Litataiso tsa kokelo ea bophelo bo botle bakeng sa tlhahlobo le kalafo ea lefu la tsoekere la mofuta oa 2 ho bana le bacha lilemong

Lefu la tsoekere le tšoaetsanoa le ho feta lilemong tsa bongoana mme e ba la bobeli khafetsa liketsahalong tsa mafu a sa foleng a bongoana.

Lefu lena le tsoaloang le sa phekoleheng le bakoa ke metabolism ea carbohydrate mme le tšoauoa ka keketseho ea khatello ea tsoekere maling a mali.

Bophelo bo botle ba mokuli e monyane le menyetla ea ho ba le mathata a tebileng bo itšetlehile ka tlhahlobo le kalafo e tlang ka nako.

Pehelo ea mafu

Tlhahlobo ea lefu lena ke bothata bo boholo ba ho kenngoa ha tsoekere maling liseleng tsa litho, tse lebisang ho bokelleng ha eona maling. Sena se ka etsahala ka lebaka la insulin e sa lekaneng kapa ha li-cell receptor li lahleheloa ke kutloisiso ea tsona ea lihormone.

Ho ipapisitsoe le phapang ea mokhoa oa kholo ea lefu lena, lefu la tsoekere le arotsoe ka mefuta e mmaloa:

1. Mofuta oa 1 oa lefu la tsoekere ke lefu la tsoekere le itšetlehileng ka insulin. E hlaha ka lebaka la ts'enyeho ea lithane tsa pancreatic tse ikarabellang bakeng sa tlhahiso ea insulin. Ka lebaka leo, palo e sa lekanang ea lihormone e hlahisoa mme boemo ba tsoekere e maling plasma ea mali bo qala ho eketseha. Lefu la tsoekere la Mofuta oa 1 ke lefu le amanang le tlhaho 'me hangata le fumanoa ho bana le lilemong tsa bocha ho tloha ho tsoalo ho isa ho lilemo tse 12.
2. Mofuta oa 2 oa lefu la tsoekere ke mofuta o mong o sa ipeleng oa insulin. Maemong ana, ha ho na insulin, empa lisele li fetoha 'mele oa hau mme ho kenngoa ha glucose lithong ho thata. E boetse e lebisa keketseho ea tsoekere 'meleng. Mofuta oa 2 oa lefu la tsoekere bongoaneng ha o bonoe ha o bonoe 'me oa hola bophelong bohle. Bakuli ba baholo ba kaholimo ho lilemo tse 35 ho ea 40 ba kotsing ea ho tšoaroa ke lefu lena.

Pathology e khetholloa ho latela botebo ba thupelo:

• 1 degree - foromo e bonolo e nang le boemo ba tsoekere ba plasma e sa feteng 8 mmol / l,
• Tekanyo ea 2 - boemo bo itekanetseng bo nang le phetoho ea matšoao a tsoekere nakong ea motšeare mme mohopolo o fihla ho 14 mmol / l,
• Kereiti ea 3 - foromo e boima le keketseho ea litekanyetso tsa tsoekere ka holimo ho 14 mmol / L.

Ha a arabela kalafo, lefu la tsoekere le fapana ka mekhahlelo:

• karolo ea matseliso - nakong ea phekolo, matšoao a tsoekere a lula a le maemong a amohelehang,
• Karolo e nyane ea moputso - ho fetisoa ha glucose e nyane ka lebaka la kalafo,
• karolo ea boikoetliso - 'mele ha o arabe kalafo e tsoelang pele le boleng ba tsoekere bo fetisoa haholo.

Lisosa tsa pathology

Etiology ea lefu lena e fapana ho latela mofuta oa pathology.

Kahoo, mabaka a susumetsang nts'etsopele ea foromo e itšetlehileng ka insulin a kenyeletsa:

• pancreatic pathology,
• khatello ea nako e telele
• phepo ea maiketsetso ho masea a sa tsoa hlaha,
• mafu a vaerase
• chefo e matla ke lintho tse chefo,
• meroalo e amanang le tlhaho ea manyeme.

Mofuta oa 2 oa lefu la tsoekere oa hlaha ka lebaka la lintlha tse joalo:

• phatsa ea tlhaho
• mefuta e fapaneng ea botena,
• boimana ba pelehi
• bophelo ba ho lula fatše
• mathata a ho ja
• ho sebelisa lithethefatsi tse nang le li-hormone
• ho kena bohlankaneng kapa boroetsaneng
• mafu a system ea endocrine.

Maemong a mangata, ho qaleha ha lefu la tsoekere ho bana ho ke ke ha thibeloa, kaha ho ka etsoa ho batho ba baholo, ntle le mabaka a ka bakang tlolo ea metabolism ea carbohydrate bophelong.

Matšoao a lefu la tsoekere ho bana

Tleliniki ea "pathology" e sa tsoa tsoaloa e tšoauoa ka matšoao a latelang:

• ho fokotsa boima ba 'mele bo sa hlalosoang
• ho ruruha khafetsa le ho tsoa ha urine e ngata,
• lenyora le matla
• moroto o bobebe le o pepeneneng,
• takatso e phahameng
• tloaelo ea ho tebela lekhopho le ponahalo ea lekhopho la bohlasoa,
• ponahalo ea matheba a boreleli holim'a liaparo tsa ka tlung le likharafu,
• lefu la marenene
• Pherekano le likeleli,
• ts'oaetso e phahameng ea mafu a vaerase le a tšoaetsanoang.

Ha u se u le moholo, u ka ela hloko matšoao a joalo:

• mokhathala,
• Ts'ebetso e mpe le ts'ebetso ea sekolo,
• fokotseha ha leihlo le bonoang,
• boroko ba motšehare le boroko,
• letlalo le omeletseng le molomo
• ponahalo ea ho hlohlona
• ho fufuleloa ho eketsehileng
• boima ba 'mele
• ho se khonehe
• tloaelo ea tšoaetso ea fungal le ea baktheria.

Ho hlokomela ngoana ka hloko ho tla u fa monyetla oa ho bona matšoao a tšosang ka nako mme o tsebe hore na lefu le methating efe ea pele. Ho qala kalafo ka nako ho tla thusa ho thibela nts'etsopele ea mathata le ho boloka bophelo bo botle ba mokuli e monyane.

Video e tsoang ho Dr. Komarovsky mabapi le lisosa le matšoao a lefu la tsoekere:

Mathata

Ho eketseha ha tsoekere maling ho etsa hore ho be le mathata a maholohali le a sa foleng. Litlamorao tse mpe li thehoa matsatsing a seng makae esita le lihora, mme ho sena, ho hlokahala thuso ea bongaka ea tšohanyetso, ho seng joalo menyetla ea lefu e eketseha.

Mathata ana a kenyelletsa maemo a latelang a bophelo:

1. Hyperglycemia - e hlaha ka lebaka la keketseho e bohale ea maemo a tsoekere. Ho ntša metsi ka potlako le lenyora le ke keng la bonoa hoa bonoa. Lesea le fetoha lefu le bolaeang. Ho na le linako tsa ho hlatsa, bofokoli bo ntse bo hola. Ngoana o tletleba ka hlooho. Nakong e tlang, pulse e potlaka le khatello ea eketseha. Haeba thuso e sa fuoe ka nako, ebe ho hlaha boemo bo khahlisang, ebe ho lahleheloa ke ho tseba 'me ho ba le komello ho etsahala.
2. Ketoacidotic coma ke boemo bo kotsi, bo tsamaeang le ho fokotseha ha khatello le bohloko ba ka mpeng. Sefahleho sa lesea sea fetoha se khubelu, leleme le fetoha raspberry mme le koaheloa ka koae e tšoeu e tšoeu. Monko oa acetone o hlaha o tsoa molomong, 'me ngoana oa fokola kapele. Ho bua ho thata, ho phefumoloha ka lerata ho hlaha. Ho ba le letsoalo hoa fifala ebe oa akheha.
3. Hypoglycemic coma - ho fokotseha ho hoholo hoa mahloriso a tsoekere ea plasma e fetoha sesosa sa hypoglycemia. Boemo ba maikutlo ba ngoana ha boa tsitsa. O fetoha lefu le bolaeang, ebe oa thaba haholo. Boikutlo ba tlala le lenyora boa eketseha. Letlalo le fetoha mongobo, liphupu lia tepella, mefokolo ea aha. Boemo bo ka emisoa ka ho fa mokuli lero le monate kapa chisi ea chokolete 'me a letsetse ambulense ka potlako, ho seng joalo ho tla hlaha boemo bo botle' me ngoana a lahleheloe ke tsebo.

Tekanyo e phahameng ea tsoekere e fetola sebopeho le thepa ea mali mme li baka tsitsipano ea mali. Ka lebaka la tlala ea oksijene, lits'ebetso tse ka hare tsa 'mele lia ameha le bokhoni ba litho tsa ts'ebetso bo fokotsehile.

Liphetoho tse joalo tsa pathological li ba teng ka nako e telele, empa ha li na mathata a kotsi joalo ka komello.

Hangata khahlano le semelo sa lefu la tsoekere, maloetse a latelang a thehoa:

1. Nephropathy ke leqeba le bohloko la liphio le lebisang ho nts'etsopele ea ho ruruha ha masapo. Phepelo e kotsi e sokelang bophelo ba mokuli ebile e hloka hore ho fetisoe setho se amehang.
2. Encephalopathy - e tsamaeang le ho tsitsipana maikutlong hape ntle le kalafo e tlang ka nako e lebisa ho khathatso ea kelello.
3. Ophthalmopathy - e baka tšenyo ea methapo ea kutlo le methapo ea mali ea mahlo, e qholotsang mats'oao a mokokotlo, strabismus le ho senyeha ha pono. Kotsi e kholo ke menyetla e phahameng ea ho koeteloa ka mokokotlo, e leng se tla lebisang bofofu.
4. Arthropathy - ka lebaka la khatello, ho sisinyeha ha manonyeletso ho holofetse 'me ho ba le letšoao le hlahang la bohloko.
5. Neuropathy - ntlheng ena, tsamaiso ea methapo ea kutlo e bohloko. Ho utloa bohloko le ho tepella maotong, ho fokotseha ha litho tsa maoto le matsoho ho ka bonoa. Mathata a tsamaiso ea methapo ea pelo le pelo le pelo a hlaha.

Monate oa mathata le ho teba ha litlamorao ho latela hore na lefu la tsoekere le phekoloa joang le hore na kalafo e khethiloe hantle hakae. Ha tsoekere e ngata haholo 'meleng e koahelloa, ho na le monyetla oa ho fokotsa tšenyo ea litho tsa ka hare le ho thibela komello.

Ts'oaetso

Ts'ebetso ea booki e bohlokoa haholo mohato oa pele oa ho fumana lefu la tsoekere ho bana.

Mooki o thusa ho bokella lintlha tse hlokahalang ho bokella setšoantšo se hlakileng sa lisosa tsa lefu lena, o nka karolo ho hlophiseng mokuli e monyane bakeng sa lithuto tsa laboratori le tsa kalafo, 'me o fana ka tlhokomelo ea booki nakong ea kalafo sepetlele le lapeng.

Mooki o tseba ho tsoa ho batsoali ka mafu a tšoanang le a nakong e fetileng ho ngoana, mabapi le ho ba teng ha lefu la tsoekere ho bona kapa ho monna oa motho ea amanang. O ithuta ka litletlebo, likarolo tsa kemiso ea letsatsi le letsatsi ea ngoana le phepo ea hae. E hlahloba 'mele oa mokuli, e lekola boemo ba letlalo le marenene, li lekanya khatello le boima.

Mohato o latelang ke ho etsa liteko tsa tlhahlobo ea mafu:

1. Tlhahlobo e akaretsang ea kliniki ea moroto le mali.
2. Teko ea mali bakeng sa tsoekere. Ho theoha ho feta 5.5 mmol / L ho netefatsa ts'oaetso.
3. Teko ea mamello ea glucose. Ho etsoa liteko tse peli tsa mali, ka mpeng e se nang letho le lihora tse 'maloa ka mor'a hore mokuli a fuoe tharollo ea tsoekere. Tekanyo ea tsoekere ka holimo ho 11 mmol / L e bontša lefu la tsoekere.
4. Teko ea mali bakeng sa insulin le hemoglobin ea glycosylated. Tekanyo e phahameng ea insulin e bontša ho hlaha ha mefuta ea 2 ea lefu lena.
5. Tlhahlobo ea Ultrasound ea manyeme. Eu lumella ho lekola boemo ba setho le ho bona libaka tse senyehileng tsa tšoelesa.

Boteng ba li-antibodies ho insulin, tyrosine phosphatase kapa glutamate decarboxylase maling hammoho le data mabapi le timetso ea manyeme li tiisa mofuta oa lefu la tsoekere.

Litlhare

Litlhahiso tsa kliniki bakeng sa lefu la tsoekere ho bana li itšetlehile ka mofuta oa lefu le fumanoeng.

Lintlha tsa bohlokoa tsa kalafo ke:

• phekolo ea lithethefatsi
• lijo tsa phepo
• keketseho ea ts'ebetso ea 'mele,
• physiotherapy.

Ka mofuta oa 1 pathology, motheo oa kalafo ke kalafo ea insulin. Liente li etsoa ka tlas'a letlalo ka ente ea insulin kapa pompo. Letlalo le hloekisoa esale pele ka setlolo se nang le joala.

Hormone e lokela ho tsamaisoa butle mme ho hlokahala hore ho fetoloe sebaka sa ente, ho qoba ho kena sebakeng se le seng sa 'mele.

Ente e ka etsoa ka lemeneng la mpa, embilical mkoa, thipa, phatleng le phatleng.

Ngaka e bala tekanyo le palo ea liente tsa letsatsi le letsatsi, 'me kemiso ea ts'ebetso ea insulin e lokela ho nkuoa ka hloko.

Ntle le moo, lithethefatsi tse joalo li ka fanoa:

• bakuli ba theolelang tsoekere,
• li-anabolic steroids
• li-anti-bacterial le li-antibacterial,
• khatello ea khatello ea maikutlo
• litokisetso tsa sulfonylurea
• tataiso ea livithamini.

• electrophoresis
• Thupelo
• magnetotherapy
• tshusumetso ea motlakase
• ho silila.

Ho tsamaellana le lijo ke ntho ea bohlokoa bophelong ba mokuli e monyane.

Melao-motheo ea phepo e nepahetseng ke e latelang:

• Lijo tse tharo tse ka sehloohong le lijo tse tharo tse batang letsatsi le letsatsi,
• lik'habohaedreite tse ngata li halofo ea pele ea letsatsi,
• felisa tsoekere ka ho felletseng ebe u e nkela monate oa tlhaho,
• hana ho ja lijo tse nang le lik'habohaedreite tse potlakileng, liswiti le lijo tse mafura,
• tlosa li-pastry le thepa e bakiloeng ka phofo ea koro lijong,
• fokotsa lijo tseo u li jang haholo,
• kenyelletsa meroho e mecha, meroho, lilamunu le litholoana tse sa buuoang ka har'a lijo,
• Sebakeng sa bohobe bo bosoeu ho buoa ka bo-rye kapa phofo ea mabele
• nama, lihlapi le lihlahisoa tsa lebese li lokela ho ba le mafura a mangata,
• fokotsa letsoai, linoko le linoko tse chesang lijong,
• jara letsatsi le letsatsi tloaelo ea metsi a hloekileng e hlokahalang bakeng sa ho boloka metsi a lekantsoe, ka tekanyo ea 30 di ml ka kilogramu e le 'ngoe.

Lijo tse nang le phepo e nepahetseng e lokela ho ba tsela ea bophelo 'me ho tla hlokahala ho e latela kamehla. Ngoana ea seng a le moholo o hloka ho koetlisoa ho bala XE (likarolo tsa bohobe) le ho sebetsana le ente ea insulin kapa pene.

Ke maemong ana feela, u ka bolokang ka katleho boemo bo amohelehang ba tsoekere ka plasma ea mali le ho lebella boiketlo ba ngoana.

Video e tsoang ho mme oa ngoana ea nang le lefu la tsoekere:

Phatlalatso le Thibelo

Ho ka etsoa eng ho thibela lefu la tsoekere? Ka bomalimabe, hoo e ka bang ha ho letho haeba lefu le bakoa ke liphatsa tsa lefutso.

Ho na le mehato e 'maloa ea thibelo, ts'ebeliso ea eona e tla fokotsa feela kotsi ea kotsi, ke hore, e fokotsa monyetla oa mathata a endocrine le ho sireletsa ngoana khahlanong le lefu:

• ho sireletsa ngoana maemong a sithabetsang,
• ho nka meriana efe kapa efe, haholo-holo lihormone, ho lokela ho fanoa ke ngaka feela,
• lesea le sa tsoa tsoaloa le lokela ho anyesoa,
• bana ba baholo ba lokela ho latela melao-motheo ea phepo e nepahetseng, eseng ho sebelisa hampe liswiti le lipitsa,
• hlokomela boima ba ngoana, ho thibela kholo ea botena,
• etsa tlhahlobo ea tloaelo likhoeli tse ling le tse ling tse 6,
• phekola mafu a tšoaetsanoang le a tšoaetsanoang ka nako,
• Fana ka ts'ebetso ea letsatsi le letsatsi e entsoeng.

Na lefu la tsoekere le ka phekoloa? Ka bomalimabe, lefu lena ha le phekolehe. Ka lefu la tsoekere la mofuta oa 2, tšoarelo ea nako e telele e ka fihlelleha le tlhoko ea lithethefatsi tse fokotsang tsoekere e ka fokotsoa, ​​empa ho latela lijo tse matla le ho ikoetlisa ka mokhoa o loketseng.

Ho lumellana le litlhahiso tsohle tsa ngaka le maikutlo a matle li lumella ngoana ea lefu la tsoekere ho phela bophelo bo tloaelehileng, a hola, a hola, a ithuta mme ha a fapana le lithaka tsa hae.

Thibelo ea sengoloa sa mahlale ho tsa bongaka le tsa bophelo ba sechaba, mongoli oa pampiri ea mahlale - Zilberman L.I., Kuraeva T.L., Peterkova V.A.

Khafetsa ea mofuta oa tsoekere ea mofuta oa 2 lefu la tsoekere (T2DM), ho kenyeletsoa har'a bacha, e eketsehile haholo, 'me T2DM e qalile ho tlalehiloe lilemong tsa bocha esita le bana ba lilemo tsa pele ho lilemo tsa bocha. Boloetse bona bo hlaha khahlano le semelo sa botena le metabolism, empa bo atile ka nako e telele, ka lebaka leo, tlhahlobo e hloka ho ts'oaroa hoa lipatlisiso. Litlhahiso tsena tsa kliniki li nts'etsopele ho IDE of FSBI ENC mme e bua ka litaba tsa tlhahlobo ea kalafo, kalafo le taolo ea bakuli ba nang le lefu la tsoekere la mofuta oa 2.

Sengoloa sa mosebetsi oa mahlale ka sehlooho "Litataiso tsa kokelo ea Federal bakeng sa tlhahlobo le kalafo ea lefu la tsoekere la mofuta oa 2 ho bana le bacha"

Litaelo tsa kliniki tsa mmuso bakeng sa tlhahlobo le kalafo ea lefu la tsoekere la mofuta oa 2 ho bana le bacha

Ph.D. L.I. SILBERMAN, MD T.L. KURAEVA, setho se tsamaellanang RAS, prof. V.A. PETERKOVA, lekhotla la litsebi la Mokhatlo oa Russia oa Endocrinologists

Federal State Budgetary Institution Endocrinological Science Science Center ea Lekala la Bophelo la Russia, Moscow

Khafetsa ea mofuta oa tsoekere ea mofuta oa 2 lefu la tsoekere (T2DM), ho kenyeletsoa har'a bacha, e eketsehile haholo, 'me T2DM e qalile ho tlalehiloe lilemong tsa bocha esita le bana ba lilemo tsa pele ho lilemo tsa bocha. Boloetse bona bo hlaha khahlano le semelo sa botena le metabolism, empa bo atile ka nako e telele, ka lebaka leo, tlhahlobo e hloka ho ts'oaroa hoa lipatlisiso. Litlhahiso tsena tsa kliniki li nts'etsopele ho IDE of FSBI ENC mme e bua ka litaba tsa tlhahlobo ea kalafo, kalafo le taolo ea bakuli ba nang le lefu la tsoekere la mofuta oa 2.

Mantsoe a bohlokoa: T2DM, bana le bacha, hyperinsulinemia, ho hanyetsa insulin, biguanides

Litlhahiso tsa tliliniki ea mmuso mabapi le tlhahlobo ea lihlahisoa tsa kalafo le kalafo ea mofuta oa 2 lefu la tsoekere ho bana le bacha

L.I. ZIL'BERMAN, T.L. KURAEVA, V.A. PETERKOVA, boto ea litsebi ea Mokhatlo oa Russia oa Endocrinologists

Setsi sa lekhetho sa lichelete sa "muso" Setsi sa Lipatlisiso sa Endocrinological ", Lekala la Bophelo la Russia, Moscow

Mofuta oa 2 oa lefu la tsoekere la mellitus (DM2) o eketsehile lilemong tse fetileng. Kholo ea eona e potlakileng e ama lithuto tse nyane ho batho ba lilemo tse ling ho kenyeletsa le lilemong tsa bocha le tsa pelehi. Mafu ana a qala ho tsamaisana le botenya le metabolic syndrome empa a lula a le asymptomatic ka nako e telele. Ka hona, ho sibolloa ha eona ho hloka patlo e sebetsang ea tlhahlobo. Litlhahiso tsa hona joale tsa kliniki li totobatsa mathata a maholo a amanang le leano la kalafo le kalafo bakeng sa taolo ea bakuli ba hlahisang mofuta oa lefu la tsoekere la mofuta oa 2.

Mantsoe a bohlokoa: mofuta oa 2 lefu la tsoekere, bana le bacha, hyperinsulinemia, khanyetso ea insulin, biguanides.

HELL - khatello ea mali

ACE - angiotensin-e fetolang enzyme

GPN - glucose e potlakileng ea plasma

Phekolo ea ka mpeng

IIA - Insulin Resistance Index

HDL - lipoprotein tse phahameng haholo

LDL - lipoprotein tse fokolang haholo

MRI - monahano oa matla a matla a letsoalo. NAFLD - sebete se seng mafura sa joala

NGN - ho sitisoa ke ho itima lijo glycemia

NTG - mamello ea tsoekere e sa sebetseng hantle

- Teko ea mamello ea glucose ea molomo

- liteko tsa tleliniki tse sa sebetseng

- mofuta oa 1 lefu la tsoekere

- mofuta oa 2 lefu la tsoekere

- polycystic ovary syndrome

- li-antigen tsa motsoako o ka sehloohong oa nalane ea histos-human (anti leukocyte antigen)

- lefu la tsoekere la batho ba baholo ba lilemong tsa bocha (Maturity-Onset Diabetes of the young)

Mekhoa e sebelisoang ho bokella / khetha bopaki:

- batla litsing tsa elektroniki.

Tlhaloso ea mekhoa e sebelisitsoeng ho bokella / khetha le ho sekaseka bopaki

Sebaka sa bopaki bakeng sa likhothaletso ke lingoliloeng tse kentsoeng Laebraring ea Cochrane

database tsa hajoale, EMBASE le MEDLINE. Botebo ba patlo e bile lilemo tse 5.

Mekhoa e sebelisitsoeng ho lekola boleng le matla a bopaki:

- Tekanyetso ea bohlokoa ho latela moralo oa tekanyetso (tab. 1, 2).

Mekhoa e sebelisitsoeng ho sekaseka bopaki:

- Liteko tsa lipatlisiso tsa meta tse phatlalalitsoeng,

- litlhahlobo tse hlophisehileng tse nang le litafole tsa bopaki.

Letlapa la 1 tekanyetso ea ho hlahloba matla a likhothaletso

Litlhahlobo tsa boleng bo phahameng ba meta-tlhahlobo, litlhahlobo tse hlophisehileng tsa liteko tse laoloang ka mokhoa o ikhethileng (RCTs), kapa li-RCT tse nang le kotsi e tlase haholo ea leeme

O entse ka nepo lits'oants'o tsa lits'oants'o, lits'ebetso, kapa li-RCT ka kotsi e tlase ea liphoso tse hlophisehileng

Meta-analaser, e hlophisehileng, kapa li-RCT li na le kotsi e kholo ea khethollo

Tlhahlobo e hlophisitsoeng ea boleng bo holimo ea lithuto tsa taolo ea linyeoe kapa lithuto tsa cohort

Litlhahlobo tsa thuto ea boemo bo holimo tse phahameng kapa lithuto tse tlase haholo tsa cohort

kotsi ea ho kopanya litlamorao kapa leeme kapa le monyetla oa kamano e tloaelehileng

Lithuto tse laoloang hantle tsa linyeoe kapa lithuto tsa sehlopha se nang le kotsi e bohareng ea litlamorao

ho kopanya kapa leeme le monyetla o tloaelehileng oa kamano ea causal

Lithuto-pale kapa lithuto tsa taolo ea cohort e nang le kotsi e kholo ea litlamorao kapa

Liphoso tse hlophisehileng le monyetla o tloaelehileng oa kamano ea causal

Lithuto tse seng tsa tlhahlobo (mohlala: tlhaloso ea linyeoe, letoto la linyeoe)

Tafole ea 2 tekanyetso ea ho hlahloba boleng ba likhothaletso

Tlhahlobo e le 'ngoe ea meta, tlhahlobo e hlophisehileng, kapa RCT e thathamisitsoeng joalo ka 1++ e sebetsa ka kotloloho ho palo ea batho ba shebiloeng,' me e bonts'a botsitso ba sephetho.

kapa sehlopha sa bopaki, ho kenyelletsoa le liphetho tsa lipatlisiso tse lekantsoeng 1+, e sebetsa ka kotloloho ho baahi ba shebiloeng le ho bonts'a matla a liphetho

Sehlopheng sa Bopaki, se kenyeletsang liphetho tsa lipatlisiso tse thathamisitsoeng joaloka 2 ++, e sebetsa ka kotlolloho ho sepheo

baahi le ho bonts'a matla a kakaretso ea sephetho, kapa bopaki bo tsoang liphuputsong tse lekantsoeng 1 ++ kapa 1 +

C Sehlopha sa bopaki, ho kenyelletsoa le liphetho tsa lipatlisiso tse lekantsoeng joaloka 2+, se sebetsa ka kotloloho ho baahi ba shebiloeng mme se bonts'a matla a liphetho, kapa bopaki bo tsoang lithutong tse lekantsoeng joalo ka 2 ++

Boemo ba 3 kapa ba bopaki ba 4

ekaba bopaki bo fetotsoe ho tsoa lithutong tse latedisitsoeng 2+

Mekhoa e sebelisitsoeng ho lekola boleng le matla a bopaki:

Litafole tsa bopaki li ile tsa tlatsoa ke litho tsa sehlopha se sebetsang.

Mekhoa e sebelisitsoeng ho etsa likhothaletso:

Malebela a Tloaelo e Ntle (GPPs)

Tloaelo e ntle e khothalelitsoeng e ipapisitse le boiphihlelo ba bongaka ba litho tsa sehlopha se sebetsang sa ntlafatso.

Ts'ebetso ea litjeo ha ea ka ea etsoa, ​​'me lingoliloeng ha li a hlahlojoa ho li-pharmacoeconomics.

Malebela a netefatso:

- Tlhahlobo ea setsebi sa kantle,

- Tekolo ea litsebi tsa kahare.

Tlhaloso ea mekhoa ea netefatso ea litlhahiso

Litlhahiso tsena ke tsa pele

mefuta e ile ea hlahlojoa ke lithaka tse ikemetseng

Ba ileng ba botsoa hore ba fane ka maikutlo a bona ka mokhoa o hlakileng ho hlalosoa ha bopaki bo tlasa likeletso.

Ho ile ha amoheloa maikutlo ho tsoa ho lingaka tsa tlhokomelo ea mantlha le lingaka tsa bana ba setereke mabapi le ho hlaka ha litlhahiso le bohlokoa ba likhothaletso e le sesebelisoa se sebetsang sa tloaelo ea letsatsi le letsatsi.

Litlhahlobo le tlhahlobo ea litsebi Liphetoho tsa morao-rao tsa likhothaletso tsena li hlahisitsoe phetolelong ea pele bakeng sa lipuisano ho Congress of Endocrinologists ka la 20 Mots'eanong, 2013 (Moscow), likopanong tsa litsebi tsa thuto ea bana ka la 22 Pherekhong 2013, (Arkhangelsk) le la 5 Loetse 2013. toropo (Sochi). Phetolelo ea mantlha e behiloe molemong oa lipuisano tse ngata webosaeteng ea FSBI ESC e le hore batho ba sa nkeng karolo lipuisanong le likopanong ba be le monyetla oa ho nka karolo lipuisanong le ntlafatsong ea likhothaletso.

Litlhahiso tsa moralo o tla boela li hlahlojoe ke litsebi tse ikemetseng tse kopiloeng.

Pele ho tsohle, ho fana ka maikutlo ka ho tiea le ho nepahala ha tlhaloso ea setsi sa bopaki se thehileng likhothaletso.

Bakeng sa ntlafatso ea ho qetela le taolo ea boleng, litlhahiso li tla ntlafatsoa hape ke litho tsa sehlopha se sebetsang, ho etsa bonnete ba hore litlhaloso tsohle le maikutlo a setsebi a nkuoa, kotsi ea liphoso tse hlophisitsoeng mabapi le nts'etsopele ea likhothaletso ea fokotsoa.

Matla a likhothaletso (A - D) a fanoa mongolo oa likhothaletso.

Tlhaloso, mekhoa ea ho khetholla le ho khetholla lefu la tsoekere

Lefu la tsoekere mellitus (DM) ke sehlopha sa mafu a metabolic a nang le tšoaetso ea "hyperglycemia" ka lebaka la secretion kapa ts'ebetso ea insulin kapa motsoako oa mafu ana. Ho lefu la tsoekere, ho na le mathata a amanang le 'mele ea lik'habohaedreite, mafura le protheine, e bakoang ke tlolo ea ketso ea insulin liseleng tse lebisitsoeng.

Bongata bo boholo (90%) ba linyeoe tsohle tsa lefu la tsoekere bongoaneng le bohlankaneng ke mofuta oa 1 lefu la tsoekere (T1DM), le tšoauoang ke khaello ea insulin e phethahetseng e bakiloeng ke ho timetsoa ha li-pancreatic p-cell.

Ha se mofuta oa 1 lefu la tsoekere ke tlolo ea metabolism ea carbohydrate, e ntlafalitsoeng ka lebaka la secretion ea insulin e sa fihlelleng litlhoko tsa 'mele. Sena se ka bakoa ke ho hanyetsa insulin, boemo bo sa lekaneng ba insulin ea ho patela, tlolo ea ts'ebetso ea eona ea secretion, le ho se sebetse hantle ha cell-r.

Litekanyetso tsa lefu la tsoekere li ipapisitse le liphetoho maemong a tsoekere ea plasma le ho ba teng kapa ho se be teng hoa matšoao a sebopeho f).

Ho na le mekhoa e 3 ea tlhahlobo ea mahlale ea lefu la tsoekere (tafoleng ea 3).

Mofuta oa 1 lefu la tsoekere, matšoao a bonoa ho bana maemong a 30%: polyuria, polydipsia, ho senyeha ha pono, ho theola boima ba 'mele hammoho le glucosuria le ketonuria (C).

Hangata tšoaetso ena e tiisoa ka potlako ha ho fumanoa keketseho e kholo ea glucose ea plasma. Haeba 'mele oa ketone o le teng maling le moroto, ho bontšoa kalafo e potlakileng. Ho emela ho fihlela letsatsi le hlahlamang ho netefatsa hyperglycemia ho ka ba kotsi, hobane nts'etsopele ea ketoacidosis e ka etsahala.

Haeba boikemisetso bo sa reroang ba lero la lero la plasma nakong ea mots'eare kapa kamora ho ja bo tiisa hore o tšoeroe ke lefu la tsoekere, OGTT ha e etsoe f). Maemong a belaetsang, tlhahlobo ea nako e telele e etsoa ka tlhahlobo e phetoang nako le nako.

Ha ho se na matšoao a lefu la tsoekere, lefu lena le etsoa feela motheong oa hyperglycemia e thehiloeng ka makhetlo a mabeli.

Tlhahlobo ea tlhahlobo ea tlhaho ea glucose e potlakileng (GPN):

- GPN ha ke fumane seo o se hlokang? Leka ts'ebeletso ea khetho ea lingoliloeng.

- GPN 5.6-6.9 mmol / l - glycemia e sa senyeheng (NGN),

- GPN> 7.0 mmol / L - tlhahlobo e lekantsoeng ea lefu la tsoekere, e lokelang ho netefatsoa ho latela mekhoa e boletsoeng kaholimo.

Litekanyetso tsa tlhahlobo ea liphetho tsa OGTT (glucose ea lihora tse 2 kamora ho ts'oaroa ha glucose - GP2):

- GP2 11.1 mmol / L - tlhahlobo e lekantsoeng ea lefu la tsoekere, e lokelang ho netefatsoa ho latela mekhoa e boletsoeng kaholimo.

NTG le NGN li nkoa e le methati e mahareng pakeng tsa metabolism e tloaelehileng ea carbohydrate le lefu la tsoekere f).

Sehlopha sa lefu la tsoekere

Sehlopha sa lefu la tsoekere se fanoe ka har'a tafole. 4.

Lethathamo la 3. Litekanyetso tsa ho hlahloba lefu la tsoekere (ISPAD, 2009)

Matšoao a nang le tšobotsi a kopantsoeng le ho ts'oaroa ha glucose ea plasma> 11.1 mmol / L *. Ho tsebahala ho nkoa e sa reroa ka nako efe kapa efe ea letsatsi ntle le ho nahana ka nako e setseng ho tloha lijo tsa ho qetela

Ho nona lero la lero la plasma> 7.0 mmol / L **. Mpa e se nang letho e hlalosoa e le ho ja lihora tse 8 tse fetileng kapa ho feta.

Tsoekere ea Plasma lihora tse 2 kamora ho ikoetlisa nakong ea teko ea mamello ea glucose ea molomo (OGTT)> 11.1 mmol / L. Bakeng sa mojaro, boima bo lekanang le 75 g ea glucose e nang le metsi e qhibilihileng ka metsing (kapa 1,75 g / kg ho ea holimo)

Hlokomela * - bakeng sa mali a capillary kaofela> 11.1 mmol / l, bakeng sa mali a venous>> 10,0 mmol / l, ** -> 6.3 bakeng sa mali ohle a venous le capillary.

Lethathamo la 4: Karolo ea thuto ea tlhaho ea likhathatso tsa metabolism ea carbohydrate (ISPAD, 2009)

I. T1DM e ka bonahala le lilemong tsohle, empa hangata ho bana le lilemong tsa bocha

A. Autoimmune lefu la tsoekere le tšoauoa ka lefu la lisele tsa p, ho ba teng ha li-autoantibodies ho li-p-cell, ho haelloa ke insulin ka botlalo, ho ts'epahalla insulin ka botlalo, netefatso e matla e nang le tšekamelo ea ketoacidosis, ho kopana le mefuta ea mofuta o moholo oa histocompatibility (HLA)

B. Lefu la tsoekere le 'mele le lona le hlaha ka lefu la lisele tsa p le tloaelo ea ketoacidosis, empa ntle le matšoao a ts'ebetso ea autoimmune (autoantibodies e ikemetseng le mekhatlo e amanang le tsamaiso ea HLA). Mofuta ona oa lefu lena o tšoaea bakuli ba mofuta oa Maafrika le Asia.

II. T2DM - mofuta o atileng haholo oa lefu la tsoekere ho batho ba baholo, o tšoauoa ka khaello ea insulin ka ho senyeha ka bobeli secretion le ketso ea insulin: ho tloha ho hanyetseng insulin ho hokahana le ho fokola ha insulin ho ea ho sekoli sa sephiri sa pele, se nang le kapa se sa kopane le insulin

III. Mefuta e meng e ikhethang ea lefu la tsoekere. Karolo ena e kenyelletsa mefuta e mengata e ikemetseng ea lefu la tsoekere (boholo ba lefutso la lefutso le mofuta oa lefagen) e kopantsoeng likarolo tse arohaneng tsa subtypes

A. Bofokoli ba liphatsa tsa lefutso tšebetsong ea cell-P:

1. Chromosome 12, HNF-1a (MODY3)

2. Chromosome 7, GCK (MODY2)

3. Chromosome 20, HNF-4a (MODY1)

4. Chromosome 13, IPF-1 (MODY4)

5. Chromosome 17, HNF-1 / i (MODY5)

6. Chromosome 2, NeuroDl (MODY6)

7. Phetoho ea DNA ea mitochondrial

8. Chromosome 6, KCNJ11 (Kir6.2), ABCC8 (Sur 1)

9. Ba bang ba bang, sesosa sa eona ke bofokoli ba monogenic ka har'a motsoako oa insulin

B. Bofokoli ba liphatsa tsa lefutso ketsong ea insulin:

1. Tlanya A Resulin ea insulin

2. Leprechaunism (Donohue syndrome)

3. Rabson-Mendelhall Syndrome

4. Lefu la tsoekere la Lipoatrophic

5. Mefuta e meng ea lefu la tsoekere e bang teng ka lebaka la liphetoho liphatseng tsa lefutso la insulin. Ka tlhaho e bonahatsoa ke metabolism ea carbohydrate e senyehileng ho tsoa ho hyperglycemia le hyperinsulinemia ho feta lefu la tsoekere. Donoghue Syndrome le Rabson-Mendelhall Syndrome li hlahella bongoaneng mme li bonts'itse ho hanyetsa insulin

C. Mafu a bolaeang ka ntle ho pancreas

2. Trauma, pancreatectomy

3. Li-pancreatic neoplasms

4. cystic fibrosis (cystic fibrosis)

6. Fibro-palo ea pancreatopathy

7. Maloetse a mang a fapaneng a fapaneng, ao ho ona, hammoho le likotlo tse matla tsa tšebetso ea pancreatic, ho haella ha ts'ebetso ea sephiri ea lisele tsa islet le tsona li bonoang.

2. Cushing's Syndrome

8. Li-endocrinopathies tse ling, ka lebaka la ts'ebetso e hanyetsanang ea lihormone tse bolokiloeng ka bongata, li ka lebisa ho fokotseha hoa polokelo ea tšebetso ea matšeliso a pancreatic p-cell

E. lefu la tsoekere le susumetsoang ke lithethefatsi tse ling kapa lik'hemik'hale tse ling

3. Asiti ea Nicotinic

5. Lihormone tsa qoqotho

7. P-adrenergic agonists

11. Lithethefatsi tse ling. Mekhoa ea ketso ea bona e fapane: ho mpefala ha ketso ea phello ea insulin, keketseho ea ho hanyetsa insulin.Bongoaneng, ts'ebeliso ea-interferon e bohlokoa haholo, tlasa ts'usumetso ea hore lefu la tsoekere la autoimmune le nang le bofokoli bo matla ba insulin bo ka hlaha

1. Congenital rubella

3. Ba bang. Tšoaetso e 'ngoe ea vaerase e lebisa lefung la lisele tsa p-nts'etsopele ka lebaka la khaello ea insulin e felletseng. Tšenyo e tobileng ea vaerase ea lisebelisoa tsa islet ha e fumanehe

Lethathamo la 4 Karolo ea thuto ea tlhaho ea likotsi tsa metabolism ea carbohydrate (ISPAD, 2009) (e ntse e tsoela pele)

G. Mefuta e sa tloaelehang ea lefu la tsoekere

1. Rigid human syndrome (mesifa ea ho thatafala ha mesifa, sesepa sa ho thatafala ha monna) - leqhubu la autoimmune la methapo ea kutlo e bohareng e khetholloang ka ho ruruha ha mesifa ea axial e nang le spasm e bohloko, li-antibodies tsa glutamate decarboxylase li fumanoa, 'me hoo e ka bang 50% ea lefu la tsoekere le hlaha.

2. Autoimmune polyglandular syndrome ea mefuta ea I le II

3. Maloetse a mang a bang teng ka ho etsoa hoa li-autoantibodies ho li-insulin receptor ke systemic lupus erythematosus, pigmented papillary dystrophy ea letlalo (acanthosis nigricans). Tabeng ena, ho hanyetsa insulin ho ka bonoa.

H. Li-syndromes tse ling tsa lefutso ka linako tse ling li amanang le lefu la tsoekere

DM e ka ba karolo ea li-syndromes tse ngata tsa lefutso, ho kenyelletsa:

1. Tungsten Syndrome

2. Down Down

3. Shereshevsky-Turner syndrome

4. Klinefelter syndrome

5. Lawrence - Khoeling - Beadle Syndrome

6. Lefu la Prader-Willi

7. Ataxia ea Friedreich

8. Chorea ea Huntington

10. Myotonic dystrophy

Bongoaneng, lefu la Wolfram (DIDMOAD) le atile haholo.

IV. Lefu la tsoekere la lefu la sethoathoa (lefu la tsoekere la basali baimana) - boemo bofe kapa bofe bo nang le metabolism ea carbohydrate (ho kenyelletsa le mamello ea glucose) e fumanoeng nakong ea kemolo. Ho itlhahisa ka lefu la tsoekere ka mofuta o fapaneng ho amahanngoa le kotsi e eketsehang ea lefu la perinatal le ho senyeha hoa tlhaho ho basali baimana ba nang le metabolism ea carbohydrate.

Sehlopha sa lefu la tsoekere ha se mofuta oa 1 ho ea ka International Classified of maloetse (ICD-10)

Mokhatlong oa machaba oa maloetse (ICD-10), lefu la tsoekere le sa itšetleheng ka insulin le hlahisoa ka li-rubric E11-E14.

E11. Lefu la tsoekere le sa itšetleheng ka insulin

E11.0 Lefu la tsoekere le sa itšetleheng ka insulin le coma

E11.1 Lefu la tsoekere le sa itšetleheng ka insulin le ketoacidosis

E11.2 Mellitus e sa itšetleheng ka insulin e nang le ts'oaetso ea meno

E11.3 Mellitus e sa itšetleheng ka insulin e nang le ts'enyo ea mahlo

E00.4 Mellitus e sa itšetleheng ka insulin e nang le mathata a methapo

Mellitus ea tsoekere e sa itšetleheng ka insulin e nang le mathata a potoloho ea mali

E00.6 Mellitus e sa itšetleheng ka insulin e nang le mathata a mang a boletsoeng

Eell.7 Mellitus e sa itšetleheng ka insulin e nang le mathata a mangata

E00.8 Mellitus e sa itšetleheng ka insulin e nang le mathata a sa hlalosoang

E11.9 Mellitus e sa itšetleheng ka insulin ntle le mathata

Lefu la tsoekere la E12 le amanang le khaello ea phepo e nepahetseng.

Lefu la tsoekere la E12.0 le amanang le khaello ea phepo e nepahetseng, le komisi

Lefu la tsoekere la E12.1 le amanang le khaello ea phepo e nepahetseng, le ketoacidosis

Lefu la tsoekere la E12.2 le amanang le khaello ea phepo e nepahetseng, le ts'enyo ea liphio

Lefu la tsoekere la E12.3 le amanang le khaello ea phepo e nepahetseng, le tšenyo ea mahlo

Lefu la tsoekere la E12.4 le amanang le khaello ea phepo e nepahetseng, le mathata a methapo

Lefu la tsoekere la E12.5 le amanang le khaello ea phepo e nepahetseng, le mathata a potoloho ea mali

Lefu la tsoekere la E12.6 le amanang le khaello ea phepo e nepahetseng, le mathata a mang a boletsoeng

Lefu la tsoekere la E12.7 le amanang le khaello ea phepo e nepahetseng, le mathata a mangata

Lefu la tsoekere la E12.8 le amanang le khaello ea phepo e nepahetseng, le mathata a sa hlalosoang

Lefu la tsoekere la E12.9 le amanang le khaello ea phepo e nepahetseng, ntle le mathata

E13 Mefuta e meng e boletsoeng ea lefu la tsoekere

E13.0 Mefuta e meng e boletsoeng ea lefu la tsoekere le coma

E13.1 Mefuta e meng e boletsoeng ea lefu la tsoekere le ketoacidosis

E13.2 Mefuta e meng e boletsoeng ea lefu la tsoekere e nang le ts'enyo ea liphio

E13.3 Mefuta e meng e boletsoeng ea lefu la tsoekere e nang le tšenyo ea leihlo

E13.4 Mefuta e meng e boletsoeng ea lefu la tsoekere le khaello ea methapo

E13.5 Mefuta e meng e boletsoeng ea lefu la tsoekere e nang le mathata a potoloha ea mali

E13.6 Mefuta e meng e boletsoeng ea lefu la tsoekere le mathata a mang a boletsoeng

E13.7 Mefuta e meng e boletsoeng ea lefu la tsoekere e nang le mathata a mangata

E13.8 Mefuta e meng e boletsoeng ea lefu la tsoekere e nang le mathata a sa hlalosoang

E13.9 Mefuta e meng e boletsoeng ea lefu la tsoekere ntle le mathata

E14 SD, ha e hlalosoe

Lefu la tsoekere la E14.0, le sa hlalosoang ka lefu la tsoekere la coma E14.1, le sa hlalosoang ka ketoacidosis

LITLHAKISO TSA BOPHELO, 5, 2014 61

Lefu la tsoekere la E14.2, le sa hlalosoang ka tšenyo ea liphio

Lefu la tsoekere la E14.3, le sa hlalosoang ka tšenyo ea mahlo

Lefu la tsoekere la E14.4, le sa hlalosoang le mathata a methapo

Lefu la tsoekere la E14.5, le sa hlalosoang ka mathata a potoloho ea potoloho

Lefu la tsoekere la E14.6, le sa amaneng le mathata a mang a boletsoeng

Lefu la tsoekere la E14.7, le sa hlalosoang ka mathata a mangata

Lefu la tsoekere la E14.8, le sa hlalosoang ka mathata a sa hlalosoang

Tsoekere ea E14.9, e sa hlalosoang ntle le mathata

T2DM - tlhaloso, setšoantšo sa tleliniki le

T2DM e tšoauoa ka hyperglycemia khahlano le semelo sa ho insulin sa maemo a fapaneng. Ka tloaelo, kholo ea lefu la tsoekere la mofuta oa 2 e amahanngoa le seo ho thoeng ke metabolic syndrome. Ho latela litlhaloso tsa WHO, mokuli ea nang le lefu la tsoekere la mofuta oa 2 (kapa motho ea nang le lefu la tsoekere la mofets'e, ho hanyetsa insulin) o na le lefu la metabolic moo ho nang le matšoao a mabeli a latelang: botenya ba ka mpeng, khatello ea mali ea methapo, maemo a eketsehang a "glycerides" le / kapa litekanyetso tsa HDL tse fokotsang.

Setšoantšo sa Kliniki sa T2DM ho bana le lilemong tsa bocha se bonoa ke likarolo tse latelang:

- lefu le na le bohloeki, butle butle,

- o fumanoe a le lilemo li ka holimo ho lilemo tse 10 (karolelano ea lilemo tsa lefu la 13.4), D),

- ho nona ho feta tekano kapa botenya (85%) ke sebopeho (C),

- ha ho setsoalle le HLA haplotypes e rerileng nts'etsopele ea lefu la tsoekere la mofuta oa 1,

- matšoao a immunological (autoantibodies ICA, GADa, IA2) ha a khethoa, kapa ho ka khethoa mofuta o le mong feela, mme karolo ea bona e tlase.

- ho 30% ea linyeoe, ponahalo e matla le ketosis (D),

- secretion e sireletsehileng ea insulin ka hyperinsulinism le ho hanyetsa insulin,

- Kopano khafetsa le likarolo tsa 'mele oa metabolic: nephropathy (micro- kapa macroalbuminuria) - ka nako ea tlhahlobo ea lefutso, e ka ba teng ho 32% ea linyeoe (C), khatello ea methapo ea methapo - ho fihla ho 35% (D), dyslip

Tekanyo ea C-peptide, insulin

Tlhokomelo ea lefu la tsoekere la ADA, 2000: 23: 381-9

Sa feiga. 1. Algorithm ea tlhahlobo ea tlhahlobo ea lefu la tsoekere ho bacha. 62

Lethathamo la 5. Matšoao a ho hanyetsa insulin

Palo ea Index

HOMA-IR (Tlhatlhobo ya semelo sa Homeostasis) (И600.) / 22,5 Ha ke fumane seo o se hlokang? Leka ts'ebeletso ea khetho ea lingoliloeng.

Matsuda (nakong ea OGTT) 10,000> 2,5

Hlokomela G - tekanyo ea tsoekere ea mali e potlakileng, GSr - boemo ba glucose bo tloaelehileng nakong ea OGTT, IRI - sekhahla sa insulin se potlakileng, IRIS - tekanyo e tloaelehileng ea insulin nakong ea OGTT, OGTT - tlhahlobo ea mamello ea glucose ea molomo.

lefu la demy - ho fihla ho 72% (D), lefu le se nang mafura a sebete (NAFLD) - steatohepatitis le ka bonoa ho 30% ea linyeoe, lefu la tsoekere la lefu la tsoekere (ho fihla ho 9-12%) (D), ts'oaetso ea methapo - boemo bo eketsehang ba protheine ea C-reactive, cyto- Lithane tsa ho ruruha le leukocytes (D).

Ho hanyetsa insulin ke tlolo ea phello ea likokoana-hloko tsa insulin le karabelo ea lisele tse hlokahallang insulin ho insulin maemong a pele le a kamoso a morao-rao, a lebisang phetohong e sa fetoheng ea metabolic hape e tsamaisana le comperatory hyperinsulinemia maemong a pele.

Ho hanyetsa insulin ho fumanoa haeba bonyane index e le 'ngoe e kheloha tloaelo (Tafole ea 5).

Morero oa Tlhahlobo oa DM2 o belaelloang:

1. Tlhahlobo ea lefu la tsoekere ho latela maemo a tlhahlobo ea lefu (sheba tafole ea 3).

2. Boikemisetso ba boemo ba insulin ea insulin (IRI) ka mpeng e se nang letho le / kapa khahlano le semelo sa mojaro oa glucose (haeba ho hlokahala).

3. Palo ea li-indices tsa insulin Resistance - HOMA, Caro le Matsuda.

4. Qeto ea boemo ba hemoglobin ea glycated.

5. Tlhahlobo ea biochemical ea mali (tšebetso ea AlAT le AsAT, maemo a HDL, LDL, triglycerides, cholesterol e felletseng, urea, creatinine, uric acid, protheine ea C-reactive).

6. Qeto ea li-autoantibodies tse ikhethang (ICA, GADa, ho tyrosine phosphatase).

Ho latela liphetho tsa tlhahlobo, tlhahlobo ea T2DM ho bana le lilemong tsa bocha e thehiloe motheong oa mekhoa e latelang:

1. Qalo ea lefu lena le fetang lilemo tse 10.

2. Keketseho ea glucose ea mali e potlakileng ho feta 7.0 mmol / L le / kapa nakong ea OGTT ho ea ho tse fetang 11.1 mmol / L kamora lihora tse 2 (bona tafole 3).

3. Tekanyo ea hemoglobin ea glycated> 6.5% (D).

4. Boemo ba insulin bo ka har'a meeli e tloaelehileng kapa bo feta litšupiso tsa boleng, ho ba teng ha insulin

ho hanyetsa f), ka lefu le nka nako e fetang lilemo tse 2-3 f).

5. Ho ba teng ha ba leloko la degree ea pele le / kapa ea bobeli ea kinship ka tlolo ea carbohydrate metabolism (DM, NTG, NGN) f).

6.Boima bo boima ba 'mele kapa botenya (bo teng ho 85% ea linyeoe) (C).

Haeba mokuli a fumana kalafo ea insulin, joale sekhahla sa insulin se ka hakangoa ke boemo ba C-peptide - secretion e bolokiloeng ea C-peptide ho feta lilemo tse 3 kamora ho bontšoa ha lefu lena ha se ntho e tloaelehileng ho bakuli ba nang le lefu la tsoekere la 1).

Mekhoa e meng ea tlhatlhobo e nang le tlhahlobo e netefalitsoeng ea T2DM:

2. Ultrasound ea mpa ea mpa.

3. Ultrasound ea litho tsa pelvic (bakeng sa tlolo ea sebopeho sa ho kena bohlankaneng kapa ho ilela khoeli ho banana).

4. Tlhokomelo e akaretsang ea khatello ea mali (ka keketseho ea khatello ea mali e fetang 90% o).

5. Keletso ea litsebi: ngaka ea mahlo, setsebi sa kelello, ngaka ea methapo, (ho ea ka matšoao), liphatsa tsa lefutso (ho latela lipontšo).

Mekhoa ea Tsamaiso e Netefalitsoe

Tsamaiso ea mokuli motheong oa kantle

1. Tlhahlobo ea endocrinologist - 1 nako e le 'ngoe ka likhoeli tse 3.

2. Qeto ea boemo ba hemoglobin ea glycated - nako e le ngoe ka likhoeli tse 3.

3. Tlhokomelo ea tsoekere ea mali - boikemisetso ba ho itima lijo le lijo tsa gluprose ea postprandial f). Ho mafu a hlobaetsang kapa a nang le matšoao a hyper- le hypoglycemia, ho hlalosoa khafetsa haholoanyane f). Bakuli ba nang le kalafo ea insulin kapa kalafo e nang le litokisetso tsa sulphanilurea ba hloka ho hlahlojoa ha asymptomatic hypoglycemia f).

4. Teko e akaretsang ea mali - hang hang ka likhoeli tse 6.

5. Tlhahlobo e akaretsang ea moroto - 1 nako likhoeling tse 6.

6. Teko ea mali a biochemical - hang ka selemo (tšebetso ea AlAT le AsAT, cholesterol e felletseng, LDL, triglycerides, protheine ea C-reactive, uric acid).

7. Boikemisetso ba microalbuminuria ho li-servings tse tharo tsa moroto - nako e le 'ngoe ka selemo.

8. Taolo ea khatello ea mali - ketelong e ngoe le e ngoe ho ngaka.

9. Ultrasound ea mpa ea mpa ea mpa - nako e le 1 ka selemo.

10. Kopo ea ngaka ea mahlo, "psychologist" nako e le ngoe ka selemo.

11. Ho kena sepetlele - hang ka selemo, ho na le keketseho ea matšoao a lefu la tsoekere (polyuria, polydipsia), le / kapa keketseho ea boemo ba hemoglobin ea glycated ho feta 7.0% - sepetlele se sa sebetsoang.

Tlhokomelo ea maikutlong

Sepetlele, ho etsoa tlhahlobo e 'ngoe:

2. Ultrasound ea mpa ea mpa.

3. Ultrasound ea litho tsa pelvic (ho ea ka lipontšo).

4. Tlhokomelo e akaretsang ea khatello ea mali (ho latela lipontšo).

5. MRI (ho ea ka lipontšo).

6. Keletso ea litsebi - ngaka ea mahlo, setsebi sa methapo ea mafu, ramatiki (ho ea ka lipontšo), genetics (ho latela lipontšo).

Tsamaiso ea kalafo ea bakuli ba nang le lefu la tsoekere la mofuta oa 2

Phekolo ea mantlha e khethoa ke matšoao a bongaka, ho teba ha hyperglycemia, le ho ba teng kapa ho ba sieo ha ketosis / ketoacidosis. Joalo ka T1DM, boteng ba matšoao, ho hlatsa haholo, boemo bo ka mpefala (D), ka hona, moriana oa pele o behiloeng ke insulin (A). Ha ho se na matšoao a matla, kalafo ea khetho ke metformin (D). Motsoako oa pele ke 250 mg / ka letsatsi bakeng sa matsatsi a 3, ka mamello e ntle, lethalamo le eketsoa ho 250 mg makhetlo a 2 ka letsatsi, haeba ho hlokahala, tekanyetso ea tekanyetso e etsoa ka matsatsi a 3-4 ho fihlela tekanyo e kholo e fihla - 1000 mg makhetlo a 2 ka letsatsi.

Phetisetso ho tsoa ho insulin ho ea ho metformin hangata e ka etsoa nakong ea matsatsi a 7-14, ho qala ka nako ea ho tsitsisoa ha metabolic - hangata libeke tse 1-2 kamora ho fumanoa. Ka keketseho e 'ngoe le e' ngoe ea lethal dose ea metformin, tekanyo ea insulin e fokotsoa butle-butle ke 10-20% (D).

Kamora ho felisoa ha kalafo ea insulin, khafetsa ea ho lekola boemo ba tsoekere ea mali e ka fokotsoa makhetlo a 2 ka letsatsi - ka mpeng e se nang letho le lihora tse peli ka mor'a lijo tsa ho qetela (D).

Lipheo tsa kalafo ea nako e telele ke:

- boima ba 'mele,

- ho ntlafatsa bokhoni ba ho mamella ho ikoetlisa,

- Tsamaiso ea maemo a tsoekere ea mali, e fihlelang boemo ba hemoglobin e ka tlase ho 7.0%,

- taolo ea maloetse a kopaneng, ho kenyelletsa le khatello ea mali ea methapo, dyslipidemia, nephropathy le hepatosis.

Karolo ea bohlokoa kalafong ea T2DM e bapaloa ke thuto ea mokuli le ba lelapa la hae. E lokela ho tsepamisa mohopolo ho fetoheng boits'oaro (lijo le tšebetso ea 'mele).Mokuli le ba lelapa la hae ba lokela ho koetlisoa ho beha leihlo hore na ba ja lijo tse ngata hakae, boleng bo nepahetseng ba ho ja le mokhoa o nepahetseng oa ho ikoetlisa. Liphetho tse ntle ka ho fetisisa li fumanoa ha u koetlisoa ke sehlopha sa litsebi, ho kenyelletsa setsebi sa phepo le setsebi sa kelello.

Mehato ea Bophelo

Ho hlokahala pheko ea lijo: ho fokotseha hoa lijo tsa letsatsi le letsatsi tsa caloric ka 500 kcal, thibelo ea ho ja mafura, haholo-holo a nang le lik'habohaedreite tse bonolo (lino tse tsoekere, lijo tse potlakileng), keketseho ea palo ea fiber, meroho le litholoana tse tsoang lijong. Hoa hlokahala ho boloka lijo ka tieo.

Ho ikoetlisa ho lokela ho ba bonyane metsotso e 50-60 ka letsatsi, ho hlokahala hore u fokotse ho shebella mananeo a TV le litlelase khomphuteng bakeng sa lihora tse peli ka letsatsi.

Pharmacotherapy e laetsoe haeba ho ne ho sa khonehe ho fihlella liphofu feela ka liphetoho tsa mokhoa oa bophelo.

Biguanides. Metformin e sebetsa ho li-insulin receptor bokong, mesifa le lithong tsa adipose; litlamorao tsa eona li boleloa haholo ka har'a sebete. Phello ea mantlha ea anorectic e ka tsosa boima ba 'mele. Tšebeliso ea nako e telele e amana le ho fokotseha hoa 1% ea hemoglobin ea glycated. Metformin e ka felisa litlolo tse tsoang ho basali ho PC tse nang le PCOS mme ea eketsa kotsi ea ho ima.

Litla-morao tse ka bang teng ka mpeng ea mahlaba a ka mpeng (bohloko ba ka mpeng, lets'ollo, ho nyekeloa ke pelo. Maemong a mangata, ba ka qojoa ka ho kenyelletsa tekanyetso ea libeke tse 3-4 le ho latela litlhahiso tsa ho nwa meriana ka lijo.

Kotsi ea ho ba le lactic acidosis ka kalafo ea metformin e tlase haholo. Metformin ha ea lokela ho laeloa bakuli ba nang le ts'ebetso ea ho ruruha ea mokokotlo, lefu la sebete, ho nyekeloa ke pelo kapa matšoafo, kapa ka nako e tšoanang le lithethefatsi tsa radiopaque. Bakeng sa mafu a ka mpeng, metformin e lokela ho emisoa ka nakoana (A).

Insulin Haeba nakong ea kalafo ka lithethefatsi tse fokotsang tsoekere ka molomo ho ke ke ha khoneha ho fihlela taolo e lekaneng ea glycemic, ho ts'oaroa ha analog ea nako e telele ea insulin ntle le litlamorao tse phahameng ho ka fana ka khotsofalo.

LITLHAKISO TSA BOPHELO, 5, 2014

Glucose (HA)> 12.5 ID1c> 9% kapa ketosis kapa _ ketoacidosis_

HA pele ho lijo 4.5-6.5 Postprandial tlhoro ea HA 6.5 / 9.0> (ID1c> 7%

Ho nahanoa ka taelo e eketsehileng: litokisetso tsa sulfonylurea

insulin glargine e le 'ngoe kapa e kopantsoe le insulin e nkang nakoana

BRD0, 2009

Sa feiga. 2. algorithm ea kalafo bakeng sa bana le bacha ba nang le lefu la tsoekere la mofuta oa 2.

Sa feiga. 3. Mokhoa o kopaneng oa kalafo ea lefu la tsoekere la mofuta oa 2 baneng.

litlamorao tsa pheko ntle le tlhoko ea ho fanoa ke insulin e amanang le lijo (prandial insulin). Phekolo ea Metformin e lokela ho tsoela pele. Haeba postprandial hyperglycemia e phehella, insulin e sebetsang ka nako e khuts'oane e ka eketsoa molemong oa kalafo.

Litlamorao tse ling tsa insulin li kenyelletsa hypoglycemia, e sa tloaelehang mofuteng oa 2 oa lefu la tsoekere ka kalafo ea insulin, le ho nona.

Dyslipidemia, khatello ea methapo ea kutlo le albinuria e nang le T2DM li tloaelehile haholo ho feta ka T1DM, li ka fumanoa kamora tlhahlobo mme li lokela ho hlahlojoa kamora ts'ebetso ea matla a taolo ea tsoekere ea mali.

Hlooho ea methapo ea mali le albinuria

Ka khatello ea methapo ea kutlo (BP> 95th percentile) kapa boteng ba albinuria, li-inhibitors tsa ACE lia phekoloa kapa, haeba li sa mamellehe, angiotensin f receptor blockers).

Haeba o fokotsa khatello ea mali le / kapa o fokotsa albinuria nakong ea kalafo u sebelisa pele ho nako

parata ha e atlehe; phekolo ea ho kopanya e kanna ea hlokahala f).

Litla-morao tsa li-inhibitors tsa ACE li kenyelletsa ho khohlela, hyperkalemia, hlooho e bohloko le ho hloka matla.

Teko ea dyslipidemia e lokela ho etsoa nakoana kamora ho fumanoa, ha ho khonahala ho fihlela taolo ea maemo a tsoekere ea mali, 'me ka selemo f). Litefiso tsa LDL tse lebelletsoeng li ka tlase ho 2,6 mmol / L.

Ka moeli oa moeli (2.6-3.4 mmol / L) kapa boemo bo phahameng ba LDL (> 3.4 mmol / L), profid ea lipid e hlahlojoa bocha kamora likhoeli tse 6 mme lijo li fetoloa ho fokotsa palo ea mafura a felletseng le a phethehileng.

Haeba maemo a LDL a lula a le phahameng bakeng sa likhoeli tse 3-6 kamora teko ea ho ntlafatsa, kalafo ea lithethefatsi e ka khonahala. Phekolo ea Statin e bolokehile ebile e sebetsa ho bana, le ha ho le joale ho se na datha mabapi le polokeho ea kalafo ea nako e telele (li-statins li laetsoe kamora ho buisana le ngaka ea lefu la pelo).

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Hyperglycemia: lisosa le matšoao

Etiology ea lefu lena e fapana ho latela mofuta oa pathology.

Mofuta oa 2 oa lefu la tsoekere oa hlaha ka lebaka la lintlha tse joalo:

• phatsa ea tlhaho
• mefuta e fapaneng ea botena,
• boimana ba pelehi
• bophelo ba ho lula fatše
• mathata a ho ja
• ho sebelisa lithethefatsi tse nang le li-hormone
• ho kena bohlankaneng kapa boroetsaneng
• mafu a system ea endocrine.

Maemong a mangata, hyperglycemia ke pontšo ea ho bola ha lefu la tsoekere. Ho eketseha ha tsoekere ka tšohanyetso ho ka baka boemo ba paroxysmal boo ho bona motho a ka hlokang tlhokomelo ea tšohanyetso.

Lisosa tsa Hyperglycemia

Ho motho ea phetseng hantle, hyperglycemia ntle le lebaka le hlakileng la kantle hangata ke sesupo sa mathata a metabolic mme e bonts'a kholo ea tsoelo-pele ea lefu la tsoekere kapa sepheo sa lefu lena.

Keketseho e mpe ea maemo a tsoekere ho batho ba nang le lefu la tsoekere e bakoa ke ho haella ha insulin, e leng hormone ea manyeme. Insulin e fokotsa (inhibits) ho sisinyeha ha likhase tse tsoekere ho pholletsa le li-membrane tsa sele, ka hona litaba tsa tsoekere ea mahala maling li nyoloha.

Ka lefu la tsoekere la mofuta oa 1, manyeme ha a hlahise insulin ka bongata bo hlokahalang, ka lefu la tsoekere la mofuta oa 2, insulin e kanna ea lekana, empa ho na le karabelo e sa tloaelehang ea 'mele ho ea ho hormone - ho hanyetsa boteng ba eona. Ka bobeli lefu la tsoekere le lebisa ho eketseheng palong ea limolek'hule tsa tsoekere maling le ho baka matšoao a sebopeho.

Matšoao a lefu la tsoekere ho bana

Lefu la tsoekere le tšoaetsanoa le ho feta lilemong tsa bongoana mme e ba la bobeli khafetsa liketsahalong tsa mafu a sa foleng a bongoana.

Lefu lena le tsoaloang le sa phekoleheng le bakoa ke metabolism ea carbohydrate mme le tšoauoa ka keketseho ea khatello ea tsoekere maling a mali.

Bophelo bo botle ba mokuli e monyane le menyetla ea ho ba le mathata a tebileng bo itšetlehile ka tlhahlobo le kalafo e tlang ka nako.

Ho fapana le tumelo e tsebahalang, lefu la tsoekere ha le bake feela batho ba baholo ba atlehileng tekanyo e itseng ea lilemo mme, ho feta moo, ba na le botenya, empa le bana. Ka hona, ho bohlokoa haholo ho lekola bophelo bo botle ba masea a hau le ho tseba hore na matšoao a pele a lefu la tsoekere ho bana a bonahatsoa joang.

Lisosa tsa lefu lena

Haeba re bua ka masea, hangata a fumanoa a e-na le lefu la tsoekere la mofuta oa 1. Ho bohlokoa ho tseba hore maemong a mangata e ba teng kamora ts'oaetso ho bana bao ba nang le liphatsa tsa lefutso ho nts'etsopele ea lefu lena.

Haeba bonyane e mong oa batsoali o na le lefu la tsoekere, ngoana o lokela ho tšoaroa ka hloko haholoanyane. Empa ka nako e ts'oanang, ha ua lokela ho leka ho mo sireletsa linthong tsohle tse khopisang: ho lekane ho tseba matšoao a pele, ho hopola hore na motsoako oa lefu lena ke eng, hlokomela ngoana ka hloko mme nako le nako o fana ka mali ho hlahloba khatello ea mali.

Haeba mme oa ngoana a tšoeroe ke lefu la tsoekere, joale lisele tsa hae tsa pancreatic li ela hloko litlamorao tsa likokoana-hloko tse ngata, ho kenyelletsa rubella, herpes, sesole le mumps. E 'ngoe le e' ngoe ea mafu ana e ka tsosa kholo ea lefu la tsoekere.

Lijo tsa masea tseo bo-'mè ba nang le lefu lena ba lokelang ho li hlokomela ka hloko. Bonyane nakong ea selemo, bana bana ba lokela ho feptjoa lebese la matsoele ho qoba mefuta eohle ea liprotheine tsa likhomo, tse fumanoang ka har'a metsoako ea maiketsetso.

Ho bohlokoa hape ho beha leihlo hore na masea a nona joang, a a fokotse, a eketsa ho itšireletsa mafung le ho thibela khatello ea maikutlo haeba ho khonahala.

Matšoao a kotsi

Empa esita le ts'ebetsong ea likhothaletso tsohle ka linako tse ling ha ho tiise hore ngoana o tla lula a phetse hantle. Ka hona, ho tlatselletsa mehatong ea thibelo, ho bohlokoa ho beha leihlo liphetoho tse nyane boitsong ba ngoana le ho tseba ho tseba ho qala ha lefu lena.

Sena se tla thusa ho tseba bothata sethaleng ha lesea le tla feela ho sitisa tsoekere ho monya. Sena se ka nka ngoana ka nako e behiloeng leihlo ke ngaka, ho fana ka kalafo e thibelang pele le ho thibela ho qala ha lefu la tsoekere.

Batsoali ba lokela ho ba hlokolosi bakeng sa matšoao a joalo:

• lenyora le eketsehileng la ngoana ntle le lebaka le hlakileng,
• ho ruruha haholo
• tahlehelo e boima ea boima ba limpa, ngoana ka libeke tse 'maloa feela a ka lahleheloa ke li-10 kg.

Ka nako e ts'oanang, litheolelo tsa metsi a nooang li makatsa haholo, ka kholo ea lefu la tsoekere, ngoana a ka qala ho noa lilithara tse 'maloa tsa metsi ka letsatsi. Hangata bana ba ka tlase ho lilemo tse 5 ba qala ho ntša metsi bosiu haholo, le pele ho moo ho ne ho se na mathata.

Haeba ngoana a qala ho noa haholo, empa u ntse u belaela, ela hloko matšoao a sa lebelloang. Tsena li kenyelletsa letlalo le omeletseng le li-membrous tsa mucous, ha leleme le penta hangata ka 'mala oa raspberry,' me ho phatsima ha letlalo ho fokotsehile.

Ho bohlokoa ho utloisisa ka nako hore ngoana o hloka ho hlahlojoa. Ho joalo, ho na le maemo a etsahalang khafetsa ha batsoali ba sa tsepamise maikutlo matšoao, ka lebaka leo, bana ba kena sepetlele ba le maemong a tebileng haholo.

Phekolo ea morao e qalile, ho ba boima le ho feta hore bokuli bo tsoele pele 'me ho ba kotsing e kholo ea ho ba le mathata a kopaneng.

Setšoantšo se ka etsahalang sa kliniki

Empa maemong a mang, lefu lena la endocrine le qala ka matšoao a mang. Haeba ngoana a e-ba le hypoglycemia, boemo boo tsoekere ea mali bo theohang haholo, o tla ba le matšoao a mang.

Ngoana o tla tletleba ka mokhathala o eketsehileng, bofokoli, o tla hlonama a bile a le meno, matsoho a hae a thothomela. Keketso e eketsehileng ea lipompong, pallor ea letlalo le eona e bonts'a ho qala ha lefu lena.

Ho a mang, lefu la tsoekere le qala ho ipata. Makhopho a makhopho a fokotsa tlhahiso ea "insulin" butle-butle, e lebisang keketseho e potlakileng ea khatello ea tsoekere maling a lesea.

Setšoantšo sa kliniki ntlheng ena se hlakile, hobane ngoana maemong a mangata ha a utloe ho qala ha lefu lena. Letšoao le sa tobang la lefu la tsoekere e ka ba boemo ba letlalo la ngoana.

O ka belaela hore ho na le ho phoso ka mathoba, makhopho kapa tšoaetso e meng ea fungal. Bopaki ba tsela e patiloeng ea lefu la tsoekere le eona e ka ba stomatitis, eo ho leng thata ho e phekola, le ho ruruha lipelong tsa mucous, ho kenyeletsa le liphatsa tsa lefutso tsa banana.

Ka lebaka la hore lefu la tsoekere ke lefu le futsitsoeng (maemong a mangata), batsoali ba bangata ba nang le lefu le joalo ba batla ho tseba hore na lefu lena le tšabehang le fetiselitsoe ngoana oa bona, mme matsatsing a pele a bophelo, makhopho a qala ho batla matšoao a lefu la tsoekere. bana.

• Matšoao a lefu la tsoekere ho ngoana ho fihlela selemo
• Lefu la tsoekere le bana
• Matšoao a lefu la tsoekere ho bana ba ka holimo ho lilemo tse 5
• Matšoao a ho isa ngoana ka potlako ho ngaka ke afe?
• U ka fumana lefu la tsoekere joang?

Ba bang, ho fapana le hoo, ba theoleloa ke mabaka a sa utloahaleng, hore feela ba se ke ba isa ngoana tlhahlobo. Matšoao a lefu la tsoekere ho ngoana ke afe, le hore na o ka fumana lefu la sethoathoa joang? Sena se tla tšohloa hamorao.

Matšoao a lefu la tsoekere ho ngoana ho fihlela selemo

Haeba ho le bonolo ho bana ba seng ba le baholo, joale u ka khetholla lefu le joang ho ngoana e monyane ea ka tlase ho selemo se le seng? Mona ke a mang a matšoao a tloaelehileng a lefu la tsoekere ho bana ba banyenyane:

• mokelikeli o eketsehileng oa metsi, ha molomo o omeletseng o ntse o le teng,
• ho fokotsa boima ba 'mele ka tšohanyetso ka lijo tse tloaelehileng,
• ponahalo ea li-pustule letlalong - matsoho, maoto, ka linako tse ling 'mele. Letlalo le omella,
• Ho hlatsuoa ha moroto ho bobebe. Ho khothalletsoa hore hang-hang u nke liteko tsa moroto bakeng sa tsoekere,
• tlhahlobo ea tsoekere ea mali. Alamo e sa tloaelehang.

Lefu la tsoekere le bana

Ho bohlokoa haholo ho hlokomela masea ho fihlela selemo, hobane nako ea ho tsoa ho bona ha e tšoarelle nako e telele, kamora lefu le kenella mohatong o matla. Ha e le molao, bana ba hlaolela lefu la tsoekere le ts'episitsoeng ke insulin, ke hore mofuta oa 1.

Batsoali ba nang le lefu le joalo ba lokela ho hlokomela ngoana oa bona ka hloko e le hore ba bone nts'etsopele ea lefu lena ka nako ebe ba qala kalafo.

U ka ba le ts'epo ea monyetla. Sena se tla lebisa ho mathata a maholo, kalafo e telele le e boima haholo.

Ha ngoana a le lilemo li 3 kapa ka tlase ho moo, mme leha e le ofe ea tsotellang o tla khona ho senola lefu la hae la lefu la tsoekere ntle le mantsoe le manonyeletso a sa hlokahaleng. E 'ngoe ea matšoao a hlakileng ka ho fetisisa a ketsahalo ea' mele ke marotholi a khang a moroto ka pitseng kapa sekoaelong sa ntloana.

Mokhoa oa ho qoba lefu la tsoekere: sireletsa basali le banna khahlanong le lefu lena

Ho sa tsotelehe hore na moriana o fetile hakae, mafu a sa phekoleheng a ntse a le teng. Har'a tsona ke lefu la tsoekere. Ho latela lipalo-palo, batho ba ka bang limilione tse 55 lefatšeng ka bophara ba tšoeroe ke lefu lena. Haeba re nahanela bakuli ba bangata ba nang le mofuta oa lefu la tsoekere, palo ea bona e tla nyoloha ka limilione tse 10.

Batho ba nang le lefu lena ba ka phela bophelo bohle ba bona. Leha ho le joalo, ho lula u shebile lijo le tsoekere ha ho eketse bophelo ba thabo. Ho qoba mathata a mang, o hloka ho tseba ho thibela nts'etsopele ea lefu la tsoekere.

Motho o lokela ho iketsetsa qeto ea hore na o batla ho loanela bophelo ba hae kapa o tlohella a le mong, a sa nahane ka hosane. Mokuli ea nang le lefu la tsoekere o hloka ho itokisetsa lithibelo tse itseng, empa sena se tla thusa ho boloka bophelo ba hae bo le boemong bo tšoanang le ho qoba mathata a lefu lena.

Mofuta oa lefu la tsoekere la mofuta oa 2: tlhahlobo ea bongaka le kalafo

Mokhatlo oa Likoetliso tse Akaretsang (Lingaka tsa Lelapa) oa Russian Federation

DIAGNOSIS, TLHOKOMELISO LE PUSO

TLHALOSO EA PAKI TSA BOPHELO

Bahlahisi: R.A. Nadeeva

2. Likhoutu ho ea ka ICD-10

3. Epidemiology ea lefu la tsoekere la mofuta oa 2

4. Lintlha le lihlopha tse kotsing

5. Screening mofuta oa 2 lefu la tsoekere

6. Tlhalo ea lefu la tsoekere. Litlhokahalo bakeng sa ho qaptjoa ha lefu la tsoekere.

7. Melao-motheo ea ho fumana lefu ho batho ba baholo ntle ho mabaka. Tlhahlobo e fapaneng.

8. Litekanyetso tsa tlhahlobo ea mafu a pelehi

9. Karolelano ea mathata a lefu la tsoekere.

10. Melao-motheo e akaretsang ea kalafo ea ka ntle

10.1. Algorithm bakeng sa khetho ea motho ka mong ea lipheo tsa kalafo bakeng sa HbA1c

10.2. Matšoao a taolo ea metabolism ea lipid

10.3. Tebello ea khatello ea mali

10.4. Phetoho ea bophelo

10.5. Phekolo ea lithethefatsi

10.6. Matlafatso ea maano a kalafo ho latela HbA1c ea pele

10.7. Kalafo ea insulin bakeng sa lefu la tsoekere la mofuta oa 2.

10.8. Likarolo tsa kalafo ea lefu la tsoekere la mofuta oa 2 botsofaling.

10.9. Likarolo tsa kalafo ea lefu la tsoekere la mofuta oa 2 ho bana le bacha.

10.10. Likarolo tsa kalafo ea lefu la tsoekere la mofuta oa 2 ho basali baimana.

11. Matšoao a boeletsi ba setsebi

12. Matšoao a ho pepesetsoa mokuli sepetlele

13. Thibelo. Thuto ea mamello

15. Ho beha leihlo bakuli ba nang le lefu la tsoekere la mofuta oa 2 ntle le mathata

AH - khatello ea mali ea methapo

aGPP-1- glucagon-tsoekere e bitsoang peptide agonists 1

HELL - khatello ea mali

GDM - lefu la tsoekere

DKA - lefu la tsoekere ketoacidosis

DR - retinopathy ea lefu la tsoekere

IDDP-4 - li-inhibitors tsa dipeptyl peptidase

ICD - insulin e nkang nakoana (Ultra-Short)

BMI - index ea boima ba 'mele

IPD - ketso ea insulin e mahareng (e telele)

NGN - ho sitisoa ke ho itima lijo glycemia

NTG - mamello ea tsoekere e sa sebetseng hantle

PGTT - tlhahlobo ea mamello ea glucose ea molomo

PSSP - Lithethefatsi tsa molomo tsa hypoglycemic

RAE - Mokhatlo oa Russia oa Endocrinologists

MSP - lithethefatsi tse theolelang tsoekere

TZD - thiazolidinediones (glitazones)

FA - Boikoetliso ba 'mele

CKD - ​​lefu la liphio le sa foleng

XE - yuniti ea bohobe

HLVP - density lipoprotein cholesterol e phahameng

HLNP - dermity lipoprotein cholesterol e tlaase

HbA1c - hemoglobin ea glycosylated

Lefu la tsoekere mellitus (DM) ke sehlopha sa mafu a metabolic (metabolic) a tšoauoang ke hyperglycemia e sa foleng, e leng litholoana tsa insulin, litlamorao tsa insulin, kapa lintlha tsena ka bobeli. Hyperglycemia e sa foleng ea lefu la tsoekere e tsamaisana le tšenyo, ho se sebetse hantle le ho haella ha litho tse fapaneng, haholo mahlo, meno, methapo, pelo le methapo ea mali.

E10 mellitus e itšetlehileng ka insulin

E mellitus ea tsoekere e sa itšetleheng ka insulin

Mofuta oa lefu la tsoekere la E12

E13 Mefuta e meng e boletsoeng lefu la tsoekere mellitus

Lefu la tsoekere la E14 mellitus, le sa hlalosoang

Lefu la tsoekere la Gestational

R73 glucose e phahameng

(ho kenyelletsa mamello ea tsoekere e nang le bothata le tsoekere e potlakileng ea ho itima lijo)

3. Epidemiology ea lefu la tsoekere la mofuta oa 2.

Ka har'a sebopeho se akaretsang sa lefu la tsoekere, lefu la tsoekere la 2 ke 90-95%. Lilemong tse 30 tse fetileng, sekhahla sa keketseho ea lefu la tsoekere se aparetse mafu a tšoaetsanoang a kang lefuba le HIV.

Palo ea bakuli ba nang le lefu la tsoekere lefatšeng ka bophara lilemong tse 10 tse fetileng e imenne habeli ebile e fihlile ho batho ba limilione tse 371 ka 2013. Sebopeho se akaretsang sa keketseho e ile ea susumetsa Machaba a Kopaneng ka Pherekhong 2006 ho amohela qeto e reng "ho thehoe mananeo a naha a thibelo, kalafo le thibelo ea lefu la tsoekere le mathata a lona le ho kenyelletsoa ha tsona mananeong a bophelo a mmuso."

Ho ea ka Ngoliso ea Naha ea bakuli ba lefu la tsoekere ho tloha ka Pherekhong 2013 ho la Russian Federation, ho na le bakuli ba limilione tse 3,779 ba nang le lefu la tsoekere mabapi le phihlello ea litsi tsa bongaka. Leha ho le joalo, ponaletso ea eona e hlile e phahame makhetlo a 3-4 ho feta "e ajoang". E leng hoo e ka bang 7% ea baahi. Ho baahi ba Europe, ho ata ha lefu la tsoekere la 2 ke 3-8% (hammoho le mamello ea glucose e sa sebetseng - 10-15%).

Litlamorao tse kotsi ka ho fetisisa tsa seoa sa lefats'e sa lefu la tsoekere ke mathata a sona a methapo ea methapo - nephropathy, retinopathy, tšenyo methapong e ka sehloohong ea pelo, bokong, likepe tse poteletseng tse lipakeng tse tlase. Ke mathata ana ke sesosa se ka sehloohong sa bokuli le lefu la bakuli ba nang le lefu la tsoekere.

4. Lintlha le lihlopha tse kotsing.

Lintho tse kotsing ea lefu la tsoekere la mofuta oa 2

- Ho nona ho feta tekano le botenya (BMI /25 kg / m2 *).

- Nalane ea lelapa la lefu la tsoekere (batsoali kapa banab'eno ba nang le lefu la tsoekere la mofuta oa 2)

-Hoa tloaelo e tlase ea ho ikoetlisa.

- Ho koala lijo tse haelloang habonolo ke "glycemia" kapa "" pale ea "glucose" e sa sebetseng hantle.

-Gestational lefu la tsoekere mellitus kapa tsoalo ea ngoana e moholo ho nalane.

-Arterial hypertension (≥140 / 90 mm Hg kapa moriana oa antihypertgency).

- HDL cholesterol ≤0.9 mmol / L le / kapa boemo ba triglyceride ≥2.82 mmol / L.

Ts'ebetso ea booki e bohlokoa haholo mohato oa pele oa ho fumana lefu la tsoekere ho bana.

Mooki o thusa ho bokella lintlha tse hlokahalang ho bokella setšoantšo se hlakileng sa lisosa tsa lefu lena, o nka karolo ho hlophiseng mokuli e monyane bakeng sa lithuto tsa laboratori le tsa kalafo, 'me o fana ka tlhokomelo ea booki nakong ea kalafo sepetlele le lapeng.

Mofuta oa 2 oa lefu la tsoekere kajeno o ama palo e ntseng e eketseha ea baahi. Tsohle tse mabapi le lefu la tsoekere la mofuta oa 2 li se li ntse li tsebahala ho tsoa likoranteng, thelevisheneng, marang-rang.

Lefu lena le tšoailoe eseng feela ka tlolo ea metabolism ea carbohydrate, joalo ka ha baahi ba bangata ba lumela, empa hape le ka ho kheloha mefuteng e meng ea metabolism: mafura, protheine le vithamini. Litsebi tse ngata tsa mafu a tšoaetsanoang li nka lefu la tsoekere la mofuta oa 2 le lefu la tsoekere le lebisang lefu la tsoekere 1 ke seoa, hobane lebelo le phetiso ea lona le tšoana le la mafu a tšoaetsanoang nakong ea ha ho phatloha.

Sengoloa se bua ka lefu la tsoekere: matšoao, lisosa, mathata a lefu la tsoekere ke eng, kalafo ea lefu la tsoekere la mofuta oa 2, litšobotsi tsa lithethefatsi.

Lefu la tsoekere ke eng?

Ho tsoa ho bakuli, setsebi sa endocrinologist se amohelang hangata se utloa: "Ke na le lefu la tsoekere la 2." Empa ha se motho e mong le e mong ea utloisisang hore na motheo oa metabolism ena ke oa mofuta ofe.

Li-endocrinopathies tsa lefu la tsoekere tsa mefuta ena ka bobeli li kopantsoe hobane mathata a metabolic a sa foleng. Insulin nts'etsopele ea liphetoho tsa methapo ea methapo ke palo ea bohlokoa.

Ketsahalong ea pele feela, ka lebaka la tšenyo ea lisele tsa manyeme (li-islets of Langerhans) ke ts'ebetso ea autoimmune kapa ke baemeli ba tšoaetsanoang, tlhahiso ea hormone ena e sitisoa. Ka nako e ts'oanang, ts'ebeliso ea tsoekere - karolo e ka sehloohong ea matla - ke lisele tsa litho le lisele tse senyehileng, hobane li-insulin li hlokahala ho sebelisa phepo ena e tsoang maling.

Mofuta oa 2 oa lefu la tsoekere: lefu lena ke eng, hona ho fapana hofe kapa hofe ho tloha ho lefu la mofuta oa? Ho fapana le lefu la tsoekere la mofuta oa 1, ntlheng ena, kutloelo-bohloko ea linama tse nang le insulin ho insulin ha e na mathata, ka lebaka leo, sephetho sa lefu lena la lisebelisoa tsa "receptor" e tla ba "metabolism ea" carbohydrate e senyehileng.

Sena se lemohuoa ka keketseho ea litaba tsa tsoekere maling le maro a mang a tlhaho: hyperglycemia (litekanyetso tse phahameng tsa mali), glucosuria (ho ba teng ha tsoekere ka har'a moroto).

Keketseho ea ntho ena lipokellong e boetse e lebisa ho chefo ea glucose. Ena ke thepa e bonahatsoang ke nts'etsopele ea likatse, neuropathy, angiopathy le mathata a mang a kotsi.

Sehlopha sa lefu la tsoekere le lefu la tsoekere

1. Bohareng
2. Lelapa
3. Autosomal dominant (vasopressin prepro-AVP2 gene liphetoho tse tlisoang ke mofuta oa proro-arginine)
4. Autosomal recessive (Tungsten syndrome lefu la tsoekere insipidus, lefu la tsoekere, lefu la sefahleho, ho se utloe litsebeng)
5. liphoso tsa tlhaho tsa mokokotlo (septooptic dysplasia, holoprosencephaly)
6. E fumanehile
7. tlhaho e sithabetsang (hlooho e sithabetsang, ts'ebetso ea methapo ea methapo)
8. hlahala (craniopharyngioma, germinoma, glioma, metastases ea lihlahala tse fapaneng)
9. granulomatous lesion ea methapo ea methapo e bohareng (lefuba, sarcoidosis, hertiocytosis X, lefu le hlasimollang ka mokokotlong)
   tšoaetso (encephalitis, meningitis, tsamaiso ea methapo ea methapo)
10. Tšenyo ea methapo ea pelo (hemorrhage, hypoxia, anemia cell anemia)
11. Nephrogenic
12. Lelapa
13. recessive X-e amanang (vasopressin arginine V2 receptor gene)
14. Autosomal recessive (mofuta oa aquaporin-2AQP2)
15. E fumanehile
16. metabolic (hypokalemia, hypercalcemia)
17. ho se sebetse hantle hantle ha renal
18. osmotic (lefu la tsoekere)
19. nephrocalcinosis
20. ho thijoa ha pampiri ea urine
21. lefu la polycystic la meno
22. Polydipsia ea mantlha
23. psychogenic - mokelikeli o qobelloang oa mokelikeli
24. Dipsogenic - e theola monyako oa li-osmoreceptors bakeng sa lenyora

Liponahatso tsa bongaka le matšoao

Matšoao a mantlha a ND ke polyuria e sa khaotseng le polydipsia (bona litekanyetso tsa polyuria tse kaholimo). Ha ho na nocturnal polyuria (eo ka linako tse ling e nkoang e le lipontšo tsa enuresis), e nang le phepelo e sa lekanang ea tahlehelo ea mokelikeli, letlalo le omileng le li-membrane tsa mucous li omme.

Ho bana ba banyenyane, ho haelloa ke metsi haholo ho ka ba teng, ho hlatsa ho etsahala ha ho ja, ho ts'oaroa, feberu, likotsi tsa boroko, ho teneha, ho fokola hoa mmele le phaello e phahameng ea mmele.

Haeba nts'etsopele ea ND e bakoa ke hlahala ea tlhaho (germoma, craniopharyngioma, glioma, jj), hangata bakuli ba na le mathata a methapo (hlooho e bohloko, ptosis, strabismus, ho senyeha ha lesapo, joalo-joalo), ho ferekana hoa pono (ho fokotseha ho tebileng le / kapa tahlehelo ea masimo a pono, diplopia), matšoao a amanang le tahlehelo kapa hypersecretion ea lihormone tse ling tsa adenohypophysis.

Nalane ea bongaka

Lilemo tsa ho qala ha polydipsia le polyuria, hammoho le mofuta oa tšebeliso ea mokelikeli ke tsa bohlokoa haholo bakeng sa lipatlisiso tse ling tsa tlhahlobo ea mafu.

Ka lefu le nang le khatello e nyane ea litho tsa lelapa, hangata lefu le bonahala pakeng tsa lilemo tse 1 ho isa ho tse tšeletseng. Matšoao hangata a eketseha lilemong tsa pele tsa ho kula.

Ka Tungsten syndrome, lefu la tsoekere le hlohlontšitsoeng maemong a mangata le iponahatsa ka mor'a lilemo tse 10, nts'etsopele ea eona e etelletsoe pele ke nts'etsopele ea lefu la tsoekere le lefu la mongobo.

Tlhaho ea mokelikeli oa metsi

Ka lefu la tsoekere la tsoekere, bakuli ba khetha ho noa metsi a batang ao eseng a khabone; ho bakuli ba nang le lefu la tsoekere ha ho khonehe (ngoana o hloka mokelikeli o mong le o mong metsotso e 15-30), ho sa tsotelehe hore na o sebetsa hakae kapa o rata eng (ho bapala, ho ithuta sekolong, ho shebella TV jj.).

Haeba ho na le litletlebo tse loketseng le lipontšo tsa kliniki, mohato o latelang oa ho hlahlojoa ha lefu la tsoekere o etsoa.

1. Hoa hlokahala ho netefatsa ho ba teng ha polyuria, ka lebaka lena tlhahlobo ea moroto oa letsatsi le letsatsi le / kapa tlhahlobo ea moroto ho latela Zimnitsky e etsoa ka boikemisetso ba kakaretso ea eona e felletseng le osmolality / jamaa ka likarolo, ka nako e ts'oanang palo ea mokelikeli o nooang ka letsatsi e lekantsoe (ho lekola ho lekana ha tekanyo ea metsi)
2. Fumana qeto ea osmolality ea plasma ea mali
3. Ha ba etsa tlhahlobo ea mali a biochemical, ba a fumana
4. Sodium (ho kenyelletsoa le ho khetholla li-contraindication tsa ho etsa liteko ka ho ja tse omisitsoeng kapa haeba ho sa khonehe ho khetholla osmolality ea plasma ea mali), tsoekere, chlorine, urea, creatinine - ho khetholla li-osmotic diuresis
5. Kakaretso ea calcium le ionized, potasiamo, protheine - ho khetholla lisosa tse atileng haholo tsa lefu la tsoekere la nephrogenic (hypercalcemia, hypokalemia, obstopathy uropathy).

Ho feta moo, bakeng sa tlhahlobo e khethollang pakeng tsa lefu la tsoekere le polydipsia ea mantlha, ho etsoa tlhahlobo e jeloang ke komello. E bonts'oa haeba:

1. ho na le hypoosmotic polyuria (osmolality ea moroto e ka tlase ho 295 mOsm / kg H2O le / kapa masene a moroto o ka tlase ho 1005 likarolong tsohle tsa tlhahlobo ea Zimnitsky),
2. plasma sodium sodium e se fetang 143 mmol / l,
3. haeba osmolality ea mali e phahame ho feta osmolality ea moroto.

Bohlokoa!
Haeba boemo ba sodium bo feta 143 mmol / l, mme hape haeba mokuli a le leqeba la tikoloho ea "chasm-salear" kapa "hertiocytosis" e tsoang liseleng tsa Langerhans, ha ho etsoe teko ea ho ja tse ommeng. Sena se ka lebisa ho nts'etsopele ea boemo bo behang bophelo kotsing ka lebaka la kholo e potlakileng ea ho omella le hypernatremia.

Algorithm bakeng sa ho etsa tlhahlobo ka lijo tse omisitsoeng:

1. bosiu, ngoana a ka sebelisa metsi a mangata ao a a hlokang
2. ka 8,00 hoseng mokuli o imeloa, ho nyekeloa ha osmolality le boemo ba sodium e plasma ea mali li lekantsoe, hammoho le osmolality (kapa matla a khoheli a itseng) le boholo ba moroto, ka mora moo ngoana a emang ho nka lino, lijo tseo ngoana a li nkang nakong ea tlhahlobo ha lia lokela ho ba le metsi a mangata mme li bonolo Lijo tse nang le lik'habohaedreite tse ngata (ho bohlokoa hore u sebelise mahe a phehiloeng, bohobe ba lijo-thollo, nama e fokolang ea nama, tlhapi, chisi e koahetsoeng).
3. litekanyo tsa boima ba 'mele, qeto ea boemo ba sodium le plasma osmolality, osmolality kapa boteng ba moroto, mocheso oa' mele, li-membrane tsa mucous, boiketlo ba ngoana ka kakaretso bo lokela ho etsoa lihora tse ling le tse ling tse peli kapa khafetsa, ho latela boemo ba mokuli,
4. ho bohlokoa ho netefatsa hore ngoana ha a noe metsi nakong ea tlhahlobo.Bakeng sa bakuli ba bangata, thibelo ea ho ja metsi ka bongata bakeng sa lihora tse 7-8 (kapa ka tlase ho moo) e lekane, maemong a polydipsia ea mantlha, tlhahlobo e ka nka lihora tse 12.

Teko e felisoa haeba:

1. boima ba mokuli bo fokotsoa ke 3-5% ea mantlha,
2. mocheso oa 'mele oa phahama
3. ho na le boemo bo mpefatsang boemo ba mokuli,
4. mokuli ha a sa khona ho mamella lenyora
5. le / kapa boemo ba sodium ea plasma bo feta 143 mmol / l,
6. plasma osmolality e feta 295 mOsm / kg H2O,
7. le / kapa osmolality ea moroto e eketseha ho boleng bo tloaelehileng,
8. le / kapa phapang ea osmolality ea moroto ka har'a disampole tse peli tse latellanang e ka tlase ho 30 mOsm / kg (kapa ka keketseho ea boemo ba sodium ea 3 mmol / l).

Haeba ngoana a e-na le lefu la tsoekere le lefu la tsoekere, ho sa na le keketseho ea boemo ba osmolality le / kapa sodium ho plasma ea mali (ka lebaka la ho fokolloa ke metsi), osmolality ea moroto ha e felle ho osmolality ea plasma, i.e. 300 mOsm / kg H2O. Maemong ana, qetellong ea tlhahlobo, ho omella ha letlalo le lera la mucous, tachycardia, ho teneha ho eketsehileng ho ka bonoa. Haeba osmolality ea mali e sa fetohe ho elella bofelong ba sampole, 'me ho phahama ha moroto ho nyolohela ho 600-700 mOsm / kg kapa ho feta, lefu la tsoekere la lefu la tsoekere le ka fetoloa.

Bakeng sa tlhahlobo e khethollang lipakeng tsa nephrogenic le lefu la tsoekere le bohareng qetellong ea sampole, desmopressin e tsamaisoa ka 10 μg intranasally, kapa 0,1 mg ka molomo, kapa 60 μg hanyane. Pele a nka desmopressin, mokuli o botsoa hore a tlose lesapo ka botlalo. Kamora lihora tse peli le tse nne ho hlokahala hore u bokelle moroto ho bona hore na molumo le osmolality ke eng. Mokuli o lumelloa ho ja le ho noa, athe bongata ba joala bo nooang ha boa lokela ho feta bongata ba moroto o fanoeng nakong ea tlhahlobo ka lijo tse omisitsoeng. Keketseho ea khatello ea moroto ke 50% e bonts'a semelo sa mantlha sa ND, mme ka tlase ho 50% e bonts'a nephrogenic ND (Lethathamo 1). Haeba ngoana a senola nephrogenic ND, tlhahlobo e eketsehileng le kalafo li etsoa ke litsebi tsa nephrologists.

Ponahalo ea polyuria le lenyora hang kamora kapa nakoana kamora ho kenella ha neurosuction (craniopharyngioma, glioma, germinoma, jj.) E bonts'a nts'etsopele ea insipidus ea lefu la tsoekere mme ha e hloke lits'ebetso tsa tlhatlhobo tse kaholimo.

Haeba ND e bohareng e fumanoa, ho hlokahala lipatlisiso tse eketsehileng ho tseba hore na lefu lena le bitsoa eng.

Ho etsa tšebeliso ea matla a khoheli a bonohe (MRI) ea boko, haholo tikoloho e rekisoang ke mala, ho o fa monyetla oa ho tseba boteng ba sebopeho sa tumor, lits'oants'o tsa bakoang / mokoetla oa pituitary gland, liphoso tsa anatomical tsa "midbrain". Ka tloaelo, ho sagittal T1-boima ba litšoantšo, neurohypophysis e bonoa e le lets'oao le matla haholo. Ho ba sieo ha letšoao ho tsoa ho neurohypophysis ke letšoao la mathata a hypothalamic-neurohypophysial, mme ho ka supa ho ba teng ha methati ea pele ea ts'ebetso ea tumor.

Boteng ba lesela la "pituitary stem" kapa "funeral" e fetang 6 mm, boikemisetso ba matšoao a hlahala (β-hCG, α-fetoprotein) a bonts'oa hore ha a kenye lesapo la kokoana-hloko ea germ. Ha ho na le keketseho ea matšoao a tumor, MRI e pheta-phetoang (le ho etsoa qeto ea matšoao a hlahala) e lokela ho etsoa nako le nako ka nako ea 1 likhoeling tse 6 (kapa ha ho hlaha matšoao a macha) bakeng sa lilemo tse 3, ebe nako e le ngoe ho likhoeli tse 12 bakeng sa lilemo tse 3-4. Ho ba teng ho MRI ea matšoao a ho thatafala ha pituara kapa steme ea 'mele e ka ba sesupo sa nts'etsopele ea maloetse a tšoaetsanoang (haholo-holo hertiocytosis e tsoang lisele tsa Langerhans) kapa germinoma, le boteng ba pituitary gland / infundibulitis le eona ea khonahala. Maemong a joalo, ho boetse ho molemo ho etsa tlhahlobo ea li-hormone ea nako le nako ho hlahloba mesebetsi ea tropic ea adenohypophysis. Khafetsa, matšoao a necrosis ea khatello e tlase a hlaha lilemo tse 'maloa pele ho hlahala ea methapo le lipontšo tse ling tsa germinoma kapa hertiocytosis.

Pheko ea lefu la tsoekere le bohareng ba lefu la tsoekere

Morero o ka sehloohong oa ho phekola insipidus ea lefu la tsoekere ho bana ke ho fokotsa bongata ba moroto o ntšoa mme (maemong a mangata) ho fokotsa lenyora, le lona, ​​le tla lumella ngoana ho phela bophelo bo tloaelehileng. Phekolo e tobileng bakeng sa lefu la tsoekere la lefu la tsoekere e itšetlehile ka etiology ea lefu lena.

Ho rarolla mathata ana, o hloka:

1. netefatsa hore ngoana o fumana metsi mahala
2. ts'ebetso ea phepo e nepahetseng bakeng sa ho fokotsa bongata ba mokelikeli o tsoang (haholoholo ho bana ba nang le NID)
3. bakeng sa kalafo ea tsamaiso ea methapo e bohareng - ts'ebeliso ea analog ea vasopressin - desmopressin
4. bakeng sa kalafo ea NND - ts'ebeliso ea lithethefatsi tse ntlafatsang ho khutlisetsa metsi methapong
   kalafo ya lefu le tlasa.

Bana ba nang le ND ba lokela ho lula ba fumana metsi mahala. Ka nako e ts'oanang, ho nka nako e telele metsi a mangata ho ka lebisa ho dyskinesia ea biliary, ho senyeha ha mpa, nts'etsopele ea lefu la mokokotlo le sa emeng, hammoho le nts'etsopele ea hydronephrosis.

Hajoale kalafo ea necrosis e nang le khatello e tlase, lithethefatsi tsa khetho ke desmopressin (1-desamino-8-D-arginine-vasopressin, DDAVP). Desmopressin ke analog ea maiketsetso ea hormone ea antidiuretic eo ho eona 1-cysteine ​​e sentsoeng 'me boemong ba 8 L-isomer ea arginine e nkeloe sebaka ke D-isomer. Ka lebaka la sena, desmopressin e na le tšusumetso e tsebahalang haholoanyane ea ho hanyetsa, e na le nako e telele ea ts'ebetso ha e bapisoa le ADH. Ka nako e ts'oanang, phello ea vasopressor ea desmopressin ke makhetlo a 2000-3000 ka tlase ho vasopressin.

Desmopressin e sebelisoa e le mokhoa oa ho kenella ka hare kapa marotholi a kenang kahare, matlapa a molomo le matlapa a nang le ntho ea lyophilized (qhibiliha) bakeng sa ts'ebeliso e tlase. Sebopeho sa intraasal sa lithethefatsi se sebelisoa hangata haholo nakong ea ts'ebetso, ka mora nako ea ts'ebetso, haeba ngoana a na le ho nyekeloa le pelo kapa kapa ho hlatsa, ka polelo e bontšang ho se tsotelle mabapi le matlapa. Melemo ea sebopeho sa moriana oa lithethefatsi ke ho monya hantle, menyetla e pharalletseng ea ho fetoha le ho khetha litekanyetso tse nepahetseng tsa lithethefatsi maemong a mangata - ho latela mamello ea mokuli hantle. Ntle le moo, bokhoni ba ho fa desmopressin matlapeng a tekanyetso e nyane haholo (ho fihlela ho 0,025 mg / lethal dose) bo fokotsa kotsi ea ho sebelisa lithethefatsi ho bana ba lilemo tse 3-5 le ho bakuli ba nang le tlhoko e tlase ea kalafo. Lethathamo la 2 le hlahisa liforomo tsa tokollo ea desmopressin, litekanyetso tse tloaelehileng tse sebelisoang le khafetsa taolong ea tsona.

Ho lokela ho hopoloa hore nako le matla a moriana li ka fapana haholo, ka hona khafetsa taolo le litekanyetso tsa eona li khethoa ka bonngoe. Ho bana ba ka tlase ho lilemo tse 3, kalafo ea lithethefatsi ea ND ea bohareng ha e sebelisoe hangata maemong a mangata ka lebaka la kotsi ea kholo ea desmopressin ka nts'etsopele ea hyponatremia. Hyponatremia e lebisa ho hypoosmolality ea extracellular fluid le ho tšela metsi liseleng, ho kenyelletsa lisele tsa boko. Ka lebaka leo, nts'etsopele ea complication e makatsang e ka khonahala - edema ea "cerebral".

Ho bana ba banyenyane, ho thata haholo ho laola boholo ba moriti o qhekelloang, ka hona ho bohlokoa hore o tsepamise maikutlo ho palo ea mokelikeli o sebelisitsoeng le / kapa boemo ba sodium e serumeng ea mali. Haeba matšoao a lefu la tsoekere a ts'oareha a hlalosoa haholo, lenyora le eketsehang le ho ruruha khafetsa ho ama nts'etsopele le boemo ba ngoana e monyane, ho a khonahala ho sebelisa litokisetso tsa desmopressin ka hloko haholo tlasa taolo e matla ea serum sodium le / kapa osmolality. Ho khothalletsoa ho sebelisa desmopressin ka mokhoa oa sesepa sa nasal, ha sethethefatsi se kenngoa ka letsoai ka karolelano ea 1: 10. Litokisetso tse hlapolotsoeng li fanoa ka molomo makhetlo a 1-2 ka letsatsi.

Ho bana ba nang le tsamaiso ea methapo e bohareng ea lilemo tse fetang tse tharo, kalafo ea desmopressin e qala ka litekanyetso tse nyane, butle-butle e eketseha ha ho hlokahala.Ntle le moo, nakong ea khetho ea mantlha ea kalafo, tekanyetso e 'ngoe le e' ngoe e latelang ea moriana e khothalletsoa hore e sebelisoe ka mor'a lihora tse 1-2 tsa diursis ka bongata ba ka tlase ho ml / kg / hora, i.e. kamora hore bongata ba moroto bo hlahe ho mokuli ka nako e itseng, moroto oa hae o ba bobebe. Sena se thusa ho tlosa moroto oa mahala le osmotically le ho thibela kholo ea hyponatremia.

Ha ho fana ka litokisetso tsa desmopressin, ho baloa ka hloko letsatsi le letsatsi le ho rekota palo ea mokelikeli o nooang le o tsoang, ts'ebetso ea letsatsi le letsatsi ea boemo ba li-electrolyte (sodium, potasiamo) ka serum ea mali, ka tekanyo e eketsehang / e fokotsehileng ea sodium, boikemisetso bo etsoa makhetlo a 'maloa ka letsatsi (hangata makhetlo a 2-3), mokuli boima ba letsatsi le letsatsi ho laola mokelikeli oa metsi. Ts'ebetso tsena kaofela li etsoa ho fihlela mmuso o tsitsa. Kamora nako, likhakanyo tsa taolo ea li-electrolyte le mokelikeli oa mokelikeli li etsoa hang ka mor'a likhoeli tse 3 le tse ling. Ho bohlokoa ho hlalosetsa bakuli le batsoali ba bona bohlokoa ba ho laola tekanyetso ea mokelikeli. Ho thibela kholo ea lithethefatsi tse ngata, lethal dose la desmopressin bakeng sa kalafo ea phetisetso ea nako e telele le lona le lokela ho khethoa e le hore palo ea metsi a tsoang ka mehla e fetang litekanyetso tse tloaelehileng tsa diuresis ea letsatsi le letsatsi. (Ka tloaelo, palo ea moroto o qhekelloang ke 15-30 ml / kg ka letsatsi). Ka karolelano, diuresis tsa letsatsi le letsatsi ho bana ba nang le khatello e tlase ea mali ka tlase ho lilemo tse 4-5 ha lia lokela ho ba ka tlase ho 1000 ml, ka tlasa lilemo tse 10 - 1200-1500 ml, ho bana ba baholo - 1800-2000 ml.

Mokhoa o hlokolosi haholo oa ho khethoa le ho khethoa ha phekolo e nkang sebaka ka lithethefatsi tsa desmopressin ho hlokahala ho bakuli ba entseng opereishene bakeng sa tumor ea tikoloho ea hypothalamic-pituitary kapa kotsi ea mokokotlo. Maemong ana, ND e kanna ea ba le likhetho tse fapaneng tsa ntlafatso.

Insuffidus ea lefu la tsoekere e ka qala ka ho felletseng ka polyuria, ka qeto e itlhahelang feela ka matsatsi a 'maloa. Tšenyo e matla ea ts'ebelisano kapa likotsi tse mpe li ka lebisa ho nts'etsopele ea ND. Lefu la tsoekere le lona le ka ba le "mekhahlelo e meraro": karolo ea pele ea polyuria, e bakoang ke tšenyo sebakeng sa hypothalamic-pituitary le ho fokotseha ha boemo ba secretion ba ADH, ho nka lihora tse 'maloa (lihora tse 12 ho isa ho tse 40) ho isa matsatsing a' maloa. Joale ho latela mohato oa bobeli, ho tloha matsatsing a mabeli ho isa ho a 14, ho thoeng Karolo ea "Antidiuretic", e tsamaeang le ho lokolloa ho sa laoleheng ha ADH ho li-neuron tse senyehileng. Ebe ho latela mohato oa boraro - mohato oa polyuria. Nakong ea karolo ea bobeli, ho bohlokoa hore u se ke oa baka khatello ea matla ho mokuli, e leng se khahlano le tšibollo ea bokhoni ba ADH e lebisang kholisong ea hyponatremia. Ho bakuli ba kenang ts'ebetsong ea methapo ea kutlo, ho sa tsotelloe mofuta oa thupelo ea LPC kamora ho buuoa (ho latela kalafo e lekaneng ea ts'ebetso, tsamaiso ea litokisetso tsa desmopressin), le boemo ba sodium ea sodium ea 145 mmol / L, ho nyamela ka tšohanyetso ha matšoao a ND hangata ho etsahala (hangata ka mor'a 3 Likhoeli tse 6 kamora ho buuoa). Haeba bakuli ba nakong ea ts'ebetso ea postoperative, boemo ba sodium ea serum ke? 145 mmol / l, monyetla oa ho nts'etsapele ND e sa feleng e phahame. Likarolo tsena tsa thupelo ea LPD nakong ea ts'ebetso e bohlokoa, ho bohlokoa ho nahana ka eona ha u khetha tekanyetso ea desmopressin. Ho bohlokoa ho lemosa bakuli le / kapa batsoali ba bona ka tlhoko ea ho laola mokelikeli o noeleng le ho tsoa, ​​ho lahla lithethefatsi ha edema e hlaha le / kapa ho fetola tekanyetso ea mokelikeli, e lateloe ke ho buisana le ngaka ea endocrinologist.

Maemong a mang, kamora ho buuoa ka volumetric bakeng sa tumor ea sebaka sa hypothalamic-pituitary ho bakuli, oligo- kapa adipsia e bonoa hammoho le polyuria e bakiloeng ke nts'etsopele ea LPC. Ho kopana ha polyuria le mokelikeli o sa lekaneng oa 'mele ho tlisa kholo ea kholo ea hypernatremia le mmuso oa hyperosmolar.Ho thibela mathata a joalo, bakuli ba joalo ba tahiloe ka mokhoa o qobelloang (hangata, empa ka bongata ba 50-100 ml ea metsi), lethal dose la desmopressin le khethoa ka nako e ts'oanang, mme ha ho hlokahala, kalafo e loketseng ea infusion e etsoa. Morero oa mekhoa ena e fetisisang ke ho fihlella boemo ba 'mele bo emisang kelello le ho nolofatsa boemo ba sodium ho plasma ea mali. Sehlopheng sena sa bakuli, likhoeling tsa pele tsa 4-6 kamora ho buuoa, hoa hlokahala ho tseba hore na 1 sodium le / kapa osmolality ea nako e le kae ka matsatsi a 10-14, ka tokiso e nepahetseng ea desmopressin.

O ka ts'ehetsa sebaka sa marang-rang ka lichelete - sena ha se na ho thusa ho lefa feela ho amohela, ho rala le ho nts'etsapele sebaka, empa hape se tla u lumella hore u se ke oa tlatsa sebaka seo sa marang-rang ka papatso e khopisang. Kahoo, u ke ke ua thusa sebaka sena feela, empa u tla thusa uena le basebelisi ba bang ho fumana litaba tse tšepahalang tse mabapi le sehlooho sa "Lefu la tsoekere, mafu a amanang le ho sitisoa ha tekano ea motlakase oa metsi."
Mme ka ho loketseng, batho ba bangata ba tla fumana leseli leo bophelo ba bona bo ka itšetlehang ka lona.Kamora ho lefa o tla lebisoa leqephe bakeng sa ho jarolla litokomane tsa semolao tse molaong.