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"lead": "состояние, характеризующееся повышенным содержанием метгемоглобина (окисленного гемоглобина) в крови и тканевой гипоксией",
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"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Метгемоглобин может быть увеличен за счет двух основных причин. Часть случаев заболевания имеет генетическую причину, это означает, что врожденная метаболическая ошибка способствует увеличению доли метгемоглобина в крови. В большинстве случаев метгемоглобинемия, однако, является приобретенной, а не врожденной. Воздействие некоторых окислителей может привести к превращению гемоглобина в метгемоглобин. Известные токсины, которые могут вызвать это заболевание:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #252525; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">анилиновые красители;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #252525; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">нитраты или нитриты;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #252525; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">употребление большого количества различных лекарств;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #252525; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">лидокаин, пролокаин;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #252525; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">дапсон – препарат, используемый для лечения и профилактики пневмоцистной инфекции.</span></p>\r\n</li>\r\n</ul>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">С химической точки зрения метгемоглобин формируется присутствием в эритроцитах железа в трехвалентной форме вместо обычной формы железа. Это приводит к снижению доступности кислорода к тканям. Симптомы заболевания обычно проявляются пропорционально уровню метгемоглобина. Только внешне болезнь проявляется, пока количество метгемоглобина не достигнет показателя 15%. Если эта величина превышается, появляются неврологические и кардиологические симптомы, являющиеся следствием гипоксии.</span></p>",
"pathogenesis": "",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Важным диагностическим признаком метгемоглобинемии служит темно-коричный цвет крови, которая, будучи помещенной в пробирку или на фильтровальную бумагу, не изменяет свой цвет на красный. При положительной пробе проводится спектроскопия, определение концентрации MtHb, активности НАД-зависимой метгемоглобинредуктазы, электрофорез гемоглобина.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В общем анализе крови может присутствовать компенсаторный эритроцитоз, увеличение Hb, ретикулоцитоз, уменьшение СОЭ. При исследовании биохимических показателей крови определяется незначительная билирубинемия, обусловленная увеличением непрямой фракции пигмента. Для хронической метгемоглобинемии типично появление в эритроцитах телец Гейнца-Эрлиха.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">У больных с энзимопенической или токсической метгемоглобинемией показательна терапевтическая проба с внутривенным введением метиленового синего – после инъекции цианоз быстро исчезает, а кожа и видимые слизистые приобретают розовую окраску.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При анализе причин метгемоглобинемии важно выяснить, имел ли больной контакт с токсическими веществами, принимал ли метгемоглобинобразующие лекарственные препараты. При подозрении на врожденную метгемоглобинемию изучается родословная, проводится консультация генетика, определяется тип наследования патологии крови. </span></p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Ранняя диагностика заболевания и начало лечения, в особенности при обнаружении приобретенной формы метгемоглобинемии, имеют решающее значение в управлении симптомами заболевания и сохранении жизненных функций пациента. Больные нуждаются в комплексных исследованиях, иногда и инвазивных, для исключения сердечной и легочной патологии. Первая помощь при метгемоглобинемии заключается во введении дополнительного количества кислорода и устранении отравляющего вещества, токсина, окислителя.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Пациенты с разовой метгемоглобинемией, возникшей в результате отравления отравляющим веществом, могут быть выписаны после 6-часового наблюдения, если симптомы заболевания были устранены. Симптоматические пациенты с длительной метгемоглобинемией должны наблюдаться в стационаре, в особенности при осложняющих факторах, таких как анемия, интенсивный цианоз, сопутствующее заболевание сердца или периферических сосудов.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Лекарственным средством первой линии против метгемоглобинемии является внутривенное введение метиленового синего. Рекомендовано также переливание крови и гипербарическое лечение кислородом. В качестве вспомогательного средства лечения применяется аскорбиновая кислота (витамин С) в таблетках или любой другой фармакологической форме.</span></p>",
"prevention": "<p><span id=\"docs-internal-guid-3b15565d-7fff-b966-7154-4d9082696da3\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Пациентам с подобной патологией следует избегать контакта с метгемоглобинобразующими веществами, переохлаждений и других провоцирующих факторов. Профилактика врожденной метгемоглобинемии заключается в проведении медико-генетической консультации для выявления гетерозиготных носителей среди будущих родителей.</span></span></p>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Учитывая тип метгемоглобинемии, следует знать, что симптомы заболевания могут отличаться. В некоторых случаях присутствует только внешнее проявление (легкие наследственные подтипы заболевания), могут иметь место и тяжелые неврологические симптомы. Нормальное количество метгемоглобина в человеческой крови составляет около 1% (диапазон от 0-3%).</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Симптомы, связанные с различным уровнем метгемоглобина, превышающим норму:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #252525; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">3-15% - незначительные изменения цвета кожи (например, бледная, серая, синяя);</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #252525; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">15-20% - цианоз, хотя не исключено бессимптомное течение;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #252525; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">25-50% - головная боль, одышка, головокружение, обмороки, общая слабость, спутанность сознания, учащенное сердцебиение, боль в груди;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #252525; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">50-70% - аномальные сердечные ритмы; изменения психического состояния, бред, судороги, кома, глубокий ацидоз;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #252525; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">> 70% - летальный исход.</span></p>\r\n</li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Физические признаки: изменение цвета кожи и крови, судороги, изменение цвета конъюнктивы, скелетные аномалии, явная умственная отсталость.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Системы организма с высокими потребностями в кислороде (например, центральная нервная система и сердечно-сосудистая система) первыми проявляют признаки заболевания. Кровь, содержащая большее, чем необходимо количество метгемоглобина, приобретает красно-коричневый цвет.</span></p>",
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"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В процессе метаболических превращений в крови здоровых людей в очень небольших количествах образуются дисгемоглобины: карбоксигемоглобин, сульфгемоглобин, метгемоглобин (0,1-1 %). Вместе с тем, в эритроцитах содержится ряд факторов, которые поддерживают долю фракции метгемоглобина на уровне, не превышающем 1,0-1,5% от общего Hb. В частности, в реакции восстановления метгемоглобина в гемоглобин участвует фермент метгемоглобин-редуктаза. В отличие от оксигемоглобина (НbО2), содержащего восстановленное железо (Fe++), в метгемоглобине содержится окисленное железо (Fe+++), не способное переносить кислород. Поэтому при метгемоглобинемии, прежде всего, страдает кислородно-транспортная функция крови, следствием которой служит тканевая гипоксия.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Наследственные формы метгемоглобинемии представлены либо ферментопатиями (врожденной низкой активностью или отсутствием фермента метгемоглобин-редуктазы), либо М-гемоглобинопатиями (синтезом аномальных белков, содержащих окисленное железо).</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В структуре приобретенных (вторичных) метгемоглобинемий выделяют токсические экзогенные и токсические эндогенные формы. Метгемоглобинемии экзогенного происхождения могут быть связаны с передозировкой лекарственных средств (сульфаниламидов, нитритов, викасола, противомалярийных препаратов, лидокаина, новокаина и др.) или отравлением химическими агентами (анилиновыми красителями, нитратом серебра, тринитротолуолом, хлорбензолом, питьевой водой и пищевыми продуктами с высоким содержанием нитратов и др.).</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Повышенный уровень MtHb в крови наблюдается у недоношенных и доношенных новорожденных, что связано с низкой активностью фермента метгемоглобин-редуктазы и окислительным стрессом в родах. Однако даже при тяжелой гипоксии и желтухе новорожденных подъем MtHb не столь выражен и клинически значим, чтобы послужить причиной метгемоглобинемии. Однако при диарее, бактериальных и вирусных энтероколитах, в условиях метаболического ацидоза у детей первого года жизни может легко развиться приобретенная эндогенная метгемоглобинемия.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">О смешанной форме патологии говорят в том случае, если метгемоглобинемия развивается под воздействием экзогенных факторов у здоровых лиц, являющихся гетерозиготными носителями генов наследственной формы заболевания.</span></p>",
"pathogenesis": "",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Важным диагностическим признаком метгемоглобинемии служит темно-коричный цвет крови, которая, будучи помещенной в пробирку или на фильтровальную бумагу, не изменяет свой цвет на красный. При положительной пробе проводится спектроскопия, определение концентрации MtHb, активности НАД-зависимой метгемоглобинредуктазы, электрофорез гемоглобина.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В общем анализе крови может присутствовать компенсаторный эритроцитоз, увеличение Hb, ретикулоцитоз, уменьшение СОЭ. При исследовании биохимических показателей крови определяется незначительная билирубинемия, обусловленная увеличением непрямой фракции пигмента. Для хронической метгемоглобинемии типично появление в эритроцитах телец Гейнца-Эрлиха.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">У больных с энзимопенической или токсической метгемоглобинемией показательна терапевтическая проба с внутривенным введением метиленового синего – после инъекции цианоз быстро исчезает, а кожа и видимые слизистые приобретают розовую окраску.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При анализе причин метгемоглобинемии важно выяснить, имел ли больной контакт с токсическими веществами, принимал ли метгемоглобинобразующие лекарственные препараты. При подозрении на врожденную метгемоглобинемию изучается родословная, проводится консультация генетика, определяется тип наследования патологии крови. Наследственные метгемоглобинемии требуют дифференциации с врожденными пороками сердца синего типа, аномалиями развития легких и другими состояниями, сопровождающимися гипоксией.</span></p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Больные с отсутствием клинических проявлений не нуждаются в специальной терапии. При значительной концентрации MtHb в крови и развернутой симптоматике метгемоглобинемии назначается медикаментозная терапия, способствующая превращению метгемоглобина в гемоглобин. Такими восстанавливающими свойствами обладают аскорбиновая кислота и метиленовый синий. Аскорбиновая кислота назначается внутрь сначала в больших, а по мере нормализации состояния - в поддерживающих дозах. Раствор метиленовой сини вводится внутривенно. При выраженном цианозе проводится кислородная терапия. Тяжелая форма метгемоглобинемии является показанием к обменному переливанию крови.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Течение наследственной и лекарственной метгемоглобинемии, как правило, доброкачественное. Неблагоприятный исход возможен при тяжелых формах токсической метгемоглобинемии с высоким содержанием MtHb в эритроцитах. Пациентам с подобной патологией следует избегать контакта с метгемоглобинобразующими веществами, переохлаждений и других провоцирующих факторов. </span></p>",
"prevention": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Профилактика врожденной метгемоглобинемии заключается в проведении медико-генетической консультации для выявления гетерозиготных носителей среди будущих родителей.</span></p>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Признаки наследственной метгемоглобинемии становятся заметны в период новорожденности. На коже и видимых слизистых ребенка (в области губ, носогубного треугольника, мочек ушей, ногтевого ложа) заметен цианоз. Кроме наследственной метгемоглобинемии, у детей часто выявляются другие врожденные аномалии - изменения конфигурации черепа, недоразвитие верхних конечностей, атрезия влагалища, талассемия и пр. Нередко дети отстают в психомоторном развитии.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В зависимости от уровня фракции MtHb, выраженность проявлений врожденной и приобретенной метгемоглобинемии может значительно варьировать.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При концентрации MtHb в крови:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\"><3% клинические проявления отсутствуют</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">3-15% - кожные покровы приобретают сероватый оттенок</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">15-30% - развивается цианоз, кровь становится шоколадно-коричневого цвета</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">30-50% - появляется слабость, головная боль, тахикардия, одышка при физической нагрузке, головокружение, возникают обмороки</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">50-70% - возникает аритмия, учащенное дыхание, судороги; развивается метаболический ацидоз; отмечаются признаки угнетения ЦНС, возможна кома</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">>70% - выраженная гипоксия, летальный исход.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Для любых форм метгемоглобинемии характерна грифельно-серая окраска кожных покровов, однако отсутствуют характерные для сердечно-легочных заболеваний изменения ногтевых фаланг по типу «барабанных палочек». Акроцианоз усиливается при охлаждении, употреблении в пищу нитратосодержащих продуктов, при токсикозах беременности у женщин, а также приеме метгемоглобинобразующих медикаментов.</span></p>",
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"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Больные с подозрением кисты селезенки, либо других болезней, затрагивающих органы брюшной полости, должны обязательно обследоваться хирургом. Врач осмотрит, опросит пациента, проведет пальпаторную и перкуссионную диагностику, благодаря чему сможет заподозрить ту или иную проблему. Уже для уточнения диагноза дополнительно будут назначены такие исследования:</span></p>\r\n<p> </p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #454343; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">общий и биохимический анализы крови;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #454343; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">общий анализ мочи;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #454343; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">исследование билирубина сыворотки крови;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #454343; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">тимоловая проба, исследование общего белка и белковых фракций, аминотрансфераз, щелочной фосфатазы, протромбина;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #454343; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">серологические реакции на эхинококкоз (иммуноферментный анализ);</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #454343; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">ультразвуковое исследование органов брюшной полости;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #454343; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">рентгенография (по показаниям – магнитно-резонансная или компьютерная томография).</span></p>\r\n</li>\r\n</ul>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Тактика лечения основывается на данных о величине и количестве образований, их местоположении и общем состоянии больного. При малой непаразитарной кисте (менее 3 см) пациенту показано динамическое наблюдение и прохождение УЗИ селезенки 1-2 раза в год. По мере увеличения объема образования, появления симптомов болезни, присоединения инфекции встает вопрос о применении хирургических методов лечения. К абсолютным показаниям к оперативному вмешательству относят:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">прорыв кисты в абдоминальную полость</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">абсцедирование</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">развитие кровотечения</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">наличие одной большой (более 10 см) или нескольких (более 5) малых патологических полостей.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">постоянно рецидивирующее течение заболевания (более 4-х эпизодов в год).</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При множественных кальцинированных кистах с поражением более 50% площади селезенки проводят полное удаление органа - спленэктомию. Лечение небольшого образования выполняют путем пункции кисты, аспирации ее содержимого и последующего введения в спавшуюся полость склерозирующих препаратов. При одиночном образовании осуществляют иссечение кисты с капсулой и проведение аргоноплазменной коагуляции пораженных участков селезенки. Средние и несколько небольших полостей, расположенных рядом, резецируют вместе с участком органа.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В современной хирургии наиболее эффективным и малотравматичным методом удаления кисты признана лапароскопия. Лапароскопическая операция позволяет значительно сократить реабилитационный период и уменьшить послеоперационный болевой синдром. При истинной кисте показано комбинированное лечение, которое заключается в чрескожной деэпителизации под контролем УЗИ с дальнейшей эмболизацией артерии, питающей стенку образования.</span></p>",
"prevention": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Общими профилактическими мероприятиями считаются:</span></p>\r\n<p> </p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #454343; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">здоровый и активный образ жизни, недопущение гиподинамии;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #454343; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">полноценное питание качественной пищей, употребление достаточного количества питьевой воды, а также необходимых витаминов и минералов;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #454343; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">своевременные визиты к врачам, регулярные обследования, позволяющие выявить патологию в органах на начальной стадии развития.</span></p>\r\n</li>\r\n</ul>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Клиническая картина может быть разной по интенсивности, что зависит от локации новообразования, от его размеров и степени сдавливания других органов и тканей. Если киста селезенки не отличается большими размерами (до 20 мм), то симптоматика часто отсутствует. Первые признаки появляются, когда развивается воспалительный процесс, либо когда происходит сдавливание рядом расположенных структур.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При развитии воспаления пациенты отмечают:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #454343; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">ощущение слабости, головокружение, иногда – тошноту;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #454343; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">периодический ноющий, тупой болевой синдром со стороны левого подреберья.</span></p>\r\n</li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Постепенно боли усиливаются, может нарушаться пищеварительный процесс. В области селезенки нарастает ощущение тяжести и дискомфорта, затрудняется дыхание, появляется сухой кашель. Во время глубокого вдоха может возникать одышка и чувство дискомфорта в груди. У некоторых больных отмечается иррадиация боли в левую ключицу, плечо, лопатку, с усилением после приема пищи.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Для множественных кист, либо для новообразования с большими размерами характерны расстройства функций органов брюшной полости. В частности, нарушается пищеварение, появляются проблемы с желудком, часто беспокоит тошнота и отрыжка.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Присоединение гнойно-воспалительного процесса дает о себе знать повышением температуры тела, ознобом, общим дискомфортом. </span></p>",
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{
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{
"id": 2690,
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{
"name": "Нарушение устойчивости"
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{
"name": "Падение"
},
{
"name": "Потрея равновесия"
},
{
"name": "Спотыкание"
}
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},
"code": "D73.3",
"name": "Абсцесс селезенки",
"icd_name": "Абсцесс селезенки",
"gender": 0,
"age_min": 20,
"age_max": 100,
"cause": [
"0"
],
"periodicity": 1,
"slug": "d73.3_abscess_selezenki",
"lead": "ограниченное от окружающих тканей скопление гнойного экссудата в селезенке",
"description": "<p><span id=\"docs-internal-guid-212dc523-7fff-df30-6818-a29202e5347c\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Абсцесс селезенки – это отдельный от окружающих тканей гнойно-воспалительный процесс, который нередко сопровождается лихорадкой, рвотой, тошнотой и болезненностью.</span></span></p>",
"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Среди возбудителей гнойного процесса при абсцессе селезенки преобладают сальмонеллы, стрептококки, стафилококки. Редко патогенная микрофлора представлена грамотрицательными бактериями и грибами. К основным причинам, приводящим к образованию гнойников, относят:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Инфекционные заболевания. Генерализация инфекционного процесса при малярии, брюшном и возвратном тифе, скарлатине, дифтерии вызывает формирование гнойных очагов в органах и тканях, в т. ч. в селезенке.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Травмы селезенки. Ушибы и ранения органа, протекающие без разрыва капсулы, сопровождаются скоплением крови под оболочкой. В этих случаях абсцесс возникает вследствие нагноения гематомы.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Распространение гнойной инфекции из других очагов. Проникновение инфекции в селезенку гематогенным путем происходит при гнойно-воспалительных заболеваниях других органов и систем (септическом эндокардите, остеомиелите, сепсисе, пиелонефрите, цистите). При раке или язве желудка, левостороннем паранефрите, абсцессах брюшной полости имеет место контактный переход патогенной флоры на селезенку.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Эхинококкоз селезенки. Абсцесс может образовываться за счет скопления личинок эхинококка в лиенальной ткани и нагноения паразитарной кисты селезенки.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Инфаркт селезенки. В результате тромбоза, эмболии или длительного спазма селезеночных артерий возникает острая ишемия и некроз части или всего органа. Инфицирование пораженной области приводит к развитию абсцесса.</span></li>\r\n</ul>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Формированию абсцесса способствуют болезни, сопровождающиеся снижением иммунитета (серповидно-клеточная анемия, хронический лимфолейкоз, лейкемия, ВИЧ-инфекция).</span></p>\r\n<p><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
"pathogenesis": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Занос микробных возбудителей в селезенку в большинстве случаев происходит по кровеносному руслу, реже - при непосредственном ранении органа или контактно (с соседних анатомических структур). Возбудители или гнойные эмболы оседают в синусоидных капиллярах, где размножаются, вызывая образование воспалительного инфильтрата с явлениями некроза.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">По мере расплавления очага воспаления формируется полость абсцесса, заполненная зловонным гноем шоколадного цвета или цвета «мясных помоев» с включениями секвестров селезеночной ткани. Полости могут иметь различные размеры, строение и локализацию. При расположении гнойника в зоне верхнего полюса селезенки отмечается реакция со стороны плевры: боль в левой половине груди, реактивный плеврит. Нижнеполюсная локализация абсцесса вызывает болезненность в левом подреберье и напряжение мышц живота.</span></p>",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В связи с вариабельностью клинической картины и частым отсутствием специфических симптомов диагностика абсцесса селезенки вызывает трудности. При подозрении на наличие патологии необходимо провести следующие обследования:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Опрос, осмотр. Включает изучение анамнеза жизни и заболевания, физикальное исследование (пальпация, аускультация живота). При осмотре хирурга выявляется болезненность в подреберье слева, пальпируется увеличенная селезенка.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Инструментальную диагностику. В первую очередь проводят УЗИ селезенки, в ходе которого абсцесс определяется как гипоэхогенная или анэхогенная округлая тень. На обзорной рентгенографии брюшной полости визуализируется затемнение под диафрагмой слева. Компьютерная томография (КТ селезенки) позволяет получить точную информацию о размерах, локализации гнойника, дополнительных образованиях и выпоте в брюшной или плевральной полости. Для выявления очага воспаления проводят радионуклидную сцинтиграфию.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Анализ крови (ОАК, биохимия). Неспецифические виды исследования, определяющие наличие воспалительного процесса в организме. При абсцессе в анализе крови отмечается лейкоцитоз со сдвигом лейкоцитарной формулы влево, анемия, гипопротеинемия.</span></li>\r\n</ul>\r\n<p> </p>\r\n<p><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Лечение осуществляют специалисты в сфере абдоминальной хирургии. При подтверждении диагноза показано срочное вмешательство. Тактика оперативного лечения зависит от локализации и величины гнойного очага, наличия осложнений и общего состояния пациента. В настоящее время применяют следующие виды хирургической тактики:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Чрескожное дренирование и санация гнойника. Под контролем УЗИ пункционной иглой удаляют гнойное содержимое и вводят в полость абсцесса лекарственные средства. Для определения патогенной микрофлоры проводят исследование полученного гноя. Манипуляцию выполняют при одиночных абсцессах до 4-5 см и противопоказаниях к проведению лапаротомии (тяжелое соматическое состояние пациента, заболевания свертывающей системы крови).</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Спленэктомия с ревизией брюшной полости. Оперативное удаление селезенки вместе с абсцессом осуществляется при больших одиночных или множественных гнойниках, неэффективности малоинвазивных методов лечения, развитии кровотечений и перитонита. В некоторых случаях проводят аутотрансплантацию с возвращением части органа в брюшную полость для сохранения иммунной функции.</span></li>\r\n</ul>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Выбор оперативного подхода зависит от местоположения абсцесса селезенки. Локализация гнойника в верхней части органа предполагает трансторакальный доступ, в нижней части - чрезбрюшинный. Всем больным в послеоперационном периоде назначают антибактериальные и обезболивающие препараты. При прорыве гнойника дополнительно показана массивная противовоспалительная и дезинтоксикационная терапия. В период реабилитации (1-2 месяца) следует воздержаться от занятий спортом, тяжелой физической нагрузки, принятия горячих ванн.</span></p>\r\n<p><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
"prevention": "<p><span id=\"docs-internal-guid-d022b355-7fff-373d-b419-584a46660ae9\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Профилактика абсцесса селезенки направлена на своевременную диагностику заболеваний, служащих патогенетической и морфологической основой для формирования гнойника.</span></span></p>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">У пациентов может возникать боль в нижней части живота. Нередко болевые ощущения могут отдавать в верхнюю часть живота, а также в левое плечо. Боль внезапная, но может быть повторяющейся или постоянной. Интенсивность воспринимается по-разному.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Если дело доходит до колик, они обычно распространяются на верхнюю область живота и в левое плечо. В зависимости от причины абсцесса селезенки могут появляться другие симптомы – тошнота, головокружение, головная боль, усталость, спленомегалия.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Симптомы гнойного воспаления селезенки зависят от расположения и размера гноя. Некоторые абсцессы внутри организма часто остаются незамеченными в течение длительного времени. Они вызывают боль только тогда, когда становятся очень большими и оказывают давление на соседние нервы или органы.</span></p>",
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"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Гиперспленизм является вторичным патологическим процессом, развивающимся при многих болезнях:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Цирроз печени. Параллельно с гиперспленизмом у пациента будут признаки портальной гипертензии, печеночной недостаточности и асцит.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Болезни крови. Чаще всего эта патология сопровождает гемоглобинопатии, гемолитические анемии, миелопролиферативные и лимфопролиферативные заболевания.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Инфекционные болезни. Спленомегалия и усиленная деструкция кровяных клеток бывает при вирусных, бактериальных и протозойных инфекциях, а также развивается на фоне инфекционного эндокардита.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Системные заболевания. В эту группу входят патологии воспалительного характера, нарушения обмена веществ и наследственные болезни.</span></li>\r\n</ul>\r\n<p> </p>\r\n<p><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
"pathogenesis": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Конкретный механизм развития гиперспленизма зависит от того, на фоне какой патологии он возникает. Выделяют два основных варианта:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Застойные явления в портальной вене вызывают перенаполнение селезенки кровью, из-за чего ускоряется разрушение ее форменных элементов. Такое бывает при циррозе печени и некоторых гемоглобинопатиях.</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Активация макрофагов в селезенке приводит к тому, что они начинают усиленно захватывать клетки крови, тем самым разрушая их в большем количестве, чем нужно. Такой механизм развития характерен для инфекций и системных заболеваний.</span></li>\r\n</ul>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">На ранних стадиях недостаток клеток крови может быть незаметен, поскольку включается компенсаторный механизм, характеризующийся усилением процессов гемопоэза в красном костном мозге. Но постепенно он перестает справляться с нагрузкой, и возникает цитопения.</span></p>",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Чаще всего пациентов ведут гематологи и гепатологи, что зависит от заболевания, на фоне которого возник гиперспленизм. Во время осмотра врачи обращают внимание на увеличенную и болезненную при пальпации селезенку. Затем пациенту назначают дополнительное обследование:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Анализ крови. Клинический анализ крови. Показывает снижение уровня форменных элементов крови – эритроцитопению, лейкопению (точнее – недостаток нейтрофилов) или тромбоцитопению, а также ретикулоцитоз.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">УЗИ органов брюшной полости. Исследование визуализирует увеличенную селезенку. Также с его помощью можно определить размеры и структуру органа.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">КТ. Позволяет уточнить состояние селезенки, если УЗИ оказалось недостаточно информативным.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Биопсия (стернальная пункция или трепанобиопсия). Проводят с целью выявления скрытого патологического процесса или для уточнения этиологии цитопении. При дальнейшей микроскопии материала в мазках обнаруживают гиперплазию ростков красного костного мозга.</span></li>\r\n</ul>\r\n<p> </p>\r\n<p><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Пациенты подлежат обязательной госпитализации в стационарное отделение (гематологии, гастроэнтерологии). Главным условием успешной терапии является лечение основного заболевания, на фоне которого возникло патологическое усиление секвестрационной функции селезенки – антицирротическая, антибактериальная терапия, химиотерапия и пр. Так как сам гиперспленизм характеризуется упорным прогрессирующим течением, лечение представляет собой тяжелую задачу. Для устранения проявлений синдрома используются различные способы.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Консервативная терапия</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Лекарственных препаратов, позволяющих полностью избавиться от признаков гиперспленизма, не существует. Так как главную опасность для жизни представляет цитопенический синдром, используют меры по поддержанию клеток крови на должном уровне. В первую очередь, это переливания цельной крови или отдельных ее компонентов (размороженной, отмытой эритроцитарной массы, концентрата тромбоцитов).</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Иногда назначают фармакологические препараты, воздействующие на отдельные ростки костного мозга – эритропоэтин, филграстим, тромбопоэтин. К этим медикаментам прибегают очень редко и только тогда, когда другие методы оказались безуспешными, т. к. костный мозг при гиперспленизме уже находится в состоянии гиперплазии. Поэтому дополнительное применение лекарственных стимуляторов гемопоэза патогенетически мало оправдано.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Хирургическое лечение</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Наиболее радикальный способ лечения гиперспленизма, позволяющий добиться нормализации показателей клеток крови – спленэктомия (оперативное удаление селезенки). Однако эта операция сопряжена с большим числом осложнений - тромбозами, повышенной чувствительностью организма к таким бактериям, как пневмококк, менингококк, гемофильная палочка. В связи с этим в последнее время все чаще выполняются малоинвазивные эндоваскулярные вмешательства ‒ эмболизация селезеночной артерии или ее ветвей. Это позволяет устранить гиперспленизм и сохранить нормальную функцию селезенки.</span></p>\r\n<p><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
"prevention": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Профилактика гиперспленизма заключается в своевременном лечении гепатита и цирроза печени, а также заболеваний крови. При возникновении заболеваний печени следует проводить рентгенографию селезенки или ее биопсию.</span></p>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Клиническая картина представлена спленомегалией, цитопенией и симптомами основной патологии. Из-за увеличенной селезенки пациент ощущает тяжесть и боли в левом подреберье. При больших размерах она начинает давить на диафрагму, из-за чего человеку трудно сделать глубокий вдох.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">При цитопеническом синдроме в крови может снижаться количество как одного форменного элемента, так и сразу трех (панцитопения). </span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Клиническая картина зависит от того, каких именно клеток крови не хватает:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Низкий уровень эритроцитов. Приводит к анемии. Кожа и видимые слизистые бледнеют. По мере прогрессирования пациент начинает жаловаться на слабость, головокружение, тахикардию.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Низкий уровень тромбоцитов. Провоцирует развитие геморрагического синдрома. Больного беспокоят носовые кровотечения. Нередко он отмечает повышенную кровоточивость десен. У женщин менструации становятся обильными и продолжительными.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Низкий уровень лейкоцитов. Чаще всего уменьшается количество гранулоцитов. В результате лейкопении снижается иммунитет. Появляются гнойничковые высыпания на коже. Развиваются воспалительные часто рецидивирующие процессы внутренних органов (пневмонии, отиты, пиелонефриты).</span></li>\r\n</ul>\r\n<p> </p>\r\n<p><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
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},
"code": "D73.0",
"name": "Гипоспленизм",
"icd_name": "Гипоспленизм",
"gender": 0,
"age_min": 30,
"age_max": 100,
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"slug": "d73.0_giposplenizm",
"lead": "временная или постоянная гипофункция селезенки, вызванная отсутствием, атрофией либо функциональной несостоятельностью ее паренхимы",
"description": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Гипоспленизмом называют снижение функциональных способностей селезенки. Чаще всего причина кроется в повреждении селезенки в ходе травм, операций или любых сторонних вмешательств. Гипоспления опасна тем, что может вызвать эритроцитоз — патологическое увеличение в крови количества эритроцитов, а также кровяных телец с избытком железа, сидероцитов.</span></p>",
"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Причины гипоспленизма:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #252525; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">оперативное удаление селезенки, например, при тяжелой травме селезенки, кистах, опухолях брюшной полости;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #252525; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">функциональный гипоспленизм, вызванный талассемией, серповидно-клеточной анемией, тромбоцитемией и лимфопролиферативными заболеваниями, в частности лимфомой Ходжкина и неходжкинской лимфомой;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #252525; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">раковые заболевания (хронический лимфолейкоз);</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #252525; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">воспалительные заболевания кишечника;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #252525; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">целиакия;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #252525; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">пересадка костного мозга;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #252525; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">облучение селезенки или отказ организма принимать донорские органы.</span></p>\r\n</li>\r\n</ul>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Гипоспленизм бывает и врожденным, связанным с сердечными аномалиями и билиарной атрезией (непроходимостью желчевыводящих путей).</span></p>",
"pathogenesis": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При разных причинах гипоспленизма существует общий механизм развития гипофункционального состояния, основанный на выпадении основных функций селезенки. Несмотря на то, что орган обладает высоким функциональным и регенерационным резервом, при сохранении менее 30% объема активной ткани нарушается антиген-зависимая пролиферация и дифференцировка Т-лимфоцитов, снижается продукция опсонинов (в первую очередь — тафцина, обладающего иммуногенным и противоопухолевым эффектом), угнетается фагоцитарная реакция, что в конечном итоге приводит к развитию выраженной иммунной недостаточности.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Из-за нарушений фильтрующей функции страдает утилизация стареющих элементов крови и опосредованно — обмен пигментов, железа, продукция желчи клетками печени. Поскольку при возникновении гипоспленизма селезенка перестает справляться с функцией депонирования кровяных элементов, увеличивается их содержание в периферической крови.</span></p>",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Постановка диагноза при гипоспленизме обычно затруднена только в тех случаях, когда развитие заболевания не связано с удалением селезенки. Это обусловлено скудностью ранних клинических проявлений нехирургической селезеночной гипофункции и отсутствием патогномоничных признаков расстройства. Диагностический поиск предполагает не только оценку структурно-функционального состояния органа, но и комплексное обследование пациента для выявления возможных осложнений. Наиболее информативными являются такие лабораторные и инструментальные методы, как:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Клинический анализ крови. При гипоспленизме обнаруживают увеличение количества эритроцитов и тромбоцитов. Характерным признаком заболевания считается повышение числа аномальных клеток (мишеневидных эритроцитов, шистоцитов, сидероцитов), появление патологических включений — телец Хауэлла-Джолли (представляют собой остатки клеточного ядра) и телец Папенхайма.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Эхография. УЗИ селезенки - неинвазивный метод обследования позволяет получить информацию о топографии и размерах органа, подтвердить наличие воспалительных или дегенеративных процессов, визуализировать кисты, новообразования. Сонография всегда проводится при подозрении на закрытые повреждения паренхимы, не сопровождающиеся разрывом органа, которые часто приводят к гипоспленизму.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Эзофагогастродуоденоскопия. ЭГДС производится при наличии стойких диспепсических симптомов с целью исключения патологии ЖКТ. Метод позволяет визуализировать состояние слизистой верхних отделов пищеварительного тракта, выявить эрозии, язвы, новообразования. Дополнительно осуществляется биопсия для гистологического анализа.</span></li>\r\n</ul>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Также при гипоспленизме рекомендованы анализы крови на содержание витамина В12 и фолиевой кислоты (обычно наблюдается снижение показателей). При изучении коагулограммы зачастую обнаруживается повышение свертывающей способности крови. Для оценки состояния сердечно-сосудистой системы назначают ЭКГ или эхокардиографию. При недостаточной информативности ультразвукового исследования выполняют КТ и МРТ селезенки, позволяющие детально исследовать внутреннюю структуру органа, оценить состояние перфузии, провести денситометрический анализ. Достаточно чувствительным методом является радиосцинтиграфия, ценность которой особо значима для выявления остатков селезеночной паренхимы (спленоза) у прооперированных пациентов.</span></p>\r\n<p><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Терапевтическая тактика зависит от причин, вызвавших развитие селезеночной недостаточности. Основными задачами являются полное или частичное восстановление функций органа при его анатомической сохранности, предупреждение тяжелых инфекционных осложнений. Пациенту рекомендовано соблюдение режима дня, исключение стрессов и значительной физической нагрузки, достаточная двигательная активность, полноценное питание, прием фолиевой кислоты и других витаминов.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Если гипоспленизм обусловлен не онкологическими заболеваниями, а другой соматической или эндокринной патологией, этиопатогенетическое лечение основного патологического процесса часто сопровождается уменьшением селезеночной гипофункции. Медикаментозная терапия для профилактики генерализованных инфекций предусматривает применение таких препаратов, как:</span></p>\r\n<p> </p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Антибиотики. Рекомендованы антибактериальные средства широкого спектра действия — β-лактамные пенициллины, производные клавулановой кислоты, диаминопиримидины, цефалоспорины II поколения. При постоперационном гипоспленизме антибиотикотерапия начинается сразу после хирургического вмешательства и может продолжаться до 2 лет.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Иммунобиологические препараты. Для иммунизации используют поливалентную пневмококковую вакцину, полисахаридную менингококковую вакцину в конъюгации с дифтерийным анатоксином, гемофильную конъюгированную вакцину типа B. Вакцинация выполняется с 8 по 14 день после экстренной спленэктомии, за 2 недели до плановой, ревакцинация — каждые 3-6 лет.</span></p>\r\n</li>\r\n</ul>",
"prevention": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Профилактика болезни заключается в выполнении органосохраняющих операций на селезенке, аутотрансплантации селезеночной паренхимы при невозможности сохранить орган, своевременном выявлении и лечении предрасполагающих состояний: талассемии, тромбоцитемии, серповидно-клеточной анемии, непереносимости глютена, лимфопролиферативных заболеваний.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Для предупреждения инфекционных осложнений гипоспленизма рекомендовано информирование спленэктомированных пациентов о повышенной восприимчивости к инфекциям, проведение вакцинации. Больным необходимо избегать посещения стран с высокой распространенностью малярии.</span></p>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Поскольку клетки селезенки важны для атаки болезнетворных бактерий и их уничтожения, снижение селезеночной функции приводит к появлению таких симптомов:</span></p>\r\n<p> </p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #252525; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">повышенная восприимчивость к любым инфекциям;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #252525; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">развитие пневмококковой септицемии;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #252525; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">хронический дефицит фолиевой кислоты;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #252525; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">нарушения работы ЖКТ;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #252525; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">разрушение слизистой оболочки ЖКТ;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #252525; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">расстройства пищеварения.</span></p>\r\n</li>\r\n</ul>",
"image": null,
"image_alt": null,
"standard_type": 0,
"danger": 30,
"published": 1,
"parent": 6203,
"block_rubric": 43,
"standards": []
},
{
"id": 6202,
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"alternative_names": [],
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{
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"name": "гастроэнтерология",
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"slug": "gastroenterologiya",
"lead": "Область медицины, включающая в себя лечение 211 заболеваний. В 341 клинике России оказывается помощь по этому направлению медицины.",
"image": null
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{
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"name": "анестезиология и реаниматология",
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"lead": "Область медицины, включающая в себя лечение 1066 заболеваний. В 376 клиниках России оказывается помощь по этому направлению медицины.",
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{
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"name": "гематология",
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"lead": "Область медицины, включающая в себя лечение 984 заболеваний. В 69 клиниках России оказывается помощь по этому направлению медицины.",
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{
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"lead": "Область медицины, включающая в себя лечение 634 заболеваний. В 731 клинике России оказывается помощь по этому направлению медицины.",
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{
"id": 27,
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"name": "онкология",
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"lead": "Область медицины, включающая в себя лечение 354 заболеваний. В 378 клиниках России оказывается помощь по этому направлению медицины.",
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{
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"lead": "Область медицины, включающая в себя лечение 175 заболеваний. В 146 клиниках России оказывается помощь по этому направлению медицины.",
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{
"id": 29,
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"branch_medicine_code": "029",
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"lead": "Область медицины, включающая в себя лечение 851 заболевания. В 696 клиниках России оказывается помощь по этому направлению медицины.",
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{
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"name": "пульмонология",
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"branch_medicine_code": "037",
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{
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{
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"lead": "Область медицины, включающая в себя лечение 66 заболеваний. В 202 клиниках России оказывается помощь по этому направлению медицины.",
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{
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},
"code": "D72.1",
"name": "Эозинофилия",
"icd_name": "Эозинофилия",
"gender": 0,
"age_min": 1,
"age_max": 100,
"cause": [
"0"
],
"periodicity": 1,
"slug": "d72.1_eozinofiliya",
"lead": "состояние, которое характеризуется аномальным повышением уровня эозинофилов в крови",
"description": "",
"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Причины повышения концентрации эозинофилов разнообразны:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">аллергические реакции;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">заражение глистами и паразитами;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">патологии легких — синдром Леффлера, эозинофильные пневмонии, аллергическая реакция на легочные формы аспергиллеза, легочные инфильтраты с эозинофилией, синдром Черджа-Стросса (один из системных васкулитов), саркоидоз;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">патологии крови — пернициозная анемия, истинная полицитемия, неходжкинские лимфомы, острый или хронический миелолейкоз, а также эозинофильный лейкоз, синдром Сезари;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">эндокринопатии;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">злокачественные опухоли — канцероматоз, аденокарциномы ЖКТ, мочевыделительной и половой системы, легких и некоторые другие раковые образования;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">некоторые доброкачественные опухоли;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">первичные иммунодефициты — гипер-IgE-синдром (или синдром Джоба), Т-лимфопатии, синдром Вискотта-Олдрича, дефект хемотаксиса нейтрофилов;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">туберкулез;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">некоторые дерматологические патологии;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">патологии ЖКТ;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">смешанные состояния — недостаток магния, идиопатическая эозинофилия, период выздоровления после инфекционных болезней, СПИД, хорея, врожденный порок сердца, скарлатина, гипоксия, облучение, реакция на трансплантацию, состояние после перитонеального диализа и др.;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">вызванные приемом некоторых лекарственных препаратов лекарственно-индуцированные эозинофилии.</span></li>\r\n</ul>\r\n<p> </p>\r\n<p><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
"pathogenesis": "",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Анализ крови на эозинофилы может проводиться путем подсчета клеточных элементов крови, взятой из пальца или же из вены. При выявлении повышения уровня эозинофилов требуется обязательное обращение к терапевту или педиатру для возможного проведения следующих исследований:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">опрос пациента с уточнением данных о перенесенных заболеваниях, присутствии аллергических реакций, приеме лекарств, системных симптомов;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">исследования крови: клиническое, на антитела к грибкам или гельминтам, гормональные, ANCА, анализы на иммунофенотипирование, на CD-маркеры, на уровень ЛДГ, на иммунодефициты, печеночные тесты;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">аллергообследование: кожные и провокационные пробы, ИФА на уровень IgE, непрямой и прямой базофильный тест;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">микроскопический анализ мокроты;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">анализ кала на яйца глистов;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">бактериологический и микологический посев мокроты с определением чувствительности к антибиотикам и противомикозным препаратам;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">спирометрия;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">рентген;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">эндоскопия с биопсией для гистологического анализа: ФГДС, фиброколоноскопия;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">биопсия легкого;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">стернальная пункция и трепанобиопсия с гистологическим анализом.</span></li>\r\n</ul>\r\n<p> </p>\r\n<p><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
"treatment": "<p><span id=\"docs-internal-guid-4db2aaeb-7fff-2b2d-ad14-fb69444a6a72\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Самостоятельная коррекция эозинофилии невозможна. Для нормализации уровня эозинофилов необходимо бороться с причиной. Если эозинофилия легкая, связана с приемом ЛС или вакцинацией либо приходится на период реконвалесценции – беспокоиться не стоит. Нужно понаблюдать кровь в динамике через 7-10 дней. При обнаружении стойкой или высокой эозинофилии в анализе крови следует обратиться к специалисту, чтобы тот на основании осмотра, жалоб, анамнеза провел диагностический поиск этиологического фактора и назначил соответствующее лечение. Для терапии большинства болезней, сопровождающихся эозинофилией, используются лекарственные препараты из группы антигистаминных средств или глюкокортикостероидов.</span></span></p>",
"prevention": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Для профилактики эозинофилии следует:</span></p>\r\n<p> </p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #231f20; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">регулярно проходить профосмотры;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #231f20; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">не принимать лекарства бесконтрольно;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #231f20; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">вовремя лечить острые и хронические заболевания;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #231f20; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">вести здоровый образ жизни для поддержания иммунитета;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #231f20; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">сдавать повторный анализ крови на эозинофилы при любом превышении референсных показателей и выявлении эозинофилии;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #231f20; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">предупреждать заражение инфекционными заболеваниями, паразитами и гельминтозами.</span></p>\r\n</li>\r\n</ul>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Если повышены эозинофилы у взрослого или ребенка, симптомы этого состояния обуславливаются болезнью, которая привела к тому, что норма эозинофилов была нарушена.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Если причины эозинофилии связаны с аллергическими и кожными болезнями, больного беспокоит зуд, покраснение, сухость кожи. Возможно также мокнутие, появление язв и волдырей, отслоение эпидермиса.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Если эозинофилы в крови у взрослого повышены в связи с аутоиммунными и реактивными болезнями, может отмечаться анемия, повышение температуры тела, снижение веса, фиброз легких, увеличение селезенки и печени, боль в суставах, сердечная недостаточность, воспаление вен.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В случае глистных инвазий увеличиваются и болят лимфатические узлы, также увеличивается селезенка и печень, отмечаются признаки общей интоксикации – тошнота, головные боли, миалгии, слабость.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При легочных инфильтратах с эозинофильным синдромом отмечается целый спектр проявлений. Для состояния характерна эозинофилия периферической крови. При эозинофильной пневмонии отмечается лихорадка, кашель, ночная потливость, потеря веса, одышка, плевральная боль. Состояние может быть как острым, так и хроническим. При остром процессе развивается дыхательная недостаточность, при которой требуется искусственная вентиляция.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">При эозинофильной реакции на лекарственные средства вероятно проявление разных синдромов. Это может быть холестатическая желтуха, сывороточная болезнь, интерстициальный нефрит, иммунобластная лимфаденопатия и др. Реакция на лекарства при эозинофилии и системные симптомы случается редко. При этом может отмечаться сыпь, атипичный лимфоцитоз, лимфаденопатия и др.</span></p>",
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},
"code": "D70",
"name": "Агранулоцитоз",
"icd_name": "Агранулоцитоз",
"gender": 0,
"age_min": 0,
"age_max": 94,
"cause": [
3
],
"periodicity": 1,
"slug": "d70_agranulocitoz",
"lead": "Нарушение здоровья, относящееся к группе другие болезни крови и кроветворных органов",
"description": " \r\nАгранулоцитоз – клинико-лабораторный синдром, основное проявление которого состоит в резком снижении или полном отсутствии нейтрофильных гранулоцитов в периферической крови, что сопровождается повышением восприимчивости организма к грибковым и бактериальным инфекциям. \r\n",
"etiology": "<p>К причинам развития агранулоцитоза относят: </p>\r\n<ul>\r\n<li>Ионизирующая радиация и лучевая терапия, химические вещества (бензол), инсектициды. </li>\r\n<li>Лекарственные средства могут вызвать агранулоцитоз в результате прямого угнетения кроветворения (цитостатики, вальпроевая кислота, карбамазепин, бета-лактамные антибиотики), либо действуя как гаптены (препараты золота, антитиреоидные препараты и пр.). </li>\r\n<li>Аутоиммунные заболевания (например, красная волчанка, аутоиммунный тиреоидит). </li>\r\n<li>Вирусные инфекции (вызванные вирусом Эпштейна – Барра, цитомегаловирус, желтая лихорадка, вирусные гепатиты) обычно сопровождаются умеренной нейтропенией, однако в некоторых случаях может развиться агранулоцитоз. </li>\r\n<li>Тяжелые генерализованные инфекции (как бактериальные, так и вирусные). </li>\r\n<li>Исхудание. </li>\r\n<li>Генетические нарушения. </li>\r\n</ul>",
"pathogenesis": "<p>В зависимости от причины возникновения и механизма развития патологии, различают следующие виды агранулоцитоза: </p>\r\n<ol>\r\n<li>Миелотоксический.</li>\r\n<li>Иммунный: аутоиммунный;гаптеновый. </li>\r\n<li>Генуинный.</li>\r\n</ol>\r\n<p>Миелотоксический агранулоцитоз возникает в результате подавляющего воздействия неблагоприятных факторов на красный костный мозг, и представляет собой глубокую депрессию кроветворного ростка, ответственного за продукцию гранулоцитов. </p>\r\n<p>В основе аутоиммунного агранулоцитоза лежит патологическая реакция иммунной системы, сопровождающаяся образованием антител к собственным нейтрофилам. Такая разновидность агранулоцитоза встречается при аутоиммунном тиреоидите, ревматоидном артрите, системной красной волчанке и других коллагенозах. Агранулоцитоз, развивающийся при некоторых инфекционных заболеваниях (гриппе, инфекционном мононуклеозе, малярии, желтой лихорадке, брюшном тифе, вирусном гепатите, полиомиелитеи др.) также имеет иммунный характер. </p>\r\n<p>Гаптеновый агранулоцитоз возникает, когда в иммунных реакциях участвуют гаптены – вещества, сами по себе безвредные, однако при определенных условиях способные провоцировать иммунные реакции, разрушающие гранулоциты. В роли гаптенов чаще всего выступают лекарственные вещества, так что гаптеновый агранулоцитоз рассматривают, как грозное осложнение различных лечебных мероприятий. О генуинном агранулоцитозе говорят в тех случаях, когда причина резкого снижения количества гранулоцитов в крови остается неизвестной. </p>",
"diagnostics": "<p> </p>\r\n<p>Наиболее важным для подтверждения агранулоцитоза является исследование общего анализа крови и пункция костного мозга. Картина периферической крови характеризуется лейкопенией (1-2х109/л), гранулоцитопенией (менее 0,75х109/л) или агранулоцитозом, умеренной анемией, при тяжелых степенях – тромбоцитопенией. При исследовании миелограммы выявляется уменьшение количества миелокариоцитов, снижение числа и нарушение созревания клеток нейтрофильного ростка, наличие большого количества плазматических клеток и мегакариоцитов. Для подтверждения аутоиммунного характера агранулоцитоза производится определение антинейтрофильных антител. </p>\r\n<p>Всем пациентам с агранулоцитозом показано проведение рентгенографии легких, повторные исследования крови на стерильность, исследование биохимического анализа крови, консультация стоматолога и отоларинголога. Дифференцировать агранулоцитоз необходимо от острого лейкоза, гипопластической анемии. Также необходимо исключение ВИЧ-статуса</p>",
"treatment": "<p> В первую очередь необходимо устранение причинного повреждающего фактора, срочная госпитализация больного агранулоцитозом, желательно в гематологическое отделение, и помещение его в стерильные условия. </p>\r\n<p>Необходим тщательный уход за кожей и слизистыми оболочками. Подкожные и внутримышечные инъекции следует заменить внутривенными, чтобы предотвратить развитие абсцессов. </p>\r\n<p>Назначаются антибиотики широкого спектра действия, по показаниям — противогрибковые и противовирусные препараты, иммуноглобулин. Могут применяться также препараты гранулоцитарного колониестимулирующего фактора (КСФ). При некротической энтеропатии больному следует проводить парентеральное питание. </p>\r\n<p>При аутоиммунном агранулоцитозе производится угнетение аутоиммунной агрессии, больному показаны глюкокортикоиды в высоких дозах до нормализации числа гранулоцитов в крови с последующей постепенной отменой гормонов. При гаптеновом агранулоцитозе введение глюкокортикоидов не эффективно. </p>\r\n<p>При лечении цитостатического агранулоцитоза средствами выбора являются препараты рекомбинантных гемопоэтических факторов роста. </p>",
"prevention": "<p>Чтобы не допустить развитие агранулоцитоза, следует избегать контакта с фактором, способным вызвать заболевание. Во время приема цитостатиков необходим тщательный контроль показателей гемограммы (картины крови). </p>\r\n<p>Большой проблемой является профилактика повторных гаптеновых агранулоцитозов. При гаптеновых агранулоцитозах - 80% смертельных исходов, и прогноз ухудшается при повторном применении вызвавшего нейтропению лекарства. Установить, какой препарат является гаптеном, нелегко, поэтому нужно навсегда исключать из употребления все препараты, которые применялись перед появлением агранулоцитоза. </p>",
"clinical_picture": "<p>Клиническая картина во многом напоминает симптомы цитостатической болезни и проявляется в виде поражения организма различными инфекциями в результате снижения эффективности иммунного ответа. Характерны (особенно при лекарственном агранулоцитозе) острое начало и быстрое нарастание клинических симптомов. Иногда возникновению основных признаков агранулоцитоза предшествует короткий скрытый период, характеризующийся слабостью, недомоганием, головными болями. Возникает лихорадка, афтозный стоматит, ангина, озноб, боль в суставах. Развиваются язвенно-некротические поражения слизистой оболочки полости рта в виде изъязвлений, покрытых сероватым налётом, некротических бляшек и язв с грязно-серым налётом на миндалинах (агранулоцитарная ангина). </p>\r\n<p>Процесс распространяется на нёбные дужки, язычок, твёрдое нёбо, дёсны и порой сопровождается незначительным увеличением регионарных лимфатических узлов, чаще всего шейных и подчелюстных. Данные изменения могут быть также на слизистой оболочке желудочно-кишечного тракта, лёгких, печени, мочевого пузыря, половых органов. </p>\r\n<p>При гаптеновом агранулоцитозе развитие болезни бурное. После приёма препаратов, вызвавших агранулоцитоз, возникает нарастающая слабость, боль в горле, повышение температуры тела до 39—40 °С, появляется и нарастает гнилостный запах изо рта (глоточно-ротовая форма). Нередко развиваются стоматит, ларингоспазм и асфиксия по причине скопления некротических плёнок и отёка гортани. К ошибке в диагностике может привести тот факт, что начальные проявления кишечно-некротической энтеропатии и поражение слизистых оболочек ротовой полости опережают появление лабораторных показателей агранулоцитоза. </p>",
"image": null,
"image_alt": null,
"standard_type": 3,
"danger": 1,
"published": 2,
"parent": null,
"block_rubric": 43,
"standards": []
}
]
}
