Yibilirubin Iyonke landa. Izinto ezibangela yibilirubin ephakamileyo egazini. A ekudleni kwabo nokwanda yibilirubin

Kuba ukutya eqhelekileyo namandla emzimbeni kufuneka ekusileleni rhoqo substrates evela ngaphandle, oko kukuthi, ukutya, amanzi kunye nomoya. izinto zabo njengeziyimfuneko iikhompawundi organic, iivithamini kunye namacandelo kwezimbiwa - potassium, nemagnesium, isodiyam, nobhedu, nesinyiti kunye nabanye abaninzi. Owokugqibela aba yinxalenye iiseli ezibomvu, single-cell abathwala ioksijini egazini lethu, kwaye ke ngoko yokucolwa nentsimbi ibaluleke kangaka umzimba. Kwaye xa ukunyhashwa kunjalo andise icteric syndrome, ungachazwa ukuba yibilirubin iyonke avuswe. Ngoku makhe sikhangele zonke iingongoma ezibalulekileyo.

insimbi nethe

Man ifumana intsimbi kuphela ngokutya. Yayo ephezulu xiyimiso zaphawula esibindini ezilwanyana, ezinye amandongomane (neenkozo zepistasi, peanuts, pine, eenqoba), imidumba (neentlumaya, ertyisi), okuziinkozo (buckwheat, ingqolowa, ihabile, nerhasi), isipinatshi, umbona. Kule zivuselela kuqala imali yayo efunekayo ukuze heme, sisiseko iseli ebomvu igazi, yaye ngoko nje isimemezelo yesinyithi yokugcina yayo emzimbeni, nto leyo malunga 3-4 grams, leyo ion, ikakhulu enxulumene kwiiproteni plasma kunye enzayim (ferritin, transferrin, xanthine oxidase, ferroflavoproteiny, succinate kunye NADH-dehydrogenase, kunye nabanye). Kodwa kwenzeka ngesiqhelo, kodwa ngoku makhe sijonge ilahleko bakhe, kunye nemeko ethile zophendlo lwezifo.

Izizathu ilahleko kwezimbiwa ezibalulekileyo

Enye nokomzimba apho kukho ilahleko nentsimbi exesheni kunye nokukhulelwa phakathi kwabasetyhini. Noko ke, mhlawumbi iimeko zibalulekileyo ukopha, ityhefu, ianemia of imvelaphi ezahlukeneyo, izifo kakhulu yangaphakathi, neoplasms amabi. Ukuba ukulahlekelwa nto ibalulekileyo, ngexesha ukuba zizizalise kwakhona ixesha elifutshane, yaye kule meko ogulayo akukho iimpawu intswelo (sideropenic syndrome). Nangona kunjalo, kukho izifo apho imali yesinyithi igcinwe, kodwa naleyo kwananwe ngayo uphazamiseke kakhulu. Kwiimeko ezinjalo ziquka icteric syndrome nayiphi genesis, xa ibanjiwe njengoko ukwanda main metabolite - yibilirubin. Okokuqala, zama ukuqonda umzimba wakhe emzimbeni kunye noonobangela yibilirubin kwaphakanyiswa egazini: kubalulekile ukuba ukuqonda Pathogenesis ezi zifo.

Exchange athwala: isigaba sokuqala

Yibilirubin inxulumene ngombala ebalulekileyo ifakiwe nokwakhiwa duct kwazona ukusuka umzimba ngeendleko zayo. Lenza indlela ende ngokusebenzisa iimpahla ngxi ngohlobo mpilo, yenza utshintsho olubalulekileyo hepatocytes yaye ekugqibeleni secreted ukuya emathunjini ukukhululwa kokusingqongileyo kunye endleni. Ngenxa yoko, le nto ukhandwa ukonakala iiseli ezibomvu zegazi nangoko elalithinjwe iiproteni yenethiwekhi izithuthi kwilebhu engundoqo - esibindini. Le iqhezu kuthiwa ngqo okanye ezingahambelaniyo, kuba yibilirubin kuyo aliguqukanga. Oku kwenzeka ngenxa yokuba ngendlela simahla, kulula ukungena ngokusebenzisa inwebu nayiphi iseli, kwaye nempembelelo enamandla zinetyhefu kakhulu kwi iiseli zemithambo-luvo. Ngenxa yoko, abambelele sayo yokusabela ukuzithethelela.

Isigaba neutralization kunye Ukuqhela yibilirubin

Nangona kunjalo, ezi iiprotheni akakwazi uhamba naye ukuya emathunjini, ngenxa yokuba kusekho ezifunwayo zizo umzimba neminye imisebenzi emininzi, yaye ngaloo ndlela yibilirubin kufuneka phantsi ukuya inguqu enjalo, ukuba waphulukana yakhe emlilweni propati ibe kwiiseli. Ukulungiselela le njongo, le hepatocytes (isibindi parenchyma iiseli zezakhiwo) na conjugation wayo, oko kukuthi, lo nomphetho glucuronic acid, leyo, kakhulu nje, aggravates kuyo. Ngenxa yoko, phantsi yintshukumo enzyme UDP-glucuronyl-diglucuronide yibilirubin kwakhiwa. Okulandelayo, ukusuka hepatocytes akungeni enyongweni ngaphakathi ekhululwe emathunjini ngexesha ukwetyisa. Ngoku abadlulayo endleleni kunye bolus lokuqala obhityileyo, uze emva koko uye ikholoni, waphenjelelwa flora iintsholongwane ukuba kwakhona wakhululwa waguquka urobilinogen, uze urobilin stercobilin ukuba kwazona ngqo endleni. Kodwa imali njalo elincinane kakhulu yibilirubin babuyela vein Portal kwaye kuqhutywa kwi kidney, apho umchamo isusiwe.

umda oluqhelekileyo

Ukophulwa kwalo exchange ebalulekileyo kombala angenzeka ngezigaba ezithathu eziphambili: ukuhamba kwegazi kweli kuwohloka erythrocytes, wokubamba futhi Ukuqhela inyongo hepatic. Nakuba kunjalo, kuzo zonke ezi embodiments, kuya zafunyanwa egazini: yibilirubin zizonke eziphakamileyo, ekukhethwa ukuba mhlawumbi ngu ngqo okanye ngokungathanga ngqo amaqhezu yayo. Ngenxa yoko, eyavela okuqhelekileyo plasma ithathwa ngokuba malunga 8,5-20,5 micromoles ilitha nganye. Ukuba le nombolo kwandisa ukuya ku-85, ngoko ke imo hyperbilirubinemia nobulali, ukususela 86 ukuya 169 - eliphakathi kwaye ekugqibeleni ngaphezulu kwe 170 mmol / l - kakhulu. Imalunga kunjalo, ukuba nje lubonisa ukuba yibilirubin ephakamileyo iyonke. Noko ke, ulawulo ikhona ngokwahlukeneyo amaqhezu: ngqo - to 5.1, engadityaniswanga kwenye - 16.5 pmol / l.

uhlobo Suprarenal of senyongo

Ngoko ke, waphula umthetho kwinqanaba lokuqala yibilirubin iyonke igazi kuvuswa ncakasana iqhekeza ngqo. Oku kuchazwa ngokuthi umyalezo likarhulumente, ezizezi nokuchithwa lokuwandisa egazi abomvu egazini. Oku kwenzeka kwiimeko ezahlukeneyo iziphene of igazi hemolytic (iziphene kumphakamo genetic iiseli ezibomvu ngokwabo, enzayim zabo, ihemoglobin) okanye lufundiwe (ukuhlasela ngumzimba sifo kunye erythrocytes zalo, sesichengeni ubuthi ubuthi, iintsholongwane, iintsholongwane kunye nezinye izinto). Ngoko ke, lo Pathogenesis inyuswe ukubunjwa yibilirubin ngenxa iiseli kwesibindi nje abanalo ixesha zifake isixa esikhulu loo nto, yaye oko oluhlala eluswini kwakunye nomkhwinya imifinya, kwaza ke esikhundleni enyama yangaphakathi, adeleke yokulimala. Ngaloo Bakha uhlobo suprarenal of senyongo.

Hepatic uhlobo senyongo

Ukuba ukuhlukunyezwa kwenzeka eqongeni yesibini ephambili, ezi hepatocytes abanalo ixesha pick up ize isebenze nkqu isixa eqhelekileyo enikwa kubo metabolite mpilo, yaye ekugqibeleni ngokuncama zombini angquzulanayo esinyusiweyo yibilirubin iyonke. Izizathu zoku - utshintsho entshabalalo enzima esibindini. Ezi ziquka kwesibindi seGenesis ezahlukeneyo (ezingenabungozi, utywala, wentsholongwane egazini) kwaye ukuqina. Ngenxa yoko, ezibangela yibilirubin ephakamileyo igazi bubuxoki kulo yokuba hepatocytes ukuze isebenze kakuhle, nokuba ukudumba kubo, mhlawumbi ngenxa ngangenani lazo ayonelanga. Zingunobangela oqhelekileyo, Kakade ke, i -hepatitis A-hlobo, B, C, Delta, E okanye PP. Utsho iphuhlisa hepatic (parenchymal) uhlobo senyongo syndrome, nto leyo sikhatshwa ngemiqondiso eliqaqambileyo mesenchymal nangokurhala, ukusilela gepatotsiliarnoy.

uhlobo senyongo Obstructive

Kwaye, kakade, kophulwa umthetho yibilirubin ukutya nako kwenzeka eqongeni wesithathu ezingundoqo, oko kukuthi xa kukhuthaza inyongo. Kunjalo, le ndlela kokuba kuvalwe iindlela imveliso okanye isibindi, okanye ukusuka vesicafellea. Ngenxa yezi nguqu kwi inyongo oluhlala esinyini kunye neendlela, ngokuthe ngcembe zaphembelela kwandisa, yaye ekugqibeleni ubuyela (le nto kuthiwa regurgitation) kwi imibhobho intrahepatic, uze emva koko - sibuphethe ngezitya yegazi, nto leyo esisizathu sokuba iyonke yibilirubin ephakamileyo. Ngelo xesha, ke, kukho ezinye utshintsho zePCR nemvelo. Ngenxa yoko, egazini kwenzeka cholehemia, ngamanye angene kuyo asidi duct kunye nee-enzayim, yaye imibhobho ngokwabo kwakhiwa cholestasis, ngamanye netuwa amile. Ngokwezonyango, oku kuya iyakubonakaliswa senyongo sclera, inwebu yangaphakathi nolusu (umbala omthubi kunye ithinti eluhlaza), kwaye ngokuhlahlela ngayi kwanela nje yibilirubin iyonke kunye ethe chatha, kodwa asidi ibile ducts, cholesterol, inqanaba phosphatase obrak, triglycerides, umsebenzi gamma-glutamyl transferase .

oonobangela

I-umyalezo we obstructive okanye, njengoko kuthiwa senyongo obstructive, kumba kakhulu. Unobangela iqhelekileyo a ukuvaleka ilitye phecana biliary kwi cholecystitis calculous okanye cholelithiasis kunye zintwala helminthic eyi- xa ziimpethu localized ngaphakathi imibhobho okanye wavakalisa cholangitis, kwaye xa sayo ebushushwini babo occlusive okanye ngenxa ekweneni iindonga, okanye ngenxa nokungena kubo. Kakade ke, oku ucacisa into yokuba yibilirubin ngqo kunye iyonke lonyuka. Izizathu kwezinye izinto ezimbi kuyo nayiphi na imeko, zibangelwa ucinezelo lwe ngaphandle. Kaninzi oku kwenzeka ngenxa yokukhula kwe ithumba, ngokuqhelekileyo echaphazela intloko zepancreas. Kodwa ke, le meko kungenzeka kwesibindi xa biliary, xa imibhobho ukuba acudisiweyo ukuba ukukhula iziza nemidzaluka kwizicwili.

senyongo ePrince

Noko ke, asingabo bonke senyongo iimeko zophendlo lwezifo ze eziphilayo. Ngoko ke, ukuba yibilirubin zizonke uwuphakamisile nangoko usana ekuzalweni okanye iiyure ezimbalwa emva kwayo, kunye nesikhumba kunye inwebu yangaphakathi abe senyongo eqaqambileyo, kufuneka ngoko nangoko ikhalise i-alam. Emva kokuba usana yimeko komzimba ekuthiwa otshintsho kuba idlule. Kakade ke, umbuzo umbuzo ukusuka kumama wakhe nemincili ofunda ukuba usana yibilirubin yakhe eziphakamileyo, "Ndingenza ntoni?" Impendulo ilula: alinde. Xa oku kubonisa ulawulo okhulelweyo kuphela, ekubeni iintsuku ezimbalwa (idla emithathu ukuya kwemihlanu) yellowness ngcembe shwaka. Kwaye kuphela ukuba ilibele, imeko umntwana sibi bebonke yibilirubin ke eziphakamileyo, unyango yenziwa ngokukhawuleza, oko kukuthi unyango ezigulela esetyenziswa kunye yiultraviolet zokukhanya. Ngoku makhe siqwalasele Pathogenesis yale meko.

kubelekwa ikakhulu kwegazi

Isibakala sokuba kwegazi ezingekazalwa esizalweni yahluke kakhulu ukusuka kuloo aba abantwana sele wazalwa. Ngexa lokukhulelwa, usana uxakeke kwiqamza kunye fluid, nangenxa imiphunga yakhe uqhelene emoyeni kodwa kwaye ukushwabana karhulumente, okt ukungenzi. Kodwa ke umntwana kubalulekile ukuba kwemali okuqhubekayo oxygen kwinyama bakhe nokudaleka, ukukhula kunye umahluko. Kungenxa yoko le nto igazi lakhe ngokusisulu inxibelelane nomzali. Ngokweenkcukacha, ebomvu iiseli kid kudityaniswe nje oksijini evela iiseli ezibomvu egazini umfazi, yaye ndizele oku kufuneka kube kwexesha ngamandla ubuchule bakhe. Ngoko ke, loo nto imelwe ngehemoglobin F-hlobo, nto leyo ithetha Fetal. Yena lula ufumana ioksijini ize uthwala ukuba kwiiseli ze olungekazalwa.

iziphumo

Noko ke, emva kokuba ukuzalwa ukubangisana enjalo ke, akuyomfuneko kuba ukususela ngoko emiphungeni yakhe ebonakalisiweyo yena ukuphefumla ngokwabo kwaye imali ngokwabo oxygen zabo. Ukuba kwalo yakhe iya kuhlala injalo, akayi kuba nako ukunika kwi iiseli. Ngoko ke, emva kokuba umoya lokuqala uqala ukuguqula ngokubonakalayo le protini ezingundoqo iiseli ezibomvu igazi foetal ukuya abadala - uhlobo A. Oku kungenxa yokwanda hemolysis iiseli ezibomvu kunye nophuhliso ezingxamisekileyo ezintsha, oluchanekileyo, ukusuka umongo wethambo. Ngoko ke, kukho senyongo kwindawo yokuqala, uhlobo suprarenal, oyekayo kamsinya nje zonke iiseli ezindala igazi ezibomvu kutshatyalaliswa kunye ezintsha bazalise egazini.

therapy

Eyona nto ibalulekileyo ekunyangeni yibilirubin ophakamileyo, kakade, ukunyanga isifo engundoqo, ukuphazamiseka yabangela utshintshiselwano ezinjalo, ngamanye antibiotics e hepatitis wentsholongwane egazini, ezigulela kwiimeko Ityhefu ityhefu, ukutofelwa igazi wapakisha iiseli ezibomvu okanye hemolysis ngexesha isibindi abohlukeneyo kwisigaba kakhulu ngokoma. Nangona kunjalo, oko kufanele komeleze ukuyifundisa gepatoprotektory ababomi ekunene, ngaphandle ubungozi nedayethi olulodwa yibilirubin ephakamileyo. Ukuze wenze oku, kuqala, kufuneka uyeke ukutshaya kunye notywala, namanqatha ngokugqithiseleyo, cholesterol, okuneziqholo ukutya eqhotsiweyo. Akuvunyelwe ngokungqongqo ukuba badle pickles kunye neemveliso zifakwa. Kuyimfuneko ukunciphisa ukuthathwa ityuwa kunye iti nekofu kufuneka ukusela kwaphela. Ngokwahlukileyo koko, ukutya kunye yibilirubin ephakamileyo iquka izidlo rhoqo ezincinane kunye nenani meatless cereals ashushu, compotes iziqhamo, ngokubuyisela isonka esimhlophe kuse. Eneneni, ngenxa amayeza kagqirha kuya kuqalisa iziphumo ezincumisayo yaye ekugqibeleni izifo kukushiya.