1dị 1 na anddị Ọrịa Shuga 2: Pathophysiology na acheszọ Ọgwụgwọ

Ọrịa shuga nke mbụ(insulin na-arịa ọrịa shuga mellitus, ụdị shuga mellitus 1, ọrịa shuga).ọrịa ahụisi ihe nchọpụta banyere ọrịa bụ nke adịghị ala alahyperglycemia- shuga di elu,polyuriaN'ihi nke a -akpịrị ịkpọ nkụ, oke ibu, oke nri, ma obu enweghi ya, ike adighi nma.Ọrịa shuga mellituspụtara na iche icheọrịaeduga na ibelata njikọta na nzuzoinsulin. A na-enyocha ọrụ nke ihe nketa.

Ọrịa shuga 1dị 1(ọrịa shuga na-adabere na shuga, ọrịa shuga) - ọrịa nke usoro endocrine, nke kpatara insulin zuru oke kpatara mbibi.mkpụrụ ndụ betapancreas. Ọrịa shuga 1dị nke Mbụ nwere ike itolite na afọ ọ bụla, mana ndị na-eto eto (ụmụaka, ndị na-eto eto, ndị okenye na-erubeghị afọ 30) na-emetụtakarị. Ejiri akara kpochapụla bu ddi:akpịrị ịkpọ nkụ,polyuriaifelataỌnọdụ ketoacidotic.

1Etiology na pathogenesis

2.1Nhazi ọkwa nke Efimov A.S., 1983

2.2Nke Ndị Otu Ahụike Ahụike WHO (Geneva, 1987)

2.3Nhazi ọkwa (M.I. Balabolkin, 1994)

3Pathogenesis na histopathology

4Foto nyocha

Etiology na pathogenesis

Usoro pathogenetic nke mmepe nke ụdị oria 1 na-esite na ezughi oke nke mmepụta insulin site na mkpụrụ ndụ endocrine (β mkpụrụ ndụagwaetiti nke Langerhanspancreas), ihe kpatara mbibi ha n'okpuru nsonaazụ nke ụfọdụ ihe pathogenic (njeoria,nrụgide,ọrịa autoimmunena ndi ozo). 1dị nke shuga 1 na-akpata 10-15% nke ọrịa shuga niile, na-etolite na nwata ma ọ bụ n'oge uto. A na-ahụ ụdị ọrịa shuga a n'ọdịdị nke mgbaàmà isi, nke na-aga n’ihu n’ihu n’oge. Mainzọ ọgwụgwọ bụ isiinje insulinnormalizing onye ọrịa metabolism. Ọ bụrụ na agwọghị ya ọrịa, ụdị shuga nke 1 na-aga n’ihu ngwa ngwa ma na-eduga na nnukwu nsogbu dịkaketoacidosisnaọrịa mamịrịna-ejedebe na ọnwụ nke onye ọrịa.

Nkewa

Nkewa site na Efimov A.S., 1983

I. linlọọgwụ:

Ihe mbu: nkpuru ndu, ihe di nkpa (ya na obesema ọ bụ na-enweghị ya).

Secondary (symptomatic): pituitary, steroid, thyroid, adrenal, pancreatic (mbufụt nke pancreas, tumo ma ọ bụ mwepụ), ọla (na hemochromatosis).

Ọrịa afọ ime(mmeme).

II. Site na ogo:

III. Ofdị ọrịa shuga mellitus (ọdịdị ya):

ụdị - insulin-based (labile nwere mmasi ya acidosisnahypoglycemia, nke ka nke dimkpa)

ụdị - nwegasighi insulin(kwụsie ike, ọrịa shuga mellitus).

Nkem. Carbohydrate metabolism ụgwọ akwụ ụgwọ ọnọdụ:

V. nnwetaọrịa shuga na-arịa ọrịa mamịrị(M, II, III ogbo) naneuropathy.

Microangiopathy—retinopathy,nephropathy, capillaropathy nke nsọtụ ala ma ọ bụ ịkọwapụta mpaghara ndị ọzọ.

Macroangiopathy- ya na ọnya nke mbu nke akwara, ụbụrụ,ukwu,uzo ozo.

Universal micro- na macroangiopathy.

Polyneuropathy(ime ihe, akpala ma ọ bụ visceral).

VI.Ọkpụkpụ nke akụkụ ahụ ndị ọzọ na sistem:ịba ọcha n'anya,cataract,oria ara,osteoarthropathyna ndi ozo).

VII. Ọrịa siri ike nke ọrịa shuga:

Nke Ndị Otu Ahụike Ahụike WHO (Geneva, 1987)

Nhazi ọkwa (M.I. Balabolkin, 1994)

Pathogenesis na pathohistology

Enweghi ike insulinn’ahụ mmadụ na-amalite n’ihi ịmachapụ nke ọmamkpụrụ ndụagwaetiti nke Langerhanspancreas.

N'ihi ụkọ insulin, akwara ndị na-emetụta insulin (ịba ọcha n'anya,abụbanaakwara) tụfuo ikike ha nwere iji glucoseọbaran'ihi ya, ọ̀tọ glucose n'ọbara na-ebili (hyperglycemia) Bu akara kaadi oria n’ariri oria shuga. N'ihi ụkọ insulin, a na-akwalite ọdịda abụba na anụ ahụ adipose.abụba, nke na-eduga n’ịba ụba n’ọkwa ha n’ime ọbara, yana n’arụ akwara - na-akpali mkpaliproteinna-eduga n'ịba ụba oririamino acidn’ime ọbara. Na-ekwupụta okwucatabolismabụba na protein na-agbanwe umeji imejuozu ketonenke a na - eji anụ ahụ na - abụghị insulin na - arụ ọrụ (ọkachasịụbụrụ) ime ka ikike dịrị n'otu ghara ịbanye na ụkọ insulin.

Glucosuriabụ usoro pụrụ ịgbanwe ekwesi iji welata glucose dị n'ọbara mgbe ọkwa glucose gafere ókè ụlọ gịakụrụuru (ihe dị ka 10 mmol / l). Ọrịa shuga bụ ihe na-arụ ọrụ nke ukwuu na mmụba ya na mmamịrị na-akpali mmụba nke mmiri (polyuria), nke n'ikpeazụ nwere ike iduga gịakpịrị ịkpọ nkụakụkụ ahụma ọ bụrụ na mmiri anaghị emebi site na mmiri zuru oke oriri (polydipsia) Yana mmiri mmiri mmamịrị na-aba ụba, mmiri nnu a na-efunahụkwa - ụkọ bidoroanakposodium,potassium,kalshialnamagnesium,anionschlorine,phosphatenabicarbonate .

Enwere ọnọdụ isii nke uto shuga mellitus nke ụdị mbụ (insulin-based):

Ọrịa mkpụrụ ndụ ihe nketa ga-ebute ọrịa shuga metụtara usoro HLA.

Hypothetical malite iyi. Mmebi mkpụrụ ndụihe diabetogenic di iche iche ma na - akpalite usoro mgbochi. Ndị ọrịa enweelarị ọgwụ mgbochi maka mkpụrụ ndụ islet na obere titer, mana ịmịnye insulin anaghị ata ahụhụ.

Insulin na-arụsi ọrụ ike. Onye na-akpọ antibody tit dị elu, ọnụọgụ sel na-agbada, insulin na-agbadata.

Mbelata insulin na-akpali glucose. N’ọnọdụ ndị na-akpata nchekasị, onye ọrịa ahụ nwere ike ịchọpụta nnabata glucose na-adịghị adịte aka (NTG) yana nsogbu glucose plasma glucose (NGF).

Clinical ngosipụta nke ọrịa shuga, tinyere a ga-ekwe omume merenụ nke "honiimuunu". A na-ebelata insulin na-egbusi ike nke ukwuu, ebe ihe karịrị 90% nke mkpụrụ ndụ β-nwụrụ.

Mbibi zuru ezu nke mkpụrụ ndụ ess, ịkwụsịchapu ikuku insulin.

Ọrịa fiolojiiki: kedu ihe ọ bụ?

Fisiolololo ogwu nke bu ihe omuma ya bu imuta ndu nke oria ma obu anumanu.

Ebumnuche ebumnuche nke ụzọ a bụ ịmụ usoro nke mmepe nke ọrịa dị iche iche na usoro ọgwụgwọ, yana ịchọpụta isi na iwu izugbe nke usoro dị iche iche na akụkụ nke ndị ọrịa.

Gịnị pathology physiology ọmụmụ:

• mmepe nke usoro nje di iche-iche, yana nsonaazụ ha,
• ihe na omume nke ọrịa,
• ọdịdị nke mmepe nke ọrụ arụmọrụ dabere na steeti ahụ mmadụ nwere ọrịa dị iche iche.

Pathophysiology nke ọrịa shuga

A maara na usoro pathophysiological maka mmepe nke ụdị ọrịa shuga bụ nke sitere na obere insulin nke mkpụrụ ndụ endocrine mepụtara.

N'ụzọ bụ isi, ọrịa shuga na-apụta na ọkwa a na 5-10% nke ndị ọrịa, mgbe nke ahụ gasịrị, na-enweghị ọgwụgwọ dị mkpa, ọ na-amalite inwe ọganihu ma bụrụ ihe kpatara mmepe nke ọtụtụ nsogbu dị njọ, gụnyere:

• ọrịa obi na-arịa ọrịa mamịrị
• gbasara akwara
• ketoacidosis
• ọrịa shuga retinopathy,
• ọrịa strok
• ọnya afọ.

N'ihi ọnụnọ insulin, akwara nke na-egbochi homonụ na-enwe ike ị absorụ shuga, nke a na-eduga na hyperglycemia, nke bụ otu n'ime ihe mgbaàmà nke ụdị 1 diabetes mellitus.

N'ihi ihe omume a na - eme na anụ ahụ adipose, egbugbere ọnụ na - akụda, nke na - aghọ ihe mere ha ji abawanye ụba, ma usoro protein na - agbadata na akwara akwara, nke na - eduga n'ịba ụba nke amino acid.

Enwere ike ịrịa ọrịa shuga IIdị nke abụọ dị ala, nwere ike ịnwe ụdị nsogbu atọ:

1. ihe bu ihe nnabata nke insulin. Enwere mmebi nke mmeju nke mmetụta insulin, ebe a na-echekwa β-mkpụrụ ndụ ma nwee ike imepụta insulin zuru ezu.
2. mkpụrụ ndụ na-ezughị ezu. Imebi ihe a bụ ntụpọ sitere na mkpụrụ ndụ nke mkpụrụ ndụ not anaghị agbaji, ma insulin insulin na-ebelata nke ukwuu.
3. mmetụta nke contra-ihe.

Ihe omume nke nguzogide insulin nwere ike ime na ọkwa nnabata na postreceptor.

Usoro nnabata na-agụnye:

• mbibi nke ndị na-anabata ya site na radicals na enzymes na-enweghị atụ,
• mgbochi nke ndị na - anabata insulin site na ọgwụ ndị na - e structureomi usoro ya.
• mgbanwe mgbanwe conrol nke ndị na - anabata insulin na - eme n'ihi ihe ndapụta nke mkpụrụ ndụ,
• mbelata na uche nke mkpụrụ ndụ nke insulin na-eme n'ihi mmụba insulin na ọbara na-abawanye ụba n'ime ndị mmadụ na-areatụbiga mmanya ókè.
• mgbanwe mgbanwe conrol nke ndị na - anabata insulin n'ihi ntụpọ nke mkpụrụ ndụ ihe nketa na - akpata ọrụ nke polypeptides ha.

Usoro Postreceptor gụnyere:

• imebi usoro intracellular nke iwepu shuga,
• ezughi oke nke ndị na-ebugharị glucose na-eche nche. A na-ahụkarị usoro a na ndị buru oke ibu.

Ọrịa mamịrị

Ndị ọrịa mamịrị kwesịrị iji nlezianya nyochaa ọnọdụ ha, ileghara ndụmọdụ dọkịta anya ga-eduga mmepe nke nsogbu dị iche iche:

• nnukwu nsogbu. Ndị a gụnyere ketoacidosis (mkpo nke anụ ketone dị ize ndụ na ahụ), hyperosmolar (shuga dị elu na sodium na plasma) na lacticidotic (mkpokọta lactic acid n'ime ọbara) coma, hypoglycemia (mbelata ọbara dị ala nke ọbara),
• nsogbu na-adịghị ala alam. Gosiputa, dị ka a na-achị, mgbe afọ 10-15 nke ọnụnọ nke ọrịa ahụ. Agbanyeghị omume dị ka ọgwụgwọ, ọrịa shuga na-emetụta ahụ mmadụ, nke na-eduga ná nsogbu na-adịghị ala ala, akụkụ ahụ dị iche iche na-ata ahụhụ: akụrụ (nsị na ụkọ), akwara ọbara (permeability na-adịghị mma, nke na-egbochi oriri nke ihe bara uru na oxygen), anụ ahụ (ọkọnọ ọbara dị ala, ọnya trophic) ) ụjọ usoro, ụjọ na-atụ ya, adịghị ike na mgbu mgbe niile.
• oge nsogbu. Effectsdị mmetụta ahụ na-ebulite nwayọ nwayọ, mana nke a na-emerụ ahụ nke ndị ọrịa mamịrị. N'ime ha: angiopathy (nhụsianya nke arịa ọbara), ụkwụ ọrịa shuga (ọnya na ọnya yiri nke ala ala), retinopathy (mkpochapu nke retina), polyneuropathy (enweghị uche na aka na ụkwụ iji kpo oku na mgbu).

Hozọ Pathophysiological na-agwọ ọrịa shuga

Ọrịa shuga na-atụ egwu ọgwụgwọ a, dị ka ọkụ!

Naanị ịchọrọ itinye ...

Mgbe ị na-agwọ ụdị ọrịa shuga ọ bụla, ndị dọkịta na-eji ụzọ atọ mbụ:

1. hypoglycemic ọgwụgwọ,
2. mmụta ndidi
3. nri.

Yabụ, n'ụdị nke mbụ, a na-eji ọgwụ insulin eme ihe, ebe ọ bụ na ndị ọrịa a na-ahụ erughi oke ya, ọ dịkwa ha mkpa iji dochie anya aka. Ebumnuche ya bụ ebulite ihe atụ nke homonụ eke.

Ekwesịrị ikpebi usoro onunu ogwu ya naanị ka onye dibia nọ maka ndị ọrịa niile n'otu n'otu. N'ihe banyere ndị ọrịa mamịrị 2, a na-eji ọgwụ ndị dị ala belata ọbara shuga eme ihe site n'ịgba ume ahụ.

Otu iwu dị mkpa maka ọgwụgwọ maka nchọpụta ahụ bụ omume ziri ezi nke onye ọrịa nye ya. Ndị dọkịta na-etinye oge dị ukwuu n’ịmụta ụzọ ziri ezi isi biri ọrịa shuga.

A na-emegharị nri ahụ nke ọma, a na-ewepụ omume ọjọọ na nrụgide, a na-agbakwunye mmega ahụ oge ọ bụla, onye ọrịa ahụ ga-ekwesịrị ileba anya mgbe niile na-egosi ọbara glucose ọbara (enwere glucose maka nke a).

Ikekwe, ndị ọrịa amarala ụdị nri pụrụ iche (table Nke 9) maka ogologo oge.

Ọ chọrọ mwepu nke ọtụtụ ngwaahịa, ma ọ bụ dochie ha. Iji maa atụ, anụ mara abụba, azụ na ahịhịa, achịcha na ihe ndị na-atọ ụtọ, chiiz ụlọ, bọta, chiiz nnu, bọta, pasta, semolina, osikapa, mkpụrụ osisi na-atọ ụtọ, nri mkpọ (gụnyere nri ndị a gbara n’ọzọ), ihe ọ juụ withụ nnukwu shuga, soda.

Enwere ike iri nri ndị ọzọ, mana ị ga-enyocha ọnụ ọgụgụ kalori riri kwa ụbọchị, yana ọnụọgụ nke carbohydrates - agaghị enwe ọtụtụ n'ime ha.

Ọ dabara nke ọma, na ụlọ ahịa niile enwere ngalaba ugbu a na ngwaahịa maka ahapụrụ ndị ọrịa shuga, nke na-eme ka ndụ ha dị mfe.

Ọrịa shuga na ọrịa shuga

Enweghị insulin na-arịa ọrịa shuga na-eduga n'ụzọ dị ukwuu mbelata glucose site na mkpụrụ ndụ na hyperglycemia. A na-ahụ ọkwa glucose plasma dị elu n'oge na-adịghị anya mgbe erichara (nke a na-akpọ postprandial hyperglycemia).

Dị ka ọ na-adịkarị, renal glomeruli bụ glucose, mana mgbe ọkwa plasma dị elu karịa 9-10 mmol / l, ọ na-amalite ịgbadosi ike na mmamịrị (glucose-ria). Nke a n'aka nke a na-eduga na mmụba osmotic mmamịrị, na mbelata nke reabsorption nke mmiri na electrolytes site akụrụ. Ọnụ ọgụgụ mmamịrị kwa ụbọchị na-abawanye ruo lita 3-5 (7-8 lita na nsogbu), i.e. na-emepe emepe poly uria n'ihi nsonaazụ akpịrị (ịmịkọrọ mmiri) ngwaa (fig 27.1) na

Fig. 27.1. Ọrịa pathophysiology nke ụkọ insulin.

Fig. 27.1. Pathophysiology

oké akpịrị ịkpọ nkụ. Na enweghị insulin, oke mbibi nke protein na abụba na - eme, nke mkpụrụ ndụ na - eji dị ka isi iyi ike. N'otu aka, ahụ na - efunahụ nitrogen (n'ụdị urea) na amino acid, n'aka nke ọzọ, ọ na - achikọta ihe na - egbu egbu nke lipolysis - ketones 1. Nke ikpeazụ a na-arụ ọrụ dị oke mkpa na pathophysiology nke ọrịa shuga mellitus: mkpochapu asịd siri ike site n'ahụ ahụ, nke bụ acetoacetic na p-hydroxybutyric acid, na-eduga na ọnwụ nke mkpobe nchekwa, mbelata nke nchekwa alkaline na ketoacidosis. Nke kachasị emetụ mgbanwe maka mgbanwe osmotic ọbara na usoro nke acid-base balance of tissue ụbụrụ. Mmụba na ketoacidosis nwere ike ibute ketoacidotic coma ma emesia ya na emebi emebi emebi neurons na onwu nke onye oria.

Ọrịa shuga na-akpata ọtụtụ nsogbu, ụfọdụ n’ime ha siri ike karịa ọrịa shuga n’onwe ya ma nwee ike ibute nkwarụ na ọnwụ. Ọtụtụ nsogbu na-esite na mmebi nke akwara ọbara n'ihi atherosclerosis na protein glycosylation (ya bụ, glucose na-agọnụ na protein molekul).

Isi nsogbu nke ọrịa shuga:

• atherosclerosis, nke n'aka nke ya na-eduga na mmepe nke nsogbu ụdọ macrovascular: infarction myocardial na ọrịa strok Atherosclerosis bụ ihe kpatara ọnwụ na 65% nke ndị ọrịa na-arịa ọrịa shuga,

• nephropathy (mmebi akụrụ) na ọganihu nke ọdịda akwara na-adịghị ala ala (na 9-18% nke ndị ọrịa),

A na-emezi Acetyl-CoA, nke etolite n'ime imeju n'oge ngwa ngwa nke ọdụdụ abụba na Acetoacetic acid, nke a ga-agbanwe ka ọ bụrụ β-hydroxybutyric acid wee bụrụ decarboxylated na acetone. Enwere ike ịchọta Lipolysis ọbara n'ọbara na mmamịrị nke ndị ọrịa (nke a na-akpọ ketones ma ọ bụ ozu ketone).

Ọrịa mamịrị mellitus - ihe dịka 485

• neuropathy (ọ na-emetụta akwara dị n'akụkụ abụọ),

• retinopathy (mmebi nke retina na-eduga ìsì) na cataracts (belatara nghọta nke oghere)

• mbelata nke ahụ na-emegide ọrịa,

• ọrịa akpukpo aru nke akpukpo aru (site na imeju arusi nke ogwugwo na adighi adi). Iche ọrịa mamịrị n'ụkwụ (oria, ọnya na / ma ọ bụ mbibi akwara dị omimi nke ụkwụ), nke jikọtara ya na nsogbu akwara ozi (neuropathy) yana mbelata nke obara ọbara (angiopathy) na akwara nke ala ala. Ọrịa shuga bụ ọrịa shuga na-agbakarị ọrịa shuga.

Addbọchị agbakwunye: 2016-03-15, Echiche: 374,

Ọrịa shuga mellitus pathophysiology

Mana, iji mee ka e nwee abụba bara ụba, a chọrọ inweta malonyl-CoA site na carboxylation nke acetyl-CoA. Dịka anyị kwuru n’elu, a na-egbochi enzyme nke mmeghachi omume a site na homonụ ndị na-egbochi ihe, a na-eziga acetyl-CoA niile ewepụtara na mitochondria na kọlestrọl.

Hypertriacylglycerolemia. Increasedba ụba nke abụba bara ụba na ọbara a na-ahụ na ndị ọrịa nwere ọrịa shuga (lee anya n'elu) na-eme ka ha banye na cytoplasm nke hepatocytes. Mana ojiji nke abuba abuba maka ebumnuche nke ike anaghi eto, nihi na ha enweghị ike ịgafe membrane nke mitochondria (n'ihi ụkọ insulin, ọrụ nke ndị na-ebu, usoro carnitine, na-akụghasị). Na imubanye na cytoplasm nke sel, a na-eji abụba abụba na lipogenesis (mmebi nke imeju), etinye ya na VLDL ma wepụta ya n'ọbara.

Dyslipoproteinemia. Ọrụ niile dị n'elu na metabolism lipid (njikọta cholesterol na-eme ka ọ dị mma, LP glycosylation) na-atụnye ụtụ na VLDL, LDL na mbelata nke oge HDL.

Mmebi nke peroxide homeostasis. Dị ka ị maara, hypoxia, njirimara nke ọrịa shuga, bụ otu n'ime ihe na-akpata Lipid peroxidation. Ọzọkwa, n'ihi mgbochi nke PFP, mgbake nke NADP +, nke dị mkpa dị ka ntinye nke mgbochi mgbochi.

Hyperazotemia. N’oge ọdịnala, okwu a na-akọwapụta nchikota nke uru dị ala na - eburu oke ibu (urea, amino acid, uric acid, creatine, creatinine, wdg). Hyperaminoacidemia na ọrịa shuga bụ ihe kpatara: 1) membrane mebiri emebi nke amino acid, 2) nwayọ n'iji amino acid na biosynthesis protein, maka ọnụego nke PFP - isi iyi nke ribose-5-phosphate - ihe dị mkpa nke mononucleotides - ndị sonyere na nchịkọta RNA - matriks na njikọta protein na-ebelata (Usoro 1). Ahụ ọnya abụọ (1,2) bụ n'ihi ụkọ insulin. Otutu homonụ nke mgbochi mgbochi nwere oke mmetụta nwere catabolic (Isiokwu 2), i.e. mee ka proteolysis rụọ ọrụ, nke na-enyekwa hyperaminoacidemia.

Na mgbakwunye, mmebi nke ojiji nke glucose maka ebumnuche ume na ọrịa shuga n'ihi ihe nke otu mgbochi homonụ na-akpata mmụba na gluconeogenesis (Usoro 2), nke bụ isi site na amino acid na mmebi ngwa ngwa nke ketogenic amino acid na ịmepụta ozu ketone - ezigbo isi iyi nke ike. Otu n'ime njedebe njedebe nke mgbanwe abụọ ga-abụ amonia, nke njikọ nke urea. Ya mere, na ọrịa shuga n'ọbara, a na-edekọ ọkwa dị elu nke ihe a (hypercarbamidemia).

Mbelata nke ike nchebe. N'ihi ụkọ insulin, a na-eji nwayọ nwayọ na-ebelata protein (lee n’elu), gụnyere immunoglobulins. Ọzọkwa, ụfọdụ n'ime ha, mgbe glycosylation (lee n'elu), hapụ ihe ha nwere, ya mere mmepe nke ndị ọrịa nwere ọrịa pustular, furunculosis, wdg.

Mmụba ọbara osmotic na-abawanye n'ihi ụba nke ihe dị iche iche dị ala na - egbochi (glucose, amino, keto acid, lactate, PVC, wdg).

Faksị (akpọnwụ akpọnwụ) nke anụ ahụ n'ihi ịba ụba ọbara osmotic.

Acidosis n'ihi mkpo nke ngwaahịa acidic (acetoacetate, β-hydroxybutyrate, lactate, pyruvate, wdg).

Ndị dị iche iche bụ urias. Glucosuria, ketonuria, aminoaciduria, lactataciduria, wdg. - kariri ịba uru nke ọnụ ahịa ụlọ ha.

Mmụba nke mmamịrị na-emetụta oke nke mmamịrị, n'ihi mmepe nke ihe dị iche iche - uria.

Polyuria a) maka iwepu ihe di iche iche choro mmiri ozo,

b) N'ihi polydipsia.

Polydipsia. Akpịrị ịkpọ nkụ mụbara n'ihi mmụba osmotic na plasma ọbara na oke mmụba mmiri na mmamịrị.

Lygba ije. Otu n'ime akara izizi nke ọrịa shuga. N'ihi insulin erughi, membrane permeability maka glucose, amino acid, na nke nwere abuba bara ụba, i.e. ọbara ahụ “ejupụtawo”, mkpụrụ ndụ na-agụkwa agụụ.

Mgbanwe ndị a na metabolism na-egwu mmepe nke nsogbu dịgasị iche iche (nnukwu na-adịghị ala ala).

Nsogbu nnukwu ọrịa:

Hyperosmolar ihe enweghị mmiri

Njikọ kachasị nke ketoacidosis nke ọrịa mamịrị bụ hyperglycemia (karịa 10 mmol / l), ya mere glucosuria, plasma hyperosmolarity, hyperketonemia, mgbaàmà ikpeazụ bụ maka metabolic acidosis (mbelata ọbara bicarbonates plasma ọbara). Ya mere, n’ime akụrụ na-egbu oge H +, nke na-akpasu acidosis ike, na-eme ka ikuku iku ume, na-ewepu ma na-ebelata ume iku ume - Kussmaul respiration, CO2 na-ewepu, nke na -ebilata ogo acidosis, mana n’otu oge ahu ike bicarbonates na-abawanye. Ihe omuma nke kpokoro n’akpa a bu isi acetone n’onu. Ketoacidosis sitere na nri nke nwere abụba na - egbochi ya n'ihu carbohydrates.

Ndabere nke ọrịa mamịrị lactic acidosis bụ mmepe nke hyperlactacidemia dị elu (lee anya), nke hypoxia anụ ahụ na-eme ka ọ dị ala ma mebie steeti acid.

Hyperosmolar bezketonny coma bụ ihe a na-ahụkarị na ndị ọrịa nke etiti na ndị agadi. Ejiri ya na hyperglycemia dị elu (karịa 55 mmol / l), n'ezie, site na ebe a, mmụba dị elu na osmolarity nke plasma ọbara, ọdịdị nke glucose na mmamịrị, nke na-akpata osmotic diuresis (ụkọ mmiri na electrolytes). N’adịghị ka nsogbu mbụ, edeghị ndị ọrịa dị otú ahụ hyperketonemia na ketonuria.

Hypoglycemic coma na-amalite na ị chronicụbiga mmiri ókè

Ketoacidosis

Ọ nwere ihe nrị oria shuga na obere glycosuria, ketoacidosis anọghị. Ego acetoacetic acid guzobere n’oge oke oke abụba nke abụba, dị mkpa iji kwụọ ụgwọ glucose na-efunahụ, ọ karịrị nke ahụ nwere ike iji ya na usoro mgbanwe. Agbanyeghị, ọ bụrụ na ọnwụ glucose dị oke mkpa (100-200 g kwa ụbọchị), mgbe ahụ oke ego nke abụba ejiri mee ihe buru ibu nke na izụlite ahụ ketone na-amalite karịa ike anụ ahụ iji ha.

Ketones chikọtara na ọbara ma kpopụta na mmamịrị. Acetoacetic na b-hydroxybutyric acid bụ ndị apụrụ iche n'ụdị ogige ha na cations, sodium na potassium na-efu, na-eme ka enweghị ihe osmotically na-arụ ọrụ metụtara mwepu glucose, yana oke nwere ugbu a na metabolic acidosis. N'ime anụmanụ dị ka ezì na nnụnụ, nke anụ ahụ nwere ike iji rụọ ọrụ nke ukwuu na acetoacetic acid, pancreatectomy anaghị akpata ketoacidosis. Ndakpọ nke abụba abụba erughị ogo, yana ọrịa shuga abụghị ọrịa dị oke njọ dịka ọ dị na mmadụ na nkịta.

N'ụzọ dị otú a ketoacidosis, nke bụ akara e ji mara shuga dị ukwuu, bụ nsonaazụ nke ịba ụba glucose na ahụ ya funahụrụ. Glucosuria, site na ntinye nke floridzine, n'agbanyeghị na ọ na-ebute hypoglycemia, na-eduga na ketoacidosis, yana n'oge ibu ọnụ, nke na-ejide afọ ojuju nke anụ ahụ site na ndakpọ abụba na protein nke na-eweta glucose.
N'ime ọnọdụ ndị a niile, mmelite mmeghe kpatara glucose, n'ihi eziokwu ahụ na ọ na - egbochi oke neoplasm nke glucose na imeju.

Isiokwu nke isiokwu nke "Ọrịa nke Thymus na Pancreas":

Mgbatị ahụ.

1dị 1 na anddị Ọrịa Shuga 2: Pathophysiology na acheszọ Ọgwụgwọ

5. Pathogenesis

Mmepe nke etuto ahụ na ntinye nke microbe na-amalite site na ntụpọ anụ ahụ na exudate serous ma ọ bụ serous-fibrinous exudate, mkpokọta nke ọnụ ọgụgụ buru ibu nke mkpụrụ ndụ, nke kachasị mkpụrụ ndụ ọbara ọcha. Yabụ ...

Ọmụmụ banyere ịdị irè nke ọrụ ọkachamara nke ndị ọrụ ahụike na mgbochi na ọgwụgwọ nke nsogbu hematological na ọrịa ụmụaka

3. Pathogenesis

Njikọ kachasị mkpa na pathogenesis nke PON bụ nsogbu microcirculatory na endothelial microvasculature. Ọ bụchaghị ihe kpatara ya, na oge ụfọdụ, ọ na-abụkarị nke ukwuu na arụmọrụ nke obi…

Ihe kpatara nsogbu na nrụgide arụmọrụ

Site na data dị na etiology nke nrụgide arụmọrụ, ọ na - esochi ya na ọ bụ “ọ kpatara” site na mgbagwoju anya nke mmeghachi omume neurohumoral…

4 Pathogenesis

A na-ekpebi pathogenesis nke pneumocystosis site na ihe ndị dị ndụ nke pathogen na steeti usoro ahụ ji alụso ọrịa ọgụ. Dị pneumocyst nke na - akọwapụtabeghị gafere akụkụ okuku ume na ...

Mmepe nke mgbochi iji toxocariasis nke nkịta

Ibepu edemede banyere sayensi na ogwu na ahuike, onye dere akwukwo sayensi bu Kurbatov D.G., Dubsky S.A., Lepetukhin A.E., Rozhivanov R.V., Schwartz Y.G.

Nyocha akwụkwọ a na-ekwupụta okwu gbasara ọrịa na-efe efe, nhazi ọkwa, pathophysiology, yana nchọpụta na ọgwụgwọ nke dysfunction drectfunction na ndị ọrịa nwere ụdị 1 ọrịa shuga. Rectkwụ ụgwọ ọrịa na-eto eto n’arụ ọrịa na-arịa ọrịa shuga bụ nnukwu nsogbu n’ihi ya zuru ebe niile, yana mmetụta na ọnọdụ ọgụgụ isi nke ndị ọrịa na ịdị mma nke ndụ n’ozuzu ya. E mesiri ya ike na nyocha oge n’oge ya na ezigbo nkọwa nke ụdị adịghịzị erectile na-enye gị ohere ịhọrọ usoro ọgwụgwọ maka onye ọrịa ọ bụla.

EGO NA-EBIRI EGO NA-EKWES PR P TBỌCH WITH 1 TBỌCH:: Nchọpụta na usoro ọgwụgwọ

Nyochaa akwụkwọ a na-egosi ọgbụgba, nhazi ọkwa, ọrịa na-achọpụta ọrịa na usoro ọgwụgwọ maka ọrịa ọgbụgba n'ime ndị ọrịa nwere ụdị ọrịa shuga 1. Erectile dysfunction na ndị ọrịa na-eto eto na-arịa ọrịa shuga mellitus bụ nnukwu nsogbu n'ihi nsonaazụ zuru oke, yana mmetụta na ọnọdụ ọgụgụ isi nke ndị ọrịa na ịdị mma nke ndụ n'ozuzu ya. Ekwusiri ya ike na nchoputa nke oge ya na ezigbo nkọwa nke ụdị adịghịzi ahụ nwere ike ịhọrọ ọgwụgwọ maka onye ọrịa ọ bụla.

Ederede nke ọrụ sayensị na isi okwu "Erectilection na ctiondị Ọrịa 1 Ọrịa: Nchọpụta na Treatmentzọ Ọgwụ Ọgwụ"

UDC: 616.69-008.14: 616.379-008.64

Mmebi Erectile na Ndị Ọrịa Na-arịa 1dị Ọrịa Shuga 1:

Ọrịa na usoro ọgwụgwọ

Kurbatov D.G., Dubsky S.A., Lepetukhin A.E., Rozhivanov R.V., Schwartz Y.G.

Federal State Budgetary Institution Endocrinological Scientific Center nke Ministry of Health of Russia, Adreesị Moscow: 117036, Moscow, ul.Dm. Ulyanova, 11, tel. (499) 3203687 E-mail: [email protected]

Nyocha akwụkwọ a na-ekwupụta okwu gbasara ọrịa na-efe efe, nhazi ọkwa, pathophysiology, yana nchọpụta na ọgwụgwọ nke dysfunction drectfunction na ndị ọrịa nwere ụdị 1 ọrịa shuga. Rectkwụ ụgwọ ọrịa na-eto eto n’arụ ọrịa na-arịa ọrịa shuga bụ nnukwu nsogbu n’ihi ya zuru ebe niile, yana mmetụta na ọnọdụ ọgụgụ isi nke ndị ọrịa na ịdị mma nke ndụ n’ozuzu ya. E mesiri ya ike na nyocha oge n’oge ya na ezigbo nkọwa nke ụdị adịghịzị erectile na-enye gị ohere ịhọrọ usoro ọgwụgwọ maka onye ọrịa ọ bụla.

Keywords: mellitus diabetes, dysfunction erectile

EGO NA-EBIRI EGO NA-EKWES PR P TBỌCH WITH 1 TBỌCH:: Nchọpụta na usoro ọgwụgwọ

Kurbatov D. G., Dubskiy S.A., Lepetukhin A.E. Rozhivanov R. V., Schwartz J. G.

Ebe nyocha Endocrinology, Moscow

Nyochaa akwụkwọ a na-egosi ọgbụgba, nhazi ọkwa, ọrịa na-achọpụta ọrịa na usoro ọgwụgwọ maka ọrịa ọgbụgba n'ime ndị ọrịa nwere ụdị ọrịa shuga 1. Erectile dysfunction na ndị ọrịa na-eto eto na-arịa ọrịa shuga mellitus bụ nnukwu nsogbu n'ihi nhụsianya zuru oke, yana nsonaazụ nke akparamaagwa na ịdị mma nke ndụ n'ozuzu ya. Ekwusiri ya ike na nchoputa nke oge ya na ezigbo nkọwa nke ụdị adịghịzi ahụ nwere ike ịhọrọ ọgwụgwọ maka onye ọrịa ọ bụla.

Okwu dị mkpirikpi: ọrịa shuga, ọrịa na-adịghị ala ala

Ọnọdụ ọrịa shuga n'ụwa na-eto n'ike n'ike. Dabere na Dilọ Ọrụ Mba Ọrịa Shuga, ihe karịrị nde mmadụ 371 taa na-arịa ọrịa shuga mellitus (DM). Ihe dị ka 10% nke ọnụ ọgụgụ ndị ọrịa na-arịa ọrịa shuga na-arịa ụdị shuga 1.

Nsogbu inwe mmekọahụ na-egosi mbelata nke ogo ndụ

Achọpụtaghị onye ọrịa, nke na-eduga n'ịhapụ ịmụ nwa na nsogbu mmekọrịta mmadụ na 40% karịa ndị ọrịa nwere ọrịa shuga nke 2. Ọ dị mkpa iburu n'uche na nsogbu mmekọahụ na ndị ọrịa nwere ụdị ọrịa shuga 1 na-eme ka mpụta mbụ ha mgbe ha dị obere ma e jiri ya tụnyere ọnụ ọgụgụ na-enweghị ọrịa shuga.

Mmebi kachasị nke ọrụ mmekọahụ na ndị ọrịa na-arịa ọrịa shuga bụ dysfunction erectile (ED). Ọtụtụ nnyocha egosila

na ED na-emetụta ihe dị ka 35-55% nke ndị ọrịa nwere ọrịa shuga 1, na ihe ize ndụ nke ED na ndị ọrịa nwere ọrịa shuga dị okpukpu atọ elu karịa nke ndị na-enweghị ọrịa shuga.

Ugboro nke mmepe nke nsogbu ọgbụgba n'ime ndị ọrịa nwere ọrịa shuga na-adabere ọ bụghị naanị na afọ onye ọrịa, kamakwa oge oge ọrịa na-akpata na oge nke decompensation oge nke carbohydrate metabolism 7, 8. mmepe nke ED na-emetụta ọnụnọ nke ọrịa concomitant, nsogbu nke ọrịa shuga na arụmọrụ nke usoro ọgwụgwọ. Ya mere, n'ọtụtụ ọmụmụ, a mụrụ mmekọrịta dị n'etiti ọnụnọ nke ED na nsogbu ịrịa ọrịa mamịrị ma gosipụtara na ED hụrụ ihe fọrọ nke nta ka ọ bụrụ ugboro abụọ karịa na ndị ọrịa nwere ọrịa nephropathy ma ọ bụ retinopathy.

Diagnosis drectfunction erectile na ndị ọrịa nwere ọrịa shuga nwere ike bụrụ akara na-apụtachaghị ìhè maka mmepe ma ọ bụ ọganihu nke usoro atherosclerotic na ọrịa obi, yana ịbụ onye mbụ gosipụtara ọrịa neuropathy mamịrị 11, 12. Ọmụmụ ihe yiri ya nke Rozhivanov R.V. (2005) na ndabere nke Federal State Budgetary Institution “Endocrinological Scientific Center” nke Ministri Ahụike nke Russian Federation, gosipụtara atụnyere ihe data sitere na mba ọzọ banyere nhụsianya nke ED n'etiti ndị ọrịa nwere ụdị 1 na 2 ọrịa shuga, ịdabere na afọ ọgụgụ nke ndị ọrịa, oge ọrịa ahụ, yana mmekọrịta ya na ọkwa nke ụgwọ

carbohydrate metabolism na ọnụnọ nke nsogbu nke ọrịa shuga.

Nyere oria odi na oria oria 1 n’azu, na nghota na onodu a, obughi sobelata ndu ndu ndi oria, kama o bu otu n’ime akara ngosiputa nke nsogbu oria, dika oria dipatria obi, obi akwara obi, atherosclerosis, oge nkpa, ndi mmadu na ndi ozo. gaa nyocha na ọgwụgwọ nke ED na ụdị ndị ọrịa.

• Organic (vasculogenic, neurogenic, endocrine)

Mix gwakọtara (ihe ọmụmụ ihe ọmụmụ na ihe gbasara mmụọ)

Ọnọdụ mmekọrịta nwoke na nwanyị

Onye otu na-ahazi ụda ụda olu dị mma nke arịa akwara ozi yana ahụ trabecula. Mgbe mkpali mmekọahụ, nitric oxide (NO), site na endothelium na-eme ka ịbawanye ụba nke guanylate cyclase (GMF). Nnukwu ịba ụba nke cyclic GMF (cGMP) na-eduga na izu ike nke akwara anụ ahụ dị nro, mmụba akwara art na viso-occlusion na amụ. Ọnụ ọgụgụ nbibi nke cGMP dabere na ọrụ enzyme 5-phosphodiesterase.

Mmepe nke ED na ọrịa shuga nwere ike ịdabere n'ọtụtụ ihe n'otu oge.

moat (atherosclerosis + neuropathy, neuropathy + psychogenic factor, wdg).

A na-achịkwa mmebi nke penile site na isoforms iche iche nke NO-syn-tetase nke neuronal, endothelial na ezigbo olu sitere. . Ọtụtụ usoro ihe eji eme ihe banyere mmiri na-akọwa ihe mere dysfunction ọrịa erectile na-arịa ọrịa shuga. Ihe vaskụla na neurogenic mekọtara ọnụ bụ ihe na-akpata ED na ọrịa shuga, ebe ọ bụ na amaara na endothelial dysfunction na-eduga na mmepe nke ischemic neuropathy, nke, n'aka nke ya, nwere mmetụta ọjọọ na njikọ njikọ NO. Ọtụtụ ọmụmụ egosiwo na ọ nwere nkwarụ endothelial na ntụrụndụ neurogenic n'akụkụ ahụ cavernous na ndị ọrịa nwere ọrịa shuga na ED. Ejikọtara nchọta a na enweghị NO. Ọzọkwa, ụfọdụ ọmụmụ ndị mba ofesi egosila mmụba dị ukwuu na saịtị nke njikọ NO-synthetase na anụ ahụ oke oke oke ọnwa ọnwa 2 ka enwechara ọrịa shuga mellitus. Usoro a yiri nke a na-ahụ n'àkwà vaskụla ndị ọzọ, ebe ntụgharị endothelium na-agbanwe mgbidi vaskụla n'ihi mmerụ ahụ ọ bụla n'ihi njikọta glucose dị elu. Ya mere, ntụpọ dị na ọrụ nke NO synthetase na-ekere òkè na etiology nke ED na ndị ọrịa nwere ọrịa shuga, n'ihi mgbasa ozi endothelial.

ọrụ. E gosiputara na ntụrụndụ nke akwara mkpụrụ ndụ dị n ’akwara dị na oghere ndị a na-arịa ọrịa shuga n’oge mkpali eletriki dị nro n’ihi mbelata nke mmepụta nitric oxide site na NO synthetase. Ọ dị mkpa ịmara na hyperglycemia ogologo oge na-akpata mmụba nke oriri nke nicotinamide adenine dinucleotide phosphate (NADPH), onye na-ahụ maka mmepụta nke NO, yabụ, na-ebelata ọkwa nke nitric oxide.

Ọgbọ dị egwu nke na-enweghị oke na-egbochikwa ntụrụndụ na-enweghị mmachi site na nchịkọta nke ngwaahịa ngwụcha afọ (AGEs) na-agagharị n'ọbara, bụ ndị na-ahụ maka mmepe nke nsogbu akwara.

AGE ngwaahịa, na-agbakọta na ndị ọrịa na-arịa ọrịa shuga, na-emekọ ihe ọnụ na-anabata ndị na-anabata anụ ahụ nke na-arịa ọnya anụ ahụ, na-emekwa ka nkwupụta nke ndị mgbasa ozi mmebi vaskụla, mwepụta nke glucose na-akpalikwa. 21, 22, 23.

Ihe ndị a dị n’elu na-etinye aka na ọnya ọrịa nke ọrịa obi na-egosipụta na oke ọnwu (ischemia myocardial mgbu na-adịghị ala ala, ọnwụ obi mberede, wdg), nke na-akpakọrịta na ED.

Neuropathy bụ akụkụ dị mkpa na mmepe nke ọrịa mamịrị

ED E gosipụtara mmerụ ahụ mebiri emebi na akwara ozi akwara na akwara nke cavernous n'ahụ ndị ọrịa nwere ọrịa shuga na ED. A na-ahụta ọnụnọ nke polyneuropathy dị ka ihe e ji mara ndị ọrịa nwere ED, ka ọ dị, mbelata ọsọ ọsọ nke akwara na ngbanwe akwara na mgbanwe obi obi na-edetu obere oge karịa na ndị ọrịa nwere ọrịa shuga na ED karịa na ndị ọrịa nwere ED na polyneuropathies nke ọdịiche dị iche.

Ọtụtụ ọrụ ewepụtara na mgbanwe nke ọrịa na akwara ozi na ndị ọrịa na-arịa ọrịa shuga na-ekwu maka nnwere onwe bụ isi emebi akwara ozi akwara.

Autonomic neuropathy yiri ka ọ bụ isi ihe na - akpata pathogenetic na ED n'ime ndị ọrịa nwere ọrịa shuga. Ndị ọrịa nwere ngosipụta nke akwara neuropathy na-enwekarị nsogbu nwere ike ịta ahụhụ na ED karịa ndị ọrịa nwere ọrịa shuga na-enweghị polyneuropathy. Ihe kachasị metụta metabolic hypothesis bụ echiche nke metabolic polyol, dị ka nke polyol ngafe glucose na-arịa ọrịa shuga, na-emesịa ghọọ sorbitol na fructose, ụtụ nke mkpụrụ ndụ akwara na-ebute mmepe nke neuropathy. Eziokwu nke hyperglycemia na mmepe nke ọrịa mamịrị na-arịa ọrịa shuga na-enyocha site na eziokwu ahụ bụ na, enyere ụgwọ kwụrụ ụgwọ,

Ọkpụkpụ levodic metabolism nke ọrịa mamịrị neuropathy na-ebelata 40-60%.

Nzube nke vasculogenic nke mmepe nke neuropathy, dabere na mbelata ọbara na-abanye, mmụba nke neurovascular enduro na belata oxygenation nke akwara, dịkwa mkpa. Dị ka usoro iwu a si dị, mgbanwe nke ọrịa na arịa arịa na hypoxia na ischemia metụtara.

Ihe niile a dị n’elu na-egosi ọrụ dị mkpa nke neuropathy nsogbu na mmepe ED na ndị ọrịa nwere ọrịa shuga. Ọtụtụ ndị na-ede akwụkwọ kọwara ọnọdụ a dị ka “neurogenic ED,” si otú a na-a attentiona ntị na ọrụ ndị isi nke ọrịa mamịrị na-arịa ọrịa shuga na nsogbu ndị ọrịa 31, 32.

Yana vasculogenic na ụdị neurogenic nke ED na ọrịa shuga, endocrine ED nke ejikọtara na androgen erughi bụ ihe a na-ahụkarị.

Nnyocha ndị e mere n'oge na-adịbeghị anya gosipụtara na OBET syntRỌ bụ enzyme na-egbochi androgen. A gosipụtara na androgenic ndabere nke NO synthetase site n'eziokwu ahụ bụ na n'ime akwara akwara nke pelvic parasympathetic ganglia, a na-ahụ ihe ndị na-anabata androgen na-eme ka njikọ nke NO na vasoactive eriri afọ peptide, yana mkpali nke njikọ NO na ganglia n'okpuru nduzi nke androgens. N'otu oge

hypogonadism bụ ihe mgbaàmà nkịtị na ndị ọrịa nwere ọrịa shuga. Ihe ndị na-akpata erighị ihe na androgen n’ime ụmụ nwoke nwere ọrịa shuga dị iche. Ihe ndị a nwere ike ịbụ oke ibu ma ọ bụ oke ibu, yana mbelata afọ na-egbochi ihe nzuzo testosterone. .

Nchọpụta nchọpụta nke ED nke ndị ọrịa nwere ọrịa shuga

A na-eme nyocha nke onye ọrịa nwere ọrịa ED na-arịa ọrịa shuga dịka usoro nhazi oge ochie si dị, gụnyere nchịkọta data gbasara ahụike, nyocha, yana ụzọ nyocha na ụzọ.

Isi ihe dị mkpa na ịnakọta ihe anamnesis na ndị ọrịa nwere ọrịa bụ nyocha nke usoro ọrịa na-akpata, ọnụnọ ma ọ bụ enweghị nsogbu nke ọrịa shuga, ozi banyere ọgwụ ndị a takenụrụ.

Mgbe a na-enyocha anụ ahụ, a na-eme tụọ nha maka ịdị arọ anụ ahụ, ịdị elu na nha maka ahụ, ebe ọ bụ na oke ibu nwere ike ibute hypogonadism. N'ọnọdụ ụfọdụ, ọ bụ ihe amamihe dị na ya ime nyocha dị iche iche maka abụba visceral site na iji nyocha CT iji nyocha nke ọma ma buo amụma ihe egwu. Na mgbakwunye, a na-enyocha ọnọdụ nke anụ ahụ, ọdịdị na uto nke ntutu, ọnọdụ nke usoro akwara na akụkụ ahụ 39, 40.

N'oge nyocha anụ ahụ, iji wee chọpụta ọrịa neuropathy, ọ dị mkpa iji mezuo opekata mpe nke nchọpụta akwara

ụzọ. Kachasị ihe ọmụma bụ nyocha nke cavernous reflex. Enwekwara ike ịtụle nyocha nke okpomoku, ihu igwe na ọmịiko nke amụ.

Ndepụta nke ụzọ nyocha pụrụ iche maka ED gụnyere nnwale ọbara nke homonụ, nleba anya banyere akpụ penile na-ehi ụra abalị, ọmụmụ ọmụmụ ọgwụ intracavernous, cavernosography, angiography of the penile arịa, ultrasound dopplerography nke arịa ndị penile na ikpebi ọsọ nke mgbasa nke akwara site na n. .р ^ е ^ ш.

A na-eji usoro nyocha niile dị n'elu iji chọpụta ED nke mkpụrụ ndụ ọ bụla, na-agbanyeghị, usoro kachasị ihe ọmụma na naanị ụzọ a pụrụ ịdabere na ya maka ịchọpụta ụdị neurogenic nke ED na ọrịa shuga bụ electroneuromyography. Ule a na-enyocha steeti sensory na akwara ọkụ na-agụnye elektrọniki eletriki nke latent oge nke bulbocavernous reflex, nnwale zoro ezo, nyocha nke ikike izisa azụ na amamịghe. A na-amata ndị ọrịa nwere ọrịa shuga na ED site na nsonaazụ nsonaazụ nke nnwale ndị a site na ndị na-egosi usoro iwu. Dịka ọmụmaatụ, maka ndị ọrịa nwere ọrịa shuga bụ mmụba mara

oge gafere oge nke bulbocavernos reflex. Agbanyeghị, ule ndị a kọwara n’elu anaghị enye echiche nke steeti efferent autonomous innervation nke kpatara arụrụala penile. Dabere na ihe ndị e kwuru n'elu, mgbe ị na-edebanye ihe ndị na-esi na nnwale ule sitere na nkịtị, anyị nwere ike were naanị ọnụnọ nke ọrịa akwara autonomic.

Dị ka usoro maka ọmụmụ kpọmkwem nke akpaaka cavernous innervation, enwere ike ịdekọ ọrụ eletriki nke akwara cavernous site na iji intracavernous ma ọ bụ electrodes elu. Ihe omuma enwetara site na iji uzo a nyere anyi aka ileba anya banyere onodu ihe akwara akwara akwara nke amam ihe ma choputa nsogbu ya na ọkwa mmekorita corpora cavernosa na njedebe akwara. N'ime omumu ihe banyere cavernous innervation na ndi ọrịa nwere oria mellitus, a na-edekọ ikike na-adịghị ala ala na obere depolarization nwayọ, na desyncation bụ ihe njiri mara - mmụba dị ukwuu na ọrụ nke anụ akwara na nzaghachi na nchịkwa nke ọgwụ vasoactive, ebe ndị ọrịa nwere ahụike mgbe nchịkwa intraca-fernal. ọgwụ vasoactive enweghị ike ịrụ ọrụ. E nwere data ezughi oke ugbu a gbasara

ọnụọgụ na ọgụgụ isi nke usoro a.

Dabere na ihe ndị e kwuru n'elu, ọ bịara doo anya na nchọpụta nke ụdị neurogenic ụdị nke ED na ndị ọrịa nwere ọrịa shuga bụ ọrụ siri ike, ọkachasị na-eleba anya na taa enweghị usoro nyocha ọfụma na akọwapụtara nke ọma. Okwesiri iburu n’uche na dysfunction erectile na-abụkarị akara izizi nke etolite neuropathy. Neurodị neurogenic nke ED n'ime onye nwere ọrịa shuga nwere ike iche na ọnụnọ ngosipụta ndị ọzọ nke ọrịa mamịrị na-arịa ọrịa shuga (ibelata okpomọkụ, ịma jijiji na mmetụta mgbu, ngosipụta dị iche iche nke akwara obi na neuropathy, ọrịa hypoglycemia). Enweghị data maka ọnụnọ nke akwara vaskụla na hypogonadism yana mkpesa nke nsogbu erectile nwekwara ike igosipụta ọrịa neurogenic ED.

Ọgwụgwọ nke ED nke ndị ọrịa nwere ọrịa shuga

Mgbe ị na-ahọrọ usoro ọgwụgwọ maka ED, onye ọrịa ọ bụla chọrọ ịbịakwute onye ọ bụla. N'inye ohere nke nsogbu ndị a kapịrị ọnụ na ndị ọrịa nwere ọrịa shuga, nhọrọ nke usoro ọgwụgwọ maka ED kwesịrị inwe ezi uche. Dị ka ị maara, ugbu a, ọ ka mma iji ọgwụ maka ọgwụgwọ nke ED, mana ihe kachasị mkpa: maka ịdị irè

Rapii ED chọrọ nweta mmezu nke ụgwọ ọrụ carbohydrate na-adịgide adịgide.

Ruo ugbu a, enwere ọtụtụ ụzọ maka ọgwụgwọ mpaghara nke ED: ọgwụ mgbochi, intracavernous na ọgwụ ọgwụ transurethral. Methodszọ ndị a niile nwere ndọghachi azụ ụfọdụ na -ebilata ojiji ha na ndị ọrịa nwere ọrịa shuga, ebe ha jikọtara ya na trauma anụ ahụ dị nro n'oge ọgwụ ọgwụ intracavernous na urethral mucosa n'oge ọgwụ transurethral, ​​nke a na-achọghị maka ndị ọrịa nwere ọrịa shuga n'ihi nnukwu ihe ize ndụ nke ọrịa microtrauma.

Ugbu a, ọgwụ ịhọrọ maka ọgwụgwọ nke ED bụ ụdị phosphodiesterase inhibitors 5 (sildenafil, vardenafil, tadalafil, udenafil). Ọgwụ nke otu a bụ modulators nke erection, bụ nke na - egbochi ihe enzyme PDE-5, na - enweghị emetụta mkpụrụ ndụ akwara dị mma nke amụ, mana na - eme ka mmetụta nke N0 pụta, nke a na - agbanye na nzaghachi mkpali mmekọahụ. Yabụ, usoro mmụta nke anụ ahụ na-ahụ maka ọpụpụ na mmezi nke oghere dị na nkwalite mkpalite mmekọahụ.

Ọtụtụ afọ nke ahụmịhe site na iji ike-denafil na ndị ọrịa nwere ọrịa shuga egosipụtawo ịdị elu ya dị ukwuu na ọgwụgwọ nke ED 46, 47. Nke a bụ

Enwere ọmụmụ ihe ogologo oge, nsonaazụ nke na-egosi na ọ ga-ekwe omume ị drugụ ọgwụ ogologo, nke na-adịghị ize ndụ, na-arụ ọrụ na-enweghị ịba ụba ya.

A gụrụ ịdị irè nke vardenafil n'ịgwọ ọrịa ED n'ime ndị ọrịa nwere ọrịa shuga n'ọtụtụ ọmụmụ, nwere ìsì abụọ, na-achịkwa placebo, nke gụnyere ndị ọrịa 452. Site na ntule nke nsonaazụ ọmụmụ a, mgbe izu iri nke iri abụọ gasịrị, a chọpụtara mmeziwanye na erection na 52% na 72% nke ụmụ nwoke ndị natara 10 na 20 mg nke vardenafil, otu ọ bụla, mgbe ha nọ na placebo, a hụrụ mmezi nke ire ere na 13% nke ndị ọrịa.

Achọpụtara ịdị mma na nchekwa nke tad-lafil n'ime ụmụ nwoke, gụnyere ndị ọrịa nwere ọrịa shuga n'ọmụmụ ihe Fonseca V. et al. (2006), nke mere usoro nyocha nke meta data sitere na placebo iri na abụọ na - achịkwa ndị ọrịa nwere oria, ọrịa shuga na enweghị ya. Ọmụmụ ihe ahụ gụnyere ụmụ nwoke 1681 na-arịa ọrịa shuga na ụmụ nwoke 637 nwere ụdị 1 na ụdị ọrịa shuga 2 bụ ndị natara tada-lafil, na usoro nke 10 na 20 mg ma ọ bụ placebo maka izu 12. Ndị ọrịa nwere ọrịa shuga nwere aha mara ọkwa Ed ma ọ bụrụ na e jiri ya tụnyere ndị ọrịa na-enweghị ọrịa shuga, ebe akara ICEF ED dabara na ọkwa HbA1c. E jiri ya tụnyere placebo, tadalafil na doses nke 10 na 20 mg budata mma ọrụ arụkọrụ n'ụzọ abụọ a, mgbakwunye na ịdị mma nke ndụ na-esonyere ya.

ndị ọrịa. N'otu oge, ịdị irè nke tadalafil adabereghị na ogo nke nkwụghachi ụgwọ metabolism metabolism yana ọgwụgwọ anata maka ọrịa shuga. Ya mere, na agbanyeghi ED kachasị njọ na ndị ọrịa nwere ọrịa shuga, tadalafil dị irè ma nwee nnabata nke ọma. Tadalafil nwere ogologo ndụ ọkara nke awa 17.5, nke na-enye oge ọrụ dị oke mkpa, na-eweghachi ọdịdị eke na mmekọrịta nwoke na nwanyị. Onye ọrịa ahụ nwere ohere ibute ndụ mmekọahụ ebumpụta ụwa, nke dị oke mkpa na ọnụnọ nke psychogenic ndị ọzọ na-eme ka usoro erectile dysfunction na-emetụta ndị ọrịa nwere ọrịa shuga.

Dabere na ndị nyocha ahụ, na 20-40% nke ndị ọrịa nwere ED, ọgwụgwọ na PDE-5 inhibitors adịghị arụ ọrụ, nke n'ọnọdụ ụfọdụ metụtara ọnụnọ androgen erughi na ndị ọrịa. N'ihi ya, n'ọtụtụ ọnọdụ, o yiri ihe kwesịrị ekwesị ịkọpụta ọgwụ njikọta yana androgens na ọgwụ ọjọọ nke PDE-5 na-egbochi oge nyocha ruo ndị ọrịa nwere njirimara ahụike dị n'elu, nke na-abawanye arụmọrụ nke ọgwụgwọ ruo 93% 53, 54, 55.

Ojiji nke PDE-5 inhibitors na ọgwụgwọ nke dysfunction mmekọahụ na ndị ọrịa nwere ọrịa mellitus nwere ike inwe mgbakwunye.

uru n'ụdị belata ihe mgbaàmà nke ọrịa neuropathy Genital.

Yabụ, n'ọmụmụ ihe gụnyere ụmụ nwoke iri na isii nwere ụdị ọrịa shuga 1 na ED dị afọ 27 25.29 na paresthesia na mpaghara nke mkpanaka ahụ na -ewepụta uche na isi nke na-enweta ihe mgbochi PDE-5 ruo ọnwa 3, ọ bụghị naanị mkpochapụ zuru ezu ka a chọpụtara Ed. na ndị ọrịa niile (ED akara oge ọgwụgwọ 21 21,22, pi'tchọta ihe ịchọrọ? Gbalịa ọrụ nhọrọ akwụkwọ.

N'agbanyeghị oke nhọrọ ọgwụ sara mbara maka ọgwụgwọ na-achọghị mgbanwe nke ED na ndị ọrịa nwere ụdị shuga 1, enwere otu ndị ọrịa ebe ụzọ ndị ae si agwọ ọrịa anaghị adị na ha. N'okwu a, a na-egosi ndị ọrịa ọgwụgwọ ịwa ahụ - phalloendoprosthetics.

Nyocha akwụkwọ a na-ekwupụta okwu gbasara ọrịa na-efe efe, nhazi ọkwa, ọrịa na-ahụ maka ya na ọgwụgwọ nke ED n'ime ndị ọrịa nwere ụdị shuga 1. ED n'ime ndị ọrịa na-eto eto na-arịa ọrịa shuga bụ nnukwu nsogbu n'ihi oke mgbasa zuru oke, yana nsonaazụ na ọnọdụ ọgụgụ isi nke ndị ọrịa na ịdị mma nke ndụ n'ozuzu ya.

Site na ihe niile edere n'elu, ọ bịara doo anya na taa na mkpesa nke dibia enwere otutu uzo di iche iche maka ichoro ED, mana rue ugbu a emebeghi ya.

usoro nchọpụta ihe ọ juiceụ sensitiveụ na sistemụ maka usoro neurogenic nke ED. Ọ dị mkpa ịtụle nyocha nke oge a na nkọwa ziri ezi nke ụdị ED na-enye gị ohere ịhọrọ usoro ọgwụgwọ maka onye ọrịa ọ bụla.

Ọgwụgwọ nke ED n'ime ndị ọrịa nwere ọrịa shuga 1 kwesịrị ịbụ nke zuru oke ma chọọ ọ bụghị naanị iji melite ọrụ erectile n'onwe ya, kamakwa iwepụ ihe ndị na-akpata pathogenetic maka mmepe nke ED, dị ka hyperglycemia na-adịghị ala ala, dyslipidemia, na ụkọ androgen. Ugbu a, a na-ahọrọ ụzọ ọgwụgwọ ọgwụgwọ, isi ọnọdụ n'etiti nke ọgwụ na-enweta site na otu ndị na - egbochi PDE-5 n'ihi ịdị mma ha dị elu, nchekwa na ịdị mfe nke ndị ọrịa. Ọ dị mma ịmara na ọgwụ ndị otu a nwere mmetụta neuroprotective, nke kachasị mkpa maka ndị ọrịa nwere ụdị neurogenic nke ED, mana okwu a chọrọ nyocha omimi.

Ya mere, agbanyeghi nnukwu ihe rụpụtara na mmepe nke ụzọ maka nchọpụta na ọgwụgwọ nke ED, a ka nwere ọtụtụ nsogbu a na-edozighi chọrọ nyocha ọzọ.

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Vidiyo ndị metụtara

Banyere pathophysiology nke ọrịa shuga na vidiyo:

Ọrịa shuga na-arịa ọrịa shuga na-enye gị ohere ịnweta ozi gbasara njirimara ọ na ọgwụgwọ nke ọrịa ahụ. Na ụdị nke mbụ na nke abụọ, ọ dị iche.

• Na-akwadokwa ọkwa shuga ruo ogologo oge
• Weghachi nrụpụta insulin nke pịkụl

Mụtakwuo. Ọ bụghị ọgwụ. ->