#31
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Óâàæàåìàÿ Òàòüÿíà!
Ìîæåò è íàïðàñíî, íî âñå æå íåêîòîðûå óòî÷íåíèÿ: Âî âðåìÿ áåðåìåííîñòè èëè ãåïàðèí èëè ÍÌÃ; âàðôàðèí è ïðî÷. êóìàäèíû çàïðåùåíû: There are two potential fetal complications of maternal anticoagulant therapy: teratogenicity and bleeding. Neither UFH nor LMWH cross the placenta; therefore, these agents do not have the potential to cause fetal bleeding or teratogenicity, although bleeding at the uteroplacental junction is possible. Several studies strongly suggest that UFH/LMWH therapy is safe for the fetus. In contrast, coumarin derivatives cross the placenta and have the potential to cause both bleeding in the fetus and teratogenicity. Coumarin derivatives can cause an embryopathy, consisting of nasal hypoplasia and/or stippled epiphyses, after in utero exposure to vitamin K antagonists (VKAs) during the first trimester of pregnancy, and CNS abnormalities after exposure to such drugs during any trimester. Ïî àíòèôîñôîëèïèäíîìó ñèíäðîìó (APLA), â îòëè÷èå îò äð. âèäîâ òðîìáîôèëèé, óæå áîëåå åäèíîãëàñíîå ìíåíèå è çàêëþ÷àåòñÿ â ñëåäóþùåì: àíòèòåëà+íåâûíàøèâàíèå - àñïèðèí+ÏÐÎÔÈË.äîçû (ÍÌ) ãåïàðèíà; àíòèòåëà+òðîìáîç â àíàìíåçå - àñïèðèí+ÏÎËÍ.äîçû (ÍÌ)ãåïàðèíà (âìåñòî êóìàäèíîâ) íà âåñü ïåðèîä áåðåìåííîñòè è çàìåùåíèå íà ïåðîðàëüíûå ÀÊ â ïîñëåðîä. ïåðèîäå: For pregnant patients with APLAs and a history of multiple (two or more) early pregnancy losses or one or more late pregnancy losses, preeclampsia, IUGR, or abruption, we suggest administration of antepartum aspirin plus minidose or moderate-dose UFH or prophylactic LMWH. Patients with APLAs and a history of venous thrombosis are usually receiving long-term oral anticoagulation therapy because of the high risk of recurrence. During pregnancy, we recommend adjusted-dose LMWH or UFH therapy plus low-dose aspirin and resumption of long-term oral anticoagulation therapy postpartum. Èç Chest. 2004 Sep;126(3 Suppl):627S-644S. Use of antithrombotic agents during pregnancy: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy... |
#32
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ÎÊ,
ïðî áåðåìåííîñòü è êóìàäèíû - ñàìî ñîáîé ðàçóìååòñÿ, èíòåðåñíî, ÷òî òåðàïèÿ àíòèêîàãóëÿíòàìè äîëæíà áûòü ïðîäîëæèòåëüíà, íî ññûëîê íà âîçìîæíîñòü ÇÃÒ ó ïàöèåíòêè ñ ÀÔÑ (ëþáûå ýñòðîãåíñîäåðæàùèå ïðåïàðàòû â ïðèíöèïå èìååò ñìûñë èçáåãàòü) íåò. ÷èñòî òåîðåòè÷åñêè - ïðåæäåâðåìåííàÿ ìåíîïàóçà è íàëè÷èå ÀÒ èìååò ïðàâî íà ñóùåñòâîâàíèå. |
#33
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Óâàæàåìàÿ Òàòüÿíà!
åñëè Âàì áóäåò èíòåðåñíûì çàðóáåæíîå ìíåíèå, ìîãó ïðåäîñòàâèòü ïîëíûé òåêñò îáçîðà: Lahita RG. Hormonal contraception and replacement and the use of androgens in the antiphospholipid syndrome. J Autoimmun. 2000 Sep;15(2):213-6. |
#34
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Äà,
äóìàþ, ÷òî äà. ýòî âàæíî â ïðèíöèïå. |
#35
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Âïå÷àòëÿåò óðîâåíü ðàçáîðà...
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#36
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Óâàæàåìàÿ Òàòüÿíà!
 òåìó: íåäàâíÿÿ ðàáîòà èç Ãîëëàíäèè - ïîñëå òùàòåëüíîãî îòáîðà (11 èç 69) óæå îïóáëèêîâàííûõ äàííûõ, ñî÷ëà äåéñòâèòåëüíî îïàñíûìè òðîìáîôèëèÿìè òîëüêî ïîâûøåííûé óðîâåíü ãîìîöèñòåèíà, óñòîé÷èâîñòü ê àêòèâ. áåëêó Ö (ôàêòîð V ñ ìóòàöèåé Ëåéäåí), àíòèòåëà ê ôîñôîëèïèäàì è (ìîæåò) ìóòàöèÿ ïðîòðîìáèíîâîãî ãåíà; è òîëüêî èõ ðåêîìåíäóåò òåñòèðîâàòü/âûÿâëÿòü ïðè íåâûíàøèâàíèè. Êàê ãîâîðèòñÿ, ñêîëüêî äîêòîðîâ, ñòîëüêî ìíåíèé: Krabbendam I, Franx A, Bots ML, Fijnheer R, Bruinse HW. Thrombophilias and recurrent pregnancy loss: a critical appraisal of the literature. Eur J Obstet Gynecol Reprod Biol. 2005 Feb 1;118(2):143-53. |
#37
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Äîáðîå óòðî âñåì!
Âîò ïîëó÷èëà ðåçóëüòàòû íåêîòîðûõ àíàëèçîâ, âñå îò 13/14.01.05: I. ÈÏÏÏ: Ìàðêåð1 - U.urealyticum Ìàðêåð2 – Candida albicans è Str.agalactiae II. Ðåçóñ-àíòèòåëà íå îáíàðóæåíû. III. HCV-àíòèòåëà - îòðèö. IV. ÊÑÐ - îòðèöàòåëüíûé V. ÓÇÈ – íîðìà (4-ûé äåíü öèêëà) VI. Êîàãóëîãðàììà: 1. ÏÄÔ - îòðèö. (îòðèö.) 2. Ýòàíîëîâûé òåñò - îòðèö. (îòðèö.) 3. Ðåòðàêöèÿ ñãóñòêà - 4.00 (3.00 - 4.00) 4. Ïðîòåèí Ñ - 100.00 (70.00 - 140.00) 5. Àãðåãàöèÿ òðîìáîöèòîâ - 14.00 (12.00 - 18.00) 6. Ôèáðèíîãåí - 401 (200 - 400) 7. Ïðîòðîìáèíîâûé èíäåêñ - 108.00 (70.00 - 120.00) 8. ÀÒÐ - 27.2 (24.00 - 32.00) 9. ÌÍÎ - 0.95 (0.70 - 2.00) 10. ÀÏÒÒ - 60.40 (28.00 - 40.00) 11. Òðîìáèíîâîå âðåìÿ - 16.50 (14.00 - 21.00) VII. Àíàëèç êðîâè: 1. Ãåìîãëîáèí – 134.00 (120.00 – 140.00) 2. Ýðèòðîöèòû – 4.30 (3.90 – 4.70) 3. Öâåòîâîé ïîêàçàòåëü – 0.90 (0.85 – 1.05) 4. Ëåéêîöèòû – 6.20 (4.00 – 9.00) 5. Íåéòðîôèëû(ïàëî÷êîÿäåðíûå) – 3.00 (1.00 – 6.00) 6. Íåéòðîôèëû (ñåãìåíòîÿäåðíûå) – 63.00 (47.00 – 72.00) 7. Ýîçèíîôèëû – 3.00 (0.50 – 5.00) 8. Ëèìôîöèòû – 24.00 (19.00 – 37.00) 9. Ìîíîöèòû – 7.00 (3.00 – 11.00) 10. ÑÎÝ - 3.00 (2.00 – 15.00) 11. ÏÒÈ – 93 % Ðåçóëüòàòû áèîõèìèè, ãîðìîíîâ è àíòèòåë ê êàðäèîëèïèíó ïîëó÷ó òîëüêî íà ñëåä. íåäåëå. ×òî-íèáóäü ìîæíî ñåé÷àñ ïî ýòèì àíàëèçàì ñêàçàòü? |
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#38
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Óâàæàåìàÿ Òåññà!
×òî òàêîå ÀÒÐ - 27.2 (24.00 - 32.00)? Íå íîðìàëüíî ÀÏÒÒ (ñòðàííàÿ àáðåâèàòóðà - îòå÷åñòâåííàÿ çâó÷èò À×Ò èíîãäà ÀÏÒ ïîñëåäíåå ñëîâî "âðåìÿ") - ïðè íîðìàëüíîì ÏÒÈ (â îäíîì ñëó÷àå 108% (N.7), â äðóãîì - 93% (N.11) - êà÷åñòâî àíàëèçîâ èëè â ðàçíûå äíè, ðàçíûå ëàáîðàòîðèè?) è íîðìàëüíîì Ò ïîâûøåííîå ÀÏÒ óêàçûâàåò íà äåôèöèò ôàêòîðîâ (òîãäà ñêëîííîñòü ê êðîâîòî÷èâîñòè) èëè íàëè÷èå âîë÷àíî÷íîãî àíòèêîàãóëÿíòà. Êðàéíå ðåäêèé ôåíîìåí äåôèöèò ôàêòîðà XII íå äàåò êðîâîòî÷èâîñòè, íî åñòü ðèñê òðîìáîçîâ. Òå íóæíî èñêàòü âîë÷. àíòèêîàãóëÿíò. Åñòü ëè ëàáîðàòîðèè, òàì ãäå Âû æèâåòå, ãäå ýòî äåëàþò êà÷åñòâåííî(ñîãë. ìåæäóí. ñòàíäàðòàì)? |
#39
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Öèòàòà:
Öèòàòà:
Öèòàòà:
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#40
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Óâàæàåìàÿ Òåññà!
Âñå âåðíî, íàñ÷åò ÀÏÒÒ ðàçîáðàëèñü, íî ìíå ïîêà íåïîíÿòíà àááðåâèàòóðà ÀÒÐ: õîòÿ ýòî è â íîðìå, íî ïðîñòî èíòåðåñíî, íå ìîãëè áû Âû äëÿ ìåíÿ óçíàòü åå ðàñøèôðîâêó? Ê ñîæàëåíèþ, íå çíàþ êàêàÿ ëàáîðàòîðèÿ ñîîòâåòñòâóåò ñòàíäàðòàì: ìîæåò Âû ñàìè áû ðàçóçíàëè â ëàáîðàòîðèè? Âîë÷àíî÷íûé àíòèêîàãóëÿíò âûïîëíÿåòñÿ â 2 ýòàïà: 1. ïðè ïîâûøåííîì ÀÏÒÒ ïëàçìó Âàøó ñíà÷àëà ñìåøèâàþò ñ íîðìàëüíîé è èíêóáèðóþò (!!!) ïðè 37°Ñ, ïðè äåôèöèòå ôàêòîðîâ - ÀÏÒÒ íîðìàëèçóåòñÿ, ïðè ÂÀ - àíòèòåëà èíãèáèðóþò ôîñôîëèïèäû è ÀÏÒÒ âñå ðàâíî óäëèíåíî (âûøå íîðìû); 2. çàòåì ê Âàøåìó îáðàçöó ïëàçìû äîáàâëÿþò ðàçìîðîæåííóþ òðîìáîìàññó - ÂÀ ñâÿçûâàåòñÿ ñ íåé è èíàêòèâèðóåòñÿ - â ðåçóëüòàòå ÀÏÒÒ íîðìàëèçóåòñÿ. Ìîæåò äîêòîð Òàòüÿíà ×åáîòíèêîâà ìîãëà áû ïîäñêàçàòü, êàêîé ëàáîðàòîðèè â Ìîñêâå ìîæíî äîâåðèòüñÿ â ýòîì ïëàíå? |
#41
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Äîáðîå óòðî, óâàæàåìûå äîêòîðà (îñîáåííî Dr. Vad è Chebotnikova T.) !
Ïîëó÷èëà ðåçóëüòàòû àíàëèçîâ íà ãîðìîíû, 6-îé äåíü ÌÖ: 1. Ëà - 2,85 (1,1 - 8,7) 2. ÔÑà - 5,28 (1,8 - 11,3) 3. Ïðîëàêòèí - 324 (57 - 600) 4. Ýñòðàäèîë - 24 (30 - 120) 5. Ïðîãåñòåðîí - 4,2 (0 - 6) 6. Òåñòîñòåðîí - 1,7 (0,5 - 4,3) 7. 17-ÎÍ ïðîãåñòåðîí - 1,44 (0,1 - 0,8) 8. ÒÒà - 1,56 (0,23 - 3,4) 9. Ò4 ñâîá. - 13,43 (11 - 26) 10. ÀÔÏ- 0,515 (0 - 10) 11. IgM (mPL) - 17,7 (ñë.-ïîë.10-23; ïîëîæ. >23) 12. IgG (gPL) - 225,5 (ñë.-ïîë.10-20; ïîëîæ. >20) Öèòàòà:
Êàê, ïî âàøåìó ìíåíèþ, ýòè ðåçóëüòàòû ìîæíî èíòåðïðåòèðîâàòü? |
#42
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Óâàæàåìàÿ Òåññà!
Âîîáùå-òî, äëÿ ìåíÿ ñòðàííî è òðóäíîîáüÿñíèìî, ïî÷åìó àêòèâèð. âðåìÿ ðåêàëüöèôèêàöèè â íîðìå, à ÀÏÒÒ - ïîâûøåíî, íî Áîã ñ íèìè - êàê-íèêàê ÀÂÐ ìåíåå ñòàíäàðòèçèðîâàííûé è çíà÷èò ìåíåå ñïåöèôè÷íûé òåñò äëÿ âîë÷àí. àíòèêîàãóëÿíòà. Èòàê, èìååì ïîëîæ. àíàìíåç, óäëèíåííîå À×Ò - ôîñôîëèïèä-çàâèñèìûé òåñò, íî íîðìàëüíîå ÀÂÐ (ôîñôîëèïèä-íåçàâèñèìûé), ò.å. äåôèöèò ôàêòîðîâ èñêëþ÷àåòñÿ (à çíà÷èò îñòàåòñÿ ÂÀ, õîòü è íå ïîäòâåðæäåí ïîêà), 11. IgM (mPL) - 17,7 (ñë.-ïîë.10-23; ïîëîæ. >23) 12. IgG (gPL) - 225,5 (ñë.-ïîë.10-20; ïîëîæ. >20) Ê ÷åìó îòíîñÿòñÿ ýòè äàííûå (íàñêîëüêî ìíå èçâåñòíî, â gPL èçìåðÿþòñÿ àíòèòåëà ê ôîñôîëèïèäàì, ïîýòîìó è òàêîå ñîêðàùåíèå PL)? åñëè òàê, òî åùå è âûñîêèé òèòð àíòèôîñôîëèïèäíûõ àíòèòåë /ìåæäóíàðîäíî: äî 20 - ñ÷èòàé îòñóòñòâèå, 20-50 gpl - ñðåäíèé, âûøå 50 - âûñîêèé òèòð/. Ò.å. äèàãíîç àíòèôîñôîëèïèäíîãî ñèíäðîìà î÷åâèäåí, íî íå âûñòàâëåí. Äåëî çà ìàëûì - íàéòè ãèíåêîëîãà-ñïåöèàëèñòà, êîòîðûé áû ýòî ñäåëàë è ìîã áû íàçíà÷èòü Âàì àäåêâàòíóþ òåðàïèþ.
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#43
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Ïðîøó ïðîùåíèÿ, íå óêàçàëà íàçâàíèå àóòîàíòèòåë - ýòî àíòèêàðäèîëèïèí.
Öèòàòà:
È î ÷åì ãîâîðÿò ðåçóëüòàòû àíàëèçà ãîðìîíîâ? Ñïàñèáî çà ïîìîùü. |
#44
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Ó Âàñ íåò íàðóøåíèé äåÿòåëüíîñòè ùèòîâèäíîé æåëåçû, íîðìàëåí óðîâåíü ïðîëàêòèíà,òåñòîñòåðîíà , Ëã è ÔÑÃ. Ìèíèìàëüíîå ïðåâûøåíèå óðîâíÿ 17 ÎÏà âðÿä ëè ÿâëÿåòñÿ ïðîáëåìîé, íî ëå÷àùèé âðà÷ ìîæåò ïðèíÿòü ðåøåíèå î ïðîâåäåíèè ïðîáû ñ 1-24 ÀÊÒà ( ÿ áû íå ñòàëà) èëè îïðåäåëåíèè óðîâíÿ ÄÝÀÑ.Ñìûñë îïðåäåëåíèÿ ïðîãåñòåðîíà â íà÷àëå öèêëà íå ÿñåí.
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Ã.À. Ìåëüíè÷åíêî |
#45
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Òîëüêî ñåãîäíÿ ñëóøàë ëåêöèþ ïî òðîìáîôèëèÿì
Öèòàòà:
 ñóåòå èç îáùåãî àíàëèçà êðîâè ïðîïàëè òðîìáîöèòû, èëè ÿ íå óãëÿäåë.. Íî äëÿ äèàãíîçà óæå íå ñóùåñòâåííî. Êëèíè÷åñêèå ïðîÿâëÿíèÿ (òðîìáîçû + àêóøåðñêàÿ ïàòîëîãèÿ) + âûñîêèé òèòð IgG ÀÒ ê êàðäèîëèïèíó. Äà, äèàãíîç ÀÔÑ äîñòîâåðåí. Îïÿòü æå èç ñåãîäíÿøíåé èíôîðìàöèè, çàíèìàþòñÿ, âðîäå áû, íà áàçå 7 ðîääîìà (íà êàôåäðå Ìàêàöàðèÿ).. |