I-NASH (Nonalcoholic Steatohepatitis)

Isibindi esinamafutha sithinta izigidi zabantu emhlabeni wonke. Lesi simo esithule kodwa esibucayi ngokuvamile asiqashelwa size sidlulele esimweni esinzima kakhulu esibizwa ngokuthi i-nonalcoholic steatohepatitis (NASH). Isifo sesibindi se-NASH sibeka engcupheni enkulu yezempilo, sibangele ukuvuvukala nokulimala kwesibindi. Ukuqonda i-NASH, izimbangela zayo, kanye nomthelela wayo empilweni yonke kubalulekile ukuze kutholakale kusenesikhathi nokuphatha ngempumelelo.

Yini i-NASH?

I-steatohepatitis engeyona utshwala yaziwa kakhulu ngokuthi i-NASH. Kuwuhlobo olunzima lokungewona ophuzweni oludakayo isifo sesibindi esinamafutha (NAFLD). Lesi simo senzeka lapho isibindi siqongelela amafutha amaningi, okuholela ekuvuvukeni nasekulinyazweni kwamangqamuzana esibindi.

Nakuba isibindi esinempilo siqukethe amafutha athile, i-NAFLD ikhula lapho okuqukethwe kwamafutha kudlula i-5%. I-NASH ithatha lesi sinyathelo ngokuqhubekayo, ihlanganisa ukunqwabelana kwamafutha nokuvuvukala. Le nhlanganisela ingaholela ekulimaleni kwesibindi okufana nalokho okubangelwa ukusebenzisa kabi utshwala, ngisho nakubantu abangaphuzi.

Izimbangela ze-NASH

Izimbangela eziqondile ze-non-alcoholic steatohepatitis (NASH) zisalokhu ziyisihloko socwaningo oluqhubekayo. Ososayensi basasebenzela ukuqonda ukuthi kungani abanye abantu bethuthukisa i-NASH kuyilapho abanye bengayenzi. Kodwa-ke, izici ezimbalwa zingaba nomthelela ekuthuthukisweni kwalesi simo sesibindi, njenge:

• Izimo Zezempilo Nezifo: Izimo ezithile zezempilo zandisa amathuba okuthuthukisa i-NASH. Lokhu kubandakanya:
  • Ukukhuluphala ngokweqile noma ukukhuluphala
  • Ukumelana ne-insulin noma thayipha 2 sikashukela
  • Ama-triglycerides aphezulu
  • Amazinga e-cholesterol engavamile (i-cholesterol ephezulu isiyonke, i-cholesterol ephezulu ye-LDL, noma i-cholesterol ephansi ye-HDL)
  • umzimba syndrome 
• I-Genetics: Ucwaningo luphakamisa ukuthi izingxenye zofuzo zidlala indima ekuthuthukisweni kwe-NASH. Izakhi zofuzo ezithile zingenza abantu bangenwe kalula yilesi simo.
• I-Diet and Digestive System: Nakuba izindlela eziqondile zisaphenywa, lokhu okutholakele kusikisela ukuthi ukudla nempilo yamathumbu kungase kube nomthelela ekuthuthukisweni kwe-NASH. Ukudla okuphezulu ku-fructose kungase kwenyuse ingozi ye-NASH, futhi izinguquko ezimila zamathumbu nazo ziyayithinta.
• Ezinye Izinto Ezingenzeka: 
  • Ukusabela kwamasosha omzimba kuzicubu zesibindi ezinamafutha amaningi
  • Ukukhishwa kwamakhemikhali anobuthi avuthayo (ama-cytokines) ngamaseli esibindi noma amafutha
  • Ukuzibhubhisa (apoptosis) kwamaseli esibindi
  • Ukucindezeleka okwexubile 

Izimpawu ze-NASH Izifo Zesibindi

Abantu abaningi abane-NASH bangase bangaziboni izimpawu eziphawulekayo, ikakhulukazi ezigabeni zokuqala zalesi sifo.

Njengoba i-NASH iqhubeka nokulimala kwesibindi kuba nzima kakhulu, abantu bangase baqale ukuzwa izimpawu ze-NASH ezihlukahlukene, njenge:

• Isikhumba esinamahloni
• Ukuqoqwa koketshezi esiswini kungabangela ukuvuvukala okubonakalayo (ama-ascites) nokungakhululeki.
• Ukuphelelwa umoya, ikakhulukazi phakathi nomsebenzi womzimba
• Ukugcina uketshezi kungaholela ekuvuvukeni kwemilenze namaqakala.
• Imithambo yegazi efana nesicabucabu, ngokuvamile esifubeni, emhlane, noma ebusweni
• I-spleen ingase ibe nkulu kunokuvamile, okungase kubangele ubuhlungu noma ukungakhululeki engxenyeni engenhla yesisu kwesokunxele.
• Izintende zezandla zingase zibonakale zibomvu kunokuvamile.
• Ukuphuzi kwesikhumba futhi amehlo kuwuphawu lwesifo sesibindi esithuthukile.

Ezimweni lapho i-NASH ithuthukele ku-cirrhosis (i-fibrosis eqinile noma izibazi), izimpawu ezengeziwe ze-NASH zingase zikhule:

• Ukulimala okulula nokopha
• Izinguquko ekuziphatheni, njengokudideka nokukhuluma kahle, kungenzeka ngenxa yokunqwabelana kobuthi egazini isibindi esonakele esingakwazi ukubuhluza.

Izinto Zobungozi ze-NASH

I-nonalcoholic steatohepatitis (NASH) inezici ezimbalwa zobungozi ezandisa amathuba omuntu okuba nalesi simo sesibindi, njenge:

• Izimo Zezempilo Nezifo: 
  • Ukukhuluphala ngokweqile noma ukukhuluphala ngokweqile
  • Ukumelana ne-insulin noma uhlobo 2 sikashukela
  • Amazinga angejwayelekile wamafutha egazini, ikakhulukazi ama-triglycerides aphezulu
  • Amazinga e-cholesterol angajwayelekile (i-cholesterol ephezulu isiyonke, i-cholesterol ephezulu ye-LDL, noma i-cholesterol ephansi ye-HDL)
  • umzimba syndrome
• Izakhi zofuzo:
  • Ucwaningo luphakamisa ukuthi izakhi zofuzo ezithile zingenza abantu abathile babe sengozini ye-NASH. Lezi zici zofuzo zingase zichaze ukuthi kungani i-NASH ivame kakhulu kwezinye izinhlanga nezinhlanga. 
• Uhlelo Lokudla kanye Nokugaya:
  • Ubudlelwano phakathi kokudla, i uhlelo lokugaya ukudla, kanye ne-NASH iyindawo yocwaningo oluqhubekayo:
  • Ukudla okuphezulu ku-fructose kungandisa ingozi ye-NASH.
  • Ucwaningo luthole umehluko phakathi kwama-microbiomes (amagciwane amathumbu) abantu abane-NASH nalabo abangenayo.
• Ubudala:
  • Nakuba i-NASH ingathinta abantu bayo yonke iminyaka, kungenzeka ukuthi yenzeke kubantu abangaphezu kweminyaka engama-50 ubudala. 

Izinkinga ze-NASH

I-steatohepatitis engeyona utshwala ingaholela ezinkingeni ezingathi sína zezempilo uma ingelashwa. 

• Isibindi fibrosis
• I-Cirrhosis Yesibindi: Cishe amaphesenti angu-20 abantu abane-NASH baba ne-cirrhosis eminyakeni embalwa, ngokuvamile amashumi eminyaka.
• I-Cirrhosis ingaholela ezinkingeni eziningi:
  • I-Ascites: Ukunqwabelana koketshezi endaweni yesisu
  • Imithambo ye-Oesophageal: Imithambo evuvukele kummizo engase iqhume futhi yophe
  • I-Hepatic encephalopathy: Ukudideka, ukozela, nenkulumo engahlelekile
  • I-Hypersplenism: I-spleen esebenza ngokweqile eholela emazingeni aphansi e-platelet yegazi
  • Umdlavuza wesibindi: Ingozi eyengeziwe yokuthuthukisa i-hepatocellular carcinoma (HCC)
  • Ukuhluleka kwesibindi sokuphela: Ukulahlekelwa okuphelele kokusebenza kwesibindi

Sifo

Odokotela basebenzisa inhlanganisela yezindlela zokuxilonga i-non-alcoholic steatohepatitis (NASH), okuhlanganisa:

• Umlando Wezokwelapha kanye Nokuhlolwa Komzimba:
  • Udokotela uqala ngokubuza ngomlando wempilo yesiguli, agxile ezimeni ezandisa ubungozi be-NASH, njengokukhuluphala, uhlobo lwesifo sikashukela sohlobo 2, amazinga aphezulu e-triglycerides, noma iyiphi i-metabolic syndrome.
• Ngesikhathi sokuhlolwa komzimba, udokotela:
  • Ibala isisindo somzimba wesiguli (BMI)
  • Bheka izimpawu zesibindi esandisiwe
  • Ihlola izinkomba zokumelana ne-insulin, njengamabala esikhumba amnyama
  • Ihlola izimpawu ze-cirrhosis, njengobende olukhulisiwe noma ukulahleka kwemisipha
• Ukuhlolwa kwegazi:
  • Odokotela benza ukuhlolwa kwegazi ukuhlola amazinga e-enzyme yesibindi, ikakhulukazi:
  • I-Alanine aminotransferase (ALT)
  • I-Aspartate aminotransferase (AST)

Amazinga aphezulu egazi alawa ma-enzyme abonisa ukuvuvukala kwesibindi. 

• Ukuhlolwa Kwezithombe: Ukuhlolwa okuhlukahlukene kwe-imaging kusiza odokotela babone ngeso lengqondo isibindi futhi babone ukunqwabelana kwamafutha kanye nezinga lokulimala kwesibindi:
  • ultrasound
  • CT scan
  • I-MRI

Izindlela ezintsha zokucabanga njenge-elastography zikala ukuqina kwesibindi ukuze kuhlolwe i-fibrosis. Ukuqina kwesibindi okwandayo kungase kubonise ukuba khona kwezibazi.

• I-Biopsy yesibindi:
  • I-biopsy yesibindi iyisilinganiso esicacile kakhulu sokuxilonga i-NASH nokunquma ubukhali bayo. I-biopsy ingadalula ukunqwabelana kwamafutha, ukuvuvukala, ukulimala kwamaseli esibindi, kanye nezinga le-fibrosis.

Ukwelashwa kwe-NASH

Ukwelashwa kwe-non-alcoholic steatohepatitis (NASH) kuhlanganisa:

• Ukulungiswa kwendlela yokuphila:
  • Odokotela batusa ukuncipha kwesisindo njengendlela eyinhloko yokuphatha i-NASH. Ukulahlekelwa ngamaphesenti amathathu kuya kwayisihlanu esisindo somzimba kunganciphisa amafutha esibindi, kuyilapho ukunciphisa ngo-7% kuya ku-10% kungase kudingeke ukunciphisa ukuvuvukala kwesibindi kanye ne-fibrosis.
  • Kunconywa ukudla okuncane, okuvamile, futhi kuhlolwe ama-micronutrients kanye nokuntuleka kwamavithamini kuyanconywa.
• Imithi:
  • I-Vitamin E: Ibhekwa njengokwelashwa kokuqala kwemithi, i-vitamin E inciphise ngempumelelo amazinga e-enzyme yesibindi, i-steatosis, nokuvuvukala.
  • I-Thiazolidinediones (TZDs)
  • Imithi Yokwelapha Inoveli: Imithi eminingana ethembisayo eqondise ezigabeni ezihlukene zesifo iyakhula, enikeza ithemba lokwelashwa okuphumelelayo kwe-NASH esikhathini esizayo.
  • Ukulawulwa Kwezinkinga: Odokotela bangasebenzisa imithi, izinqubo zezokwelapha ezincane, nokuhlinzwa ukuze babhekane nezinkinga ezihlobene ne-cirrhosis. 
  • Ukufakelwa Kwesibindi:
    • Ezimweni zokuhluleka kwesibindi noma umdlavuza wesibindi, odokotela bangase batusa ukufakelwa kwesibindi ukuze kubuyiselwe impilo.
    • Ucwaningo luyaqhubeka lokuthuthukisa izindlela zokwelapha ezintsha ze-NASH. Njengoba ukuqonda kwe-NASH pathogenesis nokuqhubeka kuguquka, umbono wokwelashwa kwe-NASH uba nethemba elikhulu.

Uzoyibona Nini Udokotela

I-nonalcoholic steatohepatitis (NASH) ivamise ukukhula buthule ibe nezimpawu ezimbalwa noma ezingabonakali. Nokho, izimpawu nezimo ezithile zidinga ukuvakashela udokotela, njenge:

• Ukukhathala noma umuzwa ojwayelekile wokungaphatheki kahle
• Ubuhlungu noma ukungakhululeki endaweni yesisu esingakwesokudla endaweni engenhla
• Ukuvuvukala kwesisu (ama-ascites)
• Ukuphelelwa umoya
• Ukuvuvukala emilenzeni
• Imithambo yegazi efana nesicabucabu ibonakala ngaphansi nje kwesikhumba

Ivimbela i-NASH

I-nonalcoholic steatohepatitis (NASH) ingavinjelwa noma ukuqhubeka kwayo kwehliswe ngoshintsho lwendlela yokuphila, okuhlanganisa:

• Ukugcina isisindo esinempilo kuvimbela i-NAFLD noma kunciphisa imiphumela yayo.
• Ukudla okunempilo kungavimbela i-NASH. Ukudla amafutha anempilo, ikakhulukazi amafutha angenayo i-unsaturated atholakala ezinhlanzi, amantongomane, nezithelo (i-omega-3 fatty acids), esikhundleni sokukhetha okuncane okunempilo kungathuthukisa impilo yonke futhi kusize ukulawula isisindo.
• Ukufaka ukudla okunenkomba ephansi ye-glycemic eyengeziwe, njengezithelo, imifino, amantongomane, imbewu, nokusanhlamvu, ekudleni komuntu kungase kuthinte amazinga kashukela egazini. 
• Nciphisa ukudla ushukela olula futhi ugweme iziphuzo ezinoshukela njengesoda, iziphuzo zezemidlalo, amajusi, netiye elinoshukela.
• Ukuzivocavoca njalo kunomthelela ekuthuthukiseni impilo yesibindi.
• Gwema ukuphuza utshwala 

Isiphetho

Ukuqonda i-NASH nomthelela wayo empilweni yesibindi kungasiza ekutholakaleni kusenesikhathi kanye nokwelapha izinhlelo zokwelashwa ezisebenzayo. Lesi simo esithule kodwa esinzima sithinta izigidi emhlabeni wonke, ngokuvamile siqhubeka singanakiwe kuze kube yilapho kwenzeka umonakalo omkhulu wesibindi. Ngokubona izinto eziyingozi ze-NASH, izimpawu, kanye nezinkinga ezingaba khona, abantu ngabanye bangakwazi ukuvikela impilo yabo yesibindi kanye nempilo yonke.

Ukuguqulwa kwendlela yokuphila kuhlala kuyisisekelo sokuvimbela nokwelashwa kwe-NASH. Njengoba ucwaningo luqhubeka futhi kuvela izindlela zokwelapha ezintsha, kunethemba lokuphathwa okuthuthukisiwe kwalesi simo sesibindi esiyinselele. 

Imibuzo Evame Ukubuzwa

1. Ingabe i-NASH iyabuyiselwa emuva?

I-NASH, noma i-steatohepatitis engeyona utshwala, inamandla okubuyiseleka emuva kwezinye izimo. Imiphumela ye-NASH ingase ishintshwe ngokuncipha kwesisindo kanye nezinguquko zokuphila okunempilo. Ngokungenelela kusenesikhathi, kwezinye izimo, ukulimala kwesibindi kungase kume noma kuzibuyisele emuva. Kwabanye, lesi sifo siyaqhubeka nokuthuthuka.

2. Imele ini i-NASH?

I-NASH imele i-nonalcoholic steatohepatitis. I-NASH ibonakala ngokukhuluphala, isibindi esivuvukele esingabangelwa ukuphuza kakhulu. Kuwuhlobo lwesifo sesibindi lapho kunqwabelana amafutha esibindini sabantu abaphuza utshwala obuncane noma abangabuphuzi nhlobo. Lesi simo sibangela ukuvuvukala kwesibindi nokulimala kwamangqamuzana esibindi, okungase kubangele isifo sokuqina kwesibindi nokwehluleka kwesibindi.

3. Ingabe isifo sesibindi se-NASH siwufuzo?

Isifo sesibindi se-NASH sinengxenye yofuzo, kodwa iphethini yefa iyinkimbinkimbi. 

4. Ingabe i-NASH iyafana nesibindi esinamafutha?

I-NASH ayifani nesibindi esinamafutha, kodwa ihlobene. I-NASH iyisifo esibi kakhulu se-Non-Alcoholic Fatty Liver (NAFLD). Isici esiyinhloko se-NAFLD ukuqoqwa kwamafutha esibindi. Ku-NASH, unamafutha esibindini sakho, kanye nokuvuvukala nokulimala kwamangqamuzana esibindi. Ukuvuvukala nokulimala kungaholela ku-fibrosis noma izibazi zesibindi.

UDkt Saket Agrawal

I-Gastroenterology Yezokwelapha

CARE Medical Team

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