Mob ntshav qab zib macroangiopathy yog li cas: cov lus piav qhia ntawm cov tsos mob ntshav qab zib

Ntshav qab zib Angiopathy - kev tawm dag zog vascular dav dav, kis mus rau cov hlab ntsha me me (lub npe hu ua "microangiopathy"), thiab ntxiv rau cov nkoj nruab nrab thiab loj (piv txwv li, macroangiopathy). Yog tias qhov hloov pauv ntawm cov hlab ntsha me me (capillaries, hlab ntsha thiab venules) tshwj xeeb rau cov ntshav qab zib, tom qab ntawd kev puas tsuaj rau cov hlab ntsha loj yog sib npaug rau cov kab mob thaum ntxov thiab thoob plaws.
Cov yam ntxwv ntawm lub qhov txhab ntawm cov hlab ntsha me thaum lub sij hawm muaj kev loj hlob ntawm cov endothelium, thickening ntawm qab daus daim nyias nyias ntawm capillaries me me, deposition ntawm glycoprotein RA5-zoo tshuaj nyob rau hauv cov hlab ntsa. Cov lus "mob ntshav qab zib microangiopathy" tau hais kom xa mus rau tus txheej txheem dav dav hauv cov nkoj me me.
Txawm hais tias muaj ntau qhov tshwm sim ntawm microangiopathies, cov hlab ntsha ntawm lub raum, fundus, qis dua qhov kawg nrog cov kev mob tshwm sim hauv daim ntawv ntawm nephropathy, retinopathy, thiab peripheral microangiopathy cuam tshuam ntau dua.

Lo lus "microangiopathy mob ntshav qab zib" yog qhov ua tau zoo tshaj plaws ntawm txhua qhov tau npaj tseg, vim tias nws qhia txog ob yam ntxwv tshwj xeeb tshaj plaws - kev sib raug zoo nrog tus kab mob hauv qab thiab hauv ib cheeb tsam ntawm cov txheej txheem hauv cov nkoj me me. Lwm lub npe, xws li "universal capillaryopathy", "nthuav tawm kab mob vascular", "peripheral angiopathy" tseem tsis tau muab txhawm rau keeb kwm.
Thaum txhim kho cov npe menyuam yaus, ib qho yuav tsum tau ua los ntawm qhov tseeb uas tsim muaj txog ob lub voos xwm txheej ntawm cov ntshav qab zib - txog atherosclerosis ntawm nruab nrab thiab cov hlab ntsha loj, uas nyob rau hauv cov ntshav qab zib pib ua ntej thiab muaj ntau dua, thiab txog kev mob ntshav qab zib microangiopathy. Tsis tas li ntawd, lwm daim ntawv thib peb ntawm qhov chaw mob tau txawv - arteriolosclerosis, uas yog raug kuaj pom tsuas yog nrog lub raum hauv cheeb tsam ntawm txoj kev.
Raws li rau thromboangiitis obliterans (endarteritis), daim ntawv ntawm kev sib txuas nrog cov kabmob ntshav qab zib tsis muaj, thiab nws yuav yog qhov ua tsis yog rau kev faib nws li kev cuam tshuam vascular mob ntshav qab zib. Thromboangiitis tsis mob ntshav qab zib ntau dua li cov neeg tsis muaj ntshav qab zib. Qhov kev tsis sib haum xeeb ntawm cov ntsiab lus "obliterating atherosclerosis" thiab "obliterating thromboangiitis" tau tshwm sim vim hais tias lub sijhawm kawg feem ntau hais txog kev tsim kho cov mob atherosclerosis thaum ntxov thiab zoo. Nyob rau tib lub sijhawm, thromboangiitis nws tus kheej yog kev ua xua collagen muaj cov kab mob pom tseeb.
Thromboangiitis obliterans tsuas yog tuaj yeem sib tham nrog kev sib xyaw ntawm ischemic syndrome thiab lwm cov tsos mob ntawm collagenosis: kub taub hau, cov chav kawm tshwm sim, kev tsis haum tshuaj, cov ntshav tiv thaiv, mob caj dab, kev puas tsuaj rau daim tawv nqaij thiab cov qog ua pa, kev koom tes ntawm cov hlab ntshav. Muaj tseeb, nyob rau theem ntawm kev mus deb nrog kev pom nrog cov tsos ntawm trophic hloov, tus ua ntej yuav yog ischemic syndrome, thiab cov tsos mob ntawm kev tsis haum rov qab rau hauv keeb kwm yav dhau los. Txawm li cas los xij, lawv cov keeb kwm yuav tsum ua. Cov kev xav saum toj no ntawm lub staged ntawm cov kab mob thromboangiitis yog piv txwv los ntawm kev faib tawm qhov txawv peb theem:
Kev ua xua rau theem
Ischemic theem
theem ntawm trophoparalytic cuam tshuam.
Muaj 3 daim ntawv ntawm kev puas tsuaj rau cov hlab ntsha ntawm qhov qis qis hauv cov ntshav qab zib mellitus, uas yog cov kab mob cuam tshuam nrog cov kab mob hauv qab:

cov kab mob ntshav qab zib microangiopathy ,
atherosclerosis obliterans,
kev sib xyaw ntawm atherosclerosis nrog kev puas tsuaj rau cov hlab ntawm cov qis qis.

Cawv kab mob endarteritis tuaj yeem tshwm sim hauv cov neeg mob ntshav qab zib. Txawm li cas los xij, raws li twb tau qhia, daim foos no tsis muaj kev sib deev nrog cov ntshav qab zib, thiab nws tsis yog ntau dua rau cov tib neeg tsis muaj ntshav qab zib.
Hauv kev txhim kho kev faib tawm ntawm cov ntshav qab zib mob angiopathies, ntxiv rau qhov kev faib ua ob hom loj (macro- thiab microangiopathies), nws raug nquahu kom qhia meej qhov chaw ntawm lub voos txhab, txij li kev kho mob sib txawv, tshwj xeeb hauv kev kho hauv zos, nyob ntawm nws. Qhov no siv tsis tsuas yog rau cov microangiopathies tshwj xeeb (retino-, nephropathy, thiab lwm yam), tab sis kuj tseem nyiam rau qhov chaw tshwj xeeb ntawm atherosclerosis ntawm nruab nrab thiab cov hlab ntsha loj (cerebral, mob hlab ntshav, thiab lwm yam).
Lwm lub hauv paus ntsiab lus rau kev faib cov mob ntshav qab zib angiopathies yuav tsum raug txiav txim siab. Peb tab tom tham txog theem ntawm kev loj hlob ntawm voos txhab. Lo lus nug no tsis tau tsa kom ntev li ntev txog cov kev xav ntawm angiopathy yog "mob ntshav qab zib lig" uas ua rau cov ntshav qab zib ntev. Tseeb, nrog rau cov chav kawm ntev ntawm tus kab mob, vascular cuam tshuam yog feem ntau pom tus mob, thiab feem ntau nyob rau hauv cov theem siab hauv cov organic. Raws li cov kev tshawb fawb txhim kho, hloov pauv vascular pib tshawb pom los ntawm thawj xyoo ntawm tus kab mob, thiab txawm tias thaum lub caij nplooj zeeg tsis muaj ntshav qab zib thiab ntshav qab zib. Tshwj xeeb feem ntau, muaj nuj nqi hloov pauv ntawm cov hlab ntsha hauv daim ntawv ntawm kev hloov pauv hauv taub, permeability, venous stasis tau pom los ntawm kev pom pob txha caj qaum, glomeruli ntawm lub raum, qis qis dua.
Txhim kho qhov ua tau zoo ntawm kev kuaj mob tau tso cai pom zoo rau kev hloov vascular ua ntej kev tsis txaus siab thiab cov tsos mob hauv chaw kho mob tau tshwm sim. Vim yog lub luag haujlwm (thim rov qab) qhov xwm txheej ntawm thawj zaug kev hloov pauv ntawm cov hlab ntsha, txoj kev kho mob yuav sib txawv piv rau kev kho kom deb li deb ntawm cov kab mob organic vascular.
Cov kev txiav txim siab tau txais kev pabcuam raws li lub hauv paus rau kev faib tawm ntawm peb theem ntawm kev mob ntshav qab zib angiopathy:
Kuv - preclinical (metabolic),
II - ua haujlwm,
III - organic.
Cov neeg mob nrog kuv (kev xav ua ntej) theem ntawm tus mob ntshav qab zib ua tsis tau yws hlo li. Kev soj ntsuam kuaj pom tias tsis muaj kev hloov pauv. Txawm li cas los xij, piv nrog cov mob ntshav qab zib tsis txaus, nyob rau theem no, raws li kev tshawb nrhiav biochemical, ib qho kev tshaj tawm ntawm cov qib ether-cholesterol (3-lipoproteins, tag nrho lipids, agglucoproteins, mucoproteins) tau pom. Kev hloov pauv ntawm daim duab capillaroscopic ntawm tus ntsia thawv lub tsev ntawm cov ntiv taw ntawm lub taw tau raug txo qis mus rau qhov nce ntawm cov lej capillaries, txoj kev nqaim ntawm cov ceg txhaws, thiab cov tsos ntawm cov ntshav ntau tuaj. Kev nce ntawm lub suab vascular los ntawm tachoscillography thiab sphygmography yog qhia nyob rau hauv kev nce siab hauv nruab nrab siab, qhov nce ntawm cov mem tes yoj yoj tawm suab nrawm dua (SRWP) txog 10.5 m / s thiab nyob rau hauv kev tiv thaiv peripheral.

Ntawm theem II (ua haujlwm) theem ntawm cov mob ntshav qab zib angiopathy, muaj qhov me thiab hloov chaw txhaj tshuaj nyob rau hauv daim ntawv ntawm mob caj dab thaum taug kev ntev, paresthesias, qaug dab peg, qhov txo qis ntawm daim tawv nqaij kub txog 2-3 ° C, qhov txo qis ntawm oscillatory index thiab ntau qhov hloov pauv ntawm cov hlab ntsha hauv daim ntawv ntawm deformation ceg, ua kom tawv nqaij, cuam tshuam ntshav ntws. Hauv txhua tus neeg mob (feem ntau mus txog 40 xyoo), qhov nce ntawm lub suab ntawm cov hlab ntsha thiab sai sai yog txiav txim siab los ntawm cov ntsuas saum toj no, suav nrog ib qho kev nce ntawm txhua yam kev mob siab, elastic modulus, PWV txog 11,5 m / s. Tib yam siv rau kev hloov biochemical.
Theem III yog qhov cim kho qhov chaw mob ntawm cov hlab ntawm ob txhais ceg hauv daim ntawv ntawm sib quas ntus claudication, qhov mob ntawm ko taw, trophic cuam tshuam ntawm daim tawv nqaij thiab cov rau tes, lub ntsej muag tsis meej lossis tsis muaj mem tes ntawm dorsal artery ntawm ko taw, poob ntawm oscillatory index nce mus txog qhov tsis muaj oscillations. Ntxiv nrog rau kev deformation ntawm capillaries, lawv cov lus pov tseg tshwm sim nrog cov tsos ntawm "thaj ua rau thaj". Raws li mechanocardiography, patency ntawm lub txaj nag lossis daus yog qhov txo qis. Kev tshaj tawm ntawm cov xov tooj ntawm cov mem tes nthwv dej nce siab tshaj 11.5 m / s. Lub ntsiab tseem ceeb ntawm cov neeg mob nyob rau theem III ntawm kev mob ntshav qab zib angiopathy piv nrog I thiab II yog qhov tsis hloov pauv ntawm vascular hloov pauv, tsis muaj lus teb rau cov kev ntsuas ua haujlwm thiab tsis tshua muaj zog nyob hauv qab ntawm kev kho mob. Cov neeg mob feem ntau ntawm cov qib no yog laus dua 40 xyoo.
Kev vam meej ntxiv ntawm cov txheej txheem vascular ua rau cov kev ua kom mob siab ntxiv, tsis tuaj yeem kho cov mob rau qhov mob thiav nrog rau kev hloov mus rau txoj kev mob plab.
Thawj theem ntawm kev hloov pauv vascular (theem I thiab II ntawm kev mob ntshav qab zib angiopathy) yog tus cwj pwm los ntawm kev hloov pauv uas tuaj yeem tshwm sim tsis tsuas yog nyob rau thawj xyoo ntawm cov ntshav qab zib, tab sis txawm tias thaum muaj ntshav qab zib thiab mob ntshav qab zib. Nws tseem yuav tsum tau sau tseg tias qhov tuab ntawm lub qab daus membrane ntawm capillaries hauv kev sib txuas nrog kev ua txhaum ntawm cov metabolism ntawm cov vascular phab ntsa thaum xub thawj yog thim rov qab thiab tej zaum yuav tshwm sim nyob rau hauv thawj theem pib hloov pauv ntawm vascular.
Kev txheeb xyuas cov mob vascular los ntawm thawj xyoo ntawm cov ntshav qab zib thiab txawm nyob hauv cov neeg mob ntshav qab zib muab txoj cai los txiav txim siab angiopathy tsis yog qhov kawg ntawm tus kab mob, tab sis raws li ib feem tseem ceeb ntawm cov txheej txheem pathological, thaj vim los ntawm kev ua txhaum ntawm cov kev cai hormonal ntawm vascular lub suab thiab cov kev hloov pauv ntawm lub cev.
Nrog txhua qhov uas tau hais, nws yog qhov tseem ceeb tshaj plaws los lees txais kev kuaj mob raws li hauv qab no ntawm kev mob ntshav qab zib angiopathies.
Kev soj ntsuam kev faib tawm ntawm cov mob ntshav qab zib angiopathies.
Raws li cov laus ntawm vascular txhab:
1. Microangiopathies:
a) tshuaj tiv thaiv,
b) cov hlwb ua kom lub cev,
c) dav dav microangiopathy, suav nrog microangiopathy ntawm plab hnyuv siab raum, leeg thiab tawv nqaij,
c) microangiopathy ntawm qis ntu.

Ntshav qab zib Angiopathy hais txog cov teeb meem mob ntshav qab zib thiab ua rau pom kev tsis txaus noj ntawm cov leeg tawv nqaij, uas ua rau lawv cov necrosis. Hauv kev mob ntshav qab zib angiopathy, cov hlab ntsha ntawm ntau yam calibers cuam tshuam, tab sis feem ntau qhov tsawg tshaj plaws thiab nruab nrab. Tsis tsuas yog cov leeg nqaj yog cuam tshuam, tab sis kuj muaj cov kab mob hauv nruab nrog.

Kev puas tsuaj rau cov hlab ntsha me hauv kev mob ntshav qab zib angiopathy

Thaum cov hlab ntsha me cuam tshuam, hloov tau tshwm sim hauv lawv phab ntsa, tso ntshav tawm los cuam tshuam, thiab ntshav ntws qeeb. Tag nrho cov no tsim cov kev mob rau kev tsim cov ntshav txhaws. Cov hlab ntsha me me ntawm lub raum, retina, lub siab thiab cov tawv nqaij yog qhov cuam tshuam loj. Qhov ntxov tshaj plaws ntawm kev mob ntshav qab zib angiopathy yog kev puas tsuaj rau qis qis.

Cov txheej txheem tshwm sim hauv cov hlab yog ntawm ob hom: cov tuab ntawm phab ntsa ntawm txoj hlab ntsha thiab leeg ntshav lossis ntawm cov hlab ntsha kom nruj. Thaum pib, nyob rau hauv lub zog ntawm cov khoom muaj kuab lom uas tsim thaum lub sijhawm ua tsis tiav ntawm kev siv cov piam thaj, txheej sab hauv ntawm cov hlab ntshav o, tom qab uas lawv nqaim.
Thawj qhov kev pom tshwm sim ntawm cov ntshav qab zib angiopathy yog cov ntshav tawm hauv qab cov ntsia hlau phaj ntawm tus ntiv taw loj. Tus neeg mob hnov mob hauv qhov siab, ceeb toom tias tawv nqaij daj ntseg, me ntsis tshwm rau nws, cov ntsia hlau ua rau lub ntsej muag, cov leeg ntawm ob txhais ceg qhuav tas ". Cov mem tes rau ntawm cov hlab ntsha tseem ceeb ntawm qhov qis qis tsis hloov, tab sis ntawm ko taw nws tuaj yeem tsis muaj zog.

Hloov pauv ntawm cov leeg ntshav liab tau tuaj yeem tshawb pom thiab cov protein nyob hauv cov zis yuav tshwm sim. Qhov tshwj xeeb uas tsis muaj qhov zis ntawm lub qhov ntshav uas ua rau los ntshav tshwm rau ntawm daim tawv nqaij ntawm tus taw. Nws kho nws tus kheej, thaum lub caws pliav tsis ua, txawm li cas los xij, cov kab mob me me tuaj yeem nkag mus rau daim ntaub thiab ua rau mob.

Txhawm rau kuaj kab mob ntshav qab zib angiopathy, cov hauv kev tshawb fawb hauv qab no yog siv:

capillaroscopy
duab infrared
cov kev qhia txog cov isotopes hluav taws xob,
laser fluometry
polarography lossis oxyhemography.

Kev puas tsuaj rau cov hlab ntsha loj hauv kev mob ntshav qab zib angiopathy

Nrog mob ntshav qab zib angiopathy, cov nkoj nruab nrab thiab loj tuaj yeem cuam tshuam. Hauv lawv, lub plhaub sab hauv cov tuab tuab, calcium ntsev yog tso nyiaj thiab atherosclerotic plaques yog tsim.

Qhov tshwm sim ntawm tus kab mob hauv cov ntaub ntawv no zoo ib yam li cov uas tshwm sim nrog qhov txhab ntawm cov hlab ntsha me. Qhov mob ntawm taw yog tab tom ntxhov, lawv dhau los ua khaub thuas thiab daj ntseg, kev noj zaub mov ntawm cov ntaub so ntswg uas tau ploj mus thaum lub sijhawm yuav ntxhov. Mob tob tob ntawm cov ntiv tes tsim, thiab tom qab ntawd ces ob txhais taw.
Mob ntshav qab zib angiopathy ntawm plab hnyuv siab raum

Hauv cov ntshav qab zib mellitus, cov hlab ntsha ntawm qhov retina thiab cov plab hnyuv siab raum feem ntau cuam tshuam los ntawm cov txheej txheem pathological. Qhov no yog vim qhov tsim ntawm cov khoom muaj tshuaj lom neeg muaj qhov ua tsis tiav "hlawv" ntawm cov piam thaj. Yuav luag txhua tus neeg mob ntshav qab zib muaj ib tug kab mob retinal hu ua retinopathy. Nrog rau tus kab mob no, pom kev pom thawj zaug txo qis, thiab tom qab ntawd ntshav raug nchuav mus rau qhov siab, thiab nws ua rau pov tseg. Qhov no ua rau ua tiav qhov tsis pom kev.

Qhov thib ob lub hom phiaj hloov khoom nruab nrog, cov hlab ntsha uas cuam tshuam los ntawm cov ntshav qab zib, yog ob lub raum - lub hlwb loj hlob tuaj. Hauv cov theem pib, tus kab mob tsis pom nws tus kheej, kev hloov pauv tuaj yeem pom tsuas yog thaum kuaj tus neeg mob. Tsib xyoos tom qab, lub raum ua haujlwm tsis zoo thiab cov protein tshwm nyob hauv cov zis. Yog tias qhov hloov tau pom nyob rau theem no, tom qab ntawd lawv tseem tuaj yeem thim rov qab. Tab sis nyob rau hauv rooj plaub thaum kev kho mob tsis nqa tawm, txoj kev ua kab mob hauv cov hlab ntsha ntawm lub raum nce zuj zus, thiab tom qab kaum xyoo pom cov tsos mob tshwm sim. Ua ntej tshaj plaws, cov protein ntau pib tawm hauv zis. Nws ua rau hauv cov ntshav tsawg dua, thiab qhov no ua rau cov khoom hauv dej ntau ntxiv hauv cov ntaub so ntswg thiab o tuaj. Thaum pib, pom pob txha yog pom hauv qab qhov muag thiab ntawm sab hauv qab, thiab tom qab ntawd cov kua dej hauv nws hauv siab thiab lub plab hauv lub cev.

Lub cev pib siv nws tus kheej cov protein ntau rau lub neej, thiab cov neeg mob poob ceeb thawj sai. Lawv muaj kev qaug zog, mob taub hau. Tsis tas li nyob rau lub sijhawm no, ntshav nce siab, uas yog ib tus neeg quav khov kho nce tus lej siab thiab tsis poob qis hauv qab ntawm cov tshuaj.

Qhov kawg tshwm sim ntawm ntshav qab zib lub raum angiopathy yog qhov kawg theem ntawm lub raum tsis ua haujlwm. Lub raum yuav luag poob, lawv tsis ua tiav lawv txoj haujlwm, thiab cov zis tsis tau tawm los. Kev lom ntawm lub cev los ntawm cov protein metabolism tshwm sim.

Ntshav qab zib angiopathy Kho nyob rau ntau theem ntawm tus kab mob

Kev ua tiav ntawm kev mob ntshav qab zib angiopathy ua tau tsuas yog thaum nws muaj peev xwm ua kom cov ntshav qabzib feem ntau. Qhov no yog dab tsi endocrinologist ua.

Txhawm rau tiv thaiv tsis ua haujlwm nyob rau hauv cov ntaub so ntswg thiab kabmob, nws yog qhov tsim nyog:

tswj ntshav qab zib thiab zis
nco ntsoov tias cov ntshav siab tsis tshaj 135/85 hli. Hg. Kos duab. nyob rau hauv cov neeg mob tsis muaj protein ntau hauv cov zis, thiab 120/75 hli. Hg. Kos duab. nyob rau hauv cov neeg mob uas lawv cov protein tau txiav txim siab,
tswj cov txheej txheem ntawm cov rog metabolism.

Txhawm rau tswj cov ntshav siab nyob rau theem ntawm cov neeg mob, cov neeg mob ntshav qab zib yuav tsum hloov pauv kev ua neej, txwv lawv kev noj zaub mov sodium sodium ntau ntxiv, ua kom lub cev ua kom lub cev muaj zog, tswj lub cev qhov hnyav, txwv lawv kev noj zaub mov tsis zoo thiab tsis rog, thiab zam kev ntxhov siab.

Thaum xaiv cov tshuaj uas txo cov ntshav siab, koj yuav tsum them sai sai seb lawv puas cuam tshuam cov metabolism hauv cov rog thiab carbohydrates, thiab seb lawv puas muaj kev tiv thaiv zoo rau lub raum thiab nplooj siab. Cov kev kho mob zoo tshaj plaws rau cov neeg mob no yog captopril, verapamil, valsartan. Beta-blockers yuav tsum tsis txhob noj, vim lawv tuaj yeem pab txhawb kev kho mob ntshav qab zib.
Cov neeg mob ntshav qab zib angiopathy tau qhia noj statins, fibrates, nrog rau cov tshuaj uas txhim kho cov rog rog. Txhawm rau kom muaj kev sib luag ntawm cov piam thaj hauv cov ntshav, nws yog ib qho tsim nyog yuav tsum tau noj glycidone, repaglimid. Yog tias ntshav qab zib nce zuj zus, cov neeg mob yuav tsum pauv mus rau cov tshuaj insulin.

Ntshav qab zib angiopathy yuav tsum tau saib xyuas tas li ntawm cov piam thaj, kev siv lub cev rog thiab cov ntshav. Thaum necrosis ntawm cov leeg tawv nqaij yog ua haujlwm, kev ua haujlwm tshem lawv tawm yog ua.Tus neeg mob raum tsis ua haujlwm, tsuas yog txoj hauv kev pab kom ncua ntev ntawm tus neeg mob lub neej yog lub raum "cuav". Nrog rau kev rov ua kom mob ntxiv los ntawm kev mob ntshav qab zib angiopathy, phais mob yuav tsim nyog.

Hauv cov neeg mob ntshav qab zib, cov tsos mob ntawm tus mob ntshav qab zib angiopathy feem ntau tshwm sim thaum cov hlab ntsha me cuam tshuam. Mob ntshav qab zib angiopathy ntawm qhov qis qis yog feem ntau kuaj mob, thaum cov kev mob tshwm sim ntawm cov mob no tshwm sim hauv cov neeg mob ntshav qab zib nrog hom 1 lossis hom 2 pathology. Yog tias kev phais mob lossis kev kho kom tsis txhob mob ntshav qab zib mob angiopathy tsis ua tiav raws sijhawm, kev mob nyhav nrog kev puas tsuaj rau ntau cov kabmob.

Dab tsi kis mob?

Ntshav qab zib angiopathy yog tus cwj pwm los ntawm kev puas tsuaj rau cov me me thiab cov hlab ntsha loj thiab cov hlab ntsha. Tus kab mob kabmob rau MBK 10 yog E10.5 thiab E11.5. Raws li txoj cai, cov kab mob ntshav qab zib tau sau tseg, tab sis kev puas tsuaj rau cov hlab ntsha ntawm lwm qhov ntawm lub cev thiab cov khoom nruab nrog cev kuj muaj peev xwm ua tau. Nws yog kev coj noj coj ua rau subdivide angiopathy mob ntshav qab zib ua 2 hom:

Microangiopathy. Nws yog tus cwj pwm los ntawm yeej ntawm capillaries.
Macroangiopathy Cov leeg mob thiab mob ntshav yog sau tseg. Daim foos no tsis tshua tshwm sim ntau, thiab cuam tshuam rau cov neeg mob ntshav qab zib uas tau mob tau ntev txog 10 xyoo lossis ntev dua.

Feem ntau, vim kev txhim kho mob ntshav qab zib angiopathy, tus neeg mob txoj kev noj qab haus huv lub cev tsis zoo thiab lub neej nyob qis dua.

Lub hauv paus tseem ceeb ua rau mob ntshav qab zib angiopathy

Qhov laj thawj tseem ceeb ntawm txoj kev loj hlob ntawm cov ntshav qab zib angiopathy ua ntu zus cov ntshav qab zib kom ntau. Cov hauv qab no qhov ua rau pom kev ua rau mob ntshav qab zib mob ntsws:

Lub caij nyoog hyperglycemia,
muaj zog concentration ntawm cov tshuaj insulin hauv cov ntshav,
muaj cov insulin tsis kam,
diabetic nephropathy, hauv kev ua rau lub raum ua tsis ua haujlwm ntxiv.

Yam pheej hmoo

Tsis yog txhua tus neeg mob ntshav qab zib muaj qhov tsis txaus ntseeg no, nws muaj kev pheej hmoo thaum lub sijhawm muaj kev puas tsuaj rau vascular nce ntxiv:

mob ntev ntshav qab zib,
hnub nyoog qeb tshaj 50 xyoo,
tsis ncaj ncees lawm txoj kev ntawm lub neej
kev noj haus tsis zoo, nrog rau qhov thawj ntawm rog thiab kib,
Ua rau cov txheej txheem metabolic qeeb,
hnyav dua
ntau dhau kev haus cawv thiab luam yeeb,
leeg ntshav siab
arrhythmia ntawm lub plawv,
kev tshuaj ntsuam genetic predisposition.

Phiaj plab hnyuv siab raum

Nws yog qhov nyuaj los twv seb qhov tshwm sim ntawm tus mob ntshav qab zib angiopathy. Ntau dua angiopathy ntawm qis qis dua yog sau tseg, txij li lawv tau hnyav nrog ntshav qab zib. Tab sis vascular, arterial, capillary kev puas tsuaj rau lwm qhov ntawm lub cev yog ua tau. Hom plab hnyuv siab raum yog qhov txawv txav, uas ntau zaus ntau dua li lwm tus neeg mob hlwb:

Cov tsos mob ntawm pathology

Kev mob ntshav qab zib thaum ntxov tuaj yeem tsis pom muaj cov paib tshwjxeeb, thiab tus neeg yuav tsis paub txog tus kabmob. Raws li kev tsim kho nws tus kheej tau tshwm sim, ntau yam kab mob pathological uas nyuaj tsis pom. Cov tsos mob ua kom pom tseeb yog nyob ntawm hom thiab theem ntawm voos txhab. Lub rooj qhia cov theem pib ntawm tus kabmob thiab cov yam ntxwv ntawm tus kheej.

Kev kho pathology

Hauv kev mob ntshav qab zib angiopathy, yuav tsum tau ua txoj kev kho mob nyuaj, uas koom nrog kev siv tshuaj ntawm cov pab pawg sib txawv thiab soj ntsuam cov zaub mov nruj thiab kev tswj hwm zoo. Ua ntej kho cov kab mob pathology, koj yuav tsum tso tseg kev haus cawv thiab tshuaj, uas cuam tshuam rau cov hlab ntsha. Kev muab tshuaj ntawm kev mob ntshav qab zib angiopathy yog siv tshuaj hauv qab no:

Qab zib-Txo:
- Siofor
- Lawj xeeb
- Ntsia hauv qab.
Cov roj (cholesterol) txo qis:
- Lovastatin
- "Simvastatin."
Ntshav thinners:
- Pob Tsuas,
- Ticlopidine
- Warfarin
- Clexane.
Txhais tau tias txhim kho cov ntshav ncig thiab microcirculation:
- Tivortin
- Ilomedin
- "Pestazolum".

Ibuprofen tau sau tseg rau qhov mob uas cuam tshuam tus neeg mob.

Ntxiv rau, tus kws kho mob yuav pom zoo kom kho cov vitamin E lossis nicotinic acid. Yog tias tus neeg mob tau txhawj xeeb txog mob hnyav hauv cov mob ntshav qab zib angiopathy, tom qab ntawd cov tshuaj kho mob qhia: "Ibuprofen", "Ketorolac". Yog tias qhov mob sib kis thib ob tau koom nrog, tom qab ntawd cov tshuaj tua kab mob muaj npe tau: Ciprinol, Ceftriaxone.

Coob tus neeg mob ntshav qab zib muaj ntau yam kab mob uas ua rau lawv mob, ua rau txhua yam hauv nruab nrog cev thiab cov hlab ntshav tu. Ib ntawm cov kabmob no yog ntaus nqi. Nws lub ntsiab lus dag hauv qhov tseeb tias txhua cov hlab ntsha raug puas ntsoog. Yog tias tsuas yog cov hlab ntsha me me xwb, ces qhov no yog mob ntshav qab zib microangiopathy. Nyob rau hauv kev tshwm sim tsuas yog cov hlab ntsha loj tau cuam tshuam thaum cuam tshuam ntawm cov hlab ntsha, qhov no yog mob ntshav qab zib macroangiopathy. Kev puas tsuaj no tsis yog qhov teeb meem nkaus xwb ntawm tus neeg mob. Tsis tas li ntawd, nrog angiopathy, homeostasis yog qhov tsis muaj.

Cov yam ntxwv ntawm ntshav qab zib microangiopathy

Yog tias peb xav txog cov yam ntxwv tseem ceeb ntawm microangiopathy, tom qab ntawd muaj peb yam tseem ceeb hu ua Virchow-Sinako triad.

Cov paib no yog raws li hauv qab no:

Cov txheej txheem uas cov phab ntsa ntawm cov hlab ntsha hloov pauv.
Cov txheej txheem nyob rau hauv cov ntshav coagulation tsis hnov lus.
Kev ua kom ntshav tsawg dua. Vim tias cov neeg platelet ntau ntxiv thiab nce ntxiv, ua rau ntshav khov dua. Ntxiv mus, nrog cov ntshav txaus thiab cov ntshav ua haujlwm, cov phab ntsa ntawm lub nkoj muaj cov roj nplua nyeem tshwj xeeb uas tsis pub ntshav txhaws rau lawv. Kev ua txhaum ntawm cov qauv ntawm cov phab ntsa ntawm cov hlab ntsha tuaj yeem ua teeb meem nrog kev tsim cov roj nplua nyeem no.

Tag nrho cov xwm txheej nthuav tawm ua rau qhov tseeb tias tsis tsuas yog cov hlab ntsha raug rhuav tshem, tab sis kuj microtrombi tshwm sim.

Xws li kev hloov pauv hauv cov txheej txheem kev txhim kho kabmob pib pib muaj kev cuam tshuam ntau ntawm cov nkoj. Feem ntau, qhov chaw mob tseem ceeb yog qhov muag, ob lub raum, myocardium, tawv nqaij, peripheral poob siab. Cov txheej txheem no ua rau kev txhim kho cardiopathy, nephropathy, neuropathy, dermatopathy thiab lwm yam kev cuam tshuam. Thawj cov tsos mob muaj kev cuam tshuam txog cov ntshav ntawm cov ntshav sab hauv qab. Qhov no tshwm sim hauv kwv yees li 65% ntawm cov neeg mob.

Qee cov kws tshawb fawb kho mob tau txiav txim siab xav tias microangiopathy yuav tsum tsis txhob muaj qhov txawv txav ua tus kab mob sib cais thiab nws yog qhov tsos mob ntawm ntshav qab zib. Ntxiv mus, lawv ntseeg tias ua ntej cov tsos mob no tshwm sim, neuropathy tshwm thawj zaug, uas ua rau microangiopathy. Lwm cov kws tshawb fawb ntseeg tias nws yog hlab ntsha ischemia uas ua rau mob neuropathy thiab qhov no tsis cuam tshuam nrog kev puas tsuaj rau cov hlab ntsha. Hauv qhov kev tshawb xav no, neuropathy yog lub txim ntawm cov ntshav qab zib mellitus, uas tsis cuam tshuam rau cov txheej txheem tshwm sim los ntawm microangiopathy. Cov pab pawg thib peb ntawm cov kws tshawb fawb tau hais tias yog tias kev ua haujlwm ntawm cov hlab ntsha cuam tshuam, ces cov hlab ntsha pib ua haujlwm tsis zoo.

Cov kab mob ntshav qab zib mob microangiopathy hauv qab no yog qhov txawv raws theem ntawm kev puas tsuaj rau cov qis qis:

Qib theem ntawm qhov uas tsis muaj kev puas tsuaj rau ntawm daim tawv nqaij ntawm ib tus neeg.
Qib thawj, thaum muaj qee qhov tsis txaus ntseeg ntawm daim tawv nqaij, tab sis lawv muaj nqaim hauv zos thiab tsis muaj txheej txheem ua mob.
Qib ob qib, thaum daim tawv nqaij ntxaum ntxiv. Lawv, nyeg, tuaj yeem tob zuj zus mus rau ntau qhov uas lawv ua rau cov pob txha thiab leeg mob.
Qeb qib thib peb, thaum lub qhov txhab mob rau ntawm daim tawv nqaij thiab pib ntawm kev tuag ntawm cov nqaij mos ntawm qhov qis qis. Cov teeb meem zoo li no tuaj yeem tshwm sim nrog kev sib kis, cov txheej txheem o, edema, qog, hyperemia thiab osteomyelitis.
Qeb plaub ntawm tus kabmob yog thaum muaj tus kabmob lossis ntau ntau tus ntiv tes nce. Cov txheej txheem no tuaj yeem pib tsis yog los ntawm cov ntiv tes, tab sis los ntawm sab caj npab.
Qeb tsib qib ntawm tus kabmob, thaum tus menyuam laib cuam tshuam feem ntau ntawm ko taw lossis tag nrho ko taw tag nrho.

Cov yam ntxwv ntawm kev loj hlob ntawm kev mob ntshav qab zib macroangiopathy

Ntshav qab zib macroangiopathy yog qhov tseem ceeb tshaj plaws rau kev tuag ntawm cov neeg mob ntshav qab zib mellitus. Feem ntau, cov kev mob tshwm sim li macroangiopathy tshwm sim hauv cov neeg mob. Ua ntej, cov hlab ntshav loj ntawm cov qis qis tau cuam tshuam. Ua ntej tshaj plaws, cov kab mob ntawm lub hlwb thiab ntshav hlab ntsha muaj kev cuam tshuam. Xws li tus kab mob tuaj yeem txhim kho thaum cov txheej txheem ntawm nce tus nqi ntawm kev loj hlob ntawm atherosclerosis pib.

Ob peb theem ntawm kev loj hlob ntawm macroangiopathy tuaj yeem paub qhov txawv. Ua ntej, tsuas muaj kev txawv txav thaum sawv ntxov, ua rau lub cev qaug zog, tsaug zog thiab qaug zog, zoo li txias ntawm sab hauv nqaj, tawm hws ntau thiab qee qhov tawv nqaij ntawm nqua tshwm sim. Cov no yog cov tsos mob ntawm kev them nyiaj hauv cov ntu hluav taws xob. Tom qab ntawd los txog theem ob, thaum ib tus neeg tuaj yeem khov khov heev, nws ob txhais ceg yog loog, saum npoo ntawm cov ntsia hlau tau tawg. Lameness tuaj yeem tshwm nyob rau theem no. Tom qab ntawv mob yuav tshwm sim ob qho tib si thaum tsiv thiab nyob hauv lub xeev txias. Qhov pom tseeb tshwm sim, daim tawv nqaij hloov ua daj ntseg thiab ua thinner. Pob qij txha muaj kev thab plaub. Ntawm cov theem kawg, tus mob caj dab yuav loj hlob ntawm ko taw, ntiv tes thiab sab ceg qis.

Kev kho mob ntawm angiopathy mob ntshav qab zib

Nrog rau cov ntshav qab zib micro- thiab macroangiopathy, cov ntsiab cai ntawm kev kho mob yog kwv yees li zoo sib xws. Ua ntej tshaj plaws, nws yog qhov yuav tsum tau nqa cov txheej txheem metabolic mus rau lub xeev ib txwm muaj kev noj qab haus huv. Nws yog qhov tseem ceeb heev uas yuav rov qab muaj cov metabolism hauv cov metabolism, vim tias nws yog hyperglycemia uas tuaj yeem cuam tshuam kev loj hlob ntawm atherosclerosis.

Lub hauv paus ntsiab lus thib ob hauv kev kho cov kab mob no yog kev tswj hwm ntawm tag nrho cov ntaub ntawv ntawm lipid metabolism. Yog tias theem ntawm lipoproteins, uas muaj qhov ntsuas qis tsis txaus, tau nce ntxiv thiab theem ntawm triglycerides tau tsawg dua, tom qab ntawd cov tshuaj uas muaj tshuaj hypolipidemic yuav tsum tau siv rau hauv kev kho mob. Cov no suav nrog antioxidants, fibrates, thiab statins.

Thaum kho macro- thiab microangiopathy mob ntshav qab zib mellitus, cov tshuaj uas muaj cov txiaj ntsig metabolic yog tsim nyog siv. Cov tshuaj no suav nrog trimetazidine. Cov tshuaj yeeb ntawm hom no tuaj yeem pab txhawb cov txheej txheem ntawm cov piam thaj oxidation hauv myocardium. Qhov no yog vim muaj qhov oxidation ntawm fatty acids.

Thaum kho cov micro- thiab macroangiopathy mob ntshav qab zib mellitus, cov tshuaj no tau raug tshaj tawm tias txhawb kev rov ua haujlwm ntawm cov ntshav txhaws hauv cov ntshav thiab ua rau cov ntshav muaj ntshav tsis khov. Qhov no yog qhov tsim nyog thiaj li hais tias cov ntshav tsis yog tuab heev hauv nws cov xwm yeem thiab tsis tsim kev txhaws cov hlab ntshav. Cov tshuaj no suav nrog ticlide, acetylsalicylic acid, heparin, dipyridamole, vazaprostan thiab lwm yam.

Nws kuj tseem tsim nyog siv cov tshuaj uas tuaj yeem ua kom ntshav nce siab. Yog tias nws tsis muaj dab tsi, mam li tswj thiab saib xyuas qhov ntsuas no yog qhov tsim nyog. Cov qib siab zoo tshaj hauv cov mob no yuav suav txog 130 txog 85 hli RT. Kos duab. Cov kev tiv thaiv zoo li no pab tiv thaiv kev txhim kho ntawm retinopathy thiab nephropathy. Ntxiv mus, qhov no yuav pab kom tsis txhob muaj teeb meem mob plawv lossis mob stroke. Ntawm cov tshuaj uas ua rau muaj qhov ceev ntawm lub siab, inhibitors, calcium channel antagonists thiab lwm yam tshuaj tau txawv.

»» No. 9-10 "99" »Cov Kws Kho Mob Tshiab

Nws tau tsim tsa hais tias lub pathogenesis ntawm kev mob plab (hauv xov tooj cua) hom kev rog, ua ke nrog hyperglycemia, insulin tsis kam (IR) thiab hyperinsulinemia (GI), yog vim muaj kev txo qis rau kev sib deev steroid-binding globulin, ib qho kev nce ntawm kev ua si ntawm androgens, uas ua rau muaj qhov nce ntawm qhov loj ntawm adipocytes thiab lawv cov insulin tsis kam.
Arterial hypertension (pom nyob rau hauv 40-60% ntawm cov neeg mob ntshav qab zib) yog qhov pib ua rau kev txhim kho cov ntshav qab zib nephropathy, uas ua rau kev cuam tshuam ntawm kev tshem tawm atherogenic feem ntawm lipoproteins thiab nrawm atherosclerosis.
Siv sijhawm ntev siv qee cov tshuaj antihypertensive yuav muaj qhov tsis zoo ntawm lipid thiab carbohydrate metabolism.
Hauv cov neeg mob ntshav qab zib, hypertriglyceridemia thiab ib qho kev txo qis hauv lipoproteins ntau ntom (HDL) tau pom, uas yog qhov muaj zog tshaj plaws thiab ywj pheej ntawm kev mob plawv.
Mob ntshav qab zib macroangiopathies (MA) raws li kev ua kom pom hauv zos thiab cov chaw kho mob tau muab faib ua pawg:
- vascular lesions ntawm lub plawv (mob plawv, mob ntshav qab zib myocardial infarction),
- cerebrovascular tus kab mob (mob sib ce thiab mob cerebrovascular)
- qhov txhab ntawm cov hlab ntsha peripheral, nrog rau cov leeg hauv qab (mob caj dab).
Kev nquag ntawm kev txhim kho ntawm MA hauv cov neeg mob ntshav qab zib yog 2-3 zaug siab dua ntawm cov tib neeg yam tsis muaj kev cuam tshuam ntawm cov metabolism.
Raven (Reaven) thawj zaug tau sau tseg qhov nquag sib xyaw ua ke ntawm hyperinsulinemia, hauv kev rog rog, mob ntshav qab zib, hypertriglyceridemia nyob rau hauv cov neeg mob uas tsis muaj peev xwm tiv taus teeb meem carbohydrate. Kev sib xyaw ua ke ntawm cov kev tsis zoo no yog hu ua metabolic syndrome "X".
Qhov ntau zaus ntawm kev txhim kho cov hlab plawv hauv cov txiv neej mob ntshav qab zib yog 2 zaug, thiab rau cov poj niam - 3 zaug ntau dua li zaus ntawm cov mob ntsig txog mob plawv hauv cov neeg tsis muaj teeb meem carbohydrate metabolism.
Qhov cov neeg tuag ntawm cov neeg mob ntshav qab zib los ntawm kab mob ntsws ua rau muaj hnub nyoog qis dua 55 xyoos yog 35%.
Kwv yees li ib nrab ntawm tag nrho cov tsis muaj mob qis dua txiav tawm yog ua rau cov neeg mob ntshav qab zib.

Lub tswvyim. Qhov tseeb ua rau kev loj hlob ntawm macroangiopathies hauv cov neeg mob ntshav qab zib

Ntshav qab zib mob macroangiopathies (MA) yog ib qho kev sib luag ntawm cov kab mob hauv cov neeg mob ntshav qab zib mellitus (DM), yog qhov tseem ceeb rau lawv txoj kev tuag thiab kev xiam oob khab. Tam sim no, pab pawg ntawm cov teeb meem no feem ntau hu ua "mob ntshav qab zib macrovascular."

Etiology thiab pathogenesis

Ib qho kev pheej hmoo ntawm kev tsim kab mob plawv hauv cov neeg mob ntshav qab zib yog vim muaj ntau yam. Lawv feem ntau muab faib ua cov tsis muaj tshwj xeeb - arterial hypertension (AH), rog rog, haus luam yeeb, lub cev tsis ua haujlwm, hyperlipidemia thiab kev mob siab - thiab cov tshwj xeeb - mob hyperglycemia, hyperinsulinemia, hloov pauv ntawm rheological yam ntxwv ntawm cov ntshav thiab vascular architectonics, microalbuminuria thiab kev ua txhaum ntawm cov lus teb coj los hloov ntawm cov hlwb hauv cov mob ntawm ischemia. Pom tseeb, kev sib cuam tshuam ntawm cov yam tseem ceeb ntawm ob pawg tseem ceeb ceev cov kev loj hlob ntawm atherosclerosis, uas yog morphological substrate ntawm MA.

Lub pathogenetic mechanisms nyob rau hauv txoj kev loj hlob ntawm MA yog tsis to taub tag nrho.

Chronic hyperglycemia (saib daim duab) zoo li yog qhov tseem ceeb rau kev tsim cov mob angiopathies. Hyperglycemia yog paub tias yuav ua rau tsis-enzymatic glycosylation ntawm cov protein los ua ib nrab hu ua Amadori khoom. Tom qab, Amadori cov khoom lag luam raug hloov qeeb thiab tsis muaj kev hloov pauv mus rau hauv cov sib txuas sib xyaw uas tau pom hauv cov nqaij sib txuas ntawm cov hlab ntsha, phospholipid tivthaiv ntawm LDL thiab ua ib feem ntawm cov qis hauv qab daus. Hauv qhov no, dawb radicals raug tsim uas muaj cov haujlwm muaj zog oxidative. Tag nrho cov no ua rau muaj kev nce ntxiv hauv permeability thiab txo qis hauv vascular elasticity, kev hloov pauv hauv kev ua haujlwm ntawm cov enzymes thiab lipoprotein metabolism. Glycosylated LDL yog qhov yooj yim oxidized thiab muaj kev sib txuam loj rau macrophages, uas ua rau kev tsim cov "ua npuas hlwb", uas yog lub hauv paus loj ntawm atherogenesis.

Cov ntshav coagulation system kuj cuam tshuam, uas nthuav tawm nws tus kheej hauv kev nce platelet kev ua si, hyperfibrinemia thiab qhov nce ntxiv ntawm yam V, VII, VIII, thiab ntshav fibrinolytic kev ua si tsawg. Qhov sib npaug ntawm qhov sib piv ntawm vasodilators (TSIS TAU, PG12) thiab vasoconstrictors (TxA2) muaj kev chim siab ntau. Cov txheej txheem uas tau teev cia ua rau kev tsim ntawm microthrombi, ua rau cuam tshuam hauv microcirculation thiab leeg txoj leeg ntshav.

Cov nta ntawm lub chaw kuaj mob

Kev puas tsuaj rau cov hlab ntshav hlab ntsha, hlab ntsha hlwb thiab hlab ntsha ntawm lub cev hauv cov neeg mob ntshav qab zib ua rau pathology ntawm qhov chaw sib piv.

Coronary mob plawv (CHD) yog qhov tseem ceeb ua rau tuag rau cov neeg mob ntshav qab zib. Cov kev soj ntsuam kab mob ntshav siab hauv ntshav qab zib muaj lawv tus yam ntxwv:

tib qhov kev mob ntawm cov hlab plawv hauv cov txiv neej thiab poj niam,
qhov xwm txheej siab ntawm "atypical" cov ntaub ntawv ntawm IHD (tsis hnov mob, tsis nco qab thiab lwm yam) thiab myocardial infarction, thiab vim li ntawd, qhov kev pheej hmoo loj ntawm "sai tuag lub plawv",
high zaus ntawm post-infarction teeb meem: cardiogenic poob siab, thromboembolic muaj teeb meem, kev tsim ntawm mob hnyav thiab mob mus ceev, mob sib dhos thiab conduction cuam tshuam, congestive plawv tsis ua hauj lwm,
kev pheej hmoo siab ntawm kev rov ua dua myocardial infarction,
nce 2 zaug hauv kev tuag ntawm myocardial infarction piv nrog cov neeg mob tsis mob ntshav qab zib.

Kab mob rau cov hlab ntshav tau pom nyob rau hauv 40-50% ntawm cov neeg mob NIDDM thiab qee zaus tsawg dua rau cov neeg mob IDDM. Feem ntau, nyob rau hauv cov neeg mob ntshav qab zib, ischemic cerebral infarction yog cai. Lub luag haujlwm tseem ceeb hauv kev tshwm sim ntawm cov teeb meem ntawm lub hlwb yog muab rau txoj hlab ntshav txhaws thiab microalbuminuria. Hauv cov neeg mob no, txoj kev pheej hmoo ntawm txoj kev mob stroke nce 2-3 zaug.

Kev kov yeej ntawm cov hlab ntsha ntawm qhov qis qis yog ib qho tshwm sim tsis tu ncua thiab tawm suab ntshav qab zib, qhov chaw kho mob tau tshwm sim los ntawm kev hloov kho claudication thiab ischemic ko taw. Kev nquag sib quas ntus nyob rau hauv cov txiv neej muaj ntshav qab zib yog 4 npaug ntau dua, thiab cov poj niam uas yog 6 npaug ntau dua li ntawm cov pej xeem. Kev cuam tshuam ntawm cov hlab ntsha ntawm qhov qis hauv qab ua rau mob hnyav ntawm lub plab hlaub, lub duav, thiab qee zaum hauv pob tw, tshwm sim los ntawm kev tawm dag zog lub cev. Nrog kev ua txhaum cai ntawm cov ntshav ntws, necrosis ntawm cov ntaub so ntswg ntawm ko taw thiab txhais ceg tuaj yeem tshwm sim, uas ua rau kev txhim kho kev mob qog. Tsawg tshaj tawm ntawm cov ntshav kev tso ntshav tawm mus nrog cov mob ntshav qab zib neuropathy thiab kev kis tus kab mob, uas ua rau mob rwj plab, ua rau kev rhuav tshem cov pob txha thiab cov nqaij mos.

Cov lus 3. Cov kev xaiv ntawm cov tshuaj rau kho ntawm dyslipidemia nyob rau hauv cov neeg mob uas mob ntshav qab zib mellitus

Cov kev ntsuas tseem ceeb rau kev tiv thaiv MA:

Txo kev haus cawv ntau,

Poob hauv cov neeg rog,

Kev qoj ib ce tas li,

Cov kev siv tshuaj kho mob yuav tsum ua kom pom tseeb tias muaj kev tswj hwm glycemic, kho kev mob ntshav siab, thiab kho kab mob dyslipidemia (Cov Lus 1). Undoubtedly qhov tseem ceeb yog qhov kho ntawm hyperglycemia. Muaj pov thawj ntawm cov txiaj ntsig zoo ntawm sulfonylurea kev npaj ntawm lipid metabolism thiab rheological zog ntawm cov ntshav. Biguanides yog cov tshuaj ntawm kev xaiv rau cov neeg mob rog nrog NIDDM. Qhov kev nqus ntawm cov tshuaj no yog los nrog poob phaus, txo qis hauv insulin tsis kam thiab nce ntxiv hauv cov fibrolytic kev ua haujlwm ntawm cov ntshav. Kev kho mob acarbose yog siv dav dav los kho kho tom qab hyperglycemia, thiab kuj txo qis triglycerides. Kev sib xyaw ua ke nrog kev kho mob sulfanylurea thiab tshuaj insulin kuj tseem tuaj yeem muaj cov txiaj ntsig zoo metabolic, txhim kho cov lipid profile. Txawm li cas los xij, nws tsis pom zoo kom siv cov koob tshuaj insulin siab hauv cov neeg mob NIDDM, vim tias qhov no tuaj yeem ua rau mob hyperinsulinemia ntev thiab nce ntshav atherogenicity. Kev kho mob ntshav siab yog qhov tseem ceeb hauv kev tiv thaiv MA. Kev kho cov ntshav siab yuav tsum pib nrog kev nce siab ntxiv ntshav siab dua 140/90 hli RT. Kos duab. Cov tshuaj nruab nrab tsis zoo yog qhov zoo dua - ACE inhibitors, calcium channel blockers, xaiv beta blockers. Kev siv ntawm thiazide diuretics thiab tsis xaiv-beta-blockers yuav tsum raug txwv vim muaj kev cuam tshuam rau cov piam thaj thiab lipid metabolism. Cov neeg mob uas muaj tus kab mob vascular tshwj xeeb tsis pom zoo kom sau ntawv xaiv cov beta-blockers.

Yog tias kev txhim kho ntawm dyslipidemia tsis ua tiav los ntawm kev soj ntsuam kev noj qab haus huv, kev noj zaub mov noj (Rooj 2), glycemic tswj thiab ntshav siab, ces kev siv tshuaj kho yog tsim nyog.

Lub hom phiaj ntawm kev kho lipid-txo qis nyob ntawm seb hom dyslipidemia (Cov Lus 3). Nrog rau kev nce ntxiv hauv cov roj (cholesterol) tag nrho thiab VLDL cov roj (cholesterol), HMG-CoA reductase inhibitors (statins) lossis cov resins yog cov xaj tau. Sequestrants ntawm cov kua tsib kua qaub yog siv tsawg dua, vim tias lawv tuaj yeem ua rau nce triglycerides. Hauv kev cais hypertriglyceridemia, fibrates thiab nicotinic acid analogues yog tshuaj. Qhov tom kawg tuaj yeem nce qib ntawm glycemia, uas yuav tsum ua tib zoo saib xyuas ntshav qabzib hauv thawj lub hlis ntawm kev kho mob. Kev cia siab ntau nyob rau hauv kev kho mob ntawm dyslipidemia yog txuam nrog cov tshuaj tshiab los ntawm cov pab pawg ntawm cov fibrates - gemfibrozil. Ntxiv nrog rau qhov lipid-txo cov nyhuv, cov tshuaj kuj tseem txo cov tshuaj insulin kuj, uas yog qhov tseem ceeb rau cov neeg mob NIDDM.

Tsis ntseeg, cov tshuaj uas txhim kho cerebral ntshav txaus, piv txwv li, instenon, vinpocetine, thiab lwm tus, muaj txiaj ntsig zoo heev rau kev tiv thaiv thiab kev kho mob ntawm cov hlab ntshav liab, uas feem ntau pom hauv cov neeg mob ntshav qab zib macroangiopathies. Qhov tshwj xeeb cog lus yog kev siv instenon. Cov tshuaj yog qhov txaus siab nrog kev sib koom ua ke ntawm vasoactive thiab neurotrophic cov neeg sawv cev uas tuaj yeem cuam tshuam ntau yam pathogenesis txuas ntawm hypoxic thiab ischemic lub hlwb puas, ua kom sai ntawm cov txheej txheem hauv cov kab mob hauv cov hlab ntsha thiab, tsis ncaj qha, los ntawm lwm cov kab ke thiab cov kabmob (ntsws, lub plawv, raum, thiab lwm yam), cuam tshuam zoo ntawm lub xeev ua haujlwm ntawm lub paj hlwb. Instenon cov cheebtsam muaj cov kev txhawb zog ntawm cov neurons ntawm qee cov qauv thiab cov hlwb ntawm lub hlwb, txhim kho microcirculation nyob rau hauv ischemic aav, thaiv cov hlab vasoconstriction ntawm intracranial arterioles thiab nce siab, ua rau lub cev ua haujlwm ntawm antiperoxidant, uas ua rau lub cev txo qis ntawm lipid peroxidation khoom, nce anaerobic glycolysis thiab nce thiab cov pa mus rau neurons. Hauv kev xaus, nws yuav tsum raug sau tseg tias kev tiv thaiv kev tiv thaiv txhawm rau txo qis kev pheej hmoo ntawm macroangiopathies ua lub luag haujlwm tseem ceeb hauv kev tiv thaiv kev txhim kho ntawm kev mob voos tsis meej.

Boris Vladimirovich Romashevsky - Department of Therapy rau Advanced Kev Kawm Kho Mob, Lavxias Medical Academy, St. Petersburg

Mob ntshav qab zib thiab siab surges yuav yog ib yam dhau los

Mob ntshav qab zib yog qhov ua rau ze li ntawm 80% ntawm tag nrho cov cwj nrag thiab txiav taws. 7 ntawm 10 leej neeg tuag vim txhaws ntawm cov hlab ntsha hauv plawv lossis paj hlwb. Yuav luag txhua qhov teeb meem, qhov laj thawj rau qhov txaus ntshai kawg no yog qhov qub - ntshav qab zib siab.

Cov piam thaj tuaj yeem thiab yuav tsum tau sib khob, tsis muaj dab tsi. Tab sis qhov no tsis kho tus kab mob nws tus kheej, tab sis tsuas yog pab txhawm rau txhawm rau tshawb xyuas, thiab tsis yog qhov ua kom muaj tus kab mob.

Cov tshuaj nkaus xwb uas raug pom zoo rau kev kho mob ntshav qab zib thiab nws kuj yog siv los ntawm endocrinologist hauv lawv txoj haujlwm yog qhov no.

Qhov ua tau zoo ntawm cov tshuaj, suav raws li tus qauv txheej txheem (tus naj npawb ntawm cov neeg mob uas tau zoo mus rau tag nrho cov neeg mob hauv pawg 100 ntawm cov neeg tau txais kev kho mob) yog:

Li qub ntawm qab zib - 95%
Kev tshem tawm ntawm cov hlab ntsha thrombosis - 70%
Ntaus tau ntawm lub plawv dhia muaj zog - 90%
Kev tshem tawm ntshav siab - 92%
Ntxiv dag zog rau nruab hnub, txhim kho pw tsaug zog thaum hmo ntuj - 97%

Cov neeg tsim khoom tsis yog lub koom haum ua lag luam thiab tau nyiaj peev nrog kev txhawb nqa los ntawm lub xeev. Yog li ntawd, tam sim no txhua tus neeg nyob hauv muaj qhov zoo.

Sab hauv phab ntsa ntawm cov hlab ntsha tau nyob hauv ntshav sib chwv. Nws sawv cev rau cov hlwb endothelial uas npog tag nrho saum npoo hauv ib txheej. Lub endothelium muaj qhov nruab nrab kho mob thiab cov nqaijrog ua kom txhawb lossis inhibit ntshav coagulation. Nws kuj ua haujlwm ua qhov thaiv - nws hla dej, lwg me me tshaj 3 nm, xaiv lwm yam tshuaj. Txoj kev no muab cov dej ntws thiab cov khoom noj haus rau hauv cov ntaub so ntswg, ntxuav lawv ntawm cov khoom lag luam metabolic.

Nrog angiopathy, nws yog endothelium uas txom nyem tshaj plaws, nws cov haujlwm yog kho tsis taus. Yog tias cov ntshav qab zib tsis tau tswj cia, cov ntshav qabzib hauv lub siab yuav pib rhuav tshem cov vascular. Kev fab tshuaj tshwj xeeb tshwm sim ntawm cov protein endothelial thiab ntshav qab zib - glycation. Cov khoom lag luam ntawm cov dej qabzib metabolism maj zuj zuj zuj zus mus rau hauv cov phab ntsa ntawm cov hlab ntsha, lawv tuaj tuab, o, tsis ua haujlwm raws li qhov thaiv. Vim tias qhov kev ua txhaum ntawm cov txheej txheem coagulation, cov ntshav txhaws pib tsim, vim li ntawd - txoj kab uas hla ntawm cov hlab ntsha poob qis thiab cov ntshav txav qis hauv lawv, lub siab ua haujlwm nrog kev nce siab, ntshav nce siab.

Cov hlab ntsha me me feem ntau yog cov puas tsuaj, lub ntsej muag cuam tshuam hauv lawv coj mus rau kev ua kom tsis muaj pa oxygen thiab khoom noj hauv lub cev. Yog tias nyob rau thaj chaw muaj mob angiopathy ntau heev hauv lub sijhawm tsis muaj kev hloov pauv ntawm cov hlab ntsha hauv lub cev nrog cov tshiab, cov ntaub so ntswg no atrophy. Kev tsis muaj oxygen tiv thaiv kev loj hlob ntawm cov hlab ntsha tshiab thiab ua kom nrawm nrawm ntawm cov khoom sib txuas.

Cov txheej txheem no muaj kev phom sij tshwj xeeb tshaj yog hauv lub raum thiab qhov muag, lawv cov kev ua tau tsis txaus ntseeg kom txog thaum ua tiav tag nrho ntawm lawv cov haujlwm.

Ntshav qab zib angiopathy ntawm cov hlab ntsha loj yog feem ntau nrog atherosclerotic cov txheej txheem. Vim tias cov roj ntsha tsis ua haujlwm, cov plahaum roj cholesterol yog tso rau ntawm phab ntsa, lub lumen ntawm cov hlab ntsha nqaim.

Yam kab mob kev loj hlob

Mob ntsws Angiopathy ua rau cov neeg mob uas muaj yam type 1 thiab type 2 mob ntshav qab zib tsuas yog tias cov ntshav qab zib ntau ntau nyob ntev. Lub sijhawm ntev dua ntawm glycemia thiab qhov ntau dua cov piam thaj hauv qab, kev hloov pauv sai sai hauv cov hlab ntsha pib. Lwm yam tuaj yeem ua rau tsuas yog ua rau chav kawm muaj mob, tab sis tsis ua rau nws.

Kev Tshawb Xyuas Angiopathy Kev Ntshaw	Lub tshuab ntawm cawv rau cov kab mob
Mob ntshav qab zib ntev	Qhov ntxim nyiam ntawm angiopathy nce nrog kev paub txog ntshav qab zib, vim tias cov hlab ntsha hloov zuj zus thaum sijhawm.
Lub hnub nyoog	Tus neeg mob laus dua, muaj kev pheej hmoo ntau dua ntawm kev tsim kab mob ntawm cov hlab ntsha loj. Cov tub ntxhais hluas mob ntshav qab zib feem ntau yuav muaj kev txom nyem los ntawm kev ua tsis taus ntshav ntawm lub plab hnyuv siab raum.
Vascular pathology	Kab mob viav vias nce ntxiv qhov mob ntawm mob tsis xwm yeem thiab pab txhawb nws txoj kev loj hlob sai.
Qhov Txaj Muag	Txhawb cov qib tshuaj insulin hauv cov ntshav nce siab ntxiv ntawm kev tsim cov quav hniav rau ntawm phab ntsa ntawm cov hlab ntshav.
Lub sijhawm luv luv coagulation sijhawm	Tsub kom qhov ntxim nyiam ntawm cov ntshav txhaws thiab capillary ntxaij tuag.
Tshaj qhov hnyav	Lub siab hnav tawm, qib roj thiab triglycerides hauv cov ntshav nce siab, cov hlab ntsha nqaim sai dua, cov hlab ntsha uas nyob deb ntawm lub siab tsis zoo rau cov ntshav ntxiv.
Ntshav siab	Txhim kho kev puas tsuaj ntawm phab ntsa ntawm cov hlab ntsha.
Haus Yeeb	Nws cuam tshuam nrog kev ua haujlwm ntawm lub zog tiv thaiv kab mob, txo qis qib pa hauv cov ntshav, ua kom muaj kev pheej hmoo ntawm atherosclerosis.
Sawv-sawv ua haujlwm, pw saum txaj.	Ob leeg tsis muaj kev tawm dag zog thiab ntau dhau ntawm kev sib tw ceg nrawm nrawm rau txoj kev txhim kho angiopathy nyob hauv qis qis.

Cov kabmob dab tsi cuam tshuam rau ntshav qab zib

Nyob ntawm seb cov nkoj twg cuam tshuam ntau tshaj plaws los ntawm tus yam ntxwv ntawm cov piam thaj hauv ntshav qab zib tsis txaus, angiopathy tau muab faib ua hom:

- sawv cev rau ib qho yeej ntawm cov hlab ntsha hauv glomeruli ntawm ob lub raum. Cov hlab ntsha no yog ntawm thawj qhov kev txom nyem, raws li lawv ua haujlwm hnyav thiab dhau los ntawm cov ntshav ntau dhau los ntawm lawv tus kheej. Raws li kev txhim kho kev mob caj dab, mob raum tsis ua haujlwm: ntshav lim los ntawm cov khoom lag luam hauv lub cev puas tsuaj, lub cev tsis ua tiav cov co toxins, cov zis tawm hauv cov ntim me, edema, constricting plab hnyuv siab raum yog tsim thoob plaws lub cev. Qhov txaus ntshai ntawm tus kab mob yog nyob rau qhov tsis muaj cov tsos mob hauv thawj theem thiab ua tiav poob ntawm lub raum ua haujlwm hauv qhov kawg. Tus kab mob tus lej raws li kev faib tawm ntawm ICD-10 yog 3.
Ntshav qab zib angiopathy ntawm qis qis dua - feem ntau muaj kev loj hlob raws li tus neeg mob ntshav qab zib hauv cov hlab ntsha me me. Cov kev mob ntshav khov uas ua rau trophic mob thiab mob caj dab tuaj yeem txhim kho txawm tias muaj kev cuam tshuam me hauv cov hlab ntsha tseem ceeb. Nws hloov tawm qhov teeb meem paradoxical: muaj ntshav hauv ob txhais ceg, thiab cov ntaub so ntswg yog tshaib plab, txij li lub capillary network raug rhuav tshem thiab tsis muaj sijhawm rov qab los vim yog cov ntshav qab zib tas li. Angiopathy ntawm qhov mob sab saud yog kuaj xyuas nyob rau hauv cov xwm txheej cais, vim tias tus neeg txhais tes ua haujlwm nrog qhov hnyav dua thiab ze rau lub siab, yog li ntawd, cov hlab ntsha hauv lawv tsis tshua puas thiab rov zoo dua. Txoj cai rau ICD-10 yog 10.5, 11.5.
- ua rau kev puas tsuaj rau cov hlab ntawm cov tshuaj retina. Zoo li nephropathy, nws tsis muaj cov tsos mob mus txog rau theem loj ntawm tus kab mob, uas yuav tsum tau kho nrog cov tshuaj kim thiab cov phais laser rau ntawm retina. Qhov tshwm sim ntawm vascular kev puas tsuaj hauv qhov muag tsis pom kev yog qhov muag plooj vim qhov o, qhov chaw txho xim txaij ntawm lub qhov muag vim hemorrhages, tshem tawm ntawm cov retina ua raws li kev dig muag vim yog ntog ntawm qhov chaw ntawm kev puas tsuaj. Kev mob ntsws lig xub thawj, uas tuaj yeem kuaj pom hauv qhov chaw kuaj xyuas tus kws kho mob, tau kho nws tus kheej nrog kev kho mob ntshav qab zib ntev ntev. Tus lej H0.
Ntshav qab zib angiopathy ntawm lub plawv hlab ntsha - ua rau angina pectoris (code I20) thiab yog qhov tseem ceeb ua rau kev tuag los ntawm cov mob ntshav qab zib. Atherosclerosis ntawm kev ua haujlwm ntawm cov hlab ntsha ua rau cov pa oxygen tshaib plab ntawm lub plawv, uas nws teb nrog nias, mob mob. Kev puas tsuaj ntawm cov hlab ntsha thiab lawv txoj kev tuaj tom ntej nrog kev sib txuas nrog cov nqaij mos ua rau lub zog ua haujlwm ntawm lub siab, mob siab cuam tshuam tshwm sim.
- ua txhaum ntawm cov ntshav mus rau lub hlwb, thaum pib pom los ntawm mob taub hau thiab qaug zog. Qhov ntev hyperglycemia, ntau dua qhov cov pa oxygen ntawm lub hlwb, thiab ntau nws cuam tshuam los ntawm cov dawb radicals.

Cov tsos mob thiab cov tsos mob ntawm mob ntsws

Thaum xub thawj, angiopathy yog asymptomatic. Txawm hais tias qhov kev rhuav tshem tsis raug cais, lub cev tswj kom loj hlob cov hlab tshiab los hloov qhov chaw puas. Thaum thawj zaug, preclinical theem, cov teeb meem metabolic tuaj yeem txiav txim siab tsuas yog los ntawm kev nce siab hauv cov ntshav thiab nce cov suab vascular.

Thawj cov tsos mob ntawm tus mob ntshav qab zib angiopathy tshwm sim ntawm cov theem ua haujlwm, thaum qhov chaw txhab ua ntau thiab tsis muaj sijhawm rov zoo. Cov kev kho mob pib thaum lub sijhawm no tuaj yeem hloov rov qab thiab rov ua tiav txoj haujlwm ntawm lub vascular network.

mob ceg tom qab lub nra ntev -,
loog thiab tingling hauv nqua,
cramps
tawv nqaij tawv ntawm taw
protein nyob hauv cov zis tom qab ua si lossis kev nyuaj siab,
me ntsis thiab qhov muag plooj,
mob taub hau tsis muaj zog, tsis zoo los yog ua kom loog.

Cov tsos mob uas tau hais tseeb tshwm sim thaum kawg, organic, theem ntawm angiopathy. Lub sijhawm no, cov kev hloov pauv ntawm cov kabmob cuam tshuam yog qhov tsis tuaj yeem hloov mus tau, thiab kev kho tshuaj kho mob tsuas tuaj yeem txo qis kev loj hlob ntawm tus kabmob.

Kev mob tas li hauv ob txhais ceg, lameness, puas rau ntawm daim tawv nqaij thiab cov rau tes vim tsis muaj zaub mov noj, o ntawm ko taw thiab plab hlaub, tsis muaj peev xwm nyob hauv qhov chaw sawv ntsug ntev ntev nrog angiopathy ntawm qis qis.
Siab, tsis zoo rau kev kho mob, ntshav siab, o ntawm lub ntsej muag thiab lub cev, nyob ib ncig ntawm cov kabmob sab hauv, intoxication nrog nephropathy.
Kev tsis pom kev zoo nrog rau retinopathy, pos huab ua ntej lub qhov muag los ntawm edema hauv ntshav qab zib angiopathy ntawm qhov chaw ntawm retina.
Kiv taub hau thiab tsaus muag vim yog lub cev khiav tsis xwm yeem, nkees thiab ua tsis taus pa vim lub plawv tsis ua hauj lwm, mob hauv siab.
Insomnia, nco tsis meej thiab kev sib koom tes ntawm kev txav mus los, txo qis ntawm kev paub lub peev xwm hauv lub hlwb angiopathy.

Cov tsos mob ntawm viav vias hauv cov nqua

Kev mob siab rau	Vim li cas
Tawv daj, txias ntawm daim tawv nqaij ntawm taw	Kev cuam tshuam capillary tseem tuaj yeem kho tau
Txhais ceg leeg tsis muaj zog	Qhov tsis txaus cov leeg noj zaub mov, qhov pib ntawm angiopathy
Liab ntawm taw, sov ntawm daim tawv nqaij	Kev mob o vim koom nrog ua mob
Tsis tshua muaj mem tes rau ntawm nqua	Qhov tseem ceeb nqaim ntawm cov hlab ntsha
Lub caij nyoog edema	Mob vascular ua kev puas tsuaj
Txo plab hlaub lossis ncej puab cov plaub hau, nres plaub hau kev loj hlob ntawm ob txhais ceg	Lub sijhawm ua pa oxygen tshaib plab
Tsis kho qhov txhab zoo	Ntau txoj kev puas tsuaj capillary
Cov rau tes dub xim	Mob ntsws angiopathy
Daim tawv nqaij xiav xiav ntawm nqua	Kev puas tsuaj hnyav, tsis muaj ntshav txaus, pib mob caj dab.

Cov Cwj Pwm Cim Ntshav Qab Zib Mob Microangiopathy

Thaum xav txog cov cim tseem ceeb ntawm microangiopathy, peb lub ntsiab tseem ceeb sawv, hu ua Virchow-Sinako triad. Cov cim no muaj dab tsi?

Cov phab ntsa ntawm cov hlab uas hloov pauv.
Ntshav coagulation yog qhov tsis taus.
Ntshav ceev poob qis.

Raws li cov txiaj ntsig ntawm cov ntshav ua haujlwm ntau ntxiv thiab nce ntshav ntxiv, nws dhau los ua viscous. Cov hlab ntsha noj qab haus huv muaj lub roj nplua nyeem tshwj xeeb uas tsis pub cov ntshav ua raws li cov phab ntsa. Qhov no saib kuas meej cov ntshav txaus.

Cov hlab ntsha uas cuam tshuam tsis tuaj yeem tsim cov roj nplua nyeem no, thiab ua rau ntshav khiav qeeb. Tag nrho cov kev ua txhaum no tsis yog ua rau kev puas tsuaj ntawm cov hlab ntsha xwb, tab sis kuj tseem yuav tsim cov microtubuses.

Nyob rau hauv tus txheej txheem ntawm kev tsim cov ntshav qab zib mellitus, qhov kev hloov pauv no muaj feem nrog ntau dua ntawm cov hlab ntsha. Feem ntau thaj tsam tseem ceeb ntawm kev puas tsuaj yog:

kabmob ntawm lub zeem muag
myocardium
ob lub raum
peripheral poob siab
daim tawv nqaij integument.

Qhov txiaj ntsig ntawm qhov kev ua txhaum no, raws li txoj cai, yog:

tshuaj mob hlwb
ntshav qab zib nephropathy,
kev mob plawv
dermatopathy.

Tab sis thawj cov tsos mob tshwm sim nyob rau hauv qis dua, uas tshwm sim los ntawm kev ua txhaum ntawm cov hlab ntshav hauv thaj chaw no. Kev cuv npe ntawm cov xwm txheej no yog kwv yees li 65%.

Qee tus kws kho mob nyiam sib cav hais tias microangiopathy tsis yog nyias muaj nyias tus kabmob, uas yog, nws yog qhov tsos mob ntawm tus mob ntshav qab zib. Tsis tas li ntawd xwb, lawv ntseeg hais tias microangiopathy yog qhov tshwm sim ntawm neuropathy, uas tau tshwm sim ua ntej.

Lwm cov kws tshawb fawb hais tias cov hlab ntsha ischemia ua rau mob neuropathy, thiab qhov tseeb no tsis cuam tshuam nrog vascular puas tsuaj. Raws li txoj kev xav no, mob ntshav qab zib mellitus ua rau mob neuropathy, thiab microangiopathy tsis muaj dab tsi ua rau nws.

Tab sis kuj tseem muaj qhov kev tshawb xav thib peb, cov neeg ua raws li uas sib cav hais tias ib qho kev ua txhaum ntawm cov hlab ntsha ua haujlwm yuav ua rau cov ntshav tsis ua haujlwm.

Cov kab mob ntshav qab zib microangiopathy muab faib ua ntau hom, uas tshwm sim los ntawm cov teeb meem ntawm kev puas tsuaj rau cov qis qis.

Nrog rau qhov "zero degree" ntawm kev puas tsuaj rau daim tawv nqaij ntawm tib neeg lub cev.
Thawj theem - muaj qhov khuam me me ntawm daim tawv nqaij, tab sis lawv tsis muaj cov txheej txheem ua mob thiab muaj kev sib txuam hauv cheeb tsam.
Ntawm qib ob, qhov txhab tawv nqaij ntxiv pom tshwm tuaj yeem ua rau tob zuj zus kom lawv thiaj li ua rau cov nqaij pob txha thiab pob txha puas.
Qeb qib thib peb yog tus cwj pwm ntawm cov tawv nqaij ua paug thiab thawj cov tsos mob ntawm cov ntaub so ntswg tuag rau ntawm txhais ceg. Cov teeb meem zoo li no tuaj yeem tshwm sim ua ke nrog cov txheej txheem ua mob, mob, edema, hyperemia, mob qog nqaij hlav thiab txha osteomyelitis.
Hauv qib plaub, tus neeg caj dab ntawm ib lossis ntau tus ntiv tes pib tsim.
Qib tsib yog tag nrho ko taw, lossis nws feem ntau cuam tshuam los ntawm kev lom zem.

Cov yam ntxwv ntawm tus yam ntxwv macroangiopathy

Lub hauv paus tseem ceeb hauv kev tuag ntau ntawm cov neeg mob ntshav qab zib yog mob ntshav qab zib macroangiopathy. Nws yog macroangiopathy feem ntau tshwm sim hauv cov neeg mob ntshav qab zib.

Ua ntej tshaj plaws, cov hlab ntsha loj ntawm cov qis qis tau cuam tshuam, qhov txiaj ntsig ntawm qhov mob hlab ntsha hlwb thiab lub hlwb.

Macroangiopathy tuaj yeem txhim kho nyob rau hauv tus txheej txheem ntawm nce tus nqi ntawm kev loj hlob ntawm cov kab mob atherosclerotic. Tus kabmob raug faib rau ntau theem ntawm txoj kev loj hlob.

Nyob rau thawj theem, thaum sawv ntxov tus neeg mob tau qaug zog ntau dhau, tawm hws ntau dhau, qaug zog, nkees nkees, zoo nkaus li mob khaub thuas ntawm cov ceg tawv thiab lawv loog. Qhov no taw qhia them nyiaj nyob rau hauv kev xa xov peripheral.
Hauv theem ob, ib tus neeg txhais ceg pib loog, nws khov heev, lub ntsej muag ntsia hlau pib tawg. Qee lub sijhawm lameness tshwm nyob rau theem no. Tom qab ntawd muaj qhov mob nyob rau hauv cov nqua, ob qho tib si thaum taug kev thiab thaum so. Cov tawv nqaij yuav daj thiab nyias. Kev tsis sib haum xeeb hauv kev ua haujlwm ntawm cov pob qij txha tau pom.
Theem kawg yog mob caj dab hauv ntshav qab zib ntawm txhais taw, ntiv tes thiab sab ceg qis.

Yuav kho cov mob angiopathy li cas

Macro thiab microangiopathy mob ntshav qab zib yog kho tib yam ib yam. Thawj qhov uas ib tus neeg mob yuav tsum tau ua yog coj cov txheej txheem hauv lub cev ntawm lub cev mus rau lub xeev ib txwm muaj. Carbohydrate cov metabolism yuav tsum tau rov qab, vim tias hyperglycemia yog qhov laj thawj tseem ceeb ntawm kev txhim kho ntawm atherosclerosis ntawm cov hlab ntshav.

Sib luag tseem ceeb hauv kev kho mob yog saib xyuas lub xeev ntawm lipid metabolism. Yog tias theem ntawm lipoproteins nrog qhov ntsuas qis tsawg sai mam li nce, thiab theem ntawm triglycerides, ntawm qhov tsis tooj, poob qis, qhov no qhia tias nws yog lub sijhawm suav nrog cov tshuaj hypolipidic hauv kev kho mob.

Peb tab tom hais txog statins, fibrates thiab tshuaj tua kabmob. Macro- thiab microangiopathy mob ntshav qab zib mellitus yog kho nrog lub luag haujlwm tso nrog kev kho mob ntawm cov tshuaj metabolic, piv txwv li, trimetazidine.

Cov tshuaj no pab txhawb rau cov txheej txheem ntawm oxidation ntawm cov piam thaj nyob rau hauv myocardium, uas tshwm sim vim lub oxidation ntawm fatty acids. Thaum lub sij hawm kho ob hom mob, cov neeg mob tau muab tshuaj rau cov tshuaj anticoagulants.

Cov no yog cov tshuaj uas pab daws cov ntshav txhaws hauv cov hlab ntshav thiab ua kom cov ntshav tsis muaj zog thaum kuaj pom tias muaj mob macroangiopathy.

Ua tsaug rau cov tshuaj no, cov ntshav tsis tau txais cov tuab sib xws thiab cov kev txwv rau cov ntshav txhaws tsis tau tsim. Anticoagulants suav nrog:

Acetylsalicylic acid.
Tiklid.
Vazaprostan.
Heparin.
Dipyridamole.

Tseem Ceeb! Txij li thaum kub siab yog yuav luag ib txwm muaj nyob rau hauv cov ntshav qab zib mellitus, nws yog ib qho tsim nyog yuav tau sau tshuaj noj uas ua rau muaj ntshav siab. Yog tias qhov ntsuas no zoo li qub, nws tseem pom zoo kom soj ntsuam nws tas li.

Hauv cov ntshav qab zib mellitus, cov txiaj ntsig zoo yog ntawm 130/85 hli Hg. Cov kev tswjfwm zoo no yuav pab tivthaiv kom tsis txhob mob hlwb thiab kho hlwb sai sai, txo qis kev pheej hmoo ntawm mob stroke thiab lub plawv nres.

Ntawm cov tshuaj no, calcium channel antagonists, inhibitors thiab lwm yam tshuaj muaj qhov txawv txav.

Thaum kho, nws yog ib qho tsim nyog yuav tsum tau ua kom tau ntawm qhov ntsuas ntawm autonomic homeostasis. Rau qhov no, cov kws kho mob tau sau ntawv rau cov tshuaj uas ua rau kom muaj kev ua haujlwm ntawm sorbitol dehydrogenase. Nws yog qhov sib npaug tseem ceeb los ua cov haujlwm uas txhawb kev tiv thaiv antioxidant.

Yog lawm, nws yog qhov zoo tshaj rau kev tiv thaiv kab mob thaum pib. Txhawm rau ua qhov no, koj yuav tsum ua tus coj txoj kev ua neej thiab soj ntsuam koj txoj kev noj qab haus huv tas li. Tab sis yog tias pom muaj ntshav qab zib txawm li ntawd tshwm sim, koj yuav tsum tau hu rau lub tsev kho mob tam sim ntawd.

Niaj hnub nimno txoj kev kho mob ntshav qab zib thiab kev pab tiv thaiv kom tus neeg tau txais kev tiv thaiv kom tsis txhob muaj kev phom sij li macro- thiab microangiopathy.