filtvebis qronikuli filtvebis qronikuli obstruqciuli obstruqciuli

daavadeba da daavadeba da metaboluri sindromimetaboluri sindromi

lela torCinava, tfdec, lela torCinava, tfdec, “samSabaToba”, 23.02.10“samSabaToba”, 23.02.10

respiraciuli sistemis qronikuli anTebiTi respiraciuli sistemis qronikuli anTebiTi

daavadebaa; upiratesad sasunTqi gzebis distaluri daavadebaa; upiratesad sasunTqi gzebis distaluri

nawilebis da filtvebis parenqimis dazianebiT da nawilebis da filtvebis parenqimis dazianebiT da

emfizemis ganvi-TarebiT. emfizemis ganvi-TarebiT.

f.q.o.d. vlindeba nawilobriv Seqcevadi f.q.o.d. vlindeba nawilobriv Seqcevadi

bronquli obstruqciiT, xasiaTdeba progre-sirebiT bronquli obstruqciiT, xasiaTdeba progre-sirebiT

da mzardi qronikuli sunTqvis ukmarisobis da mzardi qronikuli sunTqvis ukmarisobis

movlenebiTmovlenebiT..

filtvebis qronikuli obstruqciuli filtvebis qronikuli obstruqciuli daavadebadaavadeba

Sinagani faqtorebiSinagani faqtorebi::•• bronqebis hiperreaqtiulobabronqebis hiperreaqtiuloba•• filtvebis ganviTarebis anomaliafiltvebis ganviTarebis anomalia•• genetikuri faqtorigenetikuri faqtori

garegani faqtorebigaregani faqtorebi::•• Tambaqos mowevaTambaqos moweva•• sawarmoo mtveri da qimikatebisawarmoo mtveri da qimikatebi•• haeris dabinZurebahaeris dabinZureba•• infeqciebiinfeqciebi

f.qf.q..o.d. o.d. rriskisk--faqtorebifaqtorebi

•• daavadebis progresirebis sakvanZo elementidaavadebis progresirebis sakvanZo elementi

•• anTeba moicavs bronquli kedlis yvela Sres da interstianTeba moicavs bronquli kedlis yvela Sres da intersti--ciul ciul

qsovilsqsovils

•• anTebas mivyavarT filtvebis emfizemis da sasunTqi gzebis anTebas mivyavarT filtvebis emfizemis da sasunTqi gzebis

remodelirebiskenremodelirebisken

•• neitrofilebi warmoadgenen anTebis ZiriTad ujredefeqneitrofilebi warmoadgenen anTebis ZiriTad ujredefeq--torebs.torebs.

qronikuli anTeba f.q.o.d. drosqronikuli anTeba f.q.o.d. dros

f.qo.d. diagnostikis ZiriTadi f.qo.d. diagnostikis ZiriTadi

debulebebidebulebebi • risk-faqtorebis zemoqmedeba

• asaki>35w

• respiratoruli simptomebis gviani gaCena da neli ucvleli zrda (xvela, qoSini, naxvelis gamoyofa)

• f.a.m1 da f.a.m./f.f.s.t. daqveiTeba

• mateba f.a.m.1<15% bronqodilataciuri sinjis Semdeg.

• adreuli diagnostika(1 stadia) SesaZlebelia, mxolod daavadebulTa aqtiuri gamovlenisas, riskis jgufis kotigentSi.

arsebobs garkveuli cnobebi, rom filtvebis qr. obstruqciuli arsebobs garkveuli cnobebi, rom filtvebis qr. obstruqciuli

daavadeba daavadeba ((Cronic Obstractive Pulmonary Disanse - COPDCronic Obstractive Pulmonary Disanse - COPD) ) da metabolur da metabolur

sindromi erTmaneTTan garkveul urTierTkavSirSia, Tumca amis sindromi erTmaneTTan garkveul urTierTkavSirSia, Tumca amis

Taobaze myari mtkicebulebebi aqamde ar arsebobda.Taobaze myari mtkicebulebebi aqamde ar arsebobda.

birmingenis universitetisbirmingenis universitetis (didi britaneTi), guenjous saxalxo (didi britaneTi), guenjous saxalxo

saavadmyofossaavadmyofos (CineTi) da hong-kongis universitetis (CineTi) da hong-kongis universitetis

TanamSromlobiT Catarda kohortuli kvleva am urTierTTanamSromlobiT Catarda kohortuli kvleva am urTierT--kavSiris kavSiris

dasadgenad.dasadgenad. ((European Respiratory Journal European Respiratory Journal gamoqveynebulia evropis gamoqveynebulia evropis

respiraciul JurnalSi 2010; 35; 307-323)respiraciul JurnalSi 2010; 35; 307-323)

meTodebimeTodebi

kvlevam moicva guanjous moxucTa TavSesafris kvlevam moicva guanjous moxucTa TavSesafris

50 wlis pirebi, isini SeirCnen randomizaciis wesiT drois 50 wlis pirebi, isini SeirCnen randomizaciis wesiT drois

or monakveTSi(2003-2004, 2005-2006ww) sul20,431 or monakveTSi(2003-2004, 2005-2006ww) sul20,431

piri. iyvnen qmediTunarianni da ar utardebodaT piri. iyvnen qmediTunarianni da ar utardebodaT

mkurnaloba raime sicocxlisaTvis saSiSi daavdebis mkurnaloba raime sicocxlisaTvis saSiSi daavdebis

gamo. yvela monawilisagan miRebuli iqna werilobiTi gamo. yvela monawilisagan miRebuli iqna werilobiTi

Tanxmoba. TiToeul pirs Cautarda fizikaluri gasinjva da Tanxmoba. TiToeul pirs Cautarda fizikaluri gasinjva da

detalurad Seivso samedicino kiTxvari.detalurad Seivso samedicino kiTxvari.

aucilebeli gamokvlevebi:aucilebeli gamokvlevebi:1.1. arteriuli wnevis gazomva(cifruli)arteriuli wnevis gazomva(cifruli)

2.2. wilis garSemowerilobawilis garSemoweriloba

3.3. glikemiis(uzmod), trigliciridebis da maRali simk-vrivis glikemiis(uzmod), trigliciridebis da maRali simk-vrivis

lipoproteinebis(lipoproteinebis(HDLHDL)–qolesterolis gansazRvra)–qolesterolis gansazRvra

4.4. sxeulis masis indexi (sxeulis masis indexi (BMIBMI))

5.5. Tambaqos moxmarebis istoria (arasdros, yofili, Tambaqos moxmarebis istoria (arasdros, yofili,

amJamindeli)amJamindeli)

6.6. fizikuri aqtivobis donis gansazRvra (umoqmedo, fizikuri aqtivobis donis gansazRvra (umoqmedo,

minimaluri aqtivobis, aqtiuri)minimaluri aqtivobis, aqtiuri)

7.7. filtvebis funqc. statusis dasadgenad: spirometria-sam-filtvebis funqc. statusis dasadgenad: spirometria-sam-

sami cda bronqodilatatoris gamoyenebis gareSe. sami cda bronqodilatatoris gamoyenebis gareSe.

dafiqsirda saukeTeso maCveneblebi: dafiqsirda saukeTeso maCveneblebi: FEVFEV11, FVC, FEV, FVC, FEV11/FVC/FVC

sasunTqi gzebis obstruqcia sasunTqi gzebis obstruqcia ganisazRvra:ganisazRvra:

FEVFEV11/FVC<LLN /FVC<LLN ((normis qveda zRvari normis qveda zRvari Lower Lower Limit of NormalLimit of Normal))

• msubuqi xarisxis obstruqcia msubuqi xarisxis obstruqcia FEVFEV11 >80% >80%

• saSualosaSualo -FEV -FEV11 - 50% - 50%÷÷80%80%

• mZimemZime -FEV -FEV11 < 50% < 50%

miuxedavad imisa, rom arsebobs miuxedavad imisa, rom arsebobs

garkveuli cnobebi kavSirze metabo-lur garkveuli cnobebi kavSirze metabo-lur

sindromsa da restriqcias Soris, sindromsa da restriqcias Soris,

restriqciuli paTologiis dafiqsi-rebisas, restriqciuli paTologiis dafiqsi-rebisas,

SemTxveva amovarda kvlevidan.SemTxveva amovarda kvlevidan.

metaboluri sindromi:metaboluri sindromi:diabetis saerTaSoriso federaciis (diabetis saerTaSoriso federaciis (IDFIDF) gansazRvrebiT ) gansazRvrebiT

dgindeba Tu saxezea centraluri (abdominaluri) simsuqne dgindeba Tu saxezea centraluri (abdominaluri) simsuqne (welis garSemoweiloba mamakacebSi >90sm-ze qalebSi (welis garSemoweiloba mamakacebSi >90sm-ze qalebSi >80sm) da sul mcire ori kriteriumi Semdegidan>80sm) da sul mcire ori kriteriumi Semdegidan::

1. maRali arteriuli wneva(>135/85 mmhg)

2. glukozisadmi tolerantobis darRveva (glikemia uzmod>5,6mm/l) 110mg/dl

3. trigliceridebi sisxlSi (>150mg/dl) 1,7mm/l

4. hdl-qolesterolis dabali done (<40mg/dl 1,03mm/l) mamakacebSi da(<50mg/dl 1,29mm/l) qalebSi

statistikuri analizi:statistikuri analizi:

gamoyenebuli iyo gamoyenebuli iyo ANCOVAANCOVA-metaboluri markerebis -metaboluri markerebis SefasebisTvisSefasebisTvis

glukozis trigliceridebis donis maCveneblebi damuSavda glukozis trigliceridebis donis maCveneblebi damuSavda algoriTmuladalgoriTmulad

metabolur sindromsa da sasunTqi gzebis obstruqcias Soris metabolur sindromsa da sasunTqi gzebis obstruqcias Soris kavSiris dasadgenad gamoyenebuli iyo lojistikuri regresiis kavSiris dasadgenad gamoyenebuli iyo lojistikuri regresiis modelebimodelebi

yvela analizi warmodgenili iyo yvela analizi warmodgenili iyo stata stata versiiT (versiiT (statacorp.statacorp. college college station,TX, USa) station,TX, USa)

Sedegebi :Sedegebi :

20431 monawilidan sarwmuno infor-20431 monawilidan sarwmuno infor-macia miRebul iqna 8701 piridan aqedan macia miRebul iqna 8701 piridan aqedan 1343(15%) gamoiricxa, vinaidan maT 1343(15%) gamoiricxa, vinaidan maT hqondaT dadgenili asTma an bronqoeqtazia, hqondaT dadgenili asTma an bronqoeqtazia, anda gamovlenili iqna restriqciuli paTolo-gia anda gamovlenili iqna restriqciuli paTolo-gia spirometriiT.spirometriiT. amis Sedegad darCa 7358 monawile, amis Sedegad darCa 7358 monawile, 2008 mamakaci (27,3%) da 5350 2008 mamakaci (27,3%) da 5350 qali(72,7%) saSualo asaki (61,6 qali(72,7%) saSualo asaki (61,6 6,7weli)6,7weli)

ver inaxa kavSiri:ver inaxa kavSiri:

sasunTqi gzebis obstruqciasa sqess Soris (6,4%-sasunTqi gzebis obstruqciasa sqess Soris (6,4%-mamakacebi, 6,9% -qalebi)mamakacebi, 6,9% -qalebi) sxeulis masis indeqss(sxeulis masis indeqss(BMIBMI)-s Soris)-s Soris art.wnevas, art.wnevas, HDLHDL-qolesterolis da glukozis dones -qolesterolis da glukozis dones Soris. Soris.

metaboluri sindromis 5 komponentidan sasunTqi metaboluri sindromis 5 komponentidan sasunTqi

gzebis obstruqciasTan dakavSirebuli iyo mxolod 1-gzebis obstruqciasTan dakavSirebuli iyo mxolod 1-

centraluri (abdominaluri) simsuqne. (centraluri (abdominaluri) simsuqne. (CICI-1,09-1,88)-1,09-1,88)

Tambaqos moxmareba:Tambaqos moxmareba:

kvlevisas inaxa erTnairi kavSiri metabolur kvlevisas inaxa erTnairi kavSiri metabolur

sindromsa sasunTqi gzebis obstruqcias Soris rogorc sindromsa sasunTqi gzebis obstruqcias Soris rogorc

mwevel ise aramwevel pirebSi, Tumca kiTxvaridan mwevel ise aramwevel pirebSi, Tumca kiTxvaridan

gairkva, rom aramweveli pirebi iyvnen an pasiuri gairkva, rom aramweveli pirebi iyvnen an pasiuri

mwevelebi an iyvnen mtvriT dabinZurebul garemoSi mwevelebi an iyvnen mtvriT dabinZurebul garemoSi

momuSavenimomuSaveni

inaxa wrfivi kavSiri metaboluri inaxa wrfivi kavSiri metaboluri sindromis zrdasa da sindromis zrdasa da FEVFEV11 procentis procentis daqveiTebas Soris (sandoobis daqveiTebas Soris (sandoobis intervali intervali CICI 1,39-3,95). 1,39-3,95).

7358 piridan 6,7%-s daudginda 7358 piridan 6,7%-s daudginda sasunTqi gzebis obstruqcia, 20%-s sasunTqi gzebis obstruqcia, 20%-s daudginda metaboluri sindromi.daudginda metaboluri sindromi.

daskvna:daskvna:

CineTSi Catarebuli kvleva cxadyofs kavSirs CineTSi Catarebuli kvleva cxadyofs kavSirs

sasunTqi gzebis obstruqciasa da metabolur sasunTqi gzebis obstruqciasa da metabolur

sindroms, kerZod, centralur (abdominalur) sindroms, kerZod, centralur (abdominalur)

simsuqnes Soris.simsuqnes Soris.

miRebuli Sedegi dagvexmareba imis axsnaSi Tu miRebuli Sedegi dagvexmareba imis axsnaSi Tu

ratom aqvT ratom aqvT COPDCOPD–iT daavadebul pacientebs –iT daavadebul pacientebs

kardiovaskularuli daavadebebis maRali riski, rac kardiovaskularuli daavadebebis maRali riski, rac

TavisTavad gamoyenebuli iqneba klinikur TavisTavad gamoyenebuli iqneba klinikur

praqtikaSipraqtikaSi

gmadlobT yuradRebisTvisgmadlobT yuradRebisTvis