Polymyositis yog qhov tsawg heev, tab sis hnyav heev. Qhov no pathology belongs rau cov pab pawg neeg ntawm cov kab mob. Tus kab mob no tshwm sim los ntawm kev puas tsuaj rau cov leeg thiab pob txha, feem ntau ua ke nrog kev puas tsuaj rau daim tawv nqaij (qhov no, tus kab mob hu ua dermatomyositis). Kab lus no tau mob siab rau cov tsos mob ntawm polymyositis, kuaj mob thiab kho cov kab mob no.
Ua rau kab mob
Tus etiology ntawm tus kab mob no tau kawm me ntsis. Txog rau tam sim no, lub ntsiab ua rau polymyositis, hmoov tsis, tseem tsis paub.
Muaj kev xav tias qhov tseem ceeb tshwm sim yog qee kis kab mob yav dhau los. Qhov tshwm sim ntawm kev tsim cov kab mob polymyositis (cov tsos mob uas tau piav qhia hauv tsab xov xwm no) yuav ntau dua yog tias tus neeg mob muaj mob los ntawm cov kab mob cab. Nws ntseeg tau tias ib qho ntawm "qhov laj thawj" yog qhov cuam tshuam ncaj qha ntawm lub cev tiv thaiv kab mob rau cov kab mob antigens.
Ntxiv rau, cov hauv qab no tuaj yeem ua rau pom tus kab mob:
- Vim kev raug mob.
- Kev tsis haum tshuaj.
- Hypocooling/overheating.
- Nyob rau lub hnub kub heevhluav taws xob.
- Kev cev xeeb tub.
Nyob rau ib feem peb ntawm cov neeg mob, tus kab mob no nrog rau kev tsim ntawm ntau yam neoplasms thiab tej zaum yuav ua rau muaj kev phom sij ntawm cov qog nqaij hlav cancer ntawm cov leeg. Lwm qhov kev xaiv rau qhov pib ntawm tus kab mob yog qhov tshwm sim ntawm cov tshuaj tiv thaiv immunopathological vim yog qhov sib txuam ntawm myocytes thiab qog antigens, uas lub cev pom tau zoo ib yam thiab sim ua kom puas.
Risk pawg
Txoj kev xav, txhua tus tuaj yeem mob polymyositis, tsis hais poj niam txiv neej thiab hnub nyoog li cas. Txawm li cas los xij, raws li kev txheeb cais, cov poj niam feem ntau cuam tshuam ntau dua li cov txiv neej. Nws tau raug tsim los hais tias feem coob ntawm cov menyuam yaus hnub nyoog 5-15 thiab cov laus hnub nyoog 40-60.
Kev faib tawm
Raws li qhov chaw ntawm cov txheej txheem thiab cov tsos mob tshwm sim, polymyositis tau muab faib ua hom hauv qab no:
- Primary (ideopathic) daim ntawv ntawm polymyositis. Nws loj hlob qeeb, nws yog ntau dua rau cov poj niam. Nyob rau hauv rooj plaub no, cov nqaij ntshiv ntawm lub caj dab thiab ceg ceg raug puas. Cov neeg mob yws txog qhov nyuaj ntawm kev nce ntaiv, combing, leeg nro thiab mob. Qee zaum arthralgia kuj tshwm sim. Hauv qhov xwm txheej hnyav, cov leeg nqaij atrophy thiab dysphagia tsim.
- Myositis nrog suav nrog. Qhov ntau yam no tsis tshua kuaj pom. Nrog rau kev puas tsuaj rau ntu ntu ntawm cov ceg ceg.
- Juvenile (me nyuam yaus). Lub ntsiab tshwm sim yog calcification (deposition ntawm calcium ntsev) nyob rau hauv thiab nyob rau hauv daim tawv nqaij. Nrog rau kev loj hlob ntawm cov txheej txheem, atrophy thiab contractures tshwm sim, cov hlab ntsha raug cuam tshuam (txog rau vasculitis thiab thrombosis) thiab plab hnyuv, ib qho kev mob tshwm sim, ulcerations, perforations thiab los ntshav tshwm sim.
- Ua ke nrog autoimmune kab mob pathologies. Hauv qhov no, polymyositis ua rau muaj teeb meem ntawm SLE, RA, Sjögren's disease lossis scleroderma.
- Primary dermatomyositis (ideopathic). Cov tsos mob ntawm daim ntawv no yog sawv cev los ntawm qhov tshwm sim ntawm ntau cov pob liab liab (dermatitis, erythema) ntawm lub ntsej muag, hauv thaj tsam ntawm cov pob qij txha ntawm cov ntiv tes, nraub qaum thiab ceg. Stomatitis, conjunctivitis thiab pharyngitis feem ntau tshwm sim.
- Polymyositis hauv malignant neoplasms. Feem ntau pom ob xyoos tom qab qhov malignancy ntawm cov txheej txheem. Daim ntawv no yog ib qho zoo rau cov neeg laus uas muaj mob qog noj ntshav, prostate lossis lub mis, ntsws, hnyuv, nrog rau cov neeg mob lymphomas.
daim duab kho mob
Cov kab mob no (ob leeg rau cov neeg laus thiab menyuam yaus) yog qhov tshwm sim los ntawm qhov pib ntawm tus txheej txheem. Nyob rau tib lub sijhawm, kev tshwm sim ntawm kev puas tsuaj rau cov leeg ntawm lub xub pwg nyom thiab pelvis yog suav tias yog thawj cov tsos mob ntawm polymyositis.
Ntxiv mus, cov tsos mob ntawm cov kab mob hauv nruab nrog cev (lub ntsws, plab hnyuv thiab lub plawv) koom nrog. Kwv yees li 15% ntawm cov neeg mob muaj articular syndrome.
Cov neeg mob feem ntau xav paub seb cov tsos mob twg yog tus yam ntxwv ntawm polymyositis. Raws li txoj cai, kev tshwm sim ntawm cov leeg nqaij syndrome tuaj yeem tshwm sim hauv tus kab mob no. Wb tham kom ntxaws ntxiv.
Muscle Syndrome
Tus yam ntxwvmob nqaij uas tshwm sim thaum txav mus los, palpation, thiab qee zaum thaum so. Nrog rau qhov mob, cov leeg tsis muaj zog nce ntxiv, tiv thaiv tus neeg mob los ntawm kev ua haujlwm ntawm theem pib nquag thiab tag nrho. Tus neeg mob tsis tuaj yeem zaum, tuav cov khoom hauv nws txhais tes, sawv ntsug, rub lub taub hau tawm hauv ncoo, thiab lwm yam.
Cov leeg nqaij cuam tshuam los ntawm tus kab mob thicken thiab o. Tom qab ntawd, lawv raug atrophy, myofibrosis, thiab, hauv qee hom, calcification. Cov kev hloov no tuaj yeem ua rau tus neeg mob tsis tuaj yeem ua tiav.
Muscular syndrome txhais tau tias muaj qhov txhab thiab cov leeg du ntawm txoj hlab pas, lub ntsws, pharynx. Hauv qhov no, kev nqhis dej tsis zoo (dysphagia) thiab kev hais lus hloov pauv (dysarthria) tshwm sim. Yog tias tus txheej txheem kis mus rau cov leeg nqaij, tus neeg mob lub ntsej muag zoo ib yam li daim npog ntsej muag, rau cov leeg ntawm lub qhov muag - qhov tshwm sim ntawm ptosis, strabismus thiab diplopia.
Qhia kev puas tsuaj rau cov pob qij txha ntawm tes thiab dab teg.
pob taws, lub xub pwg nyom, hauv caug thiab lub luj tshib yog qhov mob tsawg dua. Nyob rau tib lub sijhawm, cov cim qhia pom tseeb ntawm cov txheej txheem inflammatory hauv kev sib koom ua ke tau pom: hyperemia thiab o ntawm daim tawv nqaij (qee zaum muaj calcifications hauv nws), txwv kev txav. Txawm li cas los xij, qhov deformation ntawm kev sib koom tes nrog polymyositis tsis tshwm sim.
Hloov pauv hauv nruab nrog cev
YThaum polymyositis feem ntau tshwm sim ntawm cov kab mob ntawm lub plab zom mov, tshwm sim los ntawm cov tsos mob hauv qab no: anorexia,plab hnyuv, raws plab / cem quav, mob plab, los ntshav erosions, perforations los yog ulcers.
Qhov tshwm sim ntawm kev ua tsis tiav ntawm cov leeg ua pa thiab ntuav cov zaub mov mus rau hauv txoj kev ua pa thaum nqos yog hypoventilation thiab, vim li ntawd, kev loj hlob ntawm mob ntsws.
Kev puas tsuaj rau cov kabmob ntawm cov hlab plawv tuaj yeem tshwm sim hauv daim ntawv ntawm arrhythmia, hypotension, Raynaud's syndrome, plawv tsis ua haujlwm thiab myocarditis.
Kev mob nkeeg
Cov kev kawm ntawm polymyositis tuaj yeem mob, subacute (ntau zaus) thiab ntev.
Nyob rau hauv cov ntaub ntawv ntawm ib tug mob hnyav, tus kab mob tshwm sim nws tus kheej nrog intoxication thiab kub taub hau, cov nqaij ntshiv kev loj hlob sai, dysarthria thiab dysphagia tshwm sim. Nyob rau hauv ib lub sij hawm luv luv, tus neeg mob yuav immobilized. Yog tias txoj kev kho tsis tau ua tiav, tus mob no zuj zus sai. Tseem muaj qhov tshwm sim tuag.
Polymyositis nrog cov chav kawm subacute yog tus cwj pwm los ntawm kev hloov pauv hauv tus neeg mob tus mob: lub sijhawm tsis zoo hloov pauv nrog kev txhim kho. Txawm hais tias zoo li kev txhim kho ib ntus, cov leeg tsis muaj zog nce ntxiv thiab kev puas tsuaj rau cov kabmob sab hauv koom nrog.
Cov kab mob ntev ntev yog suav tias yog qhov zoo tshaj plaws thiab yog qhov pom ntawm qhov swb ntawm qee cov leeg leeg, vim tias cov neeg mob tseem tuaj yeem ua haujlwm tau ntev.
ntsuas ntsuas
Yog tias xav tias polymyositis (nrog cov tsos mob tau piav qhia saum toj no), tus neeg mob yuav tsum sab laj nrog kws kho mob rheumatologist, neurologist, gastroenterologist, pulmonologist thiab kws kho plawv.
soj ntsuam cov txiaj ntsigntshav qhia tias muaj qhov mob (leukocytosis thiab nrawm ESR). Ntshav biochemistry qhia cov cim qhia ntawm cov leeg nqaij puas (nce qib ntawm aldolase, CPK, ALT, AST). Nrog polymyositis, cov ntaub ntawv no yog siv los txiav txim siab qib ntawm kev ua o hauv cov leeg nqaij. Kwv yees li 20% ntawm cov neeg mob muaj cov tshuaj tiv thaiv kab mob. Txawm tias tsis tshua muaj, qhov mob rheumatoid tau kuaj pom hauv cov ntshav ntawm cov neeg mob.
Txhawm rau kom tsis suav nrog lwm cov kab mob neuromuscular, electromyography tau sau tseg. Kev lees paub ntawm kev hloov pauv pathological hauv cov leeg nqaij yuav yog:
- Low amplitude action peev xwm.
- Spontaneous fibrillations.
- Nyob zoo dua.
Cov txheej txheem qhia paub ntau tshaj plaws uas lees paub tias muaj polymyositis yog histology ntawm cov leeg nqaij. Txhawm rau nqa cov khoom, ib qho kev kuaj ntshav ntawm quadriceps lossis biceps ntawm lub xub pwg yog siv. Nyob rau tib lub sijhawm, kev hloov pauv tus yam ntxwv ntawm polymyositis tau kuaj pom: kev nkag mus ntawm cov leeg nqaij thiab cov phab ntsa vascular los ntawm lymphocytes, muaj cov vacuoles (kab noj hniav) ntawm fibers, degenerative lossis necrotic hloov.
Rau qhov kev kuaj mob ntawm lub xeev ntawm cov kab mob somatic, X-ray ntawm lub ntsws, ultrasound ntawm lub plawv thiab plab hnyuv, gastroscopy thiab ECG tau sau.
YPathology Therapy
Kev kho mob ntawm polymyositis los ntawm kev tshem tawm cov txheej txheem inflammatory thiab tswj kom ruaj khov.
Basic therapy - glucocorticosteroid tshuaj. Thaum pib ntawm kev kho mob, qhov ntau npaum ntawm "Prednisolone" yog 40-60 mg / hnub,txo qis mus rau 10-20 mg / hnub.
Yog tias qhov kev kho mob tsis coj cov txiaj ntsig xav tau (uas yog, tsis muaj kev txhim kho ntawm tus mob thiab cov ntshav suav), cov tshuaj tiv thaiv kab mob tau muab tshuaj (piv txwv li Methotrexate). Cov tshuaj no tuaj yeem muab tshuaj los ntawm qhov ncauj lossis intramuscularly. Contraindications rau kev siv "Methotrexate" yog: lub raum / siab tsis ua hauj lwm, pathological hloov nyob rau hauv cov ntshav txhaws.
Immunosuppressants "Cyclophosphamide", "Cyclosporine", "Azathioprine", "Chlorambucil" tsis tshua nyiam rau polymyositis, tab sis lawv kuj tau muab tshuaj rau qee kis.
Ua ntej cov tshuaj tiv thaiv inflammatory yuav txo qis, tus neeg mob lub cev kev ua si yog nruj heev.
Yog tias polymyositis ua ke nrog vasculitis, tus neeg mob tau muab tshuaj lymphocyto- thiab plasmapheresis.
Huab cua
Qhov kev cia siab tsis zoo tshaj plaws yog hom mob polymyositis, ua rau thiab cov tsos mob uas peb tau tham saum toj no. Aspiration pneumonia los yog cardiopulmonary tsis ua hauj lwm los ntawm qhov no feem ntau yog ua rau tuag.
Tus neeg mob thaum yau ua rau qhov kev mob tshwm sim ntawm polymyositis (cov tsos mob thiab kev kho mob rau cov neeg mob pawg no zoo ib yam li cov neeg laus). Qhov sib txawv yog nyob ntawm qhov ntau npaum ntawm cov tshuaj, uas yuav tsum tau txiav txim los ntawm tus kws kho mob tuaj koom. Txoj kev loj hlob zuj zus thiab nrawm ntawm pathology yuav luag ib txwm ua rau immobilization ntawm tus menyuam.
Cov chav kawm ntev yog qhov zoo tshaj plaws rau lub neej thiab muaj peev xwm ua haujlwm ntxiv.
