Kupewa matenda a mtima ndi matenda ashuga

Zipangizo za Second All-Russian Diabetes Congress

Matenda A shuga ndi Matenda a Mtima: Dongosolo la Vutoli

I.I. Agogo, M.V. Shestakova

Mtundu 2 wa shuga mellitus (DM 2) uli kutsogolo pakati pamavuto a sayansi ya zamankhwala ndi zaumoyo. Matendawa, omwe amafalikira mofulumira kwambiri ngati “mliri,” akuwononga thanzi la anthu pafupifupi mayiko onse ndi azaka zonse. Epidemiologists a World Health Organisation (WHO) akuneneratu kuti m'zaka zopitilira 20 (podzafika 2025) kuchuluka kwa odwala matenda ashuga a 2 kudzachulukitsa anthu 300 miliyoni.

Matenda a shuga ndi mtundu wakale wa matenda apakhungu komanso ochepa, amene akuwoneka mu chitukuko cha zovuta za matenda: matenda ashuga a retinopathy mu 80-90% ya odwala, matenda a shuga a m'magazi a 35-25%. atherosulinosis ya ziwiya zazikulu (mtima, ubongo, malekezero) mu 70s? kudwala. Chotupa chachikulu chotere cha bedi lonse lamankhwala samachitika ndi matenda ena aliwonse (chitetezo cha mthupi kapena chilengedwe china). Choyambitsa chachikulu cha kupunduka kwakukulu ndi kufa kwa odwala omwe ali ndi matenda a shuga a 2 ndikuwonongeka kwa mtima ndi matenda amtima - kugunda kwa mtima, kugunda kwa mtima, kugunda kwa mtima. Malinga ndi State Record of Diabetes Patients mu Russian Federation | 2, kuchuluka kwa odwala omwe ali ndi matenda ashuga 2 omwe amachokera myocardial infarction ndi mtima kulephera ndi pafupifupi 60%. zomwe zimagwirizana ndi ziwerengero zapadziko lonse 8 | ,imfa yakufa ndi 1.5 peresenti kuposa ija padziko lapansi (17% ndi 12%, motsatana) 2. 8. Ndi matenda a 2 matenda a shuga, kuchuluka kwa matenda amtima wam'mawere kumakhala kowirikiza katatu poyerekeza ndi anthu opanda matenda a shuga . Kafukufuku woyembekezeredwa wochitidwa pa unyinji wa odwala omwe ali ndi matenda ashuga a 2 ku Finland, ndikuwonetsa. kuti chiwopsezo cha kufa kwa mtima ndi mtima mwa odwala omwe ali ndi matenda a shuga a 2 opanda matenda a mtima (CHD). zofanana ndi zomwe anthu opanda shuga omwe adakumana nazo matenda oyamba 7 |. Kodi chifukwa chake kupangidwira kwamphamvu kwa odwala matenda ashuga kumayambitsa matenda amtima ndi chiyani? Kuti tiyankhe funsoli, ndikofunikira kupenda zomwe zingakhale pachiwopsezo cha chitukuko cha atherosulinosis kwa odwala matenda ashuga. Zinthu izi zitha kugawidwa mosagwirizana, zomwe zimatha kupezeka mwa munthu aliyense wodwala kapena wopanda matenda a shuga 2. ndipo mwachindunji, omwe amapezeka mwa odwala omwe ali ndi matenda ashuga (Table 1).

Zomwe sizinalembedwe mwachindunji mu shuga mellitus 2 zimakhala ndi atherogenicity poyerekeza ndi

GU Endocrinological Science Science Center 1 (dir. - Acad. RAMS II. Grandfathers) RAMI, Moscow I

Zosadziwika mwatsatanetsatane zomwe zingayambitse matenda a mtima

• Matenda oopsa a matenda oopsa • Dyslipidemia • Kunenepa kwambiri - Kusuta • Hypodynamia • Okalamba • Amuna • Kusamba • Kusokonezeka kwamatenda am'mimba ka ischemic

ndi anthu omwe ali ndi vuto labwino la glucose. Malinga ndi kafukufuku wa МЯР1Т. ndi kuchuluka kofanana kwa kuchuluka kwa magazi a systolic, kufa chifukwa cha zovuta zamtima mwa odwala omwe ali ndi matenda a shuga a 2 ndiwodziwikika kawiri kuposa anthu omwe alibe shuga. Mu kafukufuku omwewo, zidawonetsedwa kuti, ndi zovuta zofanana za hypercholesterolemia, kufa kwamatenda amtima kumakhala kokwanira kawiri ndi kawiri kuposa kwa anthu opanda matenda a shuga. Pomaliza, kuphatikiza kwa zinthu zitatu zoopsa (matenda oopsa, Hypercholesterolemia ndi kusuta), kutinso, kufa kwa odwala omwe ali ndi matenda a shuga a 2 ndiwodziwikika kawiri kuposa anthu opanda matenda ashuga.

Kutengera ndi zomwe zapezeka, titha kunena kuti. Zowopsa zomwe sizikhala zachindunji za atherogenesis zokha sizingafotokoze kuchuluka kwakukulu kwa kufa kwa matenda ashuga. Zowoneka, matenda a shuga amakhalanso ndi zowonjezera (zenizeni) zowopsa zomwe zimakhala ndi zotsatira zoyipa pamtima wamagetsi kapena zimawonjezera atherogenicity ya zinthu zosakhala zowopsa. Kwapadera

Zomwe zimayambitsa chiwopsezo cha atherogenesis mu mtundu 2 wa shuga ndi monga: hyperglycemia: hyperinsulinemia, insulin.

Hyperglycemia monga chiopsezo cha atherogenesis mu mtundu 2 wa matenda ashuga

Mu kafukufuku wa iCROB, unansi wowonekeratu unapezeka pakati paubwino wolipiritsa wa carbohydrate metabolism (HbA1c) ndi zochitika zazing'ono za T2DM. Choyipa chachikulu cha kagayidwe kachakudya, chimachulukitsa pafupipafupi mtima wamavuto.

Kusanthula kwazinthu zomwe zapezeka mu kafukufuku wa ICR05 kunawonetsa kuti kusintha kwa HbA1c ndi 1 point (kuchokera pa 8 mpaka 1%) kumayendetsedwa ndi kusintha kwakukulu pamafupipidwe a micangiopathies (retinopathy, nephropathy), koma kusintha kosadalirika pakukula kwakukwanira kwa myocardial infarction (Table 2) .

Zotsatira zamalipidwe obwebweta a carbohydrate metabolism pa pafupipafupi pakupanga shuga- ndi macroangiopathies a 2 shuga (malinga ndi ICRB)

Mavuto Akuchepetsa NYALs1% | NYALs zowonjezera. 1% |

Microangiopathy 25% 37%

Myocardial infarction 16% (ND) 1 4%

ND - yosadalirika (p> 0.05).

Mkhalidwe wodabwitsa umapangidwa: kuwonjezeka kwa HbA1c kumawonjezera kuwonjezeka kwakukulu kwa kuphwanya kwa myocardial, koma kuchepa kwa zomwe zili mu HbA1c sikutsagana ndi kuchepa kwakukulu mu mtima. Cholinga cha izi sichodziwikiratu. Mafotokozedwe angapo angapangidwe.

1. Kukwaniritsidwa kwa mulingo wa HbA1c = 7% sichizindikiro cha kubwezeretsa bwino kwa kaboni

Mkuyu. 2. Hyperglycemia ndi chiopsezo cha zovuta zamatenda a shuga.

kusinthana kwamadzi kuti muchepetse kuchuluka kwa kupitirira kwa atherosulinosis.

2. Kutsika kwa HbAlc mpaka 7% sikutanthauza kukula kwazowonetsa zina za carbohydrate metabolism - kudya glycemia komanso / kapena glycemia mutatha kudya, zomwe zimatha kukhala ndi njira yodziyimira pawokha pakukula kwa atherosulinosis.

3. Matenda amtundu wa carbohydrate kokha okhala ndi dyslipidemia wolimbikira komanso matenda oopsa kwambiri samakwanitsa kuchepetsa chiopsezo cha atherogenesis.

Hypothesis yoyamba imathandizidwa ndi data pa izo. kuti zovuta zazikulu za macrovascular zimayamba kupanga ndi HbAlc zamtengo wochepera 1%. Chifukwa chake mwa anthu omwe ali ndi vuto loleza shuga (NTG) yokhala ndi HbAlc ine sindingapeze zomwe mukufuna? Yeserani ntchito yosankha mabuku.

HbAlc m'gulu la 7%, pafupifupi 11% ya odwala ali ndi post-prandiac glycemia yoposa 10 mmol / l, yomwe imakhala pachiwopsezo chachikulu chokhala ndi vuto la mtima. Kutengera ndi deta kuchokera pazoyeserera komanso zamankhwala. tingaganizire kuti pofuna kupewa matenda amtima wamtundu wa 2 shuga, ndikofunikira kuti musangolimbitsa glycemia komanso kuchuluka kwa HbAlc, komanso kuti muchepetse nsonga za post-prandial glycemic.

Posachedwa mankhwala osokoneza bongo (ma secagagogue). Kutha mwachangu (patapita mphindi zochepa kapena masekondi) kuyambitsa gawo loyamba la insulin katulutsidwe poyankha kulandira. Mankhwalawa akuphatikiza repaglinide (Novonorm), yomwe imachokera ku benzoic acid, ndi nateglinide (Starlix), yochokera ku D-phenylalanine. Ubwino wa mankhwalawa ndikuthamanga kwawo ndikusintha kwawo kwa ma receptor pamwamba (maselo atatu a kapamba) Izi zimapereka kukondoweza kwakanthawi kochepa kwa insulin katulutsidwe, kamene kamachitika kokha pakudya.

Hypothesis ya atherogenic mphamvu ya postprandial hyperglycemia imatha kuyesedwa pokhapokha ngati pakuyesa mayeso osankhidwa. Mu Novembala 2001, kafukufuku wamkulu wapadziko lonse "NAVIGATOR" adakhazikitsidwa, cholinga chake ndikuwunika gawo la nateglinide pachitukuko cha matenda amtima kwa anthu omwe ali ndi vuto la glucose. Kutalika kwa kafukufukuyu kudzakhala zaka 6.

Hyperinsulinemia monga chiopsezo cha atherogenesis mu mtundu 2 wa matenda ashuga

Hyperinsulinemia mosalekeza imayendera chitukuko cha matenda ashuga amtundu wa 2 monga njira yolipirira yothana ndi insulin kukana (IR) ya zotumphukira zimakhala. Pali umboni wazachipatala pang'ono wosonyeza kuti hyperinsulinemia ndi chiopsezo chodziyimira chokha cha chitukuko cha matenda oopsa a m'mitsempha mwa anthu opanda matenda ashuga 2: Maphunziro oyembekezera ku Paris (pafupifupi 7,000 omwe adawunikidwa), Busselton (oposa 1000

kufufuzidwa) ndi Helsinki Policemen (982 anayesedwa) (meta-kusanthula kwa B. Balck). Chifukwa chake Kafukufuku waku Paris adapeza kulumikizana mwachindunji pakati pa kusala kwadzafunso la plasma insulin ndi chiopsezo cha kufa kwa coronary.

Zaka zaposachedwa, mgwirizano wofananawo wazindikirika kwa odwala omwe ali ndi matenda ashuga 2 kale. Pali kuyeserera koyesera kwa izi. Ntchito ya R. Stout mu 80s ndi K. Naruse m'zaka zaposachedwa zikuwonetsa kuti insulini imakhudza mwachindunji makoma amitsempha yamagazi, kupangitsa kuchuluka ndi kusuntha kwa maselo osalala a minofu, kaphatikizidwe ka lipid m'maselo osalala a minofu, kuchuluka kwa ma fibroblasts machitidwe a magazi, kuchepa kwa fibrinolysis ntchito. Chifukwa chake, hyperinsulinemia imachita mbali yofunika kwambiri pakukula ndi kupitilira kwa atherosulinosis monga mwa anthu. zonenedweratu kukukula kwa matenda ashuga. ndi odwala 2 a shuga.

Kutsutsana ndi insulin (IR) monga chiopsezo cha atherogenesis mu mtundu 2 wa matenda ashuga

Mu 1988, G. Reaven anali woyamba kufotokoza udindo wa IR mu pathogenesis ya gulu lonse la zovuta zama metabolic, kuphatikizira kulekerera kwa glucose, dyslipidemia, kunenepa kwambiri, matenda oopsa, komanso kuwaphatikiza ndi mawu akuti "metabolic syndrome". Mu zaka zotsatira, lingaliro la metabolic syndrome linakulitsidwa ndipo linathandizidwa ndi zovuta za coagulation ndi fibrinosis system, hyperuricemia, endothelial dysfunction, microalbuminuria ndi kusintha kwina kwamachitidwe. Kupatula, zida zonse zomwe zimaphatikizidwa ndi lingaliro la "metabolic syndrome", lomwe limakhazikika pa IR. ndi zinthu zomwe zimayambitsa chitukuko cha atherosulinosis (onani tchati).

Metabolic Syndrome (Reaven G.) '

KULIMA KWA CARBON TOLERANCE

37-57 57-79 80-108 Ndipo> 109

Plasma insulin. mmol / l

Mkuyu. 3. Kulumikizana kwa kufa kwa coronary ndi plasma insulin.

Monga lamulo, pamavuto azachipatala, IR imatsimikiziridwa mosasamala ndi kuchuluka kwa insulini m'magazi am'magazi, poganiza kuti hyperinsulinemia imafanana ndi IR. Pakadali pano. njira zolondola kwambiri zodziwira IR ndi kuwerengetsa kuzindikira kwa minyewa mpaka insulini panthawi ya euglycemic hyperin-sulinemic clamp kapena pa testra yolekerera ya glucose (IV TSH). Komabe, pali ntchito yochepa kwambiri pomwe ubale wapakati pa IR (woyesedwa ndi njira zenizeni) ndi chiwopsezo cha matenda amtima waphunziridwa.

Posachedwa, kafukufuku wa IRAS (Insulin Resistance Atherosulinosis Study) adatsirizidwa, omwe adalinganiza kuyesa ubale pakati pa IR (wotsimikizika ndi iv TSH) ndi ziwopsezo zamtima mu kuchuluka kwa anthu opanda matenda ashuga komanso odwala 2 6 |. Monga chikhomo cha zotupa za mitsempha ya atherosselotic, khoma la chotupa cha carotid anayeza. Kafukufukuyu adawonetsera mgwirizano womwe ulipo pakati pa kuchuluka kwa IR komanso kuopsa kwa kunenepa kwambiri pamimba, kuthamanga kwa magazi a m'magazi a lipid, kutseguka kwa njira zopangika, komanso khoma la chotupa cha carotid ngati anthu opanda matenda ashuga. ndi odwala 2 a shuga. Mwa njira zowerengera, zidawonetsedwa kuti gawo lililonse la 1 la IR, makulidwe a khoma la carotid artery limawonjezeka ndi 30 μm 9).

Popeza gawo losakayikira la IR pakupanga matenda a mtima, zitha kulingaliridwa kuti kuchotsedwa kwa IR kudzakhala ndi njira yothandizira pachitukuko cha zovuta zamtundu wa 2.

Mpaka posachedwa, mankhwala okhawo omwe cholinga chake ndi kuchepetsa IR (makamaka minofu ya chiwindi) anali metformin kuchokera ku gulu la Bigu-anide. Komabe, chakumapeto kwa 90s, gulu latsopano la mankhwala linawoneka lomwe lingachepetse IR ya minofu ndi minyewa ya adipose - thiazolidinediones (glitazones). Mankhwalawa amachita pa cell nucleus receptors (PPARy receptors). Zotsatira zake, kufotokozera kwa majini omwe amayambitsa glucose ndi lipid metabolism kumakulitsidwa mu chandamale cha ma CD. Makamaka, ntchito yamayendedwe amtundu wa glucose mu minofu (GLUT-1 ndi GLUT-4) imawonjezeka. glucokinases, lipoprotein lipases ndi michere ina. Pakadali pano, mankhwala awiri ochokera pagululi adalembetsa ndipo amagwiritsidwa ntchito mochizira odwala omwe ali ndi matenda amtundu wa 2: pi-oglitazone (Actos) ndi rosiglitazone (Avandia). Funso ndiloti ngati mankhwalawa amatha kukhala ndi prophylactic pakukweza kwa matenda amtima wamtundu 2 matenda ashuga - akadali otseguka. Yankho lidzafunika mayeso azachipatala molingana ndi malamulo onse a mankhwala ofotokozera.

Mu 2002, kafukufuku wapadziko lonse lapansi, DREAM, adakhazikitsidwa, omwe cholinga chake ndi kuwunika momwe matenda a rosiglitazone angathandizire odwala omwe ali ndi vuto la glucose mogwirizana ndi chiwopsezo chokhala ndi matenda a shuga a 2 komanso matenda a mtima. Zotsatira zakonzedwa kuti ziunikidwe pambuyo pa zaka 5 za chithandizo.

Zomwe zimachitika mu matenda a mtima ndi matenda ashuga

Matenda a shuga amasiya chizindikiro pamankhwala opatsirana a mtima, kuphatikizira kuzindikirika kwawo komanso chithandizo. Zotsatira zamatenda a coronary pathology a mtundu 2 matenda a shuga ndi:

• pafupipafupi chitukuko cha matenda a mtima mu anthu amuna ndi akazi: omwe ali ndi matenda ashuga, azimayi amataya chitetezo chawo pakukula kwa mitsempha yamitsempha yama coronary:

• pafupipafupi mitundu yosapweteka (yosalankhula) yokhala ndi kuperewera kwapafupipafupi ndi kuperewera, imakhala pachiwopsezo chachikulu cha kufa mwadzidzidzi. Choyambitsa mitundu yopanda kupweteka ya myocardial infaration imawonedwa ngati kuphwanya kwa mkati mwa minofu yamtima chifukwa cha matenda a shuga.

• pafupipafupi mavuto obwera pambuyo panjira ya infaration: kugunda kwa mtima, kugunda kwa mtima, mtima wamisala,

• Imfa yayikulu pambuyo pa infa:

• Kuchepa kochepa kwa mankhwala a nitro pochiza matenda a mtima.

Vuto lodziwitsa matenda a mtima omwe ali ndi matenda ashuga limatanthauzira kufunika kwa kuwunika kwa matenda a mtima kwa odwala omwe ali ndi matenda amtundu wa 2 m'magulu omwe ali pachiwopsezo chachikulu, ngakhale pakalibe zizindikiro zamankhwala. Kuzindikira matenda amtima wodwala kuyenera kutengera njira zotsatirazi.

Njira zovomerezeka: ECG yopuma komanso pambuyo kuchita masewera olimbitsa thupi: chifuwa cha X-ray (kudziwa kukula kwa mtima).

Njira zowonjezerapo (mu chipatala cha mtima kapena chokhala ndi zida): Kuwunika kwa Holter ECG: kuyang'ana njinga, ma echocardiography, kupsinjika kwa echocardiography, coronary angiography, cyriculography, scyography ya myocardial.

Mfundo zochizira matenda amtima mwa odwala omwe ali ndi matenda a shuga a 2

Mfundo za mankhwalawa matenda a mtima m'matenda a 2 matenda a shuga zimakhazikika pakukonza zinthu zomwe sizidziwika mwatsatanetsatane: hyperglycemia ndi insulin kukana, matenda oopsa, matenda oopsa. kusokonekera kwa dongosolo. Chofunikira pakuthandizira IHD komanso kupewa thrombosis ndikugwiritsa ntchito aspirin ang'onoang'ono. Ngati mankhwala osokoneza bongo sangathandize, opaleshoni ya mtima yamitsempha imalimbikitsidwa - kuyika kolimba, kuyika kwa mitsempha yodutsa.

Kugwiritsa ntchito bwino matenda a mtima m'matenda a shuga kumatheka pokhapokha ngati kuphatikizidwa kwa zonse zomwe zingachitike pachiwopsezo. Malinga ndi "Njira za dziko zosamalira odwala omwe ali ndi matenda ashuga." Kutengera ndi malingaliro apadziko lonse lapansi, zolinga zazikulu pakuthandizira odwala omwe ali ndi matenda amtundu wa 2 ndi: kukhazikika kwa kagayidwe kazachilengedwe ndikuwonetsa Zizindikiro za HbAlc sindingapeze zomwe mukufuna? Yeserani ntchito yosankha mabuku.

Zopatsa thanzi komanso HLS za matenda ashuga

Moyo wathanzi (HLS) ndichinthu chofunikira kwambiri popewa komanso kuchiza matenda ashuga.

Kusintha kwamoyo:

• Itha kulepheretsa chitukuko cha anthu odwala matenda ashuga omwe ali ndi chiwopsezo cha matenda a shuga a mtundu wachiwiri,
• amachepetsa chiopsezo cha zovuta za shuga kwa odwala matenda ashuga.

Pazakudya ayenera kupambana:

• zipatso, masamba,
• mbewu zonse
• mafuta ochepa okhala ndi mapuloteni (nyama yamafuta ochepa, nyemba),
• CHIKWANGWANI chamafuta.

Wodwala ayenera kupeza njira zovomerezeka zowonjezera zolimbitsa thupi. Phatikizani masewera olimbitsa thupi aerobic ndi kukana.

Yesetsani kuti musiye kusuta, komwe kumachulukitsa ngozi ya matenda amtima komanso kufa msanga.

Zoopsa pamtima

Ndi matenda oyamba a shuga, odwala amakumana ndi zovuta zina. Kupezeka kwa matenda a mtima komanso matenda a shuga kumawonjezera chiopsezo cha mtima ndipo kumachepetsa chiyembekezo chokhala ndi moyo.

Ngati matenda a shuga apezeka mwa anthu osakwanitsa zaka 40, ma statins amalimbikitsidwa kuti achepetse cholesterol. Izi zimakuthandizani kuti muchepetse chiopsezo chachikulu cha mtima.

Mwa odwala omwe ali ndi zaka 40-50, ma statins sangathe kutumikiridwa pokhapokha malinga ndi lingaliro la dokotala ngati munthu ali pachiwopsezo chotsika kwambiri cha zaka 10 (osasuta, omwe ali ndi magazi abwinobwino komanso lipids).

Kuwongolera shuga

UKPDS (The UK Prospective Diabetes Study) yatsimikizira kufunikira kwa kuwunika mosamala kuchuluka kwa shuga m'magazi (kufunika kokhalabe ndi shuga pamlingo woyenera). Chithandizo chachikulu ndicho metforminpopeza ili ndi umboni waukulu koposa.

Kafukufuku wina wapeza kuti migwirizano ya shuga yamagazi siyiyenera kukhala yokhwima kwa okalamba omwe ali ndi vuto la shuga la nthawi yayitali komanso pamaso pa matenda amtima, chifukwa izi zitha kuwonjezera kufa kwamtima.

Watsopano mankhwala empagliflozin (dzina la brand Jardins), lomwe linakhazikitsidwa pamsika mu 2014, limagwiritsidwa ntchito pochiza matenda a shuga a 2. Mankhwalawa adachepetsa HbA1c (glycated hemoglobin) ndi 0,4%, kulemera kwa thupi ndi 2.5 kg ndi kuthamanga kwa magazi ndi 4 mm RT. Art. Empagliflozin linalake ndipo tikulephera kubwezeretsanso kwa glucose mu impso tubules kuchokera mkodzo woyamba. Chifukwa chake, empagliflozin imathandizira kuphipha kwa shuga mumkodzo. Kafukufuku akuwonetsa kuti empagliflozin amachepetsa kufa kwa mtima ndi 38% ndi kufa kwathunthu ndi 32%, chifukwa chake, pamene wodwala aphatikiza matenda ashuga ndi mtima, ndikofunikira kuti ayambe kulandira chithandizo mwachangu empagliflozin. Njira yochepetsera kufa kwa mankhwalawa idaphunziridwabe.

Kuyambira 2014, mankhwala enanso a gululi amapezeka pamsika wakumadzulo womwe umalimbikitsa kutulutsa kwa shuga mumkodzo, - dapagliflozin (dzina la malonda Forsiga, Forxiga). Zimawonetsanso zotsatira zolimbikitsa.

Zindikirani za wolemba malowa. Pofika pa Ogasiti 16, 2018, m'masitolo ogulitsa mankhwala ku Russia, Jardins ndi Forsiga amagulitsidwa (mtengo 2500-2900 rubles), komanso Attokana (canagliflozin) Jardins yekha amagulitsidwa ku Belarus.

Kuyendetsa magazi

Odwala omwe ali ndi matenda a shuga a 2, matenda oopsa oopsa ndi ochulukirapo kuposa anthu ambiri.

Ndi matenda a shuga, payenera kukhala chiwongolero chokhazikika osati cha kuchuluka kwa shuga, komanso mulingo wa kuthamanga kwa magazi ndi cholesterol. M'nthawi zonsezi, ndikofunikira kukwaniritsa zolinga za kuthamanga kwa magazi, kaya mukhale pachiwopsezo cha mtima:

• kufikira kuthamanga kwa magazi pansipa 140 mmHg Art. Imachepetsa kufa kwathunthu komanso chiwopsezo cha zovuta zonse,
• kufikira kuthamanga kwa magazi pansipa 130 mmHg Art. amachepetsa chiopsezo chokhala ndi proteinuria (mapuloteni mu mkodzo), retinopathy ndi stroko, koma sizikhudza kufa kwathunthu chifukwa cha kuchuluka kwa zovuta zomwe zimachitika chifukwa cha kuthamanga kwa magazi. Chifukwa chake, mwa anthu achikulire kuposa zaka 80, kuthamanga kwa magazi kumaloledwa mpaka 150 mm Hg. Art., Ngati palibe mavuto akulu ndi impso.

Ubwino wotsitsa magazi ndi matenda ashuga:

• mtima kuchepetsa chiopsezo zovutastroke, kulephera kwa mtima,
• kuchepetsa chiopsezo retinopathies (kuwonongeka kwa retinal, komwe kumachitika nonse ndi matenda oopsa komanso matenda ashuga),
• kuchepetsa chiopsezo cha kuyambuka ndi kupita patsogolo albinuria (mapuloteni a albumin mkodzo, izi ndizovuta zamitundu yambiri) komanso kulephera kwa impso,
• kukana chiopsezo cha imfa kuchokera pazifukwa zonse.

Zikomo kutsimikiziridwa zoteteza mogwirizana ndi impso, mankhwala amodzi kuchokera pagulu lililonse ayenera kuphatikizidwa pochiza matenda oopsa a matenda oopsa a shuga:

• ACE inhibitors (angiotensin-otembenuza enzyme): lisinopril, perindopril ndi ena
• angiotensin II cholandilira blockers: losartan, candesartan, irbesartan ndi ena

Chithandizo cha lipid kagayidwe kachakudya

Pamaso pa matenda amtima kapena matenda a impso, anthu omwe ali ndi vuto la matenda a shuga ayenera kukhala olimba kwambiri chifukwa chiwopsezo cha mtima. Komabe, kwa odwala matenda ashuga azaka zopitilira 85, kulandira chithandizo kuyenera kukhala kosasamala (kovutirapo), popeza kuchuluka kwa mankhwalawa m'malo moonjezera kuchuluka kwa moyo kumakulitsa chiopsezo cha zovuta zomwe wodwalayo amwalira.

Odwala matenda a shuga amachepetsa kwambiri mtima wamavuto ma statins kapena kuphatikiza kwa ma statins ndi ezetimibe. PCSK9 Inhibitors (evolokumab, dzina la malonda Repat, alirocoumab,, dzina la malonda Praluent), omwe ndi ma antibodies okwera mtengo, amachepetsa cholesterol ya LDL, koma sizinadziwikebe kuti zimakhudza bwanji chiopsezo cha kufa (maphunziro akupitilira).

Matenda a shuga a Mtundu Wachiwiri amakwezedwa triglycerides (mafuta acids) m'magazi uku akuchepetsa cholesterol ya HDL (cholesterol yopindulitsa). Komabe, kusankhidwa kwa ma fibrate, omwe amakonza zonse ziwiri, sikukulimbikitsidwa, popeza palibe umboni wokwanira wa mapindu awo.

Kuchepetsa chiopsezo cha mtima

Odwala omwe ali ndi matenda a shuga a mtundu woyamba 1 kapena 2, amayamba kuchuluka magazi. Tikufuna antiplatelet tiba (kuchepa kwa magazi m'magazi).

Pamaso pa ischemic matenda a mtima kapena atherosclerosis yamitsempha yamagazi, ma antiplatelet mankhwala (makamaka kutenga Asipirin) idachepetsa chiopsezo cha zovuta zamtima ndi 25% (meta-analysis data). Komabe, mwa odwala omwe alibe matenda amtima, a aspirin sanakhudze kwambiri kufa kwamtima ndi ziwopsezo zonse (chifukwa cha kukwera magazi pang'ono, komwe kumafanana ndi phindu loti ndi aspirin mwa odwala oterewa). Kufufuza kukupitirirabe.

Microalbuminuria

Microalbuminuria - kuchotseredwa kwa 30 mpaka 300 mg ya albumin ndi mkodzo patsiku. Ichi ndi chizindikiro cha matenda ashuga nephropathy (kuwonongeka kwa impso). Nthawi zambiri, kuchuluka kwa mapuloteni a albumin mu mkodzo sikudutsa 30 mg patsiku.

Albuminuria (kuchulukitsidwa ndi mkodzo woposa 300 mg wa albumin patsiku) nthawi zambiri kumakhala kophatikizana ndi lingaliro proteinuria (mapuloteni aliwonse mumkodzo), chifukwa ndi kuchuluka kwa mapuloteni mumkodzo, kusankha kwake (kutchulidwa) kumatayika (kuchuluka kwa albumin kumatsika). Proteinuria ndi chizindikiro cha kuwonongeka kwa impso.

Odwala omwe ali ndi matenda a shuga komanso matenda oopsa, ngakhale albuminuria yochepa imalosera mavuto amtsogolo.

Kodi njira yabwino yoyezera albuminuria ndi proteinuria ndi iti?

Kuti mudziwe kuchuluka kwa mapuloteni mu mkodzo, nthawi zonse kunali kofunikira kutola mkodzo mumaola 24 asanafike. Koma kafukufuku wasonyeza kuti ndizovuta kukwaniritsa zotsatira zolondola: odwala pazifukwa zosiyanasiyana nthawi zambiri amaphwanya njira yotengera mkodzo, ndipo anthu ena athanzi amakhalanso ndi omwe amatchedwa orthostatic proteinuria (kutulutsa kochulukirapo kwamapuloteni mumkodzo pamene nkhaniyo yayimirira). Vuto lina lowazindikira matenda a proteinuria ndilakuti mumkodzo wambiri womwe mapuloteni amakhala okwera kwambiri, ndipo mu mkodzo wowonjezera (mwachitsanzo, mutatha kudya kwa mavwende) umakhala wotsika.

Tsopano tikulimbikitsidwa kuyeza mkodzo kuchuluka pakati pa mapuloteni ndi creatinine mu mkodzo, dzina la Chingerezi ndi UPC (Mapuloteni a Urine: Creatinine Ratio). UPC sichimatengera kuchuluka ndi kuchuluka kwa mkodzo. Ndikofunika kuyeza kuchuluka kwa mapuloteni / creatinine mu mkodzo ndi gawo limodzi la mkodzo woyamba, momwe zingachitike kuti ma protein a orthostatic sangathe kusintha zotsatira zake. Ngati mkodzo woyamba m'mawa mulibe, ndi chovomerezeka kuyeza gawo lililonse la mkodzo.

Zatsimikiziridwa ubale wolunjika pakati pa kufa ndi mtima ndi kuchuluka kwa mapuloteni / creatinine mu mkodzo.

Mitundu yoyesera ya mkodzo / creatinine (UPC):

• Pansi pa 10 mg / g, i.e. osakwana 10 mg ya mapuloteni pa 1 g ya creatinine (pansi pa 1 mg / mmol) - okwanira, monga momwe angakhalire ali aang'ono,
• Pansi pa 30 mg / g (pansipa 3 mg / mmol) - zomwe aliyense ali nazo,
• 30-300 mg / g (3-30 mg / mmol) - microalbuminuria (kuchuluka kwapakati),
• zoposa 300 mg / g - macroalbuminuria, albinuria, proteinuria ("kuwonjezeka").

Odwala omwe ali ndi microalbuminuria ayenera kutumizidwa ndi ACE inhibitor (perindopril, lisinopril et al.) kapena angiotensin II receptor blocker (losartan, candesartan etc.) chilichonse kuchokera ku gawo loyambirira la kuthamanga kwa magazi.

Chinthu chachikulu mankhwalawa matenda a shuga a 2

1. Zigawo zikuluzikulu zamankhwala:
   • kusintha kwa moyo +
   • kusintha kwazakudya zazitali +
   • kuchuluka kwa zolimbitsa thupi +
   • kulimbitsa thupi.
2. Zambiri shuga ndi matenda a shuga amachepetsa chiopsezo cha mavuto a mtima. Komabe, kuwongolera sikuyenera kukhala kovuta kwa okalamba, ofooka, komanso odwala kwambiri.
3. Target BP pansi pa 140 mm Hg. Art. amachepetsa chiopsezo cha mtima. Mwa odwala ena, ndikofunikira kulimbana ndi kuthamanga kwa magazi pansi pa 130 mmHg, zomwe zimachepetsa kwambiri ngozi stroke, retinopania, ndi albinuria.
4. Odwala onse omwe ali ndi matenda a shuga opitirira zaka 40 amalangizidwa kuti atenge ma statins Kuchepetsa chiopsezo cha mtima. Pamaso pa zoopsa zingapo, ma statin amaperekedwa kwa odwala ochepera zaka 40.
5. Inhibitors a mtundu wa glucose amadalira mtundu wa 2empagliflozin ndi ena) amachepetsa kufa kwamtima ndi kuwonongeka kwathunthu popanda zovuta zoyipa. Chimalimbikitsidwa kuti mugwiritse ntchito odwala omwe ali ndi matenda a shuga a 2 omwe ali ndi matenda amtima.

Zokhudza chithandizo cha matenda amishuga amtundu 1

Matenda a shuga amtundu woyamba amakula chifukwa chosowa kutulutsidwa kwa mahomoni insulin, yomwe imayambitsidwa ndi kufa kwa maselo ofanana ndi zikondamoyo chifukwa cha kutupa kwa autoimmune. Avereji ya zaka zoyambirira za matenda ashuga 1 ndi zaka 14, ngakhale zimatha kuchitika zaka zilizonse, kuphatikiza mwa akulu (onani matenda a shuga a autoimmune mwa akulu).

Matenda a 1 a shuga amawonjezera chiwopsezo cha mtima ndi 2.3 mwa amuna ndi katatu mwa akazi. Odwala omwe sangayang'anire shuga bwino (glycated hemoglobin level 9,7%), chiwopsezo cha mtima ndimakhumi kwambiri. Chiwopsezo chachikulu cha imfa chidawonedwa ndi matenda ashuga nephropathy (kuwonongeka kwa impso), komabe kuchuluka retinopathy (mochedwa siteji ya matenda ashuga retinal) ndi autonomic neuropathy (kuwonongeka kwa autonomic mantha system) kumawonjezeranso ngozi.

Kafukufuku wanthawi yayitali wa DCCT (The Diabetes Control and Complication Trial) adatsimikiza kuti kuwunikira mosamala kuchuluka kwa glucose mu mtundu 1 wa shuga ,imfa yakufa pazifukwa zonse imachepetsedwa. Mtengo wowonongera wa glycated hemoglobin (HbA1c) wa chithandizo chautali ndi kuyambira 6.5 mpaka 7.5%.

Kafukufuku wopangidwa ndi Cholesterol Treatment Trialists adawonetsa kuti kutenga ma statins kutsitsa magazi m'mitsempha ya m'magazi kumathandizanso mofananamo mitundu yonse ya 1 ya matenda ashuga ndi mtundu 2.

Madera ndi mtundu 1 wa shuga, muyenera kutsatira izi:

• odwala onse azaka zopitilira 40 (kusiyanasiyana kungachitike kokha kwa odwala omwe ali ndi mbiri yochepa ya matenda ashuga komanso kusowa kwa ziwopsezo),
• odwala omwe ali ndi zaka zosakwana 40 ngati akhudzidwa ndi ziwalo zojambulazo (nephropathy, retinopathy, neuropathy) kapena pali zifukwa zingapo zowopsa.

Mtundu 1 wa matenda ashuga, mipherezero yamagazi ndi 130/80 mm Hg. Art. Kugwiritsa ntchito kwa ACE inhibitors kapena angiotensin-II receptor blockers, komwe kumalepheretsa kugonjetsedwa kwa zombo zazing'ono, ndizothandiza kwambiri. Malangizo owonjezereka a kuthamanga kwa magazi (120 / 75-80 mmHg) amalimbikitsidwa kwa odwala omwe ali ndi matenda a shuga 1 osakwana zaka 40 microalbuminuria. Paukalamba (zaka 65-75), kuchuluka kwa kuthamanga kwa magazi kungakhale kovutirapo (kumtunda kwa 140 mmHg) kupewa zovuta.

• mulingo wovomerezeka wa glycated hemoglobin (HbA1c) wa matenda a shuga - kuchokera 6.5 mpaka 7.5%,
• Kwa odwala ambiri, kuthamanga kwa magazi 130/80 mmHg Art. (miyezo yolimba ndiyofunikira kwa odwala ochepera zaka 40 omwe ali ndi zoopsa, komanso zovuta kwa okalamba).

Mkhalidwe wa thupi pamaso pa matenda ashuga

Kuzungulira kwa shuga wamagazi ochulukirapo kudzera m'mitsempha ya m'magazi kumatsutsa kugonja kwawo.

Mavuto abwinobwino kwambiri odwala matenda ashuga ndi awa:

1. retinopathy. Kuwonongeka kwamawonedwe. Njirayi ikhoza kukhala yokhudzana ndi chiwopsezo chamitsempha yamagazi m'matumbo amaso,
2. matenda a excretory dongosolo. Zitha kuchitikanso chifukwa chakuti ziwalozi zimalowetsedwa ndimitsempha yamagazi yambiri. Ndipo popeza ndi ochepa kwambiri komanso amadziwika chifukwa cha kusokonekera kwambiri, pamenepo, amavutika koyambirira,
3. matenda ashuga. Vutoli limadziwika ndi odwala onse omwe ali ndi matenda ashuga ndipo amadziwika ndi kusokonezeka kwakukulu kwa magazi makamaka kumadera akumunsi, komwe kumayambitsa njira zosiyanasiyana zoyenda. Zotsatira zake, gangrene amatha kuwoneka (necrosis ya minofu ya thupi, yomwe, komanso, yomwe imayendera limodzi ndi kuzola),
4. microangiopathy. Matendawa amatha kuthana ndi ziwiya zama coroni zomwe zimazungulira mtima ndikuziziritsa ndi mpweya.

Kodi ndichifukwa chiyani shuga imayambitsa matenda a mtima?

Popeza matenda ashuga ndi matenda amtundu wa endocrine, amatha kwambiri machitidwe osiyanasiyana a metabolic omwe amapezeka m'thupi.

Kulephera kupeza mphamvu yochulukirapo kuchokera kuzakudya zomwe zikubwera kumapangitsa kuti thupi lizikonzanso ndikutenga zonse zomwe mukufuna kuchokera kumapuloteni ndi mafuta. Vuto lowopsa la metabolic limakhudza mtima.

Minofu yamtima imakwanira chifukwa cha kuchepa kwa mphamvu komwe glucose amapereka, pogwiritsa ntchito zomwe zimatchedwa mafuta - zomwe zimapezeka m'maselo a cell zomwe zimakhudza kapangidwe ka minofu. Ndi chiwonetsero chawo pafupipafupi komanso kwanthawi yayitali, matendawa ndi a shuga myocardial dystrophy. Matendawa amasokoneza kugwira ntchito kwa minofu ya mtima, yomwe imawonetsedwa pakusokonekera kwa mitsempha - kufooka kwa mafupa kumachitika.

Matenda a nthawi yayitali omwe amatchedwa matenda a shuga amatha kutsogola kwina kopanda matenda oopsa - a diabetesic autonomic Cardioneuropathy. Kuchuluka kwa shuga m'magazi am'magazi kungayambitse kuwonongeka kwa mitsempha yamagazi. Choyamba, kugwira ntchito kwa parasympathetic system, komwe kumayambitsa kufupika kwa matenda a shuga.

Zotsatira zochepetsera kugunda kwa mtima, zizindikiro zotsatirazi zimawonekera:

• chisokonezo chamtondo, tachycardia ndi matenda ashuga - zochitika zomwe zimachitika nthawi zambiri,
• Kupuma komweku sikukhudza pafupipafupi mphamvu zamkati pamtima komanso ngakhale kupuma kwathunthu kwa odwala, mawonekedwewo samatha.

Ndikupitilizabe kupitiliza kwa ma pathologies mu mtima, malekezero achifundo omvera, omwe amachititsa kuti chiwonetsero chazambiri chikhale chovutikanso, amavutikanso.

Pakukula kwa matenda a mtima, zizindikiro za kuthamanga kwa magazi ndizikhalidwe:

• mawanga amdima pamaso panga
• kufooka wamba
• Kuwala koopsa m'maso,
• chizungulire chadzidzidzi.

Monga lamulo, matenda ashuga ozungulira mtima amasintha kwambiri chithunzi chonse cha mtima waschemia.

Mwachitsanzo, wodwala sangamve kupweteka kwapafupipafupi ndi kupweteka kwapakati pa matenda a mtima. Amadwalanso ngakhale kufa ndi myocardial infaration popanda kupweteka kwambiri.

Vutoli ndi losafunikira kwenikweni kwa thupi la munthu, chifukwa wodwalayo, popanda kumva mavuto, amatha mochedwa kupita kuchipatala msanga. Pakati pakugonjetsedwa kwa mitsempha yachifundo, chiopsezo chomangidwa mwadzidzidzi chamtima chikuwonjezereka, kuphatikiza pa jakisoni wothandizila pakuchita opareshoni.

Ndi matenda 2 a shuga, angina pectoris nthawi zambiri amawoneka. Kuti athetse matenda a angina pectoris, shunting ndi stenting amagwiritsidwa ntchito mtundu wa 2 shuga. Ndikofunikira kuyang'anira momwe thanzi limayendera kuti kulumikizana ndi akatswiri sikungokhala.

Zowopsa

Monga mukudziwa, mtima wokhala ndi matenda ashuga 2 ali pachiwopsezo chachikulu.

Kuopsa kwamavuto amitsempha yamagazi kumawonjezeka pamaso pa zizolowezi zoyipa (makamaka kusuta), kusadya bwino, moyo wokhazikika, kupsinjika kosalekeza ndi mapaundi owonjezera.

Zotsatira zoyipa za kukhumudwa komanso kukhumudwa pamayambiriro a matenda ashuga zimatsimikiziridwa kale ndi akatswiri azachipatala.

Gulu lina lomwe lili pachiwopsezo limaphatikizapo anthu onenepa kwambiri. Ndi ochepa omwe amazindikira kuti kukhala wonenepa kwambiri kungayambitse kufa msanga. Ngakhale kunenepa kwambiri, kuchuluka kwa moyo kumatha kuchepetsedwa ndi zaka zingapo. Musaiwale kuti chiwerengero chachikulu chaimfa chimagwirizanitsidwa ndi kusakwanira kwa mtima ndi mitsempha yamagazi - makamaka ndi vuto la mtima ndi stroko.

Momwe mapaundi owonjezera amakhudzira thupi:

• kagayidwe kachakudya matenda, pamaso pake komwe kuchuluka kwa mafuta a visceral (kuchuluka kwa thupi pamimba), ndi insulin kukana kumachitika,
• mu madzi am'magazi, kuchuluka kwa mafuta "oyipa" kumawonjezera, zomwe zimakwiyitsa kuchuluka kwa atherosulinosis yamitsempha yamagazi ndi ischemia ya mtima,
• mitsempha yamagazi imawoneka mu mafuta okwanira, motero, kutalika kwawo kokwanira kumayamba kukula mwachangu (pofuna kupopa magazi moyenera, mtima uyenera kugwira ntchito ndi katundu wowonjezereka).

Kuphatikiza pa zonsezi, ziyenera kuwonjezeredwa kuti kukhalapo kwa kuchuluka kwambiri kwa thupi ndi kowopsa pa chifukwa china chachikulu: kuwonjezeka kwa shuga mumagazi a shuga a 2 kumachitika chifukwa chakuti mahomoni apanchipi, omwe amachititsa kuti glucose ayambe kupita ku maselo, amaleka kulowetsedwa ndi minofu ya thupi. , insulin imapangidwa ndi kapamba, koma sakwaniritsa ntchito zake zazikulu.

Chifukwa chake, akupitilizabe kukhala m'mwazi. Ichi ndichifukwa chake, pamodzi ndi kuchuluka kwa shuga m'matendawa, kuchuluka kwakukulu kwa mahomoni a pancreatic amapezeka.

Kuphatikiza pa kusamutsa glucose m'maselo, insulin imayeneranso kuchuluka kwa njira zina za metabolic.

Zimakonzanso kudzikundikira kwa mafuta oyenera. Momwe titha kumvetsetsa kuchokera pazidziwitso zonsezi, mtima wamitsempha, vuto la mtima, HMB ndi matenda a shuga zimayenderana.

Kalmyk yoga yolimbana ndi matenda a shuga ndi matenda a mtima

Matenda a shuga amawopa mankhwalawa, ngati moto!

Muyenera kungolemba ...

Pali njira yopulumutsira homeostasis ndikulimbikitsidwa kwathupi lonse lotchedwa Kalmyk yoga.

Monga mukudziwa, kupezeka kwa magazi kupita ku ubongo kumatengera mtundu wa zochita za anthu. Madipatimenti ake amathandizidwa ndi okosijeni, glucose ndi michere ina chifukwa cha mbali zina za ubongo.

Popeza munthu ali ndi zaka zambiri, magazi amafunikira ziwalo zofunika kwambirizi, motero amafunika kukondoweza. Itha kuchitika mwa kupumira mpweya wolemera mu mpweya wa kaboni. Mukhozanso kukhutiritsa alveoli yamapapu mothandizidwa ndi kupuma komwe.

Yoga ya Kalmyk imasintha magazi m'magazi ndipo imalepheretsa kuwonekera kwamatenda amtima.

Matenda a shuga

Cardiomyopathy mu matenda ashuga ndi matenda omwe amawoneka mwa anthu omwe ali ndi mavuto ndi endocrine system.

Sichimayambitsidwa ndi kusintha kwamunthu kokhudzana ndi msinkhu, kuponderezana kwa ma valavu amtima, kutsika kwa magazi ndi zina.

Kuphatikiza apo, wodwalayo amatha kukhala ndi mawonekedwe osiyanasiyana ophwanya malamulo, onse amtundu wazachilengedwe komanso mwachilengedwe. Amayambitsa pang'onopang'ono kusokonekera kwa systolic ndi diastolic, komanso kulephera kwa mtima.

Pafupifupi theka la ana obadwa kwa amayi omwe ali ndi matenda ashuga amakhala ndi matenda ashuga a mtima.

Kodi Panangin ndiyotheka odwala matenda ashuga?

Anthu ambiri omwe ali ndi vuto la endocrine komanso matenda a mtima amafunsa kuti: Kodi Panangin ndiyotheka ndi matenda ashuga?

Kuti mankhwalawa apereke zotsatira zabwino ndikuthandizira mankhwalawa, ndikofunikira kuphunzira malangizo mwatsatanetsatane ndikutsatira pochita.

Panangin adalembedwa kuti pakhale zosakwanira zambiri za potaziyamu ndi magnesium m'thupi. Kutenga mankhwalawa kumapewetsa arrhythmia ndi kukula kwa zovuta zazikulu pantchito ya minofu ya mtima.

Makanema okhudzana nawo

Matenda a mtima komanso matenda obwera chifukwa cha matenda ashuga:

Monga titha kumvetsetsa kuchokera pazidziwitso zonse zomwe zalembedwa munkhaniyi, matenda a shuga ndi mtima zimalumikizana, motero muyenera kutsatira malingaliro a madokotala kuti mupewe zovuta ndi kufa. Popeza matenda ena okhudzana ndi ntchito ya mtima ndi mitsempha yamagazi ali ofanana kwambiri, muyenera kuyang'anira chidwi chanu chonse ndikuwunikidwa pafupipafupi ndi akatswiri.

Ngati simuli otsimikiza za thanzi lanu, ndiye kuti pali ngozi ya zotsatira zosasangalatsa. Pankhaniyi, mankhwala osokoneza bongo sangathenso kupewa. Ndikulimbikitsidwa kuti muziyendera pafupipafupi mtima komanso kuchita ECG yokhudza matenda a shuga a 2. Kupatula apo, matenda a mtima m'matenda a shuga siachilendo, chifukwa chake muyenera kuthana ndi chithandizo chamanthawi.

Zomwe zimachitika mu mtima ndi matenda ashuga

Kusintha kwa mtima ndi mtima ndi zovuta za matenda ashuga. Ndikotheka kuti muchepetse kukula kwa matenda a mtima mu matenda a shuga ndikumakhalabe glycemia, chifukwa tazindikira kale kuti ndizowopsa zake (hyperglycemia, hyperinsulinemia, insulin resistance) zomwe zimakhudza makoma amitsempha yamagazi, zomwe zimatsogolera pakupanga kwa micro- ndi macroangiopathies.

Matenda a mtima amapezeka nthawi 4 zambiri mwa odwala matenda a shuga. Kafukufuku awonetsanso kuti pamaso pa matenda ashuga, njira ya matenda amtima imakhala ndi zina. Aganizireni pazitsanzo za maumwini amodzi.

Matenda oopsa

Mwachitsanzo, mwa odwala oopsa omwe ali ndi matenda a shuga, kuopsa kwa kufa ndi nthenda ya mtima kumakhala kochulukirapo kawiri kuposa kwa anthu omwe akudwala matenda oopsa a m'magazi omwe amakhala ndi shuga. Izi ndichifukwa chakuti onse odwala matenda ashuga ndi matenda oopsa, zida zake ndi ziwalo zomwezo:

• Myocardium
• Mitsempha yama mtima,
• Zombo zapamadzi
• Ziwiya za impso,
• Maso amaso.

Chifukwa chake, kukwapula kwa ziwalo zomwe zimaloledwa kumachitika ndi mphamvu ziwiri, ndipo thupi limakhala lovuta kulimbana nalo.

Kusungabe kuthamanga kwa magazi mkati mwa magawo owongolera kumachepetsa chiopsezo cha zovuta zamtima ndi 50%. Ichi ndichifukwa chake odwala omwe ali ndi matenda a shuga komanso matenda oopsa amayenera kumwa antihypertensive mankhwala.

Matenda a mtima

Ndi matenda a shuga, chiopsezo chokhala ndi matenda amtima chambiri chimawonjezeka, ndipo mitundu yake yonse, kuphatikiza yopweteka:

• Angina pectoris,
• Myocardial infaration
• Kulephera kwa mtima
• Imfa yadzidzidzi ya coronary.

Angina pectoris

Matenda a mtima amatha kuchitika ndi angina pectoris - kupweteka kwapweteka kwambiri mumtima kapena kumbuyo kwa sternum komanso kufupika kwa mpweya.

Pamaso pa matenda a shuga, angina pectoris amakula pafupipafupi 2, kupezeka kwake ndi njira yopweteka. Pankhaniyi, wodwalayo amadandaula kuti samva kupweteka kwambiri pachifuwa, koma pamtima, kufupika, thukuta.

Nthawi zambiri, atypical komanso osavomerezeka pokhudzana ndi matenda a chinos pectoris - osakhazikika angina, Prinzmetal angina.

Myocardial infaration

Kufa kwa myocardial infarction mu shuga ndi 60%. Kukhumudwa kwa minofu ya mtima kumayamba ndi ma frequency omwewo mwa akazi ndi amuna. Mbali ndi kakulidwe kake ka mitundu yosapweteka. Izi zimachitika chifukwa cha kuwonongeka kwa mitsempha yamagazi (angiopathy) ndi mitsempha (neuropathy), yomwe imayamba kukhala ndi matenda osokoneza bongo.

China chomwe ndikukula kwa mitundu yoopsa ya kubadwa kwa myocardial infarction - kusintha m'matumbo, mitsempha ndi minofu ya mtima sikulola mtima kuti uchira pambuyo pa ischemia. Chiwerengero chapamwamba cha chitukuko cha zovuta za m'mbuyo mwa anthu odwala matenda ashuga chimagwirizananso ndi izi poyerekeza ndi anthu omwe alibe mbiri yamatendawa.

Kulephera kwa mtima

Kukula kwa mtima kulephera mu matenda ashuga kumachitika kangapo. Izi zimathandizira kuti pakhale mtima wotchedwa "matenda ashuga", womwe umadalira matenda a mtima.

Cardiomyopathy ndi chotupa chachikulu cha mtima ndi zinthu zilizonse zomwe zimayambitsa kukula kwake ndi mapangidwe a kulephera kwa mtima ndi kusokonekera kwa mitsempha.

Matenda a shuga a mtima amadwala chifukwa cha kusintha kwa maselo a mtima - minofu ya mtima silandira kuchuluka kwa magazi, ndipo ndi mpweya ndi michere, zomwe zimapangitsa kusintha kwa morphological ndi magwiridwe antchito. Ndipo kusintha kwa minyewa ya mitsempha pa nthawi ya neuropathy kumathandizanso kuti musokoneze kayendedwe kazinthu zamagetsi pamtima. Hypertrophy ya cardiomyocyte imayamba, njira za hypoxic zimayambitsa mapangidwe a sclerotic pakati pa ulusi wa myocardium - zonsezi zimayambitsa kukulira kwamitsempha yamtima ndi kutayika kwa kutanuka mtima kwa minofu yamtima, yomwe imakhudza kuuma kwa myocardium. Kulephera kwamtima kumayamba.

Imfa yadzidzidzi ya coronary

Kafukufuku ku Finland adawonetsa kuti mwa anthu omwe ali ndi matenda ashuga, chiopsezo cha kufa ndi nthenda ya mtima ndi chofanana ndi cha anthu omwe adayamba kudwala matenda osokoneza bongo, koma alibe mbiri ya matenda a hyperglycemia.

Matenda a shuga ndi limodzi mwamavuto omwe amabwera chifukwa cha kufa kwadzidzidzi kwa coronary, pomwe wodwalayo amafa nthawi yochepa kuchokera ku ventricular fibrillation kapena arrhythmia. Kuphatikiza pa matenda ashuga, gulu la zinthu zomwe zili pachiwopsezo limaphatikizapo matenda a mtima, matenda a mtima, kunenepa kwambiri, mbiri ya kuphwanya magazi m'mitima, kulephera kwa mtima - ndipo awa ndi "abwenzi" pafupipafupi. Chifukwa cha kukhalapo kwa "gulu" lonse la zinthu zomwe zingachitike pachiwopsezo - kakulidwe ka mtima mwadzidzidzi pamatenda a shuga amapezeka pafupipafupi kuposa anthu omwe samadwala.

Chifukwa chake, nthenda ya mtima ndi matenda a shuga - zokhudzana ndi matenda - imodzi imasokoneza maphunzirowo ndi kutsimikizira kwa enawo.