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Introduction to Medical Immunology - part 6

Biểu hiện lâm sàng biểu hiện lâm sàng của SLE khác nhau giữa các bệnh nhân khác nhau. Các loại cơ quan (quan trọng so với nonvital) tham gia xác định mức độ nghiêm trọng và tiên lượng tổng thể của căn bệnh này. Tần số trung bình của một số biểu hiện lâm sàng chính của SLE có thể được quan sát trong toàn bộ khóa học | Page 384 II. Clinical Manifestations The clinical expression of SLE varies among different patients. The kind of organ vital versus nonvital that becomes involved determines the seriousness and the overall prognosis of the disease. The average frequency of some main clinical manifestations of SLE that may be observed during the entire course of SLE is shown in Table 20.1 A. Diagnosis. The diagnosis is based on the verification that any four of the manifestations that are listed in Table 20.2 are present simultaneously or serially during a period of observation. Those manifestations are both clinical indicating multisystemic involvement and laboratory demonstration of autoantibodies. B. Course. Exacerbations and remissions heralded by the appearance of new manifestations and worsening of preexisting symptoms give the disease its fluctuating natural history. C. Overlap Syndrome. Occasionally physicians observe clinical situations in which the differentiation between SLE and another connective tissue disease is difficult. In some patients the distinction may be impossible and they are classified as having an overlap syndrome. This syndrome represents the association of SLE with another disorder such as scleroderma or rheumatoid arthritis. III. Immunological Abnormalities in SLE A. Autoantibodies 1. The LE cell is a peculiar-looking polymorphonuclear leukocyte that has ingested nuclear material. It was possible to reproduce this phenomenon in vitro by incubating normal neutrophils with damaged leukocytes preincubated with sera obtained from SLE patients. Investigations concerning the Table 20.1 Main Clinical Manifestations of SLE Manifestation Patients Musculoarticular 95 Renal disease 60 Pulmonary disease pleurisy pneumonitis 60 Cutaneous disease photosensitivity alopecia etc. 80 Cardiac disease pericarditis endocarditis 20 Fever of unknown origin 80 Gastrointestinal disease hepatomegaly ascites etc. 45 Hematological reticuloendothelial anemia leukopenia splenomegaly