Lupus nephritis: mob, kev kho mob, noj cov zaub mov

Lupus nephritis yog ib tug ntawm cov feem ntau heev teeb meem ntawm muaj quag lupus erythematosus. Scr - yog ib tug kab mob autoimmune tshwm sim los ntawm cov tsos ntawm cov tshuaj nyob rau hauv lub cev, uas tau txais lub "haiv neeg" cov nqaijrog li txawv teb chaws. Raws li ib tug tshwm sim, tsim aseptic o nyob rau hauv ntau qhov chaw ntawm lub cev. Nrog nyob rau hauv lub ob lub raum.

txhais

Lupus nephritis, lupus nephritis, los yog - ib tug hnyav lub raum tus kab mob nyob rau hauv mauj lupus erythematosus. Lub loj heev ntawm tus kab mob no nyob rau hauv cov pejxeem, nyob rau nruab nrab plaub caug cov neeg ib puas txhiab pejxeem. Feem ntau cov txom nyem los ntawm cov neeg sawv cev ntawm qhov zoo nkauj ib nrab ntawm lub hnub nyoog ntawm nees nkaum rau plaub caug xyoo. Feem ntau cov feem ntau, tus pathology yog pom nyob rau hauv Afro-Caribbean coob.

Tus kab mob muaj peev xwm muab tau los ntawm ib tug ntau yam ntawm yam, los ntawm thuam ntawm tanning, rau kev tshuaj ntsuam genetic mob, yog li nws tseem ceeb heev lub sij hawm them sai sai mus tsos mob thiab pom ib tug kws kho mob. Tom qab tag nrho, lub ntxov kho mob yog pib, lub zoo dua cov raug rau tus neeg mob lub neej thiab noj qab haus huv.

etiology

Lupus nephritis yuav tau triggered thaum uas ntev-lub sij hawm hnub raug qhov (hobby solarium los yog nyob twj ywm rau hauv hnub ci qhov chaw), tsis haum rau cov tshuaj, tas mus li kev nyuaj siab thiab txawm muaj menyuam hauv plab (cov me nyuam hauv plab yog dab tsi raws li ib tug txawv teb chaws lub cev thiab lub cev pib mus tua lub niam hlwb).

Nyob rau hauv tas li ntawd, txoj kev loj hlob ntawm kev tshuaj ntsuam genetic kab mob cuam tshuam yees, lub xub ntiag ntawm hormonal imbalances, nquag tus kab mob no cov kab mob (virus kev mus rau hauv lub cell lub cev, tawm hauv nyob rau hauv lawv nto antigens thiab ntxias nws li ib lub cev tsis teb). Sij hawm ntawm kev tsim muaj tus kab mob nyob rau hauv ze cov txheeb ze ob peb lub sij hawm siab tshaj qhov nruab nrab rau cov pejxeem.

pathogenesis

Lupus nephritis yog ib feem ntawm ib cov tsos mob uas tsim nyob rau hauv mauj lupus erythematosus. Autoantibodies tsim nyob rau hauv thawj qhov chaw rau cov neeg DNA thiab nws cov kev twb kev txuas nrog histones, rau cov nqaijrog ntawm lub complement system thiab cardiolipin. Yog vim li cas rau tej aggression - txo kam rau nws tus kheej antigens, tsis xws luag nyob rau hauv B thiab T lymphocytes.

Ncaj qha txuam nrog txoj kev loj hlob ntawm nephritis nyob rau hauv uas lub antigen-antibody ceg Tropic rau cov ntaub so ntswg ntawm lub raum tubules. Thaum xws li ib tug protein molecule yog txuas mus rau lub cell nto, nws ua ib tug cascade ntawm biochemical kev tig cev uas tshwm sim nyob rau hauv tso lub active tshuaj, melted cell. Qhov no, nyob rau hauv lem, ua rau ib tug inflammatory cov tshuaj tiv thaiv, uas tsuas exacerbates qhov kev puas tsuaj.

kev txhawj kev lub cev

Lupus nephritis nyob rau hauv SLE yuav muaj ntau yam morphological ces. Nrog rau cov qhib ntawm tus neeg mob muaj kev hloov nyob rau hauv lub week ntawm lub raum glomeruli, active division ntawm hlwb, lub expansion ntawm lub mesangium, vascular sclerosis, loops thiab tshaj. Cov ces tej zaum yuav muaj ob qho nyob rau hauv ib tug thiab nyob rau hauv ob peb lub glomeruli.

Qhov tseem hais rau lupus nephritis yog fibrinoid necrosis capillary voj ntawm Henle, thiab histologically detectable karyopyknosis thiab karyorrhexis (kev sib cais thiab lysis ntawm tes nuclei). Nyob rau hauv tas li ntawd, ib tug pathognomonic hloov nyob rau hauv glomerular qab daus membrane raws li ib tug "hlau loops" thiab muaj cov hyaline thrombi nyob rau hauv lub lumen ntawm cov hlab ntsha raws li ib tug tshwm sim ntawm deposition ntawm lub cev ceg.

kev faib

Clinically thiab morphologically yog ob peb theem uas extends lupus nephritis. Ib suam ntawm lub World Health Organization raws li nram no:

1. Thawj chav kawm ntawv: glomeruli muaj ib tug ib txwm qauv.
2. Ob txhais chav kawm ntawv: muaj cia li hloov nyob rau hauv lub mesangium.
3. Peb cov chav kawm ntawv: glomerulonephritis nrog lesion ntawm ib nrab ntawm lub glomeruli.
4. Qib plaub: diffuse glomerulonephritis.
5. Fifth kawm qib: membranous glomerulonephritis.
6. Sixth kawm qib: sclerosing glomerulonephritis.

Muaj kuj yog ib tug faib Serova, nyob rau hauv uas nws allocates focal, diffuse, membranous, mesangioproliferative, mesangiocapillary glomerulonephritis thiab fibroplastic.

cov tsos mob

Membranous lupus nephritis muaj ob obligate thiab facultative cov tsos mob. Ib qho ntawm nws ces yog yuav tsum tau proteinuria, uas yog, lub xub ntiag ntawm protein nyob rau hauv cov zis. Tsis tas li ntawd, koj muaj peev xwm feem ntau nrhiav tau hematuria, leuco - thiab limfotsituriyu. Cov cim qhia ntawm lub xub ntiag mob nyob rau hauv lub ob lub raum thiab yuav ua tau tsis tau tsuas yog nyob rau hauv SLE.

Nrog rau kev vam meej ntawm lub autoimmune txheej txheem no yog nce cov tsos mob ntawm lub raum tsis ua hauj lwm yog manifested los ntawm nce creatinine theem nyob rau hauv cov ntshav thiab zis, tsis muaj zog, nkees neeg mob soporous lub xeev.

Yog maj mam hnyav thiab sai heev hnyav nephritis. Yog hais tias tus kab mob no muaj maj mam, yeej zis thiab nephrotic syndrome. Ntxiv mus, lupus nephritis yuav tsum tau muaj nyob rau hauv ib tug tsaug zog los yog latent daim ntawv no, thaum tag nrho cov tsos mob yog tam sim no tsuas me proteinuria.

Sai hnyav lupus nephritis yog heev uas zoo sib xws rau cov classic glomerulonephritis. Raum tsis ua hauj lwm yog loj hlob sai heev, muaj tag nrho cov hematuria, nce ntshav siab, thiab nephrotic syndrome. Nyob rau hauv loj heev zaum muaj peev xwm tsim disseminated intravascular coagulation (DIC).

Lupus nephritis nyob rau hauv cov me nyuam

Nyob rau hauv 1/5 ntawm cov neeg mob nrog mauj lupus erythematosus thawj cov tsos mob tshwm sim nyob rau hauv thaum yau. Nyob rau hauv cov me nyuam yau tshaj 10 xyoo, nws yuav luag tsis tshwm sim, tab sis muaj ib tug piav qhia ntawm tus neeg mob ntawm SLE nyob rau hauv ib tug me nyuam thiab ib tug ib nrab lub hlis.

Txoj kev loj hlob ntawm tus kab mob nyob rau hauv cov me nyuam yog tsis sib txawv ntawm hais tias ntawm cov neeg laus. Cov soj ntsuam daim duab tej zaum yuav varied: los ntawm asymptomatic rau sai hnyav. Mob raum tsis ua hauj lwm yog tsis tshua muaj.

Ob peb cov tej yam tshwm sim ntawm SLE nyob rau hauv tus me nyuam:

• erythema ntawm lub ntsej muag;
• discoid pob liab liab nyob rau hauv lub cev;
• rhiab heev rau tshav ntuj;
• mucosal ulceration;
• o ntawm lub pob qij txha;
• raum kab mob;
• ib tug ua txhaum ntawm lub hauv paus poob siab system;
• nce los ntshav;
• immunological mob;
• lub xub ntiag ntawm antinuclear tshuaj.

Yog hais tias lub tsev kho mob muaj tsawg kawg yog plaub yam los ntawm daim ntawv no, peb yuav confidently hais tias tus me nyuam muaj mauj lupus erythematosus. raum puas tsuaj nyob rau hauv cov me nyuam tsis tshua tuaj rau lub fore. Feem ntau, cov tsos mob yuav ntsuas pib ntawm glomerulonephritis rau ces ntawm antiphospholipid syndrome.

Huab cua ntawm kev loj hlob ntawm tus kab mob nyob rau hauv cov me nyuam ntau paaj. Kaum xyoo tom qab lub formulation ntawm kev lim ntshav mob yuav tsum tau tsuas 10 feem pua ntawm cov neeg mob.

diagnostics

Yuav ua li cas muab tus kws kho mob ib tug yog vim li cas nyaj lupus nephritis? Kuaj feem ntau raws li uas twb muaj lawm soj ntsuam thiab kuaj-paub tseeb hais tias cov ntaub ntawv nyob rau hauv SLE:

• Mob thiab o nyob rau hauv cov pob qij txha;
• ua pob ua xyua ntawm daim tawv nqaij ntawm lub ntsej muag nyob rau hauv daim ntawv ntawm ib tug npauj npaim;
• nyob rau hauv lub xub ntiag ntawm effusion keeb kwm nyob rau hauv cov kab noj hniav (pleurisy, pericarditis);
• ceev poob phaus, kub ib ce.

Cov kev tsom xam ntawm cov ntshav cai anemia, tsis platelets, nce erythrocyte sedimentation tus nqi, tsis Nkij los txuam rau cov proteins. Rau mob yog ib qho tseem ceeb kom paub tias tshuaj rau cov haiv neeg DNA.

Feem ntau, qhov no yog txaus kom muaj tus mob ntawm muaj quag lupus erythematosus thiab, raws li ib tug rau txim ntawm lupus nephritis. Txawm li cas los, cov tsos ntawm cov protein nyob rau hauv cov zis tej zaum yuav raug ncua rau ib tug los yog ob lub xyoos los ntawm qhov pib ntawm tus kab mob. Nyob rau hauv xws li ib tug cov ntaub ntawv, tus kws kho mob cia siab rau enzyme immunoassay thiab nrhiav kom tau cov tshuaj. Yog hais tias tsis paub tseeb hais tias los ntawm laboratory cov ntaub ntawv, nws yog tsim nyog los ntxiv rau diagnostic search, tshwj xeeb tshaj yog txiv neej cov neeg mob, rau lawv cov nosology, qhov no yog tsis tshua muaj.

Qha lupus nephritis nyob rau hauv SLE cov neeg mob uas cov kab mob endocarditis, mob exacerbations ntawm rheumatoid mob caj dab, ntau yam myeloma, tus kab mob siab B, thiab amyloidosis syndrome, Henoch-Schonlein purpura.

Tus thawj theem ntawm kev kho mob

Kev kho mob ntawm lupus nephritis - ib tug ntev thiab tsho txheej txheem uas feem ntau tsuas kav ib sim neej. Nws yuav siv sij hawm qhov chaw nyob rau hauv ob ua sawv. Nyob rau hauv thawj theem docked exacerbation. Lub hom phiaj ntawm kev kho mob - mus cuag ruaj khov zam txim, los yog tsawg kawg txo cov kev soj ntsuam ces.

Tshuaj yuav tsum tau pib sai li sai tau los ntawm lub caij ntawm mob. Txhua yam tshwm sim li ntawd sai sai hais tias txawm nyob rau hauv tsib mus rau xya hnub ntawm kev ncua yuav ua tau ib tug neeg tuag taus yuam kev. Yog hais tias tus txheej txheem kev ua si yog tsis muaj (nws yuav qhia cov antibody titers), tus kws kho mob tej zaum yuav yog tas rau cov kev siv ntawm corticosteroids nyob rau hauv siab koob tshuaj rau ib lub sij hawm ntawm ob lub hlis, ua raws li los ntawm ib tug qeeb txo nyob rau hauv ntau npaum (dheev rho cov tshuaj tsis tau yuav, yuav tsis muab lub adrenal qog).

Yog hais tias ib tug ntau ceev ceev kawg ntawm tus kab mob, nyob rau hauv tas li ntawd mus steroids, intravenously muab siab koob tshuaj cytostatics. Qhov no muaj mem tes kho yog nqa tawm tsis pub dhau rau lub hlis. Tsuas yog tom qab no lub sij hawm yuav pib tau cov tshuaj ntawm cov tshuaj, thiab hloov tus neeg mob mus rau ib qho qhov ncauj tshuaj.

Tsis txhob hnov qab tias nyob rau hauv cov neeg mob uas SLE feem ntau tsim disseminated intravascular coagulation, li ntawd nws yog pom zoo kom noj cov tshuaj tiv thaiv kev ntsuas, namely:

• transfusion ntawm cov ntshav thiab nws cov Cheebtsam;
• tso dej "Trental";
• subcutaneous thawj coj ntawm 2.5 units ntawm ntau txhiab tus "heparin".

Ob txhais theem ntawm kev kho mob

Lupus nephritis nyob rau hauv SLE nyob rau hauv lub thib ob theem no kuj kho nrog steroids thiab cytotoxic tshuaj. Tsuas yog cov tshuaj lawv yog me npaum li cas. Heev maj mam, tshaj plaub mus rau rau lub hlis, lub koob tshuaj "Prednisolone" titrated mus rau 10 milligrams ib kilogram ntawm lub cev hnyav. Cytotoxic cov neeg ua hauj kuj tau xaiv bolus koob tshuaj ib zaug txhua txhua peb lub hlis, thiab yog hais tias qhov zoo muaj zog ntawm tus kab mob no, ces tsiv mus rau ib tug hluas txhaj txhua txhua rau lub hlis.

Tej txij nkawm txoj kev kho tej zaum yuav kav rau xyoo. Thaum lub sij hawm, nws yog ntxiv (yog tias tsim nyog) kev tiv thaiv ntawm tshwm sim los ntawm cov tshuaj thiab symptomatic kev kho mob.

Tab sis txawm nrog raws sij hawm pib kho mob nyob kaum tsib feem pua ntawm cov neeg mob tseem tsim raum tsis ua hauj lwm. Nyob rau hauv cov ntaub ntawv no, tsuas pab hemodialysis los sis mob raum hloov. Tu siab, cov kev kho mob yog tsis muaj rau cov pej xeem.

Noj cov zaub mov rau lupus nephritis

Nyob rau hauv thiaj li yuav muaj lub raum muaj nuj nqi nrog lupus nephritis cov neeg mob yuav tsum tau ua raws li tej yam cov kev cai:

1. Haus dej kom ntau mus rau ib tug zoo lim cov ntshav thiab tswj kom lub theem ntawm metabolism.
2. Cov zaub mov yuav tsum muaj me nqi ntawm poov tshuaj, phosphorus thiab protein, txij li thaum cov ntsiab muaj ib tug tsis ntxim rau cov puas ob lub raum.
3. Muab tsis tau phem.
4. Koom nyob rau hauv lub teeb ce.
5. Tu ncua mus saib koj cov ntshav siab.
6. Txwv txiav cov tsawg ntawm cov zaub mov muaj roj.
7. Tsis txhob noj narcotics yuav muab vim hais tias lawv muaj ib tug tsis ntxim rau cov ob lub raum.

Yog hais tias tus neeg mob raws li cov tswv yim pom zoo, qhov zoo ntawm lub neej yog ho paub, thiab cov ciaj sia taus raug yog ntau pheej.

outlook

Huab cua kho lupus nephritis membranous nyob ntawm yuav ua li cas loj cuam tshuam rau ob lub raum thiab pib ntawm txoj kev kho. Cov ua ntej lawm tus neeg mob mus rau tus kws kho mob, tus loj dua cov zaum ntawm ib tug cov paaj sij hawm.

Plaub caug xyoo dhau los, tsuas yog ib tug puv tes ntawm cov neeg mob nrog lupus nephritis tau nyob ntau tshaj ib xyoo los ntawm tus mob. Tsaug rau kev niaj hnub ntawm kev kho mob thiab kuaj mob, cov neeg mob yuav tau txais ib tug ntau tshaj tsib-xyoo lifespan.