Phaello ea mali ho lefu la tsoekere

Ho sa tsotelehe mofuta oa hau, bakuli ba nang le lefu la tsoekere ba ka fumanoa ba na le khatello ea mali. E mpefatsa boemo bo akaretsang ba mokuli, e eketsa kotsi ea ho ba le methapo ea pelo. Ho fokotsa boemo, o hloka ho sebelisa lithethefatsi tse netefalitsoeng le ho fetola mokhoa oa hau oa bophelo. Mabapi le tse bakang ponahalo ea khatello ea mali ho lefu la tsoekere, mekhoa ea ho e fumana le ho e phekola, bala ho eketsehileng sengolong sa rona.

Bala sengoloa sena

Lisosa tsa khatello ea mali ho lefu la tsoekere

Mafu ana a mabeli a amana haufi-ufi, aa tšehetsana le ho matlafatsana. Ho bohlokoa ho ela hloko hore khatello ea mali ke litholoana tsa ho senyeha ha meno ho tsoekere kapa ho theola semelo sa tsoekere e phahameng ea mali.

Ho mofuta oa 1 lefu la tsoekere, khetho ea pele ea atleha. Lefu la tsoekere lephropathy le lebisa ho ntlafatseng mafolofolo a liphio, e leng sesosa sa karabelo ea tlhaho. Ka lebaka leo, molumo oa vascular o eketseha, boemo ba sodium maling, mokelikeli oa bolokoa.

Mofuta oa bobeli oa bokuli, ho hlaha mofuta oa mantlha oa khatello ea mali, eo lefu la tsoekere le morao ka lona. E ka etella pele kapa ea hlaha ka mathata a lefu la tsoekere. Joaloka lebaka le ka sehloohong, ho hanyetsa insulin ho nkoa.

Mokuli o hlahisa insulin ka bongata bo tloaelehileng, empa lisele li felloa ke matla a ho e arabela. Glucose maling e lula e phahame, 'mele o haelloa ke matla. Makhopho a makhopho a hlahisa insulin e ngata le ho feta.

Boemo bona bo hlaha hangata ho bakuli ba nang le boima ba 'mele bo feteletseng. Mabaka a kotsi a kenyeletsa:

• ho beha mafura haholo ka mpeng,
• bokapele ba lefutso
• boemo bo tlase ba ho ikoetlisa
• Ho ja ho feta tekano, nama e mafura le tsoekere e ngata haholo 'meleng.
• tlhekefetso ea joala, ho kenyeletsa le biri.

Adipose tiske e khona ho pata metsoako e sebetsang ea bioloji. E bile e bitsoa mofuta oa setho sa endocrine. Tse ithutoang haholo ke: angiotensinogen, leptin, adiponectin, li-prostaglandins, mofuta oa kholo ea insulin.

Ka nako e ts'oanang li eketsa ho hanyetsa lisele tsa mmele ho insulin le methapo e thata ea mali. Ka ho nka karolo ha bona, karabelo ea methapo ea methapo ho adrenaline, cortisol (lihormone tsa khatello ea maikutlo) ea eketseha, sodium le metsi lia bolokoa, palo ea mesifa ea mesifa leboteng la vascular ea eketseha, e thibelang phomolo ea eona. Sena se hlalosa motsoako oa ho hanyetsa insulin, khatello ea mali le botena, cholesterol e feteletseng, e bitsoang quartet e bolaeang.

Mona ke ho eketsehileng mabapi le lijo tsa lefu la tsoekere la mofuta oa 2.

Matšoao a khatello e phahameng ea mali

Bakeng sa khatello ea mali e bonolo ho isa tekanyong, tletlebo ea sehlooho ke hlooho. E kopantsoe le ho tsekela, bofokoli ka kakaretso, ho fafatsa ha lintlha ka pel'a mahlo, tinnitus. Ha ho le e 'ngoe ea matšoao ana e tobileng,' me bakuli ba bangata ha ba utloe ho eketseha ha khatello, haholoholo ka lipalo tse telele tsa nako e telele.

Ka hona, ha ho mohla motho a ka tsepamisang maikutlo ho maikutlo, empa tekanyo ea matšoao e ea hlokahala. Bakeng sa bakuli ba nang le lefu la tsoekere, le bona ha ba bohlokoa joalo ka tsoekere ea mali. Ka lebaka la hore batho ba nang le lefu la tsoekere ba na le tloaelo ea ho fokolisa molumo oa methapo, ho hlokahala hore ho shejoe khatello ea mali bonyane hang ka beke - hora e le 'ngoe pele ho lijo, lihora tse peli ka mor'a, hoseng kamora ho robala le ka shoalane lihora tse peli pele ho eona. Hang ka letsatsi, mehato e lokela ho nkuoa ha u ntse u eme, u lutse le ho robala ka letsoho le leng le le leng.

Ha lefu la tsoekere le la khatello ea mali le ntse le eketseha, ho senyeha hoa litho tsa lona ho etsahalang: bohloko pelong, bo eketsoa ke keketseho e matla ea khatello, khatello ea maikutlo. Ho fapana le angina pectoris, ha e amane le khatello ea maikutlo 'me ha e tlosoe ke Nitroglycerin. Ka ho nyekeloa ke pelo, ho hema hanyane, ho ruruha ha maoto le ho otla ha pelo kapele ho ekeletsoa.

Bakeng sa kotsi ea ho lemala ha pelo, ho lebala, ho tsitsipana le ho hloka boroko ke tšobotsi. Bokhoni ba ho sebetsa ka bohlale bo fokotseha butle-butle, ho otsela ho hlaha mots'eare, ho ts'oenyeha ha ho tsamaea, khatello ea maikutlo le matsoho a thothomelang.

Ka khatello e ntseng e eketseha, moholi kapa lesira le hlaha ka pel'a mahlo. Ka lebaka la liphetoho tse boletsoeng ka har'a retina, pono e fokotsehile, ho hlaha makhetlo a mabeli, ho na le ho senyeha ho hoholo kapa esita le ho lahleheloa ke pono.

Mathata a ka ba teng a lefu la tsoekere

Motsoako oa lefu la tsoekere le khatello e phahameng ea mali li thusa ho hlaha le ho hatela pele ka potlako ha:

• atherosulinosis - myocardial ischemia (angina pectoris, ho nyekeloa ke pelo), bokong (discirculatory encephalopathy, stroke), maoto le matsoho (leseli le senyehileng le nang le phallo ea methapo ea kelello),
• ho nyekeloa ke pelo le ho thekesela ha mali maling, sebete,
• chefo e matla le lefu la tsoekere le phello ea ho se sebetse hantle ha methapo.
• retinopathy (liphetoho ka har'a lijana tsa retina), glaucoma, hemorrhages kahare ho retina, ho tsoa ha eona ka lebaka la ho lahleheloa ke pono,
• bofokoli ba botona le botšehali ho banna, bo fokotsehe ho khahloa ke ba bong bo bobeli.

Seo u lokelang ho se sebelisa lipilisi tsa khatello ea khatello

Ho ea ka liphuputso, ke karolo ea boraro feela ea bakuli ba nang le lefu la tsoekere e laolang khatello ea mali, mme ba ka tlase ho 17% ba fihletse boemo bo lakatsehang. Boemo bo mpefatsoa ke taba ea hore marang-rang a litlama a na le li-bioadditives le lithethefatsi tse ling tse bohlokoa tsa bobeli. Kaha khatello ea mali le lefu la tsoekere li atile, ho na le lipapatso tse fetang tse lekaneng bakeng sa ho lahla hang-hang ka thuso ea "mekhoa ea mohlolo".

Ho bohlokoa ho utloisisa hore o ka sebelisa lipilisi leha e le life, empa ke ba fokolang ba nang le phello e netefalitsoeng ea kalafo. Mohlala, ho na le amino acid Taurine e nang le sebabole bakeng sa tšebeliso ea lefu la tsoekere, khatello ea mali le ho nyekeloa ke pelo.

Setlhare se tloaela metabolism ea mafura, se ntlafatsa ts'ebetso ea litšusumetso bokong, hape se na le ts'ebetso ea anticonvulsant. Kameho ea eona khatello ea mali le eona e teng, empa e ke ke ea hlahisoa ke moemeli oa hypotensive. Liteko tsohle tsa bophelo bo botle, tsa ho iphekola li fela ka mathata.

Li-inhibitors tsa ACE le bahanyetsi ba li-receptor ba angiotensin

Angiotensin-converting enzyme (ACE) e khothaletsa sebopeho sa angiotensin 2. Ntho ena e nang le thepa e matla ea vasoconstrictor, ha boemo ba eona bo eketseha bo eketsa khatello ea mali. Sehlopha sa ACE inhibitors se thibela karabelo ena, mme bahanyetsi ba receptor ha ba lumelle angiotensin 2 e seng e entsoe hore e hlahise phello ea eona.

Lihlopha tsena tse peli tsa lithethefatsi ke tsona tsa bohlokoahali ho phekoleng lefu la tsoekere le khatello ea mali. Sena se bakoa ke taba ea hore:

• sirelletsa lisele tsa menoana hore li se ke tsa senyeha eseng ka lebaka la kalafo ea methapo ea mali, empa le ho holisa methapo ea methapo, ho fokotsa khatello ka hare ho glomerulus, lahleheloa ke protheine, ho nolofatsa ts'ebetso ea ho hlohlona ha moroto,
• thusa ho fokotsa moroalo o ka pelong ka ho hloleha ho potoloha,
• ntlafatsa kutloisiso ea lithane ho insulin.

Barekisi ba Angiotensin 2 ba mamelletsehile hantle, kaha ba na le phello e itseng 'meleng, hape ba ka fokotsa botenya ba mesifa ea pelo ea "ventricle" e setseng. Li-inhibitors tse sebetsang ka ho fetisisa tsa ACE:

Li-blocker tse sebetsang hantle haholo:

Lithethefatsi tsa diuretic

Bakeng sa kalafo o sebelisa diuretic ho tsoa sehlopheng sa thiazides - Hypothiazide ka litekanyetso tse nyane. Hangata, e fanoa e le karolo ea litlhare tse kopaneng tsa antihypertensive. Ka tekanyo ea ho fihlela ho 25 mg ka letsatsi, ha e ferekanye phapanyetsano ea tsoekere le cholesterol, li-celts tsa moroto le tekanyo ea letsoai. E kopantsoe le nephropathy. Litokisetso tse kang Thiazide Arifon, Indapamide li mamelloa hantle 'me li sireletsa liphio hore li se ke tsa senngoa. Kameho ea li-diuretics tse ling tsa tsoekere ha e netefatsoe.

Beta blockers

E bontšoa bakeng sa ho nyekeloa ke pelo, angina pectoris, kamora ho hlaseloa ke pelo. Ho bohlokoa ho ela hloko hore ts'ebeliso ea bona e emisa ponts'o ea ho theoha ha tsoekere ea mali. Ka hona, motho ea nang le lefu la tsoekere a ka lahleheloa ke ho qala ha tlhaselo ea hypoglycemia, haholo-holo libekeng tsa pele tsa kamohelo. Lithethefatsi tsa pelo li nka monyetla. Sena se bolela hore li thibela li-receptors ka har'a mesifa ea pelo mme ha li na tšusumetso ho litho tse ling.

Le lefu la tsoekere la pelo ea methapo (lefu la pelo), Nebival, Carvedilol, ke tsona tse sireletsehileng haholo.

Likhohlano tsa calcium

Monyetla oa tsona ke ho haella ha metabolism. Litsebi tsa lefu la tsoekere li bonts'oa lithethefatsi tse nkang nako e telele, li thusa ho thibela stroke. Li sebelisoa khafetsa kalafong e rarahaneng ea khatello ea mali. Bakuli ba behiloe Norvask, Nimotop, Lerkamen, retardat ea Adalat. Boemong ba pele ho sebopeho kapa ho hloleha ha pelo, matlapa a etsang lintho tse khuts'oanyane ha a lumelloa.

Ka nephropathy, li sebelisoa ka mokhoa o fokolang, hangata Cinnarizine le Diacordin retard.

Li-agonists (li-stimulants) tsa li-imidazoline receptors

Ka lebaka la ts'ebetso ea kutu ea boko, ts'ebetso ea methapo ea kutloelo-bohloko e fokotsehile: ba khatholla lebota la methapo, ba khutsisa, ba etsa hore sekhahla se otsele. Li nkuoa li le sehlopha se ts'episang lefu la tsoekere, kaha li fokotsa ho hanyetsa ha insulin hape li kenya letsoho ho phatloha hoa mafura. Meriana e tsebahalang haholo ke Physiotens, Albarel.

Li-blocker tsa Alpha

Phallo ea mali e tlase, ntlafatsa metabolism ea lik'habohaedreite le mafura. Empa ba na le thepa ea bohlokoa e fosahetseng - ba baka khatello e kholo ea khatello (ho akheha, ho putlama ha vascular). Ka hona, ka lefu la tsoekere, ha ho ratehe ho li sebelisa. Ho kotsi haholo ho fana ka taelo ka mor'a lilemo tse 55, boteng ba neuropathy. Kardura le Setegis hangata li khothaletsoa ka ho holisa ho kopaneng ha boholo ba tšoelesa ea senya.

Lijo tse nang le phepo li ama khatello ea mali joang

Haeba mokuli ea nang le lefu la tsoekere a fumanoa a e-na le keketseho e leka-lekaneng ho khatello (ho fihlela ho 65-150 / 85-90 mm Hg) ka lekhetlo la pele, joale bakeng sa khoeli ho theola boima ba 'mele le ho fokotsa letsoai lijong ho isa ho 3 g ka letsatsi ho ka khothaletsoa. Sena se bakoa ke taba ea hore hangata khatello ea mali e na le netefatso ea letsoai. Haeba mokuli ea nang le lefu la tsoekere la mofuta oa 2 a khona ho fokotsa boima ba 5% ho tloha qalong, o na le:

• 25% kotsing e tlase ea mathata a bolaeang,
• matšoao a khatello a tla theoha ka karolelano ea likarolo tse 10,
• glucose ea mali e tla fokotseha ka 35-45% le hemoglobin ea glycated ka 15%,
• Boemo ba lipid bo tloaelehileng.

Melao ea ho ja bakeng sa khatello ea mali le lefu la tsoekere

Ho mofuta oa 1 lefu la tsoekere, khatello ea mali e etsahala le nephropathy. Ka hona, ho bohlokoa ho fetohela ho pheha ntle le letsoai, mme 2-3 g e fuoa mokuli matsohong a hae bakeng sa letsoai. E khothalelitsoe ho kenyelletsoa ka har'a menu:

• salate ea oli ea limela,
• lithuto tsa pele tsa meroho
• nama e phehiloeng, moro o lokela ho tšeloa. Ke mefuta e nang le mafura a tlase feela e lumelloang,
• litlhapi tse tsoakiloeng kapa tse phehiloeng, li-meatball le li-meatball tse tsamaisitsoeng,
• chisi e nang le mafura a tlase, lino tse lactic,
• meroho e phehiloeng, casseroles,
• buckwheat le oatmeal
• Litholoana tse se nang litholoana le monokotsoai.

Lijo ha lia lokela ho ba li-canned, chisi, nama e tsubelo, lisoseji, linoko tse chesang, confectionery.

Ka botenya le khatello e phahameng ea mali, ho fanoa ka lijo tse nang le khalori e tlase. Lijo tse nang le lik'habohaedreite ho bohlokoa ho li khetha ka index e tlase ea glycemic. Meroho e sa sebelisoeng e ncha le e phehiloeng e sa tsoakoang - hop, likomkomere, zucchini, tamati, li-eggplant, meroho ea salate. Palo ea bohobe le lijo-thollo li lekantsoe. Lithollo le lipalesa li sebelisoa feela bakeng sa sopho.

Tlas'a thibelo e thata:

• tsoekere, liswiti,
• lisoso tse entsoeng ka linaoa tse tsoekere, lino tse tsoekere, senepe se tsoekere,
• lijo tse potlakileng tsa lijo
• joala
• Nama e mafura,
• pickles, a tsuba, marinade,
• litapole tse khotliloeng kapa sopho,
• bijoux, raese e tšoeu, motsoala, bulgur,
• lihoete tse phehiloeng le li-beet,
• litholoana tse monate
• tranelate, chisi ea chate e tsoang mafura a 5%.

Mokhoa oa mokuli

Haeba pele ho moo, moeli o kaholimo oa tloaelo o ne o nkuoa e le 140/90 mm RT. Art., Joale ka selemo sa 2017, Mokhatlo oa Amerika oa Pelo o khothalelitse hore nako ea lipakeng tsa 130/80 ho isa ho 140/90 e fihle maemong a pele a khatello ea mali. Bakeng sa batho ba nang le lefu la tsoekere, le pele ho moo, boemo ba 130/80 bo ne bo sa khothalletsoa hore bo fetisoe. Ha nako e ntse e tsamaea, mohlomong sekaseka sena se tla fokotseha.

Liphetoho tse joalo li bakoa ke se netefalitsoeng: ka khatello ea systolic pakeng tsa 120 le 130 mm Hg. Art. kotsi ea mathata a methapo ea methapo e fokola haholo. Ka hona, ho khothalletsoa hore esita le bakuli bao khatello ea bona e leng haufi le e tloaelehileng ba etse liphetoho mokhoeng oa bona oa bophelo. Ho feta 130/80 mm RT. Art. Melao ena e hlokahala haholo:

• ho khaotsa ho tsuba le tlhekefetso ea joala,
• ho kenyelletsoa lijong tsa lijo tse nang le mafura, haholo-holo tse nang le cholesterol e ngata (nama e nang le mafura, li-offal, lihlahisoa tse feliloeng), liswiki le li-pastry, letsoai la tafole le fetang 3-5 g,
• ho ikoetlisa letsatsi le letsatsi bonyane halofo ea hora,
• tlhokomeliso ea khatello ea mali,
• tšebeliso ea lithethefatsi ho phekola khatello ea mali,
• ho latela molao oa mots'eare, ho hana mosebetsi oa bosiu,
• ho tseba mekhoa ea ho phomola tlas'a khatello ea maikutlo (boikoetliso ba ho phefumoloha, yoga, ho thuisa, ho tsamaea ka tlhaho, 'mino o khutsitseng, aromatherapy), acupressure (pheletso e ka hare ea leseka la mahlo, sebaka sa bohloko bo tlase tlasa occiput, bohare ba moqhaka).

Mona ke ho eketsehileng mabapi le hore na mefuta ea lefu la tsoekere ke eng.

Lefu la tsoekere le khatello ea mali li tiisa lipono tsa e mong. Ho mofuta oa 1 lefu la tsoekere, nephropathy ke sesosa sa khatello e phahameng ea mali, 'me ho lefu la tsoekere la mofuta oa 2, botenya le khatello ea insulin ke tsona lisosa. Liponahatso hangata ha li hlalosoe, ka hona ho bohlokoa ho lekanya matšoao khafetsa. Li-inhibitors tsa ACE le lingiotensin 2 receptor antagonists, phekolo ea ho kopanya e loketse hantle bakeng sa phokotso ea bona ea lefu la tsoekere.

Ho khothalletsoa hape ho fetola lijo, ho fokotsa boima ba 'mele le ho tlohela mekhoa e mebe.

Mefuta ea khatello ea mali

Keketseho ea khatello ea betheng ea methapo tlas'a maemo a lefu la tsoekere e hlalosoa e le khatello ea mali ea systolic ≥ 140 mmHg. le khatello ea mali ea diastolic ≥ 90 mmHg Ho na le mefuta e 'meli ea khatello e phahameng ea mali (BP) ho lefu la tsoekere:

• Tekanyo ea khatello ea methapo ea kelello sethaleng sa lefu la tsoekere,
• Hypertension ka lebaka la lefu la tsoekere lephropathy,

Leabetes lephropathy ke e 'ngoe ea mathata a mantlha a amanang le lefu la tsoekere' me ke sesosa se ka sehloohong sa ho hloleha ha renal ho sa sebetse hantle lefats'eng la Bophirimela. Hape motsoako o ka sehloohong oa ho fokola hoa mmele le lefu ho bakuli ba nang le lefu la tsoekere la mofuta oa 2 le mofuta oa 2. Khafetsa, lefu la tsoekere la mofuta oa 1 le bonahatsoa ke khatello ea mali ka lebaka la kholo ea methapo ea methapo ea methapo. Ho bakuli ba nang le lefu la tsoekere la mofuta oa 2 lefu la tsoekere, khatello e phahameng ea mali hangata e ba teng pele ho ponahatso ea mantlha ea lipontšo lipakeng tsa liphio. Phuputsong e 'ngoe, 70% ea bakuli ba nang le mofuta oa 2 mellitus o sa tsoa fumanoa.

Lisosa tsa khatello ea mali ho lefu la tsoekere

Lefatšeng, batho ba ka bang limilione tse 970 ba na le khatello ea mali. WHO e nka khatello ea mali e le e 'ngoe ea lisosa tsa bohlokoahali tsa ho shoa pele ho nako lefatšeng,' me bothata bona boa ata. Ka 2025, ho hakanngoa hore ho tla ba le batho ba limilione tse likete tse 1,5 ba phelang le khatello e phahameng ea mali. Hypertension e hlaha ka lebaka la lintho tsa mantlha tse teng ka boithatelo kapa hammoho:

• Pelo e sebetsa ka matla a maholo, e pompa mali methapong.
• Li-vessels (arterioles) tsa spasmodic kapa tse koetsoeng ka liathomo tsa methapo e thibelang phallo ea mali.

Motsoako o eketsehileng oa mali le khatello ea mali li na le litsela tse tloaelehileng tsa pathogeneis, joalo ka tsamaiso ea methapo e nang le kutloelo-bohloko, renin-angiotensin-aldosterone system. Litsela tsena lia hokahana ebile lia susumetsa 'me li etsa potoloho e mpe. Hypertension le lefu la tsoekere ke litlamorao tsa metabolic syndrome. Ka hona, ba ka holisa e mong ka mor'a e mong ho motho a le mong kapa ka boikemelo ho e mong.

Lintho tse Kotsi le Matšoao

Ho latela American Diabetes Association, motsoako oa li-pathologies tse peli o bolaea haholo mme o eketsa menyetla ea ho tšoaroa ke lefu la pelo kapa stroke. Mofuta oa 2 oa lefu la tsoekere le khatello ea mali hape li eketsa menyetla ea tšenyo ea litho le litsamaiso tse ling, joalo ka tšenyo ea lijana tsa nephron le lipono tsa retinopathy (methapo ea methapo ea leihlo). 2,6% ea bofofu e hlaha ho lefu la tsoekere la retinopathy. Lefu la tsoekere le sa laoloeng ha se lona feela lebaka la bophelo bo botle le eketsang kotsi ea khatello e phahameng ea mali. Monyetla oa "neonosis ea pelo" kapa "hemorrhage" ea mokokotlo o eketseha haholo haeba ho na le lintlha tse latelang tse fetang tse latelang.

• khatello ea maikutlo
• ja lijo tse nang le mafura a mangata, letsoai,
• bophelo bo lutseng, adynamia,
• botsofali
• botenya
• ho tsuba
• ho nwa joala
• mafu a sa foleng.

Ha e le molao, khatello ea mali ha e na matšoao a itseng mme e tsamaisana le hlooho, ho tsekela le ho ruruha. Ke kahoo u hlokang ho hlahloba khatello ea mali ea hau khafetsa. Ngaka e tla e lekanya ketelong e 'ngoe le e' ngoe, hape e khothaletse ho e hlahloba lapeng letsatsi le leng le le leng. Matšoao a tloaelehileng a lefu la tsoekere ke:

• khafetsa ho ntša
• lenyora le matla le tlala
• boima ba 'mele kapa ho fokotsa boima ba' mele kapele,
• ts'ebetso ea thobalano e motona,
• ho tsieleha le ho tsukutla matsohong le maotong.

U ka fokotsa khatello joang?

Boteng ba litekanyo tse phahameng tsa tsoekere, ho khothalletsoa ho boloka khatello ea mali ho 140/90 mm Hg. Art. le ka tlase. Haeba lipalo tsa khatello li phahame, kalafo ka lithethefatsi tsa antihypertensive e lokela ho qala. Hape, mathata a liphio, mahlo a mahlo kapa ho ba teng ha setorouku ke matšoao a hlakileng a kalafo. Khetho ea lithethefatsi e khethoa ka bonngoe ke ngaka e eang ho latela lilemo, mafu a sa foleng, nete ea lefu lena, mamello ho moriana.

Lithethefatsi tsa kalafo ka mokhoa o tšoanang

Phekolo ea khatello ea mali ho lefu la tsoekere e lokela ho ba e felletseng. Lithethefatsi tsa pele tsa antihypertensive li kenyelletsa lihlopha tse 5. Moriana oa pele o sebelisoang hangata bakeng sa lefu la tsoekere le kopantsoeng ke sethethefatsi se tsoang sehlopheng sa li-angiotensin se fetolang enzyme inhibitors.. Ka mamello ho li-inhibitors tsa ACE, ho laetsoe sehlopha sa angiotensin 2 receptor blockers (sartans). Ntle le litlamorao tsa khatello ea maikutlo (khatello ea ho theola khatello ea maikutlo), lithethefatsi tsena li ka thibela kapa tsa fokotsa ts'abo ea methapo ea liphio le retina bathong ba nang le lefu la tsoekere. Inhibitor ea ACE ha ea lokela ho kopanngoa le angiotensin 2 receptor antagonist kalafong. Ho ntlafatsa phello ea lithethefatsi tse felisang kalafo, li-diuretics li eketsoa bakeng sa kalafo, empa feela ka khothaletso ea ngaka e eang.

Lijo joaloka mokhoa oa bophelo

Senotlolo mokhoeng oa ho phekola lefu la tsoekere le khatello ea mali ke ho bala palo ea lik'habohaedreite, ho ja tsoekere e fokolang le ho fokotseha ha letsoai le sebelisoang lijong. Malebela ana a tla u thusa ho boloka litaelo tsena:

1. Letsoai le fokolang le bolela linoko tse ling.
2. Poleiti ea lijo e tšoana le oache. Halofo ea poleiti e entsoe ka meroho le litholoana, kotara ke lijo tsa protheine mme se setseng ke lik'habohaedreite (lijo-thollo kaofela).
3. Fokotsa tšebeliso ea hau ea k'hafeine. E eketsa khatello ea mali hape e eketsa cholesterol ea mali.
4. E-ja lijo-thollo kaofela tse nang le livithamini tse ngata, liminerale le fiber.
5. Ho hana joala. Biri, veine, le bongata ba li-smoothie li na le tsoekere, e ka bakang tsoekere ea mali. Joala le bona bo tsosa takatso ea lijo 'me bo ka baka ho nona haholo.
6. Pheha lijo ka ontong kapa ho pheha. Qoba lijo tse halikiloeng.
7. Tlosa mafura a "mabe".

Thibelo ea khatello ea mali le lefu la tsoekere

Ts'ebetso ea bophelo e lula e le lejoe boits'isong ho thibela le ho phekola lefu la tsoekere le khatello ea mali. Ho ikoetlisa hantle ho fihlela metsotso e 30 letsatsi le leng le le leng, ho ja ka mokhoa o leka-lekaneng, taolo ea khatello ea mali, tsoekere le lipids tsa mali, ho lahla mekhoa e mebe - ho tla fokotsa menyetla ea ho eketsa khatello ea mali moo ho nang le lefu la tsoekere.

Ho lekola maemo a tsoekere maling ho fokotsa menyetla ea lefu la pelo le liphesente tse 42 le kotsi ea ho otloa ke pelo, ho otloa kapa lefu ka lebaka la lefu la pelo le 57%. Taolo ea lipids maling e fokotsa mathata a lefu la pelo le 20-50%. Ho fokotsa boima ba 'mele le ho lokisa boima ba' mele hammoho le ho phela bophelo bo phetseng hantle ha ho na ho ntlafatsa tsela ea lefu la tsoekere feela, empa hape ho tla ntlafatsa bophelo bo botle.

Mefuta ea lefu lena

Tekanyo e phahameng ea tsoekere ho tsoekere e senya karolo e ka hare ea bethe ea methapo. Sena se senya tlhahiso ea li-vasodilating tse ho eona, se fokotsa ho rarahana ha methapo ea methapo mme se lebisa kholong ea khatello ea mali.

Ka tšenyo ea lijana tsa liphio, e leng sesupo sa lefu la tsoekere, lefu la tsoekere le hlaha. Liphio li qala ho pata lintho tse ngata tsa vasoconstrictor tse bakang khatello ea methapo ea kutlo.

Keketseho ea khatello e amanang le khatello ea mali ea mantlha (ea mantlha) e bonoa ho 80% ea bakuli. Ba 20% ba setseng ba na le mathata a khatello ea mali e phahameng. Karolong e nyane ea bakuli, keketseho ea khatello e bakoa ke ho fokotseha ha methapo ea kutlo, pyelonephritis, glomerulonephritis.

Hypertension ea bobeli e amanang le lefu la tsoekere hangata le hlaha khahlano le semelo sa lefu la tsoekere la mofuta oa. Mofuta ona oa lefu o hlaha ho batho ba bacha mme o tsamaisana le tšenyo e potlakileng ea lithane tsa menoana. Lilemo tse 10 kamora ho qaptjoa ha methapo ea mafu, halofo ea bakuli bana e eketsa khatello haholo.

Hobaneng lefu la tsoekere la tsoekere le kotsi haholo?

Ho kopana ha khatello e phahameng ea mali le lefu la tsoekere la mofuta oa 2 haholo ho eketsa kotsi ea ho otloa ke lefu la pelo le lefu la pelo. Monyetla oa ho hloleha ha liphio oa eketseha. Tšenyo e tsoelang pele ea likepe tsa fundus e ka lebisa bofofu.

Retinopathy e nang le khatello ea methapo ea methapo le lefu la tsoekere e tsoela pele ka potlako 'me e ka lebisa bofofu

Hypertension e potlakisa ho qaleha hoa ts'oaetso ea kelello e amanang le lilemo, joalo ka lefu la Alzheimer le 'dementia' (senile dementia).

Kotsi ea ho kopana ha maloetse ana a mabeli e bohlokoa haholo ha ho e-na le mabaka a mang a kotsi:

• linyeoe tsa tlolo ea molao o bolotsana har'a beng ka motho ea haufi,
• khatello ea maikutlo
• Lijo tse nang le mafura le letsoai le lengata
• ho hloka boikoetliso
• botsofali
• ho nona haholo
• ho tsuba
• ho haella ha potasiamo kapa vithamine D,
• bokhoba ba joala
• Lefu le kopaneng la ausi, boroko bo sitisang ho robala.

Lipheo tsa bohlokoa tsa kalafo

Phekolo ea mali le lefu la tsoekere lia thatafatsa. Tsoelo-pele ea pathology e tsamaisana le kotsi e eketsehang ea mathata (ho nyekeloa ke pelo, ho otloa ke pelo, ho hloleha ha pelo) le ho se sebetse hantle ha methapo.

Phekolo ea khatello ea mali ho mellitus ea lefu la tsoekere e na le sepheo se latelang:

• kotsi e fokotsehileng ea mathata a tsoang pelong le methapong ea mali,
• Phokotso ea ho shoa hoa batho matsatsing ana,
• Thibelo ea ho se sebetse hantle ha masapo,
• ho ntlafatsa bophelo ba mokuli,
• ho boloka maemo a tloaelehileng a "glucose" (phello e sa nkeng lehlakore ho metabolism ea carbohydrate).

Khetho ea lithethefatsi

Phekolo ea khatello ea mali ho lefu la tsoekere mellitus e lokela ho qala ka angiotensin-converting enzyme inhibitors (ACE inhibitors). Ts'ebetso ea bona e bontšitsoe ke lithuto tsa machabeng.

Ka ts'ebetso e sa lekanang ea li-inhibitors tsa ACE, li-antagonists tsa calcium (amlodipine, felodipine) li eketsoa ho tsa bongaka. Motsoako ona o sireletsa pelo liphellong tse mpe tsa tsoekere e feteletseng.

Haeba ho hlokahala, li-inhibitors tsa ACE li ka kopanngoa le diuretics. Khetho e lokela ho fanoa ho indapamide, e le lithethefatsi tse sa jeleng paate haholo tsa diuretics tsohle.

Haeba khatello ea methapo ea methapo ho bakuli ba nang le lefu la tsoekere e kopana le lefu la pelo (angina pectoris, lefu la pelo), beta-blockers e lokela ho eketsoa kalafong. U hloka ho khetha tse sa amang metabolism ea carbohydrate. Lithethefatsi tsena li kenyelletsa beta-blockers ea pelo, haholo-holo, bisoprolol, carvedilol, nebivolol. Meriana ena e lokela ho sebelisoa ho thibela lefu la pelo le lefu la tšohanyetso.

Khetho ea bongaka e boetse e itšetlehile ka phello ea eona ts'ebetsong ea renal. Ho netefalitsoe hore li-inhibitors tsa ACE le indapamide li fokotsa tlhahiso ea protheine ka har'a morara ebe ka tsela eo li thibela nts'etsopele ea ho se sebetse hantle, le bahanyetsi ba calcium (verapamil le diltiazem) ba na le phello e ts'oanang. Lithethefatsi tsena li ka sebelisoa hape kalafong e rarahaneng ea khatello ea mali ho lefu la tsoekere. Tabeng ea ho se mamellane ho li-inhibitors tsa ACE, ho behiloe li-angiotensin II receptor blockers - sartans (valsartan).

Tšusumetso ea lithethefatsi maemong a kakaretso

Mekhoa e meng ea khatello ea khatello ea mali e ama metabolism ea carbohydrate hampe, ka hona ha e khothalletsoe hore e sebelisoe tsoekere. Sena se sebetsa ho li-thiazide diuretics le beta-blockers.

Mofuta o sebelisoang ka ho fetisisa oa thiazide ke hypothiazide. Ho ka baka keketseho ea glucose ea mali le ho ata ha hemoglobin ea glycosylated. Khahlano le nalane ea ts'ebetso ea eona, mamello ea tsoekere (mamello) ea mpefala. Case e tsejoa ha ho se ketonemic hyperosmolar coma e ntlafalitsoeng nakong ea tsamaiso ea hypothiazide. Sena se bakoa ke khatello ea "insulin secretion" le phokotseho ea kutlo ea lisele tsa mmele ho "hormone" ena.

Litlamorao tse bakang lefu la tsoekere le la beta-blockers. Lithethefatsi:

• fokotsa lebelo tlhahiso ea insulin,
• eketsa ho hanyetsa lisele (ho hanyetsa insulin),
• ho thibela ho monya ha tsoekere ka lisele,
• eketsa secretion ea kholo ea kholo - mohanyetsi oa insulin.

Ka lebaka leo, tsoekere e potlakileng e phahama ka mor'a ho ja. Ho tlalehiloe ka maemo a ntlafatso ea lefu la tsoekere.

Li-blockers tsa Beta li pata matšoao a ho haella ha tsoekere maling maling, e leng se etsang hore ho be thata ho tsebahatsa hypoglycemia. Li boetse li thibela phallo ea tšohanyetso ea lik'habohaedreite ka mohlala, nakong ea ha motho a ikoetlisa. Sena se lebisa nts'etsopele ea maemo a hypoglycemic khafetsa.

Boithuto bo bontšitse hore le ho batho ba nang le maemo a tloaelehileng a tsoekere ea mali ka kalafo ea nako e telele ka li-thiazides le beta-blockers, kotsi ea ho ba le lefu la tsoekere e phahame ho feta ka kalafo le li-inhibitors tsa ACE.

Thibelo ea khatello ea mali ho lefu la tsoekere

Ho qoba mathata a tebileng a mafu ana, mokuli o lokela ho fokotsa ho ja letsoai la tafoleng le ho eketsa ho ikoetlisa. Ho tsamaea ho khothalletsoa metsotso e 20 ho isa ho e 30 ka letsatsi, kapa ketso efe kapa efe ea kantle ka metsotso e 90 ka beke. Ho bohlokoa hore u tlohele lifti ebe u sebelisa koloi moo u ka tsamaeang teng.

Ho bohlokoa ho latela lijo tse nang le khalori e tlase, thibelo ho ja lijo tsa letsoai, tsoekere, nama le lihlahisoa tsa lebese tse mafura. Mehato ena e reretsoe ho phekola botenya. Ho ba motenya ke ntho ea bohlokoa ho qaleng le tsoekere ea lefu la tsoekere. Normalization ea boima ba 'mele e ntlafatsa ho monya ha tsoekere ke liseleng mme e baka phokotseho e kholo ea khatello ea mali.

Litlhahiso tsa phepo e nepahetseng bakeng sa bakuli ba nang le khatello ea mali le lefu la tsoekere:

• ja litholoana le meroho e mengata
• jang feela lihlahisoa tsa lebese tse mafura a tlase,
• qoba lijo tse letsoai le tse halikiloeng, hangata u sebelise ho utsoa kapa ho baka,
• ja lijo-thollo tse halikiloeng, raese e sootho, pasta feela ka koro ea durum,
• fokotsa ho ja lijo,
• etsa bonnete ba hore o ja lijo tsa hoseng.

Khafetsa batho ba nang le lefu la tsoekere ba "koetse" khatello ea mali, e sa fumanoeng ka litekanyo tse sa tloaelehang, empa e na le litlamorao tse mpe ho boemo ba likepe. Ka hona, bakuli bohle ba nang le lefu la tsoekere ba lokela ho etsa tlhahlobo ea khatello ea mali letsatsi le letsatsi. Phekolo ea lithethefatsi e lokela ho qalisoa ka palo e nyane e nyane.

Lefu la tsoekere hangata le thatafalloa ke khatello ea mali kapa khatello e phahameng ea mali. Ho kopana ha maloetse ana a mabeli ho eketsa kotsi ea ho ba le mathata a tsoang pelong, liphio, mahlo, bokong le litho tse ling. Ho qoba sena, ho hlokahala hore ho hlahlojoe mokhoa oa ts'ebetso, phepo e nepahetseng, ho hlahlojoa ka nako le ho sebelisa meriana e boletsoeng ke ngaka ea hau.

Hoa utloahala ho nka livithamini bakeng sa khatello ea mali, hobane ho pakoa hore li fokotsa khatello ea mali. Ke efe e lokelang ho nooa? Na magnesium B6 le li-analogues tsa eona li tla thusa?

Sartane le litokisetso tse nang le tsona li laetsoe, haeba ho hlokahala, fokotsa khatello. Ho na le sehlopha se ikhethileng sa lithethefatsi, hape li arotsoe ka lihlopha. U ka khetha moloko o kopaneng kapa oa morao-rao ho latela bothata.

Ha e mpe haholo bakeng sa batho ba phetseng hantle, ho kopana le lefu la tsoekere ho ka ba kotsi haholo ho bakuli. Ho kotsi haholo ho lefu la tsoekere la mofuta oa 2 kaha le ka fetoha sesosa sa ho otloa ke lefu la stroke le pelo.

Ka nako e ts'oanang, lefu la tsoekere le angina pectoris li beha kotsi e kholo bophelong bo botle. U ka phekola angina pectoris ka lefu la tsoekere la mofuta oa 2? Ho na le litšitiso life tsa pelo tse ka hlahang?

Lijo tse nepahetseng bakeng sa lefu la pelo li ka thusa ho boloka maemo a le maemong. Lijo tse phetseng hantle le phepo e nepahetseng bakeng sa angina pectoris le pelo ischemia e tla tšehetsa 'mele.

Phekolo ea methapo ea methapo botsofaling e ka senya haholo mokhoa oa bophelo. Ho na le mekhoa e 'maloa e sebetsang ea ho sebetsana le eona.

Hoo e ka bang ha ho motho ea atlehileng ho qoba nts'etsopele ea lefu la tsoekere ho lefu la tsoekere. Li-pathologies tsena tse peli li na le kamano e haufi, hobane tsoekere e eketsehang e ama hampe marako a methapo ea mali, e leng ho bakang nts'etsopele ea atherosulinosis ea maemo a tlase a bakuli. Phekolo e etsahala ka lijo.

Batho ba nang le lefu la tsoekere ba kotsing ea ho tšoaroa ke lefu la pelo. Ho kenella kahara lefu la tsoekere ho ka lebisa lefung. Ho tšoaroa ke pelo ho matla ho potlakile. Ka mofuta oa 2, tšoso e phahame. Phekolo e ea joang? Litšobotsi tsa eona ke life? Ho hlokahala lijo tsa mofuta ofe?

Haeba ts'ebetso ea ho khetholla lefu la angina e fetelletseng e fumaneha, kalafo e tla lebisoa pele ho motso oa kholo ea bothata, mohlala, lefu la pelo. M kalafo ea kalafo ea "angina pectoris" e etsahala sepetlele.

Pathogenesis ea khatello ea mali ka mofuta oa 1 lefu la tsoekere

Ho mofuta oa 1 lefu la tsoekere, mofuta oa khatello ea mali ke 80-90% e amanang le nts'etsopele ea DN. E bonoa ho 35-40% ea bakuli ba nang le lefu la tsoekere la mofuta oa 1 mme ba feta methating e 'maloa: sethala sa MAU, sethala sa PU le boemo ba ho se sebetse hantle ha real. Keketseho ea khatello ea mali (> 130/80 mm Hg) e bonoa ho 20% ea bakuli ba nang le MAU, ho 70% sethaleng sa PU le ka 95-100% sethaleng sa ho hloleha ha renal ho sa foleng. Lithutong tsa rona, ho ile ha bonoa khokahano e phahameng lipakeng tsa boemo ba protheine ea moroto le tekanyo ea khatello ea mali. Chelete e kopaneng ea khatello ea mali le MAU e ne e le 0,62 (p 160/95 mm RT. Art.),
- 63% ea batho ba nang le hyperuricemia (litaba tsa serum uric acid> 416 μmol / L ho banna le> 387 μmol / L ho basali),
- 84% ea batho ba nang le hypertriglyceridemia (TG> 2.85 mmol / L),
- 88% ea batho ba nang le cholesterol e tlase ea HDL (7.8 mmol / L le lihora tse 2 kamora ho tsitsa ha glucose> 11.1 mmol / L).

Ka motsoako oa lefu la tsoekere la mofuta oa 2 (kapa NTG) le dyslipidemia, hyperuricemia le khatello ea mali, i.e., ka likarolo tsa mantlha tsa metabolic syndrome, sekhahla sa ho lemoha IR e ne e le 95%. Sena se fana ka maikutlo a hore, ha e le hantle, mochini o ka sehloohong oa nts'etsopele ea metabolic syndrome ke IR.

Karolo ea IR ho nts'etsopele ea lefu la tsoekere la mofuta oa 2

Peripheral tishu ea IR e theha nts'etsopele ea lefu la tsoekere la 2. Ho bohlokoa ka ho fetisisa tleliniking ke tahlehelo ea methapo ea kutlo ea insulin methapong ea mesifa, adipose le lisele.IR ea lisele tsa mesifa e bontšoa ka ho fokotseha ha phallo ea tsoekere ho tsoa maling ho ea myocyte le ts'ebeliso ea eona liseleng tsa mesifa, adipose tiske - khahlanong le phello ea antilipolytic ea insulin, e lebisang ho bokelleng ha mafura acid acids (FFA) le glycerol. Li-FFAs li kena ka har'a sebete, moo e bang mohloli o ka sehloohong oa ho etsoa ha lipoprotein tsa atherogenic tsa density tse fokolang haholo (VLDL). Lithane tsa lisele IR li tšoauoa ka ho fokotseha ha 'mele oa glycogen le ts'ebetso ea ho phatloha ha glycogen ho glucose (glycogenolysis) le devovo glucose synthesis ho tsoa ho li-amino acid, lactate, pyruvate, glycerol (gluconeogeneis), ka lebaka leo glucose e tsoang ho sebete e kenang maling. Ts'ebetso tsena ka har'a sebete li sebetsoa ka lebaka la ho haella ha khatello ea bona ke insulin.

Peripheral tishu ea IR e etella pele nts'etsopele ea lefu la tsoekere la mofuta oa 2 mme e ka fumanoa lelapeng la bakuli ba nang le lefu la tsoekere la mofuta oa 2 ntle le mathata a metabolism ea carbohydrate. Ka nako e telele, IR e buselitsoe ke tlhahiso ea insulin e fetelletseng ke li-pancreatic β-cell (hyperinsulinemia), e tšehetsang metabolism e tloaelehileng ea carbohydrate. Hyperinsulinemia e lekantsoe le matšoao a IR mme e nkuoa e le harbinger ea lefu la tsoekere la 2. Kamora moo, ka keketseho ea tekanyo ea IR, lisele tsa β-cell li emisa ho sebetsana le mojaro o eketsehileng oa glucose, o lebisang ho fokotsoeng butle-butle ha bokhoni ba sekhukhu ba insulin le pontšo ea bongaka ea lefu la tsoekere. Pele ho tsohle, karolo ea 1 ea insulin secretion (e potlakileng) e na le bothata ba ho arabela mojaro oa lijo, karolo ea 2 (karolo ea sechertion ea basal) le eona e qala ho fokotseha.

Hyperglycemia e ntlafalitsoeng e ntlafatsa leseli le ipatileng IR hape e hatella tšebetso ea sephiri sa insulin ea lisele tsa β. Mochine ona o bitsoa chefo ea glucose.

Ho lumeloa hore ketsahalo ea IR e na le motheo o tiileng oa liphatsa tsa lefutso, e tsitsitseng nakong ea ho iphetola ha lintho. Ho ea ka polelo ea "genotype ea moruo" e etelletsoeng pele ke V. Neel ka 1962, IR ke mochine o iphetotseng oa ho iphetola ha maemo a thata, ha linako tse ngata tsa ho fapana le linako tsa tlala. Ho ba teng ha IR ho netefalitse ho bokellana ha matla ka mokhoa oa ho beha mafura, mehloli ea ona e neng e lekane ho pholoha tlala. Nakong ea khetho ea tlhaho, liphatsa tsa lefutso tseo tse fanang ka IR le polokelo ea matla li ile tsa beoa e le tsona tse loketseng haholo. Motsoako ona o tiisoa tlhahlobong ea litoeba e ileng ea bolaoa ke tlala nako e telele. Ke litoeba feela tse ileng tsa pholoha tse neng li kene ka lipakeng IR. Maemong a kajeno, linaheng tse nang le maemo a phahameng a bophelo, tse tšoauoang ke ho se sebetse le phepo e matla ea khalori, methapo ea IR e bolokiloeng mohopolong oa liphatsa tsa lefutso e tsoela pele ho "sebetsa" ka polokelo ea matla, e lebisang ho botenya ka mpeng, dyslipidemia, khatello ea mali, 'me qetellong, mofuta oa lefu la tsoekere.

Ho fihla joale, bopaki bo lekaneng bo bokelletsoe ho fana ka maikutlo a hore IR le hyperinsulinemia ea eona e kopaneng ke lisosa tsa kotsi bakeng sa atherogeneis e potlakileng le lefu le phahameng la lefu la pelo. Phuputso e kholo ea IRAS (Insulin Resistance Atherosulinosis Study) e sa tsoa phetheloa, e neng e ikemiselitse ho lekola kamano pakeng tsa tlhahlobo ea IR (e khethiloeng ke tlhahlobo ea methapo ea methapo ea methapo) le mabaka a pelo bathong ba se nang lefu la tsoekere le bakuli ba nang le lefu la tsoekere la mofuta oa 2. lijana li ne li lekanya lebota la mokokotlo oa carotid artery. Phuputso e senotse kamano e hlakileng e hlakileng lipakeng tsa tekanyo ea IR le boima ba botoneng ba mpa, ts'ebetso ea ts'ebetso ea methapo, le botenya ba mokokotlo oa carotid ho batho ka bomong ntle le lefu la tsoekere le bakuli ba nang le lefu la tsoekere la 2. mokokotlo oa carotid o nyoloha ka likokoana-hloko tse 30.

Ho na le bopaki bo bongata ba kliniki ba hore hyperinsulinemia ke sesosa se ikemetseng sa lefu la pelo ho batho ba se nang lefu la tsoekere la 2: lithuto tse lebelletsoeng tsa Paris (tse ka bang 7000 tse hlahlobiloeng), Busselton (ho hlahlojoa ho fetang 1000) le Helsinki Policemen (982 e hlahlojoang) (meta-analysis ke B. Balkau et al. ) Lilemong tsa morao tjena, ho fumanoe ho itšetleha ka mokhoa o tšoanang ho bakuli ba nang le lefu la tsoekere la 2. Ho na le bopaki ba liteko ba tlhaiso-leseling ena. Mosebetsi oa R. Stout o fana ka maikutlo a hore insulin e na le phello e tobileng ea matla marakong a methapo ea mali, e baka ho eketseha le ho fetela ha lisele tse boreleli tsa mesifa, motsoako oa lipids o ho tsona, ho ata ha li-fibroblasts, ts'ebetso ea ts'ebetso ea methapo ea mali, le ho fokotseha hoa ts'ebetso ea fibrinolysis.

Kahoo, IR le hyperinsulinemia li kenya letsoho haholo ho ntlafatseng lefu la atherosclerosis ka bobeli ho batho ba reriloeng ho nts'etsopele ea lefu la tsoekere le ho bakuli ba lefu la tsoekere la mofuta oa 2.

Karolo ea IR ho nts'etsopele ea khatello ea mali

Kamano ea hyperinsulinemia (lets'oao la IR) le khatello ea methapo ea kutlo e matla haholo hoo ka bongata bo bongata ba insulin e tsoang ho mokuli, ho ka boleloang tsoelo-pele ea khatello ea khatello ea mali ho eena haufinyane. Ho feta moo, likamano tsena li ka qaptjoa ho bakuli ba nang le botenya le batho ba nang le boima ba 'mele bo tloaelehileng.

Ho na le mekhoa e 'maloa e hlalosang keketseho ea khatello ea mali ho hyperinsulinemia. Insulin e phahamisa ts'ebetso ea ts'ebetso ea methapo e nang le kutloelo-bohloko, e eketsa ho ts'oaroa ha Na le mokelikeli ka har'a li-renal tubules, ho bokellana ka bongata ha Na le Ca, insulin e le sesosa sa mitogenic e eketsang ho eketseha ha lisele tsa mesifa e boreleli, e lebisang ho teba ha lerako la sekepe.

Hypertension ke eng?

Ka moriana, lefu lena le hlalosoa e le keketseho e phehellang ea khatello ea mali ho tloha ho 140/90 mm Hg. Art. le holimo. Tekanyetso ea bohlokoa ea khatello ea mali e ka ba 90-95% ea linyeoe. E hlahella e le bokuli bo ikemetseng mme e tšoaea lefu la tsoekere la mofuta oa 2. Hypertension ho 70-80% ea linyeoe li tla pele ho lefu lena, 'me ke bakuli ba 30% feela ba ntlafatsang kamora ho senyeha ha meno. Ho na le hypertension ea bobeli (matšoao). E hlaha le lefu la tsoekere la mofuta oa 1.

Lisosa tsa khatello e phahameng ea mali bakeng sa lefu la tsoekere

Lisosa tsa nts'etsopele ea khatello ea mali e beoa ho latela mofuta oa lefu la tsoekere. Mofuta oa 1, 80% ea maemo a amanang le khatello ea mali ea methapo e hlaha ka lebaka la lefu la tsoekere le nephropathy, i.e. ka lebaka la ts'enyo ea liphio. Tabeng ea lefu la tsoekere la mofuta oa 2, khatello e tsoha le pele e etsahala. E etella pele lefu lena le tebileng, le sebetsa e le karolo ea metabolic syndrome.

Phapang lipakeng tsa mofuta oa lefu la tsoekere la mellitus (DM 1) ke tlhoko ea mokuli ea kamehla ea liente tsa insulin - ntho e thusang glucose ho kena liseleng, e netefatsang ts'ebetso ea bona ea bohlokoa. E khaotsa ho hlahisoa 'meleng ka boeona. Sesosa sa linyeoe tse ngata tsa lefu lena ke lefu la lipalo tse fetang 90% ea li-pancreatic cell. Mofuta ona oa lefu la tsoekere o itšetlehile ka insulin, o fuoa lefa ebile ha o fumanoe nakong ea bophelo. Har'a lisosa tsa khatello ea methapo ea mali le eona, ho hlokometsoe tse latelang:

• pathology ea endocrine system - 1-3%,
• Hypstension ea methapo e ikemetseng - 5-10%,
• khatello ea mali e bohlokoa - 10%,
• lefu la tsoekere lephropathy le mathata a mang a liphio - 80%.

Ho boetse ho na le mofuta oa "insulin" o ikemetseng oa lefu la tsoekere. E tloaelehile har'a batho ba baholo ka mor'a lilemo tse 40, empa ka linako tse ling e bonoa ho bana. Sesosa sa lefu lena ke tlhahiso e sa lekaneng ea insulin ke manyeme. Ka lebaka leo, lits'ebetso tsa metabolic li ke ke tsa tsoela pele ka mokhoa o tloaelehileng. T2DM e fumanoa nakong ea bophelo. E atile haholo ho bakuli ba nang le botenya kapa botenya haholo.

Hypertension khahlanong le semelo sa mofuta ona oa lefu la tsoekere e hlaha ka lebaka la:

• pathology ea endocrine system - 1-3%,
• methapo ea methapo ea kutlo ea litho tsa renal - 5-10%,
• lefu la tsoekere lephropathy - 15-20%,
• khatello ea methapo ea kutlo - 40-45%,
• khatello ea mali ea bohlokoa (mofuta oa pele) - 30-35%.

Hypertension e bonahala joang ka lefu la tsoekere?

Ka mofuta ofe kapa ofe oa lefu la tsoekere, methapo e meholo le likepe tse nyane 'meleng oa motho lia ameha. Ka lebaka la ho fokotseha ha matla a tsona, marotholi a khatello a qala. Ho batho ba bangata ba lefu la tsoekere, ho potoloha ha lisele ho tšoenyeha ka lebaka la khatello e phahameng ea mali. Phekolo ea khatello ea mali ho lefu la tsoekere e itšetlehile ka lipontšo tsa eona. Ho lefu la tsoekere 1, e hokahana le lefu la tsoekere, le amang methapo ea methapo ea kutlo le likarolo tsa liphio, tse hlahisang:

1. Ponahalo ea moroto oa albin ke microalbuminuria. E etsa joalo ka sesupo sa khatello e phahameng ea mali.
2. Proteinuria Phetoho e fokotseha ka boholo ba liphio. Phello ke ponahalo ea liprotheine tse ngata ka har'a moroto. Ka proteinuria, menyetla ea ho ba le khatello ea mali e matla e nyolohela ho 70%.
3. Ho hloleha ho ts'oarela ha renal. Boemong bona, ho se sebetse hantle ha renal ho sebetsa, e leng tiiso ea 100% ea nts'etsopele ea khatello ea mali e mpe.

Mofuta oa 2 oa lefu la tsoekere hangata o hlaha khahlano le semelo sa botena. Haeba lefu lena le kopantsoe le khatello ea mali, joale ho hlaha ha lona ho amana le ho se mamelle lijo tsa lik'habohaedreite kapa boemo bo phahameng ba tsoekere maling. E etella pele metabolism ea "glucose" e senyehileng 'meleng. Boemo bona bo bitsoa "metabolic syndrome." Khalemelo ea ho hanyetsa insulin e etsoa ho sebelisoa phepo e tlase ea lik'habohaedreite.

Mokhoa oa ho phekola khatello ea mali ho lefu la tsoekere

Ho khethoa kalafo e khethehileng ho bakuli ba nang le mafu a joalo. Ba hloka normalization ea khatello ea mali, ho seng joalo, ho latela litsebi tsa pelo, kotsi ea ho ba le mathata a pelo le methapo e phahame: lefu la pelo (CHD), ho nyekeloa ke pelo, stroke. Phello e kotsi ke koluoa ​​ea khatello ea mali. Phekolo e felletse. E kenyeletsa:

1. Lijo tse fokolang tsa carb. Ho qoba ho fokotseha ho matla ha khatello ea mali, hoa hlokahala ho theola se ka tlase se nang le lipoprotein tse fokolang le glucose ea lijo.
2. Lipilisi tsa khatello ea lefu la tsoekere li kenyeletsa mefuta e fapaneng ea meriana e sebetsang ka methati e meng ea ho theola khatello ea mali.
3. Mekhoa ea setso. Ba khutlisetsa metabolism e sa senyeheng, ka ho etsa joalo ba fokotsa khatello. Pele u sebelisa meriana e meng, ho hlokahala hore u buisane le setsebi sa endocrinologist hore u ikhethele litlama kapa litlolo tse loketseng tsa meriana.

Lijo tse fokolang tsa carb

E 'ngoe ea litsela tse ka sehloohong tsa ho etsa hore tsoekere ea mali e be tse tloaelehileng le khatello e tlase ea mali ke ja lijo tse tlase tsa carb. Lihlahisoa tsohle tsa lijo tse sebelisitsoeng li tlameha ho ba bonolo ka ho pheha. Ho etsa sena, sebelisa ho pheha, ho baka, ho tsamaisa le ho otla. Mekhoa e joalo ea kalafo ha e khopise mabota a methapo ea mali, e fokotsang kotsi ea ho ba le tšoaetso e mpe ea mali.

Lijo tsa letsatsi le letsatsi li lokela ho kenyelletsa li-vithamine le liminerale tse thusang ho ntlafatsa phallo ea mali litsing tsa sepheo sa eona. Ha o etsa lethathamo la lijo, o lokela ho sebelisa lethathamo la lihlahisoa tse lumelletsoeng le tse thibetsoeng. Mokhahlelo oa pele o kenyelletsa:

• lijo tsa leoatleng
• jelly ea litholoana
• skim lihlahisoa tsa lebese,
• tee ea limela
• marmalade
• bohobe ba mang
• mahe
• nama le tlhapi,
• moro oa meroho
• meroho
• litholoana tse omisitsoeng
• meroho.

Tšebeliso ea lihlahisoa tsena butle-butle e tiisa boemo ba khatello ea mali. Phepo e nepahetseng ea lefu la tsoekere la mofuta oa 2 le khatello ea mali e fokotsa palo ea lithethefatsi tse fanoang ke antihypertensive. Ha hoa lekana ho kenyelletsa lijo tse matlafatsang lijong tsa hau. Ho bohlokoa hape ho lahla lihlahisoa tse 'maloa:

• mefuta ea linoko
• marinade
• joala
• lihlahisoa tsa bakery
• chokolete
• moro o mafura
• kofi le lino tse tahiloeng,
• nama e mafura le litlhapi,
• asene
• soseji, nama ea tsuba.

Phekolo ea lithethefatsi

Motsoako o khethehileng oa khatello ea mali ho tsoekere ea mafu a tsoekere o khethoa ka tlhokomeliso e fetelletseng, hobane bakeng sa meriana e mengata lefu lena ke tlolo ea molao. Litlhoko tse kholo tsa litlhare ke tse latelang:

• bokhoni ba ho fokotsa khatello ea mali ka litlamorao tse fokolang,
• ho haella ha palo ea tsoekere maling, boemo ba "cholesterol" e mpe "le triglycerides,"
• boteng ba phello ea ho sireletsa liphio le pelo ho kopaneng ea lefu la tsoekere le khatello ea mali.

Kajeno, lihlopha tse 'maloa tsa meriana li ikhethile. Li arotsoe ka mekhahlelo e 'meli: ea mantlha le e thusang. Lithethefatsi tse ling li sebelisoa ha ho fanoa ka phekolo e kopaneng ho mokuli. Sebopeho sa lihlopha tsa lithethefatsi se sebelisitsoeng se bonts'oa tafoleng:

Angiotensin II receptor blockers

Diuretics (diuretics)

Lithane tsa calcium

Imidazoline receptor agonists (lithethefatsi tse nang le phello e bohareng)

Rasilez - inhibitor e tobileng ea renin

Mekhoa e meng ea kalafo

Lingoloa tse ling tsa meriana li na le phello e bobebe 'meleng, li thusa ho fokotsa litla-morao le ho potlakisa litlamorao tsa meriana. Se ke oa itšetleha feela ka litlhare tsa setso, 'me pele u li sebelisa, o lokela ho bona ngaka ea hau. Har'a litlhare tse sebetsang khahlanong le khatello e phahameng ea mali, ho hlahella lintlha tse latelang:

1. Palo ea 1 Lokisetsa 25 g ea setlama sa mamawort, 20 g ea peo ea dill, 25 g ea lipalesa tsa hawthorn. Kopanya metsoako le grind le grinder ea kofi. Nka 500 ml ea metsi a belang bakeng sa linomoro tse boletsoeng. Motsoako ona o sesa metsotso e 15 ka lebaka la mocheso o tlase. Hlatsoa ka cheesecloth pele o sebelisoa. Se ke ua sebelisa likhalase tse fetang tse 4 ka letsatsi matsatsi a 4.
2. Palo ea 2. Bakeng sa litara e le 1 ea metsi a belang, nka 30 g ea makhasi a currant, 20 g ea lipalesa tsa oregano le chamomile, 15 g ea letoto la 'mabole. Motsoako o koahetsoe ka mocheso o tlase bakeng sa metsotso e 10-15. Sebelisa halofo ea hora pele u ja makhetlo a 3 ka letsatsi.
3. Ho ka ba 100 g ea monokotsoai oa hawthorn ka metsi a belang, u li phehe ka mocheso o tlase hoo e ka bang kotara ea hora. Ka mor'a moo, lumella moro hore o pholile ka mocheso oa kamore. Mathata ka cheesecloth pele o sebelisoa. - Noa decoction ho e-na le tee e tloaelehileng ho pholletsa le letsatsi.

Lithethefatsi tse thibelang kelello

Mokhoa oa setso oa ho phekola khatello ea mali ho lefu la tsoekere ke ho sebelisa lithethefatsi tse matlafatsang. Ho na le mefuta e fapaneng ea lichelete tse joalo. Phapang ea bona e sebakeng sa tšebetso. Ngaka e ka u fa moriana o le mong, i.e. monotherapy. Khafetsa, kalafo e sebelisoa ka mokhoa oa phekolo e kopaneng - ka mefuta e itseng kapa e 'maloa ea matlapa hang-hang. Sena se thusa ho fokotsa litekanyetso tsa li-ingredient tse sebetsang le ho fokotsa palo ea litla-morao. Matlapa a 'maloa a ama mekhoa e fapaneng ea khatello ea mali.

Beta blockers

Tsena ke lithethefatsi tse theolang pelo. Ka khatello ea khatello ea mali, li laetsoe haeba ho na le fibrillation ea atria, tachycardia, ka mor'a ho nyekeloa ke pelo, angina pectoris le pelo e sa foleng. Kameho ea meriana ena ke ho thibela li-beta-adrenergic receptors tse fumanehang liphoofolong tse fapaneng, ho kenyeletsa pelo le methapo ea mali.

Litlamorao tse ling tsa lithibelo tsohle tsa beta ke ho pepesetsoa hoa lipontšo tsa hypoglycemia. Tsela ea ho tsoa boemong bona e ea fokotseha. Ka lebaka lena, beta-blockers e hanyetsanoa ho bakuli ba utloang ho qala ha matšoao a hypoglycemia. Lintho tsohle tse sebetsang tsa beta-blockers li fela ho "-ol". Ho na le lihlopha tse 'maloa tsa lithethefatsi tse joalo: lipophilic le hydrophilic, ntle le ts'ebetso ea kahare ea kutloelo-bohloko kapa eona. Ho latela sehlopha sa mantlha, beta-blockers ke:

1. Ha e khethe. Li thibela li-beta1 receptors, li ntlafatsa ho hanyetsa ha insulin. Sethethefatsi sa Anaprilin se nang le propranolol sebopeho se fanoa mona.
2. Khetha. Ho thibela li-receptor tsa beta2 ho baka litlamorao tse sa batleheng, tse kang bronchospasm, tlhaselo ea asthma, vasospasm. Ka lebaka lena, li-blocka beta tse khethiloeng li entsoe. Li bitsoa cardioselective mme li thibela li-receptors tsa beta1 feela. Lintho tse mafolofolo bisoprolol (Concor), metoprolol, atenolol, betaxolol (Lokren) li lokollotsoe mona. Li boetse li matlafatsa ho hanyetsa insulin.
3. Beta-blockers tse nang le matla a vasodilating. Tsena ke lipilisi tsa sejoale-joale tse bolokehileng haholoanyane tsa khatello ea mali ho lefu la tsoekere.Li bontšoa ke litla-morao tse fokolang, li na le phello e molemo ho carbohydrate le profid ea lipid, hape e fokotsa ho hanyetsa ha insulin. Lithethefatsi tse loketseng bakuli ba lefu la tsoekere sehlopheng sena ke Dilatrend (carvedilol) le Nebilet (nebivolol).

Lithala tsa calcium calcium

Ka bokhutšoanyane, meriana ena e bitsoa LBC. Ba thibela likharetene tse tsamaeang butle methapong ea mali le mesifa ea pelo, e bulehileng ka tšusumetso ea norepinephrine le adrenaline. Ka lebaka leo, calcium e fokolang e fuoa litho tsena, e leng microelement e hlahisang mekhoa e mengata ea li-bioenergetic liseleng tsa mesifa. Sena se lebisa vasodilation, e fokotsang palo ea litšelo tsa pelo.

Lithaka tsa khalsiamo ka linako tse ling li baka hlooho e bohloko, ea ho fofa, ea ho ruruha le ho sokela. Ka lebaka lena, li nkeloa sebaka ke litokisetso tsa magnesium. Ha li fokotse khatello ea mali feela, empa li ntlafatsa le ts'ebetso ea bowel, ho thoba methapo ea kutlo. Ka lefu la tsoekere le lefu la tsoekere, o lokela ho botsa ngaka ea hau pele. Mefuta ea LBC e abeloa ho latela hore na literata li koetsoe:

1. Sehlopha sa Verapamil. Lithethefatsi tsena li ama lisele tsa mesifa ea methapo ea mali le pelo. Sena se kenyelletsa lithethefatsi tse tsoang sehlopheng sa li-non-dihydropyridine: phenylalkylamines (Verapamil), benzothiazepines (Dilziatem). Ha li lumelletsoe ho sebelisa hammoho le beta-blockers ka lebaka la kotsi ea ho tsosoa ha morethetho. Liphetho e ka ba ho ts'oaroa ha atrioventricular block le pelo. Verapamil le Dilziatem ke mokhoa o motle bakeng sa li-beta blocker ha li kopantsoe empa li hlokahala.
2. Sehlopha sa nifedipine le dihydropyridine BBK (pheletso ka "-dipin"). Lithethefatsi tsena ha li ame tšebetso ea pelo, ka hona li lumelletsoe ho kopantsoe le beta-blockers. Minus ea bona ke sekhahla se phahameng sa pelo, ho feta ha pelo e leka ho boloka khatello ha e fokotseha. Ntle le moo, BBK kaofela ha e na tšebetso ea nephroprotective. Contraindication ho e sebelisa ke hyperglycemia le angina e sa tsitsang. Mokhahlelong ona, li-subtypes tse 'maloa tsa lithethefatsi tsa sehlopha sa dihydropyridine li khetholloa:
   • nifedipine - Corf, Korinth
   • felodipine - Adalat SL, nimodipine (Nimotop),
   • lercanidipine (Lerkamen), lacidipine (Sakur), amlodipine (Norvask), nicardipine (Barizin), isradipine (Lomir), nitrendipine (Bypress).

Ho diabetics, ho na le maikutlo a eketsehileng a letsoai le palo e eketsehileng ea mali a potoloha. Ka lebaka leo, khatello ea mali ea phahama. Ho e fokotsa, sebelisa diuretics (diuretics). Ba tlosa mokelikeli o feteletseng le letsoai ho tsoa 'meleng, ba fokotsa bongata ba mali a potoloha, a thusang ho fokotsa khatello ea systolic le diastolic.

Khahlano le semelo sa lefu la tsoekere, diuretics hangata li kopantsoe le beta-blockers kapa li-inhibitors tsa ACE, hobane ka mokhoa oa monotherapy li bonts'a ho se sebetse ha tsona. Ho na le lihlopha tse 'maloa tsa diuretics:

Lebitso la sehlopha sa diuretics

Haeba ho hlokahala, vasodilation, ho ntlafatsa metabolism. E khothalletsoa gout, lefu la tsoekere le botsofali.

Torasemide, Furosemide, Ethacrine Acid

Ka ho se sebetse hantle. Sebelisa ka hloko ka glucophage le lithethefatsi tse ling tsa lefu la tsoekere ka lebaka la kotsi ea ho ba le matšoao a lactic acidosis.

Triamteren, Amiloride, Spironolactone

Ha lefu la tsoekere ha le sebelisoe.

DM ke contraindication ho ts'ebeliso ea li-diuretics tsena, hobane li khona ho tebisa acidosis.

Li-inhibitors tsa ACE

Phekolo ea khatello ea mali ho lefu la tsoekere ha e felle ntle le li-inhibitors tsa angiotensin - haholo-holo boteng ba mathata a liphio. Contraindication ka ts'ebeliso ea bona ke bokhachane, hyperkalemia le eketseha serum creatinine. Ho bakuli ba nang le lefu la tsoekere la mofuta oa 1, li-inhibitors tsa ACE ke lithethefatsi tsa mola oa pele. Li ngoletsoe proteinuria le microalbuminuria.

Ketso ea lithethefatsi ke ho eketsa kutloisiso ea lisele tsa mmele ho insulin. Sena se fana ka thibelo ea lefu la tsoekere la mofuta oa 2. Li-inhibitors tsa ACE li hlapolla methapo ea mali, le sodium le metsi, ka lebaka la tsona, li khaotsa ho bokellana liseleng. Sena sohle se lebisa ho fokotsehe ha khatello. Mabitso a li-inhibitors tsa ACE a fela ka "-pril." Lithethefatsi tsohle li arotsoe ka lihlopha tse latelang:

1. Sulfhydryl. Tsena li kenyelletsa benazepril (Potenzin), Captopril (Kapoten), zifenopril (Zokardis).
2. Carboxyl. Ho kenyelletsa perindopril (Prestarium, Noliprel), ramipril (Amprilan), enalapril (Berlipril).
3. Phosphinyl. Sehlopheng sena, Fosicard le Fosinopril ba hlahella.

Lithethefatsi tse thusang

Haeba mokuli a fuoa phekolo e kopantsoeng, ho tla eketsoa meriana e ka sehloohong, ho sebelisoa litlhare tse thusang. Li sebelisoa ka hlokolosi ka lebaka la litlamorao tse ka bang teng. Letšoao la ho khethoa ha liakhente tse thusang ke ho se khonehe ha kalafo ka litlhare tsa mantlha. Mohlala, ho bakuli ba nang le ACE inhibitors, ho khohlela ho omileng ho hlaha ho bakuli ba bang. Boemong bo joalo, ngaka e tšoanelehang e fetisetsa mokuli kalafong ea bahanyetsi ba angiotensin receptor antagonists. Nyeoe ka 'ngoe e nkuoa ka bomong ho latela boemo ba mokuli.

Direct renin inhibitor

Resiles ke reninhibine e tobileng e nang le mesebetsi e boletsoeng. Ketso ea moriana e reretsoe ho thibela ts'ebetso ea phetoho ea angiotensin ho tloha foromong ea I ho ea II. Ntho ena e na le methapo ea mali mme e etsa hore litšoelesa tsa adrenal li hlahise aldosterone ea hormone. Khatello ea mali e fokotseha kamora ts'ebeliso e telele ea batho ba qalang. Monyetla oa lithethefatsi ke hore katleho ea tsona ha ea itšetleha ka boima kapa lilemo tsa mokuli.

Likotsi li kenyelletsa ho se khone ho sebelisa nakong ea bokhachane kapa ho rala ha eona haufinyane. Har'a litla-morao ka mor'a ho nka Resiles ke:

• phokolo ea mali
• lets'ollo
• khohlela e omileng
• makhopho a letlalo,
• maemo a eketsehang a potasiamo maling.

Hoa bohlokoa ho hlokomela hore lithuto tsa nako e telele tsa Rasilez ha li e-so etsoe. Ka lebaka lena, lingaka li fana ka maikutlo a hore moriana o na le phello ea ho sireletsa liphio. Rasilez hangata e kopantsoe le li-angiotensin II receptor blockers le li-inhibitors tsa ACE. Khahlano le semelo sa ho ja ha bona, sethethefatsi se eketsa kutloisiso ea lisele tsa mmele ho insulin mme se ntlafatsa lipalo tsa mali. Rasilez e kopantsoe le:

• Phaello ea methapo ea kutlo
• bana ba ka tlase ho lilemo tse 18,
• hemodialysis e tloaelehileng
• nephrotic syndrome
• hypersensitivity ho likarolo tsa moriana,
• ho se sebetse hantle ha sebete.

Imidazoline receptor agonists

Ho thoeng ke lithethefatsi tse bohareng. Li ama li-receptor tsa boko. Ketso ea li-agonists ke ho fokolisa mosebetsi oa tsamaiso ea methapo ea kutloelo-bohloko. Sephetho ke ho fokotseha ha sekhahla sa pelo le khatello. Mehlala ea li-agonist tsa imidazoline receptor ke:

• rilmenidine - Albarel,
• moxonidine - Physiotens.

Bothata ba lithethefatsi ke hore katleho ea bona ho khatello ea mali e pakiloe ho bakuli ba 50% feela. Ntle le moo, li na le litla-morao tse ngata tse kang:

Monyetla oa ho phekoloa ka lithethefatsi tse joalo ke ho ba sieo ha syndrome ea ho tlohela le ho mamella. Ke tsa pele tsa ho laeloa batho ba botsofaling, haholo-holo ka li-psychology tse kopaneng, ho kenyeletsoa le lefu la tsoekere. Imonazoline receptor agonists e ngotswe ho:

• hypersensitivity
• morethetho o matla oa pelo,
• tlolo ea tekanyetso ea sinotrial le AV conduction II-III degree,
• bradycardia e ka tlase ho 50 beats ka motsotso,
• ho nyekeloa ke pelo
• Angina Khmer
• tlolo e matla ea liphio le sebete,
• boimana
• glaucoma
• maemo a sithabetsang
• ho potoloha ho potoloha ha mali.