Kawasaki Syndrome nyob rau hauv cov menyuam yaus yog ib yam kab mob tsawg heev thiab mob hnyav uas tshwm sim los ntawm cov txheej txheem inflammatory cuam tshuam rau cov hlab ntsha thiab lwm cov hlab ntsha. Nws tshwm sim hauv cov menyuam yaus, feem ntau muaj hnub nyoog qis dua tsib xyoos, tab sis muaj cov neeg paub txog tus kab mob hauv cov neeg laus - cov neeg muaj hnub nyoog 20-30 xyoo. Tus kab mob no muaj ntau dua rau cov tub hluas, thiab cov ntxhais tsim Kawasaki syndrome (daim duab) tsawg dua.
Syndrome Description
Tus kab mob no tseem hu ua periarteritis nodosa, nrog rau kev mob vasculitis lossis mucocutaneous lymph node syndrome. Kab mob Kawasaki yog qhov txaus ntshai vim nws ua rau muaj teeb meem tsis zoo uas tuaj yeem tshwm sim nws tus kheej hauv daim ntawv ntawm aneurysms thiab lawv cov ruptures, tshwm sim ntawm cov kab mob loj xws li myocarditis, aseptic meningitis, mob caj dab, thiab lwm yam. Qhov no pathology nyob rau hauv cov teb chaws Europe tau tshaj qhov tshwm sim ntawm rheumatic. kub taub hau, thiab ua rau feem ntaucomplex mob plawv. Kev kho mob Kawasaki syndrome hauv cov menyuam yaus yuav tsum tau raws sijhawm.
Mechanism ntawm kev txhim kho kab mob Kawasaki
Tus kab mob no tshwm sim raws li hauv qab no: hauv tus menyuam lub cev, kev tsim cov tshuaj tiv thaiv pib, uas kis rau lawv tus kheej cov hlwb endothelial, uas yog cov tseem ceeb hauv cov qauv ntawm cov phab ntsa ntawm cov hlab ntsha. Vim li cas qhov no tshwm sim tseem tsis paub txog science. Txawm li cas los xij, vim muaj cov tshuaj tiv thaiv kab mob no, cov txheej txheem pathological hauv qab no pib hauv tus menyuam lub cev:
- Cov phab ntsa nruab nrab ntawm daim nyias nyias ntawm cov phab ntsa vascular, uas yog hu ua xov xwm, pib ua rau mob thiab nws cov hlwb maj mam tuag.
- Cov qauv ntawm cov hlab ntsha sab nraud thiab sab hauv ntawm cov hlab ntsha raug rhuav tshem, uas ua rau pom kev nthuav dav hauv cov phab ntsa, uas yog aneurysms.
Yog Kawasaki syndrome tsis kho, nyob rau hauv ob lub hlis tus menyuam pib tsim fibrosis ntawm phab ntsa ntawm cov hlab ntsha, vim hais tias cov lumen ntawm cov hlab ntsha pib maj mam nqaim, thiab qee zaum kaw tag.
Ib qho kev pom zoo ntawm tus kab mob Kawasaki tsuas yog tshwm sim hauv cov xwm txheej uas tau pib kho mob raws sijhawm kom tshem tawm tus kab mob no. Txawm li cas los xij, kev pheej hmoo ntawm kev tuag yog siab heev, thiab feem ntau ua rau qhov no yog arterial thrombosis lossis mob myocardial infarction. 3% ntawm tag nrho cov xwm txheej kawg ntawm tus neeg mob tuag.
Kawasaki syndrome yog suav tias yog rheumatological, yog li tus kws kho mob kho tus kab mob nokws kho mob rheumatologist. Raws li qhov teeb meem uas tus kab mob tau kis tau, cov kws kho mob tshwj xeeb xws li kws phais plawv thiab kws kho plawv tuaj yeem koom nrog hauv nws txoj kev kho. Xav txog qhov ua rau Kawasaki syndrome hauv cov menyuam yaus.
Cas of Kawasaki disease
Nyob rau hauv cov tshuaj, uas cuam tshuam nrog kev kho mob ntawm tus kab mob no, tseem tsis muaj kev ntseeg siab txog cov laj thawj ntawm qhov pib ntawm cov txheej txheem inflammatory ntawm phab ntsa vascular. Txawm li cas los xij, muaj ntau qhov kev xav txog qhov no. Feem ntau ntawm lawv yog qhov kev xav tias muaj qee yam kev hloov pauv hauv lub cev, uas ua rau muaj kev cuam tshuam sab nraud - kev noj cov kab mob ntawm cov kab mob los yog kab mob etiology rau hauv tib neeg lub cev. Cov no tuaj yeem suav nrog Epstein-Barr tus kab mob, rickettsia, parvovirus, spirochetes, streptococcus, herpes vulgaris, retrovirus, staphylococcus aureus, thiab lwm yam. Kev tshawb fawb txog kev kho mob tau pom tias 10% ntawm cov neeg uas nws cov poj koob yawm txwv raug kev txom nyem los ntawm Kawasaki Syndrome.
Background
Yam yuavtsum tau kawm uantej rau kev loj hlob ntawm tus mob no yog:
- Haiv neeg, raws li cov neeg Esxias kis tus kab mob.
- Txuag lub cev tiv thaiv kab mob.
Kawasaki kab mob cov tsos mob
Tus kab mob no tshwm sim, raws li txoj cai, hauv peb lub sijhawm:
- theem mob, uas feem ntau kav li 7-10 hnub.
- Lub sijhawm subacute uas kav li 2-3 lub lis piam.
- Theem of convalescence (lub sij hawm rov qab los ntawm lub cev), uas tuaj yeem kav ntev li ob peb lub hlis, tab sis tsis pub dhau ob xyoos.
Kawasaki syndrome hauv cov menyuam yaus (duab hauv qab) txhim kho, raws li txoj cai, sai heev. Qhov ntsuas kub hauv tus menyuam tuaj yeem nce mus rau qhov siab, thiab thawj 6-7 hnub ntawm tus kab mob tseem nyob. Yog tias koj tsis pib kho qhov tsim nyog tam sim ntawd, qhov kub thiab txias tuaj yeem kav ntev li 14 hnub. Lub sij hawm ua npaws ntev npaum li ntawd, qhov kev mob tshwm sim hnyav dua rau tus neeg mob me.
Lymph node enlargement
Yog hais tias thaum lub sij hawm tus kab mob no tus me nyuam muaj kub subfebrile, cov tsos mob ntawm tus kab mob Kawasaki tej zaum yuav ib tug nce nyob rau hauv lymph nodes, feem ntau nyob rau hauv lub caj dab. Qhov no yog koom nrog cov tsos mob ntawm intoxication ntawm lub cev - qaug zog, mob plab, plab zom mov, tachycardia. Nyob rau tib lub sijhawm, tus menyuam yuav coj tus cwj pwm tsis zoo, yuav quaj ntau zaus, nws yuav pw tsaug zog thiab tsis qab los noj mov.
Thaum thawj 4-5 lub lis piam txij thaum pib muaj tus kab mob, cov tsos mob ntawm daim tawv nqaij yuav tshwm sim nyob rau hauv daim ntawv ntawm ib tug tawg ntawm cov hlwv me me, nrog rau cov pob liab liab zoo ib yam li cov uas tshwm sim nrog caws pliav thiab qhua pias. Lub ntsiab ntawm cov pob liab liab yog nyob, raws li txoj cai, nyob rau hauv puab tais thiab ntawm cov ceg. Cov tawv nqaij ntawm ob txhais taw thiab xib teg pib tuab nyob rau hauv ib qho chaw sib cais, nruab nrab ntawm cov ntiv tes pib mob thiab tawg. Nyob rau hauv rooj plaub no, tus me nyuam yuav hnov mob hnyav hauv ko taw. Cov tsos mob ntawm daim tawv nqaij no ploj mus rau 6-7 hnub, txawm li cas los xij, erythema tuaj yeem nyob mus txog 2-3 lub lis piam, tom qab ntawd.tawv nqaij tawv heev.
YConjunctivitis
Cov tsos mob ntawm Kawasaki Syndrome hauv cov menyuam yaus tuaj yeem ua rau mob conjunctivitis, nrog rau qhov mob ntawm cov hlab ntsha ntawm ob lub qhov muag. Lub qhov ncauj mucosa qhuav, cov tonsils loj, xim ntawm tus nplaig yuav ci liab.
Thaum tus kab mob cuam tshuam rau lub plawv, tus me nyuam yuav muaj arrhythmia, tachycardia, ua tsis taus pa hnyav, vim mob plawv tsis ua hauj lwm. Qee lub sij hawm muaj qhov mob ntawm pericardium - lub hnab ntim pericardial, vim tias cov txheej txheem ntawm kev loj hlob ntawm mitral thiab aortic insufficiency pib. Coronary hlab ntsha nthuav dav, thiab aneurysms ntawm ulnar, subclavian thiab femoral hlab ntsha kuj tuaj yeem tshwm sim. Hauv 40% ntawm cov neeg mob uas muaj tus mob no, qhov mob ntawm pob qij txha tuaj yeem pib. Qhov ua rau thiab kev kho mob ntawm Kawasaki Syndrome nyob rau hauv cov menyuam yaus muaj kev cuam tshuam.
Kev kuaj kab mob
Tus kab mob tuaj yeem lees paub los ntawm qhov muaj tus mob npaws 5-7-hnub, thiab cov txheej txheem kuaj mob yuav tsum muaj xws li:
- Conjunctivitis hauv ob lub qhov muag.
- Kev mob rau lub qhov ncauj thiab caj pas.
- Adenopathy (hauv zos).
- Thickening thiab redness ntawm daim tawv nqaij ntawm xib teg thiab ko taw, nrog rau o loj.
- Tshuaj tawv nqaij ntawm cov ntiv tes ntawm lub lim tiam thib 3 ntawm tus kab mob.
Thaum kuaj pom cov hlab ntsha coronary artery aneurysm thaum kuaj tus menyuam, tom qab ntawd peb lub cim ntxiv ntawm tus kabmob los ntawm cov saum toj no yuav tsum tsim kom muaj kev kuaj mob kom raug.
Labresearch
Kev tshawb fawb hauv chav kuaj yuav tsum muaj rau qhov no suav nrog:
- kuaj ntshav biochemical;
- kuaj ntshav thiab zis;
- kev tshawb fawb ntawm cerebrospinal kua.
Instrumental txoj kev los tsim cov kab mob Kawasaki suav nrog:
- ECG;
- x-ray;
- Ultrasound ntawm lub siab;
- angiography ntawm coronary hlab ntsha.
Kawasaki syndrome kho mob
Tus kab mob no teb tau zoo rau kev kho mob, tab sis nws yog ib qho tseem ceeb uas yuav tau pib ntsuas kev kho thaum ntxov. Cov xwm txheej ntawm kev tuag tsis suav nrog, txij li qhov muaj feem cuam tshuam loj heev.
Tshuaj
Vim qhov ua rau tus kab mob no tsis paub, kev kho mob tsis yog tshem tawm lawv, tab sis tiv thaiv qhov tshwm sim thiab txo cov tsos mob. Rau qhov no, cov tshuaj hauv qab no yog siv:
- "Immunoglobulin", uas yog lub ntsiab hauv kev kho mob Kawasaki. Tus neeg sawv cev yog muab tso rau hauv txoj hlab ntshav-drip rau 10-12 teev txhua hnub. Yog tias koj pib kho nrog cov tshuaj no hauv thawj hnub ntawm tus kab mob, cov nyhuv yuav zoo tshaj plaws. Nws qhov kev ua kom txo tau qhov mob ntawm phab ntsa ntawm cov hlab ntsha.
- "Acetylsalicylic acid". Cov tshuaj no tau muab tshuaj ntau hauv cov hnub thaum ntxov, ua raws li kev txo qis ntawm cov tshuaj. Cov tshuaj thins cov ntshav, txo qhov kev pheej hmoo ntawm thrombosis thiab nres o.
- Anticoagulants. Cov tshuaj no tuaj yeem yog Warfarin lossis Clopidogrel. Lawv tuaj yeem raug pom zoo rau cov menyuam yaus mob uas tau txheeb xyuas qhov aneurysms. Teem kom tiv thaiv thrombosis.
Kev tshuaj corticosteroid rau Kawasaki syndrome hauv cov menyuam yaus yog nug. Txawm li cas los xij, cov tshuaj hormonal paub tias yuav ua rau muaj qhov tshwm sim ntawm qhov txhab thiab cov kab mob thrombosis.
Zoo kawg
Cov menyuam yaus yuav tsum tau txhaj tshuaj tiv thaiv kab mob xws li qhua pias, mob khaub thuas, mob khaub thuas, vim tias kev kho tshuaj aspirin ntev dhau lawm thaum kis tus kab mob no ua rau mob siab tsis ua haujlwm thiab encephalopathy, lub npe hu ua Reye's syndrome.
Txawm hais tias qhov kev pheej hmoo ntawm cov teeb meem ntawm tus kab mob siab heev, qhov kev cia siab ntawm kev kho mob yog qhov zoo.
