Diabetes nephropathy: mekhoa ea mehleng ea kalafo Litemana tsa sengoloa sa mahlale ka ho ikhethang - Medicine le Bophelo

Tlhaloso ea "lefu la tsoekere" lephropathy "ke mohopolo o kopaneng oa mafu a mangata a bakang tšenyo ea methapo methapong khahlano le semelo sa lefu la tsoekere le hloohong.

Khafetsa poleloana e reng "Kimmelstil-Wilson syndrome" e sebelisetsoa bokuli bona, hobane mehopolo ea nephropathy le glomerulossteosis e sebelisoa e le ntho e tšoanang.

Bakeng sa ICD 10, ho sebelisoa likhoutu tse peli bakeng sa lefu la tsoekere. Ka hona, lefu la tsoekere le lefu la tsoekere, khoutu ea ICD 10 e ka ba le bobeli ba E.10-14.2 (lefu la tsoekere le senya la liphio) le N08.3 (lesapo la glomerular ho lefu la tsoekere). Hangata, ts'ebetso ea ho phekola liphofu tse sa sebetseng hantle e bonoa e itšetleha ka insulin, mofuta oa pele - 40-50%, mme ka mofuta oa bobeli, tšoaetso ea nephropathy ke 15-30%.

Mabaka a ntlafatso

Lingaka li na le likhopolo tse tharo tsa mantlha mabapi le lisosa tsa nephropathy:

1. fapanyetsana. Taba ea mohopolo ke hore karolo ea mantlha ea tšenyo e hlahisoa ke boemo bo phahameng ba tsoekere maling, ka lebaka leo phallo ea mali e ferekaneng, 'me mafura a behiloe ka har'a lijana, a lebisang ho nephropathy,
2. liphatsa tsa lefutso. Ka mantsoe a mang, ketso ea lefutso e tlang pele ho lefu lena. Moelelo oa mohopolo ke hore ke mekhoa ea lefutso e bakang mafu a kang lefu la tsoekere le lefu la tsoekere ho bana,
3. hemodynamic. Khopolo ke hore ka lefu la tsoekere ho na le tlolo ea hemodynamics, ke hore, ho potoloha ha mali lipelong, ho bakang sekhahla sa albin ka har'a moroto - liprotheine tse senyang methapo ea mali, tšenyo e bakoang ke koluoa ​​(sclerosis).

Ntle le moo, mabaka a nts'etsopele ea nephropathy ho latela ICD 10 hangata a kenyeletsa:

• ho tsuba
• tsoekere e phahameng ea mali
• khatello e phahameng ea mali
• triglycerides e mpe le cholesterol
• phokolo ea mali

Khafetsa, maloetse a latelang a fumanoa sehlopheng sa nephropathy:

• lefu la tsoekere le lefu la tsoekere,
• renal artery atherosclerosis,
• renal canal necrosis,
• mafura a mangata ka likanaleng tsa a liphio,
• pyelonephritis.

Pele ho tsohle, ho bohlokoa hore re re lefu la tsoekere le ka ba le phello e senyang lipelong tsa mokuli ka nako e telele, mme mokuli a ke ke a ba le maikutlo a sa thabiseng.

Khafetsa, matšoao a lefu la tsoekere lephropathy a qala ho fumanoa ka nako eo ho se sebetse hantle ha a phekolo ea methapo.

Nakong ea sephetho sa pele, bakuli ba ka ba le keketseho ea khatello ea mali, proteinuria, le keketseho ea 15-25% ka boholo ba liphio. Boemong bo hatetseng pele, bakuli ba na le diuretic-immune nephrotic syndrome, khatello e matla ea mali le ho fokotseha ha sekhahla sa ho hlohlona ha glomerular. Mohato o latelang - lefu le sa foleng la liphio - le tšoauoa ka ho ba teng ha azotemia, renal osteodystrophy, khatello ea methapo ea mali le ho phehella ha edematous syndrome.

Mehatong eohle ea kliniki, neuropathy, hypertrophy ea ventricular e setseng, retinopathy le angiopathy lia fumanoa.

E fumanoa joang?

Ho tseba nephropathy, ho sebelisoa nalane ea mokuli le liteko tsa laboratori. Mokhoa o ka sehloohong mokhatlong oa pele ke ho tseba hore na albin e bokae mofeng.

Mekhoa e latelang e ka sebelisoa ho fumana lefu la tsoekere le nephropathy ho latela ICD 10:

• boikemisetso ba GFR ba sebelisa tlhahlobo ea Reberg.
• biopsy ea meno.
• Dopplerography ea liphio le lijana tse poteletseng (ultrasound).

Ntle le moo, ophthalmoscopy e tla thusa ho tseba mofuta le boemo ba retinopathy, 'me electrocardiogram e tla thusa ho khetholla hypertrophy ea ventricular ea letsoho.

Lefu la tsoekere le tšaba pheko ena, joalo ka mollo!

U hloka ho kenya kopo ...

Ha ho phekoloa lefu la liphio, boemo bo hlahelletseng ke kalafo e tlamang ea lefu la tsoekere. Karolo ea bohlokoa e bapaloa ke normalization ea lipid metabolism le botsitso ba khatello ea mali. Nephropathy e phekoloa ka meriana e sirelletsang liphio le khatello e tlase ea mali.

Mehlala ea lijo tse nang le lik'habohaedreite tse bonolo

E 'ngoe ea mekhoa ea pholiso ke lijo. Lijo tsa nephropathy e lokela ho ba ho fokotsa ho ja lik'habohaedreite tse bonolo mme li na le protheine e hlokahalang.

Ha ho ja, mokelikeli ha o na moeli; ho feta moo, mokelikeli o tlameha ho ba le potasiamo (mohlala, lero le sa hlahisoang). Haeba mokuli a fokotse GFR, ho ja lijo tse nang le protheine e fokolang, empa ka nako e ts'oanang li na le palo e hlokahalang ea likhalori. Haeba nephropathy ea mokuli e kopantsoe le khatello e phahameng ea mali, ho khothalletsoa lijo tse nang le letsoai le tlase.

Phekolo ea kutlo ea lipeo

Haeba mokuli a fokotseha ka sekhahla sa ho hlohlona ha glomerular ho letšoao le ka tlase ho 15 ml / min / m2, ngaka e tlang e etsa qeto ea ho qala kalafo ea phetisetso, e ka emeloang ke hemodialysis, peritoneal dialysis kapa transplantation.

Ntho ea bohlokoa ea hemodialysis ke tlhoekiso ea mali ka "lisebelisoa tsa meno" tsa maiketsetso. Ts'ebetso e lokela ho etsoa makhetlo a 3 ka beke, lihora tse ka bang 4.

Peritoneal dialysis e kenyelletsa ho hloekisoa ha mali ka peritoneum. Letsatsi le leng le le leng, makhetlo a 3-5 mokuli o kenngoa ka tharollo ea dialysis ka ho toba ka mpeng ea mpa. Ho fapana le hemodialysis e kaholimo, peritoneal dialysis e ka etsoa lapeng.

Ho fetisoa ha liphio ke mokhoa o feteletseng oa ho loants'a nephropathy. Maemong ana, mokuli o lokela ho sebelisa meriana e hatellang sesole sa 'mele ho thibela ho lahloa.

Mekhoa e meraro ea ho thibela

Mokhoa o tšepahalang ka ho fetisisa oa ho thibela nts'etsopele ea nephropathy ke puseletso e amohelehang bakeng sa lefu la tsoekere:

1. thibelo ea mantlha ke thibelo ea microalbuminuria. Lintho tsa bohlokoa bakeng sa nts'etsopele ea microalbuminuria ke: nako ea lefu la tsoekere ho tloha ho 1 ho isa ho lilemo tse 5, lefutso, ho tsuba, retinopathy, hyperlipidemia, hammoho le ho haella ha pokello ea renal e sebetsang.
2. Thibelo ea bobeli e kenyelletsa ho liehisa kholo ea lefu lena ho bakuli ba seng ba ntse ba theotse GFR kapa boemo ba albin moseneng o phahametseng o tloaelehileng. Mokhahlelong ona oa thibelo o kenyelletsa: lijo tse nang le protheine e tlase, taolo ea khatello ea mali, tsitsitseng ea profid ea lipid maling, taolo ea glycemia le ho tloaela ha methapo ea kutlo ea methapo,
3. Thibelo ea thuto e phahameng e etsoa sethaleng sa proteinuria. Morero o ka sehloohong oa sethala ke ho fokotsa kotsi ea ho se sebetse hantle ha renal renal, eo ka nako eo e tšoaeang: khatello ea methapo ea mali, phello e sa lekaneng ea metabolism ea carbohydrate, proteinuria e phahameng le hyperlipidemia.

Livideo tse amanang

Ka lisosa le kalafo ea nephropathy ea lefu la tsoekere lenaneong la TV "Phelang bophelo bo botle!" Le Elena Malysheva:

Le ha ho na le 'nete ea hore lipakeng tsa litlamorao tsohle tsa lefu la tsoekere, nephropathy ke e' ngoe ea libaka tse etelletseng pele, ho khomarela ka hloko mehato ea thibelo e kopaneng le tlhahlobo ea meriana e tlang ka nako le kalafo e nepahetseng e tla thusa ho liehisa kholo ea lefu lena.

Sengoloa sa mosebetsi oa mahlale ho sehlooho "Diabetesic nephropathy: mekhoa ea mehleng ena ea kalafo"

UDC 616.61 -08-02: 616.379-008.64.001

DIABETIC NEPHROPATHY: MELEMO E SEBETSA HO TLHOKA

Lefapha la Propaedeutics ea Mafu a ka hare, Univesithi ea Bongaka ea Naha ea St. Acad. I.P. Pavlova, Russia

Mantsoe a bohlokoa: lefu la tsoekere, lefu la tsoekere, kalafo.

Mantsoe a bohlokoa: lefu la tsoekere, lefu la tsoekere, kalafo.

Diabetesic nephropathy (DN) hajoale ke sesosa se atileng haholo sa nts'etsopele ea ho fokola hoa lefu la ho fokola ha masapo (PN). Keketseho ea palo ea bakuli ba mofuta ona e ea makatsa - ka 1984, ea bakuli ba bacha ba hlokang phekolo ea phekolo ea renal, 11% Europe le 27% USA e ne e le bakuli ba DN, ka 1993 lipalo tsena e ne e le 17% le 36%, ka ho latellana 46 , 47. Keketseho ea liketsahalo tsa ho hloleha ha pelo sethaleng sa ho sa sebetse hantle ha renal e amana le keketseho ea khafetsa ea lefu la tsoekere mellitus (DM) ka boeona, haholo-holo ea mofuta oa II ka lebaka la botsofali bo akaretsang ba batho le ho fokotseha ha lefu ho bakoang ke mathata a pelo. Mohlala, lipalo tse latelang li ka bontšoa: ho tloha ka 1980 ho fihlela 1992, palo ea bakuli ba bacha ba nang le lefu la tsoekere ba nang le PN ba le lilemo tse 25 ho isa ho 44 e ile ea eketseha ka makhetlo a 2, ka nako e ts'oanang palo ea bakuli ba nang le lefu la tsoekere ba kaholimo ho lilemo tse 65 e eketsehile ka makhetlo a 10. Kaha nako e pakeng tsa ts'oaetso ea lefu la tsoekere le nts'etsopele ea protheine e phehellang e ka ba lilemo tse 20, lipalo tse kaholimo li supa hore lilemong tse 10 ho isa ho tse 15, leqhubu la bakuli ba lefu la tsoekere ba hlokang phekolo ea pheko ea renal - dialysis, transplantation ea liphio - ka litlamorao tsohle. ke ka lebaka leo litlamorao tsa moruo le tsa bongaka. Ho feta moo, sekhahla sa ho pholoha sa bakuli ba nang le lefu la tsoekere le mekhoa ena ea kalafo se fokola haholo ho feta ka li-pathologies tse ling tsa renal, haholo-holo ka lebaka la mathata a pelo le a 20,23. Lintlha tse boletsoeng ka holimo tsa lefutso li entse likarolo tsa tsoelo-pele le kalafo ea DN

hajoale ke ntho eo motho a lokelang ho e hlokomela ka hloko ho tsoa ho litsebi tsa thuto ea bophelo lefatšeng.

Mekhoa ea phekolo ea ho thibela le ho liehisa tsoelo-pele ea DN e thehiloe maikutlong a sejoale-joale mabapi le mekhoa e fapa-fapaneng ea pathogenetic ea lefu lena, eo ho eona ho nang le taolo e fokolang ea glycemic, ho thehoa ha lihlahisoa tse phahameng tsa glycosylation, hypomerular hypertension-hyperfiltration khahlanong le semelo sa khatello ea mali le systemation ea renal angiotensin. .

Taolo ea glycemic

Taolo e sa lekanang ea tsoekere ea mali ho lefu la tsoekere, hammoho le letšoao la eona, karolo e eketsehang ea hemoglobin ea glycosylated, e amana haholo le nts'etsopele ea li-microansopathies tsa mofuta oa I le mofuta oa lefu la tsoekere la II mme, haholoholo, ka ho qala ha methati ea pele ea DN. Mechine ea methapo ea hyperglycemia e tsamaisoa ke mekhoa e mengata, ho kenyelletsa le lihlahisoa tse ngata tsa "glycosylation" tse se nang enzymatic, myoinositol metabolism, tlhahiso ea diacylglycerol le ts'ebetso ea protheine kinase C, hammoho le phetisetso ea lihormone le mabaka a ho hola. karolo ea bohlokoa ho nts'etsopele ea glomerular hypertrophy 22, 52. Leha ho le joalo, ho bontšitsoe hore taolo e matla ea glycemic, ka boyona, e fokotsa sekhahla sa tsoelo-pele ea ho se lekane ha renal. atochnosti ka bakuli ba lefu la tsoekere thaepa ke le proteinuria. Leha ho le joalo, ho bonahala eka haeba tlhahlobo e haufi ea lefu la tsoekere e qalile pele ho nts'etsopele ea mathata a liphio, joale sena se ka thibela kholo ea bona nakong e tlang. Kahoo, thuto ea DCCT e bonts'itse

ho fokotseha ha khafetsa ha feela proteinuria le PN khahlano le kalafo e matla ea hyperglycemia, empa hape le phokotso e kholo khafetsa ea microalbuminuria, lets'oao la methati ea pele ea DN. Phokotso ea menyetla ea ho tšoaroa ke pelo e tlohile ho 40% ho isa ho 60%. Ho lekola haufi-ufi ha glycemia ho lebisa keketseho ea ho fifala ha glomerular qalong, hape ho thibela ponahalo ea liphetoho tse tloaelehileng tse ka popelong e holisitsoeng. Kahoo, taolo e tiileng ea maemo a glycemia ho tloha qalong ea lefu la tsoekere ke ea bohlokoa ho thibela nts'etsopele ea mathata a lefu la tsoekere.

Boleng ba lihlahisoa tsa bo eketsehile

glycosylation le khalemelo ea tsona

Kamoo ho bonahalang kateng, litlamorao tsa hyperglycemia liphihleng li bakoa haholo ke lihlahisoa tsa "glycosylation" (protein ea liprotheine tse ngata). Ho ile ha bontšoa hore lihlahisoa tsa ho kopanya tse se nang enzymatic tsa protheine le glucose li bokellana ka har'a lithane tsa bakuli ba nang le lefu la tsoekere, li roba likarolo tsa sebopeho sa extracellular matrix, mme li etsa hore ho putlama ha karolo ea kamore e tlase le keketseho ea li-lipoprbgeids tse tlase haholo le immunoglobulin c. Ntle le moo, PPG e baka liphetoho tse ngata tse pakeng tsa sele e lebisang ho ho senyeha ha methapo, keketseho ea tlhahiso ea matrix ea extracellular, le glomerulosclerosis. Liphetoho mesebetsing ea lisele tsa PPG li arolelanoa ka mochini o lumellanang oa li-receptor holim'a tsona. E khethiloe ka mefuta e fapaneng ea lisele - prieloid, lymphoid, monocyte-macrophage, endothelial, boreleli-mesifa, li-fibroblasts, i.e. liseleng tse amehang ka kotlolloho khabong le tsoelo-peleng ea lefu la renal. Ho kenyelletsoa ha PPG moetlong oa lisele tsa mesangial ho lebisa ho eketseha ha mRNA le keketseho ea tlhahiso ea fibronectin, mofuta oa collagen mofuta oa laminin IV le platelet ea kholo (ROOP), ntho ea bohlokoa ho glomerulosclerosis 14, 47.

Bohlokoa ba kliniki ea BCP ho hlaha le kholo ea DN bo pakahatsoa ke tsamaiso ho liphoofolo ntle le matšoao a lefu la tsoekere. Khahlano le nalane ea ts'ebeliso ea nako e telele ea PPG, setšoantšo se tloaelehileng sa morphological le matšoao a kliniki a DN a hlaha. Ka nako e ts'oanang

taolo e tšoanang ea aminoguanidine, sethethefatsi se fokotsang sebopeho sa BCPs, kapa tsamaiso ea lithibela-mafu tse thibelang monoclonal ho glycosylated albin haholo se fokotsa botebo ba liphetoho tsa methapo ea mafu a 15, 47. Liteko tsa bongaka ba aminoguanidine ho bakuli ha li sa phetheha ka botlalo. Ha joale karolo ea 3 ea liteko e ntse e etsoa bakeng sa lefu la tsoekere la mofuta oa I le DN sethaleng sa proteinuria, se tla bontša hore na sekhahla sa lefu lena se tla fokotseha ka ts'ebeliso ea amino1uanidine ho batho.

Boleng ba glomerular hypertension / hyperfiltration ho tsoelo-pele ea DN le mekhoa e meholo ea tokiso ea eona

Ka bo-80s, ho ile ha bonts'oa kamano e haufi, e ts'oanang le keketseho ea khatello ea methapo ea mali le liphetoho tsa methapo ho li-arterioles, empa mabapi le phello ea khatello ea methapo ea methapo ea methapo le khatello ea methapo mabapi le phallo, tšenyo ea endothelial, capillary microthrombosis, le glomerulosranceosis 49, 50. Mefuta ea mathata a intracubular hemency. amanang le arteriole ka lebaka la ho senyeha ha methapo ea methapo le mokokotlo oa arteriole e sebetsang khahlano le bokapele ba ho eketsa kutloisiso ea eona ho batseteli ba khatello - angiotens le, - noradrenaline, vasopressin, 3, 5, e itlhomme pele ho eketseha intra-glomerular khatello. Tšusumetso ea mochine leboteng la glomerular capillary e baka keketseho ea mefuta ea I le IV ea collagen, laminin, fibronectin, le TCR- (3, eo, qetellong, e lebisang keketseho ea matrix a extracellular, 'me joale ho glomerulosranceosis 16, 28. Ho nts'etsopele ea lits'ebetso tsa methapo ea methapo ea kutlo - hyperfiltration, ka ho hlakileng, lintlha tse latelang li bohlokoa: systemic arterial hypertension (ka khatello e eketsehileng monyako oa glomerulus), ts'ebetso ea ts'ebetso ea renal-renin-angiotensin ka nts'etsopele ea spasm ea arteryole e sebetsang, hypergly kemia le ho ja liprotheine tse feteletseng.

Thibelo ea liprotheine lijong

Boiphihlelo ba lilemo tse mashome a mararo ba sebelisa lijo tse nang le protheine e tlase li bonts'a phello e ntle ea ho liehisa tsoelo-pele ea methapo ea methapo ea kutlo, ho kenyeletsoa

le NAM. Ka bomalimabe, e 'ngoe ea lithuto tse kholo ka ho fetisisa mabapi le phello ea lijo tse nang le protheine e tlase ka sekhahla sa PN (M01J) ha e kenyeletse bakuli ba nang le lefu la tsoekere le DM. Leha ho le joalo, hamorao e sebetsa, phello e hlakileng e hlakileng ea ho fokotsa ts'ebeliso ea liprotheine ho tekanyo ea ho fokotseha ha ts'ebetso ea liphio ho bakuli ba DN ba nang le lefu la tsoekere la mofuta oa pele le PN e bontšitsoe. Takatso ea protheine ea letsatsi le letsatsi thutong ena e ne e lekantsoe ho 0,6 g / kg. Ho bohlokoa ho hlokomela hore tekanyo e joalo ea thibelo ea protheine ka nako e telele (ho fihla ho lilemo tse 5) ha ea ka ea lebisa ho litlamorao leha e le life tsa bohlokoa - ho se leka-lekane litekanyetsong tsa lijo, phetoho profilse ea mali, kapa boleng ba taolo ea glycemia. Kameho e ntle ea sejo sena mabapi le ho bolokoa ha ts'ebetso ea renal e ka fumaneha esita le ho bakuli ba nang le mathata a eona a pele ho GFR ea fetang 45 ml / min. Ka hona, ho fokotsa ho ja liprotheine ho lokela ho ba matšoao a pele a PN.

Litlamorao tsa phepo ea lijo tse nang le protheine e tlase li hlalosoa ke hore e lebisa ho fokotseha ha phepelo ea methapo ho li-nephrons tse setseng, e leng e 'ngoe ea mekhoa ea mantlha ea pathophysiological e lebisang tlhabong ea glomerular sclerosis.

Tsamaiso ea khatello ea mali ea systemic

Palo e kholo e lekantsoeng e bontšitse hore ho bakuli ba nang le lefu la tsoekere le its'epahallang le tsoekere e sebetsang hantle, ho fokotseha le ho teba ha methapo ea methapo ea methapo ea methapo ho fokotsa sekhahla sa PN 11, 31.33. Ho lokela ho hopoloa hore mesebetsing e bontšitsoeng, boemo ba khatello ea mali bo ne bo le holimo haholo mme khalemelo ea bona e felletseng e sa fumanehe. Leha ho le joalo, phello ea kalafo ea antihypertensive mabapi le ho boloka ts'ebetso ea liphio e ne e ikhethile, ka hona ho ka lebelloa hore taolo e felletseng ea khatello ea mali ea systemic e tla sebetsa le ho feta. Ka sebele, liphuputso tsa morao tjena li bonts'itse hore ho fihlela palo e tlase ea khatello ea mali sehlopheng sa bakuli ba nang le PN, ho kenyelletsa le DN, ho lebisa ho fokotseng ho boleloang haholoanyane phokotsong ea GFR le ho fokotseha ha proteinuria. Ho feta moo, ha kholo ea pele ea proteinuria e le matla, ho fokotseha ho eketsehileng ha khatello ea mali ho lokela ho fihlella.

Khetho e hlokolosi ea kalafo ea antihypertensive e hlokahala hona liteisheneng tsa pele tsa NAM, joalo ka bakuli ba nang le microalbuminuria, taolo ea khatello ea mali e lebisa ho fokotseha ha kalafo ea urin albin, mme phello ea kalafo ea antihypertensive e fokotseha ha albinuria e ntse e tsoela pele.

Boithuto bo bongata bo ithutile ka phello ea ho theola khatello ea mali ho MD nakong ea lefu la tsoekere la mofuta oa. Mekhoa e ts'oanang e ka lebelloa bakeng sa lefu la tsoekere le sa itšetleheng ka insulin, hobane boemo ba khatello ea mali maemong ana bo lumellana le ho teba ha albinuria. Boithuto bo ikhethileng (ABCS) bo ntse bo tsoela pele, mosebetsi oa ona ke ho khetholla ka nepo karolo ea khatello ea mali ho ntlafatseng mathata a amanang le lefu la tsoekere la mofuta oa II.

Kamoo ho bonahalang kateng, mekhoa ea phello e molemo ea ho fokotsa khatello ea methapo ea mali ho bakuli ba nang le DN e amahanngoa le ho fokotseha ha khatello ea methapo ea methapo ea methapo le ho fokotseha ha khatello ea lebota la "glomerular capillaries".

Blockade ea renin-angiotensin system (RAS)

Mekhoa e mengata ea pathogenetic e khethollang nts'etsopele le tsoelo-pele ea DN li amahanngoa le ASD. Li amahanngoa le ho thehoa ha methapo ea methapo ea methapo ea methapo, methapo ea methapo e kenang, ho eketseha ha lipalo tsa macromolecule ka har'a mesangium ka nts'etsopele ea liphetoho tse mpe liseleng tsa mesangium le extracellular matrix e lebisang ho glomerulossteosis, le ho hlohlelletsa ka kotlolloho tlhahiso ea bahanyetsi ba glomerulosranceosis, haholo-holo TOR-.

Lebaka la ho etsa liteko tsa tliliniki ea li-eniotensin-converting enzyme inhibitors (ACE inhibitors) e ne e le liphuputso tse ngata tsa liphoofolo tse bonts'ang phello ea ts'ireletso ea sehlopha sena sa lithethefatsi mabapi le glomerular morphology le ts'ebetso ea renal. Litšebelisong tse nang le tšebeliso ea nako e telele ea li-inhibitors tsa ACE, lipontšo tsa morphological le tšebetsong tsa li-DN li fokotsehile, ka khatello ea transcapillary glomerular. Lithethefatsi tse ling li ne li se na phello e tšoanang.

Ho baka ho fokotseha ha mocheso oa mocheso oa glomerular hyperfiltration qalong (Microalbumin-uric) sethaleng sa DN liphoofolong, ka sepheo sa

Li-inhibitors tsa ACE li fokotsa kapa tsa tsitsisa microalbuminuria le ho thibela ho qaleha ha setšoantšo se hlakileng sa lefu la 3.4. Tšusumetso e ikhethang ea kliniki ea ts'ebeliso ea li-inhibitors tsa ACE e phehella le methati e tsoetseng pele ea DN. Sehlopha se seholo sa bakuli ba nang le lefu la tsoekere la mofuta oa I le matšoao a nephropathy a feteletseng a bontšitseng ho fokotseha ha 48,5% kamanong le nts'etsopele ea PN ea pele le ho fokotseha ha 50,5% kamanong le sephetho sa ho qetela - dialysis, transplantation, le lefu la renal.

Ho bakuli ba nang le lefu la tsoekere la mofuta oa II, ho ile ha etsoa le letoto la liteko tsa bongaka tsa phello ea ACE mabapi le nts'etsopele ea proteinuria le PN. Boithuto ba enalapril bo bonts'itse phello e ntle ea lithethefatsi, e kenyelletsang ho fokotsa boemo ba microalbuminuria, ho thibela nts'etsopele ea proteinuria le PN.

Taba ea hore proteinuria e fokotseha ka ts'ebeliso ea li-inhibitors tsa ACE e bohlokoa ho eona, hobane ho tsitsipana ke ntlha e ikemetseng ea tsoelopele bakeng sa DN le li-glomerulopathies 1, 13, 37. Ho fokotseha ha proteinuria e nang le ACE inhibitors ho ka fihlella leha e le mehatong e tsoetseng pele ea DN ka nts'etsopele ea nephrotic syndrome, phokotso tahlehelo ea protheine ka har'a moroto e tsamaisana le ts'ebetso ea methapo ea meno.

Ho lokela ho hlakisoa hore phello ea antiproteinuric le ho fokotseha ha nts'etsopele ea ts'ebetso e fokotsang ea liphio ka tšebeliso ea li-inhibitors tsa ACE ha hoa itšetleha ka phello ea tsona ho khatello ea mali ea systemic. Sena se netefatsoa ke tlhahlobo ea meta ea palo e kholo ea lithuto tsa li-antihypertensive tse nang le DN mme e na le bohlokoa ba bohlokoa ba kliniki - Inhibitors ea ACE e na le tšusumetso hape ea ts'ireletso eseng feela ka ho kopana ha DN le ginertzheniyu, empa le ho bakuli ba DN ba nang le khatello ea mali e tloaelehileng 35, 39.

Kameho e nchafalitsoeng ea li-inhibitors tsa ACE e bakoa ke lintlha tse 'maloa, tseo har'a tsona e leng ho tloaelehileng ha li-intra-tubular hemodynamics, tšitiso ho litla-morao tsa tropic tsa angiotensin II tse amanang le ho hlohlelletsoa ha cellular le glomerular hypertrophy 9,17,18, le khatello ea ho bokelloa ha matrix a mesangial. Ntle le moo, li-inhibitors tsa ACE li fokotsa botebo ba liphetoho tsa methapo ho li-podocytes, tse fokotsang boteng ba membrane e ka tlase le,

Kamoo ho bonahalang kateng, ke motheo oa ts'ebetso ea anti-proteinuric e le thepa e ikhethang ea sehlopha sena sa lithethefatsi.

Ts'ebeliso ea lithethefatsi tsa khalsiamo

K'halsiamo ea Intracellular e bapala karolo ea bohlokoa ho pathophysiology ea DN, hobane litlamorao tsa hemodynamic tsa li-cytokines tse ngata, ho kenyelletsa le angiotensia II, li kenelletsoa ke keketseho ea litaba tsa calcium ea intracellular. Sena se fana ka maikutlo a hore litlamorao tsa ho hlaphoheloa ha likokoana hloko tsa ACE inhibitors le calcium antagonists li ka tšoana, hobane tsa morao li boetse li fokotsa vasoconstriction le ho thibela litlamorao tsa hypertrophic le hyperplastic ea angiotensin II le li-migogene tse ling ho mesangial le mesifa e boreleli ea 5, 43. Leha ho le joalo, litokisetso tsa mesifa le mesifa tse se nang mesifa li na le phello ena. - verapamil le diltiazem, kamoo ho hlakileng ka lebaka la phello ea bona e ikhethang mabapi le tumello ea glomerular. Le ha ho se liphuputso tse telele tsa bahanyetsi ba calcium ho DN, liphetho tse khothatsang li sa tsoa fumanoa - lira tsa khalsiamo, joalo ka lisinopril, li fokolitse tlhahiso ea albin haholo mme tsa fokotsa phokotseho ea ho hlohlona ha glomerular ho bakuli ba nang le DN. Ho ka etsahala hore phekolo ea ho kopanya le li-inhibitors tsa ACE le bahanyetsi ba calcium ba ka ba le phello e eketsehileng mabapi le ho liehisa tsoelo-pele ea DN.

Ka hyperglycemia, tsoekere e qala ho sisinyeha tseleng ea sorbitol, "e lebisang keketseho ea litaba tsa sorbitol le ho fokotseha ha palo ea myoinositol ho glomeruli, methapo le lense. Ho thibela ts'ebetso ena ka ho thibela aldose reductase ho ka fokotsa lipontšo tsa morphological le tsa bongaka tsa DN 10, 30. Liteko tsa bongaka tse ntseng li tsoela pele tsa li-aldose reductase inhibitors ha li e-so phatlalatsoe.

Lintlha tse hlahisitsoeng li re lumella ho bolela hore kalafong ea DN, ho ka khonahala ho fokotseha ho hoholo ha tsoelo-pele ea khatello ena ea lefu la tsoekere le remoutu, mme mohlomong

le ho thibela nts'etsopele ea PN. Leha ho na le taba ea hore ts'ebetso e sebetsa hantle ho feta methating ea mantlha - microalbuminuric - DN, kalafo e sebetsang le eona e ka etsoa maemong a tsoetseng pele, esita le moo ho nang le nephrotic syndrome le PN.

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Etiology le pathogeneis

Etiology le pathogeneis

Hyperglycemia e sa foleng, intracubic le systemic arterial hypertension, liphatsa tsa lefutso

Microalbuminuria e ikemiselitse ho bakuli ba 6% ba nang le lefu la tsoekere la 1 kamora lilemo tse 5-15 kamora hore e bonahale. Ka CD-2, DNF e tsoela pele ho 25% ea lebelo la Europe le ho 50% ea morabe oa Asia. Palo-palo eohle ea DNF ho CD-2 ke 4-30%

Lipontšo tse ka sehloohong tsa kliniki

Mehatong ea pele ha a eo. Hlooho ea methapo ea pelo, lefu la nephrotic, ho hloleha ha renal ho sa feleng

Microalbuminuria (albumin excretion 30-300 mg / letsatsi kapa 20-200 μg / min), proteinuria, e eketseha ebe e fokotseha ka sekhahla sa ho sefuba sa glomerular, matšoao a lefu la nephrotic le ho se sebetse hantle ha renal.

Mafu a mang a liphio le lisosa tsa ho hloleha ho tsoareloa ke methapo

Puseletso ea lefu la tsoekere le khatello ea mali, li-blockers tsa ACE kapa li-angiotensin receptor blockers, ho tloha sethaleng sa microalbuminuria, liprotheine tse fokolang le lijo tse fokolang tsa letsoai. Ka nts'etsopele ea ho ruruha ho sa sebetseng hantle ha renal - hemodialysis, peraloneal dialysis, ho fetisoa ha meno

Ho 50% ea bakuli ba nang le lefu la tsoekere la 1 le 10% ea lefu la tsoekere la 2 leo protheine ea tlhaho e fumanoeng ho lona, ​​CRF e tsoela pele lilemo tse 10 tse latelang. 15% ea batho bohle ba shoang ho bakuli ba nang le lefu la tsoekere la mofuta oa 1 ka tlase ho lilemo tse 50 ba amana le ho hloleha ho sa sebetseng hantle ha rebo