Ntshav qab zib macroangiopathy yog qhov muaj cov kab mob dav dav thiab atherosclerotic uas tshwm sim hauv nruab nrab lossis cov hlab ntsha loj nrog cov chav ntev ntev ntawm hom 1 thiab ntshav qab zib hom 2.
Xws li qhov tshwm sim tsis muaj dab tsi tab sis pathogenesis, nws ua rau pom kev txhim kho cov hlab plawv, thiab tus neeg feem ntau muaj ntshav siab, txhawm rau txhawm rau ntawm cov hlab ntsha peripheral, thiab mob hlwb yog cuam tshuam.
Kev kuaj mob tus kab mob los ntawm kev ua cov mob electrocardiograms, echocardiograms, Doppler ultrasound, ob lub raum, cov hlab ntsha hauv lub cev, cov leeg ntshav ntawm lub cev tau kuaj.
Txoj kev kho yog suav tswj ntshav siab, txhim kho cov ntshav sib xyaw, kho hyperglycemia.
Ua rau mob macroangiopathy mob ntshav qab zib
Thaum ib tug neeg mob ntshav qab zib ntev ntev, cov hlab ntsha me, hlab ntsha phab ntsa thiab leeg ntshav cuam tshuam rau ntawm cov piam thaj ntau ntxiv pib tawg.
Yog li ntawd muaj qhov ua kom yuag, deformation, los sis, hloov pauv, qhov no yog qhov ua kom tuab ntawm cov hlab ntshav.
Vim li no, cov ntshav ntws thiab cov metabolism hauv cov nqaij hauv cov nruab nrog sab hauv yuav cuam tshuam, uas ua rau hypoxia lossis oxygen tshaib plab ntawm cov nqaij mos uas nyob ib puag ncig, kev puas tsuaj rau ntau cov kabmob ntawm cov ntshav qab zib.
- Feem ntau, cov hlab ntsha loj ntawm qis dua qhov kawg thiab lub siab yog cuam tshuam, qhov no tshwm sim hauv 70 feem pua ntawm tus neeg mob. Cov seem ntawm lub cev tau txais qhov hnyav tshaj, yog li cov hlab ntsha muaj kev cuam tshuam ntau los ntawm kev hloov pauv. Hauv kev mob ntshav qab zib microangiopathy, cov nyiaj feem ntau yog cuam tshuam, uas kuaj tau tias yog mob hlwb; cov no feem ntau muaj.
- Feem ntau muaj ntshav qab zib macroangiopathy cuam tshuam rau cerebral, mob hlab ntshav hlab plawv, lub raum, hlab ntsha peripheral. Qhov no nrog los ntawm angina pectoris, myocardial infarction, ischemic stroke, ntshav qab zib mob caj dab, rov qab kho dua tshiab. Nrog rau kev puas tsuaj rau cov hlab ntsha, qhov kev pheej hmoo ntawm kev txhim kho cov hlab plawv thiab mob stroke nce peb zaug.
- Ntau yam mob ntshav qab zib ua rau atherosclerosis ntawm cov hlab ntshav. Xws li tus kab mob tau kuaj pom rau cov neeg muaj mob type 1 thiab type 2 ntshav qab zib mellitus 15 xyoo ua ntej tshaj rau cov neeg mob noj qab nyob zoo. Kuj, tus kab mob hauv cov neeg mob ntshav qab zib tuaj yeem hloov sai dua.
- Tus kab mob ua rau daim nyias nyias ntawm daim nyias nyias ntawm qhov nruab nrab thiab cov hlab ntsha loj, uas cov kab mob atherosclerotic plaques tom qab tsim. Vim yog cov calcification, ua kom pom thiab necrosis ntawm cov quav hniav, ntshav txhaws nyob rau hauv thaj chaw, lub lumen ntawm cov hlab ntsha kaw, vim li ntawd, cov ntshav ntws hauv thaj chaw muaj kev cuam tshuam cuam tshuam rau cov ntshav qab zib.
Raws li txoj cai, mob ntshav qab zib macroangiopathy cuam tshuam rau cov hlab ntshav, cerebral, visceral, peripheral leeg, yog li cov kws kho mob ua txhua yam los tiv thaiv kev hloov pauv los ntawm kev siv cov kev tiv thaiv.
Txoj kev pheej hmoo ntawm pathogenesis nrog hyperglycemia, dyslipidemia, insulin tsis kam, rog, rog ntshav siab, nce ntshav coagulation, endothelial kawg, oxidative kev nyuaj siab, kev tiv thaiv kab mob hauv lub cev yog tshwj xeeb tshaj yog.
Tsis tas li, atherosclerosis feem ntau muaj kev haus luam yeeb, nyob rau hauv lub xub ntiag ntawm lub cev tsis muaj sia, thiab kev qaug cawv. Qhov kev pheej hmoo yog cov txiv neej hnub nyoog dhau 45 xyoos thiab poj niam laus dua 55 xyoo.
Feem ntau ua rau tus kab mob dhau los ua ib qho keeb tiv thaiv kab mob.
Ntshav qab zib angiopathy thiab nws cov hom
Ntshav qab zib angiopathy yog lub tswvyim sib xyaw ua ke uas sawv cev rau pathogenesis thiab koom nrog cov leeg ntshav tsis zoo - me, loj thiab nruab nrab.
Qhov tshwm sim no suav hais tias yog qhov txiaj ntsig tshwm sim ntawm tus kab mob ntshav qab zib mellitus, uas tshwm sim kwv yees li 15 xyoo tom qab pom tus kab mob.
Cov kab mob ntshav qab zib macroangiopathy yog nrog cov mob syndromes xws li atherosclerosis ntawm aorta thiab mob hlab ntsha txhaws, leeg ntshav lossis hlab hlwb.
- Thaum lub sij hawm microangiopathy mob ntshav qab zib mellitus, retinopathy, nephropathy, thiab ntshav qab zib microangiopathy ntawm qis qis tau pom.
- Qee zaum, thaum cov hlab ntsha raug mob, pom tias mob thoob plaws lub ntiaj teb, nws lub tswvyim suav nrog kev mob ntshav qab zib micro-macroangiopathy.
Endoneural ntshav qab zib microangiopathy ua rau ua txhaum ntawm peripheral qab haus huv, qhov no nyeg ua rau cov ntshav qab zib mob neuropathy.
Mob ntshav qab zib macroangiopathy thiab nws cov tsos mob
Nrog atherosclerosis ntawm aorta thiab mob hlab ntsha, uas ua rau mob ntshav qab zib macroangiopathy ntawm qhov qis qis thiab lwm qhov chaw ntawm lub cev, cov ntshav qab zib tuaj yeem kuaj kab mob plawv, mob myocardial infarction, angina pectoris, cardiosclerosis.
Coronary mob plawv nyob rau hauv cov ntaub ntawv no proceeds nyob rau hauv ib qho kev atypical, yam uas tsis muaj mob thiab nrog los ntawm arrhythmia. Tus mob no yog qhov txaus ntshai heev, vim nws tuaj yeem ua rau mob tuag sai sai.
Pathogenesis hauv cov neeg mob ntshav qab zib feem ntau muaj xws li cov kev mob tom qab lub cev ntau ntxiv xws li mob pob qij txha, arrhythmia, thromboembolism, cardiogenic poob siab, lub plawv tsis ua haujlwm. Yog tias cov kws kho mob tau tshaj tawm tias qhov ua rau tus mob myocardial infarction yog mob ntshav qab zib macroangiopathy, txhua yam yuav tsum ua kom lub plawv nres tsis rov tshwm sim, vim tias qhov txaus ntshai heev.
- Raws li kev txheeb cais, hom 1 thiab ntshav qab zib hom 2 yog ob zaug yuav tuag taus ntawm tus mob myocardial infarction zoo li cov neeg uas tsis muaj ntshav qab zib. Kwv yees li ntawm 10 feem pua ntawm cov neeg mob txom nyem los ntawm cov hlab ntsha atherosclerosis vim yog mob ntshav qab zib macroangiopathy.
- Atherosclerosis hauv cov neeg mob ntshav qab zib ua rau nws tus kheej tau hnov los ntawm kev txhim kho ischemic mob hlab ntsha tawg los yog mob hlab hlwb ischemia. Yog tias tus neeg mob tau mob ntshav lub plawv, txoj kev pheej hmoo ntawm kev txhim kho cerebrovascular ntau dua nce peb zaug.
- Hauv 10 feem pua ntawm cov neeg mob, atherosclerotic obliterating txhab ntawm cov hlab ntsha peripheral raug kuaj pom nyob rau hauv daim ntawv ntawm atherosclerosis obliterans. Cov kab mob ntshav qab zib macroangiopathy nrog ua ke los ntawm loog, khaub thuas taw ntawm lub cev, sib chwv sib zog, hypostatic o ntawm qhov kawg.
- Tus neeg mob tau hnov mob hnyav hauv cov nqaij ntshiv ntawm lub pob tw, ob txhais ceg, sab ceg qis, uas sib zog nrog txhua qhov tawm ntawm lub cev. Yog hais tias cov ntshav ntws hauv qhov tsis txaus ntseeg yog qhov cuam tshuam, qhov no ua rau tseem ceeb ischemia, uas thaum kawg feem ntau ua rau necrosis ntawm cov nqaij ntawm ob txhais taw thiab sab ceg qis hauv daim ntawv ntawm kev mob caj dab.
- Cov tawv nqaij thiab cov nqaij mos subcutaneous tuaj yeem necrotic lawv tus kheej, yam tsis muaj kev puas tsuaj ntxiv rau kev kho tshuab. Tab sis, raws li txoj cai, necrosis tshwm sim nrog kev ua txhaum yav dhau los ntawm daim tawv nqaij - cov tsos ntawm cov kab nrib pleb, kab mob txhab, mob.
Thaum cov ntshav khiav mus tsis tshua meej, mob ntshav qab zib macroangiopathy ua rau pom qhov tsis muaj ntshav qab zib trophic mob ntshav qab zib ntawm ob txhais ceg.
Yuav kuaj li cas thiaj paub tias muaj kab mob ntshav qab zib macroangiopathy?
Kev kuaj mob yog txhawm rau txiav txim siab hnyav npaum li cas rau cov hlab ntshav ntawm lub cev, mob rau lub hlwb, thiab cov hlab ntsha peripheral.
Txhawm rau txiav txim siab txoj kev kuaj mob uas yuav tsum tau ua, tus neeg mob yuav tsum sab laj nrog kws kho mob.
Kev soj ntsuam yog nqa los ntawm tus kws kho keeb (endocrinologist), tus kws kho ntshav qab zib, tus kws kho plawv, kws phais plawv, mob plawv, kws phais plawv.
Ntawm hom 1 thiab ntshav qab zib hom 2, hom kev kuaj mob hauv qab no yog cov kws kho mob kuaj kom paub txog pathogenesis:
- Kev kuaj ntshav biochemical tau ua rau pom cov qib ntawm cov piam thaj, triglycerides, cov roj cholesterol, platelets, lipoproteins. Kev kuaj ntshav coagulation kev ua haujlwm kuj tau ua.
- Nco ntsoov soj ntsuam cov kab mob plawv siv cov tshuaj electrocardiogram, soj ntsuam txhua hnub ntawm ntshav siab, ntsuas kev ntxhov siab, echocardiogram, ultrasound dopplerography ntawm aorta, myocardial perfusion scintigraphy, coronarography, computed tomographic angiography.
- Lub neurological ntawm tus neeg mob yog teev siv ultrasound dopplerography ntawm cov hlab ntsha hauv lub hlwb, kuaj tsis meej thiab angiography ntawm cerebral cov hlab ntsha kuj tau ua.
- Txheeb xyuas cov xwm txheej ntawm cov hlab ntsha peripheral, cov ceg nqaj yog siv cov tshuaj ntsuas duplex, ultrasound dopplerography, peripheral arteriography, rheovasography, capillaroscopy, arterial oscillography.
Kev kho mob ntshav qab zib microangiopathy
Kev kho mob ntawm tus kab mob hauv cov neeg mob ntshav qab zib feem ntau yog muab kev ntsuas kom qeeb ntawm qhov kev phom sij vascular txaus ntshai, uas tuaj yeem hem tus neeg mob uas xiam oob qhab lossis tuag taus.
Kev mob ntawm qhov ncauj ntawm sab sauv thiab sab hauv qab yog kho nyob rau hauv kev saib xyuas ntawm kev phais mob. Thaum mob viav vias ntau kawg, txoj kev kho mob hnyav tsim nyog yog nqa tawm. Tsis tas li, tus kws kho mob tuaj yeem ncaj qha rau kev kho mob phais, uas muaj nyob rau hauv endarterectomy, tshem tawm ntawm cerebrovascular tsis txaus, txiav tawm ntawm cov ceg tawv cuam tshuam, yog tias nws twb mob caj dab hauv ntshav qab zib.
Cov ntsiab cai tseem ceeb ntawm kev kho yog txuam nrog kev kho cov teeb meem txaus ntshai, uas suav nrog hyperglycemia, dyslipidemia, hypercoagulation, arterial hypertension.
- Txhawm rau them nyiaj rau cov metabolism hauv cov metabolism hauv cov neeg mob ntshav qab zib, tus kws kho mob tau sau ntawv tawm kev kho mob insulin thiab kev soj ntsuam cov ntshav qab zib kom tsis tu ncua. Rau qhov no, tus neeg mob siv tshuaj lipid-txo qis - statins, tshuaj tiv thaiv kab mob, fibrates. Tsis tas li ntawd, nws yog ib qho tsim nyog yuav tau ua raws li kev kho tshwj xeeb kev noj haus thiab kev txwv kev siv cov zaub mov nrog cov ntsiab lus siab ntawm cov tsiaj rog.
- Thaum muaj kev pheej hmoo ntawm kev tsim muaj cov teeb meem thromboembolic, cov tshuaj antiplatelet raug kho - acetylsalicylic acid, dipyridamole, pentoxifylline, heparin.
- Cov tshuaj tiv thaiv kab mob ntsws thaum kuaj pom tias muaj ntshav qab zib macroangiopathy muaj nyob rau hauv kev ua tiav thiab tswj ntshav siab nyob rau theem ntawm 130/85 mm RT. Kos duab. Rau lub hom phiaj no, tus neeg mob coj ACE inhibitors, tshuaj kho mob. Yog tias ib tus neeg tau mob myocardial infarction, beta-blockers yog cov kws kho mob.
Kev tiv thaiv kev ntsuas
Raws li kev txheeb cais, nrog hom 1 thiab hom 2 mob ntshav qab zib mellitus, vim tias cov hlab plawv mob hnyav hauv cov neeg mob, cov neeg tuag muaj li ntawm 35 txog 75 feem pua. Hauv ib nrab ntawm cov neeg mob no, kev tuag tshwm sim nrog myocardial infarction, hauv 15 feem pua ntawm cov neeg mob ua kom muaj mob hlwb cerebral ischemia.
Txhawm rau zam kev txhim kho rau cov mob ntshav qab zib macroangiopathy, nws yog ib qho tsim nyog yuav tsum ua txhua yam kev tiv thaiv. Tus neeg mob yuav tsum soj ntsuam cov ntshav qab zib kom tsis txhob nyob, ntsuas ntshav siab, ntsuas kev noj zaub mov zoo, tswj nws tus kheej qhov hnyav, ua raws txhua cov lus qhia kho mob thiab muab lub luag haujlwm tsis zoo raws li qhov ua tau.
Hauv kev yees duab hauv tsab xov xwm no, cov hau kev rau kev kho mob ntshav qab zib macroangiopathy ntawm qhov kawg nkaus yog tham txog.
