Ọrịa insulin na-arịa ọrịa shuga mellitus

Ọrịa shuga mellitus (ọrịa shuga mellitus) bụ ọrịa nke insulin insulin na-akpata ma ọ bụ nke dị ala ma bụrụ nke e ji mebie ụdị ụdị metabolism niile, na, n'ụzọ bụ isi, metabolism metabolism. Okwu shuga sitere na Greek. ọrịa shuga - “M ga-agabiga”, “a na m aga”, okwu ahụ “mellitus” sitere n'okwu Latin “mmanụ a ”ụ”, nke na-egosi ụtọ mmamịrị na shuga dị n'ọbara. Ọrịa shuga mellitus na-apụta na 4% mmadụ (na Russia 1-2%), na n'etiti ndị na-asọpụrụ n'ọtụtụ mba ruo 20% na karịa. Ugbu a, enwere ihe dị ka nde mmadụ nde mmadụ abụọ na-arịa ọrịa shuga n'ụwa nke na -ele anya ndụ ya site na 7%. Dabere na ọnụ ọgụgụ, ndị agadi ọ bụla nke ise na-arịa ọrịa shuga, nke a na-ahụta na nke atọ kachasị akpata ọnwụ na isi ìsì. Ọkara nke ndị ọrịa na-anwụ n'ihi ọdịda akwara na-adịghị ala ala, 75% - site na nsogbu nke atherosclerosis. Ha ji okpukpu abụọ karịa ọrịa obi na oge 17 - nephropathy.

Aha mbụ banyere ọrịa na-echetara ọrịa shuga bụ narị afọ anọ nke BC (afọ 3200). Emere ka okwu a bu “oria shuga” n’ime akwukwo nke Arethius nke Cappadocia (ihe dika nari afo 2000 nke oge anyi). Na narị afọ XI, Avicenna kọwara n'ụzọ zuru ezu akara nke "ọrịa shuga", na 1679, Thomas Willison kpọrọ ya "ọrịa shuga." N'afọ 1869, P. Langerhans bu ụzọ kọwapụta ihe morphological mkpụrụ nke ọrụ pancreas endocrine, nke ụyọkọ nke α- (A-), β- (B-), δ- na PP-nọchiri anya ya. E mechara kpọpụta kọlụm nke ihe niile dị n’elu ekwentị, gụnyere akwara na akwara ozi, agwaetiti Langerhans. N'ime ahụ mmadụ, enwere ihe dị ka otu nde agwaetiti dị otu a nwere ngụkọta nke 1-1.5 g (0.9-3.6% nke gland mass) yana ogo 100-200. Eriri mmiri nke ọ bụla nwere ihe dị ka sel 2000 izu. Agwaetiti ndị ahụ bụ akụkụ ahụ na ọdụ nke gland.

N'afọ 1909, Minner kpọrọ ihe na-arụ ọrụ na pancreas wepụ insulin. Na 1926, Abel et al. Kewapụrụ ya n'ụdị kemist. F. Sanger (1956) kpughere ihe eji eme kemịkalụ ya na 1963, ya na Kotsoyannis na Tsang bụ ndị mejupụtara site na iji aka mee. Ugbu a, a na - enweta insulin n'ọtụtụ ụlọ ọrụ site na injinia mkpụrụ ndụ ihe nketa. Otutu agwaetiti nke Langerhans - 68% bụ B-, ma ọ bụ cells-sel, nke na - emepụta insulin. Na mgbakwunye na ha, n'ime ngwa islet enwere A- ma ọ bụ α-sel (20%) na-arụ ọrụ glucagon, yana δ-sel (10%, secrete somatostatin) na mkpụrụ ndụ PP (2%, polyteptide nzuzo nke nzuzo). Enterochromaffin D mkpụrụ ndụ nke na-emepụta vasoactive intestinal polypeptide (VIP) na serotonin bụkwa ebe a.

Insulin bu protein nke nwere ogwu polypeptide abuo, nke gunyere 51 amino acid (ihe mejuputara A- mejuputara 21, B-silin nke nkpuru amino acid 30), ma enwere otinye aka na nso 6000 D. Nkpirisi ya di na proinsulin a na ribosomes. N'okpuru ọnọdụ physiological, pancreas nwere ihe dịka 25 mg, yana mkpa ya kwa ụbọchị bụ 2.5-5 mg nke insulin. Na plasma, ọ kegidere iberibe anụ ahụ mejupụtara protein - C-peptide, a na-enyochakwa ihe ndị dị na plasma na 400-800 nanogram kwa liter (ng / l), na nke C-peptide - 0.9-3.5 ng / l . Emebila insulin site na insulinase ma ọ bụ enzymes ndị ọzọ nke lysosomes nke imeju (40-60%) na akụrụ (15-20%).

N'ime ahụ, insulin na-emetụta ụdị nke metabolism - carbohydrate, protein, abụba na mmiri-electrolyte.

I. N'ihe banyere metabolism metabolism, a na-ahụ mmetụta mmetụta insulin na-eso:

Ọ na - eme ka hexokinase enzyme (glucokinase), na - akpata mkparịta ụka biochemical nke mmebi nke ikuku aerobic na mmebi nke carbohydrates - glucose phosphorylation,

Ọ na - eme ka phosphofructokinase rụọ ọrụ, na - enye phosphorylation nke fructose-6-phosphate. A maara mmeghachi omume a ka ọ rụọ ọrụ dị mkpa na usoro nke glycolysis na gluconeogenesis.

Ọ na-eme ka a na-emegharị glycogen synthetase, na-akpali njikọ nke glycogen site na glucose na mmeghachi omume glycogenesis.

Ọ na-egbochi ọrụ nke phosphoenolpyruvate carboxykinase, na-egbochi mmeghachi omume gluconeogenesis, i.e. ntụgharị nke pyruvate gaa phosphoenolpyruvate.

Na-arụ ọrụ nchịkọta acetic acid site na citric na okirikiri nke Krebs.

Na-eme ka ebulata glucose (na ihe ndị ọzọ) mejupụta membranes cytoplasmic, karịsịa na nsụkọta insulin - adipose, akwara, na umeji.

II. Ọrụ nke insulin na nhazi nke abụba metabolism.

Ọ na - eme ka phosphodiesterase rụọ ọrụ, na - eme ka mmebi nke cAMP na - akpata nkwụsị nke lipolysis na anụ ahụ adipose.

Na-akpali njikọ nke acyl-coenzyme-A sitere na ọdụdụ abụba, na-eme ka mkpụrụ ndụ ketone rụọ ọrụ ngwa ngwa.

III. Ọrụ insulin na usoro nke protein metabolism:

Na-eme ka nnabata nke amino acid di.

Na-akwalite njikọ nke protein site na sel.

Ọ na-egbochi mmebi nke protein.

Na-egbochi oxidation nke amino acid.

Nkem. Ọrụ nke insulin na nhazi nke metabolism mmiri-electrolyte metabolism:

Na-eme ka protein a na - emepụtakarị akwara na umeji.

Na-ebelata urinary sodium excretion.

Na-akwalite njigide mmiri n'ime ahụ.

Ihe insulin na -akpata akwara mkpụrụ ndụ nke insulin na - amalite site na njikọ ya na onye na-anabata glycoprotein. Na membranes nke cytoplasmic nke mkpụrụ ndụ akwara ndị a, enwere 50000-250000 ndị nabatara, n'agbanyeghị na ihe dị ka 10% na-arụ ọrụ n'ezie. Ihe omume ndị a na-etolite n'ihi mmekọrịta nke insulin na onye nnabata:

Mgbanwe mgbanwe dị na onye na-anabata ihe na-eme

Ọtụtụ ndị na-anabata ihe na-ejikọta ọnụ ma mejupụta microaggregate,

Mkpụrụ ndụ ahụ na - abanye n'ime cell (receptor internalization),

Otu ma ọ bụ karịa na-eme mgbaàmà intracellular.

N'okpuru ọnọdụ ụfọdụ, agbakwunyere, dịka ọmụmaatụ, site na mmụba insulin n'ọbara, ọnụ ọgụgụ ndị na-anabata ọgwụ nke mkpụrụ ndụ ebumnuche maka insulin na-ebelata, mkpụrụ ndụ ndị ahụ agaghịkwa enwecha mmasị na insulin. Mmụba dị otú ahụ na ọnụ ọgụgụ ndị na-anabata ya, na mbelata na ha nwere insulin na-akọwa ihe ahụ nguzogide insulin (dịka ọmụmaatụ maka oke ibu na NIDDM, lee n'okpuru).

Ntinye insulin na-akpali site n'ọtụtụ metabolites na ihe ndị na-arụ ọrụ n'ihe ọmụmụ: glucose, mannosai, amino acids, karịsịa leucine na arginine, bọmbụ, gastrin, pancreasimine, nzuzo, glucocorticoids, glucagon, STH, β-adrenostimulants. Hypoglycemia, somatostatin, nicotinic acid, α-adrenostimulants na-egbochi mmepụta insulin. N'ebe a, anyị rịbara ama na ọrụ insulin na-agbanwe n'okpuru ikike nke ndị na - emegide insulin na-arịa ọbara plasma metụtara albumin (sinalbumin), β-lipoproteins na globulins (γ-globulin).

Hormone nke abụọ, glucagon, bụ polypeptide nwere ọnya nke nwere 29 amino acid nke nwere otutu ihe dika ihe dika 3,500 D. N'ihe dị ọcha, glucagon dịpụrụ adịpụ na 1951 site na Gede. Ọbara ọbara ya nke ndị mmadụ na-ebu ọnụ dị nso na 75-150 ng / l (naanị 40% nke homonụ nọ n'ọrụ). N'ime ụbọchị niile, mkpụrụ ndụ α-sel nke agwaetiti nke Langerhans na-arụkọta ọrụ ya kwa ụbọchị. A na-egbochi glucose na glucose na somatostatin. Dịka egosipụtara, glucagon na-akpali lipolysis, ketogenesis, glycogenolysis, gluconeogenesis, nke na-eduga n'ịba ụba glucose ọbara. Ihe di ezigbo mkpa na nhazi nke glycemia bu ihe na - akpali akpali ya na insulin insulin - mkpali na - adighi anya site na hyperglycemia na mkpali nke heterocellular ngwa ngwa di n’ime agwaetiti. Ihe homonụ ahụ na-agbaze n’ime akụrụ.

Usoro nke glucagon na-agbadata ịgbalite, site na ndị na-anabata kpọmkwem nke membranes cytoplasmic nke adenylate cyclase, nke kachasị nke imeju, yana mmụba na-esote ọdịnaya nke cAMP na mkpụrụ ndụ. Nke a na - eduga na glycogenolysis, gluconeogenesis na, n'ihi ya, hyperglycemia, lipolysis, ketogenesis na ụfọdụ mmetụta ndị ọzọ.

Ihe ngosiputa mbu nke oria oria bu ndi a:

hyperglycemia (ọkwa glucose ọbara dị elu karịa 6.66 mmol / l),

glucosuria (glucose dị na mmamịrị nwere ike iru 555-666 mmol / l, kwa ụbọchị ruo 150 g nke glucose na-enyocha n'ime mmamịrị bụ isi nke ndị mmadụ, ihe dị ka 300-600 g nke ndị ọrịa shuga, na enwere ike iwelata glucose na mmamịrị ruru na 300 g / ụbọchị),

polyuria (diureis kwa ụbọchị dị elu karịa l l, mana ọ nwere ike iru 12 l),

polydipsia - (mmiri na-eri ihe karịrị 2 lita kwa ụbọchị), akpịrị ịkpọ nkụ,

hyperlactacidemia (ọbara lactate nke ihe karịrị 0.8 mmol / l, ọtụtụ mgbe 1.1-1.4 mmol / l),

hyperketonemia - mmụba nke ozu ketone n'ime ọbara (nke kachasị elu karịa 520 μmol / l), ketonuria,

lipemia (oke lipids, nke na-adịkarị elu karịa 8 g / l),

Njirimara ibu ibu ngwa ngwa nke ndi ọrịa nwere IDDM.

nbelata nke nnabata glucose nke ahụ, kpebisiri ike site na iji nyocha glucose na 75 g nke glucose na otu iko mmiri, mgbe ahụ enwere oke okpukpu abụọ nke glucose (ihe ruru 11.1 mmol / l) n'ime mkpebi nke 60, 90th na 120th.

Ihe ngosipụta nke metabolism na-emejọ abụba bụ:

hyperlipemia (plasma lipids dị elu karịa 8 g / l, nkịtị 4-8),

hyperketonemia (ọdịnaya nke aru ketone na plasma dị elu karịa 30 mg / l ma ọ bụ 520 μmol / l),

hypercholesterolemia (ihe karịrị 6 mmol / l, ụkpụrụ 4.2-5.2),

hyperphospholipidemia (karịa 3.5 mmol / l, norm 2.0-3.5),

mmụba na ọdịnaya nke NEFA (karịa 0.8 mmol / l),

abawanye na triglycerides - triglyceridemia (karịa 1.6 mmol / l, ụkpụrụ bụ 0.1-1.6),

mmụba na ọdịnaya nke lipoproteins (karịa 8.6 g / l, ụkpụrụ bụ 1.3-4.3).

Ihe edepụtara edepụtara nke metabolism abụba gbanwere ọ bụghị naanị site na insulin ụkọ, kamakwa site na oke nke homonụ mgbochi-homonụ, yana enweghị lipocaine. Hyperlipemia na enweghị lipocaine nwere ike ibute imeju na-egbu egbu, nke a na-eme ka ọ bụrụ:

glycogen nke imeju,

ụkọ nke ihe na - akpata mmiri ara ehi,

ofufe ọrịa na egbu egbu.

Otu ihe ahụ na-eduga ketosis, n'agbanyeghị, ihe kpatara ketosis bụ ndị a:

mmụba nke abụba abụba a na-egbu egbu n'ime imeju,

imebi resynthesis nke acetoacetic acid n'ime ọdụdụ ndị nwere ọdụdụ,

ezughi oke oxidation nke acetoacetic acid na usoro okirikiri nke Krebs,

Mmụba nke acetoacetic acid na imeju.

Mgbanwe ndị a dị n'elu metabolism abụba na-ebute mmepe nke atherosclerosis.

Mmebi nke metabolism protein. Ọrịa ndị a metụtara ịba ụba protein na njikọ protein na-esighi ike. Ihe mgbochi nke protein protein bụ ihe dị mkpa maka imepụta carbohydrates site na ngwa ha - gluconeogenesis, nke glucocorticoids na glucagon na-akpali. Ihe mejupụtara protein nke plasma bụ:

albumin belata,

ịta nke globulins na-eto,

enwekwu ọkwa alfa-2-glycoproteins.

Etiology. A na - ewere IDDM dị ka ihe nketa ọtụtụ. A na-akpọ ihe ndị na-ewu ewu na endogenous IDDM ugbu a diabetogens. Ihe Diabetogenic bụ ihe omume, nke ọ bụla, nke nwere ike ịhe, nwere ike kpalite mmepe nke IDDM na ndị nwere njiri mkpụrụ ndụ ihe nketa. Viral na kemịkals nke kemịkalụ nwere ike ime ka cytolysis sel nke mkpụrụ ndụ inеток nwee ahụike nke mkpụrụ ndụ ihe nketa nwere njiri mara usoro iwu nke azịza nje ahụ. Mmetụta na-akpalite mmetụta bụ ihe kachasị mkpa n'oge mmalite na ntakịrị oge nke jikingengenesis. Ọ bụ ya mere ndị ọrịa nwere IDDM ji arịa ọrịa n’oge ha dị obere.

JenetikISDM. Ugbu a, enwere ihe ruru saịtị 20 dị iche iche na kromosoom abụọ, 6, 10, 11, 14, 16 na 18, jikọtara ya na ọrịa ahụ. Mmekọrịta nke ejima monozygotic anaghị agafe 30-54%. N'ime ụmụaka nke ndị ikwu nwere ọrịa IDDM, ugboro ọrịa a ruru ihe dịka 6%. A na-eme onyinye pụrụ iche maka ọnọdụ ịkọwapụta site na mpaghara mkpụrụ ndụ ihe ọmụmụ HCH na mkpụmkpụ nke chromosome 6 n'etiti DR loci₃, DR₄, DQ_3,2. Ekwenyere na njikọta nke protein HCGS protein nke loci na IDDM nke abụọ. N'ime ndị Caucasians, ihe fọrọ nke nta ka ọ bụrụ 95% nke ndị ọrịa nwere IDDM bụ ndị na-ebu antigens MHC DR₃, DR₄ na / ma obu ngwakọta ya. Onu ogugu onu ogugu ndi mmadu n’iile n’agha n’iile na –eme ihe kariri 4%.

Dabere na ọnụnọ nke ihe nrịba ama na njiri mara nke foto ọrịa, enwere ike ike IDDM gaa ụdị 1a na 1b. Amara Subtype 1b bụ ọnụnọ nke otu ọgwụ DR antigens na HCCH₃ (D)₃) -B₈-A, ụdị 1a - site na ọnụnọ nke Nchikota DR₄ (D)₄ ) -B₁₅-A₂-CW₃. Njikọ 1b sokwa na mmepe, na-emegide usoro IDDM, nke mmetụta mkpụrụ ndụ autoimmune nke mkpụrụobi endocrine, nke anaghị achọ mkpasu iwe na-achọghị. Ihe ruru pacenti iri na ise nke IDDM so na ụdị a. Ngosipụta nke ihe mgbochi onwe ya megide mkpụrụ ndụ  na-adịgide, ma n'otu oge ahụ, nzaghachi ọrịa insulin na-anọghị na ya. Autoimmune polyendocrinopathy abụghị njirimara nke mgbaàmà 1a, ọrụ nke ọrịa nwere ike ikwu na pathogenesis. Autoimmunity megide mkpụrụ ndụ клеток adịghị adị, oge a na-ekwuputakwa azịza nke insulin na insulin.

Dị ka egosiri, ugbu a na-ekwu maka diabetogens na-efe efe na nke na-adịghị efe efe. N'ime ndị mbụ nwere ọtụtụ nje virus: rubella, mumps vaccinia, Epstein-Barr, enterovirus Coxsackie B₄ ọ bụghị Coxsackie, reoviruses, cytomegaloviruses, nke dị na akụrụngwa akụrụngwa na ụdị nnwale nwere ike ịkpasu mmebi ahụ  mkpụrụ ndụ nke agwaetiti. Iji maa atụ, ihe ruru pacenti 40 nke ụmụ amụrụ nne ndị bu ọrịa ime na ngụkọta nke ọnwa atọ dara ọrịa IDDM na afọ mbụ nke ndụ ha.

Imirikiti nje diabetogenic na-akpata autoimmune cytolysis nke mkpụrụ ndụ islet . A na - atụgharị ihe nke autoantibodies megide ọgwụ mgbochi cytoplasmic na ọgwụ nuklia nke mkpụrụ ndụ B. Autoantibodies ndị a na-enwe ike ekekọta otu sel dị ka nje nke a na-akpọ pancreatotropic. Nje virus nke Lymphotropic na-arụ ọrụ dị ka polyclonal initiators nke autoimmune sistemụ (Epstein-Barr na nje virus) ma ọ bụ dị ka ndị na - egbochi T-suppressors (retroviruses) ma ọ bụ ndị na - akpali akpali nke ndị na - eme ya. Na nke a, usoro autoallergic nwere ike ịbụ nsonazụ nje virus nke ndị na - egbochi ya na / ma ọ bụ ndị na - eme ihe na - arụ ọrụ. N'otu oge ahụ, immunological cytolysis bu ihe a na-ebute oria na ihe ndi mmadu buru ibu.

Ọrụ na-akpali akpali nke nje na mkpụrụ ndụ ihe ọmụmụ nke autoimmune cytolysis bụ site na interleukins na interferons, ọkachasị -interferon, n'ihe banyere mbibi nke nje na-emetụta pancreas. Cytokines ndị a na-ebute nkwupụta nke MHC antigens na mkpụrụ ndụ клетв-cell na ihe ngosi onwe ya nke antigens генов-cell maka mkpụrụ ndụ cytolysis na-esochi, yana ngosipụta nke neoantigens na ọnya ọnya na-adịgide.

Chemical diabetogens gụnyere alloxan, uric acid, streptozocin, dithizone, vaccor (ngwaahịa nchịkwa), bovine serum albumin (akụkụ nke mmiri ara ehi), nitrosamines na nitrosourea (nke a chọtara na ngwaahịa ndị a okedụsa), pentamidine (ọgwụgwọ maka pneumocystosis) , ngwaahịa nwere mkpụrụ osisi cyanides (mkpụrụ akụ́kụ́ apịtị, almọnd, Kassava nke Africa, nke na-eri ihe dịka nde Aborigine 400, wdg). Sm Smụ sịga na mmanya na-eme ka mmụba nke ọkwa cyanide ọbara, mee ka ngosipụta nke autoimmunity dịkwuo mma, ma mee ka mmepe nke hemochromatosis na pancreatitis.

N’adịghị ka diabetogens, a na-akọwa ọgwụ ndị nwere ihe nchekwa, ndị a na-akpọ antidiabetogens.N'ime ha ka a na-akpọ amino acid nwere sọlfọ na-enwe, ụkọ nke na - eme ka mmadụ nwekwuo ihe na - egbu egbu, ọgwụ antioxidants, zinc (na - ekere òkè na insulin insulin), vitamin PP (na-egbochi apoptosis na necrosis, a na-eji IDDM), polyunsaturated fat fatty acids si na nri azụ (gbochie njikọ nke IL-1 na TNF-α nke ọma).

Mainzọ ndị kachasị mebie kemikal na agwaetiti dị nkwupụta interleukin agbaghị nkịtị na akpụkpọ ahụ в sel nke protein protein. mgbanwe autoimmune na autoallergykpatara obe ma ọ bụ ọgwụ na-ebukarị ọgwụ, na mmeghachi omume mgbochi enweghị nkwupụta neoantigenn'ihi mbibi nke sel. N'otu oge ahụ, ọ ga-ekwe omume ịkwụsị mmebi nke mkpụrụ ndụ кетокл site na ọgwụ mgbochi anticellular na ndị na-eme ngagharị iwe nke mbufụt autoimmune.

N'ịchịkọta ihe ndị dị n'elu banyere usoro mgbochi ọrịa nke IDDM, anyị na-egosipụta isi ihe. Nke a bụ, nke mbụ, insulin na-akpata nfụkasị ahụ kpatara site na cytotoxic T-lymphocytes (ụdị nke ogbugbu mkpụrụ ndụ) n'ihi nkwupụta nke mkpụrụ ndụ клеток na akpụkpọ ahụ cells-mkpụrụ ndụ na-anọghị n'ụkpụrụ nke protein-DR. Ewezuga mkpochapụta nke neoantigens, mkpụrụ nke mkpụrụ ndụ ihe na-efe efe latent, yana ngosipụta nke mkpụrụ ndụ ihe ọmụmụ HCH nke abụọ na mkpụrụ ndụ . Nke abuo, ụdị mbibi mmadụ mebiri emebi nke mkpụrụ ndụ д, nke ihe mejupụtara anti-cell na cytotoxicity nke cytotoxicity (cytotoxic, ma ọ bụ cytolytic). Cytokines zoro ezo (IL-1, TNF-, lymphotoxin, -interferon, platelet na-arụ ọrụ, prostaglandins) ọbụna tupu kwupụta mbibi autoimmune nke mkpụrụ ndụ клеток na-eduga na mgbochi nke insulin nzuzo. Nke a bụ eziokwu bụ eziokwu maka IL-1, nke na -ebilata ịdị nro nke sel n ’glucose. Cytokines ndị a nke lymphocytes na macrophages na-enwe nwere cytotoxic, antiproliferative na antisecretory. Na mgbakwunye na cytolysis autoallergic, IDDM bụ ihe eji amata imechi ọrụ mitotic nke mkpụrụ ndụ .

Pathogenesis nke IDDM.Otu ihe gbara ọkpụrụkpụ na pathogenesis nke IDDM bụ ọnwụ na-aga n'ihu nke mkpụrụ ndụ sel nke pancreatic. Nke a na - ebute mgbanwe nke mmekọrịta heterocellular dị n'ụsọ mmiri, insulinopenia, oke ikuku nke islet na homonụ ndị dị n'ụsọ mmiri. N'ihi ya, a na-akpaghasị itinye glucose na ụdị metabolism niile. Ọrịa metabolism na-adịghị ala ala na-ebute nsogbu nke IDDM, nke bụ isi na-ejikọ ya na angiopathies.

Ọrụ nke nje ihe na-akpata mkpasu iwe na / ma ọ bụ ọgwụ diabetogen bụ iji mee ka mgbanwe ịchekwa onwe onye. Na 10% nke ndị ọrịa nwere ụdị IDDM 1b (yana yana polyendocrinopathy system), iwe iwe adịghị mkpa. N'ime ndị ọrịa nwere ụdị IDDM 1a, ihe na-akpali akpali kwesịrị ibilite na mmalitegenesis ma ọ bụ ọbụna tupu ọmụmụ nwa, n'ihi na IDDM bụ ọrịa nwere ogologo immunological prodrome yana oge nkwụghachi metabolic. Oge dị n'etiti site na mpụta mbụ nke usoro nyocha nke autoimmune ruo mmalite nke ekweghị na glucose bụ afọ 3-4, ma ogologo oge n'etiti ngosipụta mbụ nke mbelata ikike ịmịpụta insulin na ịkọwa metabolic pụtara 1-12 afọ. Ọnọdụ kachasị elu nke IDDM na-apụta n'oge afọ site na ịmụ nwa ruo afọ atọ yana site na afọ 9 ruo 13. Mgbe afọ iri na anọ gasịrị, ikike diabetogens nwere endogenous na-akpasu mbibi nke mkpụrụ ndụ клеток belatara.

Ntọala Morphofunctional nke ISDM. Na mmeghachi omume nke mgbochi immunological, agwaetiti palọ na-etolite insulin, nke emere site na ọnwụ nke mkpụrụ ndụ клето,, mgbanwe mgbanwe, islet infiltration site na lymphocytes, macrophages, eosinophils, distore of neurovaskụla mmekọrịta, na topography cell na kọntaktị intercellular. N'oge etolite nke ọrịa shuga pụtara ìhè, mmadụ abụọ na-ebelata ibu nke pancreas, site na okpukpu atọ, yana mkpụrụ ndụ B - ihe karịrị ugboro 850. N'otu oge ahụ, ụdi A-sel (ihe ruru 75%) yana δ-sel (ihe ruru 25%) na-etolite na agwaetiti ndị a haziri ahazi. N'ihi nke a, glucagon / insulin ruru n'ọbara nke ndị ọrịa nwere IDDM, ka ọrịa ahụ na-etolite, na-eche oke.

Nkewa nke oria shuga.Elldị ọrịa shuga mbụ mellitus bụ nke mejupụtara: insulin-based, hypoinsulinemic, ntorobịa (ụmụaka) IDDM) mejupụtara 20% nke ọnụ ọgụgụ ikpe nke ọrịa mellitus isi. Tyzọ: Ia - n'ihi njikọta nke mkpụrụ ndụ ihe nketa na nsonaazụ gburugburu, Ib - bụ isi, kpebiri ihe banyere mkpụrụ ndụ na-enweghị mkpasu iwe, Ic - na mmebi mbufụt nke mkpụrụ ndụ byеток site na kemịkalụ kemịkal na viral diabetogens.

Diabetesdị ọrịa shuga mbụ (nke na-abụghị insulin, hyperinsulinemic, ndị okenye, ndị agadi, buru ibu, NIDDM) na-akpata 80% nke ọrịa shuga na ụdị ndị a:

IIa - NIDDM na ndị ọrịa na-adịghị oke oke,

IIb - NIDDM nwere nnukwu ọrịa,

IIс - NIDDM nke oge ntorobịa.

Okwu ndị ahụ "IDDM", "NIDDM" na-akọwa usoro ọgwụgwọ (ọ na-adịkarị ketoacidosis na ndị na-eguzogide ketoacidosis, Tebụlụ 3.1), na okwu ndị ahụ bụ "M na II ụdị" na-ezo aka na usoro pathogenetic nke ọrịa ahụ (nsonaazụ nke ike nke autoimmune ma ọ bụ usoro ndị ọzọ).

Ọrịa shuga (nke a bụ hyperglycemic, ma ọ bụ syndromes nke ọrịa mamịrị, nke bụ nsonaazụ nke ọrịa na-emetụta pancreas ma ọ bụ usoro nhazi nke metabolism metabolism).

Ọrịa shuga nke abụọ na-akpata site na mbibi na-abụghị autoimmune nke mkpụrụ ndụ клеток (pancreatitis na-adịghị ala ala, kansa, hemochromatosis, cystosis, trauma),

ọrịa shuga nke abụọ kpatara ọrịa endocrine na hyperproduction nke hormones contrarainlar (ọrịa syndrome, acromegaly, pheochromocytoma, glucagon, hyperthyroidism, pineal gland hyperplasia),

sekọndị ọrịa shuga iatrogenic n'ihi ọgwụ (ọgwụ corticosteroids, ACTH, ọgwụ mgbochi, propranolol, antidepressants, ụfọdụ diuretics),

ọrịa shuga nke abụọ na mkpụrụ ndụ ihe nketa (sypromystrophy), ụdị hypothalamic nke oke ibu, ụdị m glycogenosis, ọrịa Down, Shereshevsky, Klinefelter.

Esemokwu maka ọdịiche dị n'etiti IDDM na NIDDM

Enweghị insulin zuru oke

Enweghi ike insulin

Usoro autoimmune megide  mkpụrụ ndụ

Enweghị usoro nyocha nke onwe

Enweghi ike iguzogide insulin

Nnukwu ihe egwu nke ketoacidosis

Ohere dị ala nke ketoacidosis

Enweghị mkpakọrịta na oke ibu

Chọpụta njikọ maka oke ibu

Mmekorita nke ejima yiri 30-50%

Mmekorita nke ejima yiri 90-100%

Anyị na-ekwusi ike ọzọ na isi njikọta na pathogenesis nke IDDM bụ ọnwụ na-aga n'ihu nke mkpụrụ ndụ клеток n'ihi mgbanwe nke autoimmune. Achọpụtara ihe nrịbama antigens IDDM - ndị a bụ MHC antigens DR₃, DR₄, DQ_3.2.

N'ime ezinụlọ ebe nna nwere ọrịa IDDM, ọnụ ọgụgụ ụmụaka na-arịa ọrịa dị 4-5 ugboro karịa na ezinụlọ ebe nne na-arịa ọrịa.

Esemokwu nke dị n'etiti nne na nwa n’afọ n’ime usoro AB0 na Rh + na-abawanye ihe ọghọm nke ịmalite IDDM.

Ka osiladi, mkpụrụ ndụ ihe nketa na - eme ka mmadụ nwee nnukwu ọrịa. Maka mmejuputa, achọrọ ọrịa shuga na-adịghị efe efe. Usoro nke diabetogens nwere njikọ yana nkwupụta interleukin nke--cell autoantigens. E nwere ihe mere a ga-eji kwere na ọnụ ọgụgụ dị ukwuu nke ndị ọrịa nwere NIDDM bụ ndị nọ n'oge mmalite nke mmalite nke ọrịa shuga, mana ha ka nwere insulin zuru ezu iji gbochie ketoacidosis. NIDDM na obese nwere usoro pathogenetic dị egwu - mmepụta adipocyte nke counter-cytokine TNF-. IDDM na NIDDM nwere ọtụtụ njikọ nje; n'otu oge ahụ, enweghị ike ịgọnarị ịdị adị nke agwakọta na ụdị mgbanwe.

Nkọwapụta ọrịa shuga dịka ọrịa endocrine nọọrọ onwe ya na ọgwụ ahụike "Ebers Papyrus." Nkewa nke ọrịa shuga, ihe mgbaàmà ya na ihe kpatara ya. Nchoputa nke oria: nyocha nke mmamịrị, ọbara maka shuga na haemoglobin glycated.

Isi	Ogwu
Lelee	adịghị adị
Asụsụ	Russian
Addbọchị Tinye	23.05.2015
Ogo faili	18.0 K

Idobe ezigbo ọrụ gị na ntọala ihe ọmụma dị mfe. Jiri mpempe akwụkwọ dị n'okpuru

Studentsmụ akwụkwọ, ụmụ akwụkwọ gụsịrị akwụkwọ, ndị sayensị na-eto eto na-eji ihe ọmụma ihe ọmụmụ ha na ọrụ ha ga-ekele gị nke ukwuu.

Ihe edebere http://www.allbest.ru/

AKWSTKWỌ UDBUDTA AKWATEKWỌ AKW STKWỌ Gọọmentị steeti.

"Mahadum Northwest State Medical University

ha. I.I. Mechnikov »nke Ngalaba Ahụike nke Russia

Isiokwu nke adịghị ahụ: "cipleskpụrụ nke nchọpụta nke insulin-based

na ọrịa shuga na-enweghị insulin ”

Khegay Melis Dmitrievich

Ọbụna narị afọ iri na ise tupu oge anyị, ndị Ijipt oge ochie na usoro ọgwụgwọ ha "Ebers Papyrus" kọwara ọrịa shuga dị ka ọrịa nweere onwe ya. Nnukwu ndị dọkịta nke Gris na Rome oge ochie echeghị echiche banyere ọrịa a dị omimi. Dọkịta Arethaus nwetara aha “ọrịa shuga” - n'asụsụ Grik, “M na-aga, na-agafe.” Sayensị Celsus rụrụ ụka na ntaramahụhụ bụ ihe kpatara ọrịa mamịrị, yana nnukwu Hippocrates chọpụtara site na ịnụ ụtọ mmamịrị onye ọrịa. Site n'ụzọ, ndị China oge ochie makwaara na na ọrịa shuga, mmamịrị na-atọ ụtọ. Ha jiri ijiji (na wasps) wee nweta usoro nyocha izizi. Ọ bụrụ na ijiji na-anọdụ n’elu saucer na mmamịrị, mgbe ahụ mmamịrị ahụ na-atọ ụtọ ma onye ọrịa na-arịa ọrịa.

Ọrịa shuga mellitus bụ ọrịa endocrine mara nke mmụba na-adịghị ala ala nke shuga ọbara n'ihi ụkọ insulin zuru oke - hormone nke pancreas. Ọrịa a na-ebute mmebi nke ụdị metabolism niile, mmebi nke arịa ọbara, akwara ozi yana akụkụ ahụ na sistem ndị ọzọ.

Kpa iche: mellitus endocrine haemoglobin

Ọrịa shuga na-akpata insulin (ụdị shuga 1) na-etolitekarị na ụmụaka na ndị na-eto eto,

Ọrịa shuga na-abụghị insulin (ụdị 2 diabetes mellitus) na-ebukari n’etiti mmadụ karịrị 40 na-ebu oke ibu. Nke a bụ ụdị ọrịa na-ahụkarị (achọpụtara na 80-85% nke ikpe),

Secondary (ma ọ bụ symptomatic) ọrịa shuga mellitus,

Ọrịa shuga na-edozi ahụ

N'ime ụdị shuga 1, enwere insulin zuru oke n'ihi adịghị mma nke pancreas.

N'ime ụdị ọrịa shuga abụọ nke ọrịa mamịrị, a na-achọpụta ụkọ insulin. Mkpụrụ ndụ akụrụngwa na - emepụta insulin zuru oke (mgbe ụfọdụ, ọnụọgụ ego). Agbanyeghị, ọnụ ọgụgụ ụlọ ọrụ ndị na-achọpụta na kọntaktị ya na sel ma na-enyere glucose si n'ọbara banye na sel na-egbochi ma ọ bụ belata n’elu mkpụrụ ndụ. Enweghị glucose cell bụ ihe mgbaàmà maka mmepụta insulin karị, mana nke a enweghị mmetụta ọ bụla, ka oge na-aga, imepụta insulin na-ebelata nke ukwuu.

Isi ihe kpatara ụdị shuga 1 bụ usoro akpaaka nke ihe na-akpata sistem ahụ ji alụso ọrịa ọgụ, bụ nke a na-emepụta ọgwụ mgbochi anụ ahụ n’ime mkpụrụ ndụ akwara nke na-ebibi ha. Isi ihe na - akpata ọrịa oria 1 bụ ọrịa malitere ịrịa (rubella, chickenpox, ịba ọcha n'anya, mumps (mumps), wdg) megidere usoro mkpụrụ ndụ ihe nketa nke ọrịa a.

Ary dietụ nri afọ mgbe niile ị seleụ ọgwụ selenium na-abawanye ohere nke ibute ọrịa shuga 2dị nke Abụọ.

Isi ihe na-akpata mpụta nke ụdị ọrịa shuga 2 bụ ọrịa abụọ: oke ibu na ọrịa ga - eketa:

Ibu ibu Na ọnụnọ nke oke ibu M tbsp. ihe ọghọm nke ibute ọrịa shuga na-abawanye ugboro abụọ, jiri II tbsp. - ugboro ise, jiri nka. III - kariri ugboro iri. Ofdị oke abụba na - emetụta mmekọrịta nke ọrịa - mgbe ekesara abụba n'ime afọ.

Akpachapụ anya ketara eketa. Na ọnụnọ nke ọrịa shuga na nne na nna ma ọ bụ ezinụlọ dị nso, ihe ize ndụ nke ibute ọrịa ahụ na-abawanye site na 2-6 ugboro.

Ọrịa shuga na-enweghị insulin na-amalite nke nta nke nta ma mara njiri mgbaàmà na-agafeghị oke.

Ihe ndị na-akpata ọrịa shuga na-akpata pụrụ ịbụ:

1. Ọrịa pancreatic (pancreatitis, tumo, yiri, wdg),

2. ọrịa nke ụdị homonụ (ọrịa herenko-Cushing, acromegaly, inye goiter, pheochromocytoma),

3. ikpughepụta ọgwụ ma ọ bụ kemịkal,

4. gbanwee mgbanwe ndị na - anabata insulin,

5. ụfọdụ mkpụrụ ndụ ihe nketa syndromes, wdg.

Na iche, ọrịa shuga nke ụmụ nwanyị dị ime na ọrịa shuga n'ihi erighị ihe na-edozi ahụ.

Na mgbakwunye na inyocha mkpesa ndị dị adị na ozi gbasara arụmọrụ, nyocha nke ụlọ nyocha bụ ihe iwu. Mkpebi glucose na-ebu ọnụ ma nwee nnukwu nsogbu dị iche iche, ịchọpụta glucose na ahụ ketone na mmamịrị, ọmụmụ insulin, C-peptide n'ọbara ọbara, mkpebi nke glycosylated protein protein na mkpọchi nke mkpụrụ ndụ insulin na - amịpụta mkpụrụ ọgwụ a na - eme. .

Nnwale ọbara shuga

Informzọ bara uru nke ukwuu ma dịkwa ọnụ ala bụ nnwale ọbara maka shuga. A na-eme ya kpam kpam na oghere efu n'ụtụtụ. Dika odi, ntinye glucose bu site na 3.3 ruo 5.5 mmol / L. N'ehihie, ọkwa shuga na-agbanwe agbanwe na-adabere n'ihe oriri. Nchọpụta nchọpụta chọrọ otutu nha n’ụbọchị dị iche iche. N'ime onye ọrịa nwere ọrịa shuga, glycemia n'ọbara venous karịrị 10 mmol / l, na okpu - 11.1 mmol / l. Achọpụtaghị ụdị nyocha ụlọ nyocha ahụ maka iwe ọkụ, mgbe ọ gbasasịrị ọgwụ, na-emegide usoro ọgwụgwọ homonụ (dịka ọmụmaatụ, mgbe ị na-ewere homonụ thyroid).

Glycated Hemoglobin Assay

A na-eme ka haemoglobin glycated mee ihe site na mgbakwunye nke glucose na protein hemoglobin, nke a na-ahụ na mkpụrụ ndụ ọbara uhie. Ihe omumu ihe omumu bu ọbara zuru oke. Nchịkọta a bụ iwu maka nchọpụta nke ọrịa shuga, mkpebi siri ike nke ụgwọ, iji chịkwaa ọgwụgwọ nke ọrịa a. Ọ na-egosi ọkwa glucose dị elu ọ bụghị n'oge nyocha, mana ọnwa atọ gara aga. Normkpụrụ bụ 4-6%, ihe dị iche site na nke a gosipụtara n'ọtụtụ na-egosi ọrịa shuga, enweghị iron n'ime ahụ.

Mkpebi nke C-peptide na-eme ka o nwee ike ịmata ihe dị iche n'etiti ọrịa shuga na-adabere na insulin na-abụghị insulin, iji chọpụta usoro insulin kwesịrị ekwesị. Dị ka ọ na-adịkarị, ọdịnaya nke C-peptide bụ 0,5 - 2.0 μg / L. Mbelata na uru a na-egosi erughi insulin nke endogenous, njọ nke ọrịa shuga mellitus, mmụba nke ọkwa ahụ na-egosi ọdịda akwara na-adịghị ala ala, insulinoma. A na-enyo enyo enyo site na enyemaka nke nnwale maka igbochi nguzobe nke C-peptide: mgbe nyochachara, a na-eduzi insulin na -emekwa ọmụmụ ihe ọzọ ka otu elekere gasịrị.

A na-eji usoro nyocha dị ka ihe ọzọ iji chọpụta ọrịa. A na - ahụta nchọpụta glucose na mmamịrị dị ka ihe doro anya nke usoro pathological. Etechọpụta anụ ahụ ketone na-egosi mmepe nke ụdị mgbagwoju anya. Isi acetone na-esi nsi ekwuputa na-egosi acetonuria.

Ọrịa Endocrine nwere ike imetụta ọrụ akụkụ ahụ ndị ọzọ dị n'ime, yabụ, a na-atụ aro maka nchọpụta ọrịa shuga zuru oke, nke na-ekpebi ụdị, ọkwa nke ọrịa ahụ, na ịchọpụta nsị nke usoro ndị ọzọ. Dọkịta n'okwu a dabere na mkpesa ndị ọrịa, ụlọ nyocha na akụrụngwa.

Ihe ndi mmadu choro maka ichoputa oria shuga na - akpata insulin bu: a na --ebu oke mkpuru glucose ọbara karia 6.7 mmol / l, nnabata nke glucose na aru ketone n’ime mmamiri, ihe ndi mmadu na - eme ka ogwu di ndu.A na-achọpụta nsogbu nzuzo nke metabolism metabolism site na ịmụ gemocosylated haemoglobin (karịa 9%) na fructosamine (karịa 3 mmol / l), wdg.

Maka ọrịa mellitus na-abụghị insulin na-adabere, nnyocha ọrịa bụ mmụba nke ọkwa glucose na-ebu ọnụ karịa 6.7 mmol / L.

Ogologo glucose dị na mmamịrị bụ nke a na-ekpebikarị site na nyocha dị nta n'ọtụtụ ọrụ kwa ụbọchị. Glycosylated haemoglobin na fructosamine na-adịkwa elu. Mana ọkwa insulin immunoreactive insulin na C-peptide anaghị agafe ụkpụrụ kwesịrị.

Ekwesiri iburu n'uche na nyocha nke ọrịa shuga na-adabere na mkpebi mkpebi nke okpukpu abụọ nke glucose na-ebu ọnụ ma ọ bụ ngafe nke glucose ugboro abụọ n'ọbara nke 11 mmol / l n'oge a na-akwadoghị.

Na omume, enwere oge mgbe, maka nchọpụta nke ọrịa shuga mellitus, ọ dị mkpa iji nnwale glucose na -eme nnwale (yana ule a, a na-achọpụta nnabata glucose na-adịghị mma).

Nchoputa nke oria shuga dabere na ihe ngosi ndia n’inyocha ule a: n’ime afo efu - kariri 6.7 mmol / l, n ’awa abuo mgbe ebighara glucose - kariri 11.1 mmol / l. N ’oge a, ihe ngosi ndị a kwekọrọ na ngosipụta izizi nke ọrịa a.

Mkpakọ nke ọrịa shuga mellitus dị ize ndụ n'ụzọ mbụ site na mmepe nke coma, ebe a chọrọ nlekọta mberede. Ọnọdụ ndị a gụnyere ketoacidosis na ketoacidotic ọrịa mamịrị coma, hypoglycemic coma, yana hyperosmolar na lacticidal coma. Mmepe nke ọnọdụ ndị a jikọtara ya na ọrịa metabolic oke. A na-ahụkarị ketoacidotic ọrịa mamịrị coma na hypoglycemic coma.

Treatmentgwọ ọrịa shuga bụ iji kpochapụ ọrịa metabolism kpatara ụkọ insulin, yana igbochi ma ọ bụ iwepụ ọnya nke arịa ọbara. Dabere n'ụdị ọrịa shuga mellitus (nke na-adabere na insulin ma ọ bụ na-abụghị insulin), a na-enye ndị ọrịa ọgwụ insulin ma ọ bụ nchịkwa ọnụ nke ọgwụ nwere ike ịdalata shuga. Ndị ọrịa niile na-arịa ọrịa shuga mellitus ga-agbaso nri ndị dọkịta ọkachamara guzobere, ihe mejupụtara na nke pere mpe nke na-adaberekwa n'ụdị ụdị ọrịa shuga mellitus. Ihe dị ka 20% nke ndị ọrịa nwere ọrịa shuga na-abụghị insulin, nri shuga bụ naanị usoro ọgwụgwọ zuru oke iji nweta ụgwọ. N'ime ndị ọrịa nwere ọrịa mellitus na-abụghị insulin, ọkachasị na oke ibu, usoro ọgwụgwọ ga-abụrịrị iwepụ oke ibu. Mgbe ịmechara ma ọ bụ belata ahụ dị n ’ndị ọrịa dị otú a, a na-ebelata ojiji nke ọgwụ na -eme ka okpukpo belata, ma wepụ ya kpamkpam oge ụfọdụ.

Oke nke protein, abụba na carbohydrates na nri onye ọrịa na-arịa ọrịa shuga kwesịrị ịbụ nke usoro ọmụmụ. Ọ dị mkpa na oke protin bụ 16-20%, carbohydrates - 50-60%, abụba - 24-30%. A na-agbakọ nri ahụ na-adabere n'ihe a na-akpọ. ọmarịcha, ma ọ bụ n’iru, n’arụ ahụ. Onye ọrịa ọ bụla na-arịa ọrịa shuga ga-agbasochi anya na nri onye ọ bụla, nke dọkịta ọkachamara mejupụtara, na-eburu ibu, ịdị elu na ụdị ọrụ onye ọrịa na-arụ, yana ụdị ọrịa shuga. Yabụ, ọ bụrụ na, mgbe ị na-arụ ọrụ nkịtị, ahụ kwesịrị inweta 30-40 kcal kwa 1 n'arọ nke ezigbo ịdị arọ, mgbe ahụ na ịdị arọ 70 kg, nkezi nke 35 kcal kwa 1 n'arọ, nke ahụ bụ 2500 kcal, achọrọ. Mara ọdịnaya nke nri na ngwaahịa nri, ị nwere ike gbakọọ ọnụọgụ kilocalories kwa oge nke ọ bụla n'ime ha.

A na-atụ aro ka onye ọrịa nwere ọrịa mellitus regimen nke obere ihe oriri (na-eri nri ugboro 5-6 kwa ụbọchị). Uru kalori na-eri kwa ụbọchị kwesịrị ịbụ otu ihe ahụ ma ọ bụrụ na ọ ga-ekwe omume, n'ihi na nke a na-egbochi mgbanwe dị nkọ na mkpokọta glucose n'ọbara. Agbanyeghị, ọ dị mkpa iburu n'uche oke oriri ike, nke dị iche n'ụbọchị dị iche iche. Anyi aghaghi ekwuputa ugboro ugboro na o di ezigbo mkpa na nri a na-eri, nke na-eme ka o kwe omume inweta mmezu zuru oke maka oria. Amachibidoro ndị ọrịa shuga ọrịa shuga machibidoro shuga na ihe ndị ọzọ na-atọ ụtọ, mkpụrụ osisi nwere nnukwu carbohydrates na-adị ngwa ngwa (mkpụrụ vaịn, persimmon, fig, melons). Enwere ike itinye mkpụrụ ntụgharị sugar (sorbitol, xylitol, wdg) na nri na-erughị 30 g kwa ụbọchị. Dabere n'ụdị ọrịa shuga na ahụ aru nke onye ọrịa, oriri achịcha sitere na 100 ruo 400 g kwa ụbọchị, ngwaahịa ntụ ọka - ruo 60-90 g kwa ụbọchị. Obere poteto dị na 200-300 g kwa ụbọchị, abụba anụmanụ (bọta, mmanu abuba, abụba anụ ezi) ruo 30-40 g, a na-atụ aro ka edochie ha na mmanụ nri. Akwụkwọ nri - kabeeji ọcha, cucumbers, letus, tomato, zukini bụ ihe akparaghị ókè. Ojiji nke beets, karọt, apụl na mkpụrụ osisi ndị ọzọ akọwaghị ekwesịghị gafere 300-400 g kwa ụbọchị. A ga-etinye ụdị anụ na azụ nwere obere abụba na nri ụbọchị kwa ụbọchị na-erughị 200 g, mmiri ara ehi na ngwaahịa mmiri ara ehi - karịa 500 g, obere ụlọ -150 g, àkwá - 1-1, àkwá 5 kwa ụbọchị. Achọrọ mmachi nnu (ruo 6-10 g) nnu.

Nri a na-eme kwa ụbọchị nke ndị na-arịa ọrịa shuga kwesịrị inwe vitamin zuru ezu, karịchaa vitamin A, C, C. Mgbe ị na-achịkọta nri, ọnọdụ onye ọrịa ahụ, ọnụnọ nke ọrịa na-efe efe na patol, a ga-eburu ọnọdụ n'uche. Site na ketoacidosis, a na-ebelata oke abụba na nri onye ọrịa; mgbe ọ wepụsịrị ketoacidosis, onye ọrịa ahụ nwere ike ịlaghachi na nri iri nri ọ bụla. Ọ dịghị ihe dị mkpa bụ ọdịdị nke nhazi nri, nke ekwesịrị ime ka ọ bụrụ na-eburu ọrịa na-ebute ọrịa, dị ka cholecystitis, gastritis, peptic ulcer na dr.

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Pathogenesis nke ọrịa shuga na-arịa insulin na-abụghị insulin (NIDDM)

Mellitus na-arịa insulin na-abụghị insulin (NIDDM) ihe kpatara insulin na - emebi ya na iguzogide ihe ya. Dị ka ọ na-adịkarị, isi mmiri insulin na-eme site na nnyonye anya, na nzaghachi maka ibu glucose. N'ime ndị ọrịa na-arịa ọrịa shuga mellitus na-abụghị insulin (NIDDM), ntọhapụ nke basal nke insulin adịghị mma, nzaghachi maka nnabata glucose ezughị ezu, ọkwa dị elu nke insulin dị elu, ọ bụ ezie na ọ dị ala karịa hyperglycemia.

Nzọụkwụ pụtara na mbụ hyperglycemia na hyperinsulinemia, nke na-ebido mmepe nke ọrịa mellitus na-abụghị insulin na-abụghị insulin (NIDDM). Hyperglycemia na-adịgide adịgide na-ebelata uche nke sel sel islet, na-eduga n'ịbelata insulin maka ọkwa glucose ọbara. N'otu aka ahụ, ọkwa dị elu nke ọkwa insulin na-egbochi ndị na-anabata insulin, na-abawanye nguzogide insulin.

Na mgbakwunye, ebe ọ bụ na uche insulin belata, ịba ụba nke glucagon, n'ihi ịba ụba glucagon na-eme ka ntọhapụ nke glucose si na imeju, na-abawanye hyperglycemia. Na njedebe, usoro ajọ ihe a na-eduga na ọrịa mellitus na-abụghị insulin.

.Dị na-arịa ọrịa shuga na-abụghị insulin na-esite na nchikota nke nkpuru ndu na ihe ndi gbara gburugburu. Ihe nlere nke na-akwado ịkọ mkpụrụ ndụ ihe na-agụnye ọdịiche dị na nkwekọrịta n'etiti monozygous na ejima dizygotic, mkpokọ ezinụlọ, na ọdịiche dị n'etiti ọha mmadụ.

Agbanyeghị na a na-ahụta ụdị ihe nketa a otutu ihe, njirimara nke mkpụrụ ndụ ihe nketa dị ukwuu, nke mmetụta nke afọ, okike, agbụrụ, ọnọdụ anụ ahụ, nri, ị smokingụ sịga, oke ibu na ikesa abụba, enwetala ụfọdụ ihe ịga nke ọma.

Osisi zuru oke nyocha gosipụtara na mpaghara Icelandic nwere ọrịa mellitus na-abụghị insulin na-akpata, polymorphic alleles nke obere tandem na-ekwughachi na ntinye ihe na TCF7L2 transbet factor nwere njikọ. Heterozygotes (38% nke ndị bi na) na homozygotes (7% nke ndị bi na) nwere oke ihe ize ndụ nke NIDDM n'ihe gbasara ndị na-abụghị ndị na-ebu ihe ruru ihe dịka 1.5 na 2.5 ugboro, n'otu n'otu.

Ebuli elu ihe egwu A hụrụ TCF7L2 n'asụsụ Danish na ndị America ọrịa cohorts. Ihe egwu NIDDM metụtara a allele bụ 21%. TCF7L2 na - etinye ihe na - enye aka na ntụgharị nke hormone glucagon, nke na - eme ka ịbawanye ụba nke glucose ọbara, na - eme ihe megidere ihe insulin, nke na --ebelata ọkwa nke glucose ọbara. Nyochaa ndị otu Finnish na Mexico kpughere ọnọdụ ọzọ, mmụba nke Prgo12A1a na mkpụrụ ndụ PPARG, nke doro anya maka ndị a ma nye ihe ruru pacenti 25% nke NIDDM.

Ugboro ugboro allele Proline na-eme ugboro ugboro 85% ma na-akpata ntakịrị mmụba n'ihe ize ndụ (ugboro 1.25) nke ọrịa shuga.

Gene PARA - Otu onye n’ime ezinụlọ nnabata nke hormone nke dị mkpa ọ dị maka ịhazi ọrụ na ọdịiche nke sel abụba.

Nkwupụta ọrụ ihe ihe gburugburu gburugburu gụnyere ihe na-erughị 100% mmekọrịta n'ime ejima monozygotic, ọdịiche nkesa na ụdị mkpụrụ ndụ ihe nketa, yana mkpakọrịta na ụdị ndụ, nri, oke ibu, ịtụ ime, na nchekasị. Ekwadoro ya na nnabata ihe mkpụrụ ndụ bụ ihe dị mkpa maka mmepe nke ọrịa mellitus na-abụghị insulin, insulin na -adabere na ọrịa shuga mellitus (NIDDM) na-adabere nke ukwuu.

Phenotype na mmepe nke ọrịa mellitus na-abụghị insulin na-adabere (NIDDM)

Ọtụtụ mgbe na-arịa ọrịa shuga na-abụghị insulin (NIDDM) dị na ndị buru oke oke ma ọ bụ karịa, ọ bụ ezie na ọnụọgụ ụmụaka na ndị na-eto eto na-arịa ọrịa na-eto n'ihi mmụba nke ọnụ ọgụgụ oke ibu na oke mkpagharị n'etiti ndị na-eto eto.

Ọrịa shuga 2dị 2 nwere mmalite nwayọ nwayọ ma na-enyochakarị ọkwa glucose dị elu site na nyocha. N’adịghị ka ndị ọrịa nwere ọrịa shuga nke 1, ndị ọrịa nwere ọrịa shuga na-abụghị insulin na-arịa mellitus (NIDDM) anaghị etolite ketoacidosis. N'ụzọ bụ isi, mmepe nke ọrịa shuga na-abụghị insulin na-akpata (NIDDM) na-ekewa usoro atọ.

Nke mbu ọbara bụ ihe nkịtị n'agbanyeghị ogo insulin dị elu, na-egosi na uru insulin na-ezu ike na-anọgide na-eguzogide mmetụta nke hormone ahụ. Mgbe ahụ, n'agbanyeghị ịba ụba nke insulin, hyperglycemia na-amalite mgbe mgbatị ahụ gasịrị. Na mmechi, insulin na-emebi emebi na-akpata agụụ hyperglycemia agụụ na onyonyo nke ọrịa shuga.

Na mgbakwunye na hyperglycemia, metabolic nsogbuọ bụ nsonaazụ ikuku islet b-cell na nguzogide insulin na-akpata atherosclerosis, neuropathy peripheral, akụrụ gbasara akwara, cataracts na retinopathy. N'ime otu n'ime ndị ọrịa isii nwere ọrịa mellitus na-abụghị insulin na-arịa (NIDDM), ọdịda akụrụ ma ọ bụ akwara vaskụla na-achọ mmachi nke ala ala malitere, otu onye n'ime mmadụ ise na-emechi anya n'ihi mmepe nke retinopathy.

Mmepe nke ndị a nsogbu n'ihi usoro ọmụmụ na ọdịdị nke njikwa metabolic. Enwere ike ịchọpụta hyperglycemia na-adịghị ala ala site na ịchọpụta ọkwa nke haemoglobin glycosylated (HbA1c). Ọnọdụ siri ike, dị ka o kwesiri, ijigide mkpokọta glucose (ọ bụghị ihe karịrị 7%), na mkpebi siri ike nke HbA1c, belata ihe egwu nke nsogbu site na 35-75% ma nwee ike ịgbatị nkezi ndụ ndụ, nke bụ ugbu a nkezi nke afọ 17 mgbe ịtọ ntọala nchoputa ya otutu afọ.

Phenotypic atụmatụ ngosipụta nke ọrịa shuga na-abụghị insulin:
• Afọ mmalite: site na nwata rue okenye
• Hyperglycemia
• ụkọ insulin
• Nchịkwa insulin
• oke ibu
• Acanthosis nke akpụkpọ akpachi

Ọgwụ nke ọrịa shuga na-abụghị insulin na-arịa mellitus (NIDDM)

Kpebie aruMmụba anụ ahụ na mgbanwe iri nri na-enyere ọtụtụ ndị ọrịa nwere ọrịa shuga na-enweghị insulin na-agwọ ọrịa ume ume (NIDDM), na-achọpụtawanye mma ike insulin. Ọ bụ ihe nwute, ọtụtụ ndị ọrịa enweghị ike ma ọ bụ na ha achọghị ịgbanwe ụzọ ndụ ha iji kwalite, ma chọọ ọgwụ na-agwọ ọrịa hypoglycemic, dị ka sulfonylureates na biguanides. Klas nke atọ nke ọgwụ, thiazolidinediones, na-ebelata ọgwụ insulin site na ijikọ PPARG.

I nwekwara ike iji nke anọ ogwu ogwu - α-glucosidase na-egbochi, na-eme ihe site n’ibelata oke afọ nke glucose. A kwadoro klaasị ọgwụ ndị a ka monotherapy maka mellitus na-abụghị insulin-insulin (NIDDM). Ọ bụrụ na otu n'ime ha akwụsịghị ịmalite ọrịa ahụ, enwere ike ịgbakwunye otu ọgwụ si na klas ọzọ.

Ọgwụ hypoglycemic nkwadebe ọ bụghị ihe dị irè iji nweta njikwa glucose dị ka oke ibu, ịba ụba nke mmega ahụ, na mgbanwe nri.Iji mezuo nchịkwa glucose ma belata ohere nke nsogbu, ụfọdụ ndị ọrịa chọrọ ọgwụgwọ insulin, agbanyeghị, ọ na-eme ka mgbochi insulin dịkwuo elu, na-abawanye hyperinsulinemia na oke ibu.

Ihe ize ndụ nke ihe nketa nke ọrịa shuga na-arịa insulin na-abụghị insulin (NIDDM)

Onu ndi mmadu noo na-arịa ọrịa shuga na-abụghị insulin (NIDDM) dabere na onu ogugu a guru, onu ogugu ndi mmadu ihe omuma a sitere na 1 rue 5%, obu ezie na USA obu 6-7%. Ọ bụrụ na onye ọrịa ahụ nwere nwanne na-arịa ọrịa, ihe ize ndụ ahụ ga-abawanye 10%, ọnụnọ nke nwanne na-arịa ọrịa na onye ikwu ọzọ nke njikọ nke mbụ na-amụba ihe ize ndụ ahụ ruo 20%, ọ bụrụ na ejima monozygotic na-arịa ọrịa, ihe ize ndụ ahụ ga-eru 50-100%.

Na mgbakwunye, ebe ụfọdụ ụdị mellitus na-abụghị insulin na-arịa ọrịa shuga na-emetụta ụdị shuga 1, ụmụaka ndị nne na nna nwere ọrịa shuga na-enweghị insulin na-akpata insulin (NIDDM) nwere nsogbu 1 nke 10 maka ọrịa shuga na-arịa ụdị 1.

Ihe atụ nke ọrịa mellitus na-abụghị insulin. M.P., nwoke gbara afọ 38 dị mma, agbụrụ American Pima nke America, na-ajụ banyere ihe a ga --eme ka ọrịa mellitus na - abụghị insulin na - akpata insulin (NIDDM). Ndị nne na nna ya nwere ọrịa mellitus na-abụghị insulin na-akpata, nna ya nwụrụ na 60 site na infarction myocardial, na nne ya na 55 na ọdịda akụrụ. Nna nna nwoke na otu nwanne nwanyị nke okenye nwekwara ọria ọrịa shuga na-enweghị insulin na-arịa, mana ya na ụmụnne ya ndị nwanyị anọ ka dị mma.

Nyocha data dị nkịtị, ewezuga obere oke ibu, glucose ọbara na-ebu ọnụ bụ ihe dị mma, agbanyeghị, mmụba nke insulin na ọkwa glucose ọbara mgbe achọpụtara ibu glucose ọnụ. Nsonaazụ ndị a kwekọrọ na ngosipụta mbụ nke steeti metabolic, ikekwe na-eduga na ọrịa shuga na-enweghị insulin. Dọkịta ya dụrụ ndị ọrịa ọdụ ka ha gbanwee ụdị ndụ ha, felata ma nwekwuo mmega ahụ. Onye ọrịa ahụ belatara abụba ya riri nke ọma, bido njem igwe na-arụ ọrụ ma na-agba ọsọ ugboro atọ n'izu, ịdị arọ ya belatara site n'arọ 10 kilogram, nnabata glucose ya na ọkwa insulin laghachiri na nkịtị.

Ofdị ọrịa shuga dị iche iche na njiri mara ha

Ọ dị mkpa inwe ike ịmata ọdịiche dị n'etiti ụdị ọrịa pathology. Gụọ banyere atụmatụ nke ụdị shuga ọ bụla n'okpuru:

ụdị shuga 1. Nke a bụ ụdị insulin na-adabere na ọrịa nke na-ebilite dị ka ihe ndị na-egbochi ọrịa, nrụgide enwerela, mwakpo nje, nnweta ma ọ bụ na - ebi ndụ na - ezighi ezi. Dịka iwu, a na-achọpụta ọrịa ahụ na nwata. N'oge okenye, ụdị ọrịa shuga na-akpata insulin na-adịkarị ala. Ndị ọrịa na-arịa ọrịa shuga dị otú a kwesịrị iji nlezianya nyochaa ọkwa shuga ha ma jiri insulin inje ha rụọ ọrụ n'oge kwesịrị ekwesị ka ha wee ghara ibutere onwe ha nsogbu.
ụdị ọrịa shuga 2. Ọrịa a na-ebulite na ndị agadi, yana ndị na-ebi ndụ okirikiri ma ọ bụ buru oke ibu. Site n'ọrịa dị otú ahụ, ọria na-amịpụta insulin zuru ezu, agbanyeghị, n'ihi enweghị mmetụta nke homonụ na sel, ọ na-agbakọ n'ọbara, n'ihi nke a dịghị etinye glucose. N'ihi ya, ahụ na-ahụ agụụ agụụ. Ulindabere insulin anaghị arịa ọrịa shuga dị otú a,
oria shuga agbagọ. Nke a bụ ụdị ọrịa mamịrị. N'okwu a, onye ọrịa ahụ nwere ahụike ma ọ naghị arịa ọrịa mgbaàmà, nke na-emebi ndụ nke ndị ọrịa dabere na insulin. Site na ọrịa shuga na-agbakọta, ọnụọgụ glucose n'ọbara na-amụba ntakịrị. Ọzọkwa, ọ dịghị acetone dị na mmamịrị nke ndị ọrịa dị otú a,
mmegharị ahụ. Ọtụtụ mgbe, ọrịa a na - aputa ihe n’ebe ụmụ nwanyị nọ n’oge afọ ime. Ihe kpatara mmụba shuga bụ mmụba glucose, nke dị mkpa maka ịmụrụ nwa ebu n’afọ. Ọtụtụ mgbe, ọ bụrụ na ọrịa afọ ime na-apụta naanị n'oge afọ ime, ihe gbasara ọmụmụ na-apụ n'anya n'onwe ya na-enweghị usoro ahụike ọ bụla,
latent ọrịa shuga. Ọ na-aga n'ihu na-enweghị mgbaàmà doro anya. Ọbara glucose dị n'ọbara bụ ihe dị mma, mana ịnabata ọyị glucose emebi. Ọ bụrụ na ewereghị usoro a n'oge, ụdị latent ahụ nwere ike ibuo ọrịa shuga zuru oke.
latent ọrịa shuga. Ọrịa shuga na-arịa ọrịa latent na-amalite n'ihi sistem nke sistem, nke mkpụrụ ndụ akwara na-efunyụọ ike ha ịrụ ọrụ nke ọma. Ọgwụ maka ọrịa shuga latent yiri ọgwụgwọ a na-eji maka ụdị shuga 2. Ọ dị mkpa idobe ọrịa a.

Etu esi achọpụta ụdị ọrịa shuga 1 ma ọ bụ abụọ n’ime onye ọrịa?

Ọ dị mkpa iji nyocha ụlọ nyocha iji chọpụta ụdị ọrịa shuga ọ bụla ma ọ bụ ụdị nke 2. Mana maka dọkịta ahụ, ozi enwetara n'oge mkparịta ụka ya na onye ọrịa ahụ, yana n'oge nyocha, agaghị adịkwa mkpa. Typedị nke ọ bụla nwere njiri mara ya.

Ihe ndia bu nwere ike igwa eziokwu banyere na onye oria bidoro oria 1:

mgbaàmà na-apụta ngwa ngwa ma pụta ìhè n’ime izu ole na ole,
Ọrịa insulin na-adabere na ndị ọrịa shuga na-adịkarị obere nwere ibu ibu karịa. Ha nwere akpukpo aru ma obu nke ozo,
oké akpịrị ịkpọ nkụ na urination ugboro ugboro, ịdị arọ nke ezigbo agụụ, oke iwe na ụra.
ọrịa a na-ebutekarị ụmụaka nwere ọrịa nwere ike ịmụ ihe.

Ihe ngosi ndia ne gosiputa oria 2:

mmepe nke ọrịa ahụ na-apụta n'ime afọ ole na ole, yabụ na-egosipụtakarị mgbaàmà ahụ,
ndị ọrịa buru oke ibu ma ọ bụ buru oke ibu,
na-achagharị ahụ n’akpụkpọ anụ ahụ, itching, ahụ ọkụ, ọnya aka, akpịrị ịkpọ nkụ na ịbịakwute ụlọ mposi mgbe niile, agụụ na-agụ ya mgbe niile.
ahụghị njikọ ọ bụla n'etiti mkpụrụ ndụ ihe nketa na ụdị ọrịa shuga 2.

Mana na agbanyeghị, ozi enwetara na usoro isoro onye ọrịa rịa ọrịa ahụ na-ahapụ naanị nyocha nke mbu. Maka ịchọpụta ezi nchọpụta, achọrọ nyocha.

Ihe mgbaàmà dị a canaa nwere ike ịmata ọdịiche n'etiti ụdị insulin na-adabere na ụdị insulin anaghị eme onwe ya?

Akụkụ kachasị na-egosipụta bụ ngosipụta nke mgbaàmà.

Dịka iwu, ndị ọrịa nwere ọrịa shuga na-enweghị insulin anaghị arịa ọrịa mgbaàmà dị ka ndị ọrịa mamịrị na-akpata insulin.

N'okpuru nri na ndụ dị mma, ha nwere ike imecha shuga shuga kpamkpam. N'ihe banyere ụdị shuga 1, nke a agaghị arụ ọrụ.

N'oge ọzọ, ahụ agaghị enwe ike ịnagide hyperglycemia n'onwe ya, n'ihi nke nke Coma nwere ike ime.

Kedu otu esi ekpebi ụdị ọrịa shuga site na shuga ọbara?

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

Naanị ịchọrọ itinye ...

Iji bido, a na-enye onye ọrịa ule nnwale ọbara maka oke okike. A na-ewere ya site na mkpịsị aka ma ọ bụ na akwara.

Na mmechi, okenye ga-enye ọnụ ọgụgụ sitere na 3.3 ruo 5.5 mmol / L (maka ọbara si na mkpịsị aka) yana 3.7-6.1 mmol / L (maka ọbara sitere na akwara).

Ọ bụrụ na ihe ngosi ahụ karịrị akara nke 5.5 mmol / l, onye ọrịa ahụ nwere ọrịa shuga. Ọ bụrụ na nsonaazụ ahụ karịrị 6.1 mmol / l, nke a na-egosi ọnụnọ nke ọrịa shuga.

Di elu gosipụtara, o yikarịrị ka ọnụnọ nke ọrịa shuga 1. Dịka ọmụmaatụ, ọkwa glucose ọbara nke 10 mmol / L ma ọ bụ karịa ga-abụ nkwenye doro anya nke ụdị shuga 1.

Zọ ndị ọzọ nke nchọpụta ọdịiche

Dịka iwu, ihe dị ka 10-20% nke ọnụ ọgụgụ ndị ọrịa na-arịa ọrịa shuga na-akpata insulin. Ndị ọzọ niile na-arịa ọrịa shuga na-enweghị insulin.

Iji gosipụta n’ezie site n’enyemaka nke ụdị ọrịa onye ọrịa na-arịa, ndị ọkachamara na-achọpụta nchọpụta ọrịa dị iche.

Iji chọpụta ụdị ọrịa, a na-anwale ule ọbara ọzọ:

ọbara na C-peptide (ọ na - enyere aka ịchọpụta ma ọ bụrụ na emepụtara insulin a na - eme).
na autoantibodies ka pancreatic beta-sel nwere antigens,
maka ọnụnọ nke ketone n'ime ọbara.

Na mgbakwunye na nhọrọ ndị edepụtara n’elu, a pụkwara ime nyocha mkpụrụ ndụ ihe nketa.

Vidiyo ndị metụtara

Banyere ule ị ga-eme maka ọrịa shuga, na vidiyo:

Maka nyocha zuru oke nke ụdị ọrịa mamịrị, a na-achọ nyocha zuru oke. Ọ bụrụ n’ịchọta mgbaàmà ọ bụla nke ọrịa shuga, jide n’aka ịkpọ dọkịta. Ime ihe n'oge ga - ewepu ọrịa a ma zere nsogbu.

Etiology nke ọrịa

Ọrịa shuga 1dị nke Abụọ bụ ọrịa si n'ọrịa, mana ịkọwa mkpụrụ ndụ ihe nketa na-ekpebi uto ya site na naanị atọ. Ihe puru iche na ogwu banyere nwata n’aria n’ariri oria n’azu apughi ibu ihe kariri 1-2%, nna n’enwe oria - site na 3 ruo 6%, nwanne - ihe dika 6%.

Enwere ike ịchọpụta otu ma ọ bụ ọtụtụ ihe ngosi hum hum nke ọrịa pancreatic, nke gụnyere ọgwụ mgbochi agwaetiti nke Langerhans na 85-90% nke ndị ọrịa:

ihe mgbochi iji glutamate decarboxylase (GAD),
ọgwụ mgbochi ọrịa tyrosine phosphatase (IA-2 na IA-2 beta).

N'okwu a, enyere ihe dị mkpa na mbibi nke mkpụrụ ndụ beta ihe ndị na-egbochi mgbochi sel. Ọrịa shuga 1dị nke mbụ na-ejikọkarị na HLA haplotypes dịka DQA na DQB.

Ọtụtụ mgbe, a na-ejikọ ụdị ọrịa a na nkwarụ endocrine ndị ọzọ autoimmune, dịka ọmụmaatụ, ọrịa Addison, autoimmune thyroiditis. Non-endocrine etiology na-arụkwa ọrụ dị mkpa:

vitiligo
ọrịa rheumatic
alopecia
Ọrịa Crohn.

Na pathogenesis nke ọrịa shuga

Ọrịa shuga 1dị nke mbụ na-eme onwe ya obi ma ọ bụrụ na usoro igbu onwe ya na-ebibi mkpụrụ ndụ nke mkpụrụ ọgwụ beta nke 80 ruo 90%. Ọzọkwa, ike na ọsọ nke usoro a na - efe efe mgbe niile na-adịkwa iche. Ọtụtụ mgbe, n'oge oge ochie nke ọrịa na ụmụaka na ndị na-eto eto, a na-ebibi mkpụrụ ndụ ngwa ngwa, na-egosipụta ngwa ngwa.

Site na mmalite nke ọrịa ahụ na mgbaàmà mbụ ọ na-arịa na mmepe nke ketoacidosis ma ọ bụ ketoacidotic coma, ọ dịghị ihe karịrị izu ole na ole nwere ike ịgafe.

N'aka ozo, oria a na-adighi ahukebe, na ndi oria karia ogo iri-ario, oria nwere ike gaba n'ihu na nzuzo (oria shuga mellitus Lada).

Ọzọkwa, n'ọnọdụ a, ndị dọkịta chọpụtara ụdị ọrịa shuga mellitus nke 2 ma tụọ ndị ọrịa ha ka ha nwee ike kwụọ ụgwọ insulin na nkwadebe sulfonylurea.

Agbanyeghị, ka oge na-aga, akara nke enweghị homonụ na-amalite ịpụta:

ketonuria
ifelata
doro anya hyperglycemia megide ndabere nke mbadamba mgbe niile iji belata shuga ọbara.

Ọrịa pathogenesis nke ụdị shuga 1 sitere na ụkọ homonụ zuru oke. N'ihi ekwe omume ịba oriri shuga na akụrụngwa na-adabere na anụ ahụ (akwara na abụba), ụkọ ike na-etolite ma, n'ihi nke a, lipolysis na proteolysis na-akawanye ike. Usoro yiri nke ahụ na-ebute oke ibu.

Site na mmụba nke glycemia, hyperosmolarity na-apụta, tinyere osmotic diuresis na akpịrị ịkpọ nkụ. Site na enweghi ume na homonụ, insulin na - egbochi mmiri nke glucagon, cortisol na homonụ nke uto.

N'agbanyeghị glycemia na-eto, a na-akpali gluconeogenesis. Ceme ngwa ngwa nke anụ ahụ na - eme ka mmụba abụba bukwuo ibu.

Ọ bụrụ na insulin na - adịghị ike, mgbe ahụ, a na - egbochi ikike liposynthetic nke imeju, na abụba n'efu na - etinye aka na ketogenesis. Nchịkọta nke ketones na-ebute mmepe nke ketosis mamịrị na nsonaazụ ya - ketoacidosis na-arịa ọrịa shuga.

Na-emegide ihe mmụba na-abawanye n'iyi na acidosis, Coma nwere ike ịmalite.

Ya, ọ bụrụ na enweghị ọgwụgwọ (ọgwụgwọ insulin na ezumike mmiri zuru oke), n'ihe fọrọ nke nta ka ọ bụrụ 100% nke ikpe ga-akpata ọnwụ.

Forzọ maka ọgwụgwọ ọrịa shuga

Nọmba Patent: 588982

. E nyere onye ọrịa ọrịa ịsa ahụ maka njikwa onwe ya (ogo dị nfe na agafeghị oke), ma ọ bụ iodine scrubber. mpempe njikwa mbụ 11 n’ime 100- - 150 m g / lryuv nke mkpọsa ọkwa 00150 nke anọ - qing 100 in -200 8 min, itoentracin 100-150 mg / l, prolol 12 min, nke atọ na concentramg / l, oge 15 mi, bat nke asatọ. na copps ntra. mg / l, minit 15, bat nke iteghete na nke iri 100- nkeji oge nkeji iri 0 0 na-apụta dabere ogo ọrịa shuga mellitus ma e jiri ya tụnyere ọkwa ịsa ahụ m kpebiri mgbe gba ọtọ.

Forzọ maka ịchọpụta ogo ọrịa shuga dị

Nọmba Patent: 931168

. glucose Ọzọkwa, a duziri ọmụmụ banyere ọdịnaya nke 8 4 n'ọbara ọbara nke isomers nke omers-glucose na glucose site na usoro ahụ atụpụtara, rashụ nke ọdịnaya d-glucose na β-glucose 0.74, nke dabara na ịdị nro nke ọrịa shuga mellitus 1 nke ndị ọzọ kwupụtara. Ọmụmụ ihe ọmụmụ banyere ọbara na mmamịrị, ọkachasị nnwale ọbara biochemical na-enweghị ọrịa, shuga mmamịrị 23, glucosuria ruo 30 g. A na-enye ndị ọrịa ahụ usoro na-arịa ọrịa shuga, a na-enye ndị ọrịa iwu ma duzie usoro ọgwụgwọ, gụnyere usoro nri, na-enweghị nchịkwa nchịkwa nke ndị ọrịa hypoglycemic, akpan akpan insulin, PRI me R 2. Onye ọrịa K-va 52 afọ1 nọ na ngalaba ọgwụgwọ nke ụlọ ọgwụ.

Mgbaàmà nke Ọrịa Shuga 1

Pathodị ọrịa a na - adịkarị ụkọ - ọ bụghị ihe karịrị 1.5-2% nke ụdị ọrịa niile. Ihe egwu ga - eme na ndụ gị niile bụ 0.4%. Ọtụtụ mgbe, mmadụ na-achọpụta ọrịa shuga dị ka afọ 10 ruo 13. Otutu ngosi banyere oria a na - aputa ihe ruru afo iri anọ.

Ọ bụrụ na ikpe ahụ bụ nke a na-ahụkarị, ọkachasị na ụmụaka na ndị ntorobịa, mgbe ahụ ọrịa ahụ ga-egosipụta onwe ya dị ka ihe atụ doro anya. O nwere ike itolite n’ime ọnwa ole ma ole ma ọ bụ izu ole na ole. Ọrịa na-efe efe na ọrịa ndị ọzọ na-efe efe nwere ike ịkpasu iwepụta ọrịa shuga.

Ọrịa ga - amata ụdị ọrịa shuga niile:

polyuria
akpụkpọ ahụ,
polydipsia.

A na-ekwupụta ihe ịrịba ama a ụdị ọrịa 1. N'ehihie, onye ọrịa nwere ike ị drinkụ mmiri ma nwee ọ fluidụghị mmiri 5-10 nke mmiri.

Kachasị maka ụdị ọrịa a ga-abụ oke ibu dị oke oke, nke ọnwa 1-2 nwere ike iru 15 n'arọ. Na mgbakwunye, onye ọrịa ga-ata ahụhụ site na:

ike adighi ike
iro ụra
arụmọrụ belatara.

Na mbido, enwere ike ibute ya site na agụụ na-enweghị ezi uche, nke Anorexia dochiri anya mgbe ketoacidosis na-abawanye. Onye ọrịa ahụ ga-enweta isi e ji mara acetone site n’oghere ọnụ (enwere ike inwe isi mkpụrụ), ọgbụgbọ na pseudoperitonitis - ọnya afọ, akpịrị oke, nke nwere ike ibute ọgbụgba.

N'ọnọdụ ụfọdụ, ihe ịrịba ama mbụ nke ụdị shuga 1 na ndị ọrịa ụmụaka ga-abụ mmụọ na-aga n’ihu. Enwere ike ikwu ya na, site na nzụlite oria a na-asọ oyi (ịwa ahụ ma ọ bụ nke na-efe efe), nwatakịrị ahụ nwere ike ịdaba.

Ọ bụ ihe nwute na onye ọrịa karịrị afọ 35 na-arịa ọrịa shuga (ya na ọrịa shuga na-arịa ya), ọrịa ahụ nwere ike ọ gaghị enwu ya nke ukwuu, a na-achọpụta ya na mberede site n'oge ule shuga n'ọbara.

Mmadu aghaghi ifelata, polyuria na polydipsia ga adi nma.

Nke mbu, dọkịta nwere ike ichoputa oria oria abuo ma bido kwa ogwugwo na ogwu iji belata shuga n’ime mbadamba ihe. Nke a ga -, mgbe oge ụfọdụ gasịrị, na - ekwe nkwa ụgwọ ntaramahụhụ a ga - anabata ya Agbanyeghị, mgbe afọ ole na ole gasịrị, ọ na - abụkarị mgbe otu afọ gasịrị, onye ọrịa ahụ ga - enwe ihe ịrịba ama kpatara mmụba nke erughi insulin:

felata dị egwu
ketosis
ketoacidosis
enweghi ike ijikwa ọkwa shuga na ọkwa a chọrọ.

Akara nke ịchọpụta ọrịa shuga

Nyere ụdị 1 nke ọrịa a bụ ihe ejiri mara ya na ọria pụtaranụ ma bụrụkwa ọrịa na-adịghị ahụkebe, a na-eme nnyocha nyocha iji chọpụta ọkwa shuga ọbara. Ohere inweta ọrịa shuga developingdị nke mbụ n'ime ndị ikwu dị ntakịrị, nke, yana enweghị ụzọ dị irè maka nchọpụta mbụ nke ọrịa ahụ, na-ekpebi ezighi ezi nke nyocha zuru oke nke ihe nrịbama immunogenetic nke ọrịa.

Nchọpụta nke ọrịa ahụ n'ọtụtụ oge ga-esite na nhazi nke nnukwute glucose ọbara dị ukwuu n'ahụ ndị ọrịa ahụ nwere mgbaàmà nke erughi insulin zuru oke.

Nnyocha mmadụ iji chọpụta ọrịa a bụ nke a na-ahụkarị.

Ọ bụghị ebe ikpeazụ bụ nchọpụta ọdịiche. Ọ dị mkpa iji gosipụta nchoputa ahụ n'ọnọdụ ndị nwere obi abụọ, ya bụ ịchọpụta glycemia agafeghị oke na enweghị ihe doro anya doro anya nke ụdị ọrịa shuga 1, karịsịa na ngosipụta na nwata.

Ebumnuche nke nyocha dị otú ahụ nwere ike ịbụ iche ọdịiche nke ọrịa ahụ na ụdị ọrịa shuga ndị ọzọ. Iji mee nke a, tinye usoro iji chọpụta ọkwa nke basal C-peptide na awa 2 mgbe erichara.

Omuma ihe banyere odi omuma nke ihe omimi n’uche ihe di nkpa bu ihe ndi choputara ihe omumu banyere oria nke oria 1:

ihe mgbochi na usoro ogige nke akwara,
Glutamate decarboxylase (GAD65),
phoroshatase (IA-2 na IA-2P).

Usoro ọgwụgwọ

Usoro ọgwụgwọ maka ụdị ọrịa shuga ọ bụla ga-adabere n'ụkpụrụ atọ bụ:

belata shuga ọbara (n'ọnọdụ anyị, ọgwụ insulin),
nri nri
mmụta ndidi.

Ọgwụ insulin maka ụdị ọrịa 1 bụ ihe a na-eji dochie anya. Ebumnuche ya bụ ime ka i theomi insulin na-eme ka ihe dị mma iji nweta nkwụghachi ụgwọ a na-anabata. Ọgwụ insulin na-arụ ọrụ nke ọma ga-agbadata mmepụta nke homonụ.

Ihe a chọrọ kwa ụbọchị maka homonụ ahụ ga-ahazịrị ọkwa nke nzuzo ya. 2 oge ị ofụ ọgwụ ọgwụ ogologo oge ekpughere ma ọ bụ ntụtụ 1 nke insulin ogologo Glargin nwere ike inye ahụ ahụ insulin.

Oru nke homonụ nke basal ekwesịghị gafere ọkara ihe a chọrọ kwa ụbọchị maka ọgwụ.

A ga-eji mmiri ọgwụ insulin mee ka mmadụ sie ike ma ọ bụ nzụlite nke insulin ga - anọchi obere oge ma ọ bụ nke obere oge ekpughere tupu nri. Na nke a, a na-agbakọta usoro usoro ọgwụgwọ ahụ dabere na njirisi ndị a:

ego nke carbohydrate a ga-eripịa n’oge nri,
ọ̀ dị ọ̀tụ̀tụ̀ shuga dị n'ọbara, kpebisiri ike tupu ntụtụ insulin ọ bụla (nke ejiri glucometer tụrụ).

Ozugbo ekpughere ụdị shuga mellitus nke 1 na ozugbo ọgwụgwọ ya malitere ogologo oge zuru oke, mkpa maka ịkwadebe insulin nwere ike ịdị obere ma ga-erughị 0.3-0.4 U / n'arọ. A na-akpọ oge a “honiimuunu” ma ọ bụ oge mgbaghara nke na-adịgide.

Mgbe usoro nke hyperglycemia na ketoacidosis, na-eme ka insulin na-ebelata mmepụta insulin site na ịlanarị mkpụrụ ndụ beta, a na-enweta ụgwọ ọrụ insulin na-enweta ụgwọ ọrụ homonụ na metabolic. Ọgwụ a na-eweghachi arụ ọrụ nke mkpụrụ ndụ akwara, nke werezie obere insulin nke insulin.

Oge a nwere ike ịdị site na izu ole na ole rue ọtụtụ afọ. Na ngwụcha, na agbanyeghị na, n'ihi mbibi nke mkpụrụ ndụ beta-cell, usoro mgbaghara ga-akwụsị ma chọọkwa ọgwụgwọ siri ike.

Na-arịa ọrịa shuga na-arịa insulin na-abụghị insulin (ụdị 2)

Typedị ọrịa a na-etolite mgbe anụ ahụ nwere ike ghara ịmịcha shuga ma ọ bụ mee ya na oke na-ezughi ezu. Nsogbu yiri nke ahụ nwekwara aha ọzọ - ezughi ezu nke extrapancreatic. Usoro etiology nke ihe a di iche nwere ike di iche:

mgbanwe na nhazi nke insulin na mmepe nke oke ibu, ịreatụbiga nri ókè, ndụ ebughi oke ibu, ọbara ọgbụgba, na agadi na ọnụnọ riri ahụ,
ọ bụ ọrụ arụ ọrụ ndị nnabata insulin na n'ihi ihe mebiri ọnụ ọgụgụ ma ọ bụ otu ha,
erughị nri shuga na-emepụta site n’akwara akwara,
Usoro ọmụmụ intracellular, nke nnyefe nke mkpali n'ahụ ya na sel siri ike nnabata insulin,
gbanwee insulin insulin na pancreas.

Nkewa oria

Dabere ogo ịrịa ọrịa shuga 2 ga-ekewa:

ogo di ala. Ihe e ji mara ya bụ ịkwụ ụgwọ enweghi insulin, na-a theụ ọgwụ ike na nri nwere ike belata shuga ọbara n’oge dị mkpirikpi,
ọkara. Can nwere ike kwụọ ụgwọ maka mgbanwe metabolic nyere na ọ dịkarịa ala ọgwụ ọgwụ 2-3 iji belata glucose. Na ọkwa a, a ga-ejikọta ọdịda metabolism na angiopathy,
ogbo siri ike. Iji dozie ọnọdụ ahụ chọrọ iji ọtụtụ ụzọ nke ịdalata glucose yana ịba insulin. Onye ọrịa ahụ nọ n’ọgbọ a na-enwekarị nsogbu.

Gini bu oria abuo?

Ihe omuma kpochapu nke oria ojoo nke oria aghaghi ime nke abuo:

ngwa ngwa. Ngwa ngwa ịtọgbọ insulin chịkọbara na aza glucose,
oge na-adịghị. Mwepụta nke insulin iji belata shuga dị n'ọbara nwere nwayọ. Ọ na-amalite ịrụ ọrụ ozugbo usoro ọsọ ọsọ dị, mana ọ dabere na nkwụcha ike nke carbohydrates.

Ọ bụrụ na enwere ihe ọmụmụ nke mkpụrụ ndụ beta nke na-adịghị eche maka mmetụta nke homonụ nke pancreas, enweghị mgbanwe n'ọtụtụ carbohydrates n'ọbara ji nke nta nke nta tolite. 2dị ọrịa shuga abụọ nke ọrịa mellitus, usoro ngwa ngwa anaghị adị, oge na-adịghị nwayọ na-amalitekwa. Mmepụta insulin dị obere ma maka nke a, agaghị enwe ike ịkwado usoro ahụ.

Mgbe enweghị ọrụ nnabata insulin ma ọ bụ usoro nnabata, hyperinsulinemia na-amalite. Site n'ọkwa insulin dị n'ọbara, anụ ahụ na-amalite usoro nke ụgwọ ya, nke agbadoro ime ka nguzosi nke homonụ ahụ sie ike. A pụrụ ịhụ mgbaàmà a e ji amata ọbụna na mmalite nke ọrịa ahụ.

Foto doro anya banyere ọrịa ahụ na-etolite mgbe hyperglycemia na-adịgide adịgide ruo ọtụtụ afọ. Sugar sugarụbiga ọbara ókè ókè na-emetụta mkpụrụ ndụ beta. Nke a na - abụ ihe mere ha ji agbaze ma na - eyi, na - eme ka mbelata mmepụta insulin.

Site na ntule, mgbanwe insulin ga-egosiputa site na mgbanwe nke ibu na nguzo nke ketoacidosis. Na mgbakwunye, akara nke ọrịa shuga nke ụdị a ga-abụ:

polydipsia na polyuria. Ọrịa metabolic na-etolite n'ihi hyperglycemia, nke na-akpalite mmụba nke ọbara ọbara osmotic. Iji mezie usoro ahụ, anụ ahụ malitere iwepu mmiri na electrolytes,
itching nke anụahụ. Ọkpụkpụ akpụkpọ n'ihi oke mmụba nke urea na ketones n'ime ọbara,
ibu oke ibu.

Nchịkwa insulin ga-akpata ọtụtụ nsogbu, ma nke mbụ na nke abụọ. Yabụ, ndị otu mbụ nke ndị dọkịta gụnyere: hyperglycemia, mbelata nke mmepụta glycogen, glucosuria, igbochi mmeghachi ahụ nke anụ ahụ.

Ndi otu nsogbu abụọ kwesiri ịgụnye: mkpali nke mwepụta nke lipids na protein maka mgbanwe ha ka ọ bụrụ ka ọ na - eme ka ọ bụrụ nri na - egbochi protein nke protein na - edozi ahụ, belata nnabata nke carbohydrates, na - egbochi mmiri ngwa ngwa nke homonụ nke pancreas.

Ọrịa shuga 2dị nke Abụọ bụ ihe zuru oke. N'ozuzu, ezigbo ihe ngosiputa nke oria bu oria nwere ike karie oge opekata mpe ugboro abụọ.

Ọzọkwa, ndị ọrịa na-achọ enyemaka ahụike naanị mgbe mmalite nke nnukwu nsogbu dị egwu. Maka nke a, endocrinologists na-ekwusi ike na ọ dị mkpa ịghara ichezọ banyere nyocha ahụike mgbe niile. Ha ga - enyere aka ịchọpụta nsogbu ahụ ozugbo enwere ike ma bido ọgwụgwọ ngwa ngwa.

Forzọ maka ọgwụgwọ maka ọrịa shuga na-arịa insulin na-abụghị insulin

Nọmba Patent: 1822767

. hyperglycemia dịgidere, ọ bụ ezie na ọ belatara ntakịrị: shuga ọbara 8.1 mmol / L. Edepụtara onye ọrịa usoro acupuncture dịka usoro ahụ chọrọ. Mgbe nnọkọ nke mbụ gasịrị, shuga ọbara gbadara 5.5 mmol / L. Nke a bụ nsonaazụ mkpali nke ihe puru iche, dika egosiri site na mmụba nke insulinoreactive insulin n'ime ọbara na 130 mcd / ml site na ọkwa mbụ (tupu nnọkọ) -88 mcd / ml, na ọdịnaya nke C-peptide site na 0.2 ng / ml ruo 0, 4 ng / ml (mgbe emechara). ụlọ, yana isi nke Zu-san-li - site na usoro braking. Nke A. A. A. Runova Tekhred M. Morgenthal Corrector M. Samborskaya Editor S. Kulakova Order 2168 VNIIIPI nke Kọmitii Steeti maka nchọpụta na nchoputa n'okpuru Kọmitii Steeti maka sayensị na teknụzụ nke USSR 113035, Moscow, Zh Raushskaya.