Lisoele tse ngata tsa methapo ea methapo li bonoa ho bakuli ba nang le lefu la tsoekere nako e fetang lilemo tse leshome, ho linyeoe tse 45-54%. Karolo ea tsamaiso ea methapo ea kutlo ea mmele e bohlokoa haholo. Sisteme ena ea methapo ea kutlo e laola bokong, palpitations, phefumoloho, tšilo ea lijo le mesifa ea mesifa. Diabetesic polyneuropathy ea maemo a tlase (DPN) ke lefu la kelello le qalang maotong mme le pharalla ho ea holimo.

Mokhoa oa pathogenetic oa lefu lena o rarahane haholo 'me ha o utloisisoe ka botlalo ke bo-ramahlale. Mathata a tsamaiso ea methapo ea kutlo a mangata. Mofuta o mong le o mong oa DPN o na le setšoantšo sa hae sa kliniki. Leha ho le joalo, mefuta eohle ea khatello ena e kotsi ebile e hloka kalafo ea mokuli, ho seng joalo bothata ka maoto bo ka fetola motho motho ea holofetseng. Diabetesic polyneuropathy e pateloa ke lingaka tlasa khoutu ea G63.2 ho latela ICD-10 e bonts'ang phapang ea lefu lena.

Mefuta ea Neuropathy

Kaha ts'ebetso ea methapo ea kutlo e arotsoe ka somatic and autonomous (autonomic), mefuta e 'meli ea lefu la tsoekere le polyphaboliki le eona e bitsoa. Ea pele e baka liso tse ngata tse sa phekoleheng tsa maemo a tlase, ea bobeli - mathata a ho ntša, ho hloka matla le koluoa ea pelo, hangata ho bolaeang.

Tlhalo e 'ngoe e ipapisitse le mesebetsi ea methapo, e tlisoang ka lebaka la nts'etsopele ea pathology:

sensory polyneuropathy e amanang le bohloko bo eketsehang maotong, kapa, ka lehlakoreng le leng, le tahlehelo ea kutlo ea kutlo.
motor polyneuropathy, e leng mokhoa oa tlhaho oa ho fokola mesifa le ho lahleheloa ke matla a ho sisinyeha.
sensorimotor polyneuropathy, e kopanyang likarolo tsa mathata ana a mabeli.

Ponahatso ea ho qetela, e tsoakiloeng ea methapo ea kutlo ke neuropathy ea methapo ea kutlo. Batho ba nang le lefu la tsoekere ba nang le lefu le joalo ha ba utloe bohloko libakeng tse ling tsa leoto le leoto le tlase. Likarolo tse tšoanang tsa mabato a maoto ha li arabe ho bata kapa mocheso. Ho feta moo, bakuli ba felloa ke matla a ho laola maoto. Bakuli ba qobelloa ho tsamaea, ba phahamisa maoto a bona ka tsela e seng ea tlhaho ("cock" gait).

Diabetesic distal polyneuropathy

Ena ke lefu la kelello le bakang lefu la methapo ea kutlo. Boloetse bona bo lebisa ho tahlehelo e felletseng ea kutloelo-bohloko ea kutlo le lisele tsa karolo e hole-hole ea lipalo tse tlase - maoto. Boemo bo tloaelehileng ba lefu la tsoekere le distal DPN ke bohloko bo bobebe bo bohloko bo atisang ho ba matla hoo motho a sa khoneng ho robala. Ho feta moo, ka linako tse ling mahetla a qala ho opa. Polyneuropathy e tsoela pele, 'me sena se lebisa ho atrophy ea mesifa, deformation ea masapo, maoto a bataletseng, ho khaoloa maoto.

Peripheral

Ka mofuta ona oa lefu lena, ho ba le mathata a tebileng a methapo ea kutlo ea maoto le maoto. Ho li-diabetes, ha se maoto feela, maqaqailana, likarolo tse tlase tsa maoto le mahlaba le maoto, empa hape le matsoho. Peripheral polyneuropathy e etsahala haholo ha lingaka li fana ka lithethefatsi tse matla tse thibelang lijalo ka litlamorao tse mpe: Stavudine, Didanosine, Saquinavir, Zalcitabine. Ho bohlokoa ho tsebahatsa lefu lena ka nako e le hore o tlohele sethethefatsi hanghang.

Sensory polyneuropathy

Karolo e ka sehloohong ea pathology ke tahlehelo ea methapo ea maoto, eo boholo ba eona bo ka fapana haholo. Ho tloha maikutlong a nyarosang ho fihlela ho akheha, ho tsamaisana le lceration le maoto a maoto.Maemong ana, ho hloka kutloelo-bohloko ho kopantsoeng le bohloko bo matla bo sa mamelleheng bo etsahalang ka boiketsetso. Boloetse bona bo ama leoto le le leng la pele, 'me hangata bo fetela ho la bobeli, bo nyoloha le holimo, bo ama menoana le matsoho, kutu, hlooho.

Dysmetabolic

Ho hlaha hoa mathata ana a fapaneng hangata ho hlohlelletsoa, ntle le lefu la tsoekere, mafu a ka mpeng, mala, liphio, sebete. Lithapo tse ngata tsa methapo ea kutlo e ka angoang. Tlas'a methapo ea kutlo, "neurons" ea mokokotlo, bohloko, trophic ulcers, mathata a motsamao a hlaha, lengole, marang-rang a kelello a nyamela. Hangata li-elope tse senyehileng, methapo ea kutlo, "optic nerves". Dysmetabolic polyneuropathy e ka hlaha ntle le bohloko.

Hobaneng bakuli ba nang le lefu la tsoekere ba na le neuropathy

Lebaka le ka sehloohong ke glucose e phahameng ea mali le khaello ea insulin ea nako e telele. Ho senyeha ha metabolism ea cellular ho na le phello e mpe masapong a methapo ea kutlo. Ntle le moo, lefu la tsoekere la polyneuropathy ea maoto le ka bakoa ke:

mathata a endocrine
lefu le matla la sebete kapa la liphio,
khatello ea maikutlo, ho fokola 'meleng
tšoaetso
tlhekefetso ea joala
chefo ka lik'hemik'hale tse chefo
maqeba.

Lipontšo tse ka sehloohong tsa lefu la mefuta eohle:

Matšoao a utloisang bohloko - bohloko, ho fokolisa kapa ho mpefatsa hoa pono ea liphetoho tsa mocheso, vibrate.
Matšoao a ho sisinyeha - makhopho, ho thothomela, atrophy ea maoto le matsoho.
Matšoao a meroho - edema, hypotension, tachycardia, mathata a setulo sa mokokotlo, ho hloka matla.

Maoto a tukang le a bohang

Boikutlo joalo ka ha eka maoto a maoto a tuka ke mollo a hlaha ha likhoele tsa methapo ea kutlo e tsoang mokokotlong ho ea maotong e senyehile. Maoto a tukang ha se lefu, empa ke letšoao le bonts'ang polyneuropathy ho lefu la tsoekere mellitus. Li-neuron tse senyehileng lia kenngoa 'me li romela lipontšo tsa bohloko ba bohata bokong, leha e le hore maoto a eona a tsitsitse' me ha ho na mollo.

Ho lahleheloa ke kutloisiso ea maoto

Pele, lefu la tsoekere le bona le bofokoli, ho akheha maotong. Ebe maikutlo ana a hlaha maotong, matsohong. Ha polyneuropathy ea likarolo tse tlase e ntse e tsoela pele, atrophy ea mesifa ea eketseha le maikutlo a tactile a fokotseha. Maoto a thatafalloa ke ho o laola le ho fanyeha. Matsoho a haelloa ke letsoho, ho tloha ntlheng ea menoana. Ka ts'ebetso ea nako e telele ea pathological, tahlehelo ea kutlo e ama karolo ea kutu sefubeng le mpeng.

Tlhahlobo ea lefu lena

Polyneuropathy ea likarolo tse tlase e bonoa e sebelisa mekhoa e joalo ea ho etsa lipatlisiso tsa mokuli:

Ho leka ho hloka maikutlo,
tlhahlobo ea maikutlo a bohloko
tlhahlobo ea vibration
teko ea mocheso
letlalo nerve biopsy,
electroneuromyography (ENMG), e ka bontšang hore na litšusumetso tsa methapo li fetela ka har'a mesifa ea mesifa.

Phekolo ea lefu la tsoekere la polyneuropathy ea likarolo tse tlase

Mathata a joalo a ka se phekolehe ka botlalo, empa kholo ea 'ona e ka fokotsoa butle. Ho phekola li-neuropathy tsa maoto le matsoho? Boemo bo ka sehloohong ke ho fetoha ha tlhaho ha tsoekere maling. Li-analgesics, lieta tse bulehileng, ho tsamaea hanyane, libate tse pholileng li thusa ho fokotsa bohloko. Arohana le liphallelo ha o hlasimolla maoto. Hoa hlokahala ho sebelisa lithethefatsi tse eketsang likepe tsa pherekano, tse amang phetisetso ea methapo ea kutlo. Phekolo ea polyneuropathy ea likarolo tse tlase e fetoha hantle haholo ha o nka li-vithamine tsa B. Hape ho bohlokoa ho lokisa metabolism ea carbohydrate.

Phekolo ea lithethefatsi

Thepa e tsitsitseng bakeng sa kalafo e rarahaneng ea bakuli ba nang le ts'oaetso ea polyneuropathy ea libaka tse tlase:

antidepressants Amitriptyline, Imipramine, Duloxetine, e thibelang ho pheta-pheta ha li-hormone norepinephrine le serotonin,
anticonvulsants Pregabalin, Carbamazepine, Lamotrigine,
analgesics Targin, Tramadol (litekanyetso li na le litheko tse fokolang - lithethefatsi!),
Milgamma Vitamin Complex
Berlition (thioctic kapa alpha lipoic acid), e nang le bokhoni ba ho lokisa methapo e amehileng,
Actovegin, e ntlafatsang phepelo ea mali ho fihlela methapo ea kutlo,
Isodibut, Olrestatin, Sorbinil, e sirelletsang methapo tsoekere?
lithibela-mafu - ka tšokelo ea bohloka.

Phekolo ntle le meriana

Tšepo ea ho phekoloa ka thuso ea ba thusang lapeng kapa litlhare tsa setso ke utopia. Ho hlokahala hore u noe meriana le ho e sebelisa ka botlalo:

magnetotherapy
tshusumetso ea motlakase
Hyperbaric oxygenation,
Thupelo
ho silila
Boikoetliso ba 'mele (boikoetliso ba' mele).

Diabetesic polyneuropathy (mofuta oa distal, mofuta oa sensory) ke e 'ngoe ea mathata a tloaelehileng a lefu la tsoekere. Mofuta oa lefu la tsoekere la II lefu la tsoekere, nakong ea tlhahlobo ea bongaka, lipontšo tsa kliniki ea "polyal sensory polyneuropathy" li fumaneha ka 20-25%, 'me ka lefu lena le nkile lilemo tse fetang 10, hoo e ka bang 50% ea bakuli. Ho fapana le lefu la tsoekere le lefu la tsoekere, polyneuropathy ea lefu la tsoekere e ka tsamaisana le matšoao a sebetsang a kliniki. Lingaka tsa bongaka sepetleleng sa Yusupov li sebelisa mekhoa ea sejoale-joale ea tlhahlobo ea mafu ho khetholla distal symmetric polyneuropathy. Bakeng sa tlhahlobo ea bakuli ba sebelisang lisebelisoa tsa morao-rao tse tsoang ho bahlahisi ba etellang pele ba Europe le Amerika.

Mekhoa ea boqapi e sebelisoa ho phekola bakuli. Phekolo e kopaneng ea lefu la tsoekere la distal polyneuropathy sepetlele sa Yusupov e kenyeletsa:

taolo ea tsoekere ea mali le puseletso ea lefu la tsoekere,
tloaelehileng khatello ea mali,
lijo tsa phepo
thuto ea mamello
phetoho ea bophelo.

Litsebi tsa kelello li fa bakuli ba nang le lefu la tsoekere la polyneuropathy lithethefatsi tse sebetsang hantle tse nang le litla-morao tse fokolang. Litsebi tsa boipheliso li khutlisetsa mokhoa o nyarosang oa likoloi tse sebelisang mekhoa ea sejoale-joale ea 'mele. Baphehi ba lokisa lijana tsa ho ja, boleng ba bona bo sa fapana le ho pheha hae. Bakuli ba fumana kalafo nakong eo ba ntseng ba le litulong tse maemong a matle a Europe.

Mekhoa ea ho nts'etsapele polyal diabetesic polyneuropathy

Pathogenesis ea lefu la tsoekere e hlahisoa ke phello e chefo ea tsoekere e phahameng ea mali. E hlaha ka lebaka la tlhahiso e sa lekanyetsoang ea insulin kapa sekoli liketsong tsa sona kapa ka ho kopanya ha sona. Tšusumetso e mabifi ea hyperglycemia e lebisa ho nts'etsopele ea lefu la tsoekere. Ts'ebetso ea ts'ebetso ea methapo likepeng tse nyane (microangiopathy) le likepeng tsa "calroopathy" tse mahareng le tse kholo.

Matla a chefo a ho tsepamisoa ha glucose e ngata a lemohuoa ka litsela tse ling, haholo-holo ka ts'ebetso ea liprotheine tsa glycosylation. Ka lebaka la khokahano e sa hlahiseng enzymatic ea limolek'hule tsa glucose ho lihlopha tsa amino tsa protheine, likarolo tsa protheine tsa membrane ea lisele le liprotheine tsa tsamaiso ea potoloho li senyehile. Sena se lebisa ho sitisoeng ha metabolic, tsamaiso le lits'ebetso tse ling tsa bohlokoa 'meleng.

Ka khatello e phahameng ea tsoekere maling, ketoaldehydrate ea radicals ea mahala e qala ho ba teng, khatello ea oxidative kapa metabolic ea hlaha. Mmele o senya botsitso lipakeng tsa li-prooxidants le likarolo tsa sesole sa antioxidant. E tsamaisana le khaello ea insulin kapa ho hanyetsa insulin ea boholo bo fapaneng.

Ho haella ha tšebetso ea li-enzyme tsa antioxidant ho lefu la tsoekere ho khethoa ke liphatsa tsa lefutso. Ischemia (phepelo e sa lekanyetsoang ea mali), hypoxia (tlala ea oksijene) le pseudohypoxia ea tishu, tse bonoang ho lefu la tsoekere, ke lintho tse ling hape. Ba eketsa sebopeho sa li-oxidant tse sebetsang metsong le linthong tse fapaneng.

Diabetesic polyneuropathy ke litholoana tsa lesapo le atileng la li-neuron le lits'ebetso tsa tsona tsamaisong ea methapo e bohareng le e poteletseng. Ka lebaka la tlolo ea ts'ebetso ea nchafatso ho lefu la tsoekere, lefu le tsoelang pele la li-neuron le hlaha.

Likarolo tsohle tsa tsamaiso ea methapo ea kutlo e amehang:

palo ea li-axons litekong tsa methapo ea kutlo e fokotseha (ka boholo ba litšoaetso likarolong tse ka hare tsa methapo ea kutlo),
palo ea lisele tse ka mokokotlong oa mokokotlo le linaka tse ka ntle tsa mokokotlo lia fokotseha
sepheo sa ho arohana le ho aroloa hoa mekhahlelo,
Ho fetoha ho matla liseleng tsa "ganglia" tse utloisang bohloko le methapo ea kutlo.

Ka tloaelo, ho senyeha ha li-cylinders tsa myelin le axial ho etsahala. Ts'ebetso ea methapo ea kutlo e atoloha ho tloha distal ho ea ho proximal. Ho fokotseha ha matla ho baka ho fetoha ha mesifa le ho fetoha ha mesifa ho myography, ho fapana le liso tsa demyelinating feela. Ka cytoplasm le axoplasm ea lisele tsa Schwann, lihlahisoa tse joalo ka amyloid, ceramide, sulfatide, galactocerebroside lia bokellana. Ho na le liphetoho tse etsahalang methapong ea mali le sebopeho se sebetsanang le methapo ea methapo:

ho ata le hypertrophy ea lisele tsa endothelial,
tšesaane le ho ts'oaroa ka lehare le ka tlase la capillaries,
keketseho ea palo ea li-capillaries tse qalang,
ho fokotseha ha letsoalo la bethe ea "endoneural capillary" e nang le lisele tse ngata tsa mali,
ho eketsa libaka tse kopaneng le li-collagen depositi.

Mabaka a kotsi a ho hlahisoa ha lefu la tsoekere la polyneuropathy a kenyelletsa nako ea lefu lena, tekanyo ea hyperglycemia, bong ba monna, lilemo tsa mamello le kholo e kholo.

Matšoao a lefu la tsoekere la distal polyneuropathy

Diabetesic polyneuropathy (sebopeho sa sensorimotor, mofuta oa distal) ke motsoako oa lefu la tsoekere, leo ho lona ho raloang methapo e mengata ea methapo ea kutlo. E bontšoa ke ho holofala ha litho tsa 'mele, mathata a vegetovascular libakeng tse hole. Letšoao la pele la lefu lena ke tlolo ea ts'ebetso e tloaelehileng ea menoana le menoana. Ha nako e ntse e ea, ha ho se na kalafo, e koahela libaka tse kholo le ho feta tsa matsoho le maoto. E 'ngoe ea matšoao a tšoanelehang a lefu la tsoekere la polyneuropathy ke ponahalo ea lipono tse sa thabiseng lithong tsohle.

Matšoao a mantlha a lefu lena a kenyelletsa:

atrophy ea mesifa, e qalang e le mofuta oa bofokoli ba mesifa, e tsoela pele ka lebelo le phahameng,
ho hloka leeme
ho se tsebe letho ka letho
eketseha ha bohloko
ho lula u ikutloa ka mokhoa o ikhethang oa hoosebumps letlalong, ho luma ka har'a 'mele.

Boemong ba pele ba lefu lena, mokuli ha a utloe bohloko. Litsebi tsa kelello li hlokomela liphetoho tse ling ho lithane tsa methapo ho lisebelisoa tse ikhethang - li-electroneuromyographs. Ho thata ho fumana lefu lena sethaleng sena.

Karolo ea bobeli ea lefu lena e tšoauoa ka ho ba teng ha bohloko, ho chesa kapa ho akheha ha maoto le matsoho, le phetoho mokhoeng oa kutloelo-bohloko. Mokhahlelong oa boraro oa "diabetes" distal sensory polyneuropathy ea likarolo tse tlase, li-ulcers li ba teng letlalong la maoto le maotong a tlase. Li batla li se na bohloko 'me li hlaha ho 75% ea bakuli haeba ba sa phekoloe. Li-ulcers ho karolo ea 15 lekholong ea bakuli li lebisa tlhokahalong ea ho khaoloa maoto le matsoho.

Ha mokuli a amoheloa kliniking ea neurology, lingaka tsa sepetlele sa Yusupov li khetha mocheso, bohloko, kutlo le kutloalo ea maoto le matsoho bakeng sa tlhahlobo e felletseng ea methapo ea methapo ea methapo ea methapo. Boikutlo ba mocheso bo nkoa bo fokotseha ha ho na le phoso ea ho khetholla mahlakore a futhumetseng le a batang a sensor. Letšoao la ho hloka kutloelo-bohloko ke ho se khone ha mokuli ho tseba phapang ha a ama mahlakore a futhumetseng le a batang a sesebelisoa.Boikutlo ba tactile bo hlahlojoa e le bo tloaelehileng, bo fokotsehile (mokuli ha a utloe a ama ka k'hothone) kapa a le sieo (mokuli ha a utloe a ama ka k'hothone kapa letsoho).

Kutlo ea maikutlo a Vibration e hakantsoe ke mokhoa oa biotheziometry joalo ka mokhoa o tloaelehileng (ho fihlela ho 9 V), o fokotsehile (ho tloha ho 10 ho isa ho 25 V), a le sieo (ho tloha ho 25 V le kaholimo). Teko ea kutloelo-bohloko ea bohloko e etsoa ho sebelisoa nale ea ente. E nkoa e fokotsehile haeba mokuli a fositse ha a lekola mahlakore a hlabang le a hlabang ha leino kapa kutloelo-bohloko e fokotsehile ha e bapisoa le maoto le matsoho a haufi. Haeba mokuli a sa utloe ente, ba bua ka ho hloka kutloelo-bohloko.

Lingaka tsa methapo ea bongaka sepetleleng sa Yusupov li hlokomela boemo bo sebetsang ba methapo ea methapo ea methapo ea kutlo le ho teba ha methapo ea methapo ea methapo e amanang le lefu la mothapo o kopaneng, le methapo ea karabelo ea M ho khopisa ho le leng ho tsoa mokokotlong oa extensor. Mesebetsi ea bongaka e sebetsang ea tlhahlobo ea lihlahisoa e sekaseka likarolo tse latelang tsa electroneuromyographic: tšusumetso ea conduction velocity (STI) le bophahamo ba karabelo ea M. Karabelo ea M-matla a motlakase ka botlalo ha a arabela tšusumetso e le 'ngoe ea motlakase oa koloi kapa mokokotlo o tsoakiloeng. Bokhoni ba karabo ea M-M e bonts'a khokahano le boholo ba ts'ebetso ea likarolo tsa motor ea mesifa. Ho shoa ha karolo ea li-motor neurons ho lebisa ho fokotseha ha amplitude ea karabelo ea M.

SPI ke lebelo la ho phatlalatsoa ha bokhoni ba ketso ka methapo ea methapo. Ena ke pontšo e lekantsoeng e ipapisitseng le matšoao a latency ea likarabo tse peli tsa M-(bakeng sa li-motor fibers). SPI e baloang ka tsela ena e bonts'a lebelo la ho khanna ka likhoele tse khothatsang haholo. Ho bakuli ba nang le khatello ea maikutlo ea lefu la tsoekere la polyipuralathy, ka thuso ea electroneuromyography, tlolo ea ts'ebetso ea methapo ea methapo ea methapo ea kutlo, tlolo ea maikutlo a mocheso, ho se be teng kapa ho fokotseha ha bohloko, ho sisinyeha le ho hlaka hoa kutlo.

Phekolo ea lefu la tsoekere la methapo ea kutlo ea lefu la tsoekere

Ha ho na litekanyetso tse amohelehang le tse tšepahalang bakeng sa kalafo ea lefu la tsoekere la polyneuropathy. Lingaka sepetleleng sa Yusupov li ela hloko ka ho khetheha thibelo ea pelehi ea lefu lena le kholo ea matšoao. Bakuli ba ntseng ba phekoloa kalafo ea methapo ea methapo ba hlahlojoa ke setsebi sa endocrinologist. Lingaka li hlokomela ka hloko maemo a tsoekere ea mali. E lula e le boemong bo haufi le sepheo le litekanyetso tse tloaelehileng tsa hemoglobin ea glycosylated. Ho boloka motsoako o nepahetseng oa tsoekere, ho sebelisoa liente tsa insulin le tse 'maloa tsa meriana e thibelang lefu la tsoekere.

Bakuli ba khothalletsoa ho ja lijo tse matlafatsang, palo e hlokahalang ea ho ikoetlisa, e tla netefatsa ts'ebetso e tloaelehileng ea 'mele, e boloka e le hantle. Haeba mathata a trophic a hlaha letlalong, basebeletsi ba bongaka ba fana ka tlhokomelo bakeng sa libaka tse amehileng: sebelisa litlolo ho kokobetsa bohloko kapa ho nolofatsa kutloisiso ea maoto le matsoho.

Alfa-lipoic acid le litokisetso tse nang le benfotiamine li sebelisoa haholo bakeng sa kalafo ea lefu la tsoekere la polyneuropathy. Mokhoa o mong o atlehang ka ho fetisisa oa ho phekola ke ho sebelisa li-antidepressants tse tharo tse thibelang bohloko. Litsebi tsa methapo ea kelello li ela hloko tse khahlanong le tšebeliso ea lithethefatsi tsena, li qala kalafo ka tekanyetso e fokolang, li eketsa tekanyetso e ngata. Lingaka li hlokomela ka hloko ho hlaha hoa litla-morao tsa li-antidepressants tsa (trousclic antidepressants (molomo o omileng, ho otsela, bofokoli), ho lokisa litekanyetso le ho fetola lithethefatsi.

Sesebelisoa sa pele sa kalafo se amang methati ea nts'etsopele ea diabetesic distal sensory polyneuropathy ea likarolo tse tlase ke ts'ebeliso ea li-antioxidants. Sena se bakoa ke taba ea hore nakong ea lefu la tsoekere mellitus ts'ebetso ea litekanyetso tsa bona tsa antioxidant e fokotseha, li-radicals tsa mahala li thehoa ka bongata. Ho fokotseha ho teba ha khatello ea oxidative le ho hlahisoa ha lithethefatsi ka litlamorao tsa antioxidant ho tsamaisana le liphetoho tse latelang tse ntle:

ntlafatso ea phallo ea mali,
ho fokotseha ha lipid peroxidation,
ho hlophisa maemo a litaba tsa endothelial nitrous oxide,
keketseho ea litaba tsa liprotheine tse sireletsang (tse sireletsang) tsa khatello ea maikutlo.

Sebaka se etellang pele har'a li-antioxidants se lula ke α-lipoic kapa thioctic acid, e leng lipophilic antioxidant ea tlhaho. Setlhare sena se fokotsa matšoao a mabeli a neuropathic le khaello ea neuropathic. Lingaka tsa tleliniki ea methapo ea kutlo li qala kalafo ka ho kenella ka har'a intravenous drip infusions (thioctacid, 600 mg ka 200 ml ea letsoai la mmele) bakeng sa matsatsi a 15, ebe o fana ka litaelo tsa 600 mg tsa BV thioctacide ho mokuli, eo a e nkang khafetsa.

Bakeng sa ho fumana kalafo e lekaneng ea lefu la tsoekere la methapo ea methapo ea methapo e ka tlase, etsa tumellano le ngaka ea methapo ea kelello ka sepetlele sa Yusupov. Lingaka tsa bongaka sepetleleng sa Yusupov ka bomong li khetha litekanyetso tsa lithethefatsi, li etsa kalafo e rarahaneng ea angiopathy ea lefu la tsoekere, e etselitsoeng ho thibela ho felisoa ha maemo a tlase. Phekolo e felletseng ea lefu lena e thusa ho tsitsisa maemo le ho ntlafatsa bophelo ba mokuli.

Likarabo

ICD-10 (Karolo ea Machaba ea Mafu)
Sepetlele sa Yusupov
Batueva E.A., Kaygorodova N.B., Karakulova Yu.V. Litlamorao tsa phekolo ea neurotrophic ha se bohloko ba neuropathic le boemo ba limela ba psycho ho bakuli ba nang le lefu la tsoekere la lefu la tsoekere // Russian Journal of Pain. 2011. Che. 2. P. 46.
Boyko A.N., Batysheva T.T., Kostenko E.V., Pivovarchik E.M., Ganzhula P.A., Ismailov A.M., Lisinker L.N., Khozova A.A., Otcheskaya O .V., Kamchatnov P.R. Neurodiclovitis: monyetla oa ho sebelisoa ho bakuli ba nang le bohloko ba morao // Farmateka. 2010. Che 7. P. 63-68.

* Tlhahisoleseling sebakeng sena sa marang-rang ke ea tlhahisoleseling feela. Lisebelisoa tsohle le litheko tse behiloeng ho webosaete ha se tlhahiso ea sechaba, e ikemiselitsoeng ke lipehelo tsa Art. 437 ea Code Code ea Rephabliki ea Russia. Ho fumana leseli le nepahetseng, ikopanye le basebetsi ba tleliniking kapa etela tleleniki ea rona.

Sehloohong sena, re tla hlahloba ka botlalo mofuta o atileng haholo oa khatello ea methapo ea lefu la tsoekere - distal, symmetric, sensory kapa sensorimotor polyneuropathy .

Matšoao a mantlha a lefu la tsoekere ke paresthesia, botšehali, chillness le bohloko lipheletsong tse tlase, hammoho le matsoho. Ho ferekana ha methapo ea mefuta eohle ea maikutlo (bohloko, mocheso, tactile le vibrate) ho seo ho thoeng ke libaka tsa "lisokisi" le "liatlana" . Ho bakuli ba 'maloa, lipontšo tsena li ka hlahisoa ka mokhoa o fokolang. Maemong a mang a matla, ho hlobaela bosiu, bohloko ba pelo, maikutlo a tukang a maoto le matsoho ke tšobotsi. Haeba a sa phekoloe, thuto ea methapo ea kutlo e matlafala.

Matšoao a Pele a Neuropathy li ikemiselitse menoaneng, ka tsoelopele ea projeke, matšoao a ho fokotseha hoa kutlo a hlahella menoaneng. Likarolo tse liphahameng tse liphahameng tse holimo ha li amehe hangata pele.

Ka distal, symmetric, sensorimotor polyneuropathy, tšesaane e se nang myelinated (C), fokola myelinated (Aσ) le li-fiber tse matla tsa myelinated nerve (Acy, Aβ) lia utloa bohloko. Neuropathy e nang le lesion ea mantlha ea likhoele tse tšesaane e na le tšobotsi tahlehelo ea bohloko le mocheso (mocheso le serame) kutlo . Ha boholo ba likhoele tse boima li kenelletse ts'ebetsong, lebelo la ts'usumetso ea methapo ha le kenngoe mme maikutlo a leeme ebile a thothomela a fokotseha kapa a lahleheloa, e leng maemong a matla ho ka lebisang ho ataxia ea methapo. Empa ho lokela ho hopoloa hore matšoao a ho senya methapo e mesesaane ea methapo a bonoa pejana ho a maholo.

Matšoao a neuropathy ea lefu la tsoekere a tlalehiloe batho ba fetang 40% ba nang le lefu la tsoekere mme halofo ea bona e na le bohloko. Nako ea ho qala ha bohloko ke tšobotsi: phomolong, nakong ea mosebetsi o mongata, nakong ea khatello ea maikutlo, 'me haholo bosiu, ha o tsamaea, matla a bohloko a fokotseha, athe phetoho maemong a letheka ha e na phello. Syndrome ea bohloko bo boholo ka neuropathy e hlalosoa e le yuniti e ikemetseng ea kliniki. E tšoauoa ka hypersensitivity le hyperalgesia. Ka nako e ts'oanang, likhoele tsa methapo ea motor lia bolokoa, 'me mesebetsi e hlokolosi e utloa bohloko hanyane. Ntho e ts'oanang e ne e bitsoa Ellenberg "cachexia" ea lefu la tsoekere. Acute pain neuropathic syndrome e bonoa ka kalafo ea "insulin" le "glycemia" eo Caravati a e hlalosang e le "insulin neuritis." Tabeng ena, matšoao a bohloko a tsamaisana le ho nchafala ha methapo.

Tsoelo-pele ea lefu la tsoekere la polyneuropathy e lebisa ho senyeha ha li-motor (motor) fibers - atrophy ea mesifa le bofokoli libakeng tse phahameng tsa distal . Ka ho kenyelletsa ha methapo ea methapo e ikemetseng, mofufutso o fokotseha, letlalo le omella, 'me le tloaelehe ho ba hyperkeratosis. Seo ho thoeng ke "kotsi stop" se thehiloe. Metsoako ea Knee le Achilles ea fokotseha, ho hlaha bofokoli bo tloaelehileng ba masapo: lihlooho tsa masapo tse kopaneng, hamore le menoana e metenya joaloka bokahare. Letlalo le boreleli bo bofubelu kapa bo bofubelu, hangata ho na le li-hypmmetrical foci ea hyperpigmentation leotong le ka morao la leoto (eo ho thoeng ke "letheba le tlase"). Lithapo tsa Nail li ka ruruha kapa, ka lehlakoreng le leng, tsa mpefala tsa ba tsa fokola, tse lekanyang nts'etsopele ea onychomycosis. Khabareng, osteoarthropathy kapa leoto la Charcot le thehiloe (keketseho ea boholo ba leoto le potolohileng, le maoto a malelele a sephara, ho senyeha ha leoto la kopane), liphetoho phetong ea leoto e kanna ea ba li le 'ngoe kapa tsa mahlakore a mabeli, mme edema ea neuropathic le eona e ka hlaha. Pontšo ea bohlokoa ea tlhahlobo ea tlhahlobo ke ho bolokoa ha pulsation methapong ea leoto.

Khatello ea nako e telele libakeng tsa bofokoli ba masapo e lebisa ho ho ruruha ha litho tsa kahare le ho ruruha ha lisele tsa neuropathic, hangata le holim 'a leoto la leoto le libakeng tse arohaneng. Li-ulc tsena e ka ba tse se nang bohloko ka nako e itseng ka lebaka la ho fokotseha ha maikutlo, mme hangata ts'oaetso le ts'oaetso ea ho ruruha e lebisa tlhokomelo bofokoling ba hao. Ka hona ho lemoha kapele matšoao a lefu la tsoekere la polyneuropathy Ho bohlokoa haholo ho fokotsa kotsi ea ho llceration le ho khaoloa leoto le ka morao la setho.

Ka bomalimabe, ha ho na "mokhoa oa khauta" oa ho fumana mathata a neuropathic ho lefu la tsoekere. Ka 1998, ho ile ha etsoa tlhahiso ea San Antonio tumellano ea mekhoa e lekantsoeng ea ho hlahloba lefu la tsoekere la polyneuropathy ea khothaletsang liketsahalo tse latelang:

Tšoaetso ea matšoao a kliniki.
Tlhahlobo ea bongaka: tlhahlobo ea morphological le biochemical.
Boithuto ba electrodiagnostic: ho bonts'a lebelo la ts'usumetso kapele ho methapo.
Liteko tsa maikutlo a makatsang.
Liteko tsa ts'ebetso ea Autonomous.

Hangata e sebelisoa ho bona lefu la tsoekere Boholo ba Matšoao - NSS (Score ea Letšoao la Neuropathy) le tekanyo ea lipontšo - VAT (Neuropathy Dysability Score). Bakeng sa boikoetliso ba bongaka, sistimi ena e ile ea fetoloa ke M. Young et al.

maikutlo a tukang, tsebe (tsebe) kapa maikutlo a "ho oela" = 2
mokhathala, makhopho kapa bohloko .... 1
phetiso:
maoto = 1
mesifa ea namane = 1
tse ling = 0
fumana:
bosiu = 2
mots'eare kapa bosiu = 1
mots'eare = 0
ho tsoha borokong = 1
fokotseha:
ha u tsamaea = 2
e eme = 1
ho lula kapa ho bua leshano = 0

Lintlha tse felletseng e etsa boleng bo boholo:
3-4 - matšoao a manyane,
5-6 - matšoao a itekanetseng,
7-16 - matšoao a matla.

jerk knee
maikutlo a vibration
kutloelo-bohloko ea bohloko
maikutlo a mocheso
maikutlo:
tloaelehileng = 0
holisa = 1
sieo = 2 lehlakoreng ka leng
sensory (sensang):
hona joale = 0
fokotsehile kapa ho ba sieo = 1 lehlakoreng ka leng

Lintlha tse felletseng :
3-5 - matšoao a manyane
6-8 - matšoao a itekanetseng
9-10 - matšoao a matla

Litekanyetso tse fokolang tsa tlhahlobo ea methapo ea lefu la tsoekere ho ea ka NSS le VAT ke:

matšoao a itekanetseng a nang le matšoao kapa a se nang matšoao (VAT = 6-8 + HCC ≥ 0)
matšoao a manyane a nang le matšoao a bobebe (VAT = 3-5 + HCC = 5-6)

Ho hlokahala ho tseba botebo ba lipontšo tsa bongaka tlhahlobo ea methapo ea methapo ea kutlo . E kenyelletsa ho ithuta mefuta eohle ea maikutlo le maikutlo.

Tlhomamiso ea maikutlo e lekantsoe ho sebelisoa 10 g ea monofilament (5.07 Semmes-Weinstein). Libaka moo ho hlokahalang ho etsa lipatlisiso ke sebaka sa limela sa distal phalanx sa leoto le leholo, bokaholimo ba hlooho ea distal le V metatarsal bone. Bonyane ho lokela ho tšoaroa habeli ka nako e le 'ngoe. Sebaka sa kutlo sa vibrational se ikemisetsa ho sebelisa fereko ea methapo ea kutlo kapa biotheziometer. Boithuto bo etsoa maemong a tloaelehileng: motheo oa thipa le mokokotlo oa kahare. Boikutlo ba ho feto-fetoha ha maikutlo ha bo fokotsehe haeba mokuli a khaotsa ho ikutloa a le betere ha boleng ba tekanyo ea fereko e le 7 UE kapa ho feta. Ho fokotseha ha menahano ea maikutlo a pherekano ke bafuputsi ba bangata ho hlahlojoa e le lets'oao le sa rateheng la tsoelo-pele. Boikutlo ba mocheso bo khethoa ka ho feto-fetoha ha ntho e futhumetseng le e batang libakeng tse haufi tsa thipa, mokokotlo oa leoto, mokokotlo oa kahare, leoto le tlase. Boikutlo ba ho utloa bohloko bo ithutoa ka nale e nang le marang-rang kapa lisebelisoa tse khethehileng (Neuropen, Pin-wheel). Ho sekaseka boemo ba lefapha la makoloi la tsamaiso ea methapo, Achilles le likhono tsa mangole li ikemiselitse ho sebelisa sesepa sa methapo. Ho khetholla autonomic neuropathy, mokhoa o theko e phahameng ka ho fetisisa ho tloaelo ke Teko ea orthostatic .

E ipapisitse le lipontšo tsa kliniki, tse latelang methati ea methapo ea methapo ea lefu la tsoekere (Tataiso ea Machabeng bakeng sa Tsamaiso ea Kantle ho Ts'oaetso ea lefu la tsoekere la 1995,):

0 - ha ho na neuropathy, matšoao le matšoao a seng teng
1 - asymptomatic neuropathy
1 A - HCC = 0, Reflex Reflex
1 B - HCC = 0, Reflex ea knee Reflex
2 - matšoao a neuropathy
2 A - HCC ≥ 1, reflex e tloaelehileng ea mangole
2 B - HCC ≥ 1, reflex ea knee e fokotsehileng
3 - neuropathy e matla.

Le lefu la tsoekere, motho o ba le mathata a mangata a amang mosebetsi oa litho tsa ka hare. Tsamaiso ea methapo ea kutlo le eona e ameha khafetsa - haeba likhoele tsa methapo e itseng e tšoenyehile, ngaka e hlahloba lefu la tsoekere, 'me haeba ho na le lesapo le leholo, lefu la tsoekere le fumanoa.

Lefu lena le hlaha ho batho ba nang le lefu la tsoekere le mofuta oa pele le oa bobeli oa lefu la tsoekere, kotsi ea lefu lena ke liperesente tse 15-50 tsa linyeoe. Ka tloaelo, lefu la tsoekere la lefu la tsoekere le fumanoa haeba motho a bile le bothata ba ho hloka insulin nako e telele mme a phahamisitse maemo a tsoekere ea mali.

Manonyeletso a pherekano a senyeha ka lebaka la liphetoho mokhoeng oa tšebetso oa metabolic liseleng. Metsoako ea methapo e bolaoa ke tlala ea oksijene, mahlaseli a nitric oxide a fokotseha, a bakang phallo e mpe ea mali le tsamaiso ea methapo.

Polyneuropathy. Classified, lisosa, setšoantšo se akaretsang sa kliniki ea polyneuropathies.Dysmetabolic le paraneoplastic polyneuropathies. Li-polyneuropathies tse nang le khaello ea livithamini tse itseng. Guillain-Barré Syndrome

Sebaka sa marang-rang se fana ka tlhaiso-leseling e mabapi le lintlha feela. Ho hlahloba le ho phekola maloetse ho lokela ho etsoa ka tlasa taolo ea setsebi. Lithethefatsi tsohle li na le li-contraindication. Kopo ea setsebi e hlokahala!

Polyneuropathy ke eng?

Polyneuropathy (polyneuropathy, polyneuritis) Ke lefu le khetholloang ke marapo a mangata a methapo ea kutlo. Psychology ena e bonahatsoa ke ho holofala ha litho tsa kahare, mathata a maikutlo, ho hloka taolo ea methapo ea kutlo (haholo libakeng tse hole le libaka).

Lefu la tsoekere la polyneuropathy: matšoao

Maemong a fapaneng a lefu lena, matšoao a ka fapana haholo - ka sethala sa zero, matšoao ha a eo ka botlalo. Mokhahlelo oa pele ha o na matšoao a sebopeho, empa ngaka e ka tseba ho fumana lefu lena ka ho ithuta liteko tse entsoeng ka mali le sephetho sa tlhahlobo ea tlhahlobo ea mali lefapheng la lefapha la methapo ea methapo.

Mokhahlelong oa bobeli oa kliniki, bohloko bo sa foleng, bohloko bo sa foleng, amyotrophy le mofuta o se nang bohloko li khetholloa. Ka sebopeho sa bohloko bo sa foleng, batho ba nang le lefu la tsoekere ba utloa ho cha le ho opa maotong, ha maikutlo a fokotseha ka mokhoa o hlakileng, ka lebaka leo ho fumanoang hore polyneuropathy ea maemo a tlase e fumanoa. Haholo-holo Symbomatology e ka mpefala bosiu.

Ha foromo ea bohloko bo boholo e hlaha, methapo ea bohloko e qala ho hasana hohle 'meleng, maemong a mang, maikutlo a eketsehileng a bonoa lintlheng tse tlase. Amyotrophy e tsamaea le bofokoli ba mesifa le bohloko bo boholo bosiu. Ka foromo e se nang bohloko, motho ha a utloe bohloko bo felletseng le mocheso oa fetoha.

Ngaka e hlahloba mohato oa boraro oa lefu lena ha ho bonahala mathata a tebileng. Sebakeng sa maoto, u ka bona maqeba a mangata le liso, ho ka etsahala nts'etsopele ea leoto la Charcot, ntlheng ena lefu lena le atisa ho khaola leoto.

Matšoao ohle a ho bonahatsa lefu a ka aroloa ka lihlopha tse tharo tse kholo:

Matšoao a utloisang bohloko a kenyelletsa ho senyeha ha mofuta oa ho opa, ho kuta, ho thunya, le mahlaba a tukang. Ho diabetics, maikutlo a fokotseha kapa, ka lehlakoreng le leng, maikutlo a eketseha, matsoho le maoto a felloa ke matla. Hape, mokuli a ka ikutloa a sa sisinyehe kapa a fetoha ka mocheso.
Matšoao a ts'ebetso ea makoloi a tsamaisana le bofokoli kapa mokokotlo oa mesifa ea maoto, ho se khone ho thuisa, maoto le matsoho a thothomang, mesifa ea mesifa ea caviar.
Ho kenyelletsa ho lefu la tsoekere, tsamaiso ea uhuru e tšoenyehile, sena se bonahatsoa ke tachycardia, ho fokotseha ha khatello ea mali, ha motho a fetola boemo ba hae ba 'mele, ho sokela, lets'ollo, ho hloka matla, ho fufuleloa hampe, edema.

Ho hlahloba le ho phekola polyneuropathy

Lefu lena le fumanoa le ipapisitse le litletlebo tsa lefu la tsoekere, matšoao a teng le lintho tse ling. Lefu lena ho thata ho le tseba, hobane batho ba baholo ba ka ba le matšoao a tšoanang a kliniki ka lebaka la liphetoho tse amanang le lilemo.

Ho kenyelletsa, ka linako tse ling matšoao a tlhahiso ha a iponahatse ka tsela efe kapa efe, ka hona, ho ka etsahala hore o bone tlolo ea molao feela ka ho fetisa tlhahlobo e khethehileng.

Hangata, lefu le joalo le fumanoa ho banna ba baholo, ho boetse ho na le kotsi ea ho ba le lefu la tsoekere la polyneuropathy le tsoekere la tsoekere le nako e telele ea hyperglycemia, kholo ea mokuli ea phahameng, boteng ba lefu la tsoekere le nephropathy, ho fokotsa kutloelo-bohloko ea vibrations, fokolisa senson reflexes.

Haeba motho a e-na le mofuta oa maikutlo a lefu lena, bakeng sa tlhahlobo ea bokhoni, kutloisiso ea vibration e lekantsoe ho sebelisoa fereko ea ho sarolla, tekanyo ea kutlo ea liphetoho tsa mocheso e ikemiselitsoe, kutloisiso ea bohloko e fumanoa ka ho ts'oara maoto le nale e khethehileng.Ho kenyelletsa sensathivity e lekiloeng ea bokhoni le matla a lefu la tsoekere ho bona boemo ba likarolo tsa 'mele.
Haeba lefu lena le belaelloa ka mofuta oa lefu lena, ho hlahlojoa maikutlo a tendon 'me ho etsoa electromyography, e kenyelletsang ho ithuta ka ts'ebetso ea bioelectric ea mesifa ea mesifa.
Tabeng ea mofuta o ikemetseng oa polyneuropathy, sekhahla sa pelo nakong ea ho hema le ho hema ho lekanngoa, ho hlahlojoa tšobotsi ea gastroenterological le urological, mme motho o tloaetse ho ba le hypotension ea orthostatic.

Nakong ea tlhahlobo, ngaka e hlahloba hore na lefu la tsoekere le utloa ho ama, bohloko, mocheso, serame, ho thothomela le khatello. Ho sebelisoa lisebelisoa tse fapaneng bakeng sa sena, empa mokuli, haeba ho hlokahala, a ka hlahloba kutloisiso ka boeena ka lintho life kapa life tse futhumetseng le tse batang. Ho ka bonoa ka litlolo tse nang le thipa tse lohiloeng ka letlalo.

Haeba lefu la tsoekere le senola lefu la tsoekere la polyneuropathy, kalafo e lokela ho ba e felletseng, mabaka ohle a bakang lefu lena a tlameha ho felisoa. Bakeng sa sena, ka tlhahiso ea ngaka e eang, ho fanoa ka litlhare tse fapaneng tse fokotsang matšoao le ho kokobetsa boemo ba mokuli.

Ho theola tsoekere e maling, nka meriana e theolang tsoekere.
Ho tiisa ts'ebetso ea ts'ebetso ea methapo, ngaka e fana ka litlolo tsa livithamine tsa B, litlhare tsa litlhare ka tekanyetso e nyane, le litokisetso tse nang le thioctic acid.
Gabapentin ke pheko e sebetsang bakeng sa ho tsietsana, 'me li-analgesics le meriana e thibelang likokoana-hloko le tsona lia hlokahala. Ho itukisetsa matla a magnesium ho thusa ho imolla mesifa ea mesifa, ho phomotsa mesifa ho imolla spasms.
Ho eketsa lisebelisoa tsa matla tsa li-neuron, ho kgothaletswa ho nka lithethefatsi Actovegin.
Haeba motho a e-na le tachycardia, nka Nebivolol kapa Metoprolol.
E le ho felisa ho teneha letlalong, ho sebelisoa Kapsikam, Apizartron, Finalgon.

Pheko e khethehileng ea 'mele, ho ikoetlisa ka ho phomola, ho hlohlona ka thapo, ho phekola ka matla a khoheli, ho tsosa motlakase ho ka phekola lefu la kelello le tsoang lingakeng.

Mekhoa ea setso e netefalitsoeng e thusa ho tlosa maqeba le liso letlalong ka lefu la tsoekere le lefu la tsoekere, hobane sena se sebelisoa litlama, litlolo tsa pholiso le li-decoctions tse thusang.

Joala bofe kapa bofe bo nooang ha bo khetholloe lijong e le hore 'mele o be matla hape o phetse hantle.

Mehato ea thibelo

Ka ts'oaetso e tlang ka nako, kalafo e nepahetseng le thibelo, nts'etsopele ea lefu lena e ka emisoa ka nako. Ho fihlela sena, ho bohlokoa hore batho ba nang le lefu la tsoekere lilemo tse hlano kamora ho fumanoa ha lefu la tsoekere ba buisane le ngaka mme ba hlahlojoe hore na ho na le kapa ho ba teng ha lefu la tsoekere le neng le atile ho ngoana kapa ho motho e moholo. Kamora moo, o hloka ho fetisa taolo selemo se seng le se seng.

Sehloohong sena, re tla hlahloba ka botlalo mofuta o atileng haholo oa khatello ea methapo ea lefu la tsoekere - distal, symmetric, sensory kapa sensorimotor polyneuropathy .

Tšoaetso ea matšoao a kliniki.
Tlhahlobo ea bongaka: tlhahlobo ea morphological le biochemical.
Boithuto ba electrodiagnostic: ho bonts'a lebelo la ts'usumetso kapele ho methapo.
Liteko tsa maikutlo a makatsang.
Liteko tsa ts'ebetso ea Autonomous.

maikutlo a tukang, tsebe (tsebe) kapa maikutlo a "ho oela" = 2
mokhathala, makhopho kapa bohloko .... 1
phetiso:
maoto = 1
mesifa ea namane = 1
tse ling = 0
fumana:
bosiu = 2
mots'eare kapa bosiu = 1
mots'eare = 0
ho tsoha borokong = 1
fokotseha:
ha u tsamaea = 2
e eme = 1
ho lula kapa ho bua leshano = 0

Lintlha tse felletseng e etsa boleng bo boholo:
3-4 - matšoao a manyane,
5-6 - matšoao a itekanetseng,
7-16 - matšoao a matla.

jerk knee
maikutlo a vibration
kutloelo-bohloko ea bohloko
maikutlo a mocheso
maikutlo:
tloaelehileng = 0
holisa = 1
sieo = 2 lehlakoreng ka leng
sensory (sensang):
hona joale = 0
fokotsehile kapa ho ba sieo = 1 lehlakoreng ka leng

Lintlha tse felletseng :
3-5 - matšoao a manyane
6-8 - matšoao a itekanetseng
9-10 - matšoao a matla

Litekanyetso tse fokolang tsa tlhahlobo ea methapo ea lefu la tsoekere ho ea ka NSS le VAT ke:

matšoao a itekanetseng a nang le matšoao kapa a se nang matšoao (VAT = 6-8 + HCC ≥ 0)
matšoao a manyane a nang le matšoao a bobebe (VAT = 3-5 + HCC = 5-6)

Ho hlokahala ho tseba botebo ba lipontšo tsa bongaka tlhahlobo ea methapo ea methapo ea kutlo . E kenyelletsa ho ithuta mefuta eohle ea maikutlo le maikutlo.

0 - ha ho na neuropathy, matšoao le matšoao a seng teng
1 - asymptomatic neuropathy
1 A - HCC = 0, Reflex Reflex
1 B - HCC = 0, Reflex ea knee Reflex
2 - matšoao a neuropathy
2 A - HCC ≥ 1, reflex e tloaelehileng ea mangole
2 B - HCC ≥ 1, reflex ea knee e fokotsehileng
3 - neuropathy e matla.

Polyneuropathy - Hona ke bokuli bo kotsi, e leng ho felisoa hoa tsamaiso ea methapo ea kutlo, eo motheo oa eona e leng ho ferekanya kelello, mathata a kutloisiso, ho se sebetse hantle ha methapo ea methapo, ho holofala hoa litho, ho shebiloeng haholo-holo likarolong tsa maoto le matsoho. Hangata lefu lena le aroloa ho latela sebopeho sa thuto ea methapo ea kutlo, pathomorphology ea tsepamiso ea methapo le mofuta oa thupelo.

Limb polyneuropathy e nkuoa e le mokhoa o tloaelehileng o atileng, hangata o ama likarolo tsa sebaka ka ho kenella butle-butle ha likarolo tsa proximal.

Matšoao a polyneuropathy

Boloetse bo ho nahanoang ka polyneuropathy ea likarolo tse holimo le tse tlase bo qala ka bofokoli ba mesifa, 'me ka lehlakoreng la pele, likarolong tse ka thoko tsa maoto le matsoho. Sena se bakoa ke tšenyo ea likhoele tsa methapo. Ka lefu lena, pele ho tsohle, likarolo tsa litho tsa maoto le matsoho lia ameha ka lebaka la khaello ea ts'ireletso e lekaneng bakeng sa likarolo tsa tsamaiso ea methapo (mohlala, tšitiso ea mali le bokong ba mali).

Liponahatso tsa "pathology" e hlalositsoeng ka pele sebakeng sa maoto mme e pharalla hanyane ka hanyane le leoto. Ho latela typology ea methapo ea methapo e kenang timetso ho isa tekanyong e kholo, mefuta eohle ea polyneuropathy e arotsoe ka maemo hore e be lihlopha tse 'ne.

Ka lebaka la ho hlola, boholo ba lits'ebetso tse telele tsa li-neurons, matšoao a nepahetseng kapa a mabe a bonoa ho bakuli. Ea pele e tšoauoa ka ho se sebetse kapa ho theoha ha eona, matšoao a nepahetseng ke lipontšo tse sa kang tsa bonoa pele.

Khetlong la pele, ho bakuli lefu lena le hlahang le iponahatsa ka mefuta e fapaneng ea li-presthesias, joalo ka ho chesa, ho tsikitlanya, ho nyehlisa bohloa, ho ts'oaroa ke tsebe. Ebe setšoantšo sa tliliniki se thatafatsoa ke li-algias tsa matla a fapa-fapaneng, 'me menyetla ea tšusumetso e bohloko e eketseha. Ha matšoao a ntse a eketseha, bakuli ba ameha haholo ka ho tšoaroa habonolo. Hamorao, ba ile ba bonts'a li-ataxia tse otlang pelo, tse hlahisoang ke ho hloka botsitso ha likhathatso, haholo-holo ka mahlo a koetsoeng, le tšebelisano-'mele e mpe. Matšoao a fosahetseng a polyneuropathy a kenyelletsa ho fokotseha ha maikutlo libakeng tsa tšenyo ea methapo ea methapo.

Haeba ho senyeha ha axonal ho li-neuron, ho sisinyeha ha polyneuropathy ea likarolo tse holimo le tse tlase ho bonahala, khetlong la pele, ka atrophy ea mesifa mme e fumanoa bofokoling ba maoto le matsoho. Matšoao a hlalositsoeng a tsoela pele ho holofala le parresis. Hangata, boemo bo ka bonoa, bo bonahatsoa ke maikutlo a sa thabiseng maotong, bo hlaha ka ho phomola le ho qobella batho ho etsa mots'oafo oa “maoto le matsoho a sa phomotseng”. Ntle le moo, ho ka ba le maikutlo a ferekanyang le letsoalo.

Mathata a meroho a arotsoe ka mathata a trophic le mathata a methapo ea methapo. A pele a kenyelletsa ponahalo ea 'mala le ho peeling ha letlalo, ponahalo lipheletsong tsa mapetso le liso. Mathata a methapo e kenyelletsa ho hlaseloa ke serame likarolong tse senyehileng, ho fifala ha letlalo (seo ho thoeng ke "marble pallor").

Matšoao a Vegetative-trophic a boetse a kenyelletsa phetoho sebopeho sa lintho tse tsoang ho dermis (moriri le lipekere). Ka lebaka la hore likarolo tse tlase li ka khona ho mamella mojaro o mongata, polyneuropathy ea maoto e fumanoa hangata ho feta matsoho.

Polyneuropathy ea likarolo tse tlase

Boloetse bo hlahlobang polyneuropathy ea lintho tse feteletseng ke tšenyo e mpe ea lisele tsa methapo ea kutlo, tse bakang ho se sebetse hantle ha ts'ebetso ea methapo ea kutlo. Ho kula hona ho bonahala ka ho fokotseha ha bokhoni ba makoloi, ho fokotseha ha kutloisiso, ho latela sebaka seo kelello ea maoto e leng sona, karolo efe kapa efe ea maoto le bohloko ba mesifa. Ha ho buuoa ka lefu lena, methapo ea kutlo ea mokuli e fepang maoto e senyehile. Ka lebaka la tšenyo ea sebopeho sa methapo ea methapo, kutloelo-bohloko ea maoto a lahleha, e leng se amang bokhoni ba motho ba ho itsamaela ka bolokolohi.

Phekolo ea polyneuropathy ea likarolo tse tlase, joalo ka molao, e boima ebile e nka nako e telele, hobane khafetsa lefu lena le na le sebopeho se tsoelang pele 'me le ba maemong a sa foleng.

Ho fumana lisosa tse bakang kholo ea lefu le hlalositsoeng pele, o lokela ho sebetsana le sesebelisoa sa tsamaiso ea methapo, haholo karolo ea eona e arohaneng - tsamaiso ea methapo.E ipapisitse le lits'ebetso tse telele tsa methapo ea methapo, mosebetsi oa eona ke ho fetisetsa lipontšo, tse netefatsang tlhahiso ea mesebetsi ea motor le ea sensory. 'Mele oa methapo ena e phela ka har'a bokong le bokong ba lesapo la mokokotlo, ka hona li theha kamano e haufi. Ho tloha ponong e sebetsang, karolo e potoloha ea methapo ea kutlo e kopanya seo ho thoeng ke "li-conductors" tse hokahanyang libaka tsa methapo ea kutlo le li-receptors le litho tse sebetsang.

Ha polyneuropathy e etsahala, karolo e arohaneng ea methapo ea methapo ea kutlo e amehang. Ka hona, lipontšo tsa lefu lena li bonoa libakeng tse ling. Lefu la methapo ea maoto le matsoho le bonahala e le ka mokhoa o hlakileng.

Re lokela ho hlokomela hore pathology e ntseng e hlahlojoa e na le mefuta e 'maloa, e khethiloeng ho latela mesebetsi ea methapo e senyehileng. Kahoo, mohlala, haeba li-neuron tse ikarabellang bakeng sa ho sisinyeha li amehile, matla a ho sisinyeha a ka lahleha kapa a ba thata. Polyneuropathy e joalo e bitsoa motor.

Ka mofuta oa maikutlo a pherekano eo ho buuoang ka ona, likhoele tsa methapo lia ameha, li baka kutloelo-bohloko, tse bohloko haholo ha karolo ena ea methapo ea kutlo e senyeha.

Ho haella ha mesebetsi ea taolo ea autonomic ho etsahala ka tšenyo ea li-fibro nerve fibers (hypothermia, atony).

Kahoo, mabaka a latelang a bohlokoa a bakang kholo ea lefu lena a khetholloa: metabolic (e amanang le mathata a metabolic), autoimmune, lefa, alimentary (e bakoang ke mathata a ho ja), chefo le tšoaetso.

Mefuta e 'meli ea pathology e hlalositsoeng e khetholloa ho latela sebaka sa sebaka sa lesion: demyelinating le axonal. Khetlong la pele - myelin e amehile - ntho e thehang membrane ea methapo, e nang le sebopeho sa axonal, moqomo oa axial o senyehile.

Sebopeho sa axonal sa polyneuropathy ea maoto se bonoa mefuteng eohle ea lefu lena. Phapang e atile ho atileng ha mofuta oa tlolo ea molao, mohlala, ho kanna ha ba le pherekano ea ts'ebetso ea makoloi kapa ho fokotseha ha kutloisiso. Foromo ena e hlaha ka lebaka la mathata a tebileng a metabolic, ho tahoa le metsoako e fapaneng ea organophosphorus, lead, salate ea mercury, arsenic, hammoho le botahoa.

Mefuta e mene e khetholloa, ho latela tlhahlobo ea thupelo: thuto e sa foleng le e sa phetseng hantle, e hlobaetsang le e subacute.

Sebopeho se matla sa axonal polyneuropathy hangata se hlaha matsatsing a 2-4. Hangata ho halefisoa ke chefo e matla ea tlhaho ea ho ipolaea kapa ea botlokotsebe, botaoa bo akaretsang ka lebaka la ho pepesetsoa lithethefatsi tsa "arsenic", "monokotšoai", "lead", "salury", "mercury". Foromo e boima e ka qeta matsatsi a fetang a leshome.

Matšoao a mofuta oa subacute oa polyneuropathy a eketseha ka mor'a libeke tse 'maloa. Foromo ena hangata e hlaha ka mathata a metabolic kapa ka lebaka la toxicosis. Hangata, ho fola ho lieha ebile ho nka likhoeli.

Foromo e sa foleng hangata e tsoela pele ka nako e telele ea likhoeli tse tšeletseng kapa ho feta. Hangata lefu lena le hlaha khahlano le mokokotlo oa joala, lefu la tsoekere, lymphoma, mafu a mali, khaello ea livithamini thiamine (B1) kapa cyanocobalamin (B12).

Har'a li-axonal polyneuropathies, joala ba joala ba joala hangata bo fumanoa, bo bakoa ke tlhekefetso e telele le e feteletseng ea mekelikeli e nang le joala. Karolo ea bohlokoa bakeng sa ho hlaha hoa ts'oaetso ea methapo ea methapo e hlahlojoang ha e bapaloe feela ke linomoro tsa "litha e kenyelitsoeng" tsa joala, empa le boleng ba sehlahisoa ka boeona, kaha lino tse ngata tsa joala li na le lintho tse ngata tse chefo bakeng sa 'mele.

Ntho ea mantlha e bakang joala ba joala ba joala ke litlamorao tse mpe tsa lino tse tahang, tse nang le joala bo bongata lits'ebetsong tsa methapo, tse lebisang ho senyeha ha metabolism. Maemong a mangata, thuto ea methapo ea kutlo e khetholloang ke thuto e sa sebetseng. Qalong, maikutlo a ho ba botšehali a hlaha likarolong tse sephara tse tlase, le bohloko bo boholo mesifa ea namane. Ka khatello e ntseng e eketseha, maqhubu a mesifa a eketseha ka mokhoa o hlakileng.

Karolong e latelang ea kholo ea lefu lena, ho se sebetse hantle hoa lipalo tse tlase tse tlase hoa bonts'a bofokoli, hangata le ho holofala. Manonyeletso a bakang ho saroloha ha leoto a senyeha haholo. Ntle le moo, kutloisiso ea bokaholimo ba mantle sebakeng sa matsoho ke mofuta oa "li-glove" le maoto ka mofuta oa "sock" o senyehile.

Maemong a mang, bokuli bona bo ka ba le phello e mpe ea kelello. Sena se bakoa haholo ke ho tsitsa haholo.

Ntle le matšoao a kliniki a kaholimo, lipontšo tse ling tsa pathological li kanna tsa ba teng, joalo ka phetoho ea 'mala oa letlalo la maoto le mocheso oa lipalo, ho ruruha ha likarolo tsa maoto a maoto a tlase (hangata hangata matsoho), ho eketseha ha mofufutso. Boloetse bo botsoang ka linako tse ling bo ka ama methapo ea kutlo, e leng methapo ea kutlo ea oculomotor le optic.

Mathata a hlalositsoeng hangata a fumanoa le ho eketseha ka libeke tse 'maloa / likhoeli. Lefu lena le ka phela lilemo tse 'maloa. Ka ho khaotsa ho sebelisa joala, lefu lena le ka hlola.

Mofuta o fokolisang oa polyneuropathy o nkoa e le lefu le tebileng, le tsamaeang le ho ruruha ha metso ea methapo le tšenyo ea butle butle ea sheel ea ka ea myelin.

Mofuta o nkoang oa lefu lena o fumaneha seoelo. Hangata, banna ba baholo ba na le lefu lena, le ha le ka hlaha le halofo e fokolang ea bana le bana. Demyelinating polyneuropathy hangata e bonahatsoa ke bofokoli ba mesifa libakeng tse mahareng tsa maoto le matsoho, ka lebaka la tšenyo ea metso ea mokokotlo.

Ka bomalimabe, mokhoa oa nts'etsopele le sesosa sa mofuta oa lefu lena le sa tsejoeng ha li tsejoe, leha ho le joalo, liphuputso tse ngata li bontšitse tlhaho ea autoimmune ea demyelinating polyneuropathy. Ka mabaka a 'maloa, sesole sa' mele se qala ho nka lisele tsa sona e le tsa linaha tse ling, ka lebaka leo ho amoheloang ho hlahisa li-antibodies tse ikhethang. Ka mofuta ona oa pathology, li-antigen li hlasela lisele tsa metso ea methapo, li baka tšenyo ea membrane ea tsona (myelin), ka tsela eo e baka ts'ebetso ea ho ruruha. Ka lebaka la litlhaselo tse joalo, methapo ea methapo e lahleheloa ke mesebetsi ea bona ea mantlha, e bakang pherekano ho bolokoe ha litho le mesifa.

Kaha ho amoheloa ka kakaretso hore tšimoloho ea lefu leha e le lefe la autoimmune le amana le lefutso, lebaka la liphatsa tsa lefutso la lefu la demyelinating polyneuropathy li ke ke tsa hlakoloa. Ntle le moo, ho na le maemo a ka fetolang tšebetso ea sesole sa 'mele. Maemo ana kapa lintlha li kenyelletsa ho senyeha ha metabolism le lihormone, mokhathala o mongata oa 'mele, ts'oaetso ea' mele, khatello ea maikutlo, ho enta, ho sithabela maikutlo, ho pepesetsoa khatello ea maikutlo, mafu a tebileng le ts'ebetso ea bongaka.

Kahoo, kalafo ea polyneuropathy ea likarolo tse tlase e emeloa ke likarolo tse 'maloa tse lokelang ho tsotelloa, hobane tlolo ea molao ha e itlele feela. Ka hona, ha ho fumanoa lipontšo tsa pele le matšoao a bokuli, ho bohlokoa ho tseba hang-hang hore na kalafo ea "tsoekere" polyneuropathy e fapana le kalafo ea methapo e hlahisoang ke tlhekefetso ea joala.

Polyneuropathy ea maoto le matsoho a holimo

Tlolo ena e etsahala ka lebaka la ts'enyo ea tsamaiso ea methapo 'me e lebisa ho holofeng le matsoho le matsoho a holimo. Ka lefu lena, hangata ho bonoa tšenyo ea methapo ea methapo ea methapo ea kutlo.

Matšoao a polyneuropathy ea matsoho a batla a tšoana kamehla. Bakuli ba na le keketseho ea ho fufuleloa, tlolo ea kutloelo-bohloko ea maikutlo, thermoregulation, phepo ea letlalo, phetoho ea maikutlo a tactile, li-paresthesias li hlaha ka mokhoa oa "li-goose bumps". Psychology ena e tšoauoa ka mefuta e meraro ea nete, e leng e sa foleng, e hlobaetsang le e subacute.

Polyneuropathy ea likarolo tse holimo e bontšoa haholo ke bofokoli ba matsoho, li-aligas tse fapaneng, tse tukang kapa tse phatlohang ka har'a litaba, ho ruruha, ho tsikinyeha ka linako tse ling ho ka utloahala. Ka ts'ebetso ena ea methapo, maikutlo a pherekano a senyeha, ka lebaka leo bakuli ba atisang ho ba le mathata a ho etsa manyolo a tšimolohong. Ka linako tse ling batho ba nang le bothata ba polyneuropathy ba bona ho fokotseha ha kutloelo-bohloko matsohong a bona.

Sesosa sa polyneuropathy ea matsoho, hangata, ho tahoa ho fapa-fapaneng, ka mohlala, ka lebaka la tšebeliso ea joala, lik'hemik'hale, lijo tse silafetseng. Hape, ho ba teng ha lefu le hlahang ho ka baka: khaello ea vithamine, ts'oaetso ea tšoaetso (vaerase kapa bacteric etiology), li-collagenoses, sebete, ho se sebetse hantle ha meno, li-process tsa pancreatic le endocrine. Khafetsa, lefu lena le hlaha ka lebaka la lefu la tsoekere.

Boloetse bo hlalositsoeng bo ka hlaha ho mokuli ka mong ka litsela tse fapaneng.

Ka pathogenesis, polyneuropathy ea likarolo tse holimo e ka aroloa ka axonal le demyelinating, ho latela lipontšo tsa bongaka, limela, sensory, le motor. Ka sebopeho sa eona se hloekileng, ho thata ho kopana le mefuta e sa thathamisitsoeng ea bokuli bona, hangata lefu lena le kopanya matšoao a phapang e fapaneng.

Phekolo ea polyneuropathy

Kajeno, mekhoa ea kalafo ea lefu lena leo ho buuoang ka lona e batla e fokola. Ka hona, ho fihlela kajeno, kalafo ea polyneuropathies ea mefuta e fapaneng e ntse e le bothata bo tebileng. Tekanyo ea tsebo ea lingaka tsa sejoale-joale lefapheng la karolo ea pathogenetic le sesosa sa lefu lena la mafu li khethile ho nepahala ha ho khetholla libaka tse peli tsa kalafo, e leng mekhoa e sa khetholloeng le e arohaneng.

Mekhoa e arohaneng ea khalemelo ea kalafo e fana ka maikutlo a kalafo ea tahi e ka tlase ea mafu a ka tlase (mohlala, nephropathy, lefu la tsoekere), ka methapo ea tsamaiso ea tšilo ea lijo e hlahisoang ke malabsorption, e hloka taolo ea litekanyetso tse kholo tsa livithamini B1 (thiamine) le B12 (cyanocobalamin).

Ka hona, mohlala, lithethefatsi tsa kalafo ea lefu la tsoekere le lefu la bona le khethoa ke polokeho ea boemo bo itseng ba glycemic. Therapy ea polyneuropathy khahlanong le lefu la tsoekere e lokela ho fetoloa. Boemong ba pele, boima ba 'mele le lijo li lokela ho fetoloa, ho lokela ho ntlafatsoa sete sa ho ikoetlisa ka tsela e khethehileng,' me ho latela matšoao a khatello ea mali ka tloaelo ho lokela ho behoa leihlo. Mekhoa ea kalafo ea pathogenetic e kenyelletsa tšebeliso ea livithamini tsa neurotropic le ente ea alpha-lipoic acid ho litekanyetso tse kholo.

Mekhoa ea phekolo e sa khetholloang e hlahisoa ke li-glucocorticoids, lithethefatsi tsa immunosuppressive le plasmapheresis.

Lithethefatsi tsa kalafo ea polyneuropathy li lokela ho laeloa hammoho. Bohlokoa ba khetho ea mehato ea kalafo e sebelisoang kalafo ea lefu lena e lula e nahanisisa ka linako tsohle ho latela lebaka la tšibollo ea lefu lena le ileng la baka lefu lena mme la baka. Mohlala, matšoao a polyneuropathy a hlahisoang ke pyridoxine e ngata (vithamine B6) a nyamela ntle ho tšitiso kamora ho etsa hore boemo ba hae bo be bobebe.

Polyneuropathy e bakoang ke ts'ebetso ea mofets'e e phekoloa ka ho buuoa - ho tlosoa ha neoplasm, e leng khatello ea methapo ea methapo. Haeba lefu le hlaha khahlanong le hypothyroidism, joale ho sebelisoa phekolo ea li-hormone.

Phekolo ea chefo ea polyneuropathy, sebakeng sa pele, e kenyelletsa mehato ea ho ntša maikutlo, 'me ka mor'a moo ho laetsoe meriana hore e lokise lefu lena ka bolona.

Haeba ho sa khonehe ho tseba kapa ho tlosa sesosa se bakileng tsoelo-pele ea lefu le hlalositsoeng, sepheo sa mantlha sa kalafo se kenyelletsa ho tlosa bohloko le ho felisoa ha bofokoli ba mesifa.

Maemong ana, mekhoa e tloaelehileng ea physiotherapeutic le ho ts'oaroa ha lithethefatsi tse 'maloa tse reretsoeng ho imolla kapa ho fokotsa bohloko bo bakoang ke tšenyo ea methapo ea methapo lia sebelisoa. Ntle le moo, mekhoa ea physiotherapy e sebelisoa ka mafolofolo mehatong eohle ea kalafo ea ntlafatso.

Ka thuso ea lithethefatsi tsa analgesic kapa lithethefatsi tse seng khahlanong le ts'oaetso tsa mali, ho thata haholo ho li hlola Algia. Ka hona, tloaelo ea ho fana ka litlhare tsa meriana ea lefutso, lithibela-mafu le lithibela-mafu bakeng sa phokotso ea tlhaselo ea bohloko hangata e etsoa hangata.

Ts'ebetso ea li-antidepressants e matsohong a eona a ho baka ts'ebetso ea tsamaiso ea methapo. Khetho ea lithethefatsi sehlopheng sena e thehiloe ka bonngoe, hobane hangata li-antidepressants li baka ts'epahalo ea kelello.

Ts'ebeliso ea li-anticonvulsants e lokafatsoa ke bokhoni ba bona ba ho thibela litšusumetso tsa methapo tse tsoang methating e amehang.

RCHR (Setsi sa Naha sa Rephaboliki ea Bophelo bakeng sa Lekala la Bophelo la Rephaboliking ea Kazakhstan)
Mofuta: Liprotheine tsa Clinical tsa Ministry of Health of the Republic of Kazakhstan - 2017

Lefu la tsoekere la polyneuropathy (E10-E14 + LE MOTSO O MOTLE OA BOTSOALLE 4)

Tlhaloso e khutšoane

E amohetsoe
Khomishene ea Kopanelo bakeng sa Boleng ba lits'ebeletso tsa bongaka
Lekala la Bophelo la Rephabliki ea Kazakhstan
ke la 28 Pherekhong 2017
Protocol ea No. 33

Lefu la tsoekere - Tšenyo ea methapo ka lebaka la lefu la tsoekere, ho hlakile hore ho hlakile hore ke ramatiki kapa ho ikhetholla ho sa hlokahale. Mokhoa o ithutoang ka ho fetisisa le o tloaelehileng oa lefu la tsoekere ke distal symmetric polyneuropathy. DSPN - boteng ba matšoao a khatello ea methapo ea kutlo ea mokokotlo ho bakuli ba nang le lefu la tsoekere ka mor'a ho qheleloa ka thoko mabaka a mang.

Nts'etsopele ea protocol / Tlhahlobo : Selemo sa 2017.

Maele a sebelisitsoeng ho protocol:

GPP	Mokhoa o motle oa ho etsa lintho
WHO	Mokhatlo oa Lefatše oa Bophelo
TSA HAO	sekala sa analogue
DAN	lefu la tsoekere la sethoathoa
DMN	lefu la tsoekere le tsoekere
DN	lefu la tsoekere la polyneuropathy
DPN	lefu la tsoekere la polyneuropathy
DSPN	diabetesic sensorimotor polyneuropathy
ICD 10	khethollo ea machaba ea maloetse a ntlafatso ea bo10
NA	tsamaiso ea methapo
RCT	liteko tsa tleliniki tse sa sebetseng
SD I	mofuta oa lefu la tsoekere
SD 2	mofuta II lefu la tsoekere
ENMG	Electroneuromyography

Basebelisi ba Protocol : litsebi tsa kelello, litsebi tsa thuto ea tlhaho, lingaka tse akaretsang.

Boemo ba bopaki:
Tafole 1 - tekanyo ea maemo a bopaki

A	Tlhahlobo ea boleng bo phahameng ba meta-tlhahlobo, tlhahlobo e hlophisehileng ea li-RCT kapa li-RCT tse kholo tse nang le monyetla o fokolang haholo (++) oa phoso e hlophisitsoeng, litholoana tsa tsona li ka fetisetsoa ho sechaba se lumellanang.
Ho	Li-cohort tsa boleng bo phahameng (++) tse hlophisehileng kapa lithuto tse laolang linyeoe kapa lithuto tse phahameng tsa boemo bo phahameng (++) kapa lithuto tse laolang linyeoe tse nang le kotsi e fokolang haholo ea phoso e hlophisitsoeng kapa li-RCT tse nang le kotsi e fokolang ea (+) ea phoso e hlophisitsoeng, liphetho tsa tsona li ka fetisetsoa ho palo e lumellanang. .
Le	Phuputso e hlophisitsoeng ea cohort kapa ea linyeoe kapa thuto e laoloang ntle le ho ba le khethollo ka kotsi e tlase ea leeme (+). Liphetho tsa tsona li ka fetisetsoa ho sechaba se lumellanang kapa li-RCT ka kotsi e tlase haholo kapa e tlase ea phoso e hlophisitsoeng (++ kapa +), liphetho tsa tsona li ke ke tsa fetisoa ka kotlolloho ho baahi ba lumellanang.
D	Tlhaloso ea letoto la linyeoe kapa thuto e sa laoloang kapa maikutlo a setsebi.
GRP	Tloaelo e ntle ea kliniki.

Tlhahlobo e fapaneng

Tlhahlobo e fapanengle lebaka la ho etsa lipatlisiso tse ling
DSPN ke tlhahlobo e khethollang. Ho ba teng ha lefu la tsoekere le lipontšo tsa polyneuropathy ha ho bolele feela ho ba teng ha lefu la tsoekere la polyneuropathy. Tlhahlobo e hlakileng e hloka tlhahlobo e hlakileng.

Lethathamo la 3 - Tlhahlobo e khethollang ea DSPN

Tlhahlobo eo	Mokhoa oa ho fumana tšoaetso	Patlisiso	Mekhoa ea ho khetholla
Monkhoa oa joala	Teko ea mali a biochemical. Ultrasound	Lintlha tse mabapi le lefutso. Ho ba teng hoa joala ba joala ba lesapo la mokokotlo la sebete, lipontšo tse ling tsa NS: joala ba joala ba joala, myelopathy ea joala, polyradiculoneuropathy
PN ho mafu a autoimmune	Matšoao a polyneuropathy a sa lumellaneng le sebopeho sa DPNP *	Liteko tsa mali tse sa sebetseng.	Nalane ea maloetse a autoimmune. Matšoao a kliniki le a laboratori a maloetse ana.
PN e nang le khaello ea vithamine B12	Matšoao a polyneuropathy a sa lumellaneng le sebopeho sa DPNP *	Boikemisetso ba boemo ba B12 maling.	Ts'ireletso ea serum ea Bum e tlase ea serum. Mohlomong motsoako le anemia ea macrocytic megaloblastic.
PN mathateng a mang a metabolic (hypothyroidism, hyperthyroidism, botenya)	Matšoao a polyneuropathy a sa lumellaneng le sebopeho sa DPNP *	Teko ea mali bakeng sa lihormone tsa qoqotho. Psympress ea qoqotho	Lintlha tse mabapi le lefutso. Matšoao a kliniki, a laboratori le a bohlokoa a mafu ana.
Li-syndromes tsa Paraneoplastic	Matšoao a polyneuropathy a sa lumellaneng le sebopeho sa DPNP *	Tumellanong le mafu a oncological ea KP.	Lintlha tse mabapi le lefutso. Liphetho tsa lithuto tsa bohlokoa tse bonts'a ho ba teng ha ts'ebetso ea oncological.
Tšoaetso e fokotsang matla ea ho ruruha ea tšoaetso (ho ntsha phomolo kamora ho ts'oaroa ka mora ts'oaetso e bohloko)	Matšoao a polyneuropathy a sa lumellaneng le sebopeho sa DPNP *	ENMG. Tlhahlobo ea CSF. Biopsy n.suralis	Lintlha tse mabapi le lefutso. Lintlha tse ikhethileng ho ENMG. Ho fumanoa ha protheine ho mokelikeli oa "cerebrospinal". Liphetoho tse ikhethang ho n.suralis Biopsy
Moneng ea futsitsoeng	Matšoao a polyneuropathy a sa lumellaneng le sebopeho sa DPNP *	Patlisiso ho laboratori ea liphatsa tsa lefutso. ENMG	Lintlha tse mabapi le lefutso. Nalane ea lelapa. Matšoao a kliniki le a laboratori a lefu le itseng le futsitsoeng.
PN nakong ea botaoa ba kantle ho motsoala (lead, arsenic, phosphorus, joalo-joalo)	Matšoao a polyneuropathy a sa lumellaneng le sebopeho sa DPNP *	Liteko tsa mali le tsa moroto bakeng sa lintho tse chefo.	Lintlha tse mabapi le lefutso. Matšoao a kliniki le a laboratori ea tahi e itseng.
PN ea lino tse tahang tsa nako e telele (ho se sebetse hantle ha sebete ho sa sebetseng hantle, ho hlleha ho sa sebetseng hantle ha renal)	Matšoao a polyneuropathy a sa lumellaneng le sebopeho sa DPNP *	Liteko tsa mali a biochemical le urine. Ultrasound le / kapa MRI ea OBP le liphio	Lintlha tse mabapi le lefutso. Matšoao a kliniki, a laboratori le a bohlokoa a ho hloleha ha sebete ho sa foleng kapa ho se sebetse hantle ha renal.
PN ea ts'oaetso (syphilis, lepera, HIV, brucellosis, herpes, diphtheria, jj)	Matšoao a polyneuropathy a sa lumellaneng le sebopeho sa DPNP *	Teko ea mali (ELISA, PCR, jj.) Bakeng sa boteng ba tšoaetso e itseng.	Lintlha tse mabapi le lefutso. Matšoao a kliniki le a laboratori a tšoaetso e itseng

* asymmetric / motor predominely motor / localised in the maoto a holimo / maoto a ntlafalitsoeng haholo a polyneuropathy

Fumana kalafo Korea, Isiraele, Jeremane, USA

Fumana likeletso tsa bongaka

Kaha o oa itlhalosa, o ka baka likotsi tse mpe tse ke keng tsa lekanngoa.
Tlhahisoleseling e fumanehang webosaeteng ea MedElement ha e khone ebile ha ea lokela ho nka sebaka sa tlhahlobo ea sefahleho ea ngaka. Etsa bonnete ba hore o ikopanya le lits'ebeletso tsa bongaka haeba u na le mafu kapa matšoao a u khathatsang.
Khetho ea lithethefatsi le litekanyetso tsa bona li lokela ho lumellanoa le setsebi. Ke ngaka feela e ka fanang ka moriana o lakatsehang le litekanyetso tsa ona, o nahanela bokuli le boemo ba 'mele oa mokuli.
Webosaete ea MedElement ke mohloli oa litšupiso feela. Tlhahisoleseling e kentsoeng sebakeng sena sa marang-rang ha e ea lokela ho sebelisoa ho fetolela lengolo la ngaka.
Bahlophisi ba MedElement ha ba na boikarabello ba tšenyo efe kapa efe ea ts'enyo ea bophelo bo botle kapa tšenyo e bakiloeng ke ts'ebeliso ea sebaka sena sa marang-rang.

Sehlopha se matla sa maloetse se tšoauoa ka tšenyo ea systemic methapong ea kutlo. Li-polyneuropathies li arotsoe ka li-axonal tsa mantlha le tsa demyelinating ea mantlha. Ho sa tsotelehe mofuta oa polyneuropathy, setšoantšo sa eona sa kliniki se tšoauoa ka nts'etsopele ea bofokoli ba mesifa le atrophy, litekanyetso tsa tendon tse fokotsehileng, likhathatso tse fapaneng tsa maikutlo (paresthesias, hypo- le hypnothesia) tse hlahang libakeng tse poteletseng tsa distal, le mathata a tsamaiso ea kelello. Ntlha ea bohlokoa ea ho hlaseloa ha lefu la polyneuropathy ke ho tseba sesosa sa ho hlaha ha eona. Phekolo ea polyneuropathy ke letšoao, mosebetsi o ka sehloohong ke ho felisa lebaka la causative.

Tlhahisoleseling ka kakaretso

Etiology le pathogenesis ea polyneuropathies

Ho sa tsotelehe sesosa sa etiological ho polyneuropathies, mefuta e 'meli ea methapo ea methapo ea methapo e senotsoe - ho senyeha ha axon le demyelination ea nerve fiber. Ka mofuta oa axonal oa lesion, demyelination ea bobeli e etsahala, ka lesion e nyenyefatsang, karolo ea axonal e kenella hape. Haholo-holo axonal ke boholo ba li-polyneuropathies tse nang le chefo, mofuta oa axonal oa GBS, mofuta II NMS. Li-polyneuropathies tsa demyelinating tsa mantlha li kenyelletsa mofuta oa khale oa GBS, HVDP, li-polyneuropathies tsa paraproteinemic, mofuta oa N NSC.

Ka axonal polyneuropathies, ts'ebetso ea lipalangoang ea moqomo oa axial e ameha haholo ke axoplasmic ea hona joale, e tsamaisang lintho tse 'maloa tsa tlhaho tse hlokahalang bakeng sa ts'ebetso e tloaelehileng ea lisele tsa methapo le mesifa ntlheng e tlohang ho neuron ea motor ho ea mokokotlong le mahlakore a fapaneng. Meroalo e nang le li-axon tse telele ka ho fetisisa e kenella tšebetsong. Phetoho mosebetsing oa "trophic" oa axon le axonal transport e lebisa ponahalong ea liphetoho tsa mokokotlo mokokotlong.Ho boleloa ha mesifa ea mesifa ho khothaletsa kholo ea terminal ebe ho mela ka kotloloho, kholo ea lits'oants'o tse ncha le ho nchafatsoa hoa mesifa ea mesifa, e lebisang phetohong ea sebopeho sa DE.

Ka demyelination, tlolo ea tumellano ea letsoai ea ts'usumetso ea methapo e etsahala, ka lebaka leo lebelo la phallo ea methapo ea kutlo le fokotseha. Tšenyo ea methapo ea methapo e lematsang e bonts'oa ka kotloloho ke nts'etsopele ea bofokoli ba mesifa, tahlehelo ea pele ea "tendon" ntle le nts'etsopele ea mesifa ea mesifa. Ho ba teng ha atrophy ho bontša karolo e 'ngoe ea axonal. Demelelination of nerves e ka bakoa ke mabifi a autoimmune ka ho thehoa ha li-antibodies likarolong tse fapaneng tsa protheine ea myelin, bofokoli ba liphatsa tsa lefutso, ho pepesehela exotoxins. Tšenyo ea axon ea mokokotlo e ka ba ka lebaka la ho pepesehela methapo ea chefo ea kantle kapa ea setho sa botona, mabaka a liphatsa tsa lefutso.

Classified of Polyneuropathies

Ho fihla joale, ha ho na karohano e amoheloang ka kakaretso ea polyneuropathies. Ho latela lets'oao la pathogenetic la polyneuropathy, li arotsoe ka axonal (haholo-holo senya mookotlong oa axial) le demyelinating (pathology of myelin). Ka mofuta oa setšoantšo sa kliniki, li-motor, sensory le autonomic polyneuropathies li khetholloa. Leha ho le joalo, ka sebopeho sa eona se hloekileng, mefuta ena e bonoa ka seoelo, hangata e senola lesela le kopaneng la mefuta e 'meli kapa e meraro ea methapo ea methapo (motor-sensory, sensory-vegetative others).

Ho ea ka etiological factor, polyneuropathies e arotsoe ka lefutso (, Russi-Levy syndrome, lefu la Degerin-Sott, lefu la Refsum, jj), autoimmune (Miller-Flasher syndrome, mofuta oa axonal oa GBS, paraproteinemic polyneuropathies, paraneoplastic neuropathies, jj) polyneuropathy, uremic polyneuropathy, hepatic polyneuropathy, jj.), alimentary, e nang le chefo le tšoaetso.

Setšoantšo sa tliliniki ea polyneuropathy

Setšoantšo sa tliliniki ea polyneuropathy, joalo ka molao, se kopanya matšoao a ho senya ho li-motor, sensory le autonomic fibers. Ho latela tekanyo ea ho kenella ha likhoele tsa mefuta e fapaneng maemong a methapo, matšoao a motor, sensory kapa autonomic a ka ba teng pele. Tšenyo ea methapo ea motlakase e lebisa nts'etsopele ea li-flaccid paresis; bakeng sa li-polyneuropathies tse ngata, makhopho a likarolo tse holimo le tse tlase tse arolelanoang ka bofokoli ba mesifa ke a tloaelehileng, ka lesapo la nako e telele la axon, masapo a atrophies a nts'etsapele. Li-polyneuropathies tsa Axonal le tse amanang le lefutso li tšoauoa ka ho ajoa ha mesifa ea mesifa (hangata lipheletsong tse tlase), ho boleloang haholo ka mesifa e otlolohileng ho feta mesifa e boreleli. Ka bofokoli bo matla ba sehlopha sa mesifa ea sethoathoa, ho hlaha bohato ba methapo (eo ho thoeng ke "cock's gait").

Li-polyneuropathies tse fumanehang li ka fokola joaloka bofokoli ba mesifa. Maemong a tebileng, ho ka bonoa liso tsa CN le mesifa ea ho phefumoloha, e atisang ho hlokomeloa ka lefu la Guillain-Barré (GBS). Li-polyneuropathies li tšoauoa ka tatellano ea mesifa ea bofokoli ba mesifa le atrophy. Matšoao a asymmetric ke tšobotsi ea li-mononeuropathies tse ngata: multifocal motor neuropathy, multifocal sensorimotor neuropathy Sumner-Lewis. Tendon le li-periosteal reflexes tse nang le polyneuropathy hangata li fokotseha kapa li oele, pele ho tsohle, li-Achilles tendon reflexes lia fokotseha, ka nts'etsopele e tsoelang pele ea ts'ebetso - mokokotlo le carporadial, tendon reflexes e tsoang bicep le tricep ea mesifa ea mahetla e ka lula e sa sebetse nako e telele.

Ho ferekana ha maikutlo ho polyneuropathy le hona ho atisang ho tšoana hantle le ho qala libakeng tsa libaka tsa naha (joalo ka "liatlana" le "li-socks") ebe li hasana haholo.Bothateng ba polyneuropathy, matšoao a sensory a nepahetseng (paresthesia, dysesthesia, hyperesthesia) hangata a fumanoa, empa ka nts'etsopele ea ts'ebetso, matšoao a ho teneha a nkeloa sebaka ke matšoao a prolfall (hypesthesia). Ho senyeha ha likhoele tse teteaneng tsa myelinated ho lebisa ho senyeha ha mesifa e tebileng le kutloelo-bohloko ea ho sisinyeha, tšenyo ea mesifa e mesesane e lebisang tlolong ea bohloko le maikutlo a mocheso letlalong.

Tlolo ea mesebetsi ea autonomic e phatlalatsoa haholo ka li-axonal polyneuropathies, hobane likhoele tsa autonomic ha li-myelinated. Matšoao a prolfall a atisa ho bonoa hangata: tšenyo ea methapo ea kutloelo-bohloko e etsang methapo ea kutlo e bonahatsoa ke letlalo le omileng, taolo e senyehileng ea molumo oa methapo, tšenyo ea methapo ea methapo ea methapo e lebisa ho disautonomia (tachycardia, orthostatic hypotension, ho fokotseha ha litšebeletso tsa lehae.

Amyloid transthyretin polyneuropathy

... ka lebaka la ho hloka tsebo ea lingaka, nako ea ho tloha matšoao ho fihlela tlhahlobo e ka feta lilemo tse 3.

Poleloana "amyloidosis" e kopanya mafu a khethiloeng ke ho kenyelletsa protheine ea mofuta o mong oa amyloid fibrillar (fibrillar amyloid - likarolo tse khethehileng tsa protheine ea bophara ba 5-10 nm le bolelele ba li-800 nm, tse nang le lifilimi tse peli kapa ho feta tse nang le likarolo tse ngata tsa sebopeho se kopaneng). . Sebopeho sa sebopeho le lik'hemik'hale tsa amyloid li hlahisoa ke proteni ea pele ea mantlha, litaba tsa eona ka har'a fiber li fihla ho 80% mme ke sesupo se ikhethileng bakeng sa mofuta o mong le o mong oa amyloidosis (liprotheine tse fetang 30 tse ikhethang tse khona ho etsa li-fiber tsa amyloid li tsejoa).

Pele ke bala lingoliloeng tse boletsoeng ka tlase, ke khothaletsa hore ke bale tse latelang: Amyloidosis (ho laesus-de-liro.livejournal.com) bala

Transthyretin amyloidosis (ATTR) ke lefu le rarahaneng le khetholloang ka ho pepesoa ha extracellular amyloid, ntho e tlang pele ho eona e leng transthyretin (TTR), proteni e kenyang letsoho tsamaisong ea thyroxine le retinol, hape e bapala karolo ea bohlokoa phetong ea methapo. Ho fihla ho 95% ea TTR e hlophisitsoe ka har'a sebete, 5% e setseng e hlophisitsoe ke methapo ea methapo ea methapo ea kelello le pigment epithelium ea retina (ka plasma, TTR e potoloha ka pokello ea 20-40 mg / dl L. Obici et al., 2005).

ATTR e kenyelletsa amyloidosis e sa tloaelehang ea tlhaho (mofuta oa mofuta oa hlaha - ATTRwt), e hlahang ka lebaka la liphetoho tse amanang le lilemo kahare ho sebopeho sa TTR se tloaelehileng (litho tsa sepheo sa senile amyloidosis ke pelo, methapo ea kelello le aorta), hammoho le lefu la ATTRm amyloidosis (bona. ho ea pele), e hlahisoang ke phetoho ea mofuta oa TTR (mofuta oa encoding ea TTR), e kenyelletsang litlhahlobo tse 4 mme e fumaneha ka letsohong le lelelele la chromosome 18. Ho fihla joale, ho fetotsoe liphetoho tse fetang 120 tsa mofuta oa TTR. Phetoho ea mofuta oa TTR e atileng haholo e lebisang ho nts'etsopele ea ATTR ke phetisetso ea methionine e nang le vineine maemong a 30 (ATTR Val30Met). E 'ngoe ea liphetoho tse sa tloaelehang tsa mofuta oa TTR ke ho khutlisetsoa hoa cysteine ka tyrosine maemong a 114 (Tyr114Cys).

Transthyretin ke homotetramer, subunit e 'ngoe le e' ngoe e nang le masala a 127 amino acid mme e na le sebopeho sa beta. Ka lebaka la liphetoho tse bang teng mohloling oa TTR, liphetoho lipakeng tsa protheine li ba teng, li lebisa ho tsitsipano ea "tetemodynamic" ea tetemer le ho bola ho ba li-monomers. Li-monomers tsa protheine le tsona li fetoloa hore e be li-oligomers tsa pathological tse hlahisang amyloid, e nang le litlamorao tse senyehang ka kotloloho metsong ea lithane ka khatello, hape e lebisa ho phatloheng ha methapo, 'me ka lebaka leo, ho ischemia. Ka lehlakoreng le leng, liphuputso li bonts'a hore ha se li-fibrils tsa amyloid, e leng li-oligomers tse tlase tsa boima ba limolek'hule tse tataisang lits'ebetso tsa calcium tse itšetlehileng ka matla, tse lebisang lefung la sele.

Hereditary ATTR e ka hlaha ka mefuta e meraro ea kliniki: 2.1 transthyretin Lelapa amyloid polyneuropathy (mona - TTR-SAP), 2.2 transthyretin Leloko la Amyloid cardiopathy le 2.3 transthyretin Leloko leptomeningeal amyloidosis.Ka kopo hlokomela: TTP-SAP ke mofuta o atileng haholo oa lefutso o futsitsoeng ka mofuta oa lefa le busang ka ho fetesisa oa lefa.

TTP-SAP ke lefu le tsoelang pele, le holofatsang, le bolaeang le ferekanyang le thehiloeng ho amyloid deposition (ATTR) ho epineuria, perineuria, endoneuria le methapo ea mali, e lebisang ho tsitsipaneng ea axonal ea methapo ea pelo le ea bohlaba. Haeba e sa phekoloe, TTP-SAP e tla bolaoa kamora lilemo tse 7 ho isa ho tse 12 ho tloha qalong ea lefu lena. Ho ata ha TTR-SAP Europe le United States ke batho ba ka bang sekete ho ba lekholo. Palo e kholo ea bakuli e fumanoe linaheng tse qetellang joalo ka Japane, Portugal, Brazil le Sweden, tse fapaneng ho tloha ho 0.9 - 204 ho batho ba milione e le 'ngoe, ho fihla ho 3,8 - 1631 ka milione e le' ngoe ho ba ikemetseng ka bomong.

TTP-SAP e tšoauoa ka heterogeneity ea bongaka (ka lebaka la palo e kholo ea liphetoho tse ka bang teng ka mofuta oa TTR). Joalokaha ho bontšitsoe kaholimo, phetoho ea Val30Met hangata e amahanngoa le TTP-SAP, 'me lipontšo tsa eona tsa bongaka ke tsona tse ithutoang haholo. Lefu lena le ka ba pakeng tsa lilemo tse 20 le 70. Motheo oa setšoantšo sa kliniki ke sensorimotor e tsoetseng pele le "cyonomicurneathy" e tsoetseng pele ho tloha maotong ho isa methapong ea proximal, ho tloha maotong, butle-butle e fetela ho maoto le matsoho a tlase.

Taba ea pele, likhoele tsa methapo ea methapo e fokolang tse fokolisang matla lia ameha, tse tsamaisang bohloko ba maikutlo le mocheso, tse etsang hore bakuli ba fokotse maoto, methapo ea kutlo ea neuropathic methating ea pele ea TTP-SAP - bohloko ba ho chesa ka tšohanyetso le bohloko bo itšetlehileng ka tšusumetso bo hlahella ka mokhoa o batang oa allodynia ka lebaka la tšenyo le maikutlo ha likhoele tsa ka tse fokolang tse matla li shoa, bohloko bo tukang bo fetoha bo sa hlalosoe, hamorao mehopolo e tukang e nkeloa sebaka ke bohloko ba paroxysms. le ka sebopeho sa "feta motlakase oa hajoale" le "allodynia" ea methapo e matla e bakoang ke maikutlo a bohareng).

Hamorao, likhoele tsa methapo e meholo ea mokokotlo e se e le bothata, ho senyeha ha koloi, ho hlaha li-presis, 'me ho tsitsipana maikutlo ho tebileng hoa ferekana ebe ho hlaha ataxia e matla. Ka nako e ts'oanang, likhoele tsa tsamaiso ea methapo ea kutlo (ea limela) li ameha - bakuli ba nts'etsopele ho fokola hoa mmele - tsoelo-pele ea boima ba 'mele, hypotension ea methapo, ho senyeha ha kelello (lesapo la mokokotlo), ho hloka matla, mathata a gastro-intestinal - lets'ollo, le lateloang ke ho ruruha.

Polyneuropathy e ntse e tsoela pele ho fetoha sebopeho se ntseng se tsoela pele, ho bakuli ba tsamaeang ba sa tsebe hantle 'me hanyane ka hanyane ha ba khonehe, setulo sa likooa sea hlokahala bakeng sa ho sisinyeha, bakuli ba itšetleha ka thuso ea kantle. Mehato e 4 (0 - 3) ea TTR-SAP e khethollotsoe, ho latela poloko ea matla a ts'ebetso a mokuli:

Ka TTR-SAP, nts'etsopele ea methapo e mengata ea methapo ea kutlo (ho kenyelletsa sebopeho sa methapo ea methapo ea methapo ea methapo) e ka khonahala ka lebaka la phello ea li-amyloid ka har'a lisebelisoa tsa ligamentous ka khatello ea morao ea methapo ea kutlo.

Lipontšo tsa neuropathy li atoloha nakong eohle ea lefu lena. Leha ho le joalo, TTR-SAP e boetse e nts'etsapele ho senyeha ha pelo (thibelo ea pelo le ts'ubuhlellano ea methapo), liphio (proteinuria e lateloang ke nts'etsopele ea ho se sebetse ha methapo), mahlo (sekhahla sa glaucoma, vitreous opacation ho Sweden; linyeoe tsa lefu la vitreous qalong ea lefu le hlalositsoe) (sethoathoa sa sethoathoa, stroke, ischemic kapa hemorrhagic stroke, ho senyeha hoa kelello. Lefu le hlaha ka lebaka la mathata a pelo (ho nyekeloa ke pelo, ho tsitsipana hoa moea o bolaeang), cachexia, ho se sebetse hantle, le ts'oaetso ea bobeli.

Liphetoho "eseng Val30Met" tse ithutoang hanyane mabapi le ketsahalo e sa tloaelehang, li fapana setšoantšong sa kliniki. Hangata ho qaleha ha lefu lena ho bonoa (kamora lilemo tse 50), matsoele - carpal (carpal) methapo ea methapo e kanna ea ameha qalong (matšoao a bilopal carpal tunnel syndrome e hlaha: hlokomela: lets'oao la pele la kliniki la TTP-SAP ho bakuli ba joalo e kanna ea ba lefu la "carpal tun tun syndrome" feela li-polyonomuropathy tsa autonomic, tšenyo e ka sehloohong pelong kapa mahlo.

Ho tseba ka TTR-SAP e ntse e le mosebetsi o boima, haholo libakeng tse sa pheleng, moo maemong a mangata ho se nang nalane ea lefu la lefu lena ho latela matšoao a teng (neurological, cardiology, ophthalmology), bakuli ba retelehela ho lingaka tse fapaneng. Ka lebaka la ho hloka tsebo ea lingaka, nako ea ho tloha matšoao ho fihlela tlhahlobo e ka feta lilemo tse tharo. Boemo bo khahlisang ho feta mabapi le tlhahlobo le kalafo e tlang ka nako ke tšobotsi ea linaha tse kotsing ea ho phela.

Ela hloko! TTR-SAP e lokela ho belaelloa haeba mokuli a e-na le sensorimotor axonal polyneuropathy e tsoetseng pele hammoho le mathata a ho ikhula (ho theoha hoa boima ba 'mele, khatello ea methapo ea kutlo le lefu la ka mpeng, le ho hloka mabaka a mang a hlalosang polyneuropathy.

Mekhoa ea seletsa e sebelisetsoang ho lekanya tšenyo ea methapo ea kutlo e kenyelletsang electroneuromyography (ENMG), tlhahlobo ea methapo ea kutlo, le lipatlisiso tsa bokhoni ba kutloelo-bohloko ba kutlo. Kantle ho naha, ts'ebetso ea methapo ea MR e etsoa, hammoho le sudoscan, e leng mokhoa o potlakileng hape o sa hlaselleng oa ho lekola boemo ba methapo ea methapo e mesesane, e o lumellang ho lekanya boits'oaro ba motlakase ba letlalo, bo fokotsehang ha ts'ebetso ea ts'ebetso ea boteng ba mofufutso e tšoenyeha.

Litho tse ling tse nang le bothata ba ATTR le tsona li hlahlojoa: pelo (ECG, Hlahlo ea Holter ECG, Echocardiography), mahlo (tlhahlobo ea mahlo), liphio (urinalysis, ultrasound). Haeba sensorimotor le e tsoetseng pele ea tlhaho ea polyneuropathy e fumanoe, kamano ea eona le ATTR e lokela ho tiisoa. Li-amana tsa Amyloid li ka fumaneha mefuteng ea biopsy ea mothapo oa namane, litšoelesa tsa salivary, tiske ea adipose ea ka mpeng, le mucosa ea rectal. Meetso ea biopsy e etsa hore Congo e khubelu ho bona li-amana tsa amyloid tse hlahisang khanya e botala bo botala bo khanyang polarized. Ho hlokahala thuto ea immunohistochemical ho theha protheine ea amyloid precursor. Ka kopo hlokomela: ho ba sieo ha bongata ba amyloid ho li-biopsies tsa tiske ha ho khetholle tlhahlobo ea TTP-SAP, ntlheng ena, tlhahlobo ea morphological e lokela ho etsoa ke setsebi sa thuto ea mafu a kelello, ho bohlokoa hore u ithute sampole ea 2 - 3 e fapaneng ea lithane, mme ho boetse ho hlokahala thuto ea lefutso. Malapa a nang le phetoho ea TTR e khethiloeng pele a tiisa ho ba teng hoa phetoho e itseng; maemong a sporadic, ho khothaletsoa ho latela mofuta oa TTR ea mofuta oohle ho bakuli bohle ba nang le "axonalathy" e tsoetseng pele ea methapo e kenyeletsang likhoele tse tšesaane).

bala hape ka poso: Fine fiber neuropathy e ntle (ho laesus-de-liro.livejournal.com) bala

Phekolo ea TTP-SAP e sebetsa mohato oa 1 oa lefu lena, ha ho khonahala ho fokotsa tsoelo-pele ea polyneuropathy le ho eketsa pholo ea mokuli .. Ka 1990, kalafo e le 'ngoe bakeng sa TTP-SAP e ne e le phetisetso ea sebete sa orthotopic, e kenya letsoho ho pholoheng ha lilemo tse 20 ho bakuli ba ≈1 / 2 .. Ts'ebetso e sebetsa hantle haholo ka nalane e khuts'oane ea bokuli, lilemo tsa mokuli, boteng ba phetoho ea boleng ba Val30Met le ho se sebetse hantle ha pelo.Ka ho felisa mohloli o ka sehloohong oa phetoho ea methapo ea methapo transthyretin bokong, ho fetisoa ha sebete, ha ho thibele ho hlaha ha amyloid ka har'a mesifa ea pelo, mmele o matla le tsamaiso ea methapo. Haeba mokuli a e-na le bothata bo tebileng ba pelo kapa ba ho hloleha ha liphi, ka linako tse ling o tsamaisoa ka tsona - sebete le pelo, pelo le liphio.

Lilemong tsa morao tjena, menyetla ea kalafo ea pathogenetic ea methapo ea methapo ea pele ea TTP-SAP e hlahile. Tafamidis (tokisetso ea Vindakel), e khothalletsoang hore e sebelisoe Europe le Russia mohatong oa pele oa TTP-SAP, e thusa ho tsitsisa molek'hule ea transthyretin, ho thibela ho phatloha ha eona ho ba monya-amyloidogenic monomers. Dithlunisal ea lithethefatsi tse seng khahlanong le 'mele ea lithethefatsi e na le litlamorao e na le litlamorao tse ts'oanang, empa ts'ebeliso ea eona e lekanyelitsoe ke litlamorao tse mpe tse tsoang mpeng ea gastrointestinal. Ntle le kalafo ea pathogenetic, kalafo ea matšoao e sebelisoa - mekhoa ea ho emisa lefu la bohloko ba neuropathic, lithethefatsi tsa antidiarrheal, kalafo ea hypotension ea orthostatic, ho nyekeloa ke pelo, ho kenngoa ha pacemaker ha ho ka etsahala hore ho be le tsitsinyeho ea morethetho oa mmele, vitibleomy haeba ho ka etsahala hore ho senyehe 'mele oa vitreous. Haeba kalafo e bolokang litšila e sa sebetse 'me lefu le tsoela pele le ho feta, ho fetisoa ha sebete ho etsoa,' me haeba ho hlokahala, ho fetisoa hoa pelo.

Bala haholoanyane ka TTR-SAP le ATTR mehlolong e latelang.:

sengoloa se reng "Nyeoe ea transthyretin ea lelapa la amyloid polyneuropathy: patlo ea tlhahlobo ea mafu" Smirnov AP, Serdyuk AV, Kovrazhkina EA, FSBEI HE "RNIMU im. N.I. Pirogova ”(Consilium Medicum Magazine No. 9, 2018) bala,

sengoloa "Transthyretin amyloid polyneuropathy: pathogeneisis, likarolo tsa kliniki, litebello tsa kalafo" O.E. Zinoviev, E.I. Safiulina, Federal State Autonomous Educational Institution ea thuto e Phahameng "Univesithi ea Bongaka ea Pele ea Naha ea Moscow e rehiloe ka I.M. Lekala la Bophelo la Sechenov la Russia Federation ("Laola bohloko" makasine No. 4, 2017) le baliloe,

Tlhahlobo ea tlhaiso-leseling ka lefu lena le lefu la "Transthyretin Familia amyloid polyneuropathy (TTR-SAP)" Pfizer Innovation LLC, Moscow (www.pfizerprofi.ru), 12/08/2016 bala,

Sengoloa se reng "Lelapa la amyloid polyneuropathy TTR Cys 114 ho bana ba mafahla ba ma-monozygotic (teko ea bongaka)" M.O. Kovalchuk, I.A. Strokov, Setsi sa Bongaka sa Univesithi ea Utrecht, Netherlands, Utrecht, Federal State Autonomous Educational Institution of Higher Education First Moscow State Medical University I.M. Sechenova Ministry of Health of the Russian Federation, Moscow (koranta ea "Mafu a Neuromuscular" No 1, 2017) bala,

Sengoloa se reng "Transthyretin amyloidosis: boemo ba hona joale ba bothata" I.A. Dyudina, Setsi sa Naha sa "NSC" Setsi sa Cardiology se rehelletsoeng ka Acad. N.D. Strazhesko "NAMS of Ukraine", Kiev (koranta ea "Bofokoli ba pelo le Comorbidity", No. 1, 2017) e bale,

sengoloa se reng "Ketsahalo ea bongaka ea transthyretin amyloidosis e liehang ho netefatsa ts'oaetso ho mokuli ea hlahlojoang ka botlalo" E.S. Naumova, S.S. Nikitin, T.A. Adyan, 3, D.S. Druzhinin, V.A. Warsaw, Setsi sa Bongaka "Neurology e Sebetsang", Moscow, Federal State Budget Science Science Institution "Medical Genetic Research Center", Moscow, Federal State Budgetary Educational Institorial of Higher Education "Russian National Research Medical University e reheletsoeng ka mor'a N.I. Pirogov ", Letona la Bophelo la Russian Federation, Moscow, FSBEI HE" Yaroslavl State Medical University "Ministry of Health of Russian Federation, Yaroslavl, FSAEI HE First State State Medical University I.M. Sechenova Ministry of Health of the Russian Federation, Moscow (koranta ea "Mafu a Neuromuscular" No 1, 2018) bala,

sengoloa sa "Amyloid neuropathy ho mokuli ea nang le amyloidosis ea setho sa transthyretin" Zinovieva OE, Umari DA, Solokha OA, Yakhno NN, GBOU VPO "MGMU oa pele o rehiloe ka mor'a I.M. Sechenov ", Kliniki ea Mafu a Nervous mafu a bitsoang ka mor'a A.Ya. Kozhevnikova, Lefapha la Patlisiso la Neurology, Setsi sa Patlisiso, Moscow (Koranta ea Neurological, No 5, 2016) le baliloe,

Sengoloa "Ho senya ts'ebetso ea methapo ea kutlo ho" system "amyloidosis" Safiulina E.I., Zinovieva O.E., Rameev V.V., Kozlovskaya-Lysenko L.V., FGAOU VO "Univesithi ea Pele ea Bongaka ea Moscow e rehiloe ka mor'a I.M. Sechenova ”Lekala la Bophelo la Russian Federation, Moscow (koranta ea" Neurology, Neuropsychiatry, Psychosomatics "No. 3, 2018) e baliloe

Tlhahlobo ea polyneuropathies

Haeba sensorimotor polyneuropathy e tsoelang pele butle-butle, e neng e tsejoa ho tsoa sehlopheng sa mesifa ea peroneal, e bohlokoa ho hlakisa nalane ea lefutso, haholo-holo ho ba teng ha mokhathala le bofokoli ba mesifa ea leoto, liphetoho tsa gait, le deformation ea maoto (ho phahama ho phahameng). Ka nts'etsopele ea bofokoli ba symmetric ba li-extensors tsa letsoho, ho hlokahala hore ho behelle kantle ho tahi ea lead. Ha e le molao, li-polyneuropathies tse nang le chefo li tšoauoa, ho tlatselletsa matšoao a methapo, ka bofokoli bo akaretsang, mokhathala o eketsehileng, le litletlebo tsa ka mpeng. Ntle le moo, ho a hlokahala ho fumana hore na mokuli o nkile lithethefatsi life kapa o li nka e le hore a khetholle lithethefatsi polyneuropathy.

Hanyane hanyane nts'etsopele ea bofokoli ba mesifa ea asymmetric ke letšoao la kliniki la multifocal motor polyneuropathy. Diabetesic polyneuropathy e tšoauoa ka hypesthesia e liehang ho tsamaea butle butle, e kopantsoe le maikutlo a tukang le liponahatso tse ling maotong. Uremic polyneuropathy e etsahala, e le molao, khahlano le semelo sa lefu le sa foleng la liphio (CRF). Ka nts'etsopele ea polyneuropathy ea sensory-vegetative, e tšoauoa ka ho chesa, dysesthesia, har'a ho fokotseha ho hoholo ha boima ba 'mele, ho hlokahala hore ho behelle ka thoko amyloid polyneuropathy.

Bakeng sa lefutso la polyneuropathies, kholo ea bofokoli ba mesifa ea maoto a maoto, bohato ba pele, ho ba sieo ha Achilles tendon reflexes, letheba le phahameng la leoto ke tšobotsi. Boemong ba morao ba lefu lena, ha ho na marapo le mokokotlo oa "carporadial tendon". Lesapo la mokokotlo le tsamaisanang le ho ruruha ha methapo e le 'ngoe, ntle le tšitiso ea maikutlo, ke tšobotsi ea polyneuropathy e ngata. Maemong a mangata, tšenyo e holim'a libaka tse holimo e fihla pele.

Sensory polyneuropathies e tšoauoa ka ho ajoa ha distal hypesthesia. Mehatong ea pele ea lefu lena, hypnothesia e ka etsahala. Sensomotor axonal neuropathies e tšoauoa ka hypesthesia ea distal le bofokoli ba mesifa ea distal. Ho li-polyneuropathies tsa autonomic, ho pepeseha le ho ts'oaroa ha likhoele tsa methapo ea kutlo li ka khoneha. Bakeng sa polyneuropathy e boreleli, hyperhidrosis, molumo o sa sisinyeheng oa matsoho oa matsoho ke mokhoa o tloaelehileng, bakeng sa lefu la tsoekere la polyneuropathy, ka lehlakoreng le leng, letlalo le omeletseng, likhathatso tsa trophic, ho se sebetse hantle ha litho tsa ka hare.

Ho khothalletsoa thuto ea li-antibodies ho GM1 ganglycosides ho bakuli ba nang le motor neuropathies. Li-titers tse phahameng (tse kholo ho feta 1: 6400) li khethehile bakeng sa motor multifocal neuropathy. Li-titers tse tlase (1: 400-1: 800) lia khoneha ka demyelinating polyradiculoneuropathy (HVDP) e sa foleng, tsoekere ea Guillain-Barré le li-neuropathies tse ling tsa autoimmune. Re lokela ho hopola hore karolo e eketsehileng ea li-antibodies ho GM1-gangglycosides e fumanoa ho 5% ea batho ba phetseng hantle (haholo-holo maqheku). Li-antibodies ho gelcoprotein e amanang le myelin li fumanoa ho 50% ea bakuli ba fumanoang ba e-na le paraproteinemic polyneuropathy mme, maemong a mang, li-neuropathies tse ling tsa autoimmune.

Haeba polyneuropathies e belaelloa e amahanngoa le ho taoa le ho taoa le lead, aluminium, le zebury, liteko tsa mali le tsa mkojo bakeng sa lira tse boima li etsoa. Hoa khoneha ho etsa tlhahlobo ea liphatsa tsa lefutso ho mefuta eohle e meholo ea IMSS I, IVA, mefuta ea IVB. Ho etsa sindano ea li-electromyography ka li-polyneuropathies ho u fa monyetla oa ho supa matšoao a ts'ebetso ea hona joale ea taolo ea phetoho. Pele ho tsohle, ho hlokahala hore ho hlahlojoe mesifa ea distal ea holimo le tlase, 'me, haeba ho hlokahala, mesifa ea proximal. "Nerve biopsy" e na le lebaka le loketseng haeba feela ho na le lipelaelo tsa amyloid polyneuropathy (ho fumanoa ha li-amyloid deposits).

Phekolo ea polyneuropathies

Ka lefu la polyneuropathies ea lefutso, kalafo e na le matšoao.Ho autoimmune polyneuropathies, sepheo sa kalafo ke ho fihlela phallo. Ho diabetes, alcoholic, uremic le li-polyneuropathies tse tsoelang pele tsa kalafo, kalafo e fokotseha ho theoha ho teba ha matšoao le ho fokotseha ha nako ea tšebetso. E 'ngoe ea likarolo tsa bohlokoa tsa kalafo e seng ea lithethefatsi ke boikoetliso ba' mele bo etselitsoeng ho boloka molumo oa mesifa le ho thibela pelehi. Tabeng ea nts'etsopele ea maloetse a amanang le ho hema ka diphtheria polyneuropathy, ho ka hlokahala phetoho ea mochini bakeng sa moea. Phekolo e sebetsang ea lithethefatsi ea li-polyneuropathies tsa lefa ha e eo. Litokisetso tsa vithamine le li-agents tsa neurotrophic li sebelisoa e le pheko ea tlhokomelo. Leha ho le joalo, ts'ebetso ea bona ha e so ka e netefatsoa ka botlalo.

Bakeng sa kalafo ea porphyria polyneuropathy, tsoekere e laetsoe, e atisang ho baka ntlafatso maemong a mokuli, hammoho le li-painkillers le lithethefatsi tse ling tsa matšoao. Phekolo ea lithethefatsi ea polyneuropathy e sa foleng e kenyelletsa ts'ebetso, tšebeliso ea immunoglobulin ea motho kapa prednisolone. Maemong a mang, katleho ea immunoglobulin le eona ha e na ho lekana, ka hona, haeba ho se na li-contraindication, kalafo e lokela ho qala hang-hang ka glucocorticosteroids. Ntlafatso e etsahala, hangata kamora matsatsi a 25-30, kamora likhoeli tse peli, o ka qala ho fokotsa tekanyo ea tekanyo ea tekanyetso ea tekanyetso. Ka ho fokotseha ha tekanyo ea li-glucocorticosteroids, taolo ea EMG ea hlokahala. E le molao, prednisolone e ka hlakoloa ka botlalo likhoeling tse 12 - 12, haeba ho hlokahala, o ka "insure" ka azathioprine (ekaba cyclosporine kapa mycophenolate mofetil).

Phekolo ea lefu la tsoekere la polyneuropathy e etsoa hammoho le endocrinologist, sepheo sa eona se seholo ke ho boloka maemo a tsoekere a mali a tloaelehileng. Bakeng sa ho phomola bohloko, ho sebelisoa li-antidepressants tsa li-trikingclic, hammoho le pregabalin, gabapentin, lamotrigine, carbamazepine. Maemong a mangata, ho sebelisoa litokisetso tsa acid ea thioctic le livithamine tsa B. Litsebi tsa nalane ea manonyeletso li fumana ho khutlisetsoa matšoao qalong ea uremic polyneuropathy ha ho lokisoa boemo ba chefo ea mali ka maling (programmemodialysis, transplantation ea menoana). Bakeng sa meriana, ho sebelisoa livithamini tsa B, ka bohloko bo boholo - li-antidepressants tsa tricyclic, pregabalin.

Mokhoa o ka sehloohong oa ho phekola kalafo ea chefo ea polyneuropathy ke ho emisa ho kopana le ntho e nang le chefo. Ka li-polyneuropathies tse itšetlehang ka litekanyetso, hoa hlokahala ho lokisa tekanyo ea lithethefatsi tse tsamaellanang. Ka ts'oaetso e netefalitsoeng ea diphtheria, tsamaiso ea serum ea antitoxic e fokotsa monyetla oa ho nts'etsapele diphtheria polyneuropathy. Maemong a sa tloaelehang, kalafo ea opereishene e ka hlokahala ka lebaka la nts'etsopele ea contractures le holima maoto. Leha ho le joalo, ho lokela ho hopoloa hore ho se sebetse hantle ha nako e telele ka mor'a ho buuoa ho ka ama ts'ebetso ea koloi hampe.

Prognosis ea polyneuropathy

Ka ts'oaetso e sa foleng ea demyelinating polyradiculoneuropathy, tsoelo-pele ea bophelo e ntle haholo. Ho shoa ha batho ho tlase haholo, leha ho le joalo, ho fola ka botlalo ha ho na seoelo. Ho fihlela ho 90% ea bakuli ba nang le phekolo ea immunosuppression ba fumana tšoarelo e felletseng kapa e sa felletseng. Ka nako e ts'oanang, lefu lena le tloaetse ho ata, ts'ebeliso ea kalafo ea immunosuppression e kanna ea ba le litlamorao tsa eona, e lebisang ho mathata a mangata.

Ka lefu la polyneuropathies ea lefutso, ho ka se khonehe ho atleha, ha lefu le ntse le tsoela pele butle. Le ha ho le joalo, bakuli, e le molao, ba ikamahanya le maemo a bona mme, maemong a mangata, ho fihlela mekhahlelo ea morao haholo ea lefu e boloka matla a ho itlhokomela.Ka lefu la tsoekere la lefu la tsoekere, phepo ea bophelo e ntle, e fanoa kalafo e nakong le taolo e hlokolosi ea glycemia. Ke maemong a morao a lefu lena moo lefu la ho utloa bohloko le boletsoeng le ka holisang boleng ba bophelo ba mokuli haholo.

Tsoelo-pele ea bophelo bo nang le uremic polyneuropathy e itšetlehile ka ho felletseng ho teba ha ho hloleha ha renal ho sa foleng. Lenaneo la haemodialysis ka nako e nepahetseng kapa phetiso ea liphio li ka lebisa ho tlalehong e felletseng kapa e batlang e felletse ea uremic polyneuropathy.

Sengoliloeng sena se fumaneha hape ka lipuo tse latelang: Thai

Setšoantšo sa kliniki ea lefu lena

Sebakeng ka seng, nako ea dysmetabolic polyneuropathy e kanna ea fapana. Haeba lefu le hlaha kapele mme le bonahatsoa ke ho fokotseha ho hoholo hoa maikutlo, joale ho lahleheloa ke mangole le mekokotlo ea Achilles ho ka bonoa.

Nyeoe ena e tlisoang ke polyneuropathy ha e utloise bohloko, empa e tsoela pele ho feta lilemo tse ngata ka tatellano.

Lefu la tsoekere le lefu la tsoekere le ka tšoauoa ka nts'etsopele ea subacute kapa esita le a hlobaetsang. Tabeng ena, ho senya likarolo tse itseng tsa methapo ea kutlo. Ha e le molao, ts'enyo ea methapo e etsahala:

Mathata ana a ka tsamaisana le li-paresis tsa lihlopha tse lumellanang tsa mesifa, bohloko le ho sithabela ha kutlo. Haeba methapo ea botšehali e amehile, joale tahlehelo ea mokokotlo e bonoa.

Ntle le moo, ho ile ha lemosoa tšenyo ea methapo ea kutlo ea mokokotlo (ho koeteloa, ho ruruha, oculomotor).

Ho na le mofuta oa boraro oa lefu la tsoekere la polyneuropathy. E tšoauoa ka tšenyo ea methapo e meng ea maoto le nts'etsopele ea khatello ea maikutlo le koloi (haholo likarolo tse tlase).

Tendon reflexes e ka nyamela ka ho felletseng, 'me ka palpation soreness ea methapo ea kutlo e utloahala.

Ka polyneuropathy, mathata a limela le a trophic ha a tloaelehe. Mathata a ho ntša metsi le ho tsoa kelellong ka mor'a ho hlaha.

U lokela ho tšoara joang?

Pele ho tsohle, ho hlokahala hore o fetole metabolism ea carbohydrate ka thuso ea liente tsa insulin le lijo tse khethehileng tse nang le phepo. Ngaka e ka khothaletsa:

basomi
Li-vithamine tsa B,
finlepsin,
ma-ganglion blockers (gangleron),
espa lipon (berlition).

Lenane la mehato le sebelisetsoang ho felisa neuropathy le tla bontšoa.

Polyneuropathy e nang le maloetse a systemic

Haeba mokuli a e-na le lupus erythematosus, e amang letlalo, liphio le manonyeletso, joale polyneuropathy e tšoauoa ka nts'etsopele ea ho holofala kapa paresis ea mesifa e haufi, tahlehelo ea lingoloa tsa "tendon". Ho fokotseha ho hoholo ha bohloko ba bohloko bo sa ntse bo ka etsahala.

Maemong a mang, matšoao a polyneuropathy e ka ba lipontšo tsa pele tsa nts'etsopele ea bokuli bo tlase. Phekolo e tseba mefuta e nang le tšenyo e kholo methating e fapaneng ea matsoho le maoto.

Tabeng ena, re tla bua ka mononeuropathy. Ka ramatiki e matla ea ramatiki, polyneuropathy e boetse e bonoa. Pele, e tla iponahatsa e le mathata a tebileng, mme ebe ho na le sensorimotor neuropathy e matla.

Haeba periarteritis nodosa e le teng, methapo ea kutlo ea methapo ea kutlo le mothapo oa mokokotlo e ea hlaha. Tlolo e tšoanang e tla amahanngoa le mathata a tebileng:

ea limela
koloi,
hlokolosi.

Sebopeho se nahanoang sa neuropathy hangata se tsamaisana le matšoao a angiopathy a ruruhileng litho tse ling le litsamaisong.

Hereditary polyneuropathy

Pele ho tsohle, ke polyneuropathy, e hlahang ka mathata a porphyria (a genetic enzyme). Matšoao a mantlha a lefu lena la lefutso ke:

bohloko bo ka mpeng ea mpa,
keketseho ea khatello ea mali
senya ts'ebetsong ea methapo ea kutlo,
tlhahiso ea moroto e nang le 'mala o lefifi oa tlhaho.

Porphyric polyneuropathy e tla bonahala ka lebaka la ho rarahana ha methapo ea methapo. Tabeng ena, bohloko, bofokoli ba mesifa, paresthesia (lipalo tse holimo le tse tlase) lia hlaha. Liponahatso tsa makoloi li ka eketseha butle butle, ho fihlela ho ba le litho tsa litho tsa ka hare kapa parresis.

Ka bokuli bona, mokuli o tla ikutloa:

mahlomola a likutu tsa methapo,
tahlehelo ea mefuta eohle ea kutloelo-bohloko.

Ho etsa tlhahlobo e lekaneng, ngaka e tla nahanela matšoao ohle a mathata a metabolism ea porphyrin. Ho felisa lefu lena, ngaka e khothaletsa ts'ebetso ea tsoekere e kenang le e tsoang ka molomo ka tekong ea ho fihlela ho 400 mg (kalafo e ts'oanang e bonts'oa mefuta e meng ea polyneuropathy).

Amyloid polyneuropathy

Mofuta oa amyloid oa polyneuropathy o hlaha ho bakuli ba nang le nalane ea lefu la amyloidosis. Matšoao a eona a mantlha a kliniki ke:

ho holofala (ho ruruha le lets'ollo),
tšilo ea lijo tse tsoang ka mpeng
ho nyekeloa ke pelo
macroglossia (keketseho ea boholo ba leleme).

Ka bokuli bona, ho ferekana hoa maikutlo ho tla pele, ho etsa mohlala, ho hlonepha hoa pheletso, ho lahleheloa ke bohloko le kutloelo ea mocheso. Mehatong ea morao, paresis le eona e tsamaisana le lefu lena.

Ha e le kalafo e lekaneng, ka nako eo ha e be teng.

Pharal sensory-motor polyneuropathy

Ka lefu la tsoekere, likhoele tse telele tsa methapo li atisa ho ameha. Diabetesic polyneuropathy e bonoa ho 40% ea batho ba nang le lefu la tsoekere. Mofuta ona oa ho kula o tšoauoa ka ho se utloe ha khatello ea maikutlo, liphetoho mocheso o teng, bohloko, ho thothomela le sebaka se amanang le lintho tse ling.

Sensory polyneuropathy e kotsi hobane lefu la tsoekere ha le utloe bohloko kapa mocheso o phahameng.

Li-ulc li hlaha lipheletsong tse tlase, maqeba holima feshene ea leoto. Tšenyo e tebileng ea kopaneng le li-fractures ha li lahloe.

Sensomotor polyneuropathy e ka bonahatsoa ke matšoao a sebetsang, ho etsa mohlala, bohloko bo matla bo lekaneng mehatong, bo bong bo bobe le ho feta bosiu.

Ha lefu lena le ntse le eketseha, ho tla bonoa tlolo ea ts'ebetso ea ts'ebetso ea masculoskeletal system. Ha sena se etsahala:

bone deformation
mesifa dystrophy
ho omella haholo ha letlalo,
ponahalo ea matheba a lilemo,
'mala o mofubelu oa letlalo
mofufutso oa mofufutso.

Matšoao a bohlokoahali a distal polyneuropathy ho lefu la tsoekere e tla ba liso tse hlahang pakeng tsa menoana le maoto. Matsoho ha a khone ho baka tsitsipano ka lebaka la ho se utloe bohloko. Maemong a tsoetseng pele, re tla bua ka ho kuta le maoto le matsoho.

Autonomic polyneuropathy ho lefu la tsoekere

Boteng ba marang-rang a tsamaiso ea methapo ea kutlo e ikemetseng khahlanong le semelo sa lefu la tsoekere, mokuli o tla ikutloa:

ho fifala mahlong
oa akheha ha o otlolohile,
ho tsekela.

Mofuta ona oa polyneuropathy o tla tsamaisana le ho se sebetse hantle ts'ebetsong e tloaelehileng ea tšilo ea lijo, e bonahatsoang ke ho fokotseha hoa lijo. Ka lebaka lena, ho ke ke ha khoneha ho tsitsisa khatello ea tsoekere maling maling a lefu la tsoekere.

Sesosa sa lefu le tšohanyetso e ka ba ho tlola molao oa pelo ho lefu la tsoekere la polyneuropathy.

Batho bao ba nang le lefu lena ba tla utloa mathata a tsoang ho lefu la genitourinary system - ho senyeha hoa moroto ho etsahala. Leqhubu le tla lahleheloa ke matla a ho tšolla letho ka botlalo, e ba ntho ea pele e hlokahalang ho nts'etsapele mafu a tšoaetsanoang. Ho se sebetse hantle ha erectile polyneuropathy ho tla bonoa ho banna, le dyspareunia ho basali (ho sitoa ho fihlela orgasm).

Mefuta ea polyneuropathies

Polyneuropathies e ka aroloa ka tšimoloho (etiology), netefalo le liponahatso tsa bongaka.

Polyneuropathies ka mofuta oa setšoantšo sa kliniki e ka ba ka tsela e latelang:

motor polyneuropathies (tšenyo e tloaelehileng ea mofuta oa motor fiber, nts'etsopele ea bofokoli ba mesifa, ho holofala lehare),
sensor polyneuropathies (tšenyo e bakoang ke likhoele tse mahlonoko, ho akheha, ho chesa le bohloko),
autonomic polyneuropathies (tlolo ea mesebetsi ea litho tsa ka hare, tšenyo ea methapo ea methapo e laolang tšebetso ea litho tsa ka hare),
polyneuropathies ea motor-sensoryTšenyo ea methapo ea motor le sensory ke tšobotsi).

Ho latela molao-motheo oa pathogenetic oa polyneuropathy o ka aroloa ka:

axonal (lesion ea mantlha ea axon - ts'ebetso e telele ea cylindrical ea sele ea methapo),
demyelinating (myelin pathology - methapo ea sefahleho ea methapo).

Ka tlhaho (etiology) e ka aroloa polyneuropathy ho:

autoimmune (Lefu la Miller-Fisher, paraproteinemic polyneuropathy, paraneoplastic polyneuropathies, acute inflammatory axonal polyneuropathy, Sumner-Lewis syndrome),
lefalefutso la lefutso la lefutso la mofuta oa II, lefu la Rus-Levy, lefu la lefutso la lefutso la lefutso la lefutso la lefutso la lefutso, mofuta oa lefutso la lefutso la mofuta oa II, neuropathy e nang le tšekamelo ea ho shoa litho ka lebaka la compression, porphyria polyneuropathy),
metabolic (lefu la tsoekere, polyneuropathy, lefu la polyneuropathy, lefu la polyneuropathy, lefu la polyneuropathy litabeng tsa endocrine, polyneuropathy ho amyloidosis ea mantlha.),
azentary (ka lebaka la khaello ea livithamini B1, B6, B12, E),
chefo (joala polyneuropathy, li-polyneuropathies tsa lithethefatsi, polyneuropathie maemong a nang le chefo e nang le tšepe e ngata, li-soltiv tsa manyolo le lintho tse ling tse chefo),
polyneuropathies ho mafu a systemic (systemic lupus erythematosus, scleroderma, rheumatoid arthritis, sarcoidosis, vasculitis, lefu la Sjogren's),
chefo e tšoaetsangdiphtheria, kamora mafu a sefuba, maselese, mumps, mononucleosis e tšoaetsanoang, thibelo ea kamoso, le boronse e bakoang ke tšoaetso, ka ts'oaetso ea HIV, ka lepera.).

Nako ea lefu la polyneuropathy e ka ba:

bohale (matšoao a hlaha kamora matsatsi kapa libeke tse 'maloa),
subacute (matšoao a eketseha ka mor'a libeke tse 'maloa, empa eseng ho feta likhoeli tse peli),
sa foleng (matšoao a lefu lena a kula ho feta likhoeli tse ngata kapa lilemo).

ICD-10 polyneuropathy

Ho ea ka karohano ea machaba ea maloetse a ntlafatso ea leshome (ICD-10) polyneuropathy e kentsoe ke cipher G60 - G64. Sehlopha sena se na le mabitso a polyneuropathies le liso tse ling tsa tsamaiso ea methapo ea kutlo. Mofuta oa lefu lena o boetse o hlalosoa ke setšoantšo se eketsehileng, mohlala, joala polyneuropathy - G62.1.

ICod-10 polyneuropathy coding

Mota le methapo ea kutloLefu la Charcot-Marie-Tooth, lefu la Degerin-Sott, lefu la methapo ea methapo ea methapo ea lefu la setho I, IV, hypertrophic neuropathy ho bana, lefu la Rus-Levy, atrophy ea mesifa ea mesifa)

Neuropathy e kopantsoeng le ataxia ea lefutso

Idiopathic neuropathy e tsoelang pele

Li-neuropathies tse ling tsa lefutso le idiopathic (Lefu la Morvan, lefu la Nelaton, methapo ea kutlo)

Lefu la setho sa lefutso le idiopathic le sa khetholloang

Guillain-Barré Syndrome (Miller-Fisher syndrome, polyneuritis e matla ea morao-rao e tšoaetsang / e tšoaetsang)

Li-polyneuropathies tse ling tse fokolisang

Polyneuropathy e sa hlalosoang

Polyneuropathy e bakoang ke lintho tse ling tse chefo

Li-polyneuropathies tse ling tse boletsoeng

Polyneuropathy ho mafu a tšoaetsanoang le a likokonyana a arotsoe kae kapa kae (polyneuropathy e nang le diphtheria, tšoaetso ea mononucleosis, lepera, syphilis, lefuba, mumps, lefu la Lyme)

Polyneuropathy ka neoplasms

Polyneuropathy ho mafu a mang a endocrine le mathata a metabolic

Polyneuropathy le khaello ea phepo e nepahetseng

Polyneuropathy e nang le marang-rang a ho ruruha ha lisele tse sebetsanang

Polyneuropathy le liso tse ling tsa masculoskeletal

Polyneuropathy ho mafu a mang a khethiloeng libakeng tse ling (uremic neuropathy)

Mathata a mang a tsamaiso ea methapo ea kutlo

Setšoantšo se akaretsang sa kliniki ea polyneuropathies

Joalokaha ho boletsoe pejana, polyneuropathies e ka bonahatsa motor (motor), sensory (hlokolosi) le matšoao a autonomic a ka hlahang ka tšenyo ea mofuta o lumellanang oa methapo ea methapo.

Tletlebo ea mantlha ea bakuli ba nang le polyneuropathy ke bohloko. Ka tlhaho ea eona e kanna ea fapana, empa e tloaelehileng haholo ke ho chesa kamehla kapa ho opeloa ha bohloko kapa ho phunya kapa ho opeloa ke bohloko. Sebopeho sa bohloko ho polyneuropathy se latela botebo ba ts'ebetso ea methapo, mofuta le caliber ea likhoele tse amehang. Hangata, bohloko bo nang le polyneuropathies bo qala ka ho fetisisa distal (hole) mafapha, e leng ho tloha holima maoto a maoto.

Ka polyneuropathies, o ka kopana le se bitsoang maoto a sa phomoleng a maoto. Lefu lena ke boemo bo khetholloang ke maikutlo a sa thabiseng libakeng tse tlase tse hlahang phomolong (hangata mantsiboea le bosiu) hape u qobelle mokuli hore a etse metsamao e ba tsamaisang, 'me hangata e lebisa khatellong ea boroko. Matšoao a kliniki a lefu la maoto a sa phomoleng e ka ba maikutlo a makatsang, a ho makala, a ho sisinya, a ho phatloha kapa a ho sithabetsa. Ka linako tse ling ho kanna ha ba le maikutlo a hoosebumps, bohloko bo botenya kapa bo sehang, bo atisang ho hlaha maotong kapa botebong ba maoto.

Lipontšo tsa koloi tsa polyneuropathy li kenyelletsa tse latelang:

bofokoli ba mesifa (hangata tetraparesis kapa paraparesis e tlase),
hypotension ea mesifa (tekanyo e fokotsang ea khatello ea mesifa kapa ho hanyetsa ho sisinyeha),
atrophy (ho fokotseha kapa ho lahleheloa ke matla) mesifa
thothomelo (ho thothomela),
neuromyotonia (boemo ba tsitsipano ea kamehla kapa mesifa ea mesifa),
maikutlo (li-contract tsa nakoana tse sa laoleheng tsa mesifa tse bonoang ka har'a letlalo),
mesifa ea mesifa.

Khafetsa, lipontšo tsa limela tse nang le ts'ebetso ea methapo ea methapo ea kutlo li hloloheloa ke ngaka e eang ebile ha e nkuoe e le pontšo ea polyneuropathy. Bakeng sa bakuli ba nang le ts'ebetso ea likhoele tsa limela, ho na le lipontšo tsa ho se sebetse hantle ha methapo ea pelo, mokokotlo oa mpa, ho se sebetse, ho ruruha ho sa sebetseng hantle, karabelo ea bana le ho fufuleloa.

Lipontšo tse ka sehloohong tsa kliniki ea neuronomic ea autonomic ke:

orthostatic hypotension (ho fokotseha ha khatello ea mali ka lebaka la phetoho ea boemo ba 'mele ho tloha ho o mong ho isa ho o omileng),
lefu la pelo,
tlolo ea fokotseho ea maemo a bophelo a letsatsi le letsatsi khatello ea mali,
postural tachycardia (ho eketseha ha sekhahla sa pelo ha o ema le ho fokotseha ha o khutlela boemong bo otlolohileng),
latent myocardial ischemia (Tšenyo ea mali ka lebaka la ho fokotseha kapa ho felloa ke phepelo ea mali mesifa ea pelo),
kotsi e eketsehileng ea lefu la tšohanyetso,
esophagus le dysfunction,
ho se sebetse ka mpeng (ho sokela kapa lets'ollo),
ho senyeha ha gallbladder (stagnation ea bile, cholecystitis, lefu la gallstone),
tlolo ea ho ntša urination (ho thatafalloa ho ntša senya, ho fokolisa molapo oa urine, ho fetola khafetsa ho ntša, ho boloka urine),
erectile dysfunction (ho se khonehe hoa ketsahalo kapa ho boloka mokete, ho khutlisa kemiso),
ho ruruha
tlolo ea molao ea bolulo ea bana.

Boholo ba li-polyneuropathie li tšoauoa ka karolo e atileng ea ho kenella lipakeng tsa distal le ho ata ha matšoao a holimo, e leng hore maoto a kentse letsoho pejana ho feta matsoho. Sena sohle se itšetlehile ka bolelele ba likhoele tse kentsoeng tšebetsong ea methapo ea methapo.

Ho li-polyneuropathies tse ling, ntle le methapo ea lesapo la mokokotlo, methapo e meng ea craneal e ka ameha, e ka bang le boleng ba ho hlahloba maemong ana.

Kalafo ea Syndra ea Guillain-Barré

Phekolo ea lefu la Guillain-Barré ke kalafo ea matšoao. Hape, ho lokela ho hlokomeloe hore leha ho e-na le matšoao a fokolang haholo, ho na le lebaka la ho sepetla ha mokuli ka tšohanyetso. Bakuli ba nang le lefu la Guillain-Barré ba ka kenngoa sepetlele setsing sa tlhokomelo e matla.

Bakeng sa kalafo ea matšoao le keketseho ea khatello ea mali, nifedipine e fuoa mokuli (10 - 20 mg tlasa leleme) Propranolol e sebelisoa ho fokotsa tachycardia (Tekanyetso ea pele ea 20 mg makhetlo a 3 ka letsatsi, 'me butle-butle tekanyetso e nyolohela ho 80 - 120 mg bakeng sa litekanyetso tse 2 ho isa ho tse 3 tlasa khatello ea mali, sekhahla sa pelo le ECG) Ka bradycardia, mokuli ea nang le Guillain-Barré Syndrome o laetsoa atropine ka methapo (0.5 - 1 mg tlasa taolo ea ECG le khatello ea mali, mme ha ho hlokahala, kenyelletso e phetoa kamora metsotso e 3 - 5) Bakeng sa ho fokotsa bohloko, li-analgesics, lithethefatsi tse seng khahlanong le ts'oaetso tsa steroidal tse kang ketorolac (ka molomo hanngoe ka tekanyetso ea 10 mg kapa ka makhetlo, ho latela boima ba lefu lena la bohloko, 10 mg ho isa makhetlo a 4 ka letsatsi), diclofenac (intramuscularly, lethal dose le le leng ke 75 mg, mme lethal dose le leholo la letsatsi le letsatsi ke 150 mg) Ibuprofen (Letlapa le le leng ho isa ho a mabeli makhetlo a 3 kapa a 4 ka letsatsi, empa eseng ho feta litafole tse 6 ka letsatsi).

Likarolo tsa lefu lena le mefuta ea lona

E fetoletsoeng ho tsoa ho Greek polyneuropathy e bolela "mahlomola a methapo e mengata." Lisosa tsa pathology li fapane - hoo e batlang e le ntho efe kapa efe e kileng ea ba le phello e mpe tsamaisong ea methapo ea kutlo e ka baka polyneuropathy.

Kaha ts'ebetso ea bohlokoa ea 'mele e itšetlehile ka phetiso ea litaelo bokong ka methapo ea kutlo, ka nts'etsopele ea polyneuropathy, tlolo ea ts'ebetso ea methapo le maoto e sebetsa.

Bohlokoa! Polyneuropathy ea likarolo tse tlase e atile haholo, hobane maoto a na le mojaro o moholo ho feta mmele o kaholimo.

Ka polyneuropathy, hangata methapo e nyane ea ameha, hobane sheel ea ka ea myelin e tšesaane, 'me ho bonolo ho e kenya linthong tse kotsi. Ka hona, polyneuropathy ea likarolo tse holimo le tse tlase hangata e hlaha - tšenyo ea maoto le matsoho.

Hangata, ha ho etsoa qeto ea tšoaetso, mokuli ha a ngole feela "polyneuropathy ea maoto kapa matsoho", ba na le bonnete ba hore ba eketsa litlhaloso tse ling ho latela mofuta oa lefu lena. Sehlopha sa machaba sa maloetse se kenyelletsa mefuta e mengata ea polyneuropathy (khoutu ea ICD - G60-G64), e fapaneng ka sebaka, tekanyo le sebaka sa lesapo, ka mabaka a hlahang.

Ka tekanyo le tikoloho ea tšenyo

Li-fiber tsa methapo li ka aroloa ka mefuta e 'maloa - motor, autonomic, e hlokolosi. Ho ipapisitse le hore na lesion ea methapo e atile hakae, polyneuropathy e boetse e khethiloe:

Sekoloi (motor). Boemo bo tloaelehileng ba mesifa bo mpefala, bo lebisang ho hloleha mosebetsing oa bona: mesifa ea fokola, mesifa, atrophy le hypotrophy ea mesifa e ba teng.Matšoao a phatlalalitsoe ho tloha tlase ho ea holimo mme a ka lebisa ho tahlehelo e felletseng ea motsamao.

Meroho. Lithapo tsa methapo ea kutlo li amehile, 'me boemo ba litho tsa ka hare bo its'etleha. Ho na le keketseho ea mofufutso, mathata a ho ntša metsi, tšekamelo ea hore, letlalo le omeletseng le hlaha.
Sensory polyneuropathy. Ho hlaha mathata a tebileng: maikutlo a ho tepella, ho chesa, ho tsitsipana, "ho akhasa," maikutlo a bohloko le a hohelang esita le ka lehare le letshoaneng.
Sensomotor polyneuropathy. E kopanya matšoao a ho senya methapo ea kutlo le ea motor.
E tsoakiloe. Ho kenyelletsa matšoao a mefuta eohle ea likhathatso.

Ka sebopeho sa eona se hloekileng, mefuta ena e ka fumaneha ka seoelo, hangata e utloisang bohloko, e utloisang bohloko, e utloisang maikutlo le ea mofuta o mong o kopaneng oa lefu lena.

Ka mofuta oa ts'ebetso ea methapo

Polyneuropathy e ama methapo ea kutlo, e entsoe ka li-axon le myelin sheaths. Ho latela lesion, ba khetholla:

Axonal polyneuropathy - e etsahala ha axon e senyeha litsing tse fapaneng tsa metabolic: ka tahi e nang le arsenic, lead, mercury, joala,
Demyelinating polyneuropathy - e etsahala ka ho fokola ha mesifa ea methapo, lefu le hlaha ka potlako, haholo-holo likhoele tsa methapo ea kutlo le methapo ea kutlo.

Ka sebopeho sa eona se hloekileng, mefuta e joalo ha e teng ka nako e telele: ka tšenyo ea axon, lefu la demyenilizing butle-butle le kenella, 'me ka demyelination, mofuta oa axonal.

Ho latela bokhoni ba lehae, distal polyneuropathy le proximal li kopane: ka distal, pele ho tsohle, maoto a behiloeng ka tlase a ameha, ka proximal, likarolo tsa maoto le matsoho a holimo.

Lisosa tsa ho hlaha

Bakeng sa kalafo ea polyneuropathy ho fana ka liphetho, ho hlokahala ho tseba sesosa sa causative se e bakang.

Hobaneng ha polyneuropathy ea maoto le maoto a holimo e hlaha:

Factor ea lefu la tsoekere . Ho hlōloa ha likepe tse nyane, joalo ka ntho e thata, ho etsahala ho bakuli ba bangata ba nang le lefu lena. Ka hona, ke ea pele lethathamong la lisosa tsa polyneuropathy. Khatello e tšoanang hangata e etsahala ho ba nang le lefu la tsoekere nako e telele (lilemo tse 5-10).
Sebopeho sa chefo. E etsahala ha lintho tse kantle ho 'mele oa motho li kena maling: arsenic, lead, methanol, mercury le metsoako e meng ea lik'hemik'hale. Ka linako tse ling chefo ea polyneuropathy e ka ba teng ka tšebeliso e telele ea lithethefatsi, empa joala polyneuropathy ke mofuta o atileng haholo. Mofuta oa joala o hlaha ho batho ba ka bang 2-3% ea batho ba nang le bothata ba ho lemalla joala, mme khafetsa ho etsahala ka makhetlo a mabeli kamora lefu la lefu la tsoekere.
Ho haelloa ke livithamini tsa B . Mefuta e meng ea livithamini tsa B (B12, B1, B6) e na le phello ea methapo, e ama hantle methapo ea kutlo le tsamaiso ea methapo e bohareng. Ka hona, ho haella ha bona ho ka baka lipontšo tsa "axonal polyneuropathy" e sa foleng.
Mofuta oa dysmetabolic. Boloetse bona bo hlaha ka lebaka la ho sitisoa ha tšebetso ea metsoako ea methapo ka lebaka la ho monya lintho tse hlahisoang 'meleng kamora ho fetisoa ke mafu a itseng.
Likotsi. Ka lebaka la likotsi, tšenyo ea tšenyo ea methapo e ka ba teng, e lebisang nts'etsopele ea methapo ea methapo e holimo le tlase.

Ela hloko! Polyneuropathy hangata e bakoa ke maloetse ao ho 'ona' mele o bokellang lintho tse kotsi tse amang tsamaiso ea methapo hampe.

Mefuta ea mantlha ea lefu lena e kenyelletsa mofuta oa lefutso oa polyneuropathy le mofuta oa ideopathic (Guillain-Barré syndrome). Etiology ea mefuta ena ha e hlalosoe ka botlalo, e leng ho etsang hore kalafo ea mafu e be thata.

Mefuta ea bobeli ea polyneuropathy ea likarolo tse holimo le tse tlase e kenyelletsa mefuta e ileng ea hlaha ka lebaka la mafu a tšoaetsanoang, mathata a metabolic, chefo, methapo ea liphio le sebete, ts'ebetso e sa sebetseng ea litšoelesa tsa endocrine, le lihlahala tsa mefuta e fapaneng.

Matšoao le nts'etsopele ea lefu lena

Polyneuropathy e na le tšobotsi e ntle ea tleleniki ea bongaka. Letšoao le ka sehloohong la lefu lena le ka nkoa e le moelelo oa ho felisoa hoa lipalo tse tlase le tse holimo, hobane Lintho tse amanang le 'mele li potoloha le mali.

Matšoao a tloaelehileng a lefu lena:

Bohloko ba tlhaho e fapaneng, ho ba le "neuropathic" "e tukang" hue.
Matsoho a thothomelang.
Ponahalo ea mesifa ea mesifa e etsahalang ntle ho boithati.
Tlokotsi ea kutloelo-bohloko (bohloko, tactile, mocheso). Ka nts'etsopele ea lefu lena, mokuli a ka 'na a se ke a utloa e le lejoalo ka hara lieta, sebaka se chesang le tse ling tse khopisang.
Ho fokola ha mesifa, ho thata ho sisinyeha ka ho ba le kholo e kholo.
Ho ruruha hoa libaka tse tlase,
Karolo e sa lekanyetsoang ea maoto.

Matšoao a tlisoang ke lefu lena a kenyelletsa ponahalo ea bohloeki, bofokoli menoaneng, mathata a potoloha (mmala oa maoto le matsoho, pholiso e mpe ea maqeba, jj).

Lefu la tsoekere la polyneuropathy ea likarolo tse tlase e baka setšoantšo se latelang sa kliniki:

Ponahalo ea bohloko bo utloisang bohloko, bo bohloko bo matla maotong le maotong, bo bang matla ho lithemparetjha tse futhumetseng:
Ho na le bofokoli maotong.
Matšoao a meroho a ntse a eketseha
Bohloko bo ntse bo eketseha hanyane ka hanyane, ha ho hlohlona ho hlaha le 'mala oa letlalo oa fetoha (pherese e lefifi, e batla e le lefifi),
E thehiloe.

Alcoholic polyneuropathy ea hlaha butle-butle, matšoao a eona a hlaha ka lebaka la litlamorao tsa chefo ea ethanol tsamaisong ea methapo ea kutlo le mathata a metabolic methapong.

Taba ea pele, bohloko ba sebakeng sa namane bo hlaha, bo eketsang ka khatello
Ho na le bofokoli, ho holofala leoto le hlaha ka bobeli le maqaqaqaqailaneng.
Ho phatloha ha mesifa ea paretic ho etsahala
Ho bonahala ho ferekana ha maikutlo a mantlha (seo ho thoeng ke "li-socks le li-gloves",
Ho na le mofufutso o eketsehileng, ho ruruha ha libaka tse thōko tsa naha, phetoho ea 'mala oa letlalo.

Polyneuropathy e ka hlaha hape ka lebaka la ts'ebeliso e ngata ea joala, ka lebaka leo tsamaiso ea methapo e bohareng e nang le chefo ke ethanol.

Polyneuropathy ha e hlahe kamehla butle-butle: ka foromo e boima, matšoao a ka ba teng ka nako ea beke, ka mofuta oa subacute - lipontšo li eketseha nako e ka bang khoeli, ka foromo e sa foleng - lefu lena le ka ba teng ka lilemo.

Mekhoa ea kalafo

Pele ho kalafo e tobileng ea polyneuropathy, ho hlahlojoa ha eona ho etsoa, moo lipontšo tsa lefu lena li hlahlojoang, le sesosa sa lona se thehoang, e le hore ho fihlele li-pathologies tse bonahatsoang ke matšoao a tšoanang.

Tlhahlobo eo e etsoa joang:

Litletlebo tsa mokuli lia hlahlojoa.
Nako e thehoa ha matšoao a pele a lefu a hlaha.
E ea etsahala hore na tšebetso ea mokuli e amana le ho ikopanya le lik'hemik'hale.
Ho khethoa hore na mokuli o itšepa joala.
E thehiloe mabaka.
Teko ea mali e etsoa.
Liphetho tsa methapo li laetsoe.
Electroneimography e etsoa.
Tlhatlhobo e beoa maemong a mang, ho lingaka.

Kaha polyneuropathy ha se lefu le ikemetseng, kalafo ea lona ea mantlha e tla ikemisetsa ho felisa lintho tse lebisitseng ho qala ha lefu lena. Leha ho le joalo, mehato ea kalafo e lokela ho etsoa ka botlalo, e le hore ka nako e tšoanang ho felise matšoao a sa thabiseng a polyneuropathy ka nako e le ngoe kalafo e ka sehloohong.

Mesebetsi ea Boikoetliso ba 'mele

Physiotherapy e bapala karolo ea bohlokoa kalafong ea polyneuropathy, haholo haeba lefu le e-na le mofuta oa lefutso kapa o sa foleng.

Tsamaiso e latelang e etsoa:

Ho pepesehela ts'ebetsong ea methapo ea methapo, ke matla a khoheli.
Phekolo ea Massage
Electrophoresis

Ho silila ka polyneuropathy ho thusa ho matlafatsa mesifa, ho ntlafatsa le ho phahamisa tšebetso ea bona. Ka lebaka lena, lits'ebetso tsa makoloi li hlaphoheloa ka potlako, kotsi ea ho thatafala ha mesifa e fokotsehile haholo. Leha ho le joalo, ho lokela ho hopoloa hore ka mefuta e boima ea lefu lena, ho silila ha hoa lokela ho etsoa.

Ela hloko! Maemong a nang le chefo, mme haholo joala joala joala, mekhoa ea bongaka e etsoa feela kamora ho hloekisoa ha mali ho hlahisoang maemong a kemiso.

Ho ikoetlisa ka kalafo ea boikoetliso ho ka etsoa, ka boithatelo lapeng, le ka tataiso ea ngaka. Li thusa ho matlafatsa tšebetso ea mesifa, e o lumellang ho etsa karolo e itseng kapa ho khutlisetsa maoto le matsoho ka botlalo.

Mathata le bokuli

Haeba u sa batle thuso ea bongaka ka nako, lefu lena le ka u bakela mathata a maholo.

Pele ho tsohle, polyneuropathy e ka fetoha mofuta o sa foleng, o sa phekoleheng ka botlalo. Ha nako e ntse e tsamaea, motho o khaotsa ho utloa maoto le matsoho a hae ka botlalo, 'me mesifa e tla ka mokhoa oo motho a ka holofalang, hobane o sitisitse ka botlalo bokhoni ba hae ba ho sisinyeha.

Bohlokoa! Ho ka etsahala ho folisa ka botlalo polyneuropathy ka mefuta ea mafu a kang a tšoaetsanoang, joala le chefo. Ka foromo ea lefu la tsoekere, hoa khoneha ho fokotsa likarolo tsa lefu lena ka tsela e itseng.

Mefuteng e matla ea lefu le ts'ebetso e sa sebetseng ea methapo e ikarabellang mosebetsing oa pelo, e matla e ka iponahatsa, e ka lebisang lefung.

Ka mokhoa oa lefu la tsoekere, tšoaetso ea bobeli, mathata a septic, pholiso e mpe ea leqeba lia khonahala.

Ka kalafo e lekaneng e qalileng ka nako, kalafo ea lefu lena e ntle haholo, empa leha ho le joalo lefu lena le molemo ho le thibela ho fapana le ho le phekola nako e telele, le nang le matšoao a bohloko.

Ha ho khonehe ho thibela polyneuropathy, empa o ka fokotsa haholo maemo a kotsi bakeng sa nts'etsopele ea eona: inehela joala, phekola mafu a tšoaetsanoang le a vaerase ka nako, lekola boleng ba lihlahisoa tse sebelisitsoeng, fokotsa ho kopana le metsoako ea chefo ea lik'hemik'hale.

Polyneuropathy ke sehlopha sa mafu a amang palo e kholo ea liphello tsa methapo 'meleng oa motho. Boloetse bona bo na le lisosa tse fapaneng. Lintho tse bakang ho qala ha lefu lena, li halefisa methapo ea kutlo, ebe ke sona se etsang hore li senyehe. Matšoao a tšoaetso ea lefu lena ke bofokoli ba mesifa le bohloko sebakeng se amehang sa 'mele.

Lefu lena le bonahatsoa ke ho holofala, ho sitisoa ke ho ts'oaroa ha setlolo, ho senyeha ho fapaneng ha mosebetsi oa likarolo tse holimo le tse tlase tsa 'mele oa motho. Matšoao a lefu lena le matla a ponahatso ea ona a ipapisitse le mofuta oa lefu lena. Polyneuropathy hangata e bakela bakuli mahlomola a mangata, kalafo e lula e le teng. Nako ea lefu lena e tsoela pele ebile mohato o ka aroloa. Hangata, lefu lena le hlaha likarolong tse tlase tsa 'mele.

Polyneuropathy e ka hlaha ka sebopeho se monyebe, hape e na le kholo e potlakileng ea lebone.

Lisosa tsa polyneuropathy li fapane. Tse ka sehloohong li kenyelletsa:

chefo e nang le joala bo hloekileng, khase, arsenic (chefo ea lik'hemik'hale),
mafu a sa foleng (,),
tsamaiso ea methapo ea mmele,
tšebeliso ea nako e telele ea lihlopha tse itseng tsa meriana,
bokhoba ba joala
Tlolo ea molao ea ts'ireletso
lebaka la lefutso
lefu la metabolic

Pathology e ka ba ea mofuta:

ho ruruha. Maemong ana, ho na le ts'oaetso e matla ea methapo ea kutlo,
chefo. E hlaha ka lebaka la ho monya ha bongata ba lintho tse nang le chefo,
allergic
e sithabetsang.

Matsatsing ana, mofuta o atileng ka ho fetisisa ke lefu la tsoekere la polyneuropathy. Ho bohlokoa ho hlokomela hore polyneuropathy ke mofuta o kotsi oa ts'oaetso, o hlokang kalafo e nakong le e loketseng. Haeba e sa be teng, ho tsoela pele ha lefu lena ho ka lebisa ho atrophy ea mesifa le liso tsa ka mpeng. Ntho e kotsi ka ho fetisisa ke ho holofala maoto kapa matsoho le ka mor'a ho hema mesifa.

Mefuta e fapaneng

Ka ts'ebetso ea tšenyo, lefu lena le arotsoe ka mefuta e latelang:

demyelinating polyneuropathy. Nts'etsopele ea lefu lena e amahanngoa le ho phatloha ha protheine 'meleng, e koalang methapo' me e ikarabella bakeng sa lebelo le phahameng la phepelo ea methapo ka ho bona.
axonal. Mofuta ona o amahanngoa le tlolo ea mosebetsi oa lere la methapo. Mofuta ona o tsamaea le kalafo e matla le pholiso e telele,
neuropathic. Ka eona, ho senya mebele ea lisele tsa methapo ka kotloloho ho bonoa,
diphtheria le lefu la tsoekere le polyneuropathy,
polyneuropathy ea libaka tse tlase,
lekhoba la joala la joala.

Ho latela boleng ba tšenyo ea methapo, polyneuropathy ke:

senolo. E iponahatsa ka mokhoa oa letsoalo kapa bohloko,
motor. Methapo ea koloi e amehile, e tsamaeang le bofokoli mesifa,
sensory-motor. Matšoao a sebopeho sa lesion ke ho fokotseha ha kutloelo-bohloko le mesebetsi ea motor ea mesifa ea mesifa,
ea limela. Ho na le ts'ebetso ea ts'ebetso ea litho tsa ka hare ka lebaka la ho ruruha ha methapo,
tsoakane. E kenyeletsa likarolo tsohle tsa mefuta e kaholimo,
polyneuropathy ea likarolo tse tlase.

Ho latela sesosa sa ntlafatso, polyneuropathy e ka ba:

idiopathic. Ketsahalo ena e tsamaisana le mathata a teng tsamaisong ea 'mele ea ho itšireletsa mafung,
lefa. E feta molokong o mong ho ea ho o mong,
dysmetabolic. Tsoelo-pele ka lebaka la mathata a metabolic,
polyneuropathy e nang le chefo e hlaha linthong tse chefo tse kenang 'meleng,
hang-hang E etsahala le ts'oaetso ea tšoaetso 'meleng.
paraneoplastic. Nts'etsopele e tsamaea le mafu a oncological,
ka mafu a mmele, a hlaha e le karolo ea lefu,
lekhoba la joala la joala.

Ka mofuta oa thuto:

dinoko. Nako ea nts'etsopele e tsoa matsatsing a mabeli ho isa ho a mane. Phekolo e nka libeke tse 'maloa,
subacute. E hlaha libeke tse 'maloa, kalafo e nka likhoeli tse ngata,
sa foleng E tsoela pele ho tloha likhoeli tse tšeletseng kapa ho feta, e na le polelo ea kalafo ea motho ka mong.

Ho sa tsotelehe hore na motho o na le lefu la mofuta ofe, ebang ke lekhoba la tahi kapa la lefu la tsoekere, lefutso kapa lefutso la polyneuropathy kapa demyelinating, hangata matšoao a na le matšoao a tšoanang.

Lintho tse fapaneng tse bakang lefu lena, hangata li ama methapo ea kutlo, ebe li lebisa ho sitisoeng ha mosebetsi oa tsona. Matšoao a mantlha a lefu lena ke:

bofokoli ba mesifa ea matsoho le maoto,
ho hloleha ho phefumoloha
fokotseha ha maikutlo le ho utloa, ho fihlela ho ba sieo ha bona ka botlalo,
maikutlo a nako e telele a "li-goosebumps" hohle letlalong,
ho fufuleloa ho eketsehileng
thothomela kapa maqhubu
Ho ruruha ha matsoho le maoto,
pelo lippitations
Shaky gait le kizungu,
ho sokela.

Thibelo

Mehato ea thibelo ea polyneuropathy e etselitsoe ho felisa lisosa tse amang hampe methapo ea kutlo. Mekhoa ea Thibelo:

ho hana ka botlalo lino tse tahang,
haeba mosebetsi o kenyeletsa lik'hemik'hale, li tsamaise feela ka liaparo tse sirelletsang,
hlokomela boleng ba lijo tse jeoang,
seke oa sebelisa meriana ntle le taelo ea ngaka,
phekola ka nako mafu a mofuta ofe kapa ofe le a rarahaneng,
kenyelletsa li-vithamine lijong tsa hau,
ho ikoetlisa
hlokomela tsoekere ea mali kamehla
nako le nako ea ho ea litlolo tsa kalafo.

Na ntho e 'ngoe le e' ngoe e nepahetse ntlheng ee ka pono ea bongaka?

Araba feela haeba o netefalitse tsebo ea bongaka.

Mafu a nang le matšoao a tšoanang:

Guillain-Barré syndrome ke sehlopha sa maloetse a hlobaetsang le autoimmune a tšoauoang ke ho tsoela pele ka potlako. Nako ea ntlafatso e potlakileng e ka ba khoeli e le 'ngoe. Ka bongaka, bokuli bona bo na le mabitso a 'maloa - Landry paralysis kapa acute idiopathic polyneuritis. Matšoao a mantlha ke bofokoli ba mesifa le ho ba sieo hoa likhakanyo tse etsahalang khahlano le semelo sa tšenyo e kholo methapong (ka lebaka la ts'ebetso ea autoimmune). Sena se bolela hore 'mele oa motho o amohela lisele tsa hae joalo ka kantle ho naha,' me sesole sa 'mele se itšireletsa mafung khahlanong le membrane ea methapo.

Distne polyneuropathy ea likarolo tse tlase E kopanya maloetse a 'maloa a hlahang ka mabaka a fapaneng, ao ts'ebetso e tloaelehileng ea ts'ebetso ea methapo ea kutlo e ntseng e mpefala.

Khafetsa, lefu la kelello le ama maoto le matsoho, le mpefatsa mosebetsi oa ho tiisa mesifa, ho potoloha ha mali, le ho fokotsa kutloelo-bohloko. Ditlamorao tsa polyneuropathy li kotsi hobane li ka lebisa ho taolong e sa lekanyetsoang kapa e felletseng ea ho utloa matsoho le maoto kapa ho qeta thepa e senyehileng.

Boloetse bona bo hlaha ka mabaka a mangata, lintlha tse fapaneng tse amang tsamaiso ea methapo ea motho li ka qholotsa polyneuropathy. Kaha ts'ebetso ea 'mele e khethiloe ke boleng ba phetisetso ea litšusumetso ka methapo ea methapo bokong, ka ponahalo ea ts'ebetso e joalo, ho senyeha ha motility le kutloelo-bohloko maotong le hlaha.

Polyneuropathy ea libaka tse tlase tse tlaase e fumanoa hangata, hobane mojaro o tsotehang o beoa maotong ha o bapisoa le likarolo tse holimo. Pathology hangata e ama methapo e nyane, hobane li na le myelin sheath e nyane haholo, mme likarolo tse kotsi tsa trace ha li hloke ho kena ka har'a methapo ea methapo. Ka hona, polyneuropathy ea matsoho le maoto, tšenyo matsohong le maotong hangata e etsahala.

Hangata nakong ea ts'oaetso, lingaka li bonts'a tlhaloso e nepahetseng ea lefu lena, ka lebaka la li-pathologies tse fapaneng. Hona le mefuta e 'maloa ea polyneuropathy e fapaneng sebakeng, sebakeng sa sebaka se senyehileng, le lintlha tse khothatsang.

Ho ba le bothata ba makoloi ho etsahala ha boemo ba mesifa bo eketseha, ho sebetsa ha bona ho hloleha, bofokoli, boemo bo sisimosang, ho pepeseha le khaello ea phepo e nepahetseng. Matšoao a phatlalalitsoeng ho tloha tlase ho ea holimo, a etsa hore litšenyehelo tsa koloi li senyehe:

Meroho . E baka tšenyo ea methapo ea methapo, e baka boemo ba litho tsa ka hare. Ho rohakana, ho sitisoa ha tšebetso ea urini, ho sokela, ho omella hoa eketseha.
Sensory polyneuropathy , e fokotsa maikutlo, ho opa, ho chesa, ho ba le letsoele, ho na le maikutlo a hoosebumps, ho honotha, bohloko bo fokolang ka ho kopana hanyane.
Sensorimotor polyneuropathy . Ho kopanya matšoao a ho senya methapo ea kutlo le ea motor.
E kopantsoe. E u lumella hore u sebelise mefuta eohle ea litšitiso.

Ka sebopeho sa eona se hloekileng, mefuta e joalo ha e fumanehe, hangata e ba le maikutlo le limela tse ling tse kopaneng tsa pathology.

Matšoao a matšoao

Ha lefu le hlaha, ts'ebetso ea methapo ea methapo le methapo ea kutlo e senyeha. Tabeng ena, ho na le matšoao a joalo a polyneuropathy maotong:

Bokhoni.
Bohloeki.
Bohloko
Tingling.
Bofokoli ba mesifa ea mesifa.
Boikutlo bo tlase.

Litšobotsi tsa kalafo

Phekolo ea polyneuropathy ea maemo a tlase e fapana ka likarolo tsa eona, ka mohlala, sebopeho sa lefu la tsoekere ha se felisoe ka ho hana joala. Li-pathologies tse joalo ha li itlele feela. Qalong ea matšoao, ho hlokahala qeto ea sesosa sa lefu lena.

Kamora moo, o tla khona ho tseba lintlha tse u tsosetsang.Phekolo ea polyneuropathy e lokela ho ba e akaretsang mme e reretsoe ho felisa motso oa lefu lena. Ka hona, likhetho tse ling li ke ke tsa hlahisa sephetho se lakatsehang.

Pele ho kalafo, ho etsoa ts'ebetso ea ho hlahloba hore na lefu lena le fumanoa joang 'me sesosa sa lona se ikemiselitsoe ho qolla nts'etsopele ea maloetse a bonahatsoang ke matšoao a tšoanang.

Methylprednisolone e sebelisetsoa nts'etsopele ea ramatiki.
Tramadol e sebelisetsoa bohloko bo sa mamelleheng.
Palesa ea lipalesa e hlasimolla phepelo ea mali sebakeng se senyehileng.
Vitamin B.
Meriana e thusang lisele tse nang le micronutrients.

Ho silila
Ho pepesetsoa matla a makenete.
Phekolo ea tsamaiso ea methapo.
Phekolo e sa tobang ea litho tsa ka hare.

Ha chefo e fumanoa 'meleng, o hloka ho hloekisa mali. Hangata lingaka li fana ka litlhahiso tse 'maloa tsa boikoetliso.

Meriana

Mekhoa ea litlhare e laetsoe ho latela mefuta e mengata ea pathology le sethala sa nts'etsopele ea polyneuropathy le matšoao a eona:

Meetso ea vithamine. Khetho e fuoa livithamini tsa sehlopha Ha li kopana le liminerale tse ling. Liphekolo tsa Vitamin li tiisa bokhoni ba likhoele tsa methapo ea kutlo ho khutlisetsa likarolo tsa bona, li susumetsa ts'ireletso ea antioxidant.
Barekisi ba lipilisi. Ho felisa bohloko, ho boleloa li-analgesics kapa lithethefatsi tse seng tsa antiidalidal. Hangata, bakuli ba fuoa morphine kapa codeine.
Pheko ea Hormone le li-immunosuppressants. Ngoliso ea kalafo e khethoa ke setsebi se nahanang ka keketseho le ho fokotseha ha tekanyetso. Phekolo ea Hormone e tlatselletsoa ka li-immunoglobulins. Tsamaiso e joalo e etsoa sepetlele.
Lithethefatsi tse eketsang phallo ea mali methapong ea methapo.
Meriana e thusang ho isa li-micronutrients tse molemo ho li-tishu.

Ha o felisa polyneuropathy, o hloka ho utloisisa hore ho tlosa lefu la kelello ka thuso ea lithethefatsi ho ke ke ha sebetsa. Lijo li bohlokoa haholo; ho ntlafatsa le ho hlokomela bakuli ke batho ba bang le hona ho bolela ho hoholo.

Mathata a ka bang teng

Ha ho ratehe ho qala lefu lena le ho lebisa ho mathata. Ho seng joalo, ho ka hlaha mofuta o sa foleng le mathata a mangata. Haeba motho a sa khone ho fola lefu lena, maoto a hae a tla holofala ka botlalo. Ka lebaka leo, mokuli a ke ke a khona ho tsamaea ka tsela e tloaelehileng.

Haeba kalafo e qalile ka nako, kholo ea bokuli bo joalo e tla ba e ntle. Ke ka mofuta o sa foleng feela moo mathata a ka bang teng. E ke ke ea sebetsa ka botlalo, empa ho na le mekhoa ea ho fokotsa botebo ba kholo ea eona.

Sensory polyneuropathy ke lefu leo matšoao a lona a bakiloeng ke ho felisoa ha li-neuron tse ikarabellang bakeng sa ts'ebetso ea makoloi, ka lebaka leo mesebetsi ea lisebelisoa tsa motor e ka senyehang haholo. Lefu lena le kotsi le atile haholo ho bakuli ba nang le lefu la tsoekere. Joalo ka mefuta e meng ea li-polyneuropathies, e 'ngoe ea lintlha tse khethollang khetho ea kalafo le litholoana tsa eona tse latelang ke ho fumana lefu lena ka nako.

Sensory polyneuropathy e ka hlaha ka lebaka la mabaka a fapaneng, ho kenyelletsa le mabapi le lits'ebetso tse tebileng tsa autoimmune, tahi, lefutso le tšoaetso, athe molato o kotsi ka ho fetisisa ke ha lefu lena le fuoe kapa le fumaneha ka lebaka la tlhahlobo e ikhethang ea lefutso.

Matšoao a mantlha a polyneuropathy ena e kotsi ea kutlo ke ho lahleheloa ke maikutlo, ho chesoa ke maikutlo, ho tsikinyeha le ho hlohlona, ho utloahala ho thothomela le mangoleng, hammoho le mokuli ho qala ho lemoha mocheso le serame, 'me mocheso o theoha le ho feta. Ka sensory polyneuropathy, matšoao a mabe a ho ferekana ha maikutlo, maikutlo a "liatlana" le "li-socks", le tlolo ea kutloisiso ea mpa e tlase le eona e ka etsahala.

Ho latela mofuta oa li-neurons tse senyehileng, mefuta e meraro ea mantlha ea sensor polyneuropathy e ka khetholloa: foromo ea hyperalgesic, sebopeho sa atactic le mofuta o kopaneng. Ka sebopeho sa lefu lena la atactic, matšoao a kang ho se sebetse hantle ha ho sisinyeha ha motsamao, paresthesia, letsoalo, ho tsitsinyeha (haholoholo le mahlo a koehileng) a bonoa. Matla a mesifa hangata a lula a sa fetohe, leha ho le joalo, ha a hlahlojoa ke ngaka mme a hlahlojoa bakeng sa matla a amanang le tahlehelo ea matla a tebileng, a ka fokotseha haholo.

Sebopeho sa hyperalgesic se bolela matšoao a joalo ka ho hlohlona ha autonomic, bohloko (hangata ho chesa kapa ho thunya), ho fokotseha ha maikutlo a bohloko, ho fokotse maikutlo a mocheso. Mofuta o kopaneng oa sensor polyneuropathy o kenyelletsa matšoao a mefuta ea lefu lena.

Ka sensary polyneuropathy, matšoao a mantlha a atisang ho hlaha hangata ke asymmetric, haholo-holo qalong ea lefu lena. Kahoo, mohlala, lefu lena le ka qala ka leoto le le leng, ha la bobeli le tla lula le phetse hantle ka nako e telele, leha ho le joalo, ha lefu lena le ntse le eketseha, matšoao a fetoha ka ho hlaka. Hangata methating ea pele ea lefu lena, ha se maoto feela, empa le maoto le matsoho a holimo lia angoa, 'me ka linako tse ling esita le kutu le sefahleho. Matšoao a ka hlaha ka mor'a matsatsi a seng makae, le likhoeli tse 1 - tse peli.

Ha re se re fihlile ntlheng e 'ngoe, re ka re, ka matšoao a mangata, a mangata hangata a tsitsa ka nako e telele. Hangata ho etsahala hore matšoao a fokotsehe, empa khafetsa, haholo-holo ka tlhahlobo ea lefu lena le le leng, a lula a le maemong a ts'oanang, ao hangata a phahame haholo, kapa a ntseng a eketseha. Ho fapana le lefu la Guillain-Barré, sensory polyneuropathy e tšoauoa ka ho hlaphoheloa ha mesebetsi hantle.

Ho senyeha ha methapo ea kutlo ho ka qala ho tloha ho ba le letsoai le bonolo ho fihlela ho kenella ka hare ho pelo ka lefu la arthropathy le liso. Ka lefu lena, paresthesia le bohloko bo sa mamelleheng bo atisoa hangata. Hajoale, ho na le litlhaloso tse felletseng tsa lefu lena le ikhethang, le kopanyang ho hloka kutloelo-bohloko ha bohloko ba maikutlo le bohloko bo boholo ba ho ikatisa.

Tlhahlobo ea polyneuropathy ea sensory e hloka hore ho be le anamnesis ea nang le tšoaetso ea mafu a mang, lintlha tsa phepo e nepahetseng, lenane la meriana eo mokuli a e sebelisitseng, litlhaloso tsa lefutso, mafu a tšoaetsanoang a nakong e fetileng a ka amang nts'etsopele ea polyneuropathy, tlhahlobo ea sebaka sa mosebetsi oa mokuli le 'nete ea ho kopana le lintho tse chefo. Liphetho tsa ENMG, hammoho le liphetho tse ikhethang tsa biopsy ea letlalo, jj.

Ho fihla joale, kalafo ea sensor polyneuropathy e nts'etsopele hantle. Ka kalafo, corticosteroids, cytostatics, plasmapheresis le immunoglobulin hangata li sebelisoa haholo, leha ho le joalo, hangata haholo, liteko tsa kalafo li hloleha. Khahlano le semelo sa immunotherapy, mokhoa o ikhethileng oa matšoao le ho tsitsisa ha boemo bo bonoa, empa mabaka a sephetho sena ha a utloisisehe ka botlalo, leha ho le joalo, phekolo e nakong e phetha karolo ea mantlha.

Joalo ka mefuta eohle e meng ea li-polyneuropathies, ho tseba ka nako le tšimoloho ea kalafo ho thusa, haeba ho sa fole, ebe ho tiisa boemo ba mokuli. Tabeng ea sensory polyneuropathy, haeba lefu le sa fumanehe qalong, joale, kamora hore karolo e kholo ea li-neuron e hlokahale, ho ke ke ha khoneha ho etsa pholiso ea bohlokoa, empa re ka tšepa ho emisa tsoelo-pele ea lefu lena le ho tsitsisa boemo ba mokuli.

Mathata a tsamaiso ea methapo a bonahala e le matšoao a methapo.Motho a ka ba le ho ruruha (ho ruruha ho kopaneng), maoto a thothomelang, paresis (ho fokolisa) le ho holofala ha mesifa ea mesifa, ho fokotseha kapa ho tebela, hammoho le matšoao a paresthesia. Ntlha ea hoqetela e kenyelletsa maikutlo a ho sesa ka lebaka la karolo e itseng ea 'mele.

Matšoao a sebakeng seo a fumaneha haholo sebakeng sa bolulo sa methapo e amehileng, mohlala, ha lekala le sefahleho le senyehile, sefahleho kaofela sea tepella. Ka nako e 'ngoe mabaka a ipatile lits'ebetsong tsa methapo ea methapo e ileng ea hlaha mokokotlong le bokong ba mokokotlo. Ka thoko, ho hlokahala ho totobatsa lefu le kang polyneuropathy (polyneuropathy). E emela tšenyo ea methapo e mengata ka nako e le ngoe, haholoholo ke lintlha tse kantle. Lisosa tse ling, joalo ka ts'oaetso kapa lefu la tsoekere, tseo ho leng bohlokoa ho li tseba pele u etsa kalafo, li ka etella pele ts'ebetso ena.

Ka tšenyo e ngata ea methapo, hangata lingaka li hlahloba polyneuropathy, empa ke batho ba 'maloa ba tsebang hore na ke eng. Lesion e fumaneha sebakeng sa boholo ba karolo ea methapo ea methapo ea kutlo mme boholo ba eona ke lintho tse kantle, tseo ka nako e telele li ileng tsa sitisa mosebetsi oa bona, ho etella pele ts'ebetso ena.

Chefo ea polyneuropathy ke mofuta o ka sehloohong oa maloetse a mangata. Ho eena, sesosa sa pele e kanna ea ba mafu a ho bokella lintho tse chefo ho batho. Har'a tsona, ho hloka taolo ea endocrine, ka mohlala, lefu la tsoekere, le ka khetholloa. Distal polyneuropathy e tšoaea lefu lena mme e etsahala maemong a fetang halofo. Mokhoa o joalo o hlaha ka lebaka la ho pepesetsoa tsoekere e phahameng ea nako e telele. Ho tsa bongaka, mofuta ona oa "pathology" o bitsoa dysmetabolic polyneuropathy ka lebaka la tšebeliso e mpe ea "metabolism".

Ho chefo ha neuropathy ho ka hlaha eseng feela ka lebaka la tsoekere e phahameng ea mali, empa hape ka lebaka la lintho tse ling tse senyang likhoele tsa methapo.

Mohlala, ntho e kanna ea se be kahare ho mmele, empa e kenye kamehla ka ntle. Ha e le hantle, joala ke chefo 'me mofuta ona oa lefu o bitsoa joala polyneuropathy ea litlamorao tse tlase. Ha lefu la kelello le ntse le eketseha, butle-butle matsoho a mokuli a ameha. Lefu lena e boetse e le karolo ea sehlopha sa liphoso tsa dysmetabolic mme le koahela haholo matšoao a motor-sensory.

Mafu a tšoaetsanoang a oncological ha a tloaelehile ho neuropathy. Ba chefo 'mele oohle' me ho li tlosa ho thata haholo, ka hona, ts'ebetso ea ho hlaphoheloa ha pholiso e mpe haholo. Li-neoplasms ke tsa mofuta oa paraneoplastic ea lefu lena.

Maemong a sa tloaelehang, tšoaetso e kang diphtheria bacillus, e baka lefu lena. Lihlahisoa tsa hae tsa litšila li senya methapo ea kutlo mme butle-butle li qala ho se sebetse. Boloetse ba mofuta ona ke ba tšoaetso le chefo ka nako e le 'ngoe.

Lisosa tsa polyneuropathy ha se kamehla li amanang le litlamorao tsa chefo ea lintho tse fapaneng. Ka linako tse ling lefu lena le hlaha ka lebaka la khaello ea 'mele ea ho itšireletsa mafung, moo lithibela-mafu li felisang sheel ea sheel ea lisele tsa methapo. Mofuta ona oa lefu o bitsoa demyelinating mme ke oa sehlopha sa ts'ebetso ea methapo ea methapo ea methapo. Khafetsa mofuta ona oa "neuropathy" o na le ts'oaetso ea lefutso, 'me lefutso la lefutso le iponahatsa e le ts'enyeho ea mesifa ea motor.

Mefuta ea bokuli

Polyneuropathy ea likarolo tse holimo le tse tlase e bontšoa ka sebopeho sa matšoao a bonojo a boletsoeng mme boemo ba ponahatso ea bona bo its'etleha ka sebopeho sa lefu le mefuta ea tšenyo.

Ka mofuta oa tšenyo ea methapo ea methapo, methapo ea kutlo ke ea mefuta e latelang:

Demyelinating polyneuropathy (lefu le fokotsang matla a ho nyehlisa). Ts'ebetso ena ea ts'ebetso ea methapo ea methapo ke tšenyeho ea myelin sheath holim'a li-process (axons) tse tsoang li-neuron,
Axonal polyneuropathy. E etsahala ka lebaka la ho se sebetse hantle litseng,
Neuropathic polyneuropathy. Psychology e joalo e hlaha ka lebaka la ts'enyo ea 'mele oa "neuron (cell nerve").

Pathology e ka aroloa ka mefuta e itseng ea tlhahiso, e leng:

Sensory polyneuropathy. Matšoao a eona a kenyelletsa tlolo ea kutloisiso ea methapo ea methapo, mohlala, maikutlo a bohloko, ho chesa le ho akheha,
Polyneuropathy. Ho senyeha ha mesifa hoa bonoa. Sena se etsahala ka mokhoa oa bofokoli, atrophy, ho holofala, joalo-joalo,
Sensomotor polyneuropathy. Mofuteng ona oa tšenyo, mathata a maikutlo le a koloi a kopantsoe,
Autonomic polyneuropathy. Ho sitoa ketsahalong ena ho etsahala tsamaisong ea methapo ea kutlo, e ikarabellang bakeng sa ts'ebetso ea litho tsa ka hare. Mechini ena ea methapo e boetse e ikarabella bakeng sa lits'ebetso tse ling tseo motho a ke keng a li laola ka letsoalo, e leng, sekhahla sa pelo, sesafu, mofufutso, jj.
Pono e kopaneng. E kenyelletsa matšoao a fapaneng a tlolo ea tšobotsi ea lihlopha tsohle.

Ho latela sepheo sa lefutso, lefu lena le arotsoe ka lihlopha tse latelang:

Sebopeho sa Idiopathic (polyneuropathy ea tšimolohong e sa tsejoeng). Ha ho na lebaka le tobileng la mefuta ena, empa mofuta oa mantlha oa nts'etsopele o nkuoa e le ts'oaetso ea mmele,
Sebopeho se futsitsoeng. Psychology ena e fetisoa ho tsoa ho batsoali,
Sebopeho sa dysmetabolic. E etsahala ka lebaka la ho sitisoa hoa metabolism,
Sebopeho sa chefo. Nts'etsopele ea mofuta ona e bakoa ke phello ea chefo 'meleng.
Mofuta oa poso. Mofuta ona oa polyneuropathy o hlaha ka lebaka la tšoaetso e ammeng tsamaiso ea 'mele e mengata, joalo ka ts'oaetso ea HIV kapa diphtheria,
Sebopeho sa Paraneoplastic. E hlaha mokokotlong oa mofetše oa tlhaho e mpe,
Maloetse a systemic. Mofuta ona oa polyneuropathy ke karolo ea ts'ebetso e 'ngoe ea pathological e hlahileng lithong tse sebetsanang, mohlala, scleroderma (ho hloleha ho hlahisoeng ha collagen).

Polyneuropathy haholo e ama maoto le matsoho a motho, hantle le ho feta, maoto le matsoho. Sena se etsahala ka lebaka la hore boholo ba methapo e nyane e senyehile, hobane chefo e senngoa habonolo. Ka linako tse ling ho hlaha polyneuritic syndrome ebe matšoao a tšoanang lintlheng tse holimo le tse tlase a tšoaea. Khafetsa, tšenyo e etsahala ka mokhoa o lumellanang, kaha chefo e hasana ho tsoa maling.

Ka polyneuropathy, matšoao a tšenyo ea methapo a tjena:

Maikutlo a bohloko a mofuta o fapaneng oa ponahatso o nang le ntho e tukang,
Ho thothomela (ho thothomela) libakeng tse tlase le tse holimo, ho bonahala haholo menoaneng,
Litakatso tse sa laoleheng, tseo e leng mesifa ea mesifa,
Ho se sebetse hantle hantle, ho kenyelletsang pono e sa sebetseng ea mocheso, bohloko le ho ama (ho tsitsipana) ho hobe le ho feta. Ho lefu la tsoekere, bakuli ba kanna ba se ke ba bona khalase kapa lejoana le kenang ka har'a seeta ka polyneuropathy ea leoto,
Paresis (bofokoli) ba mesifa, ka lebaka leo ho ba thata hore motho a tsamaee maeto a malelele le ho etsa mesebetsi ea letsatsi le letsatsi. Letšoao lena le kopantsoe hangata le molumo o fokolang oa mesifa le ho felloa ke matla ho mokuli, 'me ho etsahala haholo ka polyneuropathy ea lipheo tse tlase.

Kotsi e kholo ke matšoao a lefu lena le a hlahang mme hara tsona matšoao a latelang a ka khetholloa:

Mocheso oa qhomela
Mosebetsi o matla oa litšoelesa tsa sebaceous,
Letlalo le mosehla
Ho hloleha ho potoloha
Arrhythmia ea pelo.

Ka polyneuropathy ea likarolo tse tlase, matšoao a boleloa hangata ke:

Fokotsa matla a kutlo
Muscle paresis
Achilles ea theoha,
Liphetoho tsa trophic.

Polyneuropathy ea likarolo tse holimo e iponahatsa ka mokhoa o ts'oanang, empa 'mala oa letlalo oa fetoha lerootho' me ho thothomela ho ho feta. Leha ho le joalo, lefu lena ha le lule le eketseha ho theosa le lilemo.Maemong a mang, e iponahatsa ka mor'a lihora tse 2-3, mohlala, kamora ho pepesetsoa kapa chefo e matla e nang le lintho tse chefo.

Maemong a sa tloaelehang, ho hlaha ho haella ha vithamine B12 haholo. Ke tšobotsi ea tšenyo lipilong tsa ka morao tsa mokokotlo. Li na le makala a methapo a ikarabellang bakeng sa pono ea manonyeletso le mesifa. Ts'ebetso ena ea pathological e na le litšobotsi tsa eona, hobane ka ataxia motho a ke ke a tsamaea lefifing, hobane ha a utloisise hore na maoto le matsoho a hae a hokae. Leha ho le joalo, ka mabone a matle, bothata bo nyamela bo le bong mme mokuli ha a utloe liphetoho.

Ka autonomic polyneuropathy, motho a ka shoa ka tšohanyetso ka lebaka la ho tšoaroa ke pelo, e etsahalang ka lebaka la ho fetoha haholo ha pelo kapa ho ferekana ha mosebetsi oa pelo. Mofuta ona oa pathology o bolela mofuta oa pelo ea polyneuropathy.

Phekolo ea lithethefatsi

Phekolo ea polyneuropathy ke ho etsa liteko tse telele. Nako ea eona hangata e itšetlehile ka tekanyo ea tšenyo le lisosa tsa eona, hobane ho hlokahala ho khutlisa mekhoa ea methapo ka tsela e ncha, mme ho thata haholo ho etsa sena. Ke ka lebaka leo polyneuropathy e bolelang liso tsa tlhaho tsa tsamaiso ea methapo, eseng tse sebetsang.

Pele, o hloka ho tseba sesosa sa lefu lena le ho le felisa. U ka utloisisa mokhoa oa ho phekola polyneuropathy ka mohlala oa lefu la tsoekere. Li lokela ho lekola tsoekere ea mali haholoanyane hore li lule li le maemong a tloaelehileng. Haeba ho tluoa ho lino tse tahang, joale ba lokela ho tlohela joala. Ho seng joalo, lithethefatsi li ke ke tsa thusa sehlopha sa pele kapa sa bobeli. Ka mafu a oncological, pele ho kalafo ea pathology, hoa hlokahala ho felisa li-neoplasms tse hlahileng 'meleng.

Ka polyneuropathy, kalafo e etsoa ka thuso ea lithethefatsi tse joalo:

Mefuta ea vithamine, mohlala, Milgamma,
Li-antioxidants tsa mofuta oa Berlition,
Lithethefatsi tse nang le metabolic e le ho susumetsa microcirculation joalo ka Trental,
Li-antesthetics joalo ka litlolo tse thibelang botenya

Ho sebelisoa ha litlolo le matlapa kalafong ea polyneuropathy ho khothalletsoa hammoho le phepo e nepahetseng. U hloka ho eketsa meroho le litholoana tse tsoang lijong tsa hau, 'me haeba ho khonahala li hana lijo tse halikiloeng, tse tsubiloeng le tse halikiloeng. Ho khothalletsoa hore u phehe lijo kapa u li chese.

Physiotherapy e ka potlakisa ts'ebetso ea pholiso mme mekhoa e latelang e sebelisoa hangata:

Dibazole le thiamine-based electropharis,
Phekolo ea foil (phuthela e kopaneng),
Libate tsa ho folisa
Thupelo

Molemo o ikhethang ke ho silila bakeng sa polyneuropathy. E lokela ho etsoa ke setsebi se nang le boiphihlelo, e le hore se se ke sa totisa lefu lena.

Phekolo ea polyneuropathy ea likarolo tse tlase hangata ha e tsamaee feela ka ts'ebeliso ea lithethefatsi, empa le ho boikoetliso ba 'mele. E u lumella ho boloka molumo oa mesifa mme e ntlafatsa boemo bo akaretsang ba mokuli. Phekolo ea mmele (LFK) e lokela ho khethoa ho latela boemo ba motho, hobane maemong a mangata ha ho khothalletsoe ho imeloa haholo mmeleng.

Ka tloaelo, tlholeho ea polyneuropathy ha e tšelise. Lefu lena le thata ho le phekola ebile le batla le tsoela pele. Ha nako e ntse e tsamaea, motho a ka holofala a ba a shoa ka lebaka la ho se sebetse hantle pelong. Mefuta e meng ea lefu lena ha e na kalafo ho hang, ka mohlala, e bakoang ke ho hloleha ha autoimmune. Haeba ho tluoa ka chefo ea joala kapa lefu la tsoekere, phepo e nepahetseng e bonahala e le ntle, empa ha feela mokuli a ka boloka tsoekere e le ngata mme a hana joala.

Polyneuropathy ke tšenyo e kholo ea tishu ea methapo mme e lokela ho phekoloa ha matšoao a pele a hlaha, ho seng joalo pathology e tla tsoela pele. Tsoelo-pele e joalo ea liketsahalo hangata e lebisa ho holofala le lefu.

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Meriana

*Herederal and idiopathic neuropathy*
	*Tšibollo ea polyneuropathy*
		*Li-polyneuropathies tse ling*
			*Polyneuropathy, bakeng sa mafu a khethiloeng kae kapa kae*
				*Mathata a mang a tsamaiso ea methapo ea kutlo*

Dysmetabolic (e ikemetseng, lefutso, distal, sensorimotor, amyloid) polyneuropathy

Mefuta ea Neuropathy

Diabetesic distal polyneuropathy

Peripheral

Sensory polyneuropathy

Dysmetabolic

Hobaneng bakuli ba nang le lefu la tsoekere ba na le neuropathy

Maoto a tukang le a bohang

Ho lahleheloa ke kutloisiso ea maoto

Tlhahlobo ea lefu lena

Phekolo ea lefu la tsoekere la polyneuropathy ea likarolo tse tlase

Phekolo ea lithethefatsi

Phekolo ntle le meriana

Mekhoa ea ho nts'etsapele polyal diabetesic polyneuropathy

Matšoao a lefu la tsoekere la distal polyneuropathy

Phekolo ea lefu la tsoekere la methapo ea kutlo ea lefu la tsoekere

Likarabo

Polyneuropathy. Classified, lisosa, setšoantšo se akaretsang sa kliniki ea polyneuropathies.Dysmetabolic le paraneoplastic polyneuropathies. Li-polyneuropathies tse nang le khaello ea livithamini tse itseng. Guillain-Barré Syndrome

Polyneuropathy ke eng?

Lefu la tsoekere la polyneuropathy: matšoao

Ho hlahloba le ho phekola polyneuropathy

Mehato ea thibelo

Matšoao a polyneuropathy

Polyneuropathy ea likarolo tse tlase

Polyneuropathy ea maoto le matsoho a holimo

Phekolo ea polyneuropathy

Tlhaloso e khutšoane

Tlhahlobo e fapaneng

Fumana kalafo Korea, Isiraele, Jeremane, USA

Tlhahisoleseling ka kakaretso

Etiology le pathogenesis ea polyneuropathies

Classified of Polyneuropathies

Setšoantšo sa tliliniki ea polyneuropathy

Amyloid transthyretin polyneuropathy

Tlhahlobo ea polyneuropathies

Phekolo ea polyneuropathies

Prognosis ea polyneuropathy

Setšoantšo sa kliniki ea lefu lena

U lokela ho tšoara joang?

Polyneuropathy e nang le maloetse a systemic

Hereditary polyneuropathy

Amyloid polyneuropathy

Pharal sensory-motor polyneuropathy

Autonomic polyneuropathy ho lefu la tsoekere

Mefuta ea polyneuropathies

ICD-10 polyneuropathy

Setšoantšo se akaretsang sa kliniki ea polyneuropathies

Kalafo ea Syndra ea Guillain-Barré

Likarolo tsa lefu lena le mefuta ea lona

Ka tekanyo le tikoloho ea tšenyo

Ka mofuta oa ts'ebetso ea methapo

Lisosa tsa ho hlaha

Matšoao le nts'etsopele ea lefu lena

Mekhoa ea kalafo

Mesebetsi ea Boikoetliso ba 'mele

Mathata le bokuli

Mefuta e fapaneng

Thibelo

Matšoao a matšoao

Litšobotsi tsa kalafo

Meriana

Mathata a ka bang teng

Mefuta ea bokuli

Phekolo ea lithethefatsi

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