79) Atherosulinosis

Atherosclerosis ikupitiliza kukhala imodzi mwazofufuza zazikulu kwambiri. Ambiri mwa matenda omwe ali ndi chiwonetsero chosiyana kwambiri chamankhwala amaphatikizidwa kwambiri ndi atherosulinosis, ndipo pakati pawo kumayambitsa matenda am'mimba, stroko, aneurysms yam'mimba, miyendo yam'munsi yam'mimba.

Amatsimikiza makamaka kuchepa komanso kufa. Zachidziwikire, kapangidwe ka zolembedwa za atherosselotic ndi gawo lalikulu pakuchita izi. Zowonadi, ndikuthokoza chifukwa cha kapangidwe kapadera kamapangidwe kameneka komwe kamatulukiridwa komwe kamatulukira, kamene kamayambitsa kuwonongeka m'moyo wa munthu, ndipo nthawi zina kumwalira. Koma, ngakhale pali matenda ambiri azachipatala, chiwonetsero chachikulu cha atherosulinosis ndichinthu chofala pathogenetic: kupasuka kwa zolengeza za atherosulinotic.

Mavuto a plaque amatha kusiyanasiyana malinga ndi ming'alu yaying'ono kapena kukokoloka kwa malo okhala zolembedwazo kuzinthu zowonongeka zomwe zimafikira mkati mwa zotupa za lipid pachimake. Muzochitika zonsezi, osachepera ena mwa kupangika kwa magazi kumachitika.

Mimba yam'mimba nthawi zambiri imakhala ndi vuto lopanga zolembera, komanso zovuta zomwe zimakhudzana ndi chidacho.

Mu chotengera chachikulu ichi, kuwonongeka kwa mapepala ndi thrombosis sikumatha ndi mawonekedwe a lumen ndipo kumatha kuyambitsa zilonda zapamwamba kwambiri, kuphatikiza zigawo zazikulu za khoma la aortic, zomwe zimatha kuwonedwa nthawi zambiri odwala okalamba. Kuphatikiza pa gawo losasinthika la atherosulinosis pakupanga kwam'mimba maaturicm, thrombosis yam'kamwa imayambitsa chida chotsika modabwitsa cha zovuta zazikulu muzipatala izi, ngakhale cholesterol embolism imatha kupezeka pafupipafupi impso ndi khungu pakhungu.

Komabe, sizikudziwika bwino momwe zinthu zosiyanasiyana zokhudzana ndi chilengedwe, zomwe zimamasulidwa ku kukokoloka kwa msempha, zingakhale ndi thupi la munthu.

Kodi pali kusiyana kotani pakati pa malo okhazikika ndi osakhazikika?

M'matumba ang'onoang'ono, ngati mitsempha ya coronary, occlusive thrombosis imakonda kupezeka kawirikawiri ndipo nthawi zambiri imapangitsa kupindika kwa chidutswa. Chifukwa chake, m'mitsempha yama coronary, plaque cleavage yaphunziridwa kwambiri, ndipo maubwenzi angapo apezeka pakati pa kapangidwe kake, kuchuluka kwa kuphatikizira kwa magazi ndi mitundu ya ischemic coronary syndromes ya odwala. Kuwona kumeneku kwadzetsa lingaliro la malo osakhazikika a atherosulinotic malo - zolembedwa zokhala ndi mawonekedwe osakhazikika, zomwe zimapangitsa kuti pakhale matenda osakhazikika a m'mitsempha.

Ntchito zambiri zofufuzira zidayang'ana kwambiri pakuwona vuto ngati cholembera chosakhazikika cha atherosulinotic.

Kapangidwe ka atherosulinotic plaque ndi chifukwa cha kuyanjana kwam ma cell mkati mwa mitsempha yomwe imachitika pakati pa maselo akuluakulu a khoma la chotengera ndi ma cell a chitetezo (maselo oyera).

Kusokonezeka kwa madzi amderalo ndi ma lipids ngati gulu loyendetsa zolembera ndizofunikira pantchitoyi. Kapangidwe ka atherosselotic kapangidwe kake, kamawonetsa kapangidwe kake ka kapangidwe ka michere, kamene kamakhala pakatikati ka zigulu zakunja ndi zinthu zina zowola.

Minofu yowoneka bwino imapereka umphumphu woyika.

Atheroma ndiofatsa, ofooka, komanso thrombogenic kwambiri. Chipilalachi chili ndi mitundu yambiri ya zam'madzi za m'mimba ndipo zimakhala zopanda maselo amoyo, koma zimatha malire ndi nembanemba ya macrophages.

Kupanda malire kwa phagocytosis wa oxidized LDL mothandizidwa ndi macrophages kumawatsogolera kuti afe. Imfa ya zinthuzi imachita mbali yofunika kwambiri pakupanga ndi kukula kwa atheroma komanso kumanga kwa lipids ku ma collagen ulusi ndi proteinoglycans.

Kusiyana kwakapangidwe kapangidwe kazinthu sikumadziwika: Kafukufuku wa histopathological wa zolembedwa zazikuluzikulu adawonetsa kusiyana kwakukulu mu:

1. kukula kwa zingwe zazingwe
2. kukula kwa atheroma.

Kuphatikiza apo, kusiyana pamlingo wa mawonekedwe a dystrophic kunawululidwa.

Phunziroli ndilofunika kwambiri, chifukwa lidawonetsa mitundu yachilendo ya zotupa zomwe zimakhudzana ndi chiwonetsero chachikulu cha matenda a atherosulinotic.

Kuwerengera kwa michere yam'manja komanso ma lipids mu zolembera

Kuphatikiza kulikonse kwa makulidwe a khoma ndi kukula kwa atheroma kumatha kuchitika. Makamaka mapangidwe olimba a fibrous ali ndi minofu yopitilira-michere ndipo ndi ochepa okha omwe amakhala ndi ma lipid akunja kapena alibe lipid konse. M'mitsempha yama coronary, zotupa zambiri zotere zimangokhala chete ndipo zimatha kuyambitsa khola laina pakapita nthawi yayitali.

Nthawi zambiri malo okhala pachiwopsezo amadziwika ndi kupezeka kwakukulu kwa lipid ndipo amakhala ndi cholembera chochepa thupi kapena chosafunikira.

Nthawi zambiri pamakhala malo okhala ndi milomo yokhala ndi mapangidwe a coronary thrombosis.

Malo okhala ndi Lipid amadziwika kuti ndi "misozi."

Si malo onse odwala omwe ali ndi matenda okhazikika m'mitsempha omwe amadwala matendawa.

Kafukufuku wasonyeza kuti makumi asanu ndi limodzi muzana mwa malo amenewa ndi am'mafupa, koma 40% anali ndi lipids zakunja. Odwala 15% okha ndi omwe anali ndi ziwonetsero zonse zomwe zimayambitsa stenosis ndipo anali amisempha, pomwe 13% mwa odwala pafupifupi malo onse anali ndi lipid pachimake. M'malo mwake, odwala ambiri anali ndi mitundu yosiyanasiyana ya zolembera.

Kusiyana kwazomwe zimapangidwa mu mbiri ya zolembedwazo ndi ubale wake ndi kapangidwe ka khoma lakale zimakhala ndi zotsatirapo zina.

Mwachitsanzo, mitundu yopanda makoma nthawi zambiri imaphulika. Mphamvu zamakina zamkati zimathandizira kuti ziwonekere.

Poterepa, kuphatikizika kwa minofu ya khoma la fibrous komanso mawonekedwe amkati mwapangidwe awa ndikofunikira.

Njira yopanga mapangidwe

Atherogenesis ndi chitukuko cha zolembera zodziwika bwino.

Amadziwika ndi kukonzanso kwina, komwe kumayambitsa kudzikundikira kwa mafuta am'madzi otchedwa plaques.

Kukula kwa atheromatous plaque kumachitika pang'onopang'ono kwa zaka zingapo kudzera munthawi zovuta kuzinthu zingapo zomwe zimachitika mkati mwa khoma lakale komanso chifukwa cha zinthu zambiri zomwe zimazungulira mtima.

Chimodzi mwazoyerekeza zaposachedwa zikuwonetsa kuti pazifukwa zosadziwika, maselo oyera, monga monocytes kapena basophils, amayamba kuukira endothelium ya lumen ya artery m'mitsempha yamtima.

Kenako kutupa kumayamba, komwe, kumayambitsa mapangidwe a atheromatous plaque mwachindunji mu mnofu wam'mimba, dera la khoma la chotengera lomwe lili pakati pa endothelium ndi nembanemba.

Gawo lalikulu lazowonongeka ili ndi mawonekedwe awa:

• mafuta ochulukirapo,
• CHIKWANGWANI cha collagen
• elastin.

Poyamba, kukula kwa zolengeza kumachitika, kumangokulitsa khoma kumawonedwa popanda kupendekera.

Stenosis ndi gawo lochedwa ndipo nthawi zambiri limachitika chifukwa cha kubwerezabwereza kwa chidacho komanso kuchiritsa, osati chifukwa chotsatira.

Atherogenesis oyambirira amadziwika ndi kupendekera kozungulira ma monocytes m'magazi (mtundu wa khungu loyera) kupita ku bedi lamitsempha, kumapeto kwa endothelium, kenako kusamukira kwawo m'malo a endothelial ndikuwonjezeranso ku monocytic macrophages.

Izi zimathandizidwa ndi makutidwe ndi okosijeni a tizinthu ta lipoprotein mkati mwa khoma, pansi pa maselo a endothelial. Mwanjira iyi, gawo lowonjezera limaseweredwa ndi kuchuluka kwa shuga m'magazi.

Mpaka kumapeto, pakadali pano, makinawa sanaphunziridwe, ndipo mafambo amafuta amatha kuwonekera ndikutha.

Kapangidwe ka atheroscrotic zolengeza

Amadziwika kuti mapangidwe omwe ali pamwambawa atha kukhala ndi mawonekedwe osiyana.

Plaque imatha kusiyanasiyana momwe imapangidwira ndipo imakhala yoyambitsa kukula kwa zovuta zina mthupi.

Ndizigawo zazikulu za zolembera za atherosulinotic zomwe zimakhudza kuzindikira komwe wodwalayo adzapatsidwe.

Mitundu iwiri yamapepala ikhoza kusiyanitsidwa:

1. Chikwangwani cha fibro-lipid (fibro-fat) chimadziwika ndi kudzikundikira kwa maselo a lipid pansi pamitsempha, ngati lamulo, popanda kufupikitsa lumen chifukwa chakukulitsa khoma la mtsempha womanga lolo. Pansi pa endothelium pali cholembera chamtali chomwe chimakwirira "maziko" a chidikacho. Mphamvuyi imakhala ndi maselo okhala ndi lipid-odzaza (ma macrophages ndi maselo osalala owoneka bwino) okhala ndi cholesterol yambiri ndi cholesterol ester, fibrin, proteinoglycans, collagen, elastin ndi zinyalala za cell. Izi malembedwe nthawi zambiri zimakhala zowononga kwambiri thupi zikaphulika. Makristali a cholesterol amathanso kupanga nawo gawo popanga matupi a plaque.
2. Chikwangwani cha ulusi chimapangidwanso pansi pa khoma, mkati mwa khoma la mtsempha, chomwe chimapangitsa kukula ndikukula kwa khoma, ndipo nthawi zina chimawonetsedwa kufalikira kwa lumen komwe kumapangitsa kuti minofu ikhale yolimba. Fibrous plaque imakhala ndi collagen fibers (eosinophilic), calcium precipitates (hematoxylinophilic) ndipo, mwakamodzikamodzi, zigawo za lipid.

M'malo mwake, gawo la minofu ya khoma la minyewa limapangira ma aneurysms ang'onoang'ono, kapena, lalikulu lokwanira kugwirizira ma atheroma.

Gawo lamkati mwa khoma la msemuyo nthawi zambiri limakhalabe lolimba, ngakhale atalipangidwanso kuti lizilipira malo opangira ma atheromatous.

Zotheka ndi zovuta zopanga zolembera

Kuphatikiza pa thromboembolism, kukula kwambiri kwa zotupa za atherosrance kungayambitse kutsekeka kwathunthu kwa lumen. Nthawi zambiri amakhala asymptomatic mpaka stenosis ya lumen imakhala yayikulu kwambiri (nthawi zambiri imakhala yoposa 80%) kotero kuti magazi omwe amafunikira minofu (minofu) amakhala osakwanira, omwe amachititsa kuti ischemia ipangidwe.

Pofuna kupewa matenda awa, ndikofunikira kudziwa kapangidwe ka maphunziro ndikupereka chithandizo choyenera.

Zilonda za atherosulinotic kapena zolembera zamtundu wa atherosulinotic zimagawika m'magulu awiri:

• khola
• komanso wosakhazikika (amatchedwanso osatetezeka).

Matenda a zotupa za atherosulinotic ndi zovuta kwambiri.

Malo osasunthika a atherosulinotic, omwe nthawi zambiri amakhala asymptomatic, ali ndi zinthu zambiri za matrix akunja komanso maselo osalala a minofu.

Malo osakhazikika ali ndi ma macrophages ndi ma cell of foam, ndipo matrix amtundu wa extracellular omwe amalekanitsa zotupa kuchokera ku lumen ya artery (omwe amadziwikanso kuti caprous cap) nthawi zambiri amakhala ofooka komanso amatha kupasuka.

Zolumikizira za caprous cap zimawononga zinthu za thrombogenic ndipo pamapeto pake zimayambitsa kupangidwe kwa thrombus. Zotsatira zake, intraluminal thrombi imatha kutseka mitsempha (mwachitsanzo, ma coronary occlusion), koma nthawi zambiri amalekanitsa, amasuntha nthawi yamagazi ndipo pamapeto pake, amatseka nthambi zocheperako, zomwe zimapangitsa thromboembolism ndi atherosclerotic cardiossteosis.

Momwe mungathetsere zolemba za cholesterol zafotokozedwa mu kanema m'nkhaniyi.