Kev puas tsuaj rau cov hlab ntshav ntawm lub plawv (mob plawv), qhia nyob rau hauv kev txhim kho angina pectoris (kab mob tshwm sim los ntawm qhov mob los yog tsis xis nyob tom qab lub pob tw vim kev ua txhaum ntawm cov ntshav xa mus rau lub plawv), myocardial infarction (kev tuag ntawm ib feem ntawm lub plawv), mob plawv tsis ua haujlwm (tsis ua haujlwm ntawm lub plawv).
Clinically manifested:
- kev mob siab ntawm kev nias, nrawm, hlawv qhov nyob hauv thaj av ntawm lub plawv, qab lub pob tw, tshwm sim los ntawm kev tawm dag zog lub cev (raws li tus kab mob nce zuj zus thiab thaum so), dhau ntawm kev so lossis tom qab siv tshuaj ntawm cov pab pawg nitrate (txhim kho ntshav ncig mus rau lub plawv),
- ua tsis taus pa - thaum xub thawj nrog kev tawm dag zog lub cev, zoo li tus kab mob no zuj zus thiab thaum so,
- o ntawm ob txhais ceg
- kev cuam tshuam nyob rau hauv kev ua haujlwm hauv lub siab,
- nce hauv cov hlab ntsha (ntshav) siab,
- cov ntaub ntawv tsis muaj mob ntawm myocardial infarction (kev tuag ntawm ib feem ntawm cov leeg lub plawv), uas feem ntau pom muaj nyob rau hauv cov ntshav qab zib mellitus vim yog qhov tsis muaj peev xwm ua haujlwm ntawm cov hlab hlwb kawg.
Kev puas tsuaj rau cov hlab ntsha ntawm lub paj hlwb (kab mob cerebrovascular):
- mob taub hau
- kiv taub hau
- tsis nco qab, saib tsis taus,
- mob hlab ntsha tawg yog qhov ua txhaum loj ntawm cov hlab hlwb nrog txoj kev tuag ntawm ib feem ntawm lub hlwb.
Kev puas tsuaj rau cov ntsha ntawm qhov qis qis:
- tes taw mob
- lameness
- ulcerative teem meem (ua txhaum ntawm kev ncaj ncees ntawm daim tawv nqaij),
- kev tuag ntawm cov ntaub so ntswg (mob qog) - lub cev ntas dub, nws lub luag haujlwm yog qhov ploj kiag li.

Lub xub ntiag ntawm cov ntshav qab zib mellitus (ib qho kabmob uas muaj cov ntshav ntshav siab) ua rau muaj kev cuam tshuam ntawm ntau yam metabolism hauv lub cev, uas ua rau tus neeg mob txoj kev pheej hmoo ua rau vascular puas tsuaj. Hauv kev sib sau ua ke, muaj qhov nce ntawm kev txhim kho atherosclerosis (kev tso nyiaj ntawm cov plahaum cov plahaum ntawm cov hlab ntsha) nrog kev puas tsuaj feem ntau cov hlab ntsha hauv lub plawv, lub paj hlwb, thiab qis qis.

Feem ntau cov kev pheej hmoo rau tus mob atherosclerotic vascular:

haus luam yeeb
haus cawv
nce hauv cov hlab ntsha (ntshav) siab,
rog dhau
cov ntsiab lus siab ntawm lipids (cov roj (cholesterol thiab lwm yam rog) hauv cov ntshav,
cov kab mob muaj keeb (muaj cov atherosclerosis hauv cov txheeb ze cov ntshav),
hnub nyoog (tshaj 50 xyoo)
atrial fibrillation (lub suab tsis sib haum lub plawv).

Qhov muaj feem ua rau mob atherosclerotic vascular kab mob vim ntshav qab zib mellitus:

ntshav qabzib cov ntshav
theem siab ntawm cov insulin (yam tshuaj lub luag haujlwm ua rau txo cov ntshav piam thaj) hauv cov ntshav,
insulin tsis kam - "lub cev tsis muaj zog" rau kev ua ntawm insulin,
ntshav qab zib nephropathy - raum puas nyob rau hauv cov ntshav qab zib mellitus,
lub sij hawm ntev kab mob ntshav qab zib.

Tus kws kho mob endocrinologist yuav pab kho tus mob

Kev kuaj mob

Kev soj ntsuam cov lus yws kab mob:
- kev mob siab ntawm kev nias, nrawm, hlawv qhov nyob hauv thaj av ntawm lub plawv, qab lub pob tw, tshwm sim los ntawm kev tawm dag zog lub cev (raws li tus kab mob nce zuj zus thiab thaum so), dhau ntawm kev so lossis tom qab siv tshuaj ntawm cov pab pawg nitrate (txhim kho ntshav ncig mus rau lub plawv),
- ua tsis taus pa - thaum xub thawj nrog kev tawm dag zog lub cev, zoo li tus kab mob no zuj zus thiab thaum so,
- o ntawm ob txhais ceg
- kev cuam tshuam nyob rau hauv kev ua haujlwm hauv lub siab,
- nce hauv cov hlab ntsha (ntshav) siab,
- mob taub hau
- kiv taub hau
- tsis nco qab, saib tsis taus,
- tes taw mob
- lameness.
Kev txheeb xyuas txog keeb kwm kev kho mob (keeb kwm kev loj hlob) ntawm tus kab mob: cov lus nug txog seb tus kab mob no pib thiab txhim kho li cas, ntev npaum li cas cov ntshav qab zib tau pib.
Kev tshuaj xyuas dav dav (ntsuas ntshav siab, ntsuas ntawm daim tawv nqaij, mloog lub siab nrog lub xov tooj, lub suab ntawm cov hlab ntsha ntawm qhov qis qis).
Kev txiav txim siab txog qib uas cov cholesterol thiab lwm cov lipids (cov rog) hauv cov ntshav.
Kev kuaj mob kev puas tsuaj rau cov kab mob plawv:
- ECG (electrocardiography),
- Holter ECG xyuas (thaum nruab hnub),
- kev ntsuam xyuas kev ntxhov siab - saib xyuas ntawm ECG, cov mem tes, ntshav siab, ib txwm muaj kev noj qab haus huv ntawm tus neeg mob nyob rau hauv kev nce ntawm cov khoom siv tshwj xeeb (tsheb kauj vab, tsheb taw),
- Txoj kev mob rau lub cev yog txoj kev tshawb fawb uas tso cai rau koj los soj ntsuam cov hlab ntshav ntawm lub plawv los ntawm sab hauv uas siv cov cuab yeej tshwj xeeb ntxig los ntawm cov leeg.
Rau kev kuaj mob ntawm cov kab mob cerebrovascular:
- ultrasound ntawm cov hlab ntsha ntawm lub taub hau thiab caj dab,
- CT (xaj tomography) lossis MRI (sib nqus resonance duab) ntawm lub hlwb.
Txhawm rau kuaj mob vascular txhab ntawm qis qis:
- kev kuaj mob ntawm cov hlab ntsha hauv qab qis dua,
- Xoo hluav taws xob xoo hluav taws xob angiography - kev kawm txog cov hlab ntshav siv tus neeg sawv cev sib piv rau cov hlab, tom qab xoo hluav taws xob tas.
Kev tswj cov ntshav khov ntawm cov piam thaj (ntsuas cov ntshav qab zib thaum nruab hnub).
Kev sab laj ntawm tus neurologist, kws kho plawv, phlebologist tseem tuaj yeem.

Kev kho mob ntshav qab zib macroangiopathy

Kev kho mob ntshav qab zib mellitus (ib tug kab mob uas muaj cov ntshav qabzib ntau dua).
Kev noj haus nrog kev txwv ntsev, protein, carbohydrates, cov rog rog.
Txiav kev haus luam yeeb thiab haus dej haus cawv.
Cov haujlwm qoj ib ce (tsis ua rau mob tawm tsam angina (ib qho kab mob tshwm sim los ntawm qhov mob lossis tsis xis nyob tom qab lub pob tw vim kev ua txhaum ntawm cov ntshav xa mus rau lub siab)).
Cov taug kev niaj hnub hauv huab cua ntshiab.
Txo hauv qhov hnyav dua.
Anti-ischemic tshuaj uas txo qhov xav tau myocardium (mob plawv) hauv oxygen.
Tshuaj rau txo cov leeg ntawm cov ntshav (ntshav).
Tshuaj uas ua kom cov lipid muaj pes tsawg leeg ntawm cov ntshav (txo cov roj (cholesterol) thiab lwm cov rog).
Tshuaj uas tiv thaiv kom ntshav txhaws ntau.
Cov tshuaj Neurotropic (txhim kho kev noj zaub mov ntawm lub paj hlwb).
Cov tshuaj vasodilator.
Kev kho mob phais: yog tias muaj kev puas tsuaj loj rau cov hlab ntsha ntawm lub plawv thiab qis qis kawg nrog cov cuab yeej atherosclerotic plaques, qhov zais pa angioplasty thiab stenting ntawm cov hlab ntsha tau ua - tshem tawm ntawm cov nqaij leeg (atherosclerotic plaque thiab stent tso kawm (tsim tshwj xeeb uas txhawb lub lumen ntawm lub nkoj hauv qhov xwm txheej).
Nrog rau kev txhim kho kev mob caj dab (nqaij tuag) - txiav tes ntawm taw.

Microangiopathy yog dab tsi?

Hauv tib neeg lub cev muaj ntau phav phav cov kab ntsha me me, uas muaj cov hlab ntsha, cov hlab ntsha thiab leeg ntshav. Lawv ntxias txhua tus xovtooj ntawm cov plab hnyuv siab raum, nqa lawv cov tshuaj muaj txiaj ntsig thiab tshem txhua yam tsis tseem ceeb. Qhov no ua kom zoo tib yam kev ua haujlwm hauv cov hlwb thiab hauv lub cev tag nrho. Thaum pathological hloov pauv hauv cov hlab ntsha me tuaj ntawm lub hauv paus ntawm kev mob ntshav qab zib mus ntev ntev, mob ntshav qab zib microangiopathy kuaj tau. Nrog rau cov mob no, qhov cuam tshuam tshaj plaws yog:

Microangiopathy txhim kho qhov tseeb los ntawm qhov tseeb tias cov piam thaj hauv cov ntshav, cov ntsiab lus ntawm cov ntshav hauv cov neeg mob ntshav qab zib tau nce ntxiv, ua rau kev puas tsuaj ntawm endothelium ntawm phab ntsa ntawm cov hlab ntsha. Cov khoom kawg ntawm cov metabolism hauv qabzib yog sorbitol thiab fructose. Ob qho ntawm cov tshuaj no nkag mus rau cov keeb kwm tsis zoo rau lub cell cell, thiab vim li ntawd pib tsub zuj zuj hauv cov hlwb endothelial. Qhov no ua rau cov pathologies:

- o ntawm cov hlab ntsa,

- nce permeability ntawm phab ntsa,

- ib qho kev txo qis ntawm cov khoom lag luam ua si ntawm qhov xaus ntawm endothelium, tsim nyog rau kev so ntawm cov leeg nqaij hauv cov hlab ntsha.

Yog li, endothelium tau puas thiab cov ntshav ntws qeeb, uas ua rau kom muaj kev sib xyaw siab. Qhov no yog hu ua Virchow Triad.

Kev faib tawm thiab kuaj mob nthuav tawm

Ntshav qab zib macroangiopathy tuaj yeem muaj ntau txoj hauv kev loj hlob. Txhua daim ntawv ntawm pathology yog tsiag ntawv los ntawm tej yam ntxwv.

Nrog kev puas tsuaj rau cov hlab ntsha, qhov tshwm sim ntawm angina pectoris yog cai. Qhov kev ua txhaum no yog txuam nrog kev ua txhaum ntawm cov txheej txheem kev pabcuam ntshav. Nws ua tau nws tus kheej hauv daim ntawv ntawm kev mob siab hauv pob tw. Kuj tseem muaj kev pheej hmoo ntawm kev tsim myocardial infarction thiab mob plawv nres.

Daim ntawv ntawm pathology yog tsiag ntawv los ntawm cov kev qhia:

Kev nias, hlawv, nyem qhov mob ntawm ib cheeb tsam ntawm lub siab thiab hauv pob tw. Nyob rau theem pib ntawm kev txhim kho tus kabmob, lawv tshwm sim nkaus xwb nrog kev tawm dag zog lub cev. Raws li nws loj hlob, tsis xis nyob yog tam sim no nyob rau hauv lub xeev siab txawm tias tom qab siv yeeb tshuaj los ntawm qeb ntawm nitrates.
Txog siav. Thaum xub thawj, nws raug pom tsuas yog nyob rau hauv lub nra hnyav, thiab tom qab ntawd ces nyob hauv lub xeev khov kho.
O o ntawm cov ceg.
Kev ua haujlwm tsis zoo ntawm lub siab.
Ua rau cov ntshav siab ntxiv.
Tsis mob plawv. Qhov kab ke no feem ntau pom nyob rau hauv cov ntshav qab zib. Qhov no yog vim muaj qhov ua tsis zoo ntawm cov hlab ntaws.

Kev puas tsuaj rau cov hlab ntsha ntawm lub hlwb yog hu ua cerebrovascular pathology. Nrog nws txoj kev loj hlob, cov kev qhia pom muaj:

Mob taub Hau.
Deterioration ntawm kev tshaj tawm.
Kiv taub hau
Lub cim xeeb ua kom tsis muaj zog.
Mob stroke Nyob rau hauv cov lus no tau to taub qhov kev ua txhaum tsis txaus ntawm lub hlwb mus ncig, uas yog qhov kev tuag ntawm qee thaj chaw.

Ntshav qab zib macroangiopathy ntawm qis qis entails xws li kev nthuav qhia:

Mob hauv ceg.
Qhov txhab mob txhab. Thaum lawv tshwm sim, kev ncaj ncees ntawm daim tawv nqaij yog qhov tsis taus.
Tswm sib.
Kev tuag ntawm cov ntaub mos muag. Thaum kev sib tw lub cev tsis haum tshwm sim, txhais ceg ua dub thiab ua tsis tau txhua yam.

Cov hau kev kho

Lub hom phiaj ntawm kev kho cov kab mob no yog ua kom qeeb ntawm kev txhim kho kev phom sij los ntawm cov hlab ntsha, tuaj yeem ua rau muaj mob xiam oob qhab ntawm tus neeg mob lossis tuag. Lub hauv paus ntsiab lus tseem ceeb hauv kev kho tus mob no yog kev kho ntawm cov mob no:

Hypercoagulation
Qog Ntshav,
Arterial kub siab,
Dyslipidemia.

Txhawm rau txhawm rau txhim kho kev mob ntawm ib tus neeg, lipid-txo cov tshuaj yog kws kho. Cov no suav nrog fibrates, statins, tshuaj tiv thaiv kab mob. Ntawm tsis muaj qhov tseem ceeb me me yog kev pom ntawm kev noj zaub mov, uas cuam tshuam nrog kev txwv tsis pub cov tsiaj rog cov rog.

Nrog rau qhov kev hem thawj siab ntawm thromboembolic teebmeem, nws tsim nyog siv tshuaj tiv thaiv antiplatelet. Cov no suav nrog heparin thiab pentoxifylline. Cov kws kho mob feem ntau kho cov tshuaj acetylsalicylic acid.

Antihypertensive kev kho mob nrog kev kuaj mob no yog nqa tawm kom ua tiav thiab tswj kev ua haujlwm siab. Nws yuav tsum nyob tas li ntawm cov theem ntawm 130/85 hli RT. Kos duab. Yuav kom daws tau qhov teeb meem no, ACE inhibitors, captopril, yog siv.

Koj kuj yuav tsum tau siv tshuaj diuretics - furosemide, hydrochlorothiazide. Cov neeg mob uas tau myocardial infarction tau txais kev kho mob beta-blockers. Cov no suav nrog atenolol.

Kev kho qhov mob ntawm thiav txhab ntawm qhov mob kawg yuav tsum tau nqa tawm los ntawm kev saib xyuas ntawm ib tus kws phais neeg. Hauv kev mob vascular hnyav, kev saib xyuas hnyav yog muab. Yog tias muaj pov thawj, kev phais yuav ua tau.

Teeb meem

Qhov kev hem thawj ntawm macroangiopathy muaj tseeb dua hauv cov neeg uas muaj ntshav qab zib hom 2. Txoj kev pheej hmoo ntawm kev tuag los ntawm cov kab mob ntawm cov kab mob no yog 35-75%. Nyob rau hauv ib nrab ntawm kis, kev tuag tshwm sim los ntawm myocardial infarction.

Qhov tsis txaus ntseeg tau yog thaum 3 lub chaw mob vascular - lub hlwb, ceg, thiab lub siab - cuam tshuam ib txhij. Ntau tshaj li ib nrab ntawm txhua txoj haujlwm nqaj qis ntawm kev txiav tawm yog txuam nrog macroangiopathy.

Nrog kev puas tsuaj ntawm ob txhais ceg, ulcerative tsis xws luag yog cai. Qhov no tsim ua ntej kev xav tau rau qhov tsim ntawm mob ntshav taw. Nrog kev puas tsuaj rau cov hlab ntsha cov hlab ntsha, cov hlab ntsha thiab cov pob txha pob txha, necrosis tau pom thiab cov txheej txheem purulent tshwm.

Cov tsos ntawm trophic mob rau sab hauv sab ceg yog vim muaj kev cuam tshuam ntawm cov hlab ntsha hauv cov hlab ntsha cuam tshuam ntawm ob txhais ceg. Qhov chaw khoob khoob khoob khawm feem ntau yog qhov chaw ntiv taw loj.

Kev hnov mob nrog rau cov tsos mob ntawm tus mob ntshav qab zib tsis ua rau pom nws tus kheej ntau dhau. Tab sis thaum cov lus tim khawv tshwm, nws tsis tsim nyog rau ncua sijhawm ua haujlwm. Txawm tias qeeb me ntsis yog fraught nrog lub caij nyoog kho ntawm qhov txhab. Qee lub sij hawm nws yog qhov tsim nyog los ua txoj kev cuam tshuam kev phais mob thib ob.

Kev tiv thaiv kev ntsuas

Txhawm rau tiv thaiv cov tsos ntawm tus kab mob no, yuav tsum muaj cov lus pom zoo:

Yuav tsum ncav sijhawm rau ntshav qab zib
Ua raws li kev noj haus uas koom nrog kev txwv cov khoom noj protein, carbohydrates, ntsev thiab cov khoom noj muaj roj,
Nquag lub cev hnyav
Tsis xam kev haus luam yeeb thiab haus dej haus cawv,
Muab cov kev tawm dag zog me ntsis, uas tsis yog qhov ua rau pom kev tshwm sim ntawm cov tsos mob ntawm angina pectoris,
Txhua hnub rau taug kev hauv huab cua ntshiab
Muab kev tshuaj ntsuam xyuas zoo ntawm cov ntsiab lus lipid - ib zaug txhua 6 lub hlis,
Ua qhov kev soj ntsuam zoo ntawm cov piam thaj hauv ntshav - qhov ntsuas no yuav ntsuas ib hnub.

Kev loj hlob ntawm macroangiopathy mob ntshav qab zib yog qhov xwm txheej tshwm sim. Cov kab mob no yog fraught nrog cov tsos ntawm qhov yuav muaj kev phom sij thiab tuaj yeem ua rau tuag taus. Yog li, nws yog ib qho tseem ceeb heev rau kev koom nrog nws kev tiv thaiv, thiab yog tias pom cov tsos mob tshwm sim, sab laj nrog tus kws kho mob tam sim ntawd.

Ntshav qab zib macroangiopathy

Ntshav qab zib macroangiopathy - generalized atherosclerotic hloov kev txhim kho hauv cov hlab ntsha ntawm nruab nrab thiab loj caliber tiv thaiv keeb kwm ntawm ib chav ntev ntawm cov ntshav qab zib mellitus. Mob ntshav qab zib macroangiopathy ua rau cov kab mob ntawm cov hlab ntshav txhaws, kev mob ntshav tawm ntawm cov hlab ntsha, cov kab mob cerebrovascular, qhov txhab txhab ntawm cov hlab ntsha txhaws. Kev kuaj mob ntshav qab zib macroangiopathy suav nrog kev kawm txog lipid metabolism, ultrasonography ntawm cov hlab ntsha ntawm qhov kawg, mob hlab ntsha hauv lub raum, lub raum, ECG, echocardiography, thiab lwm yam. Cov hauv paus ntsiab lus tseem ceeb ntawm kev kho mob ntshav qab zib macroangiopathy yog kev kho tus mob hyperglycemia, dyslipidemia, ntshav siab tswj, thiab txhim kho ntshav rheological.

Cov ntaub ntawv dav dav

Kev mob ntshav qab zib macroangiopathy ua rau mob ntshav qab zib mellitus, uas ua rau muaj kev mob hlwb ntau ntawm cov hlab hlwb, mob rau lub plawv, mob raum thiab mob txha ntshav. Clinically, mob ntshav qab zib macroangiopathy qhia nyob rau hauv txoj kev loj hlob ntawm angina pectoris, myocardial infarction, ischemic strokes, renovascular tawg, thiab ntshav qab zib mob caj dab. Diffuse vascular qhov kev puas tsuaj yog qhov tseem ceeb hauv kev soj ntsuam cov ntshav qab zib mellitus, nce kev pheej hmoo ntawm mob hlab ntsha ntshav siab thiab mob hlab ntshav txha ntshav 2-3 zaug, ceg tawv nqaij txhaws - los ntawm 20 zaug.

Atherosclerosis, uas tshwm sim hauv cov ntshav qab zib mellitus, muaj qee tus tshwj xeeb. Hauv cov ntshav qab zib, nws tshwm sim 10-15 xyoo ua ntej dua rau cov tib neeg uas tsis raug kev txom nyem los ntawm cov kev ua kom yuag yuag, thiab nce nrawm dua. Rau cov mob ntshav qab zib macroangiopathy, feem ntau qhov txhab tshwm sim feem ntau ntawm cov hlab ntsha (mob caj pas, hlab hlwb, visceral, peripheral) yog qhov raug. Hauv qhov no, kev tiv thaiv thiab kho cov mob ntshav qab zib macroangiopathy yog qhov tseem ceeb tshaj plaws hauv endocrinology.

Hauv cov kab mob ntshav qab zib macroangiopathy, cov kab mob hauv qab daus ntawm cov hlab ntsha ntawm nruab nrab thiab loj caliber thickens nrog kev tsim cov atherosclerotic plaques rau nws. Lawv cov kev ua kom ntshav ntxiv, ua kom yuag thiab necrosis pab txhawb kev tsim cov ntshav txhaws thiab ua rau muaj cov ntshav ntawm cov ntshav, uas ua rau cov mob ntshav tsis txaus hauv qee thaj chaw.

Cov kev pheej hmoo tshwj xeeb rau kev txhim kho ntshav qab zib macroangiopathy mob ntshav qab zib mellitus suav nrog hyperglycemia, dyslipidemia, insulin tsis kam, rog (tshwj xeeb tshaj yog lub plab hom), mob ntshav siab, nce ntshav coagulation, endothelial kawg, oxidative kev nyuaj siab, thiab cov kab mob hauv lub cev.Cov kev pheej hmoo ib txwm muaj rau tus mob atherosclerosis yog kev haus luam yeeb, kev qaug rau kev ua haujlwm, lub cev tsis ua haujlwm, lub hnub nyoog (hauv cov txiv neej hnub nyoog tshaj 45 xyoos, hauv cov poj niam hnub nyoog dhau 55 xyoos), kev tsis sib haum.

Kev faib tawm

Kev mob caj dab yog ib qho kev xav, uas suav nrog qhov kev yeej ntawm cov nkoj me - capillaries thiab precapillary arterioles (microangiopathy), nruab nrab thiab loj caliber hlab ntsha (macroangiopathy). Tus mob ntshav qab zib yog mob lig rau cov ntshav qab zib, pib thaj tsam li 10-15 xyoo tom qab pib mob.

Kev mob ntshav qab zib macroangiopathy tuaj yeem tshwm sim nws tus kheej hauv ntau tus kabmob: atherosclerosis ntawm cov hlab ntshav ntawm cov hlab ntsha thiab aorta, atherosclerosis ntawm lub hlwb cov hlab ntsha thiab atherosclerosis ntawm cov hlab ntsha txhaws. Mob ntshav qab zib microangiopathy muaj xws li retinopathy, nephropathy, microangiopathy ntawm cov qis hauv qab. Tsis tas li, kev puas tsuaj rau vascular tuaj yeem tshwm sim nyob rau hauv daim ntawv ntawm kev mob siab ntawm angiopathy, sib txuas nrog cov loj heev- thiab microangopathy. Nyob rau hauv lem, endoneural microangiopathy ua rau tsis pom kev peripheral hlab ntsha muaj nuj nqi, i.e., kev txhim kho cov ntshav qab zib neuropathy.

Cov tsos mob ntawm tus mob ntshav qab zib macroangiopathy

Atherosclerosis ntawm kev mob ntshav ntawm cov hlab ntsha thiab aorta nyob rau hauv cov ntshav qab zib mob macroangiopathy tshwm sim los ntawm kev txhim kho ntawm cov hlab plawv nrog nws cov mob (myocardial infarction) thiab mob ntev (cardiosclerosis, angina pectoris). IHD nyob rau hauv cov ntshav qab zib tuaj yeem tshwm sim atypically (raws li xaiv tau hla lossis tsis hnov mob), yog li ua rau muaj kev pheej hmoo ntawm txoj kev tuag sai sai. Ntshav qab zib macroangiopathy feem ntau yog nrog ntau yam mob tom qab lub cim xeeb: cov leeg pob txha caj dab, tsis tuaj yeem mob, mob plab, lub plawv dhia, lub plawv tsis ua haujlwm. Nrog cov mob ntshav qab zib macroangiopathy, qhov ntxim nyiam ntawm kev tsim rov qab ua dua myocardial infarction yog qhov siab heev. Txoj kev pheej hmoo ntawm kev tuag los ntawm kev mob plawv hauv cov neeg mob ntshav qab zib yog 2 npaug ntau dua li cov neeg tsis muaj ntshav qab zib.

Atherosclerosis ntawm cerebral cov hlab ntsha vim kev mob ntshav qab zib macroangiopathy tshwm sim hauv 8% ntawm cov neeg mob. Nws tuaj yeem pom tshwm sim los ntawm mob hlwb ntev ischemia lossis ischemic stroke. Qhov ntxim nyiam ntawm cerebrovascular cov teeb meem ntshav qab zib nce 2-3 zaug hauv lub xub ntiag ntawm txoj hlab ntshav siab.

Cuam tshuam atherosclerotic txhab ntawm cov hlab ntsha peripheral (obliterating atherosclerosis) cuam tshuam 10% ntawm cov neeg mob ntshav qab zib mellitus. Cov kev soj ntsuam mob ntshav qab zib mob macroangiopathy nyob rau hauv rooj plaub no suav nrog kev loog thiab qhov txias ntawm ko taw, sib zog claudication, hypostatic o ntawm qhov kawg, mob hnyav rau cov leeg ntawm ceg, lub duav, thiab qee zaum lub pob tw, uas sib zog nrog txhua qhov kev tawm tsam lub cev. Nrog kev ua txhaum ntawm cov ntshav khiav hauv lub distal kawg, qhov tseem ceeb ischemia loj hlob tuaj, vim qhov ntawd necrosis ntawm qis ceg thiab ko taw cov nqaij (mob caj dab) tuaj yeem tshwm sim. Necrosis ntawm daim tawv nqaij thiab subcutaneous cov ntaub so ntswg tuaj yeem tshwm sim yam tsis muaj kev cuam tshuam cov cuab yeej ntxiv, tab sis ntau zaus nws tshwm sim tawm tsam keeb kwm yav dhau los kev ua txhaum kev ncaj ncees ntawm daim tawv nqaij (nrog pedicure, ko taw tawg, fungal kis ntawm daim tawv nqaij thiab cov rau tes, thiab lwm yam). Nrog tsawg tshaj tawm cov ntshav khiav mus tsis txaus, mob rau sab hauv trophic mob ntshav qab zib mob macroangiopathy mob ntshav qab zib.

Kev kho mob ntshav qab zib macroangiopathy

Txoj kev kho yog txhawm rau ua rau muaj kev vam meej qeeb qeeb ntawm cov teeb meem vascular txaus ntshai uas tsim kev hem thawj rau tus neeg mob uas xiam oob qhab lossis tuag. Lub hauv paus ntsiab lus tseem ceeb ntawm kev kho mob ntshav qab zib macroangiopathy kev kho mob ntawm hyperglycemia syndromes, dyslipidemia, hypercoagulation, arterial hypertension.

Yuav kom tau txais cov nyiaj them rau cov metabolism ua cov metabolism, cov neeg mob ntshav qab zib macroangiopathy muaj kev tiv thaiv insulin nyob rau hauv kev tswj cov ntshav qabzib. Kev kho cov kev tsis txaus siab ntawm kev noj cov zaub mov carbohydrate yog ua tiav los ntawm kev teem caij lipid-txo cov tshuaj (statins, antioxidants, fibrates), nrog rau kev noj haus uas txwv kev noj cov tsiaj rog.

Nrog rau kev pheej hmoo ntxiv ntawm cov teeb meem thromboembolic, nws raug nquahu kom siv tshuaj antiplatelet (acetylsalicylic acid, dipyridamole, pentoxifylline, heparin, thiab lwm yam). Lub hom phiaj ntawm cov tshuaj tiv thaiv kabmob ntshav qab zib hauv kev tiv thaiv kabmob ntshav qabzib yog kom ua tiav thiab tswj lub hom phiaj ntawm cov ntshav siab ntawm 130/85 hli Hg. Kos duab. Rau qhov no, nws yog qhov zoo dua los sau tshuaj ACE inhibitors (captopril), diuretics (furosemide, spironolactone, hydrochlorothiazide), cov neeg mob uas tau mob plawv nres - beta-blockers (atenolol, thiab lwm yam).

Kev kho mob ntawm trophic mob rau sab hauv ntawm qhov kawg yog nqa tawm los ntawm kev saib xyuas ntawm ib tus kws phais neeg. Hauv kev mob taub hau vascular, kev saib xyuas tsim nyog ua. Raws li qhov ntsuas, kev kho mob phais yog ua (CABG, kev phais mob ntawm cerebrovascular tsis txaus, endarterectomy, txiav tes taw ntawm txhais tes, thiab lwm yam).

Kev twv ua ntej thiab Kev Tiv Thaiv

Kev tuag ntawm kev mob plawv hauv cov neeg mob ntshav qab zib ncav cuag 35-75%. Ntawm cov no, nyob hauv kwv yees li ib nrab ntawm cov mob, kev tuag tshwm sim los ntawm myocardial infarction, hauv 15% - los ntawm cov mob txha caj qaum ischemia.

Tus yuam sij rau kev tiv thaiv kab mob ntshav qab zib macroangiopathy yog tswj kom zoo rau cov ntshav qabzib thiab ntshav siab, kev noj zaub mov, kev tswj lub cev nyhav, muab cov kev coj ua tsis zoo, ua kom tiav txhua yam lus qhia kho mob.

Kev tiv thaiv kab mob macroangiopathy tiv thaiv kab mob ntshav qab zib

Kev tsim nyog thiab kho tau sai rau cov ntshav qab zib mellitus (mob uas yog ntshav muaj ntshav siab).
Kev noj haus nrog kev txwv ntsev, protein, carbohydrates, cov rog rog.
Txiav kev haus luam yeeb thiab haus dej haus cawv.
Cov haujlwm qoj ib ce (tsis ua rau mob tawm tsam angina (ib qho kab mob tshwm sim los ntawm qhov mob lossis tsis xis nyob tom qab lub pob tw vim kev ua txhaum ntawm cov ntshav xa mus rau lub siab)).
Cov taug kev niaj hnub hauv huab cua ntshiab.
Txo hauv qhov hnyav dua.
Kev tshuaj xyuas cov ntshav khov (ntsuas ib hnub).
Kev tswj nruj ntawm cov qib lipids (cov rog) hauv cov ntshav (ib zaug txhua rau lub hlis).

COV LUS QHIA PIV TXWV

Kev sab laj nrog kws kho mob yog qhov yuav tsum tau

Endocrinology - Dedov I.I., Melnichenko G. A, Fadeev V.F., - GEOTAR - Xov Xwm, 2007
Cov txheej txheem los kho mob tshwj xeeb rau cov neeg mob ntshav qab zib mellitus, 2012

Angiopathy ntawm cov hlab ntsha hauv "lub siab"

Qhov kev mob ntshav qab zib no feem ntau tshwm sim hauv cov neeg muaj kev kub siab, tab sis kuj tuaj yeem kuaj tau hauv cov neeg uas tsis muaj teeb meem ntshav siab. Kev mob ntshav qab zib microangiopathy ntawm lub siab yog ua los ntawm cov tsos mob hauv qab no:

- hnov mob hauv siab, ua rau tsis xis nyob hauv caj dab, sab nraub qaum, sab puab tsaig, sab caj npab sab laug,

- mob thiab zoo nkaus li kev nyem, nyem tom qab ntawm pob tw, kev hnyav los ntawm kev ua haujlwm ntawm lub cev, nrog rau thaum muaj kev ntxhov siab,

- o thiab mob nyob rau hauv txoj cai hypochondrium,

Cov tsos mob zoo li no tshwm sim nrog lwm cov kab mob hauv lub plawv. Txhawm rau kom paub tseeb, kuaj mob hlwb thiab MRI ntawm cov hlab ntsha ntawm lub plawv, nrog rau kev ua haujlwm ntawm nws tus kheej.

Raws li cov tshuaj tua kab mob, cov neeg mob yog cov tshuaj uas tiv thaiv cov hlab ntshav ntawm txoj kev nqaim, txhim kho cov ntshav txaus, tiv thaiv cov ntshav txhaws, txo cov ntshav siab, thiab txo cov "cholesterol" phem. Cov no yog "Nitroglycerin", "Aspirin", "Bisoprolol", "Verapamil", "Ramipril", "Lozartan" thiab lawv cov lus piv txwv.

Nees Qaum Ntuj

Kev noj qab haus huv microangiopathy ntawm ob lub raum yog pom nyob rau hauv cov neeg mob ntshav qab zib nrog kev paub los yog hauv cov neeg uas tsis ua raws li txhua tus kws kho mob cov lus qhia txog kev noj haus thiab noj tshuaj. Cov tsos mob

- kev ua haujlwm siab inexplicably,

- xeev siab, feem ntau ua ntej ntuav,

- thaum sawv ntxov o ntawm lub ntsej muag,

- proteinuria (protein yog txiav txim nyob hauv cov zis).

- kuaj ntshav (biochemical, uas txiav txim siab txog theem ntawm creatinine thiab urea),

Kev kho mob ntshav qab zib microangiopathy ntawm ob lub raum hauv kev pib ntawm kev loj hlob ntawm cov teeb meem muaj nyob rau hauv saib xyuas cov piam thaj hauv ntshav thiab tswj cov ntshav siab. Cov kev ntsuas no pab kom tsis txhob raum rau lub sijhawm ntev. Yav tom ntej, kev kho mob hemodialysis yog tus kws kho, thiab tshwj xeeb yog mob hnyav - lub raum hloov ntshav.

Retinopathy

Tus tib neeg retina tseem muaj hlab ntsha me me. Lawv txoj kev tsis ua haujlwm, uas tshwm sim rau cov neeg mob ntshav qab zib, hu ua retinopathy. Qhov kev tsis txaus ntseeg no tuaj yeem tsim kho ntev, 20 xyoo lossis tshaj saud, yog tias tus neeg mob ua rau tus kws kho mob sau ntawv, thiab tuaj yeem tshaj tawm nws tus kheej tom qab 2 xyoos txij li pib kuaj ntshav qab zib mellitus. Hmoov tsis zoo, ntxov lossis tom qab retinopathy cuam tshuam rau txhua tus neeg mob.

Mob ntshav qab zib retinal microangiopathy yog tus cwj pwm los ntawm cov tsos mob hauv qab no:

- kev pom tsis meej txog nws qhov ua tiav tiav,

- daim ntaub thaiv tab tom sawv hauv kuv lub qhov muag,

- “ntab” khoom hauv qhov chaw uas saib,

- pom tsis tau cov khoom me,

- me ntsis, tawg, kab txaij, cwj pwg ua ntej lub qhov muag,

- vitreous hemorrhage,

- mob hauv lub qhov muag daj.

Tus kws kho qhov muag tshwj xeeb, thaum kuaj xyuas, tuaj yeem tshawb pom cov tsos mob ntawm tus mob hlwb rov qab ua ntej tus neeg mob nws tus kheej xav tias muaj qee yam tsis raug nrog nws lub zeem muag. Qhov tshwm sim ua ntej ntawm cov kev cuam tshuam no yog:

- deformed cov hlab ntsha (feem ntau nrog microaneurysms),

Kev tiv thaiv ntawm retinopathy yog kev soj ntsuam ib txwm muaj los ntawm kws kho mob ntsej muag, soj ntsuam cov ntshav qab zib thiab kev noj haus.

Kev kho mob Retinopathy muaj kev txhaj tshuaj mus rau hauv lub qhov muag, laser ceev faj ntawm cov hlab ntshav ntawm lub fiber, thiab kev phais mob, uas tshem cov ntshav thiab caws pliav ntawm qhov muag.

Encephalopathy

Microangiopathy mob ntshav qab zib tuaj yeem cuam tshuam cov hlab ntsha ntawm lub hlwb. Xws li cov kev mob tshwm sim hauv cov neeg mob uas muaj kev paub ntau dhau los thiab hauv cov neeg uas tsis ua raws li cov kws kho mob tau sau tseg. Thawj zaug tsos mob ntawm tus mob encephalopathy:

- yws txog "lub hauv paus" taub hau,

- pw tsis tsaug zog thaum tsaus ntuj, tsaug zog nruab hnub,

- nco teeb meem,

Cov tsos mob ntxiv yog ntxiv:

- qhov tshwm sim ntawm pathological reflexes,

Kev kuaj mob yog los ntawm MRI ntawm lub paj hlwb.

Rov qab kho cov hlab ntsha tsis zoo tau ntev dua. Lub hom phiaj ntawm kev kho mob yog ua rau qeeb qeeb ntawm cov txheej txheem txuas ntxiv ntawm kev txhim kho ntawm cov teeb meem. Lub hauv paus ntawm kev kho mob yog txhawm rau soj ntsuam cov suab thaj hauv cov ntshav thiab txo nws mus rau qhov zoo.

Angiopathy ntawm cov hlab ntsha ntawm ob txhais ceg

Cov kab mob ntshav qab zib muaj xws li mob nyhav ntshav qab zib mellitus, qhia txog kev puas tsuaj ntawm cov hlab ntsha me thiab cov leeg (mob polyneuropathy) ntawm ob txhais ceg, vim tias qhov kev xa ntshav cuam tshuam, lameness tshwm sim, thiab tshwj xeeb tshaj yog cov neeg mob qog ntshav pib. Kev ua haujlwm sab nrauv, rog rog, haus luam yeeb, kub siab, keeb caj ces ua rau muaj kev txhim kho ntawm cov teeb meem.

- lub siab ntsws ntsws ntawm taw,

- mob txhav yav sawv ntxov,

Nrog cov kev hloov zuj zus ntawm cov teeb meem, ib qho mob ntshav qab zib taw yog tsim (tuab ntawm cov ntsia hlau, hloov pauv hauv lawv cov xim, qhov pom ntawm caj dab, kab nrib pleb thiab mob), thiab qhov no, nyeg, ua rau muaj qhov tshwm sim ntawm kev mob caj dab, sepsis.

Kev kuaj mob yog tsim raws kev kuaj mob thiab tus lej ntawm cov kev kuaj mob tshwj xeeb:

Kev kho mob yog nqa tawm hauv peb qhov kev qhia:

1. Classical rau ntshav qab zib (tswj ntshav qab zib, kev noj haus uas tsis pub rog rog, tswj ntshav siab).

2. Txhim kho cov kev ua tsis haum thiab cov biochemical ntawm cov ntshav (cov neeg mob noj statins, angioprotectors, tshuaj tua kab mob, biogenic stimulants, metabolics, ntshav thinners, stimulant biogenic).

3. Kev phais mob, lub hom phiaj uas yog txhawm rau kho cov ntshav ncig thiab tshem cov chaw tuag.

Macroangiopathy yog dab tsi?

Thaum cov kab mob pauv hloov los ntawm ntshav qab zib cuam tshuam rau nruab nrab thiab lub nkoj loj, kev kuaj mob ntshav qab zib macroangiopathy tau ua. Cov laj thawj tseem ceeb ntawm qhov kev cuam tshuam no:

- ua kom tob ntawm cov leeg hauv qab daus ntawm cov leeg thiab cov hlab ntsha vim cov ntshav qab zib,

- tsim nyob rau hauv cov hlab ntsha ntawm atherosclerotic plaques,

- Kev ntsuam xyuas ntawm cov hlab ntshav, lawv cov necrosis tom ntej.

Tag nrho cov no ua rau thrombosis, occlusion thiab circulatory ntshawv siab.

Kev pham, hyperglycemia, dyslipidemia, insulin tsis kam, cov txheej txheem tiv thaiv kab mob, kev ntxhov siab, ntshav coagulation pab ua rau tshwm sim ntawm macroangiopathy. Raws li qhov tshwm sim, atherosclerosis ntawm cov ntsha zoo li no:

1. Aorta thiab leeg txoj hlab ntshav. Nws ua rau lub plawv ischemia, mob plawv nres, angina pectoris, cardiosclerosis.

2. Cov hlab ntshav txhaws. Tej zaum yuav ua rau ischemic stroke lossis ischemia ntawm (muaj mob) lub hlwb.

3. Cov leeg ntshav ntawm ntshav. Nws yog tus cwj pwm txaus ntshai los ntawm kev ua laib thiab tom qab txiav ntawm tes taw. Nrog atherosclerosis ntawm peripheral ntawm cov hlab ntsha, ntaub so ntswg necrosis feem ntau tshwm sim. Kev mob siab rau qhov no tuaj yeem ua rau mob me, piv txwv li, tau txais thaum lub sijhawm pedicure, nrog rau cov kab nrib pleb, mycoses.

Lub ntsiab lus ntawm lub hauv paus chiv keeb ntawm angiopathy

Cov kev tsis zoo, tau ntev, cuam tshuam txog ntshav qab zib rau lub cev ua tau tsim nws tus kheej hauv kev ua rau muaj kev mob tshwm sim qeeb - angiopathy (kev puas tsuaj rau cov hlab ntsha). Cov kev mob tshwm sim sai ntawm cov kab mob endocrinological muaj xws li xwm txheej ceev los ntawm cov ntshav qab zib (hypoglycemia) lossis nws nce ntxiv (ketoacidosis), tsis nco qab.

Cov hlab ntsha mus rau thoob plaws lub cev. Vim tias muaj qhov sib txawv hauv lawv cov caliber (loj thiab me me), loj heev- thiab microangiopathy tau muab cais. Cov phab ntsa ntawm cov leeg thiab hlab ntsha yog mos thiab nyias, lawv muaj kev cuam tshuam zoo ib yam nkaus ntawm cov piam thaj ntau.

Kev nkag mus rau hauv cov hlab, organic teeb meem tsim cov tshuaj lom neeg lom uas tsim kev puas tsuaj rau cov hlwb thiab cov ntaub so ntswg. Cov kev hloov tshwm sim uas ua rau cuam tshuam hauv kev ua haujlwm ntawm lub cev. Ua ntej tshaj plaws, macroangiopathy mob ntshav qab zib cuam tshuam rau lub siab, lub hlwb, ceg, microangiopathy - ob lub raum, qhov muag, ko taw.

Ntxiv rau cov ntshav qab zib siab, cov hlab ntsha rhuav tshem cov roj cholesterol thiab cov tshuaj uas tsim los ntawm kev haus luam yeeb ntawm tus neeg mob nws tus kheej lossis cov neeg los ntawm nws ib puag ncig. Cov ntshav ntawm cov ntshav tau txhaws nrog cov plahaum roj av. Hauv cov ntshav qab zib, cov hlab ntsha qis qis dua zaum ob (cov piam thaj thiab roj). Tus neeg haus luam yeeb nthuav nws tus kheej mus rau qhov cuam tshuam thib peb ntawm lub cev. Nws khiav txoj kev pheej hmoo ntawm kev mob atherosclerosis, tsis pub tsawg dua tus neeg muaj mob ntshav qab zib.

Ntshav siab (BP) tseem ua rau kev puas tsuaj ntawm cov nqaij hauv cov hlab (aorta, leeg). Lub khoob tsim nyob nruab nrab ntawm lub hlwb, phab ntsa ua permeable, thiab ua kom pom tseeb ntawm cov ntaub ntawv o. Ntxiv rau cov roj av plaques, nti ua rau ntawm phab ntsa cuam tshuam. Neoplasms tuaj yeem ua ib feem thiab txawm thaiv tag nrho cov lumen hauv cov hlab. Muaj ib hom tshwj xeeb ntawm cov hlab ntsha tawg - hemorrhagic lossis cerebral hemorrhage.

Ntshav qab zib macroangiopathy los yog nqaim ntawm cov hlab ntsha loj yog cov yam ntxwv ntawm hom 2. Raws li txoj cai, tus neeg mob hnub nyoog tshaj 40 xyoo thiab cov kev hloov pauv hauv cov vascular yog superimposed ntawm cov ntshav qab zib muaj teeb meem. Nws yog tsis yooj yim sua kom tig cov txheej txheem khiav hauv qhov kev coj ua, tab sis qhov tsim ntawm caws pliav tuaj yeem nres.

Lub luag haujlwm ntawm lwm qhov ua rau muaj kev txhim kho ntawm ob hom kabmob angiopathies tsis paub meej meej - lub caj ces tsis zoo rau cov kab mob plawv.

Cov tsos mob ntawm macroangiopathy

Cov neeg mob uas mob atherosclerosis zoo li laus dua lawv lub xyoo, muaj qhov hnyav dhau los. Lawv muaj cov yam ntxwv daj plaque hauv lub luj tshib thiab tawv muag - tso nyiaj ntawm cov roj (cholesterol). Hauv cov neeg mob, qhov kev hloov kho ntawm txoj hlab ntsha ntawm femoral thiab popliteal tsis muaj zog, kom ua tiav qhov tsis tuaj yeem, qhov mob ntawm lub plab hlaub tshwm tuaj thaum taug kev thiab tom qab lub sijhawm tom qab tsum. Tus kab mob yog nrog los ntawm kev sib quas ntus claudication. Txhawm rau txhawm rau txheeb xyuas qhov tseeb, cov kws tshaj lij siv cov qauv thev naus laus zis.

Cov theem hauv qab no yog qhov tshwj xeeb hauv kev nthuav dav loj heev- thiab microangiopathy ntawm qis qis:

preclinical
haumxeeb
organic
necrotic mob rwj
kev ua laib.

Thawj theem tseem tseem hu ua asymptomatic lossis metabolic, txij li txawm tias raws li cov ntaub ntawv ntawm kev ntsuas kev ua haujlwm, kev ua txhaum tsis raug kuaj. Qhov theem ob muaj cov tsos mob hnyav heev. Nyob rau hauv tus ntawm kev kho mob, kev ntshawv siab nrog nws tseem tuaj yeem thim rov qab.

Qhov nqaim ntawm cov hlab ntsha uas txhawb nqa ib qho khoom nruab nrog cev ua rau ischemia (mob ntshav hauv zos). Cov xwm txheej zoo li no feem ntau pom nyob hauv thaj chaw ntawm lub siab. Lub leeg txha caj uas tshwm sim ua rau lub plawv nres. Cov neeg mob nco ntsoov hnov mob tom qab ntawm pob tw, lub plawv dhia tsis xis nyob.

Kev txhaws tam sim ntawm lub siab cuam tshuam cov leeg kev noj haus. Daim ntaub necrosis mob (necrosis ntawm qhov chaw hloov khoom nruab nrog) thiab myocardial infarction. Cov neeg uas tau muaj kev txom nyem los ntawm nws muaj kev mob plawv mob plawv. Kev phais mob ua tsis tuaj yeem tuaj yeem txhim kho lub neej zoo ntawm cov neeg mob uas muaj mob rau cov hlab ntsha.

Atherosclerosis ntawm cov hlab ntsha ntawm lub paj hlwb yog nrog los ntawm kiv taub hau, mob, nco qab. Kev mob stroke yog thaum muaj kev ua txhaum ntawm kev muab cov ntshav rau lub paj hlwb. Yog tias tom qab "tshuab" ua rau ib tug neeg tseem muaj txoj sia nyob, tom qab ntawd ua rau lub txim hnyav (tsis hais lus, lub cev muaj zog) tshwm sim. Atherosclerosis tuaj yeem ua rau ischemic stroke, thaum cov ntshav ntws mus rau lub hlwb tau cuam tshuam vim cov roj cholesterol siab.

Cov kev kho mob tseem ceeb rau kev mob caj dab

Teeb meem yog qhov tshwm sim ntawm cov metabolism hauv qhov ua rau tsis zoo. Cov kev kho mob yog tsom rau kev siv cov tshuaj uas ua rau lub cev txawv ntawm ntau hom metabolism hauv cov yam ntxwv ntawm cov ntshav qab zib macroangiopathy.

carbohydrate (insulin, acarbose, biguanides, tus naj npawb ntawm sulfonylureas),
rog (lipid-tej tshuaj),
cov protein (steroid anabolic hormones),
dej-electrolyte (hemodesis, reopoliglyukin, kev npaj cov poov tshuaj, calcium, magnesium).

Feem ntau, ib qho kev ntsuas pom ntawm cov roj (cholesterol) raug pom nyob hauv hom 2 mob ntshav qab zib mellitus, nce hauv lub cev nyhav. Nws raug kuaj xyuas ib xyoos ob zaug. Yog tias kuaj ntshav siab dua li ib txwm muaj, ces nws tsim nyog:

ua ntej, txhawm rau ua rau cov neeg mob lub cev tsis zoo (tsis suav cov tsiaj rog, txo cov zaub mov kom yooj yim rau 50 g hauv ib hnub, cia cov roj zaub mus rau 30 ml, ntses, zaub, thiab txiv hmab txiv ntoo),
qhov ob, noj cov tshuaj (Zokor, Mevacor, Leskol, Lipantil 200M).

Cov ntshav ncig hauv cov hlab ntsha peripheral yog txhim kho los ntawm angioprotectors. Hauv kev sib txuam nrog cov kev kho mob tseem ceeb, cov neeg endocrinologist pom zoo kom siv cov vitamins B (thiamine, pyridoxine, cyanocobalamin).

ib txwm muaj ntshav siab nrog cov tshuaj (Envas, Enalopril, Arifon, Renitek, Corinfar),
yuag yuag yuag,
kom tseg txoj kev haus luam yeeb thiab haus dej cawv,
txo ntsev kom tsawg,
kev zam ntawm lub caij nyoog ntxhov siab.

Raws li kev pabcuam rau kev kho mob vascular pathologies, endocrinologist pom zoo kom siv lwm txoj hauv kev tshuaj khomob. Rau lub hom phiaj no, kev npaj tshuaj ntsuab yog siv (cov tawv ntoo buckthorn, pob kws cov pob kws muaj lub ntsej muag, cov hauv paus loj ntawm cov hnab loj, cov txiv ntoo sowing carrots, bog nyom).

Tus mob ntshav qab zib mob mus ntev hli ntau, ntau xyoo thiab ntau xyoo. Hauv Tebchaws Meskas, Dr. Joslin Foundation tau tsim tsa tshwj xeeb saib puav pheej. Tus mob ntshav qab zib, uas tau tswj kav 30 xyoo yam tsis muaj teeb meem, suav nrog angiopathy, muab tib lub npe qhuas. Lub puav pheej qhia tau hais tias ua tau zoo tswj cov kab mob ntawm lub xyoo pua.

Ua rau mob macroangiopathy mob ntshav qab zib

Thaum ib tug neeg mob ntshav qab zib ntev ntev, cov hlab ntsha me, hlab ntsha phab ntsa thiab leeg ntshav cuam tshuam rau ntawm cov piam thaj ntau ntxiv pib tawg.

Yog li muaj qhov ua kom yuag, deformation, los sis, hloov pauv, qhov no yog qhov ua kom tuab ntawm cov hlab ntshav.

Vim li no, cov ntshav ntws thiab cov metabolism ntawm cov nqaij hauv cov plab hnyuv siab raum yog cuam tshuam, uas ua rau hypoxia lossis oxygen tshaib plab ntawm cov nqaij mos uas nyob ib puag ncig, kev puas tsuaj rau ntau cov kabmob ntawm cov ntshav qab zib.

Feem ntau, cov hlab ntsha loj ntawm qis dua qhov kawg thiab lub siab yog cuam tshuam, qhov no tshwm sim hauv 70 feem pua ntawm tus neeg mob. Cov seem ntawm lub cev tau txais qhov hnyav tshaj plaws, yog li cov hlab ntsha muaj kev cuam tshuam ntau los ntawm kev hloov pauv. Hauv cov kab mob ntshav qab zib microangiopathy, cov nyiaj pob feem ntau cuam tshuam, uas yog kuaj tau tias yog tus mob hlwb, uas tseem muaj ntau.
Feem ntau, mob ntshav qab zib macroangiopathy cuam tshuam rau cov hlab hlwb, mob rau lub plawv, lub raum, cov hlab ntsha peripheral. Qhov no nrog los ntawm angina pectoris, myocardial infarction, ischemic stroke, ntshav qab zib mob caj dab, thiab kho cov ntshav siab. Nrog rau kev puas tsuaj rau cov hlab ntsha, qhov kev pheej hmoo ntawm kev txhim kho cov hlab plawv thiab cov hlab ntshav nce siab peb zaug.
Ntau cov mob ntshav qab zib ua rau cov hlab ntsha tsis muaj ntshav. Xws li tus kab mob tau kuaj pom rau cov neeg muaj mob type 1 thiab type 2 ntshav qab zib mellitus 15 xyoo ua ntej tshaj rau cov neeg mob noj qab nyob zoo. Kuj, tus kab mob hauv cov neeg mob ntshav qab zib tuaj yeem hloov sai dua.
Tus kab mob ua rau thickening hauv qab daus daim nyias nyias ntawm qhov nruab nrab thiab cov hlab ntsha loj, uas cov kab mob atherosclerotic plaques tom qab tsim. Vim yog cov calcification, ua kom pom thiab necrosis ntawm cov quav hniav, ntshav txhaws nyob rau hauv thaj chaw, lub lumen ntawm cov hlab ntsha kaw, vim li ntawd, cov ntshav ntws hauv thaj chaw muaj kev cuam tshuam cuam tshuam hauv cov ntshav qab zib.

Raws li txoj cai, mob ntshav qab zib macroangiopathy cuam tshuam rau cov hlab ntshav, cerebral, visceral, peripheral cov hlab ntsha, yog li, cov kws kho mob ua txhua yam los tiv thaiv kev hloov pauv los ntawm kev siv cov kev tiv thaiv.

Txoj kev pheej hmoo ntawm pathogenesis nrog hyperglycemia, dyslipidemia, insulin tsis kam, rog, rog ntshav siab, nce ntshav coagulation, endothelial kawg, oxidative kev nyuaj siab, kev tiv thaiv kab mob hauv lub cev yog tshwj xeeb tshaj yog.

Kuj, atherosclerosis feem ntau muaj kev haus luam yeeb, nyob rau hauv lub xub ntiag ntawm lub cev tsis muaj zog, thiab kev qaug cawv. Qhov kev pheej hmoo yog cov txiv neej hnub nyoog dhau 45 xyoos thiab poj niam laus dua 55 xyoo.

Feem ntau ua rau tus kab mob dhau los ua ib qho keeb tiv thaiv kab mob.

Ntshav qab zib angiopathy thiab nws cov hom

Ntshav qab zib angiopathy yog lub tswvyim sib xyaw ua ke uas sawv cev rau pathogenesis thiab koom nrog kev ua txhaum ntawm cov hlab ntshav - me, loj thiab nruab nrab.

Qhov tshwm sim no suav hais tias yog qhov txiaj ntsig tshwm sim ntawm tus kab mob ntshav qab zib mellitus, uas tshwm sim kwv yees li 15 xyoo tom qab pom tus kab mob.

Cov kab mob ntshav qab zib macroangiopathy muaj nrog cov mob syndromes xws li atherosclerosis ntawm aorta thiab mob hlab ntsha txhaws, leeg ntshav lossis hlab hlwb.

Thaum lub sij hawm microangiopathy mob ntshav qab zib mellitus, retinopathy, nephropathy, thiab ntshav qab zib microangiopathy ntawm qis qis tau pom.
Qee zaum, thaum cov hlab ntsha raug mob, qhov mob thoob ntiaj teb tau tshawb pom, nws lub tswvyim suav nrog kev mob ntshav qab zib micro-macroangiopathy.

Endoneural ntshav qab zib microangiopathy ua rau ua txhaum ntawm peripheral qab haus huv, qhov no nyeg ua rau cov ntshav qab zib mob neuropathy.

Yuav kuaj li cas thiaj paub tias muaj kab mob ntshav qab zib macroangiopathy?

Kev kuaj mob yog txhawm rau txiav txim siab tias yuav muaj kev cuam tshuam zoo li cas rau cov hlab ntshav ntawm lub cev, mob hlwb thiab ib puag ncig.

Txhawm rau txiav txim siab txoj kev kuaj mob uas yuav tsum tau ua, tus neeg mob yuav tsum sab laj nrog kws kho mob.

Kev soj ntsuam yog nqa los ntawm tus kws kho keeb (endocrinologist), tus kws kho ntshav qab zib, tus kws kho plawv, kws phais plawv, mob plawv, kws phais plawv.

Ntawm hom 1 thiab ntshav qab zib hom 2, hom kev kuaj mob hauv qab no yog cov kws kho mob kuaj kom paub txog pathogenesis:

Kev kuaj ntshav biochemical yog ua rau pom cov piam thaj, triglycerides, cov roj cholesterol, platelets, lipoproteins. Kev kuaj ntshav coagulation kev ua haujlwm kuj tau ua.
Nco ntsoov soj ntsuam cov kab mob plawv siv cov tshuaj electrocardiogram, soj ntsuam txhua hnub ntawm ntshav siab, ntsuas kev ntxhov siab, echocardiogram, ultrasound dopplerography ntawm aorta, myocardial perfusion scintigraphy, coronarography, computed tomographic angiography.
Lub neurological ntawm tus neeg mob tau teev meej siv ultrasound dopplerography ntawm lub hlab hlwb hlab ntsha, tshuaj ntxuav hlwb thiab angiography ntawm cerebral cov hlab ntsha kuj tau ua.
Txheeb xyuas cov mob ntawm peripheral cov hlab ntsha, nqua yog soj ntsuam siv duplex scanning, ultrasound dopplerography, peripheral arteriography, rheovasography, capillaroscopy, arterial oscillography.

Kev kho mob ntshav qab zib microangiopathy

Txoj kev kho tus kab mob hauv cov neeg mob ntshav qab zib feem ntau yog muab cov kev ntsuas kom qeeb ntawm qhov kev phom sij vascular txaus ntshai, uas tuaj yeem hem tus neeg mob uas xiam oob qhab lossis tuag taus.

Kev mob ntawm qhov ncauj ntawm sab sauv thiab sab hauv qab yog kho nyob rau hauv kev saib xyuas ntawm kev phais mob. Thaum mob viav vias ntau kawg, txoj kev kho mob hnyav tsim nyog yog nqa tawm. Tsis tas li, tus kws kho mob tuaj yeem ncaj qha rau kev kho mob phais, uas muaj nyob rau hauv endarterectomy, tshem tawm ntawm cerebrovascular tsis txaus, txiav tawm ntawm cov ceg tawv cuam tshuam, yog tias nws twb mob caj dab hauv ntshav qab zib mellitus.

Cov ntsiab cai tseem ceeb ntawm kev kho yog txuam nrog kev kho cov teeb meem txaus ntshai, uas suav nrog hyperglycemia, dyslipidemia, hypercoagulation, arterial hypertension.

Txhawm rau them nyiaj rau cov metabolism hauv kev noj haus hauv cov neeg mob ntshav qab zib, tus kws kho mob tau sau ntawv tawm kev kho mob insulin thiab kev saib xyuas ntshav qab zib kom tsis tu ncua. Rau qhov no, tus neeg mob siv tshuaj lipid-txo qis - statins, tshuaj tiv thaiv kab mob, fibrates. Tsis tas li ntawd, nws yog ib qho tsim nyog yuav tau ua raws li kev kho tshwj xeeb kev noj haus thiab kev txwv kev siv cov zaub mov nrog cov ntsiab lus siab ntawm cov tsiaj rog.
Thaum muaj kev pheej hmoo ntawm kev tsim muaj cov teeb meem thromboembolic, cov tshuaj antiplatelet raug kho - acetylsalicylic acid, dipyridamole, pentoxifylline, heparin.
Cov tshuaj tiv thaiv kab mob ntshav siab (antihypertensive therapy) thaum kuaj pom tus mob ntshav qab zib macroangiopathy yog ua kom tiav thiab tswj cov ntshav siab ntau ntawm 130/85 mm RT. Kos duab. Rau lub hom phiaj no, tus neeg mob coj ACE inhibitors, tshuaj kho mob. Yog tias ib tus neeg tau mob myocardial infarction, beta-blockers yog cov kws kho mob.

Kev tiv thaiv kev ntsuas

Raws li kev txheeb cais, nrog hom 1 thiab hom 2 mob ntshav qab zib mellitus, vim tias cov hlab plawv mob hnyav hauv cov neeg mob, cov neeg tuag muaj li ntawm 35 txog 75 feem pua. Hauv ib nrab ntawm cov neeg mob no, kev tuag tshwm sim nrog myocardial infarction, hauv 15 feem pua ntawm cov neeg mob ua kom muaj mob hlwb cerebral ischemia.

Txhawm rau zam kev txhim kho mob ntshav qab zib macroangiopathy, nws yog ib qho tsim nyog yuav tsum ua txhua yam kev tiv thaiv. Tus neeg mob yuav tsum soj ntsuam cov ntshav qab zib kom tsis txhob nyob, ntsuas ntshav siab, ntsuas kev noj zaub mov zoo, tswj nws tus kheej qhov hnyav, ua raws txhua cov lus qhia kho mob thiab muab cov kev coj ua tsis zoo ntau li ntau tau.

Hauv kev yees duab hauv tsab xov xwm no, cov hau kev rau kev kho mob ntshav qab zib macroangiopathy ntawm qhov kawg nkaus yog tham txog.