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},
"code": "E73",
"name": "Непереносимость лактозы",
"icd_name": "Непереносимость лактозы",
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0
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"lead": "Термин для описания патологических состояний, вызванных снижением уровня лактазы — фермента, необходимого для правильного переваривания лактозы.",
"description": "Непереносимостью молока страдают несколько миллионов людей по всему миру. ",
"etiology": "<p>Врожденный дефицит фермента лактазы, распространенный преимущественно среди лиц, принадлежащих к азиатской расе.</p>\r\n<p> </p>\r\n<p>Естественное снижение уровня лактазы, которое начинается еще в детском возрасте (после 3 лет). Насколько значительным будет это снижение, зависит от особенностей организма конкретного человека. Тем не менее, можно с уверенностью сказать, что чем старше человек, тем вероятнее, что он страдает от непереносимости лактозы.</p>\r\n<p> Любое заболевание, которое влияет на клетки тонкой кишки, производящие лактазу, например, воспалительные заболевания и даже грипп. Такое состояние вызывает «вторичную недостаточность лактазы». Это временная проблема, которая исчезает, как только заболевание проходит, поврежденные клетки восстанавливаются и начинают снова вырабатывать ферменты.</p>\r\n<p> Хирургические операции на желудке и кишечнике, которые могут полностью уничтожить способность организма производить лактазу.</p>\r\n<p> </p>",
"pathogenesis": "",
"diagnostics": "<p>Иногда врачи назначают пробу на содержание водорода в выдыхаемом воздухе, анализ сахара в крови, или анализ кислотности стула, чтобы подтвердить диагноз.</p>\r\n<ul>\r\n<li>\r\n<p>Проба на содержание водорода в выдыхаемом воздухе</p>\r\n</li>\r\n</ul>\r\n<p>Это - самый точный анализ непереносимости лактозы. Перед анализом, пациент должен избегать употребления определенных продуктов, лекарств и сигарет. В день анализа, пациент выпивает жидкость, которая содержит лактозу и затем выдыхает в специальный прибор. Высокий уровень водорода - показатель непереносимости лактозы. Этот тест обычно не применяется по отношению к младенцам и очень маленьким детям, так как может вызвать сильный <a href=\"/symptom/diareya/\" title=\"Перейти на страницу симптома Диарея\">понос</a>.</p>\r\n<ul>\r\n<li>\r\n<p>Тест переносимости лактозы</p>\r\n</li>\r\n</ul>\r\n<p>Этот анализ измеряет уровень сахара в крови после употребления продукта, содержащего лактозу. Перед проведением анализа, нельзя ничего есть. В день анализа, пациент выпивает жидкость, содержащую лактозу, которая может вызывать <a href=\"/symptom/meteorizm/\" title=\"Перейти на страницу симптома Метеоризм\">газы</a> или <a href=\"/symptom/bol_v_zhivote/\" title=\"Перейти на страницу симптома Боль в животе\">боль в животе</a>. После этого, каждые 30 минут в течение 2 часов, проверяют кровь. Если уровень сахара в крови не повышается, это может указывать на непереносимость лактозы. Этот анализ не применяется по отношению к больным диабетом пациентам и младенцам.</p>\r\n<ul>\r\n<li>\r\n<p>Анализ кислотности стула</p>\r\n</li>\r\n</ul>\r\n<p>Данный анализ помогает измерить количество кислоты в толстой кишке. Для проведения анализа, необходимо образец кала в изолированном контейнере доставить в лабораторию. Наличие кислоты в кале указывает на неспособность организма нормально переваривать лактозу. Такой анализ может проводить среди младенцев и маленьких детей.</p>",
"treatment": "<p>Что может сделать врач</p>\r\n<p> </p>\r\n<p>Выписать ферменты в виде таблеток или капель. Для лечения других заболеваний выписывать препараты, не содержащие лактозу.</p>\r\n<p> Назначить лечение тяжелой вторичной недостаточности лактазы.</p>\r\n<p> Диетолог может разработать для вас сбалансированную диету.</p>\r\n<p> Врач-педиатр поможет подобрать для вашего ребенка правильное питание и дать вам необходимые рекомендации по кормлению ребенка.</p>\r\n<p> </p>",
"prevention": "<p>Будьте осторожны и старайтесь не заболеть заболеваниями пищеварительной системы. Кроме этого, почти не существует способов предотвратить такое генетически запрограммированное нарушение, как непереносимость лактозы.</p>\r\n<p> </p>\r\n<p>Однако некоторые простые правила предосторожности помогут людям с легкой степенью непереносимости лактазы избежать проявления неприятных симптомов, при этом не лишая себя полностью молока и молочных продуктов.</p>\r\n<p> Если у вас непереносимость лактозы, не лишайте себя совсем молочных продуктов. Попробуйте употреблять в пищу богатые кальцием продукты, например, молоко, но в небольших дозах (меньше чашки) и пейте его во время еды. Обычно сыр и йогурт в небольших количествах достаточно легко переносятся людьми с непереносимостью лактозы.</p>\r\n<p> Также можно попробовать молоко, сыр и творог, не содержащие лактозы или другие источники кальция, например, соевое молоко, миндаль, брокколи и другие зеленые овощи, рыбу и т.д.</p>\r\n<p> </p>",
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},
"code": "E73.9",
"name": "Непереносимость лактозы неуточненная",
"icd_name": "Непереносимость лактозы неуточненная",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
"0"
],
"periodicity": 1,
"slug": "e73.9_neperenosimost_laktozy_neutochnennaya",
"lead": "неспособность переваривать лактозу, часто связанную с недостаточностью фермента лактазы",
"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;\">Непереносимость лактозы — неспособность организма переваривать молочный сахар. Для расщепления лактозы на простые сахара или моносахариды в тонком кишечнике должен вырабатывать фермент под названием лактаза. Непереносимость лактозы характеризуется чрезмерным газообразованием, судорогами и диареей. Проявления болезни возникают, как правило, после употребления молочных продуктов.</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;\">Некоторые причины непереносимости лактозы хорошо известны. Первичная лактазная недостаточность – состояние, которое развивается с течением времени. Примерно после 2 лет организм начинает вырабатывать меньше лактазы. Вторичная лактазная недостаточность возникает, когда повреждение тонкого кишечника или некоторые заболевания пищеварительной системы снижают количество вырабатываемого фермента. К таким заболеваниям относятся:</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: 8pt; font-family: Verdana; color: #092148; 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 (глютеновая недостаточность);</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #092148; 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;\">воспаление кишечника;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #092148; 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;\">болезнь Крона.</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;\">Исследователи выявили генетическую связь непереносимости лактозы. Некоторые люди рождаются с вероятностью развития первичной лактазной недостаточности, потому что она была передана им генетически (унаследованная от родителей). Это открытие может быть полезно при разработке диагностического теста для выявления людей с этим заболеванием.</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;\">Дети, рожденные преждевременно, чаще страдают непереносимостью лактозы, поскольку уровень лактазы не повышается до третьего триместра беременности женщины.</span></p>",
"pathogenesis": "",
"diagnostics": "<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-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Для постановки точного диагноза используются лабораторные исследования: дыхательный водородный тест, анализ крови на сахар, исследование кислотности стула. Исследование активности фермента в ткани с помощью биопсии тонкой кишки считается менее чувствительным методом.</span></p>\r\n<ul>\r\n<li><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;\">Анализ крови</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: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Активность фермента можно проверить с помощью определения уровня глюкозы в крови после употребления 50 граммов лактозы (количество лактозы в литре молока). Уровень сахара в крови будет проверяться каждые 30 минут в течение двух часов. Если уровень сахара не повышается, скорее всего, это будет свидетельствовать о гиполактазии.</span></p>\r\n<ul>\r\n<li><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;\">ПЦР тест</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: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">В последние годы была предложена проверка генотипа с помощью ПЦР в реальном времени. Такой тест имеет высокую специфичность для гиполактазии и широко используется.</span></p>\r\n<ul>\r\n<li><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;\">Тест на кислотность стула</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: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Кислотность стула измеряется в образце фекалий, немедленно принесенном в лабораторию. Если в стуле присутствует кислота, то лактоза, вероятно, переваривается неправильно. Это наиболее предпочтительный метод для младенцев.</span></p>\r\n<ul>\r\n<li><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;\">Дыхательный водородный тест</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: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Это надежное, но длительное исследование, которое заключается в определении количества водорода в выдыхаемом воздухе. На протяжении нескольких часов пациент делает серию глубоких выдохов, которые затем необходимо повторить после употребления 50 гр лактозы. Повышение концентрации водорода через 2 часа после воздействия указывает на дефицит фермента, разлагающий молочный сахар.</span></p>",
"treatment": "<p> </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-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Медикаментозная терапия как таковая не используется. Основа лечения — правильно подобранная диета. При расстройствах желудочно-кишечного тракта могут назначаться противорвотные средства, миотропные спазмолитики, препараты для улучшения моторики кишечника и стабилизации стула.</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-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Для людей, страдающих непереносимостью молока, существует несколько вариантов питания. Некоторым можно употреблять продукты молочного брожения — кефир, йогурт, творог, сыр. При значительном дефиците лактазы следует отдавать предпочтение специальным продуктам — например, безлактозному молоку. Также можно принимать фермент лактазу в виде таблеток непосредственно при употреблении молочных блюд.</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-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Норма лактозы, которую можно употреблять без вреда для здоровья, является индивидуальной. При тяжелой непереносимости молока допускается не более 1 г молочного сахара в сутки. При нарушении средней тяжести — не более 10 г.</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: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Составлять диету нужно с учетом состава. Обратите внимание, что есть продукты, в которых:</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<ul style=\"margin-top: 0px; margin-bottom: 0px; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #666666; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; 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: 7pt; color: #000000; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">молочный сахар является естественным ингредиентом: сухое и цельное молоко, сыр, творог, пахта, кумыс, сыворотка, сметана, сливки;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #666666; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; 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: 7pt; color: #000000; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">лактоза присутствует в связи с особенностями производства: колбасные изделия, варенье, джем, супы и картофельное пюре быстрого приготовления, хлеб, бисквиты, горчица, майонез, кетчуп, шоколад, какао;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #666666; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; 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: 7pt; color: #000000; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">лактоза отсутствует: фрукты, овощи, чай, кофе, рис, гречка, пшеница, кукуруза, макаронные изделия, соевые продукты, бобовые, яйца, орехи, растительные масла, вино, пиво.</span></p>\r\n</li>\r\n</ul>",
"prevention": "<p><span style=\"font-family: Verdana; font-size: 9.33333px; white-space: pre-wrap;\">При непереносимости лактозы может быть рекомендовано соблюдение безлактозной/низколактозной диеты или использование препаратов лактазы</span></p>",
"clinical_picture": "<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-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Тяжесть симптомов зависит от количественного содержания лактозы и степени индивидуальной переносимости. Некоторые категории пациентов могут быть чувствительны к чрезвычайно малому количеству лактозы, в то время как другие могут съесть большее количество, прежде чем возникнут признаки болезни.</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: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Симптомы лактозной непереносимости включают:</span></p>\r\n<ul style=\"margin-top: 0px; margin-bottom: 0px; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #092148; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; 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: 7pt; color: #000000; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">тошноту;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #092148; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; 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: 7pt; color: #000000; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">судороги;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #092148; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; 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: 7pt; color: #000000; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">газообразование;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #092148; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; 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: 7pt; color: #000000; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">вздутие живота;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #092148; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; 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: 7pt; color: #000000; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">диарею.</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: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Характерные проявления отмечаются в течение промежутка времени от 30 минут до 2 часов после употребления молока или молочных продуктов. Симптомы возникают из-за того, что организм вырабатывает недостаточно лактазы, чтобы «переработать» потребляемую лактозу.</span></p>",
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"code": "E73",
"name": "Непереносимость лактозы",
"icd_name": "Непереносимость лактозы",
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0
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"lead": "Термин для описания патологических состояний, вызванных снижением уровня лактазы — фермента, необходимого для правильного переваривания лактозы.",
"description": "Непереносимостью молока страдают несколько миллионов людей по всему миру. ",
"etiology": "<p>Врожденный дефицит фермента лактазы, распространенный преимущественно среди лиц, принадлежащих к азиатской расе.</p>\r\n<p> </p>\r\n<p>Естественное снижение уровня лактазы, которое начинается еще в детском возрасте (после 3 лет). Насколько значительным будет это снижение, зависит от особенностей организма конкретного человека. Тем не менее, можно с уверенностью сказать, что чем старше человек, тем вероятнее, что он страдает от непереносимости лактозы.</p>\r\n<p> Любое заболевание, которое влияет на клетки тонкой кишки, производящие лактазу, например, воспалительные заболевания и даже грипп. Такое состояние вызывает «вторичную недостаточность лактазы». Это временная проблема, которая исчезает, как только заболевание проходит, поврежденные клетки восстанавливаются и начинают снова вырабатывать ферменты.</p>\r\n<p> Хирургические операции на желудке и кишечнике, которые могут полностью уничтожить способность организма производить лактазу.</p>\r\n<p> </p>",
"pathogenesis": "",
"diagnostics": "<p>Иногда врачи назначают пробу на содержание водорода в выдыхаемом воздухе, анализ сахара в крови, или анализ кислотности стула, чтобы подтвердить диагноз.</p>\r\n<ul>\r\n<li>\r\n<p>Проба на содержание водорода в выдыхаемом воздухе</p>\r\n</li>\r\n</ul>\r\n<p>Это - самый точный анализ непереносимости лактозы. Перед анализом, пациент должен избегать употребления определенных продуктов, лекарств и сигарет. В день анализа, пациент выпивает жидкость, которая содержит лактозу и затем выдыхает в специальный прибор. Высокий уровень водорода - показатель непереносимости лактозы. Этот тест обычно не применяется по отношению к младенцам и очень маленьким детям, так как может вызвать сильный <a href=\"/symptom/diareya/\" title=\"Перейти на страницу симптома Диарея\">понос</a>.</p>\r\n<ul>\r\n<li>\r\n<p>Тест переносимости лактозы</p>\r\n</li>\r\n</ul>\r\n<p>Этот анализ измеряет уровень сахара в крови после употребления продукта, содержащего лактозу. Перед проведением анализа, нельзя ничего есть. В день анализа, пациент выпивает жидкость, содержащую лактозу, которая может вызывать <a href=\"/symptom/meteorizm/\" title=\"Перейти на страницу симптома Метеоризм\">газы</a> или <a href=\"/symptom/bol_v_zhivote/\" title=\"Перейти на страницу симптома Боль в животе\">боль в животе</a>. После этого, каждые 30 минут в течение 2 часов, проверяют кровь. Если уровень сахара в крови не повышается, это может указывать на непереносимость лактозы. Этот анализ не применяется по отношению к больным диабетом пациентам и младенцам.</p>\r\n<ul>\r\n<li>\r\n<p>Анализ кислотности стула</p>\r\n</li>\r\n</ul>\r\n<p>Данный анализ помогает измерить количество кислоты в толстой кишке. Для проведения анализа, необходимо образец кала в изолированном контейнере доставить в лабораторию. Наличие кислоты в кале указывает на неспособность организма нормально переваривать лактозу. Такой анализ может проводить среди младенцев и маленьких детей.</p>",
"treatment": "<p>Что может сделать врач</p>\r\n<p> </p>\r\n<p>Выписать ферменты в виде таблеток или капель. Для лечения других заболеваний выписывать препараты, не содержащие лактозу.</p>\r\n<p> Назначить лечение тяжелой вторичной недостаточности лактазы.</p>\r\n<p> Диетолог может разработать для вас сбалансированную диету.</p>\r\n<p> Врач-педиатр поможет подобрать для вашего ребенка правильное питание и дать вам необходимые рекомендации по кормлению ребенка.</p>\r\n<p> </p>",
"prevention": "<p>Будьте осторожны и старайтесь не заболеть заболеваниями пищеварительной системы. Кроме этого, почти не существует способов предотвратить такое генетически запрограммированное нарушение, как непереносимость лактозы.</p>\r\n<p> </p>\r\n<p>Однако некоторые простые правила предосторожности помогут людям с легкой степенью непереносимости лактазы избежать проявления неприятных симптомов, при этом не лишая себя полностью молока и молочных продуктов.</p>\r\n<p> Если у вас непереносимость лактозы, не лишайте себя совсем молочных продуктов. Попробуйте употреблять в пищу богатые кальцием продукты, например, молоко, но в небольших дозах (меньше чашки) и пейте его во время еды. Обычно сыр и йогурт в небольших количествах достаточно легко переносятся людьми с непереносимостью лактозы.</p>\r\n<p> Также можно попробовать молоко, сыр и творог, не содержащие лактозы или другие источники кальция, например, соевое молоко, миндаль, брокколи и другие зеленые овощи, рыбу и т.д.</p>\r\n<p> </p>",
"clinical_picture": "<p>Симптомы непереносимости лактозы зависят от количества продуцируемой лактазы. Проявление симптомов обычно начинается через 30 минут - 2 часа после употребления молочных продуктов. К основным симптомам непереносимости лактозы, относится:</p>\r\n<ul>\r\n<li>\r\n<p><a href=\"/symptom/meteorizm/\" title=\"Перейти на страницу симптома Метеоризм\">Вздутие</a>.</p>\r\n</li>\r\n<li>\r\n<p>Боль и судороги.</p>\r\n</li>\r\n<li>\r\n<p>Бурчание в животе.</p>\r\n</li>\r\n<li>\r\n<p><a href=\"/symptom/meteorizm/\" title=\"Перейти на страницу симптома Метеоризм\">Газы</a>.</p>\r\n</li>\r\n<li>\r\n<p>Частый жидкий стул или <a href=\"/symptom/diareya/\" title=\"Перейти на страницу симптома Диарея\">понос</a>.</p>\r\n</li>\r\n<li>\r\n<p><a href=\"/symptom/rvota/\" title=\"Перейти на страницу симптома Рвота\">Рвота</a>.</p>\r\n</li>\r\n</ul>",
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},
"code": "E73.9",
"name": "Непереносимость лактозы неуточненная",
"icd_name": "Непереносимость лактозы неуточненная",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
"0"
],
"periodicity": 1,
"slug": "e73.9_neperenosimost_laktozy_neutochnennaya",
"lead": "неспособность переваривать лактозу, часто связанную с недостаточностью фермента лактазы",
"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;\">Непереносимость лактозы — неспособность организма переваривать молочный сахар. Для расщепления лактозы на простые сахара или моносахариды в тонком кишечнике должен вырабатывать фермент под названием лактаза. Непереносимость лактозы характеризуется чрезмерным газообразованием, судорогами и диареей. Проявления болезни возникают, как правило, после употребления молочных продуктов.</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;\">Некоторые причины непереносимости лактозы хорошо известны. Первичная лактазная недостаточность – состояние, которое развивается с течением времени. Примерно после 2 лет организм начинает вырабатывать меньше лактазы. Вторичная лактазная недостаточность возникает, когда повреждение тонкого кишечника или некоторые заболевания пищеварительной системы снижают количество вырабатываемого фермента. К таким заболеваниям относятся:</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: 8pt; font-family: Verdana; color: #092148; 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 (глютеновая недостаточность);</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #092148; 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;\">воспаление кишечника;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #092148; 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;\">болезнь Крона.</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;\">Исследователи выявили генетическую связь непереносимости лактозы. Некоторые люди рождаются с вероятностью развития первичной лактазной недостаточности, потому что она была передана им генетически (унаследованная от родителей). Это открытие может быть полезно при разработке диагностического теста для выявления людей с этим заболеванием.</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;\">Дети, рожденные преждевременно, чаще страдают непереносимостью лактозы, поскольку уровень лактазы не повышается до третьего триместра беременности женщины.</span></p>",
"pathogenesis": "",
"diagnostics": "<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-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Для постановки точного диагноза используются лабораторные исследования: дыхательный водородный тест, анализ крови на сахар, исследование кислотности стула. Исследование активности фермента в ткани с помощью биопсии тонкой кишки считается менее чувствительным методом.</span></p>\r\n<ul>\r\n<li><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;\">Анализ крови</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: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Активность фермента можно проверить с помощью определения уровня глюкозы в крови после употребления 50 граммов лактозы (количество лактозы в литре молока). Уровень сахара в крови будет проверяться каждые 30 минут в течение двух часов. Если уровень сахара не повышается, скорее всего, это будет свидетельствовать о гиполактазии.</span></p>\r\n<ul>\r\n<li><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;\">ПЦР тест</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: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">В последние годы была предложена проверка генотипа с помощью ПЦР в реальном времени. Такой тест имеет высокую специфичность для гиполактазии и широко используется.</span></p>\r\n<ul>\r\n<li><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;\">Тест на кислотность стула</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: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Кислотность стула измеряется в образце фекалий, немедленно принесенном в лабораторию. Если в стуле присутствует кислота, то лактоза, вероятно, переваривается неправильно. Это наиболее предпочтительный метод для младенцев.</span></p>\r\n<ul>\r\n<li><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;\">Дыхательный водородный тест</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: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Это надежное, но длительное исследование, которое заключается в определении количества водорода в выдыхаемом воздухе. На протяжении нескольких часов пациент делает серию глубоких выдохов, которые затем необходимо повторить после употребления 50 гр лактозы. Повышение концентрации водорода через 2 часа после воздействия указывает на дефицит фермента, разлагающий молочный сахар.</span></p>",
"treatment": "<p> </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-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Медикаментозная терапия как таковая не используется. Основа лечения — правильно подобранная диета. При расстройствах желудочно-кишечного тракта могут назначаться противорвотные средства, миотропные спазмолитики, препараты для улучшения моторики кишечника и стабилизации стула.</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-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Для людей, страдающих непереносимостью молока, существует несколько вариантов питания. Некоторым можно употреблять продукты молочного брожения — кефир, йогурт, творог, сыр. При значительном дефиците лактазы следует отдавать предпочтение специальным продуктам — например, безлактозному молоку. Также можно принимать фермент лактазу в виде таблеток непосредственно при употреблении молочных блюд.</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-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Норма лактозы, которую можно употреблять без вреда для здоровья, является индивидуальной. При тяжелой непереносимости молока допускается не более 1 г молочного сахара в сутки. При нарушении средней тяжести — не более 10 г.</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: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Составлять диету нужно с учетом состава. Обратите внимание, что есть продукты, в которых:</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<ul style=\"margin-top: 0px; margin-bottom: 0px; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #666666; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; 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: 7pt; color: #000000; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">молочный сахар является естественным ингредиентом: сухое и цельное молоко, сыр, творог, пахта, кумыс, сыворотка, сметана, сливки;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #666666; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; 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: 7pt; color: #000000; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">лактоза присутствует в связи с особенностями производства: колбасные изделия, варенье, джем, супы и картофельное пюре быстрого приготовления, хлеб, бисквиты, горчица, майонез, кетчуп, шоколад, какао;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #666666; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; 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: 7pt; color: #000000; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">лактоза отсутствует: фрукты, овощи, чай, кофе, рис, гречка, пшеница, кукуруза, макаронные изделия, соевые продукты, бобовые, яйца, орехи, растительные масла, вино, пиво.</span></p>\r\n</li>\r\n</ul>",
"prevention": "<p><span style=\"font-family: Verdana; font-size: 9.33333px; white-space: pre-wrap;\">При непереносимости лактозы может быть рекомендовано соблюдение безлактозной/низколактозной диеты или использование препаратов лактазы</span></p>",
"clinical_picture": "<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-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Тяжесть симптомов зависит от количественного содержания лактозы и степени индивидуальной переносимости. Некоторые категории пациентов могут быть чувствительны к чрезвычайно малому количеству лактозы, в то время как другие могут съесть большее количество, прежде чем возникнут признаки болезни.</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: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Симптомы лактозной непереносимости включают:</span></p>\r\n<ul style=\"margin-top: 0px; margin-bottom: 0px; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #092148; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; 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: 7pt; color: #000000; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">тошноту;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #092148; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; 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: 7pt; color: #000000; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">судороги;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #092148; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; 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: 7pt; color: #000000; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">газообразование;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #092148; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; 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: 7pt; color: #000000; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">вздутие живота;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #092148; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; 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: 7pt; color: #000000; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">диарею.</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: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Характерные проявления отмечаются в течение промежутка времени от 30 минут до 2 часов после употребления молока или молочных продуктов. Симптомы возникают из-за того, что организм вырабатывает недостаточно лактазы, чтобы «переработать» потребляемую лактозу.</span></p>",
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},
"code": "L41",
"name": "Парапсориаз",
"icd_name": "Парапсориаз",
"gender": 0,
"age_min": 15,
"age_max": 100,
"cause": [
3,
0
],
"periodicity": 4,
"slug": "l41_parapsoriaz",
"lead": "дерматоз, который объединяет в себе симптомы розового лишая, себорейной экземы, обычного псориаза и плоского красного лишая.",
"description": "Тяжелая хроническая незаразная болезнь кожи.",
"etiology": "<p>Существует несколько версий ее происхождения: ранее парапсориазу приписывали инфекционное происхождение, так как симптомы похожи на многие инфекционные кожные инфекции, но эта гипотеза не нашла подтверждения;</p>\r\n<p>на современном этапе считается, что фактором ее развития является аллергическая реакция организма на раздражитель;</p>\r\n<p>не последнюю роль играют перенесенные инфекционные заболевания (ОРВИ, ангина, грипп);</p>\r\n<p>присутствие хронических центров инфекции (тонзиллит, гайморит, пиелонефрит);</p>\r\n<p>объясняется развитие сосудистыми проблемами;</p>\r\n<p>нарушением в иммунной системе; дисфункцией эндокринной системы.</p>\r\n<p>Спровоцировать всплеск симптомов могут соматические заболевания:</p>\r\n<p>нарушение в работе ЖКТ, печени, секреторные дисфункции, неблагоприятная экология.<br /><br /><br /></p>",
"pathogenesis": "",
"diagnostics": "<p>При диагностике заболевания возникают трудности, аналогичная симптоматика с различными видами дерматитов не дает возможности однозначно поставить диагноз. Четких критериев для лабораторных исследований для определения парапсориаза еще не разработано. Дерматологи основываются: на исследовании результатов анализа крови: на основе биопсии элементов поражений в местах очагов воспаления: Это необходимо для того, чтобы дифференцировать парапсориаз от других болезней, так как визуальный осмотр не всегда дает четкой картины.</p>",
"treatment": "<p>При каплевидном парапсориазе производят санацию очагов инфекции. Назначают антибиотики широкого спектра действия, гипосенсибилизирующие, антигистаминные, сосудистые (теоникол, компламин) препараты. При хронической и подострой формах в стадии разрешения рекомендуют ПУВА-терапию. Если эффект от вышеуказанного лечения оказывается недостаточно эффективным, назначают небольшие дозы глюкокортикостероидов.</p>\r\n<p>Наружно назначают местные глюкокортикостероидные, рассасывающие мази.</p>",
"prevention": "",
"clinical_picture": "<p>Бляшечный парапсориаз</p>\r\n<p>Такая форма заболевания может быть представлена мелкими и крупными папулами. В первом случае патология относительно безопасна, а вот крупнобляшечный тип может постепенно трансформироваться в лимфому.</p>\r\n<p>Начинается парапсориаз этого типа с возникновения пятен бледно-розового оттенка с небольшим количеством инфильтрата. Диаметр высыпаний не превышает 5 сантиметров, они имеют неправильную либо округлую форму. Локализуются новообразования чаще всего на конечностях либо на самом туловище.</p>\r\n<p><a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">Сыпь</a> носит чешуйчатый характер, часто сопровождается гиперпигментацией.</p>\r\n<p>Бляшечный парапсориаз не влияет на общее самочувствие пациента. Заболевание протекает на протяжении длительного периода.</p>\r\n<p>Не исключено перерождение псориатических бляшек в грибовидный микоз. Симптомом такого перерождения является нестерпимый <a href=\"/symptom/zud/\" title=\"Перейти на страницу симптома Зуд\">зуд</a>.</p>\r\n<p>Каплевидный парапсориаз</p>\r\n<p>Появляется характерная <a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">сыпь</a>, состоящая из своеобразных узелков размером с зерно. Цвет сыпи может быть разным – от бледно-розового оттенка до насыщенно-коричневого. Центральная часть образований шелушится.</p>\r\n<p>Место локализации – конечности, туловище, но <a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">высыпания</a> могут возникать и на других частях тела.</p>\r\n<p>Каплевидный парапсориаз отличается несколькими характерными особенностями, по которым врач-дерматолог и дифференцирует его:</p>\r\n<ul>\r\n<li>«феномен облатки»: если попытаться аккуратно снять чешуйку с узелка, она отпадет монолитным пластом;</li>\r\n<li>«феномен пурпуры»: при сильном механическом воздействии на папулах можно наблюдать небольшие точечные кровоизлияния;</li>\r\n<li>«симптом скрытого шелушения»: если слегка поскоблить узелок, на нем возникает отрубевидное <a href=\"/symptom/shelushenie_kozhi/\" title=\"Перейти на страницу симптома Шелушение кожи\">шелушение</a>.</li>\r\n</ul>\r\n<p>Для ремиссии данного типа парапсориаза свойственно полное исчезновение внешних симптомов либо возникновение лейкодермических пятен.</p>\r\n<p>Острый парапсориаз</p>\r\n<p><a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">Сыпь</a> носит тотальный, полиморфный характер. <a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">Высыпания</a> могут носить разный характер:</p>\r\n<p><br /><br /><br /></p>\r\n<p> </p>\r\n<ul>\r\n<li>пузырьковый;</li>\r\n<li>папулезный;</li>\r\n<li>пустулезный;</li>\r\n<li>геморрагический.</li>\r\n</ul>\r\n<p><a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">Высыпания</a> покрывают все тело, в том числе лицо, стопы и кисти. Начинается острый парапсориаз внезапно, <a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">сыпь</a> распространяется очень быстро, покрывая всю кожу. Чаще всего <a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">высыпания</a> не оставляют следов после себя, иногда возникают осповидные рубцы.</p>\r\n<p>Острый парапсориаз может трансформироваться в каплевидную форму заболевания.</p>\r\n<p>Общие симптомы – незначительно повышенная температура, увеличенные лимфоузлы, общая <a href=\"/symptom/slabost/\" title=\"Перейти на страницу симптома Слабость\">слабость</a>.</p>\r\n<p>Лихеноидный парапсориаз</p>\r\n<p>Данная форма встречается нечасто. Для нее характерно появление на коже округлых либо конусообразных папул, окрашенных в желтовато-красный либо коричневый оттенок. Поверхность новообразований блестящая и гладкая, иногда к ней прикреплены небольшие чешуйки.</p>\r\n<p>Форма сыпи – сетевидная. Она покрывает кожу век и туловище, неприятных ощущений не вызывает.</p>",
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