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Chapter 808 Three Contradictions
What are the diseases that get better on their own and then progress again?That's a very... difficult question to answer.

To answer this question, we must first clarify a concept-self-limitation.

The process of the human body's immune system from detecting and recognizing pathogens to initiating phagocytosis and eliminating pathogens does not happen overnight.Most of the process of identification-activation-elimination takes several days to complete.In this process, the patient's condition tends to change from mild to severe at first, and then gradually relieved.Throughout this process, medical intervention is not entirely required.The use of medical means to intervene, at most, will make the patient's own recovery speed slightly faster, or slightly reduce the discomfort caused by the disease during the recovery process.

This part of self-improvement should theoretically be the corresponding manifestation of self-limitation.But... it would be strange to progress this again.

Recurrence of the disease is a very common situation in clinical treatment.Due to various reasons, patients may experience changes of "better-worse-re-better" in their condition.This may be due to the resistance of pathogenic bacteria to the antibiotics used by doctors, the deterioration of the patient's physical condition, or a problem with the dosage and administration of drugs... In short, this situation does exist .

But repeated illness means that patients are less likely to rely on their own immune system to deal with pathogens.If the pathogen cannot be resolved by itself, it means that the disease should not be self-limiting.

The first paradox appeared in Ji Xiuying's diagnosis—the disease exhibited two contradictory features.

"It doesn't necessarily mean that it will be repeated, right?" Xu Yourong raised a different opinion, "The patient has undergone a total hysterectomy and double annexectomy first, which means that her previous tumor should have reached the second stage. She is likely to continue to receive treatment after that." Chemotherapy ... which also suppressed her immune system."

Most chemotherapy drugs are myelotoxic, in that they broadly inhibit the bone marrow from producing new immune cells.So the continued use of chemotherapy drugs does suppress the patient's immune system.

"That is to say... when she got sick, her body was under immunosuppression." Dr. Pascal followed Xu Yourong's train of thought and said, "The onset of immunosuppression may be some kind of opportunistic pathogen?" He suddenly Shaking his head, "The latter situation doesn't make sense—the immunosuppressive effect of hormones is much stronger than that of chemotherapy drugs."

If the patient is infected with opportunistic pathogens, the symptoms should not improve during further immunization.Without an immune system to control opportunistic pathogens, her condition should have gotten worse.

"She was in a state of immunosuppression first, and then she became ill." Yuan Pingan explained the process in the middle, "After the onset, she received anti-tuberculosis treatment, and the regimen used was isoniazid, rifampicin and ethambutol. Ethambutol Only effective against Mycobacterium tuberculosis, but rifampicin itself is a broad-spectrum antibiotic and is effective even against viruses. Isoniazid is also effective against other bacteria-especially against bacteria of the genus Bacillus. So... Will Wouldn't it be because the anti-TB drugs acted like antibiotics in her body, keeping the pathogen in check?"

"This can't explain the different reactions to the hormones used three times." Zhou Ce leaned back, "It would be easy if it were so simple. Other hospitals wouldn't have misdiagnosed like this over and over again—they have been misdiagnosed for five years! "Zhou Ce stretched his waist and asked, "Is it possible... This disease is not caused by infection at all?"

"You mean... immunodeficiency pneumonia?" Dr. Pascal frowned, and he had considered this idea, "The closest possible cause is the lack of glucose-6-phosphate dehydrogenase. 'Central' pneumonia. But...the patient has no symptoms of hemolytic anemia."

"Repeated infection can be correct." Zhou Ce fought for his guess and then gave up. "But it's not correct—immunodeficiency pneumonia should not be improved under the influence of hormones. She is not The improvement in which the symptoms have been relieved is a substantial improvement in which part of the lesion has been absorbed."

This is the second point of contradiction in Ji Xiuying's symptoms.The hormone suppresses the immune system while reducing inflammation.If her own immune system had mistakenly attacked lung tissue, her symptoms shouldn't have improved with the TB drugs.It is also impossible to relapse when starting to self-medicate after stopping hormone drugs.

But if it is a symptom caused by a pathogen infection, it will improve under the action of isoniazid and rifampicin, and it should not be suppressed by hormones during the relapse after drug withdrawal.Hormone will not inhibit the invasion of bacteria or viruses to the human body, it can only inhibit the body's immune system.This is a basic logic.

"I don't think this is an autoimmune system disease." Sun Li'en thought over and over again, and then made a judgment. "Autoimmune diseases at any stage will not have negative reactions due to hormones. Autoimmune diseases in the quiescent phase may not respond to hormones, but it is absolutely impossible to progress from the quiescent phase under the influence of hormones. "

"So you are prone to infection?" Bruen immediately asked, "Then immunosuppression can make the damage on the image better...how can this be explained?"

"You have already explained the most likely explanation." Sun Li'en smiled a little pretending to be mysterious, and he asked, "Is the damage on the image really the damage? Or, is it really the damage caused by the disease?" Is it?"

"What do you mean?" Dr. Brunn was a little puzzled.However, Dr. Pascal and Zhou Ce on the side showed deep thinking expressions at the same time.

"No, it still doesn't make sense." Xu Yourong suddenly interrupted the "deliberation" of the two of them, "The patient's progress is very limited every time after that. Only the first time the disease has a relatively large progress - if it is the immune system The changes in imaging features caused by attacking the infected tissue, so why has the subsequent infection progressed slowly? Her progress in the next five years is not even as fast as the one year after the first hysterectomy and bilateral adnexectomy. .”

Xu Yourong's words are rather convoluted, but everyone can still understand - if it is caused by some kind of infection, maybe hormones can explain the changes in symptoms on imaging.After all, hormones can suppress the immune system, and the immune system itself will "injure innocents" when attacking pathogens, resulting in imaging symptoms that are far worse than they actually are.But the damage to the lungs is not all due to the immune system—pathogens that invade the body are bound to cause serious damage to the body.

But now it seems...the speed of the damage's deepening and the speed of progression when it first started...do not match at all.

This is the third point of contradiction - the contradiction in the speed of disease progression.

(End of this chapter)