Insulin e ntlafatsa motsoako oa li-acid tse mafura tse tsoang ho glucose ho hepato- le lipocytes. Tlas'a tšusumetso ea hae, karabelo ea carboxylation ea acetyl-CoA e hlahisoa ka sebopeho se latelang sa malonyl-CoA, se atolosang molek'hule ea FFA, sepheo sa hormone ke enzyme acetyl-CoA-carboxylase (acetyl-CoA CO2 ligase).

Insulin e sebetsana le litlamorao tsa li-hormone tsohle tsa lipolytic (adrenaline, glucagon, STH, glucocorticoils), hape e baka isocitrate e ngata le -ketoglutarate - bahlaseli ba acetyl-CoA-carboxylase.

Hoa tsebahala hore mafura a acid a tsamaisoa ho tloha sebeteng ho ea ho adipose tiske e le karolo ea lipoprotein tse tlase haholo tse bolokiloeng ke sebete. Insulin e ntlafatsa ts'ebetso ea lipoprotein lipase, e phethang tumello ea VLDL le phetoho ea mafura acid ho adipocytes.

Insulin e potlakisa ho tsamaisoa ha tsoekere ho adipocytes mme e thibela enzyme ea mantlha ea lipolytic ea lisele tsa tiske tsa adipose - lipase e itšetlehileng ka li-hormone.

Tlas'a ketso ea insulin, ts'ebetso ea glycolysis e fana ka lipogenesis ka polasetiki (alpha-glycerophosphate), le ts'ebetso ea tsela ea pentose - ka mafolofolo (ka phepelo ea NADPH₂). 4,2000

Khanyetso ea insulin

Khanyetso ea insulin ke karabelo ea metabolic ho insulin kapa "exo native insulin". Maemong ana, ho itšireletsa mafung ho ka iponahatsa ho a mang a litlamorao tsa insulin, kapa ho tse 'maloa.

Insulin ke hormone ea peptide e hlahisoang liseleng tsa beta tsa li-pancreatic li-Langerhans. E na le litlamorao tse fapaneng tsa tšebetso ea metabolic hoo e batlang e le liseleng tsohle tsa 'mele. Mosebetsi o ka sehloohong oa insulin ke ts'ebeliso ea tsoekere ke lisele - Hormone e kenya tšebetsong li-enzyme tsa bohlokoa tsa glycolysis, e eketsa matla a glucose ho li-membrane tsa lisele, e matlafatsa sebopeho sa glycogen ho tsoa glucose mesifa le sebete, mme e boetse e ntlafatsa sebopeho sa protheine le mafura. Mochine o thusang ho ntša insulin ke ho eketsa tsoekere e maling. Ntle le moo, ho etsoa le ho ipatela ha insulin ho hlohlelletsoa ke takatso ea lijo (eseng feela lik'habohaedreite). Ho felisoa ha li-hormone maling ho etsoa haholo ke sebete le liphio. Ho tlola ketso ea insulin ho lithane (ho haelloa ke insulin) ho bohlokoa nts'etsopele ea lefu la tsoekere la mofuta oa 2.

Lithethefatsi tsa Hypoglycemic li fuoe bakuli ba nang le lefu la tsoekere la mofuta oa 2, le ntlafatsang tšebeliso ea tsoekere ka linama tse poteletseng le ho phahamisa kutloisiso ea lisele tsa mmele ho insulin.

Linaheng tse tsoetseng pele moruong, ho hanyetsa insulin ho tlalehiloe ho 10-20% ea baahi. Lilemong tsa morao tjena, keketseho ea palo ea bakuli ba sa tsubeng insulin har'a bacha le bacha e hlokometsoe.

Khanyetso ea insulin e ka itlhahela ka boyona kapa ea ba sesosa sa lefu. Ho latela liphuputso, ho hanyetsa insulin ho tlalehiloe ho 10-25% ea batho ba se nang mathata a metabolic le botenya, ho 60% ea bakuli ba nang le khatello ea methapo ea methapo (ka khatello ea mali 160/95 mm Hg. Art le ho ea holimo), ho 60% ea maemo a hyperuricemia, ho 85% ea batho ba nang le hyperlipidemia, ho 84% ea bakuli ba nang le lefu la tsoekere la mofuta oa 2, le ho 65% ea batho ba nang le mamello e matla ea tsoekere.

Lisosa le Lintho Tse Kotsi

Mokhoa oa nts'etsopele ea ho hanyetsa insulin ha o utloisisoe ka botlalo. Lebaka la eona le ka sehloohong le nkuoa e le tlolo ea molao maemong a postreceptor. Ha e thehiloe ka nepo hore na ke mafu afe a liphatsa tsa lefutso a tlasa nts'etsopele ea ts'ebetso ea methapo, le ha ho na le 'nete ea hore ho na le tšekamelo ea liphatsa tsa lefutso e hlakileng mabapi le kholo ea insulin.

Ho hlaha hoa insulin ho itšireletsa mafung ho ka bakoa ke tlolo ea bokhoni ba eona ba ho hatella tlhahiso ea tsoekere maling le / kapa ho tsosa ho fufuleloa ha glucose ke lisele tsa kahare. Kaha karolo e kholo ea tsoekere e sebelisoa ke mesifa, ho khothaletsoa hore sesosa sa nts'etsopele ea insulin ho hokahana le ts'ebeliso ea tsoekere ea glucose ke tishu ea mesifa, e khothalletsoang ke insulin.

Ka nts'etsopele ea ho hanyetsa insulin ho lefu la tsoekere la mofuta oa bobeli, lintho tse amanang le tlhaho le tse fumanoeng li kopantsoe. Ma-monozygotic mafahla a mofuta oa 2 lefu la tsoekere, ho hanyetsoa ho matla ha insulin ho fumanoa ha ho bapisoa le mafahla a se nang lefu la tsoekere. Karolo e fumanoeng ea ho hanyetsa insulin e iponahatsa nakong ea ponahatso ea lefu lena.

Taolo e senyehileng ea metabolism ea lipid ka ho hanyetsa insulin e lebisa ho nts'etsopele ea sebete sa mafura (ka bobeli bo bonolo le bo matla) ka kotsi e latelang ea lefu la sethoathoa kapa lefu la sebete.

Mabaka a ho ba teng ha ho hanyetsoa ha insulin ea bobeli ho mofuta oa 2 lefu la tsoekere ho kenyelletsa boemo ba hyperglycemia ea nako e telele, e lebisang ho fokotseheng hoa phello ea likokoana-hloko tsa insulin (glucose-indedu insulin).

Ho tsoekere ea lefu la tsoekere la mofuta oa pele, ho hanyetsa insulin ea bobeli ho hlaha ka lebaka la taolo e fosahetseng ea lefu la tsoekere, ha ho ntse ho ntlafatsa matšeliso bakeng sa metabolism ea carbohydrate, kutloisiso ea insulin e eketseha haholo. Ho bakuli ba nang le mofuta oa 1 lefu la tsoekere, khatello ea insulin e fetoha hape mme e amana le mali a glycosylated hemoglobin.

Lintho tse ka behang motho kotsing ea ho hanyetsa insulin li kenyeletsa:

phatsa ea tlhaho
boima bo feteletseng ba 'mele (ha e feta boima ba' mele bo loketseng ka 35-40%, kutloisiso ea mesifa ho insulin e fokotseha ka 40%),
khatello ea kelello ea methapo
mafu a tšoaetsanoang
mathata a metabolic
nako ea kemaro
likotsi le mehato ea ho buoa,
ho se ikoetlise
mekhoa e mebe
ho sebelisa lithethefatsi tse 'maloa
khaello ea phepo e nepahetseng (haholo-holo tšebeliso ea lik'habohaedreite tse hloekisitsoeng),
boroko bo sa lekaneng ba bosiu
hangata maemo a sithabetsang
botsofe
oa litho tsa merabe e meng (Hispanics, American Americanans, Native Americanans).

Mefuta ea lefu lena

Khanyetso ea insulin e ka ba ea mantlha le ea bobeli.

Phekolo ea lithethefatsi ea ho hanyetsa insulin ntle le khalemelo ea boima bo feteletseng ha e na thuso.

Ka tlhaho, e arotsoe ka mefuta e latelang:

'meleng - e ka hlaha nakong ea bokhachane, nakong ea kemero, ea boroko bosiu, ka mafura a mangata a tsoang lijong,
metabolic - e bonoa ka mofuta oa 2 lefu la tsoekere, ho bolaoa ha lefu la tsoekere 1 lefu la tsoekere, lefu la tsoekere la ketoacidosis, botenya, hyperuricemia, khaello ea phepo e mpe, tšebeliso e mpe ea joala,
endocrine - e bonoe ka hypothyroidism, thyrotooticosis, pheochromocytoma, Itsenko-Cushing's syndrome, acromegaly,
non-endocrine - e hlaha ka ho thatafala ha sebete, ho ruruha ho sa feleng ha ramatiki, ho nyekeloa ke pelo, cachexia ea mofets'e, myotonic dystrophy, likotsi, ho buoa, ho chesa, sepsis.

Matšoao a Resulin ea Insulin

Ha ho na matšoao a itseng a ho hanyetsa insulin.

Khafetsa ho na le khatello e phahameng ea mali - ho thehoa hore khatello ea mali e phahame haholo le ho feta. Hape, ho bakuli ba hanyetsang insulin, takatso ea lijo e eketsoa khafetsa, mofuta oa ka mpeng oa botena o teng, sebopeho sa khase se ka eketsoa.

Matšoao a mang a ho hanyetsa insulin a kenyelletsa ho tsepamisa mohopolo, ho se tsebe hantle, ho fokotseha ka matla, mokhathala, ho robala mots'eare (haholo-holo ka mor'a ho ja), khatello ea maikutlo.

Ts'oaetso

Ho fumana tšoaetso ea insulin, pokello ea litletlebo le anamnesis (ho kenyeletsa nalane ea lelapa), tlhahlobo ea sepheo, tlhahlobo ea laboratori ea ho hanyetsa insulin e etsoa.

Ha ho bokelloa anamnesis, ho lebisoa tlhokomelo ho boteng ba lefu la tsoekere, khatello ea mali, lefu la pelo le beng ka motho ba haufi, le ho bakuli ba tsoalang, lefu la tsoekere nakong ea boimana.

Karolo ea bohlokoa kalafong e bapaloa ke ho lokisa mekhoa ea bophelo, haholo phepo e nepahetseng le boikoetliso ba 'mele.

Tlhahlobo ea laboratori ea ho belaelloa ha insulin e kenyelletsa tlhahlobo ea mali le moroto ka kakaretso, tlhahlobo ea mali e nang le biochemical, le boikemisetso ba laboratori ba boemo ba insulin le C-peptide maling.

Ho latela maemo a tlhahlobo ea tšoaetso ea insulin e amohetsoeng ke Mokhatlo oa Lefatše oa Bophelo, ho ka etsahala ho nka boteng ba eona ho mokuli ho latela mekhoa e latelang:

mofuta oa ka mpeng oa botena,
triglycerides e phahameng ea mali (ka holimo ho 1,7 mmol / l),
boemo bo fokotsehileng ba lipoprotein tse phahameng haholo (ka tlase ho 1.0 mmol / l ho banna le 1,28 mmol / l ho basali),
Ho mamella tsoekere e sa sebetseng hantle kapa khatello ea tsoekere e potlakileng ea tsoekere (glucose e potlakileng e phahame ho feta 6,7 mmol / l, boemo ba tsoekere lihora tse peli kamora tlhahlobo ea mamello ea glucose ea 7.8-11.1 mmol / l),
excretion ea albin ka har'a moroto (microalbuminuria ka holimo ho 20 mg / min).

Ho tseba likotsi tsa ho hanyetsa insulin le mathata a amanang le pelo le pelo, index ea boima ba 'mele e ikemiselitse:

ka tlase ho 18.5 kg / m 2 - ho haella ha boima ba 'mele, kotsi e tlase,
18.5-24.9 kg / m 2 - boima ba 'mele bo tloaelehileng, kotsi e tloaelehileng,
25.0-29.9 kg / m 2 - boima bo feteletseng, kotsi e eketsehileng,
30.0-34.9 kg / m 2 - botenya ba 1 degree, kotsi e kholo,
35.0-39.9 kg / m 2 - botenya ba 2 degrees, kotsi e kholo haholo,
40 kg / m 2 - botenya ba li-degree tsa 3, kotsi e kholo haholo.

Phekolo ea ho hanyetsa insulin

Moriana oa ho hanyetsa insulin ke ho sebelisa lithethefatsi tse tsoang molomong. Bakuli ba nang le mofuta oa lefu la tsoekere la mofuta oa 2 ba fuoa meriana e khothalletsang tšebeliso ea tsoekere ka linama tse poteletseng le ho phahamisa kutloisiso ea lisele tsa mmele ho insulin, e lebisang pusong ea metabolism ea carbohydrate ho bakuli ba joalo. E le ho qoba ts'ebetso ea ho senyeha ha sebete nakong ea kalafo ea lithethefatsi, ho lekola ho bokellana ha li-transpase tsa hepatic tse serum ea mali ea bakuli ho khothalletsoa bonyane hang ka likhoeli tse tharo.

Linaheng tse tsoetseng pele moruong, ho hanyetsa insulin ho tlalehiloe ho 10-20% ea baahi.

Tabeng ea khatello ea mali, kalafo ea antihypertensive e laetsoe. Ka k'holeseterole e phahameng maling, ho fanoa ka litlhare tse fokotsang lipid.

Re lokela ho hopola hore kalafo ea lithethefatsi ea ho hanyetsa insulin ntle le khalemelo ea boima bo feteletseng ba 'mele ha e na thuso. Karolo ea bohlokoa kalafong e bapaloa ke ho lokisa mekhoa ea bophelo, haholo phepo e nepahetseng le boikoetliso ba 'mele. Ntle le moo, ho hlokahala ho theha mofuta oa letsatsi le letsatsi ho netefatsa phomolo e felletseng ea bosiu.

Nako ea boikoetliso ba 'mele e u fa monyetla oa hore u utloe mesifa, hammoho le ho eketsa boima ba mesifa, ka hona, fokotsa tsoekere e maling maling ntle le tlhahiso e eketsehileng ea insulin. Bakuli ba nang le insulin ba khothalletsoa ho ikoetlisa ho ikoetlisa bonyane metsotso e 30 ka letsatsi.

Ho fokotsa boholo ba lisele tsa adipose tse nang le mafura a bohlokoa a mmele ho ka etsoa ka mokhoa o phahameng. Li-liposuction tse buoang e ka ba laser, metsi-jet, radiofrequency, ultrasound, e etsoa ka tlasa ts'oaetso e akaretsang 'me eu lumella ho tlosa litha e le nngwe tsa 5-6 tsa mafura tsamaisong e le' ngoe. Ho sa sebetse ka molomo ha ho sithabetse maikutlo, ho ka etsoa ka tlhekefetso ea lehae mme ho ba le nako e khuts'oanyane ea ho hlaphoheloa. Mefuta e ka sehloohong ea li-liposuction tse sa sebetseng ke li-cryolipolysis, li-ultrasonication tsa phofo hammoho le liposuction tsa ente.

Ka ho ba le botenya bo feteletseng, taba ea kalafo ka mekhoa ea ho buuoa ka bariatric e ka nkoa.

Lijo bakeng sa ho hanyetsa insulin

Ntho ea bohlokoa e hlokahalang bakeng sa katleho ea kalafo ea insulin e thibelang lijo ke lijo. Lijo li lokela ho ba haholo-holo liprotheine, lik'habohaedreite li lokela ho emeloa ke lihlahisoa tse nang le index e tlase ea glycemic.

Ho hanyetsa insulin ho tlalehiloe ho 10-25% ea batho ba se nang mathata a metabolic le botenya.

Ho khothalletsoa meroho e theko e tlase haholo le lijo tse nang le mafura a mangata, nama e halikiloeng, lijo tsa leoatleng le tlhapi, lihlahisoa tsa lebese le lebese le bolila, lijana tse nang le lijo tse nang le lijo tse nang le mafura a mangata a omega-3, potasiamo, calcium le magnesium.

Fokotsa meroho e nang le setlolo se seholo (litapole, poone, mokopu), ho sa kenye letho bohobe bo tšoeu le linoko, raese, pasta, lebese la khomo e felletseng, botoro, tsoekere le lijo-thollo, lero la litholoana tse tsoekere, joala le lijo tse halikiloeng le tse mafura .

Bakeng sa bakuli ba hanyetsang insulin, ho khothalletsoa ho ja lijo tsa Mediterranean, tseo ho tsona oli ea mohloaare e leng eona mohloli o ka sehloohong oa lipids tsa phepo. Litholoana le meroho e seng monokotšoai, veine e khubelu e sa omelletseng (ho sena methapo ea methapo ea pelo le li-contraindication tse ling), lihlahisoa tsa lebese (yoghur ea tlhaho, feta cheese, feta) li ka kenyelletsoa lijong. Litholoana tse omisitsoeng, linate, lipeo, mehloaare li ke ke tsa hlola li joa hang ka letsatsi. O lokela ho fokotsa ts'ebeliso ea nama e khubelu, likhoho, mafura a liphoofolo, mahe, letsoai.

Ho ka ba le mathata le litlamorao

Ho hanyetsa insulin ho ka baka atherosulinosis ka ho roba fibrinolysis. Ntle le moo, ho fapana le semelo sa eona, mofuta oa lefu la tsoekere la 2 lefu la tsoekere, mafu a pelo, methapo ea letlalo (acanthosis e mpe, acrochordon), polycystic ovary syndrome, hyperandrogenism, anomalies ea kgolo (ho holisa likarolo tsa sefahleho, kholo e potlakileng) e ka hlaha. Taolo e senyehileng ea metabolism ea lipid ka ho hanyetsa insulin e lebisa ho nts'etsopele ea sebete sa mafura (ka bobeli bo bonolo le bo matla) ka kotsi e latelang ea lefu la sethoathoa kapa lefu la sebete.

Ho na le tlhahlobo e hlakileng ea liphatsa tsa lefutso ho ea ho hatseng ea insulin.

Ka tlhahlobo e tlang ka nako le kalafo e nepahetseng, phepo e joalo e ntle.

Thibelo

Bakeng sa ho thibela nts'etsopele ea ho hanyetsa insulin, ho khothalletsoa:

khalemelo ea boima ba 'mele,
phepo e nepahetseng
Mekhoa e metle ea mosebetsi le phomolo,
ho ikoetlisa ka ho lekaneng
ho qoba maemo a sithabetsang
tlohela mekhoa e mebe,
kalafo e tlang ka nako ea maloetse a ka bakang kholo ea insulin,
kopo e tlang ka nako bakeng sa thuso ea bongaka le ho sekaseka ho hanyetsa insulin maemong a belaelloang a tlola molao oa metabolism ea carbohydrate,
Qoba tšebeliso e sa laoleheng ea lithethefatsi.

Matšoao a matšoao

Ho tseba tšebetso ea methapo ena ea methapo ho thata, hobane ka nako e telele e ka ba asymptomatic ka botlalo. Ntle le moo, lipontšo tsa hona joale tsa kliniki ha li na mokhoa oa tlhaho, kahoo bakuli ba bangata ha ba batle tlhokomelo ea bongaka ka nako, ba re bophelo bo seng botle ba moferefere kapa botsofaling.

Leha ho le joalo, tlolo e joalo ea ts'ebetso ea 'mele e tla tsamaea le matšoao a latelang a kliniki:

molomo o omileng, leha o nyoriloe khafetsa le tšebeliso ea metsi a mangata,
Boikhethelo lijong - maemong a mangata, maemong ao bakuli ba khethang tatso ea bona, ba "hoheloa" lijong tse monate,
ho opeloa ke hlooho ntle le lebaka le hlakileng, ka linako tse ling ho ba le letsoalo.
mokhathala, esita le ka mor'a ho phomola nako e telele,
ho se be bonolo, ho ba mabifi, ho tla ba teng ka lebaka la glucose e sa lekaneng kelellong.
pelo lippitations
ho sokela hangata ho sa bakoang ke lijo
ho fufuleloa ho eketsehileng, haholo bosiu,
ho basali - ho hloka molao ho ea khoeling,
botenya ba ka mpeng - ho bokella mafura ho pota le mpa ea mahetleng,
matheba a khubelu sefubeng le molaleng, a ka 'nang a tsamaea le ho hlohlona. Ho bonahala le matšoao a tšoanang a letlalo ha a eo.

Ntle le setšoantšo sa kantle ho tlhaho, boteng ba letšoao le joalo bo tla bontšoa ke ho kheloha molemong oa matšoao ho LHC:

mahlaseli a "cholesterol" e ntle a fokotsehile,
palo ea triglycerides kaholimo ho tloaelehileng ka 1.7 mmol / l,
palo ea "cholesterol" e mpe "e phahame ho feta e tloaelehileng ka 3.0 mmol / l,
ponahalo ea protheine ka har'a moroto,
tekanyo ea tsoekere ea mali e potlakileng e feta se tloaelehileng ka 5.6-6.1 mmol / l.

Haeba u na le setšoantšo se kaholimo sa kliniki, ka potlako u lokela ho batla thuso ea bongaka. Ho iphekola, ntlheng ena, ha ho lokele feela, empa hape ho beha bophelo kotsing.