Chikhalidwe cha kuwonongeka kwa chiwindi mu mtundu 2 shuga mellitus Zolemba za sayansi pazopadera - Mankhwala ndi Thanzi

Ubwenzi wa matenda osokoneza bongo a shuga ndi matenda a chiwindi ali pafupi kwambiri. Matenda a shuga ndi chiopsezo cha hepatitis C, komanso chiopsezo cha hepatocellular carcinoma. Chiwindi chokhala ndi matenda amtundu wa 2 chimatha kudwala mafuta, zomwe zimatha kusintha kukhala steatofibrosis. Odwala ali pachiwopsezo chotenga matenda monga cirrhosis. Mankhwala ena omwe amagwiritsidwa ntchito pochiza matenda a shuga amatha kubweretsa chiwindi monga hepatotoxicity. Dokotala aliyense wothandizila munthu wodwala matenda ashuga ayenera kuganizira kukhalapo kwa matenda oopsa a chiwindi monga mbali ya kufufuza kwathunthu.

Anthu omwe akudwala matendawa ali ndi matenda ochulukirapo a glucose ochulukirapo kuposa ambiri. Kukhalapo kwa shuga kwa odwala omwe ali ndi vuto lodana ndi chiwopsezo cha chiwopsezo ndi chiopsezo makamaka pokhudzana ndi kudwala.

Malinga ndi mayiko a azungu, hepatitis C ndi chimodzi mwazomwe zimayambitsa chiwindi kuwonongeka kwa matenda ashuga. Ma antibodies a hepatitis C ali ndi anthu ambiri (malinga ndi maphunziro osiyanasiyana) mu 0.8-1,5% ya anthu, mwa anthu omwe ali ndi matenda ashuga, kuchuluka kwake kuli pafupifupi 4-8%. Mwa anthu omwe ali ndi matenda osachiritsika a chiwindi, matenda a shuga amapezeka oposa 20%, matenda ashuga amayamba mwa anthu pambuyo pakufalikira kwa chiwalochi chifukwa cha matenda a chiwindi C pafupifupi 2/3. Mwa anthu omwe adasinthidwa pazifukwa zina zazikulu, chiwerengerochi ndi chochepera 1/10.

Malinga ndi zomwe zapezeka lero, hepatitis C imatha kudziwika ngati "chiwindi" chodziimira pakulimbana ndi shuga.

Kusanthula kwa zitsanzo zaimfa kumawonetsa kuti mtundu wa kachilombo ka hepatitis C ungawonekenso m'maselo a pancreatic. Kukula kwa zomwe zotsatirazi zingakhale zokhudzana ndi chiyambi cha matenda a shuga pakadali pano sizingatheke.

Hepatocellular carcinoma

Ubale wa khansa iyi ndi matenda amitsempha umadziwika kwambiri kwa nthawi yayitali. Kafukufuku wa Epidemiological akuwonetsa kuti shuga imakulanso kwambiri chiopsezo chokhala ndi hepatic oncology (chiopsezo cha oncology ichi mwa anthu omwe ali ndi matenda ashuga ndi 2.8-3.0%). Kukhalapo kwa matenda ashuga kumakulitsa kwambiri kudwala kwa odwala atatha kupezekanso chifukwa cha carcinoma. Zakuti pali ubale wa etiopathogenetic, womwe umakhudzana ndi mitundu ina ya kuwonongeka kwa chiwindi kwa odwala omwe ali ndi matenda ashuga ndi khansa, sanawunikenso mwatsatanetsatane.

Zowononga

Sitikukayikira kuti maselo a chiwindi olemedwa ndi zofunika za metabolism zosinthika mwa odwala omwe ali ndi matenda osokoneza bongo azikhala ovuta kwambiri kuthana ndi zotsatira zoyipa, chifukwa gawo ili liyenera kukhala ndi malo ochepetsa othandizira (mwanjira ina, magwiridwe ake ntchito ndi operewera). Zochitika zamankhwala zikuwonetsa kuti maselo amatha kukhudzidwa chifukwa cha kuchuluka kwa mankhwala. Zilinso chimodzimodzi ndi mankhwala omwe amagwiritsidwa ntchito pochiza matenda ashuga.

Glitazones - mwina ndiye mankhwala odziwika kwambiri omwe amaphatikizapo chithandizo cha chiwindi. Komabe, Troglitazone adachotsedwa pamsika pambuyo pa imfa ya anthu angapo chifukwa chofooka kwambiri. Lero kuli kutsutsana za ngati kupangika kumeneku ndi chifukwa cha gulu la mankhwala omwe amapangidwa mwakuthupi ndipo kuyambitsa zatsopano zomwe sizipangitse kulemedwa ndi chiwopsezo chofanana ndi chiwindi mu matenda ashuga.

Pioglitazone ndi Rosiglitazone ali ndi maselo osiyanasiyana amakanolo osiyanasiyana, zimawonetsedwa kuti zimachepetsa chiopsezo cha hepatotoxicity, ngakhale kuwonongeka kwa chiwindi chifukwa chogwiritsa ntchito zinthuzi kukufotokozedwa pang'onopang'ono. Zofunikira zake - kukonza insulin sensitivity - iyenera, m'malo mwake, ikhale ndi mphamvu pama cell a chiwindi, chifukwa imayendetsedwa limodzi, komanso kusintha kwina, komanso kuchepa kwa plasma ndende yamafuta acids ndipo, chifukwa chake, kutsika kwa katundu pama cell metabolic.

Sulfonylureas - intrahepatic cholestasis (ngakhale wakupha Glibenclamide) ikhoza kukhala chiwonetsero chofala, granulomatous hepatitis (Glibenclamide) ndi mawonekedwe a hepatitis (Glyclazide) yachilendo.

Biguanides - malinga ndi kuthekera komwe kungayambitse kuwonongeka kwa chiwindi, monga akuwonetsera, pakali pano, oimira gulu ili ndiye otetezeka kwambiri. Kufunika kwa mkhalidwe wa zotupa, komabe, ndikuti chifukwa cha anthu omwe ali ndi malo ochepa othandizira, parenchyma yamatenda amtunduwu amachokera ku makulidwe a Metformin kupita ku kukula kwa lactic acidosis.

Insulin - m'malo mwake, monga chidwi, uthenga umodzi ungatchulidwe womwe umafotokoza kukula kwa chiwindi chowonongeka chifukwa cha kayendetsedwe ka insulin. M'malo mwake, ndikothekera kuti ndi chiwindi chachikulu chaimpso chifukwa cha kusowa kwa chithandizo cha matenda a shuga kapena kuchepa kwake, insulin ndiye mankhwala osankha oyamba. Pambuyo pa chindapusa, zimafika pamtundu wa njira zosokoneza kwambiri za metabolic ndi kusintha kwotsatira kwa maselo owonongeka.

Pomaliza

Ubwenzi wamatenda a metabolic, ife, matenda ashuga, ndi matenda a chiwindi ndi wandiweyani. Kutengera chidziwitso chamakono, titha kunena kuti nthawi zambiri, ubale wapakati pa matenda oterewa ndi matenda ashuga umayambitsidwa ndi etiopathogenetics. Ngakhale mawonekedwe owopsa a ziwalozi mu matenda ashuga ndi Steatosis yosavuta, omwe amayankha, osachepera gawo, pakuthandizira kovuta kwa zovuta zazikulu za metabolic, sizachilendo kuwopseza mtundu wankhanza wa matendawa (steatohepatitis), womwe umafuna chisamaliro chapadera komanso kuwongolera.

Zomwe zilipo pa ubale wa matenda a hepatic ndi matenda ashuga sizokwanira kwathunthu, zonse ndipo zimafotokoza zonse. Kuchokera pakuwona za matenda ashuga, palibe ntchito zomwe zidasindikizidwa m'mabuku owonetsa a gastroenterology, opanda zolakwika kuchokera ku malingaliro.

Mawu a pepala la sayansi pa chikhalidwe cha kuwonongeka kwa chiwindi mu mtundu 2 shuga

sindikutha kupeza zomwe mukufuna? Yeserani ntchito yosankha mabuku.

Kuchepa kwa chiwopsezo cha matenda amishuga kumawoneka kuti sikungachitike, ngakhale kuti chiwindi chitha kuperewera, chiwindi cirrhosis ndichulukiridwe kawiri kuposa kuchuluka kwa anthu. Nthawi zambiri, hyperglycemia yolembedwa nthawi ya moyo imatha kukhala yachiwiri ndi matenda enaake osadziwika.

Ku Republic of Sakha V.I. Gagarin ndi L.L. Mashinsky (1996) akafufuza odwala 325 omwe ali ndi matenda ashuga okhala ndi matenda amtundu wa chiwindi ndi zotupa amasonyezedwa m'matumbo: cholecystitis yachuma mu 47.7% ya milandu, matenda a chiwindi (makamaka a etiologyitis mu 33,6%, matenda a shuga a matenda a shuga mu 16) , 1%, ma parasitic matenda a chiwindi (alveococcosis) ndi hepatoma - mu 2.6%. Pankhaniyi, zotupa za chiwindi ndi biliary zotupa zapezeka mwa odwala 216 omwe ali ndi matenda a shuga a mtundu wa 2,5 m'milandu ya 66,5%, komanso odwala matenda ashuga 1 mu 33,5% (109).

Ndi shuga omwe amadalira insulin, ma gallstones nthawi zambiri amapanga. Malinga ndi ofufuza, izi mwina zikuchitika chifukwa cha kusintha kwa kapangidwe kake ka kunenepa kwambiri, osati chifukwa cha matenda ashuga.

Odwala omwe ali ndi matenda ashuga, kuchuluka kwa olemba magazi a hepatitis ndiwokwera kwambiri kuposa anthu opeza bwino ndipo anali 7.9% ndi 4.2% kwa 100 omwe adawapeza ndi matenda a chiwindi B ndi C, motsatana (0.37-0.72% mwa anthu athanzi).

Mu ana omwe ali ndi matenda a shuga, ma serological markers a hepatitis B omwe adapezeka mu 45% ya milandu, omwe ali ndi matenda a chiwindi - 14,5%. V.N. Bokosi (1982), pakuyesa odwala 271 omwe ali ndi matenda a shuga, adawonetsa kuchuluka kwakukulu (59.7%) mwa zizindikiro zamatenda a hepatitis aakulu. Zakhazikitsidwa kuti shuga mellitus imaphatikizidwa ndi autoimmune chronic hepatitis komanso kupezeka kwa ma antigen of the main histocompatibility tata NL-B8 ndi BNC, omwe amapezeka kawiri kawiri m'matenda onse awiri.

Chithunzi cha chipatala, malinga ndi ofufuza a DG, nthawi zambiri chimakhala chosowa ndipo chimadziwika mu 4.175% ya milandu, mosasamala kuchuluka kwa kubwezeredwa kwa matenda ashuga, ndi zizindikiro zotsatirazi: kukulira chiwindi, kupweteka kapena kumva kupsinjika mu hypochondrium yoyenera, kusokonezeka kwa dyspeptic, nthawi zina subictericity ya sclera, ndi kuyabwa. Zizindikiro zapadera za kachipatala zomwe zimawonetsa matenda a chiwindi - hepatomegaly, hypochondrium ululu, subiktericity ya sclera, erythema ya kanjedza, zizindikiro za dyspeptic kapena kuphatikiza kwawo anapezeka mu 76.9% mwa ana omwe ali ndi kuwonongeka kwa DM. Yosho mu 1953. Oooh sindikutha kupeza zomwe mukufuna? Yeserani ntchito yosankha mabuku.

Kuphatikiza apo, mafuta amaloledwa kulowa pansi polimbikitsidwa ndi zinthu zopanda pake. Nthawi zambiri, imadziwonetsa koyamba mwa mawonekedwe a kulephera kwa chiwindi panthawi ya matenda, kuledzera, kuvulala kwambiri, ndi zina zambiri. Kulowa kwamafuta m'magazi a shuga kumakhudza njira yamatenda, chifukwa zimayambitsa kuphwanya chiwindi, kuphatikizapo mayamwidwe ndi antitoxic.

Magwiridwe antchito a chiwindi mu shuga amasintha malinga ndi kutha kwa maphunzirowa II

Kutalika kwa matendawa, zaka, jenda, kulemera kwa thupi la odwala 5,7,12,33, makamaka ndi chiwindi cha hepatitis komanso majini ena obwera chifukwa cha kuwonongeka kwa chiwindi. Chikhalidwe cha kuwonongeka kwa chiwindi mu matenda ashuga ndi njira yayitali yotsika, yokhala ndi zotsika zochepa komanso kusintha kwakukulu kwa morphofunctional. Chifukwa chake, sizotheka nthawi zonse kuzindikira zovuta za chiwindi pogwiritsa ntchito njira zamankhwala zoberekera, ngakhale matenda osokoneza bongo.

Olemba angapo amakhulupirira kuti chizindikiro cha ntchito ya chiwindi chimadalira mwachindunji kuchuluka kwa glucose wamagazi ndi insulin m'magazi, komabe, hemoglobin yokhazikika sinatsimikizidwe muzochita izi.

Kuphwanya kwa enzymatic ntchito ya chiwindi kunapezeka mwa odwala ambiri omwe ali ndi matenda ashuga, koma ofufuza onse amagogomezera kuzungulira kwake komanso zovuta za kufufuza kwa zasayansi 5,7,15. Amadziwika ndi kuchuluka kwa transamnases, aldolases, fructose-2,6-dnophosphataldolases. Zosintha pamlingo wa anaerobic glycolysis enzymes ndi tricarboxylic acid mozungulira, kuphwanya kwa mawonekedwe a oxidoreductase kunawululidwa, zomwe zikuwonetsa kuchepa kwa michere ya glucose catabolism m'chiwindi. Ichi ndi chifukwa cha zotupa ndi chiwongola chiwindi, kukula kwa cytolysis ndi cholestasis, mkwiyo wa reticuloendothelial maselo, komanso kusakhazikika kwa hepatocytes.

V.N. Mukamayang'ana anthu 271 omwe ali ndi matenda ashuga, nthambi ina idazindikira kuti kusintha kwa mapangidwe a pigment, protein, interstitial ndi enzymatic metabolism zimatengera mtundu wazachipatala wa odwala komanso zaka za odwala. Odwala omwe ali ndi matenda oopsa a shuga ali ndi zaka 4559, kusintha kwa zizindikirozi kunatchulidwa kwambiri kuposa mawonekedwe olimba komanso aang'ono. Palibe kudalira kwamasintha amtunduwu kagayidwe ka nthawi ya matendawa komanso mkhalidwe wa kagayidwe kazachilengedwe kamapezeka.

L.I. Borisovskaya, atawona kwa zaka 6-8, odwala matenda ashuga 200 omwe ali ndi zaka 16 mpaka 75 kumayambiriro kwa phunziroli adawonetsa kuwonongeka kwa chiwindi mu 78,5% ya milandu, ndipo kumapeto - mu 94,5%. Kuphatikiza apo, iwo amadalira mwachindunji kokha ku kuwopsa kwa maphunzirowo, kuchuluka kwa chipukutiro, komanso kutalika kwa nthawi ya matenda ashuga. Komabe, pantchito iyi, kuchuluka kwa kubwezeretsa kunatsimikiziridwa kokha ndi zizindikiro za glycemic, zomwe pano zimawonedwa ngati sizokwanira.

S. Sherlock ndi J. Dooley amafotokoza kuti, ndi shuga wofotokozedwayo, kusintha kwa magwiridwe antchito a chiwindi nthawi zambiri kulibe, ndipo ngati izi zapezeka, chifukwa chawo sichimakhudzana ndi matenda ashuga. Koma nthawi yomweyo, zimadziwika kuti mu 80% ya anthu odwala matenda a shuga omwe amaphatikizidwa ndi chiwindi chamafuta, kusintha kosachepera chimodzi mwazinthu zingapo za seramu kumawululidwa: zochitika za transamnase, alkaline phosphatase, ndi GGTP. Ndi ketoacidosis

zotheka gnerperglobulnemnii n kuchuluka pang'ono seramu bilirubin.

S.V. Turnna, pakuwunika odwala 124 omwe ali ndi matenda ashuga, adawonetsa kuti mbali ya kuyesedwa kwa ma laboratori yoyeserera magwiridwe antchito a chiwindi, kusintha kumatha kupezeka mu 15-18.6% yokha mwa milandu. Izi, kumbali imodzi, zikutsimikizira kusowa kwa kuphwanya kwakukulu kuchokera pantchito ya chiwindi, mbali inayo kukuwonetsa zambiri zazomwe zimayesedwa pakuzindikiridwa kwa chiwindi choyambirira kuwonongeka kwa matenda ashuga. Pachipatalachi, kuti ayese mkhalidwe wa chiwalo, ndikofunikira kuwunika ntchito za klnnko-bohnnmnsky syndromes.

V.L. Dumbrava odwala matenda a shuga adalembetsa kupezeka kwa ma syndromes a cytolysis, cholestasis, chiwindi kulephera, kutupa ndi pathological chitetezo chokwanira.

Zizindikiro za cytolysis syndrome ya hepatocellular necrosis ndi ntchito ya aminotransferases, LDH ndi nzoforms, aldolases, glutamndegndrogenases, sorbntdegndrogenases, ornn-carbamanthyl transges mu seramu yamagazi. Olemba ambiri adawona kuwonjezeka kwa milingo ya transamnases, aldolases, LDH 4-5, poyerekeza ndi magulu owongolera, koma pamenepa sizinatchulidwe komwe mtundu wa shuga mellitus ndi kuchuluka kwa kubweza kwake kudawululidwa 5,7,33.

Mwa odwala omwe astheno-vegetative, dyspeptic syndromes, sclera, mtima asterisks, chiwindi, zotupa za pakhungu ndi punctate hemorrhages, kufalikira kwa mbali yakunja yam'mimba komanso kuwonjezeka kwakukulu kwa chiwindi kudalembedwa, kuwonjezeka kwa ntchito ya amnotransferase ya 1,2-3. Nthawi 8. Pankhani yazovuta zachipatala, kusintha kwa zochitika za amnotransferase kunali kopanda tanthauzo.

Sh.Sh. Shamakhmudova adapeza kuchuluka kwa seramu LDH mwa odwala omwe ali ndi shuga wambiri, poyerekeza ndi kuwongolera, komanso kuchuluka kwa zochitika zimadalira kuuma kwa matendawa. Kukula kwakukulu kunawonedwa mwa mitundu yayikulu ya matenda a shuga (mayunitsi 416.8 + 11.5 m'malo mwa 284.8 + 10.6 mu kuwongolera).

Chiwindi chimagwira gawo lotsogolera pakuphatikizidwa ndi mapuloteni. Mu chiwindi, kaphatikizidwe ndi kuwonongeka kwa mapuloteni, kusinthanso ndi kupangika kwa ma amino acid, mapangidwe a urea, glutathione, creatine, holne esterase, kagayidwe kazinthu zina za ma amino acid kumachitika. 95-100% ya albumin ndi 85% ya ma globulins amapangidwa m'chiwindi. Mu shuga mellitus, kusintha kwa mawonekedwe a mapuloteni a Whey adawululidwa, adadziwika ndi kukula kwa gnpoalbumnemnn ndi gnperglobulnemnn. Kuchulukitsidwa kwa ma globulins kumayendera limodzi ndi dneptnechnemia, komwe kumakulirakulira chifukwa cha ma protein a atypical m'dera la beta-1-n alpha-2-globuln. Pali kuwonjezeka kwa mapuloteni okhala ndi tizinthu tating'onoting'ono tachulukidwe tachilengedwe komanso ma macromolecular, kuchuluka kwa ma immunoglobulins, komanso kuchuluka kwa mapuloteni okhala ndi mphamvu za euglo-

lnnov. Ofufuzawo akuwonetsanso kuchepa kwa Albin, kuchuluka kwa ma globulins, kuchepa kwa kugwiritsidwa ntchito kwa albumin-globuln ya 5.29. Kuwonjezeka kwa ma globulins kumatengedwa ngati chiwonetsero cha mayankho a kupffer maselo ndi mawonekedwe a poom-chandamale m'maselo a mesenchymal, omwe amachititsa kuchuluka kwa ma globulins, chifukwa cha kuthekera kwa njira yotupa m'magazi a chiwindi, zomwe sizinafotokozedwe zamankhwala amadzimadzi amapezeka m'magazi pa iwo. V.N. Twig imapezeka mwa odwala omwe ali ndi matenda ashuga omwe ali ndi 2 times yawonjezera indices ya mayeso a thymol, koma wolemba akuwonetsa kuti oposa theka la iwo anali ndi zizindikiro zachipatala za matenda a chiwindi. Kusintha kofananako, koma kokha mwa 8% ya milandu, komwe kudawululidwa ndi RB Sultanalneva et al. Kuchulukitsidwa kwa zotsatira za mayeso a thymol kumachitika chifukwa cha kuwonongeka kwa chiwindi, komwe kumayang'anira kupangika kwa mapuloteni a magazi a seramu.

Zochita za holnesterase zidachepa ndi 2 kawiri mu shuga poyerekeza ndi magawo a gulu lolamulira wathanzi.

Ngati pali kusokonezeka komwe kumachitika pakapangidwe ka bile, cholestasis syndrome imalembetsedwa, chizindikiritso cha mayendedwe ake pakhungu, chotsalacho sichingakhalepo nthawi zonse. Zolemba za cholestasis zimaphatikizapo kusintha kwamachitidwe a alkaline phosphatase, 5-nucleotindase. lei-cinnamnopeptindases, GGTP 25.35. Odwala omwe ali ndi matenda ashuga, kudziwika wokwanira wazotsatira zabwino amapezeka posankha ntchito ya GGTP. Kuwonjezeka kwa ntchito ya alkaline phosphatase ndi GGTP kwa odwala omwe ali ndi vuto la shuga kungayanjane ndi mphamvu zonse za chiwindi komanso kuwonongeka kwa maselo a chiwindi kuti apangitse zigawo zonse za alkaline phosphatase. I.J. Perry adanenanso kuti seramu GGT imakhala pachiwopsezo cha matenda ashuga, ndipo imatha kukhala chizindikiro cha kulephera kwa hepatic.

Malinga ndi S.V. Chimodzi mwazinthu zomwe zimapangitsa kuti pakhale kusintha kwa magwiridwe antchito a chiwindi ndi kutsegula kwa machitidwe a transoxidation a lipoproteins omwe amachititsa kuti pakhale kusintha kwa cytolysis, cholestasis syndromes, komanso kuwonongeka kwa mankhwala oopsa.

Zosokoneza zolembedwa za chiwonetsero chokwanira cha II cha chiwindi kwa odwala omwe ali ndi matenda osokoneza bongo pochita chiwopsezo mu 52% ya milandu zimaphatikizidwa ndikusintha kwa magawo amachitidwe a biochemical: gnpoalbumnumnee, gneperglobulnumnem.

kuwonjezeka kwa zomwe zili ndi ma bilirubin omangika, chizindikiro, ma enzyme ochulukirapo, komanso kuperewera kwa mafupa a hemodynamics. Kutsika kwa magazi kwa hepatic kumachulukitsa kuphwanya kwa hepato-bnlnar.

Bilirubin, yomwe imanyezimiritsa

Mtundu wachiwiri wa shuga, zovuta za kagayidwe kazakudya zimaphatikizidwa ndikusintha kwa metabolidi ya lipid. Ntchito ya chiwindi mu lipid metabolism ndiyabwino. Hepatocytes amatenga lipids kuchokera m'magazi ndikuwaphatikiza. Triglycerides imapangidwa ndikuwonjezeredwa momwemo, ma phospholipids, cholesterol, cholesterol esters, mafuta acids, lipoproteins amapangidwa, pafupifupi 30-50% ya LDL imapangidwa, ndipo pafupifupi 10% ya HDL1 5.26. Kwa odwala omwe ali ndi shuga omwe amadalira insulin, kuchuluka kwambiri kwa cholesterol kunapezeka kuti ndi 29.37, komanso triglycerides, cholesterol-VLDL ndi mafuta acids. Matenda amafuta a lip-metabolid amadziwika kwambiri mu shuga yayikulu, kuchepa kwa metabolic, kuchuluka kwa matendawa, odwala omwe ali ndi magulu okalamba, omwe ali ndi matenda a chiwindi ndi matenda amisempha, kukhalapo kwa atherossteosis, matenda a mtima.

Palinso ubale wachindunji pakati pa kugwira ntchito kwa chiwindi ndi mkhalidwe wa zinthu zamagazi: magazi amitsempha, mwachindunji

kulemera, hematocrit, acid-base bwino, serum gnaluronidase ntchito. Mothandizidwa ndi odwala omwe ali ndi matenda osokoneza bongo a shuga, poganizira momwe chiwindi chimagwirira ntchito, mphamvu ya magazi ndi ntchito ya chiwindi (protein-bilin kupanga, enzymatic) imasinthidwa munthawi imodzimodzi, pomwe mankhwalawa samaganizira za vuto la chiwindi.

Kuyesa kwa antioxidant ndi galactose, kuwonjezeka kwa ammonia ndi phenols kumapangitsa chiwindi kugwira ntchito kwa chiwindi. Ndili m'chiwindi komwe machitidwe akuluakulu a enzyme amapezeka omwe amachititsa kusintha kwa biotransfform ndikusintha kwa xenobiotic 16, 27. Mu hepatocytes, dongosolo la ma enzyme omwe amathandizira ma xenobiotic osiyanasiyana amaimiridwa, ndiye kuti, zinthu zachilendo kwa anthu 16,25,27,30. Mlingo wa biotransformation umatsimikiziridwa ndi kuchuluka kwa chromium P-450 - kwambiri

mankhwala okhala ndi heme. Pakadali pano, mitundu yoposa 300 ya isoforms ndiyodziwika bwino, yopatsa mphamvu mitundu isanu 60 ya michere ya ma enzymatic ndi mazana masauzande a zida za 17.43. Ntchito yodziwika bwino ya cyto-

Chromium P-450 ndikutembenuka kwa microsomal oxidation yamafuta sungunuka (lipophilic) kukhala michere yambiri ya madzi (sungunuka) yomwe imatha kuphulika mwachangu kuchokera mthupi. Ma enzymes a P-450 CH otchulidwa mu mitochondria amagwira ntchito yofunika kwambiri pamankhwala amtundu wa oxidative, peroxidative, komanso kuchepetsa ma metabolism ambiri amkati, kuphatikizapo steroids, bile acid, mafuta acids, ma prostaglandins, leukotrienes, ma biogenic amines 17.27, 43. Monga lamulo, panthawi ya microsomal oxidation, ma gawo a CX-P450 amasintha kukhala mitundu yochepa kwambiri yogwiritsira ntchito, ndipo mu mitochondrial substrates amapeza zochitika zofunikira zazachilengedwe (michere yambiri yogwira mineral ndi glucocorticoids, progestins ndi mahomoni ogonana).

Zakhazikitsidwa kuti mu shuga ndi jakisoni wambiri wa ethanol (mwina, ndi mawonekedwe a mayendedwe acetaldehyde), kuwonjezeka kwa gawo limodzi la mawonekedwe apadera a CH P-450 SUR2E1 m'chiwindi ndi hepatocytes akutali amachitika. Izi zimatchedwa "diabetes (mowa). Ma gawo oyeserera, ma inhibitors ndi ma inducers a PX-450 SUR2E1 CH adawululidwa. Mu matenda a shuga, chinthu cholowa cha P-450 SUR2E1 CH m'chiwindi sichimawonjezera kuchuluka kwa shuga m'magazi, koma kuchepa kwa insulin. Momwe amathandizira pakuchitika ndikusintha kosasintha kwa thupi komwe kumalimbitsa kuchepetsa (ndi makutidwe ndi okosijeni) zomwe zimakhala matupi a ketone. Kuopsa kwa kuphatikizidwa kumayenderana ndi kuopsa kwa matendawa, makamaka, ndi chisonyezo monga kukula kwa hemoglobin glycosylation. Ndikofunikira kuti zosintha zomwe zimafotokozedwa mu metabolic rate zinali, malinga ndi olemba, zimasinthidwanso pochiza matenda ashuga omwe ali ndi insulin. Zinawonetsedwa kuti dongosolo la P-450 CH limachita mosiyanasiyana makoswe amphongo ndi amuna omwe ali ndi matenda ashuga. Kuwonjezeka kwakukulu kwa zomwe zili mu CUR2E1 ndi isoform zina zinaonedwa pachiwindi cha amuna ndipo zimasinthidwa ndikukhazikitsa insulin.

M'zaka zaposachedwa, njira zapangidwa zomwe zimapangitsa kuti athe kuweruza momwe magwiridwe antchito a monoo oxygenases m'thupi amathandizira ndi ma pharmacokinetics a chizindikiro, makamaka ndi kinetics of antipyrine (AP) ndi metabolites ake mu mkodzo, malovu, ndi magazi. AP ndi gulu la mndandanda wa pyrazolone (1-phenyl-2,3-dmethylpyrazolone-5). Maziko ogwiritsira ntchito AP ngati chisonyezero cha ntchito ya CH ya P-450-kudalira monoo oxygenase ndi njira yake yolowera mu dongosolo la enzyme ili, bioavailability yayikulu (97-100%), yopanda tanthauzo pama protein a magazi (mpaka 10%), kugawa kwofananira kwa izi amaphatikizira ndi ma metabolites mu ziwalo, minofu, manyuzipepala amadzimadzi, komanso poizoni wochepa. Zosintha pama paracokinetic magawo - kuchepa kwa chilolezo ndikuwonjezereka kwa theka la moyo wa AP - akuwonetsa kutsutsana ndi ntchito ya dongosolo la biotransformatsnon mu parenchymal

razhennyakh chiwindi. Kuyesedwa kwa LIT kumadziwika kuti ndiko njira yoyenera yofananira ndikuwunika ntchito ya chiwindi pamalo oyenera. Ofufuza ambiri adazindikira kuti pamakhala kupendekeka kwapamwamba pakati pa zopindika za mankhwalawa komanso kukhulupirika kwa kapangidwe ka minyewa ya chiwindi, zomwe zili mu PX-450 m'chiwindi ndi mbiri yakale ya hepatosis yamafuta m'magazi a IDDM. Chifukwa chake, E.V. Hanina et al., Powunika odwala 19 omwe ali ndi IDDM, 13 adawonetsa kusintha kwakukulu mu dongosolo la biotransfform la hepatocytes. Mwa anthu 9, T | / 2 LI idachepetsedwa ndikuwonjezeredwa maola 27.4 + 5.1. Kusintha kwa kuchotsedwa kwa mankhwalawa kunaphatikizidwanso ndi zovuta zina zotchedwa carbohydrate ndi lipid metabolism. Mwa odwala 4, kuchotsedwa kwa LP kunathandizira, T | / 2 anali maola 3,95 + 0.04. Mu gululi, mbiri ya kumwa mowa kwambiri idadziwika.

L.I. Geller ndi M.V. Gryaznov mu 1982, poyesa odwala 77, adawonetsa kuchepa kwa chidziwitso: odwala omwe ali ndi matenda a shuga achinyamata, mpaka

26.1 + 1.5 ml / min, komanso mukulira mpaka 24.1 + + 1.0 ml / min (wathanzi 36.8 + 1.4). Mphamvu ya kunenepa kwambiri komanso kuopsa kwa matendawa pantchito ya hepatocytes yakhazikitsidwa. Omwewo adawunikidwa mu 1987 pakuwunika odwala 79 ndipo sanawonetse kusiyana kwakukulu pamlingo wochotsa mankhwalawa mu seramu yamagazi mwa odwala omwe ali ndi mitundu 1 ndi 2 ya matenda ashuga: 26.1 + 1.5 (ndi = 23) ndi

24.1 + 1.5 (L = 56) ml / min, motsatana. Komabe, odwala omwe ali ndi IDDM, povulala kwambiri, mawonekedwe a LI anali otsika kwambiri (21.9+ +2.3 ml / min ndi gf = 11) kuposa ndi zovuta za matenda ashuga (29.2 + 1.8 ml / min ndi i = 12, p sindikutha kupeza zomwe mukufuna? Yesani ntchito yosankha mabuku.

biochemical syndromes kuwonongeka kwa chiwindi mu shuga ali enieni amtundu 2, kuchuluka komwe kukufanizidwa ndi mliriwu.

Nthawi yomweyo, pali zinthu zingapo zingapo zomwe zimapangitsa kuti pakhale zotupa zambiri za chiwalo chimodzi chofunikira kwambiri - chiwindi mu mtundu 2 shuga: kuwonongeka kwa kayendedwe kazinthu zazikulu, kuphatikiza kwa shuga ndi matenda ena a hepatobiliary, kugwiritsa ntchito moyo wonse pakamwa ndi hypoglycemic ndi mapiritsi ena, metabolism yofunikira zomwe zimachitika, monga lamulo, m'chiwindi. Ntchito zochepa zomwe zidapangidwa pophunzira ntchito ya chiwindi pakumwa mankhwalawa othandizira shuga masiku ano, ziyenera kudziwika kuti biotransfform-yofunika komanso ntchito zina za chiwindi sizinaphunziridwe chithandizo chisanachitike. Poskmu akufunsa funso lofunikira kwambiri pankhani iyi - ntchito ya biotransfform ya xenobiotic m'chiwindi mu shuga imakhalabe yophunzirira. M'mabukuwa mumakhala zotsutsana kwathunthu pa kagayidwe ka mankhwala omwewo mwa odwala omwe ali ndi matenda ashuga. Funso limakhala lotseguka - ntchito yanji kuphwanya kwa chiwindi-sigenase cha chiwindi pakupanga matenda a shuga ndi zovuta zake? Kodi zosinthazi zimatsogozedwa ndi matenda ashuga mu enzymatic monoo oxygenated dongosolo la chiwindi, kapena kodi pali zotsatira za matenda a hyperglycemia komanso gawo linalake la metabolic syndrome?

Maphunziro owonjezera amafunikira kuti amvetsetse ntchito ya biotransfform ndi gawo la zosinthazi pakupanga matenda a shuga. Ndikofunikira kuti mupeze njira zatsopano zopezera matenda ashuga a chiwindi mu chipatala.

Zodziwika bwino kuti kukonza njira yolipirira anthu odwala matenda ashuga komanso kugwiritsa ntchito mitundu ya masiku amakono kumabweretsa zotsatira zabwino: kusunga miyoyo ya odwala, kuchepetsa pafupipafupi komanso zovuta za matenda ashuga, kuchepetsa kuchuluka ndi nthawi yayitali yopita kuchipatala, kuonetsetsa kuti odwala ali ndi moyo wabwino. Zonsezi zimapangitsa kuti pakhale kafukufuku wofunikira wokhudzana ndi matenda amtundu wa 2, poganizira zomwe zadziwika za matendawa.

MU DIABETES MellitUS ​​WA 2 TYPE

D.E. Nimaeva, T.P. Sizikh (Irkutsk State Medical University)

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Kodi chiwindi matenda otupa chiwindi ndi chiani?

Cirrhosis ya chiwindi ndikukonzanso pang'onopang'ono kwachilengedwe. Maselo a chiwindi amayamba kuchepa ndipo m'malo mwake mumakhala mafuta. Ntchito zake ndizodwala.Pambuyo pake, kulephera kwa hepatic ndi kupweteka kwa chiwindi.

Wodwala wodwala matenda enaake omwe akuwaganizira kuti ali ndi vuto lotere amakhala ndi zodandaula:

• kutopa,
• kusokonezeka kwa tulo,
• kuchepa kwamtima
• ukufalikira
• Madontho a khungu ndi chovala chamaso m'maso achikasu,
• Kusintha kwa ndowe,
• kupweteka kwam'mimba
• kutupa kwamiyendo,
• kuchuluka kwam'mimba chifukwa cha kuchuluka kwa madzi mkati mwake,
• pafupipafupi mabakiteriya matenda
• kupweteka m'chiwindi
• dyspepsia (belching, nseru, kusanza, kugwedezeka),
• kuyabwa kwa khungu ndi mawonekedwe a "nyenyezi" zam'mimba pakhungu.

Ngati matenda a cirrhosis apangidwa kale, ndiye, mwatsoka, sakusintha. Koma chithandizo cha zomwe zimayambitsa matenda amitsempha cha m'mimba chimakupatsani mwayi woti chiwindi chizikhala chokwanira.

Zosiyanasiyana zamafuta ndi kapangidwe kake

Zakudya zamafuta azitsulo zimayenera kumadyedwa pafupipafupi ndi onse, osadalira.

Iron imathandizira kusintha mtundu wa hemoglobin m'thupi la munthu.

Copper, imakhala yotupa ndipo imathandizira njira zambiri zofunika.

Kuphatikizidwa kwa zopangidwazo kumaphatikizapo zinthu zingapo zomwe zingakhale zopindulitsa m'thupi la munthu:

1. fufuza zinthu zachitsulo ndi zamkuwa.
2. mavitamini
3. ma amino acid
4. macronutrients omwe ali ndi phindu pa ntchito ya chiwindi ndi impso, ubongo, khungu, amasunga mawonekedwe acuity.

Mpaka pano, mutha kupeza mitundu yotere ya chiwindi:

Chiwindi cha nkhuku chimayeneranso chisamaliro chapadera, popeza chimakhala ndi mphamvu zochepa zopatsa mphamvu, zomwe zimapangitsa aliyense yemwe ali ndi matenda a shuga kuti aphatikiziremo muzakudya. Mtundu wamtunduwu uli ndi index yotsika ya glycemic, yofunikira kwambiri kuti ikhalebe yochepetsa thupi, komanso shuga wambiri.

Chiwindi cha ng'ombe chimakhalanso chopanda thanzi, monganso nyama yokha (ng'ombe). Chiwindi choterocho chimatsogolera pazinthu zachitsulo, ndikusunga michere yawo nthawi ya kutentha. Chiwindi cha ng'ombe mu mtundu 2 wa shuga chitha kugwiritsidwa ntchito ngati imodzi mwazakudya zazikulu nthawi zonse. Mndandanda wamtundu wa glycemic wopanga mu mawonekedwe okazinga ndi magawo 50.

Mitundu ya nkhumba imakhala yopindulitsa kwa odwala matenda ashuga ndipo kugwiritsidwa ntchito kwake kumayenera kuchitika modekha komanso pokhapokha ngati chithandizo choyenera cha kutentha.

Amaloledwa kugwiritsa ntchito chiwindi cha cod mu shuga yachiwiri. Zakudya izi ndizogululi komanso zimakhudza thupi la munthu. Kudya chiwindi cha cod kumatha kuwonjezera kuchuluka kwa vitamini A, kusintha mkhalidwe ndi kulimba kwa mano.

Kuphatikiza apo, imakhala ndi phindu pa kugwira ntchito kwa ubongo ndi impso. Komanso, kapangidwe kazinthu izi zimaphatikizapo zinthu zofunika monga mavitamini C, D, E ndi folic acid, ma omega-3 acid. Chofunikanso ndichakuti chiwindi cha cod chimakhala ndi mafuta ochepa, omwe amalola kuti azitha kuphatikizidwa mumenyu yotsika-calorie diabetes.

Mndandanda wamtundu wa glycemic wopangira zinthu ndi magawo 0, chifukwa chake umatha kudyeka tsiku lililonse osadandaula zakukweza shuga.

Zonse zomwe zimakhudza chiwindi mu shuga zimayeneretsedwa mwapadera. Monga mukudziwa, ng'ombe palokha ndi nyama yamitundu yosiyanasiyana.

Imakhala yamtengo wapatali chifukwa cha kuchuluka kwake kwazitsulo. Nthawi zambiri imagwiritsidwa ntchito osati kuphika zinthu zotentha, komanso masaladi.

Ngakhale kukazinga mwachangu kwambiri kumachitika, kumakhala kofewa komanso kofatsa, ndipo pambuyo poti mwapsa kumatenga mafuta bwino, mwachitsanzo, masamba kapena mafuta.

Ndikufuna kuyang'ana imodzi mwazipangizo zakukonzekera kwake. Malinga ndi maphikidwe, chiwindi cha ng'ombe chimaphikidwa m'madzi amchere ndikudula. Kupitilira apo ndikofunikira:

1. mu poto wina, mwachangu anyezi, onjezerani chiwindi pamenepo ndikuwumitsa mpaka mawonekedwe atatumphuka. Ndikofunika kwambiri kuti musangogwiritsa ntchito mopitilira muyeso zomwe zaperekedwa, chifukwa izi zimatha kukhala zosathandiza kwenikweni,
2. ndi kutsanulira mikate yoyera yopukutidwa ndi blender kapena grated,
3. tisamaiwale za zonunkhira komanso kugwiritsa ntchito zitsamba, ndipo kuti chithandizocho chikhale chofewa, tikulimbikitsidwa kugwiritsa ntchito madzi pang'ono.

Mbale yotsikirayo iyenera kulongedzeredwa kwa mphindi zitatu kapena zisanu. Ndi chifukwa ichi kuti chiwindi mu matenda ashuga chikhale chothandiza kwambiri, kuti mukhale otsimikiza za izi, mutha kufunsa kaye wodwala wazachipatala kapena wodwala.

Zizindikiro zamatsenga

Zotsatira za chiwindi mu shuga zimadziwika ndi zizindikiro monga:

• ulesi
• vuto la kugona
• kuchepa kwamtima
• kutulutsa m'mimba
• khungu la chikaso ndimatumbo oyera amaso amaso,
• Kusintha kwa ndowe,
• kupweteka m'mimba
• Kutupa kwamiyendo,
• kukula kwa m'mimba chifukwa cha kuchuluka kwa madzi,
• kupweteka m'chiwindi.

Zizindikiro

Kuzindikira kwakanthawi zamatenda a chiwindi kumakupatsani mwayi woti muyambe kulandira chithandizo chofunikira ndikuchepetsa mwayi wokhala ndi matenda akulu mtsogolo. Odwala onse omwe ali ndi matenda ashuga amayenera kuyesa kuwunika kwa chiwindi, chikhodzodzo ndi dongosolo la biliary kamodzi pa miyezi isanu ndi umodzi.

Kuchokera ku zasayansi yantchito yokhudza kuyesa magwiridwe antchito a chiwalochi, kuyesedwa kwamwazi wamwazi kumakhala kothandiza:

• ntchito ya michere AST ndi ALT (aspartate aminotransferase ndi alanine aminotransferase),
• mulingo wa bilirubin (mwachindunji komanso wosalunjika),
• kuchuluka kwamapuloteni onse
• albin ndende
• kuchuluka kwa zamchere phosphatase (ALP) ndi gamma-glutamyltransferase (GGT).

Ndi zotsatira za kusanthula uku (amatchedwanso "mayesero a chiwindi") komanso mathero a kuyezetsa magazi, wodwalayo ayenera kuwona dokotala, ndipo ngati apatuka pazikhalidwe zawo, osadzilimbitsa. Pambuyo pokhazikitsa kuzindikira koyenera komanso kuzindikira kwathunthu, katswiri amatha kulimbikitsa chithandizo chofunikira, poganizira mawonekedwe a matenda a shuga.

Popeza chiwindi chimakonda kuvutika chifukwa chodwala mankhwalawa. Mankhwala ochepa okha ndi omwe amagwiritsidwa ntchito pochiza, omwe sangapatsidwe mankhwala. Monga lamulo, izi zikuphatikiza:

• mankhwala oyamba omwe amathandizira kukonza kagayidwe kazakudya (insulin kapena mapiritsi),
• hepatoprotectors (mankhwala oteteza chiwindi ndi kuchititsa magwiridwe antchito ake),
• ursodeoxycholic acid (imathandiza kutuluka kwa ndulu ndipo imateteza kutupa),
• mavitamini ndi michere
• lactulose (yoyeretsa thupi pafupipafupi m'njira yachilengedwe).

Maziko a mankhwala osagwiritsa ntchito mankhwala osokoneza bongo ndi zakudya. Ndi matenda a chiwindi, wodwalayo amatha kutsatira mfundo zakupatsa thanzi zomwe zimalimbikitsidwa kwa onse odwala matenda ashuga.

Chakudya chofatsa komanso kudya kwamadzi kokwanira kumathandizira kusintha kagayidwe kazinthu, ndipo kupangika kolondola kwamasamba kumatsitsa shuga. Kuchokera pazakudya za wodwalayo, shuga ndi zinthu zomwe zimakhala ndimtundu wake, buledi woyera ndi zinthu zopangidwa ndi ufa, maswiti, nyama zamafuta ndi nsomba, nyama zomwe zimanunkhidwa ndi maapulo sizimayikidwa konse.

Ndi bwinonso kukana masamba osankhidwa, chifukwa, ngakhale ali ndi zakudya zochepa zopatsa mphamvu komanso zimakhala zochepa, amatha kukhumudwitsa kapamba ndikuwonjezera chikhalidwe cha chiwindi.

Mankhwala ena ochizira matenda a shuga ali ndi hepatotoxicity. Uku ndi katundu wopanda pake, komwe kumayambitsa kusokonezeka kwa chiwindi komanso kusintha kowawa m'maganizo mwake.

Ichi ndichifukwa chake, posankha mankhwala okhazikika, ndikofunikira kuti endocrinologist iganizire za ma nuances onse ndikudziwitsa wodwalayo za zoyipa zomwe zingachitike komanso zizindikiro zoopsa. Kuyang'anira shuga pafupipafupi komanso kuonetsa magazi pafupipafupi kumakupatsani mwayi wodziwa zovuta za chiwindi ndikusintha chithandizo.

Chithandizo cha matenda

Pofuna kupewa kufalikira kwa matenda a chiwindi, komanso matenda ashuga, kapena ngati pakuwoneka kuwonetsa matendawa, ndiye kulipira ngongoleyo, ndikofunikira kuchita zinthu zingapo zofunika kukonza thupi.

Gawo loyamba ndi kulumikizana ndi katswiri. Pankhaniyi, amatha kukhala gastroenterologist, endocrinologist, hepatologist.

Adzaunikira wodwalayo, omwe adzadziwitse mayendedwe ake pankhaniyi.

Ngati wodwala akudwala matenda amtundu woyamba wa shuga, ndikofunikira kupereka mankhwala othandizira, ngati sangakwanitse, ndikofunikira kuyambiranso chithandizo chamankhwala. Pachifukwa ichi, mankhwala othandizira a insulin amagwiritsidwa ntchito mu mawonekedwe a piritsi kapena mawonekedwe a jakisoni.

Kukhazikika kwa mtundu wachiwiri wa matenda ashuga nthawi zambiri kumawonedwa mwa anthu onenepa kwambiri.

Pankhaniyi, yothandiza kwambiri ndikusintha kwa moyo wanu, masewera, cholinga chochepetsa thupi, komanso chithandizo chamankhwala.

Mosasamala mtundu wa shuga, chithandizo cha chiwindi ndichofunika. Zimatengera gawo lomwe kuwonongeka kwa chiwindi kumadziwika.

M'magawo oyamba a matenda a chiwindi, kukonza madigiri a magazi nthawi yake kuli kothandiza. Mothandizidwa bwino ndi matenda a chiwindi ntchito ndi zakudya.

Pofuna kuteteza maselo a chiwindi, ndikofunikira kumwa mankhwala a hepatoprotective. Amabwezeretsa bwino maselo a chiwindi. Pakati pawo - Essentiale, Hepatofalk, Hepamerz, etc. Ndi steatosis, Ursosan amatengedwa.

Fatty diabetesic hepatosis ndi vuto lalikulu la matenda osokoneza bongo, omwe amawononga chida chochokera m'thupi - chiwindi. Ndi matendawa, mafuta ochulukirapo amadziunjikira mu hepatocytes - maselo a chiwindi.

Zachilendo mu hepatocytes ndi ma enzyme omwe amawononga poizoni. Madontho amadzimadzi, omwe amapezeka m'maselo a chiwindi, amaphwanya umphumphu wawo. Kenako zomwe zimapezeka m'matumbo a hepatocytes, kuphatikizapo ma enzymes omwe amachititsa kuti ziphe zisalowe, zimalowa m'magazi.

Dzira kapena nkhuku: shuga mellitus kapena hepatosis yamafuta

Monga matenda a shuga angayambitse hepatosis yamafuta, matenda onenepa omwe amakhudza chiwindi angayambitse matenda a shuga. Poyamba, hepatosis yamafuta amatchedwa matenda ashuga.

Chifukwa chake, mwa odwala omwe ali ndi vuto lalikulu la matenda osokoneza bongo omwe ali ndi vuto la kuthana ndi mahomoni - kusowa kwa insulin komanso kuchuluka kwa glucagon, kuwonongeka kwa glucose kumachepetsa, mafuta ochulukirapo amapangidwa. Zotsatira za njirazi ndi mafuta a chiwindi cha hepatosis.

Mankhwala amakono amagwiritsa ntchito zinthu zosatsimikizira kuti matenda a chiwindi chamafuta ndichimodzi mwazinthu zowopsa kwambiri zomwe zimayambitsa matenda a shuga.

Zizindikiro ndi Kudziwitsa

Kudzizindikira kwa matenda a shuga a shuga a hepatosis ndikosatheka. Zowonadi, chifukwa cha kuchepa kwa mathero a mitsempha, chiwindi sichimapweteka. Chifukwa chake, zizindikiro za kupsinjikizo ndizodziwika bwino m'matenda ambiri: ulesi, kufooka, kulephera kudya. Kuwononga makoma a ma cell a chiwindi, ma enzyme omwe amapanga mawonekedwe kuti asokoneze poizoni amalowa m'magazi.

Chifukwa chake, njira imodzi yodziwira matenda a chiwindi chamafuta ndi kuyesa kwamwazi wamagazi. Amawonetsa kukhalapo ndi kuchuluka kwa ma enzymes a hepatocyte m'magazi. Kuphatikiza apo, chiwindi cha odwala matenda ashuga, chomwe chimakhudzidwa ndi kuwonongeka kwamafuta, chimayesedwa pogwiritsa ntchito zida za ultrasound kapena tomograph.

Kukula kwa chiwalo, kusintha kwa mtundu wake ndi zizindikiro zotsimikizika za hepatosis yamafuta. Kupatula cirrhosis, chiwindi chokwanira chimatha kuchitika. Kuunika nthawi zambiri kumayikidwa ndi endocrinologist kapena gastroenterologist.

Zolondola kapena ayi? - mankhwala a matenda a shuga a chiwindi

M'magawo oyamba a matenda amafuta, chiwindi chokhudzidwa chimatha kubwezeretsedweratu. Chifukwa cha izi, madokotala amalimbikitsa kupatula zakudya zamafuta, zakumwa zoledzeretsa, zimapatsa phospholipids ofunikira pamapiritsi. Pambuyo pa miyezi itatu ya chithandizo chotere, chiwindi chake chimadwalanso.

Matenda a shuga amakhudza thupi lonse. Matenda a shuga ndi chiwindi ndi oyamba kulumikizana, chifukwa pali kuphwanya njira za metabolic zomwe zimakhudza gawo mwachindunji.

Mitundu yosiyanasiyana ya matenda ashuga imakhudza chiwindi, ina imayambitsa kuwonongeka msanga, inayo siyibweretsa zovuta kwazaka zambiri. Komabe, magwiridwe antchito a chiwindi amachitika pokhapokha pozindikira kuti mankhwalawa amachitika, apo ayi zotsatira zake sizingasinthe.

Matenda a shuga ayenera kuthandizidwa ndi njira zovuta. Poyamba, adotolo amawona zomwe zimayambitsa kukula kwa matendawa, ndikuti afotokozere njira zomwe zingathandize kuti athetse matendawa. Mankhwalawa, njira zosiyanasiyana zimaphatikizidwa, monga njira zamankhwala, chakudya, kusunga mankhwala olimbitsa thupi tsiku lililonse, kugwiritsa ntchito mavitamini, kuchepetsa thupi.

Zakudya za wodwala

Matenda a hepatatic, mosasamala za gawo la matenda ashuga, amafuna chakudya, owerenga shuga amawunikiranso. Zakudya zimafuna choletsa kwambiri mu mafuta, kupatula mafuta owonjezera, kukana mowa. Shuga samachotsedwa, m'malo mwa shuga mumagwiritsiridwa ntchito. Mafuta ophikira, mafuta a maolivi amakhala othandiza, ndipo chiwindi cha nkhuku zodala chimagwiritsidwa ntchito ngati chakudya.

Mankhwala ogwiritsira ntchito

Kugwiritsa ntchito moyenera matenda a endocrine system, ma pathologies a ziwalo zamkati ndi kosatheka popanda kusiya zizolowezi zoipa.

Ngati matenda a shuga akula, chiwindi chimakumana ndi chimodzi mwazomwe zasintha zamomwe zimachitika. Chiwindi, monga mukudziwa, ndi fyuluta, magazi onse amadutsa mkati mwake, insulini imawonongedwa mkati mwake.

Pafupifupi 95% ya anthu odwala matenda ashuga ali ndi vuto la chiwindi, lomwe limatsimikiziranso mgwirizano wapakati pa hyperglycemia ndi hepatopathology.

Zovuta zambiri za metabolic zama amino acid ndi mapuloteni zimadziwika, insulin imalephereka panthawi ya lipolysis, kuchepa kwamafuta sikulamulira, kuchuluka kwa mafuta acids kumawonjezeka, ndipo chifukwa chake, kukulira kwachangu kwakutulutsa.

Wodwalayo ayenera kufunsa dokotala kuti ayesedwe ngati chiwindi chikuyenda bwino, komanso ngati pali matenda amtunduwu: mtima atherossteosis, matenda amtima, matenda oopsa, kuchepa kwamitsempha, matenda oopsa, angina pectoris.

Pankhaniyi, kuyesedwa kwa magazi kwa Laborator kukuwonetsedwa pakupanga cholesterol, lipoproteins, bilirubin, glycated hemoglobin, zizindikiro za alkaline phosphatase, AST, ALT.

Malinga ngati chisonyezo chilichonse chikuwonjezereka, kudziwitsidwa mozama kwa thupi kumafunikira, izi zimathandiza kumveketsa bwino za matendawo ndikuzindikiritsa njira zina zamankhwala. Kudzipatsa nokha mankhwala ngati amenewa kumakhala kukuwonjezeka ndi matendawa.

Dokotala makamaka amatenga njira kuti athetse zinthu zomwe zimakhudza chiwindi. Kutengera ndi kuopsa kwa matenda, momwe thupi la wodwalayo limayendera, zotsatira za mayeso, mankhwala amathandizidwa kuti athetse vutoli.

Matenda a chiwindi kwa odwala omwe ali ndi matenda a shuga: njira zamakono komanso njira zamankhwala

Matenda a shuga mellitus (DM) ndivuto lalikulu lazachipatala komanso chikhalidwe cha anthu lomwe limakopa chidwi cha madokotala a zamitundumitundu yosiyanasiyana osati chifukwa chofala kwambiri komanso nthawi yayitali ya matendawa, komanso chifukwa chovuta kwambiri kuchokera ku ziwalo ndi machitidwe ambiri, makamaka thirakiti la m'mimba (GIT) )

Chiwerengero cha odwala matenda a shuga padziko lonse lapansi chikuwonjezeka chaka chilichonse. Malinga ndi WHO, pofika chaka cha 2025kuchuluka kwawo kudzafikira anthu 334 miliyoni. Chifukwa chake, ku United States, anthu 20,8 miliyoni odwala matenda ashuga (7% ya anthu), odwala opitilira 1 miliyoni omwe ali ndi matenda a shuga amalembetsedwa ku Ukraine (pafupifupi 2% ya anthu onse), ndipo malinga ndi kafukufuku wamatenda, chochitika chenicheni cha matenda ashuga m'dziko lathu ndi 2- Katatu.

Izi ndizachisanu ndi chimodzi pamndandanda wazomwe zimayambitsa kufa ndipo zimapangitsa 17.2% yaimfa pakati pa anthu opitilira 25. Chimodzi mwazomwe zimapangitsa kuti anthu azifa zimayenderana ndi matenda a shuga a 2 ndi matenda a chiwindi. Pakufufuza kwa anthu ku Verona Diabetes Study, cirrhosis ya chiwindi (CP) ili m'malo 4 pakati pa zomwe zimayambitsa kufa kwa matenda ashuga (4,4% ya chiwerengero chaimfa).

Kuonjezera apo, kuchuluka kwa anthu omwe amafa - kuchuluka kwa chochitika poyerekeza ndi kuchuluka kwa anthu ambiri - kwa CP anali 2.52 poyerekeza ndi 1.34 chifukwa cha matenda amtima (CVD). Ngati wodwala alandila mankhwala a insulin, chizindikiro ichi chimakwera mpaka 6.84.

Mu kafukufuku wina yemwe akuyembekezeredwa cohort, kuchuluka kwa CP monga chifukwa cha imfa mwa odwala matenda a shuga kunali 12,5%. Malinga ndi kuyerekezera kwaposachedwa, kuwonongeka kwa chiwindi ndi chimodzi mwazomwe zimayambitsa matenda ashuga. Cryptogenic CP, kuphatikiza yomwe imayambitsidwa ndi matenda ashuga, yakhala chizindikiro chachitatu chotsogolera pakufalikira kwa chiwindi m'maiko otukuka.

Kukula kwa matenda ashuga kumakhudza mbali ya chiwindi, kusokoneza kagayidwe ka mapuloteni, ma amino acid, mafuta ndi zinthu zina za hepatocytes, zomwe, zimatsimikizira kukula kwa matenda osachiritsika a chiwindi.

Pathogenesis ya shuga imakhazikika pazofooka zitatu za endocrine: kupanga insulin, kuphwanya mayankho a IR komanso kuwonongeka kwa chiwindi, osati kutsogolera kwa gluconeogenesis. Mwazi wamagazi umatsimikiziridwa pamimba yopanda kanthu ndikatha kudya. Chiwindi chimatulutsa shuga onse chifukwa cha kuwonongeka kwa glycogen (glycogenolysis) komanso kuphatikiza kwake (gluconeogeneis).

Nthawi zambiri pamimba yopanda kanthu, mulingo woyenera umapangidwa pakati pa kupanga shuga ndi chiwindi ndikugwiritsidwa ntchito ndi minofu. Mukatha kudya, poyankha kuchuluka kwa shuga m'magazi, kuchuluka kwa insulin kumakulirakulira. Nthawi zambiri, insulin imalimbikitsa kupangika kwa glycogen m'chiwindi ndipo imalepheretsa gluconeogeneis ndi glycogenolysis.

Ndi kukana kwa chiwindi ku ntchito ya insulin, ma metabolic asinthidwe: kaphatikizidwe ndi katulutsidwe ka glucose m'magazi kumawonjezeka, kuphwanya kwa glycogen kumayamba, ndipo mapangidwe ake ndi kudzikundikira kwa chiwindi sikuletsedwa. Ndi IR m'matumbo am'mimba, kudya kwa glucose ndikugwiritsa ntchito kwa khungu kumasokoneza.

Kulowetsedwa kwa shuga ndi minofu yodalira insulini kumachitika ndikuchita nawo gawo la GLUT-4. Kumbali ina, malinga ndi machitidwe a IR, kuchuluka kwakukulu kwamafuta acid (NEFA) amamasulidwa kulowa m'magazi, ndiko kuti, mu mitsempha ya portal. Kupyola m'mitsempha ya portal, owonjezera a NEFA amalowa m'chiwindi kudzera njira yayifupi kwambiri, komwe ayenera kutayidwa.

Komabe, m'zaka zaposachedwa, pokhudzana ndi kumvetsetsa bwino kwa kapangidwe ka kayendedwe ka chiwindi ndi matenda ashuga, mawu akuti "sichiri chidakwa chamafuta chiwindi" adayamba kuvomerezeka, kuphatikiza malingaliro a "sanali mowa" komanso "steatohepatitis", omwe ali ndi zizindikiro zofala ndi matenda a IR komanso amawonetsa kukula. kayendedwe ka matenda.

Odwala omwe ali ndi matenda a shuga a mtundu wachiwiri, pafupifupi chiwonetsero chonse cha matenda amchiwindi chimaphatikizidwa, kuphatikiza kupatuka kwa chiwindi michere, matenda osagonetsa mafuta a chiwindi (NAFLD), CP, hepatocellular carcinoma (HCC), komanso kulephera kwa chiwindi. Kuphatikiza apo, panali kuyanjana kwa matenda a shuga 1 ndi mtundu 2 ndi chiwindi C.

Mavuto a chiwindi osagwira bwino ntchito

M'mayeso anayi azachipatala omwe amaphatikiza odwala 3,701 omwe ali ndi matenda a shuga a 2, kuchokera 2 mpaka 24% ya odwala anali ndi kuchuluka kwa chiwindi kopitilira muyeso wapamwamba (VGN). Mu 5% ya odwala, matenda oyamba a chiwindi adapezeka.

Kufufuza mozama kwa anthu omwe ali ndi asymptomatic kuwonjezeka kwapakati mu ALT ndi AST kunawululira kupezeka kwa matenda a chiwindi mu 98% ya odwala. Nthawi zambiri, matendawa amakhala chifukwa cha mafuta a chiwindi kapena matenda oopsa a chiwindi.

Matenda a chiwindi osamwa mowa

NAFLD ndi amodzi mwa matenda ofala kwambiri a chiwindi m'maiko aku Europe ndi ku United States, omwe amapereka mwayi wokhala ndi mafuta a chiwindi pakadalibe mbiri yakumwa mowa mwauchidakwa (chiwindi cirrhosis)

CP ndi chimodzi mwazomwe zimayambitsa imfa zomwe zimagwirizanitsidwa ndi matenda a shuga. Malinga ndi autopsy, kuchuluka kwa chiwindi kwambiri mu chiwindi kwa odwala omwe ali ndi matenda ashuga ndikwachuluka kuposa kwa odwala opanda matenda a shuga. Maphunziro a CP ndi matenda ashuga amasokonezeka chifukwa chakuti maphunziro a CP omwewo amakhudzidwa ndikupanga IR.

Kuphatikiza apo, kulolerana kwa glucose kumawonedwa mu 60% ya milandu, komanso shuga yotsimikizika mu 20% ya odwala omwe ali ndi CP. Komabe, chiwonetsero cha matenda amtundu wa 2 kwa odwala omwe ali ndi CP nthawi zambiri kumayendetsedwa ndi kuchepa m'malo mochulukitsa katemera wa insulin. Izi zimapangitsa kusanthula kwa pathogenesis ya CP mu shuga ndikupanga zofunikira zogwirizana ndi kukonza mankhwala.

Pachimake chiwindi kulephera

Pafupipafupi kulephera pachimake chiwindi kwa odwala matenda ashuga ndi 2.31 pa anthu 10,000, poyerekeza ndi 1.44 ambiri. Mwinanso mankhwala osokoneza bongo kapena zinthu zina zimayambitsa chiopsezo chowonjezeka cha chiwindi champhamvu kwambiri m'gululi la odwala. Ziwerengero siziphatikiza milandu yovuta kwambiri ya chiwindi ndi troglitazone.

Kukula kwa matenda a chiwindi a hepatitis C (HCV) pakati pa odwala omwe ali ndi matenda amtundu wa 2 ndi matenda amtundu wa 2 ndiwokwera poyerekeza ndi kuchuluka. Matenda a shuga a Type 2 amapezeka kwambiri mwa anthu omwe ali ndi kachilombo ka HCV. M'tsogolomu, izi zatsimikiziridwa mobwerezabwereza.

Chenjezo: M'maphunziro osiyanasiyana, kuchuluka kwa matenda ashuga amtundu wa 2 kumawonekera mwa odwala omwe ali ndi vuto lalikulu la chiwindi chokhudzana ndi HCV poyerekeza ndi odwala omwe ali ndi kachilombo ka HIV komanso komwe sikunayambikiridwe ndi matenda (62 motsutsana ndi 24%), komanso poyerekeza ndi gulu lolamulira (13 ndi 3%) motsatana).

Kafukufuku wofufuzira wotchuka ku United States, komwe kunaphatikizapo odwala 1,117 omwe ali ndi matenda osachiritsika a hepatitis, kuchuluka kwa matenda a shuga 2 omwe ali ndi odwala omwe ali ndi HCV anali 21%, pomwe mwa odwala omwe ali ndi hepatitis B (HBV) anali 12% yokha.

Zochitika zomalizazi zikuwonetsa kuti, makamaka, HCV imakonzekera kukula kwa matenda ashuga, m'malo mwa matenda a chiwindi omwe. Odwala omwe adapangidwira chiwindi kwa HCV, matenda a shuga adayamba kupezeka kwambiri kuposa omwe adalandira matenda ena a chiwindi.

Masiku ano, pali chifukwa chilichonse chokhulupirira kuti HCV imachita mbali yofunika kwambiri ya matenda ashuga a mtundu 2. Izi zikutsimikiziridwa ndikuti puloteni yanyukiliya ya HCV imasokoneza insulin caserate reaction.
China chake cha HCV mu shuga ndi mtundu wa virus genotype.

Mgwirizano unadziwika pakati pa matenda omwe ali ndi HCV genotype 3 komanso kukula kwa chiwindi steatosis mu shuga. Zawonetsedwa kuti mwa odwala omwe ali ndi HCV, makamaka omwe ali ndi kachilombo ka genotype 3, komanso matenda a chiwindi chamafuta, kuchuluka kwa TNF-α kumachulukitsidwa ndipo adiponectin yafupika, zomwe zimapangitsa kutupa ndi steatosis ya chiwindi.

Imayambitsa kukhazikika kwa kuphatikiza kwa oxidative mu mitochondria ya hepatocytes ndi "kusefukira" kwamaselo ndi mafuta. Zaka zaposachedwa, deta yosangalatsa yapezeka pa kukhalapo kwa ubale pakati pa matenda ashuga komanso chithandizo cha matenda a HCV omwe ali ndi interferon-α. Zinawonetsedwa kuti matenda a shuga amtundu woyamba amatha kuchitika mwa odwala omwe amathandizidwa ndi interferon kwa HCV.

Nthawi yomaliza ya matenda ashuga imayamba masiku 10 mpaka 4 kuchokera pa chiyambi cha chithandizo. Masiku ano, kulumikizana pakati pa matenda a HCV, matenda ashuga ndi interferon ndi mutu wa kuphunzira kwambiri.

Kutengera ndi kuchuluka kwa miliri ya kufala kwa HCV pakati pa anthu odwala matenda ashuga, ndizomveka kupenda odwala onse omwe ali ndi matenda ashuga komanso okwera ALT a HCV.

Njira zamakonzedwe a odwala omwe ali ndi matenda a chiwindi ndi matenda a shuga a 2

Kutengera kuti osachepera 50% odwala omwe ali ndi matenda a shuga a 2 ali ndi NAFLD, odwala onse amayenera kuyesedwa ndi ALT ndi AST. Kuzindikira kwa NAFLD kapena NASH kuyenera kukayikiridwa mwa wodwala aliyense yemwe ali ndi matenda a shuga a 2, makamaka ngati mayeso amtundu wa chiwindi apezeka.

Tip: Malangizo apadera ayenera kuperekedwa kwa odwala omwe ali ndi matenda a shuga a 2 omwe ali ndi kuchuluka kwa thupi. Nthawi zambiri, ALT imakhala yokwanira 2-3 kuposa VGN, koma imatha kukhala yabwinobwino. Nthawi zambiri pamakhala kuwonjezeka kwapang'onopang'ono kwa milingo ya alkaline phosphatase ndi glutamyl transferase.

Miyezo ya Serum ferritin nthawi zambiri imakwezedwa, pomwe milingo yazitsulo ndi kulumikiza kwachitsulo kumakhalabe kwabwinobwino. 95% ya odwala matenda ashuga, mosasamala kanthu kuchuluka kwa kuchuluka kwa ALT ndi AST, ali ndi matenda a chiwindi osachiritsika.

Zomwe zimayambitsa kwambiri kuwonjezeka pang'ono kwa ALT / AST ndi NAFLD, HCV, HBV, ndi uchidakwa. Kumwa mowa wambiri (1, hypertriglyceridemia ndi thrombocytopenia.

Gulu lofufuzira ma seramu chikhodzodzo cha chiwindi fibrosis likukonzedwa, komwe kumalola kuwunika kwamphamvu kwa nthawi yayitali kuchuluka kwa fibrosis ndikugwiritsidwa ntchito kofala pachipatala.

Chithandizo cha NAFLD

Mpaka pano, palibe njira zamankhwala zochizira NAFLD, kapena malingaliro a FDA pakusankha kwa mankhwalawa chifukwa cha matendawa. Njira zamakono zochizira matenda amenewa zimangoyesetsa kuthetseratu kapena kufooketsa zinthu zomwe zimayambitsa chitukuko chake.

Kuchepetsa thupi, kukonza hyperglycemia ndi hyperlipidemia, kuthetsedwa kwa mankhwala omwe angakhale ndi hepatotoxic ndiye mfundo zazikulu zamankhwala a NAFLD. Kuthekera kwa chithandizo kunadziwika kokha mwa odwala omwe kuzindikira kwa NASH kumatsimikiziridwa ndi chiwindi biopsy kapena pali zinthu zomwe zili pamwambapa.

Kuyamba kwa chithandizo cha NASH ndikuchepetsa thupi komanso masewera olimbitsa thupi, omwe amalimbikitsa chidwi cha insulin ndikuchepetsa chiwindi cha steatosis. Komabe, kuchepa thupi msanga kumatha kuwonjezera necrosis, kutupa, ndi fibrosis, zomwe mwina zimachitika chifukwa chowonjezerera kuzungulira kwamafuta amafuta acid chifukwa cha kuchuluka kwa lipolysis.

Mulingo woyenera wonenepa sukudziwa; mulingo wokwanira 1.5 makilogalamu pa sabata. Popeza mafuta achete okwanira amathandizira IR, ndikofunikira kwa odwala omwe ali ndi NAFLD kuti azitsatira zakudya zambiri zamafuta ochulukirapo a monounsaturated fatty acid komanso otsika mu chakudya.

Mpaka pano, kuchuluka kwa kafukufuku wambiri kukuwonetsa kuchepa kwa hepatic steatosis panthawi ya chithandizo, komabe, kuyesedwa kwa nthawi yayitali kuti mudziwe njira yachilengedwe ya matendawa komanso kuthekanso kuyambiranso pambuyo poti chithandizo chachitika.

Kufunika! Kugwiritsa ntchito thiazolidinediones (pioglitazone, rosiglitazone), mankhwala omwe amachititsa kuti insulin ikhudzidwe, amathandizidwa ndi NAFLD motsutsana ndi matenda a shuga. Gulu la mankhwalawa liyenera kuonedwa ngati mankhwala osankhidwa.

Mayeso asanu ogwiritsa ntchito pioglitazone pakadutsa masabata 16-48 akuwonetsedwa pano, ndikuyesa kumodzi kwakukulu, kwamitundu yambiri, kumayesedwa koyesedwa ndi placebo. Maphunziro onsewa adawonetsa kuchepa kwa ma serum ALT ndipo ambiri mwa iwo amakhala otukuka mu chithunzi cha histological.

G. Lutchman et al. Dziwani kuti kugwiritsa ntchito pioglitazone, kuwonjezera kuchuluka kwa adiponectin, kutsika kwa glycosylated hemoglobin, komanso kukulitsa chidwi cha insulin, kunathandizira kusintha kwa mbiri ya mbiri ya chiwindi - kuchepa kwa steatosis, kusintha kwa kutupa, ndi chiwindi cha fibrosis.

Kukhazikitsidwa kwa rosiglitazone kwa odwala omwe ali ndi NAFLD omwe ali ndi matenda a shuga kwa masabata 24 kumathandizanso kukonza chithunzithunzi cha chiwindi. Kuchepetsa kwakukulu kwa ALT, AST, miyeso ya gamma-glutamyltranspeptidase ndi kusintha kwamphamvu kwa insulin kumawonedwa ndi rosiglitazone pa mlingo wa 8 mg / tsiku masabata 48.

Ponena za kugwiritsidwa ntchito kwa Biguanides (metformin), zimadziwika kuti cholinga chawo chimayambitsa kutsika kwa ALT, pomwe chithunzi cha mbiri sichimasintha. Cytoprotective mankhwala a NAFLD ndi matenda a shuga amachitika pogwiritsa ntchito ursodeoxycholic acid (UDCA) ndi ma phospholipids ofunikira (EF).

Kuchita bwino kwa UDCA kwawonetsedwa m'mayesero atatu oyembekezeredwa omwe akuwonetsa kuti amathandizira kuchepetsa kupsinjika kwa apoptosis. Kutha kwa EF kukhala ndi antioxidant, antifibrotic, komanso anti-yotupa kumapangitsa kuti mankhwalawa alimbikitsidwe kwa odwala omwe ali ndi NAFLD.

Chithandizo cha hepatitis C

Mankhwala othandizira kwambiri a HCV amachokera ku kuphatikiza kwa peferlated interferon ndi ribavirin. Mphamvu ya interferon pa insulin sensitivity ndi kulolerana kwa shuga yatsimikiziridwa.

Popeza njira zomwe sizingachitike zokhudzana ndi matenda a shuga pakati pa matenda ashuga, nthawi yamtunduwu ndikofunikira kuyang'anitsitsa kuchuluka kwa glycemia. Chosangalatsa ndichotsatira chamayeso omwe afalitsidwa posachedwa omwe akuwonetsa udindo wa hepatoprotective wa ma statins pa milandu ya matenda a HCV.

Kuwongolera glycemic

Pochita, madokotala samangoganiza za zovuta zomwe mankhwala a hypoglycemic angakhale nazo. Popereka mankhwala kwa odwala omwe ali ndi matenda a shuga omwe ali ndi matenda a chiwindi, munthu ayenera kukumbukira za zovuta zomwe zimapezeka mu metabolic, zomwe zimachitika pakati pawo ndi hepatotooticity.

Kuphwanya kagayidwe ka mankhwala, monga lamulo, kumawonedwa mwa odwala omwe ali ndi mbiri ya kulephera kwa chiwindi, ascites, coagulopathy, kapena encephalopathy.

Ngakhale metformin imagwiritsidwa ntchito ngati mankhwala a mzere woyamba kwa odwala ambiri, siyikulimbikitsidwa kwa odwala omwe akuwonongeka kwambiri kwa chiwindi chifukwa chowonjezera chiopsezo cha lactic acidosis. Poganizira za ntchito yogwiritsira ntchito troglitazone yochotsedwa pamsika wogulitsa mankhwala, funso loti hepatotoxicity ya thiazolidinediones imakhalabe phunziroli.

M'mayesero azachipatala ogwiritsa ntchito rosiglitazone ndi pioglitazone, kuwonjezeka kwaposachedwa katatu kwa ALT kumawonedwa ndi ma frequency ofanana ndi a rosiglitazone (0.26%), pioglitazone (0.2%) ndi placebo (0.2 ndi 0.25%) .

Komanso, mukamagwiritsa ntchito rosiglitazone ndi pioglitazone, chiopsezo chochepa kwambiri chokhala ndi vuto la chiwindi chachikulu chimadziwika kuposa kumwa troglitazone. Zidziwitso zalandiridwa ndi FDA ya milandu makumi asanu ndi atatu ya chiwindi ndi kuperewera kwa chiwindi pachimake chifukwa chothandizira ndi rosiglitazone ndi pafupifupi 37 milandu ya pioglitazone.

Chenjerani! Komabe, kulumikizana kwa kugwiritsa ntchito mankhwalawa sikunatsimikizike, popeza izi zinali zovuta ndi chithandizo chamankhwala othandizira odwala ndi matenda a mtima.
Pankhaniyi, asanagwiritse ntchito mankhwala a rosiglitazone ndi pioglitazone, tikulimbikitsidwa kuwunika mulingo wa ALT.

Kuchiza sikuyenera kuyambika ngati mukukayikira kuti akudwala matenda a chiwindi kapena kuchuluka kwa ALT wopitilira nthawi zopitilira 2,5 VGN. Pambuyo pake, ndikofunikira kuyang'anira ma enzyme a chiwindi miyezi iwiri iliyonse. Sulfonylureas, yomwe imalimbikitsa insulin katulutsidwe, imakhala yotetezeka kwa odwala omwe ali ndi matenda a chiwindi, koma osakhudza IR.

Odwala omwe ali ndi decompensated CP, ndiye kuti, kukhalapo kwa hepatic encephalopathy, ascites kapena coagulopathy, makonzedwe awa a mankhwalawa sakhala othandiza nthawi zonse pokhudzana ndi standardoglycemia. Chlorpropamide imatsogolera pakupanga kwa hepatitis ndi jaundice. Chithandizo cha repaglinide ndi nateglinide sichimayenderana ndi kukula kwa hepatotoxicity.

Ma A-glycosidase inhibitors ali otetezeka kwa odwala omwe ali ndi matenda a chiwindi, chifukwa amakhudza mwachindunji matumbo am'mimba, amachepetsa mayamwidwe a carbohydrate ndi postprandial hyperglycemia. Kuphatikiza apo, acarbose awonetsedwa kuti ndi othandiza pochiritsa odwala hepatic encephalopathy ndi matenda a shuga 2.

Mukamachita insulin mankhwala mwa odwala omwe ali ndi matenda a chiwindi, muyezo wa insulin umatha kuchepetsedwa chifukwa cha kuchepa kwa mphamvu ya gluconeogeneis ndi insulin metabolism. Nthawi yomweyo, odwala omwe ali ndi vuto la chiwindi amatha kukhala ndi chidwi chambiri chifukwa cha kupezeka kwa IR, komwe kumafunikira kuwunika mosamala glycemia komanso kusintha kwa pafupipafupi kwa mankhwala.

Zochizira odwala omwe ali ndi hepatic encephalopathy omwe amafunikira chakudya chamagulu omwe amalimbikitsa kukula kwa postprandial hyperglycemia, insulin analogi yogwira ntchito ingagwiritsidwe ntchito.

Pofupikitsa, ziyenera kudziwika kuti shuga imayenderana ndi matenda osiyanasiyana a chiwindi, kuphatikizapo kuchuluka kwa michere ya chiwindi, kapangidwe ka matenda a chiwindi chamafuta, CP, HCC ndi kulephera kwa chiwindi. Pali ubale wotsimikizika pakati pa kukhalapo kwa matenda ashuga ndi HCV.

Ofufuza ambiri amawona NAFLD ngati gawo la IR syndrome. Malangizo othandizira odwala NAFLD mwa odwala omwe ali ndi matenda ashuga, komanso kuphatikiza matenda a shuga ndi matenda a chiwindi, sanapangidwebe, ndipo palibe malingaliro kuchokera pamipangidwe yaukadaulo yofotokoza umboni pokhudzana ndi machitidwe oyang'anira a odwala otere.

Pankhani imeneyi, pochita tsiku lililonse, adokotala, choyambirira, ayenera kuwongoleredwa ndi chifukwa chomwe chikuyambitsa matendawa. Kafukufuku wokhudzana ndi zochitika ziwiri zamatenda - njira yotupa yomwe imayambira m'chiwindi komanso kuperewera kwa insulin - ndi gawo lolimbikitsa lamankhwala amakono.

Matenda a shuga komanso mafuta a chiwindi

Kodi shuga imagwirizana bwanji ndi chiwindi? Likukhalira kuti chilichonse ndi chosavuta. Magazi athu amayendetsedwa mwanjira yoti zinthu zonse zomwe zimayikiridwa m'mimba ndipo matumbo amatengedwa m'matumbo kulowa m'magazi, omwe kenako amalowa m'chiwindi.

Kuphatikiza pa kuchuluka kwambiri m'mimba mwa kapamba, chifukwa amayenera kugaya chakudya chonsechi, katundu wambiri amapangidwa pa chiwindi ndi gawo loyendetsera kapamba. Chiwindi chimayenera kudutsa mafuta onse kuchokera pachakudyacho, ndipo chimakhala ndi zowonongeka.

Chofunikira! Zikondwererozi zimayenera “kuyika” mafuta onse ndi shuga omwe amalandiridwa ndi chakudya - chifukwa mulingo wake uyenera kukhala wokhazikika. Chifukwa chake thupi limasintha chakudya chamafuta kukhala mafuta ndikuwonekanso kuwonongeka kwamafuta pachiwindi! Ndipo kapamba wamasamba, amakakamizidwa kuti apange ma homon enanso ochulukirapo.

Mpaka nthawi inayake, pamene kutupa kumayamba. Ndipo chiwindi, chomwe chimakhala chikuwonongeka nthawi zonse, sichimalira mpaka penapake. Kodi metabolic syndrome ndi chiani? Ziwalo zonse zija zikaonongeka ndikuyatsidwa, zomwe zimadziwika kuti metabolic syndrome zimayamba.

Kuphatikiza Zinthu 4 zikuluzikulu:

1. chiwindi steatosis ndi steatohepatitis,
2. matenda a shuga kapena matenda a shuga
3. kuphwanya kagayidwe kachakudya mafuta m'thupi,
4. kuwonongeka kwa mtima ndi mitsempha yamagazi.

Hepatic steatosis ndi steatohepatitis

Mafuta onse omwe amapezeka amakhala ndi cholesterol, triglycerides ndi lipoprotein osiyanasiyana. Amadziunjikira m'chiwindi mokulira, amatha kuwononga ma cell a chiwindi ndikupangitsa kutupa. Ngati mafuta ochulukirapo sangathe kusungidwa konse ndi chiwindi, amatengedwa ndi magazi kupita ziwalo zina.

Kukhazikika kwa mafuta ndi cholesterol m'mitsempha yamagazi kumabweretsa kukula kwa atherosulinosis. Mtsogolomo, zimayambitsa chitukuko cha matenda a mtima, matenda a mtima ndi stroko. Kukhazikika kwa mafuta ndi cholesterol kumawononga kapamba, kusokoneza kagayidwe kakang'ono ka shuga ndi shuga mthupi, potero kumathandizira kukulitsa shuga.

Mafuta omwe amaphatikizidwa m'chiwindi amadziwika ndi ma free radicals, ndipo peroxidation yawo imayamba. Zotsatira zake, mitundu yosinthika yazinthu imapangidwa yomwe imakhudzanso chiwindi.

Amayambitsa maselo ena a chiwindi (maselo okhathamira) ndipo minyewa yabwinobwino ya chiwindi imayamba kulowa m'malo mwa minyewa yolumikizira. Fibrosis ya chiwindi imayamba. Chifukwa chake, kusintha konse kokhudzana ndi kagayidwe ka mafuta m'thupi kumawononga chiwindi. kumabweretsa chitukuko cha:

• steatosis (kuchuluka kwa mafuta m'chiwindi),
• steatohepatitis (kusintha kwa kutupa m'chiwindi cha mafuta),
• chiwindi fibrosis (kapangidwe ka minyewa yolumikizana ndi chiwindi),
• matenda a chiwindi (kuwonongeka kwa chiwindi chonse ntchito).

Kodi ndi liti ndipo mukayikira bwanji zosinthazi?

Choyambirira, muyenera kuyamba kufuula alamu omwe adapezeka kale. Zitha kukhala Chimodzi mwazinthu zotsatirazi:

• atherosulinosis
• dyslipidemia,
• matenda a mtima
• angina pectoris
• myocardial infaration
• postinfarction atherosulinosis,
• ochepa matenda oopsa
• matenda oopsa
• matenda ashuga
• kulolerana kwa shuga,
• insulin kukana
• kagayidwe kachakudya matenda
• hypothyroidism.

Ngati muli ndi imodzi mwazodziwira pamwambapa, funsani dokotala kuti ayang'anire mawonekedwe a chiwindi, komanso kusankha mankhwala. Ngati chifukwa cha mayeso mwawonetsa kupatuka kwa magawo amodzi kapena angapo a labotale yoyesesa magazi.

Mwachitsanzo, cholesterol yokwezeka, triglycerides, lipoprotein, kusintha kwa glucose kapena glycosylated hemoglobin, komanso kuwonjezeka kwa zizindikiro za chiwindi - AST, ALT, TSH, alkaline phosphatase, nthawi zina bilirubin.

Malangizo! Ngati mulingo wina wa magawo awiri kapena zingapo ndiwokwera, funsaninso dokotala kuti afotokozere zaumoyo wanu, chitulukiraninso matenda ena ndikuwapatseni mankhwala. Ngati muli ndi chimodzi mwazizindikiro kapena zowopsa zomwe zingayambitse matenda, muyenera kuonana ndi dokotala kuti akuuzeni zowopsa zake.

Kapenanso onani kufunika koyezetsa ndi kulandira chithandizo. Zomwe zimayambitsa kapena zizindikiro za metabolic syndrome ndizonenepa kwambiri, m'chiuno kwambiri, kuwonjezeka kwa magazi pafupipafupi, kugwiritsa ntchito mafuta ochulukirapo kapena zakudya zokazinga, zotsekemera, ufa, mowa.

Kodi dokotala angavomereze chiyani? Mulimonsemo, pamaso pa matenda kapena kukhalapo kwa zowonetsa pakuwunikira kapena kupezeka kwa zizindikiro ndi zinthu zowopsa, upangiri waukatswiri ndi wofunikira! Muyenera kulumikizana ndi akatswiri angapo nthawi imodzi - katswiri, cardiologist, endocrinologist ndi gastroenterologist.

Ngati muli ndi vuto lotereku m'chiwindi, mungathe kulumikizana ndi gastroenterologist kapena hepatologist. Dokotala adzazindikira kuopsa kwa vutoli kapena kuopsa kwa matendawa, kutengera izi, ngati kuli kufunikira kwenikweni, sankhani mayeso ndikukuwuzani zomwe zikuwoneka kuti zili bwino pakuwunika kumeneku.

Asanachitike, atapima matendawa kapena atadwala, adokotala amatha kukupatsani chithandizo, izi zimatengera kuuma kwa zizindikiro ndi zovuta zomwe zapezeka. Nthawi zambiri zochizira matenda a chiwindi mafuta kuphatikiza shuga, ndiko kuti pamaso kagayidwe kachakudya matenda Mankhwala angapo amagwiritsidwa ntchito:

1. kukonza chiwindi,
2. kutsitsa cholesterol,
3. kubwezeretsa chidwi chathupi lathupi ku glucose,
4. kutsitsa magazi,
5. kuchepetsa chiopsezo cha matenda a mtima ndi mikwingwirima, ndi ena ambiri.

Sizowopsa kuyesa palokha kusinthidwa kwa mankhwala kapena kusankha kwa mankhwala! Funsani dokotala kuti amupatse chithandizo!

Zomwe mankhwala amagwiritsidwa ntchito kuti abwezeretse chiwindi

Udindo wofunikira kwambiri pa mankhwalawa umaseweredwa pochepetsa thupi, kuwonjezera masewera olimbitsa thupi, chakudya chapadera chokhala ndi cholesterol yochepa komanso mafuta othamanga, kutengera momwe zinthu zilili, mwina mungaganizire "magawo a mkate" Zochizira matenda amchiwindi, pali gulu lonse la mankhwala otchedwa hepatoprotectors.

Kunja, gulu la mankhwalawa limatchedwa cytoprotectors. Mankhwalawa ali ndi chikhalidwe chosiyana ndi kapangidwe kazinthu - pali mankhwala azitsamba, kukonzekera kwa chiyambi cha nyama, mankhwala opangira. Inde, zomwe mankhwalawa amapanga ndizosiyana ndipo amagwiritsidwa ntchito makamaka matenda osiyanasiyana a chiwindi.

M'mikhalidwe yovuta, mankhwala angapo amagwiritsidwa ntchito nthawi imodzi. Zochizira matenda amafuta a chiwindi, kukonzekera kwa ursodeoxycholic acid ndi ma phospholipids ofunikira nthawi zambiri amapatsidwa. Mankhwalawa amachepetsa lipid peroxidation, kukhazikika ndikukonza maselo a chiwindi.

Chifukwa cha izi, zowonongeka zamafuta ndi ma free radicals zimachepetsedwa, kusintha kwa chiwindi, njira zopangira minofu yolumikizira imachepetsedwa, chifukwa chake, kukula kwa fibrosis ndi cirrhosis ya chiwindi kumachepetsedwa.

Kukonzekera kwa ursodeoxycholic acid (Ursosan) kumathandizanso kwambiri zimagwira ma cell, motero zimalepheretsa kuwonongeka kwa maselo a chiwindi komanso kukula kwa kutupa m'chiwindi. Ursosan amakhalanso ndi choleretic zotsatira ndikuwonjezera mafuta a cholesterol pamodzi ndi bile.

Ichi ndichifukwa chake ntchito yake yomwe imagwiritsidwa ntchito mu metabolic syndrome. Kuphatikiza apo, Ursosan imakhazikika ndulu ya ndulu yomwe imagwiritsidwa ntchito mu ndulu ndi kapamba, imapereka gawo labwino pa ziwalo izi, zomwe ndizofunikira kwambiri kapamba.

Matenda a chiwindi chamafuta, kuphatikiza matenda a shuga ndi shuga, amafunika kugwiritsa ntchito mankhwala ena mankhwalawo. Nkhaniyi imapereka chidziwitso chochepa cha njira ndi njira zochizira matenda a chiwindi. Kuzindikira kumafunikira kupita kwa dokotala kuti akapeze njira yoyenera yolandirira!

Matenda a shuga ndi chiwindi

Chiwindi ndi chimodzi mwazomwe zimakumana ndi kusintha kwa matenda ashuga. Matenda a shuga ndi vuto lalikulu la endocrine lomwe limalepheretsa kugwira ntchito kwa pancreatic, ndipo chiwindi ndi chifanizo chomwe magazi onse amadutsa ndi komwe insulin imawonongedwa.

Mu 95% ya odwala matenda ashuga, kupatuka komwe kumagwira ntchito kwa chiwindi kumapezeka. Izi zikuwonetsedwa ndi mfundo yoti hepatopathology ndi kukhalapo kwa matenda a shuga ndizogwirizana.

Zosintha mu chiwindi ndi shuga

Zosintha zamaproteni kagayidwe ndi ma amino acid zimachitika, kupatuka kambiri kumapezeka. Thupi likayamba kumenya nkhondo, insulin imaletseka panthawi ya lipolysis. Kuwonongeka kwamafuta kumakhala kosalamulirika. Pali chiwerengero chopanda malire cha mafuta acids aulere. Mphamvu yotupa imayamba.

Nthawi zina, zotupa zimafotokozedwa ndi pathologies odziimira, mwa ena, kupweteka kwa hepatocellular carcinoma. Ndi matenda amtundu woyamba 1, chiwindi chimakulitsidwa, kupweteka palpation. Mseru wambiri ndi kusanza, kupweteka kumatheka. Ichi ndi chifukwa cha hepatomegaly, kukulira motsutsana ndi maziko a acidosis yayitali.

Kuwonjezeka kwa glycogen kumapangitsa kuti chiwindi chiwonjezeke. Ngati shuga adakwezedwa, makonzedwe a insulin amawonjezera glycogen kwambiri, chifukwa chake, poyambira chithandizo, hepatomegaly imakulitsidwa. Kutupa kungayambitse fibrosis. Kusintha kosasintha kumachitika m'ziwindi za chiwindi; chiwindi chimataya magwiridwe antchito.

Osati chithandizo chimatsogolera ku imfa ya hepatocytes, cirrhosis imachitika, limodzi ndi insulin. Ndi matenda 2 a shuga, chiwindi chimakulidwanso nthawi zambiri, m'mphepete