Bilirubin Ubude anda. Izimbangela bilirubin esiphakeme igazi. Ukudla nge bilirubin kukhuphuke

Ukuze umzimba evamile futhi amandla emzimbeni kumele kube supply njalo substrates kusukela ngaphandle, okungukuthi, ukudla, amanzi kanye nomoya. izithako zabo ezibalulekile kukhona organic compounds, amavithamini kanye izingxenye amaminerali - potassium, magnesium, i-sodium, bethusi, bensimbi kanye nabanye abaningi. Owokugcina lezi iyingxenye abomvu egazi, elilodwa-cell abathwali-mpilo egazini lethu, ngakhoke yensimbi umzimba kubaluleke kakhulu emzimbeni. Futhi lapho ukwephulwa kunjalo eba icteric syndrome, ungachazwa ukuthi bilirubin Imininingwane ephakanyiswe. Manje ake sibheke zonke amaphuzu abalulekile.

yensimbi umzimba

Man uthola yensimbi kuphela ukudla. Its eliphakeme waphawula lokuhlushwa esibindini kwezilwane, abanye amantongomane (amantongomane ephistakhiyo, amantongomane, uphayini, isicinganani), okusanhlamvu (udali, uphizi), okusanhlamvu (nokunye okufana nokolweni, ukolweni, oats, ibhali), isipinashi, ummbila. Kulokhu it is okokuqala agcwaliswa nge lemali edingekile ukuze heme akha ngesisekelo erythrocyte, bese kuphela isifika sebethule yensimbi e edepho yayo emzimbeni, okuyinto mayelana 3.4 amagremu, limelela ion, ikakhulu ezihlobene amaprotheni oketshezi olungenambala olusegazini futhi enzyme (ferritin, transferrin, xanthine oxidase, ferroflavoproteiny, succinate futhi NADH-dehydrogenase, nabanye). Kodwa kwenzeka ngendlela evamile, kodwa manje ake sibheke ngokulahlekelwa kwakhe, futhi isimo esithile sokugembula.

Izizathu ukulahlekelwa namaminerali abalulekile

Omunye izinqubo bokuphila lapho kukhona ukulahleka nokusansimbi esikhathini sokukhulelwa kwabesifazane. Nokho, mhlawumbe zimo olube lukhulu kakhulu ukopha, ubuthi, anaemia zasezindaweni ezihlukahlukene, izifo ezinzima yangaphakathi, neoplasms ebulalayo. Uma ukulahlekelwa kwabo akuyona into eyisimanga, kusho ukuthi sekuyisikhathi sokuba agcwaliswa ngesikhathi esifushane, futhi kulesi simo isiguli azikho izimpawu zokuphela ukuntula (sideropenic syndrome). Nokho, kukhona izifo lapho inani yensimbi agcinwayo, kodwa exchange yayo ekhathazwa kakhulu. Ezimweni ezinjalo zihlanganisa icteric syndrome iyiphi genesis, uma itholwa njenge main metabolite ukwanda - bilirubin. Ukuze uqale, zama ukuqonda umzimba wakhe emzimbeni izimbangela bilirubin kwaphakanyiswa igazi: kubalulekile ukuqonda pathogenesis salezi zifo.

Exchange elithwala umoya-mpilo: isigaba sokuqala

Bilirubin iphathelene zombala kubalulekile kufakwe ukubunjwa Bile futhi excreted kusuka umzimba ngezindleko zayo. Lenza ibanga elide ngokusebenzisa izitsha namanje ngendlela elithwala umoya-mpilo, yenza izinguquko ezibalulekile hepatocytes futhi ekugcineni akhishelwa emathunjini ukukhishwa ku imvelo ne indle. Ngakho, kwakheka yalolu ketshezi by ukubola amangqamuzana abomvu ngokushesha ethunjwa yenethiwekhi amaprotheni ukuthutha lab main - kwesibindi. Lokhu ingxenyenamba libizwa ngokungaqondile noma engahlobene, ngoba bilirubin kuwo zinjalo. Lokhu kwenzeka ngoba ifomu mahhala, ke kalula ukungena ngokusebenzisa ulwelwesi kwanoma iyiphi iseli, futhi kunomphumela oqinile anobuthi ngokuyinhloko izinzwa. Ngakho, engachazeki kungokwemvelo yokusabela ukuzivikela.

Isigaba neutralization nokuhlukaniswa kwemihlambi bilirubin

Nokho, lezi amaprotheni ayikwazi amphelezele emathunjini, ngoba Kusadingeka umzimba ngoba neminye imisebenzi eminingi, futhi ngaleyo ndlela bilirubin kufanele ngaphansi izinguquko, ukuthi walahlekelwa impahla pass yakhe ku amaseli. Ngenxa yale njongo, lo hepatocytes (isibindi parenchyma amaseli kwesakhiwo) kuyinto conjugation yayo, okungukuthi, yokubopha glucuronic acid, okuyinto, impela nje, eshubisa ke. Ngakho, ngaphansi isenzo enzyme UDP-glucuronyl-diglucuronide bilirubin kwakhiwa. Ngokulandelayo, kusukela hepatocytes ke engena Bile futhi ngaphakathi ikhishwe emathunjini phakathi ukugaya. Manje odlulayo indlela nge bolus lokuqala nomzimba omncane, abese eya ikholoni, bethonywe flora webhaktheriya it is futhi ikhishwe futhi waguquka waba urobilinogen, bese urobilin stercobilin ukuthi ngqo excreted endleni yabantu abanaleli. Kodwa lemali njalo encane kakhulu bilirubin wabuyela vein portal siqhutshwa e-izinso, lapho umchamo iyasuswa.

umkhawulo ka evamile

Ukwephula lokhu sombala exchange ezibalulekile ungatholakala iyokwenzeka ngezigaba ezinkulu ezintathu: kwegazi legazi e ukubola erythrocyte, ukuthunjwa kanye kwemihlambi Bile hepatic. Nokho, kuzo zonke lezi embodiments, ke iyoba ukutholwa egazini: bilirubin Imininingwane liphakeme, okungcono noma nge ngqo noma ngokungaqondile amafraktjhini yayo. Ngakho, emakamu yayo evamile e-plasma ubhekwa mayelana 8,5-20,5 micromoles ilitha. Uma le nombolo kwandisa 85 ke esimweni hyperbilirubinemia omnene, kusukela 86 kuya 169 - maphakathi kanye ekugcineni angaphezu kuka-170 mmol / l - ezinzima. Kumayelana icala, uma nje yembula ukuthi bilirubin Imininingwane ephakeme. Nokho, umthetho ukhona eceleni yamafrakshini: abaqondile - ukuba 5.1, itho olukhululekile - 16.5 pmol / l.

uhlobo Suprarenal ka-jaundice

Ngakho, ephula esigabeni sokuqala bilirubin Imininingwane egazini ophakamayo ngokuyinhloko ngokusebenzisa ingxenyenamba engesobala. Lokhu kuchazwe etiology isimo, okungukuthi, ekuhlakazekeni ngcono abomvu egazi emithanjeni yegazi. Lokhu kungenzeka ezimweni amafomu azalwa naso igazi hemolytic (ukukhubazeka ezingeni genetic abomvu egazi ashaye ngokwabo, ama-enzyme zabo, i-hemoglobin) noma atholwe (ukuhlaselwa immunological lesi sifo nge erythrocyte ayo, ukuchayeka ezintweni ezinobuthi ubuthi, amagciwane kanye nezinye izinto eziphilayo). Ngakho, pathogenesis luyanda kumiswa bilirubin ngenxa amaseli isibindi lapho nje awunaso isikhathi ukuthwebula mali enkulu-ke, futhi aqoqana isikhumba futhi lwamafinyila ulwelwesi, sabe izibilini, kubenze ukulimala kabi. kwakhiwa Ngakho uhlobo suprarenal ka-jaundice.

Hepatic uhlobo jaundice

Uma ukuhlukumeza kwenzeka ngosuku lwesibili esiteji main, hepatocytes awunaso isikhathi ayothatha futhi sicubungule ngisho nenani evamile enikeziwe kubo metabolite ka-hemoglobin, futhi ekugcineni ngezithukuthuku kokubili imibango aphakeme bilirubin Imininingwane. Izizathu zalokhu - izinguquko esindayo elimazayo esibindini. Lezi zihlanganisa i-hepatitis of genesis ehlukahlukene (anobuthi, utshwala, viral) futhi ziphathwe yisifo sokuqina. Ngakho, izimbangela zezinkumbulo bilirubin esiphakeme amanga igazi e yokuthi hepatocytes zingase zingasebenzi ngokwanele, kungaba ukuvuvukala kuzo, noma ngenxa yokuthi isibalo sabo enganele. Imbangela ezivame kakhulu, yebo, iyona -hepatitis A-hlobo, B, C, i-delta, E noma PP. ithuthukisa Ngakho hepatic (parenchymal) uhlobo jaundice syndrome, okuyinto kuhambisana izimpawu ezikhanyayo mesenchymal ukuvuvukala ukwehluleka gepatotsiliarnoy.

Obstructive jaundice uhlobo

Futhi-ke, ukuhlukumeza ka bilirubin umzimba ungakwazi futhi zenzeka olwesithathu esiteji main, okungukuthi lapho excretion of Bile. Noma kunjalo, nge le ndlela-ke ivinjelwe izindlela okukhipha noma isibindi, noma ngisho kusukela vesicafellea. Ngenxa yalezi zinguquko e Bile aqoqana esinyeni nezindlela, umfutho kancane kancane kwandisa, futhi ekugcineni kuziwa emuva (lokhu mkhuba ubizwa ngokuthi regurgitation) ku Amapayipi intrahepatic, bese - ku imithambo yegazi, yingakho isigqugquzeli bilirubin Imininingwane. Ngesikhathi esifanayo, yebo, kunezinye izinguquko assays kwamakhemikhali. Ngakho, egazini kwenzeka cholehemia, isb angena kuwo acid Bile kanye enzyme, futhi Amapayipi ngokwabo kwakhiwa cholestasis, isb uketshezi amile. Emtholampilo, lokhu siyofezwa jaundice sclera, nolwelwesi lwamafinyila kanye isikhumba (umbala ophuzi kanye tint oluhlaza), futhi cwaningo ngeke kuphela bilirubin Imininingwane neqondile anda, kodwa futhi acid Bile, cholesterol, lizinga phosphatase ane-alikhali, triglyceride, umsebenzi gamma-glutamyl transferase .

izimbangela

Etiology ka obstructive noma, njengoba libizwa ngokuthi i-jaundice obstructive, kuyinto ehluke ebanzi. Imbangela ezivame kakhulu kuyinto ukuvaleka biliary ipheshana itshe cholecystitis calculous noma cholelithiasis futhi kucabanga helminthic eyihlathi lapho worm yenziwe yaba yasendaweni ngaphakathi Amapayipi noma owayebonisa cholangitis, futhi uma they are inesikhala avuvukele occlusive noma ngenxa ukuvuvukala ezindongeni, noma ngenxa kokuziphatha kwabo. Futhi-ke, lokhu kuchaza iqiniso lokuthi bilirubin eqondile Imininingwane anda. Izizathu nezinye pathologies Kunoma yikuphi, zibangelwa kokucindezelwa zangaphandle. Ngokuvamile lokhu kwenzeka ngenxa elikhulayo isimila, ngokuvamile ezithinta ikhanda kwamanyikwe. Kodwa futhi, lesi simo kungenzeka isifo sokusha lapho biliary, lapho Amapayipi kuthiwa isibambo sikhule iziza kanye imicu zezicubu zezinzwa.

jaundice Neonatal

Nokho, akubona bonke jaundice izimo zokucabanga okubangelwa isifo umzimba. Ngakho uma bilirubin Imininingwane liphakeme e ingane ngokushesha lapho bezalwa noma emuva kwamahora ambalwa kusanda, futhi isikhumba nolwelwesi lwamafinyila abe jaundice elikhanyayo, akufanele ngokushesha ikhale alamu. Ngemva usana yisimo bokuphila ngokuthi lezivakashi ngoba lezivakashi. Yiqiniso, nawu umbuzo kunina ujabule ofundayo ukuthi umntanakhe bilirubin liphakeme, "Yini okufanele ngiyenze?" Impendulo ilula: ukulinda. Uma lokhu empeleni kubonisa ukuphathwa okhulelwe kuphela, kusukela izinsuku ezimbalwa (ngokuvamile ezintathu kuya kweziyisihlanu) yellowness kancane kancane iphele. Futhi kuphela uma imisiwe, isimo umntwana sawohloka Imininingwane bilirubin liphakeme, ukwelashwa wenziwa ngokushesha, okungukuthi yokwelapha ngokukhishwa kobuthi egazini isetshenziswa kanye ultraviolet ngemisebe. Manje ake sicabangele lo pathogenesis yalesi simo.

izinsana kwegazi Ikakhulukazi

Iqiniso lokuthi ukuzungeza fetus esibelethweni sihluke kakhulu ukuthi ebonwe izingane kakade ozalwa. Phakathi nenkathi yokukhulelwa, ingane is egxilile bubble nge-amniotic fluid, futhi ngoba amaphaphu akhe azikakabi ujwayelene emoyeni futhi esishwabene isimo, ie inoperative. Kodwa ingane kubalulekile ukuba ukugeleza esiqhubekayo umoya-mpilo ezicutshini zakhe ngoba ukwakheka yabo, ukukhula kwamangqamuzana. Yingakho igazi lakhe eduze ngakho baxhumana umzali. Ngokuningiliziwe, ebomvu egazi izinyane nje nifaka umoya-mpilo emangqamuzaneni abomvu egazi owesifazane, futhi lokhu badinga esivusa amadlingozi namandla nekhono lakhe. Ngakho-ke, imelelwa elithwala umoya-mpilo-F-hlobo, okusho kwengane. Yena kalula uthola umoya-mpilo bese ekudlulisela ke emangqamuzaneni i-fetus.

Imiphumela

Nokho, ngemva kokuzalwa ukubangisana kwemibuso emikhulu efana akudingekile, ngoba kusukela ngaleso sikhathi kuqhubeke emaphashini yakhe ebonakalisiweyo ukuthi ukuphefumula bebodwa futhi uthole umoya-mpilo zabo. Futhi uma i-hemoglobin yakhe izohlala injalo, ngeke bakwazi lona amaseli. Ngakho-ke, ngemva umoya lokuqala luqala ngenkuthalo ukushintsha lokhu amaprotheni main kwamangqamuzana egazi abomvu kusuka fetus omdala - uhlobo A. Lokhu kungenxa hemolysis okwandisiwe amangqamuzana abomvu ukuthuthukiswa ophuthumayo entsha, efanele, kusukela umnkantsha. Ngakho, kukhona i-jaundice yokuqala, uhlobo suprarenal, okuyinto eyeka ngokushesha nje wonke ubudala zamangqamuzana abomvu egazi, ubhubhe abasha ugcwalise egazini.

Ukwelapha

Isinyathelo esibaluleke kunazo zonke ekwelapheni bilirubin isigqugquzeli Yiqiniso, ukwelapha isifo eziyimbangela, iziyaluyalu okubangelwa shintshiselana, isb kwamaphilisi i-hepatitis viral, ngokukhishwa kobuthi egazini ezimweni ubuthi ubuthi, ukumpontshelwa igazi futhi amangqamuzana abomvu igcwele noma hemolysis ngesikhathi isibindi ukufakelwa i esiteji ezinzima ngokoma kwesibindi. Nokho, kufanele agcizelele Physiotherapy, gepatoprotektory, kwesokudla ayeziphilisa ngakho, ngaphandle engcupheni futhi olukhethekile lokudla ngesikhathi bilirubin ephakeme. Ukuze wenze lokhu, kuqala, kumelwe ukuyeka ukubhema kanye notshwala, amafutha ngokweqile, i-cholesterol, okubabayo futhi ukudla okuthosiwe. It is nhlobo ukudla ukhukhamba kanye nemikhiqizo zicwiliswe. Kuyadingeka ukuba kukhawulwe edonsa usawoti kanye itiye nekhofi akufanele nhlobo. Ngokuphambene, ukudla nge bilirubin isigqugquzeli kuhlanganisa njalo ukudla okuncane nenombolo Meatless okusanhlamvu ashisayo, izithelo compotes, esikhundleni isinkwa esimhlophe grey. Ngempela, sibonga kadokotela uzoqala umkhuba omuhle futhi ekugcineni isifo ngeke ngikushiye.