Bullous pemphigoid yog ib yam kab mob ntawm daim tawv nqaij uas zoo li pemphigus nyob rau hauv tsos. Tus kab mob no tshwm sim nyob rau hauv ib tug ntev daim ntawv thiab nyob rau hauv tsis muaj kev kuaj mob raws sij hawm thiab kev kho mob yuav ua rau tsis kaj siab txim. Yog li dab tsi ua rau kev loj hlob ntawm tus kab mob no? Cov tsos mob dab tsi tshwm sim? Cov tshuaj niaj hnub tuaj yeem muab kev kho mob dab tsi? Cov lus teb rau cov lus nug no txaus siab rau ntau tus nyeem.
kab mob yog dab tsi?
Bullous pemphigoid hauv cov tshuaj niaj hnub no paub los ntawm ntau lub npe - qhov no yog Lever's disease, thiab senile pemphigus, thiab senile dermatitis herpetiformis. Qhov no yog ib qho kab mob autoimmune uas muaj nrog cov tsos ntawm cov pob liab liab loj ntawm daim tawv nqaij (cov tsos mob sab nrauv qee zaum zoo li pemphigus tiag tiag).
Nws tsim nyog sau cia tias feem coob ntawm cov neeg mob uas muaj tus kab mob no yog cov neeg muaj hnub nyoog 65 xyoos thiab laus dua. Lawm, kev zam yog paub txog cov tshuaj, txij li tus kab mob no muaj qee zaum pom hauv cov menyuam yaus thiab cov neeg mob hnub nyoog nruab nrab. kab mobqhov no yog tus cwj pwm los ntawm kev kawm zoo, tab sis qee zaum tuaj yeem ua rau muaj teeb meem. Nyob rau hauv daim duab kho mob, lub sij hawm ntawm kev noj qab nyob zoo ntawm cov txheeb ze hloov nrog exacerbations. Ntawm chav kawm, rau ntau tus neeg, cov lus nug ntawm dab tsi yog bullous pemphigoid yog nthuav. Cov tsos mob thiab kev kho mob ntawm tus kab mob, qhov ua rau nws tshwm sim - cov ntaub ntawv no yuav tsum tau nyeem kom zoo zoo.
Qee yam kab mob
Nws tsim nyog sau cia tias bullous pemphigoid suav nrog hauv pab pawg hu ua blistering dermatoses. Cov kab mob no txawv ntawm pemphigus tiag tiag, vim lawv tsis nrog acantholysis. Cov kab mob ntawm daim tawv nqaij muaj xws li ob peb lwm yam kab mob, daim duab kho mob uas zoo sib xws:
- Benign uas tsis yog-acantholytic pemphigus, nyob rau hauv uas tus kab mob cuam tshuam tsuas yog cov mucous daim nyias nyias ntawm lub qhov ncauj, tsis ua rau pob khaus nyob rau hauv lwm qhov chaw. Tus kab mob no kuj yog tus yam ntxwv los ntawm ib tug benign chav kawm. Los ntawm txoj kev, nws tau piav qhia thawj zaug hauv xyoo 1959.
- Scarring pemphigoid yog ib yam kab mob txaus ntshai heev uas cuam tshuam rau cov mucous ntawm ob lub qhov muag thiab cov kab mob conjunctiva, ua rau nws atrophy. Cov pob khaus ntawm lub cev tuaj yeem ua tau, tab sis kuj tsis tshua muaj. Cov pab pawg muaj kev pheej hmoo tseem ceeb yog cov poj niam hnub nyoog 50, txawm hais tias qee zaum tus kab mob kuj tau sau tseg ntawm cov txiv neej cov neeg mob.
Caus thiab pathogenesis ntawm bullous pemphigoid
Hmoov tsis zoo, cov txheej txheem ntawm tus kab mob no tseem tsis tau nkag siab tag nrho. Txawm li cas los xij, cov kws tshawb fawb tau tswj xyuas kom pom tias tus kab mob no muaj tus cwj pwm autoimmune. Rau ib qho laj thawj lossis lwm qhov, kev ua tsis tiav tshwm simKev tiv thaiv kab mob, ua rau cov tshuaj tiv thaiv kab mob tawm tsam tsis tsuas yog txawv teb chaws, tab sis kuj lub cev cov hlwb.
Pov thawj ntawm qhov kev xav no muaj. Thaum cov kev tshawb fawb hauv tus neeg mob cov ntshav cov ntshav, nrog rau cov kua dej tawm ntawm cov hlwv, cov tshuaj tiv thaiv tshwj xeeb tau pom tias ua rau puas tsuaj rau cov ntaub so ntswg hauv qab ntawm daim tawv nqaij thiab cov mucous membranes. Nws kuj tseem muaj peev xwm tsim tau tias qhov mob tshwm sim ntau dua, qhov titer ntawm cov tshuaj tiv thaiv no ntau dua.
Nws ntseeg tau tias cov kab mob autoimmune tau txiav txim siab caj ces. Txawm li cas los xij, yuav tsum muaj qhov muaj peev xwm ua kom muaj tus kab mob. Nws tuaj yeem yog:
- txhaj tshuaj tiv thaiv qee yam kab mob;
- kev puas tsuaj lossis khaus tawv nqaij hnyav;
- raug rau hluav taws xob ultraviolet (ntev hnub ntev, kev tsim txom lub txaj, thiab lwm yam);
- daim tawv nqaij kub hnyiab;
- nquag siv qee yam tshuaj, xws li Furosemide, Captopril, Phenacetin, Amoxicillin thiab lwm yam;
- qee zaum tus kab mob tau qhib tom qab tus neeg mob tau txais kev kho hluav taws xob;
- raum tsis lees txais, rov hloov lub cev.
Bullous pemphigoid: duab thiab tsos mob
Tau kawg, ua ntej tshaj plaws, nws yog ib qho tseem ceeb kom paub txog cov tsos mob, vim tias sai npaum li tus neeg mob tau mob siab rau qhov muaj kev tsis sib haum xeeb thiab sab laj nrog kws kho mob, txoj kev kho yuav yooj yim dua. Kev tsim cov pob khaus khaus khaus ntawm daim tawv nqaij yog cov tsos mob tseem ceeb uas nrog bullouspemphigoid (daim duab qhia tias cov pob liab liab zoo li cas). Feem ntau, daim tawv nqaij ntawm qhov extremities thiab pob tw yog cuam tshuam. Cov pob khaus tuaj yeem tshwm sim hauv thaj tsam ntawm cov pob zeb loj, ntawm daim tawv nqaij ntawm lub ntsej muag thiab lub taub hau, tab sis qhov no tshwm sim tsawg dua.
Lub ntsiab tseem ceeb ntawm cov pob khaus yog cov vesicles thiab hlwv nrog cov log tsheb nruj. Hauv lawv muaj cov kua dej, feem ntau yog pob tshab, tab sis qee zaum koj tuaj yeem pom cov ntshav impurities. Feem ntau, daim tawv nqaij ib ncig ntawm cov hlwv hloov liab.
Lub "lub neej" ntawm kev tsim yog ob peb hnub. Tom qab ntawd, lawv spontaneously qhib. Ntawm qhov chaw ntawm cov pob liab liab, cov cheeb tsam ntawm kev yaig thiab qhov txhab me me yog tsim. Crusts yog xyaum tsis tsim nyob rau saum npoo, txij li cov cheeb tsam erosive sai sai epithelialize.
Thawj theem ntawm kev loj hlob ntawm tus kab mob nyob rau hauv 20% ntawm cov neeg mob pib nrog cov tsos ntawm npuas nyob rau hauv lub mucous daim nyias nyias ntawm lub qhov ncauj kab noj hniav, thiab tsuas yog tom qab ntawd cov pob liab liab kis mus rau ntawm daim tawv nqaij. Cov pob khaus ntawm cov mucous ntawm lub qhov ntswg, pharynx, qhov chaw mos, qhov muag tshwm sim tsis tshua muaj.
Cov neeg mob yws khaus khaus, thiab tom qab qhib pob qhov muag thiab qee qhov mob. Qhov kub nce tuaj yeem ua tau, txawm tias qhov no tsis tshua muaj. Cov neeg laus, uas nws lub cev tsis txaus los ntawm kev rov qab ua haujlwm tsis tu ncua, kuj muaj kev noj qab haus huv, poob phaus, thiab tsis muaj zog.
Histogenesis, histopathology thiab pathomorphology
Lub pathology ntawm bullous pemphigoid yog qhov nthuav heev. Ua ntej, ntau lub vacuoles tsim ntawm cov txheej txheem cytoplasmic ntawm cov hlwb basal. Maj mam, cov formations sib koom ua ke, tsim loj duacov qauv. Nrog rau qhov no, muaj qhov o ntawm cov ntaub so ntswg ntawm dermis.
Lub zais zis yog ib daim ntaub so ntswg. Nws cov hlwb yog stretched, tab sis cov choj ntawm lawv tsis puas. Raws li tus kab mob no zuj zus, cov hlwb ntawm cov epidermis maj mam tuag. Nyob rau tib lub sijhawm, cov ntaub so ntswg tshiab txav los ntawm cov npoo ntawm cov npuas, ntes nws hauv qab - yog li, cov hlwv txav mus rau hauv cov epidermis, thiab qee zaum mus rau hauv lub substratum.
Hauv lub zais zis muaj cov kua dej uas muaj cov lymphocytes sib xyaw nrog neutrophils. Muaj fiber ntau threads, protein molecules thiab lwm yam compounds.
Yog tias peb xav txog qhov histogenesis ntawm bullous pemphigoid, ces ua ntej nws tsim nyog nco ntsoov tias tus kab mob no yog autoimmune. Thaum kuaj xyuas cov ntaub so ntswg siv lub tshuab ntsuas hluav taws xob, nws tuaj yeem pom tias lub npe hu ua BPAg1 antigens, uas tau tso tawm thaum lub cev tiv thaiv kab mob, nyob rau hauv cov txheej txheem basal, uas yog nyob rau ntawm qhov chaw txuas ntawm keratinocyte hemidesmosomes. Lwm antigen, BPAg2, kuj tseem nyob hauv thaj av hemidesmosome. Nws ntseeg tau tias tsim los ntawm hom XII collagen.
Kuj nyob rau hauv cov txheej txheem ntawm kev tshawb fawb, nws tau pom tias macrophages thiab eosinophils nyob rau hauv tus kab mob no thawj zaug nyob rau hauv lub qab daus daim nyias nyias, tom qab uas lawv tsiv los ntawm nws thiab pib mus rau hauv lub zais zis thiab nruab nrab ntawm lub basal hlwb. Tseem muaj qhov tseem ceeb mast cell degranulation.
Histologically, nyob rau hauv tus kab mob, muaj ib tug detachment ntawm lub epidermis los ntawm lub dermis, ntawm uas ib tug subepidermal npuas tsim. Cov hlab ntsha hauv daim tawv nqaijCov ntaub so ntswg kuj tau nthuav dav, o ntawm lawv cov txheej sab hauv (endothelium) tau pom.
Cov txheej txheem kuaj mob niaj hnub
Raws li txoj cai, tsis muaj teeb meem hauv kev kuaj mob xws li bullous pemphigoid: cov tsos mob ntawm no yog tus yam ntxwv heev, thiab yog li tus kws kho mob yuav xav tias tus kab mob twb tau kuaj xyuas tus qauv. Cov hlwv hlwv ua rau ntawm tus neeg mob daim tawv nqaij, thiab cov txheej txheem ntawm erosion epithelialization tshwm sim sai.
Epidermis peel test negative. Tsis tas li ntawd, cov ntsiab lus sab hauv ntawm cov hlwv yog coj nrog kev tshuaj xyuas histological ntxiv. Thaum kuaj hauv chav kuaj, vacuoles, histiocytic cov ntsiab lus, eosinophils thiab lymphocytes tuaj yeem kuaj pom hauv cov kua.
Ntawm qhov tod tes, qhov kev kuaj mob sib txawv qee zaum nyuaj, raws li daim duab kho mob me ntsis zoo li lwm yam kab mob ntawm daim tawv nqaij, suav nrog erythema multiforme exudative, pemphigus vera, thiab Dühring's herpetiformis.
Yuav ua li cas kho tau zoo?
Yuav ua li cas yog tias koj muaj bullous pemphigoid? Kev kho mob nyob rau hauv cov ntaub ntawv no yuav tsum tau complex. Tsis tas li ntawd, kev xaiv cov kev ntsuas kev noj qab haus huv thiab cov tshuaj yog nyob ntawm ntau yam, nrog rau qhov hnyav ntawm tus kab mob, hnub nyoog thiab kev noj qab haus huv ntawm tus neeg mob, thiab muaj cov kab mob sib kis. Txawm li cas los xij, txoj kev kho mob tsuas yog kos los ntawm tus kws kho mob.
Lub hauv paus ntawm kev kho yog steroid anti-inflammatory tshuaj uas muaj glucocorticosteroids. Feem ntau, Prednisolone yog siv rau lub hom phiaj no. Cov tshuaj raug txhajintravenously, thiab koob tshuaj maj mam txo thaum cov tsos mob ploj.
Cytostatics thiab immunosuppressants kuj muab cov txiaj ntsig zoo, uas pab ua kom lub cev ua haujlwm ntawm lub cev tsis muaj zog. Feem ntau, cov neeg mob tau muab tshuaj xws li Cyclosporine A, Cyclophosphamide, Azathioprine.
Lawm, kev kho pob khaus, yaig thiab mob ntawm daim tawv nqaij kuj yog ib qho tseem ceeb. Koj yuav tsum ua kom koj cov tawv nqaij huv si. Cov neeg mob tau txais kev daws teeb meem nrog aniline dyes (piv txwv li, Furkotsin), uas ua raws li cov tshuaj tua kab mob, ua kom tawv nqaij qhuav. Hauv qhov xwm txheej hnyav dua, cov tshuaj pleev tshuaj steroid kuj tseem xav tau.
Kev kho mob nrog pej xeem tshuaj
Bullous pemphigoid, lossis Lever's disease, yog ib yam kab mob uas yuav tsum tau muaj peev xwm, kev kho mob tsim nyog. Kev siv ntau yam tshuaj hauv tsev tuaj yeem ua tau, tab sis tsuas yog muaj kev tso cai los ntawm tus kws tshaj lij. Ua ntej siv cov tshuaj, nco ntsoov nrog koj tus kws kho mob tham. Hauv pej xeem tshuaj, siv ntau yam tshuaj.
- Nws ntseeg tias Eleutherococcus tincture yuav cuam tshuam zoo rau tus neeg mob noj qab haus huv. Noj ob zaug ib hnub, 30 tee txhua.
- Rau kev kho mob sab nraud ntawm cov pob liab liab, siv cov kua txiv aloe, uas pab txo qhov khaus thiab mob, tiv thaiv kev txhim kho ntawm cov txheej txheem inflammatory, thiab ua kom cov txheej txheem rov ua dua tshiab. Moisten cov ntaub qhwv nrog kua txiv hmab txiv ntoo, tom qab ntawd siv rau qhov chaw puas ntawm daim tawv nqaij thiab ruaj ntseg nrog ntaub qhwv. Rau cov nyhuv siab tshaj plaws, koj tuaj yeem npogcompress nrog yas qhwv.
- Rau tib lub hom phiaj, kua txiv hmab txiv ntoo tshiab lossis decoction ntawm nplooj nettle tuaj yeem siv. Lub compress tau ua tiav raws li tau piav qhia saum toj no.
- Bullous pemphigoid, ntau qhov tseeb, nws cov tsos mob tuaj yeem kho tau nrog kev pab los ntawm tshuaj ntsuab tshwj xeeb decoction. Txhawm rau npaj nws, noj ib qho sib npaug (50 g txhua) ntawm eucalyptus nplooj, serpentine rhizomes, txiv hmab txiv ntoo ntawm Japanese Sophora, birch buds, yarrow nyom, yug yaj lub hnab thiab nettle. Ncuav ob tablespoons ntawm npaj sib tov ntawm tshuaj ntsuab nyob rau yav tsaus ntuj nrog ib khob ntawm boiling dej thiab tawm thaum hmo ntuj. Thaum sawv ntxov, cov infusion yuav tsum tau lim thiab muab faib ua peb ntu - lawv tau noj txhua hnub.
Nws yuav tsum nkag siab tias cov tshuaj ntsuab rau txhua tus neeg mob tuaj yeem ua txawv. Txawm hais tias kev kho mob muaj txiaj ntsig zoo, tsis muaj teeb meem koj yuav tsum tsis kam kho tshuaj.
Kev ntsuas rau cov neeg mob
Pemphigoid yog ib qho kab mob ntawm daim tawv nqaij, thiab yog li ntawd, feem ntau, nws tsis nyuaj dhau. Ntxiv mus, nyob rau hauv yuav luag txhua lub tsev kho mob hauv lub nroog loj, tus kab mob tau zoo kho raws li lub npe nyuaj - bullous pemphigoid. Hauv Orenburg, Moscow thiab lwm lub nroog koj yuav pom tus kws tshaj lij zoo. Tsuas yog tus nqi kho mob yuav nyob ntawm qhov chaw nyob, txij li tus nqi rau qee cov tshuaj hauv cov khw muag tshuaj sib txawv.
Nrog txoj kev kho kom raug, nws muaj peev xwm ua tiav qhov kev zam txim ruaj khov. Qee lub sij hawm, qee cov neeg mob tau rov qab los, uas, ntawm chav kawm, tsis kaj siab, tab sis kujtsis tuag. Ntawm qhov tod tes, thaum tsis muaj kev kho mob, qhov chaw ntawm cov pob khaus tuaj yeem dhau los ua lub qhov rooj rau kev kis kab mob, uas, raws li, xaus rau hauv cov txheej txheem inflammatory ntau dua, suppuration ntawm qhov txhab, thiab nkag mus ntawm cov kab mob pathogenic mus rau hauv cov txheej txheem sib sib zog nqus. daim tawv nqaij.
Puas muaj kev tiv thaiv?
Hmoov tsis zoo, tsis muaj kev kho tshwj xeeb rau kev tiv thaiv tus kab mob xws li Lever's bullous pemphigoid. Lawm, nws yog ib qho tseem ceeb heev uas yuav tau nrhiav kev pab nyob rau lub sij hawm, thiab vim hais tias tus kab mob no nyob ntev, txawm nyob rau lub sij hawm ntawm kev noj qab nyob zoo, ib tug yuav tsum ua tib zoo saib xyuas lub xeev ntawm kev noj qab haus huv.
Tsis txhob hnov qab tias tus kab mob hauv tshuaj yog suav tias yog tus cim ua tau ntawm oncology. Yog li ntawd, nyob rau hauv lub xub ntiag ntawm ib tug mob, tus neeg mob yuav tsum tau mus rau ib tug tag nrho kev ntsuam xyuas nyob rau hauv thiaj li yuav paub meej tias los yog tshem tawm ib qho kev kuaj oncological. Nco ntsoov tias txhua yam kab mob no yooj yim dua yog tias koj pib kho thaum ntxov.
