I-microangiopathy ichazwa njengomonakalo emithanjeni emincane yegazi kuma-pathologies ahlukahlukene. Ingadala ukuhlupheka ezithweni ezahlukene, kube nemiphumela eguquguqukayo kakhulu kuye ngokuthi ihlotshaniswa nesifo sikashukela (isifo sikashukela i-microangiopathy) noma i-thrombotic microangiopathy syndrome. Ukwehluleka kwezitho (ubumpumputhe, ukwehluleka kwezinso, ukulimala kwezitho eziningi, njll.) kubonakala ezimweni ezimbi kakhulu futhi uma kwenzeka ukubambezeleka noma ukwehluleka kokwelashwa.

Incazelo

I-Microangiopathy ichazwa njengokulimala emithanjeni emincane yegazi, futhi ikakhulukazi ama-arterioles nama-arteriolar capillaries ahlinzeka ngezitho. Kungenzeka ngaphansi kwezimo ezahlukene:

• I-Diabetesic microangiopathy iyinkimbinkimbi yohlobo loku-1 noma lwe-2 lwesifo sikashukela. Ukulimala kwemikhumbi kuvame ukutholakala esweni (i-retinopathy), izinso (nephropathy) noma i-nerve (i-neuropathy). Ngakho kungabangela ukulimala kwamehlo kuze kube yimpumputhe, ukwehluleka kwezinso, noma ngisho nokulimala kwezinzwa.
• I-Thrombotic microangiopathy iyingxenye yeqembu lezifo lapho imithambo emincane ivinjwa ngamahlule egazi (ukwakheka kwama-aggregate amaplatelet egazi). Izibonakalisa kuma-syndromes ahlukahlukene ahlotshaniswa nokungajwayelekile kwegazi (amazinga aphansi weplatelet namangqamuzana abomvu egazi) kanye nokwehluleka kwesitho esisodwa noma ngaphezulu njengezinso, ubuchopho, amathumbu noma inhliziyo. Amafomu ajwayelekile kakhulu i-thrombotic thrombocytopenic purpura, noma i-Moschowitz syndrome, kanye ne-hemolytic uremic syndrome. 

Izimbangela

Isifo sikashukela i-microangiopathy

I-Microangiopathy yesifo sikashukela ibangelwa yi-hyperglycemia engapheli edala ukulimala kwemikhumbi. Lezi zilonda zifika sekwephuzile, kanti ukuxilonga kuvame ukwenziwa ngemuva kweminyaka eyi-10 kuya kwengama-20 yokuqhubeka kwesifo. Kusheshe kakhulu lapho ushukela wegazi ungalawulwa kabi yizidakamizwa (i-glycated hemoglobin, noma i-HbA1c, iphezulu kakhulu).

Ku-retinopathy yesifo sikashukela, i-glucose eyeqile kuqala iholela ekwakhiweni kwama-micro-occlusions wemikhumbi. Ukunwetshwa okuncane kwemikhumbi bese kwakhiwa phezulu nomfula (ama-microaneurysms), okuholela ekopheni okuncane (i-punctiform retinal hemorrhages). Lo monakalo emithanjeni yegazi kubangela ukubonakala kwezindawo ze-retina ezinganiselwa kahle, ezibizwa ngokuthi izindawo ze-ischemic. Esigabeni esilandelayo, imikhumbi emisha engavamile (neovessels) yanda ebusweni be-retina ngendlela engavamile. Ezimweni ezinzima, le retinopathy ekhulayo ibangela ubumpumputhe.

Ku-nephropathy yesifo sikashukela, i-microangiopathy ibangela izilonda emithanjeni ehlinzeka nge-glomeruli yezinso, izakhiwo ezinikezelwe ekusefweni kwegazi. Izindonga zemikhumbi ezibuthakathaka nokungacheleli kahle ekugcineni kuphazamisa ukusebenza kwezinso.

Ku-diabetesic neuropathy, ukulimala kwemizwa kubangelwa yi-microangiopathy, kuhlangene nokulimala okuqondile emicu yezinzwa ngenxa yoshukela oweqile. Zingathinta imizwa yangaphandle, elawula imisipha futhi idlulise imizwa, noma izinzwa ohlelweni lwezinzwa oluzimele olulawula ukusebenza kwe-viscera.

I-Microangiopathie thrombotique

Igama elithi thrombotic microangiopathy lichaza izifo ezinezindlela ezihluke kakhulu naphezu kwamaphuzu azo avamile, izimbangela zazo ezingaziwa njalo.

I-Thrombotic Thrombocytopenic Purpura (TTP) ivame ukuba nomsuka we-autoimmune. Umzimba wenza amasosha omzimba avimba ukusebenza kwe-enzyme ebizwa ngokuthi i-ADAMTS13, evamise ukuvimbela ukuhlangana kwamaplatelet egazini. 

Ezimweni ezingavamile, kukhona ukushoda unomphela kwe-ADAMTS13 okuxhunyaniswe nofuzo.

I-hemolytic uremic syndrome (HUS) iphumela ezimweni eziningi ezivela ekuthelelekeni. Izinhlobo ezahlukene zebhaktheriya eziboshiwe zikhiqiza ubuthi obubizwa ngokuthi i-shigatoxin, obuhlasela imikhumbi. Kodwa kukhona futhi i-HUS yofuzo, exhunywe nomdlavuza, ukutheleleka nge-HIV, ukufakelwa komnkantsha wethambo noma ukuphuza izidakamizwa ezithile, ikakhulukazi izidakamizwa zokulwa nomdlavuza.

kwesifo

Ukuxilongwa kwe-microangiopathy kusekelwe ngokuyinhloko ekuhlolweni komtholampilo. Udokotela angenza ukuhlolwa okuhlukahlukene kuye komongo wesenzakalo nezimpawu, isibonelo:

• i-fundus noma i-angiography ukuthola nokuqapha i-retinopathy yesifo sikashukela,
• ukunqunywa kwe-micro-albumin emchameni; ukuhlolwa kwe-creatinine egazini noma emchameni ukuqapha ukusebenza kwezinso,
• inani legazi ukuhlola amazinga aphansi amaplatelet namaseli abomvu egazi egazini,
• sesha izifo,
• imaging (MRI) yokulimala kobuchopho

Abantu abathintekayo

Ama-microangiopathies esifo sikashukela ajwayelekile. Cishe amaphesenti angama-30 kuye kwangama-40 abantu abanesifo sikashukela bane-retinopathy ezigabeni ezihlukene, noma cishe abantu abayisigidi eFrance. Kuyimbangela ehamba phambili yobumpumputhe ngaphambi kweminyaka yobudala engama-50 emazweni anezimboni. Isifo sikashukela siphinde sibe yimbangela ehamba phambili yesifo sezinso sesigaba sokugcina eYurophu (12 kuya ku-30%), futhi inani elandayo labanesifo sikashukela sohlobo 2 lidinga ukwelashwa kwe-dialysis.

I-thrombotic microangiopathies ayijwayelekile kakhulu:

• Imvamisa ye-PPT ilinganiselwa ku-5 kuya ku-10 amacala amasha ezakhamuzini eziyizigidi ngonyaka, ngobuningi besifazane (abesifazane be-3 abathintekayo kumadoda we-2). I-Hereditary PTT, ebonwa ezinganeni nasezinsaneni, iwuhlobo olungavamile kakhulu lwe-thrombotic microangiopathy, olunamacala ambalwa kuphela akhonjwe e-France.
• Ukuvama kwama-SHUs kunohlelo olufanayo nalolo lwe-PPT. Izingane ziyizisulu eziyinhloko zezifo ezibhekene nazo eFrance, i-HUS kubantu abadala ivame kakhulu ngenxa yezifo ezitholakala ngesikhathi sohambo (ikakhulukazi i-ejenti ye-dyentria).

Izici zengozi

Ingozi ye-microangiopathy yesifo sikashukela ingakhuliswa yizici zofuzo. I-Arterial hypertension, kanye nezici ezivame kakhulu eziyingozi zenhliziyo (ukukhuluphala ngokweqile, ukukhuphuka kwamazinga e-lipid egazi, ukubhema), kungaba yizici ezibhebhethekisayo.

I-PPT ingakhuthazwa ngokukhulelwa.

Isifo sikashukela i-microangiopathy

Izimpawu ze-diabetesic microangiopathy zitholakala ngobuqili. I-evolution ithule kuze kube yilapho kuvela izinkinga:

• ukuphazamiseka kokubona okuhlobene ne-retinopathy,
• ukukhathala, izinkinga zokuchama, umfutho wegazi ophakeme, ukuncipha komzimba, ukuphazamiseka kokulala, amajaqamba, ukulunywa, njll. uma kwenzeka ukwehluleka kwezinso,
• ubuhlungu, ukuba ndikindiki, ubuthakathaka, ukuvutha noma ukuncenceza kwemizwa ye-peripheral neuropathies; unyawo lwesifo sikashukela: ukutheleleka, izilonda noma ukubhujiswa kwezicubu ezijulile zonyawo ngengozi enkulu yokunqunywa; izinkinga zocansi, ukugaya ukudla, ukuphazamiseka komchamo noma kwenhliziyo lapho i-neuropathy ithinta uhlelo lwezinzwa oluzimele ...

I-Microangiopathie thrombotique

Izimpawu ziyahlukahluka, futhi ngokuvamile ziqala.

Ukuwa kwezinga lamaplatelet egazi (thrombocytopenia) ku-PTT kubangela ukopha, okubonakala ngokubonakala kwamachashaza abomvu (purpura) esikhumbeni.

I-anemia ehambisana nenani eliphansi lamangqamuzana abomvu egazi lingabonakala njengokukhathala okukhulu kanye nokuphefumula kanzima.

Ubuhlungu bomzimba buyahlukahluka kakhulu kodwa ngokuvamile bubalulekile. Ezimweni ezimbi kakhulu, kungase kube khona ukwehla kombono ngokushesha, ukukhubazeka ezithweni, imizwa (ukudideka, i-coma, njll.), ukuphazamiseka kwenhliziyo noma ukugaya ukudla, njll. Ukubandakanyeka kwezinso ngokuvamile kuvame ukulinganisela ku-PTT, kodwa kungaba kubi kakhulu ku-HUS. Amagciwane abangela i-HUS futhi ayimbangela yohudo olunegazi ngezinye izikhathi.

Ukwelashwa kwe-microangiopathy yesifo sikashukela

Ukwelashwa kwesifo sikashukela

Ukwelashwa kwesifo sikashukela kwenza kube nokwenzeka ukubambezela ukuqala kwe-microangiopathy futhi kuncishiswe imiphumela yokulimala kwemikhumbi. Kusekelwe ezinyathelweni zenhlanzeko nokudla (ukudla okufanele, ukuvivinya umzimba, ukuncipha, ukugwema ugwayi, njll.), ekuqapheni izinga likashukela egazini nasekusungulweni kokwelashwa kwezidakamizwa okufanele (izidakamizwa ezilwa nesifo sikashukela noma i-insulin).

Ukwelashwa kwe-retinopathy yesifo sikashukela

Udokotela wamehlo angase asikisele ukwelashwa kwe-laser photocoagulation eqondise izilonda zakuqala ze-retina ukuze zizivimbele ukuthi zingaqhubeki.

Esigabeni esithuthuke kakhulu, i-pan-retinal photocoagulation (PPR) kufanele icatshangelwe. Ukwelashwa nge-laser bese kuthinta yonke i-retina, ngaphandle kwe-macula ebhekele ukubona okuphakathi.

Ezimweni ezinzima, ukwelashwa kokuhlinzwa kuyadingeka ngezinye izikhathi.

Ukwelashwa kwe-nephropathy yesifo sikashukela

Esigabeni sokuphela kwesifo sezinso, kuyadingeka ukunxephezela ukungasebenzi kahle kwezinso noma nge-dialysis noma ngokusebenzisa ukufakelwa kwezinso (ukufakelwa).

Ukuphathwa kwe-diabetesic neuropathy

Amakilasi ahlukene ezidakamizwa (ama-antiepileptics, ama-anticonvulsants, ama-tricyclic antidepressants, ama-opioid analgesics) angasetshenziswa ukulwa nobuhlungu be-neuropathic. Ukwelashwa kwezimpawu kuzonikezwa uma kwenzeka kuba nesicanucanu noma ukuhlanza, ukuphazamiseka kokuhamba, izinkinga zesinye, njll.

I-Microangiopathie thrombotique

I-Thrombotic microangiopathy imvamisa ivumela ukusungulwa kokwelashwa okuphuthumayo egunjini labagula kakhulu. Isikhathi eside, ukubikezelwa kwakungelula ngoba kwakungekho ukwelashwa okufanele futhi ukuxilongwa kwakungasebenzi. Kodwa intuthuko yenziwe futhi manje ivumela ukuphulukiswa ezimweni eziningi.

Ukwelashwa kwe-thrombotic microangiopathy

Ngokuyinhloko isekelwe ekushintshanisweni kwe-plasma: umshini usetshenziswa esikhundleni se-plasma yesiguli nge-plasma evela kumnikeli wokuzithandela. Lokhu kwelashwa kwenza kube nokwenzeka ukuhlinzeka ngephrotheni ye-ADAMTS13 entula ku-PTT, kodwa futhi nokukhipha igazi lesiguli amasosha omzimba (i-HUS yemvelaphi ye-autoimmune) kanye namaphrotheni akhuthaza ukwakheka kwamahlule.

Ezinganeni ezihlushwa i-HUS ehambisana ne-shigatoxin, umphumela uvame ukuba muhle ngaphandle kwesidingo sokushintshisana nge-plasma. Kwezinye izimo, ukushintshaniswa kwe-plasma kufanele kuphindwe kuze kube yilapho isibalo seplatelet sesijwayelekile. Ziyasebenza kakhulu, kepha zingaletha ubungozi bezinkinga: izifo, i-thrombosis, ukungezwani komzimba ...

Zivame ukuhlotshaniswa nezinye izindlela zokwelapha: i-corticosteroids, izidakamizwa ze-antiplatelet, amasosha omzimba we-monoclonal, njll.

Ukwelashwa kwezifo ngama-antibiotic kufanele kube ngabanye.

Ukuphathwa kwezimpawu ezihambisanayo 

Izinyathelo zokuvuselela zingadingeka ngesikhathi sokulaliswa esibhedlela esiphuthumayo. Ukuvela kwezimpawu ze-neurological noma zenhliziyo kuqashwe ngokucophelela.

Ngokuhamba kwesikhathi, ama-sequelae anjengokwehluleka kwezinso kwesinye isikhathi ayabonwa, okubonisa ukuphathwa kokwelapha.

Ukujwayelekile koshukela wegazi kanye nokulwa nezinto eziyingozi kuwukuphela kokuvimbela i-microangiopathies yesifo sikashukela. Kufanele kuhlanganiswe nokuqapha njalo kwamehlo nokusebenza kwezinso.

Izidakamizwa ze-antihypertensive zinomphumela wokuvikela ezinso. Kuyafaneleka futhi ukunciphisa ukudla kwamaprotheni okudla. Izidakamizwa ezithile ezinobuthi ezinso kufanele zigwenywe.

Ukuvinjelwa kwe-thrombotic microangiopathies akunakwenzeka, kodwa ukuqapha njalo kungase kudingeke ukugwema ukuphindeka, ikakhulukazi kubantu abane-TTP.