Khanyetso ea insulin ke eng? Metabolic Insulin Resistance Syndrome

Metabolic syndrome
Male: bophahamo - 177 cm, boima - 146 kg, BMI - 46 kg / m²
ICD-10-KM	E88.81
ICD-9	277.7 277.7
ICD-9-KM	277.7
Omim	605552
Ditsietsi	31955
Medlineplus	007290
Mesh	D024821

Metabolic syndrome (MS) (li-syonyms: metabolic syndrome X, Reaven syndrome, insulin resistance syndrome) - keketseho ea bongata ba mafura a visceral, ho fokotseha ha kutloisiso ea lisele tsa pherekano ho insulin le hyperinsulinemia, e sitisang carbohydrate, lipid, metaboline ea purine, hape e baka methapo ea methapo ea kutlo.

Bokapele

Ka 1981, M. Hanefeld le W. Leoonardt ba ile ba etsa tlhahiso ea ho khetha linyeoe tsa mafu a fapaneng a metabolic e le "metabolic syndrome" (MS).

Ka 1988, Moprofesa G. Reaven, puong ea hae ea Bunting, a ipapisitse le seo a se hlokometseng le ho akaretsa lithuto tsa bangoli ba bang, o ile a beha khopolo ea pele ho latela moo insulin e hanyetsanang, botenya ba ka mpeng, dyslipidemia le lefu la pelo (CHD) sebetsa e le ponahatso ea boemo ba methapo eo a reng o tla e bitsa "Syndrome X". Ka 1989, D. Kaplan o ile a qapa lentsoe "quartet e bolaeang": motsoako oa lefu la tsoekere, botena, khatello ea maikutlo le lefu la pelo.

Ho latela H. Arnesen (1992), metabolic syndrome e utloisisoa e bolela motsoako oa bonyane mathata a mabeli ho a mahlano:

• khanyetso ea insulin le mamello e fokotsehileng ea lik'habohaedreite le hyperinsulinemia,
• dyslipoproteinemia e nang le hypertriglyceridemia le litekanyo tse tlase tsa cholesterol lipoproteins e phahameng,
• tloaelo ea thrombosis le ho eketseha ha litekanyetso tsa plasmagen activator inhibitor,
• khatello ea kelello ea methapo khahlanong le semelo sa tšebetso e eketsehang ea tsamaiso ea methapo ea kutloelo-bohloko,
• botenya bo akaretsang ka secretion e eketsehang ea mafura acids mahala ho portal vein.

Bokapele

Ho latela WHO, palo ea bakuli ba nang le insulin e thibelang insulin ba kotsing e kholo ea ho ba le lefu la tsoekere la mofuta oa 2 ke batho ba limilione tse 40-60 Europe. Linaheng tse tsoetseng pele moruong, kholo ea lefu la metabolic ho batho ba fetang 30 ke 10%%, United States - 34% (44% har'a batho ba fetang 50). Ho ne ho lumeloa hore metabolic syndrome ke lefu la batho ba lilemo tse mahareng le (haholo-holo) basali. Leha ho le joalo, tlhahlobo e entsoeng tlasa maikutlo a Mokhatlo oa Amerika oa Lefu la Tsoekere e bontša hore lefu lena le bontša kholo e tsitsitseng har'a bacha le bacha. Kahoo, ho latela bo-rasaense ba tsoang Univesithing ea Washington, ho tloha ka 1994 ho fihlela ka 2000, tekanyo ea metabolic syndrome har'a bacha e eketsehile ho tloha ho 4,2 ho isa ho 6.4%. Naha ka bophara, palo ea bacha le bacha ba tšoeroeng ke Syndrome X e hakanyetsoa ho limilione tse peli.

Metabolic syndrome ke e 'ngoe ea mathata a hatellang ka ho fetisisa a meriana ea sejoale-joale e amanang le ho boloka bophelo bo seng kotsi. Khopolo ea "bophelo bo botle" e kenyelletsa ho ja lijo tse nang le phepo e nepahetseng, ho boloka boima ba 'mele bo tloaelehileng, ho ikoetlisa kamehla le ka nako e loketseng lilemo, le ho hana ho noa joala le ho tsuba.

Tlhahisoleseling ka kakaretso

Pele re sekaseka mohopolo oa "ho hanyetsa insulin", hore na ke eng le hore na o na le matšoao afe, ho lokela ho boleloa hore bokuli bona bo tloaelehile ka ho lekana. Batho ba fetang 50% ba nang le khatello ea maikutlo ba na le bothata bona. Khafetsa, ho hanyetsa insulin (seo e leng sona, ho tla hlalosoa ka tlase) e fumanoa ho batho ba tsofetseng. Empa maemong a mang, e fumanoa bongoaneng. Hangata, lefu la ho ba le insulin le lula le sa lemohuoe pele likhathatso tsa metabolic li qala ho hlaha. Sehlopha sa kotsi se kenyeletsa batho ba nang le dyslipidemia kapa mamello ea tsoekere ea glucose, botenya, khatello ea mali.

Khanyetso ea insulin

Sena ke eng Tlolo eo e na le likarolo life? Metabolic syndrome ea ho hanyetsa insulin ke karabelo e fosahetseng ea 'mele ketsong ea e' ngoe ea likhomphutha. Mohopolo ona o sebetsa ho litlamorao tse fapaneng tsa bioloji. Sena, haholo-holo se amana le phello ea insulin ho protheine le lipid metabolism, polelo ea liphatsa tsa lefutso, le ts'ebetso ea methapo ea methapo. Karabelo e sa thabiseng e lebisa hoketsong ea khatello ea motsoako e amanang le mali le palo ea tsoekere e hlokahalang bakeng sa bophahamo bo teng. Insulin resistance syndrome ke bokuli bo kopaneng. Ho kenyelletsa phetoho ea mamello ea tsoekere, mofuta oa 2 lefu la tsoekere, dyslipidemia le botenya. Syndrome X e boetse e bolela ho hanyetsa ho nka tsoekere (ho itšetleha ka insulin).

Sistimi ea nts'etsopele

Ho fihla joale, litsebi ha li sa khona ho ithuta eona ka botlalo. Mathata a lebisang ho hola ha insulin a ka hlaha maemong a latelang:

• Re amohela. Maemong ana, boemo bo bontšoa ke boteng kapa ho fokotseha hoa palo ea li-receptors.
• Boemong ba ho tsamaisa tsoekere. Tabeng ena, ho fokotsehile palo ea limolek'hule tsa GLUT4.
• Prereceptor. Maemong ana, ba bua ka insulin e sa tloaelehang.
• Postreceptor. Maemong ana, ho na le tlolo ea phospholation le tlolo ea phetisetso ea matšoao.

Li-anomalies tsa limolek'hule tsa insulin ha li na seoelo 'me ha li na bohlokoa ba kliniki. Sekhahla sa receptor se ka fokotsoa ho bakuli ka lebaka la karabelo e mpe. E bakoa ke hyperinsulinemia. Hangata bakuli ba na le ho fokotseha ho itekanetseng ha palo ea li-receptor. Tabeng ena, boemo ba maikutlo ha bo nkuoe e le sesupo seo ho ikemiselitsoeng ho sona hore na insulin e hanyetsa hakae. Lisosa tsa pherekano ena li fokotsoa ke litsebi ho kena-kenana le litaba tsa postreceptor phetisong ea matšoao. Lintlha tse fanang ka tsona, haholoholo, li kenyelletsa:

• Ho tsuba.
• Keketseho ea litaba tsa TNF-alpha.
• Ho fokotsa mmele.
• Keketseho e kholo ea mafura a sa hlahisoang.
• Mongoaha.

Tsena ke lintho tsa mantlha tseo khafetsa ho feta tse ling li ka tsosang ho hanyetsa insulin. Phekolo e kenyelletsa tšebeliso ea:

• Li-diuretics tsa sehlopha sa thiazide.
• Beta-adrenoreceptor blockers.
• Nicotinic acid.
• Corticosteroids.

Ho eketseha ha insulin

Tšusumetso ho metabolism ea glucose e hlaha litoneng tsa adipose, mesifa le sebete. Mesifa ea lesapo e tiisa hoo e ka bang 80% ea motsoako ona. Mesifa boemong bona e sebetsa e le mohloli oa bohlokoa oa ho hanyetsa insulin. Ho ts'oaroa ha glucose liseleng ho etsoa ka protheine e khethehileng ea lipalangoang GLUT4. Ha ts'ebetso ea "receptor" ea ts'ebetso ea ts'ebetso e sebetsa, ho hlaha letoto la liphetoho tse fapaneng tsa phospholution. Qetellong li lebisa ho translocation ea GLUT4 ka har'a membrane ea sele ho tloha cytosol. Kahoo tsoekere e fumana monyetla oa ho kena ka seleng. Ho hanyetsa insulin (moelelo o tla bontšoa ka tlase) o bakoa ke ho fokotseha ha tekanyo ea phetisetso ea GLUT4. Ka nako e ts'oanang, ho na le phokotso ea ts'ebeliso le phetoho ea tsoekere ke lisele. Hammoho le sena, ho kenyelletsa ho tataisa ho ts'oaroa ha tsoekere ho dinama tse ka hare, tlhahiso ea tsoekere ke sebete e hatelloa ka hyperinsulinemia. Le lefu la tsoekere la mofuta oa bobeli lea qala.

E kopantsoe le ho hanyetsa insulin hangata. Haeba mokuli a feta boima ka 35-40%, maikutlo a fokotseha ka 40%. Lithane tsa adipose tse leboteng la mpa ea ka mpeng li na le ts'ebetso e phahameng ea metabolic ho feta e fumanehang ka tlase. Nakong ea tlhahlobo ea bongaka, ho ile ha fumaneha hore ho lokolloa ho eketsehileng ha mafura acid ho tsoa mpeng ea mpa ho kena maling a khopisang tlhahiso ea li-triglycerides ke sebete.

Matšoao a kliniki

Ho hanyetsa insulin, matšoao a eona a amanang haholo le ho sitisoa ha metabolic, a ka belaelloa ho bakuli ba nang le botenya, lefu la tsoekere, nalane ea lelapa ea lefu la tsoekere la 2, dyslipidemia le khatello ea mali. Kotsi ke basali ba nang le PCOS (polycystic ovary). Ka lebaka la hore botenya ke letšoao la ho hanyetsa insulin, hoa hlokahala ho hlahloba mofuta oa kabo ea lithane tse mafura. Sebaka sa eona e ka ba gynecoid - karolong e tlase ea 'mele, kapa mofuta oa admin - leboteng le ka pele la peritoneum. Ho eketseha ka halofo e kaholimo ea mmele ho tšoauoa ke ntho e bohlokoa ho feta ea tsoelo-pele ea insulin, ho mamella tsoekere le mamello ea lefu la tsoekere ho feta botenya dikarolong tse tlase. Ho tseba palo ea lisele tsa mafura a ka mpeng, o ka sebelisa mokhoa o latelang: ho lekanya sekhahla sa letheka, letheka le BMI. Ka tekanyo ea 0,8 bakeng sa basali le ea 0,1 bakeng sa banna le BMI ea banna ba fetang 27, ho fumanoe botenya ba ka mpeng le ho hanyetsa insulin. Matšoao a lefu lena le iponahatsa a le ka ntle. Haholo-holo, libaka tse mosesane, tse mpe li bonoa letlalong. Hangata li hlahella lintšing, liqetheng, tlas'a litšoelesa tsa mammary. Ts'ebetso ea ho hanyetsa insulin ke lipalo ka semelo. HOMA-IR e baloa ka tsela e latelang: insulin ea ho itima lijo (μU / ml) x glucose e potlakileng (mmol / l). Sephetho se arotsoe ke 22,5. Phello ke lenane la ho hanyetsa insulin. Norma - Pherekhong 18, 2015

Lisosa tsa metabolic syndrome.

Insulin 'meleng e etsa mesebetsi e mengata. Empa mosebetsi oa eona o moholo ke ho ikopanya le li-receptor tse nang le insulin tse kahara membrane ea sele ka 'ngoe. Kamora moo, mochine oa ho tsamaisa glucose o tsoang sebakeng se pakeng tsa cellellular ho kena seleng oa qala. Kahoo, insulin "e bula lemati" seleng ea glucose. Haeba li-receptor li sa arabele insulin, joale lihormone ka botsona li bokellana maling.

Motheo oa nts'etsopele ea metabolic syndrome ke insulinitensity - ho hanyetsa insulin. Ketsahalo ena e ka bakoa ke mabaka a mangata.

1. Phello ea lefutso. Batho ba bang ba na le insulin ea insulin maemong a liphatsa tsa lefutso. Mofuta, o ikarabellang bakeng sa nts'etsopele ea metabolic syndrome, e ho chromosome ea 19. Liphetoho tsa hae tsa phetoho li ka lebisa molemong oa hore
   • lisele li haelloa ke li-insulin tse tlamang insulin,
   • receptors ha e amehe ka insulin,
   • sesole sa 'mele se hlahisa li-antibodies tse thibelang li-cell receptors tse nang le insulin,
   • manyeme a hlahisa insulin e sa tloaelehang.
   
   Ho na le khopolo ea hore kutloisiso ea "insulin" e fokotsang matla ke litholoana tsa ho iphetola ha lintho. Thepa ena e thusa mmele ho pholoha tlala ka polokeho. Empa ho batho ba sejoale-joale, ha ba ja lijo tse nang le khalori e ngata le mafura, batho ba joalo ba ba le botenya le metabolism.
   
2. Lijo tse phahameng tsa mafura le lik'habohaedreite - ntho ea bohlokoahali ho nts'etsopele ea metabolic syndrome. Li-acid tse nang le mafura tse tsamaeang le mafura a liphoofolo ka bongata li thusa ho nts'etsapele botenya. Ntle le moo, li-acid tse mafura li baka liphetoho mekhorong ea lisele, li etsa hore li se ananele ketso ea insulin. Ho ja lijo tse nang le khalori e ngata haholo ho lebisang 'neteng ea hore tsoekere e ngata le mafura a mangata li kena maling. Ho fetella ha tsona ho kentsoe liseleng tsa mafura ho mafura a subcutaneous, hammoho le liseleng tse ling. Sena se lebisa ho fokotseha ha maikutlo a bona ho insulin.
   
3. Mokhoa oa bophelo bo iketlileng. Ho fokotseha ha tšebetso ea 'mele ho kenyelletsa ho fokotseha ha tekanyo ea methapo eohle ea metabolic, ho kenyelletsa ho phatloha le ho kenngoa ha mafura. Li-acid tse mafura li thibela ho tsamaisoa ha tsoekere e ngata seleng le ho fokotsa kutloisiso ea membrane ea eona ho insulin.
   
4. Phekolo ea nako e telele e sa sebetseng. E baka tlolo ea potoloho ea potoloho, e tsamaeang le ho fokotseha ha kutloisiso ea lithane ho insulin.
   
5. Lekhoba la lijo tse nang le likhalori tse tlase. Haeba litaba tsa "caloric" tsa lijo tsa letsatsi le letsatsi li ka tlase ho 300 kcal, sena se baka mathata a ke keng a fetoloa a metabolic. 'Mele oa “pholosa”' me oa haha ​​mehloli e isang ho eketseheng ha mafura a mangata.
   
6. Khatello ea maikutlo. Khatello ea kelello ea nako e telele e nyopisa tsamaiso ea methapo ea litho le lisele. Ka lebaka leo, tlhahiso ea lihormone, ho kenyeletsa insulin, le karabelo ea lisele ho tsona lia senyeha.
   
7. Ho nka bahanyetsi ba insulin:
   • glucagon
   • corticosteroids
   • lithibela-pelehi tsa molomo
   • lihormone tsa qoqotho
   
   Lithethefatsi tsena li fokotsa ho kenngoa ha tsoekere ke linama, tse tsamaeang le ho fokotseha ha kutloisiso ea insulin.
   
8. Ho sebelisa insulin haholo ho phekola lefu la tsoekere. Phekolo e sa sebetseng e lebisa ho insulin e ngata maling. E kenya letsoho ho li-receptor. Maemong ana, ho hanyetsa insulin ke mofuta oa karabelo e itšireletsang ea 'mele ho tsoa bohlaseling bo bongata ba insulin.
   
9. Mathata a Hormonal. Adipose tiske ke setho sa endocrine mme se etsa hore li-hormone li fokotse kutloisiso ea insulin. Ho feta moo, ha botena bo tsebahala haholoanyane, bo fokotsa kutloelo-bohloko. Ho basali, ka tlhahiso e eketsehileng ea testosterone le estrogen e fokotsehileng, mafura a bokellana ho latela mofuta oa "monna", methapo ea mali le methapo ea methapo ea kutlo e hlaha. Ho fokotseha ha boemo ba lihormone tsa qoqotho ka hypothyroidism ho ka baka le keketseho ea boemo ba lipids (mafura) maling le nts'etsopele ea ho hanyetsa insulin.
   
10. Liphetoho tse amanang le lilemo ho banna. Tlhahiso ea testosterone e fokotseha le lilemo, e lebisang ho hanyetsanang le insulin, botenya le khatello ea mali.
    
11. Apnea torong. Ho tšoara phefumoloho torong ho baka tlala ea moea ea oksijene le tlhahiso e eketsehileng ea lihormone tsa kholo. Ntho ena e kenya letsoho kholisong ea insulin sensitivity.

Matšoao a metabolic syndrome

Mokhoa oa nts'etsopele ea metabolic syndrome

1. Ho ikoetlisa ka mokhoa o fokolang le khaello ea phepo e nepahetseng ho lebisa tlhokomelong e mpe ea li-receptor tse sebetsanang le insulin.
2. Makhopho a makhopho a hlahisa insulin e eketsehileng ho hlola ho hloka botsitso ha lisele le ho li fa tsoekere.
3. Hyperinsulinemia (e leng insulin e ngata maling) ea hlaha, e lebisang ho batenya, ho fokola ha methapo ea methapo ea methapo ea methapo, le ts'ebetso ea methapo, 'me khatello ea mali e phahama.
4. Glucose e sa koaeloang e lula maling - hyperglycemia ea hlaha. Metsoako e phahameng ea tsoekere ka ntle ho sele le e ka hare e baka tšenyo ea liprotheine le ponahalo ea li-radicals tsa mahala, tse lematsang membrane ea sele le ho baka botsofali ba tsona pele ho nako.

Boloetse bo qala bo sa hlokomeloe. Ha e utloise bohloko, empa ha e kotsi.

Mehopolo e kenelletseng ho metabolic syndrome

• Litlhaselo tsa moea o mobe naheng e lapileng. Ho nka tsoekere e futsanehileng liseleng tsa boko ho baka ho teneha, ho ba le mabifi le ho ferekana haholo.
• Mokhathala. Ho phatloha hona ho bakoa ke taba ea hore leha ho na le tsoekere e phahameng ea mali, lisele ha li fuoe tsoekere, li tloheloa li se na lijo le mohloli oa matla. Lebaka la "tlala" ea lisele ke hore mochine o tsamaisang glucose ka membrane ea sele ha o sebetse.
• Khetho ea lijo. Nama le meroho ha e bake takatso ea lijo, ke batla liswiti. Sena se bakoa ke taba ea hore lisele tsa boko li na le tlhoko ea glucose. Kamora ho noha lik'habohaedreite, maikutlo a ntlafala ka nako e khuts'oane. Lijo tsa meroho le lijo tsa protheine (chisi ea chisi, mahe, nama) li baka ho otsela.
• Litlhaselo tsa ho otla ha pelo ka potlako. Litekanyetso tse phahameng tsa insulin li potlakisa ho otla ha pelo le ho eketsa phallo ea mali ho tsoa pelong ka sekhahla se seng le se seng. Qalong sena se lebisa ho ho teba ha marako a halofo e kaholimo ea pelo, ebe ho koaloa ke lerako la mesifa.
• Bohloko bo pelong. Lits'oaetso tsa cholesterol likepeng tsa coronary li baka pherekano ho phepo e nepahetseng ea pelo le bohloko.
• Ho opeloa ke hlooho e amanang le ho fokotsa likepe tsa boko. Ho phatloha ha "capillary spasm" ho hlaha le ho eketseha ha khatello ea mali kapa ka lebaka la vasoconstriction e nang le litheolelo tsa atherosulinotic.
• Ho nyekeloa ke pelo le tšebelisano e mpe e bakoang ke khatello e matla ea intracranial mabapi le tlolo ea phallo ea mali e tsoang bokong.
• Nyoromo le molomo o omileng. Sena ke sona se bakiloeng ke ho thibeloa ha litšoelesa tse thokoa ke methapo e nang le kutloelo-bohloko e nang le insulin e ngata maling.
• Ho tloaela ho sokela. Ho nona ha litho tsa ka hare le maemo a phahameng a insulin ho theola mala, 'me ho sitise lero la metsoako ea lero. Ka hona, lijo li kenella ka har'a tšilo ea lijo ka nako e telele.
• Ho eketsa mofufutso, haholo-holo bosiu - sephetho sa ts'usumetso ea insulin ea tsamaiso ea methapo ea kutloelo-bohloko.

Lipontšo tsa kantle tsa metabolic syndrome

• Ho nona ka mpeng, ho kenngoa ha mafura ka mpeng le senyepa sa mahetla. Ho hlaha mpa ea "biri". Lithane tse mafura ha li bokelle feela tlasa letlalo, empa le litho tse ka hare. Ha e ba nyenyefatse feela, e thatafatsa mosebetsi oa bona, empa e bapala karolo ea setho sa endocrine. Mafura a tšela lintho tse kenyang ponahalo ea ho ruruha, keketseho ea boemo ba fibrin maling, e leng se eketsang kotsi ea ho bolaoa ha mali. Ho ba le botenya ka mpeng ho fumanoa haeba boemo ba letheka bo feta:
  • ho banna ba fetang cm cm 102,
  • ho basali ba fetang 88 cm.
• Matheba a bofubelu sefubeng le molaleng. Hona ke matšoao a khatello e eketsehang e amanang le vasospasm, e bakoang ke insulin e ngata.

  Khatello ea mali (ntle le lithethefatsi tse thibelang antihypertensive)

  • khatello ea mali ea systolic (e kaholimo) e feta 130 mm Hg. Art.
  • khatello ea diastolic (ka tlase) e feta 85 mm Hg. Art.

Matšoao a laboratori ea metabolic syndrome

Teko ea mali a biochemical ho batho ba nang le metabolic syndrome e senola ho kheloha ho hongata ho tloaelehileng.

1. Khaled - mafura a qheletsoeng k'holeseterole. Ho bakuli ba nang le lefu la metabolic, palo ea bona e feta 1,7 mmol / L. Tekanyo ea li-triglycerides e nyoloha maling ka lebaka la hore mafura a ntšoa ka har'a mothapo oa portal nakong ea botena ba kahare.
   
2. Lipoprotein letsoalo le phahameng (HDL) kapa "cholesterol" e ntle. Khokahano ea kelello e fokotseha ka lebaka la tšebeliso e sa lekanang ea lioli tsa meroho le bophelo ba ho lula fatše.
   • basali - ka tlase ho 1,3 mmol / l
   • banna - ka tlase ho 1,0mmol / l
3. Cholesterol, density lipoproteins (LDL) kapa "mpe" cholesterol, keketseho ea tse fetang 3.0 mmol / L. Bongata bo bongata ba mafura a tsoang lithong tsa adipose tse potileng litho tsa ka hare li kena methapong ea portal. Li-acid tsena tse mafura li hlohlelletsa sebete ho kopanya cholesterol.
   
4. Ho potlakisa glucose ea mali ho feta 5.6-6.1 mmol / l. Lisele tsa 'mele ha li amohe tsoekere e ngata, ka hona, lisele tsa eona tsa mali li phahame le kamora ho itima lijo bosiu.
   
5. Mamello ea glucose. 75 g ea tsoekere e nkuoa ka molomo 'me ka mor'a lihora tse peli boemo ba tsoekere ea mali bo behiloe. Ho motho ea phetseng hantle, tsoekere e kenella ka nako ena, mme boemo ba eona bo khutlela ho bo tloaelehileng, bo sa feteng 6.6 mmol / L. Ka metabolic syndrome, khatello ea tsoekere ke 7.8-11.1 mmol / L. Sena se fana ka maikutlo a hore tsoekere ha e amoheloe ke lisele mme e lula maling.
   
6. Uric acid tse fetang 415 micromol / l. Boemo ba eona bo nyoloha ka lebaka la metabolism e senyehileng ea purine. Ka metabolic syndrome, uric acid e thehoa nakong ea lefu la lisele mme e sa hlahisoe hantle ke liphio. E bontša botenya le kotsi e kholo ea ho ba le lefu la sethoathoa.
   
7. Microalbuminuria Ponahalo ea limolek'hule tsa protheine ka har'a moroto li bonts'a liphetoho tšebetsong ha liphio tse bakoang ke lefu la tsoekere kapa khatello ea mali. Liphio ha li hlatsoe moroto hantle, ka lebaka leo, limolek'hule tsa protheine lia kena ho tsona.

Ke ngaka efe eo ke lokelang ho ikopanya le eona haeba ke nonne haholo?

Litsebi tsa endocrinologists li phekola metabolic syndrome. Empa ha ho latela liphetoho tse ngata tsa 'mele' meleng oa mokuli, ho ka hlokahala hore ho buisanoe le motho: setsebi sa mafu a kelello, setsebi sa phepo e nepahetseng.

Khethong ea bongaka (ea endocrinologist)

Poll

Sebakeng sa kamohelo, ngaka e bokella anamnesis mme e hlophisa nalane ea bongaka. Phuputso e thusa ho tseba hore na ke eng e bakang botenya le nts'etsopele ea metabolic syndrome:

• maemo a bophelo
• tloaelo ea ho ja, ho lemalla lijo tse monate le tse mafura,
• o na le lilemo tse kae a le motenya
• hore na beng ka motho ba na le botenya,
• ho ba teng ha lefu la pelo,
• boemo ba khatello ea mali.

Tlhahlobo ea mokuli

• Boikemisetso ba mofuta oa botenya. Ho metabolic syndrome, mafura a tšeloa leboteng la ka mpeng, kutu, molala le sefahleho. Ho joalo botenya ba ka mpeng kapa botenya ba banna. Ka mofuta oa gynoid kapa oa basali oa botenya, mafura a beoa halofo e tlase ea 'mele: letheka le marikhoe.
  
• Tekanyo ea boholo ba chiist. Matšoao a latelang a paka kholo ea kholo ea metabolic:
  • ho banna ba fetang cm cm 102,
  • ho basali ba fetang 88 cm.
  
  Haeba ho na le lefutso le tlang pele ho lefu, boteng ba "botena" bo etsoa ka lisenthimithara tse 94 le 80 cm, ka ho latellana.
  
• Tekanyo ea karo-karolelano ea letheka le bophara ba letheka (OT / OB). Tekanyo ea bona ha ea lokela ho feta
  • ho banna ba fetang 1,0,
  • ho basali ba fetang 0,8.
  
  Mohlala, sebaka sa mosali oa letheka ke 85 cm, mme letheka la hae le 100 cm. 85/100 = 0.85 - letšoao lena le bontša ho nona haholo le nts'etsopele ea metabolic syndrome.
  
• Ho bekha le ho lekanya kholo. Ho etsa sena, sebelisa sekala sa bongaka le stadiometer.
  
• Ho baloa ha index ea boima ba 'mele (BMI). Ho fumana index e sebelisang foromo:

BMI = boima (kg) / urefu (m) 2

Haeba index e maemong a 25-30, sena se bontša boima bo feteletseng. Lintlha tsa bohlokoa tse fetang 30 li bonts'a botenya.

Mohlala, boima ba mosali ke 90 kg, bolelele ba 160 cm. 90/160 = 35.16, e bontshang botenya.

Boteng ba striae (matšoao a otlolohileng) letlalong. Ka keketseho e boima ea boima ba 'mele, mokokotlo oa letlalo le likarolo tse nyane tsa mali li hahuoa. Pherekano ea lefu lena e lula e le joalo. Ka lebaka leo, mela e khubelu ea 2-5 mm e hlahella letlalong, 'me qetellong e tlatselletsa ka likhoele tse amanang le eona ebe ea khanya.

Tlhahlobo ea mahlale ea metabolic syndrome

Kakaretso ea k'holeseterole e eketsehile ≤5.0 mmol / L. Sena se bakoa ke ho senyeha ha metabolism ea lipid le ho se khonehe ha 'mele ho monya mafura hantle. K'holeseterole e phahameng e amahanngoa le ho nona le ho ja insulin e ngata.

Li-lipoprotein tse phahameng tsa 'mele (HDL kapa cholesterol e phahameng) li fokotsehile ka tlase ho 1 mmol / l ho banna le ka tlase ho 1.3 mmol / l ho basali. HDL ke "cholesterol" e ntle. E qhibiliha haholo, ka hona ha e beoe maboteng a methapo ea mali ebile ha e bake atherosclerosis. Ho ts'oaroa ka bongata ba tsoekere le methylglyoxal (sehlahisoa se qhalakaneng sa monosugars) ho lebisa timetsong ea HDL.

Tekanyo e tlase ea boima ba limolek'hule tsa lipoprotein (LDL kapa k'holeseterole e fokolang) e eketseha ≤3.0 mmol / L. "Cholesterol e mpe" e thehoa maemong a insulin e ngata. Ka hona, e qhibilihile hanyane, e behiloe maboteng a methapo ea mali le liforomo tsa atherosulinotic.

Li-triglycerides li phahamisitsoe > 1.7 mmol / L. Li-esters tsa Fatty tse sebelisoang ke 'mele ho tsamaisa mafura. Ba kena ka har'a tsamaiso ea venous ho tsoa lithong tsa adipose, ka hona, ka botenya, khatello ea bona ea matla e eketseha.

Ho potlakisa glucose ea mali > 6.1 mmol / L. Mmele ha o khone ho hlahisa tsoekere le boemo ba eona bo lula bo phahame esita le ka mor'a ho itima lijo bosiu.

Insulin e ile ea eketseha > 6.5 mmol / L. Karolo e phahameng ea "hormone" ena ea "pancreatic" e bakoa ke ho hloka insulin ha insulin. Ka ho eketsa tlhahiso ea li-hormone, 'mele o leka ho sebetsa ho lisele tse hlokoang ke insulin, le ho netefatsa ho monya ha tsoekere.

Leptin o ile a eketseha > 15-20 ng / ml. Hormone e hlahisoang ke lithane tsa adipose tse bakang insulin. Lithane tse ngata tsa adipose, li tebisa maikutlo a lona.

Phekolo ea lithethefatsi ea metabolic syndrome

Phekolo ea lithethefatsi ea metabolic syndrome e reretsoe ho ntlafatsa ho monya insulin, ho tsitsisa maemo a tsoekere le ho etsa hore mmele o be le metabolism e ngata.

Sehlopha sa lithethefatsi	Mokhoa oa phekolo	Baemeli	U ka e nka joang
Phekolo ea mathata a metabolism ea lipid
Hypolipidemic lithethefatsi (li-statins le li-fibrate)	Ba fokotsa ho kopana ha cholesterol e ka hare, ba kenya letsoho ho tloseng "cholesterol e mpe" maling. Fibrate e fokotsa boemo ba uric acid ka lebaka la ho monya letsoai la eona ke liphio.	Rosuvastatin	Nka 5-10 mg ea moriana o mong le o mong ka letsatsi. Kamora libeke tse 4, ngaka e lekanyetsa boemo ba cholesterol maling le ho eketsa lethalinyana.
		Fenofibrate	Nka lithethefatsi makhetlo a 2 ka letsatsi: likhabapo tse peli nakong ea lijo tsa hoseng le 1 sephutheloana nakong ea lijo.
Phekolo ea ho hanyetsa insulin le taolo ea tsoekere
Lithethefatsi ho fokotsa ho hanyetsa insulin	Ntlafatsa tsoekere ea tsoekere ka seleng ntle le ho hlohlelletsa tlhahiso ea insulin. Fokotsa tlhahiso ea mafura a mangata, e potlakisa phetoho ea tsoekere ho glycogen. E ntlafatsa ho tlangoa ha insulin ho li-receptor tsa sele, ho eketsa kutloisiso ea lisele tsa eona.	Metformin	Litekanyetso li beoa ho latela boemo ba glucose maling a litafole tsa 1-4. Tekanyetso ea letsatsi le letsatsi e arotsoe ka litekanyetso tse 2-3. Sebelisa ka mor'a lijo.
Lithethefatsi tsa Insulin	Lithethefatsi li liehisa ho amoheloa ha tsoekere maling, li fokotsa tlhahiso ea tsoekere maling le ho eketsa kutloisiso ea lisele ho insulin. Fokotsa takatso ea lijo 'me u thuse ho theola' mele.	Siofor Glucophage	Tekanyetso ea pele ke 500-850 mg makhetlo a 2-3 ka letsatsi le lijo. Kamora libeke tse peli, ho hlokahala hore ho etsoe phetoho ea tekanyetso ha ho nahanoa boemo ba tsoekere maling.
Li-vithamine	Alpha lipoic acid e laola sebete, e ntlafatsa metabolism ea cholesterol. Ho ntlafatsa ho monya ha tsoekere ho mesifa ea marapo.	Alpha lipon	Nka tafole e le 'ngoe makhetlo a 2-3 ka letsatsi bakeng sa libeke tse 3-4.
Lithethefatsi tse thatafatsang metabolism le khatello ea mali
Angiotensin-Conversting Enzyme Inhibitors	Thibela ketso ea enzyme e bakang vasoconstriction. Ba atolosa lumel ea methapo ea mali, ba fokotsa khatello ea mali, ba tsamaisa mosebetsi oa pelo.	Captopril	Moriana o nooa ka mpeng e se nang letho makhetlo a 3 ka letsatsi. Tekanyetso ea letsatsi le letsatsi e tsoa ho 25 ho isa ho 150 mg.
		Enalapril	0,01 g hang ka letsatsi, ho sa tsotelehe lijo tse ngata.
Li-antagonists tsa calcium le li-blockchain tsa calcium calcium	Fokotsa khatello ea mali, fokotsa tlhokahalo ea oksijene ea mesifa ea pelo mme ka nako e ts'oanang u ntlafatse phepo ea eona. Li na le matla a fokolang a ho hlohlora.	Felodipine	Nka pilisi e le 'ngoe (5 mg) hang ka letsatsi. Sebelisa ho sa tsotelehe lijo.
Pheko ea botenya
Fat Absorption Inhibitors	Fokotsa tšebetso ea li-enzyme tsa ho silila ebe ka tsela eo ho senya ho phatloha le ho monya ha mafura ka mpeng e nyane.	Xenical	Nka botlolo e le 'ngoe (120 mg) ka sejo se seng le se seng se seholo kapa che kamora hora ho feta lijo.
		Orlistat	Nka 120 mg ha o ntse o e-ja lijo tse ka makhetlo a mararo ka letsatsi. Haeba lijo li na le mafura a manyane, joale orlistat e ke ke ea nkuoa.
Lithethefatsi tse amang tsamaiso ea methapo e ka hare le khatello ea maikutlo	Li bontša mokhoa oa ho ja, li fokotsa tlhoko ea lijo, hape li fokotsa takatso ea lijo. Ba thusa ho sebetsana le tlala ha ba ntse ba ja.	Fluoxetine	Ngaka ea meriana e loantšang khatello ea litlhare e fuoa matlapa a 1-3 ho pholletsa le letsatsi ka mor'a lijo.

Hlokomela! Li-anorectics (lithethefatsi tse hatellang takatso ea lijo) li ke ke tsa sebelisoa ho fokotsa boima kalafong ea metabolism. Lithethefatsi tsena li boetse li fokotsa kutloisiso ea mesifa ho insulin. Li-anorectics li kenyelletsa lithethefatsi tse joalo tse tsebahalang: Fluoxetine, Prozac, Meridia, Reduxin.

Syndrome ea Metabolic

E le ho khutlisetsa metabolism le ho eketsa sensensivity ea insulin, maemo a 2 a tlameha ho kopana:

• phepo e tlase ea lik'habohaedreite
• ho ikoetlisa ka tsela e leka-lekaneng.

A re luleng ka botlalo ho e 'ngoe ea likarolo tsena.

Koetliso ea 'mele bakeng sa lefu la metabolic.

Nakong ea lipapali, 'mele o chesa mabenkele a mafura. Ntle le moo, metabolism e potlakisitsoe, ka hona, esita le nakong ea phomolo, 'mele o tsoela pele ho sebetsana le mafura hore e be matla.

Ka lebaka la koetliso, lihormone tsa thabo - li-endorphin - li hlahisoa bokong. Lintho tsena ha li ntlafatse maikutlo feela, empa li boetse li thusa ho laola takatso ea lijo le ho fokotsa litakatso tsa lik'habohaedreite. Ka hona, ha ho e-na le maikutlo a tlala, lijo tse nang le phepo e ntle li thusa ho e hlola.

Ho hlasimoloha hamonate le ho phela hantle, kutloelo-bohloko e eketsehileng ho insulin le palo e nyane le ho lieha ha ts'ebetso ea botsofali, ts'ebetso e eketsehileng - bonase ho tsoa lipapaling tse tloaelehileng.

Melao e fokolang ea ho u thusa ho sebetsana le botenya ka katleho.

1. Natefeloa. Khetha papali e u loketseng. Haeba litlelase li tla tlisa thabo, ha u na ho tlohela ho ikoetlisa.
   
2. Koetlisa kamehla. Fa nako ea ho ikoetlisa letsatsi le letsatsi. O tlameha ho utloisisa hore bophelo ba hau bo itšetlehile ka taeo ntlheng ena. Tse ntle ka ho fetesisa li nka matsatsi a 6 ka beke bakeng sa metsotso e 60.
   
3. Khetha papali e nepahetseng.
   • Bakeng sa batho ba baholo ho feta lilemo tse 50 ba nang le mathata a ho potoloha le lefu la pelo, ho tsamaea kapa ho tsamaea ka maoto Nordic ka lipalo tsa ski ho loketse.
   • Bakeng sa batho ba ka tlase ho lilemo tse 50, ho matha hape.
   • Ka lilemo life kapa life, ho sesa, ho palama libaesekele, ho thellisa mochini, ho tsamaisa mohala ho tla thusa ho ntlafatsa ts'ebetso ea pelo.
     
4. Se ke oa sebetsa haholo. Koetliso ha ea lokela ho fokolisa, ho seng joalo e ka ama hampe ts'ireletso ea mmele. Qala ka mojaro o fokolang mme butle-butle eketsa nako ea litlelase le boholo ba tsona.
   
5. Shebella ho otla ha hao. Ka mokhoa o atlehileng, mafura a chesoa hangata makhetlo a 110-130 beats ka motsotso. Tekanyo e phahameng ea pelo: Lilemo tse mashome a mabeli a metso e meraro ka mong. Mohlala, haeba u 40, joale letšoao le kotsi bakeng sa hau ke 22040 = 180 beats ka motsotso. Ho loketse ho sebelisa cheke ea boemo ba pelo ho laola ho otla ha pelo ea hau nakong ea boikoetliso.
   
6. Nahana ka likhoka e itšetlehileng ka mafu a kopaneng le mathata a bakoang ke metabolic syndrome. Ho khothalletsoa ho hana litlelase haeba:
   • protheine e fumanoang moriring
   • khatello ea mali e phahame haholo ho feta tloaelo ea hau,
   • litekanyo tsa tsoekere ea mali ka holimo ho 9.5 mmol / L.

Batho ba bangata ba khahloa ke potso ena: "Ke lipapali life tse sebetsang hantle haholo ho loants'a botenya?" E le ho eketsa ts'ebetso ea hau ea ho ikoetlisa, ho ikoetlisa ka mefuta e meng ea anaerobic le aerobic letsatsi le leng le le leng.

Boikoetliso ba Anaerobic kapa boikoetliso ba matla (ha mesifa e sebetsa le khaello ea oksijene) li thusa ho ntlafatsa metabolism le ho fokotsa ho hanyetsa ha insulin ka ho eketsa palo ea ba tsamaisang glucose. Ho ikoetlisa ka matla ho etsa hore khutso ea mesifa e bonahale haholoanyane, ho matlafatsa masapo le manonyeletso, le ho ba matla le ho feta. Koetliso ea matla e loketse banna le baroetsana ba bacha.

Ho ikoetlisa ho etsoa ka lebelo le potlakileng 'me ho hloka boiteko bo matla. Li baka bohloko bo boholo mesifa e sebetsang. Sena se bakoa ke taba ea hore microfractures e hlaha mefuteng ea mesifa le lactic acid e bokellana liseleng tsa mesifa.

Ho lumeloa hore boikoetliso bo joalo bo eketsa kutloisiso ea insulin, empa ke batho ba nang le pelo e phetseng hantle ba ka e etsang. Boikoetliso ba Anaerobic bo kenyelletsa:

• lebenkele
• ho sesa ka lebelo le potlakileng
• ho theola cyclling,
• squats
• sutumetsa
• ho phahamisa boima ba 'mele (koetliso ea li-simulators).

Ho ikoetlisa ho etsoa ka mekhoa e 3-5 e sa feteng metsotso e 1.5. Ho ikoetlisa ka mefuta e meng ho sebetsa lihlopha tse fapaneng tsa mesifa.Nako eohle ea thuto ea motho ea qalang ke metsotso e 20. Butle-butle eketsa nako ea ho ikoetlisa ho fihlela hora.

Boikoetliso ba aerobic e entsoeng butle butle ka botebo bo tlase kapa bo bohareng. Tabeng ena, mesifa e fanoa hantle ke oksijene, 'me mafura a subcutaneous a chesoa. Boikoetliso ba aerobic bo boetse bo bitsoa ho sebetsa ha Cardio, bo thibela lefu la pelo, ho ntlafatsa ts'ebetso ea matšoafo le ho thusa ho loants'a khatello ea maikutlo. Boikoetliso ba aerobic bo kenyelletsa:

• aerobics
• ho tjeka
• ho tebela
• baesekele kapa baesekele ea boikoetliso.

Koetliso ea pele ha ea lokela ho feta metsotso e 15 ka letsatsi. Eketsa nako ea hau ea tlelase ka metsotso e 5-10 beke le beke. Butle-butle, u tla fihla boemong bo hlokahalang ba mamello, 'me lithuto tsa hau li tla nka hora. Ha u sa etse joalo, mafura a mangata a "chesoa".

Khetho ea bobebe koetliso. Haeba ho na le mathata lipelong (nephropathy) kapa mahlong (retinopathy), sebelisa sesepa se matla sa boikoetliso. Ha e bake keketseho ea khatello ebile ha e eketse mojaro ho litho tse kulang. Ho sebelisa matla a bobebe ho matlafatsa manonyeletso, ho ntlafatsa tšebelisano 'moho le ho hlasimolla mekhoa ea metabolic.

Nakong ea litlelase, sebelisa li-dumbbells (kapa libotlolo tsa metsi a polasetiki) tse boima ba 300-500 g. Etsa mefuta ena ea boikoetliso:

• ho fetoha ha maemo le ho atoloha ha li-biceps,
• ho phahamisa matsoho
• inama
• ho otlanya matsoho ka lehlakoreng le maemo.

Koetliso e 'ngoe le e' ngoe e etsoa butle le ka mokhoa o nepahetseng hantle makhetlo a 3 makhetlo a 10. Pakeng tsa li-nka nka khefu ea metsotso e 10-15.
Hopola hore ha mesifa e le ngata 'meleng oa hau ebile e le mafura a fokolang, ho tlaleha tekano ea lisele tsa mmele ho ea ho insulin. Ka hona, haeba u fokotsa boima ba 'mele, lipontšo tsa metabolic syndrome li tla fokola.

Phepo e nepahetseng le metabolic syndrome.

Morero oa mantlha oa lijo bakeng sa lefu la metabolic ke ho fokotsa ho ja lik'habohaedreite le mafura. Sena se tla thusa ho emisa botenya le ho fokotsa boima ba 'mele butle-butle.

Litsebi tsa phepo ea sejoale-joale li hanyetsa lijo tse potlakileng le tse bobebe tse tlase. Boemong bona, motho o lula a lelekisoa ke maikutlo a tlala, ka hona ke batho ba nang le takatso e matla feela ba ka khomarelang lijo tse joalo. Lijo tse thibetsoeng ke lik'habohaedreite (low-carb) li monate ebile lia khotsofatsa. Ho ka lokisoa lijana tse fapaneng ho tsoa lihlahisoa tse lumelletsoeng.

Lijo tse nang le khalori e tlase li nyenyefatsa ts'ireletso ea 'mele khahlanong le vaerase le libaktheria. Sena se bakoa ke taba ea hore 'mele o haelloa ke liprotheine le livithamini tse hlokahalang bakeng sa ts'ebetso ea sesole sa' mele. Lijo tse nang le nama e tlase ea carb, ho fapana le moo, li matlafatsa tsamaiso ea 'mele ea ho itšireletsa mafung' me li etsa hore mmele oa "microflora o ntlafatsoe" ka lebaka la liprotheine le lihlahisoa tsa lebese le bolila, litholoana le merogo.

Lijo tse nang le carb e tlaase e lokela ho ba lijo tse tsoang bophelo bohle. Ts'oaetso ea khalori ke likhalori tsa 1600-1900. U hloka ho ja khafetsa makhetlo a 4-5 ka letsatsi, empa ka likarolo tse nyane. Lijo tsena li thusa ho qoba tlala.

Lethathamo la Lihlahisoa tse Khothalelitsoeng:

• mefuta e fokolang ea nama ea liphoofolo (veal, mmutla, khoho ntle le letlalo) le likhoho 150-200 g ka letsatsi,
• lihlapi le lijo tsa leoatleng 150 g,
• mahe - 1-2 ka letsatsi ka mokhoa oa omele kapa o phehiloeng ka thata,
• lihlahisoa tsa lebese tse mafura a tlase,
• chisi ea chisi 100-200 g,
• mefuta e tlase e se nang mafura le e seng bohale ba chisi e thata - e lekantsoeng ka 30 g,
• amasose ea nama e mafura a tlase kapa sose e phehiloeng makhetlo a 2 ka beke,
• 25% meroho ka mokhoa o tala, e setseng e le sechu, e phehiloe, e phehiloe, e entsoe (bonyane 400 g).

Meroho e khothalelitsoeng,

• Litholoana tse se nang litholoana le monokotsoai ho fihlela ho 400 g. E ncha, e halikiloeng kapa e khabisitsoeng ntle le tsoekere.
• sauerkraut e hlatsoitsoeng ka metsi,
• poroho e tsoang ka harese ea pearl, buckwheat, li-groats tsa lehe, raese e sootho. 150-200 g ka ho sebeletsa, ho latela thibelo ea bohobe
• lithuto tsa pele (250-300 g) ho mafura a fokolang, nama, tlhapi kapa moro oa li-mushroom, sopho ea meroho.
• bohobe ba koro ka botlalo, lihlahisoa tsa korong ho fihlela ho 200 g,
• tee, litholoana le lino tsa meroho ntle le tsoekere,
• seporo sa chokolete e lefifi, jelly le mousse tsoekere,
• mokelikeli oa metsi o lekantsoe ke lilithara tse 1,5. Sena se baka phokotso e eketsehileng ea mafura 'meleng.

Hoa hlokahala ho hana lihlahisoa tse joalo:

• confectionery: liswiti, likuku, lihlahisoa tsa tranelate,
• ho baka, haholo-holo khekhe e mpe le ho hula,
• Lijo tse mafura: nama ea kolobe, konyana, letata,
• lijo tse halikiloeng, nama e tsubiloeng le tlhapi, soseji, ham,
• raese, semolina le oatmeal, bijou,
• tranelate, yogurt e tsoekere, chisi ea mafura le lihlahisoa tse tsoang ho eona,
• margarine, oli ea ho pheha,
• morara o omisitsoeng, libanana, morara, matsatsi le litholoana tse ling tse monate,
• mayonnaise, mafura a linoko tse nkhang hamonate, linoko,
• lino tse tsoekere, lino le lilakane tse nang le tsoekere.

Hang ka beke e 'ngoe le e' ngoe ea 1-2, o ka nka letsatsi la ho sebelisa lijo tse “sa batleheng” ka tsela e leka-lekaneng.

Sampole ea lijo tsa letsatsi

Lijoa tsa hoseng: phofo ea buckwheat ka botoro, lehe le phehiloeng ka thata kapa mahe a halikiloeng, tee kapa lero.

Lijoa tsa hoseng tsa bobeli: litholoana.

Lunch: sopho ea meroho ka tranelate e bolila (ntle le ho e halika le ntle le nama), meroho e halikiloeng ka oli ea meroho, nama e phehiloeng, litholoana tse sa fuoeng.

Lijo tsa mantsiboea: salate e ncha ea meroho, tlhapi e halikiloeng kapa e phehiloeng 150-200 g, tee.

Lijoa tsa bobeli: kefir kapa yoghur ea unsweetened.

Lisosa tse ka sehloohong tsa nts'etsopele ea metabolic syndrome

Insulin e hlahisoang ke lisele tsa "pancreatic tis" e etsa mesebetsi e mengata e fapaneng e amanang le taolo ea methapo ea metabolic.

Mosebetsi o ka sehloohong oa li-hormone ke ho theha litlamo tse nang le li-receptor tse ikhethang holim'a bokaholimo ba lisele tsa lisele tse itšetlehileng ka insulin. Ka lebaka la sebopeho sa mofuta o rarahaneng, tsoekere e tsamaisoa kahare ho sebaka sa sele, ka hona, sele e matlafalitsoe.

Ha insulin receptor immune immune e etsahala, eseng feela glucose empa hape le insulin e bokellana maling, e lebisang ho sebetseng hampe ha ts'ebetso ea methapo ea metabolic.

Ha e le hantle, metabolic syndrome e hlaha ka lebaka la ponahalo ea lisele tsa ntho e kang ho hloka insulin. Khanyetso ea insulin ka boeona e ka bakoa ke mabaka a fapaneng a fapaneng.

Mabaka a ka sehloohong a nts'etsopele ea boits'ireletso ba li-cell membrane receptors ho insulin ke:

1. Phello ea lefutso.
2. Ho ja lijo tse nang le mafura le lik'habohaedreite tse ngata.
3. Ho phela bophelo ba ho lula fatše.
4. Mokuli o holofalitse khatello ea maikutlo ea methapo e sa sebetseng.
5. Ho sebelisoa hangata lijo tse nang le khalori e tlase.
6. Ho hlaha hoa maemo a sithabetsang khafetsa.
7. Ts'ebeliso ea lithethefatsi tseo e leng bahanyetsi ba insulin.
8. Ho sebelisa insulin haholo ho phekola lefu la tsoekere.
9. Mathata a amanang le semelo sa lihormone.
10. Ho qala ho robala ka boroko.
11. Phetoho 'meleng oa banna ho ba motho e moholo.

Phello ea lefutso ke ka lebaka la kutloisiso ea tlhaho ea insulin maemong a liphatsa tsa lefutso. Mofuta o bakang ho ba le ho hloka kutloelo-bohloko o ho chromosome ea 19.

Liphetoho tse fetotsoeng pele ho motsoako oa Gene li lebisa liphetoho tse latelang:

• lisele li na le palo e sa lekanang ea li-receptor tse holim 'a membrane ea sele,
• li-insulin li hloka ho ba le insulin,
• sesole sa 'mele se qala ho hlahisa li-antibodies tse thibelang li-receptor ho membrane ea sele,
• tlhahiso ea makhopho a insulin e sa tloaelehang.

Ho sebelisa khafetsa phepelo ea lijo tse nang le mafura le lik'habohaedreite ke ntho ea bohlokoa ka ho fetisisa e tlatsetsang ho nts'etsopele ea metabolic syndrome 'meleng oa mokuli.

Ho ba teng 'meleng oa bongata ba mafura a mangata ho thusa ho nts'etsapele botenya.

Matšoao a nts'etsopele ea lefu lena

Metabolic syndrome ke lefu le ka bakang mafu a tebileng 'meleng.

Bolwetse mo mmeleng bo simologa bo sa bonwe.

Nakong ea ts'ebetso ea eona, lefu lena ha le utloise bohloko, empa nts'etsopele ea lefu lena ha e etse hore e be kotsi ho batho.

Ho hanyetsa insulin ho na le mokhoa o latelang oa nts'etsopele 'meleng:

1. Ho fokotseha ha mesebetsi ea 'mele le mathata a ho ja ho fokotseha ho fokotseha ha kutloisiso ea li-membrane receptors ho insulin.
2. Makhopho a mantle a hlahisa palo e eketsehileng ea insulin ho hlola ho hloka matla ha li-receptor, ho hlokahalang bakeng sa phepelo e felletseng ea lisele ho lisele.
3. Palo e eketsehileng ea insulin 'meleng e baka tsoelo-pele ea hyperinsulinemia, e lebisang ho nts'etsong ea botenya, ho sitisoa hoa tšebetso ea lipid metabolism, ts'ebetso ea methapo ea methapo le khatello ea mali e eketsehang.
4. Tekanyo e eketsehang ea tsoekere e sa lekanyetsoang plasma ea mali e baka tsoelo-pele ea hyperglycemia 'meleng. Ts'oaetso e phahameng ea tsoekere e halefisa botsofaling ba seleng pele ho nako.

Ka tsoelo-pele 'meleng oa tlolo ea molao joalo ka ha insulin e hanyetsa' mele, maikutlo a latelang a latelang a bonoa:

• litlhaselo tsa tlala,
• ponahalo ea mokhathala o eketsehileng,
• khetha haholo lijong,
• ketsahalong ea maikutlo a pelo,
• bohloko pelong,
• ho ba teng ha hlooho ea hlooho
• ponahalo ea ho nyekeloa ke pelo le ho se sebetse hantle ha metsamao,
• lenyora le eketsehileng le molomo o omileng,
• ponahalo ea tloaelo ea ho sokela,
• ponahalo ea mofufutso o eketsehileng.

Pontšo ea kantle ea metabolic syndrome ke matšoao a latelang:

1. Ho ba le botenya ka mpeng, ho bonahala ka ho bonahala ha mafura ka mpeng le senyepa sa mahetla.
2. Ponahalo ea matheba a khubelu sefubeng le molaleng. Matšoao a joalo ke lipontšo tsa khatello e phahameng ea mali e amanang le ho hlaha ha methapo ea methapo ea mali ea pelo. Vascular spasm e ts'oaroa ke insulin e ngata maling.

Phuputsong ea laboratori, lipontšo tse ka sehloohong tsa metabolic syndrome ke keketseho ea palo ea li-triglycerides, ho fokotseha ha palo ea lipoprotein, keketseho ea cholesterol, keketseho ea lijo tsa tsoekere ea mali le tse ling.

Lisosa tsa Resulin ea Insulin

Phokotso e nchafatsang ea insulin ea lisele e ka bakoa ke lintho tse ngata - liphetoho tse amanang le lilemo, ho ima, ho se ikoetlise 'meleng, ho kena bohlankaneng, ho nona haholo, ts'oaetso, khatello ea maikutlo, tlala, uremia, cirrhosis, ketoacidosis, mafu a endocrine. Lisosa tse tloaelehileng tsa ho hanyetsa insulin li kenyeletsa:

• Tsoekere e ngata. Ha ho ja lijo tse nang le tsoekere e ngata e ntlafalitsoeng, 'mele o qala ho hlahisa insulin ka mafolofolo. Boikutlo ba lisele ho litlamorao tsa eona boa fokotseha, 'me palo ea tsoekere e lula e phahame.
• Ho Nona Haholo Adipose tiske e na le endocrine le ts'ebetso ea paracrine - e hlahisa lintho tse amang ts'ebetso ea insulin habonolo ea lisele. Bophelong ba botona, tšebelisano ea 'mele ea li-hormone le li-receptors le ho tsamaisoa ha glucose ka hare ho eona hoa senyeha.
• Moroalo oa liphatsa tsa lefutso. Ntho e rerang ho hanyetsa insulin ke lefa. Mathata a metabolism a Carbohydrate metabolism a fumanoa ho batho bao beng ka bona ba tobileng ba fumanoang ba e-na le lefu la tsoekere, lefu la ho ferekana kapa la methapo ea methapo.

Ho hanyetsa insulin ho hlaha ha lisele tse hlokoang haholo ka insulin - sebete, adipose le mesifa ea mesifa - ba lahleheloa ke bokhoni ba ho bona ketso ea lihormone tsena. Ho sibolotsoe mekhoa e mengata e etellang pele ea pathological: ho eketseha ha boemo ba mafura a mahala, hyperglycemia e sa foleng, ho ruruha ho sa feleng ha mafura, khatello ea methapo ea methapo, phetoho liphatlalatsong tsa gene le ho se sebetse hantle ha mmele.

Mafura a mafura a mahala (FFAs) ke karolo e tlatselletsang molemong oa motsoako oa li-triglycerides, e leng bahanyetsi ba insulin. Ha khatello ea FFA e eketseha le metabolism ea triglycerides ho myocyte e fetoha, palo ea ba tsamaisang tsoekere e ea fokotseha, tsoekere e theoha butle butle. Sebeteng, ho kenella ka matla ho FFA ho thibela phetisetso le phosphorylation ea tsoekere. Insulin ha e thibele gluconeogeneis, tlhahiso ea tsoekere ka hepatocytes ea eketseha. Ka ho hanyetsa insulin, motsoako le secretion ea VLDLP e matlafatsoa, ​​mahloriso a HDLP a fokotsehile. Ka lebaka la boemo bo phahameng ba FFA, lipids li ipokella liseleng tsa manyeme, li sitisa tšebetso ea tsona ea lihormone. Matla a ho baka ha insulin a fokotsoa liseleng tsa adipose. Ho nona ho bontšoa ke ts'oaetso ea aseptic ho li-adipocytes; khatello ea oxidative le hyperglycemia li thehoa.

Tlhomamiso

Boikutlo ba mesifa ea 'mele ho litlamorao tsa insulin bo khethoa ke lintlha tse fapaneng - lilemo, boima ba' mele, boikoetliso ba 'mele, ho ba teng ha mekhoa e mebe le mafu. Ho hanyetsa insulin ho fumanoa mofuteng oa 2 oa lefu la tsoekere le ho mafu a mang a mangata le maemo a sebetsang, a ipapisitseng le mathata a metabolic. Ho latela ntlha ena, mefuta e mene ea khanyetso ea insulin e khetholloa ho endocrinology:

1. Tlhaho. Ke mokhoa oa ho ikamahanya le maemo oa linako tse fapaneng tsa tšebeliso le matla a tsoang. E etsahala nakong ea ho robala bosiu, ho ima, ho kena bohlankaneng kapa botsofaling, le tšebeliso ea lijo tse mafura khafetsa.
2. Metabolic. E tšoaetsoa ke mathata a dysmetabolic. Ke mofuta oa lefu la tsoekere la mofuta oa II, lefu la tsoekere le boletsoeng la mofuta oa pele, lefu la tsoekere la ketoacidosis, khaello e telele ea phepo e nepahetseng, botaoa ba joala le botenya.
3. Endocrine. E bakoa ke pathologies ea gland ea endocrine. E khethiloe ka thyrotoxicosis, hypothyroidism, Cushing's syndrome, acromegaly, pheochromocytoma.
4. Pathological non-endocrine. E etselitsoe ho boloka homeostasis ho mafu le maemo a mang a tšohanyetso. E tsamaea le khatello ea mali ea methapo, ho hloleha ho phekola renal, cirrhosis, cachexia, lefu le tukang, chefo ea mali le ho buuoa.

Matšoao a Resulin ea Insulin

Ho hanyetsa insulin ha ho bonahatsoe ka tleliniki, empa ho hlaha ka lebaka la litšobotsi tse ling tsa 'mele, ho baka tšenyo ea metabolic, ho fetola tšebetso ea litho tsa ka hare. Ka hona, mabapi le ho hanyetsa insulin, ho bohlokoa ho bua eseng ka matšoao, empa ka matšoao a tsamaeang le eona. Ho hlahisoa ha mafura a mangata ho bonahala, haholo hangata sebakeng sa letheka. Mofuta ona oa botena o bitsoa mpa. Mafura a visceral a bokellana ho potoloha litho, a ama ts'ebetso ea ona. Letšoao le leng le tloaelehileng ke khatello e phahameng ea mali, e bonahatsoang ke hlooho e opang mokokotlong oa hlooho, ho tsekela, pherekano, ho phahamisa mahlo, ho fufuleloa le bofubelu ba sefahleho.

Ho feto-fetoha ha maemo ho tsoekere maling maling ho lebisa ho bakuli ba ikutloang ho tepella, bofokoli, khatello ea maikutlo, ho teneha, boiphihlelo bo eketsehang ba lenyora le tlala. Letlalo le ka ba le pigmentation e khethehileng - keratosis e ntšo (acanthosis). Libaka tsa letlalo molaleng, mahlakoreng, litlamong, ka tlas'a litšoelesa tse anyesang li fifala, li ba thata ebile li boreleli, ka linako tse ling li peel. Ho basali, ho hanyetsa insulin hangata ho tsamaisana le matšoao a hyperandrogenism a tsoang ho polycystic ovary syndrome. Matšoao a sebopeho ke seborrhea e nang le mafura, makhopho a sefahleho, ho se sebetse ha menra, le kholo e feteletseng ea moriri matsohong, maotong le sefahlehong.

Mathata

Litlamorao tse atileng haholo tsa ho hlola insulin ke lefu la pelo le lefu la tsoekere.Ka ho hanyetsa insulin le botenya, ts'ebetso ea insulin e fokotseha e baka vasodilation, mme ho sitoa ha methapo ea methapo ho thella ke karolo ea pele holima nts'etsopele ea angiopathies (mathata a potoloho ea mali). Hape, ho hanyetsa insulin ho etsa hore ho be le atherosulinosis, kaha e fetola ts'ebetso ea lintlha tsa mali tsa tlhaho le ts'ebetso ea fibrinolysis. Mokhoa oa nts'etsopele ea lefu la tsoekere la mofuta oa II e le motsoako oa ho hanyetsa insulin ke tlhokomelo e telele ea hyperinsulinemia le ho theoha hoa morao hoa lisele tsa beta, ho fokotseha ha insulin, le ho theha hyperglycemia e phehellang.

Ts'oaetso

Ho tsebahala ka ho hanyetsa insulin ke mosebetsi o thata oa ho tseba hore na boemo bona ha bo na lipontšo tse ikhethang ebile ha bo khothalletse bakuli ho batla thuso ea bongaka. Ha e le molao, e fumanoa nakong ea tlhahlobo ke endocrinologist bakeng sa lefu la tsoekere kapa botenya. Mekhoa e tloahelehileng ea ho tsebahatsa lefu lena ke:

• Teko ea khatello ea insulin. Mokhoa o thehiloe ho tsamaiso ea tsoekere ea nako e telele, ha o ntse o hatella karabelo ea lisele tsa β-tlhahiso le tlhahiso ea tsoekere e tsoetseng pele. Boikutlo ba insulin bo khethoa ke boemo ba glucose bo maemong a lekanang. Ha boleng ba pontšo ea MI e le ≥7.0, ho hanyetsa insulin ho tiisitsoe.
• Teko ea ho mamella tsoekere ea molomo. E sebelisoa haholo ts'ebetsong ea tlhahlobo, e khethollang ho ba teng le ho teba ha hyperinsulinemia. Ho seramu ea mali, boemo ba tsoekere, C-peptide, insulin ka mpeng e se nang letho le ka mor'a ho nka lik'habohaedreite bo lekantsoe. Lihora tse peli kamora hore mojaro oa carbohydrate ha o na le hyperinsulinemia, index ea insulin e feta 28,5 μI / ml, ka metabolic syndrome letšoao la C-peptide le feta 1.4 nmol / L, mme ho lefu la tsoekere mellitus letšoao la glucose le feta 11.1 mmol / L.
• Teko ea mamello ea glucose e kenang kahare. Eu lumella hore u sekaseke mohato oa secretion ea insulin, ho hlahisa mofuta oa ts'ebetso ea mmele oa hau. Nakong ea ts'ebetso, tsoekere le insulin li fanoa kahare ho latela morero, liphetho li bontša liphetoho tsa tsoekere, ho sa tsotelehe insulin le tlasa ts'ebetso ea eona. Ho hanyetsa insulin ho khethoa ke index ea SI -4 - –1.
• HOMA-IR Index. Pele ho baloa hore na ho na le katleho e kae, ho etsoa tlhahlobo ea mali, ho sebelisoa lipontšo tsa palo ea insulin, tsoekere (glucose) ho plasma e potlakileng. Ho ba teng ha khanyetso ea insulin ho bontšoa ke index e kaholimo ho 2.7.

Phekolo ea ho hanyetsa insulin

Tlhokomelo ea bongaka bakeng sa bakuli e felletse. E etselitsoe eseng feela ho ntlafatsa karabelo ea insulin, empa hape le ho rarolla khatello ea tsoekere, cholesterol, insulin ea mali, ho tlosa boima bo feteletseng, le ho thibela mafu a botenya, lefu la tsoekere, pelo le lefu la vascular. Phekolo e etsoa ke endocrinologist, setsebi sa phepo e nepahetseng, morupeli oa phekolo ea boikoetliso. Bakuli ba bontšoa:

• Phekolo ea lithethefatsi. M kalafo e fuoe bakuli ba nang le index ea boima ba 'mele ba batho ba fetang 30 ba nang le kotsi e kholo ea lefu la pelo le pelo. Li-Biguanides, li-alpha-glucosidase blockers, thiazolidinediones li sebelisetsoa ho fokotsa boima le ho eketsa kutloisiso ea insulin.
• Lijo tse fokolang tsa carb Batho ba nang le insulin ba haneloa ba ja lijo tse nang le lik'habohaedreite tse ngata, empa ntle le linako tsa ho itima lijo. Lijo tse futhumalitsoeng li tsoa lijong tse 5 ho isa ho tse 7 ka letsatsi ka likarolo tse nyane. Morero ona o u lumella ho boloka boemo ba tsoekere bo tsitsitseng, ketsahalo e ts'oanang ea insulin.
• Ho ikoetlisa khafetsa. Ho ikoetlisa ho matlafatsa ho tsamaisoa ha tsoekere le bokhoni ba insulin ho susumetsa motsoako oa glycogen. Mokhoa oa boikoetliso o khethoa bakeng sa bakuli ka bonngoe: ho tloha ho tsamaea lipapaling le ho ikoetlisa ka bobebe ho ea ho matla le boikoetliso ba moea. Boemo bo ka sehloohong ke ho ba teng ha litlelase kamehla.

Phatlalatso le Thibelo

Boemo ba ho hanyetsa insulin bo ka lokisoa ka mokhoa o kopaneng, ho kenyelletsa ho ja le ho ikoetlisa. Ka tumellano eohle ea lingaka, lefu lena la tsoekere hangata le rateha. Bakeng sa thibelo, ho bohlokoa ho laola tšebeliso ea lik'habohaedreite haholo-holo tsoekere e entsoeng ka mafolofolo, ho qoba ho ikoetlisa 'meleng, ka bophelo ba ho lula fatše, ho kenella ka boomo koetliso ea lipapali ho regimen ea letsatsi le letsatsi. Ho bohlokoa hore batho ba nang le botenya ba tsepamise maikutlo ho fokotsa boima ba 'mele. Haeba ho na le nalane ea lelapa ea lefu la tsoekere mellitus, atherosulinosis, ho hlahlojoa nako le nako tsoekere, insulin le cholesterol ea mali.

Ho hlahloba lefu la metabolic

Phekolo ea metabolic syndrome e etsoa ke endocrinologists.

Ts'ebetsong ea lefu lena, ho hlaha mafu a fapaneng a ka hlokang ho buisana le litsebi tse ling tsa bongaka, joalo ka. Mohlala, setsebi sa kelello, setsebi sa kelello le setsebi sa phepo e nepahetseng.

Ha u etela setsebi sa endocrinologist, ts'ebetso ea ts'oaetso e etsahala maemong a mangata.

Mehato e ka sehloohong ea lefu lena ke e latelang:

• tlhahlobo ea mokuli
• Tlhahlobo ea mokuli
• tlhahlobo ea mahlale.

Ha u etsa tlhahlobo ea mokuli, ngaka e eang teng e bokella tlhaiso-leseling ebile e etsa nalane ea bongaka. Phuputso e fana ka leseli la maemo a bophelo, litloaelo tsa ho ja le ho lemalla lijo, ho ba teng ha botenya ho beng ka motho ea haufi, ho ba teng ha lefu la pelo le mokuli le khatello e phahameng ea mali.

Ha ho etsoa tlhahlobo ea mokuli, ngaka e eang e etsa:

1. Boikemisetso ba mofuta oa botenya.
2. Mehato e lekantsoeng ea mokuli.
3. E khetholla kamano lipakeng tsa bophara ba letheka le bophara ba letheka.
4. Mehato ea ho hola le ho imetsa mokuli.

Ho etsa tlhahlobo ea laboratori ha ho fumanoa bokuli ho kenyelletsa lithuto tse latelang:

• tekanyo ea k'holeseterole e felletseng maling,
• Tekanyo ea palo ea lipoprotein tse boima ba limolek'hule le k'holeseterole e phahameng 'meleng,
• qeto ea palo ea lipoprotein tse boima ba limolek'hule le cholesterol e tlase 'meleng,
• qeto ea triglycerides maling,
• ho itima lijo ka tsoekere ea plasma,
• ho lekanya palo ea insulin 'meleng,
• ho lekanya palo ea leptin 'meleng.

Ho latela litholoana tsa likarabo le liteko tsa laboratori, ngaka e fihlela qeto ea hore mokuli o na le metabolic syndrome.

Phekolo ea litšitiso 'meleng

Mokuli e mong le e mong ea fumanoeng a na le metabolic syndrome o hloka mokhoa o mong le o mong oa kalafo. Ho khethoa ha lithethefatsi ho latela sethala le lisosa tsa kholo ea botenya.

Ntle le moo, khetho ea lithethefatsi e ipapisitse le liphetho tsa lithuto tsa biochemical tsa litaba tsa likarolo tse itseng ho plasma ea mali.

Ts'ebetso ea kalafo ea lithethefatsi ea insulin ea ho hanyetsa insulin e ikemiselitse haholo ho ntlafatsa ts'ebetso ea ho monya insulin, ho tsitsisa index ea glucose 'meleng le ho etsa hore mekhoa ea metabolism ea mafura e be le eona.

Ts'ebetsong ea kalafo ea lithethefatsi, ho sebelisoa lihlopha tse latelang tsa lithethefatsi:

1. Li-vithamine Lithethefatsi tse ntle li kenyeletsa lefu la tsoekere la Complivit le Oligim.
2. Litlhare tsa Hypolipidemic.
3. Lithethefatsi ho fokotsa ho hanyetsa insulin.
4. Lithethefatsi tse eketsang kutloisiso ea insulin.
5. Lithethefatsi tse thatafatsang metabolism le khatello ea mali.
6. Lithethefatsi ke li-inhibitors tsa mafura.
7. Lithethefatsi tse amang tsamaiso ea methapo e ka hare le khatello ea maikutlo.

Ha ho phekoloa lefu la metabolic, ha ho kgothaletswe ho sebelisa lithethefatsi tsa sehlopha sa anorectics tse hatellang takatso ea lijo. Lithethefatsi tsena li kenya letsoho ho fokotseheng ho hoholo ha kutloisiso ea lithane ho "insulin" ea "hormone".

Lithethefatsi tsena li kenyelletsa lithethefatsi tse latelang.: Fluoxetine, Prozac, Meridia, Reduxin.

Mokhoa oa bophelo ka boteng ba metabolic syndrome

Ho khutlisetsa metabolism 'meleng le ho eketsa kutloisiso ea insulin, ho tlameha ho fihletsoe maemo a' maloa, ao karolo ea 'ona e leng phepo e nepahetseng e sebelisang lijo tse nang le lik'habohaedreite tse ngata le mmele o leka-lekaneng mmeleng.

Ha u ntse u bapala lipapali, 'mele o chesa mabenkele a mafura. Ntle le moo, ka nako tse joalo, lits'ebetso tsa metabolic li potlakisitsoe, sena se tlatsetsa ho hore leha mmele o kena boemong ba ho phomola, o ntse o tsoela pele ho sebetsana le mabenkele a mafura hore a be matla.

Ho ikoetlisa khafetsa ho lefu la tsoekere le ho fana ka matla a mangata 'meleng ho lebisa ho holiseng lihomone tsa thabo, li-endorphin,' meleng oa mokuli.

Metsoako ena ea lik'hemik'hale e sebetsang e thusa ho ntlafatsa mohopolo, e thusa ho laola takatso ea lijo le ho eketsa litakatso tsa lik'habohaedreite.

Morero oa mantlha oa lijo o sebelisoang 'meleng oa metabolic ke ho fokotsa ho ja lik'habohaedreite le mafura. Lijo tse joalo li u lumella ho emisa ts'ebetso ea botena mme butle-butle u tlose boima bo bongata.

Litsebi tsa phepo ea sejoale-joale li hanana ka matla le tlala le tšebeliso ea lijo tse nang le khalori e tlase.

Lijo tse sebelisoang 'meleng oa metabolic ke lik'habohaedreite tse fokolang. 'Me ka mokhoa o nepahetseng oa ho etsa lethathamo la lijo, le oona o ka ba monate ebile oa khotsofatsa.

U sebelisa lijo tse fapaneng tse lumelloang, u ka pheha lijana tse fapaneng.

Ho sebelisa lijo tse nang le khalori e tlase ho theola boima ba 'mele ho lebisa tšebetsong ts'ebetso ea boits'ireletso ba mmele, eo ka nako eo e fokotsang ts'ireletso ea' mele khahlanong le livaerase tsa pathogenic le libaktheria.

Ts'ebeliso ea sejo se nang le nama e tlase ea carb e u lumella ho matlafatsa 'mele le ho tloaela tšilo ea lijo ka lebaka la tšebeliso ea litholoana, meroho le lihlahisoa tsa lebese tse belisitsoeng lijong. Video e khahlisang sehloohong sena e tla u thusa ho utloisisa hore na insulin resistance syndrome ke eng.