rasseyanniy skleroz (pc)

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demielinizatsiya i degenerativnie zabolevaniya nervnoy sistemi. rasseyanniy skleroz (pc) demieliniziruyushee zabolevanie tsns, xarakterizuyusheesya mnogoochagovim porajeniem belogo veshestva i xronicheskim progredientnim techeniem. zabolevanie porajaet molodix lyudey, sokrashaya prodoljitelnost jizni v srednem na 10 let, v podavlyayushem bolshinstve sluchaev privodit k ranney invalidizatsii (cherez 20 let tolko 30% ee ne imeyut); klinika otlichaetsya polimorfizmom nevrolocheskix narusheniy. epidemiologiya. v mire naschitivaetsya 3 mln bolnix pc, zabolevanie chashe vstrechaetsya po mere udaleniya ot ekvatora (na severe ameriki i evropi), sredi zabolevshix preobladayut jenshini. v sankt-peterburge okolo 35 tis. patsientov. v ssha, kanade, zapadnoy evrope nablyudaetsya 30—60 sluchaev na 100 000 naceleniya, v tsentralnoy afrike i amerike, azii 5:100 000, v yaponii 2-4:100 000, v rossii - 25-50:100 000. pri masshtabnix epidemiologicheskix obsledovaniyax videleni geograficheskie zoni, xarakterizuyushiesya visokoy, umerennoy i nizkoy rasprostranennostyu pc. nekotorie avtori videlyayut semeynie formi pc. pri etom bolshoy interes predstavlyaet znachenie pereseleniya lyudey i vozniknoveniya pc pri semeynoy forme. esli pereselenie …

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tvetom «defektnoy» immunnoy sistemi na demielini-ruyushiy protsess. pc otnosyatsya k medlennim infektsiyam*. nekotorie avtori ukazivayut na visokiy titr v krovi i likvore patsientov protivokorevix antitel i videlenie paramiksovirusov. v semyax bolnix pc dopuskaetsya sushestvovanie v odnoy iz xromosom spetsialnogo gena guvstvitel'nosti k pc. v patogeneze zabolevaniya igrayut rol autoimmunnie narusheniya: pod vliyaniem neustanovlennogo virusa izmenyayutsya antigenni svoystva mielina, k kotoromu nachinayut virabativatsya antitela. * medlennie infektsii (mi) - ponyatie, vvedennoe b. sigurdsonom (1954). cherti mi: · dlitelniy latentniy period (neskolko mesyatsev neskolko let): progressiruyushee techenie, vedushee k tyajelomu porajeniyu organov i sistem, i smerti. zarajenie mi chashe vsego proisxodit ili v neonatalnom periode, ili v vozraste do 7 let. v likvore patsientov uvelichivaetsya kolichestvo t-limfotsitov i snijaetsya uroven t-supressorov, izmenyaetsya sostav belka mielina, gidroliticheskix fermentov, uchastvuyushix v razrushenii mielina, v krovi patsientov povishaetsya uroven xolesterina, ego efirov i fosfolipidov, snijaetsya uroven interferonov. obostrenie pc svyazano s zamedleniem ili blokadoy provedeniya …

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nalnaya forma. iii.tserebrospinalnaya forma. 2.klassifikatsiya po stadiyam: i. nachalnaya. ii. razvernutaya. iii. pozdnyaya. obichno v nachalnoy stadii preobladayut tserebralnie narusheniya, v razvernutoy tserebrospinalnie, a v pozdney spinalnie. 3.klassifikatsiya po tipu tegeniya: i. blagopriyatniy (dobrokachestvenniy). ii. remittiruyushiy (vo vremya remissii net progressirovaniya zabolevaniya, narushennie funktsii pochti polnostyu vosstanavlivayutsya). iii. pervichno-progressiruyushiy (bolezn progressiruet s samogo ee nachala bez virajennix uluchsheniy). iv. vtorichno-progressiruyushiy (nachinaetsya kak remittiruyushiy, a zatem perexodit v neuklonno progressiruyushiy). v. progressivno-retsidiviruyushiy (zabolevanie progressiruet s samogo nachala s virajennimi periodami uxudsheniya i znachitelnimi uluchsheniyami). klinicheskaya kartina pc. zabolevanie nachinaetsya v 16- 50 let, chashe v period 20—35, krayne redko do 10 i pochti nikogda posle 50. zabolevaemost jenshin v 2 raza vishe, chem u mujchin. klinicheskaya kartina predstavlena razlichnimi nevrologicheskimi simptomami, kotorie voznikayut vsled za prostudoy, stressom, peregrevaniem, silnim pereoxlajdeniem, privivkoy, udaleniem zuba, priemom nekotorix lekarstvennix preparatov (naprimer, immunomodulyatorov). nevrologicheskie narusheniya razvivayutsya preimushestvenno postepenno, reje v techenie neskolkix chasov. v debyute …

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: 1. piramidnie rasstroystva parezi i paralichi. mozjechkovie rasstroystva narusheniya ravnovesiya i triada sharko: intentsionniy tremor, skandirovannaya rech, nistagm. 3. glazodvigatelnie rasstroystva i narusheniya zreniya vipadenie chastey polya zreniya, dvoenie, pelena pered glazami. 4. narusheniya v chuvstvitelnoy sfere gipestezii, boli, parestezii. 5. narusheniya funktsii tazovix organov. gorazdo reje vstrechayutsya paroksizmalnie rasstroystva (nevralgiya troynichnogo nerva, ataksiya i dizartriya, tonicheskie sudorogi, golovokrujeniya, parestezii, akinezii i giperkinezi). vtorignie simptomi yavlyayutsya sledstviem neuspeshnogo lecheniya pervichnix. ko vtorichnim otnosyat kontrakturi i atrofiyu mishts, osteoporoz, infektsii mochevogo trakta, prolejni. sredi tretichnix sleduet nazvat problemi sotsialnie, professionalnie, suprujeskie, psixologicheskie, svyazannie s xronicheskim psixicheskim zabolevaniem. psixicheskie rasstroystva pri pc mojno razdelit na tri gruppi: i. nevrozopodobnie. p. affektivnie. iii. klinicheskie proyavleniya svoeobraznogo organicheskogo slaboumiya. na rannix stadiyax pc chashe proyavlyayutsya nevrozopodobnie narusheniya, osobenno yarko virajennie pri gospitalizatsii, soobshenii patsientam o diagnoze, posle znakomstva ix s meditsinskoy literaturoy o pc. v dalneyshem xarakter psixicheskix rasstroystv opredelyaetsya osobennostyami techeniya zabolevaniya, …

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sientov soxranyaet sposobnost k samostoyatelnomu peredvijeniyu. tolko u 20—30% bolnix pc protekaet otnositelno blagopriyatno, i oni soxranyayut trudosposobnost. prognoz. k blagopriyatnim prognosticheskim priznakam otnosyat: 1) jenskiy pol patsienta; 2) nachalo zabolevaniya v molodom vozraste; 3) remittiruyushee techenie; 4) dlitelnuyu remissiyu posle pervogo obostreniya; 5) otsutstvie virajennogo nevrologicheskogo defekta v techenie 5 i bolee let ot momenta nachala zabolevaniya; 6) nachalnie proyavleniya bolezni v vide retrobulbarnogo nevrita, a ne paralichey ili mozjechkovix simptomov. k neblagopriyatnim v plane prognoza otnosyat: 1) ekstrapiramidnie giperkinezi; 2) psixicheskie narusheniya, osobenno slaboumie i eyforiyu. srednyaya chastota obostreniy pc 0,5-1 raz v god. srednyaya prodoljitelnost jizni ot momenta nachala zabolevaniya 35 let. smert obichno nastupaet ot interkurrentnix zabolevaniy: pnevmonii, urosepsisa i dr. ili ot stvolovix rasstroystv pri zlokachestvennoy forme zabolevaniya. pc i beremennost. bolshinstvo issledovateley ukazivayut na umenshenie chastoti obostreniy vo vremya beremennosti, chto svyazivayut s povisheniem virabotki aktg pod vliyaniem platsenti. v poslerodovom periode v 25% …

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demielinizatsiya i degenerativnie zabolevaniya nervnoy sistemi. rasseyanniy skleroz (pc) demieliniziruyushee zabolevanie tsns, xarakterizuyusheesya mnogoochagovim porajeniem belogo veshestva i xronicheskim progredientnim techeniem. zabolevanie porajaet molodix lyudey, sokrashaya prodoljitelnost jizni v srednem na 10 let, v podavlyayushem bolshinstve sluchaev privodit k ranney invalidizatsii (cherez 20 let tolko 30% ee ne imeyut); klinika otlichaetsya polimorfizmom nevrolocheskix narusheniy. epidemiologiya. v mire naschitivaetsya 3 mln bolnix pc, zabolevanie chashe vstrechaetsya po mere udaleniya ot ekvatora (na severe ameriki i evropi), sredi zabolevshix preobladayut jenshini. v sankt-peterburge okolo 35 tis. patsientov. v ssha, kanade, zapadnoy evrope nablyudaetsya 30—60 sluchaev na 100 0...

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