Focal segmental glomerulosclerosis: cov tsos mob, kev kuaj mob, kev kho mob, kev kwv yees

Focal segmental glomerulosclerosis (FSH) yog qhov ua rau lub raum mob thoob ntiaj teb. Qhov pib xav tshuaj ntawm thawj lub koom haum FSHC yog qhov muaj txiaj ntsig ntshav nrog kev siv tshuaj tiv thaiv kab mob thiab muaj kev pheej hmoo rov qab los tom qab hloov raum. Hloov kho FSGS muaj feem xyuam nrog kev thauj khoom nephron ntau vim yog lub cev muaj zog ntau ntxiv, muaj peev xwm qis dua ntawm nephron, lossis lub ntsej muag glomerular hyperfiltration cuam tshuam nrog qee yam kab mob.

Focal segmental glomerulosclerosis yog thawj txoj kev ua haujlwm ntawm lub raum tsis ua haujlwm. Nws hais txog daim duab keeb kwm uas ua cim rau 6 qhov xwm txheej hauv qab txoj cai, sib qhia cov ntsiab lus dav dav txog qhov doog thiab depletion ntawm podocytes.

Kev txheeb xyuas ntawm focal segmental glomerulosclerosis cia siab rau kev sib koom ua ke ntawm keeb kwm kho mob (tsev neeg kab mob, keeb kwm yug, qhov hnyav thiab lub cev qhov hnyav, cov txiaj ntsig tshuaj), kev tshawb nrhiav hauv chaw kuaj (ntshav albumin, zis protein, thiab kab mob kis) thiab cov keeb kwm yav dhau los. Proteinuria tuaj yeem yog nyob hauv qhov tsis muaj zog ntawm qhov tsis zoo lossis qis dua ntawd. Ntawm qhov tseem ceeb ntawm kev txiav txim siab yog qhov kev tshem tawm lwm qhov kab mob ntawm cov kab mob lossis thawj kab mob ntawm ob lub raum, uas tuaj yeem ua rau muaj kev nthuav qhia zoo sib xws.

Kev mob kis thoob ntiaj teb thiab lub nra hnyav thoob ntiaj teb

Kev nthuav dav ntawm focal segmental glomerulosclerosis, piv nrog rau lwm cov kev kuaj mob ntawm cov kabmob no, tau nce thoob ntiaj teb. Txawm li cas los xij, qhov tseeb zaus thiab nthuav dav yog qhov nyuaj los tsim, muab qhov kev sib txawv loj thoob ntiaj teb hauv qhov ntsuas, muaj, thiab kev txhawb nqa pathological ntawm cov hlaus rov qab.

Kev tshuaj xyuas cov ntaub ntawv luam tawm thoob ntiaj teb tau ua tiav, uas qhia tau tias txhua xyoo cov xwm txheej tsis zoo muaj thaj tsam li ntawm 0.2 txog 1.8 rau 100,000 nyob rau ib xyoo 100,000. Qhov nruab nrab ntawm tus neeg sib txawv muaj 2.7 cov neeg mob ib lab. Muaj yog ib qho tseem ceeb ntawm kev ntxub ntxaug thiab haiv neeg. Tsis tas li ntawd, cov tsos mob ntawm lub raum tsis ua haujlwm rau cov poj niam tsis tshua hais txog txiv neej.

Kev faib tawm ntawm focal segmental glomerulosclerosis yog multifaceted. Nws suav nrog pathophysiological, keeb kwm thiab caj ces. Thaum pib, FSGS tau muab faib ua cov thawj (idiopathic) thiab cov ntawv thib ob. Cov tom kawg tuaj yeem suav tsev neeg (caj ces), kab mob cuam tshuam, tshuaj vim muaj cov tshuaj siv.

Cov lus pom zoo kho mob rau cov focal segmental glomerulosclerosis yuav cuam tshuam txog cov keeb kwm kev hloov pauv txawv, feem ntau ua rau glucocorticoid reactivity ntawm lub qhov txhab thiab qhov txhoj puab heev, qhov cuam tshuam ntawm lub cev sib txawv.

6 cov chaw kuaj mob

Ua ke los ntawm kev sib txawv ntawm caj ces, cov kab mob pathophysiological, keeb kwm kho mob thiab cov lus teb rau kev kho, nws raug nquahu kom pab pawg FSGS rau hauv 6 hom kev kho mob. Lawv suav nrog:

thawj
yoog
muaj caj ces ntau
tus kab mob-mediated
tshuaj muaj feem xyuam
Txuas APOL1-txuas.

Histopathology ntawm tus kab mob

Cov tsos mob tsawg kawg ntawm glomerulonephritis rau cov neeg laus yog pom los ntawm qhov tsis muaj tubulointerzital scarring. Qhov swb ntawm lub ntsis yog qhov focal adhesion ntawm glomerular nras mus rau Bowman tshuaj ntsiav ze ntawm qhov sib thooj coj tawm ntawm cov tubule.

Qhov kev xaiv yam ntxwv tshaj plaws yog tsaus muag. Ib qho piv txwv tshwj xeeb tuaj yeem raug ntsuas nyob rau hauv kev teeb tsa ntawm endothelial tubule reticular inclusions pom hauv kev tshuaj ntsuam ultrastructural. Lawv tuaj yeem raug soj ntsuam nyob hauv cov xeev siab ntawm cov neeg cuam tshuam, suav nrog kev kis tus kab mob. Kev hloov cov kab mob tsawg tshaj plaws thiab cov ntsis puas tsuaj yog qhov feem cuam thiab tsawg tshaj plaws, thiab tsaus muag glomerulopathies, tiv taus kev kho mob thiab kev nruam ntej.

Cov tsos mob qhia tias muaj mob

Cov tsos mob thiab cov tsos mob ntawm tus mob glomerulonephritis rau cov neeg laus nyob ntawm seb muaj daim ntawv mob los yog mob ntev ntev. Lawv suav nrog:

Paj yeeb los yog xim daj tso zis vim yog nce cov qe ntshav liab ntau ntau (hematuria).
Ua npuas ncauj zis vim muaj protein ntau dhau (proteinuria).
Ntshav siab (tawg).
Kev tuav kua dej (edema). Nws tshwm rau ntawm lub ntsej muag, caj npab, ceg thiab lub plab.

Cais, cov tsos mob ntawm lub raum tsis ua haujlwm rau cov poj niam tau txawv:

Kev tso zis tsawg ntxiv.
Kev tuav kua dej ua rau o ntawm ob txhais ceg.
Txog siav.
Nkees
Tsis meej pem pem.
Xeev siab
Neeg tsis muaj zog.
Lub plawv dhia tsis xwm yeem.
Mob hauv lub raum thaj tsam.
Tsaus muag lossis hnovqab tsis zoo nyob rau kis loj.

Txoj kev paub tseeb tshaj plaws los txheeb xyuas FSGS

Thawj qhov ua yog tso zis ntsuas raum. Nws suav nrog ob qhov kev ntsuam xyuas:

Kev ntsuas ntawm albumin rau creatinine. Ntau cov albumin hauv cov zis yog qhov pom ntawm lub raum puas thaum ntxov. Peb qhov txiaj ntsig zoo tau rau peb lub hlis lossis ntev dua yog pom ntawm mob.
Glomerular pom npaum li cas. Kuaj ntshav rau cov pov tseg hu ua creatinine. Nws los ntawm cov leeg nqaij. Thaum lub raum raug mob, teeb meem tshwm sim nrog kev tshem tawm ntawm creatinine los ntawm cov ntshav. Cov txiaj ntsig ntsuas tau siv nyob rau hauv tus qauv lej nrog lub hnub nyoog, haiv neeg thiab tub los ntxhais txhawm rau txhawm rau txhawm rau tshawb pom qhov glomerular filtration rate.

Cov laj thawj tseem ceeb

Cov mob uas tuaj yeem ua rau lub plab glomeruli ntawm lub raum yog:

Kis tau cov kab mob. Glomerulonephritis tuaj yeem tsim kho 7-14 hnub tom qab kis kab mob tawv nqaij yav dhau los (mob pob qij txha) lossis mob ntsws caj pas. Yuav kom tawm tsam lawv, lub cev raug yuam kom tsim ntau yam tshuaj tiv thaiv, uas muaj peev xwm thaum kawg txiav txim siab hauv lub glomeruli, ua rau muaj mob.
Cov kab mob endocarditis. Cov kab mob tuaj yeem sib kis los ntawm cov ntshav thiab txiav txim hauv lub plawv, ua rau kis ntawm ib lossis ntau lub plawv kev tiv thaiv. Cov kab mob endocarditis yog txuam nrog tus mob glomerular, tab sis kev sib raug zoo ntawm lawv tsis meej.
Tus kab mob kis. Kab Mob Human Immunodeficiency Virus (HIV), Kab mob siab B thiab C tuaj yeem ua rau mob.
Lupus Nws tuaj yeem cuam tshuam ntau yam kabmob thiab qhov chaw hauv lub cev, suav nrog cov qe ntshav, tawv nqaij, raum, lub plawv, pob qij txha, thiab lub ntsws.
Tshuaj Mob Goodpasture. Nov yog tus kab mob ntsws uas tsis tshua muaj kab mob ntsws. Nws tuaj yeem ua tus mob glomerulonephritis thiab los ntshav hauv cov ntsws.
Nees Qaum Ntuj Thawj tus kab mob glomerular no tshwm sim vim yog muaj tus mob glomerular immunoglobulin tso. Nws tuaj yeem ua kev nce qib ntau xyoo yam tsis muaj cov tsos mob tshwm sim.

Lwm yam laj thawj

Lwm yam ua rau tus mob muaj xws li:

Mob ntsws Polyester. Daim ntawv ntawm vasculitis cuam tshuam rau cov ntshav me me thiab nruab nrab. Hu ua Wegener lub granulomatosis.
Ntshav siab. Lub raum kev ua haujlwm tsawg zuj zus lawm. Lawv ua cov sodium zuj zus.
Focal segmental glomerulosclerosis. Nws yog qhov tshwj xeeb los ntawm diffuse scarring ntawm qee qhov glomeruli. Tus mob no tuaj yeem yog los ntawm lwm tus kab mob lossis yuav tshwm sim yam tsis paub meej.
Ntshav qab zib mob raum (mob ntshav qab zib nephropathy).
Cov Muaj Mob Alport. Txais daim ntawv. Nws kuj tseem tuaj yeem ua rau tsis hnov lus lossis tsis pom kev.
Ntau tus mob myeloma, mob ntsws cancer, thiab mob qog ua kom ntshav qab zib.

Tus kab mob mechanism

Focal segmental glomerulosclerosis yog ntau tus kabmob sib txawv uas tshwm sim tom qab raug mob rau podocytes rau ntau yam. Cov peev txheej ntawm kev puas tsuaj yog txawv:

cov keeb kwm khiav ncig
caj ces txawv txav
kis tus kab mob
tshuaj kho mob.

Rau feem ntau, kev sib txuam ntawm cov tsav tsheb no tsis paub meej thiab cov nyom. Piv txwv, kev hloov kho FSGS suav nrog ob qho kev nyuaj siab podocyte (mismatch ntawm glomerular load thiab glomerular muaj peev xwm) thiab kev muaj peev xwm hloov tau.

Kev puas tsuaj rau podocytes los ntawm txhua hom FSHC (lossis los ntawm lwm cov kab mob glomerular) pib txoj kev ua rau tus mob nephritic syndrome. Kev ploj zuj zus ntawm podocytes uas puas lawm rau hauv cov zis muaj tshwm sim. Yuav kom sib npaug qhov tsis sib luag, cov hlwb no them nyiaj rau hypertrophy, npog thaj tsam ntawm glomerular capillaries.

Nrog kev hloov kho FSGS, glomerular hypertrophy tshwm sim thaum pib ntawm cov txheej txheem kab mob. Hauv lwm cov ntawv, glomerular hypertrophy tshwm sim nrog kev ploj zuj zus ntawm lub nephron. Qhov no ua rau kom muaj kev ntxhov siab ntau ntxiv thiab cov dej ntws tam sim no hauv seem glomeruli ntawm lub patent.

Cov tshooj hauv qab no tham txog cov txheej txheem pathological, kev kho, thiab kho ntawm focal segmental glomerulosclerosis.

Thawj FSGS

Xws li kev tshuaj ntsuam caj, kab mob, thiab tshuaj muaj feem FSGS. Lub tshuab ntawm kev puas tsuaj rau podocytes suav nrog ib qho kev xa tawm mus, tej zaum muaj cytokine, uas ua rau cov neeg mob tshwj xeeb ua rau muaj kev cuam tshuam. Nov yog daim ntawv foos tshaj plaws hauv cov neeg hluas thiab cov neeg hluas. Nws yog feem ntau cuam tshuam nrog nephrotic series proteinuria (qee zaum loj), txo ntshav plasma albumin ntau ntau, thiab hyperlipidemia.

Tam sim no, kev kho FSGS thawj zaug yog ua los ntawm cov neeg siv tshuaj tiv thaiv kab mob. Cov no yog cov glucocorticoids thiab calcineurin inhibitors uas ncaj qha rau hauv cov qauv ntawm cov tshuaj tiv thaiv podocytes. FSHFs Rov Qab Los Tseem yog qhov teeb meem kev kho mob. Tsuas yog ib ntawm 77 thawj zaug tso raum tawm hauv cov neeg mob uas tom qab tau rov huam mob dua tuaj pom qhov txawv txav. Plasma pauv kev kho mob yuav ua rau muaj kev tshem tawm ib ntus.

Haum FSGS

Nws tshwm sim tom qab ib lub sijhawm ntawm glomerular hyperfiltration ntawm qib nephron thiab kub siab tom qab pathophysiology. Cov xwm txheej uas cuam tshuam nrog nws txoj kev loj hlob muaj xws li:

mob plawv cyanotic,
sickle cell anemia,
rog dhau
androgen kev tsim txom
pw apnea
cov zaub mov muaj protein ntau.

Lub sijhawm ntawm ib-glomerular hyperfiltration feem ntau ntsuas ntsuas ntau xyoo ua ntej glomerulosclerosis hloov zuj zus. Hloov kho FSGS ua rau muaj kev txhim kho glomerular hypertrophy mus los, kev ntxhov siab thiab qaug zog, ntau dhau ntawm qhov tso tawm ntawm cov lej sib ntxiv hauv cov glomerulus. Kev kuaj pom ntawm lub raum kuaj xws li lub ntsej muag loj, lub siab ntawm cov kab mob uas tsis sib luag uas qhia tias hloov sclerotic. Cov chaw kho mob muaj xws li cov ntshav albumin tsis tu ncua, uas tsis txawv ib qho hauv FSHS thawj.

Kev tshuaj ntsuam genetic FSGS

Nws yuav siv ob daim ntawv. Qee tus neeg mob uas muaj qee yam caj ces yuav tsim muaj tus kabmob, thaum lwm tus neeg yuav tsis mob. Tus naj npawb ntawm cov noob cuam tshuam nrog FSHC yog qhov nce txhua txhua xyoo, feem ntau vim yog kis ntawm ib ntu ntawm tag nrho cov kab sab nraud. Txog rau hnub, tsawg kawg 38 tau pom tias yog.

Qee cov noob caj noob ces cuam tshuam nrog ib qho syndrome uas muaj cov tsos mob ntxiv. Qhov no yuav muab qhov kev tshawb fawb soj ntsuam uas tus neeg mob yuav muaj kev hloov hauv ib hom noob. Lwm tus muaj feem cuam tshuam nrog tus cwj pwm hloov pauv hauv morphology ntawm hauv qab daus daim nyias nyias lossis cov pwm ntawm mitochondria.

Yog tias tsev neeg tsis tau dhau los kuaj kev tshuaj ntsuam genetic, txoj hauv kev tau zoo tshaj plaws yog siv cov ntoo uas tsom rau FSGS thaum ntxov (menyuam mos thiab menyuam). Kev tshuaj ntsuam txog caj ces thoob ntiaj teb muaj nyob rau ntawm National Center rau Biotechnological Information thiab National Institutes of Health.

Kev txhais cov ntsiab lus

Tus kab mob ntshav qab zib glomerulosclerosis tseem hu ua tus mob ntshav qab zib nephropathy thiab Kimmelstil-Wilson syndrome - lub npe no tshwm sim vim yog ob tug kws tshawb fawb pom tias lub raum puas. Hauv cov neeg mob ntshav qab zib tom qab 20 xyoo, tus kab mob no tshwm sim hauv 20-60% ntawm tus neeg mob (hauv cov ntaub ntawv sib txawv cov ntaub ntawv muaj ntau yam sib txawv), thiab cov poj niam muaj kev ntxim rau nws ntau dua.

Feem ntau, mob ntshav qab zib glomerulosclerosis muaj kev tiv thaiv cov kab mob ntshav qab zib insulin, thiab cov neeg tsis muaj cov insulin feem cuam tshuam tsawg dua.

Lub raum yog npog nrog daim ntaub tshwj xeeb - fascia, uas ua haujlwm ua haujlwm tiv thaiv kev puas tsuaj rau kev kho tshuab. Hauv qab fascia, ob lub raum yog sawv cev los ntawm medulla thiab cortex. Cov chaw uas cov khoom sib txuas hauv hlwb cuam tshuam rau lub hlwb qauv hu ua cov hlaus rov qab. Lawv zoo sib xws rau lobules thiab suav nrog glomeruli hu ua glomeruli. Nws yog glomeruli uas tau muab lub npe rau tus kabmob.

Muaj ntau nuances thiab teeb meem nyob rau hauv pathogenesis ntawm ntshav qab zib glomerulosclerosis. Tsis muaj kev pom zoo ntawm lub hauv paus ntawm qhov teeb meem no. Muaj ntau lub theories ntawm kev nthuav dav ntawm tus kabmob, suav nrog:

caj ces
tshuaj tiv thaiv kab mob
hemodynamics
neuroendocrine kev xav
metabolic ua.

Lub caj ces txoj kev xav yog los ntawm kev muaj keeb ntawm kev muaj mob ntshav qab zib, uas yog, muaj tus kab mob no hauv cov neeg txheeb ze. Qhov kev tshawb xav no qhia tau hais tias vascular thiab metabolic ntshawv siab, nrog rau kev hloov pauv ntawm cov carbohydrate kam rau ua, tau txais los ntawm muaj.

Immunological theory kuj tseem cuam tshuam nrog cov caj ces. Cov kev sib raug zoo ntawm qhov mob hnyav thiab ntau zaus ntawm microangiopathy (qhov mob ntawm cov hlab ntsha me) thiab qhov mob ntawm cov ntshav hauv lub cev ua kom cov ntshav hauv cov ntshav tau lees paub.

Lub neuroendocrine kev xav yog qhia tias vascular cov teeb meem ntshav qab zib tshwm sim thaum hypothalamus, anterior pituitary caj pas, thiab glucocorticosteroids yog overestimated. Raws li qhov tshwm sim, capillary permeability nce ntxiv, thiab peptide lwg me me tau muab tso rau hauv lub ntsa ntsa.

Raws li cov kev xav hauv lub cev metabolic, thaum cov protein synthesis thiab cov txheej txheem metabolic ntawm glycoproteins raug cuam tshuam, paraproteins (immunoglobulins) tau tsim. Lub zog permeability ntawm qab daus daim nyias nyias ua rau tsub zuj zuj ntawm paraproteins nyob rau hauv lub raum glomeruli thiab kev hloov mus rau hauv cov tshuaj hyaline zoo li.

Daim ntawv ntawm mob ntshav qab zib glomerulosclerosis tuaj yeem yog:

Nodular zoo lawm meej rau cov ntshav qab zib. Nws yog nws leej twg tau piav qhia los ntawm Kimmelstil thiab Wilson, tom qab leej twg muaj tus mob tshwm sim. Nrog rau daim ntawv no ntawm tus kabmob, nodules tau tsim nyob rau hauv lub raum glomeruli - eosinophilic formations. Lawv tuaj yeem muaj lub voj voos lossis kheej kheej, nyob tag nrho cov glomerulus lossis tsuas yog ib feem ntawm nws. Nodules yog hu ua membrane-zoo li, vim lawv zoo ib yam li cov khoom ntawm lub pob zeb hauv qab daus.

Ntawm diffuse daim ntawv homogeneous diffuse expansion thiab compaction ntawm mesangium tshwm sim hauv tus kab mob, tab sis cov nodules raug tsis tsim, txawm hais tias hauv qab daus daim nyias nyias ntawm cov hlab ntsha muaj feem cuam tshuam nrog.

Ntawm exudative daim ntawv ntawm lub periphery ntawm cov glomerular lobes, cov kab sib thooj sib thooj li cov kaus mom tshwm. Kev tshawb fawb Immunohistochemical qhia tau hais tias cov qauv tsim no muaj ntau yam tshuaj tiv thaiv immunoglobulins, uas yog cov txheej txheem tiv thaiv kab mob hauv lub cev.

Daim ntawv sib xyaw cov kab mob txhais tau hais tias muaj cov lus nodules, thiab diffuse mesangium densification, thiab thooj rau hauv qab daus daim nyias nyias.

Txawm hais txog tus qauv ntawm tus kabmob, nws ua rau tus tuag ntawm glomeruli thiab kev txhim kho ntawm periglomerular fibrosis.

Cov tsos mob ntawm tus mob ntshav qab zib glomerulosclerosis

Tus kab mob muaj ob peb cov tsos mob, tab sis qhov tshwm sim ntawm lawv txhua tus tib lub sijhawm yog nyob ntawm yeem:

Arterial tawg. Nov yog qhov kev mob tseem ceeb tshaj plaws hauv Kimmelstil-Wilson syndrome. Kub siab nyob rau hauv ntshav qab zib txawv los ntawm nce siab nyob rau hauv atherosclerosis los yog kub siab nyob rau hauv hais tias nws yog nrog proteinuria thiab retinopathy.
O o. Yeej, lub ntsej muag, txhais taw thiab ceg tau cuam tshuam. Thaum sawv ntxov, o tuaj yeem tshwm sim nyob ib ncig ntawm lub qhov muag.
Kev Proteinuria Lo lus no hais txog qhov tshaj ntawm cov protein ib txwm muaj nyob hauv zis. Thaum xub thawj, cov kev cai yog me ntsis dhau - txog li 0.033 g / l, thiab tom qab ntawd cov proteinuria ua tas mus li, tsis hais nruab nrab lossis tseem ceeb - 1-30 g / l.Cov proteinuria tseem ceeb feem ntau yog cov yam ntxwv ntawm nodular daim ntawv ntawm tus kabmob.
Retinopathy Lo lus no txhais tau tias kev puas tsuaj rau lub retina ntawm cov pob muag. Cov tsos mob no nthuav qhia nws tus kheej hauv 80% ntawm cov neeg mob uas mob ntshav qab zib glomerulosclerosis. Hauv kev mob ntshav qab zib retinopathy, hloov pauv pathological tshwm sim hauv tus kab mob retina, tshwm sim los ntawm microaneurysms, exudates thiab hemorrhages.
Kev ntshaib plab metabolic. Nws tuaj yeem cuam tshuam lipids, protein, protein-polysaccharide ntau txoj.
Microangiopathy yog qhov txhab ntawm cov hlab ntsha me. Hauv cov mob ntshav qab zib glomerulosclerosis, qhov no yog yam ntxwv ntau ntawm qhov kawg thiab fundus.
Tsis hlauv. Hauv qhov xwm txheej no, cov zis tawm los tsawg dua, ua pa luv tshwm, tawv nqaij qhuav. Feem ntau muaj cov cim ntawm intoxication, raws plab pib.
Cov leeg mob ntsws. Tej zaum yuav tshwm sim thaum kawg ntawm kev mob ntshav qab zib glomerulosclerosis. Hauv qhov xwm txheej no, cov proteinuria ntau tshwm sim (ntau dua 50 g / l), cov kab mob ntshav siab, ntshav qis (ntshav tsis txaus ntawm cov ntshav), hypoalbuminemia (ntshav qab zib tsawg hauv cov ntshav).
Uremia. Cuam tshuam ob lub raum tsis tshem tawm qee cov tshuaj, yog li lub cev muaj tshuaj lom. Cov neeg mob uas mob ntshav qab zib glomerulosclerosis thaum me thiab nruab nrab hnub nyoog feem ntau yuav tuag vim yog mob uremia.
Cylindruria (kev tso zis tawm ntawm cov zis tuaj ntawm cov protein).
Cov piam thaj hauv cov ntshav thiab zis (cov glucosuria). Qhov tshwm sim no tau pom nrog kev nce qib glomerulosclerosis.
Nrog tus mob mob hnyav zuj zus - mob hnyav vascular txhab. Feem ntau qhov no ua rau mob polyneuritis.
Pyelonephritis nyob rau hauv daim ntawv mob lossis mob ntev. Nws feem ntau nws ua tiav nws tus kheej hauv theem lig ntawm tus kab mob.

Kev kuaj mob

Glomerulosclerosis raug kuaj raws li cov ntshav qab zib hauv ob peb txoj kev:

Kev soj ntsuam dav dav. Nws suav nrog kev tshuaj xyuas daim tawv nqaij, palpation hauv lub raum, kuaj ntshav siab.
Soj ntsuam kev kuaj ntshav. Qhov nce ntxiv ntawm cov qe ntshav dawb, txo qis ntawm cov lymphocytes thiab kev hloov pauv hauv lwm cov ntshav yuav qhia tias muaj mob hnyav.
Mob Lub Hlaus Kev tshawb nrhiav zoo ib yam tuaj yeem tshawb pom cov proteinuria thiab albuminuria (nce ntxiv hauv cov zis hauv cov zis). Tshaj dhau ntawm tus nqi ib txwm tau txiav txim siab los ntawm 30 mg / hnub. Qhov ntsuas qhov ntau ntawm 30-300 mg / hnub qhia microalbuminuria, thiab ntau dua 300 mg / hnub - txog macroalbuminuria. Kev faib tawm qeb KDIGO tam sim no muab cov lus no tso ua qauv ntawm A2 thiab A3.
Glomerular pom npaum li cas (txiav txim los ntawm Reberg-Tareev tawg thiab tus lej ntawm lwm qhov kev tshawb fawb). Qhov taw qhia qhov tau txiav txim siab nce los ntawm 130-140 ml / min. Yog lub raum khiav tsis zoo hloov zuj zus, ces qhov ntsuas no poob qis.
Cov txiaj ntsig ntawm kev kuaj mob ultrasound (nrog rau kev kuaj mob vascular).
Raum raum. Xws li txoj kev tshawb nrhiav muab cov kev tshwm sim hauv 80-90% ntawm cov neeg mob. Ib qho me me tuaj yeem kuaj pom cov kab mob ntshav qab zib microangiopathy.
Ophthalmoscopy rau kev tshawb pom ntawm retinopathy.
Aortography. Nws tso cai rau txhawm rau txhav lub lumen ntawm lub raum leeg.
Radionuclide txoj kev.

Kev kuaj mob ntawm tus mob ntshav qab zib glomerulosclerosis yog qhov nyuaj rau cov neeg laus, vim qee qhov tsos mob tshwm sim rau lwm yam kab mob.

Kev kho mob ntshav qab zib glomerulosclerosis

Tsis hais txog ntawm daim ntawv ntawm tus kabmob, kev kho mob ntawm tus kabmob yuav tsum pib nrog kev kho mob ntawm nws lub hauv paus, uas yog, mob ntshav qab zib mellitus.

Nyob rau theem pib ntawm tus kabmob, thaum lub raum muaj peev xwm ua haujlwm, lub hom phiaj tseem ceeb ntawm kev kho mob yog los them rau cov ntshav qab zib. Kev kho mob rau lwm theem ntawm glomerulosclerosis yog qhov tsim nyog rau kev ua kom tiav lossis txo tsawg kawg ntawm nws cov neeg mob (cov mob nephrotic syndrome, kub siab, thiab lwm yam).

Yog hais tias tus kab mob nrog nrog kev ua txhaum ntawm lipid metabolism, ces tus neeg mob xav tau tshuaj nrog lipolytic thiab hypocholesterolemic nyhuv. Cov no suav nrog Atromide, Cetamifen, Nigeskin.

Thaum muaj kev cuam tshuam nrog kev sib pauv, lwm yam kuj tseem xav tau:

cov vitamins (A, B, C, P),
anabolic steroids (Retabolil, Nerobol).

Hauv kev kho mob ntshav qab zib microangiopathy, cov tshuaj antispasmodic xws li Nigexin, Anginin lossis Complamine xav tau.

Hauv kev mob ntshav qab zib retinopathy, lawv siv rau laser coagulation, uas yog, kev ceev faj ntawm cov hlab ntsha retinal. Cov txheej txheem no tseem tso cai rau koj los tsim ib txoj kev ib ntus rau qhov ntws tawm ntawm cov dej hauv nruab nrog cev uas yog cov leeg.

Yog hais tias tus kab mob no nyuaj los ntawm kev kis tus kab mob ntawm lub tso zis, tom qab ntawd cov tshuaj tua kab mob nrog qhov kev pom ntau ntawm kev txiav txim tau raug kho. Ib qho ntxiv, cov tshuaj sulfonamides lossis nitrofuran koob tshuaj yuav xav tau.

Hauv kev kho mob ntshav qab zib txhaws ntshav qab zib, heparin yog siv. Feem ntau nws muab rau ib hlis intramuscularly lossis intravenously. Cov tshuaj muaj cov tshuaj tiv thaiv hypolipemic, anticoagulant, hypotensive thiab hypohistamine ntxim. Txij nkawm hlaus ntshav nce ntxiv, proteinuria txo qis, thiab capillary permeability normalizes.

Yog tias tus neeg mob lub rheological yam ntxwv ntawm cov ntshav tau ua txhaum, uas yog, hypercoagulation yog qhia thiab microthrombosis kev loj hlob, ces reocorrectors yog siv. Nws tuaj yeem yog Hemodez lossis Reopoliglyukin.

Thaum arterial hypertension yog nrog mob ntshav qab zib glomerulosclerosis, antihypertensive tshuaj siv. Ntau zaus lawv nyiam Reserpine, Klofelin lossis Dopegit.

Yog hais tias tus mob nephrotic qhia, tom qab ntawd lawv hloov mus rau qhov ntshav ntawm ntshav lossis nws cov protein - albumin.

Yog hais tias lub raum ua haujlwm tau tsis zoo thiab lub siab tsis ua haujlwm tau tsim, ces muaj kev ntsuas loj:

hemodialysis (kho vajtse ntshav ntxuav),
peritoneal lim ntshav tas mus li (cov tshuaj lim ntshav yog siv ntau zaus hauv ib hnub)
hloov raum (qee lub sij hawm ib txhij nrog tus txiav).

Kev kho noj haus

Hauv ntshav qab zib glomerulosclerosis, qee cov ntsiab cai ntawm kev noj zaub mov noj yuav tsum tau ua raws:

Khoom noj khoom haus yuav tsum yog hypocaloric. Qhov no txhais tau tias yog qhov tseem ceeb txo qis hauv kev faib ua feem ntawm cov rog thiab carbohydrates. Raws li, koj yuav tsum tau txwv kom tsis txhob muaj cov rog - txog 30-50 grams tauj ib hnub. Nyeem ntxiv txog kev noj haus cov zaub mov carb qis ntawm no.
Xyuas kom tseeb tias muaj protein ntau kom tsawg. Qhov ntau yog suav raws li tus neeg mob lub cev qhov hnyav. Qhov nruab nrab, 1 gram ntawm lub cev qhov hnyav hauv ib hnub yuav tsum suav rau 0.8 grams ntawm cov protein.
Yog hais tias tus glomerular pom npaum li cas txo, ces kev noj zaub mov muaj protein tsawg yuav xav tau. Hauv qhov no, tus neeg mob yuav tsum muaj tsawg kawg 30-40 grams ntawm cov protein ib hnub. Nws yog ib qho tseem ceeb uas hauv qhov no muaj cov ntsiab lus tsis muaj calorie ntawm cov khoom, txwv tsis pub tus neeg mob tuaj yeem tsim cov protein-lub zog tsis txaus. Cov txheej txheem yuav tsum tau saib xyuas los ntawm kws kho mob.
Txwv koj kev noj cov zaub mov muaj roj cholesterol. Nws yuav tsum tau hloov nrog roj zaub.
Cov zaub mov yuav tsum tau faib tsawg - 5-6 zaub mov tauj ib hnub xav tau. Qhov no tso cai rau koj kom ntseeg tau tias cov ntshav qab zib nyob thoob plaws ib hnub, raws li cov kev hloov pauv hauv qhov ntsuas no cuam tshuam rau cov hlab ntsha.
Yog hais tias arterial hypertension cuam tshuam nrog kev mob ntshav qab zib glomerulosclerosis, tus neeg mob xav tau zaub mov noj ntsev tsawg. Ib hnub, nws yuav tsum haus tsis pub ntau tshaj li 4-5 grams ntawm lub rooj ntsev.
Kev ua kua dej sab nraud. Nrog ntshav qab zib, nws tuaj yeem ua tau qaug cawv yam tsis muaj kev txwv, tab sis cov teeb meem lub raum ua tsis tau kev tso cai no. Cawv thiab haus cawv yuav tsum muab pov tseg tag nrho.
Kev cais tawm ntawm cov khoom uas muaj cov nyhuv diuretic. Txoj cai no yuav tsum nco ntsoov thaum noj cov tshuaj kho, uas mob ntshav qab zib tau tso cai thiab pom zoo.

Chav kawm ntawm mob ntshav qab zib glomerulosclerosis nyob ntawm ntau yam:

tus neeg mob hnub nyoog
qhov mob hnyav heev ntawm tus kab mob
kho ntshav qab zib kom kho
cov kab mob sib xyaw
soj ntsuam daim duab.

Hauv cov kab mob ntshav qab zib glomerulosclerosis, lub neej nyob nruab nrab yog 5-8 xyoo txij li hnub pib ntawm thawj cov tsos mob tshwm sim.

Nrog rau ib tus kab mob nyob rau theem ntawm proteinuria, nws qhov muaj peev xwm tuaj yeem tiv thaiv. Yog tias muaj ntshav qab zib nephropathy ntawm lub davhlau ya nyob twg theem, ces tus mob no tsis sib haum nrog lub neej.

Yog tias mob ntshav qab zib nephropathy nrog glomerulosclerosis thiab hom ntshav qab zib hom ntshav qab zib ua rau lub raum tsis ua haujlwm ntev, tom qab ntawd 15% ntawm cov xwm txheej yuav ua rau pom kev tuag.

Ib qho kev tuag tshwm sim txog li 50 xyoo yog feem ntau txuam nrog uremia. Tom qab 50 xyoo, kev tuag feem ntau tshwm sim tawm tsam keeb kwm ntawm kev puas tsuaj rau cov hlab plawv cov ntshav. Rau tag nrho cov hnub nyoog, qhov ua rau muaj kev tuag ntau zaus yog txoj kev mob ib ce mus ib ntus.

Kev tiv thaiv ntawm tus mob ntshav qab zib glomerulosclerosis

Cov txheej txheem tiv thaiv: pom ntxov, kho thiab them rau ntshav qab zib. Nws yog ib qho tsim nyog yuav tsum ua tib zoo tswj hwm cov qib ntawm cov piam thaj hauv cov ntshav thiab tiv thaiv kev hloov pauv hauv glycemia. Rau cov laj thawj no, nws yog qhov yuav tsum tau xaiv qhov kev xaiv qhov ntau npaum ntawm cov kua dej los yog lwm tus neeg sawv cev ntawm cov piam thaj thiab ua ke ua kev ntsuas no nrog cov khoom noj muaj feem.

Tus neeg mob yuav tsum ua raws li kev noj haus - qhov no yog qhov yuav tsum tau ua ntawm kev kho mob dav dav.

Hauv cov mob ntshav qab zib glomerulosclerosis, kev tshuaj xyuas yog tsim nyog. Cov chav kawm ntawm tus kab mob yog saib xyuas los ntawm kws kho mob, endocrinologist, urologist thiab nephrologist. Tus neeg mob yuav tsum tau hla qee qhov kev tshawb fawb tsawg kawg ib zaug txhua rau lub hlis.

Ntshav qab zib glomerulosclerosis yog ib hom mob hnyav heev. Nws yog ib qho tseem ceeb rau kev kuaj mob nws kom raws sijhawm thiab taug kev mus rau txoj kev kho kom zoo. Nrog rau kev kuaj pom tus kab mob ntawm cov theem thaum ntxov, kev kho kom zoo thiab kev kho zaub mov noj, kev soj ntsuam tau muaj txiaj ntsig heev. Nws yog ib qho tseem ceeb rau cov neeg mob ntshav qab zib kom yauv tau txais kev kuaj mob los txheeb xyuas cov tsos mob ntawm tus mob thaum tseem ntxov.

Mob ntshav qab zib ntau npaum li cas Glomerulosclerosis -

Ntshav qab zib Glomerulosclerosis - Ib hom mob uas nquag thiab ua ntau tshaj plaws ntawm cov ntshav qab zib mob microangiopathy. Nws hu ua Kimmelstil-Wilson syndrome, tom qab cov kws sau txog nws thawj zaug xyoo 1936. Muaj ntau lub npe ntawm tus kabmob no - lub raum mob ntshav qab zib, mob ntshav qab zib nephropathy.

A. S. Efimov (1989) txiav txim siab los ntawm lo lus "mob ntshav qab zib nephropathy" ntau dua, vim tias tsis muaj qhov ncauj tawm ntawm lub ntsej muag txhaws txhaws tsis muaj kev koom tes nrog lwm lub nkoj thiab tubules, thiab nws nyuaj rau kev txiav txim siab nrog kev pab cuam ntawm kev soj ntsuam niaj hnub uas mob thiab qhov twg ntawm ob lub raum ua ntej. Txawm li cas los xij, lo lus "diabetic glomerulosclerosis" kuj tseem siv tau.

Qhov ntau zaus ntawm kev kho mob tshwm sim ntawm cov ntshav qab zib glomerulosclerosis, raws li ntau tus kws sau ntawv, thaj tsam li ntawm 6 txog 64% (Burger, 1970, A.S. Efimov, 1973, A. Astrug, 1976, thiab lwm yam). Mob ntshav qab zib glomerulosclerosis muaj ntau rau cov poj niam ntau dua li cov txiv neej - 30% thiab 19.5%, feem (A. S. Efimov, 1973, A. Astrug, 1976).

Cov kws tshawb nrhiav niaj hnub no nco txog kev sib raug zoo ntawm cov tsos mob ntawm glomerulosclerosis thiab lub sijhawm mob ntshav qab zib. Feem ntau nws tsis cais, tab sis ua ke nrog microangiopathies ntawm lwm qhov chaw, piv txwv li, nrog kev kho mob hlwb, sau npe hauv 70-90% ntawm cov neeg mob.

Pathogenesis (muaj dab tsi tshwm sim?) Thaum uas mob ntshav qab zib glomerulosclerosis:

Lub hauv paus chiv keeb ntawm tus mob ntshav qab zib glomerulosclerosis tsis to taub tag nrho. Muaj ntau cov kev xav, cov kws sau ntawv uas nrhiav los piav qhia cov txheej txheem nyuaj ua rau muaj kev txhim kho ntawm tus kabmob no. Yog li, txoj kev xav ntawm thawj cov khoom siv hauv lub cev qhia txog kev puas tsuaj rau cov hlab ntsha hauv ntshav qab zib los ntawm kev mob ntshav hauv cov ntshav siab ntawm ntau cov khoom ntawm cov protein tsis txaus, lipid thiab carbohydrate metabolism nrog kev puas tsuaj rau hauv qab daus ntawm cov hlab ntsha, tshwj xeeb, raum glomeruli. V. Serov, 1962, V.V. Serov li al., 1981). Piv txwv, tsis muaj protein synthesis thiab glycoprotein metabolism ua rau kev tsim cov paraproteins, uas, vim qhov nce permeability ntawm lub qab daus puas, nthuav tawm hauv lub raum glomeruli, qhov uas lawv tig mus rau hauv cov tshuaj zoo li hyaline. Txawm li cas los xij, cov kev xav hauv lub cev ntawm cov ntshav qab zib mob microangiopathies tsis muab cov lus piav qhia kev ntseeg tau rau lawv txoj kev txhim kho hauv cov theem ntshav qab zib, thaum cov teeb meem metabolic tsis tau pom.

Cov tshuaj tiv thaiv kab mob ntawm microangiopathies thiab ntshav qab zib glomerulosclerosis yog sib tham, raws li lub tswv yim uas twb muaj lawm ntawm kev tshuaj ntsuam genetic predisposition rau ntshav qab zib. Muaj cov pov thawj ntawm ib qho kev sib txuam ntawm kev ua kom pom tseeb ntawm cov roj ntsha ua kom tsis muaj zog nrog cov zaus thiab qhov mob ntawm microangiopathy.

Lub neuroendocrine hypothesis txuas rau vascular cov teeb meem ntshav qab zib nrog cov kev ua si ntawm glucocorticoids, adenohypophysis thiab hypothalamus, uas ua rau muaj kev nce siab ntxiv ntawm cov hlab ntsha capillary permeability thiab cov deposition ntawm peptide lwg me me rau hauv cov leeg ntshav.

Lub tswv yim caj ces yog ua raws li tsev neeg muaj teeb meem rau cov ntshav qab zib, pom hauv cov txheeb ze ntawm cov neeg mob ntshav qab zib. Cov neeg txhawb nqa ntawm lub zeem muag no lees txoj kev muaj peev xwm kis kab mob vascular thiab metabolic ntshawv siab hauv ntshav qab zib, hloov pauv hauv kev ua pa tsis haum.

Yog li, tsis muaj ib qho kev xav ntawm lub pathogenesis ntawm ntshav qab zib glomerulosclerosis. Thaj, lub ntsiab pathogenetic mechanisms yog txuam nrog tus mob polymetabolic nws tus kheej - mob ntshav qab zib mellitus. Cov khoom lag luam ntawm kev cuam tshuam cov metabolism hauv cov protein, glycoproteins, lipids nkag mus rau lub raum los ntawm cov kab mob hematogenous thiab tau muab tso rau hauv nws cov ntaub so ntswg.

Lub pathological anatomy ntawm ntshav qab zib glomerulosclerosis yog polymorphic. Qhia qhov txawv ntawm nodular, diffuse thiab exudative morphological cov ntawv. Qee tus kws sau ntawv tseem cais cov ntawv sib xyaw (A.M. Wichert, 1972). Daim ntawv nodular piav qhia los ntawm Kimmelstil thiab Wilson thiab txiav txim siab tshwj xeeb rau ntshav qab zib. Nws yog tus cwj pwm los ntawm qhov pom nyob hauv lub raum glomeruli ntawm eosinophilic formations (nodules) ntawm ib puag ncig lossis kheej kheej cov duab, tuav ib feem lossis tag nrho cov glomerulus. Nodules yog kev tsub zuj zuj nyob hauv mesangy ntawm clumps thiab trabeculae ntawm ntau qhov ntau thiab tsawg, zoo ib yam li cov khoom ntawm glomerular qab daus daim nyias nyias thiab vim li ntawd hu ua membranous. Nyob rau tib lub sijhawm, nthuav dav thiab pob qij taws ntawm glomerular capillaries, lub thickening ntawm lawv hauv qab daus daim nyias nyias yog cai. Nrog rau daim ntawv sib txawv ntawm cov ntshav qab zib glomerulosclerosis, kev hloov morphological ntawm cov glomerulus yog qhia nyob rau hauv qhov kev sib txawv ntawm qhov sib txawv thiab densification ntawm cov mesangium yam tsis muaj kev tsim ntawm cov hnoos qeev, tab sis nrog kev koom tes ntawm capillary hauv qab daus daim nyias nyias uas ua kom tuab. Cov kev hloov pauv txawv txav yog tsim los ntawm cov tsos ntawm lub periphery ntawm lobules ntawm glomerulus ntawm cov kab sib npaug hauv daim ntawv ntawm lub kaus mom ntawm capillary loops. Kev tshawb nrhiav tshuaj immunohistochemical hauv cov qauv no tau sau tseg ntau ntawm cov tshuaj tiv thaiv kab mob immunoglobulins, uas tau muab lub laj thawj los txiav txim rau lawv cov tshuaj tiv thaiv kab mob hauv lub cev. Lub xub ntiag ntawm cov hnoos qeev feem ntau ua ke nrog diffuse mesangium densification thiab ua rau tuab ntawm glomerular capillary hauv qab daus daim nyias nyias yog cov yam ntxwv ntawm cov ntawv sib xyaw.

Kev hloov pauv thib ob hauv cov ntshav qab zib glomerulosclerosis suav nrog kev puas tsuaj rau lub raum hlab ntsha nrog kev hloov pauv hauv epithelium, hyalinization ntawm hauv qab daus daim nyias nyias thiab roj tsis zoo. Nrog rau kev yeej ntawm glomerular capillaries, uas yog lub ntsiab lus ntawm ntshav qab zib glomerulosclerosis, cov tsos mob ntawm arteriosclerosis thiab atherosclerosis ntawm cov hlab ntsha ntawm lub raum tau kuaj pom. Qhov tshwm sim ntawm txhua hom mob ntshav qab zib glomerulosclerosis yog kev ua tiav (kev tuag) ntawm glomeruli thiab kev txhim kho ntawm periglomerular fibrosis.

Cov tsos mob ntawm tus mob ntshav qab zib Glomerulosclerosis:

Tsis muaj ib qho lees paub feem ntau lees paub ntawm kev mob ntshav qab zib angiopathies. Lawv tsim tsa ntau rau hauv tus account cov tib neeg cov kev mob tshwm sim ntawm vascular txhab (mob ntshav qab zib retinopathy, nephropathy) los yog raws cov kev hloov morphological hauv cov plab hnyuv siab raum.

Raws li kev faib tawm ntawm N. F.Skopichenko (1973), sib txawv ntawm thawj zaug (cov tsos mob qis), kev hloov pauv (thaj chaw kho mob txawv) thiab zaum kawg (nephrotic-azotemic) theem ntawm ntshav qab zib glomerulosclerosis. Los ntawm cov xwm txheej hauv chav kawm - cov ntaub ntawv qeeb thiab nrawm (xaiv). Cov pawg lus txuas ntxiv ntawm kev faib tawm no tau sau tseg qhov tseem muaj los ua ke ntawm cov ntshav qab zib glomerulosclerosis nrog microangiopathies ntawm ntau qhov chaw thiab cov stratification ntawm lwm cov kab mob hauv lub raum (pyelonephritis, amyloidosis).

Cov tsos mob tseem ceeb ntawm tus kab mob yog proteinuria, retinopathy thiab kub siab. Proteinuria yog pib me me thiab tsis khov (los ntawm kab rau 0.033 g / l), tom qab ntawd ua tas mus li, tsis hais nruab nrab lossis tseem ceeb (ntawm 1.0-2.0 txog 30 g / l). Cov proteinuria nrov tshaj plaws yog pom nrog hom nodular ntawm glomerular capillary lesions. Txawm li cas los xij, hauv qee cov neeg mob uas mob ntshav qab zib ntev, proteinuria tuaj yeem tsis tuaj (N.F. Skopichenko, 1972). Ib qho ntawm cov kev ntsuas rau qhov txawv txav ntawm proteinuria ntawm cov ntshav qab zib keeb kwm thiab proteinuria hauv pyelonephritis, mob txhaws lub raum thiab mob ntshav siab tuaj yeem yog qhov ntau ntawm nws qhov mob hnyav (nrog rau cov ntshav qab zib glomerulosclerosis nws muaj ntau dua li ntawm pyelonephritis thiab kub siab) thiab, qhov tseem ceeb tshaj plaws, kev sib xyaw ntawm kev kub siab nrog retinopathy.

Hloov pauv ntawm cov zis tso zis (hematuria, cylindruria), tshwj xeeb tshaj yog muaj tus kab mob lub sijhawm tsawg dua 10 xyoo, nws tsis tseem ceeb. Tsuas yog nyob rau hauv theem cim ntawm tus kab mob, tshwj xeeb tshaj yog nrog nephrotic syndrome, yog tus coj sib piv cylindruria pom, thaum hematuria yog negligible. Waxy thooj voos kheej kheej yog pom tsuas yog theem ntawm lub raum tsis ua haujlwm.

Tus mob retinopathy mob ntshav qab zib tshwm sim hauv 80% ntawm tus neeg mob thiab tus cwj pwm hloov pauv hauv kab mob retina: microaneurysms, hemorrhages, exudates tshwm. Microaneurysms ntawm cov hlab qhov muag yog tshwj xeeb tshwj xeeb ntawd txawm hais tias txawm tias lawv tshawb nrhiav los ntawm kev ua yuam kev, yuav tsum tau tshem tawm cov mob ntshav qab zib latent yuav tsum raug tshem tawm. Tomqab qhov kev ua rau poob rov qab tuaj yeem ua rau nws qhov kev cuam tshuam. Tag nrho cov no ua rau muaj qhov ua rau pom kev tsis txaus ntseeg thiab tsis pom kev zoo. Nws ntseeg tau hais tias kev hloov pauv ntawm cov hlab ntsha ntawm qhov retina muaj qhov muaj keeb ntawm kev puas tsuaj nrog kev puas tsuaj rau glomerular capillaries, i.e., yog tshwm sim los ntawm kev puas tsuaj rau hauv qab daus. Qee zaum retinopathy ua ntej ntawm nephropathy.

Nrog rau kev txhim kho cov ntshav qab zib glomerulosclerosis, lub cim tseem ceeb hauv tsev kho mob yog txoj kev mob ntshav siab. Hauv kev cuam tshuam nrog kev mob ntshav siab vim tias kev mob ntshav siab thiab mob atherosclerosis, nws yog tus cwj pwm los ntawm kev sib txuas nrog cov tshuaj proteinuria thiab ntshav qab zib ua kom rov qab zoo dua. Yog tias kev nce ntxiv hauv cov ntshav siab ua ntej cov ntshav qab zib lossis tshwm sim ib txhij nrog nws, ces qhov no qhia tau tias kub siab.

Lub pathogenesis ntawm kev mob ntshav hauv cov ntshav qab zib glomerulosclerosis yog qhov nyuaj thiab cuam tshuam, tshwj xeeb, nrog kev nce siab ntawm cov kev ua haujlwm ntawm renin-angiotensin-aldosterone system, uas yog los ntawm kev puas tsuaj rau cov hlab ntsha me ntawm lub raum - nqa cov hlab ntsha hyalinosis, desolation ntawm feem ntau glomeruli thiab ib qho kev txo qis ntawm cov ntshav lub raum (V.). , A. Ts. Anasashvili, 1983).

Hauv cov theem lig, tus mob ntshav qab zib feem ntau muaj feem cuam tshuam nrog nephrotic syndrome, lub tsev kho mob uas yuav luag tsis txawv ntawm qhov ntawd nyob rau hauv lub raum puas tsuaj ntawm qhov sib txawv etiology.

Mob siab rau cov ntshav qab zib mob ntshav qab zib feem ntau tshwm sim vim yog lub raum tsis ua haujlwm tag thiab mob tau tshwm sim los ntawm txhua qhov tsos mob tshwm sim hauv lub davhlau ya nyob twg ntawm kev mob raum tsis zoo. Uremia suav tias yog qhov tseem ceeb ua rau muaj kev tuag rau cov neeg mob ntshav qab zib glomerulosclerosis, feem ntau yog thaum tseem hluas thiab nruab nrab hnub nyoog. Cov neeg mob laus tuag los ntawm ntau yam kev mob tshwm sim ntawm atherosclerosis, tsis muaj txoj sia nyob rau lub davhlau ya nyob twg ntawm lub raum tsis ua haujlwm.

Tus kab mob ntshav qab zib yog ua nrog rau kev puas tsuaj rau cov hlab ntshav ntawm lub plawv, lub hlwb, qis qis dua, nce mus rau kev txhim kho ntawm myocardial infarction, mob hlab ntsha thiab mob ntsws, thiab mob ntshav qab zib txhav. Feem ntau muaj mob polyneuritis. Hauv cov theem thaum ntxov ntawm tus kab mob, mob raum lossis mob ntev pyelonephritis tuaj yeem koom nrog nws.

Ib qho ntawm cov tsos mob ntawm tus mob ntshav qab zib yog mob siab, vim tias tus kab mob mus zuj zus, kom cov ntshav qabzib tsawg zuj zus thiab txo qis, nce mus txog thaum ua tiav, ntawm glucosuria. Xws li kev kho "kev kho mob ntshav qab zib" tau pom tsuas yog qee tus neeg mob thiab tsis suav tias yog tus tsos mob tshwm sim ntawm tus kab mob. Cov laj thawj rau ploj ntawm hyperglycemia tsis tau paub meej kiag li. Nws ntseeg tau hais tias qhov kev txo qis hauv glycemia tuaj yeem piav qhia los ntawm kev txo qis ntawm kev ua haujlwm ntawm lub raum insulinase, qhov kev txo qis ntawm cov kev ua haujlwm ntawm cov protein-khi insulin thiab tsim cov tshuaj tiv thaiv insulin, qhov ua rau cov ntshav hypoglycemic ntawm cov khoom noj khoom haus metabolism metabolism, glucocorticoid tsis txaus vim yog atrophy ntawm adrenal cortical bundle (E. M. Tareev, 1972, R. Klyachko, 1974).

Ntawm cov mob ntshav qab zib glomerulosclerosis, kuj tseem muaj kev ua txhaum ntawm cov metabolism ntawm cov protein, lipids, protein-polysaccharide ntau txoj. Thaum tus kab mob loj zuj zus, hypoalbuminemia, hypergammaglobulinemia nce, tag nrho cov protein ntau hauv cov ntshav txo qis, feem ntau nrog kev loj hlob ntawm lub raum tsis ua haujlwm. Lub pathogenesis ntawm dysproteinemia nyob rau hauv ntshav qab zib glomerulosclerosis tsis meej txaus, tab sis yog tej zaum cuam tshuam nrog insulin tsis txaus tsim nyog los tswj kev ua kom muaj protein tsawg, protein tsis txaus nyob rau hauv cov zis thiab tsis hnov lus zoo vim nquag daim siab puas hauv ntshav qab zib (P. N. Bodnar, 1974, B. S Jonushas, N.A. Mkrtumova, 1976). Kuj tseem muaj qhov nce ntawm cov poov tshuaj hauv cov ntshav, kev nce siab hauv cov roj cholesterol thiab kev ua txhaum ntawm cov roj ntsha electrolyte nrog kev muaj peev xwm tsim cov hyperkalemia.

Cov yam ntxwv ntawm chav kawm rau tus kab mob ntshav qab zib muaj ntshav qab zib muaj xws li cov cim qhia txog kev loj hlob ntawm tus kab mob, yog li nws pib tshwm sim feem ntau tsis nco qab, muaj qhov tsis txaus ntawm tso zis, txo qis rau mob ntshav qab zib hauv qee cov neeg mob, thiab kev sib xyaw ntawm ntshav qab zib nrog lwm yam microangiopathies (tshwj xeeb tshaj yog nrog retinopathy thiab microangiopathies ntawm qhov kawg).

Hauv kev mob ntshav qab zib glomerulosclerosis, kev pom, txawm hais tias muaj kev kho kom nquag, feem ntau tseem tsis tau txais txiaj ntsig.

Kev Kho Mob Ntshav Qab Zib Glomerulosclerosis:

Hauv cov neeg mob uas mob ntshav qab zib glomerulosclerosis, kev kho mob yog nyob ntawm lub xeev kev ua haujlwm ntawm lub raum, qhov mob hnyav, thiab muaj cov teeb meem tshwm sim. Hauv cov theem thaum ntxov, nrog rau kev khaws cia muaj peev xwm ua haujlwm ntawm lub raum, kev kho mob yog ua raws li kev ntsuas tsom rau kev them nqi ntawm kev mob ntshav qab zib mellitus. Yav tom ntej, kev kho mob txhawm rau tshem tawm lossis txo cov neeg mob cov leeg ua haujlwm - hypertensive, nephrotic, azotemic, anemia, thiab lwm yam (V. G. Baranov, N. F. Skopichenko, 1973). Nws tseem yog qhov yuav tsum tau xav txog qhov muaj peev xwm ntawm stratification ntawm lub raum thiab mob txeeb zig hauv kab mob ntshav qab zib glomerulosclerosis.

Kev noj zaub mov noj hauv kev kho mob ntshav qab zib glomerulosclerosis yuav tsum yog hypocaloric, muaj nplua nuj nyob hauv cov carbohydrates thiab cov zaub mov tsis zoo (30-50 g ib hnub) nrog rau kev txwv cov roj uas muaj cov roj thiab hloov pauv cov roj zaub. Kev noj haus zoo sib xws yog tau txiav txim siab tias qhov tshaj ntawm cov tsiaj rog hauv kev noj zaub mov ntawm cov neeg mob ntshav qab zib ua rau muaj kev cuam tshuam ntawm vascular cov nyom. Nws yog ib qho tsim nyog kom siv zog ua kom lub cev qhov hnyav ntawm cov neeg mob ntshav qab zib mellitus, muab hais tias kev rog rog yog ib qho tseem ceeb tshaj plaws rau cov mob ntshav qab zib microangiopathies. Vim yog cov txiaj ntsig pathological rau cov hlab ntsha, nws tsis yog li hyperglycemia raws li qhov hloov pauv hauv cov ntshav qab zib cov ntshav uas feem ntau, tsib-, 6-ntu khoom noj ntawm cov neeg mob tau muaj, uas muab cov ntshav qab zib ntau dua nyob hauv qib thaum nruab hnub. Vim tias kev cuam tshuam ntawm cov neeg mob tsis txaus siab rau cov tshuaj insulin, kev tswj fwm ntawm nws thiab ob pluas noj tom qab txhaj tshuaj tas (tom qab 15-20 feeb thiab 1.5-2 teev). Ib qho kev cog lus yog kev coj ua ntawm kev siv tshuaj insulin, uas yog qhov ze tshaj plaws ntawm lub cev kev sib tw ntawm insulin secretion, siv cov khoom siv txhaj tshuaj ntawm Novo Reu hom, biostator apparatus (A. S. Efimov, 1989).

Kev noj zaub mov noj hauv kev txhim kho kev mob raum ua kom tsis muaj qhov txawv tsis txawv hauv kev kho mob ntawm cov neeg mob uas mob raum tsis ua haujlwm uas tsis muaj ntshav qab zib glomerulosclerosis.

Siv dav txhais tau tias kho hom ntxhov siab ntawm cov metabolism. Cov no suav nrog cov vitamins ntawm pawg C, A, B, rutin rau 10-20 hnub txhua lub hlis (V. R. Klyachko, 1974), anabolic steroids - nerobol, retabolil, silabolin, kev kho mob mus txog 1-3 lub hlis, tom qab ntawd so 2 lub hlis hauv 1-2 xyoos (A.F. Malenchenko, 1965, A.S. Efimov, 1973).

Muab qhov kev ua txhaum ntawm lipid metabolism, cov tshuaj nrog lipolytic thiab hypocholesterolemic nyhuv tau sau tseg: atromide, miscleron, cetamiphene, qhuas, nigexin, muaj txiaj ntsig zoo ntawm miskleron ntawm glomerular pom yog sau tseg (V. G. Spesivtsev li al., 1974). Qee tus kws sau ntawv (P. N. Bodnar et al., 1973, A. S. Efimov li al., 1974) nco txog cov txiaj ntsig zoo ntawm heparin, uas muaj anticoagulant, hypotensive, hypolipemic, thiab hypohistamine yam ntxwv zoo. Tsis tas li, heparin muaj cov txiaj ntsig zoo rau capillary permeability), ua kom cov ntshav khiav ua haujlwm zoo, thiab txo qis proteinuria. Heparin raug tswj hwm nyob rau hauv ib koob tshuaj txhua hnub ntawm 10-20 txhiab units ua haujlwm intramuscularly lossis leeg ntshav rau 3-4 lub limtiam.

Cov tshuaj antispasmodic yog siv los kho cov kab mob ntshav qab zib microangiopathy: anginin (prodectin), kev ua raws, nigexin, thiab lwm yam Anginin txo qis kev cuam tshuam ntawm cov vascular phab ntsa nrog J3-lipoproteins, txo qis vascular permeability, thiab muaj feem cuam tshuam rau chav kawm ntawm cov ntshav qab zib ua haujlwm thiab kev mob hlwb (V.R. Klyachko, 1972 T.N. Tirkina li al., 1974). Laser coagulation thiab hemocarbperfusion ua tau zoo. Cov tom kawg sawv cev rau cov kev taw qhia tshiab hauv kev kho mob ntshav qab zib retinopathy (L. A. Katznelson et al., 1991). Dicinon txo vascular permeability, txhawb kev kho dua tshiab ntawm cov ntshav, nce kev pom tseeb (V.R. Klyachko li al., 1972).

Hauv kev sib txuas nrog kev ua txhaum cai tseem ceeb ntawm rheological yam ntxwv ntawm cov ntshav hauv cov neeg mob ntshav qab zib mellitus, mob ntshav qab zib ntau ntxiv thiab kev txhim kho microthrombosis, reocorrectors - hemodesis, reopoliglyukin hauv kev sib xyaw nrog cov tshuaj uas txhim kho cov ntaub so ntswg oxygenation (solcoseryl), thiab tseem yuav txo qis kev muaj peev xwm ntawm cov ntshav ntshav (trental, chimes, tau siv dav). )

Kuj tseem muaj txiaj ntsig yog angioprotectors - Doxium, Prodectin, Qhov tseem ceeb, suav txog qhov kev ua txhaum ntawm lipid peroxidation hauv cov neeg mob ntshav qab zib, cog lus rau tshuaj antioxidants yog vitamin B, 30% daws (8 mg / kg ntawm tus neeg mob lub cev qhov hnyav rau 14 hnub).

Nws siv nyob rau hauv thaum ntxov ntawm tubuloglomerular mob tuaj yeem ua lub cev tiv thaiv kab mob ntawm nephroangiopathy (3. S. Mehdiyeva, 1989).

Lub hauv paus tseem ceeb cov tshuaj tshiab hauv kev kho mob vascular txhab nyob rau hauv cov ntshav qab zib yog isodibut - ib qho inhibitor ntawm aldoreductase enzyme lub luag haujlwm rau kev hloov pauv ntawm cov ntshav qabzib rau sorbitol yog tshuaj hauv cov ntsiav tshuaj ntawm 0.5 g 3-4 zaug hauv ib hnub rau 2 txog 6 lub lis piam (I. M. Kakhnovsky , T.V. Koroleva, 1990). Cov tshuaj tau tsim los ntawm Kiev Kev Tshawb Fawb Lub Tsev ntawm Endocrinology thiab Chemistry ntawm Hormones. Ntawm cov hau kev ntawm kev tsis siv tshuaj kho mob, hyperbaric oxygenation zoo, uas txhim kho lub xeev kev ua haujlwm ntawm lub raum (T. A. Malkova, 1990).

Nrog rau kev mob ntshav tawm hauv cov ntshav, cov tshuaj tiv thaiv kabmob ntshav yog siv (dopegitis, hemiton, clonidine, reserpine, thiab lwm yam). Yuav kom tawm tsam edema, tshuaj tua kab mob tau pom zoo ua ke nrog aldosterone antagonists (aldactone, veroshpiron). Thaum noj cov tshuaj thiazide, yuav tsum ceev faj, vim tias siv sijhawm ntev ua rau lawv muaj mob ntshav qab zib vim tias muaj ntshav txuam nrog cov ntshav dej. Ntawm diuretics, qhov xav tau yuav tsum tau muab rau anthranilic acid npaj (furosemide, lasix). Hauv cov mob nephrotic mob heev, ntshav lossis ntshav hloov ntshav qhia tau.

Txo cov kua qaub thaum lub sijhawm kev noj qab haus huv lub cev tsis ua haujlwm, alkaline dej ntxhia, kua txiv, kua txiv plab, tso dej tawm ntawm 5% sodium bicarbonate tov, hemodesis yog siv. Nrog rau kev txhim kho ntawm CPI, kev noj haus tsis raug cai thiab mob caj dab, txhais tau tias cov neeg mob hloov mus rau hemodialysis. Hauv kev mob ntshav qab zib glomerulosclerosis nyuaj los ntawm kev mob txeeb zig, cov tshuaj tua kab mob loj yuav tsum tau kho, yog tias tsim nyog sib xyaw nrog sulfonamides, nitrofuran series tshuaj.

Kev Tiv Thaiv Kab Mob Ntshav Qab Zib Glomerulosclerosis:

Nws yog nqa los ntawm kev paub ntxov thiab kev kho mob ntshav qab zib mellitus, ua tib zoo saib xyuas cov ntshav qab zib thiab tshem tawm cov kev hloov pauv hauv glycemia, uas tau ua tiav los ntawm ntau cov zaub mov nrog xaiv cov tshuaj kom txaus los ntawm cov tshuaj insulin lossis lwm yam tshuaj muaj suab thaj. Cov neeg mob xav tau kev kho noj haus kom zoo, ua haujlwm tau zoo. Tseem ceeb rau kev tiv thaiv kab mob hauv lub plab.

Soj ntsuam kev soj ntsuam ntawm cov neeg mob ntshav qab zib glomerulosclerosis yog nqa los ntawm tus kws tshaj lij hauv zos hauv kev koom tes nrog tus kws kho mob endocrinologist. Kev tshawb fawb zoo tib yam yog pom zoo ib yam li ua thooj plawv ntev li ntawm glomerulonephritis - ib zaug txhua 3-6 hlis. Kev saib xyuas tshwj xeeb yuav tsum tau them nyiaj rau saib xyuas ntshav siab, qab zib hauv zis thiab ntshav.

Cov kws kho mob twg yuav tsum tau sab laj yog tias koj muaj ntshav qab zib glomerulosclerosis:

Ib yam dab tsi yog thab koj? Koj puas xav paub cov ncauj lus kom ntxaws txog ntshav qab zib glomerulosclerosis, nws qhov ua rau, cov tsos mob, txoj kev kho mob thiab kev tiv thaiv, chav kawm ntawm tus kab mob thiab kev noj haus tom qab nws? Los yog koj puas xav tau kev kuaj xyuas? Koj ua tau teem sijhawm nrog tus kws kho mob - chaw kho mob Euro lab ib txwm nyob ntawm koj qhov kev pabcuam! Cov kws kho mob zoo tshaj plaws yuav kuaj koj, tshuaj xyuas cov cim sab nraud thiab pab txiav txim tus kab mob los ntawm cov tsos mob, qhia koj thiab muab kev pab tsim nyog thiab ua kev kuaj mob. Koj tuaj yeem ua tau hu kws kho mob tom tsevCov. Chaw Kho Mob Euro lab qhib rau koj ib ncig ntawm lub moos.

Yuav hu rau lub tsev kho mob li cas:
Xov tooj ntawm peb lub tsev kho mob hauv Kiev: (+38 044) 206-20-00 (muaj ntau txoj kev). Tus tuav ntaub ntawv hauv chaw kho mob yuav xaiv hnub thiab xuab moos yooj yim rau kev mus ntsib kws kho mob. Peb cov haujlwm thiab kev coj ua qhia nyob ntawm no. Saib rau hauv kev nthuav dav ntxiv txog txhua yam kev pabcuam ntawm tsev kho mob ntawm nws tus kheej nplooj ntawv.

Yog tias koj tau tshawb nrhiav yav dhau los, nco ntsoov nqa lawv cov txiaj ntsig rau kev sab laj nrog tus kws kho mob. Yog tias cov kev tshawb fawb tsis tau ua tiav, peb yuav ua txhua yam tsim nyog hauv peb lub tsev kho mob lossis nrog peb cov npoj yaig hauv lwm cov chaw kho mob.

Nrog koj? Koj yuav tsum ceev faj txog koj kev noj qab haus huv tag nrho. Cov neeg tsis mloog txaus cov tsos mob kab mob thiab lawv tsis paub tias cov kab mob no tuaj yeem tsim kev tuag taus. Muaj ntau yam kab mob uas thaum xub thawj tsis pom lawv tus kheej hauv peb lub cev, tab sis thaum kawg nws hloov tawm tias, hmoov tsis, nws lig dhau los kho lawv. Txhua tus kabmob muaj nws tus kheej tshwj xeeb cov cim, yam ntxwv sab nraud ua pov thawj - qhov thiaj li hu ua cov tsos mob ntawm tus kab mobCov. Kev txheeb xyuas cov tsos mob yog thawj kauj ruam hauv kev kuaj mob feem ntau. Ua li no, nws tsuas yog tsim nyog ob peb zaug hauv ib xyoos soj ntsuam los ntawm kws kho mob, tsis tsuas yog txhawm rau tiv thaiv kab mob txaus ntshai, tab sis kuj tseem ua kom muaj lub siab xav hauv lub cev thiab lub cev kom zoo.

Yog tias koj xav nug tus kws kho mob ib lo lus nug - siv cov lus sib tham hauv online, tej zaum koj yuav pom cov lus teb rau koj cov lus nug nyob ntawd thiab nyeem cov lus qhia txog kev saib xyuas tus kheejCov. Yog tias koj xav paub txog qhov chaw kuaj mob thiab kws kho mob, sim nrhiav cov ntaub ntawv koj xav tau ntawm Txhua ntu tshuaj. Kuj sau npe rau Euro kho mob portal labtxhawm rau saib xyuas cov xov xwm tshiab thiab cov ntaub ntawv hloov tshiab ntawm lub vev xaib, uas yuav raug xa ncaj qha rau koj tus e-mail.

Lub cev anatomy

Kev hloov pauv hauv keeb kwm hauv lub raum thaum lub caij G. yog polymorphic heev, peb lub ntsiab ntawm kev puas tsuaj yog qhov txawv - nodular, diffuse thiab exudative. Qee tus neeg sau ntawv hloov tawm ntawm exudative emit sib xyaw ua ke.

Daim ntawv nodular yog tus cwj pwm los ntawm qhov pom nyob hauv lub glomeruli ntawm eosinophilic formations (nodules) ntawm ib puag ncig lossis kheej li cov duab uas muaj cov vacuoles. Lawv tuaj yeem nyob hauv ib feem lossis tag nrho cov glomerulus, ntawm qhov thaiv ntawm qhov uas, nyob rau hauv rooj plaub tom kawg, qhov tseem ceeb tau muab cov capillary loo nyob rau. Nyob rau tib lub sijhawm, nthuav dav thiab pob qij taws ntawm glomerular capillaries, lub thickening ntawm lawv hauv qab daus daim nyias nyias yog cai. Thaum kuaj cov keeb kwm ntawm nodules, lawv yog thawj zaug ua fibrin, thiab tom qab ntawd ua collagen. Nodules muaj ntau ntawm cov molecular hnyav mucopolysaccharides, ib qho me me ntawm cov kua qaub mucopolysaccharides, cov roj ntsha, feem ntau yog cov roj ntsha tsis muaj roj thiab cov roj cholesterol. Kev sojntsuam hluav taws xob tsom qhia pom tau hais tias tsim cov hnoos qeev tshwm sim hauv mesangium hauv kev sib xyaw ua ke ntawm cov qog thiab cov tawv nqaij hauv nws, zoo ib yam li cov khoom ntawm lub qab daus membrane.

Daim foos xa tawm yog qhia nyob rau hauv ib qho kev sib txuas zuj zus thiab qhov sib duav ntawm mesangium nrog kev koom tes ntawm capillaries hauv qab daus daim nyias nyias, uas yog tawg zuj zus. Membrane zoo li cov qauv tsim ua hauv mesangium tsis sib koom ua ke mus rau hauv kev pheej hmoo, thiab qhov tsim muaj nodule tsis tshwm sim. Hauv qab daus daim nyias nyias ntawm cov capillary loo ntawm glomeruli yog cov tuab, lawv cov qauv ploj.

Daim ntawv sib xyaw ua ke yog tus cwj pwm los ntawm kev sib txuas ntawm cov nodules raug nrog diffuse mesangium densification thiab ua kom tuab ntawm cov npoo ntawm cov glomerular capillaries. Raws li kev tshawb fawb ntawm electron microscopic, qhov ua rau lub ntsej muag ntawm lub ntsej muag txhaws ntawm cov glomerular capillaries tshwm sim thaum ntxov, feem ntau ua ntej txhua qhov kev kho mob tshwm sim ntawm lub raum puas, thiab tshwm sim, pom meej, nrog rau txhua daim ntawv ntawm G. e. cov neeg tuaj ntawm cov tsev neeg mob ntshav qab zib.

Lub exudative daim ntawv yog qhov tsawg dua li yav dhau los, thiab yog tus cwj pwm feem ntau ntawm cov thiaj li hu ua. "Cov kaus mom Fibrinoid", uas yog qhov tso nyiaj ntawm PAS-tsis zoo cov khoom ntawm endothelium thiab hauv qab daus daim nyias nyias ntawm cov hlab ntsha. Kev tshawb nrhiav tshuaj immunohistochemical hauv cov qauv tsim tawm no qhia qhov tseem ceeb ntawm cov tshuaj tiv thaiv kab mob immunoglobulins, uas qhia tau tias lawv yog cov tshuaj tiv thaiv kev tiv thaiv kabmob (antigen-antibody complex), thiab tsis muaj qhov tseeb. "Cov kaus mom Fibrinoid" tsis yog tshwj xeeb rau G. d., Tab sis tib lub sijhawm lawv pom ntawm nws hnyav thiab hnyav zuj zus ntawm cov ntawv. Lawv feem ntau ua ke nrog qhov thiaj li hu ua. "Cov tshuaj ntsiav tee" nyob rau sab hauv ntawm daim txiag tais.

Kev hloov pauv ntawm cov tubules yog tus cwj pwm los ntawm glycogen infiltration nrog localization ntawm tus txheej txheem hauv thaj chaw corticomedullary, thawj zaug hauv qhov davhlau ya nyob twg ntawm qhov tsis sib haum ntawm cov tubules nrog kis mus rau nyias seem ntawm Henle voj. Tus txhuam ciam ntawm epithelium yog loosened, protein ntau kuj pom muaj nyob hauv cytoplasm. Thaum mob hnyav, deb ntawm qhov kis ntawm G. d. Muaj cov lus tshaj tawm ntawm cov menyuam, nthuav tawm lawv cov khoob nrog qhov muaj cov thooj voos kheej kheej hauv lawv. Hauv qab daus daim nyias nyias ntawm lub tubules yog tawg thiab thickened. Hauv cov hlab ntshav me me ntawm lub raum thiab lwm yam kabmob, ntshav impregnation, loj hlob ntawm endothelium, tuab ntawm cov leeg hauv qab daus nrog maj mam nce ntxiv hauv ob qho tib si hloov mus txog hyalinization ntawm cov leeg ntshav yog sau tseg.

Mob Ntshav (Pathogenesis). G. d. - lub raum puas tsuaj tshwj xeeb rau cov ntshav qab zib mellitus thiab cuam tshuam nrog endocrine-metabolic ntshawv siab.

Dysproteinemia uas tshwm sim hauv cov neeg mob nrog kev nce ntxiv ntawm alpha2-globulins thiab qhov tshwm sim ntawm pathological paraproteins, qhov nce ntawm qib ntawm mucopolysaccharides, tag nrho cov lipids, triglycerides, p-lipoproteins nyob rau hauv kev sib txuas nrog kev nce ntxiv ntawm vascular permeability tuaj yeem ua rau lawv nkag mus rau hauv cov keeb kwm mesangial, ncua ntev, polymerization thiab, tshwj xeeb. rau kev tsim cov nodules. Qhov zoo sib xws ntawm lub raum mob qog hauv G. d. Nrog rau kev hloov pauv hauv lub raum pom nrog kev tswj hwm ntawm ntau qhov ntau ntawm corticosteroids rau tsiaj pom tias cov txhab no muaj feem cuam tshuam nrog kev ua haujlwm ntawm lub qog adrenal, tshwj xeeb, nrog kev zais zais ntawm aldosterone.

Soj ntsuam duab

Lub xub ntiag ntawm cov proteinuria, mob ntshav siab ntawm ntshav, thiab edema yog cov yam ntxwv. Proteinuria (saib) yog thawj zaug thiab qhov xwm yeem tshaj plaws ntawm G. d. Kev poob protein mus txog 40 g ib hnub. Kev kuaj ntshav qab zib yog yuav luag tas li saib (pom), ua cim los ntawm microaneurysms nrog cov nqaij ntuag ntshav, exudates, qhov chaw tsis zoo hauv daim ntawv dawb-daj me ntsis, thiab nyob rau hauv cov ntawv hnyav tshaj plaws - nthuav dav retinitis (saib). Cov zis hauv cov zis feem ntau tsis zoo. Arterial hypertension tshwm sim hauv 60% ntawm cov neeg mob thiab, zoo li muaj proteinuria, tej zaum yuav yog thawj qhov kev sim kho mob thawj zaug. Qhov tshwm sim ntawm kev kub siab nce nrog cov ncua ntev ntawm tus kab mob. Ntawm cov tub ntxhais hluas cov tsos mob nephrotic feem ntau pom tshwm sim, thaum cov neeg laus - mob ntshav liab, ntug tau tuaj yeem ua ke nrog lub plawv tsis ua haujlwm. Hauv cov xwm txheej no, edema yog sib xyaw cardiopulmonary hauv qhov.

Cov kab mob hypoproteinemic edema feem ntau tau pom - hauv 47% ntawm cov neeg mob raws li Henderson (L. Henderson et al., Cov Neeg Mob Hluav Taws Xob) (saib) - ntau tsawg - los ntawm 6 txog 26%. Tus mob Nifaisrotic nyob rau hauv cov neeg mob ntshav qab zib yog qhov ua rau muaj peev xwm tsim tau ntau dua li cov neeg mob ua mob qog, mob nephritis.

Qib thiab qib ntawm cov protein tsawg ntawm cov ntshav dej hauv lub cev tsis tau hais txog proteinuria tseem tsis pub dhau ib qho kev txwv, nrog nephrotic syndrome, nrog rau hypoproteinemia thiab hypoalbuminemia, qhov nce ntawm alpha2 thiab tsawg dua gamma globulins yog cai. Lipid qib nce nrog nephrotic syndrome. Qib ntawm mucopolysaccharides thiab mucoproteins kuj tau nce.

Kev kho mob pathogenetic ntawm G. ntawm D. tsis muaj nyob. Muaj cov ntaub ntawv hais txog cov txiaj ntsig muaj txiaj ntsig ntawm anabolic hormones (retabolil, nerobol, thiab lwm yam), heparin. Nws raug nquahu kom hloov cov khoom noj khoom haus tau yooj yim ntawm cov carbohydrates nrog fructose nrog tus nqi txaus ntawm carbohydrates thiab cov protein (nyob rau qhov tsis muaj lub raum tsis ua haujlwm) thiab rog rog. Kev kho mob ntawm lub caj dab yog txiav txim siab los ntawm kev sib tsoo, kev nthuav qhia: kub siab, edema, kev muaj peev xwm ua haujlwm ntawm lub raum thiab hlab plawv. Cov txheej txheem phais mob ntawm kev kho mob - pituitary thiab adrenalectomy, hloov raum ib txhij nrog tus txiav tsis kis tsis thoob.

G. cov chav kawm ntawm d. Nws yog ntau yam nyob ntawm lub hnub nyoog ntawm cov neeg mob, mob hnyav ntshav qab zib thiab nws txoj kev kho. Hauv cov neeg hluas, tus kab mob hloov mus sai dua. Kev tsim kho ntawm lub raum tsis ua haujlwm pab txhawb ntxiv rau pyelonephritis. Qhov nruab nrab lub neej ntawm cov neeg mob tom qab qhov pib ntawm thawj cov tsos mob ntawm G. yog 5-6 xyoo, tab sis tuaj yeem ntev li 2 txog 12 xyoos.

Ntshav qab zib glomerulosclerosis thiab glomerulopathy: yog dab tsi?

Ntshav qab zib mob raumnpog cov kev hloov pauv pathological uas yog feem ntau ntawm cov keeb kwm vascular (microangiopathy) thiab muaj cov lus qhia txaus rau ntshav qab zib (tsis hnov mob metabolism hauv cov ntaub so ntswg ntawm lub raum).

Xav tias tsis tsuas yog lub ntiaj teb lub zeem muag muaj kev cuam tshuam, tab sis kuj tseem muaj lwm lub raum, lub npe tsuas yog txiav txim siab - mob ntshav qab zib nephropathy.

Nrog rau cov ntshav qab zib insulin-mob ntshav qab zib, mob raum yog qee yam ntau dua li cov ntshav qab zib tsis muaj tshuaj insulin (30% thiab 20%). Kev txhim kho ntawm glomerulosclerosis yog txuam nrog ib ntus ntsuas ntawm ntshav qab zib mellitus. Pom tseeb cov cim ntawm tus kabmob (proteinuria, kub siab) tau kuaj pom, raws li txoj cai, tom qab 15 xyoo dhau los ntawm kev kuaj pom.

Tab sis twb tau hloov thawj zaug - qhov kev nce siab hauv lub siab glomeruli thiab kev nce ntxiv ntawm glomerular pom npaum li cas yuav luag thooj txhij muaj ntshav qab zib. Kev ploj ntawm albumin (microalbuminuria) pib tshwm sim tom qab 5 xyoo, tab sis nws tseem tsis tau ua raws li kev ntsuam xyuas cov lus pom zoo.

Kev tsim theem (proteinuria, lub siab, lub ntsej muag tsis zoo ntawm lub ntsej muag txhaws ua haujlwm) raug kuaj pom tom qab lwm 5-10 xyoo. Uremia kev txhim kho tom qab 5 xyoo los ntawm kev kuaj mob ntawm pom tias muaj protein tsawg poob.

Thaum txheeb xyuas thawj cov cim qhia txog ntshav qab zib, nws yog ib qho tseem ceeb uas yuav tsum tau kuaj ntshav lub raum ua haujlwm kom tsis txhob muaj teeb meem loj rau lub sijhawm.

Cov laj thawj rau kev loj hlob ntawm pathology

Ntawm cov ntshav qab zib, etiopathogenesis ntawm lub raum puas yog cuam tshuam nrog ob txoj kev sib txuam nrog cov txheej txheem:

cov teeb meem metabolic tshwj xeeb (pauv),
hemodynamic kev ntxhov siab.

Tsis txaus yog txo qis, ua ntej txhua yam, kom nce glycosylation ntawm cov khoom kawg vim tias tsis muaj cov tshuaj insulin.

Ntawd yog, muaj qhov nce ntxiv ntawm cov suab thaj rau cov organic molecules, uas ua rau lawv hnyav dua thiab deform. Qhov no ua rau muaj qhov tuab ntawm lub ntsiab membrane ntawm glomerular capillaries thiab kev nce hauv cov txheej txheej intervascular (mesangial matrix).

Hemodynamic yam ua rau muaj kev nce ntxiv ntawm glomerular pom kev sib kis thiab sib kis ntawm nws thaj chaw, uas tshwm sim nyob rau hauv teb rau cov ntaub so ntswg hypoxia.

Yog li ntawd, lub siab sab hauv cov hlab ntsha ntawm lub ntsej muag glomeruli nce, uas ua rau glomerular hypertrophy. Txhawb vascular permeability txhawb kev nkag mus ntawm cov protein ua tshiab, lipids thiab lwm yam lwg me me mus rau hauv mesangium matrix.

Nws kuj tseem muaj ntau lub tswv yim tswj hwm qhov piav qhia lub pathogenesis ntawm lub raum puas tsuaj hauv cov ntshav qab zib:

txhaj tshuaj tiv thaiv kabmob, piav qhia qhov tsis txaus ntseeg ntawm angiopathies los ntawm kev ncig ntawm cov kabmob tiv thaiv kab mob uas tuaj yeem ua kev puas tsuaj rau cov hlab ntshav,
neuroendocrine, txuas cov tshuaj angiopathy nrog ntau ntxiv ntawm cov tshuaj hormones ntawm cov qog adrenal, hypothalamus, adenohypophysis,
caj ces, tso cai rau kev sib txuas ntawm cov metabolism hauv kev mob ntshav qab zib nrog kev hloov pauv ntawm qee qhov chaw hauv cov noob.

Nws yog ib qho tseem ceeb, yog tias muaj ntshav qab zib hauv tsev neeg, tshwj xeeb tshaj yog hom 1, kom muaj kev ceev faj txog qhov ua rau lub cev pib los ntawm cov khoom noj sib txawv hauv lub cev: nws tau nkag siab ntau dhau los ntawm kev tiv thaiv kev tiv thaiv, los tiv thaiv qhov hnyav.

Cov tsos mob hauv cov ntshav qab zib

Lub raum puas tsuaj nyob rau hauv cov ntshav qab zib tau muab tsis txaus vim tias kev txhim kho lub sijhawm ntev, hloov ntawm qhov tshwm sim tsis tu ncua, thiab cov paucity ntawm cov kev qhia sab nraud.

Qhov kev kuaj mob feem ntau yog tsim nyob rau theem ntawm cov ncauj lus kom ntxaws:

tshuaj ntxuav ntshav qab zib,
albuminuria
kub siab nqig (nyob rau theem pib),
retinopathy
nyiam o tuaj.

Qhov cim tseem ceeb ntawm cov ntshav qab zib mob raum yog retinopathy, uas tau pom hauv 90% ntawm cov tshuaj insulin thiab 60% ntawm cov neeg mob tsis-insulin.

Cov kev hloov pauv ntawm cov nyiaj pob txha yog li ntawd tus yam ntxwv (microaneurysms, exudative me ntsis ib ncig ntawm cov hlab ntsha, macula, hemorrhages nyob rau hauv daim ntawv ntawm cov xim liab nyob rau hauv Retina) uas mob ntshav qab zib yog glomerulopathy yog ib qho ua rau xav tias raug.

Cov theem ntawm kev loj hlob ntawm tus kabmob tau muab faib ua:

thawj zaug (nrog me qhia),
zaus (nrog pom tseeb proteinuria),
kawg (nrog lub raum tsis ua haujlwm).

Nrog rau cov ntshav qab zib mob nephropathy, muaj ntau yam kev cuam tshuam pom nyob hauv kev them nyiaj rau ntshav qab zib.

Hauv cov mob hnyav, lub luag haujlwm tseem ceeb hauv daim duab ntawm tus kabmob yog lub raum mob ntsws, thiab kev cuam tshuam ntawm cov kabmob ntshav qab zib tseem nyob hauv keeb kwm yav dhau los.

Tej zaum yuav pom muaj kev txhim kho hauv kev ntsuas ntshav qab zib (txo cov piam thaj hauv cov zis thiab ntshav, qhov yuav tsum tau insulin tsawg dua). Qhov hloov zuj zus ntawm nephropathy tuaj yeem ua rau mob nephrotic syndrome, uas yuav tsum muaj kev kuaj mob txawv txav nrog lub ntsej muag glomerulonephritis thiab lwm lub raum thiab cov kab mob.

Yog tias kuaj ntshav qab zib-tshwj xeeb hauv cov hlab ntsha uas tau kuaj pom, yuav tsum mob siab rau kev kuaj ntshav rau lub raum.

Kev kuaj mob

Ntshav qab zib yog ntshai ntawm cov tshuaj no, zoo li hluav taws!

Koj tsuas yog xav tau thov ...

Nws tsis muaj peev xwm kuaj pom thawj cov tsos mob ntawm cov ntshav qab zib mob raum hloov pauv los ntawm kev siv cov kab mob hauv chaw soj ntsuam. Qhov xav tau kev kuaj mob yog ib qho tseem ceeb, vim tias kev kuaj pom sijhawm tuaj yeem ua rau koj pib kho thiab tiv thaiv kev loj hlob ntawm tus kabmob.

Ua ntej cov tsos mob hauv tus kab mob glomerulopathy tshwm sim, cov hauv qab no kev qhia txog kev siv tus kab mob pathology:

kev txiav txim siab ntawm glomerular filtration (nws txo qis hauv thawj lub hlis ntawm tus kab mob),
kev txiav txim siab ntawm magnesium zais cia (nws qhov kev nqig zuj zus lawm),
radionuclide kawm
tswj hwm ntawm albumin nrog creatinine hauv cov zis ntawm yav sawv ntxov feem (poob ntawm albumin raug kuaj).

Tus nqi ntawm qhov kuaj me me ntawm ib theem thaum ntxov yog kom paub txog ib qho kev pom ntawm cov hlab ntsha hauv raum. Ib daig ntawm daim ntaub yog npaum li cas rau histology.

Qhov nce hauv qab lub tsom tsom tsom qhov pom tuab ntawm hauv qab daus ntawm cov hlab ntsha glomeruli twb tau nyob rau thawj 1-2 xyoo los ntawm qhov pib ntawm ntshav qab zib. Cov kab ke txuas ntxiv yog qhia nyob rau hauv qhov nce ntawm tuab ntawm cov rooj tog, qhov yeej ntawm mesangium.

Qhov kev hloov ntawm Morphological yog sawv cev los ntawm 4 cov foos:

Nodular feem ntau tshwm sim. Nws yog tus cwj pwm los ntawm kev tsim cov pob tw npawv uas muaj cov siab molecular hnyav mucopolysaccharides, ntau yam khoom muaj roj.

Lawv sau rau qee qhov los yog tag nrho glomerulus, zaws cov ceg tawv capillary. Aneurysms pom hauv cov hlab ntsha, lub ntsiab membrane yog thickened.

Nrog daim ntawv diffuse, kev hloov homogeneous hauv txheej intervascular tshwm sim nrog kev tsim cov membrane zoo li cov qauv hauv nws. Lub hauv qab nyias nyias ntawm cov hlab ntsha ua kom tuab nkoog tuab. Cov qauv tsim ntawm glomerular vascular loops ploj.

Cov exudative daim ntawv no ntau dua nrog cov ntawv ua hnyav, sai sai. "Cov kaus mom fibrinoid" ntawm endothelium thiab lub ntsiab capillary membrane, nthuav tawm hauv micropreparation, muaj cov tshuaj tiv thaiv kab mob sib xyaw ua ke (antigen-antibody complex), uas tsis yog hais txog ntshav qab zib. "Cov kua tshuaj txau" kuj tseem tuaj yeem pom hauv lub hauv Bowman capsule.

Kev sib xyaw ua ke ntawm nodules nrog kev hloov pauv nyob hauv mesangial txheej yog yam ntxwv ntawm hom sib xyaw. Thickened capillary daim nyias nyias tau pom nyob rau hauv txhua hom morphological. Kev loj hlob ntawm morphological hloov pauv ua rau lub raum ua haujlwm nyob rau lub sijhawm.

Cov kev hloov hauv lub cev ntawm lub cev ntawm cov ntshav qab zib nephropathy tau nthuav tawm hauv qhov kev piav qhia ntawm macrodrug:

lub raum loj txo
vim tias cov loj hlob ntawm cov ntaub so ntswg sib txuam, qhov ceev tau nce ntxiv,
thinned cortical txheej,
qhov saum npoo zoo nkauj-nplua-nplej.

Kev kho tus mob ntshav qab zib lub raum yog ua tau tsuas yog nyob rau theem pib ntawm kev hloov.

Yuav muaj teeb meem rau ntshav qab zib nephropathy

Kev hloov pauv hauv lub raum nrog ntshav qab zib yog qhov ua rau muaj kev tuag ntawm cov neeg mob. Teeb meem ntawm cov mob nephropathy tuaj yeem tshwm sim ob qho tib si rau thawj xyoo thiab tom qab lub sijhawm tseem ceeb.

Cov teeb meem suav nrog:

anemia
pheej nce siab hauv siab,
hloov leeg ntshav ntswg hloov,
kev tsim tawm ntawm lub siab thiab mob nkees.

Nrog rau kev txhim kho ntawm cov proteinuria pheej, qhov tshwm sim ntawm tus kabmob yog tsis tshua muaj neeg paub. Kev tsim kho lub raum tsis ua haujlwm ua rau uremia nrog lub ntiaj teb no tuag.

Nws yog ib qho tseem ceeb kom ua raws txhua cov lus pom zoo tau hais tseg, soj ntsuam tas li.

Cov hau kev kho

Ua ntej tshaj plaws, kev kho mob yuav tsum tau npaj kho qhov mob qis.

Cov hauv paus ntsiab lus ntawm kev kho mob nephropathy yog li nram qab no:

cov khoom noj uas muaj cov zaub mov tsis muaj rog, nrog rau kev txo lub raum kom tsawg - cov protein tsawg,
sib ntaus tawm tsam anemia,
normalization ntawm siab siv tshuaj (ACE inhibitors),
normalization ntawm lipid metabolism hauv,
angioprotectors
nrog rau kev txhim kho cov cim ntawm lub raum tsis ua haujlwm - hloov mus rau insulin,
nrog cov cim qhia ntawm uremia - hemodialysis.

Nws yog ib qho tseem ceeb uas yuav tsum tau soj ntsuam txhua qhov ntsuas kev ntsuas tsim nyog, sab laj nrog tus kws kho qhov muag endocrinologist, nephrologist.

Kev twv ua ntej thiab Kev Tiv Thaiv

Cov cim tseem ceeb rau txoj kev twv ua ntej yog:

qib ntawm albuminuria-proteinuria,
ntshav siab
tswj ntshav qab zib.

Kev txheeb xyuas ntawm microalbuminuria thiab proteinuria nrog qhov kev nce ntxiv tso cai rau peb ntsuas qhov kev pheej hmoo ntawm qhov tshwm sim tsis zoo yog li cas.

Kev tiv thaiv ntawm nephropathy txo qis rau cov kev ntsuas hauv qab no:

qab zib thiab lipid tswj,
tawm tsam qhov nyhav dhau heev lawm
tsis suav cov pa luam yeeb
qoj ib ce
tswj los ntawm cov kws tshaj lij.

Ua raws li kev tiv thaiv txhua qhov kev tiv thaiv, kev soj ntsuam txhua lub sijhawm kuaj ntsuas yuav ua kom lub raum ua haujlwm thiab cawm tau neeg txoj sia.