Matenda a shuga - ndi chiyani, Zizindikiro, akazi ndi abambo, chithandizo, zakukula

Matenda a shuga
Vasopressin
ICD-10	E 23.2 23.2 N 25.1 25.1
ICD-10-KM	E23.2
ICD-9	253.5 253.5 588.1 588.1
ICD-9-KM	253.5
Omim	304800
Diseasesdb	3639
Medlineplus	000377
eMedicine	med / 543 ped / 580 ped / 580
Mesh	D003919

Matenda a shuga (matenda ashuga, matenda a shuga insipidus, lat. matenda a shuga insipidus) ndimatenda osowa (pafupifupi 3 pa 100,000) omwe amagwiritsidwa ntchito ndi matenda opatsirana a hypothalamus kapena pituitary gland, omwe amadziwika ndi polyuria (excretion ya malita 6-15 a mkodzo patsiku) ndi polydipsia (ludzu).

Matenda a shuga ndi matenda osachiritsika omwe amapezeka pakati pa akazi ndi ana onse. Nthawi zambiri, achinyamata amadwala - kuyambira azaka 18 mpaka 25. Milandu yodwala ya ana a chaka choyamba cha moyo amadziwika (A.D. Arbuzov, 1959, Sharapov V.S. 1992).

Etiology

Maselo a neurosecretory a hypothalamus amawongolera kupanga kwa oxytocin ndi vasopressin (mahomoni antidiuretic). Lotsirizira ili ndimayendedwe a kayendedwe ka madzi m'madzimo a impal impso. Ma mahormoni amadziunjikira m'mbali lanyumba ya pituitary gland (neurohypophysis), kuchokera komwe imatulutsidwa m'magazi momwe amafunikira. Ndi vuto la vasopressin m'magazi, kuphwanya mayamwidwe amadzi kumachitika. Zotsatira zake ndi polyuria (kukodza kwambiri), komwe kumakhalanso chizindikiro cha matenda ashuga.

Sinthani ya Etiology |Kodi shuga ndi chiyani?

Matenda a shuga ndi matenda osachiritsika a hypothalamic-pituitary system yomwe imayamba chifukwa cha kuperewera kwa thupi la vasopressin, kapena ma antidiuretic mahomoni (ADH), mawonetseredwe akulu omwe amatulutsira mkodzo waukulu kwamikodzo yokhala ndi kachulukidwe kochepa.

Matendawa amatha kuyamba mwadzidzidzi kapena kuyamba pang'onopang'ono. Zizindikiro zoyambira matenda a shuga insipidus ndi ludzu lochulukirapo komanso kukodza pafupipafupi.

Ngakhale pali mitundu iwiri yamatenda omwe amadziwika ndi dzina - shuga ndi insipidus, izi ndi matenda awiri osiyana, koma matendawa amafanana. Amalumikizidwa kokha ndi zofananira zina, koma matendawa amayamba chifukwa cha zovuta zina mthupi.

Thupi limakhala ndi kayendetsedwe kovuta kosiyanitsa kuchuluka ndi kapangidwe ka madzi. Impso, pochotsa madzimadzi ambiri m'thupi, amapanga mkodzo, womwe umayamba mu chikhodzodzo. Madzi akayamba kuchepa kapena madzi amawonongeka (kutuluka thukuta kwambiri, kutsekula m'mimba), impso zimatulutsa mkodzo wocheperako kuti madzi amasungidwe.

Hypothalamus ndi gawo la ubongo lomwe limayang'anira dongosolo lonse la endocrine la thupi ndikupanga antidiuretic mahomoni (ADH), yotchedwanso vasopressin.

Ndi insipidus wa shuga, chilichonse chomwe chimasefa chimatuluka m'thupi. Zimasandulika malita ngakhale malita khumi patsiku. Mwachilengedwe, njirayi imapanga ludzu lamphamvu. Wodwala amakakamizidwa kumwa madzi ambiri kuti tsiku lina apange kufooka kwa thupi.

Matenda a shuga ndi matenda osokoneza bongo a endocrinopathy, omwe amakula mosaganizira za amuna ndi akazi omwe ali ndi zaka zambiri, nthawi zambiri amakhala ndi anthu azaka 20 mpaka 40. Mulingo uliwonse wachisanu, matenda a shuga amayamba ngati vuto la kulowererapo kwa mitsempha.

Mu ana, matenda a shuga a insipidus nthawi zambiri amakhala obadwa, ngakhale pomwe matendawa amatha kupezeka mochedwa - patatha zaka 20. Akuluakulu, matenda omwe amapezeka ndimomwe amapezeka nthawi zambiri.

Neurogenic shuga insipidus

Neurogenic shuga insipidus (wapakati). Amayamba chifukwa cha kusintha kwa ma pathological mu manjenje amanjenje, makamaka, mu hypothalamus kapena gland yotsatira. Monga lamulo, chomwe chimayambitsa matenda pamenepa ndi ntchito yochotsa chofufumitsa, njira yolowera mdera lino (hemochromatosis, sarcoidosis), kuvulala kapena kusinthika kwachilengedwe.

Nawonso mtundu wapakati pa matenda a shuga

• idiopathic - mtundu wamtundu wa matenda, omwe amadziwika ndi kuchepa kwa kapangidwe ka ADH,
• chidziwitso - amakula motsutsana ndi maziko a matenda ena a pathologies. Itha kupezeka zonse ziwiri (zimakula nthawi ya moyo), mwachitsanzo, chifukwa cha kuvulala kwa ubongo, kukula kwa chotupa. Kapena obadwa nawo (ndi majini kusintha).

Popeza wodwalayo amakhala ndi matenda osokoneza bongo okhalitsa, wodwalayo amakhala ndi vuto la kupweteka kwa timadzi timene timatulutsa timadzi tothandiza. Chifukwa chake, chithandizo cha matenda osokoneza bongo omwe amayamba chifukwa cha matenda amtunduwu ayambitsidwa, chidwi cha matendawa chimayamba.

Matenda a shuga a shuga

Ichi ndi chiyani NDE kapena nephrogenic ND - imalumikizidwa ndi kuchepa kwamphamvu kwa minyewa ya impso ku zotsatira za vasopressin. Matenda amtunduwu siachilendo. Choyambitsa matendawa chimakhala chocheperako cha ma nephrons, kapena kukana kwa impso receptors ku vasopressin. Matenda am'mimba amatha kubereka, ndipo amatha kuchitika chifukwa cha kuwonongeka kwa maselo a impso mothandizidwa ndi mankhwala.

Nthawi zina mtundu wachitatu wa matenda a shuga insipidus, womwe umakhudza azimayi panthawi yoyembekezera, umasiyanitsidwanso. Izi sizachilendo. Zimachitika chifukwa cha kuwonongeka kwa mahomoni ndi ma enzyme a placenta omwe adapangidwa. Mwana akabadwa, mtunduwu umadutsa.

Odwala aimpso matenda a insipidus mu akulu amakula chifukwa cha kulephera kwaimpso kwa maumboni osiyanasiyana, chithandizo chotalika cha kukonzekera kwa lithiamu, hypercalcemia, etc.

Matenda a shuga amayamba kukhala kuperewera kwa vasopressin antidiuretic (ADH) - kuperewera kapena kwathunthu. ADH imatulutsa Hypothalamus ndipo imagwira ntchito zosiyanasiyana, kuphatikizapo kukhudza kuyendetsa bwino kwamkodzo.

Matenda a shuga sindiwo matenda obadwa nawo, koma ena obwereza omwe amatenga matenda obadwa nawo (mwachitsanzo, matenda a Wolfram, insipidus wathunthu kapena osakwanira) ndi gawo limodzi mwa chipatalachi, chosonyeza kusinthika kwa majini.

Zinthu zomwe zikulosera zakukula kwa matenda awa:

• matenda opatsirana, makamaka mavairasi,
• zotupa za mu ubongo (meningioma, craniopharyngioma),
• metastases ku dera la hypothalamus khansa yowonjezera bongo (kawirikawiri bronchogenic - yochokera minofu ya bronchi, ndi khansa ya m'mawere),
• kuvulala kwa chigaza
• kukangana
• chibadwa.

Ndi mawonekedwe a idiopathic a shuga a insipidus m'thupi la wodwalayo, popanda chifukwa, ma antibodies amapangidwa omwe amawononga ma cell omwe amapanga mahomoni a antidiuretic.

Renal shuga insipidus (mawonekedwe a impso) amachitika chifukwa cha kuledzera kwa thupi ndi mankhwala, kusokonezeka kapena matenda am'mbuyomu a impso ndi kwamikodzo (kulephera kwa impso, hypercalcinosis, amyloidosis, glomerulonephritis).

Zizindikiro za matenda a shuga insipidus mwa akulu

Matendawa amapezeka chimodzimodzi kwa abambo ndi amayi, pazaka zilizonse, nthawi zambiri pa zaka 20 mpaka 40. Kukula kwa zizindikiro za matendawa kumatengera kuchuluka kwa vasopressin. Ndikusowa pang'ono kwa mahomoni, zizindikiro zamankhwala zingathetsedwe, osatchulidwa. Nthawi zina zizindikiro zoyambirira za matenda a shuga insipidus zimawonekera mwa anthu omwe amamwa moperewera - kuyenda, kukwera maulendo, kutuluka, komanso kumwa corticosteroids.

Zizindikiro zazikulu zomwe zimapezeka ndi shuga insipidus ndi izi:

• kukodza kwambiri (mpaka malita 3-15 a mkodzo patsiku),
• kukodza kwakukulu kumachitika usiku,
• ludzu komanso kuchuluka kwamadzi ambiri,
• khungu lowuma, nseru ndi kusanza, kukokana,
• kusokonezeka m'malingaliro (kusowa tulo, kutengeka mtima, kuchepa m'maganizo).

Ngakhale wodwalayo atachepera kugwiritsa ntchito madzimadzi, mkodzo umatulutsidwabe zochuluka, zomwe zingayambitse kuchepa thupi kwakuthupi.

Kuphatikiza pazizindikiro zofala, pali zingapo za zizindikiro zomwe zimapezeka mwa odwala osiyana zaka ndi zaka:

Mavuto

Chiwopsezo cha matenda a shuga insipidus ndi chiopsezo cha kuperewera kwa madzi m'thupi, komwe kumachitika muzochitika zomwe kutayika kwa mkodzo kuchokera mthupi sikulipiridwa mokwanira. Pakusowa kwamadzi, mawonekedwe omwe ali:

• kufooka wamba ndi tachycardia,
• kusanza
• mavuto amisala.

Kutseka kwa magazi, kusokonezeka kwa mitsempha ndi hypotension, komwe kumatha kufika pakugwa, kumasonyezedwanso. Ndizachilendo kuti ngakhale kutulutsa kwamphamvu kwamadzi kumayendera limodzi ndi kupulumutsidwa kwa polyuria.

Zizindikiro

Dokotala yemwe amathana ndi ma pathologies amenewa ndi endocrinologist. Ngati mukumva zambiri za matenda, ndiye kuti chinthu choyamba ndikupita kwa endocrinologist.

Paulendo woyamba, adokotala azichita “zoyankhulana”. Mukudziwitsani kuchuluka kwamadzi omwe mkazi amamwa patsiku, ngati pali zovuta ndi kusamba, kusokonekera, ali ndi endocrine pathologies, zotupa, ndi zina zambiri.

Nthawi zambiri, kupezeka kwa matenda a shuga a insipidus siovuta ndipo kwachitika:

• ludzu lalikulu
• kuchuluka kwa mkodzo wa tsiku ndi tsiku kumaposa malita atatu patsiku
• plasma hyperosmolality (zopitilira 290 mosm / kg, kutengera madzi akumwa)
• sodium wamkulu
• Hypoosmolality kwamikodzo (100-200 mosm / kg)
• kachulukidwe kakang'ono ka mkodzo (Laboratory diagnostic matenda a shuga insipidus akuphatikizira izi:

• kuyesa Zimnitsky - kuwerengetsa kolondola kwa zakumwa za tsiku ndi tsiku ndi zakumwa,
• kufufuza kwa impso,
• Kuunika kwa X-ray
• composed tomography ya ubongo,
• echoencephalography,
• malingaliro owerengeka,
• mwatsatanetsatane biochemical kusanthula magazi: kutsimikiza kuchuluka kwa sodium, potaziyamu, creatinine, urea, glucose ion.

Kuzindikiritsidwa kwa matenda a shuga insipidus kumatsimikiziridwa pamaziko a data yantchito:

• mkodzo wochepa
• magazi am'madzi ambiri osmolarity,
• kachulukidwe kakang'ono ka mkodzo,
• sodium yayikulu m'magazi.

Pambuyo povomereza matendawa ndikuzindikira mtundu wa matenda a shuga a insipidus, mankhwala amathandizidwa kuti athetse zomwe zimayambitsa - zotupa zimachotsedwa, matenda omwe amayambitsidwa amathandizidwa, ndipo zotsatira zake kuvulala kwaubongo kumachotsedwa.

Kuti alipire kuchuluka kwa ma antidiuretic mahomoni amitundu yonse yamatendawa, desmopressin (analogue yopanga ya mahomoni) ndi mankhwala. Amagwiritsidwa ntchito ndikulowetsa m'mphuno.

Masiku ano, kukonzekera kwa Desmopressin kumagwiritsidwa ntchito kwambiri kulipiritsa insipidus yapakati pa matenda ashuga. Amapangidwa m'mitundu iwiri: madontho a intranasal makonzedwe - Adiuretin ndi piritsi la Minirin.

Malangizo azachipatala amaphatikizanso kugwiritsa ntchito mankhwala monga carbamazepine ndi chlorpropamide kuti athandize kuti thupi lipangidwe. Popeza kumwa kwambiri mkodzo kumabweretsa kuchepa kwa madzi, mchere umaperekedwa kwa wodwala kuti abwezeretse mchere wamchere.

Pochiza matenda a shuga insipidus, mankhwala omwe amakhudza dongosolo lamanjenje amathanso kutumikiridwa (mwachitsanzo, Valerian, Bromine). Matenda a shuga a Nephrogenic amaphatikizapo kukhazikitsidwa kwa mankhwala omwe amaletsa kutupa ndi thiazide diuretics.

Chofunikira pakuthandizira matenda a shuga insipidus ndikukonzanso kwamchere wamchere ndi kulowetsedwa kwa kuchuluka kwa mayankho a saline. Kuchepetsa bwino diuresis, sulfonamide diuretics tikulimbikitsidwa.

Chifukwa chake, matenda a shuga a insipidus ndi omwe amayamba chifukwa cha kuchepa kwa ma antidiuretic mahomoni amunthu pazifukwa zosiyanasiyana. Komabe, zamakono zamankhwala zimakupatsani mwayi kuti mulipirire momwe mungabwezeretsere chithandizo ichi m'malo mothandizidwa ndimalo ena okhala ndi mahomoni opanga.

Chithandizo chaukadaulo chimabweza wodwala ku moyo wathunthu. Izi sizitchedwa kuti kuchira kwathunthu mu lingaliro lenileni la mawu, komabe, pankhani iyi, thanzi laumoyo lili pafupi kwambiri.

Zakudya zopatsa thanzi komanso zakudya za anthu odwala matenda ashuga

Cholinga chachikulu cha chithandizo cha zakudya ndikuchepetsa kukodza, ndipo kuwonjezera apo, kudzazanso thupi ndi mavitamini ndi michere yomwe "amasiya" chifukwa chokodza pafupipafupi.

Ndikofunika kupatsa chidwi pakuphika motere:

• wiritsani
• kwa okwatirana
• zakudya zophika mu msuzi wokhala ndi mafuta ndi maolivi,
• kuphika mu uvuni, makamaka mu malaya, pofuna chitetezo cha michere yonse,
• ophika pang'onopang'ono, kupatula ngati "mwachangu".

Munthu akakhala ndi matenda a shuga, amadyetsanso zakudya zomwe sayenera kumwa, mwachitsanzo, maswiti, zakudya zokazinga, zonunkhira ndi mchere.

Zakudya zake zimatengera mfundo izi:

• sinthani kuchuluka kwa mapuloteni omwe amwedwa, kusiya zakudya zamafuta ndi mafuta,
• chepetsa kuchuluka kwa mchere, kuchepetsa kuchuluka kwake kwa 5 g patsiku,
• chakudya chizikhala ndi zipatso ndi ndiwo zamasamba zambiri,
• kuti muchepetse ludzu lanu, gwiritsani ntchito misuzi yachilengedwe, zakumwa za zipatso ndi zakumwa zamalungo,
• Idyani nyama yokonda,
• kuphatikiza nsomba ndi nsomba zam'madzi, mazira a mazira,
• Tenga mafuta a nsomba ndi phosphorous,
• kudya nthawi zambiri m'magawo ang'onoang'ono.

Zosankha zamasiku:

• kadzutsa koyamba - omelet (wotentha) wa mazira 1.5, vinaigrette (ndi mafuta a masamba), tiyi wokhala ndi mandimu,
• nkhomaliro - maapulo ophika, zakudya,
• nkhomaliro - msuzi wamasamba, nyama yophika, beets stewed, chakumwa cha mandimu,
• tiyi wamadzulo - msuzi wa duwa lakuthengo, kupanikizana,
• chakudya chamadzulo - nsomba yophika, mbatata yophika, kirimu wowawasa, tiyi ndi mandimu.

Chakumwa chochulukirapo ndichofunika - chifukwa thupi limataya madzi ambiri ndikusowa madzi m'thupi ndipo limafunikira kulipidwa.

Zithandizo za anthu

Musanagwiritse ntchito wowerengeka azitsamba a matenda a shuga insipidus, onetsetsani kuti mukumane ndi endocrinologist, chifukwa contraindication ndizotheka.

1. Magalamu makumi awiri a mafuta owuma a elderberry amathiridwa mu kapu yamadzi otentha kwambiri, ndipo msuzi womwe umayambitsidwa umathiridwa kwa ola limodzi. The zikuchokera amaphatikizidwa ndi supuni ya uchi ndi kudya katatu tsiku lililonse.
2. Kuti muchotse ludzu komanso kuchepetsa mkodzo, ndikofunikira kuchitira kulowetsedwa kwa a burdock a. Kuti mukonzekere malonda, muyenera magalamu 60 a muzu wa mbewu iyi, womwe muyenera kupera momwe mungathere, ikani lita thermos ndikuthira madzi otentha kwathunthu. Kuumirira pa mizu ya burdock mpaka m'mawa, pambuyo pake mankhwalawa amatengedwa katatu patsiku mugalasi.
3. Kulowetsedwa kwa amayi kuchokera kwa matenda ashuga. Zosakaniza: motherwort (1 gawo), valerian muzu (1 gawo), ma hop cones (1 gawo), m'chiuno ndi rose (timagawo 1), madzi otentha (250 ml.). Zitsamba zonse zosakanizidwa zimasakanizika bwino. Tengani supuni 1 ya osakaniza ndi kutsanulira madzi otentha. Kuumirira ola. Tengani kuchuluka kwa 70 - 80 ml. musanagone. Phindu: kulowetsedwa kumachepetsa thupi, kuchepetsa nkhawa, kusintha kugona.
4. Kuchepetsa ludzu ndikubwezeretsani thanzi lanu, mutha kugwiritsa ntchito masamba ophatikizidwa. Masamba achomera awa amatengedwa, wowuma ndi wophwanyika. Pambuyo pake, supuni ya tiyi yowuma imapangidwa ndi kapu (mililita 250) yamadzi otentha. Patatha mphindi 15, msuzi wotsatira ungathe kudyedwa ngati tiyi wokhazikika.
5. Kutolere zitsamba zosiyanasiyana kudzathandizanso kuthana ndi matendawa: fennel mamawort, valerian, fennel, mbewu zochotsa. Zosakaniza zonse ziyenera kumwedwa zofanana, zosakanizidwa bwino. Zitatha izi, supuni ya chisakanizo chouma imathiridwa ndi kapu ya madzi otentha ndikuikiramo mpaka madzi atazirala. M'pofunika kumwa mankhwalawa mu theka kapu musanagone.

Matenda a shuga a insipidus, omwe amapanga nthawi ya ntchito kapena nthawi yapakati, amakhala ochulukirapo (osakhalitsa) m'chilengedwe, idiopathic - m'malo mwake, amalimbikira. Ndi chithandizo choyenera, palibe chowopsa m'moyo, ngakhale kuti kuchira sikumakhala kojambulidwa.

Kubwezeretsanso kwa odwala kumawonedwa pazochotsa zotupa, makamaka chithandizo cha matenda ashuga a chifuwa chachikulu cha malungo, malungo, ndulu. Ndi kukhazikitsidwa koyenera kwa mankhwala obwezeretsa mahomoni, kulumala kumakhalabe.

Zoyambira za kuphatikiza thupi zimagwirizanitsidwa ndi kupezeka kwa matenda a shuga

Mulingo wamadzi mthupi umathandizidwa ndi zinthu zitatu izi: ma vasopressin a mahomoni - kumverera kwa ludzu - magwiridwe antchito a impso.
Vasopressin imapangidwa mu hypothalamus, motsatira njira ya maselo amitsempha imadutsa mu gitu lotsatira, komwe limadziunjikira ndikulowa m'magazi poyankha kukondoweza koyenera. Zotsatira zazikulu za mahomoni ndiz kuchepa kwamkodzo chifukwa cha kuchuluka kwa kuchuluka kwake. Impso zimalandila mkodzo wothira madzi, wopanda mkaka. Vasopressin imawagwira mwachindunji ngati gawo lenileni: limakulitsa kuchuluka kwa madzi m'matubu. Timadzi timeneti timayendetsa kuchuluka kwa madzi mthupi, ndikuchulukitsa kuchuluka kwa mkodzo ndikuchepetsa kuchuluka kwake m'mizere ya impso.
Vasopressin alinso ndi zovuta zina zingapo:

• imalimbikitsa mamvekedwe amitsempha yamagazi, kuphatikizapo chiberekero,
• imayambitsa kuwonongeka kwa glycogen ku glucose - glycogenolysis,
• amatenga nawo mbali mu kupanga mamolekyulu a glucose ochokera ku mamolekyulu amitundu ina yopanga m'chiwindi ndi gawo lina la impso - gluconeogeneis,
• zimakhudza mkaka
• zimakhudza njira zokumbukira,
• timapitiriza magazi
• chikuwonetsa zinthu zingapo zowongolera somatic.

Ntchito zazikuluzikulu za mahandidwewo ndikusunga madzi mthupi komanso kupendekera kwamitsempha yamagazi. Kupanga kwake kumayang'aniridwa mwamphamvu. Kusintha kakang'ono mu kuchuluka kwa ma electrolyte m'madzi a m'magazi mwina kumathandizira kupanga mahomoni opatsirana, kapena kuletsa kutulutsidwa kwake mkati mwa magazi. Komanso kuchuluka kwa kuzungulira kwa magazi ndi zisonyezo zamagazi zimathandizira kubisika kwake. Kutulutsidwa kwa mahomoni kumasinthanso ndikutuluka kwa magazi.

Vasopressin amapangidwa panthawi yochita masewera olimbitsa thupi, kupitilira muyeso, ludzu, kupha mpweya wa kaboni, kupsinjika, nseru, kuchepa kwakukulu kwamagazi a glucose, mankhwala oletsa kupweteka, mukamasuta fodya, motsogozedwa ndi histamine, mitundu ina ya ma psychostimulants.

Kukondoweza kwa mahomoni kumachepetsedwa ndi zochita za norepinephrine, glucocorticosteroids, atern natureure peptide, mowa, mankhwala ena a psychotropic (fluphenazine, haloperidol), antihistamines (diprazine), anticonvulsants (phenytoin, diphenin).

Gulu la matenda

Pali mitundu ingapo ya matenda a shuga. Mitundu yodziwika bwino yamatenda ndi iyi:

• chapakati (hypothalamic, pituitary, neurogenic, shuga),
• aimpso (nephrogenic, vasopressin zosagwira),
• polydipsia yoyamba.

Mitundu ina ya matenda a shuga insipidus ndiyofala:

Ambiri mwa anthuwa ndi achichepere (azaka 20 mpaka 30) abambo ndi amayi. Ana akhanda ali ndi matenda a shuga a insipidus ndipo amayanjana ndi kusakhazikika kwa ndende.

Malinga ndi kuopsa kwa maphunzirowo, ND imapezeka m'madzi ofikira mkodzo 6 - 8 patsiku, wokwanira (malita 8 - 14 a mkodzo) ndipo wowonda, pomwe malita 14 a mkodzo amachotsedwa popanda kulandira chithandizo.
Pathology ikhoza kukhala cholowa komanso kutengapo gawo.

Matenda a shuga apakati

Central ND imayambitsidwa ndi kuphatikizika kwa mawonekedwe, kayendedwe, kapena katulutsidwe ka vasopressin. Zimachitika nthawi zambiri mwa akazi, kumadziwonetsa pakatha zaka 20-30. Matenda amakula pamene kuthekera kwa ma neurohypophysis kuti asungire mahomoni antidiuretic kumachepetsedwa ndi 85%.
Mitundu ya ND yapakati imawonetsedwa mu tebulo 1.
Gome 1

Herederal (kobadwa nawo, achibale) chapakati shuga insipidus

Pathology imadziwika m'mibadwo ingapo ndipo imatha kukhudza mabanja angapo. Cholinga chake ndi kusinthika kumabweretsa kusintha kwa kapangidwe ka mahomoni a antidiuretic. Matenda oterewa amapatsiridwa ndi cholowa champhamvu kwambiri kapena cholowa mwaumwini.
Ndi cholowa chazikuluzikulu za cholowa:

• kufalikira kwa matenda kumapitirirabe m'mibadwo yonse, popanda mipata,
• matendawa ndiwofanana kwa amuna ndi akazi,
• makolo athanzi amabereka ana athanzi, ngati kholo limodzi lidwala, chiopsezo chokhala ndi mwana wodwala chiri pafupifupi 50%.

Ndi cholowa chofananira nacho:

• mwana wodwala wabadwira makolo athanzi, wodwala amabala ana athanzi,
• cholowa cha matenda chimawonekera molunjika - abale ndi alongo amadwala,
• matendawa sapezeka m'mibadwo yonse,
• azimayi ndi abambo nawonso amakhudzidwa.

Ana obadwa kwa zaka 1 mpaka 6, omwe amakhala ndi matenda obadwa nawo a shuga. Poyamba, kutulutsa bwino kwa vasopressin pang'onopang'ono kumachepa ndi zaka. Matendawa amakula.

Matendawa nthawi zambiri amawonekera m'banja limodzi, koma kuuma kwake kumasiyanasiyana. Pali zochitika zina zomwe zimachitika pakatikati. Mtunduwu wa matenda a shuga insipidus umalumikizidwa ndi kusintha kwa mtundu wa AVP-N.

Kuperewera kwa vasopressin kumadziwikanso ndi chibadwa cha Wolfram syndrome (DIDMOAD syndrome). Ichi ndi matenda osowa a neurodegenerative. Mawonekedwe ake sakhala okwanira nthawi zonse. Matendawa nthawi zambiri amapangitsa kuti matenda ashuga akhale ochepa, kusintha kwa mitsempha yodutsamo m'zaka khumi zoyambirira za moyo, komanso ND yapakati komanso ugonthi wachiwiri.

Mitundu ya matenda ashuga

Nthawi zonse sikokwanira ndalama? Amulet wosavuta uyu wasintha moyo wa anthu ambiri!

Pali mitundu ingapo yamatenda, kutengera zinthu zomwe zidapangitsa chiwonetsero cha matenda.

Mitundu yayikulu, monga matenda ashuga, ndi iwiri:

1. Fomu ya Neurogenic - amatanthauza kuti matendawa adayamba chifukwa cha kusokonezeka kwa ubongo kwa gawo la subcortical. Izi zikutanthauza kuti kuphwanya kunachitika mu hypothalamus, pituitary, kapena mbali zonse ziwiri za subcortical zone. Amadziwika ndi kuphwanya kutulutsidwa kwa mahomoni m'magazi, zomwe zimatsimikizira kugawa kwamadzi mu minofu.
2. Fomu ya Nephropathological kapena aimpso - imawonedwa ngati yocheperako, ngakhale imatha kudziwonetsa pazifukwa zosiyanasiyana. Ziri chifukwa chakuti impso zimakhudzidwa, kuthekera kwa ziwalozi kuzosefera madzimadzi kumasokonekera, kubisala zochepa zokha zomwe ndizolimbitsa thupi.
3. Pali matenda a shuga a azimayi oyembekezera. Amapereka chidziwitso choyipa kwambiri poyerekeza ndi matenda abwinobwino a shuga, chifukwa zimawonetsa kusiyana komwe kumachitika posintha mayendedwe amakulu a mkazi. Ngati mawonekedwe a bere akapita modzidzimutsa, ndiye kuti wosapatsa shuga panthawi yoyembekezera amakhalabe mwana, pomwe akuwonjezera mwayi wokhala ndi vuto lofananalo mwa mwana.

Mitundu ya kubereka imadzipangitsa kumverera ngakhale m'miyezi yoyamba mwana atabadwa - makolo amayamba kuyang'anira chidwi chakuti mwana amawoneka wopanda madzi komanso amakodzanso pafupipafupi - komanso amatha kuchitika pambuyo pake. Zonse zimatengera zomwe zimayambitsa ndi mawonekedwe a pathogenesis.

Zoyambitsa matenda a shuga insipidus

Kukula kwa matenda a shuga insipidus, kumbali imodzi, ndizovuta kwambiri kulosera kuposa shuga, pomwe, imadziwonekera pokhapokha pamavuto akulu a endocrine omwe akukhudza ntchito zonse zowongolera.

Madokotala akuwonetsa zofunikira zotsatila za matendawa:

1. Zotupa zamafupa zokhudzana ndi hypothalamus ndi gitu pituitary. Matendawa amatha kuonekera chimodzimodzi ndi njira yoyipa komanso yovuta.
2. Ma metastases a matenda a oncological omwe amapezeka mu ubongo - amachita chimodzimodzi ndi mapangidwe oyamba a chotupa. Zovuta zilizonse pamavuto a mahomoni aumunthu - pituitary ndi hypothalamus - zimatha kudzetsa mavuto ambiri a endocrine, kuphatikizapo. Matenda a shuga.
3. Kuphwanya kwa magazi kuubongo - tikulankhulanso za malo omwewo. Zomwe zimayambitsa anomaly nthawi zina zimagona mu zovuta za stroko, koma nthawi zina kukhazikika kwa njira yowopsa kumatha kupangitsa matenda "osavulaza" monga osteochondrosis.
4. Kuvulala kwamtundu wamatumbo nthawi zonse kumakhala gawo lowopsa la zovuta zilizonse zomwe zimakhudza zochitika zamanyazi.
5. Mitundu yodzikongoletsa - imawoneka molawirira kwambiri, monga lamulo, imapezeka ngakhale pa siteji ya amayi. Zowopsa potengera kupezeka kwa impso kulephera kwa ana komanso zovuta zina.
6. Kusokonezeka kwa impso - aimpso kulephera, atherosulinosis ya khunyu, poyizoni ndi kukonzekera kwa lifiyamu.

Mwambiri, zitha kunenedwa kuti zofunikira zoyambitsa chitukuko cha matenda ashuga ndizowopsa kuposa momwe zimakhalira pakuchepa kwa chidwi cha shuga. Ngati munthu atha kuthana ndi shuga munthu amatha kukhala wathanzi, kupatula njira zodyera, kuchuluka kwa thupi ndi zina, chiwopsezo cha matenda ashuga nthawi zonse chimawonetsa kuwonongeka kwa ubongo kapena impso.

Chithandizo cha matenda a shuga insipidus

Njira yabwino kwambiri azichitira matenda ashuga -kuwongolera chomwe chinayambitsa kukula kwa matendawa. Izi ndizovuta kwambiri kuposa matenda, ndiye kuti, pomwe mizu yake itachotsedwa, zizindikilo zoipa za matenda enaake zimachokeranso.

Chithandizo cha mankhwalawa chimadalira kwathunthu pazomwe zimapangitsa komanso mwina:

1. Kuchotsa chotupa muubongo. Ndikulimbikitsidwa kuti musakhudze osavomerezeka ngati sikukhudza moyo wa munthu, koma kusokonezeka mu pituitary ndi hypothalamus ndi chizindikiro chachindunji cha kulowerera kwa mitsempha.
2. Patulani mahoni ena omwe amathandiza kuti thupi lisachotse madzi nthawi yomweyo, koma muzigwiritsa ntchito "moyenera". Mankhwala okhala ndi desmopressin amachita ntchito yabwino kwambiri pamenepa.
3. Pituitrin Oily Solution - mankhwala osakhalitsa, omwe kwa nthawi yayitali amathandizira kugwira ntchito kwa endocrine.
4. Chlorpropamide, Carbamazepine - zotchulidwa m'malo antidiuretic timadzi. Mankhwalawa amathandizanso kuti madzi asungunuke kuti ayeretse impso za poizoni ndipo amatuluka ngati mawonekedwe a mkodzo wabwinobwino.
5. Mankhwala a Nephrological nthawi zambiri amadziwikiridwa, omwe cholinga chake ndi kubwezeretsa magwiridwe antchito a ziwalo, komanso mulingo wamchere wamchere.

Chizindikiro chowopsa cha matendawa ndi polyuria. Chifukwa chake, kusungabe madzi amchere wamchere kumakhala gawo lofunika kwambiri pa zamankhwala. Kuchepa kwa thupi kumawopseza makanda, okalamba ndi omwe samayang'anira momwe aliri. Ndi matenda a shuga a insipidus, zovuta zovuta ndizotheka, kuphatikiza kukomoka chifukwa cha kuperewera kwa madzi m'thupi.

Zakudya za matenda a shuga

Zoletsa pazakudya sizingokhala zovutirapo kuposa matenda ashuga. Tiyenera kukumbukira kuti odwala nthawi zambiri amakhala ndi kuchepa kapena kusowa kudya kwathunthu, amakhala atatopa, ndiye kuti chakudyacho chimayenera kukhala chopatsa mphamvu kwambiri.

Mfundo zake ndizofunikanso:

1. Mulingo woyenera kwambiri wama protein ndi kuchepetsa nkhawa pa impso. Ndikulimbikitsidwa kuti muchotse mu zakudya osati nyama zokha, komanso mapuloteni az masamba, kuphatikizapo nyemba, nandolo, bowa.
2. Sizoletsedwa kugwiritsa ntchito ma diuretics, kuchokera muzakudya za tsiku ndi tsiku zomwe zimaphatikizapo khofi, tiyi, zakumwa za shuga zomwe zimakhala ndi caffeine.
3. Ndikofunika kuti muchepetse mafuta, makamaka mawonekedwe a broths, soups.
4. Poletsedwa ndi zakumwa zoledzeretsa, chakudya mwachangu, mankhwala aliwonse oopsa - mwachitsanzo, masoseji ogulitsa.
5. Mchere wambiri sukulimbikitsidwa. Chakudya chizikhala chowonjezera, chamagulu, komanso chopatsa thanzi.

Zakudya zamankhwala ndizofunikira pothandizira matenda a shuga insipidus, chifukwa zakudya zoyenera ndizomwe zimathandiza kuti thupi lizigwira ntchito komanso kuchepetsa katundu pazinthu zowonongeka.

Zambiri Zokhudza Matendawa

Nayi mfundo zazikuluzikulu zokhudzana ndi vuto ili:

• Matendawa imatha kuchitika chifukwa chobisalira kapena kusakhalapo kwa vasopressin - mphamvu yamagetsi yolimba - kuchokera paziwopsezo za m'mimba muubongo kapena “mayankho” a impso ku timadzi timeneti.
• Kuchulukitsa kwamkodzo kwamkodzo kumachitika limodzi ndi ludzu lochuluka ndi kuchuluka kwa madzi.
• Matenda a shuga angayambitse kuchepa kwa madzi m'thupi ngati munthu sachulukitsa kumwa kwamadzi (mwachitsanzo, pomwe wodwalayo sanganene zakumwa zake kapena kumwa madzi pawokha).
• Matenda ena amafanana ndi matenda a shuga a insipidus potengera mkodzo wapamwamba komanso ludzu lalikulu. Komabe, polyuria yomwe imadziwika mu mtundu woyamba wa 2 ndi mtundu wa 2 shuga imachitika m'magazi a glucose okwera, osati matendawa pawokha.
• Zopatsa zina komanso zowonjezera muzakudya zitha kuyambitsa zizindikiro zokhudzana ndi vutoli.
• Chifukwa matenda a shuga a insipidus si matenda wamba, kuzindikira kumatanthauza kuchotsera mafotokozedwe ena amawuwo. Ngati pali malingaliro okayikitsa atapezeka kuti ali ndi matendawa, kuyezetsa madzi kungachitike.
• Kuyesa koperewera kwamadzi kuyenera kuchitidwa ndi katswiri yemwe amayang'aniridwa ndi madokotala oyandikira chifukwa chakuchepa kwa madzi m'thupi. Ndiwodalirika pakuwonetsetsa kuti ali ndi matenda komanso amatha kusiyanitsa pakati pa matenda a shuga komanso matenda a shuga a impso.
• Chithandizo chimatengera mtundu wamatenda.
• Ngati matenda a shuga ali pakatikati (ochepa kapena osabisalira katulutsidwe ka timadzi tambiri), kusintha kwa ma hormone kumatheka pogwiritsa ntchito desmopressin.
• Muzochitika zosavuta, kuwonjezeka kwa madzi akumwa kungakhale kokwanira.
• Ngati choyambitsa ndi matenda a impso pomwe impso sizingayankhe moyenera mahomoni, chithandizo chimalimbikitsidwa kuti zitha kusintha mkhalidwe wawo.

Kodi chimayambitsa matenda a shuga ndi chiyani?

Pali mitundu iwiri ya matendawa, iliyonse yomwe ili ndi makina ake oyambitsa. Kuphatikiza apo, onse awiriwa amaphatikizidwa ndi mahomoni otchedwa vasopressin (omwe amatchedwanso antidiuretic mahomoni, ADH):

• ndi insipidus yapakati (ya neurogenic kapena vasopressin-sensip), kusakhalapo kwathunthu kapena pang'ono kwa vasopressin kumawonedwa, popeza gland ya ubongo sangathe kubisa mahomoni,
• secretion yotupa ya vasopressin ndiyachilendo, koma impso siziyankha molondola mahomoni.

Chizindikiro chachikulu, polyuria - kutulutsa mkodzo kwambiri - chimatha kukhala ndi zifukwa zina, koma nthawi zambiri chimatha kudziwitsidwa musanayambike matenda a shuga insipidus. Mwachitsanzo, kuperewera kwa shuga kapena matenda osokoneza bongo omwe amatha kuyamwa bwino kumatha kuyambitsa kukodza pafupipafupi.

Mu shuga insipidus, polyuria imabweretsa ludzu lalikulu (polydipsia). Nthawi zina, kumwa kwambiri madzi omwe amayamba chifukwa cha polydipsia yoyamba kungayambitse polyuria.

Zitsanzo za polydipsia yoyamba zimaphatikizira vuto la ludzu lomwe limayambitsa kuwonongeka kwa hypothalamus ya ubongo, yomwe itha kukhala chifukwa chamtundu wa "adiptic" komanso chizolowezi chogwiritsa ntchito nzeru kumwa madzi ambiri (psychogenic polydipsia).

Matenda a shuga okakamiza

Nthawi zina, kutenga pakati kungayambitse kupanga vasopressin. Izi ndichifukwa choti placenta imamasulidwa enzyme yomwe imalepheretsa kupanga vasopressin. Izi zimakwera pachaka chachitatu cha mimba.

Mimba imapangitsanso kuchuluka kwa ludzu mwa azimayi, kuwalimbikitsa kumwa zakumwa zambiri, pomwe kusintha kwina kwakuthupi kwakuthupi panthawi yapakati kumakhudzanso kuyankha kwa impso ku vasopressin.

Gestational matenda a shuga a insipidus, omwe amapezeka pang'onopang'ono kwa amayi 100,000 aliwonse, amatha kuthandizira panthawi yoyembekezera ndipo amasowa masabata awiri kapena atatu atabadwa.

Mankhwala Othandizira Kusamala kwamadzi

Mankhwala okodzetsa omwe amagwiritsidwa ntchito ndi anthu omwe ali ndi vuto la mtima kapena edema amatha kupangitsanso kuchuluka kwamkodzo.

Mchitidwe wamadzi amkati amathanso kuyambitsa kusalinganika kwamadzi, ngati kuchuluka kwa madontho kumayimitsidwa kapena kutsika, polyuria imayamba. Mapulogalamu apamwamba a protein yambiri amathanso kuwonjezera mkodzo.

Zizindikiro zake za matenda a shuga

1) Chizindikiro chachikulu ndi polyuria - kukakamiza pafupipafupi kutulutsa mkodzo waukulu.

2) Chizindikiro chachiwiri chododometsa ndi polydipsia - ludzu lokwanira, lomwe pamenepa ndi chifukwa cha kutayika kwa madzi kudzera mkodzo. Zimalimbikitsa munthu amene ali ndi matenda kuti amwe madzi ambiri.

3) Kufunika kukodza kungasokoneze kugona. Kuchuluka kwa mkodzo kudutsa tsiku lililonse kumatha kukhala malita atatu mpaka 20, ndi mpaka 30 malita ngati mwa ND.

4) Zizindikiro zomwe zimakhala zachiwiri zimaphatikizapo kuchepa kwa madzi chifukwa cha madzi am'madzi. Izi zimawonekera kwambiri mwa ana omwe sangathe kufotokozera ludzu lawo. Ana atha kukhala owopsa, amakhala ndi malungo, amasanza, komanso / kapena kutsekula m'mimba; Gulu lina lomwe lili pachiwopsezo ndi anthu odwala matenda a dementia, amenenso nthawi zambiri samatha kumwa madzi pawokha.

5) Kuchepa kwambiri kwa thupi kumatha kubweretsa Hypernatremia, mkhalidwe womwe, chifukwa cha kuchepa kwa madzi, kuchuluka kwa sodium m'magazi kumakhala kochuluka, ndipo maselo amthupi amatsitsidwa madzi. Hypernatremia imatha kuyambitsa zizindikiro zamitsempha, monga kuchepa kwa mitsempha, chisokonezo, kukokana, kapena ngakhale kukomoka.

Chithandizo ndi kupewa

Kuzindikira kumakhala vuto lalikulu kwa anthu okhawo omwe sangathe kubwezeretsanso madzi, omwe amachititsa kuti madzi atheretu. Ngati madzi apezeka mwaulere, amatha kuthandizira ndipo akuchira mosadukiza.

Popanda chithandizo, ND yapakati imatha kuwononga impso. Ndi a impso ND, zovuta zazikulu ndizosowa ngati madzi akwanira.

Ngati pali chifukwa chodalirika chopangira mkodzo wapamwamba, monga matenda a shuga kapena mankhwala, yankho lavutoli liyenera kuthandiza kuthetsa zizindikiro za matenda a shuga.

Ndi insipidus yapakati komanso gestational matenda a shuga, mankhwala amatha kuwongolera kusakhazikika kwa madzimadzi mwa kusintha vasopressin ya mahomoni. Ndi mtundu wa impso, chithandizo cha impso chitha kuthetsa vutoli.

M'malo mwa hormone vasopressin ndi shuga wapakatikati wa insipidus (ndi mawonekedwe a gestational), imagwiritsidwa ntchito popanga ma analogue, desmopressin. Mankhwalawa ndi osathandiza pazifukwa za impso. Imapezeka ngati mankhusu amphuno, jakisoni, kapena piritsi. Zimatengedwa ngati zofunika, mosamala, chifukwa zimatha kupititsa patsogolo kusungidwa kwa madzi, komanso milandu yayitali kwambiri, ku hyponatremia ndi kuledzera kwamadzi. Mwambiri, mankhwalawa nthawi zambiri amakhala otetezeka mukamagwiritsa ntchito Mlingo woyenera wopanda zovuta zoyipa.

Zochitika zofatsa za insipidus yapakati pa shuga, momwe kumangokhala kutayika pang'ono kwa vasopressin katulutsidwe, mwina sikungafune kulowa m'malo mwa mahomoni, amatha kuwongoleredwa ndikuwonjezera kuchuluka kwa madzi.

Chithandizo cha mano a matenda a shuga a impso chitha kuphatikizaponso:

• mankhwala othana ndi zotupa, monga NSAIDs (mankhwala omwe si a antiidal anti-yotupa),
• diuretics (okodzetsa monga amiloride ndi hydrochlorothiazide), modabwitsa, mankhwalawa nthawi zambiri amayambitsa kukodza kwamkodzo ndipo amatha kufotokozera chifukwa chake pali polydipsia mu milandu ina ya ND, koma zotsatira zake zimakhala zosiyana ndi zomwe zimagwiritsidwa ntchito ngati chithandizo cha impso ND,
• kuchepa kwa mchere wa sodium (kuchokera mchere) ndi zina zowonjezera zamadzimadzi monga zimafunikira.

Matenda okhudza ubongo

Zomwe zimayambitsa kupangika kwa insipidus yapakati pa matenda a shuga ndi zofooka za anatomical pakukula kwa ma midbrain ndi apakatikati:

• septic optic dysplasia,
• michere
• holoprozenecephaly,
• kukula kwa pituitary gland ndi hypothalamus.

Odwala omwe ali ndi zilema zotere nthawi zambiri samakhala ndi zizindikiro zakunja za vuto la craniofacial.

Idiopathic matenda a shuga insipidus

Mu 10% ya omwe ali ndi matenda osokoneza bongo apakati pa ana, chiyambi cha matenda sichingadziwike. Pamene choyambirira sichikudziwika, insipidus wamkuluyu amatchedwa idiopathic.

Mu ana omwe ali ndi matenda a shuga a idiopathic shuga a insipidus, tikulimbikitsidwa kuti tizichita zinthu monga maginito a ubongo m'mitsempha yambiri.

Chomwe chimapangitsa mtundu uwu wa matenda a shuga insipidus atha kukhala osazindikira autoimmune lymphocytic infundibuloneurohypophysitis, zomwe ndizosavuta kudziwa muzochita zamankhwala.

Matenda obwera chifukwa cha matenda ashuga

Zomwe zimapangitsa ND kukhala kwakanthawi kapena kosatha zitha kukhala zowawa, zomwe zimayendera limodzi ndi kuwonongeka kwa maziko a chigaza. Kutalika kwa machitidwe a vasopressin okhala ndi ma cell akuluakulu a cell kuli pafupi 10 mm. Amatsikira m'mbali mwake. Kuvulala kumatha kuyambitsa edema kuzungulira ma axon awa.

Matenda a shuga osakhalitsa pambuyo povulala amayamba kwambiri tsiku loyamba pambuyo povulala ndipo amasowa m'masiku ochepa. Pafupifupi 50% ya odwala omwe akuvulala pachifuwa cha ku Turkey amakula matenda ashuga osatha. Zotsatira zavulalazi zikuchedwa kuyambika - pambuyo pa masabata atatu mpaka 6. Munthawi imeneyi, ma neurons azinthu zimasintha.

Zizindikiro za insipidus yapakati pa matenda a shuga zimawonekera pambuyo pa opaleshoni yamchiberekero cha hypothalamic-pituitary. Opaleshoni yotereyi ilinso ndi zinthu zina zomwe zimatchedwa "mayankho atatu":

1. gawo la polyuria - polydipsia (kuchuluka kwa mkodzo - ludzu), lomwe limatha kuyambira ½ mpaka masiku awiri atachitidwa opaleshoni,
2. gawo la antidiuresis - kugawa mkodzo wocheperako, gawo ili ndilotalikilapo (mpaka masiku 10),
3. gawo la machiritso kapena gawo la masanjidwe othandizira odwala matenda ashuga ngati 90% yama cell a vasopressin avulala.

Pambuyo pa opaleshoni, mwina edema kapena kuwonongeka kwa mitsempha ya minyewa kumatha kuchitika. Izi zikachitika, ndiye kuti pakubwera kumasulidwa kwina kwa ma antidiuretic maholide m'matangadza. Gawo lachitatu, kubwezeretsanso kapena kusabwezeretsa kwa ntchito ya neurohypophysis ndipo, chifukwa chake, kuchira kapena kukulitsa matendawa.
Pachimake chapakati matenda a shuga insipidus pambuyo opaleshoni amapezeka odwala osakwana 30%. Pazoposa theka la milandu mwa akulu, zizindikiro za matendawa ndizakanthawi.

Matenda a shuga a tumor

Zotupa zotsatirazi za bongo zimayambitsa matenda a shuga:

• germinoma (germoma chotupa cha chapakati mantha dongosolo, gonocytoma),
• pinealoma (pineocytoma, pineal adenoma),
• craniopharyngiomas,
• ma opic nerve gliomas,
• minengioma (arachnoidendothelioma),
• pituitary adenoma.

Mitundu yodziwika kwambiri ya ubongo yomwe imayambitsa matenda a shuga a insipidus ndi germinoma ndi pinealoma. Nthawi zambiri amapanga pafupi ndi hypothalamus, pomwe njira za vasopressin zimalumikizidwa musanalowe mu neurohypophysis.

Germinomas imakhala yochepa kwambiri komanso osadziwika ndi michere ya resonance imaging (MRI) kwa zaka zingapo kuyambira kumayambiriro kwa zizindikiro za insipidus yapakati pa matenda ashuga. Kuzindikira koyambirira kwa chotupa ndikotheka kudziwa m'magazi zomwe amapezeka ndi alpha-fetoprotein komanso kugwiritsidwa ntchito kwa beta kwa chorionic gonadotropin, chomaliza nthawi zina chimapangitsa anyamata kuyamba kugonana.

Matenda a shuga a insipidus amatha kukhala ndi craniopharyngiomas ndi ma gliomas a mitsempha ya optic, ngati chotupa chikufika kwakukulu. Izi zimachitika mwa 10 mpaka 20% ya odwala. Komabe, nthawi zambiri matendawa amawonedwa pambuyo pochotsa ma neoplasms.

Ma adenomas achilengedwe amachititsa ND yapakati mwa 1% yokha mwa milandu. Zochepa zotsika za matenda oterewa mu pituitary adenomas zimachitika chifukwa chochepa pang'onopang'ono. Ma tumors pang'onopang'ono amachotsa ma neurohypophysis kumtunda, kumbuyo, zomwe zimapangitsa kuti ntchito yake isungidwe.

Kukula kwa insipidus yapakati pa odwala omwe ali ndi mbiri ya khansa, mu 90% ya milandu imagwirizanitsidwa ndi metastases. Nthawi zambiri, chifuwa, m'mapapu, Prostate, impso, ndi khansa ya m'mimba zimayendera gland.

Mitsempha imakhala yopitilira kawiri kukhudzidwa ndi metastase kuposa adenohypophysis, yomwe imalumikizidwa ndi zodabwitsa zamagazi ake (ochepa, osatinso venousohypophysis).

Kutupa kwa m'munsi ndi nembanemba wa ubongo ndi ND

Matenda akuluakulu omwe amachititsa ND yodwala ndi awa:

• Langerhans cell histiocytosis,
• lymphocytic infundibuloneurohypophysitis,
• sarcoidosis.

Langerhans cell histiocytosis ndi neoplasm yolumikizidwa ndi m'mafupa. Mwachidziwitso, matendawa ali ndi mitundu yosiyanasiyana ya maphunzirowa. Nthawi zambiri, zotupa zam'magazi zimapezeka m'mafupa, pakhungu, kumaso kwa chithokomiro, zotupa, chiwindi, ndulu, mafupa, ndi mapapu.

Sarcoidosis (matenda a Beunier-Beck-Shauman) ndi matenda amitundu mitundu osadziwika, omwe amadziwika ndi mapangidwe a sarcoid granulomas. Ochulukira kwambiri ndi intrathoracic lymph node ndi mapapu (omwe amapezeka m'malo opitilira 90%). Mu 5 - 7% ya odwala omwe ali ndi sarcoidosis, kuwonongeka kwa mitsempha - neurosarcidosis - kumachitika. Ndi zovuta za pathological zotere, mitsempha ya cranial, hypothalamus ndi gitu pituitary nthawi zambiri imakhudzidwa.

Ndi hertiocytosis ya Langerhans ndi sarcoidosis, zizindikiro za insipidus yapakati pa shuga zimawonedwa pafupifupi 30% ya odwala.
Gland pituitary ndi matenda osachiritsika omwe amapezeka m'matumbo omwe amachitika chifukwa cha opuwala. Mu 30% ya milandu, matendawa amaphatikizidwa ndi matenda ena, monga Hashimoto's chithokomiro, matenda a Graves, matenda a shuga, matenda a Addison, matenda a Sjogren, systemic lupus erythematosus.

Gland wamkati ndiofala kwambiri pakati pa akazi kuposa amuna. Olemba ena 57 peresenti yamilandu amawona kukula kwa zamatenda nthawi yapakati kapena pakubala. Nthawi zambiri, pituitary gland imayambitsa matenda a shuga.

Autoimmune chapakati ND ndi matenda osiyana. Pathology imadziwika ndi kukula kwa mwendo wa pituitary komanso kukhalapo kwa ma antibodies ku maselo a hypothalamic omwe amapanga mahomoni a antidiuretic. Vuto la pathological limakhudza magawo a gawo la hypothalamic-pituitary.
Matenda okhudzana ndi maziko ndi nembanemba a ubongo amatsogolera pakupanga ND (nthawi zambiri yosakhalitsa):

• meningococcal,
• cryptococcal
• kuyamwa
• matenda obadwa nawo a cytomegalovirus.

Zowopsa zomwe zimayambitsa matenda opatsirana a pituitary gland ndi chifuwa chachikulu, syphilis, ndi matenda oyamba ndi fungus.

Maselo a shuga a insipidus

Zotupa zam'mimba za hypothalamus zimatha kutsogolera ND:

• lembani 1 kapena mtundu 2 wa matenda a shuga,
• Kutaya magazi kwakukulu mwa azimayi panthawi yobereka,
• kupasuka kwa aneurysm,
• thrombosis
• embolism mu mtima ntchito -
• kumwa mankhwala ena - clonidine.

Skien syndrome (Shien-Simmonds syndrome, pituitary apoplexy) ndi kulowetsedwa kwa pituitary komwe kumatsitsidwa ndikuchepa kwakukulu kwa kuthamanga kwa magazi, magazi akulu, thromboembolism kapena sepsis mwa amayi atabereka mwana. Zachipatala choterechi chimayambitsa kuchepa kwa zochitika zapachilengedwe komanso kuchepa kwa vasopressin ya mahomoni. Matenda a Shien ndi omwe amachititsa kuti anthu azikhala ndi matenda ashuga. M'zaka zaposachedwa, iye samachitika konse.

Zomwe zimayambitsa chapakati ND zimatha kukhala zovuta m'magazi a mitsempha kupita ku mitsempha ya ubongo - pachimake hypoxia, yomwe imayambitsa matenda a ubongo. Mabukuwa amafotokozera mawonetseredwe am matendawa odwala matenda amitsempha, kuperewera kwamatenda ambiri, neuroinfections, matenda a Guillain-Barré, kugunda kwamtima ndi kugundana kapena kuduladula kwa matenda a m'magazi.

Family aimpso shuga insipidus

Congenital aimpso shuga insipidus ndi matenda achilendo kwambiri obadwa nawo. Nthawi zambiri anyamata odwala. Amayi omwe ana amalandila jini ya matenda a shuga a nephrogenic samadwala nawonso, koma amatha kudziwa kuchepa kwa impso.
Zomwe zimayambitsa matenda osokoneza bongo a mahomoni amagawidwa m'magulu otsatirawa:

1. kusintha kwa kuchuluka kwa zolandilira komanso kuthekera kwa chinthu kumangiriza,
2. kuphwanya kulumikizana kwa ma receptor ndi ma protein a G,
3. kuchuluka kwa kudzikweza kwa mkhalapakati wachiwiri - cyclic adenosine monophosphate,
4. kuphwanya mayendedwe amiyala yamadzi,
5. kuyanʻanila zimachitika impso kwathunthu kwa chizindikiro cha mahomoni - kufupikitsika kwa malamba a nephron, oligomeganephronia, Fanconi.

Milandu yambiri ya kubadwa kwa impso ND imalumikizidwa ndi matenda a receptor. Nthawi zambiri pamakhala kusintha kwa majini a V2 receptor.

Zisonyezo za cholowa ND

Zizindikiro za matendawa ndizosiyanasiyana. Wodwala aliyense, kuphatikiza pa zizindikiro zazikulu za matendawa - polyuria, polydipsia, kusowa koyankha kwa mahomoni antidiuretic - akuwonetsa machitidwe ake a chitukuko cha matendawa, zovuta, kuyankha pamankhwala.

Kusintha kwofananako kwa banja limodzi kumayambitsa matenda a shuga m'mitundu yofatsa komanso yowopsa. Zizindikiro za matenda obadwa nawo a impso a azimayi ndi ochepa kwambiri kuposa amuna.

M'miyezi yoyambirira ya moyo wa ana, zizindikiro za matenda ashuga amtunduwu nthawi zambiri zimakhala zopanda tanthauzo, kotero kuzindikiridwa kumapangidwa nthawi zambiri zaka 2,5 - 3. Zizindikiro zazikulu za kubadwa kwa impso ND mu ana aang'ono ndi izi:

• kusanza
• anorexia - kukakamizidwa chakudya,
• dystrophy,
• magawo a kutentha kwa magwero osadziwika,
• kudzimbidwa.

Mwa ana ambiri, ziwonetserozo sizimakhala zochepera pakati pa ana athanzi azaka zawo. Chiŵerengero cha kulemera kwa thupi kufikira kutalika, chochepetsedwa m'zaka zoyambirira za moyo, pambuyo pake chimawonjezeka mopondera.

Monga vuto la matenda aakulu a shuga, odwala amatenga ureterohydronephrosis ndi vuto la chikhodzodzo cha neurogenic.
Milandu ingapo ya kuphatikiza kwa kubadwa kwa impso ya shuga ya m'mimba ndi kuthamanga kwa magazi kwa ana afotokozedwa. Akuluakulu, kusinthasintha kwakukulu mumapanikizidwe masana kumapezeka. Ofufuzawo akuti izi zimasinthasintha modabwitsa m'madzi mu nthawi ya ND.

Nephrogenic shuga insipidus wa electrolyte-metabolic chiyambi

Kuwonjezeka kwa ndende ya plasma calcium - hypercalcemia - vuto lomwe nthawi zambiri limayambitsa kusayenda bwino m'thupi la munthu m'thupi. Calcium imakhumudwitsa zochita za antidiuretic. Hypercalcemia wolimba imayendera limodzi ndi kuphwanya kwa chidwi cha impso. Kuopsa kwa zam'mitsempha kumachokera pakuchepa kwapang'onopang'ono pokodza kwamkodzo ndikuwonekera bwino kwa matenda a shuga - kuperewera kwathunthu kwa vasopressin. Ngati zovuta izi sizikugwirizana ndi kusintha kwakukuru kwa impso, zimatha kuchotsedwa kwathunthu ndikuchotsa zomwe zidawachititsa, mwachitsanzo, kuchotsa kwa tiziwalo ta parathyroid.

Hypercalcemia wolimba nthawi zambiri imakhala limodzi ndi hypokalemia, yomwe mwa iyo yokha imayambitsa nephrogenic ND. Zomwe zimayambitsa polyuria mu hypokalemia sizikudziwika bwinobwino. Kutukuka kwapafupipafupi kwa ma prostaglandins, zinthu zokhudzana ndi chilengedwe zomwe zimachokera ku mafuta ochulukirapo a polyunsaturated, zimatha kuchita nawo gawo.

Hyponatremia imatsogolera kuwonetsero kofatsa kwa ND. Vutoli limayambitsidwa ndi kuchepa kwa sodium chloride m'thupi kapena kutayika kwake, komanso pakumwa madzi ambiri.

Polydipsia yoyamba

Polydipsia ya pulayimale ndi vuto lomwe limatha ludzu la chibadwa chamadokotala (dipsogenic polydipsia) kapena kufunitsitsa kumwa (psychogenic polydipsia) komanso kugwiritsa ntchito madzi mopitilira muyeso kumachepetsa mphamvu ya thupi yoteteza kutulutsa kwa mahomoni a antidiuretic. Izi zimatsogolera ku zizindikilo za matenda a shuga insipidus. Ngati kuchepa kwamadzi kumachitika, vasopressin kaphatikizidwe kamayambiranso.

Ndi dipsogenic polydipsia, kuchepa kwapang'onopang'ono kwa chiwopsezo cha osmoreceptors cha ludzu kumachitika.
Psychogenic polydipsia (schizophrenia) ndimavuto osowa wamaganizidwe omwe amayamba chifukwa cha kugwiritsa ntchito madzi a manic kapena kumwa kwakanthawi kwamadzi ambiri. Madzi ochulukirapo amachititsa kuchuluka, kuchepetsedwa kwa madzi akunja kwama cell. Izi zimalepheretsa katulutsidwe ka vasopressin ndipo zimayambitsa kukodza kwakukulu kwamkodzo.

Iatrogenic shuga insipidus

Mtundu wa matenda ashuga amtunduwu umatsogolera ku:

• kudya zakudya zosalamulira,
• chizolowezi chomakonda kumwa tiyi wamankhwala, ndalama zolipiritsa,
• kufunitsitsa kumwa madzi ambiri,
• kumwa mankhwala osokoneza ntchito ya vasopressin - kukonzekera kwa lithiamu,
• kumwa mankhwala omwe amayambitsa pakamwa ndi ludzu - anticholinergics, clonidine, phenothiazides.

Ma antidepressants a reactic a vasopressin amakhalanso tetracycline antibayotiki - demeclocycline, tetracycline, chlotetracycline, non-steroidal anti-yotupa mankhwala (phenacetin, indomethacin, ibuprofen), angapo anti-arrhythmias ndi kugwirira, mankhwala opatsirana, mankhwala opatsirana .