Zamkatimu
Exogenous matupi alveolitis amatchedwanso hypersensitivity pneumonitis. Chidule cha matendawa ndi EAA. Mawuwa akuwonetsa gulu lonse la matenda omwe amakhudza interstitium ya m'mapapo, ndiye kuti, minofu yolumikizana ya ziwalo. Kutupa ndi anaikira mu mapapo parenchyma ndi yaing'ono mpweya. Zimachitika pamene ma antigen osiyanasiyana (bowa, mabakiteriya, mapuloteni a nyama, mankhwala) amawalowetsa kuchokera kunja.
Kwa nthawi yoyamba, exogenous matupi alveolitis anafotokoza J.
M'tsogolomu, zinali zotheka kutsimikizira kuti matupi awo sagwirizana alveolitis amtundu wa exogenous akhoza kuyamba ndi zifukwa zina. Makamaka, mu 1965, C. Reed ndi anzake anapeza zizindikiro zofanana ndi odwala atatu omwe anali kuswana nkhunda. Iwo anayamba kutcha matenda a alveolitis "mapapo a okonda mbalame."
Ziwerengero zazaka zaposachedwa zikuwonetsa kuti matendawa ndi ofala kwambiri pakati pa anthu omwe, chifukwa cha ntchito zawo zamaluso, amalumikizana ndi nthenga ndi pansi pa mbalame, komanso ndi chakudya chamagulu. Mwa anthu 100, exogenous matupi alveolitis adzapezeka 000 anthu. Panthawi imodzimodziyo, n'kosatheka kuneneratu molondola kuti ndi munthu wanji yemwe sakugwirizana ndi nthenga kapena matenda omwe angakhale ndi alveolitis.
Monga momwe zimasonyezera, kuyambira 5 mpaka 15% ya anthu omwe adakumana ndi zovuta zambiri za allergen adzakhala ndi pneumonitis. Kuchuluka kwa alveolitis pakati pa anthu omwe amagwira ntchito ndi zinthu zochepa zolimbikitsa sikudziwika mpaka pano. Komabe, vutoli ndi lalikulu kwambiri, chifukwa makampaniwa amakula kwambiri chaka chilichonse, zomwe zikutanthauza kuti anthu ambiri akugwira nawo ntchito zoterezi.
Etiology
Matupi alveolitis amayamba chifukwa cha kupuma kwa allergen, yomwe imalowa m'mapapu pamodzi ndi mpweya. Zinthu zosiyanasiyana zimatha kukhala ngati allergen. Zowopsa kwambiri pankhaniyi ndi fungal spores kuchokera ku udzu wovunda, khungwa la mapulo, nzimbe, ndi zina zambiri.
Komanso, munthu sayenera kulemba mungu wa zomera, mapuloteni, fumbi la m'nyumba. Mankhwala ena, monga maantibayotiki kapena nitrofuran, amatha kuyambitsa matupi awo sagwirizana alveolitis ngakhale osapumirapo m'mbuyomu, komanso akalowa m'thupi mwanjira zina.
Osati kokha kuti allergens kulowa kupuma thirakiti n'kofunika, komanso maganizo awo ndi kukula. Ngati tinthu tating'onoting'ono si upambana 5 microns, izo sizidzakhala zovuta kwa iwo kufika alveoli ndi kuputa anachita hypersensitivity mwa iwo.
Popeza ma allergen omwe amayambitsa EAA nthawi zambiri amalumikizidwa ndi ntchito zamunthu, mitundu ya alveolitis idatchulidwa ntchito zosiyanasiyana:
Mapapo a Mlimi. Ma antigen amapezeka muudzu wankhungu, pakati pawo: Thermophilic Actinomycetes, Aspergillus spp, Mycropolyspora faeni, Thermoactinomycas vulgaris.
Mapapo a okonda mbalame. Ma Allergens amapezeka mu ndowe ndi dander za mbalame. Iwo amakhala whey mapuloteni a mbalame.
Bagassoz. Chothandizira ndi nzimbe, Mycropolysporal faeni ndi Thermoactinomycas sacchari.
Mapapo a anthu omwe amalima bowa. Kompositi imakhala gwero la zinthu zosagwirizana, ndipo Mycropolysporal faeni ndi Thermoactinomycas vulgaris amakhala ngati ma antigen.
Mapapo a anthu omwe amagwiritsa ntchito conditioners. Ma humidifiers, heaters, air conditioners ndi magwero a ma antigen. Kuzindikira kumayambitsidwa ndi tizilombo toyambitsa matenda monga: Thermoactinomycas vulgaris, Thermoactinomycas viridis, Ameba, Fungi.
Suberose. Khungwa la mtengo wa cork limakhala gwero la allergen, ndipo Penicillum frequentans amakhala ngati allergen palokha.
Ophika chimera chopepuka. Gwero la ma antigen ndi barele wankhungu, ndipo allergen yokha ndi Aspergillus clavatus.
Matenda a Cheesemaker. Gwero la ma antigen ndi tchizi ndi nkhungu particles, ndipo antigen palokha ndi Penicillum cseii.
Sequoyz. Ma Allergens amapezeka mufumbi lamitengo ya redwood. Amayimiridwa ndi Graphium spp., upullaria spp., Alternaria spp.
Opanga zotsukira m'mapapo. Allergen amapezeka m'ma enzymes ndi zotsukira. Amayimiridwa ndi Bacillus subtitus.
Ogwira ntchito zama labotale am'mapapo. Magwero a allergens ndi dandruff ndi makoswe mkodzo, ndipo allergens palokha amaimiridwa ndi mapuloteni mkodzo wawo.
Mapapo akununkhiza ufa wa pituitary. Antigen imayimiridwa ndi mapuloteni a nkhumba ndi bovine, omwe amapezeka mu ufa wa pituitary gland.
Mapapu amagwiritsidwa ntchito popanga mapulasitiki. Gwero lotsogolera ku kulimbikitsana ndi diisocyanates. Zomwe zimasokoneza ndi: Toluene diiosocianate, diphenylmethane diiosocianate.
Chibayo chachilimwe. Matendawa amayamba chifukwa chokoka mpweya wa fumbi kuchokera m'nyumba zonyowa. Matendawa ndi ofala ku Japan. Trichosporon cutaneum imakhala gwero la allergen.
Pazinthu zomwe zatchulidwazi pokhudzana ndi kukula kwa exogenous alveolitis, thermophilic actinomycetes ndi ma antigen a mbalame ndizofunikira kwambiri. M'madera omwe ali ndi chitukuko chachikulu chaulimi, ndi actinomycetes omwe amakhala ndi udindo wotsogola malinga ndi zochitika za EAA. Amayimiridwa ndi mabakiteriya omwe sadutsa kukula kwa 1 micron. Chinthu chodziwika bwino cha tizilombo toyambitsa matenda ndi chakuti ali ndi mphamvu osati tizilombo toyambitsa matenda, komanso bowa. Ma actinomycetes ambiri a thermophilic ali m'nthaka, mu kompositi, m'madzi. Amakhalanso m'ma air conditioner.
Mitundu yotere ya thermophilic actinomycetes imatsogolera ku chitukuko cha exogenous matupi awo sagwirizana alveolitis, monga: Mycropolyspora faeni, Thermoactinomycas vulgaris, Thermoactinomycas viridis, Thermoactinomycas sacchari, Thermoactinomycas scandidum.
Oimira onse omwe adatchulidwa a flora pathogenic kwa anthu amayamba kuchulukirachulukira pa kutentha kwa 50-60 ° C. Zili pansi pazimenezi kuti njira zowola za organic zinthu zimayambika. Kutentha kofananako kumasungidwa m'makina otentha. Actinomycetes angayambitse bagassosis (matenda a m'mapapo mwa anthu omwe amagwira ntchito ndi nzimbe), amachititsa matenda otchedwa "farmer's lung", "mapapo a otola bowa (olima bowa)", ndi zina zotero. Zonsezi zalembedwa pamwambapa.
Ma antigen omwe amakhudza anthu omwe amalumikizana ndi mbalame ndi mapuloteni a seramu. Izi ndi albumin ndi gamma globulins. Amapezeka mu zitosi za mbalame, m'zinsinsi za khungu la nkhunda, mbalame za parrots, canaries, etc.
Anthu omwe amasamalira mbalame amakumana ndi alveolitis ndi kuyanjana kwa nthawi yayitali ndi nyama. Mapuloteni a ng'ombe, komanso nkhumba, amatha kuyambitsa matendawa.
Antigen yogwira ntchito kwambiri ndi Aspergillus spp. Mitundu yosiyanasiyana ya tizilombo tating'onoting'ono timene timayambitsa matenda a suberosis, mapapo a malt brewer kapena mapapo opanga tchizi.
Ndizopanda pake kukhulupirira kuti, pokhala mumzinda ndipo osachita ulimi, munthu sangadwale ndi exogenous alveolitis. Ndipotu, Aspergillus fumigatus imakula bwino m’madera achinyezi omwe sakhala ndi mpweya wokwanira. Ngati kutentha mwa iwo kuli kwakukulu, ndiye kuti tizilombo toyambitsa matenda timayamba kuchulukitsa mofulumira.
Komanso pachiwopsezo cha chitukuko cha matupi awo sagwirizana alveolitis ndi anthu amene ntchito akatswiri kugwirizana ndi reactogenic mankhwala mankhwala Mwachitsanzo, pulasitiki, utomoni, utoto, polyurethane. Phthalic anhydride ndi diisocyanate amaonedwa kuti ndi owopsa kwambiri.
Kutengera dziko, kufalikira kwa mitundu yosiyanasiyana ya alveolitis kumatha kutsatiridwa:
Mapapo a okonda budgerigar nthawi zambiri amapezeka mwa anthu okhala ku UK.
Mapapo a anthu omwe amagwiritsa ntchito ma air conditioners ndi humidifiers ali ku America.
Mtundu wachilimwe wa alveolitis, womwe umayamba chifukwa cha kubereka kwa bowa wamtundu wa Trichosporon cutaneun, umapezeka mu 75% ya milandu ku Japan.
Ku Moscow komanso m'mizinda yomwe ili ndi mabizinesi akuluakulu, odwala omwe amakhudzidwa ndi mbalame ndi ma antigen a fungal amapezeka nthawi zambiri.
Pathogenesis wa exogenous matupi awo sagwirizana alveolitis
Mpweya wa munthu umakumana ndi fumbi nthawi zonse. Ndipo izi zimagwiranso ntchito pazachilengedwe komanso zonyansa. Zatsimikiziridwa kuti ma antigen amtundu womwewo angayambitse chitukuko cha matenda osiyanasiyana. Anthu ena amakhala ndi mphumu ya bronchial, ena amakhala ndi rhinitis. Palinso anthu amene amasonyeza matupi awo sagwirizana dermatosis, ndiye zotupa pakhungu. Tisaiwale za conjunctivitis wa matupi awo sagwirizana chikhalidwe. Mwachilengedwe, exogenous alveolitis siwomaliza pamndandanda wamatenda omwe adalembedwa. Ndi matenda amtundu wanji omwe munthu wina angakumane nawo zimadalira mphamvu ya kuwonekera, pamtundu wa allergen, momwe chitetezo cha mthupi chimakhalira ndi zinthu zina.
Kuti wodwala awonetsere matupi awo sagwirizana alveolitis, kuphatikiza zinthu zingapo ndikofunikira:
Mlingo wokwanira wa allergens omwe alowa m'njira yopuma.
Kukumana kwanthawi yayitali ndi dongosolo la kupuma.
Kukula kwina kwa ma pathological particles, omwe ndi ma microns 5. Pang'ono ndi pang'ono, matendawa amayamba pamene ma antigen akuluakulu alowa m'njira yopuma. Pankhaniyi, ayenera kukhazikika mu proximal bronchi.
Anthu ambiri omwe amakumana ndi zowawa zotere samadwala EAA. Choncho, asayansi amakhulupirira kuti thupi la munthu liyenera kukhudzidwa nthawi imodzi ndi zinthu zingapo nthawi imodzi. Sanaphunzire mokwanira, koma pali lingaliro lakuti majini ndi chikhalidwe cha chitetezo cha mthupi chimakhala.
Exogenous matupi awo sagwirizana alveolitis moyenerera amatchedwa immunopathological matenda, mosakayikira chifukwa chake ndi matupi awo sagwirizana mitundu 3 ndi 4. Komanso, kutupa kopanda chitetezo cha m'thupi sikuyenera kunyalanyazidwa.
Mtundu wachitatu wa immunological reaction ndi wofunikira kwambiri m'magawo oyamba a chitukuko cha matenda. Mapangidwe a chitetezo cha mthupi amapezeka mwachindunji mu interstitium ya mapapu pamene antigen ya pathological imagwirizana ndi ma antibodies a gulu la IgG. Mapangidwe a chitetezo cha mthupi amachititsa kuti alveoli ndi interstitium awonongeke, kuphulika kwa ziwiya zomwe zimawadyetsa kumawonjezeka.
Zotsatira zake zoteteza chitetezo kumapangitsa kuti ma macrophages agwirizane ndi ma alveolar macrophages ayambitsidwe. Zotsatira zake, mankhwala oopsa komanso odana ndi kutupa, ma hydrolytic enzymes, cytokines (tumor necrosis factor - TNF-a ndi interleukin-1) amamasulidwa. Zonsezi zimayambitsa kutupa m'deralo.
Pambuyo pake, maselo ndi zigawo za matrix za interstitium zimayamba kufa, kutupa kumakula kwambiri. Zambiri za monocyte ndi ma lymphocyte zimaperekedwa ku malo a chotupacho. Amawonetsetsa kusungidwa kwa mtundu wochedwa hypersensitivity reaction.
Zowona zomwe zimatsimikizira kuti machitidwe a immunocomplex ndi ofunikira mu exogenous alveolitis:
Pambuyo polumikizana ndi antigen, kutupa kumakula mofulumira, mkati mwa maola 4-8.
Pakutsuka kwa exudate kuchokera ku bronchi ndi alveoli, komanso mu seramu gawo la magazi, kuchuluka kwa ma antibodies a gulu la lgG amapezeka.
Mu minofu ya m'mapapo yomwe imatengedwa ku histology, mwa odwala omwe ali ndi matenda oopsa kwambiri, immunoglobulin, zigawo zothandizira, ndi ma antigen omwe amapezeka. Zinthu zonsezi ndi chitetezo cha mthupi.
Mukayesa khungu pogwiritsa ntchito ma antigen oyeretsedwa kwambiri omwe ali ndi matenda kwa wodwala wina, mawonekedwe amtundu wa Arthus amayamba.
Pambuyo kuchita provocative mayesero ndi inhalation wa tizilombo toyambitsa matenda, chiwerengero cha neutrophils odwala mu bronchoalveolar lavage madzimadzi ukuwonjezeka.
Mayankho a chitetezo chamtundu wa 4 akuphatikizapo CD+ T-cell delayed-type hypersensitivity ndi CD8+ T-cell cytotoxicity. Ma antigen akalowa m'njira yopuma, kuchedwa kwamtundu kumayamba pakatha masiku 1-2. Kuwonongeka kwa chitetezo chamthupi kumabweretsa kutulutsidwa kwa ma cytokines. Iwo, nawonso, amachititsa kuti ma leukocyte ndi endothelium ya m'mapapo afotokoze mamolekyu omatira pamwamba. Ma monocyte ndi ma lymphocyte ena amawachitira, omwe amafika mwachangu pamalo omwe amayambitsa kutupa.
Pa nthawi yomweyi, interferon gamma imayendetsa macrophages omwe amapanga CD4 + lymphocytes. Ichi ndi chizindikiro cha kuchedwa kwamtundu, komwe kumatenga nthawi yayitali chifukwa cha macrophages. Zotsatira zake, ma granulomas amapangidwa mwa wodwalayo, kolajeni imayamba kutulutsidwa mochulukirachulukira (fibroblasts imayendetsedwa ndi maselo akukula), ndipo interstitial fibrosis imayamba.
Zowona zomwe zimatsimikizira kuti mu exogenous alveolitis, kuchedwa kwamtundu wa 4 immunological reaction ndikofunikira:
T-lymphocyte amapezeka mu kukumbukira magazi. Iwo alipo m'mapapo minofu ya odwala.
Odwala ndi pachimake ndi subacute exogenous matupi awo sagwirizana alveolitis, granulomas, akulowerera ndi kudzikundikira lymphocytes ndi monocytes, komanso interstitial fibrosis ndi wapezeka.
Kuyesa kwa nyama za labotale ndi EAA kwawonetsa kuti ma CD4+ T-lymphocyte amafunikira pakuyambitsa matenda.
Chithunzi cha histological cha EAA
Nthawi zambiri, odwala exogenous matupi awo sagwirizana alveolitis ndi granulomas, popanda curdled zolengeza. Amapezeka mu 79-90% ya odwala.
Kuti musasokoneze ma granulomas omwe amakula ndi EAA komanso sarcoidosis, muyenera kulabadira izi:
Ndi EAA, ma granulomas ndi ochepa.
Granulomas alibe malire omveka.
Granulomas ali ndi ma lymphocyte ambiri.
Makoma a alveolar mu EAA ndi okhuthala, ali ndi ma lymphocytic olowera.
Pambuyo pokhudzana ndi antigen sikuphatikizidwa, ma granulomas amatha okha mkati mwa miyezi isanu ndi umodzi.
Mu exogenous matupi alveolitis, yotupa ndondomeko amayamba ndi lymphocytes, monocytes, macrophages ndi plasma maselo. Foamy alveolar macrophages kudziunjikira mkati alveoli okha, ndi lymphocytes mu interstitium. Pamene matendawa angoyamba kumene, odwala ali ndi mapuloteni ndi fibrinous effusion, yomwe ili mkati mwa alveoli. Komanso, odwala matenda bronchiolitis, zamitsempha follicles, peribronchial yotupa kulowerera, amene anaikira mu airways yaing'ono.
Choncho, matendawa amadziwika ndi utatu wa kusintha morphological:
Alveolitis.
Granulomatosis.
Matenda a bronchiolitis.
Ngakhale nthawi zina chimodzi mwa zizindikiro zikhoza kugwa. Kawirikawiri, odwala ndi exogenous matupi awo sagwirizana alveolitis kukhala vasculitis. Anamupeza ali wodwala pambuyo pomwalira, monga momwe zasonyezedwera m’zikalata zoyenera. Odwala ndi pulmonary hypertension, hypertrophy ya mitsempha ndi arterioles zimachitika.
Njira yosatha ya EAA imabweretsa kusintha kwa fibrinous, komwe kumatha kukhala kosiyana. Komabe, iwo ndi khalidwe osati exogenous matupi awo sagwirizana alveolitis, komanso matenda ena aakulu m`mapapo. Chifukwa chake, sichingatchulidwe kuti ndi chizindikiro cha pathognomic. Ndi yaitali alveolitis odwala, m`mapapo parenchyma akukumana pathological kusintha mtundu wa zisa m`mapapo.
Zizindikiro za exogenous matupi alveolitis
Matendawa akufotokozera nthawi zambiri anthu amene sachedwa ziwengo. Pathology imadziwonetsera pambuyo polumikizana kwa nthawi yayitali ndi magwero, kufalikira kwa ma antigen.
Exogenous matupi alveolitis akhoza kuchitika mu 3 mitundu:
Zizindikiro zovuta
The pachimake mawonekedwe a matenda kumachitika pambuyo kuchuluka kwa antigen kulowa kupuma thirakiti. Izi zikhoza kuchitika kunyumba ndi kuntchito kapena ngakhale mumsewu.
Pambuyo pa maola 4-12, kutentha kwa thupi la munthu kumakwera kwambiri, kuzizira kumakula, ndipo kufooka kumawonjezeka. Pali kulemera mu chifuwa, wodwalayo amayamba kutsokomola, amavutika ndi kupuma movutikira. Zowawa zimawonekera m'malo olumikizirana mafupa ndi minofu. Sputum pa chifuwa sichimawonekera kawirikawiri. Ngati ichoka, ndiye kuti ndi yaying'ono ndipo imakhala ndi ntchofu.
Chizindikiro china cha EAA pachimake ndi mutu womwe umayang'ana pamphumi.
Pa kufufuza, dokotala amaona cyanosis pakhungu. Pomvetsera mapapu, crepitations ndi wheezing amamveka.
Pambuyo pa masiku 1-3, zizindikiro za matendawa zimatha, koma pambuyo poyanjananso ndi allergen, zimawonjezekanso. General kufooka ndi ulesi, pamodzi ndi kupuma movutikira, akhoza kusokoneza munthu kwa milungu ingapo pambuyo kuthetsa pachimake siteji ya matenda.
The pachimake mawonekedwe a matenda si kawirikawiri matenda. Choncho, madokotala kusokoneza ndi SARS, chikwiyire mavairasi kapena mycoplasmas. Akatswiri ayenera kukhala tcheru kwa alimi, ndikusiyanitsa pakati pa zizindikiro za EAA ndi zizindikiro za pulmonary mycotoxicosis, zomwe zimayamba pamene fungal spores zimalowa m'mapapo. Odwala omwe ali ndi myotoxicosis, radiography ya m'mapapo sawonetsa kusintha kulikonse, ndipo palibe ma antibodies omwe amalowa m'magazi a seramu.
subacute zizindikiro
Zizindikiro za subacute mawonekedwe a matenda si monga kutchulidwa monga pachimake mawonekedwe alveolitis. Alveolitis yotere imayamba chifukwa cha kupuma kwa nthawi yayitali kwa ma antigen. Nthawi zambiri izi zimachitika kunyumba. Chifukwa chake, kutupa kwa subacute nthawi zambiri kumakwiyitsidwa ndi chisamaliro cha nkhuku.
Zizindikiro zazikulu za subacute exogenous matupi alveolitis ndi monga:
Kupuma pang'ono komwe kumawonjezereka munthu akachita masewera olimbitsa thupi.
Kuwonjezeka kwa kutopa.
Chifuwa chomwe chimatulutsa sputum.
Kumayambiriro kwa chitukuko cha matenda, kutentha kwa thupi kumawonjezeka.
Crepitus pamene kumvetsera mapapu adzakhala wofatsa.
Ndikofunika kusiyanitsa subacute EAA ku sarcoidosis ndi matenda ena a interstitium.
Zizindikiro za mtundu wosachiritsika
The aakulu mawonekedwe a matenda akufotokozera anthu amene kucheza ndi yaing`ono Mlingo wa antigen kwa nthawi yaitali. Kuphatikiza apo, subacute alveolitis imatha kukhala yosachiritsika ngati sichimathandizidwa.
Kutalika kwa matendawa kumasonyezedwa ndi zizindikiro monga:
Kuwonjezeka m'kupita kwa nthawi, kupuma movutikira, komwe kumawonekera ndi kulimbitsa thupi.
Kunenepa kuwonda, komwe kumatha kufikira anorexia.
Matendawa akuwopseza chitukuko cha cor pulmonale, interstitial fibrosis, mtima ndi kupuma kulephera. Popeza matenda exogenous matupi awo sagwirizana alveolitis akuyamba kukhala mochedwa ndipo sapereka zizindikiro kwambiri, matenda ake ndi kovuta.
Kuzindikira kwa exogenous matupi awo sagwirizana alveolitis
Kuti adziwe matenda, m'pofunika kudalira X-ray kufufuza m'mapapo. Kutengera siteji ya chitukuko cha alveolitis ndi mawonekedwe ake, zizindikiro za radiological zidzasiyana.
Chimake ndi subacute mawonekedwe a matendawa kumabweretsa kuchepa kwa kuwonekera kwa minda ngati galasi pansi ndi kufalikira kwa nodular-mana opacities. Kukula kwa nodule sikudutsa 3 mm. Amapezeka pamwamba pa mapapo onse.
Kumtunda kwa mapapo ndi zigawo zawo zoyambira sizikuphimbidwa ndi timinofu tating'onoting'ono. Ngati munthu asiya kuyanjana ndi ma antigen, pambuyo pa miyezi 1-1,5, zizindikiro za matendawa zimatha.
Ngati matendawa ali ndi vuto losatha, ndiye kuti pazithunzi za x-ray pali mithunzi yozungulira yomwe ili ndi ndondomeko yomveka bwino, madera amdima omwe amaimiridwa ndi ma nodules, kusintha kwa interstitium, ndi kuchepa kwa minda yamapapu. Matendawa akayamba kutha, mapapo a zisa amawonekera.
CT ndi njira yomwe imakhala yolondola kwambiri poyerekeza ndi radiography. Kafukufukuyu akuwonetsa zizindikiro za EAA, zomwe siziwoneka ndi radiography yokhazikika.
Kuyeza magazi kwa odwala omwe ali ndi EAA kumadziwika ndi zosintha izi:
Leukocytosis mpaka 12-15 × 103/ ml Pang'ono pomwe, mulingo wa leukocyte umafika pamlingo wa 20-30 × 103/ ml.
Njira ya leukocyte imasunthira kumanzere.
Kuwonjezeka kwa mlingo wa eosinophils sizichitika, kapena zikhoza kuwonjezeka pang'ono.
ESR mu 31% ya odwala imakwera mpaka 20 mm/h, ndipo mwa 8% ya odwala mpaka 40 mm/h. Odwala ena, ESR imakhalabe munjira yoyenera.
Mulingo wa lgM ndi lgG ukuwonjezeka. Nthawi zina pali kulumpha m'kalasi A immunoglobulins.
Odwala ena, rheumatoid factor imatsegulidwa.
Imawonjezera kuchuluka kwa LDH yonse. Izi zikachitika, ndiye kuti kutupa kwakukulu m'mapapo parenchyma kumatha kuganiziridwa.
Kuti atsimikizire matendawa, njira za Ouchterlony double diffusion, micro-Ouchterlony, counter immunoelectrophoresis ndi ELISA (ELISA, ELIEDA) zimagwiritsidwa ntchito. Amakulolani kuti muzindikire ma antibodies omwe amayambitsa ma antigen omwe adayambitsa ziwengo.
Mu gawo lachimake la matendawa, ma antibodies omwe amalowa m'magazi amazungulira pafupifupi wodwala aliyense. Pamene allergen amasiya kucheza ndi mapapu minofu ya odwala, mlingo wa ma antibodies amatsika. Komabe, amatha kukhalapo mu seramu yamagazi kwa nthawi yayitali (mpaka zaka 3).
Matendawa akakhala aakulu, ma antibodies sapezeka. Palinso kuthekera kwa zotsatira zabwino zabodza. Kwa alimi opanda zizindikiro za alveolitis, amapezeka mu 9-22% ya milandu, ndi okonda mbalame mu 51% ya milandu.
Odwala omwe ali ndi EAA, kufunika kwa ma antibodies kumayenderana ndi zochitika za pathological process. Mlingo wawo ungakhudzidwe ndi zinthu zosiyanasiyana. Kotero, mwa osuta, izo zidzachepetsedwa. Chifukwa chake, kupezeka kwa ma antibodies enieni sikungaganizidwe ngati umboni wa EAA. Panthawi imodzimodziyo, kusowa kwawo m'magazi sikumasonyeza kuti palibe matenda. Komabe, ma antibodies sayenera kulembedwa, chifukwa pamaso pa zizindikiro zoyenera zachipatala, amatha kulimbikitsa lingaliro lomwe lilipo.
Kuyesedwa kwa kuchepa kwa mphamvu ya mapapu ndikuwonetsa, popeza kusintha kwina kwa magwiridwe antchito a EAA ndi mawonekedwe amitundu ina yamatenda omwe amatsagana ndi kuwonongeka kwa interstitium ya mapapu. Hypoxemia odwala ndi matupi awo sagwirizana alveolitis anaona mu bata boma, ndi kumawonjezera pa zolimbitsa thupi. Kuphwanya mpweya wabwino m'mapapo kumachitika ndi mtundu woletsa. Zizindikiro za airway hyperreactivity zimapezeka mu 10-25% ya odwala.
Kupima pokoka mpweya kunagwiritsidwa ntchito koyamba kuti azindikire matenda a alveolitis koyambirira kwa 1963. Ma aerosol anapangidwa kuchokera ku fumbi lotengedwa ku udzu wankhungu. Iwo anachititsa exacerbation zizindikiro za matenda odwala. Nthawi yomweyo, zomwe zidatengedwa ku "udzu woyera" sizinapangitse odwala. Mwa anthu athanzi, ngakhale ma aerosol okhala ndi nkhungu sanakhumudwitse zizindikiro za pathological.
Kuyesa koyambitsa matenda kwa odwala omwe ali ndi mphumu ya bronchial sikuyambitsa kuwoneka kwachangu kwa immunological, sikuyambitsa kusokonezeka kwa mapapu. Ngakhale mwa anthu omwe ali ndi chitetezo chabwino cha chitetezo cha mthupi, amatsogolera kusintha kwa kayendetsedwe ka kupuma, kuwonjezereka kwa kutentha kwa thupi, kuzizira, kufooka ndi dyspnea. Pambuyo pa maola 10-12, mawonetseredwewa amatha okha.
N'zotheka kutsimikizira matenda a EAA popanda kuyesa zokopa, choncho sagwiritsidwa ntchito masiku ano zamankhwala. Amagwiritsidwa ntchito ndi akatswiri okhawo omwe amafunikira kutsimikizira chomwe chimayambitsa matendawa. Kapenanso, ndikwanira kuyang'ana wodwalayo muzochitika zake zonse, mwachitsanzo, kuntchito kapena kunyumba, komwe kumakhudzana ndi allergen.
Bronchoalveolar lavage (BAL) imakulolani kuti muwone zomwe zili mu alveoli ndi mbali zakutali za mapapo. Matendawa amatha kutsimikiziridwa ndi kuzindikira kwachulukidwe kasanu kwa zinthu zama cell momwemo, ndipo 80% yaiwo idzayimiridwa ndi ma lymphocytes (makamaka T-maselo, omwe ndi CD8 + lymphocytes).
The immunoregulatory index odwala amachepetsedwa kukhala osachepera mmodzi. Ndi sarcoidosis, chiwerengerochi ndi mayunitsi 4-5. Komabe, ngati kutsuka kunachitika m'masiku atatu oyambirira pambuyo pa chitukuko chachikulu cha alveolitis, chiwerengero cha neutrophils chidzawonjezeka, ndipo lymphocytosis sichimawonedwa.
Kuonjezera apo, kuchapa kumapangitsa kuti zizindikire kuwonjezeka kwa chiwerengero cha maselo khumi. Kuchulukana kwa mast cell kumatha kupitilira mpaka miyezi itatu kapena kupitilira apo mutakumana ndi allergen. Chizindikirochi chikuwonetsa ntchito ya kupanga fibrin. Ngati matendawa ali ndi njira ya subacute, ndiye kuti ma cell a plasma apezeka mukutsuka.
Kupanga matenda osiyanasiyana
Matenda omwe matupi awo sagwirizana alveolitis ayenera kusiyanitsa:
Khansara ya alveolar kapena metastases ya m'mapapo. Ndi zotupa za khansa, palibe kugwirizana pakati pa zizindikiro za matendawa zomwe zawonekera ndikukhudzana ndi zowawa. Pathology ikupita patsogolo nthawi zonse, yodziwika ndi mawonetseredwe owopsa. Mu seramu gawo la magazi, precipitating ma antibodies kwa allergens samasulidwa. Komanso, chidziwitso chikhoza kufotokozedwa pogwiritsa ntchito x-ray ya mapapu.
miliary chifuwa chachikulu. Ndi matendawa, palibenso ubale ndi ma allergen. The matenda palokha ali kwambiri njira ndi yaitali chitukuko. Njira za serological zimapangitsa kuti zizindikire ma antibodies ku antigen ya chifuwa chachikulu, pomwe sizikuwoneka ngati exoallergens. Musaiwale za mayeso a x-ray.
Sarcoidosis. Matendawa si kugwirizana ndi akatswiri ntchito ya munthu. Ndi izo, osati ziwalo zopuma zomwe zimakhudzidwa, komanso machitidwe ena a thupi. The hilar mwanabele mu chifuwa kukhala chotupa mbali zonse, pali ofooka kapena zoipa anachita kwa tuberculin. Zomwe Kveim achita, m'malo mwake, zidzakhala zabwino. Sarcoidosis ikhoza kutsimikiziridwa ndi kufufuza kwa histological.
Matenda ena a fibrosing alveolitis. Ndi iwo, nthawi zambiri odwala kukhala vasculitis, ndi zokhudza zonse kuwonongeka kwa connective minofu nkhawa osati mapapo, komanso thupi lonse. Ndi matenda okayikitsa, biopsy ya m'mapapo imachitidwa ndikuwunikanso mbiri yazinthu zomwe zapezedwa.
Chibayo. Matendawa akufotokozera pambuyo chimfine. Pa x-ray, zakuda zimawonekera, zomwe zimawoneka chifukwa cha kulowa kwa minofu.
ICD-10 imatanthawuza matupi awo sagwirizana alveolitis ku gulu X "matenda opuma".
Malangizo:
J 55 Matenda opuma obwera chifukwa cha fumbi lenileni.
J 66.0 Byssinosis.
J 66.1 Matenda a fulakesi.
J 66.2 Cannabiosis.
J 66.8 Matenda opuma chifukwa cha fumbi lina lodziwika bwino.
J 67 Hypersensitivity pneumonitis.
J 67.0 Mapapu a mlimi (wantchito waulimi).
J 67.1 Bagassose (kwa fumbi la nzimbe)
J 67.2 Mapapo oweta nkhuku.
J 67.3 Suberoz
J 67.4 Mapapo a ntchito ya chimera.
J 67.5 Mapapo a wogwira ntchito bowa.
J 67.6 Mapapo a khungwa la mapulo.
J 67.8 Hypersensitivity pneumonitis chifukwa cha fumbi lina lachilengedwe.
J 67.9 Hypersensitivity pneumonitis chifukwa cha fumbi lina losadziwika bwino.
Matendawa angapangidwe motere:
Exogenous matupi awo sagwirizana alveolitis (mlimi m'mapapo), pachimake mawonekedwe.
Mankhwala ochititsa matupi alveolitis chifukwa furazolidone, subacute mawonekedwe, ndi kupuma kulephera.
Exogenous matupi awo sagwirizana alveolitis (nkhuku woweta mapapo), aakulu mawonekedwe. Matenda a mtima wamapapo, matenda a bronchitis.
Chithandizo cha exogenous matupi awo sagwirizana alveolitis
Kuti athane ndi matendawa, ndikofunikira kusiya kuyanjana kwa wodwalayo ndi allergen. Munthu panthawi ya ntchito ayenera kugwiritsa ntchito masks, zosefera zapadera. Ndizofunikira kwambiri kusintha ntchito ndi zizolowezi zanu. Pofuna kupewa kufalikira kwa ma pathological, ndikofunikira kuzindikira kumayambiriro kwa chitukuko. Ngati kukhudzana ndi allergen kukupitilira, kusintha kwa mapapo kumakhala kosasinthika.
Njira yoopsa ya alveolitis imafuna kukhazikitsidwa kwa glucocorticosteroids. Iwo akhoza kulamulidwa ndi dokotala, mwa kusankhana.
Odwala ndi hyperresponsiveness m`mapapo zotchulidwa kupuma bronchodilators. Ngati matendawa apangitsa kuti pakhale zovuta, ndiye kuti maantibayotiki, okodzetsa, okosijeni, etc.
Kuneneratu ndi kupewa
Pofuna kupewa chitukuko cha matendawa, m'pofunika kuchepetsa kukhudzana ndi allergens. Choncho, udzu uyenera kuumitsidwa bwino, maenje a silo ayenera kutseguka. Malo opangirako ayenera kukhala ndi mpweya wabwino, ndipo ngati nyama ndi mbalame zili mmenemo, zofunikira zaukhondo ndi zaukhondo ziyenera kuwonedwa mosamalitsa. Ma air conditioners ndi mpweya wabwino ayenera kukonzedwa mwapamwamba komanso panthawi yake, ndi zina zotero.
Ngati alveolitis yayamba kale, wodwalayo sayenera kunyalanyaza kukhudzana ndi allergen. Pamene ntchito yaukatswiri imakhala vuto, ntchitoyo imasinthidwa.
Matendawa amasiyanasiyana. Ngati matendawa adapezeka koyambirira, ndiye kuti ma pathological amatha kudziletsa. Kubwereranso kwa alveolitis kumabweretsa mfundo yakuti minofu ya m'mapapo imakhala ndi kusintha kosasinthika. Izi zimaipitsa matendawa, komanso zovuta za alveolitis kapena matenda ake aakulu.