免疫学PBL报告

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1、同济大学医学院问题导向学习课程教案名称：专业年级：指导老师：日期：年月日一、请列出需要学习的问题及相关知识、拟解决的方案和预期达到的目的。一、请绘制诊断流程图。起始症状肩，膝关节疼痛肿大辐照强烈时-皮肤发痒不适皮疹（躯干，上臂，半月形）剧烈寒战剧烈咽痛/发热(1~2timeaday)肌肉酸痛EBVlymphadenitisRheumatoidArthiritisSLENoRash,evenEBVispositivebutotherbloodtestdoesnotshowEBVLymphadenitisAlonglastingrashthatbeginsonthetr

2、unkorarmsasmaculesandspreadsoutwardtoformasnakelikeringwhileclearinginthemiddle.Thisrashneverstartsonthefaceanditismadeworsewithheat.ANA,anti-Smithantibodies,andantidsDNAantibodiesarenegativeRFResultisnegative.Butitdoesnotruleoutdisease.ElevatedferritinlevelsisasignofStill‘sdiseaseType

3、IIIHypersensitivity;IgGorIgMantigenbindingmakingImmuneComplex.TheactivationofcomplimentC3aandC5awithMastcellorBasophilswillreleaseHistamineandincreasepermeabilityofbloodvesselscausingitchiness辐照强烈时-皮肤发痒不适一、请绘制发病机制图TypeIVHypersensitivity;T-cellmediated.Th1cellreleaseinflammationmediatio

4、nreactorlikeIFN-gamma,IL-3orIL-16.Mayresultincontactdermatitits剧烈寒战/发热(1~2timeaday)STILL’sDISEASE(EarlySymptoms)BlockadeofIL-1,IL-15andIL-6alsohavebeneficialeffectsandIL-17maybeimportant.Constitutionalsymptomsuchasfeverisalsocausedbycytokinesreleasedintothebloodstream肌肉酸痛LacticAcidDepo

5、sitionSTILL’sDISEASE(LateSymptoms)皮疹（躯干，上臂，半月形）肩，膝关节疼痛肿大Synovitisisinflammationofthesynovialmembranethatlinesjointsandtendonsheaths.IfTNFreleaseisstimulatedbyBcellproductsintheformofRFthroughactivationofimmunoglobulinFcreceptors,thenRAcanbeseenasaformofTypeIIIhypersensitivity.IfTNFrele

6、aseisstimulatedbyTcellproductssuchasinterleukin-17itmightbeconsideredclosertotypeIVhypersensitivity