jirovoy gepatoz

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voprosi steatogepatozi voznikayushie na osnove alkogolya voprosi pochemu jirovoy gepatoz - problema xxi veka ? sushestvuyut li kliniko-morfologicheskie kriterii jg? nado li lechit jg? kakie podxodi k terapii jg? jirovoy gepatoz patologicheskoe sostoyanie pecheni, xarakterizuyusheesya jirovoy distrofiey pechenochnix kletok, patologicheskim vnutri- i(ili) vnekletochnim otlojeniem jirovix kapel. *sinonimi: jirovaya infiltratsiya, steatoz pecheni, jirovaya distrofiya pecheni, jirovaya pechen *e.m.tareev (1948) perviy iz otechestvennix klinitsistov podrobno opisal jirovuyu distrofiyu pecheni pri tyajelix gnoynix protsessax. rasprostranennost jg statisticheskie dannie svidetelstvuyut o znachitelnom rasprostranenii jg - do 40-60% sredi naseleniya srednego i pojilogo vozrasta. *kajdaya pyataya biopsiya pecheni v sluchae neyasnogo diagnoza zabolevaniya pecheni imeet zaklyuchenie: jirovoe pererojdeniya gepatotsitov. osnovnie prichini jg ojirenie saxarniy diabet alkogol kriticheskaya doza alkogolya bolee 40-80 g chistogo etanola v den dlya mujchin v techenie 5 let. eto kolichestvo soderjitsya v 100-200 ml vodki, 400-800 ml vina krepostyu 10°, 800-1600 ml piva krepostyu 5°. dlya jenshin bezopasnaya doza do 20 …

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steatoz pecheni (n=95, raspr. – 9.5%) nealk. steatogepatit (n=36, raspr. – 3.6%) tsirroz (n=3, raspr. – 0.3%) alkog.steatogepatit (n=85, raspr. – 8.5%) tsirroz (n=3, raspr. – 0.3%) perviy udar vtoroy udar klinicheskaya kartina jg «pechenochnie» ladoni astenovegetativnie rasstroystva diskomfort, tyajest v pr. podrebere dispepsicheskie rasstroystva ikterichnost skler bol v pravom podrebere splenomegaliya teleangio- ektazii 85% 48% 45% 25% 8% 72% 65% 57% funktsionalnie narusheniya pecheni pri jg: neznachitelni i chasto ne ulavlivayutsya obichnimi bioximicheskimi probami xarakterni zamedlennaya retentsiya bromsulfaleina, dislipoproteidemiya aktivnost alat neznachitelno povishena ili v norme, uroven ggtp chasto povishen, osobenno pri alkogolnom jg u 1/3 bolnix otmechaetsya povishenie 2, , i -globulinov, timolovoy probi verifikatsiya diagnoza jg nalichie gepatomegalii dannie uzi kompyuternaya tomografiya pecheni snijenie tolerantnosti k glyukoze dislipoproteidemiya punktsionnaya biopsiya pecheni (neobxodima dlya razgranicheniya jg s drugimi porajeniyami pecheni) sonograficheskie priznaki jg sonograficheskie priznaki jg sonograficheskie priznaki jg sonograficheskie priznaki jg normalnaya pechen normalnaya pechen morfologicheskie kriterii …

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jirovix kist. prognoz - posle ustraneniya prichin jg patologicheskoe otlojenie jira v pecheni mojet regressirovat - pri prodoljayushemsya vozdeystvii gepatotoksicheskix faktorov (xronicheskiy stress, alkogol, giperlipidemiya, metabolicheskie narusheniya i dr.) vozmojno progressirovanie vospalitelnix izmeneniy s razvitiem xronicheskogo steatogepatita i mikronodulyarnogo tsirroza pecheni prognoz - jirovoy gepatoz snijaet ustoychivost pecheni k infektsiyam (virusam), operativnim vmeshatelstvam, narkozu - snijaet effektivnost terapii soputstvuyushix zabolevaniy jirovoy gepatoz 5-10 let 10 let alkogolniy nealkogolniy steatogepatit steatogepatit 5-10 let 10let tsirroz pecheni termin “nealkogolniy steatogepatit (nasg)” vpervie primenil ludwig i soavt. v 1980g., opisivaya klinicheskie osobennosti zabolevaniya pecheni nealkogolnoy etiologii, viyavil osnovnie patomorfologicheskie priznaki, prisushie alkogolnoy bolezni pecheni. pervonachalnoe opisanie etogo sostoyaniya v 1980g. ne izmenilos do nastoyashego vremeni. faktori riska nasg ojirenie, sd, golodanie i istoshenie, otkloneniya lipidnogo spektra, parenteralnoe pitanie, ileo-eyunalniy anastomoz priobreten-nie rasstroystva metabolizma abetalipoproteinemiya, tirozinemiya, bolezn vebera-krischena, bolezn vilsona vrojdennie rasstroystva metabolizma antibiotiki: tetratsiklin tsitostatiki: asparaginaza, metotreksat dr.: amiodaron, estrogeni, gk vozdeystviya lekarstven-nix …

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oy obrasheniya patsientov s nasg k vrachu dlya tselenapravlennogo obsledovaniya slujit sluchaynoe obnarujenie izmeneniy funktsionalnix testov pecheni. pri podrobnom rassprose u 40% iz nix udaetsya viyavit jalobi na obshuyu slabost, snijenie rabotosposobnosti, boli v verxnem pravom kvadrante jivota. *biopsiya pecheni yavlyaetsya edinstvenno nadejnim metodom diagnostiki i otsenki tyajesti techeniya nasg. patogenez steatoza/steatogepatita pri alkogolnom i nealkogolnom povrejdenii pecheni priznak alkogolnaya bolezn pecheni nealkogolnaya bolezn jirovoy pecheni aktivatsiya mikrosomalnix fermentov endotoksemiya aktivatsiya makrofagov/tnf povrejdenie mitoxondriy umenshenie soderjaniya atf v gepatotsitax + + + + + + + + + + a.m. diehl, 2000 jirovoy gepatoz - perviy “tolchok” razvitiya nasg nalichie okislyaemogo jira v pecheni yavlyaetsya dostatochnim, chtobi yavitsya triggerom kaskada pol, odnako, u mnogix patsientov jg nikogda ne progressiruet do stadii razvitiya nekrozo-vospalitelnix protsessov i fibroza. eto pozvolyaet predpolagat, chto pomimo nalichiya jg (pervogo “tolchka”), dlya razvitiya nasg trebuetsya nalichie drugix faktorov (vtorogo “tolchka”). “vtoroy tolchok” razvitiya nasg “vtorim tolchkom” …

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ksigenaza a.j. sanyal, 2001 patogenez lekarstvennogo nasg podavlyayut okislenie jirnix kislot (vizivaya jirovoy gepatoz) podavlyayut protsess mitoxondrialnogo dixaniya, indutsiruyut tsitoxrom r450 2e1 initsiiruyut reaktsii pol provotsiruyut okislitelniy stress povrejdenie pecheni i razvitie steatogepatita j.d. browning et al. 2004 nasg, razvivshiysya posle nalojeniya ileo-eyunalnogo anastomoza i dlitelnom totalnom parenteralnom pitanii znachenie endotoksemii i endotoksin-indutsiruemix tsitokinov v patogeneze nasg, podtverjdaet to, chto uluchshenie klinicheskogo techeniya otmechaetsya pri lechenii metronidazolom patogenez nasg pri sostoyaniyax, soprovojdayushixsya povishennoy translokatsiey bakteriy iz prosveta kishki razvitie oksidativnogo stressa i povrejdeniya pecheni rol endotoksemii endotoksini tnf- (il-6, il-8) povrejdenie pecheni (aktivatsiya makrofagov, zvezdchatix kletok i t.d.) a.j. sanyal, 2001 patogenez asg i nasg bakterii, etanol intestine lps kc tnfά pechen mezenterialniy krovotok obshaya xarakteristika patsientov s nasg -jenskiy pol; -izbitochnaya massa tela; -soputstvuyushiy saxarniy diabet klinicheskie xarakteristiki nasg priznaki steatoza pecheni uzi (2-3 raza) alt, xolesterina, tg, giperglikemiya, markeri virusov i antitela otsutstvuyut. laboratornie priznaki gepatomegaliya v 75% …

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voprosi steatogepatozi voznikayushie na osnove alkogolya voprosi pochemu jirovoy gepatoz - problema xxi veka ? sushestvuyut li kliniko-morfologicheskie kriterii jg? nado li lechit jg? kakie podxodi k terapii jg? jirovoy gepatoz patologicheskoe sostoyanie pecheni, xarakterizuyusheesya jirovoy distrofiey pechenochnix kletok, patologicheskim vnutri- i(ili) vnekletochnim otlojeniem jirovix kapel. *sinonimi: jirovaya infiltratsiya, steatoz pecheni, jirovaya distrofiya pecheni, jirovaya pechen *e.m.tareev (1948) perviy iz otechestvennix klinitsistov podrobno opisal jirovuyu distrofiyu pecheni pri tyajelix gnoynix protsessax. rasprostranennost jg statisticheskie dannie svidetelstvuyut o znachitelnom rasprostranenii jg - do 40-60% sredi naseleniya srednego i pojilogo vozrasta. *kajdaya pyataya bio...

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