Kab mob txhawm rau pob txha caj qaum: kev kuaj mob, kev kho mob thiab kev kwv yees

Kab mob Pancreatitis - ib hom mob ntawm pancreatitis, nyob rau hauv pathogenesis ntawm uas autoimmune mechanisms yog koom tes nrog. Hauv hom kab mob pancreatitis no, soj ntsuam hypergammaglobulinemia, nce qib ntawm IgG, IgG4 nyob rau hauv cov ntshav ntshav, autoantibodies muaj tam sim no, qhov lus teb zoo rau kev kho mob nrog corticosteroids yog kaw.

Ob yam mob autoimmune pancreatitis:

1. Hom 1 - lymphoplasmacytic sclerosing pancreatitis
2. Hom 2 - idiopathic duct-concentric pancreatitis nrog granulocytic epithelial txhab.

Cov hauv paus ntawm kev kuaj mob autoimmune pancreatitis yog pom nyob hauv International Kev Pom Zoo ntawm kev kuaj mob tus kab mob autoimmune pancreatitis, uas tau pom zoo hauv Nyij Pooj xyoo 2010. Lub ntsiab kev sojntsuam tseem ceeb (S1) rau kev kuaj mob ntawm AIP tau txiav txim siab los txiav txim siab txog qhov nce ntawm qib IgG4 qib ntawm ntau dua 2 tus qauv, thiab qhov tsis txaus ntseeg (S2) yog qhov nce ntawm qhov ntsuas, tab sis tsis ntau dua 2 tus qauv.

Kev kuaj mob

Hauv cov neeg mob autoimmune pancreatitis nyob rau hauv ntau yam kev sib txuas ua ke thiab nrog lub cev sib txawv (30-95%), cov tsos mob hauv qab no thiab cov kab mob sib kis tau pom:
• kev hnov ​​mob me ntsis
• kawm ntev li niaj hnub yam tsis tau hais meej txog kev ua kom tsis txhob ntoj ib ce lossis tsis muaj chav nyob tsis ntev,
• cov tsos mob ntawm tus txha nqaj tawv,

• nce nyob rau hauv tag nrho cov nyiaj ntawm gammaglobulins, IgG lossis IgG4 nyob rau hauv ntshav,
• muaj cov autoantibodies,
• diffuse kev nthuav dav ntawm tus txiav,
• tsis sib npaug (tsis xwm yeem) nqaim ntawm GLP,

• qhov ncauj ntawm intrapancreatic feem ntawm cov kua tsib cov leeg, feem ntau tsawg dua - kev koom tes hauv cov txheej txheem ntawm lwm qhov ntawm biliary huam (sclerosing cholangitis), zoo ib yam li hloov hauv PSC,
• kev hloov pauv fibrotic nyob rau hauv pancreatic parenchyma nrog lymphocyte infiltration thiab IgG4-positive plasmocytes,
• mob thrombophlebitis obliterans,

• nquag ua ke nrog lwm cov txheej txheem: PSC, thawj cov kab mob pob txha nqaj qaum, mob ncauj plab, mob Crohn, Sjogren's syndrome, retroperitoneal fibrosis, kev puas tsuaj rau interstitium thiab tubular apparatus ntawm lub raum, mob qog thyroidin
• qhov ua tau zoo ntawm glucocorticoids.

Vim tias qhov ntau ntawm cov cim autoimmune CP, qee qhov tsis tau nruj me ntsis, hauv xyoo 2002, thawj thawj zaug, Japanese Pancreatic Society tau thov cov kev kuaj mob rau autoimmune CP txhawm rau txhawm rau txhim kho kev kuaj mob.

• Cov ntaub ntawv los ntawm cov kev tshawb nrhiav cov khoom siv: qhov nqaim ntawm GLP nrog lub hauv paus phab ntsa tuab thiab qhov loj ntawm cov txiav txiav.
• Cov ntaub ntawv kuaj (laboratory): cov ntshiab ntshav ntau ntxiv ntawm gammaglobulins thiab / lossis IgG lossis qhov pom ntawm autoantibodies hauv ntshav ntshav.
• Cov ntaub ntawv kev tshawb fawb keeb kwm: kev hloov pauv ntawm cov hlab ntsws thiab plab hnyuv quav nrog lymphocytic thiab plasmacytic infiltration.

Raws li kev txiav txim siab ntawm Nyiv Neeg Kev Noj Qab Haus Huv ntawm Pancreatologist, kev kuaj mob tus kab mob autoimmune pancreatitis tsuas yog tsim tau yog tias thawj tus qauv tshuaj nrog rau qhov thib ob thiab / lossis thib peb.

Hauv xyoo 2006, K. Kim et al. tawm tswv yim, vim tias qhov tshwm sim ntau ntawm qhov tsis pom ntawm tus kabmob thaum siv cov qauv ntawm Nyijpooj ntawm Pancreatologist, muaj kev txhim kho thiab yooj yim dua rau cov kws kho mob kuaj pom tus kabmob autoimmune pancreatitis, qee feem raws cov lus tau hais tseg yav dhau los.

• Cov Qauv Ntsuas 1 (lub ntsiab) - cov ntaub ntawv los ntawm cov kev tshawb fawb hauv cov twj paj nruag:
- diffuse nce hauv lub cev raws li CT,
- diffuse lossis segmental irregular narrowing ntawm GLP.

• Cov Qauv Thib 2 - cov ntaub ntawv kuaj ntsuas (tsawg kawg yog ib ntawm ob qhov kev txawv txav hauv qab no):
- nce qhov kev haum xeeb ntawm IgG thiab / lossis IgG4,
- muaj cov autoantibodies.

• Cov Kev Ntsuas 3 - cov ntaub ntawv txheeb xyuas keeb kwm: - fibrosis,
- lymphoplasmacytic infiltration.

• Qhov 4 - koom nrog lwm cov kab mob autoimmune. Kev kuaj mob ntawm tus kab mob autoimmune pancreatitis tuaj yeem tsim nrog kev sib txuas ua ke hauv qab no: 1 + 2 + 3 + 4, 1 + 2 + 3, 1 + 2, 1 + 3.

Kev kuaj mob pom zoo yog tias muaj kev sib txuam ntawm cov qauv 1 + 4, yog tias pom muaj cov lus teb zoo rau kev kho glucocorticoid, kev kuaj mob tau txiav txim siab tsim. Kev kuaj mob yog muaj peev xwm yog tias tsuas yog tus txheej txheem 1 nyob nrog.

Kev kho thiab ntsuas qhov tseeb

Hauv cov neeg mob uas muaj cov tsos mob me me ntawm autoimmune CP, kev kho mob zoo ib yam li OP (tshaib plab, PPI, tshuaj tua kab mob) feem ntau tsis tsim nyog. Yog tias cov tsos mob tshwm sim txhaws qau, muaj tus mob transcut rau lub cev lossis tawv nqaij thim rov qab rau hauv lub cev, tshwj xeeb tshaj yog hais tias muaj cov kab mob.

Nrog cov keeb kwm kev kuaj mob (cytologically) tau txheeb xyuas tus kab mob autoimmune CP, thaum tsis tas yuav tsum muaj kev kho mob kev kho mob nrog glucocorticoids, nws tau pom zoo kom nthuav dav kev kho mob nrog rau kev suav nrog rau hauv kev tswj hwm (ntxiv rau prednisone) ntawm lub plab zom cov tshuaj tiv thaiv (feem ntau IDN) thiab kev npaj polyenzyme nrog kev hloov chaw (mob plab mob plab tsis tau hais tawm) )

Rau cov hom phiaj mob, raws li kev taw qhia, cov tshuaj antispasmodics thiab cov tshuaj tsis-tshuaj steroidal siv.
Kev kho Steroid feem ntau ua tau rau kev puas tsuaj rau cov bile ducts, cov qog salivary, thiab kev puas tsuaj rau pancreatic ducts. Hauv qee tus neeg mob, tus mob muaj zog zoo zuj zus yam tsis muaj kev siv tshuaj. Muaj qee kis, thaum lub sijhawm ntawm autoimmune CP nyuaj los ntawm hom 2 mob ntshav qab zib mellitus, kev kho mob nrog glucocorticoids tuaj yeem txhim kho tus neeg mob tus mob.

Nws tau hais tias nrog autoimmune CP, azathioprine yuav ua tau zoo. Cov kev kho mob tau txais los ntawm kev siv ursodeoxycholic acid (ursofalk) npaj rau autoimmune CP, uas tshwm sim nrog cov ntshav qab zib mellitus thiab cholestasis syndrome tiv thaiv keeb kwm yav dhau los ntawm stenosis ntawm lub davhlau ya nyob twg ntawm cov kua tsib uas feem ntau: tus naj npawb ntawm cholestasis cov cim txo qis, mob ntshav qab zib tsawg zuj zus thiab ntshav qab zib tsis tuaj yeem.

Ursofalk txoj kev kho rau autoimmune CP tuaj yeem hloov kho tau rau glucocorticoids. Raws li koj paub, ursofalk tau zoo siv rau kev ua kom mob pob txha taub thiab PSC. Cov tshuaj pab txhawm rau txhawm rau txhawm rau ntawm bile, muaj kab mob hepatoprotective thiab immunomodulating, yog li, nws tuaj yeem siv rau hauv autoimmune CP, tshwj xeeb nrog kev koom tes ntawm biliary system. Cov ntsiab lus hauv qab no rau kev saib xyuas txoj kev txuag yog muaj peev xwm ua tau (Daim duab 4-46).

Nrog kev kho mob ntev nrog kev paub tseeb, kev tswj hwm ntawm chav kawm ntawm tus kab mob yog tsim nyog:
• ntsuam xyuas cov tsos mob ua ntej,
• kuaj mob ntawm kev ua haujlwm ntawm exo- thiab endocrine pancreatic muaj nuj nqi,
• tshuaj xyuas cov cim qhia ntawm kev soj ntsuam dav dav thiab biochemical ntawm cov ntshav,
• tswj cov cim cim ntawm lub cim xeeb ua haujlwm,
• tswj xyuas ultrasound, ESM nrog siv rab koob ntawm rab qau, CT lossis MRI.

Kev kuaj mob rau autoimmune CP yog nyob ntawm qhov hnyav ntawm cov teeb meem, concomitant autoimmune kab mob thiab ntshav qab zib mellitus.

Kab mob pancreatic autoimmune yog dab tsi

Autoimmune kev puas tsuaj rau tus txiav, los yog raws li lawv tau siv los hu rau nws, autoimmune pancreatitis, uas yog tus cwj pwm los ntawm kev nce ntxiv hauv kev tiv thaiv kab mob mus rau qhov uas nws pib ua haujlwm tawm tsam nws lub cev. Hauv qhov no, qhov yeej cuam tshuam ob qho tib si lub cev ua qab thiab nws cov caj pas, ua kua tsib lub raum, kab mob ntsws ntawm cov plab hnyuv siab raum, ob lub raum, lub plab hnyuv plab, cov qog ntshav thiab lwm yam hauv nruab nrog cev.

Daim pib ntawm lub cev ua mob rau ntawm daim tawv nqaij hu ua pancreatitis yog hais txog ntau hom mob ntev ntev ntawm tus kab mob no uas kav ntev li ib nrab xyoo lossis ntau dua. Feem ntau, nws muaj feem ntau hauv cov txiv neej, txawm hais tias poj niam kuj yuav muaj kev cuam tshuam los ntawm tus kab mob no.

Ua rau

Cov laj thawj ntawm qhov tshwm sim ntawm tus mob autoimmune pancreatitis tseem tsis tau tsim, nws tsuas yog paub tias thaum lub sijhawm tshwm sim ntawm qee yam kev ua haujlwm tsis zoo hauv lub cev, kev tiv thaiv kab mob pib ua haujlwm nyob rau hauv kev coj ua txawv, thiab tawm tsam cov kabmob ntawm nws lub cev.

Kev txhim kho ntawm tus mob autoimmune ntawm kab mob pancreatic feem ntau cuam tshuam nrog kev txhim kho mob caj dab, mob Sjogren's syndrome, nrog rau kev ua kom muaj kab mob hauv plab hnyuv plab.

Cov qauv ntawm pathology

Cov theem pib ntawm tus kabmob autoimmune pancreatic thaum kuaj mob histology tau muab faib ua:

1. Kev tsim kho ntawm sclerosing lymphoplasmacytic pancreatitis, uas ua rau nws tus kheej nthuav qhia feem ntau hauv cov neeg laus. Nws yog tus cwj pwm los ntawm kev tsim cov xim yellowness ntawm daim tawv nqaij thiab cov nploos ntawm lub cev, nrog rau kev puas tsuaj rau cov txiav. Zoo saib xyuas nrog tshuaj steroid.
2. Kev tsim tawm ntawm idiopathic pancreatitis ntawm concentric hom nrog kev puas tsuaj rau granulocytic epithelium. Nws tshwm sim ntau dua rau cov neeg ntawm cov hnub nyoog yau, tsis hais poj niam los txiv neej.

Ob qho kev sib txawv no tsuas yog siv hauv kev soj ntsuam me me xwb.

Los ntawm qhov muaj tus mob concomitant pathological autoimmune mob tshwm sim thaum lwm yam kabmob muaj feem cuam tshuam, kev mob ntawm tus kabmob ua haujlwm pancreatic pathology tau muab faib ua:

• kev txhim kho ntawm ib daim ntawv sib cais ntawm cov leeg autoimmune pancreatic lesion ntawm lub caj pas, uas qhov txhab tshwm sim tsuas yog lub caj pas,
• raws li kev txhim kho ntawm tus kabmob leeg kabmob (pancreatitis syndrome), uas lwmyam kabmob muaj feem cuam tshuam nrog rau tus kabmob ntxiv.

Lub hauv paus ntawm lub nruab nrog cev xeeb tub:

• cov tsos ntawm sclerotic cov ntaub so ntswg nyob rau hauv lub ntsws ntawm cov nruab nrog plab hnyuv siab raum thiab siab,
• ua txhaum ntawm annular reabsorption nyob rau hauv lub raum, uas ua rau kev txhim kho ntawm lawv tsis muaj txhij txhua,
• cov qog ua ntshav, hu ua thyroiditis,
• o ntawm salivary qog, xa mus rau raws li sialadenitis.

Ntawm thaj chaw ntawm lub qhov txhab, cov kab mob hauv cov lus nug yuav muaj:

• daim ntawv diffuse, pom qhov txawv ntawm kev puas tsuaj rau yuav luag tag nrho cov kab noj hniav ntawm txiav,
• focal daim ntawv, nyob rau hauv uas feem ntau, qhov ua kom pom tseeb yog nyob hauv thaj av ntawm lub taub hau ntawm lub caj pas.

Cov tsos mob thiab cov tsos mob ntawm tus kab mob

Mob caj dab mob leeg sai yog nthuav rau qhov tias nws tsis ua kom pom nws tus kheej nrog cov cim qhia tau thiab muaj kev cuam tshuam meej rau hauv qhov kev noj qab haus huv feem ntau ntawm tus neeg mob, txawm tias lub sijhawm dhau los ntawm kev ua kom hnyav dua ntawm pathology. Hauv qee kis, tus kabmob tuaj yeem loj hlob yam tsis muaj cov tsos mob tshwm sim txhua lub sijhawm, thiab kev kuaj mob tau ua twb tau nyob rau theem ntawm kev loj hlob ntawm cov teeb meem.

Cov tsos mob pom ntawm tus kab mob no yog qhia raws li hauv qab no:

1. Cov tsos ntawm kev tsis xis nyob hauv plab plab nrog tsim ntawm cov yam ntxwv ntawm tus yam ntxwv mob mob nrog herpes zoster nrog kev ua kom tsis muaj zog los yog siv tshuaj tiv thaiv.
2. Qhov tsim ntawm yellowness ntawm daim tawv nqaij thiab mucous daim nyias nyias hauv qhov ncauj kab noj hniav, thiab txawm tias lub ntsej muag sclera.
3. Cov xim ntawm cov quav quav yuav ua ntau lub suab nrov dua ntais thiab tso zis tsaus dua.
4. Kev tsim kho ntawm khaus ntawm daim tawv nqaij
5. Tsis qab los noj mov.
6. Los ntshav nrog tus yam ntxwv xav tias xeev siab, uas feem ntau ua rau muaj qhov tawm ntawm ntuav ntuav.
7. Thaum sawv ntxov ntxov, cov neeg mob feem ntau hnov ​​lub qhov ncauj qhuav thiab saj ntawm kev iab.
8. Qhov theem siab ntawm kev qaug zog thiab txo lub cev lub cev nyhav nrawm nrog txoj kev ua txhaum pathological ntawm tus neeg mob psychoemotional lub xeev.
9. Cov tsos ntawm kev ua tsis taus pa, qhov mob ntawm caj pas ua qog ua rau qhov keeb kwm ntawm lawv qhov o. Tus neeg mob ntsib mob thaum hais lus, nqos khoom noj thiab haus dej.

Kev kuaj mob ntawm tus kabmob

Kev kuaj kom raug thiab qhov tseeb tuaj yeem tsuas yog ua tau los ntawm kev soj ntsuam tag nrho ntawm tus neeg mob lub cev, dhau cov kev kuaj mob thiab dhau cov txheej txheem kuaj mob ntxiv.

Yuav kom tau txais daim duab tiav hauv kev soj ntsuam ntawm kev txhim kho tus kabmob, cov txheej txheem kev kuaj mob hauv qab no pom zoo:

• kev txiav txim siab ntawm kev saib xyuas ntawm IgG4 immunoglobulin nyob rau hauv cov ntshav ntshav, nrog pathology, nws tuaj yeem nce ntxiv 10 zaug,
• kev kuaj mob dav dav tau sau tseg: ntshav rau biochemistry, kev tshuaj xyuas dav dav ntawm cov zis thiab cov quav,
• soj ntsuam kuaj hauv quav,
• kev qhia kom paub txog cov cim qog,
• txhawm rau txiav txim siab qhov ntau ntawm kev puas tsuaj thiab lub xeev ntawm cov khoom sib xyaw hauv lub cev, kev hla ntawm tomography thiab ultrasound raug sau tseg,
• thiab kuj tsis ua yam tsis muaj me thiab keeb kwm.

Tom qab tau txais daim ntawv qhia tag nrho, cov kws kho mob ua qhov kev kuaj mob kom raug, txiav txim siab tus kabmob, thiab txhim kho txoj kev kho kom zoo tshaj plaws thiab nyab xeeb.

Nws yog tsim nyog sau cia tias tus me nyuam me kuj tseem yauv raug kev loj hlob ntawm tus kab mob uas zoo sib xws, txawm hais tias qhov no yog qhov tsis tshua muaj tshwm sim. Txawm li cas los xij, thaum nws tsim nyob rau hauv tus menyuam, nws tau raug tsos los ntawm tawv nqaij ntau dhau, uas tsis tuaj yeem tsis quav ntsej los ntawm cov kws kho mob.

Kev kuaj mob ultrasound

Kev kuaj kab mob ultrasound tuaj yeem ntsuas qhov ntsuas sab nraud ntawm qhov hloov khoom nruab nrog, cuam tshuam cov qauv yam ntxwv thiab qhov ntsuas ntawm kev loj hlob ntawm cov kab mob pathology hauv kab noj hniav ntawm tus txiav, kab mob siab thiab tus po.

Siv cov txheej txheem tshawb fawb no, cov laj thawj uas ua rau muaj kev ua txhaum ntawm qhov tawm ntawm cov kua tsib, nrog rau qhov muaj cov qog-zoo li cov qog ntshav thiab cov pob zeb hauv lub caj pas ua haujlwm tau raug qhia.

Kev txiav txim siab ntawm IgG4 immunoglobulin concentration

Thaum ua qhov kev tshawb fawb soj ntsuam kev kuaj ntshav, tshwj xeeb yog them rau kev saib xyuas ntawm IgG4 immunoglobulin. Hauv cov neeg muaj kev noj qab haus huv, nws cov ntsiab lus tsis ncav cuag 5% ntawm tag nrho cov nyiaj hauv ntshav cov ntshav. Nrog kev nce siab hauv nws qhov kev xav, peb tuaj yeem hais lus nyab xeeb txog kev txhim kho ntawm kab mob pathological hauv tib neeg lub cev, nrog rau cov txheej txheem ntawm infiltration ntawm cov plab hnyuv siab raum zais cia cov tshuaj tiv thaiv immunoglobulin.

Hauv lwm lo lus, muaj kev txhim kho nquag muaj txheej txheem hauv cov txheej txheem hauv cov nqaij ua ke nrog kev tsim cov nqaij thiab tawv nqaij.

Hauv cov neeg mob uas muaj kev txhim kho autoimmune pancreatitis nyob rau hauv ntau dua li 88% ntawm cov neeg mob, muaj qib ntawm immunoglobulin nce ntxiv hauv 5 lossis txawm 10 npaug ntau dua li ib txwm.

Kho kab mob

Nws yuav luag tsis yooj yim sua kom rov zoo siab rau txoj kev kho tus mob autoimmune pancreatitis. Yog vim li cas txoj kev tseem ceeb ntawm txoj kev kho yog qhia rau kev tshem tawm ntawm cov tsos mob thiab inhibition ntawm cov kev hloov kho pathological.

Ua ntej tshaj plaws, cov lus pom zoo ntawm cov kws tshaj lij xws li Igor Veniaminovich Mayev (Honoured Gastroenterologist thiab kws kho mob ntawm Science) thiab Yuri Alexandrovich Kucheryavy (PhD), yog nyob rau hauv nruj ua raws li kev noj zaub mov kom paub meej tiv thaiv kev mob thiab ua kom zoo tshaj plaws ntawm kev txiav txim siab ntawm pancreatic congestion.

Tsis tas li, kev siv tshuaj tiv thaiv kab mob yog kho, suav nrog kev tswj hwm ntawm cytostatics thiab glucocorticoids. Yuav kom txo qis qhov mob uas qhia qhov nws tus kheej thaum lub sij hawm exacerbation ntawm tus kab mob, cov tshuaj spasmolytic.

Nrog kev tawm tsam nyuaj ntawm cov kua tsib thiab kev txhim kho ntawm yellowness ntawm daim tawv nqaij thiab cov qog ua kua, cov tshuaj siv, uas suav nrog ursodeoxycholic acid.

Nrog rau kev txhim kho stenosis hauv kev kab noj hniav ntawm cov kab mob vwm, kev phais mob tau kho.

Noj zaub mov

Nws raug nquahu kom siv cov khoom noj siv mis, cog khoom noj, nrog rau kev noj zaub mov ntau yam nqaij dawb ua zaub mov zoo.

Cov kev zam yuav tsum yog:

• tag nrho cov khoom noj uas muaj feem pua ​​ntawm cov rog, ntsim, noj nqaij thiab ntsev,
• bakery thiab confectionery khoom,
• dej cawv thiab haus cawv,
• Chocolate thiab kas fes
• muaj zog tshuaj yej
• ntau yam txuj lom thiab txuj lom,
• dawb cabbage, radish, radish, qej thiab dos.

Koj yuav tsum tso kev haus luam yeeb tseg thiab.

Teeb meem thiab qhov tshwm sim uas yuav muaj

Kev kho tsis raws sijhawm ntawm tus kab mob no yog fraught nrog cov teebmeem hauv qab no:

• kev txhim kho ntawm hypovitaminosis thiab protein tsis txaus,
• kev hnyav dhau, ua rau lub cev tsis muaj zog,
• lub cev qhuav dej
• ua txhaum ntawm cov dej-ntsev metabolism hauv,
• muaj mob ntawm subhepatic jaundice,
• kis kab mob ntawm lub cev, nyob rau hauv daim ntawv ntawm sepsis, peritonitis, purulent cholangitis, mob ntsws infiltrate,
• ulcerative thiab erosive puas rau lub plab zom mov,
• tav kev ntawm duodenum 12,
• kev loj hlob ntawm pancreatogenic ascites,
• kev pheej hmoo siab mob qog noj ntshav.

Qhov tshwm sim ntawm kev kho tsis raws caij nyoog ntawm daim ntawv autoimmune ntawm xws li mob hnyav ua rau mob ncauj zais dej tuaj yeem yog ntau. Tab sis, nws tsim nyog teev tias, raws li kev txheeb xyuas ntau, kev kho kom tsim nyog thiab raws sijhawm yuav ua rau kom muaj kev nce siab ntawm kev rov qab los ntawm cov plab hnyuv cev, nrog rau kev txhim kho kev noj qab haus huv tag nrho ntawm tus neeg mob.

1. Bezrukov V.G. Cov tshuaj tiv thaiv kab mob hauv lub cev ua kiav txhab laus. Mob txha cajqaum: etiology, pathogenesis, chaw kuaj mob, tshuaj tiv thaiv kab mob, kho mob. Omsk, 1995 pp. 34–35.
2. Yarema, I.V. Autoimmune pancreatitis ntawm Ministry of Health ntawm Lavxias Federation, kev kawm kho mob thiab tshuaj ntxiv mus. M. GOU VUNMTS Ministry of Health ntawm Lavxias Federation, 2003
3. Bozhenkov, Yu G. G. Kev Siv Tshuaj Pancreatology. Phau ntawv qhia rau cov kws kho mob M. Honey. phau ntawv N. Novgorod Kev Tshaj Tawm Tsev Kawm Ntawv ntawm Novosibirsk State Medical Academy, 2003
4. Bueverov A.O. Cov neeg daws teeb meem kev mob tshwm sim thiab puas rau cov txiav ua kua ntshav. Lavxias Journal ntawm Gastroenterology, Hepatology, Coloproctology. Xyoo 1999, No. 4, phab 15–18.
5. Velbri S.K. Kev kuaj mob tiv thaiv kab mob pancreatic. M.: Tshuaj, 1985
6. Midlenko V.I. Clinical thiab pathogenetic qhov tseem ceeb ntawm kev tiv thaiv kab mob hloov pauv hauv cov neeg mob uas muaj tus kab mob pancreatitis. Abstract ntawm dissertation. Barnaul, 1984

Cov tsos mob tseem ceeb ntawm tus kab mob

Qhov mob huam tuaj ntawm tus kab mob no yog xyaum tsis tuaj. Qee zaum cov tsos mob tsis tshwm sim txhua. Hauv cov xwm txheej zoo li no, kev kuaj mob tau ua tiav raws li cov teeb meem pom tseeb. Cov cim tseem ceeb ntawm tus kabmob:

1. Qhov mob thiab tsis xis nyob hauv plab sab sauv, qee zaum hauv qaum qis. Qhov no tuaj yeem siv sijhawm rau ob peb feeb, thiab qee zaum sijhawm. Qhov mob hauv cov xwm txheej zoo li mob sib khuav lossis mob hnyav. Qhov no feem ntau tshwm sim thaum noj cov zaub mov rog, ntsim lossis kib.
2. Yuav muaj nqaij tawv daj rau ntawm daim tawv nqaij ntawm tus neeg mob (mob daj ntseg), qhov ncauj tawm ntawm qhov ncauj, qaub ncaug, thiab lwm yam Muaj tshwm sim thaum cov kua tsib nkag mus rau hauv duodenum lossis thaum tus neeg mob pancreatic canals thiab excretory bile ducts nqaim.
3. Cov quav nrog hom kab mob pancreatitis yuav sib dua dua li ib txwm, thiab cov zis muaj xim tsaus dua.
4. Hauv ntau cov neeg mob, nws pib khaus.
5. Qab los noj mov txo.
6. Kev mob vauv plab, tus neeg mob mob, ntuav yog ua tau.
7. Thaum sawv ntxov, tus neeg mob tau lub qhov ncauj qhuav thiab tsis txaus siab, thiab los ntawm qhov ncauj tawm ntawm nws qhov ncauj tsw phem, tsis hnov ​​tsw.
8. Mob ntshav qab zib yuav tshwm sim thiab loj hlob.
9. Kev hnyav nrog lub cev sai sai.
10. Kev tsis muaj zog ntau yam, nruab hnub pw tsaug zog, poob haujlwm tsawg.
11. Kev ntxhov siab, ua haujlwm tsis zoo, ua rau kev chim siab ntau dua.
12. Ua tsis taus pa ntawm lub ntsws puas.
13. Protein hauv cov zis qhia tias lub raum tsis ua haujlwm.
14. Kev qhia paub txog ntau yam kev mob tshwm sim hauv lub siab tsis muaj kev txhim kho cov qog.
15. Kev mob caj pas ntawm cov qog ua kua dej, qhov mob nyob hauv thaj chaw no. Tej zaum yuav muaj teeb meem nqos, ua pa, thiab hais lus.

Nyeem txog cov kev hloov pauv txawv ntawm kab mob dab tsi ntxiv ntawm no.

Cov ntawv sib txawv ntawm cov kabmob pob txhaws pob txha kabmob

Muaj ob hom kab mob raws li kev hloov pauv ntawm cov kabmob uas pom nyob hauv lub tshuab tsom kab ntsig:

• sclerosing lymphoplasmacytic pancreatitis,
• duct-concentric idiopathic hom.

Qhov sib txawv ntawm ob daim ntawv no raug qhia tsuas yog thaum tshawb nrhiav keeb kwm. Yog tias tus neeg mob tau muaj lwm yam kabmob ntawm tus kabmob autoimmune, tomqab uas mob pancreatitis tau faib ua:

• raug rho tawm yam mob,
• autoimmune syndrome.

Nyob ntawm thaj chaw ntawm tus kabmob, hom diffuse thiab focal yog qhov txawv.

Kev txheeb xyuas tus kab mob ntawm ntau yam thiab txoj kev

Cov kws kho mob kuaj xyuas tus neeg mob lub ntsej muag thiab sau lub sij hawm (kwv yees) qhov tsos ntawm qee yam tsos mob tshwm sim ntawm tus kab mob. Kev muaj peev xwm ntawm tus neeg mob uas muaj cov kab mob mus ntev, nws cov keeb kwm, kev coj tsis zoo, thiab lwm yam, tseem tab tom kawm.

Tom qab ntawd qhov kev kuaj lub cev yog qhov ua tiav: kev txiav txim siab ntawm lub cev qhov hnyav, kuaj xyuas yellowness, kuaj xyuas lub plab ntawm lub plab mog, nws tapping. Qhov ntau thiab tsawg ntawm daim siab, kab txiav, ntxaij.

Tom qab ntawv cov kev tshawb fawb kuaj sim pib. Kev kuaj ntshav dav dav thiab biochemical yog ntsuas, qib ntawm cov piam thaj hauv tus neeg mob lub cev tau txiav txim siab, glycated hemoglobin yog soj ntsuam, cov lipid profile tau kos (qhov muaj cov rog hauv cov ntshav).

Tus neeg mob tau kuaj sim siv lub cim qog, kuaj ntshav tau noj, thiab tus nqi ntawm immunoglobulin yog txiav txim siab. Kev tshuaj xyuas yog txiav ntawm cov quav ntawm tus neeg mob.

Ultrasound kuaj ntawm lub plab yuav tsim nyog los tshuaj xyuas tus neeg mob. Tus neeg mob tuaj yeem xa mus rau kom meej meej txog kev kuaj mob ntawm kauv xoo tomography lossis nws qhov sib nqus resonance analogue. Tej zaum koj yuav xav tau qhov thiaj li hu ua retrograde cholangiography - kev tshuaj xyuas ntawm tus neeg mob siv cov khoom xoo hluav taws xob thiab cov teeb meem xim tshwj xeeb. Qhov no yog ua los kuaj xyuas txoj haujlwm ntawm cov channel rau tshem bile tawm ntawm tus neeg mob lub cev.

Ib qho me me ntawm lub nqus ntawm lub txiav, mob siab, hnoos qeev, thiab lwm yam.

Yog tias tsim nyog, tom qab ntawd cov kws kho mob tau mus sab laj nrog kws kho mob thiab tus kws endocrinologist.

Tom qab muab tag nrho cov ntaub ntawv, ib qho kev kuaj mob raug thiab cov hau kev los mus tua tus kab mob tau teev tseg.

Kev Kho Tus Mob Pancreatitis

Hauv qee kis, tus kab mob mus nws tus kheej yam tsis siv tshuaj kho mob. Tab sis xws li cov mob no tsis tshua muaj. Rau feem ntau cov neeg mob thaum ntxov ntawm tus kab mob, kev kho mob muaj kev teem caij noj haus No. 5. Nws cuam tshuam nrog tus neeg mob noj zaub mov 6 zaug hauv ib hnub. Fried, ntsim, fatty, smoked, nplua nuj nyob hauv coarse fiber ntau cov zaub mov yuav tsum tau muab cais tawm ntawm cov zaub mov noj. Kev siv cov tshuaj sodium chloride (sodium chloride) tsuas pub tsawg txog 3 g hauv 24 teev. Noj yuav tsum yog txhua yam vitamins, ntsev ntsev thiab phosphates. Txhawm rau ua qhov no, koj tuaj yeem siv cov nqaij siav, cov khoom noj siv mis nrog cov roj tsawg, cov ntses, zaub kua zaub thiab kua zaub raws li lawv, thiab lwm yam. Cov kev ntsuas no yuav tsum txo cov leeg nqaij muaj mob.

Yog tias tus neeg mob ntshav qab zib, tom qab ntawd nws yuav tsum txo qis siv suab thaj, hloov nws nrog tshuaj qab zib - cov khoom qab zib. Ib tug neeg nrog lawv nyob rau hauv cov xwm txheej zoo li no yuav tsum muaj khoom qab zib lossis kua qab zib kom rov qab los, yog tias tsim nyog, ib qho pib rau cov piam thaj hauv cov ntshav ntshav.

Kev txuag tshwj xeeb suav nrog kev siv glucocorticoids, immunosuppressants, antispasmodics. Txhawm rau txhim kho lub plab hnyuv plab zom mov, nws yuav tsim nyog los qhia kev txiav txim siab rau pancreatic enzymes rau tus neeg mob, thiab ua kom lub cev ua haujlwm ntawm lub bile ducts, ursodeoxycholic acid siv.

Nws raug nquahu tias cov neeg mob autoimmune pancreatitis tau sau tshuaj proton twj tso kua mis inhibitors thiab tshuaj insulin, ua haujlwm ntev thiab luv luv.

Kev phais mob yog siv los tshem tawm txoj kev nqaim ntawm cov channel uas cov kua tsib yog cov tawm.

Ua li no, stenting ntawm cov ducts ua tiav: cov qauv tshwj xeeb mesh muab tso rau sab hauv lawv, uas nthuav tawm txoj kab uas hla ntawm cov channel. Cov neeg mob feem ntau zam lub phais zoo.

Cov Mob Hlwb Pob Txha Mob Pancreatitis

Nrog kev nkag tsis tau sai rau cov kws kho mob, cov tsos mob hauv qab no tej zaum yuav tshwm sim:

• kev nqus ntawm ntau cov as-ham rau hauv txoj hnyuv cuam tshuam,
• muaj lub thiaj li hu ua protein tsis txaus,
• lub cev tsis muaj cov vitamins
• tus neeg mob lub cev qhov hnyav txo, uas ua rau txoj kev txhim kho tsis muaj zog,
• tus neeg mob tau haus tsis tu ncua,
• lub cev qhuav dej ntawm tus neeg mob lub cev yuav pib,
• o thiab cramps tshwm sim
• jaundice muaj ntau zuj zus tuaj,
• muaj kev pheej hmoo ntawm kev kis mob nrog kev mob infiltrates ntawm tus txiav ua ke,
• feem ntau muaj kev o nyob rau hauv cov kua tsib ducts - purulent cholangitis,
• mob ntshav (sepsis) lossis mob peritonitis (mob rau daim peritoneum) yog ua tau,
• yaig yuav tshwm sim hauv qhov chaw txawv ntawm txoj hnyuv,
• mob rwj thiab lwm yam tsis xws tshwm sim hauv txoj hnyuv,
• portal leeg hlab ntsha nce siab
• muaj kev cuam tshuam nyob rau hauv duodenum, uas muaj qhov muaj mob ntev,
• cov ntshav tsis nkag rau hauv plab hauv plab, uas cov kua dej tawm tuaj pib,
• pancreatic mob cancer yog ua tau.

Qhov tshwm sim ntawm tus kabmob thiab kev kwv yees

Yog tias tus neeg mob tau mus cuag kws kho mob sai, feem ntau nrog kev kuaj mob kom raug thiab kho kom tsim nyog, thaum tus kab mob nyob rau thaum ntxov, nws muaj peev xwm rov ua kom tiav tus qauv thiab kev ua haujlwm ntawm tus txiav.

Yog hais tias tus neeg mob pib kho nyob rau hauv cov theem tom qab ntawm tus kab mob thiab kev kho mob ntev yog qhov yuav tsum tau vim muaj kev hloov pauv tsis tau hauv ntau yam kabmob, ces kev kho tiav ntawm cov qauv thiab kev ua haujlwm ntawm lub cev tsis tshwm sim. Tab sis txawm tias muaj qee qhov xwm txheej no, cov kws kho mob tswj hwm kom tsis txhob ua kom muaj kev txhim kho.

Kev kwv yees rau qhov pib ntawm tus kab mob no yog nyob ntawm qhov teeb meem tshwm sim nrog tus mob autoimmune pancreatitis thiab tus mob nrog uas tus neeg mob tau (piv txwv li, ntshav qab zib mellitus).

Kev ntsuas los tiv thaiv hom mob ua mob pancreatitis tsis siv, vim qhov ua kom mob ailment tseem tsis tau paub.

Cov tsos mob ntawm Autoimmune Pancreatitis

Cov yeeb yam tseem ceeb ntawm tus mob autoimmune pancreatitis yog mob nyav ntawm txhua tus tsos mob thiab tsis muaj kev tawm tsam mob sai (mob ntu ntawm qhov mob tsis zoo nyob hauv tus neeg mob). Hauv qee kis, yuav tsis muaj tsos mob dab tsi, thiab kev kuaj mob tsuas yog tsim nrog kev txhim kho ntawm cov teeb meem.

• Mob pob txha plab (qhov mob tshwm sim tas mus li): mob thiab tsis xis nyob rau sab sauv, sab tsawg dua thaj tsam lumbar, tshwm sim li ntawm ib nrab ntawm cov neeg mob, thiab tuaj yeem nyob rau ntau feeb lossis ntau teev. Cov kev siv ntawm qhov mob yog mob pesnrab lossis me ntsis. Raws li txoj cai, kev mob siab yog ua kom los ntawm kev nqus ntawm cov ntsim, cov roj thiab kib.
• Qhov muag daj - daj daj ntawm daim tawv nqaij, cov tawv nqaij ua paug (piv txwv li lub qhov ncauj tawm) thiab cov dej ua kua (piv txwv li, qaub ncaug, kua lacrimal, thiab lwm yam). Nws tshwm sim los ntawm qhov kev ua txhaum ntawm qhov khiav ntawm cov kua tsib mus rau hauv duodenum (qhov pib ntawm txoj hnyuv me me) nrog txoj kev nqaim ntawm tus kab mob pancreatic ducts thiab cov kua tsib:
  • cov quav yuav sib zog dua li ib txwm
  • tso zis yuav tsaus dua li ib txwm
  • daj ua paug ntawm cov qaub ncaug, kua dej lacrimal, ntshav (feem ua kua) ntawm cov ntshav, thiab lwm yam.
  • khaus tawv.

• Dyspeptic tshwm sim (ua kom mob plab zom mov):
  • tsis qab los
  • xeev siab thiab ntuav
  • tsam plab
  • iab thiab qhov ncauj qhuav thaum sawv ntxov,
  • ua pa tsw phem.

• Kev ua txhaum ntawm lub exocrine muaj nuj nqi ntawm lub txiav (txiav tawm ntawm cov enzymes koom nrog hauv kev zom zaub mov) feem ntau tsis muaj kev ua yeeb yam, nws tau kuaj pom los ntawm kev tshawb nrhiav tshwj xeeb.
• Mob ntshav qab zib mellitus (ib qho kev ua txhaum ntawm cov metabolism ntawm carbohydrates - suab thaj) muaj kev txhim kho sai sai vim qhov kev cuam tshuam ntawm endocrine kev ua haujlwm ntawm tus txiav (ua haujlwm ntawm cov tshuaj hormones uas tswj cov metabolism ntawm carbohydrates). Ib qho yeeb yam ntawm cov ntshav qab zib hauv autoimmune pancreatitis yog nws txoj kev nyiam nrog txoj kev rov qab txhim kho (rov qab) tawm tsam keeb kwm ntawm kev kho kom zoo.
• Lub cev yuag.
• Mob ntsws Asthenic:
  • tsawg dua kev kawm
  • qaug zog,
  • tsis muaj zog
  • tsaug zog thaum nruab hnub
  • tsis qab los
  • nyuaj siab maum.

• Lub yeej ntawm lwm yam plab hnyuv siab raum.
  • Lub ntsws. Nws ua tau nws tus kheej hais txog qhov ua tsis taus pa (ua pa ceev), zoo nkaus li tsis muaj huab cua vim muaj qhov tsim ntawm thaj chaw ntawm kev cog lus ntawm cov nqaij ntsws.
  • Raum. Nws yog ua kom pom los ntawm lub raum tsis ua haujlwm (qhov ua txhaum ntawm txhua lub raum lub luag haujlwm) thiab cov tsos ntawm cov protein nyob hauv cov zis (qhov no yuav tsum tsis muaj dab tsi).
  • Mob siab (pseudotumor ntawm daim siab) - txoj kev txhim kho ntawm kev cog lus ntawm daim siab ua haujlwm tsis muaj cov qog. Nws yog kuaj los ntawm palpation (palpation) lossis nrog cov hau kev ntawm kev tshawb fawb. Tuaj yeem nrog kev ntev ntev ntawm qhov tsis txaus nyob hauv txoj cai hypochondrium, tsis cuam tshuam nrog kev noj mov.
  • Salivary qog (sclerosing sialadenitis) - mob rau cov mob caj pas salivary nrog kev hloov cov ntaub so ntswg uas muaj caws pliav. Qhov:
    • qhov ncauj qhuav
    • mob hauv cov qaub ncaug salivary,
    • teeb meem nqos, ua pa, thiab hais lus vim qhov ncauj qhuav.

Raws li daim duab keeb kwm(kev hloov pauv hauv tus qauv ntawm txoj kev txiav txoj cai ntawm tus kab mob hlab ntsws) ob yam ntawm tus mob hlab ntsha leeg mob kis:

• 1 hom—lymphoplasmacytic sclerosing pancreatitis,
• Hom 2 - idiopathic duct-concentric pancreatitis nrog granulocytic epithelial txhab.

Qhov sib txawv ntawm cov kev xaiv no tsuas yog keeb kwm (uas yog, qhia tawm los ntawm kev tshawb fawb keeb kwm - kawm txog qee yam ntawm cov khoom hauv qab ntawm lub tshuab tsom).

Nyob ntawm cov pom ntawm lwm cov kab mob autoimmune (kev txhim kho thaum muaj ntau yam plab hnyuv siab raum raug puas los ntawm lub zog ntawm lawv tus kheej kev tiv thaiv - qhov kev tiv thaiv ntawm lub cev tiv thaiv) muaj ob hom mob autoimmune pancreatitis:

• raug rho tawm autoimmune pancreatitis - kev txhim kho hauv tus neeg mob uas tsis muaj lwm yam kabmob autoimmune,
• cov leeg hlaus nres leeg - kev txhim kho hauv tus neeg mob uas muaj lwm yam kabmob autoimmune.

Nyob ntawm qhov chaw hauv zos (qhov chaw) ntawm qhov chaw txhab paub qhov txawv:

• diffuse duab (kev puas tsuaj rau tag nrho cov txiav)
• focal daim ntawv (kev puas tsuaj rau qee ntu ntawm tus txiav, feem ntau nws lub taub hau, thaum ntaus nkauj, nws zoo li mob qog nqaij hlav (malignant hlav) ntawm tus txiav).

Tus kws kho mob plab zom mov yuav pab kho tus kab mob

Kev Kho Tus Mob Pancreatitis

Tsawg tsawg zaus, kev kho tus kheej tshwm sim (uas yog, yam tsis tau siv tshuaj).

Qhov pib ntawm kev kho mob ntawm tus kabmob autoimmune pancreatitis.

• Kev kho noj haus.
  • Kev noj haus No. 5 - noj zaub mov 5-6 zaug hauv ib hnub, tsis suav nrog ntsim, rog, kib, haus luam yeeb, ntxhib (nplua nuj nyob hauv cov ntoo - nyuaj rau kev zom qee ntawm cov nroj tsuag) cov khoom noj los ntawm cov khoom noj, txwv sodium chloride mus rau 3 gram ib hnub. Cov zaub mov yuav tsum muaj cov vitamins, calcium thiab phosphorus ntsev kom ntau (piv txwv li ntses, nqaij siav, kua zaub ntawm cov kua zaub, cov khoom siv mis nyuj ntawm cov rog muaj ntsis, thiab lwm yam). Lub hom phiaj ntawm kev noj haus no yog kom txo tau cov load ntawm lub txiav.
  • Nrog rau txoj kev loj hlob ntawm cov ntshav qab zib mellitus (qhov ua txhaum ntawm cov metabolism ntawm carbohydrates - suab thaj) raws li muaj kev cuam tshuam ntawm cov kab mob autoimmune pancreatitis, kev noj qab zib yuav tsum tau txwv tsis pub tsawg, koj tuaj yeem hloov nws nrog qab zib.
  • Nrog rau kev txhim kho cov ntshav qab zib, muaj qhov pheej hmoo ntawm cov ntshav qog ntshav ntshav (poob qis hauv cov ntshav ntawm cov ntshav qabzib (yooj yim carbohydrate), nrog kev tsis nco qab). Yog li, tus neeg mob yuav tsum muaj cov zaub mov qab zib (kua qab zib lossis khoom qab zib) nrog nws kom rov qab cov ntshav qabzib hauv cov ntshav.

• Kev saib xyuas kom zoo (tsis yog phais) kho.
  • Glucocorticoids (hluav taws xob analogues ntawm cov tshuaj hormones ntawm adrenal cortex) - kev siv cov tshuaj no yog lub hauv paus ntawm kev kho mob. Cov neeg mob feem ntau xav tau glucocorticoids hauv ob peb lub lis piam. Qee tus neeg mob yuav xav tau siv lub sijhawm ntev ntawm cov tshuaj no.
  • Cov tshuaj tiv thaiv kabmob (Immunosuppressants) - ib pawg tshuaj uas txwv ntau dhau ntawm qhov ua lub cev tiv thaiv kabmob (lub cev tiv thaiv), uas ua rau nws lub cev puas tsuaj. Immunosuppressants yog siv yog tias glucocorticoids tsis ua haujlwm lossis tsis tuaj yeem siv (piv txwv, nrog kev txhim kho ntawm cov teeb meem).
  • Antispasmodics (cov tshuaj uas so cov leeg ntawm cov plab hnyuv siab raum thiab cov hlab ntshav) yog siv los kho qhov mob uas tshwm sim thaum cov leeg ntawm cov hlab ntsha leeg nqaim.
  • Pancreatic enzymes yog siv los txhim kho kev zom zaub mov.
  • Kev npaj Ursodeoxycholic acid yog siv los txhim kho lub nraub qaum ntawm cov kua tsib thiab rov ua cov kab mob siab.
  • Proton twj tso kua mis inhibitors (cov tshuaj uas txo qis cov khoom siv hydrochloric acid los ntawm lub plab) yog siv los kho lub ntsej muag ntawm lub plab lub xub ntiag thaum muaj kev puas tsuaj.
  • Cov tshuaj insulin (luv luv) (ib qho kev daws teeb meem ntawm cov tshuaj insulin tsis muaj cov tshuaj tshwj xeeb ntxiv uas ua rau lub sijhawm ua haujlwm) feem ntau yog siv los kho cov ntshav qabzib hauv kev txhim kho ntshav qab zib mellitus.
  • Cov tshuaj insulins ntev ntev (cov tshuaj tua kab mob insulin nrog cov tshuaj tshwj xeeb uas ua rau nws nqus tsawg dua) tuaj yeem siv los kho cov ntshav qabzib hauv cov ntshav qab zib mellitus.

• Kev phais mob. Kev phais mob decompression (kho kom rov zoo li qub lumen) ntawm txoj hnyuv quav thiab lub plab zom mov yog siv rau qhov muaj qhov nqaim loj ntawm cov ducts, uas tsis tuaj yeem kho nrog glucocorticoids. Stenting ntawm ducts yog qhov zoo dua (qhia rau txoj kev txiav ntawm txoj kev sib txuas ntawm cov kav dej - lub ntxaij ncej uas ua kom dav dav lumen), vim tias qhov haujlwm no feem ntau tau yooj yim zam los ntawm cov neeg mob.

Teeb meem thiab txim

Lwm yam mob ntawm tus mob autoimmune pancreatitis.

• Tsis hnov ​​lus zoo ntawm cov khoom noj hauv cov hnyuv.
  • Protein deficiency (ib qho mob uas muaj kev txhim kho los ntawm kev txo qis los yog tsis muaj protein ntau).
  • Hypovitaminosis (tsis muaj cov vitamins nyob hauv lub cev), tshwj xeeb tshaj yog cov rog-soluble (A, D, E, K).
  • Lub cev hnyav nce txog cachexia (lub xeev muaj kev qaug zog thiab lub cev tsis muaj zog).

• Kev ua txhaum ntawm cov dej-electrolyte sib npaug hauv lub cev.
  • Tubneeb.
  • O o.
  • Lub cev qhuav dej (cov tawv nqaij qhuav thiab cov leeg ua kua).
  • Cov leeg (paroxysmal tsis kam ua tej leeg nqaij).

• Subhepatic jaundice - daj ntseg ntawm daim tawv nqaij, pom cov nqaij mos thiab qog ua kua (xws li, cov qaub ncaug, kua lacrimal, thiab lwm yam) vim qhov ua txhaum ntawm cov tawm ntawm cov kua tsib.
• Kab mob sib kis:
  • inflammatory infiltrates (nce ntxiv ntawm qhov ntim thiab qhov ntom ntawm qee qhov ntawm cov khoom hauv nruab nrog vim muaj kev txuam nrog cov qe txawv txawv hauv lawv - piv txwv li, cov kab mob me me, cov qe ntshav, thiab lwm yam) ntawm cov txiav,
  • purulent cholangitis (mob ntawm lub bile ducts),
  • sepsis (ntshav lom - muaj kab mob tshwm sim los ntawm cov ntshav hauv pathogens thiab lawv cov co toxins (cov khoom pov tseg)),
  • peritonitis - mob rau daim peritoneum (daim nyias nyias hauv ob sab ntawm lub plab thiab ntawm lub plab uas nyob hauv nws).

• Kev yaig (ua rau lub cev tsis xws luag) thiab mob kiav txhab (mob tsis txaus) ntawm ntau seem ntawm cov khoom siv zom zaub mov (txoj hlab pas, plab, plab hnyuv).
• Subhepatic portal hypertension (nce siab hauv lub vev xaib ntawm txoj hlab ntsha (lub nkoj uas xa ntshav mus rau lub siab los ntawm lub plab hauv plab) vim muaj teeb meem ntawm cov ntshav tawm hauv lub siab).
• Mob txhaws ntawm duodenum vim yog nws qhov o thiab nrawm ntawm cov hlab ntshav txhaws.
• Mob plab ischemic syndrome (kev mob ntshav txaus rau lub plab hauv plab) ua rau vascular compression.
• Pancreatogenic ascites (tsub zuj zuj ntawm cov roj dawb hauv plab ua kom plab).
• Mob kheesxaws (mob qog-hlav hlav - cov qog uas loj hlob nrog kev puas tsuaj rau cov ntaub so ntswg puag ncig) ntawm tus txiav ua pob.

Qhov tshwm sim ntawm tus mob autoimmune pancreatitis.

• Nrog sijhawm, kev kho mob tag nrho nrog rau lub sijhawm luv luv ntawm tus kabmob, kev kho tiav ntawm tus qauv thiab kev ua haujlwm ntawm tus kabmob txiav yog qhov ua tau.
• Nrog rau lub caij nyoog ntev ntawm tus kabmob, kev hloov pauv ntawm lub cev ua rau cov leeg txhav ua rau muaj kev hloov pauv tsis tau hauv nws cov qauv thiab kev ua haujlwm, tab sis txawm tias nyob hauv cov neeg mob no, kev kho tag nrho tso cai rau nres qhov kev hloov kho (txuas ntxiv kev tsim kho) ntawm txoj kev.

Huab Cuanrog autoimmune pancreatitis yog nyob ntawm qhov hnyav ntawm cov teeb meem cuam tshuam nrog cov kab mob autoimmune (kev puas tsuaj rau koj tus kheej cov kabmob los ntawm kev tiv thaiv kab mob - lub cev tiv thaiv) thiab mob ntshav qab zib mellitus (carbohydrate-qab zib metabolism cuam tshuam).

Cov ntaub ntawv dav dav

Txawm hais tias autoimmune pancreatitis yog suav tias yog tus kab mob tsis tshua muaj, nws txoj kev qhia hauv cov qauv ntawm kev mob caj dab ntev mus txog 4-6%. Qhov ntau ntawm cov kabmob tsis ntau dua 0,0008%. Tus kab mob pathology tau piav qhia thawj zaug los ntawm Fabkis tus kws kho mob G. Sarles hauv xyoo 1961. Tus kab mob tau raug lees paub tias yog cais nosological xyoo 2001 tom qab kev txhim kho ntawm kev faib tawm etiological ntawm TIGAR-O pancreatitis. Autoimmune kev puas tsuaj rau lub caj pas pancreatic hauv cov txiv neej pom 2-5 zaug ntau dua li cov poj niam. Mus txog 85% ntawm cov neeg mob pib mob tom qab 50 xyoo. Tus kab mob no feem ntau ua ke nrog mob caj dab, mob retroperitoneal fibrosis, sclerosing cholangitis thiab lwm yam txheej txheem autoimmune.

Qhov tseem tsis tau tsim tau tus mob etiology ntawm autoimmune pancreatitis. Feem ntau, tus kab mob yog kuaj tau los ntawm kev cais tawm thaum kuaj hom G4 immunoglobulins thiab qhov tsis muaj lwm qhov ua rau muaj kev puas tsuaj rau pancreatic. Cov kws kho mob tshwj xeeb hauv kev kho mob lub cev ua haujlwm tau lees paub lub luag haujlwm tseem ceeb los ntawm kev mob caj ces, hauv kev kawm txog kev kho mob caj ces koom nrog cov txheej txheem autoimmune nrog serotypes HLA DRβ1-0405, DQβ1-0401, DQβ1-57 tau tsim. Los ntawm cov ntshav ntawm cov neeg mob cais tawm whey protein hnyav 13.1 kDa, uas yog suav hais tias yog ib qho tshwj xeeb antigen.

Lub cev muaj zog autoantigens yog carbonic anhydrase tam sim no nyob rau hauv cov ntaub so ntswg ntawm cov plab hnyuv plab zom mov, bronchial ntoo thiab distal hlaus tubules, lactoferrin, kuaj pom ntawm pancreatic acini, bronchial thiab pais plab hnyuv, Cheebtsam ntawm cell nuclei thiab cov leeg ua kom cov leeg, ib qho kev txiav cov leeg nqaij leeg rau lub cev. Kev txiav txim siab nrog cov neeg muaj tus kab mob sib kis tsis tau txiav txim siab - cov roj ntsha mimicry ntawm cov tshuaj tiv thaiv rau Helicobacteriosis pathogen protein thiab plasminogen-khi cov protein tau kuaj pom.

Kev ua rau muaj txiaj ntsig ntawm kev hloov pauv ntawm lub qog pancreatic thiab lwm qhov chaw muaj mob yog qhov sib txuas ntawm ntshiab Ig G4 nrog autoantigens ntawm acinar hlwb, hlwb epithelial zoo li ntawm pancreatic, bile, salivary ducts, thiab lwm yam Antigenic kev puas tsuaj yog nrog los ntawm kev ua txhaum ntawm apoptosis ntawm cov xovtooj ntawm lub cev tiv thaiv kab mob. Cov kev txuas tseem ceeb hauv cov pathogenesis ntawm autoimmune pancreatitis yog kev tsub zuj zuj ntawm kev ua haujlwm T thiab B lymphocytes, neutrophils thiab eosinophils hauv cov nqaij sib txuas, uas provokes fibrosclerotic cov txheej txheem.

Kev ntsuam xyuas cytological hauv lub pancreatic stroma qhia txog cov cim ntawm fibrosis thiab sclerosis thaum tsis muaj pseudocysts thiab calculi. Vim tias cov lymphoplasmacytic, neutrophilic, thiab eosinophilic infiltration, cov phab ntsa duct yog nruj, nqaim, thiab tawg thaum lub sijhawm ntev ntawm cov txheej txheem autoimmune. Txoj kev sib kis ntawm kev kis mob rau txoj hlab ntsws ntawm txoj hlab ntsws ua rau qhov ploj ntawm cov qauv ntawm lub lobular thiab feem ntau ua ke nrog phlebitis. Raws li nrog lwm cov txawv ntawm cov mob caj dab ntev, calcification ntawm parenchyma thiab stroma yog ua tau.

Kev faib tawm

Thaum systematizing cov ntaub ntawv ntawm autoimmune pancreatitis, kev nthuav dav ntawm cov txheej txheem fibro-sclerotic, qhov muaj qhov tshwm sim ntawm qhov txhab ntxiv ntawm lwm yam plab hnyuv siab raum, thiab cov yam ntxwv morphological ntawm o coj mus rau hauv tus account. Hauv cov ntawv focal sib txawv ntawm tus kabmob, ib tus kabmob ntawm tus kabmob pancreatic parenchyma, feem ntau yog lub taub hau ntawm cov khoom nruab nrog, puas ntsoog. Feem ntau tsawg kawg yog 1/3 ntawm lub qog raug cuam tshuam (ntu ntawm daim ntawv ntawm pancreatitis). Txog rau daim ntawv sib txawv ntawm cov kab mob pathology, kev koom tes ntawm txhua yam hauv nruab nrog cev yog yam ntxwv.

Thaum tsis muaj lwm cov kab mob autoimmune, mob caj pas hu ua cais. Tus neeg mob txhab tawm ntawm ntau qhov chaw haujlwm, lawv hais txog syndromic autoimmune pancreatic o. Muab cov duab keeb kwm yav dhau los, ob lub ntsiab sib txawv ntawm cov kabmob muaj qhov txawv txav, txhua qhov sib txawv hauv nws cov yam ntxwv ntawm kev soj ntsuam:

• Lymphoplasmacytic-sclerosing daim ntawv ntawm pancreatitisCov. Kev cuam tshuam los ntawm immunoglobulin-tsim cov hlwb, cim stromal fibrosis ntawm cov khoom hauv nruab nrog thiab obliterating phlebitis predominate. Ua ke nrog IgG4-txuam autoimmune pathology. Cov chav kawm uas nquag hloov nrog lub zuj zus ntawm sclerotic hloov pauv yog tus yam ntxwv.
• Zawv plab-mob siab idiopathic pancreatitisCov. Morphologically manifests nws tus kheej li neutrophilic infiltration nrog cell pawg zoo li microabscesses. Phlebitis thiab fibrosis muaj suab tsawg. Qeb IgG4 qib feem ntau yog ib txwm muaj. Hauv 30% ntawm cov neeg mob, nws yog txuam nrog ulcerative mob plab. Nws tau nyaij yam tsis muaj kev thim rov qab. Nws tshwm sim 3.5-4 lub sijhawm tsawg dua.

Cov tsos mob ntawm tus mob autoimmune pancreatitis

Cov duab hauv chav soj ntsuam ntawm tus kab mob yog txawv los ntawm kev raug mob ntawm tus txiav mob caj dab. Hauv qhov autoimmune sib txawv ntawm cov khoom hauv nruab nrog cev, qhov mob tsis tshua muaj siab, npub, tsis cuam tshuam nrog qhov tsis raug ntawm cov khoom noj. Qhov mob caj dab tsuas tshwm sim hauv tsuas yog ib nrab ntawm cov neeg mob. Lwm cov tsos mob tseem ceeb ntawm tus mob autoimmune pancreatitis yog tawv nqaij txhaws, uas tshwm sim rau thaj tsam li ntawm 60-80% ntawm cov neeg mob thiab yog pom los ntawm qhov tawv nqaij ua paug thiab tawv nqaij, ua pob khaus khaus, thiab tawv nqaij.

Mob caj dab rau lub cev nqaij daim tawv kab mob feem ntau yog nrog kev mob plab tsis zoo: xeev siab, qhov hloov ntawm qhov quav (profuse fetid quav ntawm lub greyish xim), tsam plab. Nrog kev muaj mob ntawm tus kabmob, malabsorption thiab lub cev tsis muaj peev xwm tshwm sim, uas pom los ntawm qhov txo qis hauv tus neeg mob lub cev qhov hnyav, tsis muaj protein ntau ntawm lub ntsej muag thiab qis dua. Hauv theem thaum kawg ntawm tus mob pancreatitis, kev nqhis dej ib txwm muaj, polyuria (cov tsos mob ntawm kev tsis hnov ​​qab cov ntshav qabzib).

Kev twv ua ntej thiab Kev Tiv Thaiv

Qhov tshwm sim ntawm tus kabmob yog nyob ntawm qhov ntau ntawm cov nqaij puas, qhov loj ntawm cov teeb meem. Txawm hais tias kev kho mob steroid tso cai ua kom tau txais kev zam nyob rau hauv ntau dua 90% ntawm cov neeg mob, qhov kev kwv yees ntawm tus kab mob autoimmune pancreatitis kuj tsis tshua zoo, hauv qee cov neeg mob muaj qhov txo tsis tau hauv endocrine thiab exocrine cov haujlwm. Vim yog qhov tsis txaus kawm etiopathogenetic mechanism, cov kev tiv thaiv tshwj xeeb tseem tsis tau txhim kho. Txhawm rau tiv thaiv teeb meem, nws yog ib qho tseem ceeb kom paub thiab kho cov kab mob autoimmune ntawm lub plab ua haujlwm raws sijhawm.