1dị ọrịa shuga 1 dị na ụmụaka na ndị nọ n'oge uto: etiopathogenesis, ụlọ ọgwụ, ọgwụgwọ

Nyocha ahụ na-egosi echiche ọhụụ banyere etiology, pathophysiology nke mmepe nke ụdị shuga 1 na ụmụaka na ndị na-eto eto, njirisi nyocha na njirimara nke usoro insulin. A na - egosiputa ihe ịrịba ama nke ketoacidosis nke na-arịa ọrịa shuga na ọgwụgwọ ya.

Nyocha ahụ na-egosi echiche ọhụụ banyere etiology, pathophysiology nke ụdị shuga 1 n'ime ụmụaka na ndị na-eto eto, njirisi nyocha na atụmatụ nke insulin. Ọ na-akọwapụta isi ihe dị na ketoacidosis na-arịa ọrịa shuga na ọgwụgwọ.

Ọrịa shuga mellitus (DM) bụ usoro ọmụmụ etiologically heterogene nke ọrịa metabolism nke na-egosi hyperglycemia na-adịghị ala ala n'ihi mmachi nzuzo ma ọ bụ ihe insulin, ma ọ bụ ngwakọta nke nsogbu ndị a.

N’oge izizi, a kọwara ọrịa shuga n’India oge ochie ihe karịrị puku afọ abụọ gara aga. Ugbu a, enwere ihe karịrị nde mmadụ 230 na-arịa ọrịa shuga n'ụwa, 2,076,000 nọ na Russia. N'ezie, ọrịa shuga dị elu, n'ihi na anaghị elebara ụdị ọrịa anya ya anya, ya bụ, enwere "ọrịa na-efe efe nke ọrịa shuga".

Nkewa nke oria shuga

Dabere na nhazi ọkwa nke ugbua, enwere:

1dị shuga 1 bụ mellitus (ụdị shuga 1), nke a na-ahụkarị na nwata na etolite etolite. A na - amata ụdị ọrịa a abụọ: a) ọrịa shuga autoimmune 1 (nke a na - eji mbibi mkpụrụ ndụ --insulin), b) ọrịa shuga ọrịa idiopathic nke 1, na - enwe mbibi nke mkpụrụ ndụ,-mkpụrụ ndụ, mana enweghị akara nke usoro autoimmune.
Elldị shuga abụọ nke ọrịa shuga (ọrịa shuga 2), nke erughi insulin na-emetụta ya na njide insulin na insulin na-egbochi ya.
Typesdị shuga dị iche iche.
Afọ ụkwara ume ọkụ.

Typesdị ọrịa shuga ndị a na-ahụkarị bụ ọrịa shuga anddị 1 na ụdị shuga 2. Ogologo oge, e kwenyere na ụdị oria 1 bụ ihe e ji mara nwata. Agbanyeghị, nyocha n'ime afọ iri gara aga welitere nkwupụta a. N'ụbawanye, ọ malitere ka a chọpụta ya na ụmụaka nwere ọrịa shuga nke 2, bụ nke jupụtara na ndị okenye mgbe afọ 40 gasịrị. Na mba ụfọdụ, ụdị shuga 2 bụ ihe a na-ahụkarị na ụmụaka karịa shuga nke 1, n'ihi ụdị mkpụrụ ndụ ihe nketa na ụba na-arịwanye elu nke oke ibu.

Ọrịa ịba ọcha n'anya

Akwukwo edeputara nke obodo na nke imeputara udiri oria 1 nke umuaka na umuaka n’egosiputa mgbanwe di iche na onodu ya na obodo di iche-iche nke uwa (site na asaa rue iri-ano rue otu puku umuaka n’aho). Ruo ọtụtụ afọ, ọrịa shuga 1dị nke 1 n'etiti ụmụaka anọwo na-arị elu n'esepụghị aka. Otu ụzọ n'ụzọ anọ nke ndị ọrịa na-erubeghị afọ anọ. Ná mmalite nke afọ 2010, ụmụaka 479.6 puku ụmụaka nwere ọrịa 1 bu ịdebanye aha na ụwa. Onu ogugu ohuru 75,800 ohuru.

Dabere na State Forukọsilẹ, dị ka 01.01.2011, ụmụ akwụkwọ 17 519 nwere ụdị 1 na-arịa ọrịa shuga na Russia Federation, 2911 bụ ndị ọhụrụ. Onu ogugu enwere ugbua umuaka na Russian Federation bu 11.2 n'ime umuntakiri puku 100,000 oria na egosiputa onwe ya n’agba obula (enwere oria obi aria), mana otutu mgbe umuaka na aru oria n’oge uto uto (4-6 n’ime onwa, n’agbata afọ 8-12, ntorobia) . A na-emetụta ụmụ ọhụrụ na 0,5% nke ọrịa shuga.

N'ụzọ dị iche na mba nwere oke ọnụọgụ, nke kacha na-abawanye na-apụta na nwata, na ọnụ ọgụgụ ndị nọ na Mọsko, a na-achọpụta mmụba nke ihe omume n'ihi ndị na-eto eto.

Etiology na pathogenesis nke ọrịa shuga 1

Ọrịa shuga isdị nke iri bụ ọrịa akpịrịkpa sitere na mkpụrụ ndụ ihe nketa, nke na-arịa ọnya na-adịghị ala ala na-eduga mbibi nke mkpụrụ ndụ,, nke sochiri mmepe nke ụkọ insulin zuru oke. A na-ahụta ọrịa shuga 1dị nke 1 na ebumnuche nke ịmalite ketoacidosis.

A na - ekpebi ihe ga - ebute ụdị ọrịa shuga 1 nke ọrịa mkpụrụ ndụ ihe mmadụ na - akpata, na - emetụta mmekọrịta nke ọ bụghị naanị na usoro mkpụrụ ndụ ihe nketa dị iche iche, kamakwa njikọta nke ọgwụ mgbochi na nchebe nchebe.

Oge site na mmalite nke usoro nyocha nke autoimmune ruo na mmepe nke ụdị ọrịa shuga 1 nwere ike iwe ọtụtụ ọnwa ruo afọ iri.

Ọrịa nje (Coxsackie B, rubella, wdg), kemịkalụ (alloxan, nitrates, wdg) nwere ike itinye aka na ịmalite usoro mbibi nke sel sel.

Mbibi nke mkpụrụ ndụ im-mkpụrụ ndụ bụ usoro dị mgbagwoju anya, n'ọtụtụ ebe, n'oge ana - agbagide ma mgbochi sel na humoral. Ọrụ kachasị na mmepe nke insulin bụ nke cytotoxic (CD8 +) T-lymphocytes na-egwu.

Dika echiche ohuru nke dysregulation nke oge a, ihe di egwu na mmalite nke oria site na mmalite rue ngosiputa nke oria shuga.

Ihe nrịba ama nke mbibi nke mkpụrụ ndụ include

1) islet cell cytoplasmic autoantibodies (ICA),
2) ọgwụ mgbochi insulin (IAA),
3) ihe mgbochi na protein nke mkpụrụ ndụ islet nke nwere uru dị egwu nke 64 puku kD (ha nwere mkpụrụ ndụ atọ):

Glutamate decarboxylase (GAD),
phosphatase (IA-2L),
tyrosine phosphatase (IA-2B) Ugboro nke ihe ntanetị nke autoantibodies dị iche iche na mpụta mbụ ụdị shuga: ICA - 70-90%, IAA - 43-69%, GAD - 52-777%, IA-L - 55-75%.

N'oge ikpeazu, ọnụ ọgụgụ mkpụrụ ndụ sel-agbada site na 50-70% ma ọ bụrụ na ọ ka ana - eme, ndị fọdụrụnụ ka na - ejikwa ọkwa insulin, ma ọrụ ọrụ nzuzo ha belatara.

Ihe mgbaàmà nke ọrịa shuga na-apụta mgbe ọnụ ọgụgụ mkpụrụ ndụ remaining-nke na-enweghị ike imegwara maka ịba ụba nke insulin.

Insulin bụ homonụ nke na-achịkwa ụdị metabolism niile. Ọ na-enye ume na usoro plastic na ahụ. Isi ihe dị na insulin bụ imeju, akwara na anụ ahụ adipose. N'ime ha, insulin nwere mmetụta anabolic na catabolic.

Mmetụta insulin na metabolism metabolism

Insulin na-enye ike nke membranes cell na glucose site na ijikọ ya na ndị na-anabata ya.
Arụ ọrụ enzyme intracellular na-akwado metabolism nke glucose.
Insulin na-akpali usoro glycogen synthetase, nke na-enye nchịkọta nke glycogen site na glucose na imeju.
Na-adọtị glycogenolysis (ndakpọ nke glycogen n'ime glucose).
Na-egbochi gluconeogenesis (njikọ nke glucose na protein na abụba).
Na -ebelata mkpụkọ glucose dị n'ọbara.

Mmetụta insulin na abụba metabolism

Insulin na-akpali lipogenesis.
O nwere mmetụta antilipolytic (n'ime lipocytes ọ na-egbochi adenylate cyclase, belata cAMP nke lipocytes, nke dị mkpa maka usoro lipolysis).

Enweghị insulin na-akpata ịba ụba lipolysis (mmebi nke triglycerides ka abụba abụba (FFAs) na adipocytes). Mmụba na ego FFA bụ ihe kpatara ọrịa imeju na-abawanye na oke ya. A na - eme ka mmebi nke FFA dịkwuo mma site na nguzobe nke aru ketone.

Mmetụta insulin na protein metabolism

Insulin na - akwalite njikọta protein n’anụ ahụ. Enweghị insulin na-akpata ndakpọ (catabolism) nke akwara anụ ahụ, nchịkọta nke ngwaahịa nwere nitrogen (amino acid) ma na-akpali gluconeogenesis na imeju.

Enweghị insulin na-eme ka ntọhapụ nke homonụ na-enwe ihe na-agbanwe agbanwe, ịgbalite nke glycogenolysis, gluconeogenesis. Ihe ndị a niile na - eduga na hyperglycemia, ụba osmolarity ọbara, akpịrị nke anụ ahụ, glucosuria.

Ọnọdụ mgbochi ọrịa mgbochi nwere ike ịnọ ọnwa na ọtụtụ afọ, enwere ike ịchọpụta ihe mgbochi anụ ahụ bụ ihe nrịbama nke mkpụrụ ndụ mkpụrụ ndụ (ICA, IAA, GAD, IA-L) na mkpụrụ ndụ ihe nketa nke ụdị shuga 1 (ịkọwa ma na-echebe HLA haplotypes, nke n'ihe banyere oke nwere ike ịdị iche n'etiti agbụrụ dị iche iche).

Ọrịa shuga

Ọ bụrụ na n’oge nnabata nnabata glucose ọnụ (OGTT) (a na-eji glucose na ogo nke 1.75 g / n'arọ mee ihe ruru 75 g), ọkwa glucose ọbara bụ> 7.8, mana 11.1 mmol / L.

Na-ebu ọnụ glucose plasma> 7.0 mmol / L.

2 Ogologo oge glucose mgbatị ahụ> 11.1 mmol / L.

N’ime onye ahụ dị mma, glucose dị na mmamịrị anọghị ya. Glucosuria na-eme mgbe ọdịnaya glucose dị elu karịa 8.88 mmol / L.

A na-etolite Ketone (acetoacetate, β-hydroxybutyrate na acetone) na imeju site na abụba bara ụba. A na-achọpụta mmụba ha na erughi insulin. Enwere mpempe ule maka mkpebi nke acetoacetate na mmamịrị na ọkwa nke β-hydroxybutyrate n'ime ọbara (> 0,5 mmol / L). N'ime usoro decompensation nke ụdị shuga 1 na-enweghị ketoacidosis, ahụ acetone na acidosis adịghị.

Haemoglobin glycated. N'ime ọbara, glucose na-ejikọ ahụ irighiri akwara hemoglobin na ịmepụta gemoclobin glycated (mkpokọta HBA)₁ ma obu nchikota ya bu “C” NVA_1s), i.e., na - egosipụta ọnọdụ steeti carbohydrate maka ọnwa 3. HBA larịị₁ - 5-7.8% nkịtị, ọkwa nke pere mpe (HBA_1s) - 4-6%. Site n'ọbara hyperglycemia, haemoglobin glycated dị elu.

Oria di iche

Ruo taa, nchọpụta nke ụdị shuga 1 ka bara uru. N'ime ihe karịrị 80% ụmụaka, a na-achọpụta ọrịa shuga na steeti ketoacidosis. Dabere njupụta nke ụfọdụ mgbaàmà ọrịa, mmadụ ga-achọpụta ọdịiche na:

1) ọnya ogwu (nnukwu ọrịa appendicitis, "nnukwu ime"),
2) Ọrịa na-efe efe (flu, oyi baa, meningitis),
3) ọrịa nke eriri afọ (nri toxicoinfection, eriri afọ, wdg),
4) Ọrịa akụrụ (pyelonephritis),
5) ọrịa nke ụjọ usoro (ụbụrụ akpụ, vegetovascular dystonia),
6) Ọrịa shuga insipidus.

N'iburu nwayọ nwayọ nwayọ nke ọrịa a, a na-achọpụta ihe dị iche n'etiti ọrịa shuga 1, ụdị shuga 2 na ụdị oria okenye n'etiti ndị ntorobịa (MODY).

Ọrịa shuga 1dị 1

Ọrịa shuga 1dị nke Mbụ na-amalite n'ihi ụkọ insulin. A na-enye ndị ọrịa niile nwere ụdị ụdị shuga pụtara ụdị ọgwụgwọ ọgwụ insulin.

N'ime ahụike, mmiri ọgwụ insulin na-apụta mgbe niile n'agbanyeghị nri nri (basal). Ma na nzaghachi banyere nri, a na-eme ka ihe nzuzo ya dịkwuo mma (bolus) na nzaghachi hyperglycemia mgbe ọ na-eri nri. Mkpụrụ ndụ β insulin na-abanye n'ime sistem. A na-eri 50% n'ime imeju maka ntụgharị nke glucose na glycogen, 50% fọdụrụnụ ka a na-eburu n'ọbara buru ibu n'ọbara.

N'ime ndị ọrịa nwere ụdị shuga 1, insulin na-apụ apụ na-abanye na subcutaneously, ọ na-eji nwayọ abanye n'ọbara izugbe (ọ bụghị n'ime imeju, dị ka ndị ahụ siri ike), ebe ntinye ya ka dị elu ogologo oge. N'ihi nke a, akpịrị na-arịa ọbara ọgbụgba na-arịa ha karịrị akarị, na mgbe oge na-adịghị anya enwere hypoglycemia.

N’aka nke ọzọ, a na-edebe ihe ndị glycogen n’arịa ndị na-arịa ọrịa shuga n’anụ ahụ, a na-ebelatakwa ihe ndị dị n’imeju ya. Muscle glycogen adịghị etinye aka na njigide normoglycemia.

N'ime ụmụaka, a na-eji insulins mmadụ nweta site na usoro biosynthetic (mkpụrụ ndụ ihe nketa) site na iji teknụzụ DNA recombinant.

Ọgwụ insulin na-adabere afọ na ogologo nke ọrịa shuga. N'ime afọ abụọ mbụ, mkpa insulin bụ 0,5-0.6 U / n'arọ ahụ kwa ụbọchị. Uzo a kariri ugbua na agbacha agbacha onu (bolus-base) maka oru insulin.

Bido usoro ọgwụgwọ insulin site na ntinye nke insulin dị mkpụmkpụ ma ọ bụ nke dị mkpụmkpụ (okpokoro. 1). Usoro mbu n’ime umuaka nke ndu bu 0.5-1 nkeji, n’ulo akwukwo nke 2-4 rue na ndi n’eto eto ndi nke isii n’agha. Emeghari insulin ọzọ na-arụ ọrụ dabere na ogo glucose dị n'ọbara. Site na nhazi nke usoro metabolic nke onye ọrịa, a na-ebugharị ya na atụmatụ bolus, na-ejikọ insulins dị mkpụmkpụ ma dị ogologo.

Insulins dị na vials na katridges. Ihe eji eji sirinji insulin na-ejikarị eme ihe.

Maka nhọrọ nke insulin kachasị mma, a na-eji usoro nlele glucose zuru ebe niile (CGMS). Usoro ekwentị a, nke a na-eyiri n’úkwù onye ọrịa, na-edekọ ọkwa glucose dị n’ọbara n’ime nkeji ise ọ bụla ruo ụbọchị 3. A na-edobe data ndị a na nhazi kọmputa ma gosipụta ya n'ụdị tebụl na eserese ndị akọwapụtara mgbanwe mgbanwe glycemia.

Nfuli insulin. Nke a bụ ngwa elektrọnik igwe eji agbanye n'úkwù. Igwe insulin na-ejikwa kọmputa (mgbawa) nwere insulin na-arụ ọrụ nwa oge, a na-eweta ya n'ụdị abụọ, bolus na usoro.

Nri

Otu ihe dị mkpa n’ịkwụ ụgwọ ọrịa shuga bụ nri. Principleskpụrụ dị iche iche nke ihe oriri na-edozi ahụ bụ otu nwa. Oke nke protein, abụba, carbohydrates, kalori kwesịrị kwekọrọ afọ nwatakịrị ahụ.

Featuresfọdụ atụmatụ nri dị na ụmụaka nwere ọrịa shuga:

Belata, yana n’ime ụmụaka, kpochapu shuga a nụchara anụcha.
Nri ka akwadoro idozi.
Nri kwesiri inwe nri ututu, nri ehihie, nri abali ato na abali abuo nke ndi 1-2 rue mgbe nri gasiri.

Mmetụta na-akwalite shuga n'ime nri bụ n'ihi ụba na ogo nke carbohydrates.

Dabere na nchịkọta glycemic, a na-ewepụta ngwaahịa nri nke na-abawanye ọkwa shuga ọbara ngwa ngwa (ụtọ). A na-eji ha kwụsị hypoglycemia.

Nri na-eme ngwa ngwa iwelie shuga ọbara (achịcha ọcha, crackers, ọka, shuga, Grafica).
Ihe oriri nke na - abawanye shuga ọbara (poteto, akwụkwọ nri, anụ, chiiz, sausages).
Nri na eji nwayọ na-abawanye shuga ọbara (bara ụba na eriri na abụba, dịka achịcha aja aja, azụ).
Nri ndị na-anaghị eme ka shuga dị n’ọbara bụ akwụkwọ nri.

Mmega ahụ

Mmega ahụ bụ ihe dị mkpa na-edozi metabolism metabolism. Site na mmega ahụ na ahụike ndị mmadụ, enwere mbelata insulin na mmụba n'otu oge na mmepụta nke homonụ a na-enwe. N'ime imeju, a na-eme ka mmepụta glucose site na mmiri ọgwụ na-abụghị carbohydrate (gluconeogenesis). Nke a na - arụ ọrụ dị ka ebe dị mkpa maka ya n'oge mmega ahụ, ọ na-ahakwa nhata ogo ojiji nke glucose site na uru ahụ.

Mmepụta glucose na-ebili ka ihe omumu na-esikwu ike. Ọtọ glucose na-adịgide.

Diabetesdị shuga 1, ịba insulin na-arụ ọrụ anaghị adabere na arụ ọrụ anụ ahụ, nsonaazụ nke homonụ na-egbochi mmiri ezughi iji mezie ọkwa glucose. Na nke a, n'oge mmega ahụ ma ọ bụ ozugbo enwere ike ịhụ hypoglycemia. Ihe fọrọ nke nta ka ọ bụrụ ụdị mmega ahụ niile na-adịru ihe karịrị nkeji iri atọ chọrọ mmegharị na nri na / ma ọ bụ dose nke insulin.

Njikwa onwe gị

Ebumnuche nke njide onwe onye bụ ịkụziri onye ọrịa ọrịa shuga na ndị òtù ezinụlọ ya aka ịnye enyemaka onwe ha. Ọ gụnyere:

echiche izugbe banyere ọrịa shuga,
ikike iji aka glucose na-ekpebie glucose,
Dozie dose insulin
Gụkọta achịcha achịcha
ike wepu onodu hypoglycemic,
Detuo akwụkwọ njide onwe gị.

Mmeghari mmekọrịta

Mgbe a na-achọpụta ọrịa shuga n’ime nwatakịrị, nne na nna na-enwekarị ihe furu efu, n’ihi na ọrịa ahụ na-emetụta ụdị ndụ ezinụlọ. Enwere nsogbu na ọgwụgwọ mgbe niile, nri, hypoglycemia, ọrịa na-efe efe. Ka nwata ahụ na-etolite, echiche ya maka ọrịa ahụ na-ebilite. N'oge uto, ọtụtụ ihe gbasara ahụ ike na mmekọrịta mmadụ na ibe ya na-agbagha njikwa glucose. Ihe ndị a niile chọrọ enyemaka nke mmekọrịta mmadụ na ibe ya zuru oke site n'aka ndị ezinaụlọ, endocrinologist na ọkà mmụta gbasara mmụọ.