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Назначение высоких доз глюкокортикоидов
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Назначение высоких доз глюкокортикоидов

Warning: file_put_contents(): Only 0 of 1570 bytes written, possibly out of free disk space in /var/www/filosof/data/www/medservices.info/wp-content/plugins/wp-optimize-by-xtraffic/Application/Service/PepVN_Cache.php on line 684 Warning: file_put_contents(): Only 0 of 128 bytes written, possibly out of free disk space in /var/www/filosof/data/www/medservices.info/wp-content/plugins/wp-optimize-by-xtraffic/Application/Service/PepVN_Cache.php on line 684 Warning: file_put_contents(): Only 0 of 115 bytes written, possibly out of free disk space in /var/www/filosof/data/www/medservices.info/wp-content/plugins/wp-optimize-by-xtraffic/Application/Service/PepVN_Cache.php on line 684 Warning: file_put_contents(): Only 0 of 128 bytes written, possibly out of free disk space in /var/www/filosof/data/www/medservices.info/wp-content/plugins/wp-optimize-by-xtraffic/Application/Service/PepVN_Cache.php on line 684 Warning: file_put_contents(): Only 0 of 110 bytes written, possibly out of free disk 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by admin12.02.2015
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Синдром «трансплантат против хозяина» (СТПХ) — частое последствие пересадки костного мозга. Примерно через 3 нед после полного удаления собственного и пересадки донорского костною мозга у 20-&0% пациентов развиваются поражения. Некоторые больные вскоре погибают. Пораржение кожи — первый признак СТПХ.

СТПХ может протекать в острой и хронической . Острая форма заболевания возникает с 21-го по 60-й день после трансплантации костного мозга. У пациента возникает пятнисто-папулёзная или скарлатиноподобная кожная сыпь. Б особо тяжелых случаях кожные очаги приобретают буллёзный характер, может начаться распространённая десквамация с образованием зон токсического эпидермального некролпза. Очаги поражения возникают прежде всего на ладонях и стопах, кожа туловища, шеи, щёк и ушей вовлекается в патологический процесс позже.

При хроническом СТПХ первые признаки болезни возникают не ранее, чем через 100 дней после пересадки костного мозга. При гистологическом исследовании обнаруживают лимфоцитарную инфильтрацию, напоминающую таковую на ранних стадиях хронической формы красного плоского лишая. В хорошо развитых очагах кожного поражения при хроническом СТПХ обычно заметны атрофия эпидермиса с истончением его базальной мембраны и фиброз дермы. Картина подобна таковой при пятнистой склеродермии.

Известны случаи развития СТПХ или подобного синдрома после переливаний крови пациентам. В этом случае заболевание протекает в более лёгкой форме и редко приводит к развитию тяжёлых осложнений. Тем не менее факт наличия такой формы СТПХ указывает на то, что эго состояние может быть следствием активации собственных лимфоцитов хозяина в условиях нарушения иммунитета. Повреждение тканей вызывают цитотоксические Т-лимфоциты, продуцируемые донорским или собственным костным мозгом.

Кожные очаги, возникающие под влиянием цитотоксических Т-клеток, очень похожи на те, которые развиваются у некоторых пациентов после введения им отдельных компонентов донорской крови. Более того, подобные кожные поражения могут возникать в период восстановления костного мозга у пациентов, подвергшихся его абляции. В течение нескольких недель после цитотоксической химиотерапии или воздействия на костный мозг с помощью ионизирующего излучения у пациента развивается лихорадка, а на коже образуются , сходные с таковыми при СТПХ. Время возникновения кожных поражений совпадает с периодом постепенного увеличения количества лимфоцитов в крови больного, а исчезают они, как правило, после полного восстановления костного мозга.

Морфологические изменения в коже при указанных вариантах патологии подобны таковым при типичном СТПХ и отличаются только степенью выраженности. Существует общепринятая схема оценки выраженности гистологических изменений в коже при СТПХ.

Во всех случаях около поверхностных сосудистых сплетений обнаруживают слабовыраженную периваскулярную инфильтрацию дермы лимфоцитами. Отдельные клетки присутствуют и в глубоких слоях эпидермиса, а при П-IV степени тяжести погибающие кератиноциты окружены лимфоцитами.

Дифференциальную диагностику СТПХ проводят с многоформной экссудативной эритемой, реакцией на лекарственные препараты и вирусной экзантемой.

Существует классификация острой формы СТПХ по степени тяжести поражения. Чем выше стадия развития синдрома согласно этой классификации, тем выше риск гибели больного.

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