Vasculitis ya ziwiya zapakati

Peri Arteritis Nodosa kapena PAN

Periarteritis nodosa (PAN) ndi matenda osowa kwambiri a necrotizing angeitis omwe angakhudze ziwalo zambiri, zomwe zimayambitsa zomwe sizidziwika bwino (mitundu ina imakhulupirira kuti ikugwirizana ndi kachilombo ka hepatitis B).

Odwala nthawi zambiri amakhala ndi vuto la kuchepa thupi, kutentha thupi, ndi zina zambiri.

Kupweteka kwa minofu kulipo mu theka la milandu. Ndizovuta, zimafalikira, zimangochitika zokha kapena zimayambitsidwa ndi kukakamizidwa, zomwe zimatha kukhomerera wodwala pabedi chifukwa chakuwawa komanso kuwonongeka kwa minofu ...

Kupweteka kwa m'mafupa kumakhudza kwambiri mfundo zazikulu zotumphukira: mawondo, akakolo, zigongono ndi manja.

Kuwonongeka kwa mitsempha yotchedwa multineuritis nthawi zambiri kumawoneka, kumakhudza mitsempha yambiri monga sciatica, kunja kapena mkati mwa popliteal, radial, ulnar kapena median edema ndipo nthawi zambiri imagwirizanitsidwa ndi distal segmental edema. Neuritis yosachiritsika pamapeto pake imatsogolera ku atrophy ya minofu yomwe imasungidwa ndi minyewa yomwe yakhudzidwa.

Vasculitis imathanso kukhudza ubongo kawirikawiri, zomwe zingayambitse khunyu, hemiplegia, sitiroko, ischemia kapena kutaya magazi.

Chizindikiro chowoneka pakhungu ndi purpura (mawanga ofiirira omwe satha akakanikizidwa) otukumuka ndikulowa, makamaka m'miyendo yakumunsi kapena liveo, kupanga ma meshes (livedo reticularis) kapena mottles (livedo racemosa) miyendo. Titha kuwonanso zochitika za Raynaud (zala zingapo zimasanduka zoyera kuzizira), kapena ngakhale chala kapena chala chala.

Orchitis (kutupa kwa testicle) ndi chimodzi mwa zizindikiro za PAN, zomwe zimayambitsidwa ndi vasculitis ya testicular artery yomwe ingayambitse testicular necrosis.

A biological inflammatory syndrome amapezeka mwa odwala ambiri omwe ali ndi PAN (kuchuluka kwa sedimentation kupitirira 60 mm mu ola loyamba, mu C Reactive Protein, etc.), hyper eosinophilia (kuwonjezeka kwa eosinophilic polynuclear maselo oyera a magazi).

Matenda a chiwindi B amabweretsa kukhalapo kwa antigen ya HB pafupifupi ¼ mpaka 1/3 ya odwala

Angiography imawonetsa ma microaneurysms ndi stenosis (kuchepa kwa mawonekedwe kapena kutsika) kwa ziwiya zapakatikati.

Chithandizo cha PAN chimayamba ndi corticosteroid therapy, nthawi zina kuphatikiza ma immunosuppressants (makamaka cyclophosphamide)

Ma biotherapies amachitika poyang'anira PAN, makamaka rituximab (anti-CD20).

Buerger matenda

Matenda a Buerger kapena thromboangiitis obliterans ndi angiitis yomwe imakhudza magawo a mitsempha yaing'ono ndi yapakati ndi mitsempha ya m'munsi ndi kumtunda kwa miyendo, kuchititsa thrombosis ndi recanalization ya zotengera zomwe zakhudzidwa. Matendawa amapezeka kwambiri ku Asia komanso pakati pa Ayuda a Ashkenazi.

Amapezeka mwa wodwala wamng'ono (osakwana zaka 45), nthawi zambiri wosuta fodya, yemwe amayamba kusonyeza zizindikiro za arteritis kumayambiriro kwa moyo (ischemia ya zala kapena zala zapampando, kupweteka kwapakatikati, zilonda zam'mimba, zilonda zam'mimba kapena gangrene m'miyendo, etc.).

Arteriography imasonyeza kuwonongeka kwa mitsempha ya distal.

Kuchiza kumaphatikizapo kusiyiratu kusuta, zomwe zimayambitsa komanso kukulitsa matendawa.

Dokotala amalangiza vasodilators ndi antiplatelet mankhwala monga aspirin

Opaleshoni ya revascularization ingafunike.

Maladie wa Kawasaki

Matenda a Kawasaki kapena "adeno-cutaneous-mucous syndrome" ndi vasculitis yomwe imakhudza kwambiri gawo la mitsempha ya coronary yomwe imayambitsa ma coronary aneurysms omwe amatha kupha anthu, makamaka kwa ana apakati pa miyezi 6 ndi zaka 5 omwe amakhala pafupipafupi. pausinkhu wa miyezi 18.

Matendawa amachitika mu magawo atatu kwa milungu ingapo

Pachimake gawo (masiku 7 mpaka 14): kutentha thupi ndi zidzolo ndi maonekedwe a "milomo ya chitumbuwa", "lilime la sitiroberi", "kubaya maso" ndi conjunctivitis, "mwana wosatonthozeka", edema ndi kufiira kwa manja ndi mapazi. Moyenera, chithandizo chiyenera kuyambika panthawiyi kuti achepetse chiopsezo cha zotsatira za mtima

Gawo la subacute (masiku 14 mpaka 28) zomwe zimapangitsa kuti zala ndi zala zala zala zala ndi zala ziziyamba kuzungulira misomali. Ndi panthawi imeneyi pomwe ma coronary aneurysms amapanga

Gawo la Convalescent, lomwe nthawi zambiri limakhala lopanda zizindikiro, koma panthawi yomwe zovuta zamtima zadzidzidzi zimatha kuchitika chifukwa cha mapangidwe a coronary aneurysms mu gawo lapitalo.

Zizindikiro zina ndi zotupa za thewera, zofiira zowoneka bwino ndi zotupa zowononga, zizindikiro zamtima (kung'ung'udza kwamtima, kugunda kwamtima, zovuta za Electro CardioGram, pericarditis, myocarditis ...), kugaya chakudya (kutsekula m'mimba, kusanza, kuwawa kwa m'mimba ...), Mitsempha (aseptic meningitis, kukomoka, kukomoka ... , ziwalo), mkodzo (mafinya osabala mumkodzo, urethritis), nyamakazi ...

Kutupa kwakukulu m'magazi kumawonetsedwa ndi Sedimentation Rate wamkulu kuposa 100mm mu ola loyamba ndi mapuloteni apamwamba kwambiri a C-reactive, kuwonjezeka kwakukulu kwa maselo oyera a polynuclear kuposa 20 element / mm000, komanso kuchuluka kwa mapulateleti.

Chithandizo chimakhazikitsidwa ndi ma immunoglobulins omwe amabayidwa m'mitsempha (IV Ig) mwachangu momwe angathere kuti achepetse chiopsezo cha coronary aneurysm. Ngati IVIG sikugwira ntchito, madokotala amagwiritsa ntchito mtsempha wa cortisone kapena aspirin.