Atherosclerosis: etiology, pathogenesis, likarolo tsa kliniki le tlhahlobo ea kalafo, kalafo, mekhoa ea ntlafatso

Atherosclerosis (Greek athḗra, slurry + sklḗrōsis, ho thatafatsa) ke lefu le sa foleng la methapo ea methapo ea kutlo le mesifa, e bakoang ke tlolo ea lipid le metabolism ea protheine mme e tsamaisana le ho hlahisoa ha cholesterol le likaroloana tse ling tsa lipoprotein bokong ba methapo ea mali. Li-Deposits li fetoha ka mokhoa oa li-plaque tsa atheromatous. Khōlo e latelang ea lisele tse sebetsanang le tsona (sclerosis), le khokahano ea leboteng la sekepe li lebisa ho phetoho le ho fokotsa leseli ho fihlela litšitiso (ho thijoa ha sekepe). Ho bohlokoa ho khetholla atherosulinosis ho tloha Menkeberg arteriosulinosis, mofuta o mong oa sclerotic vidion, o khetholloang ka ho hlahisoa ha letsoai la khalsiamo kahara membrane e bohareng ea methapo, ho kenella hoa lesion (ho se be teng hoa li-plaque), nts'etsopele ea aneurysms (mme eseng blockage) ea methapo ea mali. Atherosclerosis ea methapo ea mali ea pelo e lebisa nts'etsong ea lefu la pelo.

Atherosclerosis
Liphetoho ka sekepeng (ts'ebetso ea ho nts'etsopele ea atherosclerosis), ho bokellana ha cholesterol
ICD-10	Ke 70 70.
ICD-10-KM	I70 le I25.1
ICD-9	440 440
ICD-9-KM	440
Ditsietsi	1039
Medlineplus	000171
eMedicine	med / 182
Mesh	D050197

Litekanyetso tsa batho ba shoang tse ithutoang haholo ke mafu a pelo le pelo e le ponahatso ea lefu la pelo. 'Musong oa Russia ka 2000, sekhahla sa batho ba bolauoang ho tsoa ho mafu a tsamaiso ea potoloho e ne e le 800,9 ho batho ba likete tse lekholo. Ha ho bapisoa, naheng ea France palo ena ke 182.8 (e tlaase ka ho fetisisa Europe), Japane - 187.4. Ho netefalitsoe hore phokotso ea kotsi ea lefu la pelo linaheng tsena e amana le boleng ba tlhokomelo ea bongaka joalo ka mokhoa oa bophelo le litloaelo tsa ho ja.

Hajoale, ha ho na khopolo e le 'ngoe ea ho hlaha hoa lefu lena. Likhetho tse latelang li kenngoa pele, hammoho le motsoako oa tsona:

• khopolo ea ho kenella ha lipoprotein - Ho bokella ha lipoprotein tsa mantlha leboteng la methapo,
• khopolo ea endothelial dysfunction - tlolo ea mantlha ea thepa e sireletsang ea endothelium le babuelli ba eona,
• autoimmune - ho se sebetse hantle ha li-macrophage le leukocytes, ho kenella ha tsona ka lerako la methapo,
• monoclonal - ketsahalo ea mantlha ea lisele tsa mesifa e boreleli,
• bongata - Tšenyo ea mantlha ea vaerase ea endothelium (herpes, cytomegalovirus, jj.),
• peroxide - tlolo ea mantlha ea antioxidant system,
• liphatsa tsa lefutso - bofokoli ba mantlha ba lefa la pelo,
• chlamydial - Tšenyo ea mantlha leboteng la vascular le chlamydia, haholo-holo Chlamydia pneumoniae.
• hormonal - keketseho e amanang le lilemo kahara boemo ba lihormone tsa gonadotropic le adrenocorticotropic ho lebisa ho kenyelletso e eketsehileng ea thepa ea ho haha ​​bakeng sa lihormone tsa cholesterol.

• ho tsuba (ntho e kotsi ka ho fetisisa)
• hyperlipoproteinemia (cholesterol e felletseng> 5 mmol / L, LDL> 3 mmol / L, LP (a)> 50 mg / dL)
• khatello ea kelello ea methapo (khatello ea mali ea systolic> 140 mmHg. khatello ea mali ea diastolic> 90 mmHg.)
• lefu la tsoekere
• botenya
• bophelo ba ho lula fatše (ho se sebetse hantle mmeleng)
• khatello ea maikutlo e feteletseng
• khaello ea phepo e nepahetseng
• bokapele ba lefutso
• postmenopause
• hyperfibrinogenemia
• homocysteinuria le homocysteinemia
• hypothyroidism

Ho latela Tataiso ea Europe ea Thibelo ea Maloetse a pelo (European Gu> programme ea Russia) (sehokelo ha se fumanehe - pale ) . cms.escardio.org. ho bala kotsi ea ho ba le lefu la pelo. Tlhahlobo e akaretsang haholoanyane e ka etsoa ho latela tafole e ka tlase.

Pathogenesis ea atherosulinosis e bitsoa atherogeneis. E etsahala ka mekhahlelo e mengata. Ntshetsopele ea liso tsa methapo ea kutlo e kopantseng methapo ea ho kena le ho tsoa ha lipoprotein le leukocytes tse tsoang ho eona, keketseho le lefu la lisele, sebopeho le phetiso ea methapo ea methapo ea mali le calcation. Ts'ebetso tsena li tsamaisoa ke matšoao a mangata, hangata a multidirectional. Lintlha tse eketsehileng li ntse li bokellana kamanong e rarahaneng ea pathogenetic lipakeng tsa phetoho ts'ebetsong ea lisele tsa methapo ea methapo le leukocytes tse ileng tsa kena ho eona le mabaka a kotsi a atherosclerosis.

Ho bokella le ho fetoloa ha lipoprotein Ed

Ka tloaelo, karolo ea methapo ea methapo ea methapo e thehoa ke "unotellular endothelial", 'me ka tlase ho eona ho na le lisele tsa mesifa tse boreleli tse kenelletseng ka har'a ntho e kopaneng. Lipontšo tsa pele tsa lefu lena ke libaka tse bitsoang li-lipid. Ponahalo ea bona e tsamaisana le ho hlahisoa ha lipoprotein tsa sebakeng sa maqhubu. Ha se lipoprotein tsohle tse nang le thepa ea atherogenic, empa e tlase feela (LDL) le letsoalo le tlase haholo (VLDL). Pele, li bokellana ka har'a intra haholo ka lebaka la ho tlamaha likarolo tsa ntho e fapaneng - li-proteinoglycans. Libakeng moo lipid lipere li thetsoang teng, boteng ba heparan bo sulfate holim 'a tse ling tse peli glycosaminoglycans, keratan sulfates le chondroitin sulfates, e bapala karolo ea bohlokoa.

Ka thobalano, lipoprotein, haholo-holo tse amanang le proteinoglycans, li ka kena liphethong tsa lik'hemik'hale. Karolo e ka sehloohong e bapaloa ke tse peli: oxidation le non-enzymatic glycosylation. Ho fapana le plasma, intima e na le li-antioxidants tse 'maloa. Motsoako oa LDL e nang le oxid e thehoa, ka lipids ka bobeli le karolo ea protheine e ntse e hlahisoa ka bongata. Nakong ea oxidation ea lipids, ho entsoe hydroperoxides, lysophospholipids, li-oxysterines le aldehydes (nakong ea peroxidation ea mafura acid). Ho tšeleseha ha apoprotein ho lebisa ho ho qaqileng ha litlamo tsa peptide le khokahano ea liketane tse lehlakoreng tsa amino acid (hangata sehlopha sa β-amino sa lysine) ka lihlahisoa tsa ho phatloha ha mafura acid (4-hydroxynonenal le malondialdehyde). Ho phehella ha hyperglycemia ho lefu la tsoekere ho baka ho se sebetse hantle ha liprotheine tse se nang enzymatic le liprotheine tsa maiketsetso tse ka hare, tseo le tsona li sitisang tšebetso ea tsona 'me li potlakisa atherogenesis.

Ho falla ha lisele tse tšoeu le ho etsoa hoa lisele tsa xanthoma (foam)

Ho falla ha leukocytes, haholo monocytes le lymphocyte, ke karolo ea bobeli ea nts'etsopele ea sebaka sa lipid. Ho fallela ha bona ka har'a intima ho fanoa ke li-receptors tse fumanehang ho endothelium - limolek'hule tsa khokahano. Habohlokoa ka ho khetheha ke limolek'hule tsa VCAM-1 le ICAM-1 (tse tsoang ho superfamily of immunoglobulins) le P-Selectins. Meetso ea limolek'hule tsa khokahano e ka eketsa li-cytokines. Kahoo, interleukin-1 (IL-1) le tumor necrosis factor (TNFα) e baka kapa e ntlafatsa tlhahiso ea lisele tsa endothelial VCAM-1 le ICAM-1. Ka lehlakoreng le leng, ho lokolloa ha li-cytokine ke lisele tsa lebota la vascular ho susumetsoang ke lipoprotein tse fetotsoeng. Liforomo tse khopo tse potileng.

Sebopeho sa phallo ea mali se bapala karolo. Libakeng tse ngata tsa mokelikeli o sa fetoheng, mali a phalla ka mokhoa o makatsang, mme matla a hlahisoang ke sena a fokotsa polelo (ponahatso) ea limolek'hule tsa khokahanyo holim'a lisele tsa endothelial. Phallo ea mali ea Laminar e boetse e kenya letsoho ho thehoeng ha nitric oxide NO ho endothelium. Ntle le phello ea vasodilating, ka har'a khatello e tlase e tšehetsoang ke endothelium, NO e na le ts'ebetso e khahlanong le ho ruruha, ho fokotsa mohlala, mohlala oa VCAM-1. Empa libakeng tsa makala, laminar ea hona joale e lula e tšoenyeha, ke moo ho fumanehang hore lits'oants'o tsa atherosselotic.

Kamora ho khomarela, lisele tse tšoeu tsa mali li feta le endothelium ebe li kena ka har'a intima. Lipoprotein e ka ntlafatsa ho falla ka ho toba: oxidised LDL e khothalletsa leukocyte chemotaxis.

Li-monocytes li kentse letsoho ho thehoeng le leholo la lipid. Ho intima, li-monocytes li fetoha macrophage, e tsoang ho eona, ka lebaka la li-endocytosis tse amohelang methapo ea lipoprotein, lisele tsa xanthous (foamy) li tletse lipids. Pele ho moo, ho ne ho nahanoa hore li-receptor tse tsebahalang tsa LDL li ameha ka endocytosis, empa ha li-receptor tsena li le phoso, liphoofolo le liteko tsa bakuli (mohlala, hypercholesterolemia) li ntse li na le li-xanthomas tse ngata le li-plaque tsa atherosselotic tse tlatsitsoeng ka lisele tsa xanthoma. Ntle le moo, k'holeseterole ea kantle ho lintho e sitisa motsoako oa li-receptor tsena, 'me ke tse' maloa tsa tsona tse nang le hypercholesterolemia. Joale karolo ea li-macrophage scavenger receptors (tse kopanyang lipoprotein tse fetotsoeng haholo) le li-receptor tse ling tsa LDL e nang le oxidized le VPLL e nyane ea atherogenic e se e nkoa. Lisele tse ling tsa xanthoma tse monya lipoprotein ho tsoa ho ntho e kopanang li siea lebota la artery, ka tsela eo li thibela ho bokellana ha lipids ho eona. Haeba ho kenella ha lipoprotein ka har'a intla ho laola tlhahiso ea bona ka li-macrophages (kapa mekhoa e meng), lipids lia bokellana 'me qetellong e be liforomo tsa atherosranceotic plaque. Letlapeng le ntseng le eketseha, lisele tse ling tsa xanthoma li tšoaroa ke apoptosis kapa necrosis. Ka lebaka leo, mothapo o mongata o nang le lipid boima ba lipid bohareng ba lesela lena, e leng tšobotsi ea methati ea morao ea atherogeneis.

Pro- le anti-atherogenic lintlha Rulaganya

Nakong ea ts'ebetso ea lipoprotein tse fetotsoeng, li-cytokines tse sephiring tsa macrophages le lintlha tsa kholo tse khothalletsang nts'etsopele ea plaque. Lintho tse ling tsa cytokines le lintho tse hola li hlohlelletsa karohano ea lisele tse boreleli tsa mesifa le ho hlophisoa ha lintho tse kopaneng, tse bokellanang mohopeng. Li-cytokine tse ling, haholo-holo li-interferon-γ tse tsoang ho li-T-lymphocyte tse sebetsang, li thibela karohano ea lisele tsa mesifa le motsoako oa collagen. Lintho tse kang IL-1 le TNFcy li baka tlhahiso ea elemente ea kholo ea platele le kholo ea kholo ea fibroblast ho intima, e phethang karolo ea bokamoso ba sethala. Ka hona, ho na le ts'ebelisano e rarahaneng ea lintlha, e potlakisang le e thibelang atherogeneis. Karolo ea babuelli ba se nang protheine le eona e kholo. Li-macrophages tse sebetsang le lisele tsa lebota la vascular (endothelial le mesifa e boreleli) li hlahisa li-radicals tsa mahala tse nang le oksijene tse khothalletsang ho eketseha ha lisele tse boreleli tsa mesifa, li matlafatsa sebopeho sa cytokine hape li tlama NO. Li-macrophages tse sebetsoang, ka lehlakoreng le leng, li khona ho kopanya mofuta o sa lumellaneng oa NO. Enzyme ena e sebetsang haholo e hlahisa NO maemong a phahameng, a nang le chefo - ho fapana le khatello e nyane ea NO e thehiloeng ke mofuta oa enzyme, endothelial NO synthase.

Ntle le li-macrophages, li-high density lipoproteins (HDL), tse fanang ka se bitsoang reverse cholesterol transport, li kenya letsoho ho tloseng cholesterol ho tloha sehlohlolong se amehang. Kamano e hlakileng e hlakileng pakeng tsa mahlakore a HDL cholesterol le kotsi ea CHD e netefalitsoe. Ho basali ba lilemo tsa ho ba le bana, khatello ea cholesterol ea HDL e phahame ho feta ho lithaka tsa banna, mme haholo-holo ka lebaka lena, basali ha ba na monyetla oa ho tšoaroa ke lefu la atherosclerosis. Teko e bontšitse hore HDL e ka tlosa cholesterol liseleng tsa xanthoma.

Ts'ebetso ea mesifa e bonolo

Letlapa la atherosselotic le hlaha sebakeng sa lipid, empa ha se libaka tsohle tse fetohang. Haeba ho bokellana ha lisele tsa xanthoma ke tšobotsi ea libaka tsa lipid, joale fibrosis ke tšobotsi ea lits'oants'o. Ntho ea bohlokoa kahare ho pente e hlophisitsoe haholo ke lisele tsa mesifa tse boreleli, ho falla le ho eketsoa ha nako eo e ka bang motsotso oa bohlokoa tlhahisong ea lesela la fibrous sebakeng sa ho bokella lisele tsa xanthoma.

Ho fallela ho lipid letheba la lisele tse boreleli tsa mesifa, ho eketseha ha tsona le ho kopana ha ntho e kopaneng ho hlahisoa ke li-cytokines le lintlha tsa kholo tse hlahisitsoeng tlasa ts'usumetso ea lipoprotein tse fetotsoeng le lintho tse ling ke li-macrophages le lisele tsa methapo ea methapo. Kahoo, karolo ea kholo ea "platelet" e hlahisoang ke lisele tse sebetsang tsa endothelial e susumetsa ho falla ha lisele tse boreleli tsa mesifa ho tloha mecha ea phatlalatso ho ea ho intima. Lintho tse etselitsoeng ho hola sebakeng sa heno li baka karohano ea lisele tsa mesifa le lisele tse bonolo tsa intra ea methapo e tsoang mecheng ea litaba. E 'ngoe ea li matlafatso tse matla bakeng sa motsoako oa li-collagen ke lisele tsena ke phetoho ea kholo. leq. Ntle le paracrine (lintlha li tsoa liseleng tse haufi), autocrine (ntho e hlahisoang ke sele ka boeona) tsamaiso ea lisele tse boreleli tsa mesifa le eona ea etsahala. Ka lebaka la liphetoho tse bang teng le tsona, phetoho ea sebaka sa lipid ho lethekeng la atherosselotic, le nang le lisele tse ngata tse boreleli tsa mesifa le ntho e kenelletseng, li potlakisitsoe. Joalo ka li-macrophages, lisele tsena li ka kena ho apoptosis: e bakoa ke li-cytokines tse kenyang letsoho ho holiseng atherosclerosis.

Ntshetsopele ya polasetiki e thata

Ntle le mabaka a tloaelehileng a kotsi le li-cytokine tse hlalositsoeng ka holimo methating ea morao ea nts'etsopele ea atherosclerosis, karolo ea bohlokoa ke ea liphetoho mokhoeng oa ho kopanya mali. Bakeng sa ponahalo ea matšoao a lipid, ho senya kapa ho nyahamisa ha endothelium ha ho hlokahale. Empa nakong e tlang, meokho ea microscopic e ka hlaha ho eona. Ho khokhotheha ka liplatelete ho etsahala ka sebopeho se ka tlase se senotsoeng, le foromo e nyane ea liplatele libakeng tsena. Li-platelet tse sebetsang li kenya lintho tse 'maloa tse potlakisang fibrosis. Ho kenyelletsa ntlha ea kholo ea platelet le sepheo sa ho hola leq Lisele tsa mesifa e boreleli li angoa ke babuelli ba boima ba limolek'hule tse kang serotonin. Ka tloaelo, methapo ena ea mali e qhibiliha ntle le ho baka matšoao, 'me botsitso ba endothelium boa khutlisoa.

Ha li-plaque li ntse li eketseha, vasa vasorum (methapo ea mali) e qala ho hola haholo ho eona. Likepe tse ncha li ama qetello ea lesela ka litsela tse ngata. Ba theha sebaka se seholo bakeng sa ho phalla ha leukocytes ho tsoa le kahara lesela. Ntle le moo, likepe tse ncha ke mohloli oa hemorrhage e bonolo: joalo ka lefu la tsoekere le lefu la tsoekere, ha le robehe ebile le tloaetse ho phatloha. Ho hlaha hoa moea ho lebisa ho thrombosis, ho hlaha thrombin. Ha e nke karolo feela ho heestasis, empa e ama le lisele tse tebileng: e matlafatsa karohano ea lisele tse boreleli tsa mesifa le tlhahiso ea tsona ea li-cytokines, hape e baka tšusumetso ea mabaka a kholo ka endothelium. Ka lebaka la hemorrhage, hangata li-plaque li na le fibrin le hemosiderin.

Hangata, lipolao tsa atherosulinotic lia nyopa. Li-plaque li na le liprotheine tse tlatsang calcium tse nang le osteocalcin le osteopontin le liproteine ​​tse ling tse nang le mofuta oa lithane tsa masapo (haholo-holo, liprotheine tse laolang lesapo la morphogenesis).

Liponahatso tsa kliniki hangata ha li tsamaisane le morphology. Ka postmortem autopsy, lesapo le pharaletseng le le boletsoeng la atherosranceotic vasion lesion le ka 'na la fumanoa. Ka lehlakoreng le leng, kliniki ea litho tsa ischemia e ka hlaha ka ho fokotsoa ha khanya ea sejana ka sekepeng. Lesapo le ikhethang la matangoana a itseng a arohaneng ke tšobotsi. Setšoantšo sa kliniki ea lefu lena se latela sena. Ho senyeha ha methapo ea methapo ea kutlo butle-butle ho lebisa ho se lekaneng ha coronary, ho bonahatsoang ke lefu la pelo. Atherosclerosis methapo ea methapo ea pelo e baka ischemia kapa methapo ea nakoana. Ho senyeha ha methapo ea maoto le matsoho ke sesosa sa ho ikarola ha nakoana le mokokotlo o omileng. Atherosclerosis ea methapo ea mesenteric e lebisa ho ischemia le intestinal infarction (mesenteric thrombosis). Ho senyeha ha methapo ea methapo ea methapo ka popelong ea monoana oa Goldblatt hoa khoneha. Leha e le ka har'a matangoana a arohanang a lisele tse ikhethang li na le tšobotsi - ka ho nka karolo ha libaka tsa tloaelo le polokeho ea baahisani. Kahoo, ka har'a methapo ea pelo, occlusion hangata e hlaha karolong e haufi ea lekala la methapo ea methapo ea methapo. Tloaelo e 'ngoe e tloaelehileng ke tikoloho ea methapo ea methapo e amanang le methapo. Metsoako e meng e kang methapo ea methapo e ka hare ea thoracic ha e amehe hangata, leha e le haufi le methapo ea methapo ea kutlo e sebakeng le ka sebopeho. Hangata, litlaelese tsa atherosselotic li hlaha hangata ka ho ruruha ha methapo ea methapo - moo phallo ea mali e sa lekanang, ka mantsoe a mang, hemodynamics ea lehae e bapala karolo ea sebaka sa lipopae (bona pathogenesis).

Ho tseba ka mafu a amanang le atherosulinosis ho kenyelletsa:

• Ho buisana le mokuli le ho hlakisa matšoao a lefu lena: matšoao a lefu la pelo, matšoao a ho lemala ha methapo ea methapo, claudication ea nakoana, matšoao a mala a ka mpeng, jj.
• Tlhahlobo e akaretsang ea mokuli: matšoao a ho tsofala, ho mamela ho korotla ha methapo ea kelello ho maikutlo a methapo, ka mokhoa o hlakileng oa methapo eohle ea methapo e fumanehang palpation: aorta, methapo ea ka ntle ea liac, methapo e tloaelehileng ea basali, methapo ea methapo ea methapo, methapo ea maoto le morao le methapo ea methapo ea mokokotlo, methapo ea mokokotlo.
• qeto ea mookameli oa systolic ka lebaka la lintlha tse khahlisang tsa methapo ea methapo.
• haeba ho na le lipelaelo tsa tšenyo ea betheng ea lipalo tse tlase, boikemisetso ba karabelo e makatsang.
• Boikemisetso ba phallo ea cholesterol ea mali le boikemisetso ba mali lipid,
• Tlhahlobo ea X-ray ea litho tsa ka sefubeng, mekhoa ea tlhahlobo
• Tlhahlobo ea Ultrasound ea pelo le litho tsa mokokotlo oa mpa le sebaka sa ho hlopha,
• Dopplerography ea lijana tsa maoto kapa, e ka bang molemo ho feta, ho e kopitsa le ho e sekaseka ka makhetlo a mararo ea methapo ea karolo ea brachiocephalic, methapo ea methapo e tlase, karolo ea aortic-iliac, hammoho le transcranial doppler.
• diagnostics of a ritialness ea methapo, ho kenyelletsa le volumetric sphygmography le boikemisetso ba lenane la methapo ea methapo ea pelo (CAVI)

Ka kalafo ea kalafo ea atherosulinosis, mekhoa e meng ea lithethefatsi le eo e seng ea lithethefatsi e ea nkoa.

Mekhoa e se nang lithethefatsi bakeng sa tokiso ea hyperlipidemia Edita

Ho fihlela phello e lekaneng, nako ea kalafo e joalo e lokela ho ba eseng ka tlase ho likhoeli tse 6. Lintlha tse latelang ke tsa bohlokoa kalafong ea kalafo (bona lintlha tse kotsi):

• tlohela ho tsuba
• tšebeliso e ngata ea joala
• antiatherossteotic ja lijo - ka mohlala, "Mediterranean": oli e nang le mafura a mangata a mafura (Omega-3): flaxseed, rapeseed kapa olive. Ka joala, veine ea tafoleng e fihla ho 150 ml ka letsatsi (empa ho molemo ho tlohela joala ka ho felletseng, kaha ke eona e ka etsang hore motho a be le khatello ea matla). Ho hana bohobe ho tloha phofo ea limaraka tse holimo, eseng letsatsi le se nang litholoana le meroho.
• bophelo bo mafolofolo - tloaelo e tloaelehileng ea ho ikoetlisa.
• ho boloka khutso ea kelello le 'mele
• ho theola boima ba 'mele

Tlhatlhobo ea Bongaka ba Lithethefatsi

Ho kenyelletsa khalemelo ea khatello ea mali ea methapo (haholo khatello ea mali ea systolic), lefu la tsoekere, lefu la metabolic. Le ha ho le joalo, se bohlokoa ka ho fetisisa ke boemo bo tloaelehileng ba mofuta oa lipid. Lithethefatsi tse sebelisetsoang morero ona li arotsoe ka lihlopha tse 'ne tse kholo:

• Ke - thibela ho kenyelletsa k'holeseterole
• II - fokotsa litlatsetso tsa k'holeseterole le li-triglycerides sebete le ho fokotsa khatello ea bona maling a mali
• III - catabolism e ntseng e eketseha le li-excretion tsa lipids tsa atherogenic le lipoprotein
• IV - e eketsehileng

Ho tloha ka selemo sa 2012, lithethefatsi li 'nile tsa rekisoa sebakeng sa Russia se sebelisang kalafo ea methapo ea methapo ea methapo.

Kopano ea Pele ea Sehlopha

• IA - anion exchange resins (cholestyramine, gemfibrozil). Adsorb cholesterol ka boeona. Ha e kenelle kapa ea senyeha ka har'a pampitšana ea ka mpeng. Tlhōrō ea katleho e fihlelleha kamora khoeli ea kopo. Tšusumetso e lula libeke tse 2 ka mor'a ho hlakoloa. Litsietsi: adsorb lintho tse ling - lithethefatsi, livithamini, lintlha tsa mohlala. E kanna ea baka dyspepsia. Ntle le moo, liphuputso tse ikhethang li bontša hore botebo ba atherosulinosis ha bo lumellane le plasma cholesterol ka tsela efe kapa efe, 'me cholesterol ea placma ha e na plasma empa e le tšimoloho ea endothelial, ke hore, ha e behiloe leboteng la vascular ho tsoa maling, empa ke metabolite ea eona ea methapo. mohloli ha oa hlalosoa matsatsi a 3500
• IB - li-sorbents tsa limela (guarem, β-sitosterol). Thibela ho kenngoa ha cholesterol ka mpeng. Ho hloka ho nooa kholo (bonyane 200 di ml) bongata ba mokelikeli. Li ka baka le dyspepsia.
• IC - ho nts'etsopele le ho lekoa ha blocker ea AC-CoA e fetisoa. Kahoo, ho tla khonahala ho fokotsa ho netefatsoa ha cholesterol ho li-enterocytes, ka lebaka leo, thibela ho ts'oaroa ka mpeng. Leha ho le joalo, ho tsebahala hore boholo (hoo e ka bang 2/3) ea cholesterol ea setho ke ntho ea tlhaho ea tlhaho, mme "khaello" ea k'holeseterole ea alimentary e putsoa habonolo ke tlholeho e tsoang ho acetate.

Ka hona, ntoa khahlanong le alimentary le / kapa plasma cholesterol joalo ka ketsahalo e se nang moelelo ebile e sa sireletsehang e sa ntlafatseng ho fola hoa lefu lena. mohloli ha oa hlalosoa matsatsi a 3500

Tlatsetso ea Sehlopha sa Bobeli

• IIA - inhibitors ea 3-OH-3-methylgluratyl CoA reductase (HMG-CoA reductase). Ke li-statins. Sehlopha sa lithethefatsi se tummeng ka ho fetisisa (ebile se theko e boima). Baemeli ka tatellano ea ts'ebetso: lovastatin (mevacor, medostatin, apextatin), simvastatin (zosor, vasilip, simvor), fluvastatin (leskol), pravastatin (lipostat, pravol) le cerivastatin (lipobay), atorvastatin (lyprimin le rovarvard) tšela). Leha ho le joalo, ka keketseho ea phello e kholo, kotsi ea litla-morao ka tsela e itseng ea eketseha. Har'a tsona: myopathy, rhabdomyolysis ho fihlela nts'etsopele ea ho se sebetse hantle ha renal, haholoholo ha e kopana le li-fibrate le nicotinic acid, hepatotoxicity, ho hloka thari, alopecia, dyspepsia. Li ke ke tsa kopanngoa le joala, tse sebelisoang ho bana, baimana le ba lactating, bakuli ba nang le tšenyo ea sebete. Bakuli ba tlhokomeliso ka mor'a hore methapo ea methapo ea methapo ea methapo e tsamaeang ka matla ho feta.
• IIB - derivatives ea fibroic acid (fibrate): clofibrate (miskleron), bezafibrate (bezalip), ciprofibrate (lipanor), fenofibrate (treicor). Mathata ha u sebelisa meriana ena e ka ba: myositis, allergies, dyspepsia, lefu la gallstone ho clofibrate. Ka hona, lithethefatsi tsena tsa meloko e fetileng hona joale ha li sebelisoe. Fenofibroic acid derivative kapa moloko o mocha oa li-fibrate: fenofibrate joale e sebelisoa haholo. Fenofibrate e na le profil ea polokeho e phahameng ebile e na le litlamorao tse fokolang. Fenofibrate e sebetsa hantle haholo ho phekola bakuli ba nang le lefu la tsoekere la mofuta oa 2, le bonahatsoang ke keketseho ea li-triglycerides, ho fokotseha ha HDL le keketseho e leka-lekaneng ea LDL. Fenofibrate e boetse e fokotsa palo ea LDL e nyane e nyane, e leng LDα e atherogenic ka ho fetisisa. Hammoho le sena, ha ho nka fenofibrate, ho fokotseha eseng feela mathateng a macrovascular (IHD, myocardial infarction), empa hape le maemong a joalo a sitisang mathata a microvascular joaloka retinopathy, polyneuropathy, nephropathy, le ho pongoa lipheo tse tlase tsa lefu la tsoekere.

Bakeng sa kalafo e matla haholoanyane ea atherosulinosis, ho khothalletsoa ho kopanya ts'ebeliso ea li-statins le fenofibrate.

• IIC - nicotinic acid (enduracin). Ha ho ratehe ho sebelisa lefu la tsoekere. Litlamorao tsa litla-morao: ho hlohlona ha letlalo, hyperemia, dyspepsia.
• I> Karolo ea Boraro ea Sehlopha

Li-acid tse sa koaeloang ke matla: linetol, lipostabil, tribuspamine, polisponin, thioctic acid (octolipen, thiogamma, thiolepta), omacor, eikonol. Tlhokomeliso: e ka ntlafatsa litlamorao tsa lithethefatsi tse theolelang tsoekere.

Litokisetso tsa liteko

Cyclodextrin, e bonts'itseng ho felisoa ha likristale tsa cholesterol, le kalafo e atlehileng ea atherosclerosis ka sebopeho sa toeba e ka qhala k'holeseterole ka ho e tlosa masimong. Kaha cyclodextrin e tsejoa e sireletsehile bathong, sethethefatsi sena e se e le monyetla oa ho khetha ho batho ba kulang bakeng sa kalafo ea lefu la atherosclerosis.

Peptide e bitsoang Ac-hE18A-NH2 (e hlahang ka tlas'a lebitso AEM-28 nts'etsopele ea bongaka) e bonts'oa e na le bokhoni bo makatsang ba ho theola cholesterol le triglycerides hape e na le thepa ea ho hanyetsa. Ho feta moo, ho fapana le li-statins le li-inhibitors tsa PCSK-9, e ka fokotsa cholesterol ka ho tlama ho heparan sulfate proteinoglycans (HSPG). Hajoale o ntse a le tlasa liteko tsa bongaka 'me o bontšitse mamello e amohelehang,' me habohlokoa ka ho fetisisa, o tšepisa ts'ebetso.

Lithethefatsi tsa antisense joalo ka ISIS-APO (a) Rx le analogue ea eona e matla ISIS-APO (a) -LRx, e thibelang phetolelo ea apolipoprotein (a) mRNA, e ka fokotsa maemo a plasma a apo (a) / Lp (a) le mefuta e amanang le oksijene ea phospholipids (OxPL) ka 86% le 93%, ka ho latellana.

Khalemelo ea Ts'ebetso

Opereishene ea methapo e ka buleha (endarterectomy), ha ho tlosa kapa ho otlolla bothata ho etsoa ka ts'ebetso e bulehileng, kapa ho emisoa ha methapo ea methapo sebakeng sa ts'oaretso ea methapo e thibelang sekepe hore se sebetse hape (translateuminal balloon angioplasty and stenting of artery . Khetho ea mokhoa e latela sebaka le ho ata ha ho fokola kapa ho koaloa ha lumen ea artery.

Pathogenesis ea atherosulinosis le mochini oa nts'etsopele ea eona

Atherosclerosis ke lefu le tloaelehileng haholo. Ka hona, ho tla ba molemo ho motho e mong le e mong ho tseba hore na pathogenesis ea atherosclerosis ke maemo afe a kentseng letsoho kholisong ea eona. Ho tlameha ho boleloa hore mekhoa le litsela tsa nts'etsopele ea mekhoa ea methapo ea methapo methapong ea mali ha li e-so ithute ka botlalo ho fihlela joale. Empa lintlha tsa bohlokoa nts'etsopele ea lefu lena lia tsebahala.

Mekhoa le moralo oa nts'etsopele ea atherosulinosis li ithutile ka nako e telele, empa li ile tsa hloleha ho fumana mohopolo o nepahetseng oa hore na “sesosa” se hlohlelletsang kholo ea lefu lena ke eng.

Karolo e itseng ho theheng ha atherosulinosis e abeloa lintho tse mpe, ke:

• likhathatso ea metabolism e tloaelehileng ea mafura,
• mathata a lihormone
• ho ba teng ha liponto tse eketsehileng,
• khatello ea kelello ea methapo
• mekhoa e mebe (ho se ikoetlise, ho lemalla koae, jj.).

Kajeno, khopolo ea hore nts'etsopele ea lefu lena e thehiloe ho tšoaetso ea lintlha tse 'maloa tsa pathogenic ka kakaretso e amoheloa.

Endothelial dysfunction

Boithuto ba sejoale-joale bo lumela hore mohato oa pele oa ntlafatso ea atherosulinosis ke tšenyo karolong e ka hare ea mokokotlo. Ho na le bopaki bo bongata ba khopolo ena:

• Taba ea mantlha, libaka tsa pele li lula li fumaneha libakeng tsa makala a makala. Boemong ba karohano ea sekepe se ka sehloohong, ho bopa tikoloho ea mofere-fere, kahoo, kotsi ea tšenyo ea ho koaheloa ke sekepe ka sebakeng sena e lula e phahame haholo.
• Taba ea bobeli, ke khale e tsejoa hore ho lemalla koae ho bapala karolo ea kholo ea lefu lena. Mme mosi oa koae o ama hampe ts'ebetso ea lisele tsa endothelial, hobane ka lebaka la keketseho ea palo ea khase ea monoana ea carbon e potoloha maling, hypoxia ea sele e bonoa.
• Taba ea boraro, khatello ea methapo ea kutlo e eketsa moroalo likepeng mme ke sona se eketsang kotsi ea ho ba le lefu la atherosclerosis.

Mabapi le cholesterol

Kajeno ho na le batho ba 'maloa ba neng ba ke ke ba utloa hore karolo ea cholesterol ho nts'etsopele ea atherosclerosis e bohlokoa haholo. Empa ha se batho bohle ba tsebang hore na sehlahisoa sena ke eng. Ho sa le joalo, enoa ke e mong oa baemeli ba sehlopha sa li-sterols, se etsang karolo ea bohlokoa molemong oa lits'ebetso tsa tlhaho tsa tlhaho ho 'mele. Mesebetsi ea sehlooho ea cholesterol:

• tlhahiso ea li-acid acid
• synthet ea vithamine D3,
• tlhahiso ea lihormone tsa thobalano le li-hormone tsa adrenal.

Ho latela lijo, hoo e ka bang 300-500 mg ea cholesterol e kena 'meleng oa motho letsatsi le letsatsi. Ka lihlahisoa, lipid ena e ka ba teng ka mokhoa o lokolohileng kapa o tlamelletsoeng.

Empa le maemong a morao-rao, cleavage le tokollo ea cholesterol ea mahala li tla hlaha ka mpeng e nyane. Ka mpeng, k'holeseterole ea ananeloa, e sebelisoa bakeng sa methapo ea metabolic le e meng.

Ho ajoa ha lipid ena 'meleng ha ho tšoane. Boholo ba cholesterol eohle e tšoaretsoe ka cortex ea litšoelesa tsa adrenal, bokong, lisele tsa methapo. Bonyane ba tsona ke li-lipids lithong tsa mesifa e tataisang le ea masapo.

Ha e le hantle, motsoako oa cholesterol o ka etsoa hoo e ka bang sele efe kapa efe ea 'mele. Le ha ho le joalo, hangata ntho ena e hlahisoa ka har'a sebete le (ka bongata bo fokolang) ka mpeng e nyane. Tlas'a tšusumetso ea lintlha tse itseng, tlhahiso ea k'holeseterole ea eketseha. Lintlha tsena li kenyelletsa:

• tlhahiso ea mahlaseli
• ho se leka-lekane ha li-hormone le keketseho ea palo ea lihomone tsa qoqotho.

Keletso! Empa ka tlhahiso e eketsehang ea glucocorticosteroids (lihormone tse hlahisoang ke litšoelesa tsa adrenal) le tlala, tlhahiso ea cholesterol, ka lehlakoreng le leng, ea fokotseha.

Ho fumanoe hore sterol ho plasma ea mali ha e na boemo bo hloekileng, empa ka sebopeho sa lipoprotein (motsoako oa cholesterol o nang le liprotheine). Lipoprotein li tla ka mefuta e meraro e fapaneng:

• letsoalo le tlase haholo (kakaretso ea bona ha e fetang 10%),
• letsoalo le tlase (hona ke mofuta o atileng haholo oa lipoprotein ho plasma hoo e ka bang 65-70%),
• letsoalo le phahameng.

Ho latela karo-karolelano ea mefuta ea lipoprotein, menyetla ea ho ba le lefu la atherosclerosis e ikemiselitsoe. Bakeng sa sena, ho hlahlojoa ho khethehileng ho etsoa ka boikemisetso ba likhechana, 'me joale khokahano e baloa ho sebelisoa foromo e ikhethileng.

Keletso! E sireletsehileng haholo ho latela nts'etsopele ea atherosulinosis ke karolelano ea mefuta ea lipoprotein e hlokometsoeng ho bana ba banyenyane, ho lekana ha bona ke bonngoe. Ho batho ba bacha (lilemo tse ka bang 20), karolelano e loketseng ke letšoao ho tloha ho 2 ho isa ho 3. Ho batho ba fetang lilemo tse 30, matla a kopaneng ha a lokela ho feta 3.5 (bakeng sa mafu a pelo, a ka fihla ho 6).

Moetso oa sebopeho sa Plaque

Ka sebopeho sa poleloana, ho na le mekhahlelo e meraro:

• lipoidosis: sebopeho sa letheba kapa lesela lipid marakong a sekepe,
• lipossteosis: ponahalo ea lisele tse nang le fibrous,
• sebopeho sa polasetiki e rarahaneng, calcification.

Sebaka sa lipid ke sebopeho se nyane (bophara ba e seng tse fetang 1.5 mm) se bokaholimo ba mokokotlo. Lisele tsa foamy li tla pele ho sebopeho sena sa 'mala o mosehla; li entsoe ka li-lymphocyte le mafura. Ntle le moo, lisele tsa mesifa tse boreleli le li-macrophages li teng ka har'a sebopeho sa sebopeho.

Ha boholo ba matheba a lipid a ntse a eketseha, lia kopana, e leng se etsang hore moalo o tšoanang o be teng. Lihlaha le metsero li theha libakeng tsa tšenyo ea mantlha ea endothelium.

Keletso! Karolo e itseng ea tšenyo karolong e ka hare ea sekepe le sebopeho sa letheba la lipid e abeloa lintho tse sa thabiseng. Haholo-holo ho tsuba, tšoaetso ea chlamydial kapa vaerase, khatello ea mali ea methapo, jj.

Ka boeona, ho etsoa ha letheba ha ho lebise ho senya sekepe. Ho feta moo, matheba a joalo a qala ho ba bongoaneng. Ho lumeloa hore ha a le lilemo li 25, sebopeho sa lipid se ka nka halofo ea karolo e ka hare ea mokhoabo. Ka har'a methapo e fepang boko, mathe a joalo a hlaha ka lilemo tse ka bang 40.

Liposulinosis

Mokhahlelo oa bobeli ha ho etsoa moralo oa methapo ea methapo ea methapo (ukuaji) ke kholo ea lisele tsa fibrous. Sebakeng sa sebaka (strip) e thehiloeng, lisele tse nyane li qala ho theha butle butle, e lebisang kholong ea lisele tse sebetsanang.

Ha e ntse e hola, ho foka hoa lebota ho ba teng le mofuta oa pente - sebopeho se kenyang leseli la sekepe. Sena se baka tšitiso ea phallo ea mali. Boemong ba pele ba sebopeho sa atherosulinotic, lejoe le na le motheo oa lipid.

Maemong ana, sebopeho sa lisele tse sebetsanang se tšesaane. Sebopeho sena se bitsoa "mosehla", se ama phallo ea mali hanyane. Kaha kotloloho ea lisele tse sebetsanang le eona e tšesaane, e senyeha habonolo.

Mehatong ea morao ea ntlafatso, sebopeho se thehiloeng se na le moralo o teteaneng oa lithane tse amanang.E bitsoa "lejoe le lesoeu" mme e na le phello e mpe ho hemodynamics (lebelo la mali).

Sebopeho sa Plaque

Bohato bona ba nts'etsopele ea lefu lena bo tšoauoa ka keketseho e kholo ea boholo ba mantlha ea lipid ho polasetiki e seng e ntse e thehiloe. Sena se lebisa ho timeng ha lesapo la mokokotlo le ho hlaha ha hemorrhage.

Ha sebopeho sa polasetiki se senngoa, ulceration e etsahala, e leng lona lebaka le ka sehloohong la ho theha seaparo sa mali. Boemong ba hoqetela, ho bokellana ha calcium ho bonoa linthong tsa polasetiki, tse lebisang ho kopaneng le keketseho ea boholo ba lejoe.

Sephetho se ka sehloohong sa ho thehoa ha ramatiki e rarahaneng ke ponahalo ea seaparo sa mali leboteng la sejana. Ka ho arohana ha mali, a ka koala sejana, a thibela haholo phallo ea mali.

Keletso! Ke mothating ona oa nts'etsopele ea atherosulinosis moo bakuli ba nang le mathata - nts'etsopele ea ischemic stroke (e nang le tšenyo ea methapo ea mokokotlo), ho nyekeloa ke pelo (ka nts'etsopele ea atherosclerosis ea methapo ea methapo ea mokokotlo), jj.

Mathata

Morero o kaholimo oa sebopeho sa polasetiki o re lumella ho utloisisa litlamorao tsa nts'etsopele ea atherosclerosis. Hona ke:

• liphetoho tsa hemodynamic ka lebaka la ho fokotseha ha lumen ea vascular,
• Alceration of the fibrous capsule ha e phatloha, sebopeho sa methapo ea mali,
• ponts'o ea letsoai la lime ka har'a lithane tsa lesela, e eketsang letsoalo la eona haholo.

Mefuta ea Lithaka

Ka atherosclerosis, li-plaque li ka ba li-static mme ha li joalo. Thepa ena e ipapisitse le sebopeho, boholo le sebopeho. Lithane tse nang le mafura a mantlha li lula setonteng sa "static", 'me li-lipid li tla pele ho lejoe le sa tsitsang. Meetso e tsitsitseng e ntse e hola butle, kahoo boemo ba mokuli ha bo fetohe ka lilemo tse ngata. Li-plaque tse sa tsitsang li na le khubu e kholo le membrane e nyane ea fibrous.

Matlapa a joalo a phatloha habonolo le ho ruruha, 'me seo se baka ho soetseha ha mali. Ke ho ba teng ha lipopae tse sa tsitsang tse nkang karolo e kholo ho nts'etsopele ea mathata a matla a atherosclerosis.

Ka hona, pathogenesis ea atherosulinosis ke ts'ebetso e rarahaneng haholo. Karolo e itseng ho nts'etsopele ea lefu lena ha e bapaloe feela ke lintlha tse kahare, empa le litloaelo tse mpe tsa mokuli ka boeena.

E fana ka nts'etsopele ea ts'oaetso ea lefu lena la lithethefatsi lijong tsa mafura, ho tsuba, ho hloka boikoetliso, hammoho le mafu a tšoaetsanoang le ho senyeha hoa liente tsa mmele 'meleng.

Ho thibela nts'etsopele ea lefu lena, ho bohlokoa hore nako le nako ho lekole boemo ba cholesterol ho plasma.

Leseli la leseli

Matsoafo a atherosulinotic aorta hangata a fumanoa. Aorta ke sejana se seholo sa mmele oa motho, se qala ka hare-hare ho pelo, 'me se namela likarolong tse ngata tsa kahare le lisele.

Lithapo li tsoa molaleng oa thoracic aorta, li fana ka mali sefuba, maoto le matsoho a holimo, molala le hlooho. Aorta ea ka mpeng ke setsi sa ho qetela, se fana ka mali ho litho tsa mpa ea mpa. Karolo ea ho qetela e arotsoe ka methapo ea kutlo ea li-iliac. Ba fepa pelvis le maoto le matsoho a tlase ka mali.

Ka atherosclerosis ea thoracic aorta, tšenyo e felletseng kapa e itseng e bonoa, matšoao a lefu lena a ipapisitse le sebaka seo li behoang teng le ho teba ha tsona. Litšobotsi tsa mantlha tseo u lokelang ho li hlakisa:

• ho ba sieo ha nako e telele matšoao
• matšoao a pele a hlaha a le lilemo li 60, ha timetso e fihla ka bongata bo hlollang,
• ho tsekela, ho hlaseloa ke hlooho,
• bothata ba ho koenya
• ho tsofala pele ho nako ka ponahalo ea moriri o moputsoa.

Mokuli o na le kholo e potlakileng ea moriri litsebeng ka khatello e phahameng ea systolic, bohloko ba nako le nako ka morao ho sternum. Atherosulinosis ea methapo nako e telele e tsoela pele ntle le matšoao.

Ha tšenyo e ka mpeng ea mpa e tsamaea le phallo ea mali e sa lekaneng litho tsa ka hare, ba bua ka lefu la ischemic.

Ka atherosclerosis ea ka mpeng aorta, mathata a takatso ea takatso ea lijo a qala, ho fapanyetsana le lets'ollo le ho thunya. Bohloko bo ka mpeng ea mpa bo bonoa, bomalimabe bo aparetse tlholeho, ts'ebeliso ea lehae ha e ea nepahala.

Ka visceral vascular thrombosis, lefu la tsoekere le na le bohloko bo boholo, ho ke ke ha khoneha ho li felisa ka li-antispasmodics le painkillers.

Bohloko bo kopantsoe le ho fifala kapele ha bophelo bo botle. Maemong ana, o hloka ho ikopanya le ngaka kapele kamoo ho ka khonehang bakeng sa thuso.

Methapo ea methapo ea kutlo

Mofuta ona oa atherosulinosis o baka lefu la pelo, le bakoang ke tlolo ea mali ho fihla pelong. Etiology ea myocardial infarction le angina e amahanngoa le atherosclerosis. Ha blockage e sa bonahaleng, ho ba le lefu la pelo le ho phatloha hohle ha methapo ea mali ho baka lefu la pelo.

Sesosa se atisang ho ba le pherekano ho potoloha ha mali ka methapong ea methapo ea kutlo ke ho hlahisoa ha cholesterol methapong ena ea methapo. Butle-butle liphororo li senya le ho senya marako a methapo, li nyenyefatsa haholo leseli ho tsona.

Ka ts'oaetso ena, mokuli o na le bohloko bo tukang sternum, hangata e fana ka mokokotlo, lehetla le letšehali, e eketseha ka ho ikoetlisa 'meleng, maemong a sithabetsang. Motho ea nang le lefu la tsoekere o haelloa ke moea haholo, moea oa ho hloka moea, haholo ha a robala. Ka hona, o lula a leka ho lula setulong.

Litlhaselo li ka phekoleha le lithethefatsi tsa sejoale-joale:

1. kenya letsoho tlhokomelong ea bophelo bo botle bo tloaelehileng,
2. tlosa ka potlako angina pectoris.

Mathata a mabapi le ho behoa ha lipampiri methapong ea methapo ea pelo ke lefu la pelo, lefu la pelo. Matšoao a ikhethang a methapo ea methapo ea methapo e ikemiselitsoe feela ka lebaka la mekhoa e ikhethileng ea ho hlahloba lefu lena.

Ho hlōloa ha likepe tsa mesenteric

Mofuta ona oa atherosclerosis hangata o bonahatsoa ke bohloko bokaholimo ba mpa ea mpa, bo etsahala hamorao, haholo kamora ho ja.

Nako ea tlhaselo ha e fetang metsotso e fokolang, maemong a mang e fihla hora e le 'ngoe. Bohloko bona bo tsamaea le ho sokela, ho lila, ho thunya. Bakeng sa bohloko ba atherosclerosis, ho nka tharollo ea soda ha ho fane ka phomolo.

Boloetse bona bo boetse bo bitsoa thipa ea ka mpeng, bo hlaha ka lebaka la bosholu ba mali a hlokahalang bakeng sa ts'ebetso ea tšilo ea lijo le boholo ba eona.

E 'ngoe ea mathata a teng e tla ba nts'etsopele ea "thrombosis" ka har'a sekepe sa mesenteric, boemo ba lefutso bo tsamaisana le:

• ho nyekeloa
• bohloko bo potileng mokhubu
• ho boloka hoa khase, setuloana sa motlakase,
• ho hlatsa khafetsa ka secretion ea bile.

Ho na le liphihlelo tsa mali tse fumanehang makhulong, ho lefu la tsoekere, mocheso oa 'mele oa phahama,' me ho ba le boemo ba ho akheha. Lefu lena le phethela ka 'mele oa ka mpeng, o tsoela pele khahlanong le semelo sa matšoao a peritonitis.

Tlhahisoleseling mabapi le atherosclerosis e fanoa ka video sehloohong sena.

Tšoaea tsoekere ea hau kapa u khethe botaki bakeng sa likeletso. Ho batla ha ho fumanoe.

Liteko tsa mantlha tsa laboratori bakeng sa atherosulinosis

Kamora tlhahlobo le tlhahlobo ea sepheo, hangata ba ea litekong tsa laboratori, haholoholo, ba etsa setšoantšo sa biochemical le tlhahlobo ea mali ka kakaretso. Ka thuso ea bona, o ka fumana boemo ba matšoao a 'maloa ka nako e le' ngoe, bo nkang karolo ea bohlokoa kholisong ea atherosclerosis. Tekanyo ea cholesterol ka kakaretso thutong hangata e tloha ho 3,4 ho isa ho 5.9 mmol ka litha e le ngoe.

Ena ke paramente ea bohlokoa, hobane ke k'holeseterole e kentsoeng sekhahla sa likepe, e lebisang lefung la lisele tsa endothelial, ho kenella kahare ho leseli la vascular ka leukocytes le macrophages, ebe ho lateloa ke ho fifala ha lumen. Re lokela ho hopola hore boholo ba ntho ena bo hlahisoa ke 'mele,' me ke karolo ea 25% feela e tsoang ka ntle ka lijo.

Leha ho le joalo, k'holeseterole ka boeona e ke ke ea qhibiliha ka metsing, e leng mali a mangata, kahoo ho sebelisoa liprotheine tse ngata ho li tsamaisa ka 'mele o li tlama ho molek'hule ea eona.

Ditlelase tsa madi tsa Lipoprotein

Letšoao la bobeli la bohlokoa le bonts'ang boemo ba metabolism ea lipid ke li-density lipoprotein tse tlase. Li nkuoa e le sehlopha sa lintho tse nang le phello e bitsoang atherogenic, ka hona LDL ha ea lokela ho ba limilone tse fetang tse tharo ka litara.

Ho fetela boemong bona ho bontša hore ho na le cholesterol e ngata 'meleng, e tsamaisoang ho tloha sebete ho isa liseleng, ho kenyeletsoa le methapo ea methapo.

Maemong ana, ke li-lipoprotein tse fokolang tse nkang karolo ho tsamaiseng lipids. Li ts'oaroa ke lisele tsa endothelial tse nang le li-receptor liseleng tsa tsona tseo LDL e tlamellang ho tsona. Kamora ho lokolloa ha cholesterol, karolo e 'ngoe ea eona e sebelisoa ke sele bakeng sa litlhoko tsa eona, empa ka ho fetella, masala a mpa a bokella ka hare, ka lebaka leo qetellong a shoang.

Empa lipoprotein tse phahameng tsa litekanyetso li na le litlamorao tse fapaneng, 'me li nkuoa e le li-antiatherogenic. Sena se bakoa ke taba ea hore ba na le bokhoni ba ho monya limolek'hule tsa cholesterol maling, ho kenyeletsoa ho tsoa limolek'hule tse fokolang tsa lipoprotein, hammoho le ho tsoa liseleng tsa endothelial tsa lerako la methapo.

Kahoo, ba fokotsa palo ea cholesterol e ngata maling, ka tsela eo ba fokotsa ho hlaha hoa eona ka har'a likepe. Palo ea HDL maling e fokotseha ka atherosclerosis, empa ka tloaelo boemo ba bona ha boa lokela ho ba tlase ho milione e le 'ngoe ka litha e le ngoe.

Lintlha tse ling tsa tlhahlobo ea laboratori

Boemo ba li-triglycerides, le bona bo behiloeng likepeng, le bona bo bapala karolo. Ha ho fumanoa lefu la atherosclerosis, tlhahlobo e bontša ho eketseha ha triglycerides, e leng palo ea eona eo ka tloaelo e sa lokelang ho feta limilimilione tse 1,6 ka litha e le ngoe.

Lintho tse ka behang maemo a kotsing kotsing - maemo a Homocysteine ​​le fibrinogen - le ona a ikemiselitse. Ho fetola maemo a bona ho ka fana ka tlhaiso-leseling e eketsehileng mabapi le hore na bakuli ba na le kotsi e kae, hammoho le ho fumana liphetoho tse hlokahalang kalafong ea lithethefatsi.

Kahoo, tlhahlobo ea laboratori bakeng sa atherosclerosis ha e lumelle feela ho hlahloba, empa hape le ho hlahloba likotsi tsa ho ba le mathata a lefu lena. Ntle le moo, ke lipatlisiso tsa laboratori tse sebelisetsoang tlhaiso e latelang ea mokuli e le ho lekola katleho ea kalafo le khalemelo ea litlhahiso tsa lithethefatsi.

Mekhoa ea ho hlahloba lintho tse fumanehang

Tlhahiso-leseling ea bohlokoa ka ho fetisisa ea ho tseba lefu ka ho phekola lefu la athere e ka fana ka mokhoa oa angiography. Mohloli oa eona o kahara 'nete ea hore lethal dose le itseng la phapang e kenelletseng ka har'a bethe ea methapo ea mokuli,' me ho ntšoa X-ray. Sena se o lumella ho lekola botebo ba likepe, tse tla senyeha haeba ho ka ba le atherosulinosis.

Ka hona, ka thuso ea thuto ena, motho a ka lekola boholo le ho ata ha lesapo, mme a bolela esale pele mathata a ka bang teng. Haeba ka lebaka le itseng thuto ena e sa khonehe, tlhahlobo ea ultrasound ea methapo ea mali e nang le Dopplerography e ka fana ka datha e pharaletseng ka boemo ba bethe ea methapo.

Ka eona, o ka lekola boteng ba methapo e meholo, phetoho ea lebelo le litšobotsi tsa phallo ea mali. Tlhahlobo ea Ultrasound e boetse e bohlokoa haholo ho lekola phallo ea mali methapong e ka tlaase, phepelo ea mali e ka utloang ka bobeli ka lebaka la atherosclerosis le thrombosis.

Mokhoa o mong o tloaelehileng ke tlhahlobo ea X-ray ea litho tsa mokokotlo oa sefuba, e u lumellang ho tseba mathata a atherosclerosis, mohlala, ho holisa meeli ea pelo ka lebaka la ho fokotseha kapa hypertrophy ea e 'ngoe ea mafapha. Ho hlahlojoa ha pelo ka boeona ho ka fana ka tlhaiso-leseling e batsi ka boemo ba eona.

Ultrasound e ka khetholla litlamorao tsa atherosulinosis, joalo ka "ventricular hypertrophy" kapa "septum" ea "methapo" ea methapo, lebaka la stenosis ea orortice, akinesia le asynergia ka lebaka la ischemic myocyte necrosis.

Pathogenesis ea atherosulinosis le etiology ea eona

Atherossteosis ke lefu le tloaelehileng le sa foleng le ka bang lilemo tse ngata pele le qala ho fana ka matšoao a bongaka.

Ho bohlokoa haholo ho khona ho e lemoha methating ea pele le ho qala kalafo e nakong. Bakeng sa sena, ho hlokahala ho utloisisa mokhoa oa ho qala le ho hola ha lefu lena, hammoho le ho ba le mohopolo oa lintlha tse ka bang kotsing.

Karolo ea k'holeseterole

Atherosclerosis ke lefu le sa foleng la methapo ea methapo, moo ho behoang li-cholesterol le li-lipoprotein tse tlaase tse tsoang marakong a methapo ea mali.

Karolo ea k'holeseterole ho nts'etsopele ea atherosulinosis: k'holeseterole ka boeona (haholo-holo, cholesterol) ke ntho e sebetsang haholo, e leng "thepa ea ho haha" ea mantlha ea lihormone mme e hlokahala bakeng sa ho theoa hoa membrane ea sele. Ka 'mele, cholesterol ha e ka sebopeho sa eona se hloekileng, empa ho "lipakete" tsa "protheine", motsoako oa protheine le cholesterol o bitsoa lipoprotein. Ho latela karo-karo ea lintho, lipoprotein tse phahameng, tse tlaase le tse tlase haholo lia khetholoha.

Mefuta e 'meli ea ho qetela e kotsi: ke, tlasa maemo a itseng, e lulang marakong a methapo,' me e theha methapo e teteaneng e nyenyefatsang leseli la sekepe, 'me ka linako tse ling e ka e thibela ka botlalo, ea baka tlala ea tlala ea litho le lisele.

Etiology of Atherosclerosis

Ho fihla joale, lisosa tsa atherosclerosis ha li e-so theoleloe ka mokhoa o tšepahalang.

Ho na le likhopolo tse 'maloa ho etiology ea atherosulinosis:

• khopolo ea ho kenella ha lipoprotein - ho ea ka eona, sesosa sa mantlha ke ho bokella lipoprotein likepeng,
• khopolo ea endothelial dysfunction - mabaka a tlolo ea ts'ebetso ea ts'ireletso ea endothelium - sekhechana sa sele se koahelang bokaholimo ba likepe,
  ke ka lebaka leo lipoprotein li ka "kenang" likarolo tse thothofetseng tsa marako a methapo,
• autoimmune - tšilafalo ea tsamaiso ea 'mele ea ho itšireletsa mafung le ho kenella ha lesapo la mokokotlo ka leukocytes,
• bongata - endothelium e sentsoe ke livaerase (joalo ka herpes),
• liphatsa tsa lefutso - sekoli leboteng la methapo ea tlhaho se futsitse,
• hormonal - Ha motho a ntse a tsofala, boemo ba lihomone tse itseng bo nyoloha, bo lebisang ho hlahisoeng ha cholesterol e ngata.

Mme lefu le kotsi joalo ka carotid arteriosulinosis ka tekanyo e phahameng ea monyetla ke autoimmune ka tlhaho.

Lintho tse kotsi

Lingaka li bontšitse ka nepo lintlha tsa kotsi tse tlatsetsang ho holiseng lefu lena. Tse ling tsa tsona li amana le lintho tsa tlhaho tse sa fetoleheng tse ke keng tsa susumetsoa (mohlala, bong le lilemo), ha tse ling li ka fetoloa.

Lintho tse ke keng tsa qojoa:

1. Phello ea lefutso.
2. Semelo sa Hormonal. "Lihormone tsa basali" li eketsa litaba tsa lipoprotein tse phahameng maling, tse thibelang kholo ea methapo, ka hona, banna le basali ba kotsing ea basali ba ka mor'a lefu.
3. Mongoaha. Kotsi ea ho ba le lefu lena e eketseha kamora lilemo tse mashome a mane (haholoholo ho banna).

Lintlha tse ka fetoloang:

• hypothyroidism (khaello ea 'mele oa lihormone tse hlahisoang ke tšoelesa ea qoqotho),
• hyperfibrinogenemia (liprotheine tse phahameng tsa protheine ea fibrinogen),
• homocysteinemia (litekanyetso tsa mali tse eketsehileng tsa homocysteine ​​- amino acid e nang le chefo, sehlahisoa sa metabolic se sebelisoang tlas'a maemo a tloaelehileng),
• Hyperlipidemia,
• khatello ea mali

Ho pathogenesis ea atherosulinosis, i.e. Morero oa nts'etsopele, ho na le mekhahlelo e meraro e meholo:

1. Lipoidosis Boemong bona, lipoprotein tse tlaase-tlase li qala ho lula marakong a sekepe. Li kenella ka har'a lisele tsa sejana, li e thophothe ka tsela ea sebele, 'me li theha seo ho thoeng ke lipid. Ka linako tse ling matheba ana a kopana, 'me a etsa mela ea lipid. Mothating ona, matheba ha a tsoele ka holim'a lebota 'me ha a kena-kenane le phallo ea mali.
2. Sclerosis Libakeng tsa ho bokella lipoprotein, lisele tse sebetsang li qala ho hola. Litlhaka tsa lipid li ba kholo ebile lia thella.Ka linako tse ling, li-capillaries tse nang le marako a otlolohileng li ka thea leboteng la methapo ho potoloha lejoe.
3. Sebopeho sa li-plaque tse thata le calcification. Mothating ona, mabota le likamore tse haufi le ona li thatafala le ho fokola ka lebaka la ho beoa ha letsoai la calcium ho tsona. Li-capillaries maboteng a artery e phatloha, likhopo li hlaha methapong, ka lebaka la tsona li ba kholo le ho feta ebile li nyenyefatsa leseli la sekepe ho fihlela e koetsoe ka botlalo.

Leha ho le joalo, moelelo oa bongaka oa polelo ena o fapane - phetisetso ea litho tse sebetsang tsa setho se nang le lithane tse sebetsanang. Sena ke sona se etsahalang mothating oa bobeli oa nts'etsopele ea atherosclerosis - tishu e sebetsanang le eona e hola holima lejoe le mafura. Ts'ebetso ea sclerotic ka har'a lijana tsa boko e hlile e lebisa mohopolong o sa senyeheng - ke ka hona tšebeliso e mpe ea lentsoe.

Tleliniki le Tlhahlobo ea Tlhaho

Setšoantšo sa kliniki ea atherosulinosis sea fapana ho latela hore na methapo e amang methapo e joang. Leha ho le joalo, maemong afe kapa afe, e tla kenyelletsa matšoao a hypoxia - tlala ea oksijene ea lisele le litho:

• ka atherosulinosis ea thoracic aorta, matšoao a mantlha ke ho hema hanyane, mokhathala o felletseng le mokhathala, bohloko bo bolelele ba nako e telele kamora sternum,
• ka tšenyo ea mokokotlo oa mokokotlo le mokokotlo oa methapo ea mali (e ikarabellang bakeng sa phepelo ea mali mothapong le maotong) - mathata a tšilo ea lijo, ho sisinyeha ha mala, ho fetoha ha methapo ea maoto maotong - tahlehelo ea methapo ea kutlo, pallor le botenya ba letlalo (maemong a matla - cyanosis) methati - gangrene,
• haeba ho na le tšenyo methapong e ka tlas'a lefatše e fanang ka mali matsohong - tahlehelo ea kutlo ea matsoho, pallet ea letlalo, ho thothomela, ho fokolisa kapa ho se be teng ha letho ka letsoho.
• ka atherosulinosis ea methapo ea mokokotlo ea carotid - ho sitisoa kelellong le mesebetsi ea kelello, ho tsekela, ho opeloa ke hlooho, bofofu ba nakoana.

Ho ea ka lithuto, ka tekanyo e phahameng ea monyetla oa lefu lena ke autoimmune. Atherosclerosis ea aortic arch, karolo ea aorta e "koahelang" pelo eo methapo ea carotid le subclavian e tsoang ho eona, e bonahatsa tšobotsi.

Seo ho thoeng ke "letšoao la" aortic arch "se kenyelletsa liketsahalo tse ngata ka nako e le 'ngoe: ho tsekela, ho lahleheloa ke kelello ha nako e khutsoanyane, bradycardia, khatello e tlase ea mali le methapo ea methapo e nang le phetoho e bohale ea hlooho.

Phekolo le thibelo

Phekolo ea atherosclerosis e reretsoe haholo ho theola cholesterol ea mali. Ka kalafo ea lithethefatsi, ho sebelisoa lihlopha tse latelang tsa lithethefatsi:

• li-statins - ho thibela tlhahiso ea k'holeseterole, ka ho etsa joalo e tlatsetsa ho fokotseheng ha khatello ea eona maling.
• fibrate - potlakisa ts'ebetso ea ho petsoha mafura, le eona e lebisang ho fokotseha hoa khatello ea bona.
• mafura a acid - thibela ho kenngoa ha asiti ea mafura maling a tšiloang lijo, a thusang cholesterol e tlase,
• vithamine PP - e potlakisa ts'ebetso ea ho petsoha le ho lokisa mafura.

Mehatong ea morao ea lefu lena, ho sebelisoa opereishene. Ho ipapisitse le mofuta le lesapo la lesion, sena e ka ba:

1. Ho tlosa lejoe le kopantsoeng le sekhechana sa lebota la sekepe.
2. Ho buoa ka mothapo - ho kuta sekepe se secha ho feta lejoe.
3. Resection ea Aneurysm - "suturing" ea lebota la sekepe, lejoe le senyehileng.

Litlhahiso tse kholo ke tse latelang:

1. Khaotsa ho tsuba - e na le phello e bohloko methapong ea mali.
2. Fokotsa ho ja lijo tse mafura tse ngata joalo ka nama ea kolobe. Fetolela eona ka veal, mutton e mafura a tlase le likhoho.
3. E-ja meroho e mengata, linaoa le linaoa tse ling - li na le mafura a mangata a meroho a tlase.
4. Haeba u na le mathata afe kapa afe a amanang le phepo ea lik'habohaedreite, hlahloba boemo ba tsoekere ea mali khafetsa 'me u bo thibele ho nyoloha.

Epidemiology (phetisetso)

Atherosclerosis ke e 'ngoe ea maloetse a bolaeang ka ho fetisisa le a holofatsang linaheng tse tsoetseng pele. Ka lilemo tse itseng (linaheng tse fapaneng ho tloha ho lilemo tse 40 ho isa ho tse 60), hoo e ka bang 100% ea baahi e na le matšoao a atherosulinosis. Naheng ea Russia, ka 2000, lefu la batho ba neng ba le maemong a bakoang ke lefu la ho itšireletsa mafung le ne le le 800 ho baahi ba likete tse lekholo, linaheng tse nang le "lijo tsa" Mediterranean "- makhetlo a 4 ka tlase.

Etiology le pathogeneis (lisosa le mekhoa ea kholo ea lefu lena)

Bakuli ba atherosclerosis ba ka aroloa ka lihlopha tse peli.

"Qaleho", e fumanehang ka tloaelo atherosulinosis e amahanngoa le liphoso tsa lefutso ts'ebetsong ea li-enzyme system, mabapi le moo "cholesterol" e fetelletseng e bōpiloeng maemong a tloaelo a ho ja le a bophelo ba mokuli.

"Morao", atherosclerosis e kholo e amana le mokhoa oa bophelo le phepo e nepahetseng.

Bakeng sa ho hlalosa ka ho hlaka lebaka la ponahalo le ketsahalo e atileng ea "morao haholo" atherosclerosis, motho o lokela ho nahana ka bophelo ba motho pele ts'ebeliso e pharalletseng ea lihlahisoa tsa kelello ea motho - metjhini, mahlale, joalo-joalo.

Bophelo ba motho bo ne bo le thata haholo ho fumana lijo tsa hae, o ile a qobelloa ho tsamaea haholo. Ho ne ho se na mabenkele, lijo li ne li tlameha ho fumaneha ka tlas'a maoto le lifateng, kapa ho tšoasa (boemong ba lijana tsa nama), kapa ho lema, ho lema naha ba le bang.

Ka nako e ts'oanang, karolelano ea matla e sebelisitsoeng tlhahiso ea lijo ho boleng ba lijo ka boeona e ne e le haufi le bonngoe - ke jele lik'halori tse kae, ke qetile tlhahiso ea lijo (Haeba ke ne ke e-na le likhalori tse fokolang, ke bolaoa ke tlala).

Ka nts'etsopele ea lihlahisoa tsa mosebetsi oa kelello oa motho (lisebelisoa, ts'ebeliso ea matla a liphoofolo tse kholo, likoloi), theko ea ho tsamaea ho fumana lijo e ile ea qala ho theoha, 'me lijo tse fumanehang habonolo tsa hlaha bophelong ba batho (bonyane karolo ea eona).

Motho o ile a fumana monyetla oa ho tsamaea hanyane le ho ja haholo.

Baemeli ba ruileng ba sechaba e bile bona ba pele ho kopana le ketsahalo ena, mme lipatlisiso tsa baepolli ba lintho tsa khale li tiisa ho ba teng ha atherosclerosis ho batho ba mehleng ea khale haholo (ho hlakile hore masala a tlotsitsoeng a batho ba ruileng a ne a ka bolokeha haholo).

Ka lilemo tse limilione tse likete, lintho tse phelang li ikamahantse le maemo a ho hloka lintho - tlala le lenyora. Mmele oa motho o ne o sa tloaelane le limatlafatsi tse ngata.

Lijo tse fetelletseng li lebisa ho eng?

Limolek'hule tse ngata li kena 'meleng, tseo ho tsona k'holeseterole e tsoang ho tsona. Boemo ba k'holeseterole maling bo nyoloha, bo lebisang ho "tahlehelo" ea k'holeseterole e feteletseng e tsoang maling e kena marakong a methapo ea methapo (ho etsoa ha seo ho thoeng ke atherosclerotic plaque - ASB). Sena ke atherosclerosis. Kholo ea li-plaque ka mor'a nako e lebisa ho fokotseha ha lumen ea artery le ho fokotseha ha palo ea mali a phallang sebakeng se patisaneng, ho fihlela ho khaotsa ho phalla ho felletseng ha mali le lefu la sebaka se lumellanang sa lithane.

Ka ho hlahisoa ha k'holeseterole leboteng la sejana, ho tla pele litokisetso tsa ho thehoa ha thrombus sebakeng sena (ho kenyelletsa le monyetla oa ho koaloa ka botlalo ha lumen ea sekepe - occlusion). Ketsahalo ena e bitsoa atherothrombosis, hangata ke sesosa sa ho senyeha ho hoholo ha maemo a bakuli (ho nyekeloa ke pelo, stroke, ho senyeha hoa litho le litho tsa kahare).

"Tsoelo-pele" ea mokhatlo oa batho e lebisitse baemeli ba bang ba bona mokhoeng oa ho tsuba. Ho tsuba ho mpefatsa boemo ba tšebetso ea atherosselotic, 'me haeba u sheba lipalo-palo tsa likotlo tse lipakeng tse tlase, u tla bona hantle hore na banna ba tsubang ba na le palo e ngata ea batho ba joalo. Kahoo batho ba boetse ba “ithusa” ka ho bonesa koae.

Localization of atherosulinotic process (tseo litho tsa 'mele li amehang):

• Methapo ea pelo e fanang ka mesifa ea pelo (Lefu la pelo ea Coronary kapa Lefu la pelo).
• Li-valve tsa pelo (lefu le fumanehang la pelo ea pelo). Pelo e mothating oa ntlafatso ea methapo ea 'mele e thehiloe methapong ea mali, ka hona, karolo e ka hare ea pelo e ts'oana le marang-rang a methapo ea mali,' me k'holeseterole e behiloe kahare ho eona.
• Lisele tsa methapo e fepang boko (bo sa foleng le bo sa sebetseng hantle haholo ka lebaka la ho hloka sekoli ka mokokotlong).
• Meroalo ea liphaephe tse tlase (lipakeng tsa tumellano ea mantsoe, setho se ommeng).
• Methapo ea kutlo (e fokotsang (stenosis) ea methapo ea kutlo e lebisang khatello e matla ea mali - ho eketseha ha khatello ea mali).
• Methapo e meng ea methapo (ischemia ea litho tsa ka hare).

"Bohlale" ba atherosclerosis

Kotsi e kholo ea ts'ebetso ea atherosselotic ke "sephiri" sa eona, asymptomatic ho fihlela ntlheng e itseng.

Kholo ea li-plaques tsa atherosselotic ha e tsamaisane le maikutlo afe kapa afe, ha li utloe bohloko ebile ha li bake tsitsipano.

Mokuli ea hlokang tsebo o phela hamonate ho fihlela masapo a methapo a fihla mokhatlong o itseng o boima, ka mor'a moo a ts'oaroa ke lefu la pelo kapa stroke, hangata ho lebisa ho holofala kapa lefu.

Ke ka lebaka leo ts'oaetso e tlang ka nako e leng bohlokoa hakana.

Tlhahlobo ea Lefu la ho Ferekanya

Tlhahlobo ea atherosulinosis e etsoa ka likarolo tse peli:

• Tlhahlobo ea "boikemisetso" ba mali bakeng sa ho lokolla k'holeseterole e fetelletseng marakong a methapo ea mali.
• Tlhahlobo ea mathata a amanang le k'holeseterole e se e pepesitsoe maboteng a methapo ea mali.

Teko e tloaelehileng ea biochemical ea mali e fana ka matšoao a latelang: cholesterol e felletseng (OXS) - tloaelo e fihlile ho 5.2, cholesterol e tlase ("e kotsi", cholesterol ea LDL) - moetlo o teng ho isa ho 3,5, cholesterol e phahameng haholo ("e sebetsang", HDL cholesterol) - maemo a tloaelehileng a fetang 1 le triglycerides - moelelo o fihla ho 2.

Litsebi tsa "Advanced" li hlahloba matšoao a eketsehileng - cholesterol e tlase haholo (VLDL cholesterol) le seo ho thoeng ke apolipoproteins AL le B.

Tlhahlobo ea boemo ba methapo e mengata ea methapo e etsoa ho sebelisoa li-ultrasound (ultrasound ea methapo kapa, ka ho nepahala haholoanyane, ho hlahlojoa ha mebala makhetlo a mararo).

Ultrasound ha e bone methapo ea bohlokoahali ea pelo (coronary), ka hona, bakeng sa ho hlahlojoa ha coronary atherosranceosis, ho sebelisoa mokhoa o ikhethileng (o nang le ho kenella ka har'a methapo ea methapo), moo ho kenngoang ntho ea radiopaque ka har'a methapo ea methapo ea kutlo le setšoantšo sa x-ray. Ho ntse ho na le leseli le sa netefatsoang la hore mehleng ena ea rona e hlophisitsoeng ea tomography (MSCT ka lehlakoreng le leng) e fihlile boemong ba monahano bo nepahetseng mme eu lumella ho bona litšoantšo tse teng ka har'a methapo ea methapo ea kutlo e seng kotsi ho feta CAG.

Ultrasound eu lumella ho fumana setšoantšo sa methapo ea methapo ea molala, matsoho, maoto, methapo ea litho tsa ka hare.

Atherosclerotic plaque (ASB) e ka ba ea lehae (karolong e nyane ea sekepe) mme ea atoloha, e ka lula leboteng le le leng la artery kapa mabota 'ohle a eona (ASB e joalo e bitsoa circric). Ultrasound eu lumella ho lekola paramente ea bohlokoa joalo ka "liperesente tsa stenosis ka bophara".

Ha lesela le fumanoe, le nkuoa, 'me ka mor'a moo le lekanngoe "botenya" bo boholo le bophara ba methapo. Letšoao la pele le arotsoe ho ea bobeli, karolo ea stenosis e fumanoa. ASB e na le phello ea phallo ea mali ka har'a artery ka peresente ea stenosis ea batho ba fetang 50, mme 75-80% ke letšoao bakeng sa ts'ebetso e boima ka ho fetisisa ea ho tlosa li-plaque tse joalo.

Sebopeho sa ASB ea lehae (atherosulinotic plaque) le nts'etsopele ea eona e tsoetseng pele ka ho theoa le kholo ea motheo oa lipid li bontšitsoe mona. Setšoantšo se ka tlase se bonts'a letlapa le seng le ntse le ama phallo ea mali methapong e amehang ea methapo (50% di cm stenosis).

(Lipapiso tse entsoeng ke mongoli oa sebaka, karolo e telele ho tloha bohareng ba mokokotlo)

↓ Mme mona ketsahalo e bohloko - ho phatloha hoa pente. Maemong ana, ts'ebetso ea ho kopanya mali e lumela hore sekepe se lemetse, 'me karabelo ea tlhaho ha e tsoa likotsi ke thrombosis. Phallo ea mali ka har'a methapo ea methapo e kanna ea feta, mme litho tse fepehileng kapa likarolo tsa tsona - lia shoa. Ka pelong, thrombosis e joalo e lebisa ho infarction e bohloko ea myocardial.

E shebahala joaloka lesakanana le pharaletseng la (sleeve-like).

Phekolo ea Atherosulinosis

Phekolo ea atherosclerosis, hammoho le ts'oaetso, e etsoa ka mekhoa e 'meli:

• Khalemelo ea lipids tse phahameng tsa mali
• Haeba ho hlokahala, hlasolla (ka liphoofotsoana ka har'a methapo kapa pelo) ho holisa lits'itiso tsa methapo. Sena se etsoa ke lingaka tse buoang mafapheng a ikhethang.

Khalemelo ea k'holeseterole e etsoa ka litsela tse peli: liphetoho tsa bophelo (IOL) le kalafo ea lithethefatsi.

Phetoho ea bophelo ke mokhoa o tloaelehileng oa boima ba 'mele (ho fokotseha ha boima ba' mele o moholo), ho ikoetlisa (mmele) le ho fokotseha ha lijo, ho baka keketseho ea cholesterol ea mali.

Mokhoa o le mong feela oa ho theola boima ba 'mele ke ho leka-lekanya pakeng tsa ho ja likhalase le ho chesa. Mekhoa eohle e "metle" e fetohile mohopolo.

Kamora metsotso e 40 ea ho tsamaea, mmele o tuka ka hoo e ka bang matla a lekanang le lijo ka letsatsi, kahoo ho fokotsa boima ba 'mele ho ka khoneha feela ka khatello e phahameng (kapa ka thibelo e kholo ea tšebeliso).

"Lintho" tse ka sehloohong tseo k'holeseterole e entsoeng ka tsona ke seo ho thoeng ke mafura a liphoofolo a khathollang (ke hore mafura a entsoeng ka phoofolo a sa phalleng ka mocheso oa kamore).

Oli ea meroho ha e tsoe ka liphoofolo, ha e hloke ho fokotsoa. Oli ea tlhapi e phalla ka mocheso oa kamore, kahoo o ka ja litlhapi ntle le tšitiso ha o leka ho lokisa kalafo ea k'holeseterole.

Ts'ebeliso ea nama ea khomo ea nama ea khomo, nama ea kolobe, mafura a likonyana e lokela ho fokotsoa ka sebopeho sa mafura a 'nete a nama le lihlahisoa tsa nama.

Lijo tse ling tse bakang cholesterol e ngata ke letlalo la likhoho (letlalo le tlameha ho tlosoa pele ho pheha likhoho), botoro (70-80% mafura a liphoofolo) le chisi tse 'mala (hoo e ka bang 70% mafura, bala sebopeho).

Phekolo ea lithethefatsi e laetsoe ke ngaka feela!

Ho bohlokoa ho hlokomela hore sepheo sa ho nka meriana ha se ho rarolla bothata - esita le lilemo tsa ho nka meriana le eseng maemong ohle li ka fokotsa boholo ba tsona ka likarolo tsa liperesente. Ntho ea bohlokoa ke ho thibela kholo ea bona e tsoelang pele.

Tsena ke li-Statins (HMG-CoA reductase inhibitors), Fibrate, Cholesterol absorption (absorption) inhibitors le Omega-3 acid e se nang mafura.

Statins e thibela ketso ea enzyme ka har'a sebete e amehang hoeng hoa cholesterol.

Ha li theko e tlase, hangata lia mamelloa ebile li sebetsa haholo.

Mabarebare a tšabehang mabapi le litla-morao tse boima tsa li-statin, tse qapiloeng ke bo-ralitaba ba mosehla, a feteletsoa haholo.

Ngaka e eang teng, ha e fana ka kalafo ea statin ho mokuli, e tlameha ho lemosa ka tlhoko ea tlhahlobo ea mali (ALT, AST, OXS, LDL cholesterol, cholesterol ea HDL, triglycerides) khoeli e le 'ngoe ka mor'a ho qala taolo, ebe habeli le halofo ka selemo. Sena se etsoa ho lekola katleho le mamello ea kalafo.

Ka bomalimabe, ntoa khahlanong le k'holeseterole ke ntho e telele (ea bophelo bohle), ka hona poleloana e reng "ke nkile thupelo" e utloahala e le ntle ho ngaka, libeke tse 2 kamora ho hlakoloa ha li-statins, cholesterol ea mali e khutlela boemong ba eona ba pele.

Sehlopha se secha se theko e boima sa li-anti-anti-antiododies ho PCSK9. Tlhahisoleseling e nyane ho fihlela joale, emela.

Ezetimibe (Ezetrol) ea sebetsa, ho fapana le li-statins, ka mpeng mme e thibela ho kenngoa ha cholesterol. Ka hona, haeba mokuli a ja ka nepo, ha a na phello e kholo. E theko e phahameng haholo 🙁

Ezetrol e ka kopanngoa le li-statins ho fokotsa tekanyetso ea monyaolo. Ho na le motsoako oa fektheri oa Inegi (Simvastatin plus Ezetimibe).

Fenofibrate (Tricor) e laetsoe haeba, hammoho le cholesterol, boemo ba triglycerides bo eketseha haholo.

Li-cholesterol tsa Omega-3 (Omacor) li theola cholesterol e fokolang hanyane, empa etsa tse ngata tse ntle bakeng sa pelo (mohlala, sireletsa khahlanong le likhathatso tsa morethetho o mong).

Atherosclerosis e thusa haholo ho ruruha ha methapo ea methapo, kahoo bakeng sa thibelo ea thrombosis, lingaka hangata li beha Aspirin (Acetylsalicylic acid - ASA) litekanyetso tse nyane (50-150 mg ka letsatsi).

Qetellong, ke tla hlahisa maikutlo a ka ka kalafo ea atherosulinosis.Litokisetso tsa Magnesium li fokotsa cholesterol hanyane, empa li fokotsa haholo ts'ebetso ea "tahlehelo" ea cholesterol ho tloha lumen ea artery ho kena leboteng (ke hore, e thibela kholo ea li-plaque). Ka hona, magnesium, eseng ho ba moriana, e thusa litokisetso tsa cholesterol.

Moriana oa tšohanyetso

Atherosclerosis - lefu le sa foleng la methapo ea methapo ea methapo e meholo le e mahareng (mofuta oa elastic le mesifa), e tšoauoang ka ho bokellana le ho bokellana hoa tlhoko ea plasma atherogenic apoprotein-B-lipoprotein e nang le ts'ebetso ea ho eketseha ha lithane tse amanang le ho theha methapo ea methapo ea methapo.

Classified of atherosulinosis (A. L. Myasnikov, I960)

Ke likarolo tsa III, IV le V tse khetholloang ka bohlokoa bo boholo ba kliniki li fanoang.

Qeto ea lehae:

• 1. Aorta.
• 2. methapo ea methapo ea kutlo.
• 3. Metsoako ea methapo.
• 4. methapo ea kutlo.
• 5. Methapo ea mesenteric.
• 7. Methapo ea methapo ea mali.

Karolo ea bongaka:

• I period (preclinical): a) mathata a vasomotor, b) bothata ba mathata a laboratori,
• Nako ea II (ea kliniki): sethala a) ischemic, b) thrombonecrotic, c) sclerotic.

Karolo ea phallo:

• 1. Tsoelo-pele ea atherosclerosis.
• 2. Ts'ebetso ea botsitso.
• 3. Boemo ba khatello ea kelello.

Lisosa tsa kotsi

• 1. Ke lilemo tse 40-50 le ho feta.
• 2. Bong ba motho. Banna ba na le monyetla o moholo mme lilemo tse 10 pejana ho basali ba ho holisa atherosulinosis ka lebaka la hore litaba tsa anti-atherogenic a-LP maling a banna li tlaase mme ba na le menyetla ea ho tsuba ebile ba kotsing ea ho sithabela ha maemo.
• 3. Arterial khatello ea mali.
• 4. Ho tsuba.
• 5. Tlolo ea mamello ea tsoekere, lefu la tsoekere.
• 6. Ho nona ho feta tekano.
• 7. Hypodynamia.
• 8. Litšobotsi tsa botho le boitšoaro - seo ho thoeng ke khatello ea maikutlo.
• 9. Litekanyetso tse phahameng tsa mali tsa triglycerides, cholesterol, lipoprotein tsa atherogenic.
• 10. Boholo bo imeloang ke atherosclerosis.
• 11. Gout.
• 12. Metsi a bonolo a ho noesa.

Etiology. Lintho tse ka sehloohong tsa etiological: khatello ea kelello le maikutlo le kelello, tlhekefetso ea mafura, e nang le cholesterol le lijo tse fumanehang habonolo tsa nama ea nama ea kolobe, mafu a metabolic le endocrine (lefu la tsoekere, hypothyroidism, cholelithiasis).

Pathogeneis. Atherosclerosis e qala ka ho senyeha ha endothelial permeability le ho falla ho fihla sehlohlolong sa lisele tse boreleli tsa mesifa le macrophages. Lisele tsena li bokella lipids haholo 'me li fetoha “lisele tse foam”. Ho imetsa "lisele tse foamy" tse nang le cholesterol le lits'oants'o tsa eona ho lebisa ho phatloheng ha sele le ho lokolloa ha lipids le enzymes tsa lysosomal sebakeng se kantle, se lebisang kholisong ea ho fetoha ha methapo, lithane tse nang le fibrous tse potileng bongata ba lipid, le mofuta oa "fibro-atheromatous plaque". Nts'etsopele ea lits'ebetso tsena e etsahala tlasa ts'usumetso ea lihlopha tse peli tsa lintlha tsa pathogenetic: I - ke kenya letsoho kholisong ea atherogenic hyperlipoproteinemia le II - e kenya letsoho ho kenella ha lipoprotein tsa atherogenic ho kenella mokokotlong oa mokokotlo. Mabaka a I a kenyeletsa: lintlha tse kotsing le boits'oaro, ho se sebetse ha sebete, mala, litšoelesa tsa endocrine (tšoelesa ea qoqotho, litšoelesa tsa botšehali, lisebelisoa tse kenang). Sehlopha sa bobeli sa lintlha tsa pathogenetic se kenyelletsa: ho eketsa sekhahla sa endothelium, ho fokotsa mesebetsi ea amohelang cy-LP ho tlosa kholeseterole mochophorong oa methapo, ho fokotsa sebopeho sa lisele, tse eketsang palo ea lisele tse boreleli tsa mesifa, ho kenya tshebetsong lipid peroxidation, ho eketsa tlhahiso ea thromboxane le endothelin, le ho fokotsa kemiso ea phetoho ea masapo. le vasodilating factor, ho kenyelletsoa ha mekhoa ea immunological - sebopeho sa li-antibodies ho atherogenic pre-p le (5-LP.

Matšoao a bokuli

Atherosulinosis ea thoracic aorta.

1. Aortalgia - ho tobetsa kapa ho chesa bohloko ka morao ho sternum, ho bonesa matsohong ka bobeli, molaleng, mokokotlong, ka mpeng. Ho fapana le angina pectoris, bohloko ha bo tšoaroe ke paroxysmal, bo bolelele (bo nka lihora, matsatsi, ho fokolisa nako le nako le ho mpefala). Ka ho koala melomo ea methapo ea methapo e nang le methapo ea methapo, bohloko ba mokokotlo bo ka hlaha, joalo ka neuralgia e ka hare.

2. Ka keketseho e kholo ea karolo ea aortic arch kapa aneurysm, ho koenya ka thata ka lebaka la khatello ea mokokotlo, ho tsitsipana ha lentsoe (khatello ea methapo ea kutlo), ho tsekela, ho akheha le ho ts'oaroa ka hlooho e bohale.

3. Keketseho sebakeng sa pherekano ea methapo ea methapo sebakeng sa khokahano ea likhopo tsa II ho sternum, katoloso ea sebaka sa potoloho ea percussion boemong ba sebaka sa bobeli sa botšehali ho ea ka letsohong le letona la sternum ka 1-3 cm (Letšoao la Poten).

4. Ho hema ka morao feela hoa bonahala kapa ho thapisoa, ka seoelo - mokokotlo oa sebaka se kaharehali ka lehlakoreng le letona la sternum. 5. Nakong ea auscultation, modumo o khutsufatsang oa II o nang le tšepe e boreleli, ho korotla ha systolic, ho phahamisoa ka ho phahamisa matsoho le ho inamisa hlooho morao (letšoao la Sirotinin-Kukoverov).

6. Keketseho ea khatello ea systolic ka khatello e tloaelehileng ea diastolic, keketseho ea khatello ea pulse, keketseho ea velocity ea phatlalatso ea leqhubu la moea.

Atherosclerosis ea mpa ea mpa.

• 1. Bohloko ba ka mpeng ba lehae bo fapaneng, ho thunya, ho sokela e le sesupo sa ho senyeha hoa litho tsa ka mpeng ka lebaka la ho fokola ha makala a fapaneng a arohang ho tloha aorta.
• 2. Ka ho ruruha ha lesapo la mokokotlo oa mokokotlo oa mokokotlo oa mokokotlo oa mokokotlo, lefu la Lerish le ea hlaha - ho senyeha ho sa tsitsang ha maikutlo: phallo ea methapo, ho fola le ho tsitsinyeha ha maoto, ho sisinyeha ha mesifa ea leoto, ho hloka thipa, liso le necrosis menonong le maotong ka ho ruruha le methapo ea methapo ea methapo ea methapo ea methapo, methapo ea methapo ea methapo ea methapo, methapo ea methapo ea methapo, methapo ea methapo ea methapo ea methapo, methapo ea methapo ea methapo ea methapo, methapo ea methapo ea methapo ea methapo. hangata lesapo la mokokotlo la basali, ho se be teng ha makhopho a sefahleho mokhoabong, ho korotla ha methapo ea kutlo ka mothapo o motšehali oa mokokotlong.
• 3. Ha ho hlaha ka mpeng ea mpa ea mpa ho bonahala ka kotloloho ea eona le boholo ba eona bo sa lekanang.
• 4. Ka holim 'aorta aorta, ho korotla ha systolic ho utluoa bohareng le kaholimo le boemong ba mokhubu.

Atherosmithosis ea mesenteric artery pro ke "sefahleho sa ka mpeng" le mathata a ho ja.

• 1. Bohloko bo bohale bo tukang kapa bo sehang ka mpeng (hangata ho epigastrium), hangata bophahamong ba tšilo ea lijo, bo nka lihora tse ka bang 1-3. Ka linako tse ling bohloko ba nakoana bo haufinyane, bo emisa ka nitroglycerin.
• 2. Bohloko bo tsamaea le ho thunya, ho sokela, ho luma.
• 3. Nakong e tlang, lets'ollo la "fetid" le ka kopana makhetlo a 2-3 ka letsatsi ka likotoana tsa lijo tse sa koaeloang le mafura a sa lomosoang, ho fokotseha hoa tšebetso ea lekunutu la mala.
• 4. Ho utloisoa bohloko ke bohloko boikutlong sebakeng sa pelo, lipelaelo, likhathatso, ho hema hoa khoneha.
• 5. Ha ho hlahlojoa mpa, botumo, boemo bo phahameng ba ho bua, ho fokotseha kapa ho se be teng ha peristalsis, ho korotla ha systolic ho epigastrium ho ikemiselitse.
• 6. Butle-butle ho felloa ke metsi 'meleng, ho fokotseha le ho fokotseha ha turgor ea letlalo.

Atherosulinosis ea methapo ea kutlo.

• 1. Vasorenal matšoao a arterial hypertension.
• 2. Ka moroto - liprotheine, lisele tse khubelu tsa mali, li-cylinders.
• 3. Ka stenosis ea methapo ea methapo e le 'ngoe, lefu lena le tsoela pele joalo ka mofuta o potlakileng oa khatello ea mali, empa ka liphetoho tse tsoelang pele moriring, khatello e matla ea mali. Ka tšenyo e bakiloeng ke liphio, lefu lena le iphumanela letsoalo le kotsi la khatello ea mali.
• 4. Ka holim'a methapo ea kutlo, ka linako tse ling ho luma ka systolic ho utloahala hammoho le mohala oa pararectal bohareng ba sebaka pakeng tsa mokhubu le ts'ebetso ea xiphoid ka letsohong le letšehali.

HO FIHLELA ATHEROSCLEROSIS YA LIT AROBOTSI TSA BOPHELO.

• 1. Liponahatso tsa ho kenella: bofokoli le ho tepella ha mesifa ea leoto, ho bata le maoto a maoto, methapo ea methapo ea kutlo (bohloko bo ka mesifa ea namane ha o ntse o tsamaea, bohloko bo kokobela ha o phomola).
• 2. Pallor, maoto a batang, mathata a trophic (ho omella, ho pepeta ha letlalo, liso tsa trophic, gangrene).
• 3. Ho fokola kapa ho haella ha pulsation sebakeng sa methapo e meholo ea leoto.

Lintlha tsa laboratori

I. OAK: ha ho na phetoho.

2. LHC: keketseho ea cholesterol, triglycerides, npe-β- le β-lipoprotein, NEFA, hyper-lipoproteinemia ea mefuta II, IV, III, keketseho ea cholesterol ea β- le pele ho-lipoproteins, atherogenicity coeffnty.

Lipatlisiso tsa liletsa

Tlhahlobo ea X-ray: compaction, elongation, ho hola ha aorta libakeng tsa thoracic le mpa. Ultrasonic fluometry, rheovaso-, plethysmo-, oscillo-, sphygmography: Phokotso le ho lieha ha phallo e kholo ea mali methapong ea methapo e tlase. Angiography ea methapo ea methapo ea methapo e ka tlase le liphooko: ho fokotsa leseli la methapo ea methapo. Isotope renografia: ts'ebetso ea sephiri e sa sebetseng ea liphokojoe ka lefu la methapo ea methapo ea methapo ea methapo.

Lenaneo la lipatlisiso

1. OA mali, moroto. 2. LHC: triglycerides, cholesterol, pre-β- and β-lipoprotein (ho latela Burstein), polyacrylamide gel lipoprotein electrophoresis, p- le pre-p-lipoprotein cholesterol, transaminase, aldolase, kakaretso ea liprotheine le liprotheine, coagulogram . 3. ECG. 4. FCG. 5. Echocardiography. 6. Reovasography ea libaka tse tlase. 7. Fluoroscopy ea aorta le pelo.

Buka ea litšupiso ea bongaka ea kalafo. Chirkin A.A., Okorokov A.N., 1991