Pathogeneis ndi etiology ya matenda ashuga

Matenda a shuga ndi amodzi mwazodziwitsa za nthawi yathu ino. Zimakhudza anthu ochokera kumayiko onse, azaka komanso magulu. Zingawonekere kukhala zosatheka kuti mudziteteze nokha kapena kudzilimbitsa nokha. Ichi ndi matenda osawoneka omwe amatha kudumphira mwadzidzidzi komanso modzidzimutsa. Komabe, sizili choncho nthawi zonse.

Nkhaniyi imagwiritsidwa ntchito pa etiology, pathogenesis, ndikuwonetsedwa kwa matenda amisala mellitus (DM). Tithandizanso mwachidule pankhani yodziwitsa za matendawa ndi kulandira chithandizo. Mudzaona kuti matendawa ali ndi ma provocateurs enaake komanso zomwe zimayambitsa, pokhapokha njira zoteteza zitha kuperekedwa. Mupezanso zizindikiro zazikuluzikulu za matendawa, zomwe zingakuthandizeni kudziwa zomwe zimachitika munthawi yake komanso kupeza thandizo loyenera pa nthawi yake.

Chifukwa chake - shuga mellitus (etiology, kliniki, chithandizo akukambirana pansipa).

Mwachidule za matendawa

Matenda a shuga ndi matenda osachiritsika a endocrine system omwe amagwirizana ndi kupanga insulin, omwe amawonetsedwa ndi glucose wambiri m'magazi. Matendawa amatha kupangitsanso matenda a metabolic ndikupangitsa matenda ena owopsa kuchokera mu mtima, impso, mitsempha yamagazi, ndi zina zambiri.

Gulu

Musanaphunzire magawo akuluakulu a matenda a shuga (kachipatala, chithandizo, kapewedwe kameneka), muyenera kudziwa mtundu wake.

Malinga ndi dongosolo la zamankhwala, matendawa agawidwa:

1. Type 1 shuga mellitus, omwe amayamba chifukwa chosowa kwambiri insulini chifukwa chakuti ma endocrine ziwalo sangathe kuzitulutsa bwino. Dzinalo lina la mtundu woyamba wa shuga limadalira insulini, chifukwa chithandizo chokhacho chimakhala chokhazikika cha insulin.
2. Type 2 shuga mellitus ndi chifukwa cha kulumikizana kosayenera kwa maselo ndi minyewa. Matendawa amatengedwa kuti ali ndi insulin, chifukwa sizikuphatikiza kugwiritsa ntchito mankhwalawa pofuna kuchiza.

Monga mukuwonera, zomwe zimayambitsa matendawa ndizosiyana kwambiri. Chifukwa chake, zipatala zamtundu wa matenda amtundu wa 1 ndi mtundu 2 zimakhalanso zosiyana. Komabe, tidzakambirana za izi kanthawi kena.

Chimachitika ndi chiyani m'thupi pakadwala?

Pathogenesis yamatenda

Kupanga kwa chiyambi ndi chitukuko cha matenda ashuga ndi chifukwa cha mbali ziwiri zazikulu:

1. Pancreatic insulin akusowa. Izi zitha kuchitika chifukwa cha kuwonongeka kwakukulu kwa ma cell a endocrine a chiwalochi chifukwa cha kapamba, matenda am'mimba, zovuta zina, khansa komanso matenda a autoimmune.
2. Kusagwirizana kwazomwe zimachitika pakati pa maselo a minyewa ndi insulin. Vutoli limatha kuchitika chifukwa cha kusintha kwa ma pathological kapangidwe ka insulin kapena kuphwanya kwa ma cell receptors.

Etiology ya matenda

Musanafike poti mudziwe za matenda ake, chipatala, chithandizo cha matenda ashuga, muyenera kudziwa zomwe zimayambitsa matendawo.

Anthu ambiri amavomereza kuti matenda ashuga ndi matenda obadwa nawo omwe amaphatikizika ndi zina zomwe zimapangitsa.

Ngati timalankhula za matenda a shuga a mtundu woyamba, ndiye chomwe chimayambitsa matendawa chimatha kukhala matenda a virus omwe amakhudza maselo a kapamba (rubella, mumps, chikuku).

Pa vuto lachiwiri la matenda ashuga, kunenepa kwambiri kumatha kuyambitsa vuto.

Chofunikira pakuwonekera kwa chipatala cha matenda osokoneza bongo chikuyenera kuwonedwa ngati zochitika zodetsa nkhawa zomwe zingakhale ndi vuto pa endocrine system komanso kupanga insulini, komanso zizolowezi zoipa komanso moyo wongokhala.

Chifukwa chake, tidaganiza za etiology. Chipatala cha matendawa chidzasungidwa pansipa.

Zizindikiro zofala

Ndikofunikira kudziwa mawonekedwe akulu a shuga kuti muwazindikire pakapita nthawi, kukaonana ndi katswiri ndikuyamba chithandizo cha munthu payekha. Chipatala cha matenda a shuga mellitus (kuzindikira, chithandizo, njira zodzitchinjiriza tidzakambirana mwatsatanetsatane) ndizolumikizana kwambiri ndi zizindikiro zowonetsa.

Zizindikiro zazikulu zamatenda zimaphatikizapo:

• Kukodzetsa kwambiri, makamaka usiku. Ichi ndichifukwa cha kupezeka kwambiri kwa glucose mkodzo.
• Kumva ludzu kosalekeza, kukwiya ndi kutaya kwakukulu kwamadzi, komanso kuwonjezeka kwa kuthamanga kwa magazi.
• Njala yosakhutira yomwe imachitika chifukwa cha zovuta za metabolic.

Zizindikiro izi, zomwe zimawoneka mwachangu komanso nthawi imodzi, ndizizindikiro zakuchipatala cha mtundu wa 1 matenda a mellitus. Ngakhale nthawi zambiri zimawonedwa ngati zizindikiro zofala zamasamba amitundu yonse. Ngati tikulankhula za matenda omwe amadalira insulin, ndiye kuti tiyenera kunena za kuchepa kwambiri kwa thupi komwe kumachitika chifukwa cha kuwonongeka kwa metabolic wamafuta ndi mapuloteni.

Kulemera kumachitika mwachipatala cha matenda ashuga a 2.

Zizindikiro zachiwiri za matenda ashuga amitundu yonse ndiz:

• kutentha kwa khungu ndi mucous nembanemba,
• kufooka kwa minofu
• kuwonongeka kwamawonekedwe
• kuchiritsa kwamabala.

Monga mukuwonera, chiwonetsero cha matenda a shuga chimatchulidwa ndipo chimafuna chisamaliro chamankhwala.

Mavuto a matendawa

Ndikofunikira kwambiri kuyambitsa chithandizo chakanthawi. Chifukwa matenda a shuga amadziwika ndi kupweteketsa matenda akulu monga atherosulinosis, kukhumudwa, ischemia, kupsinjika, kuwonongeka kwa impso, zilonda zam'mimbamo, komanso kulephera kuwona.

Kuphatikiza apo, ngati simupereka chithandizo chamankhwala kapena kunyalanyaza malangizo a dokotala, ndiye kuti zotsatira zoyipa monga kupweteka ndi imfa zimatha kuchitika.

Kodi matenda ashuga amapezeka bwanji? Adotolo azachipatala ayenera kuchenjeza adotolo ndikulimbikitsa kuti amupatse mayeso okwanira. Zikuphatikizapo chiyani?

Kuzindikira matendawa

Choyamba, wodwalayo adzapemphedwa kukayezetsa magazi kuti ayende bwino. Izi ziyenera kuchitika pamimba yopanda kanthu, pambuyo pakusala kudya kwa maola khumi. Ndi ziti zomwe zikuwonetsa mu kafukufukuyu zomwe muyenera kumvetsera?

Matenda a shuga amadziwika ndi kuchuluka kwakukulu (kawirikawiri, zizindikiro za matendawa zidzaposa 6 mmol / l).

Komanso, katswiri angaganize kuti ndikofunikira kuyesa mayeso okhudzana ndi glucose, pomwe wodwalayo adzafunika kumwa njira yapadera ya glucose. Kenako, mkati mwa maola awiri, kuyesedwa kwa labotale komwe kumapangitsa kuti magaziwo athe kulolera. Ngati Zizindikiro zikuposa 11.0 mmol / l, ndiye chifukwa chake muyenera kunena za kuwunika kwa matenda ashuga. Chipatala cha matendawa chidzakhala umboni wotsimikizika wa izi, chifukwa pambuyo pake zingalimbikitsidwe kuti mupeze kuchuluka kwa glycosylated hemoglobin (chizindikiro chodziwika bwino chomwe chimawerengedwa pansipa 6.5%).

Komanso, adotolo amatha kuperekera mkodzo kuti aunikidwe kuti adziwe kupezeka kwa shuga ndi acetone mu biomaterial.

Chifukwa chake, tidaganizira za kupezeka kwa matenda ashuga. Chipatala ndi chithandizo cha matendawa zidzafotokozedwa pansipa.

Chithandizo cha matenda 1

Musanadziwe momwe mungachiritsire matenda ashuga, muyenera kudziwa mtundu wake wa matenda, ndikuwonetsetsa mtundu wa matenda ndi gawo lawo. Monga mukuwonera, chipatala cha odwala matenda ashuga ndichofunikira kwambiri popereka chithandizo.

Ngati tikulankhula za matenda amtundu wa 1, ndiye kuti katswiriyu amuuzeni mankhwala a insulin, pomwe awerenge tsiku lililonse la mankhwalawo. Njirayi itha kugwiritsidwanso ntchito pa matenda a shuga a mtundu wachiwiri.

Kukonzekera kwa insulin ndi timadzi totulutsidwa m'matumbo a nyama kapena anthu. Ma monovid ndi osakanikirana ophatikizika amadziwika, amagwira ntchito mwachidule komanso amakhala nthawi yayitali, chikhalidwe, monopic ndi monocomponent. Palinso fanizo la insulin yaumunthu.

Mankhwalawa amalowetsedwa mu khola lamafuta, subcutaneally, pogwiritsa ntchito syringe yochepa kapena chida chapadera m'njira yolembera ndi singano yaying'ono.

Izi zimathandizira kulipira kusokonezeka komwe kumachitika chifukwa chophwanya kagayidwe kazachilengedwe. Nthawi zina wodwala amapatsidwa insulin.

Mankhwalawa amapaka jekeseni kangapo patsiku, malinga ndi zakudya komanso mankhwala omwe mumalandira.

Mfundo zina zochizira matenda a shuga 1 mtundu wa mankhwalawa ndikuchotsa kwa zizindikiro zamankhwala, kupewa kwazovuta za matendawa, ndikusintha kwa kapamba (chifukwa ichi, mankhwala monga Actovegin, Festal, cytochrome angagwiritsidwe ntchito).

Kuti mukwaniritse chithandizo chamankhwala, wodwalayo amalimbikitsidwa kudya komanso kuchita masewera olimbitsa thupi.

Chithandizo cha matenda 2

Chithandizo cha matenda a shuga a mitundu 2 osakhudzana ndi insulin nthawi zambiri chimayamba ndi chithandizo chamankhwala komanso zolimbitsa thupi zolimbitsa thupi. Athandizira kuchepetsa kulemera komanso kusamala kagayidwe.

Ngati matendawa apezeka m'gawolo, ndiye kuti adokotala akupatseni mankhwala omwe ali ndi izi:

• Kuchepetsa kuchuluka kwa glucose m'matumbo ndi chiwindi, komanso kukonza chidwi cha minofu kuti ipange insulin (kutengera metformin: "Fomu", "Metfogama", "Diaformin", "Gliformin", kutengera rosiglitazone: "Avandia", pioglitazone: "Actos" ) Anthu amatcha mankhwalawa kuti hypoglycemic.
• Kupititsa patsogolo insulin. Awa atha kukhala othandizira a pharmacological, othandizira a mtundu wa sulfanylureas (Maninil, Diabetes, Glimepirid, Diamerid, Glimaks, Glunenorm), komanso meglitinides (Diagnlinide, Starlix).
• Kulepheretsa kwa michere yamatumbo kuti muchepetse mayamwidwe am'mimba m'matumbo am'mimba (mankhwala ozikidwa pa acarbose).
• Kutsitsa cholesterol, zolimbikitsa zolandilira m'maselo am'mitsempha, kusintha kagayidwe ka lipid (mankhwala omwe mankhwala ake amapanga ndi fenofibrate - dzina ladziko lonse losagwirizana ndi omwe akuphatikizidwa ndi WHO).

Malangizo onse

Monga mukuwonera, chinthu chofunikira pakuchiza matenda amtundu uliwonse wa shuga ndichakudya chokhwima komanso cholimbitsa thupi.

Kuphatikiza apo, odwala matenda ashuga ayenera kukumbukira kuti matendawa ndi osachiritsika komanso osachiritsika. Chifukwa chake, mankhwala onse ayenera kumwa kwa moyo wonse komanso nthawi yake.

Kudzi kudziletsa kumathandizanso pakuthandizira odwala matenda ashuga - pamene wodwalayo amakhala wathanzi kwambiri komanso wodwalayo akamayamba kudwala, zimakhala zosavuta komanso zowawa kwambiri.

Ndipo pamapeto pake

Inde, matenda ashuga ndi matenda osasangalatsa komanso ovuta omwe angayambitse matenda akulu komanso matenda. Chithunzi chachipatala cha anthu odwala matenda ashuga alengeza zizindikiro ndi zizindikiro.

Kusamalidwa kwakanthawi kwamankhwala kumathandiza kwambiri pakuchiza matendawa ndikuchotsa mawonekedwe owawa. Ngati wodwalayo amatsatira mosamalitsa zomwe dokotalayo amamuuza, kutsatira zakudya, kumakhala ndi moyo wachangu ndikukhalabe ndi malingaliro abwino, ndiye kuti zizindikiro za matenda ashuga zidzachepetsedwa, ndipo wodwalayo azitha kumva bwino ngati munthu wathanzi komanso wokhazikika.

Pathogeneis ndi etiology ya matenda ashuga. Zifukwa zazikulu

Matenda a shuga ndi matenda a metabolic omwe amayamba chifukwa cha kusowa kwenikweni kwa insulin kapena wachibale. Thupi lomwe lakhudzidwa silitha kuthana ndi glucose monga momwe limakhalira pazochitika zathupi, zomwe zimatsogolera ku hyperglycemia.

Matenda a shuga omwe matendawa amakhala osiyanasiyana, amayimiridwa ndi zifukwa zomwe zimayambitsa matendawa, zomwe, ndi gulu losiyana, osati chipatala. Pofuna kumvetsetsa tanthauzo la matendawa, ndikofunikira kuti muphunzire zofunika kuzisunga komanso momwe angapangire insulini, izi zimatsimikizira mellitus wa shuga yemwe pathogenesis imayimiridwa moyenera ndi makina amachitidwe a mahomoni awa.

Polypeptide ya mahomoni imapangidwa mu ma cell a B pancreatic a Langerhans, omwe, atatha kudziwa peptide ya siginecha, amasungidwa m'miyala yachinsinsi, ngati proinsulin.

Apa zimafika pakukula kwa molekyu, motero, ma cell a B amatulutsa mamolekyulu a insulin ndipo, nthawi yomweyo, kuchuluka kofanana kwa C-peptide. Ndi mtsempha wamagazi, ma peptides onse amafikira chiwindi, chomwe chimachita kusefa, momwe theka la molekyulu ya insulin imasonkhanitsidwa kale nthawi yoyamba.

Mwanjira imeneyi, thupi limadzitchinjiriza ku ntchito yayikulu ya insulini, yomwe pachimake kwambiri imayambitsa hypoglycemia yosafunikira. Pambuyo pakupita m'chiwindi, insulini kudzera m'magazi akulu amalowa mu zotumphukira, kuphatikizira adipose ndi minofu minofu.

Kuphatikiza pa maselo a chiwindi ndi mafuta, palinso minofu yolimba yomwe imakhala ndi ma insulin receptor pama cell awo. Ma molekyulu a insulin amalumikizana ndi ma alpha subunits a receptors ndipo, chifukwa chake, amayambitsa kukhudzana kwa unyolo, komwe kumatsimikizira mphamvu ya mahomoni.

Chifukwa chomangiriza insulin ku receptor, beta subunit imayendetsedwa, yomwe gawo lake lamkati (i.e., domain) imayendetsa gawo lapansi la insulin receptor. Pakadali pano pali mitundu ingapo ya mamolekyuwo (IRS-1, IRS-6 ...), ntchito zomwe zimamveka kale.

Ma gawo a IRS-1 ndi IRS-2 ndi molekyu yofunika kwambiri pakuwongolera zochitika zina zomwe zimachitika mkati mwa khungu. Titha kunena kuti pali njira zazikulu ziwiri: imodzi, phosphatidylinositol-3-kinase (PI 3-K) imayendetsedwa, chachiwiri, proteinasease imayatsidwa ndi mitogen.

Zotsatira zake, zimafikira kayendedwe ka glucose mu cell, momwe ma insulin omwe amadalira glucose amatenga nawo gawo, kuwonjezera, metabolic zotsatira za insulin, zomwe zimapangitsa kuphatikizika kwa mapuloteni, lipids ndi glycogen, komanso kukula kwake, zimayikidwa.

Zotsatira zomaliza zimatengera mgwirizano wangwiro womwe umachitika mwa munthu, zomwe zimapangitsa kuti shuga m'magazi ndi kagayidwe kachakudya kazisamalidwa mthupi. Zosintha zomwe zimalumikizidwa ndi gawo lililonse la insulini kaphatikizidwe kazomwe zimayang'aniridwa zimayambitsa zolakwika pakulola kwa glucose, yemwe genesis yake imasiyana kwambiri.

Ili siliri vuto limodzi, ndipo matenda ashuga si matenda amodzi, koma gulu la matenda omwe tanthauzo la "matenda" ndiloyenera kwambiri. Kugawidwa kwa shuga komwe kumagwiritsidwa ntchito masiku ano kumathandizira kudziwa pathogenesis, yomwe imalola njira yovomerezeka yovomerezeka yothandizira

Potanthauzira shuga, mawu akuti "mtheradi" kapena "wachibale" wa insulin amagwiritsidwa ntchito, omwe amafotokozedwa mwanjira ya pathogenetic yoyesera ndi kuchiza matenda a shuga. Ndiwofunikira kwambiri pamitundu iwiri yayikulu ya matenda ashuga, mtundu 1 wa matenda ashuga ndi mtundu 2 shuga.

Mtundu woyamba wa shuga

Gawo la endocrine la kapamba mu mtundu wamatendawu silingathe kupanga insulini, yomwe imayambitsa kuperewera kwathunthu komanso chizolowezi cha ketoacidosis, popeza onse mafuta omwe amamasulidwa ndi ma amino acid ndi gawo lapansipa la ketoplastic.

Matenda a shuga amayamba chifukwa cha kuchepa kwapang'onopang'ono kwa maselo a B, omwe akuwonetsedwa ndi kukhalapo kwa autoantibodies.Kuzindikira kwa ma antibodies a glutamic acid decarboxylase ndi tyrosine phosphatase (IA-2ab), komanso insulini, ndi umboni kuti mamolekyulu ena amakhala autoantigenic ndipo poyankha autoimmune amawalozera.

Ma antibodies amatha kupezeka matenda a shuga asanayambe, ndiye kuti, kulekerera kwa glucose kwa munthu kumatsimikiziridwa. Kukula kwa autoimmune kumafuna kudziwikiratu kwamtundu chifukwa cha kusintha kwa ma-haplotypes mu kalasi II la dongosolo la HLA.

Tikulankhula za mitundu ya DR3, DR4 ndi DQA1 ndi DQB1, omwe mayanjano awo ndi matenda amtundu wa 1 awonetsedwa kwambiri. Ena amankhwala amtunduwu amawonjezera mwayi wokhala ndi matenda (mwachitsanzo, DQA1-0301, DQB1-0302, DQA1-0501, etc.), ena amachita, mosiyana, mosateteza (DQA1-0102, DQB1-0602, etc.).

Makamaka, kuphatikiza kwamavuto owopsa, mwayi wokhala ndi matenda amtundu wa 1 ukuwonjezeka. Ngozi yayikulu idalembedwa mu heterozygous genotype DR3 / DR4 kapena DQA1-0501 - DQB1-0201 - DQA1-0301 - DQB1-0,302.

Pang'onopang'ono, zigawo zosiyanasiyana komanso majini omwe amayenderana ndi mtundu wa 1 shuga mellitus (wosankhidwa ngati chizindikiro cha IDDM kuyambira 1 mpaka 15) adadziwika, omwe chofunikira kwambiri ndi chikhomo cha IDDM-1 cholumikizidwa ndi chromosome 6, chomwe chikugwirizana ndi gulu lomwe latchulidwazi , ndi IDDM-2, yomwe imalumikizana ndi jini la insulin pa chromosome 11 (i.e., polymorphism ya VNTR).

Kukhazikika kwa chibadwa kumathandiza chitetezo cha mthupi, kuphatikiza ma cellular komanso amanyazi, kuwongolera motsutsana ndi ma antigen ake. Pa mulingo wa maselo, njirayi imayang'aniridwa ndi mamolekyulu a HLA omwe amamanga peptide yolingana, mwakutero akuwunikira mawonetsedwe ake ndikuzindikira T-lymphocyte receptors.

Kupezeka kwa amino acid serine kapena alanine pamalo 57 a beta unyolo wa DQ2 kapena DQ8 mamolekyamu ndikofunikira kuti amange peptide ku geno la HLA. Mphamvu ya peptide bond imalimbikitsidwa ndi arginine yomwe ili pamalo a 79 a alpha chain a DQ mamolekyulu.

Ngati molekyulu ya DQ yomwe ili pamtunda wa 57 wa beta yomwe ili ndi spartic acid, singathe kufikira cholumikizira cha peptide, motero kupewetsa kwake kwa maselo T. Chifukwa chake, zikuwonekeratu kuti kusintha kosavuta komwe kumatsogolera pakupereka ma amino acid osiyanasiyana pamalo ena omangika a HLA ma molekyulu apakati kungakhudze kukula kwa zochita za autoimmune.

Zinthu zam'mbuyomu, makamaka kachilombo ka kachilombo, zomwe nthawi zambiri zimayamba chifukwa cha enteroviruses, zimawerengedwa ngati njira yopangira matenda. Nthawi zambiri, kulumikizidwa kwawonetsedwa ndi cytomegalovirus, paramyxovirus, ma virus a Coxsackie kapena rubella. Kuphatikiza apo, zovuta zoyipa za mkaka wa ng'ombe mwa ana aang'ono kapena udindo wodziwikiratu zakumwa zina zimadziwika, koma mwatsatanetsatane izi sizikudziwika bwino, m'njira zambiri.

Kuwonongeka kwa zisumbu kumayendera limodzi ndi kulowa kwa mitsempha ya m'mimba, yomwe imawoneka koyambirira, ngakhale isanayambike njira yowerengera maselo a B. Udindo wotsatira pa njirayi umaseweredwa ndi T-lymphocyte. Kuti matenda ashuga azikula, ndikofunikira kuwononga pafupifupi 90% ya B-cell, njirayi, monga lamulo, imatha kwa miyezi ingapo kapena, mwina, ngakhale zaka.

Nthawi yeniyeni yotenga nthawi yotsatirayi imakhala yovuta kudziwa, chifukwa dokotala amakumana ndi wodwala atatha matenda ashuga. Zowona kuti njira ya autoimmune imatha kutenga nthawi yayitali m'njira zosiyanasiyana imalimbitsa chidziwitso chomwe chimapezeka kuchokera ku maphunziro a matenda a shuga a LADA.

Tikuyankhula za kuyamba pang'onopang'ono kwa shuga chifukwa cha njira ya autoimmune mwa akulu (i.e. latent autoimmune shuga mwa akulu), momwe ma antiAD a GADA kapena IA-2ab amawonetsedwa.

Poyamba, matendawa amakhala ndi njira yofatsa kotero kuti achikulire omwe ali ndi matenda ashuga nthawi zambiri amathandizidwa ndimankhwala othana ndi matenda amkamwa, kapena matendawa amathandizidwa ngati matenda a shuga 2. Pambuyo pa nthawi yosinthika, yomwe imakonda kukhala zaka zingapo, mankhwalawa samawonetsa kuwoneka bwino (chifukwa chake, mkhalidwewu umadziwika ngati kulephera kwachiwiri kwa mankhwala opatsirana pakamwa), chifukwa chomwe mankhwala a insulin amalembera.

Gawo lino likufanana ndi nthawi yomwe kupanga kwake kwa insulin kumakhala kovuta kwambiri, ndipo thupi limafunikira chakudya chambiri cha insulin. Kuyesedwa kwa ma antibodies kale koyambirira kukuwonetsa kuti izi sizokhudza matenda a shuga a 2, koma za matenda a shuga omwe akupita pang'onopang'ono.

Chifukwa chake, njira ya autoimmune mwa anthu omwe atenga nawo gawo amatha kuchitika nthawi iliyonse pamoyo komanso kuthamanga kosiyanasiyana. Chifukwa chake, matenda a shuga 1 amtundu, omwe amatsogolera kudalira kwathunthu kwa insulin, amatha kuchitika m'mibadwo yonse, kuphatikiza achikulire, chifukwa chake, mawu oti "achinyamata a shuga" samachotsedwa kwathunthu.

Njira yamachitidwe a autoimmune nthawi zambiri imathamanga ali aang'ono, koma ngakhale mutakula mumatha kukumana ndi matenda amtundu woyamba wa matenda ashuga a ketoacidosis. Kuthamanga kwa njirayi makamaka kumatengera kupezeka kwa kuphatikiza kwamavuto a ngozi, i.e. chibadwa.

Kuphatikiza pa magulu omwe atchulidwa a odwala omwe ali ndi vuto la matenda a shuga 1 komanso kupezeka kwa ma antibodies, atchulidwenso omwe ayenera kukhala ndi matenda ashuga omwe omwe ma antibodies sanapezeke. Odwala awa ali m'gulu la idiopathic mtundu 1 shuga mellitus, omwe pano amawaganizira kuti ndi gawo lawo lachiwiri. Zambiri mwatsatanetsatane wazomwe zimayambitsa matendawa m'matendawa a shuga sizinaperekedwebe.

Type 2 shuga

Mosiyana ndi gulu lakale, mtundu wachiwiri wa shuga umakhala ndi pathogenesis yosiyana kwambiri ndipo imadziwika ndi kuperewera kwa insulin. Kuphatikizika kwa insulin kumasungidwa, koma kutulutsidwa kwa mahomoni kuchokera ku maselo a B kupita kumalo achinsinsi omwe amadza ndi glucose sichachilendo.

Vutoli limakhudza gawo loyamba, lachangu la secretion ya mahomoni, kupanga kwake komwe kumachepa ndikutha pang'ono pang'ono. Izi zimasintha njira ya postprandial glycemia, chifukwa kuchepetsedwa katulutsidwe ka insulin sikumasunga mkati mwa thupi.

Kuphatikiza pa kuphwanya kwobisalira, komwe kumadziwikanso ndi zovuta zina, pali zolakwika zina pochita insulin pazomwe zilipo (chiwindi, adipose ndi minofu minofu).

Monga lamulo, tikulankhula za magulu a post-receptor. Ponena za mikhalidwe ina yolumikizidwa ndi kusokonekera kwa insulin yomanga ma receptor, omwe ali m'gulu lina la matenda ashuga, insulin yomanga mu mtundu 2 wa shuga ilibebe.

Chifukwa chake, chidwi chachikulu chimakhudzidwa ndi zomwe zimachitika pambuyo pake pamasewera olimbitsa thupi, pomwe otchedwa majini omenyera omwe angafotokoze kupezeka kwa kuchepa kwa chidwi cha insulin kapena kukana kwa timadzi timeneti.

Kuphatikizika kwakamodzi kwa zovuta pakubisika kwa insulin komanso kuchepa kwa mphamvu yake m'thupi lathu kumayambitsa matenda a shuga a mtundu 2. M'magawo onse awiri, kuphwanya kumatha kugawidwa mosiyanasiyana, komwe kumabweretsa chiwonetsero chachikulu. Matendawa amakula mwa anthu okhawo omwe ali ndi vuto lakubadwa, komabe, ali osiyana kwambiri ndi matenda amtundu woyamba.

Tiyenera kudziwa kuti kukana insulini kulipo popanda matenda a shuga, mwachitsanzo, mwa anthu onenepa kwambiri omwe ali ndi vuto labwino la shuga. Adipose minofu ndi "chotchinga" chomwe chimalepheretsa insulini, koma sizoyenera kukhala chifukwa chokhacho, chifukwa kukana kumasonyezedwanso m'misempha ndi chiwindi.

Kutenga nawo gawo kwa mahomoni a adipose minofu (mwachitsanzo, resistin, adiponectin) ndi ena oyimira pakati, omwe kayendetsedwe kake kazinthu kakang'ono kamadziwika kwambiri m'zaka zaposachedwa, pomwe ena sakudziwika, akuwonetsedwanso. Kukana kwa insulin kumawonjezera zinsinsi za ma B-cell, zomwe zimapangitsa hyperinsulinemia.

Mulingo wambiri wokwanira wa insulin, pawokha, umachepetsa mphamvu ya mahomoni, omwe amachititsa kuti magwiridwe akewo azigwira bwino ntchito. Ngati munthu alibe chibadwa chakupangitsa kuti inshuwalansi isokonekere, kukondoweza kwa katulutsidwe ka timadzi timapangitsa kuti shuga azigwirizana mkati mwazotheka ndipo, ngakhale atakumana ndi insulin yayikulu, sangadwala matenda ashuga.

Chifukwa chake, zikuwonekeratu kuti pakuwonetsa kwa matenda ashuga kuyenera kumakhala kosemphana ndi insulin katulutsidwe, pomwe kukana kwa mahomoni kumatha kuyesedwa mosiyanasiyana ndikuwonjezera kuchuluka kwa vuto.

Pazaka zingapo zapitazi, kafukufuku wazinyama adawonetsa kuti pali ubale wamkati pakati pobisika wa insulin komanso kuwonongeka kwake. Kaya ubalewu umapezekanso m'thupi la munthu udakali wotiwonekabe.

Ma cell a 2 a diabetes a b amatulutsa insulini, komabe, kubisikaku sikokwanira, monga momwe munthu amakhalira wathanzi, kukhalabe ndi kuchuluka kwa glucose muzosakhazikika, chifukwa chake, pamenepa, pali insulin. Ngakhale kuchuluka kocheperako kwa timadzi timeneti kumalepheretsa kukula kwa ketoacidosis, chifukwa chake, mtundu wachiwiri wa matenda a shuga suwonjezereka ku ketoacidosis mwachilengedwe.

Komabe, kagayidwe ka mafuta kamasintha, kuchuluka kwamafuta acids amadzuka, omwe, mwaokha, amathandizira kukulitsa kwa insulin. Zowonjezera zawo zikuwonekeranso minofu. Zovuta za metabolism yamafuta ndizofunikira kwambiri kotero kuti mawu akuti shuga mell-lipidus amagwiritsidwa ntchito potanthauza mtundu uwu wa matenda ashuga.

Malinga ndi akatswiri ena, kuphwanya lipid metabolism kumakhala koyamba, pomwe kulephera kwa glucose homeostasis kumachitika kachiwiri, motero mawu akuti "matenda a shuga lipidus" adayambitsidwa. Komanso gawo la Randle (kuchuluka kwa mafuta ndi glucose oxidation) likukulankhulidwabe pokhudzana ndi pathogenesis ya insulin kukana, ngakhale zambiri sizigwira ntchito mwa anthu chimodzimodzi monga nyama zoyesera.

Mosakayikira, komabe, chakuti njira za metabolic zamagazi ndi mafuta zimakhala pafupi kwambiri. Posachedwa, zawonetsedwa kuti ma asidi achilengedwe aulere amalowa m'maselo am'misempha, momwe, choyambirira, amathandizira kupanga mitundu ya okosijeni yomwe imatha, ndipo chachiwiri, mwa kuyambitsa protein kinase C, amatsogolera phosphorylation yachilendo ya insulin receptor, pomwe phosphorylation ya serine ndi threonine imaletsa abwinobwino tyrosine phosphorylation.

Izi zimapangitsa kuti ziletso zamagetsi ziziyenda, kuphatikizapo kuchepa kwa kayendedwe ka glucose kupita ku maselo. Kuchokera pamalingaliro awa, ndi matenda amtundu wa 2, zovuta za metabolic ziyenera kuonedwa zakuya kwambiri kuposa zovuta zosavuta pakudziwitsa kuchuluka kwa shuga. Kuwonetsedwa kwakanthawi kwa maselo a B omwe ali ndi kuchuluka kwa lipids kumayambitsa poizoni (ndiye kuti, lipotoxicity), yomwe imawonetsedwa ndi kubisala kwa insulin.

Momwemonso, kuchuluka kwamphamvu kwa glucose kumayambitsa kuyipa kwa B-cell (glucose poizoni wa glucose). Zotsatira zonsezi zimaphatikizidwa kenako zimakhudza zotumphukira zamagetsi, komwe zimakulitsa zochita za insulin, motero, zimagwiritsa ntchito shuga. Chithunzicho nthawi yomweyo chikuwonetsa lipotoxicity yoyamba pakukonza kwa hyperglycemia.

Kuchokera pakuwona mphamvu ya njirayi, ziyenera kudziwika kuti matenda a shuga a 2 ndi matenda opita patsogolo omwe amatsogolera pang'onopang'ono (kuthamanga) kwa kusungunuka kwa insulini ndikuchita kwake, ndikusokonezeka kwa metabolic ndi ziwalo.