Inqubo ye-atherosclerotic ibonakala ngokwakhiwa kwezixuku ze-atheromatous emgodini wemithambo yegazi, ikakhulukazi enkulu naphakathi ububanzi, okuvimba ukuhamba kwegazi kwizitho nezicubu, i-hypoxia ne-ischemia yezindawo ezithintekile.
Lesi sifo sibonisa abantu asebekhulile, kepha kungenzeka ukuthola izimpawu zokuqala zomonakalo ezinganeni nasebusheni.
Akukona ngaso sonke isikhathi ukuthola ukuthi kukhona i-pathology ngendlela esifike ngesikhathi, kepha uma kutholakala ukuthi kukhona ukwephula umthetho kungenzeka ukuthi kungenzeka kube nomphumela obalulekile enkambeni yalesi sifo.
Ngesikhathi sokuphulwa okutholakele kanye nokusetshenziswa okufika kwesikhathi kwenkambo eyanele yokwelapha, kungathonya inkambo yesifo, kunciphise ubungozi bokuthola izinhlobo ezinzima.
Umphumela onjalo emzimbeni uvimbela ukuvela kwezinkinga - ukuphazamiseka kokujikeleza kwengqondo okubucayi, i-angina pectoris, infarction ye-myocardial, ukuqothuka kwemithambo yethambo lomlenze ophansi nokwenzeka kwe-gangrene.
Izimbangela ze-Atherosclerosis
Njengamanje esigabeni samanje sokuthuthuka kwesayensi, izimbangela zokuthuthuka kwe-atherosclerosis emzimbeni azikasungulwa ngokuthembekile. Futhi, indlela enikela ekubukekeni kwe-pathology ayikasungulwa ngokuthembekile.
Izici ezibekwe engcupheni ezenzelwe ukuthuthukiswa kwe-atherosclerosis, ukuba khona kwayo okunyusa kakhulu amathuba wokuphazamiseka kwengqondo. Zonke izinto ezisengcupheni zingahlukaniswa ngamaqembu amaningana - ezingashintshashintshwa futhi zingashintshwa.
Izici ezingashintshwa zifaka:
- I-Hyperlipidemia ngenxa yokwanda kokudla kwamafutha ezilwane, ukudla okuphezulu ku-cholesterol, ukunganakwa kwemikhiqizo yefayibhu nemikhiqizo yobisi.
- Ukwephulwa kokwethembeka kodonga lwama-vascular ngenxa yemikhuba emibi - ukuphuza ngokweqile, ukubhema.
- Ukungasebenzi kahle komzimba, noma okuphambene nalokho, ukuba khona komzimba osindayo.
- Ukuba khona komfutho wegazi ophakeme noshukela.
- Ezinye izimbangela zezifo ezithathelwanayo noma i-endocrine (hypothyroidism, Itsenko-Cushing's syndrome), ukulimala.
Izifo ezingashintshi zifaka:
- iminyaka - ingozi yentuthuko inyuka ngemuva kweminyaka engama-45 - 50;
- ubulili - abesilisa bathambekele kakhulu ekuqaleni kwalesi sifo, njengoba ama-hormone ocansi abesifazane eba nomphumela wokuvikela;
- ukuphazamiseka kwefa lemvelo - umndeni dyslipidemia, homocysteinemia.
Ukuxilongwa kokuqala kuqala ngokuqoqwa okuphelele kwe-anamnesis (umlando) wokuphila, okubandakanya imininingwane ngezifo ezedlule, ukulimala nokuhlinzwa, ukuba khona komkhuba womndeni wezifo zenhliziyo.
Umlando walesi sifo ubaluleke kakhulu - ukuqala, izimpawu zokuqala, ubude bawo kanye nemvelo, kuphakama umbuzo wokuthi ngabe isiguli sihlobanisa ukuqala kwezimpawu nokunye, isibonelo, ukuxilongwa nokwelashwa okwenziwe ngaphambili, imiphumela yazo.
Izimpawu zezilonda ze-atherosulinotic
Izimpawu zenqubo ye-atherosulinotic zincike esikhathini sokuthuthuka kwenqubo ye-pathological, indawo okuyo kanye nezinga lokuqhathaniswa kwe-artery cavity kanye ne-degree of insuffuff of the shipping.
I-Coronary atherosulinosis, noma i-angina pectoris ezinzile, inezimpawu ezilandelayo - ubuhlungu obucindezelayo besikhathi esithile ngemuva kwe-sternum, tachycardia ne-arrhythmias.
Nge-atherosclerosis ye-aorta (isikejana esikhulu kunazo zonke emzimbeni), ukubonakaliswa okunjalo kuyabonakala - ukwanda okuqhubekayo kwengcindezi yegazi, umuzwa ovuthayo, ukukhasa ezandleni nasezinyaweni, isikhumba sokwehla kwezinga eliphansi, ukuncipha kokuzwela kwabo, ukuthokomala nobuhlungu besisu.
Ukulimazeka emithanjeni yamakhemikhali kubonakaliswa ikhanda, isiyezi, i-tinnitus, ukuncipha kwenkumbulo kanye namakhono okuqonda, ukwanda kwengcindezi ye-intracranial.
Ubunzima bezinyathelo zokuxilonga kufaka phakathi izifundo zaselaborathri kanye nezinsimbi.
Ilabhorethri ifaka izindlela zokuhlaziya zomtholampilo nezejwayelekile.
Ezicacisiwe zibandakanya ukubalwa kwegazi okujwayelekile nokubalwa kwamaseli amhlophe egazi, i-urinalysis ejwayelekile, kanye noshukela osheshayo.
Okucacisiwe ukuhlaziya kwe-biochemical nokuzimisela kwe-lipid spectrum, i-electrophoresis yama-serum lipoproteins, ukubala izinga le-protein-plasma apo-B, izindlela zokuxilonga izifo kanye nokuzimisela kwe-coagulogram.
Ukuxilongwa okujwayelekile kwelebhu yemitholampilo
Ukuhlolwa kwegazi kunquma izinga le-hemoglobin, inani lamangqamuzana egazi abomvu, amapulatelethi namaseli amhlophe egazi ngevolumu yiyunithi ngalinye, kanye nesilinganiso se-erythrocyte sedimentation rate (i-SOE).
Igazi lokuhlaziywa lithathwa ekuseni kusisu esingenalutho, imiphumela ihlala isilungile emahoreni ambalwa.
Kulolu hlaziyo, ukuba khona kwe-atherosclerosis kungakhonjiswa ngokwanda kwe-SOE - inkomba yokuphendula kokuvuvukala (okujwayelekile kwabesilisa kufinyelela ku-1 kuye ku-10 mm ngehora, kwabesifazane - kusuka kwabangu-2 kuye ku-15). Kumele kukhunjulwe ukuthi le nkomba ayicacile, futhi akunakwenzeka ukuthi kutholakale ukuthi kukhona ukwephulwa kwamafutha emzimbeni.
Ekuhlaziyweni komchamo, kunqunywa imingcele enjalo - umbala, ukuvela obala, amandla adonsela phansi athile, ukuba khona kwamaprotheni, ushukela, usawoti kanye nezinto ezengeziwe - amaseli, imikhiqizo yokubola, ama-enzyme.
Isikhombi esingakhombisa ukungasebenzi kahle kwemetabolism kanye nemetabolism yemisipha yenhliziyo yi-lactate dehydrogenase (LDH).
Le enzyme ingumkhiqizo ophula ushukela, ubukhona bayo emchameni bukhombisa i-cardiac ischemia noma i-myocardial infarction.
Izinga le-glucose linqunywa ekutholakaleni kokuqala kwesifo sikashukela, ukukhulisa ukubekezelela ushukela nezinye izifo ze-endocrine, inkomba ejwayelekile isukela ku-3.3 kuya ku-5.5 mmol.
Ukwanda kwe-glucose kukhombisa ukukhula kwesifo sikashukela i-mellitus, esingenzeka ngesifo senhliziyo nesifo sokuqina kwemithambo yegazi.
I-Special Clinical Laboratory Diagnostics
Ukuhlolwa okuqondile kokuqanjwa kwe-atherosulinosis kwenza ukuthi ukwazi ukunquma ngokunembileko ubukhulu kanye nohlobo lwezinguquko ku-lipid metabolism, ukuba khona kwe-dyslipidemia yomndeni kanye nokuqina kwe-atherogenicity.
Ukuhlolwa kokuqala okuqondile ukukhonjwa kwesimo se-lipid spectrum noma ukunqunywa kwe-cholesterol ephelele kanye nezingxenyana zayo.
Izinkomba eziphambili ze-lipids yizinga le-cholesterol ephelele, inani lamandla aphansi we-lipoproteins (ingxenyana ye-atherogenic), inani lama-lipoproteins aphezulu (antiatherogenic), triglycerides, chylomicrons.
Imvamisa, izinga le-cholesterol ephelele isukela ku-3.1 kuya ku-5 mmol ngelitha, ingxenye ye-HDL ayikho ngaphansi kwe-1 mmol ngelitha, okuqukethwe kwe-LDL ne-VLDL kufinyelela ku-3 mmol, ama-triglycerides afika ku-1,7 mmol.
Ukwanda kwazo zonke izinkomba, ngaphandle kwe-HDL, kukhombisa ukwephulwa kwe-lipid metabolism kanye nethuba eliphakeme lokuqhakambisa i-atherosulinosis ngomkhawulo obonakalayo wokujikeleza kwegazi ngisho nokuqothuka komthambo. Futhi, ukwanda kwe-triglycerides iyodwa kuyinkomba engathandeki, ekhombisa ukuthuthukiswa kwe-angina pectoris kanye nesifo sikashukela i-mellitus.
I-plasma electrophoresis yenziwa ukuthola amazinga ama-lipoprotein - amaprotheni ezokuhambisa aphethe amafutha. Nge-hyperlipidemia, inani lama-lipoproteins aphansi futhi aphansi kakhulu, futhi i-HDL, kunalokho, iyancishiswa. Lokhu kuhlaziywa akudingi ukulungiswa okukhethekile, kungenzeka kungenziwa ngesisu esingenalutho, igazi le-venous lisebenza njengokuqukethwe.
Ukuqina kwe-atherogenicity kunqunywa - inani le-HDL likhishwe kunani lama-lipids eliphelele futhi umphumela uhlukaniswe ngenani le-lipids ephezulu kakhulu.
Amanani ajwayelekile ale nkomba afinyelela kumayunithi ama-3.
Izinga lokubambisana kusuka ku-3 kuye ku-4 lisho ubungozi obukhulu bokuthuthukisa i-pathology yesistimu yezinhliziyo, ukwanda kwezilonda ezingaphezu kwe-5 - imithambo ye-atherosulinotic yemithambo yomzimba isivele isiqalile.
I-Apo-B-lipoprotein iprotheni yokuhamba edlulisa ama-triglycerides esuka emathunjini iye esibindini ngokwakhiwa kwezakhi zamafutha endo native.
Okujwayelekile kwabesilisa kusuka ku-60 kuye ku-138 mg / dl, kwabesifazane - 52 - 129.
Ngokwenyuka kwezinga layo, ngokulandelana, ama-triglycerides uqobo nawo andiswa, okuwuphawu olungathandeki lwezempilo.
Izindlela zokuxilonga ze-Immunological kanye ne-enzyme ezixhunyiwe ze-immunosorbent zenza ukuthi kunqume ukuba khona kwama-antibodies kanye nokujikeleza kwezifo zokuzivikela zomzimba. Ukuthuthukiswa kwezifo zenhliziyo kuhlotshaniswa nokuba khona kwe-plasma of antibodies to cardiolipin and cardiomyosin, okuyi-myocardial element. Inzuzo yalezi zindlela ukunemba okuphezulu kokuthola ukuthambekela kwezinguquko ze-pathological, ukuntuleka kokuqeqeshwa okuthile.
Ukuhlonza uhlelo lokuhlangana kwegazi, kwenziwa i-coagulogram.
Kunezinkomba eziningana kuyo, okuyizinto eziphambili ukubalwa kweplatelet, isikhathi se-prothrombin, i-fibrinogen, isikhathi se-thrombin, isikhathi se-teromboplastin esinqunyelwe, nokuhlolwa kwe-ethanol.
Ukujwayelekile kweplatelet kusuka ku-180 kuya ku-320 Giga ilitha ngalinye (noma ama-10 kuya ku-9 degrees ngelitha), isikhathi se-prothrombin sisuka kumasekhondi ayi-10 kuye kwayi-16, i-fibrinogen isuka ku-2 iye ku-4 amagremu ngelitha, isikhathi se-thrombin ukusuka kumasekhondi ayi-12 kuye kwangama-18 ne-ethanol isivivinyo - okukodwa noma ukususa.
Izindlela zokuhlonza izinsimbi
Ukuqinisekisa noma ukwenqaba ukutholwa, kusetshenziswa izindlela ezinamandla zokuhlola umzimba wesiguli.
Ukusetshenziswa kwalezi zindlela kuvumela ukukhomba indawo okwenziwa kuyo isifo ngalesi sifo.
Ngaphezu kwalokho, ukusetshenziswa kwamasu akhethekile wokuhlolwa kwezinsimbi kwenza ukuthi kunqunywe izinga lokuthuthuka kwalesi sifo kanye nokucacisa ukusetshenziswa kwezindlela ezithile zokuvezwa kwezokwelapha emzimbeni.
Izindlela zokuhlonza izinsimbi zihlanganisa:
- I-X-ray yesifuba, i-x-ray yemithambo yegazi (angiography - aortography, coronarography).
- Ukukalwa kwengcindezi yegazi ngokunqunywa kwenkomba ye-ankle-brachial.
- I-Electrocardiography, echocardiography.
- I-Dopplerography noma i-ultrasound yemithambo yegazi.
- Ukuhlolwa kwengcindezi ukuthola inani le-myocardial ischemia.
- I-MRI noma i-MSCT yemithambo (i-aorta, imithambo yokubeletha kanye nemikhawulo ephansi).
Kwi-radiography yezitho zesifuba, kukhuphuke ngosayizi wenhliziyo, okungukuthi iminyango engakwesobunxele, ukwanda kwe-archic arch, ukugoba kwe-pathological, ukubalwa kwezindonga zemikhumbi kuyabonakala. Ukuqondiswa kwayo yomibili imithambo yenhliziyo kanye ne-aorta uqobo kuyenzeka. Futhi, lapho i-pulmonary artery ibandakanyeka kwinqubo, iphethini yamaphaphu iyathuthuka ngenxa yengxenye yemithambo yegazi.
Ku-electrocardiography, ushintsho oluningi alunangqondo, futhi luphakama ngenxa ye-myocardial ischemia. Izazi zesifo semithambo enjengezimpawu zehypertular hypertrophy, arrhythmias, kanye noshintsho ku-conduction (blockade) ziyabonakala. I-ECG isetshenziswa ekuhlolweni kwe-atherosclerosis yenhliziyo.
Ingxenye ebalulekile yokuxilongwa ukukalwa kwengcindezi ejwayelekile. Iziguli kufanele zeluleke ukukala umfutho wegazi nsuku zonke noma kanye njalo ezinsukwini ezimbili, gcina idayari yezilinganiso. Ukuqapha okunjalo kuzosiza ekutholeni ukunyuka kwengcindezi ezigabeni zokuqala futhi kuvikele ukubonakala kwezinkomba zamanga nge "hypertension yengubo emhlophe."
Ngesikhathi sokulinganisa, inkomba ye-ankle-brachial nayo ibalwa, okuwukuthi, isilinganiso somfutho wegazi ehlombe nasezandleni. Izinga elijwayelekile lesilinganiso esinjalo lisuka ku-1 liye ku-1,3.
Izifundo ezicacisiwe zokunquma i-patency ye-vascular:
- i-angiography;
- i-dopplerography;
- imaging kazibuthe;
- i-multispiral computer tomography.
I-Angiography ucwaningo oluhlukile lwemithambo yegazi, iqukethe ukubeka ama-ejenti umehluko endaweni yegazi. Le ndlela ikuvumela ukuthi unqume ubunqenqema nobubanzi bemithambo yegazi, ubone ngeso lengqondo izinga lokugqagqana kanye nesilinganiso sawo.
I-Dopplerography yemithambo yegazi noma i-ultrasound - ukuhlolwa okufundisayo, ngaphezu kwamathuba angenhla, futhi kunquma ijubane lokuhamba kwegazi emithanjeni. Imvamisa, kwenziwa ucwaningo oluphindwe kabili noma kathathu.
Izifundo ze-Tomographic njengamanje ziyizindlela ezibaluleke kakhulu zokuxilonga ukuthola i-atherosulinotic plaques. Umongo wokuziphatha ufana ne-angiography - umenzeli ohlukile ufakwa emzimbeni futhi isiguli sifakwa kwi-tomograph.
Usebenzisa i-MRI noma i-CT, unganquma ukwakheka kwemithambo yegazi, indawo okuyo, ukuwohloka nokugqagqana kwe-lumen, isimo sokugeleza kwegazi lesifunda nemithambo yegazi elihambisanayo.
Izimpawu ze-atherosclerosis zichazwe kuvidiyo kule ngxenye.
