ATHEROSCLEROSIS - Zosiyana ndi zokambirana pazomwe zimayambitsa matenda

Atherosulinosis (kuchokera ku Chigriki pamenepo - gruel ndi sklerosis - compaction) ndi matenda osachiritsika omwe amayamba chifukwa chophwanya mafuta ndi mapuloteni, omwe amadziwika ndi kuwonongeka kwa mitsempha ya zotanuka komanso zotanuka mu mawonekedwe amomwe amafotokozera zamtundu wa lipids ndi mapuloteni komanso kuchuluka kwa minofu yolumikizika.

Nthawi "Atherosulinosis" anafunsidwa ndi Marshan mu 1904 kuti amfotokozere matenda omwe matenda amitsempha amayambitsidwa chifukwa chophwanya kagayidwe ka lipids ndi mapuloteni, omwe amatchedwa "Metabolic arteriosranceosis". Atherosulinosis ndi mtundu wa arteriosulinosis. Nthawi Arteriosulinosis ntchito kuwonetsa sclerosis yamitsempha, kaya chifukwa ndi magwiritsidwe ake a chitukuko.

o Kuchulukana kwa atherosclerosis m'maiko onse padziko lapansi pazaka 50 zapitazi kwawonjezeka kwambiri ndipo kukupitilizabe ku maiko onse aku Europe. Chikhalidwe cha kutsika kwake pazaka khumi zapitazi chimawonedwa ku United States kokha. Matendawa nthawi zambiri amadziwonekera theka lamoyo. Mavuto a atherosulinosis ndi amodzi mwazomwe zimayambitsa kulumala ndi kufa kwa anthu m'maiko ambiri padziko lapansi.. Odwala omwe akuwonetsa atherosulinosis ali m'zipatala za mbiri iliyonse yazachipatala. Kuchepetsa kwakukulu pamavuto owopsa pamayiko aku America ndi chifukwa cha zoyesayesa zomwe zimachitika palimodzi osati za akatswiri amtima, opatsirana zamankhwala, komanso akatswiri amatsenga. Chifukwa chake, zidziwitso zokhudzana ndi matenda amtunduwu ndizofunikanso kwa madokotala komanso gawo lazachipatala komanso kupewa. Kudziwa momwe matendawa agwiritsidwira ntchito matendawa, makamaka kuwonetsa kwa atherosulinosis, kumulola katswiriyo kuti azithandiza osati chithandizo chokhazikika cha pathogenetically, komanso kudziwa mtundu wa njira zodzitetezera

Etiology. Mtsutso wokhudzana ndi mtundu wa malo omwe ma atherosselotic mapepala pakati pa akatswiri m'magulu osiyanasiyana sanathebe kwazaka zana. Ma hypotheses ambiri ndi malingaliro okhudzana ndi chifukwa cha atherosulinosis amati. Komabe, pakadali pano palibe malingaliro ambiri ovomerezeka a kupezeka kwa atherosulinosis. Chimodzi mwazofunikira za matendawa ndi kusiyanasiyana kwake kwa mawonekedwe ake mwakuwapanikizika ndi kutalika kwa njirayi, kufalikira kwake mwa kutukuka mwa anthu osiyanasiyana, ngakhale pagulu lomwelo. Zinthu zambiri zimawerengedwa kuti ndizofunikira kwambiri pachiwopsezo cha chitukuko cha atherosulinosis. Komabe, pali odwala omwe ali ndi zizindikiro zotchulidwa za atherosulinosis, momwe sizingatheke kudziwa zifukwa zomveka zomwe zimathandizira kukulira kwake zomwe zitha kudziwika kuti zayambitsa ngozi.

Kuchulukana kwa atherosclerosis kumawonjezeka ndi zaka. Mwa akazi, kukula kwake musanadutse sikutha. Hypertension, kukwezeka kwa LDL-cholesterol ndi matenda oopsa a shuga ndi njira zapadera zowopsa mwa amuna ndi akazi. Paubwana, imawonedwa ngati chinthu chofunikira kwambiri pa ngozi - kusuta fodya. Zofunikira zochepa kwambiri ndizo kunenepa kwambiri, kumangokhala, komanso kuchepa kwachuma.

Pathogenesis. Ngakhale kupezeka kuchipatala kwa njira zambiri zowonera makanema, ndizovuta kwambiri kutsata kupitilira kwa atherosclerosis mwa munthu yemweyo mu mphamvu. Chifukwa chake, pafupifupi chidziwitso chonse cha chitukuko cha ma atheromatous malo oyeserera chimayesedwa pa nyama (zonse ziwiri zokha za atherosulinosis ndi atherosclerosis, zomwe zimayamba chifukwa cha chakudya chamafuta ambiri).

Ma microncopy a Electron adavumbulutsa kuti m'malo omwe akuyembekezeka kukulitsa kwa atherosulinosis, poyambira kupezeka kwake, ma macrophages osunthira mu lumen a chombo amapezeka pakati pa maselo a endothelial. Kukhazikika kwa macrophages apamwamba kwambiri ndi chimodzi mwazizindikiro zoyambirira za matendawa. Ma molekyulu a macrophage omwe amaphatikiza ndi endothelium ali ofanana ndi omwe amapezeka ndi zotupa, koma sanaphunziridwe kwathunthu. Maselo amtundu wa Endothelial pamasamba a mapangidwe atheromatous plaque ali ndi mawu owonetsa ma molekyulu omatira, kuphatikiza ICAM-1 ndi E-selein. Mwina iyi ndi imodzi mwazinthu zoyambirira kwambiri zopanga maselo. Malo opangira ma atheromatous ambiri amaphatikizira zomwe zimapangidwa ndi macrophages, lymphocyte, ndi maselo osalala a minyewa, omwe nthawi zambiri amakhala ozunguliridwa ndi minofu ya fibrous. "Kukula", makamaka PDGF, yotengedwa kuchokera ku mapulateleti imalimbikitsa kuchuluka kwa minofu yosalala (maselo olimba kwambiri) ndikupanga kwawo kollagen, elastin ndi mucopolysaccharides. PDGF imasungidwa ndi maselo ambiri okhala ndi minyewa yolumikizana, ya macrophage ndi chilengedwe cha endothelial. Koyesera mu chikhalidwe cha minofu, zidawonetsedwa kuti PDGF imathandizira kukula kwa maselo osalala a minofu ndi ma fibroblasts, imapangitsa DNA kuwirikiza motero, imathandizira kuthamangitsa magawanidwe am'magazi. Ma molekyulu a zomatira amalimbikitsa kuphatikiza kwa ma platelet, komwe kumayendetsedwa ndi kuwonongeka kwa maselo a endothelial. Kupanikizika kwa hememnamic, makamaka m'malo a nthambi zamitsempha yamagazi kumapangitsa kuti mapulateni awoneke komanso kuwonongeka kwa endothelium. Nthawi zina, kusiyana pakati pa maselo a endothelial kumawoneka kuti kukukulitsidwa, kenako malo ochepa kapena osafunikira amawoneka opanda maselo a endothelial. Kutulutsa kwotsatira kwa zinthu zomwe zikukula, monga PDGF, kumathandizanso kukulitsa komanso kuyambitsa minyewa yosalala ya minyewa. Ubale wapamwambowu pakati pa macrophages, mapulateleti, maselo endothelium pano ukuphunziridwa kwambiri ndi akatswiri ambiri.

Rudolf Virchow adanenanso kuti lipids ndi gawo lofunikira la zotupa za atheromatous. Ndipo tsopano zikuwonetsedwa kuti kuwonjezeka kwa mitundu ya lipoproteins kwambiri kumawonjezera mwayi wokhala ndi atherosulinosis mwa anthu osiyanasiyana.

Amawonetsedwa kuti kuwonjezeka kwa magazi lipoprotein ochepa, makamaka LDL cholesterolndiye chofunikira kwambiri komanso chofala kwambiri pakukula kwa zolembedwa za atheromatous. Milingo ya cholesterol imayendetsedwa ndi zonse chibadwa komanso chilengedwe. Kufa kwa anthu kuyambira kuwonongeka kwa ma atherosselotic pamatumbo a mtima kumakhudzana kwambiri ndi kuchuluka kwa cholesterol ya LDL. Chiwopsezo chowonjezeka cha matenda amtima ku England ndi maiko ena a Nordic chimalumikizidwa ndi chakudya chamafuta kwambiri m'zakudya za okhala m'maiko awa. M'mayiko aku Mediterranean, komwe gawo laling'ono lamafuta limakhala ndi mphamvu, kufa kwa matenda a m'mitsempha kumakhala kochepa. Nthawi yomweyo, zidapezeka kuti zakudya zomwe zimamwa kolesterol pang'ono zimakhudza mulingo wake wa plasma. Chidziwitso chosangalatsa kwambiri chakufunika kwa LDL-cholesterol chinapezedwa pakuphunzira kwa anthu ndi nyama kukhala popanda kwathunthu kapena kosagwirizana ndi cell membrane cholesterol receptors. Maselo ambiri ali ndi ma receptor omwe amazindikira gawo la apoprotein la molekyulu ya LDL. Kapangidwe ka molekyulu ka LDL receptor kotsimikizika. Makina omwe amawongolera kapangidwe kake ndikusunthira kwa membrane wam'maselo amaphunziridwa bwino. Zambiri mwa zovuta zosiyanasiyana za ma cell zimakhala ndi chidziwitso chodziwika bwino. Zinapezeka kuti kuchuluka kwa LDL-cholesterol kumachulukirachulukira (kupitirira 8 mmol / l) mwa odwala omwe ali ndi heterozygous, makamaka iwo omwe ali ndi zaka 40-50 ndipo ali ndi matenda amitsempha yamagazi. Odwala a Homozygous, omwe ndi osowa kwambiri (pafupifupi 1 mwa 1 miliyoni miliyoni), omwe ali ndi kuchepa kwa zolandilira, nthawi zambiri amafa ali achinyamata kuchokera ku zotupa zamatenda a mtima. Makina enieni omwe anakweza cholesterol cha LDL amathandizira kukulitsa kwa atherosclerosis sichinadziwikebe. Kuchuluka kwa cholesterol yoyenda m'magazi kumatha kuwonjezera cholesterol pazomwe zimatha endothelial nembanemba. Kuwonjezeka kwa izo mumapangidwe amtundu wam'mimba kumayambitsa kuchepa kwa elasticity yawo ndikuwonetseratu kuwonongeka. Zatsimikiziridwa tsopano kuti cholesterol cha LDL chikaphatikizidwa ndi macrophages omatira kumapeto kwa chotengera, ma radicals aulere amatha kuwononga maselo osalala a minofu. Kuphatikiza apo, matenda oopsa a hypercholesterolemia amawonjezera katulutsidwe wa endothelial pamitundu yambiri ya kukula monga PDGF.

Kafukufuku wazokhudza kuchuluka kwa maselo olemera a lipoprotein nawonso ali ndi chidwi. HDL cholesterol. HDL cholesterol imathandizira pa kayendedwe ka cholesterol, kumachokera kumapazi mpaka chiwindi. Kafukufuku wodalirika angapo am'mapazi amasonyezedwa m'mabuku, omwe akuwonetsa kuti chiwopsezo chachikulu cha HDL-cholesterol m'maselo a chiwindi chimagwirizanitsidwa ndi chiopsezo chocheperako cha kusintha kwa atherosranceotic m'mitsempha yama mtima. Kafukufuku akuwoneka kuti akupatsa mwayi.

Ngakhale kuti zili triglycerides m'magazi amatanthauza zinthu zochepa zomwe zingayambitse matenda a atherosulinosis, ziyenera kuganiziridwanso, chifukwa cholowa cholowa cha lipid metabolism chimakhudzana ndi cholesterol komanso triglycerides yokwera.

Zina za pathogenetic pakupanga atherosulinosis. Kafukufuku wam'mbuyomu wosintha kwa atheromatous mwa anthu ndi nyama akuwonetsa kuti fibrin ndi mapulateleti ndizofunikira kwambiri zotupa zoyambirira. Lero pali umboni wamphamvu kuti chiopsezo chowonjezeka cha matenda a mtima chikugwirizana chifukwa cha kuchuluka kwa coagulation factor VII. Kusintha koyambirira kwamapangidwe a thrombotic kumaphatikizapo kutsegula kwa maselo ndi kutsatiridwa kwa subendothelial collagen. Othandizira omwe amachititsa kuti magazi azigwira ntchito ndi ma collagen, thrombin, thromboxane A₂, adenosine phosphate, norepinephrine (i.e. vasopressor othandizira). Tsopano ndikudziwika kuti zinthu izi zimapangitsa kuti ma glycoprotein receptors azigwiritsa ntchito mapulateleti. Dzina lathunthu la ma receptor awa ndi platelet glycoprotein IIB / IIIA. Mlingo wa aspirin wocheperako, womwe umaperekedwa kwa odwala omwe ali ndi zotupa zamatumbo am'mimba ndipo mosakayikira amachiritsa, amalepheretsa zochita za thromboxane A₂. Kufufuza njira zina zoletsa glycoprotein IIB / IIIA receptors kukupitirirabe.

Pathological anatomy ndi morphogeneis

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.

Magawo otsatirawa a atherosulinosis morphogeneis amadziwika:

• dolipid
• lipoidosis
• lipossteosis,
• atheromatosis,
• zilonda
• atherocalcinosis.

Gawo la Dolipid macroscopically osatsimikiza. Ma Microscopically:

o focal kuwonongeka (mpaka kuwononga kwathunthu) kwa endothelium komanso kuchuluka kwa zilimidwe za intima, zomwe zimabweretsa kuchuluka kwa mapuloteni a plasma, fibrinogen (fibrin) mkati mwa membrane wamkati ndi mapangidwe a parietal thrombi,

o kudzikundikira kwa acidic glycosaminoglycans mu intima, kutukusira kwa mkati mwa membrane wamkati, mawonekedwe ake mumakhala ochepa komanso otsika kwambiri a lipoproteins, cholesterol, mapuloteni,

o Kuwonongeka kwa zotanuka ndi ma collagen ulusi, kuchuluka kwa minofu yosalala.

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 yodziwika ndi kuyika zolimba kwambiri kwa lipids (cholesterol), lipoproteins, zomwe zimatsogolera pakupanga mawanga am'mafuta (lipid) ndi magulu. Macroscopically, mawanga amafuta oterowo amawoneka ngati malo achikasu omwe nthawi zina amatha kuphatikizana ndikupanga mikwingwirima yotalikirana kwambiri 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 chiwonongeko cha 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. Malo amenewa amachepetsa lumen, yomwe imayendera limodzi ndi kuphwanya kwa magazi (ischemia) kupita ku chiwalo kapena gawo limodzi. Nthawi zambiri, zolembera zam'mimba zimawonedwa m'mimba msempha, mu nthambi zochokera ku msempha, m'mitsempha ya mtima, ubongo, impso, miyendo yam'munsi, mitsempha ya carotid, ndi zina zambiri.

Ndi atheromatosis milomo ya lipid yomwe ili mkati mwa chigawo ndi collagen moyandikana ndi ulusi wamankhwala amasiya. 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. Akubwera ulceration sitejilimodzi 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 yodziwika ndi kufalikira kwa mchere wamchere mu zigawo za 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. Mapilala amakhala ndi miyala yolimba, khoma la chotengera pamalo operekera petraro 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:

• kupita patsogolo
• kukhazikika
• kukonza kukonzanso.

Njira yokhala ngati mafunde ndikutenga kwa lipidosis pazosintha zakale - liposulinosis, atheromatosis ndi atherocalcinosis. Pa kukonzanso kwa ndondomekoyi, kugwirizananso pang'ono kwa lipids ndi macrophages ndikotheka.

Mavuto a atherosulinosis. 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.

Kutengera kuthekera kwakukulu kwa kusintha kwa atherosulinotic m'matumbo, zovuta ndi zotsatira zake komwe zimatsogolera, mitundu yotsatirayi yazachipatala ndi yamatumbo imasiyanitsidwa:

• atherosulinosis ya msempha,
• coronary artery atherosulinosis (matenda a mtima),
• arteriosclerosis yamitsempha yamagazi (matenda amiseche),
• atherosulinosis ya mitsempha ya impso (mawonekedwe a impso),
• atherosulinosis ya mitsempha yamatumbo (mawonekedwe amimba),
• atherosulinosis yamitsempha yama m'munsi.

Aortic Atherosulinosis - Uwu ndi mtundu wofala kwambiri wamatenda. Kusintha kochititsa chidwi kwambiri kwa atherosulinotic kumasonyezedwa m'mimba ndipo nthawi zambiri amadziwika ndi atheromatosis, zilonda zam'mimba, komanso atherocalcinosis. Zotsatira za thrombosis, thromboembolism, ndi embolism mwa ma atheromatous misa omwe ali ndi aortic atherosulinosis, matenda a mtima (mwachitsanzo, impso) ndi gangrene (mwachitsanzo, matumbo, miyendo yam'munsi) nthawi zambiri amawonedwa. Ndi atherosclerosis, aneurysms nthawi zambiri amakula mu msempha. Pali ma cylindrical, sacular, herniated aortic aneurysms. Kapangidwe ka aneurysm ndi kowopsa chifukwa chotumphuka komanso magazi ake. Aortic aneurysm yomwe yakhalapo kwa nthawi yayitali imatsogolera pakuwonekera kwa minofu yoyandikana (mwachitsanzo sternum, matupi a vertebral).

Matenda a mitsempha ya mtima chimayambitsa matenda ake a ischemic (onani. matenda a mtima).

Matenda a mitsempha ya muubongo ndi maziko a matenda amitsempha yamagazi. Kutalika kwa nthawi yayitali ya chithokomiro chifukwa cha stenotic atherosulinosis ya mitsempha yam'mimba kumayambitsa dystrophy ndi atrophy ya ubongo cortex, kukula kwa kuchepa kwa mtima kwa ubongo.

Ndi atherosclerosis ya aimpso mitsempha Kupendekera kwa lumen ndi zolembera nthawi zambiri kumawonedwa pamalo opangira nthambi yayikulu kapena kuyigawa ngati nthambi zoyamba ndi zachiwiri. Nthawi zambiri njirayi imakhala mbali imodzi, nthawi zambiri - ziwiri. Mu impso, mwina mwa madambo ophatikizika a parenchyma atrophy amakula ndi kuwonongeka kwa malo ndi malo amtunduwu, kapena vuto la mtima ndi gulu lawo lotsatira ndikupanga zipsera zolakwika. Coarse atherosclerotic khansa impso (atherosulinotic nephrossteosis), yemwe ntchito yake imakhala yochepa, popeza nthawi yambiri ya parenchyma imakhala yolimba. Chifukwa cha aimpso minofu ischemia, nthawi zina, stenotic atherosulinosis ya mitsempha yaimpso imayamba. Hypertatic (aimpso) matenda oopsa.

Matenda a m'matumbo, zovuta ndi thrombosis, kumabweretsa gangrene wamatumbo ndi chitukuko cha peritonitis. Mitsempha yapamwamba kwambiri ya mesenteric nthawi zambiri imavutika.

Ndi atherosulinosis ya mitsempha ya miyendo Nthawi zambiri mitsempha yachikazi imakhudzidwa. Mchitidwewu ndi wa asymptomatic kwa nthawi yayitali chifukwa cha makongoletsedwe. Komabe, ndikukula kwakukwanira kwa mabatani, kusintha kwa atrophic mu minofu, kuzirala kwa miyendo kukulira, kupweteka kwa mawonekedwe kumawonekera poyenda - kulowerera pang'ono. Ngati atherosulinosis ndi zovuta ndi thrombosis, gangrene wa miyendo akufalikira - atherosulinotic gangrene.

Pathological anatomy ndi morphogeneis

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.

Magawo otsatirawa a atherosulinosis morphogeneis amadziwika:

Gawo la Dolipid macroscopically osatsimikiza. Ma Microscopically:

1) kuwonongeka kwakuya (mpaka kuwononga kwathunthu) kwa endothelium ndi kuwonjezereka kwa ziphuphu zakumaso kwambiri, zomwe zimabweretsa kuchuluka kwa mapuloteni a plasma, fibrinogen (fibrin) mkati mwa membrane wamkati ndi mapangidwe a parietal thrombi,

2) kudzikundikira kwa acidic glycosaminoglycans mkatikati, kutupira kwamkati mwa membrane wamkati, mawonekedwe ake mumakhala ochepa komanso otsika kwambiri a lipoproteins, cholesterol, mapuloteni,

3) Kuwonongeka kwa zotanuka ndi zotupa za collagen, kuchuluka kwa minofu yosalala.

Gawo la lipoidosis yodziwika ndi kuyika zolimba kwambiri kwa lipids (cholesterol), lipoproteins, zomwe zimatsogolera pakupanga mawanga am'mafuta (lipid) ndi magulu. Macroscopically, mawanga amafuta oterowo amawoneka ngati malo achikasu omwe nthawi zina amatha kuphatikizana ndikupanga mikwingwirima yotalikirana kwambiri 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.

Ndi liposulinosis fibroblasts imachulukana, kukula kwake komwe kumalimbikitsa chiwonongeko cha 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. Malo amenewa amachepetsa lumen, yomwe imayendera limodzi ndi kuphwanya kwa magazi (ischemia) kupita ku chiwalo kapena gawo limodzi.

Ndi atheromatosis milomo ya lipid yomwe ili mkati mwa chigawo ndi collagen moyandikana ndi ulusi wamankhwala amasiya. 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. Akubwera ulceration sitejilimodzi 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 yodziwika ndi kufalikira kwa mchere wamchere mu zigawo za 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. Mapilala amakhala ndi miyala yolimba, khoma la chotengera pamalo operekera petraro ndi lopunduka kwambiri. Mchere waku calcium umayikidwa mu ma atheromatous masheya, mu minofu ya fibrous, muzinthu zamkati pakati pa ulusi wokulira.

Mavuto a atherosulinosis. 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.

Mitundu ya matenda ndi morphological

Aortic Atherosulinosis - Uwu ndi mtundu wofala kwambiri wamatenda. Kusintha kochititsa chidwi kwambiri kwa atherosulinotic kumasonyezedwa m'mimba ndipo nthawi zambiri amadziwika ndi atheromatosis, zilonda zam'mimba, komanso atherocalcinosis. Zotsatira za thrombosis, thromboembolism, ndi embolism mwa ma atheromatous misa omwe ali ndi aortic atherosulinosis, matenda a mtima (mwachitsanzo, impso) ndi gangrene (mwachitsanzo, matumbo, miyendo yam'munsi) nthawi zambiri amawonedwa. Ndi atherosclerosis, aneurysms nthawi zambiri amakula mu msempha. Pali ma cylindrical, sacular, herniated aortic aneurysms. Kapangidwe ka aneurysm ndi kowopsa chifukwa chotumphuka komanso magazi ake. Aortic aneurysm yomwe yakhalapo kwa nthawi yayitali imatsogolera pakuwonekera kwa minofu yoyandikana (mwachitsanzo sternum, matupi a vertebral).

Matenda a mitsempha ya mtima chimayambitsa matenda ake a ischemic (onani. matenda a mtima).

Matenda a mitsempha ya muubongo ndi maziko a matenda amitsempha yamagazi. Kutalika kwa nthawi yayitali ya chithokomiro chifukwa cha stenotic atherosulinosis ya mitsempha yam'mimba kumayambitsa dystrophy ndi atrophy ya ubongo cortex, kukula kwa kuchepa kwa mtima kwa ubongo.

Ndi atherosclerosis ya aimpso mitsempha Kupendekera kwa lumen ndi zolembera nthawi zambiri kumawonedwa pamalo opangira nthambi yayikulu kapena kuyigawa ngati nthambi zoyamba ndi zachiwiri. Nthawi zambiri njirayi imakhala mbali imodzi, nthawi zambiri - ziwiri. Mu impso, mwina mwa madambo ophatikizika a parenchyma atrophy amakula ndi kuwonongeka kwa malo ndi malo amtunduwu, kapena vuto la mtima ndi gulu lawo lotsatira ndikupanga zipsera zolakwika. Coarse atherosclerotic khansa impso (atherosulinotic nephrossteosis), yemwe ntchito yake imakhala yochepa, popeza nthawi yambiri ya parenchyma imakhala yolimba. Chifukwa cha aimpso minofu ischemia, nthawi zina, stenotic atherosulinosis ya mitsempha yaimpso imayamba. Hypertatic (aimpso) matenda oopsa.

Matenda a m'matumbo, zovuta ndi thrombosis, kumabweretsa gangrene wamatumbo ndi chitukuko cha peritonitis. Mitsempha yapamwamba kwambiri ya mesenteric nthawi zambiri imavutika.

Ndi atherosulinosis ya mitsempha ya miyendo Nthawi zambiri mitsempha yachikazi imakhudzidwa. Mchitidwewu ndi wa asymptomatic kwa nthawi yayitali chifukwa cha makongoletsedwe. Komabe, ndikukula kwakukwanira kwa mabatani, kusintha kwa atrophic mu minofu, kuzirala kwa miyendo kukulira, kupweteka kwa mawonekedwe kumawonekera poyenda - kulowerera pang'ono. Ngati atherosulinosis ndi zovuta ndi thrombosis, gangrene wa miyendo akufalikira - atherosulinotic gangrene.

Kodi atherosulinosis ya ziwiya zamagawo akumunsi ndi chiyani?

Mitsempha yosakhudzidwa ndi kapangidwe ka atherosulinotic imakhala ndi chidziwitso chokwanira pakuyenda koyenda m'magazi, komwe kumapereka chakudya kwa ziwalo zonse zomwe mtima wamagazi umapereka.

Zilonda zam'matumbo za mitsempha yomwe imatsogolera kumapeto pang'ono ndizotsatira zamadzimadzi a lipid pazomwe zimayambira choroid.

Gawo loyambirira la atherosulinosis (malo okhawo a lipid omwe amapangika m'malo ophatikizana) ndi gawo lomwe atherosulinosis imatha kuyimitsidwa popanda kugwiritsa ntchito kuchuluka kwa mankhwala.

Gawo ili limayamba popanda zizindikiro zotchulidwa ndipo amapezeka mwangozi, momuyesa mayeso.

Ngati simumasungunula mafuta banga munthawi yake, zimachulukana ndipo cholembera wa cholesterol umapangidwa, chomwe chimapangidwabe.

Komanso, ndimankhwala, amatha kusungunuka popanda kuvulaza chotengera chomwe chimapezeka lipid.

Pakadali pano chitukuko cha matenda am'mitsempha, kuwala kwa mitsempha kumachepa, komwe kumayambitsa zovuta pakuyenda kwa magazi m'gawo lothinitsidwa komanso kusokonekera kwake.

Mitsempha yamagazi imayamba kuvutika ndi vuto la kuperewera kwa okosijeni ndi michere, ndipo nembanemba zimataya mphamvu.

Gawo la atherocalcinosis ya omwe akukhudzidwa ndi mitsempha

Mamolekyulu a calcium amawonjezeredwa ndi kuchuluka kwa cholesterol m'ndimezi, zomwe zimapangitsa kuti zolembazo zikhale zovuta. The matenda a intravascular atherocalcinosis akufotokozera.

Atherocalcinosis imatsogolera kayendedwe ka magazi mkati mwa mitsempha yayikulu, yomwe imayambitsa kufa kwa magazi ndi ziwalo, zomwe zimawopseza hypoxia ya zimakhala, ndipo imatha kutenga gawo lovuta la maselo a minofu ofunikira.

Gawo ili lachitukuko chamatenda owopsa ndizowopsa kwa moyo wa munthu.

Komanso chikhodzodzo cha atherosselotic, chomwe chili ndi mamolekyulu a calcium, chimatha kudzipatula ku choroid, chomwe chimayambitsa matenda am'mitsempha ndipo chimatha kutsogolera ma occlusion.

Ischemia ya minyewa yam'magazi, yomwe imapereka magazi ku mitsempha yomwe imakhudzidwa ndi atherosulinosis, imabweretsa ululu m'munsi m'munsi mukamayenda ndipo imatha kudzetsa matenda amiyendo, kutsutsana pang'ono.

Kupita patsogolo kwa matenda am'mimba kumayambitsa kugundana kwa ziwalo zomwe zakhudzidwa, komanso zilonda zam'mimba, zomwe zimayamba chifukwa chodulidwa mwendo.

Kupanga minofu ya ischemia ndipo kuwonongeka kwa mitsempha kumabweretsa kupweteka m'miyendo. Kupitilira kwa matenda, kapena kusalandira bwino, kumabweretsa zilonda zam'mimba ndi ziwengo zam'manja.

Atherosulinosis ya ziwiya zamagetsi m'munsi, amuna amadwala kwambiri kuposa amayi (koposa nthawi 8). Matendawa amapezeka mwa amuna omwe ali ndi zaka zopitilira 60, koma nthawi zina mwa azaka 40 zakubadwa njira imeneyi imayamba kupita patsogolo.

Atherosulinosis ya ziwiya kumadera otsika, amuna amadwala kwambiri kuposa azimayi

Zimayambitsa atherosclerosis mu mitsempha ya miyendo

Mitundu yododometsa ya mitsempha ya mitsempha yam'mitsempha yam'munsi yam'munsi imachitika ndikukula mothandizidwa ndi zinthu zingapo zoyambitsa kukopa.

Pali zifukwa zomwe zimadalira moyo wa munthu ndi matenda ake osachiritsika, palinso zinthu zina zoyambitsa matenda atherosulinosis zomwe zimachitika mosaganizira momwe munthu amakhala, chakudya chake komanso kupezeka kwa zoyipa ndi zosokoneza:

• Matenda obadwa nawo. Ndi ma genetic code, munthu amaperekedwanso ku mawonekedwe a thupi kuti akwaniritse cholesterol, chifukwa cha kuphwanya kwa lipid metabolism, komanso kapangidwe ka choroid. Mothandizidwa ndi genetics, momwe munthu amakhudzira mphamvu ya chitetezo cha m'thupi la munthu komanso magwiridwe ake a chitetezo chake. Zonsezi zimabweretsa atherosulinosis,
• Zinthu zomwe amakonda kwambiri osokoneza bongo. Nicotine amatha kuyambitsa magawo a choroid, omwe amasakanikirana ndi magazi m'mitsempha ndikupangitsa kukokomeza magazi. M'magazi okhazikika, mamolekyulu a cholesterol amasungidwa pamakoma. Zakumwa zoledzeretsa, komanso zinthu zosokoneza bongo, zimasintha msanga kapangidwe kake ka choroid, ma microcracks amawonekeramo, komanso malo omwe amatulutsira kunja kwa khoma lamkati, lomwe limakhala malo abwino achitetezo a lipid malo, omwe pambuyo pake amadzakhala cholembedwa cha atherosselotic.
• Kutupa m'mimba yamitsempha yamagazi, amathanso kukhumudwitsa atherosulinosis mu miyendo, chifukwa cha kuphwanya magazi m'dera lodzala ndi mzere wamitsempha, zomwe zimapangitsa kuti pakhale ma lipoproteins otsika kwambiri pamphaka.
• Zinthu Zoyambitsa awa ndi mikhalidwe yovuta ya m'maganizo yomwe imatenga nthawi yayitali. Ndi kusokonezeka kosalekeza, kupindika kwam'mimba kumachitika, zomwe zimapangitsa kuti makoma amitsempha amawonongeka ndipo atherosulinosis imayamba,
• Kuchita masewera olimbitsa thupi komanso kunenepa kwambiri. Ma pathologies awiriwa amalumikizana komanso amachititsa kuti maselo amafuta azikhala othamanga. Ndi magazi ofooka, malo a lipid amalowa m'magawo ang'onoang'ono am'mimba, zomwe zimapangitsa kuti pakhale kuchuluka kwa lipoproteins m'malo ano, komwe makhiristo amtundu wa calcium amaphatikizika, ndi atherosulinosis ya gawo ili la mitundu ya mitsempha.

Chiwopsezo chotenga matenda amitsempha yamagazi amatuluka kutengera zaka za munthu, komanso kuchuluka kwa zomwe wodwala ali nazo.

Nicotine amatha kuyambitsa magawo a choroid, omwe amasakanikirana ndi magazi m'mitsempha ndipo amachititsa kuti magazi asokonekere

Matenda osachiritsika

Matenda omwe angayambitse matenda ophatikizira zigoba zam'magawo am'munsi:

• Matenda a lipid metabolism dyslipidemia. Zimatengera kuti ma lipoprotein otsika kwambiri ndi triglyceride mamolekyu amayambira molekyulu ya cholesterol. Pali kutsika kosalekeza kwa% mu molekyulu ya cholesterol yama lipoproteins apamwamba kwambiri. Kapangidwe kakang'ono kamene kamakhala ndi cholesterol kamene sikumagwirizana ndi kayendedwe kake ndipo kumangokhala pakumaluka kwamizere, kupatsirana kwa atherosulinosis
• Matenda a Endocrine. Hyperglycemia imawononga tinthu tating'onoting'ono ta nembanemba. Kukhulupirika kwamkati mwa chotengera kumatayika. Ndi kuchuluka kwa cholesterol, mapepala amakhazikika pamitsempha,
• Matenda oopsa, imadzetsa kuchepa kwa choroid, komwe kumapangitsa kutsika kwa magazi kulowa pang'onopang'ono, ndipo izi zitha kukhala chifukwa cha matenda a manja.
• NdipoZowopsa komanso zowononga ma virus mthupiAmatha kuyambitsa matenda a lipid metabolism m'thupi, ndikuyambitsa sclerotherapy ya nembanemba am'mitsempha.

Miyezo ya chitukuko

Pali magawo anayi a chitukuko cha matenda amtundu wa atherosulinosis, omwe amawonetsedwa ndi zizindikiro:

Gawo la m'munsi miyendo ischemia

Zizindikiro za atherosulinosis obliterans

Kuyang'anitsitsa miyendo

Kuti mupeze kuzindikira koyenera kwa kusintha kwa ma atherosselotic m'mitsempha ya miyendo, ndikofunikira kuzindikira mozungulira mtsempha wamagazi ndi stenosis, komanso ma capillaries onse a zotumphukira zamagazi m'miyendo:

Kugwiritsa ntchito njira zodziwikirazi kumatha kuzindikira matenda am'munsi, komanso kudziwa kuchuluka kwa matenda am'mitsempha.

Atherosulinosis stenosing njira zochizira

Therapy ya atherosulinosis imasankhidwa ndi dokotala mosasamala. Ndikofunikira kwambiri munthawi yamankhwala kuti muchepetse zinthu zonse zomwe zingayambitse kukula kwamitsempha yama miyendo.

Mankhwala othandizira

Opaleshoni yam'mimba

Kupewa

Pofuna kupewa misempha ya mtima m'magawo otsika, prophylaxis ikugwiritsidwa ntchito:

• Kukana kusuta kwa chikonga,
• Osamamwa mowa
• Khalani ndi moyo wokangalika ndi kuchita nawo masewera olimbitsa thupi,
• Mwalimbikitsa kulowa dziwe,
• Kuyenda musanagone mu mpweya wabwino kumakupatsani mwayi wothana ndi zovuta zamaganizidwe.
• Tsatirani zakudya zopatsa thanzi ndi zakudya zamafuta ochepa,
• Zakudya ziyenera kuonedwa, komanso regimen ya tsiku ndi tsiku, chakudya chimatengedwa osachepera 5 patsiku m'magawo ang'onoang'ono, ndipo nthawi yochita zolimbitsa thupi ndi nthawi yopumira iyenera kusinthidwa.

Njira zodzitetezera ziyenera kuchitika kwa anthuwa kwa moyo wonse.

Mbiri ya moyo

Vasel sclerosis m'munsi yotsika ndi njira yomwe imadutsa yoposa chaka chimodzi, ndipo mwina zaka khumi. Kuti mupewe mtundu wovuta wa atherosulinosis, ndikofunikira kuti nzika, makamaka amuna, azitha kuyang'aniridwa ndi mitsempha yamagazi pambuyo pa zaka 30 zakubadwa.

Pokhapokha pasanayambike pakuwonetsa matenda a limbicherosis, matendawa ndi abwino.

Kuzindikira pambuyo pake kumadzetsa mfundo yakuti kumakhala kovuta kwambiri kusintha komwe kumachitika m'mitsempha, komanso kufooketsa ziwopsezo zam'munsi kumayamba mwachangu ndipo kumatha kudula dzanja.

Zomwe zimachitika m'tsogolo pano.

Limagwirira a chitukuko cha matenda

Mawu akuti "atherosulinosis" akuwonetsa tanthauzo la matendawa. Zimatanthawuza kuti kuchuluka kwa lipid kumawonekera mu lumen ya ziwiya, zomwe pakapita nthawi zimakula ndi minyewa yolumikizana, yomwe imasowetsa chotengera.

Matendawa samakhudza ziwiya zonse, koma mitsempha yokha komanso zotanuka zokha komanso zotupa, zomwe zimaphatikizapo mitsempha yayikulu komanso yayikulu. Mitsempha yaying'ono siyikhudzidwa ndi matendawa.

Monga matenda aliwonse, pathanatomy ya atherosulinosis ili ndi magawo ake a chitukuko, omwe amalolera wina ndi mnzake:

• Malo amafuta ndi gawo loyamba la chitukuko. Malo awa sawoneka m'makoma amitsempha popanda chosakanikirana ndi utoto wotchedwa Sudan, ndipo musatulutse pamwamba pa chimfine. Choyambirira ndicho kuwonongeka kwa khoma lakunja kwa msempha. Izi zikuchitika chifukwa chakukakamizidwa kwambiri mmenemo. Pakapita nthawi, chidendene chimatha kulowa m'mizere, kuphatikiza ndi zotupa zapafupi.
• Zilala zowoneka bwino ndizochita zachikasu zomwe zimatuluka mu chithaphwi cha mtsempha. Amakhala ophatikizika ndipo amakhala ndi chitukuko chosiyana, chifukwa chake, chotengera chomwe chakhudzidwacho chimakhala ndi mawonekedwe owoneka bwino pamakonzedwe a pathomorphological. Nthawi zambiri, m'mimba komanso thoracic aorta, mitsempha ya impso, mesenteric mitsempha, komanso minyewa yam'munsi yam'munsi imakhudzidwa.
• Mavuto omwe amachitika pamalo opezeka zolembedwazo akuimiriridwa ndi kuphwanya kwa milomo ya lipid. Izi zimabweretsa kukha mwazi, mapangidwe a magazi ndi zilonda zam'mimba. Pambuyo pa izi, kufalikira kwa ziwiya zazing'ono za thupi kumachitika ndi kukula kwa njira za pathophysiological - necrosis kapena kugunda kwa mtima.

Kupachikidwa ndigawo lomaliza la zomwe zikuchitika. Pakadali pano, mchere wamkati umayikiridwa, zomwe zimapangitsa kuti zolembedwazi zikhale zonenepa. Izi zimayipitsa chotengera, zimapangitsa kuti ntchito yake ithe ndikuwonongeka kwa magazi.

Calcation wa atherosulinosis amathandizidwa kuchipatala cha opaleshoni.

Kupenda ma Microscopic

Ndikakuyang'anirani pang'ono, mutha kuganiza za kusintha kwa zinthu zina. Kusintha konse mu ziwiya zosiyanasiyana kumakhala kosiyana. Njirayi imadziwika ndi kutsatira momveka bwino komanso magawo.

Amalumikizidwa ndi pathological anatomy:

1. Gawo la Dolipid - limadziwika ndi kusintha kwa kagayidwe kazomwe kamayambitsa kukula kwa zolengeza. Uku ndikuwonjezereka kwa kuchuluka kwa cholesterol ndikuchepa kwa chiwerengero cha lipoproteins yapamwamba.Kuphatikiza apo, imakhala ndi zotupa khoma la mtima, kutupa, edema, kudzikulunga ndi ulusi wa fibrin ndikuwonongeka kwa endothelium (mkati mwa maselo), zomwe zimapangitsa kuti pakhale mawanga a lipid. Gawoli limatha kukhala miyezi ingapo mpaka zaka zingapo.
2. Lipoidosis amadziwika ndi kuphatikizika kwa lipid pamtunda wonse wamadzi, pomwe mawanga amakonda kuphatikiza, omwe amakulitsa dera lomwe lakhudzidwalo. Mafuta, odzikundikira m'maselo, amasintha kapangidwe kake, amatembenuka chikasu ndipo amatchedwa xanthomas.
3. Lipossteosis - yodziwika ndi kukula kwamphamvu kwa maselo a xanthoma, omwe amatsogolera kutupa kwawo mu lumen ya chombo. Fomu lamkaka lamkati. Ali ndi mitsempha yake yamagazi yomwe imamudyetsa. Umu ndi momwemo ngati zotupa zoyipa.
4. Atheromatosis - zolembera kuwola. Nthawi zambiri amayamba pakati, pang'onopang'ono kusunthira kufupi.

Gawo lomaliza, atherocalcinosis, ndikumanga kwa calcium ayoni kwa magulu a carboxyl omasuka omwe amapangika pakavunda. Calcium phosphate imapangidwa, yomwe imakonzekera.

Kudalira Kwachipatala pa Kutukuka

Atherosulinosis imatchulidwa molingana ndi kutchukitsa.

Anatomically, mitundu ingapo ya matenda am'mimba imasiyanitsidwa, kutengera bedi lamitsempha lomwe lakhudzidwa.

Mu thupi pali mitundu ingapo ya mabedi amitsempha omwe amakhudzidwa ndi njira ya pathological.

Zida zomwe zimapezeka m'mawu:

• The aorta ndiye chotengera chachikulu m'thupi. Nthambi zambiri zing'onozing'ono zimachoka kwa icho kuchokera ku ziwalo zosiyanasiyana. Nthawi zambiri kuposa ena, kumimba kumakhudzidwa. Popeza aorta imakhala ndi zovuta zambiri, nthawi zambiri imakhala ndi zovuta zingapo: thromboembolism, vuto la mtima, gangrene. Nthawi zambiri amakhala ndi aneurysm - uku ndiko kuswa kwa khoma la msempha ndikutukuka kwa matumba amwazi ndi ma sacs, momwe magazi amadziunjikira. Panthawi inayake, khoma la aneurysm limasweka, mawonekedwe okhetsa magazi kwambiri ndipo munthu amafa pakapita mphindi.
• Atherosulinosis ya chotupa cha mtima ndi matenda oopsa, omwe pafupifupi 100% ya milandu imabweretsa kubadwa kwa myocardial infarction, chifukwa kuphwanya kwa magazi kumtima komanso kuchepa kwa okosijeni kwa myocardium.
• Atherosulinosis ya mitsempha yaubongo imatsogolera kukulitsa kwa ischemic stroke, yomwe imapangidwa chifukwa chotseka kuthamanga kwa magazi m'chigawo china cha ubongo. Komanso, chifukwa cha njala yayitali ya okosijeni, hypoxia ya cortex yam'mimba imayamba, mphamvu yake ya mtima komanso kukula kwa dementia kapena dementia. Nthawi yomweyo, munthu amalephera kuganiza, njira yoloweza pamtima imasokonekera.
• Atherosclerosis ya mitsempha ya impso imayambitsa kuchepa kwa kupezeka kwa mpweya wawo. Chifukwa cha izi, impsoyma ya impso imayamba kuzimiririka, ma nephrons amafa, ndipo kulephera kwa impso kumayamba. Komanso kuwonongeka kwa mitsempha ya impso kumabweretsa kukula kwa chiwonetsero chazira, pamene dongosolo la renin-angiotensin, lomwe limayang'anira kuthamanga kwa magazi, limagwira nawo ntchito.
• Kuwonongeka m'matumbo amitsempha kumabweretsa ischemia yake yayitali. Mapeto ake, necrosis imayamba, yomwe imayambitsa kutupa kwa peritoneum kapena peritonitis.

Atherosulinosis ya mitsempha yachikazi imathanso kukhala m'thupi. Uku ndikuyenda pang'ono. Amadziwikanso ndi kukhazikika kwa kolala yamitsempha yowonjezera, komabe, ndi kufalikira kwathunthu kwa mtsempha wamagetsi, necrosis ndi gangrene kumayamba, komwe kumawopseza kudula dzanja.

Zofooka zingapo mu khoma la mtima

Atherosulinosis ndi osowa mu mtsempha uliwonse. Nthawi zambiri pamakhala mafupa angapo owumba. Poterepa, hemodynamics ya thupi lonse la munthu imavutika. Zizindikiro za multifocal atherosulinosis zitha kukhala zosiyanasiyana, kutengera malowa.

Msempha ukawonongeka, ululu umatha kusunthira - kuchokera pachifuwa kupita m'mimba, kudzipangitsa kukhala ngati matenda amtima wamitsempha, neuralgia, gastritis, chapamimba kapena duodenal ulcer, enteritis.

Ngati magazi atha kumalekezero amakhudzidwa, pakhoza kukhala ndi chizindikiro cha kusokonezeka kapena kutayidwa.

Cerebral atherosulinosis imawonetsedwa ndi kupweteka kwam'mutu komanso kukumbukira. Zizindikiro zonsezi zimatha kuphatikizana, kukhala zofanana ndi matenda osiyanasiyana, ndikupangitsa kuti chithandizo chazachipatala chizivuta.

Makina amakina otulutsa magazi ndi kutuluka kwa magazi. Kwa mtima, uku ndi kusakhazikika kwa angina, komwe kumawonetsedwa ndi kupweteka kumbuyo kwa sternum panthawi zosiyanasiyana za tsiku ndikudutsa pawokha patapita kanthawi.

Panthawi yaubongo, uku ndikuwukira kwakanthawi, komwe kumawonetsedwa ndikudutsa kwamaubongo: kulephera kukumbukira, kusokonezeka kukumbukira kukumbukira ndi zolakwika zamagalimoto.

Chifukwa cha kuwonongeka kwa ziwiya zam'munsi, kulumikizana kumayamba. Ichi ndi chikhalidwe pamene ululu umapezeka mu mwendo wokhudzidwa ndikuyenda kwakutali.

Kuphatikiza apo, kulimba kwambiri, kufupikirako mtunda ndikofunikira kuti pakhale zovuta.