Atherosulinosis: pathogenetic njira zachitukuko

Atherosulinosis (Greek athḗra, slurry + sklḗrōsis, kuumitsa) ndi matenda osachiritsika am'mitsempha ya zotanuka ndi zotupa. Amayamba chifukwa chophwanya lipid ndi kagayidwe kazakudya ndipo amaphatikizidwa ndi kuyamwa kwa cholesterol komanso tizigawo ting'onoting'ono ta lipoprotein mu lumen. Madipozomu amapanga mawonekedwe a atheromatous malo. Kukula kwa minyewa yolumikizika mwa iwo (sclerosis), ndi kuwerengera kwa khoma la chotengera kumayambitsa kusinthika ndikuchepetsa kwa lumen kuti isokonezedwe (kufalikira kwa chotengera). Ndikofunikira kusiyanitsa atherosulinosis kuchokera ku Menkeberg arteriosulinosis, mtundu wina wa zotupa zam'mitsempha, zomwe zimadziwika ndi kuphatikizika kwa mchere wa calcium mkati mwa membrane wapakati wamitsempha, kuphatikizana kwa zotupa (kusowa kwa mapepala), kukula kwa aneurysms (osati kufalikira) kwamitsempha yamagazi. Atherosulinosis ya mitsempha ya mtima imatsogolera pakukula kwa matenda a mtima.

Atherosulinosis
Zosintha mu chotengera (njira yopanga atherosulinosis), kuchuluka kwa mafuta m'thupi
ICD-10	Ine 70 70.
ICD-10-KM	I70 ndi I25.1
ICD-9	440 440
ICD-9-KM	440
Diseasesdb	1039
Medlineplus	000171
eMedicine	med / 182
Mesh	D050197

Kuwerengera kwambiri kwaimfa kwa matenda amtima monga chiwonetsero cha matenda a mtima. Mu Russian Federation mchaka cha 2000, chiwerengero chokhazikika cha anthu omwe amafa kuchokera kumatenda oyenda mozungulira anali 800.9 pa anthu zana limodzi. Poyerekeza, ku France chiwerengerochi ndi 182.8 (otsika kwambiri ku Europe), ku Japan - 187.4. Zatsimikiziridwa kuti kuchepetsa chiopsezo cha matenda amtima m'mayikowa sikugwirizana kwambiri ndi kuchuluka kwa chisamaliro chachipatala monga momwe ziliri ndi moyo komanso thanzi.

Pakadali pano, palibe lingaliro limodzi lokha lokhudza matendawa. Zotsatirazi zimayikidwa patsogolo komanso kuphatikiza:

chiphunzitso cha lipoprotein kulowetsedwa - kudzikundikira kwakukulu kwa lipoproteins kukhoma la mtima,
chiphunzitso cha endothelial - kuphwanya kwakukulu kwa chitetezo cha endothelium ndi oyimira pakati ake,
autoimmune - kusowa kwa macrophages ndi leukocytes, kulowa kwawo kwa khoma lamitsempha,
monoclonal - kupezeka koyamba kwa maselo osalala a minofu,
tizilombo - zowonongeka zazikulu zoyambirira za endothelium (herpes, cytomegalovirus, etc.),
peroxide - kuphwanya koyambirira kwa antioxidant system,
chibadwa - cholowa choyambirira cha khoma lamasamba,
chlamydial - kuwonongeka koyambirira kwa khoma la mtima ndi chlamydia, makamaka chibayo cha Chlamydia.
mahomoni - kuchuluka kwokhudzana ndi zaka msinkhu wamahomoni a gonadotropic ndi adrenocorticotropic kumabweretsa kuwonjezeranso kuphatikizika kwa zomangamanga kwa mahomoni a cholesterol.

kusuta (chowopsa)
hyperlipoproteinemia (cholesterol yathunthu> 5 mmol / L, LDL> 3 mmol / L, LP (a)> 50 mg / dL)
ochepa matenda oopsa (kuthamanga kwa magazi a systolic> 140 mmHg. kuthamanga kwa magazi kwa diastolic> 90 mmHg.)
matenda ashuga
kunenepa
kumangokhala (kutopa)
kupsinjika mtima
kuperewera kwa zakudya m'thupi
chibadwire
postmenopause
hyperfibrinogenemia
homocysteinuria ndi homocysteinemia
hypothyroidism

Malinga ndi Ndondomeko ya European for the Prevention of Cardiovascular Disease (European Gu> pulogalamu ya ku Russia) (ulalo sunapezeke - nkhani ) . cms.escardio.org. kuwerengetsa chiopsezo cha matenda amtima. Kuyesedwa kwakanthawi kochuluka kumatha kuchitika malinga ndi tebulo ili m'munsiyi.

Pathogenesis ya atherosulinosis imatchedwa atherogenesis. Zimachitika m'magawo angapo. Kukula kwa zotupa za atherosulinotic ndi kuphatikiza kwa njira yolowera ndi kutuluka kwa lipoprotein ndi leukocytes kuchokera pamenepo, kuchuluka ndi kufa kwa maselo, mapangidwe ndi kukonzanso kwa zinthu zomwe zimapangidwira, komanso kuchuluka kwa mitsempha yamagazi ndi kuwerengera. Njira izi zimayendetsedwa ndi ma siginala ambiri, nthawi zambiri ochulukirapo. Zambiri zikuchulukirachulukira pa mgwirizano wazovuta za pathogenetic pakati pa kusintha kwa ntchito ya maselo a khoma lamitsempha yama cell ndi maselo oyera ammagazi omwe adasamukira mmalo mwake ndikuyika zifukwa za atherosulinosis.

Kukhazikika ndi kusintha kwa lipoproteins Sinthani

Nthawi zambiri, mphamvu ya mitsempha imapangidwa ndi unicellular endothelial wosanjikiza, pomwe pansi pake pamakhala maselo osalala owumbidwa ndi chinthu chophatikizika. Mawonetsedwe oyamba a matendawa ndi otchedwa lipid mawanga. Mawonekedwe awo amalumikizidwa ndi kupezeka kwa lipoproteins mu intima. Osati lipoprotein onse omwe ali ndi katundu wa atherogenic, koma otsika kwambiri (LDL) komanso kachulukidwe kotsika kwambiri (VLDL). Poyamba, amadziunjikira mu intima makamaka chifukwa chomangirira pazinthu zomwe zimapangidwa ndi interellularitu - proteinoglycans. M'malo omwe ma lipid mawanga amapangika, kuchuluka kwa heparan sulfates kupitilira ma glycosaminoglycans awiri - keratan sulfates ndi chondroitin sulfates - amachita gawo lofunikira.

Muzogonana, lipoproteins, makamaka zomwe zimagwirizanitsidwa ndi proteinoglycans, amatha kulowa m'magazi. Udindo waukulu umaseweredwa ndi awiri: oxidation ndi non-enzymatic glycosylation. Mosiyana ndi plasma, intima imakhala ndi ma antioxidants ochepa. Kuphatikizika kwa oxidised LDL kumapangidwa, ndipo lipids yonse ndi gawo la protein limapangidwa. Nthawi ya makutidwe ndi okosijeni a lipids, hydroperoxides, lysophospholipids, oxysterines ndi aldehydes amapangidwa (panthawi ya peroxidation yamafuta acids). Kuchulukitsa kwa ma apoproteins kumabweretsa chiwongolero cha ma peptide bond ndi kulumikizana kwa maunyolo am'mbali mwa amino acid (nthawi zambiri gulu la β-amino lysine) ndi zinthu zomwe zimasokoneza mafuta acids (4-hydroxynonenal and malondialdehyde). Kulimbikira kwa hyperglycemia mu matenda osokoneza bongo kumapangitsa kuti ma protein asakhale ndi enzymatic komanso ma protein omwe amatha kulowa mkati, omwe amaphwanyanso ntchito zawo ndikuthandizira atherogenesis.

Kusunthika kwa maselo oyera ndi mapangidwe a maselo a xanthoma (chithovu)

Kusamuka kwa leukocytes, makamaka monocytes ndi lymphocyte, ndi gawo lachiwiri lachitukuko cha lipid malo. Kusamukira kwawo ku intima kumaperekedwa ndi ma receptors omwe ali pa endothelium - mamolekyulu omatira. Makamaka makamaka ma molekyulu VCAM-1 ndi ICAM-1 (kuchokera kwa superfamily of immunoglobulins) ndi P-Selectins. Kuphatikizika kwa mamolekyulu omatira kungakulitse cytokines. Chifukwa chake, interleukin-1 (IL-1) ndi tumor necrosis factor (TNFα) amachititsa kapena kuwonjezera kapangidwe ka maselo a endothelial VCAM-1 ndi ICAM-1. Kenako, kumasulidwa kwa ma cytokines ndi maselo a khoma lamasamba kumalimbikitsidwa ndi lipoproteins zosinthidwa. Ozungulira mabwalo moipa.

Momwe magazi amayendera amatengera mbali yake. M'madera ambiri amtsempha osasinthika, magazi amayenda momveka bwino, ndipo mphamvu zomwe zimatulukapo zimachepetsa mawu (mawonetseredwe) a mamolekyulu omatira padziko la maselo a endothelial. Kuthamanga kwa magazi a Laminar kumathandizanso kupanga mapangidwe a nitric oxide NO mu endothelium. Kuphatikiza pa vasodilating zotsatira, mu ndende yotsika yothandizidwa ndi endothelium, NO amakhala ndi ntchito yotsutsa-yotupa, kuchepetsa, mwachitsanzo, kapangidwe ka VCAM-1. Koma m'malo opangira nthambi, ma laminar omwe amapezeka nthawi zambiri amasokonezeka, ndiye kuti zolembedwa za atheroscrotic nthawi zambiri zimachitika.

Pambuyo pa kudziphatika, maselo oyera amayenda kudzera mu endothelium ndikulowa mu intima. Lipoproteins imatha kupititsa patsogolo kusamukira: oxidized LDL imalimbikitsa leukocyte chemotaxis.

Monocytes amatenga nawo mbali pakapangidwe ka lipid. Mu intima, monocytes amakhala macrophages, omwe, chifukwa cha receptor-mediated endocytosis ya lipoproteins, maselo a xanthous (thovu) amakhala ndi lipids. M'mbuyomu, zimaganiziridwa kuti ma receptors odziwika bwino a LDL amathandizira endocytosis, koma ndi vuto la zolandilira izi, nyama zoyesera zonse ndi odwala (mwachitsanzo, hypercholesterolemia) akadali ndi ma xanthomas ambiri ndi malo a atherosselotic odzala maselo a xanthoma. Kuphatikiza apo, cholesterol yakunja imalepheretsa kaphatikizidwe kazinthu izi, ndipo ndi ochepa mwa iwo omwe ali ndi hypercholesterolemia. Tsopano gawo la macrophage scavenger receptors (omanga makamaka ophatikizidwa ndi lipoproteins) ndi ma receptor ena a oxidized LDL ndi VPLL yaying'ono yamankhwala tsopano. Maselo ena a xanthoma omwe amalowetsa lipoprotein kuchokera ku chinthu chophatikizika amasiya khoma lamitsempha, potero akuletsa kudziunjikira kwa lipids momwemo. Ngati kuchuluka kwa lipoprotein mu intima kulamulidwa kuposa kwawo kwa ma macrophages (kapena njira zina), lipids imadziunjikira ndipo pamapeto pake imakhala mitundu ya atherosranceotic plaque. Pachiwonetsero chokulirapo, maselo ena a xanthoma amatenga apoptosis kapena necrosis. Zotsatira zake, mawonekedwe amtundu wazodzaza ndi mitundu yayikulu ya lipid pakati penipeni, omwe amadziwika ndi magawo a ma atherogenesis.

Pro- ndi anti-atherogenic zinthu Sinthani

Pakutenga kwa lipoproteins zosinthidwa, macrophages secrete cytokines ndi kukula kwa zinthu zomwe zimalimbikitsa chitukuko cha zolengeza. Ma cytokine ena ndi zinthu zomwe zimakula zimapangitsa kuti magawo azikhala osalala komanso kapangidwe ka zinthu zophatikizika, kamene kamapezeka m'zigawo. Ma cytokines ena, makamaka interferon-γ kuchokera ku T-lymphocyte, adaletsa maselo osalala a cell cell ndi kaphatikizidwe ka collagen. Zinthu monga IL-1 ndi TNFcy zimapangitsa kupangika kwa mapuloteni komanso zinthu zina zomwe zimapangitsa kuti khungu lizikula kwambiri, zomwe zimathandizira kutsogolo kwa zolembazo. Chifukwa chake, pamakhala kulumikizana kosiyanasiyana kwa zinthu, zonse zomwe zimathandizira komanso kulepheretsa atherogenesis. Udindo wa ochita mopanda mapuloteni nawonso ndi wamkulu. Ma macrophages ophatikizika ndi maselo otupa a mtima (endothelial ndi minofu yosalala) amatulutsa zowongolera zopanda mpweya zomwe zimathandizira kufalikira kwa maselo a minofu yosalala, kumapangitsanso kaphatikizidwe ka cytokines, komanso kumangiriza NO. Ma macrophage otsegukira, nawonso, amatha kuphatikiza mosagwirizana ndi NO synthase. Ma enzyme omwe amagwira ntchito kwambiri amatulutsa NO m'magulu okwanira, oopsa - poyerekeza ndi kuchuluka kwakanthawi kwa NO komwe kumapangidwa ndi mtundu wa enzyme, endothelial NO synthase.

Kuphatikiza pa macrophages, kupsinjika kwapamwamba kwambiri kwa lipoproteins (HDL), komwe kumapereka mayendedwe omwe amadziwika kuti ndiwosinthanitsa cholesterol, amathandizira pakuchotsa cholesterol ku intima yomwe ikukhudzidwa. Ubale wosawoneka bwino pakati pa ndende ya HDL cholesterol ndi chiopsezo cha CHD chatsimikiziridwa. Mwa azimayi amsinkhu wobala mwana, kuchuluka kwa cholesterol ya HDL ndikokwera kwambiri kuposa kwa amuna amuna, ndipo makamaka chifukwa cha izi, azimayi sakhala ndi vuto la atherosclerosis. Kuyesaku kunawonetsa kuti HDL ikhoza kuchotsa cholesterol m'maselo a xanthoma.

Kusintha kwa minofu

Chikwangwani cha Atherosclerotic chimachokera pamalo a lipid, koma si malo onse omwe amakhala zisa. Ngati kudzikundikira kwa maselo a xanthoma ndi mawonekedwe a mawanga a lipid, ndiye kuti fibrosis imadziwika ndi malo. Chuma chachilendo mu chodikirachi chimapangidwa makamaka ndi maselo osalala a minofu, kusunthira ndi kuchuluka kwa omwe mwina ndi nthawi yovuta kwambiri pakapangidwe kofiyira wa malo ena amtundu wa xanthoma.

Cytokines ndi kukula kwa zinthu zomwe zimasungidwa mothandizidwa ndi lipoprotein zosinthika ndi zinthu zina ndi macrophages ndi maselo otupa am'mimba amachititsa masisitimu a minofu yosalala, kutalika kwawo komanso kaphatikizidwe kazinthu zophatikizika. Chifukwa chake, kukula kwa zinthu za m'magazi komwe amathandizira maselo a endothelial kumapangitsa kuti minyewa yosalala iziyenda mosavuta. Zomwe zimapangidwa kukula komweku zimayambitsa magawo a maselo a minyewa komanso maselo omwe amachokera pazofalitsa. Chimodzi mwazomwe zimatithandizira kuphatikiza ma collagen ndi maselo amenewa ndi chosinthira kukula. tsa. Kuphatikiza pa paracrine (zinthu zimachokera ku maselo oyandikana), autocrine (chinthu chopangidwa ndi khungu lenilenilo) kayendetsedwe ka maselo osalala kwambiri kumachitikanso. Chifukwa cha kusintha komwe kumachitika nawo, kusintha kwa lipid malo kupita ku atherosclerotic plaque, komwe kumakhala ndi minyewa yambiri yosalala minyewa ndi ma cell a cellellular, imathandizira. Monga macrophages, maselo awa amatha kulowa mu apoptosis: amayamba chifukwa cha ma cytokines omwe amathandizira kukulitsa kwa atherosulinosis.

Kukhazikika kwa zolembedwa zovuta

Kuphatikiza pa zovuta zomwe zili pachiwopsezo ndi ma cytokines omwe afotokozedwa pamwambapa kwa chitukuko cha atherosulinosis, gawo lofunikira ndikusintha kwa kayendedwe ka magazi. Pakuwoneka kwa mawonedwe a lipid, kuwonongeka kapena kuwonongeka kwa endothelium sikofunikira. Koma mtsogolomo, misozi yama microscopic imatha kupezekanso. Kuphatikiza kwa pulateleti kumachitika pang'onopang'ono pepala loyambira, ndi mawonekedwe ang'onoang'ono a platelet m'malo awa. Mapulateni ophatikizidwa amabisa zinthu zingapo zomwe zimathandizira fibrosis. Kuphatikiza pa kukula kwa mapulateleti komanso kusintha kwa zinthu tsa Maselo osalala a minofu amakhudzidwa ndi oyimira ochepa olemera, monga serotonin. Nthawi zambiri, ziwalo zamagazi izi zimasungunuka popanda kuyambitsa zizindikiro zilizonse, ndipo kukhulupirika kwa endothelium kumabwezeretseka.

Momwe mapangidwe akukulira, vasa vasorum (mitsempha yamagazi) imayamba kukula kwambiri mmenemo. Zombo zatsopano zimakhudzana ndi kufera kwa zolembedwa m'njira zingapo. Amapanga malo abwino osunthika a leukocytes kulowa ndi kutuluka m'chipindacho. Kuphatikiza apo, zombo zatsopano zimapangitsa kuti magazi azikhala ndi hemorrhage: monga diabetesic retinopathy, amakhala osweka ndipo amatha kupasuka. Kutupa kwatsoka komwe kumatsogolera kumabweretsa thrombosis, thrombin imawoneka. Sangotenga nawo gawo la hemostasis, komanso imakhudza maselo okwanira: imalimbikitsa kugawa kwa maselo osalala a minofu ndi kapangidwe ka ma cytokines, komanso imayambitsa kaphatikizidwe ka zinthu za kukula ndi endothelium. Chifukwa cha kutaya magazi, mapepala nthawi zambiri amakhala ndi fibrin ndi hemosiderin.

Zolemba za atherosulinotic nthawi zambiri zimakhazikika. Mapulogalamuwa ali ndi mapuloteni omanga thupi a osteocalcin ndi osteopontin ndi mapuloteni ena omwe ali ndi minyewa yamafupa (makamaka mapuloteni omwe amawongolera mafupa morphogeneis).

Mawonetseredwe azachipatala nthawi zambiri sagwirizana ndi morphology. Ndi postmortem autopsy, chotupa chachikulu chotchulidwa cha atherosulinotic chingatipezeke. Momwemonso, chipatala cha ziwalo za ischemia chitha kuchitika ndikubowoka pang'ono kwa lumen kwa chombo. Vuto lodziwika bwino la maiwe ena ochepa ndi khalidwe. Chithunzi cha matenda amatengera izi. Kuwonongeka kwa mitsempha ya coronary pang'onopang'ono kumayambitsa kuperewera kwa mphamvu, komwe kumawonetsedwa ndi matenda a mtima. Atherosulinosis mitsempha ya m'magazi imayambitsa matenda a ischemia kapena osakhalitsa. Kuwonongeka kwa minyewa ya miyendo ndi komwe kumayambitsa kulumikizana kwapang'onopang'ono komanso malo owuma. Atherosclerosis ya mesenteric mitsempha imabweretsa ischemia ndi matumbo infarction (mesenteric thrombosis). Kuwonongeka kwa mitsempha ya impso ndikupanga impso ya Goldblatt ndikothekanso. Ngakhale m'madziwe am'madzi amadzimadzi zotupa zimadziwika - ndi kuphatikizidwa kwa malo wamba komanso chitetezo cha oyandikana nawo. Chifukwa chake, m'matumbo amtima, ma occlusion nthawi zambiri amapezeka mu gawo la nthambi yanthawi yakumanzere kwam'madzi. Chodziwikanso chomwe chimadziwika ndi kubadwa kwa impso ndi carotid. Mitsempha ina yam'mimba, monga mkati mwa thoracic artery, samakhudzidwa kawirikawiri, ngakhale kuti imakhala pafupi ndi mitsempha ya coronary yomwe ili pamalo ndi kapangidwe kake. Mapangidwe a atherosselotic nthawi zambiri amapezeka msempha wamagazi - komwe magazi amayenda popanda kufanana, mwanjira ina, hemodynamics yam'deralo imathandizira malo amipanda (onani pathogenesis).

Kuzindikira matenda omwe amachitika ndi atherosulinosis akuphatikizapo:

Kufunsa wodwalayo ndikumveketsa bwino matendawa: Zizindikiro zamatenda am'mtima, zizindikiro za ngozi ya mtima, kutsutsana, zizindikiro zamkati wam'mimba, ndi zina zambiri.
Kupenda wodwalayo pafupipafupi: Zizindikiro za ukalamba, kumvetsera madandaulo a m'mitsempha, ndipo kumayang'ana mitsempha yonse yam'mitsempha yama cell: kupindika kwamitsempha, zotupa zakunja, zotupa zamkati, zotupa zam'mimba, zotupa zam'mbuyo komanso zotupa zam'mimba. mitsempha yama carotid.
Kutsimikiza kwa systolic kung'ung'udza chifukwa cha kusiyanasiyana kwa mitsempha.
ngati mukukayikira kuwonongeka kwa kama wam'malo am'munsi, kutsimikiza kwa yankho.
Kudziwitsa magazi cholesterol ndende ndi kutsimikiza magazi lipid bwino,
Kuunikira kwa X-ray kwamchifuwa, njira zoyeserera za m'mimba,
Kuyesa kwa Ultrasound kwa mtima ndi ziwalo zam'mimba ndi malo opatsirana,
Dopplerografia ya ziwiya zamanja kapena, zomwe zingakhale zabwinoko, kuphatikizira mobwerezabwereza ndi kuwunika kwa ma cell a brachiocephalic gawo, mitsempha yam'munsi, gawo la aortic-iliac, komanso transcranial doppler.
diagnostics wa asterialness, kuphatikizapo volumetric sphygmography ndi kutsimikiza kwa cardio-ankle vascular index (CAVI)

Mu mankhwala a atherosulinosis, onse omwe amagwiritsa ntchito mankhwala osokoneza bongo amaganiziridwa.

Njira zosagwiritsa ntchito mankhwala pokonza hyperlipidemia Sinthani

Kuti mukwaniritse bwino, nthawi ya chithandizo chotere iyenera kukhala osachepera miyezi isanu ndi umodzi. Mfundo zotsatirazi ndizofunikira mu regimen ya chithandizo (onani Zowopsa):

kusiya kusuta
kumwa moyenera
antiatherosulinotic zakudya - mwachitsanzo, "Mediterranean": mafuta okhala ndi mafuta ochulukirapo (Omega-3): flaxseed, rapeseed kapena olive. Mwa zakumwa zoledzeretsa, pokhapokha muli ndi vinyo wokwanira ma 150 ml patsiku (koma ndibwino kusiya zonse zakumwa zoledzeretsa, chifukwa ndi chiopsezo cha stroke. Kukana mkate kuchokera ku ufa wapamwamba kwambiri, osati tsiku lopanda zipatso ndi ndiwo zamasamba.
moyo wakhama - olimbitsa thupi nthawi zonse.
kukhalabe ndi nkhawa komanso kulimbikitsidwa
kuwonda

Kusintha kwa Mankhwala Osokoneza

Mulinso kukonza kwa matenda oopsa oopsa (makamaka magazi a systolic), matenda a shuga, matenda a metabolic. Komabe, chofunikira kwambiri ndikukhazikika kwa mawonekedwe a lipid. Mankhwala omwe agwiritsidwa ntchito pacholinga ichi amagawidwa m'magulu anayi:

Ine - kuletsa mayamwidwe a cholesterol
II - kuchepetsa kapangidwe ka cholesterol ndi triglycerides mu chiwindi ndikuchepetsa kuphatikizira kwawo plasma
III - catabolism yowonjezereka ndi chimbudzi cha liphero la atherogenic ndi lipoprotein
IV - zowonjezera

Kuyambira chaka cha 2012, mankhwala agulitsidwa m'dera la Russia lomwe limagwiritsa ntchito mitsempha ya msana pogwiritsa ntchito majini am'deralo.

Kusintha Kwa Gulu Loyamba

IA - anion exchange resins (cholestyramine, gemfibrozil). Adsorb cholesterol paokha. Sizimadzidwa kapena kuwonongedwa m'mimba. Pamwamba kwambiri limakwaniritsidwa mwezi umodzi utatha ntchito. Zotsatira zimatha masabata 2-4 atachotsedwa. Zoyipa: adsorb zinthu zina - mankhwala, mavitamini, kufufuza zinthu. Zitha kuyambitsa dyspepsia. Kuphatikiza apo, Kafukufuku wapadera akuwonetsa kuti kuopsa kwa atherosulinosis sikugwirizana ndi plasma cholesterol mwanjira iliyonse, ndipo cholesterol yokhala ndi placma sinakhalepo ndi plasma koma chiyambi cha endothelial, ndiye kuti, sichinayikidwe pa khoma lamitsempha kuchokera m'magazi, koma ndi metabolite yake. gwero silinatchulidwe masiku 3500
IB - chomera sorberts (guarem, β-sitosterol). Pewani kuyamwa kwa cholesterol m'matumbo. Akufuna kumwa chachikulu (osachepera 200 ml) kuchuluka kwamadzimadzi. Zitha kuchititsanso kuti dyspepsia.
IC - pakukula ndi kuyesa kwa block-blocker ya AC-CoA. Chifukwa chake, zitha kuchepetsa kukhathamiritsa kwa cholesterol mu enterocytes, ndipo chifukwa chake, tsekani kugwidwa m'matumbo. Komabe, ndikudziwika kuti ambiri (pafupifupi 2/3) a cholesterol amoyo amachokera ku mtundu wina, ndipo "kuchepa" kwa choleentol ya alimentary kumalipiriridwa mosavuta ndi kuphatikizika kwazomwe zimachokera ku acetate.

Chifukwa chake, kulimbana ndi alimentary ndi / kapena plasma cholesterol motero sikutanthauza tanthauzo komanso losatetezeka lomwe silikukweza zakutsogolo kwa matendawa. gwero silinatchulidwe masiku 3500

Kusintha Gulu Lachiwiri

IIA - zoletsa za 3-OH-3-methylgluratyl CoA reductase (HMG-CoA reductase). Awa ndi ma statin. Gulu lodziwika bwino (komanso lodula) la mankhwala osokoneza bongo. Oyimira madongosolo owonjezereka: lovastatin (mevacor, medostatin, apextatin), simvastatin (zosor, vasilip, simvor), fluvastatin (leskol), pravastatin (lipostat, pravol) ndi cerivastatin (lipobay), atorvastatin (lyprimin ndi rovarvard) mtanda). Komabe, pakuwonjezeka kwakukulu, chiwopsezo cha zotsatirapo zina zimakulirakulira. Pakati pawo: myopathy, rhabdomyolysis mpaka kukula kwa aimpso kulephera, makamaka kuphatikiza ndi fibrate ndi nicotinic acid, hepatotoxicity, kusabala, alopecia, dyspepsia. Sangaphatikizidwe ndi mowa, wogwiritsidwa ntchito mwa ana, ali ndi pakati komanso mkaka, odwala omwe akuwonongeka kwa chiwindi. Kuchenjeza odwala pambuyo pamitsempha wamagetsiwo kumadutsa.
IIB - zotumphukira za fibroic acid (fibrate): clofibrate (miscleron), bezafibrate (bezalip), ciprofibrate (lipanor), fenofibrate (treicor). Mavuto mukamagwiritsa ntchito mankhwalawa imatha kukhala: myositis, chifuwa, dyspepsia, matenda a ndulu. Chifukwa chake, mankhwalawa a mibadwo yam'mbuyomu tsopano sagwiritsidwa ntchito. Fenofibroic acid derivative kapena m'badwo watsopano wa mafrate: fenofibrate tsopano imagwiritsidwa ntchito kwambiri. Fenofibrate ili ndi mbiri yayikulu yachitetezo komanso zotsatira zochepa zotsika. Fenofibrate imakhala yothandiza kwambiri pochiza odwala omwe ali ndi matenda a shuga a 2, omwe amadziwika ndi kuwonjezeka kwa triglycerides, kuchepa kwa HDL komanso kuwonjezeka kwapakati pa LDL. Fenofibrate imachepetsa chiwerengero chaching'ono cha wandiweyani LDL, Lhero la atherogenic kwambiri. Pamodzi ndi izi, pakudya fenofibrate, kuchepa kumangokhala mu macrovascular complication (IHD, myocardial infarction), komanso mu zovuta zomwe zimapangitsa kuti zovuta za retinopathy, polyneuropathy, nephropathy, komanso kudula kwa m'munsi kwambiri ku shuga.

Kuti muchiritse kwambiri matenda a atherosulinosis, tikulimbikitsidwa kuphatikiza kugwiritsa ntchito ma statins ndi fenofibrate.

IIC - nicotinic acid (enduracin). Ndiosafunika kugwiritsa ntchito matenda ashuga. Zotsatira zoyipa: kuyabwa pakhungu, hyperemia, dyspepsia.
I> Kusintha Kwa Gulu Lachitatu

Mafuta osasankhidwa: linetol, lipostabil, tribuspamine, polisponin, thioctic acid (octolipen, thiogamma, thiolepta), omacor, eikonol. Chenjezo: zitha kupititsa patsogolo mankhwala ochepetsa shuga.

Kukonzekera kukonzekera Sinthani

Cyclodextrin, yomwe idawonetsa kusungunuka kwa mafuta a cholesterol, komanso chithandizo chokwanira cha atherosulinosis mu mtundu wa mbewa chitha kusungunula cholesterol pochotsa pamipango. Popeza cyclodextrin imadziwika kuti imakhala yotetezeka kwa anthu, mankhwalawa pano ndiwomwe angayesere kuyesa odwala podwala atherosclerosis.

Peptide yotchedwa Ac-hE18A-NH2 (yomwe ikuwoneka pansi pa dzina la AEM-28 mu chitukuko cha zamankhwala) yawonetsedwa kuti ili ndi mphamvu yodabwitsa yotsitsa cholesterol ndi triglycerides, komanso ili ndi katundu wotsutsana ndi kutupa. Komanso, mosiyana ndi ma statins ndi PCSK-9 inhibitors, ikhoza kutsitsa cholesterol pomangiriza kwa heparan sulfate proteinoglycans (HSPG). Pakadali pano akukumana ndi gawo la 1a / 1b la mayesero azachipatala ndipo awonetsa kulolerana kovomerezeka, koposa zonse, kulonjeza kuchita bwino.

Mankhwala osokoneza bongo monga ISIS-APO (a) Rx ndi analogue yamphamvu kwambiri ISIS-APO (a) -LRx, yomwe imalepheretsa kumasulira kwa apolipoprotein (a) mRNA, imatha kuchepetsa milingo ya plasma ya apo (a) / Lp (a) ndi ma oxidised mitundu yama phospholipids (OxPL) ndi 86% ndi 93%, motsatana.

Kupanga Opaleshoni

Opaleshoni ya arterial imatha kutseguka (endarterectomy), pomwe kuchotsetsa kapena kuwongolera kukapulupudza kumachitika pogwiritsa ntchito opaleshoni, kapena kupindika - kumangika kwa mitsempha pogwiritsa ntchito balaloon catheters ndi kuyika kwa stents pamalowo pakutsekeka kwa chotupa komwe kumalepheretsanso chotengera (repuminal balloon angioplasty and stenting of the artery . Kusankhidwa kwa njira kumadalira malo komanso kuchuluka kwa kupendekera kapena kutseka kwa lumen kwa mtsempha.

The pathogenesis of atherosulinosis ndi limagwirira ake kakulidwe

Atherosulinosis ndi matenda ofala kwambiri. Chifukwa chake, zitha kukhala zothandiza kwa aliyense kuti adziwe chomwe ndi pathogenis ya atherosulinosis ndi zomwe zimathandizira kukulitsa kwake. Tiyenera kunena kuti njira ndi njira zopangira njira zopangira ma atherosulinotic m'mitsempha yamagazi sizinaphunziridwe mpaka pano. Koma zofunikira pakukula kwa matendawa zimadziwika.

Njira ndi kakonzedwe ka chitukuko cha atherosulinosis adakhala akuwerenga kwa nthawi yayitali, koma alephera kudziwa zenizeni zomwe zimayambitsa matendawa.

Udindo wina wa mapangidwe a atherosulinosis umaperekedwa pazinthu zoyipa, izi:

zosokoneza mu mafuta a kagayidwe kachakudya,
kusokonezeka kwa mahomoni
kukhalapo kwa mapaundi owonjezera,
ochepa matenda oopsa
zizolowezi zoipa (kusowa masewera olimbitsa thupi, kusuta ndudu, etc.).

Masiku ano, chiphunzitso chakuti matendawa amatengera mtundu wa zinthu zingapo zaubwinobwino nthawi zonse chimavomerezedwa.

Endothelial kukanika

Kafukufuku wamakono amakhulupirira kuti gawo loyamba pakupanga atherosulinosis ndi kuwonongeka kwa mkati mwa mtsempha. Pali umboni wambiri pamalingaliro awa:

Choyamba, zolembera zoyambirira nthawi zonse zimapezeka pamasamba osungira zombo. Pakusiyanitsidwa kwa chotengera chachikulu, malo osokoneza bongo amapangidwa, chifukwa chake, chiopsezo chowonongeka pakupanga kwamkati wam'khumbi m'malo ano chimakhala chokwera.
Kachiwiri, zidadziwika kale kuti kusuta fodya kumathandizira kuti matendawa akhazikike. Ndipo utsi wa fodya umawononga mphamvu yogwira maselo a endothelial, chifukwa chifukwa cha kuchuluka kwa mpweya wa carbon monoxide womwe umazungulira m'magazi, cell hypoxia imadziwika.
Chachitatu, matenda oopsa am'mitsempha yamagazi amawonjezera katundu pazotengera komanso zimawonjezera chiopsezo chotenga atherosclerosis.

About cholesterol

Masiku ano pali anthu ochepa omwe sangamve kuti gawo la cholesterol popanga atherosulinosis ndilofunika kwambiri. Koma sikuti aliyense amadziwa kuti thunthu ndi chiyani. Pakadali pano, uyu ndi m'modzi wa oimira kalasi yama sterols, yomwe imagwira gawo lofunikira kwambiri pakubwera kwachilengedwe m'thupi. Ntchito zazikuluzikulu za cholesterol:

chilengedwe cha bile acid
kapangidwe ka vitamini D3,
kupanga mahomoni ogonana ndi mahomoni a adrenal.

Kutengera ndi zakudya, pafupifupi 300-500 mg ya cholesterol imalowa m'thupi la munthu tsiku ndi tsiku. Pazogulitsa, lipid iyi imatha kupezeka mwaulere kapena womangidwa.

Koma ngakhale pankhani yotsirizira, cleavage ndi kutulutsidwa kwa cholesterol yaulere imapezeka m'matumbo ang'onoang'ono. M'matumbo, cholesterol imalowetsedwa, imagwiritsidwa ntchito pochita metabolic ndi njira zina zachilengedwe.

Kugawa kwa lipid mu thupi sikosiyana. Ambiri mwa cholesterol onse amachitikira mu kotekisi ya adrenal grain, ubongo, minyewa yamanjenje. Chachikulu cha zonse ndi lipids mu minofu ya yolumikizika ndi mafupa.

M'malo mwake, kapangidwe ka cholesterol kakhoza kuchitika mu khungu lililonse la thupi. Komabe, nthawi zambiri mankhwalawa amapangidwa m'chiwindi komanso (ochepa kwambiri) m'matumbo aang'ono. Mothandizidwa ndi zinthu zina, kupanga cholesterol kumachuluka. Izi ndi monga:

kuyang'anira ma radiation
kusowa kwa mahomoni ndi kuchuluka kwa mahomoni a chithokomiro, insulin.

Uphungu! Koma ndi kuchuluka kwa glucocorticosteroids (mahomoni opangidwa ndi ma adrenal gland) ndi njala, cholesterol synthesis, m'malo mwake, imachepa.

Zinapezeka kuti sterol mu plasma yamagazi mulibe machitidwe oyera, koma mawonekedwe a lipoproteins (zovuta za cholesterol ndi mapuloteni). Lipoproteins amabwera m'mitundu itatu:

kachulukidwe kakang'ono kwambiri (kuchuluka kwawo sikuposa 10%),
kachulukidwe kakang'ono (iyi ndi mtundu wanthawi zambiri wama lipoprotein a plasma pafupifupi 65-70%),
kukwera kwambiri.

Kutengera chiŵerengero cha mitundu ya lipoprotein, chiopsezo chotukula atherosulinosis chatsimikiza. Kuti muchite izi, kusanthula kwapadera kumachitika ndi kutsimikiza kwa magawo, kenako chokwanira chimawerengedwa pogwiritsa ntchito njira yapadera.

Uphungu! Otetezeka kwambiri pankhani ya kukhazikika kwa atherosulinosis ndi kuchuluka kwa mitundu ya lipoprotein yomwe imawonedwa mwa ana aang'ono, mgwirizano wawo ndi mgwirizano. Mwa anthu achichepere (pafupifupi zaka 20), chiwopsezo choyenera ndichizindikiro kuyambira 2 mpaka 3. Mwa anthu opitilira 30, chokwanira sichokwanira kupitilira 3.5 (chifukwa cha matenda a mtima, amatha kufikira 6).

Mapangidwe a plaque

Popanga zolembera, magawo atatu ndi osiyana:

lipoidosis: kapangidwe ka malo a lipid kapena Mzere pa makoma a chotengera.
lipossteosis: mawonekedwe a minofu yam'mimba,
mapangidwe ovomerezeka, zolembedwa.

Malo a lipid ndi kapangidwe kakang'ono kwambiri (mainchesi osaposa 1.5 mm) komwe kali mkati mwa mtsempha. Maselo achiwonetsero amaphatikizana ndi kupangidwa kwamtunduwu wachikasu, amapangidwa ndi T-lymphocyte ndi mafuta. Kuphatikiza apo, maselo osalala a minofu ndi ma macrophages amapezeka pakapangidwe kamapangidwe.

Kukula kwa milomo ya lipid kumachulukana, kumalumikizana, zomwe zimapangitsa kuti pakhale mzere womwewo. Mabala ndi mikwingwirima amapanga masamba omwe akuwononga koyamba kwa endothelium.

Uphungu! Udindo wina wowonongeka mkati mwa chotengera ndi mapangidwe a dongo la lipid umaperekedwa pazinthu zosavomerezeka. Makamaka, kusuta, chlamydial kapena kachilombo kavairasi, matenda oopsa, etc.

Kupanga pakokha sikubweretsa kuwonongeka kwa chotengera. Komanso, mawanga oterewa amayamba kuubwana. Amakhulupirira kuti pofika zaka 25, mitundu ya lipid imatha kukhala theka la mkati mwa msempha. M'mitsempha yamagazi yomwe imadyetsa ubongo, malo oterewa amawonekera pafupifupi zaka 40.

Lipossteosis

Gawo lachiwiri pakupanga mapangidwe a pathological (zolengeza) ndikukula kwa minofu ya fibrous. Pamalo omwe amapangidwira (Mzere), maselo achichepere amayamba kupanga pang'onopang'ono, zomwe zimapangitsa kukula kwa minofu yolumikizika.

Pamene ikukula, kukhazikika kwa khoma kumachitika ndipo zolembera - mawonekedwe ake ophatikizika ndikuwunika kwa chotengera. Izi zimapangitsa cholepheretsa magazi. Pachigawo choyamba cha mapangidwe a atherosulinotic, zolembazo zimakhala ndi maziko a lipid.

Poterepa, mawonekedwe amtundu wolumikizana ndi owonda. Mapangidwe awa amatchedwa "chikasu", amakhudza pang'ono magazi. Popeza kapisolo wa minofu yolumikizirana ndi yopyapyala, imawonongeka mosavuta.

Pakumapeto magawo chitukuko, kupangika komwe kumapangidwa kumakhala ndi mawonekedwe owoneka ngati minofu yolumikizidwa.Amatchedwa "oyera oyera" ndipo amathandizira kwambiri hemodynamics (kuthamanga kwa magazi).

Mapangidwe a plaque

Gawo ili la chitukuko cha matendawa limadziwika ndi kuwonjezeka kwakukulu pa kukula kwa lipid pachimake. Izi zimapangitsa kuti mafupa awonongeke komanso kuwonongeka kwa zotupa.

Dongosolo lokhala ndi zolengedwa likawonongeka, zilonda zam'mimba zimachitika, chomwe ndi chifukwa chachikulu chopanga magazi. Pamapeto omaliza, kuphatikizira kwa calcium kumawonedwa mu minofu ya zolembazo, zomwe zimayambitsa kuphatikizana ndikuwonjezeka kwa kukula kwa zolembazo.

Zotsatira zazikulu za mapangidwe ovuta a atherosselotic ndi mawonekedwe a magazi pamafupa a chotengera. Ndi kupatukana kwa magazi, kumatha kutchinga chotengera, kutsekera kwambiri magazi.

Uphungu! Ndi nthawi iyi yomwe chitukuko cha atherosulinosis chimadwaladwala omwe amakumana ndi zovuta - kukula kwa matenda a ischemic (kuwonongeka kwa ziwongo zamkati), vuto la mtima (ndikupanga atherosulinosis yamitsempha yama coronary), etc.

Mavuto

Njira yomwe ili pamwambapa yopangira zolembera imatithandizira kumvetsetsa zomwe zimachitika chifukwa cha chitukuko cha atherosclerosis. Izi ndi:

kusintha kwa hemodynamic chifukwa kuchepa kwa mtima lumen,
Zilonda zam'mimba zikakhazikika, mapangidwe amitsempha yamagazi.
kuchuluka kwa mchere wa mandimu mu zolengeza, womwe umawonjezera kuchuluka kwake.

Mitundu ya Mapale

Ndi atherosclerosis, zolembera zimatha kukhala zokhazikika koma ayi. Katunduyu amatengera mawonekedwe, kukula kwake komanso kapangidwe kake. Tizilombo tokhala ngati fibrous timakhazikika pachithunzichi chokhazikika, ndipo lipid imakhazikika m'zigawo zosakhazikika. Mawonekedwe okhazikika amakula pang'onopang'ono, kotero, mkhalidwe wa wodwalayo sasintha kwa zaka zambiri. Mapepala osasunthika amakhala ndi nyukiliya yayikulu komanso membrane woonda.

Zisoti zoterezi zimang'ambika mosavuta komanso zilonda, zomwe zimapangitsa magazi. Ndi kukhalapo kwa mapepala osasunthika omwe amatsogolera pakukula kwa zovuta za atherosulinosis.

Chifukwa chake, pathogenesis ya atherosulinosis ndi njira yovuta kwambiri. Udindo wina pakukula kwa matendawa umaseweredwa osati kokha ndi zinthu zamkati, komanso ndi zizolowezi zoyipa za wodwalayo.

Imapereka chitukuko cha matenda omwe amayamba chifukwa cha zakudya zamafuta, kusuta, kusachita masewera olimbitsa thupi, komanso matenda opatsirana komanso kusokonekera kwa mahomoni m'thupi.

Popewa kukula kwa matendawa, ndikofunikira kuyang'anira kuchuluka kwa cholesterol mu plasma.

Mowa chotupa

Zilonda zam'mimba za msempha zimapezeka kwambiri. Msempha ndi chotengera chachikulu cha thupi la munthu, chimayambira kumanzere kwamtima ndikufalikira kwa ziwalo zambiri zamkati ndi ziwalo.

Mitsempha imachokera ku thoracic aorta, imapereka magazi pachifuwa, miyendo yam'mwamba, khosi ndi mutu. Mimba ya m'mimba ndi malo omaliza, imapereka magazi kwa ziwalo zam'mimba. Gawo lomaliza lagawidwa kumanzere akumanzere ndi kumanja kwa iliac. Amadyetsa pelvis ndi miyendo yotsika ndi magazi.

Ndi atherosulinosis ya thoracic aorta, kuwonongeka kwathunthu kapena pang'ono kumadziwika, zizindikiro za matendawa zimatengera malo omwe madipawo azikhala ndi zovuta zake. Mbali zazikuluzikulu zomwe muyenera kutchula:

kusakhalapo kwa zizindikiro
Zizindikiro zoyambirira zikuwoneka ndi zaka 60, pomwe chiwonongekocho chikufika modabwitsa,
chizungulire, kupweteka mutu,
kuvuta kumeza
kukalamba msanga ndi mawonekedwe a imvi.

Wodwala amakula msanga m'makutu ndi kukhathamira kwa systolic, kupweteka kwakanthawi kumbuyo kwa sternum. Atherosulinosis yamatumbo kwa nthawi yayitali imayamba popanda chizindikiro.

Zowonongeka zam'mimba zimayendera limodzi ndi kuchepa kwa magazi mkati mwa ziwalo zamkati, amalankhula za matenda am'mimba ischemic.

Ndi atherosclerosis yam'mimba msempha, mavuto a chakudya amayamba, kutsekula m'mimba kumatha ndi kudzimbidwa. Kupweteka pamimba kumadziwika, kusapeza bwino kwakupezeka m'chilengedwe, kudalitsika kwawoku sikulondola.

Ndi visceral vascular thrombosis, odwala matenda ashuga amawawa kwambiri, ndizosatheka kuwathetsa ndi antispasmodics ndi painkillers.

Kupweteka kumalumikizidwa ndi kuwonongeka msanga mu thanzi. Poterepa, muyenera kulumikizana ndi adotolo mwachangu kuti athandizidwe.

Mitsempha yama coronary

Matenda amtunduwu amakhumudwitsa matenda a mtima, omwe amayamba chifukwa chophwanya magazi kumtima. The etiology ya myocardial infarction ndi angina zimagwirizana ndi atherosulinosis. Ndi kufalikira pang'ono, kudwala matenda a mtima kumayamba, ndipo kufalikira kwamitsempha yamagazi kumayambitsa matenda a mtima.

Choyambitsa chachikulu chomwe chimayambitsa kusokonezeka kwa magazi kudzera m'mitsempha yama coronary ndimayendedwe a cholesterol m'mitsempha iyi. Mapilala amapindika pang'onopang'ono ndikuwononga makoma amitsempha, ndikuchepetsa kwambiri lumen mkati mwake.

Ndi matenda awa, wodwalayo amakhala ndi ululu woyaka mu sternum, nthawi zambiri imaperekera kumbuyo, phewa lamanzere, limawonjezeka ndi kulimbitsa thupi, pamavuto. Wodwala matendawa amakhala ndi kupuma movutikira, kumakhala wopanda mpweya, makamaka akagona. Chifukwa chake, iye nthawi zonse amayesetsa kukhala pansi.

Omenyera amayankha chithandizo, zamakono zamankhwala:

thandizani kukonza thanzi labwino,
chotsani mwachangu angina pectoris.

Zovuta za kupezeka kwa zolembedwa pamitsempha yam'mimba ndi vuto la mtima, mtima. Zizindikiro zenizeni zamitsempha yama coronary zimatsimikiziridwa chifukwa chokhacho apadera omwe amadziwika kuti ali ndi matenda.

Kugonjetsedwa kwa zombo za mesenteric

Mtundu uwu wa atherosulinosis nthawi zambiri umawonetsedwa ndi ululu pamwamba pamimba, umachitika pambuyo pake, makamaka mutatha kudya.

Kutalika kwa nthawi yowukira sikupitilira mphindi zochepa, nthawi zina kumafika ola limodzi. Ululu umayenda ndi kudzimbidwa, kupindika, kutulutsa. Ululu ndi atherosulinosis, kutenga koloko ya sodium sikumapereka mpumulo.

Matendawa amatchedwanso toaddominal toad, amayamba chifukwa cha kusamvana mu kuchuluka kwa magazi ofunikira pakugwira bwino ntchito kwa m'mimba ndi kuchuluka kwake kwenikweni.

Chimodzi mwazovuta zake ndi kukhazikika kwa thrombosis m'matumbo a mesenteric, momwe matenda am'magazi amayendera limodzi ndi:

nseru
kupweteka kuzungulira navel
posungira mafuta, chopondapo,
kusanza mobwerezabwereza ndi secretion wa bile.

Mitsempha yamagazi ilipo m'misempha, m'mayendedwe a shuga, kutentha kwa thupi kumakwera, mkhalidwe wofooka umayamba. Matendawa amatha kumapeto kwa matumbo, kutsutsana ndi kumbuyo kwa zizindikiro za peritonitis.

Zambiri za atherosulinosis zimaperekedwa mu kanema munkhaniyi.

Sonyezani shuga lanu kapena sankhani jenda pamayendedwe Kusaka OsapezekaKusaka Kuyang'ana kosapezeka

Kuyesedwa kwa labotale kwa atherosulinosis

Pambuyo pa kufufuza ndi kufufuza zolinga, nthawi zambiri amapita kukayezetsa ku labotale, makamaka, amapanga mbiri yokhudzana ndi zamankhwala komanso kuyezetsa magazi ambiri. Ndi thandizo lawo, mutha kudziwa kuchuluka kwa zisonyezo zingapo nthawi imodzi, zomwe zimathandiza kwambiri pakukula kwa atherosulinosis. Mlingo wonse wa cholesterol mu phunziroli nthawi zambiri umachokera pa 3,4 mpaka 5.9 mmol pa lita.

Ichi ndi gawo lofunikira, chifukwa ndi cholesterol yomwe imayikidwa mumtsempha wa ziwiya, zomwe zimayambitsa kufa kwa maselo a endothelial, kulowetsedwa kwa khoma lamitsempha ndi leukocytes ndi macrophages, ndikutsatira kufupikitsa kwa lumen. Tiyenera kudziwa kuti zinthu zambiri zotere zimapangidwa ndi thupi lokha, ndipo 25% yokha ndi yomwe imachokera kunja ndi chakudya.

Komabe, cholesterol imatha kusungunuka m'madzi, yomwe imapanga magazi ambiri, motero mapuloteni angapo amagwiritsidwa ntchito kunyamula kudzera mu thupi lomwe limalumikiza molekyu yake.

Magazi a Lipoprotein

Chizindikiro chachiwiri chofunikira chomwe chimawonetsa mtundu wa lipid metabolism ndi low lowens lipoproteins. Amawerengedwa ngati gulu lazinthu zomwe zili ndi tanthauzo la atherogenic, chifukwa chake LDL sayenera kupitirira mamililita atatu pa lita.

Kupitilira muyeso uwu kukuwonetsa kuti pali cholesterol yochulukirapo m'thupi, yomwe imatengedwa kuchokera ku chiwindi kupita ku minofu, kuphatikizapo mtima.

Pankhaniyi, ndi lipoprotein yotsika kwambiri yomwe imatenga nawo gawo pazoyendetsa lipids. Amagwidwa ndi maselo a endothelial omwe ali ndi ma receptor pazinthu zawo zomwe LDL imamangiriza. Kutulutsa kolesterol, gawo lina limagwiritsidwa ntchito ndi khungu pazosowa zake, koma mopitirira muyeso, zotsalazo zimangodzikundikira mkati, chifukwa chomwe chimafa pambuyo pake.

Koma ma lipoproteins okwera amakhala ndi zotsatira zotsutsana, ndipo amawonedwa ngati antiatherogenic. Izi ndichifukwa choti amatha kutulutsa mamolekyulu a cholesterol kuchokera m'magazi, kuphatikiza kuchokera ku mamolekyu otsika a lipoprotein, komanso maselo a endothelial a khoma lamitsempha.

Chifukwa chake, amachepetsa kuchuluka kwa cholesterol m'magazi, potero amachepetsa mawonekedwe ake m'matumbo. Kuchuluka kwa HDL m'magazi kumatsika ndi atherosulinosis, koma mwanjira yake magawo sayenera kukhala osachepera 1 mamililita imodzi pa lita.

Zowonjezera zowunika zasayansi

Mlingo wa triglycerides, womwe umayikidwanso m'matumba, umathandizanso. Mukapezeka ndi atherosulinosis, kusanthula kumawonetsa kuchuluka kwa triglycerides, kuchuluka kwake komwe sikyenera kupitirira mamililita 1.6 pa lita.

Zofunikira zowopsa - milingo ya homocysteine ndi fibrinogen - zimatsimikizidwanso. Kusintha miyezo yawo kungapereke zowonjezera zazokhudza kuchuluka kwa omwe ali pachiwopsezo mwa wodwala aliyense, komanso kudziwa momwe angasinthire mankhwala.

Chifukwa chake, kuwunika kwa labotale ya atherosulinosis kumathandizira osati kungopeza matenda, komanso kuwunika zovuta zomwe zingayambitse matenda. Kuphatikiza apo, ndi ma diagnostics a labotale omwe amagwiritsidwa ntchito pakuwonetsetsa wodwalayo kuti athe kuwunika momwe mankhwalawa amathandizira ndikusintha mankhwala.

Njira zodziwitsa ena za zida

Chidziwitso chofunikira kwambiri chodziwitsa za atherosulinosis chingapereke njira ya angiography. Chofunikira chake chimakhala chakuti gawo lina la sing'anga yolumikizira imalowetsedwa pakama la wodwala, kenako x-ray imatengedwa. Izi zimakuthandizani kuti muziyesa kuchuluka kwa ziwiya, zomwe zingakhale zowonongeka ngati atherosulinosis.

Chifukwa chake, mothandizidwa ndi phunziroli, munthu amatha kuyesa kuchuluka kwa kuchuluka kwa zotupa, ndikulosera zovuta zomwe zingachitike. Ngati pazifukwa zina kafukufukuyu sakhoza, ndiye kuti kuwunika kwa mitsempha yamagazi ndi Dopplerography kungapereke chidziwitso chambiri pamabedi amitsempha.

Ndi iyo, mutha kuyesanso kuchuluka kwa ziwiya zazikulu, kusintha kwa liwiro komanso kuchuluka kwa kayendedwe ka magazi. Kuzindikira kwa Ultrasound kumathandizanso kwambiri pakuwona kuchuluka kwa kayendedwe ka magazi m'mitsempha yam'munsi, magazi omwe amatha kudwala chifukwa cha atherosulinosis ndi thrombosis.

Njira yodziwika ndikuwunika kwa X-ray ziwalo zamkati, zomwe zimakupatsani mwayi wodziwa zovuta za atherosulinosis, mwachitsanzo, kukulitsa malire a mtima chifukwa cha kuchepa kapena kupindika kwa gawo limodzi mwa madipatimenti. Kusanthula kwa mtima kwamtima kokha kumatha kuperekanso chidziwitso chambiri chokhudza momwe zinthu ziliri.

Ultrasound imatha kudziwa zotsatira za atherosulinosis, monga chamitsempha yamagazi kapena septum, kuchepa kwamitsempha yamanzere, chifukwa cha stenosis ya orortice orifice, akinesia ndi asynergia chifukwa cha ischemic myocyte necrosis.

The pathogenesis of atherosulinosis ndi etiology yake

Atherosclerosis ndi matenda ofala kwambiri omwe amatha kukhala asymptomatic kwa zaka zambiri asanayambe kupereka zizindikiro zamatenda.

Ndikofunikira kuti muzitha kuzindikira nthawi yoyambira ndikuyamba kulandira chithandizo chanthawi yake. Kuti muchite izi, ndikofunikira kumvetsetsa momwe zimayambira matendawa ndi chitukuko cha matendawa, komanso kukhala ndi lingaliro la zomwe zingayambitse ngozi.

Udindo wa cholesterol

Matenda a atherosulinosis momwe ma cholesterol ndi otchedwa otsika kachulukidwe lipoprotein amadziunjikira pazitseko zamitsempha yamagazi.

Udindo wa cholesterol pakukula kwa atherosulinosis: cholesterol yeniyeni (ndendende, cholesterol) ndi chinthu chothandiza kwambiri, chomwe ndicho "zomangamanga" zamahomoni ndizofunikira pakapangidwe ka cell membrane. Mthupi, cholesterol siili mwa mawonekedwe ake oyera, koma mu "kuyika" mapuloteni, kuphatikiza mapuloteni ndi cholesterol amatchedwa lipoprotein. Kutengera chiyezo cha zinthu, lipoprotein yapamwamba kwambiri, yotsika komanso yotsika kwambiri imasiyanitsidwa.

Mitundu iwiri yomaliza ndiyowopsa: imakhala, pazinthu zina, yomwe imakhazikika pamakoma am'mitsempha, ndikupanga zolembera zowoneka bwino zomwe zimachepetsa lumen ya chotengera, ndipo nthawi zina zimatha kuzitchinga kwathunthu, ndikupangitsa kuti pakhale njoka ya oxygen ndi ziwalo ndi minofu yake.

Etiology of Atherosulinosis

Mpaka pano, zomwe zimayambitsa matenda a atherosulinosis sizinakhazikike molondola.

Pali malingaliro angapo mu etiology ya atherosulinosis:

chiphunzitso cha lipoprotein kulowetsedwa - malinga ndi icho, chomwe chimayambitsa ndi kudzikundikira kwa lipoprotein m'matumba,
chiphunzitso cha endothelial - zifukwa zakuphwanya ntchito yoteteza ya endothelium - cell cell ikulowerera mkati mwa sitimayo,
ndichifukwa chake ma lipoproteins "amatha kulowa mkati" mwa mbali zopyapyala za makoma amitsempha,
autoimmune - kusokonezeka kwa chitetezo chathupi komanso kukhazikika kwa mtima kwa khoma ndi leukocytes,
tizilombo - endothelium imawonongeka ndi ma virus (monga herpes),
chibadwa - chilema mu khoma la mtima ndi cholowa,
mahomoni - Ndi zaka, kuchuluka kwa mahomoni ena kumakwera, komwe kumapangitsa kuti mafuta a cholesterol awonjezeke.

Ndipo matenda oopsa monga carotid arteriosulinosis omwe ali ndi mwayi wambiri ndi autoimmune m'chilengedwe.

Zowopsa

Madotolo adazindikira moyenera zinthu zomwe zikuthandizira kukulitsa matendawa. Zina mwazo zimakhudzana ndi zinthu zachilengedwe zomwe sizingasinthidwe (mwachitsanzo, jenda ndi zaka), pomwe zina zimatha kusintha.

Zosavomerezeka:

Makamaka.
Mbiri yakumaso. "Hormone yachikazi" estrogen imachulukitsa zomwe zimakhala ndi kuchuluka kwa lipoprotein m'magazi, zomwe zimalepheretsa chitukuko cha atherosulinosis, chifukwa chake, amuna ndi akazi omwe ali munthawi ya postmenopausal ali pachiwopsezo.
M'badwo. Chiwopsezo chotenga matendawa chimakula patatha zaka makumi anayi (makamaka mwa amuna).

Zambiri zosintha:

hypothyroidism (kuchepa kwa thupi mu mahomoni opangidwa ndi chithokomiro cha chithokomiro),
hyperfibrinogenemia (mapuloteni am'magazi ambiri a fibrinogen),
homocysteinemia (kuchuluka kwa magazi a homocysteine - poizoni wa amino acid, mankhwala a metabolic omwe amagwiritsidwa ntchito pazovuta zina),
Hyperlipidemia,
matenda oopsa

Mu pathogenesis ya atherosulinosis, i.e. Njira yachitukuko, pali magawo atatu:

Lipoidosis Pakadali pano, lipoproteins yotsika kwambiri imayamba kukhazikika pamakoma a chombo. Amalowa mkatikati mwa chotengera, ndikunyowetsa, ndikupanga mawanga otchedwa lipid. Nthawi zina mawanga awa amaphatikizana, ndikupanga lipid mizere. Pakadali pano, mawanga satuluka pamwamba pa khoma ndipo samasokoneza kutuluka kwa magazi.
Sclerosis M'malo ophatikizira lipoproteins, minofu yolumikizira imayamba kumera. Malo okhala ndi lipid amakula ndikuchulukira.Nthawi zina, ma capillaries okhala ndi makoma owonda amatha kupanga khoma la mtsempha kuzungulira chinsalu.
Kupangidwe kwa mapepala ovuta komanso kuwerengetsa. Pakadali pano, zolembera ndi zoyandikana ndi chotengera chotengera zimalimbitsa komanso kupunduka chifukwa cha kuchuluka kwa mchere wamkati mwa iwo. Ma capillaries omwe ali m'makoma am'madzi amaphulika, matumbo amatuluka m'matumba, chifukwa amayamba kukhala okulirapo komanso kufupikitsanso lumen ya chombocho mpaka atatseka kwathunthu.

Komabe, tanthauzo lachipatala la liwuli ndi losiyana - kulocha m'malo mwa ziwalo zogwirizana ndi minofu yolumikizika. Izi ndizomwe zimachitika pagawo lachiwiri la chitukuko cha atherosulinosis - minofu yolumikizana imamera m'zigawo zamafuta. Kusintha kwa zinthu m'mitsempha ya muubongo kumapangitsadi kuti musamaiwale - kotero kugwiritsidwa ntchito molakwika kwa mawu.

Chipatala ndi Kuzindikira

Chithunzi cha chipatala cha atherosulinosis chimasiyana kutengera ndi momwe mtsempha umakhudzidwira. Komabe, mulimonse momwe zingakhalire, zimaphatikizapo zizindikiro za hypoxia - kufa ndi njala kwa minofu ndi ziwalo:

ndi atherosulinosis ya thoracic aorta, zizindikiro zazikulu ndi kupuma movutikira, kutopa konsekonse ndi kutopa, kupweteka kwakutali kumbuyo kwa sternum,
ndi kuwonongeka kwa m'mimba msempha ndi mitsempha ya ilac (yokhudza magazi m'matumbo ndi miyendo) - mavuto am'mimba, kusokonekera kwamatumbo, kusintha kwa matumbo m'miyendo - kutayika kwa chidwi, pallor ndi kupepuka kwa khungu (kumapeto - cyanosis), kupindika kwa misomali, kumapeto magawo - gangrene,
kuwonongeka kwa mitsempha ya subclavia yomwe ikupereka magazi m'manja - kutayika kwa manja, khungu, kunjenjemera, kufooketsa kapena kusapezeka kwenikweni kwa mimbayo.
ndi atherosulinosis ya mitsempha ya carotid - kusokonezeka kukumbukira ndi kuzindikira, chizungulire, kupweteka kwa mutu, khungu lakanthawi.

Malinga ndi kafukufuku, kuthekera kwakukulu kwa matenda ndi autoimmune. Atherosulinosis ya theortic arch, gawo la msempha lomwe "limakwirira" mtima kuchokera komwe minyewa ya carotid ndi subclavian imachoka.

Matenda otchedwa "matenda a aortic arch" amaphatikizanso zinthu zingapo nthawi imodzi: chizungulire, kusowa kwa chikumbumtima, bradycardia, kuthamanga kwa magazi komanso kukokana kwa khunyu ndi mutu wotsekemera.

Chithandizo ndi kupewa

Chithandizo cha atherosulinosis kwenikweni ndicholinga chofuna kuchepetsa magazi m'thupi. Ndi mankhwala osokoneza bongo, magulu otsatirawa a mankhwalawa amagwiritsidwa ntchito:

ma statins - kuletsa kupanga cholesterol, potero kumapangitsa kuchepa kwa kuchuluka kwake m'magazi,
mafupa - imathandizira njira yogawa mafuta, zomwe zimapangitsanso kuti kuchepa kwawo kuzikhala,
mafuta achilengedwe - kupewa kuyamwa kwamafuta am'mimba m'mimba, omwe amathandiza kuchepa kwa cholesterol,
vitamini PP - imathandizira njira yogawa komanso kukonza mafuta.

Mu magawo amtsogolo a matendawa, opaleshoni imagwiritsidwa ntchito. Kutengera mtundu ndi kuopsa kwa chotupa, izi zitha kukhala:

Kuchotsa zolembedwa pamodzi ndi chidutswa cha khoma la chotengera.
Opaleshoni ya Bypass - kudula chotengera chatsopano kudutsa chidikacho.
Aneurysm resection - opaleshoni "yofinya" ya khoma la chotengera, zolembera zowonongeka.

Malangizo akulu ndi awa:

Siyani kusuta - imakhala ndi zowononga m'mitsempha yamagazi.
Chepetsa zakudya zanu zamafuta monga nkhumba ndi ng'ombe. M'malo mwake ndi veal, mafuta ochepa komanso mafuta ndi nkhuku.
Idyani zamasamba ambiri, nyemba ndi chimanga - ali ndi mafuta ambiri azamasamba omwe amachepetsa cholesterol.
Ngati muli ndi vuto lililonse m'thupi la carbohydrate metabolism, yang'anani kuchuluka kwa shuga mumagazi anu ndikuletsa kuti lisakwere.

Epidemiology (kufala)

Matendawa ndi amodzi mwa matenda “oyipitsa” komanso opundula anthu omwe akutukuka kumene. Pofika m'badwo wina (mayiko osiyanasiyana kuyambira zaka 40 mpaka 60), pafupifupi 100% ya anthu ali ndi zizindikiro za atherosulinosis. Ku Russia, mchaka cha 2000, anthu omwe afa chifukwa cha atherosclerosis anali 800 peresenti ya anthu, m'maiko omwe amadya zakudya za "Mediterranean" - nthawi zinayi.

Etiology ndi pathogeneis (zomwe zimayambitsa ndi njira za kukula kwa matendawa)

Odwala omwe ali ndi atherosulinosis amatha kugawidwa m'magulu awiri.

"Oyambirira", omwe samapezeka kawirikawiri m'matumbo amtunduwu amagwirizana ndi zolakwika zamtunduwu pakugwira ntchito kwa ma enzymme a chiwindi, zomwe zimapangitsa kuti cholesterol yochulukirapo ipangidwe momwe amadyera komanso momwe amayendera.

"Mochedwa", atherosclerosis yayikulu imalumikizidwa makamaka ndi moyo komanso zakudya.

Kuti afotokozere momveka bwino chifukwa chomwe matendawo amawonekera komanso kufalikira kwa “mochedwa”, munthu ayenera kulingalira za moyo wamunthu asanagwiritse ntchito zomwe amaganiza aumunthu - makina, ukadaulo, ndi zina zambiri.

Moyo wa munthu unali wovuta kwambiri kupeza chakudya chake, adakakamizidwa kusuntha kwambiri. Kunalibe mashopu, chakudya chimayenera kupezeka pansi pamiyala ndi pamitengo, kapena kugwira (pankhani ya nyama), kapena kulima, ndikulima dzikolo paokha.

Nthawi yomweyo, kuchuluka kwa mphamvu zomwe zimagwiritsidwa ntchito popanga chakudya mpaka kuchuluka kwa mphamvu ya chakudya yenyewe inali pafupi ndi mgwirizano - kuchuluka kwa zopatsa mphamvu zomwe ndimagwiritsa ntchito popanga zakudya (Ngati nditapeza ma calorie ochepa, ndimwalira ndi njala).

Ndi chitukuko cha zopangidwa ndimaganizo aubongo wamunthu (zida, kugwiritsa ntchito mphamvu za nyama zazikulu, magalimoto), mtengo wosunthira kuti upeze chakudya unayamba kutsika, ndipo chakudya chochulukirapo chomwe chapezeka m'moyo wa anthu (mwina gawo lake).

Munthu adapeza mwayi wosuntha pang'ono ndikudya kwambiri.

Oyimira anthu olemera anali oyamba kukumana ndi izi, ndipo kafukufuku wofukula zakale amatsimikizira kupezeka kwa atherosclerosis mwa anthu nthawi zakale kwambiri (zikuwonekeratu kuti zotsalira za anthu olemerawa ndizotheka kuti zisungidwe bwino).

Kwa zaka mabiliyoni ambiri, zinthu zamoyo zasintha chifukwa cha kusowa kwa zinthu - njala ndi ludzu. Thupi la munthu silinazolowere michere yambiri.

Kodi chakudya chochuluka chimabweretsa chiyani?

Mamolekyu ambiri amalowa m'thupi, momwe cholesterol imapangidwira. Mlingo wa cholesterol m'magazi umakwera, zomwe zimapangitsa "kutaya" kwa cholesterol yowonjezera kuchokera m'mwazi kulowa m'makoma amitsempha yamagazi (mapangidwe a otchedwa atherosulinotic plaques - ASB). Ichi ndiye atherosulinosis. Kukula kwa mapepala pakapita nthawi kumayambitsa kutsika kwa kufalikira kwa magazi ndi kuchepa kwa magazi komwe kumayenda kudzera pamalowo pang'onopang'ono, mpaka kutsika kwathunthu kwa magazi ndi kumwalira kwa malo ofananirako.

Ndi kuyikika kwa cholesterol mu khoma la chotengera, prerequisites imayambika mapangidwe a thrombus m'malo ano (kuphatikizapo mwayi wotseka kwathunthu kwa lumen ya chotengera - occlusion). Chodabwitsachi chimatchedwa atherothrombosis, nthawi zambiri chimayambitsa kukhumudwa kwambiri pakati pa odwala (matenda a mtima, stroko, kusokonezeka kwa miyendo ndi ziwalo zamkati).

"Kukula" kwachikhalidwe cha anthu kwatsogolera ena mwa oimira kuti azisuta. Kusuta kumakulitsa kwambiri njira ya atherosulinotic, ndipo ngati mutayang'ana kuchuluka kwa anthu akumadulidwe am'munsi, muwona kuwonekera kwa chiwerengero cha amuna akusuta. Chifukwa chake anthu adadzithandizanso ndi kuyatsa fodya.

Kutanthauzira kwa atherosulinotic ndondomeko (yomwe ziwalo zimakhudzidwa):

Mitsempha yama coronary yopereka minofu yamtima (Matenda a Mtima wa Coronary kapena Matenda A mtima A Coronary).
Mavavu amtima (anapeza mtima wodwala). Mtima mkati mwa chitukuko cha intrauterine wa thupi umapangidwa kuchokera kumitsempha yamagazi, chifukwa chake, gawo lamkati la mtima lili lofanana ndi zingwe zamkati zamitsempha yamagazi, ndipo cholesterol imayikidwa mosavuta mmenemo.
Mitsempha yama cell yomwe imapereka ubongo (aakulu komanso pachimake kukomoka kwa thupi).
Mitsempha yam'munsi yopanda malire (kuphatikizika kwina, malo owuma).
Mitsempha yamkati (kupindika (stenosis) ya mitsempha ya impso imayambitsa matenda oopsa - kuwonjezeka kwa kuthamanga kwa magazi).
Mitsempha ina (ischemia yamkati).

"Kupusitsa" kwa atherosulinosis

Kuopsa kwakukulu kwa njira ya atherosselotic ndi "chinsinsi" chake, asymptomatic mpaka penapake.

Kukula kwa zolembedwa za atherosselotic sikumayendera limodzi ndi zomverera, sizipweteka ndipo sizipangitsa chisokonezo.

Wodwala wosazindikira amakhala bwino mpaka mitsempha imachepa kwambiri, kenako amayamba kugunda ndi mtima kapena kugunda kwambiri, zomwe nthawi zambiri zimayambitsa kulumala kapena kufa.

Ndiye chifukwa chake kuzindikira nthawi yake kuli kofunikira.

Matenda a Atherosulinosis

Diagnosis ya atherosulinosis ikuchitika mbali ziwiri:

Kuunika kwa "kukonzekera" magazi kuti atulutsidwe cholesterol yowonjezereka m'makoma amitsempha yamagazi.
Kuwunika kwa mavuto omwe amayambitsidwa ndi cholesterol yomwe ilipo kale m'makoma amitsempha yamagazi.

Kuyesedwa kwa magazi kwamomweko kumapereka zisonyezo zotsatirazi: cholesterol yathunthu (OXS) - mankhwalawo afika pa 5.2, cholesterol yotsika pang'ono ("yovulaza", cholesterol ya LDL) - mankhwalawa afika pa 3.5, mkulu cholembera cholesterol ("yothandiza", cholesterol ya HDL) - zodziwika ndizoposa 1 ndi triglycerides - chizolowezi chimakhala mpaka 2.

Ma "Advanced" Laboratories amasanthula zowonjezera - mafuta otsika kwambiri a cholesterol (VLDL cholesterol) ndi omwe amatchedwa apolipoproteins AL ndi B.

Kuunika kwamomwe mitsempha yambiri imagwirira ntchito pogwiritsa ntchito ma ultrasound (ma ultrasound a mitsempha kapena, moyenera, kuwongolera maulendo amtundu).

Ultrasound siziwona mitsempha yofunika kwambiri ya mtima (coronary), kotero, pakuwunikira kwa coronary atherosulinosis, njira yofunikira (yolowerera m'mitsempha) imagwiritsidwa ntchito - CAG (coronary angiography), momwe chinthu cha radiopaque chimayikidwa m'mitsempha yama coronary ndi chithunzi cha x-ray. Pali chidziwitso chotsimikizika kuti munthawi yathu yanthawi yowerengera makanema (MSCT mosiyanitsa) chafika pamalingaliro abwino ndikukulolani kuti muwone zolemba m'mitsempha yama coronary yamagetsi osasokoneza kuposa CAG.

Ultrasound imakupatsani chithunzi cha mitsempha ya khosi, mikono, miyendo, mitsempha ya ziwalo zamkati.

Atherosulinotic plaque (ASB) ikhoza kukhala ya kwanuko (m'chigawo chaching'ono cha sitimayo) ndikutalikitsidwa, imatha kukhala ndi khoma limodzi la mtsempha kapena makoma ake onse (ASB amatchedwa distric). Ultrasound imakupatsani mwayi kuti mufufuze gawo lofunikira monga "kuchuluka kwa stenosis m'mimba mwake".

Chikwangwani chikapezeka, chimjambulidwa, kenako "kukhuthala" kwake kwapamwamba ndi mainchesi amtsempha amayesedwa. Chizindikiro choyamba chimagawidwa pachiwiri, kuchuluka kwa stenosis kumachitika. ASB imakhudza kuthamanga kwa magazi mu mtsempha wamagazi ndi kuchuluka kwa stenosis yoposa 50, ndipo 75-80% ndi chisonyezo chogwira ntchito zovuta kwambiri kuchotsa zolembedwazi.

↓ Kupangidwe kwa ASB yakumaloko (atherosulinotic plaque) ndi kukula kwina ndikupanga ndi kukula kwa lipid pachimake zikuwonetsedwa pano. Chithunzi chapansi chikuwonetsa chikwangwani chomwe chikukhudza kuthamanga kwa magazi mu mtsempha womwe wakhudzidwa (50% dien stenosis).

(Zithunzi zopangidwa ndi wolemba malowa, gawo lautali kudutsa pakati pa mtsempha)

↓ Ndipo nayi chochitika chomvetsa chisoni - chotumphukira. Pankhaniyi, dongosolo la kuphatikiza magazi limakhulupirira kuti chotengera chovulala, ndipo mayankho achilengedwe povulazidwa ndi thrombosis. Madzi otaya mumtsempha atha kudutsa, ndipo ziwalo zodyetsa kapena ziwalo zake - zimafa. Mumtima, thrombosis yotere imayambitsa kupweteka kwamatenda am'mimba.

Chimawoneka ngati chidutswa chokulirapo (chokhala ngati malaya).

Chithandizo cha Atherosulinosis

Mankhwalawa atherosclerosis, komanso kuwunika, ikuchitika mbali ziwiri:

Kuwongolera kwa lipids yamagazi ambiri
Ngati ndi kotheka, zowukira (ndi zobwezedwa mkati mwa ziwiya kapena mtima) zimakulitsa kuchuluka kwa ma atherosrance. Izi zimachitika ndi madokotala ochita opaleshoni m'madipatimenti apadera.

Kuwongolera cholesterol kumachitika m'njira ziwiri: Kusintha kwa moyo (IOL) ndi mankhwala osokoneza bongo.

Kusintha kwamoyo ndi kuchepa kwa kulemera kwa thupi (kuchepa kwa kunenepa kwambiri), zolimbitsa thupi (kuyenda) ndi kuchepa kwa chakudya, zomwe zimapangitsa kuchuluka kwa mafuta m'thupi.

Njira yokhayo yochepetsera thupi ndi kugwirira bwino pakati pakudya ma calorie ndi kuwotcha. Njira zonse “zodabwitsa” zimadzakhala chinyengo.

Pambuyo pakuyenda kwa mphindi 40, thupi limayaka pafupifupi mphamvu zambiri monga momwe limadyera ndi chakudya patsiku, kotero kuchepetsa thupi kumatheka pokhapokha ngati muli ndi nkhawa yayikulu (kapena ndi vuto loletsa kudya).

"Zinthu" zazikulu zomwe cholesterol imapangidwira ndi mafuta omwe amadziwika kuti ndi mafuta (ndiye kuti, mafuta opangidwa ndi nyama omwe samayenda pakhungu).

Mafuta ophikira samachokera ku nyama, safunikira kuchepera. Mafuta a nsomba amayenda firiji, kotero mutha kudya nsomba popanda choletsa mukamayesa kudya mafuta owonjezera a cholesterol.

Kuledzera kwa nyama yankhumba, nkhumba, mafuta a mwanawankhosa kuyenera kukhala kochepa mu mawonekedwe amomwe mumafuta eni eni mu nyama ndi zopangidwa ndi nyama, chifukwa chake masoseji osuta ndi nyama yofukizidwira sikhala chakudya chabwino kwambiri cha atherossteosis.

Zakudya zina zomwe zimayambitsa cholesterol yayikulu ndi khungu la nkhuku (khungu liyenera kuchotsedwa musanaphike nkhuku), batala (70-80% mafuta a nyama) ndi tchizi zachikasu (pafupifupi 70% mafuta, werengani zomwe zili phukusi).

Chithandizo cha mankhwala osokoneza bongo chimayikidwa ndi adokotala okha!

Ndikofunika kudziwa kuti cholinga chomwera mankhwalawa sichikuwathandiza kuthetsa zidutswa - ngakhale zaka zakumwa mankhwalawo osagwiritsidwa ntchito nthawi zonse zimachepetsa kukula kwawo ndi magawo a peresenti. Chachikulu ndikuletsa kukula kwawo kwina.

Awa ndi ma Statins (HMG-CoA reductase inhibitors), ma Fibrate, mayamwidwe a Cholesterol (mayamwidwe) ndi ma Omega-3 acid osapanga mafuta.

Statins imalepheretsa enzyme mu chiwindi yomwe imakhudzidwa ndi kuphatikizika kwa cholesterol.

Ndizotsika mtengo, nthawi zambiri zimalekeredwa komanso zimagwira ntchito kwambiri.

Mphekesera zoyipa zakuopsa kwa ma statins, omwe amalimbirana ndi makina atolankhani, zimakokometsedwa kwambiri.

Dokotala wopezekapo, popereka mankhwala a statin kwa wodwala, amakakamizidwa kuchenjeza za kufunika koyezetsa magazi (ALT, AST, OXS, LDL cholesterol, cholesterol ya HDL, triglycerides) mwezi umodzi pambuyo poyambira kukhazikitsa, ndiye chaka chimodzi ndi theka. Izi zimachitika kuti athe kuunika momwe mankhwalawo alili othandizira komanso osaloledwa.

Tsoka ilo, kulimbana ndi cholesterol ndichinthu chautali (moyo wonse), kotero mawu oti "ndinatenga maphunzirowo" amamveka osadukiza, masabata awiri atachotsa ma statins, cholesterol yamagazi ibwerera pamlingo wake woyambirira.

Gulu latsopano lodula la ma antioxodies a monoclonal kupita ku PCSK9. Zambiri pakadali pano, dikirani, bwana.

Ezetimibe (Ezetrol) amagwira ntchito, mosiyana ndi ma statins, m'matumbo ndipo amatsekera mayamwidwe a cholesterol. Chifukwa chake, ngati wodwalayo adya molondola, alibe phindu lalikulu. Ndipo ndiokwera mtengo kwambiri

Ezetrol ikhoza kuphatikizidwa ndi ma statins kuti muchepetse mlingo wotsiriza. Pali mitundu yophatikizira ya fakitale ya Inegi (Simvastatin kuphatikiza Ezetimibe).

Fenofibrate (Tricor) imalembedwa ngati, pamodzi ndi cholesterol, mulingo wa triglycerides umachulukitsidwa kwambiri.

Ma Omega-3 acid (Omacor) amachepetsa cholesterol pang'ono, koma chitani zabwino zambiri pamtima (mwachitsanzo, dzitetezeni ku zosokonezeka za mkungudza).

Atherosulinosis imathandiza kwambiri thrombosis m'mitsempha, motero pofuna kupewa thrombosis, madokotala nthawi zambiri amamulembera Aspirin (Acetylsalicylic acid - ASA) muyezo waukulu (50-150 mg patsiku).

Pomaliza, ndifotokoza malingaliro anga pa chithandizo cha matenda a matenda a mtima.Kukonzekera kwa Magnesium kumachepetsa cholesterol pang'ono, koma kumachepetsa kwambiri "kuwonongeka" kwa cholesterol kuchokera ku lumen ya artery kulowa khoma (kutanthauza kulepheretsa kukula kwa zolembera). Chifukwa chake, magnesium, posakhala mankhwala, imathandiza kukonzekera kwa cholesterol.

Mankhwala azadzidzidzi

Atherosulinosis - matenda osachiritsika am'mitsempha yayikulu komanso yapakatikati (yotanuka komanso yamankhwala-yotupa), yodziwika ndi kuphatikizika ndi kuchuluka kwa plasma atherogenic apoprotein-B wokhala ndi lipoprotein wokhala ndi kuchuluka kwa minofu yolumikizana komanso mapangidwe a mafupa am'mimba.

Gulu la atherosulinosis (A. L. Myasnikov, I960)

Gawo la III, IV ndi V pamasanjidwe omwe ali ndi tanthauzo lalikulu la chipatala ndi omwe amapatsidwa.

Njira zachitukuko:

1. Aorta.
2. Mitsempha yama coronary.
3. Mitsempha ya ubongo.
4. Mitsempha yam'mimba.
5. Mitsempha yama Mesenteric.
7. Mitsempha yam'mapapo.

Gawo lazachipatala:

Ine nthawi (preclinical): a) vasomotor matenda, b) zovuta zovuta zasayansi,
Nthawi ya II (ya chipatala): gawo a) ischemic, b) thrombonecrotic, c) sclerotic.

Gawo la mayendedwe:

1. Kukula kwa atherosulinosis.
2. Kukhazikika kwa njirayi.
3. Kukonzanso kwa atherosulinosis.

Atherosulinosis chiopsezo zinthu.

1. Zaka zaka 40-50 ndi okulirapo.
2. Amuna ndi akazi. Amuna amatha nthawi yayitali komanso zaka 10 kale kuposa azimayi kuti apange atherosulinosis chifukwa chakuti zomwe zili mu anti-atherogenic a-LP m'magazi a amuna ndizotsika ndipo amatha kusuta ndipo amatha kutengeka ndi zinthu zovuta.
3. Matenda oopsa.
4. Kusuta.
5. Kuphwanya kulekerera kwa shuga, shuga.
6. Kunenepa kwambiri.
7. Hypodynamia.
8. Makhalidwe a umunthu ndi machitidwe - otchedwa nkhawa mtundu.
9. Mankhwala othamanga kwambiri a triglycerides, cholesterol, atherogenic lipoproteins.
10. Mkulu wolemedwa ndi atherosulinosis.
11. Gout.
12. Madzi akumwa ofewa.

Etiology. Zomwe zimatchulidwa kuti ndizofunikira: psycho-maikutlo ndi psychosocial nkhawa, kuzunza mafuta, kukhala ndi mafuta ambiri komanso zakudya zosavuta za chakudya, matenda a metabolic ndi endocrine (matenda a shuga, hypothyroidism, cholelithiasis).

Pathogenesis. Atherosclerosis imayamba ndi mkhutu endothelial kupezeka ndi kusunthira mu intima yosalala minofu maselo ndi macrophages. Maselo amenewa amadzisonkhanitsa kwambiri ndi ma lipids ndikusintha kukhala "chithovu". Kuchulukitsa kwa "ma cell foamy" okhala ndi cholesterol ndi zigawo zake kumayambitsa kuwonongeka kwa maselo ndikumasulidwa kwa lipids ndi michere ya lysosomal m'malo ena, omwe amachititsa kuti pakhale mafupa, minyewa yokhala ndi mafupa ozungulira milomo ya lipid, komanso mawonekedwe a fibro-atheromatous. Kukula kwa njirazi kumachitika mothandizidwa ndi magulu awiri azinthu za pathogenetic: I - ndikuthandizira kukulitsa kwa atherogenic hyper-lipoproteinemia ndi II - zomwe zimathandizira kulowerera kwa atherogenic lipoproteins ndikulowa kwa mtsempha wamagazi. Zomwe zili m'gulu I zimaphatikizapo: chiopsezo ndi ukadaulo, kukanika kwa chiwindi, matumbo, endocrine gland (chithokomiro cha chithokomiro, ziwalo zoberekera, ziwiya zobisika). Gulu lachiwiri la zinthu za pathogenetic limaphatikizapo: kukulitsa kupezeka kwa endothelium, kuchepetsa kuvomereza kwa α-LP kuchotsa cholesterol kuchokera pachiwopsezo cha mitsempha, kuchepetsa mapangidwe a keilons, komwe kumakulitsa kuchuluka kwa maselo osalala a minofu, kuyambitsa lipid peroxidation, kukulitsa kupanga kwa thromboxane ndi endothelin ndi mapangidwe a maselo a pulototin. ndi vasodilating factor, kuphatikiza kwa zida zogwiritsira ntchito - kupanga ma antibodies kuti atherogenic pre-p ndi (5-LP.

Zizindikiro zamankhwala

Atherosulinosis ya thoracic msempha.

1. Aortalgia - kukanikiza kapena kuwawa kupweteka kumbuyo kwa sternum, kukunyezimira m'manja, m'khosi, kumbuyo, pamimba pamimba. Mosiyana ndi angina pectoris, ululu siwokhala paroxysmal, wokhalitsa (umatenga maola, masiku, nthawi zina kufooka komanso kuwonjezeka). Ndi kutsekeka kwa milomo yamitsempha yam'mimba yokhala ndi ziwalo zam'mimba, ululu wammbuyo umatha kuoneka, ngati ndi neostgia ya patent.

2. Ndi kukula kwakukulira kwa aortic arch kapena aneurysm, kuvuta kumeza chifukwa cha kupindika kwa esophagus, kutsekemera kwa mawu (kukakamiza kwa kupezekanso kwa mitsempha), chizungulire, kukomoka, ndi kukhudzika ndikutembenuza mutu ndikutheka.

3. Kuwonjezeka kwa gawo la kupsinjika kwa mitsempha ya msana m'malo ophatikizika ndi nthiti zachiwiri kwa sternum, kukulira kwa gawo loyang'ana kuzungulira kwa gawo lachiwiri la mbali yakumanzere kumanja kwa sternum ndi 1-3 cm (chizindikiro cha Poten).

4. Kutulutsa kwakumaso kumawoneka kapena kuwoneka paliponse, kawirikawiri - chotumphukira chakumaso kwazimba kumanja kwa sternum. 5. Panthawi yokondwerera, kamvekedwe ka II komwe kamakhala ndi zitsulo, kung'ung'udza, kokwezedwa ndikukweza manja kumbuyo ndikukweza mutu kumbuyo (chizindikiro cha Sirotinin-Kukoverov).

6. Kuwonjezeka kwa kupanikizika kwa systolic ndi kuthamanga kwa diastoli, kuwonjezeka kwa kuthinikizidwa kwa zamkati, kuwonjezeka kwa kufalikira kwaposachedwa kwa funde.

Matenda a m'mimba a msempha.

1. Kupweteka kwam'mimba kwa malo osiyanasiyana, kutulutsa, kudzimbidwa monga chiwonetsero cha zamkati pamimba chifukwa chakuchepetsa kwa nthambi zingapo zam'mimba zomwe zimachokera ku msempha.
2. Ndi zotupa za atherosselotic za machitidwe aortic bifurcation, matenda a Lerish amayamba - kulephera kwamitsempha, kuzizira, kuzizira, miyendo, kufinya kwa minyewa ya m'miyendo, kusabala, zilonda zam'mimba komanso zotupa m'mitsempha ndi m'miyendo ya m'miyendo, Nthawi zambiri wamkazi chotupa, kusakhalako kwa msempha wamkati, msipu wong'ambika pamalungo achikazi mu inguinal khola.
3. Pamene khansa yam'mimba imatsimikiza ndi kupindika kwake, komanso kachulukidwe.
4. Pamwamba pa msempha wam'mimba, kung'ung'udza kwa systolic kumveka pakati pamlingo wapamwamba komanso msana wa navel.

Atherosulinosis ya mesenteric mitsempha ovomereza ndi "mkanda wam'mimba" ndi zovuta m'mimba.

1. Kupweteka kwakuthwa kapena kudula ululu m'mimba (makamaka mu epigastrium), nthawi zambiri kutalika kwa chimbudzi, komwe kumatenga pafupifupi maola 1-3. Nthawi zina ululu umakhala wochepa, amasiya ndi nitroglycerin.
2. Ululu umayenda limodzi ndi kumatulutsa, kudzimbidwa, kupindika.
3. Mtsogolomo, kutsekula m'mimba mwa amayi anga kumatha kulumikizana katatu patsiku ndi zakudya zosakhudzidwa ndi mafuta osachepera, kuchepa kwa ntchito yachinsinsi m'mimba.
4. Zowawa zakumaso m'malo a mtima, palpitations, zosokoneza, kupuma movutikira ndizotheka.
5. Mukamayang'ana pamimba, kusanja, mawonekedwe okweza am'munsi, kuchepa kapena kusowa kwa peristalsis, kung'ung'udza kwa systolic mu epigastrium kumatsimikizika.
6. Pang'onopang'ono kukomoka thupi, kufooka, ndi kuchepa kwa turgor pakhungu kumachitika.

Matenda a mitsempha ya impso.

1. Vasorenal chizindikiro ochepa ochepa matenda oopsa.
2. Mumkodzo - mapuloteni, maselo ofiira a magazi, masilindala.
3. Ndi stenosis yamitsempha ya impso imodzi, matendawa amatuluka ngati matenda oopsa pang'onopang'ono, koma ndikusintha kwamkodzo mkodzo, kulimbikira kwa matenda oopsa. Ndi zowopsa aimpso, matendawa amakhala ndi matenda oopsa oopsa.
4. Pamwamba pamitsempha yamafupa, kung'ung'udza kwa systolic nthawi zina kumamveka m'mphepete mwa mzere wa pararectal pakati pa mtunda pakati pa msana ndi njira ya xiphoid kumanzere ndi kumanja.

KULEMETSA ATHEROSCLEROSIS YA MALO OGULITSIRA AMBUYE.

1. Mawonetseredwe othandizika: kufooka ndi kutopa kwa miyendo ya mwendo, kuzizira ndi kugona kwa miyendo, kupindika kwa claudication (kupweteka m'misempha ya ng'ombe poyenda, kupweteka kumachepetsa pakupuma).
2. Pallor, mapazi ozizira, zovuta zamatumbo (ziume, kusenda kwa khungu, zilonda zam'mimba, gangrene).
3. Kufooka kapena kusowa kwa pulsation m'dera lamatumbo akulu a phazi.

Zambiri zasayansi

I. OAK: palibe kusintha.

2. LHC: kuchuluka kwa cholesterol, triglycerides, npe-β- ndi β-lipoproteins, NEFA, hyper-lipoproteinemia yamitundu II, IV, III, kuchuluka kwa cholesterol ya β- ndi pre-β-lipoproteins, coheroffic.

Kufufuza kwazida

Kuunika kwa X-ray: kupangika, kufalikira, kufalikira kwa msempha mu zigawo za thoracic ndi m'mimba. Akupanga fluometry, rheovaso-, plethysmo-, oscillo-, sphygmography: Kuchepetsa ndi kuchedwa kwa magazi oyenda m'mitsempha yam'munsi. Angiography ya zotumphukira mitsempha ya m'munsi malekezero ndi impso: kuchepera lumen kwa mitsempha. Isotope renography: kuphwanya kwa msana ndi chinyezimiro cha impso ndi atherosclerosis ya mitsempha yaimpso.

Pulogalamu Yofufuzira

1. OA magazi, mkodzo. 2. LHC: triglycerides, cholesterol, pre-β- and β-lipoproteins (malinga ndi Burstein), polyacrylamide gel lipoprotein electrophoresis, p- ndi pre-p-lipoprotein cholesterol, transaminase, aldolase, mapuloteni komanso mapuloteni ambiri, coagulogram . 3. ECG. 4. FCG. 5. Echocardiography. 6. Kukonzanso mbiri yokhala m'munsi. 7. Fluoroscopy ya msempha ndi mtima.

Maupangiri othandizira owunikira. Chirkin A.A., Okorokov A.N., 1991