Vasculitis yemidziyo yepakati

Peri Arteritis Nodosa kana PAN

Periarteritis nodosa (PAN) isingawanzoitiki necrotizing angeitis inogona kukanganisa nhengo dzakawanda, chikonzero chacho chisinganyatsozivikanwi (mamwe mafomu anofungidzirwa kuti akabatanidzwa nehutachiona hweHepatitis B).

Varwere vanowanzove nekuderera kwemamiriro avo ese nekurasikirwa nehuremu, fivha, nezvimwe.

Kurwadziwa kwetsandanyama kunowanikwa muhafu yezviitiko. Iwo akanyanya, anopararira, anongoerekana aitika kana kukonzereswa nekumanikidza, izvo zvinogona kuroverera murwere pamubhedha nekuda kwekusimba kwemarwadzo uye kupera kwemhasuru ...

Kurwadza kwemajoini kunowanikwa mumajoini makuru ekutenderera: mabvi, zviziso zvemakumbo, magokora uye mawoko.

Kukuvadzwa kwemitsipa inonzi multineuritis inowanzoonekwa, inobata tsinga dzakawanda dzakadai se sciatica, kunze kana mukati popliteal, radial, ulnar kana median nerve uye inowanzobatanidzwa ne distal segmental edema. Neuritis isina kurapwa inozopedzisira yatungamira kune atrophy yemhasuru dzisina kuvharwa netsinga inobatwa.

Vasculitis inogonawo kukanganisa uropi zvakanyanya kashoma, izvo zvinogona kutungamirira kupfari, hemiplegia, sitiroko, ischemia kana kubuda ropa.

Chiratidzo chinoratidza pachikamu chekucheka ndeye purpura (mavara epurpsh asingapere kana akatsikirirwa) anoputika uye achipinda mukati, kunyanya mumakumbo ezasi kana liveo, achigadzira marudzi emameshes (livedo reticularis) kana mottles (livedo racemosa) purplish pa makumbo. Tinogonawo kuona chiitiko chaRaynaud (zvigunwe zvishoma zvinoshanduka zvichena mukutonhora), kana kunyange chigunwe kana chigunwe gangrene.

Orchitis (kuzvimba kwe testicle) ndeimwe yezvinonyanya kuratidzwa zvePAN, zvichikonzerwa ne vasculitis ye testicular artery iyo inogona kutungamirira ku testicular necrosis.

A biological inflammatory syndrome inowanikwa muhuwandu hwevarwere vane PAN (kuwedzerwa kwehuwandu hwekugadzirisa kusvika kune 60 mm muawa yekutanga, muC Reactive Protein, nezvimwewo), yakakura hyper eosinophilia (kuwedzerwa kwe eosinophilic polynuclear masero machena eropa).

Utachiona hweHepatitis B hunoguma nekuvapo kweHBs antigen munenge ¼ kusvika 1/3 yevarwere

Angiography inoratidza microaneurysms uye stenosis (kuderera kwe caliber kana tapering kutaridzika) kwepakati caliber midziyo.

Kurapa kwePAN kunotanga ne corticosteroid therapy, dzimwe nguva inosanganiswa ne immunosuppressants (kunyanya cyclophosphamide)

Biotherapies inoitika mukutarisira kwePAN, kunyanya rituximab (anti-CD20).

Burger chirwere

Chirwere cheBuerger's kana thromboangiitis obliterans is a angiitis inokanganisa zvikamu zvetsinga diki nepakati uye tsinga dzezasi nepamusoro makumbo, zvichikonzera thrombosis uye recanalization yemidziyo yakakanganiswa. Ichi chirwere chinowanzoitika muAsia uye pakati peAshkenazi vaJudha.

Inoitika mumurwere wechidiki (asingasviki makore makumi mana nemashanu), kazhinji anosvuta, anotanga kuratidza zviratidzo zvearteritis pakutanga kwehupenyu (ischemia yeminwe kana zvigunwe, kupindirana kwemukati, ischemic arterial ulcers kana gangrene yemakumbo, nezvimwewo).

Arteriography inoratidza kukanganisa kune distal arteries.

Kurapa kunosanganisira kurega kusvuta zvachose, izvo zvinokonzera uye kuwedzera kwechirwere.

Chiremba anorayira vasodilators uye antiplatelet mishonga yakadai seaspirin

Kuvhiya revascularization kunogona kudiwa.

Chirwere cheKawasaki

Chirwere cheKawasaki kana kuti "adeno-cutaneous-mucous syndrome" chirwere chevasculitis chinokanganisa nharaunda yecoronary arteries inotarisirwa kunyanya kune coronary aneurysms iyo inogona kukonzera kufa, kunyanya muvana vari pakati pemwedzi mitanhatu kusvika kumakore mashanu ane huwandu hwepamusoro. pazera remwedzi gumi nemisere.

Chirwere ichi chinoitika muzvikamu zvitatu kwemavhiki akawanda

Acute phase (inotora mazuva manomwe kusvika gumi nemana): fivha ine mapundu uye chitarisiko che "cherry miromo", "rurimi rwestrawberry", "maziso akabaiwa" nebilateral conjunctivitis, "inconsolable child", edema uye kutsvuka kwemaoko netsoka. Zvakanakisa, kurapwa kunofanirwa kutangwa panguva ino kudzikamisa njodzi yemoyo sequelae

Subacute phase (mazuva gumi nemana kusvika makumi maviri nemasere) zvichikonzera kusvuura ganda rezvigunwe nezvigunwe zvichitanga kutenderedza zvipikiri. Iri panguva ino iyo coronary aneurysms inoumba

Convalescent phase, kazhinji isina-chiratidzo-isina, asi panguva iyo kamwe kamwe matambudziko emwoyo anogona kuitika nekuda kwekuumbwa kwe coronary aneurysms muchikamu chakapfuura.

Zvimwe zviratidzo ndeichi kuputika kwenapukeni, kutsvuka kuine desquamative ruff, zviratidzo zvemoyo (kugunun'una kwemoyo, cardiac gallop, Electro CardioGram abnormalities, pericarditis, myocarditis ...), kugaya (manyoka, kurutsa, kurwadziwa mudumbu ...), Neurological (aseptic meningitis, convulsions , kuoma mitezo), weti (isingabereki pus muweti, urethritis), polyarthritis…

Kuzvimba kwakakosha muropa kunoratidzwa neSedimentation Rate yakakura kupfuura 100mm muawa yekutanga uye yakakwira kwazvo C-reactive protein, kuwedzera kwakajeka kwepolynuclear masero machena eropa anopfuura makumi maviri element / mm20, uye kuwedzera kwemaplatelet.

Kurapa kunobva pane immunoglobulins jekiseni intravenously (IV Ig) nekukurumidza sezvinobvira kudzikamisa njodzi ye coronary aneurysm. Kana IVIG isingashande, vanachiremba vanoshandisa intravenous cortisone kana aspirin.