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Tanamedrove medicinis miRwevaTa fonze paTofiziologiis funqciaa maT Sesaxeb Se-
paTofiziologiis mniSvneloba sul ufro xedulebaTa sistemis Camoyalibeba, rac gu-
matulobs. samedicino-biologiur mecniere- lisxmobs paTologiuri procesis da daa-
baTa mzardi diferencirebis gamo grovdeba vadebis dinamikuri paTogenezuri struqtu-
didi da mravalferovani informacia meqaniz- ris modelis Seqmnas. es paTofiziologiis,
mebisa da ganxorcielebis gzebis mixedviT rogorc maintegrirebeli mecnierebis, Ziri-
friad gansxvavebuli fiziologiuri da pa- Tadi amocanaa. avadmyofobis paTogenezuri
Tologiuri procesebis Sesaxeb. es aucile- struqturis dadgenas ki WeSmaritad funda-
bels xdis miRebuli faqtebis sistemati- menturi mniSvneloba aqvs.
zebas, ganzogadebas, maTi kanonzomierebebis paTofiziologia fundamenturi mecniere-
dadgenas, kvlevis axali mimarTulebebis in- baa imitomac, rom naTels xdis paTologiis
tegracias biologiur, samedicino da sxva dros organizmis cxovelmoqmedebis kanon-
sabunebismetyvelo disciplinebTan. aseTi ma- zomierebebs organizmis integraciis sxva-
integrirebeli mecnierebaa paTofiziologia, dasxva doneze: molekuluridan – organiz-
rac gansazRvravs mis adgils samedicino-bi- mulamde.
ologiur mecnierebaTa da samedicino ganaT- paTologiuri cvlilebebis meqanizmebis, e.i.
lebis sistemaSi, mniSvnelobas Teoriuli da paTogenezis garda paTofiziologia Seiswavlis
praqtikuli medicinisTvis. paTologiuri procesebis da daavadebis aRmoce-
paTofiziologiis kvlevis obieqtia pa- nebis, likvidaciis, darRveuli funqciebis kom-
Tologiuri procesi da daavadeba, xolo Zi- pensaciis da aRdgenis, gamojanmrTelebis meqa-
riTadi mizania maTi ganviTarebis Zireuli nizmebs. amrigad, is adgens paTogenezuri profi-
kanonzomierebebis dadgena da amis safu-velze laqtikis da Terapiis principebsa da meTodebs.
paTologiuri procesis da daavadebis profi- paTofiziologiis kursis aTviseba mniS-
laqtikis an misi likvidaciis gzebis SemuSaveba. vnelovania sazogadoebrivi jandacvis fa-
aRniSnuli kanonzomierebebi Seiswavleba kultetis studentebisTvis, radgan discip-
calkeuli paTologiuri procesebis da lina emsaxureba maT mier paTologiuri
avadmyofobebis meqanizmebis kvlevis da mi- procesebis da daavadebebis aRmocenebis, gan-
Rebuli Sedegebis ganzogadebis gziT. viTarebis, gamosavlis meqanizmebis, maTi Zi-
paTofiziologia emsaxureba, agreTve, riTadi kanonzomierebebis Seswavlas, codnis
profesiuli (saeqimo) amocanebis paTofizi- miRebas avadmyofobaTa profilaqtikis, eti-
ologiuri analizis unaris Camoyalibebas, otropuli da paTogenezuri mkurnalobis
klinikuri azrovnebis da eqimis raciona- da Sesaxeb.
luri moqmedebis meTodologiuri da meTo- paTofiziologiis saswavlo kursis
duri Cvevebis formirebas. amocanaa Seaswavlos students daavadebis
"paTofiziologiuri analizis" cneba gu- da paTologiuri procesis arsi, buneba,
lisxmobs pacientis Sesaxeb monacemebis ana- organizmis paTologiuri, dacviTi da sa-
lizs, Sefasebas da, aRniSnulis safuZvelze, kompensacio reaqciebi, urTierTkavSiri da
daavadebis aRmocenebis SesaZlo mizezis da mniSvneloba, etiologiur faqtorTa moqme-
pirobebis, ganviTarebis meqanizmis, profi- debis meqanizmi, tipobrivi paTologiuri
laqtikis da mkurnalobis principebis Sesa- procesebis arsi da paTogenezi, nivTierebaTa
xeb argumentirebuli daskvnis gamotanas. cvlis, calkeuli organoebis da sistemebis
daavadebis paTofiziologiuri analizi funqciis darRvevaTa tipobrivi formebi da
moicavs sxvadasxva struqturul-funqciur amis safuZvelze, moamzados is racionaluri
doneze ganviTarebul mravalferovan pro- mkurnalobis da profilaqtikis principebis
cesTa yvela kanonzomierebasa da meqanizms.
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aTvisebisTvis, Semdgomi samecniero-praqti- ganviTarebis zogad da konkretul meqa-
kuli saqmianobisTvis. nizmebs (magaliTad, sisxlisa da sisxlmbadi
paTofiziologiis Semadgeneli nawilebi organoebis paTofiziologia, saWmlis mom-
paTofiziologiis kursi Sedgeba 3 nawi- nelebeli sistemis paTofiziologia da a.S.).
lisgan: ukanasknel aTwleulebSi paTofiziolo-
1. zogadi paTofiziologia, romelic giis kavSirma klinikasTan axali forma mi-
moicavs or komponents: iRo - warmoiSva kvlevis axali sfero, pa-
a. zogadi nozologia anu zogadi moZ- Tofiziologiis kidev erTi Semadgeneli
Rvreba avadmyofobis Sesaxeb; nawili - klinikuri paTofiziologia. misi
b. tipobrivi paTologiuri procesebi; amocanac daavadebis ganviTarebis meqanizmis
2. calkeuli organoebis da sistemebis Seswavlaa, magram etiologiis da paTo-
funqciaTa moSlis zogadi kanonzomierebebi; genezis aqtualuri sakiTxebi amjerad ukve
3. klinikuri paTofiziologia. klinikis pirobebSi, uSualod adamianTan da-
zogadi nozologia ganixilavs normis da kavSirebiT ganixileba.
paTologiis urTierTdamokidebulebas, avad-
myofobis arss, mis klasifikacias, stadiebs, paTofiziologiis meTodebi
gamosavals, zogad etiologiasa da paTo- paTofiziologia, rogorc mecniereba da
genezs, dazianebis, memkvidreobiTobis da saswavlo disciplina, iyenebs meTodTa Sem-
konstituciis, organizmis reaqciulobisa deg jgufebs: modelireba, eqsperimentuli
da rezistentobis, imunuri statusis kvleva, klinikuri gamokvleva, Teoriuli
mniSvnelobas paTologiaSi da sxv. analizi. is mimarTavs, agreTve, bioqimiur,
zogadi paTofiziologiis meore kompo- biofizikur, morfologiur, statistikur
nentia moZRvreba tipobrivi paTologiuri da sxva meTodebs.
procesebis anu im procesebis Sesaxeb, aRniSnuli gzebiT miRebuli mecnieruli
romlebsac maTi warmoqmnis mizezebis, loka- faqtebi da debulebebi qmnian kerZo da zo-
lizaciisa da cxovelis saxeobis miuxedavad gadi koncefciebis, Teoriebis Camoyalibebis
ganviTarebis erTi da igive zogadi ka- safuZvels, maTi Sedegebi ki gamoiyeneba me-
nonzomierebebi axasiaTebs. aseTebia, magali- dicinisa da biologiis fundamenturi da
Tad, anTeba, cxeleba, nivTierebaTa cvlis gamoyenebiTi problemebis gadasaWrelad.
moSlis da adgilobrivi sisxlis mimoqcevis paTofiziologiis erT-erTi ZiriTadi
darRvevis tipobrivi saxeebi, SimSili da meTodia avadmyofobis an paTologiuri pro-
sxv. tipobrivi paTologiuri procesebi cesis modelireba. modelirebis meTodi medi-
sxvadasxva avadmyofobis komponentebia. am cinaSi Semotanili iqna swored paTofizi-
TvalsazrisiT aRniSnuli procesebi SeiZle- ologTa mier iseTi tipis gamokvlevebis Ca-
ba Sedardes mozaikis calkeul elementebs, tarebis mizniT, romelTa gamoyeneba adami-
romlebisgan sruliad gansxvavebuli sura- anze, gamomdinare organizmis usafrTxoebis
Tebi SeiZleba Seiqmnas. magaliTad, tipob- principidan, SeuZlebelia.
rivi paTologiuri procesebi - "anTeba" an modelirebis meTodi moicavs mode-
"cxeleba" mravali avadmyofobis komponen- lirebas fizikur obieqtebze da formali-
tebi arian. es procesebi stereotipuli, zebul modelirebas. fizikuri anu materi-
standartuli xasiaTisaa. aluri modelireba gulisxmobs avadmyofoba-
paTofiziologiis meore nawili zogad- Ta an paTofiziologiur procesTa analogis
paTologiur aspeqtSi ganixilavs calkeuli or- (an masTan maqsimalurad miaxlovebulis)
ganoebis da sistemebis dazianebas, Seiswavlis ama Seqmnas saeqsperimento cxovelze an xe-
Tu im organosa da sistemis paTologiis lovnur fizikur sistemebze (magaliTad,
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sisxlis moZraobis modelireba fizikur kuri avadmyofobebisa). yovelive es aucile-
hidrodinamikur modelebze). formalizebuli bels xdis kvlevis im klinikuri meTodebis
(aramaterialuri) modelireba moicavs lo- gamoyenebasac, romlebic klinikuri paTofi-
gikur (inteleqtur), maTematikur da kom- ziologiis safuZvelia.
piuterul modelebs. aq ar SeiZleba ar aRvniSnoT, rom eq-
paTofiziologia, iseve, rogorc zogi sperimentatorma cdebi unda Caataros cxo-
sxva samedicino disciplina (magaliTad, velTaTvis maqsimalurad damzogav pirobeb-
normaluri fiziologia, farmakologia), Si, gautkivrebis gamoyenebiT. gareSe mtkiv-
umTavresad eqsperimentuli mecnierebaa. es niS- neuli procedurebis Catareba cxovelebze.
navs, rom paTofiziologiis ZiriTadi meTo- cxovelebisadmi humanuri damokidebuleba eq-
di eqsperimentia. PpaTofiziologiur eqspe- sperimentatorTa upirvelesi da pirdapiri
rimentebs aqvT damaxasiaTebeli Tavisebure- movaleobaa, eqsperimentuli muSaobis ganu-
bebi, specifika. maTi mizania, upirveles yofeli komponenti da uryevi kanonia.
yovlisa, saeqsperimento cxovelis orga- klinikuri gamokvleva. Tanamedrove xel-
nizmSi paTologiuri procesis an avad- sawyoTa da axali teqnologiebis gamoye-
myofobis modelireba paTologiis aRmoce- nebiT SesaZlebeli gaxda, Sesabamisi argu-
nebis, ganviTarebis, mimdinareobis da ga- mentaciis pirobebSi, organizmisTvis uvne-
mosavlis meqanizmebis Seswavlis mizniT. beli mizanmimarTuli gamokvlevebis Catareba
amasTan, eqsperimentatorma unda SearCios TviT adamianze. Ppirvel rigSi es exeba
dasmuli amocanis adekvaturi kvlevis me- gamokvlevis arainvaziur meTodebs.
Todebi. klinikuri dakvirvebisgan gansxva-
vebiT, eqsperimenti iZleva avadmyofobis gan- paTofiziologiis kavSiri sxva
viTarebis meqanizmebis Seswavlis saSualebas samedicino disciplinebTan
mis nebismier stadiaSi: latenturi perio- yoveli normaluri (janmrTeli) orga-
didan - gamosavlamde. nizmi, gamomdinare mxolod biologiuri po-
paTofiziologia aZlevs klinikas avadmyo- ziciidan, SeiZleba SeviswavloT or aspeqt-
fobis diagnostikis, profilaqtikis da mkur- Si: agebulebis, kerZod struqturis, mor-
nalobis axal rekomendaciebs, romlebic Se- fologiis mixedviT da cxovelmoqmedebis
muSavebulia eqsperimentuli kvlevis Sedegebze TvalsazrisiT, funqciur aspeqtSi. jan-
dayrdnobiT. magaliTad, am gziT iqna ga- mrTeli organizmis agebulebas Seiswavlis
movlenili travmuli Sokis da damwvro-bi- normaluri anatomia (makrostruqturas) da
Ti avadmyofobis paTogenezis mravali mxa- histologia (mikrostruqturas). janmrTeli
re; reanimaciis (organizmis gacocxlebis) organizmis cxovelmyofelobis funqciuri
ZiriTadi principebic eqsperimentuli kvle- mxare ki normaluri fiziologiisa da bi-
vis pirobebSi iqna SemuSavebuli. oqimiis prerogativaa. aseve or aspeqtSi
amasTanave, unda aRvniSnoT, rom avad- ganixilaven daavadebul organizmsac. mis
myofobis yvelaze srulyofili modelic ki rogorc makro-, ise mikrostruqturas Seis-
ar aris im sneulebis zusti asli, romelic wavlis paTologiuri anatomia, xolo Sesa-
viTardeba adamianis organizmSi. aqedan ga- bamisi funqciuri mxaris Seswavla paTofi-
momdinare, eqsperimentuli monacemebis kli- ziologiis kompetenciaa.
nikaSi gadatana saWiroa erTgvari sifr- amrigad, rogorc paTanatomias aqvs Ta-
TxiliT, aucilebeli winaswari klinikuri visi safuZveli normaluri anatomiis da
aprobirebis Semdeg. aRsaniSnavia isic, rom histologiis saxiT (am disciplinebis erT-
adamianis zogierTi avadmyofobis gamowveva gvari gagrZelebaa), ise paTofiziologiac,
cxovelebSi ar xerxdeba (magaliTad, fsiqi- romelic eyrdnoba normaluri fiziologiis
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da bioqimiis monacemebs, garkveulwilad am sebis da avadmyofobebis mamoZravebel Za-
mecnierebaTa gagrZeleba da ganviTarebaa. lebs, maT urTierTqmedebas.
paTofiziologia aseve mWidrodaa da- paTofiziologiis wanamZRvrebi mravali
kavSirebuli paTanatomiasTan. qsovilTa saukunis win Camoyalibda. 1542 wlis beW-
struqturisa da funqciis erTianobis prin- dviT samedicino gamocemaSi saxelwodebiT
cipidan gamomdinare, avadmyofobis paTomor- "medicinis bunebrivi nawilebis Sesaxeb"
fologiuri substratis Seswavlis gareSe ("De natural parte medicinae") J.fernels
SeuZlebelia paTologiuri procesis zoga- Semoaqvs termini paTologia daavadebuli
di modelis Seqmna. paTanatomiis Seswavlis organizmis cxovelmoqmedebis, anu imis aR-
obieqtia paTologiuri procesis dros uj- saniSnavad, rac medicinis im nawilis kvle-
redsa da qsovilSi ganviTarebuli morfo- vis sagania, romelsac dRes paTofizio-
logiuri cvlilebebi, xolo paTofiziolo- logia ewodeba.
giis Seswavlis obieqti procesis paTogene- albaT, pirveli saxelmZRvanelo, romlis
zuri struqturaa. saTaurSi figurirebs termini "paTologi-
paTofiziologia paTanatomiasTan erTad uri fiziologia", unda iyos erfurtis uni-
erTgvari SemaerTebeli xidia Teori-ul da versitetis profesoris a.hakeris ,,paTolo-
klinikur medicinas Soris. giuri fiziologiis sakiTxebi~ (,,undriss der
paTofiziologia zedmiwevniT mWidro Physiologia pathologica", 1791). am sferoSi
kavSirSia klinikasTan (ix. zemoT). klinika Semdegi mniSvnelovani gamocema `zogadi
paTofiziologiis winaSe gasarkvev sakiTxe- paTologia da paTologiuri fiziologia~
bs wamoWris da moiTxovs misgan pasuxs ("Pathologia generale et physiologic
problemebis eqsperimentuli Seswavlis sa- pathologique") ganxorcielda 1819 wels
fuZvelze. klinika iyenebs paTofiziologiis l.gaios (l. Galliot) mier.
mier miRebul eqsperimentuli gamokvlevis paTologiis Sesaswavlad eqsperimentuli
Sedegebs maTi klinikuri aprobirebis da meTodebis sul ufro farTo gamoyenebam,
praqtikuli gamoyenebisTvis. eqsperimentebis gziT miRebuli faqtiuri
masalis dagrovebam, paTologiis funqciuri
paTofiziologiis mokle istoria aspeqtebiT gansakuTrebulma dainteresebam
paTofiziologiam Camoyalibebis da gan- ukve XIX saukuneSi aucilebeli gaxada
viTarebis sakmaod xangrZlivi da rTuli zogadi paTologiis gancalkeveba morfolo-
gza ganvlo, romlis yvela etapze mWidro giisgan (paTanatomiisgan) da eqsperimentuli
kavSirSi iyo samedicino mecnierebasa da paTologiis kaTedrebis Camoyalibeba. Eeqspe-
praqtikasTan. rimentis mniSvneloba paTologiis prob-
droTa ganmavlobaSi icvleboda paTofi- lemaTa kvlevaSi mkveTrad aamaRla frangi
ziologiis saxelwodeba da adgili eqimTa mecnieris klod bernaris (1813-1878) Sro-
momzadebis sistemaSi. sxvadasxva dros da mebma. man daaarsa zogadi eqsperimentuli
sxvadasxva qveyanaSi mas uwodebdnen "eqs- fiziologiis pirveli kaTedra. k.bernarma
perimentul paTologias, "eqsperimentul udidesi roli Seasrula normaluri da pa-
medicinas, "daavadebuli organizmis fi- Tologiuri fiziologiis Camoyalibeba-gan-
ziologias, "paTologiur fiziologias", viTarebaSi. am saqmeSi friad didi wvlili
"zogad paTologias. ukanaskneli saxelwo- Seitanes, agreTve, j.konheimma da j.samuelma -
deba, romelic Cvens droSi kvlav farTod zogadi paTologiis saxelmZRvaneloebis av-
gavrcelda, marTebulia, radgan paTofizio- torebma.
logia Seiswavlis paTologiis mTavar fun- 1852 wels, moskovis universitetis
qciur Taviseburebebs, paTologiuri proce- profesorma a.poluninma gamoaqveyna `Sesava-
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li paTologiaSi~, romelSic gamoiyena ter- debulebebs, romelTa safuZvelia calkeul,
mini "paTologiuri fiziologia", xolo 1878 konkretul avadmyofobaTa aRmocenebis, gan-
wels profesorma v.paSutinma gamosca viTarebis da gamosavlis kanonzomierebebis
`"leqciebi zogad paTologiaSi (paTologiur dadgena. nozologiur erTeuls, nozologi-
fiziologiaSi)". ur formas ki uwodeben calkeul avad-
termini "paTologiuri fiziologia" myofobas.
sakmaod didi xnis ganmavlobaSi gamoiyene-
boda, magram mas seriozuli xarvezi hqonda 1. zogadi swavleba daavadebis Sesaxeb
- Tavisi arsiT fiziologia ar SeiZleba zogadi nozologia Seiswavlis paTolo-
iyos paTologiuri. amitom mas sul ufro giis cnebebs (daavadeba, janmrTeloba, dazia-
xSirad uwodeben "paTofiziologias". Ees neba, paTologiuri procesi da sxv.), zogad
termini " sabolood dakanonda 1991 wels debulebebs daavadebis arsis Sesaxeb, adgens
paTofiziologTa saerTaSoriso kongresze. Teoriuli medicinis debulebebs, avadmyo-
am samecniero forumma, romlis muSaobaSi fobaTa nomenklaturasa da klasifikacias.
mravali qveynis sxvadasxva specialobis
swavluli medikosi monawileobda, paTofi- 1.1. janmrTeloba da avadmyofoba
ziologia aRiara fundamentur, maintegri- swavleba daavadebis arsis Sesaxeb medi-
rebel samedicino mecnierebad da saswavlo cinis erT-erTi uZvelesi problemaa.
disciplinad. jer kidev aristotele miiCnevda, rom
qarTuli paTofiziologiuri skolis Camoya- janmrTeloba da daavadeba Tvisobrivad gan-
libeba, romelic damsaxurebuli saerTaSo- sxvavebuli kategoriebia. miuxedavad dResac
riso avtoritetiT sargeblobs, dakavSire- arsebuli zogierTi mosazrebisa imis Se-
bulia saqarTvelos mecnierebaTa akademiis saxeb, rom avadmyofoba normis ukiduresi
sapatio wevris v.voroninis saxelTan. v.vo- xarisxia, unda iTqvas, rom daavadeba jan-
ronini Tbilisis universitetis mowveviT mrTelobisgan gansxvavebuli mdgomareobaa,
1922 wels saTaveSi Caudga 1919 wels romelsac axali Tvisobrivi Taviseburebebi
daarsebul zogadi paTologiis kaTedras, axasiaTebs.
romelsac 1924 wels, arsis Seucvlelad, daavadebis cnebis gansazRvris mravalma
paTologiuri fiziologiis kaTedra ewoda. mcdelobam dRemde ver uzrunvelyo misi
v.voronini 1960 wlamde uZRveboda mecnie- sayovelTaod aRiarebuli variantis SemuSa-
rebis am dargis dafuZnebas da ganviTarebas veba, rac pirobadebulia rogorc TviT
saqarTveloSi. problemis sirTuliT, misi mravalmxrivo-
paTofiziologiis swavlebas saqarTve- biT, ise gansxvavebuli midgomiT janmrTe-
loSi didi amagi dasdes profesorebma i.za- lobisa da daavadebis arsis Sefasebisadmi.
aliSvilma, T.naTaZem, a.gelaSvilma. sazogadod zogierT enaze daavadebis aRmniSvnel
paTofiziologiis, rogorc mecnierebis gan- termins safuZvlad udevs misi romelime
viTarebaSi, maTTan erTad mniSvnelovani simptomis saxelwodeba (magaliTad, rusul
roli Seasrules g.mWedliSvilma, i.gedeva- enaze daavadebis aRmniSvneli terminis -
niSvilma. T.begiaSvilma, r.amirejibma, k.cinca- "болезнь" fuZea tkivili - "боль"). magram
Zem, g.dumbaZem, g.vasaZem, l.WeiSvilma da sxvebma. gasaTvaliswinebelia, rom tkivilis gareSe
nawili I mimdinareobs da progresirebs mravali, zog-
zogadi nozologia jer metad mZime avadmyofoba (magaliTad,
zogadi nozologia (berZn. nosos - parenqimuli organoebis anTebiTi an sim-
avadmyofoba, logos - moZRvreba) ganixi- sivnuri dazianeba). meore mxriv ki, tkivili
lavs daavadebis Sesaxeb zogadi swavlebis jer kidev ar niSnavs avadmyofobis arse-
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bobas, is yovelTvis ar aris avadmyofobis "janmrTelobis" cnebis gansazRvras ar-
signali. Tulebs Sesatyvisi zusti kriteriumebis
daavadebis arsis moqmed gansazRvrebaTa ararsebobac. organizmze uamravi sxvadasxva
umravlesoba iTvaliswinebs mosazrebas, rom faqtoris zemoqmedebisas erTi an ramdenime
is normidan, janmrTeli mdgomareobidan maCvenebeli yovelTvis SeiZleba gadaixaros
gadaxraa. magram aseTi midgoma badebs fiziologiuri normidan, magram es jer
kiTxvas imis Sesaxeb, Tu ra aris norma, kidev ar niSnavs avadmyofobis arsebobas, Tu
janmrTeloba. sxvanairad rom vTqvaT, msgav- SenarCunebulia organizmis garemosTan Segu-
si formulireba qmnis axal siZneles - ebis (adaptaciis) unari.
janmrTelobis da normis ganmartebis auci- v.voronini iTvaliswinebda "janmrTelo-
leblobas. bis" da "daavadebis" cnebaTa ganmartebis
unda aRiniSnos, rom TviT “"normis" an sirTules da miaCnda, rom SeuZlebelia da-
“janmrTelobis"” cneba garkveulwilad gan- avadebis mokled ganmarteba, Tumca mcde-
sxvavdeba erTmaneTisgan. norma ufro zogadi loba am mimarTulebiT kvlav grZeldeba.
cnebaa, romelic gamoxatavs cocxali orga- magaliTad, janmrTelobis dacvis msof-
nizmis, rogorc mTlianis, mdgomareobas. Se- lio organizaciam ase gansazRvra "janmrTe-
iZleba adamiani janmrTeli iyos organizmis loba": janmrTeloba fizikuri, fsiqikuri da
funqciis da agebulebis ZiriTadi maCveneb- socialuri keTildeReobaa da ara
lebis TvalsazrisiT, magram calkeuli niS- avadmyofobis ararseboba”. aseTi midgoma,
nebiT (magaliTad, sxeulis simaRle) gan- cxadia, metismetad zogadia. janmrTeloba
sxvavdebodes normisgan. ase, rom terminebi ufro konkretuladac SeiZleba ganvsazR-
"norma" da "janmrTeloba" arc Tu sruliad vroT “janmrTelobaa wonasworoba organiz-
identuria. Tu am cnebebs mainc erTgva- ms da garemos Soris, organizmis mareguli-
rovnad CavTvliT, ganxilvadi sakiTxis sir- rebeli sistemebis unari, uzrunvelyon ga-
Tule, upirveles yovlisa, imiT iCens Tavs, remosadmi Segueba, homeostazis (homeoki-ne-
rom cvalebadia TviT norma, Tumca am cva- zis) SenarCuneba da adamianis met-naklebad
lebadobaSi SeimCneva garkveuli kanonzomi- srulyofili SromiTi saqmianoba”.
erebebic. amasTanave, unda gaviTvaliswinoT, rom
norma, iseve rogorc janmrTeloba, ar nebismieri daavadebis aRmocenebis da ganvi-
aris absoluturi da ucvleli rogorc TarebisTvis ZiriTadi procesia daavadebuli
cxovelis saxeobisTvis, ise yoveli calke- organizmis struqturis da funqciis de-
uli populaciis da individisTvis. norma zorganizeba, dazianeba an genetikuri de-
icvleba saxeobis an populaciis cvaleba- feqti. yvela reaqciuli, dacviTi, sakom-
dobasTan erTad. is sxvadasxvaa sxvadasxva pensacio, SeguebiTi procesi meoradia da
individisTvis, sxvadasxva asakisTvis da viTardeba ama Tu im faqtoris moqmedebis
sqesisTvis. dadgenilia agebulebis, qimiuri Sedegad. aqve unda iTqvas, rom SeguebiTi da
Semadgenlobis, nivTierebaTa da energiis sakompensacio procesebi daavadebis dros
cvlis, organoebis da sistemebis fun- xSirad TviT xdeba mavne da mZime gavlenas
qciobis mravali individuri sxvaoba ro- axdens mis mimdinareobaze. rac Seexeba TviT
gorc janmrTel, ise daavadebul adamianebsa daavadebis cnebas, arsebuli ganmartebebidan
da cxovelebSi. upiratesobas aniWeben im variants, romelic
v.voroninis azriT, "adamianis organizmis adgens absoluturad yvela avadmyofobis-
agebulebisa da funqciis norma ar aris Tvis damaxasiaTebel saerTo niSnebs. romeli
mkvdari nimuSi zoma-wonis sistemaSi arse- niSnebia aseTi?
buli metrisa da santimetris msgavsad".
7
nebismier daavadebas aqvs gansaz- vrisas ar SeiZleba misi erT-erTi Tvisebis
Rvruli garegani an Sinagani mizezi (magali- - Sromis unaris daqveiTebis ugulvebelyofa.
Tad, genetikuri defeqti). aqedan gamomdinare, SeiZleba Camovaya-
daavadeba sistemuri reaqciaa etio-lo- liboT daavadebis aseTi zogadi gansazRvra:
giuri faqtoris zemoqmedebaze. mis intensivo- daavadeba aris organizmis rTuli reaqcia dazianebaze,
bas da xasiaTs gansazRvravs etiologiuri Tvisobrivad axali, magram fiziologiuri safuZvlis
faqtoris buneba, siZliere, moqmedebis xang- mqone mdgomareoba, romlis dros irRveva organizmis
rZlivoba da organizmis reaqciuloba. daa- normaluri cxovelmyofeloba da struqtura, ho-
vadeba Tvisobrivad axali movlenaa, rome- meostazi, Sromis unari, garemosTan misi wonasworoba,
lic eyrdnoba im fiziologiur procesebs, mimdinareobs brZola sakuTriv paTologiur da sa-
romlebic mimdinareobs janmrTel organiz- kompensacio meqanizmebs Soris.
mSi. aq kidev erTxel unda aRiniSnos, rom
amrigad, gansxvavdeba ra Tvisobrivad mravali daavadebis safuZveli ara uSualod
janmrTelobisgan, daavadeba amave dros sa- dazianeba, aramed genetikuri defeqtia.
sicocxlo procesis gansakuTrebuli saxea,
romelsac safuZvlad fiziologiuri movle- 1.2. daavadebaTa klasifikacia da nomenklatura
nebi udevs. nozologiis erT-erTi umTavresi amoca-
janmrTelobas axasiaTebs organizmis naa daavadebaTa klasificireba Teoriulad
gawonasworebuli urTierToba garemosTan, dasabuTebuli da praqtikuli medicinis
daavadebis dros ki wonasworoba irRveva. es ar moTxovnaTa Sesatyvisi principebiT, krite-
niSnavs, rom daavadebisas mTlianad amowu- riumebiT da maTi nomenklaturis – avad-
rulia Seguebis unari, organizmis sa-kom- myofobis nozologiuri formebis nusxis
pensacio SesaZleblobani. piriqiT, daava-de- Sedgena.
bis fonze arcTu iSviaTad reliefurad unda iTqvas, rom daavadebaTa dReisTvis
iCens Tavs sakompensacio procesebi, rogorc SemuSavebuli nomenklatura mTlianad dax-
normaluri maregulirebeli meqanizmebis vewili da dasrulebuli ar aris.
gamZafrebuli gamovlineba. TiToeuli daava- daavadebis klasifikacia aris avadmyo-
deba ori urTierTsawinaaRmdego sawyisis – wmin- fobisa da paTologiuri mdgomareobis gar-
da paTologiuri procesis da sakompensacio pro- kveuli sistemiT klasebad, jgufebad da a.S.
cesebis kavSiria. is aerTianebs xsenebul or diferencireba. arsebobs sxvadasxva midgoma
Zalas, romlebic mudmiv brZolaSi arian aseTi ganawilebis kriteriumebis SerCevi-
urTierTTan. es brZola gansazRvravs daa- sadmi. magaliTisTvis movitanT dRes daava-
vadebis mimdinareobas, mis garkveul mimar- debaTa klasifikaciis yvelaze ufro gavrce-
Tulebas, ganviTarebas. lebul nusxas.
daavadebis safuZvlad udevs qsovilebis 1. etiologiis (gamomwvevi mizezis)
funqciisa da struqturis sxvadasxva xarisxis mixedviT: infeqciuri daavadebebi, travmebi,
cvlileba, rac, Sesabamisad, sxvadasxva xa- mowamvlebi, radiaciuli dazianebebi da a.S.
risxiT gamovlindeba. 2. lokalizaciis da funqciuri darRvevebis
gasaTvaliswinebelia, rom daavadebisas (anatomiur - funqciuri niSnis) mixedviT:
ama Tu im xarisxiT irRveva organizmis Sinagani sisxlis mimoqcevis, sunTqvis, saWmlis mone-
garemos mudmivoba - homeostazi. lebis da sxva sistemebis, kanis daavadebebi.
adamianis daavadebaze msjelobisas ar 3. asakis da sqesis mixedviT (qalis, bav-
unda dagvaviwydes, rom is ara marto bio- SvTa, moxucTa daavadebebi).
logiuri, aramed socialuri xasiaTis kate- 4. mimdinareobis mixedviT: mwvave, qvem-
goriacaa. amitom avadmyofobis gansazR- wvave, qronikuli daavadebebi.
8
5. ganviTarebis meqanizmis (paTogenezis) logiuri procesebi ewodeba (magaliTad, anTe-
mixedviT: alergiuli daavadebebi, ganviTare- ba, SeSupeba, cxeleba).
bis mankebi, simsivneebi da a.S. tipobriv paTologiur procesebs axasiaTebs
ganasxvaveben agreTve qirurgiul, Sinagan polietiologiuroba - is SeiZleba
sneulebebs, orsulobis garTulebebs, gine- gamowveuli iyos sxvadasxva etiologiuri
kologiur avadmyofobebs da a.S. faqtoriT, monopaTogenuroba - aqvT ste-
daavadebaTa klasifikaciis mravali prin- reotipuli, standartuli ganviTarebis meqa-
cipuli da kerZo sakiTxi jer kidev ar nizmi, kompleqsuroba - maT meqanizmSi mona-
aris jerovnad damuSavebuli. gavrcele- wileobs paTologiuri, dacviTi da sakom-
bulia janmrTelobis dacvis msoflio or- pensacio meqanizmebi, paTogenuri da adapta-
ganizaciis mier SemuSavebuli klasifikacia, ciuri procesebis rTuli da dinamikuri
romelic mudmivad ganaxlebas ganicdis. kombinacia.
nozologiis sferoa, agreTve, daavadebis, paTologiuri procesi avadmyofobis sa-
gamojanmrTelebis, samedicino SromiTi eqs- fuZvelia, magram is TavisTavad avadmyofoba
pertizis, sasamarTlo-samedicino eqsperti- ar aris. paTologiur process avadmyofobisgan
zis principebis da kriteriumebis SemuSaveba ganasxvavebs is, rom :
da dazusteba. a) avadmyofobas upiratesad erTi mTa-
vari mizezi aqvs, paTologiuri procesi ki
1.3. paTologiuri reaqcia, polietiologiuria - is SeiZleba mravalma
paTologiuri procesi da paTologiuri sxvadasxva mizezma gamoiwvios (magaliTad,
mdgomareoba anTeba).
paTologiuri reaqcia aris organizmis b) erTi da igive paTologiuri procesi,
xanmokle, gansakuTrebuli, xSirad raode- mis lokalizaciasTan dakavSirebiT, avadmyo-
nobrivad araadekvaturi, Warbi pasuxi gaRi- fobis sxvadasxva suraTs an sxvadasxva
zianebaze (magaliTad, nerwyvis uxvi gamo- avadmyofobas iZleva.
yofa piris Rrus gamRizianebeli Zlier g) avadmyofoba upiratesad ramdenime
cxare an mlaSe sakvebis miRebisas). gaRi- urTierTdakavSirebuli paTologiuri pro-
zianebis moxsnis Semdeg reaqciac wydeba. cesis erTobliobaa.
xSirad organizmis ZiriTadi fiziolo- d) paTologiuri procesi SeiZleba ar
giuri funqciebis SenarCunebis fonze irRve- aqveiTebdes Sromis unars.
va misi ama Tu im nawilis struqtura da paTologiuri procesi xSirad progresi-
funqcia, e.i. viTardeba ara generalizebuli, rebs da gadadis paTologiur mdgomareobaSi.
aramed lokaluri xasiaTis cvlileba. aseT gansxvaveba paTologiur processa da
SemTxvevaSi saqme gvaqvs ara avadmyofo- paTologiur mdgomareobas Soris mdgomare-
basTan, aramed paTologiur procesTan. obs, upirveles yovlisa, imaSi, rom paTo-
paTologiuri procesi dazianebul qso- logiuri procesis dros Warbobs funqci-
vilSi, organoSi an organizmSi ganviTare- uri, xolo paTologiuri mdgomareobis
buli paTologiuri, dacviTi da sakompensa- dros - struqturuli cvlilebebi. garda
cio reaqciebis erTobliobaa, romelic amisa, paTologiuri procesi ufro swrafad
vlindeba morfologiuri, metaboluri da mimdinareobs, igi dinamikuri, cvalebadia.
funqciuri cvlilebebis saxiT. paTologiur mdgomareobas SedarebiT ufro
paTologiuri procesebi da paTologi- neli, dune mimdinareoba axasiaTebs.
uri reaqciebi xSirad vlindeba mudmivi kom- Tavis mxriv, paTologiuri mdgomareoba
binaciebis saxiT, romlebic Camoyalibebulia SeiZleba gaxdes paTologiuri procesis sa-
evoluciis procesSi. maT tipobrivi paTo- fuZveli. magaliTad, gulis Siga garsis
9
anTeba (endokarditi) paTologiuri pro- grZlivoba sxvadasxvagvaria: zogjer is me-
cesia, romelic xSirad mTavrdeba paTo- tad xanmoklea (magaliTad, zogierTi SxamiT
logiuri mdgomareobis - gulis kompensi- mowamvlisas), zogjer ki - metad xang-
rebuli mankis CamoyalibebiT. es manki ki rZlivi (magaliTad, wlebi keTris SemTx-
SesaZlebelia gadavides dekompensaciis faza- vevaSi). latentur periodSi mobilizdeba
Si, e.i. paTologiuri mdgomareoba, Tavis organizmis dacviTi Zalebi, romlebic mi-
mxriv, SeiZleba paTologiur procesSi gada- marTulia darRveuli funqciis kompensa-
izardos. ciis, avadmyofobis gamomwvevi agentis mos-
pobis da organizmidan misi gamoZevebisken.
1.4. daavadebis stadiebi xSirad aseTi reaqciebi uzrunvelyofen
nebismier avadmyofobas misTvis speci- avadmyofobis Sewyvetas, gamojanmrTelebas,
fikuri, Taviseburi mimdinareoba axasiaTebs. anu monawileoben sanogenezur meqanizmebSi.
magram, amasTan erTad, yovel avadmyofobas prodromuli periodi grZeldeba avadmyo-
aqvs zogadad daavadebisTvis damaxasiaTebeli fobis pirveli klinikuri niSnebis gamom-
periodebic. aqedan gamomdinare, SeiZleba vi- JRavnebidan misi klinikuri suraTis srul
laparakoT daavadebis periodebze (stadiebze), gaSlamde. am periods xSirad axasiaTebs
rogorc rTul dinamikur procesze. araspecifikuri niSnebi, rogorebicaa saerTo
miuxedavad imisa, rom daavadebis wina sisuste, sxeulis temperaturis momateba,
stadiis - daavadebis wina periodis Sesaxeb Tavis tkivili da a.S.
kamaTi didi xania mimdinareobs (1952 wels zogierT SemTxvevaSi amave stadiaSi
andreevma mas "daavadebis dasawyisi", xolo vlindeba avadmyofobis specifikuri niSne-
1969 wels pavlenkom "daavadebis wina bic, romlebic mxolod am avadmyofobas axa-
mdgomareoba" uwoda), am periodis ganmar- siaTebs (magaliTad, filatov-koplikis la-
teba dRevandlamde Camouyalibebelia, kama- qebi wiTelas dros).
Tis sagania am periodis arsebobac ki. prodromuli periodis dawyeba miuTi-
daavadebis wina periodad unda miviCnioT Tebs imaze, rom sakompensacio da dacviT me-
iseTi mdgomareoba, rodesac sanogenezuri qanizmebs aRar ZaluZT Seakavon avadmyofo-
(laT. sanitas - janmrTeloba, genesis – gan- bis ganviTareba.
viTareba) anu dacviT-SeguebiTi meqanizmebi, davadebis klinikuri suraTis sruli gaSlis
mimarTuli darRveuli funqciis aRdgenis- (gaRvivebis) periodSi avadmyofoba srulad
ken, gaZlierebuli an Sesustebulia (magali- vlindeba, aRiniSneba damaxasiaTebeli sim-
Tad, adre gadatanili mZime avadmyofobis ptomTkompleqsi. am periodSi gansakuTrebiT
Semdeg, araxelsayreli garemo pirobebis ze- mkafiod mJRavndeba dacviT-sakompensacio re-
moqmedebisas da a.S.). aqciebis da TviT "paTologiuri" procese-
daavadebis wina periodi SeiZleba ganvi- bis, e.i. paTogenezuri meqanizmebis mkafiod
xiloT, rogorc araspecifikuri foni, romelzec gamoxatuli dialeqtikuri erTianoba da
paTogenur agents avadmyofobis gamowveva ufro winaaRmdegobrioba.
advilad ZaluZs, vidre sxva situaciaSi. daavadebis gamosavali
daavadebas yofen oTx periodad. laten- daavadebis gamosavali SeiZleba iyos sruli
turi periodi organizmze etiologiuri an arasruli gamojanmrTeleba, qronikul
faqtoris zemoqmedebidan avadmyofobis pir- formaSi gadasvla, sikvdili.
veli klinikuri niSnebis gamovlinebamde ga- gamojanmrTeleba darRveuli sasicocxlo
suli droa. infeqciuri avadmyofobebis Sem- funqciebis aRdgenis procesia.
TxvevaSi am stadias Seesabameba e.w. inku- ganasxvaveben srul da arasrul gamo-
baciuri periodi. latenturi periodis xan- janmrTelebas. sruli gamojanmrTeleba gu-
10
lisxmobs gadatanili avadmyofobis yvela aRigzneba, rasac CasunTqviTi moZraoba moy-
niSnis likvidacias. am dros organizmi sru- veba.
lad ubrundeba sawyis, janmrTel mdgomare- agonia (berZn. agon - brZola) sikvdilis
obas. amasTan dakavSirebiT, srul gamojan- winamorbedi mdgomareobaa, romelsac axasia-
mrTelebas "restitutio ad integrum" ("srulad Tebs organizmis cxovelmyofelobis ukanas-
aRdgena", "sruli, mTliani aRdgena") uwo- kneli afeTqeba. Rerovani warmonaqmnebis
debdnen. Tumca unda aRvniSnoT, rom gadata- uecari gaaqtiureba iwvevs arteriuli wne-
nili avadmyofoba yovelTvis ukvalod rodi vis ramdenadme momatebas, gulis muSaobis
qreba. e.w. "sruli" gamojanmrTelebisas xSi- da sunTqvis gaZlierebas. aseTi "afeTqeba"
rad rCeba cvlilebebi sxvadasxva sistemis sakmaod xanmoklea da mTavrdeba yvela sasi-
mxriv da iqmneba organizmis Tvisobrivad cocxlo funqciis daTrgunviT, e.i. klini-
axali mdgomareoba (magaliTad, yalibdeba kuri sikvdiliT.
imuniteti). klinikuri sikvdili iwyeba maSin, rodesac
sikvdili. cocxali bunebis evoluciis wydeba sunTqva da gulis muSaoba. nivTi-
procesSi Camoyalibda dacviT-sakompensacio erebaTa cvla minimalur doneze, magram ma-
reaqciebi, romlebic saSualebas aZlevs or- inc mimdinareobs, qsovilebi, maT Soris Ta-
ganizms ibrZolos sicocxlis SenarCune- vis tvinis qerqisa, jer kidev cocxalia da
bisTvis. magram Tu damazianebeli faq- am periodSi SesaZlebelia sicocxlis aR-
toris moqmedebis Zala Warbobs am tipis dgenac.
reaqciebis SesaZleblobebs, dgeba sikvdili. rogorc aRvniSneT, sikvdili ar aris
sikvdils, iseve, rogorc nebismier paTo- uecari naxtomi erTi mdgomareobidan meore-
logiur process, axasiaTebs dinamikuroba Si. is TandaTanobiT, Tanmimdevrulad ganvi-
da stadiuroba, aqvs droiTi kinetika. Tarebadi procesia. meore mxriv, gulis mu-
ganasxvaveben sikvdilis ramdenime peri- Saobis da sunTqvis Sewyvetis, e.i. klini-
ods, stadias, rac saSualebas gvaZlevs vi- kuri sikvdilis dadgomis Semdeg organizmis
laparakoT sikvdilze, rogorc Tanmimdev- calkeuli sistemebi da maTi nawilebi (maga-
rulad ganviTarebad procesze, romlis saw- liTad, nervuli sistemisa) kvdeba araerT-
yisi periodi e.w. terminaluri mdgomareobaa. droulad.
am periodSi, Cveulebriv, aRiniSneba qo- organoebis kvdomis Tanmimdevroba damo-
Sini, arteriuli wnevis daqveiTeba (zogjer kidebulia imaze, Tu rogori mgrZnobeloba
xanmokle momatebis Semdeg), taqikardia, aqvs maT Jangbadis naklebobis, anu hipoqsiis
cnobiereba dabindulia. Semdeg viTardeba mimarT. am mxriv yvelaze mgrZnobiarea fi-
bradikardia da bradipnoe. mogrZo tvinis logenezurad ufro axalgazrda warmonaq-
zemoT mdebare yvela maregulirebeli cen- mnebi. amitom, upirveles yovlisa, iTrguneba
tris gaTiSvisas sunTqva xanmokled Cerdeba sisxlis modinebis Sewyvetisadmi yvelaze
(ramdenime wamidan 3-4 wuTamde). am e.w. pre- ufro mgrZnobiare struqturis - Tavis tvi-
terminalur pauzas ukavSireben cdomili ner- nis qerqis moqmedeba, radganac is didxans
vis tonusis droebiT momatebas. pauzis Sem- ver uZlebs Jangbadovan "SimSils". Mmaqsima-
deg momakvdavi ramdenimejer Rrmad Caisun- luri dro, romlis ganmavlobaSi SesaZle-
Tqavs farTod gaRebuli piriT. igi TiTqos belia gulis gaCerebisas ganviTarebuli
eZebs da "ylapavs" haers. am moZraobaTa mi- cirkulaciuri hipoqsiis pirobebSi Tavis
zezia Rrma hipoqsia da hiperkapnia. nax- tvinis qerqis funqciis aRdgena, 5-6 wuTia.
SirorJangis siWarbe aqrobs vagusis dam- amis Semdeg qerqis ujredebi nekrozdeba,
muxruWebel refleqss, sunTqvis centris dgeba biologiuri sikvdili da reanimacia
jer kidev sicocxlisunariani ujredebi SeuZlebeli xdeba. nekrozis mizezi am
11
SemTxvevaSi ujreduli sunTqvis darRveva rigo SekumSviT, ris gamo guli veRar as-
da masTan dakavSirebuli energetikuli de- rulebs tumbos rols.
ficitia. asistolia SeiZleba ganviTardes uecrad
sisxlis mimoqcevis Sewyvetisas energe- (refleqsurad) da TandaTanobiT. uecari
tikuli cvlis ZiriTadi substrati – glu- asistolia SeiZleba gamowveuli iyos mio-
koza Tavis tvinis qsovilebidan qreba 1 kardiumis zogadi hipoqsiiT (koronaruli
wuTSi, glikogenis ZiriTadi maragi ki sisxlZarRvebis totaluri spazmi, maTi
amoiwureba 5 wuTis ganmavlobaSi. drois masiuri Trombozi), cdomili nervis mkveTri
daaxloebiT igive monakveTSi (1 wuTSi) refleqsuri gaRizianebiT (Cveulebriv, hi-
qreba fosfokreatinic, 3-5 wuTis Semdeg ki poqsiis da hiperkapniis fonze), gulis gam-
ileva tvinis ujredebis kidev erTi tari sistemis funqciis uxeSi da uecari
energetikuli wyaro - atf. JangviTi meta- darRveviT (magaliTad, uecari atrioventri-
bolizmis daTrgunvas Tan sdevs anaerobuli kuluri blokadiT).
glikolizis gaZliereba, rac, Tavis mxriv, rac Seexeba fibrilacias, rogorc gu-
iwvevs nivTierebaTa cvlis Sualeduri pro- lis muSaobis Sewyvetis meore gzas, is
duqtebis, kerZod, rZemJavas dagrovebas, ris uecari sikvdilis ZiriTadi mizezia mio-
gamo Tavis tvinis qsovilebSi Rrma acidozi kardiumis infarqtis, eleqtrotramvis, mox-
viTardeba. rCobis, mZime endokrinuli darRvevebis,
anaerobuli glikolizi filogenezurad Zlieri nervuli Seryevis dros (gulis par-
ufro Zveli, magram bevrad ufro nakleb kuWebis fibrilaciis aRmocenebis meqanizme-
produqciulia, vidre JangviTi. Eenergeti- bis Sesaxeb saubari gveqneba gulis paTofi-
kuli metabolizmis darRvevasTan erTad ziologiis ganxilvis dros).
mimdinareobs praqtikulad yvela saxis niv-
TierebaTa cvlis mkveTri darRveva – moiS- 2. zogadi etiologia
leba aminmJavebis, fosfolipidebis cvla, 2.1. daavadebis mizezebi da pirobebi
cilis sinTezi da a.S. adgili aqvs lizo- etiologia (berZn. aitia - mizezi, logos -
somebis hidrolizuri fermentebis gamos- moZRvreba) aris moZRvreba avadmyofobis ga-
rolas, rac acidozTan erTad tvinis qsovi- momwvevi mizezebisa da misi aRmocenebis pi-
lis kvdomas ganapirobebs. robebis Sesaxeb.
klinikuri sikvdilis xangrZlivoba, Cve- mikroorganizmebis aRmoCenis droidan
ulebriv, 5-6 wuTia. is wydeba Tavis tvinis XX saukunis dasawyisamde daavadebis gan-
qerqis nekrozisas da saboloo, biolo- viTarebaSi etiologiur faqtorebs TiTqmis
giuri sikvdilisgan gansxvavebiT, Seqce- absolutur mniSvnelobas aniWebdnen, ar
vadia. iRebdnen ra mxedvelobaSi organizmis reaq-
Tavis tvinis qerqis nekrozis Semdeg tiulobas, konstitucias, memkvidreobiTo-
procesi ufro qvemoT - Tavis tvinis Rero- bas, socialur-fsiqogenur faqtorebs da
vani nawilis da retikuluri formaciisken sxv. amgvarad Seiqmna da garkveuli periodis
inacvlebs (e.i. Tavis tvinis im ubnebisken, manZilze farTod gavrcelda Teoria daa-
romlebic filogenezurad ufro adre war- vadebis gamomwvevi mizezebis Sesaxeb, rome-
moqmnilia da ufro met mdgradobas iCens lic cnobilia monokauzalizmis saxelwo-
Jangbadovani SimSilisadmi). debiT.
gulis funqciobis Sewyveta ori gziT monokauzalizmis (berZn. monos - erTi,
SeiZleba moxdes: asistoliiT, e.i. gulis ga- causa - mizezi) mixedviT, avadmyofobis gan-
CerebiT da fibrilaciiT, e.i. gulis kunTis viTarebisTvis ganmsazRvrelia misi ZiriTadi
calkeuli boWkoebis arasinqronuli, uwes- mizezi. danarCen faqtorebs, TiTqosda, am
12
procesisTvis arsebiTi mniSvneloba ara aqvs. Sesaxeb moZRvrebaSi meore ukiduresobaa. is
fiqrobdnen, rom organizmze mizezis ze- iseTive calmxrivia, rogorc monokauza-
moqmedeba yovelTvis, yovelgvar pirobebSi lizmi.
iwvevs daavadebas. Tanamedrove Sexedulebis Tanaxmad, daa-
Tavis droze monokauzalizmma progresu- vadebis gamomwvevi mizezi is faqtoria,
li roli Seasrula, Tumca Semdgomma dak- romlis gareSec, miuxedavad Seqmnili, Tun-
virvebebma am koncefcias niadagi Seuryia. dac xelsayreli pirobebisa, avadmyofoba ar
cxadi gaxda, rom erTi da igive mikro- aRmocendeba. gasaTvaliswinebelia, rom swo-
organizmis moxvedra sxvadasxva adamianis red etiologiuri agenti aZlevs paTolo-
organizmSi raodenobrivad da, zogjer, Tvi- giur process (avadmyofobas) specifikur
sobrivad sxvadasxvagvar reaqcias iwvevs. xasiaTs, e.i. gansazRvravs im Taviseburebebs,
erTi da igive mikrobis zemoqmedebisas ada- romliTac es procesi an avadmyofoba ga-
mianTa erT jgufs uviTardeba avadmyofobis nirCeva sxva procesebis da avadmyofobe-
mZime forma, meores - msubuqi, xolo sxvani bisgan. am agentis moqmedebis gamo procesi
saerTod ar avaddebian. sxvagvarad rom iZens mxolod misTvis damaxasiaTebel Tvi-
vTqvaT, monokauzalizmi ar iTvaliswinebs sebebs, miuxedavad imisa, rom SeiZleba
avadmyofobis gamomwvevi faqtoris da organizmze imavdroulad mravali sxva da-
organizmis urTierTqmedebas. ignonirebulia mazianebeli faqtoric moqmedebdes. magali-
isic, rom mizezi organizmze moqmedebs ara Tad, tuberkulozi SeiZleba ganapirobos
marto, damoukideblad, aramed avadmyofobis gacivebam, arasakmarisma kvebam, organizmis
ganviTarebis xelSemwyobi an xelSemSleli winaaRmdegobunarianobis daqveiTebam da a.S.,
faqtorebis gavlenis fonze. Tumca arc erTi am faqtorTagani ar aris
monokauzalizmis sawinaaRmdegod XX tuberkulozis gamomwvevi. avadmyofoba vi-
saukunis dasawyisSi farTod gavrcelda Tardeba mxolod da mxolod koxis CxiriT
meore mimarTuleba, romelic cnobilia dasnebovnebis SemTxvevaSi, e.i. tuberku-
kondicionalizmis saxelwodebiT (berZn. lozis mizezi koxis Cxiria, sxva danarCeni
conditio- piroba). kondicionalistebis doq- faqtorebi ki pirobebia, romelTa fonze es
trinis Tanaxmad, avadmyofobas konkretul mikrobi tuberkuloziT avadmyofobas iwvevs.
SemTxvevaSi iwvevs mxolod pirobebis er- amrigad, daavadebis mizezi aris is faqtori,
Toblioba. yvela es piroba miCneuli iyo romelic iwvevs mocemul daavadebas da
Tanabari mniSvnelobis mqoned, tolfasovnad. aniWebs mas specifikurobas. am faqtoris
ar iyo diferencirebuli romelime erTi paTogenur Tvisebebs gansazRvravs:
mTavari piroba (mizezi), romelic SeiZle- a) misi ucxo, araCveulebrivi xasiaTi, rac
boda avadmyofobis ZiriTadi gamomwvevi yo- niSnavs, rom adre amgvari bunebis faqtors
filiyo. organizmze ar umoqmedia, organizms ar aqvs
kondicionalizmis fuZemdebeli fervorni misdami specifikuri dacvis da adaptaciis
amtkicebda, rom avadmyofobis gamomwvevi mi- meqanizmi (magaliTad - maionebeli radiacia);
zezi ar arsebobs, misi Zebna uazrobaa, rad- b) faqtoris siWarbe (magaliTad, Tavisu-
gan avadmyofoba mravali pirobis urTier- falradikaluri Jangvis maRali intensivoba,
TSerwymis Sedegia. avadmyofobis warmoSo- Zlier maRali an dabali temperatura);
bis garemoebaTa dadgena, fervornis azriT, g) faqtoris deficiti (magaliTad, Jangba-
SesaZlebelia mxolod im SemTxvevaSi, Tu dis, zogi hormonis mniSvnelovani naklebo-
SeviswavliT yvela SesaZlo pirobas. ba);
kondicionalizmi uaryofs daavadebis ga- d) faqtoris moqmedebis uCveulo periodu-
momwvev konkretul mizezs da etiologiis loba da/an xangrZlivoba (magaliTad, Zil-
13
RviZilis xangrZlivobis an riTmis dar- ganarCeven pirobas, romelic xels uw-
Rveva); yobs avadmyofobis ganviTarebas da pirobas,
e) indiferentuli da paTogenuri faqtoris romelic ewinaaRmdegeba mas. rogorc erTi,
erTdroulma zemoqmedebam SeiZleba Cveuli ise meore SeiZleba garegani da Sinagani
faqtori paTogenurad aqcios (magaliTad, iyos.
vardis sunze (mtverze) alergiuli reaqci- Sinagan pirobebs, romlebic xels uwyobs
is Camoyalibebis Semdeg aseTi reaqcia SeiZ- avadmyofobis aRmocenebas, miekuTvneba mem-
leba gamoiwvios vardis mxolod xilvamac). kvidreobiTi winaswarganwyoba avadmyofobi-
paTogenuri faqtoris organizmze moqme- sadmi (magaliTad, sxvadasxva formis dia-
deba yovelTvis ar iwvevs avadmyofobis gan- Tezi), asakobrivi faqtori da sxv.
viTarebas. amas, mniSvnelovanwilad gansaz- avadmyofobis xelSemwyobi garegani piro-
Rvravs is pirobebi, romelTa fonze mimdina- bebia Sromis da dasvenebis reJimis, kvebis
reobs paTogenuri faqtoris da organizmis darRveva, gadatanili avadmyofobebi da a.S.
urTierTqmedeba. unda aRvniSnoT, rom erTi da igive pro-
cxadia, rom paTologiis ganviTarebisaT- cesi SeiZleba gamoiwvios sxvadasxva faqto-
vis paTogenuri agentis organizmze zemoq- ris zemoqmedebam. aseT SemTxvevaSi saubro-
medeba sruliad aucilebelia, arsebulma pi- ben avadmyofobis polietiologiur xasiaT-
robebma ki SeiZleba xeli Seuwyos an daab- ze. mkvlevarTa nawili uaryofs avadmyofo-
rkolos paTologiis aRmoceneba. bis polietiologiur bunebas. maTi azriT,
daavadebis aRmocenebis pirobebia faqto- mravalmizezobriobis daSveba ganpirobebu-
ri an faqtorTa jgufi, romlebic xels uw- lia problemis sirTuliT da codnis ukma-
yobs, ewinaaRmdegeba an modificirebas uwevs risobiT, sinamdvileSi ki polietiologi-
gamomwvevi faqtoris zemoqmedebas, aniWebs uri avadmyofoba ar arsebobs.
avadmyofobas specifikur xasiaTs. aRsaniSnavia, rom araerTi faqti adastu-
paTogenuri faqtoris da organizmis ur- rebs zogi paTologiuri procesis polieti-
TierTdamokidebulebis analizi gviCvenebs, ologiurobas. magaliTad, iseTi tipobrivi
rom avadmyofobis an paTologiuri procesis paTologiuri procesi, rogoricaa anTeba,
ganviTareba aris organizmis da gamomwvevi SeiZleba gamowveuli iyos sxvadasxva fizi-
agentis urTierTqmedebis da ara mxolod kuri (maRali da dabali temperatura, meqa-
paTogenuri faqtoris zemoqmedebis Sedegi. nikuri dazianeba da a.S.), qimiuri (mJavebi,
avadmyofobaTa aRmoceneba, ganviTarebis tuteebi, skipidari, krotonis zeTi da a.S.),
Taviseburebebi da gamosavali ganisazRvreba biologiuri (baqteriebi, virusebi da a.S.)
erToblivad: paTogenuri agentiT, organiz- faqtoriT.
mis TvisebebiT (reaqciuloba, rezistentoba amave dros, ar SeiZleba ar vaRiaroT,
da sxv) da im pirobebiT, romelSic xdeba rom zogierT SemTxvevaSi termini "polieti-
paTogenuri faqtoris da organizmis urTi- ologiuri" namdvilad amJRavnebs daavadebis
erTqmedeba. etiologiis gaurkvevlobas. mravali "poli-
yovelive es metyvelebs daavadebaTa pro- etiologiuri" avadmyofoba, misi namdvili
filaqtikis efeqturobis gansakuTrebul mizezis Sesaxeb codnis dagrovebisas, dife-
mniSvnelobaze. rencirdeba sxvadasxva avadmyofobad, ro-
mizezi da piroba saWiroa ganvixiloT melTagan yovels Tavisi mizezi aqvs. Mmaga-
dialeqtikur erTianobaSi, e.i. mudmiv da liTad, iyo sisxldenisadmi midrekilebiT
mWidro urTierTkavSirSi. magram ar SeiZle- cnobili paTologia saxelwodebiT "hemora-
ba maT Soris tolobis niSnis dasma. mizezi giuli diaTezi". misi etiologiis Rrma Ses-
erTia, piroba ki - mravali. wavlis Semdeg gamovlinda, rom am saxel-
14
qveS erTiandeboda sisxldeniT mimdinare, mebs miekuTvneba adaptaciuri (SeguebiTi),
sxvadasxva mizeziT gamowveuli ramdenime sakuTriv dacviTi da sakompensacio reaq-
daavadeba (cinga, hemofilia da sxv.). ciebi.
adaptaciuri reaqciebi mimarTulia damazi-
3. zogadi paTogenezi anebel faqtorTan Seguebisken daavadebis
paTogenezi (berZn. pathos - tanjva, ganviTarebis gareSe. magaliTad, periferuli
genesis - warmoSoba) Seiswavlis avadmyo- sisxlZarRvebis spazmi (Seviwroveba) orga-
fobis aRmocenebis, ganviTarebisa da gamosav- nizmze dabali temperaturis moqmedebisisas,
lis meqanizmebs. eriTrocitebiT mdidari sisxlis gamosrola
paTologiuri procesebi ujredebSi, qso- sisxlis depoebidan garemoSi Jangbadis
vilebsa da organoebSi, Cveulebriv, iwyeba parciuli wnevis Semcirebisas.
dazianebis gamo. Tavad dazianeba ar aris dacviTi reaqcia mimarTulia organizmidan
paTologiuri procesi, magram is am proce- damzianebeli agentis swrafi gamoyofis an
sis ganviTarebis mizezia. TviT procesi vi- misi likvidaciisken. magaliTad, uvargisi
Tardeba sakuTari, endogenuri meqanizmebiT, sakvebiT kuWis da Tormetgoja nawlavis
romelic organizmis sxvadasxva funqciur- lorwovani garsis gaRizianebisas viTardeba
struqturul doneze (ujredi, qsovili, Rebineba, romlis dros gamRizianebeli ga-
organo) sxvadasxva meqanizmiT xorcieldeba. moidevneba organizmidan; qsovilSi paToge-
bolo wlebSi SemoTavazebuli cneba "endo- nuri mikrobis moxvedrisas viTardeba dacvi-
genezi" ar cvlis "paTogenezis cnebas - is Ti anTebiTi reaqcia, romelic ewinaaRmde-
mxolod aRiarebs paTogenezis endogenur me- geba infeqciis generalizebas da xels uw-
qanizms. yobs mikrobis likvidacias.
Tu etiologiis cneba moicavs sakiTxebs, friad sayuradReboa, rom dacviT Tu
romlebic exeba daavadebis gamomwvev mizezebs sakompensacio reaqciebs, sasargeblos garda,
da pirobebs, paTogenezi Seiswavlis im pro- xSirad uaryofiTi mxarec aqvs. magaliTad,
cesebs, romlebic viTardeba organizmSi daa- mZlavri dacviTi zRude - anTeba iwvevs
vadebis gamomwvevi mizezebis zemoqmedebis Se- ujredebis, qsovilis kvdomas dazianebis
degad. keraSi da Sesabamisi organos funqciis
darRvevas; gulis SekumSvaTa sixSiris zrda
(taqikardia) oligemiis (cirkulirebadi
3.1. paTologiuri, sakompensacio da dacviTi sisxlis sisxlis moculobis Semcireba)
reaqciebi dros mimarTulia dacemuli arteriuli
paTogenezis Seswavlisas kvlevis obieq- sisxlis wnevis momatebisken, magram wnevis
tia organizmis dazianebis da adaptaciis aseT fonze Semcirebulia gazrdili dat-
urTierTdakavSirebuli reaqciebis kompleq- virTviT momuSave gulis kunTis mkvebavi
si, romelic safuZvlad udevs avadmyofobis sisxlZarRvebis perfuzia sisxliT, rac
an paTologiuri procesis aRmocenebas, gulis kunTis dazianebas iwvevs.
ganviTarebas da gamosavals. amitom zogadi angariSgasawevia is faqti, rom fizio-
paTogenezis ganxilvisas, wminda paTolo- logiur pirobebSi organoebisa da siste-
giuri reaqciebis garda, aucilebelia Seve- mebis funqciis regulaciaSi monawile na-
xoT organizmis dacvisken mimarTul sano- tifi meqanizmebi daavadebis dros SeiZleba
genezur (sanitas - janmrTeloba, genesis - paTologiur reaqciaTa jaWvis mniSvnelovan
ganviTareba) reaqciebs, radgan nebismieri komponentad iqces. magaliTad, normaSi
daavadeba am mWidrod urTierTdakavSirebul wylis da natriumis cvlis regulaciaSi
procesTa erTobliobaa. sanogenezur meqaniz- monawile renin-angiotenzin-aldosteronuli
15
meqanizmi uaRresad mniSvnelovan rols Tama- (travma, Wriloba da sxv.), zogjer ki (ma-
Sobs gulismieri da Tirkmlismieri SeSu- galiTad, dazianeba molekulur doneze)
pebis paTogenezSi. misi gamovlena specialuri meTodebis gamo-
ujredebis, organoebis, mTlianad orga- yenebis gareSe SeuZlebelia.
nizmis SesaZlo dazianebis didi mraval- pirveladi dazianebis Sedegi axali da-
ferovneba ganapirobebs im faqts, rom yvela zianebis wyaro xdeba, ukanaskneli ki – Sem-
kompleqsuri darRvevis "winasaxe" janmrTel dgomi dazianebisa. amgvarad, procesSi er-
organizmSi ar gvxvdeba. daavadebis gamomwvev Tveba meore, mesame da a.S. rigis paToge-
mizezTan, daavadebuli organizmis biolo- nezuri faqtorebi.
giur saxeobasTan, organizmis reaqtiulo- etiologiuri faqtoris zemoqmedeba
basTan, garemo pirobebTan dakavSirebiT avadmyofobis ganviTarebis biZgia. Semdgom
organizmSi iqmneba ujredebis, organoebis, avadmyofoba SeiZleba ganviTardes paTogenu-
maregulirebeli sistemebis funqciis dar- ri agentis moqmedebisgan damoukideblad,
Rvevis da reaqciuli cvlilebebis sxvadas- organizmze am agentis uSualo zemoqmedebis
xvagvari erToblioba, sruliad gansxva- Sewyvetis miuxedavad. sxva SemTxvevaSi eti-
vebuli kombinaciebi. daavadebis meqanizmSi ologiuri faqtori ganagrZobs organizmze
monawile zogi darRveva ki ujredovani zemoqmedebas avadmyofobis mimdinareobis
elementebis, fiziologiuri sistemebis da procesSi, kvals amCnevs mis paTogenezs.
organoebis mxriv evoluciis procesSi gamo- meqanikuri, Termuli, radiaciuli faq-
muSavebuli da memkvidrulad ganmtkice- tori ganaxorcielebs ra agresiis aqts,
buli reagirebis formebiTaa pirobadebuli. Semdgom sruliad wyvets organizmze zemoq-
zogadi paTogenezis Sesaxeb moZRvrebis medebas rogorc etiologiuri faqtori. mis
arsia daavadebaTa aRmocenebis, ganviTarebis mier gamowveuli paTologiuri procesi ki
da gamosavlis zogadi kanonzomierebebis viTardeba sakuTari endogenuri meqanizmebiT.
dadgena. is eyrdnoba calkeuli avadmyofo- aseT SemTxvevaSi gansxvaveba etiologias da
bis da avadmyofobaTa jgufebis Seswavlis, paTogenezs Soris gansakuTrebiT naTlad
daavadebis eqsperimentuli modelebis an ma- Cans, e.i. paTologiuri procesi SeiZleba
Ti calkeuli simptomebis kvlevis Sedegebis viTardebodes etiologiuri faqtoris
ganzogadebas. amgvarad, iqmneba imis gamovle- organizmSi arsebobisgan damoukideblad.
nis saSualeba, Tu ra procesebi mimdina- rogorc avRniSneT, arcTu iSviaTad,
reobs daavadebul organizmSi, dgindeba maTi avadmyofobis gamomwvevi mizezi ganagrZobs
Tanmimdevroba, daavadebis paTogenezuri faq- zemoqmedebas organizmze ukve ganviTarebuli
torebi, kavSirebi paTologiur procesebs paTogenezuri meqanizmebis fonze. aseTi si-
Soris, e.i. is Zvrebi, romlebic viTardeba tuacia gansakuTrebiT damaxasiaTebelia in-
organizmze etiologiuri faqtoris moqme- feqciuri daavadebebisTvis, rodesac avad-
debis Sedegad. es faqtori, iwvevs ra pir- myofobis gamomwvevi mizezi (infeqciuri
velad dazianebas, biZgs aZlevs daavadebis agenti) ganagrZobs zemoqmedebas organizmze
ganviTarebas. daavadebis "etiologiuri" sta- avadmyofobis procesSic, e.i. etiologiuri
dia pasuxobs kiTxvas "ratom?", xolo "paTo- faqtori mudmivad zemoqmedebs paTogenezuri
genezuri" stadia ki - kiTxvas "rogor?", "ra meqanizmebis sxvadasxva rgolze da, rogorc
gziT?". wesi, aRrmavebs da arTulebs process.
16
paTogenezi mizez-Sedegobrivi damokide- cireba da hipoqsia (Jangbadis nakleboba
bulebiT dakavSirebul procesTa jaWvia, e.i. qsovilebSi). hipoqsiis gamo ziandeba mio-
iseTi procesia, romelSic raime movlenis kardiumi, mcirdeba gulis sistoluri mo-
mizezi da Sedegi ganuwyvetliv urTier- culoba, rac kvlav arteriul wnevas aqve-
Ticvlian adgils. gasaTvaliswinebelia, rom iTebs.
paTogenezis yvela elementi daavadebis arcTu iSviaTia SemTxveva, rodesac pa-
ganviTarebaSi Tanabar rols ar asrulebs. Tologiuri procesis mizezis moqmedebis
maT Soris yovelTvis arsebobs mTavari, Zi- Sedegi TviT xdeba Semdgomi paTologiuri
riTadi rgoli, romelsac wamyvani mniSvne- Zvrebis mizezi (magaliTad, maionebeli radi-
loba aqvs konkretuli avadmyofobis paTo- aciis moqmedebis Sedegad organizmSi ioniz-
genezSi. deba wyali, rac Semdgom cvlilebebs da, sa-
am ZiriTadi da wamyvani rgolis dad- bolood, ujredebis gamravlebis daTrgunvas
genas didi mniSvneloba aqvs, pirvel rigSi, iwvevs) an aZlierebs pirveladi mizezis
praqtikuli medicinisTvis, radgan misi mos- moqmedebas. ukanasknel SemTxvevaSi yalibdeba
poba iwvevs mTlianad paTologiuri proce- "mankieri wre" (circulus vitiosus). magaliTad,
sis likvidirebasac. magaliTad, arteriuli zogierTi paTologiuri procesis dros
hiperemiis paTogenezSi wamyvani rgolia ar- warmoiqmneba eriTrocitebis konglomeratebi
teriebis gafarToeba. yvela sxva movlena: (eriTrocitebis agregaciis gamo), rac sis-
sisxlis nakadis moculobiTi da xazovani xlis siblantis momatebis gziT iwvevs sis-
siCqaris zrda, hiperemiuli ubnis sisxlZar- xlis nakadis xazovani siCqaris Semcirebas.
RvebSi arteriuli wnevis momateba, siwiT- radgan xazovani siCqaris Semcireba, Tavis
le, temperaturis momateba da sxv., piroba- mxriv, eriTrocitebis agregaciis xelSem-
debulia ZiriTadi rgoliT - arteriebis ga- wyobi pirobaa, eriTrocitebis agregatebis
farToebiT. arteriebis tonusis aRdgenisas warmoqmna kidev ufro Zlierdeba. amgvarad,
yvela es movlena qreba. Seikvreba "mankieri wre" da paTologiuri
insulindamokidebuli Saqriani diabetis procesi ufro da ufro Rrmavdeba.
paTogenezSi wamyvani rgolia pankreasis Si-
gasekreciuli funqciis moSla da insulinis 3.4. adgilobrivi da zogadi paTologiaSi
nakleboba. misi likvidireba (insulinis pre- daavadebis paTogenezis analizi saWiro-
paratebis Seyvana organizmSi) aqrobs avad- ebs paTologiaSi zogads da adgilobrivs
myofobis sxva gamovlinebebsac (hiperglike- Soris urTierTTanafardobis swor gaazre-
mias, acetonemias, polifagias da a.S.). bas.
rogorc iTqva, etiologiuri faqtoris mTlian organizmSi absoluturad loka-
uSualo zemoqmedebiT gamowveuli dazianeba luri paTologiuri procesi ar arsebobs,
sxva, axali cvlilebis mizezi xdeba, uka- radgan procesSi, met-naklebad, mTlianad
naskneli ki Semdgom dazianebas iwvevs da organizmic CaerTveba. amitom saWiro xdeba
a.S. xSirad aseT procesTa jaWvi kvlav zogadis da adgilobrivis erTianobaSi
Tavdapirveli an SedarebiT adreuli dazia- vipovoT wamyvani mxare, romelic gan-
nebis gaRrmavebas iwvevs, e.i. iqmneba erT- sazRvravs procesis tendencias, misi gene-
gvari "mankieri wre". aseTis magaliTad ralizebis masStabs. magaliTad, Tu furun-
mogvyavs paTologiur cvlilebaTa jaWvi kuli (Zirmagara) viTardeba mxolod Tmis
sisxldenis dros: sisxldena iwvevs cirk- folikulSi stafilokokis CanergviT da
ulaciaSi myofi sisxlis masis Semcirebas, eqvemdebareba adgilobriv mkurnalobas, maSin
rasac mohyveba arteriuli wnevis daqvei- am process adgilobrivad miiCneven. magram
Teba, qsovilebis sisxliT perfuziis Sem- Tu furunkuli romelime zogadi avad-
17
myofobis adgilobrivi gamovlinebaa (maga- da avadmyo-fobis gamomwvevi agentis
liTad, Saqriani diabetisa), maSin, upirve- moqmedebasTan da-kavSirebiT.
les yovlisa, saWiroa brZola Saqrian dia- araspecifikuri reaqciebi Tavs iCenen yo-
betTan, radgan aseT SemTxvevaSi adgilob- velTvis, rodesac organizmze moqmedebs
rivi Careva naklebad efeqturi xdeba. Gga- Zlieri agenti anu stresori - ase uwoda
saTvaliswinebelia isic, rom adgilobrivma mas stresis da zogadi adaptaciuri sin-
procesma SeiZleba ganicados generalizeba dromis Sesaxeb moZRvrebis avtorma, kana-
da, piriqiT, generalizebuli procesi or- delma paTologma h.seliem (ix. "zogadi
ganizmis dacviTi reaqciebis gavleniT ga- adaptaciuri sindromi"). rac Seexeba paTo-
davides lokalurSi, Semoifarglos an saer- genezSi specifikurs, e.i. im niSnebs, rom-
Tod gaqres. lebze dayrdnobiTac diagnozs adgenen, aq
pirvelxarisxovan rols asrulebs TviT
3.5. araspecifikuri da specifikuri etiologiuri faqtori. daavadebis gamom-
paTologiaSi wvevi mizezi moqmedebs zogad araspecifikur
nebismieri avadmyofobis mimdinareobaSi fonze da damaxasiaTebel, specifikur niS-
SeiZleba ganvasxvavoT specifikuri movle- nebs aniWebs avadmyofobas.
nebi, romlebic axasiaTebs mxolod mas (ma-
galiTad, tipobrivi stenokardiuli tkivi- 3.6. etiotropuli da paTogenezuri Terapiis
li gulis kunTis isqemiuri avadmyofobis principebi
dros) an ramdenime sneulebas (magaliTad, etiotropuli mkurnaloba gulisxmobs
siyviTle sanaRvle gzebis gauvalobis, RviZ- zemoqmedebas avadmyofobis gamomwvev mizez-
lis parenqimis dazianebis, eriTrocitebis ze. magaliTad, antibiotikebis gamoyeneba in-
gaZlierebuli hemolizis dros) da aras- feqciuri daavadebebis dros.
pecifikuri movlenebi, romlebic daavadebaTa paTogenezuri mkurnalobis mizania dazi-
umravlesobas axasiaTebs. daavadebis es zo- anebis meqanizmebis Sewyveta an daqveiTeba da
gadi niSnebi gansazRvravs misi paTogenezis organizmis SeguebiTi (adaptaciis) reaqci-
araspecifikur mxares, romlis arsia filo- ebis da procesebis gaaqtiveba. ukanasknels
genezis procesSi Camoyalibebuli orga— zogjer sanogenezur Terapiasac uwodeben.
nizmis dacviTi reaqciebi. paTogenezuri meqanizmis Sewyvetis maga-
evoluciis procesSia formirebuli ce- liTad SeiZleba dasaxeldes antihistami-
minebis da xvelis refleqsi, antigenur ga- nuri preparatebis gamoyeneba hipermgrZno-
Rizianebaze imunokompententuri ujredebis belobis (alergiis) zogierTi reaqciis
mier antisxeulebis produqcia, hipofiz- dros.
Tirkmelzeda jirkvlis reaqcia stresul adaptaciuri procesebis gaaqtivebisken
gaRizianebaze da a.S. yoveli maTgani mimarTuli mkurnalobis magaliTia imunoma-
daavadebis ganviTarebis araspecifikuri modulirebeli da imunomastimulirebeli
meqanizmia. maTTan erTad yvela avadmyofobas Terapia an, piruku, imunodepresantebis ga-
an maT jgufs aqvs specifikuri meqanizmebic, moyeneba.
romelic axasiaTebs mxolod am paTogenezur mkurnalobas miekuTvneba,
avadmyofobas an avadmyofobaTa garkveul agreTve, CanacvlebiTi Terapiac - orga-
jgufs. zogadi paTofiziologia swavlobs nizmSi romelime nivTierebis Seyvana misi
swored avadmyofobis zogad araspecifikur deficitis dros. magaliTad, insulinisa -
da specifikur meqanizmebs, anu sicocxlis pirveli tipis Saqriani diabetisas.
"programebs", romlebic iqmneba daavadebul mkurnalobis efeqti mniSvnelovnad iz-
organizmSi mis biologiur TaviseburebebTan rdeba etiotropuli da paTogenezuri mkur-
18
nalobis erTdrouli, kompleqsuri gamoye-
nebisas.
19
20
erebas, TviT ujredebs Soris, ris Sedegad
4. organizmis adgilobrivi ziandeba organoebis da sistemebis funqci-
reaqciebi dazianebaze ebi, viTardeba avadmyofoba.
4.1. ujredis zogadi paTofiziologia ujredis dazianeba SeiZleba iyos nawi-
ujredi organizmis umciresi TviTregu- lobrivi an mTliani, Seqcevadi an Seuq-
lirebadi struqturul-funqciuri erTeulia. cevadi. ukanasknelma SeiZleba ujredis sik-
masSi mimdinare procesebi udevs safuZvlad vdili gamoiwvios.
organoebis da qsovilebis cxovelmoqmedebas,
sazogadod sicocxles. Mmisive dazianebaa ne- 4.1.1. ujredis dazianebis tipobrivi formebi
bismieri paTologiuri procesis an avadmyo- ujredis pirveladi dazianeba upirate-
fobis sawyisi. sad mimarTulia misi konkretuli moleku-
ujredSi mimdinare procesebs or jgufad luri struqturebisken da specifikuri
yofen. pirvelSi, ZiriTadad, erTiandeba pro- xasiaTisaa. aRniSnuli struqturebis dazia-
cesebi, romlebic emsaxureba ujredis cxo- neba iwvevs mTel rig meorad cvlilebebs
velmoqmedebis uzrunvelyofas da mis gamrav- da Tavs iCens ujredis araspecifikuri re-
lebas. maT miekuTvneba nivTierebaTa cvla, aqcia dazianebaze.
kavSiri garemosTan, genetikuri informaciis ujredis dazianeba masSi mravalferovan
Senaxva da gadacema, nivTierebaTa sinTezi da cvlilebebs iwvevs. maTgan aRsaniSnavia dis-
daSla, energetikuli cvla. trofiebi, displaziebi, paranekrozi, nekro-
ujredSi mimdinare procesTa meore zi da apoptozi (ukanaskneli, zogjer, uj-
jgufs miekuTvneba ujredis specializebas- redis "fiziologiuri" sikvdilis gamov-
Tan, mis specifikur funqciasTan dakavSire- linebaa).
buli movlenebi: agznebis generacia da gada- distrofia (laT. dys-darRveva, moSla,
cema (magaliTad, nervuli ujredebi), Sekum- berZn. trophe-vkvebav) xasiaTdeba ujredSi
Sva (kunTovani ujredebi), sxvadasxva nivTi- nivTierebaTa cvlis, misi funqciis da
erebis (cilebis, fermentebis, hormonebis) struqturis darRveviT, magram ujredi am
sinTezi, ujredebis da struqturebis (maga- SemTxvevaSi sicocxlisunariani rCeba. dis-
liTad, eriTrocitebis, Trombocitebis) trofia xasiaTdeba ujredSi iseTi kompo-
produqcia. nentebis gaCeniT, romlebic ar gvxvdeba
cxovelmoqmedebisTvis araxelsayreli janmrTel ujredSi an ujredis normaluri
faqtorebis zemoqmedebiT gamowveuli ujre- komponentebis urTierTSefardebis darRve-
dis funqciis darRveva, bevr SemTxvevaSi, Se- viT. distrofiis ZiriTadi saxeebia: cilo-
iZleba Seqcevadi iyos. ujredis funqciis aR- vani (disproteinozebi), cximovani (dislipi-
dgena iwyeba garemo pirobebis normalizebis- dozebi), naxSirwylovani, pigmenturi da
Tanave. mineraluri.
dazianeba (alteracia) ujredis funqcio- displazia (laT. dys-darRveva, moSla,
bis, fizikur-qimiuri Tvisebebis, metaboliz- berZn. plase-darRveva, dazianeba) ujredebis
mis cvlileba, romelic grZeldeba garkveul ganviTarebis darRvevis krebiTi cnebaa. is
xans damazianebeli agentis moqmedebis Sewyve- xasiaTdeba ujredis struqturis da
tis Semdegac. misi safuZvelia ujredis funqciis myari cvlilebebiT, rac misi
struqturuli elementebis nawilis ngreva, cxovelmyofelobis darRvevas iwvevs. dis-
ris gamo ujredi srulad veRar asrulebs plaziis magaliTad SeiZleba moviyvanoT nam-
Tavis funqciebs. gliseburi eriTrocitebis warmoqmna nam-
ujredis dazianebis gamo irRveva urTi- gliseburi anemiis dros, giganturi ujre-
erTqmedeba rogorc TviT ujredis kompo- debis gaCena reklinhauzenis avadmyofobis
nentebs, ise ujredebs da ujredSoris nivTi- dros da sxv.
21
displaziaTa uxSiresi mizezia ujredis qromatinis damaxasiaTebeli kondensirebiT
genomis dazianeba, romlis dros irRveva uj- da dnm-is fragmentirebiT, apoptozuri sxe-
redis genetikuri programa an misi reali- ulebis warmoqmniT (sur. 4-1). apoptozis
zebis meqanizmi. Sedegad moiSleba ujredis sawyisi etapi birTvSi iwyeba. endonuk-
diferencireba, misi struqturuli da fun- leazebis gavleniT viTardeba qromatinis
qciuri specializebis procesi. kondensireba, birTvis fragmentacia. es
Zlieri da xangrZlivi zemoqmedeba iwvevs fragmentebi wydeba da gamodis ujredis
ujredSi imis msgavsi cvlilebebis ganviTa- gareT "apoptozuri sxeulakebis" saxiT. ci-
rebas, romelic damaxasiaTebelia mkvdari uj- toplazmaSi farTovdeba endoplazmuri re-
redebisaTvis: citoplazmis SemRvreva, vaku- tikulumi, iWmuxneba granulebi. ujredis
olizeba, msxvildispersiuli naleqis gaCena, membrana kargavs bususebs da iCens buStu-
ujredis mier saRebavebis miRebis unaris kismagvar warmonaqmnebs. ujredi mrgvalde-
gaZliereba. es cvlilebebi xSirad Seqcevadia. ba, mcirdeba moculobaSi.
ujredis aseT mdgomareobas ewodeba, xolo apoptozis dros qromatinis degradacia
momakvdav ujredSi darRveuli funqciebis mimdinareobs sam etapad, qromatinis sul
kompensaciiT mimdinare procesebs ki ufro mcire fragmentebis warmoqmniT da
nekrobiozi (berZn. necros - mkvdari, bios - maTi invaginaciiT birTvis membranaSi. amis
sicocxle). Semdeg procesi Seuqcevadi xdeba.
nekrozi (berZ. necros - mkvdari) aris uj- termini apoptozi (bern. - "foTolcve-
redis sikvdili, romelsac Tan sdevs misi na") Semoitana kerma 1972 wels ujredis
cxovelmoqmedebis Seuqcevadi Sewyveta. is sikvdilis im formis aRsaniSnavad, romlis
aris distrofiis, displaziis, nekrobiozis prototipia Timocitebis kvdoma gluko-
da ujredis struqturebis Zlieri dazia- kortikoidebis gavleniT. is gaigivebuli
nebis Sedegi. iqna ujredis daprogramebul sikvdilTan,
nekrozis mizezia ujredze damazianebe-li romelic ufro adre iyo aRwerili. am
faqtorebis (hipoqsia, hipoosmia, pH-is procesTa saxelwodebebis gansxvaveba dakav-
mkveTri gadaxra, meqanikuri zemoqmedeba, kom- Sirebulia ujredis daRupvis identifi-
plementis efeqti, membranis dazianeba da kaciis sxvadasxva meTodis gamoyenebasTan:
sxv.) mier ujreduli struqturebis dazia- morfologiurisa - pirvel SemTxvevaSi da
neba, romelic vlindeba ujredis gajirjve- bioqimiurisa - meore SemTxvevaSi. radgan
biT, membranis gaglejiT da membranis Sig- dRevandlamde, miuxedavad kritikisa, orive
Tavsis garemoSi gadmoRvriT. daRupuli uj- termini kvlav TanabarmniSvnelovnad gani-
redebis umetesoba ganicdis autolizs li- xileba, moviyvanT orive gansazRvras.
zosomuri fermentebis moqmedebiT, rac xSi- morfologiuri midgoma: apoptozi aris
rad iwvevs dauzianebeli ujredebis acidoz- ujredis sikvdilis forma, romelic vlin-
sac. aris monacemebi, rom autolizSi mona- deba misi moculobis SemcirebiT, qromati-
wileoben Tavisufali radikalebic. daRupul nis kondensirebiT da fragmentirebiT, uj-
ujredTa alagebaSi monawileoben fago- redis membranebis gamkvrivebiT misi Sig-
citebic. Tavsis garemoSi gamosvlis gareSe.
apoptozi. ujredis kvdoma erTgvarovani bioqimiuri midgoma: daprogramebuli sik-
procesi ar aris. nekrozis zemoganxiluli vdili aris ujredis sikvdilis aqtiuri
meqanizmisgan, romelic ujredis SeSupebiT, forma, romlis mizezia misi genetikuri
organelebis dazianebiT mimdinareobs da ko- programis realizeba an pasuxi garemos sig-
agulaciuri xasiaTi aqvs, sruliad gansxva- nalze, mas esaWiroeba energiis xarjva da
vebuli aRmoCnda ujredis daprogramebuli makromolekulebis sinTezi.
destruqcia - apoptozi, romelic vlindeba
22
miuxedavad imisa, rom morfologiur li radiacia, citotoqsikuri antisimsiv-
cvlilebebTan SedarebiT ufro principulia nuri preparatebi). aris mosazreba, rom
ujredis sikvdilis programis arseboba da apoptozi SeiZleba gamoiwvios aramkveTrma
procesis aqtiuri xasiaTi, simoklis gamo hipoqsiamac.
ufro xSirad iyeneben "morfologiur" ter- apoptozis rogorc Sesusteba, ise gaZ-
mins – apoptozs. liereba paTologiaSi uaRresad mniSvnelo-
apoptozi ujredis "TviTmkvlelobis" van rols asrulebs, rac naTlad Cans su-
farTod gavrcelebuli biologiuri feno- raTze 4-2. zogierTi tipobrivi
menia, romlis stimulia sxvadasxva saxis paTologiuri procesis meqanizmSi apop-
garemo signali an gadauWreli "Sinagani" tozis mniSvneloba arcTu maRalia. maga-
konfliqti (magaliTad, dazianebuli dnm-is liTad, anTebis dros apoptozi procesSi
aRdgenis SeuZlebloba). erTveba mxolod daskvniT etapze, manamde ki
apoptozs, Cveulebriv, adareben ujredis Warbobs ujredis nekrozi. magram, amasTa-
sikvdilis ukve aRniSnul formas - nekrozs. nave, apoptozis da misi cvlilebebis roli
magram, rogorc ganviTarebis mizezebis, ise friad maRalia stres-reaqciis da avTvise-
meqanizmis da biologiuri arsis mixedviT biani zrdis paTogenezSi.
gansxvaveba am or process Soris sruliad simsivnur zrdaSi monawile zogierTi
aSkaraa. apoptozi, rogorc fiziologiuri geni Trgunavs apoptozis maregulirebel
movlena, bevrad farTodaa gavrcelebuli. Tu rols ujredTa gamravlebaSi. Sedegad ar
mravalujrediani organizmis ujredebis ma- xdeba atipobrivi, gadagvarebuli ujredebis
sobrivi kvdoma nekrozTanaa dakavSirebuli bunebrivi apoptozi da iwyeba maTi gam-
da asocirdeba saerTod organizmis sik- ravleba. magaliTad, Bcl-2 onkogeni axdens
vdilTan, ujredebis apoptozi ganixileba, avTvisebiani ujredebis apoptozis inhibi-
rogorc organizmis ganviTarebis da arsebo- rebas da zrdis am ujredebis sicocxlis-
bis aucilebeli piroba. apoptozis ZiriTadi unarianobas.
funqcia (proliferaciasTan erTad) mdgoma- cnobili gaxda, rom cila p-53 astimu-
reobs organizmis, misi "arqiteqturis" Camo- lirebs gadagvarebuli da saxeSecvlili,
yalibebaSi, rac vlindeba Semdeg procesSi maT Soris malignizebuli (gaavTvisebianebu-
monawileobiT: li) ujredebis apoptozs. misi simciris
ujredebis raodenobis mudmivobis dros aRniSnuli procesi ferxdeba, ujre-
SenarCuneba, debi mravldeba da viTardeba avTvisebiani
organizmis da misi nawilebis formis simsivne. aRsaniSnavia, rom glukokortiko-
gansazRvra, idebiT an asakobrivi cvlilebebiT gamowve-
sxvadasxva tipis ujredebis norma- uli apoptozi ar aris damokidebuli cila
luri urTierTSefardebis uzrunvelyofa P-53-ze. AmasTanave, apoptozi bevr Sem-
genetikurad defeqturi ujredebis TxvevaSi viTardeba axali genebis eqspresiis
mocileba gareSec.
amgvarad, apoptozis, rogorc procesis, apoptozi or fazad mimdinareobs. pir-
funqciaa ujredebis raodenobis regulireba veli fazis xasiaTs gansazRvravs apoptozis
normaluri ganviTarebis, organogenezis, imu- gamomwvevi signali, meore ki universaluri,
nuri funqciebis aRsrulebis da qsovilTa erTnairia apoptozis yvela SemTxvevisTvis.
zrdis dros, Tumca apoptozi inducirebuli nebismieri apoptozis meqanizmSi monawile-
SeiZleba iyos paTologiuri stimulebiTac. oben cisteinuri proteazebi. apoptozis
mcire doziT moqmedebis dros apoptozis induqtorebi, pirvel rigSi, swored maT
gamowveva ZaluZs sxva damazianebel gaaqtivebas iwveven. kaspazebis
faqtorebsac (Termuli faqtori, maionizebe-
23
cxrili 4-1
apoptozis da nekrozis SedarebiTi daxasiaTeba
pirveladi dazianebis
birTvi membrana
lokalizacia
kondensacia, granulebis
citoplazma granulebis lizisi
gamkvriveba
mikrobususebis dakargva,
ujredis membrana mTlianobis darRveva
buStukebis warmoqmna
energetikasTan
energodamokidebuli energodamoukidebeli
damokidebuleba
damokidebuleba
damokidebuli damoukidebeli
makromolekulebis sinTezTan
metamorfozi,
ujredebis sikvdili hipoqsiis,
hormondamokidebuli atrofia,
gamovlinebis magaliTebi toqsinebis moqmedebis, virusuli citolizis,
limfocitebis interfazuli
komplementuri citolizis gamo
radiaciuli sikvdili
24
sur. 4.1 ujredis apoptozi da nekrozi romelTa efeqti maTi moqmedebis Zalaze
da adgilzea damokidebuli.
damazianebeli agentis ujredze zemoq-
medebis pirveladi wertilis dadgena yo-
velTvis ar aris SesaZlebeli, magram
gaTvaliswinebuli unda iqnes, rom dazi-
anebis mimarT ujredis yvelaze mow-
yvladi, reaqciuli sistemebia: 1. ujredis
membrana, romelzec damokidebulia ionu-
ri da osmosuri homeostazi rogorc uj-
redSi, ise mis organelebSi; 2. ujredis
sunTqva (JangviTi fosforileba da atf-
is sinTezi);3. fermentebis da struqturuli
cilebis sinTezi; 4. ujredis genetikuri apa-
rati.
sagulisxmoa, rom ujredis komponen-
tebi da bioqimiuri reaqciebi imdenad
mWidro urTierTkavSirSia, rom ujredis
mcire nawilis dazianebac ki farTo speq-
suraTze naCvenebia ultrastruqturuli tris meorad cvlilebebs iwvevs. magaliTad,
cvlilebebis Tanmimdevroba apoptozis (marjvniv) da JangviTi procesis darRvevas Tan sdevs
nekrozis (marcxniv) dros. ionuri wonasworobis regulaciaSi
1. apoptozis dasawyisi monawile kaliumis tumbos funqciis moSla,
2. qromatinis SeWmuxvna-segmentacia, gamosvla rasac wylis da ionebis ujredSiga
birTvis garsis gareT, citoplazmis segregacia. Semcvelobis cvlileba moyveba.
3. birTvis fragmentacia gamoxatuli defor- ujredis dazianebis morfologiuri mxa-
maciiT, apoptozuri sxeulakebis warmoqmna, maTi re TvalsaCino xdeba mxolod dazianebidan
moneleba-fagocitireba (4). garkveuli periodis gavlis Semdeg (es "la-
5. nekrozis niSnebi _ qromatinis Sereva ci- tenturi" periodi ufro xanmoklea ujre-
toplazmis nasebSi, organelebis masiuri gajirjveba. dis Seqcevadi dazianebis dros). magaliTad,
6. membranis dazianeba. suraTze naCvenebia ultra- miokardiumis morfologiuri cvlilebebi
struqturuli cvlilebebis Tanmimdevroba apoptozis sinaTliTi mikroskopiisas mJRavndeba sruli
(mar-jvniv) da nekrozis (marcxniv) dros. isqemiidan mxolod 10-15 saaTis gasvlis
. Semdeg, miuxedavad imisa, rom kardiomi-
moqmedebis meqanizmSi wamyvani momentia dnm- ocitebis subujreduli cvlilebebi isqe-
azebis mainhibirebeli cilebis inaqtivacia. miis dawyebidan 20-60 wamSi viTardeba.
moqmedeben ra birTvis molekulebze, kaspa- amrigad, ujredis ultrastruqturuli al-
zebi Trgunaven dnm-is reparacias, repli- teracia vlindeba ufro adre, vidre is
kacias, reorganizebas da am gziT - genebis cvlilebebi, romelTa dadgena SesaZlebelia
normalur funqciobas. sinaTliTi mikroskopiiT.
ujredis dazianebis saboloo efeqti
4.1.2. ujredis dazianebis zogadi meqanizmebi damokidebulia dazianebis xarisxze, xan-
ujredis dazianebis molekuluri meqa- grZlivobaze, Zalaze, ujredis Tvisebebze,
nizmebi rTuli da kompleqsuria. mraval- misi adaptaciuri meqanizmebis mdgomareo-
gvaria ujredis damazianebeli faqtorebic, baze.
25
ujredis dazianebas maSinve mohyveba masSi agentis mier ujredis dazianeba SeiZle-
dacviT-sakompensacio reaqciebis ganviTareba. ba iyos pirveladi da meoradi. ukanasknelis
magaliTad, dazianebul ujredSi JangviTi saSualebiT SeiZleba ganxorcieldes "pirve-
procesebis darRvevisas myis aqtivdeba ladi" damazianebeli faqtoris paTogenuri
energiis sxva wyaro - anaerobuli glikolizi; efeqti. damazianebeli moqmedeba ujredze
virusis zemoqmedebas ujredi pasuxobs realizdeba nervuli da endokrinuli ze-
virusis gamravlebis dammuxruWebeli nivTi- moqmedebiT, sisxliT da JangbadiT momara-
erebis - interferonis warmoqmniT, gaZlie- gebis darRveviT, fizikur-qimiuri paramet-
rebul datvirTvas - calkeuli organelebis rebis gadaxriT, imunoalergiuli reaqcie-
hipertrofiiT da ujredebis hiperplaziiT, biT, biologiurad aqtiuri nivTierebebis
citoplazmis ubnis kvdomas - dazianebuli warmoqmniT da a.S.
ubnis endocitoziT, monelebiT, mocilebiT da es nivTierebebi - dazianebis mediatorebi
dakarguli struqturis Semdgomi aRdgeniT. sisxlis mier gadaitaneba organizmis sxva
ujredis dazianeba da mis sawinaaRmdegod nawilebSi da iwvevs adgilobriv (anTeba) da
mimarTuli dacviTi da sakompensacio reaqci- zogad (Soki) reaqciebs. faqtiurad, "dazi-
ebi mWidro urTierTkavSirSia. amgvarad, ukve anebis mediatorebs" miekuTvneba "anTebis" an
ujredul doneze vlindeba paTologiuri "alergiis mediatorebic", romlebic Sesabami-
procesis ZiriTadi Strixebi: dazianeba da si saxelwodebis procesebis meqanizmebSi
dacva, dazianeba da kompensacia. monawileoben. es mediatorebi ujredebis da
ujredis romelime erTi organelis an qsovilebis dazianebis metad mniSvnelovani
erTifunqciis darRveva iSviaTad rCeba Sualeduri rgolia.
izolirebuli. Cveulebriv, mas mohyveba sxva ujredis dazianeba SeiZleba pirobade-
struqturebis da funqciebis darRvevaTa buli iyos erTi da igive agentis rogorc
jaWvi, rac mTeli ujredis funqciis moS- siWarbiT, ise deficitiT. magaliTad, Jan-
lamde midis. aqve unda aRiniSnos, rom su- gbadis siWarbe ujredSi iwvevs lipidebis
bujreduli warmonaqmnebis doneze sxvaoba zeJanguri Jangvis gaZlierebas, am gziT
struqturul da funqciur cvlilebebs So- membranuli da ujreduli struqturebis
ris nivelirdeba. dazianebas. Jangbadis simcire ki arRvevs
ujredis damazianebeli faqtorebi SeiZ- JangviT procesebs, amcirebs atf-s sinTezs
leba iyos egzogenuri da endogenuri warmo- da Trgunavs ujredis funqcias.
Sobis. pirvels miekuTvneba fizikuri faqto- ujredis damazianebeli faqtorebi biZgs
rebi: meqanikuri, eleqtrodeni, sxivuri ener- aZleven ramdenime paTogenezur meqanizms:
gia, dabali da maRali temperatura; qimiuri a) energetikuli uzrunvelyofis dar-
(toqsikuri) nivTierebebi: organuli da araor- Rvevas ujredSi, b) membranuli struqtu-
ganuli mJavebi, tuteebi, mZime metalTa ma- rebis da fermentuli sistemebis dazianebas,
rilebi, metabolizmis darRvevis produq-te- g) wylis da ionebis disbalansis ganviTa-
bi; biologiuri agentebi: virusebi, baqteriebi, rebas, d) genetikuri programis da misi
riketsiebi, parazitebi da sxv. realizebis darRvevas, e) ujredis funqci-
endogenuri faqtorebic SeiZleba iyos fi- ebis regulaciis ujredSiga meqanizmebis
zikuri bunebis (magaliTad, osmosuri wnevis moSlas.
cvlileba), qimiuri bunebis (magaliTad, ukanasknel wlebSi mniSvnelovan yurad-
eleqtrolitebis siWarbe an deficiti, Tavi- Rebas iqcevs azotis oqsidis roli rogorc
sufali radikalebi, metabolitebi da sxv.), ujredSi mimdinare paTologiuri pro-
biologiuri bunebis (biologiuri faqtore- cesebis, ise misi dazianebis meqanizmSi (ix.
bis cxovelqmedebis produqtebi). qvemoT). ujredis dazianebis meqanizmSi gan-
sakuTrebul rols asrulebs hipoqsia.
26
energetikuli procesebis darRveva ujredSi mokidebulia membranis fermentebis da re-
xSirad wamyvan rols asrulebs mis altera- ceptorebis funqcioba.
ciaSi. ZiriTadi energetikuli substratis - lipidebis zeJanguri (Tavisufalradikaluri)
atf-s resinTezis darRvevis mizezi SeiZleba Jangva (lzJ) ujredis membranis dazianebis
iyos Jangbadis an dasaJang substratTa de- friad xSiri formaa. am procesisTvis dama-
ficiti, mitoqondriebis dazianeba. ujredis xasiaTebelia mzardi intensivobis ganto-
energomomaragebis darRveva iwvevs membra- tebadi jaWvuri reaqciebi, romlebic araiS-
nebis da maTi fermentuli sistemis dazia- viaTad ujredis kvdomiT sruldeba.
nebas, wylisa da ionebis disbalanss, uj- Tavisufali radikali aris molekula an
redis funqciaTa regulaciis moSlas. sayu- atomi gare orbitaze gauwyvilebeli eleq-
radReboa, rom ujredis cxovelmyofeloba troniT, rac ganapirobebs mis agresiulo-
SeiZleba dairRves masSi atf-s momatebuli basa da unars ara marto Sevides reaqciaSi
an normaluri Semcvelobis fonzec im Sem- membranis molekulebTan, aramed gardaqmnas
TxvevaSi, Tu Semcirebulia atf-azebis aqti- isini Tavisufal radikalebad. amitom, am
voba. reaqciaTa "daumuxruWeblobis" SemTxvevaSi
ujredis membranis dazianeba. dReisTvis procesi zvavisebur saxes iRebs.
cnobilia ujredis garsis (lipiduri biSris) Tavisufalradikaluri Jangva ujredebis
dazianebis ramdenime gza: 1) lipidebis zeJan- dazianebis erT-erTi umTavresi meqanizmia,
guri Jangva, 2) membranuli fosfolipazebis magram, amave dros, is ujredis normaluri
moqmedeba, 3) membranis meqanikuri (osmosuri) funqciobis aucilebeli komponenticaa.
gaWimva, 4) lipidur biSreze eleqtrolite- normaSi lzJ-is procesebi monawileoben
bis adsorbcia, 5) membrandamokidebuli, Tavi- ujredebis metabolizmSi, membranebSi lipi-
sufali da lizosomuri fermentebis moqme- debis Semadgenlobis da membranis ganvla-
deba, 6) wylis da ionebis disbalansi. su- dobis regulaciaSi, xels uwyoben ujredis
raTze 4-5 sqematuradaa gamoxatuli ujre- araspecifikuri da specifikuri funqciebis
dis membranis buneba da naCvenebia misi is realizebas. magram umarTavi, gaZlierebuli
elementebi, romelTa dazianeba yvelaze xSi- lzJ-is da misi damTrgunavi (antioqsida-
ria paTologiis dros. ciuri) meqanizmebis ukmaroba ujredis mem-
ujredis membrana blanti naxevradTxevadi branis da misi funqciebis darRvevas iwvevs,
mozaikuri struqturaa. mis SemadgenlobaSi e.i. Jangbadis aqtiuri formebis bunebrivad
Sedis fosfolipidebis molekulebi (membra- dabali koncentraciebis moqmedeba sawinaaR-
nis lipiduri faza), fosfolipidebi qmnian mdegoa misi maRali koncentraciis efeqtisa.
or Sres (lipiduri biSre). misi Sua nawili lzJ-s gaZlierebis Sedegad membranis
TvisebebiT waagavs gamdnar parafins da nor- lipiduri Sris es ubnebi "faSrdeba", misi
maSi praqtikulad ganuvladia ionebis, nax- cilovani komponentebi advilad misaRwevi
Sirwylebis, aminmJavebis, nukleinmJvebis, nuk- xdeba proteazebisTvis. lzJ-is gavleniT
leotidebisTvis. iJangeba membranuli an masTan dakavSirebul
fosfolipidur garemoSi Sewonilia ci- cilebis da fermentebis Tioluri jgufebi
lis molekulebi, romelTa erTi nawili - (gadasvla HS-SH-idan S=S-Si). magaliTad,
integruli cilebi gadis mis sisqeSi, xolo Tioluri jgufebis daJangva iwvevs kalci-
meore nawili - periferiuli cilebi, gan- umis satransporto atf-azas inaqtivacias,
Tavsebulia membranis zedapirze, sadac eleq- rac aferxebs kalciumis ionebis gamosvlas
trostatikuri ZalebiT kavdeba. da xels uwyobs maT Sesvlas ujredSi, kal-
membranis lipiduri fazis Tvisebebze ciumis siWarbe ki azianebs ujreds. Tiolu-
(siblante, zedapiruli muxti, polaroba) da- ri jgufebis daJangva iwvevs ujredebis da
mitoqondriebis membranebSi forebis gaCenas,
27
romlebiTac ujredSi Sedis natriumis da ga- mezobel molekulas lipidis hidrozeJangis
modis kaliumis ionebi. membranebis lipiduri (LOOH) da axali L- radikalis
faza ganvladi xdeba H+ da Ca2+ ionebis- warmoqmniT:
Tvis. pirvelis Sedegad mitoqondriebSi LO2 + LH LOOH + L-.
iTiSeba Jangva da fosforileba, viTardeba ori ukanaskneli reaqciis urTierTmo-
atf-s deficiti da energetikuli SimSili. nacvleoba process jaWvur xasiaTs aZlevs.
paTologiaSi gansakuTrebul rols asru- amgvarad, Tavisufali radikalebis da zeJan-
lebs Jangbadis Tavisufali radikalebi - gebis gavleniT procesma SeiZleba miiRos
superoqsidradikali O2- da hidroqsilradi- gantotebadi, zvaviseburi xasiaTi, romelic
kali HO-, agreTve, wyalbadis zeJangi H2O2. wydeba mxolod L--s da LO2- erTmaneTTan an
(cxrili 4-2). Jangbadis am e.w. aqtiur for- antioqsidantTan urTierTqmedebisas.
mebs warmoqmnian fagocitebi: qsoviluri mak- zeJangviTi Jangvis procesi pirobiTad
rofagebi, monocitebi da sisxlis granulo- sam etapad SeiZleba daiyos (sur. 4-2): 1.
citebi. dazianebis dros Jangbadis aqtiuri iniciaciis ("Jangbadovani"), 2. Tavisufali
formebi warmoiqmneba eleqtronebis tran- radikalebis warmoqmnis ("Tavisufalradi-
sportis darRvevisas ujredebis mitoqon- kaluri"), 3. lipidebis da sxva nivTie-
driul sunTqviT jaWvSi, kateqolaminebis me- rebebis daJangvis ("zeJangviTi").
taboluri gardaqmnis, prostaglandinebis lzJ-is toqsikuri moqmedebis sapasuxod
sinTezis dros da sxv. organizmSi moqmedebs Jangvis sawinaaRmdego
cxrili 4-2 biologiuri mdgradobis meqanizmi – anti-
ZiriTadi Tavisufali radikalebi oqsidaciuri dacvis sistema, romelic, pirvel
rigSi, mimarTulia lipidebis Tavisufal-
ZiriTadi warmoqmnis gza radikaluri Jangvis winaaRmdeg. Aamrigad,
Tavisufali zeJangebis mudmivi done organizmSi regu-
radikalebi lirdeba ori sistemis urTierTqmedebiT:
superoqsid radika- fagocitebi: sistemisa, romelic aZlierebs lzJ-s, anu
li O2- qsoviluri prooqsidaciuri sistema da sistemisa, rome-
hidroqsilradikali makrofagi, lic iwvevs aRniSnuli procesis daT-
HO- monociti, sisxlis rgunvas, anu antioqsidaciuri sistema.
wyalbadis zeJangi granulocitebi gansakuTrebiT aqtiuri prooqsidantebia
H2O2 eleqtronebis Tavisufali radikalebis warmomqmneli advi-
transportis lad Jangvadi nivTierebebi (magaliTad, naf-
darRveva toqinonebi, A da D vitaminebi), aRmdgen-
mitoqondriebis lebi, kateqolaminebisa da prostaglandi-
sunTqviT jaWvSi nebis metabolizmis produqtebi. zeJangviTi
prostaglandinebis Jangvis friad xSiri mizezia eleqtronebis
sinTezis procesSi transportis darRveva mitoqondriul sun-
reagireben ra membranis lipidebis Semad- TqviT jaWvSi NAD.H – ubiqinonoqsire-
genlobaSi Semaval ujer cximmJavebTan, OH-- duqtazul ubanze. ukanaskneli ganxilul
radikalebi iwveven maTi zeJangviTi Jangvis unda iqnas, rogorc molekulur doneze
jaWvur reaqcias. Tavdapirvelad xdeba lipi- mimdinare tipobrivi paTologiuri procesi.
dis Tavisufali radikalis warmoqmna: LH + oqsidaciaze zemoqmedebis TvalsazrisiT
HO- H2O + L-. lipidis radikali (L-) gansakuTrebul yuradRebas iqcevs azotis
Sedis reaqciaSi siTxeSi gaxsnil molekulur oqsidis (NO) roli, man SeiZleba gamoavli-
JangbadTan lipozeJangis (LO2) warmoqmniT: nos rogorc prooqsidaciuri, ise antioq-
L- + O2 LO2-. es radikali "Tavs esxmis" sidaciuri Tviseba (ix. qvemoT).
28
antioqsidaciuri, Jangvis sawinaaRmdego nis antioqsidaciuri Tvisebebi. cerulop-
sistemis ZiriTadi funqciaa lzJ-isa da sxva lazmins aqvs rogorc feroqsidazuri, ise
Tavisufalradikaluri reaqciebis inhibireba superoqsiddismutazuri Tvisebebi. es fer-
Jangvis sxvadasxva stadiaze, rasac antioq- menti, Jangavs Fe2+ ionebs Fe3+-ad. am
sidaciuri sistemis moqmedebis sxvadasxva reaqciis Sedegad sisxlis Srati Tavisuf-
meqanizmis mqone komponentebi axorcieleben. ldeba Fe2+ ionebisgan, romelic zeJanguri
ujredis antioqsidaciuri sistema uzrunvel- Jangvis uSualo induqtoria. amrigad, ispoba
yofs Jangbadis aqtiuri formebis da Tavisu- O2- radikalebis warmoqmnis SesaZleblo-
fali radikalebis daSlas, hidrozeJangebis ba.
ganadgurebas. Jangvis sawinaaRmdego sistemis aucile-
antioqsidaciuri sistema organizmSi war- beli komponentebi dabalmolekuluri naer-
modgenilia fermentuli da arafermentuli Tebia. am jgufis bunebrivi antioqsidantebi,
formiT. fermentuls miekuTvneba: katalaza, pirvel rigSi, tokoferoli (E vitamini),
glutaTionperoqsidaza, superoqsiddismuta- glutaTioni, cistamini, askorbinmJava, ubi-
za, ceruloplazmini, xolo arafermentuls - qinoni, steroiduli hormonebi da sxv.,
tokoferoli, serotonini, Tiroqsini, stero- floben lzJ-is Tavisufalradikaluri jaW-
idebi, askorbinmJava, karotinoidebi, hapto- vis gawyvetis unars. gansakuTrebiT didi
globini. mniSvneloba aqvs vitamin E-s, romelsac aR-
superoqsiddismutaza (sod) akatalizebs niSnul TvisebebTan erTad aqvs unari gazar-
superoqsidanionradikalis dismutaciis reaq- dos fosfolipiduri Sris kompaqturoba da
cias molekuluri Jangbadis da naklebaq- misi stabiloba.
tiuri H2O2-is warmoqmniT. amrigad, organizmSi ganuwyvetliv mimdi-
am gziT xorcieldeba O2--is staciona- nareobs Tavisufali radikalebis da ze-
ruli, dabali koncentraciis regulireba. Jangebis warmoqmna. paTologiuri movlenebis
sod-is mTavari biologiuri funqciaa aero- umravlesoba dakavSirebulia maTi warmoq-
buli cxovelmyofelobis SenarCuneba. is aris mnis gaZlierebasTan. membranebis dazianeba,
ujredis antioqsidaciuri dacvis mniSvne- romelic gamowveulia lipidebis jaWvuri
lovani faqtori lzJ-is inicirebis stadiaze. radikaluri JangviT, ujredSi Seuqcevadi
mxolod sod-is monawileobiT antioqsi- procesebis ganviTarebis ZiriTadi mizezia.
daciuri dacva arasrulfasovnad xorciel- endogenuri fosfolipazebis moqmedeba.
deba, vinaidan warmoiqmneba Jangbadis biolo- ujredis membranis dazianebis mniSvnelovani
giurad aqtiuri intermutanti - wyalbadis gzaa maTi fosfolipidebis hidrolizi A
zeJangi, romlis Warbi raodenobis daSla fosfolipazebiT. am procesis garkveuli
aucilebeli xdeba. zomiT gaaqtiveba fiziologiuri movlenaa,
ZiriTadi fermentebi, romlebic axorci- radgan am pirobebSi membranis ganvladoba
eleben wyalbadis zeJangis daSlas wylis or Ca2+ ionebis mimarT da am ionebis Semcve-
molekulad, katalaza da feroqsidazebia. loba ujredSi garkveul donemde izrdeba.
katalaza Slis wyalbadis zeJangs wylad da maTi momateba 10-6 mol/l-mde ujredSiga
Jangbadis molekulad. H2O2-is ganeitralebis procesebis regulaciis normaluri gzaa,
meqanizmis ararsebobis pirobebSi, es radi- radgan kalciumi ujredze mravali media-
kali reagirebs superoqsidanionTan arahe- toris moqmedebis meoradi Suamavalia.
muri rkinis monawileobiT da iwvevs OH- magram fosfolipazebis Warbi gaaqtivebisas,
radikalis generirebas, romelic SemdgomSi membranis ganvladobis momatebis gamo, kal-
aqtiurad Jangavs yvela tipis molekulas. ciumis ujredSiga koncentracia mkveTrad
gansakuTrebiT sayuradReboa sisxlis izrdeba, rac arRvevs rogorc membranis ba-
antioqsidaciuri fermentis ceruloplazmi- riers, ise mis organelebs da mTlianad uj-
29
reds. aseTi procesi viTardeba, magaliTad, centraciis momatebas, da, rogorc Sedegs,
hipoqsiis dros. kalciumis ionebis mier mi- sisxlZarRvis gafarTovebas. xsnadi guani-
toqondriebis membranuli fosfolipazebis latciklazas gaqtivebis gziT azotis oq-
gaaqtivebas gansakuTrebuli mniSvneloba aqvs. sidi aregulirebs Ca2+-is ujredSiga kon-
membranis meqanikuri gaWimva. gaWimvis gamo centracias da, amgvarad, asrulebs meoradi
ujredis membranis meorad dazianebaSi did mesenjeris (gadamcemis) funqcias ujredSiga
rols asrulebs osmosuri wonasworobis signalizaciaSi. gamoTqmulia hipoTeza, rom
darRveva. magaliTad, hipotonur xsnarSi NO da misi metabolitebi xels uwyoben
eriTrocitebis moTavsebisas, ris gamo misi kalciumis ionebis koncentraciis efeqtur
garsi iWimeba, ujredSi Sedis wyali, is regulirebas. azotis oqsids cilebi xsnadi
iRebs mrgval formas, rasac hemolizi moy- mdgomareobidan gadahyavs membranSekavSire-
veba. membranis gaWimva SeiZleba moxdes eriT- bul formaSi, am mdgomareobaSi ki aqtiur-
rocitebis paTologiis drosac. deba fermentuli sistemebi da sasicocxlo
azotis oqsidis roli. ukanasknel wlebSi procesebi. albaT, amaSi mdgomareobs NO-s
cxadi gaxda, rom ujredSi mimdinare pro- efeqti sakompensacio-SeguebiT meqanizmebSi.
cesebSi uaRresad mniSvnelovan rols asru- azotis oqsidi biologiurad uaRresad
lebs azotis oqsidi (NO). am SedarebiT aqtiuri molekulaa. man SeiZleba imoqmedos
"axali" mediatoris - gasuli "saukunis rogorc antioqsidantma, antitoqsikurma
molekulis" kvleva daiwyo 1980 wlidan., faqtorma. is afarTovebs sisxlZarRvebs da
NO Tavisufalradikaluri airia. misi sin- aumjobesebs qsovilebis sisxlmomaragebas,
Tezi xdeba L-argininisgan ferment azotis astimulirebs imunur sistemas, aZlierebs
oqsid-sinTazas (NOS) saSualebiT. dadgeni- fagocitozs. azotis oqsidis friad mniS-
lia, rom is warmoiqmneba ara marto endoTe- vnelovani dadebiTi rolis garda, aucile-
luri, aramed mravali sxva ujredis mier belia aRiniSnos misi zogjer gansakuTrebiT
sxvadasxva organosa da qsovilSi. amasTanave, saziano efeqti mTeli rigi paTologiuri
ama Tu im ujredSi NO-s warmoqmnaSi sxva- procesebis da avadmyofobis dros.
dasxva tipis NOS monawileobs. gamovlenilia NO-m SeiZleba gamoavlinos mZlavri
am fermentis minimum ori tipi – konsti- prooqsidaciuri moqmedeba. amas garda,
tuciuri da inducirebadi. superoqsidradikalTan urTierTqmedebisas
azotis oqsidi organizmSi mimdinare mra- is warmoqmnis uaRresad toqsikur naerTs
valricxovani reaqciebis aucilebeli da, peroqsinitrits, romelic iwvevs ujredebis
amasTanave, Seucvleli komponentia. am reaq- mZime dazianebas da sikvdils. aRsaniSnavia
ciebis efeqti gansazRvravs konkretul si- NO-s friad aqtiuri da mniSvnelovani ro-
tuaciaSi NO-s biologiur Rirebulebas - li anTebis paTogenezSi (ix."anTeba").
pozitiurs Tu negatiurs. NO-m SeiZleba fermentebis roli. ujredis dazianebaSi
gamoiwvios rogorc dadebiTi (Terapiuli), mniSvnelovani wvlili SeiZleba Seitanon
ise uaryofiTi (toqsikuri) efeqti. misi membrandamokidebulma, Tavisufalma da li-
moqmedebis dualuri xasiaTi SeiZleba aixsnas zosomurma fermentebma: lipazebma, fosfo-
zedmiwevniT farTo masStabis biologiuri lipazebma, proteazebma. maTi aqtivoba matu-
roliT, romelsac is asrulebs ujredis lobs ujredze paTogenuri faqtorebis moq-
cxovelmyofelobaSi. am faqtis gaTvaliswi- medebisas (magaliTad, acidozis dros). am
nebis gareSe SeuZlebelia azotis oqsidis fermentebis gaaqtivebisas xdeba membranis
efeqtis Sefaseba. glicerfosfolipidebis, cilebis, ujredis
azotis oqsidi aaqtivebs enzim guani- fermentebis hidrolizi, rasac membranebis
dinciklazas. kinazuri sistemis CarTva gana- ganvladobis Zlieri momateba moyveba.
pirobebs cikluri guanozinmonosfosfatis kon-
30
wylis da ionebis disbalansi. ujredis ujredis aerobuli sunTqva. TviT hipoqsiis
membranis dazianebas energodeficitis an mizezebi mravalgvaria - garegani sunTqvis
lzJ-is gamo Tan sdevs ionebis da wylis da sisxlis mimoqcevis darRveva, anemia da
disbalansi, romelic gamowveulia aRniSnul sxv. (ix."hipoqsia"). hipoqsiis siRrmis da
procesTa gamo ganviTarebuli ionTa trans- misdami mgrZnobelobis xarisxTan dakavSire-
portis (gansakuTrebiT, kaliumis, kalciumis, biT ujredi met-naklebad egueba mas, zian-
magniumis, qloris) darRveviT membranaSi. deba an kvdeba.
ionTa disbalansi, ufro xSirad, Tavs gansakuTrebiT mZime hipoqsias iwvevs
iCens ujredSi natriumis dagrovebiT da ka- qsovilis iSemia. hipoqsiis damazianebeli
liumis dakargviT (K- - da Na- - damokidebu- moqmedebis pirveli punqti mitoqondriebSi
li atf-azas aqtivobis cvlilebebis gamo), JangviTi fosforilebis darRvevaa, rasac
kalciumis Semcvelobis momatebiT. ionebis mohyveba ujredis energiis umTavresi wya-
disbalansi iwvevs ujredis membranuli po- ros - atf-s sinTezis daqveiTeba. hipoqsi-
tencialis, aqedan gamomdinare ki - agznebis isas ujredis dazianebis erT-erTi pirveli
aRmocenebis da gatarebis darRvevas. ionebis niSania ujredis komponentebis SeSupeba. es
Semcvelobis cvlilebebi ujredSi iwvevs misi membranis dazianebis, natrium-kaliumis
wylis disbalanssac, romelic gamoixateba tumbos funqciis darRvevis Sedegia, rac
hiperhidrataciiT (SeSupebiT) an hipohidra- atf-s raodenobis cvlilebasTanaa dakavSi-
taciiT. Sesabamisad, icvleba ujredis mocu- rebuli. xangrZlivi hipoqsiis dros ujred-
loba da forma. magaliTad, natriumis an Si Seuqcevadi cvlilebebi viTardeba. misi
kalciumis ionebis dagroveba ujredSi iwvevs CamoyalibebisTvis saWiro eqspozicia ara-
wylis mizidvas maRali osmosuri wnevis erTnairia sxvadasxva ujredisTvis. magali-
gamo. ujredi jirjvdeba, iWimeba, viTardeba Tad, RviZlis ujredSi Seuqcevadi cvlile-
citolemis da membranis mikrotramvebi maTi bebi viTardeba hipoqsiis dawyebidan 1-2
mikrogaglejiT. saaTis, Tavis tvinis ujredebSi ki - 3-5
wylis gamosvla ujredidan (dehidra- wuTis Semdeg. ujredebis dazianeba hipoqsi-
tacia) iwvevs misi birTvis SeWmuxvnas, mi- is dros gaivlis erTi da igive stadiebs,
toqondriebis da sxva organelebis daSlas. magram sxvadasxva siCqariT.
genetikuri programis darRveva. ujredis
dazianebis kidev erTi mniSvnelovani gzaa 4.1.3. ujredis dazianebis araspecifikuri
genetikuri programis darRveva, romlis gamovlinebebi
ZiriTadi mizezia mutaciebi da funqciebis ujredis dazianebis gamovlinebebi Sed-
regulaciis ujredSiga meqanizmebis moSla, geba araspecifikuri da specifikuri kompo-
romelic SeiZleba ganviTardes maregulire- nentebisgan.
beli meqanizmebis erT an ramdenime doneze. ujredis dazianebis zogad anu araspe-
maTgan yuradRebas iqcevs biologiurad aq- cifikur gamovlinebebs miekuTvneba: maTi
tiuri nivTierebebis recepciis (magaliTad, membranis ganvladobis darRveva, cilis
kateqolaminebis, insulinis), meoradi gadam- denaturacia, wylis cvlis darRveva, Se-
cemebis (magaliTad, camf, cgmf), ujreduli Supeba, ujredidan kaliumis ionebis gamos-
metaboluri reaqciebis done. vla, ujredebis autolizi, acidozi da
rogorc gansakuTrebiT mniSvnelovani, sxv. ujredis dazianebas Tan sdevs misi
calke unda iqnas ganxiluli ujredis Jan- membranis ganvladobis cvlilebebi cilebis,
gbadiT dazianebis meqanizmi. aminmJavebis, ionebis mimarT.
ujredis hipoqsia. ujredis dazianeba Jan- dazianebisas izrdeba ara marto ujrede-
gbadiT. ujredis dazianebis yvelaze xSiri bis, aramed subujreduli struqturebis
mizezia hipoqsia, romlis dros wydeba (mitoqondriebi, lizosomebi da sxv.) membranebis
31
ganvladobac, rac iwvevs Tavisufali amin- bis Sedegad gaTavisuflebuli fermentebis
mJavebis, lizosomuri fermentebis gaTavi- moqmedebasTan. acidozi ujredis dazianebis
suflebas aqedan gamomdinare yvela SedegiT. araspecifikuri gamoxatulebaa da viTardeba
cilis denaturacia viTardeba maRali damzianebeli faqtoris (hipoqsia, meqaniku-
temperaturis moqmedebis Sedegad, pH-is ri, qimiuri, baqteriuli faqtorebi da sxv.)
mkveTri cvlilebis, eqsikozis, mZime metalTa xasiaTis miuxedavad. saWiroa ujredebis
marilebiT mowamvlis dros. denaturaciisas dazianebis - pirveladi acidozis dife-
icvleba cilis molekulis sidide, xsnadoba, rencireba anTebis dros ganviTarebuli me-
optikuri aqtivoba. oradi acidozisgan, romelic dazianebidan
ujredis araspecifikuri dazianebis erT- gacilebiT ufro meti drois - ramdenime
erTi mTavari gamovlinebaa ujredSi wylis saaTis gavlis Semdeg viTardeba.
cvlis darRveva. wyali tovebs ujredis ujredis dazianebisas irRveva misi
protoplazmas da gamodis ujredidan, ris sunTqvac, rac dakavSirebulia ujredSiga
gamo dazianebul qsovilSi izrdeba JangviTi fermentebis aqtivobis cvlilebeb-
ujredgareTa wylis Semcveloba, viTardeba Tan, rac amcirebs ujredis mier Jangbadis
e.w. travmuli SeSupeba (magaliTad, tvinis moxmarebas da aZliereben aerobul
SeSupeba Tavis qalas tramvebis dros). glikolizs. ujredebis urTierTqmedebaSi
natrium-kaliumis tumboebis funqciis gadamwyvet rols maTi membranebis
darRvevis gamo dazianebul ujreds tovebs sasignalo mole-kulebi, sxvadasxva tipis
kaliumi, rac ujredis araspecifikuri da jgufis anti-genebi TamaSoben. maTi Tavi-
dazianebis kidev erTi niSania. aseT suraTs seburebebis, Se-madgenlobis cvlilebebi
aqvs adgili, magaliTad, meqanikuri travmis, iwveven urTier-Tqmedebis darRvevas ujre-
intoqsikaciebis, alergiis dros. ujredis debs Soris da qmnian maTi eliminaciis
gansakuTrebiT mZime, kompleqsur dazianebas pirobebs.
iwvevs citozolSi kalciumis ionebis ujredis dazianebas Tan sdevs energiis
dagroveba, (riTac uxSiresad iwyeba ujredis warmoqmnis procesis darRveva. normaSi mis
araspecifikuri reaqcia dazianebaze). rac mier sakvebi nivTierebebis SeTvisebisas Ta-
iwvevs fosfolipazas, atf-azas, proteazebis, visufldeba energia, romlis nawili gar-
endonukleazebis aqtivacias, fosfolipidebis daiqmneba siTbur energiad, danarCeni ki
da atf-s deficits, membranebis mito- deponirdeba makroergul naerTebSi (magali-
qondriebis birTvis dazianebas. Tad, atf) da ixarjeba sxvadasxva mizniT.
ujredis dazianebas Tan sdevs ujredSiga ujredis araspecifikuri dazianebis ki-
proteazebis gaaqtiveba, romelTa zemoq- dev erTi gamovlinebaa membranuli poten-
medebisas Zlierdeba protoplazmis cilovan- cialis daqveiTeba. is dakavSirebulia citop-
lipiduri kompleqsebis daSlis procesi, lazmis membranis struqturis an membranebis
icvleba maTi koloiduri mdgomareoba, ionuri tumboebis funqciis darRvevasTan,
grovdeba polipeptidebis, zogierTi romlebic aregulireben potencialTa tran-
aminmJavas proteolizis mJave produqtebi, smembranul sxvaobas membranis sxvadasxva
rac pH-is Sesabamis cvlilebebs iwvevs. es mxares ionTa koncentraciis mowesrigebis
procesebi udevs safuZvlad dazianebuli gziT.
ujredebis autolizs (TviTmonelebas). ujredis dazianeba xasiaTdeba misi
ujredis dazianebisas viTardeba misi genetikuri aparatis cvlilebebiT. dazianebisas
protoplazmis acidozi. rogorc aRiniSna, is icvleba ujredis birTvis forma, masSi
Sedegia proteolizis, lipolizis da qromosomebis ganawileba, struqtura da
glikolizis gaZlierebisa, rac, Tavis mxriv, simkvrive. SeiZleba adgili hqondes birTvis
didadaa damokidebuli lizosomebis daziane- SeSupebas an SeWmuxvnas (piknozi), daglejas
32
(karioreqsisi), daSlas (kariolizisi). dazianebis (zogadi, generalizebuli adaptaciuri sin-
gamo membranis garsSi warmoqmnil nakecebSi dromi) an misi qsovilebis garkveuli nawi-
Caizrdebian citoplazmis struqturebi, li an organo (adgilobrivi adaptaciuri
birTvSi Cndeba ucxo CanarTebi: cximi, reaqcia).
glikogeni, pigmentebi, metalebi (magali-Tad, selies mier stresis koncefciis formi-
Saqriani diabetis, virusuli infeq-ciebis, rebis biZgad iqca jer kidev studentobis
tyviiT mowamvlis dros). wlebSi Catarebuli dakvirveba organizmis
stereotipul, erTgvarovan reaqciebze sxva-
5. organizmis zogadi reaqciebi dasxva avadmyofobis dros. man yuradReba
dazianebaze miaqcia, rom mraval infeqciur an arain-
avadmyofobis gamomwvevi agentebi, garda feqciur daavadebas Tan sdevs umadoba, si-
adgilobrivi cvlilebebisa, imavdroulad iw- gamxdre, kunTovani Zalis Semcireba, sisus-
veven organizmis zogad reaqciebs, romelTa te da sxv. am araspecifikuri stereoti-
intensivoba da gamovlinebani sxvadasxvagvaria puli reaqciebis Seswavlam, rasac seliem
da damokidebulia damazianebeli faqtoris Tavisi xangrZlivi da nayofieri moRvaweoba
bunebaze, organizmze misi moqmedebis siZlie- Sealia, saSualeba misca mas Camoeyalibebina
resa da xangrZlivobaze, TviT organizmis re- moZRvreba stresis Sesaxeb, romelsac miiC-
aqciulobasa da rezistentobaze. aseT zogad nevda "organizmis araspecifikur pasuxad
reaqciebs miekuTvneba zogadi adaptaciuri misdami nebismier moTxovnaze". selies sit-
sindromi, "mwvave fazis" reaqciebi, prote- yvebiT "stresis koncefcia Zalze Zvelia.
olizuri sistemebis gaaqtiveba, Soki, koma albaT, jer kidev istoriamdel adamiansac
da sxv. mosdioda TavSi, rom daZabunebas mZime
Sromis Sedegad, sicxeSi an siciveSi did-
5.1. zogadi adaptaciuri sindromi, stres-reaqcia xans yofnas, sisxlis dakargvas da nebismier
stresi sicocxlea da sicocxle - stresi " avadmyofobas raRac saerTo axasiaTebda".
h.selie stresi (ingl. Stress - daZabuloba) orga-
stresis da adaptaciis fenomenebi ama Tu nizmis araspecifikur reaqciaTa erTobli-
im formiT aRwerilia mravali drois obaa, romelsac safuZvlad udevs stresor-
bunebismetyvelis da eqimis, maT Soris hipok- Ta moqmedebis pasuxad ganviTarebuli
rates, dekartis, bernaris, kenonis, seCenovis neiroendokrinuli, metaboluri cvlilebebi
mier. magram mecnieruli safuZveli am da romelic vlindeba zogadi adaptaciuri
fenomens daudes hans selies da mis sindromis saxiT. stresis dros dacviTi
Semdgomma gamokvlevebma. Zalebis daZabvis Sedegad organizmis yvela
rogorc zogadi paTogenezis ganxilvisas sistema mobilizdeba da mimarTulia axal
aRiniSna, dazianebas organizmis mxriv Tan pirobebTan Seguebisken, organizmis rezis-
sdevs rogorc paTologiuri, ise sakompensa- tentobis gazrdisken. reaqciis ukmarisobis
cio da dacviT-SeguebiTi reaqciebi. maTgan SemTxvevaSi viTardeba paTologiuri cvli-
gansakuTrebiT mniSvnelovania kanadeli paTo- lebebi.
logis selies mier gamovlenili stres-re- seliem daadgina, rom stresorTa xasi-
aqcia anu zogadi adaptaciuri sindromi. aTis miuxedavad (travma, infeqcia, intoq-
adaptacia aris organizmis sistemuri, sikacia, gadacieba, narkozi, emociebi da
stadiurad ganviTarebadi Seguebis reaqcia sxv.), maTi moqmedebisas organizmSi viTar-
Zlieri gamRizianeblis mimarT, romlebsac deba erTgvarovani funqciuri da morfo-
seliem "stresorebi" uwoda. adaptaciur re- logiuri cvlilebebi: mkerdukana jirkvlis
aqciaSi SeiZleba monawileobdes mTeli or- da limfuri kvanZebis involucia, Tirk-
ganizmi an misi sistemebis umetesi nawili melzeda jirkvlis qerqovani Sris hiper-
33
trofia, hemoragiuli wylulebi kuWis da stresoris moqmedebis Sewyvetis an misi
Tormetgoja nawlavis lorwovan garsebze da umniSvnelo Zalis SemTxvevaSi ganviTa-
sxv. rebuli cvlilebebi swrafad normalizdeba.
stresi vlindeba zogadi adaptaciuri magram Tu paTogenuri agenti metad Zlieria
sindromis formiT, romelic sam stadiad an is xangrZlivad moqmedebs organizmze,
mimdinareobs. pirvel stadiaSi, romelic viTar-deba adaptaciuri sindromis mesame –
gangaSis stadiis saxelwodebiTaa cnobili, gamo-fitvis stadia: Tirkmelzeda jirkvlis
organizmis dacviTi Zalebi dauyovneblad fun-qcia mkveTrad qveiTdeba, organizmis
mobilizdeba. mas safuZvlad udevs organiz- dacvi-sunarianoba mcirdeba da xSir
mis sxvadasxva, gansakuTrebiT ki neiroen- SemTxvevaSi sikvdili dgeba.
dokrinuli sistemis funqciis Rrma cvli- zogadi adaptaciuri sindromis stadi-
leba. stresorTa zemoqmedebisas aqtiurdeba uroba kargad Cans Semdeg magaliTze: Tu
hipoTalamuri centrebis funqcia (ix. suraTi virTagvebs drois garkveuli intervalebiT
5-1), gamoiyofa rilizing-faqtorebi, rac iw- mivayenebT eleqtrotravmas erTi da igive
vevs, erTi mxriv, hipofizis mier adreno- maxasiaTeblebis eleqtrodeniT, maTi masa
kortikotropuli hormonis gamoyofis sti- mcirdeba (gangaSis stadia). SemdgomSi, imave
mulacias da, amis Sedegad, glukokor- intensivobis eleqtrotravmis miuxedavad,
tikoidebis da adrenalinis Warb produqcias, virTagvebis masis Semcireba wydeba, bevri
meore mxriv ki - simpatikuri nervuli sis- maTganis masa matulobs kidec (rezisten-
temis gaaqtiurebas da noradrenalinis gamo- tobis stadia). magram aseTive eleqtro-
yofis zrdas. yovelive amis gamo viTardeba travmebis gagrZelebisas, garkveuli perio-
Sinagani organoebis funqciuri mdgomareobis dis Semdeg, virTagvebis masa swrafad da
cvlilebebi, romlebic mimarTulia gamRizia- mkveTrad ecema da cxovelebi iRupebian (ga-
nebel faqtorTan adaptaciisken. mofitvis stadia).
stres-reaqciis meore da yvelaze zogadi adaptaciuri sindromis Sedegebis
xangrZliv - rezistentobis stadias axasiaTebs analizi gviCvenebs, rom mas dacviT-Segue-
Tirkmelzeda jirkvlis qerqovani Sris biTi xasiaTi aqvs. magram zog SemTxvevaSi
hipertrofia da kortikosteroidebis sekre- reaqcia misi gamomwvevis Zalis araadek-
ciis mdgradi momateba. am hormonebis uSua- vaturi - saWiroze ufro Zlieri, susti an
lo zemoqmedeba, maT mier simpaTikuri efeq- gaukuRmarTebulia. aseTma situaciam SeiZle-
tis gaZliereba, kateqolaminebis didi raode- ba gamoiwvios Semdgomi paTologiuri Zvre-
nobiT gamoyofa zrdis cirkulirebadi sis- bi, romelTac h.seliem "adaptaciis daavade-
xlis moculobas da arteriul sisxlis wne- bebi" uwoda.
vas, iZleva antihistaminur efeqts, aZlierebs amgvaria, zogadi saxiT, h.selies koncef-
glukoneogenezs. rezistentobis stadiaSi cia stresis da zogadi adaptaciuri sin-
mosalodnelia darRveuli funqciebis sruli dromis, rogorc misi gamovlinebis Sesaxeb.
kompensacia da adamianis gamojanmrTeleba. am mraval dadebiT mxaresTan erTad, am fun-
stadiaSi matulobs organizmis rezistentoba damentur koncefcias aqvs zogierTi xar-
ara marto stresis gamomwvevi agentis, ara- vezic, romelTagan aRsaniSnavia stres-reaq-
med sxva faqtorTa mimarTac. organizmze ciaSi nervuli sistemis rolis TiTqmis
susti da zomieri siZlieris faqtorebis mTliani ugulvebelyofa da gaRizianebaze
sistematuri zemoqmedeba (civi Sxapi, fiziku- organizmis pasuxis specifikuri mxaris
ri datvirTva) uzrunvelyofs endokrinuli mniSvnelobis daknineba.
sistemis mzadyofnas adaptaciuri reaqciiT h.selies moZRvrebis zogierTi debule-
pasuxisTvis. bis meqanikurma gagebam gamoiwvia seriozuli
Secdoma - Terapiul praqtikaSi kortikos-
34
teroidebis xSirad gaumarTlebeli gamoye-
neba. radgan kortikosteroidebs anTebis,
ujredebis ganuwyveteli gamravlebis,
alergiis sawinaaRmdego Tvisebebi aqvs,
gavrcelda maTi farTod da didi dozebiT
gamoyenebis praqtika. kortikosteroidebis hipoTalamusis centre
siWarbe ki iwvevs mZime avadmyofur
movlenebs - arteriul hipertonias, wylis
da marilebis cvlis darRvevebs, kuWis da
Tormetgoja nawlavis wylulebs da sxv.
meore mxriv, aseTi "mkurnalobisas" mcirdeba
adrenokortikotropuli hormonis da
kortikosteroidebis produqcia, zogjer ki
saqme midis Tirkmelzeda jirkvlis hipopla-
ziamde da atrofiamdec ki, rac avadmyofis
Semdgomi sicocxlis manZilze
kortikosteroidebiT Terapias saWiroebs.
egzogenuri kortikosteroidebis dozis 5.2.
uecari Semcirebisas viTardeba Tirkmelzeda
jirkvlis mwvave ukmarisoba. klinikurad is 5..2. Soki
gamovlindeba Tirkmlis milakebSi natriumis Soki (ingl. shok - dartyma, dacema)
reabsorbciis da, aqedan gamomdinare, terminaluri mdgomareobaa, romelic
sisxlZarRvTa tonusis daqveiTebiT, xasiaTdeba organizmis sasicocxlo
arteriuli wnevis SemcirebiT (zogjer funqciebis gamofitviT. is viTardeba
kolafsamde), hipokaliemiis gamo gulis organizmze iseTi faqtorebis moqmedebis
muSaobis cvlilebebiT, gulisreviT, Sedegad, romlebic iwvevs qsovilebis didi
RebinebiT, meteorizmiT. farTobis dazianebas daanafilaqsiuri
mgrZnobiare
magram Teoriis araswori gamoyeneba ar nervuli daboloebebis Zlier gaRizianebas.
SeiZleba miviCnioT mis arasrulfasovnebad. ganasxvaveben travmul, hipovolemiur,
mTlianobaSi h.selies koncefciam stresis damwvrobiT, eleqtro-
kardiogenul, eleqtrul,
Sesaxeb mniSvnelovani roli Seasrula hemotransfuziul, anafilaqsiur, septikur
avadmyofobaTa profilaqtikisa da mkurna- da sxv. Soks (sur. 5-2).
lobis perspeqtiuli meTodebis SemuSavebaSi. Sokis cneba sakmaod zogadi da
rac Seexeba paTogenezSi specifikurs, e.i.
im niSnebs, romlebze dayrdnobiTac diagnozs
naklebdeterminirebulia.
postoperaciuli ravenis mixedviT,
"albaT sityvaTa araviTar krebuls ar
Soki
adgenen, aq pirvelxarisxovan rols asrulebs ZaluZs Sokis gansazRvra". "ufro iolia
TviT etiologiuri faqtori. gamomwvevi Sokis amocnoba, vidre misi aRwera da
mizezi moqmedebs zogad araspecifikur fonze ufro advilia misi aRwera, vidre misi
da damaxasiaTebel, specifikur niSnebs septikuri
gansazRvra"(delorie). belingeris mixedviT
aniWebs avadmyofobas. "Sokis cneba ar aris gansakuTrebiT
mecnieruli, magram, is Zalze sasargebloa
sur. 5-1. stres-reaqciis zogadi klinikur praqtikaSi". damwvrobiTi
meqanizmi migvaCnia, rom Soks aseTi (SeiZleba arc
zedmiwevniT sruli) gansazRvreba unda
mieces: Soki aris organizmze mZlavri da-
mazianebeli zemoqmedebis gamo aRmocenebu-
stresi
35
li refleqsuri warmoSobis terminaluri (sur. 5-3). pirvel rigSi, aseTia ori tipis
mdgomareoba, romelic xasiaTdeba centralu- sakompensacio-adaptaciuri reaqciebis
ri nervuli sistemis zezRurblovani CarTva. pirvelis arsia simpaTikur-adrenuli
agznebiT, mikrohemocirkulaciis da mTli- da hipofizur-Tirkmelzeda jirkvlis
anad hemodinamikis, sunTqvis da nivTiere- sistemaTa aqtivacia: sisxlis dakargvis an
baTa cvlis mkveTri darRveviT. misi moculobiTi siCqaris da gulisken
Sokis yvela formas, ganviTarebis saerTo midinebuli sisxlis masis Semcireba
kanonzomierebebTan erTad, paTogenezis speci- Sesabamisad iwvevs hipovolemias an
fikuri Taviseburebebic axasiaTebs. misi ne- SefardebiT hipovolemias, rasac arteriuli
bismieri formisTvis damaxasiaTebelia ro- hipotenzia mohyveba. amis gamo, iTiSeba
gorc centraluri sisxlis mimoqcevis , ise baroreceptorebi da refleqsurad aqtivdeba
mikrocirkulaciis mZime darRveva. es uka- zemoaRniSnuli sistemebi. Sedegad
naskneli iwvevs kapilaruli sisxlis nakadis, kateqolaminebi da kortikosteroidebi didi
qsovilebisTvis Jangbadis da energetikuli raodenobiT gadmoisroleba. kateqolaminebi
substratis miwodebis Semcirebas, qsovilebi- aviwroeben kanis, saWmlis momnelebeli
dan metabolizmis produqtebis gamotanis traqtis, -adrenorecepciis mqone sxva
dabrkolebas. am pirobebSi ganviTarebuli me- sisxlZarRvebs da am gziT iwveven sisxlis
taboluri acidozi kidev ufro aRrmavebs mimoqcevis "centralizebas" -
mikrocirkulaciis paTologias, iwvevs arte- sisxlmomarageba unarCundeba guls da Tavis
riolebis gafarToebas, sisxlis Sesqelebas, tvins, garkveul doneze regulirdeba arte-
eriTrocitebis agregacias, mikroTrombebis riuli sisxlis wnevac. naxsenebs didi
ganviTarebas. sakompensacio-adaptaciuri mniSvneloba aqvs.
sur. 5-2 Sokis saxeebi magram am fonze sxva organoebis sisxl-
momaragebis daqveiTeba iwvevs maT hipoqsias,
rac iwvevs meore tipis, e.w. vazodilataci-
uri adaptaciuri meqanizmis CarTvas, rome-
lic mimarTulia organoTa hipoqsiis wi-
naaRmdeg. warmoiqmneba vazoaqtiuri aminebi,
polipeptidebi, sxva biologiurad aqtiuri
nivTierebebi, romlebic iwveven sisxlZar-
RvTa gafarToebas, maTi ganvladobis moma-
tebas, sisxlis denadobis cvlilebas. am
procesSi mniSvnelovan rols asrulebs
dazianebul qsovilebSi ujredebis daSla.
vazoaqtiuri nivTierebebis Warbi warmoqmna
sakompensacio-adaptaciur reaqcias paTolo-
giurad aqcevs: irRveva mikrohemocirkula-
cia, mcirdeba kapilaruli da izrdeba
Suntirebuli sisxlis nakadi (sisxlis ga-
dasvla arteriolebidan uSualod venuleb-
Si), icvleba prekapilaruli sisxlZarRvebis
reaqcia kateqolaminebze (gafarToeba), iz-
bunebrivia, rom Sokis sxvadasxva formis rdeba kapilarebis kedlebis ganvladoba,
meqanizmi xasiaTdeba TaviseburebebiT, magram yalibdeba ramdenime "mankieri wre",
nebismieri formis Sokis paTogenezSi SeiZ- Rrmavdeba mikrohemocirkulaciis darRveva,
leba saerTo sakvanZo rgolebis gamoyofa mcirdeba gulisken midinebuli sisxlis
36
moculoba, mcirdeba gulis dartymiTi sisxlis mimoqceva ganicdis centralizebas,
moculoba da arteriuli wneva. viTardeba fermkrTaloba, taqikardia, xSir-
amrigad, Soki gadadis ufro mZime deba sunTqva.
stadiaSi. Sokis progresirebisTvis didi aRniSnuli sakompensacio reaqciebis
mniSvneloba aqvs sxvadasxva sistemis da ukmarisobis dros dgeba Sokis meore -
organos funqciis darRvevis gamo Sekavebis anu torpiduli stadia, romlis
ganviTarebul meorad Zvrebs, gansakuTrebiT mimdinareobaSi gansakuTrebuli mniSvneloba
filtvis, RviZlis, kuW-nawlavis traqtis aqvs Sekavebis ganviTarebas centralur
organoebis, Tirkmlis mxriv, rac SeiZleba nervul sistemaSi da sisxlis mimoqcevis
gaxdes xsenebul organoTa mwvave ukmari- dekompensacias. Sokis simZimes xSirad
sobis mizezi. sazRvraven arteriuli sisxlis wnevis
paTologiur reaqciaTa intensivoba ara- dacemis da taqikardiis xarisxiT - msubuqi
erTnairia sxvadasxva saxis Sokis dros. amas- xarisxi - sistoluri wneva 90-100 mm/Hg,
Tanave, TiToeul maTgans ganviTarebis Tavi- pulsis sixSire 90-100 wuTSi; saSualo
seburebebi axasiaTebs. xarisxi - sistoluri wneva 70-80 mm/Hg,
travmuli Soki viTardeba sayrden- pulsis sixSire 120-140 wuTSi; mZime
mamoZravebeli aparatis, gulmkerdis, muclis xarisxi - sistoluri wneva 70 mm/Hg-ze
Rrus da sxva organoebis mZime travmebis Se- dabali, pulsis sixSire 120-160 wuTSi.
degad. misi ganviTarebis Taviseburebebi da- ufro zust monacemebs Sokis simZimis
kavSirebulia eqstero- da interoreceptore- Sesaxeb mJavur-tutovani wonasworobis
bis Zlier gaRizianebasTan an uSualo da- gansazRvra iZleva.
zianebasTan, maTgan aRmavali paTologiuri Sokis torpidul stadiaSi viTardeba
impulsaciis gamo centraluri nervuli qsovilebis generalizebuli hipoqsia, rac
sistemis funqciis darRvevasTan. travmuli iwvevs nivTierebaTa cvlis darRvevebs,
Sokis paTogenezSi mniSvnelovan rols biologiurad aqtiuri nivTierebebis dagro-
asrulebs, agreTve, toqsemia (dazianebuli vebas, organizmis funqciebis neiroendok-
qsovilidan sisxlSi biologiurad aqtiuri rinuli regulaciis moSlas. mcirdeba
da toqsikuri nivTierebebis gadasvla), qsovilebis mgrZnobeloba nervuli agznebis
dazianebuli organoebis funqciis darRveva, mediatorebis, kateqolaminebis, glukokor-
fsiqikuri travma. Tu meqanikur travmas Tan tikoidebisa da neiroendokrinuli regula-
sdevs sisxldenac, travmuli Soki, cxadia, ciis sxva faqtoris mimarT; amitom, sis-
ufro mZimed mimdinareobs. xlSi kortikosteroidebis maRali Semcve-
travmuli Sokis ganviTareba da misi loba ver uzrunvelyofs maT zemoqmedebas
simZime dakavSirebulia, agreTve, organizmis qsovilur metabolizmze.
memkvidrul da konstituciur Tavisebure- torpiduli stadiis progresirebaSi
bebTan, reaqciulobasTan. didi mniSvneloba aqvs sxvadasxva organos
travmuli Sokis mimdinareobaSi ansxva- da sistemis funqciis darRvevis gamo
veben sam - ereqtiul, torpidul da termi- ganviTarebul meorad Zvrebs, gansakuTrebiT
nalur stadias. filtvis, RviZlis, kuW-nawlavis traqtis
ereqtiuli stadia xanmoklea. mas axasiaTebs organoebis, Tirkmlis mxriv, rac SeiZleba
centraluri nervuli sistemis (Tavis tvinis gaxdes am organoTa mwvave ukmarisobis
qerqi, qerqqveSa birTvebi, simpaTikuri ner- mizezi. cxadia, rom am pirobebSi irRveva
vuli sistemis vegetatiuri birTvebi) Zli- organizmis Sinagani garemos mudmivoba,
eri agzneba, ris Sedegad viwrovdeba peri- viTardeba hipokaliemia, rac gulis fun-
feriuli sisxlZarRvebi, matulobs perife- qciis cvlilebebs iwvevs. gansakuTrebuli
riuli winaaRmdegoba sisxlis nakadisadmi, mniSvneloba aqvs lizosomuri fermentebis
37
gaTavisuflebas da maTi moqmedebis Sedegad kardiogenuli Sokis paTogenezSi gansa-
ganviTarebul ujredebis meorad dazianebas. kuTrebuli mniSvneloba aqvs sam faqtors:
Sokis terminaluri stadia, kateqolami- 1) tkivilis sindroms, romelic viTar-
nebis mimarT areaqciulobis gamo, xasiaTdeba deba miokardiumis isqemiis da masSi dau-
arteriolebis tonusis dacemiT, rac Jangavi produqtebis dagrovebis Sedegad;
arteriuli sisxlis wnevis katastroful 2) miokardiumis SeSupebas sisxlZar-
daqveiTebas da mkveTr generalizebul hipoq- Rvovan-qsoviluri ganvladobis mkveTri
sias iwvevs. cxadia, rom hipoqsiis gamo momatebis gamo;
ziandeba gulis funqciac. sikvdili uxSi- 3) gul-sisxlZarRvovan ukmarisobas
resad dgeba sunTqvis Sewyvetis Sedegad. (kolafss), romelic viTardeba gulis
pirveladi hipovolemiuri Soki viTardeba dartymiTi moculobis Semcirebis da
garegani da Sinagani sisxldenis Sedegad periferiuli sisxlZarRvebis tonusis
(travma, organoebis an qsovilebis dazianeba darRvevis gamo.
paTologiuri procesebiT, sisxlis Sededebis septikuri (endotoqsikuri) Soki sefsisis
darRveva), plazmis, siTxis da eleqtroli- garTulebaa. "endotoqsikurs" mas imitom
tebis didi raodenobiT dakargvisas. uwodeben, rom mTavari damazianebeli faq-
cirkulirebadi sisxlis moculobis de- tori am dros baqteriebis (gansakuTrebiT
ficiti iwvevs gulis sistoluri da wuTmo- gramuaryofiTebis) endotoqsinia.
culobis, arteriuli sisxlis wnevis Sem- septikuri Sokis mTavari ganmasxvavebeli
cirebas. refleqsi baroreceptorebidan da niSania misi ganviTareba infeqciuri pro-
simpaToadrenaluri reaqcia (gulis -adre- cesis fonze. mas xSirad axasiaTebs Zlieri
noreceptorebis da sisxlZarRvTa -adre- Semcivneba da oflianoba, taqipnoe, sifer-
noreceptorebis stimulacia) uzrunvelyofs mkrTale, sisxlis mimoqcevis ukmarisobis
sakompensacio reaqciebs - gulis SekumSvaTa swrafi ganviTareba.
sixSiris da sisxlis nakadis mimarT peri-
feriuli winaaRmdegobis gazrdas, rac mimar- 5.3 kolafsi
Tulia sisxlis wnevis donis da organoTa meqanizmiT da klinikuri gamovlinebiT
sisxlmomaragebis normalizebisken. am meqa- Soks Zlier waagavs sisxlZarRvovani ukma-
nizmebis ukmarisobisas vlindeba SokisTvis risoba - kolafsi (laT. collafor-dacema).
damaxasiaTebeli movlenebi. orive maTgans aerTianebs arteriuli wnevis
kardiogenuli Soki viTardeba gulis tum- mkveTri dacema. kolafsi, pirvel rigSi,
bos funqciis darRvevis dros (miokardiumis sisxlZarRvovani ukmarisobaa. gansxvavebiT
infarqti, miokarditi, paroqsizmuli taqi- Sokisgan, is viTardeba vazokontriqciuli
kardia, morgan-edem-stoqsis sindromi da reaqciis pirveladi ukmarisobis gamo, ro-
sxv.). am tipis Soki zogjer dakavSirebulia melic kolafsisTvis damaxasiaTebeli yvela
parkuWebis sisxliT avsebis dabrkolebasTan sxva movlenis mizezi xdeba.
(magaliTad, filtvis Tromboembolia). iseve, rogorc iTqva, Soki upiratesad sta-
rogorc hipovolemiuri Sokis dros, simpa- diurad mimdinareobs da iwyeba agznebis
Toadrenaluri reaqciis gamo viTardeba taqi- faziT. kolafsis dros ki es faza ar
kardia da matulobs periferiuli winaaRmde- aRiniSneba. is, upiratesad, gonebis dakar-
goba, magram es mxolod amZimebs hemodinami- gviT mimdinareobs, axasiaTebs arteriuli da
kis cvlilebebs, radganac gulis, rogorc venuri wnevis daqveiTeba, cirkulirebadi
tumbos funqcia arasakmarisia, xolo taqi- sisxlis moculobis Semcireba.
kardia am pirobebSi gulis sisxlmomaragebis kolafsis klinikuri suraTi mgavsia
gazrdas moiTxovs. Sokisa, rac araiSviaTad iwvevs maTi
diferencirebis aucileblobis
38
gauTvaliswineblobas da orive SemTxvevaSi gamoyofa. am procesebis gavleniT tvinis
mkurnalobis erTnairi sqemis gamoyenebas. es qsovilis dazianebis da garsebis SeSupebis
Secdomaa Tundac imitom, rom kolafsis gamo viTardeba retikuluri formaciis,
dros nervuli komponenti ar TamaSobs qerqqveSa warmonaqmnebis da vegetatiuri
esoden mniSvnelovan rols, xolo centrebis funqciis daTrgunva.
sisxlZarRvTa tonusis aRdgenisken
mimarTuli zogierTi Careva (magaliTad,
kateqolaminebis Seyvana organizmSi),
romelic aucilebelia kolafsis dros,
Sokis SemTxvevaSi xSirad winaaRmdegnaCvenebia
sisxlZarRvTa SesaZlo paradoqsuli
reaqciebis gamo.
etiologiuri faqtoris xasiaTis
mixedviT ganasxvaveben hemoragiul, toqsikur,
infeqciur, pankreasul, orTostatikul
kolafss.
kolafsis yvela formisTvis saerToa
mkveTri sisxlZarRvovani ukmarisoba,
cirkulirebadi sisxlis masis Semcireba,
generalizebuli hipoqsia. hipoqsiis gamo
ganviTarebuli sisxlZarRvebis ganvladobis
momateba iwvevs plazmoragias, sisxlZarRvTa
tonusis kidev ufro mkveTr daqveiTebas da
mZime hipotenzias. yovelive es aZlierebs
hipoqsias da procesi sul ufro da ufro
Rrmavdeba.
samkurnalo RonisZiebebi mimarTuli unda
iyos, pirvel rigSi, sisxlZarRvTa tonusis
da sisxlis wnevis aRdgenisken. miT ufro,
rom, Sokisgan gansxvavebiT, kolafsis dros
sisxlZarRvTa mgrZnobeloba kateqolaminebis
da angiotenzinis mimarT, Cveulebriv,
Secvlili ar aris.
5.4 koma
koma (berZn. koma-Rrma Zili)
paTologiuri mdgomareobaa, romelsac
centralur nervul sistemaSi ganviTarebuli
paTologiuri Sekavebis gamo axasiaTebs 6. garegani faqtorebis
gonebis sruli dakargva, refleqsebis damazianebeli gavlena organizmze
gaqroba da organizmis funqciebis sxvadasxva bunebis mravalricxovani
regulaciis Rrma darRveva. garemo faqtorebi, romlebic zemoqmedeben
koma dgeba maSin, rodesac romelime adamianis organizmze, SeiZleba gadaiqcnen
avadmyofobis gamo viTardeba Tavis tvinis daavadebis mizezad, Tu maTi moqmedebis Zala
hipoqsia, acidozi, irRveva eleqtrolitebis an/da xangrZlivoba Warbobs organizmis
balansi da cns-is sinapsebSi mediatorebis adaptaciur (SeguebiT) SesaZleblobebs.
39
garemos faqtorTa paTogenoba SefardebiTia amitom moxucebs ufro xSirad uviTardebaT
da maTi moqmedebis realizeba dakavSirebulia motexiloba, gaWimva da a.S. qsovilebis
arsebul Sinagan da garegan pirobebTan. mdgradoba meqanikuri faqtorebis mimarT
gasaTvaliswinebelia isic, rom Cvens mcirdeba, agreTve, maTSi mimdinare paTolo-
droSi, samecniero-teqnikuri progresis giuri procesebis, magaliTad, anTebis dros.
Sedegad, adamianze xSirad zemoqmedebs iseTi gaWimva cvlis qsovilis elastikurobas
faqtorebi, romelTa mimarT mas ar aqvs - misi Wimvadoba izrdeba, xolo drekadoba
kompensaciis da Seguebis evoluciurad mcirdeba. iogebis, kanis, aortis da sxv.
gamomuSavebuli meqanizmebi. aseT e.w. ganmeorebiTi gaWimvisas - qsovilebi atro-
eqstremul faqtorebs miekuTvneba, magaliTad, firdeba, maTi funqcia irRveva. magaliTad,
kosmosuri faqtorebi (gadatvirTva, kuWis kedlebis xSiri gaWimva Warbi sak-ve-
uwonadoba), xelovnuri maionizebeli radi- biT iwvevs misi lorwovani garsis ganlevas,
acia (atomuri bombis afeTqeba, avaria sekreciuli da motoruli funqciis dar-
atomur energowyaroebSi) da sxv. Rvevas; filtvebis gaWimva emfizemis, bron-
daavadebis gamomwvev faqtorebs hyofen quli asTmis dros amcirebs mis elastikur
fizikur (meqanikuri, Termuli, eleqtruli Tvisebebs da aZnelebs amosunTqvas.
da sxivuri energia, gadatvirTva, aCqareba, dartyma aris im meqanikuri movlenebis
atmosferuli wnevis cvlilebebi, kosmosuri erToblioba, romlebic aRmocendeba moZravi
faqtorebi), qimiur (tuteebi, mJavebi da sxeulebis, an moZravi da uZravi sxeulebis
sxv.), biologiur (parazitebi, baqteriebi, ri- Sejaxebisas. dartymis Sedegad irRveva
ketsiebi, virusebi) da fsiqogenur faqtore- qsovilis mTlianoba - viTardeba Zvlis mo-
bad. zog SemTxvevaSi isini erTdroulad moq- texiloba, kanis, kunTebis, rbili qso-
medeben organizmze da kompleqsur dazianebas vilebis gagleja, sisxlZarRvebis dazianeba
iwveven. da sisxldena, Sinagani organoebis dazianeba.
travmis xasiaTi damokidebulia misi ga-
6.1. meqanikuri faqtorebis damazianebeli momwvevi garemoebis (sagnis) bunebaze
zemoqmedeba organizmze. (blagvi, mWreli, dartymiTi talRa da
6.1.1. meqanikuri travma sxv.), sxeulTa moZraobis siCqareze, maT
meqanikuri energiis moqmedebis Sedegad kinetikur energiaze, sxeulTa Sejaxebis
mosalodnelia organoebis da qsovilebis farTobze, dartymis miyenebis kuTxeze, qso-
sxvadasxva saxis dazianeba an dazianebaTa vilis da mTlianad organizmis mdgomare-
kombinacia: myesebis da kunTebis gaWimva, obaze.
Zvlebis motexiloba, amovardniloba, qsovi- dartymis moqmedeba ar Semoifargleba
lebis daJeJva an gaxleCa (Wriloba, gaWimva organoebis da qsovilebis adgilobrivi da-
da gagleja), nervebis da sisxlZarRvTa ked- zianebiT. farTo receptoruli velebis an
lebis dazianeba, sisxldena, travmuli Soki nervuli boWkoebis mravlobiTi dazianebisas
da sxv. meqanikuri faqtoris moqmedebis efeq- viTardeba organizmis zogadi reaqcia trav-
ti pirobadebulia misi ZaliT da im qsovi- muli Sokis saxiT (ix. "travmuli Soki").
lebis rezistentobiT, romlebzec is uSua- zewolas yvelaze did winaaRmdegobas
lod moqmedebs. gaglejisadmi yvelaze ufro uwevs Zvlebi. magaliTad, TeZos Zvlis
medegia Zvali (gasagleji Zala 800kg/sm2), deformacias zewoliT sWirdeba 685kg/sm2
myesi (625kg/sm2), sisxlZarRvebisTvis gasag- datvirTva. Zvlebis winaaRmdegoba zewolis
leji Zalaa 13-15kg/sm2, ganivzoliani kun- mimarT 1000-jer metia mis winaaRmdegobaze
TisTvis - 4-5kg/sm2. dartymis mi-marT.
qsovilebis rezistentoba da elastiku- zewolisadmi metad mgrZnobiarea rbili
roba asakis matebasTan erTad mcirdeba. qsovilebi. arc Tu mZlavrma zewolam SeiZ-
40
leba maTi nekrozi gamoiwvios. mozard qso- monebis" zogadtoqsikuri moqmedebis Sede-
vilze zewola zrdis Seferxebas an Sew- gia, agreTve, Tirkmlis dazianebac.
yvetas iwvevs. gansakuTrebiT mZime adgilob- xangrZlivi zewolis Semdeg, misgan uSua-
rivi da zogadi xasiaTis movlenebi viTardeba lod dauzianebel qsovilebSi ganviTarebu-
rbil qsovilebze xangrZlivi zewolis - li movlenebis ZiriTadi meqanizmebi asaxu-
kraS-sindromis dros. lia Cveni gamokvlevebis Sedegebis da, nawi-
xangrZlivi moWyletis sindromi. lobriv, literaturuli monacemebis gamo-
meqanikuri travmiT gamowveul paTologi- yenebiT Cvens mierve SemuSavebul origi-
aTa Soris gansakuTrebiT sayuradReboa rbi- nalur sqemaze (sur. 6-1).
li qsovilebis xangrZlivi moWyletis sin- kompresiis Semdeg dazianebul qsovilSi
dromi (xzs, "kraS-sindromi"). moWyletis sin- warmoqmnili toqsikuri nivTierebebis sis-
dromi gansakuTrebiT xSiria stiqiuri ube- xlSi gadasvla da stres_reaqciis gamo gan-
durebebis (mewyeri, miwisZvra, zvavi) da sa- viTarebuli hiperkateqolaminemia, iwvevs
omari moqmedebebis dros. sindromi viTardeba lzJ-is gaZlierebas. amis gamo ziandeba uj-
zewolis moxsnis (dekompresiis) Semdeg da redebis (maT Soris eriTrocitebis) mem-
mas axasiaTebs iseTive mZime funqciuri da brana, iTrguneba mikrosisxlZarRvTa adre-
morfologiuri cvlilebebi, rogorc trav- oreaqtiuli struqturebis funqcia, far-
mul Soks. mas xSirad emateba Tirkmlebis Tovdeba mikrosisxlZarRvebi da mcirdeba
ukmarisobac, romelsac axasiaTebs Sardis sisxlis nakadis xazovani siCqare maTSi.
gamoyofis Semcireba (oliguria) rogorc ukanaskneli xels uwyobs eriTrocitebis
gorglovani filtraciis, ise milakovani re- agregacias, romelic viTardeba eriTro-
absorbciis darRvevis gamo. citebis garsis zemoxsenebuli dazianebis
moWyletiT dazianebul qsovilebSi war- gamo. eriTrocitebis agregaciis da sisxlis
moiqmneba da grovdeba biologiurad aqtiuri denadobis daqveiTebis gamo viTardeba mik-
nivTierebebi - "dazianebis hormonebi": kaliumis rohemocirkulaciis mZime darRveva qsovi-
ionebi, kreatini, mioglobini, histamini da lebSi, rac generalizebuli hipoqsiis gan-
sxv.). qsovilebis kompresiis moxsnis Semdeg viTarebis iwvevs.
am nivTierebaTa zemoqmedeba rogorc uSua- generalizebuli hipoqsia iwvevs azotis
lod dazianebul, ise zewolisgan dauzi- oqsidis Semcvelobis momatebas, rac kidev
anebel qsovilebze iwvevs mikrohemocirkula- ufro aZlierebs lzJ-is. ukanasknelis gaZ-
ciis mkveTr moSlas, mitoqondriuli sunT- lierebaSi friad mniSvnelovan rols asru-
qvis darRvevas, lipidebis zeJanguri Jangvis lebs antioqsidaciuri sistemis depresiac.
gaZlierebas, ujredebis membranis dazianebas, eriTrocitebis membranis cvlilebebs
plazmis didi moculobis gaJonvas qsovilSi (13) maTi rezistentobis daqveiTeba (8)
da SeSupebis ganviTarebas. plazmis aseT ma- mohyveba, rac iwvevs maT met-naklebad
siur gasvlas sisxlZarRvTa kalapotidan mo- gamoxatul hemolizs (14), rasac
yveba sisxlis moculobis Semcireba (oli- adasturebs meThemoglobinis momateba
gemia) da misi siblantis gazrda, ukanas- sisxlSi (9). aRniSnuli aqveiTebs sisxlSi
knels ki - gulis gadatvirTva. mofunqcie hemoglobinis raodenobas, rac
cirkulirebadi sisxlis moculobis Sem- xels uwyobs generalizebuli hipoqsiis
cireba, gulis muSaobis Sesusteba da hipo- ganviTarebas (15).
tenziuri aminebis (magaliTad, histaminis) Tavis qalas travmuli dazianebebi. Qqala-
toqsikuri moqmedeba, mikrohemocirkulaciis sarqvelze meqanikuri energiis zemoqmedebam
darRveva iwvevs arteriul hipotenzias SeiZleba gamoiwvios: tvinis Seryeva
cirkulaciuri tipis hipoqsiis ganviTare-biT. (comotio cerebri), tvinis daJeJva (contusio
kraS-sindromis dros "dazianebis hor-
41
cerebri) da tvinis kompresia (compresio kinetozis calkeuli formebi gamomwvevi
cerebri). situaciis mixedviT cnobilia zRvis avadmyo-
tvinis Seryeva iwvevs masSi sisxlis mi- fobis an gadaadgilebis avadmyofobis saxel-
moqcevis darRvevas, izrdeba qalasSiga mik- wodebiT.
rosisxlZarRvTa kedlebis ganvladoba, mZime kinetozis mizezia aCqarebis Semdegi sa-
SemTxvevebSi viTardeba wertilovani xeebi da maTi kombinaciebi: 1. sworxazovani
sisxlCaqcevebi. mikrosisxlZarRvTa kedlis aCqareba, magaliTad, avtomobiliT, matareb-
ganvladobis zrdis gamo maTgan Jonavs liT mgzavrobisas, liftiT gadaadgilebis
plazma, matulobs qalasSiga wneva. Sedegad dros da a.S.; 2. radialuri, anu centridanuli
iwyeba Tavbrusxveva, Tavis tkivili, Tavis aCqareba, magaliTad, TviTmfrinavis viraJis
tvinis centrebis gaRizianeba Sesabamisi dros an pikirebisas, wriuli brunvebis
efeqtiT: cdomili nervis centris gaRizi- Sesrulebisas; 3. kuTxuri aCqareba, romelic
aneba iwvevs bradikardias da gulisrevas, Re- gamowveulia sxeulis mrudxazovani, wriu-
binebis centris gaRizianeba - Rebinebas, Ter- li da amave dros araTanabari moZraobiT; 4.
moregulaciuri centris gaRizianeba – cxe- koriolisi - aCqareba, romelic viTardeba im
lebas, Tvalis kaklis mamoZravebeli ner- SemTxvevaSi, rodesac sxeuli gadaadgildeba
vebis centrTa gaRizianeba - Tvalis uneblie Tanabari kuTxuri siCqariT wris garSemo da
moZraobas (nistagms). am simptomTa gamovli- amave dros uaxlovdeba an Sordeba wris
nebis sixSire da intensivoba damokidebulia centrs. bolo or formas gansakuTrebuli
travmis Zalaze. zog SemTxvevaSi iqmneba mZime mniSvneloba aqvs kosmosuri aparatebiT
garTulebis - tvinis SeSupebis saSiSroeba. frenisas.
tvinis daJeJvis dros ziandeba tvinis qso- kinetozis paTogenezSi (sur. 6-2) gadam-
vili. klinikuri simptomebi damokidebulia wyveti mniSvneloba aqvs: 1. baduras recep-
Tavis tvinSi dazianebis lokalizebaze. torebis gaRizianebas Tvalwin sagnebis swra-
tvinis daJeJili nawilis funqciis Sesabami- fi gaelvebis gamo; 2. vestibuluri nervis recep-
sad, Tavis, sxeulis da kidurebis sxvadasxva torebis gaRizianebas sivrceSi sxeulis mde-
nawilSi aRiniSneba mgrZnobelobis darRveva, bareobis cvlilebis - swrafi gadaadgile-
viTardeba dambla. SesaZlebelia metyvelebis bis, qanaobis, trialis, ryevis gamo; 3.
darRveva, refleqsebis daTrgunva an paTolo- muclis Rrus organoebis serozul da
giuri refleqsis gaCena. lorwovan garsebSi arsebuli mgrZnobiare
tvinis kompresias iwvevs travmis Sedegad nervuli daboloebebis gaRizianebas sxeulis
Catexili qalasarqvelis Zvlebis fragmentebi qanaobis, trialis, ryevis gamo; 4. kunTebis,
an sisxlZarRvis kedlis travmuli dazia- myesebis, iogebis proprioreceptorebis, kanis
nebis Sedegad Camoyalibebuli sisxlgrova - da Sinagani organoebis meqanoreceptorebis ga-
hematoma. am SemTxvevaSi, sxva simptomebTan Rizianebas.
erTad, iseve, rogorc tvinis daJeJilobis aRniSnuli receptorebis gaRizianeba
dros, vlindeba Tavis tvinis garkveuli re- iwvevs vegetatiuri nervuli centrebis
gionis dazianebis simptomebic. agznebas Sesabamisi efeqtiT, ris gamo
yalibdeba kinetozis damaxasiaTebeli sim-
6.1.2 aCqarebis da gadatvirTvis damazi- ptomTkompleqsi: Tavbru, moZraobis koor-
anebeli gavlena organizmze. kinetozi. gravita- dinaciis darRveva, kisris da zurgis kun-
ciuli paTofiziologia Tebis asimetria (rac dakavSirebulia badu-
kinetozi (berZn. Kinetosis - moZraoba) ras da vestibuluri aparatis receptorebis
ewodeba simptomTkompleqss, romelic vi- gaRizianebasTan), gulisreva, Rebineba,
Tardeba organizmze aCqarebis moqmedebis an oflis Warbad gamoyofa, bradikardia,
Tvalwin sagnebis swrafi gaelvebis gamo. hipotenzia; yovelive es dakavSirebulia
42
cdomili nervis mgrZnobiare da SesaZlebelia adaptacia garkveuli inten-
mamoZravebeli centrebis ag-znebasTan sivobis aCqarebis da gadatvirTvis zemoqme-
rogorc vestibuluri nervebis re- debis mimarT.
ceptorebis, ise Sinagani organoebis inte- U uwonadoba gravitaciuli paTologiaa. is
roreceptorebis gaRizianebis Sedegad. iqmneba maSin, rodesac sxeuli TiTqmis aRar
gadatvirTva. organizmze Zlieri aCqarebis ganicdis dedamiwis mizidulobis gavlenas,
zemoqmedebisas (kosmosuri xomaldiT, zes- dedamiwis mizidulobis Zala wonaswordeba
wrafi TviTmfrinaviT frenisas) viTardeba sxva kosmosur sxeulTa mizidulobiT (sta-
gadatvirTva, romelic gamowveulia aCqarebis tikuri uwonadoba) an sawinaaRmdegod mi-
veqtoris sawinaaRmdegod mimarTuli inerciis marTuli centridanuli ZalebiT (dinamiku-
Zalebis moqmedebiT. ri uwonadoba).
gadatvirTvis veqtoris sxeulTan mimar- uwonadobis ("nulovani gravitaciis")
Tebis mixedviT arCeven gaswvriv da ganiv ga- pirobebSi organizmi unda Seeguos sruliad
datvirTvas (cxrili 6-1). arsebobs gaswvrivi miuCvevel situacias, risTvisac unda
dadebiTi (kraniokaudaluri - gadatvirTvis ganaxorcielos metad rTuli adaptaciuri
veqtori mimarTulia Tavidan qveda kidu- reaqcia. is imyofeba mravalkomponentiani
rebisken) da uaryofiTi (kaudokranialuri - stresis mdgomareobaSi. uwonadobisas qreba
gadatvirTvis veqtori mimarTulia qvemo sxeulis nawilebis da qsovilebis meqani-
kidurebidan Tavisken) gadatvirTva. ganivi ga- kuri datvirTva, iqmneba pirobebi sisxlis
datvirTva SeiZleba mimarTuli iyos zurgidan da siTxeebis gadanawilebisTvis, qreba say-
mkerdisken, mkerdidan zurgisken, SeiZleba rdenis SegrZneba, icvleba analizatorTa
ganviTardes gverdiTi aCqarebac. zemoqmedebis funqcioba.
xanmokle intervalSi yvelaze Zlier paTo- sisxlis hidrostatikuri wnevis dacemis
genur moqmedebas uaryofiTi gaswvrivi aC- gamo (ix. "wylis da eleqtrolitebis
qareba iCens. cvlis regulacia"), izrdeba wylis reab-
gadatvirTvis zemoqmedebisas vlindeba sorbcia qsovilebidan sisxlSi. Sedegad
simZimis SegrZneba mTel sxeulSi, tkivili, izrdeba cirkulirebadi sisxlis moculoba,
nebiTi moZraobis SezRudva, rbili qsovile- adgili aqvs zogierTi qsovilis (upirate-
bis da Sinagani organoebis gadaTavseba ga- sad qvemo kidurebis) dehidratacias: sis-
datvirTvis moqmedebis mimarTulebiT. xlis uwonadoba aadvilebs sisxlis gada-
gadatvirTvis dros organizmis funqcie- adgilebas qvemo kidurebidan gulisken da
bis moSlaSi gansakuTrebul rols asrulebs Zneldeba misi gadanacvleba Tavis aredan
hemodinamikis da sunTqvis darRveva. hemodi- gulisken. es iwvevs saxis rbili qsovilebis
namikis cvlilebebi, ZiriTadad, gamowveulia SeSupebas, Tavis simZimes da tkivils. aR-
sisxlis gadanawilebiT. dadebiTi gadatvir- niSnuli vlindeba kosmosSi frenis sawyis
Tvisas sisxli gadaadgildeba qvemo kidure- periodSi (mwvave adaptaciis periodSi ).
bis da muclis Rrus organoebis sisx- sisxlis gadanawileba sisxlZarRvTa sis-
lZarRvebisken, gulis qvemoT mdebare sis- temaSi, gulisken midinebuli sisxlis masis
xlZarRvebSi wneva matulobs, mis zemoT mde- Semcireba, hidrostatikuri wnevis dacema,
bare sisxlZarRvebSi - mcirdeba, viTardeba organizmis energodanaxarjis momateba mniS-
tvinis da grZnobaTa organoebis anemia, zog vnelovan gavlenas axdenen gulis funqciaze.
SemTxvevaSi mosalodnelia mxedvelobis moS- icvleba miokardiumis bioeleqtruli
la da gonebis dakargva. aqtivo-ba, gulis diastoluri avseba.
aCqarebisadmi da gadatvirTvisadmi organizmi cdilobs siTxis gamodevnas:
mgrZnobeloba individuria. organizmis tre- mcirdeba antidiurezuli hormonis, reninis,
nirebiT (magaliTad, kosmonavtebis wvrTniT) adlosteronis sekrecia, izrdeba Tirkmlis
43
sisxlmomarageba, gorglovani filtracia, mniSvnelovani Zvrebi viTardeba TiT-qmis
mcirdeba milakovani reabsorbcia. yvela sistemaSi, organosa da qso-vilSi,
Zvlebze datvirTvis Semcirebis gamo misi organizmis integraciis yovel do-neze.
qsovilidan gamodis kalciumi, Zvali Rarib- 6.2. Termuli faqtoris damazianebeli gavlena
deba mineralebiT. ganivzoliani kunTebis xan- 6.2.1. siTburi faqtoris damazianebeli gavlena
grZlivi dautvirTaoba iwvevs maT atrofias, organizmze maRali temperaturis zemoq-
hipoTalamusis vegetatiuri centrebis tonu- medeba iwvevs adgilobriv (damwvroba) da
sis daqveiTebas. qveiTdeba Jangbadis moxmareba zogad (hiperTermia, siTbos dakvra) cvli-
qsovilebis mier, mcirdeba krebsis ciklis lebebs.
fermentebis aqtivoba, izrdeba glikolizis damwvroba. damwvrobas axasiaTebs sxva-
produqtebis raodenoba kunTebSi. dasxva xarisxis adgilobrivi destruqci-
kosmosSi frenis pirvel dReebSi zogierT uli da reaqciuli cvlilebebi: I xarisxi -
kosmonavts uviTardeba kinetozismagvari kanis SewiTleba, II - kanis mwvave eqsudaci-
"moZraobis" avadmyofoba. Tavis swrafi moZ- uri anTeba da eqsudatis Semcveli buS-
raoba uwonadobis dros iwvevs diskomforts, tukebis warmoqmna, III - kanis nawilobrivi
Tavbrus, sifermkrTales, hipersalivacias, nekrozi da wylulebis ganviTareba, IV -
oflianobas, gulisrevas, Rebinebas, cen- qsovilebis danaxSireba.
traluri nervuli sistemis funqciis dar- Termuli agentis moqmedebis adgilze
Rvevas. "moZraobis" avadmyofobis paTogenezSi, viTardeba cilis koagulacia, ujredebis
am TvalsazrisiT, umTavres rols unda as- kvdoma, vlindeba anTebiTi reaqcia da SeSu-
rulebdes Tavis tvinSi mikrohemocirkula- peba. mcire farTobis damwvrobas Tan sdevs
ciis moSla, sivrceSi mdebareobis orient- organizmis xanmokle reaqcia cxelebis, Ta-
taciaSi monawile analizatorebidan miRebu- vis tkivilis, leikocitozis saxiT. ufro
li informaciis "gamovardna". kosmonavtebi, didi farTobis damwvrobisas viTardeba
umeteswilad, male adaptirdebian "moZraobis" organizmis xangrZlivi da mZime reaqcia,
avadmyofobis gamomwvev faqtorebTan. romelic damwvrobiTi avadmyofobis saxeli-
mTlianobaSi adaptaciis mwvave periodi Taa cnobili. mis mimdinareobaSi arCeven
unda daxasiaTdes rogorc stresuli reaqcia Semdeg stadiebs: damwvrobiT Soks, damwvrobiT
specifikuri (nulovani gravitacia) da toqsemias, damwvrobiT infeqcias, damwvrobiT
araspecifikuri (emociuri datvirTva, marazms, gamosavals.
sadReRamiso ritmebis cvlileba) faqtorebis damwvrobiTi Sokis ganviTarebaSi umTavres
zemoqmedebaze, romlis mimdinareobaze serio- rols asrulebs tkivili da mis gamo gan-
zul gavlenas axdens regionuli sisxlis viTarebuli paTologiuri aferentuli im-
mimoqcevis darRveva, gansakuTrebiT Tavis pulsacia centraluri nervuli sistemisken.
tvinis sisxlZarRvebSi. nervuli centrebis zezRurblovani agzneba
angariSgasawevia is faqti, rom kosmosuri maTi funqciis Semdgomi gamofitviT iwvevs
xomaldiT frenis dros kosmonavtis orga- sisxlZarRvTa tonusis, sunTqvis da gulis
nizmi ganicdis ara marto uwonadobis gav- funqciebis cvlilebas. ukanasknels xels
lenas, aramed hipokineziasac. ukanaskneli ki uwyobs gulis avtomatizmis da kumSvadobis
TavisTavad SeiZleba gaxdes emociuri stre- darRveva hiperkaliemiis gamo, romelic vi-
sis da vegetatiuri garTulebebis mizezi, Tardeba dazianebuli ujredebidan kaliumis
romelTagan umTavresia gulis ariTmia da ionebis sisxlis plazmaSi gadasvlis
hipertenziuli reaqcia. Sedegad.
uwonadoba da hipokinezia mkveTr cvli- damwvrobiTi avadmyofobisas mkveTri cvli-
lebebs iwvevs ara marto gulsisxlZarR-vTa, lebebi viTardeba hemodinamikis da sisxlis
nervuli da endokrinuli sistemebis mxriv. mxriv (sqema 6-3). anTebiT ubanSi mikro-
44
sisxlZarRvTa kedlis ganvladobis momatebis anemia, Sinagani organoebis distrofia,
da anTebiTi hiperemiis gamo viTardeba eq- Tirkmelzeda jirkvlebis funqciis gamo-
sudacia (sisxlis Txieri nawilis gasvla fitva.
sisxlZarRvidan qsovilSi), rac amcirebs gansakuTrebiT mZime mimdinareoba axasi-
cirkulirebadi sisxlis moculobis aTebs bavSvis, miT ufro axalSobilis dam-
(policitemiuri hipovolemia) da zrdis sisxlis wvrobas - viTardeba gavrcelebuli SeSu-
siblantes. es ukanaskneli, Tavis mxriv, iw- peba, sisxlis Sesqeleba, Sinagani organoebis
vevs mikrocirkulaciis darRvevas Termuli dehidratacia, hiperazotemia, Zlieri intoq-
agentiT uSualod dauzianebel qsovilebSic. sikacia.
zog SemTxvevaSi viTardeba eriTrocitebis he- organizmis gadaxureba (hiperTermia)
molizi. miuxedavad amisa, plazmis raodenobis sxeulis temperaturis momatebaa Termore-
Semcirebis gamo, 1 mm3 sisxlSi normaze meti gulaciis ZiriTad procesebs - siTbos
eriTrocitia, yalibdeba e.w. cru, anu Sefar- warmoqmnas da gacemas Soris Seusabamobis
debiTi policitemia. gamo.
damwvrobis ubanSi qsovilebis rRvevis gadaxurebis xelSemwyobi faqtorebia
gamo warmoiqmneba toqsikuri nivTierebebi, siTbos produqciis gaZliereba (magaliTad,
ris Sedegad viTardeba toqsemia. am mxriv kunTovani muSaobis dros), siTbos gacemis
gansakuTrebuli mniSvneloba aqvs denatu- Seferxeba garemos maRali temperaturis
rirebul cilebsa da maTi fermentuli hid- gamo (am SemTxvevaSi mcirdeba siTbos gacema
rolizis produqtebs. kanis gziT gatarebis da gasxivebis sa-
damwvrobiTi avadmyofobis dros orga- SualebiT) an maRali tenianobis (rac afer-
nizmSi viTardeba cilis Zlieri deficiti, xebs siTbos gacemas oflis gamoyofis da
rac, erTi mxriv, dakavSirebulia anTebis misi aorTqlebis gziT) Sedegad.
ubanSi ganviTarebul eqsudaciasTan, meore gatarebiT da gasxivebiT siTbos gacemas
mxriv ki sxva qsovilebSi gaTavisuflebuli mkveTrad aqveiTebs misi cudad gamtari kan-
proteolizuri fermentebis mier cilis ge- qveSa cximis siWarbe. aseT pirobebSi kanis
neralizebul daSlasTan. cilis struqturis saSualebiT siTbos gacemis erTaderTi gza
gardaqmnis gamo warmoiqmneba autoantigenuri aorTqlebaa. amitomaa, rom msuqani adamianebi
substanciebi, rac autoalergiis ganviTarebis garemos temperaturis arcTu mkveTri moma-
mizezi xdeba. tebis drosac ki Zlier oflianoben.
organizmis intoqsikacia Zlierdeba in- gadaxurebis dros sxeulis temperatura
feqciis gamo, romlis wyaroa dazianebuli matulobs, sisxlZarRvebis gafarToebis ga-
qsovilebi da nawlavebis SigTavsi. infeqciis mo kani wiTldeba. sisxlZarRvebis gafar-
ganviTarebaSi mniSvnelovan rols asrulebs Toeba sakompensacio Termoregulaciuri re-
barieruli sistemebis funqciis daqveiTeba: aqciaa - is, erTi mxriv, xels uwyobs ga-
kanis kvdoma, saWmlis momnelebeli sistemis tarebis da gasxivebis saSualebiT siTbos
lorwovani garsebis dacviTi funqciis Se- gacemas, meore mxriv ki - oflis didi ra-
susteba, mononukleuri fagocitebis funqci- odenobiT gamoyofas. taqikardia da taqipnoe
is darRveva. sinusis kvanZsa da sunTqvis centrze Tbili
damwvrobiTi avadmyofobis dros, gansa- sisxlis zemoqmedebis Sedegia.
kuTrebiT bavSvTa asakSi, xSirad viTardeba Zlieri oflianobisas didi raodenobiT
Tirkmlis sxvadasxva xasiaTis dazianeba - ikargeba wyali, amitom sisxlis siblante
droebiTi oliguriidan da anuriidan, nef- iz-rdeba. sisxlis siblantis da gulis
rozamde da nefrozonefritamde. zog Sem- wuT-moculobis gazrda iwvevs sisxlis
TxvevaSi damwvrobiTi avadmyofobis Sedegad arteriuli wnevis momatebas, mikrohemocir-
yalibdeba e.w. damwvrobiTi marazmi, SeSu-peba, kulaciis dar-Rvevas. eriTrocitebis
45
hemolizis gaZlierebas mohyveba intoqsikacia Tirkmelzeda jirkvlebis mier, Zlier-deba.
hemoglobinis daSlis produqtebiT. Se- es iwvevs nivTierebaTa cvlis inten-sivobis
dedebis VII, VIII da X faq-toris daSlis da Jangbadis moxmarebis zrdas.
gamo qveiTdeba sisxlis Sede-deba. dabali temperaturis ufro xangrZlivi
siTburi dartyma. swrafi da Zlieri gada- da mkveTri zemoqmedebis SemTxvevaSi Ter-
xureba iwvevs siTbur dartymas (sur. 6-4), moregulaciis meqanizmebi ifiteba, dakargu-
romelsac axasiaTebs stadiuri mimdinareoba, li siTbos raodenobis kompensacia ar xdeba
zogadi kunTovani sisuste, nervuli sistemis (dekompensaciis faza), sxeulis temperatura
zezRurblovani agzneba, bodva, halucinaci- qveiTdeba, viTardeba perioduli sunTqva.
ebi, gonebis dakargva. sisxlis siblantis dekompensaciis fazaSi Jangbadis moxmareba
mkveTri momateba iwvevs gulis gadatvirTvas, da nivTierebaTa cvla mcirdeba, Tavis tvi-
bradikardias, gulis ukmarisobas. gulis uk- nis funqcia qveiTdeba. ufro gvian iTrgu-
marisoba da periferiuli sisxlZarRvebis neba qerqqveSa da mogrZo tvinis centrebis
tonusis daqveiTeba ki ganapirobebs sisxlis funqcia. sikvdilis mizezia sunTqvis Sewyve-
arteriuli wnevis dacemas. paralelurad iS- ta.
viaTdeba sunTqva, is perioduli xasiaTis hipoTermia gansakuTrebiT advilad vi-
xdeba. adamiani iRupeba sunTqvis centris Tardeba moZraobis SezRudvisas (mwoliare
damblis gamo. avadmyofebSi), agreTve, moxucebsa da Cvil
gadaxurebis mimdinareoba da gamosavali bavSvebSi Termoregulaciis meqanizmebis si-
didadaa damokidebuli organizmis individur sustis gamo. gadaciebas xels uwyobs trav-
Taviseburebebze. muli Soki, gadaRla, simTvrale. alkoholi
afarToebs kanis sisxlZarRvebs, rac qmnis
6.2.2. dabali temperaturis damazianebeli temperaturuli komfortis moCvenebiT Seg-
gavlena. hipoTermia rZnebas da xels uwyobs gadaciebas perife-
organizmSi siTbos normaluri da, miT riuli sisxlZarRvebis gafarToebis Sedegad
umetes, mcire raodenobiT warmoqmnis piro- siTbos gacemis gaZlierebis gamo.
bebSi dabali temperaturis zogadi moqmedeba aRsaniSnavia, rom hipoTermiis mdgoma-
organizmis gadaciebas - hipoTermias iwvevs. reobaSi organizmi naklebad mgrZnobiare
kanis Termoreceptorebis siciviTi gaRi- xdeba garemos mravali damazianebeli faq-
zianebis gamo warmoqmnili impulsebi gadae- toris, Jangbadis da sakvebis naklebobis,
cema hipoTalamusSi arsebul Termoregula- intoqsikaciis, infeqciis, eleqtrotravmis
ciis centrs (sur. 6-5). aqedan centrida- mimarT. Jangbadze moTxovnilebis daqveiTebas
nuli signalebi aRwevs organoebsa da sis- hipoTermiis pirobebSi iyeneben klinikuri
temebs, romlebic monawileoben sxeulis sikvdilis gaxangrZlivebis mizniT.
temperaturis SenarCunebaSi. kompensaciis xelovnur hipoTermias - hibernacias iyene-
stadiaSi aseTi impulsebis gavleniT kunTebis ben, agreTve, sasicocxlo mniSvnelobis or-
tonusi matulobs, izrdeba siTbos warmoqmna, ganoebze (tvinze, gulze, filtvebze) rTu-
iwyeba kankali, taqikardia. kanis sisxl- li operaciebis Catarebis dros. hipo-
ZarRvebi viwrovdeba, ris gamo organizmis Termias am SemTxvevaSi aRweven organizmis
mier siTbos gacema mkveTrad izRudeba. fizikuri gadaciebiT farmakologiuri
hiperadrenalinemia da simpaTikuri nervuli preparatebis gamoyenebasTan kompleqsSi.
sistemis agzneba aZlierebs glikogenolizs gamoyenebulia e.w. lizuri koqteilebi,
RviZlSi, kunTebSi, viTardeba hiperglikemia. romlebic Seicaven nervuli impulsebis
hipofizis tropuli hormonebis gadmosro- gatarebis mablokirebel nivTierebebs
lis gamo Tiroqsinis da glukokortiko- (antiadrenalinurs, antiacetilqolinurs),
idebis gamoyofa, Sesabamisad - fariseburi da antihistaminur nivTierebebs,
46
miorelaqsantebs (kunTebis modunebis da misi muSaobis Sewyveta. am movlenaTa gan-
maTSi siTbos warmoqmnis Sewyvetis miz-niT). viTarebaSi umTavresi mniSvneloba aqvs
eleqtrodenis zemoqmedebas uSualod sun-
6.3 eleqtruli denis damazianebeli gavlena Tqvis centrsa da gulze.
eleqtrodenis moqmedebisas organizmis SedarebiT msubuqi eleqtrotravmisas
dazianebis simZime damokidebulia TviT denis gonebis dakargva da sunTqvis Sewyveta
maxasiaTeblebze, qsovilebis winaaRmdegobaze droebiTia, arteriuli sisxlis wneva matu-
eleqtrodenis mimarT, sxeulSi denis gavlis lobs. travmis Semdeg aRiniSneba Tavbru,
mimarTulebasa da xangrZlivobaze, organizmis Tavis tkivili, sinaTlis SiSi, gulisreva,
filogenezuri ganviTarebis doneze da in- hipotenzia, taqikardia, taqipnoe.
dividur reaqtiulobaze. eleqtrodenis biologiur moqmedebas
dazianebis xarisxi organizmSi gamavali axasiaTebs, agreTve, gluvi da ganivzoliani
denis Zalis da Zabvis proporciulia. erTi kunTebis, jirkvlovani qsovilis, nervuli
da igive Zalis denis gavlisas ufro mZime ujredebis da receptorebis agzneba. ConCxis
dazianebas iwvevs cvladi deni. kunTebis tonuri krunCxvis Sedegad mosa-
sxvadasxva qsovili sxvadasxva winaaR- lodnelia Zvlebis motexiloba da amo-
mdegobas avlens eleqtrodenis mimarT. maga- vardniloba, gluvi kunTebis tonurma kum-
liTad, maRali winaaRmdegoba aqvs Zvlebs, Svam SeiZleba gamoiwvios hipertenzia, uneb-
kans, xolo dabali - sisxls da limfas. Ka- lie Sardva da defekacia.
nis winaaRmdegoba eleqtrodenis mimarT eleqtrodenis adgilobrivi efeqti dakav-
mkveTrad mcirdeba misi avadmyofobisas an Sirebulia mis eleqtroqimiur, siTbur da
oflis gamoyofisas - kanis sisvele amZimebs meqanikur moqmedebasTan. eleqtroqimiuri
eleqtrotravmas, radgan sveli kanis wina- efeqti mdgomareobs eleqtrolizis Sedegad
aRmdegoba eleqtrodenis mimarT dabalia. ujreduli membranebis polarizebaSi, rac
didi mniSvneloba aqvs denis gavlis mi- cvlis ujredis funqciur mdgomareobas.
marTulebasac. gansakuTrebiT mZime Sedegs garda ionebisa, gadaadgildeba cilis mole-
iwvevs denis gavla Tavis tvinSi (sunTqvis kulebic, ris gamo viTardeba cilis koa-
centris dambla) da gulSi (fibrilacia). gulacia, koloidebis gajirjveba da ujre-
eleqtrodenis moqmedeba miT ufro Zlieria, debis nekrozi.
rac ufro metia misi moqmedebis xangr- eleqtrodenis siTburi moqmedeba mJRav-
Zlivoba. ndeba kanis da, zogjer, kanqveSa qsovilebis
eleqtrotravmis Sedegze did gavlenas damwvrobiT da danaxSirebiTac ki. damwvroba
axdens organizmis saxeobrivi reaqtiuloba. viTardeba denis Sesvlis da gamosvlis
filogenezuri ganviTarebis dabal safexurze adgilze. Zalian maRali Zabvis eleqtrodeni
mdgomi cxovelebi nakleb mgrZnobiareni arian iwvevs qsovilebis gaglejas, Wrilobas (me-
eleqtrodenisadmi. organizmis individuri qanikuri moqmedeba). zog SemTxvevaSi mosa-
reaqtiulobis cvlilebam SeiZleba Secvalos lodnelia sxeulis nawilebis, kidurebis
mgrZnobeloba eleqtrotravmisadmi. Magali- mogleja, rac gamowveulia meqanikuri da
Tad, narkozis da gadaciebis gavleniT orga- siTburi energiis erToblivi afeTqebis
nizmi SedarebiT mdgradi xdeba eleqtro- magva-ri efeqtiT.
denisadmi, xolo alkoholis moqmedeba aZ-
lierebs eleqtrodenis damazianebel efeqts. 6.4. xmauris da ultrabgeris damazianebeli
organizmze eleqtrodenis moqmedeba iw- gavlena
vevs adgilobriv da zogad movlenebs. Zo- xmauris damazianebeli gavlena organizmze
gadi movlenebia: gonebis dakargva, sunTqvis dakavSirebulia mis siZlieresa da sixSires-
Sewyveta, hipotenzia, gulis fibrilacia da Tan. ufro mZime dazianebas maRali sixSiris
47
xmauri iwvevs. janmrTelobisTvis saSiSia 80 TxvevaSi paTologiuri procesebis safuZve-
decibelze maRali siZlieris xmis zemoqme- li SeiZleba gaxdes.
deba. ultrabgeris biologiuri moqmedeba mo-
xmauris specifikuri moqmedeba organiz- icavs meqanikur, siTbur da fizikur-qimiur
mze iwvevs smenis analizatoris funqciis efeqts. misi gavleniT ujredebSi Cndeba
darRvevas. misi safuZvelia bgeris SemgrZnobi mikroskopuli Rruebi, romelTa swrafi
aparatis xangrZlivi spazmi, romelic iwvevs daxurva iwvevs intensiur hidravlikur
nivTierebaTa cvlis darRvevas, degeneraciul dartymebs - kavitacias. ukanasknels Tan
cvlilebebs karibWe-lokokinas nervis dabo- sdevs molekulebis depolarizeba, des-
loebebSi da kortis organoSi. 80-100 de- truqcia, ionizeba, rac aaqtivebs qimiur re-
cibelis Zalis xmauri iwvevs smenis swraf aqciebs. saSualo da dabali intensivobis
daqveiTebas. xanmokle Zlieri xmauri iwvevs ultrabgeris (3 kg/sm2-mde) gamoyeneba xSi-
kontuzias da smenis droebiT dakargvas. rad dadebiT Sedegs iZleva, magram ufro
xmauris araspecifikuri gavlena organiz- maRali intensivobis ultrabgera azianebs
mze vlindeba Tavis tvinis qerqis, hipoTa- ujredebs, qsovilebs, mTlianad organizms;
lamusis da zurgis tvinis agznebiT. sawyis iwvevs mikrohemocirkulaciis darRvevas,
periodSi aRiniSneba centraluri nervuli ujredebis destruqcias, qsovilebis adgi-
sistemis zezRurblovani Sekaveba, agznebis da lobriv gadaxurebas, periferiuli nervebis
Sekavebis procesebis wonasworobis darRveva dazianebas, impulsebis gadacemis darRvevas
nervuli ujredebis funqciis Semdgomi gamo- sinapsebSi. Sedegad viTardeba vegetatiuri
fitviT. klinikurad yovelive es vlindeba polinevritebi, damblebi, mcirdeba smenis
agznebadobis momatebiT, emociuri gauwo- da mxedvelobis analizatorebis agznebado-
nasworeblobiT, mexsierebisa da Sromis una- ba, irRveva Zili, Tavs iCens gadaRlis Seg-
ris daqveiTebiT. mZime travmisas SesaZlebe- rZneba.
lia krunCxvis ganviTareba, gonebis dakargva, Sesabamisad, ultrabgeris gamoyeneba me-
damblis ganviTareba. dicinaSi garkveul sifrTxiles saWiroebs.
xmauris gavlena hipoTalamusze xorciel-
deba stres-reaqciis tipiT. irRveva Sinagani 6.5. atmosferuli (barometruli) wnevis
organoebis funqcia. intensiuri xmauris xan- damazianebeli gavlena
grZlivi zemoqmedeba iwves "xmauris avad- 6.5.1. maRali atmosferuli wnevis
myofobis" ganviTarebas, romelsac axasiaTebs damazianebeli gavlena. kesonis avadmyofoba
smenis daqveiTeba, centraluri nervuli sis- maRali atmosferuli wneva paTogenurad
temis, gul-sisxlZarRvTa sistemis, kuW-naw- zemoqmedebs organizmze wyalqveS da keso-
lavis funqciis darRveva. nebSi muSaobis dros (kesoni siRrmeSi sa-
ultrabgeris - maRali (20 kilohercze muSao specialuri kameraa, romlis kedlebs
meti) sixSiris bgera adamianis smenis gareT da SigniT wnevis gawonasworebis miz-
organosTvis aRuqmelia, magram sxva-dasxva niT kameraSi xelovnurad qmnian maRal wne-
qsovilSi, organoSi, substratSi ul- vas). wyalqveS yovel 10,3 metrze Casvlisas
trabgeris gavlis araerTnairi siCqare, am wneva erTi atmosferoTi matulobs.
substratebSi maTi STanTqmis da arekvlis avadmyofuri movlenebi atmosferuli
sxvadasxva intensivoba safuZvlad daedo maT wne-vis gazrdisas dakavSirebulia uSualod
gamoyenebas medicinaSi, pirvel rigSi, orga- maRali atmosferuli wnevis moqmedebasTan,
noTa dazianebis diagnostikis TvalsazrisiT. azotiT qsovilebis gaJRenTvasTan da
magram ultrabgera imdenad Zlier Jangbadis siWarbesTan - hiperoqsiasTan
biologiur efeqts iwvevs, rom zog Sem- (sur. 6-6). maRali atmosferuli wnevis
uSualo zemoqmedeba iwvevs yurebis tki-
48
vils dafis apkis Cazneqis gamo, Sinagani avadmyofobis profilaqtikis mizniT ke-
organoebis sisxlsavseobas kanis da sxva sonSi momuSaveebs sasunTqad aZleven helium-
periferiuli sisxlZarRvebis Seviwrovebis Jangbadis narevs (radgan heliumi naklebad
Sedegad; sunTqva Rrmavdeba da iSviaTdeba ixsneba qsovilebSi). iyeneben, agreTve, wila-
nawlavebSi arsebuli haeris raodenobis dobriv, TandaTanobiT dekompresias, ris Se-
SemcirebasTan da diafragmis dawevasTan degad desaturirebuli airi aswrebs orga-
dakavSirebiT. nizmidan gamoyofas buStukebis warmouqmne-
hiperbariis Sedegad organizmSi matulobs lad.
filtvebis gziT Sesul airTa xsnadoba sis- kesonis avadmyofobis mkurnalobis erTa-
xlSi, qsovilebSi. aRiniSneba qsovilebis gaJ- derTi saSualebaa rekompresia. am mizniT
avadmyofs ganmeorebiT aTavseben maRali wne-
RenTva - saturacia am airebiT. gansakuT-
vis qveS (magaliTad, barokameris gamoye-
rebuli mniSvneloba aqvs saturacias azotiT,
nebiT), ris Sedegad sisxlZarRvebis sana-
romlis xsnadoba, wnevis garda, damokide- Turi Tavisufldeba misi buStukebisgan.
bulia qsovilis Tvisebebze: cximovan qsovil- maRali barometruli wnevis damazianebe-
Si, tvinis TeTr nivTierebaSi, Zvlis yviTel li moqmedeba organizmze pirobadebulia, ag-
tvinSi ixsneba xuTjer meti azoti, vidre reTve, Jangbadis siWarbis (hiperoqsiis)
sisxlSi. toqsikuri efeqtiT. organizmis Tavdapir-
nervul qsovilSi gaxsnili azoti eifo- veli reaqciebi hiperoqsiaze SeguebiTi xasi-
riul moqmedebas iCens. viTardeba "siRrmiTi aTisaa da mimarTulia, pirvel rigSi, Tavis
aRtacebis" suraTi. vlindeba toqsikuri tvinis qsovilSi Jangbadis optimaluri re-
efeqti - Tvalebis tkivili, Tavbru, halu- Jimis SenarCunebisken. sisxlSi Jangbadis
cinaciebi, moZraobis koordinaciis darRveva. raodenobis momatebis gamo mcirdeba sisx-
maRali wnevidan dabali wnevis areSi ga- lZarRvebis kedlebSi arsebuli qemorecep-
dasvlas (dekompresias}) Tan sdevs qsovile- torebis agznebadoba da impulsacia vegeta-
bidan airebis gamosvla - desaturacia. swrafi tiuri centrebisken. sapasuxod iSviaTdeba
desaturaciis dros qsovilebidan sisxlis sunTqva da gulis SekumSvebi, mcirdeba gu-
mier desaturirebuli azoti ver aswrebs lis wuTmoculoba, cirkulirebadi sisxlis
organizmidan gamosvlas, ris gamo grovdeba moculoba, filtvebis ventilacia, viwrov-
sisxlsa da qsovilebSi. sisxlSi SedarebiT deba tvinis mkvebavi sisxlZarRvebi, sisxli
didi zomis azotis buStukebis warmoqmnas deponirdeba parenqimul organoebSi. mkveTr
sicocxlisaTvis saSiSi airovani emboliis hiperoqsias SeiZleba mohyves qsovilebidan
gaCena mosdevs. qsovilebSi dagrovili azo- naxSirorJangis gamotanis darRveva, radgan
tis buStukebis zewola nervul dabolo- hemoglobinis molekulebi am pirobebSi ga-
ebebze iwvevs kunTebis da saxsrebis tkivils jerebulia JangbadiT. es qmnis qsovilebis
(arTralgias da mialgias), kanis qavils, ka- Taviseburi "moxrCobis" suraTs.
nis emfizemas (airis dagrovebas kanqveS). na- Zlieri hiperoqsia ujredebze maionize-
xevarrkalovani arxis endolimfaSi azotis beli radiaciis msgavs toqsikur moqmedebas
dagrovebis gamo xSiria e.w. menieris simptom- - Tavisufali radikalebis warmoqmnas da
Tkompleqsi - Suili yurebSi, Tavbru, wonas- zeJangviTi procesebis provocirebas iwvevs.
worobis darRveva. zurgis tvinis SedarebiT
mwiri vaskularizebis gamo azotis buStu- 6.5.2. dabali atmosferuli (barometruli)
kebis gamotana misi qsovilidan SedarebiT wnevis damazianebeli gavlena. simaRlis (mTis)
nela mimdinareobs; mZime SemTxvevebSi is avadmyofoba
ziandeba, viTardeba qvemo kidurebis dambla, dabali atmosferuli wnevis gavlenas
irRveva Sardis gamoyofa da defekacia. or-ganizmi ganicdis mTaze asvlis dros,
ara-hermetuli safreni aparatiT frenisas,
49
spe-cialur barokameraSi. movlenebi, SedarebiT nakleb simaRleze asvlisas
romlebic viTardeba am pirobebSi, viTardeba simptomTkompleqsi, romelic
gamowveulia dabali atmosferuli wnevis cnobilia mTis anu simaRlis avadmyofobis
(hipobariis) uSualo ze-moqmedebiT da saxelwodebiT (sur. 6-7). am SemTxvevaSi wi-
garemoSi Jangbadis parciuli wnevis daqveiTebiT. na planzea movlenebi, romlebic dakavSi-
atmosferuli wnevis dacemis gamo rebulia CasunTqul haerSi Jangbadis
viTardeba dekompresiis sindromi . mas axasia- parciuli wnevis daqveiTebasTan, viTardeba
Tebs haeris gafarToeba Rru organoebSi (ha- Jangbadis nakleboba sisxlSi (hipoqsemia),
imoris RruSi, Sua yurSi da sxv.), rac iw- amas ki mohyveba qsovilis gaRaribeba Jangba-
vevs Rrus kedlebze misi zewolis momatebas, diT (hipoqsia).
maTSi arsebuli nervuli receptorebis gaRi- mTis avadmyofoba pirvelma aRwera XVI
zianebas da, aqedan gamomdinare, tkivils, saukuneSi akostam, romelmac perus andebSi
romelsac SeiZleba mohyves Sromis unaris mogzaurobis dros 4500 m simaRleze yu-
daqveiTeba, an, zogjer, gonebis dakargvac ki. radReba miaqcia avadmyofobis niSnebs, ganvi-
airi farTovdeba nawlavebSi, ris Sedegadac Tarebuls avtoris da misi Tanamgzavrebis
viTardeba meteorizmi. organizmSi. avadmyofobis mizezad akosta
9000 metr simaRleze asvlisas, wnevis dabal atmosferul wnevas miiCnevda. Mmxo-
mkveTri dacemis gamo, mcirdeba airTa xsna- lod 200 wlis Semdeg, Tavis Tavze gamo-
doba, iwyeba maTi (gansakuTrebiT azotis) ga- cada ra mTis avadmyofoba monblanze asvlis
mosvla qsovilebidan, SeiZleba warmoiqmnas dros, sosiurma mis uSualo mizezad Jan-
azotis buStukebi da ganviTardes sisxl- gbadis parciuli wnevis daqveiTeba daa-
ZarRvTa airovani embolia. sicocxlisTvis saxela.
gansakuTrebiT saSiSia gulis da tvinis sxvadasxva individs simaRlisadmi ara-
mkvebavi sisxlZarRvebis daxSoba emboliiT. erTnairi mgrZnobeloba axasiaTebs. zog ada-
atmosferuli wnevis ufro metad daqvei- mians mTis avadmyofobis niSnebi uCndeba
Tebisas aseTi buStukebi grovdeba qsovi- zRvis donidan ukve 1600-2000 m simaRleze,
lebSi, ris gamo viTardeba kanis da qsovi- 4500 m-ze asvlisas ki simaRlis
lebis emfizema. avadmyofoba uviTardeba adamianTa
Zlieri dekompresiis dros organizmis umravlesobas. organizmis trenirebiT
siTxeebis duRilis temperatura imdenad qve- SesaZlebelia simaRlis mimarT Segueba,
iTdeba, rom es siTxeebi (magaliTad, sisxli) cxadia, garkveul zRvramde.
duRils iwyebs sxeulis normaluri tempera- mTis avadmyofobis ganviTarebisTvis mniS-
turis pirobebSic. vneloba aqvs simaRlis cvlis siCqares -
atmosferuli wnevis swrafi da Zlieri rac ufro swrafad xdeba asvla, miT ufro
dacemisas (19-20 aTas metr simaRleze) dabalia simaRlis avadmyofobis aRmocenebis
yalibdeba "afeTqebiTi dekompresiis sindro- zRvari. mniSvnelovan rols TamaSobs,
mi", romlis ganviTarebaSi did rols as- albaT, cudi klimaturi pirobebic: qari,
rulebs filtvis, gulis da msxvili sis- mzis radiacia, temperaturis sadReRamiso
xlZarRvebis barotravma filtvebSiga wnevis meryeoba, haeris sinotive, Tovlis safari
mkveTri momatebis gamo. filtvis sisx- da a.S. arsebobs monacemebi imis Sesaxeb,
lZarRvebis da alveolebis gaskdomis Sede- rom adamianTa umravlesobas erTi da igive
gad airis buStukebi gadadis sisxlSi da simptomTkompleqsi uviTardeba 3000 m
viTardeba airovani embolia. kosmosuri xo- simaRleze kavkasionsa da alpebSi, 4000 m-
maldis dehermetizebis dros mosalodnelia ze - andebSi da 5000 m-ze - himalaebSi.
uecari sikvdili sisxlisa da organizmis Cveulebriv, 2000 m simaRleze hemoglo-
sxva siTxeebis duRilis da hipoqsiis gamo. binis gajereba JangbadiT progresulad
50
mcirdeba, magram oqsihemoglobinis disoci- SekumSvebi mTis avadmyofobis sawyis fazaSi
aciis mrudis S-magvari formis gamo, alve- xSirdeba, sisxlZarRvTa mamoZrave-beli
olur haerSi Jangbadis parciuli wnevis 2- centris agznebis gamo arteriuli wneva
2,5-jer Semcirebisas, sisxlis JangbadiT matulobs.
gajereba mxolod 15-20%-iT mcirdeba, rac hipoqsiis Semdgomi gaRrmavebisas irRveva
kompensirdeba sisxlis mimoqcevis da gulis kunTSi agznebis aRmoceneba da gata-
sunTqvis SeguebiTi reaqciebiT. ufro zemoT, reba, viTardeba ariTmia. ufro mZime Sem-
6000 m simaRleze, oqsihemoglobinis rao- TxvevaSi sisxlZarRvTa mamoZravebeli cen-
denoba mcirdeba 60-65%-iT, rac scildeba tris daTrgunvis gamo sisxlis wneva ecema.
organizmis adaptaciuri SesaZleblobis im mTis avadmyofoba vlindeba simaRleze
zRvars, romelic saSualebas aZlevda mas asvlidan ramdenime saaTSi mravalferovani
SeenarCunebina cxovelmoqmedeba mZime avad- fsiqikuri da nevrologiuri darRveviT,
myofuri simptomebis ganviTarebis gareSe. Tavis tkiviliT, taqikardiiT, gulis ariT-
mTis avadmyofobis ZiriTadi paTogenezuri miiT, meryevi an dabali arteriuli sisxlis
meqanizmia Jangbadisa da naxSirorJangis wneviT, qoSiniT, sunTqvis riTmis darRve-
parciuli wnevis daqveiTeba alveolebsa da viT, kanis fermkrTalobiT, tuCebis da Ti-
ar-teriul sisxlSi (sur. 6-7), alkalozi. Tebis cianoziT, Zilis darRveviT, gulis-
amasTan erTad mJRavndeba histotoqsikuri reviT, pirRebinebiT, umadobiT da, cxadia,
(qsovilebis mowamvlis) efeqti Jangbadis Sromis unaris daqveiTebiT. did simaRleze
utilizebis unaris SemcirebiT. vlindeba umaRlesi nervuli moqmedebis
hipoqsiis gamo Warbad aigzneba aortis moSla, agznebis procesis inertuloba da
rkalis da karotiduli sinusis qemorecep- Sekavebis sisuste, metyvelebis moSla.
torebi; maT gaRizianebas mosdevs sunTqvis, naTxemis hipoqsiis gamo irRveva moZraobis
sisxlZarRvTa mamoZravebeli da sxva vegeta- koordinacia, aranavarjiSeb adamians 5000 m
tiuri centrebis agzneba, viTardeba qoSini. simaRleze uviTardeba Sekaveba, romelic
qerqis ujredebis agznebis gamo viTardeba ZilSi gadadis.
eiforia. qoSinis Sedegad ganviTarebuli zemomoyvanili movlenebi, maTi intensi-
hiperventilaciisas organizmidan gamoiyofa voba da simZime damokidebulia organizmis
didi raodenobiT CO2, misi raodenoba individur gamZleobaze, mis gawvrTnilobasa
sisxlSi mcirdeba (hipokapnia) da viTardeba da simaRlis cvlilebis siCqareze. mTis
respiraciuli (airovani) alkalozi. hipokapnia avadmyofoba zogjer sikvdiliT mTavrdeba.
da alkalozi amcirebs sunTqvis centris simaRlis avadmyofobis simptomebi gansa-
agznebadobas, amis gamo sunTqva iSviaTdeba. kuTrebiT mkveTria simaRleze asvlidan pir-
progresirebadi alkalozis da hipokapniis vel or dRes. SemdgomSi SesaZlebelia mox-
Sedegad mosalodnelia sunTqvis ariTmia, des simaRlesTan sruli adaptacia (mTaze
Cein-stoqsis an biotis tipis perioduli darCenis SemTxvevaSi), xSirad ki viTardeba
sunTqvis ganviTareba, sunTqvis centris dam- mTis avadmyofobis qvemwvave an qronikuli forma
bla. (monges avadmyofoba).
Jangbadis parciuli wnevis daqveiTeba iw- ansxvaveben monges avadmyofobis or saxes:
vevs eriTrocitebis raodenobis zrdas sis- eriTremiuls ("didi simaRleebis eriTre-
xlSi rogorc depo-organoebidan gamosroli- mia"), romelic simptomebiT vakezis avad-
li sisxlis (hipoqsiis ganviTarebisTanave), myofobas waagavs da emfizemurs, romlis
ise, mogvianebiT, Zvlis tvinis mier eriT- drosac Warbobs sasunTqi sistemis cvli-
rocitebis gaZlierebuli gamomuSavebis xar- lebebi.
jze (gaxangrZlivebuli hipoqsiisas). vagu-sis qvemwvave eriTremiul formas axasiaTebs
centris tonusis Semcirebis gamo gu-lis si-suste, daRlilobis SegrZneba, umaRlesi
51
ner-vuli moqmedebis cvlileba, azrovnebis sxivebi. maTgan ukanaskneli sami Sedis mzis
pro-cesis darRveva, depresia, Zilianoba speqtris SemadgenlobaSi.
Ramis Zilis darRveviT, zogjer sruli
uZiloba. yovelive es gamowveulia 6.6.1. mzis sxivebis damazianebeli gavlena.
xangrZlivi hipoq-siiT. hipoqsiis da alkalo- dasxivebis intensivobasTan, ZalasTan da
zis fonze vi-Tardeba umadoba, gulisreva, xangrZlivobasTan dakavSirebiT mzis
Rebineba. xSiria kanis da lorwovani garsebis speqtrSi Semavalma ultraiisferma sxivebma
hiperemia, rac dakavSirebulia sisxlSi SeiZleba organizmze dadebiTad an uaryofi-
eriTrocitebis da hemoglobinis raodenobis Tad imoqmedos. am sxivebis gavleniT kanSi
momatebasTan. eriT-rocitozis gamo sisxlis aminmJava Tirozinidan warmoiqmneba melanini,
siblante matu-lobs, misi cirkulacia kani muqdeba da winaaRmdegobas uwevs orga-
ferxdeba, xSiria Trombozis da nizmze sxivebis Semdgom moqmedebas.
sisxlCaqcevebis ganviTareba. ultraiisferi sxivebis mcire dozebis
aklimatizebis SemTxvevaSi es simptomebi mastimulirebeli moqmedeba organizmze da-
qreba, magram avadmyofoba SeiZleba gadavides kavSirebulia qimiuri reaqciebis, nivTie-
qronikul formaSi, rac aucilebels xdis rebaTa cvlis, trofikuli procesebis ga-
avadmyofis gadayvanas ufro nakleb simaRle- aqtivebasTan. Sedegad izrdeba organizmis
ze. monges avadmyofobis dros eriTremiuli rezistentoba infeqciuri da toqsikuri
cvlilebebi ufro mkveTria, viTardeba Zlie- agentebis mimarT, aqtivdeba regeneraciis
ri cianozi, sisxlZarRvebi gavsebulia eriT- procesebi. sxivebi iCenen antiraqitul efeq-
rocitebiT, viTardeba sisxlis mimoqcevis da tsac - 7,8-dehidroqolesterinisgan asinTe-
centraluri nervuli sistemis funqciis zeben D vitamins (qolekalciferols). ul-
darRveva, koma da sikvdili. traiisfer sxivebs aqvT baqteriociduli
monges avadmyofobis emfizemuri tipis Zi- efeqtic.
riTadi niSnebia qoSini, gulmkerdis gafar- kanis erTjeradi Warbi dasxiveba ul-
Toeba, misi kasriseburi forma, filtvismieri traiisferi sxivebiT iwves fotoqimiur dam-
gulis Camoyalibeba. viTardeba bronqiti, wvrobas: eriTemas, siTxiani buStukebis ga-
pnevmonia sisxliani naxveliT. mkveTrad, in- Cenas kanze, cxelebas, Tavis tkivils, SesaZ-
dividis pirovnebis cvlilebamde, irRveva lebelia konuqtivis dazianebac. aseTi dam-
umaRlesi nervuli moqmedeba da fsiqika. mor- wvrobis ganviTareba dakavSirebulia lipi-
fologiurad vlindeba Zvlis wiTeli tvinis debis zeJanguri Jangvis gaZlierebasTan da,
hiperplazia, bronqebis da filtvebis des- amis gamo, ujredebis membranebis daziane-
truqcia, emfizemisTvis damaxasiaTebeli mar- basTan.
jvena parkuWis hipertrofia Semdgomi dila- Warbi ultraiisferi dasxiveba amwvavebs
taciiT. zogierT avadmyofobas (revmatizmi, wylu-
rogorc mwvave, ise qronikuli mTis avad- lovani avadmyofoba, tuberkulozi da sxv.).
myofoba SeiZleba garTuldes filtvebis an am sxivebiT xangrZlivma Warbma dasxivebam
Tavis tvinis SeSupebiT, gulis marjvenapar- SeiZleba gamoiwvios mutaciebi da kanis ki-
kuWovani ukmarisobiT, sisxlCaqceviT, Trom- bos ganviTareba.
boziT, emboliiT. im adamianebSi, romelTa sisxlSi aris
hemoglobinis araswori gardaqmnis produq-
6.6. sxivuri energiis damazianebeli moqmedeba tebi - porfirinebi, ultraiisferi sxivebis
organizmze xanmokle moqmedebac ki iwvevs "fotoaler-
damazianeblad moqmed sxivur energias gias" - viTardeba damwvroba, intoqsikacia.
miekuTvneba maionebeli gamosxiveba, ultrai-
isferi, wiTeli, infrawiTeli da lazeris
52
porfirinebis garda, fotomasensibilize- vebs da a.S.). Cvens droSi ki arsebobs maio-
beli Tviseba aqvs zogierT kosmetikur saSu- nebeli radiaciis mZlavri xelovnuri wya-
alebasac (sunamo, pomada da sxv.). roebi (rentgenis sxivebi, izotopebi, ato-
ultraiisferi da infrawiTeli sxivebis muri iaraRi, atomuri energowyaroebi),
Warbi erToblivi moqmedeba qalasarqvelze romlebic SeiZleba iqcnen organizmis da-
mzis dakvras iwvevs. zianebis mizezad. maionizebel radiacias mi-
mzis dakvra. siTbur dakvras klinikuri ekuTvneba , da -sxivebi, neitronebi,
niSnebiT (cxelebiT, nervuli sistemis agzne- rentgenis sxivebi, romelTa damazianebeli
biT da/an misi funqciis daTrgunviT, sisxlis moqmedebis siZliere dakavSirebulia maT mi-
mimoqcevis da sunTqvis darRveviT) waagavs er qsovilebis ganWolvis unarsa da maTi
mzis dakvra. am SemTxvevaSi etiologiuri gavleniT qsovilebSi warmoqmnili ionebis
faqtoria mzis sxivebis uSualo zemoqmedeba simWidrovesTan.
qalasarqvelze. mzis sxivebis nawili (in- maionebeli sxivebiT endogenuri (Sinaga-
frawiTeli sxivebi) aRwevs qalas RruSi da ni) dasxivebis wyaroa organizmSi wyliT,
iwvevs tvinis garsebis sisxlsavseobas (hipe- sakvebiT an kanis gziT Sesuli radiaqtiuli
remias), anTebas, wertilovan sisxlCaqcevebs. nivTierebebi, romlebic xangrZlivad rCebian
msubuq SemTxvevaSi aRiniSneba Tavis tkivili, masSi (magaliTad, radiaqtiuri stronciumis
saerTo sisuste, agzneba. deponireba ZvlebSi).araiSviaTad dasxiveba
kombinirebuli - egzo-endogenuria.
6.6.2. lazeris sxivis damazianebeli gavlena maionebeli radiaciis mier gamowveuli
sinaTlis energiis wvrili monoqromatuli dazianebis xarisxi damokidebulia orga-
konebi - lazerebi farTod gamoiyeneba medi- nizmis mier STanTqmuli energiis raodeno-
cinaSi, Tumca organizmze maTi moqmedebis baze, energiis saxeze, dasxivebis xangr-
efeqtis mravali mxare jer kidev Seuswav- Zlivobaze, ionizebis simkvriveze, organiz-
lelia. mis saxeobriv da individur reaqtiulobaze
dadgenilia, rom lazeris sxivi iCens (cxrili 6-2). maionebeli sxivebis erTi da
Termul da kavitaciur moqmedebas. misi dama- igive jamuri doziT dasxivebisas damaziane-
zianebeli efeqti dakavSirebulia lipidebis beli efeqti ufro Zlieria dozis xanmokle
zeJangviTi Jangvis gaZlierebasTan, atomebis moqmedebisas. wiladobrivi dasxivebis SemT-
agznebasTan, cilis molekulebis daziane- xvevaSi aRiniSneba biologiuri efeqtis Sem-
basTan, fermentebis aqtivobis cvlilebasTan. cireba - organizmi uZlebs ufro maRali
lazeris sxivebis mier gamowveuli dazi- jamuri doziT dasxivebas.
anebis simZime dakavSirebulia TviT sxivebis eqsperimentulad damtkicebulia, rom
maxasiaTeblebTan (gamosxivebis simZlavre da dasxivebis sasikvdilo doza araerTnairia
simWidrove), dasxivebuli qsovilis fizikur- sxvadasxva saxeobis cxovelebisTvis - 400-
qimiur da biologiur TvisebebTan (pigmen- dan 1400 rentgenamde (1 rentgeni energiis
taciis xarisxi, sisxlsavseoba, siTbogam- sididea, romelic mSrali haeris 10m3-Si
taroba). 0C temperaturaze 760 mm/vwy.sv. wnevis
pirobebSi qmnis 2,08109 ions).
6.6.3. maionebeli gamosxivebis damazianebeli sxvadasxva radiaqtiuli sxivis biolo-
gavlena giuri moqmedebis SedarebiTi raodenobrivi
maionizirebeli gamosxivebis organizmze SefasebisTvis sazRvraven maT fardobiT bi-
moqmedebis meqanizmi. cocxali organizmebi evo- ologiur efeqturobas. maRali biologiuri
luciis procesSi Seeguen bunebriv maionebel efeqti aqvT -sxivebs, protonebs da neit-
radiacias (kosmosur sxivebs, dedamiwis qer- ronebs.
qSi arsebul radiaqtiuli nivTierebebis sxi-
53
biologiuri efeqti ganisazRvreba ara Semdgom procesebs garkveul dinamizms ani-
marto STanTqmuli sxivuri energiis saxiT Webs (sur. 6-9).
da sididiT, aramed misi simZlavriTac. didi mniSvneloba aqvs Tavisufali ra-
simZlavris erTeulad miRebulia grei (1gr=1 dikalebis reaqcias maRali radiomgrZno-
j/kg). belobis Tiolur fermentebTan, romelTa
sxivuri energiis adgilobrivi moqmedeba aqtiuri sulfhidruli bma (H-S-S-H) am
qsovilebze iwvevs sxivuri damwvrobis, nek- SemTxvevaSi icvleba araaqtiuri disul-
rozis, kataraqtas ganviTarebas. adgilobrivi fiduri (S=S) bmiT. Tiolur fermentTa
procesebis siRrme damokidebulia dazianebis inaqtivaciis gamo irRveva nukleoproteidebis
simZimeze: Tu 8-12 greiT dasxivebisas vi- sinTezi da, Sesabamisad, iTrguneba ujre-
Tardeba msubuqi damwvroba, 20 greiT das- debis gamravleba. aseTi efeqti gansakuTrebiT
xivebisas nekrozdeba kani, fasciebi, kunTebi Zlieria axalgazrda da dabaldiferencire-
da Zvlebic ki. avadmyofs uviTardeba cxele- bul ujredebSi, romlebsac maRali mito-
ba, leikocitozi, Zlieri tkivili. zuri aqtivoba axasiaTebs. Sedegad viTar-
maionebeli radiaciis mavne zemoqmedebis deba sisxlis formiani elementebis defici-
specifikuri efeqti vlindeba misi pirdapiri ti, rac anemiis da infeqciis ganviTarebis mi-
da arapirdapiri moqmedebis SedegebiT, moq- zezi xdeba. nawlavebis epiTeluri ujre-
medebiT molekulur, ujredul, qsovilur da debis gamravlebis daTrgunvis gamo irRveva
organul doneze, mTlianad organizmze (sur. saWmlis moneleba, ikargeba eleqtrolitebi.
6-8). anemiis da sisxlis mimoqcevis darRvevis Se-
maionebeli sxivebis energia Warbobs Siga- degad viTardeba qsovilTa generalizebuli
molekuluri kavSirebis energias, maTi moq- hipoqsia (sur. 6-10). maionizebeli radiaciis
medebis pirveladi efeqti mdgomareobs aR- zemoqmedebiT viTardeba, agreTve, endokri-
niSnuli kavSirebis rRvevaSi, ionebis da Ta- nuli darRvevebi, qromosomuli mutaciebi,
visufali radikalebis warmoqmnaSi. pirvela- aberaciebi, dnm-is struqturis cvlilebebi,
di radioqimiuri gardaqmnebidan gansakuTre- genuri mutaciebi, moiSleba specifikuri
buli mniSvneloba aqvs ZiriTadi gamxsnelis - cilebis sinTezi.
wylis ionizebas. am efeqtis gamo warmo- zeJangviTi Jangvis gamo sawyisi radi-
iqmnebian Tavisufali radikalebi (H+, OH+), aciuli efeqti mravaljer izrdeba. pirvel
romlebic Sedian reaqciaSi qsovilebis Jan- rigSi, es moqmedebs ujredis da misi orga-
gbadTan, wylis molekulebTan da warmoqmnian noidebis membranaze, romelTa ganvladoba da
radikal hidroperoqsids (HO2), wyalbadis sorbciuli Tvisebebi icvleba. lizosomebis
zeJangs (H2O2) da atomur Jangbads (O-). ioni- membranis dazianebis gamo Tavisufldeba rnm-
zebis pirveladi procesebi ar iwvevs Rrma azebi, dnm-azebi, katepsinebi, fosfatazebi da
cvlilebebs qsovilebSi. maTi damazianebeli sxva fermentebi. hidrolazuri fermentebis
moqmedeba ZiriTadad dakavSirebulia meorad zemoqmedebiT mimdinareobs ujredis makro-
reaqciebTan, romlebic viTardeba pirveladi molekuluri komponentebis (nukleinmJa-
moqmedebis dros warmoqmnili maRali biolo- vebis, cilebis da sxv.) Semdgomi daSla: mi-
giuri aqtivobis mqone nivTierebaTa gavleniT. toqondriuli fermentebis gamosvla amci-
isini urTierTqmedeben erTmaneTTan, agreTve, rebs atf-is da, amis Sedegad, cilebis sin-
nivTierebebTan, romelTac ar ganucdiaT ioni- Tezs, izrdeba biologiuri membranebis gan-
zeba, TiSaven Cveulebrivad mdgrad kavSirebs vladoba.
cilebSi, dnm-Si, lipidebSi, ris Sedegad vi- qsovilis radiomgrZnobeloba pirdapir-
Tardeba jaWvuri, mzradi intensivobis qimi- proporciulia misi ujredebis prolife-
uri da biologiuri reaqciebi. es dasxivebis raciuli aqtivobis da ukuproporciulia
maTi diferencirebis xarisxisa. Radiom-
54
grZnobelobis klebis mixedviT qsovilebi Se- Rebineba, tkivili muclis areSi, dispef-
iZleba ase dalagdes: limfoiduri organoebi, siuri movlenebi, leikocitozi limfopeniis
Zvlis tvini, saTesle jirkvlebi, sakvercxe- fonze. 8-10 greiT (800-1000 rentgeni) das-
ebi, kuW-nawlavis traqtis lorwovani garsi, xivebisas amave periodSi SeiZleba gan-
kanis epiTeliumi da a.S. yvelaze dabal radi- viTardes Sokismagvari mdgomareoba arteri-
omgrZnobelobas iCenen kunTebi, nervuli qso- uli hipotenziiT, gonebis xanmokle dakar-
vili, Zvlebi. gviT, cxelebiT, nevrologiuri darRvevebiT.
ujredis radiaciuli dazianebis safuZve- avadmyofobis farul periodSi (romlis
lia organelebis ultrastruqturis darRve- xangrZlivobaa 1-2 kvira) aRniSnuli movle-
va da masTan dakavSirebuli metabolizmis nebi mcirdeba an qreba, magram Semdeg Tan-
cvlileba. sxivuri energiis mcire dozebi daTanobiT mJRavndeba hemopoezuri organo-
iwvevs ujredis araletalur, Seqcevad dazi- ebis funqciis moSlisTvis damaxasiaTebeli
anebas, romelic vlindeba nukleinis sinTezis movlenebi: ujredebis gamravlebis darRvevis
darRveviT, membranebis ganvladobis cvlile- gamo (ix. zemoT) viTardeba leikopenia, lim-
biT, birTvis nivTierebaSi marcvlebis gaCe- fopenia, Trombocitopenia.
niT, mitozis damuxruWebiT. mesame periodSi sxeulis temperatura ma-
didi doziT dasxivebisas ujredebSi vi- tulobs, aRiniSneba sisuste, Tavis tkivi-
Tardeba letaluri cvlilebebi, romlebic li, lorwovani garsebis dawyluleba, Tmis
iwveven ujrdebis interfazul kvdomas. cvena, hemoragiuli sindromi Trombocitebis
gaujerebeli cximovani mJavebis da feno- naklebobis gamo, hemopoezis mkveTri
lebis daJangvis Sedegad warmoiqmneba daTrgunva da Zlieri leikopenia, irRveva
radiotoqsinebi, romlebic aseve Trgunaven nervuli da endokrinuli jirkvlebis fun-
nukleinmJavebis sinTezs, moqmedeben, rogorc qcia, imunitetis mkveTri daqveiTebis Sede-
qimiuri mutagenebi, cvlian fermentTa aqti- gad iolad viTardeba autoinfeqcia da auto-
vobas, iwveven cilis sinTezis darRvevas. intoqsikacia. es periodi grZeldeba ramdenime
Zalze maRali doziT dasxivebisas vlin- dRidan 2-3 kviramde da avadmyofobis Seda-
deba ujredebis interfazuli masobrivi kvdoma rebiT msubuqi mimdinareobis SemTxvevaSi
metabolizmis darRvevis da radiotoqsinebiT mTavrdeba misi qronizebiT an avadmyofis ga-
intoqsikaciis gamo. aseT SemTxvevaSi sikvdi- mojanmrTelebiT (meoTxe periodi). mZime
li dasxivebidan uaxloes wuTebsa da saa- SemTxvevebSi avadmyofobis mesame periodSi
TebSia mosalodneli. avadmyofi kvdeba.
sxivuri avadmyofoba. maionebeli radiaciis 1000-2000 rentgeniT (10-20 grei) das-
organizmze zogadi moqmedebisas, dasxivebis xivebisas viTardeba mwvave sxivuri avad-
dozis Sesabamisad, SeiZleba gamovlindes su- myofobis nawlavuri forma, romelsac axasi-
raTi sustad gamoxatuli zogadi reaqcie- aTebs nawlavebis epiTeliumis mitozuri
bidan mwvave sxivur avadmyofobamde . 100-1000 gayofis Sewyveta, misi masiuri interfazuli
rentgeniT (1-10 grei) Tanabarzomieri das- kvdoma, dehidratacia, cilis da eleqtrolitebis
xivebisas viTardeba mwvave sxivuri avad- kargva, nawlavis lorwovanis gaSiSvleba,
myofobis tipobrivi - Zvlistvinovani forma rac xels uwyobs nawlavis kedlidan in-
(Zvlis tvinis upiratesi dazianebiT), rome- feqciis SeWras, mikrobuli an qsoviluri
lic mimdinareobs 4 stadiad. warmoSobis toqsinebis Sewovas. Uukanaskne-
pirveladi reaqcia iwyeba dasxivebis momen- lis gamo mosalodnelia Sokis ganviTareba.
tidan da grZeldeba 48 saaTamde. mas axasi- am formas klinikurad axasiaTebs moduneba,
aTebs nervuli sistemis agzneba, Tavbru, Ta- anoreqsia (umadoba), cxeleba, tkivili naw-
vis tkivili, gulis SekumSvebis da sunTqvis lavebSi, faRaraTi, sisxliani ganavali, pa-
gaxSireba, sisxlis wnevis labiloba, zogjer ralizuri gauvaloba, peritoniti (muclis
55
faris anTeba) sxivuri avadmyofobisTvis da- "kritikuli" organoebis upiratesi daziane-
maxasiaTebeli cvlilebebiT sisxlSi (ix. Ze- ba, romlebSic deponirebulia organizmSi
moT). letaluri gamosavali avadmyofobis me- moxvedrili radionuklidebi.
7-10 dRezea mosalodneli. sikvdilis mizezia
organizmis gauwylovneba (dehidratacia) 6.6.4. maionebuli radiaciis moqmedebis
eleqtrolitebis da cilis kargviT, mik- Soreuli Sedegebi
robuli da qsoviluri toqsinebiT gamowve- maionizebuli radiaciis moqmedebis So-
uli Soki. reuli Sedegebi Tavs iCens dasxivebidan
zesasikvdilo doziT dasxivebisas (2000- mravali wlis Semdeg arasimsivnuri da sim-
8000 rentgeni, 20-80 grei) viTardeba mwvave sivnuri saxis cvlilebebiT. pirvels mie-
sxivuri avadmyofobis toqsemiuri forma. vlin- kuTvneba sisxlmbadi qsovilis hipoplazia,
deba mZime hemodinamikuri darRvevebi, sisx- lorwovani garsebis atrofia, sklerozuli
lZarRvTa tonusis mkveTri cvlilebebi, Zli- cvlilebebi (RviZlis cirozi, nefros-
eri intoqsikacia, oliguria. avadmyofi iRu- klerozi, aTerosklerozi da sxv.), dishor-
peba avadmyofobis me-4-7 dRes. monuli movlenebi (simsuqne, hipofizuri
mwvave sxivuri avadmyofobis cerebruli kaxeqsia da sxv.), simaxinjeebi. sxivuri
formis SemTxvevaSi (dasxiveba 8000 rentgeni energiis moqmedebis xSiri Soreuli Sedegia
da meti) sikvdili mosalodnelia uSualod avTvisebiani simsivneebis ganviTareba "kriti-
dasxivebis dros ("sikvdili sxivis qveS") an kul" organoebSi, radiaciuli leikozebi,
dasxivebidan ramdenime wuTSi, zogjer – ram- simaxinjeebis ganviTareba STamomavlobaSi.
denime saaTSi. sxivuri energiis nervul qso-
vilze uSualo zemoqmedebis gamo viTardeba 6.7. qimiuri faqtorebis damazianebeli
Tavis tvinis qerqis da hipoTalamusis uj- gavlena organizmze
redebis mniSvnelovani struqturuli cvli- organizmze qimiuri nivTierebaTa zedmi-
lebebi, ujredebi iRupeba, ris gamo iwyeba wevniT mravalmxriv moqmedebas specialuri
krunCxva da damblebi, viTardeba sisxl- disciplina - toqsikologia Seiswavlis.
ZarRvTa tonusis, Termoregulaciis moSla. Cven SemovifarglebiT maTi damazianebeli
qronikuli sxivuri avadmyofoba viTardeba moqmedebis zogierTi zogadi debulebis gan-
organizmis egzo- an endogenuri dasxivebisas xilviT.
maionizebeli radiaciis SedarebiT mcire organizmze mavned moqmedi qimiuri faq-
dozebiT. avadmyofoba viTardeba TandaTanobiT torebi SeiZleba davyoT or jgufad: or-
da mimdinareobs xangrZlivad, talRiseburad. ganizmSi warmoqmnil (endogenur) da garedan
dasawyisSi vlindeba aramyari leikopenia, si- moxvedril (egzogenur) nivTierebebad.
suste, sisxlZarRvTa tonusis labiloba.
SemdgomSi viTardeba radiomgZnobiare qsovi- 6.7.1. endogenuri mowamvlebi
lebis regeneraciis, gul-sisxlZarRvTa da endogenuri warmoSobis SxamebiT – qso-
vegetatiuri nervuli sistemis funqciis vilTa daSlis da nivTierebaTa cvlis mavne
darRveva, leikopenia limfopeniiT, Trombo- produqtebiT mowamvlas autointoqsikacia
citopenia. ufro mZime SemTxvevaSi viTardeba (TviTmowamvla) ewodeba. warmoqmnili toq-
hipoplaziuri anemia, atrofiuli movlenebi sikuri nivTierebebi normis pirobebSi or-
kuW-nawlavis traqtis lorwovanSi, rasac ganizmidan gamoiyofa Tirkmlebis, nawlave-
Tan sdevs infeqciur-septikuri garTulebebi. bis, saofle jirkvlebis da filtvebis
zogjer vlindeba sisxldena da sisxlCaqce- gziT, sxvadaxva sekretTan erTad an ne-
vebi, faRaraTi, kaxeqsia. itraldeba nivTierebaTa cvlis Sedegad.
Sinagani dasxivebis gamo ganviTarebul autointoqsikacia viTardeba am procesebis
qronikul sxivur avadmyofobas axasiaTebs im darRvevis gamo. magaliTad, Tirkmlebis fun-
56
qciis moSlis dros organizmSi grovdeba Sxamma SeiZleba gamoiCinos pirdapiri an
cilebis cvlis toqsikuri azotovani pro- refleqsuri moqmedeba. misi pirdapiri moqme-
duqtebi, rac organizmis mZime mowamvlas da deba adgilobrivi (magaliTad, zemoqmedeba
uremias iwvevs; Saqriani diabetis dros cxi- kanze masTan Sexebisas) an rezorbciulia (sis-
mebis arasruli wvis gamo viTardeba aceto- xlSi Sewovisas). refleqsuri moqmedeba Se-
nemia (ketonemia), rac did rols asrulebs degia mgrZnobiare nervuli daboloebebis
hiperglikemiuri komis ganviTarebaSi; gulis gaRizianebisa rogorc Sxamis SeWris ad-
ukmarisobis dros sisxlis mimoqcevis dar- gilze, ise misi Sewovis Semdeg.
Rvevis Sedegad didi raodenobiT grovdeba organizmisaTvis ucxo, toqsikur naer-
toqsikuri naxSirorJangi, xolo RviZlis ba- Tebsa da qsovilTa ujredebis nivTierebebs
rieruli funqciis darRvevis dros ar Soris urTierTqmedeba eqvemdebareba zogad-
neitraldeba nawlavebSi warmoqmnili Sxamiani qimiur kanonzomierebas - msgavsi Semadgen-
produqtebi. lobis nivTierebebi avlenen erTsa da imave
mowamvla viTardeba, agreTve, organizmSi reaqciaSi monawileobis unars, konkurencias
toqsikuri naerTebis warmoqmnis da maTi sis- uweven, aZeveben erTmaneTs bunebrivi naer-
xlsa da limfaSi Sewovisas (magaliTad, naw- Tebidan an kansa da lorwovan garsebze ze-
lavTa gauvalobis an xangrZlivi Sekrulobis moqmedebisas. isini konkurencias uweven ci-
dros). lis molekulebis Sesabamis jgufebs. Mmaga-
intoqsikacia viTardeba baqteriuli toq- liTad, mJavebis gavleniT iTrguneba cilis
sinebis, mikrobTa cxovelmoqmedebis sxva molekulis karboqsilis jgufis ionizeba,
produqtebis warmoqmnis, TviT organizmis tuteebis zegavleniT - amoniumis jgufebis
qsovilebis travmis, dazianebis, daSlis ionizeba, irRveva, agreTve, peptiduri kavSi-
dros, biogenuri aminebis warmoqnis gamo. rebi, viTardeba cilis koagulacia, rasac
autointoqsikacia SeiZleba gamovlindes qsovilis kvdoma da mis adgilze nawiburis
organizmis daZabunebiT, TavbruTi, RebinebiT, warmoqmna mohyveba.
Tavis tkiviliT, organizmis rezistentobis rezorbciuli moqmedebisas Sxami gadai-
daqveiTebiT da sxv. taneba sxvadasxva organoSi, qsovilSi, Se-
dis reaqciaSi cilebTan, lipidebTan, fer-
6.7.2 egzogenuri mowamvlebi. mentebTan da sxv. am SemTxvevaSi xSiria
damazianebeli egzogenuri nivTierebebi toqsikuri nivTierebebis konkurentuli
SeiZleba iyos orgauli da araorganuli moqmedeba. magaliTad, cianidebis metad ma-
bunebisa (mJavebi, tuteebi, tyviis, vercxlis- Rali toqsikuroba dakavSirebulia misi mo-
wylis, dariSxanis marilebi, alkoholi, lekulis iol urTierTqmedebasTan ujredis
qloroformi, cianidebi, glikozidebi, sunTqviTi fermentis - citoqromoqsidazas
alkaloidebi, gvelis Sxami da sxv.). maTi SemadgenlobaSi myof samvalentian rkinas-
moqmedebis Sedegad xSiria sa-yofacxovrebo Tan, rac cianidebiT mowamvlisas am fer-
(ufro xSirad - kvebismieri), medikamenturi mentis blokirebas da Zlier, sasikvdilo
an profesiuli mowamvla. toqsikuri histotoqsikur (qsovilur) hipoqsias iw-
moqmedebis siZliere damokidebulia qimiuri vevs (ix. "hipoqsia").
nivTierebis dozaze, organizmze misi
zemoqmedebis da gamoyofis gzebze, organiz- 5.7.3. narkomania da toqsikomania
mis reaqtiulobasa da rezistentobaze. gamo- narkomania paTologiis formaa, romel-
yenebul dozasTan dakavSirebiT erTma da ima- sac axasiaTebs avadmyofuri ltolva narko-
ve qimiurma nivTierebam SeiZleba gamoiwvios tikul nivTierebaTa mzardi raodenobis mi-
samkurnalo efeqtic da Zlieri, sasikvdilo Rebisadmi. narkomaniis safuZvelia is faqti,
intoqsikaciac. rom daavadebuli fsiqikurad da fizikura-
57
daa damokidebuli narkotikul nivTierebaze. radaa SeZenili da mniSvnelovanwiladaa da-
misi miuReblobis SemTxvevaSi viTardeba kavSirebuli pirovnebis fsiqologiur Tavi-
Zlieri abstinencia. narkomania iwvevs fsiqi- seburebebTan. amave dros, unda iTqvas, rom
kuri, nevrologiuri, vegetatiuri da soma- narkomanis STamomavals SeiZleba ganuviTar-
turi darRvevebis kompleqss, pirovnebis deg- des garkveuli memkvidruli winaswargan-
radacias, rac zians ayenebs rogorc TviT wyoba narkomaniis mimarT.
daavadebuls, ise sazogadoebas. narko- da toqsikomaniis mizezi SeiZleba
narkotikisadmi fsiqikuri damokidebule- iyos adamianis mier narkotikuli da sxva
bis intensivoba mniSvnelovnadaa ganpirobe- fsiqotropuli nivTierebebis araswori an
buli imiT, Tu raoden Rrma iyo eiforia, ga- iZulebiTi xangrZlivi samedicino gamoyeneba,
mowveuli narkotikuli nivTierebis ramdenime am nivTierebebis arasamedicino daniSnule-
pirveli miRebiT: pirovnebis fsiqofiziolo- biT miReba fsiqikuri komfortis an eifo-
giurma Taviseburebebma SeiZleba gamoiwvios riis misaRwevad. ukanasknelis farTod gav-
eiforiis xelmeored gancdis Zlieri sur- rcelebas mniSvnelovnad uwyobs xels so-
vili da, garkveul pirobebSi, narkomaniis Ca- cialuri garemo, socialuri kataklizmebi,
moyalibeba. mZime ekonomikuri mdgomareoba, sazogadoe-
narkomanias iwveven, e.i. narkotikebs bis fsiqikuri gadaZabva da moralis dacema,
miekuTvnebian nivTierebebi (xSirad samkur- uimedoba, SiSi momavlis winaSe, mravali
nalwamlo saSualebebi), romlebic miesada- narkomanis survili narkomaniaSi "CaiTrios"
geba Semdeg kriteriumebs: gamoucdeli axalgazrdoba.
1) es nivTierebebi gamoiyeneba samedicino narkomania SeiZleba Camoyalibdes mrava-
praqtikaSi specifikuri zemoqmedebisTvis li nivTierebis mimarT. dRevandel msofli-
centralur nervul sistemaze (mastimulire- oSi farTod gavrcelebulia narkomania sxva-
beli, sedaciuri, halucinaciuri moqmedeba da dasxva saxeobis kanafidan miRebuli nivTiere-
sxv.), bebis (anaSa, marixuana, haSiSi da sxv.) mi-
2) gamoiyeneba farTo masStabiT, da, ami- marT. yvela isini Seicaven trankvilizato-
tom, socialur mniSvnelobas iZens, rebis jgufis narkotikul aldehids kana-
3) nivTiereba iuridiulad unda iyos binols.
aRiarebuli narkotikul nivTierebad (maga- pirveli kontaqtebi am nivTierebasTan
liTad, janmrTelobis dacvis sistemis an xSirad usiamovno movlenebs - gulisrevas,
saerTaSoriso organizaciebis mier). Tavbrus, pirSi simwares iwvevs. kanafis pre-
Tu nivTiereba ar akmayofilebs romelimes paratebis didi raodenobiT miReba Tanda-
am kriteriumebidan, miuxedavad imisa, rom TanobiT iwvevs intoqsikacias: adamiani kar-
SeiZleba is gamoiyenebodes eiforiuli efeq- gavs kontrols Tavis qmedebaze, aqvs ilu-
tis miRebisTvis da iwvevdes avadmyofobis ziebi, halucinaciebi (laT. hallutinatio –
ganviTarebas, narkotikad ar iTvleba. aseTi bodva, moCveneba), viTardeba moZraobiTi ag-
nivTirebebis regularuli miRebis Sedegad zneba (siarulis, sirbilis, xtomis, cekvis
Camoyalibebul paTologias toqsikomanias survili da a.S.), fsiqikis darRveva, ara-
uwodeben. wminda samedicino TvalsazrisiT adekvaturi reaqcia garemo zemoqmedebaze,
ki narkomania da toqsikomania identuri mov- eqstazi (fsiqikuri mdgomareoba, romlis
lenebia. dros mTlianad irRveva adamianis kontaqti
zogierTi nivTierebisadmi (wyali, sakvebi, garemosTan).
Jangbadi) organizmis memkvidrulad Tandayo- kanafis preparatebis xangrZlivi miRe-
lili moTxovnilebis da damokidebulebisgan bisas viTardeba fsiqozebi mxedvelobiTi da
gansxvavebiT, narkotikul nivTierebaze damo- smeniTi halucinaciebiT, devnis SiSi, inte-
kidebulebis paTologiuri forma individu- leqtis da mexsierebis daqveiTeba.
58
eqsperimentulad dadgenilia, rom es knel wlebSi sul ufro farTod
preparatebi iwveven imunitetis daqveiTebas, vrceldeba. aRniSnuli preparatebi
mamakacebis feminizebas (qaluri Tvisebebis moCvenebiTad amaRleben Sromis unars,
gaCenas) testosterinis gamomuSavebis daT- iwveven simsubuqis, energiis mozRvavebis
rgunvis gamo, genetikuri aparatis cvlile- cru SegrZnebas, rac swrafad iwvevs maTdami
bis Sedegad simaxinjeebis gaCenas STamomav- miCvevas. xangrZlivi gamoyenebisas viTardeba
lobaSi (gansakuTrebiT II TaobaSi). smeniTi da mxedvelobiTi halucinaciebi,
opiumuri (morfinuli tipis) narkomania agzneba, agresiuloba, mZime vegetosomaturi
(morfinizmi) viTardeba zogierTi saxeobis ya- darRvevebi, organizmis gamofitva.
yaCos preparatebis (morfini, opiumi, kodeini metad xSiria polinarkomania anu narko-
da sxv.) miRebisas. gavrcelebis mixedviT is mania, gamowveuli sxvadasxva narkotikis
msoflioSi amJamad meore adgilzea narkoma- erTdrouli an SenacvlebiTi gamoyenebiT,
niaTa Soris. rac iwvevs mZime intoqsikacias, narkotikze
eiforia am SemTxvevaSi xSirad narko- gansakuTrebiT Zlieri damokidebulebis swraf
tikis pirveli miRebisTanave viTardeba. zog- ganviTarebas, amZimebs prognozs da aZ-
jer mas mohyveba moduneba, Zilianoba, piris nelebs mkurnalobas. sazogadod, unda iT-
simSrale, Rebineba. opiumis preparatebTan qvas, rom miuxedavad garkveuli gansxva-
miCveva iwvevs fsiqofiziologiur gamofit- vebebisa, daavadebis ZiriTadi kanonzomiere-
vas. bebi da gamovlinebebi saerToa narkomaniis
gansakuTrebiT Zlieri toqsikuri moqmede- sxvadasxva formis da, SeiZleba iTqvas,
ba axasiaTebs friad gavrcelebul narkoti- toqsikomaniisTvisac. procesi mimdinareobs
kul saSualebas heroins. misi Warbi doza sam stadiad.
iwvevs sikvdils sunTqvis centris depresiis, pirveli (sawyisi) - narkotikisadmi fsiqi-
asistoliis, filtvis SeSupebis gamo (sur. kuri ltolvis stadia ("nevrozismagvari", "nev-
6-11). heroinis qronikul miRebas Tan sdevs rasTeniuli") xasiaTdeba yuradRebis gafan-
imunitetis daqveiTeba, nevrologiuri gar- tviT, mgrZnobelobis daqveiTebiT da sxv.
Tulebebi, gulis sarqvlovani aparatis, RviZ- avadmyofi damokidebuli xdeba narkotikze.
lis da sanaRvle gzebis, Tirkmlis paTolo- eiforiuli efeqtisTvis saWiro xdeba misi
gia, sisxlZarRvebis kedlis dazianeba. yove- sul ufro didi doziT gamoiyeneba. Nar-
live es, Sors wasul SemTxvevaSi, sicoc- kotikebis miRebebs Soris SualedSi avad-
xlesTan SeuTavsebeli xdeba. myofi grZnobs diskomforts, daukmayofi-
kokainiT gamowveuli narkomania (kokai- leblobas. misi miswrafebebi da survilebi
nizmi) ZvelTaganvea cnobili. kokainiT zoga- Semoifargleba erTi mizniT - narkotikis
di intoqsikacia iwvevs sinapsebSi agznebis miRebiT. miuxedavad miRebuli narkotikis
gatarebis darRvevas (sur. 6-12), Trobas, dozis gazrdisa, qreba dacviTi reaqciebi
energiis mozRvavebis cru SegrZnebas, fsi- (qavili, gulisreva, Rebineba) masze. Semdeg
qosomatur agznebas, sifermkrTales, lorwo- tolerantoba narkotikis mimarT qveiTdeba
vanebis gamoSrobas, gugebis gafarToebas, ta- da misi miReba Zlier intoqsikacias iwvevs.
qikardias, qoSins, zogjer sisxlis mimoq- meore - narkotikisadmi fizikuri damo-
cevis mZime darRvevebs. kokainis xangrZlivi kidebulebis stadiaSi avadmyofi grZnobs
miReba iwvevs fsiqofiziologiur asTenize- Znelad dasaZlev an dauZlevel fizikur
bas, adamiani kargavs mizanswrafvas, agzneba- ltolvas narkotikis miRebisadmi. misi mi-
dia, progresirebs Wkuasustoba, viTardeba uReblobisas viTardeba abstinenciis sura-
kaxeqsia da naadrevi dabereba. Ti: mousvenroba, sifermkrTale, gugebis ga-
amfetaminuri rigis preparatebiT (fenati- farToeba, taqikardia, arteriuli hiperto-
pini, fenamini) gamowveuli narkomania ukanas- nia, ConCxis kunTebis hipertenzia, fsiqove-
59
getatiuri cvlilebebi: sicivis da cxele-bis ini). bolo xanebSi farTod gavrcelda,
perioduli, cvladi SegrZneba, oflia-noba, orga-nuli gamxsnelebiT, nitrosaRebavebiT,
lorwovanebis sekrecia, surdo, cemine-ba, sawmen-di da sarecxi saSualebebiT da sxv.
cremlianoba, Rebineba, tenezmebi, faRara- Gamow-veuli toqsikomania.
Toba, tkivili muclis areSi, krunCxvebi, ag- organizmis cxovelmoqmedebis darRveva
resiul-naRvliani ganwyoba, SiSi, bodva, uZi- narkomaniis da toqsikomaniis dros dakav-
loba. abstinenciis mwvave periodi 4-5 kvira Sirebulia miRebuli nivTierebis da maTi
grZeldeba, Tumca misi narCeni movlenebi ram- metabolitebis CarTvasTan neiromediatore-
denime Tve SeiZleba iCendes Tavs. bis, neiropeptidebis cvlaSi, fermentebis
mesame - gamofitvis stadiaSi viTardeba mZi- aqtivobis da bioqimiuri procesebis cvli-
me somaturi paTologia fsiqikis Rrma cvli- lebebTan, organoebis da qsovilebis neiro-
lebebiT, Zlieri abstinenciiT, reaqciulobis humorul, maT Soris - nervul-trofikuli
daqveiTebiT, nervuli sistemis, RviZlis, regulaciis darRvevasTan.
gul-sisxlZarRvTa sistemis dazianebiT (bra- magram narkomaniis da toqsikomaniis in-
dikardia, arteriuli hipotenzia). darRveu- timuri meqanizmebi jer Soria srulyofili
lia moZraobis koordinacia, rac naTlad Seswavlisgan. cnobilia, rom qronikuli
vlindeba siarulis dros. damaxasiaTebelia opiumuri (morfinuli) intoqsikaciis safuZ-
avadmyofis garegnoba: ganleva, kanis -, velia centraluri nervuli sistemis, gan-
kbilebis Zlieri kariesi, Tmis da frCxi- sakuTrebiT retikuluri formaciis da qer-
lebis mtvrevadoba axalgazrda an saSualo qis sinapsoarqiteqtonikis cvlileba. Ddazi-
asakis adamians Rrmad moxucebuls amsgavsebs. anebuli sinapsebis nacvlad yalibdeba axali
am stadiaSi narkotikisadmi tolerantoba neironTaSoriso kontaqtebi, romelic nor-
Semcirebulia, misi miReba naklebi regula- malur Tavis tvinSi ar gvxdeba. es, media-
robiT xdeba, Cveul eiforiul efeqts aRar torebis metabolizmis arsebul darRveve-
iZleva da is mxolod abstitenciis mov- bTan erTad, qmnis paTologiur funqciur
lenebs xsnis. TandaTanobiT Rrmavdeba saW- sistemebs, rasac gansakuTrebuli mniSvne-
mlis monelebis sistemis da gul-sisxl- loba aqvs umaRlesi vegetatiuri centrebis
ZarRvTa sistemis funqciis darRveva, vi- funqciobisTvis. amitomaa, rom narkomanias
Tardeba toqsikuri kardiomiopaTia. sik- axasiaTebs mravalricxovani darRveva.
vdili, umeteswilad, gamowveulia gulis narkotikebi aqtiurad zemoqmedeben ro-
kunTis gadagvarebiT, neiropaTiiT, TandarTu- gorc adrenergiul, ise qolinergiul si-
li infeqciiT. napsebze. magram gansakuTrebuli yuradReba
cxadia, rom ganviTarebuli movlenebis in- unda mieqces centralur nervul sistemaSi
tensivoba da siswrafe sxvadasxvaa narkoti- arsebul e.w. opiumuri (opiaturi) recep-
kis Warbi doziT miRebisas da misi qro- torebis funqcias, romlebic ierTeben opi-
nikuli gamoyenebis dros. aRniSnuli kargad umur nivTierebebs da, agreTve, endogenurad
Cans amJamad friad gavrcelebuli narkotikis warmoqmnil endorfinebs da enkefalinebs,
- heroinis sxvadasxva dozis gamoyenebis maga- romlebic morfinis msgavs moqmedebas axde-
liTze (sur. 6-11). nen. am receptorebis rolis Seswavla dRes
aseTive mimarTulebiT viTardeba movle- gansakuTrebiT aqtualuria.
nebi toqsikomaniis drosac. toqsikomanias iw-
vevs fsiqofarmakologiuri preparatebi (maga- 6.8 biologiur faqtorTa damazianebeli
liTad, antidepresantebi, trankvilizatore- gavlena organizmze
bi), saZile saSualebebi (magaliTad, barbi- adamianis saarsebo garemoSi mravalric-
turatebi), centraluri nervulis sistemis xovani da mravalferovani cocxali arsebaa
stimulatorebi (magaliTad, efedrini, kofe-
60
romlebic SeiZleba sruliad sxvadasxvagva- zRvis Tevzebis erT nawils (zRvis katas,
ri dazianebis wyarod iqcnen. zRvis zRarbs, zRvis moriels da sxv.) aqvs
cxovelebis mier dazianeba xorcieldeba farflebiT Sxamiani Cxvletis unari. maTi
meqanikuri zemoqmedebiT (kbena, Cxvleta da toqsini iwvevs qsovilis anTebas da nek-
a.S.), Sxamiani gamonayofis, parazitebis, baq- rozs. zRvis morielis Sxami, garda adgi-
teriebis, virusebis, sokoebis moqmedebiT. lobrivi moqmedebisa (temperaturis momate-
cxovelebis meqanikuri zemoqmedebis Sede- ba, qavili da tkivili Cxvletis adgilze),
gad viTardeba sxvadasxva formis Wriloba, zogad reaqciebsac iwvevs. Sxamis moqmedeba
romelic, Cveulebriv, inficirebulia, radgan vlindeba sisustiT, qoSiniT, oflis gamo-
cxovelis sxeulis sxvadasxva nawilze (pi- yofiT, krunCxviT. zog SemTxvevaSi aseTi
ris RruSi, brWyalebSi, rqebSi da sxv.) mud- Cxvleta sikvdilsac iwvevs.
mivad budoben paTogenuri baqteriebi. Gan- zogierTi Tevzis qviriTis da xorcis
sakuTrebiT sayuradReboa kbenis Sedegad co- toqsikuroba dakavSirebulia ama Tu im mom-
fis virusis gadacemis SesaZlebloba. wamlavi nivTierebis (magaliTad, tetrodo-
Sxamis moqmedebis efeqti damokidebulia toqsinis) SemcvelobasTan.
organizmSi moxvedrili toqsinis Zlier toqsikuri nivTierebebia mori-
raodenobaze, organizmis mgrZnobelobaze, elis, futkris, krazanas Sxami.
dazianebis lokalizaciaze. morielis Sxami amgznebad moqmedebs vege-
adamianis organizmis Zlier intoqsikacias tatiur nervul sistemaze, iwvevs hiper-
iwvevs zogierTi qvewarmavlis, Tevzis, mwe- salivacias da cremldenas, sisxlis wnevis
ris Sxami. momatebas, Rebinebas, sunTqvis gaZnelebas,
gansakuTrebiT Zlieri toqsikuri Tvise- krunCxvas. TviT nakbenis areSi viTardeba
bebi axasiaTebs gvelis Sxams. magaliTad, ner- anTeba, SeSupeba da qsovilis nekrozi.
vul sistemaze kurares magvarad moqmedebs nakbenis areSi anTebas da SeSupebas
kobras Sxami. misi zegavlena iwvevs sisus- futkris Sxamic iwvevs. organizmSi didi ra-
tes, Zilianobas, gulis muSaobis da sunTqvis odenobiT mis moxvedras axasiaTebs Zlieri
daTrgunvas, hipersalivacias (nerwyvis gamo- intoqsikacia, centraluri da periferiuli
yofis gaZlierebas), Rebinebas da defekacias. nervuli sistemis funqciis darRveva, ze-
kbenidan 2-7 saaTis Semdeg adamiani gonebas moqmedeba Tavis tvinis qerqze, rac bodvas
kargavs da dgeba sikvdili. da SemdgomSi futkrisadmi gansakuTrebul
sazogadod, gvelis Sxamebis moqmedeba SiSs - apifobias iwvevs. tvinis Reroze
nervul sistemasa da sxva qsovilebze da- Sxamis moqmedebis Sedegad iwyeba gulisreva,
kavSirebulia Sxamis proteo- da lipolizur Rebineba, qoSini, zog SemTxvevaSi da-
aqtivobasTan. maTi amgvari moqmedebis gamo blavdeba sunTqvis centri, rac, cxadia,
viTardeba cvlilebebi rogorc kbenis adgil- sikvdiliT mTavrdeba.
ze, ise sisxlSi. futkris Sxams antigenuri Tvisebebi
zogierTi gvelis Sxami azianebs leiko- aqvs, amitom adamiani SeiZleba Seeguos mas
citebs, sisxlZarRvis endoTeliums, RviZli- da ganmeorebiT kbenisas zemoaRniSnuli mov-
sa da Tirkmlis parenqimas, nervul sistemas. lenebi SeiZleba ar ganviTardes. magram an-
gvelis Sxams antigenuri Tvisebebi aqvs. tigenebis arseboba SxamSi zogjer Zlier
cxovelebis imunizebiT SesaZlebelia speci- alergiuli reaqciis ganviTarebasac ganapi-
fikuri antisxeulebis miReba da samkur- robebs.
nalo Sratis damzadeba. zogierTi saxeobis Wiebis paTogenuri moqmedebis efeqti ga-
cxovels (magaliTad, zRarbs) gvelis Sxa- nisazRvreba maTi gamravlebis da organizmis
misadmi bunebrivi imuniteti aqvs. sxvadasxva nawilSi gavrcelebis xasiaTiT,
helminTebis mier gamoyofili toqsikuri
61
nivTierebebis moqmedebiT, maTi antigenuri da infeqciuri sneulebebi Seudareblad
alergiuli TvisebebiT. swrafad vrceldeba, gansakuTrebiT – inten-
helminTis gavlena adamianis organizmze siuri saaviacio gadazidvebis gziT (yovel-
dakavSirebulia misi ganviTarebis sxvadasxva wliurad 2,1 mln aviamgzavri). infeqciur
stadiis (formis) migraciasTan adamianis da-avadebaTa afeTqebebis sixSiris mixedviT
qsovilebSi, rasac Tan sdevs qsovilebis mTa-vari safrTxe modis afrikaze - 228
dazianeba. magaliTad, askaridis larvebi, gax- bolo sam weliwadSi, Semdeg - wynari oke-
vreten ra nawlavis kedels, gadadian sis- anis dasavleT regionze (108). am Tval-
xlSi, marjvena gulSi, filtvebSi, xorxis sazrisiT mesame da meoTxe adgilzea xmel-
da saylapavi milis gavliT kvlav xvdebian TaSua zRvis aRmosavleTi nawilis qveynebi
nawlavebSi, sadac gardaiqmnebian zrdasrul (89) da evropa (81), anu saqarTvelos uSu-
formebad. parazitis aseTi gadanacvleba qso- alo mosazRvre regionebi, rac masac gar-
vilebsa da organoebSi iwvevs filtvis in- kveul epidsafrTxes uqmnis.
farqts, anTebiTi kerebis Camoyalibebas, sis- amgvarad, Cveni droisTvis damaxasiaTebe-
xlCaqcevebs, nawlavis kedlis dazianebas, mis lia registrirebadi infeqciuri avadmyofo-
gaxvretas, rasac muclis faris anTeba – pe- bebis speqtris cvlileba: pirobiT-paToge-
ritoniti mohyveba. nuri baqteriebiT gamowveul daavadebaTa
nawlavebSi zrdasruli helminTebis cxo- sixSiris matebis paralelurad, Tavi iCina
velmoqmedebisas gamoiyofa biologiurad aq- axalma infeqciebma, romelTa winaaRmdeg
tiuri nivTierebebi, toqsinebi, antigenebi, efeqturi kontrolis da mkurnalobis me-
romlebic Seiwovebian da cvlian ama Tu im Todebi jer ar aris SemuSavebuli. aRsa-
organos da sistemis funqciobas, iwveven niSnavia agreTve, rom zogierTma infeqci-
alergias. urma daavadebam, romlis winaaRmdeg mimar-
Tuli zomebi efeqturi Canda, kvlav mtkiv-
infeqciuri procesis da imunuri sistemis neulad iCina Tavi. magaliTad, izrdeba tu-
paTofiziologia berkuloziT avadoba, adamianebi ganmeorebiT
6.9.1. zogadi cnobebi infeqciuri avaddebian infeqciuri avadmyofoebebiT, ro-
procesis Sesaxeb melTa mimarT adre myari imuniteti yalib-
dedamiwis mosaxleobis saerTo avadobaSi deboda (wiTela, Cutyvavila da sxv.). gax-
infeqciuri daavadebebis xvedriTi wili Sirda Setyobinebebi zogierTi Terapiuli
friad maRalia da sruliad aSkaraa misi profilis (”arainfeqciuri”) qronikuli
zrdis tendencia, razec naTlad metyvelebs daavadebis ganviTarebaSi infeqciuri sawyi-
janmrTelobis dacvis msoflio organiza-ci- sis mniSvnelovani rolis Sesaxeb. amrigad,
is 2007 wlis moxseneba. am dokumentis mi- infeqciuri paTologiam axali simwvaviT
xedviT, uaxloes aT weliwadSi kacobriobas iCina Tavi, mravali maTgani iqca ara marto
emuqreba globaluri epidemiebi, Sidsis, saeqimo, aramed socialur problemadac.
ebolis hemoragiuli cxelebis da atipob- zemoTqmuli naTels xdis, Tu raoden
rivi cxelebis Sesadari avadmyofobebis mniSvnelovania amJamad moRvawe eqimebis da
afeTqebebi. 1970 wlis Semdeg gaCnda 39 studenti-medikosebis mier infeqcuri daa-
axali avadmyofoba, ukanasknel 5 weliwadSi vadebebis da, sazogadod, infeqciuri pro-
aRiniSna epidemiis 1100 afeTqeba. cesis Sesaxeb Tanamedrove, Rrma da mas-
moxsenebaSi aRniSnulia, rom axali infeq- Staburi codnis miReba.
ciuri daavadebebi aRmocendeba dRemde ar- amisTvis, pirvel rigSi, aucilebelia
naxuli sixSiriT (erTi weliwadSi). axali infeqciuri procesis ganviTarebis kanonzo-
infeqciebi, uxSiresad, mdgradia antibioti- mierebebSi, sazogado meqanizmebSi garkveva,
koTerapiis mimarT. rac, cxadia, mxolod misi zogadi paToge-
62
nezis Sesabamisi Seswavlis safuZvelzea Se- organizmis dacvisunarianobis xarisxi
saZlebeli. gamomwvevi mizezebis mimarT da TviT mikro-
bis (virusis, riketsiis da sxv.) Tvisebebi
6.9.2. infeqciuri procesi gansazRvravs imas, rom inficirebuli in-
infeqciuri procesi (laT. infectio–dasne- dividebidan zogi saerTod ar avaddeba an
bovneba) makroorganizmSi paTogenuri mikro- gamomwvevis zemoqmedebas pasuxobs mxolod
organizmis SeWris da gamravlebis Sedegad imunuri reaqciiT, zogi iqceva infeqciis ga-
ganviTarebuli rTuli urTierTdakavSirebu- momwvevis klinikurad janmrTel mtareblad,
li funqciuri, morfologiuri, bioqimiuri, sxvani gadaitanen avadmyofobas msubuqi an
imunuri da sxva cvlilebebis erTobliobaa, waSlili, nawili – tipobrivi, maT Soris
romelic xSirad xdeba infeqciuri daavadebis mZime formiT, inficirebulTa garkveuli
safuZveli. is moicavs rogorc paTologiur, raodenoba ki kvdeba.
ise dacviT-SeguebiT da sakompensacio reaq-
ciebs, mimarTuls organizmis homeostazis 6.9.2. infeqciur daavadebaTa
SenarCunebisken an misi aRdgenisken. etiologia
paTogenuri mikroorganizmis moxvedra 6.9.2.1. gamomwvevTa saxeebi
organizmSi - inficireba yovelTvis ar iw- infeqciur process iwveven umartivese-
vevs avadmyofobas (magaliTad - mikroorga- bi, sokoebi, baqteriebi, riketsiebi, viruse-
nizmis usimptomo mtarebloba). infeqciuri bi da prionebi. yoveli maTgani gansazRvravs
procesi moicavs makroorganizmSi mikrobis an infeqciuri procesis specifikur suraTs.
virusis SeWrasTan da organizmSi mis ar- makro- da mikroorganizmebi SeiZleba
sebobasTan dakavSirebul yvela process – imyofebodes sxvadasxvagvar urTierTdamoki-
bacilmtareblobidan mZime infeqciuri avad- debulebaSi: parazitizmi, mutualizmi da
myofobis ganviTarebamde. infeqciuri daavade- komensalizmi.
ba ki infeqciuri procesis ganviTarebis parazitizmi – antagonizmis formaa,
ukiduresi xarisxi, misi aSkara gamovlinebaa. romlis dros mikroorganizmi iyenebs mak-
infeqciuri procesis ganviTareba damoki- roorganizms, rogorc arsebobis mudmiv an
debulia mikrobis paTogenobaze da viru- droebiT garemos, sakvebis wyaros da azi-
lentobaze, organizmis reaqciulobasa da anebs mas.
garemo pirobebze. infeqciuri daavadebis Zi- mutualizmi – mikro- da makroorga-
riTadi mizezi paTogenuri mikrobi an viru- nizmis urTierTsasargeblo Tanacxovrebaa.
sia, xolo organizmis reaqciuloba da gare- misi magaliTia damokidebuleba nawlavis
mo faqtorebi daavadebis ganviTarebis pi- mikrofloris zogierT warmomadgenels da
robebia. infeqciuri daavadebis aRmocenebas, organizms Soris.
mis ganviTareba-arganviTarebas gansazRvravs komensalizmi – mikro- da makroor-
mikro- da makroorganizmis urTierTqmedeba. ganizmis urTierTqmedebis iseTi formaa, ro-
paTogenuri mikrobis zemoqmedebas orga- desac mikrobis cxovelmoqmedeba makroor-
nizmi pasuxobs reaqciebis rTuli kompleq- ganizmSi ar azianebs ukanasknels (magali-
siT. am reaqciaTa erTi nawili dacviTi an Tad, kanis, nawlavis, lorwovani garsebis
kompensaciuri xasiaTisaa, meore nawili ki mikroflora).
daavadebuli organizmis cxovelmoqmedebis adamianSi infeqciuri daavadebis gamow-
darRvevis gamovlinebaa. aRniSnul reaqciaTa vevis unaris TvalsazrisiT mikrobebs yofen
Tanafardoba araerTnairia, dakavSirebulia paTogenurad, pirobiT-paTogenurad da apa-
rogorc mikrobis, ise makroorganizmis Tvi- Togenurad.
sebebTan. paTogenuri mikrobebis SeWra makroor-
ganizmSi, rogorc wesi, iwvevs Tu ara
63
infeqciuri avadmyofobis, infeqciuri proce- velis mokvdinebisTvis saWiro mikrobTa
sis ganviTarebas mainc dacviTi meqanizmebis rao-denobiT.
gaaqtivebis TvalsazrisiT. paTogenur
mikroorganizmebs axasiaTebs specifikuroba – 6.9.2.3. paTogenobis faqtorebi
makroorganizmSi moxvedrili esa Tu is toqsinebi da virulentobis sxva faq-
paTogenuri mikrobi iwvevs gamomwvevisTvis torebi aqvs baqteriebs, virusebs, riketsi-
damaxasiaTebel paTomorfologiur, paTofizi- ebs, sokoebs, umartivesebs, helminTebs. Ase-
ologiur da klinikur cvlilebebs. Ti faqtorebia:
pirobiT-paTogenuri mikroorganizmebi - gavrcelebis faqtorebi, romlebic
avadmyofobas iwveven mxolod makroorga-niz- uzrunvelyofen an aadvileben gamomwvevis
mis antiinfeqciuri rezistentobis daqveiTe- SeWras da gavrcelebas organizmSi. maT mie-
bis SemTxvevaSi (magaliTad, imunuri sistemis kuTvneba fermentebi (magaliTad, hialuro-
funqciis darRvevis dros). nidaza), Soltebi (magaliTad, qoleris vib-
apaTogenuri mikroorganizmebi infeqciur rionisa).
avadmyofobas ar iwveven. - adheziis da kolonizebis faqtorebi
avadmyofobis dinamikaSi arsebiTad ic- xels uwyobs organizmSi moxvedrili mik-
vleba rogorc gamomwvevis, ise makroorga- roorganizmebis urTierTqmedebas organizmis
nizmis Tvisebebi da, aqedan gamomdinare, maTi ujredebis specifikur receptorebTan da
urTierTqmedebis pirobebi. magaliTad, mikro- amiT uzrunvelyofs mikrobebis parazitizms,
bis virulentoba SeiZleba gaizardos makro- gamravlebas da koloniebis warmoqmnas.
organizmTan misi Seguebis gamo. - adheziuri molekulebi mikrobebis uj-
redebis cilovani an polisaqariduli bu-
6.9.2.2. gamomwvevTa Tvisebebi nebis zedapiruli qimiuri struqturebia.
paTogenoba sxvadasxva adhezini uzrunvelyofs mikrobe-
paraziti mikroorganizmebis ganmasxvavebe- bis urTierTqmedebas makroorganizmis gan-
li Tvisebaa maTi paTogenoba – mikroorga- sazRvrul ujredebTan.
nizmis unari SeiWras organizmSi, gamravldes - kolonizeba mikrobebis didi raodeno-
da gamoiwvios avadmyofoba. is erTi da igive biT gamravleba da koloniebis warmoqmnaa,
saxeobis gamomwvevisTvis damaxasiaTebeli, e.i. rasac xels uwyobs zogi egzotoqsini.
saxeobrivi niSania, romelic fiqsirebulia
genetikur programaSi da, Sesabamisad, gada- 6.9.2.4. mikrobebis dacvis faqtorebi
ecema memkvidreobiT. virusebis paTogenobas makroorganizmis baqtericiduli gavle-
(infeqciurobas) ganapirobebs genetikuri ko- nisgan mikrobis dacvis meqanizmebs mie-
dis mtarebeli nukleinmJava. kuTvneba:
paTogenoba uzrunvelyofs mikroorganiz- - mikrobis kafsula, romelic meqani-
mis infeqciurobas – makroorganizmSi misi kurad icavs mikrobs dazianebisgan (aseTi
SeWris unars, gamravlebas masSi da avadmyo- Tviseba aqvs, magaliTad, tuberkulozis ga-
fobis gamowvevas. momwvevs).
paTogenobis xarisxs gansazRvravs mikro- - fagocitozis da imunitetis damTrgu-
bis virulentoba da toqsikogenoba. navi faqtorebi. magaliTad, stafilokoke-
mikroorganizmis paTogenobis zomaa misi bis zogi Stamis katalaza Trgunavs mikro-
fenotipuri Tviseba – virulentoba. is mik- bebis monelebas fagocitSi; mikrobis pro-
roorganizmis mier daavadebis gamowvevis una- teaza iwvevs imunoglobulinebis hidro-
ris xarisxia. Ees xarisxi ganisazRvreba e.w. lizs.
minimaluri sasikvdilo doziT (DLML – - toqsinebi, romlebic azianeben maspin-
Dosis letalis minima) – eqsperimentuli cxo- Zlis organizmis ujredebs da qsovilebs.
64
warmomavlobis mixedviT maT yofenN endo- membranul toqsinebad da ujredSiga struq-
genurad (endotoqsini) da egzogenurad (eg- turebze moqmed toqsinebad.
zotoqsini). - citolemaze moqmedi membrantoqsine-
endotoqsinebs gamoyofs baqteriebi (upi- bi uzrunvelyofen maTi ganvladobis moma-
ratesad – gramuaryofiTebi) maTi daSlis tebas da/an destruqcias. ZiriTadi membra-
dros. endotoqsins aqvs SxamisTvis damaxa- ntoqsinebia: forebis warmomqmneli arafer-
siaTebeli yvela klasikuri niSani, magali- mentuli nivTierebebi, romlebmac SeiZleba
Tad, toqsikuri moqmedeba minimalur dozeb- gamoiwvion T-ujredebis apoptozi.
Si, urTierToba specifikur receptorebTan, - membranebis uSualod damazianebeli
Termostabiloba da sxv. …… nivTierebebi (neiramidaza, hialuronidaza da
endotoqsini aris lipopolisaqaridi sxv.);
(lps), is yvela gramuaryofiTi baqteriis ga- - membranebis lipidur garsze deter-
re membranis ZiriTadi struqturuli ele- genturad moqmedi toqsinebi.
mentia. endotoqsinis biologiur aqtivobas - ujredSiga struqturebze moqmedi
gansazRvravs misi hidrofobuli komponenti - toqsinebi. am tipis egzotoqsinis moleku-
A-lipidi. lps-is damazianebeli efeqti re- laSi funqciurad gansxvavebuli ori na-
alizdeba interleikin-1-is (IL 1), simsivnis wilia: receptoruli da katalizuri. yo-
nekrozuli faqtoris (TNF) da Trombo- veli maTgani pasuxismgebelia ujredTan
citebis aqtivaciis faqtoris (PAF) monawi- urTierTqmedebis garkveul etapze.
leobiT. egzotoqsinis urTierierTqmedeba uj-
- organizmSi moxvedrisas lps-is STan- redTan oTx etapad mimdinareobs:
Tqaven fagocitebi (leikocitebi, makrofage- 1. receptorTan dakavSireba
bi, kupferis ujredebi da sxv.). es ujredebi 2. internalizeba
aqtivdeba, gamoyofs lipiduri da cilovani 3. gadaadgileba citozolSi
bunebis biologiurad aqtiur nivTierebebs – 4. ujredSiga efeqtebi
prostaglandinebs, Trombocitebis aqtivaciis egzotoqsinebs, ZiriTadad, gramdadebiTi
faqtors, leikotrienebs, citokinebs da sxv. mikrobebi (difTeriis, tetanusis, da sxv.)
- endotoqsinebis in vivo moqmedebas spe- gamoimuSaveben. isini maRali specifikurobis
cifikuroba ar axasiaTebs. isini ar arian cilovani bunebis nivTierebebia, axasiaTebT
organotropuli, arCeviTad ar azianeben ro- organotropuloba. toqsinis molekula fiq-
melime qsovils da organos, TiTqmis Ta- sirdeba gansazRvruli organoebis ujrede-
nabrad moqmedeben qsovilebsa da sistemebze: bis specifikur receptorebze da reaqciaSi
sisxlZarRvebze, mezenqimur organoebze, akni- Sedis ujredis fermentul sistemebTan. am
neben fagocitozs, parenqimul organoebSi reaqciebiTaa ganpirobebuli TiToeuli toq-
iwveven difuziur distrofiul da nekro- sinis organotropuloba, specifikuroba.
zul cvlilebebs. zemoaRniSnulis gamo, organoebis da qsovilebis arCeviTi dazi-
yovel endotoqsinur infeqcias axasiaTebs aneba daavadebis paTogenezze da klinikur
TiTqmis erTnairi klinikuri polimorfizmi: suraTzec aisaxeba (magaliTad, difTeriis
toqsikozi, cxeleba, gamonayari, hepatoli- dros arCeviTad ziandeba gulis kunTi, te-
enuri sindromi, limfadenopaTia, hemodina- tanusis dros - zurgis tvinis wina rqebis
mikuri Zvrebi endotoqsinuri Sokis ganviTa- motoneironebi da a.S.).
rebiT da sxv.
egzotoqsinebi nivTierebebia, romlebsac 6.9.3. mainficirebeli doza
garemoSi gamoyofen mikroorganizmebi. Eeuka- mainficirebeli doza sicocxlisunari-
riotul ujredebSi, zemoqmedebis obieqtTan ani gamomwvevis is minimaluri raodenobaa,
dakavSirebiT, egzotoqsinebs pirobiTad yofen romelic sakmarisia infeqciuri avadmyo-
65
fobis ganviTarebisTvis. am dozaze SeiZleba anginas, kanSi – wiTel qars an piodermias,
iyos damokidebuli infeqciuri procesis saSvilosnos lorwovanSi – endometrits.
simZime, pirobiT-paTogenuri baqteriebis Sem-
TxvevaSi ki – avadmyofobis ganviTarebis Se- gamomwvevis gavrceleba organizmze
saZlebloba. gamomwvevis organizmSi SeWris Semdeg
inficirebisTvis saWiro dozis sidide SeiZleba moxdes misi gavrceleba organiz-
damokidebulia gamomwvevis virulentobaze. am mze Semdegi gzebiT:
or maxasiaTebels Soris ukudamokidebulebaa: - ujredSoris sivrciT;
rac ufro maRalia virulento-ba, miT mcirea - limfuri KkapilarebiT - limfogenurad;
mainficirebeli doza. cno-bilia, rom iseTi - sisxlis kapilarebiT – hematogenurad;
maRalvirulenturi gamomwvevisTvis, rogoric - serozuli Rruebis an Tavzurgtvinis
Savi Wiris Cxiria, mainficirebeli doza siTxiT.
SeiZleba meryeobdes erTidan ramdenime
mikrobul ujredamde; dizenteriis gamomwvevi 6.9.5. mikroorganizmebis gavlena
dozaa daxloebiT asi mikrobuli ujredi. fagocitebze
amaTgan gansxvavebiT, dabalvirulenturi Sta- infeqciuri procesis paTogenezSi wamyvan
mebis mainficirebeli doza SeiZleba iyos 105 rols asrulebs mikroorganizmebis da fa-
– 106 mikrobuli ujredi. gocitebis urTierTqmedeba, romelic mniS-
vnelovanwilad gansazRvravs infeqciuri
6.9.4. infeqciis gaviTarebis pirobebi procesis ganviTarebis Taviseburebebs.
infeqciis aRmocenebis da ganviTarebis- fagocitebis dacviTi roli mdgomareobs
Tvis didi mniSvneloba aqvs organizmSi mik- mikroorganizmebis STanTqmasa da ganadgu-
robis SeWris gzas, mis gavrcelebas orga- rebaSi (ix. “anTeba”). magram zogierTi in-
nizmSi da infeqciis sawinaaRmdego rezisten- feqciuri avadmyofobis gamomwvevi rezis-
tobis meqanizmebs. tentulia fagocitebiT destruqciis mi-
infeqciis SeWris kari aris mikrobis ma- marT, ufro metic – maT aqvs fagocitebSi
roorganizmSi Sesvlis adgili. aseTi SeiZ- gamravlebis unari.
leba iyos: ZiriTadi masala fagocitebis da mikro-
kani (magaliTad, malariis partaxtiani organizmis urTierTqmedebis Sesaxeb mocemu-
tifis, kanis leiSmaniozis gamomwvevTaTvis); lia ganakveTebSi "anTeba" da "imunuri sis-
sasunTqi sistemis lorwovani garsi (ma- tema".
galiTad, gripis, wiTelas gamomwvevTaTvis);
saWmlis momnelebeli sistemis lorwova- 6.9.6. antiinfeqciuri rezistentebis
ni garsebi (magaliTad, dizenteriis da muc- meqanizmebi
lis tifis gamomwvevTaTvis); 6.9.6.1. infeqciisgan organizmis dacvis
Sard-sasqeso sistemis lorwovani garsebi meqanizmebi
(magaliTad, gonoreis da sifilisis gamom- organizms aqvs infeqciisgan dacvis
wvevTaTvis); mZlavri meqanizmebi, sistemebi, romlebic
sisxlis da limfis milebis kedlebi, sa- ewinaaRmdegeba gamomwvevis SeWras organiz-
idanac gamomwvevi gadadis sisxlSi da mSi, maT gamravlebas da paTogenuri efeq-te-
limfaSi. bis gamovlinebas. dacviTi meqanizmebis arse-
sayuradReboa, rom infeqciis SeWris boba ganapirobebs imas, rom organizmSi in-
karma SeiZleba gansazRvros ganviTarebuli feqciuri agentis moxvedra jer kidev ar
avadmyofobis nozologia. magaliTad, strep- uzrunvelyofs infeqciuri daavadebis auci-
tokokis SeWra nuSisebur jirkvlebSi iwvevs lebel da, miT ufro, myisier ganviTarebas.
inficirebis pirobebTan da dacviT meqaniz-
66
mebTan dakavSirebiT infeqciuri daavadeba sebebiT da organizmSi misi SeWris gziT
SeiZleba sruliad ar ganviTardes an Ca- (in-feqciuri daavadebebis dros organizmSi
moyalibdes bacilmtarebloba. gan-viTarebuli procesebi detalurad ganxi-
meqanizmebs da faqtorebs, romlebic ewi- lulia qvemoT).
naaRmdegeba mikrobis SeWras da mis cxo- ujredgareT gamravlebadi mikroorganiz-
velmoqmedebas organizmSi, hyofen araspeci- mebi, rogorc wesi, iwveven humorul, xolo
fikurad da specifikurad. araspecifikuri ujredSi gamravlebadi mikroorganizmebi -
meqanizmebi monawileobs yvela mikrobTan an ujredul imunur reaqciebs. egzotoqsinebi
maT umetesobasTan kontaqtSi, specifikuri neitraldeba antitoqsinebiT, magram xSirad
meqanizmebi ki mimarTulia konkretuli mik- antitoqsinebi warmoiqmnebian gvian da ver
roorganizmis winaaRmdeg. am meqanizmebs icaven organizms egzotoqsinebisgan.
Soris Taviseburi sinergizmia, rac aZlierebs amrigad, organizmis dacva infeqciuri
organizmis dacvas. ganarCeven araspecifikur daavadebebis gamomwvevebisgan moicavs mra-
da specifikur dacviT-adaptaciur meqaniz- valferovan meqanizmebs da faqtorebs. maT-
mebs. gan umniSvnelovanesia leikocitebi, fago-
Aaraspecifikur reaqciebs - pirvel ba- citozi, baqtericiduli meqanizmebi, ref-
riers infeqciisaTvis, miekuTvneba (sur. ): leqsuri dacviTi reaqciebi, barierebi da
a. kanis da lorwovanebis barieruli funqcia – baqtericiduri faqtorebi.
gamomwvevTa umetesi nawili ver iWreba orga- kanis, lorwovani garsebis da sxva
nizmSi dauzianebeli kanidan da lorwovani- stuqturebis barierebi da baqtericiduli
dan; faqtorebi, qmnian organizmis araspecifi-
b. sekreciuli procesebi - lorwovani gar- kuri dacvis pirvel xazs.
sebis mier lizocimis, imunoglobulinebis da gamomwvevTa didi umetesoba (magaliTad,
a.S. Semcveli sekretis gamoyofa, romelic kontaqturi infeqciebisa) organizmSi SeiW-
qmnis araxelsayrel pirobebs baqteriebis mi- reba mxolod dazianebuli kanidan da lor-
magrebis da ganviTarebisTvis; wovani garsebidan. kans aqvs damcveli rqo-
g. limfuri kvanZebi da limfoiduri qsovilis vana garsi, romlis Camofcqvnis (desqva-
grovebi mravali mikrobisTvis TiTqmis dauZ- maciis) dros mas Camocildeba baqteriebis
leveli barieria; didi raodenoba. barieruli funqcia aqvs,
d. humoruli meqanizmebi - lizocimi, kom- agreTve, bronqebis mocimcime epiTeliums,
plementis komponentebi, interferoni momak- nawlavis xaoebis epiTeliums. Ggarkveul
vdinebel gavlenas axenen gamomwvevze; dacviT rols TamaSobs histohematuri da
e. ujreduli rezistentoba - pirvel rigSi - hematoencefaluri barieri, ujredebis mem-
fagocitebis: granulocitebis da makrofage- branebi.
bis reaqciebi (ix. "anTeba"); dacviT rols asrulebs kanis da lor-
v. fiziologiuri sistemebis reaqciebi: nei- wovani garsebis normaluri mikroflorac,
roendokrinuli regulaciis, gamomyofi or- disbaqteriozi ki xels uwyobs organizmSi
ganoebis, RviZlis antitoqsikuri funqciis paraziti mikrobebis SeWras da aiolebs in-
cvlilebebi, sisxlis gadanawileba. feqciuri daavadebis ganviTarebas.
infeqciuri agentebis winaaRmdeg mimar- kanis da lorwovani garsebis baqteri-
Tuli specifikuri reaqciebi imunuri xasiaTi- cidulobas ganapirobebs maT zedapirze li-
saa. imunuri sistema reagirebs agentis mra- zocimis, IgA da IgM, glikoproteinebis
valricxovan antigenur determinantebze da Semcveli sekretis arseboba. maTgan umTav-
iZleva Sesabamis pasuxs. resia IgA, romelic blokavs baqteriebis
imunuri pasuxis xasiaTi (ujreduli, hu- zedapiris dasakavSirebel monakveTebs da
moruli) pirobadebulia gamomwvevis Tvi- amiT qmnis winaaRmdegobas baqteriebis kon-
67
taqtisTvis epiTeluri ujredebis zeda-pirze
arsebul specifikur receptorebTan.
mniSvnelovania kanis baqtericiduloba.
cximmJavTa arseboba kanis zedapirze uz-run-
velyofs dabal pH-s, saofle jirkvlebi ga-
moyofen rZemJavas, isini abrkoleben mravali
mikroorganizmis cxovelmoqmedebas. mZlavri
baqtericiduli faqtoria kuWis wvenis daba-
li pH
68
sur. 6.1 organizmis dacva infeqciisgan
araspecifikuri specifikuri
qsoviluri, ujreduli,
sistemuri imuniteti
organuli humoruli
sisxlis
gadanawileba interferoni bunebrivi
sekreciuli (dedis bunebrivi
procesebi (imunizacia
antisxeulebi
endokrinuli axalSo- infeqciis
fagocitozi bilebSi) Sedegad)
regulaciis
limfoiduri cvlileba
qsovili
xelovnuri xelovnuri
gamomyofi organoebis RviZlis antitoqsikuri (antisxeulebis (imunizeba
funqciis cvlileba funqciis gaZliereba Seyvana) vaqcinebiT)
69
sur. 6.2. organizmis dacviT-adaptaciuri reaqciebi infeqciis dros
70
gamravleba, iwvevs, ZiriTadad, ujredul imuniteti mTeli cxovrebis manZilze zogi
imunur reaqciebs. virusuli infeqciis dros pirobade-bulia
endotoqsinebi, romlebic gadamwyvet gamomwvevis persistirebiT organizmSi -
rols asruleben araerTi infeqciuri avad- arasteriluri imunitetis feno-meni.
myofobis paTogenezSi (tetanusi, difte- imunuri sistemis aqtivacia mimarTulia,
ria, airovani gangrena), neitralizdeba pirvel rigSi, imunitetis formirebisken,
antitoqsinebiT. Ppirveladi infeqciisas magram infeqciuri paTologiis dros SeiZleba
antitoqsini, Cveulebriv, warmoiqmneba ganviTardes imunopaTologiuri Zvrebic: aler-
nela da, amitom, efeqturad ver icavs giuli, imunuri, autoagresiis, imunodeficitis
organizms endotoqsinis efeqtisgan. reaqciebis saxiT.
hematogenurad gavrcelebadi virusebi rogorc iTqva, mikroorganizmebis da
(magaliTad, poliomielitis, wiTelas, epi- "ucxo" makromolekulebis winaaRmdeg orga-
demiuri parotitis), neitralizdebian, nizms aqvs araspecifikuri, Tandayolili da
ZiriTadad, humoruli imunitetis masTan mWidro kavSirSi myofi specifikuri,
faqtorebiT. SeZenili imunuri dacvis meqanizmebi. Sesabamisad
SeWris adgilze gamravlebadi virusebi amisa, ganasxvaveben araspecifkur da specifikur
(magaliTad, gripisa) inficirebisas iwveven imunur sistemas.
adgilobrivi imunitetis reaqciebs.
virusebis ujredSiga gamravlebis dros 6.9.7.1. imunuri sistemis araspecifikuri
organizmis dacvaSi gansakuTrebuli rezistentoba
mniSvneloba aqvs ujredul imunitets. imunuri sistemis araspecifikur meqa-nizmebs
Uupiratesad ujreduli imuniteti emsaxureba sxnadi nivTierebebi: li-zocimi,
formirdeba sokoebiT inficirebis drosac. komplementis sistema (sur. 9-a), fagocitebi -
WiebiT invazia xasiaTdeba, upiratesad, makrofagebi (qsovilSi emigrirebuli
IgE-s sinTezis gaZlierebiT. Pparazitis monocitebi), neitrofiluri granulocitebi
SeWris adgilas xSirad viTardeba infil- (sur. 9-b).
trati, romelic Sedgeba mononukleuri sisxlsa da sekretebSi lizocimis mier
fagocitebis, limfocitebis, xdeba baqteriebis kedlis fermentuli daSla
eozinofilebis, bazofilebis, poxieri _ citolizi.
ujredebisgan. araspecifikuri imunuri rezistentobis meqanizmSi
xangrZlivi imunitetis formirebaSi monawile ujredovani elementebi. Aaras-pecifikur
wamyvan rols asrulebs gamomwvevis anti- imunur meqanizmebSi bunebrivi qileri ujredebi
genTan kontaqtis Sedegad warmoqmnili (NK-ujredebi) moqmedeben virusebis,
limfocitebi (“imunuri mexsierebis ujre- mikroorganizmebis da simsivnu-ri ujredebis
debi”). zog SemTxvevaSi imuniteti grZel- winaaRmdeg. es ujredebi, Se-icnoben ra
deba mTeli sicocxlis manZilze, zogjer „msxverpls“, Fc-receptoriT gadaejaWvebian
ki xanmoklea. imunoglobulinebiT ofsoni-rebul maT garss
araerTgvarovani imunuri pasuxis mize- (sur. 9g). NK-qilerebi egzocitirebuli
zebi gaurkvevelia. maTgan yvelaze mosa- perforinebis saSualebiT azianeben samizne
lodneli da mniSvnelovania: gamomwvevis ujredebs, warmoqmnian xvrels maT garsSi, rac
dabali imunogenoba, gamomwvevis ujred- ujredis sikvdiliT mTavrdeba. am gziT kargavs
Siga parazitizmi, virusis struqturis gamravlebis unars ujredSi SeRweuli sicocx-
cvlileba, imunuri pasuxis formirebis lisunariani virusi. amave dros, jer kidev
darRveva imunosupresiis gamo. ujredebSi myofi gamomwvevi ufro xelmi-
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sawvdomi xdeba imunuri sistemis sxva da- deg. Ffagocitebi aRWurvilia Fc recepto-
mazianebeli meqanizmebisTvis riTGimunoglobulinebis antigen-damokide-buli
Fc-nawilisTvis (sur. 9-g), romelTa
fagocitozi da lizosomuri moneleba saSualebiT xdeba maTi SekavSireba antigenTan.
fagociti-makrofagebi qsovilSi emig- amrigad, xorcieldeba urTierTkavSiri
rirebuli monocitebi da fiqsirebuli, araspecifikur da specifikur imunur
magram lokaluri moZraobis unaris mqone meqanizmebs Soris (fagocitebis Sesaxeb ixile,
ujredebia. maT miekuTvneba: 1.RviZlis kup- agreTve, ganakveTSi “anTeba”).
feris ujredebi, 2. filtvis alveolebis imunuri sistemis araspecifikuri rezis-
ujredebi, 3. nawlavis serozuli garsis tentobis ukmarisobis pirobebSi antisxeulebi,
ujredebi, 4.elenTis sinusebis ujredebi, marTalia, reagireben specifikur antigenebTan,
5.limfuri kvanZebis ujredebi, 6.kanis magram antigenebis SeboWvis da daSlis
ujredebi, 7. sasaxsre napralSi - sinoviu- procesis darRvevis gamo imunuri reaqciebis
ri ujredebi, 8.Tavis tvinSi – mikroglia, efeqturoba da, Sesabamisad, organizmis
9.Tirkmlis glomerulebis endoTeliumi. mdgradoba infeqciuri avadmyofobebis mimarT
am ujredebs aerTianeben mononukleur- qveiTdeba.
fagocitur anu retikulur-endoTelur sistemad. fagocitebis aqtivobis cvlilebebi
makrofagebi Seicnoben baqteriebis am ujredebis warmoqmnis darRvevis an maTi
zeda-piris SedarebiT araspecifikur funqciuri arasrulyofilobis Sedegia. orive
naxSir-wylovan komponentebs da axdenen am maTgani SeiZleba memkvidreobiTi an SeZenili
baqteriebis monelebas, risTvisac xasiaTis iyos. fagocitebis warmoqmnis
aucilebelia am ujredebis winaswari darRveviT mimdinare memkvidreobiTi avadmyofo-
aqtivacia (sur. 9). bebis dros ujredebis gamravleba wydeba
gaaqtivebuli fagocitebi axdenen (magaliTad, memkvidreobiTi neitropenia) an
gamomwvevis endocitozs, azianeben mas maTi momwifebuli formebi funqciurad
lizocimiT, oqsidantebiT (H2O2, O2-, OH+, NO; arasrulyofilia. imunodeficiti viTardeba im
sur. 9-g), xdeba gamomwvevis moneleba fermentTa ukmarisobis drosac, romlebic
lizosomuri enzimebiT (lizisi). Tu an- monawileoben baqteriebis ujredSiga daSlaSi.
tigeni didi zomisaa, zemoCamoTvlili aRniSnuli avadmyofobisas SenarCunebulia
„damcveli nivTierebebi“ egzocitirdeba rezistentoba strepto-, pnevmo- da
eozinofilebis mier (sur. 9-d). meningokokuri in-feqciebisadmi, magram Zalze
oqsidantebis koncentraciis dabali iolad vi-Tardeba da mZimed mimdinareobs
done regulirdeba antioqsidantebis stafilokokuri infeqcia. am fonze mZime
saSualebiT. aseTi “moTokva” aucilebelia daavadebas iwvevs, agreTve, pirobiT-paTogenuri
fagocitis aqtivobis SesanarCuneblad, mikrobi - nawlavis Cxiri.
raTa ar gai-zardos maTi baqtericiduli fagocitebis funqciuri aqtivoba qveiTdeba
moqmedebis areali, ar daziandes TviT maTSi naxSirwylebis da energetikuli cvlis
fagociti da mis irgvliv mdebare memkvidreobiTi defeqtis Sem-TxvevaSic.
qsovili. fagocituri aqtivoba mkveTrad ecema
fagocitozi da lizosomuri moneleba leikocitebis imunuri dazianebis da mis gamo
Zlierdeba antigenis antisxeulebiT an C3b ganviTarebuli leikopeniis dros. fagocituri
komplementiT SeboWvis anu ofsonirebisas aqtivoba qveiTdeba glukokortikoidebis da
(sur. 9-b), radgan polisaqariduli kaf- acetilqolinis gavleniTac, zogierTi hormonis
sulis mqone baqteriebis fagocitozi Se- da vitaminis naklebobisas, wylisa da
saZlebeli xdeba mxolod ofsonirebis Sem- marilebis cvlis darRvevis dros, ujredis
72
energiis gamomuSavebis damTrgunavi araspecifikuri imunuri dacvis meqanizmSi
Sxamebis moqmedebis Sedegad. TamaSobs. is axdens mikrobTa liziss e.w.
membranis Semtevi C5-C9 komponentebisagan Semdgari
komplementis sistema kompleqsiT (sur. 10). es kompleqsi iwvevs
komplementi plazmis cilebis funqci- mikrobis (gansakuTrebiT - gramuaryofiTis)
urad urTierTdakavSirebuli sistemaa, membranis perforacias da mis sikvdils.
rom-lis aqtivacia iwvevs biologiurad komplementis sistemis cvlilebebi da-
aqtiuri nivTierebebis warmoqmnas. es kavSirebulia, upiratesad, misi kompo-nentebis
nivTierebebi monawileoben organizmis memkvidreobiT an SeZenil defi-citTan. kom-
dacviT reaqciebSi (magaliTad, anTeba da plementis SeZenili ukmarisoba aRiniSneba
fagocitozi). kom-plements aRniSnaven C endokarditis, sefsisis, ma-lariis, virusuli
asoTi, mis komponentebs ki Sesabamisi infeqciebis dros.
cifrebiT (C1, C2 da a.S.). komplementis TiToeuli komponentis
arsebobs komplementis aqtivaciis ori deficiti damaxasiaTebel cvlilebebs iw-vevs.
gza: klasikuri da alternatiuli (sur. 10). C1 komponentis deficiti memkvidreobiTi
Aaqtivaciis klasikuri gza provocirdeba an- autosomuri niSania, romlis dros plazma
tigen-antisxeulis reaqciiT. misi kargavs baqtericidul Tvisebebs, viTardeba
sxvadasxva komponentis daSlisas zemo sasunTqi gzebis ganmeorebiTi infeqcia,
warmoiqmneba aqtiuri produqtebi. otiti, saxsrebis dazianeba, mZime
komplementis sistemis klasikuri gziT glomerulonefriti.
CarTvis yvelaze mniSvnelovani safexuria C2 komponentis ukmarisobas axasiaTebs
C3 komponentis aqtivacia, rom-lis biZgis plazmis baqtericiduli Tvisebebis daqvei-Teba,
mimcemia C1-is fiqsacia antigenTan midrekileba virusuli infeqciis, SemaerTebeli
SekavSirebul IgM an IgG antisxeulze. qsovilis dazianebis, Trom-bocitopeniisadmi.
gaaqtivebis bolo etapia C5-C9 kompleqsis C3 komponentis deficiti iwvevs komple-
warmoqmna, romelic mikrobebze mentis fermentuli regulaciuri Tvisebebis
citotoqsikur moqmedebas axdens. Secvlas, rac sikvdilobis maRal procents
komplementis yoveli komponenti iZleva.
monawi-leobs anTebiTi reaqciis C5 komponentis naklebobisas xSiria
ganviTarebis meqa-nizmSi. isini iwveven gramuaryofiTi baqteriebis mier gamowveuli
imunur aglutinacias, ofsonirebas, nawlavuri infeqcia, kanis dazianeba
virusebis neitralizebas, qe-motaqsiss, (dermatiti).
sisxlZarRvTa kedlis ganvla-dobis zrdas, C6 komponentis deficiti iwvevs saxsrebis
fagocitozis gaZlierebas, neitrofilebis anTebas, sisxlis Sededebis darRvevas.
granulebis egzocitozs, lizosomuri C7 komponentis nakleboba xasiaTdeba Sema-
fermentebis gaTavisuflebas neitrofi- erTebeli qsovilis difuzuri daziane-biT.
lebidan, ujredebis membranebis dazianebas.
komplementis komponentebis aseTi efeqti 6.9.7.2. imunuri sistemis specifikuri rezistentoba
metyvelebs, rom misi aqtivaciis biolo- araspecifikur meqanizmebs damoukideblad
giuri daniSnulebaa, imunuri (specifi- xSirad ar ZaluZs SeaCeros mikrobis
kuri) reaqciebis paralelurad, dacvis organizmSi gamravleba da gavrceleba infeq-
araspecifikuri reaqciebis – anTebis da ciur antigenTan pirveladi kontaqtisas.
fagocitozis ganviTareba. cxadia is friad secifiuri imunuri sistema (sur.11), T-kilerebis
mniSvnelovani roli, romelsac da imunoglobulinebis TaosnobiT, SedarebiT
komplementi mikrobuli agentis winaaRmdeg gvian iwyebs moqmedebas, magram, upiratesad,
73
mainc axerxebs gamomwvevis gauvnebelyofas, moyveba T-ujredebis aqtivacia da iwyeba misi
rac gamojanmrTelebiT mTavrdeba. klonuri seleqcia. ormagi signalis arsia: 1.
ganmeorebiTi inficirebis SemTxvevaSi CI da CII-Tan SekavSirebuli antigenis Secnoba
antisxeulebi „dartymiT“, swrafad T-ujredis receptoriT, koreceptoriT; 2.
producirdeba, gamomwvevi eliminirdeba da koctimulaciis signali – apu-sBB-7
avadmyofoba aRar viTardeba. proteinis T- ujredis CD-28- proteinTan
limfoiduri rigis winamorbedi ujre- kavSiri.
disgan (romelic membranaze jer ar T-ujredebi apu-s ormag signals iReben,
Seicavs antigen-receptorebs), TimusSi (T) agreTve, inficirebuli makrofagebisgan da B-
da Zvlis tvinSi (B) warmoebs daaxloebiT ujredebisgan, romlebic antigens (magaliTad,
108 sxvadasxva monospecifikuri, yvela gvelis Sxami, alergeni) Tavisi receptorebis
SesaZlo antigenis winaaRmdeg mimarTuli saSualebiT ukavSirdebian (sur. 9-5a). apu-s
limfocitis tipis warmoqmna. es umwifari ormagi signali iwvevs interleikin IL_2–is
limfocitebi cirkulireben aseTi eqspresias, romelic CaSendeba Sesabamis
mimarTulebiT: sisxli periferiuli receptorSi. IL-2 biZgs aZlevs sakuTari
limfuri qsovili limfa sisxli. ujredebis klonur eqs-presias monospecifikur
Sexvdebian da Seicnoben ra specifikur T-ujredebad. Amas-Tan, T-ujredebi
antigens, isini warmoqmnian mraval diferencirdebaA sam qve-tipad: T-qilerebi, TH1
monospecifikur Svileul ujreds. da TH2 ujredebi. es ujredebi stimulirebas
Mmimdinareobs klonuri seleqcia da pro- ar saWiroeben (sur 9-5b).
liferacia. Ddiferencirebuli, `SeiaraRebu- citotoqsikuri T-ujredebi an T- qile-
li~ T-ujredebi da plazmuri ujredebi rebi warmoiqmnebian umwifari CD8 T- ujrede-
antigenis eliminirebas emsaxurebian. bisgan MHCI-Tan asocirebuli anti-
’SeiaraRebul" T-efeqtorad gardaqmnis genprezentaciis Sedegad. (sur. 9-5b).
winapirobaa profesionali antigenwarmdgeni apu-Si MHCI-proteins antigeni
(antigenprezentaciuli) ujredebiT (apu) citozolidan zedapirze gamoaqvs. T- qilerebi
winaswar damuSavebuli antigenebis (pepti- CD8-asocirebuli receptoriT Seicnoben
duri fragmentebis) wardgena MHCI-antigenis kompleqss (sur9-5g).
(prezentacia) umwifari T-ujredebisTvis. receptorisa da am kompleqsis SekavSirebis
AmasTan, antigeni CaSendeba MHCI da MCII Sedegad CairTveba ujredebis mokvdinebis
proteinebis molekulaSi (MHC-major ramdenime meqanizmi: perforinebi warmoqmnian
histocompatibily complex _ I da II histo- forebs, romelTa saSualebiT proteazebi
SeTavsebis klasi aris genebis saxeoba; aRweven ujredSi da iwveven apoptozs an
adamianSi is Sesabamisad HlAI da HlAII citolizs. apoptozis meqanizmis CarTvis meore
klasad aris cnobili). Aantigenwarmdgeni gzaa FAS-ligandis FAS- proteinTan (=CD95)
ujredi, upirveles yovlisa, virusiT Serwyma.
inficirebuli dendrituli ujredia, umwifari CD4-ujredi MNC-II-Tan aso-
romelic, upiratesad, limfur qsovilSi cirebuli antigenprezentaciis Sedegad
imyofeba. prezentaciisTvis apu_s gardaiqmneba umwifar T-efeqtorad (THO).
zedapiris ICAM ukavSirdeba T-ujredis THOujredebi diferencirdebian T-helperebad.
membranis LFA-1-s (limphocyte function- maTi erTi qvetipia anTebiT reaqciaSi monawile
associated an-tigen-1) (sur,9-5a). misTvis TH1, romelic makro-fagebs IFN-iT aaqtivebs
specifikur T-ujredTan antigenis (sur. 23-d). meore qvetipia _ TH2, romelic B-
Sexvedrisas xdeba maTi SekavSireba, ujre-debis aqtivaciisaTvis aris aucilebeli.
reaqcia Zlierdeba ormagi sig-naliT. amas (sur. 23-b). am ori qvetipis ujredebi
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urTierTdammuxruWebel moqmedebas avlens antisxeulebis gamomuSa-vebis genetikurad
(sur. 23b). pirobadebul moSlasTan.
kombinirebuli imunodeficituri avadmyofobebi.
6.9.7.3. specifikuri imunuri humoruli pasuxi aseT avadmyofobebs axasiaTebs T- da B-
specifikuri humoruli imunuri pasuxi B- limfocitebis erTdrouli nakleboba. maga-
limfocitebiT realizdeba (sur 9-6). maT liTad, limfocitebis genezis blokireba
zedapirzea IgD da IgM-is mo-nomerebi, Timusamdeli periodis pirvel etapze, e.i.
romlebic ramdenime antigens ukavSirdeba. maSin, rodesac sisxlis yvela ujredis sawyisi
warmoqmnili antisxeulebis jaWvi forma gardaiqmneba limfocitebis warmomqmnel
STainTqmeba da gadamuSavdeba (sur 9-6a). ujredad, iwvevs rogorc T, ise B B-
B-ujredis saboloo gaaqtivebisTvis limfocitebis gamomuSavebis daTrgunvas
aucilebelia meore signalic. es sigali sisxlis sxva ujredebis normaluri genezis
SeiZleba iyos Timusdamoukidebuli anu fonze. cxadia, amgvari movlenebi gamoiwvevs
TI-antigeni, (magaliTad - baqteriuli organizmis imunur daucvelobas, romelic
polisaqaridi) an Timusdamokidebuli anu sicocxlesTan SeuTavsebelia.
T-antigeni, romelic TH2-ujredisgan war- imunodeficituri avadmyofobebis dros
modgeba. Seicnobs ra TH2-_ujredebis re- mkveTrad qveiTdeba imuniteti - mdgradoba
ceptorebi antigens, zedapirze arsebuli infeqciebisadmi. acrebisaTvis gamoyenebuli
CD40 ligandiT CD40 proteins dasustebuli vaqcinebic ki aseT fonze in-
ukavSirdeba (sur 9-6b). garda amisa, TH2- feqciur avadmyofobas da sikvdils iwvevs.
ujredi gamoyofs IL4-s, mogvianebiT IL5
da IL6-sac. IL4-sa da CD40 ligandis
moqmedebiT iwyeba B-ujredebis klonuri T-limfocitebTan dakavSirebuli imunodeficituri
seleqcia. B ujredebi dife-rencirdebian avadmyofobebi
plazmur ujredebad da gamoimuSaveben limfocitebis gamravlebis da dife-
monospecifikur IgM, IgA, IgE, IgG. rencirebis genetikurad pirobadebuli darRveva
amasTan, yvela imunoglobulini, romelic mosalodnelia maTi genezis Timusur da
B-ujredis erTi da igive klonisagan TimusSemdgom periodSi.
warmosdgeba, erTi da imave antigenisTvisaa ujreduli tipis imunuri reaqcebis da T-
specifikuri (sur 9-6g). limfocitebis sxva funqciebis moSlis gamo
ganviTarebuli mZime imunodeficituri
6.9.7.4. imunodeficituri avadmyofobebi avadmyofobebiT xasiaTdeba T-limfocitebis
imunokompetenturi ujredebis funqci- winamorbedi ujredis warmoqmnis darRveva am
obis darRveviT ganpirobebuli imunodefi- ujredebis genezis II etapze.
cituri mdgomareoba SeiZleba iyos ujredebis TimusSiga diferencirebis
pirveladi (memkvidreobiTi) da meoradi darRveva (limfocitebis genezis IV etap-ze)
(SeZenili). pirvelads miekuTvneba T- da ar iwvevs maT srul gaqrobas sisxlidan.
BB – limfocitebis dazianeba an maTi ujredebis TimusSemdgomi diferencirebis
kombinacia. moSlis (V da VI etapebi) Sesabamisad irRveva
memkvidreobiTi imunodeficituri avadmyo- T-limfocitebis subpopulaciebis - helperebis
fobebi SeiZleba dakavSirebuli iyos (T-limfocitebi, romlebic aadvileben sxva T-
imunuri sistemis organogenezis da B B-limfocitebis reagirebas antigenze),
darRvevasTan, imunitetis genetikuri supresorebisa (T-limfocitebi, romlebic
aparatis memkvidrul cvlilebebTan an amuxruWeben sxva limfocitebis reaqciebs) da
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qilerebis (antigen-Semcveli ujredebis amave toqsinis moxvedra ukve sxvagvar reaqcias
gamanadgurebeli ujredebis) warmoqmna. - hemolizs an leikolizs iwvevs.
limfocitebis warmoqmnis darRvevasTan inkubaciuri periodi iwyeba organizmis
dakavSirebuli avadmyofobebia: T- inficirebisas da grZeldeba avadmyofobis
ujredebis pirveladi ukmarisoba, pirveli klinikuri niSnebis gamovlinebamde.
mkerdukana jirkvlis hipoplazia da infeqciuri avadmyofobebi inkubaciuri
purinnukleotidfosforilazas genetikuri periodis xangrZlivobis mixedviT mkveTrad
defeqtiT gamowveuli T-limfocitebis gansxvavdeba erTmaneTisgan, rasac adasturebs
imunodeficiti, romelic am ujredebis cxrilSi 6-3 moyvanili monacemebi. inkubaciur
funqciis daqveiTebas iwvevs. periodSi avadmyofoba klinikurad ar
Tu gaviTvaliswinebT, rom T- mJRavndeba, magram organizmSi am dros friad
limfocitebi monawileoben simsivnis mniSvnelovani Zvrebi xdeba.
sawinaaRmdego imunitetSi, cxadi gaxdeba, maTgan umTavresia cvlilebebi imunur da
Tu ratom aris gansakuTrebiT xSiri nervul sistemaSi (antisxeulebis gamomuSaveba,
avTvisebiani simsivne T-limfocitebis nervuli daboloebebis da centrebis
defi-citis SemTxvevaSi. mgrZnobelobis momateba mikrobis antigenuri
substan-ciebis mimarT). Tavs iCens organoebis
6.9.8. infeqciuri procesis funqciaTa regulaciis cvlilebebi, maTi
ganviTarebis periodebi. sistemebis "momzadeba" anTebiTi reaqciis,
infeqciuri daavadebis mimdinareobaSi nivTierebaTa cvlis, Termoregulaciuri
ganasxvaveben inficirebis, inkubaciur, prod- reaqciebisTvis, sisxlis morfologiuri da
romul, ZiriTadi gamovlinebebis da gamosavlis qimiuri Semadgenlobis cvlilebebi. es Zvrebi,
periodebs. rogorc Cans, daavadebis oTx upiratesad, mimarTulia organizmis dacvisu-
stadias infeqciuri avadmyofobis Sem- narianobis momatebisken, Tumca am periodSi
TxvevaSi umateben sawyis – inficirebis iwyeba organizmisaTvis mavne movlenebic -
stadias, rac erTgvarad xelovnuria da umaRlesi nervuli moqmedebis cvlilebebi,
gamowveulia infeqciuri agentis SeWris organoebis distrofia da a.S.
gzis didi mniSvnelobiT infeqciuri prodromul periods axasiaTebs
avadmyofobis Semdgomi mimdinareobisTvis. avadmyofobis pirveli simptomebis gamom-
paTogenuri mikrobis organizmSi Caner- JRavneba. maT Soris gansakuTrebiT xSiria
gvis adgils infeqciis Sesvlis kars uwo- cxelebiTi reaqcia da umaRlesi nervuli moqme-
deben. muclis tifiT an dizenteriiT debis cvlileba. vlindeba avadmyofobis
dasnebovndebian kuW-nawlavis traqtidan. likvidaciisaken mimarTuli sakompensacio
aqedanve iWreba organizmSi poliomielitis reaqciebi, romlebic amcireben infeqciuri
virusic, romelic sisxlSi Seyvanis Sem- procesis intensivobas, zog SemTxvevaSi ki
TxvevaSi poliomielitiT dasnebovnebas ver wyveten mas. winaaRmdeg SemTxvevaSi dgeba
iwvevs. partaxtiani tifi da sxva riketsi- avadmyofobis klinikuri suraTis sruli gaSlis
ozebi viTardeba gamomwvevis mxolod periodi, romlis drosac irRveva umaRlesi
sisxlSi moxvedris SemTxvevaSi. nervuli moqmedeba, simpaTikur-adrenuli
mniSvneloba aqvs ara marto paTogenuri sistemis tonusis sakompensacio momatebis gamo
mikrobebis, aramed maTi toqsinebis Zlierdeba nivTierebaTa cvla, rac zrdis
moqmedebis adgilsac. magaliTad, organizmis mdgradobas infeqciisadmi;
airovani gangrena viTardeba misi
gamomwvevis -perfigens-is toqsinis
kunTovan qsovilSi warmoqmnisas. sisxlSi
76
sur. 6.3. araspecifikuri imunuri sistema
77
sur. 6.4. specifikuri imunuri sistema
78
7.5
infeqciuri anemiis dros xSiria sisxlSi mcire
adrenalinis gamoyofa astimulirebs, zomis eriTrocitebis arseboba da
agreTve, leikocitebis fagocitur hemoglobinis raodenobis Semcireba -
aqtivobas da organizmis sxva dacviT mikrocituli hipoqromuli anemia.
funqciebs. zogi daavadebis dros, ufro gansakuTrebiT mkveTri anemia axasiaTebs
mogvianebiT, SeiZleba gamovlindes protozoul avadmyofobebs (malarias, leiS-
cdomili nervis agznebis niSnebic: maniozs), sefsiss, airovan gangrenas, qronikul
bradikardia, hipotenzia, oflianoba, infeq- infeqciebs (sifilisi, tuberkulozi).
ciuri daavadebebis dros baqteriuli infeqciuri daavadebebis dros leikoci-
pirogenebis zegavleniT grZeldeba jer tebis raodenobis cvlilebebs xSirad fazuri
kidev prodromul periodSi dawyebuli xasiaTi aqvs - leikocitozs mohyveba
cxeleba da a.S. leikopenia, xolo mas ki - leikocitozi. am
zog SemTxvevaSi infeqciuri sneuleba fazebis xangrZlivoba gansazRvravs leiko-
SeiZleba cxelebiTi reaqciis gareSec citebis raodenobis cvlilebebis zogad
mimdinareobdes, gamojanmrTelebis dasaw- mimarTulebas infeqciuri avadmyofobis dros.
yisSi ki sxeulis temperatura da Ziri- magaliTad, wiTelas, gripis, mwvave miliaruli
Tadi cvlis intensivoba qveiTdeba. zogi- tuberkulozis, sefsisis dros leikocitozis
erT avadmyofobas am periodSi axasiaTebs Semdeg viTardeba leikopenia; muclis tifis
temperaturis swrafi dacema normis dros leikocitozi xanmoklea da avadmyofoba
qvemoT (krizisi), rac SeiZleba kolafsiT mimdinareobs leikopeniiT; leikopenia mkveTri
damTavrdes (ix. "cxeleba"). leikocitozis Semdeg damaxasiaTebelia
TiTqmis yovel infeqciur avadmyofobas krupozuli pnevmoniis, sefsisuri endokar-
axasiaTebs sisxlis morfologiuri da ditis, yivanaxvelasTvis; mkveTri leiko-
qimiuri Sedgenilobis cvlilebebi, romle- citoziT mimdinareobs mwvave Cirqovani
bic viTardeba sisxlsa da sisxlmbad qso- infeqciebi.
vilebze baqteriuli toqsinebis, antige- infeqciuri avadmyofobebis dros leiko-
nebis, virusebis an infeqciebis dros dazi- cituri formulis cvlilebebi mraval-
anebul organoebSi gamoyofili nivTi- ferovania. maTi uxSiresi variantebi moyvanilia
erebebis zegavlenis Sedegad. 6-4 cxrilSi.
sisxlis ujreduli Semadgenilobis infeqciuri avadmyofobebis dros eds-i,
cvlilebebis xasiaTi dakavSirebulia in- Cveulebriv, momatebulia, rasac ukavSireben
feqciis saxesTan da misi ganviTarebis sisxlis plazmaSi globulinebis koncen-
stadiasTan. traciis zrdas antisxeulebis gamomuSavebis
Cveulebriv, infeqciur daavadebebs gamo: globulinebs, romlebic adsorbirdebian
axasiaTebs eriTrocitebis raodenobis Sem- eriTrocitebze, maTze ufro mcire zedapiruli
cireba sisxlSi (anemia). erTgvari gamona- muxti aqvT. amitom globulinebis raodenobis
klisia qolera. am avadmyofobis dros sis- momatebis dros mcirdeba eriTrocitebis
xlis moculobis erTeulSi normaze meti zedapiruli muxtic, rac xels uwyobs
eriTrocitia, magram es dakavSirebulia eriTrocitebis agregacias da maT swrafad
ara eriTrocitebis raodenobis WeSmarit daleqvas.
zrdasTan cirkulirebad sisxlSi, aramed infeqciur daavadebebis, zogierTi gamo-
maTi koncentraciis momatebasTan naklisis garda (cofi, tetanusi, botulizmi),
organizmis mier wylis didi raodenobis axasiaTebs sxvadasxva formis anTeba ama Tu im
dakargvis gamo, e.i. viTardeba organosa da qsovilSi. magaliTad, kokur
SefardebiTi (cru) eriTrocitozi. infeqciebs axasiaTebs Cirqovani anTeba,
79
tuberkulozs - proliferaciuli, grips - buli rezistentobis mqone organizmSi. mas
serozuli (kataruli) anTeba; qole- ufro xSirad Cirqmbadi kokebi iwveven. am Sem-
risTvis damaxasiaTebelia wvrili naw- TxvevaSi sefsisi organizmis sxvadasxva
lavis, dizenteriisTvis - msxvili nawla- nawilSi arsebuli Cirqgrovebis garTulebaa.
vis, gripisTvis - sasunTqi gzebis anTeba. sefsiss SeiZleba axasiaTebdes swrafi
infeqciis gamo aRmocenebuli anTebis (ramdenime saaTi elviseburi formis Sem-
kera, Tavis mxriv, moqmedebs infeqciuri TxvevaSi) an qronikuli mimdinareoba (qroni-
procesis mimdinareobaze. is sxvadasxva osefsisi). mis klinikur gamovlinebaSi
saxis gaRizianebis wyaro, biologiurad umTavresia intoqsikacia, sefsisuri cxeleba,
aqtiuri da pirogenuli nivTierebebis war- nervuli sistemis funqciis, qsoviluri
moqmnis damatebiTi keraa. organos anTeba fermentebis aqtivobis, sisxlis suraTis cvli-
ar aris lokaluri procesi, is gavlenas lebebi.
axdens mTlianad organizmze (ix. anTeba). sefsisur cxelebas axasiaTebs sxeulis
temperaturis mkveTri meryeoba. temperaturis
6.9.9. infeqciuri daavadebebis garTulebebi swraf momatebas ramdenime saaTSi mohyveba
sefsisi. garTuleba infeqciuri sneulebis misi krizisuli, mkveTri dacema. periferiul
iseTi gamovlinebaa, romelic ar aris sisxlSi aRiniSneba neitrofilia axalgazrda
aucilebeli avadmyofobis tipobrivi formebis mniSvnelovani gazrdiT (leikocituri
mimdinareobisTvis da amZimebs avadmyofobis formulis marcxniv gadaxra), limfopenia,
saerTo suraTs. magaliTad, qunTruSis eozinopenia, qveiTdeba makrofagebis aqtivoba,
garTulebebia otiti, nefriti, endokardi- fagocitozi, antisxeulebis da komplementis
ti. gamomuSaveba, rac mkveTrad amcirebs organizmis
garTulebad unda CaiTvalos dacvisunarianobas. dazianebis pirvelad keraSi
infeqciuri avadmyofobis dros qsovilTa myof mikrobebs organizmis sxeulis sxvadasxva
dazianebis aratipobrivi lokalizacia. ma- nawilsa da sisxlSi TiTqmis daubrkolebeli
galiTad, gonoreis SemTxvevaSi paTologi- gamravlebis saSualeba eZleva.
uri procesi, Cveulebriv, lokalizebulia
SardsadenSi. misi gavrceleba winamdebare 6.9.10. infeqciuri daavadebis gamosavali
jirkvalze an Sard-sasqeso sistemis sxva arcTu iSviaTia qronikulad mimdinare
nawilebze garTulebaa. infeqciuri avadmyofobis (brucelozis, tuber-
infeqciuri daavadebis garTuleba kulozis da sxv.) gamwvaveba an recidivi.
SesaZlebelia ara ZiriTadi avadmyofobis ukanaskneli kanonzomierad viTardeba zogierTi
gamomwvevi mikrobis moqmedebis Sedegadac. infeqciuri avadmyofobis (magaliTad,
magaliTad, gripi SeiZleba garTuldes SebrunebiTi tifis) dros.
strepto- an stafilokokuri infeqciiT infeqciuri daavadebis gamosavali SeiZleba
cxviris damatebiT RruebSi. iyos gamojanmrTeleba, avadmyofobis qronikul
ramdenime mikrobiT gamowveul avadmyo- formaSi gadasvla da sikvdili.
fobas uwodeben Sereul infeqcias, xolo gamojanmrTelebisas organizmis gamZleoba
erTi da igive mikrobiT ganmeorebiT infi- gamomwvevi mikrobisadmi matulobs da avad-
cirebas - reinfeqcias. garTulebebis ganvi- myofobis dros darRveuli funqciebi aRdgeba.
Tarebas xels uwyobs organizmis reaq- gamojanmrTeleba mosalodnelia avadmyofobis
ciulobis daqveiTeba. friad mniSvnelovani gamomwvevi mizezisgan organizmis sruli gaTa-
garTulebaa sefsisi (septicemia). visuflebisas avadmyofobis gamomwvevisadmi
sefsisi generalizebuli infeqciuri steriluri imunitetis CamoyalibebiT (magali-
procesia, romelic viTardeba daqveiTe- Tad, partaxtiani tifi, yvavili da sxv.).
80
zog SemTxvevaSi gamojanmrTelebuli maSi gadadis, metwilad, organizmis reaqci-
organizmi mTlianad ver Tavisufldeba ulobis daqveTiebis dros.
avadmyofobis gamomwvevi mikrobisgan. SeiZ- infeqciuri daavadebisas sikvdils iwvevs
leba Camoyalibdes arasteriluri mikrobisgan dacvis unaris sruli ukmarisoba
imuniteti da bacilmtarebloba - adamianis organizmis mxriv an sasicocxlo mniSvnelobis
organizmi gamohyofs mikrobs, romelmac mqone romelime organos funqciis
SeiZleba gamoiwvios sxva adamianis sicocxlesTan SeuTavsebeli moSla.
dasnebovneba (magaliTad, muclis tifi, 1. infeqciuri avadmyofis mkurnalobis
difTeria da sxv.). efeqturoba damokidebulia misi mdgomareobis
zogjer gamojanmrTeleba viTardeba swor Sefasebaze avadmyofobis yovel
myari imunitetis Camoyalibebis gareSe da konkretul periodSi da adekvaturi samkur-
iqmneba pirobebi imave infeqciiT ganme- nalo RonisZiebebis kompleqsis mniSvneloba in-
orebiTi dasnebovnebisTvis (magaliTad, feqciisgan dacvaSi
gripi, brucelozi da sxv.)
infeqciuri daavadeba qronikul for-
2. inkubaciuri (daavadebis
pirveli
niSnebis
gamovlinebamde)
3. prodromuli (avadmyofobis
pirveli,
xSirad “araspecifikuri”
simptomebi)
4. klinikuri suraTis garTulebebi,
sruli gaSla sefsisi
steriluri
5. gamosavali gamojan- imunitetis
mrTeleba CamoyalibebiT
sur.6.6
81
cxrili 6
leikocituri formulis yvelaze damaxasiaTebeli cvlilebebi
zogierTi infeqciis dros (a. ados mixedviT)
leikocituri
infeqciis jgufi
formulis cvlilebebi
neitropenia, regeneraciuli
virusuli infeqcia (gripi,
gadaxra, eozinopenia, plazmuri
wiTela, ybayura)
ujredebi
82
maRali temperaturis moqmedeba
qsovilze
hipoTalamusi
jakbc ufvj.jabcf lf
fjhsmkt,bc itvwbht,f
cbs,jc ghjlemwbbc uf'kbtht,f jhufybpvblfy cbs,jc
ufwtvbc itpqeldf
83
vfqfkb fnvjcathekb oytdf
/fthbc itrevidf qhe
(/bgth,fhbf)
jhufyjt,ib
rfybcf lf
uekbc gthbathbekb
lbfahfuvbc lfotdf fbhsf oytdbc vjvfnt,f
oesvjwekj,bc cbc['fhqdt,bc
xfceysmek /fthib
itvwbht,f itdbohjdt,f
ceysmdbc
,hflbrfhlbf ufbidbfst,f fbhsf zfh,b uflfcdkf
njmcbrehb tatmnb (sfd-
cbc[kib
,he^ /fkewbyfwbt,b^
/bgthjmcbf vj'hfj,bc rjjhlbyfwbbc
lfhqdtdf)
/tvjukj,bybc
uf]tht,f sfdbceafkhflbrfkehb
yfhrjnbrekb tatmnb
;fyu,flbs ;fyudbc uf'kbtht,f
(tbajhbf^ @cbqhvbsb
fqnfwt,f#)
mcjdbkblfy CO2-bc e]htlekb mcjdbkt,bc uf;qtysdf
ufvjnfybc lf,hrjkt,f cnhemneht,bc
(cfnehfwbf) fpjnbs
lfpbfyt,f
rjvghtcbf
fpjnbc
fhshfkubf ltcfnehfwbf vbfkubf
mcjdbkt,blfy
rfybc vtybthbc cbvgnjvsrjvgktmcb (iebkb
tvabptvf^ .eht,ib^ sfd,he^ ojyfcojhj,bc
fbhjdfyb tv,jkbf
cohfab^ fhftnfgj,hbdb
ltrjvghtcbf
mcjdbkt,bc
bcmtvbf^ ytrhjpb
ltrjvghtcbbc cbcohfatpt)
84
Tavis tkivili
haeris gafarToeba
dabali atmosferuli Rru organoebSi
wneva tkivili zedaybis
(hipobaria) wiaRidan
Jangbadis parculi
wnevis Semcireba hipoqsemia
sisxlis dafis
Casunqul haerSi gamosrola apkis
depoebidan dazianeba
taqikardia hipoqsia (hipobariisTanave)
refleqsi eriTropoezis
qemorecep-
torebidan gaZliereba
sunTqvis (gaxangrZlivebuli
centris hipoqsiisas)
agzneba kompensaciis
arteriuli
hipertenzia faza
eriTrocitozi
qoSini
sisxlZarRvTa
tonusis meryeoba
dekompensaciis
faza
sur. 6-10. organizmze dabali atmosferuli wnevis moqmedebis ZiriTadi Sedegebi da maTi
meqanizmebi (movlenaTa mravalferovnoba da simZime damokidebulia hipobariis xarisxze da
individur mgrZnobelobaze hipobariisa da hipoqsiis mimarT)
85
sur. 6-11 heroinis miRebis umTavresi Sedegebi
86
7. memkvidreobiTobis roli uviTardeba individs mucladyofnis pe-
paTologiaSi riodis paTologiis gamo (am periodSi
7.1. memkvidreobiToba da paTologia virusuli da baqteriuli infeqciebis,
memkvidreobiTi anu genetikuri aparati sxva egzogenuri zemoqmedebis gamo
qromosomaTa kompleqsia, romelic mravali ganviTarebuli paTologia) normaluri
genisgan Sedgeba da gadaecema STamomavlobas. genotipis fonze. memkvidreobiTi unda
misi ZiriTadi funqciebia memkvidreobiTi in- ewodos mxolod im avadmyofobebs, rom-
formaciis Senaxva, ganayofierebis procesSi lebis safuZvelia genotipis paTolo-
misi gadatana, cilis biosinTezis marTva, ge- giuri cvlilebebi.
nebis funqciis aRdgena maTi dazianebis Sem- memkvidreobiTi avadmyofobis ganviTa-
deg. genetikuri aparati flobs meqanizmebs, reba xSirad ar aris damokidebuli ga-
romlebic memkvidreobiTi aparatis simyares remo pirobebze. magaliTad, hemofiliis,
ganapirobebs. pirvel rigSi, es aris geno- qondrodistrofiis, daltonizmis Sem-
tipis struqturuli elementebis dublireba TxvevaSi paTologiuri genis penetrantoba
- yvela genotipuri lokusi ormagadaa war- (paTologiuri niSnis mqone individTa
modgenili da amiT genotipis simyare orjer procentuli raodenoba Sesabamisi genis
izrdeba. amgvari diploiduroba ewinaaRmde- mtarebelTa raodenobidan) TiTqmis
geba paTologiuri recesiuli genebis, aqedan 100%-ia da avadmyofoba Tavs iCens genis
gamomdinare, paTologiuri niSnebis gamovli- homozitoguri mtareblobis yvela Sem-
nebas (ix. qvemoT). TxvevaSi, miuxedavad imisa, Tu ra gare-
genotipis simyare didadaa damokidebuli, moSi viTardeba individi.
agreTve, dazianebis dros genetikuri apara- paTologiuri genis SedarebiT daba-
tis, pirvel rigSi, dnm-is reparaciis mra- li penetrantobis SemTxvevaSi, avadmyo-
valkomponentiani sistemis funqciobaze. fobis gamovlinebasa da mimdinareobaSi
memkvidreobiTi faqtorebi gansazRvraven garkveul rols asruleben garemo faq-
e.w. memkvidreobiTi avadmyofobebis ganvi- torebi, romlebic xels uwyoben an ewi-
Tarebas da, amasTan erTad, gavlenas axdenen naaRmdegebian paTologiuri memkvidre-
avadmyofobis mimdinareobasa da gamojanmrTe- obiTi Tvisebebis gamovlinebas da, ume-
lebaze aramemkvidreobiTi faqtorebiT gamo- teswilad, gansazRvraven mutaciuri ge-
wveuli avadmyofobebis SemTxvevaSic. nis gamomJRavnebis xarisxs anu eqspre-
ganasxvaveben memkvidreobiT, Tandayolil siulobas. amgvar avadmyofobebs memkvid-
da SeZenil avadmyofobebs. reobiTi winaswarganwyoba axasiaTebT, rac
SeZenili avadmyofobebi viTardeba garemos vlindeba mxolod Sesabamis pirobebSi
mavne faqtoris (faqtorebis) moqmedebis gamo (magaliTad, nikrisis qari, Saqriani dia-
individebSi, romlebsac aqvT normaluri ge- beti, aTerosklerozi).
netikuri kodi da mucladyofnis periodSi genetikuri safuZvlis mixedviT mem-
normaluri zrda-ganviTareba ganvles, e.i. kvidreobiT avadmyofobebs hyofen moleku-
isini daibadnen sruliad janmrTelni, raime lur-genetikur (genetikur) da qromosomul
paTologiisadmi gansakuTrebuli midrekile- avadmyofobebad.
bis gareSe. memkvidreobiTi avadmyofobebis
Tandayolili avadmyofobebi, zogierTi umravlesoba adreul asakSi vlindeba,
ganmartebiT, moicavs yvela avadmyofobas, zogierTi maTgani - dabadebisTanve. magram
romlebic Tan dahyveba individs dabadebi- zogi memkvidreobiTi avadmyofoba klini-
sas. ufro swori iqneba, Tandayolili ewo- kurad vlindeba mxolod zrdasrul da
dos mxolod im avadmyofobebs, romlebic xanSiSesul asakSi. magaliTad, nikrisis
87
qaris pirveli niSnebi 40-45 wlis asakidan mologiuri qromosomebis gauTiSvelobis
mJRavndeba. Sedegia.
rogorc yvela sxva avadmyofobas, ise mutacia SeiZleba ganviTardes ro-
memkvidreobiT avadmyofobebsac axasiaTebs gorc somatur, ise sasqeso ujredSi. mu-
klinikuri polimorfizmi , rac mdgomareobs tirebuli geni SeiZleba iyos dominan-
avadmyofobis adreul an gvian manifesta- turi an recesiuli. pirveli Tavis arse-
ciaSi, avadmyofobis simptomatikis, ganviTa- bobas STamomavlobaSi yovelTvis av-
rebuli bioqimiuri, imunuri da sxva cvli- lens, recesiuli genis arseboba ki vlin-
lebebis sxvadasxva siRrmeSi. magaliTad Se- deba mxolod homozigotur mdgomareo-
iZleba davasaxeloT gentigtonis qorea, ro- baSi.
melic, Cveulebriv, vlindeba 40-45 wlis fenotipuri gamovlinebebiT genuri
asakSi, magram zogjer is viTardeba 60 wlis mutaciebi gansxvavdeba erTmaneTisgan. Tu
asakis Semdegac; dazianebis sxvadasxva xaris- mutacia exeba dnm-is naklebmniSvnelovan
xi vlindeba fenilketonuriis drosac - am regions, misi Sedegi SedarebiT mcire
avadmyofobisTvis damaxasiaTebeli Wkuasus- gavlenas axdens Sesabamis funqciaze da
toba SeiZleba sxvadasxva xarisxis iyos: Se- organizmis cxovelmyofelobaze. Tu
darebiT msubuqi xarisxidan Rrma imbe- mutacia Seexeba dnm-is principulad
cilobamde. mniSvnelovan ubans, viTardeba funqciis
seriozuli darRveva da zogjer sik-
7.2. memkvidreobiTi avadmyofobebis vdilic ("letaluri mutacia").
etiologia mutaciis gamomwvev faqtors mutageni
memkvidreobiTi avadmyofobebis mizezia ewodeba. fizikuri bunebis mutagenebidan
mutacia - myari naxtomiseburi cvlileba gansakuTrebuli mniSvneloba aqvs maione-
ujredis memkvidreobiT aparatSi. ganarCeven bel radiacias. qimiur mutagenebs mie-
genur, qromosomul da genomur mutaciebs. kuTvneba citostatikuri preparatebi,
genuri mutacia pirobadebulia genis purinis da pirimidinis fuZeebis analo-
qimiuri struqturis cvlilebebiT - dnm-is gebi, antibiotikebi, Tavisufali radika-
ubanSi purinisa da pirimidinis fuZeebis lebi, biologiur mutagenebs - virusebi.
specifikuri Tanamimdevrobis darRveviT, rac zemoCamoTvlili faqtorebiT gamowveul
iwvevs anomaliuri cilebis sinTezs da Sem- mutaciebs inducirebuls uwodeben. Spon-
dgom bioqimiur, struqturul da funqciur tanuri mutaciebi ki viTardeba jer kidev
cvlilebebs. Tu mutacia exeba mxolod erT arasrulyofilad Seswavlili endogenu-
gens, mas wertilovans uwodeben. ri bunebis mizezebiT (replikaciis Sec-
qromosomuli mutaciis arsia qromosomaTa domebi, metabolizmis procesSi warmoq-
struqturis cvlileba. qromosomebis ubnis mnili nivTierebebi da a.S.).
amovardnas delecia ewodeba, 180(-iT Se-
mobrunebas - inversia, segmentebis gacvlas 7.3.molekulur-genetikuri daavadebebi
qromosomebs Soris – translokacia, segmen- rogorc iTqva, ganasxvaveben moleku-
tis gameorebas - duplikacia. lur-genetikur daavadebebs, romlebic
qromosomul mutaciebs xSirad Tan sdevs viTardeba genebis mutaciebis Sedegad da
qromosomebis raodenobrivi cvlilebac. Qro- qromosomul daavadebebs, dakavSirebulebs
mosomebis ricxvis cvlileba maTi struqtu- qromosomTa raodenobisa da struqturis
ris ucvlelobis fonze cnobilia, rogorc cvlilebebTan.
genomuri mutacia. qromosomaTa ricxvis radgan genuri mutacia, qromosomuli
cvlilebebi, ufro xSirad, meiozis dros ho- mutaciisgan gansxvavebiT, exeba geneti-
88
kuri masalis SedarebiT mcire regions, is, mJavebis cvlis defeqtebi, Tandayolili
Cveulebriv, naklebad uxeS cvlilebebs iw- yrumunjoba, mikrocefalia, sxvadasxva
vevs. am SemTxvevaSi individis reproduq- saxis fermentopaTia.
ciuli funqcia SenarCunebulia da avadmyo- recesiuli paTologiuri geniT gamo-
foba xSirad gadaecema momaval Taobebs. wveuli avadmyofobebis sixSire mniSvne-
mravali aramemkvidreobiTi avadmyofobis- lovanwiladaa damokidebuli paTologiu-
gan gansxvavebiT, memkvidreobiTi avadmyofobis ri genis ganTesvis xarisxze - rac ufro
dros etiologiuri faqtori (mutanturi ge- maRalia is, miT ufro xSirad xvdeba pa-
nis funqcioba) mudmivad moqmedebs orga- Tologiuri geni heterozigotul mdgo-
nizmze. amitom memkvidreobiTi avadmyofoba, mareobaSi da memkvidreobiTi avadmyofoba
Cveulebriv, ganuwyvetlad mimdinareobs da ar viTardeba. qorwineba sisxliT axlo
progresirebs. naTesavebs Soris (incesti) ki mkveTrad
memkvidreobiTi avadmyofoba SeiZleba amaRlebs recesiuli memkvidreobiTi
iyos monogenuri - (erTi genis paTologiiT avadmyofobis ganviTarebis Sanss, radgan
gamowveuli) da poligenuri (ix. qvemoT). mo- am SemTxvevaSi mkveTrad izrdeba paTo-
nogenuri avadmyofobebidan yvelaze gavrcele- logiur genTa homozigotur mdgomareo-
buli da SedarebiT ukeT Seswavlilia enzi- baSi yofnis Sansi (sur. ).
mopaTiebi.
somaturi ujredis mutacia Semdegi Tao- 7.3.1. sqesTan SeWiduli memkvidreobiTi
bis organizmebs ar gadaecema, gametebis mu- avadmyofobebi
tacia ki vrceldeba Taobidan Taobaze. es avadmyofobebic molekulur-gene-
STamomavlobas dominanturi gziT gadae- tikuria. dReisTvis cnobilia X qromo-
cema ConCxisa da sxva anomaliebi, romlebic somasTan dakavSirebuli 90-mde avadmyo-
xels ar uSlian gamravlebas, ar amcireben foba, romelTagan umetesi recesiuli
sicocxlis xangrZlivobas. magaliTad, Sez- tipisaa. recesiuli gziT gadaecema, maga-
rdili TiTebi, gaRunuli TiTebi, moRunuli liTad, hemofilia - avadmyofoba, ro-
frCxilebi, axlomxedveloba, Sorsmxedvelo- melsac axasiaTebs sisxlis Seudedebloba
ba, astigmatizmi. mZime avadmyofobebidan do- da, gamomdinare aqedan, midrekileba sis-
minanturi gziT gadaecema Tandayolili ka- xldenisken. hemofiliis klasikuri for-
taraqta, gentigtonis qorea, aqondroplazia, ma dakavSirebulia antihemofiluri A
romlisTvisac damaxasiaTebelia dabali tani globulinis, B hemofilia ki – kristma-
da sxeulis araproporciuloba. dominanturi sis faqtoris arqonasTan. paTologiuri
gziT gadacemuli avadmyofobebidan gansakuT- X qromosomis mtarebloba qalebSi kom-
rebiT mZimea msxvili nawlavis mravlobiTi pensirdeba meore, normaluri X qromo-
polipozi, romelsac midrekileba aqvs avTvi- somiT. janmrTeli, magram hemofiliis
sebiani gadagvarebisken da neirofibromatozi, mxriv heterozigotuli qalis janmrTel
anu reklinhauzenis avadmyofoba mamakacTan qorwinebis Sedegad maTi vaJi-
molekulur-genetikuri avadmyofobebis Svilebis naxevari, romelic dedisgan mi-
umravlesoba recesiul genTa saSualebiT ga- iRebs paTologiur X qromosomas, da-
daecema. avadmyofoba viTardeba mxolod ma- avaddeba hemofiliiT. qaliSvilebis erTi
Sin, Tu individi recesiul genebs miiRebs naxevari ki paTologiuri X qromosomis
orive mSoblisgan, e.i. rodesac paTologiuri mtarebeli da, Sesabamisad, avadmyofobis
geni homozigotur mdgomareobaSia, heterozigo- konduqtoria. avadmyofi mamakacis jan-
ti mSoblebi fenotipurad janmrTelebi ari- mrTel qalze daqorwinebis SemTxvevaSi
an. daavadebulTa am jgufs miekuTvneba amin- yvela vaJiSvili janmrTeli, magram yvela
89
qaliSvili avadmyofobis konduqtori iqneba. daunis avadmyofoba bavSvTa Wkuasus-
gogonebis hemofilia Zalze iSviaTia. tobis yvelaze xSiri formaa (500-600
zemoTqmulis sailustraciod, suraTze axalSobilze modis erTi daunis avad-
(7-2) mocemulia hemofiliis gavrcelebis myofobiT dasneulebuli). kariotipis
sqema evropis monarqTa ojaxebSi, avadmyo- Seswavlam gamoavlina avadmyofobis ori
fobis zedmiwevniT maRal sixSires aq xels varianti: ufro xSiri - 21-e qromosomis
uwyobda qorwineba sisxliT axlo naTesavebs trisomia da ufro iSviaTi - zedmeti
Soris. 21-e qromosomis Serwyma me-15 qromoso-
7.4. qromosomuli daavadebebebi masTan. Wkuasustobis garda, avadmyofs
qromosomul avadmyofobebs hyofen or axasiaTebs dabali tani, monRoloiduri
jgufad: genomuri mutaciebiT, e.i. mxolod Tvalebi, maRali yvrimalebi, Cazneqili
qromosomebis ricxvis cvlilebebiT gamowve- cxviri, kunTebis hipotonia. daunis avad-
ul (poliploidur, aneuploidur) da qromo- myofobian qalebs iSviaTad aqvT Svilos-
somebis struqturis darRveviT (transloka- nobis unari. avadmyofobas xSirad Tan
cia, delecia, inversia) gamowveul avad- sdevs RviZlis paTologia, leikozi, gu-
myofobebad. mutacia SeiZleba moxdes mSob- lis mankebi. daqveiTebulia humoruli da
lebis gametebSi an embrionis organizmSi ujreduli imuniteti, amitom, xSiria
(gansakuTrebiT zigotis danawevrebis dros). avadoba infeqciuri sneulebebiT.
aRwerilia 750-mde qromosomuli anoma- daunis avadmyofobis pirveli variantis
lia, maTgan 700-is safuZveli qromosomebis sixSires (94%) ukavSireben pirvelad
struqturis cvlilebaa. mSobiare dedis asaks - rac ufro gvian
cocxlad Sobis SemTxvevaSi qromosomul daorsuldeba qali pirvelad da rac
aberaciebian individebs xSirad aReniSnebaT ufro gvian asakSi imSobiarebs, miT
somaturi an fsiqikuri ganuviTarebloba, iS- ufro mosalodnelia daunis avadmyo-
viaTad - ganayofierebis unari. fobiT dasneulebuli nayofis dabadeba.
sazogadod, qromosomul avadmyofobebs
mravlobiTi dazianeba axasiaTebs: Tavis da 7.4.2. sasqeso qromosomebis araswor
tvinis anomaliebi, Sinagani da garegani orga- daTiSvasTan dakavSirebuli avadmyofobebi
noebis ganviTarebis mankebi, zrdis da goneb- sasqeso qromosomebis araswor daTiSvas-
rivi ganviTarebis CamorCena, nervuli da en- Tan dakavSirebuli avadmyofobebic qro-
dokrinuli sistemis funqciis darRveva. es mosomuli sneulebebia. maTi gaviTarebis
gadaxrebi, met-naklebi simkveTriT gamoxatu- gza naCvenebia suraTze (7-3).
li, sazogadod qromosomul avadmyofobebs klainfelteris sindromiT avaddeba
axasiaTebs. erTi-ori mamakaci yoveli aTasidan. In-
divids erTi an ramdenime zedmeti X
7.4.1. autosomebTan dakavSirebuli qromosomuli qromosoma aqvs (sur.7-4). gareTa sasqeso
avadmyofobebi organoebi mamakacis tipisaa. avadmyofs
autosomuri avadmyofobebi mimdinareobs axasiaTebs maRali tani, grZeli kidure-
ufro mZimed, vidre sasqeso qromosomebis bi, asTeniuri agebuleba, sustad ganvi-
anomaliebi. amis mizezia qromosomaTa sxva- Tarebuli muskulatura, dagvianebuli
dasxva genetikuri aqtivoba: -qromosomaSi spermatogenezi, inertuloba, zogjer -
naklebi genia, vidre X-qromosomaSi, xolo gonebrivi CamorCeniloba. somaturi uj-
erTi X-qromosoma qalebSi araaqtiur mdgo- redebi Seicavs sasqeso qromatins (baris
mareobaSia. sxeulaks) raodenobiT: X qromosomis
ricxvi - 1.
90
SereSevski-terneris (X0) sindromis Sem- memkvidreobiTi winaswarganwyobis sa-
TxvevaSi individs - qals aqvs 44 autosoma fuZveli xSirad paTologiuri genis he-
da mxolod erTi X qromosoma Y qromosomis terozigotuli mtareblobaa. recesiuli
gareSe. damaxasiaTebelia dabali tani da go- paTologiuri geni avadmyofobas iwvevs
nebis ganuviTarebloba, sasqeso organoebis homozigotur mdgomareobaSi, hetero-
infantiloba, pirveladi amenorea da unayo- zigotuli mtareblobisas ki adamiani
foba, kanis frTiseburi naoWi, mimarTuli ke- avaddeba mxolod Sesabamisi garemo piro-
fidan mxrebisken. individs sasqeso qromatini bebis fonze. magaliTad, bavSvTa asakSi
ara aqvs. Saqriani diabeti mxolod homozigotur
X-trisomiis dros individi qalia zed- mdgomareobaSi vlindeba. heterozigotebi
meti X qromosomiT, SedarebiT ganviTarebu- janmrTe lebi arian. magram pankreasis
li sakvercxeebiT, menstrualuri cikli yo- langerhansis kunZulebis ujredebis ga-
velTvis ar aris darRveuli, somaturi uj- datvirTvis dros paTologiuri genis
redebi Seicavs baris sxeulaks, zogjer - arseboba maTSic mJRavndeba da viTardeba
ors. aseTi qalebi friad male berdebian. Saqriani diabeti.
iTvleba, rom qromosomuli anomaliebi
aqvs 8-12-kviriani embrionebis 3%-s, coc- memkvidreobiTi winaswarganwyobis mqone
xladSobili nayofis 0,6-0,7%-s; perinata- monogenuri avadmyofobebi gamowveulia
luri sikvdilobis 6% modis qromosomebis mxolod erTi genis paTologiuri muta-
anomaliebis mqone individebze. ciiT. is Tavis arsebobas avlens speci-
fikuri garegani faqtoris moqmedebisas.
7.5. memkvidreobiTi winaswarganwyoba magaliTad, laqtozas monelebis mem-
avadmyofobis mimarT kvidreobiTad pirobadebuli darRveva
arsebobs avadmyofobebi, romelTa ganvi- vlindeba mxolod rZis miRebisas.
Tareba determinebulia rogorc genetikurad, metad mravalferovania memkvidreo-
ise garemo faqtorebis moqmedebiT. aseT Sem- biTi winaswarganwyobis mqone polige-
TxvevaSi saubaria ara memkvidreobiT avad- nuri avadmyofobebi . rogorc wesi, es
myofebebze, aramed maTdami memkvidreobiT wi- avadmyofobebi recesiulia da dakav-
naswarganwyobaze. Sesabamisi garemo pirobe- Sirebulia autosomebTan an X-qromo-
bis Seqmnis gziT SesaZlebeli xdeba iseTi somasTan. miuxedavad aseTi avadmyo-
avadmyofobebis SemTxvevaTa Semcireba, rogo- fobebis (hipertonuli avadmyofoba,
ricaa hipertonuli avadmyofoba, Tormetgoja bronquli asTma, Sizofrenia, wylu-
nawlavis wylulovani avadmyofoba, Sizof- lovani avadmyofoba da sxv.) uaRre-
renia, epilefsia, Saqriani diabeti da sxv. sad farTo gavrcelebisa, maTi warmo-
maTdami memkvidreobiTi winaswarganwyoba Sobis genetikuri meqanizmi nakleb
avadmyofobaSi gadaizrdeba mxolod Sesabamis Seswavlilia. adamianis paTologiis
pirobebSi. garemos erTi da igive faqtori aranakleb 10-25%-isa pirobadebulia
memkvidreobiT winaswarganwyobasTan dakavSi- memkvidreobiTi winaswarganwybiT.
rebiT xSirad sxvadasxva avadmyofobas iwvevs.
magaliTad, fsiqikuri gadaZabva da uaryofiTi 7.6. memkvidreobiTi avadmyofobebis
emociebis zemoqmedeba zogierT adamianSi iw- profilaqtika da mkurnaloba
vevs hipertonul avadmyofobas, adamianTa me- memkvidreobiTi daavadebis profilaq-
ore nawilSi - nervul da fsiqikur avadmyo- tikisTvis mniSvnelovania maTi dispanse-
fobebs, sxvebSi - Saqrian diabets. rizeba, prenataluri da preklinikuri
91
diagnostika, mutagenuri safrTxis kontro-
li.
memkvidruli paTologiis mqone ojaxebis
dispanserizeba mimarTulia anomaluri nayo-
fis Casaxvis (pirveladi profilaqtika) an
avadmyofi bavSvis dabadebis prevenciisken.
prenataluri diagnostika tardeba orsu-
lobis I da II trimestrSi, e.i. im periodSi,
rodesac nayofis paTologiis aRmoCenisas
SesaZlebelia orsulobis Sewyveta. aseTi ga-
mokvleva gulisxmobs ultrabgeriT diag-
nostikas, dedis sisxlis plazmis bioqimiur
gamokvlevas, amniocentezis (amnionis siTxis
miReba), kordocentebis (nayofis sisxlis
miReba Wiplaridan), qornobiofsia (qorionis
bususebis ujredebis gamokvleva).
preklinikuri diagnostika gulisxmobs
axalSobilTa nivTierebaTa cvlis darRve-
vebiT mimdinare memkvidruli daavadebebis
skrinings.
mutagenuri safrTxis kontroli mimar-
Tulia garemos damazianebeli faqtorebis
organizmze moqmedebis SesaZleblobis Semci-
rebisken, rac miRweuli unda iqnas warmo-
ebebSi, dawesebulebebSi da yofacxovrebaSi
organizaciuli da higienuri RonisZiebebis
gatarebiT (magaliTad, gamwmendi nagebobebis
aSenebiT, haeris, wylis, sakvebis gasufTa-
vebiT, radiaciuli safrTxis SemcirebiT da
sxv.).
92
7. organizmis konstituciis da 7.1.1. ZiriTadi konstituciuri tipebi
reaqtiulobis mniSvneloba praqtikuli medicinisTvis saWiro gaxda
paTologiaSi konstituciuri tipebis klasificireba. Ase-
7.1. organizmis konstituciis mniSvneloba Ti klasifikaciebis safuZvlad iReben sxva-
paTologiaSi dasxva niSans: morfologiurs, biologiurs,
memkvidreobiToba da garemos zemoqme- umaRlesi nervuli sistemis moqmedebis tipsa
deba gansazRvravs organizmis uaRresad da sxv.
mniSvnelovan Tvisebebs - konstitucias da yvelaze adreulia hipokrates klasifika-
reaqtiulobas. cia, romelic dafuZnebulia adamianis tempe-
konstituciis qveS igulisxmeba organiz- ramentis Taviseburebebze. hipokrate ganas-
mis funqciuri da morfologiuri Tavise- xvavebda oTx tips: qoleriks - Zliers, ag-
burebebis erToblioba, romelic yalibdeba znebads, zogjer TavSeukavebels; sangviniks -
memkvidreobiTi da SeZenili Tvisebebis sa- gabeduls, cocxals, moZravs, emociurs;
fuZvelze da gansazRvravs organizmis re- flegmatiks - nels, wynars, mdgrads; me-
aqtiulobas. lanqoliks - gulCaTxrobil, xSirad depre-
metad mniSvnelovania sakiTxi konsti- siul, gaubedav tips.
tuciaSi memkvidreobiTis da SeZenilis Ta- morfologiur kriteriumebze dafuZnebu-
nafardobis Sesaxeb. am mimarTebiT arsebobs li klasifikaciebidan aRsaniSnavia sigos
urTierTsawinaaRmdego mosazrebebi. erT- klasifikacia, romelic gamoyofda sxeulis
erTi maTganis mixedviT, konstitucia ga- agebulebis oTx tips: respiraciuls, diges-
nisazRvreba mxolod memkvidreobiT miRe- tiurs, kunTovans, cerebruls.
buli myari, stabiluri TvisebebiT da is respiraciul tips axasiaTebs wagrZelebu-
ar icvleba garemo faqtorTa zemoqmedebiT. li gulmkerdi, maxvili epigastriuli kuTxe,
amgvari poziciidan gamomdinareobs ama Tu grZeli kiseri, midrekileba sasunTqi gzebis
im avadmyofobis ganviTarebis garduvaloba avadmyofobebisadmi. digestiur tips - ganieri
Sesabamisi paTologiuri winaswarganwyobis gulmkerdi, blagvi epigastriuli kuTxe,
dros. cxadia, es azri mcdaria. amave mokle kiseri, midrekileba nivTierebaTa
dros, dauSvebelia konstituciuri tipis cvlis moSlilobisken. kunTovani tipi gamoir-
CamoyalibebaSi garemo faqtorTa rolis Ceva kunTebis kargi ganviTarebiT, midrekile-
gadaWarbebiT Sefaseba, rac gamoiwvevda biT gul-sisxlZarRvTa sistemis avadmyofo-
organizmis konstituciuri Tvisebebis mar- bebisken. cerebruli tipisTvis damaxasiaTebe-
Tvis SesaZleblobis daSvebas. lia Tavis qalas, gansakuTrebiT misi Sublis
marTebulia mosazreba, romlis mixed- wilis ganviTareba.
viT organizmis konstituciis Camoyalibe- Cernorucki organizmis morfologiur Tvi-
baSi did rols asrulebs memkvidreobiTi sebebs ukavSirebda mis gansazRvrul fun-
faqtori, magram memkvidreobiTi informa- qciur Taviseburebebs. is gamoyofda asTeniur,
ciis gziT miRebuli niSan-Tvisebebi SeiZ- hipersTeniul da normosTeniul tipebs. asTeniur
leba garkveulwilad Seicvalos garemo tips axasiaTebs maRali, msubuqi tani;
faqtorebis zemoqmedebis Sedegad. aqedan hipersTeniurs - SedarebiT grZeli torsi da
gamomdinare, adamianis aRzrdisa da mokle kidurebi. normosTeniuli tipi ata-
mkurnalobis dros saWiroa orientireba rebs rogorc hipo-, ise hipersTeniuli ti-
organizmis konstituciis sust da Zlier pis niSnebs, mas Sualeduri mdgomareoba uka-
mxareebze, SesaZlebeli paTologiuri wi- via am or tips Soris. Cernoruckis mixed-
naswarganwyobis dadgena da garkveul viT, asTeniur tips axasiaTebs SedarebiT da-
farglebSi zemoqmedeba mis gamovlinebaze. bali arteriuli wneva da filtvebis sa-
sicocxlo tevadoba, kuWis SedarebiT susti
93
motorika da nawlavebSi Sewovis daqveiTe- TierebaTa cvlis darRveva, naRvel-kenWovani
buli unari. avadmyofoba, asTeniur tipebs ki - kuWis da
farTod iyo gavrcelebuli kremCeris Tormetgoja nawlavis wylulovani avadmyo-
klasifikacia, romelic ganasxvavebda sam foba, qronikuli koliti, tuberkulozi.
konstituciur tips: aTleturs, piknikurs da aTerosklerozi da koronaruli ukmarisoba
asTeniurs. kremCeri, specialobiT fsiqiat- xSirad uvlindebaT piknikur tipebs; nev-
ri, cdilobda adamianis organizmis mor- rasTenia, hipertoniuli da wylulovani
fologiuri maxasiaTeblebi daekavSirebina avadmyofoba - nervuli sistemis agznebadi
xasiaTis, fsiqikis, temperamentis Tavise- tipis mqone individebs da a.S.
burebebTan da garkveuli fsiqikuri avad- konstituciuri tipebis Seswavlisas na-
myofobis sixSiresTan. Teli gaxda, rom "wminda" tipebs SeiZleba
konstituciis zogierT klasifikacias mivakuTvnoT adamianTa mxolod mcire nawili,
safuZvlad udevs organizmis sistemebis maTi umetesoba ki gardamavali tipia. amave
iseTi maxasiaTeblebi, romlebic organoebs dros, rogorc avRniSneT, konstituciuri
aerTianeben raime erT fiziologiur tipi garkveul farglebSi SeiZleba Seicva-
tipad. bogomolecis azriT, es aris Sema- los garemo faqtorebis (fizikuri Sroma,
erTebeli qsovilis fiziologiuri sistema, sporti, gadatanili avadmyofobebi da sxv.)
epingerisa da hesis mixedviT - vegetatiuri ner- zemoqmedebiT. aucilebelia individis biolo-
vuli sistema, pavlovis azriT - centraluri giuri ritmis gaTvaliswinebac. is, konsti-
nervuli sistema. tuciur niSnebTan erTad, gansazRvravs orga-
epingeri da hesi parasimpaTikuri da nizmis reaqciulobas, amitom, gaTvaliswine-
simpaTikuri nervuli sistemis tonusis buli unda iyos avadmyofobaTa paTogenezis
mixedviT nsxvavebdnen vagotonikebsa da sim- Seswavlisas.
patikotonikebs. konstituciuri tipis dadgena da Seswav-
pavlovs miaCnda, rom organizmis yvela la SesaZlebels xdis droulad gamovlindes
nawilis Sinagani erToblioba, reaqtiu- midrekileba avadmyofobisadmi, ganisazRvros
loba da garemosTan wonasworoba xorci- misi mimdinareobis mimarTuleba da, aqedan
eldeba centraluri nervuli sistemis sa- gamomdinare, Seiqmnas mkurnalobis individu-
SualebiT. igi konstituciur tipebad da- alizebis SesaZlebloba. amis garda, profi-
yofas axorcielebda umaRlesi nervuli laqtikur medicinas TiToeuli konstitu-
moqmedebis xasiaTis mixedviT da gamoyofda ciuri tipis cxovrebisa da Sromis sasurve-
Semdeg konstituciur tipebs: 1. Zliers, li pirobebis rekomendaciebis SemuSavebis sa-
gauwonasworebels agznebis siWarbiT, 2. Sualeba eZleva.
Zliers, gawonasworebuls, moZravs, 3. diaTezi (berZn. diathesis - winaswargan-
Zliers, gawonasworebels, dinjs, 4. wyoba) avadmyofobis mimarT organizmis gark-
susts, Sekavebis siWarbiT. pirveladi da veuli mzadyofnaa. mas axasiaTebs Taviseburi,
meoradi sasignalo sistemis siWarbis mi- gansxvavebuli reaqcia Cvevulebriv gaRizia-
xedviT pavlovi adamianebs hyofda, agreTve, nebaze da midrekileba ama Tu im paTologi-
moazrovne da mxatvrul tipebad. uri procesisadmi.
klinikuri dakvirvebis mixedviT, adami- ganasxvaveben eqsudaciur (alergiul), Ti-
anis agebulebasa da ama Tu im avadmyofo- musur-limfatur, arTritul, spazmofilur, hemo-
bisadmi midrekilebas Soris garkveuli ragiul diaTezs. diaTezis cneba friad axloa
kavSiria, Tumca, am damokidebulebis meqa- konstituciuri anomaliis cnebasTan. is da-
nizmi yovelTvis ar aris naTeli. Cnobi- kavSirebulia organizmis memkvidreobiT da
lia, rom hipersTeniul tipebs ufro xSirad SeZenil TvisebebTan. diaTezi jer kidev ar
aqvT gul-sisxlZarRvTa avadmyofobebi, niv- aris avadmyofoba, magram iolad viTardeba
94
Cveulebrivi gamRizianeblebis organizmze - dune mimdinareoba da waSlili simptoma-
zemoqmedebisas. diaTezi SeiZleba didxans tika.
ar avlendes Tavis arsebobas da Tavs iCens
mxolod maprovocirebel faqtorTa zemoq- 7.2.1. reaqtiulobis saxeebi
medebisas, magaliTad, reJimis darRvevis, reaqtiulobis yvelaze ufro zogadi
cudi kvebis dros da a.S. formaa biologiuri anu saxeobrivi reaqtiu-
loba (sur.7-1). is mimarTulia mTlianad sa-
7.2 organizmis reaqtiulobis roli xeobisa da calkeuli individis SenarCune-
paTologiaSi bisken. reaqtiulobis saxeobrivi Tavisebu-
reaqtiuloba organizmis unaria cxo- rebebiT ganisazRvreba saxeobrivi imuniteti
velmoqmedebis cvlilebiT upasuxos garemo infeqciuri avadmyofobebisadmi. saxeobrivi
zemoqmedebas. rac Seexeba organizmis re- imunitetiTaa pirobadebuli is faqti, rom
aqcias garemo faqtorTa zemoqmedebaze, is adamiani ar avaddeba msxvilfexa rqosani pi-
reaqtiulobis gamovlenis formaa. Reaqti- rutyvis WiriT. saxeobrivi reaqciuloba
ulobis cvlilebebi umTavresad dacviT- vlindeba, magaliTad, imiTac, rom hiperto-
SeguebiTi xasiaTisaa. nuli avadmyofobiT sneuldeba mxolod ada-
reaqtiuloba nebismier cocxal orga- miani, Tagvis damaxasiaTebeli avTvisebiani
nizms axasiaTebs. evoluciis procesSi, simsivneebi ar gadaenergeba adamians da sxv.
cocxali arsebebis organizebis garTule- saxeobrivi reaqciulobis safuZvelze ya-
bis paralelurad, rTuldeba reaqciulo- libdeba jgufuri da individuri reaqtiuloba.
bis meqanizmebic. rac ufro maRalorgani- ukanaskneli iqmneba memkvidreobiTi da SeZeni-
zebulia cxoveli, miT ufro mdidaria mi- li faqtorebis zemoqmedebiT.
si aqtiurad reagirebis saSualebebi gare- reaqtiuloba damokidebulia sqeszec. qa-
mo damzianebeli faqtorebis zemoqmedebaze. lis organizmis reaqtiuloba icvleba ovari-
gansakuTrebiT rTuli da mravalfero- ul-menstrualur ciklTan da orsulobasTan
vania adamianis organizmis reaqtiuloba. dakavSirebiT, misi organizmi ufro gamZlea
mis Camoyalibebasa da cvlilebebSi arsebi- sisxlis dakargvisadmi, SimSilisadmi, vidre
Ti mniSvneloba meorad sasignalo sistemas mamakacisa.
aqvs: cnobilia, rom sityvam adamianze, zog organizmis reaqtiulobisTvis didi mniS-
SemTxvevaSi, SeiZleba imoqmedos rogorc vneloba aqvs asaks. Zalze dabali reaqtiu-
samkurnalo saSualebam, zogjer ki – ro- loba axasiaTebT Cvil bavSvebs, rac piroba-
gorc avadmyofobis gamomwvevma faqtorma. debulia nervuli, endokrinuli, imunuri
reaqtiulobis cneba farTod gamoiye- sistemebis, Termoregulaciis arasruli Ca-
neba praqtikul medicinaSi, pirvel rigSi, moyalibebiT, barieruli sistemebis arasrul-
daavadebuli organizmis zogadi mdgoma- yofilebiT. reaqtiuloba qveiTdeba daberebis
reobis SefasebisTvis. momatebuli reaqti- procesSic.
ulobis mdgomareoba hiperergiis, daqveiTe- individuri reaqtiuloba SeiZleba iyos spe-
buli - hipoergiis, sruli areaqtiuloba ki cifikuri da araspecifikuri. pirveli vlindeba
anergiis saxelwldebiTaa cnobili. ase ma- antigenur gaRizianebaze antisxeulebis war-
galiTad, Sinagani da infeqciuri avad- moqmnis da infeqciuri sneulebebisadmi Seu-
myofobebis klinikaSi arCeven pnevmoniis, valobis - imunitetis Camoyalibebis unariT,
tuberkulozis, dizenteriis hiperergiul qsovilebis biologiuri SeuTavseblobis re-
da hipoergiul formebs. hiperergiul aqciiT. araspecifikuri reaqciuloba mJRav-
formebs axasiaTebs ufro swrafi, inten- ndeba organizmze sxvadasxva garemo faq-to-
siuri mimdinareoba da avadmyofuri mov- ris zemoqmedebisas da realizdeba iseTi
lenebis mkveTri gamovlineba, hipoergiuls
95
meqanizmebiT, rogoricaa stresi, parabiozi,
fagocitozi da sxv. reaqtiuloba
saxeobrivi
jgufuri
individuri
specifikuri araspecifikuri
96
medebaze. aseTebia organizmis aras-peci- vobis SenarCunebaa, adgilobrivi sisxlis mi-
fikuri da specifikuri dacvis mraval- moqcevis ZiriTadi funqciaa organoebisa da
ricxovani meqanizmebi, romlebic mWidrod qsovilebis uzrunvelyofa maTi funqciuri
arian dakavSirebuli organizmis reaqti- mdgomareobis adekvaturi raodenobis sis-
ulobasTan. am reaqciebis magaliTia imuni- xliT da metabolizmis produqtebis gamo-
tetis sxvadasxva saxe, Sxamebis neitra- tana maTgan.
lizeba organizmSi, Wrilobis Sexorceba sxvagvarad rom vTqvaT, gul-sisxlZar-
da sxv. gasaTvaliswinebelia is faqti, rom RvTa sistemis es nawili, imyofeba ra speci-
zog SemTxvevaSi reaqtiuloba da re- aluri nervuli da humoruli meqanizmebis
zistentoba icvleba sxvadasxva mimarTu- gavlenis qveS, ganapirobebs organoebisa da
lebiT. magaliTad, cxovelTa zamTris Zi- qsovilebis adeqvatur sisxlmomaragebas. pe-
lisas organizmis reaqtiuloba mkveTrad riferiuli sisxlis mimoqceva kanSi mona-
qveiTdeba, infeqciebisadmi rezistentoba ki wileobs TermoregulaciaSic.
izrdeba sistemuri da adgilobrivi sisxlis mi-
moqcevis SedarebiT damoukideblobaze met-
nawili II yvelebs, magaliTad, is faqti, rom muSaobiTi
tipobrivi paTologiuri hiperemia, e.i. adgilobrivi sisxlsavseoba,
procesebi romelic gamowveulia organos funqciis
8. periferiuli (adgilobrivi) gaZlierebiT, erTnairad vlindeba rogorc
sisxlis mimoqcevis da mikro- kunTis sisxlZarRvebis SenarCunebuli iner-
cirkulaciis paTofiziologia vaciisas, ise misi sruli denervaciis dros.
8.1. zogadi cnobebi periferiuli es didi xnis win dadgenili movlena aixsneba
sisxlis mimoqcevis Sesaxeb momuSave kunTSi arsebuli metabolitebis
gul-sisxlZarRvTa sistema daxSuli uSualo zemoqmedebiT sisxlZarRvTa kedel-
sistemaa, romelic uzrunvelyofs qsovi- ze.
lebsa da organoebs sakvebi nivTierebebiT sisxlis mimoqcevis sistemis sxvadasxva
da amasTanave gamoaqvs maTgan nivTierebaTa monakveTi gansxvavdeba sxvadasxva morfo-fun-
cvlis produqtebi. am saerTo saboloo qciuri TaviseburebiT, TviT funqciiT, ris
amocanis ganxorcieleba rTuli, mraval- gaTvaliswinebiTac sisxlZarRvebs yofen Sem-
safexuriani procesia, romelSic sisxlis deg jgufebad:
mimoqcevis sistemis sxvadasxva ubani gan- 1. maamortizebeli (makompensirebeli, bu-
sxvavebul funqcias asrulebs da rom- feruli) tipis sisxlZarRvebi - aorta da
lebic, amasTan dakavSirebiT, sisxlis cir- msxvili arteriebi anu elastikuri tipis
kulaciis sxvadasxva doneze gansxvavebuli sisxlZarRvebi. isini uSualod ar monawi-
meqanizmebiT regulirdeba. amitom sisxlis leoben sisxlis mimoqcevis regulaciaSi,
mimoqcevis fiziologiisa da paTofizio- uzrunvelyofen sisxlis mowodebas sxeulis
logiis Seswavlisas am sistemaSi saWiroa sxvadasxva nawilSi da, amitom, miekuTvnebian
gamovyoT sul cota ori qvesistema: sis- saerTo, anu sistemur sisxlis mimoqcevis
temuri (centraluri) da periferiuli sistemas (ufro sworad qvesistemas). Makom-
(adgilobrivi, regionuli) sisxlis mi- pensirebeli tipis sisxlZarRvebis erT-erTi
moqceva. Tu centraluri sisxlis mimoq- funqciaa wyvetili sisxlis nakadis uw-
cevis funqcia umTavresad saerTo arte- yvetSi gadayvana.
riuli wnevis donis, gulis wuTmocu- 2. rezistiuli anu winaaRmdegobis sisx-
lobis, gulisken dabrunebuli venuri sis- lZarRvebi warmodgenilni arian wvrili ar-
xlis raodenobis, cirkulaciaSi myofi teriebis, arteriolebis, venulebisa da
sisxlis moculobis SedarebiTi mudmi- wvrili venebis, e.i. kunTovani tipis
97
sisxlZarRvebis saxiT. isini, gansakuT- postkapilaruli venulebis (100-200 mkm-mde
rebiT ki wvrili arteriuli sisxlZar- diametris) doneze, e.i. iq, sadac saboloo
Rvebi, ZiriTad rols TamaSoben sisxlis jamSi xorcieldeba gul-sisxlZarRvTa sis-
nakadisadmi perife-riuli winaaRmdegobis temis satransporto funqcia. yvela procesi,
SeqmnaSi, uzrunvelyofen qsovilebis adeq- aseTi sisxlZarRvebis doneze mimdinare yve-
vatur sisxlmomaragebas, rac pirobadebu- la cvlileba erTiandeba mikrocirkulaciis
lia am sisxlZarRvebis unariT aqtiurad cnebaSi.
Seicvalon sanaTuris sidide. prioriteti adgilobrivi sisxlis mi-
3. cvlaSi monawile sisxlZarRvebi - moqcevisa da mikrocirkulaciis SeswavlaSi
kapilarebi da venulebis sawyisi frag- normisa da paTologiis dros yofil ssrk-Si
mentebi, sadac xorcieldeba nivTierebaTa qarTvel paTofiziologebs ekuTvnodaT (v.vo-
da airTa cvla sisxlsa da qsovilebs So- roninis skola: i.zaaliSvili, g.mWedliSvili,
ris. T.naTaZe, a.gelaSvili, i.gedevaniSvili, T.begi-
4. moculobiTi sisxlZarRvebi - venebi aSvili, v.yifiani da sxv.).
(umTavresad wvrili venebi), sadac depo- periferiuli sisxlis mimoqcevis moS-
nirdeba sisxlis ZiriTadi masa (75-80%) las miekuTvneba: arteriuli hiperemia, ve-
da romlis tevadobis cvlileba gansaz- nuri hiperemia, iSemia(isqemia), stazi, Trom-
Rvravs gulisken dabrunebuli venuri bozi, embolia.
sisxlis raodenobas.
5. sisxlZarRvebi - Suntebi ewodeba 8.2. arteriuli hiperemia
arteriolur-venulur anastomozebs, e.i. arteriuli hiperemia adgilobrivi
iseT sisxlZarRvebs, romlebic uzrunvel- sisxlmetobaa, romelic viTardeba qso-
yofen sisxlis gadasvlas arteriidan uSu- vilSi didi raodneobiT arteriuli sis-
alod venaSi kapilarebis gamotovebiT. xlis modinebis Sedegad momtani sisxl-
arteriolo-venuluri anastomozebi pir- ZarRvebis gafarToebis gamo.
velma aRmoaCina da aRwera cnobilma qar- gamomwvevi mizezidan gamomdinare Se-
Tvelma fiziologma iv.TarxniSvilma. iZleba ganvasxvavoT fiziologiuri (ga-
arteriolor-venulur anastomozebs mowveuli Cveulebrivi fiziologiuri
aqvT kargad ganviTarebuli kunTovani Sre gamRizianeblebiT) da paTologiuri ar-
da, ZiriTadad, gvxvdebian sxeulis warzi- teriuli hiperemia, romelic paTolo-
dul nawilebSi (gansakuTrebiT TiTebis, giuri zemoqmedebis Sedegad viTardeba. am
cxviris, yurebis boloebSi). maTi fun- ori jgufidan TiToeuli moicavs sxva-
qciebia: TermoregulaciaSi monawileoba dasxva saxis arteriul hiperemias.
(rasac uzrunvelyofs Tbili sisxlis pir- aseTi klasifikacia pirobiTobis gar-
dapiri gadasrola arteriolebidan kveuli elementebisgan dazRveuli ar
venulebSi), monawileoba adgilobrivi sis- aris. magaliTad, siTbos zemoqmedeba iw-
xlis mimoqcevis regulaciaSi da a.S. vevs Cveulebriv fiziologiur vazodi-
hemocirkulacia sisxlZarRvTa bolo lataciur reaqcias, e.i. siTbur hipe-
oTx jgufSi gaerTianebulia adgilobrivi remias, magram ufro maRali tempera-
(periferiuli, regionuli, organuli) sis- turis zemoqmedebisas viTardeba ara mar-
xlis mimoqcevis cnebaSi. to pirveladi hiperemiuli reaqcia, ara-
bolo wlebSi gansakuTrebuli inten- med damwvrobac. am SemTxvevaSi tempe-
sivobiT Seiswavleba sisxlis mimoqcevis raturuli faqtori ara fiziologiuri,
kanonzomierebebi uwvriles sisxlZar- aramed Zlieri paTogenuri gamRizianebe-
RvebSi kapilarebisa da prekapilaruli ar- licaa.
teriebis (100-200 mkm-mde diametris),
98
meore mxriv, reaqciuli (postisqe--mi- degad sisxlis nakadis moculobiTi siCqare
uri) hiperemia, romelsac paTologiur hi- izrdeba.
peremias akuTvneben, SeiZleba ganvixiloT, izrdeba ara mxolod sisxlZarRvis ganiv-
rogorc fiziologiuri, Tu is viTardeba kveTis farTobi (q), aramed sisxlis mo-
sisxlis nakadis xanmokle, swrafad war- culobiTi siCqarec (V). erTi SexedviT es
mavali Seferxebis Semdeg. ewinaaRmdegeba ganuwyvetlobis gantolebas
arteriuli hiperemiis, venuri hipe- (V=qv=const), magram unda gvaxsovdes, rom
remiis da iSemiis ZiriTadi simptomebi es formula marTebulia mxolod stacio-
mocemulia v.voroninis mier mowode- naruli pirobebisaTvis, rodesac moculobi-
bul cxrilSi. cxrilis mixedviT, Ti siCqare (V) mudmivi da ucvleli sididea.
arteriuli hiperemiisas arteriebis arteriuli hiperemiis dros ki moculobiTi
ganivkveTis farTobi momatebulia, rac siCqare ama Tu im mizezis gamo matulobs
ganapirobebs hiperemias - sxva danar- (magaliTad, sisxlis mimoqcevis ufro zemo
Ceni simptomebi misi Sedegia; arteri- ubanSi sisxlis wnevis awevisas an sisxlis
uli hiperemiis dros arteriebis ga- nakadis mimarT winaaRmdegobis Semcirebisas)
farToeba umeteswilad aqtiuri proce- da iqmneba axali stacionaruli pirobebi,
sia, amitom mas aqtiur hiperemiasac sadac ganuwyvetelobis gantoleba inarCunebs
uwodeben. kanonis Zalas.
arteriebis gafarToebas iwvevs va- hemodinamikis kanonebidan gamomdinare,
zokonstriqciuli nervebis dambla an SegviZlia davaskvnaT, rom arteriuli hipe-
gadaWra (neiroparalizuri hiperemia), remiis dros sisxlZarRvis gafarToebul
vazodilataciuri nervebis agzneba (ne- ubanSi sisxlis wneva izrdeba, radgan wi-
irotonuli hiperemia), temperaturis naaRmdegoba sisxlis nakadis mimarT da Se-
(siTburi hiperemia) an zogierTi vazo- sabamisad energiis xarjva (wnevis danakargi)
aqtiuri nivTierebis uSualo zemoq- mcirdeba. es faqti sisxlis wnevis pirdapiri
medeba sisxlZarRvis kedelze. gazomvebiT daamtkica bogomolecma, rome-
postisqemiuri hiperemia viTardeba kve- lic specialuri manometriT zomavda boc-
biTi (nutriciuli) refleqsis moqmedebis veris yuris sisxlZarRvebis ganivkveTis far-
Sedegad - qsovilis adgilobrivi sisxl- Tobs da arteriul wnevas normisa da hi-
nakleboba (iSemia) iwvevs masSi nivTiere- peremiis dros.
baTa cvlis darRvevas. warmoqmnili naer- aRmoCnda, rom siTburi hiperemiisas upi-
Tebi aRizianeben iq arsebul nervul da- ratesad farTovdeba wvrili yalibis arte-
boloebebs da refleqsurad viTardeba riebi (0,2 mm diametriT), neiroparali-
arteriuli hiperemia. vakaturi arteriuli zurisas - SedarebiT ufro msxvili (0,8 mm
hiperemia ki qsovilis irgvliv wnevis da- diametri). e.i. siTburi hiperemiisas energiis
cemis Sedegia. rig SemTxvevebSi arteri- xarjvis Semcireba da wnevis mateba gan-
uli hiperemiis mizezi TviT sisxlZarRvis sakuTrebiT mkveTradaa gamoxatuli wvril
kedlis miocitebis funqciis darRvevaa arteriebSi, xolo neiroparalizuri hipere-
(mioparalizuri hiperemia). miisas - saSualo yalibis arteriebSi. es
momtani sisxlZarRvebis dilatacia iw- monacemebi naTlad warmoaCenen hemodinamikis
vevs kapilarebis da venebis meorad gafar- kanonebis universalobas - rac ufro metia
Toebas. sisxlZarRvis ganivkveTis farTobi, miT nak-
arteriebis gafarToebis gamo hiperemi- lebia winaaRmdegoba sisxlis nakadis mimarT,
uli ubnis sisxlZarRvebSi mcirdeba wina- moZravi sisxlis energiis xarjva mis dasaZ-
aRmdegoba sisxlis nakadis mimarT, ris Se- levad da miT metia arteriuli wneva sisxl-
ZarRvebSi.
99
arteriebsa da arteriolebSi wnevis ma- kavSirebulia momtani sisxlZarRvebis ga-
teba iwvevs mis zrdas kapilarebSic da am farToebasTan da prekapilaruli sfinqte-
sisxlZarRvebis gafarToebas. rebis modunebasTan. izrdeba sisxlis nakadis
organos fers, Cveulebriv, akvirdebian xazovani siCqare kapilarebSi. sisxlis wnevis
kansa da xilul lorwovan garsebze. Sis- gazrdis gamo daxuruli (pasiuri) kapila-
xli yvelaze kargad Cans epidermisis Txe- rebi gadaiqcevian jer plazmur kapilarebad,
li fenis qveS kapilarebis maryuJebsa da romlebic atareben mxolod plazmas, Semdeg
zedapirul venur wnulebSi. swored maTi ki aqtiur kapilarebad, romlebSic gaivlis
sisxlsavseoba gansazRvravs hiperemiuli rogorc plazma, ise formiani elementebi,
ubnis wiTel Sefervas. e.i. matulobs mofunqcie kapilarebis ricxvi,
qsovilis temperatura damokidebulia rac kapilarebis gafarToebasTan erTad iw-
masSi gavlili sisxlis moculobaze. es vevs qsovilSi gamavali sisxlis moculobis
kargad Cans kanis magaliTze, romelic ma- zrdas.
ragdeba Sinagani organoebidan momdinare
Tbili sisxliT. amasTanave masSi SedarebiT 8.3. venuri hiperemiis mizezebi, Sedegebi
dabalia metaboluri procesebis intensi- da misi niSnebis meqanizmebi
voba. Sinagani organoebis hiperemiisas maTi venuri hiperemia adgilobrivi sisxlme-
temperatura TiTqmis ar icvleba, radgan tobaa, romelic viTardeba venebis saSuale-
organoebi organizmis RruSi – erTgvar biT qsovilidan sisxlis gatanis dabrkole-
TermostatSi imyofebian imave temperatu- bis gamo. venuri hiperemiis gamomwvevi adgi-
raze, romelic aqvs gamdinare sisxls. aq lobrivi mizezebidan aRsaniSnavia zewola ve-
siTbos kargva an gacema ar xdeba, ara aqvs nebze garedan (simsivne, nawiburi, hipertro-
mniSvneloba, Tu ra raodenobiT gaivlis firebuli organo), sanaTuris Seviwroveba
organoSi Tbili sisxli. rac Seexeba kans, Signidan (Trombi, emboli, anTebiTi procesi).
misi temperatura miT ufro metia, rac me- venuri hiperemiis zogadi mizezi gulis
tia masSi gamavali sisxlis moculoba. ukmarisobaa. aseT SemTxvevaSi hiperemia vi-
ukanaskneli ki izrdeba arteriuli hipere- Tardeba sxeulis gulidan daSorebul nawi-
miiisas. lebSi, magaliTad, qvemo kidurebSi.
qsoviluri siTxis warmoqmnas – tran- aRsaniSnavia, rom venuri hiperemiisadmi
sudacias gansazRvravs ori procesi – midrekilebas iCenen is pirebi, romelTac
filtracia da rezorbcia. radgan arte- konstituciurad ganpirobebuli venebis sus-
riuli hiperemiisas wneva momatebulia, ti elastikuri aparati aqvT (venebis kedle-
filtraciis procesi Zlierdeba, magram bis Semadgeneli gluvkunTovani elementebis
filtraciis gaZlierebis miuxedavad, hi- arasruli ganviTareba an maTi dabali tonu-
peremiul ubanSi SeSupeba TiTqmis araso- si, venuri sarqvelebis ukmarisoba). xangr-
des ar viTardeba, radgan arteriuli hi- Zlivad vertikalur mdgomareobaSi yofnisas
peremiisas gaZlierebulia limfis mimoq- aseT pirebs qveda kidurebis distalur na-
cevac, rac uzrunvelyofs zedmeti qsovi- wilebSi venuri hiperemia uviTardebaT.
luri siTxis gatanas. venuri hiperemiisaTvis damaxasiaTebelia
qsovilTa kvebas ZiriTadad gansaz- Semdegi niSnebi:
Rvravs qsovilTa sisxlmomarageba. cxadia, venebSi dabrkolebis gaCenis Sedegad
rom arteriuli hiperemiis dros sisxlis mcirdeba sisxlis nakadis xazovani siCqare
nakadis moculobiTi siCqaris momatebis (V);
gamo qsovilTa kveba gaZlierebulia. sisxlis nakadis xazovani siCqaris
mikrocirkulaciis darRvevebi arte- Semcirebis Sedegad mcirdeba winaaRmdegoba
riuli hiperemiis dros umTavresad da-
100
sisxlis nakadis mimarT da sisxlis wneva swored qsoviluri hipoqsia aris is Zi-
venebSi izrdeba; riTadi mizezi, romelic iwvevs adgi-
sisxlis wnevis momateba iwvevs ve- lobriv cvlilebebs qsovilebSi atro-
nebis pasiur gaganierebas (ris gamo venur fiis da distrofiis saxiT, organos pa-
hiperemias pasiur hiperemiasac uwodeben), renqimis ganvlevas da SemaerTebeli qso-
izrdeba sisxlZarRvTa ganivkveTi; vilis Warb ganviTarebas masSi (cirozi).
miuxedavad ganivkveTis farTobis venuri hiperemiis Sedegia organos
zrdisa, sisxlis nakadis moculobiTi siC- (RviZlis, Tirkmlis, elenTis, filtvis)
qare mcirdeba, rac gamowveulia sisxlis SegubebiTi gamkvriveba - induracia. Ggan-
nakadis xazovani siCqaris mkveTri Semci- sakuTrebiT mZime mdgomareoba iqmneba, Tu
rebiT; venur Segubebas Tan axlavs limfosta-
Sesabamis ubanSi organos an qso- zic.
vilis sisxlsavseoba matulobs; venebis xangrZlivi gafarToebisas qve-
organos feri cianozuria - muqi iTdeba maTi kedlebis kunTovani Sris
wiTeli molurjo elferiT. es aixsneba elastikuroba, arc Tu ise iSviaTad ya-
imiT, rom venur sisxlSi Warbi raode- libdeba venebis varikozuli gaganiereba.
nobiT myofi aRdgenili hemoglobinis muqi mikrocirkulacias venuri hiperemiis
alublisferi epidermisis Txeli fenis dros axasiaTebs sisxlis nakadis xazovani
qveS lurjad aRiqmeba (fluorokontras- siCqaris Semcireba. Tu sisxlis gatana veniT
tis movlena); ar xdeba, wneva dabrkolebis win uTanabrdeba
organos an qsovilis temperatura diastolur wnevas arteriebSi. amitom dias-
daqveiTebulia masSi gavlili sisxlis tolis fazaSi sisxlis moZraoba wydeba,
moculobis Semcirebis Sedegad; sistolis fazaSi ki aRdgeba. Tu wneva dab-
qsoviluri siTxe Warbad warmo- rkolebis win gadaaWarbebs diastolur wne-
iqmneba hidrodinamikuri wnevis momatebisa vas arteriaSi, viTardeba sisxlis saqanela-
da, Sesabamisad, filtraciis gaZlierebis seburi moZraoba: sistolis dros sisxli
gamo. filtracia imdenad matulobs, rom moZraobs normaluri mimarTulebiT, dias-
arteriuli hiperemiisagan gansxvavebiT, ve- tolis dros ki retrogradulad – ar-
nuri hiperemiis dros viTardeba SeSupebac, teriebis mimarTulebiT.
romlis CamoyalibebaSi monawileobs, ag- gazrdili sisxlis wneva afarToebs ve-
reTve, kapilarebis kedlebis fenestrebis nebs da kapilarebs. ixsneba adre aramofun-
da ganvladobis zrda maTi gafarToebis ga- qcie sisxlZarRvebic. sisxlis wnevis zrdis
mo. airTa cvlis darRvevis Sedegad sis- gamo matulobs qsoviluri siTxis warmoq-
xlZarRvTa kedlis garSemo arsebuli fa- mnac. cxadia, rom miuxedavad sisxlZarRvTa
Sari SemaerTebeli qsovilis Wimvadoba gafarToebisa, mikrocirkulaciis intensivoba
matulobs, xolo elstikuroba qveiTdeba venuri hiperemiis dros mkveTrad Semcirdeba.
(ix. SeSupeba), rac qsovilSi wylis dag-
rovebis winapirobaa. amas garda, adgili 8.4. iSemia
aqvs limfis mimoqcevis darRvevasac tran- iSemia (isqemia) adgilobrivi sisxl-
sudatis limfur ZarRvebze zewolis ga- naklebobaa, romelic viTardeba mkvebavi
mo; sisxlZarRvebiT qsovilisaken sisxlis
organos kveba daqveiTebulia, motanis Semcirebis an Sewyvetis gamo.
radgan Semcirebulia sisxlis moculo-
biTi siCqare.
xangrZlivi venuri Segubebis Sede-
gad viTardeba qsovilebis hipoqsia.
101
iSemiis mizezebi, klasifikacia da glikoliziT. Sedegad grovdeba rZemJava
Sedegebi da pH gadaixreba mJavianobisken, rac tki-
ganasxvaveben iSemiis kompresiul, vilis erT-erTi mizezia. amas garda,
obturaciul, neirotonul da neiro- iSemiis ubanSi, ujreduli membranebis
paralizur formebs. ganvladobis momatebis gamo, Cndeba niv-
kompresiul iSemias iwvevs nawibu- Tierebebi, romlebic aseve iwveven tki-
ris, simsivnis, ucxo sxeulis, ligatu- vils: histamini K+, bradikinini da ka-
ris an nebismieri sxva saxis zewola lidini. tkivili SeiZleba gamoiwvios,
mkvebav arteriaze. agreTve, acetilqolinma, serotoninma.
obturaciuli iSemia mkvebavi sisx- iSemia qsovilebisa da organoebis-Tvis
lZarRvis sanaTuris TrombiT an embo- mavne procesia, radgan sisxlnaklebobis
liT nawilobrivi an sruli daxSobis dros irRveva qsovilebisadmi Jangbadisa
Sedegia. arteriis sanaTuris Seviwro- da sakvebi nivTierebebis miwodeba, rac,
eba an daxSoba SeiZleba gamowveuli bevr SemTxvevaSi, isqemiuri qsovilis
iyos misi kedlis infiltraciuli an sikvdils (nekrozs, infarqts) iwvevs.
anTebiTi cvlilebebiT, aTerosklero- iSemiis gamosavali dakavSirebulia kola-
ziT, endarteriitiT, kvanZovani peri- teraluri sisxlis mimoqcevis ganvi-
arteriitiT. Tarebasa da TviT iSemiis xarisxTan, mis
neirotonul iSemias xSirad ref- xangrZlivobasTan.
leqsuri xasiaTi aqvs da viTardeba
emociebis, tkivilis, meqanikuri gaRi-
zianebis, sicivis dros, pirobiTref-
leqsurad. rig SemTxvevebSi iSemia Se-
iZleba dakavSirebuli iyos sisxlZar-
Rvis kedlis kunTovani elementebis
mgrZnobelobis matebasTan SekumSvis
mastimulirebel faqtorTa mimarT.
arteriuli hiperemiis zemoT moyva-
nili simptomebis analizis Semdeg, iSe-
mia ar saWiroebs specialur ganxilvas,
radgan process aqvs sawinaaRmdego mi-
marTuleba da gasagebia calke garCevis
gareSec. amasTan saWiroa yuradReba ga-
vamaxviloT erT simptomze, romelsac
sxva saxis adgilobrivi sisxlis mi-
moqcevis moSlis dros iSviaTad aRmo-
cendeba. esaa tkivilis SegrZneba iSemi-
is ubanSi.
gansakuTrebiT mwvave tkivilebi aR-
mocendeba iSemiis fonze momuSave or-
ganoSi. tkivili viTardeba qsovilebis
receptorebis gaRizianebisas, romelsac
ganapirobebs hipoqsiis pirobebSi dag-
rovili nivTierebaTa cvlis dauJangavi
produqtebi. ujredebis energiiT uz-
runvelyofa xdeba naklebad efeqturi
102
simptomi arteriuli hiperemia isqemia venuri hiperemia
103
fibrinogenis, globulinebis nasxvaveben TeTr anu aglutinaciur
koncentra-ciis zrda da albuminebis Trombs (Sedgenils, ZiriTadad, Trom-
koncentraciis Semcireba, biologiurad bocitebis, leikocitebis da plazmis
aqtiuri niv-Tierebebis (serotonini, cilebisgan), wiTel anu koagulaciur
bradikinini, histamini) zemoqmedeba, Trombs (Sedgenils ZiriTadad fibrinis
acidozi. ZafebiT urTierTdamagrebuli eriTroci-
stazi xSirad aRmocendeba lokalu- tebisgan) da Sereul Trombs, romelic
rad, ama Tu im organos sisxlZar- TeTri da wiTeli fenebisagan Sedgeba.
RvebSi adgilobriv faqtorTa moqmede- Trombis warmoqmnis umTavresi mizezi
bis Sedegad. magram rig SemTxvevebSi sisxlZarRvis kedlis dazianebaa. mis
saqme gvaqvs gavrcelebul stazirebas- gamo intaqtur sisxlZarRvSi arsebuli
Tan - stazi erTdroulad viTardeba laminaruli sisxlis nakadi icvleba
sxeulis sxvadasxva nawilSi (magali- turbelenturiT, es ki iwvevs formiani
Tad, zogierTi infeqciuri daavadebi- elementebis Sekavebas sisxlZarRvTa ke-
sas). delTan da amgvarad iqmneba Trombis
Tu stazis dros sisxlZarRvTa ked- formirebis safuZveli. normis pirobebSi
lebSi da sisxlSi Rrma cvlilebebi ar sisxlZarRvis kedels da sisxlis for-
ganviTarda, sisxlis mimoqceva mizezis mian elements erTnairi muxti aqvT, rac
moqmedebis Sewyvetis Semdeg aRdgeba. maT Soris ganzidvas iwvevs. dazianebis
winaaRmdeg SemTxvevaSi stazi Seuqce- adgilze ki sisxlZarRvis kedlis muxti
vadi xdeba, Sesabamisi qsovili nekroz- ikargeba, ris gamo formiani elementebi
deba, rasac aCqarebs momtani sisxl- am regionSi grovdeba. rodesac laparakia
ZarRvebis refleqsuri spazmi. sisxlZarRvis kedlis dazianebis rolze
Trombis formirebaSi, unda gvaxsovdes,
rom dazianebuli kedeli sisxlSi ga-
8.6. Tromozi moyofs qsovilur Tromboplastins, ro-
8.6.1. Trombis warmoqmnis meqanizmi melic biZgs aZlevs sisxlis Sededebas,
Trombozi cocxali organizmis sis- rac aucilebelia Trombis warmoq-
xlZarRvTa sanaTurSi sisxlis elemen- mnisaTvis. meore mxriv, sisxlZarRvis
tebisagan Sedgenili warmonaqmnis (an kedlis dazianebisas iTrguneba adgilob-
warmonaqmnebis) - Trombis gaCenaa, ro- rivi fibrinolizis procesi, mcirdeba
melic nawilobriv an Tlianad axSobs sisxlZarRvis endoTelis mier prosta-
sisxlZarRvis sanaTurs. ciklinis warmoqmna, romelic normis pi-
unda aRiniSnos, rom Trombi yalib- robebSi Trombocitebis mimarT dezagre-
deba sicocxleSive. is advili gansas- gaciul moqmedebas iCens. aqedan gamom-
xvavebulia sisxlZarRvis sanaTurSi dinare, kedlis dazianebisas adgili eq-
sikvdilis Semdeg sisxlis Sededebis neba Trombocitebis agregacias, rac
(koagulaciis) gamo warmoqmnili masis- Trombwarmoqmnis erT-erTi ZiriTadi mo-
gan, romelic Tavisufladaa moTavsebu- mentia.
li sanaTurSi. Trombis warmoqmna ara Trombis warmoqmnis procesis metad
marto sisxlis Sededebis Sedegi, ara- mniSvnelovani xelSemwyobi faqtorebi
med bevrad ufro rTuli procesia, sisxlis Semadedebeli da Sededebis sawi-
romelSic aucileblad monawileoben naaRmdego sistemebis aqtivobis cvlile-
sisxlZarRvis kedeli da sisxlis for- bebia.
miani elementebi. Trombis Semadgenlo- Sededebis sistemis gaaqtiveba sisx-
baSi maTi Semcvelobis mixedviT ga- lSi prokoagulantebis (Trombini, Trom-
104
boplastini) koncentraciis momateba, SemdgomSi, intaqturi Trombocite-bis
iseve, rogorc Sededebis sawinaaRmdego mier gamoyofili Trombasterinis
sistemis aqtivobis daqveiTeba (antiko- gavleniT xdeba Trombis SemWidroveba,
agulantebis Semcvelobis Semcireba da retraqcia. retraqciis procesSi mona-
maTi inhibitorebis raodenobis zrda) wileoben: kalciumis ionebi, glukoza,
da fibrinolizis daTrgunva Trombis atf da sxv.
warmoqmnis friad xelSemwyobi pirobe- Zogadbiologiuri TvalsazrisiT Trom-
bia. bozi SeguebiTi movlenaa, radganac is
Trombis warmoqmnis meqanizmSi sisxlZarRvis kedlis mTlianobis dar-
mniSvnelovan rols TamaSobs sisxlis Rvevisas ganviTarebuli sisxldenis Sew-
nakadis wrfivi siCqaris Semcireba. yvetas emsaxureba. magram sxva Sem-
amitomaa, rom Trombi bevrad ufro TxvevebSi Trombis gaCena abrkolebs an
xSirad Cndeba venebSi, sadac sisxlis sruliad wyvets sisxlis moZraobas
nakadis siCqare dabalia, agreTve im sisxlZarRvebSi da Sesabamis qsovilebSi
daavadebebis dros, romlebic sisxlis (organoSi), iwvevs adgilobrivi sisxlis
nakadis SenelebiT xasiaTdebian (maga- mimoqcevis darRvevas.
liTad, sisxlis mimoqcevis dekompen- Trombozis gamosavali. qsovilis,
sacia). organos da, xSirad, mTlianad organiz-
mTlianobaSi Trombis warmoqmnis mis bedisTvis gadamwyveti mniSvneloba
procesi ase SeiZleba warmovidginoT: aqvs Trombozis gamosavals, romelic Se-
sisxlZarRvis kedlis da sisxlis uj- iZleba mravalgvari iyos.
redebis eleqtrul potencialTa ga- a. Trombis aseptikuri (fermentuli
daxrebi iwveven Trombocitebis adhezi- autolizi) ganleva.
uri da agregaciuli Tvisebebis cvli- b. Trombis organizeba - misi nawi-
lebebs. am pirobebSi Trombocitebi ek- lobrivi an mTliani gawova an mis ad-
vrian sisxlZarRvis kedels, xdeba maTi gilze SemaerTebeli qsovilis ganviTare-
urTierTSewebeba (agregacia), Semdeg ki ba.
daSla, ris Sedegad Tavisufldeba sis- g. TrombSi arxis gaCena SeiZleba
xlis Sededebis Trombocituli faqto- moxdes im SemTxvevaSi, Tu Trombi araa
rebi - iwyeba sisxlis koagulacia. mis mkvrivi, xolo sisxlis dawneva maRalia.
pirvel etapze xdeba sisxlisa da aRniSnul pirobebSi SesaZlebelia sis-
qsovilebis proTromboplastinis gadas- xlis nakadma TrombSi gaWras arxi da
vla aqtiur formaSi – Tromboplas- sisxlis moZraoba nawilobriv aRdges.
tinSi, romelsac proTrombini gadayavs d. Trombis mowyveta da misi embolad
maRali specifikurobis mqone proteo- gadaqceva. am SemTxvevaSi emboli sisxlis
lizur fermentSi - TrombinSi. mier gadaitaneba sxva sisxlZarRvovan
Trombini Tavis mxriv fibrinogens ubanSi da is, axSobs ra Tavisze mcire
gardaqmnis fibrinad. Trombini da diametris mqone sisxlZarRvs, iwvevs ad-
kalciumis ionebi aaqtiveben sisxlis gilobrivi sisxlis mimoqcevis darRvevas
fibrinmastabilizebel faqtorsac. Swo- Sesabamis qsovilSi.
red warmoqmnili fibrinis Zafebi Sead- e. Trombis Cirqovani daSla viTardeba
genen Trombis ConCxs, xolo fibrinis Trombis inficirebisas. Cirqovani anTebis
badis maryuJebSi lagdebian agregire- gamo Trombs swydeba mcire nawilebi,
buli Trombocitebi, eriTrocitebi, romlebic embolebad gadaiqceva. cxadia,
leikocitebi. rom hemodinamikis cvlilebebis garda
isini gamoiwveven mikrobebis diseminire-
105
bas sxvadasxva organosa da qsovilSi Sededebis sawinaaRmdego sistemac,
mravlobiTi abscesis da septikopiemiis fibrinolizi. sisxlSi gamoisroleba
ganviTarebiT. heparinis didi raodenoba. maTi gav-leniT
8.6.2. diseminirebuli sisxlZarRvSiga procesi SeiZleba Sewydes. Wina-aRmdeg
koagulacia SemTxvevaSi avadmyofi iRupeba ad-
sisxlZarRvTa gavrcelebuli mrav- gilobrivi sisxlis mimoqcevis moSliT
lobiTi Trombozi, romelic cnobilia an dsk gadadis meore, e.w. "moxmarebis
diseminirebuli sisxlZarRvSiga koagu- koagulopaTiis" stadiaSi. mis arsi mdgo-
laciis sindromis (dsk) saxelwodebiT, mareobs fibrinogenisa da Sededebis sxva
mravali daavadebis da terminaluri faqtorTa gamolevis gamo Sededebis
mdgomareobis paTogenezis umniSvnelo- procesis SewyvetaSi. aseT SemTxvevaSi
vanesi rgolia. ukve ganviTarebuli mikroTrombebis fon-
dsk-s TiTqmis yvela formas sa- ze iwyeba masiuri sisxldenebi. Tu avad-
fuZvlad udevs Trombocitebis aqtiva- myofi am stadiaSic ar daiRupa, dgeba
cia da Trombinis gavleniT fibrinoge- dsk-is mesame - fibrinolizis stadia.
nidan xsnadi da uxsnadi fibrinis war-
moqmna. TviT Trombis aqtivacia dsk-is 8.7. embolia
sxvadasxva formisas sxvadasxva gziT embolia sisxlis an limfis mier maT-
xdeba. erT-erTi aseTi gzaa kapilarebis Tvis ucxo elementebis gadatana da am
endoTelis difuzuri dazianeba (maga- elementebiT sisxlis an limfuri Zar-
liTad, septicemiis an cirkulaciuri Rvebis daxSobaa.
Sokis SemTxvevaSi). warmoSobis mixedviT ansxvaveben egzo-
xSiria situacia, rodesac sisxlis genur da endogenur embolias. pirvels
Sededebis faqtorebis aqtivacia dakav- akuTvneben airovan, mikrobul, parazitul
Sirebulia Tromboplastinis da misi emboliebs da embolias ucxo sxeuliT.
analogebis moqmedebasTan. airovani embolisas sisxliT gadai-
dsk SeiZleba ganviTardes ujrede- taneba airis buStukebi. aseT suraTs ad-
bis eqstravaskuluri dazianebis, sis- gili aqvs kesonis daavadebebisas , sisx-
xlis ujredebis dazianebis (magaliTad, lZarRvebSi haeris moxvedris (kisris da
eriTrocitebis hemolizi), agreTve sim- gulmkerdis yafazis Wrilobebi, araswo-
sivnuri ujredebis dazianebis dros. rad Catarebuli gadasxmebi venaSi), did
msgavsi meqanizmiT viTardeba dsk amni- simaRleze asvlisas, anaerobuli (airo-
onis siTxis emboliis SemTxvevaSic. vani) gangrenis dros.
SedarebiT iSviaTia SemTxvvebi, ro- mikrobuli embolia viTardeba sisx-
desac fibrinogeni gardaiqmneba fibri- lSi didi raodenobiT mikroorganizmebis
nismagvar nivTierebad Trombinisagan moxvedrisas, romlebic wvrili sisxl-
gansxvavebuli fermentis moqmedebiT ZarRvebis daxSobiT arRveven adgilobriv
(magaliTad, zogierTi gvelis, mweris sisxlis mimoqcevas, meores mxriv ki iw-
kbenisas, mwvave pankreatitis, kuWqveSa veven infeqciis kerebis gaCenas Sesabamis
jirkvlis simsivneebis dros). organoebSi.
dsk-is pirveli, koagulaciis sta- parazituli embolia araiSviaTia
dia xasiaTdeba sisxlis Sededebis pro- cxel qveynebSi. is viTardeba kidurebis
cesis mkveTri gaaqtivebiT. klinikuri sisxlZarRvebis helminTebiT emboliis
suraTi ganisazRvreba imiT, Tu sxe- gamo, rasac iwvevs kidurebidan limfis
ulis romel nawilSi viTardeba pro- gamotanis darRvevas. limfis Segubebis
cesi upiratesad. amave dros aqtivdeba
106
gamo kiduris moculoba mkveTrad iz-
rdeba, viTardeba e.w. "spilos
daavadeba".
endogenuri embolia uxSiresad
Trom-bis mowyvetis ( Tromboemboliis )
Sedegia. Trombis mowyveta misi
arasrulyofi-lobis niSnad iTvleba.
aseTi "avad-myofi" Trombebi
umeteswilad warmoiq-mneba sisxlis
mimoqcevis didi wris, gansakuTrebiT
ki qvemo kidurebis ve-nebSi. swored
amitomaa xSiri mcire wris
Tromboembolia.
qsoviluri emboliisas emboli war-
modgeba organizmis romelime qsovilis
nawilisagan. ufro xSiria cximovani
embolia, romelic viTardeba lulovani
Zvlebis motexilobis da cximis Warbad
Semcveli Zvlis tvinis dazianebisas.
cximis wveTebi sisxlSi SeiZleba mox-
vdnen agreTve kanqveSa cximidan, gacxi-
mebuli RviZlidan qsovilebis trav-
misas. emboliis es saxe, upiratesad,
mcire wris Tromboembolias iwvevs.
qsoviluri emboliis sxva saxeebidan
gansakuTrebiT sayuradReboa embolia
avTvisebiani simsivneebis ujredebiT,
rac did rols asrulebs metastazi-
rebaSi. es procesi upiratesad limfis
gziT xorcieldeba, amitom limfuri
sistemis embolia am Tval--sazrisiT
gansakuTrebiT mniSvnelovania.
lokalizaciis mixedviT ansxvaveben
limfuri da sisxlZarRvovani sistemis
emboliebs. ukanasknels yofen didi
wris, mcire wris da karis venis
emboliebad.
107
zianebuli qsovilis aRdgenisken. anTe-bis
sur. 9-1 mwvave anTeba safuZvelia qsovilebis dazianeba -
alteracia, mikrohemocirkulaciis cvli-
9. anTeba leba anTebis ubanSi, sisxlis kompo-
anTeba (laT. - Inflamatio, berZ. - phlogo- nentebis gasvla ujredSoris sivrceSi -
sis) dazianebaze evoluciis procesSi eqsudacia da SemaerTebelqsoviluri el-
Camoyalibebuli adgilobrivi sisxl- ementebis gamravleba - proliferacia .
ZarRvovani dacviT-SeguebiTi reaqciaa, anTeba paTologiuri gamRizianeblis
romelic mimarTulia paTogenuri agen- mimarT organizmis reaqciis yvelaze gav-
tis lokalizaciis da mospobisken, da- rcelebuli formaa, yvelaze gavrcele-
108
buli tipobrivi paTologiuri fagocitozi, ise plazmuri faqtori
procesia, tipobrivia imitom, rom misi (antisxeulebi). am faqtis dadgenisTvis
ganviTarebis kanonzomierebebi ar aris meCnikovs da erlixs 1908 wels nobelis
damokidebuli gamomwvevi agentis premia mieniWaT.
bunebaze da pro-cesis lokalizaciaze. anTebis paTogenezis kvlevis Semdeg
jer kidev Cvens welTaRricxvamde I mniSvnelovan etaps saTave daudo luisma ,
saukuneSi celsma aRwera mwvave anTebis romelmac daadgina, rom sixlZarRvovani
damaxasiaTebeli oTxi ZiriTadi reaqciis meqanizmSi anTebis dros did
klinikuri niSani: siwiTle (rubor), rols asrulebs ujredebis dazianebisas
temperaturis moma-teba (calor), Sesiveba gamoyofili nivTierebebi. kvlevis am
SeSupeba (tumor), tkivili (dolor). mimarTulebis Semdgomma ganviTarebam
mogvianebiT (III sauku-neSi Cvens gamoavlina anTebis mediatorebi da Seqmna
welTaRricxvamde) galenma maT miumata anTebis sawinaaRmdego saSualebebis
mexuTe niSani - funqciis moSla (functio SemuSavebis safuZveli.
laesa). am niSnebs, rogorc movlenis ganasxvaveben mwvave da qronikuli
kanonzomierebaTa amsaxvels, mimarTaven anTebas. mwvave forma SedarebiT xanmok-
dResac, Tumca mexuTe ni-Sani, rogorc lea (ramdenime saaTidan ramdenime dRem-
mxolod anTebisTvis da-maxasiaTebeli, de). misi mTavari Taviseburebebia sisxl-
SegviZlia ugulvebel-vyoT, radgan ZarRvovani reaqcia, wylis da plazmis
qsovilis funqciis moSla nebismier cilebis eqsudacia, leikocitebis (gansa-
paTologiur process axlavs Tan. kuTrebiT neitrofilebis) emigracia,
ori saukunis win Sotlandielma qi- met-naklebad stereotipuli xasiaTi. (ix.
rurgma hunterma gamoTqva azri, rom sur.9-1)qronikul anTebas axasiaTebs xan-
anTeba organizmis gamojanmrTelebisken grZlivi mimdinareoba, anTebiTi ubnis in-
mimarTuli araspecifikuri pasuxia da- filtracia limfocitebiT da makrofa-
zianebaze. anTebis paTogenezis Seswav- gebiT, sisxlZarRvebis da SemaerTebeli
laSi didi roli iTamaSa konheimis ga- qsovilis proliferacia.
mokvlevebma, romelmac pirvelma aRwera anTebis dros viTardeba mTeli rigi
vazodilatacia, sisxlis nakadis cvli- struqturuli da funqciuri cvlile-
lebebi, sisxlZarRvTa kedlebis ganvla- bebi, dawyebuli ultrastruqturuli
dobis momateba, leikocitebis emigra- donidan, damTavrebuli ujredebis da
cia, SeSupeba anTebis ubanSi. am movle- qsovilebis distrofiuli cvlilebebiT
naTa meqanizmis kvlevaSi mniSvnelovani maT srul destruqciamde da daRupvamde.
wvlili Seitana, agreTve, samuelma . alteraciis movlenebi aRiniSneba rogorc
anTebis paTogenezis SeswavlaSi organos parenqimaSi, ise stromaSi, maT
gansakuTrebuli etapi iyo meCnikovis Soris - kapilarebis faSar adventiciaSi.
mier fagocitozis Teoriis Camoyali- anTebis movlenebi viTardeba vaskulari-
beba, romlis mixedviT anTebis mizania zebul SemaerTebel qsovilSi, cirkuli-
fagocitebis mitana anTebis keraSi iq rebad sisxlSi, sisxlZarRvebSi, Semaer-
arsebuli baqteriebis mosaspobad. meC- Tebeli qsovilis ujredovan da arauj-
nikovsve ekuTvnis erTi SexedviT al- redovan komponentebSi. am procesisTvis
ternatiuli Teoriac, romlis mixedviT mniSvnelovan cirkulirebad ujredebs
infeqciuri agentis neitralizebaSi miekuTvneba neitrofilebi, eozinofilebi,
garkveul rols arulebs sisxlis bazofilebi, limfocitebi, monocitebi,
plazmac. Semdeg damtkicda, rom pro- agreTve, Trombocitebi, fiqsirebulebs -
cesSi monawileobs rogorc ujreduli mastocitebi, romlebic ganlagebuli
109
arian sisxlZarRvebis garSemo anTeba, Cveulebriv, iwyeba misi
(labroci-tebi, poxieri ujredebi), gamomwvevi flogogenuri (berZn. Phlogo-sis
SemaerTebeli qsovilis fibroblastebi - anTeba) agentis mier gamowveuli
da sxv. (sur.9-2) pirveladi alteraciiT (ix. alteracia).
pirveladi alteraciis moqmedebiT
upir-velesad ziandeba ujredebis
citole-ma, agreTve, lizosomebis
membrana, ro-melic didi raodenobiT
Seicavs hid-rolizur fermentebs
(daaxloebiT 30-s). maT ZaluZT
daSalon praqtikulad yvela
biologiuri makromolekula, romelic
qsovilTa SemadgenlobaSi Se-dis
(cilebi, nukleinmJavebi, naxSir-
wylebi, lipidebi). swored lizoso-
muri fermentebis gamosrola ganapiro-
bebs SemdgomSi e.w. meoradi altera-
ciis process. lizosomebis fermen-
tebis moqmedebiT grZeldeba sisxl-
ZarRvebis garSemo arsebuli SemaerTe-
beli qsovilis dezorganizaciis pro-
cesi. Tavisufldeba an warmoiqmneba
biologiurad aqtiuri nivTierebebi -
anTebis mediatorebi (ix. anTebis me-
diatorebi). dRes cnobilia 20-ze me-
ti aseTi nivTiereba (histamini, sero-
9.2. anTebis etiologia
tonini, prostaglandinebi, kininebi,
anTebas mravalferovani, sxvadasxva
leikotrienebi da sxv). maTi moq-medebis
bunebis mizezi iwvevs: biologiuri
efeqti anTebis paTogenezis erT-erTi
(baqteriebi, virusebi, parazitebi, mwe-
pirveli da umTavresi rgolia da
rebi), fizikuri (sxivuri da eleq-
gamoixateba SemdegSi: vazodilatacia,
troenergia, maRali da dabali tempe-
sisxlZarRvTa gamavlobis mateba, qemo-
ratura, meqanikuri travma), qimiuri
taqsisi, temperaturis mateba, tkivili,
(mJavebi, tuteebi, skipidari, krotonis
ujredebis dazianeba.
zeTi) faqtorebi da sxv. garda egzo-
genuri agentebisa, anTebis provocire-
anTebis ZiriTadi mediatorebis
ba ZaluZs endogenur faqtorebsac (ma-
warmoSoba da moqmedebis efeqti
galiTad, lorwovani garsis anTeba
uremiis dros, rodesac azotovani niv-
Tierebebis gamoyofa xdeba am garsebis
saSualebiT; anTebiTi reaqcia nekrozu-
li ubnebis da ucxo sxeulebis irg-
vliv - e.w. demarkaciuli anTeba da
a.S.), e.i. anTeba polietiologiuri pa-
Tologiuri procesia.
9.3. anTebis paTogenezi
110
umeteswilad, pirveladi xasiaTisaa da
swored anTebis mediatorebis gav- damokidebulia ara imdenad sisxlis mo-
leniT mimdinareobs anTebisTvis damaxa- dinebis zrdaze, ramdenadac lokalur
siaTebeli movlenebis formireba: sis- movlenebze.
sisxlZarRvT moqmedeba
mediatori warmoSoba sxvagvari moqmedeba
a ganvladoba qemotaqsisi
mastociti, bazofili,
histamini da serotonini + __
Trombociti
sxva
mastocitebi, vazodilatacia,
prostaglandinebi mediatorTa _
fosfolipiduri membrana tkivili, cxeleba
potencireba
leikocitebis da
Jangbadis metabolitebi leikocitebi +
qsovilebis dazianeba
112
ram zog SemTxvevaSi leikocitebidan moqmedebisas. maTi gavleniT icvleba am
gamoTavisuflebuli fermentebi, qimiu- adheziuri molekulebis zedapiruli aq-
ri mediatorebi, radikalebi amZimeben tivoba. zogierTi am agentebidan moqme-
da axangrZliveben TviT anTebis mimdi- debs mxolod leikocitebze an endo-
nareobas. Telocitebze, zogierTi - orive maTgan-
sur.9-3. leikocitebis emigracia ze. sxvadasxva saxis leikociti emigra-
ciis erTnair meTodebs iyenebs.
adheziis Semdeg leikociti nela
moZraobs en-doTeliumis zedapiris
gaswvriv da ga-yofs fsevdopodias
endoTeliocitebs Soris. Semdeg is
gaZvreba endoTelio-citebs Sua
gaCenil xvrelebSi, gaiv-lis bazalur
membranas da gadis pe-rivaskulur
sivrceSi. rac Seexeba eriTrocits,
moZraobis TvalsazrisiT, is pasiuria
da gamoitaneba sisxlZar-Rvidan milis
kedlis Zlieri daziane-bisas
leikocituri reaqcia anTebis dros
hidrodinamikuri wnevis gavleniT
mimdinareobs ramdenime stadiad: 1)
(eriTrocitebis diapedezi). Emigrire-
marginacia, 2) adhezia, 3) sakuTriv
buli leikocitebi anTebis ubanSi ganag-
emigracia, 4) fagocitozi, 5) leiko-
rZoben aqtiur moZraobas - migracias
cituri faqtorebis gaTavisufleba.
upiratesad qimiuri gamRizianeblis (at-
emigraciis fenomenSi monawileobs ro-
raqtantis) mimarTulebiT fsevdopodiebis
gorc wminda fizikuri (hemodinamiku-
saSualebiT e.i. migrireben anTebis gamom-
ri), ise biologiuri kanonebi.
wvevisken da qsovilebis proteolizis
anTebis dros sisxlis wrfivi siC-
produqtebisken, rac xorcieldeba qemo-
qare qveiTdeba. leikocitebi sisxl-
taqsisis gziT (termini dadebiTi qemo-
ZarRvis sanaTurSi kidurad lagdebian
taqsisi SemoRebuli pfeferis mier).
(leikocitebis marginacia). Mmikrocir-
sxvanairad rom vTqvaT lokomocia (gada-
kulaciuri qselis anTebiTi dilata-
adgileba) orientirebulia qimiuri gra-
ciis fonze, kapilarebis venulebSi ga-
dientis mimarTulebiT. zogi qemotaqsi-
dasvlis adgilas leikocitebis nawili
suri substancia moqmedebs granuloci-
xvdeba praqtikulad uZravi sisxlis
tebze, zogi - monocitebze, zogi ki -
ubnebSi. iwyeba adhezia - leikocitebi
yvela leikocitze. (neitrofilebisTvis
didi raodenobiT fiqsirdebian endo-
qemotaqsisuri agentebia baqteriebis pro-
Teliumze. adheziaze moqmedebs ramde-
duqtebi, komplementis komponentebi (C5a),
nime faqtori ( Ca2+, zedapiruli muxti),
araqidonmJavas metabolizmis produqtebi
gadamwyvet rols asrulebs urTier-
da sxv. zogi maTgani peptidia, romlis
Tqmedeba leikocitis da endoTelio-
gavleniT sinTezdeba leikocitebis mi-
citis zedapirze arsebul komplemen-
marT maRali qemotaqsisuri aqtivobis
tur adheziur molekulebs Soris
mqone oligopeptidebi). leikocitebi qe-
procesSi am molekulebis CarTva xor-
motaqsisur nivTierebebs "grZnoben" lei-
cieldeba anTebis agentebis an qimiuri
kocitebis membranaze qemotaqsisuri niv-
mediatorebis (magaliTad, baqteriuli
TierebebisTvis specifikuri receptore-
endotoqsinebi, citokinebi da sxv.)
bis saSualebiT. qemotaqsisuri agentebis
113
maRali koncentracia ganapirobebs lei- kulad ar tovebs araviTar kvals. Ka-
kocitebis vezikulebis degranulirebas taruli eqsudati yalibdeba lorwovan
da toqsikuri superoqsiduli produq- garsebze, masSi SeiZleba mniSvnelovani
tebis gamoyofas. raodenobiT iyos lorwo (lorwovani
leikocitebis emigraciis da qso- katari), Cirqi (Cirqovani katari);
vilSi maTi dagrovebisTanave iwyeba in- fibrinuli eqsudati xasiaTdeba fib-
tensiuri fagocitozi da leikocitebis rinogenis didi raodenobis SemcvelobiT,
degranulireba. nawilakebis fagocito- romelic anTebiT ubanSi fibrinad iqceva,
zi moicavs fagocitis miaxlovebas (ma- rac eqsudatis Sesqelebas iwvevs.
galiTad, baqteriis zedapirTan), mi- fibrinuli eqsudati Cndeba anTebis
magrebas (Sewebebas) masTan (rac moi- mZime, xSirad mwvave formebis dros. misi
cavs amocnobasac, risTvisac saWiroa gamosavali damokidebulia anTebis loka-
maTi "Semosva" Sratismieri faqtorebiT lizaciasa da dazianebis xarisxze –
- ofsoninebiT IqG da C3B), STanTqmas lorwovan garsze fibrinuli anTebis
("Caylapvas"), fagosomis gaCenas da fa- ganviTarebisas iwyeba warmoqmnili uj-
golizosomis warmoqmnas. amas mohyveba redebis TandaTanobiT moSoreba, sero-
lizosomebis degranulireba (lizoso- zul garsebze ki aseTi ram ar xdeba. iq
mebis granulebi SeiZleba gaTavisuf- dagrovili fibrini Cainacvleba Semaer-
ldes eqstraceluluradac) da leiko- Tebeli qsoviliT, rac plevraSi, peri-
citis mier STanTqmuli masalis deg- toneumsa da epikardiumSi Sexorcebis
radacia, mkvleloba. degranulaciisas ganviTarebas iwvevs.
hidrolizuri fermentebi SeiZleba Cirqovani eqsudati gamoirCeva leiko-
moxvdes citoplazmaSi an fagolizo- citebis, ZiriTadad neitrofilebis, didi
somis dauxSobeli arxiT – ujredga- raodenobiT SemcvelobiT. aq neitrofi-
reT, rasac qsovilebis dazianeba - "me- lebi umTavresad daSlis procesSi arian
oradi alteracia" moyveba. fagocitozi da cilebTan erTad eqsudats aZleven
garkveul energetikul danaxarjebs mRvrie moyviTalo-momwvano fers (Cirqi).
moiTxovs. baqteriebis dazianebis da Cirqovani anTebis mimdinareoba SeiZleba
degradaciisTvis, mokvdinebisTvis lei- iyos mwvave da qronikuli, man SeiZleba
kociti iyenebs or gzas: Jangbaddamo- miiRos abscesis an flegmonis saxe.
kidebuls da Jangbaddamoukidebels. hemoragiuli eqsudati warmoiqmneba
pirveli xorcieldeba, ZiriTadad, mie- Zalze aqtiurad mimdinare anTebis Sem-
loperoqsidazas saSualebiT, meore - TxvevaSi, romlis dros mkveTrad matu-
mis gareSe. lobs sisxlZarRvTa kedlebis ganvladoba
eqsudacia da leikocitebis emigra- da zogjer irRveva kedlis mTlianobac.
cia gansazRvravs anTebiTi siTxis - am dros eqsudatSi Cndeba eriTrocitebi.
eqsudatis gaCenas. eqsudatis Semad- eqsudatis ujreduli Semadgenloba
genlobis da bunebis mixedviT ganar- damokidebulia anTebis stadiaze, xan-
Ceven mis ramdenime saxes. Tu qsovi- grZlivobaze, dazianebis xarisxze, dama-
lebsa da RruebSi grovdeba TiTqmis zianebeli agentis bunebaze. mwvave anTe-
gamWvirvale siTxe, romelic Seicavs 3- bis sawyis periodSi (pirveli 6-24 saa-
8% Sratis cilas da erTeul lei- Ti) eqsudatSi Warbobs neitrofilebi,
kocitebs, maSin laparakia serozul xolo 24-48 saaTis Semdeg isini Cai-
eqsudatze. serozuli eqsudati , ro- nacvlebian monocitebiT. virusuli in-
gorc wesi, aRmocendeba mwvave anTebis feqciebis dros infiltratSi pirvelni
dros, advilad gaiwoveba da praqti-
114
Cndebian limfocitebi, hipermgrZnobe- plazmur ujredebs, T-limfocitebi ki
lo-bisas eqsudatSi bevri cvlilebebs ar ganicdian. anTebis ubnis
eozinofilia. gawmendis paralelurad mcirdeba mak-
anTebis meoTxe kardinaluri niSani rofagebis raodenoba, radgan mcirdeba
_ tkivili (dolor) gamowveulia Semde- maTi motana sisxliT. amasTanave, limfiT
gi faqtorebiT: isini gaitanebian regionul limfur kvan-
tkivilis SemgrZnobi receptorebis ZebSi, sadac iRupebian.
gaRizianeba anTebiTi SeSupebis da qso-
vilTa gaWimvis gamo ganviTarebuli me- 9.4. anTebis gamosavali, anTebis
qanikuri wneviT, receptorebze anTebis mniSvneloba organizmisTvis
zogierTi mediatoris (magaliTad, bra- anTebiTi procesis xasiaTi da gan-
dikininis) moqmedebiT, anTebiTi ubnis viTareba pirdapir kavSirSia flogoge-
qsovilebSi cvlis Sualeduri pro- nuri agentis bunebasTan, misi moqmedebis
duqtebis dagrovebis Sedegad ganviTa- xangrZlivobasa da intensivobasTan, orga-
rebuli acidozis zemoqmedebiT recep- nizmis reaqtiulobasTan, ris wyalobi-
torebze. Tac erTi da igive flogogenuri agentis
anTebis damamTavrebeli etapi ujre- moqmedebam erTi da igive pirobebSi sxva-
debis proliferaciaa (gamravleba). dasxva individSi SeiZleba gamoiwvios
proliferaciuli procesebi garkveul- klinikurad sruliad gansxvavebuli su-
wilad mwvave anTebis dasawyisSi iwyeba. raTi, movlenebis gansxvavebuli mimdina-
anTebis dasaruls ki isini wina plan- reobiT da gamosavliT.
zea wamoweuli. proliferaciuli pro- Tu anTebiTi reaqcia atarebs Cveu-
cesi vrceldeba adgilobriv kambialur lebriv, e.i. iseT xasiaTs, romelic yve-
(winamorbed), pirvel rigSi mezenqimur laze xSirad aRiniSneba, laparakoben
ujredebze, romlebic dasabams aZleven normergiul anTebaze. rodesac anTebiTi
nawiburovani qsovilis mTavari struq- procesi mimdinareobs duned da iRebs
turuli nawilis masinTezebel fibrob- gaWianurebul xasiaTs, mas hipoergiul
lastebs. mravldebian adventiciuri, anTebas uwodeben. zog SemTxvevaSi flo-
endoTeluri, agreTve sisxlidan gada- gogenuri agenti iwvevs Zlier adgi-
suli ujredebi: T da B-limfocitebi, lobriv da zogad reaqciebs, romlebic
monocitebi. ujredebi, romlebic Sead- agentis Zalis araadekvaturni arian. aseT
genen infiltratis masas, transfor- reaqciebs uwodeben hiperergiuls, maT
mirdeba, nawili ujredebisa, romlebmac imunuri safuZveli aqvT. magaliTad, ci-
Seasrules fagocitis funqcia, iRupeba. lovani nivTierebiT winaswar sensibili-
mimdinareobs daRupuli ujredebis f- zebul organizmSi igive nivTierebis gan-
agocitozi hematogenuri (monocitebi) meorebiT, Tundac umniSvnelo raodenobiT
da qsoviluri (histiocitebi) makrofa- Seyvana iwvevs mkveTrad gamoxatuli mo-
gebiT . matebuli mgrZnobelobis suraTs.
monocitebi gardaiqmnebian histio- anTebis gamosavali ganisazRvreba ram-
citebad (makrofagebad), xolo makro- denime faqtoriT: anTebiTi procesis
fagebi SeiZleba gaxdnen epiTeluri formiT, lokalizaciiT, dazianebuli ub-
ujredebis msgavsi epiTeloiduri uj- nis zomebiT, organizmis reaqtiulobiT.
redebis sawyisi. maTgan warmoiqmnebian anTebas yovelTvis Tan axlavs danek-
giganturi ujredebi erTi msxvili an rozebuli ujredebis daRupva, misi kera
mravalricxovani birTviT. B-limfoci- uxSiresad SemosazRvrulia janmrTeli
tebi dasabams aZleven poxier da qsovilebisgan, qsovilebis daSlis pro-
115
duqtebi ganicdian Semdgom fermentul iseT zogad movlenebs, rogoricaa lei-
daSlas da fagocitozs, anTebis ubani kocitozi, cxeleba, eds-is aCqareba,
ki, ujredebis proliferaciis gamo, nivTierebaTa cvlis moSla. infeqciis
ivseba granulaciuri qsoviliT. Tu generalizebas ganapirobebs e.w. arasruli
anTebiTi kera (dazianebis ubani) mcire fagocitozi, rodesac mikroorganizmi
zomisaa, SeiZleba moxdes sruli fagocitis mier mTlianad ar moineleba
aRdgena, xolo Tu dazianebis ubani da gamoTavisuflebuli mikrobebi infeq-
ufro didi zo-misaa, maSin defeqtis cias desiminirebis wyarod iqceva.
adgilze war-moiqmneba nawiburi.
biologiuri TvalsazrisiT anTebiTi 10. alergia
procesi, iseve, rogorc sxva paTo- alergia (berZn. allos - sxvagvari, ergon -
logiuri procesebi, atarebs ambiva- vmoqmedeb) organizmis Secvlili, momate-
lentur, dualistur xasiaTs. erTis buli mgrZnobelobaa antigenuri Tvisebe-
mxriv is aris evoluciis procesSi bis mqone nivTierebebisadmi. gasaTva-
gamomuSavebuli dacviT-SeguebiTi reaq- liswinebelia, rom alergiuli reaqcia
cia: anTebis gziT organizmi Semosaz- SeiZleba ganviTardes im araantigenuri
Rvravs Tavisgan mavne faqtors, afiq- bunebis nivTierebebis (arasruli antige-
sirebs mas anTebis fokusSi da xels nebis - haptenebis) mimarTac, romlebic
uSlis procesis generalizebas, rac antigenur Tvisebebs iZenen mxolod or-
miiRweva sxvadasxva meqanizmebiT: venu- ganizmis makromolekulebTan SeerTebis
ri Segubeba da limfostazi, Trombis Semdeg. aRsaniSnavia agreTve, rom aler-
warmoqmna xels uSlis paTogenuri saw- gia SeiZleba ganviTardes organizmze zo-
yisis gavrcelebas dazianebis ubnidan; gierTi fizikuri faqtoris (sicivis,
warmoqmnili eqsudati Seicavs kompo- siTbos, radiaciis) an iseTi qimiuri
nentebs, romlebsac aqvT baqterici- nivTierebebis moqmedebiTac, romlebic
duli, toqsinebis fiqsirebis da Se- TavisTavad alergenebi ar arian, magram
boWvis unari; mimdinareobs fagocito- iwveven alergenebis warmoqmnas cilis
zi emigrirebuli leikocitebiT; lim- denaturaciis gamo faruli antigenuri
focitebis da plazmuri ujredebis determinantebis warmoqmnis gziT. TviT
proliferacia ganapirobebs adgilobri- es antigenebi gamomuSavebul antisxeu-
vi da zogadi imunitetis Camoyalibe- lebTan ar reagireben.
bas, antisxeulebis gamomuSavebas; pro-
liferciis stadiaSi yalibdeba Zlieri 10.1. alergiis etiologia
dacviTi zRude granulaciuri qsovi- alergiis gamomwvev nivTierebebs
lisgan. yofen egzo- da endoalergenebad. Su-
magram amave dros anTebas SeiZleba raTze 10-1 mocemulia alergenebis kla-
hqondes organizmisTvis saziano da sa- sifikacia a.ados mixedviT. Eegzoalerge-
xifaTo efeqtic. nebi (mcenareTa mtveri, baqteriebi, viru-
anTebis zonaSi ujreduli elemen- sebi, quCis mtveri da sxv.) xvdebian or-
tebis daRupva iwvevs calkeuli qsovi- ganizmSi sasunTqi sistemidan, saWmlis
lebis da zogjer mTeli organos sik- momnelebeli sistemidan (kvebiTi aler-
vdils. dagrovil eqsudats SeuZlia genebi, samkurnalwamlo saSualebebi), ka-
gamoiwvios qsovilebis daSla sisxlis nisa da lorwovani garsebis gziT (kos-
mimoqcevis da kvebis moSlis, zewolis metikuri saSualebebi, sarecxi fxvnili
gamo. eqsudatis da daSlis produq- da sxv.), infeqciis Sedegad.
tebis Sewova iwvevs intoqsikacias,
116
10.1. alergiuli reaqciebis alergiuli reaqcia viTardeba aseTi
klasifikacia kontaqtidan ramdenime wuTSi an sa-aTSi,
FKTHUTYT<B
xolo dayovnebuli tipis reaqcia - 1-2
dRe-Ramis Semdeg an ufro gvian. gukis
tyljfkthutyt,b klasifikacias amJamadac iyeneben, magram
tupjfkthutyt,b
(fenjfkthutyt,b) is ar moicavs alergiuli reaqciebis
mTel mravalferovnobas.
vwtyfhtekb w[jdtkehb .jafw[jd- ofvkt,b cfrdt,b cfofh- evfhnb
ofhvjij,bc% aseT ht,bsb%
ofhvjij,bc% xarvezs ,bybcmoklebuliaybdsb- gelisa vjj
da dtct,b%
,eyt,hbdb (,hjkbc it'tybkb
mcjdbkb^ ythdekb (gfsjkjubehb vndthb^ kumbsis vndthb^
ew[j cbc[kbc klasifikacia, tht,t,bromelic vndthb ,fmnt-
mcjdbkt,b) yf.jab^ ihfnb^
paTogenezur cbystpehb princips eyrdnoba. am hbt,b^
mcjdbkb^ afhbct,hb
ajskt,b^ tgblthvbcb^ mcjdbkt,b^ dbhe-
]bhrdkbc rjkjblb lf klasifikacias sa-fuZvlad udevs
atcdt,b votht,b lf cfhtw[b ct,b^
c[d&) alergiula[dybkt,b^
reaqciaTa imunuri meqanizmebis
c[d& cjrj- t,b
fhfbyatmwbehb^
xasiaTi, rjcvtnbrehb
ris mixedviTac ansxvaveben oTxi
cfiefkt,t,b
tipis reaqcias (ix. cxrili 10-1).
(lfvodhj,bsb^
byatmwbeh cbwbdbsb^ c[bdehb)
b cxrili 10-1
alergiuli reaqciis tipebi
dbhec-bylewbht,ekb
(p.gelisa da r.kumbsis mixedviT, 1975)
rjvgktmcehb%
mcjdbkb + vbrhj,b t
mcjdbkb + njmcbyb reaqciis tipis saxelwodeba g
ipi
117
alergenis moxvedra organizmSi "alergiis mediatorebis" gamoyofiT.
iwvevs mis sensibilizebas. unda dReisaTvis cnobilia aTze meti aseTi
aRvniSnoT, rom am terminSi yovelTvis nivTiereba: histamini, serotonini,
erTsa da imave movlenebs ar alergiis nela moqmedi substancia,
gulisxmoben. ufro farTo gagebiT, bradikinini, acetilqolini, prostag-
sensibilizeba niSnavs organizmis landinebi da sxv. (ix. sqema).
gaZlierebul reaqcias antigenuri an histamins Seicavs SemaerTebeli qsovi-
haptenuri bunebis nivTierebaTa zemoq- lis poxieri ujredebi, sisxlis neit-
medebaze. aseTi midgoma sensibilizeba rofilebi, gansakuTrebiT Warbad – bazo-
alergiis sinonimad aqcevs. ufro swo- filebi, miocitebi, hepatocitebi, kuW-
ri iqneba, Tu sensibilizacias vuwo- nawlavis traqtis ujredebi. alergiis
debT organizmis mxolod imunurad nela moqmedi substancia gaujerebeli
pirobadebul momatebul mgrZnobelobas cximovani mJavaa. is warmoiqmneba poxier
antigenuri da haptenuri bunebis niv- ujredebSi alergenebis gavleniT; sero-
Tierebebisadmi. alergiis cneba ki moi- tonini (5-hidroqsitriptamini) Tavisuf-
cavs rogorc sensibilizebas, ise mo- ldeba poxieri ujredebisagan, misi mo-
matebuli mgrZnobelobis reali-zebas nawileoba adamianis alergiul reaqcieb-
alergiuli reaqciis saxiT. organizmze Si eWvs iwvevs. bradikinini 9 amin-
alergenis moqmedeba iwvevs jer moma- mJavasagan Semdgari polipeptidia, is
tebul mgrZnobelobas (sensibilizebas), afarToebs kapilarebs, zrdis maTi ked-
mxolod amis Semdeg, alergenis orga- lis ganvladobas, amcirebs arteriolebis
nizmSi ganmeorebiTi moxvedrisas vi- tonussa da arteriul sisxlis wnevas.
Tardeba alergiuli reaqcia (reaqcia acetilqolini monawileobs im orga-
viTardeba maSinac, Tu alergeni dar- noTa da qsovilTa alergiul reaqciebSi,
Cenilia organizmSi misi pirveli mox- romlebSic qolinergiuli procesebi mim-
vedris Semdeg). droiTi kinetikis mi- dinareoben normis pirobebSic (centra-
xedviT es procesi or nawilad iyofa: luri da vegetatiuri nervuli sistemis
pirvelia organizmis momzadeba sinapsi, gulisa da nawlavebis nervuli
alergiuli reaqciisaTvis, misi sensi- aparati). prostaglandinebi iwveven bron-
bilizeba, meore ki - TviT alergiuli qospazms, ujredebis liziss, aTavisuf-
reaqcia. sensibilizebuli organizmi leben mediatorebs.
praqtikulad janmrTeli rCeba alerge- paTofiziologiuri cvlilebebis stadia
nTan ganmeorebiT kontaqtamde, e.i. vlindeba ujredebis, qsovilebisa da sis-
alergiuli reaqciis ganviTarebamde. temebis reaqciebiT alergiis meore sta-
nebismieri saxis alergiuli reaqci- diaSi gamoyofil biologiurad aqtiuri
is ganviTarebaSi ganasxvaveben sam sta- nivTierebebis zemoqmedebaze.
dias imunuri stadia moicavs sensi- alergiul dazianebaze calkeuli
bilizebis process - antisxeulebis da ujredis reaqciis xasiaTi ganisazRvreba
sensibilizebuli limfocitebis war- am ujredis fiziologiuri Tavisebure-
moqmnas, agreTve, maT reaqcias speci- bebiT. magaliTad, nervuli ujredSi aR-
fikur alergenebTan. mocendeba agznebis da Sekavebis proce-
paToqimiuri cvlilebebis stadia sebi, gluvi kunTebis miofibrilebSi -
iwyeba imunuri cvlilebebis stadiis SekumSva, kapilarebSi iwyeba eqsudacia
dasasruls, alergen-antisxeulis reaq- da sxv.
ciis gamo dazianebuli ujredebis mier qsovilebisa da organoebis alergi-
biologiurad aqtiuri nivTierebebis - uli reaqcia viTardeba rogorc maTSi
118
Semavali ujredebis dazianebis, ise am analogebze – bazofilebis membranas
organoTa funqciebis nervuli da humo- specifikuri receptoris saSualebiT.
ruli regulaciis darRvevis Sedegad. (pirveli rigis samizne ujredebi),
10.4. hipermgrZnobelobis I (ana- fiqsacia xdeba agreTve makrofagebze,
filaqsiuri) tipi. ( sur. 10-2. eozinofilebze, bazofilebze, Trombo-
)hipermgrZnobelobis I tipis reaqciebs citebze, limfocitebze (meore rigis
dauyovnebel an reaginuli tipis reaq- samizne ujredebi).
ciebsac uwodeben. es saxelwodebebi
dakavSirebulia reaqciis aRmocenebis sur. 10-2 I tipis hipermgrZnobelobis
siswrafesTan an am tipis reaqciebSi reaqciis patogenezi
monawile antisxeulebTan – reagineb- organizmSi alergenis ganmeorebiT
Tan, vinaidan gadamwyveti momenti am moxvedrisas viTardeba antigen-antisxe-
reaqciis ganviTarebaSi IgE-s produq- ulis reaqcia. es kompleqsic fiqsirdeba
ciaa. IgE mkveTrad gansxvavdeba sxva ujredebze. Tu alergeni SekavSirdeba
antisxeulebisgan rigi TvisebebiT, pir- IgE-s (antisxeulis) or molekulasTan
vel rigSi citotropulobiT (citofi- mainc, samizne ujredis membrana ziandeba
lurobiT) - ujredebze fiqsaciis una- da ujredi aqtivdeba (alergiuli reaq-
riT. ciis meore stadia). poxieri ujredebis
antigenis pirveli moxvedra orga- da bazofilebis granulebi Seicaven bio-
nizmSi sxvadasxava imunocitebis aqti- logiurad aqtiur nivTierebebs (ban) -
vaciis gziT (makrofagebi, T-ujredebi) alergiis mediatorebs: histamins, hepa-
iwvevs plazmuri ujredebidan IgE-s rins, eozinofilebis qemotaqsisis faq-
gaTavisuflebas. warmoqmnili reaginebi tors (eqf), neitrofilebis qemotaqsisis
(IgE, ufro iSviaTad IgG) fiqsirdeba faqtors (nqf). pirveli rigis samizne
poxier ujredebisa da maT sisxlismier ujredebis membranis dazianebis da
119
gaaqtivebisas iwyeba aRniSnul anafilaqsia. anafilaqsiuri reaqcia
mediator-Ta gamoyofa. aRniSnulis SeiZleba iyos generalizebuli xasia-Tis
garda, ujre-debSi iwyeba axali (anafilaqsiuri Soki) da adgilob-rivi
mediatorebis swrafi sinTezi, romelTa (overis fenomeni). organizmis
wyaroa e.w. anafilaq-siis nela sensibilizaciisTvis sakmarisia alerge-
reagirebadi substancia: Trom- nis minimaluri dozis moxvedra orga-
bocitebis aqtivaciis faqtori, nizmSi. 5-10 dRis Semdeg cxoveli mza-
prostaglandinebi, Tromboqsanebi, daa alergenis ganmeorebiT Seyvanas ana-
leikotriene-bi. poxieri ujredebidan filaqsiuri reaqciiT upasuxos. re-
da bazofilebidan eqtf-s da nqf-s aqciis misaRebad alergenis ganmeorebiT
gamoyofis gamo eozinofilebi da Seyvanili doza 10-jer unda Warbobdes
bazofilebi grovde-bian aRniSnuli masensibilizebel dozas. zogadi anafi-
ujredebis garSemo, aq-tivdebian da laqsiis (anafilaqsiuri Sokis) misaRe-
TviT iwyeben biologi-urad aqtiuri bad alergeni unda SeviyvanoT uSualod
nivTierebebis da fer-mentebis sisxlis nakadSi. ramodenime aTeul wamSi
gamoyofas. maTi nawili iwvevs zRvis goWi xdeba mousvenari, ewyeba
dazianebas (dazianebis mediatorebi), cemineba da xvela, wina TaTebiT iqavebs
xolo meore nawili (fermentebi) - cxvirs, sunTqva uxSirdeba, uviTardeba
dazianebis mediatorebis daSlas (maga- uneblie Sardva da defekacia, cxoveli
liTad, histaminaza - histaminisas). vardeba, ewyeba krunCxva da ramdenime
gamoyofili biologiurad aqtiuri wuTSi kvdeba.
nivTierebebis gavleniT alergiuli re- anafilaqsiuri reaqcia maqsimalur in-
aqciis mesame - paTofiziologiur tensivobas aRwevs masensibilizebeli ini-
(klinikuri gamovlinebis) stadiaSi eqciidan 2 kviris Semdeg.
izrdeba mikrosisxlZarRvTa kedlis ama Tu im organizmis dazianebis xa-
ganvladoba, sisxlZarRvebidan gamodis risxi anafilaqsiis dros sxvadasxva sa-
siTxe, viTardeba anTeba da SeSupeba. xeobis cxovelSi sxvadasxvaa, rac gan-
lorwovani garsebis mier izrdeba sazRvravs am cxovelebSi Sokis araer-
lorwos gamoyofa, viTardeba bronqos- Tgvarovan mimdinareobas. magaliTad, ZaR-
pazmi, rac bronqis sanaTurSi lorwos lisaTvis anafilaqsiis "Sokuri organo"
dagrovebasTan erTad mkveTrad aZnelebs RviZlia, bocverebis anafilaqsiisas ki
sunTqvas. klinikurad yovelive es Se- wamyvan rols asrulebs filtvis arte-
saZlebelia gamovlindes bronquli as- riis spazmi.
Tmis SeteviT, rinitiT, koniuqtivitiT, anafilaqsiuri Soki adamianSi SeiZ-
WinWris ciebiT, kvinkes SeSupebiT. eqf- leba gamowveuli iyos ucxo Sratis Sey-
is gamoyofis gamo dauyovnebeli aler- vaniT, antibiotikebiT, novokainiT, aspi-
giuli reaqciebisas izrdeba eozino- riniT, vitaminebiTa da sxv. Sokuri mdgo-
filebis raodenoba sisxlSi, es ujre- mareoba viTardeba upiratesad prepara-
debi Cndeba eqsudatSi da naxvelSi. tebis ineqciis Sedegad, Tumca gansa-
I tipis alergiuli reaqcia udevs kuTrebiT mgrZnobiare individebs zogadi
safuZvlad anafilaqsias, bronquli as- anafilaqsia SeiZleba ganuviTardeT pre-
Tmis atopiur formas, polinozebs paratebis per os miRebis, inhalaciis, ma-
(alergia mcenaris mtverze), kvebiTi lamos saxiT gamoyenebisas. bavSvebSi ana-
alergiis da WinWris ciebis uxSires - filaqsiuri Soki SeiZleba ganviTardes
reaginul formebs da sxv. Zroxis rZis, kvercxis, Tevzis miRebisas.
120
adamianSi anafilaqsiuri Sokis bronquli asTmis dros alergenis
yvela-ze xSiri gamovlinebebia: gul- ganmeorebiTi zemoqmedebis sapasuxod
sisxlZar-RvTa sistemis mxriv - viTardeba bronqiolebis spazmi da maTi
sisxlZarRvovani kolafsi, susti da lorwovanis SeSupeba, irRveva sunTqvis
xSiri pulsi, xan-daxan - gonebis orive faza, gansakuTrebiT ki amosun-
dakargva; sasunTqi organoebis mxriv - Tqvis procesi.
xvela, bronqospazmi moxrCobis
SegrZnebiT da amosunTqvis gaZnelebiT, 10.5. hipermgrZnobelobis II (cito-
asfiqsia; nervuli sistemis mxriv - toqsikuri) tipi
SiSis grZnoba, pulsirebadi Ta-vis am tipis (sur. 10-3.) hipermgrZno-
tkivili, Zlieri oflianoba, qavili belobis dros imunuri stadiis ganvi-
WinWris ciebiT da kvinqes SeSupebiT, Tarebas biZgs aZlevs ujredebis mier
kuW-nawlavis traqtis mxriv – gulis- autoalergiuli Tvisebebis SeZena. aseTi
reva, Rebineba, mwvave tkivili mucel- gardaqmna viTardeba zogierTi qimiuri
Si, muclis Seberva, faRaraToba, zog- nivTierebis, samkurnalwamlo preparatis,
jer - uneblie defekacia. baqteriuli enzimis, virusis an lizo-
overis fenomeni adgilobrivi anafi- somebis fermentebis moqmedebis Sedegad.
laqsiuri reaqciaa. is viTardeba sen- mas organizmi G da M klasebis auto-
sibilizebul organizmSi alergenis ga- antisxeulebis warmoqmniT pasuxobs.
damwyveti dozis kanqveS Seyvanis dros. sur. 10-3 hipermgrZnobelobis II
ineqciis adgilze qsovilebis bazofi- (citotoqsikuri) tipi.
luri ujredebis degranulaciis gamo
gamoiyofa alergiis mediatorebi, izr-
deba kapilarebis ganvladoba, farTov-
deba sisxlZarRvebi.
WinWris cieba xasiaTdeba Zlieri
qaviliT, kanze wiTeli laqebis an buS-
tukebis gaCeniT. is viTardeba zogi
sakvebi produqtis (magaliTad, marw-
yvi) an samkurnalo preparatebis miRe-
bis Semdeg.
kvinqes SeSupeba giganturi, gavrce-
lebuli WinWris ciebaa. mas xSirad an-
gionevrozul SeSupebasac uwodeben.
WinWris ciebisagan gansxvavebiT kvinqes warmoqmnili antisxeulebis bunebasa
SeSupebisas kanSi da SemaerTebel qso- da raodenobasTanaa dakavSirebuli dazi-
vilSi, gansakuTrebiT quTuToebis, tu- anebis sxvadasxva variantis Camoyalibeba.
Cebis, gareTa sasqeso organoebis, enisa zogierT antisxeuls (IgM, IgG1, IgG2) aqvs
da xaxis lorwovanSi grovdeba eqsu- komplementis fiqsaciisa da gaaqtivebis
dati. WinWris ciebis da kvinqes SeSu- unari. amitom ZiriTadi mediatori maTi
pebis paTogenezSi gansakuTrebul rols monawileobiT mimdinare reaqciebSi kom-
TamaSobs histaminisa da biologiurad plementia, gavleniT xdeba samizne ujre-
aqtiuri sxva nivTierebebis gamoyofa, debis dazianeba da mospoba maTi Semdgomi
romlebic iwveven prekapilarebis, kapi- fagocitirebiT paTofiziologiuri sta-
larebis da venulebis adgilobriv ga- diaSi.
farToebas, eqsudacias.
121
antisxeulebis meore nawils (ofso- antigenebis demaskirebas adgili aqvs
ninebi) aqvs fagocitozis gaZlierebis histohematuri barieris darRve-visas,
una-ri, isini komplementis fiqsacias ris gamo organizmis bunebrivi, magram
ar ax-denen, ukavSirdebian ra T normalur pirobebSi imunuri
citotoqsiur ujredebs ganapirobeben qsovilebisagan izolirebuli antigene-bi
maT liziss. (magaliTad, Tavis tvinSi, farisebur
lizisis procesSi samizne ujredi jirkvalSi) axdenen imunuri sistemis
pa-siuria, misi funqcia mxolod gaRizianebas da iwveven antisxeulebis
antisxeu-lis mierTebaa. is iRupeba warmoqmnas. fizikuri, qimiuri, biolo-
imitom, rom T citotoqsiur ujredebis giuri faqtorebis zemoqmedebiT SesaZ-
da qileris zegavleniT (romelic am lebelia moxdes im autoantigenTa de-
procesis dros ar kvdeba) ujredis maskirebasac, romlebic specialuri ba-
membranaSi Cndeba 5-16 ang diametris rierebiT gamocalkevebulni ar arian da
cilindruli forebi, saidanac ujredSi Sedian biologiuri makromolekulebis
Sedis wyali. samizne ujrdebis SemadgenlobaSi. rig SemTxvevebSi qsovi-
eliminireba apoptozuri gzi-Tac xdeba. lebis infeqciuri an arainfeqciuri da-
citostatikuri tipis reaqciebi zianeba iwvevs e.w. "meoradi" antigenebis
mniSvnelovan rols asruleben im imu- gaCenas. magaliTad, sxvadasxva paTolo-
nur reaqciebSi, romlebSic antigeni giuri procesis dros icvleba sisxlisa
organizmisTvis ucxo ujredebia (maga- da qsovilebis cilebis struqtura. isini
liTad mikrobebi, umartivesni, simsiv- iZenen organizmisaTvis ucxo, alergenul
nuri ujredebi). magram im SemTxve- Tvisebebs da iqcevian autoalergenebad.
vebSi, rodesac organizmis normaluri aseT suraTs adgili aqvs damwvrobiTi da
ujredebi iZenen autoantigenur Tvise- sxivuri daavadebis, qsovilebis distro-
bebs, es dacviTi meqanizmebi imunuridan fiis da nekrozis dros.
alergiulad gadaiqceva da ujredebis autoalergiuli procesebi organizmSi
dazianebas, xSirad ki maT ganadgurebas SeiZleba ganviTar-dnen mutaciebis gziT
iwvevs (paTofiziologiuri stadia). ujredebis "akrZaluli" klonebis gamo,
klinikaSi citotoqsikuri tipis re- romlebic organizmis normalur cilebs
aqciebi viTardeba wamlismieri alergi- aRiqvaven, rogorc ucxo antisxeulebs.
is zogierT SemTxvevaSi da vlindeba
leikopeniiT, TrombocitopeniiT, hemo- 10.6 hipermgrZnobelobis III (artusis)
lizuri anemiiT. am tipis reaqcia Se- tipis reaqciebi
iZleba ganviTardes SeuTavsebeli sis- hipermgrZnobelobis reaqciebis III
xlis gadasxmisas, is udevs safuZvlad tipis SemTxvevaSi damzianebeli faqtori
mraval autoalergiul avadmyofobasac. antigen-antisxeulis kompleqsebia. maT
autoalergiuli (autoimunuri) artusis tipis reaqciebsac uwodeben,
daavadebebi viTardeba iseTi antisxeu- radgan artusis fenomenis ganviTarebaSi
lebis gamomuSavebis gamo, romlebic aseTi reaqciebi wamyvan rols asruleben
urTierTqmedeben TviT organizmis an- (artusis mier aRmoCenili fenomeni gamo-
tigenebTan. aseT suraTs SeiZleba adgi- ixateba adgilobrivi hemoragiul-nekro-
li hqondes antigenebis demaskirebisas, zuli anTebis ganviTarebiT xsnadi aler-
sakuTari antigenebisadmi toleranto- genis ramdenjerme Seyvanis sapasuxod). am
bis moxsnisas, organizmSi meoradi reaqciebs zogjer ixsenieben imunuri
antigenuri struqturebis gaCenisas, kompleqsebis avadmyofobebad an imuno-
somaturi mutaciebis dros. kompleqsuri tipis reaqciebad.
122
organizmSi xsnadi antigenis moxved- avadmyofobas (revmatoiduli arTriti,
risas iwyeba IgG da IgM klasis sistemuri wiTeli mglura da sxv.).
antisxeulebis warmoqmna. Sesabamis III tipis alergiuli reaqciebi wamyvan
antigeneb-Tan maTi urTierTqmedebisas rols TamaSoben Sratismieri daavadebis,
warmoiqmneba precipitati. imunuri alergiuli alveolitis, zogjer -
kompleqsebi yalib-deba qsovilebSi an wamlismieri da kvebiTi alergiis
sisxlSi. maTi war-moqmnis adgili paTogenezSi.
mniSvnelovnadaa damoki-debuli imunuri konfliqtis dros gamoyo-
alergenebis producirebis an SeWris filma kininebma da histaminma SeiZleba
gzebze. gamoiwvios bronqospazmi da, amgvarad,
cirkulirebadi imunuri kompleqsebi monawileoba miiRos bronquli asTmis
(anitgen-antisxeuli) paTogenurobas zogierTi variantis meqanizmSi. yvela
iCe-nen im SemTxvevaSi, Tu: a) isini moyvanili alergiuli reaqcia aRmoce-
xsnadi arian, b) antigenis raodenoba nebis drois mixedviT dauyovnebeli
zomierad Warbobs antisxeulTa tipisaa.
raodenobas da g) gazrdilia rogorc aRiniSna, III tipis alegiuli
sisxlZarRvTa kedlis gan-vladoba. reaqciebi wamyvan rols TamaSoben Sra-
qsovilebSi warmoqmnili imunuri tisimeri daavadebis paTogenezSi (garkve-
kompleqsebi SedarebiT xangrZlivad uli mniSvneloba mis meqanizmSi I tipis
kavdebian maTSi. am kompleqsebis gav- alergiul reaqciasac aqvs). daavadeba vi-
rcelebis topografia dakavSirebulia Tardeba alergiuli konstituciis mqone
sisxlZarRvTa ganvladobasTan – kom- pirebSi samkurnalo Sratis an imunuri
pleqsis upiratesi Calageba xdeba iq, globulinis Seyvanis Sedegad. reaqcia
sadac ganvladoba maRalia. antigen-an- umeteswilad vlindeba 1-2 kviris Semdeg
tisxeulis kompleqsebi didi raodeno- Sratis rogorc pirveladi, ise ganme-
biT fiqsirdeba qsovilebSi, magaliTad, orebiTi Seyvanidan da gamoixateba regio-
sisxlZarRvebze da Tirkmlebis gor- nuli limfuri jirkvlebis gadidebiT,
glovan aparatSi. antigen-antisxeulis eriTematozuli gamonayariT, qaviliT,
kompleqss aqvs komplementis gaaqti- quTuToebis, saxis, saxsrebis SeSupebiT
vebis da NK-ujredebis mozidvis unari. da tkiviliT. am simptomTa gaCena, e.i.
amoqmedebuli komplementis sistema da daavadebis manifestireba zustad
qiler-ujredebi azianebs im qsovilis emTxveva ucxo cilis sawinaaRmdego
ujredebs, sadac aRniSnuli kompleq- antisxeulebis warmoqmnas. antisxeulebi
sebis Calageba moxda. fiqsaciis adgil- - precipitinebi cirkulireben sisxlSi,
ze Tavs iyris sxvadasxva subpopu-la- nawilobriv ki fiqsirdebian ujredebze.
ciis leikocitebi, gamoisroleba an- reaqcia iwyeba maSin, rodesac antisxe-
Tebis mediatorebi. viTardeba anTeba: ulebis - precipitinebis titri miaRwevs
TirkmelebSi - glomerulonefriti, specifikur antigenTan reaqciisaTvis sa-
filtvebSi - alergiuli alveoliti, Wiro dones. antigen-antisxeulis komp-
kanSi - dermatiti da a.S. bevr SemTxve- leqsi fiqsirdeba kapilarebis endoTel-
vaSi anTeba iRebs alteraciul xasiaTs, ze, limfocitebze, kanis, Tirkmlis da
viTardeba qsovilebis nekrozi, wylu- sxva qsovilebis ujredebze, azianebs maT,
lebi, sisxlCaqcevebi, Trombozi. rasac mohyveba kapilarebis ganvladobis
III tipis alergiuli reaqcia udevs mateba, gamonayari, limfuri kvanZebis,
safuZvlad zogierTi autoalergiuli Tirkmlis gorglebis anTeba da Sra-
123
tismieri daavadebisaTvis torebi (ujredebis migraciis damT-
damaxasiaTebeli sxva cvlilebebi. rgunavi, makrofagebis maaglutinire-beli,
qemotaqsisuri faqtorebi, lim-
10.7 hipermgrZnobelobis IV (tuber- fotoqsinebi) da 2) gadatanis faqto-
kulinuri) tipis reaqciebi rebi (makrofagebis an limfocitebis
IV tipis alergiul reaqciebs gamaaqtivebeli faqtorebi, mitogenuri
miekuTneba dayovnebuli (ujredovani) faqtorebi da sxv.).
alergiuli reaqciebi, romlebic gan- ujredebis da qsovilebis dazianeba
sxvavdeba dauyov-nebeli tipis reaqci- SeiZleba ganviTardes sami meqanizmiT: 1)
ebisgan rigi niS-nebiT. aseTi sensibilizebuli T-limfocitebis
ujredovani tipis reaqcia viTardeba uSualo moqmedeba samizne ujredebze,
sensibilizebul organizmSi romlebsac autalergiuli Tvisebebi aqvT
specifikuri alergenis ganmeorebiTi (komplementi am procesSi ar mo-
Seyvanidan 48 saaTis an ramdenime dRis nawileobs); 2) limfotoqsinebis cito-
Semdeg. toqsikuri moqmedeba; 3) fagocitozis
dayovnebuli tipis alergiuli reaq- procesSi lizosomuri fermentebis ga-
ciis pasiuri gadatana erTi indi- moyofa upiratesad makrofagebidan. Bo-
vididan meoreze SesaZlebelia mxolod lo ori procesi azianebs ara marto sa-
limfo-citebis kulturis saSualebiT. mizne, aramed irgvlivmyof ujredebsac.
hipermgrZnobelobis aseTi pasiuri sensibilizebuli limfocitis aler-
gadatanis SesaZlebloba pirobadebulia genTan kontaqtis areSi ujredebis dag-
imiT, rom sensibilizebuli roveba maqsimums aRwevs 24-72 saaTSi. am
limfocitebi Seicaven peptiduri regionSi mimdinareobs samizne ujredebis
bunebis e.w. "gadatanis faqtors". daSla, fagocitozi, kapilarebis ganvla-
imunuri reaqciebis stadiaSi orga- dobis momateba mediatorebis gavleniT,
nizmSi moxvedrili alergenis gavleniT warmoebs alergenis eliminirdeba, yalib-
imunogenezis organoebSi formirdeba deba proliferaciuli tipis anTeba. zog
sensibilizebuli limfocitebi (upira- SemTxvevaSi alergenis an imunuri kom-
tesad - T-limfocitebi), romelTa ze- pleqsebis garSemo viTardeba granulema.
dapirze ganlagebulia antisxeulis xSirad am warmonaqmnis centri nekroz-
funqciis mqone receptorebi. Sensibi- deba, ujredis kvdomis adgilze viTar-
lizebuli limfocitebi infiltrireben deba SemaerTebeli qsovili.
organoebSi da qsovilebSi specifikuri IV tipis alergiul reaqciebs miekuT-
alergenebis an autoalergenebisken. am vneba infeqciur-alergiuli asTmis da
alergenebis urTierTqmedeba T-limfo- rinitis variantebi, zogierTi autoaler-
citebTan iwvevs qsovilebis dazianebas. giuli avadmyofoba, baqteriuli alergia,
paToqimiuri cvlilebebis stadiaSi transplantantis mocilebis reaqcia,
alergenebTan urTierTqmedebisas lim- kontaqturi dermatiti da sxv. am tipis
focitebSi viTardeba rigi morfolo- reaqciebi mniSvnelovan rols TamaSoben
giuri, bioqimiuri da funqciuri Zvre- infeqciur-alergiuli avadmyofobebis
bi: mimdinareobs blasttransformacia (tuberkulozi, brucelozi, sifilisi da
Semdgomi mitozebiT, limfokinebis ga- sxv.) paTogenezSi.
moyofa. gamowveuli efeqtis mixedviT baqteriuli alergia pirvelma aRwera
limfocitebis mier gamoyofil nivTi- r.koxma 1890 wels: tuberkuloziT daa-
erebebs hyofen 2 jgufad: 1) ujredis vadebulebs tuberkulinis Seyvanis ad-
funqciuri aqtivobis damTrgunavi faq- gilze 6-12 saaTSi uviTardebodaT si-
124
wiTle, Sesieba, gamkvriveba. reaqcia buli tipis reaqcias T-limfocitebis
maq-simums aRwevda 24-48 saaTSi. aseTi monawileobiT.
re-aqcia tuberkuloziT daavadebis 10. 8 hipermgrZnobelobis mkurnalobis
damadas-turebeli faqtia. principebi.
Senelebuli tipis alergiuli reaq- alergiuli reaqciebis paTogenezuri
ciebi SeiZleba ganviTardes sxva infeq- mkurnaloba gulisxmobs, pirvel rigSi,
ciebis drosac (magaliTad, difteriis, specifikur desensibilizacias anu sensibili-
qunTruSis da sxv.), profilaqtikuri zebuli organizmis mgrZnobelobis
da samkurnalo vaqcinaciebisas. Semcirebas specifikuri antigenisadmi. is
kanis alergiuli sinjebi gamoiyeneba miiRweva specifikuri alergenis parente-
Senelebuli tipis momatebuli mgrZno- ruli SeyvaniT specialuri sqemis mixedviT.
belobis dasadgenad: magaliTad, pirkes mkurnalobis am meTodis mizania alergenisa
da mantus reaqciebi tuberkulozisas, da specifikuri antisxeulis kompleqsis
biurnes reaqcia brucelozis dros. warmoqmna da am gziT "alergiuli
Senelebuli tipis alergiuli antisxeulebis" titris Semcireba an
reaqciebi kans garda SeiZleba antigenmablokirebeli (dacviTi) alergenebis
ganviTardes sxva organoebSic: gamomuSavebis provocireba organizmSi.
rqovanaSi, bronqebSi, paren-qimulebSi. im SemTxvevaSi, rodesac specifikuri
zogierTi qimiuri nivTierebis xan- hiposensibilizacia SeuZlebeli an uefeqtoa,
grZlivi zemoqmedeba kanze xSirad iw- an rodesac ar xerxdeba specifikuri
vevs kontaqtur alergias (kontaqtur alergenis dadgena specialuri sinjebiT,
dermatits). aseT nivTierebebs miekuT- mimarTaven araspecifikur desensibilizebas
vneba organuli da araorganTuli da- samkurnalwamlo preparatebis saSualebiT.
balmolekuluri nivTierebebi, romleb- magaliTad, dauyovnebeli tipis alergiuli
sac aqvT kanis cilebTan SeerTebis reaqciebis dros iyeneben antihistaminur
unari: sxvadasxva qimiuri nivTierebebi nivTierebebs, dayovnebuli tipis alergiis
(magaliTad, fenolebi), saRebavebi (ma- dros - imunodepresorebs, maT Soris glu-
galiTad, ursoli), metalebi (mag. Ko- kokortikoidebs
baltis naerTebi), kosmetikuri saSua-
lebebi da sxv. isini alergenul 11. cxeleba
Tvisebebs iZenen kanis cilebTan Seer- cxeleba (febris) Termoregulaciis cen-
Tebis Semdeg. anTeba, upiratesad, vi- trebze pirogenuli (cxelebis gamomwvevi)
Tardeba kanis zeda fenebSi - adgili nivTierebebis zemoqmedebis gamo ganviTare-
aqvs infiltracias mononukluri lei- buli tipobrivi paTologiuri procesia, ro-
kocitebiT, epidermisis degeneracias melsac axasiaTebs sxeulis temperaturis
da Camofcqvnas. momateba.
transplantantis mocilebis reaqcia cxelebas ar SeiZleba miekuTvnos sxeu-
viTardeba donoris qsovilis antigenu- lis temperaturis momatebis yoveli Sem-
ri Tvisebebis sxvaobis gamo antigene- Txveva. magaliTad, sxeulis temperatura ma-
bis im kompleqsTan, romlis mimarTac tulobs intensiuri kunTovani muSaobis an
recipientis organizmi tolerantulia. sxeulidan siTbos gacemis dabrkolebis
transplantantis mocilebis reaqcia dros, rac ara cxeleba, aramed hiperTermiaa.
Seesabameba alergiuli reaqciebis gan-
viTarebis zogad kanonzomierebebs. gan- 11.1 cxelebis SedarebiTi paTologia
sakuTrebuli mniSvneloba aqvs Senele- cxelebiTi reaqciis unari yalibdeba fi-
lo- da ontogenezuri ganviTarebis pro-
125
cesSi. es reaqcia paTogenur zemoqmedebaze aqtivoba aqvs TiTqmis yvela paTogenur
uviTardeba mxolod im saxeobis baqterias. amave dros, aRsaniSnavia, rom
cxovelebs, romlebsac aqvT baqteriebis pirogenuli potencia TiTqmis
maRalganviTarebuli centra-luri nervuli araa dakavSirebuli maT paTogenobasTan an
sistema da Termoregulaciis unari, e.i. toqsikurobasTan. am nivTierebebs sufTa
umaRles homoioTermul (Tbil-sisxlian) saxiT gamohyofen baqteriuli ujredebis
cxovelebs. saxeobebi, romlebsac mdgradi membranebidan specialuri qimiuri damu-
homoioTermia ar axasiaTebs, paToge-nuri Savebis gziT da iyeneben rogorc eq-
agentebis zemoqmedebas pasuxoben susti da sperimentSi, ise klinikaSi. isini, poli- an
aratipobrivi cxelebiTi reaqciiT. A-lipoidis Semcveli lipopolisa-qari-debi,
Termoregulaciis arasrulyofilebis Termostabiluri, aratoqsikuri ari-an da
ga-mo cxeleba axalSobilebSi xSirad susti antigenuri Tvisebebi aqvT. unda
mimdina-reobs sxeulis temperaturis vifiqroT, rom lipopolisaqaridebis
mdgradi moma-tebis gareSe, temperatura pirogenuli da toqsikuri Tvisebebi sxva-
naxtomisebur cvlilebebs ganicdis drois dasxva qimiuri jgufebiT aris pirobade-
mcire monak-veTSi. Zogjer Cvili bavSvis buli.
organizmi pa-Togenur zemoqmedebas baqteriuli pirogenebi uxSiresad
cxelebiTi reaqciiT saerTod ver maTive endotoqsinebia. egzotoqsinebis ga-
pasuxobs. momyofi mikroorganizmebis mier gamowveuli
cxelebis meqanizmi jer kidev gaurkvevelia.
11.2 cxelebis etiologia da paTogenezi daudgenelia, agreTve, pirogenebis arseboba
ganasxvaveben infeqciur da arainfeqci- virusebSi, spiroqetebSi, riketsiebSi, ro-
ur cxelebas. pirvels iwveven baqteriebi, melTa mier gamowveuli daavadebebis dros
virusebi, umartivesebi, sokoebi. Arainfeq- zogjer Zlier cxelebas aqvs adgili. Ro-
ciuri cxeleba viTardeba iseTi egzo- da gorc Cans, aRniSnuli baqteriebi da vi-
endogenuri faqtorebis moqmedebis Sede- rusebi cxelebas iwveven endogenuri piro-
gad, romlebic iwveven qsovilebis dazi- genebis: citokinebis - interleikin-1-is da
anebas da aseptikur anTebas (magaliTad, simsivnis nekrozuli faqtoris - TNF-is
cxeleba damwvrobis, infarqtis, travmebis, warmoqmnis inducirebis gziT. albaT, aseTive
Sinagani sisxldenis dros da sxv.). meqanizmi udevs safuZvlad cxelebas, rome-
arainfeqciur cxelebas, zogjer lic viTardeba sisxlis gadasxmis an orga-
akuTvneben cxelebas hormonuli dar- nizmSi cilis Seyvanis dros.
Rvevebis, emociuri stresis, isteriis, Tbilsisxliani cxovelebis ujredebi da
zogierTi farmakologiuri preparatis qsovilebi mza pirogenul nivTierebebs ar
moqmedebisas, Tumca maTi paTogenezi Seicaven, magram aseTi nivTierebebi warmo-
sxvadasxvagvaria da yovelTvis ar aris iqmneba dazianebul qsovilebSi infeqciuri
dakavSirebuli pirogenuli nivTierebe- daavadebebisa da aseptikuri anTebis dros. am
bis moqmedebasTan. endogenur pirogenul nivTierebaTa wyaroa
pirogenuli nivTierebebi . pirogenul leikocitebi, ris gamo endogenur pirogenebs
nivTierebebs miekuTvneba naerTebi, rom- leikocitursac uwodeben. endogenuri piro-
lebic organizmSi garedan moxvedris an genebi warmoiqmnebian rogorc moZravi, ise
TviT organizmSi warmoqmnisas iwveven cxe- fiqsirebuli makrofagebis, neitrofilebis
lebas. maT yofen egzogenur da endogenur mier. rac Seexeba limfocitebs, isini Tavad
pirogenebad. egzogenur pirogenebs gamo- pirogens ar warmoqmnian, magram xsnadi lim-
yofen mikroorganizmebi Tavisi cxovel- fokinebis saSualebiT astimulireben mono-
moqmedebis an daSlis dros. pirogenuli
126
citebis mier endogenuri pirogenis war- hormonebs ara aqvT cxelebis gamow-vevis
moqmnas (sur. 13-1). unari, magram maTi gavleniT SeiZleba
leikocituri pirogenebi Seicvalos Termoregulaciis centris
producirdebian organizmSi moxvedrili mgrZnobeloba pirogenebis mimarT. magali-
egzogenuri piroge-nebis moqmedebis Tad, TireotoqsikoziT sneulebSi infeq-
Sedegad, agreTve, sxva niv-Tierebebis, maT ciuri daavadebebi mimdinareobs ufro ma-
Soris hormonebis moqme-debiT. magaliTad, Rali temperaturiT, hipofizis an fari-
steroiduli hormonebis mier endogenuri seburi jirkvlis hipofunqciis fonze ki
pirogenuli nivTierebebis warmoqmnis igive daavadebebs SedarebiT naklebad ga-
stimulireba, sxva garemoebebTan erTad, moxatuli cxeleba axasiaTebs.
iwvevs janmrTeli qalis sxeulis glukokortikoidebi Trgunaven metabo-
temperaturis momatebas ovulaciis momen- lur procesebs leikocitebSi, maT Soris
tidan menstruaciis pirvel dReebamde pirogenebis warmoqmnasac da, albaT, am gziT
0,4-0,9C-iT. amuxruWeben cxelebiTi reaqciis gan-
rac Seexeba arainfeqciur pirogenebs, viTarebas.
ma-Ti specifikuroba, rogorc Cans, ar
aris ma-Rali, magram maT ZaluZT 12.2.1. centraluri nervuli sistemis
leikocituri pirogenebis warmoqmnis roli cxelebis ganviTarebaSi
provocireba. Ase-Tive efeqts iCens TermoregulaciaSi monawileobas iRebs
antigen-antisxeulis kompleqsi. centraluri nervuli sistema zurgis tvinis
meoradi pirogenebis moqmedebis meqa- segmenturi nawilebidan hemisferoebis qer-
nizmi aseTia: isini prostaglandin F-1-is qamde, magram gansakuTrebuli mniSvneloba am
warmoqmnis stimulirebis gziT moqmedeben mxriv hipoTalamuss aqvs. ukana hipoTala-
wina hipoTalamusis neironebze – Termore- musSi xdeba temperaturuli informaciis in-
gulaciis centrze, neironebis membranaze tegrireba da im efeqtoruli stimulebis
arsebul specifikur receptorebze. amis formireba, romlebic marTaven fizikur da
gamo amoqmeddeba ujredis adenilatcik- qimiur Termoregulacias. pirogenebi isini
lazuri sistema, masSi izrdeba cikluri amf- uSualod moqmedeben wina hipoTalamusis ne-
is raodenoba. es ukanaskneli cvlis ironebze – Termoregulaciis centrze; re-
centris neironebis mgrZnobelobas sici- agireben neironebis membranaze arsebul
viT-siTburi signalebis mimarT – matu- specifikur receptorebTan. amis gamo amoq-
lobs maTi mgrZnobeloba siciviTi da meddeba ujredis adenilatciklazuri siste-
mcirdeba mgrZnobeloba siTburi signale- ma, masSi izrdeba cikluri amf-is raodenoba.
bisadmi. Sedegad adgili aqvs siTbos ga- es ukanaskneli cvlis centris neironebis
cemis Semcirebas da misi produqciis mgrZnobelobas siciviT-siTburi signalebis
zrdas (sur. 13-2). endogenuri pirogenebi mimarT; matulobs maTi mgrZnobeloba sicivi-
centris neironebze zemoqmedebiT amaRleben Ti da mcirdeba mgrZnobeloba siTburi signa-
mis maregulirebel dones. esaa done, rome- lebis mimarT. Sedegad mcirdeba siTbos ga-
lic ucvleli rCeba manam, sanam orga- cema da izrdeba misi produqcia. endogenuri
nizmSi mimdinareobs leikocituri piroge- pirogenebi centris neironebze zemoqmedebiT
nebis sinTezi. maRla sweven mis maregulirebel dones.
pirogenebis garda cxelebiTi reaqciis maregulirebeli done SeiZleba Seicva-
formirebaSi garkveul rols TamaSoben los or SemTxvevaSi: 1. am meqanizmis mTliani
sxva nivTierebebi, gansakuTrebiT ki hor- an nawilobrivi gamovardnisas gansakuTrebu-
monebi. li zemoqmedebis dros (gadaxureba, gadaci-
eba, hipoqsia). 2. pirogenebis moqmedebisas,
127
roca es meqanizmi ar irRveva, magram kavSirebulia periferiuli sisxlZarRve-bis
icvleba ise, rom Termoregulaciis gafarTovebasTan, ris gamo kanis tempe-
centris maregu-lirebeli done ratura matulobs, siTbos gacema Zlier-
gadainacvlebs ufro maRla, ris Sedegad deba, pirvel stadiaSi arsebuli ferm-
viTardeba cxeleba. krTaloba qreba.
cxelebis meore stadiaSi sxeulis tem-
11.3 cxelebis stadiebi peraturis simaRlis mixedviT ansxvaveben
cxeleba mimdinareobs sam stadiad: tem- subfebrilur temperaturas - 38C-mde,
peraturis awevis (Stadium incrementum), zomier - 38-39C-mde, maRal - 39-41C da
nor-maze maRali temperaturis (Stadium hiperpireqsiul (41C-ze meti) cxe-lebas.
fastigium), da temperaturis dawevis cxelebis done da misi meryeobis sidide
(Stadium decremen-tum) stadia. dRe-Ramis ganmavlobaSi pirobadebu-lia rigi
temperaturis awevis stadiaSi icvleba faqtorebiT: pirogenebis raode-nobiT,
rogorc siTbos produqcia, ise siTbos ga- Termoregulaciis centris funqci-uri
cema, magram ise, rom pirveli yovelTvis mdgomareobiT, siTbos gamomyofi sis-temis
Warbobs meores. siTbos gacema mcirdeba simZlavriT, intoqsikaciis doniT da sxv.
periferiuli sisxlZarRvebis Seviwrovebis, temperaturis meryeobis dinamikaze dak-
kanisken Tbili sisxlis modinebis, oflis virvebiT SesaZlebelia cxelebis tipis dad-
gamoyofisa da aorTqlebis Semcirebis xar- gena, rasac arsebiTi mniSvneloba aqvs daava-
jze. cxovelebSi amas emateba Tmis parkis debaTa diagnostikaSi.
kunTebis SekumSva da balnis aweva, rac temperaturis daqveiTebis stadiaSi siT-
adi-debs Termoizolirebas. am reaqciis bos gacema Warbobs siTbos produqcias, rac
analogi adamianSi e.w. "batis kania". gamowveulia rogorc siTbos gacemis gaZlie-
siTbos warmoqmna izrdeba JangviTi rebiT (gansakuTrebiT oflis gamoyofisa da
procesebis gaZlierebis gamo RviZlSi, Si- aorTqlebis xarjze), ise, xSirad, siTbos
nagan organoebSi, ConCxis kunTebSi. Uuka- produqciis SemcirebiT. temperaturis daq-
naskneli viTardeba am kunTebis tonusis veiTeba SeiZleba moxdes TandaTanobiT – li-
momatebis (e.w."kumSviTi Termogenezi") da, zisiT, an swrafad, ramodenime saaTis gan-
rig SemTxvevebSi, kunTebis kankalis gamo. mavlobaSi - krizisiT. am SemTxvevaSi sxeu-
kankals safuZvlad udevs refleqsuri re- lis temperatura xSirad normaze dabla
aqcia: kanis temperatura sisxlZarRvTa ecema. temperaturis krizisulad dacemisas
Seviwrovebis da sisxlmomaragebis Semci- sisxlZarRvTa tonusis mkveTri daqveiTebis
rebis Sedegad zogjer ramdenime gradu- gamo SeiZleba ganviTardes mwvave sisxlZar-
siT mcirdeba. amis gamo Riziandeba Termo- Rvovani ukmarisoba - kolafsi. temperaturis
receptorebi, vlindeba Semcivneba. kankali, krizisul dacemas xSirad win uZRvis misi
romlis drosac kunTebSi siTbo warmoiq- momateba meore stadiaSi arsebul donesTan
mneba. aseT suraTs aqvs adgili tempera- SedarebiT. sxeulis temperaturis am kri-
turis swrafi momatebisas. im SemTxve- zisis wina momatebas perturbatio praecritica
vebSi, rodesac temperaturis momateba ewodeba.
TandaTanobiT xdeba, Semcivneba da kankali 11.4 .hiperTermiis gansxvaveba cxelebisagan
ar viTardeba. cxelebasa da hiperTermias Soris princi-
temperaturis maRal doneze dgomis puli sxvaobaa. cxelebis dros Termoregu-
stadiaSi myardeba garkveuli wonasworoba lacia aqtiuradaa mimarTuli sxeulis tem-
siTbos warmoqmnasa da gacemas Soris. am peraturis momatebisken, hiperTermiis dros ki
periodSi intensiuria rogorc siTbos Termoregulacia mimarTulia temperaturis
warmoqmna, ise misi gacema. ukanaskneli da- daqveiTebisken. cxelebiTi reaqciis arsi
128
mdgomareobs imaSi, rom Termoregulaciis sunTqvis sixSire cxelebis pirvel
meqanizmebis SenarCunebis pirobebSi, stadiaSi ramdenadme mcirdeba, meore sta-
piroge-nuli nivTierebebis zemoqmedebiT, diaSi ki matulobs sunTqvis centrze Tbi-
sxeulis mudmivi temperaturis li sisxlis moqmedebis gamo. filtvis ven-
maregulirebeli wer-tili adis ufro tilacia mniSvnelovan cvlilebebs ar ga-
maRal doneze. nicdis, radgan gaxSirebis fonze sunTqva
gadaxurebis mizezia organizmze maRali zerele xdeba.
temperaturis moqmedeba, TviT organimzSi saWmlis monelebis darRvevebi da uma-
siTbos Warbi raodneobiT warmoqmna da doba cxelebiTi daavadebebis dros sigam-
siT-bos gacemis dabrkoleba (ix. "maRali xdris mizezi xdeba.
tempe-raturis moqmedeba organizmze"). cxelebis pirvel stadiaSi diurezi
Termore-gulacia hiperTermiis izrdeba sisxlis wnevis momatebisa da sis-
kompensaciis stadiaSi mimarTulia sxeulis xlis Sinagani organoebisaken gadanawi-lebis
temperaturis daqve-iTebisken. magram Tu gamo. meore stadiaSi aldosteronis Warbi
siTbos gacemis maqsi-malurad gamoyofisa da am gziT natriumis Sekavebis
funqcionirebadi meqanizmebi sakma-risi ar Sedegad diurezi mcirdeba, mesame stadiSi ki
arian am miznis misaRwevad, Termo- natriumis qloridis didi ra-odenobiT
regulacia irRveva, temperatura pasiurad gamoyofasTan dakavSirebiT, kvlav izrdeba.
matulobs da SeiZleba ganviTardes siTbos centralur nervul sistemaSi cvlile-
dakvra. bebs ganicdis agznebisa da Sekavebis pro-
11.5 organoebisa da sistemebis funqciaTa cesebi, xSirad Sekavebis procesis siWarbiT.
cvlilebebi cxelebis dros viTardeba uZiloba, daRlilobis SegrZneba,
cxelebis dros temeraturis momateba Tavis tkivili. es movlenebi ufro mkveT-
1C-iT iwvevs gulis SekumSvaTa gaxSirebas radaa gamoxatuli infeqciuri sneulebebis
8-10 dartymiT (libermeisteris kanoni). dros. xSirad goneba ikargeba, viTardeba
taqikardia dakavSirebulia sinusis kvanZis halucinaciebi, bodva.
agznebasTan Tbili sisxliT da simpati-
kuri nervebis tonusis momatebasTan. Iz- 11.6. cxelebis mniSvneloba, misi gamoyeneba
rdeba gulis sistoluri da wuTmoculo- medicinaSi
ba, magram zogierTi infeqciuri daavadebis cxeleba, rogorc mravali sxva tipobrivi
dros (magaliTad, muclis tifi, Sebrune- paTologiuri procesi, moicavs rogorc dac-
biTi tifi) temperaturis 1C-is awevisas viT, sasargeblo, ise dazianebis, mavne ele-
gulis muSaoba Cqardeba mxolod 4-5 dar- mentebsac.
tymiT ("SedarebiTi bradikardia") an vi- iTvleboda, rom cxeleba sicocxlisaTvis
Tardeba sruli bradikardia, aRniSnuli saSiSi movlenaa, amitom sxeulis tempera-
dakavSirebulia am daavadebebis dros mi- turis daqveiTebas xelovnurad, sicxis dam-
okardze toqsikuri nivTierebebis zemoq- wevi saSualebebiT cdilobdnen. magram aseTi
medebasTan. Careva ar amcirebs ZiriTadi daavadebis gamo
cxelebis pirvel stadiaSi siTbos ga- ganviTarebul paTologiur movlenebs. Sem-
cemis SezRudvasTan dakavSirebiT perife- dgom, cxovelebze Catarebuli eqsperimente-
riuli sisxlZarRvebis Seviwrovebis gamo bis safuZvelze dadgenili iqna, rom cxe-
arteriulma sisxlis wnevam SeiZleba mo- lebis daTrgunva amZimebs infeqciuri daava-
imatos. mesame stadiaSi ki temperaturis debebis mimdinareobas, temperaturis xelov-
krizisuli dacemis fonze SeiZleba ganvi- nuri momateba ki zrdis organizmis rezis-
Tardes kolafsi. tentobas infeqciebis mimarT. sxeulis tempe-
raturis momateba xels uSlis mravali in-
129
feqciuri agentis - kokebis, virusebis, Cvens droSi piroTerapiis mizniT gamo-
spi-roqetebis gamravlebas. marTalia, iyeneba maRali siwmindis naklebad toqsi-
zogierTi mikroorganizmi gamravlebis kuri pirogenebi (magaliTad, pirogenali).
unars ar kar-gavs maRal temperaturazec, piroTerapias iyeneben sxva infeqciuri da
magram mcirdeba maTi gamZleoba rigi arainfeqciuri daavadebebis mkur-
samkurnalwamlo preparatebis mimarT. nalobisTvisac (tuberkulozis Zvalsax-
magaliTad, tuberkulozis Cxiris srovani forma, egzema, furunkulozi, rev-
mgrZnobeloba streptomicinis mimarT 42C matiuli da araspecifikuri poliarTriti,
temperaturaze 100-jer metia, vidre 37C avTvisebiani hipertonia, nawiburebi da sxv.).
temperaturaze. infeqciur agentTan
organiz-mis brZolas aadvilebs isic, rom 12. simsivnuri zrda
cxeleba astimulirebs antisxeulebis samwuxarod, Cvens droSic SeuZlebelia
gamomuSavebas, interferonis warmoqmnas, gaeces srulyofili pasuxi kiTxvas, Tu ra
intensiurs xdis fagocitozs. aRsaniSnavia, aris simsivne. simsivnuri zrdis ganmarteba
rom sxeulis tem-peraturis xelovnuri dRevandelamde eyrdnoba mxolod mis Ziri-
daqveiTeba iwvevs sis-xlSi neitrofiluri Tad gamovlinebebs, ar exeba ra simsivne-ebis
leikocitebis raode-nobis da etiologis da paTogenezs.
makrofaguli elementebis funqciis ansxvaveben keTilTvisebian da avTvise-bian
daqveiTebas, rac amcirebs organizmis simsivneebs. unda aRiniSnos, rom TviT
mdgra-dobas infeqciuri agentis mimarT. termini "keTilTvisebiani simsivne" ar aris
cxelebis dros organizmis dacvisuna- moklebuli pirobiTobis elements, radgan
rianobis matebaSi did rols TamaSobs jer bevri ramaa ucnobi keTil- da avTvisebi-
araspecifikuri rezistentobis zrda hipo- ani simsivneebis rogorc etiologiaSi, ise
Talamo-hi-pofizarul-Tirkmelzeda jirk- maT paTogenezSi, TviT "keTilTvisebiani" sim-
vlis sistemis stresuli ativaciis gamo. sivne ki xSirad prekanceruli mdgomareobaa,
cxelebis dadebiTi gavlena organizmis e.i. SeiZleba gaavTvisebiandes. Cveulebriv ki
rezistentobaze infeqciuri agentebis mi- keTilTvisebiani simsivneebi qsovilis adgi-
marT SemCneuli iyo jer kidev gasul lobriv hiperplaziaa da organizmisaTvis
saukuneSi. Cnobili gaxda, rom sifilisiT naklebad paTogenurnia.
sneulTa mdgomareoba umjobesdeboda, Tu qvemoT moyvanili masala simsivneebis Se-
isini maRali cxelebiT mimdinare Sebrune- saxeb, ZiriTadad, avTvisebian simsivneebs See-
biTi tifiT avaddebodnen. SemdgomSi, si- xeba.
filisis bolo stadiebis mkurnalobis- 12.1 simsivnuri zrda
Tvis malariiT gamowveul cxelebas iye- simsivnuri zrda paTologiuri procesia,
nebdnen. mkurnalobis efeqti dakavSirebu- romelsac axasiaTebs moumwifebeli ujredo-
lia imasTan, rom sifilisis bolo sta- vani elementebis araregulirebadi usasrulo
diaSi gamomwvevi - mkrTali spiroqeta bu- gamravleba.
dobs Tavis tvinSi: hematoencefaluri simsivne (tumor, neoplasma) Cndeba norma-
barieris arsebobis gamo samkurnalo pre- luri ujredebis simsivnurad gardaqmnis
paratebis moxvedra am organoSi gaZnele- gamo. gansxvavebiT normaluri ujredebisagan,
bulia. cxeleba adidebs barieris gamavlo- ukanasknelT naklebad an sruliad ara aqvT
bas, amitom organizmSi Seyvanili samkur- ujredebis gamravlebis damuxruWebis da
nalo saSualebebi iolad aRwevs Tavis Sewyvetis unari. amitom simsivnuri qsovilis
tvins da aq myof mkrTal spiroqetas. zrda usazRvroa da wydeba mxolod sik-
vdilis Semdeg. simsivne ar eqvemdebareba
homeostazis maregulirebel meqanizmebs da
130
SedarebiT avtonomiuria. is izrdeba genuri gziT metastazireba da simsivnuri
Sinagani potenciiT - "Tavis Tavidan" ujredebis Canergva regionul limfur
malignizebuli ujredebis gamravlebis kvanZebSi.
xarjze. mezobeli ujredebi procesSi ar metastazirebis ZiriTadi etapebia: sim-
erTveba. sivnuri ujredebis mowyveta qsovilidan da
simsivnuri ujredebi gamoimuSaveben maTi moxvedra limfur an sisxlis Zar-
angiogenezis (sisxlZarRvebis ganviTarebis) RvebSi, ujredebis cirkulacia sisxlsa da
faqtorebs (folkmani). maTi moqmedebis limfaSi, embolad gadaqceva, maTi miwepeba
Sedegad warmoqmnili sisxlZarRvebi sisxlZarRvis kedelze, simsivnuri ujre-
kvebaven simsivnes maspinZlis organizmis debis gamosvla sisxlZarRvidan qsovilSi da
sisxliT. simsivnuri qsovili proliferacia, e.i. metastazuri keris gaCena.
struqturiT, bioqimi-uri, fizikur- pirveli etapis ganxorcielebaSi didi
qimiuri da imunuri TvisebebiT ganirCeva mniSvneloba aqvs simsivnuri ujredebis
im qsovilebisagan, romlisganac TviT urTierTSeWidulobis daqveiTebas, rac
warmoiSva da emgvaneba embrionul qso- aadvilebs ujredebis mowyvetas simsivnis
vils (anaplazia). xSirad simsivnuri ZiriTadi masisgan.
qsovi-li emsgavseba sxva qsovilebsac, metastazirebis procesi ar SeiZleba
rasac metap-lazia ewodeba. ganxiluli iqnas, rogorc simsivnuri uj-
simsivne mTliani organizmis daavadebis redebis meqanikuri, pasiuri gadatana: me-
adgilobrivi gamovlinebaa. keTilTvisebiani tastazirebisTvis aucilebelia garkveuli
simsivneebi zrdis procesSi awvebian da latenturi periodi, organoSi mitanili
ganze gaweven sxva qsovilebs (eqspansiuri ujredebi yovelTvis ar gardaiqmneba me-
zrda). Tu es warmonaqmnebi Tavisi tastazebad, metastazireba xdeba ara yvela
moculobiT da lokalizaciiT ar zRudaven organoSi.
sicocxlis-Tvis didmniSvnelovani
organoebis fun-qciebs, isini sikvdils ar
iwveven.
maTgan gansxvavebiT, avTvisebiani sim-
sivnebi Caizrdebian normaluri qsovilis
ujredebs Soris (invaziuri zrda) an
spoben am ujredebs (destruqciuli zrda).
simsivneebi Caizrdebian agreTve sisxlisa
da limfuri ZarRvebis kedlebSi, maTi uj-
redebi limfisa da sisxlis gziT gadai-
taneba sxva organoebSi, sadac qmnian sim-
sivnuri zrdis axal kerebs - metastazebs.
metastazirebis arsi mdgomareobs sim-
sivnuri qsovilidan calkeuli ujredebis
mowyvetasa da maT gadatanaSi sxva orga-
noebSi simsivnis Svileuli kerebis gan-
viTarebiT. metastazireba axasiaTebs avTvi-
sebian simsivneebs da is viTardeba Semdegi
gzebiT: hematogenuri (sisxlismieri), lim-
fogenuri (limfis saSualebiT) da qso-
viluri (ujredSua sivrceebiT an qso-
vilSi CazrdiT). maTgan uxSiresia limfo-
131
mikrocirkulaciis darRvevaa. simsivniani or-
sur. 12-1. avTvisebiani simsivnis ganizmis simsivnisagan jer dauzianebel or-
metastazireba ganoebSi mikrocirkulaciis mkveTri, e.w. "pa-
raneoplaziuri" Zvrebi ki dadgenili faqtia
12.2. metastazireba (T.naTaZe, v.yifiani).
sisxliT motanili simsivnuri ujredis ama Tu im avTvisebian simsivnes aqvs ro-
organoSi Canergvis erT-erTi piroba masSi melime erT organoSi upiratesi
132
metastazirebis unari. magaliTad, sakver- qsoviluri atipizmi mdgomareobs qsovi-
cxis kibo xSirad metastazirebs RviZlSi lis parenqimas da stromas Soris normalu-
an xerxemalSi, saSvilosnos qorionepi- ri urTierTobis darRvevaSi.
Telioma - filtvebSi, centraluri ner- jirkvalTa simsivneebSi sekretoruli
vuli sistemis simsivneebi metastazireben qsovili SeiZleba usistemod, sxva struq-
mxolod mis farglebSi da a.S. cxadia, turul elementebTan yovelgvari kavSiris
rom metastazis Camoyalibeba moxdeba ma- gareSe, kunZulebis saxiT iyos gafantuli
Sin, rodesac organo an qsovili, romel- (dawvrilebiT masala simsivneebis mor-folo-
Sic xvdeba simsivnuri ujredebi, garkveul giuri atipizmis Sesaxeb mocemulia paTolo-
mzadyofnaSia metastazis ganviTarebisaTvis. giuri anatomiis kursSi).
metastazebis gaCenas xels uwyobs orga- metaboluri (bioqimiuri) atipizmis sa-
noebis qimiuri, meqanikuri, toqsikuri da- fuZvels simsivnuri ujredebis genetikuri
zianeba da maTi qronikuli anTebiTi pro- regulaciis darRvevebi qmnis. genebis erTi
cesebi. nawilis represiis gamo wydeba Sesabamisi
metastazi xSirad inarCunebs pirveladi fermentebis, cilebis sinTezi, sxva genTa
simsivnuri struqturis Tvisebebs an ufro depresia ki iwvevs ujredSi cilebis axali
martivi Seneba da funqciurad naklebi sim- tipebis, izofermentebis gaCenas. Cveulebriv,
wife aqvs. aRar warmoiqmnebian is cilebi da fermen-
tebi, romlebic apirobadeben ujredis speci-
12.3. simsivnuri zrdis biologiuri fikur funqcias. amave dros aqtivdeba uj-
Taviseburebebi redis gayofaSi monawile fermentebi. Aqtiv-
simsivnuri zrdis biologiuri Tavise- deba agrTeve nukleinmJavebis sinTezi. Gans-
burebebi simsivnuri qsovilis im niSnebis xvavebiT simsivniani organizmis sxva qsovi-
erToblioba, romlebic ansxvaveben maT lebisagan, plastikuri procesebis Sesabami-
janmrTeli qsovilisgan. am TaviseburebaTa sad, simsivnur ujredebSi cilis sinTezi
krebiTi saxelwodebaa "atipizmi". Warbobs mis daSlas. simsivneebs aqvT amin-
morfologiuri atipizmi vlindeba sim- mJavebis gaZlierebuli STanTqmis da sakuTa-
sivnis qsovilebisa da ujredebis atipiz- ri cilebis SenebisaTvis maTi gamoyenebis
miT. ukanaskneli vlindeba simsivnuri uj- gansakuTrebuli unari. metad didi rao-
redebis araCveulebriv sidideSi, formaSi, denobiT iyeneben simsivnuri ujredebi nax-
SenebaSi. aRiniSneba ujredebis gaaxalgaz- Sirwylebsac. swored glukozaa maTTvis
rdaveba, primitiuli, embrionuli struq- energiis ZiriTadi wyaro. simsivnur qsovi-
turisken dabruneba. isini Cveulebrivze lebSi anaerobuli glikolizi Warbobs aero-
mozrdili da am qsovilisaTvis ucxo buls, e.i. irRveva normaluri qsovilisTvis
formis arian, xSirad ki sruliad uCveu- damaxasiaTebeli e.w. pasteris efeqti – Jan-
lo konturebs iReben. gbadi ver amuxruWebs anaerobul glikolizs.
simsivnur ujredebs Zalze didi zomis, amgvarad, naxSirwylebis moxmareba simsivnuri
maxinji formis, dakbilulkideebiani bir- ujredebis mier emsgavseba embrionuls.
Tvebi aqvT. maTSi xSiria mitozis movle- naxSirwylebis anaerobuli gardaqmnis ga-
nebi. araiSviaTad ujredebi mravalbirTvi- mo simsivnur qsovilSi grovdeba rZemJava,
ania, birTvebi ki Seicaven sxvadasxva rao- rac adgilobriv acidozs iwvevs. magaliTad,
denobis qromosomebs. ujreduli atipizmi normaluri RviZlis qsovilis pH=7,4, hepa-
simsivneebSi sxvadasxva xarisxiTaa gamoxa- tomisas (RviZlis avTvisebiani simsivne) ki
tuli. pH 7,0-is tolia.
imunuri atipizmi mdgomareobs simsivnuri
ujredebis anitgenuri Semadgenlobis
133
cvlilebebSi. kerZod, gvxvdebian embrionu- cikluri aromatuli naxSirwyalbadebi: 3,4 -
li ujredebisaTvis damaxasiaTebeli anti- benzpireni, 1,2,5,6 - dibenzantraceni, 9,10 -
genebi. maT garda ansxvaveben simsivnuri an- dimeTil - 1,2 -benzatraceni, meTilqolan-
tigenebis Semdeg tipebs: virusebiT indu- treni da sxv. am nivTierebebs, ZiriTadad,
cirebuli simsivneebis antigenebi, kancero- adgilobrivi moqmedeba axasiaTebs. kanqveS
genebiT inducirebuli simsivneebis antige- Seyvanisas isini iwveven sarkomas, xolo kan-
nebi, heteroantigenebi, e.i. sxva organoe- Si Sezelvisas - kibos. am tipis kancero-
bisaTvis damaxasiaTebeli anitigenebi. genebi farTod arian gavrcelebuli adamianis
saarsebo sferoSi, radganac umeteswilad
12.4. simsivneebis etiologia da paTogenezi arasruli wvis produqtebi arian.
kancerogenuli faqtorebi. simsivneebis aRniSnuli klasis nivTierebebisagan gans-
ganviTarebis mizezebia faqtorebi, romleb- xvavebiT, aminoazoSenaerTebsa da aminebs axa-
sac aqvT normaluri ujredebis simsivnu- siaTebs organotropuloba. magaliTad, dime-
rad gardaqmnis unari, e.i. avlenen kance- Tilaminoazobenzoli da orToaminoazoto-
rogenul anu blastomogenur Tvisebebs. luoli miuxedavad organizmSi maTi Seyvanis
aseTebs ganekuTvneba qimiuri, fizikuri da adgilisa, iZlevian RviZlis kibos ganviTa-
biologiuri bunebis faqtorebi, romlebic rebis maRal procents, -naftilaminis Sey-
miuxedavad friad gansxvavebuli bunebisa vana organizmSi ki Sardis buStis kibos iw-
da organizmze zemoqmedebis sxvadasxva vevs. organotropuloba axasiaTebs agreTve
gzisa, arRveven ujredebis gamravlebis re- nitrozaminebs.
gulacias. azri endogenuri kancerogenebis arsebo-
sxvadasxva kancerogenuli faqtorebis bis Sesaxeb daibada mas Semdeg, rac naRvlis
moqmedebas zogierTi ram saerTo aqvT: yve- mJavebis damuSavebiT miRebuli iqna ukve
la maTgani moqmedebs ujredis genomze, aRniSnuli Zlieri kancerogeni – meTilqo-
aqvs organizmis garegani da Sinagani bari- lantreni. endogenuri kancerogenebi (stero-
erebis daZlevis unari, garkveuli inten- idebis, aminmJavebis, cilebis metabolizmis
sivobiT zemoqmedebisas ar spobs ujreds, produqtebi) TviT organizmSi warmoiqmneba.
arRvevs qsovilur sunTqvas da imunur endogenuri kancerogenuli nivTierebebia
reaqciebs, aZlierebs erTmaneTis moqmedebis hormonebi, estrogenebi, qolesterinis meta-
efeqts. bolitebi, Tirozinis da triftofanis war-
organoebisa da qsovilebis Tavisebure- moebulebi.
bebTan dakavSirebiT SeiZleba Seiqmnas ama biologiur kancerogenul faqtorebs
Tu im kancerogenuli faqtoris moqmedebis miekuTvneba virusebi, gansakuTrebiT - rnm-is
realizebis xelSemwyobi an xelis SemSle- Semcvelni. jer kidev rausma (1911) daadgina,
li pirobebi. amitomaa, rom zogierTi kan- rom qaTmis sarkoma simsivnis uujredo fil-
cerogenuli faqtori organotropul moq- tratis saSualebiT SeiZleba gadaeces daa-
medebas iCens (magaliTad, orToaminoazo- vadebuli frinvelidan janmrTels. am faqtma
toluolis Seyvana organizmSi RviZlis ki- dasabami misca virusuli simsivneebis da sim-
bos ganviTarebas iwvevs). sivnis gamomwvevi virusebis Seswavlas. 1930
qimiur kancerogenul nivTierebebs yo- wels Soupma aRwera bocverTa virusuli
fen egzo- da endogenurad. egzogenuri kan- papiloma, romelic uujredo filtratiT
cerogenuli nivTierebebi moqmedeben orga- gadaitaneboda daavadebuli cxovelidan jan-
nizmze garedan. maT miekuTvneba sruliad mrTelze da ganicdida malignizebas (gaav-
sxvadasxva bunebis qimiuri nivTierebebi: Tvisebianebas). bitnerma (1936) daadgina, rom
naxSirwyalbadebi, aminoazoSenaerTebi, ami- maRalkiboiani Tagvebis rZeSi arsebobs faq-
nebi da sxv. Zlieri kancerogenebia poli- tori, romelic iwvevs STamomavlobaSi
134
sarZeve jirkvlis kibos ganviTarebas. aR- sivneebi, rogorc profesiuli daavadebebi.
moCnda, rom Tu maRalkiboian Tagvs Svi- magaliTad, rentgenologebis kibo, filtvis
lebs movacilebT pirvel kvebamde (e.i. Tu kibo radiaqtiuli nivTierebebis mosapovebe-
isini ar miiReben dedis rZes) da mivcemT li Saxtebis muSebSi. simsivneebis ganviTareba
maT gamosakvebad dabalkiboian Tagvs, sar- maionebeli radiaciis gavleniT savsebiT da-
Zeve jirkvlis kibos sixSire am axal Ta- majerebladaa damtkicebuli eqsperimentula-
obaSi mkveTrad ecema. magram Tu dabal- dac.
kiboiani Tagvebis STamomavlebs vkvebavT
maRalkiboiani Tagvebis rZiT, sarZeve jir- 12.5. ujredis neoplaziuri transformacia
kvlis kibos SemTxvevebi mkveTrad izrdeba. simsivneebis paTogenezi. simsivneebis pa-
ase dadginda e.w. "rZis faqtoris" arsebo- TogenezSi wamyvani procesia normaluri uj-
ba, romelic virusuli bunebis aRmoCnda. redis tranformacia simsivnur ujredad (ne-
SemdgomSi dadgenili iqna zogierTi sxva oplazmuri transformacia), rac xorciel-
saxeobis cxovelis da leikozis zogierTi deba etapobrivad ujredis mier simsivnuri
formis virusuli bunebac. fiqroben, rom ujredis ZiriTadi Tvisebis - usasrulo
virusuli genezisaa adamianis zogierTi gamravlebis da Svileuli ujredebisTvis mi-
simsivne, magaliTad, afrikis samxreT na- si gadacemis unaris SeZeniT, romlis auci-
wilSi gavrcelebuli berkitis limfoma, lebeli pirobaa dnm-is Sesabamisi gardaqmna.
romelic azianebs ybisqveSa limfur kvan- TviT dnm-is aseTi cvlileba jer kidev
Zebs. ar aris malignizebis niSani - ujredis neo-
1945 wels l. zilberma SeimuSava sim- plaziuri transformacia xdeba mxolod kan-
sivneebis ganviTarebis virusul-genetikuri cerogeniT dazianebuli dnm-is replikaciis
Teoria, ukanasknel xanebSi ki hiubernma da Semdeg, e.i. iniciaciisTvis saWiroa kance-
todarom aRmoaCines, rom janmrTeli uj- rogeniT dazianebuli ujredis prolifera-
redis qromosomebi Seicaven onkornaviru- ciis minimum erTi cikli, romlis dros dnm-
sebs dnm-formaSi. unda vifiqroT, rom gen- is cvlileba "fiqsirdeba". magram amis Semde-
represorTa moqmedebis gamo, romlebic gac ki ujredis malignizebisTvis da sim-
Trgunaven ujredis genoms, es virusebi Ta- sivnis ganviTarebisTvis saWiroa masze pro-
vis moqmedebas ver amJRavneben. magram kan- motoris zemoqmedeba.
cerogenuli nivTierebebis moqmedebisas es avTvisebiani simsivnis aRmoceneba da
araaqtiuri dnm (provirusi) iwyebs fun- ganviTareba qsovilur kulturaSi Tu orga-
qciobas da normalur ujreds simsivnurad nizmSi dinamikuri procesia. is moicavs uj-
gardaqmnis. l.Sabadis gamoTqmiT qimiuri redis gardaqmnis Tanmimdevrul etapebs, rom-
kancerogenebi gamoaRviZeben proviruss ise, lebsac yofen iniciaciis, promociis da
rogorc "mZinare mzeTunaxavs". progresiis stadiebad. iniciaciis stadia
fizikur kancerogenul faqtorebs mie- moicavs TviT neoplazmur transformacias.
kuTvneba maionebeli radiacia, ultrai- ujredis neoplazmuri transformacia.
isferi sxivebi, zogjer - meqanikuri dRes cnobilia, rom cxovelebis da ada-
faqtoric. mianebis dnm Seicavs nukleotidebs, rom-
gansakuTrebiT xSiria avTvisebiani - lebic rausis sarkomis gamomwvevi virusis
ganviTareba sxivuri energiis zemoqmedebis onkogenis dnm-is nukleotidebis homolo-gi-
Sedegad. amas mowmobs Tundac xirosimas uri arian. 1981 wels biSopma Tanaavtoreb-
da nagasakis tragediis Sedegebi - atomuri Tan erTad daadgina manamde cnobili 20 ret-
bombis afeTqebis Semdeg mkveTrad imata rovirusis onkogenis analogebis arseboba
leikozebiT da simsivneebiT avadobam. janmrTeli da simsivniT daavadebuli cxove-
sakmaod xSirad adamianebSi aRiniSneba sim- lebis ujredebSi. janmrTel ujredSi viru-
135
sis onkogenis analogi araaqtiuria da mas somebis reduqtazebiT), dimeTilirebiT (fer-
protoonkogeni ewodeba, xolo simsivnur mentuliT da arafermentuliT), koniugacia
ujredSi es analogi atipobrivia da mas glukuronmJaviT da gogirdmJaviT; SesaZloa,
ujreduli onkogeni daerqva. agreTve, kancerogenuli nivTierebis elimi-
protoonkogenebi aqtiur ujredul on- nacia organizmidan naRvlis, Sardis, ganav-
kogenad gardaiqmneba qimiuri da fizikuri lis gziT, maTi fagocitoziT, antioqsi-
kancerogenebis an onkovirusebis zemoqme- dantebis saSualebiT, kancerogenis Tavisufa-
debiT. li radikalebis inhibirebiT, antisxeulebis
aqtiuri ujreduli onkogenebis gavle- warmoqmniT kancerogenis (rogorc haptenis)
niT xdeba simsivnuri (kibos) cilebis anu winaaRmdeg.
onkocilebis warmoqmna (amJamad cnobilia onkogenebis winaaRmdegaa mimarTuli inhi-
20-ze meti aseTi cila). am cilebis eqs- bireba interferoniT an neitralizeba speci-
presiiT genetikuri simsivnuri programa fikuri antisxeulebiT.
gardaiqmneba realur simsivnur niSnebad maionebeli radiaciis kancerogenuli
(atipizmebi). normalur ujredSi onkoci- efeqtis blokirebisTvis organizmi iyenebs
lebis mcire Semcvelobaa. isini, albaT, antiradikalur da antizeJangur meqanizmebs
arian ujredis zrdis faqtorebisadmi re- (E vitamini, seleni, glutaTioperoqsidaza,
ceptorebis mgrZnobelobis regulatorebi superoqsiddismutaza, katalaza - ix. "ujre-
an am faqtorTa sinergistebi. Tumca arse- dis paTofiziologia").
bobs iseTi mosazrebac, rom TviT onkoci- antitranformaciuli meqanizmebi axdnen
lebi moqmedeben, rogorc zrdis faqtore- normaluri ujredis simsivnurad gardaqmnis
bi. inhibirebas. maT mikuTvneba antimutaciuri
kancerogenezis moyvanili meqanizmis meqanizmebi - dnm-is "Secdomis" gamosworeba
realizeba jer kidev ar aris sakmarisi ujredis fermentuli sistemebis mier dnm-is
avTvisebiani simsivnis aRmocenebis da reparaciiT.
ganviTarebisTvis. amisTvis aucilebelia gansakuTrebuli mniSvneloba aqvs trans-
organizmis antiblastomuri (antisimsivnu- formirebuli ujredebis apoptozs, an mis
ri) rezistentobis Semcireba. darRvevas genebis - supresorebis gardaqmnis
da maTi defeqtis gamo.
organizmis antiblastomuri rezisten- rogorc iTqva, ujredis neoplaziuri
toba transformaciisTvis ar aris sakmarisi mxo-
simsivnis aRmocenebis da ganviTarebis- lod onkogenis aqtivacia. ujredebis arakon-
Tvis, kancerogenuli meqanizmebis CarTvis trolirebad proliferacias ewinaaRmdegebian
garda, aucilebelia antiblastomuri re- genebi - supresorebi. isini astimulireben
zistentobis dabali done, anu im meqa- gardaqmnili ujredebis apoptozs. aseT ge-
nizmebis ukmaroba, romlebic ewinaaRmde- nebs miekuTvneba cila p53 - genomis "mTavari
geba simsivnur zrdas. aseTs miekuTvneba mcveli", genebi p16, p21 da sxv. (sur. 12-2)
antikancerogenuli, antitransformaciuli
da anticeluluri (antiujreduli) meqa-
nizmebi.
antikancerogenuli meqanizmebi mimar-
Tulia kancerogenuli faqtorebis winaaR-
mdeg. qimiuri kancerogenebis moqmedebis ga-
neitraleba xorcieldeba maTi inaqtivaci-
iT, daJangviT (magaliTad, mikrosomebis
oqsidazebiT), aRdgeniT (magaliTad, mikro-
136
sur. 12-2 cila p-53-is efeqti 53-is umTavresi funqciaa genomis
stabilobis kontroli da
apoptozis in-duqcia im
SemTxvevaSi, Tu vi-Tardeba dnm-
is gamousworebeli dazianeba. p-
53-is funqciuri inaqtivacia,
erTi mxriv, xels uwyobs
transformirebuli uj-redis
simsivnurad gardaqmnas, meore
mxriv ki - ukve warmoq-mnili
simsivnis progresias.
anticeluluri meqanizmebi,
romlebic pirveli simsivnuri
ujredebis warmoqmnisTanave iCe-
nen Tavs, mimarTuli arian sim-
sivnuri ujredebis inhibirebis
da mospobisken. am procesebs
normalur damutaciur ujredSi
biZgs aZlevs simsivnuri ujrede-bis
cila-53 uaRresad konservatulia - mas
antigenuri Semadgenlobis "ucxooba"
Seicavs cxovelTa samyaros mravali war-
organizmis imunuri sistemisTvis.
momadgenlis birTvi. es cila defeqturi
anticeluluri meqanizmi xorcieldeba imu-
aRmoCnda adamianis avTvisebian simsivneTa
nuri da araimunuri gziT.
udidesi nawilis ujredebSi, miuxedevad
imunuri anticeluluri meqanizmebi imu-
maTi warmoSobis da lokalizaciisa (fil-
nuri sistemis im funqciis gamovlinebaa, ro-
tvis, Tavis tvinis, saylapavis, msxvili
melic akontrolebs qsovilebis antigenuri
nawlvis, ZuZus, saSvilosnos yelis, RviZ-
Semadgenlobis mudmivobas. am sistemis reaq-
lis, hemopoezuri da retikulur-endoTe-
ciebi realizdeba T-limfocitebis – qile-
luri qsovilis simsivneebi da sxv.).
rebis, imunuri makrofagebis, Fcrecepto-
p-53-is gavleniT xdeba Secvlili,
rebis mqone K-limfocitebiT, araspecifikuri
transformirebuli ujredebis apoptozi
citotoqsikuri moqmedebiT, zrdis inhibi-re-
da am gziT qsovili gadagvarebuli ujre-
biT, simsivnuri ujredebis lizisiT natura-
debisgan Tavisufldeba, realizdeba prin-
luri qileri ujredebis mier.
cipi: "ar aris ujredi - ar aris prob-
araimunur anticelulur faqtorebs da
lema". p-53-is Semcveloba izrdeba nor-
meqanizmebs miekuTvneba simsivnis nekrozuli
maluri ujredebis dnm-is dazianebisas.
faqtori, interleikin - 1, alogenuri
magram geni p-53 mutanturia mraval sim-
damuxruWeba, keilonuri inhibireba da sxv.
sivnur ujredSi (SesaZloa, yvelaSi), rac
miuxedavad esoden mZlavri anticelulu-
SeiZleba gamowveuli iyos sxvadasxvva mi-
ri meqanizmebisa, avTvisebiani simsivne mainc
zeziT, maT Soris ujredis im virusebiT
xSirad viTardeba. aRniSnulis mizezia is,
inficirebiT, romelTa produqtebi urTi-
rom kancerogenuli faqtorebi, ujredis av-
erTqmedeben p-53-Tan. aseTi unda iyos,
Tvisebiani transformaciis garda (xSirad
magaliTad, HPV virusi da sxv.
aseT transformaciamdec), iwveven imunodep-
p-53-is deficitis mqone ujredebs
resias, romelic Rrmavdeba TviT simsivnis
axasiaTebs genomis mzardi arastabiloba,
zemoqmedebiTac.
rasac Tan sdevs genebis amplifikacia. p-
137
seriozul yuradRebas ipyrobs lobs, organizmsa da mas Soris mainc sak-
keilone-bis - ujredis araspecifikuri maod mWidro urTierTkavSiri arsebobs.
nivTierebebis deficitis roli ujredTa rogorc ukve aRniSnuli iyo, simsivne
ganuwyvetel gam-ravlebaSi. naCvenebia, rom ikvebeba organizmidan miRebuli sisxliT.
keiloni "amSvi-debs" ujreds, wyvets mis organizmis reaqtiulobis cvlileba arsebiT
gamravlebas, aadvilebs ra mitozis gavlenas axdens rogorc simsivnis aRmo-
represoris gavlas ujredis birTvSi. am cenebis, ise misi zrdis procesze. Magali-
nivTierebebs warmoq-mnis simsivnuri Tad, mwvave anTebiTi procesi da infeqcia
ujredebic, magram war-moqmnili keilonebi amuxruWebs simsivneebis zrdas, xolo qro-
am ujredebSi naklebad fiqsirdeba da nikuli anTebiTi procesi xels uwyobs av-
ujredi ganicdis mis de-ficits. amas ki Tvisebiani simsivneebis warmoSobas.
ujredebis gamravlebaze kontrolis rac Seexeba memkvidrul faqtors, am
moxsna da misi usasrulo gam-ravleba gziT gadaecema organizmis konstituciuri,
moyveba. keiloni funqciobs mxo-lod fiziologiuri, bioqimiuri, hormonuli da
zogierTi hormonis, gansakuTrebiT sxva Taviseburebebi, romlebic amcireben an
adrenalinis Tanaobisas. amitom, simsivnuri adideben simsivnis ganviTarebis Sanss, e.i.
ujredebis mier adrenalinisadmi mgrZnobe- memkvidrulad gadaecema ara simsivne, aramed
lobis daqveiTeba, rac Cveulebrivi movle- garkveuli winaswarganwyoba mis mimarT, ro-
naa, adrenoreceptorTa daTrgunvis gamo melic mJRavndeba mxolod Sesabamis piro-
iwvevs keilonis moqmedebis inaqtivacias bebSi.
Sesabamisi, ukve aRniSnuli efeqtiT. garkveuli mniSvneloba simsivnuri zrdi-
xelSemwyobi pirobebis arsebobis Sem- sTvis aqvs nervul da endokrinul sistemas.
TxvevaSi kancerogenezi gadadis Semdgom magaliTad, eqsperimentuli nevrozi aCqarebs
stadaSi - promociaSi ("waqezeba", aqtiva- simsivnur zrdas, estrogenebis xangrZlivi
cia). Seyvana organizmSi ki xSirad iwvevs hipofi-
progresiis qveS igulisxmeba zrdis zis adenomis, sarZeve jirkvlis an saSvi-
procesSi simsivnuri ujredis mzardi ga- losnos kibos ganviTarebas Tagvebsa da vir-
avTvisebianeba, morfologiuri anaplaziis TagvebSi. adamianebSi (gansakuTrebiT qalebSi)
(kataplaziis) simkveTre, tendencia avto- araiSviaTad viTardeba dishormonuli simsiv-
nomiurobis, invaziur – infiltraciuli neeebi (l.Sabadi), rig SemTxvevebSi kancero-
zrdis tempis gadidebisken. genuli agentis rolSi TviT hormonebi ga-
simsivneebis progresiis procesSi meo- modian.
radi mutaciebis gamo SeiZleba warmoiqmnas simsivnis zrda organizmze mZlavr ze-
simsivnuri ujredebis axali klonebi, war- moqmedebas axdens. ganviTarebul movlenaTa
moiSveba poliklonuri simsivneebi (sawyisi erTi nawili dakavSirebulia simsivnis da
avTvisebini simsivne upiratesad monoklo- misi metastazebis lokalizaciasTan, Sesaba-
nuria). aseTi klonuri seleqcia dominan- misi organoebisa da qsovilebis funqciis
turad yvelaze avTvisebian klons aqcevs. darRvevebTan, e.i. am rigis cvlilebebi spe-
amasTan dakavSirebiT, avTvisebiani simsivnis cifikur xasiaTs atarebs. magaliTad, saW-
sxvadasxva ubanSi SeiZleba diferencirebis mlis momnelebeli sistemis simsivneebi iwve-
sxvadasxva xarisxis mqone ujredebi gadar- ven sakvebis monelebisa da kvebis mkveTr
Cnen. darRvevebs.
12.6 organizmisa da simsivnis simsivnis zrda organizmSi iwvevs mkveTr
urTierTdamokidebuleba araspecifikur cvlilebebsac, romlebic
miuxedavad imisa, rom simsivne garkve- dakavSirebulia simsivneebSi gamomuSavebuli
uli damoukideblobiT, avtonomiiT sargeb- da warmoqmnili nivTierebebis zemoqmedebas-
138
Tan, mniSvnelovan cvlilebebTan da mikrocirkulaciis mkveTri darRveva. es
nivTierebaTa cvlaSi (ix. zemoT). darRvevebi simsivnian organizmSi nivTiere-
simsivnuri zrda mraval-ferovan morfo- baTa cvlis totalur cvlilebebTan er-Tad
funqciur cvlilebebs iwvevs organizmis organoTa atrofiisa da simsivnuri kaxeqsiis
"intaqtur" organoebsa da qsovilebSi. es mizezi xdeba.
Zvrebi udevs safuZvlad e.w. 13. nivTierebaTa cvlis tipobrivi
paraneoplaziur sindromebs, romelTa darRvevebis paTofiziologia
raodenoba 50-s aWarbebs. paraneoplaziuri 13.1. naxSirwylebis cvlis darRvevebi
sindromebi arian ara simsivnuri zrdis naxSirwylebi adamianis sakvebis umTav-
Tanmxlebi daavadebebi, aramed im biolo- resi energetikuli komponentia. Energeti-
giuri procesebis klinikuri gamovli- kuli cvlis garda, naxSirwylebi umniS-
nebebi, romlebic aRmocendebian simsivnuri vnelovanes rols asruleben metabolizmis
zrdis zegavleniT da qmnian "simsivnuri praqtikulad nebismier sferoSi. es niv-
daavadebebis arasimsivnur sindromebs". Tierebebi aucilebelia organizmis cxo-
paraneoplaziuri sindromebi xSirad velmoqmedebisTvis. gansakuTrebuli mniS-
mJRavndeba TviT simsivnis arsebobis mani- vneloba aqvT maT nervuli sistemisTvis,
festaciamde da amitom didi mniSvneloba romelic sisxlSi arsebuli glukozis
aqvT simsivneebis diagnostikaSi. amZimeben 2/3-s iyenebs .
ra ZiriTadi daavadebis mimdinareobas, isi-
ni xSirad sikvdilis uSualo mizezebi naxSirwylebis monelebis da Sewovis
xdebian. darRveva
aRsaniSnavia, rom paraneoplaziur sin- nawlavebSi naxSirwylebis fermentuli daS-
dromTa simZime yovelTvis ar korelirebs lis darRveva SedarebiT iSviaTia, radgan maT
simsivnis gavrcelebasTan da mis histolo- damSlel ferments - amilazas Seicavs rogorc
giasTan. isini mcirdeba an qreba ZiriTadi nerwyvi, ise nawlavis da pankreasis wveni. rac
daavadebis remisiebis dros. fiqroben, rom Seexeba naxSirwylebis Sewovis darRvevas, is
paraneoplaziuri sindromebis ganviTareba viTardeba nawlavis lorwovani garsis anTebis
dakavSirebulia simsivnuri ujredebis mier (enteritis), hormonuli regulaciis darRve-
sxvadasxva cilis, hormonis an jer kidev vis, ferment heksokinazas moqmedebis
ucnobi nivTierebis gamomuSavebasTan. Sim- mablokirebeli SxamebiT (magaliTad,
sivneebs aqvT rogorc simsivniT dazia- floriZini, monoiodacetati) mowamvlisas.
nebuli organoebis bunebrivi hormonis, ise heksokinazas blokirebis dros irRveva
eqtopiuri hormonebis (polipeptidebis da nawlavis kedelSi monosaqaridebis
proteinebis) warmoqmnis unari, romlebic fosforileba, rac amcirebs naxSirwylebis
organizmze sistemur gavlenas axdenen. SewovisTvis xelsayrel koncentraciis
kargadaa cnobili, rom simsivneebi gradients.
gamoimuSaveben arahormonul nivTierebeb- nawlavebSi naxSirwylebis Sewovis
sac. maTi zegavleniT organizmSi viTardeba Semcireba SeiZleba dakavSirebuli iyos maTi
movlenaTa mTeli jaWvi, romelic sxva- monelebis darRvevasTan nawlavis RruSi
dasxva sistemis, organos da qsovilis da- (magaliTad, (amilazas naklebobisas pankreasis
zianebas, maTi funqciobis, nivTierebaTa wvenSi, nawlavis amilolizuri fermentebis
cvlis darRvevas iwvevs. dabali aqtivobisas) an kedelTan monelebis
organizmis funqciebis paraneoplaziur darRvevasTan (naxSirwylebis monosaqaridebamde
moSlaSi did rols unda TamaSobdnen "in- damSleli disaqaridazebis ukmarisobisas),
taqturi" organoebisa da qsovilebis sis- agreTve monosaqaridebis transmembranuli
xlmomaragebis progresirebadi daqveiTeba
139
gadamtanebis - fosforilazebis an glukozis dakavSirebulia glukozis fosforilebaSi
gadamtani cilis GlUT5-is ukmarisobisas. monawile fermentebis (heqso- da
naxSirwylebis cvlis darRvevis da glukokinazebis) da glikolizis procesSi
hiperglikemiis uxSiresi mizezia misi monawile sxva naerTebis aqtivaciasTan. am
nervul-hormonuli regulaciis moSla. maTi hormonis deficiti iwvevs hiperglikemias, rac
metabolizmis centraluri nervuli dakavSirebulia glukozis mimarT ujredTa
regulaciis Sesaxeb cnobilia 1856 wlidan, ganvladobis SemcirebasTan, glukozis
rodesac klod bernarma daadgina, rom fosforilebis heqsokinazuri reaqciis
Cxvleta Tavis tvinis IV parkuWis fskerze SenelebasTan, glukoneogenezis procesebis
("Saqris Cxvleta") iwvevs hiperglikemias gaZlierebasTan.
(sisxlSi glukozis raodenobis momateba pankreasuli insulinuri ukmarisobis
120mg%-ze, anu 6,05 mmol/l-ze zemoT). ganviTarebaSi did rols asrulebs insulinuri
nervuli sistemis gavlenas aparatis memkvidrulad pirobadebuli
naxSirwylebis cvlaze adasturebs isic, rom potenciuri ukmarisoba.
hiperglikemia Tan sdevs hipoTalamusis ruxi pankreasgareSe insulinuri ukmarisoba
birTvis, zoliani sxeulis gaRizianebas, SeiZleba ganviTardes insulinis daSlisas
fsiqikur daZabulobas, emociebs - es e.w. sisxlSi proteolizuri fermentebis didi
emociuri hiperglikemiaa, romlis drosac raodenobiT gadasvlis gamo (magaliTad,
tvinis qerqis agzneba iradirdeba qerqqveSa qronikuli anTebiTi procesebis dros),
warmonaqmnebisken. SemdgomSi, rogorc hidrokortizonis siWarbisas, rac iwvevs
centraluri warmoSobis nebismieri heqsokinazas moqmedebis damuxruWebas. aseTive
hiperglikemiis SemTxvevaSi, impulsebi tipis insulinuri ukmarisoba viTardeba
simpaTikuri boWkoebis saSualebiT gadaecema sisxlis satransporto cilebTan insulinis
Tirkmelzeda jirkvlis tvinovan nivTierebas, zedmetad mdgradi kavSiris damyarebisas,
rac iwvevs adrenalinis gadmosrolas, radgan cilasTan SekavSirebuli insulini
adrenalini ki astimulirebs glikogenolizs araaqtiuria RviZlsa da kunTebSi (glikogenis
(glikogenis daSlas) RviZlSi da glukozis depo organoebSi), magram Cveulebrivad
gadasvlas sisxlSi. glikogenolizs moqmedebs cximovan qsovilze. cxadia, rom aseT
aZlierebs, agreTve, simpaTikuri boWkoebiT SemTxvevaSi ganviTardeba hiperglikemia da,
RviZlamde misuli impulsebi. amave dros, cximi dagrovdeba Sesabamis
naxSirwylebis cvlis hormonuli depoebSi, e.i. Camoyalibdeba "msuqanTa diabetis"
regulaciis darRveva viTardeba ara marto niSnebi. pankreasgareSe insulinuri ukmarisoba
Sesabamisi endokrinuli jirkvlebis viTardeba, agreTve, qsovilebis insulinisadmi
funqciobis centraluri regulaciis mgrZnobelobis daqveiTebisas, rac
moSlisas, aramed TviT jirkvlebis dakavSirebulia ujredebis insulinuri
paTologiis an hormonebis moqmedebis receptorebis raodenobisa da insulinisadmi
periferiuli meqanizmebis cvlilebis maTi Sesatyvisobis SemcirebasTan.
drosac. pankreasgareSe insulinuri ukmarisoba
gansakuTrebuli mniSvneloba SeiZleba ganviTardes sisxlSi insulinis
naxSirwylebis cvlaSi aqvs pankreasis normaluri an daqveiTebuli raodenobis
langerhansis kunZulebis (β-ujredebis fonzec. fiqroben, rom amis mizezia sisxlSi
hormons - insulinsa da (α-ujredebis insulinis antagonistis arseboba.
hormons – glukagons. insulini xels pankreasgareSe insulinur ukmarisobas adgili
uwyobs naxSirwylebis fiqsacias, wvas, aqvs, agreTve, organizmSi insulinis
aTvisebasa da naxSirwylebis cximad sawinaaRmdego antisxeulebis warmoqmnis
gardaqmnas. misi moqmedebis meqanizmi drosac.
140
hiperglikemia viTardeba glukagonis da ukuSewova (e.w. Tirkmlismieri diabeti).
kontrinsulinuri hormonebis - adrenalinis, sisxlsa da SardSi Saqris raodenobis
Tiroqsinis, glukokortikoidebis, agreTve, cvlilebiT xasiaTdeba fruqtozuria,
somatotropinisa da kortikotropinis galaqtozuria, pentozuria (ix. qvemoT).
siWarbisas (hormonuli hiperglikemia). alimenturi hiperglikemia viTardeba didi
glukagoni aZlierebs glikogenolizs raodenobiT naxSirwylebis miRebisas da
RviZlSi, glukoneogenezs, lipolizs, aqvs droebiT, tranzitorul xasiaTs atarebs.
insulinmastimulirebeli moqmedeba. imis hiperglikemiis am saxes e.w. SaqriT datvirTvis
miuxedavad, rom insulini da glukagoni cdis saxiT iyeneben klinikaSi naxSirwylebis
urTierTsawinaaRmdegod moqmedeben sisxlSi cvlis Sesafaseblad. aRsaniSnavia, rom ukve
Saqris raodenobaze, isini mainc Saqris moxvedra piris RruSi, aq arsebuli
sinergistebad iTvlebian, ramdenadac receptorebis gaRizianebis gamo, refleqsurad
glukagoni uzrunvelyofs ujredebs iwvevs xanmokle hiperglikemias.
glukoziT, insulini ki xels uwyobs mis Saqriani diabeti (diabetes mellitus) friad
utilizacias ujredebis mier. gavrcelebuli paTologiaa, romelic viTardeba
adrenalinuri hiperglikemiac RviZlSi insulinis absoluturi an SefardebiTi
glikogenolizis Sedegia. naklebobisas da xasiaTdeba nivTierebaTa cvlis
mkveTri hiperglikemiis SemTxvevaSi, totaluri, gansakuTrebiT ki naxSirwylebis
rodesac glukozis done sisxlSi Warbobs cvlis darRveviT.
Tirkmelis gamoyvanis zRurbls mis mimarT Saqrian diabets axasiaTebs mZime
(180 mg%), viTardeba glukozuria garTulebebi, invalidobis da letalobis
(glukozis arseboba SardSi). rogorc maRali procenti. Saqriani diabeti da
cnobilia, glukoza yovelTvis aris gamsuqneba, erTi mxriv, da arteriuli
pirvelad, provizorul SardSi, saidanac hipertenzia da gulis isqemiuri avadmyofoba,
xdeba misi ukuSewova Saqris fosforilebis meore mxriv, Seadgenen "metabolur sindroms",
(heqsokinazas saSualebiT) da Semdgomi "sasikvdilo kvartets". jandacvis msoflio
defosforilirebis (fosfatazas organizaciis monacemebiT, Saqriani diabeti
saSualebiT) gziT. Tu pirvelad SardSi pacientTa saerTo sikvdilobas 2-3-jer zrdis.
glukozis koncentracia maRalia (rasac is sicocxlis xangrZlivobis saerTo saSualo
adgili aqvs Zlieri hiperglikemiis dros), maCvenebels 7%-iT amcirebs.
igi pirveladi Sardidan mTlian ukuSewovas ganasxvaveben pirvelad da meorad Saqrian
aRar ganicdis da rCeba saboloo, definitur diabets. meoradi Saqriani diabeti kuWqveSa
SardSi. amitom, glukozuria xSirad jirkvlis dazianebiT mimdinare romelime
hiperglikemiis Sedegia. daavadebis (anTeba, simsivne) an toqsikuri
glukozuria SeiZleba ganviTardes dazianebis dros ganviTarebuli "diabeturi"
hiperglikemiis gareSec. eqsperimentSi aseTi ("hiperglikemiuri") sindromia. mas ganixilaven,
suraTi miiReba organizmSi glikozid rogorc darRvevaTa heterogenul jgufs,
floriZinis Seyvanisas. floriZini romelsac safuZvlad udevs genetikuri da
ablokirebs heksokinazas, ris gamo aRar garemo faqtorebis zemoqmedeba.
xdeba glukozis defosforileba da, pirveladi Saqriani diabeti
Sesabamisad, misi ukuSewova pirveladi metabolizmis insulinuri regulaciis
Sardidan, glukoza rCeba definitur SardSi. darRvevis idiopaTiuri formaa.
klinikaSi glukozuria hiperglikemiis amgvarad, Saqriani diabeti viTardeba an
gareSe SeiZleba ganviTardes Tirkmlis insulinis absoluturi deficitis, an
milakebis iseTi dazianebisas, romlis dros insulinis efeqtebis ukmarisobis gamo sisxlis
Seferxebulia pirveladi Sardidan Saqris
141
plazmaSi misi momatebuli, normaluri an jgufiT: nivTierebaTa cvlis mravalferovani
daqveiTebuli Semcvelobis dros. moSliT da organoebsa da qsovilebSi mis gamo
daavadebis paTogenezis kidev erTi ganviTarebuli paTologiiT ( sur.13-1).
aspeqtis - masSi imunuri procesebis rolis avdmyofobis dros mkveTrad mcirdeba
mixedviT, Saqriani diabets yofen I da II glikogenis sinTezi, brkoldeba glukozis
tipis diabetad. pirvels miekuTvneba Saqriani gardaqmna cximad, misi aTviseba ujredebis
diabeti, romlis etiologiaSi umTavres mier, Cqardeba glukoneogenezi (glukozis
rols (β-ujredebis mimarT imunuri agresia warmoqmna aranaxSirwylovani cvlis
asrulebs). produqtebisgan). yovelive zemoTqmulis gamo,
etiologia viTardeba hiperglikemia. hiperglikemiis
insulindamokidebuli diabetis mniSvneloba Saqriani diabetis paTogenezSi
etiologia multifaqtorulia. iTvleba, rom orgvaria. erTi mxriv, mas adaptaciuri xasiaTi
egzogenur faqtorebs, maT Soris virusebs aqvs, radganac hiperglikemiis pirobebSi
da qimiur nivTierebebs, autoimunuri muxruWdeba glikogenis daSla, glukoza ufro
procesis gamowvevis gziT ZaluZT advilad aRwevs ujredebs, qsovilebs da isini
langerhansis kunZulebis (β-ujredebis ar ganicdian glukozis mkveTr ukmarobas.
citolizis provocireba. magram hiperglikemias uaryofiTi mxarec aqvs,
fiqroben, rom ujredebis citolizis radgan sisxlSi Saqris momatebisas izrdeba
gamowveva SesaZlebelia mxolod imunuri gluko- da mukoproteidebis raodenobac,
pasuxis genetikurad winaswarganwyobili romlebic, ileqebian ra SemaerTebel qsovilSi,
Taviseburebebis mqone individebSi. xels uwyoben hialinis warmoqmnas. es
faqtorebs, romlebsac ZaluZT Saqriani gansazRvravs Saqriani diabetis Zalze xSir
diabetis gamowveva, diabetogenuri ewodeba. garTulebas - sisxlZarRvTa kedlebis
gasaTvaliswinebelia, rom verc erTi maTgani aTerosklerozis ganviTarebas. es procesi
ver iwvevs Saqrian diabets 100%-Si da im vrceldeba koronarul sisxlZarRvebze
individebSi, romlebsac ar aqvT garkveuli (koronaruli ukmarisobis ganviTarebiT),
winaswarganwyoba insulinuri aparatis Tirkmlis sisxlZarRvebze
potenciuri ukmarisobisadmi. (glomerulonefritis ganviTarebiT), kidurebis
Saqriani diabeti SeiZleba gamowveuli sisxlZarRvebze (sisxlZarRvebis
iyos yvela im mizeziT, romelic iwvevs obliteraciisa da gangrenis ganviTarebiT) da
pankreasul da pankreasgareSe insulinur a.S. meore tipis Saqrian diabets xSirad Tan
ukmarisobas. daavadebis ganviTarebaSi did sdevs arteriuli hipertenzia.
rols asrulebs memkvidruli, fsiqikuri da im SemTxvevaSi, rodesac glukozis
alimenturi faqtorebi. rogorc aRiniSna, raodenoba sisxlSi gadaaWarbebs 170-180 mg%-
Saqriani diabetis aRmoceneba SeiZleba s, Tirkmlis milakebSi mimdinare Saqris
dakavSirebuli iyos langerhansis kunZulebis fosforilebis da defosforilebis procesi
memkvidrul arasrulfasovnobasTan, romelic (romlebic normaSi uzrunvelyofs Saqris
vlindeba iseTi maprovocirebeli faqtorebis mTlian rezorbcias pirveladi Sardidan) ver
zemoqmedebisas, rogorebicaa infeqcia, uzrunvelyofs Saqris mTlian rezorbcias
intoqsikacia, xangrZlivi emociuri pirveladi Sardidan da glukoza rCeba
daZabuloba an fsiqikuri travma, sakvebad saboloo SardSi - viTardeba glukozuria.
didi raodenobiT cximis da, gansakuTrebiT, Saqris siWarbis gamo Sardis osmosuri wneva
naxSirwylebis gamoyeneba. maRalia. amitom, saboloo SardSi gadadis
paTogenezi bevri wyali, Sardis raodenoba mkveTrad
Saqriani diabeti xasiaTdeba izrdeba (poliuria), wylis didi raodenobiT
urTierTdakavSirebuli darRvevebis ori
142
kargvis gamo qsovilebi Sreba da Sedegad cximovani qsovilidan. Sesabamisad viTardeba
viTardeba wyurvili - polidifsia. sigamxdre, sisxlSi matulobs cximi
(hiperlipemia). cximmJavebi RviZlSi
resinTezirdeba trigliceridebad, rac qmnis
RviZlis cximovani gadagvarebis saSiSroebas.
bycekbybc gacximeba ar xdeba im SemTxvevaSi, Tu
rfnfhfmnf
ervfhbcj,fpankreasis sadinrebis epiTelur ujredebSi ar
kbgjkbpb
aris darRveuli lipokainis warmoqmna. Saqrian
diabets, romlis drosac adgili aqvs
fkljhtlemnfpf
ytbhjgfsbf cjh,bnjkb insulinis ukmarisobas lipokainis produqciis
/bgthukbrtvbf /bgthkbgbltvbf
daurRvevlad, kunZulovani ewodeba. am formis
dros RviZlis gacximeba ar xdeba. insulinuri
ukmarisobis ganviTareba lipokiainis
vbrhjfyujgfsbf ukerjpehbf sfdbceafkb
arasakmaris produqciasTan erTad diabetis fsthjcrkthjpb
suraTs iZleva, romelsac w[bvv;fdt,bc
Tan sdevs RviZlis
gacximeba. vjvfnt,f cbc[kib
wbkbc ukbrjpbht,f
gjkbehbf
imis gamo, rom Saqriani diabetis dros
Zlierdeba cximmJavebis gadasvla
rtnjytvbf cximis
rfgbkfht,bc ,fpfkehb depoebidan RviZlSi da maTi Jangva
vtv,hfybc lfpbfyt,f o.ehdbkb
ketosxeulebad, mcirdeba am mJavebis
resinTezi, irRveva ketonuri fwbljpbsxeulebis Jangvarjvf lf
krebsis ciklis darTgunvis gamo, viTardeba cbrdlbkb
ufeo.kjdfyt,f
ketonemia - sisxlSi mkveTrad matulobs
ketosxeulebis (acetoZmarmJava, acetoni, β-
rfkbevbc lf
oqsierbomJava) raodenoba, rac iwvevs
yfnhbevbc rfhudf
arakompensirebul acidozs, organizmis Zlier
sur. 13-1. insulinis intoqsikacias, fermentebis moqmedebis,
ukmarisobisbSedegebi diabeturi centraluri nervuli sistemis funqciobis
sindromis dros daTrgunvas da am gziT terminaluri
mdgomareobis - diabeturi komis ganviTarebas:
insulinis naklebobisas ujredebi gonebis dakargva, pulsi xSiri, susti avsebis,
jerovnad ver iTviseben sisxlis mier didi adgili aqvs hipotenzias, periodul sunTqvas.
raodenobiT motanil glukozas. amitom
organizmi nawilobrivi SimSilis 13.2 cilebis cvlis darRveva
mdgomareobaSi vardeba. amiTaa gamowveuli cila gadamwyvet rols asrulebs
avdmyofis mier sakvebis didi raodenobiT organizmis cxovelmoqmedebaSi, radgan aris
miReba polifagia. zogjer Tavs iCens e.w. Seunacvladi aminmJavebis da azotis wyaro,
mglis mada - bulimia. normaluri da paTologiuri zrdisa da
cximovani cvla Saqriani diabetis dros ganviTarebis ganmsazRvreli, nivTierebaTa
xasiaTdeba naxSirwylebisgan cximebis cvlis regulaciis safuZveli fermentebis
warmoqmnis da cximovan qsovilSi cximovani warmoqmnis gziT, memkvidruli informaciis
mJavebidan trigliceridebis resinTezis gadacemis saSualeba. cilis cvlis darRvevis
darRveviT. somatotropuli hormonis sxvadasxva varianti uklebliv yoveli
lipolizuri aqtivobis mateba (rac paTologiuri procesis paTogenezis
ferxdeba insulinis moqmedebiT), aZlierebs komponentia.
lipolizs da cximovani mJavebis gamosvlas
143
yvelaze zogad formaSi msjeloba cilis nawlavis anTeba), nawlavis kedlis SeSupebis,
cvlis Sesaxeb SeiZleba azotovan pankreasis funqciis moSlis dros.
wonasworobaze dakvirvebiT. janmrTeli angariSgasawevia is faqti, rom ama Tu im
mozrdili organizmi gamohyofs imdenive paTologiuri procesis dros aminmJavebi
azotovan nivTierebas, ramdensac iRebs RviZlSi SeiZleba moxvdnen sxvadasxva
sakvebiT. gadaxrebi azotovani proporciiT. erTi Seunacvladi aminmJavas
wonasworobidan SeiZleba gamoixatos deficiti ki qmnis sxvaTa SedarebiT siWarbes,
dadebiTi an uaryofiTi azotovani balansiT. rac cilovani cvlis seriozul darRvevas
dadebiTi azotovani balansis iwvevs.
SemTxvevaSi organizmi azotovan nivTierebebs cilis sinTezisa da daSlis darRveva
miRebulze ufro mcire raodenobiT cilis sinTezi SeiZleba dairRves Semdegi
gamohyofs. magaliTad, bavSvTa asakSi, faqtorebis zemoqmedebiT:
orsulobisas, regeneraciisas, SimSilis 1. cilebSi aminmJavebis Semcvelobis
dros, anaboluri hormonebis arasrulyofiloba.
(somatotropuli da zogierTi sasqeso 2. genebis paTologiuri mutaciebi (es
hormoni, insulini) siWarbisas. Seexeba rogorc paTologiuri struqturuli
uaryofiTi azotovani balansi iseTi genebis gaCenas, ise normaluri
mdgomareobaa, rodesac organizmi gamohyofs maregulirebeli da struqturuli genebis
ufro met azotovan nivTierebas, vidre ararsebobas).
iRebs. is gvxvdeba proteinuriis, infeqciuri 3. humoruli faqtorebiT im fermentTa
avdmyofobebis, travmis, damwvrobis, blokireba, romlebic monawileoben cilis
qirurgiuli operaciebis, kataboluri sinTezSi.
hormonebis (glukokortikoidebi, Tiroqsini) 4. im kataboluri da anaboluri
siWarbis dros. faqtorebis urTierTSefardebis darRveva,
cilis cvlis darRvevis tipobrivi romlebic aregulireben cilis sinTezs.
saxeebi da maTi meqanizmebi ujredSi erTi Seunacvladi aminmJavis
cilovani cvla SeiZleba dairRves mis ararsebobac ki wyvets cilis sinTezs.
sxvadasxva etapze, ris mixedviT SeiZleba ukanaskneli icvleba maSinac, rodesac
gamoiyos cilis cvlis tipobrivi darRveulia organizmSi Sesuli Seunacvladi
darRvevebi. aminmJavebis urTierTSefardeba.
organizmis normaluri cilis sinTezi irRveva struqturuli
cxovelmoqmedebisTvis gansakuTrebuli genebis paTologiuri mutaciebis dros, ris
mniSvneloba aqvs sakvebSi cilis Semcvelobis gamo informaciul rnm-s moaqvs mcdari
da Semadgenlobis Sesabamisobas organizmis informacia romelime aminmJavas saxis an cilis
moTxovnilebasTan. sakvebiT miRebulma cilam, molekulaSi misi CarTvis adgilis Sesaxeb.
srulad unda aanazRauros misi danaxarji magaliTad, namgliseburi anemiis SemTxvevaSi
da moTxovna Seunacvlad aminmJavebze. (ix. "sisxlis paTofiziologia").
cxadia, rom sakvebSi cilis nakleboba cilis sinTezis darRveva, zogierT
ganviTardeba absoluturi da sruli SemTxvevaSi, gamoixateba garkveuli saxis
SimSilis dros. cilis sinTezis genetikurad pirobadebuli
cilis monelebis da Sewovis darRveva SewyvetiT, magaliTad, globulinebisa, ris
organizms ar aqvs cilis depo, amitom, Sedegad viTardeba agamaglobulinemia.
cilebis Sewovisa da monelebis darRvevas bunebrivia, rom im fermentTa sinTezis
misi alimenturi ukmarisoba mohyveba. darRveva, romlebic aregulireben cilisa da
cilis rogorc daSlis, ise Sewovis aminmJavebis gardaqmnas, iwvevs cilis
darRveva viTardeba enteritis (wvrili
144
Sualeduri cvlis paTologiasa da sistema), mcirdeba Jangbadis moxmareba,
aminmJavaTa metabolizmis moSlas. viTardeba koma.
cilis Sualeduri cvlis darRvevebidan
gansakuTrebiT mniSvnelovania aminmJavebis
gardaqmnis universaluri gzebis - 15.5. lipidebis cvlis darRveva
dezaminirebis da gadaaminirebis cximebis monelebis da Sewovis darRveva.
(transaminirebis) cvlilebebi. cximebis normaluri Sewovis aucilebeli
dezaminirebisas aminmJavebi iSleba, pirobebia maTi emulgireba, glicerinad da
gadaaminirebisas ki axali aminmJavebi cximmJavebad daSla, naRvelmJavebTan
warmoiqmneba. SeerTebis gziT qoleinatebis warmoqmna.
cilovani cvlis bolo etapis naRvlis sekreciis an Tormetgoja nawlavSi
darRveva dakavSirebulia azotovani misi gadasvlis Sewyveta (RviZlis da
produqtebis (Sardovana, amoniaki, SardmJava) sanaRvle gzebis daavadebebi, pankreasis Tavis
warmoqmnisa da maTi gamoyofis kibo) cximis Sewovis darRvevas iwvevs,
cvlilebebTan. radgan naRvelmJavebis gareSe wydeba cximis
cilovani cvlis saboloo etapis Sesaxeb emulgireba. Tu cximma nawlavis da
ZiriTadad msjeloben sisxlSi narCeni pankreasis wvenSi Semavali fermentebis
(aracilovani) azotis raodenobis an gavleniT mainc ganicada umniSvnelo
Semadgenlobis gansazRvris safuZvelze. hidrolizi, warmoqmnili cximmJavebi
narCeni azotis Semcveloba sisxlSi normis qoleinatebis warmoqmnis Sewyvetis gamo
pirobebSi - 20-30 mg%-ia, misi 50% mainc ar Seiwoveba.
Sardovanaa, 25% - aminmJavebi, xolo cximis moneleba da Sewova irRveva
danarCeni ki sxva azotovani produqtebia. pankreasis wvenis fermentebis sekreciis
narCeni azotis momateba sisxlSi moSlisas (pankreatiti, pankreasis mwvave
gamowveulia RviZlis mier Sardovanas nekrozi, sklerozi), nawlavis epiTeliumis
warmoqmnis moSliT (produqciuli anu funqciis daqveiTebisas, nawlavebis
RviZlismieri hiperazotemia) an Tirkmlis peristaltikis gaZlierebisas, radgan cximi
gamomyofi funqciis darRveviT (retenciuli am pirobebSi Sewovas ver aswrebs. aseTi
anu Tirkmlismieri hiperazotemia). suraTi viTardeba wvrili nawlavis anTebis
aminmJavebis daSlis saboloo (enteriti), A- da B-hipovitaminozebis,
produqtebia amoniaki, Sardovana, CO2 da trigliceridebis resinTezSi monawile
H2O. amoniaki warmoiqmneba dezaminirebis fermentebis warmoqmnis darRvevis, wvrili
procesSi ujredis protoplazmaSi da mas nawlavis epiTeliumis infeqciuri da
toqsikuri moqmedeba axasiaTebs. amoniakis toqsikuri dazianebis dros.
inaqtivacia RviZlSi mimdinareobs Sardovanas cximis gamoyofis darRveva
warmoqmnis gziT, sxva qsovilebSi ki organizmi iTvisebs miRebuli cximis
amoniaki uerTdeba glutaminis mJavas 95%-s, mcire nawili gamoiyofa ganavalTan
(amidireba) da warmoiqmneba glutamini. erTad, kanis jirkvlebiT, SardSi ki cximis
Sardovanas masinTezebeli fermentis mxolod niSnebia. cximis Sewovis darRvevis
aqtivoba mcirdeba RviZlis paTologiis dros ganavali Seicavs didi raodenobiT
(hepatitebi, cirozi), hipo-proteinemiis, dauSlel cxims da umaRles cximmJavebs
JangviTi forsforilebis dros; sisxlsa da (steatorea), ris Sedegad ganavali
qsovilebSi grovdeba amoniaki (amoniemia), monacrisfro-TeTri ferisaa. cximis didi
viTardeba Zlieri intoqsikacia (romlis raodenobiT miReba, Zvlis tvinis travmuli
mimarT gansakuTrebiT mgrZnobiarea nervuli dazianeba, cximovani qsovilis masiuri
dazianeba, lipoiduri nefrozi SardSi
145
cximis didi raodenobiT gaCenas - lipurias cximis Sualeduri cvlis darRveva
iwvevs. cximis Sualeduri cvlis darRveva
cximis transportirebis da misi qsovilebSi vlindeba aceto- anu ketosxeulebis
gadasvlis darRveva (acetoni, -oqsierbomJava, acetoZmarmJava)
neitraluri cximi cirkulirebs dagrovebiT.
sisxlSi qilomikronebis (romlebic 1%- acetosxeulakebis momatebas sisxlSi
mde cilebs da 99% cximebs Seicavs) da (normaSi 0,02-0,04 g/l) acetonemia anu
-lipoproteidebis saxiT. normaSi ketonemia ewodeba. acetonemia iwvevs
neitraluri cximis Semcveloba sisxlSi 1- aRniSnuli sxeulakebis gadasvlas SardSi -
2 g/l-ia. acetonurias (ketonurias), ris gamo Sards
sisxlSi cximis raodenoba droebiT, acetonis suni aqvs. acetosxeulakebi
tranzitorulad matulobs cximis Warbad gamoiyofa filtvis gziTac amosunTqul
miRebisas (alimenturi hiperlipemia), haerTan erTad da amitom avadmyofs
depoebidan cximis gaZlierebuli mobiliza- ketonemiisas acetonis suni aqvs.
ciisas (transportuli hiperlipemia), ketonemia viTardeba naxSirwylebis
cximis qsovilebSi gadasvlis darRvevis deficitis dros (Saqriani diabeti,
dros (retenciuli hiperlipemia). SimSili), RviZlis glikogeniT gaRaribebisas
alimenturi hiperlipemia, romelic da krebsis ciklis Sesustebis Sedegad. am
iwyeba cximis didi raodenobiT miRebidan SemTxvevaSi RviZlSi Warbad motanili
2-3 saaTSi da normamde qveiTdeba 9 saaTis cximmJavebi iJangeba acetoZmarmJavamde,
Semdeg, Zlierdeba da xangrZlivdeba arasakmarisi xdeba ketosxeulebidan
heparinis warmoqmnis darRvevisas (ris cximmJavebis resinTezi, risTvisac
gamo ar xdeba lipoproteiduli lipazas glikolizis energiaa saWiro.
gaaqtiveba), natriumis qloridis, simsuqne. simsuqne cximovan qsovilSi
naRvelmJavebis moqmedebisas, romlebic cximis Warbad dagrovebaa. mis ganviTarebaSi
lipoproteiduli lipazas inhibitorebi garkveul rols asrulebs memkvidruli
arian. faqtori, romelic gansazRvravs cximovan
transportuli hiperlipemia viTardeba qsovilSi cximovani ujredebis -
SimSilis dros somatotropuli hormonis, lipocitebis raodenobas da sidides.
glukagonisa da adrenalinis gamomwvevi mizezebis mixedviT
kooperaciuli moqmedebis Sedegad. ganasxvaveben alimentur, cerebrul da
hiperlipemia viTardeba, agreTve, hormonul simsuqnes. mis ganviTarebaSi
filtvebis gaZlierebuli ventilaciis monawileobs ramdenime paTogenezuri
pirobebSi, rac iwvevs cximis mobilizebas faqtori: energetikul danaxarjebTan
filtvebidan (magaliTad, momRerlebSi). SedarebiT didi raodenobiT sakvebis miReba,
retenciuli hiperlipemia viTardeba neiropeptidis sekreciis gaZliereba
sisxlSi lipoproteiduli lipazas hipoTalamusSi, leptinis deficiti,
raodenobis daqveiTebisas (ix. zemoT), rac lipolizis simcire, depo organoebidan
iwvevs proteidebTan SekavSirebuli cximis mobilizebis Semcireba,
trigliceridebis daSlas da am gziT naxSirwylebidan cximis gaZlierebuli
Tavisufali cximmJavebis warmoqmnis warmoqmna.
dabrkolebas. aseT hiperlipemias aqvs didi raodenobiT sakvebis miRebas adgili
adgili hipoalbuminemiis drosac aqvs madis gaZlierebisas, rac
(magaliTad, SimSili, nefrozebi), radgan dakavSirebulia hipoTalamusSi mdebare kvebis
cximmJavebi sisxlidan qsovilebSi centris agznebasTan. hipoTalamusis
albuminebTan SeerTebisas gadadian. ventrolateraluri birTvebis gaRizianeba da
146
ventromedialuri birTvebis dangreva uaresdeba gulis sisxlmomarageba da
eqsperimentSi iwvevs madis momatebas, kumSvadoba, xSirad viTardeba
maZRrobis grZnobis gaqrobas, polifagias aTerosklerozi, matulobs arteriuli wneva,
(sakvebis didi raodenobiT miReba) da e.w. sisxlis Sededebis unari, viTardeba
hipoTalamuri simsuqnis ganviTarebas. Trombozebi; araiSviaTia Tavis tvinSi
klinikaSi misi analogi Suamdebare tvinis sisxlis mimoqcevis darRveva; mcirdeba
toqsikuri, infeqciuri, travmuli an filtvis sasicocxlo tevadoba, misi
simsivnuri dazianebis dros ganviTarebuli ventilacia, mcire fizikuri datvirTvis
diencefaluri simsuqnea. aRniSnuli drosac ki aRiniSneba qoSini. simsuqnis
centris agznebas amuxruWebs signalizacia fonze xSirad viTardeba
saWmlis momnelebeli milis, gansakuTrebiT insulinrezistentuli Saqriani diabeti.
ki kuWis kedlebSi arsebuli
receptorebidan. kuWis gaganierebis dros
es receptorebi naklebad Riziandebian
sakvebis masiT, da, Sesabamisad, maTSi
aRmocenebuli aferentuli impulsaciiT
kvebis centris funqciis Sekaveba ar xdeba.
Sedegad viTardeba polifagia da simsuqne.
qsovilebSi cximis Calagebis da
depoebidan misi mobilizebis regulireba
nervuli da endokrinuli sistemebis
saSualebiT xorcieldeba. simpaTikuri
nervuli sistemis tonusis daqveiTeba
cximis mobilizebis Semcirebas iwvevs.
aseTive suraTi yalibdeba fariseburi
jirkvlis da hipofizis hipofunqciisas,
radgan somatotropuli, Tireotropuli
hormonebi da Tiroqsini aaqtiureben
cximis gamotanas depoebidan da mis
Semdgom daJangvas. maTi naklebobis dros
lipolizi ferxdeba.
adrenokortikotropuli hormonis,
glukokortikoidebisa da insulinis Warbi
raodenobiT gamoyofa xels uwyobs
naxSirwylebisgan cximebis warmoqmnas da
mis Calagebas qsovilebSi. sasqeso
jirkvlebis funqciis daqveiTeba, Tu mas
Tan sdevs hipoTalamuri centrebis
funqciis darRvevac, aseve aZlierebs
cximebis Calagebas da iwvevs simsuqnes.
xangrZlivi da Zlieri simsuqne iwvevs
mravali Sinagani organos datvirTvis
zrdas da struqturul Zvrebs,
metabolizmis darRvevas maTSi. simsuqnis
dros izrdeba datvirTva gulze.
miokardiumSi cximis Calagebis gamo
147
13.4. wylis cvlis darRveva fazis intensivoba, xolo meore Zalis (O1-O2)
organizmSi wylis saerTo Semcveloba veqtori mimarTulia sawinaaRmdego mxares -
damokidebulia sxeulis masaze, asakze da ujredSoris sivrcidan kapilaris
sqesze. asakTan erTad wylis Semcveloba mimarTulebiT da ganapirobebs rezorbcias.
organizmSi progresulad mcirdeba: sxeulis filtracia xorcieldeba im SemTxvevaSi, Tu
saerTo masis 95%-dan embrionSi - 55%-mde h1-h2>O1-O2, xolo rezorbcia xorcieldeba
mozrdil adamianSi. maSin, Tu h1-h2<O1-O2. dadgenilia, rom
rogorc normis, ise paTologiis filtracia normaSi mimdinarebs kapilaris
pirobebSi wylis cvlis regulaciaSi arteriul nawilSi, e.i. sadac h1-h2>O1-O2,
monawileobs adgilobrivi da zogadi xolo rezorbcia xdeba venur boloSi, sadac
meqanizmebi. umTavresi adgilobrivi meqanizmi, h1-h2<O1-O2 (sur. 13-2).
romelic, cxadia, zogad procesebzec
mniSvnelovnadaa damokidebuli, transudaciaa.kapilaris
h1=30 O1=23 h1=12 O1=28
transudacia - sisxlZarRvis kedlis gavliTarteriuli
nawili A=+17
qsoviluri siTxis cvlis procesi, Sesdgeba
ori fazis - filtraciisa da h2=0 O2=10 h2=0 O2=10
itiegt,f
produqcia, viTardeba hipernatriemia, rac
osmoreceptorebis gaRizianebis gziT iwvevs
rogorc iTqva, SegubebiTi SeSupeba, antidiurezuli hormonis (vazopresinis) didi
romelic gamowveulia sisxlis mimoqcevis raodenobiT gamoyofas. amas mohyveba wylis
zogadi ukmarisobiT, ufro rTuli ukuSewovis gaZliereba pirveladi Sardidan da
paTogenezisaa. aq procesSi CaerTvebian misi Sekaveba organizmSi. nefrituli SeSupebis
refleqsuri meqanizmebic, romlebsac ganviTarebaSi garkveul rols kapilarebis
mivyavarT renin-angiotenzin-aldosteronis kedlebis ganvladobis zrdac TamaSobs.
sistemis aqtivaciamde. sqemaze warmodgenil ganvladobis zrdis gamo kapilarebidan
reaqciebs kompensaciuri xasiaTi aqvT. isini qsovilTaSua sivrceSi gadadis cila da
mimarTulni arian mocirkulire sisxlis matulobs qsovilebis hidrofiloba, rac maTSi
moculobis aRdgenisaken. magram paTologia, wylis dagrovebas uwyobs xels.
pirvel rigSi ki gulis ukmarisoba, xSirad nefrozuli SeSupeba (sur.13-6) viTardeba
iwvevs situaciis Camoyalibebas - gulis Tirkmlis klaknili milakebis dazianebisas. am
dekompensaciisas viTardeba Segubeba SemTxvevaSi adgili aqvs Sardis gziT cilis,
moculobiT sisxlZarRvebSi (venebSi), ZiriTadad albuminebis, didi raodenobiT
mcirdeba gulisken dabrunebuli sisxlis kargvas, rasac hipoproteinemiamde
raodenoba. amrigad, miuxedavad imisa, rom mivyavarT.hipoproteinemiis gamo mcirdeba
sisxlis saerTo raodenoba ar mcirdeba, sisxlis koloidur-osmosuri wneva, rac
cirkulaciaSi aRmoCndeba sisxlis naklebi amcirebs qsovilebidan wylis rezorbcias da am
masa, anu Seiqmneba hipovolemiis analogiuri gziT iwvevs SeSupebas. meores mxriv, siTxis
mdgomareoba. amis gamo CairTveba gaZlierebuli transudacia kapilarebidan xels
zemoaRniSnul procesTa jaWvi. Sedegad uwyobs hipovolemias, ris gamo CairTveba
adgili aqvs hipernatriemias, wylis natriumis gamoyofis aldosteronuli
reabsorbciis gaZlierebas Tirkmlis meqanizmi, Warbad gamoiyofa antidiurezuli
milakebSi da sisxlis saerTo moculobis hormoni da organizmSi grovdeba wyali.
gazrdas. sisxlis masis momateba moculobiT kaxeqsiuri SeSupebis paTogenezSi wamyvani
sisxlZarRvebSi iwvevs venuri wnevis zrdas, roli ekuTvnis hipoproteinemias, romelic
rac xels uwyobs SeSupebis ganviTarebas. ase viTardebaa) SimSilobisas,b) organizmis
viTardeba "regulaciis Secdoma". gamomfitavi daavadebis dros (rogoricaa,
Tirkmelebis daavadebebis dros SeiZleba magaliTad, avTvisebiani simsivne),g) cilis
ganviTardes nefrituli, nefrozuli tipis sinTezisa da Sewovis darRvevis
SeSupeba an maTi kombinacia. SemTxvevaSi.hipoproteinemiis Sedegad ecema
nefrituli SeSupeba (sur.13-5) viTardeba sisxlis koloidur-osmosuri wneva (O1), rasac
nefritebis dros. mas safuZvlad udevs mivyavarT O1-O2 Zalis Semcirebamde, e.i.
erTis mxriv filtraciis Semcireba sabolood rezorbciis Sesustebamde. amave
Tirkmlis gorglebSi da amiT gamowveuli dros izrdeba kapilarebis kedlebis
wylis dagroveba organizmSi. meores mxriv, ganvladoba, rac dakavSirebulia maTi trofikis
am tipis SeSupebis ganviTarebaSi did rols moSlasTan. es ganapirobebs sisxlidan
TamaSobs sisxlis mimoqcevis darRveva qsovilur siTxeSi cilebis ufro intensiur
TirkmelebSi, rac Tirkmlis gorglebis ga-dasvlas, rac erTis mxriv iwvevs
kapilarebSi wnevis dacemas da, amis gamo hipoproteinemiis gaRrmavebas da sisxlis
iuqstaglomeruluri aparatis mier reninis koloidur-osmosuri wnevis (O1) kidev ufro
gaZlierebul produqcias iwvevs. mkveTr dacemas, meores mxriv ki qsoviluri
ukanasknelis Sedegad, zemomoyvanili siTxis koloidur-osmosuri wnevis (O2-is)
meqanizmiT Zlierdeba aldosteronis momatebas, e.i. O1-O2 Zalis Semdgom dacemas.
151
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o.kbc rkfrybk
htpjh,wbbc itvwbht,f yfn
vbkfrt,ib
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o.kbc itrfdt,f mcjdbkt,ib
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j
itiegt<f
sur. 13-6. nefozuli SeSupebis
sur. 13-5. nefrituli SeSupebis meqanizmi
meqanizmi
152
sicocxlisTvis aucilebeli Tu organizmSi vitaminebze gaZlierebul
dabalmolekuluri naerTebi - vitaminebi moTxovnilebaa (magaliTad, mozard asakSi,
uaRresad mniSvnelovan rols asruleben laqtaciis periodSi, intensiuri fizikuri
organizmis ganviTarebasa da datvirTvisas, infeqciuri daavadebebis dros).
cxovelmoqmedebaSi. rogorc wesi, isini meoradi (endogenuri)
arian kofermentebi an maTi komponentebi. hipovitaminozebi viTardeba nawlavebSi
dRes cnobilia ramdenime aseuli fermenti, vitaminebis Sewovis, maTi tranportirebis,
romelTa kofermenti vitaminia. deponirebis, SeTvisebis da gamoyenebis
vitaminebi, vitamerebi da maTi funqciebi darRvevisas. magaliTad, cximis monelebis
moyvanilia 15-2 cxrilSi. dRes cnobilia moSlisas (naRvelis an pankreasis wvenis
vitaminebis 13 jgufi. TiToeul jgufSi gamouyofloba) irRveva cximSi xsnadi A, D, E
(ojaxSi) Sedis ramdenime vitamini, da K vitaminebis Sewova Sesabamisi
romlebsac vitamerebi ewodeba. hipovitaminozis ganviTarebiT. hipovitaminozebi
adamianis organizmSi sakmarisi viTardeba xangrZlivi dispefsiis dros.
raodenobiT sinTezirdeba mxolod biotini zogierTi endogenuri hipovitaminozi viTardeba
da K vitamini. nawlavebSi mikroorganizmebis vitaminebis aqtiuri energiis STanTqmasTan
mier sinTezirdeba wyalSi xsnadi zogierTi dakavSirebuli Sewovis darRvevis Sedegad
vitamini, magram arasakmarisi raodenobiT. nawlavis kedelSi, magaliTad B12 - vitaminisa.
ganasxvaveben cximSi xsnad da wyalSi xsnad vitaminis sisxlSi transportirebisTvis
vitaminebs. pirvels mikuTvneba A, D, E, K, saWiro cilis deficitsac hipovitaminozi
meores - yvela danarCeni vitamini. mohyveba (magaliTad, kalciumSemakavSirebeli
vitaminebis biologiuri efeqtis cilis deficitisas viTardeba D avitaminozi).
damTrgunav qimiur nivTierebebs hipovitaminozs iwvevs vitaminebis aqtiur
antivitaminebs uwodeben. maTi umravlesobis formad gardaqmnis moSla (rac Sesabamisi
struqtura msgavsia vitaminis struqturisa. fermentebis deficitiT vlindeba) an im
antivitaminebia, agreTve, is fermentebi, cilebis sinTezis darRveva, romlebTan
romlebic ar arian vitaminebis kontaqtSi xorcieldeba vitaminis an misi
struqturuli antagonistebi, magram Slian aqtiuri formis funqcia da bolos,
vitaminebs. antivitaminebma SesaZloa avitaminozis mizezi SeiZleba iyos organizmSi
gamoiwvion vitaminebis cvlis darRvevis antivitaminebis moxvedra (magaliTad B
tipobrivi formebi - avitaminozebi da vitaminisaTvis - piritiaminisa, C
hipovitaminozebi cxadia, rom hipo- da vitaminisTvis - askorbinazisa da a.S), romelTa
avitaminozebi SeiZleba gamoiwvios vitaminis moqmedebis meqanizmebi motanilia zemoT.
daSlam, misi molekulis modificirebam, hipervitaminozi viTardeba Sesabamisi
vitaminisTvis ujredis receptorTa vitaminis didi raodenobiT miRebis an/da misi
blokadam da vitaminis ujredTa Warbi efeqtis gamo. aseTi situacia iqmneba,
metabolizmis blokadam. Cveulebriv, vitaminebis Warbi raodenobiT
vitaminebis xangrZlivi deficitis an miRebisas, gansakuTrebiT ineqciebis formiT.
organizmSi maTi efeqtis ukmarisobis dros mZimed mimdinareobs hipervitaminozi,
ganviTarebul daavadebebs avitaminozebi an gamowveuli cximSi xsnadi A da D vitaminebis
hipovitaminozebi ewodeba. pirveladi siWarbiT. cximSi xsnadi vitaminebidan
(egzogenuri) avitaminozi viTardeba toqsikur efeqts iZleva B1 vitaminisa da
SimSilis an sakvebSi vitaminis xangrZlivi folimJavas didi dozebi.
deficitis dros. hipovitaminozi SeiZleba disvitaminozi SeiZleba ganviTardes erTi
ganviTardes, agreTve, sakvebSi maTi an ramdenime vitaminis ukmarisobisas sxva
normaluri arsebobis drosac im SemTxvevaSi, vitaminTa an vitaminis Warbi efeqtis fonze.
153
A-avitaminozi. cximSi xsnadi A sisxlis plazmaSi Ca2+ - is da fosfatebis
vitamini (retinoli, retinali, dones, agreTve, Zvlovani qsovilis gajerebas
antiqseroftalmini) monawileobs mraval kalciumiT.
cvliT reaqciaSi, foto-recepciaSi, D vitaminis deficits axasiaTebs
Zvlovani qsovilis zrdaSi, epiTeliumis fosforis da kalciumis cvlis darRveva.
diferencirebaSi. misi normaluri Sewovisa misi ZiriTadi gamovlinebaa kalcifikaciis
da metabolizmisTvis saWiroa naRveli da procesis moSla, ris gamo irRveva Zvlovani
cximis normaluri moneleba. qsovilis mineralizeba, viTardeba
A-avitaminozi iwvevs zrdisa da osteomalacia (Zvlis darbileba) da
inteleqtis ganviTarebis dabrkolebas, osteoporozi, mcirdeba kalciumis da
midrekilebas infeqciuri sneulebebisadmi, fosforis Semcveloba sisxlSi. gansakuTrebiT
qaTmis sibrmaves, Tvalis rqovanas mZime cvlilebebs iwvevs D avitaminozi
dazianebas, koniuqtivis garqovanebas, bavSvebSi, romlebsac iolad uviTardebaT
sacremle jirkvlebis sekreciis daqveiTebas raqiti. raqitis dros, Zvlebis mineralizebis
xSirad Tvalis infeqciis da anTebis daqveiTebis garda, paraThormonis Warbi
ganviTarebiT, kanis da lorwovani garsebis raodenobiT gamoyofis gamo aRiniSneba
epiTeliumis metaplazias da garqovanebas, kalciumis da fosforis kargva ukve
mis simSrales, frinodermas (gombeSoseburi formirebuli Zvlebidan. Zvlebis darbileba
kani), folikulur hiperkeratozs. raqitis dros iwvevs maT deformacias,
A-hipovitaminozis dros qveiTdeba yiflibandis gvian Sexorcebas, cvlilebebs
piris Rrus lorwovani garsebis dacviTi nervul da kunTovan sistemebSi, rasac mohyveba
funqcia. aRiniSneba lorwovanis simSrale, gonebrvi ganviTarebis Seferxeba da kunTebis
garqovaneba, sanerwyve jirkvlebis funqciis tonusis daqveiTeba.
daqveiTeba, nerwyvis gamoyofis Semcireba, D-hipervitaminozi. didi dozebiT D
anTebiTi procesebi (gastroenterokoliti, vitaminis miReba bavSvebSi iwvevs ConCxis
bronqiti, ureTriti) Semdgomi eroziebiT da Zvlebis zrdis SeCerebas. aRiniSneba
wylulebiT, rasac Tan axlavs Zlieri yiflibandis adreuli Sevseba, ris gamo
tkivili. rig SemTxvevaSi A- viTardeba mikrocefalia. hiperkalciemia iwvevs
hipovitaminozis dros viTardeba farisebri jirkvlis funqciis daqveiTebas,
hipoqromuli anemia. paraThormonis hiposekreciis fonze Zlierdeba
A-hipervitaminozi viTardeba misi fosforis da kalciumis reabsorbcia
preparatebis Warbi miRebisas, xasiaTdeba Tirkmelebidan. viTardeba hiperfosfatemia da
kanis pigmentaciiT, misi aqercvliT, hiperkalciemia. Sedegad warmoiqmneba
siarulis dros tkiviliT saxsrebSi, Zneladxsnadi fosformJava kalciumis marili,
frCxilebis mtvrevadobiT, umadobiT, romelic Tirkmlis filtrSi gavlisas
gulisreviT, RebinebiT, hepato- da ferxdeba. garda amisa, kalcinozuri naleqi
splenomegaliiT, uZilobiT, momatebuli viTardeba sisxlZarRvebis kedlebze da Sinagan
gaRizianebadobiT. organoebze. iTrguneba rezorbciis procesebi
D - hipovitaminozi. D vitaminis cnebaSi Zvlovan qsovilSi, ris gamo mcirdeba
erTiandeba antiraqituli moqmedebis kalciumisa da fosforis gamotana Zvlebidan,
cikluri steroidebis msgavsi nivTierebebi. ferxdeba Zvlovani matricis cilovani daSla,
misi biologiuri efeqti mdgomareobs Ca2+ - romlis adgilze xtilovani qsovili aRar
is da fosfatebis transportis viTardeba, rac iwvevs Zvlis deformacias da
stimulirebaSi nawlavis kedelsa da lulovani Zvlebis sigrZeSi zrdis Seferxebas.
Tirkmlis milakebSi. paraThormonTan da KK- avitaminozi. cximSi xsnadi
TireokalcitoninTan erTad, is aregulirebs "antihemoragiuli" K vitaminis fiziologiuri
154
roli mdgomareobs sisxlis Sededebis II metad mniSvnelovania C vitaminis
(proTrombini), VII (prokonvertini), IX monawileoba samvalentiani rkinis
(kristmasis) da X (stiuartpraueris) orvalentianad gardaqmnaSi, rac saWiroa rkinis
faqtorebis aqtivaciaSi, rac xorcieldeba SewovisTvis nawlavebSi, e.i. aRniSnuli
RviZlSi glutaminmJavas naSTebis (- vitaminis deficitisas irRveva
dekarboqsilebis gziT. amitom vitaminebis sisxlwarmoqmnac. misi deficitisas Zabundeba
deficitisas qveiTdeba sisxlis Sededeba, organizmis imunuri Zalebic. radgan C vitamini
vlindeba midrekileba sisxldenisa da mastimulirebel gavlenas axdens imunogenezze.
sisxlCaqcevebisadmi. misi nakleboba amcirebs organizmis medegobas
K-hipovitaminozi SeiZleba iyos infeqciis mimarT.
rogorc endogenuri, ise egzogenuri C avitaminozis gamovlinebebi cvlis
warmoSobis. endogenuri hipovitaminozi procesebSi mis zemoaRniSnul
aRmocendeba nawlavebSi K vitaminis Sewovis monawileobasTanaa dakavSirebuli. C hipo- da
darRvevis dros (naRvlis da pankreasis avitaminozis dros mJRavndeba hemoragiuli
wvenis deficiti), RviZlis mwvave da diaTezis niSnebi: sisxldena RrZilebidan,
qronikuli dazianebisas, zogierTi sisxlCaqcevebi Tmis folikulebSi, kunTebSi,
samkurnalo preparatis, antibiotikebis, saxsrebSi, lorwovan garsebSi, epikardiumSi,
sulfanilamidebis, arapirdapiri moqmedebis perikardiumSi. viTardeba gingiviti (RrZilebis
antikoagulantebis moqmedebisas. pirveli anTeba), kbilebis dakargva, piris Rrus,
ori Trgunavs K vitaminis SewovisTvis saylapavi milis, Zvlovani qsovilebis nekrozi.
aucilebel mikrofloras nawlavebSi. kani mSralia, viTardeba hemoragiuli
klinikurad K vitaminis deficiti folikuluri hiperkeratozi. qvemo kidurebze
iwvevs sisxldenebs, sisxlCaqcevebs kansa da Cndeba peteqiebi (wertilovani sisxlCaqcevebi).
lorwovanze, saxsrebSi da Tvalis badura Cvens droSi cingis (C avitaminozis Zveli
garsze. is xasiaTdeba cxviridan da saxelwodeba) mZime SemTxvevebi (Sinagani
RrZilebidan sisxldeniT uxeSi sakvebis sisxldeniT, plevritiT, hemoragiuli ascitiT
miRebisas da kbilebis wmendisas. da enterokolitiT) iSviaTia. ufro xSiria
K vitaminis deficiti tipobrivia C hipovitaminozis movlenebi: sisuste, Sromis
axalSobilTaTvis. K hipervitaminozi ki unaris daqveiTeba, midrekileba sisxldenisken,
viTardeba maTTvis didi raodenobiT K gingiviti, folikuluri hiperkeratozi.
vitaminis micemisas, rac hemolizuri dedis rZeSi C vitaminis deficitis
sindromiT xasiaTdeba. paralelurad xSirad viTardeba P vitaminis
C-avitaminozi. C vitamini (retini, eskuretini) naklebobac. mas axasiaTebs
(askorbinmJava) organizmSi cvliTi organizmis rezistentobis daqveiTeba,
procesebis umravlesobis aqtiuri kapilarebis ganvladobis momateba, maTi
monawilea. Jangva-aRdgeniT reaqciebSi simyife, peteqiuri gamonayari.
askorbinmJava uzrunvelyofs eleqtronebis B1 hipovitaminozi. wyalSi xsnadi B1
transports, xels uwyobs ujredis vitamini (Tiamini) mniSvnelovan rols
sunTqvas, ewinaaRmdegeba hemoglobinis asrulebs metabolizmSi, gansakuTrebiT
daSlas, monawileobs kolagenis warmoqmnaSi. naxSirwylebis cvlaSi. Tiamini
C vitaminis naklebobisas ziandeba Tiaminpirofosfatis (kokarboqsilaza) saxiT
SemaerTebeli qsovili, izrdeba monawileobs piroyurZenmJavas gardaqmnaSi A
sisxlZarRvebis kedlebis ganvladoba, acetilkoenzimad, rac saWiroa krebsis
viTardeba hemoragiuli diaTezi, mcirdeba ciklisTvis. B1 vitaminis deficitis dros
qsovilebis regeneraciis unari. organizmSi grovdeba rZe - da piroyurZenmJava.
B1 hipovitaminozi viTardeba vitaminis
155
naklebobis dros sakvebSi, misi Sewovis B6 avitaminozi. B6 vitamini (piridoqsini,
darRvevisas xangrZlivi faRaraTobis, piridoksali, adermini) organizmSi
nawlavis rezeqciis gamo, RviZlis mZime fosforildeba im fermentTa kofermentad,
dazianebis, hemodializis, alkoholizmis romlebic monawileoben dezaminirebaSi,
SemTxvevebSi. transaminirebaSi, dekarboqsilirebaSi;
B1 hipo- da avitaminozis dros irRveva minawileoben mravali Seunacvladi aminmJavisa
rogorc naxSirwylebis, ise energetikuli da cximovan cvlaSi.
cvla. Sesabamisad, yvelaze metad ziandeba B6 hipovitaminozi viTardeba axalSobilTa
energiis Warbad momxmarebeli sisxlis xelovnuri kvebis, malabsorbciis sindromis,
mimoqcevisa da nervuli sistemebis funqcia. nawlavebis mikrofloris daTrgunvisas
B1 avitaminozis mkveTr deficits - beri- antibiotikebiT. vitaminis deficiti iwvevs
beris axasiaTebs polinevriti, damblebi, nervuli sistemis funqciis cvlilebebs
kidurebis kunTebis atrofia, krunCxvebi, (maRali agznebadoba, epilefsia). nikotinmJavas
gulis marjvena nawilis dilatacia da sinTezis darRvevis gamo aRiniSneba cvlilebebi
ukmarisoba, sisuste, qoSini, taqikardia, kanze (saxis seboreuli dermatozi). irRveva
tkivilebi gulis areSi, kardiuli SeSupeba. gadaaminirebis, dekarboqsilirebis procesebi,
daavadeba vlindeba ramdenime formiT: 1. rasac mosdevs aminmJavebis cvlis darRveva.
paralizuriT, nevrologiuri simptomatikis qveiTdeba Jangbadis moxmareba qsovilebSi,
siWarbiT; 2. SeSupebiT; 3. kardiuliT, ferxdeba endokrinuli jirkvlebis funqcia,
romelic swrafad iwvevs marjvena parkuWis viTardeba periferiuli polinevropaTiebi,
ukmarisobasa da sikvdils (gansakuTrebiT anemia, limfopenia.
xSiri da mZimea gulis funqciis mwvave PP avitaminozi. vitamini PP (nikotinamidi,
darRveva mcire asakis bavSvebSi); 4. kuW- antipelagruli) Sedis im fermentTa
nawlavis formiT - mkveTri umadobiT, SemadgenlobaSi, romlebic monawileoben
sxeulis masis mkveTri daqveiTebiT, kuWis qsovilur sunTqvasa da JangviT
wvenis gamoyofis SemcirebiT, pirRebinebiT, fosforilebaSi. misi faruli deficiti iwvevs
faRaraTiT; 5. cerebruliT (sinonimebi: umadobas, faRaraTobas an yabzobas, kanis
veronike-korsakovis sindromi, hemoragiuli simSrales, sifermkrTales, cianozs, ena
poliencefaliti), romelic iwyeba Tavis SeSupebuli da prialaa. hipertrofiis Semdeg
tvinis sisxlis mimoqcevis darRveviT. enis dvrilebi atrofirdeba.
Semdeg viTaradeba encefalopaTia, koma da PP vitaminis ufro mkveTri deficitisas
dgeba sikvdili. viTardeba pelagra, romelsac axasiaTebs sami
B2 hipovitaminozi. B2 vitamini "d": dermatiti (kanis anTeba), diarea (faRaraTi)
(riboflavini) organizmSi Sedis fermentebis da demencia (fsiqikis darRveva, xSirad
- flavoproteidebis SemadgenlobaSi, depresiiT). am sindromTa safuZvelia
romlebic monawileoben qsovilur sunTqvasa distrofiuli cvlilebebi Tavis tvinis qerqSi,
da JangviT fosforilebaSi. B2 avitaminozis naTxemSi, qerqqveSa warmonaqmnebSi, simpaTikur
dros ziandeba tuCebi da saxis qvemo kvanZebSi. vlindeba Tavis tkivili, Suili
nawilis kani, romelzec Cndeba napralebi. yurebSi, adinamia, metyvelebisa da
tuCebi macerirebulia, viTardeba seboreuli mgrZnobelobis darRveva. gulis kunTSi
dermatiti, glositi (enis lorwovanis aRiniSneba degeneraciuli cvlilebebi,
anTeba), qreba enis dvrilebi, ziandeba qveiTdeba arteriuli wneva.
Tvalis garsebi, vlindeba koniuqtiviti, egzogenuri avitaminozis mkurnaloba
kataraqta, zogjer sinaTlis SiSi Tvalebis dRes gansakuTrebul problemas ar warmoadgens
tkivilis gamo. B2 avitaminozisas Cndeba - is aRmoifxvreba Sesabamisi vitaminis per os
midrekileba wylulovani daavadebisadmi. an parenteruli SeyvaniT organizmSi.
156
endogenuri avitaminozis prognozze tutianobisken (alkalozi) - sisxlSi tuteebis
seriozul gavlenas axdens TviT absoluturi an SefardebiTi momatebiTa da
avitaminozis gamomwvevi paTologiuri wyalbadionTa koncentraciis SemcirebiT.
procesis xasiaTi, misi simZime. gamovlinebis simkveTris mixedviT
13.6. mJavur-tutovani wonasworobis ansxvaveben kompensirebul da arakompensirebul
darRvevebi acidozs da alkalozs. Tu miuxedavad qimiuri
ujredebSi da biologiur siTxeebSi da funqciuri Zvrebisa, mJavur-tutovani
wyalbadionTa koncentracia, romelic wonasworobis regulaciaSi monawile sistemebi
gansazRvravs mJavur-tutovan wonasworobas, uzrunvelyofen pH-is SenarCunebas Tundac
homeostazis (homeokinezis) uzrunvelyofis normis sazRvarze, laparakoben kompensirebul
erT-erTi umniSvnelovanesi faqtoria. is acidozze an alkalozze. dacviTi meqanizmebis
arsebiT gavlenas axdens praqtikulad yvela gamofitvisa da ukmarisobis dros pH normidan
sasicocxlo funqciaze. optimaluri gadaixreba, viTardeba arakompensirebuli
diapazonidan (7,35-7,45) misi gadaxra iwvevs (dekompensirebuli) acidozi an alkalozi.
metabolizmis da organizmis funqciebis ganviTarebis meqanizmis mixedviT acidozi
mZime, xSirad sicocxlesTan SeuTavsebel da alkalozi SeiZleba iyos airovani
darRvevas. pH-is (pH - wyalbadionTa (respiraciuli), romelic viTardeba CO2-is
koncentraciis uaryofiTi logariTmi) 0,1- transportisa da cvlis darRvevebis Sedegad
is diapazonSi cvlileba iwvevs sisxlis da araairovani (metaboluri), romelic
mimoqcevis da sunTqvis darRvevas, 0,3-is viTardeba organizmSi araaqroladi mJave da
farglebSi - gonebis dakargvas, 0,4-ze tute nivTierebebis dagrovebisas. pH-is yvela
meti gadaxra ki, xSirad, sasikvdiloa. zemoaRniSnuli gadaxra mJavur-tutovani
Sinagani garemos pH-is mudmivoba wonasworobis darRvevis tipobrivi formaa.
organizmis arsebobisa da fiziologiuri mimdinareobis mixedviT ganasxvaveben mJavur-
procesebis normaluri mimdinareobis tutovani wonasworobis mwvave darRvevebs,
aucilebeli pirobaa. misi uzrunvelyofa romelTa dros H-ionebis koncentraciis
xorcieldeba fizikur-qimiuri da fiziologiuri gadaxraze reagirebas aswrebs mxolod
regulaciis meqanizmebiT. pirvelisTvis, sakompensacio buferuli meqanizmebi
garda qsoviluri siTxiT mJavebis (hemoglobinuri, bikarbonatuli, fosfaturi,
ganzavebisa, didi mniSvneloba aqvs sisxlisa cilovani buferi) da xangrZliv darRvevebs,
da qsovilebis buferul sistemebs, romlis dros sakompensacio procesSi
romelTac ZaluZT moaxdinon rogorc erTvebian fiziologiuri meqanizmebic. pH-is
mJavebis, ise tuteebis neitralizeba da maTi mwvave darRvevebi araiSviaTad gadaizrdebian
gamosayofad mosaxerxebel formaSi (susti "Camoyalibebul", xangrZliv moSlilobebad.
mJavebi da fuZeebi) gadayvana. magram pH-is Sesabamisad, ganasxvaveben kompensaciis swraf,
sruli normalizebisTvis saWiroa ZiriTadad, buferul meqanizmebs (garda
regulaciis fiziologiuri meqanizmebis filtvebis ventilaciis cvlilebebisa,
monawileobac. am TvalsazrisiT romelic aseve swrafi reaqciaa) da xangrZliv,
gansakuTrebuli mniSvneloba aqvs filtvebsa ZiriTadad fiziologiur meqanizmebs, romlebic,
da Tirkmlebs, SedarebiT naklebi - kuWs, umetesad, Tirkmlis funqciis cvlilebebis
nawlavebs, kans. xarjze xorcieldeba.
paTologiis dros mJavur-tutovani respiraciuli (airovani) acidozi
wanasworoba SeiZleba gadaixaros rogorc (sur.13-7) viTardeba organizmSi naxSirmJavas
mJavianobisken (acidozi) - sisxlSi mJavebis dagrovebis dros aseT suraTs adgili aqvs: 1)
absoluturi an SefardebiTi siWarbiTa da garemoSi CO2-is koncentraciis momatebisas, 2)
wyalbadionTa koncentraciis momatebiT, ise garegani sunTqvis darRvevebisas (sunTqvis
157
centris funqciis daTrgunva, filtvebis gamoyofa, rac kidev ufro aviwroebs qvemo
daavadebebi, asfiqsia da sxv.), ris gamo sasunTq gzebs da aZnelebs sunTqvas. sunTqvis
mcirdeba filtvebis ventilacia. ukmarisobis dros qsovilebSi matulobs
airovani acidozis dros sisxlSi Jangvis produqtebi, airovan acidozs daerTveba
matulobs CO2-is raodenoba (hiperkapnia), araairovanic, rac friad amZimebs mdgomareobas.
mas organizmi pasuxobs sakompensacio mkveTri hiperkapniisas, vagusis Zlieri agznebis
reaqciebiT, romlebic mimarTulia gamo, viTardeba bradikardia, arteriuli
organizmidan Warbi CO2-is gamoyofis, misi hipotenzia, gulis SekumSvebi SeiZleba
SekavSirebisa da bikarbonatebis raodenobis sruliad Sewydes.
momatebis, e.i. H2CO3-sa da NaHCO3-s Soris metaboluri (araairovani) acidozi (sur.13-
normaluri Sefardebis (1:20) 6) - mJavur-tutova-ni wonasworobis darRvevis
SenarCunebisken. yvelaze xSiri da yvelaze mZime forma -
naxSirorJangis Warbi raodenobis viTardeba sisxlSi metabolizmis araaqroladi
gamoyofa xdeba qoSinis dros, romelic mJave produqtebis (magaliTad, ketosxeulebis,
sunTqvis centris hiperkapniiT gaRizianebis rZemJavas) dagrovebis gamo nivTierebaTa cvlis
Sedegad viTardeba (es meqanizmi umoqmedo darRvevebis dros (Saqriani diabeti, hipoqsia,
rCeba im SemTxvevaSi, Tu garemoSi maRalia SimSili da sxv.), mJave produqtebis
CO2-is koncentracia). airovani acidozis organizmidan gamoyofis darRvevisas
kompensaciaSi gadamwyveti mniSvneloba (Tirkmlebis paTologia, uremia) an organizmSi
hemoglobinis (naklebi xarisxiT cilovan) maTi didi raodenobiT Sesvlisas (ZmarmJaviT
bufersa da Tirkmelebs aqvs. mowamvla da sxv.). aseTi tipis acidozi
eriTrocitebSi arsebuli aRdgenili SeiZleba ganviTardes, agreTve, saWmlis
hemoglobini akavebs naxSirmJavas momnelebel wvenebSi Semavali fuZeebis didi
disociaciis dros Warbi raodenobiT raodenobiT dakargvisas (magaliTad, xangrZlivi
+
warmoqmnil H ionebs. am ionebis nawils faRaraTobis dros).
ikavSireben cilebi, romlebic, am gansakuTrebiT swrafad viTardeba da mZime
SemTxvevaSi, fuZis rolSi gamodian. mimdinareobiT xasiaTdeba metaboluri acidozi
+
Tirkmlebi aZliereben H ionebis da sisxlis mimoqcevis darRvevebis gamo
hidrokarbonatebis reabsorbcias. Zlieri da ganviTarebuli hipoqsiis dros (gulis gaCereba,
xangrZlivi hiperkapniisas es reaqciebi Soki, kolafsi), romelsac sisxlidan CO2-is
ukmari xdeba da viTardeba gatanis Semcirebis Sedegad daerTvis airovani
arakompensirebuli airovani acidozi, acidozic.
romelic organizmis mravali funqciis swrafi kompensaciuri reaqcia Warbi
mkveTr darRvevas iwvevs. mJave produqtebis gasaneitraleblad
acidozis gamo ganviTarebul mdgomareobs am produqtebis ganzavebaSi
hiperkateqolaminemias mohyveba ujredSorisi siTxis mier. Semdeg vJave
sisxlZarRvebis Seviwroeba, arteriuli produqtebi uerTdeba bikarbonatebs, romelTa
sisxlis wnevis momateba, taqikardia. raodenoba sisxlSi mcirdeba da, Sesabamisad,
Tirkmlis arteriebis spazmis gamo mcirdeba mcirdeba Sefardeba H 2CO3 . ferment
Sardis gamoyofa, tvinis sisxlZarRvebis NaHCO 3
karboanhidrazas moqmedebiT naxSirmJavas Warbi
gafarToebis Sedegad matulobs qalasSiga raodenoba iSleba wylad da naxSirorJangad. es
wneva. mkveTri hiperkapnia iwvevs gulze ukanaskneli aRagznebs sunTqvis centrs da
vagusuri gavlenis matebas, ramac SeiZleba ganviTarebuli qoSinis dros gamoiyofa
gulis gaCereba gamoiwvios. organizmidan.
hiperkapniisas viTardeba bronqebisa da es meqanizmi metad mniSvnelovania acidozis
bronqiolebis spazmi, maTSi lorwos Warbad kompensaciisTvis, magram mas uaryofiTi mxarec
158
aqvs: CO2-is koncentraciis Semcireba
aqveiTebs sunTqvisa da sisxlZarRvTa
mamoZravebeli centrebis agznebadobas.
garkveuli mniSvneloba kompensaciisTvis
aqvs cilovan bufersac, romelic moqmedebs
rogorc susti fuZe da ierTebs wyalbadis
ionebs. metaboluri acidozis kompensaciaSi
monawileoben Tirkmlebic, romlebic
aZliereben Tavisufali mJave produqtebis
((-oqsierbomJava, piroyurZenmJava da sxv.)
gamoyofas; izrdeba bikarbonatebis
reabsorbcia, mcirdeba Sardis pH.
moyvanili da rigi sxva naklebad
mniSvnelovani sakompensaco meqanizmebis
gamofitvis da ukmarisobis dros viTardeba
dekompensirebuli araairovani acidozi, rac
mZime gavlenas axdens organizmis
funqciebze: irRveva sunTqva, ecema
sisxlZarRvTa tonusi, Tirkmlis
sisxlmomarageba, Sardis gamoyofa; K+-is,
Na+-is da Ca2+-is dakargvis gamo viTardeba
gulis ariTmia (taqikardia, eqstrasistolia, r
mZime SemTxvevebSi - parkuWebis fibrilacia),
nerv-kunTovani agznebadobis daqveiTeba,
Zvlebis dekalcinacia da sxv. sisxlis
mimoqcevis da sunTqvis cvlilebebi
hemoglobinis JangbadTan Sesatyvisobis
darRvevasTan erTad, rac iwvevs filtvebSi
oqsihemoglobinis warmoqmnis da
qsovilebisTvis Jangbadis gacemis
dabrkolebas, iwvevs Zlier hipoqsemias da
hipoqsias. pH-is 7,2-ze metad daqveiTebisas
viTardeba koma.
hfjltyj,bs itcdkf
vfqfkb rjyltycfn-
fhfcfrvfhbcb
jhufybpvib
v;fdt,bc
wdkbc v;fdt
ufvj.jaf
ybdsbtht,fsf
ghjlemnt,bc
ceysmdbc
itceysmdf
yfhtdt,bc
159
ufhtufyb
lfuhjdt,f
ervfhj,f
H2CO3-is parciuli daZabuloba sisxlSi adgils wyalbadionebi ikavebs. sisxlSi am
mcirdeba. ionebis Semcireba ki, cxadia, gazrdis sisxlis
sakompensacio reaqciebi airovani pH-s.
alkalozis dros mimarTulia sisxlSi sakompensacio reaqciebi metaboluri
hidrokarbonatebis raodenobis Semcirebisken. alkalozis dros mimarTulia organizmidan
am procesSi mniSvnelovan rols asruleben karbonatebis gamoyofisa da CO2-is
cilebi, romlebic sisxlis plazmaSi Sekavebisken. sisxlSi wyalbadionTa
NaHCO3-dan natriumis kaTionebis koncentraciis Semcirebas mohyveba sunTqvis
+
sanacvlod gascemen H ionebs. centris funqciis Sekaveba, mcirdeba filtvebis
umTavres rols airovani alkalozis ventilacia, cilovani buferi gascems
kompensirebaSi TamaSoben Tirkmlebi, wyalbadisa da ierTebs natriumis ions, SardiT
mcirdeba maT mier ionebis gamoyofa da gamoiyofa hidrokarbonatis didi raodenoba.
iklebs hidrokarbonatebis reabsorbcia. dekompensaciis SemTxvevaSi izrdeba
Tumca, kompensaciis Tirkmlismieri meqanizmi sunTqvis centris agznebadoba, qoSinis gamo
pH-is cvlilebebidan mxolod 16-18 saaTSi gamoiyofa CO2-is didi raodenoba da viTardeba
iCens Tavs. Zlieri alkalozi. K+-is deficiti arRvevs
Zlieri hiperkapnia xasiaTdeba gulis funqcias, xolo wyalbadionTa nacvlad
sisxlZarRvTa tonusis da, Sesabamisad, Ca++-is didi raodenobiT Sesvla Zvlovan
arteriuli sisxlis wnevis daqveiTebiT. qsovilSi amcirebs ionizebuli kalciumis
mcirdeba gulis sistoluri da raodenobas sisxlSi, zrdis nerv-kunTovan
cirkulirebadi sisxlis moculoba, Tavis agznebadobas da iwvevs krunCxvebs (magaliTad,
tvinis momarageba JangbadiT, natriumisa da gastruli tetania).
kaliumis didi raodenobiT gamoyofis gamo
izrdeba diurezi da SeiZleba ganviTardes
qsovilebis gamoSroba (eqsikozi).
sunTqvis centris agznebadobis
daqveiTeba hipokapniis gamo, mZime
SemTxvevebSi, iwvevs periodul sunTqvas.
wyalbadionebis koncentraciis Semcireba
aqveiTebs kalciumis ionebis Semcvelobasac,
rasac SeiZleba krunCxvebi mohyves. fkrfkjpb
metaboluri (araairovani)
alkalozi (sur. 13-7) viTardeba tuteebis
didi raodenobiT miRebisas an araaqroladi rjvgtycbht,ekb
organuli mJavebis didi raodenobiT
dakargvis dros (Zlieri Rebineba,
pilorusis stenozi da sxv.). Rebinebisas fbhjdfyb
kuWis wvenTan erTad ikargeba Cl-, romelic
susti fuZea. ionuri wonasworobis aRdgena
xdeba anion HCO3-is xarjze, romelic
/bgthdtynbkfwbf
meqanizmi
mofunqcie ka- gulis tvinis da koncentrirebuli qsoviluri sun-
pilarebis sistoluri gulis mkve- sis[lis gamos- Tqvis da
raodenobis moculobis bavi sisxl- rola depoebidan, glikolizis
momateba, da SekumSve- ZarRvebis eriTrocitebis aqtivacia,
sunTqvis gaR- bis si[Siris gafarToeba eliminireba Jangvis da
Zvlis tvinidan,
rmaveba da momateba fosfolirebis
oqsihemoglobinis
ga[Sireba disociaciis
SeuRlebis
momateba gaZliereba
Sedegebi
biologiuri
alveoluri ven- gulidan gamos- sis[lis mier
sis[lmomaragebis Jangvis
tilaciis mocu- rolili sis[lis Jangbadis SeT- efeqturobis
lobis momateba raodenobis centralizeba visebis unaris zrda
momateba momateba
165
nawili 111 imas, rom sisxlis komponentebic normaluri
organoebis da sistemebis moculobiTaa warmodgenili. cirkulirebadi
paTofiziologia
15. sisxlis sistemis
normovolemiebi
paTofuziologia
sisxlis sistemas miekuTvneba cirku- 45
lirebadi da deponirebuli sisxli, sisx- - ubralo
lmbadi da sisxlis damSleli organoebi. 35
sistemis es nawilebi imdenad mWidro ur-
- oligocitemiuri
TieTrkavSirSi imyofebian, rom cvlilebe-
bi erT-erT maTganSi, rogorc wesi, iwvevs 58
met-naklebad gamoxatul cvlilebebs sis- - policitemiuri
temis sxva nawilebSic. ama Tu im zemoq-
medebas sistema pasuxobs rogorc mTli- hipovolemiebi
ani, Tumca am pasuxis intensivoba siste-
45
mis sxvadasxva nawilis mxriv sxvadasxvaa.
sisxlis sistemis maRali - ubralo
reaqtiuloba gansazRvravs mis swraf da, 35
xSirad, mZafr reagirebas damzianebel - oligocitemiuri
faqtorTa ara marto uSualo
58
zemoqmedebaze, aramed sxva organoebisa da
sistemebis dazianebazec. es ki umravles - policitemiuri
SemTxvevaSi da pir-vel rigSi airekleba
cirkulirebadi sis-xlis cvlilebebze. hipovolemiebi
167
ubralo hipervolemia - cirkulirebadi aqvs. ubralo hipovolemia (plazmisa da
sisxlis moculobis momateba plazmisa da eriTrocitebis proporciuli Semcireba
eriTrocitebis moculobis proporciuli hematokritis normaluri maCvenebliT)
zrdis gamo (e.i. hematokritis normaluri vlindeba sisxldenisas da uSualod mis
maCveneblis fonze) droebiTi movlenaa, Semdeg, Sokis dros sisxlis deponirebisa da
romelic viTardeba sisxlis gadasxmis misi sakmaod didi nawilis cirkulaciidan
dros, agreTve, intensiuri fizikuri gamoTiSvis Sedegad.
datvirTvisas deponirebuli sisxlis da oligocitemiuri hipovolemia cirkulirebadi
qsoviluri siTxis sisxlZarRvebSi sisxlis moculobis Semcirebaa eriTrocitebis
gadasvlis gamo. saerTo moculobis daqveiTebis xarjze.
oligocitemiuri hipervolemia hematokritis maCvenebeli am SemTxvevaSi
(cirkulirebadi sisxlis raodenobis dabalia. sisxlis masis amgvari cvlileba
momateba plazmis xarjze, hematokritis viTardeba sisxlSi eriTrocitebis
dabali maCvenebliT) viTardeba wylis koncentraciis Semcirebis, e.i. anemiis dros
didi raodenobiT miRebisas, organizmSi (ix. "anemiebi").
wylis Sekavebis Sedegad Tirkmlis policitemiuri hipovolemiisas (mocirku-
zogierTi daavadebis dros, gavrcelebuli lire sisxlis moculobis Semcireba plazmis
SeSupebis alagebisas qsoviluri siTxis moculobis daqveiTebis xarjze hematokritis
plazmaSi gadasvlis gamo, izotonuri maRali maCvenebliT) iwvevs yvela is procesi,
siTxeebis gadasxmis SemTxvevaSi, adh-is romelic organizmis mier wylis didi
hiperproduqciisas, sisxlis plazmis raodenobiT dakargvas iwvevs: Zlieri
hiperosmolurobis dros. faRaraToba, Rebineba da poliuria, gadaxureba,
policitemiuri hipervolemia – cirkuli- sxeulis zedapiris didi farTobis damwvroba
rebadi sisxlis masis momateba da sxv. aseT SemTxvevaSi yalibdeba SedarebiTi
eriTrocitebis xarjze (e.i. hematokritis (cru) eriTrocitozi - miuxedavad imisa, rom
maRali maCvevnebliT), rogorc mTlianad sisxlSi eriTrocitebis raodenoba
kompensaciuri movlena aRmocendeba momatebuli araa, plazmis moculobis
organizmze dabali atmosferuli wnevis Semcirebis gamo maTi koncentracia gazrdilia
moqmedebis dros (mTis daavadebisas - depo da sisxlis moculobis erTeulSi normaze
organoebidan sisxlis gamosrolis gamo, meti eriTrocitia.
maRamTianeTSi macxovreblebSi -
eriTropoezis gaZlierebis Sedegad),
gulis mankebiT an filtvis emfizemiT
daavadebulebSi - eriTropoezis 15.2. anemia
gaZlierebis gamo. hipervolemia anemia ewodeba eriTrocitebis da/an
paTologiuri, Zlieri policitemiiT hemoglobinis raodenobis Semcirebas sis-xlis
damaxasiaTebelia vakezis daavadebisTvis, moculobis erTeulSi. raodenobriv
cvlilebebs Cveulebriv Tan sdevs eriT-
romelsac safuZvlad udevs
rocitebisa da hemoglobinis xarisxobrivi
eriTropoezuri qsovilis avTvisebiani
cvlilebebic.
hiperplazia (ix. "eriTrocitozebi").
anemiis gamomwvevi mizezebi mraval-
hipovolemias - cirkulirebadi sisxlis
ferovania. is xSirad viTardeba sxvadasxva
raodenobis Semcirebas aseve sami varianti daavadebis, sisxlwarmoqmnaSi monawile
168
faqtorebis ukmarisobis, eriTrocitebis feradobis maCvenebliT) anemiebs. warmo-Sobis
hemolizis gaZlierebis dros da a.S. mixedviT arCeven memkvidrul, Tandayo-lil da
anemiebis dros ganviTarebuli hemuri SeZenil anemiebs
hipoq-siis pasuxad Tavs iCenen dacviT- anemiebis swori diagnostikis da progno-
sakompensacio movlenebi, magram maTi zirebisTvis aucilebelia xsenebuli kriteri-
ukmarisobis an anemiis progresirebis umebis gamoyeneba, magram anemiebis klasifi-
SemTxvevaSi viTardeba qsovile-bis kaciis umTavres principad maTi ganviTarebis
generalizebuli hipoqsia, rac xSirad meqanizmi unda CaiTvalos. aseTi paTogenezuri
sikvdilis mizezi xdeba. klasifikaciebis mixedviT anemiebs yofen sam
ZiriTad jgufad: posthemoragiul, hemolizur
15.2.1. anemiebis klasifikaciis da eriTropoezis darRvevis Sedegad
principebi ganviTarebul (dizeriTropoe-zul) anemiebad.
anemiebis klasifikaciis principebs
safuZ-vlad udevs maTi raime saerTo sur. 15-2. eriTrocitebis regeneraciuli da
niSani, ganvi-Tarebis mizezi an paTogenezi. degeneraciuli formebi
mimdinareobis mixedviT anemia
SeiZleba iyos mwvave da qronikuli.
periferiul sisxlSi arsebuli
eriTro-citebis sididis mixedviT arCeven
mikrocitul (mcire zomis
eriTrocitebiT), normocitul
(normaluri zomis eriTrocitebiT),
makroci-tul (didi zomis
eriTrocitebiT) da megalo-citur
(giganturi eriTrocitebiT) anemiebs.
sisxlwarmoqmnis tipis mixedviT
ganasxvaveben normoblastur anemiebs –
eriT-ropoezis normaluri,
postembrionuli xasia-TiT da
megaloblastur anemiebs – eriTro-poezis
paTologiuri, embrionuli xasiaTiT
(magaliTad, B12 deficituri anemiebis).
Zvlis wiTeli tvinis funqciobis
mixedviT anemia SeiZleba iyos
regeneraciuli (gaZlierebuli
eriTropoeziT), hiporegeneraciuli
(eriTro-citebis warmoqmnis daqveiTebiT)
da arege-neraciuli (eriTropoezis
droebiTi an sruli daTrgunviT) tipis.
feradobis maCveneblis sididis
mixedviT ganasxvaveben hipoqromul
(daqveiTebuli fera-dobis maCvenebliT),
normoqromul (feradobis normaluri
maCvenebliT) da hiperqromul (ma-Rali
169
mwvave sisxldenisas organizmis funqci-ebis
darRvevis paTogenezis ZiriTadi rgole-bia:
cirkulirebadi sisxlis moculobis Sem-cireba
Tanmxlebi arteriuli hipotenziiT, hi-poqsemia,
organoebisa da qsovilebis hipoqsia. hipoqsiis
gamo Zlierdeba eriTropoezi, sisxldenidan me-
3-5 dRes sisxlSi izrdeba hemoglobinis
SedarebiT naklebi raodenobis Semcveli
eriTrocitebis ricxvi, viTardeba
retikulocitozi, ris gamo uSualod
sisxldenis Semdeg normis farglebSi myofi
feradobis maCvenebeli mcirdeba, e.i.
normoqromuli tipis anemia gadadis
hipoqromulSi. feradobis maCvenebeli
normalizdeba sisxlis suraTis sruli
aRdgenis Semdeg. gaZlierebuli sisxlwarmoqmna
dakavSirebulia eriTropoetinis1 produqciis
zrdasTan, radgan sisxldenis gamo
ganviTarebuli hipoqsia eriTropoetinis
warmoqmnis Zlieri stimulatoria.
sisxldenisas dakarguli sisxlis
cilebis Sevseba warmoebs jer qsoviluri
resursebidan, sisxldenis me-8-10 dRidan ki -
RviZlSi cilis sinTezis gaZlierebis gziT.
qronikuli posthemoragiuli anemia vi-
Tardeba sisxlis SedarebiT mcire ulufebis
ganmeorebiT dakargvis gamo, magaliTad, kuWis
wylulis, buasilis, saSvilosnos fibromis,
dismenoreis dros da a.S.
am tipis anemiis ganviTarebis meqanizmSi
mniSvnelovan rols TamaSobs rkinis didi ra-
odenobiT dakargva, ris gamo anemia rkinade-
ficituri xasiaTisaa. rkinis deficiti iwvevs
15.1.2. postemoragiuli anemia. hemoglobinis sinTezis daqveiTebas, sisxlSi
sisxldena. Cndebian hipoqromuli (hemoglobinis naklebo-
TviT saxelwodeba gviCvenebs, rom
posthemoragiuli anemia viTardeba
1 sisxlis yvela formiani elementi warmoiqmneba erTiani
sisxldenis Sedegad. sisxldenis
polipotenturi RerZuli ujredisgan. is sawyiss aZlevs
siswrafisa da dakarguli sisxlis unipotenturi winamorbedi ujredebis klass, romlebisg an
rigi etapebis gavlis Semdeg warmoiqmneba sisxlis
raodenobis Sesabamisad SeiZleba ujredebi. eriTropoezis deda ujredia morfologiurad
ganviTardes mwvave an qronikuli aradiferencirebadi birTviani ujredi (eriTropoetin-
mgrZnobiare ujredi), romelic, rogorc fiqroben,
posthemoragiuli anemia. eriTroblastad eriTropoetinis gavleniT gardaiqmneba
(sur. 17-5). eriTropoetini - eriTropoezis mTavari
stimulatori - warmoiqmneba TirkmelSi, nawilobriv -
RviZlSi.
170
bis gamo aramkveTrad Seferili), mcire normoblasturi tipisaa. misi re-generaciuli
zomis eriTrocitebi (mikrocitebi). xasiaTi periferiul sisxlSi garda
xangrZlivad mim-dinare qronikul eriTrocitebis regeneraciuli (axalgazrda)
posthemoragiul anemias sis-xlwarmoqmnis formebisa, gvxvdeba maTi degene-
daTrgunvis gamo SeiZleba hipo- an sur. . Talesemia
arageneraciuli xasiaTi mieces. raciuli formebic (anizocitebi, poiki-
15.1.3. hemolizuri anemia locitebi, ericrocitebis naglejebi).
hemolizuri anemia viTardeba SeZenil hemolizur anemias miekuT-vneba
eriTroci-tebis gaZlierebuli daSlis toqsikur-hemolizuri anemia (fenil-
(eriTrodierezis) Sedegad, e.i. maSin, hidraziniT, aniliniT saRebavebiT, berTo-les
rodesac eriTrocitebis hemolizi mariliT, gvelisa da zogierTi so-kos SxamiT
Warbobs maT warmoqmnas. eriTro-dierezis mowamvlisas da a.S.), anemia zogi infeqciuri
gaZliereba SeiZleba dakavSirebuli iyos da parazituli daavade-bis dros
eriTrocitebis membranis, stromis an (hemoliziuri streptokoki, anaerobuli
hemoglobinis molekulis struqturis da sefsisi, malaria), anemia eriTrocitebis
me-tabolizmis memkvidrul, Tandayolil meqanikuri dazianebis gamo, anemia damwvrobis
da Se-Zenil cvlilebebTan, membranis dros, anemia sis-xlis jgufebis an rezus-
damzianebeli fizikuri, qimiuri da faqtoris mixed-viT SeuTavsebeli sisxlis
biologiuri agentebis zemoqmedebasTan, gadasxmisas (romelic zogjer hemolizur
elenTis makrofagocitebis aq-tivobis Soksac iw-evs), anemia autoantigenebis gaCenis
momatebasTan da sxv. gamo sakuTari eriTrocitebis mimarT.
hemolizuri anemia xasiaTdeba ukanasknel or SemTxvevas aerTianeben
hemolizuri siyviTliT, rac kanisa da imunuri hemolizuri anemiebis qvejgufSi. mas
lorwovani gar-sebis yviTeli pigmentiT - akuTvneben agreTve Tandayolil hemolizur
bilirubiniT Sefervis Sedegia. SeZenili anemias, romelic viTardeba dedisa da nayofis
hemolizuri anemia, Cveulebriv, rezus-SeuTavseblobis SemTxvevaSi.
rezus-konfliqti - Tandayolili hemolizuri
anemia viTardeba maSin, rodesac deda rezus-
uaryofiTi, xolo nayofi - rezus-dadebiTia.
radgan nayofis eriTrocitebSi arsebuli
rezus-aglutinogeni ucxoa rezus-uaryofiTi
dedis organizmisTvis, ukanaskneli
gamoimuSavebs rezus-aglutininebs, romlebic
iwveven eriTrocitebis aglutinacias maTi
Semdgomi hemoliziT (sur. 17-8). Tu pirveli
amgvari orsulobis rezus-aglutininebis
titri araa maRali, ibadeba cocxali nayofi
hemolizuri anemiiTa da siyviTliT. rezus-
uaryofiTi qalis ganmeorebiTi orsulobisas
rezus-dadebiTi nayofiT eriTrocitis rezus-
aglutinogens dedis organizmSi mzad xvdeba
wina orsulobis dros gamomuSavebuli rezus-
aglutininebi. procesi Zlieri, nayofisTvis
171
sasikvdilo hemoliziT mTavrdeba. hemoglobinopaTiebs miekuTvneba namgliseburi
araiSviaTad viTardeba nayofis wyalmanki anemia da Talasemia.
an is hemolizuri siyviTliT ibadeba (sur. indoeTis zogierTi regionisa da afrikis
17-8). mkvidrTa Soris gavrcelebuli daavadebis -
memkvidruli hemolizuri anemia namgliseburi anemiis safuZvelia genetikurad
dakav-Sirebulia genetikurad pirobadebul pirobadebuli cvlilebebi hemoglobinis
darRve-vebTan eriTrocitebSi struqturaSi - nacvlad A1 hemoglobinisa
(eriTrocitopaTia), hemoglobinis sinTezirdeba paTologiuri S hemoglobini
struqturaSi (hemoglobino-paTia) an (HBs), romlis -jaWvSi glutaminis mJava
eriTrocitebis fermentTa aqtivobis Canacvlebulia valiniT. amis gamo
aseTive bunebis cvlilebebTan eriTrocitebi iReben namglisebur formas (sur.
(enzimopaTia). 17-11) da advilad hemolizdebian.
eriTrocitopaTiebs miekuTvneba namgliseburi formis eriTrocitebis
mikrosferocituli anemia (minkovski- warmoqmnis mizezia HBs-is dabali xsnadoba
Sofaris daavadeba), romelic autosomur- aRdgenil mdgomareobaSi, rac hemoglobinis
dominanturi gziT gadaecema. daavadeba polimerizebas, mis gamokristalebas da am
xasiaTdeba xangrZlivi latenturi gziT eriTrocitebis formis Secvlas iwvevs.
mimdinareobiT, romlis erTaderTi HBs-is xsnadoba 50-jer naklebia HBA-s
klinikuri niSani siyviTle, xolo xsnadobaze. hemoglobinis xsnadobis
hematologiuri - mikrosferocitozia cvlilebebi mWidro kavSirSia HbS-is
(sur. 17-10). daavadebis gamwvavebisas SemcvelobasTan eriTrocitebSi da Jangbadis
iwyeba eriTrocitTa masiuri hemolizi parciul wnevasTan. Tu HbS-is Semcveloba
retikulur-endoTelur sistemaSi, sisxlSi hemoglobinis saerTo Semcvelobis
gansakuTrebiT elenTaSi, rasac Tan sdevs 45%-ze naklebia, xsnadobis mkveTri daqveiTeba
am organos gadideba (splenomegalia), da gamokristaleba viTardeba Jangbadis
siyviTlis gaZliereba, urobilinemia da parciuli wnevis 20-10 mmHg. sididis dros,
urobilinuria, cxeleba. eriTrocitebis magram Tu HbS-is Semcveloba 45%-ze metia,
hemolizis Sedegad warmoqmnili gamokristaleba iwyeba Jangbadis parciuli
mikroTrombebi iwveven sisxlis mimoqcevis wnevis mmHg-zec, e.i. hemoglobinis
darRvevas da trofikuli wylulebis gamokristaleba gansakuTrebiT intensiurad
ganviTarebas wvivebze. hematologiurad mimdinareobs hipoqsiis pirobebSi (pnevmoniebi,
aRiniSneba eriTrocitebis nakleboba, adgilobrivi sisxlis mimoqcevis moSla) da
retikulocitozi, eriTrocitebis sxv.
osmosuri rezistentobis daqveiTeba. paTologiuri genis homozigoturi
swored aseTi eriTrocitebi blokirdebian mtareblobisas eriTrocitebSi aris TiTqmis
da iSlebian retikulur-endoTelur mxolod HbS (misi Semcveloba am SemTxvevaSi
sistemaSi. 30-100%-ia). aseTi individi iRupeba
hemoglobinopaTiebi (hemoglobinozebi) dabadebamde an misi sicocxlis xangrZlivoba
memkvidruli daavadebebia, romlebsac Zalze mcirea. heterozigotebSi daavadebis
axasiaTebs erTi an ramdenime saxis gamovlinebis diapazoni didia, araiSviaTad is
paTologiuri hemoglobinis arseboba mJRavndeba maprovocirebeli faqtorebis
sisxlSi. gansakuTrebiT gavrcelebul (hipoqsia, sisxlis mimoqcevis moSla)
172
moqmedebis gamo ganviTarebuli gamwvavebis Zvlis qsovilis aseptikur anTebasa da Zvlis
- krizis dros. deformacias iwvevs (sur. 17-11).
gamwvavebis periodSi xSiria tkivili, hipoqsiisa da okluziuri krizebis
romelic dakavSirebulia (Trombozebi) gamo irRveva koronaruli
mikrohemocirkulaciis darRvevebTan, sisxlis mimoqceva, rac anginozur Setevebs da,
rac, Tavis mxriv, namgliseburi SesaZloa, gulis kunTis infarqts iwvevs.
eriTrocitebis daSlis gamo Talasemiebis (xmelTaSua zRvis daavadeba)
ganviTarebuli Trombozebis Sedegia. memkvidruli hemolizuri anemiis jgufia,
namgliseburi anemiisas, gansakuTrebiT romelTa safuZvelia hemoglobinis - an -
bavSvebSi, xSiria siyviTliTa da cxelebiT jaWvSi A1 hemoglobinis sinTezis darRveva, ris
mimdinare hemolizuri krizebi. Sesabamisad viTardeba Talasemiis - an -
hemolizis intensivoba da, Sesabamisad, forma. radgan Talasemiis dros hemoglobinis
anemiebis simZime gansazRvravs sinTezi darRveulia, zogjer mas
ganviTarebuli hipoqsiis simptomebs. eriTropoezis darRvevis Sedegad ganviTarebul
periferiul sisxlSi vlindeba anemiebs akuTvneben.
retikulocitozi, hiperbilirubinemia -Talasemiis etiologiuri faqtori -
arapirdapiri bilirubiniT, Zvlis tvinSi - globinuri genebis nawilobrivi an sruli
eriTropoezis gaZlierebis niSnebi. zog deficitia. embrionul periodSi aseTi
SemTxvevaSi bavSvebSi Zvlis tvinis deficiti kompensirdeba -globulinuri
funqcia ifiteba, viTardeba aplaziuri jaWvebis Warbi sinTeziT, ris Sedegad
krizi, romelic iwvevs eriTropoezis warmoiqmneba Bart's (wminda barTlomes
funqciur, droebiT, magram mkveTr hospitalis saxelis mixedviT, sadac pirvelad
Semcirebas zogjer - sisxlwarmoqmnis iqna aRmoCenili es paTologiuri hemoglobini)
megaloblastur tipze gadasvliT. hemoglobini. dabadebis Semdeg -globulinuri
namgliseburi anemiis klinikur suraTs jaWvebis deficiti kompensirdeba -globinuri
upiratesad gansazRvravs daavadebis dros jaWvebis sinTeziT, romlebic qmnian uxsnad
ganviTarebuli qronikuli hipoqsia. metad tetramerebs da warmoiqmneba HbH. tetramerebi
xSiri garTulebaa sisxlis mimoqcevis absorbideba eriTrocitebis membranaze, azianebs
darRvevebis gamo ganviTarebuli kidurTa mas. Secvlilmembraniani eriTrocitebi xdebian
trofikuli wylulebi. namgliseburi sakuTari fagocitebis samizne. hemoglobinis
anemiis xangrZlivi mimdinareobisas arabalansirebuli (wyvilis armqone) jaWvi
naRvlis sadinrebSi kenWebis gaCenis, agregirdeba da ileqeba eriTroiduli
namgliseburi eriTrocitebiT RviZlis ujredebis citolizSi, maT Soris,
sinusebis daxSobis da amis gamo periferiuli sisxlis eriTrocitebSi da
Camoyalibebuli organos hipoqsiis Sedegad leikocitebSi (haincis sxeulakebi). aseTi
ziandeba RviZlis parenqima, Cndeba eriTrocitebi iSleba elenTaSi, rasac
nekrozis kerebi, viTardeba SemaerTebeli eriTropenia mohyveba. Tumca, mcire -
qsovili da RviZlis cirozi. Tavis Talasemiis dros eriTrocitozic vlindeba.
tvinSi sisxlis mimoqcevis darRvevis da -globinuri jaWvebis sinTezis daqveiTebis
hipoqsiis gamo viTardeba mravali xarisxis da, Sesabamisad, klinikuri
nevrologiuri darRveva. lulovani gamovlinebis simZimis mixedviT arCeven
Zvlebis TavebSi Trombozebis ganviTareba Talasemiis Semdeg saxeebs:
173
1. didi -Talasemia (Thalasemia major) -Talasemiis dros elastikurobis
xasiaTdeba hemoglobinis molekulaSi daqveiTebis gamo eriTrocitebi brkoldebian
-jaWvebis sruli ararsebobiT elenTaSi da hemolizdeba. gaZlierebuli
(gvxvdeba homozigotebSi). aseT hemolizi da, agreTve, eriTropoezis
SemTxvevaSi nayofi an axalSobili darRvevebi, romlebic am daavadebas axasiaTebs,
iRupeba adreul postnatalur iwvevs hipoqsiis ganviTarebas, Zvlis wiTeli
periodSi. tvinis hiperplazias, ConCxis da Zvlebis
2. Suamdebare -Talasemia (Thalasemia deformacias (sur. 17-12), sisxlwarmoqmnis
intermedia anu H-hemoglobinozi) eqstrameduluri (Zvlis tvinis gareSe) kerebis
saSualo simZimisaa. hemoglobinTan gaCenas, splenomegalias; rkinis utilizaciis
erTad postembrionul periodSi darRvevebi da plazmaSi misi raodenobis
gvxvdeba Bart's hemoglobinis 40%. gazrda iwvevs Sinagani organoebis
3. mcire Talasemia (Thalasemia minor) hemosiderozs, am organoTa funqciebis
xasiTdeba -jaWvebis zomieri darRvevas Sesabamisi simptomatologiiT.
deficitiT, aramkveTri anemiiT. klinikuri suraTis simkveTre
daavadebul bavSvebs dabadebisas dakavSirebulia Talasemiis formasTan. mcire
gaaCniaT Hb Bart's 5-6%. da minimaluri Talasemia sustad gamoxatuli
4. minimaluri anu "munji" Talasemiis simptomatologiiT, zogjer ki mxolod
(Thalasemia minima) dros -jaWvebis hematologiuri niSnebiT - sisxlSi
deficiti umniSvneloa da amitom "samizniseburi" eriTrocitebisa da daSlili
eriTrocitebis narCenebis (Sizocitebis)
anemia ar viTardeba. am formis
arsebobiT xasiaTdeba (sur. 17-12a).
diagnozireba xdeba HbBart's-is
enzimopaTiebi gansazRvruli arian
umniSvnelo raodenobiT Semcvelobisas.
eriTrocitebis fermentuli sistemebis
Talasemiis bolo sami forma
memkvidrulad pirobadebuli defeqtebiT.
heterozigotebSi gvxvdeba. -Talasemiis
magaliTad, glukozo-6-
paTogenezSi wamyvan rols asrulebs fosfatdehidrogenazodeficituri anemiisas
eriTrocitebis gaZlierebuli daSlis gamo Sesabamisi fermentis nakleboba eriTrocitebSi
ganviTarebuli hipoqsia. anomaluri iwvevs glukozo-6-fosfatis metabolizmis
hemoglobini advilad iJangeba da darRvevas, ris gamo mcirdeba glutaTionis
ileqeba precipitatis saxiT, mcirdeba
aRdgenili formis warmoqmna - im formisa,
eriTrocitebis membranis plastikuroba,
romelic icavs eriTrocitebis membranas da
rigiduli eriTrocitebi brkoldebian
globinis jgufebs daJangvisgan. aseT pirobebSi
elenTaSi da hemolizdebian.
organzmSi mJangavi nivTierebebis moxvedrisas
-Talasemiis dros irRveva (antimalariuli preparatebi, paski, ftivazidi)
hemoglobinis SemadgenlobaSi Semavali - izrdeba membranis ganvladoba, icvleba ionuri
jaWvis sinTezi. am tipis Talasemiis yvela wonasworoba, mcirdeba eriTrocitebis
SemTxveva SeiZleba daiyos or jgufad: - rezistentoba, rasac Zlieri sisxlZarRvSiga
Talasemia, romlis dros -jaWvebis hemolizi mohyveba. es anemia gadaecema
sinTezi savsebiT Sewyvetilia da +- dominanturi gziT, paTologiuri geni X
Talasemia, rodesac -jaWvebis sinTezi qromosomasTanaa asocirebuli.
daqveiTebulia.
174
periferiul sisxlSi eriTrocitebis
re-generaciul formebTan erTad gvxvdeba
da-avadebis Sesabamisi degeneraciuli
formebi: sferocitebi - minkovski-Sofaris
daavadebis dros, namgliseburi
eriTrocitebi – nam-gliseburi anemiis
dros, samizniseburi eriT-rocitebi -
Talasemiis dros.
175
.
sur.17-2. namglisebri anemia B12-vitaminodeficituri da folide-
ficituri anemiebi
hemopoezis darRvevebis Sedegad am jgufis anemiebs axasiaTebs sis-xlis
ganviTarebuli anemiebi. Sratsa da qsovilur depoebSi B12 vitaminis an
am jgufis anemiebi viTardeba eriT- folimJavas nakleboba. anemiis ZiriTadi
rocitebis an hemoglobinis warmoqmnis mizezia am nivTierebebis Sewovis darRveva an
darRvevebis Sedegad. maT miekuTvneba rki- Warbi raodenobiT gamoyeneba, ufro iSviaTad -
nadeficituri, B B12 - da folidefi-citu- maTi mcire raodenobiT miReba sakvebiT.
ri, hipo- da aplaziuri anemiebi.
176
B12-vitamindeficituri anemiebis eti- citozi tendenciiT makrocitozisken, leiko-
ologiasa da paTogenezSi garkvevisTvis penia, Trombocitopenia.
saWiroa vicodeT, rom sakvebiT miRebuli vinaidan eriTrocitebis raodenobis
B12-vitamini (ciankobalamini) janmrTel mkveTri Semcirebis fonze sisxlSi arsebuli
organizmSi uerTdeba kuWis wvenSi myof eriTrocitebis sidide gazrdilia da isini,
gastromukoproteins, romelic icavs mas Sesabamisad, normaluri zomis eriTrocitebze
daSlisgan. nawlavis kedelSi ciankobala- met hemoglobins Seicaven, mTlianad sisxlSi
mini (kaslis Sinagani faqtori) uerTdeba eriTrocitebis procentuli Semcveloba qve-
aqceptorsa da am saxiT Seiwoveba sis- iTdeba ufro mkveTrad, vidre hemoglobinisa2.
xlSi. aq ciankobalamini uerTdeba cilas amitom feradobis maCvenebeli izrdeba da ane-
da warmoiqmneba naerTi proteincian- mia hiperqromuli xasiaTisaa.
kobalamini, romelic deponirdeba, pirvel hipo- da aplaziuri anemiebi. hipo- da
rigSi, RviZlSi. ciankobalamins foli mJa- aplaziuri anemiebis mizezebi mravlgvaria. maTi
va gadayavs aqtiur formaSi – tetrahid- gamowveva ZaluZT infeqciur agentebs, benzins,
rofilis mJavaSi, romelic astimulirebs benzols, antibiotikebs (streptomicini, le-
da aregulirebs eriTropoezs. vomicetini, sintomicini), citostatikur da
Sesabamisad, B B12-vitaminis deficiti leikozis sawinaaRmdego preparatebs (ureTani,
SeiZleba ganviTardes sakvebSi misi nakle- milerani, sarkolizini, tio-tefi da sxv.),
bobisas, Sinagani faqtoris ukmarisobisas oqros, bismutisa da dariSxanis preparatebs,
(sruli aqilia, sruli an nawilobrivi maionizebel radiacias, hemopoezis hormonuli
gastreqtomia, kuWis kibo), wvril naw- regulaciis darRvevebs, autoimunur proce-
lavSi B12-vitaminis Sewovis darRvevisas sebs da sxv. am jgufis anemiebis paTogenezSi
(botriocefuli anemia), orsulobis dros mniSvnelovan rols TamaSobs intoqsikacia da
B12-vitaminis nayofisTvis didi organizmis sensibilizeba qimiuri, fizi-kuri
raodenobiT gadacemis gamo. an infeqciuri agentebiT. hipo- da aplaziur
rogorc iTqva, B12-vitaminis anemiebs xSirad meoradad iwve-ven leikozebi
deficitis dros ferxdeba (ix. "leikozebi").
normoblastebSi irRveva dnm-is sinTezi, hipo- da aplaziuri anemiebis safuZ-velia
am ujredebis momwifeba. Nnormoblasturi Zvlis tvinis umwifari ujredebis
tipis sisxlwarmoqmna gardaiqmneba proliferaciis unaris Semcireba an da-kargva.
megaloblasturad, romelic normis pi- mkveTrad mcirdeba sisxlwar-moqmnis deda
robebSi vlindeba mxolod embrionul ujredebis raodenobac. aRi-niSneba ujredovani
peri-odSi. metad damaxasiaTebelia elementebis (gansakuT-rebiT eriTrocituli
periferiuli sisxlis suraTi. Cndebian rigis) raodenobis Semcireba, mieloiduri
giganturi (12-15 mkm diametris) rigis ujredebis diferenciaciis darRvevebi,
eriTrocitebi - megalocitebi da maTi TiTqmis mTlianad qreba megakariocitebi,
adreuli formebi - megaloblastebi, mcirdeba sisxlmbadi qsovilis moculoba,
romlebic iolad iSlebian; viTarde-ba Zvlis tvinis aplazia.
eriTrocitebSi gvxvdeba paTologiuri
CanarTebi: Jolis sxeulakebi (birTvis 15.2 eriTrocitozebi
naSTi) da kabos beWdebi (birTvis garsis
naSTi), bazofiluri mar-cvlovneba,
2 hemoglobiniT maqsimaluri gajerebisas saSualo
vlindeba anizocitozi da poikilo- zomis eriTrocitebi Seicaven 30 -33 pikogram
hemoglobins, megalocitebi ki (didi moculobis gamo) -
50 pikogramamde hemoglobins.
177
eriTrocitozi (policitemia) eriT- raode-noba. is SeiZleba iyos kompensaciuri an
rocitebis raodenobis momatebaa sisxlis paTo-logiuri.
moculobis erTeulSi. uxSiresad is vi- kompensaciuri xasiaTis absoluturi
Tardeba rogorc am Tu im daavadebis eriTrocitozi viTardeba hipoqsiis dros,
simptomi da qreba am daavadebebis likvi- magaliTad, gul-sisxlZarRvTa da sunTqvis
daciis Semdeg. sistemis ukmarisobis (gulis Tandayolili
mankebi, emfizema, pnevmosklerozi, qronikuli
eriTrocitozebis saxeebi pnevmoniebi), intoqsikaciebis (naxSirJangiT)
ganasxvaveben absolutur (WeSmarit) dros da sxv. am tipis eriTrocitozi Se-
da SefardebiT (cru) eriTocitozs (po- iZleba ganuviTardes maRalmTianeTSi mcxov-
licitemias). SefardebiTi policitemia reblebsac. aRniSnul SemTxvevebSi eriTroci-
viTardeba organizmis mier wylis didi tebis raodenoba sisxlSi matulobs eriTro-
raodenobiT dakargvisas, e.i. im daavade- poezis gaZlierebis xarjze, romelic, Tavis
bebis dros, romlebsac axasiaTebs Zlieri mxriv, dakavSirebulia Zvlis tvinze hipoqsiis
faRaraToba, Rebineba an poliuria. aseTi gamRizianebel moqmedebasTan, hipoqsiis gamo
tipis eriTrocitozi viTardeba areTve hemopoetinebis (eriTropoezis mastimulire-
farTo aris damwvrobisas, radganac da- beli nivTierebebis) produqciis zrdasTan.
zianebis ubanSi adgili aqvs sisxlis kompensaciuri absoluturi eriTrocito-
plazmis didi raodenobiT gaJonvas. Se- zi SeiZleba ganviTardes garemoSi Jangbadis
fardebiTi policitemia dakavSirebulia parciuli wnevis daqveiTebisas (magaliTad,
sisxlis plazmis moculobis Semcire- mTis daavadeba). am pirobebSi eriTrocitebis
basTan, rac, bunebrivia, zrdis sisxlSi raodenoba sisxlSi Tavdapirvelad matulobs
eriT-rocitebis koncentracias mTlianad hipoqsiis gamo sisxlis depo-organoebidan
mocirku-lire sisxlSi eriTrocitebis koncentrirebuli sisxlis gamosrolis Sede-
normaluri raodenobis SemTxvevaSic. gad, xolo SemdgomSi - eriTropoezis
ufro metic, amgvari policitemia gaZlierebis xarjze.
SeiZleba ganviTardes cirkuli-rebad paTologiuri absoluturi policitemia
sisxlSi eriTrocitebis saerTo raode- viTardeba vakezis daavadebis dros. vakezis
nobis Semcirebis drosac. magaliTad, daavadebis (eriTremia, namdvili policitemia)
Zlieri damwvrobisas (ix. "maRali safuZ-velia totaluri hiperplaziuri
temperaturis dama-zianebeli gavlena procesi Zvlis tvinSi, gansakuTrebiT mis
organizmze") xSiria eriT-rocitebis eriTro-citul StoSi. dReisTvis vakezis
hemolizi, magram amave dros plazmis daavade-bis miiCneven leikozis erT-erT saxed
danakargi misi damwvrobis areSi ga-Jonvis - eriTromielozad, romlis drosac gansa-
gamo SeiZleba imdenad didi iyos, rom 1 kuTrebuli intensivobiT producirdeba
mm3 sisxlSi eriTrocitebis raodenobam eriTrocitebi da hemoglobini.
normasTan SedarebiT moimatos kidec, e.i.
am SemTxvevaSi mTlianad mocirkulire 15.3 leikocitebis raodenobrivi da
sisxlSi eriTrocitebis raodenobis xarisxobrivi cvlilebebi
Semcirebis miuxe-davad, sisxlis 15.3.1. leikocituri formulis
moculobis erTeulSi eriTro-citebis cvlilebebi
raodenoba momatebulia. ganasxvaveben leikopoezis darRvevvis
absoluturi eriTrocitozis dros Semdeg saxeebs:
moma-tebulia eriTrocitebis absoluturi leikocitebis warmoqmnis momateba
178
leikocitebis warmoqmnis Semcireba (metamielocitebis) arsebobiT. amgvari gadaxra
leikocitebis momwifebis procesis mieloiduri Stos ujredebis gaZlierebul
cvlileba produqciaze miuTiTebs da gvxvdeba pnev-
paTologiurad Secvlili leikoci- moniebis, muclis tifis, qunTruSis, difte-
tebis warmoqmna. riis, wiTeli qaris, zogjer septikuri pro-
leikopoezis darRvevis sxvadasxva cesis dros.
saxe xSirad erwymis urTierTs. Mmagali- 2. leikocituri formulis hiperrege-
Tad, leikozebis dros leikocitebis neraciul gadaxras marcxniv sisxlSi neit-
produqcia izrdeba. Ees procesi SeiZle- rofilebis didi raodenobis SemcvelobasTan
ba mimdinareobdes leikocitebis diferen- erTad axasiaTebs mielocitebis gaCenac, rac
cirebis unaris SenarCunebiT an mis ga- miuTiTebs granulopoezis mkveTr gaaqtivebaze.
reSe, rac ganapirobebs periferiul sis- misma esoden mkveTrma gaZlierebam saboloo
xlSi leikocitebis momwifebuli an um- jamSi SeiZleba migviyvanos mieloiduri Stos
wifari formebis gamosvlas. gamofitvamde. cxadia, rom aseTi hiperrege-
leikopoezi irRveva endogenuri da neraciuli gadaxra viTardeba mZimed mimdinare
egzogenuri faqtorebis moqmedebis Sede- infeqciebis, Cirqovani, septiuri procesebis
gad. pirvels miekuTvneba leikocitebis dros da pronozulad arasasiamovnoa.
warmoqmnis da diferencirebis genetikuri 3. leikocituri formulis marjvniv
xasiaTis moSla. leikopoezis darRvevis gadaxra xasiaTdeba CxirbirTviani neitrofi-
gamomwvev garegan faqtorebs miekuTvneba lebis raodenobis SemcirebiT da hiperseg-
biologiuri (baqteriebi, virusebi, umar- mentirebuli birTviani leikocitebis gaCeniT.
tivesebi), fizikuri (maionizirebeli ra- marjvniv gadaxra leikopeniis fonze miuTiTebs
diacia, ultraiisferi sxivebi) da qimi- granulopoezis daTrgunvaze (magaliTad, sxi-
uri agentebi. vuri daavadebis dros, B12 deficituri anemiis
organizmis reaqtiulobisa da dros).
leikopoezis organoebis funqciuri
mdgomareobis SefasebisTvis aucilebelia
ganisazRvros ara marto leikocitebis
saerTo Semcveloba periferiul sisxlSi,
aramed maTi calkeuli formebis
raodenobac, am monacemebis safuZ-velze
leikocituri formulis (sxvadasxva sa-
xis leikocitebis procentuli
urTierTSefardeba, ix. cxr. 15-1) Sedgena
da analizi. amave dros yuradReba unda
mieqces momwifebis sxvadasxva stadiaSi
myofi neitrofilebis Semcvelobas.
leikocituri formulis ZiriTadi
ti-pobrivi cvlilebebi Semdegia:
1. leikocituri formulis zomieri
e.w. regeneraciuli tipis gadaxra
marcxniv xasi-aTdeba sisxlSi
CxirbirTviani leikocitebis raodenobis
momatebiT da yrma neitrofilebis
179
180
cxrili 15-1 cxivovani distrofiis Sedegebi - citoplazmis
leikocituri formula normisa da vakuolizeba (aseTi ujredebis spirtiT fiq-
paTologiis dros saciisas cximi ixsneba da Cndeba carieli
organ le neitrofilebi
izmis ikocit. ba e
areebi), romelsac adgili l
aqvs sefsisis
g
mZime
cvlile
raodenob zofi- ozino- formis, abscesebis, sxivuri
imfoci daavadebis
onoci dros.
bebi
a
leikocitebis degeneraciis niSnebs miekuTvneba
mdgoma 1 l f m met C segme t t leikog
reoba mkl ebi ilebi agreTve
ieloc amieloci xirbir-birTvis
nt- SeWmuxvna
ebi (piknozi)
ebi ramaSida
sisxlSi itebi tebi Tvianebi birTvianebi
mTlianad ujredis SeWmuxvna.
norma 100 0- 2- - - 3- 51-64 2 4
(%) 2 4 5 1-35 -8
absol 450 0- 10 - - 18 15.3.2.
3000- leikocitozi
1 2
uturi 0-8000 80 0-250 0-400 5500 800-2500 00-600
cifrebi
leikocitozi ewodeba leikocitebis rao-
apendi 150 - 1 - denobis
2% momatebas
15 periferiul
65% 1 sisxlSi
4 (maTi
neitro
citi 00 - % - 300 % 9750 3% % filuri
15
Semcveloba2 janmrTeli adamianis
1
sisxlSi mer-
6 leikocitozi
0 yeobs 4,5103-dan
250 8-103-mde
950 litrSi).
00 Lei-
birTvis
generaciuli
kocitozi ar aris damoukidebeli daavadeba.
gadaxriT
is rogorc reaqcia, simptomi Tan sdevs mra-
marcxniv
sefsis 250 - - 5 12% 2 28% 1 2 neitro
val sneulebas. leikocitozi xSiria fizio-
i 00 % 450 9% 7000 8% % filuri
1 0logiur 7pirobebSic da 4mas fiziologiur
5 leikocitozi
250
leikocitozs uwodeben. 500
250 00 birTvis
aseTs miekuTvneba le-
hiper-
ikocitozi sakvebis monelebisas (sakvebis mi-
regeneraciul
i gadaxriT
Rebidan 2-3 saaTis Semdeg), kunTovani muSa-
marcxniv
obis dros, axalSobilTa leikocitozi,
eozino
penia
premenstrualuri leikocitozi, orsulTa le-
B12 250 - - - - 1 45% leikop5 4
vitamindefici 0 ikocitozi.
% 1125 0%
enia %
turi anemia reaqtiuli
2 tipis paTologiuri
1 leiko-
1 neitropenia
5 250 00 birTvis
citozi viTardeba mravali daavadebisgadaxriT
dros.
misi aRmocenebis meqanizmSi ZiriTadmarjvniv.
rols
SefardebiTi
TamaSobs leikopoezis stimulacia da leiko-
limfocitozi
citebis sisxlSi gamosvlis daCqareba. Llei-
eozinopenia.
monocitopenia
kocitebis warmoqmnis mniSvnelovani stimula-
.
181
tebi, antigen-antisxeulebis kompleqsebi, xarjze. absoluturi limfocitozi viTardeba
leikocitebis, kerZod, maTi birTvis daS- qronikuli infeqciuri sneulebebis (tuberku-
lis produqtebi (leikocituri trefo- lozi, aTaSangi, keTri), yivanaxvelas, yvavilis,
nebi). limfoleikemiis dros da sxv.
leikopoezis simsivnuri tipis gaZ-
liereba viTardeba genebis mutaciisas kan- 15.3.3. leikopenia
cerogenezis gamo an sisxlmbadi ujrede- leikopenia sisxlSi leikocitebis raode-
bis II-IV klasebis (ix. zemoT) gamrav- nobis Semcirebaa 4103/l-ze qvemoT. Lleikoci-
lebis regulaciis epigenomuri darRve- tebis romelime erTi saxis upiratesi Sem-
vebisas. aseT SemTxvevaSi moumwifebeli cireba cnobilia neitro-, eozino-, monocito-
atipobrivi ujredebi ganusazRvrelad an lifopeniis saxelwodebiT.
mravldebian. imis mixedviT, Tu lei- leikopeniis ganviTarebis ZiriTadi gzebia:
kocitebis romeli saxis xarjze matu- leikopoezis darRveva an daTrgunva, leikoci-
lobs sisxlSi am ujredebis raodenoba, tebis gaZlierebuli daSla, leikocitebis ga-
ganasxvaveben leikocitozis sxvadasxva danawileba sisxlZarRvTa sistemaSi.
saxes. leikopeniis paTogenezSi monawileobs
neitrofilia (neitrofilebis raode- sxvadasxva meqanizmi: Zvlis tvinis leikopo-
nobis momateba sisxlSi) gansakuTrebiT ezuri funqciis, leikopoezis regulaciis
xSiria Cirqovani anTebis gamomwvevi in- nervuli da hormonuli darRveva, plastikuri
feqciebis (streptokoki, stafilokoki da masalis deficiti da sxv.
sxv.) dros, neitrofilebis warmoqmnis mkveTri daT-
sisxlSi eozinofilebis raodenobis rgunva zemoxsenebul faqtorTa zemoqmedebiT
momateba - eozinofilia viTardeba WiebiT iwvevs agranulocitozs - sisxlSi neit-
invaziis, zogierTi infeqciuri da kanis rofilebis raodenobis mkveTr Semcirebas
daavadebis, qronikuli mielozis dros, (1103/l-ze qvemoT) maT mTlianad gaqrobamde.
Tirkmelzeda jirkvlebis funqciis dar- agranulocitozis dros iTrgunebian organiz-
Rvevisas. mis dacviTi reaqciebi (anTeba, fagocitozi),
limfocitebis raodenobis momateba rac aadvilebs organizmSi paTogenuri mikrobe-
sisxlSi - limfocitozi, iseve, rogorc bis SeWras da xels uwyobs mZime infeqciur
sxva saxis leikocitozebi, SeiZleba iyos garTulebebs.
absoluturi da SedarebiTi. absoluturi fiqroben, rom medikamentozuri agranu-
limfocitozis dros momatebulia locitozis safuZvelia preparatis pirveli an
limfocitebis absoluturi raodenoba ganmeorebiTi Seyvanis gamo Camoyalibebuli
sisxlis moculobis erTeulSi. misgan sensibilizacia. igive preparatis morigi mi-
gansxavebiT, SedarebiTi limfocitozisas Reba am pirobebSi iwvevs mwvave krizs tempe-
limfocitebis absoluturi raodenoba ar raturis swrafi momatebiT da neitropeniis
aris momatebuli, magram leikocitur ganviTarebiT, rac dakavSirebulia leikocite-
formulaSi maTi procentuli raodenoba bis da sensibilizebis procesSi warmoqmnili
gazrdilia sxva saxis leikocitebis, uf- antileikocituri antigenebis (leikoagluti-
ro xSirad - neitrofilebis Semcirebis ninebis) urTierTqmedebasTan.
182
eozinopenia sisxlSi eozinofilebis hiperplazia leikozebis dros Seuqcevadi xa-
raodenobis Semcirebas ewodeba. am ujre- siaTisaa. mas Tan sdevs ujredebis momwifebis
debis sruli gaqroba sisxlidan ki aneo- Seferxeba an leikozis simsivnur
Sewyveta.
zinofiliis saxelwodebiTaa cnobili. bunebaze metyvelebs moumwifebeli ujredebis
limfocitopenia axasiaTebs neitro- SeuzRudavi zrda, maTi momwifebis darRveva,
filiiT mimdinare rig infeqciur sneu- morfologiuri anaplazia, leikozuri ujre-
lebebs, Cirqovan procesebs, mZimed mim- debis metastazirebis unari.
dinare tuberkulozs, sxivur daavadebas, leikozis dros sisxlmbadi qsovilis
limfogranulomatozs, limfosarkoma- kerebi Cndeba RviZlSi, TirkmelebSi, Tirkmel-
tozs. limfocitopenia viTardeba agreTve zeda jirkvlebSi, filtvebSi, nawlavebSi, kan-
glukokortikoidebis, imunodepresantebisa qveSa qsovilSi, e.i. organoebSi, romlebSic
da citostatikuri prepratebis xangr- mozrdil janmrTel organizmSi hemopoezi ar
Zlivi gamoyenebisas. mimdinareobs.
gadanawilebiTi leikopenia viTarde- simsivnuri (leikozuri) ujredebi Tavi-
ba, magaliTad, hemotransfuziuli da ana- danve metastazireben da azianeben mTel
filaqsiuri Sokis dros filtvebis, sisxlmbad sistemas. swored simsivnuri zrdis
nawlavebis, RviZlis gafarToebul kapila- sistemuri xasiaTi ganasxvavebs leikozs ada-
rebSi leikocitebis dagrovebis gamo. mas mianis mravali sxva avTvisebiani simsivnisgan.
droebiTi xasiaTi aqvs da, Cveulebriv, simsivnuri zrdis substratis – lei-
icvleba leikocitoziT. kozuri ujredebis diferencirebisa da mom-
15.4 leikozebi wifebis unaris mixedviT ansxvaveben mwvave da
leikozi sisxlmbadi qsovilis sim- qronikul leikozebs. mwvave leikozebis dros
sivnuri bunebis sistemuri daavadebaa. Pa- simsivneebis ZiriTadi substratia hemopoezis
Tologiuri hiperplaziuri procesi upi- II, III da IV klasebis blasturi ujredebi.
ratesad azianebs sisxlmbadi qsovilis maT dakarguli aqvT momwifebis unari. Qqro-
romelime - mieloidur, limfoidur, nikuli leikozis ZiriTadi substrati mom-
eriTroblastur nawils. droebiTi hiper- wifebis stadiaSi myofi an momwifebuli ujre-
plaziisgan gansxvavebiT, romelic iwvevs debia. ujredebis morfologiuri da cito-
leikocitozs an viTardeba anemiis gamo,
183
qimiuri Taviseburebebis mixedviT 15.5.1. sisxlis Sededebis daqveiTeba
ganasxvaveben mwvave mielo-, limfo-, mono- sisxlis Sededebis daqveiTeba (hipokoagulacia)
da megakari-ocitul leikozs, vlindeba midrekilebiT sisxldenisken,
eriTromielozs da aradiferencirebad sisxlCaqcevebisken (hemoragiuli diaTezi).
formebs. qronikul leikozs yofen mie- misi ZiriTadi meqanizmebia: 1) sisxldenis
lo- da limfoleikozebad, monocitur, Sededebis romelime faqtoris an faqtorebis -
megakariocitul leikozad, qronikul prokoagulantebis deficiti, 2) endogenuri
eriTromielozad. antikoagulantebis (heparini, antiTrombini da
. sxv.) siWarbe, 3) fibrinolizis aqtivacia, 4)
15.5. sisxlis Sededebis darRvevebi antikoagulantebis da fibrinolizuri prepa-
sisxlis Sededebis procesis Sesaxeb ratebis Warbi raodenobiT gamoyeneba.
sisxlis Sededebis (hemostazis) bio- hemostazis sisxlZarRvovan-Trombocitu-
logiuri sistemis ZiriTadi funqciebia: li darRvevebi viTardeba Trombocitopeniebis
organizmis dacva sisxldenisgan, sisxlde- (Trombocitebis raodenobis Semcireba
nis SeCereba da cirkulirebadi sisxlis 200109/l qvemoT) da TrombocitopaTiebis
Txier mdgomareobaSi SenarCuneba. is war- (Trombocitebis xarisxobrivi arasrulyofi-
moadgens efeqtorul nawils sxva zedmi- loba) dros. Trombocitopenia vlindeba
wevniT rTuli da mravalkomponentiani Trombocitebis arasakmarisi produqciis, maTi
sistemisa - organoebisa da meqanizmebisa, gaZlierebuli daSlis, intensiuri gamoyenebis
romlebic monawileoben hemostazis nei- dros. pirveli viTardeba Zvlis tvinis me-
rohumorul regulaciaSi da mikrohemo- gakariocituli Stos dazianebisas maionebeli
cirkulaciaSi. radiaciiT, qimiuri nivTierebebiT, misi gamo-
Hemostazi, ZiriTadad, xorcieldeba devnisas simsivneebis metastazebiT an leiko-
erTmaneTTan urTierTmoqedi sami funqci- zuri infiltratebiT, ciankobalaminis da
ur-struqturuli komponentiT: sisxlZar- folimJavas deficitis, Trombocitebis war-
RvTa kedlebiT, sisxlis formiani ele- moqmnis genetikuri defeqtis dros. verlhofis
mentebiT da plazmis fermentuli siste- simptomTkompleqsis SemTxvevaSi irRveva Trom-
mebiT, romlebsac miekuTvneba Sededebis, bocitebis momwifeba da megakariocitebisgan
Sededebis sawinaaRmdego, fibrinolizisa mocileba, sisxlSi Cndeba giganturi, fun-
da kalikrein-kininuri sistema. qciurad arasrulyofili Trombocitebi.
fiziologiur pirobebSi sisxlis Trombopenia Trombocitebis gaZlierebuli
Sededebisa da Sededebis sawinaaRmdego daSlis gamo SeiZleba gamowveuli iyos maTi
sistemebi, Sededebisa da fibrinolizis meqanikuri dazianebiT splenomegaliis (elen-
sistemebi dinamikur wonasworobaSi imyo- Tis gadideba) dros, gulis xelovnur sar-
febian. paTologiis dros xSirad amgvari qvelebaTn kontaqtisas, agreTve imunuri me-
wonasworoba irRveva, sisxlis Sededebis qanizmebiT. magaliTad, Trombocitebis anti-
unari qveiTdeba an piriqiT, sisxlis Se- genuri struqtura icvleba virusebis (wiTu-
dedebis unari matulobs da yalibdeba ra, wiTela), samkurnalo preparatebis (sul-
midrekileba Trombozisadmi. fanilamidebi, natriumis paraaminosalicilati)
zemoqmedebiT. aseTive Sedegi axasiaTebs anti-
184
Trombocituli antisxeulebis produqci- sisxlis Sededebis meore fazis dar-
as SemaerTqsovilis difuzuri dazianebis, Rvevas miekuTvneba hipoproTrombinemia (sis-
qronikuli limfoleikozis dros. xlSi proTrombinis raodenobis Semcireba).
Trombocitopenia Trombocitebis sisxlis Sededebis mesame fazis dar-
Warbi xarjvis gamo viTardeba sisxlis Rvevas axasiaTebs fibrinis sinTezis moSla.
koagulaciisas. maTi raodenobis Semcireba is, upirveles yovlisa, dakavSirebulia RviZ-
50-30109/l-ze qvemoT iwvevs spontanur lSi fibrinogenis sinTezis ukmarisobasTan,
sisxldenas (cxviridan, RrZilebidan, naw- fibrinogenis molekulis struqturis cvli-
lavebidan, saSvilosnodan) da sisxlCaq- lebebTan (disfibrinogenemia), fibrinolizuri
cevebs. sistemis gaaqtivebasTan.
sisxlis Sededebis pirveli – Trom- gansakuTrebiT mkveTria sisxlis Sedede-
boplastinis warmoqmnis faza irRveva he- bis mesame fazis darRvevvebi fibrinogenis gaZ-
mofiliis A da B formebis dros. Trom- lierebuli daSlis dros ferment plazminis
boplastinis deficitis gamo moiSleba (fibrinolizinis) zemoqmedebiT.
sisxlis Sededebis mTeli procesi da
umniSvnelo travamac ki xangrZliv sis-
xldenas iwvevs. cxrili 15-2 sisxlis Sededebis
Seneleba
185
15.5.2. sisxlis Sededebis unaris sisxlis Sededebis gaZliereba
momateba (hiperkoagulacia) vlindeba lokaluri (Trombozi) an
hiperkoagulaciis meqanizmi mraval- generalizebuli sisxlZarRvSida
gvaria. sisxlis Sededebis droebiTi ga- koagulaciis saxiT.
aqtiveba vlindeba simpatoadrenaluri sis-
16. sistemuri sisxlis mimoqcevis
temis agznebisas (tkivili, SiSi, stresi).
paTofiziologia
sisxlis Sededebis aqtivacias iwvevs
sisxlis mimoqcevis ukmarisoba
sisxlZarRvTa endoTeliumis Tromborezis- mosvenebis mdgomareobaSi mozrdili
tentuli Tvisebebis Secvla sisxlZarRvis ada-mianis organizmis jamuri
kedlis dazianebisas, rasac moyveba va- moTxovnileba sis-xlze saSualod 5
zoaqtiuri nivTierebebis gamoyofa hiper- l/wT/m2-ia. intensiuri muSaobis dros is
koagulacia Trombocitebis adheziur- SeiZleba gaizardos 3-5-jer. aseTi Warbi
agregaciuli Tvisebebis gaZlierebis gamo moTxovnilebis dakmayofi-lebis unari
viTardeba agreTve sisxlSi Trombocite-bis dakavSirebulia gul-sisxl-ZarRvTa
raodenobis momatebisas. sistemis did funqciur SesaZleblo-
sisxlis Sededebis momatebaSi gan- bebTan, rac Tavis mxriv efuZneba gulisa
sakuTrebul rols TamaSobs Sededebis da sisxlZarRvebis natif da, amave dros,
pirveli - Tromboplastinis warmoqmnis mdgrad regulacias. am gziT xorcieldeba
fazis maRali intensivoba, rac iwvevs ara marto gulisa da sisxlZarRvTa
Trombinad proTrombinis didi raodenobiT sistemis sxvadasxva nawilis muSaobis
gardaqmna). aseTi suraTi vlindeba sisxlSi koordinacia, aramed misi kavSiri
Tromboplastinis didi raodenobis sunTqvisa da sisxlis sistemebTanac.
gadasvlisas drois mcire monakveTSi gulisSiga da zogadi nervul-humoruli
(travma, operaciebi qsovlTa didi re-gulacia uzrunvelyofs iseT SeguebiT
dazianebiT, Soki, placentis mocileba). am reaq-ciebs, rogorebicaa gulis
SemTxvevebSi sisxlis Sededeba viTardeba wuTmoculobis zrda, sisxlis nakadis
dazianebis adgilidan daSorebul qsovi- aCqareba, sisxlZarRvTa periferiuli
lebis sisxlZarRvebSic. winaaRmdegobis Semcireba, sis-xlis
hiperkoagulaciisTvis didi mniSvne- gadanawileba, sunTqvis gaRrmaveba da
loba aqvs agreTve bunebrivi antikoagu- gaxSireba, eriTrocitebis gamosrola
lantebis (heparini, antiTrombini) defi- depo organoebidan, eriTropoezis
cits da fibrinolizis procesis daTr- gaZliereba da sxv. es SeguebiTi an
gunvas (magaliTad, maRal temperaturaze sakompensacio reaqciebi funqcioben
momuSaveebSi, aTerosklerozis, alkoho- rogorc janmrTeli organizmis gul-
luri intoqsikaciis dros). vinaidan Tavi- sisxlZarRvTa sistemis datvirTvis gaz-
sufali heparini lipazas aqtivatoria, misi rdisas, ise sisxlis mimoqcevis
didi raodenoba ixarjeba organizmSi darRvevebis dros. magram Tu es
lipidebis siWarbisas. am pirobebSi darRvevebi metad Zlieri an xangrZlivia,
(aTerosklerozi, cximiani sakvebis miReba) kompensaciuri reaqciebi sus-tdeba,
isaxeba tendencia hiperkoagulaciisken ifiteba, yalibdeba gul-sisxlZarRvTa
(simsuqne). ukmarisoba.
186
ganviTarebis meqanizmebisa da ratis cvlilebebic, rac gulis gadat-
klinikuri gamovlinebis mixedviT virTvas iwvevs.
ganasxvaveben sisxlis mimoqcevis - perikardiumis dazianebis Sedegad
ukmarisobis Semdeg saxeebs: gulis ganviTarebuli gulis ukmarisoba.
ukmarisoba, sisxlZarRvTa ukmarisoba da
gul-sisxlZarRvTa ukmarisobis Sereuli
forma TiToeuli maTgani SeiZleba 16.2 gadatvirTvis gamo
ganviTarebuli gulis ukmarisoba
atarebdes mwvave an qronikul xasiaTs.
gulis gadatvirTva misi kamerebis
sis-xliT gadavsebis an kameridan sisxlis
16.1. gulis ukmarisoba
gulis ukmarisobas uwodeben mdgoma- gamo-tanisadmi winaaRmdegobis zrdis
reobas, rodesac guli gamoisvris ufro Sedegia. Ppir-vels iwvevs mZime fizikuri
terminis ufro viwro gagebiT gulis uk- suraTi vlindeba gulis Zgideebis
187
winaaRmdegobis gazrdiT sisxlis mimoqcevis sindromis (stenokardia) an miokardiumis
did da mcire wreSi, pnev-moskleroziT, nekrozis saxiT.
filtvis emfizemiT.
sisxlis mimoqcevis didi an mcire miokardiumis koronarogenuli nekrozi
wris hipertenzias axasiaTebs sisxlZarRvTa miokardiumis infarqti – miokardiu-
periferiuli winaaRmdegobisa da saSualo mis koronarogenuli nekrozi gulis kun-
arteriuli sisxlis wnevis zrda. Tis kerovani isqemia da kvdomaa, romelic
dasasruls unda iTqvas, rom gadatvir- viTardeba koronaruli sisxlis mimocevis
Tvis gamo ganviTarebul gulis absoluturi an SedarebiTi ukmarisobis
ukmarisobas yovelTvis Tan sdevs gulis dros.
kompensaciuri hi-perfunqcia da absoluturi koronaruli ukmarisoba
hipertrofia. rac ufro didia gulis iseTi mdgomareobaa, rodesac gulis kun-
datvirTva, miT ufro intensiuria Tis sisxlmomarageba Semcirebuli an
hipertrofia da miT ufro metia gulis sruliad Sewyvetilia. SedarebiT
ukmarisobis ganviTarebis albaToba. koronarul ukmarisobaze laparakoben
maSin, rodesac gulis kunTis
16.3 miokardis dazianebiT gamowveuli sisxlmomarageba normaluri an
gulis ukmarisoba
momatebulia, magram sisxlis raodenoba
miokardis dazianebis ZiriTadi
araa sakmarisi didi datvirTviT momuSave
meqanizmebi
gulis kunTis moTxov-nilebis
gulis ukmarisobis metad mniSvnelo-
dasakmayofileblad.
vani meqanizmi miokardis dazianebaa. is
absoluturi koronaruli ukmarisoba
SeiZleba gamowveuli iyos anTebiTi pro-
da, Sesabamisad, miokardiumis infarqti
cesiT) (miokarditi), distrofiiT (mio-
SeiZleba gamowveuli iyos qvemomoyvanili
kardiodistrofia), genetikuri defeqtiT,
mizezebiT.
infeqciiT (magaliTad, streptokokuli
gvirgvinovani arteriebis
infeqciiT), intoqsikaciiT (magaliTad,
neirogenuli spazmi iwvevs gulis kunTis
difteriuli toqsiniT), imunopaTologi-
isqemiis, xolo metad xangrZlivi an
uri procesiT, miokardis hipoqsiiT, niv-
ganmeorebiTi spazmebi - infarqtis
TierebaTa cvlis darRvevis gamomwvevi da-
ganviTarebas. dauzianebeli kedlebis mqone
avadebebiT.
sisxlZarRvebis spazmisas infarqtis Ca-
miokardis dazianebis metad xSiri
moyalibeba SedarebiT iSviaTia. infarqtis
mizezi gvirgvinovani sisxlis mimoqcevis
gan-viTarebis uxSiresi mizezia
darRvevaa.
gvirgvinovani sis-xlZarRvebis
daavadebebsa da paTologiur proce-
aTerosklerozi. aTeroskleroziT
sebs, romlebsac Tan sdevs gvirgvinovani
dazianebuli gvirgvinovani sisxlZarRvebi
sisxlis mimoqcevis darRvevis gamo gan-
ki gansakuTrebiT midrekilia xangrZlivi
viTarebuli miokardis hipoqsia, aerTianeben
da Zli-eri spazmisken.
gulis kunTis isqemiuri daavadebis cnebaSi.
garda spazmebisa,
es daavadeba SeiZleba gamovlin-des
koronarosklerozis dros infarqtis
funqciuri cvlilebebis, tkivilis
ganviTarebas xels uwyobs gvirgvinovani
188
sisxlZarRvebis Trombozi, sisx-lZarRvebis marcxena nawilSi. aseT tkivils xSirad
sanaTuris Seviwroveba aTeros-klerozuli Tan sdevs sikvdilis SiSi ("angor
"folaqebis" mier, rac sisxlis moZraobis precordialis").
darRvevas da, aqedan gamomdinare, tkivili mniSvnelovan rols Tama-
gvirgvinovani sisxlZarRvebis Trombozs uw- Sobs infarqtis paTogenezSi. mis gamo gan-
yobs xels. igive "folaqebis" dawyluleba, viTarebuli stres-reaqcia iwvevs stresu-
daSla iwvevs gvirgvinovani arteriebis li hormonebis - glukokortikoidebisa da
embo-lias, koronaruli arteriebis kateqolaminebis didi raodenobiT gamos-
Trombozi da embolia ki TviT
warmoadgenen infarqtis mi-zezs.
aTeroskleroziT dazianebuli gvirgvi-
novani arteriebi xSirad avlenen
paradoqsul reaqciebs. magaliTad,
kateqolaminebis gavle-niT aseTi
sisxlZarRvebi gafarTovebis nac-vlad
viwrovdebian.
gvirgvinovani sisxlis mimoqcevis
moSla (gvirgvinovani ukmarisoba) iwvevs
JangviTi procesebis darRvevas da
anaerobuli cvlis dauJangavi produqtebis
(rZemJavas da piro-yurZenmJava) dagrovebas
miokardSi. ujre-debis dazianebas Tan sdevs rolas. im SemTxvevaSi, Tu stres-reaqcia
K+ ionebis, fermentebis, biologiurad mTavrdeba rezistentobis stadiaze,
aqtiuri nivTi-erebebis ganTavisufleba, stresuli hormonebi as-ruleben
romlebic aR-rmaveben miokardiumis bioenergetikuli procesis gamaaqtivebel
dazianebis process. gulisken rols, monawileoben kardiomiocitebis
kateqolaminebis didi raodeno-biT mitana membranebis ganax-lebis reaqciebSi, rac
mkveTrad zrdis mis moTxov-nilebas metad mniS-vnelovania miokardiumis
Jangbadze, rac kidev ufro aR-rmavebs dacvisTvis. magram Tu paTogenuri
hipoqsias. amave dros gulis kun-Ti faqtoris moqmedeba ar wydeba, stres-
ganicdis energetikuli resursebis reaqcia gadadis gamofitvis stadiaSi, ro-
(glukoza, cximovani mJavebi) naklebobas, melSic kateqolaminebis siWarbe
misi kumSvadoba, sistoluri moculoba da histotoqsikur efeqts iZleva - maT mier
gulis indeqsi mcirdeba. Zlier gaaqtivebuli lipazebi da
gulis kunTSi hipoqsiiTa da acido- fosfolipazebi arRveven miocitebis
ziT receptorebis gaRizianeba iwvevs ste- membrane-bis lipidur Sres, rac am
nokardiisa da infarqtisTvis damaxasi- ujredebSi Seuq-cevad cvlilebebs iwvevs.
aTebel tkivilis sindroms. tkivili ux- Aamgvari movlenebi aRrmaveben gulis
Siresad viTardeba gulmkerdis areSi, kunTis nekrozirebis process, infarqtis
mkerdis Zvlis ukan, iradiaciiT marcxena are farTovdeba, es, Tavis mxriv,
xelSi, marcxena beWSi, kisrisa da qve-daybis aZlierebs tkivils, e.i. iqmneba Ta-
189
viseburi "mankieri wre". amitom, da agreTve infarqtis erT-erTi umZimesi garTu-
im mizeziT, rom tkivili monawileobs lebaa kardiogenuli Soki, romlis dros
kardio-genuli Sokis paTogenezSic, gulis sistoluri da wuTmoculoba qve-
infarqtis dros erT-erT upirvelesi iTdeba periferiuli winaaRmdegobis ma-
amocana tkivilis sin-dromis likvidaciaa. tebis paralelurad. ukanaskneli Sedegia
miokardiumis danekrozebuli ubnis imisa, rom wnevis uecari dacemis dros
mde-bareobis gansazRvra SesaZlebelia iTiSebian baroreceptorebi, rac simpati-
eleqtro-kardiografiulad (ekg) ramdenime kur-adrenuli da renin-angiotenzinuri
ganxris analiziT. ekg infarqtis dros sistemis gaaqtivebas da periferiuli sis-
mkveTr cvlilebebs ganicdis da mas droiTi xlZarRvebis Seviwrovebas iwvevs. aRniSnu-
kinetika axasiaTebs. li da, agreTve, mikrocirkulaciis Tan-
gulis kunTis isqemiuri (an darTuli darRvevebi iwveven qsovilebis
danekrozebuli) ubnis kumSvis unaris hipoqsias, acidozs, organoTa funqciebis
daqveiTebis gamo mcirdeba gulis cvlilebebsa da sikvdils.
sistoluri moculoba da, Sesabamisad, gulis SekumSvis fazaSi miokardiu-
gvirgvinovani sisxlis nakadi. es ki xels mis danekrozebuli ubani pasiurad iWime-
uwyobs infarqtis zonis gadidebas, gulis ba, rasac SedarebiT axali infarqtis Sem-
sistoluri moculobis kidev ufro met TxvevaSi SeiZleba misi gagleja an, mog-
Semcirebas, e.i. yalibdeba meore "mankieri vianebiT, nawiburebis gaCenis Semdeg,
wre". aRsaniSnavia, rom mcirdeba miokardis anevrizmis Camoyalibeba moyves. danekroze-
da-uzianebeli nawilis SekumSvis unaric, buli kardiomiocitebis ujredSiga ci-
rac gamowveulia misi sisxlZarRvebis lebis gadasvla sisxlSi xSirad iwvevs
refleqsuri spazmiT ("interkordialuri organizmis autoimunizebas Sesabamisi an-
refleqsi"). tisxeulebisa da gulis antigenebis mi-
isqemiis zonaSi kardiomiocitebis marT sensibilizebuli limfocitebis
bioeleqtruli Tvisebebis mkveTri cvli- warmoq-mniT. imunuri reaqcia aRrmavebs
lebebis gamo isqemiuri an dainfarqtebis gulis kunTis dazianebas, xels uwyobs ra
procesSi myofi qsovili SeiZleba iqces meoradi nekro-zebis ganviTarebas.
eqtopuri aqtivobis kerad, rac eqs- autoantisxeulebis war-moqmnas
trasistoliis ganviTarebas iwvevs. Mrav- ukavSireben agreTve postinfarqtuli
lobiTi eqtopiuri kerebi ujredebis nek- (dresleris) sindromis Camoyalibebas,
rozis gamo ganviTarebul blokadasTan rome-lic xasiaTdeba gulis serozuli
erTad qmnian agznebis cirkulaciis aRmo- garsis, filtvebis, saxsrebis anTebiT,
cenebis pirobebs. ukanaskneli sikvdilis romlebic ar emorCilebian mkurnalobas
uxSiresi mizezia mwvave infarqtis dros. antibiotikebiT, mag-ram rogorc sxva
miokardiumis infarqts xSirad Tan alergiuli reaqciebi, eqvem-debarebian
sdevs gulis mwvave an qronikuli ukmari- mkurnalobas kortikosteroidebiT.
soba. hemodinamikis cvlilebebi miT ufro SedarebiTi koronaruli ukmarisobis
mkveTria, rac ufro didi moculobisaa dros miokardiumi gvirgvinovani
dainfarqtebuli are. arteriebiT iRebs sisxlis normalur
raodenobas, magram ufro naklebs, vidre
190
moiTxovs didi dat-virTviT momuSave Wimvis xarisxi Warbobs dasaSveb zRvars,
gulis kunTi. magaliTad, aratrenirebuli SekumSvis Zala Semcirebas iwyebs.
adamianis mier mZime fizikuri muSaobis winaaRmdegobis zrdis gamo ganviTa-
Sesrulebisas gaZlierebiT momuSave guli, rebuli gulis gadatvirTvisas Tavs iCens
miuxedavad koronaruli sisxlZarRvebis kompensaciis homeometruli meqanizmi. aseT
gafarToebisa da sisxlis nakadis SemTxvevaSi kameris gavsebisas boWkoebis
momatebisa, ver iRebs gazrdili sigrZe arc Tu mkveTrad matulobs, magram
moTxovnilebis Sesabamis sisxlis izrdeba wneva da daZabuloba kunTis Se-
raodenobas. amitom gvirgvinovani sis-xlis kumSvis dasawyisSi. SekumSvis Zalis mate-
mimoqcevis SedarebiTi ukmarisoba mio- ba kibiseburad, yoveli Semdgomi Sekum-
kardiumSi mravalricxovani mcire Svisas xdeba.
nekrozebis ganviTarebas iwvevs. kompensaciis heterometruli meqaniz-
mi bevrad (daaxloebiT 8-jer) ufro eko-
16.4. sakompensacio meqanizmebi gulis nomiuria, vidre homeometruli. albaT,
ukmarisobis dros
amiT aixsneba im paTologiuri procesebis
gulis ukmarisobis nebismieri formis
SedarebiT keTilTvisebiani mimdinareoba,
dros Tavs iCens sakompensacio reaqciebi,
romlis drosac kompensaciis heteromet-
mimarTuli sisxlis mimoqcevis zogadi ukma-
ruli meqanizmi vlindeba (magaliTad, sar-
risobis winaaRmdeg. am reaqciaTa
qvelebis ukmarisobisa xvrelebis stenoz-
mniSvnelovani nawili aRmocendeba TviT
Tan SedarebiT).
gulSi. maT miekuTvneba: 1. gulis kunTis
gulis kunTis tonogenuri dilate-
kumSvadobis cvlileba, 2. gulis kunTis
cia dazianebuli mioakrdiumis Rruebis
tonogenuri dilatacia, 3. gulis riTmis
tonogenuri gafarToeba sisxlis diasto-
cvlileba, 4. miokardis hipertrofia.
luri moculobis zrdasTanaa dakavSire-
pirveli sami sakompensacio reaqcia Ca-
buli. aseTi suraTi mJRavndeba, magali-
irTveba dazianebis an sisxlis nakadisadmi
Tad, aortis sarqvelebis ukmarisobis
ma-Rali winaaRmdegobis gaCenisTanave. amave
dros marcxena parkuWSi aortidan ukug-
dros, gulis datvirTvis zrdis formasTan
debuli sisxlis dabrunebis gamo, rasac
dakav-SirebiT aRmocendeba gulis SekumSvis
Tan sdevs parkuWis SekumSvebis gaZli-
cvlilebis esa Tu is saxe.
ereba frank-starlingis meqanizmebiT (ix.
gulis kunTis kumSvadobis cvlilebebi.
zemoT). magram Tu gulis kunTis
gulis gadatvirTvisas gazrdili
boWkoebis di-astoluri gaWimva mkveTria
moculobiT vlindeba kompensaciis hete-
da procesi xan-grZliv xasiaTs iRebs,
rometruli meqanizmi. diastolis dros
irRveva koronaruli sisxlis mimoqceva,
gulis esa Tu is Rru Warbad ivseba
miokardiumis sisxlmomarageba, energiis
sisxliT, rac kunTovani boWkoebis Zlier
warmoqmnis da aqtomiozinis SekumSvis
gaWimvas iwvevs. gaWimvis zrdas Tan sdevs
procesi, tonogenuri dilatacia gadadis
gulis SekumSvis gaZlierebac, rac
miogenurSi da gulis kumSvadoba qve-
miokardiumis ujredebis saerTo Tvisebaa
iTdeba.
(frank-starlingis kanoni). magram Tu ga-
gulis riTmis cvlilebebi. gulis
wuT-moculobis SenarCunebisken
191
mimarTuli kidev erTi sakompensacio didi simZlavre saSualebas aZlevs Seda-
reaqciaa gulis SekumSvebis gaxSireba - rebiT iolad daZlios zedmeti datvir-
taqikardia, romelic viTar-deba Tva, e.i. miokardis hipertrofia gazrdili
refleqsurad marjvena winagulis sis-xliT muSaobis Sesrulebisken mimarTuli Segue-
gadavsebisas, rac breinbrijis ref-leqsis biTi movlenaa. is uzrunvelyofs paTolo-
saxelwodebiTaa cnobili. Tumca unda giuri procesis dros ganviTarebuli hem-
iTqvas, rom am refleqsis arsebobas odinamikis darRvevis xangrZlivi droiT
mravali mkvlevari eWvis qveS ayenebs. kompensacias.
energetikuli TvalsazrisiT hipertrofirebuli guli normalu-
taqikardia kompensaciis yvelaze risgan gansxvavdeba mTeli rigi Tavise-
araxalsayreli meqaniz-mia, radgan is iwvevs burebebiT, romlebic saSualebas aZlevs
didi raodenobiT Jan-gbadis xarjvas da organos xangrZlivad gauZlos gaZliere-
mkveTrad amcirebs dias-tolas - miokardis bul datvirTvas, meores mxriv ki isini
dasvenebisa da energe-tikuli resursebis qmnian im paTologiuri cvlilebebis aR-
aRdgenis periods. garda amisa, taqikardiis mocenebis safuZvels, rac, xSirad, gulis
dros irRveva hemodinamikac: diastolis dekompensacias iwvevs. GgansakuTrebiT
fazaSi parkuWebi ver aswrebs sis-xliT aRsaniSnavia hipertrofirebuli miokardis
gavsebas da sistola arasrulfasovani Semdegi Taviseburebebi.
xdeba. gulis masis gadideba gamowveulia
miokardiumis hipertrofia. TiToeuli kunTovani boWkos gasqelebiT.
miokardiumis hipertrofia gulis kunTis miocitis moculoba aseT SemTxvevaSi
masis momatebaa miocitebis moculobis izrdeba misi mesame xarisxis, xolo
zrdis xarjze. fiziologiuri hipertrofia zedapiri - meore xarisxis
SeguebiTi xasiaTisaa da uviTardeba proporciulad. amitom mcirdeba ujredis
sportsmenebsa da saerTod im ada-mianebs, zedapiris farTobi misi masis er-Teulze.
romelTa organizmi xangrZlivi drois radgan ujredsa da ujredSoris siT-xes
ganmavlobaSi asrulebs mZime fi-zikur Soris nivTierebaTa cvla xorcieldeba
samuSaos. gulis hipertrofiis xa-risxi am ujredis zedapiris saSualebiT,
SemTxvevaSi korelirebs ConCxis hipertrofia iwvevs miocitis,
muskulaturis ganviTarebasTan. msgavsi gansakuTrebiT ki misi centraluri
paralelizmi ar axasiaTebs gulis kunTis nawilis momaragebis darRvevas.
paTologiur hipertrofias. hipertrofias radgan hipertrofiis procesi ar
am SemTxvevaSi ganicdis gulis kunTis is vrceldeba miokardis mkvebav
nawili, romelsac gaZlierebuli datvir- sisxlZarRvebze, hiper-trofirebul
TviT muSaoba xvda wilad. kunTSi kapilarebis ricxvi mio-kardiumis
rogorc aRiniSna, hipertrofiis dros zedapiris erTeulze mcirdeba, e.i.
matulobs calkeuli kunTovani boWkos hipertrofirebuli miokardi ar aris
moculoba, maTi raodenoba ki uc-vleli saTana-dod uzrunvelyofili
rCeba. amrigad, miokardis hiper-trofia sisxlZarRvebiT, amis Sedegad ki
amcirebs datvirTvas kunTis masis hipertrofirebuli gulis sisxl-
erTeulze. hipertrofirebul miokards momarageba ukmari xdeba.
192
hipertrofiis dros miocitis birTvis maRali datvirTva araTanabrad na-
gadideba CamorCeba mTlianad ujredis mocu- wildeba kunTovani boWkoebis sxvadas-xva
lobis zrdas. radgan birTvis funqcia jgufze. SedarebiT adre iRupeba da
cilis sinTezis uzrunvelyofaa, Cainacvleba SemaerTebeli qsoviliT ufro
hipertrofiis dros birTvis moculobis intensiurad mofunqcie boWkoebi. maT
SedarebiTi simcire iwvevs cilis sinTezis funqcias Tavis Tavze iReben boWkoebis
deficits da ujredis plastikuri sxva jgufebi da a.S. kardiomiocitebis
uzrunvelyofis deficits. Canacvleba SemaerT-qsoviliT iwvevs
hipertrofia ar vrceldeba gulis kardiosklerozs, jer kidev saRi
ner-vul da gamtar aparatze. amitom miocitebis kompresias, gu-lis meqanikuri
hipertro-firebuli miokardiumi ganicdis Tvisebebis cvlilebebs, difuziisa da
nervuli regulaciis deficits (sur. 20). nivTierebaTa cvlis dar-Rvevebis
irRveva uj-redSiga struqturebis gaRrmavebas. SemaerTebeli qsoviliT
urTierTSefardebac. kerZod, hipertrofiis miokardis masis 20-30%-is Canacvlebisas
sawyis periodSi mito-qondriebis swrafi gulis muSaoba SeuZlebeli xdeba.
zrda qmnis gulis fun-qciis kompensaciis gulis kunTis distrofia iwvevs gu-
karg pirobebs. magram Sem-dgomSi, procesis lis Rruebis gafarToebas, SekumSvis
gaRrmavebisas, mitoqondri-ebis masis zrda Zalis Semcirebas, e.i. viTardeba gulis
CamorCeba citoplazmis masis zrdas, miogenuri dilatacia, romelsac Tan
mitoqondriebi iwyeben funqciobas zRvruli sdevs gulis da Rru venebis gadavseba
datvirTviT, viTardeba maTi des-truqcia da sisxliT. amis Sedegad ganviTarebuli ta-
qveiTdeba muSaobis efeqturoba. Sesabamisad, qikardia kidev ufro aRrmavebs nivTi-
hipertrofirebuli miokardiumi ganicdis erebaTa cvlis moSlas miokardSi. amito-
energetikul ukmarisobasac. maa, rom miogenuri dilatacia da taqi-
yovelive zemoTqmulis gamo kardia gulis dekompensaciis dawyebis
hipertrofirebul miokards SedarebiT mrisxane simptomebia.
SezRuduli adaptaciuri SesaZleblobebi
aqvs, Semcirebulia misi funqciuri re-
zervic.
hipertrofirebuli miokardiumis Ta-
viseburebebis gamo xangrZlivi da inten-
siuri datvirTva mis gamofitvas da de-
kompensacias iwvevs. gulis ukmarisobis
sxvadasxva formis dros SeiZleba
Warbobdes kardiomiocitebis kumSvado-bis
darRveva mitoqondriebis mier energiis
warmoqmnis procesis an am energiis
gamoyenebis moSlis gamo. Uka-naskneli
Warbobs, magaliTad, gulis xangrZlivi
hiperfunqciis dros. mas SeiZleba moyves
kardiomiocitebis dis-trofia da nekrozi.
193
darRvevebi iwveven SekumSvaTa
16.5. gulis riTmis darRveva
gulis muSaobis efeqturoba ricxvis, riTmis da Tan-mimdevrobis
damokidebulia misi nawilebis cvlilebebs, e.i. ariTmias.
194
neracia neldeba da, Sesabamisad, viTardeba yvela is daavadeba, romelsac axasiaTebs
bradikardia. sisxlSi naR-vlis mJavebis gadasvla
taqikardia viTardeba gulis anTebi- (qolemia), radgan naR-vlis mJavebi
Ti, isqemiuri, infeqciuri an toqsikuri aRagzneben vaguss da akaveben sinusis
dazianebis gamo, mioakrdiodistrofiisas. kvanZis funqcias.
gulis datvirTvis zrdis Sedegad aRmo- taqikardias axasiaTebs T-P
cenebuli taqikardia xSirad kompensaci- intervalis Semcireba
uri xasiaTisaa. eleqtrokardiogramaze (ekg), xolo
taqikardia araiSviTad viTardeba eq- bradikardias - am intervalis gazrda.
strakardiuli mizezebis moqmedebis Sede- eqstrasistoluri ariTmia. sinusis
gad: amgvari taqikardiac rig SemTxvevebSi kvanZis avtomatizmis Semcirebis an
(sisxlis wnevis dacema, anemiebi, hipoqsia miokardis sxva nawilebSi impulsebis
da sxv.) kompensaciuri xasiaTisaa. generaciis unaris momatebis dros
gulis SekumSvebi xSirdeba im pirveli rigis peismekeris mi-er
paTolo-giuri procesebis dros, romlebic generirebuli impulsebi arasakmarisi
simpatiku-ri gavlenis an kateqolaminebis xdeba eqtopiur kerebSi warmoSobili
siWarbes iw-veven. metad damaxasiaTebelia agznebis da-saTrgunavad, rac damatebiTi
taqikardia Ti-reotoqsikozisTvis. impulsebis aRmocenebas iwvevs.
taqikardia viTardeba cxe-lebis drosac, agznebis eqtopiuri kerebis aRmoce-
radganac Tbili sisxli aRag-znebs sinusis nebas iwvevs agreTve potencialTa sxvao-
kvanZs. Cveulebriv, sxeulis temperaturis bis gaCena mezobel miocitTa Soris, maga-
momateba 1C-iT iwvevs gulis SekumSvebis liTad, maTi araerTdrouli repolariza-
gaxSirebas 8-10-iT wuTSi (li-bermeisteris ciis dros. aseTi suraTi vlindeba loka-
kanoni). magram zogjer (magali-Tad, muclis luri isqemiisas da gulis glikozidebiT
tifis dros) es kanonzomiereba irRveva: mowamvlis dros.
temperaturis 1C-iT momatebisas gulis agznebis eqtopiuri kerebis gaCena
muSaoba xSirdeba ara 8-10, aramed 4-6 gulis riggareSe SekumSvas – eqstrasis-
SekumSviT. am movlenas SedarebiTi tolas iwvevs. eqtopiuri agznebis keris
bradikardia ewodeba. lokalizaciis mixedviT ganasxvaveben si-
bradikardia nusur (nomotopur), winagulovan, atrio-
gulis muSaobis Seneleba - ventrikulur da parkuWovan eqstrasis-
bradikardia SeiZleba gamowveuli iyos tolas. aRmocenebuli damatebiTi agznebis
TviT gulis dazianebiT an eqstrakardiuli talRa vrceldeba araCveulebrivi mimar-
mizezebiT. gansakuTrebiT xSiria cdomili TulebiT, rac aisaxeba ekg-is struq-
nervis agznebis gamo ganviTarebuli turaze. peismekeri sinusis kvanZSia, QRST
bradikardia. magaliTad, bradi-kardia kompleqss win uswrebs dadebiTi
vlindeba vagusis centris agznebis gamo im winagulovani P kbili.
daavadebebis dros, romlebsac qalasSiga ekg sinusuri eqstrasistolis dros
wnevis momateba axasiaTebs, cdomili nervis normalurisgan gansxvavdeba mxolod T-P
receptorebis gaRizianebisas kinetozis intervalis SemcirebiT. diastolis xangr-
dros da sxv. bradikardias iwvevs agreTve
195
sur. 16-3 eqstrasistolebi. a. sinusur- aRmo-cenebisas eqstrasistolis Semdgomi
winagulovani kvanZi. b. marcxena-parkuWovani
g. winagulovan-parkuWovani diasto-luri intervali ramdenadme
gaxangr-Zlivebu-lia, agznebis keris
kvanZis qvemo nawilSi warmoqmnisas ki
eqstrasistolis Semdeg aRi-niSneba
sakompensacio pauza (ix. qvemoT).
parkuWovani eqstrasistolis dros
rig-gareSe agzneba aRmocendeba parkuWis
gamta-rebeli sistemis romelime nawilSi.
eqtopiuri keridan misi gavrceleba
SeiZleba sul sxvadasxvagvari iyos
imasTan dakavSirebiT, Tu sad da gulis
ciklis romel momentSi warmoiSva
impulsi. radgan impulsis gatarebis
livobis Semoklebis gamo parkuWi sisxliT siCqare miokardiumSi naklebia, vidre
mTlianad ver ivseba, rac pulsur talRas gamtarebel sis-temaSi, agznebis
am-cirebs. gavrceleba gaxangrZlivebu-lia. impulsis
winagulovani eqstrasistola aRmocend- araCveulebrivi gziT gavrce-leba iwvevs
eba maSin, rodesac eqtopiuri agznebis kera QRS kompleqsis mkveTr defor-macias.
winagulSia lokalizebuli. mas axasiaTebs parkuWebSi aRmocenebuli impulsi
wi-nagulovani kbilis deformacia winagulebs ver aRwevs, ris gamo ekg-ze
(dadableba, orfazianoba, uaryofiToba) ar aris winagulovani P kbili. SedarebiT
parkuWovani QRST kompleqsis SenarCunebiT iSviaTia CarTuli (interpolirebuli) eq-
da eqstrasistolis Semdgomi intervalis strasistola, romelic SeiZleba warmo-
mciredi gaxangrZlivebiT. iSvas or normalur SekumSvas Soris iseT
atrioventrikuluri eqstrasistolis SemTxvevaSi, Tu gulis SekumSvaTa sixSire
dros kvanZis midamoSi warmoSobili agzneba dabalia. am pirobebSi damatebiTi agznebis
gadaecema winagulebs da parkuWebs. radgan aRmocenebis momentSi parkuWi gamosulia
agzneba winagulebze vrceldeba wina SekumSvis Sedegad ganviTarebuli
retrogradulad (qvemodan zemoT), refraqteruli periodidan, e.i. im perio-
winagulovani P kbili uar-yofiTi xdeba. didan, rodesac miokards ara aqvs ag-
imisda mixedviT, Tu kvanZis romel nawilSi znebaze reagirebis unari. Semdegi rigiTi
(zemo, Sua Tu qvemo) aRmocendeba riggareSe agzneba ki parkuWebs aRwevs maSin, rode-
agzneba, uaryofiTi P kbili Se-iZleba win sac dasrulebulia damatebiTi SekumSvis
uswrebdes QRST kompleqss, er-wymodes an momdevno refraqteruli periodi. CarTu-
miyvebodes mas. QRST kompleqsi aseT li eqstrasistola ekg-ze Tavsdeba gulis
SemTxvevaSi umeteswilad Cveulebrivia, agznebis or normalur cikls Soris. mas
radgan agzneba hisis konis saerTo Reros kompensaciuri pauza ar axasiaTebs.
sa-SualebiT miokardiums Cveulebrivad ga- parkuWovani eqstrasistolis gulis
dae-cema. damatebiTi impulsis winagulovan- SekumSvaTa ufro maRali sixSiris fonze
par-kuWovani kvanZis zemo an Sua nawilSi aRmocenebisas mas Tan sdevs kompensaciuri
196
pauzac. kompensaciuri pauzis gaCena da- olizmis darRvevebTan.
kavSirebulia imasTan, rom sinusis kvan- sur. 16-4. winagulovan-parkuWovani
blokada. a) I xarisxis b) II xarisxis g) II
Zidan wamosuli morigi impulsi parku-
xarisxis d) III xarisxis sruli
Webamde aRwevs maSin, rodesac isini eq-
strasistoluri agznebis Semdeg imyofebian
absoluturi refraqterebis fazaSi. amitom
parkuWi ver pasuxobs sinusis kvanZidan
mosul impulses, Semdegi impul-sis
mosvlisas ki parkuWebi ukve gamosu-li
arian refraqterobis fazidan da Se-kumSviT
pasuxoben agznebis am talRas. aseT
SemTxvevaSi drois intervali par-kuWebis
bolo normaluri SekumSvidan pirvel
16.5.2. gamtareblobis darRvevis Sedegad
postsistolur SekumSvamde ori normaluri
ganviTarebuli ariTmiebi
intervalis tolia; sxvanairad rom vTqvaT,
impulsebis gavlis darRvevas gulis
eqstrasistolis wina Semoklebuli
gam-tarebel sistemaSi gulis blokada
diastolisa da Semdgomi gaxangrZlivebuli
ewodeba. agznebis gatareba SeiZleba
diastolis (kompensaciuri pauzis) saerTo
Seferxdes gamtarebeli sistemis
xangrZlivoba udris ori nor-maluri
sxvadasxva nawilSi, ris mi-xedviT
diastolis xangrZlivobas.
diferencirdebian blokadis Semdegi
gulis heterotopuli avtomatizmis
formebi: 1. sinoaurikuluri blokada,
ke-rebis mkveTri gaaqtiveba jgufur eqstra-
romlis dros irRveva impulsis gatareba
sistolebs iwvevs. swrafad ganmeorebadi
sinusis kvanZsa da winagulebs Soris, 2)
jgu-furi eqstrasistolebis aRmocenebisas,
atrioven-trikuluri (winagulovan-
rom-lebic sruliad Trgunaven
parkuWovani) bloka-da, romlis dros
fiziologiur ritms, viTardeba
impulsis gatareba irRveva
paroqsizmuli taqikardia: gulis
atrioventrikulur kvanZSi, 3) hisis
normaluri ritmi uecrad icvleba me-tad
konis marjvena an marcxena fexis blokada,
xSiri SekumSvebiT (140-250 wuTSi). Sete-va
romelsac axasiaTebs impulsis gatarebis
grZeldeba ramdenime wams an wuTs, romlis
moSla hisis konis romelime fexSi
Semdeg aseve uecrad wydeba. ufro xSiria
sinoaurikuluri blokadis dros si-
pa-roqsizmuli taqikardiis winagulovani
nusis kvanZSi warmoSobili impulsis ga-
forma.
tareba xangrZlivdeba an wydeba. Ukanas-
eqstrasistolia uSualo kavSirSia
knels gulis Sesabamisi ciklis sruli
gu-lis agznebadobis nervuli regulaciis
gamovardna moyveba. amgvari blokada vi-
cvli-lebebTan an miokardSiumSi
Tardeba cdomili nervis agznebis, mio-
eleq
kardiodistrofiebis, miokardSiumSi eleq-
tro
trolituri balansis darRvevis dros.
lite
ansxvaveben srul da arasrul atri-
bis
oventrikulur blokadas, ukanasknels ki
metab
yofen sam xarisxad. I xarisxis blokadis
197
dros atrioventrikuluri kvanZi parkuWe- mekerSi Cndeba impulsebis gatarebis Sew-
bamde atarebs sinusis kvanZidan momaval yvetidan garkveuli drois gavlis Semdeg.
yovel impulss, magram gaxangrZlivebulia am periods preavtomaturi pauza ewodeba.
impulsebis gavlis dro, rac eleq- pauzis dros ganviTarebuli sruli
trokardiogramaze vlmndeba P-Q interva- asistoliis Sede-gad Tavis tvins sisxli
lis gadidebiT: 0,2-0,5 wm nacvlad nor- ar miewodeba, vi-Tardeba gonebis dakargva,
maluri 0,08-0,12 wamisa. II xarisxis blo- krunCxvebi (morgan-edems-stoqsis
kadis dros P-Q intervali ufro da uf-ro sindromi). am periodSi SesaZle-belia
xangrZlivdeba gulis yoveli ciklis Semdeg sikvdilic, magram xSirad parkuWebi kvlav
manam, sanam parkuWebis agznebis morigi iwyeben SekumSvas sakuTari avtomatizmis
talRa (Cveulebriv VII-X) mTlia-nad ar gavleniT da aRniSnuli simptomebi qreba.
gamovardeba. Semdegi ciklis dros P-Q Sin-dromi SeiZleba mravaljer ganmeordes.
intervali normaluri sididisaa, magram is hisis konis romelime fexis blokada
kvlav xangrZlivdeba yoveli mo-rigi (gaswvrivi blokada) dakavSirebulia
ciklis dros erT-erTi impulsis srul impulse-bis gatarebis SewyvetasTan
blokadamde, e.i. parkuWovani kom-pleqsis atrioventrikulu-ri kvanZis bifurkaciis
gamovardnamde. parkuWovani kom-pleqsis qvemoT. aseT pirobeb-Si winagulidan
amgvar gamovardnebs maTi Semdgo-mi momavali impulsi gadaecema mxolod erT
aRdgeniT venkenbaxis periodebs uwodeben. III parkuWs, meore parkuWs ki Se-sustebuli
xarisxis arasruli blokadis dros impulsi SeiZleba gadaeces par-kuWTaSua
gamovardeba yoveli meore-mesame impulsi da Zgidis saSualebiT. amitom parkuWebi
ekg-ze ar aRinusxeba yoveli meore an mesame ikumSebian arasinqronulad da araerTnairi
parkuWovani kompleqsi. ZaliT.
sruli atrioventrikuluri blokada
(zogi avtoris mixedviT IV xarisxis 16.5.3. winagulebisa da parkuWebis
blokada) viTardeba maSin, rodesac at- mocimcime ariTmia
rioventrikuluri kvanZi ar atarebs si- gulis kunTis calkeuli
nusis kvanZidan mosul arc erT agznebis miofibrilebis an miofibrilebis jgufis
talRas, e.i. parkuWamde ar aRwevs sinusis araerTdrouli, qaosuri SekumSva
kvanZSi aRmocenebuli arc erTi impulsi. vlindeba winagulebis an parkuWebis
aseT SemTxvevaSi winagulebi da parkuWebi TrTolvisa da cimcimis saxiT. ag-znebis
ikumSebi-an damoukidebeli riTmiT, qaosuri gavrcelebis gamo viTar-deba
urTierTkavSiris gareSe: winagulebi gulis kunTis funqciuri frag-mentacia -
sinusuri riTmiT, xolo parkuWebi bevrad miofibrilebis nawili ikumSe-ba, sxvani ki
ufro iSviaTad - mesame rigis peismekeris am periodSi modunebuli arian.
riTmiT. gansakuTrebuli mniSvnelobisaa winagulebis TrTolvis dros ekg-ze
arasruli blokadis srul blokadaSi Pkbilebis nacvlad aRiniSneba mravlobiTi
gadasvlis momenti, rodesac sru-liad xerxiseburi konfiguraciis talRa, 200-
wydeba sinusis kvanZidan momavali im- 350 wuTSi. winagulebis cimcimis dros
pulsebis gadacema parkuWebisTvis. neli di- gulis am nawilebis aqtivoba registrir-
astoluri depolarizeba mesame rigis peis- deba maRali sixSiris (350-600 wuTSi)
198
araregularuli rxevebis saxiT (F tal- sisxlis raodenobiT da winaaR-mdegobiT,
RebiT). ikumSebian mxolod calkeuli mi- romelsac xvdeba moZravi sisxli
ofibrilebi, mTlianad winaguli ki aras- sisxlZarRvebSi (R): mniSvneloba aqvs,
ruli SekumSvis mdgomareobaSi imyofeba. agreT-ve, sisxlis siblantes, mis masas,
calkeuli kunTovani boWkoebis gavliT sisx-lZarRvTa saerTo moculobas da sxv.
impulsebi atrioventrikulur kvanZamde Pperiferiul winaaRmdegobas gansazRvravs
aRweven refraqterul mdgomareobaSi yof- sisxlis siblante da, gansakuTrebiT,
nisas, amitom aRniSnuli kvanZi araregu- rezistiuli ar-teriebis tonusi da
larulad aRigzneba da parkuWebis Se-kumSva drekadoba.
sruliad uwesrigo xasiaTisaa. xSirad hemodinamikuri maCveneblebis da, maT
parkuWebi TiTqmis carieli ikumSebian, So-ris, arteriuli wnevis stabilobas
amitom periferiaze pulsuri talRa ar uzrun-velyofs neirohumoruli
aRinusxeba. Sesabamisad, gulis SekumSvis regulaciis rTuli da mravalsafexuriani
sixSire aRemateba pulsis six-Sires, meqanizmi, romelic moq-medebs ukukavSiris
adgili aqvs pulsis deficits. imis gamo, principiT.
rom sistolis momentSi par-kuWebi Seicaven saerTo periferiuli winaaRmdegoba
sisxlis araTanabar rao-denobas, pulsuri sis-xlis mimoqcevis dad wreSi
dartymebic araTanabari avsebisaa. daaxloebiT 6-jer metia, vidre mcire
gansakuTrebiT mZime Sedegebi axasi- wreSi. misi cvlilebebi upiratesad
aTebs parkuWebis TrTolvas da fibri- dakavSirebulia sisxlZarRvTa to-nusis
lacias - gulis muSaobis terminalur darRvevebTan.
darRvevas. agzneba parkuWebze vrceldeba sisxlZarRvebis tonusis darRveva
qaosurad, ris gamo parkuWebis avseba da SeiZ-leba gamoixatos misi momatebiT
maT mier gamosrolili sisxlis raode-noba (hipertonia)3 da daqveiTebiT (hipotonia).
araTanabaria, sisxlis mimoqceva ram-denime orive proce-si SeiZleba dakavSirebuli
wuTSi sruliad wydeba da dgeba sikvdili. iyos sisx-lZarRvTa tonusis regulaciis
safiqrebelia, rom mocimcime ariTmiis darRve-vasTan, rac Tavis mxriv
dros gulis avtomatizmi da gamtareblo-ba gamowveulia cen-traluri nervuli
erTdroulad irRveva. sistemis, Sinagani sek-reciis jirkvlebis,
Tirkmelebis funqciis moSliT da a.S.
16.6. sisxlZarRvovani ukmarisoba 16.5.1. sisxlZarRvTa tonusis nervuli
sisxlZarRvTa sistemis erT-erTi
regulaciis darRveva
umniS-vnelovanesi funqcia arteriuli
wnevis saWiro donis uzrunvelyofaa.
3 xSirad aramarTebulad iyeneben termins
puazeilis formulis (P=QR) mixedviT, "hipertonia" da "hipertenzia". "hipertoniis" qveS unda
sisxlis wnevis sidide milTa sistemaSi vigulisxmoT arteriebis tonusis momateba, xolo
"hipertenzia" gulisxmobs wnevis momatebas. marTalia, es
udris maTi sisxlsavseobis (Q) da sisxlis
ori procesi umetesad Tan xvdeba erTmaneTs, magram
nakadisadmi winaaRmdegobis (R) namravls. zogjer aseTi paralelizmi irRveva. periferiuli
arteriul sisxlZarRvebTan mimarTebaSi es arteriebis tonusis momatebis fonze vlindeba
hipotenzia (magaliTad, mkveTri hipovolemiis
niSnavs, rom sis-xlis wneva
arteriuli SemTxvevaSi).
ganisazRvreba gulis mier gamos-rolili igive unda iTqvas terminebis - "hipotoniis" da
"hipotenziis Sesaxeb".
199
sisxlis mimoqcevis regulaciaSi mo- arteriul hipertonias. simpatikuri
nawileobs ori urTierTdakavSirebuli da nervuli sistemis gavleniT arteriuli
urTierTmoqmedi nervuli centri – pre- wneva moimatebs maSin, rodesac ka-
soruli (wnevis amwevi) da depresoruli teqolaminebis sisxlZarRvTa
(wnevis damwevi), romlebic moTavsebulia Semaviwrovebeli efeqti, romelic
Tavis tvinis sxvadasxva doneze - mogrZo dakavSirebulia rezistiul sisxlZarRvTa
tvinidan Suamdebare tvinis vegetatiur kedlebis -adrenoreceptore-bis
centrebamde da tvinis qerqamde. Presoru- agznebasTan da gulis wuTmocuobis zrda,
li neironebis ricxvi centralur nervul dakavSirebuli gulis -
sistemaSi oTxjer metia, vidre depre- adrenoreceptorebis agznebasTan,
sorulebisa, rac qmnis hipotenziuri meqa- gadaaWarbebs sisxlZarRvTa ked-lebSi
nizmebis potenciur ukmarisobas. arsebul -adrenoreceptorebze adrena-
Tavis tvinis qerqis mniSvneloba sis- linis moqmedebis vazodilataciur efeqts.
xlZarRvTa tonusis da arteriuli wnevis sisxlZarRvTa tonusis cvlilebebis
cvlilebebisTvis mtkicdeba klinikuri me-qanizmSi metad mniSvnelovan rols
dakvirvebebiT da eqsperimentuli kvlevis TamaSobs misi TviTregulacia, romelic
SedegebiT. eWvs ar iwvevs, rom nervuli dakavSirebulia barorecepatorebTan. aseTi
daZabuloba, mZime cxovrebiseuli situa-cia, receptorebis um-Tavresi zonebi
uaryofiTi emocia xSirad iwvevs hi- ganlagebulia karotidul si-nussa da
pertonias adamianebSic. Aaris mosazreba, aortis rkalSi. maTi adeqvaturi
rom uaryofiTi emociebis gavleniT ir-Rveva gamRizianebelia sisxlis wneva, impulsebi
agznebisa da Sekavebis procesebis am receptorebidan gadaecema
urTierTSefardeba. am pirobebSi vlindeba sisxlZarRvTa mamoZ-ravebel centrsa da
qerqqveSa warmonaqmnebis ukontrolo retikulur formacias. aqedan
"amboxi", romelic iwvevs hipoTalamusis eferentuli impulsebi igzavnebian pe-
vegetatiuri centrebis, pirvel rigSi ki riferiisken da aregulireben
sisxlZarRvTa mamoZravebeli centris arteriolebis sanaTurs, gulis
mdgrad agznebas. SekumSvebis sixSiresa da Zalas.
eWvgareSea agreTve simpatikuri sisxlZarRvTa mamoZravebel centrze,
nervuli sistemis centraluri nawilebis hipoTalamusze da tvinis Reros badisebr
monawileoba sisxlZarRvTa tonusis formaciaze baroreceptorebis dammux-
cvlilebebSi, rac mravalricxovani ruWebeli gavlenis moxsna oTxjer zrdis
eqsperimentebiTaa dadgenili. swored kateqolaminebis gamoyofas Tirkmelzeda
simpatikuri nervuli sistemis hipo- jirkvlis mier. sistemuri arteriuli
Talamuri centrebis hiperreaqtiulobaa wnevis momatebisas Zlierdeba impulsacia
hiper-tonuli daavadebis paTogenezis erT- presoreceptorebidan, rac refleqsurad
erTi um-Tavresi rgoli. simpatikuri iwvevs gulis SekumSvaTa gaiSviaTebas,
regulaciis umaR-lesi centrebis aqtivacia rezistiuli arteriebis gafarToebas (e.i.
neirohumoruli me-qanizmebiT zrdis gulis saerTo periferiuli winaaRmdegobis
wuTmoculobasa da sisxlZarRvebis Semcirebas) da, rogorc maT Sedegs,
periferiul winaaRmdegobas, e.i. iwvevs arteriuli wnevis daqveiTebas.
200
16.5.2. sisxlZarRvTa tonusis humoruli matulobs sisxlZarRvebis kedlebSic, ris
regulaciis darRveva. gamo aq kavdeba wyali, sisxlZarRvebis
rogorc aRiniSna, simpatikuri kedeli jirjvdeba, matulobs misi
nervuli sistemis agznebas (emociuri bazaluri tonusi. amas garda natriumi
gadaZabva, meqanikuri travma da sxv.) Tan zrdis sisxlZarRvis ked-lebis -
sdevs kateqolaminebis koncentraciis adrenoreaqciuli struqturebis
momateba sisxlSi (hiperkateqolaminemia), mgrZnobelobas kateqolaminebis mimarT. Tu
rac gulis -adrenoreceptorebis da ga-viTvaliswinebT, rom aldosteroni
sisxlZarRvTa kedlebis -adrenorecep- aadvilebs noradrenalinis
torebis agznebis gziT zrdis gulis gamoTavisuflebasac simpati-kuri nervebis
wuTmoculobasa da rezistiuli arteriebis daboloebebidan, cxadia, rom
kedlebis tonur daZabulobas. orive es aldosteronis gavleniT gaizrdeba
procesi ki arteriul hipertenzias iwvevs. sisxlZar-RvTa neirogenuli tonusic.
sakmaod Zlieri hipertenziuli Tvi- amgvarad, aldos-teroni sisxlZarRvTa
seba aqvs kidev erT hormons – hi- tonusze ramodenime gziT moqmedebs.
poTalamusis produqts vazopresins, rom- amasTanaa dakavSirebuli misi esoden
lis rezervuari hipofizis ukana wilia. Zlieri hipertenziuli efeqti.
rogorc fiqroben, is aviwroebs arterio- TirkmelSi reninis gamomuSaveba
lebs centraluri da periferiuli ad- Zlier-deba maSinac, rodesac ecema wneva
renergiuli meqanizmebis saSualebiT. orive Tirkmlis gorglis sisxlZarRvebSi.
gamokvlevebiT dadginda Tirkmlis Tirkmlis isqemia xangrZliv hipertenziul
metad mniSvnelovani roli sisxlZarRvTa efeqts ar iZleva, magram iwvevs
tonusis regulaciaSi. Tirkmlis es funqcia arteriuli wnevis mo-matebas meore
xorcieldeba proteolizuri fermentis - Tirkmlis amokveTis Semdeg. saqme imaSia,
reninis saSualebiT, romel-sac rom Tirkmeli gamoimuSavebs fer-ment
gamoimuSavebs Tirkmlis iuqstglome- angiotenzinazas, romelic Slis an-
ruluri aparatis ujredebi. renini giotenzins.
moqmedebis RviZlSi warmoqmnil reninis gamoyofis zrda isqemiuri
angiotenzinogenze (2-globulinze) da Tirkmlis mier iwvevs angiotenzinis Cveu-
gadayavs is angiotenzin-1-Si (dekapeptidi). lebrivze meti raodenobiT warmoqmnas,
ukanasknelze moqmedebs gardamqmneli magram saR TirkmelSi didi raodenobiT
fermenti da gardaqmnis mas angiotenzin-II- gamomuSavebuli angiotenzinaza Slis Warb
ed (oqtapeptidi), romelic uZliere-si angiotenzins da sisxlZarRvTa tonusi
presoruli nivTierebaa garda imisa, rom mniSvnelovnad icvleba. amitomaa, rom
angiotenzin-II uSua-lod Semaviwroveblad mdgradi arteriuli hipertenzia klinika-
moqmedebs sisxlZar-Rvebze, is aZlierebs Si gvxvdeba im daavadebebis dros, romle-
natriumis reabsorbcias Tirkmlis klaknil bic Tirkmlebis ormxriv isqemias iwveven.
milakebSi, rac saboloo jamSi organizmSi Tirkmlebis roli sisxlZarRvTa to-
akavebs wyals, e.i. arteri-uli wnevis nusis regulaciaSi amiT ar amoiwureba.
momatebis erT-erTi mizezia. aR-saniSnavia organos intersticiul varskvlavisebur
agreTve, rom natriumis raodenoba ujredebSi da, agreTve, rezistiul sisx-
201
lZarRvTa kedlebSi sinTezirdeba A da E simptomuri arteriuli
prostaglandinebi, romlebic ewinaaRmdege- hipertenziebi, sxvadasxva monacemiT,
bian vazokonstriqcias, e.i. iCenen hipoten- Seadgens arteriuli hi-pertenziis saerTo
ziur efeqts. Tirkmlis dazianebis dros am raodenobis 5-25%-s. sim-ptomuri
organos mier prostaglandinebis warmoqmna hipertenziis arsebobis gamoricxvis
qveiTdeba. Semdeg hipertenziis yvela SemTxvevaSi,
sisxlZarRvTa tonusis humorul re- sauba-ria esenciur hipertenziaze anu
gulaciaSi monawileobs agreTve Tirkmlisa hipertonul daavadebaze. gansazRvra
da sisxlis kininuri sistema: ki-ninogenze "esenciuri" niSnavs, rom, hipertenziis am
ferment kalikreinis moqmedebis Sedegad tipis dros arteriuli wnevis momateba
warmoiqmneba Zlieri vazodila-tatoruli aris hipertonuli daavadebis mTavari
(sisxlZarRvTa gamafarToe-beli) arsi.
nivTierebebi - bradikinini da kalidini, etiologia. pirveladi, esenciuri
romelTa moqmedeba xorciel-deba, hiper-tenziis anu hipertonuli daavadebis
nawilobriv, prostaglandinebis sin-Tezis uSualo mizezi jer kidev araa sabolood
stimaulaciiT. dadgenili. eWvgareSea, rom erT-erTi
meqanizmi "wneva-diurezi". iseTi pa- upirvelesi mniS-vneloba am TvalsazrisiT
Tologiuri procesebis dros, romlebic aqvs umaRlesi ner-vuli moqmedebis
iwveven sisxlZarRvTa tonusis meryeobas, gadaZabvas uaryofiTi emo-ciebiT,
sisxlis wnevis met-naklebad normalur gaxangrZlivebuli fsiqoemociuri
doneze SenarCunebaSi did rols TamaSobs stresiT. amaze metyvelebs, magaliTad,
TviT arteriuli wnevis gavleniT wylisa hiper-tonuli daavadebis maRali sixSire
da marilebis gamoyofa - meqanizmiT "wne-va- "stre-suli" profesiis adamianebSi.
diurezi". natriumisa da wylis gamo-yofa hipertoniiT ma-siuri daavadebis
izrdeba wnevis momatebisas da mcir-deba SemTxvevebi aRiniSneba mZime socialuri
misi daqveiTebis dros. wnevis mkveTri da- kataklizmebis dros da sxv. Amas-Tanave,
cemisas (50 mm vwy. sv.) diurezi metad mniSvnelovan rols asruleben
praqtikulad wydeba. reagirebis gareSe darCenili emociebi,
16.5.3. hipertonuli daavadeba radgan am emociaTa paTogenuri Zala
arteriuli hipertenzia mdgomareobaa, mTlianad atydeba Tavs sisxlis
romlis drosac mosvenebul mdgomareobaSic mimoqcevis sistemas.
sisxlis sistoluri wneva mxris arteriaSi hipertonuli daavadebis aRmocenebaSi
140 mm vwy/sv. an masze metia, xolo di- garkveuli mniSvneloba aqvs kvebis faq-
astoluri wneva - 90 mm vwy. da meti. torsac, gansakuTrebiT ki NaCl-is didi
hipertenziis mizezis gamovlenis raodenobiT miRebas. natriumis ionebis
SemTxvevaSi mas simptomurs (meoradis), roli arteriuli wnevis momatebaSi ga-
xolo hiperten-ziis aSkara mizezis movlenili iqna im xalxTa kvebis reJimis
dadgenis SeuZleblobisas esenciurs gamokvlevisas, romlebSic hipertenzia
(pirvelads) an hipertonul daava-debas praqtikulad ar gvxvdeba: wnevis momateba
uwodeben. TiTqmis arasdros vlindeba primitiul
tomebSi, romlebic yoveldRiurad 1-2
202
gram marils iReben, ganviTarebul qvey-nebSi xSirad Tan sdevs cximovani cvlis
ki es maCvenebuli 5-10 gramia. am darRvevebis gamo ganviTarebuli aTe-ros-
TvalsazrisiT saintereso masala iqna mi- klerozi. am paTologias da hipertonul
Rebuli solomonis kunZulebis mosaxleo- daavadebas Soris uSualo kavSiria, ufro
baSi Catarebul gamokvlevebSi: genetiku-rad metic, aRiniSneba garkveuli korelacia
monaTesave tomebs Soris hipertoniis sis-xlSi qolesterinis Semcvelobasa da
SemTxvevebi Zalze xSiri aRmoCnda im to-mis arte-riuli wnevis dones Soris.
adamianebSi, romlebic sakvebSi zRvis wyals gansazRvruli roli arteriuli
iyenebdnen. im tomisTvis ki, rome-lic am hiper-toniis genezSi ganekuTvneba
mizniT mtknar wyals mimarTavda, hipertonia memkvidrul faq-tors. amaze miuTiTebs
saerTod ar iyo cnobili. hipertoniis ganviTa-reba monozigotur
sufris marilis rolze arteriuli tyupebSi da ojaxuri hi-pertoniis
hipertenziis ganviTarebaSi metyvelebs sixSire.
cnobili faqti - sufris marilis Sez- amrigad, dReisTvis dadgenilia
Rudva sakvebSi keTilmyofel gavlenas ax- hiperto-nuli daavadebis ramdenime
dens hipertonuli daavadebis mimdinareo- etiologiuri faq-tori, magram araa
baze. cnobili, romel maTgans Se-iZleba
bolo wlebSi didi yuradReba eqceva vuwodoT mizezi da romelia hiper-toniis
kaliumis ionebsac. hipertoniiT avadobis ganviTarebis piroba.
maRali done ganviTarebul qveynebSi gar- paTogenezi. sur. (16-5) zemoTqmuli
kveulwilad dakavSirebulia sakvebSi ka- sisxlZarRvTa tonusis regulaciisa da
liumis simciresTan. xandazmul adamia-nebSi misi darRvevebis Sesaxeb naTels xdis
aRiniSneba kavSiri arteriuli wne-vis hipertonuli daavadebis ZiriTad meqaniz-
donesa da organizmSi natriumis mebsac, romlebic xSirad araerTdroulad
Semcvelobas Soris, axalgazrda asaks ki vlindebian, Tavs iCe-nen hipertonuli
axasiaTebs uaryofiTi ukukavSiri kali-umis daavadebis sxvadasxva etapze.
Semcvelobasa da arteriuli wnevis dones fsiqoemociuri stresi
Soris. fiqroben rom, sakvebSi kaliumis
mcire raodenobiT gamoyeneba garkveul
rols TamaSobs hipertoniis aRmocenebaSi, simpaTikuri centrebis
aqtivacia
maSin, roca momatebuli sis-xlis wnevis
stabilizeba hipertonuli daava-debiT
sneulebSi dakavSirebulia Tirkmlebis Tirkmlis kateqolamine
dazianeba hiperproduq
saSualebiT natriumis gamoyofis gulis
Semcirebas-Tan. dartymiTi da endoTeli
didi mniSvneloba aqvs miRebuli wuTmoculobis sxva preso
momateba faqtorebis
sakvebis raodenobas da kaloriulobas,
radgan xSirad masTanaa dakavSirebuli depresoruli barorecep- arteriebis
simsuqne, xolo sim-suqnesa da hipertonias
faqtorebis gamoyofis toruli lebis gajir
refleqsis maTi mgrZ
Soris arsebuli kav-Siri sruliad aSkaraa. Semcireba gamovardna belobis mo
unda iTqvas agreTve, rom hipertonias adh-is
hiperproduqcia
203
arteriebis tonusis
renin-angiotenzin- momateba, sisxlZarRvTa
aldosteronis generalizebuli spazmi
sistemis aqtivacia
arteriuli
sur. 16-5. hipertenzia
hipertonuli arteriebis kunTovani Sris
hipertrofia
daavadebis paTogenezi.
204
procesSi miuTiTebs imaze, rom es wnevis sisxlZarRvebis kedlis struqturul
daqveiTebisken mimarTuli kompensaciuri cvlilebebs - kunTovani elemen-tebis
reaqciaa. gajirjvebas da hipertrofias.
depresoruli faqtorebis moqmedebis am etapze hipertonuli daavadebis
gaZliereba hipertonuli daavadebis labi- paTo-genezSi erTveba reaqciebi, mimdinare
lur stadiaSi metyvelebs imaze, rom am "mankieri wris" principiT - procesis
periodSi arteriuli wnevis regulaciis saboloo efeqti aZlierebs misi
fiziologiuri sistema SenarCunebulia, gamomwvevi mizezis moqmedebas. amgvari
magram TviT regulacia wnevis ufro ma-Ral paTogenezuri reaqciebis magaliTi Semdegi
doneze mimdinareobs. reaqciebia: sisxlZarRvTa mamoZravebeli
SeiZleba iTqvas, rom arteriuli centris agznebas mohyveba simpatikuri
wnevis maRali done kompensaciurad gavlenis momateba, rac iwvevs
aaqtivebs depresorul sistemas, rac bolos periferiuli arteriebis, maT Soris -
da bolos iwvevs ukanasknelis gamo-fitvas Tirkmlis arteriebis spazms. process
da daavadeba gadadis stabiluri aRrmavebs kateqolaminebis didi
hipertoniis stadiaSi. amas adasturebs A da raodenobiT gamoyofa Tir-kmelzeda
E prostaglandinebis koncentraciis jirkvlis qsovilis mier, rac kvlav
Semcireba im avadmyofebSi, romelTa arte- simpatikuri nervuli sistemis tonusis
riuli wneva mudmivad maRal donezea. momatebis Sedegia. am gziT viTardeba
am periodSi wnevis maRal doneze Tirkmlebis iSemia, ecema wneva Tirkmlis
stabilizebis mniSvnelovani faqtoria ba- gorglis kapilarebSi, rac reninis
lansis darRveva, erTi mxriv, angiotenzin hiperproduqcias iw-vevs, e.i. aqtivdeba
II-s da aldosterons, meore mxriv - ki renin-angiotenzin-aldos-teronuli
maTi antagonists - winagulovan natriu- meqanizmi, rac kidev ufro me-tad
rezul hormons (atriopeptins) Soris aviwroebs sisxlZarRvebs. Aangiotenzin II-
pirvelTa sasargeblod. Sedegad matulobs is uSualo vazokonstriqciul efeqtTan
rezistiuli arteriuli sisxlZarRvebis erTad yuradRebas imsaxurebs is faqti,
neirogenuli da miogenuri tonusi. rom aRniSnuli sistemis gaaqtiu-rebis
hipertonuli daavadebis meore (stabi- Sedegad organizmSi Sekavebul natriums
luri hipertonia) stadiaSi hemodinamikis ZaluZs imoqmedos sisxlis wnevis doneze
Zi-riTadi Taviseburebaa sisxlZarRvTa sami gziT: 1.hipernatriemia osmo-
periferi-uli winaaRmdegobis mdgradi, receptorebis gaRizianebis saSualebiT aZ-
stacionaruli momateba gulis SekumSvaTa lierebs antidiurezuli hormonis gamo-
normaluri an, zogjer, Semcirebuli Zalis yofas, romelic organizmSi akavebs wyals
fonze. da, am gziT, xels uwyobs arteriuli
saerTo periferiuli winaaRmdegobis wnevis momatebas, 2.natriumis koncentra-
mo-matebis safuZvelia rezistiuli tipis ciis momateba sisxlZarRvis kedelSi
arte-riebis hipertonia. amasTanave, met- zrdis mis mgrZnobelobas presoruli niv-
naklebad Se-iZleba gaZlierdes tonusis Tierebebis, magaliTad kateqolaminebis mi-
rogorc mioge-nuri, ise neirogenuli marT, 3.natriumis dagroveba sisxlZarRvis
komponenti; didi mniS-vneloba aqvs, agreTve, kedelSi iwvevs sisxlZarRvis kedlis ga-
205
jirjvebas da misi sanaTuris Seviwroebas. arteriuli wnevis momateba iwvevs
sisxlZarRvTa kedlebis hiperreaqtiuloba gulis marcxena parkuWis kompensaciur
ki aZlierebs da axangrZlivebs aRniSnuli hipertrofias. hipertrofia iwyeba
nivTierebebis mier gamowveul sisxlZarRvTa hipertenziis yvelaze ad-reuli etapidan
spazms. amitomaa, rom stabiluri hi- da matulobs misi xang-rZlivobis
pertoniis stadiaSi saxezea saerTo peri- paralelurad. eqokardiografiuli gamok-
feriuli winaaRmdegobis myari momateba vlevebis Sedegebi miuTiTebs, rom arse-
miuxedavad imisa, rom presoruli nivTi- bobs kavSiri wnevis sididesa da marcxena
erebebis koncentracia hipertonuli daa-va- par-kuWis masis momatebas Soris.
debis sawyis stadiasTan SedarebiT Sem- hipertenziisas met-nakleb hipertrofias
cirebulia. ganicdian gulis sxva nawilebic.
hipertonuli daavadebis procesSi, marcxena parkuWis masis kompensaci-
garda sisxlZarRvTa kedlebis gajirjve- uri momateba aZlierebs misi SekumSvis
bisa da SeSupebisa, viTardeba misi gluv- Zalas, rac qmnis pirobebs imisTvis, rom
kunTovani ujredebis hipertrofia. gulma xangrZlivi periodis ganmavlobaSi
fiqroben, rom es aris adaptaciuri reaqcia SeZlos did wreSi sisxlis nakadisadmi
preso-rul datvirTvaze, magram aRniSnuli gazrdili winaaRmdegobis daZleva. magram
hi-pertrofia xels uwyobs arteriuli wne- hipertrofirebuli miokardiumis funqci-
vis stabilizebas maRal doneze. amas garda, uri da morfologiuri Taviseburebebi
sisxlZarRvis hipertrofia da spazmi xels (ix. "hipertrofirebuli miokardiumis
uwyobs misi kedlis kerovani iSemiis Taviseburebebi") qmnian parkuWis funqciis
ganviTarebas, rac aTeros-klerozis TandaTanobiT gamofitvis winapirobas, rac
ganviTarebis xelSemwyobi faqtoria. bolos da bolos marcxena parkuWis mwva-
sisxlZarRvTa metad xangrZlivi ve an qronikuli ukmarisobiT mTavrdeba.
spazmi, rac esoden damaxasiaTebelia xangrZlivi arteriuli hipertenzia
hipertonuli da-avadebisTvis, iwvevs (hipertenziis mesame - organuli cvlile-
organoebis jer funqciur, Semdeg ki bebis stadia) iwvevs koronarosklerozs
morfologiur cvlilebebs da daavadeba da gulis kunTis iSemiur daavadebas. maTi
gadadis daskvniT stadiaSi, rodesac wina safuZvelia hipertenziiT gamowveuli
planzea wamoweuli organizmis funqciis da cvlilebebi sisxlZarRvebis kedlebSi da
struqturis darRvevebi. miokardiumSi. sxva organoebidan hiperto-
xangrZlivi arteriuli hipertenziis nuli daavadebis dros gansakuTrebiT xSi-
dros gansakuTrebiT ziandeba guli, rad ziandeba Tirkmelebi da Tavis tvini.
romelic TviT monawileobs wnevis arteriuli hipertenziis garTulebe-
momatebis genezSi da, amave dros, ganicdis bi da maTi prevenciis da mkurnalobis
yvelaze did fun-qciur datvirTvas erTis principebi. arteriuli hipertenziiebis,
mxriv wuTmoculobis gazrdis gamo, meores pir-vel rigSi ki hipertonuli daavadebis
mxriv ki - aortaSi wnevis da sisxlZarRvTa yvelaze saxifaTo garTulebebia
saerTo periferiuli winaaRmdegobis miokardiumis infar-qti, Tavis tvinis
momatebis Sedegad. insulti, gulis an/da Tirkmlebis
ukmarisoba, hipertonuli encefa-lopaTia,
206
hipertonuli krizi. maTi ganviTa-reba, sasunTqi sistemis nebismierma daava-
ZiriTadad, sisxlZarRvTa aTerosklero-zis debam SeiZleba gamoiwvios garegan sun-
Sedegia. TqvaSi monawile procesebis - alveolebis
ventilaciis, alveolur-kapilarul mem-
17. garegani sunTqvis branaSi Jangabadisa da naxSirorJangis di-
paTofiziologia fuziis, filtvis kapilarebSi saWiro ra-
17.1 garegani sunTqvis ukmarisoba odenobiT sisxlis gavlis (perfuziis)
organizmis uzrunvelyofa JangbadiT izolirebuli an kombinirebuli darRveva.
da naxSirorJangis gamoyofa SesaZlebelia airTa cvlis darRvevisas, moiSleba Jan-
mxo-lod garegani sunqTvis, sisxlis mier
gbadiT sisxlis gajereba da misi nax-
airebis transportisa da Sinagani SirorJangisgan ganTavisufleba, e.i. vi-
(qsoviluri) sun-Tqvis normaluri Tardeba sunTqvis garegani
ukmarisoba.
funqciobisas. sunTqvis ukmarisobis ZiriTadi meqanizmebi
airebis cvlis umniSvnelovanesi swored ventilaciis, difuziis, perfuzi-
meqanizmi cxovelebSi da adamianSi aris is darRvevebTan an maT kombinaciebTanaa
difuzia - airis maRali koncentraciis dakavSirebuli.
aridan dabali koncen-traciis areSi sunTqvis ukmarisoba vlindeba Jan-
gadasvla, magram am gziT airis gadatana gbadze organizmis moTxovnilebis gazrdi-
SesaZlebelia araumetes 1 mm-is man-Zilze. sas (magaliTad, fizikuri datvirTvis
airis ufro Sors gadasatanad orga-nizmi dros) an mosvenebul mdgomareobaSic.
iyenebs konveqciur transports. Magali-Tad,
ase gadaitaneba airis molekulebi sa-sunTq 17.1.1. filtvebis ventilaciis
gzebSi filtvebis ventilaciis dros. darRvevebi
konveqciur transports miekTvneba agreTve
filtvebis ventilaciis arsia airTa
airebis transporti sisxliT. amgvarad, Jan-
cvla atmosferul da alveolur haers
gbadis gadatana garemodan qsovilebamde
Soris. am procesSi monawileoben centra-
aseTi TanmimdevrobiT xdeba: 1. konveqciuri
luri nervuli sistema (Tavis tvinis
tran-sporti alveolebamde (ventilacia), 2.
sunTqvis centrebi da zurgis tvinis mo-
difu-zia alveolebidan filtvis
toneironebi), mgrZnobiare da mamoZra-
kapilarebis sis-xlSi, 3. konveqciuri
vebeli periferiuli nervebi, zemo sa-
transporti qsovilTa kapilarebamde, 4.
sunTqi gzebi, gulmkerdis yafazi da fil-
difuzia kapilarebidan ga-remo qsovilSi.
tvebi. romelime maTganis funqciis moSla
naxSirorJangis gamotana qso-vilebidan
filtvebis ventilaciis darRvevas iwvevs.
xorcieldeba piruku gziT. airTa difuzias
gansazRvravs maTi parciuli wnevebis
sunTqvis regulaciis moSlasTan
sxvaoba.
dakavSirebuli filtvebis ventilaciis
mTlianad airebis cvla filtvebSi
darRveva
damo-kidebulia filtvebis ventilaciaze,
filtvebis ventilacia damokidebu-
Casun-Tquli haeris ganawilebaze, airTa
lia sunTqvis aqtis erTmaneTTan mWidrod
difu-ziasa da filtvebis perfuziaze.
dakavSirebul nervul da humorul re-
gulaciaze. am mxriv umniSvnelovanes
207
rols TamaSoben mogrZo tvinsa da varolis sunTqvis regulaciaSi normisa da pa-
xidSi mdebare sunTqvis centrebi, romelTa Tologiis dros did rols TamaSobs
gavleniT formirdeba sunTqvis cdomili nervis mgrZnobiare daboloebebi
gansazRvruli riTmi, sixSire da siRrme. alveolebSi. maTi gaRizianeba CasunTqvis
sunTqvis centrebi mudmiv impulsacias dros alveo-lebis kedlebis gaWimvis
iReben umaRlesi centrebidan (Ta-vis tvinis gamo refleq-surad iwvevs amosunTqvas
qerqi, hipoTalamusi), periferiul qemo-, (hering-breieris refleqsi). sunTqvis
baro-, meqano- da Termoreceptorebidan moculobaze moqmedebs gaWimvis
(igulisxmeba sasunTqi kunTebis gaWimvis receptorebis agznebadobis cvlilebebic.
SemgrZnobi receptorebi). maT garda magaliTad, alveolebSi mJa-ve eqsudatis
sunTqvis centris funqciobisTvis dagrovebisas (filtvebis anTebis dros)
garkveuli mniSvne-loba aqvs sxeulis matulobs receptorTa mgrZnobeloba da
temperaturas (maRali temperaturis CasunTqvis aqti Cveu-lebrivze swrafad
pirobebSi sunTqva xSirdeba), zogierT wydeba, viTardeba ze-rele sunTqva.
hormons (magaliTad, adrenalini da filtvis ventilaciis darRvevebi
progesteroni zrdian filtvebis ventila- vlindeba sasunTqi kunTebis mainervire-
cias). beli nervebis an maTi centrebis dazi-
sunTqvis centris agznebadoba da fil- anebisas (simsivneebi, anTeba, avitaminozebi,
tvebis ventilacia damokidebulia sisxlSi travma) da am kunTebisTvis impulsebis
CO2 daZabulobasa (pCO2) da pH-is cvlile- gadacemis darRvevisas (miasTenia, polio-
bebze. sunTqvis centris receptorebi reagi- mieliti, botulizmi, tetanusi).
reben mxolod H+-ionebze. CO2-is moqmedeba
ki dakavSirebulia am ionTa warmoqmnasTan. gulmkerdis yafazis, plevris da sasunTqi
Sun-Tqvis centris agznebadoba mcirdeba da, gzebis paTologiasTan dakavSrebuli
Sesa-bamisad, filtvebis ventilacia filtvebis ventilaciis darRvevebi
qveiTdeba cen-traluri nervuli sistemis gulmkerdis yafazis moZraobis darRvevebi
dazianebisas (tvi-nis sisxlZarRvebis da filtvis ventilaciis Se-sabamisi
sklerozi da spazmi, sis-xlCaqcevebi cvlilebebi viTardeba TviT sasunTqi
tvinSi, tvinis kompresia, intoq-sikaciebi). kunTebis funqciis darRvevisas (mioziti,
sunTqvis regulaciaSi monawile distrofia, atrofia), diaf-ragmis maRla
qemoreceptorebi reagireben, ZiriTadad, dgomis SemTxvevaSi ascitis (siTxis
arteriul sisxlSi Jangbadis daZabulobis dagroveba muclis RruSi), peri-tonitis
daqveiTebaze. aseT SemTxvevebSi filtvebis (muclis faris anTeba), mete-orizmis
ventilacia izrdeba (magaliTad, zogierTi (gazebis dagroveba nawlavebSi) Sedegad,
anemiis dros). gansakuTrebul rols xerxemlisa da neknebis Tandayo-lili an
sunTqvis regulaciaSi TamaSobs SeZenili deformaciis, neknTa xrtilebis
vegetatiuri nervuli sitema: simpatikuri gaZvalebis, plevruli Sexor-cebebis
nervuli sistemis zegavleniT bronqebi dros. filtvis eqskursia zogjer
farTovdeba, xolo parasimpatikuri gavleni izRudeba tkivilis gamoc (magaliTad,
siWarbe bronqospazms iwvevs. neknTaSua nevralgia, plevriti da a.S.).
208
dabrkoleba zemo sasunTq gzebSi unars, Wimvadoba ki SeiZleba Semcir-des
amcirebs haeris Casvlas filtvebSi da am filtvebis anTebis an mcire wreSi Se-
gziT aqveiTebs filtvebis ventilacias, e.i. gubebis dros. filtvebis Wimvadoba
iwvevs garegani sunTqvis obstruqciuli mcirdeba fibrozis dros, romlis arsia
tipis ukmarisobas (laT. obstructio - SemaerTebeli qsovilis ganviTareba
winaaRmdegoba). dabrkoleba, romelic daRupuli parenqimuli elementebis
winaaR-mdegobas uqmnis haeris moZraobas, elastikuri boWkoebisa da ka-pilarebis
amcirebs an sruliad wyvets haeris Casvlas adgilze. fibrozi qronikuli an-TebiTi
filtvebamde, SeiZleba gamowveuli iyos procesebis, toqsikuri dazianebis,
zemo sasunTq gzebSi ucxo sxeulis pnevmokoniozebis, emfizemis, SemaerTebeli
moxvedriT, cxviris, xorxis., traqeis qsovilis difuzuri dazianebis, mcire
anTebiT an am organoebis simsivniT, xorxis wreSi sisxlis Segubebis Sedegia.
kunTebis spazmiT (laringospazmiT), zemo filtvis Wimvadobis da sasunTqi
sasunTq gzebze garedan zewoliT mezobeli zedapiris SemcirebaSi gansakuTrebul
qsovilebis moculobis zrdis dros. rols surfaqtantis nakleboba TamaSobs.
dabrkoleba qvemo sasunTq gzebSi gare- surfaqtanti ewinaaRmdegeba filtvis
gani sunTqvis aseve obstruqciuli tipis SeWmuxnvas alveolebSi zedapiruli
uk-marisobas iwvevs. dabrkoleba viTardeba daWimulobis Semcirebis gziT. filtvis
wvrili bronqebis an bronqiolebis sasunTqi zedapiri mcirdeba misi farTo
sanaTurSi siTxis (pirnaRebi masa, wyali, ubnebis nekrozisas tuberkulozis dros,
lorwo, tran-sudati) moxvedrisas, filtvis segmentis, wilis rezeqciis an
bronqebis lorwovanis SeSupebis an eqstirpaciis Semdeg, ateleqtazisas. Uka-
anTebiTi hiperemiis, filtvebSi SegubebiTi nasknel SemTxvevaSi alveolebis ventila-
procesebis, alergiuli bronqos-pazmis cia wydeba da haeris ganwovis gamo isini
dros, zogierTi nivTierebis (magali-Tad, iWmuxnebian. ateleqtazis mizezi SeiZleba
histamini, -adrenoblokatorebi, qolino- gaxdes plevris RruSi wnevis gazrda
blokatorebi) moqmedebis Sedegad. (penvmoToraqsi, eqsudaciuri plevriti),
janmrTeli organizmis wvril bronqebSi bronqebis daxSoba da sxv. ateleqtazis
haeris nakadi-sadmi winaaRmdegoba mcirea, paTogenezSi araiSviaTad mniSvnelovan
magram paTologiis dros winaaRmdegobis rols surfaqtantis nakleboba TamaSobs.
mkveTri mateba swored wvrili bronqebis
mxriv viTardeba. filtvebis ventilaciis darRvevis formebi
filtvebis ventilaciis darRvevis
filtvebis sasunTqi zedapiris Semcirebas- formebia hiperventilacia da hipoventi-
Tan dakavSirebuli ventilaciis darRvevebi lacia. fiziologiuri an kompensaciuri
filtvis sasunTqi zedapiris Semcirebas hiperventilacia (magaliTad, fizikuri
axasiaTebs ventilaciis mkveTri daqveiTeba datvirTvisas) organizmis reaqciaa Jan-
garegani sunTqvis ukmarisobis retriqsiuli gbadze gaZlierebul moTxovnilebaze an
tipis ganviTarebiT (laT.: retrictie - naxSirJangis siWarbeze da wydeba maTi
SezRudva, Semcireba). filtvebis Wimvadobis mospobisas.
Semcireba mkveTrad zRudavs maTi gaSlis
209
paTologiuri hiperventilacia ar aris xolo difuziis manZili moklea. filtvis
dakavSirebuli Jangbadze moTxovni-lebis barieri difuziisTvis sruliad
gaZlierebasTan an naxSirorJangis Warbi akmayofilebs am moTxovnebs difuziis
raodenobiT gamoyofis saWiroe-basTan. is procesSi Jangbadi gaivlis Semdeg
viTardeba sunTqvis centris agznebis dros substratebSi: alveolebis epi-Teli,
Tavis tvinisa da misi garsebis daavadebisas, intersticiuli sivrce ZiriTad mem-
tvinSi sisxlCaq-cevebis Semdeg da a.S. branebs Soris, kapilarebis endoTeli,
metad xSiria kompensaciuri hiperven- sis-xlis plazma, eriTrocitis membrana .
tilacia iseTi daavadebebis dros, filtvebis difuziis unaris (fdu)
romlebic organizmSi Jangbadis deficits Sefasebisas eyrdnobian Jangbadis difuzias
an nax-SirorJangis dagrovebas iwvevs, - rac ufro metia winaaRmdegoba Jangbadis
magaliTad, filtvis sasunTqi zedapiris difuziisadmi alveolur-kapilarul
Semcirebis Sem-TxvevaSi, gul-sisxlZarRvTa membranaSi da eriTro-citebSi, miT
ukmarisobis, ane-miebis dros da a.S. am naklebi iqneba fdu. fdu qveiTdeba
tipis hiperven-tilaciisas sunTqvis alveolur-kapilaruli membra-nis
gaxSirebis gamo wuT-moculoba ar mcirdeba dazianebisas. membranis sumaruli farTobi
da SeiZleba mcired gaizardos kidec. mcirdeba alveolebSi eqsudatis an
magram xangrZlivi da Zlieri transudatis dagrovebis SemTxvevaSi
hiperventilacia araiSviaTad iwvevs (Sesabamisad, anTebisa da filtvis SeSu-
naxSiror-Jangis didi raodenobiT gamoyofas pebis dros), ateleqtazis, kavernuli tu-
organiz-midan, hipokapnias da alkalozs, berkulozis, filtvis abscesis, filtvze
rac sunTqvis centris daTrgunvisa da am zewolis gamo, plveris RruSi siTxis
niadagze ganvi-Tarebuli hipoventilaciis dagrovebis (magaliTad, eqsudaciuri
mizezi xdeba. plevriti), pnevmoToraqsis Sedegad da a.S.
hipoventilacia viTardeba agreTve fdu mkveTrad mcirdeba alveolur-
sunTqvis centris funqciis daTrgunvis, sa- kapilaruli membranis gasqelebisas, rac
sunTqi kunTebis dazianebis, filtvebis SeiZleba alveolur-kapilaruli blokis
zogi daavadebis, qalasSida wnevis CamoyalibebiT damTavrdes. magaliTad,
momatebis, Tavis tvinSi sisxlis mimoqcevis filtvis intersticiuli SeSupebis an
darRvevis dros da sxv. filtvebis alveolebSi hialinuri membranebis gaCenis,
hipoventilaciisTvis damaxasia-Tebelia sarkoidozis, pnevmokoniozebis, fibrozis,
hipoqsiisa da hiperkapniis ganviTareba. sklerodermiis, emfizemis dros. Jangbadis
srul difuzias alveolur-kapilarul
17.2 difuziis darRveva filtvebSi membranaSi sul 0,2 wm esaWiroeba. amitom
rogorc iTqva, Jangbadis gadasvla
filtvis kapilarebSi sisxlis gavlis
alveo-luri haeridan sisxlSi da
dro (0,3-0,5 wm) sruliad sakmarisia
naxSirorJangisa sisxlidan alveolur
airTa difuziisTvis. magram membranis
sivrceSi difuziis gziT xorcieldeba.
cvlilebebisas drois es monakveTi difu-
difuzia mimdinareobs iseT pirobebSi,
ziisTvis arasakmarisi xdeba im Sem-
rodesac airTa cvlaSi monawile
TxvevaSi, Tu sisxlis nakadis siCqare
alveolebis zedapiri sakmarisia farTobisaa,
filtvis kapilarebSi izrdeba (magaliTad,
210
fizikuri datvirTvis, anemiis, mTis daava- filtvebidan gamotanili sisxli kargadaa
debis dros) airebi mTlianad ver as-wreben oqsigenirebuli, Seicavs nax-SirorJangis
difundirebas alveolur-kapila-rul SedarebiT mcire raodenobas, magram
membranaSi da sisxlis oqsigenacia irRveva. radgan sisxlis wuTmoculoba Semci-
rebulia, qsovilebi Jangbadis naklebobas
17.3 filtvis sisxlZarRvebis perfuziis mainc ganicdian.
daqveiTeba
filtvis membranebSi gazebis difuzia 17.4. sunTqvis aqtis cvlilebebi
da sisxlis oqsigenacia mniSvnelovnadaa janmrTeli adamianis organizmSi
damokidebuli sisxlis nakadze filtvis sunTqva-Si monawile mravali komponentis
sisxlZarRvebSi. filtvis perfuziis daq- koordini-rebuli moqmedeba uzrunvelyofs
veiTebas iwvevs: 1. marjvena parkuWis uk- sunTqvis normalur riTms, siRrmes,
marisoba (miokardiumis infarqti, sixSires da filtvebis normalur
kardioskle-rozi, eqsudaciuri perikarditi ventilacias, adamiani sunTqavs
da sxv.). 2. marcxena parkuWis ukmarisoba yovelgvari daZabvis gareSe da ume-
SegubebiT fil-tvebSi, 3. gulis is mankebi, teswilad verc grZnobs am process. es
romlebic amcire-ben filtvebis e.w. sunTqviTi komforti - eupnoea.
sisxlmomaragebas (magaliTad, filtvis paTologiis dros SeiZleba Seicva-
arteriis stenozi, marjvena venuri xvrelis los sunTqvis riTmi, siRrme da sixSire,
stenozi da sxv.), 4. sisxlZarRvovani ganviTardes qoSinic. sunTqvis aseTi
ukmarisoba (Soki, kolafsi), 5. filtvis cvlilebebi zogjer wminda paTologiuri
arte-riis embolia. xasiaTisaa da dakavSirebulia sunTqvis
ventilaciisa da perfuziis urTierT- regulaciis darRvevebTan. sxva SemTxve-
Sefardebis darRveva warmoiqmneba TviT vaSi sunTqvis aqtis cvlileba kompensa-
fil-tvebis mravali daavadebis (bronqiti, ciuria da mimarTulia sisxlSi gazebis
bronqu-li asTma, pnevmonia da a.S.) dros. normaluri daZabulobis SenarCunebisken.
filtvebis dazianebis dros (magaliTad, rogorc mraval sxva SemTxvevaSi, am kom-
Zlieri emfizema) perfuziasa da pensaciur reaqciebs SeiZleba uaryofiTi
ventilacias Soris Sesabamisoba imdenad mxarec hqondes da sunTqvis aqtis dar-
irRveva, rom TiTqmis aRar xdeba im Rvevebi gamoiwvios. magaliTad, mTis daa-
alveolebis ventilacia, romlebic vadebis dros garemoSi Jangbadis parci-
perfuzir-debian da im alveolebis uli wnevis dacemis gamo ganviTarebuli
perfuzia, romelTa ventilacia Rrma da xSiri sunTqvis - hiperpnoes
SenarCunebulia. Sedegad viTardeba mkveTri dros organizmidan gamoiyofa CO2-is di-
hipoqsemia da hiperkapnia, zogjer di raodenoba, rac hipokapnias, alkalozs,
dekompensirebuli gazovani acidozis sunTqviT ariTmias da zogjer sunTqvis
Camoyali-bebiT. droebiT Sewyvetas iwvevs.
filtvebSi sisxlis mimoqcevis daqvei- garkveuli intensivobis hiperpnoe
Tebisas mcirdeba sisxlis gadineba viTardeba fizikuri datvirTvisas: kunTe-
alveolebis kapilarebSi. am pirobebSi bidan da saxsrebidan wamosuli impulsebi
ventilacia Warbobs perfuzias. amitom mogrZo tvinis retikulur formaciaze
211
zemoqmedebiT zrdian sunTqvis centris gaRizianeba momatebuli arteriuli
agznebadobas. zogjer Zlier hiperpnoes sisxlis wneviT, qemoreceptorebisa -
aseTive gziT iwveven emociebi, sxeulze sisxlSi Jangbadis raodenobiT.
civi an cxeli wylis moqmedeba (refleqsi dabrkolebis gaCena zemo sasunTq
kanis Termoreceptorebidan). hiperpnoes gzebSi zrdis neknTaSua kunTebis
zogjer uwodeben sunTqvis gaRrmavebasac datvirTvas. aqedan wamosuli impulsaciis
imis miuxedavad, Secvlilia Tu ara sun- Sedegad muxruWdeba sunTqvis centris
Tqvis sixSire. funqcia. Sedegad ki xan-grZlivdeba
taqipnoe (polipnoe) - xSiri zerele amosunTqvisa, da, gansakuTrebiT,
sunTqvaa, viTardeba sunTqvis centris mu- CasunTqvis procesebi, sunTqva iSviaTdeba.
Saobis refleqsuri gardaqmnis Sedegad da es e.w. stenozuri sunTqvaa, romlis
adgili aqvs cxelebis, isteriis, filtvis meqanizmSi garda zemoTqmulisa, garkveul
dazianebis dros. unda vifiqroT, rom rols TamaSobs hering-breieris (ix.
zogjer polipnoes mizezia CasunTqvis zemoT) dammuxruWebeli refleqsis
gaZlierebuli stimulacia da misi dam- dagvianeba. cnobilia, rom am ref-leqsis
muxruWebeli faqtorebis aqtivacia. maga- aRmavali gzis gamoTiSva cdomili
liTad, ateleqtazis dros sunTqvis centri nervebis gadaWriT sunTqvis Zlier
aRgzneba gaZlierebuli impulsaciiT gaiSvia-Tebas da gaRmavebas iwvevs
filtvis alveolebis SeWmuxnvis ubnidan. (vagusuri sunTqva).
aseT SemTxvevaSi dauzianebeli alveolebi bradipnoe viTardeba sunTqvis
Casun-Tqvisas Cveulebrivze metad iWimebian, centris funqciis daTrgunvis gamo masze
rac iwvevs impulsaciis Zlier nakads paTogenuri faqtorebis uSualo
CasunTqvis dammuxruWebeli receptorebidan zemoqmedebisas. aseT faq-torebs
da CasunTqva droze adre wydeba, sunTqva miekuTvneba mZime hipoqsia, hipo-kapnia,
zerele xdeba. narkotikuli nivTierebebi, Tavis tvinis
taqipnoe viTardeba im SemTxvaSic, ro- organuli dazianebebi (anTeba, Ta-vis
desac CasunTqva iwvevs tkivils sxeulis im tvinSi sisxlis mimoqcevis darRveva,
nawilebSi, romlebic sunTqvis aqtSi SeSupeba da sxv.), misi funqciuri
monawi-leoben (plevra, gulmkerdis yafazi, paTologia (nevrozi, isteria). Sedegad
muclis kedeli). CasunTqvis siRrmis filtvebis ventilacia mkveTrad qveiTdeba
Semcireba am dros "dazogviTi" xasiaTisaa. da viTardeba sunTqvis ukmarisoba. am
taqipnoes dros alveolebis pirobebSi mcirdeba sunTqvis siRrmec.
ventilaciis SemcirebasTan erTad ZiriTadad apnoe sunTqvis SeCerebas ewodeba. mis
xdeba mkvdari sivrcis ventilacia, rac mizezebi sunTqvis centris fiziolo-
sunTqvis efeqturo-bis daqveiTebas iwvevs. giuri gamRizianeblebis deficiti (magali-
bradipnoe - sunTqvis gaiSviaTeba Tad, CO2-is mkveTri Semcireba sisxlSi)
dakav-Sirebulia sunTqvis nervuli an sunTqvis centris neironebis agzneba-
regulaciis dar-RvevebTan an Secvlil dobis Zlieri daqveiTebaa (hipoqsia, in-
impulsaciasTan sunTqva-Si monawile toqsikacia, Tavis tvinis organuli dazi-
sxvadasxva receptorebidan. maga-liTad, aneba).
bradipnoes iwvevs baroreceptorebis
212
17.4.1. qoSini mravalferovania sunTqvis maregulirebeli
qoSini (dispnoe) filtvebis venti- faqtorebi. maTgan umTavresia: impulsacia
laciis darRvevaa sunTqvis gaZnelebis alveoluri recepto-rebidan da filtvis
SegrZnebasTan erTad. adamians ebadeba intersticiuli recepto-rebidan (j-
sunTqvis gaZlierebuli moTxovna. swored recptorebidan), refleqsebi sasun-Tqi
es mZime SegrZneba ganasxvavebs qoSins gzebidan, refleqsebi baroreceptorebidan
sunTqvis aqtis darRvevis sxva saxeebisgan (sisxldenis, Sokis, kolafsis dros arte-
(hiperpnoe, polipnoe da sxv.). qoSins riuli wnevis mkveTri dacemis gamo mniS-
xSirad Tan sdevs mousvenroba, SiSi. es vnelovnad mcirdeba CasunTqvis centris
dakavSirebulia, albaT, agznebis gavrce- mas-timulirebeli impulsacia),
lebasTan Tavis tvinis limburi sistemis refleqsebi qemo-receptorebidan
elementebze, sadac, Tanamedrove Sexedu- (hipoqsiis, hiperkapniis, H-hiperioniis
lebis mixedviT, formirdeba SiSis Seg- gamo anemiebis, acidozis, sunTqvis
rZneba. Tavisi gamovlinebiT qoSini sun- ukmarisobis dros), sunTqvis centris
Tqvis aqtis darRvevis romelime ganxi- neiro-nebis uSualo stimulacia
luli tipia mousvenrobis an SiSis erT- (hiperkapnia, H-hiperionia), refleqsebi
droul subieqtur SegrZnebasTan erTad. sasunTqi kunTebidan, sunTqvis centris
qoSini SeiZleba gamowveuli iyos stimulacia sakuTari me-tabolizmis
sisxlis oqsigenaciis darRvevebiT (fil- produqtebiT (naxSirmJavas da mJave
tvebis ventilaciisa da perfuziis dar- produqtebis dagroveba).
Rveva, CasunTqul haerSi Jangbadis parci- qoSinis paTogenezi yovel
uli wnevis daqveiTeba), sisxliT airebis konkretul SemTxvevaSi rTulia da
transportirebis darRveviT (anemia, sis- moicavs mraval kom-ponents. gulis
xlis mimoqcevis paTologia), gulmkerdis dekompensaciisas filtvebSi viTardeba
ya-fazisa da diafragmis moZraobis sisxlis Segubeba, rac iwvevs al-veolebis
darRveviT, centraluri nervuli sistemis kompresias da maTSi siTxis rao-denobis
funqciuri da organuli dazianebiT (Zlieri zrdas transudaciis gamo. am pro-cesebs
emociebi, iste-ria, Tavis tvinSi sisxlis Tavis mxriv mivyavarT airebis difuziis
mimoqcevis dar-Rveva da sxv.), SegubebiT darRvevamde, hipoqsiamde da hiperkapni-
filtvebSi (magali-Tad, marcxena parkuWis amde, romelic uSualod da, agreTve, hi-
mwvave ukmarisoba), filtvebis mravali poqsiasTan erTad qemoreceptorebis gaRi-
daavadebiT. zianebis gziT aRagznebs sunTqvis centrs.
qoSinis paTogenezi rTulia da jer alveolebis kompresia aRizianebs alveo-
kidev ar aris saTanadod Seswavlili. lebisa da intersticiul J-receptorebs,
cxadia, rom qoSinis ganviTarebisTvis rac aseve sunTqvis centris agznebas iw-
aucilebelia sunT-qvis centris mudmivi vevs.
stimulacia. qoSini aR-mocendeba sunTqvis gulis dekompensacia xasiaTdeba qso-
stimulatorebis siWarbis da sunTqvis vilebis sisxlmomaragebis darRveviT, H-
centris agznebadobis momatebis dros. hiperioniiT, hipoqsiiTa da qsovilebSi
dispnoes gamomwvevi faqtorebi naxSirorJangis Semcvelobis daqveiTebiT.
imdenadve mravalferovania, ramdenadac
213
aseTi procesebi Tavis tvinSi ki iwveven mniSvnelovnad qveiTdeba filtvis
sunTqvis centris uSualo agznebas. ventilacia, viTardeba hi-poqsemia da
sunTqvis centris agznebis kidev erTi hiperkapnia, zogjer asfiqsia (mox-rCoba).
SesaZlebeli meqanizmia barorecep-torebis eqspiraciuli (amosunTqviTi) qoSinis
gaRizianebis Semcireba gulis dros upiratesad irRveva amosunTqvis
dekompensaciis dros arteriuli wnevis pro-cesi.
daqveiTebis gamo da am receptorebidan Ca- eqspiraciuli tipis mkveTri qoSini
sunTqvis Semkavebeli impulsaciis Sew-yveta. vi-Tardeba bronquli asTmis Setevis dros
ganxiluli meqanizmebi mimarTulia wvri-li bronqebisa da bronqiolebis
sunTqvis centris agznebisa da sunTqvis alergiuli genezis spazmis, lorwovanis
gaxSirebisken. agznebis gavrceleba lim-bur SeSupebis da lorwos Warbi gamoyofis
sistemaze sunTqvis cvlilebebTan erTad ki gamo (ix. "alergia"), rac aviwrovebs
qoSinis ganviTarebas iwvevs. bronqebisa da bronqiolebis sanaTurs da
qoSinis dros sunTqva upiratesad mkveTrad zrdis winaaRmdegobas haeris
Rrma da xSiria, gaZlierebulia rogorc nakadis mimarT. es ki damatebiT
CasunTqva, ise amosunTqva, romelic aqti-ur datvirTvas uqmnis sasunTq kunTebs.
xasiaTs iRebs. zogjer qoSinis dros CasunTqva, rogorc ufro mZlavri,
Warbobs CasunTqvis an amosunTqvis pro- aqtiuri procesi, naklebad irRveva. rac
cesi, ris mixedviTac ansxvaveben Casun-TqviT Seexeba amosunTqvas, normaSi is
da amosunTqviT qoSins. xorcieldeba filtvis qsovilis
inspiraciul (CasunTqviT) qoSins elastikurobis xarjze. bronqiolebSi
axasiaTebs CasunTqvis fazis upiratesi winaaR-mdegobis gazrdisas ukanaskneli
gaxangrZliveba. is viTardeba zemo sasunTq ukmari xdeba alveolebidan haeris
gzebSi dabrkolebis gaCenis dros (difte- gamosadevnad. amitom amosunTqvis
riuli krupi, xorxis SeSupeba, larin- dasrulebisTvis aucilebeli xde-ba
gospazmi, ucxo sxeulebis moxvedra da damatebiTi eqspiraciuli (Siga iribi nek-
sxv.). stenozis sawyis periodSi Casun- nTaSua da ukana dakbiluli) kunTebis
Tquli haeris raodenoba normaluria an Sekum-Svac. amosunTqvaSi monawileoben
matulobs kidec. sunTqva Rrma da muclis pre-sis kunTebic, romlebis
gaiSviaTe-bulia hering-breieris refleqsis SekumSva maRla swevs diafragmis gumbaTs
mogvianebiT ganxorcielebasTan da forsirebul amo-sunTqvas iwvevs. ase
dakavSirebiT, rac gamow-veulia rom, amosunTqvis pasiuri aqti bronquli
Seviwrovebuli sasunTqi gzebidan Ca- asTmis dros ufro metad irRveva da
sunTquli haeriT alveolebis neli da xangrZlivdeba, vidre Casun-Tqvisa,
gviani gavsebiT, gviandeba agreTve amosunTqva aqtiur formas iRebs.
CasunTqvis centris Semakavebeli impulsacia eqspiraciuli qoSini viTardeba fil-
qvemo sasunTqi gzebi-dan, radgan tvis emfizemis drosac, radgan daqvei-
CasunTquli haeris nakadi bron-qebSi Tebulia filtvis qsovilis elastiku-
normasTan SedarebiT nela izrdeba. roba da gazrdilia misi Wimvadoba.
Zlieri stenozis dros sunTqviTi moZ- CasunTqvis dros gaWimuli alveolebi
raobebis amplituda mcirdeba, amosunTqvis dros arasrulad iCutebian.
214
sunTqva xorcieldeba amosunTqvis aqtiva- epizoduri, araxSiri xvela da
ciiT da gaxangrZlivebiT. filtvebi mkveT- cemineba ar moqmedebs gazTa cvlaze
rad gafarToebulia, magram maTi sasunTqi filtvebSi, magram xangrZlivi SeteviTi
zedapiri Semcirebulia alveolTaSorisi xvelis dros alveolebis ventilacia da
Zgideebis atrofiis gamo, irRveva Jangba-dis sisxlis mimoqceva mkveTrad irRveva.
difuziac alveolur-kapilarul mem-branaSi. epizoduri, araxSiri xvel da
orTopnoe iseTi qoSinia, romelic cemineba ar moqmedebs gazTa cvlaze
dakavSirebulia sisxlis SegubebasTan filtvebSi, magram xangrZlivi SeteviTi
filtvis kapilarebSi marcxena parkuWis xvelis dros alveolebis ventilacia da
ukmarisobis dros. qoSini Zlierdeba ho- sisxlis mimoqceva mkveTrad ir-Rveva.
rizontalur mdgomareobaSi, amitom aseT
avadmyofebs uWirT wola. 17.5. perioduli sunTqva
xvela da cemineba dacviTi reaqci-ebia, perioduli sunTqva aris sunTqvis
romlebic mimarTulia sasunTqi gze-bis riTmis iseTi darRveva, rodesac sunTqvis
gawmendisken lorwosgan, naxvelisgan, garkveul periodebs Soris is droebiT
qimiuri nivTierebebisa da meqanikuri na- sruliad wydeba (apnoe). periodul
wilakebisgan. isini viTardebian refleq- sunTqvas akuTvneben Cein-stoqsisa da
surad zemo sasunTq gzebSi xsenebuli biotis sunTqvas .
gamRizianeblebis arsebobisas. Cein-stoqsis tipis sunqTvis dros
xvela uxSiresad viTardeba ena-xaxis sun-TqviTi pauzis - apnoes Semdeg
da cdomili nervebis daboloebebis gaRi- dawyebuli sunTqviTi moZraobebis
zianebisas xorxis, traqeis da bronqebis amrplituda TandaTan izrdeba, aRwevs
lorwovanSi. zogjer is gamowveulia garkveul maqsimums (hiper-pnoe), Semdeg ki
plevris nervuli daboloebebis gaRizia- kvlav TandaTanobiT mcirdeba sunTqvis
nebiTac. xvela xanmokle refleqsuri aqtia. mTlian Sewyvetamde. pauzis Semdeg suraTi
mokle CasunTqvas eqspiraciuli kunTebis meordeba. biotis tipis perioduli
daZabvasTan erTad maSinve moyveba xmovani sunTqvis dros pauzis Semdeg dawyebuli
napralis daxurva, wneva alveo-lebSi, sun-TqviTi moZraobis amplituda
plevris Rrusa da sasunTq gzebSi mkveTrad Tanabaria, sunTqviT moZraobas moyveba
izrdeba. Semdeg xmovani naprali uecrad pauza (apnoe), Semdeg ki yovelive
ixsneba da haeri didi siswrafiTa da ZaliT meordeba perioduli sunTqvis sxvadasxva
gamoisroleba sasunTqi gze-bidan, Tan SemTxvevaSi sunTqvisa da pauzis
waiyolebs ra lorwovanis zeda-pirze xangrZlivoba araerTnairia.
ganlagebul nawilakebs. xSirad sunTqviTi aqtivobisa da
cemineba cxviris lorwovanSi pauzis paralelurad icvleba arteriuli
arsebuli samwvera nervis daboloebebis wneva da pulsis sixSire - isini
gaRizianebis Se-degia. xvelisgan matuloben sunTqvis da mcirdebian apnoes
gansxvavebiT, ceminebisas xmo-vani napralis periodSi. araiSviaTad apnoes dadgomisas
gaRebis Semdeg haeri ara piris, aramed goneba ikargeba an ibindeba, xolo
cxviris gziT gamoisroleba. sunTqvis ganaxlebisas - aRdgeba.
215
perioduli sunTqva viTardeba Tavis uli, uremiuli da, gansakuTrebiT,
tvinis dazianebisas, gansakuTrebiT maSin, diabeturi koma) dros. misi mizezi
Tu mas Tan sdevs qalasSiga wnevis mo- sunTqvis centrze H+- ionebisa da,
matebac (sisxlCaqceva, simsivneebi, meningi- SesaZloa, acetosxeulakebis moqmedebaa.
ti da a.S.), narkotikebiT an saZile saSu- diabeturi komis terminalur stadiaSi
alebebiT mowamvlisas. perioduli sun-Tqvis sunTqvis centris agzneba misi dep-resiiT
yvelaze xSiri mizezi gul-sis-xlZarRvTa icvleba, "didi sunTqva" xdeba zerele,
sistemis daavadebebis – hi-pertoniis, Tavis xSiri da gadadis agoniur sunTqvaSi.
tvinis sisxlZarRvebis aTerosklerozis romel-Sic, Cveulebrivi sunTqvisgan
garTulebebi da gulis ukmarisobaa. gansxvavebiT, monawileobs piris da
perioduli sunTqvis meqanizmi mTli- kisris muskulaturac, adgili aqvs haeris
anad naTeli ar aris. mis paTogenezSi TiToqosda "ylapvis" mcdelobas. amitom
mTavari mniSvneloba eniWeba sunTqvis agoniur sunTqvas gasping-sunTqvasac
centris mgrZnobelobis daqveiTebas fizi- uwodeben (ingl. gasp - ylapva).
ologiuri gamRizianeblis - CO2-is mi-marT, ramodenime aseTi moZraobis Semdeg
romlis mizezi sunTqvis centrebis Zlieri sunTqva sabolood wydeba.
hipoqsiaa. CO2-sadmi sunTqvis centris
mgrZnobelobis daqveiTebisas sisxlSi am 18. saWmlis monelebis
nivTierebis Cveulebrivi kon-centracia paTofiziologia
aRar kmara centris asagznebad, amitom saWmlis monelebis sistema
sunTqva wydeba, dgeba pauza. magram am uzrunvel-yofs sakvebis miRebas, mis
pirobebSi qemoreceptorebi jer kidev daSlas SewovisTvis Sesatyvis ubralo
inarCuneben naxSirorJangze reagirebis qimiur naerTebamde, am niv-Tierebebisa da
unars da pauzis dros dagrovili CO2-iT wylis Sewovas, rac aucilebe-lia
Zlieri gaRizianebis gamo mZlavr impul- organizmis energetikuli da plastikuri
sacias gzavnian sunTqvis centrebisken. amas momaragebisTvis.
emateba naxSirorJangis gazrdili saWmlis momnelebeli sistemis
koncentraciis uSualo gavlena sunTqvis calkeul nawilebs Soris mWidro
centrebze. aseT pirobebSi centrebi gana- urTierTkavSiria. es gansakuTrebiT
axleben funqciobas, iwyeba sunTqviTi mkveTrad vlindeba paTologiis dros,
moZraobebi, matulobs arteriuli sis-xlis rodesac sistemis erTi nawilis fun-qciis
wneva, magram amosunTqvebis dros CO2 darRveva iwvevs sxva nawilebis fun-qciis
tovebs organizms, misi koncentra-cia moSlasac. aRniSnuli urTierTkavSiri
sisxlSi qveiTdeba, CO2 kvlav veRar gansazRvravs saWmlis momnelebeli
aRagznebs sunTqvis centrs - sunTqva kvlav sistemis uaRresad did kompensaciur
wydeba, xolo apnoes periodSi dag-rovili SesaZleblobes, rac naTlad iyo naCvenebi
naxSirorJangis moqmedebiT kvlav aR-dgeba e.londonis eqspe-rimentebSi ZaRlebze -
da a.S. dadgenili iqna, rom cxoveli cocxali
kusmaulis "didi sunTqva" xasiaTdeba rCeba, Tu ramdenime etapad amoikveTeba
Rrma, xmauriani sunTqviT, viTardeba Zlieri kuWi, TeZos, mlivi da TiTqmis mTeli
acidoziT mimdinare daavadebebis (hepatargi-
216
msxvili nawlavi misi dasawyisi nawilisa da stimulaciis an sanerwyve jirkvlebis
swori nawlavis garda. sekreciuli nervebis gaRizianebis Sedegia.
saWmlis monelebis ukmarisoba iseTi amgvari stimulacia SeiZleba
mdgomareobaa, rodesac saWmlis momnele- dakavSirebuli iyos centraluri nervuli
beli sistema ver uzrunvelyofs orga- sistemis daziane-basTan (bulburi
nizmSi Sesuli sakvebi nivTierebebis SeT- damblebi), piris Rrus an kuWis anTebiT
visebas: misi ZiriTadi gamomwvevi mizeze-bia: procesebTan, saylapavi milis
uxarisxo sakvebis miReba, infeqciuri daavadebebTan (ezofagosalivaciuri
agentebi (dizenteria, kvebiTi toqsikoin- refleqsi), gulisrevasTan da
feqciebi da sxv.), Sxamebi (mZime metale-bis RebinebasTan, intoqsikaci-asTan
marilebi, mcenareuli Sxamebi), simsiv-neebi, (magaliTad, parasimpatomimetikebiT – pi-
alkoholis da nikotinis Warbi ga-moyeneba, lokarpiniT an fizostigminiT),
fsiqikuri travma, saWmlis mom-nelebeli orsulobis toqsikozTan.
traqtis Tandayolili anomali-ebi, zogierTi mowamvlis dros
postoperaciuli mdgomareoba. hipersali-vacia garkveulwilad dacviTi
reaqciaa da emsaxureba Sxamebis ganzavebas,
18.1 sakvebis monelebis darRveva piris toqsikuri naerTebisa da nivTierebaTa
RruSi
cvlis mavne produqtebis gamoyofas.
piris RruSi sakvebi sveldeba, mu-
magram xangrZlivi hipersalivacia iwvevs
Savdeba meqanikurad da, nawilobriv, qimi-
kuW-nawlavis traqtis funqciisa da
urad. sakvebis daqucmaceba irRveva kbi-
nivTierebaTa cvlis darRvevas, organizmis
lebis dazianebis an ararsebobis dros,
gamofitvas. Zlieri hipersaliva-ciisas
saReWi kunTebis funqciisa da inervaciis
gamoyofili nerwyvis nawili gadmodis
darRvevisas, safeTqel-qvemoybis saxsrebis
piris Rrudan da iwvevs kanis maceracias.
an piris Rrus lorwovanis dazianebisas.
Se-saZlebelia nerwyvis moxvedra da
ReWvis aqtis darRvevis erT-erTi
infeqciis Setana piris Rrudan sasunTq
uxSiresi mizezi kbilebis kariesia. Kbile-
gzebSi.
bis kariesi paTologiuri procesia, ro-
nerwyvis gamoyofis Semcireba
melsac axasiaTebs kbilis myari qsovi-lebis
(hiposalivacia) vlindeba infeqciuri
(emali da dentini) progresirebadi
daavadebebis, cxelebis, organizmis
destruqcia. kbilebis kariess iwvevs
gauwylovnebis dros, parasimpatikuri
mikroorganizmebi. kariesis paTogenezSi
inervaciis darRvevisas, saner-wyve
mniSvnelovan rols TamaSobs emalis zeda-
jirkvlebis anTebis (magaliTad, paroti-
pirze moqmedi procesebi. gansakuTrebuli
tis - ybayura jirkvlis anTebis) da
mniSvneloba eniWeba wyalSi ftoris sim-
simsiv-neebis dros. nerwyvis gamoyofis
cires, nerwyvis gamoyofis darRvevebs,
meqanikuri Seferxeba viTardeba sanerwyve
romelic icavs emals dazi-anebisgan.
jirkvlebis sadinrebSi kenWebis gaCenis
Nnerwyvis gamoyofis darRveva. ner-
Sedegad. nerwyvis gamoyofa mcirdeba
wyvis gamoyofis momateba (hipersalivacia)
agreTve Zlieri emociebis (SiSi,
mogrZo tvinSi moTavsebuli nerwyvis ga-
mRelvareba) da tkivilis, agreTve
moyofis centris uSualo da refleqsuri
217
zogierTi vegetatiuri SxamiT (atropiniT, yalibdeba e.w. "gastruli tetaniis" sura-
skopalaminiT) mowamvlis dros. Ti.
piris Rrus simSrale hiposalivaciis kuWis sekreciuli funqciis darRveva.
dros arRvevs ReWvisa da ylapvis aqts. janmrTeli adamianis kuWis lorwovani
cudad dasvelebuli sakvebi azianebs dRe-RameSi gamoimuSavebs 2 l kuWis
lorwovans. enaze gaCenili nadebi mSvenieri wvens. misi gamoyofis momateba (hipersek-
sakvebi niada-gia mikrofloris zrda- recia) da daqveiTeba (hiposekrecia), Cveu-
ganviTarebisTvis. amas emateba nerwyvis lebriv, Tanxvdeba kuWis wvenis Sedgeni-
lizocimis ukmarisoba da iq-mneba pirobebi lobis Sesabamis cvlilebebs - mJavianobis
rogorc piris RruSi infeqciis momatebas (hiperaciditis) an mJavianobis
ganviTarebisTvis, ise evstaqis milis daqve-iTebas (hipoaciditis) kuWis wvenSi
saSualebiT Sua yurze misi gav- Tavisufali marilmJavis srul gaqrobamde
rcelebisTvis. hiposalivacia, rogorc (anaciditis). mag-ram paTologiis dros
aRiniSna, xels uwyobs kbilebis kariesis zogjer gvxvdeba diso-ciacia kuWis wvenis
ganviTare-basac. raodenobas, mJavianobasa da momnelebel
Zalas Soris: hiposekrecias Tan sdevs
18.2 saWmlis monelebis darRveva kuWSi monelebis maRali, xolo hipersek-recias
kuWs ramodenime urTierTdakavSire- - monelebis dabali unari.
buli funqcia aqvs: rezervuaris, eqs- hipersekrecia mJavianobis momatebiT
kreciuli, sekreciuli, motoruli, Sewo- axa-siaTebs kuWis Warbad mJave SigTavsis
vis. gadasvla Tormetgoja nawlavSi
kuWis rezervuaruli funqciis dar- refleqsurad iwvevs pilorusis
Rveva SeiZleba gamowveuli iyos am or- xangrZliv spazms. Sedegad sakvebi yovndeba
ganos kunTovani garsis atoniiT, kedlis kuWSi, iwyeba duRilis procesi, mas Tan
atrofiiT, rezeqciiT da a.S.. am funqciis sdevs boyini, gulZmarva, zogjer Rebineba,
darRvevas xels uwyobs agreTve sakvebis mcirdeba nawlavebis peristaltika,
didi raodenobis regularulad miReba, viTardeba yabzoba.
pilorusis stenozi, qirurgiuli opera-cia hiposekrecia da fermentebis
muclis Rruze da a.S.. aqtiurobis momateba araiSviaTad iwvevs
kuWis rezervuaruli funqciis dar- lorwovanis dazi-anebas, zogjer eroziisa
Rvevisas organo gafarToebulia, misi ke- da wylulis ganvi-Tarebamde.
deli gaTxelebuli, gaWimulia, peristal- kuWis wvenSi Tavisufali
tika Semcirebuli, sekrecia – daqveiTebu- marilmJavas srul gaqrobas (anaciditas),
li. gaganierebul kuWSi sakvebi didxans xolo wvenis srul gamouyoflobas
yovndeba, grovdeba siTxe da airebi. Yyo- aqilia ewodeba. ganasxvaveben funqciur
velive es boyinsa da Rebinebas iwvevs. (labilur) da organul (stabilur)
zogjer Rebineba Zalze intensiuria, didi aqilias. pirvel SemTxvevaSi kuWis
raodenobiT ikargeba siTxe, qloridebi, HI lorwova-nis jirkvlebi SenarCunebulia,
-ionebi. Sedegad viTardeba organizmis magram isini sisxlmomaragebis an
gauwylovaneba (eqsikozi) da metaboluri inervaciis darRvevis gamo ar funqcioben.
alkalozi, rac iwvevs krunCxvebs, e.i. sekreciis dammuxruWebeli faq-toris
218
(magaliTad, intoqsikaciebis, uaryofiTi kuWis motoruli funqciis darRveva
emociebis) moqmedebis Sewyvetisas kuWis kuWis motorikis darRvevebs miekuT-
wve-nis sekrecia aRdgeba. organuli aqilia vneba misi tonusis momateba (hipertonia),
kuWis lorwovanis jirkvlebis atrofiis tonusis daqveiTeba (hipotonia), tonusis
Sedegia (ma-galiTad, atrofiuli dakargva peristaltikis momateba (hiper-
gastritis, kuWis kibos, sanaRvle gzebisa kinezia), peristaltikis daqveiTeba, ag-
da RviZlis qronikuli da-avadebis dros). reTve gulZmarva, slokini, boyini, gulis-
saWmlis moneleba hiposekreciisa da reva da Rebineba.
Ta-visufali marilmJavas ararsebobis, miT Rebineba (vomitus) rTuli refleqsu-
umetes sruli aqiliis dros, mkveTrad ri aqtia, romlis Sedegad kuWis da, nawi-
irRveva. rogorc cnobilia, pilorusi lobriv, nawlavebis SigTavsi gamoZevdeba
ixureba maSin, ro-desac Tormetgoja organizmidan piris Rrus gziT. ufro
nawlavis dasawyis nawilSi reaqcia mJavea xSirad is dakavSirebulia kuWis lorwo-
(pilorusis refleqsi). radgan aqiliis da vanis gaRizianebasTan uxarisxo sakvebiT
anaciduri mdgomareobis dros kuWis wvenSi an receptorebis mgrZnobelobis momate-
ar aris Tavisufali maril-mJava, pilorusi basTan kuWis daavadebis dros, e.i. mas
mudmivad Riaa, kuWis jer kidev ref-leqsuri xasiaTi aqvs.
mounelebeli SigTavsi Tormetgoja Rebinebis refleqsis umniSvnelovanes
nawlavSi zedmetad swrafad xvdeba. irRveva refleqsogenur zonebs kuWis garda
am masis moneleba Tormetgoja nawlavSic, miekuT-vneba xaxis ukana kedeli da
radgan sakvebis didi ulufebi naklebad iliocekuri are. Rebinebis centris
iJRinTeba Tormetgoja nawlavis wveniT, agzneba da refleqsuri Re-bineba, kuWSi
meore mxriv ki marilmJavas ararsebobis arsebuli receptorebis gaRizia-nebis
gamo ar gamomuSavdeba pankreasis wvenis garda, SeiZleba gamoiwvios impulsaciam
gamoyofis mastimulirebeli sekretini. piris Rrudan, nawlavebidan
yovelive amas moyveba sakvebis zed-miwevniT (gansakuTrebiT iliocikuri midamodan),
cudad monelebuli masis gadas-vla vestibuluri aparati-dan, umaRlesi
qvemdebare nawlavebSi, rac maTi re- nervuli centrebidan (magali-Tad,
ceptorebis gaRizianebas da mdgrad faRa- arasasiamovno sunis pasuxad) da sxv.
raTobas iwvevs. viTardeba saWmlis mone- Rebinebas xSirad dacviTi
lebis ukmaroba, hipovitaminozebi, nivTie- mniSvneloba aqvs, radgan aTavisuflebs
rebaTa cvlis moSla, sakvebSi arsebuli kuWs uxarisxo sak-vebis da toqsikuri
rkinis ionizaciis darRvevis gamo yalib- nivTierebebisgan. magram xangrZlivi da
deba aqlorihidruli anemia (ix. "rkinade- xSiri Rebineba (magaliTad, bav-Svebis
ficituri anemiebi"). marilmJavas baqteri- toqsikuri dispefsia, orsulTa pirRe-
ciduli moqmedebis ararsebobis gamo TviT bineba) iwvevs organizmis mier wylis,
kuWSi aRmocendeba duRilisa da lpobis wyalba-dionebis ionebis da qloridebis
procesebi, warmoiqmneba organuli mJavebi didi raode-nobis kargvas, ris gamo
(pirvel rigSi rZemJava) da gogirdwyal- viTardeba eqsikozi, alkalozi, krunCxvebi
badi. (magaliTad, gastruli tetania),
organizmis gamofitva.
219
kuWis SewoviTi funqciis darRveva 18.3 wylulovani daavadeba
kuWSi, Cveulebriv, mcire raodenobiT wylulovani daavadeba qronikuli
Seiwo-veba wyali da alkoholi. am organos sneulebaa, romelsac axasiaTebs kuWis an
dazia-nebisas Sewova SeiZleba mkveTrad Tormetgoja nawlavis lorwovan garsebze
gaZlierdes. magaliTad, kuWSi sakvebi masis wylulovani defeqtis arseboba da po-
xangrZlivi Se-ferxebisas Seiwoveba licikluri mimdinareoba.
polipeptidebi, rac or-ganizmis etiologia. wylulovani daavadebis
intoqsikacias iwvevs. intoqsikacia SeiZleba ganviTarebaSi mravali faqtori monawile-
ganviTardes gastritebis dros im obs. mas iwvevs sxvadasxva garemo faq-
SemTxvevaSi, Tu kuWis lorwovanis tori daavadebisadmi garkveuli memkvid-
dazianebis gamo is ganvladi xdeba ruli winaswarganwyobis fonze. memkvid-
toqsinebis da saWmlis monelebis zogierTi rulad gadaecema ara TviT daavadeba,
produqtis mimarT. aramed saWmlis momnelebeli sistemis da
misi funqciobis regulaciis garkveuli
kuWis eqskreciuli funqciis darRveva tipi, romlis dros daqveiTebulia kuWisa
kuWis eqskreciuli funqcia organizmis de- da Tormetgoja nawlavis lorwovanis re-
zintoqsikaciis mniSvnelovani faqtoria, zistentoba ulcerogenul (wylulis ga-
rad-gan nawilobriv am gziT gamoiyofa momwvev) faqtorTa mimarT.
sisxlSi mocirkulire toqsikuri SeiZleba gamovyoT faqtorTa ori
nivTierebebi. magram zogjer es nivTierebebi jgufi, romelic wylulovani davvadebis
azianeben TviT kuWis lorwovan garss. ganviTarebaSi ucilobel rols TamaSoben.
magaliTad, uremiis dros kuWis saSualebiT pirvel jgufs miekuTvneba
gamoyofili azotovani nivTierebebi iwveven neirogenuli faqtorebi, romlebic,
kuWis lorwovani garsis anTebas. ujredebis pirvel rigSi, fsiqo-emociur sferoze
daSlis gamo warmoqmnili nivTierebebis zemoqmedeben: cxovrebis da-Zabuli reJimi,
eqskrecia ku-Wis lorwovanis mier iwvevs xangrZlivi inteleqturi daZa-buloba,
gastrits gripis, dizenteriisa da sxva gonebrivi gadaRla, uaryofiTi emo-ciebi,
daavadebebis Semdeg. e.i. faqtorebi, romlebic fsiqikur
SimSilis dros kuWis saSualebiT travmas iwvevs daavadebis gamomwvevi ze-
gamoiyofa azotovani produqtebi, romle- moqmedebis
bic Seiwovebian nawlavebSi da gamoiyene-bian meore jgufs akuTvneben alimentur
sasicocxlo mniSvnelobis mqone or-ganoebis faqtorebs. magaliTad SeiZleba moviyvanoT
kvebisTvis. qronikuli Cirqovani anTebiTi cxare sakvebis regularuli miReba.
procesebis dros gamoiyofa didi Wylulo-vani daavadebis maRali sixSire
raodenobiT kuWis wveni, romelSic mcirea saqarTveloSi (aq is 2,5-jer xSiria,
marilmJavas da maRalia azotovani nivTi- vidre ruseTSi) dakav-Sirebuli unda iyos
erebebis Semcveloba, magram am nivTiere- cxare kerZebis gamoye-nebasTan.
bebis Sewova nawlavebSi CamorCeba maT eq- wylulovani daavadeba xSiria aRmo-savleT
skrecias. es aris Wrilobebis dros ganvi- afrikaSi, indoneziaSi, indoeTis zog
Tarebuli organizmis gamofitvis erT-erTi StatSi, sadac sakvebad iyeneben
mizezi. lorwovanis gamRizianebel produqtebs.
220
sakvebi produqtebis etiopaTogenezuri roli wylulovani daavadebis etiologi-
moqmedebis gza dakavSirebulia sakvebis aSi. arsebobs pirdapiri korelacia heli-
kompo-nentebis gavlenasTan kuWis wvenis kobaqteriebs, wylulovani daavadebis aR-
gamoyofaze. dadgenilia wvenis sekreciis mocenebas da mis recidivs Soris.
maRali dife-rencireba sxvadasxva sakvebis paTogenezi. (sur. 18-1) Tanamedrove
miRebaze. Magali-Tad, xorci iwvevs maRali SexedulebiT wylulovani daavadeba vi-
mJaveobis kuWis wvenis didi raodenobiT Tardeba kuWis wvenis damzianebeli moq-
gamoyofas, rac hi-peraciduli medebis da mis mimarT kuWis da
mdgomareobisken midrekilebis pi-rebSi Tormetgoja nawlavis lorwovani garsis
zrdis lorwovanis dazianebis Sanss. rezistentobis Seusabamobis dros. aqedan
kuWis wvenis gamoyofis mizezia gamomdinare, qronikuli wylulovani
araregularuli kvebac, rac iwvevs daavadebis safuZveli, erTi mxriv, mJavas
hipersekrecias da am gziT qmnis kuWis da peptiduri agresiis gaZlierebaa, meores
Tormetgoja nawlavis lorwovanis mxriv ki - lorwovanis garsis mdgradobis
dazianebis winapirobas. daqveiTeba im faqtorTa deficitis gamo,
faqtorebis am jgufs miekuTvneba romlebic icaven am garss kuWis wvenis
samkurnalwamlo nivTierebebic. zogierTi mier monelebisgan. sxvanairad rom vTqvaT,
maTgani (magaliTad, salicilatebi) wyluli viTardeba lorwovanis TviTmone-
uSualod azianebs kuWis lorwovans lebis gamo kuWis aqtiuri sekretiT. rad-
nekrozis kerebis ganviTa-rebamdec ki. sxva gan kuWis wvenis damzianebeli moqmedeba
preparatebi (kortikoste-roidebi) cvlian izrdeba ara marto misi mJaveobis an mom-
kuWis wvenis sekrecias da amcireben misi nelebeli unaris momatebis, aramed dacvi-
damcveli lorwos gamoyofas, rac wylulis Ti faqtorebis deficitis drosac, kuWis
ganviTarebas uwyobs xels. Me-dikamenturi wyluli xSirad normaluri an daqviTebu-
wyluli ufro xSirad mwvaved viTardeba da li mJaveobis fonzec ki mimdinareobs. mag-
lokalizdeba kuWSi. xSiria mravlobiTi ram kuWis wvenis mJave reaqciis roli
wylulebis warmoSoba da hemora-giuli wylulovani daavadebis paTogenezSi eWvs
movlenebi. medikamenturi wyluli ar aris ar iwvevs.
tipobrivi wylulovani daavadeba. is, lorwovanis defeqtis gaCena aris
Cveulebriv, qreba ulcerogenuli niv- agresi-uli faqtorebis (marilmJava,
Tierebis miRebis Sewyvetis Semdeg. amave pefsini) da damcveli faqtorebis
dros, ar SeiZleba uaryofil iqnas kor- (lorwos) wonasworobis darRvevis Sedegi
tikosteroidebis paTogenezuri roli agresiul faqtorTa sasar-geblod.
wylulovani daavadebis ganviTarebaSic. lorwovani garsis damcveli
faqtorebis mesame jgufs, romlebic faqtorebi-dan umTavresia lorwo,
monawileobs wylulovani daavadebis romelic icavs lor-wovan garss
genezSi, akuTvneben mavne Cvevebs, pirvel TviTmonelebisgan kuWis wvenis
rigSi, Tambaqosa da alkoholis intensiur fermentebiT, qimiuri da meqanikuri
gamoyenebas. daziane-bisgan. damcveli lorwos erT-
gansakuTrebul yuradRebas iwvevs erTi funqciaa winaaRmdegoba wyalbadis
helikobaqteriebis (kampilobaqteriebis) ionebis jirkvlovani aparatis siRrmeSi
221
Sesvlis mimarT. lorwovani barieris mkvebavi sisxlZarRvis Trombozis dros),
dazianebis dros misi ganvladoba iz-rdeba, iqmneba pirobebi wylulis ganviTarebis-
wyalbadionebi aRwevs kuWis qsovileb-Si, Tvis.
mis lorwqveSa sisxlZarRvebSi, azianebs lorwovanis dacviTi Tvisebebis Sec-
endoTeliums da iwvevs sisxlZarRvebis vla ulcerogenezisTvis mxolod winapi-
nawi-lobriv okluzias. sisxlmomaragebis robaa. wyluli Cndeba maSin, rodesac aR-
darRvevas moyveba kuWis lorwovanis niSnuls emateba kuWis wvenis mJaveobis da
dazianeba da nek-rozi. wyalbadionebi agresiulobis mateba.
azianebs agreTve kuWis poxier ujredebs, am kuWis wvenis agresiuloba dakavSire-
dros gamoTavisufle-buli histamini ki bulia e.w. mJavur-heptiuri faqtoris (ma-
kuWis wvenis sekreciis mZlavri rilmJava, pefsini) moqmedebasTan, rome-
stimulatoria. fiqroben, rom hista-mini lic gansazRvravs kuWis wvenis momnele-
zrdis marilmJavas gamoyofas parietuli bel Zalas. marilmJavas da pepsinis hiper-
ujredebis mier H-2-histaminreceptorebze produqcia ufro xSirad gamowveulia ku-
moqmedebis gziT. histaminis da sxva Wis lorwovanis hiperplaziiT, romelic,
biogenuri aminebis gamoyofa iwvevs ZiriTadad, am nivTierebis maproduci-
lizosomuri fer-mentebis gamosvlas rebeli ujredebis hiperplaziis xarjze
ujredebidan. es fer-mentebi ki, zogierTi viTardeba. amgvari hiperplazia SeiZleba
mkvlevaris azriT, azia-neben lorwovan dakavSirebuli iyos parasimpatikuri
garss. nervebis tonusis momatebasTan, genetikur
aq aucileblad unda gamaxvildes faqtorebTan, kuWis antraluri nawilis
yurad-Reba helikobaqteriebis rolze lorwovanis garsis p-ujredebis mier gas-
wylulovani daavadebis paTogenezSi. am trinis hiperproduqciasTan. es hormoni
baqterias aqvs lorwovanis epiTelur cirkulirebs sisxlSi da astimulirebs
ujredebze adheziis unari, rac amcirebs ujredebis mier wyalbadionTa sekrecias,
lorwovanis damcveli lorwos gamoyofas iwvevs kuWis lorwovani garsis hiper-
da cvlis mis Semad-genlobas, e.i. asustebs plazias.
lorwovanis damcvel bariers. damcveli marilmJavas gamoyofis momateba SeiZ-
lorwos gamoyofa mcirdeba neirohumoruli leba gamowveuli iyos agreTve mfaravi
faqtorebis moqmedebis (qroni-kuli ujredebis hiperreaqtiulobiT, maTi moma-
stimulacia, histamini, glukokor- tebuli mgrZnobelobiT stimulaciis mi-
tikoidebi) Sedegadac. marT, romlis safuZveli kuWis
kuWis da Tormetgoja nawlavis lorwovanis memkvidruli
damcveli faqtoria, agreTve, lorwovanis morfofunqciuri Taviseburebaa.
regeneraciis unari. normalur pirobebSi marilmJavas neitralizeba
kuWis da Tormetgoja nawlavis mkveTri Tormetgoja nawlavSi dakavSirebulia
dazianeba (magaliTad, biofsiis Semdeg) kuWis motorul funqciasTan, romlis
xorcdeba 3-4 dRe-RameSi. lorwovanis gaZliereba, Cveulebriv, Tanxvdeba kuWis
garkveuli ubnis mier regeneraciis unaris wvenis mJaveobis momatebas. motorikis
dakargvisas (magaliTad, romelime ubnis gaZlierebis gamo kuWis SigTavsi swrafad
tovebs am organos, ris gamo mcirdeba
222
kuWis wvenis marilmJavas SekavSireba fiqroben, rom wvrili nawlavis li-
sakvebTan da naklebad xdeba misi berkunis jirkvlebi gamoimuSaveben nawla-
ganeitraleba. vis wvenis Txier komponents fermentebis
kargadaa cnobili kuWis lorwovanis gareSe, fermentebs ki nawlavis xaoebis
dazianebis ganviTarebis SesaZlebloba cen- ujredebi gamoyofen. distanciuri mone-
traluri nervul sistemaze, gansakuTrebic leba damokidebulia, pirvel rigSi, pan-
ki hipoTalamusze zemoqmedebisas amgvari kreasis wvenisa da naRvlis gamoyofaze,
dazi-anebis Camoyalibeba dakavSirebulia membranuli moneleba ki xaoebis ujrede-
cdomili nervis gavlenis siWarbesTan, bis mier fermentebis produqciaze.
romelic iwvevs kuWis lorwovanis mier wvrili nawlavis yvelaze mniSvnelovani
marilmJavas, pefsinis da gastrinis
gamoyofis qolinergiul stimu-lacias,
motoruli funqciis gaZlierebas. yovelive
es qmnis wylulis ganviTarebis pirobebs.
centraluri nervuli sistemis fun-
qciuri mdgomareobis mniSvnelobaze
metyvelebs e.w. stresuli wylulebis
miRebis SesaZleb-loba cxovelebze
stresuli gamRizianeblebis (imobilizeba,
eleqtrotravma da sxv.) moqme-debiT.
fsiqosomaturi stresis gamomwvevi ne-
irogenuli faqtorebis zemoqmedebis
pasuxad aqtiurdeba hipoTalamuri centrebi,
romlebic pasuxismgebelni arian kuWisa da
Tormetgoja nawlavis sekreciul da
motorul funqciebze. stresuli
faqtorebis aseTi arCeviTi moqme-deba
dakavSirebulia imasTan, rom procesi
uviTardeba im adamianebs, romlebsac
darRveu-li aqvT kuWis funqcia (gastriti,
sekreciis da motorikis darRveva da sxv.).
18.4 saWmlis monelebis darRveva
nawlavebSi
nawlavs sekreciuli, motoruli,
Sewovi-Ti da inkreciuli funqcia aqvs.
nawlavebSi saWmlis monelebis pirvel -
distanciur etap-ze (nawlavis RruSi
moneleba) iSleba msxvili molekulebi,
xolo meore - membranul etapze (moneleba
kedelTan) mimdinareobs sakvebi
nivTierebebis saboloo hidroli-zi.
223
ukuaferentacia stresi
glukokor-
motorikis naRvlis simpaTikuri tikoidebis
aqtivacia refluqsi centrebis siWarbe
hipertonusi
lorwovani damcveli
barieris dazianeba lorwos helikobaq-teri-
gamoyofis ebis adhezia
Semcireba lorwovanze
H+-
kuWis SigTavsis
swrafi hiperionia
evakuacia lorwova- D-4 klasis
nis sisxl- leikotrie-
momaragebis nebis gamoyofa
daqveiTeba
histaminis
gamoyofa
k u W i s w v e n i s m J a v ia -n ob i s
d a f e rm e n tu l i
a qt iv o b is m om at eb a
wylulovani daavadeba
224
am sadinris kompresiiT pankreasis Tavis pankreasis wvenis sekreciis darRveva
simsivnis dros. naRvlis gamoyofis sti- pankreasis wvenis sekreciis
mulatoria sekretini, gastrini, sakvebis daqveiTebas saWmlis monelebis Rrma
miReba, kuWis wvenis marilmJava. TviT darRvevebi axasiaTebs, radgan es jirkvali
naRvlis buStidan naRvlis gamoyofis gamoimuSavebs saWmlis momnelebel yvela
stimulatori qolecistokininia. naRvlis ZiriTad ferments. am fer-mentebis erTi
gamoyofas aqveiTebs SimSili da sim- nawili (tripsini, qimotripsini, elastaza,
patikuri nervuli sistemis agzneba. karboqsilpolipeptidazebi, kali-kreini,
aqoliis dros gansakuTrebiT mkveT- fosfolipaza A) gamoiyofa araaqtiur
rad irRveva cximis moneleba, radgan pan- mdgomareobaSi da aqtivdeba Tormetgoja
kreasis wvenis lipaza naRvlis gareSe naw-lavSi. meore nawili (lipaza, amilaza,
araaqtiuria, xolo Tormetgoja nawlavSi rnm-aza da dnm-aza) ki aqtiuri formiT
naRvlis deficitis dros cximis emul- producirdeba.
gireba ar xdeba, misi kontaqti fermentTan pankreasis fermentebis
gaZnelebulia. aseve Zlier dabrkolebulia gamouyoflobis - pankreasuli aqiliis an
cximmJavebis, qolesterinis da cximSi am fermentebis gamoyofis mniSvnelovani
xsnadi vitaminebis Sewova. cximis monelebis Semcirebis dros mkveTrad irRveva
da Sewovis darRvevis gamo vlindeba cximebis cvla, radgan pankreasis wveni
steatorea - ganavlSi cximis didi Seicavs yvelaze aqtiur lipolizur
raodenobiT Semcveloba. fermentebs. pankreasis garesekreciuli
aqoliis dros irRveva naxSirwyle-bisa funqciis daqveiTebisas miRebuli cximis
da cilebis monelebac, radgan da-uSleli 60-80% gamoiyofa ganavliT, e.i. viTardeba
cximi xels uSlis Sesabamisi fermentebis steatorea. ar moineleba agreTve sakvebSi
kontaqts sakvebis masasTan. amave dros arsebuli cilis 30-40%, xorceulis
qveiTdeba TviT proteolizu-ri da miRebis Semdeg ga-na-valSi gvxvdeba
amilolizuri fermentebis aqtivo-ba, radgan kunTovani boWkoebi, rasac kreatorea
es fermentebi maRalaqtiuria mxolod ewodeba. irRveva naxSirwylebis mo-ne-
Tormetgoja nawlavSi tute reaqciisas, lebac, vlindeba saWmlis monelebis
romelsac aq gamoyofili naRveli qmnis. ukmarobis suraTi.
rogorc iTqva, aqoliis gamo cximis saWmlis monelebis darRveva wvril
monelebisa da Sewovis moSlasTan erTad nawlavSi
irRveva cximSi xsnadi vitaminebis Sewovac, wvril nawlavSi saWmlis monelebis
e.i. viTar-deba avitaminozebi. darRveva dakavSirebulia nawlavis wvenis
gansakuTrebuli mniSvnelo-ba aqvs K gamoyofis SemcirebasTan, masSi
vitaminis Sewovis darRvevas, romlisgan fermentebis naklebobasTan da membranuli
RviZlSi sinTezdeba proTrombini. aqo-liis monelebis moSlasTan. nawlavis wvenis
dros proTrombinis sinTezis Semcireba gamoyofis Semci-rebisas kompensaciurad
sisxlis Sededebis daqveiTebas iwvevs. Zlierdeba pankrea-sis wvenis fermentebis
radgan naRveli aaqtiurebs nawlavebis gamoyofa.
motorikas, aqoliis dros peristaltika membranuli moneleba iSleba Semdeg
qveiTdeba, xSiria yabzoba da meteorizmi. SemTxvevebSi: a)xaoebis struqturisa da
225
wvrili nawlavis epiTeliumis mikros- gamRizianeblebic ki peristaltikis
truqturis darRvevebisas. (magaliTad, gaxSirebas da gaZlierebas iwvevs.
mwvave nawlavuri infeqciebis dros peristaltika aqtivdeba agreTve cdo-mili
mcirdeba xaoebis simaRle, sprus axasia- nervis centris agznebadobis momatebis
Tebs xaoebis epiTelis jagrisebri arSiis dros, fsiqogenuri zemoqmedebisas,
subtotaluri atrofia); b) membranul nawlavis kedelze paTologiuri
monelebaSi monawile fermentebis raode- gamRizianebelebis gav-leniT. aseTebia:
nobis an aqtivobis daqveiTebisas (magali- duRilisa da lpobis pro-duqtebi,
Tad, nawlavis ujredebis distrofia fer- toqsikuri nivTierebebi, mounelebeli
mentebis gamoyofis, xolo hipo- da aqo-lia sakvebi. magaliTad aqiliis dros
nawlavebis epiTelis mier qimusidan pilorusis refleqsis gamovardnis gamo
fermentebis adsorbciis daqveiTebas iw- (refleqsi mdgo-mareobs pilorusis
vevs); g) nawlavis motorikis moSlisas, daxurvaSi maSin, rodesac kuWis
rac arRvevs substratis gadatanas nawla- lorwovanis mier gamomuSavebuli ma-
vis Rrudan misi lorwovanis zedapirze; d) rilmJava Tormetgoja nawlavis
nawlavis RruSi monelebis darRve-visas, distalur na-wilSi mJave reaqcias qmnis)
radgan dauSleli msxvili moleku-lebi ver kuWSi moune-lebeli sakvebi swrafad
aRwevs xaoebis epiTelis jagri-sebur evakuirdeba nawla-vebSi, rasac Zlieri da
arSias. mdgradi faRaraToba axasiaTebs.
membranuli monelebis darRveva iw-vevs nawlavebis sekreciuli da Sewovis
mZime dispefsias. fermentebis defi-citis fun-qciis darRveva faRaraTobis dros
gamo sakvebi nivTierebebi arasakma-risad saWmlis monelebis mZime ukmarisobas
iSleba da ar Seiwoveba, viTardeba saWmlis iwvevs. kvebiTi mowamvlis dros
monelebis ukmarisoba (malabsorbciis faRaraTobas dacviTi mniS-vneloba aqvs,
sindromi _ nawlavebSi Sewovis darRvevis radgan aTavisuflebs organizms
sindromi). toqsikuri nivTierebebisgan. magram
xangrZlivi faRaraToba, gansakuTrebiT
nawlavebis motoruli funqciis moSla bavSTa asakSi, or-ganizmis gauwylovnebas,
nawlavebis motoruli funqciis dar- eleqtrolitebis kar-gvas, hipovolemias
Rveva vlindeba peristaltikis gaZliere-biT da gulsisxlZarRvovan kolafss iwvevs.
an SemcirebiT, am procesis Tanmim-devrobis spazmuri yabzoba (Sekruloba)
cvlilebebiT, nawlavebis saqane-laseburi viTardeba nawlavebis peristaltikis
moZraobis darRveviT, nawlave-bis Semcirebisas fsiqogenuri ze-moqmedebis
gauvalobiT. gamo, intoqsikaciebisas (magaliTad,
peristaltikis gaZlierebisa tyviiT mowamvla). am faqtorTa
nawlavebis SigTavsi swrafad gadaadgildeba zemoqmedeba iwvevs nawlavis calkeuli
da viTardeba faRaraTi (diarea). misi ubnebis xangrZliv spazmur SekumSvas da
yvelaze xSiri mizezia kuW-nawlavis ganavlovani masebis dag-rovebas.
traqtis anTebiTi dazianeba, ro-melic atoniuri yabzoba viTardeba im
zrdis nawlavis receptorebis agzneba- faqtore-bis moqmedebis Sedegad, romlebic
dobas. am fonze adeqvaturi amcirebs nawlavis kedlis tonuss da
226
peristal-tikas. aseTebia: kvebis daqveiTeba, peritonitis gamo ganviTarebuli
sakvebSi kaliumis da kalciumis marilebis, paralizuri gauvaloba dakavSirebulia
ujre-disis simcire, naRvelmJavebis simpatoadrenaluri sistemis, - da -
nawlavebSi gamoyofis Semcireba an Sewyveta adrenoreceptorebis aqti-vaciasTan, rac
(aqolia). nawlavSi naRvlis mJavebis amuxruWebs nawlavebis peris-taltikas.
gadmosvlis Semcirebisas qveiTdeba gauvalobisas mkveTrad irRveva
peristaltika, vi-Tardeba yabzoba, rac nawlave-bis SigTavsis evakuacia. misi
iwvevs nawlavebSi airebis dagrovebas interorecepto-rebis gaRizianebas
(meteorizmi, ix. Qqve-moT). adamianebSi axasiaTebs Zlieri tkivili. paTologiuri
atoniur yabzobas iw-vevs, agreTve, B1 impulsebis nakadi iwvevs centraluri
avitaminozi. nervuli sistemis zezRurblovan agznebas,
xangrZlivi yabzobisas mcirdeba zogjer Sokis ganviTarebasac. TviT
nawlavis wvenis sekrecia, masSi grovdeba gauvalobis midamoSi viTardeba
ganavlis masa, Cndeba ganavlis qvebi, SeguebebiTi hiperemia, sisxlZarRvebis
mravldeba lpobiTi baqteriebi da viTar- dambla, SeSupeba, an-Teba da nekrozi.
deba autointoqsikacia nawlavebidan. mkveTrad mcirdeba Sewova, Tumca nawlavis
nawlavebis gauvaloba yalibdeba naw- sekreciuli funqcia Senar-Cunebulia.
lavebSi sakvebis fafis gadaTavsebisTvis nawlavis kedlis gaWimva da re-
dabrkolebis arsebobisas. ganasxvaveben me- ceptorebis gaRizianeba Zlier Rebinebas
qanikur, dinamikur da Tromboemboliur da dehidratacias iwvevs. sisxli
gauvalobas. sqeldeba, naw-lavebSi lpobiTi procesebis
meqanikuri gauvaloba gamowveulia ganviTarebis gamo grovdeba indikani da
nawlavis sanaTuris daxSobiT, misi sxva toqsikuri nivTie-rebebi, romelTa
simsivniT, helminTebiT, simsivneebis da Sewova iwvevs mZime autointoqsikacias
nawiburebis zewoliT, nawlavebis gadag- nawlavebidan (ix. qvemoT).
rexviT, invaginaciiT, naw-lavis maryuJis duRilisa da lpobis procesebis
CaWedviT Tiaqaris dros, muclis RruSi dros nawlavebSi grovdeba airi (meTani,
SexorcebiTi procesebis gamo. gogird-wyalbadi, naxSirmJava), rasac
dinamikuri gauvaloba viTardeba naw- meteorizmi ewo-deba. meteorizmi iwvevs
lavebis muskulaturis spazmis an damblis nawlavis kedelSi sis-xlis mimoqcevis
Sedegad. darRvevas, misi meqano- da qe-
Tromboemboliuri (hemostazuri) ga- moreceptorebis Zlier gaRizianebas.
uvaloba nawlavebis sisxlZarRvebis Trom-
bozis an parezis Sedegia. 19. RviZlis paTofiziologia
gauvaloba SeiZleba ganviTardes naw- adamianisa da cxovelebis organizmSi
lavebis nebismier nawilSi. gansakuTrebiT RviZli asrulebs homeostazis
mZime mimdinareoba axasiaTebs misi zemo SenarCunebisken mimarTul metad
nawilis gauvalobas. mniSvnelovan da mravalfero-van
gauvalobis paTogenezis sawyisi eta-pi funqciebs. maTgan ZiriTadia: 1)
didadaa damokidebuli mis gamomwvev nivTiereba-Ta cvlaSi monawileoba, 2)
mizezze. magaliTad, operaciis Semdgomi an naRvlis sekrecia, 3) naRvelTan erTad
227
metabolitebis, toqsiku-ri da izrdeba acetosxeulebis warmoqmna, qo-
samkurnalwamlo nivTierebebis gamoyofa, 4) lesterinis sinTezi.
barieruli (dezintoqsikaciuri) funqcia, 5) cilebis cvlis moSla RviZlis da-
fibrinogenis sinTezi, 6) proTrobinis zianebis dros ganisazRvreba im metad
sinTezi, 7) albuminebis, - da - mniSvnelovani roliT, romelsac TamaSobs
globuli-nebis sinTezi, 8) heparinis es organo aminmJavebis daSlaSi da gar-
warmoqmna, 9) sisxlZarRvTa tonusis daqmnaSi, cilis sinTezSi da Sardovanas
regulacia, 10) sisxlwarmoqmna(embrionul war-moqmnaSi.
periodSi), 11) glikogenis deponireba, 12) RviZlis ukmarisobis erT-erTi
sisxlis depo-nireba, 13) rkinis da pirveli niSani cilis sinTezis darRvevaa.
ciankobalaminis de-ponireba, 14) icvleba plazmis cilebis rogorc
fagocitozSi monawileoba. raodenobrivi, ise Tvisobrivi
RviZlis ukmarisoba vlindeba aRniS- Semadgenloba - RviZlis parenqimis
nuli funqciebis moSliT. es funqciebi ki dazianebisTanave Cndeba Secvlili
Seswavlili iqna eqsperimentis gziT. struqturis globulinebi -
paraproteinebi. RviZlis funq-ciis ufro
19.1 nivTierebaTa cvlis darRvevebi mZime moSla iwvevs albuminebis, - da -
RviZlis ukmarisobis dros
globulinebis, proTrobinis, fibrinogenis
RviZlis dazianeba iwvevs naxSir-
da sisxlis Sededebis sxva faqtorebis
wylebis cvlis mkveTr moSlas. kerZod,
sinTezis darRvevas, ris gamo viTardeba
irRveva glikogenis sinTezi monosaqari-
hipoproteinemia, hipoonkia (onkozuri
debidan, glikolizi, glikoneogenezi
wnevis Sem-cireba), SeSupeba, hemoragiuli
(glukozis warmoqmna aranaxSirwylovani
sindromi. cilis sinTezis darRvevis
bunebis nivTierebebidan, rac mxolod
dros mkveTrad icvleba sxvadasxva
RviZlSi mimdinareobs), galaqtozas da
fermentis aqtivoba.
fruqtozas gardaqmna glukozad. viTarde-ba
RviZlis paTologiis dros irRveva
hipoglikemia, zogjer (sisxlSi Saqris
amoniakis inaqtivebis ZiriTadi gza -
raodenobis Semcirebisas 0,45-0,40g/l-ze
Sardovanas sinTezi. sisxlSi izrdeba
qvemoT) hipoglikemiuri komac. Ddazianebul
amoniakis da aminuri azotis, xolo
RviZlSi glikogenis raodenobis Semcireba
sisxlsa da SardSi mcirdeba Sardovanas
iwvevs organos dezintoqsikaciuri
da SardmJavas raodenoba. amoniakis
funqciis darRvevas, radgan am procesSi
dagroveba iwvevs organizmis,
monawile glukuronis mJava glikogenisgan
gansakuTrebiT centraluri nervuli
warmoiqmneba.
sistemis Zlier in-toqsikacias. amoniemia
cximebis cvlis darRveva. RviZlis
wamyvan rols TamaSobs heparuli
dazianebis dros vlindeba cximmJavebis
(RviZlismieri) komis ganviTarebaSi.
(neitraluri cximis, fosfolipidebis, qo-
RviZlis paTologias Tan sdevs
lesterinis) sinTezis da daSlis moSla.
hipovi-taminozebic. magaliTad, RviZlis
RviZlSi cximis Jangvis darRveva da
parenqimis dazianebisas irRveva
fosfolipidebis warmoqmnis Semcireba am
ciankobalaminis deponireba am organoSi
organos cximovan infiltracias iwvevs.
(e.i. viTardeba B12-avitamino-zi),
228
nikotinmJavas Sualeduri cvla. garda amisa, heparuli komis ZiriTad meqanizms
RviZlis naRvlis gamomyofi funqciis miekuTvneba agreTve mJava-tutovani
darRvevisas moiSleba cximSi xsnadi vita- wonasworobis darRveva sisxlSi mJave
minebis Sewova, rac iwvevs maT deficits metabolitebis dagrovebis gamo
Se-sabamisi SedegebiT. magaliTad, am gziT (metaboluri acidozi) da wylis da
ganvi-Tarebuli K K vitaminis Sewovis marilebis cvlis moSla.
darRvevis Se-degad mcirdeba proTrombinis RviZlismieri koma SeiZleba gamoiw-
sinTezi da, amis gamo, sisxlis Sededebis vios misma dazianebam, magram ufro xSi-
unari. rad is viTardeba virusuli hepatitis,
dazianebul RviZlSi hormonebis toqsikuri distrofiis, cirozis, portu-
/Tiroq-sinis, insulinis, li hipertenziisas (karis venis sistemaSi
kortikosteroidebis, andro-genebis, wnevis momatebisas).
estrogenebis/ daSlis darRvevas sis-xlSi portuli hipenteziis dros
maTi raodenobis cvlileba da en-dokrinuli nawlavebidan momdinare sisxli RviZlis
paTologia moyveba. gauvlelad gadadis Rru venebis
sistemaSi. amitom nawlavebSi war-moqmnili
19.2 RviZlis dacviTi funqciis darRveva toqsikuri nivTierebebi ar neitraldeba.
RviZli mraval egzo- da endogenur
toqsikur naerTs gardaqmnis aratoqsikur 19.3 naRvlis warmoqmnisa da gamoyofis
nivTierebad - dezintoqsikaciuri funqcia, darRveva
dRe-Ramis ganmavlobaSi RviZli
romelic moicavs RviZlis barierul fun-
warmoq-mnis daaxloebiT 0,5-0,7l naRvels,
qciasac. am procesebis darRvevas moyveba
romlis SemadgenlobaSi Sedis
organizmSi amoniakis, fenolebis da sxva
naRvelmJavebi, naRvlis pigmenti,
Sxamiani produqtebis dagroveba, rac iw-
qolesterini, fosfolipidebi, cxi-movani
vevs organizmis mZime intoqsikacias ce-
mJavebi, ionebi, mucini, hormonebi, wyali.
rebruli simptomebis gamovlinebiT, hepa-
naRvelTan erTad gamoiyofa mravali
ruli komis ganviTarebiT.
egzogenuri da endogenuri nivTiereba, maT
RviZlismieri koma RviZlis funqci-
Soris samkurnalwamlo saSualebebi.
uri umarisobis yvelaze mZime gamovline-baa.
naRvlis gamoyofis darRveva
RviZlis dezintoqsikaciuri funqciis
viTardeba RviZlis an naRvlis saerTo
darRveva iwvevs Tavis tvinis toqsikur
sadinrebis dax-Sobisas kenWebiT,
dazianebas, nervul-fsiqikur darRvevebs,
simsivneebis (magaliTad, pan-kreasis Tavis
gonebis dabindvas, dakargvas, moZraobis
kibos) zewoliT, helminTebiT, anTebis
regulaciis moSlas, krunCxvebs.
produqtebiT. naRvlis gamoyofa Se-
tvinis dazianebaSi umTavres rols
saZlebelia Sewydes an Semcirdes
amoniakis dagroveba TamaSobs. amoniakis
funqciuri darRvevisas naRvlis buStis,
neirotoqsikuri moqmedeba pirobadebulia
naRvlis gamo-yofis Sewyveta axasiaTebs
imiTac, rom es nivTiereba nervuli sis-
agreTve parasimpa-tikuri nervuli
temis membranebSi Trgunavs qloris tum-
sistemis agznebas.
bos, rac arRvevs damuxruWebis process
sinapsebSi da iwvevs krunCxvebs.
229
RviZlSi warmoqmnili naRvlis sdevs nawlavebSi airebis dagroveba -
Sesabamis sadinrebSi da nawlavebSi meteorizmi.
gamoyofis dabrko-leba an Sewyveta naRvlis
Segubebis, naRvlis kapilarebis gaskdomis 19.4 siyviTle
da sisxlSi naRvlis gadasvlis gamo, siyviTle (ikterus) kanisa da lorwo-
pigmentebis cvlis darRvevis (ix. vani garsebis naRvlis pigmentiT – bili-
"siyviTleebi") garda iwvevs qolemias rubiniT yviTlad Sefervaa. siyviTle, pir-
(naRvlis mJavebis arseboba sisxlSi), hi- vel rigSi, vlindeba Tvalis skleraze da
perqolesterinemias, cximis monelebis rbil sasaze.
mkveTr darRvevebs, yabzobas da a.S.. ganviTarebis meqanizmebis mixedviT
avadmyofuri movlenebi qolemiis dros ganasxvaveben meqanikur (obturaciul),
dakavSirebulia imasTan, rom naRvlis parenqimul (RviZlismier) da hemolizur
mJavebi toqsikurad moqmedebs zogierT siyviTles.
sistemaze da organoze. kerZod, maTi meqanikuri siyviTle Tan sdevs naR-
gavlena centralur nervul sistemaze vlis nawlavSi gadasvlis Sewyvetas (ix.
iwvevs zogad asTenias, ag-znebisSemdgom zemoT), romlis dros aqoliiT da qole-
depresias, Zilis darRvevas, Tavis tkivils, miiT gamowveul simptomebTan erTad vlin-
sisustes. kanis nervuli re-ceptorebis deba naRvlis pigmentebis cvlis darRveva.
gaRizianebas naRvelmJavebiT Zlieri qavili, janmrTeli organizmis retikulur-
xolo vagusis agznebas da sinusis kvanZis endo-Telur sistemaSi eriTrocitebis
funqciis daTrgunvas - bradikardia moyveba. daSlis dros ganTavisuflebuli
ukanasknelis da, ag-reTve, periferiuli hemoglobinisgan war-moqmnili e.w.
sisxlZarRvebis ga-farToebis gamo arapirdapiri anu Tavisufali bilirubini
arteriuli sisxlis wneva qveiTdeba. sisxlis mier miitaneba RviZlSi, aq is
aqoliuri sindromis dros mkveTrad koniugirebs glukuronmJavas or mole-
irRveva saWmlis moneleba. nawlavSi naR- kulasTan da gardaiqmneba pirdapir anu
vlis gadausvlelobis gamo pankreasis Sekav-Sirebul bilirubinad. nawlavSi
lipaza ar aqtivdeba, Sesabamisad ar xdeba naRvlis ga-dasvlis dabrkoleba iwvevs
cximis emulgireba da moneleba, ar Se- pirdapiri (RviZl-gavlili) bilirubinis
iwoveba sakvebSi arsebuli cximis 60-70%, moxvedras damskdari naRvlis
ganavali Seicavs cximis did raodenobas kapilarebidan sisxlSi, hiperbiliru-
(steatorea). cximis monelebis da Sewovis binemias pirdapiri bilirubiniT,
darRvevis Sedegad moiSleba cximSi xsna-di bilirubinu-rias, rac Sards muq ludis
vitaminebis Sewovac. K vitaminis Sewo-vis fers aZlevs.
Seferxebis gamo RviZlSi mcirdeba nawlavSi bilirubinis gadasvlis
proTrobinis sinTezi da sisxlis Sede-deba Sewyve-tasTan dakavSirebiT mkveTrad
qveiTdeba. mcirdeba urobi-linis da sterkobilinis
naRvelmJavebi iwvevs nawlavis peris- warmoqmna, amitom ga-navalSi ar aris
taltikas, ukanasknelis Sesusteba aqoli-is pigmenti, is Tixis feri, aqo-liuri xdeba.
dros ki yabzobas; mas, Tavis mxriv, Tan meqanikur siyviTles Tan sdevs is
mov-lenebi, romelic saerTod aqolias
230
axasiaTebs (qolemia, hiperqolesterinemia sterkobilinis warmoqmnac, ganavali
da sxv.). pa-renqimuli siyviTle viTardeba xSirad aqoliuria.
hepatocitebis dazianebis gamo zogierTi hepatocitebis kidev ufro mkveTri
infeqciuri sneule-bebisas zogierTi dazianebisas glukuroniltransferazas
nivTierebebiT (fosforiT, dariSxaniT, aqtivobis daqveiTebis gamo irRveva bili-
samkurnalwamlo preparatebiT, alkoholiT rubinis koniugacia, arapirdapiri biliru-
da sxv.) mowamvlis, qronikuli hepatitebisa bini mTlianad ar gardaiqmneba pirdapirad.
da RviZlis cirozis dros. amitom sisxlSi matulobs rogorc pir-
RviZlis parenqimis dazianebis dros dapiri, ise arapirdapiri bilirubinis ra-
saxezea RviZlis funqciebis kompleqsuri odenoba, mcirdeba naRvlis mJavebisa da
moS-lis suraTi hepatocitebis dazianebiT, qolesterinis warmoqmna. parenqimuli siy-
naR-vlis gadasvliT sisxlSi, bilirubinis viTlis dros saWmlis monelebis dar-
cvlis darRveviT (RviZlujredovani Rveva, Cveulebriv, naklebadaa gamoxatuli,
siyviTle). RviZ-lis ujredebis dazianebis vidre meqanikuri siyviTlis dros, Tumca
dros Cndeba uSua-lo kavSiri sanaRvle es procesic mkveTrad iSleba. Zlier ir-
gzebs, sisxlsa da lim-fur ZarRvebs Soris, Rveva RviZlis funqciebic, gansakuTrebiT
romelTa saSualebiT naR-vlis nawili nivTierebaTa Sualeduri cvla.
sisxlsa da limfaSi gadadis. gajirjvebuli hemolizuri siyviTle viTardeba
hepatocitebi iwveven sanaRvle sadinarebis hemolizuri anemiebis dros. siyviTlis mi-
kompresias da qmnian dabrkolebas naRvlis zezia eriTrocitebis hemolizis (eriTro-
moZraobisTvis. parenqimuli siyviTlis dros dierezis) gaZliereba. ganTavisuflebuli
irRveva RviZlis ujredebis metabolizmi da hemoglobinis didi raodenobiT gardaqmna
funqcia. msubuqi dazianebisas
SedarebiT bilirubinad da am pigmentis gadasvla
brkoldeba nawlavebidan Sewovili urobi- sisxlSi. arapirdapiri bilirubinis didi
linogenis gardaqmna bilirubinad. urobi- rao-denobiT warmoqmnis gamo RviZli ver
linogeni gadadis sisxlSi, SardSi matu- aswrebs mis mTlian gardaqmnas pirdapir
lobs urobilinis Semcveloba. mcirdeba bilirubinad da mis gamoyofas nawlavebSi.
nawlavSi gadasuli bilirubinis, urobi- arsebobs mona-cemebi imis Sesaxeb, rom
linogenis da, Sesabamisad, ganavalSi hemolizuri siyviT-lis ganviTarebisaTvis
sterkobilinis raodenoba. aucilebeli pirobaa RviZlis sekreciuli
hepatocitebis ufro mZime daziane- funqciis daqveiTeba. fiqroben agreTve,
bisas warmoqmnili naRvlis nawili gada-dis rom qronikuli hemolizuri anemiebis
sisxlSi, viTardeba hiperbilirubine-mia, dros myardeba Cveulebrivze ufro
qolemia Sesabamisi gamovlinebiT, mdgradi kavSiri bilirubinsa da sisxlis
hiperqolisterinemia, bilirubinemia (e.i. satransporto cilebs Soris, rac
sisxli Seicavs rogorc arapirdapir, ise, aZnelebs bilirubinis koniugacias
didi raodenobiT, pirdapir bilirubins). RviZlSi.
SardSi mkveTrad izrdeba bilirubinis ra- vinaidan RviZlSi sisxliT mitanili
odenoba, is ludisfebri xdeba. nawlavebSi ara-pirdapiri bilirubinis koniugacia
gadasuli bilirubinis raodenoba mkveT-rad mTlianad ar xdeba, hemolizuri
qveiTdeba, mcirdeba urobilinogenis da siyviTlis dros sis-xlSi matulobs
231
pirdapiri bilirubinis rao-denoba, meore mxriv, organizmis Sinagani ga-
viTardeba hiperbilirubinemia arapir-dapiri remos pirveladi cvlilebebi TviT SeiZ-
bilirubiniT. es bilirubini SardTan erTad leba gaxdnen Tirkmelebis funqciis dar-
ar gamoiyofa, radgan dauzianebeli Rvevis mizezi (magaliTad, diseleqtroli-
Tirkmeli ar atarebs cilasTan kompleqsSi turi nefropaTiebi Tirkmlis ukmarisobis
myof bilirubins. niSnebiT).
miuxedavad imisa, rom ar xdeba imis gamo, rom TirkmelSi metad ma-
RviZlSi mitanili arapirdapiri Rali sisxlmomarageba da energetikuli
bilirubinis mTliani koniugacia, pirdapiri cvlaa, is Zalze mgrZnobiarea sisxlmoma-
bilirubini mainc didi raodenobiT ragebis daqveiTebis, toqsikuri da sam-
warmoiqmneba da, Sesabamisad, naw-lavebSi kurnalwamlo nivTierebebis moqmedebis mi-
gadadis bevri bilirubini, matulobs marT. es faqtorebi xSirad iwveven paTo-
urobilinogenis da sterkobilinis logiuri renuli sindromebisa da Tir-
warmoqmna, ganavali xdeba hiperqoliuri, kmlis ukmarisobis ganviTarebas.
SardSi matu-lobs urobilinis raodenoba, Tirkmlis dazianebisas xSirad vi-
rac, zog SemT-xvevaSi, Sards met-naklebad Tardeba arteriuli hipertenzia da anemia,
muq fers aZlevs. radgan es organo monawileobs sisxlZar-
RvTa tonusis regulaciaSi da hemopoezis
20. Tirkmelebis paTofiziologia stimulaciaSi.
Tirkmlis funqciis mravalmxrivoba Tirkmlis, gansakuTrebiT misi gor-
gan-sazRvravs paTofizologiuri glebis antigenuri naTesaoba SemaerTebel
darRvevebis Ta-viseburebebs am organos qsovilTan da streptokokebTan ganapiro-
dazianebis dros ro-gorc TviT TirkmelSi, bebs Tirkmlebis zogierTi daavadebis (ma-
ise mTlianad organiz-mSi. Tirkmeli galiTad, mwvave da qronikuli glomeru-
gadamwyvet rols TamaSobs ho-meostazis lonefriti) mWidro kavSirs SemaerTebeli
regulaciaSi, radgan uSualod mo- qsovilis difuzur dazianebasTan da
nawileobs siTxis masis mudmivobis streptokokis mier gamowveul imunur da
(izovolemia), misi osmosuri autoimunur daavadebebTan.
koncentraciis mudmivobis (izotonia), Tirkmeli dabali rezistentobisaa
ionuri Semadgenlobis mudmivobis paTologiuri mikrooragnizmebis mimarT,
(izoionia), wyalbadionTa koncentraciis xolo Sardi kargi niadagia zogierTi
mudmivobis (izohidria) SenarCunebaSi. mikroorganizmis ganviTarebisTvis. amitom
homeostazis regulaciaSi Zalze mniSvne- araiSviaTia TirkmelSi hematogenuri an
lovan rols TamaSobs agreTve Tirkmlis aRmavali infeqciebi. es daavadebebi
unari gamoyos organizmidan azotovani TiTqmis garduvalad vi-Tardeba zemo
cvlis produqtebi da kenWis warmomqmneli saSarde gzebis Seviwroebisas (magaliTad,
nivTierebebi, organizmisTvis ucxo naerTebi SardsawveTis daxSoba), rasac Tan sdevs
da a.S. Sesabamisad, Tirkmlis funqciis Sardis Segubeba SardsawveTSi an Tir-
darRveva iwvevs homeostazis me-qanizmebis kmlis menjSi (hidronefrozi). imis gamo,
moSlas, organizmSi, kerZod - sisxlSi rom Tirkmeli moTavsebulia naklebad
narCeni azotis dagrovebas, uremias da sxv. Wimvad fibrozul kafsulaSi,
232
hidronefrozis, iseve, rogorc Tirkmlis feqciuri dazianebebi (pielonefriti, ke-
anTebiTi SeSupebis dros, TirkmelSiga wneva rovani nefriti), 5) Sardis gamotanis
mkveTrad matulobs, ris gamo mcirdeba darRvevebi (kenWebis gaCena, SardsawveTis
Sardis gamoyofa da viTardeba Tirkmlis daxSoba), 6) Tirkmlis toqsikuri dazi-
ukmarisoba. anebebi (sefsisi, damwvroba, mZime metale-
uremia - sisxlSi Sardis Semadgeneli biT mowamvla), 7) Tirkmlis Tandayolili
nawilebis arseboba Tirkmlebis ukmarisobis paTologia (poliskistozi), 8) milakebis
terminaluri stadiis klinikuri sindromia. fermentebis memkvidruli defeqtebi (fan-
mas axasiaTebs sisxlSi azotovani cvlis konis sindromi da sxv.).
sa-boloo produqtebis momateba, wylis da
eleqtrolitebis balansis, sisxlis 20.1. diurezis darRvevebi
osmosuri wnevis, mJavur-tutovani dRe-RameSi adamianis Tirkmeli gamo-
wonaswrobis mkveTri darRvevebi. yofs 1-2 l (saSualod 1,5 l.) Sards.
uremiis dros mkveTrad irRveva Sardis raodenobis Semcirebas oliguria,
centra-luri nervuli sistemis funqcia - momatebas - poliuria, xolo srul
vlindeba Zlieri Tavis tkivili, apaTia, gamouyoflobas - anuria ewodeba; xSiri
Zilianoba pe-rioduli agznebiT da Sardva polakiuriis, xolo Sardis RamiT
krunCxvebiT, qoSini, gonebis dakargva didi raodenobiT gamoyofa - niqturiis
(uremiuli koma). mkveTrad qveiTdeba saxelwldebiTaa cnobili.
sunTqvis centris agznebadoba, rac iwvevs
Cein-stoqsis tipis periodul sunTqvas. 20.1.1.Sardis gamoyofis regulaciis
acidozis gamo SeiZleba ganviTardes kusmau- darRvevebi
lis didi xmauriani sunTqva. sisxlSi kali- nefronebis gorglebis funqciis darRveva
umis raodenobis Semcirebam SeiZleba gulis gorglebis membranebis ganvladobis
SekumSvebis Sewyveta gamoiwvios. momateba. normis pirobebSi gorglebSi ga-
hipokalciemia astimulirebs filtruli cila TiTqmis mTlianad reab-
paraTireoiduli jirkvlebis funqcias, ris sorbirdeba klaknil milakebSi. amitom
gamo irRveva kalciumis da fosforis cvla, Cveulebrivi laboratoriuli meTodebis
viTardeba osteoporozi da osteomalacia. gamoyenebisas is SardSi ar vlindeba.
Tirkmlis funqciis gamovardnisas gorglebis membranebis ganvladobis
azotovani produqtebi gamoiyofa kanis moma-tebis umTavresi niSania proteinuria
gziT, rac metad Semawuxebel da mdgrad - SardiT cilis Cveulebrivze (30-80 mg
qavils iwvevs. dRe-RameSi) meti raodenobiT gamoyofa an
Tirkmlis funqciis darRvevis SardSi maRali molekuluri wonis
mizezebi mravalgvaria. maT miekuTvneba: 1) (70000-ze meti) cilebis arseboba.
Tirkmlis funqciis nervuli da humoru-li gorglebis filtris ganvladobis
regulaciis moSla, 2) Tirkmlis sis- mateba dakavSirebulia membranis forebis
xlmomaragebis darRveva (Soki, aTeros- diametris zrdasTan da difuziis
klerozi, hipertonuli daavadeba), 3) gamaiolebel fizikur-qimiur
autoalergiuli daavadebebi (difuzuri cvlilebebTan membranaSi. am meqanizmiT
glomerulonefriti), 4) Tirkmlis in- viTardeba gorglovani proteinuria,
233
romelic SeiZleba iyos funqciuri an Sardis paTologiuri Semadgeneli
organuli warmo-Sobisa. nawilebi Tirkmlebis daavadebis dros
funqciuri proteinuria droebiTia da Sardis paTologiuri Semadgeneli
vi-Tardeba TirkmelSi sisxlis mimoqcevis nawilebia is elementebi, romlebic ar
cvli-lebebis dros, kateqolaminebis aris janmrTeli adamianis SardSi da niv-
gavleniT, bav-SvebSi fexze didxans dgomis Tierebebi, romlebic SardiT normalurze
dros (orTostatikuri proteinuria), mZime meti raodenobiT gamoiyofa.
fizikuri muSaobisas, Cvili bavSvebis mier Sardis Semadgenlobis cvlileba Se-
wylis didi raodenobiT dakargvisas, didi iZleba ar iyos dakavSirebuli Tirkmlis
raodenobiT cilis miRebisas. funqciuri daavadebasTan. magaliTad, bilirubinis
proteinuriis dros cila, Cveulebriv, arseboba SardSi siyviTlis dros, aceto-
mcire raodenobiT ikargeba. nisa da glukozisa - Saqriani diabetis
organuli proteinuria, romelic dros.
mwvave da qronikuli Tirkmlebis dazianebisTvis damaxasi-
glomerulonefritebis, nefro-zuli aTebelia Semdegi niSnebi:
sindromis, TirkmelSi sisxlis mimoqce-vis 1. proteinuria - SardSi cilis ar-
darRvevebis dros viTardeba, myari xasi- seboba, romelic viTardeba Tirkmlis
aTisaa. membranis SedarebiT msubuqi dazia- gorglebis an milakebis dazianebisas.
nebisas izrdeba albuminebis filtracia, pirvel SemTxvevaSi gazrdilia gorglebis
cila ver aswrebs ukuSewovas da viTardeba ganvladoba cilis mimarT, xolo meore
albu-minuria. ufro mZime dazianebisas SemTxvevaSi irRveva cilis reabsorbcia
cilis kargva xSirad metad intensiuria, milakebSi (ix. zemoT).
SardSi maRali mo-lekuluri wonis 2. glukozuria - glukozis arseboba
plazmuri cilebi Cndeba. SardSi umetesad eqstrarenuli warmoSo-
gorglebis eqskreciuli funqciis bisaa(magaliTad, Saqriani diabetis dros).
darRvevisas sisxlSi grovdeba azotovani magram glukozuria SeiZleba ganviTardes
cvlis produqtebi (narCeni azoti): TviT Tirkmlebis daavadebis drosac, ma-
Sardovana, Sard-mJava, kreatinini, indikani Sin, rodesac blokirebulia fermentebi
da sxv. Eqskre-toruli funqciis darRvevis heqsokinaza da glukozo-6-fosfataza. es
dros brkol-deba fosfatebis, fermentebi aucilebelia glukozis reab-
sulfatebis, organuli mJavebis gamoyofa, sorbciisaTvis pirveladi Sardidan.
rac acidozs iwvevs (metaboluri 3. hematuria - SardSi eriTro-
azotemiuri acidozi). azotemiuri citebis arseboba viTardeba gorglebis
acidozisas moiSleba natri-um-kaliumis membranebis uxeSi dazianebis dros
tumbos funqcia, rac iwvevs hiponatriemias, (magaliTad, mwvave
hiperkaliemias da hipo-qloremias, izrdeba glomerulonefritisas). eriTrocitebi
ujredSiga natriumis raodenoba. ionTa SardSi SeiZleba moxvdnen dazianebuli
cvlis aRniSnul darRvevebs Tan sdevs SardsawveTidan an Sardis buStidanac.
wylis dagroveba ujredSoris sivrceebSi 4. leikocituria - mxedvelobis
da SeSupebis ganviTareba. areSi 1-3-ze meti leikocitis arseboba
SardSi axa-siaTebs Tirkmlis anTebiT
234
procesebs (pielonefriti) da saSarde meqanizmebis moSla (hormonebis
gzebis anTebas. Cirqis Semcveli, mRvrie transportis, metabolizmis da moqmede-
Sardis gamoyofas piuria ewodeba. bis realizebis cvlilebebi).
5. cilindruria sisxlSi sxvadasxva 21.1.1. Sinagani sekreciis jirkvlebis
Semadgenlobis cilindrebis arsebobaa. funqciis centraluri regulacia
epiTe-luri da marcvlovani cilindrebi Aam mxriv umTavres rols TamaSobs
Sedgebian milakebis gadagvarebuli hipoTalamusi, romlis funqcia mWidrodaa
epiTeluri ujrede-bisgan, hialinuri dakavSirebuli retikulur formaciasTan,
cilindrebi warmoiqmnebian anTebis an centraluri nervuli sistemis zemoT
distrofiuli cvlilebebis dros cilis mdebare nawi-lebTan da hipofizTan.
Sededebis gamo milakebis sanaTurSi. endokrinuli funqciebis hipoTalamuri
6. marilebi uratebis, oqsalatebis, regulaciis moSlis uxSiresi mizezebia
fos-fatebis saxiT SardSi didi raodenobiT infeqciuri da anTebiTi procesebi
Cndeba Tirkmlis kenWovani daavadebis dros. hipoTalamusSi, sisx-lZarRvovani da
travmuli dazianebebi.
21. endokrinuli sistemis hipofizis hormonebis sekreciis ma-
paTofiziologia regulirebeli mTavari centrebi hipoTa-
Sinagani sekreciis sistema umTavres lamusSia ganlagebuli. hipoTalamusSi aR-
rols TamaSobs organizmis ZiriTadi fizi- moCenilia neirosekreciuli ujredebi,
ologiuri funqciebis regulaciaSi, adapta- romlebic gamoyofen hipofizis ama Tu im
ciur reaqciebSi, homeostazis SenarCune- hormonis sekreciaze moqmed peptidur, e.w.
baSi, organizmis zrda-ganviTarebaSi, gamrav- rilizing-faqtorebs. zogi maTgani as-
lebaSi, fsiqikur procesebSi, sistemebisa timulirebs Sesabamisi Sinagani sekreciis
da organoebis funqciobaSi. yovelive es jirkvlis funqcias (liberinebi), xolo
xorcieldeba Sinagani sekreciis jirkvlebis sxvebi - amuxruWeben mas (statinebi).
hormonebis meSveobiT. pirvels miekuTvneba kortikoliberi-
ni, Tireoliberini, somatoliberini, gona-
21.1. endokrinuli darRvevebis
doliberini, prolaqtoliberini, melano-
etiologia da paTogenezi
liberini. hormonebis sekreciis dammux-
endokrinuli darRvevebis mizezebidan
ruWebeli nivTierebebia prolaqtostatini,
umTavresia: Sinagani sekreciis jirkvlebis
somastostatini, melanostatini da sxv.
anTeba, simsivne an nekrozi, adgilobrivi
isini nervuli aqsonebis da kapilaruli
sisxlis mimoqcevis darRveva jirkvlebSi,
sistemis, Semdeg ki hipofizis fexiT
infeqcia, intoqsikacia, autoalergia, fsiqi-
aRweven adenohipofizs.
kuri travma, arasrulfasovani kveba, maio-
hipoTalamusSi ama Tu im rilizing-
nebeli radiacia, genetikuri anomaliebi.
faqtoris warmoqmnis darRveva iwvevs hi-
rac Seexeba endokrinuli moSlilobe-bis
pofizis mier Sesabamisi tropuli hor-
paTogenezur gzebs, maTgan wamyvania: 1. jir-
monis sekreciis cvlilebebs.
kvlebis funqciis centraluri regulaciis
hipofizuri gza yvela Sinagani jirk-
darRveva, 2. TviT jirkvalSi mimdinare
vlis funqciis regulaciaSi ar monawile-
paTologiuri procesebi, 3. hormonebis
obs. MmagaliTad, paraTireoiduli jirkv-
aqtivobis periferiuli (jirkvalgareSe)
235
lebi, pankreasis langerpansis kunZulebi, gamoiwvios sisxlCaqceva Tirkmelzeda
Tirkmelzeda jirkvlis tvinovani nivTie- jirkvalSi misi mwvave ukmarisobis gan-
reba. maTi funqciis centraluri regulacia viTarebiT.
xorcieldeba parahipofizuri gziT, gamtari simsivne SeiZleba ganviTardes nebis-
nervebis saSualebiT. mier jirkvalSi. daavadebis gamovlineba
endokrinuli jirkvlebis funqciis dakavSirebulia gamoyofili hormonebis
darRvevis meqanizmis miuxedavad paTologiis raodenobasa da SemadgenlobasTan. ufro
dros yovelTvis icvleba maTi funqciis xSirad, simsivnuri ujredebi TviT gamoi-
regulaciis metad mniSvnelovani gza – uar- muSaveben Sesabamis hormons, ris gamo
yofiTi ukukavSirebi: saregulacio para- viTardeba jirkvlis hiperfunqcia. im
metri (hormonis sekrecia) amuxruWebs SemTxvevaSi, Tu simsivnuri ujredebi ar
jirkvlis funqcias. gamoyofen hormons da, amave dros, iwveven
saregulacio parametris bunebis mi- jirkvlis qsovilebze zewolas da mis
xedviT uaryofiTi ukukavSiri orgvaria: atrofias, viTardeba jirkvlis hipofun-
pirveli tipis dros saregulacio para- qcia.
metria hormonis koncentracia sisxlSi, endokrinuli jirkvlebis funqciis
meore tipis dros - raime metaboliti, darRveva SeiZleba gamoiwvios autoaler-
cvlis maCvenebeli. pirvel SemTxvevaSi sis- giam - antisxeulebis gamomuSavebam jir-
xlSi hormonis koncentraciis momateba kvlis qsovilis antigenebis an sisxlSi
amuxruWebs hipoTalamusis Sesabamisi roli- cirkulirebadi hormonis mimarT.
zing-faqtoris, aqedan gamomdinare ki tro- jirkvlis hipofunqcia viTardeba
puli hormonis da jirkvlis mier inkretis jirkvlis parenqimis masis Semcirebis
gamoyofas. hormonis sekreciis daqveiTe- (atrofia, nekrozi), fermentuli sisteme-
bisas sapirispiro suraTi vlindeba. bis da kofaqtorebis ukmarisobis dros.
meore tipis uaryofiTi ukukavSiri jirkvlis hiperfunqcias iwvevs misi masis
xorcieldeba analogiurad. sxvaoba, ro- gadideba. nervuli da humoruli regula-
gorc iTqva, saregulacio parametrSia. Mma- ciis mimarT Sinagani sekreciis jir-
galiTad SeiZleba moviyvanoT glukozis kvlebis mgrZnobelobis daqveiTebisas
koncentracia sisxlSi - insulinis Warbi mcirdeba maTi aqtivoba.
raodenoba iwvevs sisxlSi Saqris raode- im jirkvlebis funqcia, romlebic ar
nobis Semcirebas, rac insulinis gamoyofis eqvemdebareba hipofizis tropuli hormo-
stimulatoria. nebis gavlenas, mTlianad damokidebulia
sisxlSi im nivTierebebis raodenobaze,
21.1.2. paTologiuri procesebi romelTa Semcveloba regulirdeba jirk-
jirkvlebSi vlebis hormonebiT.
endokrinuli funqciis darRveva 21.1.3. hormonebis aqtivobis darRvevis
vlindeba izolirebulad an sxvadasxva periferiuli (jirkvalgareSe)
kombinaciebis saxiT. sakmaod xSirad Sina- meqanizmebi
gani sekreciis jirkvlebis dazianeba ga- gamoyofili da sisxlSi gadasuli
mowveulia infeqciuri daavadebebiT. Mmaga- hormonebis aqtivoba damokidebulia peri-
liTad, meningokurma infeqciam SeiZleba feriul meqanizmebze, romlebsac ZaluZT
236
gazardon an Seamciron is. aseT SemTxvevaSi lis da sxva organoebis fermentebis mier
saqme gvaqvs ara TviT endokrinuli am hormonebis daSla da inaqtivacia.
jirkvlis funqciis cvlilebebTan, aramed
misi hormonis transportis, metabolizmis 21.2.. hipofizis paTofiziologia
an biologiuri moqmedebis realizebis dar- 21.2.1. hipofizis wina nawilis
ukmarisoba
RvevebTan.
hipofizis sruli ukmarisoba - panhi-
endokrinul darRvevebs iwvevs hor-
popituitarizmi viTardeba simsivnis, qalas
monebis satransporto an SemkavSirebeli
travmebis, hipofizis anTebis,
cilebis deficiti. magaliTad, Tiroqsin-
sisxlCaqcevis, sisxlZarRvebis, Trom-
SemakavSirebeli cilis deficitis dros
bozis, virusuli infeqciis Sedegad.
viTardeba hiperTireozi.
jirkvlis dazianeba embrionul da