zibonise icala elibi le-MASH, isimo sesifo sesibindi esinamafutha esingaqhubekela ezimweni ezimbi kakhulu njenge-cirrhosis kanye nomdlavuza wesibindi.

Ingabe ukusetshenziswa kotshwala kubangela i-MASLD?

Cha, ukuphuza utshwala akukubangeli ngqo i-MASLD. Njengoba sishilo ngaphambili, lokhu kwakubizwa ngokuthi isifo sesibindi esinamafutha esingesona utshwala (i-NAFLD). Lokhu kusho ukuthi lesi simo singakhula ngisho noma ungaphuzi utshwala obuningi.

Kodwa, into ebaluleke kakhulu ukuthi uma umuntu one-MASLD ephuza utshwala, usengozini enkulu kakhulu yokuthola isifo sokuqina kwesibindi kunomuntu ojwayelekile. Yingakho odokotela bevame ukweluleka abantu abane-MASLD ukuthi bagweme utshwala ngokuphelele.

Okokugcina, izinto okufanele uzikhumbule

Uma ukuhlolwa kwegazi ngesikhathi sakho sonyaka kubonisa ukuthi unenkinga ngesibindi sakho, kungase kwenziwe ezinye izivivinyo ukuqinisekisa ukuthi une-MASLD. Lesi sifo sesibindi singaholela ezinkingeni ezinkulu uma singaphathwa kahle.

Kodwa izindaba ezinhle ukuthi izinguquko zendlela yokuphila, njengokunciphisa isisindo nokuba matasa, zingasiza ekuvimbeleni i-MASLD ukuthi ibe yimbi kakhulu. Zingabuyisela ngisho nomonakalo esibindini sakho. Kodwa ukunciphisa isisindo nokuba matasa akuyona into ongayenza ngobusuku obubodwa. Kuthatha isikhathi nokuzinikela. Ngezinye izinsuku, ungase uzizwe sengathi uyakhathala yilezi zinto. Ithimba lakho lezokunakekelwa kwempilo liyaqonda inselele yokuzama izinto ezibonakala zingasebenzi ngokushesha. Ngakho-ke, ungalokothi unqikaze ukucela usizo nokusekelwa. Isibindi sakho siyigugu kuwe, futhi kukuwe ukuthi usinakekele!

Amafutha esibindi , isibindi esinamafutha, isifo sikashukela, ukukhuluphala, isifo sokuqina kwesibindi, impilo yesibindi