ASPIRATSION SINDROMDAN NOBUD BOʼLGAN CHAQALOQLAR BUYRAGINING MORFOLOGIK OʼZGARISHLARI

BUYRAGINING MORFOLOGIK OʼZGARISHLARI

Egamov Bunyodbek Jumanazarovich, Salaeva Zulfiya Shanazarovna

Toshkent tibbiyot akademiyasi Urganch filiali, Urganch, O'zbekiston

Olingan natijalar. 7 kungacha bo‘lgan davrda aspiratsion sindrom bilan kasallangan chaqaloqlar buyragi gipoksiya sababli, epitelial hujayralar nekrozi odatda arang seziladigan bo’ladi va bazal membranalarning qiyinchilik bilan aniqlanadi. Kanalchalarning distal qismi va yig’uvchi naychalarda oqsil silindrlarni bo’lishi aspiratsion sindromdan dalolat beradi. Nekrozga uchragan va ko’chib tushgan hujayralar kanalchalarning pastki bo’limlariga o’tib boradi va silindrlarni hosil qilganligini kuzatdik. Zararlangan membrana atrofida limfositlar, makrofaglar to’planib qolganligini kuztish mumkin bo’ladi.

Хulosa: Buyrak toʼqimasining mikroskopik tekshiruvlari neonatal davrda ajratib olingan buyrak toʼqimasini morfologik oʼzgarishlarini oʼrganishimiz shuni koʼrsatadi. Buyrakda qon aylanishi susaygan paytda ya’ni kislorod yaxshi yetib bormagan vaqtda boshlanadigan nekrotik o’zgarish ishemik kanalchalar nekrozi deb yuritiladi. Bunday holatda kanalchalarning proksimal qismi va Genle qovuzlog’ining pastga tushib boruvchi qismi zararlanganligini ko’rishimiz mumkin bo’ladi. Kanalchalar nekrozga uchrashi bilan o’tkir buyrak yetishmovchiligi boshlanganligidan dalolat beradi.

Kalit soʼzlar: chaqaloq, neonatal davr, o’tkir buyrak yetishmovchiligi, gipoksiya, Ishemik nekroz, autopsiya

Mavzunihg dolzarbligi: Tug’ruqdan keyingi aspiratsiya sindromi neonatologiyada hali ham dolzarb tadqiqot mavzularidan biri bo'lib qolmoqda, klinik ahamiyatiga qaramay ko’pincha, yangi tug'ilgan chaqaloqlarda va chaqaloqlarda tug'ruqdan keyingi aspiratsiyaga hali ham kamroq e'tibor qaratilganligi kuzatilmoqda. Neoanatal davr shartli ravishda ikkita davrni oʼz ichiga oladi. Bular erta neonatal davr bunda chaqaloq tugʼilganidan 0-7 kungacha boʼlgan vaqtni o’z ichiga oladi. Ikkinchi kechki neonatal davr 8-28 kungacha boʼlgan muddatni o’z ichiga oladi. Neonatal davrda aksariyat ichki aʼzolarning rivojlanishi xar qanday taʼsirlovchi omillarga javoban tizimli javob reaktsiyasi koʼrinishida namoyon boʼladi. Erta neonatal davrda chaqaloqlarda yuzaga keladigan aspiratsion sindromda ichki aʼzolardan asosan parenximatoz aʼzolarning gipoksiyasi kuzatiladi. Quyidagi tadqiqotimizda ushbu patologik oʼzgarishlar buyrak toʼqimasining posnatal ontogenezida quyidagi morfologik oʼzgarishlar bilan rivojlanadi. Ya’ni yangi tug’ilgan chaqaloq buyragi nisbatan katta va yumaloq shaklda bo’ladi. U bo’laklardan iborat bo’lib, po’stloq qavati yaxshi rivojlanmaganligi uchun yuzasi g’adir-budur bo’ladi. Yangi tug’ilgan chaqaloq buyragi o’rtacha uzunligi 4.2 sm, kengligi uchlari sohasida 2.2 sm, darvoza sohasida 1.5 sm, og’irligi esa 12 g. Chap buyrak o’ngiga nisbatan katta. Chaqaloq buyragining po’stloq moddasini qalinligi o’rtacha 2 mm bo’ladi, mag’iz moddasiniki 8 mm bo;lib ularning bir-biriga nisbati 1:4 bo’ladi. Yangi tug’ilgan chaqaloq buyragining yuqori uchi XII ko’krak umurtqasining yuqori qirrasi sohasida joylashadi. Pastki uchi esa IV bel umurtqasining pastki qirrasi sohasida joylashadi. XII qovurg’a chap buyrakning yuqorigi uchini kesib o’tsa, o’ng buyrakning yuqorigi uchi XII qovurg’aning pastki qirrasiga to’g’ri keladi. Yangi tug’ilgan chaqaloq buyragi uch qavat g’ilof bilan o’ralgan. Buyrak fassiyasi qorinparda orqa fassiyasini yupqa varag’idan iborat. Buyrakning yog’ pardasi yo’q. Buyrakning fibroz g’ilofi yupqa biriktiruvchi to’qimadan iborat bo’lib buyrak parenximasiga yopishib turadi va oson ajraladi. Yangi tug’ilgan chaqaloqning buyrak jomi keng, ampula shaklida bo’lib, ko’pincha buyrak tashqarisida joylashadi. Buyrak kosachalari homila hayotining oxirida paydo bo’ladi.

Olingan natijalar. Buyrak toʼqimasining mikroskopik tekshiruvlari neonatal davrda aspiratsion sindrom tashxisi bilan kasallanib nobud boʼlgan chaqaloqlar autopsiyasida ajratib olingan buyrak toʼqimasini morfologik oʼzgarishlarini oʼrganishimiz shuni koʼrsatadi. Buyrakda qon aylanishi susaygan paytda ya’ni kislorod yaxshi yetib bormagan vaqtda boshlanadigan nekrotik o’zgarish ishemik kanalchalar nekrozi deb yuritiladi. Bunday holatda kanalchalarning proksimal qismi va Genle qovuzlog’ining pastga tushib boruvchi qismi zararlanganligini ko’rishimiz mumkin bo’ladi. Kanalchalar nekrozga uchrashi bilan o’tkir buyrak yetishmovchiligi boshlanganligidan dalolat beradi. Bunga asosan kanalchalarning zararlanishi preglomerular arteriolalarnig tortishib, torayib qolishiga olib kelishi kuzatilishi mumkin. Bu esa koptokchalardagi filtrlash tezligi pasayishiga olib kelishini kuzatish mumkin. Ishemik nekrozga uchragan buyrak to’qimasini mikroskop bilan tekshirib ko’rilganda kanalchalar qisqa segmentlarining zaralamganligi topildi. Epitelial hujayralar nekrozi odatda arang seziladigan bo’ladi va bazal membranalarning qiyinchilik bilan aniqlanadi. Kanalchalarning distal qismi va yig’uvchi naychalarda oqsil silindrlarni bo’lishi aspiratsion sindromdan dalolat beradi. Nekrozga uchragan va ko’chib tushgan hujayralar kanalchalarning pastki bo’limlariga o’tib boradi va silindrlarni hosil qilganligini kuzatdik. Zararlangan membrana atrofida limfositlar, makrofaglar to’planib qolganligini kuztish mumkin bo’ladi.

Xulosa. Respublika patologik anatomiya markazida 2020-2023 yillardagi tug’ruqdan keyingi neonatal davrda jami 48 nafar neonatal davrning erta (0-7 kunlik) davrida nobud boʼlgan chaqaloqlar va nobud boʼlgan chaqaloqlarning buyrak toʼqimasi materiallari olingan. Buyrak toʼqimasining mikroskopik tekshiruvlari neonatal davrda ajratib olingan buyrak toʼqimasini morfologik oʼzgarishlarini oʼrganishimiz davomida kanalchalarning proksimal qismi va Genle qovuzlog’ining pastga tushib boruvchi qismi zararlanganligini ko’rishimiz mumkin bo’ldi. Kanalchalar nekrozga uchrashi bilan o’tkir buyrak yetishmovchiligi boshlanganligidan dalolat berdi.

Foydanilgan adabiyotlar.

1. Steinhorn RH. Advances in neonatal pulmonary hypertension. Neonatology. 2016;109:334–44.

2. Steurer MA, Jelliffe-Pawlowski LL, Baer RJ, Partridge JC, Rogers EE, Keller RL. Persistent pulmonary hypertension of the newborn in late preterm and term infants inCalifornia. Pediatrics. 2017;139:e20161165.

3. Nakwan N, Jain S, Kumar K et al. An Asian multicenter retrospective study on persistent pulmonary hypertension of the newborn: incidence, etiology, diagnosis, treatment and outcome. J Matern Fetal Neonatal Med. 2020;33:2032–7.

4. Abdel Mohsen AH, Amin AS. Risk factors and outcomes of persistent pulmonary hypertension of the newborn in neonatal intensive care unit of Al-minya university hospital in Egypt. J Clin Neonatol. 2013;2:78–82. [CrossRef] [PMC free

5. Selewski DT, Jordan BK, Askenazi DJ, Dechert RE, Sarkar S. Acute kidney injury in asphyxiated newborns treated with therapeutic hypothermia. J Pediatr. 2013;162:725–9. [CrossRef] [PubMed] [Google Scholar]

6. Rozmiarek AJ, Qureshi FG, Cassidy L, Ford HR, Hackam DJ. Factors influencing survival in newborns with congenital diaphragmatic hernia: the relative role of timing of surgery. J Pediatr Surg. 2004;39:821–4. [CrossRef] [PubMed] [Google Scholar]

7. Mortazavi F, Hosseinpour Sakha S, Nejati N. Acute kidney failure in neonatal period. Iran J Kidney Dis. 2009;3:136–40. PMID: 19617661.

8. Bendapudi P, Rao GG, Greenough A. Diagnosis and management of persistent pulmonary hypertension of the newborn. Paediatr Respir Rev. 2015;16:157– 61. [CrossRef] [PubMed] [Google Scholar]

9. Jetton JG, Boohaker LJ, Sethi SK et al. Incidence and outcomes of neonatal acute kidney injury (AWAKEN): a multicentre, multinational, observational cohort study. Lancet Child Adolesc Health. 2017;1:184–94. [CrossRef] [PMC free

10. Agras PI, Tarcan A, Baskin E, Cengiz N, Gürakan B, Saatci U. Acute renal failure in the neonatal period. Ren Fail. 2004;26:305–9. [CrossRef]

11. Zwiers AJ, de Wildt SN, Hop WC, Dorresteijn EM, Gischler SJ, Tibboel D, Cransberg K. Acute kidney injury is a frequent complication in critically ill neonates receiving extracorporeal membrane oxygenation: a 14-year cohort study. Crit Care. 2013;17:R151. [CrossRef] [PMC free article] [PubMed] [Google Scholar]

12. Sheta MM, Al-Khalafawi AI, Raza SM, Gad SS, Hesham MA. Acute kidney injury in term babies with persistent pulmonary hypertension of the newborn. Glob J Health Sci. 2019;11:60–6. [CrossRef] [Google Scholar]

13. Kamolvisit W, Jaroensri S, Ratchatapantanakorn B, Nakwan N. Factors and outcomes of persistent pulmonary hypertension of the newborn associated with acute kidney injury in Thai neonates. Am J Perinatol. 2018;35:298–304. [CrossRef]

14. Rocha G, Baptista MJ, Guimaraes H. Persistent pulmonary hypertension of non cardiac cause in a neonatal intensive care unit. Pulm Med. 2012;2012:818971. [CrossRef] [PMC free article] [PubMed] [Google Scholar]

15. Jetton JG, Askenazi DJ. Update on acute kidney injury in the neonate. Curr Opin Pediatr. 2012;24:191–6. [CrossRef] [PMC free

16. Ryan A, Gilhooley M, Patel N, Reynolds BC. Prevalence of acute kidney injury in neonates with congenital diaphragmatic hernia. Neonatology. 2020;117:88– 94. [CrossRef] [PubMed] [Google Scholar]

17. Steurer MA, Baer RJ, Oltman S et al. Morbidity of persistent pulmonary hypertension of the newborn in the first year of life. J Pediatr. 2019;213:58– 65. [CrossRef] [PubMed] [Google Scholar]

18. Mat Bah MN, Tan RYH, Razak H, Sapian MH, Abdullah N, Alias EY. Survival and associated risk factors for mortality among infants with persistent pulmonary hypertension of the newborn in Malaysia. J Perinatol. 2021;41:786– 93. [CrossRef] [PMC free article] [PubMed] [Google Scholar]

19. Fraisse A, Geva T, Gaudart J, Wessel DL. Doppler echocardiographic predictors of outcome in newborns with persistent pulmonary hypertension. Cardiol Young. 2004;14:277–83. [CrossRef] [PubMed] [Google Scholar]

20. Wedgwood S, Lakshminrusimha S, Schumacker PT, Steinhorn RH. Hypoxia inducible factor signaling and experimental persistent pulmonary hypertension of the newborn. Front Pharmacol. 2015;6:47. [CrossRef] [PMC free

21. An Y, Zhang JZ, Han J et al. Hypoxia-inducible factor-1alpha dependent pathways mediate the renoprotective role of acetazolamide against renal ischemiareperfusion injury. Cell Physiol Biochem. 2013;32:1151–66. [CrossRef]

22. Afolayan AJ, Eis A, Teng RJ et al. Decreases in manganese superoxide dismutase expression and activity contribute to oxidative stress in persistent pulmonary hypertension of the newborn. Am J Physiol Lung Cell Mol Physiol. 2012;303:L870– 9. [CrossRef] [PMC free article] [PubMed] [Google Scholar]

23. Plotnikov EY, Pavlenko TA, Pevzner IB et al. The role of oxidative stress in acute renal injury of newborn rats exposed to hypoxia and endotoxin. FEBS J. 2017;284:3069–78. [CrossRef] [PubMed] [Google Scholar]