Lub xeev ntawm lub cev qhov kev pheej hmoo rau kev txhim kho vascular thrombosis, uas tuaj yeem rov muaj dua thiab muaj kev sib txawv hauv zos, hu ua thrombophilia. Tus kab mob tuaj yeem yog caj ces lossis kis tau. Qhov ua rau ntawm pathology yog feem ntau nce ntshav txhaws. Clinically, tus kab mob tuaj yeem tshwm sim los ntawm ntau yam thromboses ntawm qhov chaw sib txawv. Thrombophilia feem ntau tshwm sim ntawm cov pej xeem thiab tshwm sim hauv ntau hom. Tus kab mob no xav tau kev kho mob lossis kev phais mob.
Thrombophilia: yog dab tsi?
Pathology yog hais txog cov kab mob ntawm cov ntshav, tshwm sim hauv kev nyiam ua rau cov ntshav txhaws thiab ua tsis taus hemostasis. Ntau cov thrombophilia rov tshwm sim tuaj yeem tshwm sim los ntawm kev raug mob, phais, lub cev ua haujlwm dhau, lossis thaum lub sijhawmcev xeeb tub. Tus mob no txaus ntshai vim nws tuaj yeem ua rau muaj teeb meem xws li pulmonary embolism, mob stroke, myocardial infarction, tob vein thrombosis. Feem ntau cov ntawv khiav yog qhov tuag taus.
Kev tshawb nrhiav, kuaj mob thiab kho cov kab mob thrombophilias yog ua los ntawm ntau ceg tshuaj. Hematology kawm txog kev ua txhaum ntawm cov ntshav, phlebology - cov txheej txheem rau kev kuaj mob thiab kho thrombosis ntawm venous hlab ntsha, vascular kws phais tau koom nrog kev tshem tawm cov ntshav txhaws. Kev tsim cov thrombus ua rau muaj kev cuam tshuam ntawm cov ntshav ntws ib txwm, uas yog nrog los ntawm kev txhim kho cov xwm txheej txaus ntshai uas nyuaj rau kho. Txhawm rau tiv thaiv qhov teeb meem hauv lub sijhawm, koj yuav tsum tau kuaj ntshav coagulation ib ntus. Cov qauv rau cov poj niam, piv txwv li, rau cov ntshav venous yog 5-10 feeb.
Vim txoj kev loj hlob
Muaj ntau ntau yam uas ua rau kev loj hlob ntawm pathology. Yuav luag txhua tus neeg tuaj yeem ntsib tus kab mob xws li thrombophilia. Dab tsi yog qhov txaus ntshai no, ntau tus neeg mob qee zaum txawm tsis xav thiab nrhiav kev pab lig. Muaj cov npe ntawm cov laj thawj uas tuaj yeem ua rau muaj kev txhim kho ntawm pathology.
Hereditary (los yog caj ces) thrombophilia tshwm sim los ntawm cov caj ces predisposition rau tus kab mob. Cov kab mob ntshav dhau los (thrombocytosis, erythremia, antiphospholipid syndrome) kuj tuaj yeem ua rau nws txoj kev loj hlob. Kev pheej hmoo muaj xws li atherosclerosis, malignant neoplasms, atrial fibrillation, varicose leeg,kab mob autoimmune. Qhov tshwm sim ntawm thrombophilia nce tom qab mob stroke lossis plawv nres. Cov neeg mob uas rog rog, coj txoj kev ua neej nyob tsis muaj zog, noj tshuaj tiv thaiv kab mob hormonal, noj zaub mov tsis zoo, tau raug mob hnyav lossis kev phais yav dhau los muaj kev pheej hmoo. Thaum muaj hnub nyoog ntxov, tus kab mob no tsis tshua muaj, feem ntau nws tshwm sim hauv cov neeg laus. Txhawm rau tiv thaiv tus kab mob lossis tsis pib tus mob, nws raug nquahu kom kuaj mob thrombophilia ib ntus.
daim duab kho mob
Kev kho mob tshwm sim ntawm cov kab mob pathology yog tus cwj pwm los ntawm kev nce ntxiv thiab lub sijhawm ntawm chav kawm, yog li cov neeg mob tsis pom kev hloov pauv hauv lawv lub xeev kev noj qab haus huv thiab tsis txhob muaj kev tsis txaus siab. Cov ntsuas ntsuas ntsuas tuaj yeem kuaj mob thrombophilia, thiab cov duab qhia ntxaws ntxaws hauv qee kis tsis tshwm sim txog li ob peb xyoos tom qab. Cov tsos mob vivid raug pom thaum muaj cov ntshav txhaws lawm. Qhov degree ntawm obturation ntawm lub lumen ntawm lub nkoj thiab lub zos ntawm thrombus cuam tshuam rau qhov hnyav ntawm cov tsos mob.
Arterial thrombosis, tshwm sim los ntawm cov ntshav txhaws nyob rau hauv lub lumen ntawm cov hlab ntsha ntawm lub txaj arterial, yog nrog los ntawm kev tsim cov ntshav txhaws nyob rau hauv lub lumen ntawm cov hlab ntsha ntawm lub placenta, intrauterine fetal tuag, ntau yam nchuav menyuam, tawm tsam ntawm mob plawv tsis txaus, ischemic stroke.
Nrog venous thrombosis ntawm qis extremities, cov tsos mob tshwm sim lawv tus kheej nyob rau hauv daim ntawv ntawm trophic hloov nyob rau hauv daim tawv nqaij, hnyav heev.o ntawm qis extremities, qhov tsos mob, ib qho kev xav ntawm hnyav nyob rau hauv qis extremities.
Mesenteric plab hnyuv thrombosis tshwm sim thaum lub thrombus nyob rau hauv cov hlab ntsha mesenteric thiab nrog cov tsos mob hauv qab no: quav quav, ntuav, xeev siab, dagger ntse mob.
Thrombosis ntawm daim siab cov hlab ntsha tsim hydrothorax (Budd-Chiari syndrome), ascites, o ntawm phab ntsa hauv plab thiab sab qis, ntuav tsis txaus thiab mob hnyav hauv thaj tsam epigastric.
YHematogenous thrombophilia
Thromboses cuam tshuam rau lub xeev ntawm cov phab ntsa vascular, ua rau nws thiab txo kev ruaj ntseg, pab txhawb kom qeeb cov ntshav khiav thiab kev loj hlob ntawm lwm yam hemodynamic ntshawv siab uas cuam tshuam nrog kev hloov pauv hauv viscosity thiab coagulability. Thrombophilic tej yam kev mob nyob rau hauv ntau yam yog txuam nrog cov muaj vascular kab mob, xws li atherosclerosis, kev puas tsuaj rau lub intima ntawm cov hlab ntsha, vasculitis ntawm toxicogenic, tiv thaiv kab mob los yog kis kab mob. Ntau yam thromboembolism rov tshwm sim tuaj yeem yog vim muaj kev hloov pauv hauv cov ntshav nws tus kheej, uas muab txoj cai hais txog tus kab mob hu ua "hematogenous thrombophilia". Txoj kev loj hlob ntawm pathology yog txuam nrog lub siab nyiam ntawm lub cev los tsim thrombosis vim qhov txawv txav ntawm lub coagulation systems, ua txhaum ntawm hemostatic peev xwm ntawm cov ntshav.
Hematogenous thrombophilia los ntawm keeb kwm tuaj yeem yog los yog kis tau. Raws li cov txheej txheem tseem ceeb, cov kab mob sib txawv uas tshwm sim los ntawm: cuam tshuam thrombogenic hloov pauv, platelet tsis ua haujlwm,fibrinolysis ntshawv siab, inhibition, txawv txav los yog tsis muaj peev xwm ntawm cov ntshav coagulation, tsis muaj lub hauv paus physiological anticoagulants. Tsis tas li ntawd, iatrogenic thrombophilias uas tsim los ntawm kev siv tshuaj los yog kev kho mob kuj raug cais tawm.
Hereditary thrombophilia
Nws tuaj yeem txiav txim siab qhov tshwm sim hauv lub cev lossis keeb kwm ntawm thrombosis raws li cov kev kho mob hauv qab no: thrombosis thaum muaj hnub nyoog ntxov, cov neeg mob thrombosis ntawm pulmonary artery, mesentery, qis qis hauv tsev neeg keeb kwm, thawj ntu ntawm venous thrombosis ua ntej hnub nyoog 30 xyoo, thrombosis thaum ntxov cev xeeb tub, thrombotic teeb meem. Cov kab mob los yog caj ces thrombophilia tau txiav txim siab tom qab kev kuaj mob dav dav ntawm cov neeg mob uas muaj kev pheej hmoo ntawm kev tsim cov teeb meem thrombophilic.
Cov kab mob hauv lub cev tuaj yeem muaj qhov sib txawv. Thaum kuaj pom tus kab mob, cov cim caj ces ntawm thrombophilia raug coj mus rau hauv tus account. Thawj yam uas ua rau kev loj hlob ntawm pathology yog ib qho genetic predisposition. Nyob rau hauv cov ntaub ntawv no, tus kab mob yuav tsis tshwm sim nws tus kheej nyob rau hauv tsis muaj tej yam kev mob uas ua rau lub mechanisms ntawm nws txoj kev loj hlob. Qhov thib ob yog kev hloov pauv noob thaum lub sij hawm kev loj hlob ntawm embryonic. Tsis ntev los no, qhov concentration ntawm yam uas thawb rau kev hloov noob caj noob ces tau nthuav dav zuj zus. Ntawm lawv yog cov uas tshwm sim los ntawm tib neeg kev ua ub no: hluav taws xob, kev siv cov khoom noj khoom haus ntxiv, tshuaj, kev ua qias tuaj ib puag ncig (cov tshuaj hauv tsev, ntau hom roj, tshuaj tua kab), kev puas tsuaj rau tib neeg. Nws tsis tuaj yeem kwv yees thaum twgNyob rau hauv cov xwm txheej dab tsi ib tug noob hloov tau, yog li mutagenesis yog suav hais tias yog ib tug random txheej txheem uas tshwm sim ntawm nws tus kheej thiab muaj peev xwm los hloov hereditary zog.
Hereditary thrombophilia kuj tuaj yeem tshwm sim los ntawm kev hloov pauv ntawm cov qauv lossis kev hloov pauv ntawm cov chromosomes uas tau txais los ntawm cov tiam dhau los. Lub xeev ntawm tus kab mob gene tseem ceeb ntawm no: recessive los yog dominant. Nyob rau hauv rooj plaub thib ob, pathology yuav tshwm sim nws tus kheej nyob rau hauv tej yam kev mob.
Acquired thrombophilia
Tsis yog los ntawm caj ces xwb, tiam sis kuj muaj keeb kwm tuaj yeem muaj tus kab mob no. Tus neeg mob yuav raug kuaj pom tias muaj cov kab mob antiphospholipid (APS). Qhov no yog li cas tau txais thrombophilia manifests nws tus kheej nyob rau hauv feem ntau. Dab tsi yog nws, dab tsi yog cov txheej txheem ntawm nws txoj kev loj hlob thiab yuav ua li cas nrog nws?
Antiphospholipid Syndrome yog ib qho nyuaj ntawm cov tsos mob uas ua ke nrog cov ntaub ntawv kuaj thiab cov tsos mob. Tus kab mob no nrog rau cov kab mob neurological, kev tiv thaiv kab mob thrombocytopenia, fetal loss syndrome, venous thiab arterial thrombosis. Muaj cov ntaub ntawv ntawm APS: thawj, theem nrab thiab kev puas tsuaj; serological variants: seronegative thiab seropositive. Cov tsos mob tshwm sim ntawm keeb kwm ntawm neoplastic, kis kab mob, ua xua lossis kab mob autoimmune lossis vim yog tshuaj tsis haum.
Kev txhim kho ntawm APS tuaj yeem cuam tshuam nrog cov kab mob xws li: malignant neoplasms (cancer, lymphoproliferative kab mob, leukemia), kab mob(mycoplasmosis, HIV, syphilis), asymptomatic APA ncig, mob raum tsis ua haujlwm, kab mob peripheral arterial thiab valvular, kab mob siab, kab mob sib txuas, thiab kab mob autoimmune (Crohn's disease, systemic vasculitis, SLE).
thrombophilia thaum cev xeeb tub
Thaum cev xeeb tub, caj ces lossis caj ces thrombophilia feem ntau tshwm sim thawj zaug. Ua ntej tshaj plaws, qhov no yog vim qhov tshwm sim ntawm qhov thib peb, placental lub voj voog ntawm kev ncig, uas ua rau muaj kev cuam tshuam ntxiv rau ntawm cov hlab ntsha. Kev tsim cov ntshav txhaws kuj tseem ua rau muaj ntau yam ntawm lub voj voog placental. Tsis muaj capillaries nyob rau hauv lub placenta, nws tau txais cov niam cov ntshav los ntawm cov hlab ntsha, ces, ntws los ntawm lub chorionic villi, nkag mus rau hauv txoj hlab ntaws.
Lub cev ntawm tus poj niam cev xeeb tub yog tus cwj pwm los ntawm cov ntshav txhaws, uas txo cov ntshav poob thaum yug menyuam lossis thaum muaj teeb meem xws li nchuav menyuam lossis qhov chaw mos. Nws ua rau muaj kev pheej hmoo ntawm cov ntshav txhaws, thiab qhov no yog qhov txaus ntshai nyob. Yog hais tias lawv nyob rau hauv cov hlab ntsha uas ua rau cov placenta, cov as-ham tsis ntws mus rau hauv lub cev xeeb tub, hypoxia tshwm sim. Nyob ntawm seb cov hlab ntsha txhaws thiab cov ntshav txhaws ntau npaum li cas, cov teeb meem loj tuaj yeem tshwm sim: yug ntxov ntxov, nchuav menyuam, cev xeeb tub tsis ua haujlwm, fetal malformations lossis tuag, placental insufficiency, placental abruption. Lawv feem ntau tshwm sim tom qab 10 lub lis piam. Nyob rau theem ua ntej, thrombophilia nrogcev xeeb tub yog tsawg heev. Yog tias tus kab mob no tshwm sim tom qab 30 lub lis piam, tom qab ntawd nws xaus rau ntau zaus nrog placental abruption, placental insufficiency lossis mob hnyav ntawm preeclampsia. Thaum lub sij hawm kuaj, tus kws kho mob yuav tsum tau xyuam xim rau cov ntshav txhaws, cov qauv rau cov poj niam "nyob rau hauv txoj hauj lwm" yog me ntsis txawv los ntawm cov feem ntau txais.
Diagnosis
Kev kho mob tshwm sim ntawm thrombosis tau lees paub hauv tsev kho mob siv cov chaw kuaj mob (cytological, biochemical, genetic, coagulological) thiab cov txheej txheem ntsuas. Los ntawm qhov tsos thiab qhov mob ntawm lub cev, ib tus tuaj yeem txiav txim siab qhov kev xav ntawm venous thrombosis (edema). Ob leeg venous thiab arterial yog nrog los ntawm tas li nias qhov mob thiab ib qho kev xav ntawm fullness. Qee zaum hauv thaj chaw hauv cheeb tsam, qhov kub ntawm daim tawv nqaij nce (venous). Nrog arterial thrombosis nyob ze ntawm qhov chaw ntawm thrombus tsim, muaj qhov kub thiab txias, cyanosis (cyanosis), thiab mob hnyav. Cov tsos mob uas tau teev tseg yog thawj cov cim ntawm thrombophilia, uas yog qhov tseem ceeb tshaj plaws uas yuav tau mus ntsib tus kws kho mob tshwj xeeb.
Ncaj nraim hauv tsev kho mob, kev tshuaj xyuas ntau dua ntawm tus neeg mob tus mob tau ua tiav. Nws yog ib qho tseem ceeb uas yuav tsum tau ua ib qho kev ntsuam xyuas rau thrombophilia, ua ultrasound ntawm cov hlab ntsha (txiav txim siab qhov xwm txheej, qhov loj thiab qhov chaw ntawm lub thrombus), ua qhov sib txawv arteriography thiab venography, uas tso cai rau koj mus rau thaj chaw thiab tshawb xyuas lub cev ntawm cov txheej txheem thrombotic. Tsis tas li ntawd, X-ray, radioisotope txoj kev, tshuaj ntsuam genetic tsom xam ntawm polymorphisms, kev txiav txim siab ntawm cov concentration.homocysteine.
Kev kho mob
Lo lus nug ntawm kev kov yeej tus kab mob tshwm sim hauv cov neeg uas tau ntsib nrog kev kuaj mob thrombophilia. Nws yog dab tsi thiab yuav ua li cas nrog nws kom tsis txhob muaj qhov tshwm sim loj? Kev kho mob ntawm cov kab mob pathology yuav tsum ua tiav thiab ua tiav nrog kev koom tes ntawm cov kws kho mob ntawm ntau yam tshwj xeeb: tus kws phais mob vascular, phlebologist, hematologist. Hauv thawj theem, nws yog ib qho tsim nyog los kawm txog etiopathogenetic mechanisms ntawm kev loj hlob ntawm tus kab mob. Cov txiaj ntsig zoo los ntawm kev kho mob yuav tsum xav tau tsuas yog tom qab tshem tawm cov hauv paus hauv paus. Ib qho tseem ceeb ntawm kev kho mob yog kev noj zaub mov, uas muaj nyob rau hauv kev tsis suav cov khoom noj uas muaj cov roj cholesterol siab, txwv tsis pub muaj rog thiab kib. Nws raug pom zoo kom suav nrog txiv hmab txiv ntoo qhuav, zaub thiab txiv hmab txiv ntoo, tshuaj ntsuab tshiab hauv kev noj haus.
Kev kho tshuaj muaj nyob rau hauv kev teem caij ntawm cov tshuaj antiplatelet, uas yog ntxiv los ntawm kev siv cov tshuaj anticoagulant, kho cov ntshav, hemodulation. Qee qhov xwm txheej, nws yog ib qho tsim nyog yuav tsum tau nqa tawm cov ntshav khov tshiab ua ke nrog heparinization. Kev hloov kho yog raug sau tseg rau daim ntawv keeb kwm yav dhau los, uas yog tshwm sim los ntawm qhov tsis txaus ntawm antithrombin III.
Mob thrombophilia (kev kuaj ntshav yuav pab txiav txim siab daim ntawv) yog kho nrog lyophilized plasma (intravenously) los yog qhuav pub ntshav plasma. Nyob rau hauv cov ntaub ntawv hnyav, cov tshuaj fibrinolytic yog siv, uas yog siv nyob rau theem ntawm cov hlab ntsha txhaws siv lub catheter. Nrog rau kev kuaj mob ntawm thrombophilia, kev kho mob yuav tsum tau xaiv tus kheej thiab ua tiav, uas yuav ua kom muaj kev kho mob sai thiab zoo.rov qab.
Kev Tiv Thaiv
Yuav kom tsis txhob ntsib tus kab mob loj no lossis nws cov teeb meem, nws yuav tsum tau ua ntu zus los tiv thaiv nws. Cov neeg mob uas muaj thrombophilia tau pom zoo kom ua cov ntshav plasma hauv cov koob tshuaj qis thiab kev tswj hwm subcutaneous ntawm cov tshuaj "Heparin". Rau kev tiv thaiv, tus neeg mob yuav tsum tau muab cov tshuaj uas ntxiv dag zog rau phab ntsa vascular (Trental intravenously, Papaverine qhov ncauj).
Rau kev tiv thaiv thiab kev kho mob ntawm thrombophilia, nws raug nquahu kom siv cov tshuaj pej xeem, xws li cov nroj tsuag tshuaj. Yog li, cranberry tshuaj yej los yog kua txiv hmab txiv ntoo yuav pab txo platelet kev ua si. Koj tuaj yeem txo cov ntshav nrog ib qho tincture ntawm Japanese Sophora noob. Tsis tas li ntawd, nws raug nquahu kom noj zaub mov kom raug, taug kev ntau zaus hauv huab cua ntshiab thiab tso tus cwj pwm phem.
