Schonlein tus kab mob - Henoch, lossis hemorrhagic vasculitis, yog ib yam kab mob uas cuam tshuam tsis tau rau tib neeg cov hlab ntsha, tab sis kuj ntawm daim tawv nqaij, pob qij txha, plab hnyuv, thiab lub raum glomeruli. Qhov no pathology yog sib npaug ntawm cov menyuam yaus thiab cov neeg laus. Kev kuaj mob yog nyob ntawm ntau txoj kev tshawb fawb, thiab kev kho mob vasculitis suav nrog kev siv tshuaj tiv thaiv kab mob.
Vasculitis yog ib qho ntawm cov kab mob hemorrhagic tshaj plaws. Feem ntau, qhov no pathology yog sib npaug nrog ib qho kev tsis haum tshuaj ntawm cov xwm txheej sab nraud, uas cuam tshuam rau cov hlab ntsha me me thiab cov leeg, nrog rau cov hlab ntsha. Yeej, hemorrhagic vasculitis yog kuaj pom hauv cov menyuam yaus uas muaj hnub nyoog qis dua 4-13 xyoos. Qhov cuam tshuam tshaj plaws rau cov txheej txheem inflammatory yog cov menyuam yaus hnub nyoog 6-13.
Tus kab mob no nce mus rau theem thiabnrog rau cov tsos mob hnyav. Nws tshwm sim los ntawm ntau yam provoking yam uas tuaj yeem tsim tau tsuas yog tom qab kev ntsuam xyuas tag. Raws li kev kho mob vasculitis ntawm ob txhais ceg thiab lwm qhov hauv lub cev, nws yog lub sijhawm ntev thiab raug xaiv rau txhua tus neeg mob ib leeg. Tsis txhob koom nrog kev kho tus kheej, vim qhov no tuaj yeem ua rau muaj qhov tshwm sim tsis zoo.
Kev faib tawm
Hauv cov tshuaj niaj hnub no, muaj qee yam kev faib tawm ntawm tus kab mob no, uas tau pom zoo ua raws li kev kuaj mob. So:
- chav kho mob: theem mob hnyav (qhov pib ntawm tus kab mob lossis lub sijhawm exacerbation) thiab theem qis (kev txhim kho hauv cov xwm txheej dav dav).
- Cov ntaub ntawv raws li cov tsos mob: yooj yim, articular, plab, fulminant.
- Los ntawm qhov hnyav: me me, nruab nrab, hnyav. Txhua qib yog sawv cev los ntawm qee cov tsos mob.
Kuj, raws li qhov xwm txheej ntawm chav kawm, kab mob yog: mob (txog li ob lub hlis), ncua (mus txog 6 lub hlis), mob ntev.
Vim txoj kev loj hlob
Yuav kom kev kho mob vasculitis ua tau zoo, nws tsim nyog txheeb xyuas qhov ua rau muaj qhov tshwm sim. Cov hauv paus ntsiab lus ntawm cov tshuaj niaj hnub tseem tsis tau tsim, tab sis muaj cov kev xav tias pathology tuaj yeem tsim los ntawm:
- Cov kab mob ua pa dhau los, tshwj xeeb tshaj yog tom qab mob caj pas lossis kub taub hau.
- Kev tsis haum ntawm lub cev rau zaub mov lossis tshuaj.
- tshuaj tiv thaiv tsis zoo.
- Hypothermia.
- Kab tom.
Cov kab mob tiv thaiv kab mob kuj tuaj yeem ua rau muaj kev txhim kho vasculitis.
Symptomatics
Txhua cov tsos mob ntawm hemorrhagic vasculitis tau muab tso ua ke rau hauv pawg neeg mob. Cov no suav nrog cov hauv qab no:
- Skin Syndrome. Tus neeg mob muaj me me hemorrhages uas nce saum daim tawv nqaij. Lawv tuaj yeem pom hauv pob qij txha, tes, taw, ncej puab, pob tw, ntsej muag, lossis thoob plaws lub cev. Tom qab tus neeg mob tau tshem ntawm cov hemorrhage, pronounced pigmentation tseem nyob rau hauv nws qhov chaw. Nws tseem tsim nyog sau cia tias nrog hom kab mob no, tus neeg mob tsis muaj ntshav ntws los ntawm qhov ntswg thiab qhov ncauj.
- Articular Syndrome. Nws manifests nws tus kheej nyob rau hauv daim ntawv ntawm mob thiab o nyob rau hauv cov pob qij txha, tshwj xeeb tshaj yog nyob rau hauv ob txhais ceg. Hauv qhov no, qhov tsis xis nyob yuav nce ntxiv thaum lub sijhawm hemorrhage hauv qab ntawm daim tawv nqaij. Cov tawv nqaij ntawm cov pob qij txha hloov xim. Cov mob no tuaj yeem pom hauv 5-7 hnub. Nws yuav tsum raug sau tseg tias tsis muaj kev hloov pauv mus tas li hauv cov duab ntawm cov pob qij txha nrog kev ua txhaum ntawm lawv txoj haujlwm.
- Abdominal syndrome. Tej zaum yuav nrog los ntawm cov ntshav tawm mus rau hauv cov hnyuv thiab peritoneum. Hauv qhov no, tus neeg mob yuav yws yws ntawm qhov mob ntawm qhov mob hnyav, paroxysmal xwm, uas tau sau tseg hauv lub plab. Cov tawv nqaij ntawm tus neeg mob yuav daj ntseg, lub ntsej muag yog emaciated, lub qhov muag tog, muaj dryness ntawm tus nplaig. Tus neeg mob hauv lub xeev no tsis xis nyob, tsuas yog pw ntawm nws sab. Ib txhij nrog qhov mob syndrome, ntuav thiab raws plab nrog ntshav impurities tshwm. Kev tsis xis nyob dhau musib leeg lossis tom qab thawj hnub ntawm kev kho mob vasculitis.
- Nyob rau hauv lub siab. Hauv qhov xwm txheej no, kev puas tsuaj rau cov hlab ntsha me ntawm ob lub raum tau sau tseg. Hauv qhov no, tus neeg mob muaj ntshav tso zis, ntshav siab thiab o.
Yog tias tus neeg mob pib mob ntshav qab zib los ntawm keeb kwm ntawm vasculitis, tom qab ntawd cov tsos mob xws li malaise, kev ua haujlwm tsis zoo, kiv taub hau, qaug zog, tinnitus, tachycardia yam tsis muaj laj thawj zoo, stabbing mob hauv siab. Kev kho mob vasculitis hauv cov neeg laus yog ua raws li kev tshem tawm cov tsos mob thiab lwm yam teeb meem.
Diagnosis
Tom qab tus neeg mob tau tig mus rau tus kws kho mob tshwj xeeb, nws raug tshuaj xyuas, cov kab mob thiab cov lus tsis txaus siab raug tshuaj xyuas. Tom qab ntawd kev saib xyuas yog them rau lub neej zoo. Tus kws kho mob yuav tsum paub seb puas muaj cov kab mob sib kis, kab mob ntawm cov kab mob, seb tus neeg mob puas muaj tus cwj pwm phem, txawm tias nws noj tshuaj, seb nws puas tau txhaj tshuaj tiv thaiv yav tom ntej.
Nws yog qhov yuav tsum tau ua rau tus neeg mob yuav tsum tau muab cov kev ntsuam xyuas xws li:
- kuaj ntshav. Thaum thawj theem ntawm vasculitis, cov cim tseem tsis hloov pauv. Tom qab ntawd kev sib txawv xws li kev nce hauv cov leukocytes thiab ESR, qhov txo qis hauv erythrocytes thiab hemoglobin yuav tshwm sim.
- ntsuas zis thiab quav. Nrog rau kev loj hlob ntawm cov kab mob pathology, cov ntshav txhaws yuav raug sau tseg hauv cov khoom siv lom neeg.
- Biochemistry ntawm ntshav. Cov qib roj cholesterol, qab zib, creatinine, urea, electrolytes yog txiav txim siab. Qhov kev tshuaj ntsuam no pab txheeb xyuas cov kab mob uas twb muaj lawm.
- Immunological thiab virological kawm.
Kev mloog yog kos rau lub sijhawm los ntshav hauv tus neeg mob, ntshav txhaws. Ib pinch, tourniquet, cuff test tuaj yeem ua tau. Tsis tas li ntawd, tsis txhob suav nrog kev kuaj xyuas ultrasound ntawm lub plab hnyuv, kuaj lub raum, kuaj ntshav ntawm daim tawv nqaij, endoscopy, FEGDS, colonoscopy, bronchoscopy, laparoscopy, kuaj pob txha pob txha, trephine biopsy.
Differential Diagnosis
Kev kho mob hemorrhagic vasculitis hauv cov neeg laus yuav tau txais txiaj ntsig tsuas yog tias tsis tsuas yog kuaj mob xwb, tab sis kuj tau them nyiaj rau kev tshawb fawb sib txawv. Cov tsos mob uas tau teev tseg ua ntej tshwm sim tsis tsuas yog nrog tus kab mob no, yog li ntawd, kev sab laj ntawm ntau tus kws kho mob tshwj xeeb yog xav tau. Vasculitis yuav tsum paub qhov txawv ntawm qhov txawv txav xws li:
- kab mob endocarditis.
- Vasculitis ntawm ib hom kab mob.
- Diffuse connective cov ntaub so ntswg pathologies.
- kab mob meningococcal
- YCryoglobulinemic vasculitis.
- Yersiniosis.
Vasculitis feem ntau tsis meej pem nrog tus kab mob Crohn.
kho mob vasculitis
Duab kab mob tau nthuav tawm saum toj no hauv kab lus. Kev kho tus kab mob yuav nyob ntawm ntau yam. Piv txwv li, los ntawm theem, daim ntawv kho mob, qhov hnyav ntawm qhov tshwm sim thiab qhov xwm txheej ntawm chav kawm. Tsuas yog tus kws kho mob tshwj xeeb tuaj yeem txiav txim siab cov ntaub ntawv no tom qab kev kuaj xyuas kom meej thiab ntev.
rau tus neeg mob nrogHom vasculitis no yuav raug sau tseg:
- Antiaggreants - Curantil thiab Trental. Yog hais tias tus kab mob no hnyav heev, ces muab ob yam tshuaj ib zaug. Analogues ntawm cov tshuaj no tuaj yeem siv tau. Cov koob tshuaj yog xaiv tus kheej. Yog tias tsis muaj txiaj ntsig zoo los ntawm kev kho, ces koob tshuaj yuav nce ntxiv.
- Fibrinolysis activators. Qhov ntau npaum li cas yog xaiv los ntawm tus neeg mob susceptibility.
- YGlucororticosteroids. Lawv raug tshuaj tsuas yog rau cov kab mob hnyav.
- YCytostatics. Muab tshuaj rau tus neeg mob uas muaj vasculitis hnyav, nrog rau lub raum puas, tawv nqaij mob hnyav.
- Antihistamines. Feem ntau, lawv raug sau rau kev kho mob vasculitis hauv cov menyuam yaus uas raug kev txom nyem los ntawm ntau hom kev tsis haum tshuaj.
- Enterosorbents.
- Membrane stabilizers.
Plasmopheresis kuj raug sau tseg. Nws normalizes lub zog ntawm cov ntshav, tshem tawm spasms nyob rau hauv cov hlab ntsha, txhim kho microcirculation, tsub kom cov kev ua ntawm immunological hlwb thiab tus neeg mob lub susceptibility rau tshuaj.
Lub sijhawm kho mob vasculitis yuav nyob ntawm qhov hnyav thiab daim ntawv kho mob. Hauv qhov xwm txheej tsis saib xyuas, kev kho mob tuaj yeem ncua sijhawm rau ib xyoos. Yog tias tus neeg mob muaj lub sijhawm ntev, tom qab ntawd rov ua cov chav kawm txhua 3-6 lub hlis.
Kev nyuaj siab
Yog tias koj tsis suav nrog kev kho mob vasculitis ntawm ob txhais ceg, qhov no tuaj yeem ua rau muaj teeb meem. Hais txog qhov tshwm sim hauv cov menyuam yaus, feem ntaurooj plaub nws yog qhov zoo. Yog tias kev kho mob tsis tu ncua, ces tus kab mob no tshwm sim mus rau hauv daim ntawv ntev thiab nrog rau ntawm daim tawv nqaij thiab kev sib koom ua ke. Kev puas tsuaj rau lub raum kuj tseem raug sau tseg, dhau sijhawm, kev ua haujlwm tsis zoo. Raws li rau lub raum tsis ua haujlwm, nws raug kuaj pom tsis tshua muaj tshwm sim.
ntsuas kev tiv thaiv
kev tiv thaiv Vasculitis yog qhov yuav tsum tau ua. Cov kws tshaj lij pom zoo ua raws li cov lus qhia no:
- Txoj kev tiv thaiv kab mob.
- tshawb nrhiav thiab kho cov kab mob sib kis.
- Siv tshuaj tsis tsim nyog.
- Tsis txhob txias.
- Kev tsis lees paub lub cev ua haujlwm ntau dhau.
- kuaj pom ntxov ntawm vasculitis. Cov tsos mob thiab kev kho mob ntawm cov kab mob no ib txwm sib cuam tshuam.
- Kev cais tawm ntawm kev sib cuag nrog cov tshuaj thiab cov khoom uas tuaj yeem ua rau muaj kev tsis haum rau lub cev.
- Yog tias tus kab mob twb kis mus lawm, nws tsim nyog tsis suav nrog kev txhaj tshuaj tiv thaiv.
- Cia li haus cawv thiab haus cawv.
Yog koj ua raws li cov lus qhia no, tus kab mob no yuav tsis cuam tshuam thiab yuav tsis loj hlob mus rau theem ntev.
Vasculitis hauv me nyuam
Raws li tau hais ua ntej, hom vasculitis no muaj ntau dua hauv cov menyuam yaus dua li cov neeg laus. Feem ntau, nws raug kuaj pom hauv cov tub. Nws tuaj yeem tshwm sim nyob rau hauv ib qho mob, ncua sij hawm lossis ntev.
Hauv tshuaj, cov ntaub ntawv no ntawm cov menyuam yaus vasculitis yog qhov txawv:
- Simple.
- Rheumatoid.
- xob laim.
- Pab plab.
Ua rau vasculitis hauv tus menyuam tuaj yeem yog yam xws li hypothermia, raug mob, noj thiab tsis kam noj tshuaj, ua xua rau lub cev, thiab txhaj tshuaj tiv thaiv tsis zoo.
Pathology tseem nrog cov mob hnyav:
- Feem ntau, muaj kab mob ntawm daim tawv nqaij, tej zaum yuav ntxiv los ntawm articular, uas tsis tshua muaj tshwm sim.
- Kuj rau cov menyuam yaus uas muaj qhov kev kuaj mob no, mob plab plab kuj yog ib yam, uas kav ntev li ob peb hnub. Hemorrhagic vasculitis tuaj yeem ua rau ntau yam kab mob ntawm lub plab kab noj hniav.
- Raws li vascular syndrome, nws tsis tshua tshwm sim.
Kev kuaj mob tau ua raws li cov neeg mob laus. Kev saib xyuas kuj tau them rau qhov sib txawv ntawm kev tshawb fawb.
Kev kho mob vasculitis thaum yau
Kev kho cov menyuam yaus uas muaj kab mob no tau ua hauv tsev kho mob. Thaum kev txhim kho raug sau tseg, kev kho mob txuas ntxiv tom tsev. Lub txaj so rau vasculitis yog pom zoo rau tsawg kawg 23 hnub.
Kev kho nws tus kheej yog qhov nyuaj, kev noj zaub mov nruj yog qhov yuav tsum tau ua. Allergen cov zaub mov tsis suav nrog cov khoom noj. Thaum kho vasculitis ntawm ob txhais ceg (daim duab ntawm tus kab mob, saib saum toj no) thiab lwm qhov ntawm lub cev, ntau yam tshuaj siv. Cov menyuam yaus tsis raug tso cai muab tshuaj sulfonamides, tshuaj tua kab mob, ascorbic acid thiab calcium ntxiv. Lub hauv paus yog kev kho mob heparin. Lawv tuaj yeem sau tshuaj prednisonevascular npaj, antiaggregants, sorbents. Yog tias tus kab mob loj tuaj, ces plasmapheresis raug pom zoo.
Yog tias kev kho mob hemorrhagic vasculitis hauv cov menyuam yaus qeeb, cov teeb meem xws li perforation, intussusception, los ntshav hauv plab hnyuv, peritonitis thiab mob ntshav siab tuaj yeem tshwm sim.
