Tus mob ntshav qab zib retinopathy (ICD-10 code - H36 lossis E10-E14 p. 3) yog ib qho kev mob nyhav rau cov ntshav qab zib mellitus, uas ua rau muaj kev cuam tshuam loj lossis tsis pom kev ntawm cov neeg mob lub hnub nyoog ua haujlwm. Muaj peev xwm tsim txoj kev mob zoo li cas yog nyob ntawm hom mob lwm yam, kev kho mob thiab nyiaj mob.
Yam pheej hmoo
Kev tsim cov pathology ntawm tus ntsuas qhov muag pom tau nce los ntawm:
- Lub sijhawm tiv thaiv tus kab mob. Kev mob ntshav qab zib muaj tsawg heev nyob rau thawj 6-7 xyoo, zoo li thaum tseem nyob rau hauv nkauj tiav nraug, txawm li cas los xij, kuaj pom nyob rau 5% ntawm cov neeg mob uas tsis mob ntshav qab zib-mob ntshav qab zib thaum lub sijhawm tiv tauj cov kws tshaj lij.
- Tsis muaj kev tswj kom zoo los ntawm cov ntshav qab zib provokes cov tsos ntawm decompensation thaum ntxov.
- Lub sij hawm ntawm kev xeeb tub. Ntawm qhov tshwj xeeb yog qhov kev txhim kho ntawm tus mob hlwb lig (preeclampsia).
- Ntshav siab. Tus mob no provokes qhov muaj mob ntawm cov ntshav qab zib.
- Teeb meem ntawm ob lub raum (nephropathy). Cov kws tshawb fawb tau ua pov thawj tias kev kho mob raum rov qab ua ke nrog photocoagulation tuaj yeem txhim kho tus neeg mob tus mob.
- Rog dhau.
- Cov cwj pwm tsis zoo.
Kev tsim kho tshuab
Mob ntshav qab zib mellitus yog ib yam kab mob uas cuam tshuam rau txhua hom metabolism. Ua ntej tshaj plaws, cov hlab ntsha ntawm loj thiab me me caliber raug kev txom nyem los ntawm qhov no.
Siab glycemia yog qhov txhais rau kev tsim kho ntawm pathology ntawm tus ntsuas qhov muag pom
Lub pathogenesis ntawm kev mob ntshav qab zib retinopathy yog ua raws cov kev hloov pauv hauv txhua theem, nrog rau kev nce ntxiv hauv cov ntshav coagulation, hypoxia thiab protein siab glycated. Cov piam thaj tseem ceeb ua rau muaj qhov tsis txaus, tawm tsam tom qab ntawm cov kev hloov pauv hauv lub cev, yam ntxwv ntawm cov pa oxygen tsis txaus ntawm cov nqaij thiab lub cev. Hauv cov theem thaum ntxov, kev txhim kho qhov kev ua haujlwm tau qhib, tab sis nrog kev nce qib ntawm cov ntshav qab zib, qhov qis ntawm lub lumen ntawm cov hlab ntsha pom tshwm vim lub suab nrov ntawm lawv cov phab ntsa.
Kev tsim cov glycosylated cov protein (ntshav qabzib lub cev sib xyaw ua ke nrog cov protein molecule) yog los ntawm kev tso tawm ntawm cov khoom lag luam kawg, cov lej siab uas ua rau muaj kev cuam tshuam hauv cov protein metabolism, thiab ua kom cov cell ua kom tuab. Tawm tsam cov keeb kwm yav dhau los ntawm cov kev hloov pauv, kev tsim cov tshuaj protein txawv teb chaws tshwm sim, uas lub cev tab tom sim ua kom rhuav tshem, pib qhov kev tawm tsam ntawm "kev ua kom sib luag". Qhov tshwm sim yog kev puas tsuaj rau phab ntsa ntawm cov hlab ntsha, lawv cov permeability siab.
Lub pathology ntawm cov roj metabolism ua rau lub zog tseem ceeb ntawm cov roj cholesterol, triglycerides thiab lwm yam khoom zoo sib xws uas tuaj yeem kaw lumen ntawm cov hlab ntsha retinal. Qhov no ua rau foci tshiab ntawm kev noj zaub mov tsis zoo thiab ntshav microcirculation.
Retinal hypoxia yog pom los ntawm kev tsim ntawm tus kab mob tshiab pathological vascular network (neovascularization) thiab cov tsos ntawm arteriovenous shunts (ua haujlwm rau cov ntshav).
Kev faib tawm
Muaj ntau tus lej ntawm kev faib tawm ntawm tus mob retinopathy hauv ntshav qab zib. Qhov no cuam tshuam nrog ntau qhov kev tshwm sim ntawm pathology. Ib qho ntawm cov dav siv:
- tsis-loj;
- preproliferative theem;
- loj hlob theem.
Tseem Ceeb! Xws li kev sib cais ntawm cov kev mob hnyav kom meej meej txiav txim siab lub sijhawm ntawm kev kho mob laser yog qhov tsim nyog.
Hloov pauv ntawm choroid - qhov tseem ceeb tshwm sim ntawm retinopathy nrog ntshav qab zib
Cov kev faib tawm hauv qab no:
- retinopathy ntawm hom yooj yim (keeb kwm yav dhau);
- maculopathy;
- preproliferative retinopathy;
- proliferative retinopathy.
Tsis-loj hlob theem
Lub retina ntawm qhov ntsuas tsom xam twb muaj microaneurysms, cov ntshav tawm me me uas zoo li tsaus nti thiab pom thaum kuaj cov fundus. Hemorrhages, raws li txoj cai, tshwm sim nyob rau hauv qhov chaw ntawm choroid ntawm ob lub qhov muag lossis hauv qhov tob tob ntawm cov leeg ntshav. Nyob rau tib lub sijhawm, foci ntawm exudate tsub zuj zuj tuaj (nrhiav hauv thaj chaw, zoo ib yam li cov xim dawb lossis daj uas tsis muaj thaj chaw tsis pom tseeb) thiab o.
Preproliferative theem
Txoj kev tsis pom kev ntawm txoj hlab ntshav ntawm lub cev sib txawv. Cov leeg ua convoluted, zoo sib xws hauv cov qauv rau lub rosary, loops tshwm, qhov ntsuas ntawm cov hlab ntsha hloov. Lub vascular membrane yog them los ntawm ib qho tseem ceeb ntawm exudative formations. Hemorrhages ua ntau dua.
Tshaj tawm theem
Nyob rau theem no, kev tsim cov mob neovascularization tshwm sim (pathological proliferation ntawm cov hlab ntshav qhov chaw uas lawv yuav tsum tsis txhob). Ua ntej, lawv tshwm sim ntawm choroid thiab posterior vitreous membrane, thiab tom qab ntawd loj hlob mus rau hauv vitreous nws tus kheej.
Neovascularization yog ib qho ntawm cov kev qhia tawm ntawm kev nthuav dav retinopathy.
Yog hais tias neovascularization cuam tshuam rau iris, qhov kev pheej hmoo ntawm kev mob cuam tshuam ntxiv ob peb zaug. Tsis tas li ntawd, cov hemorrhage yog hloov los ntawm cov nqaij mos, uas tuaj yeem ua rau kom pom qhov zoo li ntawm retinal detachment.
Cov tsos mob ntawm pathology
Tus mob ntshav qab zib thaum pib ua retinopathy kuj yuav yog asymptomatic los yog tshwm sim raws li hauv qab no:
- tsis pom qhov tseeb;
- daim ntaub thaiv los yog ntab maub ua ntej lub qhov muag - pom ntshav ntws;
- tsis pom qhov khoom me me;
- dawb ntab aav - qhov tsos mob ntawm edema;
- tsis xis nyob hauv thaj chaw kho qhov muag.
Qhov muag qis lossis tsis pom kev yog qhov tshwm sim qeeb ntawm kev mob ntshav qab zib retinopathy. Lawv txoj kev loj hlob qhia tias qhov tsis raws cai ntawm tus txheej txheem. Raws li kev txheeb cais, kev ua tiav kev dig muag tshwm sim hauv 2% ntawm cov neeg mob ntshav qab zib.
Qhov sib txawv ntawm lub zeem muag ntawm ib tus neeg noj qab haus huv thiab tus mob ntshav qab zib nrog cov kab mob kev kho qhov muag los ntawm lub qhov muag tsom xam
Ntxiv rau qhov kev qhia
Microaneurysms yog kev ncua ntawm cov phab ntsa ntawm cov hlab ntsha me me. Lawv cov chaw hauv cheeb tsam yog ciam teb ntawm cov chaw uas tsis muaj ntshav. Vasodilation nyob rau hauv thawj theem yog qhov taw qhia ntawm kev suav nrog ntawm kev txwv cov txheej txheem.
Yog tias cov microaneurysms tshwm sim yam tsis muaj lwm yam kev ntsuas ntawm tus kws tshuaj pov thawj pathology, lawv tsis muaj kev phom sij, tab sis tsuas yog qhia qhov pib ntawm kev txhim kho ntawm cov teeb meem. Txawm li cas los xij, ntau tus kab mob loj zuj zus, lawv yuav nce ntxiv. Ib qho tshwm sim tshwm sim tas li ntawm microaneurysms hauv nruab nrab ntawm qhov retina yog qhov zoo li puffiness.
Hemorrhage
Lawv tuaj yeem tshwm sim hauv ntau cov txheej ntawm choroid, muaj qhov sib txawv. Yog tias cov khaubncaws sab nraud povtseg muaj kev cuam tshuam, hemorrhages yog dots lossis duav ntawm oval lossis round puab. Thaum localized ntau superficially, lawv zoo li cov kab zas.
"Khoom" exudate
Nws yog cov tsub zuj zuj ntawm lipids thiab lawv cov khoom tawg. Lawv muaj lub zas daj thiab lub ntsej muag kom pom. "Khoom" exudates nyob rau thaj chaw ntawm kev nthuav dav ntawm cov leeg thiab raws tus ciam ntawm puffiness. Cov nyiaj tso tawm zoo sib xws hauv nruab nrab ntawm cov choroid ua rau kom muaj kev txo qis hauv cov qauv pom.
Mos Exudates
Lawv yog cov thaj chaw me me ntawm ischemia (necrosis) ntawm cov hlab ntsha cov hlab ntsha uas tshwm sim vim yog capillary occlusion. "Mos" exudates saib rau hauv daim ntawv ntawm thaj chaw dawb uas tsis muaj thaj chaw ntshiab.
Ntshav qab zib maculopathy
Ib qho ntawm cov tsos mob ntawm angioretinopathy, uas yog tus cwj pwm los ntawm lub qhov txhab ntawm lub macula.
Ntshav qab zib maculopathy tshwm sim vim yog nce permeability ntawm capillaries thiab lawv cov microocclusion thaum ntxov. Cov ntaub ntawv tam sim no hais txog qhov tsis muaj ntawm kev lees paub feem ntau ntawm macular lesion, tab sis feem ntau cov kws sau ntawv nyiam muab nws faib ua edematous thiab ischemic, uas nyob ntawm qhov muaj ntawm kev nthuav dav hauv zos.
Edematous maculopathy tuaj yeem yog:
Kev kho mob polyneuropathy mob ntshav qab zib- hauv zos (txwv) - kev soj ntsuam qhia pom tias muaj ib lossis ntau qhov chaw ntawm kev sib xyaw hauv nruab nrab ntawm qhov retina;
- diffuse - qhov tseem ceeb ntawm edema tshwm, uas tsis muaj thaj tsam huv, nrog kev tsim cov pob txha me.
Ischemic maculopathy muaj qhov tshwm sim tsis zoo nyob rau hauv kev sib raug zoo rau kev ua haujlwm ntawm lub qhov muag tsom xam thiab lub suab pom. Nws yog qhov nyuaj heev rau kev sib txawv thaum kuaj cov nyiaj. Optometrists, raws li txoj cai, xav txog kev txhim kho ntawm hom pathology nrog kev tsis sib haum xeeb ntawm qhov muag pom tsis pom thiab tsis pom kev hloov me me. Rau kev kuaj mob, fluorescence angiography yog siv.
Kev kuaj mob
Ophthalmologist xyuas cov mob ntshav qab zib nrog rau qee zaus:
- tom qab 5 xyoo los ntawm qhov pib ntawm "tus kab mob qab zib" uas muaj ntshav qab zib hom 1;
- thaum koj xub hu qhov endocrinologist nrog hom 2 tus kab mob;
- 1 zaug nyob rau ib xyoo uas tsis muaj nyob ntawm retinopathy;
- txhua txhua 6 lub hlis nrog ib qho kev kuaj mob ntawm cov tsis muaj phom sij hloov hlwb;
- preproliferative theem - ib zaug txhua 3-4 lub hlis;
- "proliferative retinopathy" hauv keeb kwm kev kho mob - ib zaug txhua 2-3 lub hlis.
Ophthalmologist - tus pab cuam tseem ceeb hauv kev kho thiab tiv thaiv kab mob
Kev kuaj mob siv:
- Kev txiav txim siab txog cov nplaim retinal teb - yog nqa tawm siv cov duab thaij duab. Cov txheej txheem yog tsiag ntawv los ntawm qhov chaw rhiab siab ceev ceev, kev siv duab ceev ceev. Kev tshawb nrhiav yog kim.
- Ophthalmoscopy ncaj qha - tus kws kho mob ncaj qha tus nqaj ntawm lub teeb rau hauv tus neeg mob lub qhov muag, uas tso cai rau koj los kuaj xyuas qhov mob ntawm pob nyiaj.
- Biomicroophthalmoscopy - tsom iav lo ntsiab muag siv rau kev tshawb nrhiav.
- Kev mob fluorescence angiography - cov tshuaj tshwj xeeb yog txhaj rau hauv cov ntshav ntawm cov ncauj lus, uas muaj peev xwm ci ntsa rau hauv kev teb rau lub teeb pom kev. Tso cai rau koj soj ntsuam lub xeev ntawm microcirculation, hauv cheeb tsam ntawm cov hlab ntsha, qhov muaj cov ischemia, hemorrhage.
- Optical coherence tomography - tso cai rau koj los ntsuas lub xeev o.
- Echography - siv tus txheej txheem txiav txim siab qhov ceev thiab hauv zos ntawm pathological yam sab hauv qhov muag.
- EFI yog qhov nyuaj uas suav nrog ntau qhov kev tshawb fawb. Lawv tso cai rau peb kom paub meej txog cov txheej txheem ntawm bioelectrogenesis ntawm cov khaubncaws sab nraud povtseg ntawm choroid ntawm lub ntsuas qhov pom.
Cov ntsiab lus ntawm kev kho mob
Ua ntej tshaj plaws, nws yog ib qho tseem ceeb uas yuav ua kom cov ntshav qabzib nyob rau hauv qhov ntsuas thiab ua tiav lub xeev ntawm kev them nyiaj rau tus mob qis. Nws raug nquahu tias cov ntshav ceev ceev suav tsis muaj ntau dua 6 mmol / L, thiab qib glycated hemoglobin yog siab txog 6,5%.
Tsis tas li ntawd, qhov tsis muaj kub siab yog suav tias yog ib qho tseem ceeb. Lub hom phiaj tseem ceeb ntawm cov ntshav qab zib yog ntshav siab tsis siab tshaj 140/90 hli Hg. Txhawm rau kev loj hlob ntawm cov naj npawb, cov pawg hauv qab no ntawm cov tshuaj siv:
- ACE inhibitors - Captopril, Lisinopril.
- Calcium Antagonists - Verapamil, Tiapamil.
- Diuretics - Dichlothiazide, Furosemide.
BP cov cim taw qhia - qhov txuas hauv kev tiv thaiv ntawm retinopathy
Kev Kho Cholesterol
Cov tshuaj siv rau lub hom phiaj no ua rau nws tuaj yeem them nyiaj rau kev mob ntshav qab zib mellitus thiab qeeb kev txhim kho thiab kev loj hlob ntawm cov teeb meem. Siv cov peev nyiaj los ntawm cov pab pawg ntawm cov statins (Lovastatin, Fluvastatin) thiab fibrates (Fenofibrate, Bezafibrat).
Txhim kho cov mob rheology thiab ntshav ntsa
Tus mob retinopathy yog nrog rau qhov nce ntxiv hauv cov ntshav lo nplaum. Qhov no piav qhia txog kev xav tau los sib tham ntawm cov nyiaj hauv qab no:
- Acetylsalicylic acid;
- Heparin;
- Sulodexide;
- Ticlopidine;
- Pentoxifylline.
Txhawm rau txhawm rau kho lub suab ntawm cov vascular phab ntsa, vitamin C, Rutozid, Pirikarbat, Etamzilat tau kho.
Antioxidants thiab txhim kho metabolic
Kev siv cov vitamin E, methylethylpyridinol, Ginkgo biloba extract hauv cov caij nyoog tsis ntev los no yog thoob plaws. Cov tshuaj muaj cov tshuaj antioxidant, khi thiab tshem tawm dawb radicals los ntawm lub cev.
Txhais tau tias txhim kho cov metabolism hauv cov txheej txheem hauv cov tshuaj retina (muab tshuaj rau niam txiv, hais tawm thiab periocularly):
- Dihydroergocriptine;
- Inosine;
- qhuav blueberry txiv ntoo extract;
- blueberry txiv hmab txiv ntoo extract nrog beta-carotene.
Laser coagulation
Txoj kev no suav hais tias yog ib qho zoo tshaj plaws ntawm kev kho mob ntshav qab zib. Nws lub hom phiaj yog:
- kaw ntawm ischemic aav;
- kev tsuj ntawm kev tsim ntawm cov nkoj tshiab pathological;
- kaw ntawm cov leeg tshav ntawm cov capillaries uas tau nce permeability ntawm phab ntsa;
- qhov tsim ntawm qhov ua kom haum, txo qhov ua rau kev txiav tawm.
Laser retinal coagulation - txoj kev ua tau zoo ntawm kev txwv qhov kev vam meej ntawm tus mob
Kev sib xyaw co yog nqa tawm los ntawm argon, solid-state lossis diode (duab liab) laser. Muaj ntau txoj hauv kev ntawm laser coagulation, uas sib txawv los ntawm kev sib txuam hauv lub hom phiaj ntawm kev ua haujlwm, kev ntsuas, kev siv.
Panretinal coagulation
Siv nyob rau hauv kev kho mob ntawm preproliferative thiab proliferative retinopathy ntawm ntau yam etiologies. Cov tshuaj txhuam coagulates tau thov rau tag nrho thaj chaw ntawm choroid, tshwj tsis yog lub corpus luteum, los tiv thaiv lossis txo cov tsos ntawm cov nkoj tshiab. Qhov no tso cai rau peb txhawm rau txhim kho trophism ntawm cov cheeb tsam ntawm cov retina uas tseem tsis cuam tshuam los ntawm cov txheej txheem pathological.
Ua ntej kev ntxias, tus neeg mob yuav tsum paub txog qhov tseeb tias cov txheej txheem tsis yog ua nrog lub hom phiaj ntawm kev kho kom pom tseeb tseeb, tab sis txhawm rau tiv thaiv kev txhim kho ntawm nws poob.
Antiangiogenic kev kho mob
Ib txoj hauv kev uas cov tshuaj tau txhaj ncaj qha rau hauv cov tshuaj vitreous. Txhawm rau tiv thaiv neovascularization, angiogenesis blockers siv. Cov txiaj ntsig tseem yog qhov txo qis hauv edema hauv thaj av ntawm corpus luteum.
Cov txheej txheem tsis yog siv coj los ua txheej txheem cais. Antiangiogenic kev kho mob yog suav tias yog ib feem ntawm kev kho mob nyuaj thiab yog koom ua ke nrog laser coagulation lossis phais.
Kho plawv
Kev phais mob yog tsim nyog los tiv thaiv qhov kev vam meej ntawm cov txheej txheem pathological, nrog rau kev kho tus neeg mob tus mob yog muaj teeb meem. Kev kho mob rau tus kheej yog tsis ua raws li cov lus hauv qab no:
- rubeosis ntawm iris;
- theem nrab neovascular glaucoma;
- optic atrophy;
- corneal pathology;
- lub davhlau ya nyob twg theem ntawm proliferation;
- decompensation ntawm ntshav qab zib thiab lwm yam kab mob.
Raws li ophthalmologists, kev ua haujlwm ruaj khov ntawm lub luag haujlwm ntawm lub zeem muag pom tom qab kev phais mob tshwm sim hauv 45% ntawm tus neeg mob, thaum ntawm cov neeg mob uas tsis ua raws li cov lus qhia los ntawm cov kws kho mob, tsuas yog 14%.
Cov tshuaj kho neeg mob
Kev kho mob nrog cov tshuaj kho mob hauv pej xeem tso cai tsis tsuas yog tswj lub luag haujlwm ntawm cov khoom siv kom pom, tab sis kuj ua kom cov ntshav qab zib nyob hauv qhov txwv tsis pub siv. Kev siv hauv kev ua tau zoo pom nettle. Cov nplooj tshiab tau tawg, tau txais kua txiv. Nws yog qhov tsim nyog los haus ib feem peb ntawm khob iav peb zaug ib hnub. Nettle nplooj tuaj yeem muab ntxiv rau zaub nyoos, thawj cov chav kawm.
Nettle kua txiv - lub tsev rau khoom ntawm cov tshuaj tseem ceeb tsis tsuas yog rau cov neeg mob, tab sis kuj rau tib neeg noj qab haus huv
Ib qho zoo sib xws muaj cov kua txiv ntawm aloe nplooj. Ua ntej rho tawm cov kua dej zoo, cov nplooj tau tso rau hauv lub tub yees rau ob peb teev. Tom qab ntawd lawv raug crushed, kua txiv yog tau, nws tau rhaub rau tsis pub ntau tshaj 3-4 feeb. Kev Siv Nyiaj 1 tsp. peb zaug hauv ib hnub, thaum tsaus ntuj koj tuaj yeem nqus dej ntawm lub qhov muag (2 tee ib qho).
Koj tuaj yeem siv Txoj kev lis ntshav ntawm blueberries (haus hauv qhov me me thoob plaws hauv ib hnub), kua txiv lingonberry, decoctions ntawm tshuaj ntsuab npaj.
Kev tiv thaiv kev ntsuas
Lub ntsiab lus tseem ceeb yog kev saib xyuas ntawm cov ntsuas pom zoo ntawm cov ntshav qab zib, ntshav siab, lub cev qhov hnyav. Qhov no tso cai rau koj kom tsis txhob los yog ncua kev txhim kho tsis tsuas yog retinopathy, tab sis kuj tseem muaj lwm yam mob hnyav thiab mob ntshav qab zib mellitus.
Kev tiv thaiv yog li nram qab no:
- kev ua raws li kev noj haus ntawm cov zaub mov tsis muaj carbohydrate;
- kev siv lub cev kom txaus;
- kev kuaj mob tsis tu ncua nrog kws kho ntsej muag;
- kev kho mob raws sij hawm ntawm qhov pib mob thiab pib ua cov kev mob.
Hmoov tsis zoo, nws yog kev coj tsis yooj yim los kho qhov kev tsis txaus siab, tshwj xeeb tshaj yog nyob rau theem tom ntej, thiab nws muaj peev xwm tiv thaiv nws txoj kev txhim kho, tswj kev ua kom pom tseeb thiab nres qhov muaj mob. Qhov loj tshaj plaws yog ua raws li cov lus qhia thiab cov lus pom zoo ntawm cov kws tshaj lij thiab muaj qhov mob siab txog qhov pib mob.
