Lithethefatsi tsa Antithyroid li sebelisetsoa hyperthyroidism (lefu la thyrotooticosis, lefu la bazedova). Hajoale, lithethefatsi tsa antithyroid li sebelisoa haholo. thiamazole (merkazolil)e thibelang thyroperoxidase mme ka hona e thibelang ho iodination ea masala a tyrosine ea thyroglobulin le ho sitisa semelo sa T₃ le T₄. Abela ka hare. Ha o sebelisa sethethefatsi sena, leukopenia, agranulocytosis, lekhopho la letlalo le ka khonahala. Ho eketsoa hoa tšoelesa ea qoqotho.

Joaloka lithethefatsi tsa antithyroid, iodide e beoa kahare - kalia iodide kapa iodide ea sodium ka tekanyetso e phahameng haholo (160-180 mg). Maemong ana, iodide e fokotsa tlhahiso ea qoqotho ea qoqotho ea qoqotho e sebetsang ka har'a popelo, ka ho latellana, sebopeho le secretion ea T ea fokotseha₃ le T₄ . Mokhoa o tšoanang oa thibelo ea ho lokolloa ha lihomone tsa qoqotho o boetse o bonoa le diiodotyrosine. Lithethefatsi li fanoa ka molomo. Li baka ho fokotseha ha palo ea tšoelesa ea qoqotho. Litla-morao: hlooho ea hlooho, lacrimation, conjunctivitis, bohloko mahlaba a makhopho, laryngitis, lekhopho la letlalo.

Liente tsa insulin kamehla

Ho kenella ka insulin: haholo ka bonngoe.

Tekanyetso e nepahetseng e lokela ho fokotsa tsoekere ea mali hore e be e tloaelehileng, e felise glucosuria le matšoao a mang a lefu la tsoekere.

Sebaka sa Injection ea Subcutaneous (tekanyetso e fapaneng ea ho monya): bokantle ba lebota la mpa, bokantle ba mahetla, bokantle ba bokantle ba lirope, lithupa.

Lithethefatsi tse khutšoane - ka mpeng (ho kenngoa ka potlako),

Lithethefatsi tse sebetsang nako e telele - lethekeng kapa marikeng.

Mahetla ha a phutholohe bakeng sa ho intša.

Ts'ebetso ea phekolo e hlahlojoa ka

-Kemisetso e mabapi le "tsoekere" ea tsoekere ea mali le

- excretion ea eona ka moroto ka letsatsi

Khetho e bohlale haholo bakeng sa kalafo ea lefu la tsoekere la mofuta oa

Regimen ea liente tse ngata tsa insulin tse etsisang secretion ea 'mele ea ho boloka insulin.

Maemong a mmele

secaltion ea basal (morao) ea insulin e etsahala khafetsa 'me ke karolo e le' ngoe ea insulin ka hora.

Nakong ea boikoetliso secretion ea insulin hangata e fokotseha.

Secretion ea "insulin" e eketsehileng (e tsosang) ea insulin (likarolo tse 1-2 ho ya ka 10 g ea lik'habohaedreite) lia hlokahala.

Secretion ena e rarahaneng ea insulin e ka etsisoa ka tsela e latelang:

Pele ho sejo se seng le se seng, ho fanoa ka lithethefatsi tse sebetsanang le nako e khuts'oane.

Secretion ea basal e ts'ehetsoa ke lithethefatsi tse nkileng nako e telele.

Mathata a kalafo ea insulin:

Mathata a lefu la tsoekere

Ts'ebeliso ea "insulin" e sa lekaneng

Ntle le tlhokomelo e potlakileng, komello ea lefu la tsoekere (e tsamaeang le lefu la letsoalo la mokokotlo)

kamehla oa bolaea.

- ho eketsa tahi ea CNS ka 'mele oa ketone,

Phekolo ea maemo a tšohanyetso etsoa entraven kenyelletso ea insulin.

Tlas'a tšusumetso ea tekanyetso e kholo ea insulin liseleng hammoho le tsoekere e kenyelletsa potasiamo

(sebete, mesifa ea marapo),

Ts'oarello ea potasiamo ea mali o theoha haholo. Ka lebaka leo, mathata a pelo.

Insulin allergy, insulin insulin.

Lipodystrophy sebakeng sa ente.

Bakeng sa ho thibela, ho khothalletsoa ho fetola libaka tsa tsamaiso ea insulin kahare ho sebaka se le seng.

Litokisetso tsa hormone ea parathyroid

Li-hormone tsa parathyroid tsa polypeptide parathyroid li ama metabolism ea calcium le phosphorus. E baka decalcification ea masapo a masapo. E khothaletsa ho kenngoa ha ion ea calcium ho tsoa mokokotlong oa mpa, e eketsa ho ts'oaroa ha calcium mme e fokotsa ho ts'oaroa ha phosphate ka har'a renal tubules. Mabapi le sena, ketso ea lihormone tsa parathyroid e eketsa boemo ba Ca 2+ ho plasma ea mali. Setlhare sa Slaughterhouse parathyroid parathyroidin sebelisoa bakeng sa hypoparathyroidism, spasmophilia.

1. Litokisetso tsa insulin le li-agents tsa maiketsetso

Insulin e ntlafatsa li-receptor tsa membrane ea sele tse kopaneng le tyrosine kinase. Tabeng ena, insulin:

e khothaletsa ho amoheloa ha tsoekere ke lisele tsa lisele (ntle le ts'ebetso ea methapo e bohareng), e nolofalletsang ho tsamaisoa ha tsoekere ka litho tsa 'mele,

e fokotsa tsoekere e maling,

3) e tsosa sebopeho sa glycogen le sebopeho sa eona sebeteng,

4) e khothalletsa mofuta oa liprotheine le mafura hape e thibela catabolism ea bona.

5) e fokotsa glycogenolysis ka har'a sebete le masapo a marapo.

Ka tlhahiso e sa lekanang ea insulin, tsoekere ea tsoekere, eo ho eona ho nang le lik'habohaedreite, mafura le protheine ea methapo.

Mofuta oa lefu la tsoekere la Mofuta oa tsoekere (ho itšetleha ka insulin) o amahanngoa le ho felisoa ha li-islets tsa Langerhans. Matšoao a mantlha a mofuta oa lefu la tsoekere la lefu la tsoekere: hyperglycemia, glucosuria, polyuria, lenyora, polydipsia (ho eketsa mokelikeli oa metsi), ketonemia, ketonuria, ketacidosis. Mefuta e matla ea lefu la tsoekere ntle le kalafo e fela ka mokhoa o bolaeang, lefu le hlaha maemong a kelello ea hyperglycemia (bohlokoa ba hyperglycemia, acidosis, ho se tsebe letho, monko oa acetone o tsoang molomong, ponahalo ea acetone ka har'a moroto, joalo-joalo). Ka mofuta oa lefu la tsoekere la lefu la tsoekere, lithethefatsi tse sebetsang feela ke litokisetso tsa insulin tse tsamaisoang ka botsoali.

Mofuta oa lefu la tsoekere la mofuta oa II mellitus (o sa itšetleheng ka insulin) o amahanngoa le ho fokotseha ha secretion ea insulin (mesebetsi e fokotsehileng ea β-cell) kapa nts'etsopele ea ho hanana le tishu ho insulin. Ho hanyetsa insulin ho ka amahanngoa le ho fokotseha hoa bongata kapa ho hlaka hoa li-insulin receptors. Tabeng ena, maemo a insulin a ka ba a tloaelehileng kapa a phahame. Maemo a phahameng a insulin a thusa ho nona haholo, ka lebaka leo, lefu la tsoekere la mofuta oa 2 ka linako tse ling le bitsoa lefu la tsoekere la obese. Mofuta oa lefu la tsoekere la mofuta oa II, ho sebelisoa li-hypoglycemic, tseo ka ho se sebetse hantle, li kopantsoeng le litokisetso tsa insulin.

Hajoale, litokisetso tse ntle tsa insulin ke litokisetso tsa insulin tsa batho. Ntle le moo, ba sebelisa lithethefatsi tsa insulin tse tsoang ho makhopho a likolobe (pig insulin).

Litokisetso tsa insulin ea motho li fumanoa ke boenjiniere ba liphatsa tsa lefutso.

Insulin e qhekellang ea motho (Actrapid NM) e hlahisoa ka botlolo ea 5 le 10 ml e nang le PIERES 40 kapa 80 ho 1 ml, hammoho le mabokoseng a 1.5 le 3 ml bakeng sa lipene tsa syringe. Hangata moriana o fanoa ka tlas'a letlalo ka metsotso e 15-20 pele ho lijo makhetlo a 1-3 ka letsatsi. Tekanyetso e khethoa ka bonngoe ho latela botebo ba hyperglycemia kapa glucosuria. Matla a hlaha kamora metsotso e 30 mme a nka lihora tse 66. Lipodystrophy e ka hlaha libakeng tsa ente ea insulin ea insulin, ka hona ho kgothaletsoa hore o fetole sebaka sa ente kamehla. Ho tsoala lefu la tsoekere, insulin e ka tsamaisoa ka matla. Haeba ho na le insulin e ngata, ho hlaha hypoglycemia. Pallor, mofufutso, maikutlo a matla a tlala, ho thothomela, ho tšoha, ho se ts'oarehe, ho thothomela hoa hlaha. Litšisinyeho tsa kelello (ho felloa ke letsoalo, ho tsikinyeha, ts'ebetso ea pelo e sa tsitsang) li ka hlaha. Ka matšoao a pele a hypoglycemia, mokuli o lokela ho ja tsoekere, likuku, kapa lijo tse ling tse nang le tsoekere. Maemong a ts'oaetso ea hypoglycemic, glucagon kapa 40% tharollo ea glucose e kenngoa kahare.

Crystalline Zinc Ho emisoa ha Insulin ea Batho (Ultratard HM) e tsamaisoa feela ka tlasa letlalo. Insulin e kenngoa butle butle ho tloha ho li-tiske tse subcutaneous, phello e ba teng ka mor'a lihora tse 4, phello e phahameng kamora lihora tse 8-12, nako ea ts'ebetso ke lihora tse 24. Lithethefatsi li ka sebelisoa e le moemeli oa mantlha hammoho le lithethefatsi tse potlakileng le tse khuts'oanyane.

Litokisetso tsa "insulin" tsa insulin li tšoana le ts'ebetsong ho litokisetso tsa insulin ea motho. Le ha ho le joalo, lintho tse ling li ka ama karabelo ea tsona.

Insulinqhibilihangse jele paate e hlahisitsoe ka botlolo ea 10 ml e nang le lintlha tsa 40 kapa 80 PIERES ho 1 ml. Kenya ka tlas'a letlalo metsotso e 15 pele u ja makhetlo a 1-3 ka letsatsi. Tsamaiso ea methapo le methapo e ka etsahala.

Insulin-zincho emisoaamorphous e tsamaisoa feela ka tlasa letlalo, e fana ka "insulin" butle ho tsoa sebakeng sa ente, 'me ka lebaka leo, ketso e teletsana. Ho qala ha ts'ebetso kamora lihora tse 1.5, tlhōrō ea ts'ebetso kamora lihora tse 5-10, nako ea ts'ebetso ke lihora tse 12-16.

Insulin Ts'ebetso ea Insulin Zinc e tsamaisoa feela ka tlasa letlalo. Ho qala ha ts'ebetso kamora lihora tse 3-4, tlhoro ea ts'ebetso kamora lihora tse 10-30, nako ea ts'ebetso ke lihora tse 28-36.

Synthetic hypoglycemic agents

Lihlopha tse latelang tsa baetsi ba maiketsetso ba hypoglycemic li khethollotsoe:

1) Serronylurea

Mehloli ea sulfonylureas - butamide, chlorpropamide, glibenclamide e laetsoeng ka hare. Lithethefatsi tsena li matlafatsa secretion ea "insulin" ka li-lets-cell tsa lihlekehleke tsa Langerhans.

Mochine oa ts'ebetso oa lintho tse tsoang ho sulfonylurea o amahanngoa le thibelo ea liteishene tsa K + tse itšetlehileng ka KP tsa lisele tsa β-depolarization ea membrane ea sele. Tabeng ena, menyetla ea Ca 2+ e itšetlehileng ka eona e kenelletse, ho kenoa ha Ca g + ho tsosa secretion. Ntle le moo, lintho tsena li eketsa kutloisiso ea li-insulin receptors ketsong ea insulin. Ho ile ha boela ha bontšoa hore lintho tse tsoang ho sulfonylurea li eketsa phello e susumetsang ea insulin tsamaisong ea glucose liseleng (mafura, mesifa). Li-derivatives tsa Sulfonylurea li sebelisetsoa mofuta oa II lefu la tsoekere. Ka lefu la tsoekere la mofuta oa I, ha li na thuso. E kenelletse ka har'a tšilo ea lijo ka potlako le ka botlalo. Boholo bo tlama ho protheine ea plasma. E etselitsoe sebeteng. Li-metabolism li patiloe haholo ke liphio, 'me ka karolo li ka epolloa ka bile.

Litla-morao: ho nyekeloa ke pelo, tatso ea tšepe ka hanong, bohloko ka mpeng, leukopenia, le lintho tse sa utloahaleng. Ka overdose ea sulfonylurea derivatives, hypoglycemia e ka etsahala. Lithethefatsi li etsoa ka phoso maemong a amanang le sebete, liphio le tsamaiso ea mali.

Biguanides - metformin e laetsoeng ka hare. Metforminum:

1) e eketsa tsoekere ea glucose ka lisele tsa kahare, haholoholo mesifa,

2) e fokotsa tsoekere e maling,

3) e fokotsa ho kenngoa ha tsoekere ka mpeng.

Ntle le moo, metformin e fokotsa takatso ea lijo, e tsosa lipolysis le inhibits lipogenesis, e lebisang ho fokotseng boima ba 'mele. E fuoe mofuta oa lefu la tsoekere la mofuta oa II. Setlhare se kenelletse hantle, nako ea ketso e fihlile ho lihora tse 14. Litla-morao: lactic acidosis (keketseho ea lactic acid maling a mali), bohloko bo ka pelong le mesifa, ho hema ka thata, hammoho le tatso ea tšepe molomong, ho nyekeloa ke pelo, ho hlatsa, lets'ollo.

2.3.1.2. Li-hormone tsa “pancreatic” le tse ling tsa tsona tsa maiketsetso

Makhopho a pepesehetse li-hormone tse peli: insulin le glucagon, tse nang le matla a mangata phapusing ea glucose maling. Insulin e theola tsoekere ea mali, e netefatsa ho tsamaisoa ha lisele le ho sebelisoa ha lisele, e khothaletsa sebopeho sa glucose-6-phosphate, e tsosetsa ts'ebetso ea tlhahiso ea matla, e tsosetsa motsoako oa protheine le mafura acid. Khaello ea insulin e bakoa ke lefu la tsoekere - lefu le kotsi, le hlahisoang ke ho eketseha ha tsoekere ea mali le ponahalo ea lona ka har'a moroto, lits'ebetso tsa oxidative tse bokellaneng (ka ho bokellana ha 'mele oa ketone), metabolism ea methapo ea methapo le nts'etsopele ea methapo ea methapo (diabetesic angiopathies). Ho bolaoa ke tlala ea lik'habohaedreite tsa lisele (li-insulin tse itšetlehileng ka insulin), ho se leka-lekane ha electrolyte le ketoacidosis ho baka nts'etsopele ea lipontšo tse matla tsa lefu la tsoekere - lefu la tsoekere.

Insulin ke proteni e 'ngoe e nang le liketane tse peli tsa polypeptide tse hokahantsoeng ke marokho. Hona joale, motsoako oa "insulin" oa motho le phoofolo o se o entsoe, mokhoa oa biotechnological bakeng sa tlhahiso ea ona (genetically enjene insulin) o ntlafalitsoe. Insulin e sebelisetsoa mellitus e itšetlehileng ka lefu la tsoekere le tloaelo ea ketoacidosis. Ho kenngoa ha insulin ho bakuli ba nang le lefu la tsoekere ho lebisa ho theoheng ha tsoekere ea mali le ho bokellana ha glycogen liseleng. E fokotsa glucosuria le polyuria le sepheo sa eona. Protein le lipid metabolism li tloaelehile, e lebisang ho fokotseheng ha litaba tsa metheo ea naetrojene morong. Litopo tsa Ketone li khaotsa ho fumanoa maling le mochineng.

Ts'ebetsong ea bongaka, litokisetso tsa insulin tse nang le linako tse fapaneng tsa ketso (tse khutšoane, tse bohareng, tse telele) li sebelisoa. Tekanyetso e baloa ka bonngoe, ho nahanela botebo ba ts'ebetso. Bakeng sa ho fokotsa palo ea liente, kamora hore phello e fumanoe, bakuli ba fetisetsoa ho insulin ea nako e telele e sa sebetseng: ho emisoa ha crystalline zinc-insulin, ho emisoa ha insulin-ultralong, protamine-zinc - insulin. Khafetsa, mefuta ea li-insulin e fapaneng (ho latela nako ea ketso) mefuta ea insulin e sebelisoa bakeng sa kalafo. Litokisetso tsa insulin le tsona li na le mathata. Insulin ha e kenngoe ka har'a sebete ka insulinase, e isang nako e sa lekanang ea ketso ea eona (lihora tse 4-6). Liente tsa insulin li bohloko haholo; Insulin le mefuta ea eona ea nako e telele e ka baka ho haroha letsoalo. Ha e na le insulin e ngata, e ka 'na ea e-ba le komello ea hypoglycemic. Ka tekanyo e fokolang ea hypoglycemia, e ka buseletsoa ka ho ja tsoekere kapa lijo tse nang le lik'habohaedreite tse ngata, ka komello ho hlokahala hore u tsamaise tsoekere ka tsoekere.

Ntle le insulin, li-agents tse entsoeng ka maqhubu a hypoglycemic li sebelisoa e le mahlahana a hypoglycemic. Tsena li kenyelletsa litlatsetso tsa sulfonylurea: tolbutamide (butamide), chlorpropamide, biguanides: buformin (glibutide, metformin (glucophage, glyformin) .Sulfonylureas e laetsoe lefu la tsoekere le itekanetseng ho kenyelletsa kalafo ea phepo e ntle. hape le insulin le sulfonamides.Moano o khothalelitsoeng oa ts'ebetso ea li-antidiabetesic tsa molomo o amahanngoa le secretion e eketsehileng ea insulin le kutloisiso ea sele ho eona sheney. mochine ea nkang khato ea biguanide derivatives mesifa bakoang ke tlhotlheletso ya tsoekere uptake le hatelloang tsa dithulaganyo tsoekere absorption.