Ntshav qab zib Angiopathy - kev tawm dag zog ntawm cov leeg ntshav hauv ntshav qab zib, kis tau ob qho tib si rau cov hlab ntsha me me (microangiopathy) thiab cov leeg ntshav ntawm qhov loj thiab nruab nrab caliber (macroangiopathy).

Ntshav qab zib microangiopathy - kev mob ntshav qab zib mellitus ntau qhov txhab ntawm cov hlab ntsha me me (hlab ntsha, hlab ntsha, leeg ntshav), cov cwj pwm hloov pauv hauv lawv cov qauv (ua kom tuab ntawm lub hauv qab daus, endothelial proliferation, deposition ntawm glycosaminoglycans nyob rau hauv vascular phab ntsa, arterioles phab ntsa hyalinosis, microthromboses, kev loj hlob ntawm perme rau ntau npaum li cas ntawm perme; :

1. Mob ntshav qab zib retinopathy - qhov tseem ceeb ua rau qhov muag tsis pom kev hauv cov neeg mob ntshav qab zib, tsis-nthuav tawm (muaj cov microaneurysms, hemorrhages, edema, tawv exudates nyob rau hauv retina), preproliferative (+ hloov pauv ntawm cov leeg: cov ntshiab, tsim txom, loops, thim rov qab, hloov pauv ntawm cov leeg ntshav) thiab nthuav dav (+ cov tsos ntawm cov hlab ntsha tshiab) , nthuav dav nws mob ntshav khov hauv qhov retina nrog nws cov cuam tshuam thiab tsim kom muaj cov ntaub so ntswg sib txuas) cov ntaub ntawv, chaw kuaj mob tsis txaus siab ntawm cov yoov flickering, me ntsis, lom zem ntawm cov huab, cov khoom qhov muag zuj zus qis dua. s nrig txog kev pom pom tseeb tseeb.

Kev soj ntsuam rau cov ntshav qab zib kom txhob ua mob hlwb.

"Tus Txuj Kub" yog cov xim thaij duab thaij duab ntawm lub pob nyiaj, fluorescence angiography ntawm retina, thiab ncaj qha ophthalmoscopy yog qhov nkag tau rau kev soj ntsuam tam sim no.

Kev kuaj thawj 1 tom qab 1.5-2 xyoo txij li hnub ntawm kev kuaj mob ntshav qab zib, thaum tsis muaj mob ntshav qab zib, kev kuaj mob tsawg kawg yog 1 zaug hauv 1-2 xyoos, yog tias muaj - tsawg kawg 1 zaug hauv ib xyoos lossis ntau dua, nrog kev sib xyaw ntawm cov ntshav qab zib nrog cev xeeb tub , AH, CRF - ib qho kev kuaj mob ntawm ib tug neeg, nrog kev poob qis sai sai rau qhov muag pom - kev kuaj mob tam sim los ntawm tus kws kho qhov muag.

Cov hauv paus ntsiab lus ntawm kev kho mob ntshav qab zib:

1. Kev siv tshuaj kho mob: cov nyiaj them siab tshaj plaws rau cov khoom noj carbohydrate metabolism (qhov ncauj qab zib-txo cov tshuaj, insulin txoj kev kho), kho cov teeb meem concomitant, tshuaj tua kab mob (nicotinamide) rau cov tsis muaj mob ntshav qab zib retinopathy nrog cov ntshav lipids, tsis tshua muaj molecular hnyav heparins thaum pib ntawm txoj kev

2. Photocoagulation ntawm cov hlab ntsha ntu hauv cov theem pib ntawm kev mob ntshav qab zib retinopathy (hauv zos - foci ntawm laser coagulation tau thov hauv thaj chaw ntawm cov txheej txheem pathological lossis preretinal hemorrhage, focal - coagulates yog thov hauv ntau kab hauv thaj chaw paramacular thiab parapapillary, panretinal - siv rau kev nthuav dav rov qab, los ntawm 1200 txog 1200 foci tau thov nyob rau hauv tus qauv ntsuas ntawm cov kab ntawm retina, txhua txoj kev los ntawm thaj chaw paramacular thiab parapapillary mus rau qhov nruab nrab cheeb tsam ntawm qhov chaw ntawm retina.

3. Cryocoagulation - qhia rau cov neeg mob uas muaj ntshav qab zib ua kom lub cev rov qab zoo dua, nyuaj los ntawm kev mob ntshav tawm hauv lub cev ntau dua ntawm lub cev, muaj kev nkees nce rau hauv cov nqaij mos thiab cov nqaij mos kom nthuav dav, ua kom pom qhov kawg ntawm ib nrab ntawm lub pob muag, thiab tom qab ib lis piam hauv ib nrab, nws tso cai txhim kho lossis ruaj khov lub zeem muag, kom tiv thaiv tag nrho lub zeem muag dig muag.

4. Txoj kev kho ntshav (Vitrectomy) - qhia rau kev mob ntshav qab zib nrog kev txhim kho ntawm kev hloov pauv ntawm fibrotic hauv vitreous thiab retina

2. Mob ntshav qab zib nephropathy - vim yog pob tw lossis diffuse nephroangiosclerosis ntawm lub raum glomeruli.

Cov chaw kho mob thiab kuaj ntshav kuaj ntshav qab zib ua rau mob nephropathy.

1. Hauv cov theem pib, kev tshwm sim tsis tuaj, nyob rau hauv chaw kho mob tau hais tawm, nce cov proteinuria, mob ntshav nce hlwb, mob ntshav nce hlwb, cov chaw kho mob qeeb zuj zus ntawm lub raum tsis ua haujlwm yog tus yam ntxwv.

2. Microalbuminuria (tso zis urin albumin, tshaj li qhov muaj nuj nqis, tab sis tsis ncav qib ntawm cov proteinuria: 30-300 mg / hnub) - qhov tshwm sim ntxov tshaj plaws ntawm ntshav qab zib nephropathy, nrog cov tsos ntawm tas mus li microalbuminuria, qhov chaw kho mob qhia theem ntawm tus kab mob yuav pib loj hlob hauv 5-7 xyoo.

3. Kev ua kom tau ntshav siab (GFR> 140 ml / min) - qhov tshwm sim thaum ntxov ntawm kev cuam tshuam ntawm hyperglycemia rau lub raum ua haujlwm hauv ntshav qab zib, ua rau lub raum puas, nrog rau kev nce ntshav hauv lub sijhawm ntev, GFR zuj zus txo qis hauv kev faib ua feem rau kev nce siab ntawm proteinuria thiab qhov hnyav ntawm cov neeg mob ntshav siab.

Hauv cov theem lig ntawm tus mob ntshav qab zib nephropathy cov proteinuria tsis tu ncua, qhov txo qis hauv GFR, kev nce ntawm azotemia (creatinine thiab ntshav urea), kev nyuaj siab thiab ruaj khov ntawm kev mob ntshav siab, thiab kev txhim kho ntawm cov leeg nephrotic yog cov yam ntxwv.

Theem ntawm kev loj hlob ntawm mob ntshav qab zib nephropathy:

1) hyperfunction ntawm ob lub raum - kev nce qib hauv GFR> 140 ml / min, nce ntxiv rau cov ntshav cov ntshav raum, raum hypertrophy, normoalbuminuria 131 Kuv los ntawm cov thyroid caj pas: qhov kev nqus tau yog nce ntxiv tom qab 2-4 thiab 24 teev.

6) radioisotope kev soj ntsuam ntawm cov thyroid caj pas - tso cai rau koj txheeb xyuas lub cev ua haujlwm kom zoo, txiav txim siab cov duab thiab qhov loj ntawm lub qog, muaj cov nodes nyob rau hauv nws, cov yam ntxwv ua kom pom cov duab ntawm cov thyroid caj pas nrog kev nce ntawm isotope.

7) radioimmune kev txiav txim siab ntawm cov ntshav ntawm T3 thiab T4

8) kev txiav txim siab ntawm lub ntsiab lus nyob rau hauv cov ntshav ntawm iodine ua txhua yam rau cov protein, ncaj qha cuam tshuam qhov kev ua haujlwm ntawm cov thyroid caj pas: cov kev ntsuas tau nce

9) reflexometry - qhov tseem ceeb luv luv ntawm lub sijhawm ntawm Achilles tendon reflex (ib txoj hauv kev ncaj rau kev txiav txim qhov kev ua haujlwm ntawm cov thyroid caj pas, ua cim qhov cuam tshuam rau qhov tshwm sim ntawm cov qog cov thyroid hormones)

Cov hauv paus ntsiab lus ntawm kev kho mob ntawm DTZ:

1. Cov kab mob thyrostatic: mercazolil / thiamazole 30-60 mg / hnub ntawm qhov ncauj hauv 4 koob tshuaj kom txo cov tsos mob ntawm thyrotoxicosis, tom qab ntawd cov koob tshuaj yog txo 5 mg rau ib lis piam los pab txhawb 2.5-10 mg / hnub, potassium perchlorate 400 mg / hnub qhov ncauj ( nws yog siv nyob rau hauv cov ntaub ntawv ntawm intolerance rau mercazolilum), lithium carbonate, microiodide npaj (Lugol lub tov, "Microiod" ntsiav tshuaj)

2. GCS tau qhia: 1) hauv qhov mob hnyav ntawm tus kabmob nrog lub cim loj ntawm cov thyroid caj pas thiab qhov tseem ceeb exophthalmos, 2) nrog cov mob caj dab ntau thaum kho nrog mercazolil thiab tsis tuaj yeem kho nrog kev txhawb nqa ntawm leukopoiesis (yog tias nws tsis tuaj yeem tshem tawm mercazolil, 3) nrog thyrotoxic ophthalathy , 4) thaum tsis muaj txiaj ntsig ntawm kev kho mob nrog thyreostatics, prednisone 15-30 mg / hnub pom zoo (2/3 ntawm koob tshuaj txhua hnub ntawm 7-8 a.m., 1/3 ntawm 11 a.m.), hloov pauv yog qhov tuaj yeem tiv thaiv kev cuam tshuam ntawm adrenal cortex ( kev teem sijhawm ntawm 48-teev koob tshuaj ntawm GCS thaum sawv ntxov txhua lwm hnub) lossis sib quas ntus (hloov 3-4 hnub noj GCS nrog 3-4 hnub so) kev kho mob

3. Kev kho tshuaj tiv thaiv kab mob rau kev kho kom lub cev tsis muaj zog: kev noj tshuaj sodium nucleinate hauv hmoov 0.1 g 4 zaug / hnub 3-4 lub lis piam, thymalin 10-30 mg / hnub i / m 5-20 hnub, tactivin 1 ml p / mus rau 5-6 hnub, decaris / levamisole 150 mg 1 lub sijhawm / hnub rau 5 hnub

4. Beta-blockers - qhia rau ib qho qauv ntawm DTZ, tshwj xeeb tshaj yog mob hnyav, thiab tseem cuam tshuam nrog kub siab thiab tsis tuaj yeem: propranolol 40 mg 4 zaug / hnub qhov ncauj lossis xaiv cov beta-adrenolytics (talinolol / cordanum)

5. Kev kho mob nrog kev siv tshuaj radioactive iodine (131 Kuv tau nce rau hauv cov thyroid caj pas thiab tso tawm beta hais uas rhuav tshem nws) - yog ua nrog kev tsis muaj txiaj ntsig ntawm kev kho thyrostatic, cov mob hnyav ntawm thyrotoxicosis nrog cov teeb meem, rov mob dua ntawm DTZ tom qab kev phais mob.

6. Cov kev kho mob: kev rov ua dua ntawm cov thyroid caj pas raws li Nikolaev - yog qhia rau cov mob hnyav ntawm cov kabmob, rau cov ntaub ntawv me me uas tsis muaj kev cuam tshuam los ntawm kev kho thyreostatic, thaum cev xeeb tub thiab lactation, rau nodular, sib xyaw ntawm cov goiter, rau qhov ntau ntau ntawm kev ua haujlwm ntawm cov thyroid caj pas, Kev tsim kho MA

7. Kev kho mob ntawm ophthalmopathy: nws pom zoo hnav tsom iav tsaus, pw tsaug zog nrog lub taub hau tsa, ua ntu zus diuretics (furosemide 40 mg ncauj 2 zaug / vas thiv), instill hydrocortisone poob rau hauv lub qhov muag thiab siv tshuaj pleev hydrocortisone hla lub qhov muag (txo qhov mob ua paug thiab keratitis), retrobulbar tswj hwm nyob rau hauv fiber GCS (4 mg dexazone nrog ib ncua sijhawm ntawm 4 hnub, chav kawm ntawm kev kho mob yog 6-8 txhaj tshuaj), lidase (hyaluronidase) 1 ml hauv 1 ml ntawm lub cev. daws, parlodel 25 mg 2 zaug / hnub los ntawm qhov ncauj (inhibits ntau lawm ntawm thyrotropin, txo exophthalmos, edema thiab fibrosis hauv retrobulbar fiber).

8. Kev kho cov tsos mob (sedatives, anxiolytics, anabolic tshuaj, hepatoprotectors, antihypertensive tshuaj, thiab lwm yam)

Cov Hom Mob Vascular

Nyob ntawm qhov kev thaj tsam ntawm cov hlab ntsha cuam tshuam, hom kab mob tshwm sim feem ntau yog:

nephropathy
retinopathy
microangiopathy ntawm qis qis kawg.

Nrog nephropathy, hloov pauv pathological cuam tshuam yuav luag txhua lub nkoj me me ntawm lub raum. Nrog rau qhov no, cov hlab ntsha loj kuj tseem cuam tshuam, uas ua rau lub cev tsis ua haujlwm ntawm lub cev no. Cov metabolism hauv zos tsis muaj zog txaus, cov ntaub so ntswg thiab cov hlwb tsis tau txais cov pa oxygen thiab cov khoom noj muaj txiaj ntsig zoo. Ntxiv rau vascular hloov pauv, nrog nephropathy, kev ua haujlwm ntawm cov txheej txheem thiab cov qauv ua lub luag haujlwm rau nws siv (tubules thiab glomeruli) raug kev txom nyem.

Retinopathy yog qhov mob ntawm lub retina. Cov hlab ntsha me me hauv thaj chaw no yog lub luag haujlwm rau cov ntshav ib txwm xa mus rau cov tseem ceeb ntawm cov khoom hauv nruab nrog pom, yog li lawv cov kev hloov pauv tsis zoo cuam tshuam rau tus neeg lub peev xwm pom. Ua raws li theem ntawm tus mob retinopathy, cov tsos mob tuaj yeem yog ob qho tib si me thiab cuam tshuam rau tus neeg mob. Qhov tshwm sim loj tshaj plaws ntawm qhov muag microangiopathy yog qhov muag tsis pom kev, yog li, cov neeg mob ntshav qab zib yuav tsum tau kuaj tsis tu ncua los ntawm kws kho qhov muag.

Kev hloov pauv ntawm cov hlab ntsha hauv qab ntawm qhov qis qis yog ib qho ntawm cov kev ua kom muaj kev loj hlob ntawm cov mob ntshav qab zib mob ko taw. Kev ua txhaum ntawm cov ntshav ncig, cov roj ntsha ntawm cov leeg ua rau cov khoom noj tsis txaus ntawm cov leeg ntawm ob txhais ceg, yog li cov ntaub so ntswg no plam lawv cov laus ib txwm thiab ywj. Daim tawv nqaij ntawm qhov qis qis yuav ua kom qhuav, txhua qhov tawg thiab khawb ua rau lub qhov rooj nkag rau kev kis mob. Kev puas tsuaj rau daim tawv nqaij ntawm ob txhais ceg heals rau ib lub sij hawm ntev heev thiab yog qhov nyuaj, ib tus neeg yuav muaj kev mob siab rau trophic mob. Qhov kev mob tshwm sim tshaj plaws ntawm angiopathy ntawm qis qis yog mob caj dab, uas ua rau txiav tes txiav lossis tuag.

Ua rau

Kev mob ntshav qab zib microangiopathy tshwm sim vim kev ua txhaum ntawm microcirculation ntawm cov ntshav, ua rau cov hlab ntsha tsis muaj pa oxygen thiab cov as-ham. Kev cuam tshuam ntawm cov metabolism hauv cov kab mob ntshav qab zib ua rau cov ntshav qab zib ua rau muaj kev ua haujlwm txawv ntawm cov qog thiab phab ntsa ntawm cov hlab ntsha, hlab ntsha thiab venules, vim cov qauv txheej txheem no tseem muaj cov carbohydrates.

Vim tias muaj ntshav qab zib, cov khoom seem ntawm cov protein metabolism ntxiv hauv cov neeg mob cov ntshav, uas yuav tsum nquag tawm ntawm lub cev. Qhov no ua rau muaj kev hloov pauv ntawm cov ntshav thiab ua kom phab ntsa ntawm cov hlab ntsha me. Feem ntau, microangiopathy tshwm sim hauv 10-15 xyoo ntawm cov mob ntshav qab zib, tab sis kuj tseem muaj cov kev loj hlob sai ntawm pathology tom qab 1-2 xyoo los ntawm qhov pib ntawm endocrine cuam tshuam. Vim li ntawd kiag li txhua tus neeg mob poob rau hauv pab pawg muaj kev pheej hmoo, thiab txhawm rau tswj kev noj qab haus huv lawv yuav tsum ua tib zoo mloog lawv lub cev thiab mus ntsib kws kho mob kom ncav sijhawm.

Thaum pib ntawm txoj kev loj hlob ntawm cov txheej txheem pathological (tsis hais nws qhov chaw nyob), cov tsos mob yog qhov tsis tseem ceeb uas ib tus neeg tsis tshua mob siab rau lawv. Yog tias peb tab tom tham txog teeb meem nrog cov hlab ntawm ob txhais ceg, tom qab ntawd lawv cov cim tseem yuav yog tingling lossis kev xav loog.

Thaum tus kab mob pathology ntawm tus neeg mob zuj zus, cov tsos mob hauv qab no pib thab:

daim duab mob hauv ceg
muaj zog rog ntau zuj zus
o tuaj
ntau dhau ntawm cov tawv nqaij ntawm tus taw thiab txhais ceg,
plaub hau hauv thaj chaw no,
cramps
poob qhov kub thiab (lossis) qhov mob rhiab,
Qhov tsim ntawm trophic mob rau sab hauv uas nyuaj rau kev kho.

Tus neeg mob ob txhais ceg feem ntau nyob txias txawm tias lub caij sov vim yog ntshav khiav tsis txaus. Ntxiv rau cov teeb meem nrog cov hlab ntsha me, cov hlab ntsha thiab cov hlab ntsha loj thiab leeg ntshav tau teeb tsa rau hauv tus txheej txheem. Vim tias qhov no, cov xim ntawm daim tawv nqaij ntawm ob txhais ceg yuav dhau mus ua xim daj lossis ua xim paj yeeb, cyanotic. Kev tsis saib txoj cai ntawm tus kheej kev tu cev, raws li txoj cai, ua rau muaj qhov xwm txheej tsis zoo thiab ua rau lub zog ua kom muaj kev mob txhab ntxiv. Ua kom koj ob txhais ceg huv si thiab qhuav yog ib qho ntawm txoj cai kev ua neej nyob rau ntshav qab zib.

Retinopathy thaum pib yuav luag tsis ua rau nws tus kheej, txawm hais tias thaum kuaj los ntawm tus kws kho pob ntsej muag, tus neeg mob ntawd yuav muaj qhov hloov pauv. Feem ntau, cov neeg mob ntaus nqi xws li ua kom pom kev qaug zog, thiab tsis txhob sau qhov tshwj xeeb rau lawv. Thaum pib, me "yoov" lossis cov txim taws yuav tshwm sim ua ntej lub qhov muag, tab sis pom tseeb, raws li txoj cai, tsis raug kev txom nyem. Tom qab ntawd tus neeg ceeb toom tias nws yuav nyuaj rau nws ua haujlwm hauv lub koos pij tawj, nyeem thiab sau ntawv (nws lub qhov muag sab heev thiab qhov pom tseeb ntawm lub zeem muag poob qis). Cov tsos mob tau nce ntxiv vim yog lub xeev ntawm qhov tsis nco qab mob siab dua, thiab yog tias koj tsis tham nrog tus kws kho mob raws sijhawm, qhov kev pheej hmoo ntawm qhov muag dig nce.

Nws yog qhov nyuaj rau xav tias tsis muaj nephropathy thaum pib ntawm nws txoj kev loj hlob, vim tias nws tuaj yeem pom tsuas yog los ntawm qhov muaj cov protein nyob hauv cov zis (qhov no tuaj yeem kuaj tau los ntawm kev kis tsom tawm). Thaum lub raum puas ua rau lub cev muaj mob ntau, ntau tuaj yuav ua rau muaj kev ntshaus siab, txhaws hauv ntshav siab, tso zis tsis zoo, tsis hnov tsw ntawm ammonia tawm ntawm lub qhov ncauj thiab qhov tsis muaj zog.

Kev kuaj mob

Txhawm rau tsim kev kuaj mob microangiopathy ntawm qhov qis qis, kev kuaj mob ntawm kws kho mob, kuaj ntshav hauv tsev kuaj thiab xoo hluav taws xob yog tsim nyog. Cov nkoj me me thiab cov nkoj loj ntawm ob txhais ceg kuj tseem tuaj yeem kuaj xyuas siv Doppler (ultrasound xim). Qee qhov xwm txheej, MRI lossis xam tomography scan tuaj yeem raug xaj kom paub meej cov teeb meem tsis sib haum. Yuav kom tau txais daim duab tseeb, tus neeg mob feem ntau pom zoo kom ua qhov kev kawm nrog tus neeg sawv cev sib piv, uas txhim kho qhov tseeb ntawm daim duab.

Nrog nephropathy nyob rau hauv kev ntsuas dav dav ntawm cov zis, kev hloov pauv tau pom tshwm sim dhau los uas yog qhov laj thawj ntawm kev kuaj mob hnyav dua.

Nws muaj peev xwm txiav txim siab vascular cuam tshuam nyob rau hauv ob lub raum siv ultrasound, Xoo hluav taws xob, MRI. Txhawm rau ntsuas lub xeev ntawm qhov retina thiab kev kuaj pom thaum ntxov ntawm tus neeg muaj hlwb, tus neeg mob yuav tsum tau mus kuaj mob tsis tu ncua los ntawm tus kws kho qhov muag. Ntxiv nrog rau kev sib tham thiab kev kuaj mob, tus kws kho mob feem ntau siv cov hauv kev siv rau kev kuaj xyuas lub tshuab raj, ntawm lub hauv paus uas nws kos lub ntsiab lus hais txog lub xub ntiag lossis tsis muaj kev hloov pauv hauv pathological.

Kev kho mob ntawm microangiopathy mob ntshav qab zib yog nyob ntawm kev ua kom pom ntawm cov txheej txheem pathological. Nws yog qhov nyuaj heev kom nres qhov pib ntawm retinopathy, teeb meem nrog cov hlab ntsha ntawm ob txhais ceg los yog nephropathy, tab sis nws tseem muaj peev xwm ua kom qeeb lawv txoj kev txhim kho me ntsis. Lub hauv paus tseem ceeb ntawm kev kho txhua yam vascular cuam tshuam hauv lub cev yog tswj cov ntshav qab zib ntawm cov qib thiab ua raws kev noj haus. Yog tsis muaj qhov no, tsis muaj cov txheej txheem hauv zos thiab cov tshuaj pabcuam yuav pab lossis nqa kom tshwm sim ntev.

Txhawm rau kom lub cev ntws nrawm nrawm hauv qhov retina, tus neeg mob tuaj yeem kho qhov muag pom tseeb, cov vitamins thiab lub teeb zaws ntawm lub tawv muag. Cov txheej txheem zoo li no yuav tsis tshem qhov teeb meem kiag li, tab sis yuav ua rau nws qeeb zuj zus. Nrog nephropathy, nws yog ib qho tseem ceeb kom ua raws li kev noj zaub mov noj, tso tseg ntsev thiab muaj protein ntau, thiab tswj ntshav siab.Nrog rau cov mob ntshav siab (concomitant hypertension), tus neeg mob yuav tsum noj tshuaj antihypertensive (piv txwv li, ACE inhibitors).

Lub cev loj hauv lub cev tsis zoo cuam tshuam rau qhov mob ntawm qhov qis qis, vim tias qhov no lawv muaj ntau dhau kev thauj khoom. Cov kev ua kis las muaj ntsis thiab taug kev ntev kuj tseem ceeb kom ntshav khiav, txhim kho cov nqaij mos nyob sab hauv tsev thiab txhim kho kev zom zaub mov. Kev zaws tus kheej txhua hnub thiab kev tawm dag zog zoo txo cov kev pheej hmoo ntawm kev txhim kho tus mob ko taw mob ko taw. Qee zaum tus neeg mob tuaj yeem raug kho cov txheej txheem kho lub cev ua haujlwm thiab tshuaj pleev rau cov ntaub ntawv tshuaj pleev, uas txhim kho cov mob ntawm cov nqaij mos thiab cov hlab ntshav ntawm ob txhais ceg.

Kev Tiv Thaiv

Txoj hauv kev zoo tshaj plaws los tiv thaiv txhua yam vascular cuam tshuam ntawm ntshav qab zib yog tswj ntshav qab zib kom nyob ntawm qhov hom phiaj. Txhawm rau ua qhov no, nws yog ib qho tseem ceeb kom ua raws li kev noj zaub mov noj, yauv mus kuaj kev kuaj mob los ntawm tus kws endocrinologist raws sijhawm, thiab kuaj ntshav.

Tsis tas li rau kev tiv thaiv lub hom phiaj nws yog qhov tsim nyog heev:

txiav kev haus luam yeeb thiab haus dej haus cawv,
tsis txhob noj ntsev ntau ntau nrog koj cov khoom noj,
tsis tu ncua kuaj theem ntawm cov roj cholesterol hauv cov ntshav thiab, yog tias tsim nyog, txo qis,
coj lub neej nquag
txhawm rau tswj kev ua haujlwm ntshav, tiv thaiv nws cov nce siab.

Mob ntshav qab zib mellitus, ntawm chav kawm, cuam tshuam rau lub xeev ntawm cov hlab ntsha, thiab nws yuav luag tsis tuaj yeem tiv thaiv txhua qhov kev hloov tsis zoo hauv lawv. Tab sis thaum txheeb xyuas teeb meem thaum ntxov, koj tuaj yeem tiv thaiv kev tsis zoo ntawm cov txheej txheem pathological. Kev noj qab haus huv zoo thiab ua raws li cov lus pom zoo ntawm tus kws kho mob koom nrog tso cai rau ntau tus neeg mob ntshav qab zib kom tsis nco qab txog qhov cuam tshuam ntawm tus kab mob mus ntev.

Ntshav qab zib microangiopathy - kuaj mob thiab kho mob

Mob ntshav qab zib microangiopathy yog qhov txhab ntawm cov hlab ntsha me - capillaries, hlab ntsha thiab cov leeg ntshav. Qhov tshwm sim no tshwm sim ntau heev, ua rau muaj kev tsis zoo. Txhawm rau tiv thaiv qhov pib ntawm tus mob no, nws tsim nyog ua raws li kev teem caij kho mob txhua lub sijhawm. Yog tias muaj cov tsos mob zoo li no tshwm sim, yuav tsum tau ua sai sai.

Lub ntsiab lus ntawm pathology

Kev mob ntshav qab zib microangiopathy yog to taub raws li kev puas tsuaj rau vascular, uas yog qhov tshwm sim ntawm kev mob ntshav ntev. Yeej, muaj kev hloov pauv ntawm cov nkoj me me - capillaries, venules thiab hlab ntsha. Pathology yuav tsis pom nws tus kheej txog li 10-15 xyoo - qhov no yog txiav txim siab los ntawm kev muaj peev xwm them nyiaj ntawm tus neeg mob.

Kev nce ntxiv ntawm cov ntshav qab zib provokes tsub zuj zuj ntawm cov tshuaj tiv thaiv immunological rau ntawm cov hlab ntsha. Qhov no ua rau o ntawm daim nyias nyias thiab nqaim ntawm lub lumen ntawm cov hlab ntsha, uas ua rau kev ua txhaum ntawm cov ntshav kev.

Tus txheej txheem no yog nrog los ntawm kev ua txhaum ntawm cov ntshav tawm, ua tiav ntawm cov ntshav me ntshav, hloov pauv hauv cov txheej txheem hauv cov metabolism. Lub sijhawm ntev, cov kabmob muaj lub cev tsis muaj pa oxygen. Qhov no ua rau muaj kev poob qis hauv lawv cov kev faib tawm thiab nce kev poob zoo.

Ntau yam ua rau muaj qhov tshwm sim ntawm microangiopathy mob ntshav qab zib mellitus:

Irreversible processes vim muaj kev nce siab sai sai ntawm cov hlab ntsha permeability,
Ua txhaum ntawm cov yam ntxwv ntawm cov khoom sib txuas,
Thrombosis - qhov tshwm sim hauv cov hlab ntshav ntawm cov ntshav txhaws uas cuam tshuam cov ntshav ncig,
Hyaline dystrophy - cov yam ntxwv ntawm qhov cia ntawm cov protein muaj feem ua qauv ntom ntom,
Necrosis - kev tuag thiab tuag ntawm cov ntaub so ntswg.

Raws li cov piam thaj kom nce siab, dawb radicals thiab peroxides yog tsim hauv lub cev. Lawv ua rau kev rhuav tshem thiab lom ntawm endothelium, uas yog qhov tseem ceeb heev rau kev tsim kho tag nrho ntawm cov ntaub so ntswg thiab lwm yam haujlwm.

Nquag, endothelium ua rau muaj nitric oxide. Nrog txoj kev loj hlob ntawm pathology, cov khoom lag luam ntawm cov tshuaj no tsawg dua. Hauv qhov xwm txheej no, cov hlab ntsha poob lawv qhov peev xwm nthuav dav. Qhov no dhau los ua qhov pathologies ntawm lub plawv thiab cov hlab ntshav.

Kev faib tawm

Coob tus neeg xav paub txog dab tsi hais txog microangiopathies hauv ntshav qab zib. Nyob ntawm lub chaw ntawm lub anomaly, cov hom mob hauv qab no tau pom:

Neesnkauj,
Retinopathy
Microangiopathy ntawm ob txhais ceg.

Retinopathy yog to taub tias txhais tau tias kev puas tsuaj ntawm lub pob txha o. Cov hlab ntsha me me hauv thaj chaw no yog lub luag haujlwm rau cov ntshav xa mus rau cov khoom tseem ceeb ntawm cov khoom hauv nruab nrog tsis pom kev. Vim hais tias cov kev pauv hloov pathological ua rau pom kev tsis pom kev. Ua raws li theem ntawm kev rov ua dua, qhov kev tshwm sim tuaj yeem yog me lossis ua rau muaj kev tsis yooj yim rau tus neeg mob kom ua tiav qhov tsis pom kev.

Nrog nephropathy, hloov pauv txawv txav yuav luag txhua qhov me me ntawm lub raum. Tsis tas li ntawd, cov hlab ntsha loj tuaj yeem raug kev txom nyem, uas ua rau muaj teeb meem hauv kev ua haujlwm ntawm lub cev no. Cov metabolism hauv zos tsis zoo txaus. Qhov no ua rau lub cev tsis txaus oxygen thiab cov txiaj ntsig zoo.

Tsis tas li ntawd, nrog cov mob nephropathy, kev lim pom yuav cuam tshuam thiab cov qauv uas muaj lub luag haujlwm rau cov txheej txheem no tau cuam tshuam.

Txhab ntawm cov hlab ntsha ntawm ob txhais ceg los ua ib qho ntawm cov laj thawj ntawm cov tsos ntawm ko taw mob ntshav qab zib. Cov kev pauv hauv cov hlab ntsha hauv ntshav thiab ntshav ncig ua rau lub cev tsis zoo ntawm cov leeg nqaij ntawm ob txhais ceg. Yog li, ntshav qab zib microangiopathy ntawm qis qis provokes qhov poob ntawm lub cev tawv nqaij tsis tu ncua. Nws yuav qhuav, thiab muaj kev puas tsuaj ua rau kis tau tus mob.

Txhua qhov khawb thiab qhov mob ntawm cov tawv nqaij zoo mob tau ntev ntev. Tus neeg mob yuav pib ua rau muaj pob kiav txhab. Qhov phom sij txaus ntshai tshaj plaws uas tuaj yeem ua rau microangiopathy ntawm qis qis hauv ntshav qab zib yog mob caj dab. Nws ua rau kev txiav ib ceg tawv lossis tuag.

Soj ntsuam duab

Thawj theem pib ntawm kev tshwm sim ntawm pathology, nws cov tsos mob yog li pom tsis tau tias tus neeg mob tsuas tsis quav ntsej lawv. Nrog kev puas tsuaj rau cov hlab ntawm ob txhais ceg, tingling thiab loog yog qhov kev ua yeeb yam tseem ceeb.

Raws li tus neeg xav tsis thoob, cov tsos mob hauv qab no tshwm sim:

Mob hauv ob txhais ceg ntawm rub tus cwj pwm,
O o
Siab rog
Ntau qhuav ntawm txhais taw thiab txhais ceg,
Xaus cov leeg mob
Ceg plaub hau poob
Poob siab rhiab
Cov tsos ntawm trophic mob rwj, uas nyuaj rau kho.

Cov teeb meem circulatory ua rau tus neeg mob ob txhais ceg tseem txias txawm tias kub. Ntxiv nrog rau qhov yeej ntawm cov hlab ntsha me, cov hlab ntsha cov leeg, cov hlab ntsha thiab cov hlab ntsha feem ntau muaj feem cuam tshuam hauv txoj kev txawv txav. Qhov no tuaj yeem ua rau muaj kev hloov xim tawv nqaij - nws ua liab, xiav lossis daj ntseg.

Kev ua txhaum txoj cai ntawm kev nyiam huv feem ntau ua rau muaj qhov xwm txheej phem thiab tsim nyog ua ntej ntawm kev kis kab mob. Yog li, cov kws kho mob tau pom zoo kom ua kom koj txhais taw qhuav thiab huv si.

Thaum nyuam qhuav pib ntawm retinopathy, txoj cai kawm asymptomatic. Txawm li cas los xij, tus kws kho qhov muag thaum kuaj tau tuaj yeem sau cov kev hloov pauv ntawd. Thaum xub thawj yoov lossis lub txim taws tuaj yeem tshwm ntawm hauv ntej lub qhov muag, tab sis pom qhov tseeb tsis poob.

Tom qab ntawd nws nyuaj rau tus neeg mob sau ntawv, ua haujlwm ntawm lub khoos phis tawj lossis nyeem ntawv. Cov duab hauv tsev kho mob raug hnyav dua vim tias tus kab mob retina cuam tshuam. Yog tias koj tsis hu rau tus kws kho qhov muag, muaj qhov pheej hmoo ntawm qhov tsis pom kev.

Txheeb xyuas cov kab mob nephropathy nyob rau theem pib ntawm kev txhim kho yog qhov teeb meem heev. Pathology tshwm sim tshwj xeeb tshaj tawm los ntawm kev tsim cov protein ua kom tsis muaj zog hauv cov zis. Soj ntsuam kev tshuaj ntsuam yuav pab tshawb kom paub cov khoom no.

Yog hais tias lub raum puas ua haujlwm tshaj li yuav ua rau lub cev ntuav, muaj kev o, nias poob, teeb meem nrog tso zis. Coob leej ntau tus ntsib qhov tsis muaj zog, lawv hnov tsw ntawm ammonia ntawm lub qhov ncauj.

Kev kuaj mob

Ua ntej tshaj plaws, koj yuav tsum txiav txim siab hom ntshav qab zib. Tus kab mob ntawm thawj hom yog insulin-tiv thaiv, pathology ntawm hom ob tsis xav tau kev qhia ntawm cov tshuaj insulin.

Cov kws kho mob tseem txheeb xyuas cov ntaub ntawv ntawm glycemic profile, C-peptide, glycated hemoglobin.

Tus kws tshaj lij yuav tsum kawm txog keeb kwm ntawm kab mob pathology, ua ib qho kev kuaj mob thiab txheeb xyuas qhov teeb meem. Yog tias muaj kev ua xyem xyav ntawm microangiopathy, ua qhov kev tshawb fawb no:

Fundusgraphy - lub tshuab tsom tsom iav tsom xam cov qauv ntawm pob txha ntsej muag. Cov txheej txheem tso cai rau koj txheeb xyuas tus vaub kib ntawm cov hlab ntsha, kuaj ntshav khov thiab txhaws ntawm lub lens.
Kev kuaj ntshav ntawm lub plab hnyuv siab raum - tso cai rau koj los txiav txim siab txog kev mob ntshav siab, nce ntxiv ntawm lub raum, thiab cov zis ntau ntxiv nyob rau hauv lub raum plab mog. Cov txheej txheem kuj tseem pab txheeb xyuas qhov nqaim ntawm lub lumen ntawm cov nkoj sib txawv.
Sib suav thiab kev sib nqus ntawm lub ntsej muag - pab ua kom cov qauv ntawm cov khoom nruab nrog cev thiab txiav txim siab txawv txav.
Angiography ntawm ob txhais ceg - cuam tshuam nrog kev siv cov duab xoo hluav taws xob uas siv kev sib piv. Ua tsaug rau cov txheej txheem, nws muaj peev xwm txiav txim siab qhov loj me ntawm lub nkoj thiab tus nqi ntawm lawv cov staining nrog kev sib thooj.
Rheovasography - siv los ntsuas cov leeg ntshav hauv ob txhais ceg. Txoj kev tshawb fawb kuj tseem pab txiav txim siab qhov patency ntawm cov hlab ntsha thiab qhov zoo ntawm cov hlab ntsha tuaj.

Cov hau kev kho

Txhawm rau tiv thaiv tus kab mob, nws yog ib qho tsim nyog kom ua raws nraim nrog txhua cov lus pom zoo ntawm tus kws kho mob. Nco ntsoov txiav luam yeeb, muab kev tawm dag zog me me thiab lub cev hnyav.

Los ntawm cov khoom noj yog kom tshem cov carbohydrates uas yooj yim zom. Qee qhov xwm txheej, kev noj zaub mov nrog ntsev qhov yuav tsum tau.

Ntxiv nrog rau cov tshuaj insulin, ib feem ntawm cov kev kho mob nyuaj ntawm pathology yog kev siv colloidal phytoformulas uas cuam tshuam rau txhua yam hauv kev txhim kho ntshav qab zib. Lawv muaj cov nyhuv hypoglycemic, normalize microcirculation, xa cov khoom uas yuav tsum tau them nyiaj rau qhov tshwm sim ntawm tus kabmob mus rau lub cev.

Hauv tsev kho mob, angioprotectors tuaj yeem siv, uas ua rau kom rov kho dua thiab tiv thaiv cov hlab ntsha. Hom no suav nrog cov tshuaj xws li parmidin, angin, dicinone.

Txhawm rau txhim kho cov txheej txheem hauv metabolic, trimetazidine thiab mildronate siv. Kev siv cov statins, xws li atorvastatin, simvastatin, yuav tsum ua tib zoo saib xyuas. Ntxiv rau kev txo qis roj, lawv tuaj yeem ua rau muaj kev phiv tshuaj tsis zoo.

Raws li kev qhia, anticoagulants tuaj yeem siv. Lawv pab txo cov ntshav coagulation. Cov nyiaj no suav nrog fraxiparin, heparin, thiab lwm yam.

Ua cov tshuaj ntxiv rau cov kev kho mob tseem ceeb, cov kws kho mob tshwj xeeb tshaj tawm xws li txhais tau tias laser, kev kho hluav taws xob, kho pob ntseg. Lwm yam kev tawm dag zog lub cev uas tuaj yeem kho vascular morphology thiab paub daws kev mob caj dab kuj tseem siv tau.

Microangiopathy mob ntshav qab zib yog qhov mob hnyav, uas ua rau muaj kev phom sij txaus ntshai. Qhov pom tseeb kev ua haujlwm ntawm kev teem caij kho mob thiab kev ua neej hloov kho pab ua kom tsis txhob muaj qhov no. Yog tias cov tsos mob ntawm tus kab mob pathology tshwm sim, koj yuav tsum hu rau tus kws endocrinologist tam sim. Tom qab ua kom qhov xwm txheej tsis zoo, tom qab ntawd nws yuav tsum tau kuaj mob tiv thaiv kev kuaj mob ib xyoos ib zaug.

Lub ntsiab manifestations ntawm tus kab mob

Cov duab hauv chaw soj ntsuam ntawm tus kab mob nyob ntawm thaj chaw thiab thaj tsam ntawm lub qhov txhab.

Raws li kev nce siab osmotic siab, uas tshwm sim los ntawm cov ntshav qab zib ntau ntau thiab noj cov dej ntau dhau, tus neeg mob yuav o tuaj rau hauv cov nqaij mos. Vim tias kev ua txhaum ntawm cov protein thiab cov rog rog, lub xeev cov hlab ntsha tuaj, cov ntshav liab tau raug puas, cov ntshav tawm (purpura) tshwm sim, thiab lub raum tsis ua haujlwm.

Lwm yam ntawm tus kab mob:

cov ntshav qab zib nephropathy - pom nyob rau hauv ib feem peb ntawm cov neeg mob. Nrog nws, raum tsis ua haujlwm, o tshwm sim, cov protein ntau nyob rau hauv cov zis,
pathology ntawm cov hlab nyob hauv qis qis,
kev puas tsuaj rau cov hlab ntsha ntawm retina ntawm pob muag (angioretinopathy).

Qhov xwm txheej thim rov qab ntawm kev pib hloov pauv ntawm cov hlab ntsha thaum lub sij hawm kho kom cuam tshuam cov kev sib txawv ua kom sib txawv nrog cov kev kho rau cov organic vascular txhab.

Raws li qhov no, peb theem ntawm kev mob qog mob ntshav qab zib hauv ntshav qab zib tau txawv:

soj ntsuam
haumxeeb
organic.

Cov neeg mob nrog rau thawj theem ntawm kev tsis txaus siab feem ntau tsis tshwm sim. Nws tsis muaj pathologies thaum kuaj. Txawm li cas los xij, raws li cov txiaj ntsig tau ntawm kev tshawb nrhiav biochemical, qhov ntsuas qhov siab ntawm cov roj (cholesterol) tau raug qhia tawm, cov naj npawb ntawm capillaries ntawm cov ntiv taw nce ntxiv.

Hauv theem ob, mob me thiab dhau mus mob ntawm txhais ceg tshwm sim thaum taug kev ntev, cramps tshwm, tawv nqaij ntawm daim tawv nqaij ntawm sab hauv qis dua li 2-3 degrees. Kev hloov biochemical, hloov ntshav sib quas ntus thiab ntshav siab tshwm sim.

Hauv theem thib peb, qhov mob ntawm cov hlab ntawm ob txhais ceg tau tshaj tawm, ua rau muaj kev tsis txaus siab, mob hauv taw, mob rwj, mob asystole ntawm txoj kab dorsal leeg ntawm ko taw. Hloov ntshav khov, hloov me me ntawm kev hloov kho uas tsis muaj kev cuam tshuam. Cov theem thaum uas mob ntshav qab zib macroangiopathy tshwm sim yog muaj ntau yam hais tawm.

Ntxiv nrog rau kev tshuaj ntsuam biochemical yuav tsum muaj:

Nyiaj txiag ultrasound,
xam tomography,
Kev tshawb nrhiav xoo hluav taws xob
sib nqus resonance ntsuam xyuas,
kev kuaj mob ntawm cov hlab ntsha.

Cov kev kho mob yog nyob ntawm lub hauv zos ntawm cov txheej txheem pathological, qhov ua rau thiab cov teeb meem uas microangiopathy tshwm sim. Feem ntau, cov neeg mob tau raug xaj kom noj tshuaj kho mob txhawm rau txhim kho qhov ua tau ntawm cov ntshav microcirculation hauv cov ntaub so ntswg.

Xws li ntxiv rau nws, kev kho lub cev yuav kho tau. Ib qho ntawm cov xwm txheej rau qhov txiaj ntsig zoo hauv kev kho mob yog kev ua raws li cov qauv ntawm kev noj haus thiab kev ua neej pom zoo los ntawm kws kho mob.

Cov lus pom zoo tshaj plaws nyob rau hauv cov ntaub ntawv no yog qhov tsis kam noj cov zaub mov uas muaj "carbohydrates ceev" - chaw ua khoom noj, kua txiv thiab dej qab zib, nplej zom, ncuav qab zib thiab qee hom zaub thiab txiv hmab txiv ntoo. Khoom noj ntsev yuav muaj tsawg.

Koom nrog kev coj zoo li kev haus luam yeeb yog qhov tseem ceeb rau cov neeg mob. Cov kab thiab ntau yam sib xyaw hauv cov pa luam yeeb ua rau muaj vasoconstriction thiab necrosis.

Ntawm cov lus pom zoo uas ua rau muaj txiaj ntsig kho tau zoo dua tuaj yeem ua raws li kev ua haujlwm kom zoo ntawm lub hnub thiab kev faib tawm lub cev.