Imtixaanka xakamaynta Dexamethasone

Baaritaanka xakamaynta Dexamethasone wuxuu cabiraa in dheecaanka adrenocorticotrophic hormone (ACTH) ee dheecaanka pituitary la xakamayn karo.

Inta lagu jiro baaritaankaan, waxaad heli doontaa dexamethasone. Tani waa dawooyin adag oo uu sameeyay dad (synthetic) glucocorticoid. Kadib, dhiigaaga ayaa lagaa qaadayaa si loo qiyaaso heerka cortisol ee dhiigaaga.

Waxaa jira laba nooc oo kala duwan oo ah baaritaanada xakamaynta dexamethasone: qadar hoose iyo qadar sare. Nooc kasta waxaa lagu sameyn karaa habeyn (caadi ah) ama heer (3-maalmood) ah (dhif). Waxaa jira habab kala duwan oo loo isticmaali karo labada imtixaan midkood. Tusaalooyinka kuwaas ayaa hoos lagu sharaxay.

Caadi ah:

• Qiyaas-yar oo habeenkii ah - Waxaad heli doontaa 1 milligram (mg) oo ah dexamethasone markay tahay 11-ka fiidnimo, daryeel caafimaad bixiye ayaana dhiigaaga ka qaadi doona subaxa dambe 8-da subaxnimo si loo cabiro cortisol.
• Qadar-qaadasho sare habeenkii - Bixiyuhu wuxuu cabirayaa cortisol subaxa baaritaanka. Kadib waxaad heli doontaa 8 mg oo ah dexamethasone 11 pm. Dhiigaaga ayaa lagaa qaadayaa subaxa xigta 8da subaxnimo si loo cabiro cortisol.

Dhif ah:

• Qiyaasta-hooseeya - Kaadida waxaa la ururiyaa in ka badan 3 maalmood (oo lagu kaydiyaa 24-saac weelasha aruurinta) si loo cabiro cortisol. Maalinta 2, waxaad afka ka heli doontaa qadar yar (0.5 mg) oo ah dexamethasone 6 saacadood kasta 48 saacadood.
• Qiyaasta heerka sare ah - Kaadida waxaa la soo ururiyaa in ka badan 3 maalmood (oo lagu kaydiyaa 24-saac weelasha aruurinta) si loo cabiro cortisol. Maalinta 2aad, waxaad afka ka heli doontaa qadar sare (2 mg) oo ah dexamethasone 6 saacadood kasta 48 saacadood.

U akhri oo u raac tilmaamaha si taxaddar leh. Sababta ugu badan ee natiijada baaritaanka aan caadiga ahayn waa marka aan la raacin tilmaamaha.

Bixiyaha ayaa laga yaabaa inuu kuu sheego inaad joojiso qaadashada daawooyinka qaarkood ee saameyn ku yeelan kara baaritaanka, oo ay ku jiraan:

• Antibiyootikada
• Daawooyinka ka-hortagga suuxdinta
• Daawooyinka ku jira corticosteroids, sida hydrocortisone, prednisone
• Estrogen
• Ka hortagga uurka ee afka (ka hortagga uurka)
• Kiniiniyada biyaha (durayo)

Marka irbadda la geliyo si dhiig loo qaado, dadka qaar waxay dareemaan xanuun dhexdhexaad ah. Qaar kale waxay dareemaan oo keliya dharbaaxo ama xaniin. Intaas ka dib, waxaa laga yaabaa in xoogaa wax garaaco ama nabarro yar yeeshaan. Tani dhawaan way tagi doontaa.

Tijaabadani waxaa la sameeyaa marka adeeg bixiyuhu ka shakiyo in jirkaagu soo saarayo cortisol aad u tiro badan. Waxaa loo sameeyaa si looga caawiyo baaritaanka cudurka Cushing syndrome iyo in la ogaado sababta.

Tijaabada qiyaasta yar waxay kaa caawin kartaa inaad sheegto in jirkaaga uu soo saarayo ACTH aad u badan. Baadhitaanka qaddarka sare ayaa kaa caawin kara go'aaminta haddii dhibaatadu ku jirto qanjirka 'pituitary gland' (Cushing disease).

Dexamethasone waa steroid-samee (synthetic) steroid ah oo ku dalbanaya isla qaan-qaadaha sida cortisol. Dexamethasone wuxuu yareeyaa sii deynta ACTH ee dadka caadiga ah. Sidaa darteed, qaadashada dexamethasone waa inay yareeysaa heerka ACTH oo ay u horseedaa hoos u dhac ku yimaada heerka cortisol.

Haddii qanjirka 'pituitary gland' uu soo saaro ACTH aad u badan, waxaad kuheli doontaa jawaab aan caadi aheyn baaritaanka qiyaasta yar. Laakiin jawaab caadi ah ayaad ku heli kartaa baaritaanka qaddarka sare leh.

Heerka Cortisol waa inuu yaraadaa ka dib markaad hesho dexamethasone.

Qadar yar:

• Habeenkii - 8 subaxnimo plasma cortisol oo ka hooseeya 1.8 microgram halkii deciliter (mcg / dL) ama 50 nanomoles halkii litir (nmol / L)
• Heerka - Kortisol bilaash ah oo kaadi haysta maalintii 3 oo ka hooseeya 10 microgram maalintii (mcg / maalin) ama 280 nmol / L

Qadar sare:

• Habeen - wax ka badan 50% hoos u dhaca plasma cortisol
• Jaangooyo - in ka badan 90% hoos u dhac ku yimaada cortisol-ka aan lahayn kaadida

Heerarka qiimaha caadiga ahi way ku kala duwanaan karaan shaybaarada kala duwan. Shaybaarada qaarkood waxay isticmaalaan cabbiro kala duwan ama waxay tijaabin karaan tijaabooyin kala duwan. Kala hadal dhakhtarkaaga macnaha natiijooyinka baaritaankaaga gaarka ah.

Jawaab aan caadi ahayn oo ku saabsan baaritaanka qaddarka yar ayaa laga yaabaa inay macnaheedu tahay inaad si aan caadi ahayn u sii deysay cortisol (Cushing syndrome). Tan waxaa u sababi kara:

• Buro Adrenal ah oo soo saarta cortisol
• Burooyinka pituitary ee soo saara ACTH
• Buro ku jirta jirka oo soo saarta ACTH (ectopic Cushing syndrome)

Imtixaanka qaddarka sare wuxuu kaa caawin karaa inaad u sheegto sababaha pituitary (Cushing disease) sababaha kale. Baadhitaanka dhiigga ACTH ayaa sidoo kale kaa caawin kara in la ogaado waxa keena cortisol sare.

Natiijooyinka aan caadiga ahayn way kala duwan yihiin iyadoo ku saleysan xaaladda dhibaatada keentay.

Cudurka 'Cushing syndrome' oo uu sababo buro adrenal:

• Tijaabinta qaddar-yar - hoos uma dhicin cortisol dhiigga
• Heerka ACTH - hooseeya
• Xaaladaha badankood, baaritaanka qaddarka sare looma baahna

Ectopic Cushing cillad

• Tijaabada qaddar-yar - hoos uma dhicin cortisol dhiigga
• ACTH heerka - sare
• Baadhitaanka qaddarka sare - hoos uma dhicin cortisol dhiigga

Cudurka 'Cushing syndrome' ee uu sababo burooyinka 'pituitary buro' (Cushing disease)

• Tijaabinta qaddar-yar - hoos uma dhicin cortisol dhiigga
• Baadhitaanka qaddarka sare - hoos u dhaca la filayo ee cortisol dhiig

Natiijooyinka baaritaanka beenta ah waxay ku dhici karaan sababo badan awgood, oo ay ku jiraan dawooyin kala duwan, buurnida, diiqadda, iyo walbahaarka. Natiijooyinka beenta ah ayaa dumarka ku badan ragga.

Khatar yar ayaa ku jirta in dhiigga lagaa qaado. Xididdada iyo halbowlayaasha waxay ku kala duwan yihiin cabirka bukaanku mid kale, iyo dhinac jirka ah dhinaca kale.Qaadashada dhiigga dadka qaar way ka dhib badnaan kartaa kuwa kale.

Khataraha kale ee la xiriira dhiig qaadashada waa yar yihiin, laakiin waxaa ka mid noqon kara:

• Dhiigbax xad dhaaf ah
• Miyir beelid ama dareemid madax-wareer
• Daloollo badan si loo helo xididdada
• Hematoma (dhiig ku ururaya maqaarka hoostiisa)
• Infekshan (halis yar mar kasta oo maqaarku jabo)

DST; ACTH xakamaynta tijaabada; Imtixaanka xakamaynta Cortisol

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Guber HA, Farag AF. Qiimeynta shaqada endocrine. Gudaha: McPherson RA, Pincus MR, eds. Henry's Clinical Diagnosis iyo Maareynta Hababka Shaybaarka. 23aad ed. St Louis, MO: Elsevier; 2017: cutubka 24.

Stewart PM, Newell-Price JDC. Kiliyaha adrenal. Gudaha: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Buugga Buugga Endocrinology. 13aad. Philadelphia, PA: Elsevier; 2016: cutubka 15.