Atherosclerosis yog ib qho mob ntev mus ntev ntawm lub plawv thiab cov hlab ntsha loj, tus yam ntxwv ntawm kev puas tsuaj rau lub phab ntsa arterial thiab qhov tso nyiaj ntawm atheromatous masses rau nws nrog txuas ntxiv ntawm lumen thiab kev txhim kho ntawm cov teeb meem nyuaj los ntawm lub hlwb, lub plawv, raum, qis qis dua.
Tus kab mob nws tus kheej feem ntau tshwm sim hauv cov neeg laus, txawm hais tias tam sim no cov roj ntshav me me tso rau ntawm cov phab ntsa ntawm cov hlab ntshav tau kuaj pom txawm tias cov menyuam yaus thiab cov hluas.
Thaum tsis muaj kev kho mob kom zoo, atherosclerosis ntawm txhua qhov chaw hauv zos ua rau ischemia thiab hypoxia ntawm cov kabmob thiab cov tshuab, trophic thiab necrotic hloov ntawm daim tawv nqaij thiab cov nqaij mos.
Cov laj thawj ntawm txoj kev pathology no tuaj yeem faib ua ob pab - hloov kho thiab hloov pauv tsis tau.
Qhov thib ib suav nrog cov laj thawj uas tuaj yeem cuam tshuam los ntawm kev hloov pauv hauv kev ua neej thiab kev noj tshuaj, ntawm no yog qee yam ntawm lawv:
- Ib txoj kev ua neej nyob uas muaj kev nyob ntsiag to hauv kev ua haujlwm.
- Kev ua txhaum ntawm kev noj haus kom meej pem - cov zaub mov tsis xwm yeem nrog cov roj ntau, cov khoom kib ua muaj cov roj cholesterol ntau.
- Cov cwj pwm tsis zoo - haus ntau dhau, haus luam yeeb.
- Kev nyuaj siab thiab lub siab ntsws dhau.
- Arterial hypertension nrog qhov ntsuas ntawm qhov siab siab tshaj 140 los ntawm 90 millimeters ntawm cov mercury thaum so nrog ob peb ntsuas tawm.
- Mob ntshav qab zib mellitus nrog glycemic tsis zoo tswj thiab nquag ketoacidotic mob.
- Hypercholesterolemia - ib qho kev nce ntxiv ntawm cov roj (ntau dua 5.5 mmol / l), dyslipidemia - qhov ua txhaum ntawm qhov sib piv ntawm lipotroteins ntawm cov feem sib txawv (kev nce ntawm lipoproteins tsawg ntom, triglycerides, txo qis hauv lipoproteins ntau).
- Kev rog rog ntawm lub duav nrog lub duav rau tus txiv neej yog ntau tshaj 102 cm, thiab hauv cov poj niam ntau dua 88 cm.
Cov xwm txheej uas tsis tuaj yeem cuam tshuam nrog lub keeb kwm muaj tsev neeg tsim txom (tsev neeg hypercholesterolemia thiab dyslipidemia, kev tuag los ntawm cov neeg txheeb ze ntawm cov hlab plawv mus txog 50 xyoo), hnub nyoog (hauv cov txiv neej, atherosclerosis muaj tom qab 45 xyoo, hauv cov poj niam - tom qab 55), poj niam txiv neej ( ntau zaus muaj kev loj hlob hauv cov txiv neej, vim tias cov poj niam kev sib deev cov poj niam muaj kev tiv thaiv ntawm cov hlab ntsha)
Cov kab mob pathogenetic ntawm cov quav hniav tsim
Kev sib xyaw ua ke ntawm hyperlipidemia thiab vascular puas tsuaj ua rau kev tsim cov roj cholesterol ua ke nrog cov protein, thiab lawv hloov mus rau hauv qab ntawm intima ntawm cov hlab ntsha.
Lipids yog txhom los ntawm macrophages, uas tig mus rau hauv xanthomatous cov hlwb, hloov zuj zus hauv qhov loj me.
Cov kab mob no tsim cov kev loj hlob thiab tsiv teb tsaws chaw rau cov qe ntshav dawb thiab qe ua kom ntshav khov. Muaj kev ua kom haum thiab kev sib sau ua ke ntawm platelets, kev faib nyiaj ntawm thrombotic yam.
Cov quav hniav hlob sai, thaiv cov lumen ntawm cov hlab vim qhov tsim ntawm lub cev qhov txuas thiab cov log tsheb.
Ntxiv mus, nyob rau hauv tus ntawm kev loj hlob yam, capillaries yog tsim rau cov ntshav muab rau cov feem ntau atheromatous loj. Qhov kawg theem ntawm kev tsim kho yog necrosis ntawm nruab nrab ntawm cov quav hniav, nws sclerosis thiab calcification.
Kev hloov pauv Morphological hauv kev tshwm sim ntawm atherosclerosis yog tus cwj pwm los ntawm kev hloov zuj zus ntawm tus kab mob, txij li me los ntawm mob hnyav.
Thawj theem ntawm kev txhim kho ntawm atherosclerosis yog dolipid, nws tsis muaj morphological kev hloov pauv tshwj xeeb. Nws yog tus cwj pwm los ntawm kev nce ntxiv hauv cov permeability ntawm cov vascular phab ntsa, ib qho kev ua txhaum ntawm nws txoj kev coj ncaj ncees - focal lossis tag nrho, tawm hws ntawm cov kua ntawm cov ntshav ua rau hauv qhov chaw subendothelial.
Mucoid o, txuam nrog cov tshuaj fibrin thiab fibrinogen, lwm cov protein ntshav, cov lipoproteins tsawg thiab cov roj cholesterol tau tsim.
Txhawm rau kuaj xyuas cov theem no, nws txaus los siv txoj kev tshawb nrhiav keeb kwm txog kev npaj vascular phab ntsa thiab siv cov dyes tshwj xeeb - xiav thionine, uas cov tshuaj tua kab mob (metachromasia) tau soj ntsuam thiab cov cheeb tsam uas cuam tshuam tau tsuas yog hauv ntshav.
Qhov thib ob theem - lipoidosis - yog tus yam ntxwv ntawm kev tso cov roj (cholesterol) thiab lipoproteins nyob rau hauv daim ntawv ntawm cov rog rog thiab cov tawv nqaij daj uas tsis nce siab tshaj theem ntawm endothelium.
Cov kev hloov pauv hauv tus qauv ntawm cov hlab ntshav tuaj yeem pom txawm tias cov menyuam yaus thiab cov hluas, thiab tsis tas yuav muaj kev vam meej yav tom ntej. Lipids tau muab tso rau hauv qab ntawm intima hauv macrophages, los yog npuas hlwb, thiab cov leeg nqaij ntawm cov hlab ntshav. Nws tseem muaj peev xwm txheeb xyuas cov theem no histologically, staining yog nqa los ntawm Sudan 4, 5, rog liab O.
Muab hais tias atherosclerosis yog ib tus kab mob maj mam hloov zuj zus, cov theem no tuaj yeem ntev ntev thiab tsis ua rau muaj kev mob tshwm sim hauv chaw kuaj mob.
Cov hlab ntsha loj, xws li aorta, mob hlab ntsha, cov hlab ntsha ntawm lub paj hlwb, raum, thiab siab, yauv mus rau thawj qhov kev hloov pauv pathological.
Kev ua kom tiav ntawm cov txheej txheem nyob ntawm cov yam ntxwv ntawm hemodynamics ntawm cov chaw ntawm bifurcation ntawm cov hlab ntsha, xws li aortic bifurcation mus rau hauv cov hlab ntsha iliac.
Qhov thib peb theem ntawm kev txhim kho ntawm atherosclerotic quav hniav yog liposclerosis - kev tsim ntawm elastic thiab collagen fibers nyob rau hauv endothelium, nthuav tawm ntawm fibroblasts, lawv rho tawm ntawm kev loj hlob yam thiab kev loj hlob ntawm cov hluas sib txuas cov ntaub so ntswg.
Ntxiv pathophysiological kev loj hlob ntawm atherosclerotic quav hniav
Morphologically, cov plaques raug tsa siab siab tshaj theem ntawm kev sib txheeb ze, cov npoo ntawm lub nkoj ua cov hlab, ua ntu zus. Xws li cov chaw ua haujlwm tuaj yeem nqaim lub lumen ntawm cov leeg thiab ua rau ischemia ntawm cov plab hnyuv siab raum thiab cov tshuab, nyob ntawm qhov chaw nyob, ua rau muaj teeb meem xws li mob stroke, hloov ischemic nres, myocardial infarction, obliteration ntawm cov hlab ntsha ntawm qhov qis qis.
Cov theem tom ntej ntawm kev hloov kho tus kab mob yog atheromatous, tus yam ntxwv pom los ntawm qhov lwj ntawm qhov nruab nrab ntawm cov quav hniav, nws txoj kev cais tawm.
Cov kab mob hauv cov roj hauv cov roj, cov rog ua rog, tawg ntawm collagen fibers, xanthoma hlwb thiab T thiab B lymphocytes raug tshawb pom nyob rau hauv kev ua kom tshem tawm. Qhov loj no tau cais tawm ntawm cov kab noj hniav ntawm lub nkoj los ntawm cov tshuaj ntsiav ntawm cov quav hniav, uas muaj cov ntaub so ntswg sib txuas.
Cov theem tom ntej yog ulceration, muaj tus yam ntxwv los kua muag ntawm cov quav hniav ua paug, thiab tso tawm nws cov ntsiab lus rau hauv cov hlab ntshav, qhov tsim ntawm qhov tawv nqaij atheromatous. Qhov phom sij ntawm cov qib no yog qhov tsis txaus ntseeg ntawm cov plaques, qhov tseem ua rau muaj ischemic thiab thromboembolic qhov txhab ntawm cov plab hnyuv siab raum thiab cov ntaub so ntswg.
Ntawm thaj chaw ntawm kev ua haujlwm ntawm lub plab, pob txha caj qaum yuav pib txhim kho - tiv thaiv ntawm phab ntsa vascular, thiab tseem tawg. Cov theem kawg ntawm cov txheej txheem pathological yog petrification ntawm cov quav hniav, uas yog, qhov kev tso nyiaj ntawm calcium ntsev rau hauv nws.
Raws li qhov tshwm sim, thaj chaw uas muaj kev cuam tshuam ntawm lub nkoj tau cog lus, patency tsis muaj peev xwm lossis tsis tuaj kiag li.
Kev tshwm sim ntawm cov yam ntxwv ntawm cov hlab ntsha tuaj yeem yog polymorphic, uas yog, cov quav hniav uas muaj qhov quav nrog cov roj calcifications thiab cov rog tuaj yeem pom ib txhij.
Atherosclerotic plaques lawv tus kheej tuaj yeem nyuaj los ntawm kev mob ntshav, ntshav txhaws, thiab tshuaj ntsiav ua kom mob.
Clinically, atherosclerotic plaques tau muab faib ua kom ruaj khov thiab tsis khov.
Hauv cov plaques ntawm thawj hom, cov ntaub npog qhov ncauj npog tau txiav txim siab zoo, ntom, tsis muaj kua muag thiab tso cov ntsiab lus tawm, thiab yog li tsis ua rau mob hnyav ntawm atherosclerosis. Cov plaques no tus cwj pwm mob los ntawm kev mob tshwm sim - mob ntsws ischemia ntawm cov plab hnyuv siab raum lossis cov ntaub so ntswg, lawv sclerosis, dystrophy lossis atrophy, ruaj khov angina pectoris, mob vascular tsis txaus.
Nyob rau hauv ob hom, lub log yog lub kua muag nquag thiab tawm ntawm nws lub nucleus, muaj teeb meem - mob vascular tsis txaus thiab ischemia ntawm cov plab hnyuv siab raum, tsis khov tsis khov thiab mob caj dab, mob txho faus ntawm lub hlwb, mob caj dab ntawm qhov kawg.
Cov hauv paus ntawm kev kho mob ntawm atherosclerosis thiab nws cov kev tiv thaiv
Cov kev kho ntawm twb tau tsim cov atherosclerotic plaques kuaj kuaj mob thiab lub hom phiaj muaj nyob rau hauv kev sib koom ua ke, thiab suav nrog qhov yuav tsum tau kho ntawm cov kev hloov pauv tau.
Cov txheej txheem nyuaj no suav nrog - txoj cai ntawm khoom noj khoom haus, kev siv ntau cov zaub thiab txiv hmab txiv ntoo tshiab, zaub mov mis, khoom noj siv mis thiab tsim kom muaj cov dej haus.
Nws kuj tseem ceeb kom tsis txhob haus luam yeeb, haus dej cawv kom tsawg, kev tawm dag zog kom txaus (taug kev, khiav, dhia aerobics).
Cov kev kho mob tseem ceeb yog kev siv tshuaj, qhov no suav nrog cov tshuaj uas nws txoj kev ua lag luam tshuaj tsom rau txo cov roj (cholesterol) thiab nws cov roj:
- statins (Atorvastatin, Lovastatin, Simvastatin);
- fibrates;
- probucol;
- nicotinic acid.
Kuj siv:
- cov tshuaj tiv thaiv kab mob siab (Acetylsalicylic acid, Magnikor);
- anticoagulants (heparin);
- vasoactive tshuaj (Cilostazolum);
- antispasmodics (Drotaverinum, Papaverineum);
- vitamin npaj.
Thaum mob hnyav, nrog rau cov mob hnyav, trophic lesions ntawm cov nqaij mos mos thiab caj pas txhaws qog, kev kho mob phais yog siv - los ntawm kev ua haujlwm qis los kho cov ntshav ncig (stenting, bypass phais, zais pa angioplasty), tshem tawm cov hlab ntsha (endarterectomy nrog ntxiv cov hlab ntaws) ua ntej kev cuam tshuam rau lub hom phiaj kev tshem tawm ntawm cov nqaij uas tsis muaj qhov tsis tseeb (txiav tsis ua haujlwm, txiav ib ceg ntawm tus kheej).
Kev tiv thaiv ntawm kev ua kom cov cholesterol thiab kev txhim kho ntawm atherosclerosis yog thawj - hauv cov neeg muaj kev noj qab haus huv, thiab theem nrab - nrog ib tus kab mob twb tau kuaj pom.
Cov kauj ruam tseem ceeb ntawm kev tiv thaiv thawj yog kev noj zaub mov zoo rau lub cev, kev tawm dag zog lub cev, muab tus cwj pwm tsis zoo, soj ntsuam lub siab thiab cov roj cholesterol, kev tshuaj xyuas tas li los ntawm cov kws kho mob.
Txog kev tiv thaiv kab mob thib ob, nws yog ib qho tsim nyog yuav tsum pib nrog kev kho mob ntawm cov kab mob concomitant, txo qis ntshav siab, noj cov statins thiab cov tshuaj tiv thaiv kab mob, kev kuaj mob raws sij hawm thiab kev kho mob ntawm cov teeb meem.
Lub etiology ntawm atherosclerosis yog tau piav qhia hauv video hauv kab lus no.
