ʻIke ʻia e like me ka hōʻino ʻana i nā kīʻaha koko liʻiliʻi, ʻike ʻia ka microangiopathy i nā ʻano pathologies. Hiki iā ia ke hoʻoulu i ka ʻeha i loko o nā ʻāpana like ʻole, me nā hopena ʻokoʻa e pili ana i ka pili ʻana me ka maʻi diabetes (diabetic microangiopathy) a i ʻole me ka thrombotic microangiopathy syndrome. ʻIke ʻia nā hemahema o ke kino (makapō, hōʻino ʻole ʻana, ʻeha nui o ke kino, a me nā mea ʻē aʻe) i nā hihia koʻikoʻi a i ka wā o ka lohi a i ʻole ka mālama ʻana.

Definition

Ua wehewehe ʻia ʻo Microangiopathy ma ke ʻano he pōʻino i nā kīʻaha koko liʻiliʻi, a ʻoi aku ka nui o nā arterioles a me nā capillaries arteriolar e hoʻolako i nā kino. Hiki ke hana ma lalo o nā kūlana like ʻole:

• ʻO ka microangiopathy diabetic kahi hoʻopiʻi o ka maʻi diabetes type 1 a i ʻole 2. ʻO ka pōʻino o nā moku aia ma ka maka (retinopathy), kidney (nephropathy) a i ʻole nerve (neuropathy). Hiki iā ia ke hoʻopōʻino i ka ʻike a hiki i ka makapō, ka hōʻino ʻole ʻana o ke kīpē, a i ʻole ka pōʻino o ke aʻalolo.
• ʻO ka thrombotic microangiopathy kahi ʻāpana o kahi pūʻulu o nā maʻi kahi i hoʻopaʻa ʻia ai nā moku liʻiliʻi e nā clots koko (ka hoʻokumu ʻana o nā aggregates o nā platelets koko). Hōʻike ʻo ia iā ia iho i nā maʻi like ʻole e pili ana i nā ʻano like ʻole o ke koko (nā haʻahaʻa haʻahaʻa o nā platelets a me nā ʻulaʻula ʻulaʻula) a me ka hiki ʻole o hoʻokahi a ʻoi aku paha o nā kino e like me ke kīpē, ka lolo, ka ʻōpū a me ka puʻuwai. ʻO nā ʻano maʻamau ka thrombotic thrombocytopenic purpura, a i ʻole Moschowitz syndrome, a me ka hemolytic uremic syndrome. 

Nā kumu

ʻO ka microangiopathy maʻi diabetes

ʻO ka maʻi maʻi microangiopathy ka hopena mai ka hyperglycemia mau e hoʻopōʻino ai i nā moku. Hoʻokumu ʻia kēia mau ʻeha ma hope, me ka ʻike pinepine ʻana ma hope o 10 a 20 mau makahiki o ka piʻi ʻana o ka maʻi. ʻOi aʻe lākou i ka wā e hoʻomalu maikaʻi ʻole ʻia ke kō koko e nā lāʻau (glycated hemoglobin, a i ʻole HbA1c, kiʻekiʻe loa).

I ka maʻi maʻi retinopathy, ʻoi aku ka nui o ka glucose i alakaʻi i nā micro-occlusions kūloko o nā moku. Hana ʻia nā dilations liʻiliʻi o nā moku i uka (microaneurysms), e alakaʻi ana i nā hemorrhages liʻiliʻi (punctiform retinal hemorrhages). ʻO kēia pōʻino i nā kīʻaha koko ka hopena o nā wahi retinal irrigated maikaʻi ʻole, i kapa ʻia nā wahi ischemic. I ka pae aʻe, hoʻonui nā moku ʻino hou (neovessels) ma ka ʻili o ka retina ma ke ʻano anarchic. I nā ʻano koʻikoʻi, ʻo kēia proliferative retinopathy e hoʻomaka ai ka makapō.

I ka nephropathy maʻi maʻi, ʻo ka microangiopathy ke kumu i nā ʻeha i loko o nā kīʻaha e hāʻawi ana i ka glomeruli o ka puʻupaʻa, nā hale i hoʻolaʻa ʻia no ka kānana koko. ʻO ka nāwaliwali o nā pā moku a me ka maikaʻi ʻole o ka irrigation e hoʻopilikia i ka hana ʻana.

I ka neuropathy maʻi maʻi, ʻo ka pōʻino i nā aʻalolo e loaʻa mai ka microangiopathy, i hui pū ʻia me ka pōʻino pololei i nā aʻalolo ma muli o ka nui o ke kō. Hiki iā lākou ke hoʻopili i nā aʻalolo peripheral, nāna e hoʻomalu i nā ʻiʻo a hoʻouna i nā manaʻo, a i ʻole nā ​​aʻalolo i loko o ka ʻōnaehana neʻe autonomic e hoʻomalu i ka hana o ka viscera.

Microangiopathie thrombotique

Hōʻike ka huaʻōlelo thrombotic microangiopathy i nā maʻi me nā ʻano hana like ʻole ʻoiai ko lākou mau helu maʻamau, ʻaʻole ʻike mau ʻia nā kumu.

ʻO ka Thrombotic Thrombocytopenic Purpura (TTP) loaʻa pinepine kahi kumu autoimmune. Hana ke kino i nā antibodies e ālai i ka hana o kahi enzyme i kapa ʻia ʻo ADAMTS13, ka mea maʻamau e pale i ka hōʻuluʻulu ʻana o nā platelets i loko o ke koko. 

I nā hihia koʻikoʻi, aia kahi hemahema mau o ADAMTS13 i pili i nā hoʻololi hoʻoilina.

ʻO ka hemolytic uremic syndrome (HUS) ka hopena i ka hapa nui o nā hihia mai kahi maʻi. ʻO nā maʻi bacteria like ʻole i hoʻopiʻi ʻia e hūnā i kahi ʻawaʻawa i kapa ʻia ʻo shigatoxin, nāna e hoʻouka i nā moku. Akā aia kekahi mau HUS hoʻoilina, pili i ka maʻi kanesa, i ka maʻi HIV, i ka hoʻololi ʻana i ka iwi iwi a i ʻole i ka lawe ʻana i kekahi mau lāʻau lapaʻau, ʻo ia hoʻi nā lāʻau anti-cancer.

PalekanaEND_LINK

Hoʻokumu ʻia ka maʻi o ka microangiopathy ma ka hoʻokolokolo hoʻokolohua. Hiki i ke kauka ke hana i nā hoʻokolohua like ʻole e pili ana i ke ʻano o ka hanana a me nā hōʻailona, ​​no ka laʻana:

• fundus a i ʻole angiography e ʻike a nānā i ka retinopathy maʻi maʻi,
• ka hoʻoholo ʻana o ka micro-albumin i loko o ka mimi; ka hoʻāʻo ʻana no ka creatinine i loko o ke koko a i ʻole ka mimi e nānā i ka hana ʻāʻī,
• helu koko e nānā i nā pae haʻahaʻa o nā platelets a me nā ʻulaʻula koko i loko o ke koko,
• ʻimi i nā maʻi maʻi,
• kiʻi kiʻi (MRI) no ka pōʻino lolo

Pili ka poʻe

He mea maʻamau ka maʻi microangiopathies. Ma kahi o 30 a 40% o ka poʻe maʻi maʻi i loaʻa i ka retinopathy ma nā pae like ʻole, a i ʻole miliona mau kānaka ma Farani. ʻO ia ke kumu nui o ka makapō ma mua o ka makahiki 50 ma nā ʻāina ʻoihana. ʻO ka maʻi maʻi ke kumu nui o ka maʻi renal pae hope ma ʻEulopa (12 a 30%), a ʻo ka piʻi nui ʻana o ka maʻi maʻi type 2 e koi i ka mālama dialysis.

ʻAʻole maʻamau ka thrombotic microangiopathies:

• ʻO ka pinepine o ka PPT i manaʻo ʻia ma 5 a 10 mau hihia hou i kēlā me kēia miliona mau kānaka i kēlā me kēia makahiki, me ka nui o ka wahine (3 wahine i hoʻopilikia ʻia no 2 kāne). ʻO ka PTT hoʻoilina, ka mea i ʻike ʻia i nā keiki a me nā keiki hānau hou, he ʻano kakaikahi loa ia o ka thrombotic microangiopathy, me kahi mau kakini wale nō i ʻike ʻia ma Farani.
• ʻO ke alapine o nā SHU e like me ka PPT. ʻO nā keiki ka pahuhopu nui o nā maʻi i kuleana no lākou ma Farani, ʻo ka HUS i nā pākeke ke ʻoi aku ka pinepine ma muli o nā maʻi i loaʻa i ka wā huakaʻi (ʻo ia hoʻi e ka agent of dysentria).

Nā mea pilikino

Hiki ke hoʻonui ʻia ka pilikia o ka microangiopathy diabetic e nā kumu genetic. ʻO ke kiʻekiʻe kiʻekiʻe o ke aʻa, a me nā mea maʻamau maʻamau o ka maʻi cardiovascular (ke kaumaha, hoʻonui i ka pae lipid koko, ka puhi paka), hiki ke lilo i mea hoʻonāukiuki.

Hiki ke hāpai ʻia ka PPT e ka hāpai ʻana.

ʻO ka microangiopathy maʻi diabetes

Hoʻokomo ʻia nā hōʻailona o ka microangiopathy diabetic. Noho mālie ka hoʻomohala ʻana a hiki i ke ʻano o nā pilikia:

• nā pilikia ʻike e pili ana i ka retinopathy,
• ʻO ka luhi, nā pilikia mimi, ke koko kiʻekiʻe, ke kaumaha o ke kaumaha, ka pilikia o ka hiamoe, ka cramps, ka ʻili, a me nā mea ʻē aʻe i ka hihia o ka hana ʻole o ka renal,
• ʻeha, ʻeha, nāwaliwali, wela a i ʻole ke kani ʻana no nā neuropathies peripheral; ka wāwae diabetic: ka maʻi, ka ulceration a i ʻole ka luku ʻana i nā ʻiʻo hohonu o ka wāwae me ka nui o ka ʻoki ʻana; nā pilikia pili i ka wahine, ka digestive, ka mimi a i ʻole nā ​​maʻi puʻuwai ke hoʻopilikia ʻia ka neuropathy i ka ʻōnaehana neʻe autonomic ...

Microangiopathie thrombotique

ʻOkoʻa nā hōʻailona, ​​​​a pinepine ka hoʻomaka ʻana.

ʻO ka hāʻule ʻana o ke kiʻekiʻe o nā platelets koko (thrombocytopenia) i loko o ka PTT ke kumu o ke koko, i hōʻike ʻia e ke ʻano o nā kiko ʻulaʻula (purpura) ma ka ʻili.

Hiki ke hōʻike ʻia ka anemia e pili ana me ka helu haʻahaʻa o ke koko ʻulaʻula e like me ka luhi nui a me ka pōkole o ka hanu.

He ʻokoʻa ka ʻeha o ke kino akā he mea nui. I nā hihia koʻikoʻi, hiki koke mai ka hāʻule ʻana o ka ʻike, nā hemahema o nā lālā, neurological (ka huikau, coma, a me nā mea ʻē aʻe). ʻO ka maʻi bacteria e pili ana i ka HUS ke kumu o ka maʻi maʻi koko i kekahi manawa.

Ka mālama ʻana i ka microangiopathy diabetic

Lapaʻau maʻi diabetes

ʻO ka lāʻau lapaʻau o ka maʻi diabetes e hiki ke hoʻopaneʻe i ka hoʻomaka ʻana o ka microangiopathy a e kaupalena i nā hopena o ka pōʻino i nā moku. Hoʻokumu ʻia ia ma nā ʻano maʻemaʻe a me ka meaʻai (ka meaʻai kūpono, ka hoʻoikaika kino, ke kaumaha o ke kaumaha, ka pale ʻana i ka paka, a me nā mea ʻē aʻe), ma ka nānā ʻana i ke kiʻekiʻe o ke kō koko a me ka hoʻokumu ʻana i kahi lāʻau lapaʻau kūpono (nā lāʻau anti-diabetic a i ʻole insulin).

Ka mālama ʻana i ka maʻi retinopathies

Manaʻo paha ke kauka ophthalmologist i ka mālama ʻana i ka photocoagulation laser e kuhikuhi ana i nā ʻeha mua o ka retina e pale aku iā lākou mai ka holomua ʻana.

Ma kahi pae kiʻekiʻe, pono e noʻonoʻo ʻia ka pan-retinal photocoagulation (PPR). A laila pili ka hoʻomaʻamaʻa laser i ka retina holoʻokoʻa, koe wale ka macula kuleana no ka ʻike kikowaena.

I nā ʻano koʻikoʻi, pono ke hoʻomaʻamaʻa ʻokiʻoki i kekahi manawa.

Ka mālama ʻana i nā nephropathies maʻi maʻi

I ka pae o ka maʻi renal hope, pono ia e uku no ka hana ʻole o nā puʻupaʻa ma o ka dialysis a i ʻole ka hoʻohana ʻana i kahi transplant renal (transplant).

Ka mālama ʻana i nā neuropathies maʻi maʻi

Hiki ke hoʻohana ʻia nā ʻano lāʻau like ʻole (antiepileptics, anticonvulsants, tricyclic antidepressants, opioid analgesics) e hakakā i ka ʻeha neuropathic. E hāʻawi ʻia nā hōʻailona hōʻailona inā loaʻa ka nausea a i ʻole ka luaʻi ʻana, nā maʻi transit, nā pilikia ʻōpū, etc.

Microangiopathie thrombotique

Hoʻopono pinepine ka thrombotic microangiopathy i ka hoʻokumu ʻana i ka mālama ulia pōpilikia i kahi keʻena mālama koʻikoʻi. No ka manawa lōʻihi, ua pōʻeleʻele ka wānana no ka mea ʻaʻohe lāʻau lapaʻau kūpono a ʻaʻole pono ka ʻike. Akā ua hana ʻia nā holomua a i kēia manawa e ʻae i ka ho'ōla i nā hihia he nui.

ʻO ka lāʻau lapaʻau o ka thrombotic microangiopathy

Hoʻokumu ʻia ia ma ka hoʻololi plasma: hoʻohana ʻia kahi mīkini e pani i ka plasma o ka mea maʻi me ka plasma mai kahi hāʻawi manawaleʻa. Hiki i kēia lāʻau lapaʻau ke hāʻawi i ka protein ADAMTS13 i nele i ka PTT, akā e hoʻopau pū i ke koko o ka mea maʻi i nā autoantibodies (HUS o ke kumu autoimmune) a me nā protein e hoʻoikaika i ka hoʻokumu ʻana o nā clots.

I nā keiki e loaʻa ana i ka HUS e pili ana i kahi shigatoxin, ʻoi aku ka maikaʻi o ka hopena me ka ʻole o ka hoʻololi plasma. I nā hihia ʻē aʻe, pono e hana hou ʻia nā hoʻololi plasma a hiki i ka helu platelet maʻamau. ʻOi aku ka maikaʻi o lākou, akā hiki ke hōʻike i nā pilikia o nā pilikia: nā maʻi, nā thromboses, nā hopena maʻi ...

Hoʻohui pinepine ʻia lākou me nā lāʻau lapaʻau ʻē aʻe: corticosteroids, antiplatelet drugs, monoclonal antibodies, etc.

ʻO ka mālama ʻana i nā maʻi me nā lāʻau antibiotic pono e hoʻokahi.

Hoʻoponopono i nā hōʻailona pili 

Pono paha nā hana ho'ōla hou i ka wā o ka hoʻokipa pilikia. ʻO ka loaʻa ʻana o nā hōʻailona neurological a i ʻole cardiological e nānā pono ʻia.

I ka wā lōʻihi, ʻike ʻia nā sequelae e like me ka renal failure i kekahi manawa, e hōʻoiaʻiʻo ana i ka hoʻokele therapeutic.

ʻO ka maʻamau o ke kō koko a me ka hakakā ʻana i nā mea pilikia ʻo ia wale nō ka pale ʻana i ka microangiopathies diabetic. Pono e hui pū ʻia me ka nānā mau ʻana i nā maka a me ka hana ʻāʻī.

Loaʻa i nā lāʻau antihypertensive kahi hopena pale i ka puʻupaʻa. He mea maikaʻi hoʻi e hoʻemi i ka lawe ʻana i ka protein meaʻai. Pono e ʻalo ʻia kekahi mau lāʻau ʻawaʻawa i ka puʻupaʻa.

ʻAʻole hiki ke pale i nā microangiopathies thrombotic, akā pono ka nānā mau ʻana e pale i ka hoʻihoʻi ʻana, ʻoi aku ka nui o nā poʻe me TTP.