Bilirubin Total zvakawedzera. Zvinokonzera yakakwirira bilirubin muropa. Zvokudya pamwe zvakawedzera bilirubin

For kwomuzvarirwo muviri uye simba mumuviri tinofanira kuramba dziripo substrates kubva kunze, kuti ndizvo, zvokudya, mvura uye mhepo. zvinhu zvavo zvinokosha zviri Organic yeimwe, mavhitaminzi uye chicherwa zvinoriumba - potassium, magnesium, yavaibvisa, mhangura, simbi uye nevamwe vakawanda. Wokupedzisira izvi ndiyo chikamu masero matsvuku eropa, chimwe-sero vatakuri okisijeni muropa redu, uye naizvozvo simbi muviri kuchikosha nokuda muviri. Uye kana kutyorwa zvakadaro anova icteric urwere, inozivikanwa kuti yose bilirubin vanomutswa. Zvino ngatitarise zvose zvinokosha pfungwa.

simbi muviri

Man anowana simbi chete nezvokudya. Its soro akaona pfungwa iri chiropa remhuka, mamwe nzungu (pistachio nzungu, nzungu, nemipaini, cashew), bhinzi (nenyemba, pizi), bota (Buckwheat, gorosi, oats, bhari), sipinachi, chibage. Muchiitiko ichi zvinonzi kutanga kukasawedzerwa ane inodiwa mari nokuda heme vanoumba hwaro erythrocyte, uye chete ipapo anotora nzvimbo deposition redare racho chakazara mumuviri, riri pamusoro 3.4 magiramu, rinomiririra ions, kunyanya zvine chokuita mapuroteni eplasma uye makemikari (ferritin, transferrin, xanthine oxidase, ferroflavoproteiny, succinate uye NADH-dehydrogenase, uye vamwe). Asi zvinoitika dzinowanzoona, asi zvino ngatitarisei kurasikirwa ake, uye zvimwe pathological ezvinhu.

Zvikonzero kurasikirwa zvicherwa zvakakosha

Mumwe vasiri pezvakaitwa umo kurasikirwa nesimbi kumwedzi uye pamuviri vakadzi. Zvisinei, zvichida rinonyatsooneka mamiriro ezvinhu vari kurasikirwa neropa, chepfu, kupererwa neropa-siyana mavambo, zvakakomba dzakawanda zvirwere, nyanyisa neoplasms. Kana kurasikirwa kwacho kwakanga kusingakoshi, inguva kuti kukasawedzerwa munguva pfupi, uye ari iyi murwere haana zviratidzo kushaikwa (sideropenic urwere). Zvisinei, pane hosha umo mari dzesimbi kuramba, asi nahwo akashatirwa chaizvo. Muzviitiko zvakadaro zvinosanganisira icteric chirwere chipi Genesi, kana kuona sezvo huru metabolite kuwedzera - bilirubin. Chokutanga, edza kunzwisisa kuti muviri wake mumuviri uye zvinokonzera akakwidziridzwa bilirubin muropa; zvakakosha kuti kunzwisisa pathogenesis zvirwere izvi.

Exchange Chizenga: wokutanga kutotanga

Bilirubin chokuita zvinokosha pigments vanobatanidzwa Zvinoumba bile uye yabudiswa kubva muviri panguva wayo mari. It anoenda refu nzira kuburikidza nhumbi achiri muchimiro Chizenga, anoita kuchinja kukosha hepatocytes uye pakupedzisira secreted kupinda ura kuti kusunungurwa kupinda kwezvakatipoteredza pamwe mutsvina yadzo. Saka, fuma ichi chakaumbwa naMweya kuora masero matsvuku eropa uye pakarepo akabatwa keriya mapuroteni kutakurirwa kune huru yezvirwere - chiropa. chikamu chiduku ichi anonzi zvisina kunanga kana chokuita, nokuti bilirubin mariri kuzochinja. Izvi zvinoitika nokuti vakasununguka chimiro, inogona nyore kupinda napakati Kamudzira upi muchitokisi, uye ane simba hunokachidza nomugumisiro achinyanya Tutsinga tunofambisa mashoko utwu. Saka, ayo kubata romuzvarirwo kuzvidzivirira kuita.

Danho neutralization uye voga kuti bilirubin

Zvisinei, mapuroteni izvi hazvigoni kuenda naye ura, nekuti vachiri kudiwa ne muviri vazhinji mamwe mabasa, uye nokudaro bilirubin zvinofanira pasi ndokuchinja yakadaro, kuti akarasa ake pfuma kuyambuka mumakamuri. Nokuti chinangwa ichi, kuti hepatocytes (chiropa parenchyma masero STRUCTURAL) raro conjugation, ndiko kuti, nokusungwa glucuronic acid, izvo, zvikuru nyore, kuwedzera izvozvo. Saka, pasi Zvakaitwa enzayemu UDP-glucuronyl-diglucuronide bilirubin aumba. Next, kubva hepatocytes nayo anopinda bile uye mukati maro ukasunungurwa muura panguva kugaya. Zvino kupfuura nzira ine bolus mutete rokutanga, uye zvadaro muura, kufurirwa kwemabhakitiriya kasvisto nayo anosunungurwa zvakare uye vatendeukira urobilinogen, uye ipapo urobilin stercobilin kuti yabudiswa zvakananga mutsvina yadzo. Asi nguva dzose zvikuru shoma bilirubin vakadzokera portal tsinga uye chiri kuitwa itsvo, apo weti chinobviswa.

panogumira dzose

Kutyora ichi chinokosha ruvara Exchange munogona zvikuru matanho matatu: riparadzirwe ropa iri kuora pamusoro erythrocytes, ari kubatwa uye voga kuti hepatic bile. Zvisinei, mune embodiments izvi zvose, zvichava kuonekwa muropa: zvachose bilirubin rakakwirira, zvinganaka kana nokuda zvakananga kana zvisina kunanga zvikamu zviduku ayo. Saka, ayo wevasungwa zvakajairika mu yeplasma anoonekwa zvinenge 8,5-20,5 micromoles por fő. Kana nhamba iyi kunowedzera kusvika 85, ipapo ezvinhu munyoro hyperbilirubinemia, kubvira 86 kusvika 169 - pakati uye pakupedzisira kupfuura 170 mmol / L - kwazvo. Zviri pamusoro nyaya, kana iwe chete yakaratidza kuti chakakwirira nhamba bilirubin. Zvisinei, mutemo aripo oga kuti zvikamu zviduku: twasu - kuti 5.1, vasina kusungwa - 16.5 pmol / l.

Suprarenal mhando jaundice

Saka, muna kutyora Danho rokutanga zvachose bilirubin muropa chinomutswa zvikurukuru kuburikidza kunanga hacho. Izvi zvinotsanangurwa maererano etiology wenyika, dzinova kunowedzera pokufa matsvuku masero muropa. Izvi zvinogona kuitika vanenge vachiberekwa siyana hemolytic kupererwa neropa (kuremara panguva majini pachiyero masero matsvuku eropa pachavo, makemikari dzavo, Chizenga) kana vawana (immunological kurwisa chirwere pamwe yayo erythrocytes kugarotamba zvinokachidza Inobaya, nemavhairasi, mabhakitiriya uye zvimwe zvinenge). Saka pathogenesis ichiwedzerwa paumbwe bilirubin nokuda chiropa masero izvo havambokwanisi nguva kuti andobata yakadaro guru mari nayo, uye rinoungana paganda uye mucous membranes, uye ipapo zvomukati, vachashora zvakakomba makuvaro. Saka akaumba suprarenal mhando jaundice.

Hepatic mhando jaundice

Kana kutyora kunoitika pazuva huru Danho rechipiri hepatocytes havana nguva tonotora uye dzinoona kunyange chakaipa mari yaipiwa kwavari metabolite pamusoro Chizenga, uye pakupedzisira tichiregeredza zvose Mapato akakwidziridza zvachose bilirubin. Zvikonzero ichi - rinorema dzinoparadza zvachinja chiropa. Izvi zvinosanganisira chiropa-siyana Genesisi (chepfu, chidhakwa, nemavhairasi) uye cirrhosis. Saka, kuti hepatocytes kungasashanda zvakakwana zvinokonzera yakakwirira bilirubin muropa nhema iri chokwadi, kana nokuda kuzvimba mavari, kana nokuda kukwana nhamba yavo. Vakawanda chikonzero Chokwadi, ndiyo nehepatitis A-mhando, B, C, Delta, E kana PP. Saka anovandudza hepatic (parenchymal) mhando jaundice chirwere, icho pamwe yakajeka zviratidzo mesenchymal kuzvimba uye gepatotsiliarnoy kukundikana.

Obstructive jaundice mhando

Uye, chokwadi, kutyorwa bilirubin muviri kunogonawo musiwa yechitatu huru pachikuva, ndizvo apo excretion kuti bile. Zvisinei, pamwe nzira iyi chakavharwa goho nzira kana chiropa, kana kunyange vesicafellea. Nokuda ndachinja bile rinoungana iri dundira uye nenzira, ayo kumanikidzwa zvishoma kunowedzera, uye pakupedzisira totaura shure (Fani iyi inonzi regurgitation) ari intrahepatic ducts, uye ipapo - nemidziyo ropa, riri sei yakasimukira zvachose bilirubin. Panguva iyoyowo, Chokwadi, pane dzimwe kuchinja nokukanganisika assays. Saka, muna ropa kunoitika cholehemia, i.e. kupinda mariri bile acids uye makemikari, uye ducts pachavo kuumbwa cholestasis, i.e. mira secretions. Akaora, ichi chichange akaratidza jaundice sclera, mucous membranes uye ganda (yero ruvara pamwe mutema tint), uye muna Analyses asingadi chete bilirubin zvachose uye yakananga ikawanda, asiwo bile acids, remafuta akawandisa, pachiyero alkaline phosphatase, triglycerides, basa wegamma-glutamyl transferase .

zvinokonzera

The etiology pamusoro obstructive kana, sezvo iye anonzi obstructive jaundice, ndizvo chaizvo rakakura. The inonyanya chikonzero ari blockage pamusoro biliary turakiti ibwe panguva calculous cholecystitis kana cholelithiasis uye helminthic infestations chaunga kana richinge vemunyika mukati ducts kana akaratidza cholangitis, uye kana vari zvomoto lumen occlusive kana nokuda mumatenhere masvingo, kana nokuda infiltration wavo. Uye, chokwadi, iri anotsanangura chokwadi chokuti zvakananga uye nhamba bilirubin zvawanzwa. Zvikonzero zvimwe pathologies chero zvazvingava, zvinokonzerwa compression ari kunze. Kakawanda izvi zvinoitika nokuda kukura pakati bundu, kazhinji zvichiita musoro rwatata. Asi zvakare, izvi zvingaitika kana biliary cirrhosis, kana ducts vari kusvinwa kukura kwokurangana uye tambo kuti connective tishu.

Neonatal jaundice

Zvisinei, kwete jaundice vose pathological ezvinhu nhengo. Saka kana zvachose bilirubin rakakwirira ari mwana pakarepo pakuzvarwa kana maawa mashoma pashure pacho, uye ganda uye mucous membranes vane rakajeka jaundiced, haufaniri pakarepo kuridza aramu. Mushure achangoberekwa chirwere vasiri rinonzi zvinopfuura nokuti zvinopfuura. Chokwadi, mubvunzo ndewokuti kubva mai vake kufara uyo anodzidza kuti wake bilirubin mwana rakakwirira, "Ndinofanira kuitei?" Mhinduro iri nyore: kumirira. Kana ichi chaizvoizvo zvinoratidza chete pamuviri utariri, sezvo kwamazuva mashoma (kazhinji matatu shanu) yellowness zvishoma nezvishoma nokupera. Uye chete kana ndikanonoka, mamiriro ezvinhu mwana dzakaderera uye zvachose bilirubin rakakwirira, kurapwa rinoitwa zvikurusa, kureva detoxification kurapa rinoshandiswa uye ultraviolet irradiation. Zvino ngationei pathogenesis uyu ezvinhu.

Kunyanya kweropa vachangoberekwa

Chokwadi chokuti fetus kuparadzirwa ari mudumbu yakasiyana kuti kuchengetwa vana kare kuzvarwa. Panguva pamuviri, mwana achinyatsotaurira imwe sefuro pamwe Líquido fluid uye nekuti mapapu ake asati aiziva mhepo uye vari rakawunyana mamiriro, kureva inoperative. Asi mwana kunokosha rinoramba nokuyerera reokisijeni kuti nyama yake kuti inotungamirwa kwavo, kukura uye Kusiyanisa. Ndokusaka ropa rake zvikuru anokurukura mubereki. Zvose, kuti masero matsvuku eropa mbudzana chete nokupinza okisijeni kubva masero matsvuku eropa mukadzi, uye kuti ichi vanoda kuva nesimba hune simba nesimba rake. Saka, zviri inomiririrwa Chizenga F-mhando, zvinoreva Fetal. Iye nyore anopiwa okisijeni uye anoita kuti masero ari mudumbu.

zvabuda

Zvisinei, pashure kuzvarwa superpower zvakadaro zviri basa, nekuti kubva ipapo mapapu ake aratidzwe ari kufema voga uye kuwana pachavo okisijeni kwavo. Uye kana Chizenga wake achagara chete, hazvizovi kupa kuti masero. Naizvozvo, pashure wokutanga kufema anotanga vanoshingaira kushandura ichi puroteni chikuru masero matsvuku eropa kubva child kuti munhu mukuru - mhando A. Izvi imhaka vawedzere hemolysis masero matsvuku eropa uye kukurumidza kukura idzva, kwakarurama, kubva mumwongo. Saka, pane jaundice ari wokutanga suprarenal mhando, iyo anodzivira rekukwazisa masero ose akare matsvuku vaparadzwa uye vatsva vazadze muropa.

kurapa

Danho rinokosha mukurapa yakakwirira bilirubin Zvechokwadi, Mabatirwo zvinokonzera chirwere, zvirwere akaita Exchange kwakadaro, i.e. mishonga iri nemavhairasi chiropa, detoxification mu vakuvadzwe nomuchetura chepfu, kuisira ropa uye ndokurongedza masero matsvuku kana hemolysis panguva chiropa transplantation nokuda kwazvo padanho cirrhosis. Zvisinei, izvozvo zvinofanira kusimbisa physiotherapy, gepatoprotektory, kurudyi nechouviri, pasina zvinokonzera njodzi uye chinokosha kudya panguva yakakwirira bilirubin. Kuti aite izvi, kutanga, unofanira kusiya kuputa uye doro, kunyanya mafuta, remafuta akawandisa, Spicy uye zvakakangwa zvokudya. Zvinonzi zvaisambobvumirwa kudya mufushwa uye pickled zvigadzirwa. Zvakakodzera kutirambidza yaunodya munyu uye tii uye kofi haafaniri kunwa zvachose. Kusiyana, zvokudya pamwe yakakwirira bilirubin zvinosanganisira kakawanda zvokudya zviduku pamwe nokuwanda meatless inopisa zviyo, michero compotes, kutsiva chingwa chena kuti vhudzi. Zvechokwadi, nemhaka mushonga zvinodhaka ichatanga yakanaka kuitika uye pakupedzisira chirwere achasiya iwe.