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},
"code": "I73.1",
"name": "Облитерирующий тромбоангиит [болезнь Бергера]",
"icd_name": "Облитерирующий тромбоангиит [болезнь Бергера]",
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],
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"slug": "i73.1_obliteriruyuschiy_tromboangiit_bolezn_bergera",
"lead": "воспалительное поражение кровеносных сосудов",
"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;\">Облитерирующий тромбангиит - воспалительный тромбоз мелких артерий, среднего размера артерий и некоторых поверхностных вен, вызывающий артериальную ишемию дистальных отделов конечностей и поверхностный тромбофлебит. Главный фактор риска - курение.</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;\">До настоящего времени причины данного заболевания так до конца и не выяснены. Но на основании многолетних наблюдений за пациентами с облитерирующим тромбангиитом удалось выявить некоторые причинно-следственные связи. К ним можно отнести:</span></p>\r\n<p> </p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Наследственность, т. е. если данное заболевание наблюдалось хотя бы у одного из кровных родственников (у бабушки, дедушки, мамы, папы или кого-то из братьев и сестёр).</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Аутоиммунный механизм повреждения сосудов циркулирующими иммунными комплексами. В этом случае иммунная система человека вместе защиты организма человека от внешних воздействий, таких как вирусы, бактерии, паразиты и др. возбудители инфекций, начинает повреждать собственные клетки, \"считая\" их врагами. По каким причинам это происходит, к сожалению, медицине до сих пор точно неизвестно.</span></li>\r\n<li style=\"list-style-type: none; font-size: 8pt; font-family: Verdana; color: #181d21; 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;\">Самая главная причина, без которой заболевание не развивается, даже если у человека есть наследственная предрасположенность и аутоиммунная настроенность организма — это табакокурение. В настоящее время выяснено, что 98 % больных облитерирующим тромбангиитом, а по некоторым данным 100 %, являются злостными курильщиками. Именно в связи с этим заболевание еще называют болезнью молодых курильщиков.</span></p>\r\n</li>\r\n</ul>",
"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;\">Первичными в звене патогенеза облитерирующего тромбангиита считаются наследственность и генетическая предрасположенность. В последние годы признаётся важная роль собственных антигенов гистосовместимости (совместимости тканей) в осуществлении ряда основных функций иммунитета человека. Это создаёт предпосылки для понимания механизмов взаимосвязи между антигенами совместимости тканей (они ещё называются HLA-антигены, или human leukocyte antigens) и болезнями. Считается, что эти гены регулируют иммунный ответ и являются посредниками в различных иммунологических реакциях, в том числе патологических (вызывающих заболевание). Однако даже наличие наследственности и генетической предрасположенности не приводит к развитию заболевания без внешних провоцирующих факторов, основным из которых является табакокурение.</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;\">Важно знать, что для развития заболевания не нужен большой стаж курения и не нужно выкуривать по несколько пачек сигарет, достаточно 1-2 сигарет в сутки и через промежуток времени от месяца до года могут возникнуть симптомы заболевания. Но только в том случае, если у пациента имеется генетическая предрасположенность.</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;\">Итак, когда необходимые звенья патогенеза собрались в цепь и были запущены курением, в сосудах мелкого и среднего калибра поэтапно начинают развиваться патологические изменения.</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;\">Никотин, содержащийся в табаке, попадает в кровь и начинает воздействовать на внутреннюю поверхность сосудов — эндотелий. В результате нормальный эндотелий становится изменённым и организм начинает воспринимать его как чужеродный, опасный для себя. При этом запускается механизм выработки циркулирующих иммунных комплексов (это специальные защитники нашего организма для борьбы с чужеродными клетками). Иммунные комплексы в крови взаимодействуют с эндотелием сосудов и начинают атаковать его. В результате в стенке артерии или вены возникает множество повреждённых участков, стенки сосудов воспаляются и утолщаются.</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;\">В таком воспалённом сосуде происходит стаз кровотока (замедление, сгущение) и образуются тромбы. Эти сгустки крови перекрывают просвет сосуда, кровоснабжения тканей ухудшается, что, в свою очередь, является причиной нарушения трофики (клеточного питания) и возникновения клинических симптомов заболевания.</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 общем и биохимическом анализах крови выявляются неспецифические изменения: лейкоцитоз, рост СОЭ, увеличение фибрина, серомукоида, гаптоглобина, сиаловых кислот, γ-глобулинов. При иммунологическом исследовании определяются антигены HLA В5, А9, DR4. Коагулограмма при облитерирующем тромбангиите выявляет повышенную свертываемость крови и агрегацию тромбоцитов.</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 проведении кожной термографии и теплометрии определяются зоны пониженной температуры, свидетельствующие о нарушении кровообращения в дистальных отделах конечностей. Степень микроциркуляторных нарушений уточняется в ходе радиоизотопного сканирования (сцинтиграфии), УЗДГ, реовазографии, рентгеноконтрастной ангиографии периферических сосудов. При ЭКГ обнаруживаются ишемические изменения в сердце.</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;\">Медикаментозное лечение включает прием ангиоспазмолитических препаратов (ксантинола никотината, дротаверина, кислоты никотиновой, циннаризина, алпростадила); нестероидных анальгетиков; средств, улучшающих реологические показатели крови (пентоксифиллина, ацетилсалициловой к-ты, дипиридамола) и трофику тканей (витаминов группы В, никотиновой кислоты, аденозинмонофосфата, пирикарбата, даларгина).</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;\">Пациентам с облитерирующим тромбангиитом назначается тренировочная ходьба, фотогемотерапия (УФОК, ВЛОК), плазмаферез, гемосорбция, гипербарическая оксигенация, санаторное лечение.</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 неэффективности консервативной терапии пациенту необходима консультация сосудистого хирурга. Хирургическое лечение облитерирующего тромбангиита может заключаться в проведении поясничная симпатэктомии, операции обходного шунтирования пораженных сосудов, баллонной ангиопластики или ампутации конечности.</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;\">Профилактика заболевания заключается в соблюдении правил здорового образа жизни:</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;\">категорическом отказе от курения;</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;\">правильном питании;</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;\">активном двигательном режиме (ежедневная ходьба, лёгкий бег, скандинавская ходьба, катание на велосипеде, плавание);</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;\">соблюдении режима сна и бодрствования (необходим полноценный ночной сон длительностью 6-8 часов в сутки).</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 для профилактики заболевания важно регулярно проходить плановые медицинские осмотры.</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;\">Поражение периферических артериальных путей при облитерирующем тромбангиите носит двусторонний характер с заинтересованностью обеих верхних либо нижних конечностей от дистальных до проксимальных отделов. Облитерирующий тромбангиит отличается триадой признаков: перемежающейся хромотой, синдромом Рейно и поверхностным мигрирующим тромбофлебитом дистальных участков конечностей.</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;\">Клинические проявления перемежающейся хромоты включают боли в стопе и икроножных мышцах во время ходьбы; при поражении верхних конечностей в процессе выполнения действий руками боли возникают в кистях и предплечьях. Отмечается бледность и цианотичность пальцев, повышение чувствительности стоп и кистей к холоду, появление кровоизлияний и болезненных узелков на коже подушечек пальцев. Тяжелые ишемические поражения конечностей при облитерирующем тромбангиите проявляются болями в покое, отсутствием пульсации на артериях стопы и рук, изъязвлениями, трофическими нарушениями и гангреной пальцев вплоть до самоампутации некротизированных зон.</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;\">Вовлеченность венечных артерий выражается развитием стенокардии и инфаркта миокарда. При поражении брыжеечных артерий возникают резкие боли в животе, кровотечения из пищеварительного тракта, язвы и некрозы стенки кишки. При заинтересованности сосудов мозга возможно развитие инсульта, ишемического неврита зрительных нервов. Тромбозы почечных артерий ведут к инфарктным изменениям паренхимы почки.</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;\">Обострения облитерирующего тромбангиита провоцируются холодом и частым курением, возможно развитие вторичного инфицирования мягких тканей конечностей.</span></p>",
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},
"code": "I77.6",
"name": "Артериит неуточненный",
"icd_name": "Артериит неуточненный",
"gender": 0,
"age_min": 1,
"age_max": 100,
"cause": [
"0"
],
"periodicity": 1,
"slug": "i77.6_arteriit_neutochnennyy",
"lead": "группа заболеваний, обусловленная иммунопатологическими воспалительными процессами, происходящими в кровеносных сосудах",
"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;\">Ключевым звеном большинства случаев поражения артерий выступают идиопатические аутоиммунные нарушения, повреждения сосудистой стенки при системных болезнях соединительной ткани. К предрасполагающим факторам развития васкулита относятся следующие:</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;\">Отягощенная наследственность. Связь патологии с расовой принадлежностью, а также нередкие семейные случаи заболевания позволяют установить влияние генетических факторов на формирование артериита. Повышенный риск болезни обусловлен носительством определенных генов главного комплекса гистосовместимости (HLA).</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 заболевания. В этом случае поражение артерий развивается как осложнение инфекционного процесса любой локализации. Чаще всего предпосылкой артериита выступают бактериальные (стрептококковый фарингит, сифилис, туберкулез), вирусные процессы (грипп, герпетические инфекции, вирусные гепатиты, сыпной тиф).</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;\">Ятрогенные факторы. В качестве триггера манифестации артериита нередко выступает вакцинация, введение сывороток с целью иммунизации или лечения инфекционных болезней, применение некоторых лекарств. При этом негативные последствия являются индивидуальной реакцией организма на препарат, и они не связаны с врачебной ошибкой.</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;\">Прочие причины. Пусковым фактором аутоиммунного процесса изредка выступают экзогенные влияния: повышенная инсоляция, переохлаждение, резкая смена климата и/или часовых поясов. У женщин нарушения иммунной системы нередко провоцируются циклическими гормональными изменениями, беременностью, менопаузой.</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;\">Основные диагностические методы, позволяющие обнаружить артериит:</span></p>\r\n<ul>\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;\">Сбор анамнеза;</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;\">Общий осмотр больного, измерение пульса, аускультация сердца и легких,</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;\">Общий и биохимический анализ крови — повышение СОЭ и С-реактивного белка, умеренная анемия;</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;\">УЗИ сосудов;</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;\">Биопсия артерии — выявление многоядерных гигантских клеток;</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;\">Артериография;</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;\">Осмотр глазного дна;</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;\">Офтальмоскопия – обнаружение ишемического неврита глазного нерва.</span></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;\">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;\">Основу терапии артериитов составляют медикаментозные методы, которые направлены на коррекцию иммунологических нарушений, стабилизацию общего состояния больного, предупреждение осложнений. Подбирается персонализированная схема фармакотерапии с учетом вида артериита, наличия сопутствующих патологий. Применяются такие группы препаратов:</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;\">Кортикостероиды. Лекарства первой линии для подавления гиперергических реакций иммунной системы, снижения продукции аутоантител и провоспалительных цитокинов. В зависимости от тяжести состояния назначается пульс-терапия и/или длительная схема приема гормональных препаратов.</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;\">Цитостатики. Медикаменты используются как дополнение к кортикостероидной терапии, чтобы усилить иммуносупрессивный эффект, быстрее достичь клинико-лабораторной ремиссии.</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;\">Биологические препараты. Моноклональные антитела, которые инактивируют провоспалительные факторы, показывают хорошую эффективность для купирования острых симптомов артериита. Подобные лекарства имеют щадящее действие, по сравнению с цитостатиками.</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;\">Антиагреганты. Для коррекции показателей свертывания крови эффективны вазодилатирующие средства, препараты из групп НПВС. С целью ликвидации и профилактики тромбозов рекомендованы лекарства из группы антикоагулянтов.</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;\">Противомикробные средства. Антибиотики, противовирусные, противопротозойные лекарства требуются для ликвидации инфекций, вызывающих вторичный артериит.</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 аутоиммунном воспалении артерий для снижения числа циркулирующих иммунных комплексов, аутоантител, цитокинов проводится экстракорпоральное очищение крови. С этой целью применяются методики плазмафереза, криоафереза, каскадной фильтрации плазмы. При почечной недостаточности пациенты переводятся на гемодиализ, который обеспечивает выведение токсических метаболитов из организма.</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;\">Поскольку поражение артерий чревато утолщением их стенки или закупоркой тромбом при критическом снижении кровотока в поврежденном участке сосуда показано хирургическое вмешательство. С учетом локализации стенозированного участка возможно проведение эндартерэктомии, чрескожной ангиопластики, обходного шунтирования. При сопутствующем поражении клапанного аппарата крупных сосудов (аорты, легочной артерии) выполняется замена клапанов.</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;\">В основе профилактики артериита лежит ранняя диагностика и терапия болезней, которые могут стать пусковым фактором его развития. Также больным рекомендуется соблюдение противоэпидемических мер, избегание необоснованного приема лекарств, исключение чрезмерной инсоляции. </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;\">Врачи выделяют несколько основных типов артериита: гигантоклеточный, Такаясу и нижних конечностей. Каждый из них имеет ряд специфических симптомов. При гигантоклеточном или височном артериите заболевание затрагивает сосуды в области глаз, висков и даже позвоночника. При этом пациент жалуется на:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"font-size: 7pt; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">падение остроты зрения;</span></li>\r\n<li><span style=\"font-size: 7pt; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">пульсирующие головные боли;</span></li>\r\n<li><span style=\"font-size: 7pt; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">помутнение в глазах;</span></li>\r\n<li><span style=\"font-size: 7pt; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">общее недомогание;</span></li>\r\n<li><span style=\"font-size: 7pt; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">повышение температуры тела;</span></li>\r\n<li><span style=\"font-size: 7pt; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">потерю аппетита.</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\"><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;\">Помимо этого, у человека с такой формой артериита опускается веко на глазу, расположенном рядом с пораженным сосудом. Как правило, такой тип заболевания беспокоит в подавляющем большинстве случаев людей старшего возраста.</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 артериите нижних конечностей появляются болезненные ощущения в ногах. Симптом значительно усиливается после длительной ходьбы и физических нагрузок. Помимо этого, у больного постоянно мерзнут ноги, даже если на них теплые носки.</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;\">Самой редкой формой считается артериит Такаясу или неспецифический аортоартериит. При этом заболевании поражаются артерии в области рук, а также сосуды, который отвечают за кровоснабжение головного мозга. Распознать такую болезнь можно по следующим симптомам:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"font-size: 7pt; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">головокружения;</span></li>\r\n<li><span style=\"font-size: 7pt; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">слабость в руках;</span></li>\r\n<li><span style=\"font-size: 7pt; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">отсутствие пульса в пораженной области;</span></li>\r\n<li><span style=\"font-size: 7pt; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">разность артериального давления в руках;</span></li>\r\n<li><span style=\"font-size: 7pt; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">головные боли.</span></li>\r\n</ul>",
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