Urticaria yog lub cim tseem ceeb ntawm kev kho mob ntawm ntau yam kab mob ua xua, uas tshwm sim nws tus kheej ua pob liab liab lossis pob liab liab hauv daim ntawv hlwv, papules ntawm ntau qhov ntau thiab tsawg. Lawv qhov tsos yog nrog los ntawm khaus ntawm daim tawv nqaij. Generalized urticaria tuaj yeem tshwm sim raws li tus kab mob ywj pheej, lossis yog cov tsos mob ntawm lwm yam kab mob, sib txawv hauv lawv txoj kev loj hlob thiab keeb kwm.
Nws yog tus yam ntxwv los ntawm thaj chaw dav ntawm cov pob liab liab, qee zaum npog tag nrho tib neeg lub cev. Qhov ntau yam no tuaj yeem ua rau muaj kev hem thawj rau tus neeg mob lub neej, vim hais tias feem ntau urticaria feem ntau nrog Quincke's edema. ICD-10 L50 yog tus kab mob code hauv International Classification of Diseases (2018).
Ntau yam ntawm pathology
Tus kab mob tuaj yeem muaj ob txoj kev txhim kho: tsis muaj kab mob thiab tiv thaiv kab mob. Qhov kev xaiv thib ob yog ntau dua. Thaum ib tug allergen nkag mus rau hauv lub cev, nws pib intensivelytsim tawm tsam nws immunoglobulin E tiv thaiv kab mob. Thaum lub sij hawm sib cuam tshuam ntawm antigens nrog nws, mast hlwb raug rhuav tshem, ib tug loj npaum li cas ntawm histamine tso rau hauv cov ntshav, uas ua rau kom cov permeability ntawm phab ntsa ntawm cov hlab ntsha, thiab ua rau cov tsos mob ntawm urticaria.
Daim ntawv tsis muaj kev tiv thaiv kab mob ntawm cov kab mob urticaria feem ntau cuam tshuam nrog kev ua xua ntawm cov qog nqaij hlav mast. Qhov tseeb ua rau tus kab mob niaj hnub no, cov kws tshawb fawb tseem tsis tau muaj npe. Nws tau raug tsim tsa tias daim ntawv dav dav ntawm urticaria tshwm sim ntau zaus hauv cov neeg uas muaj keeb kwm ntawm cov kab mob atopic ntawm kev tsis haum xeeb.
Kwv yees li 75% ntawm cov ntaub ntawv kaw tseg ntawm tus kab mob sawv cev rau tus mob urticaria. Kev loj hlob sai thiab lub sijhawm tsis pub ntau tshaj ib thiab ib nrab lub hlis yog cov yam ntxwv ntawm nws. Feem ntau, nws txoj kev loj hlob yog txuam nrog kev siv tshuaj tsis raug. Feem ntau kuaj tau rau menyuam yaus.
Tus kab mob urticaria mob ntev tau kuaj pom hauv 25% ntawm cov neeg mob. Nyob ntawm daim duab kho mob, nws muab faib ua:
- recurrent;
- ntseeg (sluggish).
Tus kab mob no feem ntau kuaj tau thaum yau, thiab thoob plaws lub neej nws tuaj yeem rov zoo dua txhua zaus cov tshuaj tsis haum nkag mus rau hauv cov hlab ntsha.
kab mob daim ntawv
Hauv kev faib tawm zaum kawg, tus kab mob tau muab faib raws li qhov xwm txheej ntawm chav kawm, thiab tseem, nyob ntawm qhov ua rau nws tshwm sim, rau hauv cov ntaub ntawv kho mob. Los ntawm cov xwm txheej, pathology tuaj yeem mob thiab mob ntev. Cia peb xam seb lawv yog dab tsisib txawv.
Acute generalized urticaria
Tus yam ntxwv los ntawm kev loj hlob sai thiab lub sijhawm tsawg kawg rau lub lis piam. Nyob rau hauv daim ntawv no, cov pob khaus yuav ploj mus nyob rau hauv cov tshuaj los yog tom qab tshem tawm cov allergen uas ua rau nws.
Chronic form
Peb twb tau hais lawm tias daim ntawv mob ntev ntawm cov kab mob urticaria muaj ntau yam: tiv thaiv kab mob, tsis tiv thaiv kab mob, thiab idiopathic (thaum qhov ua rau tsis tsim). Tsis tas li ntawd, daim ntawv mob ntev yuav yog:
- Ntxub (thawj lossis theem nrab).
- Solar.
- Cholinergic, uas yog tshwm sim los ntawm rhiab heev rau acetylcholine, uas yog ib qho ua xua. Cov tshuaj tiv thaiv zoo li no tuaj yeem ua rau muaj kev tawm dag zog ntau dhau, cov tshuaj tiv thaiv kev puas siab puas ntsws, huab cua kub, dej kub, ntsim lossis zaub mov kub.
- Cia.
Lub pathogenesis ntawm tus kab mob no complex, nws yog txuam nrog mast cell degranulation, thaum lub sij hawm uas inflammatory mediators raug tso tawm. Lawv ua rau kev loj hlob ntawm cov tsos mob.
Cov kws tshaj lij ntseeg tias cov tshuaj tiv thaiv kab mob autoimmune koom nrog hauv kev tsim cov tshuaj tiv thaiv kab mob urticaria (generalized form), txij li ib nrab ntawm cov neeg mob nrog qhov kev kuaj mob no muaj cov tshuaj tiv thaiv kab mob autoimmune rau high-affinity receptor alpha saw uas cuam tshuam nrog Fc fragment ntawm immunoglobulin E. Raws li qhov tshwm sim degranulation ntawm basophils thiab mast hlwb tshwm sim thiab anaphylotoxin (ib yam tshuaj lom) raug tso tawm.
Cov kab mob kis tau ntev tshaj li rau lub lis piam. Generalized urticaria nyob rau hauv cov me nyuam hnub nyoog qis dua ob xyoos tshwm sim nyob rau hauv daim ntawv mob, mus txog rau 12 xyoo - mob thiab mob, nrog rau yav tas los predominating. Tom qab 12 xyoos - feem ntau tshwm sim mob.
Diagnosis
Kev kuaj mob urticaria dav dav yog nyob ntawm keeb kwm thiab daim duab kho mob. Yog tias qhov ua rau urticaria tsis raug tsim los thaum lub sijhawm kuaj lub cev thiab keeb kwm noj, tus kws kho mob tau sau ntawv mus kuaj. Nyob rau hauv daim ntawv mob ntawm tus kab mob, raws li txoj cai, tsis muaj yuav tsum tau mus soj ntsuam kuaj, tshwj xeeb tshaj yog cov neeg mob thaum provoking yam yog qhia nyob rau hauv lub anamnesis. Feem ntau, urticaria dav dav hauv daim ntawv mob hnyav tau nres zoo los ntawm H1-histamine blockers, thiab tshwj xeeb tshaj yog mob hnyav - los ntawm glucocorticosteroids.
Kev tshawb fawb hauv cov ntawv mob ntev
Nyob rau hauv rooj plaub no, kev sim tshuaj ntsuam xyuas yog txhawm rau txheeb xyuas qhov ua rau tus kab mob. Kev kuaj yuav tsum muaj xws li: kuaj ntshav, kuaj pom cov qib C-reactive protein muaj nyob hauv cov ntshav ntshav. Nrog rau kev soj ntsuam txuas ntxiv, kev sim tau ua kom tsis suav nrog qhov muaj cov kab mob sib kis, helminthic ntxeem tau.
Tus kws kho mob tshwj xeeb yuav xav tau cov txiaj ntsig kuaj thyroid (anti-thyroid antibodies, T4, TSH).
Txhob Cia Siab
Lub ntsiab ua rau muaj tus kab mob loj hlob muaj xws li zaub mov:
- nqaij thiab nqaij cov khoom (tsuas yog nqaij npuas thiab nqaij nyuj);
- fish;
- ntses thiab nqaij haus cov khoom;
- miv;
- qe qaib;
- pob zeb berries thiab txiv hmab txiv ntoo (strawberries, strawberries qus);
- liab apples;
- melon;
- carrot;
- khoom noj khoom haus ntxiv;
- med.
Tshuaj:
- tshuaj tua kab mob (feem ntau yog pab pawg penicillin);
- tshuaj tsis yog tshuaj steroid;
- sulfonamides;
- iodine npaj;
- Vitamin C;
- Pob B;
- tshuaj tua kab mob.
Lub cev muaj zog:
- kev kho dej;
- sunbeams;
- kub thiab txias yam;
- tshuaj lom ntawm qee cov kab.
Ntxiv rau, qhov ua rau muaj xws li: kab mob fungal, kab mob thiab kab mob, plab hnyuv dysbacteriosis, plab pathology tshwm sim los ntawm cov kab mob Helicobacter pylori, psychogenic yam, tshuaj pleev ib ce.
Symptomatics
Rau cov kab mob urticaria dav dav (peb tau tshaj tawm cov duab ntawm cov tsos mob hauv tsab xov xwm), cov tsos mob tshwm sim yog yam ntxwv: qhov tshwm sim ntawm cov pob liab liab thoob plaws lub cev, khaus khaus hnyav, uas tshwm sim thaum yav tsaus ntuj, o ntawm khaus khaus. thiab o ntawm daim tawv nqaij, kub hnyiab. Cov hlwv tuaj yeem yog cov kab sib txawv, uas feem ntau sib koom ua ib qho chaw liab. Lawv tau tsa sawv thiab yog bounded los ntawm papillary txheej ntawm daim tawv nqaij nrog ib tug tsa nto. Outwardly, cov pob khaus zoo li nettle hlawv, tab sis dav heev. Lawv sai sai kis thoob plaws lub cev thiabtsim ib qhov chaw loj heev.
Cov pob khaus tsis tshua pom tshwm rau ntawm daim tawv nqaij thiab daim di ncauj. Hauv thawj ob hnub, cov pob khaus ploj hauv qee qhov chaw, tab sis tshwm sim hauv lwm qhov chaw. Tsis tshua muaj ntau yog cov hemorrhagic thiab bullous daim ntawv ntawm generalized urticaria. Cov ntaub ntawv no yog qhov txaus ntshai heev. Tus neeg mob mob khaub thuas, kub taub hau, tsis qab los noj mov, malaise, xeev siab, mob pob qij txha, ntshav los ntshav.
Thaum muaj kev poob qis hauv lub siab, ua tsis taus pa thiab ua tsis taus pa, mob plab hauv plab, tsis nco qab, o ntawm lub caj pas, qhov ncauj, tus nplaig, yuav tsum tau pw hauv tsev kho mob sai.
txoj kev kho
Kev kho rau cov kab mob urticaria dav dav rau:
- tshem tawm cov pob khaus khaus;
- kev zam txim;
- relapse tiv thaiv.
Thaum pom muaj mob tshwm sim, hu rau lub tsheb thauj neeg mob. Ua ntej tuaj txog ntawm cov kws kho mob, nws yog ib qho tsim nyog yuav tsum sim txiav txim siab qhov ua xua uas ua rau muaj qhov tshwm sim thiab tsis suav nrog kev sib cuag.
Tshuaj
Tus neeg mob yuav tsum tau noj tshuaj tiv thaiv kab mob:
- "Tavegil".
- Y"Suprastin".
- Zodak.
- "Loratadine".
Thawj tiam antihistamine blockers yuav tsum tsuas yog noj yog tias cov tsos mob tshwm sim. Qhov no yuav nres cov tsos mob sai sai thiab tiv thaiv kev txhim kho ntawm Quincke's edema. Tus kws kho mob xwm txheej ceev yuav sau ib qho kev txhaj tshuaj (ntev)ib qho tshuaj tiv thaiv kab mob lossis (thaum mob hnyav) Prednisolone.
Yog tias muaj qhov tsis txaus ntseeg ntawm kev txhim kho ntawm Quincke's edema, tus neeg mob yuav raug txhaj tshuaj intramuscularly nrog "Epinephrine". Ntshav siab yog rov qab los nrog saline crystalloid daws, uas yog muab tso rau hauv cov hlab ntsha. Thaum lub pathology yog nrog los ntawm ib tug convulsive syndrome, tus kws kho mob sau cov kev taw qhia ntawm Diazepam los yog Relanium. Generalized urticaria, uas tus neeg mob qhov mob hnyav zuj zus sai, yuav tsum tau kho mob ceev hauv chav saib xyuas mob hnyav lossis chav saib xyuas mob hnyav.
Nyob ntawm qhov ua xua uas ua rau tus kab mob, ntxiv rau kev kho tshuaj tiv thaiv, kev siv tshuaj diuretics, sorbents, thiab plasmapheresis zaug yuav tsum tau ua. Yog tias tsim nyog, cov tshuaj uas ua rau lub hauv nruab nrab lub paj hlwb tuaj yeem raug sau tseg. Amitriptyline pab txo kev ntxhov siab. Txhawm rau txo cov tawv nqaij khaus thiab khaus, cov tshuaj tsis yog tshuaj steroidal siv sab nraud:
- Bepanthen.
- Solkoseril.
- Nyob zoo.
- Desitin.
Tsis txhob siv tshuaj pleev tshuaj hormonal rau thaj chaw loj ntawm daim tawv nqaij.
tawm tswv yim tiv thaiv
Kev kho mob ntawm urticaria dav dav yog ib txoj haujlwm ntev thiab nyuaj. Yog li ntawd, nws yog ib qho tseem ceeb los tiv thaiv tus kab mob. Feem ntau daim ntawv no tshwm sim ntawm ib qho kev tsis haum tshuaj tshwm sim vim tsis raws sij hawm lossis siv tshuaj rau tus kheej. Thaum thawj lub cim ntawm tus kab mob, koj yuav tsum tau mus ntsib kws kho mob tam sim ntawd. Qhov no yuav tiv thaiv kab mobkev tshwm sim.
Yog tias koj muaj kev fab tshuaj tiv thaiv kab mob, tsis txhob tiv tauj nrog cov tshuaj allergens. Piv txwv li, yog tias koj intolerant rau qee cov khoom, ua tib zoo kawm cov khoom xyaw ntawm cov tais diav.
Tshuaj tsuas yog yuav tsum tau noj raws li tus kws kho mob qhia. Nws yog ib qho tseem ceeb rau kev cob qhia tsis kam mus rau txhua hom irritants ntawm lub cev tiv thaiv kab mob. Rau qhov no koj xav tau:
- Qhia cov khoom noj ntxiv rau cov menyuam mos raws li cov lus pom zoo ntawm tus kws kho menyuam yaus;
- tshem tawm cov zaub mov uas tsis haum rau cov khoom noj;
- txhob tus cwj pwm phem;
- ua kis las;
- ua pa tsis tu ncua thiab ntxuav chav ntub dej.
Tus kab mob urticaria yog ib yam kab mob hnyav, kho nyuaj. Thaum thawj cov tsos mob ntawm kev rov tshwm sim ntawm pathology, tag nrho cov kev ntsuas tsim nyog yuav tsum tau coj los txo cov tsos mob txhawm rau tiv thaiv cov txheej txheem inflammatory los ntawm kev sib kis thoob plaws hauv lub cev. Ib txwm muaj tshuaj tiv thaiv kab mob ntawm tes. Tom qab txhua qhov exacerbation, mus ntsib kws kho mob yog qhov yuav tsum tau ua ua ntej uas lav kev kho mob zoo.
