Isizathu esiyinhloko sokuvela kwanoma yiziphi izingqinamba zesifo sikashukela umphumela olimazayo we-glucose kwezicubu zomzimba, ikakhulukazi imicu yezinzwa nezindonga zemithambo. Ukwehlulwa kwenethiwekhi yemithambo yegazi, i-angiopathy yesifo sikashukela, kunqunywa kumaphesenti angama-90 kwabanesifo sikashukela esivele eminyakeni eyi-15 ngemuva kokuqala kwalesi sifo.
Ezigabeni ezinzima, leli cala liphela ngokukhubazeka ngenxa yokuqunjelwa, ukulahleka kwezitho zomzimba, ukungaboni. Ngeshwa, ngisho nodokotela abahle kakhulu banganciphisa kancane ukuthuthuka kwe-angiopathy. Isiguli uqobo kuphela esingavimba izinkinga zesifo sikashukela. Lokhu kuzodinga intando yensimbi nokuqonda izinqubo ezenzeka emzimbeni wesifo sikashukela.
Uyini umsuka we-angiopathy
I-Angiopathy yigama lasendulo lesiGrikhi, empeleni lihunyushwa ngokuthi "ukuhlupheka kwemithambo yegazi". Banenkinga yegazi elimnandi ngokweqile eligeleza kubo. Ake sibheke kabanzi kabanzi indlela yokuthuthuka kwezifo ku-angiopathy yesifo sikashukela.
Isifo sikashukela nokucindezela kuzoba yinto yesikhathi esedlule
- Ukwehlela ushukela -95%
- Ukuqedwa kwe-vein thrombosis - 70%
- Ukuqedwa kokushaya kwenhliziyo okuqinile -90%
- Ukuqeda umfutho wegazi ophakeme - 92%
- Ukwanda kwamandla ngesikhathi sosuku, ngcono ukulala ebusuku -97%
Udonga lwangaphakathi lwemithambo luxhumana ngqo negazi. Limelela amaseli e-endothelial amboza wonke umhlaba ungqimba olulodwa. I-endothelium iqukethe abalamuli abangamakhompiyutha kanye namaprotheni akhuthaza noma avimbele ukuqina kwegazi. Isebenza futhi njengesithiyo - idlula amanzi, ama-molecule angaphansi kwe-3 nm, ngokukhetha ezinye izinto. Le nqubo ihlinzeka ukugeleza kwamanzi kanye nokudla okunempilo kwezicubu, ukuwahlanza kwemikhiqizo ye-metabolic.
Ngama-angiopathy, yi-endothelium ehlupheka kakhulu, imisebenzi yayo ikhubazekile. Uma isifo sikashukela singagcinwanga ngaphansi kokulawulwa, amazinga aphezulu kashukela aqala ukubhubhisa amaseli we-vascular. Ukuhlangana okukhethekile kwamakhemikhali kwenzeka phakathi kwamaprotheni endothelial noshukela wegazi - glycation. Imikhiqizo ye-glucose metabolism ihlangana kancane kancane ezindongeni zemithambo yegazi, iyaqina, idumbe, iyeke ukusebenza njengesithiyo. Ngenxa yokuphazamiseka kwezinqubo zokubumbana, ukugeleza kwegazi kuqale ukwakheka, ngenxa yalokho - ubukhulu bemithambo buyancipha futhi nokunyakaza kwegazi kwehle kuwo, inhliziyo kufanele isebenze ngomthwalo owandayo, umfutho wegazi ukhuphuka.
Imikhumbi emincane kakhulu yonakaliswa kakhulu, ukuphazamiseka kokujikeleza okukuyo kuholela ekuqothulweni kwe-oksijini kanye nokudla kwezicubu zomzimba. Uma ezindaweni ezine-angiopathy enzima ngesikhathi kungabikho okunye okubuyiselwe kwama-capillaries abhujisiwe amasha, la ma-izicubu atrophy. Ukuntuleka kwe-oksijeni kuvimbela ukukhula kwemithambo yegazi emisha futhi kusheshise ukugcwala ngokweqile kwezicubu ezihlukumezekile ezilimele.
Lezi zinqubo ziyingozi ikakhulukazi ezinso nasezinyweni, ukusebenza kwazo kukhubazekile kuze kuphele ukulahlekelwa ngokuphelele kwemisebenzi yazo.
I-angiopathy yesifo sikashukela yemikhumbi emikhulu imvamisa ihambisana nezinqubo ze-atherosulinotic. Ngenxa yokulimala kokudla okunamafutha, ama-cholesterol plaque afakwa ezindongeni, okukhanyayo kwemikhumbi kuyancipha.
Izici zokuthuthukisa izifo
I-Angiopathy iba neziguli ezinesifo sikashukela sohlobo 1 nohlobo 2 kuphela uma ushukela wegazi uphakanyisiwe isikhathi eside. Uma isikhathi eside i-glycemia iphakama futhi ingena ezingeni likashukela, izinguquko emikhunjini ziqala ngokushesha. Ezinye izinto zingaqinisa kakhulu lesi sifo, kodwa hhayi ukusibangela.
| Izici Zokuthuthukiswa Kwe-Angiopathy | Umshini wethonya kulesi sifo |
| Isikhathi sikashukela | Amathuba we-angiopathy anda ngesipiliyoni sikashukela, njengoba izinguquko emikhunjini ziqongelela isikhathi. |
| Iminyaka | Lapho isiguli siguga, sikhulu ingozi yaso yokuthola izifo zemikhumbi emikhulu. Abashukela abancane abanesifo sikashukela basengozini enkulu yokuhlushwa i-microcirculation ezithweni zezitho zomzimba. |
| Isifo sezinzwa | Izifo zemithambo ehambisanayo zikhulisa ubulukhuni be-angiopathy futhi zinomthelela ekuthuthukisweni kwayo okusheshayo. |
| Ukuba khona kokumelana ne-insulin | Amazinga aphakeme we-insulin egazini asheshisa ukwakheka kwama-plaque odongeni lwemithambo yegazi. |
| Isikhathi sokuhlangana esifushane | Kwandisa amathuba okugoqeka kwegazi nemisipha ye-capillary efa. |
| Isisindo esiningi | Inhliziyo iyalila, izinga le-cholesterol ne-triglycerides egazini liyakhuphuka, imithambo inciphise ngokushesha, ama-capillaries akude nenhliziyo ahanjiswa kabi ngegazi. |
| Umfutho wegazi ophakeme | Ngcono ukucekelwa phansi kwezindonga zemithambo yegazi. |
| Ukubhema | Kuyaphazamisa umsebenzi wama-antioxidants, kunciphisa izinga le-oksijini egazini, kwandisa ingozi ye-atherosclerosis. |
| Umsebenzi wokuma, ukuphumula kombhede. | Kokubili ukuntuleka kokuzivocavoca nokukhathala ngokweqile komlenze kusheshisa ukuthuthukiswa kwe-angiopathy emaphethelweni aphansi. |
Yiziphi izitho ezithintekayo kwisifo sikashukela
Ngokuya ngokuthi yimiphi imikhumbi ehlupheka kakhulu ethonyeni likashukela kushukela ongafakwanga ushukela, i-angiopathy ihlukaniswe izinhlobo:
- Isifo Sikashukela Sikashukela - umele ukunqotshwa kwama-capillaries ku-glomeruli yezinso. Le mikhumbi iphakathi kokuqala kokuhlupheka, njengoba besebenza ngaphansi komthwalo oqhubekayo futhi bedlula inani elikhulu legazi ngokwabo. Njengomphumela wentuthuko ye-angiopathy, ukwehluleka kwe-renal kwenzeka: ukuhlunga kwegazi kusuka emikhiqizweni ye-metabolic kuwohloka, umzimba awususi ngokuphelele ubuthi, umchamo uthululwa ngevolumu encane, i-edema, ifomu lezitho zomzimba ezihlanganayo emzimbeni wonke. Ingozi yalesi sifo ilele ukungabikho kwezimpawu ezigabeni zokuqala kanye nokulahleka ngokuphelele kokusebenza kwezinso ekugcineni. Ikhodi yesifo ngokuya ngokuhlukaniswa kwe-ICD-10 ingu-3.
- I-angiopathy yesifo sikashukela semikhawulo ephansi - kuvame ukukhula ngenxa yethonya lesifo sikashukela emikhunjini emincane. Ukuphazamiseka kwegazi okujikelezayo okuholela kwezilonda ze-trophic kanye ne-gangrene kungakhula ngisho nokuphazamiseka okuncane emithanjeni eyinhloko. Kuvela isimo esiyindida: kunegazi emilenzeni, izicubu ziyafa yindlala, ngoba inethiwekhi ye-capillary ibhujisiwe futhi ayinasikhathi sokululama ngenxa kashukela wegazi ophakeme njalo. Ama-angiopathy wemikhawulo ephezulu atholakala ezimweni ezikhethekile, ngoba izandla zomuntu zisebenza ngomthwalo omncane futhi zisondelene nenhliziyo, ngakho-ke, izitsha ezikuzo azilimalanga kakhulu futhi ziphola ngokushesha. Ikhodi ye-ICD-10 ingu-10.5, 11.5.
- I-retinopathy yesifo sikashukela - kuholela kumonakalo emikhunjini ye-retina. Njenge-nephropathy, ayinazimpawu kuze kube yizigaba ezibucayi zesifo, ezidinga ukwelashwa ngemithi ebizayo kanye nokuhlinzwa kwe-laser kwi-retina. Umphumela wokucekelwa phansi kwamathambo e-retina uwumbono ofiphele ngenxa ye-edema, amabala grey phambi kwamehlo ngenxa yokuphefumula, ukuqhekeka kwe-retina, kulandelwa ubumpumputhe ngenxa yokulimala endaweni yomonakalo. I-angiopathy yokuqala, etholakala kuphela ehhovisi le-ophthalmologist, ingalapheka ngokwayo ngokunxeshezelwa yisifo sikashukela sesikhathi eside. Ikhodi H0.
- I-angiopathy yesifo sikashukela yemithambo yenhliziyo - kuholela ku-angina pectoris (ikhodi I20) futhi imbangela eyinhloko yokufa kusuka ezinkingeni zesifo sikashukela. I-atherosulinosis yemithambo ye-coronary ibangela ukulamba kwe-oxygen kwezicubu zenhliziyo, okuphendula kuyo ngokucindezela, nobuhlungu obucindezelayo. Ukucekelwa phansi kwama-capillaries kanye nokugcwala kwawo okwandayo kwezicubu ezixhunywayo kuthambisa ukusebenza kwemisipha yenhliziyo, ukuphazamiseka kwesigqi kwenzeka.
- I-encephalopathy yesifo sikashukela - ukwephulwa kokuhlinzekelwa kwegazi kubuchopho, ekuqaleni kubonakaliswa yikhanda nobuthakathaka. I-hyperglycemia ende, kukhulu ukuntuleka komoya-mpilo, futhi lapho kuthinteka kakhulu ngama-radicals mahhala.
Izimpawu nezimpawu ze-angiopathy
Ekuqaleni, i-angiopathy yi-asymptomatic. Ngenkathi ukubhujiswa kungagxili, umzimba uyakwazi ukuphatha umkhumbi omusha ukuze ungene endaweni owonakele. Ngesikhathi sokuqala, isigaba sokuqala, ukuphazamiseka kwe-metabolic kunganqunywa kuphela ngokwandisa i-cholesterol egazini kanye nokukhula kwethoni ye-vascular.
Izimpawu zokuqala ze-angiopathy yesifo sikashukela zenzeka esigabeni sokusebenza, lapho izilonda ziba ziningi futhi zingenaso isikhathi sokululama. Ukwelashwa okuqale ngalesi sikhathi kuyakwazi ukuhlehlisa inqubo futhi kubuyiselwe ngokuphelele ukusebenza kwenethiwekhi yemithambo.
Izimpawu ezingaba khona:
- Ubuhlungu emilenzeni ngemuva komthwalo omude - kungani abanesifo sikashukela benobuhlungu emilenzeni;
- ukuzindla nokuhwaqa emilenzeni;
- iminyakazo
- isikhumba esibandayo ezinyaweni;
- amaprotheni kumchamo ngemuva kokuvivinya umzimba noma ukucindezela;
- amabala kanye nomuzwa wombono onsomi;
- ikhanda elibuthakathaka, alidambiswanga ama-analgesics.
I-Diabetesic polyneuropathy yemikhawulo ephansi
Izimpawu ezichazwe kahle zenzeka ekugcineni, esigungwini, esigabeni se-angiopathy. Ngalesi sikhathi, ushintsho ezithweni ezithintekile selungaphenduki, futhi ukwelashwa ngezidakamizwa kungahle kwehlise ukukhula kwesifo.
Ukuboniswa kwemitholampilo:
- Ubuhlungu obuqhubekayo emilenzeni, i-lameness, ukulimala kwesikhumba namazipho ngenxa yokuntuleka kokudla, ukuvuvukala kwezinyawo namathole, ukungakwazi ukuhlala endaweni emi isikhathi eside ne-angiopathy yemikhawulo engezansi.
- Kuphakama, akunakukwazi ukwelashwa, umfutho wegazi, ukuvuvukala ebusweni nasemzimbeni, ezizalweni zangaphakathi, ukudakwa nge-nephropathy.
- Ukulahleka kombono okukhulu nge-retinopathy, inkungu phambi kwamehlo ngenxa ye-edema ku-angiopathy yesifo sikashukela maphakathi ne-retina.
- Isiyezi kanye nokufelwa ngenxa ye-arrhythmia, ulethisa kanye nokuphefumula okufushane ngenxa yokuhluleka kwenhliziyo, izinhlungu esifubeni.
- Ukuqwasha, inkumbulo ephazamisekile nokuxhumana kokunyakaza, kwehlise amakhono okuqonda ku-engiopathy yobuchopho.
Izimpawu zezilonda ze-vascular emilenzeni
| Izimpawu | Isizathu |
| Ipende, isikhumba esipholile sezinyawo | Ukubhujiswa kwe-capillary kusalapheka |
| Ubuthakathaka bemisipha yomlenze | Ukungondleki kahle kwemisipha, ukuqala kwe-angiopathy |
| Ubomvu ezinyaweni, isikhumba esifudumele | Ukuvuvukala ngenxa yokujoyina ukutheleleka |
| Ukuntuleka kokushayela emilenzeni | Ukuncipha okubalulekile kwemithambo yegazi |
| I-edema ende | Ukulimala okukhulu kwemizwa |
| Ukunciphisa amathole noma imisipha yamathanga, kumisa ukukhula kwezinwele emilenzeni | Indlala yesikhathi eside ye-oxygen |
| Amanxeba angapholi | Ukulimala okuningi kwe-capillary |
| Iminwe emnyama | I-angiopathy yemithambo |
| Isikhumba esibandayo esiluhlaza okotshweni emilenzeni | Umonakalo omkhulu, ukuntuleka kokujikeleza kwegazi, ukuqala i-gangrene. |
Ukuxilongwa kwalesi sifo
Ukutholwa kusenesikhathi kwe-angiopathy kuyisiqinisekiso sokuthi ukwelashwa kuzophumelela. Ukulindela ukuqala kwezimpawu kusho ukuqala kwesifo sigcwele ukululama ngezigaba ezi-3 akunakwenzeka, ingxenye yemisebenzi yezitho ezonakele izolahleka ngokungenakulungiswa. Kunconywe ukuthi kwenziwe izivivinyo eminyakeni engu-5 ngemuva kokutholwa kwesifo sikashukela. Njengamanje, izinguquko emikhunjini zingabonakala nangaphambi kwalokho, okusho ukuthi bangaqala ukuzelapha ngenkathi izilonda zincane. Isifo sikashukela sohlobo 2 sivame ukutholakala eminyakeni embalwa ngemuva kokuqala kwesifo, futhi nemikhumbi iqale ukulinyazwa ngisho nasesigabeni se-prediabetes, ngakho-ke kufanele uhlole imikhumbi ngokushesha ngemuva kokutholwa kwe-hypoglycemia.
Ekungeneni kwentsha kanye nabantu asebekhulile abanesifo sikashukela eside, ama-angiopathies amaningana ezitho ezihlukene aqala ukuvela, omabili nabasha abalimala. Ngemuva kokuthola uhlobo olulodwa lwesifo kubo, badinga ukuhlolwa okuphelele kohlelo lwethambo nenhliziyo.
Zonke izinhlobo ze-angiopathy zibonakala ngoshintsho olufanayo ekutholakaleni kwamaprotheni namafutha. Ngokuphazamiseka kwemithambo yegazi, ukungasebenzi kahle kwe-metabolic egcwele ezigulini ezinesifo sikashukela kuyanda. Ngosizo lokuhlola igazi le-biochemical, isimo okuthiwa yi-lipid siyatholakala. Amathuba okukhula kwe-angiopathy aboniswa ngokwanda kwe-cholesterol, ukwanda kwama-lipoproteins aphansi, ukwehla kwe-albhamuin, ukwanda kwama-phospholipids, ama-triglycerides, kwamafutha asimahla nama-alpha-globulin kubaluleke kakhulu.
>> Funda mayelana i-microangiopathy kushukela singenye yezinhlobo ze-angiopathy.
Ukuhlolwa okuphelele kwezitho ezihlushwa kakhulu ukulimala kwemithambo kunconywa kwiziguli ezinesifo sikashukela ezinezinguquko ezinjalo ekwakhiweni kwegazi.
| Uhlobo lwe-angiopathy | Izindlela Zokuxilonga |
| I-Nephropathy |
|
| I-angiopathy yonyawo | I-Ultrasound yemikhumbi yamaphethelo aphansi kanye ne-angiography yemithambo yemilenze. |
| I-retinopathy |
|
| I-Angiopathy yemikhumbi yenhliziyo | I-Electrocardiogram, i-ultrasound yenhliziyo kanye ne-coronary angiography yemithambo yegazi |
| Encephalopathy | I-MRI yobuchopho |
Ngingaphatha kanjani
Ukwelashwa kwe-angiopathy yesifo sikashukela kuhloswe ukuthi kube noshukela wegazi, kuvuselele ukuhamba kwegazi nokuqinisa izindonga zemithambo yegazi.
Ukunciphisa ushukela nokuwugcina isikhathi eside ngaphakathi kwemikhawulo ejwayelekile kuyindlela ephumelela kunazo zonke yokwelapha i-angiopathy. Ezigabeni zokuqala zesifo, lokhu kwanele ukuba imithambo ilulame ngokwayo. Konke okunye ukwelashwa kubhekwe njengokululama okwengeziwe, okusheshayo. Izidakamizwa ezisehlisa ushukela, i-insulin, ukudla okuqukethe ukuncishiswa kokuqukethwe kwama-carbohydrate namafutha ezilwane asetshenziselwa ukulawula ushukela.
| Iqembu lezidakamizwa | Isenzo | Amagama |
| Izimo | Ukuvinjwa kokukhiqizwa kwe-cholesterol embi "embi" ephansi | Izidakamizwa ezivela esizukulwaneni sakamuva sama-statins - Atorvastatin, Liptonorm, Tulip, Lipobay, Roxer |
| Ama-Anticoagulants | Ukuncishiswa kokubumbana | Warfarin, Heparin, Clexane, Lyoton, Trolmblesse |
| Ama-antiplatelet agents | Khuphula ukuhamba kwegazi, yehlisa amathuba okuqhekeka kwegazi futhi unikele ekubhujisweni kokukhona | Acetylsalicylic acid, Cardiask, Clopidex, Pentoxifylline, ThromboAss |
| Ama-VEGF Inhibitors | Ukuphindukuzalwa kwamathambo, ukuvimbela ukwakheka kwemikhumbi emisha e-retina | Lucentis, Eilea |
| Ama-inhibitors e-ACE | Ukwehliswa kwengcindezi yangempela, i-vasodilation | I-Enap, i-Enalapril, iKapoten, iLister |
| Ama-diuretics | Yehlisa i-edema, yehlise umfutho wegazi | I-Torasemide, i-Furosemide, iHypothiazide |
| Amavithamini | Shintsha izinqubo ze-metabolic | Iqembu B, i-thioctic ne-nicotinic acid |
Isetshenziselwa ukwelashwa kwe-angiopathies enzima nokungenelela kokuhlinzwa. Uma kwakukhona ukuncishiselwa endaweni yomkhumbi omkhulu esilevini, kwenziwa izithungo - kubekwa ngaphakathi kohlaka lwe-mesh. Icindezela izindonga zesitsha futhi ibuyise ukugeleza kwegazi endaweni ethintekile. Ngokuncipha okubanzi okuthe xaxa, ukushunqa kungenziwa - ukudala ukubambisana kokugeleza kwegazi okuvela emthanjeni wesiguli.
Ekwelapheni i-retinopathy, kusetshenziswa imisebenzi ye-laser - kusetshenziswa ngemikhumbi i-cauterize egcwele i-retina. Iziguli ezine-nephropathy esigabeni esibulalayo zidinga i-hemodialysis ejwayelekile zisebenzisa izinsiza "zokugcina izinso", futhi, uma kunokwenzeka, ukuthunyelwa kwesitho esinikelayo.
Izindlela zokuvimbela
Iqoqo lezinyathelo ezingavimba noma zibambezele kakhulu ukuvela kwe-angiopathy yesifo sikashukela:
- Ukuqapha ushintsho ekusebenzeni kwe-metabolism kubantu abasengozini yesifo sikashukela sohlobo 2, izilinganiso ezijwayelekile zokudla okushukela noshukela ongaphansi komthwalo. Umkhawulo ekudleni kwama-carbohydrate asheshayo, ukulwa nesisindo ngokweqile, indlela yokuphila esebenzayo.
- Ukugcina amazinga eglucose kuyinto eyejwayelekile ezigulini ezinazo zombili izinhlobo zesifo sikashukela. Ukuqaliswa okuqondile kwazo zonke izincomo zikadokotela.
- Vakashela ku-ophthalmologist kabili ngonyaka nge-ophthalmoscopy ephoqelekile.
- Ukuhlolwa kwonyaka ukuthola i-microalbuminuria.
- I-Ultrasound yemithambo yemilenze ekubonakalisweni kokuqala kwe-angiopathy.
- Ukunakekelwa kwezinyawo okuphelele, ukuhlolwa nsuku zonke ngomonakalo, ukwelashwa nokwelashwa kwamanxeba amancane, ukukhethwa kwezicoci ezintofontofo, ezingezona ezihlukumezanayo.
- Vocavoca umzimba izikhathi ezi-3-4 ngesonto, mhlawumbe emoyeni omusha. Ukuqeqeshwa kweCardio ngesivinini esikhulu kuyathandwa, okwenza kube nzima njengoba izicubu zenhliziyo ziqinisa.
- Ukulinganiselwa kokuphuza ngokweqile, ukuyeka ngokuphelele ukubhema.
