免疫学PBL报告.doc

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 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。 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 (1~2time a day) 肌肉酸痛 EBV lymphadenitis Rheumatoid Arthiritis SLE No Rash, even EBV is positive but other blood test does not show EBV Lymphadenitis A long lasting  HYPERLINK /wiki/Rash rash that begins on the trunk or arms as  HYPERLINK /wiki/Macule macules and spreads outward to form a snake like ring while clearing in the middle. This rash never starts on the face and it is made worse with heat. ANA, anti-Smith antibodies, and anti dsDNA antibodies are negative RF Result is negative. But it does not rule out disease. Elevated  HYPERLINK /wiki/Ferritin ferritin levels is a sign of  HYPERLINK /wiki/Still%27s_disease Still‘s disease Type III Hypersensitivity; IgG or IgM antigen binding making Immune Complex. The activation of compliment C3a and C5a with Mast cell or Basophils will release Histamine and increase permeability of blood vessels causing itchiness 辐照强烈时- 皮肤发痒不适 请绘制发病机制图 Type IV Hypersensitivity; T-cell mediated. Th1 cell release inflammation mediation reactor like IFN-gamma, IL-3 or IL-16. May result in contact dermatitits 剧烈寒战 /发热 (1~2time a day) STILL’s DISEASE (Early Symptoms) Blockade of IL-1,  HYPERLINK /wiki/Interleukin_15 \o Interleukin 15 IL-15 and  HYPERLINK /wiki/Interleukin_6 \o Interleukin 6 IL-6 also have beneficial effects and  HYPERLINK /wiki/Interleukin_17 \o Interleukin 17 IL-17 may be important. Constitutional symptom such as fever is also caused by cytokines released in to the blood stream 肌肉酸痛 Lactic A cid Deposition STILL’s DISEASE (Late Symptoms) 皮疹 （躯干，上臂，半月形） 肩，膝关节疼痛肿大  HYPERLINK /wiki/Synovitis \o Synovitis Synovitis is inflammation of the  HYPE