Mukati
Exogenous allergic alveolitis inonziwo hypersensitivity pneumonitis. Chidimburiko chechirwere ndeche EAA. Iri izwi rinoratidza boka rose rezvirwere zvinokanganisa interstitium yemapapu, kureva, iyo inobatanidza tishu yenhengo. Kuzvimba kunowanikwa mumapapu parenchyma uye madiki emhepo. Zvinoitika apo zvakasiyana-siyana zvemaantigen (fungi, mabhakitiriya, mapuroteni emhuka, makemikari) anopinda mavari kubva kunze.
Kekutanga, exogenous allergic alveolitis yakatsanangurwa naJ.
Mune ramangwana, zvaive zvichigoneka kuona kuti allergic alveolitis yerudzi rwekunze inogona kukonzerwa nezvimwe zvikonzero. Kunyanya, muna 1965, C. Reed nevamwe vake vakawana zviratidzo zvakafanana muvarwere vatatu vakanga vachibereka njiva. Vakatanga kudana alveolitis yakadaro kuti "mapapu evanoda shiri."
Huwandu hwemakore achangopfuura hunoratidza kuti chirwere ichi chakapararira pakati pevanhu avo, nekuda kwemabasa avo ehunyanzvi, vanodyidzana neminhenga nekudzika kweshiri, pamwe nekudya kwemusanganiswa. Kubva muhuwandu hwe100, exogenous allergic alveolitis ichaonekwa muvanhu 000. Panguva imwecheteyo, hazvibviri kunyatsofanotaura kuti ndeupi munhu allergic kusvika pasi kana minhenga ichakura alveolitis.
Sezvinoratidzwa nemaitiro, kubva pa5 kusvika ku15% yevanhu vakapindirana nepamusoro-soro yezvipembenene vanozoita pneumonitis. Kuwanda kwealveolitis pakati pevanhu vanoshanda nekudzika kwakadzika kwezvinhu zvinokurudzira hazvizivikanwe kusvika parizvino. Zvisinei, dambudziko iri rakanyanya kukura, sezvo indasitiri inokura zvakanyanya uye zvakanyanya gore negore, izvo zvinoreva kuti vanhu vakawanda vanobatanidzwa mumabasa akadai.
Etiology
Allergic alveolitis inokura nekuda kwekufemerwa kweiyo allergen, iyo inopinda mumapapu pamwe nemhepo. Zvinhu zvakasiyana-siyana zvinogona kuita senge allergen. Izvo zvakanyanya hutsinye zvinokonzeresa mune izvi fungal spores kubva kune yakaora huswa, maple bark, nzimbe, nezvimwe.
Zvakare, munhu haafanire kunyora kuremerwa kwechirimwa, mapuroteni emakemikari, guruva remba. Mimwe mishonga, yakadai semishonga inorwisa mabhakitiriya kana kuti nitrofuran derivatives, inogona kukonzera allergic alveolitis kunyange isina kumbofema, uye mushure mekupinda mumuviri nedzimwe nzira.
Kwete chete chokwadi chekuti allergens inopinda mukufema turakiti yakakosha, asiwo yekuisa kwavo uye saizi. Kana zvimedu zvisingapfuuri 5 microns, saka hazvizove zvakaoma kwavari kusvika kune alveoli uye kumutsa hypersensitivity reaction mavari.
Sezvo zvipembenene zvinokonzeresa EAA zvinowanzobatanidzwa nemabasa ehunyanzvi emunhu, mhando dzealveolitis dzakapihwa mazita ehunyanzvi hwakasiyana:
Murimi Bapu. Maantigens anowanikwa muhuswa hwakaumbwa, pakati pavo: Thermophilic Actinomycetes, Aspergillus spp, Mycropolyspora faeni, Thermoactinomycas vulgaris.
Mapapu evanoda shiri. Allergens anowanikwa mutsvina uye dander yeshiri. Vanova whey mapuroteni eshiri.
Bagassoz. Chinosanganisa nzimbe, zvinoti Mycropolysporal faeni uye Thermoactinomycas sacchari.
Mapapu evanhu vanorima howa. Kompositi inova manyuko ezvinokonzeresa, uye Mycropolysporal faeni uye Thermoactinomycas vulgaris anoita semaantigen.
Lung yevanhu vanoshandisa maconditioners. Humidifiers, heaters, uye air conditioners ndiko kunobva maantigen. Sensitization inotsamwiswa nezvirwere zvakadai se: Thermoactinomycas vulgaris, Thermoactinomycas viridis, Ameba, Fungi.
Suberose. Iyo bark yemuti wekork inova iyo sosi yezvinokonzeresa, uye Penicillum frequentans anoita seye allergen pachayo.
Vanogadzira chimera chakareruka. Iko kunobva maantigens ibhari yakaumbwa, uye iyo allergen pachayo ndeye Aspergillus clavatus.
Chirwere che cheesemaker. Kunobva maantigens chizi uye mold particles, uye antigen pachayo ndiPenicillum cseii.
Sequoyz. Allergens anowanikwa muredwood wood dust. Ivo vanomiririrwa neGraphium spp., upullaria spp., Alternaria spp.
Vagadziri vekuchenesa mapapu. Iyo allergen inowanikwa mune enzymes uye detergents. Inomiririrwa neBacillus subtitus.
Vashandi verabhoritari yemapapu. Izvo zvinokonzeresa ndeye dandruff uye rodent weti, uye izvo zvinokonzeresa pachazvo zvinomiririrwa nemapuroteni eweti yavo.
Lung kufemba pituitary powder. Iyo antigen inomiririrwa neporcine uye bovine mapuroteni, ayo anowanikwa muupfu hwepituitary gland.
Mapapu anoshandiswa mukugadzira mapurasitiki. Mhedzisiro inotungamira mukukurudzira ndeye diisocyanates. Zvinokonzeresa ndeizvi: Toluene diiosocianate, diphenylmethane diiosocianate.
Zhizha pneumonitis. Chirwere ichi chinokura nekuda kwekufema kweguruva kubva munzvimbo dzekugara dzakanyorova. Iyo pathology yakapararira muJapan. Trichosporon cutaneum inova sosi yezvipembenene.
Pakati pezvinyorwa zvakanyorwa maererano nekuvandudzwa kweexogenous allergic alveolitis, thermophilic actinomycetes uye maantigen eshiri anonyanya kukosha. Munzvimbo dzine budiriro yepamusoro yekurima, ndeye actinomycetes inotora chinzvimbo chekutungamira maererano nechiitiko cheEAA. Ivo vanomiririrwa nemabhakitiriya asingapfuuri saizi ye1 micron. Chinhu chakasiyana chema microorganisms akadaro ndechekuti iwo ane hupfumi kwete chete hutachiona, asiwo fungi. Mazhinji thermophilic actinomycetes ari muvhu, mucompost, mumvura. Vanogarawo muma air conditioners.
Mhando dzakadaro dze thermophilic actinomycetes dzinotungamira mukuvandudzwa kweexogenous allergic alveolitis, senge: Mycropolyspora faeni, Thermoactinomycas vulgaris, Thermoactinomycas viridis, Thermoactinomycas sacchari, Thermoactinomycas scandidum.
Vese vamiriri vakanyorwa veflora pathogenic kuvanhu vanotanga kuwanda zvinesimba patembiricha ye50-60 °C. Izvo zviri pasi pemamiriro ezvinhu akadaro kuti maitiro ekuora kwe organic matter anotangwa. Kupisa kwakafanana kunochengetedzwa mumasisitimu ekudziya. Actinomycetes inogona kukonzera bagassosis (chirwere chemapapu muvanhu vanoshanda nenzimbe), kukonzera chirwere chinonzi "farmer's lung", "mapapu evanotora howa (varimi vehowa)", nezvimwewo zvakanyorwa pamusoro apa.
Maantigen anobata vanhu vanodyidzana neshiri mapuroteni eSerum. Aya ndiwo albumin uye gamma globulins. Ivo varipo mumadonhwe eshiri, mune zvakavanzika kubva kune ganda gland renjiva, maparrots, canaries, nezvimwe.
Vanhu vanochengeta shiri vanoona alveolitis nekubatana kwenguva refu uye nguva dzose nemhuka. Mapuroteni emombe, pamwe chete nenguruve, anokwanisa kukonzera chirwere ichi.
Iyo inonyanya kushanda fungal antigen ndeye Aspergillus spp. Mhando dzakasiyana dzeiyi microorganism dzinogona kukonzera suberosis, mapapu emubiki wemalt kana mapapu emugadziri wechizi.
Hazvina maturo kutenda kuti, kugara muguta uye kwete kuita zvekurima, munhu haagoni kurwara ne exogenous allergic alveolitis. Muchokwadi, Aspergillus fumigatus inokura munzvimbo dzakanyorova dzisinganyanyi kupinza mhepo. Kana kutonhora mavari kwakakwirira, ipapo microorganisms inotanga kuwanda nokukurumidza.
Uyewo panjodzi yekuvandudzwa kwealveolitis vanhu vane mabasa eunyanzvi akabatanidzwa ne reactogenic chemical compounds, somuenzaniso, plastiki, resins, pendi, polyurethane. Phthalic anhydride uye diisocyanate inoonekwa seine njodzi zvakanyanya.
Zvichienderana nenyika, huwandu hunotevera hwemhando dzakasiyana dzealveolitis dzinogona kuteverwa:
Mapapu evanoda budgerigar anowanzo onekwa muvagari vemuUK.
Mapapu evanhu vanoshandisa ma air conditioners uye humidifiers ari muAmerica.
Mhando yezhizha yealveolitis, inokonzerwa nemwaka kubereka kwefungi yeTrichosporon cutaneun mhando, inowanikwa mu75% yezviitiko muJapan.
MuMoscow uye mumaguta ane mabhizimisi makuru emabhizimisi, varwere vane maitiro kune shiri uye fungal antigens vanowanzoonekwa.
Pathogenesis ye exogenous allergic alveolitis
Hunhu hwekufema hunogara huchisangana neguruva. Uye izvi zvinoshanda kune zvese organic uye inorganic zvinosvibisa. Yakave yakasimbiswa kuti maantigen emhando imwechete anogona kukonzera kukura kwezvirwere zvakasiyana-siyana. Vamwe vanhu vanoita bronchial asthma, vamwe vanokura chisingaperi rhinitis. Kunewo vanhu vanoratidza allergic dermatosis, kureva, maronda eganda. Hatifanire kukanganwa nezve conjunctivitis ye allergic nature. Nomuzvarirwo, exogenous alveolitis haisi yekupedzisira mune yakanyorwa pathologies. Ndeupi rudzi rwechirwere icho mumwe munhu achakura zvinoenderana nesimba rekuratidzwa, pamhando yeallergen, mamiriro ekudzivirira kwemuviri uye zvimwe zvinhu.
Kuti murwere aratidze exogenous allergic alveolitis, musanganiswa wezvinhu zvakati wandei unodiwa:
Chiyero chakakwana chezvipembenene zvakapinda mukati mekufema.
Kugara kwenguva refu kuhurongwa hwekufema.
Imwe saizi yepathological particles, inova 5 microns. Zvishoma kazhinji, chirwere chinokura apo maantigen makuru anopinda muhurongwa hwekufema. Muchiitiko ichi, vanofanira kugara mune proximal bronchi.
Ruzhinji rwevanhu vanosangana nemhando dzakadaro havatambudzi kubva kuEAA. Nokudaro, masayendisiti anotenda kuti muviri wemunhu unofanirwa kuchinjwa panguva imwe chete nezvinhu zvakawanda panguva imwe chete. Havana kudzidzwa zvakakwana, asi pane fungidziro yekuti genetics uye mamiriro ekusadzivirirwa zvinhu.
Exogenous allergic alveolitis inofanirwa kunzi immunopathological zvirwere, chikonzero chisina mubvunzo icho chinokonzera maitiro emhando 3 uye 4. Uyewo, kusava nehutachiona hwehutachiona hakufaniri kuregererwa.
Rudzi rwechitatu rwehutachiona hwehutachiona hunonyanya kukosha mumatanho ekutanga ekukura kwechirwere. Kuumbwa kwema immune complexes kunoitika zvakananga mu interstitium yemapapu apo pathological antigen inopindirana nemasoja ekudzivirira eIgG class. Kuumbwa kwezvidziviriro zvekudzivirira zvirwere zvinotungamirira kune chokwadi chokuti alveoli uye interstitium yakakuvadzwa, kupera kwemidziyo inovadyisa kunowedzera.
Izvo zvinokonzeresa immune complexes zvinokonzeresa iyo complement system uye alveolar macrophages kuti iite activated. Somugumisiro, zvigadzirwa zvine chepfu uye zvinopesana nekuputika, hydrolytic enzymes, cytokines (tumor necrosis factor - TNF-a uye interleukin-1) inosunungurwa. Zvese izvi zvinokonzeresa kuita kuzvimba padanho renzvimbo.
Zvadaro, masero uye matrix zvikamu zve interstitium zvinotanga kufa, kuzvimba kunowedzera. Zviyero zvakakosha zvemonocytes uye lymphocytes zvinopihwa kunzvimbo yekukuvadza. Ivo vanovimbisa kuchengetedzwa kwekunonoka-mhando hypersensitivity reaction.
Chokwadi chinosimbisa kuti immunocomplex maitiro akakosha mune exogenous allergic alveolitis:
Mushure mekubatana neantigen, kuzvimba kunowedzera nekukurumidza, mukati meawa 4-8.
Mukushambidzwa kwe exudate kubva kubronchi uye alveoli, pamwe chete nechikamu cheserum yeropa, huwandu hwakawanda hwema antibodies ekirasi yelgG inowanikwa.
Mumushonga wemapapu unotorwa kuhistology, mune varwere vane chirwere chechirwere chechirwere, immunoglobulin, zvikamu zvinopindirana, uye maantigen pachavo anowanikwa. Zvese izvi zvinhu zvine immune complexes.
Paunenge uchiita bvunzo dzeganda uchishandisa yakanyanya kucheneswa maantigen ayo ari pathological kune mumwe murwere, yemhando yemhando yeArthus inokura.
Mushure mekuita miedzo inotsamwisa nekufemerwa kwehutachiona, huwandu hweneutrophils muvarwere vari mubronchoalveolar lavage fluid inowedzera.
Type 4 immune responses dzinosanganisira CD+ T-cell delayed-type hypersensitivity uye CD8+ T-cell cytotoxicity. Mushure mekunge maantigen apinda muhurongwa hwekufema, maitiro anononoka anokura mukati memazuva 1-2. Kukuvadza kune immune complexes kunotungamirira pakusunungurwa kwe cytokines. Ivo, zvakare, vanokonzera leukocytes uye endothelium yemapapu tishu kuratidza mamorekuru anonamira pamusoro. Monocytes uye mamwe ma lymphocyte anoita kwavari, ayo anoshingaira kusvika panzvimbo yehutachiona hwehutachiona.
Panguva imwe chete, interferon gamma activates macrophages anobudisa CD4 + lymphocytes. Ichi ndicho chiratidzo chekunonoka-mhando yekuita, iyo inogara kwenguva yakareba nekuda kwema macrophages. Somugumisiro, granulomas fomu mumurwere, collagen inotanga kusunungurwa muhuwandu hwakawandisa (fibroblasts inoshandiswa nekukura kwemasero), uye interstitial fibrosis inokura.
Chokwadi chinosimbisa kuti mune exogenous allergic alveolitis, kunonoka mhando 4 immunological reactions yakakosha:
T-lymphocytes inowanikwa mundangariro yeropa. Ivo varipo mumapapu evarwere.
Mune varwere vane acute uye subacute exogenous allergic alveolitis, granulomas, inopinda nekuunganidza lymphocytes uye monocytes, pamwe ne interstitial fibrosis inowanikwa.
Ongororo pamhuka dzemurabhoritari neEAA dzakaratidza kuti CD4+ T-lymphocytes inodiwa pakuita chirwere.
Histological mufananidzo weEAA
Kazhinji, varwere vane exogenous allergic alveolitis vane granulomas, pasina curded plaque. Ivo vanoonekwa mu79-90% yevarwere.
Kuti usakanganise granulomas inokura neEAA uye ne sarcoidosis, unofanirwa kutarisisa kune zvinotevera mutsauko:
NeEAA, iyo granulomas idiki.
Granulomas haina miganhu yakajeka.
Granulomas ine lymphocytes yakawanda.
Alveolar madziro muEAA akakora, ane lymphocytic infiltrates.
Mushure mekusangana neantigen isingabatanidzwe, magranulomas anonyangarika ega mukati memwedzi mitanhatu.
Mune exogenous allergic alveolitis, iyo yekuzvimba maitiro inokonzerwa nelymphocytes, monocytes, macrophages uye plasma masero. Foamy alveolar macrophages inoungana mukati mealveoli pachayo, uye lymphocytes mu interstitium. Apo chirwere chichangotanga kukura, varwere vane puroteni uye fibrinous effusion, iyo iri mukati me alveoli. Uyewo, varwere vanoonekwa kuti vane bronchiolitis, lymphatic follicles, peribronchial inflammatory infiltrates, iyo yakanyanyisa mumhepo duku.
Saka, chirwere ichi chinoratidzirwa nehutatu hwekuchinja kwe morphological:
Alveolitis.
Granulomatosis.
Bronchiolitis.
Kunyangwe dzimwe nguva chimwe chezviratidzo chinogona kudonha. Kashoma, varwere vane exogenous allergic alveolitis vanokura vasculitis. Akaonekwa mune murwere mushure mekufa, sezvinoratidzwa mumagwaro akakodzera. Mune varwere vane pulmonary hypertension, hypertrophy ye arteri uye arterioles inoitika.
Iyo isingaperi kosi yeEAA inotungamira kune fibrinous shanduko, iyo inogona kuve nekusimba kwakasiyana. Nekudaro, ivo vane hunhu kwete chete kune exogenous allergic alveolitis, asiwo kune zvimwe zvisingaperi zvirwere zvemapapu. Nokudaro, haigoni kunzi chiratidzo chepathognomic. Nenguva refu alveolitis muvarwere, parenchyma yemapapu inosangana nekuchinja kwehutano mumhando yemapapu emuzinga.
Zviratidzo zveexogenous allergic alveolitis
Chirwere ichi chinokura kazhinji muvanhu vasingatarisirwi neallergic reactions. Pathology inozviratidza mushure mekubatana kwenguva refu nezvinyorwa, kupararira kwemaantigen.
Exogenous allergic alveolitis inogona kuitika mumhando nhatu:
Zviratidzo zvakasimba
Chimiro chechirwere chechirwere chinoitika mushure mekunge yakawanda ye antigen inopinda mumhepo yekufema. Izvi zvinogona kuitika kumba uye kubasa kana kunyange mumugwagwa.
Mushure memaawa 4-12, kupisa kwemuviri wemunhu kunokwira kusvika kumazinga akakwirira, kutonhora kunokura, uye kushaya simba kunowedzera. Pane kurema muchipfuva, murwere anotanga kukosora, anotambudzwa nekufema. Aches anoonekwa mumajoini uye tsandanyama. Sputum panguva yekukosora hairatidzike kazhinji. Kana ikabva, saka idiki uye inosanganisira kunyanya mucus.
Chimwe chiratidzo hunhu hweacute EAA kutemwa nemusoro kunotarisa pahuma.
Munguva yekuongorora, chiremba anocherechedza cyanosis yeganda. Pakuteerera kumapapu, crepitations uye kufema kunonzwika.
Mushure memazuva 1-3, zviratidzo zvechirwere zvinopera, asi mushure meimwe kusangana ne-allergen, zvinowedzera zvakare. Kushaya simba uye kupera simba, pamwe chete nekupfupika kwekufema, zvinogona kukanganisa munhu kwemavhiki mashomanana mushure mekugadzirisa kwechirwere chechirwere.
Chimiro chechirwere chechirwere hachiwanzoongororwa. Saka, vanachiremba vanoivhiringidza neSARS, inotsamwiswa nemavhairasi kana mycoplasmas. Nyanzvi dzinofanira kungwarira varimi, uye zvakare kusiyanisa pakati pezviratidzo zveEAA uye zviratidzo zvepulmonary mycotoxicosis, inokura apo fungal spores inopinda mumapapu emapapu. Muvarwere vane myotoxicosis, mapapu radiography hairatidzi chero shanduko yehutachiona, uye hapana anodzivirira ekudzivirira muserum chikamu cheropa.
subacute zviratidzo
Zviratidzo zve subacute fomu yechirwere hazvina kutaurwa seyakanyanya fomu yealveolitis. Alveolitis yakadaro inokura nekuda kwekufema kwenguva refu kwemaantigen. Kazhinji izvi zvinoitika kumba. Saka, subacute kuzvimba kazhinji kunotsamwiswa nekuchengetwa kwehuku.
Zviratidzo zvikuru zve subacute exogenous allergic alveolitis zvinosanganisira:
Kutadza kufema kunowedzera mushure mekuita basa remuviri.
Kuwedzera kuneta.
Chikosoro chinoburitsa sputum yakajeka.
Padanho rekutanga mukukura kwepathology, tembiricha yemuviri inogona kuwedzera.
Crepitus pakuteerera mapapu ichava munyoro.
Zvakakosha kusiyanisa subacute EAA kubva kune sarcoidosis uye zvimwe zvirwere zve interstitium.
Zviratidzo zvechirwere chisingaperi
Chimiro chisingaperi chechirwere chinokura muvanhu vanobatana nediki maantigens kwenguva yakareba. Mukuwedzera, subacute alveolitis inogona kuva isingaperi kana isina kurapwa.
Chirwere chisingaperi chechirwere chinoratidzwa nezviratidzo zvakadai se:
Kuwedzera nekufamba kwenguva, kupfupika kwekufema, izvo zvinova pachena nekushanda kwemuviri.
Kutaura kuderera kwehuremu, izvo zvinogona kusvika kune anorexia.
Chirwere ichi chinotyisidzira nekuvandudzwa kwecor pulmonale, interstitial fibrosis, mwoyo uye kutadza kufema. Sezvo chronic exogenous allergic alveolitis inotanga kukura zvishoma nezvishoma uye isingapi zviratidzo zvakakomba, kuongororwa kwayo kwakaoma.
Kuongororwa kwe exogenous allergic alveolitis
Kuti uone chirwere chacho, zvakakosha kuvimba ne-X-ray kuongororwa kwemapapu. Zvichienderana nedanho rekukura kwealveolitis uye chimiro chayo, zviratidzo zveradiological zvichasiyana.
Iyo acute uye subacute fomu yechirwere inotungamira kudzikira kwekujeka kweminda senge girazi repasi uye nekupararira kwenodular-mesh opacities. Kukura kwemanodules hakupfuuri 3 mm. Vanogona kuwanikwa pamusoro pese pese pemapapu.
Chikamu chepamusoro chemapapu uye zvikamu zvadzo zvepasi hazvina kuvharwa nemanodule. Kana munhu akarega kupindirana nemaantigen, zvino mushure memwedzi 1-1,5, zviratidzo zvechirwere zvechirwere zvinopera.
Kana chirwere chacho chine kosi isingaperi, ipapo mimvuri mitsetse ine chinyorwa chakajeka, nzvimbo dzakasviba dzinomiririrwa nemanodule, shanduko muinterstitium, uye kuderera kwehukuru hweminda yemapapu zvinoonekwa pa x-ray mufananidzo. Kana chirwere chacho chave nekumhanya, mapapu emuzinga anoonekwa.
CT inzira ine hunyanzvi hwepamusoro kana ichienzaniswa neradiography. Chidzidzo chinoratidza zviratidzo zveEAA, izvo zvisingaonekwe neyakajairwa radiography.
Kuongororwa ropa muvarwere vane EAA kunoratidzwa nekuchinja kunotevera:
Leukocytosis kusvika 12-15 × 103/ ml Zvishoma zvishoma, chiyero che leukocytes chinosvika pachiyero che 20-30 × 103/ ml.
Iyo leukocyte formula inoshandura kuruboshwe.
Kuwedzera kwehuwandu hweeosinophils hakuiti, kana kuti inogona kuwedzera zvishoma.
ESR mu31% yevarwere inokwira kusvika 20 mm/h, uye mu8% yevarwere kusvika ku40 mm/h. Mune vamwe varwere, ESR inoramba iri mukati meyakajairika.
Chiyero chelgM nelgG chinowedzera. Dzimwe nguva pane kusvetuka mukirasi A immunoglobulins.
Mune vamwe varwere, rheumatoid factor inoshandiswa.
Inowedzera huwandu hwehuwandu hweLDH. Kana izvi zvikaitika, ipapo kuzvimba kwakanyanya mumapapu parenchyma kunogona kufungidzirwa.
Kuti asimbise kuongororwa, Ouchterlony kaviri diffusion, micro-Ouchterlony, counter immunoelectrophoresis uye ELISA (ELISA, ELIEDA) nzira dzinoshandiswa. Ivo vanokutendera iwe kuti uone chaiwo anokonzeresa masoja ekudzivirira chirwere kune maantigen akakonzera allergy.
Muchikamu chechirwere chechirwere, ma antibodies achatenderera muropa remurwere wese. Kana iyo allergen ikamira kupindirana nemapapu evarwere, mwero wemasoja ekudzivirira anodonha. Zvisinei, vanogona kunge varipo mu serum chikamu cheropa kwenguva yakareba (kusvika kumakore matatu).
Kana chirwere chisingaperi, masoja ekudzivirira chirwere haaonekwi. Panewo mukana wemigumisiro yakanaka yenhema. Muvarimi vasina zviratidzo zvealveolitis, vanoonekwa mu 9-22% yematambudziko, uye mune vanoda shiri mu51% yematambudziko.
Mune varwere vane EAA, kukosha kwekudzivirira ma antibodies hakuenderane nebasa reiyo pathological process. Chiyero chavo chinogona kukanganiswa nezvinhu zvakasiyana. Saka, mune vanoputa, zvichave zvisingatarisirwi. Nokudaro, kuonekwa kwemasoja ekudzivirira chirwere haagone kuonekwa sehuchapupu hweEAA. Panguva imwecheteyo, kusavapo kwavo muropa hakuratidzi kuti hapana chirwere. Zvisinei, ma antibodies haafaniri kunyorwa, sezvo pamberi pezviratidzo zvekliniki zvakakodzera, anogona kusimbisa fungidziro iripo.
Muedzo wekudzikira kwesimba rakapararira remapapu rinoratidza, sezvo dzimwe shanduko dzinoshanda muEAA dziri hunhu hwemamwe marudzi epathologies anoperekedzwa nekukuvadzwa kweiyo interstitium yemapapu. Hypoxemia muvarwere vane allergic alveolitis inoonekwa mune yakadzikama mamiriro, uye inowedzera panguva yekurovedza muviri. Kukanganisa kwekufema kwemapapu kunoitika nemhando yekudzivirira. Zviratidzo zve airway hyperreactivity zvinowanikwa mu10-25% yevarwere.
Miedzo yekufema nekufema yakatanga kushandiswa kuona kusawirirana kwealveolitis kare kare muna 1963. Maaerosol aigadzirwa kubva muguruva rakatorwa kubva muuswa hwakaoma. Vakakonzera kuwedzera kwezviratidzo zvechirwere muvarwere. Panguva imwecheteyo, zvinyorwa zvakatorwa kubva ku "uswa wakachena" hazvina kukonzera kuita kwakadaro muvarwere. Muvanhu vane hutano, kunyange aerosols ane mold haina kutsamwisa zviratidzo zvepathological.
Miedzo inotsamwisa muvarwere vane bronchial asthma haikonzeri kutaridzika kwekukurumidza immunological reaction, haikonzeri kukanganisa mukushanda kwemapapu. Nepo kune vanhu vane maitiro akanaka ekudzivirira zvirwere, vanotungamirira kukuchinja kwekushanda kwemaitiro ekufema, kuwedzera kwekushisa kwemuviri, kutonhora, kushaya simba uye dyspnea. Mushure memaawa 10-12, zviratidzo izvi zvinopera pachavo.
Zvinogoneka kusimbisa kuongororwa kweEAA pasina kuita bvunzo dzinotsamwisa, saka hadzishandiswe mune zvemazuva ano zvekurapa. Izvo zvinoshandiswa chete nenyanzvi dzinoda kusimbisa chikonzero chechirwere. Neimwe nzira, zvakakwana kuona murwere mumamiriro ake enguva dzose, semuenzaniso, kubasa kana kumba, uko kune kusangana neiyo allergen.
Bronchoalveolar lavage (BAL) inokubvumira kuti uongorore kuumbwa kwezviri mukati mealveoli uye nzvimbo dziri kure dzemapapu. Kuongororwa kunogona kusimbiswa nekuonekwa kwekuwedzera kwekashanu kwezvikamu zvemasero mairi, uye 80% yavo ichamiririrwa ne lymphocytes (kunyanya T-cells, iyo CD8 + lymphocytes).
Iyo immunoregulatory index muvarwere inoderedzwa kusvika pasi peimwe. Ne sarcoidosis, nhamba iyi ndeye 4-5 zvikamu. Zvisinei, kana kuchenesa kwakaitwa mumazuva matatu ekutanga mushure mekukura kwakanyanya kwealveolitis, ipapo nhamba yeutrophils ichawedzerwa, uye lymphocytosis haina kuonekwa.
Uye zvakare, lavage inoita kuti zvikwanise kuona kuwedzera kwenhamba yemasero mast kagumi. Uku kuungana kwemaseru maseru kunogona kuenderera kwemwedzi inosvika mitatu kana kupfuura mushure mekusangana neiyo allergen. Ichi chiratidzo chinoratidza chiitiko chekugadzirwa kwefibrin. Kana chirwere chacho chiine subacute course, ipapo masero eplasma achawanikwa mukugezera.
Kuita chirwere chakasiyana
Zvirwere kubva kune exogenous allergic alveolitis inofanira kusiyaniswa:
Alveolar cancer kana metastases yemapapu. Negomarara regomarara, hapana kubatana pakati pezviratidzo zvechirwere zvakaonekwa uye kusangana neallergens. Pathology inogara ichifambira mberi, inoratidzwa nekuratidzwa kwakanyanya. Mune serum chikamu cheropa, precipitating masoja ekudzivirira chirwere haasunungurwe. Zvakare, ruzivo runogona kujekeswa uchishandisa x-ray yemapapu.
miliary tuberculosis. Nechirwere ichi, hapanawo hukama nehutachiona. Utachiona pachahwo hune nzira yakaoma uye kukura kwenguva refu. Serological matekiniki anoita kuti zvikwanise kuona antibodies kune tuberculosis antigen, asi ivo vasingaratidzike kune exoallergens. Usakanganwa nezve x-ray kuongororwa.
Sarcoidosis. Ichi chirwere hachina kubatanidzwa nebasa reunyanzvi remunhu. Nezvo, kwete nhengo dzekufema chete dzinobatwa, asiwo mamwe maitiro emuviri. Iyo hilar lymph nodes muchipfuva inoputika kumativi ose maviri, pane kushaya simba kana kusagadzirisa tuberculin. Kuita kwaKveim, pane kudaro, kuchava kwakanaka. Sarcoidosis inogona kusimbiswa ne histological kuongorora.
Zvimwe fibrosing alveolitis. Navo, kazhinji, varwere vanokura vasculitis, uye systemic kukuvara kune inobatana tishu ine hanya kwete mapapu chete, asiwo muviri wose. Nekukahadzika kuongororwa, biopsy yemapapu inoitwa pamwe nekumwe kuongorora histological yezvinyorwa zvakawanikwa.
Chirwere chemabayo. Chirwere ichi chinokura mushure mekutonhora. Pa x-ray, kudzima kunoonekwa, izvo zvinoonekwa nekuda kwekupinzwa kwematishu.
ICD-10 inoreva exogenous allergic alveolitis kukirasi X "Zvirwere zvekufema".
Kujekeswa:
J 55 Chirwere chekufema chinokonzerwa neguruva chairo.
J 66.0 Byssinosis.
J 66.1 Chirwere cheflakisi.
J 66.2 Cannabiosis.
J 66.8 Chirwere chekufema nekuda kwemamwe mavhu akatsanangurwa.
J 67 Hypersensitivity pneumonitis.
J 67.0 Lung yemurimi (agricultural worker).
J 67.1 Bagassose (yeguruva renzimbe)
J 67.2 Bapu remuridzi wehuku.
J 67.3 Suberoz
J 67.4 Bapu romushandi weMalt.
J 67.5 Bapu romushandi wehowa.
J 67.6 Mepu inogwadza bapu.
J 67.8 Hypersensitivity pneumonitis nekuda kwemamwe mavhu ehupfu.
J 67.9 Hypersensitivity pneumonitis nekuda kwezvimwe zvisingazivikanwi guruva.
Iyo diagnostic inogona kugadzirirwa sezvinotevera:
Exogenous allergic alveolitis (murimi wemapapu), acute fomu.
Zvinodhaka-induced allergic alveolitis inokonzerwa nefurazolidone, subacute fomu, nekutadza kufema.
Exogenous allergic alveolitis (huku breeder's lung), chisingaperi chimiro. Mwoyo wemapapu usingaperi, chisingaperi bronchitis.
Kurapa kwe exogenous allergic alveolitis
Kuti utsungirire chirwere chacho, zvakakosha kusabvisa zvachose kusangana kwemurwere uye allergen. Munhu panguva yebasa anofanira kushandisa masikisi, mafirita anokosha. Zvinonyanya kudiwa kuti uchinje mabasa nemaitiro ako. Kuti udzivise kufambira mberi kwepathology, zvakakosha kuiziva mumatanho ekutanga ekukura. Kana kusangana neiyo allergen kuchienderera mberi, shanduko mumapapu inozove isingadzokerike.
Iyo yakaoma nzira yealveolitis inoda kugadzwa kweglucocorticosteroids. Vanogona kurongerwa chete nachiremba, nekugadzwa.
Varwere vane hyperresponsiveness yemapapu vanorayirwa inhaled bronchodilators. Kana chirwere chacho chakakonzera kukura kwezvinetso, zvino ma antibiotics, diuretics, oksijeni, nezvimwewo zvinoshandiswa.
Prognosis uye kudzivirira
Kuti udzivise kukura kwechirwere, zvinodikanwa kuderedza zvese zvinogoneka kusangana neallergens. Saka, uswa hunofanira kunyatsoomeswa, makomba esilo anofanira kuvhurika. Nzvimbo dziri mukugadzirwa dzinofanira kunyatsofefeterwa, uye kana mhuka neshiri dziri mazviri, zvinodiwa zvehutsanana uye zvehutsanana zvinofanira kunyatsocherechedzwa. Air conditioners uye ventilation systems dzinofanirwa kugadziriswa nemhando yepamusoro uye nenguva, nezvimwe.
Kana iyo alveolitis yakatotanga, ipapo murwere anofanira kusabvisa kusangana neallergens. Kana basa reunyanzvi rikava mhosva, basa rinochinjwa.
Kufungidzira kunosiyana. Kana chirwere chacho chakawanikwa mumatanho ekutanga, ipapo chirwere chinogona kuzvigadzirisa pachacho. Kudzokazve kwealveolitis kunotungamira kune chokwadi chekuti mapapu emapapu anochinja zvisingachinjiki. Izvi zvinowedzera kufungidzira, pamwe chete nematambudziko ealveolitis kana nzira yayo isingaperi.