Hepatic steatosis

Cov txheej txheem:

Hepatic steatosis
Hepatic steatosis
Anonim

kab mob siab hepatic steatosis yog dab tsi?

Hepatic steatosis yog ib yam kab mob ntawm daim siab, uas yog tus cwj pwm los ntawm cov kab mob metabolic hauv cov hlwb ntawm lub cev, ua rau lawv cov rog degeneration. Hauv qhov no, tus kab mob tseem hu ua fatty hepatosis.

Feem ntau, ua rau lub siab muaj teeb meem sib txawv, tab sis feem ntau yog:

  • Kev quav cawv;
  • siv tshuaj;
  • yeeb tshuaj thiab lwm yam intoxication;
  • noj tsis txaus lossis tshaib plab;
  • mob ntshav qab zib mellitus;
  • mob plab plab;
  • myxedema;
  • ntau dhau ntawm cov tshuaj hormones adrenal hauv cov ntshav (Cushing's syndrome).
Steatosis ntawm daim siab
Steatosis ntawm daim siab

Nyob rau hauv daim siab hlwb, cov rog ntau dhau yog tsim los ntawm ntau yam txheej txheem.

Yog li, cov roj fatty acids ntau tau tsim hauv cov hnyuv, ces lawv nkag mus rau daim siab. Tab sis tib lub sijhawm, hauv hepatocytes (lub npe hu ua daim siab hlwb), muaj kev ua txhaum ntawm cov txheej txheem oxidative ntawm cov rog, uas ua rau muaj teeb meem ntawm kev tshem tawm cov rog hauv lub siab.

Vim li ntawd, cov rog hauv lub siab ua rau cov rog nkag mus. Tsis tas li ntawd, teeb meem nrog cov roj cholesterol metabolism pib hauv daim siab, vim tias cov haujlwm ntawm qee cov enzymes hloov pauv.

Hom steatosis:

YDiffuse hepatic steatosis

Yog tias cov rog suav nrog 10% lossis ntau dua ntawm lub siab ntim, ces steatosis tuaj yeem kuaj tau. Feem ntau ntawm cov rog accumulates nyob rau hauv lub thib ob thiab thib peb kab mob siab lobes, thiab nyob rau hauv cov ntaub ntawv ntawm tus kab mob hnyav dua, lawv yog diffusely faib.

Yog li, tus yam ntxwv tseem ceeb ntawm steatosis yog tias nws tuaj yeem ua tau diffuse lossis focal. Yog hais tias focal steatosis tau tshwm sim nyob rau hauv qhov tseeb tias cov rog tau sib sau ua ke, txhim kho qhov chaw muaj roj tsis tu ncua, tom qab ntawd diffuse steatosis cuam tshuam qhov chaw ntawm cov rog rog nyob rau tag nrho cov khoom nruab nrog cev.

Fatty siab steatosis

Raws li qhov tshwm sim ntawm cov rog rog nkag mus, daim siab tsis tsuas yog nce ntxiv, tab sis kuj hloov xim mus rau daj lossis liab-xim av. Cov hlwb hauv siab khaws cov rog ua triglycerides. Qhov tshwm sim ntawm xws li pathological cia yog tias cov roj poob ntawm cov rog txav cov cell organelles nyob rau hauv hepatocyte mus rau periphery.

Raws li qhov tshwm sim ntawm cov rog rog nkag mus, lub siab tuaj yeem tuag. Cov roj tee tau muab tso ua ke rau hauv cov hlwv rog, thiab cov ntaub so ntswg txuas ntxiv mus ntxiv nyob rau tom kawg.

Fatty hepatosis feem ntau asymptomatic. Feem ntau, tus kab mob no tau kuaj pom los ntawm lub caij nyoog - thaum lub sij hawm ultrasound ntawm tus neeg mob.

Qee zaum nrog daim siab steatosis, muaj hnyav nyob rau sab xis, uas nce thaum lub zog txav. Cov neeg mob yuav yws yws ntawm xeev siab, qaug zog, qaug zog.

Yeej, lub siab rog nyob ruaj khov, tsis tshua muaj tshwm sim. Thaum fatty infiltration yog ua ke nrog o (steatohepatitis), ib feem peb ntawm cov neeg mob yuav tsim fibrosis, thiab 10% yuav ua rau cirrhosis.

Alcoholic siab steatosis

Lub sijhawm thawj ntawm kev hloov pauv hauv daim siab, uas yog tshwm sim los ntawm cov txheej txheem ntev ntawm kev haus cawv, hu ua cawv steatosis thiab tseem hu ua fatty siab.

Muaj ntau yam ua rau tus kab mob no. Piv txwv li, tshuaj lom rau lub cev. Qhov laj thawj feem ntau yog siv cov dej cawv. Thiab qhov koob tshuaj cawv ntau dua, tus nqi siab dua thiab qib ntawm kev txhim kho kev puas tsuaj ntawm cov hlwb hauv daim siab.

Kev tshwm sim ntawm hom steatosis no feem ntau thim rov qab. Lawv raug txo qis tom qab 4 lub lis piam tshem tawm. Txawm li cas los xij, cawv steatosis tuaj yeem ua rau lub siab mob hnyav heev. Cov kev tshawb fawb soj ntsuam qhia tias qhov hnyav ntawm steatosis cuam tshuam nrog kev pheej hmoo ntawm kev tsim kab mob siab ntev.

Cov ntawv tseem ceeb ntawm steatosis:

  1. macrovesicular (ib qho roj vacuole loj muaj nyob hauv hepatocyte);
  2. microvesicular.

Hauv daim siab, sib xyaw micro- thiab macroforms feem ntau kuj pom, thiab yog li nws tuaj yeem xav tias lawv sawv cev rau qee theem ntawm kev loj hlob ntawm tus kab mob. Yog li, daim ntawv microvesicular yog ib qho mob tshwm sim ntawm steatosis, thiab daim ntawv macrovesicular yog ib qho mob ntev.

Feem ntau steatosis tsim nyob rau hauv kev sib txuas nrog kev ua txhaum ntawm lipid metabolism hauv hepatocytes, uas yog tshwm sim los ntawm kev hloov pauv hauv hepatocellular redox peev xwm. Tab sis thaum lub sij hawm ntev intoxication (cawv), ib txwm ntsuas ntawm redox muaj peev xwm rov qab los, tsis hais txog ntawm txoj kev loj hlob ntawm steatosis, uas txhais tau hais tias lwm yam kuj muaj feem xyuam rau cov cawv daim siab puas.

Non-alcoholic hepatic steatosis

Tsis yog-alcoholic steatosis, dhau los, muaj ntau lub npe (infiltration lossis fatty degeneration, non-alcoholic fatty disease). Tag nrho cov no yog cov npe ntawm thawj theem ntawm daim siab kab mob los yog ib tug syndrome uas yog tsim los ntawm ib tug ntau ntawm fatty inclusions (tsuas yog triglycerides) nyob rau hauv lub cev.

Nws yuav tsum tau muab sau tseg tias nrog tsis muaj kev cuam tshuam thaum lub sijhawm muaj tus kabmob, yav tom ntej, hauv 14% ntawm cov neeg mob nws nyhav mus rau hauv steatohepatitis, hauv 10% - mus rau hauv kev loj hlob ntawm fibrosis, thiab qee zaum mus rau hauv. cirrhosis ntawm daim siab.

Cov ntawv txheeb cais niaj hnub no qhia meej tias vim li cas qhov teeb meem zoo li no rau pej xeem nyiam. Tom qab tag nrho, yog tias koj qhia meej txog etiology thiab pathogenesis ntawm tus kab mob, nws yuav ua kom paub tseeb tias koj tuaj yeem sib ntaus sib tua thiab tshem tawm cov kab mob zoo li cas. Nws tsim nyog xav txog tias qee tus neeg mob yuav muaj tus kab mob, thiab qee tus tsuas muaj cov tsos mob xwb.

Qhov tseem ceeb ntawm kev pheej hmoo rau cov tsis muaj cawv steatosis yog:

  1. overweight;
  2. mob ntshav qab zib mellitus hom 2;
  3. presence of ileocecal anastomosis;
  4. poob ceeb thawj (kwv yees li 1.5 kg hauv ob peb hnub);
  5. khoom noj khoom haus parenteral;
  6. nce tus kab mob hauv plab;
  7. tshuaj ntau ntau (cov tshuaj tiv thaiv kab mob, corticosteroids, tshuaj tiv thaiv kab mob, thiab lwm yam)

Raws li tau hais los saum toj no, hmoov tsis, nrog kev pab los ntawm kev tshawb fawb hauv chav kuaj, nws yuav luag tsis tuaj yeem kuaj pom cov rog rog. Raws li txoj cai, bilirubin, prothrombin thiab albumin yog qhov qub, thaum cov ntshav transaminase nce siab me ntsis.

Tsis tas li ntawd, echogenicity ntawm daim siab cov ntaub so ntswg, txawm tias nrog kev kuaj mob ultrasound, tuaj yeem hloov mus rau yam tsis muaj qhov txawv txav tshwj xeeb, lossis siab dua me ntsis ntawm cov qauv, uas tsis ua rau muaj kev txhim kho thiab kho kom raug.. Yog li ntawd, hauv qee qhov xwm txheej, kev kuaj pom tus kab mob tsuas yog ua tau ua tsaug rau kev sib nqus resonance imaging.

Txawm li cas los xij, txawm tias tib lub sijhawm, qhov kev kuaj mob zaum kawg yuav tsum tau ua raws li kev kuaj mob ntawm daim siab ntawm daim siab thaum lub sijhawm kuaj ntshav.

Focal hepatic steatosis

Raws li txoj cai, tsis muaj kev sim kuaj ntawm qhov txawv txav hauv kev kuaj ntshav dav dav. Qee lub sij hawm nws tuaj yeem txiav txim siab me ntsis ntawm cov haujlwm ntawm cholestasis thiab cytolysis enzymes.

Kev kuaj mob ntawm cov qog nqaij hlav hauv siab yog ua tiav nyob rau hauv chav kawm ntawm kev tshawb fawb. Scintigraphy nyob rau hauv cov ntaub ntawv no tsis muab cov ntaub ntawv tsim nyog, vim nws tuaj yeem kuaj pom cov kab mob focal hauv daim siab uas muaj txoj kab uas hla tsuas yog ntau tshaj 4 cm. Yog li, nws yuav tsim nyog xa tus neeg mob mus rau ultrasound tom qab kuaj lub cev.

Qhov tsim ntawm cov qog nqaij hlav zoo yog pov thawj los ntawm focal hyperechoic formations nrog txawm thiab meej cov ntsiab lus nrog txawv diameters hauv daim siab parenchyma. Tus naj npawb ntawm cov formations tuaj yeem sib txawv ntawm 1 txog 45, thiab tsis yog hauv ib qho xwb, tab sis hauv ob qhov sib koom.

Kev noj qab haus huv rau daim siab steatosis

Noj zaub mov
Noj zaub mov

Ib qho ntawm 15 txoj kev noj zaub mov tseem ceeb (qee zaum lawv tuaj yeem hu ua cov rooj) yog noj zaub mov 5, tshuaj rau cov kab mob siab, nrog rau cov teeb meem nrog lub gallbladder thiab penitent biliary tract. Nws lub hom phiaj yog los muab kev noj zaub mov kom tiav rau tus neeg mob, uas ua rau muaj kev ruaj ntseg ntawm daim siab ua haujlwm, txhim kho cov kua tsib, muab cov txheej txheem sparing ncaj qha rau daim siab nws tus kheej.

Cov khoom tso cai thiab pom zoo rau kev noj:

  • Cov khoom noj khoom haus: cov khoom noj pastry (koj tuaj yeem siv cov nqaij npuas kib), rye qhob cij, croutons lossis ncuav qab zib.
  • Cov kua zaub: kua mis nrog pasta, zaub kua zaub kua zaub, kua zaub, zaub mov borscht, kua zaub beetroot.
  • Y Nqaij thiab nqaij: nqaij nyuj, qaib ntxhw, qaib, boiled pilaf, luav, lean lamb.
  • ntses muaj roj tsawg: boiled zoo tshaj plaws, ntses meatballs, muaj peev xwm yuav varied los ntawm ci ntses tom qab boiling.
  • Fats as refined zaub roj thiab butter.
  • Cov khoom noj mis nyuj: cov tsev cheese tsis muaj rog thiab rog tsawg, paj npleg, kefir, tsis muaj rog (thiab tsis ntsim heev) cheese, mis nyuj muaj roj, qaub cream, tub nkeeg dumplings.
  • Qe: Protein omelette, muag muag, tab sis tsis pub ntau tshaj ib lub qe ib hnub.
  • Cereals - oatmeal thiab buckwheat, txhua yam cereals, pilaf nrog carrots, pasta yuav pab tau tshwj xeeb.
  • Zaub: Ntau yam zaub mov npaj los ntawm boiled, stewed los yog nyoos zaub mov. Koj tuaj yeem siv lawv tsis tsuas yog cov tais diav, tab sis kuj nyob rau hauv daim ntawv ntawm cov zaub nyoos thiab cov tais diav ywj pheej. Sauerkraut tau tso cai (tsis qaub heev!), mashed ntsuab peas, dos, tab sis tsis nyoos, tab sis tsuas yog boiled.
  • khoom noj txom ncauj: txiv hmab txiv ntoo zaub, nqaij ntses tsawg (soaked), vinaigrettes, nqaij nruab deg thiab boiled nqaij zaub xam lav, squash caviar, mis nyuj sausage, ntau yam zaub zaub xam lav.
  • Y Txiv hmab txiv ntoo thiab txiv hmab txiv ntoo, compotes, txiv hmab txiv ntoo qhuav, jam, zib ntab, qab zib.
  • Dej: dub, tshuaj yej ntsuab, kua txiv hmab txiv ntoo, kas fes nrog mis nyuj, ntau yam decoctions (piv txwv li, nplej bran lossis rosehips).

Yog li, koj tuaj yeem tsim cov kev xaiv noj zaub mov haum rau koj tus kheej thiab pleev xim rau lawv ib hnub.

Hnub Ib

Rau noj tshais: txiv hmab txiv ntoo nyias, steamed nqaij nyug patties, kas fes.

Rau ib tav su noj: ib khob ntawm fermented ci mis nyuj.

Rau pluas su: neeg tsis noj nqaij borscht, ci hake nrog stewed cabbage, berry jelly.

Rau noj hmo: spaghetti nrog butter thiab cheese, dej ntxhia.

Ua ntej pw: banana.

Hnub Ob

Rau pluas tshais: steamed protein omelette, rye toast nrog txiv hmab txiv ntoo jam, kua txiv hmab txiv ntoo.

Rau noj su: pear.

Rau noj su: zaub kua zaub, stewed carrots nrog boiled nqaij qaib, raisin thiab qhuav apricots.

Rau noj hmo: mashed qos yaj ywm nrog ci zaub, tshuaj yej. Ua ntej yuav mus pw: Borjomi.

Hnub Peb

Rau noj tshais: luav stew penne, tshuaj yej.

Rau ib tav su noj: txiv hmab txiv ntoo thiab kua txiv hmab txiv ntoo.

Rau noj su: qos yaj ywm kua zaub, carrot cheesecakes, jelly.

Rau noj hmo: ci omelet, cheese, tshuaj yej.

Ua ntej yuav mus pw: ib khob ntawm fermented ci mis nyuj.

Hnub Plaub

Rau pluas tshais: pilaf, tsev cheese casserole nrog qaub cream.

Rau noj su: carrot-apple salad.

Rau pluas su: nqaij qaib meatballs nrog buckwheat, txiv hmab txiv ntoo compote.

Rau noj hmo: qos yaj ywm thiab zaub qhwv zrazy, ci corop, dej ntxhia.

Ua ntej yuav pw: ci apple.

Cov zaub mov saum toj no ua raws nrog tshuaj thiab kho lub cev. Nws tsis tsim nyog pib ntawm koj tus kheej, nws yog ib qho tseem ceeb kom tau txais cov lus qhia ntawm koj tus kws kho mob.

Cov khoom noj khoom haus zoo li no tuaj yeem ua tiav sai sai ntawm kev tshem tawm cov kab mob, txo cov exacerbations, thiab normalize qhov tsis txaus ntawm cov plab hnyuv siab raum. Tsis tas li ntawd, kev noj zaub mov muaj lwm qhov zoo - ua tsaug rau nws, qhov hnyav tau txo qis, kev noj qab haus huv zoo tuaj thiab pom muaj zog txhawb zog.

Rau cov neeg mob uas txhawj xeeb txog cov kab mob ntawm cov kua tsib thiab daim siab, nws yog ib qho tseem ceeb heev uas yuav tsum tsis txhob noj cov zaub mov txwv tsis pub, tsis yog rau lub sijhawm ntawm kev noj zaub mov xwb, tab sis kuj tom qab nws tas. Ua ntej ntawm tag nrho cov, qhov no siv rau cov nqaij haus luam yeeb, ntsim thiab rog-nplua nuj tais diav, thiab cawv. Txwv tsis pub, cov nyhuv yuav raug txo kom tsawg thiab cov kev kho mob yuav tsum tau rov ua dua.

Pom zoo: