Mtundu 1 ndi Matenda A shuga A 2: Njira ya Ma Pathophysiology ndi Chithandizo

Mtundu Woyamba wa Matenda A shuga(insulin yodalira matenda a shuga, mtundu 1 wa matenda a shuga, matenda ashuga) -nthendayoChizindikiro chachikulu chodziwitsa za matenda ake omwe ali aakuluhyperglycemia- shuga wambiri,polyuriaZotsatira zake -ludzukuchepa thupi, kulakalaka kwambiri, kapena kusowa kwake, thanzi labwino.Matenda a shugalimachitika mosiyanasiyanamatendazikupangitsa kuchepa kaphatikizidwe ndi katulutsidweinsulin. Udindo wa cholowa chofufuzira ukufufuzidwa.

Mtundu woyamba wa shuga(shuga wodalira insulin, shuga mwana) - matenda a dongosolo la endocrine, amadziwika ndi kuperewera kwambiri kwa insulin chifukwa cha kuwonongekamaselo a betakapamba. Matenda a shuga a Type 1 amatha kukhala ndi zaka zilizonse, koma anthu azaka zazing'ono kwambiri (ana, achinyamata, achikulire osakwana 30) nthawi zambiri amakhudzidwa. Chithunzi cha chipatala chimayendetsedwa ndi zizindikiro zapamwamba:ludzu,polyuriakuwondaketoacidotic zinthu.

1Etiology ndi pathogenesis

2.1Gulu la a Efimov A.S., 1983

2.2Gulu la Katswiri a WHO (Geneva, 1987)

2.3Gulu (M.I. Balabolkin, 1994)

3Pathogenesis ndi histopathology

4Chithunzi cha kuchipatala

Etiology ndi pathogenesis

Njira ya pathogenetic ya chitukuko cha matenda a shuga 1 imachokera ku kuperewera kwa insulin yopanga maselo a endocrine (β maselozilumba za Langerhanskapamba), yoyambitsidwa ndi chiwonongeko chawo mothandizidwa ndi zina za tizilombo (tizilombomatenda,kupsinjika,matenda a autoimmunendi ena). Mtundu woyamba wa matenda a shuga umakhala ndi 10% ya matenda onse a shuga, nthawi zambiri amakula ubwana kapena unyamata. Mtunduwu wa shuga umadziwika ndi mawonekedwe azizindikiro zazikulu, zomwe zimapita patsogolo mofulumira. Njira zazikulu zakuchiritsira ndijakisoni wa insulinkusintha wodwala kagayidwe. Ngati sichinapatsidwe matendawa, mtundu 1 wa shuga umapita patsogolo mwachangu ndipo umabweretsa zovuta zazikulu mongaketoacidosisndiwodwala matenda ashugakutha kwa imfa ya wodwala.

Gulu

Gulu la Efimov A.S., 1983

I. Mitundu yazachipatala:

Poyamba: chibadwa, chofunikira (ndi onenepakapena popanda icho).

Sekondale (chisonyezo): pituitary, steroid, chithokomiro, adrenal, kapamba (kutupa kwa kapamba, zotupa kapena kuchotsa), mkuwa (ndi hemochromatosis).

Matenda a shuga apakati(ofatsa).

II. Mwa kuwopsa:

III. Mitundu ya matenda a shuga (mtundu wa maphunzirowa):

mtundu - wodalira insulini (olemetsa ndi chizolowezi cha acidosisndihypoglycemia, makamaka unyamata),

mtundu - osagwirizana ndi insulin(khola, matenda osokoneza bongo okalamba).

IV. Carbohydrate kagayidwe kachakudya gawo:

V. Kupezekamatenda ashuga angiopathy(I, II, siteji ya III) ndimitsempha.

Microangiopathy—retinopathy,nephropathy, capillaropathy ya malekezero kapena kutulutsa kwina.

Macroangiopathy- ndi chotupa chachikulu cha ziwiya za mtima, bongo,mapazi,kutengera kwina.

Universal micro- ndi macroangiopathy.

Polyneuropathy(zotumphukira, kudziyimira pawokha kapena visceral).

VI.Zilonda za ziwalo zina ndi machitidwe:hepatopathy,mphira,dermatopathy,Matendawandi ena).

VII. Zovuta za matenda ashuga:

Gulu la Katswiri a WHO (Geneva, 1987)

Gulu (M.I. Balabolkin, 1994)

Pathogenesis ndi histopathology

Kuperewera insulinm'thupi limakula chifukwa chobisalira mosakwaniraβ maselozilumba za Langerhanskapamba.

Chifukwa cha kuchepa kwa insulin, zimakhala zodalira insulin (otupa,mafutandimwamisempha) ataya kugwiritsa ntchito glucosemagaziZotsatira zake, kuchuluka kwa glucose m'magazi kumakwera.hyperglycemia) Ndi chizindikiro chodziwitsa matenda ashuga. Chifukwa cha kuchepa kwa insulin, kuchepa kwamafuta kumalimbikitsidwa mu minofu ya adipose.mafuta, zomwe zimabweretsa kuwonjezeka kwa mulingo wawo m'magazi, ndipo m'misempha minofu - kuvunda kumalimbitsidwamapulotenizomwe zimatsogolera pakukula kwambirima amino acidm'magazi. Magawocatabolismmafuta ndi mapuloteni amasinthidwa ndi chiwindi kukhalamatupi a ketoneomwe amagwiritsidwa ntchito ndi minofu yosadalira insulini (makamakabongo) kukhalabe ndi mphamvu moyenera motsutsana ndi maziko a kuchepa kwa insulin.

GlucosuriaNdi njira yosinthira yochotsa glucose yayikulu m'magazi pamene gawo la glucose liposa gawo lakeimpsomtengo (pafupifupi 10 mmol / l). Glucose ndi chinthu chomwe chimagwira ntchito kwambiri komanso kuwonjezeka kwake m'mikodzo kumapangitsa kuti madzi azikhala amtopola (polyuria), yomwe pamapeto pake ingayambitsekusowa kwamadzichamoyoNgati madzi samatayika chifukwa chomwa madzi okwanira (polydipsia) Pamodzi ndi kuwonjezeka kwa madzi mu mkodzo, mchere wamchere umasungidwanso - kuchepa kwa zinthu kumayambamawusodium,potaziyamu,calciumndimagnesium,anionsmankhwala a chlorine,phosphatendibicarbonate .

Pali magawo 6 a chitukuko cha matenda a shuga a mtundu woyamba (wodalira insulin):

Kutengera kwa chibadwa cha matenda ashuga omwe amalumikizana ndi dongosolo la HLA.

Zoyambira kuyerekezera. Zowonongeka β maseloosiyanasiyana diabetogenic zinthu ndi zomwe zimayambitsa chitetezo cha mthupi. Odwala ali kale ndi ma antibodies opita ku ma islet cell omwe ali ndi gawo laling'ono, koma kutulutsidwa kwa insulin sikuvutikabe.

Yogwira autoimmune insulin. Antibody titer ndi yokwera, kuchuluka kwa β-cell kumachepetsa, insulin secretion imachepa.

Kuchepetsa shuga. Pamavuto, wodwalayo amatha kuwona kuloza kwapang'onopang'ono kwa glucose (NTG) ndikutsitsa shuga wa plasma glucose (NGF).

Mawonetseredwe azachipatala a shuga, kuphatikiza ndi gawo la "chikondwerero cha tchuthi". Katemera wa insulini amachepetsedwa kwambiri, monga 90% ya β-cell anafa.

Kuwonongeka kwathunthu kwa maselo a β, kuthetseratu kwathunthu kwa insulin.

Pathological physiology: ndi chiyani?

Pathological physiology ndi sayansi yomwe cholinga chake ndikuphunzira moyo wa munthu wodwala kapena chinyama.

Cholinga chachikulu cha ulendowu ndikuphunzira momwe mungapangire chitukuko cha matenda osiyanasiyana komanso njira yakuchiritsira, komanso kudziwa malamulo akuluakulu othandizira pamagulu osiyanasiyana ndi ziwalo za odwala.

Zomwe kafukufuku wamaphunziro a matenda:

• Kukhazikika kwa njira zosiyanasiyana zamatenda, komanso zotulukapo zawo,
• mitundu ya matenda.
• chikhalidwe cha kukula kwa ntchito zolimbitsa thupi kutengera mkhalidwe wamthupi la munthu wokhala ndi ma pathologies osiyanasiyana.

Pathophysiology ya matenda ashuga

Amadziwika kuti makina a pathophysiological pakupanga mtundu wa matenda a shuga I amachokera ku insulin yaying'ono yomwe imapangidwa ndi maselo a endocrine.

Kwenikweni, matenda a shuga amapezeka mu gawo lino mwa 5-10% ya odwala, pambuyo pake, popanda chithandizo chofunikira, amayamba kupita patsogolo ndipo amakhala chifukwa cha zovuta zambiri, kuphatikizapo:

• matenda ashuga
• kulephera kwa aimpso
• ketoacidosis
• matenda ashuga retinopathy,
• sitiroko
• zilonda zam'mimba za matenda ashuga.

Chifukwa cha kuperewera kwa insulin, minofu yodalira timadzi timatenda ta shuga timatha kuyamwa shuga, izi zimabweretsa ku hyperglycemia, chomwe ndi chimodzi mwazinthu zazikulu za mtundu 1 shuga mellitus.

Chifukwa cha kupezeka kwa njirayi mu adipose minofu, lipids imasweka, yomwe imakhala chifukwa chowonjezera gawo lawo, ndipo njira yothetsera kuwonongeka kwa mapuloteni imayambira minofu minofu, zomwe zimapangitsa kuti ayambe kudya ma amino acid.

Matenda a shuga a Type II amatha kudziwika ndi kuperewera kwa insulin, komwe kumatha kukhala ndi mitundu itatu yamatenda:

1. chodabwitsa cha insulin kukana. Pali kuphwanya kukhazikitsa zotsatira za insulin, pomwe ma cell a β-amasungidwa ndipo amatha kupanga insulin yokwanira,
2. chinsinsi cha β-cell kusowa. Kuphwanya kumeneku ndi vuto la chibadwa lomwe ma β maselo saphwanya, koma katulutsidwe ka insulin kamachepetsedwa kwambiri,
3. zotsatira za zotsutsana.

Kupezeka kwa kukana kwa insulin kumatha kuchitika pa receptor ndi postreceptor.

Njira zolandirira ndi monga:

• chiwonongeko cha ma receptor ndi ma radicals aulere ndi ma enzymes a lysosome,
• blockade of insulin receptors ndi ma antibodies omwe amatsata mawonekedwe ake,
• kusintha kwa mapangidwe a insulin receptors chifukwa cha kupezeka kwa vuto la majini,
• kuchepa kwa chidwi cha zigawo za cell kuti insulini ichitike chifukwa cha kuchuluka kwakukulu kwa insulin m'magazi mwa anthu omwe amadya mopitirira muyeso,
• kusintha kwa mapangidwe a insulin receptors chifukwa cha chilema mu majini omwe amayang'anira kapangidwe ka polypeptides awo.

Njira zopangira postreceptor zimaphatikizapo:

• kuphwanya njira zina zapakati pazochotsa shuga,
• kusakwanira kwa transmembrane glucose onyamula. Izi zimawonedwa makamaka mwa anthu onenepa kwambiri.

Matenda Asemva

Anthu odwala matenda ashuga ayenera kuwunika bwino momwe alili, kunyalanyaza malangizo a dokotala kungawongolere zovuta zosiyanasiyana:

• zovuta pachimake. Izi zimaphatikizapo ketoacidosis (kuchuluka kwa matupi owopsa a ketone m'thupi), hyperosmolar (shuga wambiri ndi sodium mu plasma) ndi lacticidotic (ndende ya lactic acid m'magazi) chikomokere, hypoglycemia (kuchepa kwakukulu kwa shuga m'magazi),
• zovuta zovutaine. Kuwonekera, monga lamulo, patatha zaka 10-15 kukhalapo kwa matendawa. Mosasamala kanthu za momwe amathandizidwira, matenda ashuga amakhudza thupi, zomwe zimayambitsa zovuta, ziwalo zotere zimavutika: impso (kusokonezeka ndi kusakwanira), mitsempha yamagazi (kuvulala kwakanthawi, komwe kumasokoneza kudya zakudya zopindulitsa ndi mpweya), khungu (magazi ochepa, zilonda zam'mimba). ), dongosolo lamanjenje (kutaya mtima, kufooka ndi ululu),
• zovuta mochedwa. Zotsatira zotere nthawi zambiri zimayamba pang'onopang'ono, komanso zimavulaza thupi la odwala matenda ashuga. Pakati pawo: angiopathy (kusokonekera kwa mitsempha yamagazi), phazi la matenda ashuga (zilonda zam'mimba komanso zotupa zofananira zam'munsi), retinopathy (kuthana ndi retina), polyneuropathy (kusowa kwa chidwi ndi manja ndi mapazi kutentha ndi kupweteka).

Njira za patathophysiological zochizira matenda a shuga

Matenda a shuga amawopa mankhwalawa, ngati moto!

Muyenera kungolemba ...

Pochiza matenda amtundu uliwonse a shuga, madokotala amagwiritsa ntchito mfundo zitatu izi:

1. chithandizo cha hypoglycemic,
2. maphunziro odwala
3. chakudya.

Chifukwa chake, ndi mtundu woyamba, chithandizo cha insulin chimagwiritsidwa ntchito, popeza odwalawa amamva kuperewera konse, ndipo amafunikira cholowa m'malo. Cholinga chake chachikulu ndikukulitsa kutsanzira kwa mahomoni achilengedwe.

Mlingo uyenera kutsimikiziridwa ndi dokotala wopita kwa wodwala aliyense payekhapayekha. Pankhani ya odwala matenda ashuga amtundu wa 2, mankhwalawa amagwiritsidwa ntchito omwe amachepetsa shuga ya magazi poyambitsa kapamba.

Lamulo lofunika la chithandizo cha matendawa ndi lingaliro lolondola la wodwalayo kwa iye. Madokotala amatha nthawi yayitali kuphunzira njira yoyenera yokhalira ndi matenda ashuga.

Zakudya zimasinthidwa kwambiri, zizolowezi zoyipa ndi kupsinjika zimachotsedwa, zolimbitsa thupi zolimbitsa thupi zimawonjezeredwa, ndipo wodwalayo adzafunikiranso kuyang'anira chizindikiro chamagazi a magazi (pali glucometer pazomwezi).

Mwina, odwala amazolowera zakudya zapadera (tebulo No. 9) kwa nthawi yayitali.

Zimafunika kuphatikizidwa kwa zinthu zambiri, kapena zina. Mwachitsanzo, nyama zamafuta, nsomba ndi ma broth, makeke ndi maswiti, tchizi chokoleti, zonona, tchizi zamchere, batala, pasitala, semolina, mpunga woyera, zipatso zotsekemera, zakudya zamzitini (kuphatikiza zamasamba zamzitini), misuzi shuga wamkulu, koloko.

Zakudya zina zimatha kudyedwa, koma muyenera kuwunika kuchuluka kwa zopatsa mphamvu zomwe zimadyedwa patsiku, komanso kuchuluka kwa chakudya - sikuyenera kukhala zochuluka za izo.

Mwamwayi, pafupifupi m'masitolo onse pano pali dipatimenti yomwe ili ndi zinthu zomwe zimaloledwa kwa odwala matenda ashuga, zomwe zimapangitsa moyo wawo kukhala wosavuta.

Pathological physiology ya matenda ashuga

Kuperewera kwa insulin m'matenda a shuga kumayambitsa kuchepa kwa kuthamanga kwa shuga m'magazi ndi hyperglycemia. Makamaka shuga a m'magazi am'magazi amawonedwa atangotha ​​kudya (otchedwa postprandial hyperglycemia).

Nthawi zambiri, aimpso a glomeruli satha kulowa glucose, koma ndi plasma yomwe ili pamtunda wa 9-10 mmol / l, umayamba kupukusidwa mwachangu mkodzo (glucose-ria). Izi zimathandizira kuwonjezeka kwa osmotic kukakamiza kwa mkodzo, komanso kutsika kwa kubwezeretsanso kwa madzi ndi ma elekitiroma ndi impso. Kuchuluka kwa mkodzo watsiku ndi tsiku kumawonjezeka mpaka malita 3-5 (malita 7-8 ovulala kwambiri), i.e. akupanga poly uria Zotsatira zake, kutaya mtima (Hypohydration) chamoyo (mkuyu. 27.1) kuti

Mkuyu. 27.1. The pathophysiology ya insulin akusowa.

Mkuyu. 27.1. Pathophysiology

limodzi ndi ludzu lalikulu. Popanda insulin, kuwonongeka kwambiri kwa mapuloteni ndi mafuta kumachitika, zomwe zimagwiritsidwa ntchito ndi maselo ngati mphamvu zamagetsi. Mbali imodzi, thupi limataya nayitrogeni (mwanjira ya urea) ndi ma amino acid, ndipo, mbali inayo, limapeza mankhwala oopsa a lipolysis - ma ketoni 1. Omaliza amachita gawo lofunikira kwambiri mu pathophysiology ya shuga mellitus: kuchotsa ma asidi amphamvu mthupi, omwe ndi acetoacetic ndi p-hydroxybutyric acids, kumabweretsa kuchepa kwa buffer cations, kufooka kwa mchere wamchere ndi ketoacidosis. Makamaka chidwi ndi kusintha kwa osmotic kuthamanga kwa magazi ndi magawo a acid-maziko olimba a minyewa yaubongo. Kuwonjezeka kwa ketoacidosis kungayambitse ketoacidotic chikomokere, ndipo pambuyo pake kuwonongeka kosasintha kwa mitsempha ndi kufa kwa wodwalayo.

Matenda a shuga amayambitsa zovuta zingapo, zina ndizovuta kwambiri kuposa matenda a shuga ndipo zimatha kuyambitsa kulumala ndi kufa. Mavuto ambiri amatengera kuwonongeka kwa mitsempha yamagazi chifukwa cha atherosulinosis ndi glycosylation (i.e., glucose imamangidwa ndi mamolekyulu a protein).

Mavuto akulu a shuga:

• atherosulinosis, yomwe imatsogolera pakukula kwa zovuta zazikulu: myocardial infarction ndi stroke. Atherosulinosis ndiyomwe imayambitsa imfa mu 65% ya odwala matenda ashuga,

• nephropathy (kuwonongeka kwa impso) ndi kupitilira kwa matenda aimpso kulephera (9-18% ya odwala),

1 Acetyl-CoA, yomwe imapangidwa m'chiwindi pakachulukidwe kakang'ono ka mafuta acids, kenako imasinthidwa kukhala acetoacetic acid, yomwe idzasinthidwa kukhala β-hydroxybutyric acid kenako decarboxylated kukhala acetone. Zinthu zopangidwa ndi lipolysis zimatha kupezeka m'magazi ndi mkodzo wa odwala (omwe amatchedwa ma ketones kapena matupi a ketone).

Matenda a shuga - pafupifupi 485

• neuropathy (makamaka zotumphukira zamitsempha zimakhudzidwa),

• retinopathy (kuwonongeka kwa retina komwe kumatsogolera khungu) ndi ma catalo (kuchepa kwa mawonekedwe a mandala)

• kuchepa kwa thupi kukana matenda,

• zovuta zamtundu wa pakhungu (ndikupangika kwa zilonda zamkati zosachiritsa). Olekanitsa odwala matenda ashuga phazi (matenda, zilonda ndi / kapena kuwonongeka kwa minyewa yakuzama ya phazi), yomwe imalumikizidwa ndi mitsempha ya mitsempha (neuropathy) ndi kuchepa kwa kuthamanga kwa magazi (angiopathy) m'mitsempha yam'munsi. Matenda a shuga a matenda ashuga ndiwofala kwambiri wa matenda ashuga.

Tsiku Lowonjezera: 2016-03-15, Views: 374,

Matenda a shuga mellitus pathophysiology

Koma, kuti apangitse mapangidwe azakudya zamafuta ambiri, amafunika kupeza malonyl-CoA mwa carboxylation ya acetyl-CoA. Monga tafotokozera pamwambapa, kukonzekera kwa izi kumalepheretsedwa ndi mahomoni opanga, ndipo ma acetyl-CoA onse omwe atulutsidwa kuchokera ku mitochondria amatumizidwa ku kapangidwe ka cholesterol.

Hypertriacylglycerolemia. Kuchulukitsidwa kwama asidi ambiri m'magazi omwe amawonedwa mwa odwala omwe ali ndi matenda ashuga (onani pamwambapa) kumathandizira kulowetsa kwawo mu cytoplasm of hepatocytes. Koma kugwiritsa ntchito mafuta acids pazinthu zamagetsi sikukula, chifukwa sangathe kudutsa nembanemba wa mitochondria (chifukwa cha kuchepa kwa insulin, ntchito yonyamula, dongosolo la carnitine, yasokonekera). Ndipo kudziunjikira mu cytoplasm ya maselo, mafuta acids amagwiritsidwa ntchito ku lipogenesis (mafuta ofooketsa chiwindi), amaphatikizidwa mu VLDL ndikutulutsidwa m'm magazi.

Dyslipoproteinemia. Kusintha konseku pamwambapa kwa lipid metabolism (kuphatikiza cholesterol synthesis, LP glycosylation) kumathandizira kuti pakhale kuchuluka kwa VLDL, LDL ndi kutsika kwamodzimodzi pamiyezo ya HDL.

Kuphwanya kwa peroxide homeostasis. Monga mukudziwa, hypoxia, chikhalidwe cha matenda ashuga, ndi imodzi mwazomwe zimayambitsa lipid peroxidation. Komanso, chifukwa cha kuletsa kwa PFP, kuchira kwa NADP +, komwe kuli kofunikira kwambiri monga gawo la chitetezo chotsutsa.

Hyperazotemia. Mwachikhalidwe, liwulo limatanthauzira kuchuluka kwa zomwe zimakhala ndi zinthu zochepa zamankhwala okhala ndi urogenrogen (urea, amino acid, uric acid, creatine, creatinine, ndi zina). Hyperaminoacidemia mu matenda a shuga amayamba chifukwa cha: 1) kuperewera kwamitsempha yama cell kwa amino acid, 2) kutsika kosagwiritsidwa ntchito kwa amino acid mu protein ya biosynthesis, chifukwa kuchuluka kwa PFP - gwero la nthiti-5-phosphate - gawo lama mononucleotides - omwe amapanga RNA - masanjidwewo m'mapuloteni amachepetsa (Chiwembu 1). Zilonda zonse ziwiri (1,2) zimachitika chifukwa cha kuchepa kwa insulin. Ndipo mahomoni ambiri otsutsana a mahomoni ochulukirapo amakhala ndi mphamvu ya catabolic (Table 2), i.e. yambitsa proteinolysis, yomwe imaperekanso hyperaminoacidemia.

Kuphatikiza apo, kuphwanya kugwiritsidwa ntchito kwa glucose kwa mphamvu zamagetsi m'matenda a shuga chifukwa cha zomwe zimachitika pakubwera kwa mahomoni amomwe amachititsa kuchuluka kwa gluconeogenesis (Scheme 2), makamaka kuchokera ku ma amino acid ndikuwonjezera kuwonongeka kwa ma ketogenic amino acid ndikupanga matupi a ketone - magwero abwino a mphamvu. Chimodzi mwazinthu zomaliza zakusintha konseku ndi ammonia, komwe sikunasakanizidwe ndi kapangidwe ka urea. Chifukwa chake, ndi matenda a shuga m'magazi, gawo lalikulu la chinthuchi limalembedwa (hypercarbamidemia).

Kuchepetsa mphamvu yoteteza. Chifukwa cha kuchepa kwa insulin, kuchuluka kwa kapangidwe ka mapuloteni amachepetsa (onani pamwambapa), kuphatikizapo immunoglobulins. Komanso, ena a iwo, atatha glycosylation (onani pamwambapa), ataya katundu wawo, motero chitukuko cha odwala omwe ali ndi matenda a pustular, furunculosis, etc.

Kuchulukitsa kwa magazi a osmotic chifukwa cha kuchuluka kwa zophatikiza zama cell ochepa (glucose, amino, keto acids, lactate, PVC, ndi zina).

Kuthetsa madzi m'thupi (kuchepa madzi m'thupi) kwamisempha chifukwa cha kuthamanga kwa magazi a osmotic.

Acidosis chifukwa cha kuchuluka kwa zinthu acidic (acetoacetate, β-hydroxybutyrate, lactate, pyruvate, etc.).

Zosiyanasiyana ndizamaas. Glucosuria, ketonuria, aminoaciduria, lactataciduria, etc. - chifukwa chowonjezera mphamvu zawo zapamwamba.

Kuwonjezeka kwamphamvu kwamkodzo, chifukwa cha kusintha kwa uria osiyanasiyana.

Polyuria a) Kuchotsa zinthu zosiyanasiyana pamafunika madzi owonjezera,

b) chifukwa cha polydipsia.

Polydipsia. Kuchulukitsa ludzu chifukwa cha kuthinana kwa osmotic m'madzi am'magazi komanso chifukwa cha kuchepa kwa madzi mkodzo.

Polyphagy. Chizindikiro chimodzi komanso chachikulu cha matenda ashuga. Chifukwa cha kuchepa kwa insulini, kupezeka kwa membrane kwa glucose, amino acid, ndi mafuta acids ambiri, i.e. magazi ndi "odzala", ndipo maselo "ali ndi njala."

Kusintha kwa kagayidwe kameneka kumawopseza kukula kwa zovuta zingapo (pachimake komanso chovuta).

Mavuto owopsa kwambiri:

Hyperosmolar concretless chikomokere

Maulalo apamwamba a matenda a shuga a ketoacidosis ndi hyperglycemia (oposa 10 mmol / l), motero glucosuria, plasma hyperosmolarity, hyperketonemia, chizindikiro chomaliza ndi chomwe chimayambitsa metabolic acidosis (kuchepa kwa zomwe zili m'magazi a bicarbonates a plasma). Chifukwa chake, mu impso mukuchedwa kuchepa kwa H +, komwe kumakulitsa acidosis, kusangalatsa kupumira, kumachepetsa ndikuchepetsa kupuma - Kussmaul kupuma, CO2 imachotsedwa, zomwe zimachepetsa kuopsa kwa acidosis, koma nthawi yomweyo kuperewera kwa bicarbonates kumawonjezeka. Chizindikiro chapamwamba pankhaniyi ndi kununkhira kwa acetone kuchokera mkamwa. Ketoacidosis imayambitsidwa ndi zakudya zomwe zimakhala ndi mafuta ambiri ndipo imalephereka pamaso pa chakudya.

Maziko a diabetesic lactic acidosis ndikutukuka kwa hyperlactacidemia (onani pamwambapa), yomwe imayendetsedwa ndi minofu hypoxia komanso kuphwanya boma la acid-base.

Hyperosmolar bezketonny coma imadziwika kwambiri kwa odwala azaka zapakati ndi zaka. Amadziwika ndi hyperglycemia yapamwamba (zoposa 55 mmol / l), mwachidziwikire, kuchokera pano kukwera kowopsa mu osmolarity wa madzi am'magazi, mawonekedwe a glucose mumkodzo, omwe amachititsa osmotic diureis (kutayika kwa madzi ndi ma elekitirodi. Mosiyana ndi vuto loyamba, mwa odwala hyperketonemia ndi ketonuria sanalembedwe.

Hypoglycemic coma imayamba ndi bongo wambiri

Ketoacidosis

Ndi chotsatira chake matenda ashuga ndi glycosuria pang'ono, ketoacidosis kulibe. Kuchuluka kwa asidi acetoacetic omwe amapangika pakuwonongeka kwakukulu kwamafuta acids, ofunika kulipirira kutayika kwa glucose, sizidutsa zomwe zingagwiritsidwe ntchito ndi thupi posinthanitsa. Komabe, ngati kuchepa kwa glucose ndikofunikira kwambiri (100-200 g patsiku), ndiye kuti kuchuluka kwamafuta omwe amagwiritsidwa ntchito kumakhala kwakukulu kwambiri kotero kuti mapangidwe a matupi a ketone amayamba kupitirira mphamvu zomwe thupi limatha kuzigwiritsa ntchito.

Ketones kudziunjikira m'magazi ndi kuthira mkodzo. Acetoacetic ndi b-hydroxybutyric acid amachotsedwa mu mawonekedwe awo omwe amapanga ndi ma cations, sodium ndi potaziyamu amataika, kukulitsa kuchepa kwa zinthu zosafunikira zogwirizana ndi kuchepa kwa glucose, komanso chizolowezi chomwe chilipo kale cha metabolic acidosis. Mu nyama monga nkhumba ndi mbalame, zomwe thupi lake limatha kugwiritsa ntchito bwino kuchuluka kwa acetoacetic acid, kapamba sayambitsa ketoacidosis. Kuwonongeka kwa mafuta acids sikufika pamlingo wokulirapo, ndipo matenda ashuga sindiwo matenda oopsa monga mwa anthu ndi agalu.

Mwanjira imeneyi ketoacidosis, komwe ndi chizindikiro cha matenda akulu a shuga, ndizotsatira za kupangika kwa glucose komanso kutayika kwa thupi. Glucosuria, chifukwa cha kuyambitsa kwa floridzine, ngakhale imayambitsa hypoglycemia, imayambitsa ketoacidosis, komanso pakusala, komwe kukhutitsidwa kwa zosowa za thupi kumatsimikiziridwa ndikuwonongeka kwa malo ogulitsa mafuta komanso mapuloteni omwe amapanga shuga.
Muzochitika zonsezi, kusintha komwe kumayambitsidwa ndi mawu oyamba shuga, chifukwa chakuti imalepheretsa kuchuluka kwa shuga m'chiwindi.

Zamkatimu za mutu wa "Matenda a Thymus ndi Pancreas":

Thymus anatomy.

Mtundu 1 ndi Matenda A shuga A 2: Njira ya Ma Pathophysiology ndi Chithandizo

5. Pathogeneis

Kukula kwa abscess pamalo oyamba a michere kumayambira ndi kuphatikizika kwa minofu yokhala ndi serous kapena serous-fibrinous exudate, kudzikundikira kwazinthu zambiri zama cell, makamaka zigawo zama cell oyera. Chifukwa chake ...

Kafukufuku wokhudza luso la ntchito za ma paramedics popewa komanso kuchiza matenda a hematological mu ana

3. Pathogenesis

Ulalo wofunikira kwambiri mu pathogenesis ya PON ndi zovuta zam'magazi komanso endothelial microvasculature. Sizomwe zimayambitsa, ndipo nthawi zina sizochuluka ndi kuchepa kwa magwiridwe a mtima ...

Zoyambitsa ndi zotsatira za kupsinjika kwa magwiridwe antchito

Kuchokera pamawu omwe amafotokoza za kupsinjika kwa magwiridwe antchito, zimatsata kuti "zimayambitsa" ndi zovuta za kusintha kwamikono ...

4 Pathogenesis

The pathogenesis ya pneumocystosis imatsimikiziridwa ndi kwachilengedwe kwa tizilombo toyambitsa matenda komanso mkhalidwe wa chitetezo chamthupi cha wolandila. Mitundu yowonjezereka ya pneumocyst yomwe siyinafotokozedwebe idutsa njira yapamwamba yopumira ...

Kukula kwa njira za toxocariasis agalu

Wotsutsa nkhani yasayansi pankhani zamankhwala ndi zaumoyo, wolemba pepala lasayansi ndi Kurbatov D.G., Dubsky S.A., Lepetukhin A.E., Rozhivanov R.V., Schwartz Y.G.

Izi zikuwunikanso za matenda a matenda a m'magazi, gulu, pathophysiology, komanso kuwunika ndi kuchiza kwa erectile kukanika kwa odwala omwe ali ndi matenda a shuga 1. Kuchepa kwa Erectile kwa odwala achinyamata omwe ali ndi matenda ashuga ndi vuto lalikulu chifukwa kufalikira kwake, komanso momwe zimakhudzira thanzi la odwala komanso moyo wabwino. Zinanenedwa kuti kupezeka kwakanthawi kokwanira ndi tanthauzo lolondola la erectile dysfunction kumakupatsani mwayi wosankha bwino wodwala aliyense payekhapayekha.

KUDZICHEPETSA KWAULERE KWA AMAVUTA NDI MALO OYAMBIRA 1: DIAGNOSIS NDI NJIRA ZOTHANDIZA

Mukuwunikanso kwa mabukuwa kukuwonetsa za miliri, gulu, pathophysiology, kuzindikira ndi kuchiza kwa erectile kukanika kwa odwala omwe ali ndi matenda a shuga 1. Kuchepa kwa Erectile kwa odwala achinyamata omwe ali ndi matenda osokoneza bongo ndi vuto lalikulu chifukwa chofala, komanso kukhudzidwa kwa malingaliro ndi odwala komanso moyo wabwino ambiri. Anatsimikiza kuti kuwunika kwakanthawi kokwanira ka mtundu wina wa kusokonekera kwa erectile kukhoza kusankha wodwala aliyense payekhapayekha.

Zolemba za ntchito yasayansi pamutu wakuti "Erectile Dysfunction in Type 1 Diabetes Patients: Diagnostic and Njira za Chithandizo"

UDC: 616.69-008.14: 616.379-008.64

Kuchepa kwa Erectile kwa Odwala omwe ali ndi Type 1 Diabetes Mellitus:

DIAGNOSTIC NDI NJIRA ZOTHANDIZA

Kurbatov D.G., Dubsky S.A., Lepetukhin A.E., Rozhivanov R.V., Schwartz Y.G.

Federal State Budgetary Institution Endocrinological Science Science Center of the Ministry of Health of Russia, Moscow adilesi: 117036, Moscow, ul.Dm. Ulyanova, 11, tel. (499) 3203687 Imelo: [email protected]

Izi zikuwunikanso za matenda a matenda a m'magazi, gulu, pathophysiology, komanso kuwunika ndi kuchiza kwa erectile kukanika kwa odwala omwe ali ndi matenda a shuga 1. Kuchepa kwa Erectile kwa odwala achinyamata omwe ali ndi matenda ashuga ndi vuto lalikulu chifukwa kufalikira kwake, komanso momwe zimakhudzira thanzi la odwala komanso moyo wabwino. Zinanenedwa kuti kupezeka kwakanthawi kokwanira ndi tanthauzo lolondola la erectile dysfunction kumakupatsani mwayi wosankha bwino wodwala aliyense payekhapayekha.

Mawu osakira: shuga mellitus, kukanika kwa erectile

KUDZICHEPETSA KWAULERE KWA AMAVUTA NDI MALO OYAMBIRA 1: DIAGNOSIS NDI NJIRA ZOTHANDIZA

Kurbatov D. G., Dubskiy S.A., Lepetukhin A.E. Rozhivanov R. V., Schwartz J. G.

Endocrinology Research Center, Moscow

Mukuwunikanso kwa mabukuwa kukuwonetsa za miliri, gulu, pathophysiology, kuzindikira ndi kuchiza kwa erectile kukanika kwa odwala omwe ali ndi matenda a shuga 1. Kuchepa kwa Erectile kwa odwala achinyamata omwe ali ndi matenda opha matenda a shuga ndi vuto lalikulu chifukwa kuli ambiri, komanso kukhudzidwa kwa malingaliro ndi malingaliro a anthu ambiri. Anatsimikiza kuti kuwunika kwakanthawi kokwanira ka mtundu wina wa kusokonekera kwa erectile kukhoza kusankha wodwala aliyense payekhapayekha.

Mawu ofunikira: matenda a shuga, kukanika kwa erectile

Kuchuluka kwa matenda ashuga padziko lapansi kukukula mwachangu. Malinga ndi International Diabetes Federation, anthu opitilira 371 miliyoni lero ali ndi matenda a shuga mellitus (DM). Pafupifupi 10% ya odwala onse omwe ali ndi matenda a shuga amawerengetsa mtundu woyamba wa shuga.

Zovuta zakugonana zomwe zimadziwika ndi kuchepa kwa moyo

ngakhale wodwala, zomwe zimabweretsa kubala komanso mavuto amtundu wina, amawonedwa muoposa 40% ya odwala omwe ali ndi matenda a shuga a mtundu wa 2. Ndikofunikira kudziwa kuti zovuta zakugonana kwa odwala omwe ali ndi matenda amtundu woyamba 1 amapangitsa kuti aziyamba kubereka poyerekeza ndi kuchuluka kopanda matenda a shuga.

Kuphwanya kwakukulu kwa ntchito yogonana kwa odwala matenda ashuga ndi erectile dysfunction (ED). Kafukufuku wambiri wawonetsa

kuti ED imakhudza mpaka 35-55% ya odwala omwe ali ndi matenda amtundu 1, ndipo chiopsezo cha ED kwa odwala matendawa ndi 3 kuchulukirapo poyerekeza ndi kuchuluka kopanda matenda ashuga.

Pafupipafupi pachitukuko cha zovuta za erectile kwa odwala omwe ali ndi matenda ashuga sizimangotengera zaka za wodwalayo, komanso kutalika kwa matenda omwe amayambira komanso kutalika kwa nthawi yowonongeka ya kagayidwe kazakudya 7, 8. Kukula kwa ED kumakhudzidwa ndi kukhalapo kwa matenda ophatikizika, zovuta za matenda ashuga komanso kutha kwa mankhwalawa. Chifukwa chake, mu maphunziro angapo, ubale pakati pa kukhalapo kwa ED ndi zovuta za matenda ashuga adawerengera ndipo adawonetsedwa kuti ED amapezeka pafupipafupi kawiri mwa odwala omwe ali ndi matenda ashuga a nephropathy kapena retinopathy.

Diagntile erectile dysfunction kwa odwala omwe ali ndi matenda ashuga ikhoza kukhala chizindikiro chosakhudza kukula kwa dongosolo la atherosselotic ndi matenda a mtima, komanso kukhala chiwonetsero choyamba cha matenda ashuga a mtima, 11, 12. Kafukufuku wofanana ndi Rozhivanov R.V. (2005) pamaziko a Federal State Budgetary Institution "Endocrinological Sayansi Center" a Ministry of Health of the Russian Federation, akuwonetsa ofanana ndi kuchuluka kwakunja kwa kuchuluka kwa ED pakati pa odwala omwe ali ndi matenda amtundu wa 1 ndi 2, kuchuluka kwa matendawa kumadalira msinkhu wa odwala, kutalika kwa matendawa, komanso ubale ndi mulipidwe

chakudya kagayidwe kachakudya ndi kupezeka kwa zovuta za matenda ashuga.

Popeza kuchuluka kwa ED mu mtundu 1 wa matenda ashuga, komanso kumvetsetsa kuti matendawo samangochepetsa moyo wa odwala, komanso atha kukhala chimodzi mwazovuta za matenda ashuga, monga matenda ashuga a mtima, matenda a mtima, matenda a mtima, njira yodziwikiratu komanso yodziwika bwino. Kuzindikira ndi kulandira chithandizo cha ED m'gululi.

• Organic (vasculogenic, neurogenic, endocrine)

• Zosakanikirana (organic pathology and psych factor)

Ntchito zogonana

membala amayendetsedwa ndi yosalala minofu kamvekedwe ka ziwiya ochepa ndi trabecula cavernous matupi. Pambuyo pakukondweretsedwa, kugonana kwa nitric oxide (NO), wopangidwa ndi endothelium, kumakulitsa kuchuluka kwa guanylate cyclase (GMF). Kuchulukitsa kwa cyclic GMF (cGMP) kumabweretsa mpumulo wa minofu yosalala, kuwonjezeka kwa ochepa ndi veno-occlusion mu mbolo. Kuwola kwa cGMP kumadalira ntchito ya enzyme 5-phosphodiesterase.

Kukula kwa ED mu matenda ashuga kumatha kukhazikitsidwa pazinthu zingapo nthawi imodzi.

moat (atherosulinosis + neuropathy, neuropathy + psychogenic factor, etc.).

Penile erection imayendetsedwa ndi ma isoforms osiyanasiyana a NO-syn-tetase ya neuronal, endothelial ndi yosalala minofu chiyambi. . Pali mitundu ingapo ya michere yomwe imafotokoza zomwe zimayambitsa matenda osokoneza bongo a erectile. Zomwe zimapangidwira mtima ndi neurogenic palimodzi ndizomwe zimayambitsa ED mu shuga, chifukwa zimadziwika kuti kusokonekera kwa endothelial kumabweretsa kukula kwa ischemic neuropathy, yomwe, imakhala ndi vuto pa NO synthesis. Kafukufuku wambiri akuwonetsa kupsinjika kwa endothelial-kudalira komanso kupumula kwa neurogenic m'matupi a cavernous odwala omwe ali ndi matenda a shuga. Kupeza kumeneku kumalumikizidwa ndi kusowa kwa NO. Komanso, maphunziro ena akunja awonetsa kuwonjezeka kwakukulu kwa malo osagwirizana ndi NO-synthetase-zomangamanga mu minofu ya matupi a rat caousous miyezi iwiri itatha kuperekedwa kwa matenda osokoneza bongo. Ndondomeko iyi ndi yofanana ndi yomwe imapezeka m'mabedi ena amitsempha, pomwe kupumula kwa endothelium kukhazikika kwamasamba kunasinthidwa chifukwa cha kuphatikizika kwa NO chifukwa chifukwa cha kutsekeka kwakukulu kwa glucose. Chifukwa chake, vuto la ntchito ya NO synthetase limagwira gawo la etiology ya ED odwala omwe ali ndi matenda ashuga, chifukwa chopatsa endothelial dis-

ntchito. Zinawonetsedwanso kuti kupumula kwa maselo osalala owoneka bwino m'matupi am'kati mwa odwala omwe ali ndi matenda ashuga panthawi ya kukondoweza kwamagetsi anali ofatsa chifukwa cha kuchepa kwa kupanga kwa nitric oxide ndi NO synthetase. Ndikofunikira kudziwa kuti hyperglycemia yomwe imatenga nthawi yayitali ikuchulukitsa kumwa kwa nicotinamide adenine dinucleotide phosphate (NADPH), cofactor pakupanga NO, chifukwa chake, kuchepetsa kuchuluka kwa nitric oxide.

Kuchulukitsa kwaulere kwakakonzedwe kameneka kumathandizanso kupumula kwa NO-komwe kumapangitsa kuti pakhale kupendekera kwapamwamba kwa mankhwala a glycation end-product (AGE) ozungulira m'magazi, omwe amakhalanso ndi vuto la matenda a shuga.

Zogulitsa za AGE, kudziunjikira odwala omwe ali ndi matenda ashuga, zimalumikizana ndi ma membrane a minofu omwe amapezeka ndi zotupa zam'mimba, komanso zimawonjezera kuyankhula kwa oyimira pakati owonongeka a mtima, kumasulidwa kwake komwe kumalimbikitsidwanso ndi shuga. 21, 22, 23.

Zinthu zonsezi pamwambapa zimaphatikizidwa mu pathophysiology yamatenda amtima omwe amadziwika ndi kupha kwakukulu (kupweteka kosavulaza kwa myocardial ischemia, kufa kwadzidzidzi kwamtima, ndi zina zambiri), omwe amagwirizana kwambiri ndi ED.

Neuropathy ndi gawo lofunikira pakupanga matenda ashuga

ED Kuwonongeka kwa morphological kwa ulusi wa mitsempha yodziyimira mu minofu ya matupi a cavernous mwa odwala omwe ali ndi matenda a shuga adawonetsedwa. Kukhalapo kwa zotumphukira za polyneuropathy kumawerengedwa kuti ndiwowonekera kwa odwala omwe ali ndi ED, komabe, kuchepa kwa kuthamanga kwa mphamvu ya mitsempha m'mitsempha ya mitsempha ndi kusinthasintha kwa mtima kumalembedwa mochulukira kwambiri kwa odwala omwe ali ndi matenda ashuga komanso ED kuposa odwala omwe ali ndi ED ndi polyneuropathies ochokera kwina.

Ntchito zambiri zomwe zimaperekedwa pakusintha kwamitsempha yamagetsi mu odwala matenda a shuga amalankhula zodziyimira pawokha zowonongeka m'mitsempha yamitsempha.

Autonomic neuropathy imawoneka ngati chinthu chachikulu cha pathogenetic ku ED kwa odwala matenda a shuga. Odwala omwe amawonetsedwa ndi zotumphukira za neuropathy amatha kuvutika ndi ED kuposa odwala omwe ali ndi matenda osokoneza bongo opanda polyneuropathy. Cholimba kwambiri cha metabolic hypothesis ndicho chiphunzitso cha polyol metabolism, malinga ndi momwe shuga yambiri mu shuga imapangidwira ndi mtundu wa polyol, pamapeto pake imasandulika kukhala sorbitol ndi fructose, kudzikundikira komwe m'maselo a mitsempha kumayambitsa kukula kwa neuropathy. Kufunika kwa hyperglycemia mu chitukuko cha matenda ashuga a m'mimba kumatsimikiziridwa ndimachidziwitso kuti, ngati chipepeso chimakwaniritsidwa,

levodic kagayidwe, kupita patsogolo kwa matenda ashuga amachepetsa 40-60%.

Vasculogenic hypothesis yokhudzana ndi kukhazikika kwa mitsempha, potengera kutsika kwa magazi a endoneural, kuchuluka kwa mitsempha ya endoneural komanso kuchepa kwa okosijeni wamitsempha, kumakhalanso kofunikira. Malinga ndi chiphunzitso ichi, kusintha kwa ma pathological m'matumbo am'mimba komanso hypoxia yomwe ikukhudzana ndi ischemia ndiyofunikira.

Zonsezi pamwambapa zikuwonetsa gawo lofunikira la zotumphukira za neuropathy pakukula kwa ED mwa odwala matenda a shuga. Olemba ambiri amati izi ndi "neurogenic ED," potero amalabadira gawo lotsogolera la matenda ashuga a mtima mu zovuta za erectile mwa odwala 31, 32.

Pamodzi ndi mitundu ya vasculogenic ndi neurogenic ya ED mu shuga, endocrine ED yokhudzana ndi kuchepa kwa androgen ndizofala.

Kafukufuku waposachedwa akuwonetsa kuti NO synthetase ndimtundu wa androgen wodalira. Kudalira kwa androgenic kwa NO synthetase kumawonetsedwa ndi chakuti mu maselo amitsempha am'mimba a pelvic parasympathetic ganglia, ma androgen receptors amapezeka momwe kuphatikiza kwa NO ndi vasoactive intestinal peptide kumachitika, komanso kusangalatsa kwa NO synthesis mu ganglia motsogozedwa ndi androgens. Nthawi yomweyo

hypogonadism ndi chizindikiro chofala kwa odwala matenda ashuga. Zomwe zimayambitsa kusowa kwa androgen mwa amuna omwe ali ndi matenda ashuga ndizosiyana. Izi zimatha kukhala zonenepa kwambiri kapena kunenepa kwambiri, komanso kuchepa kwa zaka ndi mphindikati kwa testosterone. .

Kuzindikira kwa ED odwala omwe ali ndi matenda ashuga

Kuyesedwa kwa wodwala yemwe ali ndi matenda a shuga kumachitika molingana ndi dongosolo lakale, kuphatikiza deta ya mbiri yakale yakuchipatala, kufufuza, komanso njira za labotale ndi zothandizira.

Chofunikira pakusonkhanitsa anamnesis odwala omwe ali ndi matenda ashuga ndikuwunika komwe kumayambira matenda, kupezeka kapena kusapezeka kwa zovuta za matenda ashuga, zambiri zamankhwala omwe amwedwa.

Mukamayesedwa, kuyeza kulemera kwa thupi, kutalika ndi index ya thupi kumachitika, chifukwa kunenepa kwambiri kumatha kuyambitsa hypogonadism. Nthawi zina, zimakhala zomveka kuwunikira kosiyanitsa kwamafuta a visceral pogwiritsa ntchito Sc scan kuti aunike mozama komanso kuwonetseratu kuwopsa. Kuphatikiza apo, momwe khungu limakhalira, chikhalidwe chake komanso kukula kwake kwa tsitsi, mkhalidwe wama minofu ndi amitundu 39, 40 amawunika.

Pakufufuzidwa kwakuthupi, kuti mupeze neuropathy, ndikofunikira kukwaniritsa kuchepa kwapadera kwa mitsempha

njira. Chothandiza kwambiri ndikuwunika kwa cavernous Reflex. Kuwunikanso kutentha, kusangalatsa komanso makulidwe a mbolo kungalimbikitsidwenso.

Mndandanda wa njira zapadera zoyeserera za ED zimaphatikizapo kuyesa magazi m'magazi, kuyang'anira zotupa za usiku, ma caprousvernous pharmacodynamic maphunziro, cavernosography, angiography ya ziwiya za penile, dopplerografia ya ziwiya za penile ndikuwonetsa kuthamanga kwa kufalikira kwa mitsempha yodutsitsa ndi n .р ^ е ^ ш.

Njira zonse zoyesedwa pamwambazi zimagwiritsidwa ntchito pofufuza ED ya mtundu wina uliwonse, komabe, njira yothandiza kwambiri komanso yokhayo yodziwira mawonekedwe a neurogenic a ED mu shuga ndi electroneuromyography. Kuyesedwa komwe kumawunikira momwe zinthu zilili pakuphatikizika kwa ulusi wophatikizira umaphatikizaponso electromyography ya nthawi yaposachedwa ya bulbocavernous Reflex, mayeso obisika obisika, kuwunika kwa mphamvu yolumikizira dorsal somatosensory komanso kusanthula kwamphamvu kwa kuzindikira. Odwala omwe ali ndi matenda ashuga ndi ED amadziwika ndi kupatuka kwa zotsatira za mayesowa kuchokera ku chizindikiro chodziwika bwino. Mwachitsanzo, kwa odwala matenda a shuga amadziwika ndi kuwonjezeka

nthawi yaposachedwa ya bulbocavernos Reflex. Komabe, mayeso omwe afotokozedwa pamwambapa samapereka lingaliro la boma la chidziwitso chodziyimira pawokha chomwe chimayambitsa ma penile erection. Kutengera ndi zomwe tafotokozazi, polembetsa kupatuka kwa zotsatira zoyeserera kuchokera kwabwinobwino, titha kungoganiza za kukhalapo kwa autonomic neuropathy mu mbolo.

Monga njira yowerengera za kudziyimira pawokha, magetsi a minofu yosalala ya cavernous amatha kujambulidwa pogwiritsa ntchito ma electrodes amkati kapena pamunsi. Zomwe zapezedwa pogwiritsa ntchito njirayi zimatithandizira kuti tidziwe momwe ntchito yamkati ya neuro-Reflex imathandizira kudziwa zovuta zomwe zimachitika pamlingo wogwirizana wa Corpora cavernosa ndi mathero a mitsempha. Mu kuphunzira kwa kudziyimira kwokha kwaokha kwa odwala omwe ali ndi matenda a shuga, kusamveka kosakwanira ndi matalikidwe ochepetsetsa komanso kulembedwa pang'onopang'ono, ndikuwonetsa desynchronization imachitikanso - kuwonekera modabwitsa kwa ziwopsezo zamankhwala othandizira pakhungu la mankhwala osokoneza bongo, pomwe odwala omwe ali ndi thanzi labwino atatha kulowetsedwa mwachangu. mankhwala osokoneza bongo palibe chochita. Pali zosakwanira pakadali pano

kuchuluka ndi chidwi cha njirayi.

Kutengera ndi zomwe tafotokozazi, zikuwonekeratu kuti kuzindikira mtundu wa neurogenic wa ED mwa odwala matenda ashuga ndi ntchito yovuta, makamaka poganizira kuti masiku ano palibe njira yodziwira komanso yodziwikiratu. Tiyenera kukumbukira kuti kusokonekera kwa erectile nthawi zambiri zimakhala chizindikiro choyamba cha neuropathy. Fomu ya neurogenic ya ED wodwala yemwe ali ndi matenda ashuga amatha kuganiziridwa pamaso pa mawonetseredwe ena a matenda amitsempha ya m'mimba (kuchepa kwa kutentha, kugwedezeka ndi kumva kupweteka, kuwonetsa kosiyanasiyana kwa mtima ndi matenda am'mimba am'mimba, hypoglycemia yosadziwika). Kuperewera kwa kupezeka kwa kuperewera kwa mitsempha ndi hypogonadism pamodzi ndi zodandaula za zovuta za erectile kungathenso kuwonetsa neurogenic ED.

Chithandizo cha ED cha odwala matenda ashuga

Posankha njira yothandizira ED, wodwala aliyense amafunikira njira imodzi. Popeza kuthekera kwa zovuta zovuta kwa odwala matenda ashuga, kusankha njira zamankhwala zochizira ED kuyenera kukhala koyenera. Monga mukudziwa, pakadali pano ndikofunikira kugwiritsa ntchito mankhwala pochiza ED, koma koposa zonse: wogwira mtima

Rapii ED imafuna kukwaniritsa kulimbikira kwa carbohydrate metabolism.

Mpaka pano, pali njira zingapo zochizira mankhwalawa a ED: vacuum therapy, intracavernous and transurethral pharmacotherapy. Njira zonsezi zili ndi zovuta zina zomwe zimalepheretsa kugwiritsa ntchito odwala omwe ali ndi matenda ashuga, chifukwa zimagwirizanitsidwa ndi zoopsa zofewa zamankhwala amkati mwa intracavernous pharmacotherapy ndi urethral mucosa panthawi ya transurethral pharmacotherapy, yomwe ndi yosafunika kwa odwala matenda a shuga chifukwa choopsa kwambiri chotenga kachilombo ka microtrauma.

Pakadali pano, mankhwala osankha zochizira ED ndi mtundu wa 5 phosphodiesterase inhibitors (sildenafil, vardenafil, tadalafil, udenafil). Mankhwala osokoneza bongo a gululi ndi ma erection modulators omwe mosankha amalepheretsa puloteni ya PDE-5 popanda kukhudza mwachindunji maselo osalala a minofu, koma kupititsa patsogolo kuchitapo kanthu kwa N0, komwe kumapangidwa poyankha kukondweretsedwa kwa kugonana. Chifukwa chake, njira zolimbitsa thupi zomwe zimayambitsa kukonzekera ndikukonza gawo lokonzekera kuyambiranso kugonana zimalimbikitsidwa.

Zambiri pazaka zambiri pakagwiritsidwe ntchito ka mphamvu-denafil kwa odwala omwe ali ndi matenda ashuga adawonetsa kugwira ntchito kwake bwino pamankhwala a ED 46, 47. Izi ndi

Pali maphunziro omwe atenga nthawi yayitali, zomwe zotsatira zake zikuwonetsa kuti mungagwiritse ntchito mankhwalawa kwa nthawi yayitali, mosatekeseka, osachulukitsa.

Kuchita bwino kwa vardenafil pochiza ED odwala omwe ali ndi matenda a shuga anaphunzitsidwa mu kafukufuku wamitundu yambiri, wakhungu lachiwiri, wolamulidwa ndi placebo, wophatikiza odwala 452. Malinga ndi kuwunika kwa zotsatira za phunziroli, patatha milungu 12 yogwiritsira ntchito, kusintha kwa erection kunawonedwa mu 52% ndi 72% ya amuna omwe adalandira 10 ndi 20 mg ya vardenafil, motsatana, ali mgulu la placebo, kusintha kwa erection kumawonedwa mwa 13% yokha ya odwala.

Kuchita bwino ndi chitetezo cha tad-lafil mwa amuna, kuphatikiza odwala omwe ali ndi matenda ashuga, adaphunzira mu kafukufuku yemwe Fonseca V. et al. (2006), yomwe idayendetsa meta-kuwunika kwa data kuchokera ku maphunziro khumi ndi awiri oyendetsedwa ndi placebo mwa odwala omwe ali ndi ED, matenda a shuga komanso popanda iwo. Phunziroli linaphatikizapo amuna 1681 opanda matenda ashuga ndi amuna 637 omwe ali ndi matenda amtundu wa 1 ndi mtundu wa 2 omwe adalandira tada-lafil, pa Mlingo wa 10 ndi 20 mg kapena placebo kwa masabata 12. Odwala omwe ali ndi matenda ashuga anali ndi ED lotchulidwa kwambiri poyerekeza ndi odwala omwe alibe matenda ashuga, pomwe ICEF ED ikuphatikiza mosiyanasiyana ndi HbA1c. Poyerekeza ndi placebo, tadalafil mu Mlingo wa 10 ndi 20 mg kwambiri ntchito ya erectile m'magulu onse awiriwa, omwe adatsatana ndi kuwonjezeka kwa moyo wabwino

odwala. Nthawi yomweyo, kuyendetsa bwino kwa tadalafil sikudalira kuchuluka kwa kubwezeretsa kwa kagayidwe kazakudya komanso chithandizo chamankhwala chomwe chimalandiridwa chifukwa cha matenda ashuga. Chifukwa chake, ngakhale anali ovuta kwambiri a ED odwala omwe ali ndi matenda ashuga, tadalafil inali yothandiza komanso yolekeredwa bwino. Tadalafil amakhala ndi moyo wautali wa maola 17.5, womwe umapereka nthawi yayitali kwambiri yochitapo kanthu, ndikubwezera chikhalidwe chake. Wodwala ali ndi mwayi wotsogola, womwe ndi wofunikira kwambiri pamaso pa zinthu zina zowonjezera zomwe zimakulitsa njira ya kukanika kwa erectile kwa odwala matenda ashuga.

Malinga ndi ofufuzawo, mu 20-40% ya odwala omwe ali ndi ED, chithandizo ndi PDE-5 inhibitors sichitha, zomwe nthawi zina zimagwirizanitsidwa ndi kupezeka kwa kuchepa kwa androgen mwa odwala. Chifukwa chake, nthawi zina, zikuwoneka zoyenera kupereka mankhwala ophatikiza ndi androgens ndi mankhwala a PDE-5 inhibitors kuyambira pomwe apezeka ndi odwala omwe ali ndizomwe zili pamankhwala omwe ali pamwambawa, omwe amawonjezera mphamvu ya mankhwalawa mpaka 93% 53, 54, 55.

Kugwiritsa ntchito mankhwala osokoneza bongo a PDE-5 inhibitors pothana ndi vuto logonana mwa odwala omwe ali ndi matenda osokoneza bongo akhoza kukhala ndi zina

mwayi mu njira yochepetsera zizindikiro za maliseche neuropathy.

Chifukwa chake, mu kafukufuku yemwe anaphatikiza amuna 16 omwe ali ndi matenda ashuga 1 ndi ED ali ndi zaka 27 25.29 ali ndi vuto la paresthesia m'chigawo cha penile shaft komanso kuwonongeka kwa mutu komwe akulandila PDE-5 inhibitor kwa miyezi 3, sikuti kuwonongedwa kwathunthu kwa ED kunadziwika mwa odwala onse (manambala a ED pamankhwala 21 21.22, pi) Simukupeza zomwe mukufuna? Yeserani ntchito yosankhira mabuku.

Ngakhale pali mankhwala osankhidwa bwino othandizira odwala a matenda a shuga 1, pali gulu la odwala omwe njira zakuchira sizigwira ntchito. Pankhaniyi, odwala akuwonetsedwa chithandizo cha opaleshoni - phalloendoprosthetics.

Kuwerenga uku kumawunikira mavuto okhudzana ndi matenda a m'magazi, gulu, pathophysiology, komanso kuwunika ndi kuthandizira ED odwala omwe ali ndi matenda ashuga 1. ED mu odwala achichepere omwe ali ndi matenda ashuga ndi vuto lalikulu chifukwa cha kuchuluka kwakukulu, komanso kukhudzika kwa mkhalidwe wamaganizidwe a odwala komanso moyo wabwino ambiri.

Kuchokera pazomwe tafotokozazi, zikuwonekeratu kuti masiku ano mu chipatala cha adotolo pali njira zosiyanasiyana zodziwira matenda a ED, koma pakadali pano sizinapangidwe

njira yodziwika bwino yodziwira ngati muli ndi mtundu wa neurogenic wa ED. Ndikofunikira kulingalira kuti kuzindikira kwakanthawi kokwanira ndi tanthauzo lolondola la mawonekedwe a ED kumakupatsani mwayi wosankha bwino wodwala aliyense payekhapayekha.

Chithandizo cha ED odwala omwe ali ndi matenda a shuga 1 ayenera kukhala okwanira komanso osangothandiza kukonza erectile yokha, komanso kuti athetse zinthu zazomwe zimayambitsa matenda a ED, monga hyperglycemia, dyslipidemia, kuchepa kwa androgen. Pakadali pano, zokonda zimaperekedwa njira zamankhwala zochizira, malo otsogola omwe amakhala ndi mankhwala ochokera ku gulu la PDE-5 inhibitors chifukwa chogwira ntchito kwambiri, chitetezo komanso zovuta kugwiritsa ntchito kwa odwala. Ndizofunikira kudziwa kuti mankhwalawa gululi ali ndi vuto la neuroprotective, lofunikira kwambiri kwa odwala omwe ali ndi mawonekedwe a neurogenic a ED, koma nkhaniyi ikufunika kupitilizidwa mozama.

Chifukwa chake, ngakhale atachita zambiri pakupanga njira zodziwitsira ndi kuthandizira ED, padakali zinthu zambiri zosakonzedwa zomwe zimafuna kufufuza kwina.

1. Internet Diabetes Federation Intaneti. Yatchulidwa 2013 Dec 9. Url.: Http: //www.idf.org/worlddiabetesday/tool ​​kit / gp / zowonadi.

2. Kuyambika kwa kukokoloka kwa erectile ndi kuwongolera kwake: kafukufuku wokhazikitsidwa ndi anthu ku Morocco / S. Berrada, N. Kadri, S. Mechakra-Tahiri, C. Nejjari // Int J Impot Res. - 2003. - Vol.15, Suppl 1. -P.3-7.

3. Kuyang'anira ndi kusakanikirana kwa kukokoloka kwa erectile mu kafukufuku wokhazikitsidwa ndi anthu ku Belgium / R. Mak, G. De Backer, M. Kornitzer, J.M. De Meyer // Eur Urol 2002 .-- Vol 41 (2). - P.132-138.

4. Rozhivanov, R.V. Kuchepa kwa Erectile kwa odwala omwe ali ndi matenda a shuga mellitus malingana ndi maphunziro a miliri / R.V. Rozhivanov, Yu.I. Suntsov D.G. Kurbatov // Matenda a shuga. -2009. - Na. 2. - S. 51-54.

5. Bancroft, J. Erectile kukanika kwa amuna omwe ali ndi vuto la matenda ashuga: kafukufuku woyerekeza / J. Bancroft, P. Gutierrez // Diabetes Med. - 1996 .-- Vol.13 (1). - P.84-89.

6. Schiel, R. Kufikira kwa mavuto azakugonana pagulu losankhidwa la anthu odwala matenda ashuga (JEVIN) / R. Schiel, U.A. Müller // Matenda a shuga Atsopano. - 1999, Meyi. -V. 44 (2). - P. 115-121.

7. Vinik, A. Erectile kukanika mu shuga. / A. Vinik, D. Richardson // Matenda a shuga. - 1998 .-- Vol.6 (1). - P.16-33.

8. Kugonana kwa amuna omwe ali ndi matenda a shuga 2: kuyanjana ndi glycemic control / J.H. Romeo, A.D. Seftel, Z.T. Madhun, D.C. Aron // J Urol. -000. - Vol. 163 (3). - P.788-791.

9. Zotsatira zamatenda oyamba chifukwa cha kusokonekera kwa erectile dysfunction / R. Shiri, J. Koskimaki, M. Hakama et al. // Urology. - 2003 .-- Vol.62 (6). - P.1097-1102.

10. Seyoum, B. Impotence ku Ethiopia anthu ashuga / B. Seyoum // East. Afr. Med. J. - 1998. - Vol 75 (4). -P.208-210.

11. Comorbidities yomwe imakhudzana ndi zovuta za matenda ashuga pakati pa anthu aku Asia aku kumwera kwa California / P.Y. Han, R. Ezquerro, K.M. Pan et al. // J Am Podiatr Med Assoc. - 2003. - Vol 93 (1). - P.37-41.

12. Diabetesic autonomic neuropathy / A.I. Vinik, R.E. Maser, B.D. Mitchell, R. Freeman // Matenda a shuga. - 2003. - Vol 26 (5). - P.1553-1579.

13. Rozhivanov, R. V. Erectile kukanika kwa odwala matenda a shuga: kupenyerera, kapangidwe, kufunikira kwa patsogolo: Wolemba. dis. Chinsinsi. wokondedwa sayansi. - 2005.

14. Nitric oxide monga mkhalapakati wotsitsimula wa corpus cavernosum poyankha nonadrenergic, noncholinergic neurotransication / J. Rajfer, W.J.Aron-son, P.A. Bush et al. // N Engl J Med. -1992. - Vol 326 (2). - P.90-94.

15. Nusbaum, M.R. Kusokonekera kwa Erectile: kuchuluka, etiology, ndi chiopsezo chachikulu

zinthu / M.R. Nusbaum // J Am Osteopath Assoc. - 2002 .-- Vol.102 (12), Sup. 4. - P.1-6.

16. Protein ndi mtundu wa nitric oxide synthase isoforms I ndi III mu cholembera shaile / C.M. Gonzalez, R.E. Brannigan, T. Bervig et al. // J An-Drol. - 2001. - Vol.22. - P.54-61.

17. Sullivan, M.E. Zowopsa zam'mitsempha komanso kukokoloka kwa erectile / M.E. Sullivan, S.R. Keoghane, M.A. // Br J Ural Int. - 2001. - Vol 87. - P.838-845.

18. Nitricoxide ndi penile erection, kodi kusokonekera kwa erectile kwawonetsanso kwina kwamatenda am'mimba? / M.E. Sullivan, C.S. Thompson, M.R. Dashwood et al. // Cardiovasc Res. - 1999 .-- Vol. 43 (3). -P.658-665.

19. Cartarant, J.J., Kuwonongeka kwa Corpus cavernosal kupuma kosangalatsa kwa minyewa yokhala ndi grycosylated hemoglobin / J.J. Cart Cart, I. Eardley, J.F.B. Morrison // Br J Urot Int. - 2001. - Vol 85. - P.735-741.

20. Chingwe, J.J. Zotsogola zam'mbuyo zotsogola ndizomwe zimayambitsa kusokonekera kwa Corpus posmosal yosalala minofu yopuma yomwe imawoneka mu shuga / J.J. Cart Cart, I. Eardley, J.F. Morrison // Br J Urol Int. - 2001 .-- Vol 87 (4). -P.402-407.

21. Ma molekyulu ndi kwachilengedwenso michere ya endothelial grow factor banja la mapuloteni / N. Ferrara, K. Houck, L. Jakeman, D.W. Leung // En-docr Rev. - 1992 .-- Vol.13 (1). - P. 18-32.

22. Advanced glycation kumapeto kwa zinthu kumalimbikitsa mawu a mtima endothelial

kukula kwa maselo a retinal Muller / C. Hirata, K. Nakano, N. Nakamura et al. // Biochem Biophys Res Commun. -

1997 .-- Vol.236 (3). - P.712-715.

23. Sarman, B. Udindo wa endothelin-1 mu shuga mellitus / B. Sarman, M. Toth, A. Somogyi // Diabetes Metab Rev -

1998. - Vol. 14 (2). - P. 171-175.

24. Wobweza, A.S. Carnitine ndi udindo wake matenda a mtima. / A.S. Kubwezera / Mtima Dis. - 1999 .-- Vol 1 (12). P.108-113.

25. Zosintha mu VIPergic, cholinergic ndi adrenergic innervation ya minile ya anthu mu matenda ashuga komanso osadwala a shuga / aamuna a J. Lincoln, R. Crowe, P.F. Blacklay et al. // J Urol. - 1987. — Vol 137 (5). - P.1053-1059.

26. Neuropathy ndiyothandiza kwambiri kudwala matenda ashuga erectile dysfunction / M.J. Hecht, B. Neundorfer, F. Kiesewetter F, M.J. Hilz // Neural Res. - 2001.-Vol 23 (6). - P.651-654.

27. Harati, Y. Matenda a shuga ndi pulogalamu yamanjenje / Y. Harati // Endocrinol Me-tab Clin North Am. - 1996 .-- Vol.25 (2).

28. Aetiopathogenesis ndi kasamalidwe ka kusabala kwa amuna odwala matenda ashuga: zaka zinayi zokuchitikira kuchokera kuchipatala chophatikizira / A. Veves, L. Webster, T.F. Chen et al. // Diabetes Med. - 1995 .-- Vol 12 (1).

29. Hakim, L.S., Goldshtein I. Matenda osokoneza bongo a shuga / L.S. Hakim, I. Goldshtein // Endocrinol. Metab. Clin. N. Am. - 1996. - Vol.25 (2) - P.379-400.

30. Stevens, M.J. A shuga zotumphukira neuropathy. Njira zamakono zochizira matenda ashuga mellitus / M.J. Stevens, E.L. Feldman, D.A. Greene // Eds. R. A. Defronzo. - St. Louis: Mosby. - 1998. - P.160-165.

31. Balabolkin, M.I. Pathogenesis ya angiopathy mu matenda a shuga mellitus / M.I. Balabolkin, E.M. Klebanova,

B.M. Kreminskaya // Matenda a shuga.

32. Kalinchenko, SJ. Matenda a neurogenic a kugonana kwa amuna omwe ali ndi matenda a shuga mellitus /

C.Yu. Kalinchenko, R.V. Rozhivanov // Dokotala. - 2006. - Na. 1. - S. 48-51.

33. Kurbatov, D.G. Kuchepa kwa Erectile mwa odwala matenda a shuga mellitus / D.G. Kurbatov, R.V. Rozhiva-nov, D.V. Priymak // Russian Medical Journal - 2009. - Na. 17 (25). -C. 1672-1676.

34. Rossi, P. Kufanizira pakati pa plasma wozungulira wa testosterone, nitric oxide ndi endothelin 1-2 mu magazi a penile ndi brachial venous: zoyambirira zimapangitsa amuna omwe ali ndi vuto la kusabala kwa psychogenic / P. Rossi, F. Menchini Fabris, I. Fiorini et al. // Wochulukitsidwa. Mankhwala

- 1998. - Vol 52 (7-8). - P.308-310.

35. Schirar, A. Localization of androgen receptor mu nitric oxide synthase ndi vasoactive matumbo am'mimba omwe ali ndi ma neurons of the pelvic ganglion gangervic penis / A. Schirar, C. Chang, J.P. Rousseau // J. Neuroendo-crinol. - 1997 .-- Vol 9 (2). P.141-150.

36. Hormones ndi nocturnal penile tumescence mu okalamba athanzi amuna / R.C. Schiavi, D. White, J. Mandeli, P. Schreiner-Engel // Arch. Kugonana. Behav. -1993. - Vol 22 (3). - P.207-215.

37. kukanika kwa Erectile ndikuchepetsa-drogenicity mu mtundu wa 1 odwala matenda ashuga / O. Alexopoulou, J. Jamart, D. Maiter et al. // Matenda A shuga. - 2001. Vol 27 (3).

38. Cunningham, M.J. Zochita za Leptin pam axis yobala: malingaliro ndi makina / M.J. Cunningham, D.K. Clifton, R.A. Steiner // Biol. Kukonzanso. - 1999. - Vol.60. - P.216-222.

39. Laurent, O.B. Njira zamakono zodziwitsira komanso kuchiza matenda a erectile dysfunctions / O.B. Laurent, P.A. Scheplev, S.N. Nesterov, S.A. Kukharkin // Russian Medical Journal. - 2000.-№8 (3). - S. 130-134.

40. Agogo aamuna, I.I. Ndondomeko ya Federal chandamale "Shuga mellitus". / I.I. Agogo, M.V. Shestakova, M.A. Malangizo a Maksimova // Njira. 2002.

41. Tiktinsky, O. L. Andrology. / O.L. Tiktinsky, V.V. Mikhailichenko // Media Press. - 1999.

42. Kuunika kwamanjenje monga njira yowunika yozindikira matenda a neurogenic erectile dysfunction kwa odwala omwe ali ndi matenda a shuga mellitus / R.V. Rozhivanov, O.N. Bond-Renko, O.V. Udovichenko et al. // Sing'anga.

43. Kuchepa kwa kugonana mwa amuna omwe ali ndi matenda ashuga. / Mkonzi. M.I. Kogan // Moscow. - 2005.

44. Maso, E.B. Kuyerekeza kuwunika kwa penile electromyography ndi data ya minvernc ya microscopy mwa odwala omwe ali ndi vuto la erectile pozindikiritsa cavernous innervation / EB. Maso, D.G. Dmitriev, D.Yu. Chudoley // Andrology ndi opaleshoni ya maliseche. -000. - Na. 1. S.55-56.

45. Aggour, A. Kuunikira kwa udindo wa Corpus cavernosum electromyography ngati chida chodziwitsira zinthu chosagwiritsa ntchito dysfunction ya abambo / A. Aggour, H. Mostafa, H. El-Shawaf // Int Urol Nephrol. - 1998. - Na. 30 (1). - S. 75-79.

46. ​​Kupezeka kwa Ultrasound kwamatenda a ziwalo zakunja kwa amuna / A.R. Zubarev, M.D. Mit-kova, M.V. Koryakin, V.V. Mitkov // Moscow. - 1999.

47. Kurbatov, D.G. Momwe mungagwiritsire ntchito mankhwalawa amtundu wa neuropathy a mtundu wa 5 phosphodiesterase inhibitors mwa odwala omwe ali ndi matenda osokoneza bongo a mellitus / D.G. Kurbatov, R.V. Rozhivanov // Urology. - 2009. - Na. 5. - S. 48-49.

48. Rafalsky, V.V. Njira zoyambira mwanzeru za mtundu wa 5 phosphodiesterase inhibitors / V.V. Rafalsky // Farmateka. - 2004. - Na. 19 (20). - S. 1-8.

49. Gulu La Phunziro la Matenda a shuga a Vardenafil. Vardenafil, mtundu watsopano wa phosphodiesterase 5 inhibitor, mankhwalawa erectile kukanika kwa amuna omwe ali ndi matenda ashuga: mul-

ticenter, akhungu-kawiri, owongolera-placebo, kuphunzira kwa dokotala / I. Goldstein, J.M. Wamng'ono, a J. Fischer et al. // Matenda a shuga. - 2003. - Vol 26. - P.777-783.

50. Zovuta za matenda obwera chifukwa cha matenda ashuga komanso kutha kwa chithandizo: kuwunika kwa kafukufuku wa mayeso a tadalafil / V. Fonseca, A. Seftel, J. Denne, P. Fredlund // Diabe-tologia. - 2004 .-- Vol 47. - P. 1914-1923.

51. Giuliano, F. Tadalafil: chithandizo cholemba cha erectile dysfunction / F. Gi-uliano, L. Varfnese // Eur. Mtima J. Suppl. - 2002. - Vol 4 4 (sup.H) - P.24-31.

52. Zotsatira za Tadalafil pa kukanika kwa erectile mwa amuna omwe ali ndi matenda ashuga / I. Saenz de Tejada, G. Anglin, J.R. Knight, J.T. Emmick // Diabetes. Chisamaliro - 2002. - Vol 25. - P.2159-2164.

53. Kuphatikiza mankhwala a Tadalafil & Testosterone mu hypogonadal osayankha / A. Yassin, H.E. Diede, F. Saad, A. Traish // Int. J. Impot. Res. -2003. - Vol 15 (Sup. 6). - P.27.

54. Rozhivanov, R.V. Zida zamankhwala othandizira kukanika kwa erectile kwa odwala omwe ali ndi hypogonadism / R.V. Ro-zhivanov, D.G. Kurbatov // Dokotala. -

55. Zowongolera kusowa kwa kugonana mwa amuna omwe ali ndi matenda a shuga mellitus / R.V Rozhiva-nov, A.E. Lepetukhin, S.A. Dubsky, D.G. Kurbatov // Matenda a shuga. -

56. Hackett, G. PDE5 zoletsa za matenda ashuga zotumphukira neuropathy / G. Hackett

// Int J Clin Exerc. - 2006. - Vol.60. P.1123-1126.

57. Ziegler, D. Zokhudza matenda, kuzindikira ndi kuchiritsa matenda a matenda ashuga / D. Ziegler // Ther Umsch. - 1996. - Vol. 53 (12). - P.948-957.

Makanema okhudzana nawo

About the pathophysiology ofabetes mu kanema:

Psychology yokhudza matenda a shuga imakupatsani mwayi wodziwa za maphunzirowa ndi chithandizo cha matendawa. Mu mtundu woyamba ndi wachiwiri, ndizosiyana.

• Imakhazikika pamisempha ya shuga kwa nthawi yayitali
• Imabwezeretsa kapangidwe ka insulin

Phunzirani zambiri. Osati mankhwala. ->