Inotsanangurwa sekukuvadzwa kwemidziyo midiki yeropa, microangiopathy inoonekwa mune dzakasiyana pathologies. Inogona kukonzera kutambura munhengo dzakasiyana-siyana, nemigumisiro yakasiyana-siyana zvichienderana nokuti inosanganiswa nechirwere cheshuga (diabetic microangiopathy) kana ne thrombotic microangiopathy syndrome. Kukundikana kwenhengo (kupofumadza, kutadza kwerenal, kukanganisa kwenhengo dzakawanda, nezvimwewo) kunoonekwa mumatambudziko akakomba uye kana chiitiko chekunonoka kana kukundikana kwekurapa.

tsananguro

Microangiopathy inotsanangurwa sekukuvadzwa kwetsinga diki dzeropa, uye kunyanya arterioles uye arteriolar capillaries inopa nhengo. Inogona kuitika mumamiriro ezvinhu akasiyana:

• Diabetic microangiopathy idambudziko rerudzi rwekutanga kana 1 chirwere cheshuga. Kukuvadzwa kwemidziyo kunowanzo kuwanikwa muziso (retinopathy), itsvo (nephropathy) kana nerve (neuropathy). Kunogona nokudaro kuparira kuvadziko yokuona kusvikira kuupofu, kukundikana kweitsvo, kana kuti kunyange kukuvara kwetsinga.
• Thrombotic microangiopathy chikamu cheboka rezvirwere umo midziyo miduku yakavharwa neropa (kuumbwa kwezvikamu zveplatelet yeropa). Inozviratidza mumhando dzakasiyana-siyana dzesyndromes dzinobatanidza kukanganisa kweropa (yakaderera mazinga eplatelet uye masero matsvuku eropa) uye kukundikana kweimwe kana dzimwe nhengo dzakadai seitsvo, uropi, matumbo kana mwoyo. Mafomu emhando yepamusoro ndeye thrombotic thrombocytopenic purpura, kana Moschowitz syndrome, uye hemolytic uremic syndrome. 

Zvinokonzera

Chirwere cheshuga microangiopathy

Diabetic microangiopathy inokonzerwa nekusingaperi hyperglycemia inokonzera kukanganisa kumidziyo. Aya maronda anononoka, uye kuongororwa kunowanzoitwa mushure memakore gumi kusvika makumi maviri ekukura kwechirwere. Izvo zvese zvinonyanya kukurumidza kana shuga yeropa isingadzoreki zvakanaka nemishonga (glycated hemoglobin, kana HbA10c, yakakwira zvakanyanya).

Muchirwere cheshuga retinopathy, glucose yakawandisa inotanga kutungamirira kune localized micro-occlusions yemidziyo. Dilations diki dzemidziyo dzinobva dzasikwa kumusoro kwerwizi (microaneurysms), zvichitungamira kudiki hemorrhages (punctiform retinal hemorrhages). Uku kukuvadza kwemidziyo yeropa kunoguma nekuonekwa kwenzvimbo dzisina kudiridzwa dzeretinal, dzinonzi ischemic areas. Padanho rinotevera, midziyo mitsva isina kujairika (neovessels) inowanda pamusoro pe retina nenzira yekusagadzikana. Mumhando dzakakomba, iyi proliferative retinopathy inokonzera upofu.

Muchirwere cheshuga nephropathy, microangiopathy inokonzera maronda mumidziyo inopa glomeruli yeitsvo, zvimiro zvakatsaurirwa kusefa ropa. Madhuri emidziyo akaneta uye kusadiridza kwakashata kunozokanganisa kushanda kweitsvo.

Muchirwere cheshuga neuropathy, kukuvadzwa kwetsinga kunobva ku microangiopathy, yakasanganiswa nekukuvara kwakananga kune tsinga fibers nekuda kweshuga yakawandisa. Dzinogona kukanganisa tsinga dzeperipheral, dzinodzora tsandanyama uye kutumira manzwiro, kana tsinga mu autonomic nervous system inodzora kushanda kwe viscera.

Microangiopathie thrombotique

Izwi rekuti thrombotic microangiopathy rinoratidzira hosha dzine nzira dzakasiyana siyana kunyangwe dzakajairika pfungwa, izvo zvinokonzeresa izvo zvisingawanzo kuzivikanwa.

Thrombotic Thrombocytopenic Purpura (TTP) kazhinji ine autoimmune mavambo. Muviri unogadzira masoja ekudzivirira chirwere anovharisa kushanda kweenzyme inonzi ADAMTS13, iyo inowanzo dzivirira kuungana kwemaplatelet muropa. 

Muzviitiko zvisingawanzoitiki, pane kushomeka zvachose kweADAMTS13 kwakabatana nekuchinja kwenhaka.

Hemolytic uremic syndrome (HUS) inokonzeresa kuwanda kwezviitiko kubva kuhutachiona. Mhando dzakasiyana dzebhakitiriya dzakasungirirwa dzinoburitsa muchetura unonzi shigatoxin, unorwisa midziyo. Asi kune zvakare HUS yenhaka, ine chekuita negomarara, kutapukirwa neHIV, kuisirwa mwongo kana kutora mimwe mishonga, kunyanya inorwisa gomarara.

chirwere

Kuongororwa kwe microangiopathy kunonyanya kubva pakuongorora kwekiriniki. Chiremba anogona kuita bvunzo dzakasiyana zvichienderana nemamiriro ekuitika uye zviratidzo, semuenzaniso:

• fundus kana angiography yekuona uye kutarisa chirwere cheshuga retinopathy,
• kutsunga kwe micro-albumin muweti; kuongororwa kwe creatinine muropa kana weti kutarisa kushanda kweitsvo,
• kuverenga kweropa kutarisa kuderera kweplatelet uye masero matsvuku eropa muropa,
• tsvaga zvirwere,
• imaging (MRI) yekukuvara kwehuropi

Vanhu vane hanya

Diabetic microangiopathies inowanzoitika. Inenge 30 kusvika 40% yevane chirwere cheshuga vane retinopathy pamatanho akasiyana, kana vanhu vangangoita miriyoni muFrance. Ndiyo inonyanya kukonzera upofu vasati vasvitsa makore makumi mashanu munyika dzakabudirira. Chirwere cheshuga ndicho chiri kukonzerawo kuguma kwechirwere chetsvo muEurope (50 kusvika 12%), uye nhamba iri kuwedzera yerudzi rwechipiri rwechirwere cheshuga inoda kurapwa kwedialysis.

Thrombotic microangiopathies haina kunyanya kuwanda:

• Kuwanda kwePPT kunofungidzirwa kune 5 kusvika ku10 mitsva yezviitiko pamamiriyoni evagari vegore negore, nehuwandu hwevakadzi (3 vakadzi vanobatwa nevarume ve2). Hereditary PTT, iyo inocherechedzwa muvana nevacheche, inzira isingawanzoitiki yethrombotic microangiopathy, ine mashoma gumi nemaviri zviitiko zvakaonekwa muFrance.
• Kuwanda kweSHUs ndeyekurongeka kwakafanana neyePPT. Vana ndivo vanonyanya kutariswa nehutachiona hunovakonzeresa muFrance, HUS muvakuru kazhinji kazhinji nekuda kwehutachiona hwakabatwa panguva yekufamba (kunyanya nemumiririri wedyentria).

Zvinhu zvinotyisa

Ngozi yechirwere cheshuga microangiopathy inogona kuwedzerwa ne genetic factor. Arterial hypertension, uye zvakanyanya kazhinji njodzi yemoyo (kuwedzeredza, kuwedzera kweropa lipid mazinga, kuputa), zvinogona kuwedzera zvinhu.

PPT inogona kusimudzirwa nekuzvitakura.

Chirwere cheshuga microangiopathy

Zviratidzo zvechirwere cheshuga microangiopathy zvakaiswa muhunyengeri. Iko kushanduka kwakanyarara kusvika pakuonekwa kwematambudziko:

• kukanganisa kwekuona kwakabatana neretinopathy,
• kuneta, matambudziko eweti, kukwira kweropa, kuderera kwehuremu, kuvhiringika pakurara, chinyamunhari, kukoira, nezvimwewo kana ukatadza renal,
• kurwadziwa, kupera simba, kushaya simba, kupisa kana kurira kwekunzwa kweperipheral neuropathies; Diabetic tsoka: utachiona, maronda kana kuparadzwa kwematishu akadzika etsoka ane njodzi huru yekugurwa; matambudziko ebonde, kugaya, weti kana kusagadzikana kwemoyo kana neuropathy inokanganisa autonomic nerve system ...

Microangiopathie thrombotique

Zviratidzo zvakasiyana-siyana, uye kazhinji zvinotanga.

Kuputsika kwehuwandu hwemaplatelet eropa (thrombocytopenia) muPTT kunokonzera kubuda ropa, kunoratidzwa nekuonekwa kwemavara matsvuku (purpura) paganda.

Anemia inobatanidza nekushomeka kwemasero matsvuku eropa inogona kuratidza sekuneta kwakanyanya uye kupfupika kwekufema.

Marwadzo enhengo anosiyana zvakanyanya asi kazhinji akakosha. Muzviitiko zvakakomba, panogona kuva nekudonha kwekuona pakarepo, kukanganisa mumakumbo, neurological (kuvhiringidzika, coma, nezvimwewo), zvirwere zvemwoyo kana kudya, etc. Kubatanidzwa kweitsvo kunowanzova pakati nepakati muPTT, asi inogona kuva yakaoma muHUS. Utachiona hunokonzera HUS ndihwowo hunokonzera dzimwe nguva manyoka ane ropa.

Kurapa kwechirwere cheshuga microangiopathy

Chirwere cheshuga kurapwa

Kurapa kwechirwere cheshuga kunoita kuti zvikwanise kunonoka kutanga kwe microangiopathy uye kuderedza migumisiro yekukuvara kwemidziyo. Inobva pahutsanana uye nhanho dzekudya (kudya kwakakodzera, kuita basa remuviri, kurasikirwa uremu, kudzivisa fodya, nezvimwewo), pakutarisa chiyero cheshuga yeropa uye nekugadzwa kwekurapa kwakakodzera kwezvinodhaka (anti-diabetic drugs kana insulin).

Kutungamirirwa kwechirwere cheshuga retinopathies

Iyo ophthalmologist inogona kupa zano laser photocoagulation kurapwa yakanangana nekutanga maronda eretina kuti asaenderere mberi.

Pane imwe nhanho yepamusoro, pan-retinal photocoagulation (PPR) inofanirwa kutariswa. Kurapa kwelaser kunobva kwabata retina yese, kunze kweiyo macula inotarisira kuona kwepakati.

Mumhando dzakakomba, kurapwa kwekuvhiya dzimwe nguva kunodiwa.

Kutungamirirwa kwechirwere cheshuga nephropathy

Padanho rekupedzisira renal chirwere, zvinodikanwa kutsiva kusashanda kweitsvo kungave nedialysis kana kushandisa renal transplant (transplant).

Kutungamirirwa kwechirwere cheshuga neuropathies

Makirasi akasiyana emishonga (antiepileptics, anticonvulsants, tricyclic antidepressants, opioid analgesics) inogona kushandiswa kurwisana neuropathic marwadzo. Symptomatic marapirwo anozopihwa muchiitiko chekusvotwa kana kurutsa, kusagadzikana kwekufamba, matambudziko edundira, nezvimwe.

Microangiopathie thrombotique

Thrombotic microangiopathy inowanzo ruramisa kugadzwa kwekurapwa kwekukurumidzira muchikamu chekuchengetedza zvakanyanya. Kwenguva refu, fungidziro yacho yakanga isina kujeka nekuti pakanga pasina kurapwa kwakakodzera uye kuongororwa kwacho kwaisashanda. Asi kufambira mberi kwakaitwa uye zvino kubvumira kuporeswa mune dzakawanda zviitiko.

Kurapa kwekurapa kwe thrombotic microangiopathy

Inonyanya kuenderana nekuchinjana kweplasma: muchina unoshandiswa kutsiva plasma yemurwere neplasma kubva kune anozvipira. Kurapa uku kunoita kuti zvikwanise kupa ADAMTS13 puroteni iyo isina kukwana muPTT, asiwo kubvisa ropa remurwere re autoantibodies (HUS of autoimmune origin) uye mapuroteni anokurudzira kuumbwa kwekuvhara.

Muvana vanotambura neHUS yakabatana neshigatoxin, mhedzisiro yacho inowanzova yakanaka pasina kudiwa kwekuchinjana kweplasma. Mune zvimwe zviitiko, kuchinjana kweplasma kunofanira kudzokororwa kusvikira nhamba yeplatelet yave yakajairika. Izvo zvinoshanda, asi zvinogona kupa njodzi dzematambudziko: hutachiona, thromboses, allergic reactions ...

Zvinowanzobatanidzwa nemamwe marapirwo: corticosteroids, antiplatelet zvinodhaka, monoclonal antibodies, nezvimwewo.

Kurapa kwezvirwere nemishonga inorwisa mabhakitiriya kunofanira kunge kune mumwe munhu.

Kutarisira zviratidzo zvakabatana 

Kumutsiridza matanho angave akadikanwa panguva yekukurumidzira muchipatara. Kuitika kwezviratidzo zvetsinga kana zvemoyo zvinotariswa zvakanyanya.

Mukufamba kwenguva, sequelae dzakadai sekutadza kwetsvo dzimwe nguva dzinoonekwa, kururamisa kurapa kwekurapa.

Kujairika kweshuga yeropa uye kurwisa zvinhu zvine njodzi ndiko chete kudzivirira kwechirwere cheshuga microangiopathies. Inofanira kusanganiswa nekutarisa nguva dzose kwemaziso uye kushanda kwetsvo.

Antihypertensive mishonga ine kudzivirira itsvo. Zvinokurudzirwawo kuderedza kudya kweprotein yezvokudya. Mimwe mishonga ine chepfu kuitsvo inofanira kudziviswa.

Kudzivirirwa kwethrombotic microangiopathies hakugoneki, asi kugara uchiongorora kungave kuri madikanwa kuti usadzoke zvakare, kunyanya muvanhu vane TTP.