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},
"code": "E56",
"name": "Недостаточность витаминов",
"icd_name": "Недостаточность других витаминов",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
"0"
],
"periodicity": 1,
"slug": "e56_nedostatochnost_vitaminov",
"lead": "группа заболеваний, которые возникают в результате дефицита в организме одного или нескольких витаминов",
"description": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Авитаминоз – это дефицит в организме человека одного витамина или группы витаминов.</span></p>",
"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Основной причиной авитаминозов является несбалансированное питание, вследствие чего человек не получает необходимые витамины. Такая ситуация наблюдается как при добровольном ограничении в пище, например, при строгих диетах с целью похудения, так и при вынужденном — при низком уровне дохода, у людей без постоянного места жительства, страдающих наркоманией. Остальные причины витаминного дефицита объединяются в следующие группы:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Наследственные факторы. В литературе описаны врожденные формы гиповитаминозов, обусловленные генетическим мутациями. Они могут затрагивать обмен любых жирорастворимых витаминных нутриентов, а также фолиевой кислоты, соединений группы В – В1, В2, В6, В12. Признаки состояния манифестируют в детском возрасте, его коррекция затруднена.</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Нарушения пищеварения. Мальабсорбция витаминов наблюдается при хронических гастроэнтеритах, болезни Крона, целиакии, других заболеваниях. Симптомы проявляются на разных этапах – переваривания, высвобождения нутриентов, всасывания готовых биоактивных форм.</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Расстройства доставки витаминов. При дефектах транспортных белков, что чаще всего бывает при поражении печени, витаминные вещества не перемещаются к органам-мишеням, поэтому симптомы витаминодефицита бывают даже при нормальном уровне нутриентов в крови. Реже встречаются расстройства взаимодействия транспортных протеинов с клеточными рецепторами.</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Нарушения клеточного метаболизма. При отсутствии определенных ферментов изменяется течение внутриклеточных биохимических процессов, что приводит к неспособности соединения превращаться в активную форму, либо «выключает» нутриент из метаболических реакций, провоцируя появление соответствующих признаков.</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Антивитамины. Так называются соединения, имеющие структурное сходство с витаминами, но не выполняющие их функции (например, сульфаниламиды, изониазид, метотрексат). К этой группе также принадлежат вещества, способные связывать или разрушать полезные нутриенты — тиаминазы, деактивирующие витамин В1, яичный белок авидин, нарушающий функции биотина.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Все вышеописанные этиологические факторы авитаминозов относятся к патологическим. Однако существуют физиологические причины витаминной недостаточности — несоответствие между поступлением нутриентов в организм и повышенной потребностью в них. Это наблюдается у женщин во время беременности, грудного вскармливания, у детей в периоды «скачков роста», у людей, интенсивно тренирующихся в спортзале или занятых тяжелой физической работой.</span></p>\r\n<p><span><span> </span></span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Отдельно выделяют дисвитаминозы — состояния, при которых гипо- или авитаминоз определенных нутриентов сопровождается симптомами гипервитаминоза другого либо нескольких витаминов. Расстройство возникает вследствие избирательного всасывания нутриентов в кишечнике, при несбалансированной диете с преобладанием одной группы продуктов. Иногда признаки дисвитаминоза развивается у тех, кто самостоятельно бесконтрольно принимает витаминные монопрепараты.</span></p>\r\n<p><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
"pathogenesis": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Витаминонутриенты подразделяются на 2 группы: жирорастворимые — А (ретинол), D (эрго- и холекальциферол), Е (токоферол), К (менахинон, филлохинон), водорастворимые — С (аскорбиновая кислота), В1 (тиамин), В2 (рибофлавин), В6 (пиридоксин), В9 (фолиевая кислота), В12 (цианокобаламин), РР (ниацин). Также выделяют витаминоподобные соединения, дефицит которых не вызывает ярких клинических симптомов.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Витамины — низкомолекулярные соединения, которые являются кофакторами для более чем 100 ферментов, необходимых для корректного протекания метаболических процессов. Такая функция в большей степени присуща водорастворимым веществам, которые зачастую называются энзимовитаминами. Жирорастворимые нутриенты в основном выполняют сигнальные функции, стимулируют работу эндокринной системы, за что они получили название гормоновитаминов.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Отличительная черта всех витаминных соединений — они не могут синтезироваться в достаточном количестве в организме человека (а некоторые вещества вовсе не вырабатываются эндогенно), поэтому для правильного метаболизма необходимо регулярное поступление этих веществ извне. Если ежедневное потребление нутриента не соответствует физиологической норме, нарушаются соответствующие биохимические реакции, появляются клинические признаки расстройства.</span></p>",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Симптомы авитаминозов, как правило, довольно специфичны, поэтому заподозрить их удается при клиническом осмотре больного у врача общей практики (семейного доктора, терапевта или педиатра). Особое внимание уделяется выяснению характера питания больного, наличия у него признаков хронических заболеваний ЖКТ или других факторов риска. Расширенная диагностика включает следующие методы:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Определение уровня витаминов. Это основной анализ, используемый для подтверждения диагноза. При обнаружении признаков недостатка жирорастворимых форм он дает максимально точные результаты, а вот колебания водорастворимых нутриентов в течение суток могут стать причиной диагностической ошибки, поэтому при сомнительных данных необходимо повторное исследование.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Другие анализы крови. Гемограмма проводится, чтобы оценить количество гемоглобина, число, форму эритроцитов, что необходимо для выявления лабораторных симптомов разных типов анемий. Обязательно выполняется коагулограмма для оценки свертываемости крови. При необходимости назначается биохимическое исследование уровня электролитов, кислотно-основного баланса.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Гормональные исследования. При возможных признаках гиповитаминоза D показано определение содержания паратгормона. Симптомы нарушения фертильности при недостатке А и Е — повод к расширенному исследованию на половые гормоны (эстрогены, гестагены, андрогены), гонадотропные гормоны гипофиза.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Инструментальные методы. Для выяснения причины витаминодефицита необходимы исследования ЖКТ: фиброгастродуоденоскопия, рентгенография с пассажем бария по кишечнику, КТ или МРТ органов брюшной полости. При подозрении на витаминодефицит D рекомендована рентгенография костей скелета.</span></li>\r\n</ul>\r\n<p> </p>\r\n<p><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Основная цель терапии – поступление в организм пациента недостающих витаминов. Лечение авитаминоза базируется на разработке соответствующей диеты. Вещества, получаемые человеком из пищи, быстро всасываются в кишечнике. Оптимально подобранный рацион включает в себя разные группы питательных элементов, которые участвуют в обменных процессах. Их присутствие в употребляемых блюдах ускоряет выздоровление пациента.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Медикаментозный курс включает пероральный прием поливитаминных препаратов. Гиповитаминозы тяжелой формы лечатся посредством инъекций. Монопрепараты редко используются при лечении витаминной недостаточности. Авитаминозы сопровождаются нарушением баланса нескольких групп витаминов в организме человека. Поливитаминные комплексы способствуют быстрому решению этой проблемы. Отказ от них возможен при индивидуальной непереносимости отдельных компонентов препарата пациентом.</span></p>",
"prevention": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Для профилактики авитаминоза пациентам рекомендуется:</span></p>\r\n<p> </p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">употреблять в пищу продукты, богатые витаминами;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">в осенне-зимний период принимать поливитаминные препараты;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">придерживаться сбалансированного питания;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">следить за правильным приготовлением и хранением пищевых продуктов.</span></p>\r\n</li>\r\n</ul>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Симптомы витаминной недостаточности зависят от нехватки конкретного вещества.</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Витамин А (ретинол). Авитаминоз проявляется дерматологическими и офтальмологическими нарушениями. Человек утрачивает способность нормально ориентироваться в темноте, испытывает дискомфортные ощущения при ярком свете. Кожа страдает от недостатка влаги, становится чрезмерно сухой.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Витамин С. Недостаток проявляется хрупкостью сосудов, кровоточивостью десен и развитием цинги.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Витамины группы В. Авитаминоз сопровождается разными клиническими проявлениями. Нехватка витамина В1 (тиамин) вызывает заболевание бери-бери. Оно проявляется мышечной слабостью, головными болями, повышением артериального давления и тахикардией.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При недостатке витамина В2 (рибофлавин) появляются «заеды» в области уголков губ. Кожа становится чрезмерно сухой. Возможно развитие хронической анемии.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Нехватка витамина В6 вызывает неврологические нарушения, кожные заболевания. Возможно появление себорейного дерматоза, поражающего волосистую часть головы, развитие анемии. У детей нередко возникают судороги. Недостаток витамина В12 вызывает развитие анемии. Она сопровождается общей слабостью, тахикардией, одышкой, головокружением, потерей сознания.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Витамин D. Он может синтезироваться в коже при контакте с прямыми солнечными лучами и поступать вместе с пищей, развивается рахит у детей. У взрослых людей, особенно в период климакса, может прогрессировать остеопороз. Витаминная недостаточность делает кости хрупкими, провоцирует появление переломов, физической слабости, проблем со сном.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Витамин Е. Выполняет роль антиоксиданта. Провоцирует распад эритроцитов, негативно влияет на репродукцию человека, состояние кожи, ногтей и волос.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Витамин К. Его нехватка вызывает нарушения свертываемости крови, провоцирует появление синяков и кровотечений.</span></li>\r\n</ul>\r\n<p> </p>",
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},
"code": "E53",
"name": "Недостаточность других витаминов группы B",
"icd_name": "Недостаточность других витаминов группы B",
"gender": 0,
"age_min": 0,
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3
],
"periodicity": 4,
"slug": "e53_nedostatochnost_drugih_vitaminov_gruppy_b",
"lead": " Патологическое состояние, обусловленное дефицитом этого витамина в организме и проявляющееся нарушениями преимущественно со стороны нервной системы, сердца и кишечника.",
"description": "",
"etiology": "<p>Гиповитаминоз B1 в развитых странах встречается нередко и наблюдается в основном у больных с хроническими заболеваниями желудочно-кишечного тракта, хроническим алкоголизмом, полиневритами, эндокринными заболеваниями (сахарный диабет, токсический зоб) и др. Недостаточность тиамина часто сочетается с дефицитом других витаминов группы В.</p>",
"pathogenesis": "<p>Витамин B1 хорошо растворяется в воде; кофермент тиаминдифосфат (кокарбоксилаза) играет существенную роль в углеводном обмене. Наряду с этим тиамин участвует в обмене аминокислот, нуклеотидов, ацетилхолина и холинэстеразы. При дефиците витамина В1 в тканях и крови накапливаются недоокисленные продукты: пировиноградная кислота, молочная кислота и др. При этом нарушается деятельность различных отделов нервной системы (особенно периферической нервной системы), скелетных мышц и миокарда, а также функция желудочно-кишечного тракта.</p>",
"diagnostics": "<p>Диагноз гиповитаминоза B1 подтверждается уменьшением содержания тиамина в крови (в сыворотке ниже 5 мкг/л, в эритроцитах ниже 30 мкг/л), резким повышением концентрации пировиноградной кислоты в крови (выше 0,01 г/л) и моче (выше 30 мг/сут), повышением содержания в крови молочной кислоты (выше 200 мг/л). В последнее время с этой целью используют также ряд более сложных современных методов.</p>",
"treatment": "<p>Лечение больных обычно проводится амбулаторно. Рекомендуется диета, богатая тиамином, в сочетании с препаратами тиамина внутрь (50-100 мг/сут) или парентерально (30-60 мг/сут).</p>\r\n<p>Больные с выраженными формами болезни часто нуждаются в стационарном лечении. Парентерально вводят тиамин по 1 мл и кокарбоксилазу. Одновременно назначают другие витамины группы В (рибоксин, пиридоксин, никотиновая кислота) и аскорбиновую кислоту.</p>",
"prevention": "",
"clinical_picture": "<p>Характерны ухудшение аппетита, <a href=\"/symptom/toshnota/\" title=\"Перейти на страницу симптома Тошнота\">тошнота</a>, наклонность к запорам, парестезии в ногах, боль в икроножных мышцах при ходьбе, ухудшение сна, <a href=\"/symptom/razdrazhitelnost_i_ozloblenie/\" title=\"Перейти на страницу симптома Раздражительность и озлобление\">раздражительность</a>, плаксивость, снижение физической и психической работоспособности. Иногда умеренное похудание, лабильность пульса на фоне общей психоэмоциональной лабильности. Язык суховат, живот нерезко вздут, умеренно снижена болевая и глубокая чувствительность в области стоп и голеней, нерезко ослаблены сухожильные рефлексы (больше на ногах).</p>",
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"lead": "порок сердца, при котором происходит обратное движение крови из легочной артерии (сосуда, несущего кровь к легким) в правый желудочек во время расслабления желудочков сердца вследствие неполного смыкания его створок",
"description": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Недостаточность клапана легочной артерии — один из дефектов порока сердца, при котором происходит неполное закрытие клапаном во время диастолы правого желудочка отверстия легочной артерии, что приводит к возникновению оттока крови из артерии обратно в желудочек.</span></p>",
"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Врожденная форма порока формируется вследствие дилатации легочного ствола или нарушения развития створок клапана. В детской кардиологии встречается гипоплазия и полное отсутствие клапана легочной артерии (агенезия, врожденная бес­клапанная легочная артерия). Иногда в легочном клапане отсутствует одна створка, а две другие могут быть нормальными или рудиментарными. Врожденная недостаточность клапана легочной артерии обычно встречается при тетраде Фалло, сочетается с открытым артериальным протоком, дефектом межпредсердной перегородки, дефектом межжелудочковой перегородки, двойным отхождением магистральных сосудов от правого желудочка, синдромом Марфана.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Наиболее частой причиной приобретенной недостаточности клапана легочной артерии служит септический эндокардит. К расширению клапанных комиссур может приводить поражение легочной артерии при сифилисе, атеросклерозе.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Недостаточность клапана легочной артерии может возникать после баллонной вальвулопластики и вальвулотомии. Относительная недостаточность клапана легочной артерии встречается при легочной гипертензии, хронических заболеваниях легких и митральном стенозе, тромбоэмболии легочной артерии. Иногда недостаточность клапана развивается вследствие давления аневризмы аорты на легочную артерию.</span></p>",
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"diagnostics": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Диагностика тяжелых врожденных пороков осуществляется непосредственно после рождения ребенка. Легкие формы клапанной недостаточности, а также приобретенные патологии диагностируются в более зрелом возрасте при проявлении симптомов или во время диспансерного наблюдения. Характерным объективным признаком порока является шум, определяемый врачом при аускультации сердца. </span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Для окончательной диагностики врожденных и приобретенных пороков клапана легочной артерии кардиологами клиники применяются высокоточные методы исследования, среди которых: </span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Эхокардиография – визуализация сердца при помощи ультразвукового сканера;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Рентгенография органов грудной клетки с целью оценки размера сердца и легочных изменений; </span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Контрастная рентгенография по протоколу исследования сосудов (ангиография), в том числе коронарная ангиография; </span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Измерение уровня кислорода и давления в камерах сердца при помощи малоинвазивной катетеризации; </span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Пульсоксиметрия – неинвазивный мониторинг насыщения крови кислородом; </span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Электрокардиографические исследования (запись ЭКГ в реальном времени и продолжительный мониторинг сердечного ритма). Запись электрических потенциалов сердца помогает кардиологам диагностировать сопровождающие клапанный порок ишемические нарушения, аритмии и гипертрофию миокарда; </span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Томографические методы исследования сердца (компьютерная и магнитно-резонансная томография); </span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Изотопное сканирование легочной перфузии.</span></li>\r\n</ul>",
"treatment": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Медикаментозное лечение пороков легочной артерии направлено на предотвращение развития и прогрессирования сердечной недостаточности. </span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Хирургическое лечение, в большинстве случаев, способно нормализовать гемодинамику путем устранения сердечного порока. </span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Баллонное расширение стеноза, стентирование и применение инновационной методики режущего баллона, позволяющей не только расширить суженный участок, но и удалить избыток фиброзной ткани, приводящей к рецидиву стеноза; </span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Органосохраняющие процедуры реконструкции поврежденного клапана, предотвращающие необходимость его замены; </span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Операции на открытом сердце с целью восстановления нормальной проходимости при атрезии и стенозе легочного ствола; </span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Операции по замене клапана легочной артерии. Искусственные биологические или механические клапаны полностью справляются со своей функцией, гарантируя восстановление гемодинамики на долгие годы. </span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Эндоваскулярное малоинвазивное протезирование в кардиохирургии:</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Процедура проводится под местной анестезией. С помощью катетера, который вводится в бедренную вену, искусственный клапан, упакованный в специальную гильзу-cтент, доставляется через правый желудочек в место повреждённого лёгочного клапана (чаще всего, дегенерировавшего гомографта). После контроля местоположения нового клапана с помощью Эхо-КГ и рентгена, клапан расправляется и фиксируется в правильной позиции. Процедура длится около часа и позволяет избежать повторной операции у детей и взрослых с применением аппарата искусственного кровообращения и рискa, связанного с открытием грудной клетки при наличии сращений после первой операции.</span></p>",
"prevention": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При ведении беременности у женщин с недостаточностью клапана легочной артерии необходимо проводить профилактику гипоксии плода и преждевременных родов. Беременным требуется УЗИ-мониторинг маточно-плацентарного кровообращения, наблюдение акушера-гинеколога, кардиолога, терапевта, кардиохирурга.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Профилактика вторичной недостаточности клапана легочной артерии сводится к предупреждению бактериального эндокардита, атеросклероза, сифилиса, хронических болезней легких, ятрогенных осложнений при операциях на сердце. Профилактика первичной недостаточности клапана легочной артерии – такая же, как при других ВПС.</span></p>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Клиника врожденной недостаточности клапана легочной артерии манифестирует вскоре после рождения с признаков правожелудочковой недостаточности, респираторных нарушений, обусловленных сдавлением бронхов и трахеи расширенными ветвями легочной артерии. При изолированной вторичной недостаточности клапана легочной артерии клинических проявлений может не отмечаться длительное время.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Жалобы появляются при прогрессировании недостаточности правого желудочка и трикуспидальной недостаточности. У больных появляется сонливость, слабость, сердцебиение, приступы одышки, цианоз, боли в сердце. У взрослых больных старше 20-30 лет возможно возникновение аритмий. При осмотре обращает внимание набухание шейных вен, изменение фаланг пальцев в виде барабанных палочек. В дальнейшем возникают периферические отеки, стойкая тахикардия, гидроторакс, асцит, кардиальный цирроз печени. К наиболее опасным осложнениям недостаточности клапана легочной артерии следует отнести легочные эмболии, аневризму легочной артерии.</span></p>",
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"code": "E52",
"name": "Недостаточность никотиновой кислоты [пеллагра]",
"icd_name": "Недостаточность никотиновой кислоты [пеллагра]",
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"lead": " Патологическое состояние, обусловленное дефицитом этого витамина в организме. ",
"description": "При выраженном дефиците развивается пеллагра, в менее тяжелых случаях — гиповитаминоз РР, проявляющийся нарушениями функции нервной системы, кишечника, дистрофическими изменениями кожи.",
"etiology": "<p>• Первичная — недостаток в поступающей пище, например, при преобладании в рационе кукурузы, поскольку витамин РР, хотя и содержится в ней, находится в связанном состоянии и не ассимилируется вЖКТ. Кроме того, белки кукурузы бедны триптофаном, используемого в организме для синтеза эндогенноговитамина РР<br />• Вторичная — обусловлена нарушением всасывания или усвоения витамина РР, а также увеличениемпотребности в нём <br />• Длительная <a href=\"/symptom/diareya/\" title=\"Перейти на страницу симптома Диарея\">диарея</a> <br />• Заболевания печени (чаще всего к недостаточности приводит цирроз)<br />• Алкоголизм<br />• Парентеральное питание без достаточного возмещения витаминов<br />• Злокачественные карциноидные опухоли (увеличивается потребность в триптофане)<br />• Сахарный диабет <br />• Болезнь Хартнапа</p>",
"pathogenesis": "",
"diagnostics": "<p>• Выделение N'-метилникотинамида с мочой менее 4 мг/сут<br />• Снижение содержания никотиновой кислоты<br />• Снижается содержание в крови и моче других витаминов группы В.</p>",
"treatment": "<p>В среднетяжёлых и тяжёлых случаях необходима госпитализация.<br />• Диета. Включение в рацион продуктов, богатых витамином РР (мясо, яйца) и триптофаном (молоко).<br />• Назначение никотиновой кислоты (или никотинамида) от 300 до 1000 мг/сут внутрь в начале лечения привыраженном снижении содержания витамина РР в плазме крови, затем по 300-500 мг.<br />• При заболеваниях ЖКТ никотиновую кислоту (или никоти-намид) вводят парентерально (50-100 мг в/м 2-5раз/сут или 25-100мг <br />• Одновременно назначают по 5 мг тиамина, рибофлавина и пиридоксина.</p>",
"prevention": "<p>• Питание с достаточным содержанием в пищевом рационе продуктов, богатых никотиновой кислотой<br />• При эндогенной форме — своевременная диагностика и лечение заболеваний, нарушающих всасывание иусвоение витамина РР, профилактическое введение препаратов никотиновой кислоты; дополнительноевведение витамина РР лицам с увеличенной в нём потребностью.</p>",
"clinical_picture": "<p>При недостаточности витамина РР возникают нарушения функций кожи, слизистых оболочек, ЖКТ и ЦНС. Характерно наличие трёх Д (дерматит, <a title=\"Перейти на страницу симптома Диарея\" href=\"../../../symptom/diareya/\">диарея</a>, <a title=\"Перейти на страницу симптома Деменция\" href=\"../../../symptom/demenciya/\">деменция</a>) и поражение слизистых оболочек.<br />• Стадия прегиповитаминоза — неспецифические нарушения (<a title=\"Перейти на страницу симптома Слабость\" href=\"../../../symptom/slabost/\">слабость</a>, <a title=\"Перейти на страницу симптома Утомляемость\" href=\"../../../symptom/utomlyaemost/\">утомляемость</a>, <a title=\"Перейти на страницу симптома Снижение аппетита\" href=\"../../../symptom/snizhenie_appetita/\">снижение аппетита</a> ит.д.).<br />• Стадии гипо- и авитаминоза<br />• Дерматит. Поражение кожи может быть четырёх типов. Чаще всего оно симметрично и возникает научастках кожи, подвергающихся солнечному облучению или травматизации (давлению)<br />• Остро возникают кожные проявления в виде пеллагрической эритемы с последующим образованиемпузырьков, пузырей, корочек. Часто присоединяется вторичная инфекция <br />• Поражение кожных складок — <a title=\"Перейти на страницу симптома Покраснение кожи\" href=\"../../../symptom/pokrasnenie_kozhi/\">покраснение</a>, мацерация, эрозирование и присоединение вторичнойинфекции</p>\r\n<full></full>\r\n<p><br />• Хронические гипертрофические изменения -кожа утолщена, теряет эластичность, становится складчатой. Отмечают выраженную пигментацию на открытых участках тела и в местах, подвергающихся давлению. Очаги поражения имеют чёткую границу и окружены бордюром восстанавливающегося эпителия<br />• Хронические атрофические изменения кожи с потерей эластичности и шелушением. Характерны длядлительно текущих форм пеллагры. <br />• Поражение слизистых оболочек первично затрагивает ротовую полость, хотя возможно вовлечениеслизистых оболочек влагалища и уретры<br />• Для острой недостаточности характерны <a title=\"Перейти на страницу симптома Глоссит\" href=\"../../../symptom/glossit/\">глоссит</a> и стоматит, причём язык приобретает ярко-краснуюокраску. Первоначально в процесс вовлекаются кончик и края языка, а также участки слизистой оболочки, окружающие выходное отверстие стенбнова протока<br />• Постепенно вовлекается вся слизистая оболочка, язык становится болезненным и отёчным, возникаетгиперсаливация<br />• На поздних стадиях заболевания возникает характерная картина лакового языка (ярко-красный язык сгладкой поверхностью вследствие атрофии сосочков)<br />• Возможно появление язв на слизистой оболочке дна полости рта, нижней губы, а также напротив моляров. <br />• <a title=\"Перейти на страницу симптома Диарея\" href=\"../../../symptom/diareya/\">Диарея</a> — самый характерный признак нарушения функций пищеварительной системы. Поражение ЖКТвозникает на поздних стадиях заболевания. Характеризуется появлением чувства жжения слизистой оболочкиполости рта, глотки, пищевода; возникает желудочная <a title=\"Перейти на страницу симптома Диспепсия\" href=\"../../../symptom/dispepsiya/\">диспепсия</a> в виде тошноты, реже рвоты, чтообусловлено атрофическими изменениями слизистой оболочки желудка и возникновением ахилии. Возможнадиарея, чередующийся с запорами. О тяжёлом течении свидетельствует <a title=\"Перейти на страницу симптома Диарея\" href=\"../../../symptom/diareya/\">диарея</a> с прожилками крови врезультате образования эрозий и язв слизистой оболочки кишечника.<br />• <a title=\"Перейти на страницу симптома Деменция\" href=\"../../../symptom/demenciya/\">Деменция</a> — самый яркий признак поражения ЦНС; может сопровождаться органическим психозом и/илиэнцефало-патическим синдромом. На ранних стадиях появляется <a title=\"Перейти на страницу симптома Раздражительность и озлобление\" href=\"../../../symptom/razdrazhitelnost_i_ozloblenie/\">раздражительность</a>, возможны признакиполиневрита<br />• Органический <a title=\"Перейти на страницу симптома Психоз\" href=\"../../../symptom/psihoz/\">психоз</a> проявляется галлюцинаторно-параноидной, аффективной симптоматикой, психомоторным возбуждением<br />• Энцефалопатический синдром, характеризующийся затемнением сознания, гипертонусом мышцконечностей, появлением неконтролируемых сосательного и хватательного рефлексов.<br />• На поздних стадиях нарушаются функции эндокринной системы, возникает гипопротеинемия.</p>",
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