Antiphospholipid syndrome: well, symptoms and causes, diagnosis, treatment and inheritance. antiphospholipid syndrome

Antiphospholipid syndrome (APS) is the prevalence of clinical and laboratory signs, which appear in the body of antibodies to phospholipids and phospholipids-binding proteins. Phospholipid is the basis of the cell membrane. Antibody to them reacts with the words and ears of the shells. As a result, a complex of signs is developed, including:

• blockage (thrombosis) of veins and arteries;
• non-blame vaginosti and obstetric pathology;
• Decrease in the number of platelets in the blood (thrombocytopenia).

Cause I will become unavailable. It is indicated that the deyak is interconnected with the transfer of infectious diseases. Є spadkov ability to develop the APS. Tsey syndrome can be accelerated overbig systemic red blood pressure abo, navpaki, overdue development.

Let’s talk about those who have tied antiphospholipid syndrome and vaginism.

Thrombosis of glide veins in young women may be familiar with antiphospholipid syndrome.

To deliver often deprived of repeated mimic abortions is suspicious of a serious illness. It is clear that symptoms can be helpful in the diagnosis of APS before vaginosis. It is necessary to start drinking and not letting the fetus die.

samiy frequent sign getting sick -. The most frequent enemies are gliboki veni lower kintzivok... Ale innocent and superficial veins, as well as the judges of the stoves, supernaturals and other organs. Thrombosis of glibaceous veins is accompanied by pain and enlargement of the temperature, increased temperature. At the same time, it is possible to develop more and more expeditiously -. Vaughn can be manifested by an easy cough, hemoptysis, an insolence. In more important cases, there is a sharp brute in the breasts, the back is swollen, the cyanosis of the shkiri. Thromboembolism of a legacy artery can lead to death of a sick person.

When a young woman develops an insult, a transient ischemic attack, an episode of severe obstruction, the court will need to diagnose thrombosis of the cerebral arteries, APS. In some cases, arterial thrombosis can manifest itself instantly or in a hospitable mental state.

Patients can have a heart-vascular system. When echocardiography, a change of valves appears in the form of growth - vegetation. Z'yavlyayutsya signs abo. Appearing in a young woman unmotivated zadishka, weakness, nagryakiv, accelerated sertsebitt, and also becomes a drive for the degraded obsozhennya and viklyuchennya AFS.

It is typical to deliver the shkiri - often livedo, shkirnі virazki, purple, poppy seeds and dolon (eritema).

In the blood of ailments, there is a decrease in the number of platelets. To reach often thrombocytopenia will drop from hemolytic anemia. Frustration to bleeding is uncommon, and most often in case of overdose.

Obstetric pathology in APS

In females, APS can be manifested in vaginosis, spontaneous recurrent mimic abortions. For three spontaneous abortions, the risk of new vaginality in the early term increases to 45%.

Razvivaetsya zatrimka development or internal uterine bend of the fetus, manifestations occur. Most often in the II and III trimesters. Without treatment, such sums are more favorable for 90 - 95% of patients. With the right therapy, the uncomfortable development of the warehouse is up to 30%.

Variants of pathology of vaginosity:

• the death of a healthy fetus was unreasonable, stretching out all the vaginosity;
• the death of a healthy fetus due to preclampsia, or placental deficiency in terms of up to 34 vaginosis;
• at least three spontaneous abortions in terms of up to 10 months of vaginosity when chromosomal damage in fathers, hormonal or anatomical damage in mother's organs is out.

Features of the provision of vaginosti

During the period of planning the woman's vaginosity, the woman is guilty but reliably checked by a rheumatologist, cardiologist, and others.

Stretching out the necessary attendance ultrasonic testing behind the development of the fruit. Placental blood circulation can be evaluated for additional Doppler measurements. In the third trimester, it is necessary to regularly conduct cardiotocography, so that you do not miss an ear of acidic starvation of the fetus in case of placental insufficiency.

The value of antibodies to phospholipids is carried out at 6 days before the planned canopies.

Regularly blame the indicators of the blood circulation system, including those of the bed. Tse can help change the thrombotic acceleration.
In case of changes, as to indicate about an increased guttural blood, the dose of heparin taken by the patient is to blame.

Heparin, including low molecular weight, vimag thoracic treatment... Of those vipadoks, if the threat to the health and life of the mother is not healthy, there should be no inheritance for a child with a piece of clothing.

Elimination of antiphospholipid syndrome in vaginosis

Yakshcho at the woman of the AFS, key manifestations Illness is nemaє, and it doesn’t manifest itself by laboratory tests, the drug can include acetylsalicylic acid in doses up to 100 mg per dose, however, the cinnamon of such therapy has not been sufficiently established.

The first option for the treatment of asymptomatic APS is the intake of hydroxychloroquin. Especially the drug of indications in case of the presence of a woman's congenital ailments from the resulting tissue, including the systemic red worm. When diagnosed with thrombosis in asymptomatic patients (surgery, trivial nerves), heparin is indicated in a prophylactic dose.

Important officials in the prevention of thrombotic acceleration in asymptomatic patients are in the form of pregnancy and normalization of the mass.

For the duration of the vaginosity, the main reason for the prevention of APS is warfarin, which is responsible for the development of thrombosis. However, every hour of vaginosti is in contraindications. Yogo vikorystannya in the whole period to produce up to the development of the so-called warfarin embryopathy (uzhennya fetus). Vaughn to manifest itself in destructive development system systems, Nasal septum, neurological disorders.

In females with innocent women, vaginosity is shown to be treated with heparin. In doslіdzhennyakh not shown any changes of NMG before nefraktsіonovanim. However, low molecular weight heparin is more effective, more expensive. Take LMWH in combination with low doses acetylsalicylic acid... Such therapy is two or three times greater chance for the wedding of a healthy child. Most often, Enoxiparin is used in a dose of 20 mg for additional use. The whole drug does not penetrate the placenta and do not mischievous children.

Vikoristannya glucocorticosteroid hormones with the help of a lot less effectively. However, many people recommend vikoristovuvati up to drugs in heparin low doses of glucocorticoids (5-10 mg per pererakhunka on prednisolone).

Glucocorticosteroids tend to be viscous during the development of such an accelerated vaginosis, as a catastrophic microangiopathy. Anticoagulants, plasmapheresis, the introduction of frozen plasmas and human immunoglobulin are immediately administered.

be carried out drug therapy, It is focused on the prevention of placental insufficiency.

On the basis of APS, pre-warfarin therapy is indicated.

Veronika Ulanova, director of the "Semeyny Dzherelo" Center, reports on those diagnosing and diagnosing antiphospholipid syndrome in vaginosis:

Phospholipid syndrome - the pathology of autoimmune progression is gradually expanded. On aphids, there is often a fight against sudins, nirok, cysts and other organs. With the outbreak of therapy, the illness can lead to a somewhat slower pace, right up to the death of the patient. Moreover, it is often the case that women come to visit women for an hour of vaginosity, so that they pose a threat to the health of their mother and child.

It’s quite a lot of people to joke about additional information, stating food about the reasons for the development of ill health. What are the symptoms that need to be respected? What is the diagnosis for phospholipid syndrome? How can medicine propose effective methods of treatment?

Phospholipid Syndrome: What?

Above given zhvoryuvannya bulo is described not so long ago. Office services about the new boule published in the 1980s rock. Oskilki pratsyuvav over the predictions of the English rheumatologist Graeme Hughes, the disease is often called Hughes syndrome. Є y іnshi name - antiphospholipid syndrome і syndrome

Phospholipid syndrome is an autoimmune disease, when the immune system is repaired by viral antibodies, which attack the vascular phospholipid organisms. Oscillations of the chain enter up to the storage of the membrane walls of the bagatokh clitin, then the strikes with a similar ailment are:

• Antibodies to attack the health of the endothelium, reducing the synthesis of factors in growth and prostacyclin, which is a result of the enlargement of the disease. On aphids, there is a deterioration in platelet aggregation.
• Phospholipids can also be found in the walls of the thrombocytes themselves, to produce them to the strength of their aggregation, as well as a shimmery ruin.
• With the presence of antibodies, there is a decrease in the activity of heparin.
• The process of ruining is not the mind and nerves of the cell.

The blood is to be repaired in the vessels, creating a thrombus, which ruins the blood flow, and from the same function of the other organs - this is how phospholipid syndrome develops. The causes and symptoms of the general ailment are to show people. Aje chim earlier, there will be a sickness, and less quickly it will develop at the patient's.

The main reasons for the development of ailments

Why do people develop phospholipid syndrome? Reasons can be different. Seemingly, it is often the case that patients have a genetic strength. The disease develops in the case of the wrong robots immune system Because of this, it is the cause of the anti-virus virality to the blood cells of the body. In any case, it is provoked to get sick of maє buti. On this year's day, we look into the distance to see the number of factors in the risk:

• Frequently, phospholipid syndrome develops on a variety of microangiopathies, trobocytopenia growth, hemolytic-uremic syndrome.
• To factors in risik it is possible to bring in autoimmune disease, For example, chervoniy vovchak, vasculitis, scleroderma.
• Ailments often develop with the presence of malignant fluffs in the body of the patient.
• To factors in the risk of taking Infectious diseases... Especially not safe to become infectious mononucleosis and SNID.
• Antibody can be found in DIC syndrome.
• Seemingly, that ailment can develop on only a few people drugs, Including hormonal contraceptives, psychotropic drugs, Novocainamide, etc.

Naturally, it is important for the patient to develop phospholipid syndrome. Diagnostics and identification of guilt to emerge and, according to your ability, suspect the cause of the disease.

Lesion of the heart-vascular system in Phospholipid syndrome

Shelter and judges - tsі pershі "mіshenі", as hostile phospholipidny syndrome. Symptoms of it lie in the stage of development of the disease. Thrombies, as a rule, are sometimes found in other vessels of children. The stench will ruin the bloodstream, so that it is superfluous to the tissue. The kintzivka is ugly and colder on the dot, shkіra blіdne, and the m'yazi step by step atrophy. Trivale destructive tissue harvesting leads to necrosis and further gangrene.

Mossy and thrombosis of glibaceous veins of the dots, which is supervised by the appearance of swellings, pains, decay. Phospholipid syndrome can be accelerated by thrombophlebitis (burning of the vertebral column), fever, chills, chills, heart attacks and grief, acute pain.

The establishment of blood clots in great Sudyns can lead to the development of such pathologies:

• aortic syndrome tricky adjustments the vice in the vessels of the upper part of the tila);
• syndrome (for a given camp is characterized by swelling, cyanosis of the skin, bleeding from the nose, trachea and trachea);
• (It will help you to suffer from impaired blood circulation in the lower part of the body, a lot of dots, pain in the legs, black wastesі groin).

Thrombosis is indicated on the robotic heart. Often, the ailment is caused by the development of angina pectoris, arterial hypertension, myocardial infarction.

Improvement of nirok and main symptoms

Confirmation of blood clots to produce blood circulation is not only in kintzivka - it’s awesome and internal organisms, nirka sprinkles. With the trivial development of the phospholipid syndrome of mobility, the so-called nirka infarction. Denmark will suffer from pains across, a decrease in the number of slashes and appearances in these blood houses.

A blood clot can override the nirkov artery, sharp pains, Nudota and blues. tse unfinished mill- when there is a liquid growth of the necrotic process. Prior to the insecure inheritance of phospholipid syndrome, nirkov microangiopathy is recognized, with such a small thrombus settling in the glomeruli. Podibny mill is not fast before the development of chronic nirkova lack.

Inodі sposterіgaєtsya deterioration of blood circulation in the supra-nirkovy valleys, scho to lead to deterioration of the hormonal background.

How can you organize the enemy?

Phospholipid syndrome is an ailment that is an enemy of many organs. The yak is already zgaduvalsya, anti-tila feuds the shell nerve cells, But you can’t do without the inheritance. It’s a lot of kids to skip for severe headaches, as they often get stuck, tedious and bluish. Isnu imovіrnіst development of young psychic derailments.

In children, thrombi will appear in the vessels, which will cause the blood loss of the healthy analyzer. Trivial shortage of souring i living talk lead to atrophy of the healthy nerve. Mossy thrombosis of the blood vessels with increased blood loss. Deyakі from internal pathologies, unfortunately, not escaping: the ruin of the dawn zalishayutsya with a patient for all life.

The pathological process can be acquired and cysts. Were often diagnosed in people with werewolf osteoporosis, which is supervised by deformation of the skeleton and frequent fractures. More delicate є aseptic necrosis of the cyst.

For the ailment is characteristic і shkіrnі battle. Often on the upper and lower sketches, there are veritable stars. In some cases, it is possible to remember even more characteristic visip, yak nagaduє dribnі, blood points... For children, children develop an erythema on their feet and lobes. To promote the frequent establishment of pediatric hematomas (without an apparent reason) and hemorrhage nigtyov plate... The triviality of the destruction of the trophism of fabrics, I will be pulling after myself, as I will go out of my way and it is important to be attracted to the liking.

Mi z'yasuvali, which is a phospholipid syndrome. The causes and symptoms of illness are extremely important nutrition. Even from the tsikh chinnikiv when they lie down, a lykar diagram of the process is shown.

Phospholipid syndrome: diagnosis

Zrozumіlo, in this vipad in the edge, it is important to immediately reveal the manifestation of ill health. To diagnose phospholipid syndrome of a cartilage even before taking an anamnesis. Nashtovuyu on tsyu dumka zdatne the visibility of the patient of thrombosis and trophic virazok, part of the Wikid, signs of anemia. Zrozumіlo, in general, additional cleaning is carried out.

Analysis for phospholipid syndrome in patients with a level of antibodies to phospholipids in the blood of patients. In the analysis of blood, it is possible to note the decrease in the level of thrombocytes, the increase in the SHOE, the increase in the number of leukocytes. It is not uncommon for the syndrome to develop hemolytic anemia;

Dodatkovo blood is carried out. Patients are encouraged to increase the number of gamma globules. As soon as there are some pathologies of the liver, there is a bit of bilirubin and other phosphatase in the blood. With the manifestation of nirkovy ailments, it is possible to promote the growth of creatine and sechovy.

For children, I recommend specific immunological blood analyzes. For example, it is possible to carry out laboratory follow-up on the diagnosis of rheumatoid factor and lupus coagulant. With Phospholipid Syndrome in the blood, the presence of antibodies to erythrocytes, the increase in lymphocytes can be detected. If there is a suspicion of the appearance of important features of the liver, nirok, cysts, then instrumental provision is carried out, including an X-ray, ultrasound, tomography.

Tied with a twig with a quick twist?

When there is a lack of treatment, the phospholipid syndrome can be caused to the edge of the inconvenient delay. A thrombosis can be found in the ships when a thrombus becomes ill, but it’s not safe by itself. Blood clots clog up the judgment, disrupting normal blood circulation - tissues and organisms do not get enough old words and sourness.

It is not uncommon for ailments in patients to develop an insult and myocardial infarction. Blockage of the kidneys can lead to the development of gangrene. The yak is already degraded, the children are spared the destructions in the robots of nirok and supra-nirkovy vines. best the most insecure heritageє Thromboembolism of the Legendary Artery is a pathology that develops into a state of health, and it is far from all types of patients that the patient must be taken to the hospital immediately.

Viability in patients with phospholipid syndrome

The yak is already dying, phospholipid syndrome is diagnosed with vaginosity. What is the most important ailment and how much work in a particular situation?

Through the phospholipid syndrome, thrombi is established in the Sudins, which clog up the arteries, and carry shelter to the placenta. The Embryo will not reject a sufficient amount of money and lively talk, in 95% of cases until the weekend. If the vagina was not interrupted, because of the early loss of the placenta and the development of a low gestosis, it is even more important both for the mother and for the child.

In the ideal option, the woman is guilty of creating an analysis at the planning stage. Protein is often diagnosed with phospholipid syndrome in vaginosis. In such cases, it is even more important to immediately notice the manifestation of ailments and to survive the necessary visits. For maybutny mother, there may be signs of taking anticoagulants in small doses. In addition, the woman is guilty of regularly passing through the placenta. The skin cells of the miscellaneous are undergoing a course of antioxidant therapy, taking medications, and taking vitamins, minerals and antioxidants. With the right approach, the vagina often ends well.

Yak viglyadaє lykuvannya?

What robiti, how do people have phospholipid syndrome? Lіkuvannya in this vypadku is complex, moreover, to lie down in a kind of obviousness at the patient's quiet time. Oskіlki on aphids become thrombotic, then therapy in the first place is directed to the development of blood. The scheme of treatment, as a rule, includes the storage of drug groups:

• In the first place, anticoagulants of indirect and antiaggreganti ("Aspirin", "Warfarin") are prescribed.
• Often the therapy includes selective antiapalny drugs of non-steroidal walking, zokrem "Nimesulid" or "Celecoxib".
• There is also an ailment of dressings with systemic chervonia in general and those with deyakimi autoimmune ailments, as a result of taking glucocorticoids (hormonal anti-inflammatory drugs). The order of the cym can be found in the form of immunosuppressive drugs, which increase the activity of the immune system and reduce the release of non-safe antibodies.
• Vaginal women are given intravenous administration of immunoglobulin.
• Patients periodically take medications to avenge V.
• For zagalnaya health improvement, to get rid of sudin and cell membranes, vikoristoyutsya liquids-antioxidants, as well as preparations, such as a complex of polyunsaturated fatty acids ("Omacor", "Mexicor").

The procedure of electrophoresis is indicated on the patient's station. As soon as Ide about the secondary Phospholipid Syndrome, it is important to control the primary disease. For example, patients with vasculitis and those who are guilty of treating them adequately eliminate the same pathologies. It is also important to get an infectious disease and to carry out an ongoing therapy until you get tired again (which is worthwhile).

Predictions for patients

If the phospholipid syndrome is diagnosed immediately and if the patient needs help, then the prognosis will be more friendly. If you have a problem with ailments, it’s a pity, it’s unfortunate, but for additional medications it is possible to control thrombosis and prevent thrombosis. They are not uncomfortable in the situation, in case of any ailment of dressings with thrombocytopenia and an arterial grip.

In any case, under the control of a rheumatologist, all patients are known to be guilty of the diagnosis "phospholipid syndrome". The analysis is repeated through the clicks, as it is often necessary to take a look at some of the drugs, as the preparations need to be taken, as the quilts behind the body of a vile organism - about the whole price of a drug.

In case of deyakikh ailments, systemic chervonia vovchak [in 70% of cases], systemic scleroderma, rheumatoid arthritis, Malignant poohlini, chronic infections and inn.) Antibodies are violated, the formation of phospholipids is a component of cell membranes. Attachment to the stems of sudins, thrombocytes, which without a priori enter into the reaction of the laryngeal blood, so the antibodies to phospholipids to produce thrombosis.

Besides, deyakі vchenі vvazhayut, there can be no-mediocre "toxic" infusion of the whole group of antibodies on the tissues of the organism. The complex appears in case of a number of symptoms by recognizing the name antiphospholipid syndrome (APS) And in 1994, at the International Symposium on Antibodies to Phospholipids, APS was propounded Hughes syndrome(Hughes) - by the name of the English rheumatologist, having first described this and the most important additions in the development of a number of problems.

Antibody to phospholipids, anti-inflammatory: antibodies to cardiolipin, anti-coagulant, b2-glucoprotein-1-cofactor, antibodies, antibodies to the factors of hypoprotein, antihypertensive processes In practice, the most frequent start is the first two - antibodies to cardiolipin, vovchakovy anticoagulant.

Yak to manifest?

A clear picture with antiphospholipid syndrome can be very useful and can be found in:

• the size of the urazhenih sudin (dribn, middle, great);
• shvidkosti blockage of the vessel (more than a closure of the thrombus, which is in a new virus, or shvidke - a thrombus, which emerges, which is “playing” into the whole vessel from the bottom);
• їх functional designation (arteries abo veni);
• m_sceznakhodzhennya (brain, legends, heart, skin, nirka, pechinka).

As well as thrombosed other cases, it may cause damage to the organ's function to admirably easy. So, with blockage of the heart disease in the heart, there is a breakdown in the health of the heart disease, at that hour the closure of the main coronary artery stump of the heart disease.

In case of thrombosis, the symptoms are often uncomfortable; The clogging of the vertebral body with a thrombus, which has emerged, navpaki, will lead to the development of "catastrophic damage" functions of the body. So, thromboembolism of the legendary artery is manifested by attacks of breath, pain in breast cells, With a cough, in a great deal of vomiting, to bring to death.

Antiphospholipid syndrome can be imitated and nasal malignant disease, but on the other hand, the symptoms of varto can be brutal.

To reach often with antiphospholipid syndromes, it is more often lively (simple, a thin mesh of sudin on the surface of the school, as it becomes more beautifully visible in the cold), chronic flares of homosexuals, but it is important to prevent fingering,

In cholovikіv often, nіzh in females, manifestation of antiphospholipid syndrome can be caused by myocardial infarction.

Women often suffer from impairment of cerebral blood flow (stroke, especially up to 40 years, headaches, and suck up a lot of grains).

The separation of liver vessels can lead to an increase in the size of the liver, ascites (accumulation of birth in the black empty days), an increase in the concentration of liver enzymes (aspartate and alanine transfer of blood vessels) in the blood arterial hypertension(In general, people have special respect for people who have a vice, especially the lower, temple, often change throughout the day).

With thrombosis of the placental arteries, the intrauterine bend of the fetus can occur, or the canopy. The antiphospholipid syndrome itself is associated with those women who are ill with systemic chervonia, cannot “save” their vagina, as they often end up with a wickedness.

Yak to see?

The presence of antiphospholipid syndrome can be suspected in the onset of symptoms:

• Iakshcho lyudin's ailment on systemic chervonia vovchak (frequency of development of antiphospholipid syndrome with given supra-mucous membrane disease).
• Even if people are up to 40 years old, signs of thrombosis of any kind appear.
• Yakshcho thrombosed sudini, for which the tse is not even more typical, for example, sudini, which supply blood to the intestines. Їх blockage can lead to "black toad". The same name is given to the name of tsyogo zhvoryuvannya Viniklo for the analogue of angina pectoris - "angina pectoris". "Cherevna toad" is characterized by the appearance of being crushed, squeezing pain in the abdomen, as well as being able to detect the sound of a ryazy reception. chim more than lyudin Z'iv, Tim needs more blood herbal tract, Shcheb to digest їzhu. If it enlightens the sound of a thrombus, then there is a lack of blood to the organs of the black emptying, it is not sour, they accumulate products of exchange of words - there is a beel.
• Even in the blood, the number of thrombocytes is reduced, and with a lot of hematological ailments.
• It’s like the woman’s got 2 and more weekend, and the gynecologists can’t be sure of the exact reason.
• Yaksho Vinik myocardial infarction in people younger than 40 years.

lykuvannya

First for everything, antiphospholipid syndrome is caught only under the control of a rheumatologist-doctor.

Since antiphospholipid syndrome has developed against the background of autoimmune disease (for example, systemic chervony vovchak), it is necessary to get sick, if you want to reduce your activity. As soon as you can achieve this, in syrovatz blood there will be a decrease in the number of antibodies to phospholipids. The lower the thrombosis in the blood, the lower the thrombosis. To that ailment, it is so important to take the basic therapy (glucocorticoids, cytostatics) prescribed by the drug.

With an even higher titer (amount, concentration), antibodies can be used for plasmapheresis (purified blood).

It is possible, a lykar, to identify whether any drugs, such as reducing the rate of thrombosis, are injected without a priori onto the system of hypopharyngeal blood. For the їkh sign of the need for rigor, it is shown: the cinnamon is guilty of signifi- cantly revisiting the side effects. Prototypical indications before taking the drugs є vaginism (may cause damage to the development of the nervous system in the fetus) shlunkovo-intestinal tract... Slide to honor all "for" and "against", as in the case of an ailing one є uzhennya liver abo nirok.

Antimalarial drugs (for example, hydroxychloroquine) should be taken in anti-fatigue due to the formation of platelets aggregation (malignancy), which also prevents thrombosis development.

Women with antiphospholipid syndrome develop kidney disease from vaginitis to normal laboratory parameters. If the syndrome has developed even after conception, then think about the introduction of immunoglobulin or small doses of heparin.

The forecast is abundant in what will be found in the freedom of the spirited behavior and discipline of the sick.

Antiphospholipid syndrome (APS) is a type of autoimmune disease, which is characterized by viral changes in large quantities of antibodies to phospholipids - chemical structures, among which it is caused by a part of the cellini.

Antiphospholipid syndrome occurs in approximately 5% of vaginal women. In 30% of patients with APS, the main reason for non-guilt is the most urgent problem of obstetrics. In case of unattractive singing visits, the APS can lead to the most uncomfortable and not safe for life, the slower the hour of vaginosity and the time of flatness.

cause APS

Prior to the main provocative factors, before the development of the APS, include:

Genetic skill;
- bacterial or viral infections;
- autoimmune disease - systemic chervoniy vovchak (VKV), university perіarterіїt;
- trivial use of drugs (hormonal contraceptives, psychotropic drugs);
- oncological illness.

Symptoms of antiphospholipid syndrome

How to manifest antiphospholipid syndrome? Klinichnі show the incapacitation of rіznomanіtnі, even more and more from every day. I will continue to try to finish it often, if it’s because of absolute health. great women Wikipedia is displayed. If it is not in place, then the diagnosis of the APS can be readily completed. The main reason for non-malignancy in APS is the chain of increased activity of the blood laryngeal system. Thrombosis of the placenta sudin is seen as a reason, but it will inevitably lead to vaginosis.

Until the most "non-dull" symptoms of APS, the appearance of a cradled baby of judges on the lower parts of the body is indicated. Naybilsh often bears of small swelling on homilkas, feet, stegna.

In more important cases, APS can be manifested in vigilantes, when they appear unrepentantly at homosexuals, gangrene of fingers nig (for a chronic depletion of blood loss). Thromboembolism in the vessel with APS can lead to thromboembolism of the leg artery (gostra blockage of the vessel with a thrombus), which is fatal!

Until the broadened symptoms of APS are reported, a rapid decrease is observed, right up to the appearance of a slump (through thrombosis of arteries and veins of the blood); development of chronic nirkovo deficiency, which can be manifested in viglyadas arterial vise and appear the white in the battle.

Itself by its own reason, the presence of an APS is even greater if you can, so if you have already been diagnosed with an APS, the obstetrician-gynecologist will go on to the planned vaginosity. With the manifestation of the symptoms of the description of the digestive tract, it is not safe to grow!

Obstezhennya at APS

To confirm the diagnosis of "Antiphospholipid syndrome", it is necessary to obtain an analysis of blood from the vein for the marker of APS - for vovchak anticoagulant (VA) and for antibodies to cardiolipine (ACL). As soon as the analysis is positive (tobto as well as the markers of the AFS), it should be republished again after 8-12 times. And if the repeated analysis is also positive, then there is a sign of liking.

For the emergence of the degree of severity, the disease is obviously recognized zagalny analiz blood (with APS, a decrease in platelet level is indicated) and a coagulogram (hemostasis) - an analysis of blood for hemostasis (laryngeal blood). With the presence of APS, a coagulogram is created with a minimum vaginosity once every 2 days. In the psychoanalytic period, analyzes will be completed in the third and second half of the year.

Ultrasound and Doppler measurements (blood flow monitoring in the "mother-placenta-plate" system) are more often observed in women with APS, but less often in women without pathologies. Recovering from 20 days, it’s possible to spend the day before the end of the day, to transfer and reduce the risk of developing placental insufficiency (loss of blood circulation in the placenta).

For the assessment, I will also use the CTG (cardiography) for the fetus. dane doslіdzhennya vikonutsya in a general order, repairing from 32 types of vaginosti. With the presence of chronic fetal hypoxia, placental insufficiency (which often occurs with APS), CTG should be performed every day.

Elimination of antiphospholipid syndrome

Yake lykuvannya AFS is recognized in vaginosis? As it is already said, if you know about your diagnosis and situation, before planning your vagina you need to go to an obstetrician-gynecologist.

For the development of the development of the pores from the side of the blood larynx system, before the vaginosity, the glucocorticoids are prescribed in small doses (prednizolone, dexamethasone, metipred). Dal, if the woman is pregnant, I will continue to take the preparation until the period of sleep. Only after two months the preparation can be steadily skated.

In quiet cases, the diagnosis of APS arises when vaginosity - the tactics are the same. Likuvannya glucocorticoids is recognized in any form, like є APS, and it’s absolutely normal!

Oskilki trivial with the use of glucocorticoids to produce to weakened immunity, then in parallel, in small doses of immunoglobulins.

In total, immunoglobulin is administered 3 times for the duration - up to 12 times, in 24 times and without the middle before the canopy.

Obov'yazkovo for the correction of blood loss is associated with antiaggreganti (Trental, Kurantil).

Likuvannya is carried out under the control of indicators of hemostasis. In some cases, heparin and Aspirin are prescribed in small doses.

Plasmapheresis (purification of blood for rakhunok visible plasmas) before the main treatment. It should be aimed at improving the rheological powers of the blood, for promoting immunity, as well as for increasing sensitivity before the drug is administered. When plasmapheresis is consumed, the dose of glucocorticoids and antiplatelet agents can be reduced. It is especially important for vaginites, as it is rotten to transfer glucocorticoids.

The retreat control over the camp of the blood circulation system will take place for an hour. The guilt canopies must be kept under control of the CTG.

With a free diagnostics, real-time visibility and visualization, the vagina and the canopy pass pleasantly and end with the people of healthy children. Rizik pislyapologovykh accelerated when he was going to be minimal.

As long as you have been diagnosed with APS, you do not need to worry about it, and to allow yourself to be satisfied with your mother. It’s like it’s a wikid day, it’s not going to be on those that will be the same. The staff of modern medicine, AFS is not є for the current day in general. We prepare the head for the ordering of the doctor and prepare to the trivial treatment and the numerical situation, like roaming with one aim - to save you and not the folk children from all the unacceptable slowdowns.

accelerated AFS

Uskladnennya, pererakhovanі lower, they are found in 95 out of 100 ailments of the APS at the time of the dynamic sparing і lіkuvannya. Prior to them, it should be mentioned:
- non-guilt of vaginosity (repeated wikis on early terms of vaginosti);
- overlapping the development of the fetus, hypoxia of the fetus (lack of acidity);
- vidsharuvannya placenta;
- the development of an important gestosis (accelerated vaginosity, as well as supervising the development of an arterial vise, the appearance of bends, bulges in the section). With the absence of a lactation, preeclampsia can lead not only to the bend of the fetus, but the mother;
- thromboembolism of the leg artery.

Prevention of antiphospholipid syndrome

APS prophylaxis includes a prescription for planned vaginosity for the markers of APS - anti-coagulant anticoagulant (VA), antibodies to cardiolipin (ACL).

Consultation of an obstetrician-gynecologist on APS

Nutrition: Is it possible to use oral contraceptives with the presence of APS?
Suggestion: Not at all! Take oral contraceptives to increase the amount of APS.

Pitannya: Do you want to bring the AFS to no end?
Suggestion: Ні.

Pitannya: If the traffic is not okay, why would you give it for "reinsurance" on the AFS marker?
Suggestion: Hi, the coagulogram is normal.

Nutrition: Yak dovgo take antiaggreganti in case of vaginosis with the presence of APS?
Suggestion: All the time, without interruption.

Pitannya: How can you say the AFS to provoke kurinnya?
Suggestion: Maloimovirno, ale, if the AFS is still є, then it’s even more so than it’s possible.

Pitannya: How can you visit the weekend through the AFS?
View: Minimum 6 months. Over the course of an hour, it is necessary to improve the situation and take anti-thrombotic drugs.

Pitannya: Is it really true that you can't work with the AFS?
Suggestion: І so, і nі. By itself, the operation has increased thrombotic acceleration. If it is shown (placental insufficiency, fetal hypoxia, etc.), then the operation is obovyazkov.

Obstetrician-gynecologist, Ph.D. Christina Frambos.

Antiphospholipid syndrome (APS) is considered to be the number of the most urgent multidisciplinary problems in modern medicine and is seen as a unique model of autoimmune thrombotic vasculopathy.

An ear of AFS vivchennya has been deposited close to a hundred times to that in robots A. Wassermann, assigned to laboratory method diagnostics of syphilis. During the screening sessions, it became obvious that a positive Wasserman reaction can be found in people without the clinical signs of syphilistic infections. I will call this phenomenon “biologic hybnopositive reaction of Wasserman”. It has been established that the main antigenic component in the Wasserman reaction is negatively charged phospholipids, called cardiolipin. According to modern representations, antiphospholipid antibodies (AFL) are a heterogeneous population of autoantitils, which enter into the interaction with negatively charged, before neutral phospholipids and / According to the method of determination, APL is cleverly subdivided into three groups: which appear with an additional IPM from cardiovascular tests, earlier than other phospholipids, antibodies, which function as tests for additional antibodies that cannot be diagnosed using standard methods (antibodies to C, S, thrombomodulin, heparan sulfate, endothelium and in.).

A taste of the sawing interest before the introduction of the role of the AFL and the improvement of the methods laboratory diagnostics has become a registration, that AFL is a serological marker of a kind of symptomatic complex, including venous and / or arterial thrombosis, development of obstetric pathology, thrombocytopenia, as well as wide spectrum of neuropsychiatric neurology Beginning in 1986, the development of the symptom complex became known as an antiphospholipidnyyndrome (APS), and in 1994, at the international symposium with the AFL, it was also proposed to use the term “Hughes syndrome” - according to the Mentional rheumatology specialist.

The extent to which APS is widespread in the population is still unknown. Since the synthesis of APS is high in normal conditions, a low level of antibodies is not uncommon in the blood. healthy people... According to the recent data, the frequency of occurrence of aCL in the population varies from 0 to 14%, in the middle it is 2-4%, with a high titer it appears to be reached in about 0.2% of donors. Some of the AFLs appear in the elderly. At the same time, the value of aFL in "healthy" individuals (ie, there are no obvious symptoms of illness) is not entirely clear. Often, repeated analyzes of the previous definitions of the bodies are normalized.

The increase in the frequency of the population of AFL is indicated in case of some inflammatory, autoimmune and infectious diseases, malignant new drugs, on the basis of the use of medications (oral contraceptives, psychotropic drugs) and others. Є Data on immunogenetic schilosity before the increase in the synthesis of APS and more frequent occurrence of APS in relatives of ailments.

It has been reported that the AFL is not only a serological marker, but the most important "pathogenetic" mediator, that the development of the main clinical manifestations of the APS. Antiphospholipid antibodies are capable of influencing a large number of processes, which form the basis for the regulation of hemostasis, which can lead to hypercoagulation. The clinical meaning of AFL lies in the fact that it is associated with its manifestation in the blood of a developmental characteristic symptomatology. Thus, the manifestation of APS is observed only in 30% of the ailments with a positive anticoagulant in vovchakov, and in 30-50% of the ailments, although there may be less or a high level of ACL. The disease develops especially in a young person, with a wide APS it can be diagnosed in children and in newborns. As well as other autoimmune rheumatic illnesses, the Danish symptom complex is more common in females, but not in choloviks (ratio 5: 1).

Klinichny show

The most frequent and characteristic manifestations of APS are venous / abnormal arterial thrombosis and obstetric pathology. In case of APS, judges of any caliber and localization - such as capillaries of sub-large venous and arterial stubburs - can be affected. To this, the spectrum of clinical manifestations of superficially susceptible development of thrombosis and localization of thrombosis. Within the framework of the APS, the description of the central nervous system, heart-vascular system, Damage to the function of nirok, liver, endocrine organs, shlunkovo-intestinal tract. With thrombosis of the placenta vessels, the development of various forms of obstetric pathology ( Table 1).

Venous thrombosis, especially thrombosis of glib veins of the lower symptoms, -naybіlsh typical manifestation of APS, including in the onset of the disease. Characteristics of recurrent embolism of legacy arteries, which can lead to the development of legacy hypertension. Descriptions of the development of adrenal insufficiency in cases of thrombosis of the central venous adrenal glands. Arterial thrombosis in general occurs approximately 2 times higher than venous. The stench is manifested by ischemia and cerebral infarctions, coronary arteries, impaired peripheral blood circulation. Thrombosis of intracerebral arteries is the most frequent localization of arterial thrombosis in APS. Thrombosis of large arteries, as well as visual aortic symptoms (with developmental arthritis syndrome) and cranial aorta, are present before small manifestations. Especially AFS є high risik recurrent thrombosis. When ailing with first thrombosis, the varterial bed of repeated episodes can also develop in the arteries. If the first thrombosis is venous, then repeated thrombosis, as a rule, is indicated in the venous bed.

Porazka nervovoї sistemi vіdnositsya to naybіlsh vazhkim (potentsіalnosmertelnim) proyavіv ASF i vklyuchaє tranzitornі іshemіchnі attack іshemіchny іnsult, GOSTR іshemіchnu entsefalopatіyu, epіsindrom, mіgren, chorea, transversely mієlіt, neyrosensornoї prigluhuvatіst drugіenevrologіcheskіe i i psihіatrichnі symptoms. The provincial cause of the defeat of the central nervous system є cerebral ischemia due to thrombosis of the cerebral arteries, however, is a number of neurological and neuropsychic manifestations, summarized by the lower mechanisms. Transient ischemic attacks (TIA) are supervised by the second shock, paresthesias, weakness, fatigue, transient foreign amnesia, and it is not easy for a lot of time to navigate misconceptions. Recurrence of TIA leads to multi-infarction dementia, which can manifest itself as cognitive impairment, decrease in health to a concentration of respect and memory and other symptoms that are nonspecific for APS. It is not very difficult to differentiate between senile dementia, metabolic (lytoxic) damage to the brain and Alzheimer's ailments. One of the ischemia of the brain is tied with a thromboembolism, dzherel such valve Іpolit heart or internal sleep artery. In general, the frequency of hemic insult is in ailments with lesions of the valves of the heart (especially in all patients).

Heads are traditionally viewed as one of the most frequent clinical manifestations of APS. The nature of the headache varied from classical intermittent migraines to persistent, non-vinous pains. Є a number of other symptoms (Hyun-Barré syndrome, idiopathic intracranial hypertension, transverse muscle, parkinsonic hypertonicity), development of which is also associated with the synthesis of AFL. In ailments with APS, it is not often possible to suffer from occlusive disease of the eyes. One of the forms of this pathology is a transient loss of vision (amaurosis fugax). The first manifestation of the neuropathic nerve is carried out until the most common reasons slipti priAFS.

Heartbreak presented a wide range manifesting, including myocardial infarction, lesion of the valvular apparatus of the heart, chronic ischemic cardiomyopathy, internal cervical thrombosis, arterial and legene hypertension. Yak in adults, and in children, thrombosis of the coronary arteries is one of the main localization of arterial occlusion in hyperproduction of AFL. Myocardial infarction develops in about 5% of AFL-positive ailments, with a lot of guilt, as a rule, it occurs in people younger than 50 years old. The most part of the cardiac awareness of the APS is the reduction of the valves of the heart. It changes the form of minor lesions, emerging only preechocardiography (slight regurgitation, swelling of the stools of the valves), to heart defect (stenosis or lack of the mitral, rarely aortic and tricuspid valve). Uninvolved on a widespread, clinically significant pathology, such as leading to cardiac failure and in the process of surgical treatment, it is difficult to develop rapidly (5% of ailments). However deyakih vipadkah Mauger Shvydko rozvivatisya ochentyazheloe urazhennya klapanіv of vegetatsієyu, obuslovlennimіtrombotіcheskіmі nasharuvannyami indistinguishable od іnfektsіynogo endokardіta.Viyavlenіe vegetations on the valves, Especially Yakscho stink poєdnuyutsya sgemorragіyamі in pіdnіgtove bed i "of the drum with your fingers," sozdaetslozhnie dіagnostichnі problemi i neobhіdnіst provedenіyadіfferentsіalnogo dіagnozu with. Within the framework of the APS, the development of heart thrombi is described, and the mix is ​​imitated.

Nirkova pathology to complete the development of a person. At bіlshostі patsіentovnablyudaetsya tіlki asymptomatic pomіrna proteїnurіya (less then 2 g vsut) without torn down funktsії nirok, ale Mauger rozvivatisya GOSTR pochechnayanedostatochnost of virazhenoyu proteїnurієyu (already before nefrotіcheskogosіndroma) Activity sechovim siege i arterіalnoї gіpertonіey.Porazhenіe nirok pov'yazano bunt of rank i vnutrіklubochkovimmіkrotrombozom yak "nirkova thrombotic microangiopathy" begins.

Ailments from the APS may be more severe and specific for children, first of all, more often than not (in 20% of patients), post-thrombophlebitic flares, gangrene of fingers, multiple hands and no

With APS, liver damage (Budd-Kyar syndrome, nodular regenerative hyperplasia, portal hypertension), intestinal tract (intestinal tract hemorrhage, intestinal infarction, biliary thrombosis, mesenteric thrombosis)

To the number of characteristic manifestations of APS, obstetric pathology is recognized, the frequency of which can reach 80%. The loss of the fruit can come to a stagnant term of vaginosity, but sometimes it is often indicated in the II and III trimester. In addition, the synthesis of AFL is associated with other manifestations, including with preeclampsia, preeclampsia, occlusion of intrauterine development of the fetus, premature births. The development of thrombotic acceleration in newborns with APS is described to reduce the possibility of transplacental transmission of antibodies.

For APS, thrombocytopenia is typical. The number of platelets fluctuates from 70 to 100 x 109 / l and does not require special treatment. specific officials blood coagulation, pathology or overdose of anticoagulants. Coombs-positive hemolytic anemia is often observed (10%), and Evans syndrome is less common (additional thrombocytopenia and hemolytic anemia).

diagnostic criteria

The polyorganism of the symptomatology and the need for special confirmatory laboratory tests to summarize in a number of cases of difficulties in establishing the diagnosis of APS. In 1999, there were several proposals of the foremost classification criteria, as if the diagnosis of APS was evidently valid when received, at least, one key and one laboratory sign.

CLINIC CRITERIA:

• Sudden thrombosis: one or more recurrent thrombosis (arterial, venous, thrombosis of other sudins). Thrombosis is to blame for assistance instrumental methods abo morphological (morphology - without significant fading of the vertebral column).
• Pathology of vaginosity can be one of three options:

  - one and more types of intrauterine bend morphologically of a normal fetus after 10 types of vaginosis;

  - one and more epizodes of the anterior canals of the morphological normal fetus up to 34 types of vaginosity through abnormal preeclampsia, or eclampsia, or abnormal placental insufficiency;

  - three and more recent types of spontaneous abortions up to 10 types of vaginosity (with anatomical defects of the uterus, hormonal disorders, maternal and father chromosomal damage).

Laboratory criteria:

• positive aCL to the IgG class or IgM in syrovatts in the middle and high titles, singing, accepting, dividing, with an interval not less than 6 times, with an additional standardized enzyme-linked method;
• positive lupus anticoagulant, which appears in plasma, at least with an interval of not less than 6 times, using a standardized method.

Differential diagnosis

Differential diagnostics of APS is carried out with a wide range of diseases, which prevent from vernal damage. On the other hand, with APS, there is an even greater number of clinical manifestations, which can cause problems: infectious endocarditis, swelling of the heart, rosy sclerosis, Hepatitis, nephritis, etc. APS in ryadі vipadkіv poєdnuєtsya of systemically vaskulіtamі.Polagayut scho ASF responsible Buti zapіdozreny at rozvitku trombotіcheskіhnarushenіy (mnozhinnih Especially, retsidivuyuchih, s neobichnoylokalіzatsіey) trombotsitopenії, akusherskoї patologії at osіb young i serednі vіku at vіdsutnostі faktorіv riziku viniknennya etіhpatologіcheskіh stanіv. Yogo success in case of unexplained thrombosis in neonatal women, in cases of necrosis of the skin on the basis of treatment with non-direct anticoagulants, and in patients with an increase in the active thromboplastin hour during the screening

APS is a collection of buv descriptions of systemic chervony vovchak (VKV) variants. Moreover, it was found that there was a greater universional character between hyperproducts of FL and thrombotic disorders, and it could be possible to preserve the availability of reliable clinics and serological tests. Tse served as a guide for the introduction of the "pervinny AFS" (PAFS). Vvazhayut, about half of the patients with AFS suffer from the primary form of illness. However, chi є PAFS is independent nosological form until the end is not clear. Beastly, we respect the frequency of development of PAPS in the middle of choloviks (the ratio of men to women becomes 2: 1), which leads to PAPS in other hautoimmune rheumatic diseases. Outside of clinical manifestations, or else they develop in ailments with PAPS with a different frequency, but, in fact, it is associated with the heterogeneity of the syndrome itself. At the moment, there are three groups of PAPS who are ill:

• ailments with idiopathic thrombosis of glibular veins of homilies, which are often accelerated by thromboembolism, persistent for everything in the pulmonary artery, leading to the development of a legacy hypertension;
• ailments young vik(Up to 45 years) with idiopathic strokes, transient ischemic attacks, earlier occlusion of other arteries, including the number of coronary arteries; Sneddon's syndrome is the best butt of this variant of PAPS;
• women with obstetric pathology (repeated spontaneous abortion);

Excessive APS, severity and widening of thrombotic acceleration of non-transmission and in a large number of cases does not correlate with the change in the level of AFL and the activity of sickness (in case of secondary APS). In some patients with APS, it can be manifested by a hostile, recurrent coagulopathy, often in the presence of vasculopathy, which is rich in vital importance of the organisms and systems. The price served as a guide for the vision of the so-called "catastrophic AFS" (CAFS). For the purpose of this constancy, they called it "gostra disseminated coagulopathy-vasculopathy" or "ruinous non-inflammatory vasculopathy", which is also full-bodied hospitals, fulminant characteristic of AFS options. The main provocative factor of CAFS is infection. Earlier in the development of dressings with the use of anticoagulants in the treatment of certain drugs. CAFS occurs in approximately 1% of patients with APS, and if the therapy is not intrusive in 50% of cases, it ends in a lethal result.

lykuvannya AFS

Prevention and treatment of APS is a folding problem. This is due to the heterogeneity of pathogenetic mechanisms, polymorphism of clinical manifestations, as well as the appearance of reliable clinical laboratory indicators, as well as allow predicting recurrent events. Not based on the recognized international standards of treatment, but on the basis of the recommendations based on the headache on the results of the critical vip testing of drugs in the retrospective analysis of the results of the disease.

The use of glucocorticoids and cytotoxic drugs for APS, as a rule, is ineffective, with the blame of situations when the feasibility of these signs is dictated by the activity of the underlying disease (for example, VKV).

The management of ailments with APS (as with other thrombophilia) is based on the indication of indirect anticoagulants (warfarin, acenocoumarol) and antiplatelet agents (in the first place of low doses of acetylsalic acid). There is a reason for all the time that APS is characterized by a high risk of repeated thrombosis, which is significantly superior to that in idiopathic venous thrombosis. Vvazhayut, but a large number of ailments of APS with thrombosis require prophylactic antiaggregant and / or anticoagulant therapy for a long time, and sometimes even more often. Krіm order rizik Parvin i povtornihtrombozov in APS neobhіdno znizhuvati Shlyakhov vplivu on takіekorrіgіruemie factorization riziku, yak gіperlіpіdemіya (Statins: simvastin -sіmvastol, Sіmli; lovastatin - rovakor, kardіostatіn; -lіpostat pravastatin, atorvastatin - Awas, lіprimar; fіbrati: bezafіbrat -holestenorm ; fenofibrat - nofibal, grofibrat; cyprofibrate - Lipanor), arterial hypertension ( іngіbіtori APF- kapoten, sinopril, diroton, Moeks; b-blockers - atenolol, Concor, egilok, betalok ZOK, dilatrend; antagonism of calcium - Amlovas, Norvask, Normodipin, lacidipine), hyperhomocysteinemia, a little destructive way of life, chicken, premoral contraceptives and in.

Ailments with a high level of AFL in Sirovattsi, ale without clinical signs of APS (including women without obstetric pathology anamnesis) have been interrupted by signs of additional doses of ASA (50-100 mg). The most effective preparations are aspirin cardio, thrombotic ACC, which may be low in the range shlunk juice). This form allows you to provide not only a superior antiplatelet effect, but also to reduce the poor effect on the slurry.

sick s key signs APS (in the first place, stromboses) require more aggressive anticoagulant therapy. Application of antagonists to vitaminu To vimaga retail clinical and laboratory control. Accordingly, it is tied to the increased risk of blood loss, and the development of this acceleration through its severity is surpassed by cinnamon as a prophylaxis for thrombosis. Differently from chastinі bolnihretsіdіvіrovanіe thrombosis vіdznachaєtsya pіslya pripinennya terapііantіkoagulyantamі (osoblivo protyagom pershit 6 months at pіslya vіdmіni) .In-tretє have ailments ASF mozhut sposterіgatisya virazhenі spontanniekolebanіya mіzhnarodnogo normalіzovanogo vіdnoshennya (INR) chtoznachіtelno uskladnyuє vikoristannya tsogo pokaznika for monіtorіngalechenіya warfarin. However, all perahovanes are innocent to be an obstacle to the conduct of active anticoagulant therapy in medical patients, since life is necessary ( tab. 2).

Scheme of dosing with warfarin polyagaє in the prescribed dosage of the preparation (5-10mg of the drug per day) for the first two days, and then in the selection of optimal dosage, which will prevent the preparation of the whole INR. Everywhere dozіlno take in the rankings of the year, up to the value of the INR. In an elderly patient, to achieve the same level of anticoagulation, a higher dose of warfarin should be used, not in young people. Neobhіdnomati on uvazі scho warfarin vzaєmodіє of next lekarstvennihpreparatov, SSMSC at priznachennі yak znizhuyut (barbіturati, estrogeni, antacids protigribkovі protіvotuberkulezniepreparati i), so i pіdsilyuyut Yogo anticoagulant dіyu (nesteroіdnieprotіvovospalіtelnie Costa, antibіotiki, propranolol, ranіtidin that іn.). Slid date singing recommendations for children, as rich in vitamins Do uzha ( green tea, Leafy vegetables - broccoli, spinach, Brussels sprouts and cabbage, papa, lettuce) to develop resistance to warfarin. Alcohol is switched on for an hour of therapy.

With a lack of efficacy of monotherapy with warfarin, it is possible to carry out combined therapy with indirect anticoagulants and low-dose ASA (and / or dipyridamole). It is also true that a young person has no risk of bleeding in the streets of a young person.

In case of superficial anticoagulation (INR> 4) in the absence of bleeding, it is recommended to immediately skasuvati warfarin until the return of MNO to the whole rivny. In the case of hypocoagulation, accompanied by bleeding, there is a lack of signs of only vitamins K (due to the delayed ear of corn - after 12-24 years of introduction); recommended fresh frozen plasma abo (more beautifully) concentrate of the prothrombin complex.

Aminochloroquine preparations (hydroxychloroquine - plaquenil, chloroquine - delagil) can prevent effective prevention of thrombosis (at least in case of secondary APS on aphids). The order of anti-inflammatory disease, hydroxychloroquin is determined by anti-thrombotic (induction of aggregation and adhesion of platelets, changes in the size of a thrombus) and hypolipidemic effects.

The central microscope in the treatment of thrombotic acceleration in patients with APS is given direct anticoagulants - heparin and especially the preparation of high molecular weight heparin (fraxiparin, clexane). The tactics of becoming more common is not to be recognized.

At KAFS, the whole arsenal of methods of intensive and anti-inflammatory therapy, stagnant for critical camps in patients with rheumatic illnesses, is used. The efficiency of treatment at the singing stage is to lie in the capacity of being able to put down the factor, to provoke its development (infection, activity of the main disease). Appointment of high doses of glucocorticoids in CAFS is directed mutely to the elimination of thrombotic lesions, or is determined by the need for therapy for systemic ignition syndrome (enlarged necrosis, distress syndrome of adolescents, adrenal insufficiency). It is necessary to carry out pulse therapy according to the standard scheme (1000 mg of methylprednizolone intravenously per day for 3-5 days) with the further signs of glucocorticoids (prednizolone, methylprednizolone) orally (1-2 mg / kg / dobu). Intravenous immunoglobulin should be administered at a dose of 0.4 g / kg for 4-5 days (especially in thrombocytopenia).

CAPS Je єdinim absolute indication for provedenіyaseansov plasmapheresis, SSMSC slіd poєdnuvati of maksіmalnoyіntensіvnoy anticoagulant terapієyu, vikoristannyam svezhezamorozhennoyplazmi i conducting pulse terapії glyukokortikoїdami that tsіtostatіkamі.Tsіklofosfamіd (tsіtoksan, endoksan) (0.5-1 g / Dobou) readings at razvіtііKAFS on tlі zagostrennya VKV і for zapobіgannya "ricochet syndrome" for conducting sessions of plasmapheresis. It is true that the use of prostatsiklina (5 ng / kg / hv for 7 days) is not correct, however, when looking at the possibility of developing "ricochet" thrombosis, it is guilty that it is carried out with caution.

The appointment of glucocorticoids in women with obstetric pathology is not shown in The congestion of glucocorticoids is justified only in case of secondary APS on the same type of VKV, although it is aimed at the elimination of the underlying disease.

The standard for the prevention of recurrent infusions of the fetus є maliedosi ASK, which is recommended to be taken before, by stretching vaginosti and after the development of the child (accepted, by stretching 6 ms). At the time of pregnancy, small doses of ASA were found to be combined with drugs of low molecular weight heparin. In case of canopy for additional cesarean care, the introduction of LMWH is skated in 2-3 days and is renewed in the psychoactive period with the onset of transition to indirect anticoagulants. Trial therapy with heparin in vaginal women can lead to development of osteoporosis, therefore, in order to reduce the loss of cystic mass, it is necessary to recommend the intake of calcium carbonate (1500 mg) in conjunction with vitamin D disease. One izogranіchenіy before the stagnation of LMWH is the danger of the development of epidural hematoma, that is, the likelihood of premature birth, elimination of low molecular weight hepatomas ceases not in less than 36 longevity. Intravenous immunoglobulin stagnation (0.4 g / kg for 5 days) has NO advantages over standard likuvannyam ASA and heparin, and is indicated only for non-efficacy of standard therapy.

Thrombocytopenia in patients with APS is not reduced to special treatment. In case of secondary APS, thrombocytopenia is well controlled by glucocorticoidamy, aminochinolin drugs, and in some cases, low doses of ASA. The tactics of eliminating resistant thrombocytopenia, which can lead to the risk of bleeding, including the intake of glucocorticoids in high doses and internal immunoglobulin. At different effects of high doses of glucocorticoids by the method of vibration є splenectomy.

In the rest of the rock, new antithrombotic agents are intensively broken up, up to some heparinoids (heparoid Lechiva, Emeral, sulodexide - Wessel Duye), Ingibitorium of platelet receptors (idolopidin, ticlopidin, In front of the classroom tribute to the undeniable perspectives of the cich likarsky zasobіv.

All the ailments of the APS are responsible for the treatment of patients with dispensary supervision, perceptive departments of which є assessment of the risk of thrombosis and prophylaxis. Necessary control of the activity of the main disease (with secondary APS), timely detection and detection of subnormal pathology, including infectious complications, as well as injecting into the correction of risk factors. It was established that it is prognostically unpleasant factors in relation to mortality in APS є arterial thrombosis, a high frequency of thrombotic acceleration and thrombocytopenia, and laboratory markers - the presence of an anticoagulant. Excessive APS, severity and prevalence of thrombotic acceleration of non-transmission; Universal therapy schemes, sorry, on the day. The abovementioned facts, as well as the multiple organisms of the symptomatology, allow for the identification of doctors of various specialties for the detection of problems associated with the management of this category of ailments.

N. G. Klyukvina, Candidate of Medical Sciences, Associate Professor
MMA im. І. M. Sechenova, Moscow