Lefu la tsoekere la LADA ke eng

O tsejoa e le mantlha mofuta II lefu la tsoekere mashano a hola khanyetso ea insulin (sesepa sa insulin ho insulin) le ho qobella ka nakoana secretion e eketsehileng ka ho fokotseha ha eona le ho eketseha ha tsoekere ea mali. Leha ho le joalo, bo-rasaense ba ne ba sa utloisise hore na hobaneng ho bakuli ba bang ba nang le lefu la tsoekere la mofuta oa II, ho theoha ha pancreatic le tlhokahalo ea kalafo ea insulin li etsahala feela lilemong tse mashome a seng makae, ha ba bang (palo ea bona e nyane haholo) - e se e le teng ka lilemo tse 'maloa (ho tloha ho likhoeli tse 6 ho isa ho tse 6) Ba ile ba qala ho utloisisa melao ea lefu la tsoekere la mofuta oa II. Ka nako ena, karolo ea bohlokoa ea li-autoantibodies ho nts'etsopele ea lefu la tsoekere la mofuta oa I e ne e se e tsebahala (haeba ha u e-so e bale, ke khothaletsa hore u e bale).

Litsebi tsa lefu la tsoekere la Australia ka 1993 mosebetsi o hatisitsoeng o nang le liphetho tsa lipatlisiso tsa maemo li-antibodies le mekhala C peptide e le karabelo ea eona glucagontse eketsang maemo a tsoekere.

C-peptide ke masalela a proteni a manyane a ntlafalitsoeng ke li-enzyme ho fetola molek'hule ea proinsulin hore e be insulin. Tekanyo ea C-peptide e tšoana hantle le boemo ba "insulin" e kenang kahare. Ka khatello ea C-peptide, motho a ka sekaseka sephiri sa insulin ea kahare ho mokuli mabapi le kalafo ea insulin.

C-peptide e sala nakong ea ho etsoa ha insulin ho tsoa ho proinsulin.

Ho batla li-autoantibodies le boikemisetso ba boemo ba li-C-peptide tse khothatsang ho bakuli ba nang le lefu la tsoekere la II ho file litholoana tse sa lebelloang. Ho ile ha fumaneha hore bakuli ba boteng ba li-antibodies le secretion e tlase ea C-peptide ha ba na lefu la tsoekere la mofuta oa II (ka tsela e latelang ho latela tlhahlobo ea mafu), empa ho lokela ho hlahisoa Type lefu la tsoekere (ka mochini oa nts'etsopele). Hamorao ho ile ha fumaneha hore ba hloka tsamaiso ea insulin esale pele ho feta sehlopha sohle. Lithuto tsena li re file monyetla oa ho khetholla mofuta oa "lefu la tsoekere" lipakeng -mofuta oa 1.5 lefu la tsoekere", E tsejoang hamolemonyana tlasa polelo ea Senyesemane Lada (lefu la tsoekere la autoimmune ho batho ba baholo - lefu la tsoekere la autoimmune ho batho ba baholo) Latent - e patiloeng, e sa bonahale.

Bohlokoa ba ho khetholla LADA

Ho ne ho ka bonahala, phapang eo bo-rasaense ba bileng le eona ke efe? Hobaneng u thatafalletsa bophelo ba hau ka litlhahlobo tse ling? Empa ho na le phapang. Haeba mokuli a sa fumanoe a e-na le LADA (lefu la tsoekere la autoimmune ho batho ba baholo), oa phekoloa ntle le insulin joalo ka lefu la tsoekere la mofuta oa II, ho fana ka lijo, thuto ea 'mele le litafole tse theolelang tsoekere hangata ho tsoa sehlopheng sa sulfonylurea (glibenclamide, glycidone, glyclazide, glimepiride, glipizide jj.). Lithethefatsi tsena, har'a tse ling, li hlohlelletsa insulin le ho matlafatsa lisele tsa beta, li li qobella hore li sebetse ka botlalo. A ha ts'ebetso e sebetsa ea lisele li le matla, ke moo li senyehileng haholo le ts'oaetso ea autoimmune. Arises terata e khopo:

autoimmune beta cell senya?
secretion ea insulin?
Ho fana ka lipilisi tse fokotsang tsoekere?
ts'ebetso e eketsehileng ea lisele tse setseng tsa beta?
ho ruruha ha autoimmune le lefu la lisele tsohle tsa beta.

Sena sohle bakeng sa Lilemo tse 0.5-6 (karolelano ea lilemo tse 1-2) e fela ka ho khathala ha pancreatic le tlhoko e matla kalafo ea insulin (tekanyetso e phahameng ea insulin le taolo ea glycemic khafetsa e nang le phepo e tiileng) Ka lefu la tsoekere la mofuta oa II oa khale, tlhokahalo ea insulin e hlaha kamora nako e telele.

Ho khaola potoloho e mpe ea ts'oaetso ea autoimmune, hang hoba ho fumanoe lefu la lefu la tsoekere la LADA, ho lokela ho beoa tekanyetso e nyane ea insulin. Phekolo ea insulin ea pele e na le lipheo tse 'maloa:

ho fana ho phomola lisele tsa beta. Ha tšibollo e sebetsa haholoanyane, lisele tse eketsehileng li senyeha ts'ebetsong ea autoimmune,
thibelo ea ts'oaetso ea autoimmune makhophong ka ho fokotsa polelo (ho teba le boholo ba "li-autoantigenet", "likhara tse khubelu" bakeng sa sesole sa 'mele' me li qala ka kotloloho ts'ebetso ea autoimmune, e tsamaeang le ponahalo ea li-antibodies tse tsamaellanang. Litekong, ho bontšitsoe hore taolo ea insulin ea nako e telele maemong a mangata e fokotsa bongata ba li-autoantibodies maling.
hlokomela tsoekere e tloaelehileng. Haesale ho tsejoa hore maemo a phahameng le a malelele a tsoekere ea mali a lula a le teng, e le kapele ebile ho le thata le ho feta mathata a fapaneng a lefu la tsoekere.

Phekolo ea insulin ea pejana ka nako e telele e tla boloka secretion ea eona e setseng ea pancreatic. Ho boloka Ho boloka sephiri ho bohlokoa ka mabaka a 'maloa:

E thusa ho boloka boemo ba tsoekere ea mali bo lebisitsoeng ka lebaka la ts'ebetso e itseng ea pancreatic,
e fokotsa kotsi ea hypoglycemia,
e thibela nts'etsopele ea pele ea mathata a lefu la tsoekere.

Nakong e tlang, e tobileng kalafo ea immunological ho ruruha ha autoimmune ka manyeme. Bakeng sa mafu a mang a autoimmune, mekhoa e joalo e se e le teng (bona sethethefatsi Infliximab).

Mokhoa oa ho belaella LADA?

Nako e tloaelehileng ea ho qala ea LADA ke ho tloha ho lilemo tse 25 ho isa ho tse 50. Haeba lilemong tsena u belaelitsoe kapa u fumanoe u na le lefu la tsoekere la mofuta oa II, etsa bonnete ba hore u hlahloba lintlha tse ling tsa LADA. Mabapi le 2-15% ea bakuli ba nang le lefu la tsoekere la mofuta oa II ba na le lefu la tsoekere la autoimmune ho batho ba baholo. Har'a bakuli Type II lefu la tsoekere ntle le botenya LADA li na le 50%.

Ho na le "Sekala sa Kotsi ea Kliniki ea LADA"Ho kenyelletsa lintlha tse 5:

Lefu la ho qala la lefu la tsoekere lilemo tse ka tlase ho 50.
Ho qala ho hlohlona (moroto o eketsehileng> 2 L ka letsatsi, lenyora, ho theola boima ba 'mele, bofokoli, joalo-joalo, ho fapana le thuto ea asymptomatic).
Lenane la boima ba 'mele bo ka tlase ho 25 kg / m 2 (ka mantsoe a mang, ho ba sieo ha boima ba' mele bo feteletseng le botenya).
Maloetse a Autoimmune hajoale kapa nakong e fetileng (rheumatoid arthritis, systemic lupus erythematosus le maloetse a mang a rheumaticmultiple sclerosis Hashimoto autoimmune thyroiditis, e hlahisang chefo e kotsi, lefu la autoimmune, lefu la Crohn, lesapo la mokokotlo, lefu la autoimmune pancreatitis, autoimmune bullous dermatosis, lefu la celiac, cardiomyopathy, myasthenia gravis, vasculitis e itseng., perngic (B12 - khaello ea folic) phokolo ea mali, alopecia areata (baldness), vitiligo, autoimmune thrombocytopenia, paraproteinemia jj.).
Ho ba teng ha mafu a autoimmune ho beng ka bona ba haufi (batsoali, nkhono le ntate-moholo, bana, barab'eso le likhaitseli).

Ho latela baqapi ba tekanyo ena, haeba ke likarabo tse ntle ho tloha 0 ho isa ho 1, monyetla oa ho ba le LADA ha o fetele 1%. Haeba ho na le likarabo tse 2 kapa ho feta tse joalo, kotsi ea LADA e ka ba 90%, maemong ana, ho hlokahala tlhahlobo ea laboratori.

U ka netefatsa tšoaetso eo joang?

Bakeng sa tlhahlobo ea mahlale lefu la tsoekere la autoimmune ho batho ba baholo le sebelisa liteko tse peli.

1) Boikemisetso ba boemo anti- — li-antibodies tsa glutamate decarboxylase. Liphetho tse mpe (i.e., ho se be teng ha li-antibodies ho glutamate decarboxylase maling) li felisa LADA. Phello e ntle (haholo-holo ka tekanyetso e phahameng ea li-antibodies) ho fetisisa (!) Litekanyetso li bua li rata LADA.

Ho feta moo, ke feela ho bolela esale pele tsoelo-pele ea LADA e ka ikemisoang ICA — li-antibodies ho lisele tsa islet manyeme. Ho ba teng ka nako e tšoanang ho anti-GAD le ICA ke tšobotsi ea mefuta e matla le ho feta ea LADA.

2) Tlhaloso boemo ba peptide (ka mpeng e se nang letho le kamora ho hlohlona) C-peptide ke sehlahisoa sa insulin biosynthesis ka hona litaba tsa eona li tsamaellana ka kotloloho le boemo ba "insulin" ea methapo. Ho mofuta oa lefu la tsoekere la mofuta oa (le la LADA le lona, hobane LADA ke mofuta oa lefu la tsoekere la mofuta oa I) le tsebahalang boemo ba C-peptide bo fokotsehile.

Ha u bapisa: le lefu la tsoekere la mofuta oa II le hlokometsoeng pele khanyetso ea insulin (tisense insensitivity ho insulin) le hyperinsulinemia e qobellang (ho fokotsa maemo a tsoekere, "makhopho a pepeseha insulin haholo ho feta a tloaelehileng", ka hona, ka lefu la tsoekere la mofuta oa II, boemo ba C-peptide ha bo fokotsehe.

Kahoo, ha ho se na anti-GAD, tlhahlobo ea LADA ha e ahloloe. Boteng ba anti-GAD + le maemo a tlase a C-peptide, tlhahlobo ea LADA e nkoa e netefalitsoe. Haeba ho na le anti-GAD, empa C-peptide e tloaelehile, tlhaiso e eketsehileng ea hlokahala.

Ka tlhahlobo e nang le phehisano, LADA e bonts'a monyetla o phahameng oa ho fumanoa matšoao a lefutso mofuta oa lefu la tsoekere (li-kotsi tsa HLA tse kotsing e kholo), hobane mofuta ona oa khokahano o ne o sa fumanehe mofuteng oa lefu la tsoekere la mofuta oa II. Khafetsa, ho ne ho e-na le khokahano le antigen ea B8 HLA, 'me ho ne ho batla ho se na setsoalle le "antigen" e sireletsang "HLA-B7".

Subtypes ea mofuta oa lefu la tsoekere

Ho na le litlatsetso tse peli tsa mofuta oa lefu la tsoekere la 1:

lefu la tsoekere la bana (bana le bacha) = subtype 1a,
subtype 1b, sena sea sebetsa Lada (lefu la tsoekere la autoimmune ho batho ba baholo). Arohane idiopathic Type lefu la tsoekere.

Lefu la tsoekere (subtype 1a) e tlaleha 80-90% ea linyeoe tsa lefu la tsoekere la Mofuta oa. E tlameha ho itšireletsa mafung a nang le tšoaetso mokuli. Ka subtype 1a, likokoana-hloko tse 'maloa (Coxsackie B, sekholopane, adenoviruse le tse ling) li baka tšenyo ea vaerase liseleng tsa manyeme. Ho arabela, lisele tsa sesole sa 'mele li senya lisele tse amehang tsa li-isanc tsa pancreatic. Li-autoantibodies ho iske tiske ea manyeme (ICA) le insulin (IAA) li potoloha maling ka nako ena. Palo ea li-antibodies (titer) maling butle-butle ea fokotseha (ba fumanehile ho 85% ea bakuli qalong ea lefu la tsoekere mme ke feela ho 20% kamora selemo). Subtype ena e etsahala libeke tse 'maloa ka mor'a ts'oaetso ea vaerase ho bana le bacha ba ka tlase ho lilemo tse 25. Qalo e na le sefefo (bakuli ba kena tlhokomelo e matla ka matsatsi a 'maloa, moo ba fumanoang ba le teng). Khafetsa ho na le li-antigen tsa HLA B15 le DR4.

Lada (subtype 1b) e hlaha ho 10-20% ea linyeoe tsa lefu la tsoekere la Mofuta oa. Subtype ena ea lefu la tsoekere ke e 'ngoe feela ea lipontšo tsa ts'ebetso ea autoimmune' meleng ka hona hangata e kopantsoe le mafu a mang a autoimmune. E etsahala khafetsa ho basali. Li-autoantibodies li potoloha maling ho pholletsa le nako eohle ea lefu lena, karolo ea bona ea methapo ("level) e lula e le teng. Tsena ke li-antibodies tsa anti-GAD ho glutamate decarboxylase, hobane IA-2 (antibodies to tyrosine phosphatase) le IAA (ho etsa insulin) ha li fumanehe haholo. Subtype ena ea lefu la tsoekere e bakiloe ke boemo bo tlase ba T-suppressors (mofuta oa lymphocyte o hatellang karabelo ea 'mele ea ho itšireletsa mafung khahlanong le li-antigen tsa' mele).

LADA-lefu la tsoekere ka mochini oa lona o hlaha ka lefu la tsoekere la mofuta oa I, empa matšoao a lona a batla a tšoana le lefu la tsoekere la II (ho qala butle le thuto ha le bapisoa le lefu la tsoekere la bana). Ka hona, lefu la tsoekere la LADA le nkoa le le pakeng tsa lefu la tsoekere la mofuta oa II le lefu la tsoekere. Leha ho le joalo, boikemisetso ba boemo ba autoantibodies le C-petid ha bo kenyelelloe lenaneng le tloaelehileng la tlhahlobo ea mokuli ea nang le lefu la tsoekere le sa tsoa fumanoa, mme tlhahlobo ea LADA ha e fumanehe haholo. Khafetsa, ho hokahana ka kamano le li-antigen tsa HLA B8 le DR3.

Ho idiopathic mofuta oa I lefu la tsoekere ha ho na tšenyo ea autoimmune ea lisele tsa beta, empa leha ho le joalo ho na le ho fokotseha ha ts'ebetso ea bona ka ho felisoa ha insulin secretion. Ketoacidosis ea hlaha. Lefu la tsoekere la Idiopathic le fumaneha haholo Asia le Maafrika mme le na le lefa le hlakileng. Tlhokahalo ea kalafo ea insulin ho bakuli ba joalo e ka hlaha mme ea nyamela ha nako e ntse e tsamaea.

Ho tsoa sengoloeng sohle ho bohlokoa ho hopola lintlha tse 'maloa.

Lefu la tsoekere la LADA ha le tsejoe haholo ho lingaka (polelo e hlahile ka 1993) mme ka hona ha e fumanoe hangata, leha e fumaneha ho 2-15% ea linyeoe tsa lefu la tsoekere la II.
Phekolo e fosahetseng ka litafole tse fokotsang tsoekere e lebisa ho potlakileng (ka karolelano ea lilemo tse 1-2) pancreatic depletion le phetisetso e tlamang ho insulin.
Phekolo ea insulin ea lethathamo le tlase e thusa ho emisa tsoelo-pele ea ts'ebetso ea autoimmune le ho boloka sekhahla sa insulin sa eona nako e telele.
Secretion e bolokiloeng ka insulin e nolofatsa tsela ea lefu la tsoekere hape e sireletsa khahlanong le mathata.
Haeba ho fumanoa hore u na le lefu la tsoekere la mofuta oa II, itlhahlobe hore na u fumana mekhoa e 5 ea lefu la tsoekere la LADA.
Haeba litekanyetso tse peli kapa ho feta li le ntle, lefu la tsoekere la LADA le ka etsahala 'me Ceptide le li-antibodies tsa glutamate decarboxylase (anti-GAD) li lokela ho hlahlojoa.
Haeba anti-GAD le maemo a tlase a C-peptide (basal le e hlohlellelitsoeng) a fumanoa, o na le lefu la tsoekere la autoimmune batho ba baholo (LADA).