Автореферат и диссертация по медицине (14.00.09) на тему:Тромботические осложнения при системной красной волчанке у детей: клиника, лечение и профилактика
- Ученая степень
- кандидата медицинских наук
- ВАК РФ
- 14.00.09
Оглавление диссертации Меграбян, Марина Феликсовна :: 2006 :: Москва
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Введение диссертации по теме "Педиатрия", Меграбян, Марина Феликсовна, автореферат
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Заключение диссертационного исследования на тему "Тромботические осложнения при системной красной волчанке у детей: клиника, лечение и профилактика"
выводы
1. У детей с системной красной волчанкой отмечается высокая частота тромботических осложнений (47,87%), большинство из которых формируется в рамках антнфосфолнпндного синдрома (у 39,46% больных). Особенностями тромботических осложнений у детей с СКВ в современных условиях являются преимущественная локализация тромбоокклюзионных изменений в мелких сосудах кожи (48,89%), ЦНС (37,78%) и почек (17,78%).
2. Сравнительный анализ частоты тромботических осложнений у детей СКВ, наблюдавшихся в 60-70 гг. выявил относительно большую частоту (56,67%) и тяжесть тромботических осложнений с более частым вовлечением сосудов среднего и крупного калибра и развитей летальных исходов (19,3%), на фоне лечения терапии высокими дозами ГКС и менее интенсивной антитромботичсской терапии.
3. Основными факторами риска развития тромботических осложнений у больных СКВ являются наличие активности основного заболевания (84,44%) в сочетании с высокими показателями, определяющими громбннемню (68,89%), и циркуляцией аФЛ (АКЛ - 75,56% и ВА 33,33%).
4. Комплексная терапия СКВ, включающая нммуносупрессивиые и антитромботическне препараты, позволяют существенно снизить частоту рецидивов тромбоза у детей до 18,57% за длительный период наблюдения
Збмес.).
5. Наиболее часто рецидивы тромботических осложнений отмечаются в относительно раннем периоде наблюдения (в первые 6 мсе.). Основными триггерами, обуславливающими развитие рецидивов. являются повышение активности основного заболевания и присоединение инфекционных осложнений.
6. При тщательном лабораторном мониторинге (МНО) герапня варфарнном у дегей относительно безопасна и сопровождается развитием геморрагических осложнений у 14.29% больных, в виде малых и минимальных геморрагий.
7. Генетическое исследование полиморфизмов гена цигохрома Р 450 СУР2С9 выявило носнтельство дефектных аллелей у 37,5% больных, что совпадает с популяинонными данными, У постелей муганзных аллелей риск развития геморрагических осложнений более высокий.
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