Hemorrhagic vasculitis yog ib hom kab mob uas tiv thaiv kab mob vasculitis. Cov kab mob no cuam tshuam rau cov hlab ntsha me. Nws yog tus cwj pwm los ntawm kev nce hauv kev tsim ntawm lub cev tiv thaiv kab mob, nce permeability thiab txo qis hauv elasticity ntawm cov hlab ntsha thiab cov phab ntsa capillary.
Tus kab mob no feem ntau tshwm sim 10-20 hnub tom qab mob ua pa nyuaj, tonsillitis, mob khaub thuas lossis kub taub hau, yog li menyuam yaus muaj kev pheej hmoo rau tus kab mob no. Cov menyuam yaus hnub nyoog 3 txog 7 xyoos tshwj xeeb tshaj yog raug rau pathology. Los ntawm txoj kev, cov tub hluas tau mob 2-3 zaug ntau dua li cov ntxhais. Hauv kev faib tawm thoob ntiaj teb ntawm cov kab mob ntawm qhov kev hloov kho thib 10 (ICD 10), hemorrhagic vasculitis tau sau npe D69.0, D89.1 - "Systemic hemorrhagic vascular lesions."
Ua rau kab mob
Vim li cas ib qho mob tshwm sim, uas tseem hu ua Henoch-Schonlein kab mob thiab capillary toxicosis? Cov txheej txheem ntawm kev txhim kho vasculitis yog qhov yooj yim heev: cov txheej txheem aseptic inflammatory tshwm sim hauv cov hlab ntsha, tshwm sim los ntawm kev puas tsuaj ntawm cov kab mob hauv lub cev.tshuaj tiv thaiv. Henoch-Schonlein tus kab mob yog tshwm sim los ntawm hemorrhages, ib tug malfunction nyob rau hauv cov txheej txheem ntawm intravascular coagulation thiab ua txhaum ntawm cov ntshav ncig nyob rau hauv cov hlab ntsha me.
Ua rau hemorrhagic vasculitis nyob rau hauv cov neeg mob ntawm txhua lub hnub nyoog yog conditionally muab faib ua ob peb pawg:
- teeb meem tom qab muaj mob (ua pa kab mob, kab mob qhua pias, kab mob herpes, scarlet fever) tshwm sim los ntawm pathogenic microflora thiab cab;
- kev tsis haum;
- hypothermia;
- tshuaj tiv thaiv tsis haum;
- kev hloov pauv.
Qhov tseem ceeb ntawm qhov tshwm sim ntawm hemorrhagic vasculitis yog tsim ntawm lub cev tiv thaiv kab mob uas muaj cov tshuaj tiv thaiv. Cov txheej txheem no tau tso rau sab hauv ntawm phab ntsa ntawm cov hlab ntsha, uas ua rau cov hlab ntsha puas tsuaj thiab, vim li ntawd, muab cov xwm txheej rau kev txhim kho ntawm kev mob aseptic tom qab mob. Raws li, nrog rau cov kab mob ntawm lub vascular cov ntaub so ntswg, nws elasticity txo qis markedly, raws li ib tug tshwm sim ntawm cov phab ntsa ua permeable, qhov khoob tshwm sim. Cov kab mob no ntawm cov hlab ntsha thiab cov hlab ntsha ua rau cov fibrin deposits thiab tsim cov ntshav txhaws. Cov saum toj no piav qhia txog cov tsos mob ntawm vasculitis - bruising, provoked los ntawm microthrombosis ntawm cov hlab ntsha.
Ntau yam
Hnub no, cov kws kho mob paub ntau hom hemorrhagic vasculitis. Nyob ntawm daim duab kho mob, tus kab mob tshwm sim:
- dermal;
- abdominal, uas yog, tsim nyob rau hauv lub plab kab noj hniav;
- renal;
- combined.
Tus kab mob tuaj yeem tshwm sim ib txhij hauv ntau hom. Ntawm cov kev sib xyaw ua ke feem ntau, cutaneous-articular vasculitis yog qhov ntau tshaj. Cov kws tshaj lij kuj hu daim ntawv no yooj yim. Nyob ntawm qhov hnyav ntawm pathology, nws tau muab cov qib qis, nruab nrab thiab siab ua haujlwm. Lwm typology ntawm hemorrhagic vasculitis yog tsim raws li qhov xwm ntawm tus kab mob. Yog li, capillary toxicosis tuaj yeem yog:
- xob laim nrawm (kom txhim kho qhov tseeb hauv ib hnub);
- mob (mob kab mob feem ntau tsis tshaj 30-40 hnub);
- protracted (tshaj 2 lub hlis);
- recurrent (cov tsos mob ntawm tus kab mob rov tshwm sim ntau zaus tshaj 3-4 xyoos);
- mob ntev (cov duab kho mob tseem tsis hloov pauv rau 1.5-2 xyoos, kev tshem tawm hloov pauv nrog cov nquag lossis tsis tshua muaj exacerbations).
Cov cim tseem ceeb ntawm pathology
Hais txog kev kho mob tshwm sim ntawm cov kab mob vascular tau piav qhia, nws tsim nyog sau cia tias cov neeg laus thiab menyuam yaus muaj cov tsos mob ntawm hemorrhagic vasculitis. Nyob rau tib lub sijhawm, cov yam ntxwv ntawm chav kawm ntawm tus kab mob yuav txawv nyob ntawm lub hnub nyoog. Feem ntau, tus kab mob no tshwm sim los ntawm patchy pob khaus ntawm lub epidermis. Lawv hu ua daim tawv nqaij hemorrhagic rash.
Nyob rau hauv daim ntawv articular ntawm vasculitis, cov neeg mob yws ntawm qhov mob ntawm pob qij txha. Cov tsos mob no tshwm sim nyob rau hauv xya tawm ntawm kaumrooj plaub. Nrog rau daim ntawv plab ntawm cov kab mob hemorrhagic, nws qhov kev tshwm sim uas tsis tuaj yeem tshwm sim yog npub, mob plab hauv plab.
Nrog rau qhov nyuaj hemorrhagic vasculitis nyob rau hauv cov neeg laus, cov hlab ntsha ntawm lub nruab nrog cev, nrog rau ob lub raum, ntsws, thiab hlwb, feem ntau cuam tshuam. Qhov kev pom zoo tshaj plaws yog muab rau cov neeg mob uas tus kab mob tshwm sim tsuas yog nrog qhov tshwm sim ntawm qhov muag pom nyob rau hauv daim ntawv ntawm cov pob khaus hemorrhagic.
Ntawm ntawm daim tawv nqaij nrog vasculitis
Raws li twb tau sau tseg, nrog rau txhua hom kab mob no, qhov nqaij tawv nqaij raug pom. Lub swb ntawm lub epidermis yog lub ntsiab tshwm sim ntawm hemorrhagic vasculitis. Nws tshwm sim hauv txhua tus neeg mob, tsis hais qhov tshwm sim ntawm cov tsos mob ntxiv. Cov pob khaus ntawm daim tawv nqaij tuaj yeem tshwm sim ob qho tib si thaum pib, thawj theem ntawm tus kab mob, thiab tom qab qee lub sijhawm, raws li pathology nce. Qhov tshwj xeeb tshaj plaws yog cov tsos ntawm purpura - me me-spotted hemorrhages, palpable ntawm palpation. Xws li cov pob liab liab yog sib luag, muaj cov me me (los ntawm 1 mus rau 3 hli) nodules. Thaum xub thawj, cov pob khaus cuam tshuam rau ob txhais taw thiab sab ceg, tab sis tom qab ntawd kis mus rau tag nrho cov ceg. Ntxiv nrog rau purpura, lwm yam tseem tuaj yeem tshwm sim (cov hlwv, liab nrog tev, thiab hauv cov xwm txheej hnyav txawm tias qhov chaw necrotic ntawm txheej txheej sab saud ntawm cov epidermis).
mob pob qij txha
70% ntawm cov ntaub ntawv keeb kwm qhia qhov mob hnyav ntawm cov tsos mob ntawm vasculitis xws li mob pob qij txha. Cov cim no feem ntau tshwm nrog cov pob khaus hauv thawj lub lis piam ntawm kev mob. Cov kev hloov ntawm cov pob qij txha thiab cov seem sab hauv tuaj yeem ua nrog me me thiabCov kev mob luv luv, txawm li cas los xij, qhov mob hnyav dua tsis suav nrog, uas tsis yog qhov loj (pob taws thiab hauv caug), tab sis kuj cov pob qij txha ntawm cov ntiv taw raug kev txom nyem. Lawv swell, thiab ib tug luv luv-term hloov nyob rau hauv lawv cov duab kuj ua tau. Txawm li cas los xij, nrog rau kev kawm ib txwm muaj thiab kho raws sijhawm, tus kab mob tsis ua rau muaj kev cuam tshuam loj ntawm cov pob qij txha, thiab qhov tsis xis nyob tsis cuam tshuam qhov nruab nrab ntev tshaj 5 hnub.
mob plab kab mob
Qhov hnyav ntawm chav kawm yog tus cwj pwm los ntawm hemorrhagic vasculitis hauv cov neeg laus, uas yog nrog los ntawm kev puas tsuaj rau cov hlab ntsha ntawm txoj hnyuv. Feem ntau, qhov tshwm sim ntawm qhov mob plab yog ua ntej ntawm cov pob khaus hemorrhagic. Cov kev xav tsis zoo tshwm sim thaum me me capillaries tawg rau ntawm phab ntsa ntawm txoj hnyuv, thiab yog li ntawd muaj qhov mob hnyav heev. Cov neeg mob, piav qhia qhov tsis xis nyob, nco ntsoov tias nws feem ntau tshwm sim nyob rau hauv lub plab, txoj cai iliac thiab hypochondral cheeb tsam.
Mob mob hauv hemorrhagic vasculitis zoo ib yam li daim duab kho mob uas tshwm sim los ntawm kev mob appendicitis, ulcer perforation lossis plab hnyuv. Qhov mob yuav kav ntev li 3-10 hnub. Feem ntau cov kab mob tshwm sim nrog xeev siab thiab ntuav, uas muaj cov hnoos qeev thiab ntshav impurities. Los ntawm txoj kev, cov ntshav nyob rau hauv cov quav nrog lub plab daim ntawv ntawm vasculitis yog ib qho mob heev. Nyob rau hauv cov xwm txheej hnyav, cov hnyuv los ntshav tshwm sim, ua rau muaj kev poob qis hauv cov ntshav siab thiab qaug zog.
Tus kab mob no tshwm sim li cas ntawm cov hnub nyoog sib txawv
Qhov sib txawv ntawm cov kab mob hauv cov menyuam yaus thiab cov neeg laus nyob hauv nws txoj kev loj hlob. Hauv cov neeg laus, daim duab kho mob yog "blurred". Vim li no, hauv thawj theem, kev kuaj mob ntawm hemorrhagic vasculitis yog qhov nyuaj, vim tias cov tsos mob tsis tshwm sim tag nrho. Kev noj qab nyob zoo ntawm tus neeg mob xyaum tsis raug kev txom nyem.
Hauv cov menyuam yaus, pathology ntawm cov hlab ntsha me muaj qhov pib mob hnyav. Vasculitis nyob rau hauv cov menyuam yaus hnub nyoog qis dua 6 xyoo muaj kev loj hlob sai, nrog rau kub taub hau, ua daus no thiab qaug zog. Nyob rau tib lub sijhawm, nyob rau hauv ib nrab ntawm kev kho mob hauv cov neeg mob ntawm txhua lub hnub nyoog, ib qho mob plab tau pom, uas yog nrog los ntawm cov kab mob dyspeptic (xeev siab, ntuav, quav quav nrog ntshav streaks). Yog tias ob lub raum koom nrog cov txheej txheem pathological, kuaj pom muaj protein nyob hauv cov zis ntawm cov neeg mob, hematuria tuaj yeem ua tau. Nrog rau kev ncua kev kho mob, lub raum puas ua rau muaj kev loj hlob ntawm cov kab mob glomerulonephritis ntev, ua raws li kev tsim ntawm lub raum tsis ua haujlwm.
Kab mob sib kis
Nws tsis tsim nyog ncua kev kho mob hemorrhagic vasculitis. Cov teeb meem tshwm sim ntawm tus kab mob no suav nrog kev txhim kho ntawm:
- plab hnyuv;
- pancreatitis;
- perforation ntawm gastric thiab plab hnyuv ulcers;
- peritonitis;
- moderate anemia;
- DIC nrog thrombocytopenia;
- thrombosis;
- subtotal lossis tag nrho lub plawv nres;
- neuritis;
- mob hlwb.
Cov teebmeem zoo ib yam ntawm hemorrhagic vasculitismuaj peev xwm tsuas yog nyob rau hauv cov ntaub ntawv ntawm tsis quav ntsej cov tsos mob ntawm tus kab mob thiab belatedly nrhiav kev pab kho mob. Yog li ntawd nws yog ib qho tseem ceeb kom pib kho sai li sai tau. Tom qab tag nrho, nws tsis yog ib qho zais cia rau leej twg uas txhua tus kab mob yog yooj yim dua los kov yeej nws cov theem pib. Nws yog tsis yooj yim sua rau nws tus kheej tshuaj thiab mus rau uncontrolled noj tshuaj los yog tshuaj tsoos tshuaj. Cov tshuaj yuav tsum tau muab los ntawm tus kws kho mob tshwj xeeb nkaus xwb tom qab kev tshuaj xyuas thiab kev kuaj mob.
Cov txheej txheem kuaj mob
Hemorrhagic vasculitis yog kho los ntawm kws kho mob rheumatologist. Nyob rau hauv cov ntaub ntawv ntawm ib tug complex txheej txheem ntawm tus kab mob thiab kev puas tsuaj rau lub hauv nruab nrog cev, kev sab laj ntawm cov kws kho mob tshwj xeeb kuj yuav tsum tau - ib tug dermatologist, gastroenterologist, neurologist, nephrologist, cardiologist thiab pulmonologist.
Kev xav tias tus neeg mob uas muaj hemorrhagic vasculitis, tus kws kho mob yuav tsum kuaj xyuas, sau cov tshuaj anamnesis, sau ntawv hauv chav kuaj thiab ntsuas ntsuas. Cov tswv yim kws tshaj lij yuav pab kom tau txais daim duab lub hom phiaj ntawm tus kab mob thiab pib kho kom tsim nyog.
Cov kev kuaj mob tseem ceeb rau hemorrhagic vasculitis hnub no yog:
- coagulogram;
- kev tshuaj xyuas rau lub xub ntiag ntawm immunoglobulins ntawm chav kawm A thiab G (thawj qhov taw qhia hauv vasculitis yog nce, thiab qhov thib ob yog txo), cryoglobulins thiab lwm yam tshuaj tiv thaiv;
- assay txhawm rau txheeb xyuas cov kab mob tiv thaiv kab mob;
- kuaj ntshav biochemical;
- dav dav (ntau yam) kuaj ntshav (rauCov ntsuas ntawm leukocyte formula yog coj los ua lub hauv paus).
Tom qab ua qhov kuaj pom tseeb, lawv mus rau kev tsim kho kev kho mob.
Txoj kev kho mob
Hemorrhagic vasculitis, tshwm sim nyob rau hauv daim tawv nqaij me-articular, yuav tsum muaj kev kho mob sab nraud nrog kev ua raws nraim li kev so hauv txaj thiab noj zaub mov uas tsis suav nrog kev noj cov tsiaj protein thiab kev ua xua. Capillarotoxicosis nyob rau lub sijhawm mob hnyav yuav tsum tau mus pw hauv tsev kho mob thiab saib xyuas kev kho mob tas li, thiab thaum lub cev sab hauv koom nrog cov txheej txheem pathological, kev siv cov tshuaj muaj zog tau sau tseg hauv qee qhov ntau npaum. Cov pab pawg tshuaj uas siv los kho tus kab mob hauv nqe lus nug (hemorrhagic vasculitis) suav nrog cov tshuaj hauv qab no:
- Disaggregants ("Kurantil", "Trental"). Lawv muab intravenously los ntawm drip. Tsis tas li ntawd, rau kev txhaj tshuaj subcutaneous lossis parenteral, "Heparin" raug tshuaj, uas maj mam tso tseg nrog kev txo qis.
- Fibrinolysis activators (cov tshuaj muaj nicotinic acid).
- Steroids (possible plasmapheresis).
- Cytostatics ("Azathioprine" lossis "Cyclophosphamide").
Lub sijhawm kho tus kab mob no hauv cov menyuam yaus thiab cov neeg laus feem ntau nyob ntawm nws qhov hnyav thiab daim ntawv kho mob. Raws li txoj cai, tag nrho cov kev kho mob yuav tsum tau 2-3 lub hlis rau ib tug me me, mus txog rau lub hlis rau ib tug nruab nrab chav kawm, thiab txog 12 lub hlis rau ib tug hnyav, nrog rau relapses thiab nephritis.
Raws li ICD-10 cov lej, hemorrhagic vasculitis nyob hauv tib pab pawg ua xua thiab rheumatic purpura. Kev kho mob ntawm cov kab mob no kuj nyuaj los ntawm qhov tsis muaj cov tshuaj zoo uas ncaj qha cuam tshuam cov txheej txheem pathological, tsis hais nws qhov chaw nyob.
Vasculitis khoom noj
Txhawm rau tiv thaiv kev nkag siab ntawm daim tawv nqaij ntxiv, kev noj haus yog qhov tseem ceeb tshaj plaws. Nrog hemorrhagic vasculitis, cov tshuaj extractive thiab tag nrho cov khoom uas nyuaj rau zam los ntawm lub cev yuav tsum raug tshem tawm tag nrho ntawm cov khoom noj. Muaj peev xwm ua xua (chocolate, kas fes, zib ntab, txiv ntoo, txiv kab ntxwv, txiv pos nphuab, qe, zaub mov kaus poom) kuj raug txwv.
Nyob rau hauv rooj plaub ntawm plab thiab lub raum mob, kev noj zaub mov raug xaiv los ntawm tus kws kho mob, suav nrog cov lus pom zoo ntawm tus kheej. Nrog hemorrhagic vasculitis nyuaj los ntawm nephritis, nws raug pom zoo kom ua raws li kev noj haus No. 7 (nws peculiarity nyob rau hauv inadmissibility ntawm kev siv ntsev thiab tsiaj cov khoom).
Yuav ua li cas rov qab tau
Nws yuav tsum tau sau tseg tam sim ntawd tias nrog hemorrhagic vasculitis, qhov kev cia siab yog qhov zoo heev. Qhov tshwm sim tuag rau cov neeg mob uas muaj kev kuaj mob zoo li no tuaj yeem tshwm sim nyob rau theem mob hnyav ntawm tus kab mob vim muaj teeb meem ntawm lub plab zom mov (los ntshav sab hauv, intussusception, plab hnyuv infarction). Hauv cov xwm txheej sib cais, kev tuag tshwm sim los ntawm lub raum tsis ua haujlwm lossis kev puas tsuaj loj rau lub hauv paus paj hlwb.
