Autoimmune pancreatitis: njirisi nyocha, ọgwụgwọ na prognosis

Ọrịa autoimmune - ụdị ụdị nke a na - eme ka ọ bụrụ ọrịa pancreatitis, na pathogenesis nke usoro autoimmune gụnyere. N'ime ụdị ọrịa a, a na-ahụ hypergammaglobulinemia, IgG4 dị elu, IgG4 n'ọbara ọbara, autoantibodies dị ugbu a, nzaghachi dị mma nke ọgwụgwọ na corticosteroids.

A na - amata ụdị ọrịa pancreatitis abụọ nke autoimmune:

1. 1dị 1 - lymphoplasmacytic sclerosing pancreatitis
2. 2dị nke abụọ - idiopathic duct-concentric pancreatitis nwere ọnya ọnya epithelial granulocytic.

A na-ahụta ihe nchoputa nke ọrịa autoimmune pancreatitis na Nkwekọrịta International na nchọpụta nke autoimmune pancreatitis, nke nakweere na Japan na 2010. Ekpebiri ihe nkatọ serological (S1) maka nchọpụta nke AIP kpebiri ịtụle mmụba na ọkwa IgG4 nke ihe karịrị 2 iwu, yana nkatọ nwere obi abụọ (S2) bụ mmụba na njirimara, mana ọ bụghị karịa 2 iwu.

Nchoputa akara

N'ime ndị ọrịa nwere ọrịa autoimmune pancreatitis n'ọtụtụ nkwonkwo yana mgbanwe mgbanwe (30-95%), a na-ahụ ihe mgbaàmà na syndromes:
• ọrịa mgbu na-erughị ala,
• ogologo oge ị nọgidesiri ike na-enweghị mgbachapụ ọpụpụ doro anya ma ọ bụ usoro latent,
• mgbanwe nke ọrịa jaundice,

Mmụba nke ngụkọta gammaglobulins, IgG ma ọ bụ IgG4 na plasma,
• ọnụnọ nke autoantibodies,
Na-eme ka ịmụba amụba,
• enweghị ngbanwe (enweghị oge) nke GLP,

• stenosis nke akụkụ nke intrapancreatic nke ihe na-ahụkarị ihe na-egbu egbu, obere oge - itinye aka na usoro akụkụ ndị ọzọ nke biliary tract (sclerosing cholangitis), nke yiri mgbanwe na PSC,
• mgbanwe nke fibrotic na paịlị pancreatic parenchyma nwere inflatration lymphocyte na plasmocytes IgG4.
• na - emechi thrombophlebitis,

• njikọta ugboro ugboro yana usoro sistemụ ndị ọzọ: PSC, isi biliary cirrhosis, ọnya akwara, ọrịa Crohn, ọrịa Sjogren, ọrịa retroperitoneal fibrosis, mmebi nke intraiti na ngwa tubular nke akụrụ, thyroidin na-adịghị ala ala.
• ịdị irè nke glucocorticoids.

N'ihi oke ọnụọgụ ihe nrịba ama autoimmune CP, ụfọdụ nke anaghị akọwapụtakarị nke ọma, na 2002, na nke mbụ, ndị Japan Pancreatic Society tụpụtara usoro nyocha maka autoimmune CP iji melite ogo nchọpụta.

• Ihe omuma sitere na ihe omumu ihe: nchikota nke GLP na nkpa mgbidi ma ju ebe ya.
• Ihe nyocha nke ụlọ nyocha: ịba ụba ọbara nke gammaglobulins na / ma ọ bụ IgG ma ọ bụ ọnụnọ nke autoantibodies na plasma ọbara.
• Nnyocha nyocha nke Histological: mgbanwe fibrotic na parenchyma na pancreatic ducts nwere lymphocytic na plasmacytic infiltration.

Dika mkpebi nke ndi Japanese nke Pancreatologists, nyocha nke autoimmune pancreatitis nwere ike guzosie ike ma oburu na ichotara nchoputa nke mbu na nke abuo na nke ato.

N’afọ 2006, K. Kim et al. tụrụ aro, n'ihi oke ọnụọgụ nke ọrịa a na-enyochaghị mgbe ị na-eji njirisi nke Japanese Society of Pancreatologists, ihe kachasị mma ma dịkwuo mma maka ndị dọkịta na-achọpụta ọrịa nke ọrịa autoimmune pancreatitis, akụkụ ụfọdụ dabere na njirisi ndị a chọrọ mbụ.

• Criterion 1 (isi) - data sitere na ngwa ọmụmụ:
- agbasawanye mmụba na pancreas dika CT,
- na - agbasa ma ọ bụ nkewaha warara nke GLP.

• Criterion 2 - data nyocha ụlọ nyocha (opekata mpe otu n'ime mgbanwe abụọ):
- ịbawanye ụba nke IgG na / ma ọ bụ IgG4,
- ọnụnọ nke autoantibodies.

• Agba 3 - nyocha nyocha nke akụkọ ihe mere eme: - fibrosis,
- lymphoplasmacytic infiltration.

• Agba 4 - mkpakọrịta na ọrịa ndị ọzọ autoimmune. Enwere ike ịmalite nchọpụta nke autoimmune pancreatitis site na njikọ ndị a: 1 + 2 + 3 + 4, 1 + 2 + 3, 1 + 2, 1 + 3.

Achọpụtara nchọpụta ahụ ma ọ bụrụ na enwere njikọ nke 1 + 4, ma ọ bụrụ na a na-ahụ nzaghachi dị mma na ọgwụgwọ glucocorticoid, a na-ahụta nchọpụta ahụ guzosiri ike. Oria ga - ekwe omume ma oburu na ihe nkatọ 1 dị.

Ọgwụ na prognosis

N'ime ndị ọrịa nwere mgbaàmà dị nro nke autoimmune CP, ọgwụgwọ yiri nke OP (agụụ, PPI, ọgwụ antibacterial) adịkarịghị mkpa. Ọ bụrụ na mgbaàmà nke ọrịa jaundice na-enwe mmerụ, ọgbụgba transpepatic ma ọ bụ endoscopic retrograde na-egosi, ọkachasị na nje nke nje.

Site na akụkọ ihe mere eme (cytologically) nyochapụtara nyocha nke autoimmune CP, mgbe enweghị mkpa maka monotherapy ọnwụnwa na glucocorticoids, a na-atụ aro ka ọ gbasaa ọgwụgwọ na ntinye na regimen (na mgbakwunye na prednisone) nke ndị na-egbochi mgbochi nzuzo (tumadi IDN) na nkwadebe nke polyenzyme na ebumnuche nnọchi (mgbu afọ na-apụtabeghị aka) )

Maka ebumnuche symptomatic, dị ka ihe na-egosi, a na-eji ọgwụ antispasmodics na ọgwụ mgbochi mkpali.
Usoro ọgwụgwọ steroid na-adịkarị mma maka mmebi nke dule dule, glandvagevicva, yana mmebi nke akwara. N'ebe ụfọdụ ndị ọrịa nọ, ọnọdụ ahụ na-akawanye mma oge enweghị ọgwụ ọ bụla. N'ọnọdụ ụfọdụ, mgbe usoro autoimmune CP na-agbagha ụdị ọrịa shuga mellitus 2, ọgwụgwọ na glucocorticoids nwere ike imeziwanye ọnọdụ onye ọrịa.

A na-atụ aro na ya na autoimmune CP, azathioprine nwere ike ịdị irè. Enwetara nsonaazụ site na iji ursodeoxycholic acid (ursofalk) nkwadebe maka autoimmune CP, nke na-apụta na ọrịa shuga mellitus na cholestasis na-emegide nzụlite nke stenosis nke akụkụ ọnụ nke ihe na-agakọkarị ọnụ ọgụgụ: akara ọnụ ọgụgụ cholestasis na-ebelata, ọnụ ọgụgụ pancreas na-ebelata ma na-eme ka ọrịa shuga kwụsịlata.

Ursofalk ọgwụgwọ nke autoimmune CP nwere ike ịbụ ihe ọzọ na glucocorticoids. Dịka ịmara, ejiri ursofalk rụọ ọrụ nke ọma maka biliary cirrhosis bụ isi na PSC. Ọgwụ ahụ na-enyere aka ịba ụba nke bile, nwere ọrụ hepatoprotective na immunomodulating, yabụ, enwere ike iji ya na autoimmune CP, ọkachasị na itinye aka na sistemụ biliary. Usoro algorithm a na-esote maka ọgwụgwọ na - ekwe omume (Fig 4-46).

Site na usoro ọgwụgwọ ogologo oge na ọgwụ prednisone, ịchịkwa usoro ọrịa ahụ dị mkpa:
• nyocha nke mgbaàmà nke ọria,
• nyocha nke nsogbu nke exo- na endocrine pancreatic function,
• nleba anya nke ndị na - egosi ihe gbasara izugbe na nyocha ndụ banyere mmiri.
• njikwa ihe nrịbama nke njikwa onwe onye,
• na-ejikwa ultrasound, ESM nwere biopsy nke pancreas, CT ma ọ bụ MRI.

Nkwupụta nke autoimmune CP dabere na ogo nsogbu, ọrịa autoimmune concomitant na ọrịa shuga mellitus.

Gini bu oria a na egbu egbu

Mmebi nke onwe ya na nsogbu nke pancreas, ma ọ bụ dika esi akpọ ya, autoimmune pancreatitis, nke emere ka amatawanye ọrụ ọria ọgụ rue oke oke nke na ọ malitere ịrụ ọrụ megide ahụ nke ya. N'okwu a, mmeri ahụ na-emetụta ma ọria pancreas n'onwe ya yana gland dị iche iche, ma ọ bụ akụkụ akwara ozi, akụkụ akwara nke akụkụ ahụ, akụrụ, olu afọ, akụkụ ahụ na akụkụ ahụ.

Autodị ọrịa pancreatitis na-emetụta ụdị ọrịa na-adịghị ala ala nke na-adịgide ruo ọkara afọ ma ọ bụ karịa. Ọtụtụ mgbe, ọ na-etolitekarị n'ime ụmụ nwoke, ọ bụ ezie na ọrịa a nwekwara ike ịmetụta ụmụ nwanyị.

Na-akpata

E guzobebeghị ihe ndị na-akpata ọrịa autoimmune pancreatitis, na ọ bụ naanị na n’oge ihe ụfọdụ adịghị njọ n’anụ ahụ, ihe mgbochi na-amalite ịrụ ọrụ n’usoro, ma na-alụso akụkụ ahụ nke aka ya ọgụ.

Mmepe nke ụdị autoimmune ụdị ọrịa akwara na-ejikọkarị ya na mmepe nke ọrịa ogbu na nkwonkwo, ọrịa Sjogren, yana ọrịa ọnya na ọnya afọ.

Ofdị pathology

E kewara onyonyo nke ọrịa pancreatic autoimmune n'oge usoro nyocha ihe omimi gaa:

1. Mmepe nke sclerosing lymphoplasmacytic pancreatitis, nke na-egosipụta onwe ya n'ọtụtụ oge na ndị agadi. Ihe e ji amata ya bụ mkpụkọ akpụkpọ ahụ na mucous nke ahụ, yana mmebi nke ahụ. Ọgwụ steroid dị mma.
2. Mmepe nke idiopathic pancreatitis nke ụdị ihe ndọba ahụ mebiri epithelium granulocytic. Ọ na - abụkarị ihe na - emekarị na ndị ọgbọ, n'agbanyeghị agbụrụ okike.

Varietiesdị abụọ a dị iche na nyocha microscopic.

Site na ọnụnọ ọnya na-emetụta ahụike akwara nke na-etolite mgbe akụkụ ahụ ndị ọzọ na-emetụta ọrịa nke akwara nkewa.

• mmepe nke ụdị dịpụrụ adịpụ nke ọrịa gland, nke ọnya ahụ na-emetụta naanị gland,
• yana mmepe nke autoimmune pancreatitis syndrome, nke a na-emetụta akụkụ ahụ ndị ọzọ na mgbakwunye nke pancreas.

Ejikọtara ọnya nke akwara nke anwapụta:

• Ngosipụta nke akwara sclerotic n'ime usoro akwara nke ahụ na akwara,
• imebi rehasorption akụrụngwa nke n’afọ, nke na-eduga na mmepe nke ụkọ ha,
• ọnya afọ ọsịsa, nke akpọrọ thyroiditis,
• mbufụt nke gland na-egbu egbu, na-ezo aka na sialadenitis.

N'ebe ọnya ọnya ahụ, ọrịa a nọ na ya nwere ike inwe:

• ụdị mgbasa, mara ihe na emebi emebi ihe fọrọ nke nta ka ọ bụrụ akụkụ nke pancreas,
• ụdị nlezianya, nke kachasị na ọnọdụ, elebara anya dị na mpaghara isi nke gland.

Mgbaàmà na ihe ịrịba ama nke ọrịa

Ọrịa pancreatitis na-adịghị ala ala bụ ihe na-adọrọ mmasị n'ihi na ọ naghị egosipụta onwe ya site na iji nkwupụta akpọpụta yana ọfụma n'ụzọ doro anya na ọdịmma mmadụ niile, ọbụlagodi n'oge iwe nke pathology. N'ọnọdụ ụfọdụ, ọrịa ahụ nwere ike ịmalite n'enweghị ihe mgbaàmà ọ bụla ma ọlị, a na-eme nchọpụta ahụ tupu oge mmepe nke nsogbu.

Ihe ngosiputa oria a bu ndi ekpughere dika ndi a:

1. Ọdịdị nke ahụ erighi ala na oghere dị n’afọ ya na ngosipụta nke njiri mara ihe na-egbu mgbu nke herpes zoster na ike ngosipụta adịghị ike ma ọ bụ agafeghị oke.
2. Guzobe nke yellowness nke akpukpo aru na mucous membranes na onu, ya na obulu nke anya.
3. Agba nke feces na-aghọrọ ọkụ ugboro ugboro na mmamịrị na-agba ọchịchịrị.
4. Mmepe nke itching na anụahụ
5. Agụụ agụụ.
6. Bloating nwere njirimara nke ọgbụgba, nke na-edugakarị na iwepụ nnukwu ọgbụgbọ.
7. N’ụtụtụ, ndị ọrịa na-enwekarị akpịrị ịkpọ nkụ na uto nke ilu.
8. Oke ike ọgwụgwụ ma na-agbadata ngwa ngwa n’arụ ahụ, ya na ọrịa mmebi nke steeti psychoemotional onye ọrịa.
9. Ọdịdị nke ume dị mkpụmkpụ, ihe mgbu na gland dị iche iche megide ihe ndabere nke ọnya ha. Onye ọrịa ahụ na-enwe ihe mgbu mgbe ọ na-ekwu okwu, na-elo nri na mmiri ọ drinkingụ drinkingụ.

Nchoputa nke oria

Enwere ike ịme nchọpụta ziri ezi na nke ziri ezi naanị na ndabere nke nyocha zuru oke nke ahụ onye ọrịa, na-agafe ule na ịgafe usoro nchọpụta ọzọ.

Iji nweta nkọwapụta ọgwụ zuru ezu banyere mmepe nke ọrịa, a na-atụ aro usoro nchọpụta ọrịa a:

• mkpebi siri ike nke ịta IgG4 immunoglobulin n'ọbara ọbara, yana ọrịa, ọ nwere ike ịbawanye ugboro iri,
• Edere ule ụlọ ọgwụ n'ozuzu: ọbara maka ihe ọmụmụ ndu, nyocha nke mmamịrị na feces,
• nyocha ahụ nke feces,
• njirimara nke ihe nrịba ama,
• iji chọpụta ogo nke mmebi yana steeti parenchymal akụkụ ahụ, a na-agabiga ebe ntụnyere tomography na ultrasound,
• na-emekwa na-enweghị biopsy na akụkọ ihe mere eme.

Mgbe ọ nwetasịrị foto ahụike zuru ezu, dọkịta ahụ mere nchọpụta ziri ezi, chọpụta ụdị ọrịa ahụ, wee mepụta usoro ọgwụgwọ kachasị dị nchebe ma dị mma.

Ọ dị mma ịmara na nwatakịrị nwekwara ike ịmalite ụdị ọrịa yiri nke ahụ, n'agbanyeghị na nke a bụ nnukwu oge. Agbanyeghị, mgbe etolitere n'ime nwatakịrị, a na-egosipụta ya site na oke mkpọtụ nke akpụkpọ ahụ, nke ndị dọkịta enweghị ike ileghara anya.

Nchọpụta ọrịa ultrasound

Ihe omimi nke ultrasound nwere ike itule nha nke mpụga nke akụkụ ahụ metụtara, nyochaa njirimara nke ogo yana ogo nke ọrịa na akwara nke pancreas, imeju na ọnya.

N'iji usoro nyocha a, ekpughere ihe ndị na-eso akpata mmebi nke bile, yana ọnụnọ tumor dị ka neoplasms na okwute n'ime oghere gland.

Mkpebi nke IgG4 immunoglobulin ịta

Mgbe ị na-eme nyocha ụlọ ọgwụ gbasara nyocha ọbara, a na-akwụ ụgwọ pụrụ iche na ntinye IgG4 immunoglobulin. N'ime ahụike, ọ gbasaghị erughị 5% nke ngụkọta ọbara ọbara. Site na mmụba dị nkọ na ntinye ya, anyị nwere ike ikwudo banyere mmepe nke ọrịa ọrịa na ahụ mmadụ, yana usoro ọgbụgba nke akụkụ ahụ na - egbochi immunoglobulin a.

N’aka ozo, enwere oganihu mmeghari ohuru nke usoro mkpali n’ahu mmadu na ewepu fibrosis na ihie.

N'ime ndị ọrịa mmepe nke autoimmune pancreatitis n'ihe karịrị 88% nke ikpe, enwere ọkwa immunoglobulin na 5 ma ọ bụ karịa ugboro 10 karịa nke nkịtị.

Ọrịa

Ọ fọrọ nke nta ka ọ ghara ikwe omume ịgbake n'ụzọ zuru ezu na ọgwụgwọ nke ọrịa autoimmune pancreatitis. Ọ bụ ya mere a na-eji usoro ọgwụgwọ dị iche iche na-eduga na mwepụ nke akara Symptomatic na mgbochi nke usoro pathologies na-aga n'ihu.

Nke mbu, nkwenye nke ndi okacha amara dika Igor Veniaminovich Maev (Onye Gonored Gastroenterologist na Dọkịta nke Sciences) na Yuri Alexandrovich Kucheryavy (PhD), na-agbasochi anya na nri nri iji hụ na igbochi ihe mgbu ma belata ahụ efe nke mkpọchi akwara.

Ọzọkwa, a na-enye ọgwụ mgbochi immunosuppressive, na-esonye na nlekọta nke cytostatics na glucocorticoids. Iji belata ọnya nke na-egosipụta onwe ya n'oge oge ọrịa ahụ, a na-enye ọgwụ ọgwụ spasmolytic.

Site na mpụta nke siri ike na mmepe nke anụ ahụ na akpụkpọ ahụ mucous, a na-eji ọgwụ ọjọọ eme ihe, nke gụnyere ursodeoxycholic acid.

Site na mmepe nke stenosis na oghere nke akwara ji agbanye mmiri, a na-enye ọgwụgwọ ọgwụgwọ.

Nri nri

A na-atụ aro ka iji ngwaahịa mmiri ara ehi, nri osisi, yana ụdị anụ ọcha dị ka ngwaahịa nri bara uru.

Wezụga kwesịrị:

• ihe oriri niile nwere oke abụba, ụtọ, anụ riri ya na nnu,
• ebe a na-eme achịcha na ebe a na-afectionụ mmanya
• mmanya na mmanya na-egbu egbu,
• Chocolate na kọfị
• tii siri ike
• ngwa nri di iche iche na oge,
• kabeji na-acha ọcha, radish, radish, garlic na eyịm.

I kwesịrị ịkwụsị ị upụ sịga.

Nsogbu na nsonaazụ Pụrụ Isi

Eji usoro a na - agbaso ọgwụgwọ a na - arịa ndị a:

• mmepe nke hypovitaminosis na ụkọ protein,
• oke iribiga ihe ókè, na - eduga gị n'ike nke ahụ,
• mmepe nke akpịrị ịkpọ nkụ
• mmebi nke metabolism mmiri-nnu,
• protin nke subhepatic jaundice,
• ọrịa nke ahụ, n'ụdị nke sepsis, peritonitis, purulent cholangitis, mkpali infiltrate,
• ọnya na ọnya na - emebi ihe na-egbu nri,
• ihe mgbochi nke duodenum 12,
• mmepe nke pancreatogenic ascites,
• nnukwu oria cancer.

Nsonaazụ nke ọgwụgwọ akpachaghị anya n'ụdị ụdị ọrịa ọnya ọgbụgba nwere ike ịbụ ọtụtụ. Mana, ọ dị mma arịba ama na, dị ka ọtụtụ nyocha, ọgwụgwọ zuru oke na oge ga-enyere aka na mgbake dị ukwuu nke akụkụ parenchymal, yana ịmezi ọdịmma ndị ọrịa n'ozuzu ya.

1. Bezrukov V.G. Mmeghachi omume onwe ya na pancreatitis na-adịghị ala ala. Ọrịa pancreatitis na-adịghị ala ala: etiology, pathogenesis, njirimara ụlọ ọgwụ, nchọpụta ọgwụ mgbochi, ọgwụgwọ. Omsk, 1995 p. 34-35.
2. Yarema, I.V. Autoimmune pancreatitis nke Ministri Ahụike nke Russian Federation, agụmakwụkwọ ọgwụ na ọgwụ na-aga n'ihu. M. GOU VUNMTS Ministry of Health of Russia Federation, 2003
3. Bozhenkov, Yu. G. Nnukwu omumu ihe egwu. Ntụziaka maka ndị dọkịta M. Mmanụ a .ụ. akwụkwọ N. Novgorod Publishing house of Novosibirsk State Medical Academy, 2003
4. Bueverov A.O. Ogbenye nke mbufụtara na mmebi ahụ. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 1999, Nke 4, p. 15-18.
5. Velbri S.K. Nchoputa ihe omimi banyere oria akwara. M .: Medicine, 1985
6. Midlenko V.I. Clinical na pathogenetic uru nke immunological mgbanwe na ndị ọrịa na-nnukwu pancreatitis. Ahapu akwukwo. Barnaul, 1984

Isi ihe mgbaàmà nke ọrịa

Nnukwu akụkụ nke ọrịa a na-anọkarị. Mgbe ụfọdụ mgbaàmà anaghị adị ma ọlị. N'ụdị ndị ahụ, a na-eme nchọpụta ahụ dịka nsogbu ndị pụtara ìhè. Isi ihe ịrịba ama nke ọrịa:

1. Ahụ mgbu na ahụ erughị ala na mpaghara elu, mgbe ụfọdụ na azụ ala. Nke a nwere ike ịdị ruo ọtụtụ nkeji, na oge ụfọdụ. Mgbu ahụ n'ụdị ndị a dị obere ma ọ bụ agafeghị oke. Nke a na - apụtakarị mgbe ị na - eri nri abụba, oseose ma ọ bụ nke e ghere eghe.
2. Yellowing nke anụahụ nke onye ọrịa (jaundice), onu ura, onu, wdg na-eme mgbe bile banye n'ime duodenum ma ọ bụ mgbe pancreatic canals na excretory bile ducts warara.
3. Ọrịa dị iche iche a na-eme ka o sie ike karịa ka ọ na-adị, mmamịrị na-agba ọchịchịrị karịa.
4. N'ime ọtụtụ ndị ọrịa, itching na-amalite.
5. A na-ebelata agụụ.
6. Ime na-emegharị, onye ọrịa na-arịa ọrịa, na-agbọ agbọ
7. N'ụtụtụ, onye ọrịa nwere akpọnwụ nkụ na obi ilu, o sikwa n'ọnụ ọnụnụ ahụ na-esi isi nke ọma, na-enweghị atụ.
8. Ọrịa shuga nwere ike ịpụta wee tolite.
9. Ibu ibu na ike ọgwụgwụ ngwa ngwa.
10. Ike ọgwụgwụ, ụra ehihie, obere ọrụ.
11. Obi ilu, ọnọdụ ọjọọ, iwe iwe.
12. Nku ume dị mkpụmkpụ n'ihi mmebi nkuume.
13. Protin n'ime mmamịrị na-egosi arụ ọrụ akụrụ.
14. Otutu ihe di iche iche na-etolite n’ime ime ya ma o ghaghi ito ya.
15. Mbufụt nke gland na nnu, ihe mgbu na mpaghara a. Enwere ike isi nri, ilo mmiri, na ikwu okwu.

Gụọ banyere mgbanwe dị iche iche na-agbanwe na pancreas ebe a.

Differentdị dị iche iche nke autoimmune pancreatitis

E nwere ụdị ọrịa abụọ dịka mgbanwe na akụrụngwa ndị a hụrụ n'okpuru mikroskopu:

• Ọrịa lymphoplasmacytic pancreatitis,
• ụdị idiopathic duct-concentric.

E gosipụtara ọdịiche dị n'etiti ụdị abụọ a naanị n'oge ọmụmụ akwụkwọ akụkọ. Ọ bụrụ na onye ọrịa ahụ nwere ụdị ọrịa ọrịa autoimmune ndị ọzọ, e kewara pancreatitis n'ime:

• ofdị ọrịa dịpụrụ adịpụ,
• autoimmune syndrome.

N'ebe ọnọdụ oria ahụ, ụdị ọdịiche dị na iche.

Nchoputa oria a n'uzo di iche iche

Ndị dọkịta na-enyocha onye ọrịa na anya ma detuo oge (ihe dị ka) ọdịdị nke otu ọrịa. A na-atụle ohere onye ọrịa nwere ọrịa na-adịghị ala ala, nketa ya, omume ọjọọ, wdg.

Mgbe ahụ a na-eme nyocha anụ ahụ: mkpebi siri ike nke ahụ, chọpụta maka yellowness, nyocha akwụkwọ ime, afọ ya. A na-atụle nha nke imeju, pancreas, spleen.

Mgbe ahu omumu ihe omumu lawa. A na-enyocha ọbara ọbara n'ozuzu ya na nke mmiri ọgwụ, a na-ekpebi ọkwa glucose na ahụ onye ọrịa, a na-enyocha haemoglobin gly, a na-adọrọ profaịlụ nwere ume (ọnụnọ nke abụba n'ọbara).

A na-anwale onye ọrịa site na iji ihe nrịba ama, a na-anwale mmamịrị, ma kpebie ego immunoglobulin. A na-eme nyocha banyere feces nke onye ọrịa.

Nnyocha ultrasound nke afọ nwere ike ịdị mkpa iji nyochaa onye ọrịa. Enwere ike izipu onye ọrịa ahụ iji mee ka nchọpụta ahụ dịkwuo elu ma ọ bụ ihe anaemetiki ndọtị akpọrọ. May nwere ike ịchọ nyocha akpọrọ retrograde cholangiography - nyocha nke onye ọrịa ahụ na-eji ngwa ray-ray na ihe agba agba pụrụiche. Emere nke a ka ị nyochaa arụmọrụ nke ọwa maka iwepu ihe ọria site na ahụ onye ọrịa.

Ọrịa bio nke afọ, akwara, spleen, wdg.

Ọ bụrụ na ọ dị mkpa, mgbe ahụ ndị dibịa bekee na-agakwuru onye na-agwọ ọrịa na endocrinologist.

Mgbe ikpokọta data niile, a na-eme nchọpụta ziri ezi na ụzọ iji kpochapụ ọrịa ahụ.

Ọgwụgwọ autoimmune Pancreatitis

N'ọnọdụ ụfọdụ, ọrịa ahụ na-apụ naanị n'enweghị ọgwụ ọ bụla. Ma ụdị ikpe ndị a adịghị obere. Maka ọtụtụ ndị ọrịa na mmalite nke ọrịa, ọgwụgwọ mejupụtara nhọpụta nri Nke 5. Ọ na - agụnye onye ọrịa na - a foodụ ihe oriri 6 ugboro n'ụbọchị. A ga-ewepụ nri, oseose, abụba, aokedụrụma, nke nwere ihe oriri n'ụba n'ime nri. Ojiji sodium chloride (sodium chloride) bụ 3 g n’ime awa iri abụọ na anọ. Nri kwesịrị ịbụ ụdị vitamin, sọlfọ calcium na phosphates. Iji mee nke a, ịnwere ike iji anụ esi nri, ngwaahịa mmiri ara ehi nwere obere abụba, azụ, akwukwo nri na ofe na ofe na-esite na ha, wdg. Ihe ndị a kwesịrị ịkwụsị belata ọrịa.

Ọ bụrụ na onye na-arịa ọrịa shuga na-arịa ọrịa shuga, mgbe ahụ ọ dị mkpa iji belata oke shuga, were ihe ndị na-atọ ụtọ dochie ya. Onye ya na ha nọ n'ọnọdụ dị otú a kwesịrị ịnwe swiiti ma ọ bụ nnukwu mmanu iji weghachi, ma ọ bụrụ na ọ dị mkpa, ụzọ maka glucose na plasma ọbara.

Ọgwụ nchekwa na-agụnye iji glucocorticoids, immunosuppressants, antispasmodics. Iji meziwanye canes digestive, ọ nwere ike ịdị mkpa iwepụta onye ọrịa enzymes pancreatic, yana ime ka arụ ọrụ nke bile, a na-eji ursodeoxycholic acid.

A na-atụ aro ka ndị ọrịa nwere autoimmune pancreatitis kọwaa proton pump inhibitors na insulin, ma ogologo oge ma nke na-eme obere oge.

A na-eji usoro ịwa ahụ eme ihe iji kpochapụ warara nke ọwa mmiri nwere ike ịfefe.

Iji mee nke a, a na-eme ntanetị nke ducts: a na-etinye akwa ntanetị pụrụ iche n'ime ha, nke na-agbasa dayameta nke ọwa ahụ. Ọtụtụ ndị ọrịa na-anabata ịwa ahụ nke ọma.

Ihe omimi abuo nke Autocmune Pancreatitis

N'iburu ndị dọkịta ahụ n'ụzọ na-enweghị isi, mgbaàmà ndị a nwere ike ịpụta:

• absorption nke nri di iche-iche n’ime akụkụ eriri afọ na-enye nsogbu,
• enwere ọrịa a na-akpọ protein,
• ahụ gị anaghị enwe vitamin
• Ọkpụkpụ ahụ onye ọrịa na-ebelata, nke na-eduga na mmepe nke adịghị ike,
• akpịrị na-akpọ onye ọrịa nkụ,
• akpọnwụ nke ahụ onye ọrịa nwere ike ịmalite,
• ọzịza na cramps apụta
• jaundice na-abawanye n'ike n'ike.
• enwere ihe ibute ọrịa na mkpali nke na-efe efe.
• mgbe ọ na ebupute mbuze na bile dupe - purulent cholangitis,
• nsị ọbara (sepsis) ma ọ bụ peritonitis (usoro mkpali na peritoneum) ga - ekwe omume,
• ozize nwere ike iputa n'akụkụ dị iche iche nke eriri afọ,
• ọnya na nkwarụ ndị ọzọ na-apụta na eriri afọ,
• Portal vein pressure na-abawanye
• enwere ihe mgbochi na duodenum, nke nwere odida ala,
• ọbara abanyeghị na-abanye n'afọ, nke mmiri na-amalite ito,
• Ọrịa mamịrị na-agwọ ọrịa.

Nsonaazụ nke ọrịa na prognosis

Ọ bụrụ na onye ọrịa ahụ gakwuuru ndị dọkịta n’egbughị oge, mgbe ahụ, ọ na-enwekarị nchọpụta ziri ezi na ọgwụgwọ kwesịrị ekwesị, mgbe ọrịa ahụ dị na mmalite, ọ ga-ekwe omume iweghachi ihe owuwu na ọrụ nke pancreas kpamkpam.

Ọ bụrụ na onye ọrịa ahụ bidoro ọgwụgwọ n’oge ndị ọzọ n’ọrịa ahụ wee chọọ ọgwụgwọ ogologo oge n’ihi mgbanwe mgbanwe a na-apụghị ịgbanwe agbanwe na akụrụngwa dị iche iche, mgbe ahụ, iweghachite usoro na arụ ọrụ ahụ kpamkpam anaghị eme ya. Mana ọbụlagodi n'ọnọdụ ndị dị otú a, ndị dọkịta jikwaa ịkwụsị mmepe nke ọrịa ahụ.

Ọrịa maka mmalite nke ọrịa a dabere kpam kpam na mgbagwoju anya nke na-ebute autoimmune pancreatitis na ọrịa na-esochi onye ọrịa ahụ (dịka ọmụmaatụ, ọrịa shuga mellitus).

Usoro mgbochi maka ụdị ọrịa a na - eme ọfụma adịghị adị, ebe ọ bụ na amabeghị ihe kpatara ọrịa ahụ.

Ọrịa nke Autoimmune Pancreatitis

Isi ihe dị na ọrịa autoimmune pancreatitis bụ ogo ogo adịghị njọ nke ihe mgbaàmà ọ bụla na enweghị mwakpo ọjọọ (akụkụ nke ajọ ọrịa n'ọnọdụ onye ọrịa). N'ọnọdụ ụfọdụ, enwere ike ọ nweghị mgbaàmà, na-achọpụta nchọpụta ahụ naanị na mmepe nke nsogbu.

• Ọrịa mgbu afọ (usoro mgbaàmà na-adịgide): mgbu ma ọ bụ ahụ erughị ala na mpaghara elu, nke na-adịkarịghị na mpaghara lumbar, na - apụta n'ihe dị ka ọkara nke ndị ọrịa, ọ nwere ike ịdị ọtụtụ minit ma ọ bụ awa. Ihe ngbu di nfe. Dịka iwu, a na-akpasu ihe mgbu site na oriri nke anụ ndị na-atọ ụtọ, kegriiz na nri eghe.
• Jaundice - edo edo, akpụkpọ ahụ mucous (dịka ọmụmaatụ, ọnụ mmiri) na mmiri ọmụmụ (dịka ọmụmaatụ, ọnụ mmiri, ọnụnụ lacrimal, wdg). Ọ na - etolite n'ihi mmebi nke mmiri nke bile n'ime duodenum (akụkụ mbụ nke obere eriri afọ) yana imechi obere akwara ndị ahụ.
  • feces dị mfe karịa ka ọ dị na mbụ
  • mmamịrị gbara ọchịchịrị karịa ka ọ na-adị
  • ọbara ọgbụgba, odo mmiri, plasma (akụkụ mmiri) ọbara, wdg,
  • akpụkpọ anụ?

• Mmebi nke dyspeptik (nsogbu digestive):
  • nri riri
  • ọgbụgbọ na ọgbụgbọ
  • bloating
  • ilu na akpịrị ịkpọ nkụ n'ụtụtụ,
  • nku ume ojoo.

• Mmebi nke exocrine ọrụ nke pancreas (oke nke enzymes aka na mgbaze nri) n'ọtụtụ oge enweghị ngosipụta, site na nyocha ụlọ nyocha pụrụ iche.
• Ọrịa shuga mellitus (imebi metabolism nke carbohydrates - sugars) na-etolite ngwa ngwa n'ihi mmebi nke ọrụ endocrine nke pancreas (imepụta homonụ nke na-edozi metabolism nke carbohydrates). Otu akụkụ nke ọrịa shuga na ọrịa pancreatitis bụ usoro ya kachasị mma na enwere ike nzụlite mgbanwe (mgbake) megide usoro ọgwụgwọ kwesịrị ekwesị.
• Ibu ibu.
• Ọrịa Asthenic:
  • arụmọrụ belatara
  • ike ọgwụgwụ,
  • adịghị ike
  • iro ụra n’ehihie
  • nri riri
  • nkụda mmụọ.

• Mmeri nke akụkụ ndị ọzọ.
  • Ume. Ọ na-egosipụta onwe ya dị ka mkpụmkpụ nke iku ume (ngwa ngwa iku ume), mmetụta nke enweghị ikuku n'ihi nguzobe mpaghara nke akụkụ akụrụngwa anụ ahụ.
  • Akụrụ. E gosipụtara ya site na ọdịda akụrụ (imebi ọrụ akụrụ niile) yana ọdịdị protein na mmamịrị (nke a ekwesịghị ịbụ ihe kwesịrị ekwesị).
  • Imeju (pseudotumor nke imeju) - mmepe nke mkpokọta akwara imeju na-ejighị akpụ akpụ. Achọpụtara ya site na palpation (palpation) ma ọ bụ jiri usoro nyocha. Enwere ike ijikọ ya na ogologo oge na hypochondrium ziri ezi, ejikọghị ya na iri nri.
  • Ọrịa Salivary glands (sclerosing sialadenitis) - mbufụt nke gland ọrịre na nnọchi anụ ahụ nkịtị na anụ ahụ. Nkpughari:
    • ọnụ kpọrọ nkụ
    • ihe mgbu na gland dị nnu,
    • ilo nri, iku ume, na ikwu okwu n’ihi ọnụ kpọrọ nkụ.

Dabere na foto mgbe ochie(mgbanwe na usoro nke pancreas nke ekpughere n'okpuru microscope) A na - amata ụdị ọrịa autoimmune pancreatitis abụọ:

• Dị 1—lymphoplasmacytic sclerosing pancreatitis,
• 2dị nke abụọ - idiopathic duct-concentric pancreatitis nwere ọnya ọnya epithelial granulocytic.

Ọdịiche dị na nhọrọ ndị a bụ naanị ihe akụkọ ihe mere eme (ya bụ, site n’inyocha akụkọ ihe mere eme - na-amụ iberibe anụ ahụ n’ebuso microscope).

Dabere na ọnụnọ ọrịa ndị ọzọ nke ọrịa autoimmune (na - etolite mgbe akụkụ dị iche iche nke ihe nchebe nke onwe ha mebiri akụkụ ahụ dị iche iche - usoro ihe eji egbochi ahụ) enwere ụdị ọrịa abụọ nke autoimmune pancreatitis:

• Ọpụrụiche autoimmune pancreatitis - na-etolite na onye ọrịa na - enweghị ọrịa ọrịa autoimmune ndị ọzọ,
• autoimmune pancreatitis syndrome - na-etolite na onye ọrịa nwere ọrịa ọrịa autoimmune ndị ọzọ.

Dabere na nsonye (ọnọdụ) nke ọnya ịmata:

• ụdị mgbasa (mbibi dum pancreas)
• ụdị nlezianya (mmebi nke akụkụ ụfọdụ nke pancreas, ọtụtụ mgbe isi ya, mgbe akụrụngwa, ọ yiri ọrịa kansa (oke ịba) nke pancreas).

Onye na-ahụ maka eriri afọ ga-enyere aka n'ịgwọ ọrịa ahụ

Ọgwụgwọ autoimmune Pancreatitis

N’oge ndị a na-adịghị ahụkebe, ịgwọ onwe onye na-eme (ya bụ, na-ejighị ọgwụ).

Ntọala nke ọgwụgwọ nke ọrịa autoimmune pancreatitis.

• Usoro ọgwụgwọ.
  • Nri Nke 5 - iri nri ugboro 5-6 kwa ụbọchị, ewepu ihe na-atọ ụtọ, ma abụba, eghe, nke na-ese anwụrụ, na -eme ka nri (nke bara ụba na fiber - siri ike ịgbari akụkụ nke osisi) nri site na nri, na-egbochi sodium chloride ka gram 3 kwa ụbọchị. Nri kwesiri inwe vitamin zuru ezu, calcium na site na salts (dika imaatu, azu, sie sie, ofe n’elu ahihia akwukwo nri, nkpuru mmiri ara ehi nke nwere abuba ozo, wdg). Ebumnuche nke nri a bụ iji belata ibu na pancreas.
  • Na mmepe nke ọrịa shuga mellitus (imebi metabolism nke carbohydrates - sugars) dị ka ngosipụta nke autoimmune pancreatitis, oriri shuga kwesịrị oke oke, ị nwere ike dochie ya na ndị na-atọ ụtọ.
  • Site na mmepe nke ọrịa shuga, enwere nnukwu nsogbu nke hypoglycemia (mbelata ọbara nke glucose (carbohydrate dị mfe), yana oke isi). Ya mere, onye ọrịa ahụ ga-enwerịrị nri dị ụtọ (gbochie sugar ma ọ bụ ihe na-atọ ụtọ) na ya iji weghachi ọkwa glucose ọbara.

• Ọgụgụ (ịwa ahụ).
  • Glucocorticoids (analogues ana-akpọ homonụ nke eriri afọ adrenal cortex) - iji ọgwụ ndị a bụ ntọala nke ọgwụgwọ. Imirikiti ndị ọrịa chọrọ glucocorticoids n'ime izu ole na ole. Fọdụ ndị ọrịa nwere ike ịchọ ogologo oge iji obere ọgwụ ọgwụ ndị a ogologo oge.
  • Immunosuppressants - otu ọgwụ na - egbochi oke ọrụ nke usoro ahụ ji alụso ọrịa ọgụ (ihe nchekwa ahụ), nke na - emebi akụkụ ahụ ya. A na-eji immunosuppressants eme ma ọ bụrụ na glucocorticoids adịghị arụ ọrụ ma ọ bụ enweghị ike iji ya (dịka ọmụmaatụ, na mmepe nke nsogbu).
  • A na - eji ọgwụ na - egbochi ahụ mgbu nke akwara dị n'ime ahụ na akwara ọbara iji gwọọ mgbu na - eme mgbe mpe mpekere akwara.
  • A na-eji enzymes Pancreatic emeziwanye nri nri.
  • A na-eji nkwadebe acid Ursodeoxycholic iji melite mpụga nke bile ma weghachite akụrụ imeju.
  • A na - eji proton pump inhibitors (ọgwụ ndị na - ebelata mmiri hydrochloric acid site na afọ) iji weghachite elu afọ ahụ na mmebi ahụ.
  • A na - ejikarị insulin (dị mkpụmkpụ) insulin (ihe ngwọta nke insulin homonụ na-enweghị ihe mgbakwunye pụrụ iche nke na-abawanye oge ọ ga-eme) na-ejikarị emeziwanye glucose ọbara n'ọkwa mmepe nke ọrịa mellitus.
  • Enwere ike iji insulins na-arụ ọrụ ogologo oge (usoro mmiri ọgwụ insulin na mgbakwunye pụrụ iche nke na-akwụsịlata ịmịkọrọ ya) iji mee ka ọkwa glucose ọbara dị elu na mmepe nke ọrịa mellitus.

• Ọgwụ ịwa ahụ. A na-eji mmerụ ahụ (weghachite lumen nkịtị) nke akwara na -eme ihe na ebe a na-ejikwa mkpụchi akwara, nke enweghị ike iji glucocorticoids gwọọ ya. Predabere na dupe ahụ ka ọ ka mma (iwebata n'ụra warara stent - ntupu nke na - agbasa lumen), ebe ọ bụ na ndị ọrịa na - anabatakarị ọrụ a.

Nsogbu na nsonaazụ ya

Nsogbu nke autoimmune pancreatitis.

• Nnukwu nri na eriri afọ.
  • Enweghi ike protin (onodu na - etolite n'ihi mbelata ma obu iwepu protein a na - enweta).
  • Hypovitaminosis (enweghi vitamin na ahụ), ọkachasị abụba (A, D, E, K).
  • Ibu ibu rue cachexia (ọnọdụ oke ume na adịghị ike nke anụ ahụ).

• Mmebi nke mmiri-electrolyte itule ahụ.
  • Obi mgbawa.
  • Uwe.
  • Akpịrị ịkpọ nkụ (akpụkpọ akpọnwụ na akpụkpọ mucous).
  • Mpepu (ogwe anakpo paroxysmal.).

• Subhepatic jaundice - edo edo nke anụ ahụ, akpụkpọ ahụ mucous na-ahụ anya na mmiri ọmụmụ (dịka ọmụmaatụ, ọnụ mmiri, ọnụnụ lacrimal, wdg) n'ihi mmebi nke agịga.
• Ọrịa na-efe efe:
  • mbufụt na-akpata mkpali (ihe na-abawanye na oke na njupụta nke akụkụ ụfọdụ nke anụ ahụ n'ihi mkpo nke mkpụrụ ndụ na - adịghị adị - dịka ọmụmaatụ, microorganisms, sel ọbara, wdg) nke pancreas,
  • mbufụt cholangitis (mbufụt nke bile ducts),
  • sepsis (nsị ọbara - ọrịa kpatara ọnụnọ nke ọbara nke nje na nsị (nsị ngwaahịa)),
  • peritonitis - mbufụt nke peritoneum (akpụkpọ ahụ na-ekpuchi elu nke oghere afọ ma na-ekpuchi akụkụ ndị dị na ya).

• Ntutu (ntụpọ dị elu) na ọnya (ntụpọ dị omimi) nke akụkụ dị iche iche nke usoro nri (esophagus, afo, eriri afọ).
• Ọbara mgbali Subhepatic (mgbali elu na sistem veinal (arịa nke na-ebute ọbara na umeji site na akụkụ nke afọ) n'ihi mgbochi nke ọbara na-agbapụta site na imeju).
• Ihe mgbochi ogologo oge nke duodenum n'ihi ọnya ya na mkpakọ nke nnukwu nsogbu.
• Ọria afọ ischemic syndrome (ọbara ọgbụgba na-abanye na uru afọ) n'ihi mkpakọ vaskụla.
• Pancreatogenic ascites (mkpokọta mmiri nke na - enweghị nsogbu dị na oghere apịtị).
• Ọrịa kansa (akwara ọjọọ) - akpụ na-eto na mbibi nke anụ ahụ gbara ya gburugburu.

Nsonaazụ nke autoimmune pancreatitis.

• Site na oge, ọgwụgwọ zuru oke site na obere oge ọrịa ahụ, mweghachi zuru ezu nke ihe owuwu na ọrụ nke pancreas ga-ekwe omume.
• Site na ọrịa ahụ ruo ogologo oge, mgbanwe nke cicatricial na pancreas na-eduga mgbanwe ndị a na-apụghị ịgbanwe agbanwe na nhazi ya na ọrụ ya, mana ọbụlagodi na ndị ọrịa a, ọgwụgwọ zuru oke na-enye ohere ịkwụsị ọganihu (mmepe na-aga n'ihu) nke usoro ahụ.

Amụmana ọrịa autoimmune pancreatitis dabere na ogo nsogbu nke metụtara ọrịa autoimmune (imebi ahụ gị site na usoro ahụ ji alụso ọrịa ọgụ - ihe nchebe nke anụ ahụ) yana ọrịa shuga mellitus (ọrịa metabolism-metabolism).

Ozi izugbe

Ọ bụ ezie na ọrịa autoimmune pancreatitis bụ ọrịa a na-adịghị ahụkebe, ikere òkè ya na nhazi nke ọrịa mgbu na-adịghị ala ala ruru 4-6%. Mgbasa oria a kariri 0,0008%. Onye France dibịa ahụ bụ G. Sarles kọwara nke izizi ahụ na 1961. A ghọtara oria ahụ dịka ngalaba nosological dị iche iche na 2001 mgbe mmepe mmepe etiological nke TIGAR-O pancreatitis. A na-achọpụta mmerụ ahụ na-emetụta ọnya na-egbu mmadụ n'ime ụmụ nwoke ugboro 2-5 ugboro abụọ karịa ụmụ nwanyị. Ihe ruru 85% nke ndị ọrịa na-arịa ọrịa mgbe afọ 50 gasịrị. A na-ejikọkarị ọrịa ahụ yana ọrịa ogbu ogbu na nkwonkwo, fibrosis retroperitoneal, sclerosing cholangitis na usoro autoimmune ndị ọzọ.

E guzobebeghị etiology nke ọrịa autoimmune pancreatitis. A na - achọpụta ọrịa a site na mwepu oge ịchọpụta ụdị G4 immunoglobulins na enweghị ihe ndị ọzọ nwere ike ịkpata mmerụ ahụ. Ọkachamara n'ọhịa nke akparamaagwa gastroenterology kwenyere n'ibu ọrụ nke ibu eketa eketa, n'ọmụmụ ihe ọmụmụ banyere ahụike metụtara njikọ nke usoro autoimmune yana serotypes HLA DRβ1-0405, DQβ1-0401, DQβ1-57. Site n'ọbara nke ndị ọrịa dịpụrụ adịpụ whey protein na-atụle 13.1 kDa, nke a na-ewere otu ọgwụ nje.

Enwere ike ịnya bụ carbonic anhydrase dị na anụ ahụ nke akwara nri, akwara na osisi na-ahụkarị akwara, lactoferrin, nke achọpụtara na acini acrones, brachial na gastric, ihe nke nuclei cell na akwara anụ ahụ dị mma, ihe na-egbochi pancreatic trypsinogen inhibitor. Achọpụtabeghị na mmesapụ ihe na-efe efe na - egbochi mkpụrụ ndụ ihe dị n’etiti ihe ndị na - egbochi protein nke helicobacteriosis na protein protein na - ejide plasminogen.

Usoro ihe eji eme mgbanwe maka mgbanwe na akwara puru iche na akwara ndị ọzọ nwere mmetụta bụ njikọta nke serum Ig G4 nwere mkpụrụ ndụ acantar nkịtị, mkpụrụ ndụ epithelial nkịtị nke pancreatic, bile, sọks, wdg mmebi Antigenic na-eso ya na apoptosis nke mkpụrụ ndụ nke sistem. Njikọ isi na pathogenesis nke autoimmune pancreatitis bụ nnabata nke lymphocytes T na B na-anọgidesi ike, neutrophils na eosinophils na anụ ahụ na-ejikọta, nke na-akpalite usoro fibrosclerotic.

Nnyocha nke cytological na akwara na-ekpughe ihe ịrịba ama nke fibrosis na sclerosis na enweghị pseudocysts na calculi. N'ihi lymphoplasmacytic, neutrophilic, na eosinophilic infiltration, a na-emechi mgbidi ndị ahụ, warara ma kewaa n'oge ogologo oge nke usoro autoimmune. Mgbasa nke infrimration infulsing na lobules nke pancreas na-eduga na mfu nke ihe owuwu lobular nke akwara ma jikọtara ya na phlebitis. Dị ka ọ dị na ndị ọzọ dịgasị iche nke ọrịa pancreatitis na-adịghị ala ala, enwere ike ịme calcification nke parenchyma na stroma.

Nkewa

Mgbe ị na-ahazi usoro nke ọrịa ọrịa akwara na-agafe agafe, ọnụnọ nke ọnya ọnya ahụ, na ọnụnọ nke mbufụt na-emetụta. N'ime ụdị mgbanwe ọrịa a, akụkụ ngalaba nke pancreatic parenchyma, ọkachasị isi nke anụ ahụ, mebiri emebi. Ọtụtụ mgbe, a na-emetụta ma ọ dịkarịa ala 1/3 nke gland (usoro nke pancreatitis). Maka ụdị ọrịa pathology, njikọta akụkụ ahụ dum bụ ihe e ji mara ya.

Ọ bụrụ na ọrịa ndị ọzọ na-arịa ọrịa autoimmune, a na-akpọ pancreatitis dịpụrụ iche. N'ihe banyere ọnya ọnya nke ọtụtụ akụkụ ahụ, ha na-ekwu maka ọrịa syndromic autoimmune pancreatic. Nyere onyonyo ihe mgbe ochie, ọdịiche abụọ nke ọrịa ahụ ka amụrụ iche, nke ọ bụla nwere njiri mara ya na akparamaagwa:

• Lydị Lymphoplasmacytic-sclerosing nke pancreatitis. Ọbara site na sel na - amịpụta immunoglobulin, akara akwara nke stromal nke akụkụ ahụ na iwepu ihe phlebitis. Ejikọtara ya na IgG4 metụtara ọrịa autoimmune. Relazọ ịlaghachi azụ na mgbanwe nke ọrịa sclerotic bụ njirimara.
• Ductal-concentric idiopathic pancreatitis. Ihe omimi na egosiputa onwe ya dika ihe di n’ime otiti nke nebe di nkpa. Phlebitis na fibrosis anaghị ekwusi ike. Ọkwa IgG4 etoju na-abụkarị nkịtị. Na 30% nke ikpe, ọ na-ejikọta ya na ọnya afọ. Ọ na-aga n'ihu na-alọghachi azụ. Ọ na - aputa ihe ruru ugboro anọ ugboro anọ na ise.

Ọrịa nke autoimmune pancreatitis

Ihe onyonyo onyonyo nke oria a di iche site na mbufụt ahuria ahu. N'ime ụdị mgbanwe mkpụrụ ndụ nke onwe ya, ihe mgbu ahụ adịchaghị njọ, sie ike, anaghị ejikọ ya na njehie nri. Ọrịa mgbu na-ebilite na ọkara nke ndị ọrịa. Mgbaàmà ọzọ dị mkpa nke ọrịa akwara autoimmune bụ ihe na-egbochi jaundice, nke na-eme na nkezi na 60-80% nke ndị ọrịa na-egosipụtakwa site na ị icụcha akpụkpọ ahụ na ọnya ọnya, ọnya akpụkpọ ahụ, na mwepụ nke feces.

A na - ejikarị nsogbu akwara nke autoimmune pancreatic pathologies: ọgbụgba, mgbanwe n'ụdị stool (profuse fetid stool of a grayish colors), bloating. Site na ọrịa ahụ, ọrịa Malabsorption na ụkọ nri na-ebilite, nke a na-egosipụta site na mbelata nke ahụ aru nke onye ọrịa, edepụtara na protein nke ihu yana akụkụ ala. N'oge ngwụcha nke ọrịa pancreatitis, akpịrị ịkpọ nkụ na-amalite mgbe niile, polyuria (ihe mgbaàmà nke metabolism na-akpata nsogbu).

Amụma na Mgbochi Ya

Nsonaazụ nke ọrịa a dabere na ogo anụ arụ, ogo nke nsogbu. Ọ bụ ezie na usoro ọgwụgwọ steroid na-enye ohere ịnweta mgbaghara ihe karịrị 90% nke ndị ọrịa, prognosis nke autoimmune pancreatitis dịtụ ogbenye, na ụfọdụ ndị ọrịa enwere nkwụghachi mgbanwe na ọrụ endocrine na exocrine nke akụkụ ahụ. N'ihi usoro mmụta etiopathogenetic ezughi oke, enweghị usoro mgbochi akọwapụtara. Iji gbochie nsogbu, ọ dị mkpa ịchọpụta ma mesoo ọrịa autoimmune nke ngọngọ nri n’oge.