Ts'ebetso ea atherosclerotic e khetholloa ke ho theoa ha masapo a atheromatous ka har'a mokokotlo oa methapo, ho thibela bophara ba mali le methapo, ho thibela phallo ea mali ho litho le lisele, hypoxia le ischemia ea libaka tse amehileng.
Boloetse bona bo tšoaea batho ba baholo, empa hoa khoneha ho bona matšoao a pele a tšenyo baneng le lilemong tsa bocha.
Ha ho khonehe kamehla ho fumana ho ba teng ha methapo ea mafu ka nako ka nako, empa ka ho elelloa ka tlolo ea molao, monyetla oa phello e kholo tseleng ea lefu o hlahella.
Nakong ea ts'oaetso e fumanoeng le ts'ebeliso ea nako e nepahetseng ea kalafo, e ka ba le tšusumetso ea lefu lena, ea fokotsa kotsi ea ho ba le mefuta e matla.
Tšusumetso e joalo 'meleng e thibela ho hlaha ha mathata - ho potoloha ha methapo ea mali bokong, angina pectoris, infraction ea myocardial, ho felisoa ha methapo ea mokokotlo le mokokotlo oa mpa.
Lisosa tsa Atherosclerosis
Boemong ba hona joale ba nts'etsopele ea mahlale, lisosa tsa nts'etsopele ea atherosulinosis 'meleng ha li so ka li thehoa ka ts'epahalo. Hape, mochine o kentseng letsoho ponahalong ea pathology ha o so thehiloe ka ts'epahalo.
Mabaka a behiloeng ka nepo kotsing ea ho holisa atherosclerosis, ho ba teng ha ona ho eketsang monyetla oa bothata ba lefu la methapo. Mabaka ohle a kotsi a ka aroloa ka lihlopha tse 'maloa - eseng a fetoloe ebile a ka fetoha.
Lintlha tse ka fetoloang li kenyeletsa:
- Hyperlipidemia ka lebaka la tšebeliso e ngata ea mafura a liphoofolo, lijo tse nang le cholesterol e ngata, ho se tsotelle lihlahisoa tsa fiber le lebese.
- Ts'ebetso ea ts'epo ea lerako la methapo ka lebaka la mekhoa e mebe - ho itlopa joala haholo, ho tsuba.
- Ho ikoetlisa ho sa lekaneng, kapa ho fapana le hoo, ho ba teng ha mosebetsi o boima oa 'mele.
- Ho ba teng ha khatello e phahameng ea mali le glucose.
- Lisosa tse ling ke maloetse a tšoaetsanoang kapa endocrine (hypothyroidism, Itsenko-Cushing's syndrome), likotsi.
Mafu a sa fetoloeng a kenyelletsa:
- lilemo - kotsi ea nts'etsopele e eketseha ka mor'a lilemo tse 45 - 50;
- bong - banna ba tloaetse ho qala ha lefu lena, kaha lihormone tsa basali tsa thobalano li na le tšireletso;
- mafu a amanang le lefutso - lefu la dyslipidemia, homocysteinemia.
Tlhahlobo ea pele e qala ka pokello e felletseng ea anamnesis (nalane) ea bophelo, e kenyelletsang tlhaiso-leseling ka maloetse a fetileng, likotsi le ts'ebetso, ho ba teng ha tloaelo ea lelapa ho mafu a pelo.
Nalane ea lefu lena le eona e bohlokoa haholo - ho qala, matšoao a pele, nako le tlhaho ea bona, potso e hlaha ea hore na mokuli o amahanya matšoao a ho qala le matšoao le ho hong, liphetho tsa bona.
Matšoao a ho ruruha ha lesapo la mokokotlo
Matšoao a ts'ebetso ea atherosulinotic a ipapisitse le hore na nako ea tsoelo-pele ea methapo e sebetsa joang, sebaka seo a leng ho sona le boemo ba phallo ea methapo ea methapo le boemo ba ho se lekane ha phepelo ea mali.
Coronary atherosulinosis, kapa angina e tsitsitseng, e na le matšoao a latelang - bohloko bo sa feleng ba khatello ka morao ho sternum, tachycardia le arrhythmias.
Ka atherosulinosis ea aorta (sekepe se seholo ka ho fetisisa 'meleng), lipontšo tse joalo li bonoa - keketseho e phehellang ea khatello ea mali, maikutlo a tukang, ho khasa ka matsoho le maoto, pallor ea letlalo la lipalo tse tlase, ho fokotseha ha kutloelo-bohloko ea bona, ho phaellana, le bohloko ba ka mpeng.
Tšenyo ea methapo ea methapo ea kutlo e bonahatsoa ke hlooho, ho tsekela, tinnitus, ho fokotseha mohopolo le bokhoni ba ho lemoha, khatello e eketsehileng ea methapo.
Ho rarahana ha mehato ea ho hlahloba ho kenyelletsa lithuto tsa laboratori le tsa lisebelisoa.
Laborator e kenyelletsa mekhoa e akaretsang ea tlhahlobo ea kliniki le e ikhethileng.
Tse ikhethang li kenyelletsa palo ea mali ka kakaretso le palo ea lisele tse tšoeu tsa mali, urinalysis ka kakaretso le tsoekere e potlakileng.
Mefuta e ikhethileng ke tlhahlobo ea biochemical le qeto ea bophahamo ba lipid, li-electrophoresis tsa serum lipoprotein, ho bala boemo ba protheine ea plasma apo-B, mekhoa ea tlhahlobo ea immunological le boikemisetso ba coagulogram.
Tlhahlobo ea bongaka ea kliniki e akaretsang
Tlhahlobo ea mali e lekanyetsa boemo ba hemoglobin, palo ea lisele tse khubelu tsa mali, liplatelete le lisele tse tšoeu tsa mali ka bophahamo ba unit, le sekhahla sa erythrocyte sedimentation (SOE).
Madi bakeng sa ho hlahlojoa a nkuoa hoseng ka mpeng e se nang letho, litholoana li fumaneha hantle kamora lihora tse 'maloa.
Thutong ena, boteng ba atherosclerosis bo kanna ba bonts'oa ke keketseho ea SOE - sesupo sa karabelo ea ts'oaetso (tloaelo ho banna e fihla ho 1 ho isa ho 10 mm ka hora, bakeng sa basali - ho tloha 2 ho isa ho 15). Ho lokela ho hopoloa hore letšoao lena ha le na letho, 'me ho ke ke ha khoneha ho tseba hantle hore na ho na le tlolo ea metabolism ea mafura.
Ha ho hlahlojoa moroto, likhakanyo tse joalo li ikemiselitse - 'mala, pepeneneng, matla a khoheli, ho ba teng ha protheine, tsoekere, letsoai le likarolo tse ling - lisele, lihlahisoa tse bolileng, li-enzyme.
Letšoao le ka bontšang hore metabolism e senyehileng le metabolism ea mesifa ea pelo ke lactate dehydrogenase (LDH).
Enzyme ena ke sehlahisoa se qhekellang tsoekere, ho ba teng ha eona ka har'a moroto ho bontša pelo le ischemia kapa myocardial infarction.
Tekanyo ea glucose e ikemiselitsoe bakeng sa tlhahlobo ea pele ea lefu la tsoekere, ho eketsa mamello ea tsoekere le mafu a mang a endocrine, letšoao le tloaelehileng le tsoa ho 3,3 ho isa ho 5.5 mmol.
Keketseho ea tsoekere e bonts'a nts'etsopele ea lefu la tsoekere, le ka bang teng ka lefu la pelo le coronary.
Tlhahlobo e Khethehileng ea Kliniki ea Laboraro
Liteko tse ikhethileng bakeng sa tlhahiso ea atherosulinosis li etsa hore ho khonehe ho tseba hantle hore na liphetoho le mofuta oa liphetoho tsa metabolism ea lipid, ho ba teng ha dyslipidemia ea lelapa le coheroffike ea atherogenicity.
Teko ea pele e ikhethang ke ho supa sebopeho sa lipid kapa qeto ea k'holeseterole e felletseng le likaroloana tsa eona.
Letšoao le ka sehloohong la lipids ke boemo ba cholesterol e felletseng, palo ea lipoprotein tse fokolang (karoloana ea atherogenic), palo ea lipoprotein tse phahameng (antiatherogenic), triglycerides, chylomicrons.
Ka tloaelo, boemo ba cholesterol e felletseng e tsoa ho 3,1 ho isa ho 5mmol ka litha e le ngoe, karolo ea HDL ha e ka tlase ho 1 mmol ka litha e le ngoe, litaba tsa LDL le VLDL li ka fihla ho 3 mmol, triglycerides e fihla ho 1,7 mmol.
Keketseho ea matšoao ohle, ntle le HDL, e bonts'a tlolo ea metabolism ea lipid le monyetla o moholo oa ho nts'etsopele ea atherosulinosis ka thibelo e kholo ea phallo ea mali esita le ho senyeha ha methapo ea methapo. Hape, keketseho ea triglycerides feela ke letšoao le sa lokelang, le bonts'ang nts'etsopele ea angina pectoris le lefu la tsoekere.
Plasma electrophoresis e etsoa ho tseba maemo a lipoprotein - liprotheine tsa liprotheine tse tsamaisang mafura. Ka hyperlipidemia, palo ea lipoprotein tse tlaase le tse fokolang haholo lia eketseha, mme HDL, ka lehlakoreng le leng, ea fokotsoa. Tlhahlobo ena ha e hloke boitokiso bo khethehileng, e kanna ea se ke ea etsoa ka mpeng e se nang letho, mali a venous a sebetsa e le thepa.
Coheroffity ea atherogenicity e ikemiselitse - palo ea HDL e tlositsoe ho boleng ba lipids tse felletseng mme sephetho se arotsoe ke palo ea lipids tse phahameng haholo.
Lits'oants'o tse tloaelehileng tsa letšoao lena li ho fihla ho likhato tse 3.
Boemo bo kopanetsoeng ho tloha ho 3 ho isa ho 4 bo bolela kotsi e kholo ea ho ntšoa ha methapo ea methapo ea pelo, ho eketseha ha lisele tsa methapo ea methapo ea methapo e fetang 5.
Apo-B-lipoprotein ke protheine ea lipalangoang e fetisang li-triglycerides ho tloha ka mpeng ho ea sebeteng bakeng sa litlatsetso tsa mafura a emeng.
Tloaelo ho banna e tsoa ho 60 ho isa ho 138 mg / dl, bakeng sa basali - 52 - 129.
Ka keketseho ea boemo ba eona, ka ho latellana, li-triglycerides le tsona lia eketseha, e leng lets'oao le sa rateheng la kliniki.
Mekhoa ea tlhahlobo ea immunosological le enzyme e kopantsoeng le "enzunicor" e etsa hore ho khonehe ho tseba ho ba teng ha li-antibodies le li-immune system tse potileng. Nts'etsopele ea maloetse a pelo e amahanngoa le boteng ba plasma ea antibodies ho cardiolipin le cardiomyosin, e leng likarolo tsa myocardial. Monyetla oa mekhoa ena ke ho nepahala ho phahameng ho khetholla tloaelo ea liphetoho tsa methapo, ho hloka koetliso e khethehileng.
Ho khetholla mokhoa oa ho kopanya mali, ho etsoa coagulogram.
Ho na le matšoao a 'maloa ho eona, tse ka sehloohong ke palo ea liplatelete, nako ea prothrombin, nako ea fibrinogen, nako ea thrombin, nako ea ts'ebetso ea karolo ea thromboplastin, le tlhahlobo ea ethanol.
Tloaelo ea liplatelete e tsoa ho 180 ho isa ho 320 Giga ka litha e le ngoe (kapa likhato tse 10 ho isa ho 9 ka litha e le ngoe), nako ea prothrombin ho tloha ho metsotsoana e 10 ho isa ho e 16, fibrinogen ho tloha ho ligrama tse 2 ho isa ho tse 4 ka litha e le ngoe, nako ea thrombin ho tloha ho metsotsoana e 12 ho isa ho e 18. tlhatlhobo - e le 'ngoe kapa minus.
Mekhoa ea ho hlahloba lintho tse fumanehang
Ho netefatsa kapa ho hanyetsa tlhahlobo eo, ho sebelisoa mekhoa e matla ea ho hlahloba mmele oa mokuli.
Ts'ebeliso ea mekhoa ena e lumella ho supa sebaka sa lefu lena.
Ntle le moo, tšebeliso ea mahlale a khethehileng a tlhahlobo ea bongaka e etsa hore ho khonehe ho tseba tekanyo ea kholo ea lefu lena le ho fumana ts'ebeliso ea mekhoa e meng ea ho pepeseha bongaka 'meleng.
Mekhoa ea ho hlahloba hore na o sebetsa joang e kenyelletsa:
- X-ray ea sefuba, x-ray ea methapo ea mali (angiography - aortography, coronarography).
- Tekanyo ea khatello ea mali le qeto ea index ea ankle-brachial.
- Electrocardiography, echocardiography.
- Dopplerography kapa ultrasound ea methapo ea kutlo.
- Liteko tsa khatello ea maikutlo ho fumana hore na ischemia e fokola hakae.
- MRI kapa MSCT ea methapo ea methapo (aorta, likepe tsa mokokotlo le likhakanyo tse tlase).
Ho radiograph ea litho tsa mokokotlo oa sefuba, keketseho ea boholo ba pelo, e leng mafapha a leqeleng, keketseho ea leholiotsoana la methapo, ho kobeha ha methapo ea methapo, likhokahano tsa marako a likepe li bonoa. Lits'oants'o tsa methapo ea pelo le pelo li ka etsahala. Hape, ha methapo ea methapo ea methapo e kenella ts'ebetsong, sebopeho sa pulmonary se matlafatsoa ka lebaka la karolo ea methapo.
Ho electrocardiography, liphetoho tse ngata ha li na taba, 'me li hlaha ka lebaka la ischemia ea myocardial. Litsebi tsa mafu a kelello tse kang matšoao a hypertrophy ea ventricular e ka letsohong le letšehali, arrhythmias le phetoho ea li-conduction (blockade) lia hlokomeloa. ECG e sebelisoa ho fumanoa ha atherosclerosis ea pelo.
Karolo ea bohlokoa ea tlhahlobo ke mehato ea khatello ea khafetsa. Bakuli ba lokela ho eletsoa ho lekanya khatello ea mali letsatsi le letsatsi kapa hang ka matsatsi a mabeli, boloka lethathamo la litekanyo. Ho lekola joalo ho tla thusa ho bona ho phahama ha khatello methating ea pele le ho thibela ponahalo ea matšoao a bohata ka "hypertension ea kobo e tšoeu."
Nakong ea tekanyo, index ea ankle-brachial e boetse e baloa, ke hore, tekanyo ea khatello ea mali lehetleng le mokokotlong. Sekhahla se tloaelehileng sa tekanyo e joalo se tsoa ho 1 ho isa ho 1.3.
Boithuto bo ikhethileng ba ho khetholla patency ea vascular:
- angiography;
- dopplerography;
- monahano oa matla a khoheli;
- multispiral computed tomography.
Angiography ke thuto e fapaneng le ea methapo ea mali, e kenyang li-agents tsa phapang maling. Mokhoa ona o u lumella ho tseba hore na methapo ea methapo le bophara ba bophara ba methapo ea methapo e joang, bona le boemo ba ho se lekane le boholo ba eona.
Dopplerografia ea methapo ea mali kapa ultrasound - tlhahlobo e nang le tsebo, ho tlatselletsa le menyetla e ka holimo, e boetse e khetholla lebelo la phallo ea mali ka har'a lijana. Khafetsa, ho etsoa tlhahlobo ea boithuto ba motho kapa "triplex".
Lithuto tsa Tomographic hajoale ke mekhoa ea bohlokoa ka ho fetisisa e khethollang ea ho khetholla li-plagios tsa lefutso. Mohloli oa boitšoaro o ts'oana le angiography - moemeli ea fapaneng o kenngoa kahare kahare 'me mokuli o behiloe ka tomograph.
U sebelisa MRI kapa CT, u ka tseba sebopeho sa methapo ea mali, sebaka sa eona, bofokoli le phallo ea lumen, boemo ba phallo ea mali le methapo ea methapo.
Matšoao a atherosclerosis a hlalositsoe videong ena.
