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filtvebis qronikuli obstruqciuli daavadeba

filtvebis qronikuli obstruqciuli daavadeba da metaboluri sindromi lela torCinava, tfdec, “samSabaToba”, 23.02.10. filtvebis qronikuli obstruqciuli daavadeba.

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filtvebis qronikuli obstruqciuli daavadeba

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  1. filtvebis qronikuli obstruqciuli daavadeba da metaboluri sindromilela torCinava, tfdec, “samSabaToba”, 23.02.10

  2. filtvebis qronikuli obstruqciuli daavadeba respiraciuli sistemis qronikuli anTebiTi daavadebaa; upiratesad sasunTqi gzebis distaluri nawilebis da filtvebis parenqimis dazianebiT da emfizemis ganvi-TarebiT. f.q.o.d. vlindeba nawilobriv Seqcevadi bronquli obstruqciiT, xasiaTdeba progre-sirebiT da mzardi qronikuli sunTqvis ukmarisobis movlenebiT.

  3. f.q.o.d. risk-faqtorebi Sinagani faqtorebi:•bronqebis hiperreaqtiuloba•filtvebis ganviTarebis anomalia•genetikuri faqtorigaregani faqtorebi:•Tambaqos moweva•sawarmoo mtveri da qimikatebi•haeris dabinZureba•infeqciebi

  4. 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.

  5. 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 jgufiskotigentSi.

  6. 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)

  7. 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.

  8. aucilebeli gamokvlevebi: • arteriuli wnevis gazomva(cifruli) • wilis garSemoweriloba • 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

  9. 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%

  10. miuxedavad imisa, rom arsebobs garkveuli cnobebi kavSirze metabo-lur sindromsa da restriqcias Soris, restriqciuli paTologiis dafiqsi-rebisas, SemTxveva amovarda kvlevidan.

  11. 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(>135/85mmhg) 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

  12. 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)

  13. 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)

  14. ver inaxa kavSiri: • sasunTqigzebisobstruqciasasqessSoris (6,4%-mamakacebi, 6,9% -qalebi) • sxeulismasisindeqss(BMI)-s Soris • art.wnevas, HDL-qolesterolisdaglukozisdonesSoris. metabolurisindromis 5 komponentidansasunTqigzebisobstruqciasTandakavSirebuliiyomxolod 1-centraluri (abdominaluri) simsuqne. (CI-1,09-1,88)

  15. 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

  16. 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.

  17. 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

  18. gmadlobT yuradRebisTvis

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