Total bilirubin kuchuluka. Zimayambitsa okwera bilirubin m'magazi. A zakudya ndi kuchuluka bilirubin

Pakuti kagayidwe zachilendo ndipo mphamvu m'thupi ilo liyenera kukhala okwanira nthawi zonse magawo kuchokera kunja, ndiko, ndi chakudya, madzi ndi mpweya. zosakaniza awo zofunika ndi mankhwala organic, mavitamini ndi mbali mchere - potaziyamu, magnesium, sodium, yamkuwa, yachitsulo ndi ena ambiri. Otsiriza awa ndi mbali ya maselo ofiira, limodzi-selo onyamula mpweya magazi athu, chotero kagayidwe chitsulo n'kofunika kwambiri m'thupi. Ndipo pamene kuyan'anila mulimonse akufotokozera syndrome icteric, yodziwika ndi kuti bilirubin okwana anamuukitsa. Tsopano tiyeni tiyang'ane pa mfundo zonse zofunika.

chitsulo kagayidwe

Munthu afika chitsulo yekha ndi chakudya. Ake ananena ndende apamwamba mu chiwindi nyama, mtedza (mtedza pistachio, mtedza, paini, cashew), nyemba (mphodza, nandolo), dzinthu (buckwheat, tirigu, Mapila, balere), sipinachi, chimanga. Pankhaniyi koyamba kudzadza ndi kuchuluka koyenera heme kupanga maziko a erythrocyte, ndiyeno zichitika ndi mafunsidwe a chitsulo zofikira ake mu thupi, ndiwo za 3.4 magalamu, ikuimira ayoni, makamaka zokhudzana ndi mapuloteni plasma ndi michere (ferritin, transferrin, xanthine oxidase, ferroflavoproteiny, succinate ndi NADH-dehydrogenase, ndi ena). Koma zimachitika zambiri, koma tsopano tiyeni tiyang'ane pa zomvetsa wake, ndi zina chikhalidwe pathological.

The zifukwa imfa ya mchere wofunika

Imodzi mwa njira thupi limene pali imfa ya chitsulo ndi kusamba ndi mimba akazi. Komabe, mwina zinthu zofunika kwambiri ndi magazi imfa, poizoni, magazi a magwero osiyanasiyana, aakulu matenda mkati, neoplasms zilonda. Ngati imfa sikunali kwakukulu, ndi nthawi limabwezeretsa mu nthawi yaifupi, ndipo mu nkhani iyi mtima alibe zizindikiro za akusowa (sideropenic syndrome). Komabe, pali matenda amene kuchuluka kwa chitsulo anapitiriza, koma kuwombola ake anawawidwa mtima kwambiri. Zikatero monga icteric syndrome Genesis iliyonse pamene wapezeka monga waukulu metabolite kuwonjezeka - bilirubin. Kuyamba, yesetsani kumvetsa kagayidwe wake mu thupi ndi zimayambitsa kukwezeka bilirubin mu mwazi: ndikofunika kuzindikira chifukwa cha pathogenesis a matenda amenewa.

Kusinthana hemoglobin: gawo loyamba

Bilirubin chikukhudza inki zofunika m'gulu zikuchokera ya ndulu ndi excreted mthupi ndi ndalama zake. Iwo umapita nthawi yaitali ziwiya akadali mu mawonekedwe a hemoglobin, asintha zofunika hepatocytes ndipo potsiriza tochoka mu intestine kuti amasulidwe mu chilengedwe ndi ndowe. Choncho, mankhwala aumbike mwa oipa maselo a magazi ndi yomweyo anagwidwa ndi mapuloteni chonyamulira zoyendera kwa labu chachikulu - chiwindi. kachigawo amatchedwa mozungulira kapena zifukwa zina, chifukwa bilirubin ali sichinasinthe. Izi zimachitika chifukwa mawonekedwe ufulu mosavuta mkatikati mwa nembanemba wa selo lililonse, ndipo ali wamphamvu poizoni zotsatira makamaka manyuroni. Choncho, nsinga yake yachibadwa kumbuyo anachita.

Gawo neutralization ndi kudzipatula bilirubin

Komabe, mapuloteni amenewa sangathe apite naye intestine, chifukwa ofunikabe ndi thupi ntchito zina, ndipo motero bilirubin ayenera pansi chotero kusintha, kuti anataya malo ake chikudutsa mu maselo. Chifukwa chaichi, ndi hepatocytes (chiwindi parenchyma maselo structural) ndi conjugation ake, ndiye kumanga asidi glucuronic, amene, ndithu chabe, kukuwonjezera izo. Choncho, pansi zochita za enzyme ndi UDP-glucuronyl-diglucuronide bilirubin anapanga. Kenako, kuchokera hepatocytes izo akulowa ya ndulu ndipo mwa iwo adzamasulidwa ku matumbo pa chimbudzi. Tsopano kudutsa njira ndi bolus woyamba wochepa thupi, ndiye kuti m'matumbo, motsogoleredwa ndi zomera bakiteriya izo kachiwiri anamasulidwa ndipo anatembenukira kwa urobilinogen, kenako urobilin stercobilin kuti mwachindunji excreted mu chimbudzi. Koma nthawi yaing'ono kwambiri kuchuluka kwa bilirubin anabwerera m'mitsempha zipata ndi amachitika impso, kumene mkodzo atachotsedwa.

malire a yachibadwa

Kulakwila izi pigment kuwombola zofunika angayambe mu magawo atatu lalikulu lomwe magazi mu oipa a erythrocytes, kuti analanda ndi kudzipatula ya ndulu kwa chiwindi. Komabe, mu embodiments onsewa, adzakhululukidwa wapezeka mu mwazi: okwana bilirubin ndi kukwezeka, makamaka kaya ndi mwachindunji kapena mozungulira tuzigawo twa ake. Choncho, ndende mwake mwa madzi akuti ndi za 8,5-20,5 micromoles pa lita. Ngati nambala iyi kumawonjezera kwa 85, ndiye mkhalidwe hyperbilirubinemia wofatsa, kuyambira 86 mpaka 169 - pakati ndipo potsiriza oposa 170 mmol / l - kwambiri. Ndipafupifupi choncho, ngati inu anasonyeza kuti okwera okwana bilirubin. Koma ulamuliro alipo padera kwa tuzigawo twa: molunjika - kuti 5.1, unbound - 16.5 pmol / l.

Suprarenal mtundu wa matenda a chikasu ndiyo

Choncho, kuphwanya gawo loyamba la okwana bilirubin m'magazi liukitsidwa poyambilira kudzera kachigawo zina. Zimenezi zalongosoledwa ndi etiology a boma, womwe ndi kuvunda kumatheka wa maselo a magazi m'magazi. Izi angayambe milandu mitundu kobadwa nako wa hemolytic magazi m'thupi (zopindika pa mlingo majini a maselo ofiira a magazi okha, michere awo, hemoglobin) kapena kugula (immunological kuukira matenda ndi erythrocytes yake, kukhudzana ndi poizoni ndi ziphe, mavairasi, mabakiteriya ndi zamoyo zina). Choncho, pathogenesis kwambiri chifukwa mapangidwe bilirubin chifukwa maselo chiwindi omwe alibe nthawi kukalanda kuchuluka zazikulu kwambiri za izo, ndipo amasonkhana mu khungu ndi mucous zimagwira ntchito zosiyanasiyana, ndiyeno ziwalo mkati, kuwachititsa anavulala kwambiri. Choncho anapanga mtundu suprarenal wa matenda a chikasu ndiyo.

Kwa chiwindi mtundu matenda a chikasu ndiyo

Ngati kuphwanya kumachitika pa siteji yachiwiri yofunika kwambiri hepatocytes alibe nthawi kukatenga ndi pokonza ngakhale chokwanira amaperekedwa kwa iwo metabolite wa hemoglobin, ndipo pamapeto pake likuvutika magulu onse kukwezeka okwana bilirubin. The zifukwa - katundu zowononga kusintha mu chiwindi. Zikuphatikizapo chiwindi ya chiyambi zosiyanasiyana (poizoni, mowa, tizilombo) ndi matenda enaake. Choncho, zimayambitsa okwera bilirubin mu bodza magazi chakuti hepatocytes mwina ntchito mokwanira, kapena ndi kutupa mu, mwina chifukwa chiwerengero chawo osakwanira. Chifukwa ambiri, ndithudi, ndi chiwindi A-mtundu, B, C, ankadziwana, E kapena PP. Choncho akufotokozera kwa chiwindi (parenchymal) mtundu wa matenda a chikasu ndiyo syndrome, amene anatsagana ndi zizindikiro yowala kutupa mesenchymal ndi gepatotsiliarnoy kulephera.

Obstructive mtundu matenda a chikasu ndiyo

Ndipo, ndithudi, kuphwanya kagayidwe bilirubin akhoza zimachitika pa siteji yachitatu chachikulu, apo ndi pamene excretion wa ya ndulu. Lang'anani, ndi njira iyi iwo watsekedwa ndi njira linanena bungwe kapena chiwindi, ngakhalenso vesicafellea. Chifukwa cha kusintha mu ya ndulu amasonkhana mu chikhodzodzo ndi njira, kukakamiza pang'onopang'ono kumawonjezera, ndipo pamapeto pake akubwerera (zodabwitsazi amatchedwa regurgitation) mu ducts intrahepatic, ndiyeno - mu zotengera magazi, nchifukwa chake okwera okwana bilirubin. Pa nthawi yomweyo, ndithudi, pali zinthu zina mu kafukufuku amuzolengedwa. Choncho, magazi kumachitika cholehemia, i.e. mu izo zidulo ya ndulu ndi michere, ndipo ducts okha anapanga cholestasis, i.e. patsogolo secretions. Kukomoka, izi adzalamulira matenda a chikasu ndiyo sclera, zikopa mucous ndi khungu (mtundu wachikasu ndi kulocha zobiriwira), ndipo mu nkhani sitikanati okwana bilirubin ndi mwachindunji kuchuluka, komanso zidulo ya ndulu, mafuta m'thupi, mlingo wa phosphatase zamchere, triglycerides, ntchito ya Popanga madzi a gamma-glutamyl transferase .

zimayambitsa

The etiology wa obstructive kapena, monga momwe adziwikira obstructive matenda a chikasu ndiyo, ndi yaikulu kwambiri. Chifukwa ambiri ndi blockage wa biliary thirakiti mwala pa cholecystitis calculous kapena cholelithiasis ndi infestations helminthic clump pamene nyongolotsi isanafalikire mkati ducts kapena kudera cholangitis, ndipo pamene iwo ali lumen chofuna occlusive kapena chifukwa kutupa makoma, kapena chifukwa kusalola iwo. Ndipo, ndithudi, izi akufotokoza mfundo yakuti bilirubin mwachindunji ndi okwana kuchuluka. The zifukwa pathologies ena Mulimonsemo, chifukwa cha psinjika wa kunja. Nthawi zambiri izi zimachitika chifukwa cha kukula chotupa zambiri zokhudza mutu wa kapamba. Komanso zimenezi zingachitike pamene biliary matenda enaake, pamene ducts ndi cholizira kukula ziwembu ndi chingwe minofu connective.

Neonatal matenda a chikasu ndiyo

Komabe, si onse matenda a chikasu ndiyo zochitika pathological wa chamoyo. Choncho ngati okwana bilirubin ndi wokwezeka pa mwana yomweyo pobadwa kapena maola angapo pambuyo, ndi khungu ndi nembanemba mucous ndi yowala jaundiced, simuyenera yomweyo kuomba Alamu. Pambuyo ana akhanda ndi chikhalidwe thupi otchedwa chosakhalitsa chifukwa chosakhalitsa. Kumene, funso n'lakuti mayi ake okondwa amene amaphunzira kuti mwana wake bilirubin ndi kukwezeka, "Kodi nditani?" Yankho lake ndi losavuta: dikirani. Pamene izi makamaka amaonetsera kasamalidwe woyembekezera, kuyambira kwa masiku angapo (zambiri atatu kapena asanu) yellowness pang'onopang'ono kusiyiratu. Ndipo pokhapokha ngati mochedwerapo, mmene mwanayo zinafika poipa okwana bilirubin ndi kukwezeka, mankhwala ikuchitika mwachangu, ndicho detoxification mankhwala ntchito ndi ultraviolet walitsa. Tsopano tiyeni tikambirane pathogenesis a chikhalidwe ichi.

akhanda makamaka magazi

Popeza kuti yoopsa makope ali m'mimba zimasiyana kuti anaona ana obadwanso kale. Woyembekezera, mwana kumizidwa mu kuwira ndi madzimadzi amniotic, ndi chifukwa mapapo ake sali kudziŵa mlengalenga ndipo makwinya boma, mwachitsanzo inoperative. Koma mwanayo n'kofunika otaya mosalekeza kwa mpweya kuti zimakhala wake uyambike awo, kukula ndi zosiyanasiyana. N'chifukwa chake magazi ake ali kwambiri amalankhulira ndi kholo la. Mwatsatanetsatane, ndi maselo ofiira magazi mwana basi kutchula mpweya ku maselo ofiira mkazi, ndipo chifukwa cha zimenezi ayenera wamphamvu yosangalatsa luso lake. Choncho, ukufanizidwa ndi hemoglobin F-mtundu, kutanthauza yoopsa. Iye mosavuta itagwa mpweya ndi kumenya kwa maselo a mwana wosabadwayo.

zotsatira

Komabe, atabadwa chotero mayiko amphamvu ndi zosafunika, chifukwa kuyambira pamenepo mapapo chake iye kupuma paokha ndi kupeza mpweya wawo. Ndipo ngati hemoglobin wake sizinasinthe, izo sadzatha kuti adzalipereka kwa maselo. Choncho, pambuyo mpweya woyamba umayamba kusintha mwachangu mapuloteni wamkulu uyu maselo a magazi kuchokera yoopsa kuti wamkulu - mtundu A. Ichi ndi chifukwa kuchuluka hemolysis maselo a magazi ndi chitukuko mwamsanga latsopano, yolondola, kuchokera m'mafupa. Motero, pali matenda a chikasu ndiyo choyamba, mtundu suprarenal, amene mabasi mwamsanga pamene maselo onse akale ofiira anawonongedwa ndipo atsopano lembani m'magazi.

mankhwala

Chinthu chofunika kwambiri pochiza okwera bilirubin zoona, chithandizo cha matenda vutoli, matenda anachititsa kuwombola amenewa, i.e. mankhwala mu chiwindi tizilombo detoxification mu milandu ziphe poizoni, kuikidwa magazi ndi maselo ofiira okhaokha kapena hemolysis pa chiwindi kupatsidwa zina pa siteji kwambiri chifukwa cha kuwuma kwa chiwindi. Komabe, tiyenera kulimbikitsa physiotherapy, gepatoprotektory, n'zodalirika bwino, popanda zifukwa chiopsezo ndi kudya zakudya zapadera pa bilirubin okwera. Kuti tichite zimenezi, choyamba, inu muyenera kusiya kusuta ndi kumwa mowa, mafuta kwambiri, mafuta, zokometsera ndi zakudya yokazinga. Izo kutiletsa kudya Nkhaka ndi mankhwala kuzifutsa. M'pofunika kuchepetsa kudya mchere ndi tiyi ndi khofi ayenera kumwa. Mosiyana ndi zakudya ndi bilirubin okwera zikuphatikizapo pafupipafupi chakudya ang'onoang'ono ndi chiwerengero cha meatless dzinthu otentha, compotes zipatso, kuchotsa mikate yoyera kuti imvi. Inde, chifukwa mankhwala akuchipatala, padzayamba azimuth zabwino ndipo pamapeto pake matenda adzasiya inu.