临床医学荨麻疹课件.ppt

荨麻疹 Urticaria 　 定义　 俗称风疹块,为皮肤和粘膜因血管扩张。血浆外渗而引起的一种暂时性红斑和水肿反应,由真皮乳头层血管扩张，血浆渗出所致。临床上较为常见。 Urticaria or hives as it is commonly called, is an itchy rash consisting of localized swellings of the skin that usually last for a few hours before fading away. When urticaria develops around loose tissues of the eyes or lips, the affected area may swell excessively. Fetures Each individual hive lasts a few hours before fading away, leaving no trace. [病因与发病机理] 荨麻疹病因十分复杂，而且大多数患者原因难觅，特别是慢性型病人。引起本病发病的最常见原因有：食物：从主食到副食的许多食物，甚至包括食品添加剂、饮料等可能成为荨麻疹的因。其中以蛋白质、如鱼类、虾、甲壳类、蛋类、牛奶、肉等尤为常见。 [病因与发病机理] 药物：药物荨麻疹在临床上颇为常见， 以青霉素、痢特灵、阿斯匹林等引起者居多；使用磺胺制剂、链霉素、四环素或氯霉素后有时也可发生本病。此外，象可待因、吗咖、维生素B1等引发荨麻疹也屡见报告。 [病因与发病机理] 　感染：细菌、病毒、原虫、蠕虫、真菌等病原微生物感染与荨麻疹发病，对某些患者至关重要，甚至连虫咬或蜂螫刺都可导致荨麻疹发生。花粉及其它吸入物：如各种花粉、屋尘、动物皮屑等吸入物招引本病亦不乏其例。此外，精神因素、物理因素、全身性疾病、遗传素质等也可成为荨麻诊发病的原因。 发病机制Pathogenesis Immune-mediated urticaria Immune-mediated urticaria can be caused by 3 of 4 types of immune mechanisms. The type I allergic IgE response is initiated by antigen-mediated IgE immune complexes that bind and cross-link Fc receptors on the surface of mast cells and basophils. The types of antigens that bind to IgE are varied and include proteins, polysaccharides, and other immunogenic molecules. Type II responses are mediated by cytotoxic T cells. The disease process activates byproducts that cause urticarial vasculitis or bullous pemphigoid. Type III immune-complex disease is associated with systemic lupus erythematosus and other connective tissue disorders that activate urticaria. Early-phase reaction Late-phase reaction Non–immune-mediated Chemicals that can directly induce mast cell degranulation, presumably by altering the membrane properties, cause non–immune-mediated urticaria. Common agents associated with direct mast cell activation are opiates, antibiotics, curare, radiocontrast media, azo dyes, aspirin, and aspirin derivatives. Clinical Features Clasifacation Acute urticaria Chronic urticaria Specific types of urtica