Atherosclerosis ikupitiliza kukhala imodzi mwazofufuza zazikulu kwambiri. Ambiri mwa matenda omwe ali ndi mitundu yosiyanasiyana ya matenda amawonetseredwa makamaka ndi atherosulinosis, ndipo mwa iwo amayamba kubalirana; sitiroko; aneurysms pamimba; miyendo yam'munsi ischemia.
Amatsimikizira kuchepa komanso kufa. Zachidziwikire, kapangidwe ka zolembedwa za atherosselotic ndi gawo lalikulu pakuchita izi. Zowonadi, ndikuthokoza chifukwa cha kapangidwe kapadera kamapangidwe kameneka komwe kamatulukiridwa komwe kamatulukira, kamene kamayambitsa kuwonongeka m'moyo wa munthu, ndipo nthawi zina kumwalira. Koma, ngakhale pali matenda ambiri azachipatala, chiwonetsero chachikulu cha atherosulinosis ndichinthu chofala pathogenetic: kupasuka kwa zolengeza za atherosulinotic.
Mavuto a plaque amatha kusiyanasiyana malinga ndi ming'alu yaying'ono kapena kukokoloka kwa malo okhala zolembazo. Muzochitika zonsezi, osachepera ena mwa kupangika kwa magazi kumachitika.
Mimba yam'mimba nthawi zambiri imakhala ndi vuto lopanga zolembera, komanso zovuta zomwe zimakhudzana ndi chidacho.
Mu chotengera chachikulu ichi, kuwonongeka kwa zolembera ndi thrombosis sikumatha ndi mawonekedwe a lumen ndipo kungayambitse zilonda zapamwamba kwambiri, kuphatikiza zigawo zazikulu za khoma la aortic, zomwe zimatha kuwonedwa nthawi zambiri odwala okalamba. Kuphatikiza pa gawo losagwirizana ndi atherosulinosis pakupanga aneurysm yam'mimba, thrombosis yam'kamwa imayambitsa chida chotsika chodabwitsa cha zovuta zamatenda kwambiri mwa odwalawa, ngakhale embolism ya cholesterol imatha kupezeka kawiri kawiri impso ndi khungu pakhungu.
Komabe, sizikudziwika bwino momwe zinthu zosiyanasiyana zokhudzana ndi chilengedwe, zomwe zimamasulidwa ku kukokoloka kwa msempha, zingakhale ndi thupi la munthu.
Kodi pali kusiyana kotani pakati pa malo okhazikika ndi osakhazikika?
M'matumba ang'onoting'ono, monga ma coronary artery, occlusive thrombosis ndi pafupipafupi ndipo nthawi zambiri imapangitsa kupezeka kwa ziphuphu. Chifukwa chake, m'mitsempha yama coronary, plaque cleavage yaphunziridwa kwambiri, ndipo maubwenzi angapo apezeka pakati pa kapangidwe kake, kuchuluka kwa kuphatikizira kwa magazi ndi mitundu ya ischemic coronary syndromes ya odwala. Kuwona kumeneku kwadzetsa lingaliro la malo osakhazikika a atherosulinotic malo - zolembedwa zokhala ndi mawonekedwe osakhazikika, zomwe zimapangitsa kuti pakhale matenda osakhazikika a mtsempha wamagazi.
Ntchito zambiri zofufuzira zayang'ana kwambiri pakuwona vuto ngati cholembera chosakhazikika cha atherosulinotic.
Kapangidwe ka atherosulinotic plaque ndi chifukwa cha kuyanjana kwam ma cell mkati mwa mitsempha yomwe imachitika pakati pa maselo akuluakulu a khoma la chotengera ndi ma cell a chitetezo (maselo oyera).
Kusokonezeka kwa madzi amderalo ndi ma lipids ngati gulu loyendetsa zolembera ndizofunikira pantchitoyi. Kapangidwe ka atherosselotic kapangidwe kake, kamawonetsa kapangidwe kake ka kapangidwe ka michere, kamene kali pakatikati ka zigulu zakunja ndi zinthu zina zowola.
Minofu yowoneka bwino imapereka umphumphu woyika.
Atheroma ndiofatsa, ofooka, komanso thrombogenic kwambiri. Chipilalachi chili ndi mitundu yambiri ya zam'madzi za m'mimba ndipo zimakhala zopanda maselo amoyo, koma zimatha malire pamalowo.
Kupanda malire kwa phagocytosis wa oxidized LDL mothandizidwa ndi macrophages kumawatsogolera kuti afe. Kufa kwa zinthu izi kumathandiza kwambiri pakupanga ndi kukula kwa atheroma komanso kumanga kwa lipids ku ma collagen ulusi ndi proteinoglycans.
Kusiyana kwakapangidwe kapangidwe kazinthu sikumadziwika: Kafukufuku wa histopathological wa zolembedwa zazikuluzikulu adawonetsa kusiyana kwakukulu mu:
- kukula kwa zipewa zamkati;
- kukula kwa atheroma.
Kuphatikiza apo, kusiyana pamlingo wa mawonekedwe a dystrophic kuwululidwa.
Phunziroli ndilofunika kwambiri, chifukwa lidawonetsa mitundu yachilendo ya zotupa zomwe zimakhudzana ndi chiwonetsero chachikulu cha matenda a atherosulinotic.
Kuwerengera kwa michere yam'manja komanso ma lipids mu zolembera
Kuphatikiza kulikonse kwa makulidwe a khoma ndi kukula kwa atheroma kumatha kuchitika. Makamaka michere yokhazikika ya fibrotic imakhala ndi minyewa yosasintha ndipo ndi ochepa okha omwe amakhala ndi ma lipid akunja kapena alibe lipid konse. M'mitsempha yama coronary, zotupa zambiri zotere zimangokhala chete ndipo pakapita nthawi, zimatha kuyambitsa kukhazikika kwa angina pectoris.
Nthawi zambiri malo omwe ali pachiwopsezo amadziwika ndi kupezeka kwakukulu kwa lipid ndipo amakhala ndi kapu kochepa thupi kapena komwe kulibe.
Nthawi zambiri pamakhala malo okhala ndi milomo yokhala ndi mapangidwe a coronary thrombosis.
Malo okhala ndi Lipid amadziwika kuti ndi "misozi."
Si malo onse odwala omwe ali ndi matenda okhazikika pamitsempha.
Kafukufuku awonetsa kuti makumi asanu ndi limodzi muzana mwa malo amenewa ndi am'mafupa, koma 40% anali ndi lipids zakunja. Mwa odwala 15% okha, zolembera zonse zimayambitsa kukula kwa stenosis ndipo zinali zowoneka bwino, pomwe 13% mwa odwala pafupifupi malo onse anali ndi lipid pachimake. M'malo mwake, odwala ambiri anali ndi mitundu yosiyanasiyana ya zolembera.
Kusiyana kwazomwe zimapangidwa mu mbiri ya zolembedwazo ndi ubale wake ndi kapangidwe ka khoma lakale zimakhala ndi zotsatirapo zina.
Mwachitsanzo, mitundu yopanda makoma nthawi zambiri imaphulika. Mphamvu zamakina zamkati zimathandizira kuti ziwonekere.
Poterepa, kuphatikizika kwa minofu ya khoma la fibrous komanso mawonekedwe amkati mwapangidwe awa ndikofunikira.
Njira yopanga mapangidwe
Atherogenesis ndi chitukuko cha malo opangira ma atheromatous.
Amadziwika ndi kukonzanso kwina, zomwe zimatsogolera kudzikundikira kwa mafuta am'madzi otchedwa plaques.
Kukula kwa zolembedwa za atheromatous ndi njira yomwe imayamba pang'onopang'ono zaka zingapo kudzera munthawi zovuta kuzinthu zingapo zomwe zimachitika mkati mwa khoma lakale, komanso chifukwa cha zinthu zambiri zomwe zimazungulira mtima.
Chimodzi mwazoyerekeza zaposachedwa zikuwonetsa kuti pazifukwa zosadziwika, maselo oyera, monga monocytes kapena basophils, amayamba kuukira endothelium ya arterial lumen mu minofu yamtima.
Kenako kutupa kumayamba, komwe, kumayambitsa mapangidwe a atheromatous plaque mwachindunji mu umwini wa membrane, gawo la khoma la chotengera lomwe lili pakati pa endothelium ndi nembanemba.
Gawo lalikulu lazowonongeka ili ndi mawonekedwe awa:
- mafuta ochulukirapo;
- ulusi wa collagen;
- elastin.
Poyamba, kukula kwa zolengeza kumachitika, kumangokulitsa khoma kumawonedwa popanda kupendekera.
Stenosis ndi gawo lochedwa ndipo nthawi zambiri limakhala chifukwa chobwereza-bwereza komanso kuchiritsa, osati chifukwa chotsatira.
Atherogenesis oyambirira amadziwika ndi kupendekera kozungulira ma monocytes m'magazi (mtundu wa khungu loyera) kupita ku bedi lamimba, mu endothelium, kenako kusamukira kwawo m'malo a endothelial ndikuwonjezeranso ku monocytic macrophages.
Izi zimathandizidwa ndi makulidwe a oxopation a lipoprotein tinthu mkati mwa khoma, pansi pa maselo a endothelial. Mwanjira iyi, gawo lowonjezera limaseweredwa ndi kuchuluka kwa shuga m'magazi.
Mpaka kumapeto, pakadali pano, makinawa sanaphunziridwe, ndipo mafambo amafuta amatha kuwonekera ndikutha.
Yoyambira kapangidwe ka atheroscrotic zolengeza
Amadziwika kuti mapangidwe omwe ali pamwambawa atha kukhala ndi mawonekedwe osiyana.
Plaque imatha kusiyanasiyana momwe imapangidwira ndipo imakhala yoyambitsa kukula kwa zovuta zina mthupi.
Ndizigawo zazikulu za zolembedwa za atherosulinotic zomwe zimakhudza kuzindikira komwe wodwalayo adzapatsidwe.
Mitundu iwiri yamapepala ikhoza kusiyanitsidwa:
- Fibro-lipid (fibro-fat) cholembera amadziwika ndi kudzikundikira kwa maselo okhala ndi lipid pansi pamitsempha, ngati lamulo, popanda kupendekera ku lumen chifukwa chakukulira kulimba kwa khoma la mtsempha womanga wosanjikiza minofu. Pansi pa endothelium pali cholembera chamtunduwu chomwe chimakwirira "maziko" a zolembazo. Mphamvuyi imakhala ndi maselo okhala ndi lipid-odzaza (ma macrophages ndi maselo osalala owoneka bwino) okhala ndi cholesterol yambiri ndi cholesterol ester, fibrin, proteinoglycans, collagen, elastin ndi zinyalala za cell. Izi malembedwe nthawi zambiri zimakhala zowononga kwambiri thupi zikaphulika. Makristali a cholesterol amathanso kupanga nawo gawo popanga matupi a plaque.
- Chikwangwani chopindika chimapangidwanso pansi pa khoma, mkati mwa khoma la mtsempha, chomwe chimapangitsa kukula ndikukula kwa khoma, ndipo nthawi zina chimafooketsedwa ndi lumen ndi kufinya kwina. Fibrous plaque imakhala ndi collagen fibers (eosinophilic), calcium calcium (hematoxylinophilic) ndipo, osadziwika kwambiri, okhala ndi lipid.
M'malo mwake, gawo la minofu lakhoma la minyewa limapangika ma aneurysms ang'onoang'ono, kapena, lalikulu lokwanira kugwirizira atheroma yamakono.
Gawo lamkati mwa makoma a mitsempha limakhalabe lolimba, ngakhale atapangidwanso kuti alipire malo okhala.
Zotheka ndi zovuta zopanga zolembera
Kuphatikiza pa thromboembolism, kukula kwambiri kwa zotupa za atherosulinotic kungayambitse kuvuta kwathunthu kwa lumen. Nthawi zambiri amakhala asymptomatic mpaka stenosis ya lumen imakhala yayikulu kwambiri (nthawi zambiri imakhala yoposa 80%) kotero kuti magazi omwe amapezeka m'matumbo (minofu) amakhala osakwanira, omwe amachititsa kuti ischemia ipangidwe.
Pofuna kupewa matenda awa, ndikofunikira kudziwa kapangidwe ka maphunziro ndikupereka chithandizo choyenera.
Zilonda za atherosulinotic kapena zolembera zamtundu wa atherosulinotic zimagawika m'magulu awiri:
- khola;
- komanso wosakhazikika (amatchedwanso osatetezeka).
Matenda a zotupa za atherosulinotic ndi zovuta kwambiri.
Malo osasunthika a atherosulinotic, omwe nthawi zambiri amakhala asymptomatic, ali ndi zinthu zambiri za matrix akunja ndi maselo osalala a minofu.
Malo osakhazikika ali ndi ma macrophages ndi ma cell of foam, ndipo matrix amtundu wa extracellular omwe amalekanitsa zotupa kuchokera ku lumen ya artery (yomwe imadziwikanso kuti caprous cap) nthawi zambiri imakhala yofooka komanso yomwe imakonda kupasuka.
Zolumikizira za caprous cap zimawononga zinthu za thrombogenic ndipo pamapeto pake zimayambitsa kupangidwe kwa thrombus. Zotsatira zake, intraluminal thrombi imatha kutseka mitsempha (mwachitsanzo, corlary occlusion), koma nthawi zambiri imalekanitsa, imayenda pakubwera kwa magazi ndipo, pomaliza, imatseka nthambi zazing'onoting'ono zomwe zimayambitsa matenda a thromboembolism ndi atherosclerotic cardiossteosis.
Momwe mungathetsere zolemba za cholesterol zafotokozedwa mu kanema m'nkhaniyi.
