Insulin Resistance ndi HOMA-IR Index

akuti (mbiri yake imaphatikizapo maphunziro a kusala shuga ndi insulin).

Njira yodziwika yodziwira kukana kwa insulini yokhudzana ndi kutsimikiza kwa basal (kusala) chiyerekezo cha glucose ndi milingo ya insulin.

Phunziroli limachitika pang'ono pamimba yopanda kanthu, pambuyo pa kusala kudya kwa maola 8 mpaka 12 usiku. Mbiri imaphatikizanso ndi zizindikiro:

1. shuga
2. insulin
3. HOMA-IR yowerengera insulini yotsutsa.

Kukana kwa insulini kumalumikizidwa ndi chiwopsezo chowonjezeka cha matenda ashuga ndi mtima ndipo, mwachiwonekere, ndi gawo limodzi la zida za pathophysiological zomwe zimayambitsa kuphatikiza kunenepa ndi mitundu yamatendawa (kuphatikizapo metabolic syndrome). Njira yosavuta kwambiri yoyesera kukana insulini ndi HOMA-IR Insulin Resistance Index, chizindikiro chochokera ku Matthews D.R. et al., 1985, yokhudzana ndi kukhazikitsidwa kwa mtundu wa masamu wogwiritsa ntchito njira yoyesera insulin kukana (HOMA-IR - Homeostasis Model Assessment of Insulin Resistance). Monga tawonetsera, kuchuluka kwa insulin (kusala) kwa insulin ndi glucose, kuwonetsa kuyanjana kwawo m'chiwonetsero cha mayankho, kumagwirizana kwambiri ndi kuwunika kwa insulini mu njira yachindunji yowunikira zotsatira za insulin pa kagayidwe kazakudwala - njira ya hyperinsulinemic euglycemic.

Mlozera wa HOMA-IR umawerengeredwa ndi njira: HOMA-IR = glucose kudya (mmol / L) x insulin (μU / ml) / 22.5.

Kukula kwa glucose kapena insulin, chiwonetsero cha HOMA-IR, motero, chikuwonjezeka. Mwachitsanzo, ngati glucose yothamanga ndi 4.5 mmol / L ndipo insulini ndi 5.0 μU / ml, HOMA-IR = 1.0, ngati shuga yothamanga ndi 6.0 mmol / L ndipo insulin ndi 15 μU / ml, HOMA- IR = 4.0.

Mtengo wa kukana insulini womwe ukuwonetsedwa mu HOMA-IR nthawi zambiri umafotokozedwa ngati kuchuluka kwa magawo 75 a kuchuluka kwake kwa anthu. Malowa a HOMA-IR amadalira njira yodziwira insulini; ndizovuta kuyima bwino. Kusankhidwa kwa gawo lofunsira, kuwonjezera, kumatha kutengera zolinga za phunziroli ndi gulu lowonetsera lomwe lasankhidwa.

Mlozera wa HOMA-IR sunaphatikizidwe mu njira zazikulu zowunika za metabolic syndrome, koma umagwiritsidwa ntchito ngati maphunziro owonjezera a Laborator awa. Poyesa chiopsezo chokhala ndi matenda a shuga pagulu la anthu omwe ali ndi shuga m'munsi mwa 7 mmol / L, HOMA-IR imakhala yothandiza kwambiri kuposa kusala shuga kapena insulini pachilichonse. Kugwiritsa ntchito kwachipatala pozindikira matenda a masamu kuti mupeze kutsika kwa plasma insulin ndi glucose kumakhala ndi malire ndipo sikuvomerezeka nthawi zonse chifukwa choganiza za kuchepetsa shuga, koma mutha kugwiritsidwa ntchito pakuwonetsetsa. Matenda a insulin omwe amakhudzidwa ndi kuwonjezereka kumadziwika mu matenda a hepatitis C (genotype 1). Kuwonjezeka kwa HOMA-IR pakati pa odwalawa kumalumikizidwa ndi kuyankha koyipa kwambiri pochizira kuposa odwala omwe ali ndi insulin yotsutsana, chifukwa chake, kukonzekera kwa insulin kumawerengedwa ngati chimodzi mwazolinga zatsopano pochiza matenda a hepatitis C. Kukula kwa insulin (HOMA-IR) kumawonetsedwa ndi steatosis yopanda mowa. .

Zolemba

1. Matthews DR et al. Homeostasis kuwunika: insulin kukana ndi beta-cell ntchito kusala plasma glucose ndi insulin ndende mwa munthu. Diabetesologia, 1985, 28 (7), 412-419.

2. Dolgov VV et al. Laboratory matenda a carbohydrate kagayidwe kachakudya. Metabolic syndrome, matenda a shuga. M. 2006.

3. Romero-Gomez M. et al. Kukana kwa insulini kumapangitsa kuti mayankho a peginterferon komanso ribavirin azikhala ndi matenda a hepatitis C. Gastroenterology, 2006, 128 (3), 636-641.

4. Mayorov Alexander Yuryevich Mkhalidwe wa insulin kukana kusintha kwa matenda a shuga a 2. Chotsani. diss. d. M.N., 2009

5. O.O. Hafisova, T.S. Polikarpova, N.V. Mazurchik, P.P. Nkhaka Mphamvu ya metformin pa mapangidwe khola virologic poyankha ophatikizana antiviral matenda a chiwindi ndi Peg-IFN-2b ndi ribavirin mwa odwala koyamba insulin. Bulletin ya RUDN University. Ser Mankhwala 2011, No.2.

Zambiri

Kukaniza (kuchepa kwa chidwi) kwamaselo omwe amadalira insulini kupita ku insulini kumayamba chifukwa cha zovuta za metabolic komanso njira zina za hemodynamic. Choyambitsa kulephera nthawi zambiri chimakhala chibadwa chakuthupi kapena njira yotupa. Zotsatira zake, munthu ali ndi chiopsezo chowonjezereka cha matenda a shuga, metabolic syndrome, matenda a mtima, komanso kukanika kwa ziwalo zamkati (chiwindi, impso).

Kafukufuku wokhudzana ndi insulini ndi kuwunika kwa zizindikiro izi:

Insulin imapangidwa ndi ma cell a pancreatic (beta cell of isanger of Langerhans). Amatenga nawo mbali mthupi lathupi lathupi. Koma ntchito zazikulu za insulin ndi:

• kuperekera kwa shuga m'maselo am'matumbo,
• Malangizo a lipid ndi carbohydrate metabolism,
• matenda a shuga wamagazi, ndi zina zambiri.

Mothandizidwa ndi zifukwa zina, munthu amayamba kukana insulini kapena ntchito yake yeniyeni. Ndi chitukuko cha kukana kwa maselo ndi minyewa kupita ku insulin, kuyika magazi m'magazi kumawonjezeka, zomwe zimapangitsa kuti magazi azikhala ndi glucose. Zotsatira zake, kukulira mtundu wa shuga wachiwiri, matenda a metabolic, komanso kunenepa kwambiri ndikotheka. Metabolic syndrome imatha kubweretsa vuto la mtima komanso sitiroko. Komabe, pali lingaliro la "zolimbitsa thupi insulin", limatha kuchitika pamene thupi lifunikira mphamvu (panthawi yoyembekezera, kulimbitsa thupi kwambiri).

Chidziwitso: Nthawi zambiri, kukana insulin kumadziwika mwa anthu onenepa kwambiri. Ngati kulemera kwa thupi kukwera ndi oposa 35%, ndiye kuti insulin sensitivity imachepetsedwa ndi 40%.

Chizindikiro cha HOMA-IR chimawerengedwa ngati chidziwitso chothandiza pakuzindikira insulin.

Phunziroli limawerengetsera kuchuluka kwa basal (kusala) glucose ndi insulin. Kuwonjezeka kwa index ya HOMA-IR kukuwonetsa kuwonjezeka kwa glucose kapena insulin. Uku ndikumvekera bwino kwa matenda ashuga.

Komanso, chizindikirochi chitha kugwiritsidwa ntchito ngati akuwonetsa kuti ali ndi vuto la insulini mu azimayi omwe ali ndi polycystic ovary syndrome, matenda a shuga a m'matumbo, kulephera kwaimpso, matenda a chiwindi B ndi C, komanso chiwindi cha steatosis.

Zizindikiro zakusanthula

• Kuzindikira kwa insulin kukana, kuyesa kwake mumphamvu,
• Kuneneratu kuopsa kokhala ndi matenda a shuga komanso kutsimikizika kwa matendawa pamaso pake pakuwonekera.
• Matendawa amakakamizidwa kulolerana ndi shuga,
• Kafukufuku wowerengeka wa mtima wamatsenga - matenda a mtima, matenda a mtima, kulephera kwa mtima, ndi zina zotero.
• Kuyan'ana mkhalidwe wa odwala onenepa kwambiri,
• Mayeso ovuta a matenda a endocrine system, matenda a metabolic,
• Kuzindikira kwa polycystic ovary syndrome (kukanika kwa ovari pamsana wa endocrine pathologies),
• Kupima ndi kuchiza kwa odwala omwe ali ndi hepatitis B kapena C osakhazikika,
• Dziwitsani matenda osokoneza bongo a chiwindi steatosis, kulephera kwaimpso (mitundu yovuta komanso yovuta),
• Kuwona za chiwopsezo chotenga matenda oopsa komanso zina zokhudzana ndi kuthamanga kwa magazi,
• Dziwani matenda amisala mwa amayi apakati,
• Kwambiri matenda opatsirana, kuikidwa kwawofatsa mankhwala.

Fotokozani za zotsatira za kusanthula kwa insulin kukaniza akatswiri: akatswiri a zamankhwala, dokotala, opaleshoni, othandiza kudziwa za matenda, endocrinologist, zamtima, gynecologist, dokotala wamkulu.

Mfundo zam'mbuyo

• Malire otsatirawa akufotokozedwera glucose:
  • 3,9 - 5.5 mmol / L (70-99 mg / dl) - zabwinobwino,
  • 5.6 - 6.9 mmol / L (100-125 mg / dl) - prediabetes,
  • oposa 7 mmol / l (shuga mellitus).
• Mitundu ya 2.6 - 24.9 mcED pa 1 ml imadziwika kuti ndi insulin.
• NOMA-IR insulin kukana index (coeffokwanira) kwa akuluakulu (wazaka 20 mpaka 60) wopanda matenda ashuga: 0 - 2.7.

Pakuphunzira, Zizindikiro zimaphunziridwa: kuchuluka kwa shuga ndi insulin m'magazi, komanso index ya insulin. Zotsalazo zimawerengeredwa ndi njira:

NOMA-IR = "glucose concentration (mmol pa" 1 l) * mulingo wa insulini (μED pa 1 ml) / 22.5

Fomuloli ndikofunika kugwiritsa ntchito pokhapokha ngati mukusala magazi.

Zinthu zothandiza pa zotsatirapo zake

• Nthawi yoyeserera magazi yoyeserera,
• Kuphwanya malamulo okonzekera phunziroli,
• Kumwa mankhwala ena ake
• Mimba
• Hemolysis (pokonzekera kuwononga maselo ofiira am'magazi, ma enzyme omwe amawononga insulin amatulutsidwa),
• Mankhwala a Biotin (kuyesa kwa insulini kumachitika popanda kale kuposa maola 8 mutakhazikitsidwa kwa mlingo waukulu wa mankhwala),
• Mankhwala a insulin.

Kuchulukitsa Mfundo

• Kukula kwa kukana (kukana, chitetezo chokwanira) kwa insulin,
• Chiwopsezo chachikulu cha matenda ashuga
• Matenda a shuga
• Matenda a mtima
• Metabolic syndrome (kuphwanya chakudya, mafuta ndi metaboline a purine),
• Polycystic ovary syndrome
• Kunenepa kwamitundu yosiyanasiyana,
• Matenda a chiwindi (kusowa, chiwindi cha hepatitis, steatosis, cirrhosis ndi ena),
• Kulephera kwa impso
• Kusokonezeka kwa ziwalo za endocrine system (adrenal gland, pituitary, chithokomiro ndi kapamba, etc.),
• Matenda opatsirana
• Njira zama oncological, etc.

Chizindikiro chotsika cha HOMA-IR chikuwonetsa kusowa kwa insulini ndipo imawoneka ngati yachilendo.

Kukonzekera kwa kusanthula

Kafukufuku wofufuza: magazi a venous.

Njira zotsatsira zotsalira zazomera: kupuma kwamitsempha yamkamwa.

Kuzungulira kwa mpanda: makamaka pamimba yopanda kanthu!

• Ana osakwana zaka 1 asadye kwa mphindi 30 mpaka 40 maphunziro asanachitike.
• Ana a zaka zapakati pa 1 mpaka 5 samadyanso kwa maola 2-3 maphunziro asanachitike.

Zowonjezera maphunziro

• Patsiku la ndondomeko (pomwepo musananyengedwe) mutha kumwa madzi wamba osagwiritsa ntchito mpweya ndi mchere.
• Madzulo atayesedwa, mafuta, zakudya, zokazinga ndi zokometsera, zonunkhira, ndi zakudya zosuta ziyenera kuchotsedwa muzakudya. Sizoletsedwa kumwa mphamvu, zakumwa za tonic, mowa.
• Masana, kupatula katundu aliyense (mwakuthupi ndi / kapena psycho-maikutlo). Mphindi 30 asanaperekedwe magazi, kusakhazikika kulikonse, kuthamanga, kukweza thupi, ndi zina.
• Ola limodzi chiyeso cha insulin chisanachitike, muyenera kukana kusuta (kuphatikizapo ndudu yamagetsi).
• Maphunziro onse aposachedwa a mankhwala othandizira kapena othandizira, mavitamini amayenera kudziwitsidwa kwa adokotala pasadakhale.

Muyenera kuti mwapatsidwanso ntchito: