Matambudziko mukurapa chirwere chefungal chinopararira muvarwere vane chirwere cheropa: Ruzivo kubva kuASH 2024
PaMusangano weGore negore wechi66 weAmerican Society of Hematology (ASH) muna 2024, Purofesa Sun Yuqian wekuPeking University People's Hospital akapa chidzidzo chakakosha pamusoro pechirwere chefungus chinopararira (bIFD) muvarwere vari kuisirwa masero eropa allogeneic hematopoietic (allo-HSCT) muChina. Chidzidzo ichi, chakaitwa muzvipatara gumi nezviviri, chakaburitswa mujenari repamutemo re Zvirwere Zvinotapukira Sangano reAmerica,Zvirwere Zvinotapukira zveKliniki (CID).
Tsvagiridzo iyi, inozivikanwa seongororo yeCAESAR 2.0, yakatarisana nevanhu vakuru 2,015 vakagamuchira mishonga yekudzivirira fungus kubva muna Ndira kusvika Zvita 2021. Yakaratidza kuti 76.08% yevarwere vakapihwa mishonga yekudzivirira fungus, kunyanya voriconazole (44.37%) uye posaconazole (31.71%). Pasinei nekushandiswa kwakawanda kwemishonga iyi yekudzivirira fungus, chidzidzo ichi chakawana kuwanda kwezvirwere zvefungus (IFD) pagore kwe6.3%, nehuwandu hwerufu hunokonzerwa ne48.28%. Candida, Aspergillus, nedzimwe fungus dzakaonekwa sezvirwere zvikuru zvinokonzera hutachiona.
Purofesa Sun vakataurawo nezvematambudziko ekurapa ane chekuita nekuongorora nekurapa bIFD muvarwere vane chirwere cheropa. Kubudirira kwe IFD kunoitika panguva yekudzivirira fungus, izvo zvinoita kuti kuongororwa nekurapwa kuve kwakaoma. Nekuda kwekushaikwa kwetsananguro yakajairika, huwandu hwehuwandu hwe bIFD hunosiyana zvikuru, kubva pa1% kusvika pa42%. Kusiyana uku kunoita kuti zviome kuisa nzira dzekuongorora dzakafanana uye nzira dzekurapa.
Chimwe chezvinetso zvikuru zvakaratidzwa naProfessor Sun ndechekuoma kwezvinhu zvinokonzera njodzi ye bIFD, zvinosanganisira neutropenia kwenguva refu, kushandiswa kwe steroid, uye kushandiswa kwenguva refu kwemishonga inorwisa mabhakitiriya yakawanda. Uyezve, mishonga inorwisa mabhakitiriya inoshandiswa kudzivirira inogona kusagara ichifukidza huwandu hwese hwezvirwere zvinogona kuitika, uye mhando dzefungus dziri kubuda dzinogona kudzivirira kuonekwa nekuda kwekudzikira kwekunzwa mumiedzo yekuongorora yakadai sePCR ne GM tests.
Purofesa Sun akasimbisa kukosha kwekurapwa kwefungus nekukurumidza, kunyanya kune varwere vane njodzi huru vanoratidza zviratidzo zvehutachiona. Akakurudzira kuti kurapwa kwefungus kunofanira kutanga nekukasika kune varwere vanorwara zvakanyanya vane zvinofungidzirwa kuti bIFD, kunyangwe mhedzisiro yerabhoritari isati yawanikwa. Akakurudzirawo kushandiswa kwemishonga yefungus yakasiyana neyakagadzirirwa kudzivirira kuti kurapwa kubudirire zvakanyanya.
Zvakawanikwa muchidzidzo cheCAESAR 2.0 zvinoratidza kudiwa kwemaitiro akavandudzwa ekugadzirisa njodzi yeIFD muvarwere vane HSCT uye kudiwa kwekukurumidzira kuongororwa nekukurumidza uye kupindira. Sezvakagumiswa naProfessor Sun, nepo mishonga inouraya fungus iripo ichiri kuita basa rakakosha, kugadzirwa kwemishonga mitsva nezvishandiso zvekuongororwa kwakakosha mukuvandudza mhedzisiro yemurwere. Mishonga iri kubuda, yakaita se Kurapa nekudzivirira muviri uye mishonga mitsva yekuuraya fungus, zvinogona kupa tariro itsva kuvarwere vari kurwisana nehutachiona uhwu hunotyisidzira hupenyu.
Tsvagiridzo iyi inoshamisa pamusoro pe bIFD inoratidza matambudziko ari kusangana nevanachiremba mukurapa hutachiona hwefungus muvarwere vane chirwere cheropa uye inoratidza kudiwa kukuru kwekufambira mberi mukudzivirira nekurapa.