Mofuta oa 1 le Lefu la 2 la Lefu la tsoekere: Pathophysiology le Litsela tsa kalafo

Mofuta oa pele oa lefu la tsoekere("Mellitus" ea lefu la tsoekere e itšetlehileng ka insulin, mofuta oa 1 lefu la tsoekere, lefu la tsoekere la bana) -lefulets'oao le ka sehloohong la ho tsebahatsa lefu le sa folenghyperglycemia- tsoekere e phahameng ea mali,polyuriaka lebaka la sena -lenyoraho fokotsa boima ba 'mele, takatso e feteletseng ea lijo, kapa ho haella ha eona, bophelo bo botle ba' mele.Lefu la tsoekeree etsahala ka linako tse fapanengmafue lebisang ho ho fokotseha ha tlhaho le sephiriinsulin. Karolo ea karolo ea lefutso e ntse e hlahlojoa.

Type 1 lefu la tsoekere(lefu la tsoekere le itšetlehileng ka insulin, lefu la tsoekere la bana) - lefu la tsamaiso ea endocrine, le tsejoang ke khaello ea insulin e felletseng e bakiloeng ke ts'enyolisele tsa betamanyeme. Lefu la tsoekere la Mofuta oa 1 le ka ba teng lilemong life kapa life, empa batho ba lilemong tse tlase (bana, bacha, batho ba baholo ba ka tlase ho lilemo tse 30) ba ameha hangata. Setšoantšo sa kliniki se laoloa ke matšoao a khale:lenyora,polyuriaho theola boima ba 'melemaemo a ketoacidotic.

1Etiology le pathogeneis

2.1Tlhotlhomiso ka Efimov A.S., 1983

2.2Tlhalo ea litsebi tsa WHO (Geneva, 1987)

2.3Classified (M.I. Balabolkin, 1994)

3Pathogenesis le histopathology

4Setšoantšo sa Clinical

Etiology le pathogeneis

Mokhoa oa pathogenetic oa nts'etsopele ea lefu la tsoekere la mofuta oa 1 o ipapisitse le ho haella ha tlhahiso ea insulin ke lisele tsa endocrine (β liselelihlekehleke tsa Langerhansmanyeme), e bakoang ke timetso ea bona tlasa ts'usumetso ea lintlha tse ling tsa pathogenic (bongatats'oaetso,khatello ea maikutlo,mafu a autoimmunele ba bang). Mofuta oa 1 oa lefu la tsoekere o etsa karolo ea 10-15% ea mafu ohle a lefu la tsoekere, hangata a hlaha bongoaneng kapa bohlankeng. Mofuta ona oa lefu la tsoekere o tšoauoa ka ponahalo ea matšoao a sehlooho, a tsoelang pele kapele ka nako. Mekhoa e meholo ea kalafo keliente tsa insulinho ntlafatsa metabolism ea mokuli. Haeba a sa phekoloe, lefu la tsoekere la mofuta oa 1 le tsoela pele kapele 'me le lebisa ho mathata a tebileng a kangketoacidosislelefu la tsoekereho qetella lefung la mokuli.

Tlhomamiso

Tlhotlhomiso ka Efimov A.S., 1983

I. Mefuta ea meriana:

Ntho ea mantlha: liphatsa tsa lefutso, ho bohlokoa (ka fetakapa kantle ho eona).

Bobeli (matšoao): pituitary, steroid, thyroid, adrenal, pancreatic (ho ruruha ha manyeme, lesapo la lesapo kapa ho tlosoa), boronse (ka hemochromatosis).

Letsoalo la tsoekere(gestational).

II. Ka boima:

III. Mefuta ea lefu la tsoekere mellitus (mofuta oa nete)

mofuta - o itšetlehileng ka insulin (o labile o nang le tloaelo ea acidosislehypoglycemia, boholo ba bocha),

mofuta - eseng insulin e ikemetseng(ea tsofetseng, ea tsoekere mellitus maqheku).

IV. Boemo ba puseletso ea metabolism ea carbohydrate.

V. Ho fumanehalefu la tsoekere(I, II, Mothati oa III) leneuropathy.

Microangiopathy—retinopathy,nephropathy, capillaropathy ea libaka tse tlase kapa tsa lehae tse ling.

Macroangiopathy- ka lesent ea mantlha la lijana tsa pelo, bokong,maoto,tsa lehae tse ling.

Universal micro- le macroangiopathy.

Polyneuropathy(peripheral, autonomous or visceral).

VI.Manonyeletso a litho tse ling le litsamaiso:hepatopathy,cataract,dermatopathy,osteoarthropathyle ba bang).

VII. Mathata a tebileng a lefu la tsoekere:

Tlhalo ea litsebi tsa WHO (Geneva, 1987)

Classified (M.I. Balabolkin, 1994)

Pathogenesis le histopathology

Khaello insulinmmeleng oa hola ka lebaka la secretion e sa lekanengβ liselelihlekehleke tsa Langerhansmanyeme.

Ka lebaka la khaello ea insulin, lisele tse itšetlehileng ka insulin (hepatic,mafuralemesifa) lahleheloa ke bokhoni ba bona ba ho sebelisa tsoekeremadimme ka lebaka leo, boemo ba tsoekere maling bo nyoloha (hyperglycemia) Na ke letšoao la "diagnostic" la lefu la tsoekere. Ka lebaka la khaello ea insulin, ho phatloha ha mafura ho khothalletsoa liseleng tsa adipose.mafura, e lebisang keketseho ea boemo ba bona maling, 'me liseleng tsa mesifa - ho bola hoa hlohlonaprotheinee lebisang tlhokomelong e eketsehilengamino acidmaling. Metsetsoanakatatemafura le liprotheine li fetoloa ke sebete homele ea ketonetse sebedisoang ke lisele tse sa ts'epeng insulin (haholo-holokelello) ho boloka tekanyo ea matla khahlanong le semelo sa ho haelloa ke insulin.

Glucosuriake mokhoa o sebetsang oa ho tlosa glucose e phahameng maling ha boemo ba glucose bo feta monyako oasesoboleng (hoo e ka bang 10 mmol / l). Glucose ke ntho e sebetsang ebile e na le keketseho ea karolo ea eona ka har'a moroto e thusa metsi hore a eketsehe (polyuria), eo qetellong e ka lebisang hoho omellasebopuoahaeba tahlehelo ea metsi e sa felisoe ke tšebeliso e lekaneng ea metsipolydipsia) Hammoho le tahlehelo e eketsehileng ea metsi ka har'a moroto, letsoai la liminerale le lona le lahlehile - sekhahla sea ntlafalalikeresodium,potasiamo,calciumlemagnesium,anionschlorine,phosphatelebicarbonate .

Ho na le methati e 6 ea nts'etsopele ea lefu la tsoekere la mellitus ea mofuta oa pele.

Bokapele ba lefutso bo amanang le lefu la tsoekere bo amanang le tsamaiso ea HLA.

Khoele ea ho qala Hypothetical. Tšenyo β liselelintlha tse fapaneng tsa diabetogenic le lisosa tsa ts'ebetso ea boits'ireletso ba mmele. Bakuli ba se ba ntse ba e-na le li-antibodies tsa ho iske lisele ka karolo e nyane, empa secretion ea insulin ha e e-so utloe bohloko.

Insulin e sebetsang ea autoimmune. Li-antibody titer li phahame, palo ea β-lisele ea fokotseha, secretion ea insulin e ea fokotseha.

Sekhahla sa insulin se theotsoeng tsoekere. Maemong a sithabetsang, mokuli a ka bona tsoalo e sa tsitsang ea tsoekere e potlakileng (NTG) le "glucose" e fokolisang botsitso.

Pontšo ea kliniki ea lefu la tsoekere, ho kenyelletsa le karolo e ka hlahang ea "mahe a linotsi". Secretion ea insulin e fokotsehile haholo, kaha ho feta 90% ea lisele tsa β-lefu li ile tsa shoa.

Tšenyo e felletseng ea lisele tsa β, ho felisoa ka botlalo ha insulin.

Pathological physiology: ke eng?

Pathological physiology ke mahlale ao sepheo sa ona e leng ho ithuta bophelo ba setho se kulang sa motho kapa sa phoofolo.

Morero oa mantlha oa tataiso ena ke ho ithuta mochini oa nts'etsopele ea maloetse a fapaneng le ts'ebetso ea pholiso, hammoho le ho khetholla melao ea mantlha le e akaretsang ea tšebetso ea litsamaiso tse fapaneng le litho tsa bakuli.

Seo lithuto tsa 'mele li amanang le tsona:

• nts'etsopele ea lits'ebetso tse fapaneng tsa pathological, hammoho le sephetho sa bona,
• mekhoa ea ho hlaha hoa maloetse,
• mofuta oa nts'etsopele ea mesebetsi ea 'mele ho latela boemo ba' mele oa motho ka li-pathologies tse fapaneng.

Pathophysiology ea lefu la tsoekere

Hoa tsebahala hore mochine oa pathophysiological bakeng sa nts'etsopele ea lefu la tsoekere la mofuta oa I o thehiloe ho palo e nyane ea insulin e hlahisoang ke lisele tsa endocrine.

Ha e le hantle, lefu la tsoekere le hlaha sethaleng sena ho bakuli ba 5-10%, kamora moo, ntle le kalafo e hlokahalang, e qala ho tsoela pele mme e ba sesosa sa nts'etsopele ea mathata a mangata a tebileng, ho kenyelletsa:

• lefu la lefu la tsoekere
• ho hloleha ha rems
• ketoacidosis
• lefu la tsoekere,
• stroke
• lefu la tsoekere la leoto la lefu la tsoekere.

Ka lebaka la khaello ea insulin, lisele tse itšetlehileng ka lihormone ha li sa khona ho amohela tsoekere, sena se lebisa ho hyperglycemia, e leng e 'ngoe ea matšoao a mantlha a lefu la tsoekere la mofuta oa 1.

Ka lebaka la ts'ebetso ea ts'ebetso ena ho lithane tsa adipose, lipids lia senyeha, e ba lebaka la ho eketsa boemo ba bona, mme ts'ebetso ea ho phatloha ha liprotheine e qala liseleng tsa mesifa, e lebisang keketseho e eketsehileng ea li-amino acid.

Lefu la tsoekere la Mofuta oa II le ka tšoaetsoa ke ho haella ha insulin, ho ka bang le mefuta e meraro ea likotsi:

1. ntho e makatsang ea ho hlola insulin. Ho na le tlolo ea ts'ebetsong ea litlamorao tsa insulin, ha lisele tsa β-li bolokiloe mme li khona ho hlahisa palo e lekaneng ea insulin,
2. lekunutu la letsoalo la β-cell. Tlolo ena ke phoso ea lefutso eo lisele tsa β li sa robeheng, empa secretion ea insulin e fokotsoa haholo.
3. litlamorao tsa lintho tse hanyetsanang.

Ketsahalo ea ho hanyetsa insulin e ka etsahala maemong a receptor le a postreceptor.

Mechine ea li-receptor e kenyelletsa:

• Tšenyo ea li-receptors ka li-radicals tsa mahala le li-enzyme tsa lysosome,
• blockade of insulin receptors ke li-antibodies tse fetohang ho etsisa sebopeho sa ona,
• phetoho mokhatlong oa li-insulin receptors ka lebaka la ho hlaha hoa sekoli sa liphatsa tsa lefutso,
• ho fokotseha ha kutloisiso ea lisele tse reretsoeng ho ea ho insulin ho etsahala ka lebaka la keketseho e lekaneng ea khatello ea "insulin" maling ho batho ba jang khafetsa.
• phetoho mokhatlong oa li-insulin receptors ka lebaka la bofokoli ho liphatsa tsa lefutso tse ikarabellang bakeng sa tlhahlobo ea polypeptides ea bona.

Mehato ea postreceptor e kenyeletsa:

• tlolo ea melaoana e amanang le ho tlosa tsoekere,
• ho haella ha baeti ba tsoekere ba transmembrane glucose. Ts'ebetso ena e shebiloe haholo ho batho ba nonneng haholo.

Mathata a lefu la tsoekere

Litsebi tsa lefu la tsoekere li lokela ho hlokomela boemo ba tsona ka hloko, ho se tsotelle likeletso tsa ngaka ho tla etsa hore ho be le mathata a mangata.

• mathata a hlobaetsang. Tsena li kenyelletsa ketoacidosis (ho bokellana ha 'mele ea ketone e kotsi' meleng), hyperosmolar (tsoekere e phahameng le sodium ho plasma) le lacticidotic (mahloriso a lactic acid maling) coma, hypoglycemia (ho fokotseha ho matla ha tsoekere ea mali),
• mathata a sa folengnna. Ho bonahatsa, joalo ka molao, kamora lilemo tse 10-15 ho ba teng ha lefu lena. Ho sa tsotelehe maikutlo a kalafo, lefu la tsoekere le ama mmele hampe, le lebisang ho mathata a sa foleng, litho tse joalo li utloa bohloko: liphio (ho nyekeloa le ho se lekane), methapo ea mali (tumello e mpe, e kenang kahare ho ho ja lintho tse thusang le oksijene), letlalo (phepelo e tlase ea mali, liso tsa trophic) ), tsamaiso ea methapo (ho lahleheloa ke maikutlo, bofokoli bo sa feleng le bohloko),
• mathata a morao. Hangata litla-morao tse joalo li ba teng butle, empa sena se lematsa le lefu la tsoekere. Har'a tsona: angiopathy (fragility ea methapo ea mali), leoto la tsoekere (ulcers le liso tse tšoanang tsa maemo a tlase), retinopathy (detachment of retina), polyneuropathy (ho hloka kutloelo-bohloko ea matsoho le maoto ho chesa le ho utloa bohloko).

Mekhoa ea likokoana-hloko ea kalafo ea mafu

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

U hloka ho kenya kopo ...

Ha ba phekola mofuta oa lefu la tsoekere, lingaka li sebelisa melao-motheo e meraro e ka sehloohong:

1. kalafo ya hypoglycemic,
2. thuto ea mamello
3. ja

Ka hona, ka mofuta oa pele, kalafo ea insulin e sebelisoa, hobane bakuli bana ba na le bofokoli ba eona bo phethahetseng, 'me ba hloka sebaka sa maiketsetso. Morero oa eona o moholo ke ho holisa ho etsisa li-hormone tsa tlhaho.

Litekanyetso li lokela ho khethoa feela ke ngaka e eang ho mokuli e mong le e mong. Tabeng ea batho ba nang le lefu la tsoekere la mofuta oa 2, ho sebelisoa lithethefatsi tse tsoekere e tlase ea mali ka ho hlohlelletsa manyeme.

Molao oa bohlokoa oa kalafo bakeng sa tšoaetso ke boemo bo nepahetseng ba mokuli ho eena. Lingaka li qeta nako e ngata li ithuta ka tsela e nepahetseng ea ho phela le lefu la tsoekere.

Lijo li nchafatsoa haholo, litloaelo tse mpe le khatello ea maikutlo li felisoa, 'mele o eketsa ho ikoetlisa ka mokhoa o leka-lekaneng,' me mokuli o tla hloka ho lekola letšoao la tsoekere ea mali (ho na le li-glucometer bakeng sa sena).

Mohlomong, bakuli ba tloaetse ho ja lijo tse ikhethileng (tafoleng ea 9) ka nako e telele haholo.

E hloka ho qheleloa ka thoko lihlahisoa tse ngata, kapa tse nchafatsoang. Mohlala, nama e nang le mafura, tlhapi le ma-broth, li-pastry le liswiti, chisi ea chisi, tranelate, chisi e halikiloeng, botoro, pasta, semolina, raese e tšoeu, litholoana tse monate, lijo tse ka makotikoting (ho kenyeletsoa meroho e khabisitsoeng), lino tse nang tsoekere e phahameng, soda le ho e.

Lijo tse ling li ka jeoa, empa u lokela ho lekola palo ea likhalori tse jeoang ka letsatsi, le palo ea lik'habohaedreite - ha ea lokela ho ba ngata ea tsona.

Ka lehlohonolo, hoo e ka bang mabenkeleng ohle hona joale ho na le lefapha le nang le lihlahisoa tse lumelloang bakeng sa lefu la tsoekere, tse nolofatsang bophelo ba bona haholo.

Pathological physiology ea lefu la tsoekere

Ho haella ha insulin ho lefu la tsoekere ho lebisa haholo ho fokotseheng ha tsoekere ea tsoekere ke lisele le hyperglycemia. Haholo-holo maemo a tsoekere a plasma e phahameng a bonoa nakoana kamora ho ja (seo ho thoeng ke postprandial hyperglycemia).

Ka tloaelo, glomeruli ea renal ha e khonehe ho tsoekere, empa ha boemo ba plasma bo le kaholimo ho 9-10 mmol / l, e qala ho pepesoa ka matla ka har'a moroto (glucose-ria). Sena se lebisa keketseho ea khatello ea osmotic ea moroto, le ho fokotseha ho khutlisong ea metsi le li-electrolyte ke liphio. Palo ea moriti oa letsatsi le letsatsi o nyolohela ho lilithara tse 3-5 (lilithara tse 7-8 maemong a boima), i.e. ea nts'etsapele poly uria ka lebaka la ho fokolloa ke metsi (hypohydration) sebopuwa (feiga 27.1) seo

Sa feiga. 27.1. Pathophysiology ea khaello ea insulin.

Sa feiga. 27.1. Pathophysiology

e tsamaeang le lenyora le matla. Ha ho na le insulin, ho phatloha ho hoholo ha liprotheine le mafura hoa hlaha, tse sebelisoang ke lisele e le mehloli ea matla. Ka lehlakoreng le leng, 'mele o lahleheloa ke naetrojene (ka tsela ea urea) le amino acid,' me ka lehlakoreng le leng, o bokella lihlahisoa tse chefo tsa lipolysis - ketone 1. Tse latelang li bapala karolo ea bohlokoa ho pathophysiology ea lefu la tsoekere: ho felisoa ha li-acid tse matla 'meleng, e leng acetoacetic le p-hydroxybutyric acid, ho lebisang ho tahlehelo ea libaka tse bolokang lijo, ho fokotsoa ha pokello ea alkaline le ketoacidosis. Haholo-holo e shebile haholo ka liphetoho phetohong ea osmotic ea mali le litekanyo tsa tekanyetso ea acid e thehiloeng liseleng tsa boko. Keketseho ea ketoacidosis e ka lebisa ho ketoacidotic coma, 'me hamorao ka tšenyo e ke keng ea fetoloa ea li-neuron le lefu la mokuli.

Lefu la tsoekere le baka mathata a mangata, ao a mang a 'ona a leng matla ho feta lefu la tsoekere ka boeona' me a ka baka ho holofala le lefu. Liphetoho tse ngata li thehiloe ho senyeha ha methapo ea mali ka lebaka la atherosulinosis le glycosylation ea protheine (glucose) e hokahantsoe le limolek'hule tsa protheine).

Mathata a mantlha a lefu la tsoekere:

• atherossteosis, e leng se lebisang ho ntlafatsong ea mathata a macrovascular: infarction ea myocardial le stroke. Atherosclerosis ke sesosa se tobileng sa lefu ho bakuli ba 65 ba nang le lefu la tsoekere,

• nephropathy (Tšenyo ea liphio) le ho phahama ha lefu le sa foleng le sa foleng (ho 9-18% ea bakuli),

1 Acetyl-CoA, e bōpiloeng ka har'a sebete nakong ea ha e na le li-oxid tse potlakileng tsa mafura, 'me ka mor'a moo e fetoloa acid e acetoacetic, e tla fetoloa β-hydroxybutyric acid ebe decarboxylated ho acetone. Lihlahisoa tsa lipolysis li ka fumanoa maling le moroto oa bakuli (seo ho thoeng ke li-ketone kapa 'mele oa ketone).

Lefu la tsoekere - hoo e ka bang 485

• neuropathy (haholo methapo ea kutlo e amehang)

• retinopathy (tšenyo e tsoang ho retina e lebisang bofofu) le likatse (pono e fokotsehileng ea lense)

• Ho fokotseha ha boits'epo ba mmele ho tšoaetsong

• mathata a trophic a letlalo (ka sebopeho sa li-ulcers tsa nako e telele tse sa foliseng). Arohane lefu la tsoekere la maoto (ts'oaetso, ulcer le / kapa tšenyo ea litho tse tebileng tsa leoto), e amanang le mathata a methapo ea methapo (neuropathy) le ho fokotseha ha phallo ea mali e ka sehloohong (angiopathy) methapong ea methapo e tlase. Lefu la tsoekere la maoto ke lona pheko e atileng haholo ea lefu la tsoekere.

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Lefu la tsoekere la mellitus pathophysiology

Empa, bakeng sa ho susumetsa sebopeho sa li-acid tse phahameng tsa mafura, hoa hlokahala ho fumana malonyl-CoA ka carboxylation ea acetyl-CoA. Joalokaha ho boletsoe kaholimo, mohopolo oa karabelo ena o thibeloa ke lihormone tse loantšanang, 'me acetyl-CoA eohle e lokollotsoeng mitochondria e romelloa ho syntlesterol.

Hypertriacylglycerolemia. Keketseho e eketsehang ea mafura a mangata maling a hlokometsoeng ho bakuli ba nang le lefu la tsoekere (bona kaholimo) e nolofalletsa ho kenella ha bona ho cytoplasm ea hepatocytes. Empa ts'ebeliso ea li-acid tse mafura bakeng sa sepheo sa matla ha e eketsehe, hobane ba sitoa ho tšela membrane ea mitochondria (ka lebaka la khaello ea insulin, mosebetsi oa mokalli, sistimi ea carnitine, e sitisoa). 'Me ho bokellana ho cytoplasm ea lisele, mafura a acid a sebelisoa ho lipogenesis (mafura a mafura a sebete), a kenyellelitsoe ho VLDL' me a lokolloe maling.

Dyslipoproteinemia. Liphetoho tsohle tse boletsoeng kaholimo ho metabolid ea lipid (tlhahiso ea cholesterol e ntlafalitsoeng, gPcylylation ea LP) e kenya letsoho ho bokelleng ha VLDL, LDL ka phokotso e tšoanang ka litekanyetso tsa HDL.

Ts'ebetso ea peroxide homeostasis. Joalokaha u tseba, hypoxia, tšobotsi ea lefu la tsoekere, ke e 'ngoe ea lisosa tsa lipid peroxidation. Ho feta moo, ka lebaka la thibelo ea PFP, ho hlaphoheloa ha NADP +, e hlokahalang joalo ka karolo ea ts'ireletso e khahlanong le radical, ea fokotseha.

Hyperazotemia Ka setso, poleloana ena e bua ka kakaretso ea boleng ba likhomphutha tse nang le boima ba naetrojene e ngata (urea, amino acid, uric acid, creatine, creatinine, jj.). Hyperaminoacidemia ho lefu la tsoekere e bakoa ke: 1) ho senyeha ha membrane membrane bakeng sa amino acid, 2) ho theoha ha ts'ebeliso ea liamino acid ho protheine biosynthesis, hobane sekhahla sa PFP - mohloli oa ribose-5-phosphate - karolo e tlamang ea li-mononucleotides - barupeluoa molemong oa RNA - matrix ho synthesis protein e fokotsehile (Sekema sa 1). Maqhubu ka bobeli (1,2) a bakoa ke khaello ea insulin. Lihormone tse ngata tse hanyetsanang le li-hormone tse ling tse fetisisang li na le phello ea catabolic (Lethathamo 2), i.e. activate proteinolysis, eo hape e fanang ka hyperaminoacidemia.

Ntle le moo, tlolo ea ts'ebeliso ea "glucose" ea sepheo sa matla tsoekere ka lebaka la ts'ebetso ea li-hormone tse ts'oanang le li-hormone e baka keketseho ea gluconeogenesis (Scheme 2), haholo-holo ho tsoa ho li-amino acid le ho senyeha ho potlakileng ha acid ea ketogenic amino acid ka ho theha 'mele oa ketone - mehloli e metle ea matla. E 'ngoe ea lihlahisoa tsa phetoho tse peli e tla ba ammonia, e sa aroloang ke motsoako oa urea. Ka hona, ka lefu la tsoekere maling, ho tlalehiloe boemo bo phahameng ba ntho ena (hypercarbamidemia).

Fokotsa matla a tšireletso. Ka lebaka la khaello ea insulin, tekanyo ea protheine ea motsoako e fokotseha (bona ka holimo), ho kenyelletsa immunoglobulins. Ho feta moo, ba bang ba bona, kamora ho glycosylation (bona ka holimo), ba lahleheloa ke thepa ea bona, ke ka lebaka leo nts'etsopele ea bakuli ba nang le mafu a pustular, furunculosis, jj.

Keketseho ea khatello ea mali ea osmotic ka lebaka la ho bokelloa ha metsoako e fapaneng ea boima ba limolek'hule (tsoekere, amino, acid ea keto, lactate, PVC, jj.).

Ho omella (dehydration) ea lisele ka lebaka la khatello e matla ea mali ea osmotic.

Acidosis ka lebaka la ho bokelloa ha lihlahisoa tsa acidic (acetoacetate, β-hydroxybutyrate, lactate, pyruvate, jj.).

Tse fapaneng ke tsonaas. Glucosuria, ketonuria, aminoaciduria, lactataciduria, jj. - ka lebaka la boleng bo fetisisang ba boleng ba bona ba renal.

Keketseho ea matla a itseng a moriti, ka lebaka la nts'etsopele ea tse fapaneng - uria.

Polyuria a) Bakeng sa ho tlosa lintho tse fapaneng ho hloka palo e eketsehileng ea metsi,

b) ka lebaka la polydipsia.

Polydipsia. Lenyora le eketsehang ka lebaka la khatello e eketsehang ea osmotic ho plasma ea mali le ka lebaka la tahlehelo e eketsehileng ea metsi ka har'a moroto.

Polyphagy. E 'ngoe ea matšoao a pele le a mantlha a lefu la tsoekere. Ka lebaka la khaello ea insulin, permeability ea membrane ea tsoekere, amino acid le mafura a mangata, i.e. madi "a tletse", mme disele tsa "tlala."

Liphetoho tse joalo tsa metabolism li sokela nts'etsopele ea mathata a mangata a fapaneng (a hlobaetsang le a sa foleng).

Mathata a tebileng ka ho fetisisa:

Hyperosmolar concretless coma

Lihokela tsa mantlha tsa lefu la tsoekere ketoacidosis ke hyperglycemia (ho feta 10 mmol / l), ka hona, glucosuria, plasma hyperosmolarity, hyperketonemia, letšoao la ho qetela ke lona le ikarabellang bakeng sa metabolic acidosis (ho fokotseha ha litaba tsa mali a bicarbonates a plasma. Ka hona, liphekeng ho na le ho lieha ha H +, e eketsang acidosis, e thabisang setsi sa ho hema, e tebisa le ho fokotsa ho hema - ho phefumoloha ha Kussmaul, CO2 e kenyelletsoa, ​​e fokotsang ho teba ha acidosis, empa ka nako e ts'oanang bofokoli ba bicarbonates bo eketseha. Letšoao la khale ntlheng ena ke monko oa acetone e tsoang molomong. Ketoacidosis e hlohlelletsoa ke lijo tse nang le mafura hape e thibetsoe ho na le lik'habohaedreite.

Motheo oa lefu la tsoekere la lactic acidosis ke nts'etsopele ea hyperlactacidemia (bona kaholimo), e tsamaisoang ke hypoxia ea tishu le tlolo ea naha ea acid-base.

Hyperosmolar bezketonny coma e atile haholo ho bakuli ba lilemo tse mahareng le ba tsofetseng. E tšoauoa ka hyperglycemia e phahameng (ho feta 55 mmol / l), ehlile, ho tloha mona ho phahama ka sekhahla ha osmolarity ea plasma ea mali, ponahalo ea tsoekere maling ka moriring, e bakang osmotic diuresis (tahlehelo ea metsi le li-electrolyte). Ho fapana le complication ea pele, ho bakuli hyperketonemia le ketonuria ha lia tlalehoa.

Hypoglycemic coma e fetoha le lithethefatsi tse ngata tse feteletseng

Ketoacidosis

Ka sejoale-joale lefu la tsoekere ka glycosuria e fokolang, ketoacidosis ha e eo. Palo ea asiti ea acetoacetic e thehiloeng nakong ea ho phatloha ho feteletseng hoa mafura acids, a hlokahalang ho lefella tahlehelo ea tsoekere, ha e fetelle ho se ka sebelisoang ke 'mele ts'ebetsong ea phapanyetsano. Leha ho le joalo, haeba tahlehelo ea tsoekere e bohlokoa haholo (100-200 g ka letsatsi), tekanyo ea mafura a sebelisitsoeng e ba ngata hoo palo ea metsoako ea ketone e qalang ho feta bokhoni ba 'mele ba ho li sebelisa.

Ketones bokellana maling le ha o tsoa ka har'a moroto. Li-acetoacetic le b-hydroxybutyric acid li pepesoa ka tsela ea metsoako ea tsona ka li-cations, sodium le potasiamo li lahlehile, li mpefatsa ho haella ha lintho tse sebetsang tse amanang le tahlehelo ea tsoekere, hammoho le tloaelo e seng e le teng ea metabolic acidosis. Ho liphoofolo tse kang likolobe le linonyana, tseo 'mele oa tsona o khonang ho sebelisa hantle esita le bongata bo boholo ba acetoacetic acid, pancreatectomy ha e bake ketoacidosis. Ho felisoa ha acid e mafura ha ho fihle ka tekanyo e fetelletseng, 'me lefu la tsoekere ha le kotsi joalo ka batho le lintja.

Ka tsela ena ketoacidosis, eo e leng lets'oao le tsebahalang la lefu la tsoekere le matla, ke phello ea ho thehoa ha tsoekere e maling le ho lahleheloa ke eona ke 'mele. Glucosuria, ka lebaka la ho hlahisoa ha floridzine, leha e baka hypoglycemia, e lebisa ho ketoacidosis, hape le nakong ea ho itima lijo, moo khotsofalo ea litlhoko tsa mmele e netefatsoang ke ho phatloha ha mabenkele a mafura le liprotheine tseo e leng mehloli ea tsoekere.
Maemong ana kaofela, ntlafatso e hlahisitsoeng ke kenyelletso tsoekere, ka lebaka la hore e thibela "neoplasm" e ngata ea tsoekere maling.

Lethathamo la litaba tsa "Mafu a Bokooa ba" Thymus le Pancreas ":

Thymus anatomy.

Mofuta oa 1 le Lefu la 2 la Lefu la tsoekere: Pathophysiology le Litsela tsa kalafo

5. Pathogeneis

Nts'etsopele ea leqheka sebakeng sa ho hlahisoa ha micbe e qala ka ho kenella ka har'a tishu ka serous kapa serous-fibrinous exudate, ho bokelloa ha palo e kholo ea likarolo tsa sele, haholo-holo likarolo tse tšoeu tsa lisele tse tšoeu tsa mali. Kahoo ...

Phuputso e mabapi le katleho ea mesebetsi ea botsebi ea li-paramedics ho thibelo le kalafo ea mathata a hematological ho bana

3. Pathogenesis

Khokahano ea bohlokoahali ho pathogenesis ea PON ke mathata a microcirculatory le endothelial microvasculature. Ha li bakoe haholo, 'me ka linako tse ling ha li ngata hakalo ka ho fokotseha ha ts'ebetso ea pelo ...

Lisosa le litlamorao tsa khatello ea ts'ebetso

Ho tsoa ho data ea etiology ea khatello ea ts'ebetso, ho latela hore e "baka" le motsoako o fapaneng oa karabelo ...

4 Pathogeneis

Pathogenesis ea pneumocystosis e khetholloa ke likarolo tsa tlhaho tsa pathogen le boemo ba sesole sa 'mele ba mofani. Mefuta e atamelaneng ea pneumocyst e e-so ka e hlalosoa e fetisa pampiri e kholo ea ho hema ...

Ntshetsopele ea mehato ea thibelo bakeng sa toxocariasis ea lintja

Sengoloa sa sengoloa sa saense lefapheng la bongaka le tsa bophelo bo botle, mongoli oa pampiri ea mahlale ke Kurbatov D.G., Dubsky S.A., Lepetukhin A.E., Rozhivanov R.V., Schwartz Y.G.

Tlhahlobo ena ea lingoliloeng e sebetsana le litaba tsa lefu la seoa, ho khetholla, pathophysiology hammoho le tlhahlobo le kalafo ea ho se sebetse hantle ha erectile ho bakuli ba nang le lefu la tsoekere la mofuta oa 1. Ho hloka taolo ea erectile ho bakuli ba banyenyane ba nang le lefu la tsoekere ke bothata bo boholo ka lebaka la ho ata ha bona, hammoho le tšusumetso maemong a kelello a bakuli le boleng ba bophelo ka kakaretso. Ho ile ha hatisoa hore tlhahlobo ea nako e nepahetseng ka tlhaloso e nepahetseng ea sebopeho sa erectile dysfunction eu lumella ho khetha khetho e loketseng le e loketseng bakeng sa mokuli ka mong.

LITLHAKISO TSA BOPHELO TSE BONAHALANG HO BATSOALI BA LE MAHALA A 1: LITLHAKISO TSA TLHATSI

Thutong ena ea lingoliloeng ho bonts'oa lefu la seoa, ho khetholla, pathophysiology, ho hlahloba le kalafo bakeng sa ho se sebetse hantle ha erectile ho bakuli ba nang le lefu la tsoekere la mofuta oa 1. Ho se sebetse hantle ha erectile ho bakuli ba banyenyane ba nang le lefu la tsoekere ke bothata bo boholo ka lebaka la ho ata hohle, le tšusumetso maemong a kelello a bakuli le boleng ba bophelo ka kakaretso. O ile a totobatsa hore tlhahlobo e tlang ka nako e nang le tlhaloso e nepahetseng ea mofuta oa dysfunction ea erectile e ka nka kalafo e loketseng le e loketseng bakeng sa mokuli ka mong.

Sengoloa sa mosebetsi oa mahlale ka sehlooho se reng "Erectile Dysfunction in Type 1 Diabetes Patients: Diagnostic and Treatment mekhoa"

UDC: 616.69-008.14: 616.379-008.64

Ho se sebetse hantle ha erectile ho Bakuli ba nang le lefu la tsoekere la Mofuta oa 1:

MELAO EA DIAGNOSTIC LE TS'ELISO

Kurbatov D.G., Dubsky S.A., Lepetukhin A.E., Rozhivanov R.V., Schwartz Y.G.

Federal State Budgetary Institution Endocrinological Science Science Center ea Ministry of Health of Russia, aterese ea Moscow: 117036, Moscow, ul.Dm. Ulyanova, 11, tel. (499) 3203687 E-mail: [email protected]

Tlhahlobo ena ea lingoliloeng e sebetsana le litaba tsa lefu la seoa, ho khetholla, pathophysiology hammoho le tlhahlobo le kalafo ea ho se sebetse hantle ha erectile ho bakuli ba nang le lefu la tsoekere la mofuta oa 1. Ho hloka taolo ea erectile ho bakuli ba banyenyane ba nang le lefu la tsoekere ke bothata bo boholo ka lebaka la ho ata ha bona, hammoho le tšusumetso maemong a kelello a bakuli le boleng ba bophelo ka kakaretso. Ho ile ha hatisoa hore tlhahlobo ea nako e nepahetseng ka tlhaloso e nepahetseng ea sebopeho sa erectile dysfunction eu lumella ho khetha khetho e loketseng le e loketseng bakeng sa mokuli ka mong.

Mantsoe a bohlokoa: lefu la tsoekere, ho hloka taolo ea erectile

LITLHAKISO TSA BOPHELO TSE BONAHALANG HO BATSOALI BA LE MAHALA A 1: LITLHAKISO TSA TLHATSI

Kurbatov D. G., Dubskiy S.A., Lepetukhin A.E. Rozhivanov R. V., Schwartz J. G.

Setsi sa Patlisiso sa Endocrinology, Moscow

Thutong ena ea lingoliloeng ho bonts'oa lefu la seoa, ho khetholla, pathophysiology, ho hlahloba le kalafo bakeng sa ho se sebetse hantle ha erectile ho bakuli ba nang le lefu la tsoekere la mofuta oa 1. Ho se sebetse hantle ha kelello ho bakuli ba banyenyane ba nang le lefu la tsoekere ke bothata bo boholo ka lebaka la ho ata hohle, le tšusumetso maemong a kelello a bophelo le boleng ba bophelo ka kakaretso. O ile a totobatsa hore tlhahlobo e tlang ka nako e nang le tlhaloso e nepahetseng ea mofuta oa dysfunction ea erectile e ka nka kalafo e loketseng le e loketseng bakeng sa mokuli ka mong.

Mantsoe a bohlokoa: lefu la tsoekere, ho hloka taolo ea erectile

Tekanyo ea lefu la tsoekere lefatšeng e ntse e eketseha ka potlako. Ho ea ka International Diabetes Federation, batho ba fetang limilione tse 371 kajeno ba na le lefu la tsoekere mellitus (DM). Hoo e ka bang 10% ea palo eohle ea bakuli ba nang le lefu la tsoekere ba tlalehiloe ka lefu la tsoekere la 1.

Mathata a thobalano a tšoauoa ka ho fokotseha hoa bophelo

hape ha ho na mokuli, ea isang bothateng le mathata a sechaba, a bonoang ho bakuli ba fetang ba 40% ba nang le lefu la tsoekere la 2. Ho bohlokoa ho hlokomela hore likotsi tsa thobalano ho bakuli ba nang le lefu la tsoekere la 1 ba etsa hore mokotla oa bona o monyane ha o bapisoa le palo ea batho ba se nang lefu la tsoekere.

Tlolo e kholo ea ts'ebetso ea thobalano ho bakuli ba nang le lefu la tsoekere ke erectile dysfunction (ED). Ho bontšitsoe lithuto tse ngata

hore ED e ama ho fihla ho 35-55% ea bakuli ba nang le lefu la tsoekere la 1, mme kotsi ea ED ho bakuli ba nang le lefu la tsoekere e phahame makhetlo a 3 ha ho bapisoa le palo ea batho ntle le lefu la tsoekere.

Khafetsa ea nts'etsopele ea maloetse a erectile ho bakuli ba nang le lefu la tsoekere ha ea itšetleha feela ka lilemo tsa mokuli, empa hape le nako ea lefu le ka tlase le nako ea nako ea ho bolaoa ha metabolism ea carbohydrate 7, 8. Nts'etsopele ea ED e angoa ke ho ba teng ha maloetse a kopaneng, mathata a lefu la tsoekere le katleho ea kalafo. Kahoo, lithutong tse 'maloa, kamano pakeng tsa ho ba teng ha ED le mathata a lefu la tsoekere la morao-rao e ile ea ithutoa mme ho bontšoa hore ED e fumanoe hangata makhetlo a 2 ho bakuli ba nang le lefu la tsoekere kapa nephropathy.

Ho hlahlojoa ha erectile dysfunction ho bakuli ba nang le lefu la tsoekere e ka ba letšoao le sa tobang la nts'etsopele kapa kholo ea ts'ebetso ea atherosselotic le lefu la pelo, hammoho le ho ba ponahatso ea pele ea lefu la tsoekere la neuropathy 11, 12. Phuputso e ts'oanang e entsoeng ke Rozhivanov R.V. (2005) motheong oa Federal State Budgetary Institution "Endocrinological Science science Center" ea Ministry of Health of the Russian Federation, e bonts'a ho bapisoa le datha tsa kantle ho naha mabapi le ho ata ha ED ho bakuli ba nang le lefu la 1 le la 2 lefu la tsoekere, ho ipapisa le batho ho latela lilemo tsa bakuli, nako ea lefu lena, le kamano le boemo ba puseletso.

carbohydrate metabolism le ho ba teng ha mathata a lefu la tsoekere.

Ha ho fanoa ka kakaretso ea lefu la lefu la tsoekere la mofuta oa 1 hammoho le kutloisiso ea hore boemo bona ha bo fokotse bophelo ba bakuli ba banyenyane feela, empa e ka ba e 'ngoe ea matšoao a lefu la tsoekere, lefu la pelo, lefu la pelo, atherosulinosis. ho hlahlobeloa le kalafo ea ED sehlopheng sena sa bakuli.

• Organic (vasculogenic, neurogenic, endocrine)

• Motsoako o tsoakaneng (oa tlhaho ea tlhaho le oa kelello)

Boemo bo sebetsang ba thobalano

setho se laoloa ke molumo o boreleli oa mesifa ea methapo ea mmele le litopo tsa trabecula cavernous. Kamora ho hlohlelletsa thobalano, nitric oxide (NO), e hlophisitsoeng ke endothelium, e eketsa khatello ea khatello ea "cyanyase cyclase" (GMF). Keketseho e ntseng e eketseha ea cyclic GMF (cGMP) e lebisa phomolong ea mesifa e boreleli ea mesifa, ho ata ha methapo ea kutlo le veno-occlusion ka botoneng. Lebelo la ho bola la cGMP le ipapisitse le ts'ebetso ea enzyme 5-phosphodiesterase.

Nts'etsopele ea lefu la tsoekere e ka thehiloe linthong tse ngata ka nako e le 'ngoe.

moat (atherosclerosis + neuropathy, neuropathy + psychogenic factor, jj).

Phekolo ea penile e laoloa ke li-isoforms tse fapaneng tsa NO-syn-tetase ea neuronal, endothelial le tšimoloho ea mesifa e boreleli. . Mehato e 'maloa ea biochemical e hlalosa ho hlaha hoa ho fokola ha lefu la tsoekere ho lefu la tsoekere. Karolo ea vascular le neurogenic hammoho ke lisosa tsa ED ho lefu la tsoekere, hobane ho tsebahala hore ho se sebetse hantle ha endothelial ho lebisa ho nts'etsopele ea ischemic neuropathy, eo, ka lehlakoreng le leng, e nang le phello e mpe ho synthesis ea NO. Boithuto bo bongata bo bonts'itse ho hloka botsitso ho felletseng ha mmele ho ea ho endothelial le neurogenic 'meleng ea mahaheng a bakuli ba nang le lefu la tsoekere le ED. Ho fumana hona ho tsamaisana le ho haella ha CHA. Ho feta moo, lithuto tse ling tsa kantle ho naha li bonts'itse keketseho e kholo ea palo ea libaka tsa NO-synthetase-binding meleng ea lisele tsa 'mele oa rat ca likhoeli tse 2 kamora ho kenngoa ha lefu la tsoekere. Ts'ebetso ena e ts'oana le e fumanoang libetheng tse ling tsa methapo, moo boiketlo ba phepelo ea endothelium bo fetotsoeng ka lebaka la ho haella ha motsoako ka lebaka la ho teba ha tsoekere e ngata. Kahoo, bofokoli mosebetsing oa NO synthetase bo bapala karolo ea thuto ea lefu la lefu la bophelo bo botle ho bakuli ba nang le lefu la tsoekere, ka lebaka la ho ferekanya endothelial dis-

mesebetsi. Ho ile ha boela ha bontšoa hore ho phomola ha lisele tse boreleli tsa mesifa ho 'mele ea li-cavernous ho bakuli ba nang le lefu la tsoekere nakong ea ts'usumetso ea motlakase ho ne ho le bobebe ka lebaka la ho fokotseha ha tlhahiso ea nitric oxide ka NO synthetase. Ho bohlokoa ho hlokomela hore hyperglycemia ea nako e telele e etsa hore ho be le keketseho ea tšebeliso ea nicotinamide adenine dinucleotide phosphate (NADPH), cofactor tlhahisong ea NO, ka hona, e fokotsang boemo ba nitric oxide.

Moloko o fetoloang o sa sebetseng oa phepo e ntle o boetse o sitisa phomolo ea NO-e khothalletsang ho bokella lihlahisoa tse tsoetseng pele tsa glycation end-lihlahisoa (AGE) tse potileng maling, tseo hape li ikarabellang bakeng sa nts'etsopele ea mathata a methapo ea lefu la tsoekere.

Lihlahisoa tsa AGE, tse bokellanang ho bakuli ba nang le lefu la tsoekere, li kenella le li-receptor tse itseng tsa tiske tse kenang le maqeba a vascular, hape li eketsa polelo ea basireletsi ba senya senya, e leng ho lokolloa ha eona hape ho susumetsoang ke glucose. 21, 22, 23.

Lintho tsena kaofela tse kaholimo li kenyelletsoa pathophysiology ea maloetse a pelo a tšoaeang le lefu le phahameng (ischemia e se nang bohloko, ischemia ea lefu la tšohanyetso, joalo-joalo), e amanang haholo le ED.

Neuropathy ke karolo ea bohlokoa ntlafatsong ea lefu la tsoekere

Ed Tšenyo ea morphological ho li-fibro tsa methapo ea kutlo ea "likarolong" tsa 'mele ea cavernous ho bakuli ba nang le lefu la tsoekere ba bontšitsoe. Ho ba teng ha peripheral polyneuropathy ho nkoa e le tšobotsi ea bakuli ba nang le ED, leha ho le joalo, ho fokotseha ha lebelo la tšusumetso ea methapo haufi le methapo ea methapo le phapang ea methapo ea pelo le ha ho le joalo ho tlalehiloe hangata ho bakuli ba nang le lefu la tsoekere le ED ho feta ho bakuli ba nang le ED le polyneuropathies ea semelo se fapaneng.

Mesebetsi e mengata e sebelisitsoeng phetohong ea methapo tsamaisong ea methapo ho bakuli ba nang le lefu la tsoekere e bua ka tšenyo ea mantlha ea methapo ea methapo ea kutlo.

Autonomic neuropathy e bonahala e le eona ntho e ka sehloohong ea pathogenetic ho ED ho bakuli ba nang le lefu la tsoekere. Bakuli ba nang le lipontšo tsa neuropathy ea peripheral ba na le monyetla oa ho utloisoa bohloko ke ED ho feta bakuli ba nang le lefu la tsoekere ntle le polyneuropathy. Motsoako o matla ka ho fetisisa oa metabolic ke khopolo ea polyol metabolism, ho latela moo tsoekere e fetelletseng ho tsoekere e hlahisoang ke mofuta oa polyol, qetellong e fetoha sorbitol le fructose, e leng ho bokellana ha lisele tsa methapo ea kutlo ho baka tsoelo-pele ea neuropathy. Bohlokoa ba hyperglycemia ho nts'etsopele ea lefu la tsoekere le phekoloa ka lefu la tsoekere le netefalitsoe ke 'nete ea hore, ha matšeliso a fumaneha,

levodic metabolism, tsoelo-pele ea lefu la tsoekere e fokotsoa ke 40-60%.

The vasculogenic hypothesis ea nts'etsopele ea neuropathy, e thehiloeng ho fokotseha ha phallo ea mali ea endoneural, ho eketseha ha khatello ea methapo ea methapo le ho fokotseha ha moea oa moea, le hona hoa bohlokoa. Ho ea ka khopolo ena, liphetoho tsa methapo ea methapo ea methapo ea methapo ea kutlo le hypoxia le ischemia li bohlokoa.

Tsohle tse kaholimo li bonts'a karolo ea bohlokoa ea peripheral neuropathy ho nts'etsopele ea ED ho bakuli ba lefu la tsoekere. Bangoli ba bangata ba supa boemo bona e le "neurogenic ED," ka tsela ena ba ela hloko karolo e etelletseng pele ea lefu la tsoekere ho lefu la pelo ho bakuli ba joalo ba 31, 32.

Hammoho le mefuta ea vasculogenic le neurogenic ea ED ho lefu la tsoekere, endocrine ED e amanang le khaello ea androgen e atile.

Phuputso ea morao tjena e bontšitse hore NO synthetase ke enzyme e itšetlehileng ka androgen. Ho itšetleha ka androgenic ea NO synthetase ho bontšoa ke 'nete ea hore liseleng tsa methapo ea methapo ea kutlo ea mokokotlo, "androgen receptors" e fumaneha moo motsoako oa NO le vasoactive intestinal peptide o bang teng, hammoho le ho tsosa ha synthesis ea ganglia tlasa ts'usumetso ea androgens. Ka nako e ts'oanang

hypogonadism ke letšoao le tloaelehileng ho bakuli ba nang le lefu la tsoekere. Lisosa tsa khaello ea androgen ho banna ba nang le lefu la tsoekere ha li tšoane. Mabaka ana a kanna a nona haholo kapa a nona haholo, hammoho le ho fokotseha ho amanang le lilemo ho secretion ea testosterone. .

Tlhahlobo ea ED ea bakuli ba nang le lefu la tsoekere

Ho hlahlojoa ha mokuli ea nang le lefu la tsoekere ho etsoa ho latela moralo oa mantlha, ho kenyelletsa le pokello ea data ea bongaka ea bongaka, tlhahlobo, le mekhoa ea laboratori le ea lisebelisoa.

Ntlha ea bohlokoa ea ho bokella anamnesis ho bakuli ba nang le lefu la tsoekere ke tlhahlobo ea lefu le ka tlase, ho ba teng kapa ho se be teng ha mathata a lefu la tsoekere, tlhaiso-leseling ka meriana e nooeng.

Nakong ea tlhahlobo ea 'mele, tekanyo ea boima ba' mele, bolelele le index ea boima ba 'mele ea etsoa, ​​hobane ho nona haholo ho ka baka hypogonadism. Maemong a mang, hoa utloahala ho etsa tlhahlobo e fapaneng ea mafura a visceral a sebelisa mochine oa CT ho hlahloba ka nepo le ho bolela esale pele likotsi. Ntle le moo, boemo ba letlalo, tlhaho le boholo ba kholo ea moriri, boemo ba tsamaiso ea mesifa le liphatsa tsa lefutso 39, 40 lia hlahlojoa.

Nakong ea tlhatlhobo ea 'mele, bakeng sa ho fumana lefu la neuropathy, ho hlokahala ho phetha bonyane ba tlhahlobo ea methapo

mekhoa. Seo e leng sa bohlokoa ka ho fetisisa ke tlhahlobo ea lintho tse etselitsoeng ho hlasela. Ho ka khothaletsoa tlhahlobo ea mocheso, tactile le maikutlo a pherekano ea botoneng.

Lethathamo la mekhoa e khethehileng ea tlhahlobo bakeng sa ED e kenyelletsa tlhahlobo ea mali a li-hormonal, ho hlahloba li-tumile tsa penile bosiu, lithuto tsa boteng tsa meriana ea tlhaho, angiography ea lijana tsa penile, dopplerografia ea li-penile le ho bonts'a lebelo la phatlalatso ea ts'usumetso ea methapo ka n. .р ^ е ^ ш.

Litsela tsohle tsa tlhahlobo tse kaholimo li sebelisetsoa ho hlahloba mofuta oa mofuta oa genesis, leha ho le joalo, mokhoa o nepahetseng le o tšepahalang ka ho fetisisa oa ho fumana mofuta oa neurogenic oa ED ho lefu la tsoekere ke electroneuromyography. Liteko tse lekolang boemo ba methapo ea kutlo le e sebetsang e kenyelletsa "peromal electromyography" ea nako ea morao-rao ea bulbocavernous reflex, tlhahlobo e patiloeng ea sephiri, tlhahlobo ea bokhoni ba ts'ebetso ea dorsal somatosensory le tlhahlobo ea maikutlo a pherekano. Bakuli ba nang le lefu la tsoekere le ED ba tšoauoa ka ho kheloha ha litholoana tsa liteko tsena ho tloha matšoao a tloaelehileng. Mohlala, ho bakuli ba nang le lefu la tsoekere ba tšoauoa ka keketseho

nako ea morao-rao ea bulbocavernos Reflex. Leha ho le joalo, liteko tse hlalositsoeng kaholimo ha li fane ka leseli la boemo ba boikemelo ba boikhethelo bo ikarabellang bakeng sa penile erection. Ho latela se boletsoeng ka holimo, ha re ngolisa ho kheloha ha liphetho tsa liteko ho tsoa ho tse tloaelehileng, re ka nahana feela ka boteng ba neuropathy ea sethoathoa ka botoneng.

E le mokhoa oa ho ithuta ka kotlolloho ha bolokolohi ba bolulo bo ikemetseng, ts'ebetso ea motlakase ea mesifa e boreleli ea cavernous e ka rekota ho sebelisoa li-electrodes tse kenang kahare kapa tse sehang ka holim'a metsi. Lintlha tse fumanoeng li sebelisa mokhoa ona li re lumella ho lekola boemo ba ts'ebetso ea neuro-Reflex ea botoneng le ho khetholla mathata maemong a tšebelisano ea Corpora cavernosa le methapo ea methapo. Phuputsong ea bolulo bo ikhethileng ba ho amohela bolulo ho bakuli ba nang le lefu la tsoekere, ho sa ngolisoe litšitiso tse sa sebetseng ka nako e tlase le boemo bo tlase ba ho nyenyefala, 'me tlhalohanyo le eona e le tšobotsi - keketseho e makatsang ea ts'ebetso ea lithaelese tse tsoang karabong ea ts'ebetso ea lithethefatsi tse mpe, ha ba ntse ba le bakuli ba phetseng hantle ka mora ts'ebetso e mpe ea kelello. lithethefatsi tse tloloang ha li na lintho tse ka u thusang. Hajoale ha ho na lintlha tse lekaneng mabapi le

palo le kutloisiso ea mokhoa ona.

Ho ipapisitsoe le se boletsoeng ka holimo, ho hlakile hore ho hlahlojoa ha mofuta oa neurogenic oa ED ho bakuli ba nang le lefu la tsoekere ke mosebetsi o boima, haholo ha ho nahanoa hore kajeno ha ho na mokhoa o hlokolosi haholo oa ho tsebahatsa lefu lena. Ho lokela ho hopoloa hore ho se sebetse hantle ha erectile hangata ke letšoao la pele la ho ruruha neuropathy. Sebopeho sa neurogenic sa ED ho mokuli ea nang le lefu la tsoekere se ka nahanoa boteng ba lipontšo tse ling tsa lefu la tsoekere (ho fokotseha ha mocheso, vibrate le maikutlo a bohloko, lipontšo tse fapaneng tsa methapo ea pelo le gastrointestinal ea neuronomous diabetesic neuropathy, hypoglycemia e sa tsejoeng. Ho haella ha data bakeng sa ho ba teng ha vasility ea vascular le hypogonadism hammoho le litletlebo tsa mathata a erectile ho ka boela ha supa neurogenic ED.

Phekolo ea bakuli ba lefu la tsoekere

Ha u khetha mokhoa oa kalafo bakeng sa ED, mokuli e mong le e mong o hloka mokhoa oa motho ka mong. Ka lebaka la monyetla oa mathata a itseng ho bakuli ba nang le lefu la tsoekere, khetho ea mekhoa ea kalafo bakeng sa ED e lokela ho utloahala. Joalo ka ha u tseba, hajoale ho loketse ho sebelisa meriana bakeng sa kalafo ea ED, empa ho bohlokoa le ho feta: ho sebetsa hantle

Rapii ED e hloka ho fihlella puseletso e tsitsitseng bakeng sa metabolism ea carbohydrate.

Ho fihla joale, ho na le mekhoa e mengata ea kalafo ea lehae ea ED: kalafo ea vacuum, intracavernous le transurethral pharmacotherapy. Mekhoa ena kaofela e na le mathata a itseng a fokotsang ts'ebeliso ea bona ho bakuli ba nang le lefu la tsoekere, kaha ba amahanngoa le ho sithabela ha mesifa e bonolo nakong ea pharmacotherapy e kenelletseng le mucosa ea urethral nakong ea transurethral pharmacotherapy, e sa rateheng ho bakuli ba nang le lefu la tsoekere ka lebaka la kotsi e kholo ea ts'oaetso ea microtrauma.

Hajoale, lithethefatsi tsa khetho bakeng sa kalafo ea ED ke mofuta oa 5 phosphodiesterase inhibitors (sildenafil, vardenafil, tadalafil, udenafil). Lithethefatsi tsa sehlopha sena ke li-modulators of erection, tse khethang PDE-5 ka mokhoa o ikhethileng, ntle le ho ama ka kotloloho lisele tsa mesifa tsa botoneng, empa e ntlafatsa phello ea N0, e hlophisitsoeng ho arabela ts'usumetso ea thobalano. Ka hona, lits'ebetso tsa 'mele tse ikarabellang bakeng sa ho hlaha le ho boloka sekhahla se arabelang ho tsusumetso ea thobalano li matlafatsoa.

Boiphihlelo ba lilemo tse ngata ka tšebeliso ea matla-denafil ho bakuli ba nang le lefu la tsoekere ba bontšitse ts'ebetso ea bona e phahameng kalafong ea ED 46, 47. Sena ke

Ho na le lithuto tsa nako e telele, litholoana tsa tsona li bonts'a monyetla oa tšebeliso ea lithethefatsi nako e telele, e bolokehileng ntle le ho eketsa tekanyetso ea eona.

Ho sebetsa hantle ha vardenafil kalafo ea ED ho bakuli ba nang le lefu la tsoekere ho ithutoe lithutong tse ngata tse sa boneng mahlo, tse laoloang ke placebo, tse neng li kenyelletsa bakuli ba 452. Ho latela tlhahlobo ea sephetho sa boithuto, kamora libeke tse 12 tsa ts'ebeliso, ntlafatso ea bokhoni bo bonoe ho 52% le 72% ea banna ba amohetseng 10 le 20 mg ea vardenafil, ka ho latellana, ha ba le sehlopheng sa placebo, ntlafatso ea tokiso e ile ea bonoa feela ho 13% ea bakuli.

Ho sebetsa hantle le polokeho ea tad-lafil ho banna, ho kenyeletsa le bakuli ba nang le lefu la tsoekere, ho ithutoe thutong ke Fonseca V. et al. (2006), e entseng tlhaiso-leseling ea lintlha ho tsoa lithutong tse laoloang ke placebo tse 12 ho bakuli ba nang le lefu la tsoekere, ntle le lona. Phuputso eo e kenyelelitse banna ba 1681 ba se nang lefu la tsoekere le banna ba 637 ba nang le lefu la tsoekere la mofuta oa 2 ba ileng ba amohela tada-lafil, tekong ea 10 le 20 mg kapa placebo bakeng sa libeke tse 12. Bakuli ba nang le lefu la tsoekere ba ne ba e-na le ED e boletsoeng hanyane ha e bapisoa le bakuli ba se nang lefu la tsoekere, athe sekhahla sa ICEF ED se ne se amana hantle le boemo ba HbA1c. Ha ho bapisoa le placebo, tadalafil ka tekanyetso ea 10 le 20 mg e ntlafalitse haholo ts'ebetso ea erectile ka lihlopha tsena ka bobeli, e neng e tsamaea le keketseho ea boleng ba bophelo

bakuli. Ka nako e ts'oanang, katleho ea tadalafil e ne e sa itšetleha ka tekanyo ea matšeliso a metabolism ea carbohydrate le kalafo e fumanoeng bakeng sa lefu la tsoekere. Kahoo, ho sa tsotelehe ED e boima haholo ho bakuli ba nang le lefu la tsoekere, tadalafil e ne e sebetsa ebile e mamellehile hantle. Tadalafil e na le nako e telele ea bophelo ba lihora tse 17.5, e fanang ka nako e telele haholo ea ketso, e khutlisetsa tlhaho ea likamano tsa thobalano. Mokuli o na le monyetla oa ho phela bophelo ba thobalano ba tlhaho, bo bohlokoa haholo ha ho e-na le lintlha tse eketsehileng tsa psychogenic tse eketsang ho se sebetse hantle ha erectile ho bakuli ba lefu la tsoekere.

Ho latela bafuputsi, ho 20-40% ea bakuli ba nang le ED, kalafo e nang le inhibitors ea PDE-5 ha e na thuso, eo maemong a mang e amanang le ho ba teng ha khaello ea androgen ho bakuli. Kahoo, maemong a 'maloa, ho bonahala ho loketse ho fana ka kalafo ea ho kopanya le li-androgens le lithethefatsi tsa PDE-5 inhibitors ho tloha nakong ea tlhahlobo ho bakuli ba nang le likarolo tse ka holimo tsa kliniki, tse eketsang katleho ea kalafo ho 93% 53, 54, 55.

Ts'ebeliso ea lithethefatsi ea li-inhibitors tsa PDE-5 kalafong ea ho hloka thobalano ho bakuli ba nang le lefu la tsoekere e ka ba le tlatsetso

molemo ka tsela ea ho fokotsa matšoao a lefu la setho la botšehali.

Kahoo, thutong e kenyellelitseng banna ba 16 ba nang le lefu la tsoekere la 1 le ED ba lilemo li 27 25,99 ba nang le paresthesia seterekeng sa penile shaft le maikutlo a sitisang hlooho e amohelang PDE-5 inhibitor ka likhoeli tse 3, eseng feela ho felisoa ka ho felletseng ha ED ho boletsoeng ho bakuli bohle (lintlha tsa ED nakong ea phekolo 21 21.22, pi Ha u fumane seo u se hlokang? Leka ts'ebeletso ea khetho ea lingoliloeng.

Leha ho na le litlhetho tse ngata tse fapaneng tsa kalafo bakeng sa kalafo e bolokehileng ea bakuli ba nang le lefu la tsoekere la 1, ho na le sehlopha sa bakuli bao mekhoa ena ea kalafo e lulang e sa sebetse. Tabeng ena, bakuli ba bontšoa kalafo ea ho buoa - phalloendoprosthetics.

Tlhahlobo ena ea lingoliloeng e sebetsana le litaba tsa lefu la seoa, ho khetholla, pathophysiology, hammoho le tlhahlobo le kalafo ea ED ho bakuli ba lefu la tsoekere la mofuta oa 1. ED ho bakuli ba nang le lefu la tsoekere ke bothata bo boholo ka lebaka la ho ata ha bongata, hammoho le tšusumetso maemong a kelello a bakuli le boleng ba bophelo ka kakaretso.

Ho tsoa ho tse boletsoeng ka holimo, hoa hlaka hore kajeno setsing sa bongaka sa bongaka ho na le mekhoa e mengata e fapaneng ea ho hlahloba ED, empa ho fihlela joale ha e e-so ntlafatsoe

mokhoa o ikhethileng oa ho tsebahala ka lero la lero la mofuta oa mofuta oa neurogenic hantle bakeng sa mofuta oa neurogenic. Ho bohlokoa ho ela hloko hore tlhahlobo e tlang ka nako e nang le tlhaloso e nepahetseng ea sebopeho sa ED eu lumella ho khetha khetho e loketseng le e loketseng bakeng sa mokuli ka mong.

Phekolo ea ED ho bakuli ba nang le lefu la tsoekere la mofuta oa 1 e lokela ho ba e felletseng mme e sa ikemisetsa feela ho ntlafatsa ts'ebetso ea erectile ka boeona, empa hape le ho felisa lintlha tsa pathogenetic bakeng sa nts'etsopele ea ED, joalo ka hyperglycemia e sa foleng, dyslipidemia, le androgen. Hajoale ho khethiloe mekhoa ea kalafo ea bongaka, sebaka se etelletseng pele seo ho sona ho nang le lithethefatsi tse tsoang sehlopheng sa li-inhibitors tsa PDE-5 ka lebaka la ts'ebeliso e phahameng, polokeho le boiketlo ba tšebeliso ea bona ho bakuli. Hoa bohlokoa ho hlokomela hore meriana ea sehlopha sena e na le phello ea methapo, e bohlokoa haholo ho bakuli ba nang le mofuta oa neurogenic oa ED, empa taba ena e hloka ho tsoela pele ho ithuta ka botebo.

Kahoo, leha ho bile le katleho e kholo ntlafatsong ea mekhoa ea tlhahlobo le kalafo ea ED, ho ntse ho na le litaba tse ngata tse sa rarolloang tse hlokang lipatlisiso tse ling.

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Livideo tse amanang

Mabapi le pathophysiology ea lefu la tsoekere ho video:

Psychology ea lefu la tsoekere eu lumella ho fumana leseli mabapi le likarolo tsa thupelo le kalafo ea lefu lena. Mofuta oa pele le oa bobeli o fapane.

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