Transcript sasunTqi gzebis obstruqcia da metaboluri sindromi

filtvebis qronikuli obstruqciuli daavadeba da
metaboluri sindromi
lela torCinava, tfdec, “samSabaToba”, 23.02.10
filtvebis qronikuli obstruqciuli daavadeba
respiraciuli sistemis qronikuli anTebiTi daavadebaa; upiratesad sasunTqi
gzebis distaluri nawilebis da filtvebis parenqimis dazianebiT da emfizemis ganviTarebiT.
f.q.o.d. vlindeba nawilobriv Seqcevadi bronquli obstruqciiT, xasiaTdeba
progre-sirebiT da mzardi qronikuli sunTqvis ukmarisobis movlenebiT.
f.q.o.d. risk-faqtorebi
Sinagani faqtorebi:
• bronqebis hiperreaqtiuloba
• filtvebis ganviTarebis anomalia
• genetikuri faqtori
garegani faqtorebi:
• Tambaqos moweva
• sawarmoo mtveri da qimikatebi
• haeris dabinZureba
• infeqciebi
qronikuli anTeba f.q.o.d. dros
•
daavadebis progresirebis sakvanZo elementi
•
anTeba moicavs bronquli kedlis yvela Sres da intersti-ciul qsovils
•
anTebas mivyavarT filtvebis emfizemis da sasunTqi gzebis remodelirebisken
•
neitrofilebi warmoadgenen anTebis ZiriTad ujredefeq-torebs.
f.qo.d. diagnostikis ZiriTadi debulebebi
• risk-faqtorebis zemoqmedeba
• asaki>35w
• respiratoruli simptomebis gviani gaCena da neli ucvleli zrda (xvela, qoSini, naxvelis gamoyofa)
• f.a.m1 da f.a.m./f.f.s.t. daqveiTeba
• mateba f.a.m.1<15% bronqodilataciuri sinjis Semdeg.
• adreuli diagnostika(1 stadia) SesaZlebelia, mxolod daavadebulTa aqtiuri gamovlenisas, riskis jgufis kotigentSi.
arsebobs garkveuli cnobebi, rom filtvebis qr. obstruqciuli daavadeba (Cronic Obstractive
Pulmonary Disanse - COPD) da metabolur sindromi erTmaneTTan garkveul urTierTkavSirSia, Tumca
amis Taobaze myari mtkicebulebebi aqamde ar arsebobda.
birmingenis universitetis (didi britaneTi), guenjous saxalxo saavadmyofos (CineTi) da hong-kongis
universitetis TanamSromlobiT Catarda kohortuli kvleva am urTierT-kavSiris dasadgenad. (European
Respiratory Journal gamoqveynebulia evropis respiraciul JurnalSi 2010; 35; 307-323)
meTodebi
kvlevam moicva guanjous moxucTa TavSesafris 50 wlis pirebi, isini SeirCnen
randomizaciis wesiT drois or monakveTSi(2003-2004, 2005-2006ww) sul20,431 piri. iyvnen
qmediTunarianni da ar utardebodaT mkurnaloba raime sicocxlisaTvis saSiSi daavdebis gamo. yvela
monawilisagan miRebuli iqna werilobiTi Tanxmoba. TiToeul pirs Cautarda fizikaluri gasinjva da
detalurad Seivso samedicino kiTxvari.
aucilebeli gamokvlevebi:
1.
arteriuli wnevis gazomva(cifruli)
2. wilis garSemoweriloba
3.
4.
5.
6.
7.
glikemiis(uzmod), trigliciridebis da maRali simk-vrivis lipoproteinebis(HDL)–qolesterolis gansazRvra
sxeulis masis indexi (BMI)
Tambaqos moxmarebis istoria (arasdros, yofili, amJamindeli)
fizikuri aqtivobis donis gansazRvra (umoqmedo, minimaluri aqtivobis, aqtiuri)
filtvebis funqc. statusis dasadgenad: spirometria-sam-sami cda bronqodilatatoris gamoyenebis gareSe.
dafiqsirda saukeTeso maCveneblebi: FEV1, FVC, FEV1/FVC
sasunTqi gzebis obstruqcia ganisazRvra:
FEV1/FVC<LLN (normis qveda zRvari Lower Limit of
Normal)
• msubuqi xarisxis obstruqcia FEV1 >80%
• saSualo -FEV1 - 50%÷80%
• mZime -FEV1 < 50%
miuxedavad imisa, rom arsebobs garkveuli cnobebi kavSirze metabo-lur
sindromsa da restriqcias Soris, restriqciuli paTologiis dafiqsi-rebisas,
SemTxveva amovarda kvlevidan.
metaboluri sindromi:
diabetis saerTaSoriso federaciis (IDF) gansazRvrebiT dgindeba Tu saxezea centraluri
(abdominaluri) simsuqne (welis garSemoweiloba mamakacebSi >90sm-ze qalebSi >80sm) da sul mcire ori
kriteriumi Semdegidan:
1. maRali arteriuli wneva(>135/85 mmhg)
2. glukozisadmi tolerantobis darRveva (glikemia uzmod>5,6mm/l) 110mg/dl
3. trigliceridebi sisxlSi (>150mg/dl) 1,7mm/l
4. hdl-qolesterolis dabali done (<40mg/dl 1,03mm/l) mamakacebSi da(<50mg/dl
1,29mm/l) qalebSi
statistikuri analizi:
 gamoyenebuli iyo ANCOVA-metaboluri markerebis SefasebisTvis
 glukozis trigliceridebis donis maCveneblebi damuSavda algoriTmulad
 metabolur sindromsa da sasunTqi gzebis obstruqcias Soris kavSiris dasadgenad gamoyenebuli iyo
lojistikuri regresiis modelebi
yvela analizi warmodgenili iyo stata versiiT (statacorp. college station,TX, USa)
Sedegebi :
20431 monawilidan sarwmuno infor-macia miRebul iqna 8701
piridan aqedan 1343(15%) gamoiricxa, vinaidan maT hqondaT dadgenili
asTma an bronqoeqtazia, anda gamovlenili iqna restriqciuli paTolo-gia
spirometriiT.
amis Sedegad darCa 7358 monawile, 2008 mamakaci (27,3%) da 5350
qali(72,7%) saSualo asaki (61,6 6,7weli)
ver inaxa kavSiri:
 sasunTqi gzebis obstruqciasa sqess Soris (6,4%-mamakacebi, 6,9% -qalebi)
 sxeulis masis indeqss(BMI)-s Soris
 art.wnevas, HDL-qolesterolis da glukozis dones Soris.
metaboluri sindromis 5 komponentidan sasunTqi gzebis obstruqciasTan dakavSirebuli iyo
mxolod 1-centraluri (abdominaluri) simsuqne. (CI-1,09-1,88)
Tambaqos moxmareba:
kvlevisas inaxa erTnairi kavSiri metabolur sindromsa sasunTqi gzebis obstruqcias
Soris rogorc mwevel ise aramwevel pirebSi, Tumca kiTxvaridan gairkva, rom aramweveli
pirebi iyvnen an pasiuri mwevelebi an iyvnen mtvriT dabinZurebul garemoSi momuSaveni
inaxa wrfivi kavSiri metaboluri sindromis zrdasa da FEV1
procentis daqveiTebas Soris (sandoobis intervali CI 1,39-3,95).
7358 piridan 6,7%-s daudginda sasunTqi gzebis obstruqcia, 20%s daudginda metaboluri sindromi.
daskvna:
CineTSi Catarebuli kvleva cxadyofs kavSirs sasunTqi gzebis obstruqciasa da metabolur
sindroms, kerZod, centralur (abdominalur) simsuqnes Soris.
miRebuli Sedegi dagvexmareba imis axsnaSi Tu ratom aqvT COPD–iT daavadebul
pacientebs kardiovaskularuli daavadebebis maRali riski, rac TavisTavad gamoyenebuli
iqneba klinikur praqtikaSi
gmadlobT yuradRebisTvis