Contents
ʻO ka alveolitis allergic exogenous ka mea i kapa ʻia ʻo hypersensitivity pneumonitis. ʻO ka pōkole no ka maʻi ʻo EAA. Hōʻike kēia huaʻōlelo i kahi hui holoʻokoʻa o nā maʻi e pili ana i ka interstitium o nā māmā, ʻo ia hoʻi, ka ʻiʻo pili o nā kino. Hoʻopili ʻia ka hū ma ka parenchyma māmā a me nā ala ea liʻiliʻi. Hiki ia i ka wā e komo ai nā ʻano antigens (fungi, bacteria, protein holoholona, kemika) iā lākou mai waho.
No ka manawa mua, ua wehewehe ʻia ka exogenous allergic alveolitis e J.
I ka wā e hiki mai ana, hiki ke hoʻokumu i ka alveolitis allergic o ke ʻano exogenous hiki ke hoʻoulu ʻia e nā kumu ʻē aʻe. ʻO keʻano, i ka makahiki 1965, uaʻikeʻo C. Reed a me kāna mau hoa i nā hōʻailona likeʻole iʻekolu mau maʻi e hānai ana i nā nūnū. Ua hoʻomaka lākou e kapa i kēlā alveolitis "ka māmā o nā mea aloha manu."
Hōʻike ka ʻikepili o nā makahiki i hala iho nei ua laha loa ka maʻi i waena o ka poʻe, ma muli o kā lākou ʻoihana ʻoihana, e launa pū me nā hulu manu a me lalo o nā manu, a me nā meaʻai hui pū. Ma loko o 100 heluna kanaka, e ʻike ʻia ka alveolitis maʻi exogenous i 000 poʻe. I ka manawa like, ʻaʻole hiki ke wānana pololei ʻo wai ka mea maʻi i lalo a i ʻole nā hulu e ulu i ka alveolitis.
E like me ka hoʻomaʻamaʻa hōʻike ʻana, mai 5 a 15% o ka poʻe i launa pū me nā kiʻekiʻe o nā allergens e hoʻomohala i ka pneumonitis. ʻAʻole ʻike ʻia ka laha ʻana o ka alveolitis ma waena o ka poʻe e hana me nā haʻahaʻa haʻahaʻa o nā mea hoʻonaninani. Eia nō naʻe, ʻoi aku ka paʻakikī o kēia pilikia, ʻoiai ke ulu nui nei ka ʻoihana i kēlā me kēia makahiki, ʻo ia hoʻi, ʻoi aku ka nui o nā poʻe i komo i ia mau hana.
Kaupio
Hoʻoulu ʻia ka alveolitis maʻi ma muli o ka inhalation o kahi allergen, e komo ana i loko o ka māmā me ka ea. Hiki i nā mea like ʻole ke hana ma ke ʻano he allergen. ʻO nā allergens koʻikoʻi loa i kēia ʻano he fungal spores mai ka mauʻu pala, ka ʻili maple, ke kō, etc.
Eia kekahi, ʻaʻole pono e kāpae i ka pollen mea kanu, nā pūhui protein, ka lepo o ka hale. ʻO kekahi mau lāʻau lapaʻau, e like me nā lāʻau ʻokoʻa a i ʻole nā mea waiwai nitrofuran, hiki ke hoʻoulu i ka alveolitis maʻi me ka ʻole o ka inhalation mua, a ma hope o ke komo ʻana i ke kino ma nā ʻano ʻē aʻe.
ʻAʻole wale ka mea nui o ka komo ʻana o nā allergens i ka ʻōpū hanu, akā ʻo kā lākou ʻike a me ka nui. Inā ʻaʻole ʻoi aku ka nui o nā ʻāpana i ka 5 microns, a laila ʻaʻole paʻakikī iā lākou ke hiki i ka alveoli a hoʻonāukiuki i kahi hopena hypersensitivity i loko o lākou.
Ma muli o ka pili pinepine ʻana o nā allergens e kumu ai i ka EAA me nā hana ʻoihana a ke kanaka, ua kapa ʻia nā ʻano alveolitis no nā ʻoihana like ʻole:
Ka Puku Mahiai. Loaʻa nā antigens i loko o ka mauʻu maloʻo, ma waena o lākou: Thermophilic Actinomycetes, Aspergillus spp, Mycropolyspora faeni, Thermoactinomycas vulgaris.
Ka māmā o nā mea aloha manu. Loaʻa nā allergens i loko o ka lepo a me ka ʻili o nā manu. Lilo lākou i mau protein whey o nā manu.
Bagassoz. ʻO ka allergen ke kō, ʻo ia hoʻi ʻo Mycropolysporal faeni a me Thermoactinomycas sacchari.
ʻO ka māmā o nā kānaka e ulu ana i nā halo. Lilo ka compost i kumu o ka allergens, a me Mycropolysporal faeni a me Thermoactinomycas vulgaris e hana ana ma ke ano he antigens.
ʻO ka māmā o ka poʻe e hoʻohana ana i ka conditioners. ʻO nā mea hoʻohaʻahaʻa, nā mea hoʻomehana, a me nā ea ea nā kumu o nā antigens. Hoʻoulu ʻia ka Sensitization e nā pathogens e like me: Thermoactinomycas vulgaris, Thermoactinomycas viridis, Ameba, Fungi.
Suberose. ʻO ka ʻili o ka lāʻau koka ke kumu o nā allergens, a ʻo Penicillum frequentans ke hana ma ke ʻano he allergen ponoʻī.
ʻO nā mea hana malt māmā. ʻO ke kumu o nā antigens he bale moldy, a ʻo ka allergen ponoʻī ʻo Aspergillus clavatus.
ʻO ka maʻi kāki. ʻO ke kumu o nā antigens ʻo ia ka cheese a me nā ʻāpana mold, a ʻo ka antigen ponoʻī ʻo Penicillum cseii.
Sequoyz. Loaʻa nā allergens i ka lepo lāʻau ʻulaʻula. Hōʻike ʻia lākou e Graphium spp., upullaria spp., Alternaria spp.
ʻO nā mea hana lole holoi māmā. Loaʻa ka allergen i nā enzymes a me nā mea holoi. Hōʻike ʻia ia e Bacillus subtitus.
ʻO nā limahana keʻena hoʻokolohua māmā. ʻO nā kumu o nā allergens he dandruff a me ka rodent urine, a ʻo nā mea allergens ponoʻī e hōʻike ʻia e nā protein o kā lākou mimi.
ʻO ka pauka pituitary e honi ana i ka māmā. Hōʻike ʻia ka antigen e ka porcine a me ka bovine protein, i loaʻa i ka pauka o ka pituitary gland.
Hoʻohana ʻia ka māmā i ka hana ʻana i nā plastics. ʻO ke kumu e alakaʻi ai i ka sensitization ʻo diisocyanates. ʻO nā mea allergens: Toluene diiosocianate, diphenylmethane diiosocianate.
Pneumonitis kauwela. Piʻi ka maʻi ma muli o ka inhalation o ka lepo mai nā wahi noho pulu. Laha ʻia ka pathology ma Iapana. Lilo ʻo Trichosporon cutaneum i kumu o nā allergens.
ʻO nā mea allergens i helu ʻia e pili ana i ka hoʻomohala ʻana o ka exogenous allergic alveolitis, thermophilic actinomycetes a me nā antigens manu he mea koʻikoʻi. Ma nā wahi me ka ulu kiʻekiʻe o ka mahiʻai, ʻo ia nā actinomycetes e noho ana i kahi kūlana alakaʻi e pili ana i ka hopena o ka EAA. Hōʻike ʻia lākou e ka bacteria ʻaʻole i ʻoi aku ma mua o ka nui o 1 micron. ʻO kahi hiʻohiʻona ʻokoʻa o ia mau microorganism ʻo ia ka loaʻa ʻana o nā waiwai ʻaʻole wale nā microbes, akā pū kekahi. Nui nā thermophilic actinomycetes i loko o ka lepo, i ka compost, i ka wai. Noho pū lākou i loko o nā ea.
ʻO ia mau ʻano o ka thermophilic actinomycetes e alakaʻi i ka ulu ʻana o ka alveolitis allergic exogenous, e like me: Mycropolyspora faeni, Thermoactinomycas vulgaris, Thermoactinomycas viridis, Thermoactinomycas sacchari, Thermoactinomycas scandidum.
ʻO nā mea i helu ʻia a pau o ka flora pathogenic no nā kānaka e hoʻomaka e hoʻonui ikaika i kahi mahana o 50-60 °C. Aia ma lalo o ia mau kūlana e hoʻomaka ai nā kaʻina o ka palaho o nā mea organik. Mālama ʻia kahi mahana like i nā ʻōnaehana hoʻomehana. Hiki i nā Actinomycetes ke hoʻoulu i ka bagassosis (ka maʻi māmā i ka poʻe hana me ke kō), ke kumu o ka maʻi i kapa ʻia ʻo “farmer's lung”, “lung of mushroom pickers (hushroom growers)”, etc. Ua helu ʻia lākou a pau ma luna.
ʻO nā antigens e pili ana i ke kanaka e launa pū me nā manu he mau protein serum. ʻO kēia nā albumin a me gamma globulins. Aia lākou i loko o nā kulu manu, i loko o nā mea huna mai nā ʻili ʻili o nā manu nūnū, nā parrots, nā canaries, etc.
Loaʻa ka poʻe mālama manu i ka alveolitis me ka launa pū ʻana me nā holoholona. ʻO nā protein o nā pipi, a me nā puaʻa, hiki ke hoʻonāukiuki i ka maʻi.
ʻO ka antigen fungal ikaika loa ʻo Aspergillus spp. Hiki i nā ʻano ʻano like ʻole o kēia microorganism ke kumu i ka suberosis, ka māmā o ka malt brewer a i ʻole ka māmā o ka mea hana cheese.
He mea makehewa ka manaʻoʻiʻo, e noho ana i ke kūlanakauhale a ʻaʻole hana i ka mahiʻai, ʻaʻole hiki i ke kanaka ke maʻi me ka exogenous allergic alveolitis. ʻO ka ʻoiaʻiʻo, ulu maikaʻi ʻo Aspergillus fumigatus ma nā wahi pulu ʻaʻole hiki ke hoʻokuʻu ʻia. Inā kiʻekiʻe ka mahana i loko o lākou, a laila hoʻomaka nā microorganisms e hoʻonui wikiwiki.
ʻO ka pilikia no ka hoʻomohala ʻana i ka alveolitis maʻi maʻi he poʻe nona nā hana ʻoihana e pili ana me nā pūhui kemika reactogenic, no ka laʻana, plastic, resins, pena, polyurethane. Manaʻo ʻia ʻo Phthalic anhydride a me diisocyanate i ka pōʻino.
Ma muli o ka ʻāina, hiki ke ʻike ʻia ka nui o nā ʻano like ʻole o ka alveolitis maʻi:
ʻO ka māmā o nā mea aloha budgerigar e ʻike pinepine ʻia i nā kamaʻāina o UK.
Aia ma ʻAmelika ka māmā o ka poʻe e hoʻohana ana i ka ea a me ka humidifier.
ʻO ke ʻano kauwela o ka alveolitis, i hoʻokumu ʻia e ka hana hou ʻana o nā fungi o nā ʻano Trichosporon cutaneun, ua ʻike ʻia i ka 75% o nā hihia ma Iapana.
Ma Moscow a me nā kūlanakauhale me nā ʻoihana ʻoihana nui, ʻike pinepine ʻia nā mea maʻi me ka pane ʻana i nā manu a me nā antigens fungal.
Pathogenesis o exogenous allergic alveolitis
ʻIke mau ka ʻōnaehana hanu kanaka i nā ʻāpana lepo. A pili kēia i nā mea hoʻohaumia organik a me nā mea haumia ʻole. Ua hoʻokumu ʻia e hiki i nā antigens o ka ʻano like ke kumu i ka hoʻomohala ʻana i nā ʻano pathologies. Hoʻomohala kekahi poʻe i ka hānō bronchial, hoʻomohala kekahi poʻe i ka rhinitis mau loa. Aia kekahi poʻe e hōʻike ana i ka dermatosis maʻi, ʻo ia hoʻi, nā ʻili ʻili. ʻAʻole pono mākou e poina e pili ana i ka conjunctivitis o kahi ʻano maʻi. ʻO ka mea maʻamau, ʻaʻole ʻo exogenous alveolitis ka mea hope loa i ka papa inoa o nā pathologies i helu ʻia. He aha ke ʻano o ka maʻi e ulu ai kekahi kanaka ma muli o ka ikaika o ka ʻike ʻana, ma ke ʻano o ka allergen, ke kūlana o ka ʻōnaehana pale o ke kino a me nā mea ʻē aʻe.
I mea e hōʻike ai ka mea maʻi i ka alveolitis allergic exogenous, pono ka hui pū ʻana o kekahi mau mea:
ʻO kahi maʻa kūpono o nā allergens i komo i ka ʻōpū hanu.
ʻIke lōʻihi i ka ʻōnaehana hanu.
ʻO kahi nui o nā ʻāpana pathological, ʻo ia ka 5 microns. ʻO ka mea maʻamau, ulu ka maʻi ke komo nā antigens nui i ka ʻōnaehana hanu. I kēia hihia, pono lākou e noho i ka bronchi proximal.
ʻO ka hapa nui o nā poʻe e hālāwai me ia ʻano allergens ʻaʻole i loaʻa iā EAA. No laila, manaʻo ka poʻe ʻepekema e hoʻopili ʻia ke kino o ke kanaka i ka manawa like e kekahi mau kumu i ka manawa hoʻokahi. ʻAʻole lawa lākou i aʻo ʻia, akā aia kahi manaʻo e pili ana ka genetics a me ke kūlana o ka palekana.
ʻO ka exogenous allergic alveolitis ka mea kūpono i kapa ʻia he mau maʻi immunopathological, ʻo ke kumu kānalua ʻole ʻo ia nā hopena maʻi o nā ʻano 3 a me 4. Eia kekahi, ʻaʻole pono e mālama ʻia ka ʻeha non-immune.
ʻO ke kolu o ke ʻano o ka hopena immunological he mea koʻikoʻi ia i nā pae mua o ka hoʻomohala ʻana o ka pathology. Hoʻokumu pololei ʻia ka hoʻokumu ʻana o nā paʻakikī immune i ka interstitium o nā māmā i ka wā e launa pū ai kahi antigen pathological me nā antibodies o ka papa IgG. ʻO ka hoʻokumuʻiaʻana o nā paʻakikī immune e alakaʻi i kaʻoiaʻiʻo ua hōʻinoʻia ka alveoli a me ka interstitium, ke piʻi nei ka permeability o nā moku e hānai iā lākou.
ʻO ka hopena o nā paʻakikī paʻakikī e hoʻoikaika i ka ʻōnaehana hoʻopihapiha a me nā macrophages alveolar. ʻO ka hopena, hoʻokuʻu ʻia nā huahana ʻona a me nā anti-inflammatory, hydrolytic enzymes, cytokines (tumor necrosis factor - TNF-a a me interleukin-1). ʻO kēia mau mea a pau ke kumu o ka hopena inflammatory ma ka pae kūloko.
Ma hope iho, hoʻomaka ka make o nā ʻāpana a me nā matrix o ka interstitium, ʻoi aku ka ikaika o ka mumū. Hāʻawi ʻia ka nui o nā monocytes a me nā lymphocytes i ke kahua o ka lesion. Hoʻopaʻa lākou i ka mālama ʻana i ka hopena hypersensitivity type lohi.
ʻO nā mea e hōʻoiaʻiʻo ana he mea nui ka hopena immunocomplex i ka alveolitis allergic exogenous:
Ma hope o ka launa pū ʻana me ka antigen, ulu wikiwiki ka mumū, i loko o 4-8 mau hola.
I ka holoi ʻana o ka exudate mai ka bronchi a me ka alveoli, a me ka ʻāpana serum o ke koko, loaʻa nā kiʻekiʻe kiʻekiʻe o nā antibodies o ka papa lgG.
I loko o ka ʻiʻo māmā i lawe ʻia no ka histology, i nā poʻe maʻi me kahi ʻano maʻi o ka maʻi, ʻike ʻia ka immunoglobulin, nā mea hoʻohui, a me nā antigens ponoʻī. ʻO kēia mau mea a pau he mau mea paʻakikī.
I ka hana ʻana i nā hoʻāʻo ʻili me ka hoʻohana ʻana i nā antigens i hoʻomaʻemaʻe maikaʻi ʻia no kahi maʻi maʻi, hoʻomohala kahi pane ʻano Arthus maʻamau.
Ma hope o ka hana ʻana i nā hoʻokolohua hoʻonāukiuki me ka inhalation o nā pathogens, piʻi ka nui o nā neutrophils i nā mea maʻi i ka wai bronchoalveolar lavage.
ʻO ka ʻano 4 ʻano pane immune e pili ana i ka CD+ T-cell delayed-type hypersensitivity a me CD8+ T-cell cytotoxicity. Ma hope o ke komo ʻana o nā antigens i ka ʻōnaehana hanu, hoʻomohala ʻia nā ʻano ʻano lohi i nā lā 1-2. ʻO ka pōʻino i nā paʻakikī immune e alakaʻi i ka hoʻokuʻu ʻana o nā cytokines. ʻO lākou hoʻi, ke kumu i nā leukocytes a me ka endothelium o ka ʻiʻo māmā e hōʻike i nā molekole pili i ka ʻili. Hoʻopili nā Monocytes a me nā lymphocytes ʻē aʻe iā lākou, e hōʻea ikaika ana i ke kahua o ka hopena inflammatory.
I ka manawa like, hoʻoulu ka interferon gamma i nā macrophages e hana i nā lymphocytes CD4 +. ʻO kēia ka hiʻohiʻona o kahi ʻano hoʻopaneʻe, e mau ana no ka manawa lōʻihi e mahalo i nā macrophages. ʻO ka hopena, hoʻokumu ʻia nā granulomas i ka mea maʻi, hoʻomaka ka hoʻokuʻu ʻana o ka collagen i ka nui o ka nui (hoʻoulu ʻia nā fibroblasts e nā mea ulu), a ulu ka fibrosis interstitial.
ʻO nā mea e hōʻoiaʻiʻo ana i ka alveolitis allergic exogenous, he mea nui nā hopena immunological type 4:
Loaʻa nā T-lymphocytes i ka hoʻomanaʻo koko. Aia lākou i loko o ke akemāmā o nā maʻi.
I nā poʻe maʻi me ka alveolitis a me ka subacute exogenous allergic alveolitis, granulomas, infiltrates me ka hōʻiliʻili o nā lymphocytes a me nā monocytes, a me ka interstitial fibrosis ʻike ʻia.
Ua hōʻike ʻia nā hoʻokolohua ma nā holoholona laboratory me EAA e koi ʻia nā CD4 + T-lymphocytes no ka hoʻokomo ʻana i ka maʻi.
Kiʻi mōʻaukala o EAA
I ka hapanui o na hihia, loa'a i ka po'e ma'i me ka alveolitis allergic exogenous he granulomas, me ka ho'opa'a 'ole. ʻIke ʻia lākou ma 79-90% o nā maʻi.
I ʻole e huikau i nā granulomas e ulu ana me EAA a me ka sarcoidosis, pono ʻoe e hoʻolohe i nā ʻokoʻa aʻe:
Me EAA, liʻiliʻi nā granulomas.
ʻAʻole maopopo nā palena ʻo Granuloma.
Nui nā lymphocytes i loko o nā granuloma.
Ua mānoanoa nā pā Alveolar ma EAA, loaʻa iā lākou nā lymphocytic infiltrates.
Ma hope o ka hoʻokaʻawale ʻana me ka antigen, nalowale nā granulomas iā lākou iho i loko o ʻeono mahina.
I loko o ka alveolitis allergic exogenous, hoʻokumu ʻia ke kaʻina inflammatory e nā lymphocytes, monocytes, macrophages a me nā cell plasma. ʻO nā macrophages alveolar foamy e hōʻiliʻili i loko o ka alveoli iā lākou iho, a me nā lymphocytes i ka interstitium. Ke hoʻomaka nei ka maʻi e ulu, loaʻa i nā maʻi kahi protein a me ka fibrinous effusion, aia i loko o ka alveoli. Eia kekahi, ua ʻike ʻia nā mea maʻi me ka bronchiolitis, lymphatic follicles, peribronchial inflammatory infiltrates, i hoʻopaʻa ʻia i nā ala liʻiliʻi.
No laila, ʻike ʻia ka maʻi e kahi triad o nā loli morphological:
Alveolitis.
Granulomatosis.
ʻO Bronchiolitis.
ʻOiai i kekahi manawa e hāʻule paha kekahi o nā hōʻailona. Kakaʻikahi, hoʻomohala nā maʻi me ka alveolitis allergic exogenous i ka vasculitis. Ua ʻike ʻia ʻo ia i loko o kahi maʻi ma hope, e like me ka mea i hōʻike ʻia ma nā palapala pili. I nā poʻe maʻi me ka hypertension pulmonary, hiki mai ka hypertrophy o nā aʻa a me nā arterioles.
ʻO ka papa hana maʻamau o EAA e alakaʻi i nā loli fibrinous, hiki ke loaʻa i nā ʻano like ʻole. Eia nō naʻe, ʻaʻole wale lākou no ka exogenous allergic alveolitis, akā no nā maʻi ʻē aʻe o ka maʻi maʻi. No laila, ʻaʻole hiki ke kapa ʻia he hōʻailona pathognomic. Me ka alveolitis lōʻihi i nā maʻi, ua hoʻololi ʻia ka parenchyma māmā i nā loli pathological i ke ʻano o ka pūpū meli.
Nā hōʻailona o ka exogenous allergic alveolitis
Hoʻoulu pinepine ka maʻi i ka poʻe i maʻa ʻole i ka maʻi maʻi. Hōʻike ka pathology iā ia iho ma hope o ka launa pū ʻana me nā kumu, ka hoʻolaha ʻana o nā antigens.
Hiki ke loaʻa ka alveolitis exogenous allergic i 3 mau ʻano:
Nā hōʻailona koʻikoʻi
ʻO ke ʻano koʻikoʻi o ka maʻi ma hope o ka nui o ka antigen e komo i ka ʻōpū hanu. Hiki kēia ma ka home a ma ka hana a ma ke alanui paha.
Ma hope o nā hola 4-12, piʻi ka wela o ke kino o ke kanaka i nā pae kiʻekiʻe, ulu ke anuanu, a piʻi ka nāwaliwali. Aia ke kaumaha ma ka umauma, hoʻomaka ka mea maʻi e ʻū, ua hoʻopilikia ʻia ʻo ia e ka hanu hanu. ʻIke ʻia nā ʻeha ma nā hui a me nā ʻiʻo. ʻAʻole ʻike pinepine ʻia ka sputum i ka wā ʻuʻu. Inā haʻalele, a laila liʻiliʻi a loaʻa ka nui o ka mucus.
ʻO kekahi hōʻailona ʻē aʻe o ka EAA koʻikoʻi he maʻi poʻo e kālele ana ma ka lae.
I ka wā o ka hoʻokolokolo ʻana, ʻike ke kauka i ka cyanosis o ka ʻili. I ka hoʻolohe ʻana i ke akemāmā, lohe ʻia ke kani ʻana a me ke kani ʻana.
Ma hope o 1-3 mau lā, nalowale nā hōʻailona o ka maʻi, akā ma hope o ka launa pū ʻana me ka allergen, hoʻonui hou lākou. ʻO ka nāwaliwali maʻamau a me ka lethargy, i hui pū ʻia me ka pōkole o ka hanu, hiki ke hoʻopilikia i ke kanaka no kekahi mau pule ma hope o ka hoʻonā ʻana o ka pae koʻikoʻi o ka maʻi.
ʻAʻole ʻike pinepine ʻia ke ʻano koʻikoʻi o ka maʻi. No laila, huikau nā kauka me SARS, hoʻonāukiuki ʻia e nā maʻi a i ʻole mycoplasmas. Pono nā poʻe akamai e makaʻala i ka poʻe mahiʻai, a e hoʻokaʻawale hoʻi i waena o nā hōʻailona o ka EAA a me nā hōʻailona o ka mycotoxicosis pulmonary, e ulu ana i ka wā e komo ai nā spores fungal i ka ʻiʻo māmā. I nā poʻe maʻi me ka myotoxicosis, ʻaʻole hōʻike ʻia ka radiography lung i nā loli pathological, ʻaʻohe precipitating antibodies i ka ʻāpana serum o ke koko.
hōʻailona subacute
ʻAʻole i ʻōlelo ʻia nā hōʻailona o ke ʻano subacute o ka maʻi e like me ke ʻano o ka alveolitis. Hoʻokumu ʻia kēlā ʻano alveolitis ma muli o ka inhalation lōʻihi o nā antigens. ʻO ka hapa nui o kēia hana ma ka home. No laila, hoʻonāukiuki ʻia ka maʻi subacute i ka hapa nui o ka mālama ʻana i ka moa.
ʻO nā hōʻike nui o ka subacute exogenous allergic alveolitis penei:
ʻO ka pōkole o ka hanu e ʻoi aku ka ʻino ma hope o ka hoʻoikaika kino ʻana o ke kanaka.
Hoʻonui i ka luhi.
ʻO ka maʻi e hoʻopuka ana i ka sputum maopopo.
I ka wā mua o ka hoʻomohala ʻana o ka pathology, hiki ke piʻi ka mahana o ke kino.
ʻO Crepitus i ka hoʻolohe ʻana i ka māmā e mālie.
He mea nui e hoʻokaʻawale i ka subacute EAA mai sarcoidosis a me nā maʻi interstitium ʻē aʻe.
Nā hōʻailona o ke ʻano maʻi
Ke ulu nei ke ʻano maʻi o ka maʻi i ka poʻe e launa pū me nā ʻāpana liʻiliʻi o nā antigens no ka manawa lōʻihi. Eia kekahi, hiki i ka subacute alveolitis ke lilo i mau loa inā ʻaʻole mālama ʻia.
Hōʻike ʻia ke ala mau o ka maʻi e nā hōʻailona e like me:
Ke hoʻonui nei i ka manawa, pōkole o ka hanu, e ʻike ʻia me ka hoʻoikaika kino.
ʻO ke kaumaha o ke kaumaha, hiki ke hōʻea i ka anorexia.
Hoʻoweliweli ka maʻi me ka ulu ʻana o ka cor pulmonale, interstitial fibrosis, naʻau a me ka hanu ʻana. Ma muli o ka hoʻomaka ʻana o ka alveolitis maʻi exogenous maʻi maʻi maʻi maʻamau a ʻaʻole hāʻawi i nā hōʻailona koʻikoʻi, paʻakikī kona ʻike.
ʻO ka hōʻailona o ka alveolitis allergic exogenous
No ka ʻike ʻana i ka maʻi, pono ia e hilinaʻi i ka hoʻokolokolo X-ray o nā māmā. Ma muli o ke kahua o ka ulu ʻana o ka alveolitis a me kona ʻano, ʻokoʻa nā hōʻailona radiological.
ʻO ke ʻano koʻikoʻi a me ka subacute o ka maʻi e alakaʻi i ka emi ʻana o ke aniani o nā māla e like me ke aniani honua a i ka laha ʻana o nā opacities nodular-mesh. ʻAʻole ʻoi aku ka nui o nā nodules ma mua o 3 mm. Hiki ke loaʻa ma luna o ka ʻili holoʻokoʻa o ka māmā.
ʻAʻole uhi ʻia ka ʻaoʻao o luna o ka māmā a me ko lākou mau ʻāpana basal i nā nodules. Inā ho'ōki ke kanaka i ka launa pū ʻana me nā antigens, a laila ma hope o 1-1,5 mau mahina, nalowale nā hōʻailona radiological o ka maʻi.
Inā loaʻa ka maʻi maʻi maʻi, a laila ʻike ʻia nā aka linear me kahi outline, nā wahi ʻeleʻele i hōʻike ʻia e nā nodules, nā loli i ka interstitium, a me ka emi ʻana o ka nui o nā māla māmā e ʻike ʻia ma ke kiʻi x-ray. I ka wā e holo ana ka pathology, ʻike ʻia ka ʻōpū meli.
ʻO CT kahi ʻano i ʻoi aku ka kiʻekiʻe o ka pololei ma mua o ka radiograph. Hōʻike ka haʻawina i nā hōʻailona o EAA, ʻaʻole ʻike ʻia me ka radiograph maʻamau.
Hōʻike ʻia kahi hoʻāʻo koko i nā maʻi me ka EAA e nā hoʻololi aʻe:
Leukocytosis a hiki i ka 12-15×103/ml ʻAʻole maʻamau, hiki ke kiʻekiʻe o nā leukocytes i ke kiʻekiʻe o 20-30 × 10.3/ ml.
Hoʻololi ke ʻano leukocyte i ka hema.
ʻAʻole hiki ke piʻi i ka pae o nā eosinophils, a i ʻole e piʻi iki paha.
ʻO ka ESR ma 31% o nā mea maʻi e piʻi i 20 mm / h, a ma 8% o nā mea maʻi a hiki i 40 mm / h. I nā poʻe maʻi ʻē aʻe, noho mau ka ESR i loko o ka pae maʻamau.
Piʻi ka pae o lgM a me lgG. I kekahi manawa aia ka lele ma ka papa A immunoglobulins.
I kekahi mau maʻi, hoʻāla ʻia ka rheumatoid factor.
Hoʻonui i ka pae o ka LDH a pau. Inā loaʻa kēia, a laila hiki ke kānalua ʻia ka mumū nui o ka parenchyma māmā.
No ka hōʻoia ʻana i ka maʻi, hoʻohana ʻia nā ʻano Ouchterlony double diffusion, micro-Ouchterlony, counter immunoelectrophoresis a me ELISA (ELISA, ELIEDA). Hāʻawi lākou iā ʻoe e ʻike i nā antibodies precipitating kikoʻī i nā antigens i hoʻokumu i ka maʻi allergy.
I ka manawa koʻikoʻi o ka maʻi, e kahe ana nā antibodies i loko o ke koko o kēlā me kēia maʻi. Ke pau ka mea allergen i ka launa pū ʻana me ka ʻiʻo māmā o nā maʻi, hāʻule ka pae o nā antibodies. Eia nō naʻe, hiki iā lākou ke noho ma ka ʻāpana serum o ke koko no ka manawa lōʻihi (a hiki i 3 mau makahiki).
Ke lōʻihi ka maʻi, ʻaʻole ʻike ʻia nā antibodies. Aia kekahi hiki ke loaʻa nā hopena maikaʻi ʻole. I nā mahiʻai me ka ʻole o nā hōʻailona o ka alveolitis, ʻike ʻia lākou ma 9-22% o nā hihia, a ma nā mea aloha manu i 51% o nā hihia.
I nā maʻi me EAA, ʻaʻole pili ka waiwai o ka precipitating antibodies me ka hana o ke kaʻina pathological. Hiki ke hoʻopili ʻia ko lākou pae e nā kumu like ʻole. No laila, i ka poʻe puhi paka, e hoʻohaʻahaʻa ʻia. No laila, ʻaʻole hiki ke noʻonoʻo ʻia ka ʻike ʻana i nā antibodies kikoʻī he hōʻike o EAA. I ka manawa like, ʻaʻole hōʻike ko lākou hele ʻana i ke koko ʻaʻohe maʻi. Eia naʻe, ʻaʻole pono e kākau ʻia nā antibodies, e like me ke alo o nā hōʻailona lapaʻau kūpono, hiki iā lākou ke hoʻoikaika i ka manaʻo e kū nei.
ʻO ka hoʻāʻo no ka emi ʻana o ka mana ākea o nā māmā he hōʻailona, no ka mea, ʻo nā loli hana ʻē aʻe i ka EAA ke ʻano o nā ʻano pathologies ʻē aʻe i hui pū ʻia me ka pōʻino i ka interstitium o nā māmā. ʻO ka Hypoxemia i nā mea maʻi me ka allergic alveolitis e ʻike ʻia ma kahi kūlana mālie, a hoʻonui i ka wā o ka hoʻoikaika kino. ʻO ka uhaki ʻana i ka ventila o ka māmā e hana ʻia e kahi ʻano kaohi. Hōʻike ʻia nā hōʻailona o ka hyperreactivity ea i loko o 10-25% o nā maʻi.
Ua hoʻohana mua ʻia nā hoʻāʻo inhalation no ka ʻike ʻana i ka alveolitis maʻi maʻi ma mua o 1963. Ua hana ʻia nā aerosol mai ka lepo i lawe ʻia mai ka mauʻu moldy. Ua alakaʻi lākou i ka exacerbation o nā hōʻailona o ka maʻi i nā maʻi. I ka manawa like, ʻaʻole i loaʻa i nā mea i lawe ʻia mai ka "hay maʻemaʻe" i kēlā ʻano hopena i nā maʻi. I nā poʻe olakino, ʻaʻole i hoʻonāukiuki nā aerosol me ka ʻōpala i nā hōʻailona pathological.
ʻO nā ho'āʻo hoʻonāukiuki i nā mea maʻi me ka hānō bronchial ʻaʻole ia e hoʻohālikelike i nā hopena immunological wikiwiki, mai hoʻonāukiuki i nā haunaele i ka hana o nā māmā. ʻOiai i loko o ka poʻe me ka pane kūlohelohe maikaʻi, alakaʻi lākou i nā loli i ka hana o ka ʻōnaehana hanu, i ka piʻi ʻana o ka mahana o ke kino, ke anuanu, nāwaliwali a me ka dyspnea. Ma hope o 10-12 mau hola, nalowale kēia mau hōʻike iā lākou iho.
Hiki ke hōʻoia i ka hōʻailona o EAA me ka hanaʻole i nā ho'āʻo hoʻonāukiuki, no lailaʻaʻole lākou i hoʻohanaʻia i ka hana lapaʻau hou. Hoʻohana wale ʻia lākou e nā poʻe loea e pono e hōʻoia i ke kumu o ka maʻi. ʻO kahi ʻē aʻe, ua lawa ka nānā ʻana i ka mea maʻi i kāna mau kūlana maʻamau, no ka laʻana, ma ka hana a ma ka home paha, kahi e pili ai me ka allergen.
ʻO ka Bronchoalveolar lavage (BAL) hiki iā ʻoe ke nānā i ke ʻano o nā mea o ka alveoli a me nā ʻāpana mamao o ka māmā. Hiki ke hōʻoia ʻia ka hōʻailona ma ka ʻike ʻana i ka piʻi ʻana o ʻelima mau mea i loko o ia mea, a ʻo 80% o lākou e hōʻike ʻia e nā lymphocytes (ʻo ka nui o nā T-cell, ʻo ia hoʻi CD8 + lymphocytes).
Hoʻemi ʻia ka helu immunoregulatory i nā maʻi ma lalo o hoʻokahi. Me ka sarcoidosis, ʻo kēia helu he 4-5 mau ʻāpana. Eia nō naʻe, inā hana ʻia ka lavage i nā lā 3 mua ma hope o ka ulu ʻana o ka alveolitis, a laila e hoʻonui ʻia ka nui o nā neutrophils, a ʻaʻole mālama ʻia ka lymphocytosis.
Eia kekahi, hiki i ka lavage ke ʻike i ka piʻi ʻana o ka nui o nā mast cell he ʻumi. Hiki ke hoʻomau kēia ʻike o nā mast cell a hiki i 3 mahina a ʻoi aʻe paha ma hope o ka hoʻopili ʻana me ka allergen. Hōʻike kēia hōʻailona i ka hana o ke kaʻina hana fibrin. Inā he subacute ka maʻi, a laila e ʻike ʻia nā cell plasma i ka lavage.
Ke hana ʻana i kahi hōʻailona ʻokoʻa
ʻO nā maʻi kahi e hoʻokaʻawale ʻia ai ka alveolitis allergic exogenous:
ʻO ka maʻi maʻi alveolar a i ʻole ka metastases o ka māmā. Me nā maʻi maʻi kanesa, ʻaʻohe pilina ma waena o nā hōʻailona o ka maʻi i ʻike ʻia a pili pū me nā allergens. Ke holomua mau nei ka pathology, hōʻike ʻia e nā hōʻike koʻikoʻi. Ma ka ʻāpana serum o ke koko, ʻaʻole i hoʻokuʻu ʻia nā antibodies i nā allergens. Eia kekahi, hiki ke wehewehe ʻia ka ʻike me ka hoʻohana ʻana i ka x-ray o nā māmā.
ka maʻi maʻi maʻi miliary. Me kēia maʻi, ʻaʻohe pilina me nā allergens. ʻO ka maʻi pono'ī he ala koʻikoʻi a lōʻihi ka uluʻana. Hiki i nā ʻenehana serological ke ʻike i nā antibodies i ka antigen tuberculosis, ʻoiai ʻaʻole lākou e ʻike i nā exoallergens. Mai poina e pili ana i ka hoʻokolokolo x-ray.
Sarcoidosis. ʻAʻole pili kēia maʻi i ka hana ʻoihana a ke kanaka. Me ia, ʻaʻole wale nā mea hanu i hoʻopilikia ʻia, akā pū kekahi ʻōnaehana kino. ʻO ka hilar lymph nodes i loko o ka umauma e wela ma nā ʻaoʻao ʻelua, aia kahi hopena nāwaliwali a maikaʻi ʻole paha i ka tuberculin. ʻO ka pane ʻana o Kveim, ma kahi ʻē, e maikaʻi. Hiki ke hōʻoia ʻia ʻo Sarcoidosis e ka nānā ʻana i ka histological.
ʻO nā alveolitis fibrosing ʻē aʻe. Me lākou, ʻo ka hapa nui o nā mea maʻi e hoʻomohala i ka vasculitis, a me ka pōʻino ʻōnaehana i ka ʻiʻo connective e pili ana ʻaʻole i ka māmā wale nō, akā i ke kino holoʻokoʻa. Me kahi maʻi kānalua, hana ʻia kahi biopsy lung me ka nānā histological hou o ka mea i loaʻa.
Pneumonia. Ke ulu nei kēia maʻi ma hope o ke anu. Ma ka x-ray, ʻike ʻia nā ʻeleʻele, i ʻike ʻia ma muli o ke komo ʻana o ka ʻiʻo.
ʻO ka ICD-10 e pili ana i ka alveolitis allergic exogenous i ka papa X "Maʻi hanu".
ʻO nā wehewehe:
J 55 Ka ma'i hanu i hanaia e ka lepo.
J 66.0 Byssinosis.
J 66.1 Ma'i o ke olonā.
J 66.2 Cannabiosis.
J 66.8 ʻO ka maʻi hanu ma muli o nā lepo kino ʻē aʻe.
J 67 Pneumonitis hypersensitivity.
J 67.0 Māmā o kahi mahiʻai (mea hana mahiʻai).
J 67.1 Bagassose (no ka lepo kō)
J 67.2 Ka māmā o ka mea hānai moa.
J 67.3 Suberoz
J 67.4 Māmā o ka mea hana malt.
J 67.5 Māmā o ka mea hana halo.
J 67.6 Māmā ʻili maple.
J 67.8 Pneumonitis hypersensitivity ma muli o nā lepo kino ʻē aʻe.
J 67.9 Pneumonitis hypersensitivity ma muli o ka lepo kino i hōʻike ʻole ʻia.
Hiki ke hoʻonohonoho ʻia ka diagnostic e like me kēia:
ʻO ka alveolitis allergic exogenous (ka māmā o ka mahiʻai), ʻano ʻeha.
ʻO ka alveolitis maʻi i hoʻokomo ʻia i ka lāʻau i hoʻokumu ʻia e furazolidone, ʻano subacute, me ka hāʻule ʻole o ka hanu.
ʻO ka alveolitis allergic exogenous (ka māmā o ka mea hānai moa), ʻano maʻi mau. ʻO ka puʻuwai māmā maʻamau, bronchitis mau.
ʻO ka mālama ʻana i ka alveolitis allergic exogenous
No ka paleʻana i ka maʻi, pono e hoʻopau loa i ka pilina o ka mea maʻi a me ka allergen. Pono ke kanaka i ka wā hana e hoʻohana i nā masks, nā kānana kūikawā. He mea makemake nui ia e hoʻololi i nā hana a me kāu mau maʻamau. I mea e pale ai i ka holomua o ka pathology, he mea nui e ʻike iā ia i ka wā mua o ka hoʻomohala ʻana. Inā hoʻomau ka pilina me ka allergen, hiki ke hoʻololi ʻia nā loli o ka māmā.
ʻO ke ala koʻikoʻi o ka alveolitis e pono ai ke koho ʻana i nā glucocorticosteroids. Hiki iā lākou ke kuhikuhi wale ʻia e ke kauka, ma ke koho.
ʻO ka poʻe maʻi me ka hyperresponsiveness o ka māmā e kuhikuhi ʻia i nā bronchodilators inhaled. Inā ua alakaʻi ka maʻi i ka ulu ʻana o nā pilikia, a laila hoʻohana ʻia nā antibiotics, diuretics, oxygen, etc.
Ka wānana a me ka pale ʻana
No ka paleʻana i ka uluʻana o ka maʻi, pono e hōʻemi i nā mea a pau e pili ana me nā allergens. No laila, pono e maloʻo loa ka mauʻu, e wehe ʻia nā lua silo. Pono e hoʻoheheʻe maikaʻi ʻia nā hale hana, a inā he holoholona a me nā manu i loko o lākou, pono e mālama pono ʻia nā pono maʻemaʻe a me ka maʻemaʻe. Pono e hana ʻia nā ea a me nā ʻōnaehana ea me ke ʻano kiʻekiʻe a me ka manawa, etc.
Inā ua ulu mua ka alveolitis, a laila pono ka mea maʻi e haʻalele i ka pilina me nā allergens. Ke lilo ka hana ʻoihana i hewa, hoʻololi ʻia ka hana.
ʻOkoʻa ka wānana. Inā ʻike ʻia ka maʻi i ka wā mua, a laila hiki i ka pathology ke hoʻoholo iā ia iho. ʻO ka hoʻihoʻi ʻana o ka alveolitis e alakaʻi i ka ʻoiaʻiʻo e loaʻa i ka ʻiʻo māmā nā loli hiki ʻole ke hoʻololi. Hoʻonui kēia i ka prognosis, a me nā pilikia o ka alveolitis a i ʻole kona papa mau.