Kev ua xua tau dhau los ua teeb meem rau ntau tus neeg txhua hnub. Nws cov kev kho mob zoo, kev tiv thaiv ntawm qaug dab peg nyob ntawm lub sijhawm tsim cov tshuaj uas ua rau lub cev tsis txaus thaum cuam tshuam nrog nws. Qee qhov xwm txheej, ib tus neeg tsim kev tsis haum tshuaj ncua ntev. Tom qab ntawd cov kev kuaj mob zoo dhau los ua lub hauv paus rau kev saib xyuas kev noj qab haus huv.
teb tsis txaus
Txhua tus tau hnov txog kev ua xua. Tab sis tsuas yog cov neeg uas tau ntsib teeb meem kev noj qab haus huv ua ntej paub tias muaj kev tsis haum tshuaj sai sai thiab qeeb. Tab sis txawm li cas los xij, qhov no yog qhov ua txhaum loj ntawm kev noj qab haus huv, uas tuaj yeem ua rau tuag taus thaum muaj kev loj hlob ntawm kev ua xua thiab kev pab kho mob tsis raws sijhawm.
Cov txheej txheem ntawm qhov tshwm sim ntawm qhov tsis txaus ntawm lub cev rau qee yam tshuaj, txawm tias kawm, tseem tsis tau nkag siab tag nrho. Zoo sib xws rau kev ua xuahypersensitivity txhais tau tias yog ib qho kev tsis txaus siab ntau dhau ntawm lub cev tiv thaiv kab mob rau txhua yam khoom. Thaum pib, nws yog hypersensitivity uas tau muab faib ua ob hom raws li qhov ceev ntawm qhov tshwm sim. Tom qab ntawd qhov kev tsis haum tshuaj tau txais xws li kev faib. Cov tshuaj tiv thaiv ncua sij hawm muaj xws li cov txheej txheem uas tshwm sim los ntawm kev txhawb nqa ntawm cellular tiv thaiv kab mob hauv cov lus teb rau kev sib cuam tshuam ntawm cov tshuaj tiv thaiv nrog macrophages thiab hom 1 T-helpers.
Kev faib tawm
Kev tshawb fawb txog kev ua xua thiab ua xua tau los ntev, vim tias 4 hom kev tsis haum tshuaj tau txheeb pom:
- anaphylactic;
- cytotoxic;
- precitipine;
- ncua kev ntxhov siab.
Anaphylactic hom yog hom tshuaj tiv thaiv tam sim ntawd uas tshwm sim tom qab tsuas yog 15-20 feeb tom qab kev sib cuag ntawm cov tshuaj tiv thaiv reagin nrog cov tshuaj tsis haum, vim tias cov tshuaj lom neeg tshwj xeeb raug tso tawm rau hauv lub cev - cov neeg kho, piv txwv li, heparin, histamine, serotonin, prostaglandin, leukotrienes thiab lwm yam.
Cytotoxic tshuaj tiv thaiv yog txuam nrog hypersensitivity rau cov tshuaj. Nws yog raws li kev sib xyaw ua ke ntawm cov tshuaj tiv thaiv kab mob nrog cov hloov pauv, uas ua rau kev puas tsuaj thiab tshem tawm tom kawg.
Hom thib peb ntawm kev tsis haum tshuaj kuj hu ua immunocomplex. Qhov no yog vim qhov rov qab noj cov protein ntau ntau rau hauv lub cev, piv txwv li, thaum ntshav lossis ntshav ntshav, thaum txhaj tshuaj tiv thaiv. Tib cov tshuaj tiv thaiv yog ua tau nrogKev kis kab mob ntawm cov ntshav plasma nrog cov kab mob los yog cov kab mob microbes, tawm tsam keeb kwm ntawm kev tsim cov proteins vim neoplasms, kab mob, kab mob nrog helminths, thiab lwm yam txheej txheem pathological.
Plaub hom kev tsis haum tshuaj sib xyaw ua ke ntawm qhov tshwm sim ntawm kev cuam tshuam ntawm T-lymphocytes thiab macrophages nrog cov neeg nqa khoom ntawm cov tshuaj tiv thaiv txawv teb chaws thiab hu ua tuberculin, kis-xws li, cell-mediated. Lwm lub npe rau qhov kev xav tsis zoo no, uas tau dhau los ua ntau tshaj, yog cov tshuaj tiv thaiv qeeb. Nws yog tus yam ntxwv ntawm kev sib cuag dermatitis, rheumatoid mob caj dab, tuberculosis, mob ruas, salmonellosis thiab lwm yam kab mob thiab pathologies. Nws yog los ntawm hom kev ua xua uas qhov kev faib tawm ntawm cov tshuaj tiv thaiv ncua sij hawm tau ua tiav.
Koj puas muaj kev fab tshuaj sai?
Cov kws kho mob tshwj xeeb txhais qhov mob siab rau vim qhov ua txhaum ntawm lub cev tiv thaiv kab mob. Thiab nws yog qhov ceev, nrog rau cov txheej txheem ntawm kev txhim kho, uas txiav txim siab qhov sib txawv ntawm kev tsis haum tshuaj ntawm hom tam sim thiab ncua sij hawm. Thaum xub thawj, cov kws tshaj lij pom tias cov tshuaj tsis haum tshuaj sib txawv tuaj yeem ua rau muaj kev cuam tshuam ntawm lub cev tom qab lub sijhawm sib txawv. Yog li qeeb-hom kev ua xua tshwm sim tom qab 12-48 teev. Thiab tam sim no-hom hypersensitivity tshwm sim 15-20 feeb tom qab kev sib cuag nrog cov allergen.
Kev faib tawm ntawm qhov ncua sij hawm-hom kev tsis haum tshuaj
Yuav kom nkag siab zoo dua cov ntsiab lus ntawm kev ua xua qeeb, koj yuav tsum kawm nwsKev faib tawm, vim nws yog nyob rau hauv cov qauv ntawm cov lus teb tsis txaus ntawm lub cev tiv thaiv kab mob uas nws cov ntsiab lus tseem ceeb tau cuam tshuam:
- Tiv tauj: tus yam ntxwv tshwm sim yog daim tawv nqaij dermatitis. Nws tsim ib hnub los yog ob hnub tom qab kev sib cuag nrog cov allergen, lymphocytes thiab macrophages koom nrog nws txoj kev loj hlob. Lub ntsiab yam ntxwv ntawm qhov tshwm sim yog cov ntaub so ntswg edema.
- Tuberculin tshwm sim tom qab 6-48 teev, lymphocytes, macrophages, monocytes koom nrog.
- Granulomatous - hom tshuaj tiv thaiv no tshwm sim tom qab 21-28 teev, macrophages, epithelioid hlwb raug txiav txim hauv kev loj hlob. Kev tshwm sim - fibrosis.
Lub tshuab ntawm kev txhim kho ntawm kev ncua sij hawm-hom kev tsis haum tshuaj yog qhov pib zoo ib yam li cov txheej txheem ntawm kev tiv thaiv ntawm tes. Qhov sib txawv ntawm lawv tuaj yeem txiav txim siab los ntawm qhov kawg tshwm sim: yog tias qhov kev tsis haum tshuaj tsis ua rau cov ntaub so ntswg puas, ces peb tuaj yeem tham txog kev tiv thaiv ntawm tes.
tshuaj-allergens
Feem ntau nws ntseeg tau tias kev ua xua yog qee yam tshuaj uas tuaj yeem ua rau muaj kev cuam tshuam tsis zoo ntawm lub cev tiv thaiv kab mob thaum sib cuag nrog lawv. Tab sis allergens muaj xws li cov tshuaj uas muaj peev xwm potentiate allergens. Cov tshuaj tiv thaiv tsis tsim nyog, hu ua kev tsis haum tshuaj, tshwm sim thaum cuam tshuam nrog cov tshuaj hauv qab no:
- dust;
- plua plav mites;
- cov proteins txawv teb chaws (tus pub ntshav plasma thiab tshuaj tiv thaiv);
- paj noob hlis;
- mold;
- tshuaj: penicillins, salicylates; sulfonamides, tshuaj loog hauv zos;
- Nyob zoo ib tsoom niam txiv kwv tij neej tsas sawv daws,txiv ntseej, citrus txiv hmab txiv ntoo, qe;
- kab kab, arthropods;
- tsiaj cov khoom: tsiaj tawv nqaij (piv txwv li flakes), ntaub plaub, kab laum, tsev mites;
- tshuaj - latex, tu cov khoom, nickel compounds.
Qhov no nyob deb ntawm ib daim ntawv teev tag nrho, txawm tias pawg allergen nyuaj rau sau, tsis hais txog kab ntawm txhua pab pawg. Nws yog tas li tshiab, nthuav thiab refined. Yog li, feem ntau yuav, ncua kev tsis haum tshuaj tsis yog tsuas yog tau txheeb xyuas cov teeb meem kev noj qab haus huv xwb, tab sis kuj tseem muaj qee qhov uas tseem tsis tau muaj qhov txawv ntawm qhov tsis txaus ntseeg.
Yuav ua li cas qeeb cov tshuaj tiv thaiv rau qhov ua xua tshwm sim?
Txhua txheej txheem, suav nrog tib neeg kev tsis haum, mus dhau ntau theem hauv nws txoj kev loj hlob. Ib qho kev tsis haum tshuaj ntawm ib hom ncua sij hawm ua raws li hauv qab no: rhiab heev; Tom qab ntawd qhov tshwm sim hauv cov qog ntshav hauv cheeb tsam ntawm ntau cov pyroninophilic hlwb, los ntawm qhov uas, nyob rau hauv lem, sensitized tiv thaiv lymphocytes yog tsim. Cov hlwb no ua haujlwm raws li qhov hu ua hloov pauv hloov pauv thiab, ncig hauv cov ntshav, yog nqa los ntawm cov ntaub so ntswg. Tom ntej no kev sib cuag nrog cov allergen activates lawv nrog tsim ntawm allergen-antibody tiv thaiv complex, uas ua rau cov ntaub so ntswg puas.
Kev tshawb fawb tseem tsis tau paub txog qhov xwm txheej ntawm cov tshuaj tiv thaiv hauv HRT. Kawm txog hom kev ua xua hauv cov tsiaj no, cov kws tshawb fawb tau sau tseg tias kev hloov pauv tsis tu ncua ntawm kev ua xua los ntawm cov tsiaj mus rau tsiaj tsuas yog ua tau nrog kev pab ntawm kev ncua ntawm tes. Tab sis nrog cov ntshav ntshav, xws li kev hloov pauv yog xyaum tsis yooj yim sua, lub xub ntiag ntawmtsawg kawg yog ib qho me me ntawm cov xov tooj ntawm tes.
Kev txhim kho ntawm qhov ncua sij hawm ntawm kev ua xua yog ua tsis tau, pom meej, tsis muaj cov hlwb ntawm lymphoid series. Cov ntshav lymphocytes muaj peev xwm ua tau raws li cov neeg nqa khoom ntawm kev kub siab rau cov tshuaj lom neeg xws li tuberculin, picryl chloride, thiab lwm yam tshuaj tsis haum. rhiab heev thaum sib cuag yog passively kis los ntawm cov hlwb ntawm lub thoracic lymphatic duct, tus po. Kev sib raug zoo zoo kawg nkaus tau raug tsim los ntawm qhov tsis muaj peev xwm los tsim cov kev ua xua qeeb thiab tsis txaus ntawm lymphoid system.
Piv txwv li, cov neeg mob lymphogranulomatosis tsis raug kev txom nyem los ntawm kev ua xua qeeb. Kev tshawb fawb tau supposedly xaus li cas raws nraim lymphocytes yog lub ntsiab nqa thiab nqa ntawm cov tshuaj tiv thaiv nyob rau hauv ncua kev ua xua. Lub xub ntiag ntawm cov tshuaj tiv thaiv ntawm lymphocytes kuj yog pov thawj los ntawm qhov tseeb tias, nrog kev ua xua qeeb, lawv muaj peev xwm kho qhov tsis haum rau lawv tus kheej. Txawm li cas los xij, ntau cov txheej txheem tshwm sim hauv tib neeg lub cev, rau ntau yam, tseem tsis tau kawm txaus.
Reaction mediators
Qhov tshwm sim ntawm txhua yam kev ua xua yog ib txoj hauv kev uas muaj ntau yam tshuaj koom nrog. Yog li ncua-hom kev ua xua tshwm sim nrog kev pab los ntawm cov neeg sib kho. Nov yog cov tseem ceeb:
- Blastogenic yam uas ua kom nrawm hloov pauv ntawm lymphocytes rau hauv blasts.
- Lymphotoxin yog cov protein uas muaj qhov hnyav ntawm 70000-90000. Cov tshuaj no inhibits kev loj hlob los yog ua rauKev puas tsuaj ntawm lymphocytes, nrog rau kev loj hlob (kev loj hlob) ntawm lymphocytes. Qhov ncua sij hawm-hom kev ua xua tus neeg nruab nrab no inhibits DNA synthesis hauv tib neeg thiab tsiaj.
- Macrophage migration inhibition yam tseem yog cov protein uas muaj qhov loj ntawm 4000-6000. Cov tshuaj lom neeg lom neeg no cuam tshuam qhov nrawm ntawm kev txav ntawm macrophages hauv cov ntaub so ntswg kab lis kev cai, ua rau nws qeeb.
Ntxiv rau cov qauv no, cov kws tshawb fawb tau txheeb xyuas ob peb lwm tus neeg nruab nrab ntawm kev ua xua rau cov tsiaj. Lawv tseem tsis tau pom nyob rau hauv tib neeg.
Discovery keeb kwm
Thaum kawg ntawm lub xyoo pua puv 19, tus kws kho mob microbiologist R. Koch pom qhov kev sib raug zoo ntawm qhov tshwm sim qeeb ntawm hyperergy thiab kev sib cuag nrog qee yam tshuaj. Tib qhov kev soj ntsuam no tau ua los ntawm Viennese tus kws kho mob menyuam yaus Clemens von Pirke, ceeb toom hauv cov menyuam yaus txoj kev sib raug zoo ntawm kev raug rau qee yam tshuaj thiab kev tsis zoo hauv kev noj qab haus huv. Txoj kev tshawb fawb txog qhov tsis txaus ntawm tib neeg lub cev los tiv thaiv qee yam ntawm cov xwm txheej, lub neej txhua hnub, thiab kev tsim khoom txuas ntxiv mus.
Nyob rau hauv thaum ntxov 60s ntawm lub xyoo pua xeem, British immunologists Jell thiab Coombs tau txheeb xyuas 4 lub ntsiab ntawm hypersensitivity tshua. Tau ntev nws tau ntseeg tias qhov tsis txaus ntawm lub cev tiv thaiv kab mob yog tshwm sim los ntawm kev ua haujlwm tsis zoo ntawm immunoglobulins E. Tab sis tom qab ntawd nws tau pom tias cov tshuaj tiv thaiv no yog ua los ntawm cov txheej txheem nyuaj rau kev sib cuam tshuam ntawm tib neeg lub cev thiab ntau yam khoom.. Yog li ntawd, lo lus "kev ua xua" tau tshwj tseg rau thawj ntawm cov saum toj no hom hypersensitivity.
Symptomatic pathologies
Kev ncua sij hawm tsis haum yog qhov tshwm sim ntawm cov tsos mob uas paub zoo:
- Kab mob ua xua tshwm sim los ntawm kev kis cov kab mob uas tuaj yeem ua rau brucellosis, gonorrhea, syphilis, tuberculosis, anthrax.
- Tuberculin hypersensitivity paub rau txhua tus, zoo li kev kuaj Mantoux, uas tso cai rau kuaj pom tus kab mob Koch bacillus.
- Protein allergy - hypersensitivity rau zaub mov - qe, mis nyuj, ntses, txiv ntseej, legumes, cereals.
- Autoimmune allergy - qhov tsis muaj peev xwm ntawm lub cev tiv thaiv kab mob kom paub qhov txawv ntawm nws tus kheej cov tshuaj thiab cov khoom txawv teb chaws, ua rau lawv ua xua.
Txoj kev ntawm HRT
Cov txheej txheem tshawb fawb ntawm kev ncua sij hawm ua xua yog ua raws ob hom kev tiv thaiv kab mob T-cell. Kev xav tshwm sim ua ntej.
Los ntawm qhov chaw uas cov allergen nkag mus rau hauv cov qog nqaij hlav hauv cheeb tsam, thaj tsam ntawm qhov chaw no, kev tsiv teb tsaws ntawm cov txheej txheem dawb epidermocytes (Langerhans hlwb) los yog dendritic hlwb ntawm mucous daim nyias nyias pib, txav peptide fragment ntawm antigen raws li ib feem ntawm MHC class II membrane molecules.
Tom qab ntawd muaj cov tshuaj tiv thaiv ntawm qee pawg lymphocytes thiab lawv cov lus teb hauv daim ntawv ntawm kev loj hlob, sib txawv rau hauv Th1 hlwb. Thaum cov antigen nkag mus rau hauv lub cev dua, twb sensitized lymphocytes react, activating thawj neeg nyob thiab ces migrating macrophages. Cov txheej txheem no ua rau txoj kev loj hlob ntawm o, nyob rau hauv uas cellular infiltration dominates vascular hloov.
Ntawm noLub luag haujlwm tshwj xeeb yog muab rau cov khoom lag luam humoral ntawm cov cell effector - cytokines. Raws li qhov tshwm sim ntawm kev tiv thaiv kab mob tiv thaiv kab mob ntawm tes thaum sib cuag nrog ib qho kev ua xua, qeeb-hom hypersensitivity dhau los ua ib qho kev puas tsuaj hauv lub cev. Piv txwv li, cov tshuaj tiv thaiv granulomatous hauv tuberculosis: macrophages thiab T-lymphocytes nyob ib puag ncig cov hlwb nrog cov kab mob, tsim cov granuloma tiv thaiv. Nyob rau hauv no tsim, cov hlwb tuag, uas ua rau lub disintegration ntawm cov ntaub so ntswg raws li caseous hom. Yog li kev tiv thaiv ntawm lub cev hloov mus ua kev puas tsuaj.
Kab mob ib yam
Ntev kev tsis haum tshuaj tshwm sim tsis pub dhau 6-24 teev tom qab kev sib cuag nrog cov khoom ua xua. Hauv qhov no, qhov kev kuaj mob tau tsim nrog ib qho teeb meem tshwj xeeb raws li cov tsos mob:
- Hansen's disease;
- gonorrhea;
- phototoxic dermatitis;
- ua xua conjunctivitis;
- mycosis;
- syphilis.
Kev ncua sij hawm-hom kev tsis haum tshuaj kuj suav nrog kev hloov pauv thiab kev tiv thaiv kab mob tiv thaiv kab mob. Tsuas yog ib tus kws kho mob tshwj xeeb tuaj yeem txiav txim siab qhov ua rau muaj teeb meem kev noj qab haus huv tom qab kuaj xyuas kom meej thiab zoo.
Diagnosis
Kev ncua sij hawm-hom kev tsis haum tshuaj loj hlob raws li cov txheej txheem zoo ib yam li kev tiv thaiv ntawm tes. Rau lawv txoj kev kho kom raug, kev kuaj xyuas kom ntseeg tau yog qhov tsim nyog, vim tias nws yuav pab txheeb xyuas cov khoom uas ua rau muaj qhov tsis txaus ntseeg. Xws liQhov kev txiav txim siab yog ua los ntawm kev kuaj kev tsis haum tshuaj - cov tshuaj lom neeg siv hauv kev kuaj mob thiab ua raws li qhov nce rhiab heev ntawm lub cev mus rau qee yam ua xua.
Txoj kev tshawb no yog ua raws li ob txoj hauv kev - hauv vivo thiab hauv vitro. Thawj zaug hauv vivo yog nqa ncaj qha nrog tus neeg mob. Qhov thib ob yog sab nraum lub cev, xws li kev sim lossis kev tshawb fawb tseem hu ua "in vitro" cov tshuaj tiv thaiv. Hauv ob qho tib si, allergens ua raws li kev kuaj mob. Qhov zoo-paub Mantoux cov tshuaj tiv thaiv yog hais txog kev tshawb fawb hauv vivo, thaum Mycobacterium tuberculosis raug txhaj tshuaj subcutaneously. Yog hais tias lub cev rhiab heev nrog Koch lub wand, cov lus teb yuav tsis txaus: daim tawv nqaij ntawm qhov chaw txhaj tshuaj hloov liab, o. Raws li qhov loj ntawm infiltrate, tus kws tshaj lij sau npe cov txiaj ntsig ntawm qhov kev sim.
Yuav ua li cas thiab yuav kho li cas?
Ntev-hom kev tsis haum tshuaj - cov lus teb tsis txaus ncua sijhawm los ntawm kev cuam tshuam ntawm tib neeg lub cev thiab cov tshuaj lom neeg. Kev kho mob ntawm hom teeb meem no tsuas yog ua raws li kev pom zoo ntawm tus kws kho mob tshwj xeeb - tus tsis haum tshuaj thiab tus kws tshuaj tiv thaiv kab mob. Txhawm rau kho qhov teeb meem zoo li no, kev kho mob nrog cov tshuaj uas tso tseg cov kab mob ntawm cov kab mob sib txuas, nrog rau cov tshuaj tiv thaiv kab mob yog siv.
thawj pab pawg tshuaj siv los kho HRT suav nrog:
- glucocorticoids, xws li Dexamethasone, Prednisolone, Triamcinolone;
- non-steroidal anti-inflammatory tshuaj xws liDiclofenac, Indomethacin, Naproxen, Piroxicam.
tshuaj tiv thaiv kab mob siv rau kev ua xua ncua sij hawm tau muab faib ua pawg hauv qab no:
- Y cytostatics - "Azathioprine", "Mercaptopurine", "Cyclophosphamide";
- tshuaj tiv thaiv-lymphocyte serum, anti-lymphocyte globulin thiab tib neeg tiv thaiv kev ua xua immunoglobulin;
- slow-acting antirheumatic tshuaj ("Hingamin", "Penicillamine");
- tshuaj tua kab mob - "Cyclosporin A".
Txhua yam tshuaj yuav tsum tau pom zoo los ntawm koj tus kws kho mob nkaus xwb!
Kev tsis haum ntawm hom tam sim thiab qeeb yog ib qho teeb meem kev noj qab haus huv loj uas yuav tsum tau kuaj xyuas kom zoo thiab kho kom zoo. Kev ncua sij hawm tsis txaus siab tshwm sim tshwm sim ntawm qib cellular, hloov cov qauv ntawm cov ntaub so ntswg thiab ua rau lawv puas tsuaj, uas tuaj yeem ua rau muaj kev tsis taus thiab tuag yam tsis muaj kev kho kom raug. Tsuas yog tus cwj pwm zoo rau kev noj qab haus huv thiab kev kuaj mob raws sijhawm, ua raws li kev kho mob zoo, yuav ua rau muaj txiaj ntsig zoo.
