第七 单元 免疫变态反应结缔组织病Seventh unit immunity allergy connective tissue disease.docx

第七 单元 免疫变态反应结缔组织病Seventh unit immunity allergy connective tissue disease.docx

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第七单元免疫变态反应结缔组织病Seventhunitimmunityallergyconnectivetissuedisease

第七单元免疫、变态反应、结缔组织病（Seventhunitimmunity,allergy,connectivetissuedisease）

第七单元免疫、变态反应、结缔组织病（Seventhunitimmunity,allergy,connectivetissuedisease）第七单元免疫、变态反应、结缔组织病（Seventhunitimmunity,allergy,connectivetissuedisease）Unitseventh,immunity,allergy,connectivetissuedisease.Txtyoucannotmakeeveryonesatisfied,becausenotallpeoplearepeople,successfulpeopleareinawaycattleB,roaderectiondoyouthinkIwillwatchyoudie?

Iwillclosemyeyeswiththeseventhunitofimmunity,allergy,connectivetissuediseaseSection1CharacteristicsofpediatricimmunesystemSpecificcellularimmunity（Tcellimmunity）（I）thymus:

thymusisthecentralimmuneorgan,andlymphoidstemcellsdifferentiateintomatureTcells（CD3positive,CD4orCD8singlepositive）sites.（two）Tcells:

thefunctionofCD4+Tcellsistomodulateimmuneresponses,calledhelperTcells（TH）.CD8+cellsfunctionascytotoxicantigens,termedcytotoxicTcells.（three）cytokines:

avarietyofcytokinescanbeproducedintheprocessofimmuneresponse.TH1cellssecreteinterferongamma,interleukin-2,andTH2cellssecreteinterleukin-4,5,6,8,and9.Two,specifichumoralimmunity（Bcellimmunity）

（1）bonemarrowandlymphnodes:

thebonemarrowisthematuresiteofBcellsandfunctionsasacapsule.（two）Bcells:

comparedwithTcellimmunity,Bcellsdevelopslowly.（three）immunoglobulin:

theimmunoglobulinwithantibodyactivityiscalledimmunoglobulin.1.IgG:

throughtheplacenta,therearefoursubclasses,withthehighestproportionofIgG1.IgG1targetsproteinantigens,antibodies,andIgG2againstpolysaccharideantigenantibodies,andIgG4isassociatedwithallergies.2.IgM:

notthroughtheplacenta,IgMhighatbirth,needtofurtherdetectspecificantibodies,clearwhetherthepresenceofintrauterineinfection.Earlyadultlevel.3.lgA:

highlgAincordbloodsuggestsintrauterineinfectionandlocalantiinfectionofsecretorylgAmucosa.4.lgD（5yearsofage,adult20%）andlgE（7yearsofage）aredifficulttopassthroughtheplacenta.Three、nonspecificimmunityPhagocytosis:

largemononuclearcellsandneutrophilsarethemajorphagocyticcellsincirculation.（two）complementsystem:

reachedadultlevelin6~12months.SecondsectionbronchialasthmaBronchialasthmaisachronicinflammatorydiseaseoftheairways,whichisinvolvedinavarietyofcells,especiallymastcellsandeosinophilsandTlymphocytes,andishighlyreactivetotheairways.I.diagnosis（emphasis）

（1）infantasthmadiagnosticcriteria:

age3years.1.morethan3timesofwheezing3points2.lungwheezing2points3.wheezingsymptoms,suddenattack1points4.,otherspecifichistoryof15.ofoneortworelativeshaveasthma1pointsStandardforevaluation:

totalscoremorethan5pointsforthediagnosisofinfantasthma;suchaslungwheezedothefollowingtests:

（1）1gofepinephrine,each0.01mg/kgsubcutaneousinjection,15~20minuteslater,ifwheezingrelieforwheezingsignificantlyreduced,plus2points;IItosalbutamolaerosoloritswatersolutionafterinhalation,observethewheezingwheezingorchanges,suchasreducedobviouslycanbe2points.（two）diagnosisofasthmainchildrenover3yearsold1.asthmaisrecurrent（ormaybetracedtosomeallergenorirritationfactor）2.episodesofwheezingoccurinthelungs3.,antiasthmaticdrugseffective.Suspectedcasesgive1perthousandper0.01mg/kgsubcutaneousinjectionofepinephrine,orsalbutamolaerosolinhalationoritswatersolutionafter15minutesifasthmaremissionorwheezedecreasedishelpfultothediagnosisof.（three）diagnosticcriteriaofcoughvariantasthma1.coughcontinuedorrepeatedattacks1months,oftenaccompaniedbynocturnalorearlymorningparoxysmalcough,lesssputum,increasedafterexercise.2.,noclinicalsymptomsofinfection,orlong-termantibiotictreatmentinvalid.3.bronchodilatorcanrelievecoughonset（thebasicconditionforthediagnosisofthisdisease）4.haveallergiestoindividualsorfamilies,Airwayreactivitytestandallergendetectioncanbeusedasauxiliarydiagnosis.Two,treatment

（1）removalofthecauseofdisease（two）controlseizure;1.bronchodilator

（1）Adrenomimeticdrugs:

drugscommonlyusedinthesalbutamol（ShuChuanling）;theterbutaline（ShuChuanningandBricasol）;KleTero（clenbuterol）.Inhalationtherapyisthefirstchoice.

（2）theophyllinedrugs:

aminophylline,sustained-releasetheophylline.（3）anticholinergicagents:

ipratropiumbromide.2.glucocorticoids:

thefirstchoiceforthetreatmentofasthma.

（1）:

inhalationofbeclomethasone,budesonide.

（2）oralmedication:

short-termtreatmentofpatientswithmoreseverecondition.3.antibiotics:

usewithrespiratorytractbacterialinfections.（three）treatmentofpersistentstatusofasthma;1.oxygeninhalation:

oxygenconcentrationof40%,maintainPaO270~90mmHg.2.rehydrationandcorrectionofacidosis:

supplement1/5sodicsolutionwithsodiumbicarbonate,correctacidosis.3.glucocorticoiddrugs:

intravenoushydrocortisoneormethylprednisolone.4.bronchodilator:

1.Inhalationofsalbutamolaerosol1timesevery1~2hours;aminophyllineintravenousdrip;theabovetreatmentisnotgood,canbeinjectedintravenouslywithsalbutamol.5.isoproterenol:

theabovetreatmentisinvalid,try0.1g/kgperminuteintravenousdrip.6.sedatives:

chloralhydrateenema.7.:

thepersistentrespiratorymechanicalbreathingdifficulties;thedecreasedbreathsounds,thenwheezedisappeared;therespiratorymusclefatigueandthethoracicactivityislimited;thedisturbanceofconsciousness,andevencoma;theinhaled40%oxygenandcyanosisstillnoimprovement,PaCO2=65mmHg.Three,prevention（I）self-educationManagement:

（two）preventionofrecurrence1.immunotherapy

（1）desensitizationtherapy

（2）immunemodulationtreatment:

canusethymuspeptideandChinesetraditionalmedicinetowait.2.sodiumcitrate:

shouldbeinthefirst1monthsbeforetheonsetofgoodseasonbeganmedication.Ketotifen3.4.inhaledcorticosteroidaerosolcanrelieveasthmaticchildren,shouldcontinuetomaintaintheamountofinhalationfor6~24months.ThethirdsectionisacuterheumaticfeverHairageis5~15,andheartattackisthemostserious.Cancausepermanentheartvalvedisease.First,etiologyandpathogenesis:

AgroupBhemolyticstreptococcusinfectionaftertheimmuneresponse.Two,clinicalmanifestations（2,3,4,5）（I）generalperformanceAcuteonsetfeverat38~40degrees,abouthalfofthechildrenbeforetheonsetof1~4haveahistoryofupperrespiratorytractinfection.Lethargy,fatigue,anorexia,pale,sweating,nasalbleeding.（two）cardiacinflammation:

40to50%involvingtheheart,istheonlypersistentorgandamage.1.myocarditis:

tachycardia,heartenlargement,heartfailure,electrocardiogramisthemostcommononedegreeatrioventricularblock.2.endocarditis:

majorinvasionofthemitralvalveand/oraorticvalve.3.pericarditis:

pericardialeffusion,pericarditisisusuallyfullofinflammation.（three）arthritis:

seenin50to60%patients,mostlymigratoryarthritis,mainlyknee,ankle,elbowandwristjoints.Nodeformityofjoint.（four）dancingsickness:

3~7%.Thecourseofdiseaseisabout1~3months.（five）skinsymptoms;1.subcutaneousnodules:

in5%ofrheumaticfeverchildren,oftenaccompaniedbycardiacinflammation.2.ringerythema:

rare.Three.DiagnosticcriteriaThediagnosticcriteriaofJonesinclude3parts:

mainmanifestations;secondarymanifestations;evidenceofstreptococcalinfection.Inthepresenceofstreptococcalinfection,therearetwomainmanifestations,oramajormanifestationandtwosecondarymanifestations,afterexcludingotherdiseasescanbediagnosed.Four,treatmentandPrevention

（1）rest:

8peoplewhohavenoheartattackstayinbedfor2weeks;thepatientswithcardiacinflammationstayinbedfor4weeks;thepatientswithheartfailurestayinbedfortwoweeks.（two）eliminationofstreptococcalinfection:

penicillinfor2weeks.（three）winddampheattreatment:

1.aspirin:

withoutcardiacinflammation,use80to100mg/kgeveryday,4~8weeks.2.glucocorticoids:

Patientswithcardiacinflammationweretreatedwithprednisonedaily2mg/kg,8~12weeks.（four）thetreatmentofcongestiveheartfailure:

largedosemethylprednisolone,10to30mg/kgperday,for1~3days.Carefuluseofdigitalis.（five）thetreatmentofchorea:

canusephenobarbital,valiumandothersedative.（six）prevention:

long-actingpenicillin1million200thousandunits,1timesamonthintramuscularinjection,atleast5years.Exercises1.,thehighestproportionofIgGsubclassesintheserumis（A）A.IgG1B.IgG2C.IgG3D.IgG4E.IgG5[answernumber:

21070101]What2.Th1cellsproduceis（answer:

A）A.interleukin2B.interleukin4C.interleukin5D.interleukin6E.interleukin8[answernumber:

21070102]3.doesnotmeetthecoughvariantasthmacharacteristic（answer:

C）A.coughsrepeatedlyfor1monthsB.coughaggravatedafterexerciseC.phlegmD.hasnofeverCoughrelievingE.afterinhalationofsalbutamol[answernumber:

21070103]4.thetreatmentofasthmastatusiscorrect（answer:

B）A.inhalationofsodiumcitrateB.glucocorticoidintravenousdripC.oralpropranololD.highdosegammaglobulinE.applicationofdigitalisyellow[answernumber:

21070104]5.theorganofcontinuousrheumaticfeverinjuryis（answer:

D）A.jointdeformityB.renalfailureC.coronaryarteryaneurysmD.heartvalvediseaseE.pulmonaryfibrosis[answernumber:

21070105]6.themostcommonelectrocardiographicchangeinrheumaticfeveris（answer:

D）A.ventricularprematurecontractionProlongationofB.QTintervalC.therightatriumislargeD.d