Autoimmune pancreatitis: litekanyetso tsa tlhahlobo ea kalafo, kalafo le ho ruruha

Autoimmune Pancreatitis - mofuta oa pancreatitis, ho pathogenesis eo mekhoa ea autoimmune e amehang ho eona. Ka mofuta ona oa pancreatitis, hypergammaglobulinemia e bonoa, maemo a phahameng a IgG, IgG4 serum ea mali, autoantibodies e teng, karabelo e hlakileng ea kalafo e nang le corticosteroids e tlalehiloe.

Mefuta e 'meli ea autoimmune pancreatitis e khetholloa:

1. Mofuta oa 1 - lymphoplasmacytic sclerosing pancreatitis
2. Mofuta oa 2 - idiopathic duct-concentric pancreatitis e nang le lesapo la granulocytic epithelial.

Metheo ea ho hlahloba autoimmune pancreatitis e bonts'oa ho Consensus ea Machabeng mabapi le ts'ebollo ea lefu la autoimmune pancreatitis, e ileng ea amoheloa Japane ka 2010. Mohloli o ka sehloohong oa serological (S1) bakeng sa tlhahlobo ea AIP ho ile ha etsoa qeto ea ho nahana ka keketseho ea litekanyetso tsa serum IgG4 tsa maemo a fetang a 2, 'me tlhahlobo e belaetsang (S2) ke keketseho ea letšoao, empa eseng ho feta 2 tloaelo.

Tlhahlobo ea tšoaetso

Bakeng sa bakuli ba nang le autoimmune pancreatitis ka metsoako e fapaneng le maqhubu a feto-fetohang (30-95%), matšoao a latelang le syndromes a bonoa:
• Litla-morao tse utloisang bohloko ba bohloko,
• Ho phehella thuto ntle le thuto ntle le ho bontša ntle le ho bonts'a thuto e hlakileng.
• matšoao a jaundice e thibelang,

• keketseho ea kakaretso ea li-gammaglobulins, IgG kapa IgG4 ho plasma,
• boteng ba li-autoantibodies,
• fetisa keketso ea manyeme,
• ho se leka-lekane (ho seng joalo) ha GLP,

• stenosis ea karolo ea "intrapancreatic" ea karolo e tloaelehileng ea bile duct, hangata - ho kenella ts'ebetsong ea likarolo tse ling tsa phepelo ea methapo (sclerosing cholangitis), e tšoanang le liphetoho ho PSC,
• Liphetoho tsa fibrotic ho pancreatic parenchyma e kenang kahare ea li-lymphocyte le li-plasmocytes tse ntle tsa IgG4,
• pheko ea bohloko bo botle,

• Ho kopana khafetsa le lits'ebetso tse ling tsa kemiso: PSC, cirrhosis ea mantlha, lefu la ho ruruha, lefu la Crohn, lefu la Sjogren's, reprositoneal fibrosis, tšenyo ea methapo ea methapo ea methapo le methapo ea methapo ea methapo.
• katleho ea li-glucocorticoids.

Ka lebaka la palo e kholo ea matšoao a autoimmune CP, tse ling tsa tsona li sa qaqisa, ka 2002, ka lekhetlo la pele, Mokhatlo oa Japane oa Pancreatic o ile oa etsa tlhahiso ea tlhahlobo ea autoimmune CP e le ho ntlafatsa boleng ba tlhahlobo.

• Tlhahiso-leseling e tsoang lithutong tse nang le thuso: ho fokotseha ha GLP ka botebo ba lebota le ho kenyelletsa katoloso ea manyeme.
• Lintlha tsa laboratori: li-serum tse eketsehileng tsa gammaglobulins le / kapa IgG kapa ho ba teng ha li-autoantibodies ho plasma ea mali.
• Tlhahlobo ea tlhahlobo ea nalane: Liphetoho tsa li-fibrotic ho parenchyma le li-pancreatic ducts tse kenang kahare ea li-lymphocytic le plasmacytic.

Ho latela qeto ea Mokhatlo oa Japane oa Pancreatologists, ho fumanoa ha lefu la autoimmune pancreatitis ho ka theoa feela haeba mokhoa oa pele o kopantsoe le oa bobeli le / kapa oa boraro.

Ka 2006, K. Kim et al. o khothalelitsoe, ka lebaka la kholo e kholo ea linyeoe tse sa fumanoeng tsa lefu lena ha a sebelisa mekhoa ea Mokhatlo oa Japane oa Pancreatologists, tlhahlobo e ntlafalitsoeng le e bonolo haholoanyane bakeng sa lingaka tsa tlhahlobo ea kalafo ea autoimmune pancreatitis, ka karolo e itseng e ipapisitse le mekhoa e neng e reriloe pele.

• Tlhahlobo ea 1 (e ka sehloohong) - datha tse tsoang lithutong tse fanoeng ka matla:
- nyatsa keketseho ea manyeme ho latela CT,
- Ho ferekanya kapa ho patela ka mokhoa o sa lumellaneng ha GLP.

• Kh'ebetso ea Bobeli - tlhaiso-leseling ea liteko tsa laboratori (bonyane e 'ngoe ea liphetoho tse peli tse latelang)
- Ho eketsa khatello ea kelello ea IgG le / kapa IgG4,
- boteng ba autoantibodies.

• Karolo ea 3 - data ea tlhahlobo ea nalane: - fibrosis,
- ho kenella ka hare ho lymphoplasmacytic.

• Bofuto ba 4 - tloaelano le mafu a mang a autoimmune. Ts'oaetso ea lefu la autoimmune pancreatitis e ka hlahisoa ka mekhoa e latelang: 1 + 2 + 3 + 4, 1 + 2 + 3, 1 + 2, 1 + 3.

Ts'oaetso e kanna ea ba teng haeba ho na le motsoako oa litekanyetso 1 + 4, moo ho ka arabeloang karabelo e ntle ho glucocorticoid kalafo, ha ho hlahlojoa hore ho na le ts'ebetso. Tlhahlobo ea tšoaetso e ka etsahala haeba feela ho le teng tlhahlobo ea 1.

Phekolo le ramatiki

Ho bakuli ba nang le matšoao a bobebe a autoimmune CP, kalafo e tšoanang le ea OP (tlala, PPI, lithethefatsi tse thibelang likokoana-hloko) hangata ha e hlokahale. Haeba matšoao a ts'oaetso ea jaundice a le teng, ho bonahala drainage e poteletseng kapa ea endoscopic dra dragege, haholoholo maemong a tšoaetso ea baktheria.

Ka tlhahlobo e netefalitsoeng ea histological (cytologically) ea autoimmune CP, ha ho sa hlokahala tlhahlobo ea monotherapy ka li-glucocorticoids, ho kgothaletsoa ho atolosa phekolo ka ho kenyeletsoa ho regimen (ho ekelletsa ho prednisone) ea litokisetso tsa secretion tsa gastric (haholo-holo IDN) le litokisetso tsa polyenzyme tse hlahisitsoeng ka morero o sa hlaloseheng (lefu la ka mpeng la tumbo. )

Bakeng sa lipontšo, ho ea ka lipontšo, li-antispasmodics le lithethefatsi tse seng khahlanong le ts'oaetso tsa steroidal li sebelisoa.
Pheko ea steroid hangata e sebetsa bakeng sa ho senya li-ducts tsa bile, litšoelesa tsa salivary le tšenyo ea li-dancts tsa pancreatic. Ho bakuli ba bang, boemo bo ntlafala ntle le tšebeliso ea meriana leha e le efe. Maemong a mang, ha nako ea autoimmune CP e thatafatsoa ke mofuta oa 2 lefu la tsoekere, kalafo e nang le glucocorticoids e ka ntlafatsa boemo ba mokuli.

Ho khothalletsoa hore ka autoimmune CP, azathioprine e kanna ea sebetsa. Litlamorao tsa kliniki li fumanoe ts'ebelisong ea litokisetso tsa ursodeoxycholic acid (ursofalk) bakeng sa autoimmune CP, e etsahalang ka lefu la tsoekere la mellitus le cholestasis syndrome khahlanong le semelo sa stenosis sa karolo ea ho qetela ea duct e tloaelehileng: palo ea matšoao a cholestasis e ea fokotseha, boholo ba makhopho a chancreas boa fokotseha.

Phekolo ea Ursofalk bakeng sa autoimmune CP e ka ba mokhoa o mong oa glucocorticoids. Joalokaha u tseba, ursofalk e sebelisoa ka katleho bakeng sa cirrhosis ea mantlha ea biliary le PSC. Setlhare se thusa ho eketsa kholo ea bile, se na le hepatoprotective and immunomodulating, ka hona, se ka sebelisoa ho autoimmune CP, haholo-holo ka ho kenya letsoho ha tsamaiso ea biliary. Algorithm e latelang bakeng sa kalafo ea Conservative e ka khonahala (feiga 4-46).

Ka kalafo ea nako e telele le prednisone, taolo ea lefu lena ea hlokahala:
• Tlhahlobo ea matšoao a supang
• ts'oaetso ea maloetse a ts'ebetso ea pancreatic ea exo le endocrine,
• ho lekola matšoao a tlhahlobo ea mali ka kakaretso le ea biochemical,
• taolo ea mats'oao a autoimmunity,
• laola ultrasound, ESM e nang le biopsy ea manyeme, CT kapa MRI.

Tsoelo-pele ea autoimmune CP e ipapisitse le mathata a mangata, maloetse a amanang le autoimmune le lefu la tsoekere.

Lefu la autoimmune pancreatic ke eng

Tšenyo ea autoimmune ho manyeme, kapa kamoo ba e tloaetseng ho e bitsa, autoimmune pancreatitis, e khethiloeng ke keketseho ea ts'ebetso ea boits'ireletso ho isa tekanyong eo e qalang ho sebetsa khahlanong le 'mele oa eona. Tabeng ena, ho hloloa ho ama makhopho ka bobeli ka boeona le litšoelesa tsa makhopho, li-ducts tsa bile, tsamaiso ea methapo ea litho, liphio, mala a ka mpeng, li-lymph node le litho tse ling.

Mofuta oa autoimmune oa pancreatitis o bua ka mefuta e sa foleng ea methapo ena e lutseng halofo ea selemo kapa ho feta. Maemong a mangata, e hlaha haholo ho banna, leha basali le bona ba ka angoa ke lefu lena.

Lisosa tsa ho hlaha

Lisosa tsa ho hlaha ha autoimmune pancreatitis ha li e-so ho thehoe, ho tsejoa feela hore nakong ea ho hlaha ha ts'ebetso e itseng 'meleng, boits'ireletso ba mmele bo qala ho sebetsa ka tatellano e fapaneng, mme bo hlasela litho tsa' mele oa eona.

Nts'etsopele ea mofuta oa autoimmune oa lefu la pancreatic hangata e amahanngoa le nts'etsopele ea rheumatoid arthritis, Sjogren's syndrome, hammoho le li-pathologies tsa ts'oaetso ea mala.

Mefuta ea pathology

Mohato o tsoelang pele oa lefu la autoimmune pancreatic nakong ea nalane ea lefu la lefutso o arotsoe ka:

1. Nts'etsopele ea sclerosing lymphoplasmacytic pancreatitis, e iponahatsang hangata maemong a tsofetseng. E tšoauoa ka sebopeho sa ho phatsima ha letlalo le likarolo tsa mmele, hammoho le ts'enyo ho manyeme. E sebetsana hantle le lithethefatsi tsa steroid.
2. Ntshetsopele ea idiopathic pancreatitis ea mofuta o tataisang e nang le tšenyo ho epithelium ea granulocytic. E etsahala khafetsa ho batho ba lilemo tse nyane ho sa tsotelehe bong.

Mefuta ena e 'meli e fapana feela ka tlhahlobo ea microscopic.

Ka ho ba teng ha mathata a concomitant pathological autoimmune a hlahang ha litho tse ling li ameha, pancreatic pancreatic pathology e arotsoe ka:

• nts'etsopele ea mofuta o ikhethileng oa lesapo la autoimmune pancreatic la gland, moo lesion e amang feela tšoelesa,
• hammoho le nts'etsopele ea autoimmune pancreatitis syndrome, eo ho eona litho tse ling li amehang ho kenyelletsa manyeme.

Li-pathologies tse lumellanang tsa litho tsa kahare tsa tlhaho ea autoimmune:

• ponahalo ea lisele tsa sclerotic tsamaisong ea methapo ea litho le sebete,
• Tlolo ea tlhabollo ea selemo le selemo lipelong, e lebisang khorong ea khaello ea bona,
• ts'oaetso ea qoqotho ea hau e bitsoa thyroiditis,
• ho ruruha ha litšoelesa tsa mongobo, tse bitsoang sialadenitis.

Sebakeng sa lesapo, lefu le hlahang le ka ba le:

• fomate sebopeho, se tšoauoa ka tšenyo e batlang e le haufi le lesapo lohle la manyeme,
• sebopeho sa maiketsetso, moo maemong a mangata, ho tsepamisoa maikutlo ho setereke sa hlooho ea boteng.

Matšoao le matšoao a lefu lena

Kankere ea autoimmune pancreatitis e ea khahlisa hobane e sa iponahatse e na le matšoao a boletsoeng le ho senyeha ho hlakileng ha bophelo bo botle ba mokuli, esita le nakong ea ho mpefala ha lefu la pelo. Maemong a mang, lefu lena le ka hlaha ntle le matšoao a ho hang, 'me tlhahlobo eo e se e entsoe mothating oa ho ntlafala ha mathata.

Matšoao a bonahatsang a lefu lena a hlahisoa ka tsela e latelang:

1. Ponahalo ea ho hloka botsitso ka mpeng ea mpa ea mokokotlo ka sebopeho sa matšoao a bohloko a herpes zoster ka matla a fokolang a ho bonahala.
2. Sebopeho sa yellowness ea letlalo le membrane ea mucous bokong ba molomo, esita le sclera ea mahlo.
3. 'Mala oa makhopho o fetoha bobebe haholoanyane ha a bona moroto o le lefifi.
4. Nts'etsopele ea ho hlohlona letlalong
5. Ho fokotse takatso ea lijo.
6. Ho fafatsa ka mokhoa o tsebahalang oa ho nyekeloa ke pelo, hangata ho lebisang ho hlatsuo e matla.
7. Lihoreng tsa hoseng, hangata bakuli ba utloa molomong o omileng le tatso ea ho hlonama.
8. Boemo bo phahameng ba ho tepella le ho fokotseha kapele ha boima ba 'mele bo tsamaeang le tlolo ea molao ea boemo ba kelello ba mokuli.
9. Ponahalo ea ho hema hanyane, bohloko bo kahare ke litšoelesa tse thellang ka hanong. Mokuli o utloa bohloko ha a bua, a metsa lijo le metsi a nooang.

Tlhahlobo ea lefu lena

Tlhahlobo e nepahetseng le e nepahetseng e ka etsoa feela motheong oa tlhahlobo e felletseng ea mmele oa mokuli, ho fetisa liteko le ho fetisa mekhoa e meng ea tlhahlobo ea mafu.

Ho fumana setšoantšo se felletseng sa tlhabollo ea lefu lena, ho khothalletsoa mekhoa e latelang ea tlhahlobo:

• Boikemisetso ba mahloriso ba IgG4 immunoglobulin ka serum ea mali, ka lefu la tsoekere, bo ka eketseha makhetlo a 10,
• Liteko tsa Kliniki ka kakaretso li ngotsoe: mali bakeng sa biochemistry, tlhahlobo e akaretsang ea moroto le makhopho,
• Tlhahlobo ea tlhaho
• tlhahlobo ea matšoao a hlahala,
• ho fumana tekanyo ea tšenyo le boemo ba setho sa parenchymal, ho fanoa ka karolo ea compact tomography le ultrasound,
• hape o seke oa etsa ntle le biopsy le histology.

Kamora ho fumana setšoantšo se felletseng sa bongaka, ngaka e etsa tlhahlobo e nepahetseng, e lekola hore na lefu lena le tsoetse pele hakae, 'me le nts'etsapele mofuta oa kalafo o sebetsang hantle le o sireletsehileng.

Ho bohlokoa ho hlokomela hore ngoana e monyane le eena a ka feta tlung ea lefu le tšoanang, leha sena e le tharollo. Leha ho le joalo, ha e thehoa ka lesea, e bonahatsoa ke ho pepeta ho sa tloaelehang ha letlalo, le ke keng la hlokomolohuoa ke lingaka.

Tlhahlobo ea Ultrasound

Litlhatlhobo tsa Ultrasound li ka lekanya hantle likarolo tsa kantle tsa setho se amehang, li lekola likarolo tsa sebopeho le boemo ba tsoelo-pele ea methapo methapong ea manyeme, sebete le botoneng.

U sebelisa mokhoa ona oa ho etsa lipatlisiso, lisosa tse bakang tlolo ea ts'ebetso ea bile, le boteng ba li-neoplasms le majoe ka har'a gland cavity li senoloa.

Boikemisetso ba IgG4 immunoglobulin mahloriso

Ha u etsa tlhahlobo ea bongaka ea liteko tsa mali, ho lebisoa tlhokomelo e khethehileng ho khatello ea maikutlo ea IgG4 immunoglobulin. Ho motho ea phetseng hantle, mahloriso a ona ha a fihle ho 5% ea palo eohle ea serum ea mali. Ka keketseho e potlakileng ea khatello ea eona, re ka bua ka mokhoa o sireletsehileng ka nts'etsopele ea ts'oaetso ea methapo 'meleng oa motho, e tsamaeang le ts'ebetso ea ho kenella ha litho tsa mpa tse sebelisang immunoglobulin ena.

Ka mantsoe a mang, ho na le nts'etsopele e sebetsang ea ts'ebetso ea ho ruruha ka har'a likarolo tsa tishu ka sebopeho sa fibrosis le leqeba.

Ho bakuli ba nts'etsopele ea autoimmune pancreatitis maemong a fetang 88%, ho na le boemo ba immunoglobulin ka makhetlo a 5 kapa esita le makhetlo a 10 ho feta bo tloaelehileng.

Phekolo ea mafu

Ho batla ho le thata ho fola ka botlalo kalafong ea autoimmune pancreatitis. Ke ka hona mekhoa e ka sehloohong ea kalafo e lebisitsoeng ho tloseng ha matšoao le matšoao a ts'ebetso ea pathological e ntseng e tsoela pele.

Taba ea mantlha, litlhahiso tsa litsebi tse kang Igor Veniaminovich Mayev (Gastroenterologist le Doctor of Science) le Yuri Alexandrovich Kucheryavy (PhD) li latela ka tieo mokhoa oa ho ja oa phepo e le ho netefatsa thibelo ea bohloko le ho eketsa phokotso ea khatello ea pancreatic.

Hape, kalafo ea immunosuppression e laetsoe, e kenyelletsa ts'ebetso ea cytostatics le glucocorticoids. Ho fokotsa bohloko bo iponahatsang nakong ea lefu lena le ntseng le mpefala, ho fanoa ka litlhare tsa spasmolytic.

Ka ho phatloha ho thata ha bile le nts'etsopele ea letlalo le masapo a letlalo, ho sebelisoa lithethefatsi tse kenyeletsang ursodeoxycholic acid.

Ka nts'etsopele ea stenosis bokong ba methapo ea manyeme, kalafo ea bongaka e laetsoe.

Lijo tsa lijo

Ho khothalletsoa ho sebelisa lihlahisoa tsa lebese, lijo tsa semela, hammoho le mefuta ea lijo ea nama e tšoeu joaloka lijo tse phetseng hantle.

Khetso e lokela ho ba:

• Lijo tsohle tse nang le mafura a mangata, linoko, lijo tse tsubiloeng le letsoai,
• bakery le lihlahisoa tsa confectionery,
• lino tse tahang le lino tse tahiloeng
• Chokolete le kofi
• tee e matla
• linoko tse fapaneng
• k'habeche e tšoeu, radish, radish, konofolo le lieie.

U lokela hape ho tlohela ho tsuba.

Liphephetso le Liphello tse ka bang teng

Phekolo ea lefu lena ntle ho tšenyo ea maikutlo e na le mathata a latelang:

• nts'etsopele ea hypovitaminosis le khaello ea protheine,
• ho theola boima ba 'mele haholo, ho lebisa mokhatlong o matla oa' mele,
• nts'etsopele ea 'mele
• tlolo ea metabolism ea metsi a letsoai,
• tsoelo-pele ea subhepatic jaundice,
• tshwaetso ya mmele, ka sebopeho sa sepsis, peritonitis, purulent cholangitis, infrate e kenang,
• ho senya le ho senyeha ha tšilo ea lijo,
• duodenum 12,
• nts'etsopele ea li-ascins tsa pancreatogenic,
• Kotsi e kholo ea mofetše.

Liphetho tsa kalafo e sa lebelloang ea mofuta oa autoimmune oa lesapo le tebileng joalo la pancreatic li ka ba ngata. Empa, ho bohlokoa ho hlokomela hore, ho latela litlhahlobo tse ngata, kalafo e lekaneng le e nakong e tla tlatsetsa boemong bo boholo ba ho hlaphoheloa ha setho sa parenchymal, hammoho le ho ntlafatsa boiketlo ba mokuli ka kakaretso.

1. Bezrukov V.G. Boitšoaro ba Autoimmune ho pancreatitis e sa foleng. Pancreatitis e sa foleng: etiology, pathogenesis, likarolo tsa kliniki, tlhahlobo ea immunological, kalafo. Omsk, 1995 maq. 34–35.
2. Yarema, I.V. Autoimmune pancreatitis ea Lekala la Bophelo bo Botle la Russia, thuto e tsoelang pele ea bongaka le thuto ea meriana. M. GOU VUNMTS Lekala la bophelo bo botle la Russian Federation, 2003
3. Bozhenkov, Yu. G. Pancreatology e sebetsang. Tataiso bakeng sa lingaka M. Mahe a linotsi. buka N. Novgorod Publishing ntlo ea Novosibirsk State Medical Academy, 2003
4. Bueverov A.O. Lipakeng tsa ho ruruha le Tšenyo ea makhopho. Koranta ea Russia ea Gastroenterology, Hepatology, Coloproctology. 1999, No. 4, maq. 15-18.
5. Velbri S.K. Tlhahlobo ea tšoaetso ea mafu a mafu a pancreatic. M. M: Bongaka, 1985
6. Midlenko V.I. Bohlokoa ba kliniki le ea pathogenetic ea liphetoho tsa immunological ho bakuli ba nang le pancreatitis e matla. Sebaka sa dissertation. Barnaul, 1984

Matšoao a mantlha a lefu lena

Mokhahlelo o matla oa lefu lena ha o eo. Ka linako tse ling matšoao ha a hlahe ho hang. Maemong a joalo, lefu lena le fumanoa ho latela mathata a hlahang. Matšoao a mantlha a lefu lena

1. Bohloko le ho hloka botsitso ka mpeng e kaholimo, ka linako tse ling mokokotlong o tlase. Sena se ka nka metsotso e mengata, 'me ka linako tse ling lihora. Bohloko maemong a joalo bo bobebe kapa bo itekanetse. Hangata hona ho etsahala ha ho ja lijo tse mafura, tse tsoekere kapa tse halikiloeng.
2. Ho roala letlalo la mokuli (jaundice), molomo oa molomo, mathe, joalo-joalo ho etsahala ha bile e kenella ka har'a duodenum kapa ha likotloana tsa "pancreatic" le "ducts" e patisane.
3. Metsoako ea mofuta ona oa pancreatitis e bobebe ho feta tloaelehileng, 'me urine e ntšo haholo.
4. Ho bakuli ba bangata, ho hlohlona ho qala.
5. Takatso ea lijo ea fokotseha.
6. Mpa ea ruruha, mokuli oa kula, ho hlatsa hoa khoneha.
7. Hoseng, mokuli o na le molomo o omileng le ho hlonama, 'me ho tloha molomong oa hae o utloahala haholo, ho sa ratehe.
8. Lefu la tsoekere le ka hlaha le ho hola.
9. Ho fokotsa boima ba 'mele ka mokhathala o potlakileng.
10. Bofokoli bo akaretsang, boroko ba motšehare, bo fokotsitse ts'ebetso.
11. Ho sithabela maikutlo, ho hlonama ho hoholo, ho eketsa ho teneha.
12. Ho phefumoloha ka nakoana ka lebaka la tšenyo ea matšoafo.
13. Liprotheine tse ka moroto li bontša ho se sebetse hantle ha liphio.
14. Mefuta e fapa-fapaneng ea sebete e ba teng ka har'a sebete ntle le hore hlahala.
15. Ts'oaetso ea litšoelesa tse hlabang, bohloko sebakeng sena. Ho ka ba le bothata ba ho koenya, ho hema le ho bua.

Bala ka liphetoho tse fetotsoeng makhophong mona.

Mefuta e fapaneng ea autoimmune pancreatitis

Hona le mefuta e 'meli ea bokuli ho latela liphetoho lipakeng tsa litho tse bonoang tlasa microscope:

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

Phapang lipakeng tsa mefuta ena e 'meli e senoloa feela nakong ea lithuto tsa nalane. Haeba mokuli a e-na le mefuta e meng ea lefu la autoimmune, joale pancreatitis e arotsoe ka:

• lefu le ikhethileng,
• autoimmune syndrome.

Sebakeng sa lefu lena, mefuta e ikhethileng le e ikhethileng e ea khetholoha.

Ho hlahloba lefu lena ka mekhoa le mekhoa e mengata

Lingaka li hlahloba mokuli ka pono le ho ngola nako (e ka bang) ponahalo ea letšoao le itseng la lefu lena. Monyetla oa hore mokuli o na le mafu a sa foleng, lefu la hae, litloaelo tse mpe joalo-joalo, le ntse le ithutoa.

Ebe ho etsoa tlhahlobo ea 'mele: boikemisetso ba boima ba' mele, ho bona hore na ho chaba ho lekana, tlhahlobo ea matsoho ka mpeng, ho teba ha eona. Boholo ba sebete, manyeme, masenke a lekantsoe.

Ebe lithuto tsa laboratori li qala. Tlhahlobo ea mali a akaretsang le a biochemical e nkuoa, boemo ba tsoekere 'meleng oa mokuli bo ts'oaroa, hemoglobin e ea hlahlojoa, ho hlaha setšoantšo sa lipid (boteng ba mafura maling).

Mokuli o hlahlojoa a sebelisa matšoao a hlahala, ho etsoa liteko tsa moroto, 'me ho lekantsoe palo ea immunoglobulin. Tlhahlobo e etsoa ka mafura a motho ea kulang.

Tlhahlobo ea Ultrasound ea mpa e ka hlokahala ho hlahloba mokuli. Mokuli a ka romeloa ho ea hlakisa hore na o tšoeroe ke lefutso la moea le tšoaetsanoang kapa a matla a lona a makatsang. U kanna ua hloka seo ho thoeng ke retrograde cholangiography - tlhahlobo ea mokuli ea sebelisang lisebelisoa tsa x-ray le taba e khethehileng ea ho etsa mebala. Sena se etsoa ho lekola ts'ebetso ea likheo tsa ho tlosa bile 'meleng oa mokuli.

Tlhahlobo ea manyeme, sebete, masapo, jj.

Haeba ho hlokahala, lingaka tse eang ho tsona li buisana le setsebi sa bongaka le lingaka tsa endocrinologist.

Kamora ho bokella tlhaiso-leseling eohle, ho fumanoa tlhahlobo e nepahetseng 'me ho hlalositsoe litsela tsa ho felisa lefu lena.

Kalafo ea Autoimmune Pancreatitis

Maemong a mang, lefu lena le itulela ntle le tšebeliso ea meriana. Empa linyeoe tse joalo ha li na seoelo. Bakeng sa bakuli ba bangata ba methating ea lefu lena, kalafo e kenyelletsa ho khethoa ha lijo No. 5. Ho kenyelletsa mokuli ho ja lijo makhetlo a 6 ka letsatsi. Lijo tse halikiloeng, tse nang le linoko tse ngata, tse mafura, tse tsubileng, tse nang le lijo tse matla tse mafura li lokela ho behelloa ka thoko lijong. Ts'ebeliso ea sodium chloride (sodium chloride) e lekantsoe ho 3 g ka lihora tse 24. Ho ja e lokela ho ba mefuta eohle ea livithamini, letsoai la calcium le phosphates. Ho etsa sena, o ka sebelisa nama e phehiloeng, lihlahisoa tsa lebese tse nang le mafura a fokolang, tlhapi, moroho oa meroho le sopho e thehiloeng ho tsona, jj. Mehato ena e lokela ho imolla manyeme a kulang.

Haeba motho ea kulang a e-na le lefu la tsoekere, ho tla hlokahala hore haholo-holo a fokotse tšebeliso ea tsoekere, a e nkele lintho tse monate - li-sweeteners. Motho ea nang le bona maemong a joalo o lokela ho ba le tsoekere ea lipompong kapa tsoekere ho khutlisetsa, haeba ho hlokahala, monyako oa tsoekere maling maling a mali.

Phekolo ea Conservative e kenyelletsa tšebeliso ea li-glucocorticoids, li-immunosuppressants, antispasmodics. Ho ntlafatsa methopo ea ho silila, ho ka hlokahala hore o hlahise mokuli oa pancreatic, mme o tsitsise ts'ebetso ea li-ducts tsa bile, ursodeoxycholic acid e sebelisoa.

Ho khothalletsoa hore bakuli ba nang le autoimmune pancreatitis ba hlahise proton inhibitors le insulin, ka nako e telele ebile ba nka bohato bo khuts'oane.

Ts'ebetso ea ts'ebetso ea ts'ebetso e sebelisoa ho felisa lits'ebetso tse fokotsang tseo ka tsona bile e epolloang.

Ho etsa sena, ho ts'oaroa ha ducts ho etsoa: sebopeho se ikhethang sa mesh se kenngoa kahare ho bona, se eketsang bophara ba seteitara. Boholo ba bakuli ba mamella ho buuoa hantle.

Autoimmune Pancreatitis Mathata

Ha re sa khone ho fumana lingaka ka tšohanyetso, matšoao a latelang a ka hlaha:

• ho kenngoa ha limatlafatsi tse fapaneng kahara metso ea mala ho khathatsehile,
• ho na le seo ho thoeng ke khaello ea protheine,
• mmele o haelloa ke livithamini
• boima ba 'mele oa mokuli boa fokotseha, bo lebisang kholong ea bofokoli,
• mokuli o na le lenyora le sa feleng
• ho felloa ke matla 'meleng oa mokuli ho ka qala,
• ho ruruha le makhopho a hlaha
• jaundice e eketseha haholo,
• ho na le kotsi ea tšoaetso ea tšoaetso ea makhopho ka boeona.
• hangata e ba le ho ruruha methapong ea bile - purulent cholangitis,
• chefo ea mali (sepsis) kapa peritonitis (ts'oaetso ea ho ruruha ho peritoneum) e khonahala,
• khoholeho e ka hlaha likarolong tse fapaneng tsa mala.
• ulc le liphoso tse ling li hlaha ka seterateng sa ka mpeng,
• khatello ea methapo ea methapo ea methapo e eketseha
• ho na le litšitiso ka har'a duodenum, e nang le mofuta o sa foleng,
• mali ha a kenelle ka mpeng ea ka mpeng, moo mokelikeli o qalang ho bokellana,
• kankere ea pancreatic e ka etsahala.

Litholoana tsa lefu lena le lefu la morao

Haeba mokuli a etela lingaka ka potlako, joale hangata ka tlhahlobo e nepahetseng le kalafo e nepahetseng, ha lefu le le methating ea pele, ho ka khonahala ho khutlisa ka botlalo sebopeho le mesebetsi ea manyeme.

Haeba mokuli a qalile kalafo maemong a morao a lefu lena mme kalafo ea nako e telele e hlokahala ka lebaka la liphetoho tse ke keng tsa fetoloa lithong tse fapaneng, ho khutlisetsoa ka botlalo sebopeho le tšebetso ea setho. Empa le maemong a joalo, lingaka li khona ho emisa ho hola ha lefu lena.

Katleho ea lefu lena e qala ka ho felletseng ka mathata a bang teng ka autoimmune pancreatitis le maloetse a tsamaeang le ao mokuli a nang le ona (mohlala, lefu la tsoekere).

Mehato ea thibelo ea mofuta ona oa pancreatitis ha e eo, hobane ha ho tsejoe sesosa sa lefu lena.

Matšoao a Autoimmune Pancreatitis

Litšobotsi tse ka sehloohong tsa autoimmune pancreatitis ke ho teba ha litekanyetso tsohle le ho se be teng ha litlhaselo tse mpe (liketsahalo tsa ho senyeha ho hoholo boemong ba mokuli). Maemong a mang, ho ka 'na ha se be le matšoao,' me lefu lena le fumanoa feela ka nts'etsopele ea mathata.

• Letsoalo la bohloko ba ka mpeng (letšoao le sa khaotseng la matšoao): bohloko kapa ho hlonama ka mpeng e kaholimo, hangata khafetsa sebakeng sa lumbar, le hlaha hoo e ka bang halofo ea bakuli, 'me e ka lula metsotso kapa lihora tse' maloa. Botebo ba bohloko bo lekane kapa bo bobebe. Ha e le molao, bohloko bo ts'oaroa ke ho kenella ha lijo tse nokiloeng ka linoko tse ngata, tse mafura le tse halikiloeng.
• Jaundice - 'mala o mosehla oa letlalo, li-membrane tsa mucous (mohlala, lera la molomo) le mokelikeli oa likokoana-hloko (mohlala, sesepa, mokelikeli oa lacrimal, jj.). E ba teng ka lebaka la tlolo ea phallo ea bile ho ea duodenum (karolo ea pele ea mala a manyane) ka ho thella ha methapo ea methapo ea mokokotlo le ducts tsa bile:
  • makhopho a bobebe ho feta tloaelehileng
  • moroto o lefifi ho feta mehleng
  • mahlaka a tshehla a mathe, mokelikeli oa lacrimal, plasma (karolo e metsi) ea mali, jj.
  • letlalo la letlalo le boreleli.

• Matšoao a ho hlaseloa ke dyspeptic (mathata a ho ja):
  • takatso e fokotsehileng
  • ho nyekeloa le pelo le ho hlatsa
  • bloating
  • ho baba le molomo o omileng hoseng,
  • phefumoloho e mpe.

• Tlolo ea ts'ebetso ea exocrine ea manyeme (karolelano ea li-enzymes tse kenyelletsang tšilo ea lijo) maemong a mangata ha e na lipontšo, e fumanoe ke thuto e khethehileng ea laboratori.
• Lefu la tsoekere (tlolo ea metabolism ea lik'habohaedreite - tsoekere) le hlaha ka potlako ka lebaka la ts'ebetso ea ts'ebetso ea endocrine ea li-pancreas (tlhahiso ea lihormone tse laolang metabolism ea lik'habohaedreite). Karolo ea lefu la tsoekere ho autoimmune pancreatitis ke mokhoa oa eona o motle ka nts'etsopele e ka ntlafatsang (ho hlaphoheloa) khahlano le semelo sa kalafo e nepahetseng.
• Ho fokotsa boima ba 'mele.
• Boloetse ba Asthenic:
  • ts'ebetso e fokotsehile
  • mokhathala,
  • bofokoli
  • ho otsela mots'eare
  • takatso e fokotsehileng
  • khatello ea maikutlo.

• Ho hlola litho tse ling tsa mmele.
  • Malinyane. E iponahatsa e le bokhutšoanyane ba ho hema (phefumoloho e potlakileng), maikutlo a ho hloka moea ka lebaka la sebopeho sa libaka tsa ho ts'oaroa ha lisele tsa matšoafo.
  • Liphio. E bonahatsoa ke ho se sebetse hantle ha liphio (tlolo ea mesebetsi eohle ea liphio) le ponahalo ea protheine ka har'a moroto (hona ha ea lokela ho ba ntho e tloaelehileng).
  • Sebete (pseudotumor ea sebete) - nts'etsopele ea ho rarahana ha lisele tsa sebete ntle le lisele tsa tumor. E bonoa ke palpation (palpation) kapa ka mekhoa ea lipatlisiso e sebetsang. E kanna ea tsamaisoa le ho teba ha nako e telele ho hypochondrium e nepahetseng, e sa amaneng le ho ja.
  • Litšoelesa tsa Salivary (sclerosing sialadenitis) - ho ruruha ha litšoelesa tse tlotsitsoeng ka phetisetso ea lisele tse tloaelehileng ka lisele tsa letlalo. Lipontšo:
    • molomo o omileng
    • bohloko litšoeleneng
    • bothata ba ho koenya, ho hema le ho bua ka lebaka la molomo o omileng.

Ho latela setšoantšo sa nalane(Liphetoho ka sebopeho sa manyeme a senotsoeng tlasa microscope) mefuta e 'meli ea autoimmune pancreatitis e khetholloa:

• Mofuta oa 1—lymphoplasmacytic sclerosing pancreatitis,
• Mofuta oa 2 - idiopathic duct-concentric pancreatitis e nang le lesapo la granulocytic epithelial.

Phapang lipakeng tsa likhetho tsena ke nalane feela (ke hore, e senotsoeng ke tlhahlobo ea nalane - lithuto tsa setho se tlas'a microscope).

Ho ipapisitse le boteng ba mafu a mang a autoimmune (Ho nts'etsapeleha ha litho tse fapaneng li senyeha ke matla a boits'ireletso ba tsona - tsamaiso ea ts'ireletso ea 'mele) ho na le mefuta e' meli ea autoimmune pancreatitis:

• autoimmune pancreatitis e ikemetseng - e hlaha ho mokuli ea se nang mafu a mang a autoimmune,
• autoimmune pancreatitis syndrome - e hlaha ho mokuli ea nang le mafu a mang a autoimmune.

Ho latela maemo a lehae (leseli) la lesion khetholla:

• senya sebopeho (Tšenyo ea manyeme kaofela)
• sebopeho se lebelletsoeng (Tšenyo ea likarolo tse itseng tsa manyeme, hangata hlooho ea eona, ha e sebelisoa, e tšoana le mofetše (tumello e mpe) ea manyeme.

Ngaka ea gastroenterologist e tla thusa ka kalafo ea lefu lena

Kalafo ea Autoimmune Pancreatitis

Maemong a sa tloaelehang, ho iphekola ho etsahala (ke hore, ntle le ts'ebeliso ea meriana).

Lintho tsa motheo tsa kalafo ea autoimmune pancreatitis.

• Pheko ea lijo.
  • Lijo tsa nama ea 5 - ho ja makhetlo a 5-6 ka letsatsi, ntle le linoko, mafura, mafura, koae, koae (tse nang le fiber e ngata - ho thata ho chesa karolo ea limela) lijo tse tsoang lijong, li fokotsa sodium chloride ho isa ho ligrama tse 3 ka letsatsi. Lijo li lokela ho ba le livithamini tse ngata, calcium le phosphorus (mohlala, tlhapi, nama e phehiloeng, sopho ho meroho ea meroho, lihlahisoa tsa lebese tse nang le mafura a lekaneng, jj.). Morero oa lijo tsena ke ho fokotsa mojaro ho manyeme.
  • Ka nts'etsopele ea lefu la tsoekere mellitus (tlolo ea metabolism ea lik'habohaedreite - tsoekere) joalo ka pontšo ea autoimmune pancreatitis, tšebeliso ea tsoekere e lokela ho fokotsoa haholo, o ka e nkela sebaka ka li-sweeteners.
  • Ka nts'etsopele ea lefu la tsoekere, ho na le kotsi e kholo ea hypoglycemia (ho theoha ho hoholo hoa litekanyetso tsa mali tsa glucose (carbohydrate e bonolo), e tsamaeang le kelello e sa sebetseng). Ka hona, mokuli o tlameha ho ba le lijo tse tsoekere (tsoekere e ngata kapa liswiti) le eena ho khutlisetsa maemo a tsoekere ea mali.

• Phekolo ea Conservative (eo eseng ea ho buoa).
  • Glucocorticoids (synthetic analogues ea lihormone tsa adrenal cortex) - ts'ebeliso ea lithethefatsi tsena ke motheo oa kalafo. Boholo ba bakuli ba hloka li-glucocorticoids ka mor'a libeke tse 'maloa. Bakuli ba bang ba ka hloka tšebeliso ea nako e telele ea litekanyetso tsena tsa lithethefatsi tsena.
  • Li-Immunosuppressants - sehlopha sa lithethefatsi tse hatellang ts'ebetso e feteletseng ea sesole sa 'mele (ts'ireletso ea' mele), e lematsang litho tsa eona. Li-immunosuppressants li sebelisoa ha li-glucocorticoids li sa sebetse kapa li sa khone ho sebelisoa (mohlala, ka nts'etsopele ea mathata).
  • Li-antispasmodics (lithethefatsi tse khathollang mesifa e ka hare ea litho tsa kahare le methapo ea mali) li sebelisetsoa ho phekola bohloko bo hlahang ha litokonyana tsa manyeme li khutsufatsoa.
  • Li-enzymes tsa pancreatic li sebelisetsoa ho ntlafatsa tšilo ea lijo.
  • Litokisetso tsa Ursodeoxycholic acid li sebelisoa ho ntlafatsa phallo ea bile le ho khutlisa lisele tsa sebete.
  • Proton pump inhibitors (lithethefatsi tse fokotsang tlhahiso ea hydrochloric acid ka mpeng) li sebelisoa ho khutlisetsa bokaholimo ba mpa ka pela ho senyeha.
  • Insulin e bonolo (e khutšoanyane) e nang le insulin ntle le lisebelisoa tse eketsang nako ea ts'ebetso ea eona hangata e sebelisetsoa ho ntlafatsa tsoekere ea mali nts'etsong ea lefu la tsoekere.
  • Li-insulin tse lulang li sebetsa ka nako e telele (litharollo tsa li-insulin li-ingredient tse nang le lisebelisoa tse tlatsetsang tse liehang ho monya) li ka sebelisoa ho fetofatsa maemo a tsoekere ea mali nts'etsopeleng ea lefu la tsoekere.

• Phekolo ea kalafo. Opereishene e thibelang (ho khutlisetsa lumen e tloaelehileng) ea li-ducts tsa manyeme le li-ducts tsa bile e sebelisetsoa ho fokotsa lits'oants'o, tse ke keng tsa phekoloa ka glucocorticoids. Ho ts'oaroa ha methapo ea methapo ho loketse (ho kenyelletsa ho fokotseha ha seretse - mesifa e atolosang lesen) kaha ts'ebetso ena hangata e mamelloa habonolo ke bakuli.

Mathata le litlamorao

Mathata a autoimmune pancreatitis.

• Ho kenngoa ha limatlafatsi tse ngata ka mpeng.
  • Khaello ea liprotheine (boemo bo emang ka lebaka la phokotso kapa ho felisoa hoa protheine).
  • Hypovitaminosis (ho haella ha livithamini 'meleng), haholo-mafura a qhibilihang (A, D, E, K).
  • Ho fokotsa boima ba 'mele ho fihlela cachexia (boemo ba ho tepella ho tebileng le bofokoli ba' mele).

• Ho tlosoa ha tekanyo ea motlakase oa motlakase 'meleng.
  • Nyoriloe.
  • Ho ruruha.
  • Ho omella (letlalo le omeletseng le membrane ea mucous).
  • Makhopho a (mesarelo ea mesifa ea paroxysmal e sa ikemiseng).

• Subhepatic jaundice - 'mala o mosehla oa letlalo, litho tsa mucous tse hlahang le maro a tlhaho (mohlala, mathe, lero la lacrimal, jj) ka lebaka la tlolo ea ts'ebetso ea bile.
• Mathata a tšoaetsanoang:
  • inferior infusions (keketseho ea molumo le letsoalo la likarolo tse ling tsa setho ka lebaka la ho bokellwa ha lisele tse sa tloaelehang ho tsona - mohlala, likokoana-hloko, lisele tsa mali, jj.) tsa manyeme,
  • purulent cholangitis (ho ruruha ha ducts ea bile),
  • sepsis (chefo ea mali - lefu le bakoang ke ho ba teng hoa mali a likokoana-hloko le chefo ea tsona (lihlahisoa tsa litšila),
  • peritonitis - ho ruruha ha peritoneum (membrane e lekanyang bokaholimo ba mpa ba mpa le ho koaela litho tse ho eona).

• Erosion (bofokoli bo holimo) le liso tsa ka mpeng (likoli tse tebileng) tsa likarolo tse fapaneng tsa tšilo ea lijo (esophagus, mpa, mala).
• Subhepatic portal hypertension (khatello e eketsehileng ea tsamaiso ea portal vein (sejana se tlisang mali ho sebete ho tsoa litho tsa ka mpeng) ka lebaka la tšitiso ea phallo ea mali ho tsoa ho sebete).
• Tšitiso e sa feleng ea duodenum ka lebaka la ho ruruha ha eona le khatello ea manyeme a holisitsoeng.
• Abdominal ischemic syndrome (phallo ea mali e kenang ka mpeng) ka lebaka la khatello ea methapo.
• Pancreatogenic ascites (ho bokellana ha mokelikeli oa mahala mokokotlong oa mpa).
• Kankere (hlahala e kotsi - hlahala e holang ka ts'abo ea litho tse haufi) tsa manyeme.

Litholoana tsa autoimmune pancreatitis.

• Ka kalafo e nakong, e phethahetseng ka nako e khuts'oane ea lefu lena, ho khutlisetsoa ka botlalo sebopeho le tšebetso ea manyeme li khonahala.
• Ka nako e telele ea lefu lena, liphetoho tse bakoang ke makhopho a letlalo li baka liphetoho tse ke keng tsa fetoloa moahong le tšebetsong ea ona, empa le ho bakuli bana, kalafo e felletseng e emisa ho tsoela pele (nts'etsopele) ea ts'ebetso.

Forecastle autoimmune pancreatitis ho latela botebo ba mathata a amanang le mafu a autoimmune (tšenyo ea litho tsa hau ke sesole sa 'mele - ts'ireletso ea' mele) le lefu la tsoekere la lefu la tsoekere (carbohydrate-tsoekere metabolism).

Tlhahisoleseling ka kakaretso

Le ha autoimmune pancreatitis e nkuoa e le lefu le sa tloaelehang, karolo ea eona ka sebopeho sa ts'oaetso ea pancreatic e sa foleng e fihla ho 4-6%. Ho ata ha lefu lena ha ho fetele 0,0008%. Psychology e ile ea hlalosoa ka lekhetlo la pele ke ngaka ea Mafora G. Sarles ka 1961. Lefu lena le ile la bonoa e le yuniti e arohaneng ea nosological ka 2001 kamora nts'etsopele ea sehlopha sa thuto ea lefutso sa TIGAR-O pancreatitis. Tšenyo ea Autoimmune ho pancreatic gland ho banna e fumanoa makhetlo a 2-5 hangata ho feta ho basali. Ho fihlela ho 85% bakuli ba kula ka mor'a lilemo tse 50. Lefu lena le lula le kopantsoe le ramatiki, ramatiki ea methapo ea morao-rao, sclerosing cholangitis le lits'ebetso tse ling tsa autoimmune.

Etiology ea autoimmune pancreatitis ha e e-so theoe. Ka tloaelo, lefu lena le fumanoa le qheleloa ka thoko ha le fumana li-immunoglobulins tsa G4 le ho ba sieo ha lisosa tse ling tsa tšenyo ea pancreatic. Litsebi lefapheng la bongaka ba bongaka ba mafu li lumela karolo e etelletseng pele ea mojaro oa lefutso, nakong ea lithuto tsa lefutso tsa bongaka mokhatlo oa ts'ebetso ea autoimmune le serotypes HLA DRβ1-0405, DQβ1-0401, DQβ1-57 e thehiloe. Ho tsoa maling a bakuli a arohaneng a protein a boima ba 13.1 kDa, e nkoang e le antigen e ikhethileng.

Li-autoantigener tse ka bang teng ke khase ea carbonic anhydrase e teng liseleng tsa litho tse silang lijo, sefate sa bronchial le li-distal renal tubules, lactoferrin, tse fumanoeng ho li-pancreatic acini, bronchial and gastric gland, dikarolo tsa methapo ea sele le masapo a boreleli a mesifa, pancreatic trypsinogen inhibitor. Boitšoaro ba maikutlo le batho ba tšoaetsanoang ha bo ahloloe - ho etsisoa ha limolek'hule lipakeng tsa li-antibodies ho liprotheine tsa pathogen tsa Helicobacteriosis le liprotheine tse tlamang plasminogen li fumanoe.

Mokhoa o hlohlelletsang oa liphetoho mokhoeng oa pancreatic le litho tse ling tse tebileng ke khokahano ea serum Ig G4 le li-autoantigener tsa lisele tsa moea, lisele tse tloaelehileng tsa epithelial tsa pancreatic, bile, sesvary ducts, joalo-joalo. Tšenyo ea antigenic e tsamaisana le tlolo ea molao ea apoptosis ea lisele tsa mmele tsa sesole sa mmele. Khokahano ea mantlha ho pathogenesis ea autoimmune pancreatitis ke ho bokella ha li-T le B tsa li-lymphocyte tse sa phetseng, li-neutrophils le eosinophils ka har'a lithane tse sebetsanang, tse tsosang lits'ebetso tsa microsselotic.

Tlhahlobo ea cytological ho "pancreatic stroma" e senola matšoao a fibrosis le sclerosis ha ho na pseudocysts le calculi. Ka lebaka la ho kenella ka hare ho lymphoplasmacytic, neutrophilic, le eosinophilic, marako a duct a tiisitsoe, a patoa ebile a arotsoe nakong ea nako e telele ea ts'ebetso ea autoimmune. Ho ata ha ho kenella ho kenang bocheng ba makhopho ho baka tahlehelo ea sebopeho sa setho 'me hangata se kopantsoe le phlebitis. Joalo ka mefuta e meng e mengata ea pancreatitis e sa foleng, ho boleloa ha parenchyma le stroma hoa khoneha.

Tlhomamiso

Ha ho hlophisoa mefuta ea autoimmune pancreatitis, ho ata ha ts'ebetso ea fibro-sclerotic, ho ba teng ha liso tse kopaneng tsa litho tse ling, le likarolo tsa morphological tsa ho ruruha li tsotelloa. Karolong e fapaneng ea lefu lena, likarolo tsa motho ka mong tsa pancreatic parenchyma, haholo-holo hlooho ea setho, li senyehile. Hangata, bonyane 1/3 ea tšoelesa e ameha (mofuta oa karolo ea pancreatitis). Bakeng sa mofuta o ferekanyang oa pathology, ho kenella ha setho sohle ke tšobotsi.

Ha ho se na mafu a mang a autoimmune, pancreatitis e bitsoa thoko. Tabeng ea liso tsa systemic tsa litho tse 'maloa, li bua ka ho ruruha ha syndromic autoimmune pancreatic. Ha ho fanoa ka setšoantšo sa nalane, mefuta e 'meli ea lefu lena ea arohana,' me e 'ngoe le e' ngoe e fapana ka litšobotsi tsa eona tsa bongaka.

• Lymphoplasmacytic-sclerosing mofuta oa pancreatitis. Ho kenella ka har'a lisele tse hlahisang immunoglobulin, letšoao le sa bonahaleng la "litho" le "phlebitis" le senyehang. E kopantsoe le psychGmune e amanang le autoimmune pathology. Thutong e khutlelang morao le tsoelo-pele ea liphetoho tsa sclerotic ke tšobotsi.
• Ductal-concentric idiopathic pancreatitis. Morphologic e iponahatsa e le ho kenella ha neutrophilic ka lihlopha tsa sele e tšoanang le li-microabscesses. Phlebitis le fibrosis ha li hlahisoe haholo. Hangata maemo a Serum IgG4 a tloaelehileng. Maemong a 30%, e amana le ulcerative colitis. E tsoela pele ntle le ho khutlela morao. E etsahala makhetlo a 3.5-4 hangata.

Matšoao a autoimmune pancreatitis

Setšoantšo sa kliniki ea lefu lena se fapana le ho ruruha ho tloaelehileng ha manyeme. Ho fapana ha autoimmune ka tšenyo ea setho, bohloko bo bobebe, bo bobebe, ha bo amane le liphoso tsejoeng. Ramatiki e ba teng halofong ea bakuli feela. Letšoao le leng la bohlokoa la autoimmune pancreatitis ke jaundice e thibelang, e etsahalang ka karolelano ho bakuli ba 60-80% mme e bonahatsoa ke boteng ba letlalo le sclera, ho hlohlona ha letlalo, le ho fifatsoa ha makhopho.

Autoimmune pancreatic pathology hangata e tsamaisana le mathata a dyspeptic: ho nyekeloa ke pelo, phetoho sebopeho sa setuloana sa sefahleho (profuse fetid stool of the brownish color), bloating. Ha lefu lena le ntse le eketseha, ho haella ha mala le ho haella ha limatlafatsi, ho bonahatsoa ke ho fokotseha ha boima ba 'mele oa mokuli, edema ea sefahleho e senang protheine le maemo a tlase. Mehatong ea morao ea pancreatitis, lenyora le sa khaotseng le hlaha, polyuria (matšoao a metabolism ea tsoekere e sa sebetseng).

Phatlalatso le Thibelo

Phello ea lefu lena e itšetlehile ka tekanyo ea tšenyo ea lisele, boima ba mathata. Le ha kalafo ea steroid e lumella ho fihleleha ha bakuli ho feta 90% ea bakuli, kholo ea "autoimmune pancreatitis" e fokola haholo, ho bakuli ba bang ho na le phokotso e ke keng ea fetoloa ea mesebetsi ea setho sa endocrine le exocrine. Ka lebaka la ts'ebetso ea thuto ea etiopathogenetic e sa ithungheng hantle, mehato e khethehileng ea thibelo ha e so hlahisoe. Ho thibela mathata, ho bohlokoa ho tseba le ho alafa mafu a autoimmune a tšilo ea lijo ka nako e nepahetseng.