KORONAR MIKROTOMIRLI DISFUNKSIYA: EPIDEMIOLOGIYASI, PATOFIZIOLOGIYASI, DIAGNOSTIKASI (INVAZIV VA NOINVAZIV USULLAR), BIOMARKERLARI VA DAVOLASH STRATEGIYALARI (ADABIYOTLAR SHARHI)
Kalit so‘zlar:
koronar mikrotomirli disfunksiya, INOCA, ANOCA, koronar oqim zaxirasi, mikrotsirkulyator qarshilik indeksiAbstrak
Koronar mikrotomirli disfunksiyaning (KMD) epidemiologiyasi, patofiziologik asoslari, zamonaviy invaziv va noinvaziv diagnostika usullari, diagnostik va prognostik ahamiyatga ega biomarkerlari hamda davolash strategiyalarini adabiyotlar asosida keng qamrovli tahlil qilish. Material va usullar. PubMed, Scopus, Google Scholar, Cochrane Library va Web of Science maʼlumotlar bazalarida 2000-2026 yillarda chop etilgan tizimli sharhlar, meta-tahlillar, randomizatsiyalangan klinik tadqiqotlar (CorMicA, ACOVA, WARRIOR, ENCORE II va boshqalar) va rasmiy xalqaro yoʻriqnomalar tahlil qilindi. Natijalar. Angiografik jihatdan obstruktiv boʻlmagan koronar arteriyalarga ega bemorlarning (ANOCA/INOCA) yarmigacha qismida KMD aniqlanadi, bu holat ayollarda ancha koʻp uchraydi va yurak-qon tomir asoratlari xavfini ikki barobardan ortiq oshiradi. KMD ni tasdiqlashning invaziv “oltin standarti” koronar funktsional angiografiya boʻlib, uning davomida koronar oqim zaxirasi (KOZ), mikrotsirkulyator qarshilik indeksi (IMR) oʻlchanadi hamda atsetilxolin sinamasi endoteliyga bogʻliq disfunksiya va vazospazmni aniqlaydi. Noninvaziv usullar orasida pozitron-emission tomografiya (PET) eng yuqori aniqlikka ega. Soʻnggi tadqiqotlar shuningdek NT-proBNP, yuqori sezuvchanlikdagi C-reaktiv oqsil (hs-CRP), interleykin-6 (IL-6) va Endotelin-1 kabi biomarkerlarning KMD bilan patogenetik va prognostik jihatdan bogʻliqligini tasdiqlamoqda, ular endoteliy disfunksiyasi, tizimli yalligʻlanish va mikrovaskulyar remodellanish jarayonlarini aks ettiradi. Davolashda statinlar va angiotenzin-konvertlovchi ferment ingibitorlari birinchi qatorda tavsiya etilsa, ranolazin, kalsiy kanali blokatorlari va yangi endotelin retseptor antagonistlari qoʻshimcha yoki endotipga yoʻnaltirilgan terapiya sifatida oʻrganilmoqda
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Havolalar
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