filtvebis qronikuli obstruqciuli daavadeba
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filtvebis qronikuli obstruqciuli daavadeba da metaboluri sindromi lela torCinava, tfdec, “samSabaToba”, 23.02.10. filtvebis qronikuli obstruqciuli daavadeba. - PowerPoint PPT PresentationTRANSCRIPT
filtvebis qronikuli filtvebis qronikuli obstruqciuli obstruqciuli
daavadeba da daavadeba da metaboluri sindromimetaboluri sindromi
lela torCinava, tfdec, lela torCinava, tfdec, “samSabaToba”, 23.02.10“samSabaToba”, 23.02.10
respiraciuli sistemis qronikuli anTebiTi respiraciuli sistemis qronikuli anTebiTi
daavadebaa; upiratesad sasunTqi gzebis distaluri daavadebaa; upiratesad sasunTqi gzebis distaluri
nawilebis da filtvebis parenqimis dazianebiT da nawilebis da filtvebis parenqimis dazianebiT da
emfizemis ganvi-TarebiT. emfizemis ganvi-TarebiT.
f.q.o.d. vlindeba nawilobriv Seqcevadi f.q.o.d. vlindeba nawilobriv Seqcevadi
bronquli obstruqciiT, xasiaTdeba progre-sirebiT bronquli obstruqciiT, xasiaTdeba progre-sirebiT
da mzardi qronikuli sunTqvis ukmarisobis da mzardi qronikuli sunTqvis ukmarisobis
movlenebiTmovlenebiT..
filtvebis qronikuli obstruqciuli filtvebis qronikuli obstruqciuli daavadebadaavadeba
Sinagani faqtorebiSinagani faqtorebi::•• bronqebis hiperreaqtiulobabronqebis hiperreaqtiuloba•• filtvebis ganviTarebis anomaliafiltvebis ganviTarebis anomalia•• genetikuri faqtorigenetikuri faqtori
garegani faqtorebigaregani faqtorebi::•• Tambaqos mowevaTambaqos moweva•• sawarmoo mtveri da qimikatebisawarmoo mtveri da qimikatebi•• haeris dabinZurebahaeris dabinZureba•• infeqciebiinfeqciebi
f.qf.q..o.d. o.d. rriskisk--faqtorebifaqtorebi
•• daavadebis progresirebis sakvanZo elementidaavadebis progresirebis sakvanZo elementi
•• anTeba moicavs bronquli kedlis yvela Sres da interstianTeba moicavs bronquli kedlis yvela Sres da intersti--ciul ciul
qsovilsqsovils
•• anTebas mivyavarT filtvebis emfizemis da sasunTqi gzebis anTebas mivyavarT filtvebis emfizemis da sasunTqi gzebis
remodelirebiskenremodelirebisken
•• neitrofilebi warmoadgenen anTebis ZiriTad ujredefeqneitrofilebi warmoadgenen anTebis ZiriTad ujredefeq--torebs.torebs.
qronikuli anTeba f.q.o.d. drosqronikuli anTeba f.q.o.d. dros
f.qo.d. diagnostikis ZiriTadi f.qo.d. diagnostikis ZiriTadi
debulebebidebulebebi • 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 arsebobs garkveuli cnobebi, rom filtvebis qr. obstruqciuli
daavadeba daavadeba ((Cronic Obstractive Pulmonary Disanse - COPDCronic Obstractive Pulmonary Disanse - COPD) ) da metabolur da metabolur
sindromi erTmaneTTan garkveul urTierTkavSirSia, Tumca amis sindromi erTmaneTTan garkveul urTierTkavSirSia, Tumca amis
Taobaze myari mtkicebulebebi aqamde ar arsebobda.Taobaze myari mtkicebulebebi aqamde ar arsebobda.
birmingenis universitetisbirmingenis universitetis (didi britaneTi), guenjous saxalxo (didi britaneTi), guenjous saxalxo
saavadmyofossaavadmyofos (CineTi) da hong-kongis universitetis (CineTi) da hong-kongis universitetis
TanamSromlobiT Catarda kohortuli kvleva am urTierTTanamSromlobiT Catarda kohortuli kvleva am urTierT--kavSiris kavSiris
dasadgenad.dasadgenad. ((European Respiratory Journal European Respiratory Journal gamoqveynebulia evropis gamoqveynebulia evropis
respiraciul JurnalSi 2010; 35; 307-323)respiraciul JurnalSi 2010; 35; 307-323)
meTodebimeTodebi
kvlevam moicva guanjous moxucTa TavSesafris kvlevam moicva guanjous moxucTa TavSesafris
50 wlis pirebi, isini SeirCnen randomizaciis wesiT drois 50 wlis pirebi, isini SeirCnen randomizaciis wesiT drois
or monakveTSi(2003-2004, 2005-2006ww) sul20,431 or monakveTSi(2003-2004, 2005-2006ww) sul20,431
piri. iyvnen qmediTunarianni da ar utardebodaT piri. iyvnen qmediTunarianni da ar utardebodaT
mkurnaloba raime sicocxlisaTvis saSiSi daavdebis mkurnaloba raime sicocxlisaTvis saSiSi daavdebis
gamo. yvela monawilisagan miRebuli iqna werilobiTi gamo. yvela monawilisagan miRebuli iqna werilobiTi
Tanxmoba. TiToeul pirs Cautarda fizikaluri gasinjva da Tanxmoba. TiToeul pirs Cautarda fizikaluri gasinjva da
detalurad Seivso samedicino kiTxvari.detalurad Seivso samedicino kiTxvari.
aucilebeli gamokvlevebi:aucilebeli gamokvlevebi:1.1. arteriuli wnevis gazomva(cifruli)arteriuli wnevis gazomva(cifruli)
2.2. wilis garSemowerilobawilis garSemoweriloba
3.3. glikemiis(uzmod), trigliciridebis da maRali simk-vrivis glikemiis(uzmod), trigliciridebis da maRali simk-vrivis
lipoproteinebis(lipoproteinebis(HDLHDL)–qolesterolis gansazRvra)–qolesterolis gansazRvra
4.4. sxeulis masis indexi (sxeulis masis indexi (BMIBMI))
5.5. Tambaqos moxmarebis istoria (arasdros, yofili, Tambaqos moxmarebis istoria (arasdros, yofili,
amJamindeli)amJamindeli)
6.6. fizikuri aqtivobis donis gansazRvra (umoqmedo, fizikuri aqtivobis donis gansazRvra (umoqmedo,
minimaluri aqtivobis, aqtiuri)minimaluri aqtivobis, aqtiuri)
7.7. filtvebis funqc. statusis dasadgenad: spirometria-sam-filtvebis funqc. statusis dasadgenad: spirometria-sam-
sami cda bronqodilatatoris gamoyenebis gareSe. sami cda bronqodilatatoris gamoyenebis gareSe.
dafiqsirda saukeTeso maCveneblebi: dafiqsirda saukeTeso maCveneblebi: FEVFEV11, FVC, FEV, FVC, FEV11/FVC/FVC
sasunTqi gzebis obstruqcia sasunTqi gzebis obstruqcia ganisazRvra:ganisazRvra:
FEVFEV11/FVC<LLN /FVC<LLN ((normis qveda zRvari normis qveda zRvari Lower Lower Limit of NormalLimit of Normal))
• msubuqi xarisxis obstruqcia msubuqi xarisxis obstruqcia FEVFEV11 >80% >80%
• saSualosaSualo -FEV -FEV11 - 50% - 50%÷÷80%80%
• mZimemZime -FEV -FEV11 < 50% < 50%
miuxedavad imisa, rom arsebobs miuxedavad imisa, rom arsebobs
garkveuli cnobebi kavSirze metabo-lur garkveuli cnobebi kavSirze metabo-lur
sindromsa da restriqcias Soris, sindromsa da restriqcias Soris,
restriqciuli paTologiis dafiqsi-rebisas, restriqciuli paTologiis dafiqsi-rebisas,
SemTxveva amovarda kvlevidan.SemTxveva amovarda kvlevidan.
metaboluri sindromi:metaboluri sindromi:diabetis saerTaSoriso federaciis (diabetis saerTaSoriso federaciis (IDFIDF) gansazRvrebiT ) gansazRvrebiT
dgindeba Tu saxezea centraluri (abdominaluri) simsuqne dgindeba Tu saxezea centraluri (abdominaluri) simsuqne (welis garSemoweiloba mamakacebSi >90sm-ze qalebSi (welis garSemoweiloba mamakacebSi >90sm-ze qalebSi >80sm) da sul mcire ori kriteriumi Semdegidan>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:statistikuri analizi:
gamoyenebuli iyo gamoyenebuli iyo ANCOVAANCOVA-metaboluri markerebis -metaboluri markerebis SefasebisTvisSefasebisTvis
glukozis trigliceridebis donis maCveneblebi damuSavda glukozis trigliceridebis donis maCveneblebi damuSavda algoriTmuladalgoriTmulad
metabolur sindromsa da sasunTqi gzebis obstruqcias Soris metabolur sindromsa da sasunTqi gzebis obstruqcias Soris kavSiris dasadgenad gamoyenebuli iyo lojistikuri regresiis kavSiris dasadgenad gamoyenebuli iyo lojistikuri regresiis modelebimodelebi
yvela analizi warmodgenili iyo yvela analizi warmodgenili iyo stata stata versiiT (versiiT (statacorp.statacorp. college college station,TX, USa) station,TX, USa)
Sedegebi :Sedegebi :
20431 monawilidan sarwmuno infor-20431 monawilidan sarwmuno infor-macia miRebul iqna 8701 piridan aqedan macia miRebul iqna 8701 piridan aqedan 1343(15%) gamoiricxa, vinaidan maT 1343(15%) gamoiricxa, vinaidan maT hqondaT dadgenili asTma an bronqoeqtazia, hqondaT dadgenili asTma an bronqoeqtazia, anda gamovlenili iqna restriqciuli paTolo-gia anda gamovlenili iqna restriqciuli paTolo-gia spirometriiT.spirometriiT. amis Sedegad darCa 7358 monawile, amis Sedegad darCa 7358 monawile, 2008 mamakaci (27,3%) da 5350 2008 mamakaci (27,3%) da 5350 qali(72,7%) saSualo asaki (61,6 qali(72,7%) saSualo asaki (61,6 6,7weli)6,7weli)
ver inaxa kavSiri:ver inaxa kavSiri:
sasunTqi gzebis obstruqciasa sqess Soris (6,4%-sasunTqi gzebis obstruqciasa sqess Soris (6,4%-mamakacebi, 6,9% -qalebi)mamakacebi, 6,9% -qalebi) sxeulis masis indeqss(sxeulis masis indeqss(BMIBMI)-s Soris)-s Soris art.wnevas, art.wnevas, HDLHDL-qolesterolis da glukozis dones -qolesterolis da glukozis dones Soris. Soris.
metaboluri sindromis 5 komponentidan sasunTqi metaboluri sindromis 5 komponentidan sasunTqi
gzebis obstruqciasTan dakavSirebuli iyo mxolod 1-gzebis obstruqciasTan dakavSirebuli iyo mxolod 1-
centraluri (abdominaluri) simsuqne. (centraluri (abdominaluri) simsuqne. (CICI-1,09-1,88)-1,09-1,88)
Tambaqos moxmareba:Tambaqos moxmareba:
kvlevisas inaxa erTnairi kavSiri metabolur kvlevisas inaxa erTnairi kavSiri metabolur
sindromsa sasunTqi gzebis obstruqcias Soris rogorc sindromsa sasunTqi gzebis obstruqcias Soris rogorc
mwevel ise aramwevel pirebSi, Tumca kiTxvaridan mwevel ise aramwevel pirebSi, Tumca kiTxvaridan
gairkva, rom aramweveli pirebi iyvnen an pasiuri gairkva, rom aramweveli pirebi iyvnen an pasiuri
mwevelebi an iyvnen mtvriT dabinZurebul garemoSi mwevelebi an iyvnen mtvriT dabinZurebul garemoSi
momuSavenimomuSaveni
inaxa wrfivi kavSiri metaboluri inaxa wrfivi kavSiri metaboluri sindromis zrdasa da sindromis zrdasa da FEVFEV11 procentis procentis daqveiTebas Soris (sandoobis daqveiTebas Soris (sandoobis intervali intervali CICI 1,39-3,95). 1,39-3,95).
7358 piridan 6,7%-s daudginda 7358 piridan 6,7%-s daudginda sasunTqi gzebis obstruqcia, 20%-s sasunTqi gzebis obstruqcia, 20%-s daudginda metaboluri sindromi.daudginda metaboluri sindromi.
daskvna:daskvna:
CineTSi Catarebuli kvleva cxadyofs kavSirs CineTSi Catarebuli kvleva cxadyofs kavSirs
sasunTqi gzebis obstruqciasa da metabolur sasunTqi gzebis obstruqciasa da metabolur
sindroms, kerZod, centralur (abdominalur) sindroms, kerZod, centralur (abdominalur)
simsuqnes Soris.simsuqnes Soris.
miRebuli Sedegi dagvexmareba imis axsnaSi Tu miRebuli Sedegi dagvexmareba imis axsnaSi Tu
ratom aqvT ratom aqvT COPDCOPD–iT daavadebul pacientebs –iT daavadebul pacientebs
kardiovaskularuli daavadebebis maRali riski, rac kardiovaskularuli daavadebebis maRali riski, rac
TavisTavad gamoyenebuli iqneba klinikur TavisTavad gamoyenebuli iqneba klinikur
praqtikaSipraqtikaSi
gmadlobT yuradRebisTvisgmadlobT yuradRebisTvis