Dýisenbi, 18 Qantar 2021
Bilgenge marjan 3345 3 pikir 20 Shilde, 2020 saghat 12:59

Sitokin dauyly jәne auyr nauqastardy emdeu

SITOKIN (cytokine) 

Sitokin (SK) – Búl kóp týrli tkan (tin) kletkalarynda (negizinen immundyq kletkalarda) óndiriletin jәne bólinetin kishkene molekulaly poliypeptid nemese glikoproteiyn. Sitokinderdi negizinen immundyq kletkalar óndirgenimen, solardyng ishinde bastysy leykositter óndiredi (sintezdeydi) jәne leykositterding ózara sәikesip, selbesip әrekettesuine әser etedi, sondyqtan Sitokinderdi interleykin (IL) dep te ataydy. Bir sózben aitqanda sitokinder jasushalardyng (immundyq jasushalardyn) ózara ýilesip, selbesip әrekettesuine deldaldyq qyzmet atqarady.  

1, Sitokinderdi sintezdeytin (óndiretin) jәne bólip shygharatyn (sekresiya) immundyq jasushalar - monositter, makrofagtar, T jasushalary, NK jasushalary jәne t.b.) 

2, Sitokinderdi óndiretin immundyq emes jasushalar - endoteliy jasushalary, epiydermaldyq jasushalar, fibroblasttar jәne t.b.

Sitokinderding biologiyalyq әser etu belsendiligi joghary, aumaghy ken. Sitokinder - úsaq molekulaly, molekulalyq salmaghy tómen (jenil), suda erigish aquyzdar bolyp tabylady. Sitokinder әdette, jasushanyng syrtqy betindegi tiyisti reseptorlarmen baylanysu, reseptorlargha  jabysu arqyly jasushalardyng (ósui, gematogenez, differensirovaniye, zaqymdalghan tinderdi qalpyna keltiru t.b.) qyzmetin retteydi, immundyq reaksiyalardy da retteydi. 

1957 jyly Lssak interferondy zerttep tapqannan beri, osy uaqytqa deyin 200-den astam týrli sitokinder tabyldy. Ghalymdar (interferondardy, isik nekrozynyng faktorlaryn, gemopoetikalyq faktorlardy, ósu faktorlaryn, himokinderdi jәne t.b.) bәrin birtútas sitokinder dep ataydy.

Sitokinderge qatysty zertteu nәtiyjeleri – klinikada aurudyng aldyn-aluda, diagnostikalauda jәne emdeude, bәrin de ghylymy negizben qamtamasyz etude. Ásirese sitokinderdi qoldana otyryp isikterdi, infeksiyalardy, autoimmundyq aurulardy jәne t.b. aurulardy emdeuding bolashaghy zor. 

SITOKIN DAUYLY (cytokine storm)

Sitokin dauyly (cytokine storm) – virus siyaqty mikroorganizmder adam organizmde qabynu tudyrghanda dene súiyqtyghyna (mysaly, qangha) tez әri kóp mólsherde sitokinderdi bólu (óndiru) qúbylysy. Sitokin jedel respiratorlyq distress sindromynyng (Acute respiratory distress syndrome, ARDS) jәne kóptegen mýsheler qyzmetining jetispeushiligin tudyratyn manyzdy sebebi bolyp tabylady. 

Qan sarysuyna (syvorotkagha) jasalghan taldaular, koronavirus pnevmoniyasynyng auyr týrde ótui, jii ólimge alyp kelui sitokin dauylynyng reaksiyasymen tyghyz baylanysty ekenin kórsetti. Sitokin dauyly - virustyq infeksiyadan tuyndaghan tútas organizmdi qamtityn qabynu reaksiyasy

Adamgha virus júghyp, virus tynys joldary, ókpe siyaqty aghzalarda qabynu tudyryp, zaqymday bastaghan kezde immundyq jasushalar oghan qarsy tez әreketterge kóshedi. Patogenderding (auru qozdyrghyshtardyn) kózin joyady, organizm patogenderden tazaryp, qabynu basylady. Ádettegi jaghdayda osylaysha auru jazylyp, qalpyna keledi. Adam aghzasy әrdayym osynday keri baylanys siklin ózi baqylap, ózi rettep otyrady.

Key jaghdayda shamadan tys mólsherdegi sitokinder bólinip, immundyq jasushalar shamadan tys aktivtenedi, әsili ókpe qatarly aghzalardy virustardan tazalap ghana qoi kerek edi, biraq, sitokinder shamadan tys kóp bólingendikten, immundyq kletkalar tym qatty aktivtenip, baqylaudan shyghyp, asyra siltep, tipti «joyghysh myqty qarulardy» da iske qosyp oranizmning ózin zaqymday bastaydy. Immundyq jýiening múnday adamnyng aghzasyn da zaqymdaytyn «keri tónkeris» nәtiyjesinde, bastysy qan tamyrlardyng býlinuine, jyrtyluyna, qannyng úngyna, qan qysymynyng tómendeuine, eng qiyny ókpe, býirek, bauyr t.b. aghzalar qyzmetining jetispeushiligine (әlsireuine) alyp keledi. Osylaysha densaulyqty saqtau perishtesi (immundyq kletkalar) kerisinshe virustyng kómekshisine ainalyp, jan alghysh naghyz jendetke ainalady.

Sitokin dauyly azot oksiydining jappay bosatylyp, qangha ótuine sebep bolady. Qangha týsken azot oksiydi qan tamyrlardy odan ary býldiredi. Barlyq osy faktorlardyng qosylyp әser etui qan qysymyn tómendetip qauipti dengeyge jetkizdi. Sondyqtan Covid-19 infeksiyasymen auyrghan nauqastyng deni qan joghaltudan emes, auyr septikalyq shokqa úqsas problemadan óledi.

Intensivti terapiya bóliminde (Intensive Care Unit,ICU) sitokin dauyly -  sepsispen auyratyn nauqastardyng jii ólimine әkeletin negizgi mehanizm. Sondyqtan sitokin dauylynyng payda bolatynyn qalay aldyn-ala qalay boljaugha bolady? Jәne payda boluynyng aldyn qalay alugha bolady? búl әrdayym manyzdy әri óte kýrdeli mәsele bolyp tabylady. 

SITOKIN DAUYLYNYNG PAYDA BOLU SEBEPTERI

Koronavirus (Covid-19) pnevmoniyasyn mysal retinde ala otyryp, sitokin dauylynyng payda bolu sebepteri tómendegi joldarmen tuyndauy mýmkin:

1, Aghzadaghy koronavirustardyng kenetten kóbeyip, kýsh aluy. 

2, Virustyq infeksiya bakteriyalyq qabynudy qatar tudyryp, al immundyq jasushalar bakteriyalargha qarsy әrekettenu prosesinde shamadan tys belsendirilip, baqylaudan shyghyp ketui.

3, virus ókpege, býirekke, bauyrgha jәne basqa da tinderge zaqym keltirgennen keyin sitokinderding kóp mólsherde óndirilui immundyq jasushalardy belsendirip, sitokin dauylyna әkep soghuy. 

EMDEU ÁDISTERI

COVID-19 infeksiyasy bar nauqastardy emdeu kezinde últtyq DSM tarabynan resmy týrde jariyalaghan virusqa qarsy emdeu josparlary boyynsha emdeuden basqa, dәrigerler auyr nauqastardy emdeuge sitokin dauylynyng orasan zor zaqymdau әserining qashan tuylatynyna basa nazar audarulary kerek. Oslay isteu jaghdayy auyr nauqastardy emdeude, nauqastardyng ólim-jitim mólsherin meylinshe azaytu ýshin erekshe manyzgha iye. Alghashqy qadamdaghy klinikalyq baqylaular nәtiyjesinde, COVID-19 infeksiyasymen auyrghan jaghdayy auyr nauqastarda «IL-6, TNF-a jәne IFN-γ» siyaqty sitokinderding dengeyi aiqyn  kóteriletini bayqaldy. Yaghni, sitokin dauylynyng ereksheligi bayqaluda. Eger nauqasta sitokin dauyly jәne tútas aghzalardyng jýieli qabynu reaksiyasynyng sindromy (Systemic inflammatory response syndrome ,SIRS) anyqtalghan jaghdayda tiyisti emdeu sharalaryn qabyldau kerek.

Tómendegi emdeu әdisterin әr nauqastyng ózindik densaulyq jәne auru jaghdayyna qaray otyryp dәrigerler tandap paydalanugha bolady:

1, Shokke qarsy emdeu (birinshi kezekte ómirdi saqtap qalu): qan kólemin qorghau ýshin infuziya, qan qysymyn kóteru nemese tómendetu maqsatynda vazoaktivti preparattardy qoldanu, manyzdy organdardyng funksiyalaryn qorghau, qajet bolghan kezde IVL aparatyn qoldanyp jasandy jolmen ókpede aua almastyru;

2, Sýiemeldeu terapiyasy jәne simptomatikalyq emdeu, dene quatyn qalpyna keltiru: sistema qoi arqyly organizmge qajetti  su men miyneraldardyng qajettiligin óteu, qyshqyl-negizdik balanysty saqtau, organizmdi qajetti qorektikpen qamtamasyz etu jәne t.b.

3, Immundyq jasushalardyng shamadan tys aktivtenuin tejeu jәne sitokinning óndiriluin azaytu (yaghni, aurudyng sebebin emdeu, sauyqtyru): qalypty dozadaghy gormonmen emdeu kursyn alyp baru (mysaly deksametazon nemese basqasy), steroidti emes qabynugha qarsy preparattardy (NPVP) qoldanu jәne S dәrumeni, E dәrumeni t.b.

4, Sitokin dauylyn antiydenelermen beytaraptandyru: Monoklonaldy antiydenelerdi (monoclonal antibodies, mAb) qoldanyp sitokinderdi beytaraptandyru – aurudyng órshui men ólimning aldyn alu ýshin manyzdy.

Kenjebek Qúdysúly

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