Cachexia

**Cachexia** / / kə ˈkəksiə /  )  ne mai rikitarwa wanda ke da alaƙa da rashin lafiya mai zurfi, yana haifar da asarar tsoka mai gudana wanda ba a juyo gaba ɗaya tare da ƙarin abinci mai gina jiki ba . Yawancin cututtuka na iya haifar da cachexia, mafi yawan ciwon daji, ciwon zuciya na zuciya, cututtuka na huhu na kullum, cututtukan koda na kullum, da AIDS . Kumburi na tsarin daga waɗannan yanayi na iya haifar da canje-canje masu lahani ga metabolism da tsarin jiki. Ya bambanta da asarar nauyi daga rashin isasshen abincin caloric, cachexia yana haifar da mafi yawan asarar tsoka maimakon asarar mai. Binciken cachexia na iya zama da wahala saboda rashin ingantaccen ka'idojin bincike. Cachexia na iya inganta tare da jiyya na rashin lafiya amma sauran hanyoyin magani suna da iyakacin amfani. Cachexia yana hade da karuwar mace-mace da rashin ingancin rayuwa.

Kalmar ta fito daga Girkanci κακός *kakos* 'bad' da ἕξις *hexis* 'condition'.
## Dalilai
Cachexia na iya haifar da yanayi daban daban na likita, amma galibi ana danganta shi da ciwon daji na karshen zamani, wanda aka sani da ciwon daji cachexia. Kimanin kashi 50% na duk masu fama da ciwon daji suna habaka cachexia. Wadanda ke da ciwon daji na ciki na sama da na pancreatic suna da mafi girman mitar habaka alamar cachexic. Yawancin cachexia yana karuwa a cikin matakai masu zurfi kuma an kiyasta zai shafi kashi 80% na masu ciwon daji na karshe. Ciwon zuciya, AIDS, ciwon huhu na huhu, da ciwon koda wasu yanayi ne da ke haifar da  Cachexia kuma na iya zama sakamakon ci-gaba matakai na cystic fibrosis, mahara sclerosis, motor neuron cuta, Parkinson ta cuta, dementia, tarin fuka, mahara tsarin atrophy, mercury guba, Crohn ta cuta, trypanosomiasis, rheumatoid amosanin gabbai, da Celiac cuta da sauran tsarin. cututtuka.

## Makanikai
Ba a fahimci ainihin tsarin da wadannan cututtuka ke haifar da cachexia ba, kuma
mai yiwuwa yana da yawa tare da hanyoyin cututtuka da yawa. Cytokines masu ƙumburi sun bayyana suna taka muhimmiyar rawa ciki har da ƙwayar necrosis factor (TNF) (wanda kuma ake kira 'cachexin' ko 'cachectin'), interferon gamma da interleukin. An nuna TNF don samun tasirin catabolic kai tsaye a kan skeletal tsoka da adipose. nama ta hanyar ubiquitin proteasome. Wannan tsarin ya haɗa da samar da nau'in oxygen mai amsawa wanda ke haifar da haɓakar ma'anar rubutun NF-kB. NF-κB sananne ne mai kula da kwayoyin halittar da ke ɓoye cytokines da masu karɓar cytokine. Ƙara yawan samar da cytokines yana haifar da proteolysis da rushewar sunadaran myofibrillar. Har ila yau kumburin tsarin yana haifar da raguwar furotin ta hanyar hana hanyar Akt/mTOR.

Kodayake yawancin kyallen takarda da nau'ikan tantanin halitta na iya zama alhakin haɓakar cytokines masu yawo, shaidu sun nuna ciwace-ciwacen da kansu sune mahimman tushen abubuwan da zasu iya haɓaka cachexia a cikin ciwon daji. Kwayoyin da aka samo daga Tumor irin su nau'in motsi na lipid, proteolysis-inducing factor, da mitochondrial uncoupling proteins na iya haifar da lalacewar furotin kuma suna taimakawa ga cachexia. Kumburi da ba a sarrafa shi ba a cikin cachexia na iya haifar da haɓakar adadin kuzari, yana ƙara haɓaka buƙatun furotin da makamashi.

Hakanan akwai shaidar canji a madaukakan sarrafa ciyarwa a cikin cachexia. Babban matakan leptin, hormone da adipocytes ke ɓoyewa, yana toshe sakin neuropeptide Y, wanda shine mafi ƙarfin ciyarwa-mai ƙarfafa peptide a cikin cibiyar sadarwar hypothalamic orexigenic, wanda ke haifar da raguwar yawan kuzari duk da yawan buƙatar abinci mai gina jiki.

## Bincike
Jagororin bincike da ma'auni don bambanta daga sarcopenia kawai kwanan nan [yaushe?] aka ba da shawarar duk da yawan cachexia da ma'auni daban-daban; Siffofin farko na cachexia sun haɗa da ci gaba da raguwar tsoka da kitse mai yawa, rage cin abinci, rashin daidaituwa na metabolism na carbohydrate, furotin, da mai, rage ingancin rayuwa, da haɓaka nakasar jiki.[9] 

A tarihi, an yi amfani da sauye-sauyen nauyin jiki azaman ma'auni na farko na cachexia, gami da ƙananan ma'auni na jiki da asarar nauyi na fiye da 10%. Yin amfani da nauyi kawai yana iyakance ta kasancewar edema, yawan ƙwayar cuta da kuma yawan yawan kiba a cikin jama'a.[10] Ma'auni na tushen nauyi ba sa la'akari da canje-canje a cikin abun da ke cikin jiki, musamman asarar nauyin jiki. 

A cikin yunƙurin haɗawa da ƙima mai faɗi game da nauyin cachexia, an ba da shawarar ma'aunin bincike ta amfani da kima na ma'aunin dakin gwaje-gwaje da alamomin ban da nauyi. Sharuɗɗan sun haɗa da asarar nauyi na aƙalla 5% a cikin watanni 12 ko ƙananan ma'auni na jiki (kasa da 22 kg / m2) tare da aƙalla uku daga cikin abubuwan da ke biyowa: rage ƙarfin tsoka, gajiya, anorexia, ƙarancin ƙima mara nauyi, ko rashin lafiyar biochemistry (ƙarin alamomin kumburi, anemia, ƙananan ƙwayar albumin).[11] A cikin marasa lafiya na ciwon daji, ana gano cachexia daga asarar nauyi da ba a yi niyya ba fiye da 5%. Ga marasa lafiya da ciwon daji tare da ma'auni na jiki na kasa da 20 kg / m2, an gano cachexia bayan asarar nauyi fiye da 2%. Bugu da ƙari, ana iya gano shi ta hanyar sarcopenia, ko asarar ƙwayar kwarangwal.[12]

Ƙididdigar sauye-sauye a cikin tsarin jiki yana iyakancewa ta hanyar wahala wajen auna yawan ƙwayar tsoka da lafiya a cikin hanyar da ba ta da haɗari da kuma tsada. An bincika hoto tare da ƙididdige yawan ƙwayar tsoka da suka haɗa da bincike na impedance bioelectrical impedance analysis, computed tomography, dual-energy X-ray absorptiometry (DEXA), da hoton maganadisu amma ba a amfani da su sosai.[10] 

### Ma'anarsa
Ganewa, jiyya, da bincike na cachexia a tarihi an iyakance su ta hanyar rashin cikakkiyar ma'anar cachexia. A cikin 2011, ƙungiyar yarjejeniya ta kasa da kasa ta karɓi ma'anar cachexia a matsayin "cututtuka masu yawa da aka bayyana ta hanyar asarar ƙwayar jijiyar kwarangwal (tare da ko ba tare da asarar kitsen mai ba) wanda zai iya zama wani ɓangare amma ba gaba ɗaya ba ta hanyar tallafin abinci na al'ada." 13] 

Cachexia ya bambanta da asarar nauyi saboda rashin abinci mai gina jiki daga malabsorption, anorexia nervosa, ko anorexia saboda babban rashin damuwa. Rashin nauyi daga rashin isasshen adadin kuzari gabaɗaya yana haifar da asarar mai kafin asarar tsoka, yayin da cachexia ke haifar da ɓatawar tsoka. Cachexia kuma ya bambanta da sarcopenia, ko asarar tsoka mai alaƙa da shekaru, kodayake galibi suna kasancewa tare.[11]

## Magani
Gudanar da cachexia ya dogara ne akan dalilin da ya haifar da shi, da hasashen gaba ɗaya, da kuma bukatun wanda abin ya shafa.[14] Hanyar da ta fi dacewa ga cachexia ita ce magance tsarin cututtukan da ke ciki. Misali shi ne raguwar cachexia daga cutar kanjamau ta hanyar aikin jiyya na rigakafin cutar kanjamau.[15] Duk da haka wannan sau da yawa ba zai yiwu ba ko watakila bai isa ba don kawar da ciwon cachexia a wasu cututtuka. Hanyoyi don rage asarar tsoka sun haɗa da motsa jiki, hanyoyin kwantar da hankali, da magunguna.

### Motsa jiki
Ana iya ba da shawarar maganin da ya haɗa da motsa jiki na yau da kullum don maganin cachexia saboda sakamako mai kyau na motsa jiki a kan tsokar kwarangwal amma shaidar yanzu ba ta da tabbas game da tasiri, yarda da aminci ga masu ciwon daji.[16]. Mutanen da ke da cachexia gabaɗaya suna ba da rahoton ƙarancin matakan motsa jiki kuma kaɗan suna yin motsa jiki na yau da kullun, saboda ƙarancin motsa jiki da kuma imani cewa motsa jiki na iya cutar da alamun su ko kuma haifar da lahani.[17]

### Magunguna
Ana amfani da magungunan motsa jiki don magance cachexia don ƙara yawan abincin abinci, amma ba su da tasiri wajen dakatar da ɓata tsoka kuma suna iya samun sakamako masu illa. Abubuwan motsa jiki sun haɗa da glucocorticoids, cannabinoids, ko progestins kamar megestrol acetate.[9] [18] [19] Anti-emetics kamar 5-HT3 antagonists suma ana amfani dasu a cikin cachexia na ciwon daji idan tashin zuciya ya kasance sanannen alama.[6] 

Anabolic-androgenic steroids kamar oxandrolone na iya zama da amfani a cikin cachexia amma ana ba da shawarar amfani da su na tsawon makonni biyu tun da tsayin daka na jiyya yana ƙaruwa.[19][20] Duk da yake binciken farko ya nuna thalidomide na iya zama da amfani, nazarin Cochrane bai sami wata shaida da za ta yanke shawara game da amfani da wannan magani a cikin marasa lafiya na ciwon daji tare da cachexia.[21]

### ƙari
An bincika gudanar da abubuwan amino acid na waje don yin aiki azaman furotin da ke hana haɓakar kuzari ta hanyar samar da abubuwan da ke haifar da ƙwayar tsoka da gluconeogenesis. Amino acid mai rassa leucine da valine na iya samun yuwuwar hana wuce gona da iri na hanyoyin rushewar furotin.[22] An yi amfani da amino acid glutamine a matsayin wani ɓangare na kari na baka don juyar da cachexia a cikin mutanen da ke fama da ciwon daji [23] ko HIV/AIDS.[24]. 

β-hydroxy β-methylbutyrate (HMB) metabolite ne na leucine wanda ke aiki azaman kwayar sigina don tada haɗin furotin. Nazarin ya nuna sakamako mai kyau ga cututtukan huhu na yau da kullun, raunin hip, da kuma cachexia mai alaƙa da AIDS da ciwon daji. Duk da haka, da yawa daga cikin waɗannan karatun na asibiti sunyi amfani da HMB a matsayin wani ɓangare na haɗin magani tare da glutamine, arginine, leucine, furotin mai girma da / ko bitamin, wanda ke ƙayyade ƙimar ingancin HMB kadai.[25][26].

## Tarihi
Kalmar "cachexia" ta samo asali ne daga kalmomin Helenanci "Kakos" (mara kyau) da "hexis" (sharadi). Wani likitan ido dan kasar Ingila John Zachariah Laurence shi ne ya fara amfani da kalmar "Cancerous cachexia", yin haka a shekara ta 1858. Ya yi amfani da wannan furci ga ɓata lokaci mai tsanani da ke da alaƙa da malignancy. Sai a shekara ta 2011 ne aka ba kalmar "cachexia mai alaƙa da ciwon daji" ma'ana ta yau da kullun, tare da buga ta Kenneth Fearon. Fearon ya ayyana shi a matsayin "cututtuka iri-iri da ke tattare da ci gaba da asarar tsokar kwarangwal (tare da ko ba tare da asarar kitsen mai ba) wanda ba za a iya jujjuya shi gaba ɗaya ta hanyar tallafin abinci na al'ada ba kuma yana haifar da rashin aiki na ci gaba".[12]

## Manazarta