Mofuta oa 1 lefu la tsoekere ho bana le bacha: etiopathogenesis, tleliniki, kalafo

Tlhahlobo e hlahisa maikutlo a sejoale-joale mabapi le etiology, pathophysiology ea nts'etsopele ea lefu la tsoekere la mofuta oa 1 ho bana le bacha, lintlha tsa tlhahlobo le likarolo tsa kalafo ea insulin. Matšoao a ka sehloohong a lefu la tsoekere la ketoacidosis le kalafo ea lona lia totobatsoa.

Tlhahlobo e hlahisa maikutlo a sejoale-joale mabapi le etiology, pathophysiology ea mofuta oa 1 lefu la tsoekere ho bana le lilemong tsa bocha, litekanyetso tsa tlhahlobo le likarolo tsa insulin. E totobatsa likarolo tsa bohlokoa tsa lefu la tsoekere la ketoacidosis le kalafo.

Lefu la tsoekere mellitus (DM) ke sehlopha sa mafu a metabolic a nang le tšoaetso ea "hyperglycemia" ka lebaka la secretion e sa sebetseng kapa ketso ea insulin, kapa motsoako oa mafu ana.

Ka lekhetlo la pele, lefu la tsoekere le hlalosoa India ea khale lilemong tse fetang likete tse 2 tse fetileng. Hajoale, ho na le bakuli ba fetang limilione tse 230 ba nang le lefu la tsoekere lefats'eng, Russia - 2,076 000. Ha e le hantle, ho ata ha lefu la tsoekere ho phahame, hobane mefuta ea bona ea morao-rao ha e nkeloe hloko, ke hore, ho na le "lefu la seoa le sa foleng" la lefu la tsoekere.

Sehlopha sa lefu la tsoekere

Ho latela sehlopha sa sejoale-joale, ho na le:

Mofuta oa 1 lefu la tsoekere (lefu la tsoekere la 1), le atileng haholo bongoaneng le bohlankeng. Mefuta e 'meli ea lefu lena e arohantsoe: a) mofuta oa lefu la tsoekere la autoimmune (le bonts'itsoeng ka ts'enyo ea mmele ea ts'oaetso ea β-cell - insulin), b) idiopathic mofuta 1 lefu la tsoekere, le hlaha hape ka ts'enyo ea lisele tsa β-cell, empa ntle le matšoao a ts'ebetso ea autoimmune.
Mofuta oa lefu la tsoekere la mofuta oa 2 (lefu la tsoekere la mofuta oa 2), le khetholloang ka lebaka la bofokoli ba insulin le ho holofala le ho hloka insulin.
Mefuta e ikhethileng ea lefu la tsoekere.
Lefu la tsoekere.

Mefuta e atileng haholo ea lefu la tsoekere ke mofuta oa 1 lefu la tsoekere le lefu la tsoekere la mofuta oa 2. Ka nako e telele, ho ne ho lumeloa hore mofuta oa 1 lefu la tsoekere ke tšobotsi ea bongoana. Leha ho le joalo, patlisiso e fetang lilemo tse leshome tse fetileng e sisintse kopo ena. Ka ho eketsehileng, o ile a qala ho fumanoa ho bana ba nang le lefu la tsoekere la mofuta oa 2, le hlahang ho batho ba baholo ka mor'a lilemo tse 40. Linaheng tse ling, lefu la tsoekere la mofuta oa 2 le tloaelehile haholo ho bana ho feta lefu la tsoekere la 1, ka lebaka la liphatsa tsa lefutso le ho ata ha botenya.

Epidemiology ea lefu la tsoekere

Rejista e hlophisitsoeng ea naha le ea tikoloho ea lefu la tsoekere la 1 ho bana le lilemong tsa bocha e bontšitse phapang e batsi ea ho etsahala le ho ata ha batho ho latela linaha tsa lefatše tse fapaneng (ho tloha ho tse 7 ho isa ho 40 ho bana ba likete tse lekholo ka selemo). Ka mashome a lilemo, ts'oaetso ea lefu la tsoekere la mofuta oa 1 ho bana e ntse e eketseha ka sekhahla. Karolo ea kotara ea bakuli e ka tlase ho lilemo tse 'ne. Mathoasong a 2010, bana ba likete tse 479.6 ba nang le lefu la tsoekere 1 ba ngolisitsoe lefatšeng. Palo ea ba sa tsoa tsebahala ba 75,800. Kholo ea selemo le selemo ea 3%.

Ho latela Ngoliso ea Naha, ho tloha ka 01.01.2011, bana ba 17 519 ba nang le lefu la tsoekere ba 1 ba ngolisitsoe 'Musong oa Russia, bao ho bona ba 2911 e neng e le linyeoe tse ncha. Tekanyo e tloaelehileng ea bana ba Pusong ea Russia ke 11,2 ho bana ba likete tse 100. Lefu lena le iponahatsa ka nako efe kapa efe (ho na le lefu la tsoekere la tlhaho), empa hangata bana ba kula ka linako tsa kholo e kholo (lilemo tse 4-6, lilemo tse 8-12, ho kena bohlankaneng) . Masea a ameha ka 0.5% ea maemo a lefu la tsoekere.

Ho fapana le linaha tse nang le sekhahla se seholo sa maemo a holimo, moo keketseho ea sona e phahameng e hlahang o le monyane lilemong, ho baahi ba Moscow ho eketseha ha maemo ho bonoa ka lebaka la bacha.

Etiology le pathogenesis ea lefu la tsoekere la mofuta oa 1

Mofuta oa 1 oa lefu la tsoekere ke lefu la autoimmune ho batho ba reriloeng esale pele ka lefutso, leo ho lona ho tsitsitseng ha li-lymphocytic insulitis ho isang timetsong ea lisele tsa β, ebe ho lateloa ke nts'etsopele ea khaello ea insulin ka botlalo. Mofuta oa 1 oa lefu la tsoekere o tšoauoa ka tšekamelo ea ho nts'etsapele ketoacidosis.

Bokapele ba mofuta oa 1 lefu la tsoekere la autoimmune bo khethoa ke tšebelisano ea liphatsa tsa lefutso tse ngata, ka tšusumetso ea mefuta e fapaneng ea liphatsa tsa lefutso, empa hape le tšebelisano ea lintho tse reriloeng esale pele le tse sireletsang.

Nako ho tloha qalong ea ts'ebetso ea autoimmune ho fihlela tsoekere ea mofuta oa 1 lefu la tsoekere e ka nka likhoeli tse 'maloa ho isa ho tse 10.

Tšoaetso ea vaerase (Coxsackie B, rubella, jj), lik'hemik'hale (alloxan, nitrate, jj) li ka nka karolo ho qala lits'ebetso tsa ts'ebetso ea lisele tsa islet.

Tšenyo ea Autoimmune ea lisele tsa β ke mohato o rarahaneng, o mekhahlelo e mengata, eo kahare ho ts'ireletso ea cellular le hum humer ho kengoa ts'ebetsong. Karolo ea mantlha kholisong ea insulin e bapaloa ke cytotoxic (CD8 +) T-lymphocyte.

Ho latela maikutlo a sejoale-joale a thibelo ea 'mele ea ho itšireletsa mafung, karolo ea bohlokoa ho qaleheng ha lefu ho tloha qalong ho isa ponahalong ea lefu la tsoekere.

Matšoao a timetso ea autoimmune ea lisele tsa β a kenyeletsa:

1) islet cell cytoplasmic autoantibodies (ICA),
2) anti-insulin li-antibodies (IAA),
3) li-antibodies ho protheine ea lisele tse islet tse nang le boima ba li-kD tse likete tse 64 (li na le limolek'hule tse tharo):

glutamate decarboxylase (GAD),
tyrosine phosphatase (IA-2L),
tyrosine phosphatase (IA-2B) Khafetsa khafetsa ea li-autoantibodies tse fapaneng mokhatlong oa lefu la tsoekere la 1: ICA - 70-90%, IAA - 43-69%, GAD - 52-77%, IA-L - 55-75%.

Nakong ea preclinical ea nako ea morao-rao, palo ea baahi ea β-lisele e fokotseha ka 50-70% ha e bapisoa le tloaelo, 'me tse setseng li ntse li boloka boemo ba insulin, empa mesebetsi ea bona ea lekunutu e fokotsehile.

Matšoao a phekolo ea lefu la tsoekere a hlaha ha palo e setseng ea β-cell e sa khone ho lefella tlhokahalo e eketsehileng ea insulin.

Insulin ke hormone e laolang mefuta eohle ea metabolism. E fana ka matla le lits'ebetso tsa polasetiki 'meleng. Litho tse ka sehloohong tsa insulin ke lisele, mesifa le adipose tiske. Ho tsona, insulin e na le litla-morao tsa anabolic le li-catabolic.

Matla a insulin ho metabolism ea carbohydrate

Insulin e fana ka bophahamo ba membrane ea lisele ho glucose ka ho hokahana le li-receptor tse ikhethang.
E kenya ts'ebetsong li-enzyme tsa intracellular tse tšehetsang metabolism ea glucose.
Insulin e phahamisa tsamaiso ea glycogen synthetase, e fanang ka motsoako oa glycogen o tsoang ho tsoekere e maling.
E hatella glycogenolysis (ho phatloha ha glycogen ho glucose).
E hatella gluconeogenesis (motsoako oa glucose o tsoang liprotheine le mafura).
E fokotsa khatello ea tsoekere maling.

Matla a insulin ho metabolism ea mafura

Insulin e hlohlelletsa lipogenesis.
E na le phello ea antilipolytic (lipocytes tse ka hare e thibela inthanete ea adenylate, e fokotsa cAMP ea lipocytes, e hlokahalang bakeng sa lits'ebetso tsa lipolysis).

Khaello ea insulin e baka lipolysis tse eketsehileng (ho phatloha ha triglycerides ho mafura acid acids (FFAs) a adipocytes). Keketseho ea palo ea FFA ke sesosa sa mafura a mangata le keketseho ea boholo ba eona. Ho bola ha FFA ho matlafatsoa ka ho etsoa ha 'mele oa ketone.

Matla a insulin ho metabolism ea protheine

Insulin e khothalletsa mofuta oa protheine liseleng tsa mesifa. Ho haella ha insulin ho baka ho phatloha (catabolism) ha lisele tsa mesifa, ho bokellana ha lihlahisoa tse nang le naetrojene (amino acid) le ho phahamisa gluconeogenesis ka har'a sebete.

Ho haella ha insulin ho eketsa ho lokolloa ha lihormone tse loantšanang, ts'ebetso ea glycogenolysis, gluconeogeneis. Sena sohle se lebisa ho hyperglycemia, ho eketseha ha osmolarity, ho omella ha lisele, glucosuria.

Mohato oa ho hlohlona ho thibelo ea mafu a tšoaetsanoang o ka nka likhoeli le lilemo, 'me li-antibodies li ka fumanoa tse tšoaeang li-autoimmunity ho β-cell (ICA, IAA, GAD, IA-L) le matšoao a lefutso a mofuta oa 1 lefu la tsoekere (preisposing le immune HLA haplotypes, e kotsi e lekanang e ka fapana hara merabe e fapaneng).

Lefu la tsoekere

Haeba nakong ea tlhahlobo ea mamello ea glucose ea molomo (OGTT) (tsoekere e sebelisoa ka tekanyo ea boima ba 'mele ba 1,75 g / kg ho fihlela tekanyo e phahameng ea 75 g), boemo ba tsoekere ea mali ke> 7.8, empa 11.1 mmol / L.

Phepelo ea glucose e potlakisang> 7.0 mmol / L.

Glucose lihora tse 2 kamora ho ikoetlisa> 11.1 mmol / L.

Ho motho ea phetseng hantle, tsoekere e ka moriring ha e eo. Glucosuria e etsahala ha litaba tsa glucose li le kaholimo ho 8.88 mmol / L.

Litopo tsa Ketone (acetoacetate, β-hydroxybutyrate le acetone) li thehoa ka har'a sebete ho tsoa mafura acids a mahala. Keketseho ea bona e bonoa ka khaello ea insulin. Ho na le metsero ea liteko bakeng sa ho fumana qeto ea acetoacetate ka moriring le boemo ba β-hydroxybutyrate maling (> 0.5 mmol / L). Karolong ea ho bola ea lefu la tsoekere la mofuta oa 1 ntle le ketoacidosis, 'mele oa acetone le acidosis ha o eo.

Glycated hemoglobin. Maling, tsoekere e kenella molek'huleng ea hemoglobin ha e thehoa ka hemoglobin e tsoang glycated₁ kapa karoloana ea eona "C" NVA_1s), i.e., e bonts'a boemo ba metabolism ea carbohydrate bakeng sa likhoeli tse 3. Boemo ba HBA₁ - 5-7.8% e tloaelehileng, boemo ba likotoana tse nyane (HBA_1s) - 4-6%. Ka hyperglycemia, hemoglobin e phahameng e phahame.

Tlhahlobo e fapaneng

Ho fihla joale, ho hlahlojoa ha lefu la tsoekere la mofuta oa 1 ho ntse ho sebetsa. Ho bana ba fetang 80%, lefu la tsoekere le fumanoa le le maemong a ketoacidosis. Ho ipapisitse le tšoaetso ea matšoao a itseng a kliniki, motho o lokela ho fapana le:

1) pathology ea ho buoa (appendicitis e hlobaetsang, "mpa e hlabang"),
2) mafu a tšoaetsanoang (feberu, pneumonia, meningitis),
3) maloetse a pampitsana ea mala: (toxicoinfection, gastroenteritis, jj),
4) lefu la liphio (pyelonephritis),
5) maloetse a tsamaiso ea methapo (lesapo la mokokotlo, vesttovascular dystonia),
6) lefu la tsoekere.

Ka nts'etsopele ea butle-butle ea lefu lena, tlhahlobo e khethollang e etsoa lipakeng tsa lefu la tsoekere la 1, lefu la tsoekere la mofuta oa 2 le lefu la tsoekere la batho ba baholo ho bacha (MODI).

Type 1 lefu la tsoekere

Mofuta oa 1 oa lefu la tsoekere oa hlaha ka lebaka la khaello ea insulin e felletseng. Bakuli bohle ba nang le mofuta oa mofuta oa 1 lefu la tsoekere ba fuoe kalafo ea phetisetso ea insulin.

Ho motho ea phetseng hantle, secretion ea "insulin" e lula e etsahala ho sa tsotelehe takatso ea lijo (basal). Empa ha o arabela lijong, secretion ea eona ea ntlafatsoa (bolus) ha e arabela hyperglycemia ea ka mor'a phepo. Insulin e bolokiloe ke lisele tsa β ka har'a portal system. 50% ea eona e jeoa ka har'a sebete ho fetola tsoekere ho glycogen, karolo e setseng ea 50% e tsamaisoa ka potoloho e kholo ea phallo ea mali ho ea litho.

Ho bakuli ba nang le lefu la tsoekere la mofuta oa 1, insulin ea tlhaho e kenngoa ka mokhoa o ikhethileng, 'me butle-butle e kenella maling a mangata (eseng ho sebete, joalo ka ba phetseng hantle), moo khatello ea eona e lulang e le telele ka nako e telele. Ka lebaka leo, glycemia ea bona ea post-mortem e phahame, mme lihoreng tsa morao ho na le tšekamelo ea hypoglycemia.

Ka lehlakoreng le leng, glycogen ho bakuli ba nang le lefu la tsoekere e kenngoa haholo mesifa, 'me mehloli ea eona ea sebete e fokotsehile. Musical glycogen ha e kenelle ho boloka standardoglycemia.

Ho bana, ho sebelisoa li-insulin tse fumanoeng ke mekhoa ea biosynthetic (genetic engineering) e sebelisang theknoloji ea DNA e kopantsoeng.

Tekanyo ea insulin e itšetlehile ka lilemo le tsoekere ea lefu la tsoekere. Lilemong tse 2 tse qalang, tlhoko ea insulin ke boima ba 0.5-0.6 U / kg ka letsatsi. Morero o atileng ka ho fetesisa o fumanehang ka matla haholo (bolus-base) oa ho tsamaisa insulin.

Qala kalafo ea "insulin" ka ho hlahisa insulin e khutšoanyane kapa e khuts'oane ea nakoana (tafole. 1). Motsoako oa pele ho bana ba lilemo tsa pele tsa bophelo ke li-unit tsa 0.5-1, ho bana ba sekolo 2-5, lihlopheng tsa 4-6 tsa bacha. Phetoho e eketsehileng ea insulin e etsoa ho latela boemo ba tsoekere maling. Ka ho lumellana ha maemo a metabolism a mokuli, a fetisetsoa mokatong oa setsi sa bolus, o kopanya li-insulin tse khutšoane le tse telele.

Li-insulin li fumaneha ka lipompong le mabokoseng. Lijana tsa seratsoana tse sebelisoang ka ho fetisisa tsa insulin.

Bakeng sa khetho ea lethal dose e nepahetseng ea insulin, mokhoa o pharaletseng oa ho lekola tsoekere (CGMS) o sebelisitsoe haholo. Sistimi ena ea mobile, e apereng lebanta la mokuli, e tlaleha boemo ba tsoekere maling maling ka mor'a metsotso e meng le e meng e 5 ka matsatsi a mararo. Lintlha tsena li kenngoa ts'ebetsong ea likhomphutha mme li hlahisoa ka mokhoa oa litafole le li-graph moo ho feto-fetohang ho feto-fetoha ha maemo ho glycemia.

Lipompo tsa insulin. Sena ke sesebelisoa sa elektroniki se tsamaeang ka lebanta. Pompo ea insulin e laoloang ke k'homphieutha e na le insulin e nkang nakoana 'me e fanoa ka mekhoa e' meli, bolus le basement.

Lijo

Ntho ea bohlokoa ea ho lefella lefu la tsoekere ke lijo. Melao-kakaretso ea phepo e nepahetseng e tšoana hantle le ngoana ea phetseng hantle. Tekanyo ea liprotheine, mafura, lik'habohaedreite, lik'hilojule li lokela ho lumellana le lilemo tsa ngoana.

Tse ling tsa likarolo tsa phepelo ho bana ba nang le lefu la tsoekere:

Fokotsa, 'me baneng ba banyenyane, tlosa tsoekere e hloekisitsoeng ka botlalo
Lijo li khothalletsoa ho lokisoa.
Lijo li lokela ho ba le lijo tsa hoseng, lijo tsa mots'eare, lijo tsa mantsiboea le lino tse tharo ka 1.5-2 lihora tse ngata kamora lijo tse kholo.

Phello e matlafatsang ea tsoekere ea lijo e bakoa haholo ke bongata le boleng ba lik'habohaedreite.

Ho latela index ea glycemic, ho hlahisoa lihlahisoa tsa lijo tse eketsang maemo a tsoekere ea mali kapele haholo (monate). Li sebelisetsoa ho emisa hypoglycemia.

Lijo tse eketsang tsoekere ea mali kapele (bohobe bo tšoeu, likharafu, lijo-thollo, tsoekere, liswiti).
Lijo tse eketsang tsoekere ea mali ka tekano (litapole, meroho, nama, chisi, lisose).
Lijo tse eketsang tsoekere ea mali butle-butle (tse nang le mafura a mangata le mafura, joalo ka bohobe bo sootho, tlhapi).
Lijo tse sa eketseng tsoekere ea mali ke meroho.

Ho ikoetlisa

Ho ikoetlisa ke ntho ea bohlokoa e laolang metabolism ea carbohydrate. Ka ts'ebetso ea 'mele ho batho ba phetseng hantle, ho na le ho fokotseha ha secretion ea insulin ka keketseho e ts'oanang ka nako e le ngoe ho hlahiseng lihormone tse loantšanang. Sebeteng, tlhahiso ea tsoekere e tsoang metsong e sa amaneng le 'mele ea "gluconeogeneis" e ea matlafatsoa. Sena se sebetsa e le mohloli oa bohlokoa oa ona nakong ea boikoetliso 'me se lekana le boleng ba ts'ebeliso ea tsoekere ke mesifa.

Ho hlahisa lihlahisoa tsa glucose hoa eketseha ha boikoetliso bo ntse bo eketseha. Tekanyo ea tsoekere e lula e tsitsitse.

Ho mofuta oa 1 lefu la tsoekere, ketso ea "insulin" ea ka ntle ha e felle ka ts'ebetso ea 'mele,' me phello ea lihormone tsa li-contra ha ea lekana ho lokisa maemo a glucose. Ntlheng ena, nakong ea boikoetliso kapa hang ka mor'a ho ka bonoa hypoglycemia. Hoo e batlang e le mefuta eohle ea boikoetliso ba 'mele bo fetang metsotso e 30 e hloka hore ho fetoloe lijo le / kapa tekanyetso ea insulin.

Ho itaola

Morero oa boitšoaro ke ho ruta mokuli ea nang le lefu la tsoekere le litho tsa lelapa la hae hore a ikemele ho fana ka thuso. E kenyeletsa:

mehopolo e akaretsang ka lefu la tsoekere,
bokhoni ba ho khetholla tsoekere ka glucometer,
Lokisa tekanyetso ea insulin
Bala likarolo tsa bohobe
bokhoni ba ho tlosa boemong ba hypoglycemic,
boloka letoto la boitšoaro.

Tloaelo ea maemo sechabeng

Ha ho khetholla lefu la tsoekere ho ngoana, batsoali hangata baa lahleha, kaha lefu lena le ama tsela eo lelapa le phelang ka eona. Ho na le mathata a kalafo e sa khaotseng, phepo e nepahetseng, hypoglycemia, maloetse a kopaneng. Ha ngoana a ntse a hola, maikutlo a hae ka lefu lena a thehoa. Nakong ea ho kena bohlankaneng, lintho tse ngata tsa 'mele le tsa kelello li thatafatsa taolo ea tsoekere. Sena sohle se hloka thuso e felletseng ea kelello le ba malapa ho tsoa ho litho tsa lelapa, setsebi sa endocrinologist le psychologist.