Kab lus no piav qhia txog Reiter's syndrome: cov tsos mob thiab kev kho mob ntawm cov poj niam, nws cov qauv thiab ua rau muaj qhov tsis zoo no. Nws tuaj yeem tshwm sim tom qab kis kab mob hauv plab hnyuv thiab ib qho ntawm nws cov yam ntxwv yog tias cov tsos mob tsis tshwm sim tam sim ntawd, tab sis nyob rau lub sijhawm qeeb. Qhov txaus ntshai ntawm pathology nyob rau hauv qhov tseeb hais tias cov txheej txheem yuav ua tau systemic. Txawm li cas los xij, nrog kev kuaj mob raws sij hawm thiab kev kho mob, qhov tshwm sim ntawm tus kab mob yog qhov zoo - qhov tshwm sim ntawm tus mob no ploj hauv 80% ntawm cov neeg mob.
Short description
Reiter's Syndrome yog ib qho mob ntawm cov pob qij txha, uas muaj cov kab mob autoimmune thiab nrog rau cov kab mob tshwm sim. Qhov pib tshwm sim rau kev txhim kho ntawm qhov teeb meem no yog kev mob plab hnyuv. Feem ntau ntawm tus kab mob ntawm cov txiv neej yog yuav luag 2 npaug ntau dua ntawm cov poj niam, tab sis cov tsos mob thiab tshwm sim ntawm Reiter's syndrome nyob rau hauv ob qho tib si poj niam txiv neej yog zoo sib xws. Feem ntau, pathology raug kuaj pom hauv cov tub ntxhais hluas hnub nyoog 20-40.
Tawm tsam keeb kwm ntawm tus kab mob sib kis, kev puas tsuaj sib koom ua ke tshwm sim hauv 2scenarios:
- reactive (sterile) mob caj dab - ua xua o ntawm txheej sab hauv ntawm lub hnab sib koom;
- mob caj dab, thaum cov kab mob nkag mus rau hauv kev sib koom ua ke.
Hauv tshuaj, kuj tseem muaj lwm lub tswv yim - Reiter tus kab mob. Nws txawv ntawm tus mob nyob rau hauv uas lub ntsiab tseem ceeb ntawm nws txoj kev loj hlob yog kab mob genitourinary (feem ntau chlamydia), thiab cov chav kawm ntawm tus kab mob yog ntev thiab loj hlob. Hauv ntau tus neeg mob, tus kab mob ua rau muaj ntau yam mob ntawm cov pob qij txha.
Yog vim li cas
Reiter's syndrome yog tshwm sim los ntawm 2 yam:
- kab mob plab hnyuv (shigellosis, yersiniosis, salmonellosis, campylobacteriosis thiab lwm yam);
- genetic predisposition.
Cov kab mob no tshwm sim hauv 1 lub lis piam mus rau 1 lub hlis tom qab kho tus kab mob sib kis. Yog tias lub sijhawm dhau mus, qhov kev kuaj mob no tsis zoo li, qhov ua rau mob pob qij txha nyob hauv lwm yam. Hauv lub sijhawm mob hnyav ntawm tus txheej txheem kis, tus mob tsis tshua tshwm sim.
Qhov kev nthuav dav ntawm cov kab mob no, raws li kev txheeb xyuas kev kho mob, yog 1-4% ntawm cov neeg mob uas tau muaj kab mob hauv plab. Tus kab mob no hnyav dua, qhov kev pheej hmoo siab dua ntawm cov teeb meem hauv daim ntawv ntawm o ntawm cov pob qij txha. Txawm li cas los xij, hauv kwv yees li 10% ntawm cov neeg mob, mob caj dab tshwm sim yam tsis muaj kab mob hauv plab.
Qhov no yog vim qhov tseeb tias cov neeg mob no feem ntau muaj cov kab mob HLA B27 antigen, uas yog qhov tseem ceeb hauv kev txhim kho cov kab mob autoimmune. Nws pom nyob rau hauv 80% ntawm cov neeg mob. Dhau li ntawm mob caj dab,pathologies xws li:
- Ankylosing spondylitis, nyob rau hauv qhov kev txav ntawm cov pob qij txha thiab txha nraub qaum yog qhov tsis zoo vim yog fusion ntawm cov kab noj hniav;
- ulcerative colitis, lossis o ntawm cov kab mob ntawm txoj hnyuv loj;
- Crohn tus kab mob, lossis granulomatous o ntawm lub plab hnyuv, nrog rau lwm yam, cov teeb meem hauv plab hnyuv;
- mob choroid ntawm lub cev ntawm lub zeem muag, uas feem ntau ua rau dig muag.
theem ntawm tus kab mob
Kev tshwm sim thiab cov tsos mob ntawm Reiter's syndrome hauv cov poj niam mus txog 3 theem:
- Thaum thawj theem, cov kab mob nkag mus rau hauv lub cev, uas ua rau muaj kev txhim kho ntawm plab hnyuv thiab enterocolitis.
- Tom qab ntawd los mob mob hauv cov pob qij txha, uas feem ntau cov neeg mob yuav rov zoo.
- Yog tias tus neeg mob muaj caj ces los yog kev tiv thaiv tsis zoo, ces mob caj dab tuaj yeem ua mob ntev. Muaj cov kab mob tshwm sim ntawm tus mob syndrome.
Enterocolitis, tom qab ntawd Reiter's syndrome tshwm sim hauv cov poj niam, nrog rau cov tsos mob hauv qab no:
- kua quav;
- poob qab los, xeev siab, ntuav;
- flatulence;
- fever;
- mob plab;
- cim ntawm kev qaug cawv - mob taub hau thiab mob leeg, tsis muaj zog.
Nyob rau hauv mob enterocolitis, lwm yam cim koom nrog:
- hloov raws plab thiab cem quav;
- poob phaus;
- fermenting zaub mov hauvplab.
Ntse
Reiter's syndrome yog tus cwj pwm los ntawm cov yam ntxwv hauv qab no:
- pob qij txha feem ntau cuam tshuam symmetrically;
- txheej txheem cuam tshuam nrog txha nraub qaum thiab tshwj xeeb tshaj yog nws qhov lumbosacral;
- cov phalanges ntawm cov ntiv tes thiab cov ntiv taw ua rau mob, ua rau lawv ua rau "khoom noj qab zib zoo li" zoo li;
- cov pob qij txha ntawm sab qis yog qhov cuam tshuam rau kev puas tsuaj;
- mob pob taws vim qhov mob ntawm cov leeg thiab calcaneal insertion.
Qee tus neeg mob tsim ko taw tiaj tus vim yog kev puas tsuaj ntawm ko taw ligament. Kev koom tes ntawm cov pob qij txha nyob rau hauv cov txheej txheem pathological nyob rau hauv ntau zaus tshwm sim raws li "hauv qab-up" tswv yim los yog raws li cov tsos mob ntawm kauv - opposite pob qij txha cuam tshuam raws li ascending kab ntawm tus txha nraub qaum.
Reiter's syndrome hauv cov poj niam: kev tshwm sim thiab cov tsos mob
Hauv cov tshuaj, qhov triad classic ntawm cov tsos mob ntawm tus mob tau sau tseg, uas pom muaj nyob hauv 30% ntawm cov neeg mob:
- mob caj dab;
- cervicitis - mob ntawm cov ntaub so ntswg ntawm lub ncauj tsev menyuam;
- pathology ntawm lub cev ntawm lub zeem muag.
Ntxiv rau kev mob caj dab, cervicitis ua rau tsis xis nyob. Nws cov tsos mob ntawm Reiter's syndrome hauv cov poj niam yog raws li nram no:
- tawm qhov chaw mos ntau (nqaj lossis purulent);
- khaus, kub hauv qhov chaw mos;
- pab mob hauv plab plab thiab sab nraub qaum;
- ua rau tsis xis nyob tom qab tso zis thiab sib deev.
Thaum koom nrog lwm yam pathologies ntawm lub plab me me (cystitis, cervical erosion, salpingo-oophoritis, endometritis)Cov cim ntxiv tshwm sim:
- tso zis ntau zaus;
- nce lub cev kub;
- ntshav tom qab kev sib deev;
- mob hnyav hauv plab plab.
mob caj dab
Kev mob ntawm cov pob qij txha yog cov yam ntxwv tseem ceeb ntawm Reiter's syndrome hauv cov poj niam. Cov tsos mob ntawm mob caj dab yog raws li nram no:
- mob pob qij txha;
- lawv o vim edema;
- paj-bluish xim ntawm daim tawv nqaij ntawm thaj tsam ntawm qhov sib koom ua ke;
- txo qis hauv kev ua lub cev, tshwj xeeb tshaj yog thaum sawv ntxov.
Feem ntau, tus naj npawb ntawm cov pob qij txha cuam tshuam tsis pub tshaj rau. Cov pob qij txha ntawm qhov chaw hauv qab no feem ntau yog mob:
- articulation ntawm cov pob txha ntawm qis ceg thiab txhais taw;
- knee;
- toes (tshwj xeeb tus ntiv tes xoo);
- lumbosacral sib koom;
- kev sib cav ntawm sacrum thiab coccyx;
- hip sib koom.
Qee zaum, cov ntaub ntawv asymptomatic lossis cov txheej txheem tshem tawm ntawm tus kab mob tau pom, uas lub cev kub nce mus txog 37.9 ° C, tsis muaj zog, xav tias qab los noj mov.
Dermatological signs
Cov tsos mob thiab tshwm sim ntawm Reiter's syndrome nyob rau hauv cov poj niam tsis cuam tshuam nrog kev mob ntawm pob qij txha. Qee tus neeg mob yuav ntsib cov kab mob dermatological hauv qab no:
- Y Hyperkeratosis - keratinization ntawm daim tawv nqaij, nws tsis mob thickening. Pathological foci ntau duatsuas yog tshwm sim ntawm ob txhais taw thiab xib teg. Ib leeg papules lossis plaques tuaj yeem tsim nyob txhua qhov ntawm lub cev thiab zoo li psoriasis zoo li.
- Kev tsis zoo ntawm cov ntsia hlau daim hlau - lawv cov xim daj, thickening thiab tev tawm cov nqaij mos ntawm cov ntiv tes.
- Lymphadenopathy - nce hauv cov qog ntshav hauv cov leeg.
- Ntau zaus, myocarditis, glomerulonephritis tsim, cov leeg pob txha thiab cov hlab ntsha peripheral ua rau mob.
qhov muag raug mob
Kev tshwm sim ntawm Reiter's syndrome ntawm ib feem ntawm lub cev ntawm lub zeem muag yog kev txhim kho cov kab mob xws li:
- conjunctivitis;
- mob iris, ua rau tsis pom kev;
- kev puas tsuaj rau cov ntaub so ntswg sib txuas ntawm sclera thiab conjunctiva;
- mob ntawm daim nyias nyias ntawm lub qhov muag, nyob rau hauv lub network ntawm cov hlab ntsha nyob.
Conjunctivitis feem ntau asymptomatic thiab kav ntev li ob peb hnub. Kev mob tshwm sim tuaj yeem tshwm sim hauv ib lub qhov muag lossis ib txhij hauv ob qho tib si. Nyob rau tib lub sijhawm, cov neeg mob txhawj xeeb txog qhov mob, profuse lacrimation, photophobia.
Diagnosis
txhawm rau txhawm rau kuaj pom tus kab mob thiab kev hloov pauv hauv lub cev, hom kev sim hauv qab no tau muab rau Reiter's syndrome:
- OAK - nce ESR, platelet suav, immunoglobulin IgA thiab leukocytes raug kuaj pom;
- kuaj ntshav biochemical - nce cov ntsiab lus ntawm C-reactive protein, rheumatic factor, fibrin;
- OAM - leukocytes, protein tuaj yeem kuaj pom;
- fecal tsom xam, coprogram.
ThaumKev loj hlob ntawm cervicitis syndromes qhia tau hais tias kev sab laj nrog tus kws kho mob gynecologist thiab noj smear los ntawm lub ncauj tsev menyuam los txiav txim siab txog kab lis kev cai ntawm tes.
Kev kuaj mob ntawm Reiter's syndrome muaj nyob rau hauv kev ua cov kev kuaj mob hauv qab no:
- X-ray ntawm pob qij txha, txha nraub qaum thiab sacroiliac pob qij txha. Cov duab qhia txog qhov o ntawm cov pob qij txha, thiab nyob rau hauv cov ntaub ntawv ntawm ib tug ntev lub sij hawm ntawm cov kab mob, cov cheeb tsam ntawm cov pob txha puas, nqaim ntawm qhov sib txawv ntawm cov pob qij txha.
- Synovial kua sampling los ntawm cov kab noj hniav sib koom. Nyob rau tib lub sijhawm, cov kev hloov pauv tsis tshwj xeeb tau pom tias kuj yog cov yam ntxwv ntawm lwm hom kev mob caj dab - txo qis hauv viscosity, muaj cov ntshav txhaws, siab concentration ntawm leukocytes. Hom kev kuaj no yog ua los ntawm kev kuaj mob sib txawv ntawm gout thiab septic mob caj dab.
Raws li kev kawm ntxiv, tus kws kho mob tuaj yeem sau ntawv:
- ECG;
- FGDS;
- Ultrasound ntawm lub raum thiab lub plab;
- kev sab laj ntawm tus kws kho qhov muag thiab kws kho hniav.
Drug therapy
Lub hauv paus ntawm kev kho tus mob no yog cov tshuaj hauv qab no:
- Antibacterial agents. Lawv raug xaiv nyob ntawm seb tus kab mob tau txheeb xyuas thiab nws qhov rhiab heev rau cov tshuaj tua kab mob. Raws li cov tshuaj, cov tshuaj los ntawm cov pab pawg neeg ntawm tetracyclines, "Ciprofloxacin" thiab lwm yam tshuaj. Tom qab kev kho mob nrog tshuaj tua kab mob, kev kho mob tau zoo yog saib xyuas tom qab 4-5 lub lis piam.
- Non-steroidal tshuaj tiv thaiv kab mob - Diclofenac, Aceclofenac,"Naproxen", "Indomethacin", "Nimesulide" thiab lwm yam. Lawv txo qis qhov mob ntawm cov pob qij txha thiab txha nraub qaum, thiab tseem muaj cov nyhuv analgesic.
- Multivitamins - "Duovit", "Complivit", "Alphabet", "Vitrum" thiab lwm yam.
- Gastroprotectors - Omeprazole, De-Nol, Kev khiav tawm, Biogastron, Duogastron thiab lwm yam.
- Myospasmolytics - Tolperison, Tizanidin, Tizalud.
nyiaj hauv zos
Cov tshuaj pleev, tshuaj pleev lossis cov gels uas muaj NSAIDs yog siv los kho tshuaj pleev ib ce:
- Voltaren.
- Nise.
- Fastum.
- YDiclofenac.
- Ortofen thiab lwm tus.
Lawv muaj kev kho mob ncaj qha rau ntawm qhov mob. Daim ntawv thov tshuaj pleev kuj txo qhov kev pheej hmoo ntawm cov kev mob tshwm sim uas tuaj yeem tshwm sim nrog kev kho NSAID systemic.
tshuaj hormonal
Nrog rau txoj kev loj hlob ntawm tus kab mob no thiab nws cov tsos mob tshwm sim, tus kws kho mob yuav muab tshuaj glucocorticoids - Betamethasone, Prednisolone. Lawv tau siv hauv zos - kev txhaj tshuaj yog txhaj rau hauv cov kab noj hniav sib koom ua ke thiab rau hauv cov ntaub so ntswg uas nyob ib sab. Lub sijhawm ntawm kev kho yog qhov nruab nrab ntawm 3 lub lis piam. Qhov kev kho no txo qhov mob.
Yog tias muaj ntau cov pob qij txha koom nrog cov txheej txheem pathological, ces kev npaj tshuaj hormonal raug muab rau tus neeg mob intravenously. Nrog rau qhov tshwm sim ntawm tus kab mob, lub raum lossis lub plawv puas, glucocorticoids tau muab rau hauv cov kev kawm luv luv. Rau qhov mob ntawm daim tawv nqaij, cov tshuaj pleev qhov muag lossis tshuaj pleev nrog dexamethasone yog siv.
kev kho tsis yog tshuaj
Reiter's syndrome kuj tuaj yeem kho nrog kev kho lub cev:
- Phonoresis nrog glucocorticoids thiab NSAIDs. Lub hauv paus ntsiab lus ntawm txoj kev no yog qhov cuam tshuam ntawm ultrasonic nthwv dej ntawm thaj chaw cuam tshuam, uas ua rau muaj kev nkag mus tob ntawm cov tshuaj thiab cov txiaj ntsig kho siab tshaj plaws.
- Diadynamic tam sim no yog ib txoj hauv kev kho hluav taws xob uas cov pob qij txha thiab cov cheeb tsam ib puag ncig cuam tshuam los ntawm cov hluav taws xob tsawg zaus. Lawv muaj cov nyhuv stimulating ntawm lub paj hlwb thiab cov leeg. Yog li ntawd, cov ntshav hauv zos, cov ntaub so ntswg metabolism txhim kho, thiab cov nyhuv analgesic tshwm.
- Magnetic therapy. Lub teb sib nqus ua rau muaj qhov tshwm sim ntawm cov eddy tam sim no nyob rau hauv cov kua synovial thiab muaj ib tug complex lub cev thiab lom nyhuv. Cov nyhuv ntawm magnetotherapy zoo ib yam li txoj kev dhau los.
- Laser kho. Lub laser beam ua rau thermal nyhuv ntawm cov ntaub so ntswg. Cov o tuaj yeem txo qis, cov ntshav ncig thiab cov ntaub so ntswg kev noj qab haus huv txhim kho, uas txhawb nqa lawv cov kev tsim dua tshiab.
- Massage hauv pob qij txha, tiv thaiv kev loj hlob ntawm cov leeg nqaij atrophy thiab pab ua kom cov txheej txheem metabolic hauv cov ntaub so ntswg.
Yog tias muaj tus kab mob mus ntev, cov lus pom zoo hauv qab no yuav tsum ua raws:
- sim kom tsis txhob muaj yam uas ua rau muaj mob hnyav (kab mob sib kis, txo qis, kev ntxhov siab, haus luam yeeb thiab haus cawv);
- ua raws li kev noj zaub mov muaj ntau cov roj polyunsaturated fatty acids, nrog rau txiv hmab txiv ntoo thiab zaub;
- tawm dag zog nrogKev tawm dag zog lub cev, ua kom lub cev qoj ib ce 1-2 zaug hauv ib lub lis piam.
Kev Teeb Meem thiab Kev Ntsuas
Reiter's syndrome hauv cov poj niam, qhov tshwm sim thiab cov tsos mob ntawm cov lus piav qhia saum toj no, tuaj yeem ua rau muaj kev loj hlob ntawm cov teeb meem hauv qab no:
- deformation ntawm cov pob qij txha thiab lawv cov subluxation;
- muscular atrophy;
- osteoporosis;
- kev cuam tshuam ntawm lub plawv thiab lub raum.
Thaum tsis muaj cov tsos mob tshwm sim tau piav qhia saum toj no, thiab kho raws sijhawm, qhov tshwm sim ntawm tus kab mob yog qhov zoo. Hauv cov neeg mob uas muaj HLA B27 antigen, qhov kev cia siab tsawg dua, vim tias feem ntau ua txhaum txoj haujlwm ntawm lub cev hauv nruab nrog cev.
