miokardiumis struqturul-funqciuri da sisxlis reomorfologiuri cvlilebebi autoimunuri kardiomiopaTiis dros

r. kapanaZe, T. jorbenaZe, n. jorbenaZe

ivane javaxiSvilis saxelobis Tbilisis saxelmwifo universitetis paTologiis kaTedra, saqarTvelo

sadReisod gansakuTrebiT gaxSirda kardiomiopaTiebi da maT fonze ganviTarebuli gulis mwvave da qronikuli ukmarisoba. am dros miokardiumis dazianebis mTavari mizezi organizmSi Secvlilad mimdinare autoimunuri procesebia (M.L. davis, 1975, L.L. Anderson, et al, 1982; R.Eckstein, et al; 1982; Ф.И. Комаров, 1990; r. kapanaZe, l. ninoSvili, 1995).

autoimunuri kardiomiopaTiis CamoyalibebaSi garkveuli roli unda miekuTvnos ,,jvaredina” reagirebis antigenebis arsebobas, erTi mxriv mikrobuli, virusuli, an sxva tipis determinatorebis da meore mxriv, miokardiuli antigenuri determinatorebis arsebobas, romlis winaaRmdegac ,,jvaredinad” reagirebadi antisxeulebi gamomuSavdeba da viTardeba ,,jvaredina” tipis imonopaTologiuri reaqcia. amiT unda aixsnas miokardiumis upiratesi dazianeba. ufro zustad, warmoebs autoantisxeulebis gamomuSaveba sakuTari qsovilebis daSliTi produqtebis mimarT da yalibdeba autoimunizaciis fenomeni, anu autoagresia sakuTari qsovilis winaaRmdeg, zogierT SemTxvevaSi ki miokardiumis winaaRmdeg.

Cvens gamokvlevebSi miznad davisaxeT autoimunuri kardiomiopaTiis miRebul modelze eqsperimentSi Segveswavla gulSi mimdinare morfo-funqciuri cvlilebebi, razec didad aris damokidebuli miokardiumis srulyofili kumSvadunarianoba da zogadi hemodinamika.

rac Seexeba hemoreomorfilogiur cvlilebebs, unda aRiniSnos, rom aucilebloba moiTxovs dadgenili iqnes obieqturi kriteriumebi autoimunuri kardiomiopaTiis mimdinareobis simZimis, prognozis da mkurnalobis efeqturobis Sesafaseblad, risTvisac SerCeuli unda iqnes iseTi sistema, romelSic TvalsaCinod aisaxeba organizmSi mimdinare cvlilebebi. rogorc cnobilia, aseT erT-erT maRalmgrZnobiare sistemas, romelic Tavidanve pasuxobs organizmze momqmed yovelgvar faqtors da masSi mimdinare paTologiur procesebs warmoadgens sisxli.

kardiomiopaTiis dros miokardiumSi paTologiuri procesis zogadi mimdinareobisa da miokardiumis kumSvadi funqciis cvlilebebis farTomasStabiT Seswavla aucilebelia jer erTi, gulis funqciis ukmarisobis materialuri safuZvlebis sworad gagebis da dadgenis mizniT da meore mxriv, mizanmimarTuli samkurnalo RonisZiebebis Casatareblad aRniSnuli daavadebis dros.

vinaidan autoimunuri kardiomiopaTiis dros ar arsebobs detaluri gamokvlevebi, romlebic asaxaven miokardiumis funqciur, struqturul, ultrastruqturul, enzimo-qimiur da hemoreomorfologiur cvlilebebs da am cvlilebaTa reversiis SesaZleblobebs, amitom autoimunuri kardiomiopaTiis miRebul da aprobirebul modelze eqsperimentis pirobebSi miznad davisaxeT Segveswavla: miokardiumis morfo-funqciuri cvlilebebi, am cvlilebebis reversis SesaZleblobebi samkurnalo preparatis gamoyenebis pirobebSi da amave dros dagvezustebina reomorfologiuri cvlilebebis xasiaTi daavadebis mimdinareobisa da mkurnalobis pirobebSi.

Ggamokvlevebi Catarebulia 45 mamal virTagvaze woniT 180-dan 200,0-mde. autoimunur kardiomiopaTias viwvevdiT aprobirebuli da miRebuli meTodiT. janmrTeli virTagvas gulidan vamzadebdiT homogenats, romlis 0,5sm³ vumatebdiT freindis sruli adiuantis 0,5 sm³-s. axlad momzadebuli xsnaris Tanabari raodenoba Segvyavda virTagvis muclis midamoSi. Ppirveladi imunizaciidan erTi Tvis Semdeg, meoradi imunizaciis mizniT virTagvis muclis imave midamoSi kanqveS Segvyavda axlad damzadebuli homogenatis 0,25sm³, romelsac aseTive raodenobiT damatebuli hqonda freindis adiuanti.

Ddakvlis win cxovelebs vuRebdiT eleqtrokardiogramas nemsis eleqrodebiani kardiografiiT. 10 eqsperimentul cxovels meoradi imunizaciis meore Tvis bolos 10 dRis manZilze vutarebdiT mkurnalobas perparat citoqrom “C”-Ti, romlis 1ml. Segvyavda kunTebSi yoveldRe.

Hhemoreomorfologiuri gamokvlevisaTvis cxovelebs sisxls vuRebdiT kudis venidan autoimunuri kardiomiopaTiis meore Tvis bolos, rogorc mkurnalobamde, ise 10 dRiani mkurnalobis Semdeg.

miokardiumis struqturisa da metabolizmis Sesaswavlad gamoyenebuli iqna kvlevis zogadi morfologiuri, histoenzimoqimiuri da eleqtronulmikroskopuli meTodebi, xolo hemoreomorfologiuri cvlilebis dasadgenad maskanirebeli eleqtronuli mikroskopia.

Kkvlevis natifi meTodebis masStaburma gamoyenebam SesaZlebloba mogvca dagvedgina miokardiumis parenqimaSi, stromaSi da sisxlis formian elementebSi struqturuli cvlilebebis arseboba. kardiomiocitebSi sustdeba Jangva-aRdgeniT da hidrolizur procesSi monawile fermentebis aqtivoba; mcirdeba maTSi gliokenisa da ribonuklenoproteidebis raodenoba, ziandeba sarkulema?, mitoqondiriebi, endoplazmuri bade da miofibrilebi. Aamave dros, adgili aqvs kardiomiocititebis nekrobiozs, nekrozs, mioliziss, e.w. uanTebo wvrilkerovani difuzuri kardiosklerozis Camoyalibebas, nawili kardiomiocitebis kompensaciur hipertrofias. periferiul sisxlSi mcirdeba diskocitebis raodenoba, matulobs formaSecvlili da wanazardebiani eriTrocitebis ricxvi, amasTanave xSirdeba pulsi, Cndeba parkuWovani eqstrasistolia, dabldeba T-kbili da voltaJi.

TvalsaCinod gamoxatuli kardiolsklerozis Camoyalibeba Sedegia dazianebuli kunTovan ujredebisa da stromaSi organizaciis procesis, xolo kardiomiocitebis nekrozi, garda mitoqondriebis sruli distruqciisa, aris Sedegi lizosomuri fementebis aqtivaciisa. stromis nekrozis mizezi danekrozebuli kardiomiocitebisagan gamonTavisuflebuli anomaluri cilebia.

amrigad, autoimunuri kardiomiopaTiis struqturul safuZvels kardiomiocitebis pirveladi dazianeba warmoadgens, xolo maTi hipertrofia da stromaSi sklerozi sapasuxo reaqciaa dazianebis mimarT. am cvlilebebis Camoyalibebas uzrunvelyofs jvaredina tipis reaqciis arseboba, kerZod miokardiuli antigenuri determinatebis arseboba, romelTa winaaRmdeg jvaredina reaqciebis ganmaxorcielebeli antisxeulebi gamomuSavdeba, rac Tavis mxriv xels uwyobs jvaredina tipis imunopaTologiuri reaqciis ganviTarebas gulis upiratesi dazianebiT, anu kardiomiopaTiis Camoyalibebas.

autoimunuri kardiomiopaTiis dros sisxlis reomorfologiuri cvlilebebis genezze gavlenas axdens gulis kumSvadi funqciis ukmarisobiT gamowveuli discirkulaciuri hipoqsia, ra Tavis mxriv kidev ufro auaresebs miokardiumis SekumSvis Zalas da ganapirobebs misi ukmarisobis materialuri safuZvlebis Seqmnas. Aaq naTlad Cans mizez-Sedegobrivi kavSirebis urTierTobis sakiTxi, rasac didi prognozuli mniSvneloba aqvs kardiomiopaTiis mimdinareobis, mkurnalobis da gamosavlis swori SefasebisaTvis.

preparat citoqromi “C”-Ti mkurnaloba aumjobesebs ekeqtrokardiografiul monacemebs, aCqarebs sisxlis reomorfologiuri cvlilebebis reversias da awesrigebs miokardiumSi metabolizms. miuxedavad amisa, es preparati ar unda CaiTvalos strategiuli daniSnulebis samkurnalo saSualebad.

Lliteratura

1. Davies M.L. The pathology of the heart blackwell. 1975. p. 211-250

2. Anderson L.L. et al, 1982. Am J. cardiol-1982-vol.#9,? #8-p. 1954-1958

3. Eckstein R, et al, circulation-1982-vol 65; #6-p. 1224-1229

4. Комаров Ф.И. Внутренные болезни. М. Медицина, 1990. ст. 688

5. kapanaZe r., ninoSvili l. saqarTvelos mecnierebaTa akademiis moambe, 151, #1, 1995, 145-147.

Summary

Myocardium structural-functional and blood reomorphology changes in autoimmune cardiomiopathy

R. Kapanadze, T. Jorbenadze, N. Jorbenadze

Iv. Javakhishvili Tbilisi State University, Department of Pathology, Georgia

It is assumed, that in autoimmune cardiopathy in myocardium, activity of ferments, which take part in acid-restoration and hydrolytic processes lowers, quantity of glycogen and ribonucleitics is reduced. Treatment with the help of “C” favors normalization of metabolism in myocardium.