Txhais raws li kev puas tsuaj rau cov hlab ntsha me, microangiopathy tau pom nyob rau hauv ntau yam pathologies. Nws tuaj yeem ua rau muaj kev txom nyem hauv cov kabmob sib txawv, nrog cov txiaj ntsig sib txawv nyob ntawm seb nws puas cuam tshuam nrog ntshav qab zib (diabetic microangiopathy) lossis nrog thrombotic microangiopathy syndrome. Lub cev tsis ua haujlwm (qhov muag tsis pom kev, lub raum tsis ua haujlwm, ntau lub cev puas tsuaj, thiab lwm yam) raug pom nyob rau hauv cov xwm txheej hnyav tshaj plaws thiab thaum muaj kev ncua lossis kev kho tsis tiav.

Lus txhais

Microangiopathy txhais tau tias yog kev puas tsuaj rau cov hlab ntsha me me, thiab tshwj xeeb tshaj yog cov hlab ntsha thiab cov hlab ntsha ntawm cov hlab ntsha uas muab cov khoom nruab nrog cev. Nws tuaj yeem tshwm sim hauv cov xwm txheej sib txawv:

• Mob ntshav qab zib microangiopathy yog ib qho teeb meem ntawm hom 1 lossis 2 mob ntshav qab zib. Kev puas tsuaj rau cov hlab ntsha feem ntau yog nyob hauv qhov muag (retinopathy), raum (nephropathy) lossis paj hlwb (neuropathy). Nws tuaj yeem ua rau pom kev puas tsuaj mus rau qhov muag tsis pom kev, lub raum tsis ua haujlwm, lossis txawm tias cov hlab ntsha puas.
• Thrombotic microangiopathy yog ib feem ntawm ib pab pawg ntawm cov kab mob uas cov hlab ntsha me raug thaiv los ntawm cov ntshav txhaws (kev tsim cov sib sau ntawm cov ntshav platelets). Nws manifests nws tus kheej nyob rau hauv ntau yam syndromes txuam nrog cov ntshav abnormality (qis platelets thiab cov qe ntshav liab) thiab tsis ua hauj lwm ntawm ib los yog ntau yam kabmob xws li lub raum, hlwb, cov hnyuv los yog lub plawv. Cov ntaub ntawv classic feem ntau yog thrombotic thrombocytopenic purpura, lossis Moschowitz syndrome, thiab hemolytic uremic syndrome. 

Ua rau

Mob ntshav qab zib microangiopathy

Mob ntshav qab zib microangiopathy tshwm sim los ntawm cov mob hyperglycemia uas ua rau muaj kev puas tsuaj rau cov hlab ntsha. Cov kab mob no tau teem caij lig, nrog kev kuaj mob feem ntau tau ua tom qab 10 txog 20 xyoo ntawm kev kis kab mob. Lawv tag nrho ntxov dua thaum cov ntshav qab zib tswj tsis tau los ntawm cov tshuaj (glycated hemoglobin, lossis HbA1c, siab dhau).

Hauv ntshav qab zib retinopathy, cov piam thaj ntau dhau ua ntej ua rau thaj chaw micro-occlusions ntawm cov hlab ntsha. Qhov me me ntawm cov hlab ntsha yog tom qab ntawd tsim cov dej ntws (microaneurysms), ua rau me me hemorrhages (punctiform retinal hemorrhages). Qhov kev puas tsuaj rau cov hlab ntsha no ua rau pom qhov tsis zoo ntawm cov hlab ntsha hauv cov hlab ntsha, hu ua thaj chaw ischemic. Nyob rau theem tom ntej, cov hlab ntsha tshiab txawv txav (neovessels) proliferate nyob rau saum npoo ntawm lub retina nyob rau hauv ib tug anarchic zam. Nyob rau hauv cov ntaub ntawv hnyav, qhov proliferative retinopathy ua rau dig muag.

Hauv kev mob ntshav qab zib nephropathy, microangiopathy ua rau muaj kab mob hauv cov hlab ntsha uas muab cov glomeruli ntawm lub raum, cov txheej txheem mob siab rau lim ntshav. Cov phab ntsa ntawm cov hlab ntsha tsis muaj zog thiab cov dej tsis zoo thaum kawg ua rau lub raum tsis ua haujlwm.

Hauv kev mob ntshav qab zib neuropathy, kev puas tsuaj rau cov hlab ntsha tshwm sim los ntawm microangiopathy, ua ke nrog kev puas tsuaj ncaj qha rau cov paj hlwb vim muaj suab thaj ntau dhau. Lawv tuaj yeem cuam tshuam cov hlab ntsha peripheral, uas tswj cov leeg nqaij thiab xa cov kev xav, lossis cov hlab ntsha hauv lub paj hlwb uas tswj kev ua haujlwm ntawm lub viscera.

Microangiopathie thrombotique

Lub sij hawm thrombotic microangiopathy qhia cov kab mob nrog cov txheej txheem sib txawv txawm tias lawv cov ntsiab lus sib txawv, qhov ua rau uas tsis yog ib txwm paub.

Thrombotic Thrombocytopenic Purpura (TTP) feem ntau muaj keeb kwm autoimmune. Lub cev ua cov tshuaj tiv thaiv uas thaiv kev ua haujlwm ntawm enzyme hu ua ADAMTS13, uas ib txwm tiv thaiv kev sib sau ntawm platelets hauv cov ntshav. 

Hauv cov xwm txheej tsis tshua muaj, muaj qhov tsis muaj peev xwm mus tas li ntawm ADAMTS13 txuas nrog kev hloov pauv hloov pauv.

Tus mob hemolytic uremic syndrome (HUS) ua rau feem coob ntawm cov neeg mob los ntawm tus kab mob. Cov kab mob sib txawv incriminated secrete ib co toxins hu ua shigatoxin, uas tawm tsam cov hlab ntsha. Tab sis kuj tseem muaj keeb kwm ntawm HUS, txuas rau mob qog noj ntshav, mus rau tus kab mob HIV, mus rau kev hloov cov pob txha pob txha lossis kev noj cov tshuaj, tshwj xeeb yog tshuaj tiv thaiv kab mob.

diagnostic

Kev kuaj mob ntawm microangiopathy feem ntau yog nyob ntawm kev kuaj mob. Tus kws kho mob tuaj yeem ua ntau yam kev ntsuam xyuas nyob ntawm qhov xwm txheej ntawm qhov tshwm sim thiab cov tsos mob, piv txwv li:

• fundus lossis angiography txhawm rau txheeb xyuas thiab saib xyuas ntshav qab zib retinopathy,
• kev txiav txim siab ntawm micro-albumin hauv cov zis; kuaj creatinine hauv cov ntshav lossis zis los saib xyuas lub raum ua haujlwm,
• cov ntshav suav los kuaj xyuas cov qib qis ntawm platelets thiab cov qe ntshav liab hauv cov ntshav,
• nrhiav kev kis kab mob,
• imaging (MRI) rau lub hlwb puas

Cov neeg txhawj xeeb

Mob ntshav qab zib microangiopathies feem ntau tshwm sim. Kwv yees li 30 txog 40% ntawm cov neeg mob ntshav qab zib mellitus muaj retinopathy ntawm ntau theem, lossis txog li ib lab tus tib neeg hauv Fabkis. Nws yog qhov ua rau qhov muag tsis pom ua ntej hnub nyoog 50 xyoo nyob rau hauv industrialized lub teb chaws. Ntshav Qab Zib kuj yog qhov ua rau muaj kab mob hauv lub raum kawg hauv Tebchaws Europe (12 txog 30%), thiab ntau tus neeg mob ntshav qab zib hom 2 xav tau kev kho ntshav lim ntshav.

Thrombotic microangiopathies tsis tshua muaj tshwm sim:

• Qhov zaus ntawm PPT yog kwv yees li ntawm 5 mus rau 10 tus neeg mob tshiab rau ib lab tus neeg nyob hauv ib xyoos, nrog rau poj niam feem ntau (3 tus poj niam cuam tshuam rau 2 tus txiv neej). Keeb kwm PTT, uas tau pom nyob rau hauv cov menyuam yaus thiab cov menyuam yug tshiab, yog ib hom kab mob thrombotic microangiopathy tsawg heev, tsuas yog ob peb lub kaum os raug txheeb xyuas hauv Fabkis.
• Qhov zaus ntawm SHUs yog tib yam li ntawm PPT. Cov menyuam yaus yog lub hom phiaj tseem ceeb ntawm cov kab mob uas muaj lub luag haujlwm rau lawv hauv Fab Kis, HUS hauv cov neeg laus feem ntau yog vim muaj kab mob sib kis thaum mus ncig (tshwj xeeb los ntawm tus neeg sawv cev ntawm dysentria).

Risk yam tseem ceeb

Kev pheej hmoo ntawm mob ntshav qab zib microangiopathy tuaj yeem nce ntxiv los ntawm cov caj ces. Arterial hypertension, thiab feem ntau ntawm cov kab mob plawv (mob rog, nce ntshav lipid, haus luam yeeb), tuaj yeem ua rau hnyav dua.

PPT tuaj yeem txhawb nqa thaum cev xeeb tub.

Mob ntshav qab zib microangiopathy

Cov tsos mob ntawm tus mob ntshav qab zib microangiopathy tau teeb tsa hauv insidiously. Lub evolution yog ntsiag to kom txog rau thaum cov tsos ntawm cov teeb meem:

• kev cuam tshuam tsis pom kev txuas nrog retinopathy,
• qaug zog, teeb meem tso zis, ntshav siab, poob phaus, pw tsaug zog cuam tshuam, cramps, khaus, thiab lwm yam thaum lub raum tsis ua haujlwm,
• mob, loog loog, qaug zog, kub hnyiab los yog tingling rhiab heev rau peripheral neuropathies; mob ntshav qab zib ko taw: kis kab mob, rwj lossis kev puas tsuaj ntawm cov ntaub so ntswg sib sib zog nqus ntawm ko taw nrog kev pheej hmoo siab ntawm kev txiav; Teeb meem kev sib deev, digestive, urinary lossis mob plawv thaum neuropathy cuam tshuam rau lub paj hlwb autonomic…

Microangiopathie thrombotique

Cov tsos mob muaj ntau yam, thiab feem ntau pib tshwm sim.

Lub cev qhuav dej ntawm qib ntawm cov ntshav platelets (thrombocytopenia) hauv PTT ua rau los ntshav, uas yog qhia los ntawm cov tsos ntawm cov pob liab liab (purpura) ntawm daim tawv nqaij.

Anemia cuam tshuam nrog cov qe ntshav liab tsawg tuaj yeem tshwm sim raws li kev qaug zog hnyav thiab ua tsis taus pa.

Qhov mob ntawm lub cev sib txawv tab sis feem ntau tseem ceeb. Nyob rau hauv cov xwm txheej hnyav, tej zaum yuav muaj kev poob rau hauv qhov muag tam sim ntawd, kev puas tsuaj ntawm cov ceg ceg, paj hlwb (tsis meej pem, coma, thiab lwm yam), mob plawv los yog digestive ntshawv siab, thiab lwm yam. Kev koom tes hauv lub raum feem ntau yog nruab nrab hauv PTT, tab sis tuaj yeem hnyav hauv HUS. Cov kab mob uas muaj feem xyuam rau HUS kuj yog qhov ua rau qee zaum mob raws plab.

Kev kho mob ntshav qab zib microangiopathy

Kev kho mob ntshav qab zib

Kev kho mob ntawm cov ntshav qab zib mellitus ua rau nws muaj peev xwm ncua qhov pib ntawm microangiopathy thiab txo qis qhov tshwm sim ntawm kev puas tsuaj rau cov hlab ntsha. Nws yog ua raws li kev noj qab haus huv thiab kev noj qab haus huv kev ntsuas (kev noj zaub mov kom zoo, kev ua si lub cev, kev poob phaus, zam kev haus luam yeeb, thiab lwm yam), ntawm kev saib xyuas cov ntshav qab zib thiab kev tsim kho cov tshuaj tsim nyog (cov tshuaj tiv thaiv mob ntshav qab zib lossis insulin).

Kev tswj cov ntshav qab zib retinopathies

Tus kws kho mob ophthalmologist tuaj yeem hais qhia txog kev kho mob laser photocoagulation tsom rau qhov mob thaum ntxov ntawm retina txhawm rau tiv thaiv lawv ntawm kev loj hlob.

Nyob rau theem siab dua, pan-retinal photocoagulation (PPR) yuav tsum tau txiav txim siab. Kev kho mob laser tom qab ntawd cuam tshuam tag nrho cov retina, tshwj tsis yog lub macula lub luag haujlwm rau lub hauv paus tsis pom kev.

Hauv cov ntaub ntawv hnyav, qee zaum kev kho phais yog tsim nyog.

Kev tswj cov ntshav qab zib nephropathies

Nyob rau theem kawg ntawm lub raum kab mob, nws yog ib qho tsim nyog yuav tau them nyiaj rau qhov tsis ua haujlwm ntawm lub raum los ntawm kev lim ntshav lossis los ntawm kev hloov mus rau lub raum (hloov).

Kev tswj cov ntshav qab zib neuropathies

Cov chav kawm sib txawv ntawm cov tshuaj (antiepileptics, anticonvulsants, tricyclic antidepressants, opioid analgesics) tuaj yeem siv los tawm tsam qhov mob neuropathic. Cov kev kho mob yuav muab rau thaum xeev siab lossis ntuav, kev hloov pauv, teeb meem ntawm lub zais zis, thiab lwm yam.

Microangiopathie thrombotique

Thrombotic microangiopathy feem ntau pom zoo rau kev tsim kho mob xwm txheej ceev hauv chav saib xyuas mob hnyav. Tau ntev, qhov kev kuaj mob tau zoo dua vim tias tsis muaj kev kho mob tsim nyog thiab kev kuaj mob tsis zoo. Tab sis kev nce qib tau ua tiav thiab tam sim no tso cai rau kev kho mob hauv ntau kis.

Kev kho mob ntawm thrombotic microangiopathy

Nws feem ntau yog raws li kev sib pauv plasma: lub tshuab yog siv los hloov cov neeg mob cov ntshav nrog ntshav los ntawm tus neeg pub dawb. Qhov kev kho no ua rau nws muaj peev xwm muab cov ADAMTS13 cov protein uas tsis muaj nyob hauv PTT, tab sis kuj tshem tawm cov neeg mob cov ntshav ntawm autoantibodies (HUS ntawm autoimmune keeb kwm) thiab cov proteins uas txhawb kev tsim cov hlab ntsha.

Hauv cov menyuam yaus uas raug kev txom nyem los ntawm HUS cuam tshuam nrog shigatoxin, qhov tshwm sim feem ntau yog qhov zoo yam tsis tas yuav muaj kev sib pauv plasma. Hauv lwm qhov xwm txheej, kev sib pauv plasma yuav tsum rov ua dua kom txog thaum cov platelet suav tau zoo. Lawv muaj txiaj ntsig zoo, tab sis tuaj yeem muaj kev pheej hmoo ntawm cov teeb meem: kab mob, thromboses, kev tsis haum tshuaj ...

Lawv feem ntau txuam nrog lwm yam kev kho mob: corticosteroids, tshuaj antiplatelet, monoclonal antibodies, thiab lwm yam.

Kev kho mob ntawm cov kab mob nrog tshuaj tua kab mob yuav tsum yog tus kheej.

Kev tswj cov tsos mob uas txuam nrog 

Kev ntsuas kev rov qab los yuav tsim nyog thaum mus pw hauv tsev kho mob xwm txheej ceev. Qhov tshwm sim ntawm neurological lossis cardiological cov tsos mob yog saib xyuas zoo.

Nyob rau hauv lub sij hawm ntev, sequelae xws li lub raum tsis ua haujlwm yog qee zaum pom, ua pov thawj kev tswj hwm kev kho mob.

Qhov normalization ntawm cov ntshav qab zib thiab kev tawm tsam ntawm kev pheej hmoo yog tsuas yog kev tiv thaiv ntawm cov ntshav qab zib microangiopathies. Nws yuav tsum tau ua ke nrog kev saib xyuas tsis tu ncua ntawm lub qhov muag thiab lub raum ua haujlwm.

Cov tshuaj antihypertensive muaj kev tiv thaiv ntawm lub raum. Nws kuj tseem pom zoo kom txo qis kev noj zaub mov muaj protein ntau. Tej yam tshuaj uas muaj tshuaj lom rau lub raum yuav tsum tau zam.

Kev tiv thaiv ntawm thrombotic microangiopathies tsis tuaj yeem ua tau, tab sis kev saib xyuas tas li yuav tsum tau ua kom tsis txhob rov ua dua, tshwj xeeb tshaj yog rau cov neeg muaj TTP.