Matenda a kapamba komanso matenda ashuga

Gulu Lopitilira Maphunziro ndi Professional retraining of akatswiri

Department of Therapy, Endocrinology ndi Emergency Medicine

"Matenda a shuga chifukwa cha chifuwa chachikulu kapena chifuwa chachikulu"

shuga kapamba

1. Malo a shuga a pancreatogenic m'magulu osiyanasiyana a shuga

2. Tizilombo toyambitsa matenda a shuga chifukwa cha chifuwa chachikulu kapena chovuta

3. Kufalikira kwa matenda ashuga chifukwa cha kapamba kapena chifuwa chachikulu

4. Mawonekedwe amtundu wa shuga chifukwa cha kapamba kapena chifuwa chachikulu

4.1 Matenda apakati a matenda a shuga a pancreatogenic

5. Kuzindikira matenda ashuga okhala ndi kapamba wambiri

6. Zochizira zokhudzana ndi matenda a shuga a pancreatogenic

Matenda a shuga, odwala matenda am'mimba a kapamba, kapenanso matenda a shuga kapamba, ndi mkhalidwe womwe umangokulirakulira chifukwa cha nthenda ya kapamba, yomwe imayambitsa kuphwanya kwa mitundu yonse ya exocrine ndi endocrine pancreatic. Odwala nthawi zambiri amakhala ndi zomwe zimachitika ndi hyperglycemia, koma amawonetsa kuwopsa kwa hypoglycemia ndi kusakhazikika kwa glycemic.

Matenda a shuga okhudzana ndi matenda a kapamba adayamba kufotokozedwa koyamba mu 1788 ndi a Sir Thomas Cowley, omwe anasimba za bambo "wazaka 34, wamphamvu, wathanzi komanso wonenepa", "yemwe adadwala matenda ashuga" ndipo "adatopa pang'onopang'ono, ngakhale adalandira chithandizo, adamwalira. " Pa autopsy, "kapamba anali odzaza ndi miyala yomwe inali yolowedwa m'zinthu zake. Zinali zamitundu yosiyanasiyana. Maso awo anali osafanana ndi miyala ya mabulosi. Kumapeto kwenikweni kwa kapamba kunali kovuta kwambiri, ndikuwoneka ngati kopingika."

Zaka zopitilira 100 pambuyo pake, mu 1889, Minkowski adawonetsa kuti kuyesanso kwa kapamba mu agalu kudayambitsa matenda ashuga, ndipo mu 1940, Schumaker adatsimikiza kuti pafupifupi 2% ya milandu yonse yamatenda a pancreatitis owopsa idayambitsa matenda ashuga kwambiri. Ngakhale kuvomereza kuti pancreatitis yovuta ya pachaka sikunayambitse shuga yayikulu, madokotala adayamba kuzindikira kapamba kapena chizolowezi chodwala ngati chifuwa chachikulu chololera shuga.

Matenda a shuga ndi limodzi mwa matenda ofala kwambiri padziko lonse lapansi. Ichi ndi chifukwa chachisanu ndi chiwiri chakufa ku United States konse, chiopsezo cha kufa pakati pa anthu omwe ali ndi matenda ashuga chimakhala chofanana ndi cha anthu opanda matenda ashuga. Anthu omwe ali ndi matenda a shuga ali pachiwopsezo chachikulu chotenga matenda a mtima, matenda am'mimba, matenda a impso, kuchepa kwa miyendo, komanso kufooka kwamaso. Kuchokera pamalingaliro azachuma, anthu omwe ali ndi matenda osokoneza bongo amafunikira kawiri kawiri ndalama zowonjezera poyerekeza ndi anthu omwe alibe. Pazifukwa izi, komanso chifukwa chophatikizidwa ndi zina zodziwika za ngozi ya mtima, kuphatikiza matenda oopsa, matenda osokoneza bongo komanso kunenepa kwambiri, kupewa komanso kupezeka kwa nthawi yake kwa prediabetes ndi matenda osokoneza bongo amakhala ndi zotsatirapo zazikulu.

Pachimake kapamba ndi njira yotupa mu kapamba, kuphatikizapo zotumphukira zimakhala ndi kusakwanira kwa machitidwe ndi ziwalo. Zomwe zimachitika pachaka pachakudya zimasiyana ndi kapamba kuyambira 13 mpaka 45/100000 anthu. Acute pancreatitis ndimatenda ofala kwambiri a pancreatic, ndipo hyperglycemia ndi chizindikiritso choyambirira chomwe chimagwiritsidwa ntchito pamitundu yotchedwa Progic. Hyperglycemia iyi, monga lamulo, imawonedwa ngati chochitika chochepa, chomwe chimathetsedwa pafupifupi odwala onse. Izi zikufotokozera chifukwa chake glucose homeostasis imayang'aniridwa mobwerezabwereza atachotsedwa kuchipatala. Zambiri pazofalikira za prediabetes komanso matenda ashuga omwe amayamba kudwala pambuyo pancreatitis yayikulu amatsutsana. Malipoti ena amawonetsa kuti glucose homeostasis imabwezeretseka kwathunthu, ndipo malinga ndi ena, zovuta zake zimapitilira gawo lalikulu la odwala. Kafukufuku waposachedwa adawonetsanso kuti odwala omwe ali ndi kuchepa kwa hyperglycemia m'matenda owopsa ali pachiwopsezo chotenga matenda a shuga. Kuphatikiza apo, kufunikira kwa prediabetes ndi matenda ashuga pambuyo poti chida chachikulu cha kapamba sichidziwikiratu, monga momwe umakhalira ndi zovuta za kapamba kapamba. Pafupifupi kotala ya milandu yodwala kapamba imayamba ndipo imayambitsa matenda.

Matenda a pancreatitis ndi njira yotupa ndipo amadziwika ndi chotupa chokhazikika komanso chosinthika makamaka cha exocrine ndipo, pambuyo pake, endocrine parenchyma ya kapamba, kenako ndikulowetsedwa ndi minyewa yam'mimba. Kuchulukana kwapachaka kumasiyana kuchokera pa 5 mpaka 12/100000 anthu omwe ali ndi kapamba, ndipo kuchuluka kwake ndi anthu pafupifupi 50/100000. Kuphatikizika kwa minofu ya endocrine pancreatic kumachitika kumapeto kwa matendawo. Malinga ndi malangizo azachipatala a matenda a kapamba komanso matenda a chifuwa chachikulu cha Russian Gastroenterological Association mu 2013, zizindikiro za kuperewera kwa pancreatitis ndi endocrine zikuwonekera gawo lachitatu la kapamba, komanso matenda a shuga amayamba mu siteji ya IV, yodziwika ndi kufooka kwa kapamba.

Odwala nthawi zambiri amakhala ndi zizindikiro zokhudzana ndi hyperglycemia, koma amakhala ndi chiopsezo chokhala ndi hypoglycemia ndi kusakhazikika kwa glycemic. Hypoglycemia yolumikizana ndi mankhwala a insulin kapena sulfonylurea ndi ochulukirapo ndipo imakhala yolimba kwambiri komanso imatenga nthawi yayitali. Hypoglycemia ndi chifukwa chophwanya kukakamiza komanso kubwezeretsa shuga chifukwa chosakwanira katemera wa glucagon, kufooka kwa katecholamine wothandizika ndikuwonjezera mphamvu ya chiwindi. Kuchokera pakuwona momwe achire angathere, kungakhale kofunikira kuti azikhala ndi kuchuluka kwa glucose pang'ono pamwamba pamlingo wabwinobwino kuti apewe kusintha kwamaganizidwe pafupipafupi komanso kusintha moyo wabwino.

Kuzindikira koyipa kwa matenda a shuga chifukwa cha chifuwa chachikulu kapena kupweteka kwamatumbo kumabweretsa chithandizo chokwanira cha odwala awa, palimodzi ndi zochitika zina (kugaya chakudya, kuyamwa, ndi zina zambiri) zomwe zimakhudza thanzi la wodwalayo. Kuphatikiza apo, kugwiritsa ntchito kwambiri pancreatic resection komanso kupulumuka kwakutali kwa odwala omwe ali ndi cystic fibrosis, ndipo, koposa zonse, kufalikira kochulukira kwa matenda kapamba, akuwonetsa kuti matenda osokoneza bongo chifukwa cha pachimake kapena matenda apathengo amafunika chidwi chachikulu kuchokera kwa odwala matenda ashuga ndi gastroenterologists.

1. Ikani shuga pancreatogenic m'magulu osiyanasiyana a shuga

Malinga ndi zofunikira pakupanga njira yodziwira matenda osokoneza bongo a shuga m'magulu a 5 a ma algorithms a chithandizo chapadera chamankhwala kwa odwala omwe ali ndi matenda a shuga, kuzindikira kwa matendawa kuyenera kumveka ngati "Matenda a shuga chifukwa (akuwonetsa chifukwa)".

Malinga ndi gulu la American Diabetes Association, matenda a shuga a pancreatogenic ndi mtundu 3 shuga (T3cDM). Pazotsatira za matenda ashuga, matenda am'mimba komanso matenda a mtima a EASD / ESC, matenda a chifuwa cha m'mimba amadziwika kuti "Mitundu ina ya matenda ashuga: matenda ashuga a m'mbuyo pambuyo pa matenda angapo (kapamba, kuvulala kapena kupweteka kwa m'mimba)"

Gulu la zomwe zimayambitsa matenda a shuga mellitus yachiwiri ku matenda a exocrine pancreas (T3cDM, American Diabetesic Association, 2013)
1. Pancreatitis
2. Zowonongeka / kuphatikizanso kwa kapamba
3. Neoplasia
4. cystic fibrosis
5. Hemochromatosis
6. Fibrocalcule pancreatopathy
7. Ena.

2. Pathogenesis ya matenda osokoneza bongo a shuga chifukwa cha kapamba kapamba kapenanso matenda osachiritsika

Palibe lingaliro lomveka latsatanetsatane wa kayendedwe ka pathogenetic ka kukokoloka kwa mahomoni mu pancreatitis yovuta, palibe ma algorithms wamba pakuwongolera kwake. Kuyanjana kwakanthawi komanso magwiridwe antchito pakati pa exo- ndi endocrine ntchito za kapamba zimatsogolera ku kuthandizirana pamavuto a chiwalochi.

Kuwonongeka kwa kapamba ka chitukuko cha matenda a shuga kuyenera kukhala kokulirapo, kupatula khansa, yomwe kuphatikiza kuchepetsa kuchuluka kwa maselo a beta, njira zina za pathological. Zochitika pakugwiritsa ntchito kwathunthu pancreatic resection zikuwonetsa kuti poyambira matenda ashuga, zopitilira 80-90% ya zotulutsa pancreatic ziyenera kuchotsedwa. Kupangitsa matenda a shuga kuperewera, gawo lama pancreatic mwa anthu liyenera kukhala loposa 50%, pomwe kuphatikiza kwathunthu kwapancreatic kumapangitsa shuga. Mwa anthu athanzi, hemipancreatectomy imayendera limodzi ndi kulekerera kwa glucose mu 25% ya milandu, ndipo, monga lamulo, zosaposa 20-25% za zikondamoyo zotsalira zimafunikira kuti zitsimikizidwe ngati glucose homeostasis.

Mu 1896, Chiari adaganizira chimbudzi cha kapamba chifukwa chamadongosolo okhazikika a ma pancreatic encyes ngati chida cha pancreatitis pachimake. Pambuyo pake zinaonekeratu kuti theka la maselo acinar amatha kuwonongeka ngakhale atayambitsa trypsinogen. Mpaka pano, pathogenesis yeniyeni ya pancreatitis pachimake siyidaphunziridwe kwathunthu, ngakhale kuti imadalira kwambiri komanso / kapena yolumikizidwa ndi kuyankha kwadongosolo. Zachilengedwe zotupa zomwe zimatsogolera pancreatic necrosis komanso kufooka kwa ziwalo zingapo ndi 7-16% zitha kuwonetsedwa mu 20% ya odwala. Kuyendetsa kwamachitidwe koyenda kumasungidwa ndikusungidwa ndikuwongolera kwa kutseguka kwamasewera olimbitsa thupi omwe amalumikizidwa ndi ma cytokines, immunocytes ndi pulogalamu yothandizira. Nthawi yomweyo, anti-yotupa imachitika, imayendetsedwa ndi ma cytokines odana ndi kutupa ndi ma cytokine zoletsa. Kuthana ndi kutupa kumeneku kungalepheretse mayankho a chitetezo cha mthupi, zomwe zimayika wolandidwayo pachiwopsezo cha matenda oyamba ndi matenda. Chosangalatsa ndichakuti ma cell a beta a pancreatic akuwonetsa masensa amkati owonongeka, omwe amaphatikizidwanso mu pathogenesis ya matenda a shuga a 2.

Hyperglycemia mu pachimake kapamba chifukwa cha kuwonongeka kwa insulini, kuchepa kwa kugwiritsira ntchito kwa glucose, komanso kuchuluka kwa mahomoni olimbana ndi mahomoni. Hyperglycemia yayikulu imalumikizidwa ndi chifuwa chachikulu cha khansa ndipo ndi chinthu china chovuta. Hyperglycemia wosakhalitsa ndi glucosuria amapezeka pafupifupi 50% ya odwala omwe ali ndi pancreatitis yachilendo. Mlingo wa kulolerana kwa glucose ndi chizindikiro cha zovuta za kapamba. Mowa umayambitsa kupweteka kwakukuru kwapancreatic ndi mowa kapamba nthawi zambiri umakhala wovuta chifukwa cha kulolera kwa glucose. Hyperglycemia yotsatana ndi vuto la kapamba ndi chifukwa cha kuwonongeka kwa kapamba ndi nkhawa. Onse kukula ndi kutalika kwa kagayidwe kachakudya mu chakudya zimagwirizana ndi kuchuluka kwa kuwonongeka kwa pancreatic minofu. Kafukufuku woyambirira wa kuyesa kwachulukidwe ka necrotic pancreatitis mu makoswe (maora 5 kuyambira kumayambiriro kwa matendawa) adawonetsa edema, hemorrhage, mafuta necrosis, kuwonongeka kwa ziphuphu ndi kulocha kwa leukocyte kwa gawo la pancreas, pomwe endocrine inakhazikikiratu, . Komabe, kuthekera kopanga insulini poyankha kukoka kwa glucose kunali kolemekezeka bwino (P> 0.05). Kapangidwe ka zisumbu za pancreatic kunakhalabe kolimba komanso kusintha kwachidziwikire kotupa kumadera oyandikana nawo. The islet cell glucose transporter (GLUT 2) poyeserera anali ochepa, motero, kusokonezeka kwa insulini mu pancreatitis yovuta kwambiri kumatha kuphatikizidwa ndi zovuta kutengera shuga m'magulu a b.

Odwala omwe ali ndi pancreatitis pachimake, plasma insulin yotsika kuposa anthu athanzi. Katemera wa insulini poyankha shuga kapena glucagon amawonongeka, pomwe kulowetsedwa kwa alanine kumabweretsa kuwonjezeka kwachilengedwe kwa plasma insulin. Ndi kuchepa kwamphamvu kwa njira ya pachimake, kupangira insulin yachilendo kumayamba kubwezeretsedwanso. Masautso a plasma glucagon amawonjezeka, ndipo nthawi zambiri amakhala okwera pafupifupi sabata limodzi. Kuphatikiza kwa hyperglucagonemia ndi hypoinsulinemia ndikokwanira kufotokoza kukula kwa ketoacidosis komanso kupezekanso kovuta kwa matenda ashuga.

Kuphatikiza kuwonjezera kuchuluka kwa shuga m'magazi, m'magulu ochepa odwala omwe ali ndi pancreatitis yachilendo komanso kusowa kwa mbiri ya hyperlipidemia, serum lipid ndende ikhoza kuchuluka. Serum triglycerides> 1000-2000 mg / dl mwa odwala omwe ali ndi mtundu I, IV kapena V hyperlipidemia (gulu la Fredrickson) ndiwomwe umayambitsa chiopsezo cha pancreatitis pachimake. Plasma wozungulira wamafuta acids achulukitsa pambuyo pachimake kapamba, chifukwa cha kusokonezeka insulin katulutsidwe ndi kuwonjezereka kwa chinsinsi cha glucagon ndi cortisol. Ngakhale kuti kusinthika kwa magwiridwe achilengedwe mu pancreatitis yacute kumatha kuyambitsa ketoacidosis, izi sizachilendo, chifukwa cha kuteteza kwatsalira kwa insulin ya insulin, yokwanira kuletsa lipolysis ndi ketogeneis, komanso chifukwa chosakwanira katemera wa glucagon.

Mndandanda wofanana wa zochitika zomwe zimayambitsa kupweteka kwa pancreatitis sizinadziwikebe. Kafukufuku wasonyeza kuti zowononga zomwe zimayambitsa zimayambitsa kubadwa kwa mitundu yotakataka ya okosijeni, kumasulidwa kwa ma cytokines ndi kutsika kwina kwa antioxidants, komwe kumabweretsa pancreatostasis, i.e. kupewa apical exocytosis ndi pancreatic acinar maselo. Maselo amenewa amatulutsa ma enzymus omwe angopangidwa kumene m'mitsempha yamagazi ndi m'mitsempha yamagazi, zomwe zimayambitsa kukwiya. Posachedwa akuti cycloo oxygenase 2, yomwe imayang'anira kwambiri kupanga kwa prostaglandin, imagwira gawo lofunikira pathogenesis yowonongeka kwa mbali za exocrine ndi endocrine mu chikhazikitso chokhazikika.

Zisumbu za Langerhans, kwenikweni, zimasungidwa bwino, poyerekeza ndi kuwonongeka kwa maselo acinar. Nthawi zina kapamba amatha kukhala wodabwitsa chifukwa kutayika kwathunthu kwa minyewa yathunthu kuphatikiza ndikusunga gawo lake la endocrine.M'masamba otsalawa, kukonzanso kwa gawo la endocrine la maselo kumachitika ndikutayika kwakukulu kwa maselo a beta kuposa maselo a alpha, zomwe zimapangitsa kuti kusintha kwa 2: 1. Chiwerengero cha maselo a delta, monga lamulo, chikhalebe chachilendo, ndipo pali kuchuluka pang'ono kwa maselo a PP. Zilumba zozunguliridwa ndi minyewa yabwinobwino ya acinous, monga lamulo, zimakhala ndi mawonekedwe abwinobwino a cytological, omwe amawonetsa mphamvu ya trophic ya exocrine pancreas. Malabsorption omwe amapezeka pancreatitis yosatha amatha kubweretsanso zovuta zamkati, zomwe zimathandizanso kuti maselo azitha kusokonekera komanso kulolerana ndi shuga.

Mulingo wambiri wa shuga umawonedwa ndi fibrocalculous pancreatitis m'malo otentha, wokhala ndi chithunzi chachipatala chodziwika bwino. Njira yamtunduwu yoletsa kapamba imawonedwa makamaka mwa ana ndi achinyamata akumidzi omwe akutukuka kumene. Kwanenedwa kuti 60-70% ya milandu yonse yamatenda achamba ku India ndi China mwachidziwikire imakhudzana ndi pancreatitis yotentha. Kuchuluka kwake kwa odwala matenda ashuga kumasinthasintha kwambiri, kuyambira 0,5 mpaka 16% ku India ndipo amafika 80% mwa achinyamata omwe amatenga insulin ku Nigeria.

Matenda a shuga ndi njira yofikira pompopompo yochizira matenda a kapamba ndipo nthawi zambiri amakula patatha zaka khumi chikhumbo cha kapamba, koma chimagwirizana ndi m'badwo wa wodwalayo. Odwala ambiri ali ndi miyala ikuluikulu mkati mwa nthawi yoyeserera, etiology yomwe imaphatikizapo kuperewera kwa calcium-calorie, kugwiritsa ntchito poizoni zosiyanasiyana zakunja, zovuta zapakhosi komanso mwina kutulutsa chibadwa. Matenda a shuga, monga lamulo, ali ovuta kwambiri ndipo mankhwala a insulin amafunikira, ngakhale kuti kafukufuku wamatenda ndi immunohistochemical amawonetsa kusungidwa kwapadera kwa maselo okhala ndi insulini mu kapamba wa odwala a fibrocalcule pancreatitis. Chotsalira cha insulin katulutsidwe ka mankhwala ambiri chimafotokozera za kuchepa kwapadera kwa ketoacidosis mwa odwala omwe ali ndi chifuwa cham'mimba.

Katswiri wodziwika bwino yemwe amayambitsa matenda a pancreatic angapangitse kuti pakhale tsankho. Hypertriglyceridemia, mwachitsanzo, imagwirizanitsidwa ndi insulin kukaniza ndipo nthawi zambiri imayambitsa matenda oopsa a shuga. Mowa umachepetsa mphamvu za insulini ndipo umapangitsa kuti shuga asamavute chifukwa chodziwikiratu. Ndi chibadwa chokhala ndi chibadwa, nthenda yachilendo kwambiri ya matenda osokoneza bongo, matenda a shuga amatha kuyamba kumapeto, ndipo mavuto obwera chifukwa cha matenda ashuga angayambike.

Mbiri yabwino yabanja yodwala matenda ashuga mellitus imatha kupangitsa odwala omwe ali ndi pancreatitis yayikulu mpaka kukula kwa shuga ali mwana. Kukula kwa matenda ashuga osagwirizana ndi pancreatitis kuli kwenikweni m'mabanja mwa odwala omwe adwala matenda ashuga. Komabe, kuwonjezeka kwakukulu kwa mitundu ya HLA mitundu B8, DR3, DR4, ndi DR3 / DR4 yawonetsedwa mwa odwala omwe ali ndi matenda osokoneza bongo pambuyo pancreatitis yosatha. Akuti autoimmunity ingathandizire kukulitsa shuga yachiwiri ku matenda apakhungu, chifukwa ma antibodies opita ku maselo a islet amapezeka mwa ena mwa odwala matenda ashuga asanayambe. Komabe, iyi ndi malo osangalatsa kwambiri. Autoimmune chronic pancreatitis imadziwika ndi kupukusa ndipo imakhala ndi kukula kwakukulu kwa fibrosis yolumikizana ndi kulowetsedwa kwa ma pancreas a exancine a kapamba ndi maselo a mononuclear. Vutoli limatha kuyambitsa kupweteka kwambiri kwa kapamba kapena chotupa, ndi kupweteka kwa malabsorption ndi cholestasis, ndipo nthawi zina amapezeka kuti ali ndi khansa ya pancreatic kapena lymphoma.

Kusintha kwa chibadwa kumatha kupangitsa kuti insuffini ya insulin itha komanso kusokonekera kwa pancreatic; kumapangitsa kutsika kwa cell ya cell ya beta, monga momwe zimapezekera pancreatitis yosatha.

Njira ya fibrous mu pancreatitis yosatha imayambitsa kuchepa kwa kuchuluka kwa maselo a beta ndipo imatha kusintha kufalikira kwa kapamba, komwe kumapangitsa kutsika kwa ma islets, kuperekera kwa secagagogess ku cell ya beta, komanso kuchepa kwa kutuluka kwamafuta am'mimba pancreatic. Kuchepa kwa magwiritsidwe a beta kumafotokozera kuchepa kwa insulin: kuchuluka kwa kuchepa kwa minyewa ya pancreatic endocrine, kuipiraipira kwa insulin katulutsidwe komanso kuchuluka kwa kulolera kwa shuga. Odwala omwe ali ndi matenda osokoneza bongo a mellitus sekondale yosachiritsika yokhala ndi kapamba wofatsa pang'ono komanso osokoneza bongo a hyperglycemia, plasma ya ndende ya insulin ikhoza kukhala yabwinobwino kapena yochepa. Komabe, kubisala kwa insulin komwe kumachitika pafupifupi kumakhalapo. Kutsika kwa kuthekera kwakukulu kwa insulin katemera mwa odwalawa ndikudziwikiratu ndikuwonetsa kuchepa kwa insulin. Minyewa ya m'magazi ya plasma ikadutsa 10 mmol / L (180 mg / dl), plasma insulin ndi mpweya wa C-peptide nthawi zambiri siziwoneka.

Kuyankha kwa maselo a beta ku amino acid kumatsikikiranso pamlingo wokufa kwa maselo a beta komanso kuopsa kwa kulolerana kwa shuga.

Arginine-yolimbikitsidwa ndi C-peptide katulutsidwe kamakhala koyenera kwa odwala omwe ali ndi kapamba komanso kulekerera kwa glucose, koma nthawi zonse kumachepetsedwa kwa odwala omwe amasala kudya kwa hyperglycemia.

Exocrine ndi endocrine imagwira ntchito limagwirizanirana, zomwe zimawonetsa mgwirizano wapadera wa chotupa mkati mwa zotupa za pancreatic ndi kukula kwa matenda ashuga. Kulemberana makalata kunapezeka pakati pa mayankho a insulini pakumwa shuga wa m'magazi komanso kuchuluka kwa michere ya pancreatic mu madzi a duodenal atatha kulowetsedwa kwa cholecystokinin-pancreosimine (CCK-PZ). Odwala omwe ali ndi steatorrhea amakhala ndi mawonekedwe apansi a C-peptide kuposa odwala omwe ali ndi vuto lalikulu la exocrine.

Mwa anthu athanzi, kumeza shuga kumapangitsa kuti pakhale chitetezo champhamvu kwambiri kuposa kulowetsedwa mwa kuchuluka kwa glucose, chifukwa cha kutseguka kwa dongosolo la insretin. Mu chifuwa chachikulu cha pancreatitis, kubisala kwa zinthu za insretin: cholecystokinin, gastrin, enteroglucagon, glucose amadalira insulinotropic peptide (GIP) ndi vasoactive matumbo a polypeptide worsensens. Komabe, kafukufuku waposachedwa wanena za kutulutsa kochulukira ngati glucagon-peptide-1 (GLP-1), poyankha makonzedwe am'magazi a odwala omwe ali ndi matenda ashuga a sekondale kupita kwa kapamba poyerekeza ndi odwala omwe ali ndi kulekerera kwabwinoko kapena shuga. Odwala omwe ali ndi matenda osokoneza bongo a mellitus sekondale kuti apite pancreatitis, mayankho a insulini ku cholecystokinin ndi ofanana ndi kuchuluka kwa hyperglycemia. Mosiyana ndi izi, kutulutsidwa kwa insulin poyankha GIP kumachepetsedwa. Komabe, kulowetsedwa kwa GLP-1 kwa odwala omwe ali ndi matenda ashuga a m'matenda a shuga kapenanso kumachitika ndi kuchepa kwa glucose wamagazi ndi kuchuluka kwa plasma ndende ya C-peptide, izi sizimasiyana ndi zomwe zimawoneka mwa anthu athanzi. Mu shuga mellitus yachiwiri mpaka chifuwa chachikulu, sichidziwika bwinobwino ngati pali cholumikizira kapena chosavomerezeka cha matumbo a m'mimba ndi chikhodzodzo. Kuzama kwa plasma GIP kumawonjezera odwala omwe ali ndi matenda osokoneza bongo omwe ali ndi pancreatitis yosatha, makamaka atachoka ku insulin. Kumbali ina, kuchuluka kwa kuchuluka kwa zakudya zokhudzana ndi plasma cholecystokinin kumachepetsedwa poyerekeza ndi maphunziro opanda matenda ashuga kapena odwala omwe alibe matenda ashuga omwe ali ndi chifuwa chachikulu.

Odwala omwe ali ndi chifuwa cham'mimba, chizolowezi chomanga shuga nthawi zambiri chimasungidwa mpaka 20-25% ya kuchuluka kwa maselo a beta atayika. Komabe, kuchuluka kwa kuchepa kwa khungu la beta kumayendera limodzi ndi kuwonongeka kwa glucose-mediated insulin, ngakhale kuyankha kwa cholecystokinin ndi arginine ndikadali kwachilendo. Kusintha poyankha pazinthu zomwe zimapanga ma incretin ndi ma amino acid kumawonekera kwambiri pamene cell ya beta imatsika ndi 40-60%. Pomaliza, beta-cell ikucheperachepera 80-90%, kusala kudya kwa hyperglycemia komanso kuphwanya insulin kutulutsa kanthu chifukwa cha zobisika zonse. Katemera wa Glucagon mwa odwalawa ndiwopanda mphamvu, ndipo mikhalidwe iwiri ikuluikulu imadziwika. Ngakhale odwala ena ali ndi vuto losakanikirana ndi insulin ndi katulutsidwe wa glucagon, ena amatha kuwonetsa kwambiri hypoinsulinemia komanso kutsika kwa plasma glucagon. Kuphatikiza apo, kuyamwa kwa glucagon kukondoweza ndi arginine kapena alanine kumangopangidwira 50% ya odwala omwe ali ndi vuto la shuga. Kupita patsogolo kwa matenda apakhungu, kuthekera kwa maselo a alpha poyankha insulin-insulin kumafooketsa. Komabe, kutsitsa shuga mkamwa kumatha kutsagana ndi kuchuluka kwa shuga m'magazi a glucagon, pomwe mayankho a glucagon ku secretin ndi cholecystokinin amakhala abwinobwino kapena akuwonjezeka.

Pali mikangano yokhudza kukula kwa molekyulu ndi gwero la kufalikira kwa glucagon kwa odwala omwe ali ndi matenda ashuga chifukwa chokhala ndi chifuwa chachikulu. Mitundu inayi yakukula kwa glucagon (kulemera kwakukulu kwa oposa 50,000, 9,000, 3,500 ndi 2,000) kudatsimikizika mu plasma ya anthu athanzi. Glucagon yokhala ndi kulemera kwakukulu kwa 3500 ndiyachidziwikire cha pancreatic ndipo ali ndi zochita zathupi zathunthu. Umu ndi mtundu wokhawo womwe umayankha ndikulimbikitsidwa ndi arginine ndi kukakamiza kwa somatostatin. Maphunziro a ntchito ndi kusanthula kwa chromatographic kumathandizira kulingalira kwa pancreatic komwe kumazungulira glucagon mu chifuwa chachikulu, koma gawo lofunikira la glucagon ya enteropancreatic pamatenda ake a plasma omwe amayesedwa ndi radioimmunoassay amathanso. Chifukwa chake, kuchuluka kwa shuga m'matumbo kumachulukanso mwa odwala matenda a shuga.

3. Kufalikira kwa matenda ashuga chifukwa cha kapamba kapena chifuwa chachikulu

Zambiri zakufala kwa matenda ashuga owonjezera pokhudzana ndi matenda a pancreatic zimasowa, koma zochitika za matendawa mwina ndizokwera kuposa zomwe anthu ambiri amakhulupirira. Malinga ndi kafukufuku wakale, matenda a shuga a pancreatogenic ndi 0,5-1.7% yamilandu yonse yamatenda a shuga. Mu lipoti laposachedwa, kuchuluka kwa anthu odwala matenda ashuga kumawerengeredwa pafupifupi 9,2% mwa anthu odwala matenda ashuga aku 1868 ku Germany omwe amalembapo kuperewera kwa kapamba komanso kulingalira kosadziwika bwino. M'chipinda china cha 1922 odwala omwe ali ndi vuto la autoantibody-negative omwe ali ndi kuchepa kwa pancreatic komanso endocrine pancreatic, ndi 8% yokha ya milandu omwe adapezeka ndi matenda osokoneza bongo, pomwe 80% ya milandu yodwala 2 adapezeka ndipo 12% ya odwala - mtundu 1 shuga. M'malo mwake, pagulu lino la anthu, 76% ya odwala anali ndi kapamba wambiri, 8% anali ndi matenda a hemochromatosis, 9% anali ndi khansa ya kapamba, 4% anali ndi cystic fibrosis, ndipo kuyambiranso kwanyimbo kunachitika mu 3% ya milandu.

Chiwopsezo cha pancreatitis chachilengedwe chimakhala chambiri mu anthu omwe amamwa kwambiri zakumwa zoledzeretsa komanso kumayiko otentha, momwe kuchuluka kwa matenda ashuga a sekondale kwa fibrocalcule pancreatitis kungafikire 90%, komwe kuli mpaka 15-20% ya onse odwala matenda ashuga. Chifukwa chake, kufalikira kwa matenda ashuga omwe amayamba chifukwa cha kapamba mwina samachepetsa, kuwunika kwa matenda a pancreatogenic nthawi zambiri kumayang'aniridwa, ndipo odwala nthawi zambiri amalembedwa molakwika.

M'mayeso 24 omwe akuyembekezeredwa kuchipatala omwe amaphatikizapo odwala 1102 omwe ali ndi pancreatitis yacute, prediabetes ndi / kapena matenda a shuga amawonetsedwa mu 37% ya milandu. Kukula konse kwa prediabetes, matenda a shuga, ndi chithandizo cha insulin pambuyo pancreatitis yayikulu inali 16%, 23%, ndi 15%, motero. Posachedwa matenda a shuga amayamba mwa anthu 15% mkati mwa miyezi 12 pambuyo pa gawo loyambirira la pancreatitis pachimake.

ndipo chiwopsezocho chinakula kwambiri pazaka 5 (chiopsezo wachibale 2.7). Zomwezi zimachitikanso pankhani ya chithandizo cha insulin.

Odwala omwe ali ndi pancreatitis pachimake nthawi zambiri amakhala ndi prediabetes komanso / kapena matenda ashuga atachotsedwa kuchipatala, ndipo chiopsezo chawo chotenga matenda a shuga chikuwonjezeka kawiri pazaka 5 zikubwerazi.

Matenda a shuga ndi / kapena shuga adawonedwa pafupifupi 40% ya odwala pambuyo pancreatitis yovuta, ndipo shuga adapangidwa pafupifupi 25% ya odwala pambuyo pancreatitis yayikulu, 70% yomwe imafuna insulin nthawi zonse. Kuphatikiza apo, kuopsa kwa pancreatitis ya pachimake kumawoneka kuti sikunathandize kwenikweni pakukonzekera kwa prediabetes kapena matenda ashuga pambuyo pancreatitis yayikulu. Odwala omwe anali ndi pancreatitis yovuta kwambiri anali ndi kuchuluka kwapamwamba kwambiri kwa prediabetes (20%) komanso matenda a shuga (30%). Kuwunika kwa meta-regression kunawonetsanso kuti chiopsezo chokhala ndi prediabetes kapena matenda ashuga pambuyo pancreatitis yachuma imayima payokha pa etiology, komanso zaka komanso jenda. Kukula kwa onse prediabetes ndi matenda ashuga kumakonda nthawi yoyamba pambuyo pancreatitis pachimake. Kukula kwa prediabetes ndi matenda ashuga mkati mwa miyezi 12 kuchokera gawo loyamba la kapamba owopsa anali 19% ndi 15%, motero. Tsoka ilo, pali kafukufuku umodzi wokha yemwe adayesa odwala omwe ali ndi prediabetes omwe anali ndi pancreatitis pachimake kuti adziwe ngati ali ndi matenda a shuga, koma, malinga ndi mabuku onena za matenda ashuga, odwala omwe ali ndi prediabetes atha kukhala ndi matenda ashuga.

Acute pancreatitis ndi chifukwa chodziwika bwino cha matenda ashuga. Ngakhale kuchepa kwa maselo a pancreatic chifukwa cha necrosis (ndi kapena popanda kuchitapo kanthu opaleshoni) kumatengedwa ngati chifukwa chachikulu cha matenda osokoneza bongo pambuyo pancreatitis yacute, odwala oposa 70%, kuchuluka kwa necrosis sikunapitirire 30%, ndipo 78% ya odwala anali okhazikika. Kuphatikiza apo, zikuwoneka kuti palibe chomwe chinayambitsa kuwopsa kwa matendawa pachiwopsezo cha matenda a shuga. Izi zikusonyeza kuti matenda ashuga pambuyo pancreatitis yachilendo amatha kupezeka chifukwa cha masisitimu osiyana ndi necrosis.

Ma antibodies a glutamic acid decarboxylase (IA2) amapezeka mwa odwala omwe ali ndi autoimmune latentabetes mellitus ndi mtundu wa matenda ashuga a 1. Ndikotheka kuti kapamba kovuta kwambiri amachititsa anthu omwe ali ndi vuto la matenda ashuga kale. Kuphatikiza apo, akuti posachedwapa zinthu zina za metabolic, monga kunenepa kwambiri komanso hypertriglyceridemia, zimayika odwala pachiwopsezo chachikulu chokhala ndi pancreatitis pachimake yotchedwa pachimake metabolic pancreatitis, ndipo zinthu izi zimapangitsanso chiwopsezo chokhala ndi matenda ashuga pambuyo pancreatitis yayikulu.Popeza kunalibe zidziwitso zama metabolic asanafike kumenyedwa koyamba kwa pancreatitis yovuta kwambiri, maphunziro amtsogolo amayenera kuyankha mafunso okhalapo preexisting autoantibodies, kusintha kwa magwiridwe antchito kapena kusintha kwa ntchito komwe kumatsimikizira kukula kwa hyperglycemia ndi shuga mellitus pambuyo pancreatitis yayikulu.

Ndizofunikanso kudziwa kuti kukhalapo kwa matenda ashuga omwe amakhalapo kale kumapangitsa kuti pakhale matenda oopsa a pancreatitis, omwe amatsimikizira maziko osavuta a kusintha kwa kagayidwe kachakudya.

Mukamasanthula momwe matendawa amathandizira pakapita nthawi, zimapezeka kuti kuchuluka kwa matenda ashuga komanso matenda ashuga ambiri komanso matenda a shuga makamaka akuchulukirachulukira pakapita nthawi. Tiyenera kuzindikira kuti kufalikira kwa matenda osokoneza bongo kumawonjezereka pambuyo pa zaka 45, ndipo zotsatira za kukalamba pa ntchito ya maselo komanso kuchuluka kwa insulin chifukwa cha kunenepa kwambiri kungafotokoze pang'ono izi, komabe, kuwunika kwa kulingalira kwawonetsa kuti zaka sizofunika kwambiri pakati odwala pambuyo pachimake kapamba. Njira ina yomwe ingagwiritsidwe ntchito ndikuti anthu ena atha kudwala matenda a pancreatitis pachimake asanakayezedwe zaka 5. Izi zidanenedwa m'maphunziro ena, koma izi sizinatengedwe m'mabuku ambiri ophatikizidwa. Izi zikutanthauza kuti kuthana ndi mobwerezabwereza kwa kapamba ka pachimake pangozi ya matenda a shuga ndi matenda a shuga kungakulitse kuchuluka kwawo nthawi yayitali. Sizikudziwika ngati kubwereza kokhazikika kwa pancreatitis kwamphamvu kumathandizira kuchepa kwa maselo a kapamba, ngati njira imodzi yopititsira patsogolo matenda a shuga ndi zina.

4. Mawonekedwe amtundu wa shuga chifukwa cha kapamba kapena chifuwa chachikulu

Odwala omwe ali ndi mitundu yachiwiri ya matenda ashuga amakhala ndi zizindikiro zokhudzana ndi hyperglycemia, koma chiwopsezo chowopsa cha hypoglycemia. Zochitika za hypoglycemia zokhudzana ndi mankhwala a insulin kapena mankhwala a sulfonylurea ndizofala kwambiri ndipo nthawi zambiri zimakhala zowopsa komanso zimapitilira, izi zimapangitsa kuti azigonekedwa kuchipatala ndikuwapatsa odwala chiopsezo cha kufa. Hypoglycemia imakonda makamaka pambuyo pancreatectomy, ndikupangitsa kufa mu 20-50% ya odwala. Chithunzi chochititsa chidwi chotere ndi zotsatira za kuphwanya kwa kutsutsana ndikupatsanso shuga. Kulephera kwa thupi kuyankha msanga kuchepa kwa plasma glucose chifukwa cha kusakwanira katulutsidwe wa glucagon, kuchepa kwa katecholamine komanso kuperewera kwa kupangika kwa shuga m'magazi. Kuwonjezeka kwa zochitika za hypoglycemic kumalumikizidwa ndi kusakhazikika kwa glycemic.

Kupitilizidwa kwa ethanol pambuyo pa mankhwala osokoneza bongo kapena chithandizo cha opaleshoni ya kapamba kumatha kusokoneza kagayidwe kachakudya ka odwala omwe ali ndi matenda ashuga, popeza mowa umalepheretsa gluconeogeneis, umakhudza kutulutsa kwa hypothalamic-pituitary kwa adrenocorticotropic timadzi timene timene timapanga komanso kukula kwa insulin, ndipo timapangitsa insulin kukana. Hypoglycemia ikhoza kukhala yoopsa kwambiri ngati michere ya zakudya itachepa komanso malo ogulitsira a chiwindi amatha.

Kuledzeretsa pambuyo pancreatectomy ndikofunikira kwambiri pakukula kwa hypoglycemia ndi imfa. Odwala awa, kutsatira kwambiri insulin makonzedwe kumapangitsa kuti metabolic asakhazikika.

Komabe, chitukuko cha ketoacidosis ndi matenda ashuga mu kapamba ka chifuwa chachikulu cha shuga chimakhala chofunikira ngakhale kwa odwala popanda chinsinsi cha C-peptide. Izi zikachitika, nthawi zambiri zimagwirizana ndi zovuta monga matenda kapena opareshoni. Pa nsonga yotsalira ya insulin katulutsidwe, kuchepa kwamafuta ndimasungidwe otsika a lipolysis kumathandizira pang'ono pachiwopsezo cha ketosis. Kutsutsa kofananako kwa ketosis kumawonedwa mu matenda otumphukira a shuga, komwe vuto la kusoŵa kwa zakudya m'thupi komanso kumwa kwambiri mafuta osakwaniritsidwa kumapangitsa kuchepa kwa kapangidwe ka matupi a ketone. Udindo wa kusowa kwa glucagon poteteza odwala a shuga a pancreatic ku ketoacidosis ndiwotsutsana. Komabe, ndizotheka kuti, ngakhale kuti glucagon ikhoza kukhala yofunikira pakukula kwa ketosis, kuchepa kwake kungachedwetse kapena kuchepetsa kuchepa kwa matenda ashuga a ketoacidosis.

Mavuto osungika pokhazikika pakukhutiritsa kwa kagayidwe kachakudya kwa odwala omwe ali ndi matenda osokoneza bongo chifukwa cha pachimake kapena pancreatitis yayikulu idayambitsa kuphatikizidwa kwa gulu ili la matenda omwe ali m'gulu la "matenda osalimba a shuga."

Exocrine pancreatic kusakwanira ndi malabsorption kumatha kuyambitsa kusakhazikika kwa kayendedwe ka shuga. Steatorrhea imatha kuyambitsa malabsorption a glucose, potero, imathandizira pakumachitika kwa postprandial hypoglycemic, komanso kusintha kwa insulin secretion. Kukula kwa matenda a shuga kwa odwala omwe ali ndi matenda a pancreatic amatha kumalumikizidwa ndi kuchepa kwambiri, komwe kumakhala kovuta kuwongolera ngakhale ndi chithandizo choyenera cha insulin. Kuphatikiza apo, kuchepa thupi kokha kumatha kusintha kwambiri kumva kwa insulin.

4.1 Matenda apakati a matenda a shuga a pancreatogenic

Kuyambira chakumapeto kwa zaka za m'ma 1950, zakhala zikumveka kuti matenda ashuga pambuyo pancreatitis yayitali samayenderana ndi zovuta zam'mimba. Pofotokozera chikhulupiriro ichi, zinthu zingapo zidanenedwa, kuphatikiza kusakhalapo kapena kuchepa kwa chibadwa, procrine pancreatic insufficiency, low serum cholesterol, otsika calorie, etc. Komabe, chifukwa cha kuchuluka kwa nthawi yayitali kwa odwala, milandu yambiri ya matenda ashuga imasonkhanitsidwa.

Kukula kwa matenda ashuga retinopathy mwa odwala matenda ashuga pambuyo pancreatitis aakulu kapena kapamba amasiyana kwambiri ndi zomwe akuti poyamba. Posachedwa, kuwunika kolondola kwambiri kwa matenda ashuga retinopathy kwawonetsa kuchuluka kwa 3040%, chithunzi chofanana ndi chomwe chimapezeka mwa odwala omwe ali ndi matenda a shuga 1. Chiwopsezo cha retinopathy chikugwirizana ndi kutalika kwa hyperglycemia. Palibe njira yodziwikiratu pakati pa kukhalapo kwa retinopathy ndi mbiri yabwino yabanja la matenda ashuga, kufalikira kwa ma antigen a HLA, kukhalapo kwa ma antibodies kuma cell a islet, kapena kuchuluka kwa plasma a C-peptide.

Mavuto akupitilizabe pazovuta za matenda ashuga a m'mimba. Olemba ena adanena kuti "sanathe kupeza aliyense yemwe akudziwa za vuto la gloperillos glomerulosranceosis wophatikizika ndi hemochromatosis kapena kapamba. Komabe, milandu yambiri ya nodular glomerulossteosis kwa odwala omwe ali ndi matenda ashuga chifukwa pachimake kapena matenda apakhungu a chifuwa chachikulu cha matenda a shuga a shuga akuti anthu odwala matendawa amatha kupindika, koma amakhala nthawi yayitali. Izi zikulongosola chifukwa chake zimakhala zovuta kudziwa kuzimiririka kwa vuto la matenda ashuga, pomwe kusintha kwakanthawi kumatha kupezeka zaka zingapo isanayambike albinuria. M'magulu a odwala 86 omwe ali ndi matenda ashuga chifukwa cha kupweteka kwambiri kapena kupweteka kwa khansa, kwamikodzo albumin excretion oposa 40 mg / 24 h adatsimikizika mu 23% ya odwala, ndipo albinuria adalumikizidwa ndi nthawi yayitali ya shuga ndi kuthamanga kwa magazi, koma osati ndi mbiri ya banja la matenda ashuga, ma antigen a HLA, kapena plasma C-peptide. Kuchuluka kwa retinopathy kunali pafupifupi kuwirikiza kawiri kwa odwala omwe ali ndi maUU, ndikuwonetsa kuti gulu la "oculorenal" lomwe limafotokozedwa mu 1 mtundu wa odwala matenda a shuga amapezekanso matenda a shuga a pancreatogenic. Glomerular hyperfiltration, chizindikiro china choyambirira cha kusokonezeka kwa impso, imatha kupezeka ndi shuga wa kapamba monga mtundu 1 wa shuga. Ngakhale kuwonongeka kwa matenda a impso a shuga, kuchuluka kwa kuchuluka kwa mankhwala a albumin kuposa 0.5 g / tsiku kapena kulephera kwa impso sikuchitika.

Neuropathy ndimadandaula ambiri pancreatogenic shuga. 10-20% ya milandu ya distal polyneuropathy kapena mononeuropathy ikupezeka, ndipo ma electrophysiological zizindikiro za mkhutu wamkati wozungulira amapezeka muoposa 80% ya odwala matenda a shuga a mellitus sekondale matenda opatsirana. Zinapezeka kuti kumva kugwedezeka kwamphamvu kumasokonekera pafupifupi chimodzimodzi ndi matenda a shuga 1.

Mosiyana ndi onse retinopathy ndi nephropathy, palibe ubale pakati pa neuropathy ndi nthawi yayitali ya matenda ashuga. Izi zitha kuchitika chifukwa cha zomwe zimachitika motsutsana ndi hyperglycemia (kusuta, mowa ndi malabsorption).

Palinso zosintha mu dongosolo la mantha aumwini. Zovuta zam'mtima zimapezekanso mu 8% ya odwala matenda a shuga pambuyo pancreatitis yosatha, pomwe vuto la malire lidawonekeranso mu 13% ya odwala. Komabe, kusamala kwina kuyenera kuchitika pakukonza hyperglycemia ndi matenda ashuga somatic ndi autonomic neuropathy, chifukwa kumwa mowa kumachitika mwa anthu awa. Chifukwa chake, njira yeniyeni ya pathogenetic ya neuropathy mwa odwala omwe ali ndi matenda osokoneza bongo omwe ali ndi matenda a kapamba, makamaka, amaphatikizapo zinthu zambiri.

Macroangiopathies, makamaka myocardial infaration, ndi osowa mu shuga wa pancreatogenic. Mu lipoti limodzi, zovuta za mtima zimapezeka mu 25% ya odwala omwe ali ndi matenda osokoneza bongo pambuyo pancreatitis yayitali, ndipo ena amafunidwa kapena kudulidwa opaleshoni ya mtima. Kutalika kochepa kwambiri kwa matenda a shuga komanso chifukwa chachikulu cha matenda a pancreatic kumapangitsa kuti zikhale zovuta kudziwa kuchuluka kwa zovuta m'matendawa. Malinga ndi kafukufuku wina yemwe wapezeka kwa nthawi yayitali, kuchuluka kwa anthu omwe amafa ndi mtima chifukwa cha odwala kapamba ndi 16%, omwe ndi otsika poyerekeza ndi matenda akale a shuga.

5. Kuzindikira matenda ashuga okhala ndi kapamba wambiri

Nthawi zina zimakhala zovuta kudziwa bwino komanso kupatsa wodwala matenda a shuga chifukwa cha chifuwa chachikulu kapena chifuwa chachikulu. Kukhalapo kwa nthawi yayitali kwa mitundu 1 ndi 2 ya matenda osokoneza bongo a shuga kumayendera limodzi ndi kuperewera kwa gawo la kapamba, ndipo odwala matenda a shuga ali pachiwopsezo chachikulu chokhala ndi pancreatitis yovuta komanso / kapena pancreatitis yayitali.

Odwala omwe ali ndi mbiri ya pancreatitis amatha kukhala ndi matenda amtundu wa 1 kapena mtundu wa 2, mosasamala kanthu za mtundu wa exocrine pancreatic function. Kuti magawo abwino a odwala azikhala ndi matenda ashuga chifukwa cha mphuno kapena chamba chodwala, njira zambiri zodziwikiratu zomwe sizipezeka pakadali pano ziyenera kukhazikitsidwa. N. Ewald et al akuwonetsa kugwiritsa ntchito izi:

Njira zazikulu (ziyenera kukhalapo):

- Mayeso a Exocrine pancreatic insufficiency (monoclonal fecal elastase-1 test kapena mayeso ogwirira ntchito mwachindunji)

- Pathology ya kapamba pakuganiza (endoscopic ultrasound, MRI, CT)

- Kuperewera kwa matenda ashuga amtundu woyamba wokhudzana ndi chizindikiro cha autoimmune

- Palibe pancreatic secretion ya polypeptide

- Kubisala kubisala (mwachitsanzo, GLP-1)

- Palibe kukana insulini (mwachitsanzo H index-IR insulin resistance index)

- Matenda a beta operewera (mwachitsanzo HOMA-B, C-peptide / glucose ratio)

- Ochepera mavitamini a seramu osungunuka (A, D, E ndi K)

Mulimonsemo, mawonekedwe atsopano a shuga ayenera kugwiritsira ntchito njira zomwe zafotokozedwa ndi European Association for the Study of Diabetes (EASD) ndi American Diabetes Association (ADA) ndikuwona matenda a shuga a pancreatogenic. Osachepera, ngati wodwalayo akuwonetsa chithunzi cha chipatala cha atypical ndikudandaula zazizindikiro kuchokera m'matumbo am'mimba, adokotala ayenera kudziwa za kukhalapo kwa matenda a shuga a pancreatogenic ndikuyambitsa matenda ena.

Wodwala aliyense wodwala kapamba ayenera kuyang'aniridwa pancreatogenic shuga mellitus. Kuunika koyambirira kwa odwala omwe ali ndi pancreatitis yayikulu kuyenera kuphatikizapo kuyesa kudya glycemia ndi HbA1c. Izi zimayenera kubwerezedwa pachaka. Kupeza kwachidziwitso ndi wina aliyense wa iwo kumafunikanso kuwazindikira. Ngati zotsatira za mayeso zikusonyeza kulekerera kwa glucose, kuyesedwa kwa shuga mkamwa kumalimbikitsidwanso. Kuwunika kofananira kwa kuchuluka kwa insulin ndi / kapena C-peptide kungakhale kothandiza kusiyanitsa pakati pa mtundu 2 shuga mellitus ndi shuga mellitus chifukwa cha pancreatitis yayikulu kapena yayitali.

Kuwona kuyankha kwa pancreatic polypeptide kwa insulin-insulin, kulowetsedwa kwa katulutsidwe kapena kaphatikizidwe kazakudya kungakhale kowonjezera kuzindikira. Kupanda kuyankha kwa pancreatic polypeptide kumalola munthu kusiyanitsa matenda a shuga a pancreatogenic ndi mtundu 1, amathanso kusiyanitsa matenda ashuga chifukwa cha pancreatitis yayikulu kapena yayitali chifukwa cha mtundu wachiwiri wokhala ndi pancreatic polypeptide. Kutsimikiza kwokhazikika kwa pancreatic incretin secretion ndi kuyankha kwa pancreatic polypeptide muzochita zamasiku onse, komabe, sizingatheke.

6. Zochizira zokhudzana ndi matenda a shuga a pancreatogenic

Zolinga zikuluzikulu zamankhwala othandizira odwala matenda ashuga, ngakhale atakhala amtundu wotani, zimaphatikizapo: kuthana ndi zovuta zomwe zimayambitsa matendawa, kupewa matenda a shuga, kupewa komanso kuchepetsa kuchepa kwa zovuta za matenda a shuga. Njira yothetsera vutoli, malingana ndi malingaliro amakono, ndizotheka mukakwaniritsa ndikusunga glycemia moyandikira kwambiri kwa anthu athanzi, ndikuchotsa zofunikira komanso zovuta za matendawa.

Zakudya za pancreatogenic shuga mellitus zimafanana ndi za mtundu 1 wa matenda a shuga, kupatulapo kufunika kokonza malabsorption, kuperewera kwa mavitamini ndi kufufuza zinthu, kusankha zakudya zazoperewera kumathandiza kupewa hypoglycemia.

Pancreatitis pachimake imayendera limodzi ndi hyperglycemia mu 50% ya odwala, ndipo nthawi zina ketosis kapena matenda ashuga angayambenso. Pankhani yofunika kwambiri hyperglycemia, ketosis kapena chikomokere, kuwunika mosamala plasma shuga ndende, ma elekitiroma, ma ketones ndi zina za metabolic ndikofunikira, limodzi ndi kulowetsedwa kwamadzimadzi ndi kulowetsedwa kwa insulin malinga ndi mfundo zachikhalidwe zamankhwala a matenda ashuga a ketoacidosis.

Hyperglycemia imawerengedwa ngati chopinga chachikulu chothandizira pakulandidwa bwino, ngakhale kwa odwala omwe alibe shuga. Chifukwa chake, kupezeka bwino kwa insulin panthawi yakudya yamaukonde ndizofunikira, pogwiritsa ntchito makina anthawi zonse a insulin.Ndikulimbikitsidwa kuti odwala omwe ali ndi pancreatitis yovuta kwambiri azisamaliridwa ndi gulu la madokotala osiyanasiyana.

Kwa odwala omwe ali ndi pancreatitis yovuta kwambiri, ayenera kulimbikitsidwa pokhapokha, m'malo mochotsa chifuwa, chifukwa chomaliza chimayendera limodzi ndi matenda ashuga. Mulimonsemo, kulolera kwa glucose kuyenera kuwunikira miyezi 3-6 pambuyo pa gawo la pancreatitis pachimake.

Odwala omwe ali ndi pancreatitis kapena pancreatectomy yochepa, othandizira pakamwa amatha kuperekedwa kwa iwo omwe amakhalabe ndi yankho la C-peptide lokwanira pa glucagon kapena chakudya. Mwachidule, m'malo mochita sulfonylureas amasankhidwa kuti achepetse chiopsezo cha hypoglycemia. Komabe, muyenera kusamala mukamagwiritsa ntchito mankhwala amkamwa mwa odwala omwe akusintha mu magwiridwe antchito a chiwindi. Posachedwa, mwayi wakugwiritsa ntchito GLP-1 ndi dipeptidyl peptidase 4 inhibitors wafotokozedwa, chifukwa kutsika kwa glucose kutsika kwawo sikuwoneka kuti kukukulitsa chiopsezo cha hypoglycemia. Komabe, pali zovuta zina chifukwa sizikudziwikabe ngati pali chiopsezo chowonjezeka cha kapamba, womwe umagwirizana ndi kugwiritsa ntchito mankhwala a insretin.

Mankhwala a insulin amafunikira pambuyo pancreatectomy yathunthu, ngakhale kufunikira kwa insulini kumatsika kuposa odwala omwe ali ndi matenda a shuga 1, makamaka usiku. Mosiyana ndi izi, kufunikira kwa insulin ya postprandial kungakhale kokulirapo. Izi zimachitika makamaka kwa odwala omwe ali ndi pancreatectomy yonse, pomwe odwala omwe amadalira insulin kapena pancreatectomy osagwirizana nthawi zambiri amakhala ndi zofunika za insulini zofanana ndi za matenda a shuga 1. Mlingo wa insulin womwe watenga nthawi yayitali ayenera kugwiritsidwa ntchito kuwongolera hyperglycemia usiku komanso pamimba yopanda kanthu. Ma analogi omwe amakhala ndi nthawi yayitali amachepetsa chiopsezo cha nocturnal hypoglycemia poyerekeza ndi insulin NPH, kotero oyamba ayenera kusankhidwa. Chifukwa chake, mtundu wapamwamba wa basal-bolus wokhala ndi fanizo lalifupi komanso lalitali ungakhale woyenera. Odwala omwe ali ndi chidwi chachikulu komanso ophunzitsidwa bwino, chithandizo cha insulin kudzera kulowetsedwa kosalekeza chimagwiritsidwa ntchito bwino kukwaniritsa kuyang'anira kwa metabolic, popewa hypoglycemia ndi ketosis.

Ngakhale atalandira chithandizo chiti, hypoglycemia idakali vuto lalikulu. Kuwonjezeka kwa pafupipafupi komanso kuopsa kwa zochitika za hypoglycemic ndi mwina chifukwa cha kuphatikiza kwa zinthu zingapo, kuphatikiza insulin, chidwi cha insulini, kutsutsana, kuphwanya zakudya, kapena kuperewera kwa michere, kumwa mowa komanso matenda a chiwindi. Chiwopsezo cha hypoglycemia chakupha chimakhala chachikulu kwambiri kwa odwala omwe ali ndi pancreatectomy kwathunthu, ndipo izi zapangitsa kuti kufunafuna njira zopangira opaleshoni zotetezeka komanso mankhwala. Chifukwa chake, kusungidwa kwa duodenum ndi pylorous kumawoneka kuti kumatsimikizira kuyendetsa bwino kwambiri kagayidwe kachakudya ndi kuchepetsa ma episode a hypoglycemia. Hypoglycemic reaction, ngati zichitika, ziyenera kuthandizidwa mwamphamvu, ndipo zomwe zimayambitsa ndi njira zake ziyenera kuwunikiridwa bwino ndikufotokozera odwala. Odwala ayenera kuphunzitsidwa kuteteza kuti pakubwera matenda oopsa a hypoglycemia, kuyenera kuyang'aniridwa kukana kumwa mowa, kuchuluka kwa masewera olimbitsa thupi, kudya pang'ono komanso kutsatira njira yothandizira enzyme. Posachedwa, aslet autotransplantation yafunsidwa kuti iteteze kudalira kwa insulin. Islet autotransplantation imathandizira kukhazikika kwa cell ya beta ndikuwongolera glycemic kosatha kwa zaka 13 mutatha kuchita pancreatectomy yonse yochizira matenda apamba.

Chifukwa cha "kusokonekera" kochulukirapo kwa odwala omwe ali ndi matenda a kapamba, maphunziro a odwala komanso kudziyang'anira pawokha kuchuluka kwa glucose ndikofunikira kwambiri. Kuwongolera kwambiri glucose wakunyumba ndikusinthidwa kwakanthawi kwamankhwala a insulin, komanso mapulogalamu owonjezera, kungapangitse kuwongolera kwabwino kwa metabolic mwa odwala. Komabe, akuyenera kutsagana ndi masitepe ena, kuphatikiza kukonza zakudya komanso zakumwa zoledzera. Kumwa mowa kwambiri kumapangitsanso kuti chiwindi chiwonongeke pang'onopang'ono, chokhacho chomwe chingalepheretse kuwongolera kwa metabolic.

Kuchepa kwamkati ndi steatorrhea kumawonjezera chiopsezo cha hypoglycemia komanso kuphwanya insulin chifukwa cha zovuta za insretin. Odwala omwe ali ndi pancreatogenic shuga mellitus, mankhwala a enzyme omwe ali ndi mankhwala osagwirizana ndi asidi ayenera kuperekedwa kuti achepetse kumasulidwa kwa mafuta okhala ndi ziwengo zosakwana 20 g / tsiku. Chithandizo chogwirizana ndi H2 receptor antagonists tikulimbikitsidwa chifukwa kuchepetsedwa kwa secretion ya chapamimba kumachepetsa kuchepa kwa michere ya pancreatic. Zakudya zama calorie ambiri (zopitilira 2500 kcal / tsiku) zopatsa mphamvu zamafuta pang'ono komanso zamafuta ochepa zimalimbikitsidwa. Odwala omwe ali ndi chifuwa chachikulu cha m'mimba, kudya kwambiri kwamafuta kumawonjezera pafupipafupi komanso kulimba kwam'mimba. Chifukwa chake, kudya mafuta kwambiri sayenera kupitirira 20-25% ya kuchuluka kwa kalori. Mankhwalawa amayenera kukhala ocheperako komanso zakudya pafupipafupi, okhala ndi zakudya zazikulu zitatu ndi ziwiri kapena zochepa. Ngati ndi kotheka, chakudyacho chikuyenera kuphatikizidwa ndi ma electrolyte, calcium, vitamini D ndi potaziyamu. Kupititsa patsogolo matumbo komanso kutaya matumbo pambuyo pa gastrectomy kumathandizanso kuti malabsorption azitha kusunthika poyenda. Pomaliza, mwa odwala ena omwe ali ndi matenda a shuga a mellitus sekondale kuti apeze matenda a kapamba, zimakhala zovuta kukwaniritsa chiwongolero choyenera chifukwa cha chiwopsezo chachikulu cha hypoglycemia. Kusungabe kuchuluka kwa shuga m'magazi pang'ono pocheperapo kungakhale kofunikira kupewa kupewa zochita pafupipafupi ndi kusintha moyo wabwino. Tiyenera kukumbukira kuti ambiri mwa odwalawa adachepetsa moyo wokhala ndi mwayi wokhala ndi matenda ashuga. Ngakhale ketoacidosis imachitika kawirikawiri, imatha kumangika mwadzidzidzi nkhawa (matenda, opareshoni, ndi zina), ndipo imafunikira kusintha kwamankhwala a insulin.

Mitundu ya Pancreatitis

Matendawa amapezeka m'mitundu yovuta komanso yopweteka.

Mu mawonekedwe owopsa, chifukwa cha kutukusira, madzi a kapamba samadutsa mu lumen ya duodenum, koma amataya timinyewa ta kapamba palokha. Njirayi imapangitsa kusintha kwa maselo a chinthu chodwala, makamaka muzovuta zazikulu, kufa kwathunthu kwa chithokomiro.

Matenda a kapamba, kutengera chifukwa, amalembedwa motere:

1. Poyambirira - poyambirira amapezeka m'mapamba pazifukwa zina.
2. Sekondale - ndi chifukwa cha matenda a ziwalo zina: cholecystitis, zilonda zam'mimba, enterocolitis.
3. Zotsatira zammbuyo - zotsatira za mawonetseredwe kapena opareshoni

Type 1 shuga mellitus, wokhala ndi pancreatitis, akuwonekera chifukwa chakuti zoulutsira zopweteka za pancreatic sizidutsa ma enzymes opangira chimbudzi cha duodenum 12 ndipo kudzimbidwa kumayambira, kusinthika kwa minyewa yam'm cell kukhala mafuta, kufalikira kapena kufa kwathunthu kwa zidutswa za limba. Thupi limakumana ndi insulin yokwanira, ndipo kuchuluka kwa glucose amakwera, komwe kumawononga machitidwe onse a thupi.

Matenda a 2 a mtundu wa shuga amapezeka ndikupanga insulin yokwanira. Koma chifukwa chophwanya njira zama metabolic, sizikwaniritsa ntchito yake yayikulu, ndikupanga kuchepa kwa abale.

Kusintha kwachidziwitso kumadziunjikira kwakanthawi ndipo kumagawika magawo anayi:

1. Pachigawo choyamba, kukokoloka kwakanthawi kumakhala kolumikizidwa ndi zingwe zazitali. M'matumbo, kutupa kosakhazikika kumapangidwa, makamaka kumayenda mosachedwa ndi ma syndromes osowa. Nthawi imeneyi imatha mpaka zaka 10-15.
2. Gawo lachiwiri limadziwika ndi kusapeza bwino kwa dongosolo logaya chakudya. Kutupa kumapangitsa kuti insulini idulidwe m'magazi, zomwe zimapangitsanso kuti hypoglycemia ikhale kwakanthawi. Vutoli limapanikizika chifukwa cha kusokonezeka kwa chopondapo, nseru, kuchepa kwa chakudya, kapangidwe ka mpweya m'magawo onse am'mimba.
3. Magwiridwe a kapamba amachepetsa kwambiri. Ndipo, ngati pamimba yopanda kanthu, mayesowo samawonetsa kupatuka, ndiye kuti mutatha kudya, shuga m'magazi amadziwikiridwa koposa nthawi yayitali.
4. Ndipo gawo lomaliza, kupangidwa kwa matenda ashuga kwachiwiri kumachitika, kukhudza gawo limodzi mwa magawo atatu a odwala omwe ali ndi chifuwa chachikulu.

Zolemba za maphunziro a shuga matenda a kapamba

Zingakhale zomveka kunena kuti matenda awiri ndi ovuta kwambiri kuchiza kuposa amodzi. Koma kuchita kumawonetsa kulephera kwa lingaliro lotere. Njira yachiwiriyo ili ndi zinthu zingapo, chifukwa chake imatha kuchiritsidwa:

1. Pafupifupi popanda ketoacitosis,
2. Chithandizo cha insulin nthawi zambiri chimayambitsa hypoglycemia,
3. Zabwino pazakudya zochepa za carb,
4. Mbali yoyamba, mankhwala amkamwa a shuga amachiritsidwa. Kupewa ndi kuchiza kwa matenda a shuga a pancreatic

Sikuti pancreatitis iliyonse yodwala yomwe imayambitsa matenda a shuga. Ndi chithandizo choyenera komanso kudya mosamalitsa, simungangowongolera kapamba, komanso kupewa matendawa.

Dokotala endocrinologist amasankha chithandizo cha aliyense payekha. Kutengera ndi zomwe zimapangidwa ndi ma enzymes ophatikizidwa ndi gland, katswiri wodziwa bwino amatha kusankha mankhwala osintha malinga ndi michere ya mankhwala ofanana. Komanso jakisoni wa insulin ngati pangafunike.

Zakudya za pancreatitis ndi matenda ashuga

Muyenera kudziwa kuti chithandizo choyenera ndikutsatira kwambiri zakudya kumatha kukuthandizani kuti muchiritsidwe matendawo. Idyani nthawi zambiri komanso magawo ang'onoang'ono - magalamu 250-300 pachakudya chilichonse.Patsani zomwe zili ndi mapuloteni: soya, dzira loyera, nyama, nsomba, mtedza.

Chotsani m'zakudya za acidic zomwe zimapangitsa kuti madzi asamayende bwino: acidic, zokometsera, osuta, okazinga, okhala ndi mowa, otentha kwambiri kapena ozizira. M'mawu, mbale zonse. zomwe zingayambitse kupsinjika kowonjezereka pachitetezo cha pancreatic.

Chakudya chimasinthidwa makamaka ndikuwadyedwa, m'malo otentha kapena ozizira.

Ngati nkovuta kusankha pawokha zakudya zoyenera, mutha kugwiritsa ntchito malangizo omwe adapangidwira omwe amaperekedwa pansi pa mayina: tebulo Na. 5 kwa odwala omwe ali ndi kapamba ndi tebulo Na. 9 kwa odwala matenda ashuga. Koma musanasankhe izi kapena chakudyacho, ndikofunikira kukaonana ndi dokotala.

Kungotengera mbali zonse za matendawa komanso momwe wodwalayo alili, dokotala amapereka malingaliro olondola pazakudya.

Kusankhidwa kwazinthu

Panthawi zosiyanasiyana za matendawa, zakudya zimatha kusintha pang'ono. Chifukwa chake, mwachitsanzo, zipatso zotsekemera ndi zowawasa kapena zokhala ndi mpunga, oatmeal ndi semolina ndizovomerezeka panthawi yanthawi yayitali, sizichotsedwa pakakhala matenda.

Malonda oyenera ayenera kusankhidwa payekhapayekha kwa wodwala aliyense, makamaka:

1. Zokonda zanga
2. Kutenga kwa glucose
3. Kusalolera kuzinthu zilizonse
4. Kuwongolera kwa pang'ono kuyamwa kwa michere.

Mu nthawi ya pachimake, ndizoletsedwa kudya mbale zokhala ndi shuga wambiri, zakudya zamafuta ndi zomwe zimasuta, makeke, zakudya yokazinga, chinangwa: mpunga, oatmeal, semolina, zipatso zosaphika ndi masamba, mkate woyera.

Mafuta a masamba, ndibwino kugwiritsa ntchito, moyenera, ocheperako ndi maolivi oyamba atapanikizidwa, omwe ali ndi katundu wochiritsa. Zingawononge mkaka wokhala ndi mafuta ochepa. Mkaka umalemeretsa thupi ndi mavitamini, michere ndipo umathandizanso kutulutsa kachulukidwe kazakudya m'mimba.

Tsoka ilo, anthu adakonzedwa mwakuti, pakumvetsetsa kwathunthu thanzi, "amakumbanso manda awo ndi supuni." Koma nzeru zomwezo wowerengeka wapeza kale njira yosavuta yothetsera mavuto ndi ziphuphu - njala, kuzizira ndi mtendere.

Kutsatira lamuloli losavuta ndi kutsatira chithandizo chosankhidwa mwapadera, odwala ambiri amatha kuthana ndi zovuta zambiri ndikubwerera mkhalidwe wathanzi, wathanzi.