Thrombophilia - nws yog dab tsi? Thrombophilia: ua, tsos mob, kuaj thiab kho

Lub xeev ntawm lub cev ntawm tus kabmob rau txoj kev loj hlob ntawm lub plab thrombosis, uas tuaj yeem rov ua tau thiab muaj chaw txawv, hu ua thrombophilia. Tus kabmob no tuaj yeem yog cov caj ces lossis nrhiav tau. Qhov ua rau ntawm tus kab mob yog feem ntau zog rau cov ntshav txhaws. Clinically, tus kab mob no tuaj yeem tshwm sim los ntawm ntau qhov chaw ntawm lub chaw sib txawv. Thrombophilia feem ntau tshwm sim ntawm cov pejxeem thiab tshwm sim hauv ntau hom ntawv. Tus kab mob yuav tsum tau kho nrog tshuaj los yog kev phais mob.

Thrombophilia: yog dab tsi?

Pathology yog hais txog cov kab mob ntawm cov ntshav system, pom tshwm sim rau cov ntshav txhaws thiab ua txhaum ntawm hemostasis. Ntau yam mob thrombosis hauv thrombophilia tuaj yeem tshwm sim los ntawm kev raug mob, kev phais, lub cev kev hnyav lossis thaum cev xeeb tub. Mob yog txaus ntshai vim hais tias nws yuav ua tau kom mob xws li pulmonary embolism, mob stroke, heart attack myocardial infarction, sib sib zog nqus cov hlab ntsha thrombosis. Feem ntau, cov ntaub ntawv uas tsis saib xyuas tau ua rau tuag.

Txoj kev tshawb nrhiav, kuaj mob thiab kev kho mob ntawm thrombophilia koom nrog ntau qhov chaw ntawm cov tshuaj. Hematology kev tshawb xyuas kev ua txhaum ntawm cov ntshav, phlebology - txoj kev kuaj mob thiab kev kho mob ntawm venous thrombosis, kev tshem tawm ntawm cov kab mob thrombi yog ua los ntawm vascular phais. Tus tsim tawm ntawm ib qho thrombus ua rau ib qho kev ua txhaum ntawm cov ntshav khiav, uas yog nrog los ntawm txoj kev loj hlob ntawm cov kev mob nyaum uas nyuaj rau kho. Nyob rau hauv lub sij hawm los mus tiv thaiv cov teeb meem, koj yuav tsum tseg tau soj ntsuam kuaj rau cov ntshav txhaws. Cov cai rau cov poj niam, rau piv txwv, venous ntshav yog 5-10 feeb.

Ua rau kev txhim kho

Cov yam tseem ceeb uas ua rau kev loj hlob ntawm pathology yog ntau. Yuav luag txhua tus neeg muaj peev xwm fim xws li ib tug kab mob li thrombophilia. Qhov no yog ib qho txaus ntshai, ntau tus neeg mob tej zaum kuj tsis txawm txhawj xeeb thiab thov kev pab lig. Muaj ib daim ntawv teev cov laj thawj uas yuav pab tau rau kev loj hlob ntawm kev mob ntsws.

Hereditary (los yog caj ces) thrombophilia tshwm sim los ntawm kev tshuaj ntsuam genetic 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. Cov xwm txheej muaj xws li atherosclerosis, malignant neoplasms, atrial fibrillation, varicose leeg, cov kab mob autoimmune. Tej zaum yuav ua rau muaj ntshav liab tsawg tom qab stroke los yog infarction. Qhov chaw muaj kev pheej hmoo kuj muaj cov neeg mob uas muaj rog, ua rau lub cev tsis muaj zog, noj cov tshuaj hormonal contraceptives, noj tsis zoo, tau raug kev cuam tshuam loj lossis kev phais mob yav dhau los. Thaum muaj hnub nyoog ntxov, tus kab mob yog tsawg, nws feem ntau tshwm sim hauv cov neeg laus. Txhawm rau tiv thaiv kab mob los yog tsis tau pib mob, nws raug nquahu kom mus soj ntsuam ib qho kev ntsuam xyuas rau thrombophilia txij ua ke mus ua ke.

Clinical duab

Kev soj ntsuam ntawm pathology yog characterized los ntawm smoothness ntawm txoj kev loj hlob thiab lub sij hawm ntawm cov khiav, yog li cov neeg mob tsis sai tam sim ntawd pom hloov hauv lub xeev kev noj qab haus huv thiab tsis ua tej yam tsis txaus siab. Cov pa roj carbon monoxide muaj peev xwm kuaj tau tus kab mob thrombophilia, thiab ib qho kev qhia txog kev kuaj mob qee qhov tshwm sim rau ob peb xyoos tom qab ntawd. Ib qho symptomatology tiag yog txoj cai thaum lub thrombus twb tau ua. Cov teeb meem ntawm kev nrawm ntawm lub lumen ntawm lub nkoj thiab qhov chaw ntawm lub thrombus cuam tshuam qhov kev mob ntawm cov tsos mob.

Arterial thrombosis, tshwm sim los ntawm cov ntshav cov ntshav hauv cov lumen ntawm cov hlab ntsha ntawm lub txaj hauv arterial, yog nrog cov pob txha ntawm cov hlab ntsha ntawm lub tsho me nyuam, kev tuag ntawm tus me nyuam hauv plab, ntau tus me nyuam mos, cov kev mob ntawm kev mob ntsws tsis muaj zog, kev sib zog khaus pob txha.

Nrog venous thrombosis ntawm qhov nquag sab, cov tsos mob tshwm sim pom lawv tus kheej hauv daim ntawv ntawm trophic hloov nyob rau hauv daim tawv nqaij, qhia tau hais tias o ntawm sab qis extremities, qhov tsos ntawm qhov mob, thiab lub siab hnyav hauv lub sab nraub qaum.

Mezentealny thrombosis plob tsis so tswj tshwm sim thaum ib tug ntshav los khov rau ntawd nyob rau hauv lub chaw ntawm cov mesenteric hlab ntsha thiab nrog xws tsos mob li xoob quav, ntuav, xeev siab, riam-ntse mob.

Nrog rau lub siab ntawm lub siab ntawm daim siab, hydrothorax tus mob (Badd-Chiari syndrome), ascites, edema ntawm phab ntsa hauv sab hauv plab thiab sab hauv qab, ntuav thiab mob siab heev hauv cheeb tsam epigastric.

Hematogenous thrombophilia

Thrombosis muaj feem xyuam rau cov xwm txheej ntawm cov vascular phab ntsa, ua rau nws thiab txo kev ruaj ntseg, pab txhawb kev qeeb ntawm cov ntshav txaus thiab kev loj hlob ntawm lwm tus mob hemodynamic uas yog txuam nrog kev hloov hauv viscosity thiab xau. Thrombophilic puag hauv ntau zaus yog txuam nrog kev muaj cov kab mob hauv cov leeg, xws li atherosclerosis, raug mob rau vascular, raug mob, lossis kab mob sib kis kab mob vasculitis. Ntau lub plhaub taummom thromboembolisms tuaj yeem tshwm sim los ntawm cov kev hloov ntawm cov ntshav ntawm nws tus kheej, uas muab txoj cai los hais txog tus kab mob hu ua "hematogenous thrombophilia". Txoj kev loj hlob ntawm pathology yog txuam nrog lub propensity ntawm lub cev los tsim muaj cov thrombosis los ntawm kev txawv txav hauv cov tshuab xauv, qhov ua txhaum ntawm haemostatic peev xwm ntawm cov ntshav.

Hematogenic thrombophilia los ntawm keeb kwm tuaj yeem yog congenital los yog tau. Lub ntsiab mechanism ntawm tus kab mob yog los ntawm: conjugated thrombogen shifts, platelet kawg, fibrinolysis ntshawv siab, inhibition, txawv txav los yog deficiency ntawm cov ntshav coagulation, tsis muaj cov kab mob physiological anticoagulants. Ntxiv rau, iatrogenic thrombophilia yog tshwm sim los ntawm kev kho mob los sis kev kho mob.

Hereditary thrombophilia

Ntsuas lub cev pob txha los ntawm lub plab los ntawm qhov muaj tus mob thrombosis los ntawm qhov tshwm sim hauv plab nram no: qhov tshwm sim hauv plab hnyuv taum thaum muaj hnub nyoog, mob ntses ntawm cov hlab ntsws plab ntsws, mob me, sab qis tshaj hauv tsev neeg keeb kwm, thawj zaug ntawm cov hlab ntsha rov qab mus txog 30 xyoo, Cov nyom thrombotic. Hereditary los yog mob caj pas thrombophilia yog txiav txim siab tom qab ib qho kev kuaj mob ntawm cov neeg mob uas muaj feem yuav tsim muaj cov kab mob thrombophilic.

Cov kab mob hauv tus kab mob yuav muaj peev xwm sib txawv. Thaum kuaj pom tus kab mob, cov caj ces tshuaj ntawm thrombophilia raug muab tso rau hauv koj tus account. Thawj qhov zoo tshaj plaws uas txhawb nqa kev loj hlob ntawm pathology yog ib qho kev tshuaj ntsuam genetic predisposition. Nyob rau hauv cov ntaub ntawv no, tus kab mob yuav tsis manifest nws tus kheej nyob rau hauv qhov tsis muaj peev xwm, uas ua rau lub mechanisms ntawm nws txoj kev loj hlob. Qhov thib ob yog qhov hloov ntawm cov noob thaum lub sij hawm embryonic kev loj hlob. Qhov concentration ntawm yam cuam tshuam rau kev hloov ntawm cov noob yog noticeably nce lately. Ntawm lawv yog cov uas ua los ntawm tib neeg cov dej num: hluav taws xob hluav taws xob, siv cov khoom noj khoom haus, tshuaj, kev ua qias tuaj (tsev tshuaj, ntau yam roj hmab, tshuaj tua kab), neeg tsim kev puas tsuaj. Ib qho tsis tuaj yeem kwv yees nyob rau hauv yam dab tsi uas muaj ib tus gene yuav tsum tau hloov mus hloov, yog li ntawd mutagenesis yog suav hais tias yog ib qho txheej txheem uas tshwm sim los ntawm nws tus kheej thiab muaj peev xwm los hloov cov khoom qub.

Mob muaj keeb thrombophilia kuj tej zaum yuav tshwm sim los ntawm cov yam ntxwv los yog genomic hloov ntawm chromosomes, pub los ntawm yav dhau los tiam. Lub xeev ntawm tus kab mob noob qoob loo tseem ceeb heev nyob ntawm no: ua kom rov qab los sis tseem ceeb. Nyob rau hauv qhov thib ob rooj plaub, cov pathology yuav manifest nws tus kheej nyob rau hauv tej yam kev mob.

Tau txais thrombophilia

Tsis yog tsuas pub tshuaj ntsuab xwb, tab sis kuj tseem tuaj yeem tuaj yeem tuaj yeem muaj tus kab mob no. Tus neeg mob tuaj yeem kuaj tau tus mob antiphospholipid syndrome (APS). Qhov no yog li cas cov kis tau tus kab mob thrombophilia tshwm sim hauv nws tus kheej feem ntau. Dab tsi yog nws, dab tsi yog cov mechanisms ntawm nws txoj kev loj hlob thiab yuav ua li cas nrog nws?

Antiphospholipid syndrome yog ib txoj haujlwm ntawm cov tsos mob uas ua ke nrog cov ntaub ntawv kuaj mob thiab kev kuaj mob. Tus kab mob no yog los ntawm kev mob neurological, kev tiv thaiv kab mob hauv lub cev, kev xeeb tub hauv plab, venous thiab arterial thrombosis. Tso cov hom ntawv ntawm APS: thawj, theem nrab thiab kev puas tsuaj; Serological variants: seronegative thiab seropositive. Tus mob no tshwm sim tawm tsam ntawm keeb kwm ntawm kev hnoos, kis kab mob, los yog mob oob qhab los yog vim muaj kev quav tshuaj yeeb.

Kev txhim kho ntawm APS tuaj yeem txuam nrog cov kev mob ntsws xws li: kev mob plab (cancer), mob plawv (lymphoproliferative diseases, leukemia), kis kab mob (mycoplasmosis, HIV, syphilis), asymptomatic kev ua ntawm AFA, mob raum tsis ntev, mob plab hnyuv laus thiab mob ntsws, connective cov ntaub so ntswg mob, thiab cov kab mob autoimmune (Crohn tus kab mob, mauj vasculitis, SLE).

Thrombophilia thaum cev xeeb tub

Thaum muaj menyuam hauv plab, feem ntau caj ces lossis keeb kwm thrombophilia feem ntau tshwm nws tus kheej rau thawj zaug. Ua ntej tshaj plaws, qhov no yog vim qhov pom ntawm ib feem peb, qhov chaw ncig ntawm vaj tse, uas ua rau muaj kev ntxhov ntxiv rau hauv lub cev. Qhov kev tsim ntawm thrombi kuj muaj feem xyuam rau ib tug xov tooj ntawm cov qauv ntawm lub vajvoog pluaj. Hauv lub tsho me nyuam, tsis muaj capillaries, leej niam cov ntshav tawm ntawm cov hlab ntsha, ces, ntws los ntawm villi ntawm chorion, nkag mus rau hauv lub umbilical qaum.

Tus kab mob ntawm tus poj niam cev xeeb tub yog tus cwj pwm ntawm cov ntshav muaj zog, uas ua kom txo qis ntshav hauv lub cev tsis muaj zog los yog thaum muaj teeb meem xws li qaub ncaug los yog plab plab plhu. Nws yuav pab ua rau kom muaj ntshav txaus txhav, tab sis qhov no yog qhov txaus ntshai hauv lawv. Yog tias lawv nyob rau hauv cov hlab ntsha uas ua rau lub tsho me nyuam, cov keeb kwm nres tau mus rau hauv lub cev me nyuam hauv plab, hypoxia tshwm sim. Raws li cov theem ntawm cov hlab ntsha thiab cov qe ntshav tsawg, cov teeb meem loj yuav ua tau raws li: kev yug ntxov, yug me nyuam, cev xeeb tub, malformations lossis fetal tuag, fetoplacental tsis muaj txaus, plab tsis taus plab. Lawv tshwm sim, raws li txoj cai, tom qab 10 lub lim tiam. Yav dhau los, thrombophilia thaum cev xeeb tub muaj tsawg kawg nkaus. Yog tias tus kab mob no tshwm sim tom qab 30 lub lis piam, qhov no xaus rau ntau zaus, qhov chaw ploj zuj zus, plab tsis tuaj tsis txaus los yog muaj mob hnyav. Ntawm qhov kev kuaj mob tus kws kho mob yuav tsum tau saib xyuas kom zoo rau cov ntshav, qhov txawv ntawm cov poj niam "nyob rau hauv txoj hauj lwm" uas txawv me ntsis ntawm tus txheej txheem.

Diagnostics

Cov kev mob tshwm sim ntawm thrombosis tau pom zoo nyob hauv qhov chaw kho mob nrog kev pab los ntawm kev sim (cytological, biochemical, genetic, coagulogic) thiab cov kev coj ua. Los ntawm qhov tsos thiab mob ntawm lub cev yuav txiav txim tau qhov kev xav ntawm venous thrombosis (edema). Ob lub venous thiab arterial yog nrog nws los ntawm qhov nias ntawm kev mob nkeeg thiab zoo nkaus ntawm tawg ntho. Qee lub sij hawm nyob rau hauv cheeb tsam hauv cheeb tsam, qhov tawv kub nce (venous). Nrog arterial thrombosis nyob ze rau ntawm qhov chaw ntawm thrombus tag, muaj ib tug txo nyob rau hauv kub, cyanosis (cyanosis), ntse mob. Cov tsos mob no yog thawj cov cim ntawm thrombophilia, uas yog qhov tseem ceeb tshaj plaws mus ntsib kws kho mob tshwj xeeb.

Ncaj nraim hauv tsev kho mob, ntau qhov kev tshawb fawb ntawm tus neeg mob tus mob yog nqa tawm. Nws yog ib qho tsim nyog yuav tsum tau ntsuam xyuas seb puas muaj tus kab mob thrombophilia, ua ultrasound ntawm cov hlab ntsha (txiav txim seb qhov xwm txheej, qhov loj me thiab qhov chaw nyob ntawm qhov khoom plig), coj tus cwj pwm sib txawv thiab venography, uas tso cai rau qhov chaw hauv lub cev thiab kev tshawb nrhiav ntawm lub plhaw. Tsis tas li ntawd, X-duab hluav taws xob, cov xov tooj cua hauv xov tooj, txoj kev ntsuam xyuas ntawm genetic analysis ntawm polymorphisms, kev txiav txim siab ntawm homocysteine concentration yog siv.

Kev Kho Mob

Cov lus nug ntawm kev kov yeej tus kab mob no tshwm sim nyob rau hauv cov neeg uas tau muaj tus mob trombophilia. Yuav ua li cas yog nws thiab yuav ua li cas nrog nws kom thiaj li tsis txhob raug txim loj? Kev kho cov kab mob pathology no yuav tsum tau ua thiab muaj kev koom tes ntawm cov kws kho mob ntawm cov kws kho mob tshwj xeeb: vascular phais, phlebologist, hematologist. Nyob rau ntawm thawj theem nws yog ib qhov tsim nyog yuav tau kawm cov etiopathogenetic mechanisms ntawm kev loj hlob ntawm tus kab mob. Cov txiaj ntsim tau zoo los ntawm kev kho mob yuav tsum tsuas yog tom qab tshem tawm qhov ua dhau los. Ib qho tseem ceeb ntawm txoj kev kho yog noj cov zaub mov uas tsis suav nrog cov zaub mov muaj roj cholesterol, txo cov khoom noj roj thiab cov khoom kib. Nws yog pom zoo kom muaj xws li cov zaub mov qhuav, zaub thiab txiv hmab txiv ntoo, cov tshuaj tshiab.

Kev kho tshuaj kho mob yog nyob rau ntawm qhov kev teem caij tsis sib haum xeeb, uas yog ntxiv los ntawm kev siv tshuaj anticoagulant, kev kho mob ntshav, dej hiav txwv. Qee zaum, cov tshuaj khov nab kuab tshiab yuav tsum tau muab ntxiv ua ke nrog nrog heparinization. Hloov kho txoj kev kho yog sau rau hauv daim ntawv ntawm lub cev, uas yog vim muaj qhov tsis muaj peev xwm ntawm antithrombin III.

Yooj yim thrombophilia (kev kuaj ntshav yuav pab txiav txim rau daim ntawv) yog kho nrog lyophilized plasma (intravenously) los yog qhuav ntshav siab. Nyob rau hauv cov ntaub ntawv loj, cov tshuaj siv fibrinolytic yog siv, uas tau ua nyob rau theem ntawm lub nkoj siv khawm uas siv lub catheter. Thaum qhov kev kho tus mob thrombophilia yuav tsum tau xaiv ib tus neeg xaiv thiab ua ke, uas yuav ua kom sai thiab zoo rov qab.

Kev Tiv Thaiv

Yuav kom tsis txhob muaj cov kab mob loj no lossis nws cov teeb meem, yuav tsum tau tiv thaiv kom tsis txhob muaj kev tiv thaiv kab mob. Cov neeg mob uas muaj tus kab mob thrombophilia tau pom zoo kom ua kom ntshav txhob ntshav tsawg thiab txhaj cov tshuaj txhaj "Heparin". Cov neeg mob rau kev tiv thaiv yuav tsum tau sau cov tshuaj uas ntxiv dag zog rau phab ntsa ("Trental" intravenously, "Papaverin").

Yuav kom tiv thaiv thiab kho cov thrombophilia, nws raug nquahu kom siv cov tshuaj tua neeg, piv txwv li, cov nroj tsuag ntawm cov nroj tsuag. Yog li, txo cov kev ua ntawm platelets yuav pab tshuaj yej los ntawm cranberries los yog kua txiv hmab txiv ntoo. Yuav tua cov ntshav tuaj yeem nrog kev pab ntawm tincture los ntawm cov noob ntawm Japanese Sophora. Tsis tas li ntawd, nws yog ntshaw kom noj zaub mov zoo, feem ntau taug kev hauv cov huab cua ntshiab thiab tso tseg cov cwj pwm phem.