Okuqukethwe
I-alveolitis ye-aleji engavamile ibizwa nangokuthi i-hypersensitivity pneumonitis. Isifinyezo salesi sifo sithi EAA. Leli gama libonisa iqembu lonke lezifo ezithinta i-interstitium yamaphaphu, okungukuthi, izicubu ezixhumene nezitho. Ukuvuvukala kugxile ku-parenchyma yamaphaphu nasemigudwini yokuphefumula emincane. Kwenzeka lapho ama-antigen ahlukahlukene (isikhunta, amagciwane, amaprotheni ezilwane, amakhemikhali) engena kuwo evela ngaphandle.
Ngokokuqala ngqa, i-exogenous alveolitis ye-alveolitis yachazwa ngu-J.
Esikhathini esizayo, kwakungenzeka ukuthi kutholakale ukuthi i-alveolitis ye-alveolitis yohlobo lwe-exogenous ingabangelwa ezinye izimbangela. Ikakhulukazi, ngo-1965, uC. Reed nozakwabo bathola izimpawu ezifanayo ezigulini ezintathu ezazizalanisa amajuba. Baqala ukubiza i-alveolitis enjalo ngokuthi “amaphaphu abathandi bezinyoni.”
Izibalo zeminyaka yamuva zibonisa ukuthi lesi sifo sisakazeke kakhulu phakathi kwabantu abathi, ngenxa yemisebenzi yabo yobungcweti, bahlangane nezimpaphe nokwehla kwezinyoni, kanye nokudla okuyinhlanganisela. Kubantu abayi-100, i-alveolitis ye-alveolitis yangaphandle izotholakala kubantu abayi-000. Ngesikhathi esifanayo, akunakwenzeka ukubikezela ngokunembile ukuthi yimuphi umuntu ongazwani nokuya phansi noma izimpaphe ozoba ne-alveolitis.
Njengoba umkhuba ubonisa, kusukela ku-5 kuya ku-15% yabantu abaxhumane nokugxila okuphezulu kwe-allergener bazoba ne-pneumonitis. Ukusabalala kwe-alveolitis phakathi kwabantu abasebenza ngokugxilisa okuphansi kwezinto ezizwelayo akwaziwa kuze kube manje. Kodwa-ke, le nkinga inzima kakhulu, njengoba imboni ikhula ngokujulile njalo ngonyaka, okusho ukuthi bayanda abantu abahileleka emisebenzini enjalo.
etiology
I-alveolitis ye-allergic iqala ngenxa yokuhogela i-allergen, engena emaphashini kanye nomoya. Izinto ezihlukahlukene zingasebenza njenge-allergen. I-allergener enolaka kakhulu kulokhu yizinhlamvu ze-fungal ezivela ku-hay ebolile, i-maple bark, umoba, njll.
Futhi, umuntu akufanele abhale impova yezitshalo, ama-protein compounds, uthuli lwendlu. Eminye imithi, njengama-antibiotics noma okuphuma ku-nitrofuran, ingabangela i-alveolitis eguliswayo ngisho nangaphandle kokuhogela kwangaphambili, nangemva kokungena emzimbeni ngezinye izindlela.
Akukona nje kuphela ukuthi ama-allergener angena emgudwini wokuphefumula kubalulekile, kodwa futhi ukugxila kwawo nobukhulu. Uma izinhlayiya zingeqi ama-microns angu-5, khona-ke ngeke kube nzima ukuthi zifinyelele ku-alveoli futhi zibangele ukusabela kwe-hypersensitivity kuzo.
Njengoba izifo ezibangela i-EAA zivame ukuhlotshaniswa nemisebenzi yomuntu siqu, izinhlobo ze-alveolitis zethiwa imisebenzi ehlukahlukene:
Iphaphu Lomlimi. Ama-Antigen atholakala kutshani obukhuntile, phakathi kwawo: Thermophilic Actinomycetes, Aspergillus spp, Mycropolyspora faeni, Thermoactinomycas vulgaris.
Iphaphu labathandi bezinyoni. Ama-Allergens atholakala endle nasebunzimeni bezinyoni. Baba amaprotheni whey ezinyoni.
Bagassoz. I-allergener ingumoba, okungukuthi i-Mycropolysporal faeni ne-Thermoactinomycas sacchari.
Iphaphu labantu abatshala amakhowe. Umquba uba umthombo wezinto ezingezwani nomzimba, kanti i-Mycropolysporal faeni kanye ne-Thermoactinomycas vulgaris zisebenza njengama-antigen.
Amaphaphu abantu abasebenzisa ama-conditioner. Ama-Humidifiers, ama-heaters, nama-air conditioner ayimithombo yama-antigen. Ukuzwela kucasulwa amagciwane afana nalawa: Thermoactinomycas vulgaris, Thermoactinomycas viridis, Ameba, Fungi.
I-Suberose. Igxolo lesihlahla sikakhokho liba umthombo wezinto ezingezwani nomzimba, kanti iPenicillum frequentans isebenza njenge-allergen ngokwayo.
Abaphisi bemila ekhanyayo. Umthombo wama-antigens ibhali elikhuntile, futhi i-allergen ngokwayo i-Aspergillus clavatus.
Isifo sikaCheesemaker. Umthombo wama-antigens ushizi kanye nezinhlayiya zesikhunta, futhi i-antigen ngokwayo i-Penicillum cseii.
Sequoyz. Ama-Allergens atholakala othulini lwezinkuni ze-redwood. Bamelwe yi-Graphium spp., upullaria spp., Alternaria spp.
Abakhiqizi bezinto zokuhlanza amaphaphu. I-allergen itholakala kuma-enzyme nama-detergents. Imelwe yi-Bacillus subtitus.
Abasebenzi belabhorethri yamaphaphu. Imithombo ye-allergener ingumchamo we-dandruff kanye ne-rodent, futhi izifo ngokwazo zimelelwa amaprotheni omchamo wabo.
Iphaphu lihogela impushana ye-pituitary. I-antigen imelelwa ama-porcine kanye namaprotheni ezinkomo, atholakala ku-powder ye-pituitary gland.
Amaphaphu asetshenziswa ekukhiqizeni amapulasitiki. Umthombo oholela ekuqwashiseni ama-disocyanate. Izinto ezingezwani komzimba yilezi: Toluene diiosocianate, diphenylmethane diiosocianate.
Inyumoniya ehlobo. Lesi sifo siqala ngenxa yokuhogela uthuli oluvela ezindaweni zokuhlala ezimanzi. I-pathology yandile eJapan. I-Trichosporon cutaneum iba umthombo wezinto ezingezwani nomzimba.
Kulezi zifo ezibaliwe mayelana nokuthuthukiswa kwe-alveolitis engavamile, i-thermophilic actinomycetes nama-antigen ezinyoni abaluleke kakhulu. Ezindaweni ezinokuthuthuka okuphezulu kwezolimo, ama-actinomycetes athatha isikhundla esiphambili ngokwezehlakalo ze-EAA. Bamelelwa amabhaktheriya angadluli usayizi we-micron engu-1. Isici esihlukile sama-microorganisms anjalo ukuthi anezakhiwo zama-microbes kuphela, kodwa futhi nesikhunta. Ama-actinomycetes amaningi e-thermophilic atholakala emhlabathini, kumquba, emanzini. Bahlala futhi kuma-air conditioner.
Izinhlobo ezinjalo ze-actinomycetes ze-thermophilic ziholela ekuthuthukisweni kwe-alveolitis engavamile, njenge: Mycropolyspora faeni, Thermoactinomycas vulgaris, Thermoactinomycas viridis, Thermoactinomycas sacchari, Thermoactinomycas scandidum.
Bonke abameleli abasohlwini lwe-flora pathogenic kubantu baqala ukuphindaphindeka ngenkuthalo ekushiseni kuka-50-60 °C. Kungaphansi kwezimo ezinjalo lapho izinqubo zokubola kwezinto eziphilayo ziqaliswa. Izinga lokushisa elifanayo liyagcinwa kumasistimu okushisa. I-Actinomycetes ingabangela i-bagassosis (isifo samaphaphu kubantu abasebenza ngomoba), ibangele isifo esibizwa ngokuthi “iphaphu lomlimi”, “amaphaphu abakha amakhowe (abatshali bamakhowe)”, njll. Wonke abhalwe ngenhla.
Ama-antigen athinta abantu abaxhumana nezinyoni angamaprotheni e-serum. Lawa ama-albumin nama-gamma globulins. Zikhona emanzini ezinyoni, ekusithekeni okuvela ezinhlakeni zesikhumba zamajuba, ama-parrots, ama-canaries, njll.
Abantu abanakekela izinyoni baba ne-alveolitis ngokusebenzelana okude nokujwayelekile nezilwane. Amaprotheni ezinkomo, kanye nezingulube, ayakwazi ukuvusa lesi sifo.
I-antigen yesikhunta esebenza kakhulu i-Aspergillus spp. Izinhlobo ezahlukene zale microorganism zingadala i-suberosis, amaphaphu ophisa i-malt noma amaphaphu omenzi kashizi.
Kuyize ukukholelwa ukuthi, ukuhlala edolobheni futhi engenzi ezolimo, umuntu akakwazi ukugula nge-alveolitis engavamile. Eqinisweni, i-Aspergillus fumigatus iyachuma ezindaweni eziswakeme okungavamisile ukuthi kungene umoya kuzo. Uma izinga lokushisa kuzo liphezulu, khona-ke ama-microorganisms aqala ukwanda ngokushesha.
Futhi engozini yokuthuthukiswa kwe-alveolitis ye-alveolitis abantu imisebenzi yabo yobuchwepheshe ihlotshaniswa ne-reactogenic chemical compounds, isibonelo, ipulasitiki, ama-resin, amapende, i-polyurethane. I-phthalic anhydride ne-disocyanate zibhekwa njengengozi kakhulu.
Kuye ngezwe, ukusabalala okulandelayo kwezinhlobo ezahlukene ze-alveolitis yokungezwani komzimba kungalandelelwa:
Amaphaphu abathandi be-budgerigar avame ukutholakala ezakhamuzini zase-UK.
Amaphaphu abantu abasebenzisa ama-air conditioner nama-humidifiers aseMelika.
Uhlobo lwasehlobo lwe-alveolitis, olubangelwa ukukhiqizwa kwesikhunta ngezikhathi ezithile zohlobo lwe-Trichosporon cutaneun, lutholakala kuma-75% wamacala kumaJapane.
EMoscow nasemadolobheni anamabhizinisi amakhulu ezimboni, iziguli ezisabela ezinyonini nama-antigens esikhunta zivame ukutholwa.
I-pathogenesis ye-exogenous alveolitis ye-alveolitis
Isimiso sokuphefumula somuntu sihlala sihlangana nezinhlayiya zothuli. Futhi lokhu kusebenza kukho kokubili ukungcola kwe-organic kanye ne-inorganic. Kuye kwasungulwa ukuthi ama-antigens ohlobo olufanayo angabangela ukuthuthukiswa kwama-pathologies ahlukahlukene. Abanye abantu bahlakulela i-asthma ye-bronchial, abanye bahlakulela i-rhinitis engapheli. Kukhona futhi abantu ababonisa i-allergic dermatosis, okungukuthi, izilonda zesikhumba. Akumelwe sikhohlwe nge-conjunctivitis yemvelo eguliswayo. Ngokwemvelo, i-alveolitis yangaphandle ayiyona yokugcina ohlwini lwama-pathologies asohlwini. Uhlobo luni lwesifo umuntu othize oluzokhula luncike emandleni okuchayeka, kuhlobo lwe-allergen, isimo sokuzivikela komzimba nezinye izici.
Ukuze isiguli sibonise i-alveolitis engavamile, inhlanganisela yezinto eziningana iyadingeka:
Umthamo owanele wezinto ezingezwani nezifo ezingene emgudwini wokuphefumula.
Ukuchayeka isikhathi eside ohlelweni lokuphefumula.
Ubukhulu obuthile bezinhlayiya ze-pathological, okuyi-5 microns. Ngokuvamile, lesi sifo siqala lapho ama-antigen amakhulu engena ohlelweni lokuphefumula. Kulokhu, kufanele bahlale ku-proximal bronchi.
Iningi labantu abahlangabezana nezifo ezinjalo alihlushwa yi-EAA. Ngakho-ke, ososayensi bakholelwa ukuthi umzimba womuntu kufanele uthinteke ngesikhathi esisodwa izici eziningana ngesikhathi esisodwa. Abazange bafundelwe ngokwanele, kodwa kunomcabango wokuthi izakhi zofuzo kanye nesimo sokuzivikela komzimba kunendaba.
I-alveolitis ye-allergic exogenous ibizwa ngokufanelekile njengezifo ze-immunopathological, imbangela engangabazeki okuyizimpendulo ze-allergies zezinhlobo 3 no-4. Futhi, ukuvuvukala okungezona amasosha omzimba akufanele kunganakwa.
Uhlobo lwesithathu lokusabela kwe-immunological lubaluleke kakhulu ezigabeni zokuqala zokuthuthukiswa kwe-pathology. Ukwakheka kwama-immune complexes kwenzeka ngqo ku-interstitium yamaphaphu lapho i-antigen ye-pathological ixhumana nama-antibodies ekilasi le-IgG. Ukwakhiwa kwama-immune complexes kuholela eqinisweni lokuthi i-alveoli ne-interstitium yonakalisiwe, ukuvuthwa kwemikhumbi eyondlayo kuyanda.
Umphumela we-immune complexes udala ukuthi uhlelo oluhambisanayo kanye nama-macrophage e-alveolar asebenze. Ngenxa yalokho, imikhiqizo enobuthi ne-anti-inflammatory, ama-enzyme e-hydrolytic, ama-cytokines (i-tumor necrosis factor - TNF-a ne-interleukin-1) ikhishwa. Konke lokhu kubangela ukusabela kokuvuvukala ezingeni lendawo.
Kamuva, amaseli kanye nezingxenye ze-matrix ze-interstitium ziqala ukufa, ukuvuvukala kuba kunamandla kakhulu. Amanani abalulekile wama-monocyte nama-lymphocyte anikezwa endaweni yesilonda. Baqinisekisa ukulondolozwa kokusabela kwe-hypersensitivity yohlobo olubambezelekile.
Amaqiniso aqinisekisa ukuthi ukusabela kwe-immunocomplex kubalulekile ku-exogenous alveolitis ye-alveolitis:
Ngemuva kokusebenzisana ne-antigen, ukuvuvukala kukhula ngokushesha, kungakapheli amahora angu-4-8.
Ekugezeni kwe-exudate kusuka ku-bronchi ne-alveoli, kanye nasengxenyeni ye-serum yegazi, ukugxila okuphezulu kwama-antibodies ekilasi le-lgG kutholakala.
Ezicubu zamaphaphu ezithathelwe i-histology, ezigulini ezinesimo esibi kakhulu sesifo, i-immunoglobulin, izingxenye ezihambisanayo, nama-antigen ngokwawo atholakala. Zonke lezi zinto ziyi-immune complexes.
Lapho kwenziwa izivivinyo zesikhumba kusetshenziswa ama-antigen ahlanzwe kakhulu angama-pathological esigulini esithile, kuvela ukusabela okujwayelekile kohlobo lwe-Arthus.
Ngemva kokwenza izivivinyo ezivusa inkanuko ngokuhogela amagciwane, inani lama-neutrophils ezigulini eziku-bronchoalveolar lavage fluid liyakhula.
Izimpendulo zokuzivikela zohlobo 4 zihlanganisa i-CD+ T-cell delayed-type hypersensitivity kanye ne-CD8+ T-cell cytotoxicity. Ngemuva kokuthi ama-antigen engene ohlelweni lokuphefumula, ukusabela kohlobo olubambezelekile kwenzeka ezinsukwini eziyi-1-2. Ukulimala kwama-immune complexes kuholela ekukhululweni kwama-cytokines. Bona-ke, babangela ukuthi ama-leukocyte kanye ne-endothelium yezicubu zamaphaphu kuveze ama-molecule anamathelayo phezulu. Ama-monocyte namanye ama-lymphocyte asabela kuwo, afika ngenkuthalo endaweni yokusabela kokuvuvukala.
Ngesikhathi esifanayo, i-interferon gamma yenza kusebenze ama-macrophage akhiqiza i-CD4 + lymphocyte. Lokhu kuwuphawu lokusabela kohlobo olubambezelekile, oluhlala isikhathi eside ngenxa yama-macrophages. Ngenxa yalokho, ifomu le-granulomas esigulini, i-collagen iqala ukukhululwa ngamanani angaphezulu (ama-fibroblasts acushwa amangqamuzana okukhula), futhi i-interstitial fibrosis iqala.
Amaqiniso aqinisekisa ukuthi ku-exogenous alveolitis ye-alveolitis, ukubambezeleka kohlobo 4 lwe-immunological reaction kubalulekile:
Ama-T-lymphocyte atholakala kumemori yegazi. Bakhona esicutshini samaphaphu eziguli.
Ezigulini ezine-acute and subacute exogenous alveolitis, i-granulomas, ingena ngokunqwabelana kwama-lymphocyte nama-monocytes, kanye ne-interstitial fibrosis kutholwa.
Ukuhlolwa kwezilwane zaselabhorethri nge-EAA kubonise ukuthi i-CD4+ T-lymphocyte iyadingeka ukuze kufakwe izifo.
Isithombe se-Histological se-EAA
Ezimweni eziningi, iziguli ezine-alveolitis ye-alveolitis engavamile zine-granulomas, ngaphandle kwe-curd plaque. Zitholakala ku-79-90% weziguli.
Ukuze ungaphambanisi ama-granulomas akhula nge-EAA kanye ne-sarcoidosis, udinga ukunaka umehluko olandelayo:
Nge-EAA, ama-granulomas mancane.
I-Granulomas ayinayo imingcele ecacile.
I-Granulomas iqukethe ama-lymphocyte amaningi.
Izindonga ze-alveolar ku-EAA ziminyene, zine-lymphocytic infiltrates.
Ngemuva kokuthi ukuxhumana ne-antigen kukhishwe, ama-granulomas ayanyamalala ngokwawo phakathi nezinyanga eziyisithupha.
E-exogenous alveolitis ye-alveolitis, inqubo yokuvuvukala ibangelwa ama-lymphocyte, ama-monocyte, ama-macrophages namaseli e-plasma. Ama-macrophage e-alveolar anegwebu anqwabelana ngaphakathi kwe-alveoli ngokwawo, nama-lymphocyte ku-interstitium. Lapho lesi sifo sisanda kuqala ukukhula, iziguli zine-protein kanye ne-fibrinous effusion, etholakala ngaphakathi kwe-alveoli. Futhi, iziguli zitholakala ukuthi zine-bronchiolitis, i-lymphatic follicles, ukungena kwe-peribronchial ukuvuvukala, okugxilwe emigwaqweni encane yomoya.
Ngakho-ke, lesi sifo sibonakala ngonxantathu wezinguquko ze-morphological:
I-Alveolitis.
I-Granulomatosis.
I-bronchiolitis.
Nakuba ngezinye izikhathi esinye sezibonakaliso singase siwe. Akuvamile, iziguli ezine-exogenous alveolitis ye-alveolitis ziba ne-vasculitis. Utholwe esigulini ngemuva kokushona kwakhe, njengoba kushiwo emibhalweni efanele. Ezigulini ezine-hypertension ye-pulmonary, i-hypertrophy ye-arteries kanye ne-arterioles kwenzeka.
Inkambo engapheli ye-EAA iholela ekushintsheni kwe-fibrinous, okungaba namandla ahlukene. Kodwa-ke, azibonakali nje kuphela nge-alveolitis engavamile ye-alveolitis, kodwa futhi nezinye izifo zamaphaphu ezingamahlalakhona. Ngakho-ke, ayikwazi ukubizwa ngokuthi isibonakaliso se-pathognomic. Nge-alveolitis yesikhathi eside ezigulini, i-parenchyma yamaphaphu iba nezinguquko ze-pathological ohlotsheni lwe-honeycomb lung.
Izimpawu ze-exogenous allergic alveolitis
Lesi sifo sikhula kaningi kubantu abangajwayele ukungezwani komzimba. I-Pathology izibonakalisa ngemuva kokuxhumana isikhathi eside nemithombo, ukusabalala kwama-antigen.
I-exogenous alveolitis ye-alveolitis ingenzeka ngezinhlobo ezi-3:
Izimpawu ezizwakalayo
Ifomu elibi lesifo lenzeka ngemva kokuba inani elikhulu le-antigen lingena emgudwini wokuphefumula. Lokhu kungenzeka kokubili ekhaya nasemsebenzini noma ngisho nasemgwaqweni.
Ngemuva kwamahora angu-4-12, izinga lokushisa lomzimba womuntu likhuphukela emazingeni aphezulu, amakhaza akhula, futhi ubuthakathaka buyanda. Kunobunzima esifubeni, isiguli siqala ukukhwehlela, sihlushwa wukuphelelwa umoya. Ubuhlungu buvela emalungeni nasemisipha. Isikhwehlela ngesikhathi sokukhwehlela asiveli njalo. Uma isuka, incane futhi iqukethe ikakhulukazi amafinyila.
Esinye isici sesibonakaliso se-EAA esibuhlungu yikhanda eligxile ebunzini.
Ngesikhathi sokuhlolwa, udokotela uphawula i-cyanosis yesikhumba. Uma ulalele amaphaphu, kuzwakala ukuvuthwa nokushaywa umoya.
Ngemuva kwezinsuku ezingu-1-3, izimpawu zesifo ziyanyamalala, kodwa ngemva kokunye ukusebenzisana ne-allergen, zanda futhi. Ubuthakathaka obujwayelekile kanye nokukhathala, kuhlangene nokuphefumula, kungaphazamisa umuntu amasonto ambalwa ngemuva kokuxazulula isigaba esibi sesifo.
Ifomu elibukhali lalesi sifo alivame ukutholakala. Ngakho-ke, odokotela bayiphambanisa ne-SARS, ecasulwa amagciwane noma i-mycoplasmas. Ochwepheshe kufanele baqaphele abalimi, futhi bahlukanise phakathi kwezimpawu ze-EAA kanye nezimpawu ze-pulmonary mycotoxicosis, ezikhula lapho izinhlamvu zesikhunta zingena ezicubu zamaphaphu. Ezigulini ezine-myotoxicosis, i-radiography yamaphaphu ayibonisi izinguquko ze-pathological, futhi awekho amasosha omzimba ahlaselayo engxenyeni ye-serum yegazi.
izimpawu ze-subacute
Izimpawu ze-subacute zesifo azibonakali ngendlela ebukhali ye-alveolitis. I-alveolitis enjalo iqala ngenxa yokuhogela isikhathi eside kwama-antigen. Ngokuvamile lokhu kwenzeka ekhaya. Ngakho-ke, ukuvuvukala kwe-subacute ezimweni eziningi kucasulwa ukunakekelwa kwezinkukhu.
Izimpawu eziyinhloko ze-subacute exogenous alveolitis ye-alveolitis zihlanganisa:
Ukuphefumula okubuhlungu okuba kubi ngemva kokusebenza komzimba womuntu.
Ukwanda kokukhathala.
Ukukhwehlela okukhipha isikhwehlela esicacile.
Ekuqaleni kwe-pathology, izinga lokushisa lomzimba lingakhuphuka.
I-Crepitus lapho ilalela amaphaphu izoba mnene.
Kubalulekile ukuhlukanisa i-EAA engaphansi kwe-sarcoidosis nezinye izifo ze-interstitium.
Izimpawu zohlobo olungapheli
Ifomu elingapheli lesifo likhula kubantu abasebenzisana nemithamo emincane yama-antigen isikhathi eside. Ngaphezu kwalokho, i-subacute alveolitis ingaba yisifo esingelapheki uma ingelashwa.
Inkambo yesifo esingelapheki ibonakala ngezimpawu ezifana nalezi:
Ukwanda ngokuhamba kwesikhathi, ukuphefumula, okubonakala ngokuzikhandla ngokomzimba.
Ukwehla kwesisindo esibiziwe, okungase kufinyelele ku-anorexia.
Lesi sifo sisongela ukuthuthukiswa kwe-cor pulmonale, i-interstitial fibrosis, inhliziyo nokuhluleka kokuphefumula. Njengoba i-alveolitis ye-alveolitis engapheli engapheli iqala ukukhula kancane kancane futhi inganiki izimpawu ezinzima, ukuxilongwa kwayo kunzima.
Ukuxilongwa kwe-exogenous alveolitis ye-alveolitis
Ukuhlonza lesi sifo, kuyadingeka ukuncika ekuhlolweni kwe-X-ray yamaphaphu. Ngokuya ngesigaba sokuthuthukiswa kwe-alveolitis kanye nesimo sayo, izimpawu ze-radiological zizohluka.
Ifomu lesifo elibukhali nelincane liholela ekwehleni kokungafihli kwamasimu njengengilazi yaphansi kanye nokusabalala kwe-nodular-mesh opacities. Ubukhulu bama-nodule abudluli ku-3 mm. Angatholakala phezu kwendawo yonke yamaphaphu.
Ingxenye engenhla yamaphaphu kanye nezingxenye zawo eziyisisekelo azimboziwe ngamaqhuqhuva. Uma umuntu eyeka ukuxhumana nama-antigens, emva kwezinyanga ezingu-1-1,5, izimpawu ze-radiological zesifo ziyanyamalala.
Uma lesi sifo sinenkambo engapheli, khona-ke izithunzi eziqondile ezinohlaka olucacile, izindawo ezimnyama ezimele ama-nodules, izinguquko ku-interstitium, nokuncipha kobukhulu bezinkambu zamaphaphu kubonakala esithombeni se-x-ray. Lapho i-pathology inenkambo egijima, i-honeycomb lung ibonakala ngeso lengqondo.
I-CT iyindlela enokunemba okuphezulu kakhulu uma kuqhathaniswa ne-radiography. Ucwaningo lwembula izimpawu ze-EAA, ezingabonakali nge-radiography evamile.
Ukuhlolwa kwegazi ezigulini ezine-EAA kubonakala ngezinguquko ezilandelayo:
I-leukocytosis ifinyelela ku-12-15 × 103/ml Kancane kancane, izinga le-leukocyte lifinyelela ezingeni lika-20-30×103/ml.
Ifomula ye-leukocyte ishintshela kwesokunxele.
Ukwanda kwezinga le-eosinophils akwenzeki, noma kungase kukhuphuke kancane.
I-ESR ku-31% yeziguli ikhuphukela ku-20 mm/h, kanti ku-8% yeziguli ifinyelela ku-40 mm/h. Kwezinye iziguli, i-ESR ihlala ngaphakathi kwebanga elijwayelekile.
Izinga le-lgM ne-lgG liyakhuphuka. Ngezinye izikhathi kukhona ukweqa ekilasini A immunoglobulins.
Kwezinye iziguli, i-rheumatoid factor iyasebenza.
Inyusa izinga le-LDH ephelele. Uma lokhu kwenzeka, khona-ke ukuvuvukala okunamandla ku-parenchyma yamaphaphu kungasolwa.
Ukuqinisekisa ukuxilongwa, i-Ouchterlony diffusion double, micro-Ouchterlony, counter immunoelectrophoresis kanye nezindlela ze-ELISA (ELISA, ELIEDA) zisetshenziswa. Zikuvumela ukuthi ukhombe amasosha omzimba athile afaka ama-antigen abangele ukungezwani komzimba.
Esigabeni esibucayi sesifo, amasosha omzimba ahlaselayo azozungeza egazini laso sonke isiguli. Lapho i-allergen iyeka ukuxhumana nezicubu zamaphaphu eziguli, izinga lama-antibodies liyehla. Kodwa-ke, zingaba khona engxenyeni ye-serum yegazi isikhathi eside (kuze kufike eminyakeni emi-3).
Uma lesi sifo singapheli, amasosha omzimba awatholakali. Kukhona futhi amathuba okuba nemiphumela emihle engamanga. Kubalimi abangenazo izimpawu ze-alveolitis, batholakala ku-9-22% wamacala, futhi kubathandi bezinyoni ku-51% yamacala.
Ezigulini ezine-EAA, inani lama-antibody precipitating alihambisani nomsebenzi wenqubo ye-pathological. Izinga labo lingathinteka yizici ezihlukahlukene. Ngakho, kwababhemayo, kuzobukelwa phansi. Ngakho-ke, ukutholwa kwamasosha omzimba athile akukwazi ukubhekwa njengobufakazi be-EAA. Ngesikhathi esifanayo, ukungabi khona kwabo egazini akubonisi ukuthi asikho isifo. Kodwa-ke, amasosha omzimba akufanele abhalwe phansi, njengoba lapho kukhona izimpawu zomtholampilo ezifanele, angaqinisa ukucabanga okukhona.
Ukuhlolwa kokuncipha kwamandla okusabalalisa amaphaphu kuyinkomba, njengoba ezinye izinguquko zokusebenza ku-EAA ziyisici sezinye izinhlobo ze-pathologies ezihambisana nokulimala kwe-interstitium yamaphaphu. I-Hypoxemia ezigulini ezine-alveolitis yokungezwani komzimba ibonakala esimweni esizolile, futhi iyanda ngesikhathi sokuzikhandla ngokomzimba. Ukwephulwa kokungena komoya wamaphaphu kwenzeka ngohlobo oluvimbelayo. Izimpawu ze-hyperreactivity ye-airway zitholakala ku-10-25% yeziguli.
Ukuhlolwa kokuhogela umoya kwaqala ukusetshenziswa ukuze kutholwe i-alveolitis yokungezwani nomzimba kusukela ngo-1963. Ama-aerosol enziwa ngothuli oluthathwe kutshani obukhuntile. Baholele ekwandeni kwezimpawu zesifo ezigulini. Ngesikhathi esifanayo, izingcaphuno ezithathwe "ku-hay ohlanzekile" azizange zibangele ukusabela okunjalo ezigulini. Kubantu abanempilo, ngisho nama-aerosols anesikhunta awazange abangele izimpawu ze-pathological.
Ukuhlolwa okuvusa amadlingozi ezigulini ezinesifuba somoya we-bronchial akubangeli ukuvela kokusabela okusheshayo kwe-immunological, akubangeli ukuphazamiseka ekusebenzeni kwamaphaphu. Nakuba kubantu abanesimo esihle sokuzivikela komzimba, baholela ekushintsheni kokusebenza kwesimiso sokuphefumula, ekwandeni kokushisa komzimba, ukugodola, ubuthakathaka kanye ne-dyspnea. Ngemva kwamahora angu-10-12, lezi zibonakaliso ziyanyamalala ngokwazo.
Kungenzeka ukuqinisekisa ukuxilongwa kwe-EAA ngaphandle kokwenza izivivinyo ezivusa inkanuko, ngakho-ke azisetshenziswa ezenzweni zezokwelapha zanamuhla. Zisetshenziswa kuphela ochwepheshe abadinga ukuqinisekisa imbangela yalesi sifo. Ngaphandle kwalokho, kwanele ukugcina isiguli ezimweni zakhe ezijwayelekile, isibonelo, emsebenzini noma ekhaya, lapho kukhona ukuxhumana ne-allergen.
I-Bronchoalveolar lavage (BAL) ikuvumela ukuthi uhlole ukwakheka kokuqukethwe kwe-alveoli nezingxenye ezikude zamaphaphu. Ukuxilongwa kungaqinisekiswa ngokutholwa kokukhuphuka okuphindwe kahlanu kwezakhi zamangqamuzana kuwo, futhi ama-80% azo azomelwa ama-lymphocyte (ikakhulukazi ama-T-cell, okuyi-CD8 + lymphocytes).
Inkomba ye-immunoregulatory ezigulini iyancipha ibe ngaphansi kweyodwa. Nge-sarcoidosis, lesi sibalo singamayunithi angama-4-5. Kodwa-ke, uma ukugeza kwenziwa ezinsukwini ezi-3 zokuqala ngemuva kokukhula okukhulu kwe-alveolitis, inani lama-neutrophils lizokwenyuka, futhi i-lymphocytosis ayibonwa.
Ngaphezu kwalokho, i-lavage yenza kube nokwenzeka ukubona ukwanda kwenani lamaseli ensika ngokuphindwe kashumi. Lokhu kuhlanganiswa kwamaseli ensika kungaqhubeka kuze kube yizinyanga ezi-3 noma ngaphezulu ngemva kokuxhumana ne-allergen. Le nkomba ibonisa umsebenzi wenqubo yokukhiqiza i-fibrin. Uma lesi sifo sinenkambo ye-subacute, khona-ke amaseli e-plasma azotholakala ekugezeni.
Ukwenza ukuxilongwa okuhlukile
Izifo lapho i-alveolitis engezwani nayo kufanele ihlukaniswe khona:
Umdlavuza we-Alveolar noma i-metastases yamaphaphu. Ngezimila ezinomdlavuza, akukho ukuxhumana phakathi kwezimpawu zesifo esivele futhi sithintane ne-allergen. I-Pathology iqhubeka njalo, ibonakala ngokubonakaliswa okunzima. Engxenyeni ye-serum yegazi, ama-anti-anti-precipitating kuma-allergener awakhululwa. Futhi, ulwazi lungacaciswa kusetshenziswa i-x-ray yamaphaphu.
isifo sofuba. Ngalesi sifo, abukho futhi ubudlelwano nama-allergener. Ukutheleleka ngokwako kunenkambo enzima kanye nentuthuko ende. Amasu we-serological enza kube nokwenzeka ukuthola amasosha omzimba ku-antigen yesifo sofuba, kuyilapho engabonakali kuma-exoallergens. Ungakhohlwa ukuhlolwa kwe-x-ray.
I-Sarcoidosis. Lesi sifo asihlotshaniswa nomsebenzi wochwepheshe womuntu. Ngalo, hhayi kuphela izitho zokuphefumula ezithintekayo, kodwa nezinye izinhlelo zomzimba. Ama-lymph nodes e-hilar esifubeni avuvukala ezinhlangothini zombili, kukhona ukusabela okubuthakathaka noma okungalungile ku-tuberculin. Ukusabela kukaKveim, ngokuphambene nalokho, kuzoba kuhle. I-Sarcoidosis ingaqinisekiswa ngokuhlolwa kwe-histological.
Enye i-fibrosing alveolitis. Ngazo, ngokuvamile, iziguli zenza i-vasculitis, futhi ukulimala kwesistimu ku-tishu exhumeneyo akukhathazi nje amaphaphu, kodwa futhi umzimba wonke. Ngokuxilongwa okungabazekayo, i-lung biopsy yenziwa ngokuhlolwa okwengeziwe kwe-histological yezinto ezitholiwe.
Inyumoniya. Lesi sifo siqala ngemva komkhuhlane. Ku-x-ray, ubumnyama buyabonakala, okubonakala ngenxa yokungena kwezicubu.
I-ICD-10 ibhekisela exogenous alveolitis ye-alveolitis ekilasini X "Izifo zokuphefumula".
Ukucaciswa:
J 55 Isifo sokuphefumula esibangelwa uthuli oluthile.
J 66.0 I-Byssinosis.
J 66.1 Isifo samaflaya efilakisi.
J 66.2 I-Cannabiosis.
J 66.8 Isifo sokuphefumula ngenxa yolunye uthuli olushiwo lwemvelo.
J 67 Hypersensitivity pneumonitis.
J 67.0 Iphaphu lomlimi (umsebenzi wezolimo).
J 67.1 I-Bagassose (yothuli lukamoba)
J 67.2 Iphaphu lomfuyi wezinkukhu.
J 67.3 I-Suberoz
J 67.4 Iphaphu lomsebenzi we-Malt.
J 67.5 Iphaphu lomsebenzi wamakhowe.
J 67.6 I-maple igxolo iphaphu.
J 67.8 I-hypersensitivity pneumonitis ngenxa yolunye uthuli lwemvelo.
J 67.9 I-hypersensitivity pneumonitis ngenxa yolunye uthuli lwemvelo olungashiwongo.
Ukuxilongwa kungenziwa ngale ndlela elandelayo:
I-alveolitis ye-alveolitis ye-exogenous (iphaphu lomlimi), ifomu elibukhali.
I-alveolitis ye-alveolitis ebangelwa izidakamizwa ebangelwa i-furazolidone, ifomu le-subacute, elinokuhluleka kokuphefumula.
I-alveolitis ye-alveolitis ye-exogenous (iphaphu lomfuyi wezinkukhu), ifomu elingapheli. Inhliziyo yamaphaphu engapheli, i-bronchitis engapheli.
Ukwelashwa kwe-alveolitis ye-allergic exogenous
Ukuze ubhekane nalesi sifo, kubalulekile ukukhipha ngokuphelele ukusebenzisana kwesiguli kanye ne-allergen. Umuntu ngesikhathi somsebenzi kufanele asebenzise imaski, izihlungi ezikhethekile. Kuyinto efiselekayo kakhulu ukushintsha imisebenzi nemikhuba yakho. Ukuze uvimbele ukuqhubeka kwe-pathology, kubalulekile ukuyibona ezigabeni zokuqala zokuthuthuka. Uma ukuthintana ne-allergen kuqhubeka, izinguquko emaphashini ngeke zihlehliswe.
Inkambo enzima ye-alveolitis idinga ukuqokwa kwe-glucocorticosteroids. Bangakwazi kuphela ukunqunywa udokotela, ngokuqokwa.
Iziguli ezine-hyperresponsiveness yamaphaphu zinqunywe ama-bronchodilators aphefumulelwe. Uma lesi sifo sibangele ukuthuthukiswa kwezinkinga, khona-ke ama-antibiotics, ama-diuretics, umoya-mpilo, njll.
Ukubikezela kanye nokuvimbela
Ukuvimbela ukuthuthukiswa kwalesi sifo, kuyadingeka ukunciphisa konke ukuxhumana okungenzeka ne-allergener. Ngakho-ke, utshani kufanele bomiswe kahle, imigodi yesilo kufanele ivuleke. Izakhiwo ezikhiqizwayo kufanele zifakwe umoya kahle, futhi uma izilwane nezinyoni zikhona kuzo, izidingo zokuhlanzeka nokuhlanzeka kufanele zibhekwe ngokuqinile. Ama-air conditioner kanye nezinhlelo zokungenisa umoya kumele zicutshungulwe ngekhwalithi ephezulu nangesikhathi, njll.
Uma i-alveolitis isivele ithuthukile, isiguli kufanele singabandakanyi ukuxhumana ne-allergen. Lapho umsebenzi wobungcweti uba yiphutha, umsebenzi uyashintshwa.
Isimo sokubikezela siyahlukahluka. Uma lesi sifo sitholakala ezinyathelweni zokuqala, khona-ke i-pathology ingazixazulula ngokwayo. Ukubuyela emuva kwe-alveolitis kuholela eqinisweni lokuthi izicubu zamaphaphu ziba nezinguquko ezingenakulungiseka. Lokhu kubi kakhulu ukubikezela, kanye nezinkinga ze-alveolitis noma inkambo yayo engapheli.