Atherosulinosis pathogeneis magawo

1. Kukula kwa atherogenic dyslipoproteinemia, limodzi ndi mawonekedwe a lipoproteins zosinthidwa, zomwe zimagwidwa kwambiri ndi maselo a endothelial ndikusamutsira kumalo a subendothelial.

2. Kuwonongeka kwa endothelium ndi lipoprotein zosinthika kapena zinthu zina (mavairasi, zovuta za chitetezo, poizoni wa bakiteriya, ndi zina).

3. Kuwonjezeka kwa mtima kupindika komanso kukoka kwa zinthu za m'magazi, kuphatikiza lipoproteins mu intima.

4. Kutsatira kwa mapulateleti ndi ma monocytes kupita ku endothelium, kusunthira kwa monocytes kupita ku intima, kusintha kwawo kukhala ma macrophages ndi kupanga ma cytokines ambiri (interleukin -1, kupatsidwa zinthu za m'magazi, chinthu chotupa, kuwonjezeka kwa maselo komanso kuchuluka kwa maselo.

5. Kusunthira kufalikira ndikukula kwa maselo osalala (HMC) mchikakamizo cha maselo othandiza kukula kwa zinthu za m'magazi otsegulidwa ndi macrophages, endothelium ndi HMC iwo eni, omwe amatenga phenotype yopanga (nthawi zambiri contractile phenotype predominates), amapanga collagen ndi zotanuka ulusi, proteinoglycans, mwachitsanzo. khalani maziko a zolembedwa za atherosulinotic.

6. Kusinthidwa kwina kwa lipoproteins, mapangidwe a ma protein okhala ndi ma proteinoglycans, kugwidwa kwawo ndi ma macrophages, omwe, atatha kugwiritsa ntchito machitidwe ogwiritsira ntchito ndikuchotsa (makamaka lysosomes), amadzaza ndi lipids ndikusandulika ma foamy, kapena xanthoma (kuchokera ku Greek xantos - chikasu). Gawo la maselo a xanthoma limapangidwa kuchokera ku HMCs, yomwe, pokhala ndi ma receptors osinthidwa a β-VLDLPs,

7. Kusintha kwotsatira kwa zolembazo kumalumikizidwa ndi kupangika kwa capillaries mmenemo mothandizidwa ndi kukula, momwe zinthu zina za cell (T ndi B lymphocyte, fibroblasts), necrosis ya zigawo zikuluzikulu za chindapusa, sclerosis, hyalinosis, calcation.

Kusintha kwa chikhalidwe.

Ndi atherosulinosis mu mnofu wa msempha ndi mitsempha, mafupa a minyewa, mafuta-mapuloteni (ather) ndi kufalikira kwa ziwalo zolumikizana (sklerosis) zimawonekera, zomwe zimatsogolera kupanga mapangidwe a atherosulinotic plaque omwe amachepetsa lumen ya chotengera. Mitsempha yamtundu wa zotanuka ndi zotupa zimakhudzidwa, i.e. Mitsempha yayikulu komanso yapakatikati, nthawi zambiri minyewa yaying'ono imakhudzidwa.

Kusintha kwa macroscopic kumawonetsera mphamvu ya njirayi.

1. Malo owaka ndi mafuta - malo amtundu wachikasu kapena wachikasu (mawanga), omwe nthawi zina amaphatikizika ndikupanga mawonekedwe, koma osakwera pamwamba pa intima. Amayamba kuoneka ngati mokhotakhota pachipupa chakumaso ndi pakuchoka kwa nthambi zake, ndipo pambuyo pake m'mitsempha yayikulu.

2. Malo owoneka bwino - ozungulira owoneka kapena oyera opyapyala oyera kapena achikasu oyera omwe amakwera pamwamba pamtunda, nthawi zambiri kuphatikiza ndikupereka mawonekedwe owoneka bwino, atayamba kuchepa kwa thovu. Nthawi zambiri, mapanga amapezeka m'mimba, msempha wamtima, ubongo, impso, miyendo, komanso mitsempha ya carotid. Nthawi zambiri, magawo amitsempha yamagazi omwe amakhala ndi vuto la hemodynamic (makina) amakhudzidwa - mdera la nthambi ndi kupindika kwa mitsempha.

3. Zilonda zovuta.

- mafupa am'mimba okhala ndi zilonda zam'mimba (atheromatous zilonda),

- hemorrhages mu makulidwe a zolengeza (intramural hematoma),

- kapangidwe ka zophatikizika za thrombotic pamalo a ulceration wa zolembazo.

Zilonda zovuta zimalumikizidwa ndi kukhazikika kwa vuto la mtima (mu pachimake thrombosis), embolism ndi ma thrombotic komanso ma atheromatous maselo, mapangidwe a chotengera aneurysm pamalo amodzi a zilceration, komanso magazi am'mimba atagundika ndi khoma la chotengera.

4. Kuchulukitsa (atherocalcinosis) - gawo lomaliza la atherosulinosis, lomwe limadziwika ndi kufotokozeredwa kwa mchere wa calcium m'mazira a fibrous.

Magawo otsatirawa a atherosulinosis morphogeneis amadziwika:

Gawo la dolipid silimatsimikizika kuti limasunthika. Microscopically, focal kuwonongeka (mpaka kuwononga kwathunthu) kwa endothelium ndikuwonjezereka kwa kuchuluka kwa ma membala a intima kumawonedwa, komwe kumabweretsa kuchuluka kwa mapuloteni a plasma, fibrinogen (fibrin) mu membrane wamkati ndi mapangidwe a parietal thrombi, kudzikundikira kwa asidi glycosaminoglycans mkati mwa kuwonekera kwa kutsekeka, kutsekeka kwa mkati. milomo yake ya lipoprotein yotsika kwambiri komanso yotsika kwambiri, cholesterol, mapuloteni, kuwonongeka kwa zotanuka ndi zotupa za collagen, kuchuluka kwa maselo osalala. Kuti muzindikire gawoli, kugwiritsa ntchito utoto wa thiazine ndikofunikira. Mwachitsanzo, chifukwa chakugwiritsa ntchito kupaka utoto wa mankhwalawa ndi toluidine buluu (thionine), mutha kuwona maonekedwe a utoto wofiirira (chodabwitsa cha metachromasia) m'malo omwe amapanga gawo loyambirira la minofu yolumikizana. Gawo la lipoidosis limadziwika ndi kufalikira kwambiri kwa lipids (cholesterol), lipoproteins, komwe kumapangitsa kuti pakhale mawanga am'magazi (lipid) komanso magulu. Macroscopically, mawanga amafuta oterowo amawonekera ngati mawonekedwe amtundu wachikaso womwe nthawi zina amatha kuphatikiza ndikupanga mikwingwirima yopyapyala yomwe singakweze pamwamba paubwenzi. M'malo awa, mukamagwiritsa ntchito utoto ku mafuta, mwachitsanzo, Sudan III, IV, mafuta ofiira a O ndi ena, lipids amapezeka wambiri. Lipids imadziunjikira m'maselo osalala a minofu ndi ma macrophages, omwe amatchedwa ma foamy, kapena xanthoma, maselo (ochokera ku Greek. Hanthos - chikasu). Lipid inclusions imawonekeranso mu endothelium, yomwe imawonetsera kulowetsedwa kwa intima ndi ma plidma lipids. Kutupa ndi chiwonongeko cha zimimba zotanuka zimawonedwa. Choyamba, mawanga am'mafuta ndi mitanda imawonekera mu aorta ndi kumalo komwe nthambi zake zimayambira, kenako m'mitsempha yayikulu. Kuwoneka kwa mawanga sikutanthauza kukhalapo kwa atherosulinosis, popeza kuwoneka kwa mawonedwe a lipid kumatha kuonedwa muubwana, osati mu msempha, komanso m'mitsempha yama mtima. Ndi zaka, ma lipid mawanga, zomwe zimadziwika kuti "zokhudza thupi lipidosis", muzochitika zambiri zimazimiririka ndipo sizoyambitsa kusintha kwina kwa atherosulinotic. Kusintha kofananako kwa mitsempha yamagazi mwa achinyamata kumatha kupezeka ndi matenda ena opatsirana. Ndi liposulinosis, fibroblasts imachulukana, kukula kwake komwe kumalimbikitsa kuwonongeka kwa macrophages (maselo a xanthoma) ndi kukula kwa minofu yolumikizana ndi achinyamata. Pambuyo kusasinthika kwa minofuyi kumayendera limodzi ndi kupangika kwa chosema. Macroscopically, malembedwe amkati ndi owonda, ozungulira kapena owaza, oyera kapena oyera ngati oyera achikuda omwe amakwera pamwamba pamtunda. Kugwiritsa ntchito utoto wapadera kumalola lipids kupezeka m'mafupa am'manja. Zidazi zimachepetsa lumen, yomwe imayendera limodzi ndi kuphwanya kwa magazi (ischemia) kupita ku chiwalo kapena gawo limodzi. Nthawi zambiri, zolembera zam'mimba zimawonedwa m'mimba msempha, munthambi zochokera ku msempha, m'mitsempha ya mtima, ubongo, impso, kutsika kwam'munsi, mitsempha ya carotid, etc. Ndi atheromatosis, milomo ya lipid yomwe ili mkati mwa chigawo ndi pafupi ndi collagen ndi zotanuka ulusi zimasokonekera. Makristali a cholesterol ndi mafuta acids, zidutswa za elastic ndi collagen ulusi, madontho amakanika osagwirizana ndi mafuta (atheromatous detritus) amapezeka mu mawonekedwe abwino amorphous misa. Kuchuluka kwa maselo a xanthoma, ma lymphocyte ndi plasmocytes amapezeka. Mitengo ya atheromatous imachotsedwa kuchokera ku chimbudzi cha chotengera ndi chosanjikiza cha okhazikika, minyewa yokhazikika ya (chosavomerezeka). Kukula kwa kusintha kwamphamvu kwambiri kumabweretsa chiwonongeko cha taye. Nthawi imeneyi imadziwika ndi zovuta zambiri zingapo. Pomwepo pamabwera gawo la zilonda zam'mimba, limodzi ndi mapangidwe a zilonda zapakhomo. M'mphepete mwa zilonda zoterezi ndi zotsekemera, zosagwirizana, pansi zimapangidwa ndi minofu, ndipo nthawi zina mawonekedwe osangalatsa a khoma la chotengera. Chochepa chokwanira chimakonda kuphimbidwa ndi kuphatikizika kwa thrombotic. Zotsatira za necrosis zakuya kwa khoma la chotengera, aneurysm (kutulutsa kwa khoma) ikhoza kupanga. Nthawi zambiri magazi amachoka pachakudya chamkati ndikuwatsuka. Kuopsa kwa zovuta izi kuli mwa kuthekera kwa kupasuka kapena aneurysm, kapena khoma la chotengera pamalo a zilonda za atheromatous. Anthu ophatikizika amatha kutsukidwa ndi mtsinje wamagazi ndikupanga emboli. Atherocalcinosis imadziwika ndi kufalikira kwa mchere wamchere mu malo amkati mwa fibrous, i.e. calcation (kupulumutsidwa). Ili ndiye gawo lomaliza la atherosulinosis. Komabe, ziyenera kukumbukiridwa kuti kuphatikizika kwa mchere wamchere kumatha kuonedwa m'magawo ake oyambirirawo. Mapiri amatenga kachulukidwe kakang'ono, khoma la chotengera pamalo operekera petrity ndi lopunduka kwambiri. Mchere waku calcium umayikidwa mu ma atheromatous masheya, mu minofu ya fibrous, muzinthu zamkati pakati pa ulusi wokulira. Maphunziro azachipatala. Matenda a atherosclerosis ndi matenda obwerezabwereza. Amadziwika ndi kutuluka konga mafunde, komwe kumaphatikizapo kusinthana kwa magawo atatu:

- kukhazikika; - kusinthika kwa njirayi.

Maphunziro osasinthika amakhala ndi zigawo za lipidosis pazosintha zakale - liposulinosis, atheromatosis ndi atherocalcinosis. Pa kukonzanso kwa ndondomekoyi, kugwirizananso pang'ono kwa lipids ndi macrophages ndikotheka.

Mosasamala kanthu za kusintha kwa atherosulinotic, magulu awiri azovuta amasiyanitsidwa: okhazikika komanso owawa.

Mavuto aakulu Chingwe cha atherosulinotic, chimalowerera mu lumen ya chotengera, chimayambitsa kupendekera (stenosis) ya lumen (stenotic atherossteosis). Popeza kupangika kwa zolembera kumayendedwe kumapangika pang'onopang'ono, ischemia yachilendo imapezeka m'dera lamadzi. Matenda osakwanira a mtima amaphatikizidwa ndi hypoxia, dystrophic ndi kusintha kwa atrophic mu chiwalo ndi kuchuluka kwa minofu yolumikizika. Kuchepetsa kwamitsempha pang'onopang'ono mu ziwalo kumabweretsa gawo laling'ono loyambira.

Zovuta zazovuta. Amayamba chifukwa cha kupezeka kwa magazi, emboli, kuphipha kwamitsempha yamagazi. Acute mtima occlusion kumachitika, limodzi ndi pachimake mtima kuperewera (pachimake ischemia), zomwe zimabweretsa kukula kwa matenda a mtima (mwachitsanzo, myocardial infarction, kufewetsa imvi kwa ubongo, ziwalo zam'mimba, zina. Nthawi zina kumatulukiranso kwa aneurysm yam'madzi yowopsa imatha kuonedwa.

Njira za patathogenetic zopanga zolembera

Kuphatikiza kwa hyperlipidemia ndi kuwonongeka kwa mtima kumabweretsa mapangidwe osinthika a cholesterol omwe amakhala ndi mapuloteni, ndikusunthidwa kwawo motsogozedwa ndi mitsempha.

Lipids imagwidwa ndi ma macrophages, omwe amasintha kukhala maselo a xanthomatous, omwe amawonjezeka kwambiri.

Maselo amenewa amatulutsa kukula ndi kusunthika kwa zinthu za m'magazi oyera ndi mapulateleti. Kuphatikiza kwamapulatifomu ndi kuphatikizika, zinthu za thrombotic zimamasulidwa.

Chingwecho chimakula mwachangu, kutsekereza lumen zija chifukwa cha mapangidwe a minofu yolumikizana ndi matayala.

Kuphatikizanso, mothandizidwa ndi kukula, ma capillaries amapangidwa kuti aziwapatsa magazi kwa anthu odziwika kwambiri. Gawo lomaliza la chitukuko ndi necrosis ya pakatikati pa zolembazo, kuperewera kwake ndi kuwerengeka.

Kusintha kwa morphological pakupezeka kwa atherosulinosis kumadziwika ndi kupitilira kwa matendawa, kuyambira ang'ono mpaka akulu.

Gawo loyamba la chitukuko cha atherosulinosis ndi dolipid, lilibe kusintha kwakuthupi kwa morphological. Amadziwika ndi kuwonjezeka kwa permanability kwa mtima khoma, kuphwanya umphumphu wake - woyang'ana kapena wathunthu, thukuta la gawo lamwazi m'magazi a subendothelial space.

Kutupa kwa Mucoid, kudzikundikira kwa fibrin ndi fibrinogen, mapuloteni ena a plasma, lipoproteins otsika ndi cholesterol amapangidwa.

Kuti muwone gawoli, ndikokwanira kugwiritsa ntchito kuwunika kwa mapangidwe a mtima wamankhwala ndikugwiritsa ntchito utoto winawake - thionine ya buluu, momwe mumakhala chodabwitsa cha metachromasia ndikuwunika madera omwe akukhudzidwa ndi utoto.

Gawo lachiwiri - lipoidosis - imadziwika ndi kupezeka kwa cholesterol ndi lipoproteins mwa mawonekedwe amizere yamafuta ndi mawanga achikasu omwe samakwera pamwamba pa gawo la endothelium.

Kusintha kotereku m'magazi a mitsempha yamagazi kumatha kuonedwa ngakhale mwa ana ndi achinyamata, ndipo sikuti kumapita patsogolo. Lipids imayikidwa pansi pa intima muma macrophages, kapena maselo ofunda, ndi maselo osalala amitsempha yamagazi. Ndikothekanso kuzindikira gawoli m'mbiri, kutsika kumachitika ndi Sud 4, 5, mafuta ofiira O.

Popeza kuti atherosulinosis ndi matenda opita pang'onopang'ono, gawoli limatha kukhala nthawi yayitali koma osayambitsa zizindikiro zazikulu zamankhwala.

Zida zazikulu, monga aorta, mitsempha ya m'mimba, ziwiya zaubongo, impso, ndi chiwindi, zimasintha.

Kukula kwazomwe zimachitika zimadalira mawonekedwe a hemodynamics pamasamba obisika a ziwiya, monga kuwongolera kolowera m'mitsempha ya iliac.

Gawo lachitatu la chitukuko cha atherosulinotic plaque ndi liposulinosis - mapangidwe a zotanuka ndi kolala mu endothelium, kuchuluka kwa fibroblasts, magawidwe awo a zinthu ndi kukula kwa minofu yolumikizana.

Fheror wa Atherosulinosis

Chiwopsezo cha atherosulinosis chimadziwika kuti chikuwonjezeka ndi zaka. Kwa amuna, izi ndi zopitilira zaka 40, kwa akazi - zaka 50-55. Ali aang'ono, ma phospholipids omwe amatha kugwiritsidwa ntchito mosavuta, omwe amatha kupezeka mosavuta acid mucopolysaccharides (makamaka hyaluronic acid), scleroproteins (collagen) amapezeka khoma la chotengera m'chiwerengero chachikulu.

Zinthu zonsezi zimatengapo gawo mu kagayidwe, kamene kamapereka khoma lamitsempha komanso kuthekera komanso kuyankha mwachangu kusintha kosiyanasiyana. Ndi zaka, kuchuluka kwa phospholipids amachepetsa, pakati pa asidi mucopolysaccharides, kuchuluka kwa chondroitine sulfates kumawonjezeka, komwe kumapangitsa kuti khoma la chotengera lithe.

Pakati, chromotropic chinthu cha mucoid chimachulukana, kuchuluka kwa ma scleroproteins kumawonjezeka. Collagen amachotsedwa bwino. Kuzindikira kwa endothelium kuzinthu zamakina kumakulitsa, kukulitsa kwa gawo la subendothelial kumawonedwa.

Pazovuta zapamadzi, maselo apadera amtundu wa minofu amawoneka, omwe amadziwika ndi malo a myofibrils pamtunda wa cytoplasm. M'maselo oterowo, mapuloteni ena amaphatikizana.

Kuphatikiza apo, kusintha kwa lipid mbiri yamagazi (dyslipidemia), omwe amawerengedwa ngati gawo lina lowopsa, amayamba kukula nthawi zambiri atakalamba.

Komabe, zomwe zimachitika m'badwo komanso kusintha kwokhudzana ndi kapangidwe kake ndi khoma lake, komanso kusintha kwa milomo ya magazi. Amangodziwonetseratu kukula kwake.

Kudziletsa

Zinthu zamkati zimatha kuyambitsa chitukuko cha atherosulinosis chifukwa cha kusintha kwa chibadwa cha zochita zamunthu zingapo zama enzyme. Makamaka, izi zimatsimikiziridwa ndi kuyesa komwe adayesa kuyambitsa atherosclerosis mu nyama powadyetsa cholesterol yambiri.

Mu makoswe, njirayi yamatumbo siyimakhala, chifukwantchito ya enzymatic ya makoma a zotengera mkati mwake ndi yokwera kwambiri. Akalulu, m'malo mwake, pali cholesterol yochuluka kwambiri pakhoma la mtsempha. Komabe, ziyenera kutsimikiziridwa pano kuti mu nkhani iyi sitikulankhula za atherosulinosis, koma kuphwanya kwa lipid metabolism, zomwe zimapangitsa kuti mafuta azikhala kwambiri.

Chikhalidwe cha chibadwidwe cha atherosulinosis chimatsimikizidwanso ndi kukhalapo kwa matenda monga zofunika monga achibale a xeromatosis), momwe mumakhala kuperewera, chilema chotsimikizika mu chibadwidwe cha ma enzymme system. Pankhaniyi, mamembala angapo am'banja limodzi, kuyambira ubwana, amayamba kukula kwambiri atherosclerosis.

Mwa zina zomwe zitha kupeweka, kusuta fodya (mankhwala osokoneza bongo) kuyenera kuyikidwa pamalo oyamba. Chifukwa chake, ngakhale ndi kumwa mwachikatikati nikotini (mpaka ndudu 15 patsiku), chiopsezo cha kuwonongeka kwa mitsempha ya mitsempha imayamba kuchulukanso kawiri.

Hypodynamia

Kuchita masewera olimbitsa thupi osakwanira, omwe asintha kukhala chimodzi mwazovuta zazikulu zaanthu. M'dziko lamakono, limakhala ngati chiopsezo chokhacho cha atherosulinosis. Kuperewera kwa zolimbitsa thupi kumabweretsa kusintha kwa kagayidwe kachakudya, kuphatikiza ndi metabolidi ya lipid, yomwe imagwira ntchito yofunika kwambiri ya pathogenesis yamatenda.

Kunenepa kwambiri komanso kunenepa kwambiri

Kafukufuku wambiri akuwonetsa kuti atherosclerosis "imayenderana ndi kunenepa kwambiri." Kugwirizana kwa mikhalidwe iwiriyi kukuwonetsedwa ndi mawu otsatirawa: atherosulinosis imatha kukhazikika popanda kunenepa kwambiri, koma palibe kunenepa kwambiri popanda atherosulinosis. Ndi kunenepa kwambiri, mulingo wa triacylglycerides m'magazi nthawi zambiri umakwera.

Kusintha kwina kwa ma lipid sipekitiramu kumawonekera, kumathandizira kukulitsa kwa atherosclerosis. Komabe, ziyenera kudziwidwa kuti kunenepa kwambiri komanso kunenepa kwambiri kumayambitsa kusintha komweko mu metabolid ya lipid pokhapokha atakwanitsa zaka zina.

Matenda a Endocrine

Kuchepa kwa endocrine glands kumakhudza kwambiri pathogenesis ya atherosulinotic process. Chifukwa chake, ndi matenda ashuga, atherosulinosis imayamba kupita patsogolo kwambiri. Izi zimachitika, makamaka, chifukwa chakuti kusowa kwa insulin kumabweretsa kuwonjezereka kwa endo native cholesterol.

Ntchito yofunikira pakukula kwa atherosulinosis imayimbidwanso ndi hypothyroidism. Mahomoni a chithokomiro amadziwika kuti amawonjezera ntchito ya lipolysis. Ndi kuchepa kwa mahomoni awa, kuletsa kwa lipolysis kumatha kuchitika, komwe kungayambitse kuphwanya kwa lipid metabolism ambiri ndipo, chifukwa chake, kukula kwa dyslipidemia.

Kusokonezeka kwa kagayidwe ka mafuta kumatha kuchitika chifukwa cha kusowa kwa ziwalo zina za endocrine: gland ya pituitary, glands

Matenda a Neurogenic (kupsinjika kwa m'maganizo)

Popanga atherosclerosis, izi zimagwira ntchito yofunika kwambiri. Atherosulinosis tsopano ndi yolondola mndandanda wa matenda omwe amatchedwa chitukuko - gulu lodziwika bwino la matenda lomwe limafala kwambiri mdziko lonse m'zaka za zana la 20. komanso kumayambiriro kwa zaka za XXI. komanso yolumikizidwa ndi kuthamanga kwa moyo, zomwe zimatsogolera pafupipafupi kupsinjika kwa psychoemotional.

Malinga ndi ziwerengero zochokera ku World Health Organisation, m'maiko omwe ali ndi mafakitale ambiri, atherosulinosis imayambitsa kufa kangapo konse m'maiko omwe akutukuka kumene. Izi ndichifukwa choti poyerekeza zakumbuyo wa kupita patsogolo kwa sayansi ndi ukadaulo, kuchuluka kwa anthu amene agwidwa ntchito mwachindunji m'magawo osiyanasiyana ogwira ntchito zofunikira kukukula kwambiri.

Kafukufuku wambiri komanso wazachipatala amatsimikizira gawo la cortical neurosis kumayambiriro ndikukula kwa njira ya atherosulinotic.

Zadziwikanso kuti atherosulinosis ndiofala kwambiri pakati pa anthu okhala m'mizinda kuposa okhala m'midzi, komanso pakati pa anthu omwe amachita ntchito yamatenda kuposa akuthupi.

Imodzi mwa njira zomwe matenda a neurogenic amakhudzira khoma la mtima ndi kuphwanya trophism ya khoma lamasamba, komwe kumachitika chifukwa cha kupindika kwa nthawi yayitali kwa vasa vasorum - zing'onozing'ono zomwe zimapereka khoma lakale. Makinawa amathanso kupitilizidwa mwa kukhudzana ndi ma catecholamine ochulukirapo, omwe amadziwika kwambiri pamikhalidwe yovuta. Chifukwa cha izi, njira za metabolic mu khoma lamitsempha zimasokonekera, zomwe zimapanga zofunikira zoyambitsa kukhazikitsa kwa atherosulinotic process.

Ponena za zinthu zoopsa monga kuchepa kwa matenda oopsa, dyslipidemia, kuperewera kwa estrogen ndi homocyteinemia, amatenga mbali mwachindunji mu pathogenesis ya atherossteosis, chifukwa chake tikambirana m'gawo lotsatira.

Njira zopangira

Malinga ndi malingaliro amakono, kukula kwa atherosulinosis ndi chifukwa cha kuphatikiza njira ziwiri zazikulu zomwe zimathandizira kusokonekera kwa kagayidwe kachakudya ka lipids ndi mapuloteni mu khoma la mtsempha:

• kusintha (kuwonongeka) kwa khoma lakale ndi kutupa kwakanthawi

• dyslipidemia - kusintha kwa lipid mbiri yamagazi.

Kusintha

Kusintha kwa khoma kungachitike pazifukwa izi:

• ochepa matenda oopsaMomwe malo opangira ma bifurcation khoma la mitsempha limakumana ndi zovuta kwambiri za kukameta ubweya, chifukwa chomwe kufalikira kwamphamvu kumachitika nthawi zonse,

• kusutaothandizira vasospasm, kuphatikizira kwa maselo ambiri, komanso kuchuluka kwama cytokines omwe amathandizira kutupa,

• othandizira opatsiranamonga Chlamydia Pneumoniae ndi Cytomegalovirus, am'banja la Herpesviridae, tizilombo tating'onoting'ono timatha kukhala ndi cytopathic zotsatira, komanso timathandizanso kuphatikiza ma cell ndi kuyambitsa kuyankha kwamthupi komwe kumapangitsa kuwonongeka kwa endothelial,

• homocysteinemia (kuchuluka kwa amino acid homocysteine m'magazi) ndizomwe zimapangitsa kuti pakhale kupanga kwakukulu kwa ma okosijeni a okosijeni, omwe amawonongeranso khoma lamankhwala, kuphatikiza, ma Homocysteine amalimbikitsa oxidation wa otsika osalimba a lipoproteins komanso kuchuluka kwa maselo osalala a minofu. Kuti akhalebe athanzi lachilengedwe mu magazi, mavitamini Bg, B12 ndi folic acid amafunikira, omwe amathandizira pakugwiritsa ntchito amino acid iyi. Kuwonongeka kwa endothelium yamitsempha pakadali pano imawonedwa ngati chinthu chofunikira kwambiri pakukula kwa atherosulinosis.

Dyslipidemia

Dyslipidemia ndi kusintha kwa lipid mbiri yamagazi, yodziwika ndi kuwonjezeka kwa cholesterol yathunthu, kutsika kwa lipoproteins (LDL), lipoproteins otsika kwambiri (VLDL), komanso kutsika kwa lipoproteins yapamwamba kwambiri (HDL). Cholesterol ndi ma lipid metabolites ena, omwe ali zinthu za hydrophobic, amatha kunyamula ndi magazi pokhapokha ngati njira zapadera zoyendera zikapangidwa - lipoproteins, yomwe imakhala ndi mapuloteni m'mapangidwe awo omwe amapereka solubility m'madzi.

Pali mitundu ingapo ya ma lipoprotein:

• LDL - thamangitsani cholesterol kuchokera ku chiwindi kupita ku minofu ndi khoma lamitsempha,

• VLDL - zoyendetsa ma triglycerides, ma phospholipids ndi cholesterol kuchokera ku chiwindi kupita ku minofu, zimakhala ndi cholesterol yocheperako kuposa LDL,

• APVP - tengani cholesterol kuchokera kumakoma amitsempha yamagazi ndi minyewa kupita kuchiwindi.

Mukamaganizira za pathogenesis ya atherosulinosis, lipoproteins nthawi zambiri imagawika m'magulu awiri: atherogenic, i.e., ikuthandizira kukulitsa kwa atherosulinosis (LDL ndipo, pang'ono, VLDL) ndi anti-heterogenous (HDL).

Komabe, ziyenera kukumbukiridwa kuti lipoproteins imawonetsa zinthu za atherogenic / anti-atherogenic pamene magawo awo abwinobwino m'magazi amasintha ndipo, koposa zonse, kokha motsutsana ndi maziko osintha ndi njira yotupa mu khoma lakale.

Muzochita zamankhwala, cholozera chofikirika kwambiri chomwe chikuwonetsa mawonekedwe a lipid mbiri ndi mulingo wa cholesterol yonse. Nthawi zambiri, ndi 3.9-5.2 mmol / L. Odwala omwe ali ndi cholesterol yathunthu ya 5.2-6.76 mmol / L amapanga "gulu lowopsa" lachitukuko cha atherosulinosis, hypercholesterolemia (oposa 6.76 mmol / L) amawonetsa chiopsezo.

Ma estrogens amakhala ndi vuto la estrogen-phospho-lycetin index, kuletsa kukula kwa dyslipidemia mwa azimayi amsinkhu wobala mwana. Mwa azimayi a postmenopausal komanso amuna, makina otetezawa palibe.

Njira za atherosulinotic mtima kuwonongeka

Choyambirira, ziyenera kudziwika kuti kusuntha kwa cholesterol khoma lamitsempha komanso phagocytosis ya kuchuluka kwake ndi macrophages ndichinthu chachilendo. Komabe, pazovomerezeka, ma macrophages amalanda cholesterol yochepa ndikusiya khoma la mtsempha.

Ndi chitukuko cha atherosulinosis, LDL imadutsa peroxidation komanso magawo amtundu wa okosijeni omwe amasinthidwa, kukhala "LEML" yosinthika, yomwe imatha kudzikundikira mumacrophages ochuluka. Zotsatira zake, maselo otchedwa foam amapangidwa. Pambuyo pake, maselo a thovu amawonongeka. Poterepa, milu yokhala ndi lipid-protein yotuluka kuchokera kwa iwo imadzunjikira mu gawo la subithothelial la artery. Lipids imayikidwa mkati mwa maselo onse (ma macrophages ndi maselo osalala a minofu) komanso m'malo ophatikizika.

Kumbali inayo, macrophages ophatikizidwa ndi ma cell ndi ma cell omwe amapanga zotchinga khoma la zinthu zomwe zimapangitsa kuti minofu yosalala isamuke.

Ma macrophages ophatikizika amathandiziranso ma cytokines omwe amalimbikitsa kusunthira kwa ma T-cell ndi ma monocytes kulowa mu intima, komanso kumathandizira kupanga kwa zinthu zomwe zimapangitsa kukula (zimapangitsa kuchuluka kwa minofu yosalala) komanso kapangidwe kazinthu zotulutsa mpweya (oxidize LDL). Maselo otsekemera a minofu amayamba kuchulukana ndikupanga collagen, yomwe imakhala maziko a minofu yolumikizira mafupa.

Gawo Atherosulinosis

1. Gawo la Dolipid. Amadziwika ndi kusinthika ndi kutupa mu khoma la mitsempha komanso kukula kwa dyslipidemia. Komabe, palibe zizindikiro za ma morcological za atherosulinosis.

2. Lipoidosis. Mwakukula, ma protein a lipid-protein amawayika, njira yongopeka imayamba.

3. Lipossteosis. Chikwangwani cha atherosclerotic chimapangidwa: kudzikundikira kwa mapuloteni a lipid-protein kumapitiliza ndi kupanga kwa munthawi yomweyo.

4. Atheromatosis. Pakadali pano, chidacho ndi chipika chokhala ndi minofu yolumikizira minyewa, chomwe ndi choswa cha lipids ndi mapuloteni.

5. Atherocalcinosis. Mchere waku calcium umayikidwa mu zolengeza.

6. Atherosulinosis. Nembanemba imakhala yochepa thupi, zilonda zam'mapazi, ndipo zomwe zili mkati mwake zimalowa m'magazi.

Zotsatira za Atherosulinosis

1. Stenosis ya mtsempha wamagazi.

2. Kutumphuka kapena kukokoloka kwa mwala wa atherosulinotic, kupangira zinthu zomwe zingayambitse kukula kwa thrombosis (njira yodziwika kwambiri yopezeka kuti imachitika pachimake myocardial infarction).

3. Kutsika kwa mphamvu ya khoma la mtima, komwe kumayambitsa kukula kwa aneurysms ndi chiopsezo cha kuwomboka kwawo kotsatira.

4. Kuwonongeka kwa zolembera zamtundu wa atherosselotic, limodzi ndi kulekanitsidwa kwa tizinthu tating'onoting'ono, timene timasandulika kukhala emboli. Omaliza omwe amayenda ndi magazi amayenda m'mitsempha yaying'ono ndipo, kutsekeka, kumapangitsa minofu ischemia.

Udindo wa atherosclerosis mu matenda a mtima dongosolo

Ndi atherosulinosis, mitsempha yotsatirayi imakhudzidwa nthawi zambiri (yomwe ikuwonetsa kuchepa kwa pafupipafupi):

• mitsempha yotupa komanso yachikazi,

• mkati mwa carotid mtsempha wamagazi,

• mitsempha yamatumbo (makamaka bwalo la Willis).

Matenda a atherosclerosis ndi omwe amachititsa kwambiri zotsatirazi zamatsenga:

• kulowetsedwa pachimake (mu 95% ya milandu),

• ngozi ya pachimake ya ubongo (matenda amiseche),

• micenteric artery occlusion,

• zigawenga za m'munsi,

Ndime zinayi zoyambirira zikuwonetsa momwe atherosulinosis imayambitsa khoma la chotengera, kutsika kwa kuchepa kwawo ndipo, chifukwa chake, patency, yomwe imatsogolera kukukula kwa ischemia. Njira ina ya ischemia imagwirizanitsidwa ndi mfundo yoti atherosclerosis nthawi zambiri imayambitsa mapangidwe a magazi.

Magawo a zolengeza

Zigawo zazikuluzikulu za zolembazo ndi minofu ya fibrous ndi lipids, makamaka cholesterol. Njira yopanga zolembera imakhala magawo angapo. Chifukwa cha zina, mwachitsanzo, microdamage kukhomalo la chotengera, zinthu zimapangidwa kuti zilowe mkati mwa lipids kulowa mumtsempha wa chombo. Pamalo ano, pali kuchuluka kwa lipoproteins yotsika kwambiri yodzaza ndi cholesterol. Amakhulupirira kuti kuti lipids yotsika kwambiri ikhale atherogenic, ayenera kudutsa peroxidation. Kusintha koteroko kumatha kusokoneza kumangika kwawo m'maselo ndikupangitsa kukwiya kwa monocytes. Lipids imagwidwa ndi ma monocytes, kudutsa gawo la macrophages ndikukhala maselo ofunda. Morphologically, izi zimawonetsedwa ndi mawonekedwe a magulu amafuta. Kupitilira apo, pamene kusintha kwa atherosulinotic kumapita patsogolo m'malo mwa lipid, kukula kwa minofu yolumikizana ndikupanga zolembera zam'mimba zimachitika.

Chikwangwani ndi chophatikizika ndi collagen ndi maselo osalala a minofu, mkati mwake momwe muli maselo a chithovu ndi makhiristo a cholesterol. Gawo lotsatira la atheromatosis limadziwika ndi kuwonongeka kwa zolembera ndi kuwonongeka kwa ulusi wa collagen, maselo am'misempha ndi lipids. Pamalo otumphuka chikalatacho, muli mawonekedwe amkati momwe amapangidwira mafuta. Minofu yolumikizana imawalekanitsa ndi lumen ya chotengera.

Mavuto obwera chifukwa cha kufalikira kwa matenda a mtima

Atherosulinotic zotupa za mitsempha ya mtima (mtima mitsempha) kumabweretsa kukula kwa matenda a mtima. Atherosulinosis ya mitsempha yaubongo imayambitsa kugunda, ndipo kuwonongeka kwa mesenteric artery kumakhala kovuta ndi matumbo ischemia (mesenteric thrombosis). Vuto lalikulu limachitika pamene magazi amtundu wa magazi adayamba ndi kupasuka komanso kulowa kwa ma atheromatous pamalopo am'madzi, zomwe zimapangitsa kuti pakhale mawonekedwe.

Vuto lowopsa chifukwa cha chotupa cha msempha ndi thonje lomwe limachitika. Aortic aneurysm ndikutukuka kwa gawo la msempha, chifukwa cha kusintha kwa mawonekedwe ake osakanikirana. Kutupa kwa msempha pamalo a aneurysm kapena thrombosis yake nthawi zambiri kumayambitsa imfa ya wodwalayo.

Kuchitapo kanthu kwakanthawi kwamankhwala kwa vuto la lipid metabolism kumathandizira kuchepa kwa atherosulinosis, kupewa zovuta zovuta komanso kusintha moyo.

Kuyamba kwa njira ya atherosulinotic

Gawo loyamba la atherosulinosis limatchulidwa m'mabukuwa ngati nthawi ya preclinical (asymptomatic). Munthawi imeneyi, njira za metabolic zimasokonezeka - kuwonjezeka kwa cholesterol, kuphwanya kuchuluka kwa kuchuluka kwa cholesterol ndi phospholipids. Ndizomwe zimayambitsa chitukuko cha atherosulinosis. Nthawi zovutazi zimatha kukhala zosakhazikika komanso zosinthira mayankho pafupipafupi. Pakadali pano, pakadalibe zotupa m'matumbo, mapangidwe a zolembera sanachitikebe, ndipo zizindikiro za matenda a pathognomonic sizikuwoneka. Pakadali pano, ndizotheka kuzindikira zopatuka mu mawonekedwe a metabolic njira kokha mwa maphunziro apadera a labotale.

Magawo a kuwonongeka kwa mtima

Atherosulinosis imadziwika ndi kusintha kwa pathological m'makoma amitsempha yamagazi. Magawo otsatirawa a chitukuko cha atherosclerosis amadziwika:

Lipid Madontho - Ili ndi gawo loyamba la matenda, komwe ndiko kukonzanso kwa makoma a zotengera zam'madzi zokhala ndi ma lipid. Njira yodabwitsayo imayambira magawo ena amipanda yazakale. Kunja, madera oterewa amawoneka ngati timizeremizere tofiira kutalika konse kwa chotengera. Zizindikiro ndi zovuta zina zooneka sizikupezeka. Zochitika zina zam'mbuyomu komanso matenda, mwachitsanzo, matenda ashuga (shuga mellitus), kuthamanga kwa magazi, kunenepa kwambiri, zimatha kuyambitsa mapangidwe.

Kapangidwe ka zolembera zam'mimba - gawo lotsatira la matendawa, momwe malo omwe amafotokozedwera ziwiya zowonongeka (malo a lipid) amayamba kuyatsidwa. Chitetezo cha mthupi chimayankha zoterezi ndipo olowererapo akumasulidwa amatulutsidwa. Kuchita motalika kotereku kumabweretsa kutsekeka kwa mafuta omwe amakhazikika pakhoma (necrosis yawo imachitika), m'malo omwe sclerosis imayamba - minofu yolumikizana imakula. Zotsatira zake, mapangidwe a zolembera zam'mimba zimapangika ndikutuluka kwa lumen ya chiwiya, komwe, komwe kumatsimikiza kuchuluka kwa stenosis komanso kuthamanga kwa magazi.

Mapangidwe ovuta mapepala - gawo lomaliza la matendawa, momwe zovuta zimachitika chifukwa cha zomwe zimachitika mu zolembazo za fibrous. Gawoli limadziwika ndi mawonekedwe a matendawa.

Magawo a chitukuko cha atherosulinosis pa ma cellular

Kuti adziwe kusintha komwe kumakhala mu maselo a mitsempha, kuwunika kwa mbiri kunapangidwa pazidutswa za ziwiya zomwe zakhudzidwa. Kutengera pa iwo, amasiyanitsa:

Dolipid - kuchuluka kwachulukidwe khoma la mtima ndi kutupa kwake kopitilira. Mapuloteni am'magazi, mamolekyulu akulu ndi ma polysaccharides atsekeredwa mu chotupa cha mtsempha wamagazi. Matenda a metabolism amachitika.
Lipoid. Kusintha kwa masabolic kumakulitsa, mafupa achikasu achikasu amapezeka. M'malo awa, mozama kwambiri ndi cholesterol ndi mawonekedwe a maselo a chitho. Atherosulinosis ya gawo la lipoidosis imawonetsedwa ndi kutumphuka kwa chidutswa cha chotengera chokhala ndi maselo a xanthoma.
Lipossteosis - m'malo obwera, njira zotupa zimapita patsogolo, zomwe zimayendera limodzi ndi kupukutika kwa ulusi wa minyewa yolumikizana mu khoma la mtsempha. M'mphepete mwake, pamapangidwa zida zazing'ono zomwe zimapatsa chidacho mafuta ndi mapuloteni.
Atheromatosis. Pakadali pano, zolembera za cholesterol zimawonongeka kuyambira pakati mpaka kumapeto. M'chigawo chowola, makhiristo a cholesterol m'mankhwala okhala ndi organic amatha kuwoneka bwino. Kuphatikizidwa kwa zolendazo kumapangidwa ndi mamolekyu ochulukirapo, maselo a xanthoma ozunguliridwa ndi minofu yolumikizana. Mukutupa - hematoma.
Mgawo wa kukwera. Mu gawo ili la atherosclerosis, zolengeza zimawonongeka ndipo zomwe zili mkati mwake zimalowa m'magazi. Pali kukokoloka pamtunda wa minofu yosalala, ili ndi mawonekedwe olakwika. Mapulatifomu ndi zinthu zina zamagetsi am'magazi amatumizidwa pazomwe zimawonekera. Amayamba machitidwe a parietal thrombosis.
Atherocalcinosis. Mu kapangidwe ka thrombus wopangika, mchere wamchere umathandizira ndikutsatsa uku. Kujambula kumayambira ndikukula kwotsatira ndikukula kwa gawo ili la khomalo, ndikupangitsa matenda a stenosis komanso zovuta kuzungulira magazi.

Mlandu wina wamatendawa ndi atherosulinosis obliterans of the m'mphepete (OASNK). Ndi matenda am'mitsempha, pali kuphwanya kwamayenda wamagazi m'magawo apansi. Pali magawo anayi, kutengera ndi zizindikiro za atherosulinosis. Mbali yoyamba, kupweteka kwa miyendo kumawonekera kwambiri pakuchita masewera olimbitsa thupi. Mu gawo lachiwiri la kudwala kwamatenda - mukamayenda mtunda wopitilira mazana awiri, mu digiri ya 3 - mpaka mazana awiri. Ndikofunika kukumbukira kuti ndi gawo liti la atherosclerosis lomwe limasokoneza ululu womwe ukupuma - wachinayi. Amakhala osakhazikika mwanjira zina ndipo amayambitsidwa ndi ulcerative process mu minofu ya khoma lamitsempha yolumikizira atherosulinosis.

Masiteti kutengera ndi chotupa

Pa dera lililonse la matenda, magawo awo a chitukuko cha atherosclerosis amadziwika. Tsopano tilingalira za mawonekedwe athu ndi kusiyana kwa mitsempha ya mitsempha kwa dipatimenti iliyonse yamtima.

Khola la msempha ndi chotengera champhamvu kwambiri, limakhala ndi nthambi zambiri ndipo limapereka magazi pafupifupi ziwalo zonse zofunika m'thupi. Njira za atherosulinotic zimakhazikika pafupipafupi m'mimba msempha kuposa thoracic. Ndi malo oyang'anirawa, gulu la magawo ndi lotere:

Choyamba. Amadziwika ndi madontho a cholesterol, omwe amadziunjikira mu intima ndipo pang'onopang'ono amapanga banga la lipid. Kutalika kwa siteji sikuchepera ndipo zimatengera kulimba kwa zomwe zingachitike pachiwopsezo cha atherosulinosis.
Chachiwiri ndi fibrosis. Chikwangwani cha atherosulinotic chimapangidwa chifukwa cha kukula kwa minyewa yolumikizira kuzungulira kwa lipid.
Chachitatu ndi atherocalcinosis. M'malo mwake, chotupa chimamasulidwa ku misa ya thrombotic ndikuthira mchere wamchere, chifukwa chomwe khoma lamankhwala limafikira mu lumen ndikuyambitsa kupendekera - stenosis.

Zombo zapamadzi

Atherosulinosis imakumana ndi ziwiya zomwe zimadyetsa ubongo. Pamaso pa madera angapo chitukuko cha matendawa, matenda amtundu wambiri amadziwika. Magawo a chitukuko cha mtundu uwu wa atherosulinosis ndi awa:

Poyamba - kuwonetsedwa ndi kukumbukira kukhumudwa, kusowa tulo, chizungulire. Zilonda zam'mimba ndizochepa.
Kukalipirana - zizindikiro zofanana ndi zoyambira, koma kuopsa kwake kumakhala kwamphamvu. Kuphatikiza apo, kusintha kwam'mawonekedwe kumawonekera, kugwira ntchito kumachepa. Ma protein m'matumba amakhala olimba kwambiri.
Kuwongolera - chisonyezo chimakhala chokhazikika, kuchepa kwa dementia, ntchito za luntha zimachepa, kusunthika kwa mphamvu, ndipo kuchuluka kwa nzeru kumachepa.

Zotengera za m'munsi

Ndi kutanthauzira kwa njirayo pamiyendo, atherosulinosis obliterans ya ziwiya zamagawo am'munsi amakula. Mankhwala amakono, magulu otsatirawa a madigiri ake amakupangira:

Poyamba. Ululu m'munsi m'munsi pokhapokha mutachita masewera olimbitsa thupi.
Gawo lapakati. Ululu umachitika poyenda kupitirira mazana mazana awiri
Zotsutsa Kuyenda kupitirira mamitala makumi asanu kumalepheretsedwa ndi zowawa.
Gawo lovuta. Massive necrotic foci, makamaka pamapazi, chifukwa chomwe sichingatheke kuloza miyendo.

Mitsempha ya mtima

Mitsempha yama coronary (ndiyo ma coronary) imapereka magazi mkati mwake. Mosiyana ndi mitundu ina ndi kutengera kwawo, kugonjetsedwa kwawo kumachitika mwachangu kwambiri. Pali magawo atatu ofunikira a atherosulinosis mu dipatimenti iyi:

Choyamba. Mawonetsero osokoneza bongo a atherosulinosis nthawi zambiri samakhalapo, koma kusintha kwina pa ECG kumatha kuwoneka kale - kusintha pang'ono pakanthawi ka S-E, makamaka pambuyo pochita masewera olimbitsa thupi. Chikhalidwe chachikulu cha nthawi ino ya coronary artery atherosulinosis ndi njira ya dystrophic mu minofu yamtima.
Wachiwiri. M'mabuku, amatchedwa necrotic chifukwa cha kupangidwa kwa magawo a mtima minofu necrosis ndi predominance of degenerative process. Zitha kukhala zovuta ndi vuto la mtima lalitali. Gawo ili la matendawa limasiyanitsidwa ndi zizindikiro wamba. Pa ECG, kusintha kosinthika kwa S-T ndi mafunde a T ndi Q kukuwoneka bwino kale.
Chachitatu. Akatswiri azachipatala nthawi zambiri amatcha gawo ili atherosulinotic mtima. Foci of scarring ingakhale yocheperako kapena yodziwika ponseponse myocardium. Kutuluka kwa myocardium komwe kumachitika kungafanane ndi aneurysms. Zizindikiro za siteji ndizovuta kwambiri - atrustic fibrillation, kugwa kwa contractility, kuchepa kwa magazi m'magulu onse a magazi, mtima mphumu, blockages - sinoatrial, atgency, atrioventricular, etc. Pa ECG - kutchulidwa kosachedwa kuchepa kwamagetsi ndi kusintha kwina kwakukulu.

Mitsempha yammbali

Mitsempha ya impso imakhala pachiwopsezo pakamwa kapena madera oyandikana nawo. Ndi atherosulinosis ya mitsempha iyi, magawo a kukula kwa matendawa ndi awa:

Gawo loyamba. M'mabuku amatchedwa "ischemic", omwe amadziwika ndi kuchepa kwa mavuto m'mitsempha ya impso. Njira za Ischemic mu impso zimayambitsa kuchuluka kwa magazi ndipo zimayambitsa kulimbikira koopsa (matenda oopsa).
Gawo lachiwiri. Kuwonetsedwa ndi parenchyma necrosis ndi thrombosis mu ochepa dongosolo la impso.
Gawo lachitatu. Imayendera limodzi ndi zizindikiro za nephrocirrhosis, kulephera kwa impso kumayamba, kusintha kwa mthupi mu mkodzo chifukwa cha kuwonongedwa komanso kupasuka kwa munthu wa glomeruli kumatha kuonedwa.

Atherosclerosis ndi matenda a dongosolo omwe angakhudze gawo lililonse la mtima wamunthu. Kuti mupeze chithandizo komanso kupewa, muyenera kuyang'anira cholesterol yamagazi, kutsatira moyo wathanzi ndikukambirana ndi akatswiri oyenerera panthawi yake.