Imunoloģijā

1. Sistemātiskā sarkanā vilkēde
Systemic Lupus Erythematosus (SLE)
Ilga Grīnberga
MF IV
2012.g.

2. SLE
Hroniska, multisistēmiska, iekaisuma slimība,
kurai ir autoimuniloģiska etioloģija. *1,2+
1)http://www.merckmanuals.com/professional/musculoskeletal_and_connective_tissue_disorders/autoimmune_rheumatic_disorders/systemic_lupu
s_erythematosus_sle.html
2)http://www.medscape.com/public/mobileapp
http://animalsspecies.blogspot.com/2011/02/gray-wolf-wolves-are-one-species-of-dog.html

3. Sastopamība
• No visiem gadījumiem 70 - 90% ir sievietēm
(parasti fertilā vecumā) [1]
• Biežāk Afroamerikāņiem un Āziešiem nekā
Eiropiešiem *1,2+
• ASV 5,1:100’000 *2+
1)http://www.merckmanuals.com/professional/musculoskeletal_and_connective_tissue_disorders/autoimmune_rheumatic_disorders/sy
temic_lupus_erythematosus_sle.html
2)http://www.medscape.com/public/mobileapp

4. Imunopatoģenēze
http://emedicine.medscape.com/article/332244-overview#a0104

5. Etioloģija
• Vismaz 35 gēni ir saistīti ar SLE
• Biezāk sastopami leikocītu antigēni: HLA-A1,
B8, DR3
• Arī komplimentu deficīts ( biežāk C4, C2)
• Biežāk EBV nēsātājiem
• Zems D vitamīna līmenis
1)http://www.merckmanuals.com/professional/musculoskeletal_and_connective_tissue_disorders/autoimmune_rheumatic_disorders/sy
temic_lupus_erythematosus_sle.html
2)http://www.medscape.com/public/mobileapp

6. Klīniskās pazīmes*a+
• Biežāk simptomu triāde
– Drudzis
– Izsitumi
– Locītavu sāpes *1,2+
1)http://www.merckmanuals.com/professional/musculoskeletal_and_connective_tissue_disorders/autoimmune_rheumatic_disorders/sy
temic_lupus_erythematosus_sle.html
2)http://www.medscape.com/public/mobileapp

7. Tauriņveida izsitumi
http://emedicine.medscape.com/article/332244-treatment

8. Eritrēma
http://emedicine.medscape.com/article/332244-treatment

9. Locītavu sāpes
http://www.diyhealth.com/lupus-symptoms.html

10. Klīniskās pazīmes*b+
Bet var izpausties arī citās sistēmās:
– Muskuloskelitārā
– Dermaoloģiskā
– Renālā
– Kardiopulmonālā
– Gastrointestinālā
– Hematologiskā [1,2]
1)http://www.merckmanuals.com/professional/musculoskeletal_and_connective_tissue_disorders/autoimmune_rheumatic_disorders/sy
temic_lupus_erythematosus_sle.html
2)http://www.medscape.com/public/mobileapp

11. Diagnostika
• Klīniskie kritēriji
• Citopēnijas
• Autoantivielas
http://www.merckmanuals.com/professional/musculoskeletal_and_connective_tissue_disorders/autoimmune_rheumatic_disorders/syst
emic_lupus_erythematosus_sle.html

12. Criteria for the Classification of SLE*
At least 4 of the following are required to classify patients as having SLE in reports of clinical research:
• Malar rash
• Discoid rash
• Photosensitivity
• Oral ulcers
• Arthritis
• Serositis
• Renal disorder
• Leukopenia (< 4000/μL), lymphopenia (< 1500/μL), hemolytic anemia, or thrombocytopenia (<
100,000/μL)
• Neurologic disorder
• Positive test for anti-DNA, anti-Smith, or antiphospholipid antibodies
• Antinuclear antibodies in high titers
*These 11 criteria are from the American College of Rheumatology and are also often used as aids in
diagnosis. Although at least 4 criteria are not needed to make a diagnosis of SLE, the criteria help
in recognizing manifestations of SLE.
http://www.merckmanuals.com/professional/musculoskeletal_and_connective_tissue_disorders/autoimmune_rheumatic_disorders/syst
emic_lupus_erythematosus_sle.html

13. Terapijas principi
• NPIL
• Pret malārijas medikamenti (vieglai formai)
– Hydroxychloroquine 200 mg po 1xdienā
• Kortikosterioīdi
– Prednisone 40-60 mg po 1xdienā
• Imūnsupresanti
http://www.merckmanuals.com/professional/musculoskeletal_and_connective_tissue_disorders/autoimmune_rheumatic_disorders/syst
emic_lupus_erythematosus_sle.html

14. Prognoze
• SLE ir hroniska, recidivējoša un neparedzama
• Remisija var ilgt gadiem
• 10 gadu dzīvildze attīstītajās valstīs ir >95%
• Ātra diagnoze paildzina dzīvildzi
• Medikamentu dēļ pieaug osteoporozes un
KSS risks.
http://www.merckmanuals.com/professional/musculoskeletal_and_connective_tissue_disorders/autoimmune_rheumatic_disorders/syst
emic_lupus_erythematosus_sle.html

15. Paldies par uzmanību!
http://www.petandwildlife.com/wolves/wolf_species.htm