Lefu la tsoekere la lefu la tsoekere - etiopathogenesis, tlhahlobo ea lihlahisoa, sehlopha

Lefu la tsoekere le sa itšetleheng ka insulin (NIDDM, mofuta oa 2 lefu la tsoekere) - Boloetse bo nang le heterogenible bo khetholloang ke secretion ea insulin e senyehileng le maikutlo a insulin ea likaroloana tsa khatello ea pelo (insulin).

1) lefu - liphatsa tsa lefutso tse senyehileng (ho chromosome 11 - tlolo ea insulin secretion, ho chromosome 12 - insulin receptor synthesis imremament, bofokoli ba liphatsa tsa lefutso tsamaisong ea tlhokomeliso ea glucose ke li-β-cell kapa tishu tsa peripheral), li fetisoa haholo, ka mafahla a mabeli a tšoanang, NIDDM e hlaha ho 95-100% linyeoe.

2) phepo e nepahetseng le botenya - Lijo tse nang le khalori e ngata tse nang le lik'habohaedreite tse ngata tse monyang habonolo, liswiti, joala le khaello ea fiber ea limela, hammoho le mokhoa oa bophelo oa ho lula, o kenya letsoho ho secretion ea insulin le ho holisa insulin ho hanyetsa

Pathogenesis ea NIDDM e bakoang ke tlolo ea molao maemong a mararo:

1. Tlolo ea secretion ea insulin - sekoli sa pele sa lefuba ho NIDDM, se fumanoeng mathoasong a lefu lena le ho fetisisa ka ho fetisisa:

a) Tlolo ea molao- ka NIDDM, boemo ba insulin ea mali bo potlakileng bo fokotsehile haholo, proinsulin predominates

b) likhathatso tsa kinetic - bathong ba phetseng hantle, ha ho arabeloa taolo ea tsoekere, biphasic insulin secretion e bonoa: tlhoro ea pele ea secretion e qala hang kamora ho hlohlelletsa tsoekere, e fela ka motsotso oa 10, ka lebaka la tokollo ea "insulin" e bolokiloeng ho tsoa merianeng ea β-cell, mme tlhoro ea bobeli ea secretion e qala kamora metsotso e 10. with the on / Selelekelong kapa kamora metsotso e 30 kapa hamorao kamora taolo ea molomo ea tsoekere, ea nako e telele, e bonts'a secretion ea insulin e sa tsoa etsoa hore e arabe tsoalo ea β-lisele tse nang le tsoekere, ka NIDDM ha ho na karolo ea pele mme karolo ea bobeli ea seculin e fumaneha.

c) litlolo tsa bongata - NIDDM e tšoauoa ka insulinopenia e kholo ka lebaka la ho fokotseha ha boima ba β-lisele tsa li-isang tsa Langvrhans, depositi ea li-amyloid deposits lihlekehlekeng (tse qapiloeng ho tsoa ho amylin, e bolokiloeng ke β-cell le insulin mme e kenella phetolelong ea proinsulin ho ba le insulin), "glucoselyciaosis" tsoalo ea "glucoselycoseia" glucose acid mathata a sebopeho sa lihlekehleke tsa Langerhans le ho fokotseha ha secretion ea insulin), jj.

2. Ho itšireletsa ha insulin:

a) prereceptor - E amanang le lihlahisoa tse khethiloeng ka liphatsa tsa lefutso tse fetotsoeng, tse sa sebetseng

limolek'hule tsa insulin kapa phetoho e sa phethahalang ea proinsulin ho insulin

b) receptor - e amanang le ho fokotseha hoa palo ea li-insulin receptors tse sebetsang, sebopeho sa li-receptor tse sa sebetseng hantle, ponahalo ea li-antibodies tsa antireceptor.

c) postreceptor - ho fokotseha ha ts'ebetso ea "tyrosine kinase" ea insulin receptor, ho fokotseha ha palo ea ba tsamaisang tsoekere (liprotheine tse karolong e ka hare ea membrane ea sele e netefatsang hore ho tsamaisoa ha glucose kahare ho sele).

Ha nts'etsopele ea ho hanyetsa insulin, ho potoloha ha bahanyetsi ba insulin maling (li-antibodies tsa insulin, lihormone tsa insulin: lihormone tsa kholo, cortisol, lihomone tsa qoqotho, thyrotropin, prolactin, glucagon, CA) le tsona li bohlokoa.

3. Ho eketsa tlhahiso ea tsoekere ea sebete - ka lebaka la tsoekere e eketsehang ea gluconeogeneis, khatello ea tlhahiso ea tsoekere ke sebete, tlolo ea mokokotlo oa circadian oa sebopeho sa tsoekere (ha ho na ho fokotseha hoa tlhahiso ea tsoekere ka bosiu), jj.

Lipontšo tsa Kliniki tsa NIDDM:

1. Litletlebo tse latelang ke tšobotsi e ikhethang:

- Bofokoli bo phatlalalitsoeng ka kakaretso le ba mesifa (ka lebaka la khaello ea sebopeho sa matla, glycogen le protheine ka har'a mesifa)

- lenyora - nakong ea ho bolaoa ha DM, bakuli ba ka nooa ka lilithara tse 3-5 kapa ho feta ka letsatsi, hyperglycemia e phahameng, lenyora le boleloang haholoanyane, molomo o omileng (ka lebaka la ho omella le ho fokotseha hoa ts'ebetso ea gland)

- urination khafetsa le profuse bosiu le motšehare

- botenya - hangata, empa eseng kamehla

- ho hlohlona ha letlalo - haholo-holo ho basali ba sebakeng sa genital

2. Ka mokhoa o hlakileng, boemo ba litho le litsamaiso:

a) letlalo:

- letlalo le omeletseng, turgor e fokotsehileng le elasticity

- maqeba a letlalo a pustular, furunculosis e tloaelehileng, hydroadenitis, lefu la maoto

- letlalo la xanthomas (lipopae le maqhubu a mmala o moputsoa, ​​a tlatsitsoeng ka lipids, a teng marikeng, maotong a ka tlase, lengoleng le manonyeletsong, maotong) le xanthelasma (matenya a lipid letlalong la letlalo la eyelids)

- Rubeosis - ho hola ha likhahla tsa letlalo ka ho fifala hoa letlalo marameng le marameng (lefu la tsoekere)

- lipoid necrobiosis ea letlalo - hangata maotong, qalong ho na le marumo a bosoeu bo bofubelu kapa bo bosehla kapa makhasi a pota-potiloeng ke moeli oa "erythematous" oa "li-capillaries" tse tlotsitsoeng butle, letlalo le li koahelang butle butle butle, le ba le boreleli, le benyang, ka lesapo le matla ("letlalo"), ka linako tse ling le amehang libaka tsa ho ruruha, ho fola butle haholo, ho siea libaka tsa pigmentation

b) tsamaiso ea tšilo ea lijo:

- lefu le sa foleng, ho lohla le ho senyeha ha meno

- alveolar pyorrhea, gingivitis, ulcerative kapa aphthous stomatitis

- gastritis e sa foleng, duodenitis le nts'etsopele ea butle-butle ea atrophy, e fokotsehile secretion ea lero la gastric,

fokotseha ts'ebetso ea motor ea mpeng ho fihlela gastroparesis

- ho se sebetse ka mpeng: lets'ollo, lefu la ho nyekeloa ke lefu la ho ferekanya lefu la sethoathoa

- mafura a sebete sa hepatosis, cholecystitis e sa foleng, gysbladder dyskinesia, jj.

c) tsamaiso ea pelo:

- Nts'etsopele ea pele ea lefu la pelo le lefu la pelo le mathata a fapa-fapaneng (lefu la pelo le lefu la tsoekere le ka hlaha ntle le bohloko - Cardiac hypesthesia syndrome ea Parishioner, hangata ho fetella, ho thata ho tsoela pele, e tsamaisana le mathata a mangata)

- khatello ea mali ea methapo (hangata ea bobeli ka lebaka la nephroangiopathies, atherosclerosis ea methapo ea kutlo, joalo-joalo)

- "pelo ea lefu la tsoekere" - dysmetabolic myocardial dystrophy

g) Mokhoa oa ho hema:

- boikemisetso ba lefuba la pulmonary le lefu le matla haholo, ho eketseha khafetsa, mathata

- khafetsa pneumonia (ka lebaka la microangiopathy ea matšoafo)

- khafetsa a hlobaetsang le bronchitis le sepheo sa ho nts'etsopele ea bronchitis e sa foleng

e) Sisteme ea urine: preisposition ea mafu a tšoaetsanoang le a tšoaetsanoang a ts'ebetso ea urine (cystitis, pyelonephritis), jj.

Tlhahlobo ea NIDDM: bona potso ea 74.

1. Lijo - e tlameha ho latela litlhokahalo tse latelang:

- e be pholoji ka sebopeho le karolelano ea metsoako ea mantlha (60% lik'habohaedreite, mafura a 24%, protheine ea 16%), e koahelang litšenyehelo tsohle tsa matla ho latela tekanyo ea boikoetliso ba 'mele le ho netefatsa ho boloka boima ba' mele bo "loketseng" haholo, ka boima bo fetelletseng ba 'mele bojong ba hypocaloric ho tloha ho lipalo tsa 20-25 kcal ka kilo e le 'ngoe ea boima ba' mele / ka letsatsi

- Lijo tse 4-5 tse lenngoeng ka nako e latelang lipakeng tsa lijo tsa khalori ea letsatsi le letsatsi: 30% - lijo tsa hoseng, 40% - bakeng sa lijo tsa mots'eare, 10% - bakeng sa lijo tsa mots'eare, 20% - bakeng sa lijo tsa mantsiboea

- felisa lik'habohaedreite tse bonolo tse kenang habonolo, tšebeliso ea lino tse tahang, eketsa likateng tsa fiber ea limela

- fokotsa mehloli ea tlhaho ea liphoofolo (40-50% ea mafura e lokela ho ba meroho)

Lijo ka mokhoa oa monotherapy li etsoa ho fihlela, khahlano le tšebeliso ea eona, ho khona ho boloka matšeliso a felletseng bakeng sa lefu la tsoekere.

2. Ho fokotsa boima ba 'mele, ho ikoetlisa ka ho lekaneng (ka boima ba 'mele bo feteletseng, ho ka sebelisoa li-anorectics - litokisetso tsa bohareng-bohato bo thibelang ho khutlisoa ha komine ea methapo, meridia (sibutramine) 10 mg 1 nako / letsatsi, bakeng sa ho lahleheloa ke boima ba lik'hilograma tse 1 ho nepahetse

3. Phekolo ea lithethefatsi - lithethefatsi tsa molomo tsa hypoglycemic (le ho bakuli ba nang le mofuta oa insulin ea mofuta oa 2 lefu la tsoekere + kalafo ea meriana e kopaneng le litla-morao tsa ketso e kopaneng: mixtard-30, humulin profile-3, insuman comb-25 GT ka mokhoa oa tsamaiso ea habeli pele ho lijo tsa hoseng le lijo tsa mantsiboea):

a) secretogens - lithethefatsi tse tsosang sephiri sa insulin e felisitsoeng ke li-b-cell:

1) li-derivatives tsa sulfonylurea - chlorpropamide (I moloko) 250 mg / letsatsi ho tekanyetso e le 1 kapa e 2, glibenclamide (maninyl) 1.25-20 mg / letsatsi, ho kenyelletsa mefuta ea micronized ea mannyl 1.75 le 3.5, glipizide, glycoslazide (lefu la tsoekere) 80-320 mg / letsatsi, glycidone, glimepiride (amaryl) 1-8 mg / letsatsi

2) lits'ebetso tsa li-amino acid - e loketseng bakeng sa taolo ea postprandial hyperglycemia: novonorm (repaglinide) ea 0.5-2 mg pele ho lijo ho fihlela ho 8-10 mg / ka letsatsi, Starlix (nateglinide)

b) biguanides - keketseho ea boteng ba insulin ts'ebeliso ea methapo ea tsoekere, fokotsa tsoekere, eketsa ts'ebeliso ea tsoekere ke mala ho fokotseha ha glucose ea mali ho tsoa mala: N, N-dimethylbiguanide (siofor, metformin, glucophage) 500-850 mg makhetlo a 2 / ka letsatsi

c) a-glucosidase inhibitors - fokotsa ho kenngoa ha lik'habohaedreite ka har'a tšilo ea lijo: glucobai (acarbose) ho 150-300 mg / ka letsatsi ho tekanyetso tse 3 tse arohaneng le lijo

d) glitazones (thiosalidinediones, sensulin insulin) - eketsa kutloisiso ea mesifa ea pherekano ho insulin: actos (pioglitazone) 30 mg 1 nako / letsatsi

4. Thibelo le kalafo ea mathata a morao-rao a NIDDM - bakeng sa tharollo ea bothata bo hlokahalang:

a) ho lefella litlolo tsa tlolo ea metabolism ea carbohydrate ho Normoglycemia, aglycosuria ka kalafo e lekaneng le e nepahetseng ea NIDDM

b) buseletsa metabolism ea mafura ka kalafo e loketseng ea ho fokotsa lipid: lijo tse nang le lithibelo tsa mafura, lithethefatsi (li-statins, fibrate, litokisetso tsa acid ea nicotinic, jj.)

c) netefatsa boemo bo tloaelehileng ba khatello ea mali (lithethefatsi tse felisang kalafo, haholo-holo li-inhibitors tsa ACE, tseo ka ho eketsehileng li nang le phello e ntle)

g) ho etsa bonnete ba litsamaiso tsa mali tse kopanyang le tsa anticoagulation

Ho thibela mathata a morao ho kenyeletsa ho boloka matšeliso a phehellang a metabolism ea carbohydrate nako e telele le ho lemoha ha methati ea pele ea mathata a morao-rao a lefu la tsoekere.:

1) lefu la tsoekere - ho hlokahala hore ho etsoe tlhahlobo ea fundus hang ka selemo bakeng sa lilemo tse 5 tsa pele, 'me hang kamora likhoeli tse 6, ka neoplasm ea likepe tsa retinal, ho bontšoa laser coagulation

2) lefu la tsoekere - Hoa hlokahala ho khetholla microalbuminuria hang kamora likhoeli tse ling le tse ling tse 6, ha ho hlaha matšoao a ho se sebetse hantle ha rewal - lijo tse nang le liprotheine tsa phoofolo (ho fihlela ho 40 g ka letsatsi) le sodium chloride (ho fihlela ho 5 g ka letsatsi), ts'ebeliso ea li-inhibitors tsa ACE, kalafo ea detoxification, le ts'ebetso e tsoelang pele ea ts'ebetso. liphio - hemodialysis le mathata a mang.

Thibelo ea NIDDM: ho phela ka mokhoa o phetseng hantle (qoba ho ba le hypodynamia le botenya, u se ke ua sebelisa joala hampe, ho tsuba, jj., phepo e nepahetseng, ho felisoa ha khatello) + khafetsa khalemelo e lekantsoeng ke lijo kapa liketsahalo tsa pele tsa hyperglycemia, tse lateloang ke ho lekola linako tsa boemo ba tsoekere ea mali.

Mathata a morao-rao (a sa foleng) a lefu la tsoekere: microangiopathies (lefu la tsoekere le lefu la tsoekere, lefu la tsoekere), macroangiopathy (lefu la tsoekere la lefu la tsoekere), polyneuropathy.

Lefu la tsoekere - lesapo la mokokotlo le akaretsang la tsoekere, le jalang likepe tse nyane (microangiopathy) le methapo ea methapo e meholo le e mahareng (macroangiopathy).

Lefu la tsoekere le lefu la tsoekere - lefu la tsoekere le fetisang lefu la tsoekere le atisang ho hlaha ha likepe tse nyane tse matla le ho eketseha ha li-microane le palo ea matla a manyane a ho eketseha ha li-micaneroses le ho eketseha ha li-micane le matla a maholo a ho eketseha ha li-micaneur. :

1. Le lefu la tsoekere la retinopathy - sesosa se ka sehloohong sa bofofu ho bakuli ba nang le lefu la tsoekere, se sa feteng (ho ba teng ha li-microaneurysms, hemorrhages, edema, li-exudates tse tiileng kahare ho "retina", liphetoho tse tsoang methapong ea methapo: ho hlaka, ho hlaka, ho tlosoa, ho fokotseha ha methapo ea mali) le ho eketseha (+ ponahalo ea methapo e mecha) , khafetsa khafetsa khafetsa kahare ho retina e nang le ho phatloha ha eona le sebopeho se matla sa litho tse sebetsanang), litletlebo tsa sephooko tse fofang, mathe, maikutlo a moholi, lintho tse ferekaneng tse ntseng li tsoela pele tlase s bonwang acuity.

Ho hlahlojoa bakeng sa lefu la tsoekere le lefu la tsoekere.

"Gold Standard" ke lifoto tsa "stereoscopic color" tsa "fund", "fluorescence angiography" ea "retina" le "ophthalmoscopy" e fumanehang habonolo ho feta hona joale.

Tlhahlobo ea pele kamora lilemo tse 1.5-2 ho tloha ka letsatsi leo ho fumanoang lefu la tsoekere ka lona, ​​ha ho na lefu la tsoekere, ho hlahloba bonyane nako e le ngoe ho lilemo tse 1-2, haeba ho na le nako e le 'ngoe ka selemo kapa khafetsa, hammoho le lefu la tsoekere la retinopathy le kemaro. , AH, CRF - lenane la tlhahlobo ea motho ka mong, le ho fokotseha ka tšohanyetso hoa Acuity ea pono - tlhahlobo ea hanghang ke setsebi sa mahlo.

Melao-motheo ea kalafo ea lefu la tsoekere:

1. Phekolo ea lithethefatsi: matšeliso a mantlha bakeng sa metabolism ea k'habohaedreite (lithethefatsi tse theolelang tsoekere ka hanyane, kalafo ea insulin), kalafo ea mathata a kopaneng, li-antioxidants (nicotinamide) bakeng sa retinopathy ea lefu la tsoekere e se nang proliferative e nang le lipids tse phahameng tsa mali, li-heparin tse tlase tsa boima ba 'mele methating ea pele ea ts'ebetso.

2. Photocoagulation ea li-retina tsa methapo ea methapo ea pele ea lefu la tsoekere (lehae - tsepamiso ea laser coagulation li sebelisoa sebakeng sa ts'ebetso ea methapo kapa methapo ea methapo ea methapo, tsepamiso - li-coagulates li sebelisoa ka mela e 'maloa libakeng tsa paramacular le parapapillary, panretinal - e sebelisoang bakeng sa retolopathy ea nako e telele, ho tloha 1200 ho isa 1200 ho isa ho 1200 ho isa ho 1200 ho isa ho 1200 ho isa ho 1200 ho isa ho 1200 ho isa ho 1200 ho isa ho 1200 ho isa ho 1200 ho isa ho 1200 ho isa ho 1200 ho isa ho 1200 ho isa ho 1200 ho isa ho 1200 ho isa ho 1200 ho isa ho 1200 ho isa ho 1200 ho isa 1200 tse tsepamisitsoeng e sebelisoa ka paterone ea chekehalo ho retina, ho tloha libakeng tse paramehang le tse paramente ho ea fihla sebakeng sa equina sa retina.

3. Cryocoagulation - e bonts'itsoeng ho bakuli ba nang le lefu la tsoekere le feteletsang, le rarahaneng ka ho phefumoloha khafetsa 'meleng oa vitreous, keketseho e mpe ea methapo ea kutlo le ts'ebetso, e etsoa pele halofo e tlase ea leihlo, mme kamora beke ka halofo e holimo, e lumella ho ntlafatsa kapa ho tsitsisa pono e setseng. bofofu.

4. Vitrectomy - e bontšitsoe bakeng sa hemorrhages e lulang e le teng le tsoelo-pele ea liphetoho tsa phetoho ea fibrotic ho vitreous le retina

2. Lefu la tsoekere - ka lebaka la nodular kapa diffuse nephroangiosclerosis ea renal glomeruli.

Lipontšo tsa kliniki le tsa laboratori tsa lefu la tsoekere.

1. Mehatong ea pele, lipontšo tsa subjential ha li eo, ka sethaleng se hlalositsoeng ka kliniki, ho eketseha ha protheine, khatello ea methapo ea kutlo, lefu la nephrotic, tleliniki e tsoelang pele ea ho se sebetse hantle ke ho hlaka hoa renal.

2. Microalbuminuria (urin albin excretion, e fetang litekanyetso tse tloaelehileng, empa e sa fihle tekanyo ea proteinuria: 30-300 mg / letsatsi) - lets'oao la pele la lefu la lefu la tsoekere, ka ponahalo ea microalbuminuria e sa khaotseng, sethaleng sa lefu lena le tla hlaha lilemo tse 5-7.

3. Hyperfiltration (GFR> 140 ml / min) - litlamorao tsa phello ea hyperglycemia ts'ebetsong ea liphio ho lefu la tsoekere, e baka tšenyo ea liphio, ka keketseho ea nako ea lefu la tsoekere, GFR e ntse e fokotseha hanyane ka hanyane mabapi le keketseho ea proteinuria le ho teba ha tekanyo ea boemo ba khatello ea mali.

Mehatong ea ho qetela ea lefu la tsoekere proteinuria e sa khaotseng, ho fokotseha ha GFR, keketseho ea azotemia (creatinine le urea ea mali), ho eketseha le ho tsitsinyeha ha khatello ea mali, le nts'etsopele ea nephrotic syndrome ke tšobotsi.

Mothati oa nts'etsopele ea lefu la tsoekere:

1) hyperfunction ea liphio - GFR e eketsehile> 140 ml / min, phallo ea mali a renal, hypertrophy ea renal, albinuria e tloaelehileng

Ha ua fumana seo u se batlang? Sebelisa patlo:

Lipolelo tse ntle:Moithuti ke motho ea lulang a qoba ho se khone ho ikemela. 10160 - | 7206 - kapa bala tsohle.

Etiopathogenesis le ho khetholloa ha lefu la tsoekere

Ho latela litsebi tsa WHO (1999), lefu la tsoekere le hlalosoa e le bothata ba metabolism ba mefuta e fapaneng ea methapo, e khetholloang ke hyperglycemia e sa foleng ea phepo e nepahetseng, mafura le protheine ea metabolism e amanang le sekoli ho secretion ea insulin, litlamorao tsa insulin, kapa ka bobeli.

Bofokoli bo ka sehloohong ba lefu la tsoekere ke ho fetisoa ha tsoekere le amino acid ka likarolo tsa cytoplasmic membranes ho li-tishu tse itšetlehileng ka insulin. Thibelo ea ho fetisoa ha transmembrane ea lintho tsena e baka liphetoho tse ling tsohle tsa metabolic.

Lilemong tsa morao tjena, mohopolo o se o hlahisitse hore lefu la tsoekere ke liphatsa tsa lefutso le lefutso la tsoalo la hyperglycemia, mefuta ea mantlha eo e leng lefu la tsoekere la II le II. Khafetsa boits'oaro le ho kenya letsoho kholisong ea mafu li ka se khetholle.

Kaha ka lipontšo tsa kliniki tsa lefu la tsoekere le netefalitsoeng ka methapo ea biochemical karolong ea batho ba baholo, khafetsa khatello ea methapo ea morao-rao (nts'etsopele ea eona e etsahala nako ea mathata a metabolic ho feta lilemo tse 5-7), joale ka 1999 litsebi tsa WHO li ile tsa etsa tlhahiso ea tatellano ea lefu lena le lefu le lecha. litekanyetso tsa tlhahlobo ea laboratori ea lefu la tsoekere (tafole. 33.1).

Ho khothalletsoa hore u se ke ua sebelisa mantsoe a reng "lefu la tsoekere le itšetlehileng ka insulin" le ho se tlohele feela mabitso "mofuta oa I le II lefu la tsoekere". Sena se bakoa ke pathogenesis ea mefuta ena, 'me ho se ele hloko kalafo e ntseng e tsoela pele. Ntle le moo, monyetla oa phetoho ea foromo e ikemetseng ea insulin ho phethela ho itšetleha ka eona e ka hlaha maemong a fapaneng a bophelo ba mokuli (Lethathamo la 33.3).

Lethathamo la 33.3. Mathata a glycemic: mefuta ea etiological le methati ea kliniki (WHO, 1999)

Mefuta e atileng ka ho fetisisa ea lefu la tsoekere la II le II, le hlahisang ho feta 90% ea linyeoe tsohle tsa lefu la tsoekere.

Mofuta oa lefu la tsoekere la Mofuta oa I o kenyeletsa mathata a metabolism ea carbohydrate e amanang le ho timetsoa ha li-β-cell tsa li-isanc tsa pancreatic ho batho ba reriloeng pele ho lefu lena le khahlano le semelo sa mathata a amanang le ts'oaetso ea mmele.

Bakuli ba tšoauoa ka lilemo ho isa ho lilemo tse 30, khaello ea insulin e felletseng, tloaelo ea ketoacidosis le tlhoko ea ho tsamaisa insulin.

Maemong moo ho senngoa le ho fokotseha ha palo ea lisele tsa b ho bakoang ke ts'ebetso ea boits'ireletso kapa ea autoimmune, lefu la tsoekere le nkoa e le autoimmune. Mofuta oa lefu la tsoekere la Type I o khetholloa ke ho ba teng ha li-autoantibodies tse fapaneng.

Qeto ea eona esale pele e kopantsoe le mefuta ea HLA tata DR3, DR4 kapa DR3 / DR4 le liqoso tse ling tsa loco tsa HLA DQ. Ho khothalletsoa hore lefu la tsoekere la mofuta oa (autoimmune) le ka feta maemong a nts'etsopele ho tsoa maemong a tloaelehileng ntle le tlhoko ea tsamaiso ea insulin ho felisa ts'ebetso ea lisele tsa b. Ho fokotseha kapa ho nyamela ka botlalo ha lisele tsa b ho lebisa ho itšetleheng ka botlalo ka insulin, ntle le moo mokuli a hlaolela tloaelo ea ketoacidosis, komisi. Haeba etiology le pathogenesis e sa tsejoe, joale maemo a joalo a mofuta oa lefu la tsoekere a bitsoa "lefu la tsoekere" "lefu la tsoekere".

Mofuta oa lefu la tsoekere la Mofuta oa II o kenyelletsa mathata a metabolism ea carbohydrate, e tsamaeang le litekanyo tse fapaneng tsa kamano pakeng tsa ho teba ha insulin le sekoli ho secretion ea insulin. E le molao, mofuteng oa lefu la tsoekere la II, lintlha tsena tse peli li kentse letsoho ho pathogene ea lefu lena, ho mokuli e mong le e mong o ikemiselitse ka tekanyo e fapaneng.

Lefu la tsoekere la Mofuta oa II le tloaetse ho fumanoa kamora lilemo tse 40. Hangata, lefu lena le hlaha butle butle, butle-butle ntle le lefu la tsoekere le itellang feela. Phekolo, joalo ka molao, ha e hloke tsamaiso e potlakileng ea insulin ho pholosa bophelo. Ts'ebetsong ea mofuta oa lefu la tsoekere la mofuta oa II mellitus (hoo e ka bang 85% ea mafu ohle a lefu la tsoekere), ntlha ea lefutso (lelapa) e bohlokoa haholo.

Khafetsa, lefa le nkoa e le polygenic. Keketseho ea lefu la tsoekere ho bakuli ba imetsoeng haholo e ea eketseha ka lilemo, 'me ho batho ba baholo ho feta lilemo tse 50 ba atamela 100%.

Bakuli ba nang le lefu la tsoekere la mofuta oa II hangata ba phekoloa ka insulin bakeng sa hyperglycemia e phahameng, empa ka ho tlosoa ha insulin spontaneous ketoacidosis ha e etsahale.

Metabolic syndrome

Ka genesis ea lefu la tsoekere la mofuta oa II, karolo ea bohlokoa ea boiphetetso e bapaloa ke botena, haholoholo mofuta oa mpa.

Mofuta ona oa lefu la tsoekere o amahanngoa le hyperinsulinemia, ho hanyetsa insulin ho hanyetsa, tlhahiso e eketsehileng ea tsoekere ea sebete, le ho hloleha ho tsoelang pele ha b-cell.

Khanyetso ea insulin e hlaha linthong tse hlokoang ke insulin, tse kenyelletsang mesifa ea marapo, lisele tsa adipose le sebete. Kamano pakeng tsa maemo a insulin le botenya e tsebahala.

Tlas'a maemo a hyperinsulinism ho botenya, ho eketseha ha litekanyetso tsa mali tsa somatostatin, corticotropin, mafura acids a mahala, acid ea uric le lintlha tse ling tsa contra li fumanoe, ka lehlakoreng le leng li ama boemo ba tsoekere le insulin maling a mali, 'me ka lehlakoreng le leng, ho etsoa ha maikutlo a "physiological" tlala. Sena se lebisa ho predominance ea lipogenisis holim'a lipolysis. Ho hanyetsa insulin ka matla ho feteletseng ho hlola mathata a eketsehileng a plasma insulin.

Ha ho na ntho e ikhethang ea lijo tsa diabetogenic, empa ho ja mafura a mangata le ho se lekane ha lijo tse nang le phepo e ngata ho tlatsetsa ho fokotseheng ha kutloisiso ea insulin.

Ho fokotseha ha boima ba 'mele ba 5-10%, le haeba botenya bo ntse bo phehella, ho lebisa ho khalemelo ea bofokoli ba receptor, ho fokotseha ha khatello ea insulin ho plasma, ho fokotseha ha boemo ba glycemia, lipoprotein tsa atherogenic le ntlafatso maemong a akaretsang a bakuli.

Keketseho ea lefu la tsoekere ho bakuli ba bang ba batenya haholo e tsoella ka ho eketseha ha insulin ho tloha ho amanang ka ho felletseng. Kahoo, botenya, ka lehlakoreng le leng, ke sesosa sa ho ba le lefu la tsoekere, ka lehlakoreng le leng, ke ponahatso ea lona ea pele. Mofuta oa lefu la tsoekere la Mofuta oa II ke pathogenetically heterogenible.

Tlaleho ea 1999 ea WHO e hlahisitse mohopolo oa metabolic syndrome e le ntho ea bohlokoa mathateng a methapo.

Le ha ho na tlhaiso ea tumellano ea metabolic syndrome, mohopolo oa eona o kenyelletsa likarolo tse peli kapa ho feta tse latelang:

- metabolism ea tsoekere e nang le tsoekere kapa boteng ba lefu la tsoekere,
- Khanyetso ea insulin,
- keketseho ea khatello ea mali e fetang 140/90 mm RT. Art.,
- triglycerides e eketsehileng le / kapa k'holeseterole e tlaase low density lipoprotein(LDL),
- botena,
- microalbuminuria e fetang 20 mcg / min.

Ts'ebeliso ea mehato e matla ea ho ja e reretsoeng ho fokotsa boima ba 'mele ho bakuli ba batenya, ho pepesehela mabaka a kotsi a metabolic syndrome hangata ho lebisa ho tloaelehileng kapa ho fokotsehe ha glycemia le ho fokotseha ha mathata a mangata.

Mathata a lefu la tsoekere

Bakuli ba 'maloa (ba ka bang 5%) ba na le mathata a mantlha ho latela mathata, ho sa tsotelehe hore na matseliso a phello ea metabolism ea carbohydrate; karolong e' ngoe ea bakuli (20-25%), mathata ha a bonoe hangata ka lebaka la boemo bo tlase ba lefutso.

Ho bakuli ba bangata (70-75%), tekanyo ea liphatsa tsa lefutso e ka fapana, 'me ho bakuli bana ho boloka matšeliso a nepahetseng a metabolism ea carbohydrate ho na le phello e phatlalalitsoeng e le phello ea nako ea angiopathy le neuropathy.

Diabetesic angiopathy (macro- le microangiopathy) le neuropathy ke tse ling tsa lipontšo tse matla tsa lefu la tsoekere, ho sa tsotelehe mofuta oa hau. Nts'etsopele ea maloetse ana, a kenyelletsa bohlokoa bo boholo ho glycation ea liprotheine (ho tlama ha tsona molek'hule ea glucose ka lebaka la ts'ebetso eo e seng ea enzymatic mme, mothating oa ho qetela, ts'ebetso ea lik'hemik'hale e ke keng ea fetoha ea liphetoho tsa ts'ebetsong ea selefounu liseleng tse sa itšetlehang ka insulin) le phetoho maemong a rheological a mali.

Ho nyelisoa ha liprotheine tsa hemoglobin ho lebisa ho sitiseng tsamaiso ea khase. Ntle le moo, ho na le ho fifala ha likarolo tsa kamore e ka tlase ka lebaka la tlolo ea sebopeho sa protheine ea membrane. Ho bakuli ba nang le lefu la tsoekere, ho ile ha fumanoa mohato oa ho kenyelletsa glucose liprotheineng tsa serum ea mali, lipoprotein, methapo ea kutlo le likarolo tse sebetsanang le methapo.

Bophahamo ba glycation bo lekana ka kotloloho le pokellong ea tsoekere. Boikemisetso ba glycosylated hemoglobin (HbA1b, HbA1c) e le karolo ea kakaretso ea litaba tsa hemoglobin e fetohile mokhoa o tloaelehileng oa ho hlahloba boemo ba matšeliso a metabolism ea carbohydrate ho bakuli ba nang le lefu la tsoekere la mellitus. Ka hyperglycemia e sa khaotseng le e phahameng haholo, ho fihla ho 15-20% ea hemoglobin eohle e ka feta boteng. Haeba litaba tsa HbA1 li feta 10%, joale nts'etsopele ea lefu la tsoekere ke phetho e boletsoeng esale pele.

Boikarabello bakeng sa nts'etsopele ea angio- le neuropathy e boetse e nkuoa e le ts'ebetso e feteletseng ea tsoekere ho lisele tsa "tisulin" tse ikemetseng. Sena se lebisa ho bokellweng ho bona ba cyclic alcohol sorbitol, e fetolang khatello ea osmotic liseleng ebe ka tsela eo e kenya letsoho kholisong ea edema le ts'ebetso e sa sebetseng. Ho bokellana ho atileng ha sorbitol ho etsahala liseleng tsa tsamaiso ea methapo ea kutlo, li-lens, lilense le maboteng a likepe tse kholo.

Mekhoa ea pathogenetic ea sebopeho sa microthrombi ho lefu la tsoekere ke mathata a homeostasis, pono ea mali, microcirculation: eketseha liplatelese tse ngata, thromboxane A2, bofokoli ba bofokoli ba ts'ebetso ea ts'ebetso ea ts'ebetso ea ts'ebetso ea ts'ebetso ea ts'ebetso ea ts'ebetso ea ts'ebetso ea ts'ebetso ea ts'ebetso ea ts'ebetso ea ts'ebetso ea ts'ebetso ea ts'ebetso ea ts'ebetso ea ts'ebetso ea ts'ebetso ea ts'ebetso ea ts'ebetso ea ts'ebetso ea ts'ebetso ea ts'ebetso ea ts'ebetso ea ts'ebetso ea ts'ebetso ea ts'ebetso ea mali?

Boholo ba bakuli ba nang le lefu la tsoekere ba na le nephropathy. Ho kenyelletsa lefu la tsoekere la lefu la tsoekere, nephroangiosclerosis, pyelonephritis, jj. Micro- le macroangiopathy le tsona li ama nts'etsopele ea mathata ana. Lilemong tsa morao tjena, kamano e hlakileng e bonts'itsoe lipakeng tsa ho ba le protheine ka har'a moroto le qetello ea liphio ho bakuli ba nang le lefu la tsoekere.

Ho bohlokoa ho tseba microalbuminuria, ho sa kenyeletselle mafu a kahare. Tekanyetso ea albin excretion e fetang 20 μg / min ke sesupo sa tlhahlobo ea microalbuminuria, karo-karolelano ea li-albin le li-creatinine tse fetang 3 li u lumella ho bolela esale pele maemo a ntlafatsang bosiu bosiu a fetang 30 μg / min.

Liphetoho tse tsoang liphateng tse tlase li khetholla ho lefu la lefu la tsoekere. Ho khaoloa hoa lipheo tse tlase ho etsoa ho bakuli ba nang le lefu la tsoekere hangata ka makhetlo a 15 ho feta bathong.

Keketseho ea lefu la tsoekere le amanang le lefu la tsoekere e lumellana le lilemo, nako ea lefu lena, glycemia, ho tsuba, ho teba ha khatello ea mali ea methapo. Lefu la tsoekere la maoto le tsoekere ha le amahanngoe haholo le microangiopathy joalo ka polyneuropathy, atherosulinosis ea likepe tse kholo le tse mahareng tsa lisosa tse tlase (macroangiopathy), kapa hammoho le lintlha tsena.

Ho bolaoa ha lefu la tsoekere nako e telele ho mpefatsa le mafu a kopaneng, ho lebisa ho fokotseheng hoa boits'ireletso, ho hlaha ha lits'oaetso tsa ts'oaetso le ho ruruha, le bokuli ba tsona.

Ho ke ho hlokomeloe hore lingaka tse ngata tsa lefu la tsoekere la mofuta oa II li nka hore ke lefu le fokolang haholo. European Bureau ea International Federation ea Diabetesologists le WHO European Bureau ka 1998 e hlahisitse mekhoa e mecha ea ho lefella metabolism le kotsi ea mathata ho bakuli ba nang le lefu la tsoekere la II, le hlahisitsoeng ho Lethathamo. 33.4.

Lethathamo la 33.4. Litekanyetso tsa Tlatsetsolefu la tsoekeremofuta II

Ka mpeng e se nang letho / pele ho lijo mmol / L (mg / dL) 6.1 (> 110)> 7.0 (> 126)

Etiology ea lefu lena

Mofuta oa 1 oa lefu la tsoekere ke lefu le futsitsoeng, empa lefutso le bolela hore ke karolo ea boraro feela eo e ka holang. Monyetla oa lefu la tsoekere ho ngoana ea nang le lefu la tsoekere e ke ke ea feta 1-2%, ntate ea kulang - ho tloha ho 3 ho isa ho 6%, ngoan'eso - hoo e ka bang 6%.

Letšoao le le leng kapa a 'maloa a tlotlollang a lipancreatic lesion, le kenyelletsang li-antibodies lihlekehlekeng tsa Langerhans, a ka fumanoa ho 85-90% ea bakuli:

• li-antibodies ho glutamate decarboxylase (GAD),
• li-antibodies ho tyrosine phosphatase (IA-2 le IA-2 beta).

Tabeng ena, bohlokoa ba mantlha ba ho timetsoa ha lisele tsa beta bo fanoa ka mabaka a ho itšireletsa mafung. Mofuta oa 1 oa lefu la tsoekere hangata o amahanngoa le HLA haplotypes joalo ka DQA le DQB.

Hangata mofuta ona oa pathology o kopantsoe le mathata a mang a autoimmune endocrine, ho etsa mohlala, lefu la Addison, autoimmune thyroiditis. Etiology e seng ea endocrine le eona e bapala karolo ea bohlokoa:

• vitiligo
• rheumatic pathologies
• alopecia
• Lefu la Crohn.

Pathogenesis ea lefu la tsoekere

Mofuta oa 1 oa lefu la tsoekere o itlhahisa ha ts'ebetso ea autoimmune e senya 80 ho isa ho 90% ea lisele tsa pancreatic beta. Ho feta moo, botebo le lebelo la ts'ebetso ea methapo ena ea methapo li lula li fapana. Hangata, lithutong tsa khale tsa lefu lena ho bana le ho bacha, lisele li timetsoa kapele, 'me lefu la tsoekere le hlaha ka potlako.

Ho tloha qalong ea lefu lena le matšoao a lona a pele a kliniki ho ea ho nts'etsopele ea ketoacidosis kapa ketoacidotic coma, ha ho ka feta libeke tse 'maloa.

Maemong a mang, a sa tloaelehang haholo ho bakuli ba lilemo tse ka tlase ho 40, lefu lena le ka tsoela pele ka lekunutu (latent autoimmuneabetes mellitus Lada).

Ho feta moo, maemong ana, lingaka li ile tsa fumana mofuta oa lefu la tsoekere la mofuta oa 2 'me tsa khothaletsa bakuli ba tsona hore ba tsebe ho lefella bofokoli ba insulin ka litokisetso tsa sulfonylurea.

Le ha ho le joalo, ha nako e ntse e tsamaea, matšoao a ho haella ka botlalo a li-hormone a qala ho hlaha:

1. ketonuria
2. ho theola mmele
3. hyperglycemia e hlakileng khahlano le tšebeliso ea kamehla ea litafole ho fokotsa tsoekere ea mali.

Pathogenesis ea lefu la tsoekere la mofuta oa 1 e ipapisitse le khaello e phethahetseng ea li-hormone. Ka lebaka la ho se khonehe ha tšebeliso ea tsoekere linthong tse amanang le insulin (mesifa le mafura), khaello ea matla ea eketseha, ka lebaka leo, lipolysis le protheine e ba matla le ho feta. Mokhoa o tšoanang o baka boima ba 'mele.

Ka keketseho ea glycemia, hyperosmolarity e etsahala, e tsamaisana le osmotic diuresis le ho felloa ke metsi 'meleng. Ka lebaka la khaello ea matla le hormone, insulin e thibela secretion ea glucagon, cortisol le hormone ea ho hola.

Leha ho na le glycemia e ntseng e eketseha, gluconeogenesis e hlohlelletsoa. Ho potlakisa ha lipolysis liseleng tsa mafura ho baka keketseho e kholo ea palo ea mafura a acid.

Haeba ho na le khaello ea insulin, joale matla a liposynthetic a sebete a hatelloa, 'me mafura a mahala a mafura a kenella ka matla ho ketogeneis. Ho bokellana ha li-ketones ho baka nts'etsopele ea lefu la tsoekere le lefu la sethoathoa - lefu la tsoekere.

Khahlano le semelo sa keketseho e tsoelang pele ea ho omella le acidosis, komisi e ka hlaha.

Eona, haeba ho se na kalafo (kalafo e lekaneng ea "insulin" le ho hlasimolla mmele), maemong a ka bang 100% e tla baka lefu.

Matšoao a lefu la tsoekere la Mofuta oa 1

Mofuta ona oa pathology o fumaneha seoelo - eseng ho feta 1.5-2% ea linyeoe tsohle tsa lefu lena. Kotsi ea ho ba teng bophelong bohle e tla ba 0,4%. Khafetsa, motho o fumanoa a e-na le lefu la tsoekere joalo ha a le lilemo li 10 ho isa ho tse 13. Boholo ba ponahatso ea methapo ea methapo e etsahala ho fihlela lilemo tse 40.

Haeba nyeoe e tloaelehile, haholo ho bana le bocha, lefu lena le tla iponahatsa e le letšoao le hlakileng. E ka hola ka likhoeli kapa libeke tse 'maloa. Maloetse a tšoaetsanoang le a mang a ka tsosang ponahalo ea lefu la tsoekere.

Matšoao e tla ba tšobotsi ea mefuta eohle ea lefu la tsoekere:

• polyuria
• ho hlohlona ha letlalo,
• polydipsia.

Matšoao ana a bitsoa haholo ka lefu la mofuta oa 1. Motšehare, mokuli a ka nooa le ho tšela bonyane lilithara tse 5-10 tsa metsi.

E ikhethang bakeng sa mofuta ona oa bokuli e tla ba tahlehelo e boima ea 'mele, eo ka likhoeli tse 1-2 e ka fihlelang 15 kg. Ntle le moo, mokuli o tla hlokofatsoa ke:

• bofokoli ba mesifa
• ho otsela
• ts'ebetso e fokotsehile.

Qalong, a ka 'na a tšoenngoa ke keketseho e sa utloahaleng ea takatso ea lijo, e nkeloang sebaka ke anorexia ha ketoacidosis e eketseha. Mokuli o tla utloa monko o bohloko oa asetone e tsoang molomong oa molomo (ho ka ba le lephoka la litholoana), ho nyekeloa le pelo le pseudoperitonitis - bohloko ba ka mpeng, ho felloa ke metsi 'meleng, bo ka bakang komello.

Maemong a mang, lets'oao la pele la mofuta oa 1 lefu la tsoekere ho bakuli ba bana e tla ba le letsoalo le ntseng le tsoela pele la ho kula. E ka bitsoa hoo e ka bang ka morao ea li-pathologies tsa concomitant (opereishene kapa tšoaetso), ngoana a ka oelang.

Ha se hangata, ha mokuli a le moholo ho feta lilemo tse 35 a e-na le lefu la tsoekere (lefu la tsoekere la morao-rao), lefu lena le ka 'na la se ke la ikutloa le khanya haholo,' me le fumanoa ka tšohanyetso nakong ea tlhahlobo ea tsoekere ea mali.

Motho a ke ke a theola boima ba 'mele, polyuria le polydipsia e tla ba tse itekanetseng.

Taba ea mantlha, ngaka e ka hlahloba lefu la tsoekere la mofuta oa 2 'me ea qala kalafo ka lithethefatsi ho fokotsa tsoekere matlapeng. Sena se tla re kamora nako e itseng, se tiisetse puseletso e amohelehang ea lefu lena. Leha ho le joalo, kamora lilemo tse 'maloa, hangata kamora selemo sa 1, mokuli o tla ba le matšoao a bakoang ke keketseho ea khaello ea insulin e felletseng:

1. ho theola boima ba 'mele haholo
2. ketosis
3. ketoacidosis
4. ho sitoa ho boloka maemo a tsoekere ka lebelo le hlokoang.

Mekhoa ea ho hlahloba lefu la tsoekere

Ka lebaka la mofuta oa 1 oa lefu lena le tšoauoa ka matšoao a hlakileng ebile ke mokhoa o sa tloaelehang, boithuto ba ho hlahloba maemo a tsoekere ea mali ha boa etsoa. Monyetla oa ho ba le lefu la tsoekere la mofuta oa 1 ho beng ka motho o haufi ha o na letho, le moo ho sa sebelisoeng mekhoa e sebetsang bakeng sa tlhahlobo ea mafu a mantlha.

Ho fumanoa ha lefu lena ka bongata ba linyeoe ho tla thehiloe ho thehwa ha glucose e ngata ea mali ho bakuli ba nang le matšoao a ho haelloa ke insulin ka botlalo.

Teko ea molomo e le ho bona lefu lena e fumaneha seoelo.

Ha se sebaka sa ho qetela ke tlhahlobo ea tlhahlobo. Hoa hlokahala ho netefatsa ts'oaetso ea mafu maemong a belaetsang, e leng ho bona glycemia e itekanetseng ntle le matšoao a hlakileng le a hlakileng a mofuta oa 1 lefu la tsoekere, haholo-holo ka ponaletso a sa le monyane.

Morero oa tlhahlobo e joalo e kanna ea ba ho khetholla lefu lena le mefuta e meng ea lefu la tsoekere. Ho etsa sena, sebelisa mokhoa oa ho khetholla boemo ba basal C-peptide le lihora tse peli ka mor'a ho ja.

Mekhoa ea boleng bo sa hlalosoang ka ho hlaka maemong a makatsang ke qeto ea matšoao a lefu la tsoekere la mofuta oa 1:

• li-antibodies tsa ho hasana libaka tsa manyeme,
• glutamate decarboxylase (GAD65),
• tyrosine phosphatase (IA-2 le IA-2P).

Mokhoa oa kalafo

Phekolo ea mofuta ofe kapa ofe oa lefu la tsoekere e tla ipapisa le melao-motheo e 3 e latelang:

1. ho fokotsa tsoekere ea mali (molemong oa rona, kalafo ea insulin),
2. lijo tsa phepo
3. thuto ea mamello.

Phekolo ka insulin ea mofuta oa 1 methapo ea mafu ke ea mofuta o mong. Morero oa eona ke ho holisa ho etsisa lits'oants'o tsa secretion ea tlhaho ea "insulin" ho fumana mekhoa e amohelehang ea matšeliso. Phekolo ea insulin e matla e tla lekana haholo tlhahiso ea lihormone tsa 'mele.

Tlhokahalo ea letsatsi le letsatsi ea hormone e tla lumellana le boemo ba secretion ea eona ea basal. Liente tse peli tsa sethethefatsi sa nako e telele sa ho pepeseha kapa 1 ente ea insulin e telele Glargin e ka fa 'mele insulin.

Boholo bo bongata ba li-hormone tsa basal ha boa lokela ho feta halofo ea tlhoko ea letsatsi le letsatsi ea moriana.

Sekhahla sa "insulin" ("phepo") sa "insulin" se tla nkeloa sebaka ke liente tsa homone ea motho ka nako e khuts'oanyane kapa e khutšoane ea ho pepeseha e entsoeng pele ho lijo. Maemong ana, litekanyetso li baloa ho latela mekhoa e latelang:

• palo ea lik'habohaedreite tse lokelang ho jeoa nakong ea lijo,
• tekanyo ea tsoekere ea mali e fumanehang pele ho ente e ngoe le e ngoe ea "insulin" (e lekantsoeng ho sebelisa glucometer).

Hang ka mor'a ho bonts'oa ha mofuta oa lefu la tsoekere la 1 lefu la tsoekere le hang ha kalafo ea lona e se e qalile nako e telele e lekaneng, tlhoko ea litokisetso tsa insulin e ka ba nyane mme e tla ba ka tlase ho 0,3-0.4 U / kg. Nako ena e bitsoa "kharebe ea batho ba bang" kapa mohato oa ho ts'oarela.

Kamora karolo ea hyperglycemia le ketoacidosis, moo tlhahiso ea "insulin" e hatelloang ke lisele tse ntseng li phela tsa beta, li-insulin tsa lihormone le metabolic li lefelletsoa ka ente ea insulin. Lithethefatsi tsena li thusa ho sebetsa ha lisele tsa "pancreatic", tse ka bang tsa ipatela insulin haholo.

Nako ena e ka nka libeke tse 'maloa ho isa ho lilemo tse' maloa. Qetellong, leha ho le joalo, ka lebaka la timetso ea autoimmune ea masala a beta-cell, mohato oa ho hlakola o fela mme ho hlokahala kalafo e tebileng.

Mellitus e sa itšetleheng ka insulin (mofuta oa 2)

Mofuta ona oa pathology o hlaha ha lisele tsa 'mele li sa khone ho amohela tsoekere ka ho lekaneng kapa li e etsa ka bongata bo sa lekaneng. Bothata bo tšoanang bo na le lebitso le leng - ho haella ha extrapancreatic. Bopaki ba ketsahalo ena bo ka fapana:

• Phetoho sebopeho sa insulin le kholo ea ho nona haholo, ho nona ho feta tekano, ho phela bophelo ba ho lula fatše, khatello ea maikutlo ea methapo, botsofaling le boteng ba lithethefatsi.
• ts'ebetso e mpe mesebetsing ea li-insulin receptors ka lebaka la tlolo ea palo ea tsona kapa sebopeho,
• tlhahiso e sa lekaneng ea tsoekere ke linama tsa sebete,
• intracellular pathology, eo ho eona phetiso ea tšusumetso ho lisele tsa litho tsa 'mele e tsoang setsing sa insulin e leng thata,
• phetoho ho secretion ea "insulin" makhophong.

Pehelo ea mafu

Ho latela boholo ba mofuta oa lefu la tsoekere la 2, e tla aroloa ka likarolo tse latelang:

1. tekanyo e bonolo. E tšoauoa ka bokhoni ba ho lefella ho haella ha insulin, ho latela ts'ebeliso ea lithethefatsi le lijo tse ka fokotsang tsoekere ea mali ka nako e khuts'oane,
2. degree e mahareng. O ka buseletsa liphetoho tsa metabolic ha feela ho sebelisoa meriana e ka bang 2-3 ho fokotsa tsoekere. Boemong bona, ho hloleha ha metabolic ho tla kopanngoa le angiopathy,
3. mohato o boima. Ho lokisa maemo ho hloka hore ho sebelisoe mekhoa e mengata ea ho theola tsoekere le ho enta insulin. Mokuli mothating ona o atisa ho ba le mathata.

Mofuta oa 2 oa lefu la tsoekere ke eng?

Setšoantšo sa kliniki ea lefu la tsoekere se tla ba le mekato e 'meli:

• bohato bo potlakileng. Ho tšela ka potlako insulin e bokellaneng ka lebaka la tsoekere,
• butle butle. Ho lokolloa ha insulin ho fokotsa tsoekere e phahameng ea mali ho ea butle. E qala ho sebetsa hang ka mor'a karolo e potlakileng, empa ho latela botsitso bo sa lekaneng ba lik'habohaedreite.

Haeba ho na le lefu la lisele tsa beta tse sa nahaneleng litlamorao tsa li-pancreas, ho se leka-lekane ha palo ea lik'habohaedreite maling ho ba butle butle. Mofuta oa 2 lefu la tsoekere, lefu le potlakileng ha le eo, 'me mohato oa lona o potlaka haholo. Tlhahiso ea insulin ha e na thuso ebile ka lebaka lena ho ke ke ha khoneha ho tsitsisa ts'ebetso.

Ha ho na le ts'ebetso e sa lekaneng ea insulin receptor kapa mekhoa ea post-receptor, hyperinsulinemia ea hlaha. Ka tekanyo e phahameng ea insulin maling, 'mele o qala mochine oa mats'oafo a oona, oo sepheo sa ona e leng ho tiisa botsitso ba lihormone. Letšoao lena le nang le tšoaetso le ka bonoa leha e sa le qalong ea lefu lena.

Setšoantšo se totobetseng sa lefu la tsoekere se hlaha ka mor'a ho phehella hyperglycemia ka lilemo tse 'maloa. Tsoekere e ngata haholo e ama lisele tsa beta. Ena ke lebaka la ho tepella le ho roala ha bona, ho bakang ho theoha hoa tlhahiso ea insulin.

Ka karolelano, khaello ea insulin e tla bonahatsoa ke phetoho ea boima le sebopeho sa ketoacidosis. Ntle le moo, matšoao a lefu la tsoekere la mofuta ona e tla ba:

• polydipsia le polyuria. Metabolic syndrome e hlaha ka lebaka la hyperglycemia, e bakang keketseho ea khatello ea mali ea osmotic. Ho etsa hore maemo a fetohe, mmele o qala ho tlosa ka matla metsi le li-electrolyte,
• ho hlohlona ha letlalo. Matlalo a letlalo ka lebaka la keketseho e matla ea urea le li-ketane maling.
• ho nona haholo.

Ho hanyetsa insulin ho tla baka mathata a mangata, a mantlha le a bobeli. Kahoo, sehlopha sa pele sa lingaka se kenyeletsa: hyperglycemia, ho theoha butle-butle tlhahiso ea glycogen, glucosuria, thibelo ea tšebetso ea 'mele.

Sehlopha sa bobeli sa mathata se lokela ho kenyelletsa: ho hlohlelletsa ho tsoa ha lipids le protheine bakeng sa phetoho ea bona ea lik'habohaedreite, thibelo ea tlhahiso ea mafura le liprotheine, ho fokotseha ho mamelleha ha lik'habohaedreite tse omisitsoeng, tse sitisang secretion ea kapele ea lihormone.

Mofuta oa 2 oa lefu la tsoekere o tloaelehile ka ho lekana. Ka kakaretso, matšoao a tšoaetso ea lefu lena a ka feta tekanyo e boletsoeng ea makhetlo a 2-3.

Ho feta moo, bakuli ba batla thuso ea bongaka feela kamora ho qaleha ha mathata a tebileng le a kotsi. Ka lebaka lena, li-endocrinologists li tsitlella hore ho bohlokoa hore u se ke oa lebala ka liteko tse tloaelehileng tsa bongaka. Li tla thusa ho tseba bothata kapele le ho qala kalafo kapele.