An bayyana shi azaman lalacewa ga ƙananan tasoshin jini, ana lura da microangiopathy a cikin cututtuka daban-daban. Yana iya haifar da wahala a cikin gabobin daban-daban, tare da sakamako mai ma'ana sosai dangane da ko yana da alaƙa da ciwon sukari (microangiopathy na ciwon sukari) ko tare da ciwo na microangiopathy na thrombotic. Rashin gazawar gabobi (makanta, gazawar koda, lalacewar gabobin jiki da yawa, da sauransu) ana lura da su a cikin mafi munin lokuta kuma a yayin jinkiri ko gazawar jiyya.

definition

An bayyana Microangiopathy azaman lalacewa ga ƙananan tasoshin jini, kuma musamman arterioles da arteriolar capillaries waɗanda ke ba da gabobin. Yana iya faruwa a ƙarƙashin yanayi daban-daban:

• Microangiopathy na ciwon sukari wani rikitarwa ne na nau'in ciwon sukari na 1 ko 2. Lalacewar tasoshin yawanci suna cikin ido (retinopathy), koda (nephropathy) ko jijiya (neuropathy). Don haka yana iya haifar da lalacewar gani har zuwa makanta, gazawar koda, ko ma lalacewar jijiya.
• Thrombotic microangiopathy wani bangare ne na rukuni na cututtuka wanda ƙananan tasoshin ke toshe ta hanyar ɗigon jini (samuwar tara tarin platelets). Yana bayyana kansa a cikin cututtuka daban-daban masu alaƙa da rashin daidaituwa na jini (ƙananan matakan platelet da jajayen jini) da gazawar ɗaya ko fiye gabobin kamar koda, ƙwaƙwalwa, hanji ko zuciya. Mafi kyawun nau'ikan su ne thrombotic thrombocytopenic purpura, ko ciwo na Moschowitz, da ciwon uremic na hemolytic. 

Sanadin

Microangiopathy na ciwon sukari

Microangiopathy na ciwon sukari yana haifar da hyperglycemia na yau da kullun wanda ke haifar da lalacewa ga tasoshin. Wadannan raunuka sun kafa a cikin marigayi, tare da ganewar asali sau da yawa bayan shekaru 10 zuwa 20 na ci gaban cututtuka. Su duka suna da wuri lokacin da magunguna ba su da iko sosai (glycated haemoglobin, ko HbA1c, yayi yawa).

A cikin ciwon sukari na retinopathy, wuce haddi na glucose da farko yana haifar da ƙananan ƙwayoyin cuta na tasoshin. Sannan ana haifar da ƙananan faɗuwar tasoshin zuwa sama (microaneurysms), wanda ke haifar da ƙananan jini (cututtukan retinal punctiform). Wannan lalacewa ga hanyoyin jini yana haifar da bayyanar wuraren da ba a ba da ruwa mara kyau ba, wanda ake kira yankunan ischemic. A mataki na gaba, sabbin tasoshin jiragen ruwa marasa kyau (neovessels) suna yaduwa a saman idon ido a cikin yanayin tashin hankali. A cikin nau'i mai tsanani, wannan ƙwayar cuta mai yaduwa yana haifar da makanta.

A cikin ciwon sukari nephropathy, microangiopathy yana haifar da raunuka a cikin tasoshin da ke ba da glomeruli na koda, tsarin da aka keɓe don tace jini. Rauni bangon jirgin ruwa da rashin ban ruwa a ƙarshe suna lalata aikin koda.

A cikin ciwon sukari neuropathy, lalacewa ga jijiyoyi yana haifar da microangiopathy, hade tare da lalacewa kai tsaye ga zaruruwan jijiya saboda yawan sukari. Suna iya shafar jijiyoyi na gefe, waɗanda ke sarrafa tsokoki da watsa abubuwan jin daɗi, ko jijiyoyi a cikin tsarin kulawa mai cin gashin kansa wanda ke sarrafa aikin viscera.

Microangiopathy thrombophlebitis

Kalmar thrombotic microangiopathy tana bayyana cututtuka tare da hanyoyi daban-daban duk da abubuwan da suka saba da su, waɗanda ba a san su ba koyaushe.

Thrombotic Thrombocytopenic Purpura (TTP) yawanci yana da asalin autoimmune. Jiki yana yin rigakafi da ke toshe aikin wani enzyme mai suna ADAMTS13, wanda yawanci yana hana haɗuwar platelet a cikin jini. 

A lokuta da ba kasafai ba, akwai rashi na dindindin na ADAMTS13 da ke da alaƙa da maye gurbi na gado.

Ciwon uremic na hemolytic (HUS) yana haifar da mafi yawan lokuta daga kamuwa da cuta. Daban-daban nau'ikan ƙwayoyin cuta sun haifar da ɓoye wani guba mai suna shigatoxin, wanda ke kai hari ga tasoshin. Amma akwai kuma HUS na gado, wanda ke da alaƙa da ciwon daji, da kamuwa da cutar HIV, zuwa dashen kasusuwa ko kuma shan wasu magunguna, musamman magungunan cutar kansa.

bincike

Sakamakon ganewar microangiopathy yana dogara ne akan gwajin asibiti. Likitan na iya yin gwaje-gwaje daban-daban dangane da yanayin faruwar lamarin da alamun, misali:

• fundus ko angiography don ganowa da saka idanu akan ciwon sukari,
• ƙayyade micro-albumin a cikin fitsari; gwajin creatinine a cikin jini ko fitsari don lura da aikin koda,
• Ƙididdigar jini don bincika ƙananan matakan platelet da jajayen jini a cikin jini,
• neman cututtuka,
• Hoto (MRI) don lalacewar kwakwalwa

Mutanen da abin ya shafa

Microangiopathies masu ciwon sukari sun zama ruwan dare gama gari. Kimanin kashi 30 zuwa 40% na masu ciwon sukari suna fama da ciwon ido a matakai daban-daban, ko kuma kusan mutane miliyan a Faransa. Ita ce kan gaba wajen makanta kafin shekaru 50 a kasashe masu arzikin masana'antu. Ciwon sukari kuma shine babban abin da ke haifar da cututtukan koda na ƙarshe a Turai (12 zuwa 30%), kuma karuwar adadin masu ciwon sukari nau'in 2 na buƙatar maganin dialysis.

Thrombotic microangiopathies ba su da yawa:

• An kiyasta yawan adadin PPT a sababbin lokuta 5 zuwa 10 a kowace mazaunan miliyan a kowace shekara, tare da rinjaye na mace (mata 3 ya shafi maza 2). PTT na gado, wanda ake lura da shi a cikin yara da jarirai, wani nau'i ne na microangiopathy na thrombotic da ba kasafai ba, tare da wasu dozin kaɗan ne kawai aka gano a Faransa.
• Yawan SHUs daidai yake da na PPT. Yara sune manyan abubuwan da ke haifar da cututtukan da ke da alhakin su a Faransa, HUS a cikin manya suna yawanci saboda cututtuka da aka kamu da su yayin tafiya (musamman ta wakilin dysentria).

hadarin dalilai

Haɗarin microangiopathy na ciwon sukari na iya ƙaruwa ta hanyar abubuwan halitta. Hawan jini na jijiya, da ƙari gabaɗaya abubuwan haɗari na zuciya da jijiyoyin jini (kiba, ƙara yawan matakan lipid na jini, shan taba), na iya zama abubuwa masu ta'azzara.

Ana iya haɓaka PPT ta hanyar ciki.

Microangiopathy na ciwon sukari

Alamomin ciwon sukari microangiopathy da aka saita a cikin wayo. Juyin halitta shiru ne har sai bayyanar rikitarwa:

• matsalolin hangen nesa da ke da alaƙa da retinopathy,
• kasala, matsalar fitsari, hawan jini, rage kiba, damun barci, ciwon ciki, izza, da dai sauransu idan akwai gazawar koda.
• zafi, numbness, rauni, ƙonawa ko tingling abubuwan jin daɗi don neuropathy na gefe; ƙafar ciwon sukari: kamuwa da cuta, ciwon ciki ko lalata zurfafan kyallen ƙafar ƙafa tare da babban haɗarin yankewa; matsalolin jima'i, narkewa, urinary ko cututtukan zuciya lokacin da neuropathy ya shafi tsarin juyayi mai cin gashin kansa ...

Microangiopathy thrombophlebitis

Alamun sun bambanta, kuma galibi suna farawa.

Rushewar matakin platelet na jini (thrombocytopenia) a cikin PTT yana haifar da zubar jini, wanda aka bayyana ta bayyanar jajayen spots (purpura) akan fata.

Anemia da ke hade da ƙananan ƙwayoyin jinin jini na iya bayyana a matsayin gajiya mai tsanani da ƙarancin numfashi.

Ciwon gabobi ya bambanta sosai amma galibi yana da mahimmanci. A lokuta masu tsanani, nan da nan za a iya samun raguwa a cikin hangen nesa, nakasa a cikin gabobin jiki, neurological (rikici, rashin lafiya, da dai sauransu), cututtuka na zuciya ko narkewa, da dai sauransu. Shigar koda yana da matsakaici a cikin PTT, amma yana iya zama mai tsanani a HUS. Bakteriyar da ke da alhakin HUS kuma su ne ke haifar da gudawa na jini wani lokaci.

Maganin microangiopathy na ciwon sukari

Maganin ciwon suga

Maganin likita na ciwon sukari yana ba da damar jinkirin farawar microangiopathy da iyakance sakamakon lalacewa ga tasoshin. Ya dogara ne akan matakan tsafta da abinci (abincin da ya dace, motsa jiki, asarar nauyi, guje wa shan taba, da dai sauransu), akan sa ido kan matakin sukari na jini da kuma kafa tsarin maganin da ya dace (maganin ciwon sukari ko insulin).

Gudanar da retinopathies masu ciwon sukari

Likitan ido na iya ba da shawarar magani na photocoagulation na Laser wanda ke niyya ga raunukan farko na retina don hana su ci gaba.

A mafi ci gaba mataki, pan-retinal photocoagulation (PPR) ya kamata a yi la'akari. Sa'an nan kuma maganin Laser ya shafi dukkanin retina, sai dai macula da ke da alhakin hangen nesa na tsakiya.

A cikin nau'i mai tsanani, magani na tiyata wani lokaci ya zama dole.

Gudanar da nephropathies masu ciwon sukari

A mataki na ƙarshe na cututtukan koda, ya zama dole a rama rashin aikin koda ta hanyar dialysis ko kuma ta hanyar dashen koda (dashe).

Gudanar da ciwon sukari neuropathy

Za'a iya amfani da nau'ikan kwayoyi daban-daban (magungunan antiepileptics, anticonvulsants, tricyclic antidepressants, opioid analgesics) don magance ciwon neuropathic. Za a ba da magungunan bayyanar cututtuka idan akwai tashin zuciya ko amai, rikice-rikicen wucewa, matsalolin mafitsara, da sauransu.

Microangiopathy thrombophlebitis

Microangiopathy na thrombotic sau da yawa yana ba da tabbacin kafa magani na gaggawa a cikin sashin kulawa mai zurfi. Na dogon lokaci, tsinkayen ya kasance mara kyau saboda babu magani mai dacewa kuma ganewar asali ba ta da inganci. Amma an sami ci gaba kuma yanzu an ba da izinin warkarwa a lokuta da yawa.

Maganin likita na thrombotic microangiopathy

Ya dogara ne akan musayar jini: ana amfani da na'ura don maye gurbin plasma na majiyyaci da plasma daga mai ba da gudummawa na son rai. Wannan magani yana ba da damar samar da furotin ADAMTS13 wanda ke da ƙarancin PTT, amma kuma don kawar da jinin mara lafiya na autoantibodies (HUS na asali na autoimmune) da kuma sunadaran da ke inganta samuwar jini.

A cikin yara masu fama da HUS da ke hade da shigatoxin, sakamakon yana da kyau sau da yawa ba tare da buƙatar musayar jini ba. A wasu lokuta, ya kamata a maimaita musayar plasma har sai an daidaita adadin platelet. Suna da tasiri sosai, amma suna iya gabatar da haɗarin rikitarwa: cututtuka, thromboses, halayen rashin lafiyan ...

Sau da yawa ana danganta su da wasu jiyya: corticosteroids, magungunan antiplatelet, ƙwayoyin rigakafi na monoclonal, da sauransu.

Maganin cututtuka tare da maganin rigakafi ya kamata ya zama daidaikun mutane.

Gudanar da alamun alaƙa 

Matakan farfadowa na iya zama dole yayin asibiti na gaggawa. Ana lura da abin da ya faru na jijiya ko alamun cututtukan zuciya.

A cikin dogon lokaci, ana lura da abubuwan da ke biyo baya kamar gazawar koda a wasu lokuta, yana ba da hujjar kula da warkewa.

Daidaitawar sukarin jini da kuma yaƙi da abubuwan haɗari shine kawai rigakafin ciwon sukari microangiopathies. Ya kamata a haɗa shi tare da kulawa akai-akai na idanu da aikin koda.

Magungunan antihypertensive suna da tasirin kariya akan koda. Hakanan yana da kyau a rage cin abinci mai gina jiki. Ya kamata a guji wasu magungunan da ke da guba ga koda.

Rigakafin microangiopathies na thrombotic ba zai yiwu ba, amma kulawa na yau da kullun na iya zama dole don guje wa sake dawowa, musamman a cikin mutanen da ke da TTP.