Koresha amakuru na serivisi bya NEJM Itsinda kugirango witegure kuba umuganga, gukusanya ubumenyi, kuyobora umuryango wita ku buzima no guteza imbere umwuga wawe.
Igihe kirageze cyo guhindura uko tubona ibyiyumvo byikizamini cya Covid-19.Ikigo cy’Amerika gishinzwe ibiryo n’ibiyobyabwenge (FDA) n’umuryango w’ubumenyi muri iki gihe bibanda cyane cyane ku kwiyumvisha ibintu, bipima ubushobozi bw’uburyo bumwe bwo gutahura poroteyine za virusi cyangwa molekile ya RNA.Icy'ingenzi, iki gipimo cyirengagije imiterere yukuntu wakoresha ikizamini.Ariko, kubijyanye no kwerekanwa kwinshi Amerika ikeneye cyane, imiterere ni ngombwa.Ikibazo cyingenzi ntabwo ari uburyo bwiza bwa molekile ishobora kugaragara murugero rumwe, ariko se ubwandu bushobora kugaragara neza mubaturage bakoresheje ikizamini cyatanzwe murwego rwo kumenya rusange?Ibyiyumvo bya gahunda yikizamini.
Gahunda yo kwipimisha isanzwe irashobora gukora nkubwoko bwa Covid-19 mu kuyungurura, gutandukanya no kuyungurura abantu banduye ubu (harimo nabantu badafite ibimenyetso).Gupima sensibilité ya gahunda yikizamini cyangwa kuyungurura biradusaba gusuzuma ikizamini murwego: inshuro zikoreshwa, ninde ukoreshwa, mugihe ikora mugihe cyanduye, kandi niba ari ingirakamaro.Ibisubizo bizasubizwa mugihe kugirango birinde gukwirakwira.1-3
Inzira yanduye yumuntu (umurongo wubururu) irerekanwa murwego rwa gahunda ebyiri zo kugenzura (uruziga) hamwe nuburyo butandukanye bwo gusesengura.Isesengura rito ryo gusesengura ibyakozwe akenshi bikorwa, mugihe isesengura ryinshi ryisesengura ridasanzwe.Gahunda zombi zo kwipimisha zirashobora kumenya kwandura (uruziga rwa orange), ariko nubwo rufite isesengura rito ryo gusesengura, gusa ikizamini cyinshi-gishobora gusa kugitahura mumadirishya yo gukwirakwiza (igicucu), bigatuma ikora neza muyungurura Igikoresho.Idirishya ryerekana polymerase (PCR) ryerekana idirishya (icyatsi) mbere yo kwandura ni mugufi cyane, kandi idirishya rihuye (ibara ry'umuyugubwe) rishobora gutahurwa na PCR nyuma yo kwandura ni ndende cyane.
Gutekereza ku ngaruka zo gukoresha inshuro nyinshi ni igitekerezo kimenyerewe kubavuzi ninzego zishinzwe kugenzura;irasabwa igihe cyose dupima efficacy ya gahunda yo kuvura aho kuba ikinini kimwe.Hamwe niterambere ryihuse cyangwa ihindagurika ryimanza za Covid-19 kwisi yose, dukeneye byihutirwa guhindura ibitekerezo byacu kubitekerezo bitagabanije kubyerekeranye no gusesengura ibyakozwe (igipimo cyo hasi cyubushobozi bwacyo bwo kumenya neza ubukana bwa molekile nto murugero ) n'ikizamini Porogaramu ifitanye isano no kumva ko yanduye (abantu banduye bumva ko bashobora kwandura mugihe cyo kuyungurura mu baturage no kwirinda gukwirakwira ku bandi).Ikizamini cya point-of-care, gihenze bihagije kandi gishobora gukoreshwa kenshi, gifite sensibilité yo kumenya indwara zifata mugihe kitarinze kugera kumipaka yisesengura ryikizamini cyibanze (reba ishusho).
Ibizamini dukeneye biratandukanye cyane nibizamini byubuvuzi biri gukoreshwa, kandi bigomba gusuzumwa ukundi.Ikizamini cya clinique cyagenewe abantu bafite ibimenyetso, ntigisaba ikiguzi gito, kandi gisaba sensibilité yo hejuru.Igihe cyose hari amahirwe yo kwipimisha, isuzuma ryamavuriro rishobora gusubizwa.Ibinyuranye na byo, ibizamini muri gahunda zishinzwe kugenzura neza kugabanya ubwandu bwa virusi z’ubuhumekero mu baturage bigomba gusubiza vuba ibisubizo kugira ngo bigabanye kwanduza ibimenyetso, kandi bigomba kuba bihendutse bihagije kandi byoroshye gukora kugira ngo bipimishe kenshi - inshuro nyinshi mu cyumweru.Ikwirakwizwa rya SARS-CoV-2 risa nkaho riba nyuma yiminsi mike nyuma yo kugaragara, iyo umutwaro wa virusi ugeze hejuru.4 Iyi ngingo mugihe cyongera akamaro ko kwipimisha inshuro nyinshi, kuko kwipimisha bigomba gukoreshwa mugitangira kwandura kugirango birinde gukomeza gukwirakwira no kugabanya akamaro ko kugera kumipaka mike cyane yo kwipimisha bisanzwe.
Ukurikije ibipimo byinshi, igipimo ngenderwaho gisanzwe cyamavuriro ya polymerase yerekana (PCR) ikananirwa iyo ikoreshejwe muri protocole yo kugenzura.Nyuma yo gukusanya, icyitegererezo cya PCR gikenera kujyanwa muri laboratoire ikomatanyije igizwe ninzobere, byongera ibiciro, bigabanya inshuro, kandi bishobora gutinza ibisubizo kumunsi umwe cyangwa ibiri.Ikiguzi n'imbaraga zisabwa kwipimisha ukoresheje ibizamini bisanzwe bivuze ko abantu benshi muri Amerika batigeze bapimwa, kandi igihe gito cyo guhinduka bivuze ko nubwo uburyo bwo kugenzura ubu bushobora kumenya abanduye, barashobora gukwirakwiza ubwandu muminsi myinshi.Mbere, ibi byagabanije ingaruka za karantine no gukurikirana amakuru.
Ikigo gishinzwe kurwanya no gukumira indwara (CDC) kigereranya ko muri Kamena 2020, umubare wa Covid-19 wagaragaye muri Amerika uzaba wikubye inshuro 10 umubare w’imanza zagaragaye.5 Muyandi magambo, nubwo byakurikiranwe, gahunda yo kugerageza uyumunsi irashobora gusa kumenya sensibilité ya 10% cyane kandi ntishobora gukoreshwa nkayunguruzo ya Covid.
Byongeye kandi, nyuma yicyiciro cyanduza, umurizo muremure wa RNA urasobanuwe neza, bivuze ko, niba atari benshi, abantu benshi bakoresha sensibilité yisesengura kugirango bamenye kwandura mugihe gikurikiranwa bisanzwe, ariko ntibaba bakanduye mugihe cyo gutahura. .Kumenya (reba ishusho).2 Mubyukuri, ubushakashatsi buherutse gukorwa na The New York Times bwerekanye ko muri Massachusetts na New York, abantu barenga 50% banduye bavumbuwe binyuze mu igenzura rishingiye kuri PCR bafite inzitizi ya PCR hagati ya 30 na 30., Kwerekana ko virusi ya RNA ibara ari mike.Nubwo umubare muto ushobora kwerekana kwandura hakiri kare cyangwa bitinze, igihe kirekire umurizo mwiza wa RNA cyerekana ko abantu benshi banduye bamenyekanye nyuma yigihe cyo kwandura.Icy'ingenzi mu bukungu, bivuze kandi ko nubwo barenze icyiciro cyo kwandura, abantu ibihumbi n'ibihumbi baracyafite akato mu minsi 10 nyuma y’ikizamini cyiza cya RNA.
Kugirango duhagarike neza iki cyorezo cya Covid filter, dukeneye kubigerageza kugirango tubone igisubizo gifata indwara nyinshi ariko kiracyanduye.Uyu munsi, ibi bizamini bibaho muburyo bwo kwihuta kwa antigen yihuta, kandi ibizamini byihuta byihuta bishingiye kuri tekinoroji yo guhindura gene CRISPR bigiye kugaragara.Ibizamini nkibi bihendutse cyane (<5 USD), miriyoni mirongo cyangwa zirenga zipimisha zirashobora gukorwa buri cyumweru, kandi zishobora gukorerwa murugo, zifungura umuryango wigisubizo cyiza cya Covid.Ikizamini cya antigen ikurikira ntabwo gifite intambwe yo kongera imbaraga, bityo igipimo cyacyo cyo kumenya cyikubye inshuro 100 cyangwa 1000 icy'ibipimo ngenderwaho, ariko niba intego ari ukumenya abantu bakwirakwiza virusi, ibi ahanini ntaho bihuriye.SARS-CoV-2 ni virusi ishobora gukura vuba mu mubiri.Kubwibyo, mugihe igipimo cyibizamini bya PCR ari cyiza, virusi izakura vuba vuba.Icyo gihe, birashobora gufata amasaha aho kuba iminsi kugirango virusi ikure kandi igere ku mbibi zerekana ibizamini bihendutse kandi byihuse biboneka muri iki gihe.Nyuma yibyo, iyo abantu babonye ibisubizo byiza mubizamini byombi, barashobora kwitega ko bandura (reba ishusho).
Twizera ko gahunda yo gupima igenzura ishobora guca iminyururu ihagije kugirango igabanye kwanduza abaturage igomba kwiyongera aho gusimbuza ibizamini byo kwisuzumisha kwa kliniki.Ingamba zitekereza zirashobora kwifashisha ibyo bizamini byombi, ukoresheje ibipimo binini, kenshi, bihendutse kandi byihuse kugirango ugabanye icyorezo, 1-3 ukoresheje ikizamini cya kabiri cyihuse kuri poroteyine zitandukanye cyangwa ukoresheje igipimo cya PCR kugirango hemezwe ibisubizo byiza.Ubukangurambaga bugamije kumenyekanisha rubanda bugomba kandi kwerekana umushinga uwo ariwo wose w’itegeko ry’ibizamini bidasobanura byanze bikunze ubuzima, hagamijwe gushishikariza gukomeza kwitarura abantu no kwambara masike.
FDA ya Abbott BinaxNONI Uruhushya rwo gukoresha byihutirwa (EUA) mu mpera za Kanama ni intambwe igana.Nibizamini byambere byihuse, bidafite ibikoresho bya antigen kubona EUA.Igikorwa cyo kwemeza gishimangira ubushishozi bukabije bwikizamini, gishobora kumenya igihe abantu bashobora gukwirakwiza ubwandu, bityo bikagabanya imipaka isabwa kugirango hamenyekane ibipimo bibiri byerekana ubunini buva ku gipimo cya PCR.Ibi bizamini byihuse ubu bigomba gutezwa imbere no kwemezwa gukoreshwa murugo kugirango tugere kuri gahunda nyayo yo kugenzura abaturage muri SARS-CoV-2.
Kugeza ubu, nta nzira ya FDA yo gusuzuma no kwemeza ikizamini cyo gukoresha muri gahunda yo kuvura, ntabwo ari ikizamini kimwe, kandi nta bushobozi bw’ubuzima rusange bugabanya kwanduza abaturage.Inzego zishinzwe kugenzura ibintu ziracyibanda gusa ku bizamini byo kwisuzumisha kwa muganga, ariko niba intego zabo ari ukugabanya umubare w’abaturage banduye virusi, ibimenyetso bishya birashobora gukoreshwa mu bizamini byo gusuzuma bishingiye ku cyorezo cya epidemiologiya.Muri ubu buryo bwo kwemeza, ibicuruzwa biva hagati yinshuro, igihe ntarengwa cyo kumenya nigihe cyo guhinduka birashobora gutegurwa no gusuzumwa neza.1-3
Kugirango dutsinde Covid-19, twizera ko FDA, CDC, Ikigo cyigihugu cyita ku buzima n’ibindi bigo bigomba gushishikarizwa gusuzuma ibizamini mu rwego rwa gahunda z’ibizamini byateganijwe kugira ngo tumenye porogaramu y'ibizamini ishobora gutanga akayunguruzo keza ka Covid.Gukoresha kenshi ibizamini bihendutse, byoroshye, kandi byihuse birashobora kugera kuriyi ntego, nubwo ibyumviro byabo byisesengura biri hasi cyane ugereranije nibizamini.1 Gahunda nkiyi irashobora kandi kudufasha gukumira iterambere rya Covid.
Ishuri ry’ubuzima rusange rya Boston Harvard Chenchen (MJM);na kaminuza ya Colorado Boulder (RP, DBL).
1. Larremore DB, Wilder B, Lester E, nibindi Kubireba COVID-19, sensibilité yikizamini ni iya kabiri nyuma yinshuro nigihe cyo guhinduka.Ku ya 8 Nzeri 2020 (https://www.medrxiv.org/content/10.1101/2020.06.22.20136309v2).Gutegura.
2. Paltiel AD, Zheng A, Walensky RP.Suzuma ingamba zo gusuzuma SARS-CoV-2 kugirango yemererwe gufungura neza ibigo bya kaminuza muri Amerika.JAMA Cyber Gufungura 2020;3 (7): e2016818-e2016818.
3. Chin ET, Huynh BQ, Chapman LAC, Murrill M, Basu S, Lo NC.Inshuro yo kwipimisha bisanzwe kuri COVID-19 ahantu hashobora guteza ibyago byinshi kugirango ugabanye icyorezo cyakazi.Ku ya 9 Nzeri 2020 (https://www.medrxiv.org/content/10.1101/2020.04.30.20087015v4).Gutegura.
4. We X, Lau EHY, Wu P, nibindi. Imbaraga zigihe cyo kumena virusi hamwe nubushobozi bwa COVID-19.Nat Med 2020;26: 672-675.
5. Ibigo bishinzwe kurwanya no gukumira indwara.Inyandiko mvugo ya CDC ivuguruye kuri terefone kuri COVID-19.Ku ya 25 Kamena 2020 (https://www.cdc.gov/media/ibitangaza/2020/t0625-COVID-19-update.html).
Inzira yanduye yumuntu (umurongo wubururu) irerekanwa murwego rwa gahunda ebyiri zo kugenzura (uruziga) hamwe nuburyo butandukanye bwo gusesengura.Isesengura rito ryo gusesengura ibyakozwe akenshi bikorwa, mugihe isesengura ryinshi ryisesengura ridasanzwe.Gahunda zombi zo kwipimisha zirashobora kumenya kwandura (uruziga rwa orange), ariko nubwo rufite isesengura rito ryo gusesengura, gusa ikizamini cyinshi-gishobora gusa kugitahura mumadirishya yo gukwirakwiza (igicucu), bigatuma ikora neza muyungurura Igikoresho.Idirishya ryerekana polymerase (PCR) ryerekana idirishya (icyatsi) mbere yo kwandura ni mugufi cyane, kandi idirishya rihuye (ibara ry'umuyugubwe) rishobora gutahurwa na PCR nyuma yo kwandura ni ndende cyane.
Igihe cyo kohereza: Werurwe-11-2021