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NASIERUA UTET SYNAPSE NATONOMMA BOCNANEHUA Natonorua BocnaneHuna VicyepnpiBatoluee pyKOBOACTBO, KOTOPOe NOMOxXKeT Bam my6oKo NOHATb OCHOBbI UU MexaHU3MbI BOCNaseHNA B OpraHu3me. B MeToOgUUKe BbI HaipeTe NOoApOGHble onucaHuaA NaTonorMuecknx NPOLjeccos, a TakKKe npakTUYeCKNe pekomeHAAaLNN No AMarHoctuke uv neyeHuto. Metoguuka HanucaHa FOCTyNHbIM AZbIKOM, YTO HeNaeT €@ NOHATHON u NoNesHON Kak AIA CTYQ@HTOB, Tak UV AA ONbITHbIX Bpayen. NpusatHoro utenua! OunaiiH-kypc nogrotoBKu K USMLE Step 1 - OCTaBUTb 3aABKy Ha O6yyeHve ak OcbuyManbHbii Cant 4 MeQVUWHCKON WKonbI Synapse uc) Mb! BkoHTakTe 4) Mp1 B Telegram OOO "CUHAMNC" Bce Mpasa SaujnusjeHb! (C) NATONOMMA BOCNANEHUA Octpoe BocnaneHune Octpoe BocnaneHvie — 3TO NpexomALaA UV PaHHAA peaklvA Ha TpaBMy, koTOpaa xapakTepu3yeTCA BbICBOOOKAeHVeM MHOFOUUCNeHHbIX MeAMaTOPOB UU NpuBoguT K CTepeOTUNHbIM peakLVAM MeNKUX COCYAOB Mi NeNKOLIVTOB. BocnaneHue — He CUHOHUM UHdeKuyun! OcHOBHbIMU NpusHakamu OcTporo Bocnanenna (puc. 1) ABNALOTCA: e Kpacuota (mMecTHoe noKpacHeHie KO>KHbIX NOKPOBOB MIN CNU3UCTON) U >Kap (NOBbILUeHUe MeCTHON Temnepatypbi). O6a npusHaka O6ycnoBneHb! TUCTaMNH-onocpeAOBaHHbIM paccna6bneHvem NpekanusApPHbIX CcPUHKTeposB B apTepvoNax, YTO NPUBOAMT K HANONHEHUIO KanusAPHOU CeTN VM pacluupeHuio KanunnApos vu NocTKanusNApHbIX BeHYN (pic. 2) e Otek TKaHei. Bcnegcteue ructamut-onocpesoBaHHoro yBenu4eHua NpoOHuLaemocTy BeHyN. OTeK CBYeTeNbCTByeT 06 yBenuyeHun KonNYeCcTBa >KUQKOCTU B UHTEPCTULIVabHOM NpocTpaHcTBe. ¢ Bonb. NpoctarnaHany E2 (PGE2) noBpiwaeT YyBCTBUTENbHOCTb cnelvanu3npoBaHHbIx HEPBHbIX OKOHYaHN K BO3AelcTBUIO 6pagukuHnHa u Apyrux meguatopos 6onu. Puc.1. Mpu3Haku octporo Bocnanenya. Y store HOBOPO>KAEHHOO CUHAPOM "olunapeHHoro pe6eHka", BbIZBaHHbIii SONOTUCTbIM cTacbunoKoKkom. NpusHakn octporo BocnaneHnva, npucytcTByloue Ha cbotorpacun, BKMIOYAIOT MOKPacHeHue MU OTeK. Vncbekuna TakoKke ConpoBoxKnaeTca >KapoM VU Bont. Kentble, NpunogHATble yYacTKU — STO NycTysbI, 3anonHeHHble HeipoTpodunamu. Stuonorua ocTporo Bocnanenua: e Wncbekyuu (Hanpumep, SakTepuvanbHble “nu BUpyCHble), AMMYHHbIe peakuuu (Hanpumep, peakuna Ha ykyc nuenbi). e Dpyrue pa3sapaKutenu: HeKpo3 TKaHei (HanpyMep, OCTPbI UHcpapKT muokKapya), TPaBMbI, pagMalua, OrKOrU, U MHOPOPHble Tena (Hanpumep, nysa, OCKONIOK). NATONOMMA BOCNANEHUA Normal Arteriole => Closed precapillary Impulse V Smooth muscle cell Acute inflammation Dilatation => Open precapillary sphincter Dilatation | Arterial blood im Venous blood Puc. 2. A3meHeHua KpoBoo6pajeHnusa np Bocnanenun. PaccnabneHue npekanunnApHOorO ccpuHkTepa B apTepvonax NPUBOAMT K HANOsIHEHUIO KanusinaApHon ceTu VU pacluMpeHUtO KanWvsNAPOB VU NOCTKAaNUIApPHbIX BeHYs. Natodu3nonorua octporo BocnaneHna Cocyguctbie peakynn: 1. Cy>keHue aptepvon. Mepsoe cocyauctoe co6pitue npu ocTpom BocnaneHuu, KOTOPOe O6ycnoBneHo HeiiporeHHbiM pednekcom, ANAWMMCA BCerO HECKOMIbKO CeKYHA. Baszoqunatauyna aptepuon. Aptepvonb!i — sTo HeNpOHMaemble Menkue apTepun, KOTOPbIe UMeIOT HECKOSIbKO CNOEB SNACTUYECKMX BOSIOKOH UU TO/IbKO OT OAHOrO AO Tpex CNoeB MagyKUXx MbILUL| B CTeHKe. TcTaMu Apyrue Basogunatatopbl (Hanpumep, oKcug azoTa [NO]) paccna6natoT magkue MbILULIbI B aPTepUONAX, YTO NPUBOAUT K yBENUYeHUIO KPOBOTOKa. TcTamu BbICBOGO>KAAeTCA U3 TYYHbIX K/IETOK, PACMOSIOXKEHHbIX B UHTeEPCTULVasIbHON TKaHM BOKpyr Menkux cocygoB. YBenuyeHue KPOBOTOKa, BbISBAHHOe BasOAMNaTaliven apTepvoNn, NOBbILAeT rugpoctatuueckoe AaBneHue (GaBneHve, CO3MaBaeMoe %KUAKOCTbIO) B npocBeTax BeHyNl. NATONOMMA BOCNANEHUA 1. Maprunaynsa HenTpodbunos (puc. 4). Npu octpom BocnaneHun SspUuTPOLWTbI CO6upaloTcs B PysOHbI ("“CTONKU MOHET") B BeHyslax (pvc. 4). O6pasoBaHue pysoHoB O6ycnoBneHo cpu6putoreHom, 6enkom OcTpoN cha3bl, KOTOPbI CUHTeESUpyeTCA NeYeHbIO. PynoHbI MexaHUYeCKl BbITECHAIOT HEUTPO*uNbI U3 LIEHTPaNbHOrO OCeBOrO pycna 1 OTTeCHAIOT UX K Nepucbepun BeHyn (Tak Ha3sbIBaemMaA MapruHalva). NB! MapruHauus HeitpocbunoB — 3TO He TO Ke CaMoe, YTO MaprMuHasbHbli hyn HeiTpocbunos! 2. Ponnuur Heitpodunos (pic. 4) Ponnunr (“Ka4eHnue”) nponcxoguT B BeHynax u O6ycnoBneH skKcnpeccuen mMonekyn anre3un CenekTUHa Ha HeiTpOCPMNaX NU SHAOTeEMMANIbHbIX KNETKAX BeHyn. Heitpocbunb! npununaloT K SHAOTeNUIO UV 3aTeM BbICBOOOKAAIOTCA, CHOBa NpununaicT u ocBoboxKAaloTcA, NPOFOMkKasA LIpPKyNNUpoBaTb No BeHynlam. CenekTuHb! — 3To yrneBog-cBa3biBatoluMe Monekynbl agresun. L-ceneKTUH pacnono>KeH Ha NeKOUNTax (HanpuMep, HeiTpOdunax), Torga Kak E-cenekKTUH vu P-cenekTUH pacnono>KeHb! Ha NOBEPXHOCTU SHAOTENNANIbHbIX KMETOK BeHYsI. P-cenekTUH BbIpabaTbiBaeTcA B Tenblax Bei6ens-Nanage 3HH0TeNnouMTOB. Tena Bevw6ens-Nanage — sto "cba6puka kien" SHAOTeENNANbHbIX KNETOK, NOCKONIbKy OHV CUHTesupyroT P-ceneKTUH, Monekyny agresuu ANA NenKOLVTOB, uv cbaktop cboH Bunne6panaa (vWF), Monekyny agre3suu TPOMOOLITOB. Untepnenkur-1 (IL-1) u cdbaktop Hekpo3a onyxonn (TNF) cTumynupytoT SKCNPECCUIO CENEKTUHOBBIX JIVraHAOB Ha NOBEPXHOCTU HeATpOCunoB (L- cenekTUh) u akKcnpecculo Monekyn CeneKTNHa Ha NOBepxXHOCTH 9HAOTeNUA (E- cenekTu, P-cenektuh). CBA3biBaHue LIVpKyNUpytOLNx HeMTpodunos c E- CeneKTUHOM VU P-ceneKTVHOM Ha SHAOTeENNN ABNAeTCA Cna6bIM VU NpexopALVM, YTO 3aCTaBNAeT UX "NepeKaTbIBaTbCA" (CBASbIBATbCA-OTCOEANHATECA, CBASbIBATbCA-OTCOCAMHATECA) BAONb NOBEPXHOCTU Cocysa. 3. Mpounaa agresua B BeHynax O6ycnoBneHa aKcnpeccuen B2-nHTerpuHOB Ha HeuTpocbunax u akCNpeccuei MONekyN apres UVHTerPUHOB Ha SHAOTeNUNU. B2-nHTerpuHb! pacnonoKeHb! Ha HeTPOdunax U B3aNMOg_eNCTBYIOT C COOTBETCTBYIOLUMMY AMraHAaMu Ha SHAOTeNUU. Katexonamunbl KOPTUKOCTepoupb! UHTM6upyicoT akTVBAaLltO STUX MONekyN agresuu Heltpocpunos. Unru6upoBanve B2-nHTerpuHosB HeiTpodunoB NPUBOAUT K yBenuyeHnio B nepudbepuyeckon KpoBu KoNUYeCcTBa HeTPO*PUIOB B nNepudepuyeckon Kposn (Tak HasbIBaeMbIN HEMTPOCUsIbHbI NeWKOLMTOS) — MapruvasibHblid ny CTAHOBUTCA YaCTbIO LiMpKynupyrolero nyna. NATONOMMA BOCNANEHUA Margination Rouleaux . a ar acer Nee a ’ Interstitial space Exudate Bacteria <————_—_ } Chemotaxis <= Transmigration Puc. 4. Co6bitus, nponcxogsume c HeiiTpodunamn npu octpom Bocnanenun. PonnuHr o6ycnosneH akTuBalive Monekyn anresun CeneKTUHa Ha NOBEPXHOCTH HeliTPO*UsOB, B TO Bpema Kak NpouHaa anresua O6ycnoseHa akTUBal\ve Monekyn apresuu B2-vHTerpuHa (CD11a:CD18) Ha noBepxHoctu HeiiTpocbunoB (He NOKa3aHo). JIuraHg”b! (MecTa npuKpenmeHua) ayia cenekTuHa Uv B2-nHTerpuHa HaXOPATCA Ha NOBEPXHOCTU SHAOCTENNANbHbIX KIIETOK (HE nNoka3aHo). TpaHcmurpaliua HeiTpodusios Yepes SasanbHy!o MeMOpaHy NpoucxopuT B OCHOBHOM B BeHysax. Heiitpodunb! pacTBOpAloT OOHAKEHHYIO GasanbHy!O MeMOpalHy BeHyN TpaHCMurpupytoT B MHTePCTULMaNbHy!0 TkKaHb. STO NPUBOAMT K usnuTuIO GoraTon Genkamu >KNAKOCTU (Tak Ha3bIBaeMOro SKCCyAaTa) BMEeCTe Cc HeTPOdunamn. OKasaBlLUcb B VHTeEPCTULIMANbHOM NPOCTPAHCTBE, HeMTPOCMbI HaNpaBNAIOTCA K MECTY BOCNaseHNs Nop, BIIMAHVIeM XEMOTAKCUYeCKUX cbakTOPOB. B2-nHTerpuHbI Ha HeiTpocbunax akTuBupyrotca Cd5a u nevkoTpueHom B4 (LTB4). SHAOTOKCUHbI TakKe YCUTUBaIOT aKTMBaLINIO B2-MHTerpuHOB HeviTpocpunos. YouneHHasr akTUBalNA B2-UHTErPUHOB NPUBOAMT K CHY>KEHIIIO o6wero KonuyecTBa Lvpkynupylolux HeiTpodunos (Tak Ha3bIBaemaAa HeiTponenna) — ny WNpkynupytOLyUx HeEUTPOCPUNOB CTAHOBUTCA YacTbIO Nya MapruHasibHbIx HEUTPO*UNOB. AKkTuBalva Monekys afresun SHAOTeNUA - MOsIeKysIbI MEXKKeETOYHON agresun (ICAM) u MonekynbI agresnu cocyancTbIx KneToK (VCAM) — npoucxomuT B pesynbtate Bosgelictsua IL-1 u TNF. AktuBuposaHublie nuraHab! ICAM CBASbIBaIOTCA C AKTUBNPOBaHHbIMU B2-VHTerpuHamnu Ha HeiiTpocpunax/ Makpodparax, B pe3ysibTaTe Yero HEMTPOCPUIbI NDOYHO CBASbIBaIOTCA C 9HpoTennem. B cBolo OYepesb, AKTUBUPOBaHHble NuraHAbl VCAM CBASbIBaIOTCA C AKTUBUPOBaHHbIMN B1-VvHTerpuHaMu Ha s03nHOdpunax, MOHOLIVTAX UW IUMCPOLTAaX, KOTOPbIe 3ATEM NPOYHO CBASbIBAIOTCA C 9HpOTeNneM. NATONOMMA BOCNANEHUA 5. Tpancmurpauna (quanege3) HeiTpocbunoB B UHTepCcTULManbHoe NpocTpaHcTBo. Heitpodunbl, ABYraACb BAONb SHAOTeNUA BeHyN, NONagaloT B LEN, o6pas0BaBlueca B pesybTaTe FrMCTaMUH-ONOCpepOBaHHOrO COKpaleHuA sHgoTenna. B atom mecTe HeliTpocpunb! BbIGeNnAloT KONNareHaszy IV Tuna, koTOpaa pacTBopseT 6asanbHyto MemOpahy, No3sBoNAA HeiTpodunam NPOHVKHYTb (TPaHCMUrpupoBaTb) B UVHTEPCTULMasIbHytO TKAaHb. Monekyna agre3uv TPOMGOUIVTOB kK SHAOTeNMaNbHbIM KNeTKam-1 (PECAM-1; CD31) 9KCNpeccupyeTca Ha NOBEPXHOCTU TPOMOOLNTOB, HeUTpPOCcunoB UU SHAOCTeNNA. PECAM-1 onocpegyeT TpaHcmurpauuio HeiiTpodunosB MeExgAy SHAOTeNVeM U WHTePCTULVanbHON TK@Hbbo. B UHTEPCTULVaNbHON TKaHU HakansIUBaeTCA NNa3Ma, 6oratan 6enkamu nu kneTKamnu (Tak Ha3bIBaeMbIN BKCCYAAT WM THO!) (puc. 6). Injury Activation of vascular endothelium Increased capillary permeability Chemokines for cellular recruitment ,/ Complement components / Antibodies r Pro-inflammatory Pa mediators Vascular PMNs \ Macrophages + \ Lymphocytes | Puc. 6. MexaHu3m HakonneHna oKccyfata. PacwiupeHue cocyfoB npv BocnaneHun BbI3bIBaeT NOKPACHEHMe VM NOBbILUEHNe TemnepaTypbl, a TakoKe YBeNNYeHVe NPOHULaeMocTU kanunnapos, YTO NO3BONAeT BKCCyAaTy HakanNUBaTbCA, YTO NPUBOAUT K OTeKy TKaHeM nputoKy KneTOK (HeTpocbunoB) K MecTy NOBpexkAeHVA TKaHM. Kak TOKO KNeTKM NonapaloT B 30HY NOBPeEXKAeHUA, OH BbIeNAIOT XeMOTAaKCUYeCKUe ChakTOpb! AVIA NpvBNeYeHuA Apyrux KNeTOK, YTO NPUBOAMT K NOKaNbHON aKTUBALINN B NOBPeXAeHHOM MeCcTe. NATONOMMA BOCNANEHUA @yxHKuUMN aKcCyfaTa: e Pa36aBnaeT GakTepnanbHble TOKCUHbI, ECU OHM NpUCyTCTBYIOT. ¢ O6ecneuvBaeT ONCOHMHamn (uMMyHoro6ynuH G [IgG], C3b) ana cogelctBua cbarouuto3y HeTpodunamu, Makpodaramn UV AeHAPUTHbIMU kneTkamn 6. Xemotakcuic HeliTpodunos — 3sTo HanpaBneHHaa murpaliva HeiTpocuos. Heiitpocbunb! cnegytoT no xumuyeckuM “cnegam”, BeAYLUMM K OYary VHcpeKLMN (puc. 4). Xemotakcuyeckue Meguatopbl - BKNOYatoT C5a, LTB4, npopyKTbl KUBHeEDeATeNbHOCTU SakTepuid vv IL-8 - CBASbIBaIOTCA C peLlenTopamu HeiTpodbunoB. CBA3bIBAaHUe BbISbIBaeT BbICBOOOKAEHNe KasIbLINA, KOTOPbI YBeENUYNBaeT NOABYXKHOCTb HeUTpPOCcpuoB. 7. MaroyNtTo3 HeiTpOduNoB MU yHUYTORKeHMe GakTepui — STO MHOrOCTyNeHYaTbI NPOL|ECC, COCTOALNI U3 ONCOHNZaLUU, NOMNOLWeHUA U YHNYTOKEHUA. Oncouusauna (puc. 7 uv puc. 8). OncoHuHDb! - IgG, cbparmeHT C3b KomnnemeHTa VY Apyrue 6enku (Hanpumep, C-peakTUBHbIi Genok) - NPUKpenNsAIOTCA K 6akTepuam (uni UHOpopHbiM Tenam). Heitpocbunbi uMeroT MemMOpaHHble peyentopp! ana IgG u C3b. Onconusayua ycunuBaeT pacnosHaBaHie Uv npukpensenue HeiTpodusoB K GakTepuaM (UM UVHOPOAHbIM Team). Granules Granules Ls Bacterium /\ Invagination of cell membrane, Phagocytic vacuole A B PHAGOCYTOSIS, (6; DEGRANULATION Puc. 7. Darountos 6axtepuik. A. OncoHnusupoBaHnas (T. €. NOKpbITaA IgG uv KOMNIeMeHTOM [C3]) 6axtepua cBA3bIBaeTCA C peyenTopamu Fc uv KomnnemeHTa Ha NOBEPXHOCTU HeNKOLMTOB. B. 3axBatT 6akTepun B UHBarMHauvio NOBEPXHOCTHON MemOpaHb! CBASAH C OKVICUITesIbHbIM B3PbIBOM Ul O6pa3s0BaHieM CBOGOPHbIX pagukanoB, KOTOpbie O6NagaloT SakTepuL|VAHbIMU cBoiicTBamu u y6uBaioT 6akTepuio. C. BkmoueHve 6akTepun B cbarouvTapHyto BakyOsIb CBAZAHO CO C/IMAHNeM BakyOsN C NMZ0COMaMN MU CnelMcpuyecKuMN rpakynamn NenKoUNTa (Tak Ha3biBaemaa cbaronusocoma). Copep»kumoe 130CoM MU cneLMdpu4eckux rparyn o6nagaet GakTepuuVpHbIMN CBOCTBAMN UW CnocoGcTBYyeT OKOHYATEsIbHOM MHAKTUBALINN qerpagjauun Gaktepuu B cbaronusocome. Livronnasma NevKOUNTAa NPY STOM AMWeHa rpaHys ("gerpaHynsauua nevKOUNTOB"). NATONOMMA BOCNANEHUA (7 Deficient in G6PD So Bacteria i aatcianey Wi | / | jj <5 : ~ o> Wise eal o> Respiratory a ae Basra t Fe receptor "NADPH oxidase V4 i mn \\ eeenin) Neutrophil complex ! C3b cell membrane. NADP*~ 5 (superoxide) receptor <—SOD H202 : ee r Hydrolases Cl OH ee <—MPO ge OP <- HOC (bleach) Dysfunctional in CGD GSH peroxidase GSH GSSG NADP+ NADPH Cofactor for NADPH G6-P 6PG oxidase Glucose-6-phosphate dehydrogenase Deficient in G6PD deficiency Phagolysosome MPO. Hydrolases MPO Bacteria Puc. 9. O2-3aBucumas MuenonepoKcuga3Has cuctema. B cbaronu3zocome npoucxoguT pay 6voxumuyeckux peakunii, B pesyibTaTe KOTOPbIx O6pa3yloTcA CBOGOAHbIe pagVkasibl runoxnoputa HOCI- (ucnonb3yetca B oT6enuBaTensax), YHNYTOKaIoLUMe GaKTepuu. Npeo6pasoBaHue H202 B OH- c uicnonb30BaHvem BOCCTaHOBNeHHOrO Fe2+ B KavecTBe UCTOYHNKa 3NeKTPOHOB Ha3biBaeTcA peaklvei DeHTOHa. NADPH, o6pa3yiowuiica B pesynbTaTe NeHTOso*ocdarTHoro WYyHTa, ABIAeTCA KOcpakTOpom ~yIA NADPH-okcua3bl, Aeduuyt KoTOpON HabmogaeTca Npu xPOHUYeCKON rpaHynemaTosHo GonesHu. CHW>KeHVe kocbaktopa NADPH (npu gecbuute rntoKo30-6-cbocdbatgerugporeHasb! [G6PD)) TakKe NpensaTCTByeT HOPMasbHOMY ChyHKLMOHUpOBaHuio MVenonepoKcuga3sHon cucTembl. IgG u C3b ABNAIOTCA ONCOHUHaMI, KOTOPbIe OGNeryaloT AevicTBUA carolVTOB (He”TpocbunoB,MOHOLNTOB). HoBeWWNi TecT Ha Hane OKUCAUTeNbHOrO B3PbIBa B HeiTpodbuax - oKUcNeHUe AUrMApOpoAAaMmuHa AO cnyopecleHTHOrO pogamuta. Xponuyeckas rpahynemato3Haa 6one3Hb (XIB) — ato X-cuenneHHoe pelieccuBHoe 3a6oneBanne (65% cnyyaeB) unu ayTOCOMHOE peLl|eccuBHoe 3a6oneBanue (30% cnyyaes). X-CLIeENNeHHbI TUN XapakTepu3yeTCA MyTaLVen B reHe CYBB, KOTOpbIi KOgUpyeT KOMNOHEHT cbepmMeHTHOrO KomnneKca NADPH-okcupa3bl, B pe3ysbTaTe Yero STOT KOMMeKC He CbyHKLMOHMpye§r. CHu>KeHHOe Npou3sBogCcTBo Q2 - NPUBOAMT K OTCYTCTBUIO OKUCNIMTESIbHOrO B3pbiBa. KaTanazononoxKuTenbHble OpraHvi3MbI, npoAyUNpyroLuMe H202 (Hanpumep, Staphylococcus aureus, Nocardia asteroides, Serratia marcescens, Aspergillus species u Candida species) nornoujatotca, HO He Norv6ator, noTomy uTO KaTana3a paspylwaeT npopyuupyempbi” umu H202. Muenonepokcugasa npucytcTByer, HO CBOGOpHbIe pagukasibI runoxnopuiTa He CUHTesupytoTca u3- 3a oTcyTcTBuA H202. OpHako, KaTanasOOTpULaTesbHbIe OPraHu3MbI (Hanpumep, Bua! Streptococcus), KoTOpbie BbIPAbaTbIBaloT H2O02, nonaaloT B OpraHu3M VU MOryT O6bITb y6uTbI, Kora MPO coequuset H202 (nony4eHHyto OT 6aktepui) c Cl, o6pasya HOCI. NATONOMMA BOCNANEHUA TpavynemaTo3Hoe BOCNaNeHie BOSHUKa@eT B TKAaHAX, NOTOMY YTO HeTPOdUNbI, koTopble cparouTupytoT GakTepun, HO He yOuBaloT GONbLUNHCTBO U3 HX, B KOHEYHOM MTOre 3AMeHAIOTCA XPOHVYECKUMU BOCNANNTEsIbHbIMU KeTKaMI, B OCHOBHOM sIMMcpouNTamu u Makpodaramu. Makpodarn cnusatotca, o6pa3ya MHOrosgepHble ruraHTCkie KNeTKM, YTO ABNACTCA XapakKTePHbIM NPUSHAKOM TpaHynemato3Horo BocnaneHua. NauweHTb! c XTB ctpamatoT OT TAKeNbIX MHCPeKNN, NOparKalo”x Nerkue (HauGonee pacnpocTpaHeHHaa cbopma - NHEBMOHMA), KOKY, BHYTPEHHMe opraHbl U KocTU. Knaccu4eckum CKPUHUHTOBbIM TECTOM Ha XB ABNAeTCA TECT C HUTPOCUHUIM TeTpa3zonuem (NBT). B 3Tom TecTe nevikouuTb! B NPO6upKe UHKy6upyloT c KpacuTenem NBT, KOTOpbIi CTAHOBUTCA CUHUM, eCNU NpUcyTCTBYIOT CBOGOAHbIe paAVkasbl, YTO yka3bIBaeT Ha TO, YTO OKVICAUTENbHbIN B3PbIB He HapyLieH (CuNTaeTCA NONOKUTENbHbIM TeCcTOM). Mpu X-cuenneHHom Tune XIB tect c KpacuTenem NBT otpuuyatened (kpacutenb NBT He npespatyaetca B CUHUI LIBeT), nockonbky cbepMeHTHbI KOMnneKc NADPH-okcnga3bi He pa6oTaer. OAHakoO, U3-3a HEOCTATOUHON YYBCTBUTEsIbHOCTU TeCT C KpacuTenem NBT 6bin 3aMeHeH Gonee YYBCTBUTENbHbIM TECTOM, BKOYAIOLUIMM OKUCFeHNe Aurupzpopogamuna Ao cbnyopecueHTHOrO posamuHa. TOT TeCT OTPULaTeNeH npu o60nux BapnaHtax XB. Hecbuynt MPO — 3T0o ayTOCcOMHO-peLeccuBHoe 3a6oneBaHue, KOTOPOe oTnuyaetca oT XIB Tem, 4TO BbIPabaTbIBaloTCA Kak O2--, Tak u H202 (HOPMasbHbI OKUCHUTeNbHbI B3PbIB). OAHAKO, OTCyTCTBUe MPO npensatctByet cuHTesy HOCI. Qecbuuuvt NADPH (npn Aedbuunte rntoKo30-6-cbocdbatgerugAporeHa3b! [G6PD]) TakKe NPUBOAUT K HecbeKTy yHUYTOxKeHUA GakTepun. NauveHTb! Cc AecuyVTOM G6PD o4eHb BOCnpuuMuLBb! K GakTepvasibHbIM V HEKOTOPbIM FPUGKOBbIM UHdekuWaM, NOCKONbky O2-3aBucumaa cuctema MPO HapylweHa. Kpome Toro, AucdyHkuusa NADPH npu gecdbuunte G6PD, koTopbiii aBnaeTcA NpUYNHON remonuTuyeckon aHemun. Temonutuyeckan aHeMuA XapakTepu3yeTCA HapylWweH“emM MemMOpaHb! SPVTPOLIMTOB C BbIXOGOM remormo6uHa B nnasmy kposn. Temonutuyeckas aHeMNA OG6bIYHO BbI3bIBAeTCA UHCPeknei. YHuYTOKeHUe GakTepui HeVTPOCUNAaMN MO%KET NPOUCXOAUTb Tak>Ke C NOMOLbIO O2-HesaBluicuMbIx Ciictem. KucnopoAHesaBuicumble CUCTeMbI YHUYTOXKeHNA BakTepuih OCYLUECTBNAIOTCA NyYTeM BbICBOG6OKAeHUA TOKCUYECKMX BELIECTB U3 rpakyn NevKOWUNTOB. K TAKUM BELLECTBAM OTHOCATCA JlakTocbeppu (npucytctByeT B rpaHynax HeUTpodunos), KOTOPbIN CBA3SbIBaeT >KeNe30, HEOOXOAMMOE ASIA HOPMasIbHOrO PocTa U pasMHOKeHNUA BakTepuii, UV OCHOBHOM 6enok (MBP), nposyKT S03MHOCPUNOB, LIUTOTOKCUYHbI AA TeNbMUHTOB (NapasuTuYecknx YepBei). Mpouecc cbarounto3a ucTowaeT 3anacbl mukoreHa B HeiTpodunax, YTO B KOHeYHOM UTOre NpUBOAMT kK ruGenu HeTpoduna. NATONOMMA BOCNANEHUA Ta6nuya 1. DyHKUMN Me_uaToposB BocnaneHua (npofomKeHne). Meguatop Uctounnku @ynKynn MertaGonutb! apaxugoHoBon KucnoTbI Komnnement Cuntesupyertca B neyeHu (Genku ° C3a, C5a (aHacbunatoKcunb)): OcTpon chasbi) cTumysupytoT BbICBO6OKGeHNe rucTaMuHa TYYHbIMM KeTKaMU © C3b: oncoHusayna ° CSa: akTuBalva monekyn agresuu HeiTpocbunos, xeMOTAKCUC ° C5-C9 (Mem6paHoatakyrouui KOMMseKC): NM3UC KNeTOK Uwtokunpt IL-1, TNF IL-1: maxpoqparu (ocHoBHOM @ynkuunu IL-1: VICTOYHNK), SHAOTeNMANIbHbIe ¢ Tunotanamyc: ctumynupyet KneTKM, HEKOTOPbIe ceKpelvio KOPTMKOTpONMH- OnuTenvanbHble KNeTK punu3unr-ropmona; nepepHui runocpus3: TNF: makpocbary, T-KneTKu cTumysupyeT CeKpeLivio AKTI; kny604koBaa 30Ha HagInOye4HUKOB: cTumysupyeT Cekpeyinio TOKOKOPTUKONOB (koptusona). © SanyckatoT cuHTes PGE2 B nepegHem runotanamyce, 4TO NPUBOAMT K pasBUTMIO simxopaykn ¢ Tevenb: cuHtes 6enkoB OCTpON cha3bi © AKTUBUpyIoT MoneKysibI agresun sHg0TennanbHbix kleTOK ° T-KneTKn: AucbcbepeHunposka TH17 @ynkuyun TNF: ¢ TMpomotop anonto3a MHOrUx TunoB KneTOK ¢ AktuBalna sHpoTenua ° AktuBayna HeiTpodunos e Kaxekcua (uctoujeHne MbILULI) IL-2 CD4+ T-KneTKu e B-KnerTku: nponudepauna, CUHTes aHTuTen in vitro ° T-kneTKu: nponucbepaynn/ AucbcbepeHunposka Ha kKneTKM naMaTu ocbcbeKTOpHble KNeTKN e NK-KnerTku: akTuBauya, nhponucbepayna NATONOMMA BOCNANEHUA Ta6nuya 1. DyHKUMN Me_uaToposB BocnaneHua (npofomKeHne). Meguatop Uctounnku @ynKynn Uwtokune IL-3 T-KneTKu ¢ CTumynupyeT cospeBaHue Bcex remonosTM4eckux JHU B KOCTHOM Mosre IL-4 CD4+ Th2-KnerTku, TyYHbIe KneTKN = ®-: B-KeTKi: Mepekmio4eHue ugoTuna aHTuTen Ha IgE ° T-KneTKu: Aucbcbepenunposka Th2, nponudepayna IL-5 CD4+ Th2-knetKu e B-KneTku: nponudepayna YeunupaetT nepeknioyeHve Tuna Knacca Ha IgE ¢ NosbiwexHaa npopyKuna 903uHOdunoB IL-6 Makpodparu, sHgoTenuii, T-kneTkKu = ® OCHOBHOM WMTOKUH, OTBETCTBEHHbI 3a NOBbILUGHHbI CMHTES B neyeHn 6enkos ocTpon cpa3bi (Hanpumep, C-peakTusBHoro 6enka) © T-KneTKn: AucbcbepeHunposka Th17 ¢ B-KneTkn: nponudepayya B- kneTOoK IL-8 Makpogparu, snutenvanbhble Xemotakcuc HeiTpodunos u KNeTKM, SHAOTeENMAaNbHbIe KNeTKU, pecnupatopHbiit B3pbIB TaQKOMBILeYHbIe KeTKU CTumynupyer AbIxaTenbHbIx nyTeli BbICBO6OKAeHNe HeiTpodbunamu MepvaTopos, BbIPabaTbIBaeMbIX B rpavynax (9k30yNTO3) IL-10 T-KneTKn Wnru6utop akTuBupoBaHHbix Makpocbaros MW JeHAPUTHbIX KNeTOK, YYACTBYIOLUX B KOHTpone BpO>KAeHHOrO VMMYHMTeTa Ml KMeTOUHO- onocpefoBaHHoro vmmyHuteta nyTem: Unru6uposanya BbipaboTKu IL-12 axTusupoBaHHbiMu mMakpocbaramu//feHAPUTHbIMU. kneTkaMn Unru6uposaHna akcnpeccun kOcTUmynATOpOB UM MoneKyn MHC xnacca II Ha mMakpocharax/eHApUTHbIX knleTKax NATONOMMA BOCNANEHUA K 6enkam, CUHTe3UpyeMbIM MeYeHbIO, KOTOPbIe CHUKAIOTCA, OTHOCATCA asbOyMUH (AMUHOKMCNOTHI Ucnonb3yemble AIA CuHTesa BO®), TpaHcdbeppun (6enok, CBASbIBaIOLMICA C >KeENe3OM) U TPAHCTUPeTHUH (TaKxKe Ha3bIBaeMbIi npeanb6ymuHoM). BO® tHe Bcerfa none3sHbl; K BDeGHbIM acpcbekTaM OTHOCATCA UCTOLUCHMe MbILUL, (kaxekcua), aAHOpeKcuaA (NOAaBNeHue anneTuta), HapylwieHue pocta y AeTen. Cell membrane phospholipids Phospholipase A, Corticosteroids inhibits; 2 calcium enhances Linoleic acid —> Arachidonic acid Aspirin: irreversible effect; off 3-5 days to reverse Zileuton: inhibits enzyme effect on platelets (must synthesize enzyme) 5-Lipoxygenase Cyclooxygenase Montelukast: inhibits NSAIDS: reversible effect; < 24 hours to reverse receptors for LTC, D, E, LXA,, LXB4 effect on platelets LTB,, LTC,, LTD,, LTE, PGG, Bronchoconstrictors Dipyramidole enhances Thromboxane synthase ~~, __ Prostacyclin synthase oS Platelet Nae Endothelium paele Platelet aggregation Inhibit platelet Vasoconstriction i aggregation PGD, Vasodilator PGE, ———> pGF, Puc. 10. YnpowenHHbii MeTa6onu3mM apaxvfOHOBON KucnoTpI. ApaxugoHosas Kucnota (AK) BbICBO6oxKAaeTCA U3 MeMOpaHHbIx cbocdonunugos nog ZeiicTBuem cbocconunasbi A2. SToT cbepmedT uHruGupyetca KOpTUKOCTepoupaMn VU akTUBUpyeTca Kanblvem. JIMHoneBaa KucnoTa — 9TO W-6 HesaMeHuMaa X%KUPHaA KUicroTa, KOTOpaA Vicnonb3yeTca AA CuHTesa AK. AK Npeo6pasyerTca LIMKNOOKCUreHason NO OAHOMy U3 nyTet B NpocTarnaHgunel (Ml). O6patute BHUMaHle Ha BMAHVe acnupuna U HMBC Ha ynKnookcu-reHa3y TPOMOoLITOB. Visocbopma COX-1 (He nokasaHa) NOCTOAHHO SKCNpeccupyeTcA B PasNNYHbIX TKAHAX, Tora KaK usocbopma COX-2 (He noka3aHa) UHAYLIMpyeTCA pasnU4HbIMN cbakTOpamn pocta uv NpoBocnanutenbHbIMU WIVTOKMHaMn. PGH2 sBnaeTca npeglWwecTBeHHUKoM ITI, KoTopbIi npespawjaetca B TpoM6oKcaH A2 (TXA2) B Tpom6ounTax nog Ae”cTBVemM TpomMboKCaH- CHHTasbI VB PGI2 6 SHAOTeNMaNbHbIX KeTKaXx NOg AeVCTBMeM NPOCTALMKNUH-CUHTasbl. O6patuTe BHYMaHve, 4TO AUNUpamupON ycunuBaeT WelicTBNe cbepMeHTa. TakxKe OOpaTuTe BHUmaune, 4TO TXA2 u PGI2 o6nagatoT NpoTMBONONO>KHbIM AeVcTBNeM B TpOMboLMTax. PGH2 TakwxKe npeobpasyertca B PGD, E u F2. Ha qpyrom nytu 5-nunokcureHasa npespajaeT AK B HeiKoTpuveub! (JIT). 5-nvunokcureHa3a uHru6upyetca 3uneyTOHOM, a peyentopb! Ana LTC4, LTD4, LTE4 - moutenykactom. O6patute BHUMaHne, 4TO AK TakKe npeocbpasyerTca B Snokeu A4 (LXA4) uv sunokcuH B4 (LXB4). NATONOMMA BOCNANEHUA Tunbi octporo BocnaneHua MecTo, npuuuna uv npopomkKNTeNbHOCTb BOCNaneHuA ONpegenstoT Mopdbonorulo BoCcnanuTenbHON peak. e THoiHoe (HarHouTenbHoe) BOCnaneHue — STO NOKaNUusOBaHHoe ees pacnpoctpaHeHnve rHoeobpa3ylOlunx OpraHU3MoB, Takux Kak Staphylococcus aureus (Hanpumep, a6cuecc koxKu; pric. 11A). SonoTucTbIi cTacpunoKOKK Cofep»KUT KOaryna3y, KOTOpaA pacluennseT cbu6puHoreH AO cdu6pnna uv 3agqepxKuBaet 6akTepun uv HeiTpocbunbl, TeM CaMbIM COxpaHsAA nokanuzalio UnceKyUN. Llenntonut — 3To pacnpoctpaHaroljaarca GakTepuanbHan UHCpeKLNA NOAKOX%KHON KNeTYaTKU, KOTOPAA OG6bINHO BO3HNKaeT Nocne TpaBMbI KOK (puc. 11B). Ctpentokokk rpynnp! A (Hanpumep, Streptococcus pyogenes) - pacnpoctpaHeHHbii Bo3s6yAuTenb Wennonuta. TvanypoHugasa, BbIpa6aTbIBaemas NaTOreHoM, NO3BONAeT eMy pacnpocTpaHATbCA NO TkaHaM. Mpu3Haku Wenmonuta BKMOYaloT Mxopagky, yBenuueHve Mmnouwjagu NoKpacHeHnaA, YYBCTBUTEbHOCTb NPY Nanbnaywu, npunyxnoctp, 6one3HeHHylo AUMcbageHonatuio B MecTax APeHaxka U KpacHble NPOKMNKU, npepctasnatowue co6on numcbatuyeckoe pacnpoctpaHeHue UHeKuUNN. Cumntomb! Wenmonuta BKMOUaIOT yCTaNOCTb, HPO%Kb UNM O3HOG, NOTNUBOCTb. @uG6puno3sHoe BocnaneHue — 3To BoCcnaneHnve, O6ycnoBneHHoe NOBbILUCHHON NPOHULJAeMOCTbIO COCYAOB, C OTNO>KeHVeM GoraToro cbu6puHom 9kccyfata Ha NOBeEPXHOCTH TKaHH (puic. 11C). PacnpoctpaHeHHble MeCTa oKasUsaluu - Cepo3sHan O6onouKa NepuKapza, 6prowuMHb! wn NnesBpbl. Mpu cbu6puHo3Hom NepukapAtTe, CBASAHHOM C MHcbapkKTOM MUOKapAa WI peBMaTuYecKoN NUXOpankon, B NoArPyAVHHON oO6NacTu MOET BbICIYLUUBATbCA TPeHNe. TpeHue MOET 6bITb CIIbILUHO Takke B NOArPyAVHHON o6nactTu wnuv nerkumu npu du6puHo3sHom MneBpute, BTOPUYHOM NO OTHOLWeHMI0 K UHdpapkKTy Nerkoro unn NHEBMOHNN. TOHKOKULWeYHas HENPOXOAUMOCTb U3-3a Cnaek MexKAY Apyrumn netnAMN KULWEYHUKa MOKET BOSHUKHYTb B PesysibTaTe pasapaKeHua Sproul, CBASAHHOrO C NpeAbIAyLUeN aBAOmNHaNbHON onepauven. Cnaiiku YacTo BbI3bIBalOT HENPOXOAVMOCTb TOHKOM KLIK. Cepo3Hoe BocnaneHue — 3TO BOCNaneHnve, CBASAHHOe C TOHKUM, BOQAHVCTbIM 3KCCYAaTOM, B KOTOPOM HeEAOCTAaTOYHO cpv6puHorena ANA o6pazoBaHna cbu6pua. Mpumepamu cepo3Horo BOCMaNeHUA ABMAIOTCA BOsIAbIPU Np OrxKOrax BTOPO CTeneHn (puc. 12) v BUpyCHbI nneBpuT. NcesgomemG6panosHoe Bocnanennve OTHOCMTCA kK TuNy GakTepvabHoro, BbISBaHHOrO TOKCUHAMM NOBpexXAeHUA CIU3SUCTON O6ONOUKN C o6pazo0BaHvem MOxXpoBON MemMOpaHbi, COCTOALIEN U3 HEKPOTUYECKON TKaHU. MpvmMepamyu MOryT ChyKUTb NCeBAOMeMOpaHbl, CBAZAHHbIE C: . Clostridium difficile, nov nceBgomem6paHo3Hom KonuTe (puc. 11D) . Corynebacterium diphtheriae, koTopaa BbIPabaTbIBaeT TOKCUH, NnpuBoAAWUn K o6paz0BaHuio ncespgomem6panb! B MOTKe U Tpaxee. 
