Kev Kuaj Mob Txog Kab Mob Autoimmune
Cov kab mob autoimmune yog ib pawg kab mob uas lub cev tiv thaiv kab mob—uas yuav tsum tiv thaiv lub cev ntawm kev kis kab mob—es tawm tsam lub cev cov nqaij. Qhov no ua rau muaj kev o tuaj yeem cuam tshuam rau yuav luag txhua lub cev: daim tawv nqaij, pob qij txha, ntshav, qog, ntsws, raum, thiab txawm tias lub paj hlwb. Cov piv txwv zoo ntawm cov kab mob autoimmune suav nrog systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), autoimmune thyroid disease (Graves' thiab Hashimoto's), hom 1 diabetes mellitus, multiple sclerosis, psoriasis, celiac disease, thiab inflammatory bowel diseases xws li Crohn's thiab ulcerative colitis. Vim tias cov tsos mob feem ntau tsis tshwj xeeb thiab tuaj yeem zoo li kev kis kab mob lossis lwm yam kab mob, kev kuaj mob ntawm cov kab mob autoimmune xav tau kev ua tib zoo, kev ua haujlwm, thiab kev xaiv cov kev kuaj mob txhawb nqa.
Vim li cas kev kuaj mob autoimmune feem ntau nyuaj?
Qhov teeb meem tseem ceeb yog qhov sib txawv ntawm cov tsos mob thiab qhov xwm txheej ntawm tus kab mob (mob hnyav zuj zus thiab rov zoo li qub). Ib tug neeg mob yuav muaj kev qaug zog tas li thiab mob pob qij txha me ntsis, thaum lwm tus yuav muaj pob khaus tawv nqaij, kub taub hau, poob phaus, lossis ua haujlwm tsis zoo ntawm lub cev xws li mob ntsws. Ntxiv mus, qee cov kab mob autoimmune muaj cov tsos mob sib tshooj; piv txwv li, kab mob Sjögren yuav muaj nrog SLE lossis scleroderma. Qee tus neeg mob kuj muaj cov autoantibodies zoo uas tsis muaj cov tsos mob pom tseeb, yog li cov ntaub ntawv kuaj mob yuav tsum tau txhais lus hauv cov ntsiab lus kho mob.
Cov kauj ruam pib: cov ntaub ntawv keeb kwm qhia
Feem ntau kev kuaj mob pib nrog keeb kwm tag nrho. Tus kws kho mob yuav tsum tshawb nrhiav qhov teeb meem tseem ceeb, lub sijhawm ntev npaum li cas, tus qauv ntawm kev rov qab mob dua, cov yam ntxwv ua rau mob hnyav dua, thiab kev cuam tshuam rau cov dej num niaj hnub. Kev qaug zog heev uas tsis zoo dua thaum so, kub taub hau me ntsis rov qab los, thiab poob phaus tsis paub meej yog cov cim qhia txog lub cev uas tsim nyog sau tseg.
Cov tsos mob tshwj xeeb ntawm lub cev pab qhia txog kev xav. Mob pob qij txha sib npaug ntawm tes nrog rau kev mob thaum sawv ntxov ntev tshaj 30-60 feeb tej zaum yuav qhia txog RA. Cov pob khaus zoo li npauj npaim ntawm lub ntsej muag uas hnyav dua tom qab raug tshav ntuj, cov qhov ncauj rov tshwm sim, cov plaub hau poob dav dav, thiab mob pob qij txha tej zaum yuav ua rau muaj kev xav tias muaj SLE. Qhov muag qhuav thiab qhov ncauj ntev ntev tej zaum yuav qhia txog Sjögren's syndrome. Raws plab ntshav ntev ntev lossis mob plab tas li tej zaum yuav qhia txog kab mob inflammatory bowel. Kev yws txog kev loog, tsis muaj zog hauv ob txhais ceg, lossis kev pom tsis meej yuav tsum tsa cov lus nug txog kab mob autoimmune xws li multiple sclerosis.
Keeb kwm tsev neeg kuj tseem ceeb, vim tias kev xeeb tub los ntawm noob caj ces ua lub luag haujlwm hauv ntau yam kab mob autoimmune. Tsis tas li ntawd, keeb kwm ntawm qee yam kab mob, kev siv tshuaj, kev haus luam yeeb, kev ntxhov siab, kev nyuaj siab tom qab yug menyuam, thiab cov mob hormonal yuav cuam tshuam nrog qhov pib lossis hnyav zuj zus ntawm cov kab mob autoimmune hauv qee tus neeg mob.
Kev kuaj lub cev: nrhiav cov cim qhia txog kev o thiab kev koom tes ntawm lub cev
Kev kuaj lub cev lub hom phiaj yog los nrhiav pov thawj ntawm kev o, ntsuam xyuas kev koom tes ntawm cov kab mob hauv lub cev, thiab tshem tawm cov kev kuaj mob sib txawv. Tus kws kho mob yuav ntsuam xyuas cov cim tseem ceeb (kub taub hau, ntshav siab), nrhiav cov pob khaus (piv txwv li, pob khaus vim raug tshav ntuj, purpura), mob qhov ncauj, cov qog ntshav loj hlob, thiab cov cim ntawm kev tsis muaj ntshav xws li daj ntseg.
Hauv cov leeg nqaij thiab pob txha, kev kuaj xyuas qhov mob, o ntawm cov pob qij txha, kev txav mus los tsawg, kev puas tsuaj, lossis cov pob qij txha rheumatoid pab qhia qhov txawv ntawm kev o ntawm cov pob qij txha thiab kev mob ntawm lub cev. Hauv cov qog thyroid, kev loj hlob, kev co, lossis bradycardia tej zaum yuav qhia txog tus kab mob autoimmune thyroid. Kev kuaj mob ntsws, lub plawv, thiab plab yog qhov tsim nyog vim tias cov kab mob autoimmune tuaj yeem ua rau pleural effusion, pericarditis, hepatosplenomegaly, lossis mob plab. Kev kuaj mob neurological ntsuas lub zog, reflexes, kev xav, thiab kev sib koom tes, tshwj xeeb tshaj yog tias muaj cov tsos mob ntawm neurological.
Kev kuaj mob hauv chaw kuaj mob yooj yim: ntsuas qhov o thiab nws qhov cuam tshuam
Thaum xav tias muaj kab mob autoimmune, thawj qhov kev kuaj mob hauv chaw kuaj mob feem ntau suav nrog kev kuaj ntshav, erythrocyte sedimentation rate (ESR) lossis C-reactive protein (CRP), kev kuaj mob raum thiab siab, kev kuaj zis, thiab kev kuaj metabolic profile. Tej zaum yuav muaj ntshav tsis txaus, leukopenia, lossis thrombocytopenia hauv SLE lossis lwm yam kab mob autoimmune hematologic. ESR/CRP siab yuav qhia tau tias muaj kev o, txawm hais tias qee yam kab mob autoimmune yuav muaj CRP siab me ntsis txawm tias ua haujlwm ntau.
Kev kuaj zis yog qhov tseem ceeb rau kev kuaj pom cov protein hauv zis lossis cov ntshav hauv zis uas qhia tau tias muaj teeb meem raum, xws li mob lupus nephritis. Tej zaum yuav tsum kuaj cov protein hauv zis/creatinine piv lossis khaws cov zis 24 teev kom paub seb muaj protein ntau npaum li cas.
Autoantibodies thiab kev kuaj mob tiv thaiv kab mob: qhov tseem ceeb tab sis tsis yog tib qho xwb
Kev kuaj mob autoantibody yog ib qho tseem ceeb ntawm kev kuaj mob, tab sis nws cov kev txwv yuav tsum tau nkag siab. Cov tshuaj Antinuclear antibodies (ANA) feem ntau siv los ua kev kuaj mob rau cov neeg uas xav tias muaj SLE, Sjögren's kab mob, cov kab mob sib xyaw ua ke, thiab scleroderma. ANA zoo tsis qhia tias muaj kab mob autoimmune, vim nws tuaj yeem pom muaj nyob rau hauv qee tus neeg noj qab haus huv, tshwj xeeb tshaj yog thaum cov titers qis. Ntawm qhov tod tes, ANA tsis zoo ua rau qee qhov kev kuaj mob, xws li SLE, tsis tshua muaj, txawm hais tias nws tsis tshem tawm qhov ua tau.
Cov tshuaj tiv thaiv kab mob tshwj xeeb ntxiv pab lees paub qhov kev kuaj mob, xws li anti-dsDNA thiab anti-Sm hauv SLE; anti-CCP thiab rheumatoid factor hauv RA; anti-Ro/SSA thiab anti-La/SSB hauv Sjögren's; anti-centromere lossis anti-Scl-70 hauv scleroderma; thiab ANCA hauv qee yam vasculitis. Kev kuaj ntxiv (C3, C4) kuj tseem muaj txiaj ntsig, tshwj xeeb tshaj yog hauv SLE, vim nws tuaj yeem txo qis thaum muaj mob.
Txawm li cas los xij, kev txhais lus yuav tsum xav txog cov tsos mob, cov ntaub ntawv kuaj lub cev, thiab lwm yam kev tshawb pom txhawb nqa. Cov tshuaj tiv thaiv kab mob autoantibodies tej zaum yuav yog "cov lus qhia," tab sis kev kuaj mob yuav tsum tsis txhob raws li ib qho txiaj ntsig xwb.
Kev kuaj duab thiab cov txheej txheem tshwj xeeb
Kev thaij duab pab ntsuas kev puas tsuaj ntawm cov kab mob hauv lub cev thiab qhia qhov txawv ntawm kev o ntawm cov pob qij txha thiab lwm yam mob. Kev siv tshuab X-ray, kev siv tshuab ultrasound rau pob qij txha, lossis MRI tuaj yeem ntsuas kev mob synovitis, kev puas tsuaj ntawm pob txha, thiab kev koom tes ntawm cov nqaij mos hauv kev mob pob qij txha. Yog tias muaj kev koom tes ntawm lub ntsws, kev siv tshuab CT scan hauv siab tuaj yeem ntsuas kev mob ntsws interstitial, uas tuaj yeem tshwm sim hauv scleroderma, RA, lossis myositis. Kev kuaj lub plawv (echocardiography) tej zaum yuav tsim nyog yog tias xav tias muaj mob pericarditis lossis mob ntshav siab hauv lub ntsws.
Muaj tej rooj plaub uas yuav tsum tau kuaj mob los yog ntsuas seb puas muaj kev puas tsuaj ntau npaum li cas, xws li kuaj lub raum thaum muaj mob lupus nephritis, kuaj daim tawv nqaij thaum muaj mob vasculitis lossis mob cutaneous lupus, thiab kuaj plab hnyuv thaum muaj mob celiac lossis mob plab hnyuv o. Cov txheej txheem no tseem ceeb vim tias cov txiaj ntsig tuaj yeem txiav txim siab cov kev xaiv kho mob thiab kev kwv yees.
Cov txheej txheem faib tawm thiab kev kuaj mob sib txawv
Rau qee yam kab mob, cov qauv kev faib tawm thoob ntiaj teb (piv txwv li, ACR/EULAR) muaj los pab txhawb kev ua qauv, tshwj xeeb tshaj yog hauv kev tshawb fawb thiab kev kho mob. Txawm hais tias tsis yog ib qho "cuab yeej kuaj mob," cov qauv no tuaj yeem coj cov kws kho mob hauv kev ntsuam xyuas kev sib xyaw ua ke ntawm cov tsos mob, kev kuaj lub cev, cov tshuaj tiv thaiv kab mob, thiab cov ntaub ntawv txhawb nqa.
Yuav tsum xav txog kev kuaj mob sib txawv tas li. Cov kab mob ntev (tuberculosis, hepatitis, HIV), cov kab mob ntshav tsis zoo, cov tshuaj tsis haum, cov kab mob endocrine, thiab txawm tias fibromyalgia tuaj yeem ua raws li cov tsos mob ntawm tus kab mob autoimmune. Vim tias kev kho mob autoimmune feem ntau siv cov tshuaj immunosuppressants, kev tshem tawm cov kab mob uas nquag thiab lwm yam mob uas yuav ua rau hnyav dua nrog kev tiv thaiv kab mob yog qhov tseem ceeb heev.
Txheeb xyuas cov haujlwm ntawm tus kab mob thiab kev koom tes ntawm lub cev
Ntxiv rau kev txiav txim siab hom kab mob, cov kws kho mob feem ntau ntsuas qib kev ua ub no thiab cov kab mob twg koom nrog. Qhov no cuam tshuam rau qhov kev kho mob sai thiab qhov hnyav ntawm kev kho mob. Piv txwv li, mob pob qij txha me me hauv SLE raug kho txawv ntawm lupus nephritis lossis kev koom tes ntawm lub paj hlwb hauv nruab nrab. Kev ntsuam xyuas kev ua ub no tuaj yeem siv cov qhab nia tshwj xeeb (piv txwv li, rau SLE lossis RA), nrog rau cov kev ntsuas hauv chaw kuaj mob xws li complement, anti-dsDNA, CRP, thiab cov kev tshawb pom hauv kev kho mob.
Lub luag haujlwm ntawm kev koom tes thiab kev ua raws li
Kev kuaj mob ntawm cov kab mob autoimmune feem ntau xav tau kev koom tes ntawm ntau lub koom haum: kev kho mob sab hauv—rheumatology, dermatology, neurology, nephrology, gastroenterology, thiab hematology. Nws tsis yog ib qho txawv txawv rau kev kuaj mob kom pom tseeb tsuas yog tom qab kev saib xyuas tsis tu ncua, vim tias qee tus neeg mob thaum xub thawj tsuas muaj cov tsos mob me me xwb. Yog li ntawd, kev saib xyuas raws li kev teeb tsa, kev sau cov tsos mob, thiab kev rov ntsuam xyuas cov kev kuaj hauv chaw kuaj mob yuav yog ib feem ntawm cov txheej txheem kuaj mob.
Kev kaw
Kev kuaj mob ntawm tus kab mob autoimmune yog ib qho txheej txheem ntau kauj ruam uas muab keeb kwm tsom mus rau, kev kuaj lub cev kom ntxaws, kev ntsuam xyuas hauv chaw kuaj mob yooj yim, kev kuaj mob autoantibody xaiv, thiab kev thaij duab thiab biopsy thaum tsim nyog. Cov teeb meem tseem ceeb yog nyob rau hauv qhov tsis tshwj xeeb ntawm cov tsos mob, cov qauv kab mob hloov pauv, thiab qhov sib tshooj ntawm cov tsos mob. Cov yuam sij rau kev vam meej yog kev txhais txhua qhov txiaj ntsig ntawm kev kuaj mob hauv tus neeg mob lub ntsiab lus kho mob, tshem tawm cov kev kuaj mob sib txawv uas yuav ua rau muaj kev phom sij, thiab ua kev saib xyuas mus sij hawm ntev. Yog tias kuaj mob raug, kev kho mob tuaj yeem hloov kho kom txo qhov o, tiv thaiv kev puas tsuaj rau lub cev, thiab txhim kho tus neeg mob lub neej zoo.
