Performance】 【symptoms
The clinical manifestations of allergic purpura is: 1-3 weeks, often before the onset of upper respiratory tract infection. The first disease to the most common skin purpura, a few cases of anaphylactoid purpura purpura before the joint pain, abdominal pain, back pain, or hematuria, melena and so on. Usually based on parts of the lesions involving the clinical manifestations appear divided into the following types.
First, the most common type of purpura to dermal capillaries and small arteries is characterized by aseptic inflammation, blood vessel wall may have focal necrosis and platelet thrombosis. Most of the skin, recurrent petechiae, ecchymosis as the main performance, the most found in lower limbs and buttocks, symmetrical distribution, occur in batches, petechiae vary in size, was purple, can be integrated into tablets or slightly higher than the skin surface. Was bleeding and other measles-shaped papules or small, can be accompanied by mild itching. Integration of National Cheng Kung University Xuepao severe cases, the center was hemorrhagic necrosis. Petechia, ecchymosis gradually subsided in a few days can also be repeated, a few cases may be associated with eye face, lips, hands, feet and other limitations of angioedema.
Second, the abdominal (Henoeh purpura) mainly as abdominal pain, located around the navel or lower abdomen, often has colic or persistent intermittent dull pain can be accompanied by nausea, vomiting, diarrhea, blood in the stool. As serous bloody discharge into the intestinal wall, caused by submucosal edema, hemorrhage, caused by irregular bowel motility can cause intussusception. If the symptoms of this type before in skin purpura misdiagnosed as acute abdomen.
Third, the joint type (Schonlein purpura) in joint swelling, and pain, more common in the knee, ankle and other large joints, joint cavity can be fluid, but not purulent. Recurrent pain, were migratory, may be associated with redness, swelling and movement disorder, usually subside in a few months, after leaving abnormal fluid absorption. Before the event of the purpura misdiagnosed as rheumatoid arthritis.
IV --- also known as renal purpuric nephritis, more common in youth, often appears in purpura 1 Zhoufa Sheng, who occasionally until 7-8 weeks. Showed proteinuria, hematuria, urinary tube, sometimes accompanied by swelling, usually recover in a few weeks, there are recurrent, persistent for several months by. Even a small number of lesions involving the entire kidney and the development of chronic nephritis or nephrotic syndrome, uremia occurred individually.
V. rare type of mixed type and type of clinical manifestations of the above, if any exist two or more are called mixed. Which also have symptoms of abdominal and joint type are known as Henoch-Schonlein purpura. Others such as lesions involving the central nervous system, respiratory system and other symptoms may appear appropriate, a few may have optic atrophy, iris or conjunctival inflammation, retinal hemorrhage.
Diagnosis of allergic purpura is mainly based on skin purpura, capillary fragility test was positive in some patients. Bleeding time, clotting time, platelet count, clot retraction test and bone marrow examination were normal. If the merger increased the total number of infected white blood cells; parasite infection can be increased when eosinophils; involving the kidney may have hematuria, proteinuria or urinary tube; involved when intestinal fecal occult blood until the blood will be positive.
Henoch-Schonlein purpura in Chinese medicine as "spot", "rash", "Nvxue" category. More commonly due to yin, Wang Xing due to blood heat, but there are Deficiency and the like. The performance of those who have fever, the use of heat and detoxifying, cooling blood and yin, and other methods to stop bleeding Xiaoyu; performance by Xu Zheng, the use of qi and blood, spleen Ning heart, nourish liver and kidney and other laws, both wind-heat, humidity, etc. disease, heat and dampness should Zhuojia Shufeng the goods.
Friday, November 19, 2010
The Cause of Allergic Purpura
Allergic purpura (allergic purpura) is a common allergic hemorrhagic vascular diseases. Is because the body is allergic to certain allergens occurred, causing a wide range of small vessel vasculitis, making the small arteries and capillary permeability and fragility, with exudative hemorrhage, edema. The main clinical manifestations of allergic purpura purpura skin and mucous membrane bleeding may be associated with skin rash, joint pain, abdominal pain and kidney damage. Henoch-Schonlein purpura in children and adolescents is more common, more men than women, mostly in spring and autumn disease.
】 【Etiology
The direct cause of allergic purpura is often difficult to determine the relevant factors are:
First, bacterial infection (caused by β hemolytic streptococcus most common upper respiratory tract infection, in addition there are Staphylococcus aureus, streptococcus pneumoniae, Mycobacterium tuberculosis), viruses (rubella, chicken pox, measles, influenza), and intestinal parasites .
Second, food fish, shrimp, crab, eggs, milk and other food heterosexual protein.
Third, drug antibiotics (blue, chain, red, chloramphenicol), sulfonamides, isoniazid, anti-inflammatory drugs (salicylic acid, phenylbutazone, quinine, etc.).
Fourth, others such as cold, pollen, insect bites, vaccinations and so on. These factors antigen - antibody complex reaction, this complex deposition in the vessel wall or the glomerular basement membrane, and activate complement, release of allergens such as, damage capillaries, arterioles, capillaries, causing widespread inflammation, even necrotizing inflammation of small arteries, the blood vessel wall permeability and fragility increase, leading to subcutaneous tissue, mucous membranes and internal organs, hemorrhage, edema. Gastrointestinal tract and joints can have a similar change. Focal renal lesions are mostly light nephritis, can have severe local necrosis or total glomerular renal involvement. Some scholars believe that the disease is rapid onset allergic reaction, a large number of IgE. Adsorbed on the mast cells, release of biologically active substances which have caused the damage.
】 【Etiology
The direct cause of allergic purpura is often difficult to determine the relevant factors are:
First, bacterial infection (caused by β hemolytic streptococcus most common upper respiratory tract infection, in addition there are Staphylococcus aureus, streptococcus pneumoniae, Mycobacterium tuberculosis), viruses (rubella, chicken pox, measles, influenza), and intestinal parasites .
Second, food fish, shrimp, crab, eggs, milk and other food heterosexual protein.
Third, drug antibiotics (blue, chain, red, chloramphenicol), sulfonamides, isoniazid, anti-inflammatory drugs (salicylic acid, phenylbutazone, quinine, etc.).
Fourth, others such as cold, pollen, insect bites, vaccinations and so on. These factors antigen - antibody complex reaction, this complex deposition in the vessel wall or the glomerular basement membrane, and activate complement, release of allergens such as, damage capillaries, arterioles, capillaries, causing widespread inflammation, even necrotizing inflammation of small arteries, the blood vessel wall permeability and fragility increase, leading to subcutaneous tissue, mucous membranes and internal organs, hemorrhage, edema. Gastrointestinal tract and joints can have a similar change. Focal renal lesions are mostly light nephritis, can have severe local necrosis or total glomerular renal involvement. Some scholars believe that the disease is rapid onset allergic reaction, a large number of IgE. Adsorbed on the mast cells, release of biologically active substances which have caused the damage.
Guillain-Barre syndrome
This disease is an acute onset, with nerve root, peripheral nerve damage mainly associated with cerebrospinal fluid protein - a syndrome characterized by cell separation. Also known as Guillain-Barre syndrome. Both men and women of any age and disease, but young men is more common.
Etiology and pathogenesis is not fully understood, generally considered to have non-specific infection before the onset of vaccination history and history of allergic reactions caused by delayed immune diseases. Between the onset of infection to a latent period. Role in the immune response of peripheral nerve Schwann cells and myelin, resulting in limitations of segmental demyelination change around the vessels and nerves associated with endometrial lymphocytes, monocytes and macrophages infiltration. Axonal degeneration in severe cases can be seen, fragmentation. Myelin can regenerate in the same nerve fibers can be seen both demyelination and regeneration. Sometimes see the meningeal inflammatory reaction, spotting the spinal cord, anterior horn cells and motor nucleus of cranial nerve degeneration. Denervation muscle atrophy was.
The onset of clinical symptoms 1-4 weeks before there is a history of upper respiratory or gastrointestinal infection, or vaccination history. Four Seasons may be the disease, for many summer and autumn.
The clinical features of infectious diseases in 1 to 3 weeks after the sudden sharp pain to the nerve root (in the neck, shoulders, waist and lower extremities as much), and acute flaccid paralysis sexual symmetry of limbs, subjective sensory disturbances, or diminished tendon reflexes the main symptoms disappear. The specific performance:
(1) movement disorders: muscle paralysis of limbs and trunk are the main symptoms of the disease. Usually start from the lower extremities, and gradually spread to the trunk muscles, both upper limbs and cranial nerves, from side to side. Usually 1 to 2 weeks to peak in disease progression. Weight than the remote generally proximal paralysis, hypotonia. Such as breathing, swallowing and pronunciation involvement, spontaneous breathing can cause paralysis, difficulty swallowing and sound life-threatening.
(2) sensory dysfunction: General lighter, more from the extremities of numbness, tingling started. Can also be a sock-like feel diminished, disappeared, or allergies, as well as spontaneous pain, tenderness in the gastrocnemius muscle and the anterior horn obvious. Occasionally visible, or tracts of segmental sensory disturbance.
(3) launch obstacles: symmetry of limb tendon reflexes are mostly reduced or lost, abdominal, cremasteric reflex were normal. Small number of patients can be affected by the emergence of pathological vertebral beam reflector sign.
(4) autonomic dysfunction: the initial or recovery often sweating, sweat smell thick, may be the result of sympathetic irritation. Small number of patients may have short-term urinary retention initially may be due to the urinary bladder of a temporary imbalance in autonomic function or control of external sphincter damage caused by spinal nerve; stool Permanent Secretary of Results; unstable blood pressure can occur in some patients, tachycardia, and ECG disorders.
(5) cranial nerve symptoms: half of the patients had cranial nerve damage to tongue, pharyngeal, vagus nerve and one side or both sides of the peripheral facial nerve paralysis more common. Followed by eye, tackle, abducens nerve. Occasionally papilledema, optic nerve itself may be changed or cerebral edema caused by inflammation, it may be significantly higher CSF protein, blocking the arachnoid villi, impact on cerebrospinal fluid absorption. Diagnosis of infectious diseases, according to the disease suddenly appeared after the symmetry of the limbs distal sensory, motor and nutritional disorders and tendon reflexes can be confirmed.
Etiology and pathogenesis is not fully understood, generally considered to have non-specific infection before the onset of vaccination history and history of allergic reactions caused by delayed immune diseases. Between the onset of infection to a latent period. Role in the immune response of peripheral nerve Schwann cells and myelin, resulting in limitations of segmental demyelination change around the vessels and nerves associated with endometrial lymphocytes, monocytes and macrophages infiltration. Axonal degeneration in severe cases can be seen, fragmentation. Myelin can regenerate in the same nerve fibers can be seen both demyelination and regeneration. Sometimes see the meningeal inflammatory reaction, spotting the spinal cord, anterior horn cells and motor nucleus of cranial nerve degeneration. Denervation muscle atrophy was.
The onset of clinical symptoms 1-4 weeks before there is a history of upper respiratory or gastrointestinal infection, or vaccination history. Four Seasons may be the disease, for many summer and autumn.
The clinical features of infectious diseases in 1 to 3 weeks after the sudden sharp pain to the nerve root (in the neck, shoulders, waist and lower extremities as much), and acute flaccid paralysis sexual symmetry of limbs, subjective sensory disturbances, or diminished tendon reflexes the main symptoms disappear. The specific performance:
(1) movement disorders: muscle paralysis of limbs and trunk are the main symptoms of the disease. Usually start from the lower extremities, and gradually spread to the trunk muscles, both upper limbs and cranial nerves, from side to side. Usually 1 to 2 weeks to peak in disease progression. Weight than the remote generally proximal paralysis, hypotonia. Such as breathing, swallowing and pronunciation involvement, spontaneous breathing can cause paralysis, difficulty swallowing and sound life-threatening.
(2) sensory dysfunction: General lighter, more from the extremities of numbness, tingling started. Can also be a sock-like feel diminished, disappeared, or allergies, as well as spontaneous pain, tenderness in the gastrocnemius muscle and the anterior horn obvious. Occasionally visible, or tracts of segmental sensory disturbance.
(3) launch obstacles: symmetry of limb tendon reflexes are mostly reduced or lost, abdominal, cremasteric reflex were normal. Small number of patients can be affected by the emergence of pathological vertebral beam reflector sign.
(4) autonomic dysfunction: the initial or recovery often sweating, sweat smell thick, may be the result of sympathetic irritation. Small number of patients may have short-term urinary retention initially may be due to the urinary bladder of a temporary imbalance in autonomic function or control of external sphincter damage caused by spinal nerve; stool Permanent Secretary of Results; unstable blood pressure can occur in some patients, tachycardia, and ECG disorders.
(5) cranial nerve symptoms: half of the patients had cranial nerve damage to tongue, pharyngeal, vagus nerve and one side or both sides of the peripheral facial nerve paralysis more common. Followed by eye, tackle, abducens nerve. Occasionally papilledema, optic nerve itself may be changed or cerebral edema caused by inflammation, it may be significantly higher CSF protein, blocking the arachnoid villi, impact on cerebrospinal fluid absorption. Diagnosis of infectious diseases, according to the disease suddenly appeared after the symmetry of the limbs distal sensory, motor and nutritional disorders and tendon reflexes can be confirmed.
Behcet's disease (Fox puzzled disease)
Enter>>> feature of Behcet's disease
Behcet's disease is a small vessel vasculitis of unknown cause for the pathological basis of chronic, progressive relapsing, multisystem disease damage. To the mouth, genital ulcers, ophthalmia, skin lesions for clinical characteristics. The disease is autoimmune disease. Behcet's syndrome in traditional Chinese medicine for the disease first Fox set out in confusion, "Golden Lily Ann Fox slightly puzzled yin and yang, Treatment of toxic abnormal pulse." Chinese believe that the disease is "cold sores", "Yin ulcer", the card is, the cold, empty. The main pathological basis for the hyperactivity. Syndromes that the disease mainly in the liver heat, spleen and kidney is less wet and, therefore, TCM Differential Treatment of this disease is also carried out for the above three.
[Pathology and pathogenesis]
Etiology of this disease is not known, according to research, with several factors.
1 infection: It is reported that the disease and the acute and chronic viral infections, bacterial infections such as Streptococcus, Mycobacterium tuberculosis infection, caused by autoimmune disorders. For example: According to China to reports, the patients, one third in the past suffered from tuberculosis or are suffering from TB, some TB patients after treatment, not only to cure tuberculosis, and Behcet's disease symptoms have improved. It was also found that herpes simplex virus and the disease related with hemolytic streptococcus. That bacterial infection and the disease related.
2, genetic factors: a regional incidence of the disease tendencies, such as more common in Mediterranean countries. Characteristics of human genetic material that HLA study found that patients with Behcet the HLA-B5 positive rate of up to 60%, HLA-B51 positive rate is also high. Therefore, it was suggested that representatives of these two HLA types may be part of the genetic characteristics of Behcet's disease in the internal or the environment. Because not all patients with Behcet were HLA-B5 or HLA-B51 positive, Behcet autosomal recessive inheritance may be relevant.
3, trace elements: trace elements in patients with higher content of lesions, such as organic chlorine, organic phosphorus and copper ions. It was also found that certain trace elements zinc, selenium deficiency, may be related to the disease.
4, immune abnormalities: presence of serum antibodies against oral mucosa, antibodies against the arterial wall and other autoantibodies, immune complexes in serum positive rate of 60%, and with disease activity, patients with elevated immunoglobulin, lymphocyte imbalance, around blood vessels, cerebrospinal fluid, blood vessel walls and other lesions can be seen at the lymphocyte immune globulin, complement and other substances in the immune response, indicating that closely related to the disease and immune disorders.
[Clinical manifestations]
1, skin lesions: erythema nodules, common in the lower extremities, occur in the extensor side of the front leg, and sometimes also occur on the flexor side of the back and thighs, upper limbs and buttocks. Erythema diameter of 1-5cm, bright red, round or oval-shaped nodules, sometimes fused into large number of tumor nodules. After about 2-3 weeks, nodules from the red into a dark, gradually disappeared, no ulceration, nodular area often edema. Pseudo folliculitis can also occur, acne-like folliculitis, superficial thrombotic phlebitis performance. There is a class of rash with or without pus pus head head folliculitis, common in the face, neck.
2, recurrent oral ulcers: Oral ulcer disease accounted for 98% of patients, is the first symptom of Behcet's, but also have symptoms of attacks in more than three times a year during attacks in the buccal mucosa, tongue edge of the lips, soft palate, etc. there single or multiple a summary of the big red rice to soybeans, there is pain, followed by the formation of ulcers, ulcer diameter of about 2-3cm. Some like herpes onset, about 7-14 days after the self-limiting, leaving scars, ulcers after another, repeatedly. Factor of a few weeks in patients unhealed, left behind after a scar.
3, recurrent genital ulcers: ulcers common in female patients the size of the labia, followed by the vagina, the male scrotum, penis. Can also appear in the perineum and anus, the symptoms and oral ulcers similar traits, accounting for 80% of Behcet's.
4, ophthalmia: more men than women, the most common eye disease is also known as uveitis, uveitis, but also caused by vasculitis of the retina. The recurrent lesions. Can lead to serious visual impairment, severe can cause blindness.
5, system damage symptoms:
(1) the digestive tract: the digestive tract involvement can occur in multiple vascular ulcers, abdominal pain and other symptoms, severe cases, intestinal bleeding, intestinal paralysis, perforation and fistula formation. (2) the nervous system: a small number of patients have central nervous system involvement, meningitis, encephalitis, paralysis, increased intracranial pressure, spinal cord injury and peripheral neuropathy. Patients may present consciousness, paralysis, action instability, feeling disorders. (3) vessels: large, medium and small artery, vein inflammation causes tissue ischemia, venous obstruction and other symptoms. Artery when the blood vessels involved a large vein stenosis, occlusion, aneurysm formation or thrombosis. Pulmonary vascular involvement, there hemoptysis, shortness of breath, pulmonary hypertension, pulmonary embolism and other symptoms. (4) Joint: Common joint pain, swelling and a small number of the relevant section to knee involvement more common. In addition, some patients have a new disease activity or organ damage, accompanied by fever, fatigue, myalgia and other symptoms.
Behcet's disease is a small vessel vasculitis of unknown cause for the pathological basis of chronic, progressive relapsing, multisystem disease damage. To the mouth, genital ulcers, ophthalmia, skin lesions for clinical characteristics. The disease is autoimmune disease. Behcet's syndrome in traditional Chinese medicine for the disease first Fox set out in confusion, "Golden Lily Ann Fox slightly puzzled yin and yang, Treatment of toxic abnormal pulse." Chinese believe that the disease is "cold sores", "Yin ulcer", the card is, the cold, empty. The main pathological basis for the hyperactivity. Syndromes that the disease mainly in the liver heat, spleen and kidney is less wet and, therefore, TCM Differential Treatment of this disease is also carried out for the above three.
[Pathology and pathogenesis]
Etiology of this disease is not known, according to research, with several factors.
1 infection: It is reported that the disease and the acute and chronic viral infections, bacterial infections such as Streptococcus, Mycobacterium tuberculosis infection, caused by autoimmune disorders. For example: According to China to reports, the patients, one third in the past suffered from tuberculosis or are suffering from TB, some TB patients after treatment, not only to cure tuberculosis, and Behcet's disease symptoms have improved. It was also found that herpes simplex virus and the disease related with hemolytic streptococcus. That bacterial infection and the disease related.
2, genetic factors: a regional incidence of the disease tendencies, such as more common in Mediterranean countries. Characteristics of human genetic material that HLA study found that patients with Behcet the HLA-B5 positive rate of up to 60%, HLA-B51 positive rate is also high. Therefore, it was suggested that representatives of these two HLA types may be part of the genetic characteristics of Behcet's disease in the internal or the environment. Because not all patients with Behcet were HLA-B5 or HLA-B51 positive, Behcet autosomal recessive inheritance may be relevant.
3, trace elements: trace elements in patients with higher content of lesions, such as organic chlorine, organic phosphorus and copper ions. It was also found that certain trace elements zinc, selenium deficiency, may be related to the disease.
4, immune abnormalities: presence of serum antibodies against oral mucosa, antibodies against the arterial wall and other autoantibodies, immune complexes in serum positive rate of 60%, and with disease activity, patients with elevated immunoglobulin, lymphocyte imbalance, around blood vessels, cerebrospinal fluid, blood vessel walls and other lesions can be seen at the lymphocyte immune globulin, complement and other substances in the immune response, indicating that closely related to the disease and immune disorders.
[Clinical manifestations]
1, skin lesions: erythema nodules, common in the lower extremities, occur in the extensor side of the front leg, and sometimes also occur on the flexor side of the back and thighs, upper limbs and buttocks. Erythema diameter of 1-5cm, bright red, round or oval-shaped nodules, sometimes fused into large number of tumor nodules. After about 2-3 weeks, nodules from the red into a dark, gradually disappeared, no ulceration, nodular area often edema. Pseudo folliculitis can also occur, acne-like folliculitis, superficial thrombotic phlebitis performance. There is a class of rash with or without pus pus head head folliculitis, common in the face, neck.
2, recurrent oral ulcers: Oral ulcer disease accounted for 98% of patients, is the first symptom of Behcet's, but also have symptoms of attacks in more than three times a year during attacks in the buccal mucosa, tongue edge of the lips, soft palate, etc. there single or multiple a summary of the big red rice to soybeans, there is pain, followed by the formation of ulcers, ulcer diameter of about 2-3cm. Some like herpes onset, about 7-14 days after the self-limiting, leaving scars, ulcers after another, repeatedly. Factor of a few weeks in patients unhealed, left behind after a scar.
3, recurrent genital ulcers: ulcers common in female patients the size of the labia, followed by the vagina, the male scrotum, penis. Can also appear in the perineum and anus, the symptoms and oral ulcers similar traits, accounting for 80% of Behcet's.
4, ophthalmia: more men than women, the most common eye disease is also known as uveitis, uveitis, but also caused by vasculitis of the retina. The recurrent lesions. Can lead to serious visual impairment, severe can cause blindness.
5, system damage symptoms:
(1) the digestive tract: the digestive tract involvement can occur in multiple vascular ulcers, abdominal pain and other symptoms, severe cases, intestinal bleeding, intestinal paralysis, perforation and fistula formation. (2) the nervous system: a small number of patients have central nervous system involvement, meningitis, encephalitis, paralysis, increased intracranial pressure, spinal cord injury and peripheral neuropathy. Patients may present consciousness, paralysis, action instability, feeling disorders. (3) vessels: large, medium and small artery, vein inflammation causes tissue ischemia, venous obstruction and other symptoms. Artery when the blood vessels involved a large vein stenosis, occlusion, aneurysm formation or thrombosis. Pulmonary vascular involvement, there hemoptysis, shortness of breath, pulmonary hypertension, pulmonary embolism and other symptoms. (4) Joint: Common joint pain, swelling and a small number of the relevant section to knee involvement more common. In addition, some patients have a new disease activity or organ damage, accompanied by fever, fatigue, myalgia and other symptoms.
Raynaud's disease
Raynaud's disease, also known as Raynaud's syndrome and Raynaud's phenomenon, vascular and nerve disorders caused by small artery spasm limb disease. Paroxysmal limb to limb (mainly the fingers) symmetry of the intermittent pale, cyanosis, and flushing of its clinical features, and often emotional or induced by the cold.
Raynaud's disease rare, mostly occurs in women, especially the nervous allergy to female ratio was 1:10. Age of onset of Raynaud's disease more than 20 to 30 years old. Heavy attack during the cold season.
Raynaud's disease is mainly limb spasm of small arteries, the cause is not entirely clear, may be related to the following factors:
1, the central nervous system dysfunction, the sympathetic hyperfunction;
2, the blood circulation of epinephrine and norepinephrine levels increased;
3, the condition often aggravated during menstruation, pregnancy reduced, and it was felt and endocrine-related;
4, limb defects in small arteries themselves, show normal physiological phenomenon caused by over-reaction;
5, also suggested that initially a small artery on the cold extremities over-reaction, then the long-term vascular spasm, so that arterial intimal hyperplasia, poor blood flow, if more are to reduce limb blood flow in all arteries Physiological factors, can act on the arterial lesions caused by seizures;
6, patients often have a family history, suggesting that hereditary;
7, immune and connective tissue diseases such as systemic lupus erythematosus, scleroderma, nodular nodosa, dermatomyositis, rheumatoid arthritis, polymyositis, mixed connective tissue disease, hepatitis B antigens induced vasculitis, drug-induced vasculitis and Sjogren syndrome;
8, obstructive arterial disease, such as arteriosclerosis obliterans, thromboembolism, vasculitis, etc.;
9, physical factors, such as vibration damage, direct arterial trauma, cold injury;
10, due to certain drugs, such as ergot, lead, thallium, arsenic poisoning, polyvinyl chloride, β-blockers, cytotoxic drugs, contraceptives, etc.;
11, the mechanism of neural factors such as vascular neck rib, anterior scalene muscle syndrome, thoracic outlet syndrome, axillary crutches improper use of compression, tumor compression of brachial plexus and subclavian vessels, cervical inflammation, or rupture of the nucleus, peripheral nerve Yan, syringomyelia, or tabes, etc.;
12, cold agglutinin in the blood increase, or cryoglobulinemia, polycythemia vera, paroxysmal hemoglobinuria, etc.;
13, some with migraine and variant angina related.
Pathology and pathogenesis
The cause of Raynaud's syndrome, currently remains unclear. Most scholars believe that with the cold stimulation, nervous excitement and endocrine disorders, connective tissue disease and other factors. Divided into three basic changes: spastic ischemic period, expansion and congestion period.
Early lesions, fingers and toes were no significant pathological changes veins visible. Arterial intimal hyperplasia can be seen later, elastic membrane rupture and myometrial thickening and other changes, the small arteries narrow, blood flow. Finally, a small number of patients may have thrombosis, luminal occlusion, accompanied by changes in local tissue nutrition, severe cases can occur (toe) end of ulcers, occasional necrosis. Artery disease refers to conditions under the sign can be divided into obstructive (62.6%) and spastic (37.4%), the two groups. Obstructive obvious palm, digital artery obstruction, and more from autoimmune diseases and are associated with atherosclerosis due to chronic arteritis. Because of severe arterial obstruction, so the room temperature, mean arterial pressure was significantly reduced. Obstruction of the normal vasoconstrictor response to cold enough to cause seizures. Spastic no palm, digital artery obstruction in normal room temperature refers to the artery, at the critical temperature (18 ~ 20 ℃) was caused by seizures. Spastic abnormal adrenergic receptor changes in platelet α2-receptor activity was significantly increased, resulting in blood increased sensitivity to cold stimuli.
During the onset of Raynaud's disease, first finger (toe) artery spasm or functional occlusion, followed by capillaries and small veins are cramps, which showed local skin pale. Small vein artery spasm spasm subsided quickly, causing capillary blood stasis, hypoxia, cyanosis appears. Vasospasm removed, the local circulation restored, and the emergence of reactive hyperemia, it is skin flushing, and then to normal color.
Clinical manifestations
A typical attack of Raynaud's symptoms can be divided into three phases:
Pale period: the early performance, the case of cold stimulation, finger (toe) side of the skin pale. This change was the process of development, that is first and foremost from the finger (toe) end of the beginning, and then to refer to parts of the development of roots and above, generally no more than wrist. Pale skin began to start with a finger, and then gradually involving the other fingers, some involving almost all the fingers, the thumbs rich blood circulation, so the only serious condition involving only when. Attack consciously fingers, palms, toes, feet are cold feeling, the local temperature decreases, the temperature lower than normal limbs. At the same time may have numbness, needle-like, heavy and stiff feeling, bend your fingers to feel your fingers hold back inflation, flexion and extension negative, it can cause movement disorders. Some patients will be sweating and so on.
Bruising on: pale after a few minutes of emergence, self-lifting of small artery spasm, and spasticity is still a small vein, impairing blood flow, venous plexus and the capillaries appear at this time of hypoxic paralysis, slow blood flow or stasis, resulting in blood oxygen reduction, so the skin appears pale purple after the phenomenon. At this time the symptoms are relatively light.
Flushing period: bruising of the fingers (toes) to get warm, the cold stimulation relieved vasospasm can ease or disappear, then arterioles, capillaries and small veins reactive hyperemia, so that the phenomenon of skin flushing. At this point the local temperature increase, may have swelling and mild pulsating pain. When the normal blood perfusion, skin color and the symptoms were back to normal.
But there are many "Raynaud's sign" in patients with disease onset, unlike the laws of the clear changes in the boundaries of performance is not clear if any bruising directly into the onset of a serious number of patients with the Sustainable months without relief, the state was sustained attack, intermittent period almost disappeared, there are changes in local tissue nutrition, such as skin atrophy or thickening of the nail deformity was buckling, the finger pad weight loss, decalcified distal phalanx, finger nails to the ulcer Under the expansion, causing separation of the nail and nail bed, accompanied by severe pain. In addition, it may cause the tip of finger gangrene. 10 ~ 12% of patients can occur after a long illness limitations (toe) skin sclerosis. Some patients are also always in the first phase, after the two less obvious; also some of the patients without flushing from the pale and (or) directly after the restoration of the normal purple. Occasionally at the tip of individual patients, the zygomatic cheek, ear and other parts of the head and face similar symptoms.
Raynaud's disease rare, mostly occurs in women, especially the nervous allergy to female ratio was 1:10. Age of onset of Raynaud's disease more than 20 to 30 years old. Heavy attack during the cold season.
Raynaud's disease is mainly limb spasm of small arteries, the cause is not entirely clear, may be related to the following factors:
1, the central nervous system dysfunction, the sympathetic hyperfunction;
2, the blood circulation of epinephrine and norepinephrine levels increased;
3, the condition often aggravated during menstruation, pregnancy reduced, and it was felt and endocrine-related;
4, limb defects in small arteries themselves, show normal physiological phenomenon caused by over-reaction;
5, also suggested that initially a small artery on the cold extremities over-reaction, then the long-term vascular spasm, so that arterial intimal hyperplasia, poor blood flow, if more are to reduce limb blood flow in all arteries Physiological factors, can act on the arterial lesions caused by seizures;
6, patients often have a family history, suggesting that hereditary;
7, immune and connective tissue diseases such as systemic lupus erythematosus, scleroderma, nodular nodosa, dermatomyositis, rheumatoid arthritis, polymyositis, mixed connective tissue disease, hepatitis B antigens induced vasculitis, drug-induced vasculitis and Sjogren syndrome;
8, obstructive arterial disease, such as arteriosclerosis obliterans, thromboembolism, vasculitis, etc.;
9, physical factors, such as vibration damage, direct arterial trauma, cold injury;
10, due to certain drugs, such as ergot, lead, thallium, arsenic poisoning, polyvinyl chloride, β-blockers, cytotoxic drugs, contraceptives, etc.;
11, the mechanism of neural factors such as vascular neck rib, anterior scalene muscle syndrome, thoracic outlet syndrome, axillary crutches improper use of compression, tumor compression of brachial plexus and subclavian vessels, cervical inflammation, or rupture of the nucleus, peripheral nerve Yan, syringomyelia, or tabes, etc.;
12, cold agglutinin in the blood increase, or cryoglobulinemia, polycythemia vera, paroxysmal hemoglobinuria, etc.;
13, some with migraine and variant angina related.
Pathology and pathogenesis
The cause of Raynaud's syndrome, currently remains unclear. Most scholars believe that with the cold stimulation, nervous excitement and endocrine disorders, connective tissue disease and other factors. Divided into three basic changes: spastic ischemic period, expansion and congestion period.
Early lesions, fingers and toes were no significant pathological changes veins visible. Arterial intimal hyperplasia can be seen later, elastic membrane rupture and myometrial thickening and other changes, the small arteries narrow, blood flow. Finally, a small number of patients may have thrombosis, luminal occlusion, accompanied by changes in local tissue nutrition, severe cases can occur (toe) end of ulcers, occasional necrosis. Artery disease refers to conditions under the sign can be divided into obstructive (62.6%) and spastic (37.4%), the two groups. Obstructive obvious palm, digital artery obstruction, and more from autoimmune diseases and are associated with atherosclerosis due to chronic arteritis. Because of severe arterial obstruction, so the room temperature, mean arterial pressure was significantly reduced. Obstruction of the normal vasoconstrictor response to cold enough to cause seizures. Spastic no palm, digital artery obstruction in normal room temperature refers to the artery, at the critical temperature (18 ~ 20 ℃) was caused by seizures. Spastic abnormal adrenergic receptor changes in platelet α2-receptor activity was significantly increased, resulting in blood increased sensitivity to cold stimuli.
During the onset of Raynaud's disease, first finger (toe) artery spasm or functional occlusion, followed by capillaries and small veins are cramps, which showed local skin pale. Small vein artery spasm spasm subsided quickly, causing capillary blood stasis, hypoxia, cyanosis appears. Vasospasm removed, the local circulation restored, and the emergence of reactive hyperemia, it is skin flushing, and then to normal color.
Clinical manifestations
A typical attack of Raynaud's symptoms can be divided into three phases:
Pale period: the early performance, the case of cold stimulation, finger (toe) side of the skin pale. This change was the process of development, that is first and foremost from the finger (toe) end of the beginning, and then to refer to parts of the development of roots and above, generally no more than wrist. Pale skin began to start with a finger, and then gradually involving the other fingers, some involving almost all the fingers, the thumbs rich blood circulation, so the only serious condition involving only when. Attack consciously fingers, palms, toes, feet are cold feeling, the local temperature decreases, the temperature lower than normal limbs. At the same time may have numbness, needle-like, heavy and stiff feeling, bend your fingers to feel your fingers hold back inflation, flexion and extension negative, it can cause movement disorders. Some patients will be sweating and so on.
Bruising on: pale after a few minutes of emergence, self-lifting of small artery spasm, and spasticity is still a small vein, impairing blood flow, venous plexus and the capillaries appear at this time of hypoxic paralysis, slow blood flow or stasis, resulting in blood oxygen reduction, so the skin appears pale purple after the phenomenon. At this time the symptoms are relatively light.
Flushing period: bruising of the fingers (toes) to get warm, the cold stimulation relieved vasospasm can ease or disappear, then arterioles, capillaries and small veins reactive hyperemia, so that the phenomenon of skin flushing. At this point the local temperature increase, may have swelling and mild pulsating pain. When the normal blood perfusion, skin color and the symptoms were back to normal.
But there are many "Raynaud's sign" in patients with disease onset, unlike the laws of the clear changes in the boundaries of performance is not clear if any bruising directly into the onset of a serious number of patients with the Sustainable months without relief, the state was sustained attack, intermittent period almost disappeared, there are changes in local tissue nutrition, such as skin atrophy or thickening of the nail deformity was buckling, the finger pad weight loss, decalcified distal phalanx, finger nails to the ulcer Under the expansion, causing separation of the nail and nail bed, accompanied by severe pain. In addition, it may cause the tip of finger gangrene. 10 ~ 12% of patients can occur after a long illness limitations (toe) skin sclerosis. Some patients are also always in the first phase, after the two less obvious; also some of the patients without flushing from the pale and (or) directly after the restoration of the normal purple. Occasionally at the tip of individual patients, the zygomatic cheek, ear and other parts of the head and face similar symptoms.
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