Kab mob ntsws hnyav xws li mob ntsws tsis yog ib txwm ua los ntawm cov kab mob flora. Parasites, fungi, tshuaj, immunodeficiency xeev, thiab kev tsis haum tshuaj tuaj yeem cuam tshuam cov homeostasis ntawm sab sauv thiab sab hauv ua pa. Thiab nyob rau hauv cov xwm txheej zoo li no, eosinophilic pneumonia tshwm sim.
Definition
Eosinophilic pneumonia yog cov txheej txheem pathological hauv lub ntsws uas tshwm sim los ntawm ntau dhau ntawm eosinophils nyob rau hauv alveoli. Muaj ntau ntau hom lossis txawv ntawm cov kab mob no uas tuaj yeem txhim kho txhua lub hnub nyoog.
Kev kho mob, nws yog qhov ua tau zoo sib xws los ntawm cov kab mob zoo sib xws los ntawm cov kab mob, yog li qhov tseem ceeb hauv kev kuaj mob yog nyob rau hauv kev sim kuaj: ua tiav cov ntshav suav, hnoos qeev microscopy. Feem ntau, tom qab txiav txim siab txog hom kab mob, kev kho nrog steroid hormones ntawm adrenal cortex pib. Qhov no yuav pab txo qis cov lus teb inflammatory thiab txo cov tsos mob ntawm mob ntsws. Qhov kev cia siab rau cov neeg mob no feem ntau yog qhov zoo.
History
Ntawmeosinophilic pneumonia, qhov ua rau ntawm lub sijhawm ntawd tsis paub, tau piav qhia thawj zaug hauv nruab nrab ntawm lub xyoo pua nees nkaum, xyoo 1969, los ntawm tus kws kho mob Harrington. Nws tsis txaj muag, yog li nws tau muab tus kab mob rau nws tus kheej lub npe, thiab tom qab luam tawm, tag nrho lub ntiaj teb kev tshawb fawb tau pib hu cov kab mob tshiab Harrington's syndrome.
Ua ntej tsab xov xwm keeb kwm no, eosinophilic pneumonia tau paub tias yog ib yam kab mob uas tshwm sim hauv lub ntsws thaum kis kab mob los yog tshuaj tiv thaiv tsis tau. Nees nkaum xyoo tom qab, xyoo 1989, lo lus "mob eosinophilic pneumonia" tshwm sim hauv cov tshuaj.
Etiology
Muaj ntau ntau yam hauv qab kev cuam tshuam ntawm cov mob ntsws eosinophilic tshwm sim. Ua rau thiab cov tsos mob zoo sib xws. Piv txwv li, mob ntsws ntsws yog tshwm sim los ntawm kev haus luam yeeb (ob leeg nquag thiab tsis muaj zog), ua xua rau tshuaj, lossis txo qis hauv lub cev tiv thaiv kab mob HIV lossis AIDS. Yog tias tsis muaj qhov ua rau haum, ces tus kab mob ntsws yog suav tias yog idiopathic.
mob eosinophilic pneumonia tuaj yeem tshwm sim los ntawm cov kab mob fungal (aspergillosis, pneumomycosis), helminthic ntxeem tau (ascariasis, echinococcosis), kev siv ntev ntev ntawm cov tshuaj uas ua rau lub cev tsis muaj zog (glucocorticosteroids, cytostatics), kab mob sib kis. kab mob (rheumatoid mob caj dab, sarcoma).
Eosinophils ua haujlwm tiv thaiv lub cev, tab sis vim qhov mob yog ib qho txheej txheem pathological, thaumntau dhau thiab khiav ceev, nws tuaj yeem cuam tshuam rau lub xeev ntawm tib neeg kev noj qab haus huv.
Pathogenesis
Qhov etiological feem ntau txiav txim siab seb eosinophilic pneumonia yuav loj hlob li cas. Ua rau, tsos mob, kev kho mob - txhua yam nyob ntawm qhov no. Lub hauv paus pob zeb ntawm hom kab mob ntsws no yog qhov txuam nrog ntau ntawm eosinophils nyob rau hauv cov ntaub so ntswg ntawm lub ntsws. Ntau yam kab mob, suav nrog eczema thiab bronchial hawb pob, yog tshwm sim los ntawm kev ua haujlwm dhau ntawm lub cev nrog kev tso tawm cov tshuaj lom neeg lom neeg.
Tshuaj thiab lwm yam tshuaj lom neeg hloov pauv cov kev ua haujlwm ntawm eosinophils, ua rau lawv raug mob ntau dua. Cov tshuaj tiv thaiv kab mob, tshuaj tua kab mob, tshuaj ua rau muaj kev tsis haum tshuaj uas ua rau muaj kev loj hlob ntawm kev mob ntsws thib ob. Tsis tas li ntawd, yam uas ua rau muaj qhov tshwm sim ntau ntawm eosinophils hauv cov ntaub so ntswg muaj xws li haus luam yeeb thiab tshuaj vapors.
kab mob kis kab mob
Cov kws kho mob txheeb xyuas peb lub tswv yim rau kev txhim kho mob ntsws thaum muaj kab mob parasitosis. Qhov thib ib yog helminthic kab mob nyob rau hauv lub ntsws, qhov thib ob yog ib feem ntawm lub neej voj voog ntawm cov cab, thiab qhov thib peb yog random los ntawm cov ntshav. Txhawm rau tiv thaiv lawv, lub cev xa eosinophils. Lawv yuav tsum provoke tso tawm cytokines, prostaglandins, leukotrienes thiab lwm yam active tshuaj rau tshem tawm cov cab. Tab sis lawv ua rau mob ntsws.
Tapeworms, xws li echinococcus thiab tapeworm, nrog rau cov kab mob ntsws pulmonary, tshwj xeeb tshaj yog nkag rau hauv cov ntaub so ntswg ntawm lub ntsws. Nyob hauv lub ntswsthiab nkag mus rau atmospheric oxygen yog qhov tseem ceeb rau cov kab mob roundworms, plab hnyuv pob txuv, hookworms, thiab necators. Eosinophilic pneumonia, uas yog tshwm sim los ntawm cov kab mob saum toj no, yog lwm yam hu ua Loeffler's syndrome. Los ntawm cov hlab ntsha, Trichinella qe thiab schistosomes nkag mus rau hauv lub ntsws.
Clinic
Raws li txoj cai, nws nyuaj rau tus kws kho mob, kws kho mob pulmonologist lossis txawm tias tus kws kho mob tshwj xeeb los teb cov lus nug thaum xub thawj siab, tus neeg mob muaj tus mob eosinophilic zoo li cas. Cov tsos mob, txawm coj mus rau hauv tus account txawv etiologies, yog heev zoo sib xws rau ib leeg. Tus neeg mob yws yws ntawm hnoos, ua npaws, ua pa luv thiab tawm hws thaum hmo ntuj. Ob peb lub lis piam tom qab pib hnoos, yog tias tsis muaj dab tsi ua tiav, koj tuaj yeem pom cov tsos mob ntawm decompensated ua pa tsis ua haujlwm. Hauv qhov no, tus neeg mob yuav tsum raug xa mus rau cov tshuab ua pa.
Tus mob ntsws eosinophilic mob ntsws loj zuj zus zuj zus mus ntau lub hlis. Cov neeg mob poob phaus, lawv ua tsis taus pa, hawb pob thiab hnoos, lub cev kub tsis poob qis dua tus lej subfebrile. Qee zaum cov tsos mob ntawm tus kab mob ua rau mob hawb pob bronchial, ua rau nws nyuaj rau kev kuaj mob thiab xaiv cov kev kho mob tsis raug.
Kho mob eosinophilic mob ntsws ua rau muaj ntau yam teeb meem rau kev kuaj mob. Nws cov tsos mob, kev kho mob thiab kev tiv thaiv zoo ib yam li cov tshuaj aspirin hawb pob, uas ua rau tus kws kho mob yuam kev. Kab mob parasitic muaj ib qho tshwj xeeb prodrome uas yuav qhia tau tias muaj kab mob helminthic.
Diagnosis
Txij li kev kho mob eosinophilic pneumonia xyaum tsis txawv ntawm lwm cov kab mob ntsws, qhov kev kuaj mob yog tsim los ntawm kev kuaj thiab ntsuas ntsuas. Hauv kev tshuaj ntsuam ntshav dav dav, eosinophilia tau tshaj tawm, thaum pom lub ntsws ntawm fluoroscopy lossis suav tomography, cov yam ntxwv hloov pauv tau pom. Txhawm rau kom paub tseeb, koj tuaj yeem nqa cov nqaij mos ntawm lub ntsws, nrog rau ua kom dej ntws tawm ntawm lub bronchi thaum lub sij hawm bronchoscopy.
txhawm rau tsim kom muaj kev koom tes nrog kev siv tshuaj, raug rau thaj chaw muaj tshuaj lom neeg, lossis mob qog noj ntshav, yuav tsum ua tib zoo kawm tus neeg mob keeb kwm kev kho mob, nrog rau sau cov ncauj lus kom ntxaws txog lub neej thiab mob. Yog tias, tom qab tag nrho cov kev tshawb fawb, nws tseem tsis tuaj yeem txheeb xyuas qhov ua tau, ces qhov kev kuaj mob tau sau tseg tias yog idiopathic eosinophilic pneumonia.
Nco ntsoov qhia qhov ua pa tsis ua haujlwm hauv daim npav. Tsis pub dhau ib lub lis piam txij li qhov pib ntawm tus kab mob, nws thawj cov cim tshwm sim:
- ntau qhov txhab ntawm lub ntsws;
- cov kua hauv cov kab noj hniav pleural;
- leukocytosis thiab nce erythrocyte sedimentation tus nqi hauv kev kuaj ntshav dav dav;
- nce qib ntawm immunoglobulin E;- spirometry qhia tau tias txo qis hauv qhov ua pa ntawm lub ntsws.
Kev kho mob
Txawm tias ua ntej kev kuaj pom tseeb ntawm eosinophilic pneumonia, kev kho mob pib sai li sai tau thaum tus neeg mob mus ntsib kws kho mob.
Yog mob ntsws yog qhov thib ob, ces yuav tsum tau kho lub ntsiabkab mob: qog los yog helminthic ntxeem tau. Qhov no yuav pab txo cov tsos mob ntawm lub ntsws thiab ua kom rov zoo dua.
Yog tias qhov ua rau tus kabmob tsis tuaj yeem txheeb xyuas tau, kev kho glucocorticosteroid raug tshuaj. Lawv zoo tshem tawm cov tshuaj tiv thaiv inflammatory, stabilize cell membranes, txo qhov kub thiab txias. Kev zam txim tau ua tiav sai sai - hnub thib peb lossis plaub. Tab sis cov tshuaj tsis xaus rau ntawd. Kev ploj ntawm cov tsos mob tsis txhais hais tias tus kab mob no kho tau. Yog li ntawd, tus neeg mob siv cov tshuaj corticosteroids rau lwm lub hlis, nrog rau cov tshuaj maj mam txo mus txog rau lub sijhawm thaum cov txheej txheem kuaj mob tsis paub meej tias rov zoo.
Daim ntawv mob ntev ntawm tus kab mob yuav tsum tau kho rau peb lub hlis lossis ntau dua, txawm tias tom qab ploj ntawm cov tsos mob tshwm sim. Relapses ntawm mob ntsws muaj peev xwm tiv thaiv keeb kwm yav dhau ntawm kev tshem tawm sai ntawm corticosteroids. Qee zaum, tus neeg mob yuav tau hloov mus rau qhov cua tshuab.
Huab cua
Yog eosinophilic pneumonia yog ib yam kab mob thib ob ntawm keeb kwm ntawm qog nqaij hlav cancer lossis kab mob parasitosis, ces qhov tshwm sim ntawm tus kab mob yog nyob ntawm cov kab mob hauv qab. Qhov tshwm sim tuag, raug kho kom txaus thiab raws sijhawm, tsis zoo li.
Mob ntsws eosinophilic pneumonia nquag rov tshwm sim ntawm keeb kwm ntawm kev tshem tawm ntawm glucocorticosteroids. Yog li ntawd, qee cov neeg mob noj cov tshuaj no rau lub neej. Tab sis qhov xwm txheej no kuj muaj qhov tsis zoo. Kev mob tshwm sim los ntawm kev kho mob, xws li prednisolone, tuaj yeem ua rau lub neej tsis zootus neeg. Cov no suav nrog: peptic ulcer, osteoporosis, cushingoid, txo kev tiv thaiv.
Kab mob kis
Pneumonias tshwm sim los ntawm cov kab mob parasites feem ntau tshwm sim nyob rau hauv thaj chaw uas cov kab mob no muaj kev sib kis. Nws tuaj yeem yog tropics, Siberian taiga, Mediterranean lossis lub phiab ntawm qee tus dej sib cais.
Tus mob eosinophilic mob ntsws tuaj yeem tshwm sim rau txhua lub hnub nyoog, txawm tias nyob rau hauv cov menyuam yaus, tab sis feem ntau tshwm sim hauv cov neeg hnub nyoog nruab nrab: hnub nyoog nees nkaum thiab plaub caug xyoo. Tus kab mob no muaj qee qhov kev ntxub ntxaug poj niam txiv neej - txiv neej tau mob ntau dua li poj niam, txij li tus kab mob no tshwm sim los ntawm kev haus luam yeeb. Hauv cov ntaub ntawv kho mob niaj hnub no, muaj cov lus piav qhia txog kev txhim kho ntawm eosinophilic mob ntsws tom qab hluav taws xob kho mob cancer mis.
Eosinophilic pneumonia hauv dev
Eosinophilic pneumonia kuj tshwm sim hauv cov tsiaj. Qhov ua rau, tsos mob, tiv thaiv tus kab mob no zoo ib yam li tib neeg. Ib yam li ntawd, cov kab mob ua rau muaj kab mob hauv lub ntsws, cov kab mob fungi, kev ua xua rau paj ntoos thiab kab, tshuaj thiab tshuaj.
Tus dev muaj lub cev tsis muaj zog tiv thaiv kab mob uas ua rau eosinophils nkag mus rau hauv lub ntsws. Lub airiness ntawm cov seem qis qis, cov kab mob fungi tsim muaj, uas ua rau mob ntsws. Tus tsiaj tuag los ntawm acidosis thiab hypoxia. Clinic zoo ib yam li tib neeg: hnoos, ua tsis taus pa, tsis muaj zog, kub taub hau, tsis qab los noj mov, poob phaus.
Kev kuaj mob, kuaj ntshav, X-ray ntawm lub ntsws, kuaj cytological ntawm bronchoalveolarntxuav, kuaj serological. Cov duab hluav taws xob qhia tau hais tias o ntawm lub ntsws cov ntaub so ntswg, muaj cov cellular granulomas, nce nyob rau hauv cov lymph nodes ntawm lub mediastinum thiab lub ntsws hauv paus, thiab ib tug expansion ntawm tus duab ntxoov ntxoo ntawm lub plawv. Tom qab txiav txim qhov etiology ntawm eosinophilic pneumonia, tus kws kho tsiaj tau sau ib qho kev kho mob tshwj xeeb txhawm rau tshem tawm cov kab mob tseem ceeb. Qhov zoo tshaj plaws yog corticosteroids, nrog rau cov tshuaj tua kab mob thiab cov tshuaj bronchodilators. Raws li txoj cai, tsiaj nyob twj ywm ntawm kev kho mob mus ib txhis.
