Kutanthauzidwa ngati kuwonongeka kwa mitsempha yaying'ono yamagazi, microangiopathy imawonedwa m'matenda osiyanasiyana. Itha kuyambitsa kuzunzika kwa ziwalo zosiyanasiyana, zomwe zimakhala ndi zotsatira zosinthika kwambiri kutengera ngati zimalumikizidwa ndi matenda ashuga (diabetesic microangiopathy) kapena thrombotic microangiopathy syndrome. Kulephera kwa ziwalo (khungu, kulephera kwaimpso, kuwonongeka kwa ziwalo zambiri, ndi zina zotero) kumawonedwa pazochitika zazikulu kwambiri komanso ngati kuchedwa kapena kulephera kwa chithandizo.

Tanthauzo

Microangiopathy imatanthauzidwa ngati kuwonongeka kwa mitsempha yaying'ono yamagazi, makamaka ma arterioles ndi arteriolar capillaries omwe amapereka ziwalo. Zitha kuchitika pazikhalidwe zosiyanasiyana:

• Diabetesic microangiopathy ndizovuta zamtundu 1 kapena 2 shuga. Kuwonongeka kwa mitsempha nthawi zambiri kumakhala m'maso (retinopathy), impso (nephropathy) kapena mitsempha (neuropathy). Motero kungayambitse kuwonongeka kwa maso mpaka khungu, kulephera kwa impso, kapena kuwononga mitsempha.
• Thrombotic microangiopathy ndi gawo la gulu la matenda omwe ziwiya zazing'ono zimatsekedwa ndi magazi (mapangidwe amagulu a mapulateleti amagazi). Imadziwonetsera mu ma syndromes osiyanasiyana okhudzana ndi kuperewera kwa magazi (ochepa mapulateleti ndi maselo ofiira a magazi) ndi kulephera kwa ziwalo chimodzi kapena zingapo monga impso, ubongo, matumbo kapena mtima. Mitundu yapamwamba kwambiri ndi thrombotic thrombocytopenic purpura, kapena Moschowitz syndrome, ndi hemolytic uremic syndrome. 

Zimayambitsa

Diabetesic microangiopathy

Matenda a shuga a microangiopathy amayamba chifukwa cha hyperglycemia yomwe imayambitsa kuwonongeka kwa mitsempha. Zilondazi zimayamba mochedwa, ndipo matendawa amapezeka pakatha zaka 10 mpaka 20 zakukula kwa matenda. Zimakhala zoyamba kwambiri pamene shuga wa m'magazi sakuyendetsedwa bwino ndi mankhwala (glycated hemoglobin, kapena HbA1c, yokwera kwambiri).

Mu diabetesic retinopathy, kuchuluka kwa shuga m'magazi kumayambitsa ma micro-occlusions am'mitsempha. Dilations yaing'ono ya ziwiya ndiye analenga kumtunda (microaneurysms), kumabweretsa kukha magazi pang'ono (punctiform retinal hemorrhages). Kuwonongeka kwa mitsempha yamagazi kumabweretsa maonekedwe a retina osathiriridwa bwino, omwe amatchedwa kuti ischemic. Pa gawo lotsatira, ziwiya zatsopano zachilendo (neovessels) zimachulukana pamwamba pa retina mosokonezeka. Mu mitundu yoopsa, proliferative retinopathy imayambitsa khungu.

Mu diabetesic nephropathy, microangiopathy imayambitsa zotupa m'mitsempha yomwe imapereka glomeruli ya impso, zomwe zimaperekedwa kuti zisefe magazi. Kufooka kwa makoma a zombo ndi kuthirira kosakwanira kumatha kusokoneza ntchito ya impso.

Mu diabetesic neuropathy, kuwonongeka kwa minyewa kumabwera chifukwa cha microangiopathy, kuphatikiza kuwonongeka kwachindunji kwa ulusi wa mitsempha chifukwa cha shuga wambiri. Zitha kukhudza mitsempha yozungulira, yomwe imayang'anira minofu ndi kufalitsa zowawa, kapena mitsempha mu dongosolo lamanjenje la autonomic lomwe limayang'anira kugwira ntchito kwa viscera.

Microangiopathie thrombotique

Mawu akuti thrombotic microangiopathy amatanthauza matenda omwe ali ndi njira zosiyana kwambiri ngakhale ali ndi mfundo zofanana, zomwe zimayambitsa zomwe sizidziwika nthawi zonse.

Thrombotic Thrombocytopenic Purpura (TTP) nthawi zambiri imakhala ndi chiyambi cha autoimmune. Thupi limapanga ma antibodies omwe amalepheretsa kugwira ntchito kwa enzyme yotchedwa ADAMTS13, yomwe nthawi zambiri imalepheretsa kusanjika kwa mapulateleti m'magazi. 

Nthawi zambiri, pali kuchepa kwa ADAMTS13 kokhazikika komwe kumalumikizidwa ndi masinthidwe obadwa nawo.

Matenda a hemolytic uremic (HUS) amachititsa kuti anthu ambiri azidwala matenda. Mitundu yosiyanasiyana ya mabakiteriya yomwe imayikidwa imatulutsa poizoni wotchedwa shigatoxin, yomwe imawononga ziwiya. Koma palinso HUS yobadwa nayo, yolumikizidwa ndi khansa, kutengera kachilombo ka HIV, kuika m'mafupa kapena kumwa mankhwala enaake, makamaka mankhwala oletsa khansa.

matenda

Kuzindikira kwa microangiopathy kumatengera kuwunika kwachipatala. Dokotala atha kuyesa mayeso osiyanasiyana kutengera zomwe zachitika komanso zizindikiro zake, mwachitsanzo:

• fundus kapena angiography kuti azindikire ndikuwunika matenda a shuga retinopathy,
• kutsimikiza kwa micro-albumin mu mkodzo; kuyesa kwa creatinine m'magazi kapena mkodzo kuti muwone ntchito ya impso,
• kuchuluka kwa magazi kuti muwone ngati kutsika kwa mapulateleti ndi maselo ofiira amagazi m'magazi,
• fufuzani matenda,
• kujambula (MRI) kwa kuwonongeka kwa ubongo

Anthu okhudzidwa

Diabetesic microangiopathies ndizofala kwambiri. Pafupifupi 30 mpaka 40% ya odwala matenda ashuga amakhala ndi retinopathy pamagawo osiyanasiyana, kapena pafupifupi anthu miliyoni miliyoni ku France. Ndiwo omwe amayambitsa khungu asanakwanitse zaka 50 m'maiko otukuka. Matenda a shuga ndiwonso omwe amayambitsa matenda a aimpso ku Europe (12 mpaka 30%), ndipo kuchuluka kwa odwala omwe ali ndi matenda amtundu wa 2 amafunikira chithandizo cha dialysis.

Thrombotic microangiopathies ndizochepa kwambiri:

• Mafupipafupi a PPT akuyerekeza 5 kwa 10 milandu yatsopano pa anthu milioni pachaka, ndi chiwerengero cha akazi (3 amayi amakhudzidwa ndi amuna a 2). Hereditary PTT, yomwe imawonedwa mwa ana ndi makanda, ndi mtundu wosowa kwambiri wa thrombotic microangiopathy, ndi milandu khumi ndi iwiri yokha yomwe imadziwika ku France.
• Mafupipafupi a SHUs ndi ofanana ndi a PPT. Ana ndi omwe amakhudzidwa kwambiri ndi matenda omwe amawatsogolera ku France, HUS mwa akuluakulu nthawi zambiri chifukwa cha matenda omwe amapezeka paulendo (makamaka ndi wothandizira wa kamwazi).

Zowopsa

Chiwopsezo cha diabetesic microangiopathy chikhoza kuchulukitsidwa ndi majini. Kuthamanga kwa magazi, komanso nthawi zambiri zomwe zimayambitsa matenda amtima (kunenepa kwambiri, kuchuluka kwa lipids m'magazi, kusuta), zitha kukhala zokulitsa.

PPT ikhoza kulimbikitsidwa ndi mimba.

Diabetesic microangiopathy

Zizindikiro za diabetesic microangiopathy zimayikidwa mobisa. Chisinthikocho chimakhala chete mpaka kuwoneka kwa zovuta:

• kusokonezeka kwa masomphenya komwe kumalumikizidwa ndi retinopathy,
• kutopa, vuto la mkodzo, kuthamanga kwa magazi, kuchepa thupi, kugona, kukokana, kuyabwa, etc.
• kupweteka, dzanzi, kufooka, kuyaka kapena kumva kulasalasa kwa zotumphukira neuropathy; phazi la matenda a shuga: matenda, zilonda kapena kuwonongeka kwa minofu yakuya ya phazi ndi chiopsezo chachikulu chodulidwa; zovuta zogonana, kugaya chakudya, mkodzo kapena mtima pomwe neuropathy imakhudza dongosolo lamanjenje la autonomic ...

Microangiopathie thrombotique

Zizindikiro zake zimakhala zosiyanasiyana, ndipo nthawi zambiri zimayamba.

Kugwa kwa mlingo wa mapulateleti a magazi (thrombocytopenia) mu PTT kumayambitsa magazi, omwe amawonetsedwa ndi maonekedwe a mawanga ofiira (purpura) pakhungu.

Kuperewera kwa magazi m'thupi komwe kumakhudzana ndi kuchepa kwa maselo ofiira a magazi kumatha kuwonetsa kutopa kwambiri komanso kupuma movutikira.

Kupweteka kwa chiwalo kumasiyana mosiyanasiyana koma nthawi zambiri kumakhala kofunikira. Zikavuta kwambiri, pakhoza kukhala nthawi yomweyo kugwa kwa masomphenya, kuwonongeka kwa miyendo, mitsempha (kusokonezeka, chikomokere, etc.), matenda a mtima kapena m'mimba, etc. Kukhudzidwa kwa impso nthawi zambiri kumakhala kochepa mu PTT, koma kungakhale koopsa mu HUS. Mabakiteriya omwe amachititsa HUS ndi omwe amayambitsa matenda otsekula m'mimba nthawi zina.

Chithandizo cha diabetesic microangiopathy

Chithandizo cha matenda a shuga

Chithandizo cha matenda a shuga chimapangitsa kuti achedwetse kuyambika kwa microangiopathy ndikuchepetsa zotsatira za kuwonongeka kwa ziwiya. Zimakhazikitsidwa paukhondo ndi zakudya (zakudya zoyenera, kuchita masewera olimbitsa thupi, kuchepa thupi, kupewa fodya, ndi zina zotero), kuyang'anira kuchuluka kwa shuga m'magazi komanso kukhazikitsa chithandizo choyenera chamankhwala (mankhwala oletsa matenda a shuga kapena insulin).

Chithandizo cha matenda a shuga a retinopathy

Katswiri wamaso anganene chithandizo cha laser photocoagulation choloza zotupa zoyambirira za retina kuti zisapitirire patsogolo.

Pakapita patsogolo kwambiri, pan-retinal photocoagulation (PPR) iyenera kuganiziridwa. Chithandizo cha laser chimakhudzanso retina yonse, kupatula macula omwe ali ndi masomphenya apakati.

Pazovuta kwambiri, chithandizo cha opaleshoni nthawi zina chimakhala chofunikira.

Chithandizo cha matenda a shuga a nephropathy

Kumapeto kwa matenda a aimpso, ndikofunikira kulipirira kusagwira ntchito kwa impso mwina ndi dialysis kapena kuyika aimpso (kumuika).

Kuwongolera kwa matenda a shuga a neuropathies

Magulu osiyanasiyana a mankhwala (antiepileptics, anticonvulsants, tricyclic antidepressants, opioid analgesics) angagwiritsidwe ntchito polimbana ndi ululu wa neuropathic. Chithandizo cha symptomatic chidzaperekedwa pakachitika nseru kapena kusanza, kusayenda bwino, vuto la chikhodzodzo, ndi zina zambiri.

Microangiopathie thrombotique

Thrombotic microangiopathy nthawi zambiri imalungamitsa kukhazikitsidwa kwa chithandizo chadzidzidzi m'chipinda chosamalira odwala kwambiri. Kwa nthawi yayitali, matendawo anali odekha chifukwa panalibe chithandizo choyenera komanso matendawo anali osagwira ntchito. Koma kupita patsogolo kwapangidwa ndipo tsopano kulola machiritso nthawi zambiri.

Chithandizo chamankhwala cha thrombotic microangiopathy

Zimakhazikitsidwa makamaka pakusinthana kwa plasma: makina amagwiritsidwa ntchito m'malo mwa plasma ndi plasma kuchokera kwa wopereka mwaufulu. Mankhwalawa amachititsa kuti azitha kupereka mapuloteni a ADAMTS13 omwe alibe PTT, komanso kuchotsa magazi a wodwalayo a autoantibodies (HUS of autoimmune origin) ndi mapuloteni omwe amalimbikitsa mapangidwe a magazi.

Kwa ana omwe akudwala HUS yolumikizidwa ndi shigatoxin, zotsatira zake nthawi zambiri zimakhala zabwino popanda kufunikira kwa kusinthana kwa plasma. Nthawi zina, kusinthana kwa plasma kuyenera kubwerezedwa mpaka kuchuluka kwa mapulateleti kukhazikika. Zimakhala zogwira mtima, koma zimatha kuyambitsa zovuta: matenda, thrombosis, ziwengo ...

Nthawi zambiri amagwirizanitsidwa ndi mankhwala ena: corticosteroids, antiplatelet mankhwala, ma antibodies monoclonal, etc.

Chithandizo cha matenda ndi maantibayotiki ayenera payekha payekha.

Kusamalira zizindikiro zogwirizana 

Njira zotsitsimutsa zingakhale zofunikira panthawi yachipatala mwadzidzidzi. Kupezeka kwa zizindikiro za minyewa kapena zamtima kumayang'aniridwa mosamala.

M'kupita kwa nthawi, zizindikiro monga kulephera kwaimpso nthawi zina zimawonedwa, zomwe zimalimbikitsa chithandizo chamankhwala.

Kukhazikika kwa shuga m'magazi komanso kulimbana ndi zinthu zoopsa ndiye njira yokhayo yopewera matenda a diabetesic microangiopathies. Ziyenera kuphatikizidwa ndi kuyang'anira nthawi zonse kwa maso ndi ntchito ya impso.

Mankhwala a antihypertensive amateteza impso. Ndikoyeneranso kuchepetsa kudya kwa mapuloteni a zakudya. Mankhwala ena omwe ali poizoni ku impso ayenera kupewedwa.

Kupewa kwa thrombotic microangiopathies sikutheka, koma kuwunika pafupipafupi kungakhale kofunikira kuti mupewe kuyambiranso, makamaka kwa anthu omwe ali ndi TTP.