Lefu la tsoekere > Lefu la tsoekere

Lefu la tsoekere (Lefu la tsoekere la Selatine mellitus) ke sehlopha sa mafu a endocrine a bakoang ke ho hloka matla kapa tšebelisano (ho se sebetse hantle ha tšebelisano le lisele tse fumanehang) khaello ea li-insulin, ka lebaka la moo hyperglycemia e nts'etsapele - keketseho e phehellang tsoekere ea mali. Lefu lena le tšoauoa ka thupelo e sa foleng le tlolo ea mefuta eohle ea metabolism: carbohydrate, mafura, protheine, liminerale le letsoai la metsi.

Ho na le lihlopha tse ngata tsa lefu la tsoekere ka litsela tse fapaneng. Ka kopanelo, li kenyelelitsoe sebopeho sa tlhahlobo mme li lumella litlhaloso tse nepahetseng hantle tsa boemo ba mokuli ea nang le lefu la tsoekere.

Sehlopha sa lefu la tsoekere ke etiology

I. Mofuta oa 1 lefu la tsoekere kapa "lefu la tsoekere la bana", empa batho ba lilemo life kapa life ba ka kula (tšenyo ea li-b-cell, e lebisang tlhabisong ea khaello ea insulin ea bophelo bohle)

II. Mofuta oa 2 lefu la tsoekere la mellitus (sekoli se sirelelitsoeng ka insulin se nang le insulin)

· MOTLATSI - bofokoli ba liphatsa tsa lefutso ts'ebetsong ea lisele tsa b.

III. Mefuta e meng ea lefu la tsoekere:

1. bofokoli ba liphatsa tsa lefutso (lits'oants'o) tsa insulin le / kapa li-receptor tsa eona,
2. maloetse a manyeme pancreas,
3. maloetse a endocrine (endocrinopathies): Itsenko-Cushing's syndrome, acromegaly, ferekanya lefu le nang le chefo, pheochromocytoma le ba bang,
4. lefu la tsoekere le susumetsoang ke lithethefatsi,
5. lefu la tsoekere le ts'oaetso
6. Mefuta e sa tloaelehang ea lefu la tsoekere le methapo,
7. liphatsa tsa lefutso hammoho le lefu la tsoekere.

IV. Mellitus ea lefu la tsoekere la setho sa botšehali ke boemo ba lefu la ho kula bo khetholloang ke hyperglycemia e etsahalang nakong ea kemaro ho basali ba bang mme hangata e itlhahela feela ka mor'a ho beleha. Mofuta ona oa lefu la tsoekere o lokela ho khetholloa ho bokhachane ho bakuli ba nang le lefu la tsoekere.

Ho latela likhothaletso tsa WHO, mefuta e latelang ea lefu la tsoekere ho basali baimana e khetholloa:

1. Mofuta oa 1 lefu la tsoekere le fumanoeng pele ho ima.
2. Mofuta oa 2 oa lefu la tsoekere le fumanoeng pele ho ima.
3. Mellitus ea lefu la tsoekere la moimana - polelo ena e kopanya mathata afe kapa afe a mamello ea glucose a bileng teng nakong ea kemaro.

Ho latela botebo ba lefu lena lefu la tsoekere le na le likhato tse tharo tsa phallo:

Mofuta oa "Mild" (I degree) oa lefu lena o tšoauoa ka boemo bo tlase ba glycemia, e sa feteng 8 mmol / l ka mpeng e se nang letho, ha ho se na liphetoho tse kholo tsa litaba tsa tsoekere maling maling, ho tloha matsatsing a 20 ho isa ho 20 g / l. Matšeliso a lula a le kalafo ka kalafo ea phepo. Ka mofuta o bonolo oa lefu la tsoekere, angioeuropathy ea mekhahlelo ea preclinical le e sebetsang e ka fumanoa ho mokuli ea nang le lefu la tsoekere.

Ka tekanyo e phahameng (II degree) ea tekanyo ea tsoekere e bakoang ke lefu la tsoekere, glycemia e potlakileng e phahama, joalo ka molao, ho fihlela ho 14 mmol / l, ho fokotseha ha glycemic ho pholletsa le letsatsi, glucosuria ea letsatsi le letsatsi hangata ha e felle ka 40 g / l, ketosis kapa ketoacidosis e hlaha. Matšeliso a lefu la tsoekere a fumaneha ka lijo le ka li-insulin tsa molomo kapa insulin. Ho bakuli bana, li-angioneuropathies tsa tsoekere tsa maemo a fapaneng a lehae le mehato e sebetsang li ka bonoa.

Mofuta o matla oa "lefu la tsoekere" la tsoekere le tšoauoa ka maemo a phahameng a 'mele oa glycemia (ka mpeng e se nang letho e fetang 14 mmol / l), ho fokotseha hoa bohlokoa hoa tsoekere ea mali letsatsi lohle, glucosuria e phahameng (e fetang 40-50 g / l). Bakuli ba hloka kalafo ea "insulin" khafetsa.

Ho latela tekanyo ea matseliso a metabolism ea carbohydrate lefu la tsoekere le mekhahlelo e meraro:

1. Karolo ea matšeliso
Karolo ea peeletso
3. Mokhahlelo oa ho bola

Mofuta o lekantsoeng oa lefu la tsoekere ke boemo bo botle ba mokuli moo kalafo e ka fihlelang maemo a tloaelehileng a tsoekere maling le ho ba sieo ha hae ka botlalo ka har'a moroto. Ka mofuta o fokotsoeng oa lefu la tsoekere, ho ke ke ha khoneha ho fumana liphetho tse phahameng joalo, empa boemo ba tsoekere ea mali ha bo fapane hole le tloaelo, ke hore, ha bo feta 13.9 mmol / l, 'me tahlehelo ea tsoekere ea letsatsi le letsatsi ka har'a moroto ha e fetang 50 g ka nako e ts'oanang, acetone ka har'a moroto. lahlehileng ka botlalo. Nyeoe e mpe ka ho fetesisa ke mofuta oa tsoekere o bolailoeng, hobane maemong ana ho ke ke ha khoneha ho ntlafatsa metabolism ea carbohydrate le tsoekere e tlase ea mali. Leha kalafo e le teng, boemo ba tsoekere bo nyoloha ka holimo ho 13.9 mmol / l, mme tahlehelo ea tsoekere ka moriring ka letsatsi e feta 50 g, acetone e hlaha ka har'a moroto. Hyperglycemic coma e khonahala.

Setšoantšong sa bongaka ba lefu la tsoekere, ke moetlo ho khetholla lipakeng tsa lihlopha tse peli tsa matšoao: ea mantlha le ea bobeli.

Sehlopha sa lefu la tsoekere mellitus (WHO, 1985)

A. Tlelase ea bongaka

I. Lefu la tsoekere

1. "Mellitusus" ea lefu la tsoekere e itšetlehileng ka insulin

2. Mellitus (DIA) e sa itšetleheng ka insulin

a) ka batho ba nang le boima ba 'mele bo tloaelehileng

b) bathong ba batenya

3. Lefu la tsoekere le amanang le khaello ea phepo e nepahetseng

4. Mefuta e meng ea lefu la tsoekere e amanang le maemo a mang le li-syndromes:

a) lefu la pancreatic,

b) mafu a endocrine,

c) maemo a bakoang ke ho sebelisa meriana kapa ho pepesehela lik'hemik'hale,

d) mathata a insulin kapa receptor ea eona,

e) li-syndromes tse ling tsa lefutso,

e) linaha tse tsoakiloeng.

II. Ho mamella tsoekere e sa sebetseng hantle

a) ka batho ba nang le boima ba 'mele bo tloaelehileng

b) bathong ba batenya

c) amanang le maemo a itseng le li-syndromes (bona serapa sa 4)

B. Ditlelase tsa kotsi ya Statistical (batho ba nang le mamello e tloaelehileng ea glucose empa ba nang le kotsi e kholo ea ho ba le lefu la tsoekere)

a) Mamello ea tsoekere e neng e senyehile ea nakong e fetileng

b) mamello e ka fokolisang tsoekere.

Haeba mokhatlong o hlalositsoeng ke komiti ea litsebi ea WHO mabapi le lefu la tsoekere mellitus (1980), ho sebelisitsoe mantsoe a reng "DIA - mofuta oa" lefu la tsoekere "le" lefu la tsoekere la mofuta oa II ", mantsoe" mofuta oa "lefu la tsoekere" le "mofuta oa" lefu la tsoekere "a sa hlahisoe ka tatellano e kaholimo. ”Mabaka a hore ba fana ka maikutlo a ho ba teng hoa mekhoa e se e hlahisitsoe ea pathogenetic e bakileng boemo bona ba methapo ea methapo (methapo ea autoimmune bakeng sa lefu la tsoekere la lefu la tsoekere le secretion ea insulin kapa ts'ebetso ea lona bakeng sa lefu la tsoekere la II). Kaha ha se litleliniki tsohle tse nang le bokhoni ba ho khetholla liketsahalo tsa lefu la sethoathoa le matšoao a lefutso a mefuta ena ea lefu la tsoekere, ho latela litsebi tsa WHO, maemong ana ho loketse haholoanyane ho sebelisa mantsoe a IZD le IZND. Leha ho le joalo, ka lebaka la hore mantsoe ana "Type Iabetes mellitus" le "mofuta II oa lefu la tsoekere" a sebelisoa hona joale linaheng tsohle tsa lefats'e, ho kgothaletsoa ho li nka e le lipapatso tse felletseng tsa mantsoe IZD le IZND ho qoba pherekano, eo re lumellanang ka botlalo .

Joaloka mofuta o ikemetseng oa "pathology" ea bohlokoa, lefu la tsoekere le amahanngoa le khaello ea phepo e nepahetseng. Hangata lefu lena le fumanoa linaheng tse futhumetseng ho batho ba ka tlase ho lilemo tse 30, tekanyo ea banna ho basali ba nang le lefu la tsoekere la mofuta ona ke 2: 1 - 3: 1. Ka kakaretso, ho na le bakuli ba ka bang limilione tse 20 ba nang le mofuta ona oa lefu la tsoekere.

Tse atileng haholo ke li subtypes tse peli tsa lefu lena la tsoekere. Ea pele ke lefu la tsoekere le bitsoang "fibrocalculeous pancreatic". E fumanoa India, Indonesia, Bangladesh, Brazil, Nigeria, Uganda. Matšoao a tšoaetso ea lefu lena ke ho thehoa ha majoe ka har'a mouoane o ka sehloohong oa manyeme le ho ba teng ha pancreatic fibrosis e ngata. Setšoantšong sa kliniki, ho bonahala ho hlaseloa khafetsa ka bohloko ba ka mpeng, ho theola boima ba 'mele le matšoao a mang a khaello ea phepo e nepahetseng. Ho leka-lekana, 'me hangata ho phahame haholo, hyperglycemia le glucosuria ho ka felisoa feela ka thuso ea kalafo ea insulin. Ho ba sieo ha ketoacidosis ke tšobotsi, e hlalosoang ke ho fokotseha hoa tlhahiso ea insulin le secretion ea glucagon ke lisebelisoa tsa islet tsa manyeme. Ho ba teng ha majoe ka har'a li-pancreas ho netefatsoa ke liphetho tsa x-ray, retrograde cholangiopancreatography, ultrasound kapa computer tomography. Ho lumeloa hore sesosa sa lefu la tsoekere la fibrocalculous pancreatic ke tšebeliso ea metso ea "cassava" (tapioca, Cassava) e nang le cyanogenic glycosides, ho kenyelletsa le linamarine, e tsoang ho eona hydrocyanic acid nakong ea hydrolysis. Ha e nke lehlakore ka ho nka karolo ha li-amino acid tse nang le sebabole, le khaello ea phepo e nepahetseng ea protheine, eo hangata e fumanoang ho baahi ba linaha tsena, e lebisa ho bokelleng ha cyanide 'meleng, e leng sesosa sa fibrocalculosis.

Subtype ea bobeli ke lefu la tsoekere la pancreatic le amanang le khaello ea protheine, empa ha ho na calcization kapa pancreatic fibrosis. E tšoauoa ka ho hanyetsa nts'etsopele ea ketoacidosis le ho hanyetsa insulin hantle. E le molao, bakuli ba khathetse. Secretion ea insulin e fokotsehile, empa eseng joalo ka tekanyo e joalo (ho latela secretion ea C-peptide) joalo ka bakuli ba nang le lefu la tsoekere, le hlalosang ho ba sieo ha ketoacidosis.

Ha ho na karolo ea boraro ea lefu lena la tsoekere ho sehlopha sena sa WHO - seo ho thoeng ke mofuta oa lefu la tsoekere la J (le fumanoang Jamaica), se arolelanang likarolo tse ngata tse tloaelehileng le lefu la tsoekere la pancreatic le amanang le khaello ea protheine.

Bothata ba mekhahlelo ea WHO e amohetsoeng ka 1980 le 1985 ke hore ha bo bonts'a sebaka sa kliniki le likarolo tsa phetoho ea lefu la tsoekere. Tumellanong le litloaelo tsa lefu la tsoekere la malapeng, tlhahlobo ea bongaka ba lefu la tsoekere e ka ba ka monahano oa rona.

I. Mefuta ea mafu a lefu la tsoekere

1. Lefu la tsoekere le itšetlehileng ka insulin (mofuta oa lefu la tsoekere)

tšoaetso ea vaerase kapa mofuta oa khale (mofuta oa IA)

autoimmune (mofuta IB)

2. Lefu la tsoekere le sa itšetleheng ka insulin (lefu la tsoekere la II)

bathong ba nang le boima bo tloaelehileng ba 'mele

bathong ba batenya

ho bacha - mofuta oa MOD

3. Lefu la tsoekere le amanang le khaello ea phepo e nepahetseng

fibrocalcule pancreatic lefu la tsoekere

khaello ea protheine ea "pancreatic" lefu la tsoekere

4. Mefuta e meng ea lefu la tsoekere (bobeli, kapa letšoao, lefu la tsoekere):

a) endocrine genesis ('senenko-Cushing's syndrome, acromegaly, hlahisa mofuta o nang le chefo, pheochromocytoma, jj.)

b) mafu a manyeme (lesapo la mokokotlo, ho ruruha, ho fokola, hemochromatosis, jj)

c) mafu a bakoang ke lisosa tse sa tloaelehang (ho sebelisa meriana e mengata, li-syndromes tsa tlhaho tsa tlhaho, boteng ba insulin e sa sebetseng, mesebetsi e amohelang insulin receptor, jj.)

5. Letsoalo la Tsoekere

A. Botebo ba lefu la tsoekere

B. Boemo ba puseletso

B. Mathata a kalafo

1. Phekolo ea insulin - karabelo ea lehae ea teng, tšabo ea anaphylactic, lipoatrophy

2. Lithethefatsi tsa Oral hypoglycemic - litla-morao, ho nyekeloa le pelo, ho se sebetse hantle ka mpeng ea gastrointestinal, jj.

G. Mathata a tebileng a lefu la tsoekere (hangata ka lebaka la kalafo e sa lekaneng)

a) ketoacidotic coma

b) hyperosmolar coma

c) lactic acidosis coma

g) hypoglycemic coma

D. Mathata a morao-rao a lefu la tsoekere

1. Microangiopathy (retinopathy, nephropathy)

2. Macroangiopathy (myocardial infarction, stroke, legdomrene)

G. Lesions ea litho tse ling le litsamaiso tse ling - enteropathy, hepatopathy, cataracts, osteoarthropathy, dermopathy, jj.

II. Ho mamella tsoekere e sa sebetseng hantle - lefu la tsoekere le morao

a) ka batho ba nang le boima ba 'mele bo tloaelehileng

b) bathong ba batenya

c) amanang le maemo a itseng le li-syndromes (bona serapa sa 4)

III. Li-Class kapa lihlopha tsa batho ba kotsing ea lipalo, kapa li-prediabetes (batho ba nang le mamello e tloaelehileng ea tsoekere, empa ba na le monyetla oa ho ba le lefu la tsoekere):

a) batho bao pejana ba neng ba sitisitse mamello ea tsoekere

b) batho ba nang le monyetla oa ho mamella tsoekere e maling.

Mehato e meraro e khethollehile thupelong ea bongaka ba lefu la tsoekere: 1) mamello ea tsoekere le ea nakong e fetileng e sa holiseng tsoekere, i.e. lihlopha tsa batho ba nang le lintlha tse bohlokoa tsa kotsi ea lipalo, 2) mamello ea tsoekere ea glucose, kapa lefu la tsoekere la morao-rao, 3) e pepesang kapa e bonts'ang lefu la tsoekere, "" "" "" "" "" "" "" "" "" "" "" "" "" "" "" "" "" "" "" "" "" "" "" "" "" "" "" "" "" "" "" "" "" "" "" "" "" "" "" "" "" "" glucose "li mamellehe kapa li hlahisoe ke lefu la tsoekere.

Mellitus ea bohlokoa ea lefu la tsoekere ke sehlopha se seholo sa li-syndromes tsa mefuta e fapaneng, eo maemong a mangata e bonahatsoang ke litšobotsi tsa thupelo ea lefu la tsoekere. Phapang ea patathogenetic pakeng tsa IDD le IDD e hlahisoa ka tlase.

Phapang e ka sehloohong lipakeng tsa EDI le ADI

Letšoao la mofuta I mofuta oa mofuta oa II oa mofuta oa bopaki

E le lilemo tse qalang,

Mafu a ho fihlela lilemo tse 30

Onset Acute butle-butle

Boima ba 'Mele bo Fokotsehile Maemong a mangata

Bong: Ho ka etsahala hore banna ba kula, hangata ba kula.

Tekanyo e bohale e bohale

Thupelo ea lefu la tsoekere Maemong a mang, ho ts'oaroa ha ho tsitsitseng

Ketoacidosis Tendency ho ketoacidosis hangata ha e hola

Hangata maemo a Ketone a phahame.

Urinalysis Glucose mme Hangata Glucose

Nako ea ho qala Hangata hoetla-mariha Ha ho na

Insulinopenia le C-peptide Insulinopenia le Tloaelehileng kapa hyper

ho fokotseha ha plasma ho C-peptide insulinemia (insulin

ho bina khafetsa, hangata le

Boemo bo Fokotseha Palo ea Lihlekehleke

li-cell tsa "pancreatic", ho nyenyefatsa ha tsona le liperesente

ho fokotseha kapa ho se be teng ha lisele tsa b-, a-, d- le PP ho

li na le insulin, sehlekehleke se pakeng tsa lilemo

e na le lisele tse tloaelehileng tsa-, d- le PP

Lymphocyte le ba bang ba teng ho pele Hangata ba sieo

lisele tsa ho ruruha ka libeke tsa ho kula

Li-antibodies ho lihlekehlekeng. Hoo e batlang e ka bonoa.

manyeme maemong ohle ho la pele

Mefuta ea liphatsa tsa lefutso Ho kopanya le HLA-B8, B15, mefuta ea HLA eseng

DR3, DR4, Dw4 li fapane le tse phetseng hantle

Concordance ka tlase ho 50% Ho feta 90%

Ts'oaetso ea lefu la tsoekere ka tlase ho 10% Ho feta 20%

Ke na le degree ea kinship

Phekolo ea lijo, phepo ea insulin (phokotso),

Mathata a morao-rao esale pele

Insulin e itšetlehileng ka lefu la tsoekere (EDI, mofuta oa lefu la tsoekere mellitus) e tšoauoa ka ho qala ho bola, insulinopenia, tloaelo ea ho hola khafetsa ka ketoacidosis. Khafetsa, mofuta oa lefu la tsoekere le hlaha ho bana le lilemong tsa bocha, tseo pele li neng li amahanngoa le lebitso "lefu la tsoekere la bana", empa batho ba lilemo life kapa life ba ka kula. Bophelo ba bakuli ba nang le mofuta ona oa lefu la tsoekere bo itšetlehile ka taolo e ntle ea insulin, moo ho seng moo komello ea ketoacidotic e nts'etsopele ka potlako. Boloetse bona bo kopantsoe le mefuta e meng ea HLA, 'me li-antibodies ho Langerhans islet antigen hangata li fumanoa serum ea mali. Hangata e rarahaneng ke macro- le microangiopathy (retinopathy, nephropathy), neuropathy.

Lefu la tsoekere le itšetlehileng ka insulin le na le mofuta oa liphatsa tsa lefutso. Mabaka a kantle a tlatsetsang ho rererposition ea lefu la tsoekere ke mafu a mangata a tšoaetsanoang le mafu a autoimmune, a tla hlalosoa ka botlalo ka tlase.

Lefu la tsoekere le sa hlokeng insulin (NIDA, mofuta II lefu la tsoekere mellitus) le hlaha ka mathata a fokolang a lefu la tsoekere. Joalokaha e le molao, bakuli ba etsa ntle le insulin ea kantle ho kalafo, le kalafo ea ho ja kapa lithethefatsi tsa molomo tseo ho hlokahalang hore maemo a tsoekere a tlase ho lefella metabolism ea carbohydrate. Leha ho le joalo, maemong a mang, matšeliso a felletseng a metabolism ea carbohydrate a ka fumanoa feela ka khokahano e eketsehileng ea insulin ea kalafo ho kalafo. Ntle le moo, ho tlameha ho hopoloa hore tlas'a maemo a fapaneng a sithabetsang (ts'oaetso, ho sithabela maikutlo, ho buoa), bakuli bana ba tlameha ho ea kalafo ea insulin.Mofuteng ona oa lefu la tsoekere, litaba tsa "insulin" tse kenang serapeng sa mali li tloaelehile, li phahame kapa li (insulinopenia) ka mokhoa o sa tloaelehang. Ho bakuli ba bangata, hyperglycemia e potlakileng e kanna ea ba sieo, 'me e ka ba lilemo tse ngata ba sa tsebe lefu la bona la tsoekere.

Ka mofuta oa lefu la tsoekere la II mellitus, macro- le microangiopathies, likatse le li-neuropathie le tsona lia fumanoa. Lefu lena le ata khafetsa kamora lilemo tse 40 (pherekano e etsahala hangata ka lilemo tse 60), empa e ka etsahala le hanyane lilemong. Ona ke mofuta o bitsoang mofuta oa MODI (lefu la tsoekere la batho ba baholo ho bacha), le khetholloang ke mofuta o mong o atileng oa lefa. Ho bakuli ba nang le lefu la tsoekere la mofuta oa II, "metabolism ea" carbohydrate e holofetseng e lefshoa ka lijo le meriana ea molomo e fokotsang tsoekere. NIDH, joalo ka IDD, e na le liphatsa tsa lefutso, tse iponahatsang ka mokhoa o hlakileng (khafetsa mefuteng e fapaneng ea mefuta ea malapa a lefu la tsoekere) ho feta IDD, mme e tšoauoa ka mofuta o hlahelletseng oa lefa. Ntho e kantle e tlatsetsang ho phethahatseng bokamoso ba lefu la tsoekere ke ho ata haholo, ho lebisang ho holiseng botenya, bo shebiloeng ho 80-90% ea bakuli ba nang le ADHD. Mamello ea Hyperglycemia le tsoekere ho bakuli bana li ntlafala ka ho fokotseha ha boima ba 'mele. Li-antibodies tsa li-antibodies tsa lihlekehleke tsa Langerhans ka mofuta ona oa lefu la tsoekere ha li eo.

Mefuta e meng ea lefu la tsoekere. Sehlopha sena se kenyelletsa lefu la tsoekere, le hlahang ho "psychology" e 'ngoe eo ho ka etsahalang hore ha e kopane le lefu la tsoekere.

1. Maloetse a manyeme

a) Bacha ba sa tsoa hlaha - ho ba sieo hoa lihlekehleke ka har'a manyeme, lefu la tsoekere la nakoana la masea a sa tsoa tsoaloa, ts'ebetso ea ho se sireletsehe ha methapo ea insulin,

b) likotsi, tšoaetso le maqeba a chefo a makhopho a hlahang kamora nako ea neonatal, hlahala tse mpe, cystic fibrosis ea manyeme, hemochromatosis.

2. Mathata a mofuta oa Hormone: pheochromocytoma, somastatinoma, aldosteroma, glucagonoma, lefu la Itsenko-Cushing, sekethale, mofuta o nang le chefo, ho eketsa secretion ea li-progestin le estrogens.

3. Maemo a bakoang ke ts'ebeliso ea lithethefatsi le lik'hemik'hale

a) Lintho tse sebetsang tsa lihormone: ACTH, glucocorticoids, glucagon, lihormone tsa qoqotho, kholo ea ho hola, lithibela-pelehi tsa molomo, calcitonin, medroxyprogesterone,

b) diuretics le li-antihypertgency agents: furosemide, thiazides, gigroton, clonidine, clopamide (brinaldix), ethacosterone acid (uregite),

c) Lintho tse ferekanyang kelello: haloperidol, chlorprotixen, chlorpromazine, li-antidepressants tsa trickclic - amitriptyline (tryptisol), imizin (melipramine, imipramine, tofranil),

d) adrenaline, diphenin, isadrine (novodrin, isoproterenol), propranolol (anaprilin, obzidan, inderal),

e) li-analgesics, li-antipyretics, lintho tse thibelang mafu: indomethacin (methindole), asiti ea acetylsalicylic ho litekanyetso tse phahameng,

e) Lithethefatsi tsa chemotherapeutic: L-asparaginase, cyclophosphamide (cytoxin), megestrol acetate, jj.

4. Ts'ebetso ea li-insulin tsa li-insulin

a) sekoli ho li-insulin receptor - congenital lipodystrophy, hammoho le virilization, le pigment-papillary dystrophy ea letlalo (acantosis nigricans),

b) li-antibodies ho li-insulin receptor, hammoho le mathata a mang a ho itšireletsa mafung.

5. Li-syndromes tsa lefutso: mofuta I glycogenosis, porphyria e hlobaetsang, Down syndrome, Shereshevsky-Turner, Klinefelter, jj.