Zizindikiro za matenda a shuga a diabetes

Matenda a shuga - zotupa zapamtundu wamagulu, zimafalikira ku zombo zazing'ono (zomwe zimatchedwa "Microangiopathy"), komanso ma sing'anga akuluakulu komanso akulu (mwachitsanzo, macroangiopathy). Ngati kusintha kwa zotengera zazing'onoting'ono (ma capillaries, arterioles ndi venule) ndizodziwika bwino kwa matenda ashuga, ndiye kuti kuwonongeka kwa ziwiya zazikulu ndikofanana ndi koyambirira komanso kufalikira kwa matenda atherosclerosis.
Chizindikiro cha zotupa zazing'onoting'ono panthawi yake ndizochulukitsa kwa endothelium, makulidwe amkati mwa zipinda zing'onozing'ono zamkati, kuyika kwa glycoprotein RA5-zabwino pazitseko za chotengera. Mawu akuti "diabetesic microangiopathy" akuti angafotokozere zomwe zimachitika m'matumba ang'onoang'ono.
Ngakhale pali kuchuluka kwa micangiopathies, ziwiya za impso, fundus, malekezero otsika omwe amakhala ndi mawonekedwe a nephropathy, retinopathy, ndi zotumphukira za microangiopathy amakhudzidwa kwambiri.

Mawu akuti "diabetic microangiopathy" ndiwopambana kwambiri poyerekeza, chifukwa akuwonetsa zinthu ziwiri - ubale ndi zomwe zimayambitsa matenda komanso kutengera kwa njira m'matumba ang'onoang'ono. Mayina ena, monga "universal capillaryopathy", "matenda opatsirana", "peripheral angiopathy" sanalembetsedwepo m'mbiri.
Popanga mtundu wa mankhwalawo, wina ayenera kuchoka paziwonetsero za kuwonongeka kwakawiri kwa mtima wa matenda ashuga - atherosulinosis ya sing'anga yayikulu komanso yayikulu, yomwe matenda ashuga amatenga m'mbuyomu ndipo imakhala yofala kwambiri, komanso makamaka za matenda ashuga a shuga. Kuphatikiza apo, mtundu wina wachitatu wa zotupa umakhala wodziwika - arteriolosclerosis, omwe amangopezeka ndi matenda a impso.
Ponena za thromboangiitis obliterans (endarteritis), njira yolumikizana ndi pathogenetic ndi matenda a shuga ilibe, ndipo zingakhale zolakwika kuzigawa ngati vuto la mtima la shuga. Thromboangiitis siofala kwambiri m'matenda a shuga kuposa anthu opanda shuga. Kusokonezeka kwa malingaliro akuti "kuwononga ma atherosulinosis" ndi "kuwononga thromboangiitis" kunachitika chifukwa mawu omaliza nthawi zambiri amatanthauza mitundu yoyambira ndi yabwino yopangira matenda opatsirana. Nthawi yomweyo, thromboangiitis palokha imakhala matenda a collagen omwe ali ndi chithunzi chomveka chachipatala.
Thromboangiitis obliterans imatha kungokambirana ndi kuphatikiza kwa ischemic syndrome ndi zizindikiro zina za collagenosis: kutentha thupi, njira yopita patsogolo, mawonetseredwe amtundu, kutupa kwa magazi, nyamakazi, kuwonongeka kwa khungu ndi mucous nembanemba. Zowona, kuti pakutha kwa kuwonongeka kwakukulu ndikuwoneka ngati kusintha kwa ma trophic, kutsogoloku kumatha kukhala ischemic syndrome, ndipo zizindikiro za kufooka kwa thupi ziwonekeranso kumbuyo. Komabe, mbiri yawo ndiyofunika. Kuganizira pamwambapa kwa kutsika kwa thromboangiitis kukuwonetsedwa ndi gulu logawanitsa magawo atatu:
Gawo lolimbitsa thupi
Ischemic siteji
gawo la zovuta trophoparalytic.
Pali mitundu itatu yowonongeka pamatumbo am'munsi am'magazi a shuga, omwe amadziwika ndi matenda oyamba:

• matenda a shuga a shuga ,
• atherosulinosis obliterans,
• kuphatikiza kwa atherosulinosis ndi kuwonongeka kwa ziwiya zam'munsi.

Kuchepetsa endarteritis kumatha kupezekanso mwa odwala matenda a shuga. Komabe, monga tawonetsera kale, mawonekedwe awa alibe ubale wa pathogenetic ndi matenda ashuga, ndipo siofala kwambiri kuposa kwa anthu omwe alibe shuga.
Popanga kagayidwe kakang'ono ka matenda a shuga, kuphatikiza magawikidwe m'magulu awiri (macro- ndi microangiopathies), ndikofunikira kumveketsa bwino malo omwe khansa imapangidwira, popeza chithandizo chosiyanitsa, makamaka mankhwala am'deralo, zimatengera. Izi sizingogwira ma microangiopathies enieni (retino-, nephropathy, ndi zina zotere), komanso kutengera kukondweretsa kwa atherosclerosis a zombo zapakatikati ndi zazikulu (matenda, korona, zina).
Mfundo ina yophatikizira angiopathies a shuga iyenera kuganiziridwanso. Tikuyankhula za gawo la chitukuko cha zotupa zam'mimba. Funsoli silinayankhidwe malinga ngati lingaliro lakale la angiopathy linali "mochedwa wodwala matenda ashuga" omwe amachititsa matenda ashuga okhalitsa. Inde, patadutsa nthawi yayitali matenda, zovuta zam'mitsempha zimapezekanso, ndipo nthawi zambiri zimakhala zotsogola kwambiri. Njira zofufuzira zitasintha, kusintha kwa mtima kunayamba kupezeka kuyambira zaka zoyambirira za matendawa, komanso ngakhale pa matenda ashuga komanso prediabetes. Makamaka nthawi zambiri, kusintha kwa magwiridwe am'madzi mu ma mawonekedwe osintha m'mimba mwake, kupezeka, ma venous stasis amapezeka kuchokera ku conjunctiva, glomeruli la impso, malekezero otsika.
Kupititsa patsogolo ziyeso zakuzindikira kwapangitsa kuti kusintha kwa mitsempha kuzindikirike musanadandaule komanso zizindikiro zamankhwala zisanachitike. Chifukwa cha magwiridwe antchito (asinthidwe) a kusintha koyambirira m'matumba, njira yothandizira mankhwalawo imakhala yosiyana poyerekeza ndi chithandizo cha zotupa zam'mimba zomwe zimakhala zikuluzikulu.
Izi zilingalira ngati maziko a magawidwe atatu a matenda a shuga:
I - preclinical (metabolic),
II - zothandiza,
III - organic.
Odwala omwe ali ndi gawo la matenda a matenda ashuga angokhala alibe nkhawa. Kafukufuku wachipatala sanawonetse kusintha kwasinthidwe. Komabe, poyerekeza ndi shuga wovuta, pakadali pano, malinga ndi maphunziro a biochemical, kuchuluka kodziwika bwino kwa cholesterol (3-lipoproteins, lipids yonse, ma bullucoproteins, mucoproteins) amapezeka. Zosintha mu chithunzi cha capillaroscopic cha bedi la misomali ya kumapazi kumachepetsedwa kuti chiwonjezeke kuchuluka kwa ma capillaries, kupendekera kwa nthambi zam'mbuyo, ndikuwoneka ngati magazi oyenda m'magazi. Kuwonjezeka kwa kamvekedwe ka mtima ka tachoscillography ndi sphygmography kukuwonetsedwa pakuwonjezeka kwa kupanikizika kwapakati, kuwonjezeka kwa pulse wave propagation velocity (SRWP) mpaka 10,5 m / s komanso makamaka pakupewera kwina.

Pa gawo lachiwiri (lantchito) la matenda ashuga angiopathy, pali mawonekedwe owoneka pang'ono komanso osakhalitsa am'mapazi mu maulendo ataliatali, paresthesias, kugwirira, kuchepa kwa kutentha kwa 2-3 ° C, kuchepa kwa index ya oscillatory, ndikuwoneka bwino kwa capillaries mwa mawonekedwe osintha. nthambi, nyansi, magazi othamanga. Mwa odwala onse (makamaka mpaka zaka 40), kuwonjezeka kwa kamvekedwe ka ma arterioles ndi mpweya wotchulidwa ndi zomwe zili pamwambazi, kuphatikizapo kuwonjezeka kwa mitundu yonse ya kukakamiza, zotanuka modulus, PWV mpaka 11.5 m / s. Zomwezo zimagwiranso ntchito pakusintha kwazinthu zam'mwazi.
Gawo lachitatu ndi lodziwika ndi zotupa zam'miyendo mwanjira yolumikizana, kupweteka m'mapazi, kusokonezeka kwa khungu ndi misomali, kuchepa kwakukulu kapena kusapezeka kwa kugunda kwamkono kwa phazi, kutsika kwa mndandanda wamkati mpaka kutsika kwa oscillations. Kuphatikiza pa kusinthika kwa ma capillaries, kuchepa kwawo kumachitika ndi mawonekedwe a "khonde". Malinga ndi mechanocardiografia, patency ya kama yomwe ili patsogolo pake imachepetsedwa kwambiri. Vesi yakufalikira kwa mafunde osangalatsa imakwera pamwamba pa 11.5 m / s. Chomwe chimasiyanitsa odwala omwe ali mu gawo lachitatu la matenda ashuga angiopathy poyerekeza ndi I ndi II ndi chikhalidwe chosasintha cha kusintha kwamasamba, kusowa poyankha kumayeso olimbitsa thupi komanso mphamvu zochepa pothandizidwa ndi mankhwalawa. Odwala ambiri a gawo ili ndi achikulire kuposa zaka 40.
Kupitilira patsogolo kwa mitsempha kumabweretsa zovuta zakuchulukirapo za trophic, zilonda zam'mimba zosachiritsika zomwe zimasinthidwa kukhala gangrene.
Magawo oyamba akusintha kwamasamba (gawo I ndi II la diabetesic angiopathy) amadziwika ndi kusintha kosinthika komwe kumatha kuwoneka osati kuyambira zaka zoyambirira za matenda ashuga, komanso ngakhale pa matenda ashuga komanso prediabetes. Tiyeneranso kudziwa kuti kukula kwa chipinda chapansi pa capillaries polumikizana ndi kuphwanya kwa kagayidwe kamankhwala koyambirira koyamba ndikosintha ndipo kumatha kuwoneka koyambirira kwa kusintha kwa mtima.
Kuzindikiritsa zotupa zam'mimba kuyambira zaka zoyambirira za matenda ashuga komanso ngakhale mwa anthu omwe ali ndi matenda ashuga kumapereka mwayi woganiza angiopathy osati mathero a matendawa, koma monga gawo lofunikira la njira ya pathological, mwachidziwikire chifukwa chophwanya mayendedwe a mahomoni a kusintha kwa mtima komanso kusintha kwakukuru kwa metabolic.
Ndi zonse zomwe wanena, ndizabwinobwino kwambiri kuvomereza magulu azotsatira za odwala matenda ashuga.
Gulu la odwala matenda ashuga.
Mwa kutulutsa zotupa zam'mimba:
1. Microangiopathies:
a) retinopathy,
b) nephropathy,
c) michereopathy yodziwika bwino, kuphatikiza ma microangiopathy a ziwalo zamkati, minofu ndi khungu,
c) microangiopathy ya malekezero a m'munsi.

Matenda a shuga amatanthauza zovuta za matenda ashuga ndipo amawonetsedwa ndi kuperewera kwa ziwalo za miyendo, zomwe zimatsogolera ku necrosis. Mu matenda a shuga a shuga, ziwiya zama caliber osiyanasiyana zimakhudzidwa, koma zazing'ono kwambiri komanso zapakatikati. Osangokhala miyendo yokha yomwe imakhudzidwa, komanso ziwalo zamkati.

Kuwonongeka kwa ziwiya zing'onozing'ono za diabetes

Mitsempha yaying'ono ikakhudzidwa, kusintha kumachitika khoma lawo, kuchuluka kwa magazi kumasokonekera, ndipo magazi amayenda pang'onopang'ono. Zonsezi zimapangitsa kuti pakhale kupanga magazi. Zida zochepa za impso, retina, minofu yamtima, ndi khungu zimakhudzidwa makamaka. Kuwonetsedwa koyambirira kwa matenda ashuga angawonongeke kumapeto.

Njira zomwe zimachitika m'sitimazi ndi zamitundu iwiri: kukula kwa khoma la arterioles ndi mitsempha kapena makulidwe a capillaries. Poyamba, mchikakamizo cha zinthu zopangidwa ndi poizoni zomwe zimapangidwa pakagwiritsidwa ntchito kosakwanira kwa glucose, gawo lamkati lamitsempha yamagazi limatupa, pambuyo pake limachepa.
Mawonekedwe oyamba a matenda a shuga a shuga ndi zotupa zazing'ono pansi pa msomali wa chala chachikulu. Wodwalayo amamva kupweteka m'miyendo, amawona kuti khungu limatuluka, mawanga amawoneka, misomali imakhala yofinya, minofu ya miyendo "yowuma". Kugunda kwamitsempha yayikulu yam'munsi yam'munsi sikumasintha, koma pamapazi kumatha kukhala kofooka.

Zosintha m'mitsempha yam'mimba zimatha kupezeka ndipo mapuloteni amkodzo amatha kuwonekera. Chikhodzodzo china chopanda ululu chodzadza ndimadzi wamagazi chimatuluka pakhungu la mapazi. Amadzichiritsa pawokha, pomwe vanga sikupanga, komabe, tizilombo tating'onoting'ono timatha kulowa mu minofu ndikuyambitsa kutupa.

Kupeza matenda a shuga a shuga, njira zotsatirazi zikugwiritsidwa ntchito:

• capillaroscopy
• infrared chozizira
• kuyambitsa ma radio isotopes,
• laser fluometry
• polarography kapena oxyhemography.

Kuwonongeka kwa ziwiya zazikulu zamatenda a shuga

Ndi matenda ashuga angiopathy, ziwiya zapakatikati ndi zazikulu zimatha kukhudzidwa. Mwa iwo, zipolopolo zamkati zimadzaza, mchere wa calcium umayikidwa ndipo ma atherosranceotic malo amapangidwa.

Mawonekedwe a matenda pankhaniyi ali ofanana ndi omwe amapezeka ndi zotupa za mitsempha yaying'ono. Zowawa m'mapazi ndizosokoneza, zimakhala zozizira komanso zotumbululuka, chakudya chamthupi chomwe chimafa pakapita nthawi chimasokonekera. Minyewa ya zala imayamba, kenako phazi.
Matenda a shuga angiopathy a ziwalo zamkati

Mu shuga mellitus, zotengera za retina ndi ziwalo zamkati zimakonda kukhudzidwa ndi njira ya pathological. Izi zimachitika chifukwa cha kupangidwa kwa zinthu zopangidwa ndi poizoni ndi "kuyaka" wopanda shuga wa shuga. Pafupifupi odwala onse omwe ali ndi shuga wamagazi ambiri ali ndi matenda amtundu wotchedwa retinopathy. Ndi matendawa, kupenyerera koyambirira kumayamba kuchepa, kenako magazi amathiridwa m'madzi a retina, ndipo amachoka. Izi zimabweretsa kutaya kwamaso kwathunthu.

Chigawo chachiwiri chandamale, zotengera zomwe zimakhudzidwa ndi matenda a shuga, ndiye impso - nephropathy imayamba. Mu magawo oyamba, matendawa samadziwonetsa, kusintha kumatha kupezeka pokhapokha wodwalayo akamamuyesa. Zaka zisanu pambuyo pake, ntchito ya impso imalephera ndipo mapuloteni amawonekera mkodzo. Ngati zosinthika zadziwika pano, ndiye kuti zitha kusintha. Koma ngati chithandizo sichikuchitika, njira ya m'mitsempha ya impso imayendera, ndipo patatha zaka khumi zikuwoneka zizindikiro za matendawa. Choyamba, mapuloteni ambiri amayamba kuponyedwa mkodzo. Zimakhala zochepa m'mwazi, ndipo izi zimapangitsa kudzikundikira kwamadzi mu minofu ndi kutupa. Poyamba, edema imawoneka pansi pa maso ndi m'munsi, kenako timadzi timadzi totikatika pachifuwa komanso m'mimba.

Thupi limayamba kugwiritsa ntchito yake mapuloteni amoyo, ndipo odwala amachepetsa thupi msanga. Amakhala ndi kufooka, mutu. Komanso panthawiyi, kuthamanga kwa magazi kumakwera, komwe kumangokhala pamiyala yambiri ndipo sikumachepetsedwa ndi mankhwala.

Zotsatira zakutha kwa matenda ashuga aimpso ndi gawo lomaliza la kulephera kwa aimpso. Impso zimalephera kwathunthu, sizikwaniritsa ntchito yawo, ndipo mkodzo suthiridwa. Poizoni wa thupi ndi metabolism ya protein.

Matenda a shuga Chithandizo cha magawo osiyanasiyana a matendawa

Kuchita bwino kwa matenda a shuga a shuga kungachitike pokhapokha ngati pali kotheka misempha yamagazi. Izi ndi zomwe endocrinologists amachita.

Kuti tipewe kusintha kosasintha mu minofu ndi ziwalo, ndikofunikira:

• kuwongolera shuga ndi mkodzo
• onetsetsani kuti kuthamanga kwa magazi sikudutsa 135/85 mm. Hg. Art. odwala popanda mapuloteni mu mkodzo, ndi 120/75 mm. Hg. Art. mwa odwala omwe protein yawo yatsimikizika,
• kuwongolera njira mafuta kagayidwe.

Pofuna kukhalabe ndi kuthamanga kwa magazi pamlingo woyenera, odwala matenda ashuga ayenera kusintha moyo wawo, kuchepetsa kudya kwawo kwa sodium mankhwala ena, kuonjezera zolimbitsa thupi, kukhala ndi thupi labwino, kuchepetsa kudya zakudya zamafuta ndi mafuta, komanso kupewa kupsinjika.

Mukamasankha mankhwala omwe amachepetsa kuthamanga kwa magazi, muyenera kuwonetsetsa ngati akukhudza kagayidwe kazakudya ndi mafuta, komanso ngati ali ndi mphamvu yoteteza impso ndi chiwindi. Njira zabwino kwambiri zothandizira odwala ndi captopril, verapamil, valsartan. Beta-blockers sayenera kumwedwa, chifukwa amathandizira kupititsa patsogolo shuga.
Odwala omwe ali ndi matenda ashuga angiopathy amawonetsedwa akutenga ma statins, michere, komanso mankhwala omwe amasintha kagayidwe ka mafuta. Pofuna kukhalabe ndi shuga m'magazi, ndikofunikira kutenga glycidone, repaglimid. Ngati matenda a shuga akupita patsogolo, odwala ayenera kusinthana ndi insulin.

A shuga angiopathy amafuna kuwunika pafupipafupi kuchuluka kwa shuga, mafuta kagayidwe ndi mtima. Pamene necrosis ya minofu ya miyendo imagwiritsidwa ntchito, ntchito zowachotsa zimachitika.Pankhani yolephera kupweteka kwa impso, njira yokhayo yotalikitsa moyo wa wodwalayo ndi impso "yopanga". Ndi kufinya kwam'mbuyo chifukwa cha matenda a shuga, angafunikire opaleshoni.

Kwa odwala omwe ali ndi matenda ashuga, Zizindikiro za matenda a shuga angiopathy nthawi zambiri zimawonetsedwa ngati zotengera zazing'ono zimakhudzidwa. A shuga angiopathy a m'munsi malekezero ambiri amapezeka, pomwe zovuta za mtundu uwu zimapezeka mwa odwala matenda ashuga a mtundu 1 kapena mtundu 2. Ngati mankhwalawa opaleshoni kapena yothandiza odwala matenda ashuga sangachitike pa nthawi yake, zovuta zina zowonongeka ziwalo zambiri zimatheka.

Matenda amtundu wanji?

Diabetes angiopathy imadziwika ndi kuwonongeka kwa ziwiya zazing'ono komanso zazikulu ndi mitsempha. Khodi yamatenda a MBK 10 ndi E10.5 ndi E11.5. Monga lamulo, matenda am'magazi a shuga amadziwika, koma kuwonongeka kwa ziwalo zina zamthupi ndi ziwalo zamkati ndizothekanso. Ndichizolowezi kugawa mitundu ya matenda ashuga m'mitundu iwiri:

• Microangiopathy. Amadziwika ndi kugonjetsedwa kwa capillaries.
• Macroangiopathy Zilonda zam'mimba ndi venous zimadziwika. Fomuyi siyachilendo, ndipo imakhudza anthu odwala matenda ashuga omwe akhala akudwala kwa zaka 10 kapena kuposerapo.

Nthawi zambiri, chifukwa cha matenda a shuga a shuga, kuchuluka kwa odwala kumakulirakulira komanso chiyembekezo cha moyo chimachepa.

Zomwe zimayambitsa matenda a shuga a shuga

Chifukwa chachikulu chomwe chitukuko cha matenda a shuga chimakhalira nthawi zambiri chimakweza shuga. Zotsatirazi zimadziwika zomwe zikutsogolera kukula kwa matenda ashuga angiopathy:

• yaitali hyperglycemia,
• kuchuluka kwa insulin m'madzi,
• pamaso pa insulin kukana,
• matenda ashuga nephropathy, pomwe aimpso kukanika kumachitika.

Zowopsa

Si onse odwala matenda ashuga omwe ali ndi vuto lotere, pamakhala zovuta zomwe zimapangitsa chiwopsezo cha minofu kuwonongeka.

• yaitali matenda a shuga,
• gulu lazaka zopitilira 50,
• njira yolakwika ya moyo
• kuperewera kwa zakudya m'thupi, kuphatikiza mafuta ndi nyama yokazinga,
• Kuchepetsa kagayidwe kachakudya,
• kunenepa kwambiri
• kumwa kwambiri mowa ndi ndudu,
• ochepa matenda oopsa
• kusintha kwa mtima,
• chibadwa.

Zida zachivalo

Ndikosavuta kuneneratu za matenda ashuga a shuga. Nthawi zambiri angiopathy am'munsi amadziwika, popeza amadzaza ndi matenda ashuga. Koma zotupa, zowonongeka, zowononga zina za thupi zimatha. Ziwalo zomwe zikuyembekezeredwa zimasiyanitsidwa, zomwe nthawi zambiri kuposa zomwe anthu ena amadwala ndi angiopathy:

Zizindikiro zamatsenga

Kuthamanga kwa matenda ashuga angiopathy sikuwonetsa zizindikiro zilizonse zapadera, ndipo munthu sangadziwe matendawa. Monga kupita patsogolo kumadziwonetsera, zizindikiro zingapo za pathological zomwe ndizovuta kuzindikira. Mawonetseredwe azizindikiro amatengera mtundu ndi gawo la zotupa za mtima. Gome limawonetsa magawo akuluakulu a matendawa ndi mawonekedwe awonekera.

Chithandizo cha matenda a mtima

Pa matenda ashuga angiopathy, chithandizo chovuta ndichofunikira, chomwe chimaphatikizapo kumwa mankhwala a magulu osiyanasiyana ndikuwonetsetsa kuti kudya zakudya zopatsa thanzi komanso njira zina. Musanachiritse matenda, muyenera kusiya zakumwa zoledzeretsa ndi mankhwala osokoneza bongo omwe amakhudza ziwiya. Mankhwala a shuga angiopathy amwa mankhwala otsatirawa:

• Kutsitsa shuga:
  • Siofor
  • Diabetes
  • Glucophage.
• Mankhwala ochepetsa cholesterster:
  • Lovastatin
  • "Simvastatin."
• Zoponda magazi:
  • Trombone,
  • Ticlopidine
  • Warfarin
  • Clexane.
• Njira zomwe zimathandizira kutsika kwa magazi ndi kukoka kwa magazi:
  • Tivortin
  • Ilomedin
  • "Pestazolum".

Ibuprofen amalembera ululu womwe umasautsa wodwalayo.

Kuphatikiza apo, adotolo adzavomereza chithandizo cha vitamini E kapena nicotinic acid. Ngati wodwalayo akuda nkhawa ndi kupweteka kwambiri mu matenda ashuga a shuga, ndiye kuti ophatikizana amasonyezedwa: Ibuprofen, Ketorolac. Ngati chotupa chachiwiri chathandizira, ndiye kuti mankhwala a antibacterial awonetsedwa: Ciprinol, Ceftriaxone.

Odwala ambiri omwe ali ndi matenda ashuga ali ndi matenda ambiri omwe amawonjezera mkhalidwe wawo, omwe amakhudza ziwalo zonse zamagazi ndi mitsempha yamagazi. Chimodzi mwazodwala zimadziwika. Chofunika chake chimakhala chakuti mitsempha yonse yamagazi imawonongeka. Ngati ziwiya zochepa zokha zowonongeka, ndiye kuti ndi diabetesic microangiopathy. Mowona ngati mitsempha yayikulu yokha idakhudzidwa pakasokonekera kwamitsempha yamagazi, ichi ndi matenda a shuga a macroangiopathy. Kuwonongeka kotereku sikuli vuto lokhalo la wodwala. Kuphatikiza apo, ndi angiopathy, homeostasis imalephera.

Zomwe zimachitika mu diabetesic microangiopathy

Ngati tilingalira zazikulu za microangiopathy, ndiye kuti pali zinthu zitatu zomwe zimatchedwa Virchow-Sinako triad.

Zizindikiro izi ndi izi:

1. Njira yomwe makoma amitsempha yamagazi amasinthira.
2. Njira yomwe magazi amapangidwira.
3. Kutsika magazi. Chifukwa cha kuchuluka kwa kupatsidwa zinthu za m'magazi komanso kuchuluka kachulukidwe, magazi amathanso kukhala owoneka bwino. Kuphatikiza apo, ndimayenda moyenera wamagazi ndi ntchito ya mtima, makhoma a zotengera ali ndi mafuta apadera omwe samalola magazi kuwamatira. Kuphwanya kapangidwe ka makoma amitsempha yamagazi kumatha kuyambitsa mavuto popanga mafuta awa.

Zinthu zonse zomwe zaperekedwa zimatsogolera kuti sikuti ziwiya zokha ndizowonongeka, komanso microtrombi amawonekera.

Kusintha koteroko pakukonzekera matendawa kumayamba kukhudza ziwiya zambiri. Nthawi zambiri, gawo lalikulu la zotupa ndi maso, impso, myocardium, khungu, zotupa zamanjenje. Njira izi zimabweretsa kukula kwa mtima, nephropathy, neuropathy, dermatopathy ndi zovuta zina. Zizindikiro zoyambirira ndikusokonezeka m'mitsempha yamagazi yam'munsi. Izi zimachitika mu milandu pafupifupi 65%.

Asayansi ena azachipatala amakonda kuganiza kuti microangiopathy siyenera kusiyanitsidwa ndi matenda enaake ndipo ndi chizindikiro cha matenda ashuga. Kuphatikiza apo, amakhulupirira kuti matendawa asanafike, neuropathy imayamba kuwonekera, yomwe imayambitsa microangiopathy. Asayansi ena amakhulupirira kuti ndi mitsempha ya mitsempha yomwe imayambitsa mitsempha ndipo izi sizimayenderana ndi kuwonongeka kwa mitsempha yamagazi. Mu lingaliro ili, neuropathy ndi chifukwa cha matenda a shuga, omwe sagwirizana ndi njira zoyambitsidwa ndi microangiopathy. Gulu lachitatu la asayansi likutsimikizira kuti ngati ntchito ya mitsempha yasokonekera, ndiye kuti mitsempha yamagazi imayamba kugwira ntchito bwino.

Mitundu yotsatirayi ya diangiicathyangiopathy imasiyanitsidwa molingana ndi kuwonongeka kwa malekezero otsika:

1. Mulingo wa Zero pomwe palibe kuwonongeka kwa khungu la munthu.
2. Gawo loyamba, pakakhala zolakwika zina pakhungu, koma zimasanjidwa pang'onopang'ono ndipo sizikhala ndi njira yotupa.
3. Mulingo wachiwiri, pomwe zotupa zakuya pakhungu zimapangika. Nawonso amatha kuzama mpaka kuwononga mafupa ndi ma tendon.
4. Gawo lachitatu, pomwe pali zilonda pakhungu ndi chiyambi cha kufa kwa minofu kumapeto. Mavuto oterewa amatha kuchitika limodzi ndi matenda, kutupa, njira ya edema, ma abscesses, hyperemia ndi osteomyelitis.
5. Mulingo wachinayi wa matendawa ndi pamene phula limodzi ndi zala zingapo zimayamba. Njirayi imayamba osati kuchokera zala, koma kuchokera kumbali ya phazi.
6. Gawo lachisanu la matendawa, pomwe gangrene amakhudza kwambiri phazi kapena phazi lonse kwathunthu.

Zomwe zimachitika popanga matenda ashuga a macroangiopathy

Matenda a shuga a macroangiopathy ndi omwe amachititsa kwambiri odwala omwe ali ndi matenda a shuga. Nthawi zambiri, zovuta monga macroangiopathy zimachitika mwa odwala. Choyamba, mitsempha yayikulu yamagazi yam'munsi imakhudzidwa. Choyamba, mitsempha ya m'magazi ndi coronary imakhudzidwa. Matenda oterewa amatha kuyamba pamene njira yowonjezera kukula kwa atherosulinosis ikuyamba.

Magawo angapo a chitukuko cha macroangiopathy amatha kusiyanitsidwa. Choyamba, kusuntha pang'ono m'mawa, kukhathamira, kugona komanso kufooka, kumva kuzizira m'miyendo, thukuta lomwe lidawonjezeka ndipo matupi ake ena akuwoneka. Izi ndi zizindikiro za kubwezeretsedwa mu kufalikira kwaziphuphu. Kenako pakubwera gawo lachiwiri, pamene munthu amatha kumasuka kwambiri, miyendo yake imatha, nkhope ya misomayo idasweka. Ziphuphu zitha kuwonekera paziwopsezozi. Kenako kupweteka kumatha kuchitika mukamayenda komanso kukhazikika. Kutembenuka kumawonekera, khungu limasanduka lotumbululuka ndikuchepera. Mafupa amasokonezeka. Pa gawo lotsiriza, gangrene amakula kumapazi, zala ndi mwendo wotsika.

Chithandizo cha angiopathy mu shuga

Ndi matenda a shuga a shuga- komanso macroangiopathy, mfundo zamankhwala ndizofanana. Choyamba, ndikofunikira kubweretsa njira za metabolic munthawi yathanzi. Ndikofunikira kwambiri kubwezeretsa kagayidwe kazakudya, chifukwa ndi hyperglycemia yomwe ingakhudze kukula kwa atherosulinosis.

Mfundo yachiwiri yothandizira mankhwalawa ndikuwongolera kwa deta yonse ya metabolid ya lipid. Ngati kuchuluka kwa lipoproteins kwachuluka, komwe kumakhala ndi mawonekedwe otsika kwambiri, ndipo mulingo wa triglycerides umachepa, ndiye kuti mankhwala omwe ali ndi mankhwala a hypolipidemic ayenera kugwiritsidwa ntchito pochiza. Izi zimaphatikizapo ma antioxidants, ma fibrate, ndi ma statin.

Pa mankhwalawa macro- ndi microangiopathy mu shuga mellitus, mankhwala omwe ali ndi metabolic zotsatira amagwiritsidwa ntchito. Mankhwalawa amaphatikizapo trimetazidine. Mankhwala osokoneza bongo amtunduwu amatha kuthandizira kukonzekera kwa glucose oxidation mu myocardium. Izi zimachitika chifukwa cha makutidwe ndi okosijeni amafuta acids.

Pa mankhwalawa a micro- and macroangiopathy mu shuga mellitus, mankhwala oterewa amakonzedwa kuti amalimbikitse kuyambiranso kwa magazi m'magazi ndi kufooketsa magawo a magazi othandiza magazi kuundana. Izi ndizofunikira kuti magazi asakhale akuthina kwambiri pakukhazikika kwake ndipo samapanga kutsekeka kwamitsempha yamagazi. Mankhwalawa akuphatikiza ticlide, acetylsalicylic acid, heparin, dipyridamole, vazaprostan ndi ena ambiri.

M'pofunikanso kugwiritsa ntchito mankhwala omwe amatha kuchepetsa magazi. Ngati zili zabwinobwino, ndiye kuti kuyang'anira ndi kuwunikira chizindikirochi ndikofunikira. Mulingo woyenera kwambiri mu izi mudzawerengedwa kuti ndi 130 mpaka 85 mm RT. Art. Kusamala kotereku kumathandizira kupewa kukula kwa retinopathy ndi nephropathy. Komanso, izi zithandiza kuti musakhale pachiwopsezo cha matenda a mtima kapena sitiroko. Mwa mankhwala omwe amathandizira pakukakamiza kwa kupanikizika, ma inhibitors, othandizira calcium calcium ndi ena amadziwika.

»» No. 9-10 "99" »New Medical Encyclopedia

• Zinakhazikitsidwa kuti pathogenesis yam'mimba (android) ya kunenepa kwambiri, yophatikizidwa ndi hyperglycemia, insulini (IR) ndi hyperinsulinemia (GI), imayamba chifukwa chakuchepa kwa kugonana kwa steroid-binding globulin, kuwonjezeka kwa zochitika za androgens, zomwe zimatsogolera kukula kwa adipocytes ndi kukana kwawo insulin.
• Matenda oopsa a arterial (omwe amawonetsedwa mu 40-60% ya odwala omwe ali ndi matenda ashuga) amatsogolera pakukula kwa matenda a shuga, omwe amachititsa kuti ziwopsezo za kuchotsedwa kwa zigawo za atherogenic za lipoproteins zikulimbikitse atherosulinosis.
• Kugwiritsira ntchito kwakanthawi mankhwala ena a antihypertensive kungakhale ndi vuto pa metabolidi ya lipid ndi carbohydrate.
• Odwala omwe ali ndi matenda ashuga, hypertriglyceridemia ndi kuchepa kwa matenda osachulukitsa lipoproteins (HDL) zimayang'aniridwa, chomwe ndichinthu champhamvu kwambiri komanso chodziimira palokha cha mtima.
• Anthu odwala matenda ashuga macroangiopathies (MA) malinga ndi kutchukitsa komanso mawonetsedwe azachipatala amagawidwa m'magulu otsatirawa:
  • zotupa za mtima (matenda a mtima, matenda amitsempha yamagazi),
  • matenda amitsempha yamagazi
  • zotupa za zotumphukira mitsempha, kuphatikiza malekezero ena (gangrene).
• Pafupipafupi kukula kwa MA odwala odwala matenda ashuga ndi kawiri kawiri kuposa anthu omwe ali ndi vuto la metabolism.
• Raven (Reaven) kwa nthawi yoyamba anazindikira kuphatikiza kwapafupipafupi kwa hyperinsulinemia, kufooka kwa android, matenda oopsa, hypertriglyceridemia mwa odwala omwe ali ndi vuto la kuwonongeka kwa chakudya chambiri. Kuphatikiza kwa izi kumatchedwa metabolic syndrome "X".
• The pafupipafupi chitukuko cha matenda a mtima kwa amuna omwe ali ndi matenda ashuga nthawi 2, ndipo mwa akazi - 3 kuchulukitsa kuposa pafupipafupi matenda a mtima ochepa mwa anthu osavulala kagayidwe kazakudya.
• Kufa kwa odwala omwe ali ndi matenda ashuga a m'matumbo a mtima osakwana zaka 55 ndi 35%.
• Pafupifupi theka la zovuta zonse zopanda thupi zomwe zimadulidwa mwendo zimachitika mwa odwala matenda ashuga.

Chiwembu. Zinthu zomwe zimabweretsa kukula kwa macroangiopathies mwa odwala matenda a shuga

Anthu odwala matenda ashuga macroangiopathies (MA) ndi njira yodziwika bwino kwa odwala matenda ashuga mellitus (DM), chifukwa chachikulu cha kufa kwawo ndi kulumala. Pakadali pano, gulu la zovuta limatchedwa "matenda ashuga a macrovascular."

Etiology ndi pathogenesis

Chiwopsezo chowonjezeka cha kukhala ndi matenda amtima mwa odwala matenda a shuga ndichifukwa cha zifukwa zingapo. Nthawi zambiri amagawidwa osakhala eni ake - ochepa matenda oopsa (AH), kunenepa kwambiri, kusuta, kusagwira ntchito, hyperlipidemia ndi cholowa - ndi zina zotchulidwa - matenda a hyperglycemia, hyperinsulinemia, kusintha kwa maselo ena amitsempha yamagazi ndi maselo arteryonics, microalbuminuria ndi kuphwanya kwa kusintha kwa maselo. Mwachidziwikire, kulumikizana kwa zinthu m'magulu onsewa kumathandizira kwambiri kukulitsa kwa atherosulinosis, yomwe ndi gawo laling'ono la MA.

Njira zopangira pathogenetic zomwe zimayambitsa kukula kwa MA sizimamveka bwino.

Matenda a hyperglycemia (onani tchati) amawoneka kuti ndi wofunikira kwambiri pakapangidwe ka angiopathies. Hyperglycemia imadziwika kuti imapangitsa kuti mapuloteni osapanga enzymatic apangidwe apangidwe apakati omwe amatchedwa mankhwala a Amadori. Pambuyo pake, mankhwala a Amadori amasintha pang'onopang'ono komanso osasinthika kukhala mankhwala osakanikirana omwe amapezeka mu minyewa yolumikizira yamitsempha yamagazi, gawo la phospholipid la LDL komanso ngati gawo lakumeza lokwanira. Pankhaniyi, ma radicals aulere amapangidwa omwe amakhala ndi zochita zamphamvu zamankhwala opha. Zonsezi zimabweretsa kuwonjezeka kwa permeability ndi kuchepa kwa mtima wamankhwala, kusintha kwa ntchito ya michere ndi lipoprotein metabolism. Glycosylated LDL imaphatikizidwa mosavuta komanso imakhala ndi mgwirizano waukulu wama macrophages, omwe amatsogolera pakupanga "cell foamy", omwe ndiye chinthu chachikulu cha atherogenesis.

Dongosolo la coagulation la magazi limasokonezedwanso, lomwe limadziwonetsera pakuwonjezeka kwa ntchito ya kupatsidwa zinthu za m'magazi, hyperfibrinemia ndi kuwonjezeka kwa zinthu V, VII, VIII, ndi ntchito ya magazi ya fibrinolytic imachepa. Kuyesa pakati pa chiyezo cha vasodilators (NO, PG12) ndi vasoconstrictors (TxA2) kumakwiyitsidwa kwambiri. Njira zomwe zalembedwazo zimatsogolera pakupanga kwa microthrombi, zomwe zimayambitsa kusokonezeka kwa microcirculation ndi ochepa occlusion.

Zojambula pachipatala

Kuwonongeka kwa ziwalo zam'mimba, ziwindi ndi zotumphukira mu odwala omwe ali ndi matenda osokoneza bongo kumayambitsa matenda a kutengera kwofananira.

Matenda a mtima a Coronary (CHD) ndiwomwe amatsogolera omwe amafa odwala matenda ashuga. Mawonetsedwe azachipatala a matenda a mtima mu shuga ali ndi mawonekedwe awo:

• zomwezi zimayambitsa matenda amtima wam'mimba mwa amuna ndi akazi,
• zochitika zochulukirapo za mitundu ya "atypical" ya IHD (yopweteka, yaukadaulo ndi mitundu ina) ndikuyambitsa matenda obwera chifukwa, chifukwa chake, ngozi yayikulu ya "kufa mwadzidzidzi"
• kuchuluka kwa mavuto obwera pambuyo pa infarction: kugunda kwa mtima, kusokonezeka kwa maselo, mapangidwe acute, matenda amimba, komanso kusokonekera kwa mtima, kusokonekera kwa mtima,
• chiopsezo chobwera mobwerezabwereza myocardial infaration,
• kuwonjezeka kwa 2 pawiri kwa kufa kwa myocardial infarction poyerekeza ndi odwala omwe alibe matenda a shuga.

Matenda a coronary artery amawonedwa 40-50% ya odwala omwe ali ndi NIDDM ndipo nthawi zambiri amakhala mwa odwala IDDM. Nthawi zambiri, odwala matenda ashuga, ischemic ubongo infarction amawonedwa. Udindo wofunika kwambiri pakupezeka kwa zovuta m'matumbo am'mimba umaperekedwa kwa ochepa matenda oopsa komanso microalbuminuria. Mwa odwala, chiopsezo chokhala ndi stroko chikuwonjezeka ndi katatu.

Kugonjetsedwa kwa ziwiya zotumphukira zam'munsi zam'mphepete ndikuwonetsa pafupipafupi komanso kwa shuga, komwe kumawonekera mwa kusintha kwa phokoso ndi phokoso la ischemic. Nthawi zambiri kulumikizana pakati pa amuna omwe ali ndi matenda ashuga kumawonjezeka kanayi, ndipo kwa akazi kumakhala kochulukirapo kuposa kasanu ndi kawiri. Kutsekeka kwa mitsempha yam'munsi yakumapeto kumayambitsa kupweteketsa ng'ombe, m'chiuno, ndipo nthawi zina matako, kupweteketsedwa ndi kulimbitsa thupi. Ndi kuphwanya kwamphamvu magazi, necrosis ya minofu ya miyendo ndi miyendo imatha kuchitika, yomwe imatsogolera kukukula kwa gangrene. Mavuto ochepa otaya magazi amaphatikizidwa ndi matenda ashuga a m'mimba komanso matenda, omwe amachititsa zilonda zam'mimba, zomwe zimapangitsa kuti mafupa awonongeke.

Gome 3. Kusankha kwa mankhwala kuti akonzeke dyslipidemia mwa odwala matenda a shuga

Njira zofunikira popewa Ma:

Kuchepetsa kumwa,

Kuchepetsa thupi kwa anthu onenepa kwambiri,

Zochita zolimbitsa thupi pafupipafupi,

Njira zochizira mankhwalawa ziyenera kukhala ndi cholinga chowonetsetsa kuti chiwongolero cha matenda a glycemic chikonzedwe, kukonza kwa matenda oopsa, komanso kuchiza matenda a dyslipidemia (Gome 1). Mosakayikira mfundo yofunika ndi kukonza kwa hyperglycemia. Pali umboni wa zotsatira zabwino za sulfonylurea kukonzekera kwa lipid metabolism ndi zigawo zamagazi. Biguanides ndi mankhwala osankha kwa odwala onenepa kwambiri omwe ali ndi NIDDM. Kumwa kwa mankhwalawa kumayendetsedwa ndi kuchepa thupi, kuchepa kwa insulini komanso kuwonjezeka kwa ntchito ya fibrolytic ya magazi. Kukonzekera kwa Acarbose kumagwiritsidwa ntchito kwambiri kukonza postprandial hyperglycemia, komanso kuchepetsa triglycerides. Kuphatikiza mankhwala ndi sulfanylurea ndi kukonzekera kwa insulin kungakhale ndi zotsatira zabwino za metabolic, kukonza mbiri ya lipid. Komabe, osavomerezeka kugwiritsa ntchito kwambiri Mlingo wa insulin mwa odwala omwe ali ndi NIDDM, chifukwa izi zimatha kuyambitsa hyperinsulinemia komanso kuwonjezera magazi atherogenicity. Chithandizo cha matenda oopsa ndichofunikira popewa MA. Kuwongolera matenda oopsa kuyenera kuyamba ndi kuwonjezeka kwa kuthamanga kwa magazi pamwamba pa 140/90 mm RT. Art. Mankhwala osagwirizana ndi ma metabolism amasankhidwa - ACE inhibitors, calcium blockers blockers, kusankha beta blockers. Kugwiritsa ntchito thiazide diuretics komanso osagwiritsa ntchito beta-blockers kuyenera kukhala ochepa chifukwa chotsatira mphamvu ya glucose ndi lipid metabolism. Odwala omwe ali ndi zotumphukira matenda ali osavomerezeka kuti apereke kusankha kwa beta-blockers.

Ngati kukonza kwa dyslipidemia sikukwaniritsidwa ndikuwona moyo wathanzi, chakudya (Gome 2), kayendetsedwe ka glycemic ndi kuthamanga kwa magazi, ndiye kuti chithandizo cha mankhwala ndikofunikira.

Cholinga cha kutsitsa kwa lipid kumadalira mtundu wa dyslipidemia (Table 3). Ndi kuwonjezeka kwa cholesterol yathunthu ndi VLDL cholesterol, HMG-CoA reductase inhibitors (statins) kapena ma resini ndi omwe amapatsidwa. Omwe amapanga asidi a bile samagwiritsidwa ntchito pafupipafupi, chifukwa amatha kuyambitsa kuchuluka kwa triglycerides. Mu hypertriglyceridemia yokhayokha, michere ndi michere ya nicotinic acid ndi mankhwala. Omalizirawa amatha kukulitsa kuchuluka kwa glycemia, komwe kumafuna kuyang'anitsitsa shuga m'magazi oyambira chithandizo. Zoyembekeza zazikulu pa chithandizo cha dyslipidemia zimagwirizanitsidwa ndi mankhwala atsopano kuchokera ku gulu la fibrate - gemfibrozil. Kuphatikiza pa kuchepa kwa lipid, mankhwalawa amachepetsa kukananso kwa insulin, komwe ndikofunikira kwa odwala omwe ali ndi NIDDM.

Mosakayikira, mankhwala omwe amasintha magazi a mitsempha, mwachitsanzo, Instenon, vinpocetine, ndi ena, ndi othandiza kwambiri popewa komanso kuchiza matenda amitsempha yamagazi a m'mitsempha. Zolimbikitsa kwambiri ndikugwiritsa ntchito instenon. Mankhwalawa ali osangalatsa ndi kuphatikiza kopambana kwa ma vasoactive ndi ma neurotrophic othandizira omwe angakhudze mawonekedwe osiyanasiyana a pathogenesis a hypoxic ndi kuwonongeka kwa ubongo wa ischemic, kuthamangitsa njira za metabolic mu minyewa yamanjenje, komanso, osadalilika, kudzera machitidwe ena ndi ziwalo (mapapu, mtima, impso, ndi zina), moyenera pa magwiridwe antchito amanjenje. Zida za Instenon zimakhala ndi mphamvu yolimbikitsira ma neuron amachitidwe ndi machitidwe ena a ubongo, kusintha masinthidwe amtundu wa ischemic, kutsekereza vasoconstriction wa intracranial arterioles ndi capillaries, amathandizira kwambiri machitidwe a antiperoxidant a thupi, omwe amachititsa kuchepa kwa kugwiritsidwa ntchito kwa lipid peroxidation product, kuwonjezera anaerobic glycol ndi okosijeni ku mitsempha. Pomaliza, ziyenera kudziwidwa kuti njira zodzitchinjiriza zomwe zimapangidwa kuti muchepetse ziwopsezo za macroangiopathies zimagwira ntchito yofunika kwambiri poletsa kukula kwa vuto la mtima.

Boris Vladimirovich Romashevsky - Dipatimenti Yachithandizo cha Advanced Medical Study, Russian Medical Academy, St. Petersburg

Matenda a shuga ndi kupsinjika kudzakhala chinthu chakale

Matenda a shuga ndi omwe amayambitsa pafupifupi 80% yonse yamikwingwirima ndi kuduladula. Anthu 7 mwa anthu 10 amafa chifukwa cha mitsempha ya mtima kapena ubongo. Pafupifupi nthawi zonse, chifukwa chomaliza chomaliza ndi chimodzimodzi - shuga wamwazi.

Shuga akhoza ndipo amayenera kugwetsedwa, apo ayi. Koma izi sizichiritsa matendawa, koma zimangothandiza kulimbana ndi kufufuza, osati zomwe zimayambitsa matendawa.

Mankhwala okhawo omwe amavomerezeka pamankhwala othandizira odwala matenda ashuga komanso amagwiritsidwa ntchito ndi ma endocrinologists pantchito yawo ndi awa.

Kugwiritsa ntchito bwino kwa mankhwalawa, kuwerengera malinga ndi njira yokhazikika (kuchuluka kwa odwala omwe achiwonjezere kuchuluka kwa odwala omwe ali pagulu la anthu 100 omwe adachitiridwa chithandizo):

• Matenda a shuga - 95%
• Kuthetsa kwa mitsempha thrombosis - 70%
• Kuthetsa kwa kugunda kwamtima kwamphamvu - 90%
• Kuthana ndi kuthamanga kwa magazi - 92%
• Kulimbitsa tsiku, kukonza kugona usiku - 97%

Opanga si bungwe lazamalonda ndipo amalipidwa ndi chithandizo cha boma. Chifukwa chake, tsopano wokhala aliyense ali ndi mwayi.

Khoma lamkati la ziwiya limalumikizana ndi magazi. Imayimira maselo a endothelial omwe amaphimba pansi lonse limodzi. Endothelium imakhala ndi oyimira pakati komanso mapuloteni omwe amalimbikitsa kapena kuletsa magazi kuundana. Imagwiranso ntchito ngati chotchinga - imadutsa madzi, mamolekyulu ochepera 3 nm, mosankha zinthu zina. Njirayi imapereka kutuluka kwa madzi ndi chakudya m'thupi, ndikuyeretsa zinthu za metabolic.

Ndi angiopathy, ndiye endothelium yomwe imavutika kwambiri, ntchito zake ndizodwala. Ngati matenda a shuga samayang'aniridwa, shuga wambiri amayamba kuwononga maselo a mtima. Kusintha kwachilengedwe kwapadera kumachitika pakati pa mapuloteni a endothelial ndi shuga wa magazi - glycation. Zochita za kagayidwe kakang'ono ka glucose zimayamba kudziunjikira m'makoma amitsempha yamagazi, amayamba kuzikika, kutupa, kusiya kugwira ntchito ngati cholepheretsa. Chifukwa chophwanya njira zosakanikira, ma magazi amayamba kupanga, chifukwa - m'mimba mwake mumachepa ndipo kayendedwe ka magazi kamachepa mkati mwake, mtima umayenera kugwira ntchito ndi katundu wowonjezereka, kuthamanga kwa magazi kumakwera.

Zombo zazing'onoting'ono kwambiri ndizowonongeka kwambiri, kusokonezeka kwazinthu mkati mwake kumabweretsa kutsekeka kwa mpweya ndi zakudya m'thupi lathu. Ngati madera omwe ali ndi vuto lalikulu la angiopathy mu nthawi yake palibe omwe atha kusintha ma capillaries omwe awonongedwa ndi atsopano, zimakhalazi zimalira. Kuperewera kwa mpweya kumalepheretsa kukula kwamitsempha yatsopano yamagazi ndikuthamanga kuchuluka kwa minofu yolumikizika yowonongeka.

Njira izi ndizowopsa m'm impso ndi maso, magwiridwe antchito awo amakhala opuwala mpaka kuwonongeka konse kwa ntchito zawo.

A shuga angiopathy a ziwiya zazikulu nthawi zambiri limodzi ndi atherosulinotic njira. Chifukwa cha kuperewera kwa mafuta m'thupi, ma cholesterol cholembera amayikidwa pamakoma, kuwonda kwa ziwiya kumachepa.

Zokhudza chitukuko cha matenda

Angiopathy imayamba mwa odwala omwe ali ndi mtundu woyamba wa 2 ndi shuga wachiwiri ngati shuga ya m'mwazi imakwezedwa nthawi yayitali. Kutalika kwa msambo ndi kukwera msanga, msanga zisinthidwe zimayamba. Zinthu zina zimangokulitsa matendawa, koma osayambitsa.

Zochitika Zachitukuko cha Angiopathy	Limagwirira a chikoka pa matenda
Kutalika kwa matenda ashuga	Kuchepa kwa angiopathy kumawonjezeka ndi chidziwitso cha matenda ashuga, monga kusintha m'matumbo kumadziunjikira kwakanthawi.
M'badwo	Okalamba akadwala, amatha kutenga matenda a ziwiya zazikulu. Achinyamata odwala matenda ashuga nthawi zambiri amakhala ndi vuto lochepa ziwalo zina.
Matenda a mtima	Matenda ophatikizika amitsempha yamagetsi amawonjezera zovuta za angiopathy ndipo amathandizira kuti ikule kwambiri.
Kupezeka	Miyezo yambiri ya insulin m'magazi imathandizira kupanga mapangidwe pazitseko zamitsempha yamagazi.
Nthawi yocheperako	Kuchulukitsa kwina komwe kumapangitsa magazi kuwundana komanso kupweteka kwa mauna.
Kulemera kwambiri	Mtima umatopa, mulingo wa cholesterol ndi triglycerides m'magazi umakwera, ziwiya zimachepetsedwa mwachangu, ma capillaries omwe ali kutali ndi mtima amapatsidwa magazi kwambiri.
Kuthamanga kwa magazi	Imawonjezera kuwonongeka kwa makoma amitsempha yamagazi.
Kusuta	Zimasokoneza ntchito ya antioxidants, zimachepetsa kuchuluka kwa mpweya m'magazi, zimawonjezera chiopsezo cha atherosulinosis.
Ntchito yoweruka, kugona pakama.	Onse osachita masewera olimbitsa thupi komanso atatopa kwambiri mwendo amathandizira kukulitsa angiopathy m'munsi.

Ndi ziwalo ziti zomwe zimakhudzidwa ndi matenda a shuga

Kutengera ndi zotengera zomwe zimavutika kwambiri chifukwa cha shuga mu shuga yopanda tanthauzo, angiopathy imagawidwa m'mitundu:

1. - akuimira kugonjetsedwa kwa capillaries mu glomeruli impso. Zotengera zoterezi ndi zina mwa zoyambirira kuvutika, chifukwa zimagwira ntchito mokhazikika ndikudutsa magazi ambiri kudzera mwaiwo. Zotsatira zake za kupangika kwa angiopathy, kufooka kwa impso kumachitika: kusefedwa kwa magazi kuchokera ku zinthu za metabolic kumachepa, thupi silimachotsa konse poizoni, mkodzo umachotsedwa pang'onopang'ono, edema, ziwalo zopangika zimapangidwa thupi lonse. Kuopsa kwa matendawa kuli m'kusowa kwa zizindikiritso zake m'magawo oyambawo ndi kuwonongeka kwathunthu kwa impso kumapeto kwake. Nambala yamatenda malinga ndi gulu la ICD-10 ndi 3.
2. A shuga angiopathy a m'munsi malekezero - nthawi zambiri zimayamba chifukwa cha mphamvu ya matenda ashuga pazombo zazing'ono. Mavuto oyenda m'magazi omwe amatsogolera zilonda zam'mimba ndi gangore amatha kukhala ndi zovuta zazing'ono m'mitsempha yayikulu. Zimakhala zodabwitsazi: pali magazi m'miyendo, ndipo minofu ikufa ndi njala, chifukwa ma network a capillary awonongedwa ndipo alibe nthawi yochira chifukwa cha kuchuluka kwa shuga m'magazi. Angiopathy yamtunda wapamwamba imapezeka mu milandu yakutali, popeza manja a munthu amagwira ntchito ndi zochepa mphamvu ndipo amakhala pafupi ndi mtima, chifukwa chake, zotengera mkati mwake sizowonongeka ndikuchira msanga. Khodi ya ICD-10 ndi 10.5, 11.5.
3. - kumabweretsa zowonongeka m'matumbo a retina. Monga nephropathy, ilibe zizindikiro mpaka magawo akuluakulu a matendawa, omwe amafunikira chithandizo chamankhwala odula komanso opaleshoni ya laser ku retina. Zotsatira zakuwonongeka kwa mtima mu retina ndizosawona bwino chifukwa chotupa, mawanga amaso kutsogolo kwa maso chifukwa cha zotupa, kupindika kwa retina kutsatiridwa ndi khungu chifukwa cha kuwonongeka pamalo owonongeka. Angiopathy yoyambirira, yomwe imatha kupezeka muofesi ya ophthalmologist, imachiritsidwa yokha payokha ndikulipira shuga kwa nthawi yayitali. Khodi H0.
4. Matenda a shuga a mtima - imayambitsa angina pectoris (code I20) ndipo ndiyomwe imayambitsa kufa chifukwa cha matenda ashuga. Atherosulinosis yamitsempha yama coronary imayambitsa kuperewera kwa mtima kwa minofu ya mtima, komwe imayankha ndikumakanikiza, kupweteka kowawa. Kuwonongeka kwa ma capillaries ndikuwonjezereka kwa minofu yolumikizana imasokoneza ntchito ya minofu ya mtima, kusokonezeka kwa milomo kumachitika.
5. - kuphwanya magazi kupita ku ubongo, pachiwonetsero cha mutu ndi kufooka. Hyperglycemia yotalikirapo, ndichoperewera cha kuperewera kwa okosijeni, ndipo makamaka imakhudzidwa ndi kusintha kwaulere.

Zizindikiro ndi angiopathy

Poyamba, angiopathy ndi asymptomatic. Ngakhale chiwonongeko sichili chinyengo, thupi limatha kukulitsa zombo zatsopano kuti zithetse zina zowonongeka. Poyamba, gawo loyambirira, zovuta za metabolic zitha kutsimikizika pokhapokha kuwonjezera cholesterol m'magazi komanso kuwonjezeka kwa kamvekedwe ka mtima.

Zizindikiro zoyambirira za matenda a shuga a shuga zimachitika pakanthawi kogwira, pamene zotupa zimachulukirachulukira ndipo alibe nthawi yochira. Mankhwalawa omwe adayamba panthawiyi amatha kusintha njirayi ndikuthandiziratu ntchito ya mtima.

• kupweteka kwa mwendo pambuyo pamtolo wautali -,
• dzanzi ndi kumva kuwawa m'miyendo,
• kukokana
• khungu lozizira pamapazi
• mapuloteni mumkodzo mutatha kuchita masewera olimbitsa thupi kapena kupsinjika,
• mawanga ndi mawonekedwe osalala,
• mutu wofooka, osatsitsimutsidwa ndi analgesics.

Zizindikiro zofotokozedwa bwino zimapezeka kumapeto komaliza, organic, gawo la angiopathy. Pakadali pano, kusintha kwa ziwalo zomwe zakhudzidwa kale sikungasinthe, ndipo chithandizo chamankhwala chitha kuchepetsa kukula kwa matendawa.

1. Kupweteka kosalekeza m'miyendo, kuwonda, kuwonongeka pakhungu ndi misomali chifukwa cha kusowa kwa chakudya, kutupa kwa miyendo ndi ana amphongo, kulephera kukhazikika kwakanthawi yayitali ndi angiopathy am'munsi.
2. Mkulu, osagwiritsidwa ntchito pochiza, kuthamanga kwa magazi, kutupa pa nkhope ndi thupi, kuzungulira ziwalo zamkati, kuledzera ndi nephropathy.
3. Kutaya kwamaso kwakumaso ndi retinopathy, chifunga pamaso pa maso chifukwa cha edema yokhudzana ndi matenda a shuga a pakati pa retina.
4. Chizungulire komanso kukomoka chifukwa cha kufinya, kufinya komanso kufupika chifukwa cha kulephera mtima, kupweteka pachifuwa.
5. Kusowa tulo, kusokonezeka kwa kukumbukira ndi kuyendetsa kayendedwe, kuchepa kwa luso la kuzindikira mu angiopathy ya ubongo.

Zizindikiro za zotupa zam'mimba mu miyendo

Zizindikiro	Chifukwa
Paka, khungu lozizira la kumapazi	Kusokonezeka kwa capillary kudakali kothekera
Kufooka kwa minofu ya mwendo	Kusakwanira kwa minofu, kuyambitsa angiopathy
Kufupika pamapazi, khungu lotentha	Kutupa chifukwa cholumikizana ndi matenda
Kuperewera kwa miyendo	Kuchepetsa kwakukulu kwa mitsempha
Yaitali edema	Mitsempha yambiri
Kuchepetsa ng'ombe zazing'ono kapena ntchafu, kuletsa kukula kwa tsitsi pamiyendo	Kutalika kwa mpweya kwa oxygen
Mabala osachiritsa	Zowonjezera zambiri za capillary
Mtundu wakuda zala	Mtima angiopathy
Khungu lozizira lamtambo m'miyendo	Zowonongeka zazikulu, kusayenda kwa magazi, kuyamba gangrene.

Chizindikiro Chokhudza Matenda Aakulu a shuga

Mukamaganizira za zazikulu za microangiopathy, zinthu zitatu zazikulu zimadziwika, zotchedwa Virchow-Sinako triad. Zizindikiro izi ndi ziti?

1. Makoma azombo amayenda.
2. Kuphatikizika kwa magazi kumakhala kusokonekera.
3. Kuthamanga kwa magazi kumachepa.

Zotsatira za kuchuluka kwa ntchito ya magazi a m'magazi komanso kuchuluka kwa magazi, kumayamba kuchepa. Zida zathanzi zimakhala ndi mafuta apadera omwe samalola magazi kutsatira khoma. Izi zimathandizira kutuluka kwamagazi koyenera.

Zida zosokoneza sizitha kutulutsa mafuta awa, ndipo pamakhala kutsika kwa magazi. Zophwanya zonsezi zimangobweretsa kuwonongeka kwa mitsempha yamagazi, komanso mapangidwe a microtubus.

Pakupanga matenda a shuga, mtundu uwu wa kusinthika umaphatikizapo zombo zambiri. Nthawi zambiri gawo lalikulu lowonongeka ndi:

• ziwalo zamasomphenya
• myocardium
• impso
• zotumphukira zamanjenje dongosolo
• khungu mawonekedwe.

Zotsatira za kuphwanya izi, monga lamulo, ndi:

1. mitsempha
2. matenda ashuga nephropathy,
3. mtima
4. dermatopathy.

Koma zizindikiro zoyambirira zimawonekera m'munsi, zomwe zimayambika chifukwa chophwanya mitsempha yamagazi m'derali. Kulembetsa kwamilandu yotere ndi pafupifupi 65%.

Madokotala ena amakonda kunena kuti microangiopathy si matenda osiyana, ndiye kuti ndi chizindikiro cha matenda ashuga. Kuphatikiza apo, amakhulupirira kuti microangiopathy ndi zotsatira za neuropathy, zomwe zimachitika kale.

Asayansi ena amati mitsempha ya m'mimba imayambitsa neuropathy, ndipo izi siziphatikizidwa ndi kuwonongeka kwa mtima. Malinga ndi lingaliro ili, matenda a shuga amachititsa neuropathy, ndipo microangiopathy ilibe kanthu.

Koma palinso lingaliro lachitatu, omwe amatsatira omwe amati kuphwanya kwamanjenje kungathandizire mitsempha ya magazi.

Matenda a shuga a shuga a shuga amagawidwa m'mitundu ingapo, omwe amayamba chifukwa cha kuwonongeka kwakumapeto.

• Ndi zero zero yakuwonongeka khungu pakhungu la munthu kulibe.
• Mulingo woyamba - pali zolakwika zochepa pakhungu, koma sizikhala ndi zotupa ndipo zimangokhala zochepa patokha.
• Pa gawo lachiwiri, zotupa zowonekera kwambiri pakhungu zimawonekera zomwe zimatha kuzama kuti ziwononge tendon ndi mafupa.
• Gawo lachitatu limadziwika ndi zilonda za pakhungu ndi zizindikiro zoyambirira za kufa kwa minofu pamiyendo. Mavuto oterewa amatha kuchitika limodzi ndi njira zotupa, matenda, edema, hyperemia, abscesses ndi osteomyelitis.
• Pa mulingo wachinayi, gulu la chala chimodzi kapena zingapo zimayamba kukula.
• Gawo lachisanu ndi phazi lonse, kapena ambiri amakhudzidwa ndi gangrene.

Makhalidwe a macroangiopathy

Chochititsa chachikulu pakufa kwakukulu kwa odwala omwe ali ndi matenda ashuga ndi matenda ashuga macroangiopathy. Ndi macroangiopathy yomwe nthawi zambiri imapezeka mwa odwala matenda ashuga.

Choyamba, ziwiya zazikulu zam'munsi zimakhudzidwa, chifukwa cha momwe mitsempha yam'mimba komanso matenda ammimba imagwirira ntchito.

Macroangiopathy imatha kukulira njira yowonjezera kukula kwa matenda a atherosulinotic. Matendawa amagawidwa m'magawo angapo chitukuko.

1. Poyamba, m'mawa wodwalayo wawonjezera kutopa, thukuta kwambiri, kufooka, kugona, kumva kuzizira m'miyendo ndi kugona kwawo pang'ono. Izi zimawonetsera kubwezeretsedwa kwa kufalikira kwazungulira.
2. Mu gawo lachiwiri, miyendo ya munthu imayamba kugoneka, amasungika kwambiri, mawonekedwe akumisomali akuyamba kusweka. Nthawi zina lameness amapezeka pamenepa. Ndipo pamakhala kupweteka m'miyendo, poyenda komanso popuma. Khungu limakhala lotuwa komanso loonda. Kusokonezeka kwa ntchito yamalumikizidwe kumawonedwa.
3. Gawo lomaliza ndilopanda matenda a shuga m'miyendo, zala ndi mwendo wotsika.

Kodi kuchitira angiopathy

Macro ndi microangiopathy mu shuga amathandizidwanso chimodzimodzi. Choyambirira chomwe wodwala amayenera kuchita ndikubweretsa njira ya thupi yokhala bwino. Carbohydrate metabolism iyenera kubwezeretsedwa, chifukwa hyperglycemia ndiye chifukwa chachikulu cha chitukuko cha atherosulinosis yamitsempha yamagazi.

Chofunikanso kwambiri pakuthandizira mankhwalawa ndikuwunika momwe metabolidi a lipid amawonongera. Ngati miloproteins yokhala ndi zizindikiro zotsika kwambiri imachulukana mwadzidzidzi, ndipo mulingo wa triglycerides, m'malo mwake, utachepa, izi zikusonyeza kuti ndi nthawi yophatikizira mankhwala a hypolipidic pamankhwala.

Tikulankhula za ma statins, ma fibrate ndi ma antioxidants. Macro- ndi microangiopathy mu matenda osokoneza bongo amachitidwa ndi kukakamizidwa kuphatikiza achire mankhwala a metabolic kanthu, mwachitsanzo, trimetazidine.

Mankhwalawa amathandizira kuti makutidwe ndi okosijeni a glucose mu myocardium, omwe amapezeka chifukwa cha oxidation wamafuta acids. Mankhwalawa onse amtundu wa matendawa, odwala amapatsidwa anticoagulants.

Awa ndimankhwala omwe amathandizira kuthetsa kuundana kwa magazi m'magazi ndikuchepetsa ziwalo zam'magazi akapezeka ndi macroangiopathy.

Chifukwa cha zinthuzi, magazi samakhala osasinthasintha ndipo mikhalidwe yotseka mitsempha yamagazi sinapangidwe. Ma Anticoagulants akuphatikizapo:

• Acetylsalicylic acid.
• Tiklid.
• Vazaprostan.
• Heparin.
• Dipyridamole.

Zofunika! Popeza matenda olembetsa magazi nthawi zambiri amakhala alipo m'matenda a shuga, ndikofunikira kupereka mankhwala omwe amathandizira magazi. Ngati chizindikirochi ndichabwinobwino, chikulimbikitsidwa kuti chizitha kuwunikira nthawi zonse.

Mu shuga mellitus, mulingo woyenera kwambiri ndi 130/85 mm Hg. Njira zowongolera zoterezi zikuthandizira kupewa kukulira kwa nephropathy komanso retinopathy munthawi yake, kuchepetsa kwambiri chiopsezo cha kugwidwa ndi matenda a mtima.

Mwa mankhwalawa, otsutsana ndi calcium njira, othandizira ndi zoletsa zina amadziwika.

Mankhwalawa, ndikofunikira kusintha zizindikiro za autonomic homeostasis. Chifukwa cha izi, madokotala amatipatsa mankhwala omwe amalimbikitsa ntchito ya sorbitol dehydrogenase. Ndikofunikanso kuchita ntchito zomwe zimalimbikitsa chitetezo cha antioxidant.

Inde, ndibwino kupewa matendawa poyamba. Kuti muchite izi, muyenera kukhala ndi moyo wabwino ndikuwunikira thanzi lanu nthawi zonse. Koma ngati zizindikiro za matenda ashuga zikuwonekera, muyenera kufunsa kuchipatala.

Njira zamakono zochizira matenda a shuga ndikuthandizira kupewa zingathandize munthu kupewa zovuta zoyipa monga macro- ndi microangiopathy.