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},
"code": "D86.0",
"name": "Саркоидоз легких",
"icd_name": "Саркоидоз легких",
"gender": 0,
"age_min": 20,
"age_max": 50,
"cause": [
"0"
],
"periodicity": 1,
"slug": "d86.0_sarkoidoz_legkih",
"lead": "системное заболевание, которое характеризуется образованием воспалительных уплотнений в легочной ткани (гранулем)",
"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;\">Саркоидоз легких является заболеванием с неясной этиологией. Ни одна из выдвинутых теорий не дает достоверного знания о природе происхождения саркоидоза. Последователи инфекционной теории предполагают, что возбудителями саркоидоза могут служить микобактерии, грибы, спирохеты, гистоплазма, простейшие и другие микроорганизмы. Существуют данные исследований, основанные на наблюдениях семейных случаев заболевания и свидетельствующие в пользу генетической природы саркоидоза. Некоторые современные исследователи развитие саркоидоза связывают с нарушением иммунного ответа организма на воздействие экзогенных (бактерий, вирусов, пыли, химических веществ) или эндогенных факторов (аутоиммунные реакции).</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;\">Таким образом, на сегодняшний день есть основания считать саркоидоз заболеванием полиэтиологического генеза, связанного с иммунными, морфологическими, биохимическими нарушениями и генетическими аспектами. Саркоидоз не относится к контагиозным (т. е. заразным) заболеваниям и не передается от его носителей к здоровым людям. Прослеживается определенная тенденция заболеваемости саркоидозом у представителей некоторых профессий: работников сельского хозяйства, химических производств, здравоохранения, моряков, почтовых служащих, мельников, механиков, пожарных в связи с повышенными токсическими или инфекционными воздействиями, а также у курящих лиц.</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;\">Как правило, саркоидоз характеризуется полиорганным течением. Легочный саркоидоз начинается с поражения альвеолярной ткани и сопровождается развитием интерстициального пневмонита или альвеолита с последующим образованием саркоидных гранулем в субплевральной и перибронхиальной тканях, а также в междолевых бороздах. В дальнейшем гранулема либо рассасывается, либо претерпевает фиброзные изменения, превращаясь в бесклеточную гиалиновую (стекловидную) массу.</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 прогрессировании саркоидоза легких развиваются выраженные нарушения вентиляционной функции, как правило, по рестриктивному типу. При сдавлении лимфатическими узлами стенок бронхов возможны обструктивные нарушения, а иногда и развитие зон гиповентиляции и ателектазов.</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;\">Морфологическим субстратом саркоидоза служит образование множественных гранулем из эпитолиоидных и гигантских клеток. При внешнем сходстве с туберкулезными гранулемами, для саркоидных узелков нехарактерно развитие казеозного некроза и наличие в них микобактерий туберкулеза. По мере роста саркоидные гранулемы сливаются во множественные большие и малые очаги. Очаги гранулематозных скоплений в каком-либо органе нарушают его функцию и приводят к появлению симптоматики саркоидоза. Исходом саркоидоза служит рассасывание гранулем или фиброзные изменения пораженного органа.</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;\">Для диагностики саркоидоза назначают:</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;\">Анализы крови\u2028 с несколькими показателями, среди которых титры гамма-глобулина.</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 легких\u2028. </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\u2028 и МРТ\u2028. </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;\">Реакцию Квейма. Это исследование при котором больному вводят под кожу специальный антиген. Если на коже появляется красный бугорок, это подтверждает наличие в организме саркоидоза. Необязательно он будет локализован именно в легких — просто как факт болезни. Бронхоскопию\u2028 (факультативно). В процессе исследования делается забор измененных тканей для 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;\">Такое комплексное исследование позволяет довольно точно провести диагностику саркоидоза и дифференцировать его среди других заболеваний.</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 саркоидоза проводится назначением длительных курсов (до 6-8 месяцев) стероидных (преднизолон), противовоспалительных (индометацин, ацетилсалициловая к-та) препаратов, иммунодепрессантов ( хлорохин, азатиоприн и др.), антиоксидантов (ретинол, токоферола ацетат и др.). Терапию преднизолоном начинают с ударной дозы, затем постепенно снижают дозировку. При плохой переносимости преднизолона, наличии нежелательных побочных эффектов, обострении сопутствующей патологии терапию саркоидоза проводят по прерывистой схеме приема глюкокортикоидов через 1—2 дня. Во время гормонального лечения рекомендуется белковая диета с ограничением поваренной соли, прием препаратов калия и анаболических стероидов.</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 назначении комбинированной схемы терапии саркоидоза 4-6-месячный курс преднизолона, триамцинолона или дексаметазона чередуют с нестероидной противовоспалительной терапией индометацином или диклофенаком. Лечение и диспансерное наблюдение за пациентами с саркоидозом осуществляется фтизиатрами.</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;\">Сегодня не разработано никаких средств, которые помогли бы предупредить появление заболевания. Никакие профилактические мероприятия разработать нет возможности, так как неясно, что провоцирует возникновение болезни. Однако иногда врачи говорят о том, что сократить риск появления недуга можно, повысив иммунитет, а также снизив воздействие на организм профессиональных вредностей.</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;\">Заболевание на раннем этапе развития практически не проявляется. Первые симптомы возникают, когда гранулемы достигают больших размеров. Человек с саркоидозом легких испытывает общее недомогание, слабость, повышенную утомляемость. Он может замечать, что теряет вес, часто испытывает необоснованное беспокойство. В дальнейшем возникают следующие специфические симптомы саркоидоза легких:</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;\">сухой кашель;</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;\">нарушения сна;</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;\">боли в грудной клетке;</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;\">потливость;</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;\">лихорадка.</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\"><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 человека поднимается температура тела, беспокоит потеря аппетита. Боли могут распространяться на суставы. На поздней стадии развития заболевания у пациента возникает одышка. Дыхание становится усложненным, сопровождающимся хрипами. Если не начинать срочно лечение, то состояние пациента будет быстро ухудшаться. Его начинает беспокоить:</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;\">постоянный кашель с отхождением 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;\">боли в лимфатических узлах;</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;\">суставные боли.</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> </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 дальнейшем заболевание грозит появлением серьезных осложнений. Оно может вызвать поражение и других органов. Например, распространиться на кости, лимфоузлы и кожу.</span></p>",
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}
]
}