BOLALARDA BRONX-O’PKA KASALLIKLARIDA MIKROSIRKULYATSION O’ZGARISHLARNING KLINIK-PATOGENETIK XUSUSIYATLARI
Abstrakt
Mavzuning dolzarbligi. Bolalarda bronxit, pnevmoniya va bronxiolit kabi yallig‘lanishli bronx-o‘pka kasalliklari pediatriyada eng dolzarb muammolardan biri bo‘lib, ularning patogenezida mikrosirkulyatsion disfunktsiya markaziy o‘rin egallaydi. Mikrosirkulyatsiya tizimining buzilishi nafaqat alveolyar gaz almashinuvini, balki to‘qimalarning trofik ta’minotini ham izdan chiqaradi. Zamonaviy adabiyotlarda ushbu disfunktsiyaning yallig‘lanish mediatorlari, xususan interleykin-1β (IL-1β), interleykin-6 (IL-6), tumor nekroz omili-α (TNF-α), interleykin-8 (IL-8) hamda anti-inflamator sitokinlar (IL-10) darajasidagi nomutanosiblik bilan chambarchas bog‘liqligi ta’kidlanadi. Ushbu mediatorlar endotelial hujayralar faoliyatini buzib, kapillyar devor o‘tkazuvchanligini oshiradi, glyukokaliks strukturasining degradatsiyasiga olib keladi va natijada mikrosirkulyatsion perfuziya izdan chiqadi. Maqsad. Bolalarda bronx-o‘pka yallig‘lanishli kasalliklari kechishida mikrosirkulyatsion disfunktsiyaning asosiy patofiziologik mexanizmlarini aniqlash, yallig‘lanish sitokinlari (IL-1β, IL-6, TNF-α, IL-8, IL-10) darajasi bilan mikrotsirkulyator ko‘rsatkichlar o‘rtasidagi o‘zaro bog‘liqlikni baholash hamda ularning klinik ahamiyatini prognoz biomarkerlari sifatida asoslashdan iborat. Materiallar va usullar. Tadqiqot davomida bemor bolalarda mikrosirkulyatsiya holatini baholash uchun kompleks instrumental va laborator diagnostik usullar qo‘llanildi. Kapillyaroskopiya yordamida tirnoq yostiqchasidagi kapillyarlarning morfofunksional holati o‘rganildi; pulse oksimetriya orqali arterial oksigenatsiya darajasi aniqlanib, qon laktat konsentratsiyasi metabolik gipoksiya darajasini baholash uchun ishlatildi. Shuningdek, gemostaziogramma va mikroperfuziya indekslari hisoblandi. Yallig‘lanish mediatorlari darajasi ELISA usuli bilan aniqlanib, statistik jihatdan o‘zaro korrelyatsiya tahlili o‘tkazildi. Natijalar va muhokama. O‘tkazilgan tahlillar natijasida, bronx-o‘pka kasalliklari kechayotgan bolalarda yallig‘lanish sitokinlari darajasining keskin oshishi endotelial disfunktsiyani rivojlanishiga olib kelishi aniqlandi. Kapillyar devor o‘tkazuvchanligining ortishi, glyukokaliksning parchalanishi va interstitsial shish jarayonlari mikrosirkulyatsion oqimning pasayishiga sabab bo‘ldi. Bu esa qon reologiyasining buzilishi, eritrotsit deformabilligining kamayishi va mikrotrombozlar shakllanishi bilan kechdi. Shuningdek, IL-6 va TNF-α darajalari bilan laktat konsentratsiyasi hamda kapillyar perfuziya ko‘rsatkichlari o‘rtasida ishonchli ijobiy korrelyatsiya (r = 0,68–0,74; p < 0,01) qayd etildi. Ushbu bog‘liqlik og‘ir pnevmoniya va bronxiolit kechishini prognozlashda muhim diagnostik ahamiyatga ega biomarker sifatida baholandi. Ayniqsa, erta yoshdagi bolalarda adaptatsion va kompensator mexanizmlarning morfofunksional jihatdan yetarlicha shakllanmaganligi sababli mikrosirkulyatsion buzilishlar tezda gipoksik-dekompensatsion bosqichga o‘tadi. Xulosa. Olingan natijalar shuni ko‘rsatadiki, mikrosirkulyatsion disfunktsiya bolalarda yallig‘lanishli bronx-o‘pka kasalliklarining asosiy patogenetik halqalaridan biridir. Ushbu disfunktsiyani erta bosqichda aniqlash va kompleks tuzatish choralarini qo‘llash kasallik og‘irligini kamaytiradi, gipoksik asoratlarning rivojlanishining oldini oladi hamda klinik prognozni yaxshilaydi. Kelgusida mikrosirkulyatsiya markerlari, yallig‘lanish sitokinlari va oksidlovchi stress ko‘rsatkichlarini integratsiyalashgan monitoring tizimida o‘rganish diagnostik va terapevtik strategiyalarni optimallashtirish imkonini beradi.
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