Glycated hemoglobin pakuwona matenda a shuga

Popeza kufala kwa matenda a shuga, kuthekera kwa zovuta zam'mbuyo komanso mwachangu zovuta zake, kuchuluka kwamilandu yosadziwika komanso zolosera zokhumudwitsa za WHO zokhudzana ndi chiyembekezo cha kufalikira kwa matenda ashuga padziko lapansi, kudziwikitsa kwakwanthawi komanso molondola kwa matenda a carbohydrate metabolism ndikofunikira. Glycated hemoglobin ndi chisonyezo kuti, mukamagwiritsa ntchito njira zokhazikika, imapereka lingaliro lolumikizana la kuchuluka kwa glycemia nthawi yayitali ndipo limathandizira kuzindikira kukhumudwa kwa kagayidwe kazakudya. Mukamagwiritsa ntchito glycated hemoglobin monga njira yodziwira matenda omwe amachititsa kuti matenda a carbohydrate agwiritsidwe ntchito kapena kuchuluka kwa chiphuphu cha matenda a shuga, ndikofunikira kusankha njira yodziwitsira chizindikiro ichi poganizira kudalirika kwake.

Ntchito ya Glycated Hemoglobin pakuwonetsetsa ndi kuwunika a shuga Mellitus

Consellisus mellitus, kuthekera kwa kufalikira kwa matenda ashuga komanso rap> matenda osokoneza bongo ndikofunikira. Glycated hemoglobin ndi chisonyezo kuti, akamagwiritsa ntchito njira zokhazikitsidwa, amatsimikizira kuti glycated hemoglobin monga njira yodziwira zovuta zamagulu a kagayidwe kazinthu kapena digiri ya shuga yamankhwala a shuga, njira yolondola posankha njira ya kutsimikiza kwa index iyi, poganizira kusanthula kwake kudalirika, ndikofunikira.

Zolemba za asayansi pantchito ya glycated hemoglobin pakuwunika komanso kuwunika matenda a shuga

Kiev City Clinical Endocrinology Center

Ntchito ya hemoglobin wa glycated pakuwunika komanso kuwunika matenda a shuga

Chidule Popeza kufala kwa matenda a shuga, kuthekera kwa zovuta zam'mbuyo komanso mwachangu zovuta zake, kuchuluka kwamilandu yosadziwika komanso zolosera zokhumudwitsa za WHO zokhudzana ndi chiyembekezo cha kufalikira kwa matenda ashuga padziko lapansi, kudziwikitsa kwakwanthawi komanso molondola kwa matenda a carbohydrate metabolism ndikofunikira. Glycated hemoglobin ndi chisonyezo kuti, mukamagwiritsa ntchito njira zokhazikika, imapereka lingaliro lolumikizana la kuchuluka kwa glycemia nthawi yayitali ndipo limathandizira kuzindikira kukhumudwa kwa kagayidwe kazakudya. Mukamagwiritsa ntchito glycated hemoglobin monga njira yodziwira matenda omwe amachititsa kuti matenda a carbohydrate agwiritsidwe ntchito kapena kuchuluka kwa chiphuphu cha matenda a shuga, ndikofunikira kusankha njira yodziwitsira chizindikiro ichi poganizira kudalirika kwake. Mawu ofunikira: matenda a shuga, glycated hemoglobin, glycation, glycemic control.

Matenda a shuga mellitus (DM) pakali pano ndivuto lalikulu lazachipatala komanso chikhalidwe cha anthu. Malinga ndi kulosera kwa WHO, podzafika chaka cha 2030 kuchuluka kwa odwala matenda ashuga kudzaposa 592 miliyoni. Koma vutoli silimangokhala pakukula kwa matenda ashuga, komanso kukula kwazovuta zomwe zimapangitsa kutsika kwa moyo wa wodwala, kulumala ndi kufa. Kwa odwala matenda ashuga, kukula koyambirira komanso kupindika kwakanthawi kwamitsempha imakhala yodziwika bwino: ndi mtundu wa 2 - macrovascular (kuwonongeka kwa mitsempha, ziwalo zam'mimba komanso zotumphukira) komanso microvascular (retinopathy, nephropathy, neuropathy), yokhala ndi mtundu 1 - microvascular. Chimodzi mwa maphunziro a matenda ashuga amtundu wa 2 ndi kupezeka kwa zovuta zina panthawi yokhazikitsa matenda, zomwe zimakulitsa nthawi ya matendawa ndikuwapatsa mwayi wolipiridwa.

Pakadali pano, odwala miliyoni miliyoni omwe ali ndi matenda a shuga amalembetsedwa ku Ukraine. Kuphatikiza apo, kafukufuku wamaphunziro akuwonetsa kuti odwala omwe ali ndi matenda osokoneza bongo omwe ali ndi matenda osokoneza bongo ndi 2-2.5 nthawi zambiri kuposa kuchuluka kwa odwala omwe adadziwika. Chifukwa chake, kwa endocrinologists, ochiritsira, ndi madokotala am'banja, vuto lofufuza matenda ashuga achilengedwe ndilofunika.

Njira imodzi yodziwira zovuta za kagayidwe kachakudya ndi kudziwa kuchuluka kwa glycemia. Tiyenera kudziwa kuti zotsatira zake zimawonetsa kuchuluka kwa shuga wokha

pa nthawi yopereka magazi, komanso mfundo za glycemia zimasinthasintha masana. Chifukwa chake, kulumikizana pakati pa gulu la glucose yodziwika bwino komanso kuchuluka kwenikweni kwa glycemia kumakhala kofooka, chifukwa chake sikotheka kunena kuti wodwalayo ali ndi vuto la metabolism yodalirika kapena yosapezeka yazowonjezera zamisempha. Malangizo a WHO (2006) akuwonetsa kuti mu 30% ya milandu sikotheka kuzindikira matenda ashuga pogwiritsa ntchito tanthauzo la kusala kudya kwa glycemia.

Chizindikiro chomwe chimapereka lingaliro lolumikizika la kuchuluka kwa glycemia nthawi yayitali ndi glycated hemoglobin (L1L1c). Maphunziro ambiri amatsimikizira ubale pakati pa Lyb1c ndi glycemia wodwalayo 2, 3.

M'mabuku asayansi m'zaka zaposachedwa, pali lingaliro lapanga njira ziwiri zomwe zimawoneka zofanana - glycosylation ndi glycation. Glycosylation, kapena m'malo mwake, kudarika, ndiko kusamutsa kwatsalira kwa monosaccharide kupita ku monosaccharide wina ndikupanga mgwirizano wa glycosidic, womwe ndi njira ya enzymatic. Glycation (non-enzymatic glycosylation)

chidziwitso) ndizowonjezera zopanda enzymatic za zotsalira za monosaccharide ku gulu la amino mapuloteni (peptide kapena amino acid) ndikupanga maziko a Schiff, kenako ketamine. Zofunikira izi ndizofunikira pakuchita izi: 1) kukhalapo kwa magulu aulere komanso osakhazikika a My2 mu mapuloteni, 2) kupezeka kwa aldehydes, 3) nthawi yokwanira yolumikizana, 4) kuthekera kwa mapuloteni kuti asinthe msanga confform ndikubwerera momwe anali kale. Ndiye kuti, mawu akuti "glycated hemoglobin" akuwonetsa bwino momwe mawonekedwe a hemoglobin a maselo ofiira amwazi amakhala ndi shuga. Kuwonetsa kuwonjezera kwa shuga kopanda enzymatic, protein, IUPAC (International Union of Pure and Applied Chemistry) yogwirizana pa biochemical nomenclature imalimbikitsa kugwiritsa ntchito mawu akuti glycation, omwe amafunikira kuti mawu oti non-enzymatic glycosylation. Pali mitundu yosiyanasiyana ya ma hemoglobin a glycated: LABA1a, HbA1b, HbA1c. Kuphatikiza kwa HbA1c kokha ndi komwe kumapereka kuphatikizana ndi kuopsa kwa matenda ashuga. Njira ya glycation siyingasinthe, kuthamanga kwake (komanso kuchuluka kwa HbA1c) kumakhala molingana ndi mulingo wa glycemia.

Mwa anthu athanzi, kuchuluka kwa HbA1c m'magazi kumayambira 4 mpaka 5.9%, mwa odwala matenda ashuga, mulingo wake umadalira kuchuluka kwa hyperglycemia. HbA1c yomwe imatsogolera imadziunjikira mkati mwa maselo ofiira amthupi ndikupitilira moyo wonse wama cell ofiira. Popeza maselo ofiira am'magazi omwe amayenderera m'magazi ali ndi mibadwo yosiyanasiyana, tikulimbikitsidwa kuyang'ana theka la moyo wama cell ofiira - masiku 60. Chifukwa chake, kuchuluka kwa HbAk kumawonetsa wodwala kuchuluka kwa glycemia 60 (mpaka 90) masiku asanachitike kafukufukuyu. Mphamvu yayikulu pamlingo wa HbA1 (, khalani ndi masiku 30 omaliza musanatenge kuwunikira. Mlingo wa glycemia panthawiyi ndi chifukwa cha 50% ya mtengo wa HbA1,.., Motero, kudziwa kwa HbA1), chifukwa kumakhala kuchuluka kwa shuga m'magazi kwakutali nthawi yayitali, ndiye kuti, zamankhwala a carbohydrate metabolites m'miyezi iwiri yapitayi.

Kuchokera pakuwona phindu lamankhwala, tanthauzo la HbA1c lili ndi maubwino angapo poyerekeza ndi kutsimikiza kwa glycemia:

- zotsatira za HbA1c sizitengera chakudya (ndizotheka kudziwa osati pamimba yopanda kanthu), zolimbitsa thupi, mkhalidwe wamaganizo wodwala,

- sampuli yamagazi imatha kuchitika nthawi iliyonse: HbA1c imakhazikika pamtunda wambiri komanso nthawi yayitali,

- kuthekera kosungira magazi kuti mupeze HbA1c pa 2-8 ° C kwa masiku 7,

- ili ndi mitundu yachilengedwe yotsika kwambiri.

Pali kulumikizana mwachindunji pakati pa mfundo za HbA1c ndi glycemia (pre- and postprandial), yomwe imawonetsedwa mu Table. 1.

Kutanthauzira kwa zotsatira za HbA1c kumatha kukhala kovuta. Kubalalika kwa HbA1c kwa anthu awiri omwe ali ndi kuchuluka kwa shuga m'magazi kumatha kufika 1%, zomwe zimachitika chifukwa cha kukhalapo kwa kusiyana kwa matekinoloje a Laborator ndi kusiyana pakati pa odwala. Izi zikutsimikizira kufunikira kwa kusinthasintha njira zakufufuzira.

Kusintha kwa njira za glycated hemoglobin

Pakuwerenga HbA1c, ndikofunikira kulingalira njira yotsimikiza ndi kudalirika kwa njira yomwe imagwiritsidwa ntchito. Makumi makumi angapo apitawa, panalibe kuyimilira kwa njira zoyezera HbA1c, zomwe zidachepetsa mphamvu yakuchipatala pakugwiritsa ntchito mayesowa. Mu 1993, American Clinical Chemistry Association idapanga National Glycohemoglobin Standardization Program (NGSP). Pakadali pano, opanga makina oyesa kuyeza HbA1c akuyenera kuyesedwa ndikupeza setifiketi ya DCCT yofanana (DCCT - Diabetes Control and Complication T kesi). American Diabetes Association (ADA) yalimbikitsa kuti ma laboratori onse azigwiritsa ntchito mayeso okhawo a NGSP 6, 7. Chofunikira chachikulu cha njira za NGb pakuwunikira HbA1c ndi kubereka ndi mgwirizano wambiri (CV) wochepera 4%. Tsoka ilo, njira zomwe zimagwiritsidwa ntchito m'ma laborataka nthawi zonse sizikwaniritsa izi. CV yotsika ndiyofunikira ngati magazi a HbA1c a wodwalayo ali pafupi ndi malire operekera kubwezeredwa kwa DM. Mtengo wa CV pamwambapa 5% umapangitsa kuti zikhale zosatheka kugwiritsa ntchito tanthauzo la HbA1c pazifukwa zodziwunikira, chifukwa zimapangitsa kuti muzindikire bodza.

Mpaka pano, njira zopitilira 20 zodziwitsa HbA1c zimadziwika. Mothandizirana, amatha kugawidwa mu chromatographic (chromatography yamadzimadzi, chromatography yoyanjana), electrophoretic, immunochemical, colorimetric. Njira iliyonse ili ndi zopindulitsa ndi zoyipa zake (tebulo 2).

Tebulo 1. Kutsatira kwa Mfundo za HbA1c Target

kuchuluka kwa glucose komanso chisanachitike

HbA1c,% Kusala glucose, mmol / L plasma glucose patatha maola 2 mutatha kudya, mmol / L

sindikutha kupeza zomwe mukufuna? Yeserani ntchito yosankha mabuku.

2) chiyembekezo chamoyo (chiyembekezo cha moyo). Lingaliro ili limakupatsani mwayi wowunika momwe wodwalayo alili komanso mwayi wokhala ndi vuto la mtima (kuposa zaka). Chifukwa chake, zolinga za kayendetsedwe ka glycemic zitha kukhala zochepa kwa odwala omwe amakhala ndi moyo wa 10%), C ndi S

Kukakamiza kochepa kwa ion kusinthana ndi ma chromatography - Kuphatikizika kwabwino ndi HPLC - Kufunika kukonzekera kwachitsanzo - Kuchepa kochepa, kusokoneza pamaso pa HbF

Microcolumn affoper chromatography - Mtengo wotsika kwambiri - Samakwaniritsa zofuna za NGSP - Malipiro akulu antchito

Gome 3. Zolinga zakuchiritsira pochiza matenda amtundu wa 2

Ndondomeko za Chithandizo (zotsatira zasayansi)

id ,,% 1c 'Mulingo wovomerezeka kwambiri kwa odwala ambiri ndikuti sindingapeze zomwe mukufuna? Yeserani ntchito yosankha mabuku.

4) chiopsezo chokhala ndi hypoglycemia yayikulu. Kuthekera kwa kuwongolera kwambiri glycemic kumakhala kochepa chifukwa kumakhala pachiwopsezo chachikulu cha kufa kwa mtima.

Zolinga zochizira mankhwalawa matenda a shuga 1

Malinga ndi malangizo apano (ADA, 2013), mtengo wa HbA1c sindikutha kupeza zomwe mukufuna? Yeserani ntchito yosankha mabuku.

0-6 Sindikutha kupeza zomwe mukufuna? Yeserani ntchito yosankha mabuku.

1. International Diabetes Federation, matenda ashuga. - 6h ed. // International Diabetes Federation. - 2013. - 159 ma ruble.

2. Gonen B.A. Hemoglobin A1: Chizindikiro cha kagayidwe kachakudya ka odwala matenda ashuga / B.A. Gonen, A..H. Rubinstein, H. Rochman et al. // Lancet. - 1977. - Vol. 310. - P. 734-737.

3. Koenig R.J. Kuphatikizika kwa malamulo a shuga ndi hemoglobin Ac mu shuga mellitus / R.J. Koenig, C.M. Peterson, R.L. Jones et al. //

New England Journal ofMedicine. —1976. - Vol. 295, No. 8. - R. 417420.

4. Korolev V.A. Njira ya Isoelectrofocusing ndi Photocolorimetry yodziwira hemoglobin A1c / V.A. Korolev,

B.I. Umera wa Molchanov // Biomedical chemistry. - 2006. - T. 52, No. 2. -

5. Peters-Harmel E. Matenda a shuga: kuzindikira ndi kuchiza / E. Peters-Harmel, R. Matur: Trans. kuchokera ku Chingerezi - M: Yesezani, 2008 .-- 496 p.

6. American Diabetes Association Standards of Medical Care ku matenda ashuga - 2010 // Matenda a shuga. - 2010 .-- Vol. 33 (1). - P. 511-561.

7. A komiti ya akatswiri apadziko lonse anena za udindo wa wodwala Ac kuti azindikire za matenda a shuga // Matenda a shuga. - 2009. - Vol. 32 (7). - P. 1327-1334.

8. Njira yovomerezeka ya IFCC pakuyeza kwa HbAlc m'magazi a anthu // Clin. Chem. Labu. Med. - 2002. - Vol. 40 (1). - R. 78-89.

9. DCCT. Ubale wamavuto a glycemic (HbAlc) pachiwopsezo cha kukula ndi kupitiliza kwa retinopathy mu kayendedwe ka matenda a shuga ndi zovuta zokhudzana ndi matenda a shuga. - 1995. - Vol. 44 (8). - P. 968-983.

10. Stratton J.M. Association of glycaemia with macrovascular and microvascular complication of Type 2abetes (UKPDS 35): akuyembekeza, kafukufuku wowonera / J.M. Stratton, A.I. Adler, A.W. Neil et al. // BMJ. - 2000. - Vol. 321. - P. 405-412.

11. Zotsatira za Gnudi L. komanso kukopa kwa ACCORD ndi ADVANCE / L. Gnudi // Mawu a shuga. - 2009. - Vol. 54, Ayi. 1. - S. 29-32.

Kivsky Moscow 1 ^

CHITSANZO CHA HEMOGLOGUS YOSAFA MU ZINSINSI NDI ZOKHUDZA ZA ZINSINSI

Chidule Ndi matenda a shuga a uachuachuam okwanira zukrovogo, mutha kuyamba mwachangu komanso mwachangu izi, izi! Mavuto a yulkosp undiagnostic komanso kulosera zam'kati zomwe sizili zamkati mu WHO. Pali ziyembekezo zambiri za kufala kwa matenda a shuga mu SVT, zomwe ndizofunikira komanso zowona, kuwunika kotsimikizika ndikuwonongeka kwa chomera chamoto. Glashanov haemoglobsh ndi chisonyezo chomwe chimalola kusintha kwa njira kuti apereke chidziwitso cha mulingo wa miyala yamtengo wapatali yogulitsidwa pamtengo wambiri, ndipo mumaloledwa kuti muwone mitundu ya kaboni yowonongeka kale. Pankhani ya kupambana kwa glgan hemoglobe, monga njira yodziwira, imafooketsa mafuta osokoneza bongo kapena gawo lolipirira la shuga. wamkulu

Mawu ofunika: matenda a shuga a m'magazi, glomerular hemoglobch, gl kuvannya, glycemic control.

Kyiv Municipal Clinical Endocrinological Center, Kyiv, Ukraine

CHITSANZO CHA HEMOGLOBIN YOPHUNZITSIRA NDIPONSO ZOLENGA ZA DIABETES MellITUS

Chidule Poona kuchuluka kwa matenda a shuga, kuthekera kwa zovuta zam'mbuyo komanso mwachangu, zovuta zambiri zomwe sizinadziwike komanso kukhumudwitsa kwa World Health Organisation pa chiyembekezo cha matenda osokoneza bongo omwe amafalikira mdziko lapansi, kupezeka kwa nthawi komanso molondola kwa matenda a kagayidwe kazakudya. kusokonezeka ndikofunikira. Glycated hemoglobin ndi chisonyezo kuti, akamagwiritsa ntchito njira zokhazikika, amapereka malingaliro ophatikizika a glycemia panthawi yayitali ndipo amathandizira kudziwa panthawi yomwe zovuta za carbohydrate metabolism. Mukamagwiritsa ntchito hemoglobin ya glycated monga njira yodziwitsa za matenda a carbohydrate metabolism kapena kuchuluka kwa matenda a shuga, njira yolondola yosankhidwa mwanjira yotsimikiza iyi, poganizira kudalirika kwake.

Mawu ofunikira: matenda a shuga, glycated hemoglobin, glycation, glycemic control.

Mawonekedwe Ozindikira

Maselo ofiira amakhala ndi hemoglobin A. Ndiye amene, akaphatikizana ndi glucose ndikukumana ndi zotsatirapo zosiyanasiyana za mankhwala, amakhala glycosylated hemoglobin. Kuthamanga kwa "kutembenuka" kumeneku kumadalira kuchuluka kwa shuga mu nthawi yomwe maselo ofiira ali moyo. Nthawi yokhala ndi maselo ofiira a m'magazi mpaka masiku 120. Ndi munthawi imeneyi kuti manambala a HbA1c amawerengedwa, koma nthawi zina, kuti athe kupeza zotsatira zolondola kwambiri, amalingalira theka la moyo wam'magazi ofiira - masiku 60.

Mitundu yotsatana ya glycosylated hemoglobin ndi iyi:

Malinga ndi ziwerengero, kuchuluka kwa mayeso a chizindikirochi sikupitirira 10% yazochitika zonse zamankhwala, zomwe sizowona pakufunika kofunikira. Ichi ndichifukwa chosazindikira zambiri za odwalawa za kufunikira kwa kusanthula, kugwiritsa ntchito kwa osanthula osunthika omwe ali ndi zotsatira zochepa komanso kuchuluka kwakanapezeke m'malo ena, komwe kumakulitsa kusakhulupirika kwa akatswiri pakuyesa.

Ndani anapatsidwa kuwunikaku?

Kuwongolera sikofunikira osati kwa odwala matenda ashuga okha, komanso kwa anthu athanzi omwe amakonda kunenepa kwambiri komanso matenda oopsa. Kuzindikira pafupipafupi kukuwonekera pazochitika zotsatirazi:

• kwa anthu onse zitatha zaka 45 (zaka 2-3 zilizonse, ngati zotsatira zoyambazo zinali zabwinobwino),
• odwala ndi abale omwe ali ndi matenda ashuga
• anthu okhala ndi moyo wokhala chete,
• omwe ali ndi kulolera kwa glucose
• azimayi omwe ali ndi mbiri yodwala matenda ashuga,
• azimayi omwe ali ndi mbiri ya macrosomia
• odwala polycystic ovary syndrome,
• odwala matenda a shuga a mellitus (amene amadziwika koyamba motsutsana ndi maziko azovuta zopweteka),
• ndi pathologies ena (omwe ali ndi matenda a Itsenko-Cushing, acromegaly, thyrotoxicosis, aldosteroma).

Kukonzekera kusonkhanitsa kwa zinthu sikofunikira. Kuyesedwa kwa kudziwa kwa glycosylated hemoglobin sikuti kwa ana osakwana miyezi 6.

Maubwino Ozindikira

Zatsimikiziridwa mwachipatala kuti kufufuza pafupipafupi kwa odwala omwe ali ndi matenda a shuga kumachepetsa zovuta, chifukwa zimatha kuyang'ana ndikusintha chindapusa.

Ndi mawonekedwe odalira insulini, chiopsezo cha retinopathy chimachepetsedwa ndi 25-30%, polyneuropathy - ndi 35-40%, nephropathy - mwa 30-35%. Ndi mawonekedwe odziyimira pawokha a insulin, chiopsezo chokhala ndi matenda osiyanasiyana a angiopathy amachepetsedwa ndi 30-35%, zotsatira zakupha chifukwa cha zovuta za "matenda okoma" - mwa 25-30%, kuphwanya myocardial - mwa 10-15%, ndi kufa kwathunthu - mwa 3-5%. Kuphatikiza apo, kuwunika kumatha kuchitika nthawi iliyonse, mosasamala kanthu za kudya. Matenda oyamba samakhudza mayendedwe a kafukufukuyu.

Zizindikiro za magazi

Zotsatira zakuzindikira pa labotale yopanda kanthu zalembedwa mu%. Makhalidwe azikhalidwe wamba ndi azitsamba ndi awa:

• mpaka 5.7 - ikuwonetsa kagayidwe kabwino, sikufuna njira zowonjezera,
• Pamwambapa 5.7, koma pansipa 6.0 - palibe "matenda okoma", koma kukonza zakudya ndikofunikira, popeza chiwopsezo cha matenda opatsirana ndi matenda ndi chachikulu,
• pamwambapa 6.0, koma pansipa 6.5 - mkhalidwe wa prediabetes kapena kulolera shuga.
• 6, 5 ndi pamwamba - kudziwika kwa matenda a shuga ndikukaikira.

Zowonetsa za Ndalama

Kuzindikira mphamvu ya mankhwala a mtundu 1 matenda a shuga monga glycated hemoglobin:

• pansipa 6.1 - palibe matenda,
• 6.1-7.5 - chithandizo ndi chothandiza,
• Pamwambapa 7.5 - kusowa kwa chithandizo chamankhwala.

Malipiro a mitundu 1 ndi matenda 2:

• pansipa 7 - chobwezera (chizolowezi),
• 7.1-7.5 - zopereka,
• pamwambapa 7.5 - kubwezeretsa.

Chiwopsezo chotenga angiopathies motsutsana ndi mtundu wa matenda ashuga amtundu wa 2 malinga ndi zonena za HbA1c:

• mpaka ndipo kuphatikiza 6.5 - chiopsezo chochepa,
• Pamwambapa 6.5 - chiwopsezo chachikulu chotukula macroangiopathies,
• Pamwambapa 7.5 - chiwopsezo chachikulu chotukula micangiopathies.

Kuwongolera pafupipafupi

Ngati matenda a shuga adapezeka koyamba, odwala otere amapezeka kamodzi pachaka. Ndi pafupipafupi, omwe sagwiritsa ntchito mankhwalawa chifukwa cha "matenda otsekemera" amawunikira, koma amafufuza pothandizidwa ndi zakudya komanso zolimbitsa thupi zolimbitsa thupi.

Pankhani yogwiritsa ntchito othandizira a hypoglycemic, kulipira bwino kumafunikira kuyang'ana zizindikiro za HbA1c kamodzi pachaka, ndi kubwezeredwa koyipa - kamodzi pa miyezi 6. Ngati adotolo adakonzera kukonzekera kwa insulin, ndiye kuti kuwunikirako ngati chithandiziro chabwino kumachitika kuyambira 2 mpaka 4 pachaka, osakwanira - 4 times pachaka.

Zofunika! Kupitilira kanthawi 4 kuti mudziwe kuti zili bwino sizikumveka.

Zoyambitsa kusinthasintha

Kuchuluka kwa hemoglobin wa glycosylated kumatha kuonedwa osati ndi "matenda okoma", komanso motsutsana ndi maziko a zotsatirazi:

• hemoglobin yayikulu mu akhanda (mkhalomu ndiwamoyo komanso sikutanthauza kukonza),
• kutsika kwachuma m'thupi,
• motsutsana ndi maziko a opaleshoni yochotsa ndulu.

Kutsika kwa HbA1c kumachitika mu milandu yotere:

• kukulitsa kwa hypoglycemia (kuchepa kwa shuga wamagazi)
• kuchuluka kwa hemoglobin wabwinobwino,
• chikhalidwe pambuyo magazi, pamene hematopoietic dongosolo adamulowetsa,
• hemolytic anemia,
• kupezeka kwa zotupa ndi magazi a pachimake kapena matenda,
• kulephera kwa impso
• kuthira magazi.

Njira Zozindikira ndi Openda

Pali njira zingapo zomwe zimagwiritsidwa ntchito kuti zidziwike mawonekedwe a glycated hemoglobin; motero, pali angapo omwe amasanthula mwanjira iliyonse yodziwira matenda.

Kupsinjika kwakukulu kwa ion chromatography ndi njira yolekanitsa chinthu chovuta kukhala tinthu tating'ono, komwe sing'anga yayikulu ndi madzi. Gwiritsani ntchito owerenga a D 10 ndi Variant II. Kuyesaku kumachitika ndi m'magulu azachipatala a zigawo zam'mizinda ndi zamzindawo, malo owerengera anthu odwala. Njira ndi yotsimikizika kwathunthu komanso yodziwikiratu. Zotsatira za kuzindikira sizifuna kutsimikizika kowonjezereka.

Osamayama

Njira yowunikira yozikidwa pa pulogalamu yakale ya antigen-antibody. Kuphatikizika kwa kuphatikizako kumalola mapangidwe a maofesi omwe, akaphatikizidwa ndi zinthu zowunikira, amatha kutsimikiza pansi pa chithunzi. Pofufuza, seramu yamagazi imagwiritsidwa ntchito, komanso zida zapadera za diagnostic pa biochemical analysis.

Kafukufuku wamtunduwu akuchitika mu labothem yamankhwala opangidwa ndi ma biochemical ndi kuyeza kwapakati kapena kotsika. Choyipa cha njirayi ndikufunika kukonzekera pamasamba.

Chiyanjano chokomera

Njira yofufuzira mwachindunji yochokera pakumagwirana kwa mapuloteni okhala ndi zinthu zina zachilengedwe zomwe zimawonjezeredwa kumalo achilengedwe. Openda mayesowo - In2it, NycoCard. Njira imakuthandizani kuti muzindikire mwachindunji muofesi ya dokotala (wogwiritsidwa ntchito m'maiko aku Europe).

Kuyeserako kumagwiritsidwa ntchito pazinthu zayekha, zimakhala ndi mtengo wokwanira wowonjezera, kotero sizofala kugwiritsa ntchito. Kutanthauzira kwa zotsatira kumachitika ndi dotolo yemwe wakupatsani phunzirolo. Kutengera ndi zomwe zidapezeka, njira zina zowongolera odwala zimasankhidwa.