Matenda a shuga > Matenda a shuga

Matenda a shuga (Latin shuga mellitus) ndi gulu la matenda amtundu wa endocrine omwe amayamba chifukwa chamtheradi kapena wachibale (kusokonezeka kwa mgwirizano ndi maselo ojambulidwa) kuchepa kwa insulin, chifukwa chomwe hyperglycemia imayamba - kuchuluka kosalekeza kwa glucose. Matendawa amadziwika ndi zovuta komanso kuphwanya mitundu yonse ya kagayidwe: chakudya, mafuta, mapuloteni, mchere komanso mchere wamchere.

Pali magawo angapo a shuga m'magulu osiyanasiyana. Pamodzi, zimaphatikizidwa ndikuwunika kwake komanso zimapereka kulongosola kolondola kwa zomwe wodwala ali ndi matenda ashuga.

Gulu la matenda ashuga ndi etiology

I. Mtundu woyamba wa matenda ashuga kapena "shuga ana", anthu azaka zilizonse amatha kudwala (kuwonongeka kwa maselo am'mimba, zomwe zimapangitsa kuti pakhale matenda a insulin a moyo wonse)

II. Type 2 shuga mellitus (insulin secretion yotsutsana ndi insulini)

· MODZI - zolakwika zamtundu mu ntchito ya ma b-cell.

III. Mitundu ina ya matenda ashuga:

1. zolakwika zamtundu (zonyansa) za insulin ndi / kapena zolandilira,
2. Matenda a pancreas exocrine,
3. matenda a endocrine (endocrinopathies): Itsenko-Cushing's syndrome, acromegaly, kuphatikiza zakumwa zoledzeretsa, pheochromocytoma ndi ena,
4. matenda osokoneza bongo
5. matenda a shuga anayambitsa matenda
6. mitundu yachilendo ya matenda osokoneza bongo okhudzana ndi matenda,
7. ma gennd syndromes ophatikizidwa ndi shuga.

IV. Matenda a shuga a gestational mellitus ndi matenda omwe amadziwika ndi hyperglycemia omwe amapezeka nthawi yomwe amayi amakhala ndi pakati ndipo nthawi zambiri amangobereka akangosabereka. Matenda amtunduwu amayenera kusiyanitsidwa ndi pakati pa odwala omwe ali ndi matenda ashuga.

Malinga ndi malingaliro a WHO, mitundu yotsatirayi ya shuga mwa amayi apakati ndiosiyanitsidwa:

1. Type 1 shuga mellitus wapezeka asanakhale ndi pakati.
2. Type 2 shuga mellitus wapezeka asanakhale ndi pakati.
3. Matenda a shuga oyembekezera - mawuwa amaphatikiza zovuta zilizonse za kulekerera kwa glucose zomwe zinachitika panthawi ya pakati.

Malinga ndi kuopsa kwa matendawa shuga ali ndi madigiri atatu otaya:

Matenda ofatsa (I degree) amadziwika ndi glycemia wocheperako, osapitirira 8 mmol / l pamimba yopanda kanthu, pomwe palibe kusinthika kwakukulu mu shuga mumagazi tsiku lonse, osafunikira tsiku lililonse glucosuria (kuyambira zovuta mpaka 20 g / l). Malipiro amasamalidwa kudzera mu chakudya. Ndi mtundu wofatsa wa shuga, angioeuropathy a preclinical ndi magawo othandiza amatha kupezeka mwa wodwala yemwe ali ndi matenda osokoneza bongo.

Ndi kukula kwamagulu (II digiri) matenda osokoneza bongo a shuga, kuthamanga kwa glycemia kumadzuka, monga lamulo, mpaka 14 mmol / l, kusinthasintha kwa glycemic tsiku lonse, glucosuria tsiku ndi tsiku nthawi zambiri simapitilira 40 g / l, ketosis kapena ketoacidosis imayamba. Kulipiritsa kwa matenda a shuga kumachitika kudzera pakudya ndi pakamwa hypoglycemic othandizira kapena insulin. Mu odwalawa, odwala matenda ashuga angioneuropathies osiyanasiyana kutanthauzira ndi magawo zinchito angathe kupezeka.

Matenda akulu a shuga (III digiri) amadziwika ndi kuchuluka kwa glycemia (pamimba yopanda 14 mmol / l), kusinthika kwakukulu mu shuga m'magazi tsiku lonse, glucosuria yayikulu (kupitilira 40-50 g / l). Odwala amafunikira chithandizo cha insulin nthawi zonse.

Malingana ndi kuchuluka kwa kubwezeretsa kwa chakudya cha carbohydrate shuga ali ndi magawo atatu:

1. Gawo la malipiro
2. Gawo lolipirira
3. Gawo lowongolera

Mitundu yowonjezera ya shuga ndi vuto labwino kwa wodwala yemwe chithandizo chake chimatha kukhala ndi shuga m'magazi komanso kupezeka kwake mkodzo kwathunthu. Ndi mtundu wophatikizidwa wa matenda a shuga, sizingatheke kupeza zotsatira zapamwamba zoterezi, koma kuchuluka kwa shuga m'magazi sikusiyana kwambiri ndi chizolowezi, ndiye kuti, sikuposa 13.9 mmol / l, ndipo kutayika kwa shuga tsiku lililonse mumkodzo sikupitirira 50 g. Nthawi yomweyo, acetone mu mkodzo kusowa kwathunthu. Mlandu woipa kwambiri ndi mtundu wosakanizika wa matenda ashuga, chifukwa pamenepa sizotheka kusintha kagayidwe kazakudya ndi shuga m'magazi. Ngakhale mankhwalawa, kuchuluka kwa shuga kumakwera pamwamba pa 13.9 mmol / l, ndipo kuchepa kwa shuga mumkodzo patsiku kupitirira 50 g, acetone imawonekera mkodzo. Hyperglycemic coma ndiyotheka.

Pachithunzi cha matenda ashuga, ndimakonda kusiyanitsa magulu awiri azizindikiro: choyambirira komanso chachiwiri.

Gulu la anthu odwala matenda ashuga (WHO, 1985)

A. Makalasi azachipatala

I. Matenda a shuga

1. Mellitus wodwala matenda a shuga

2. Mellitus (DIA) wosadalira insulini

a) mwa anthu omwe ali ndi thupi labwinobwino

b) mwa anthu onenepa kwambiri

3. Matenda a shuga omwe amaphatikizidwa ndi kuperewera kwa zakudya m'thupi

4. Mitundu ina ya shuga yokhudzana ndi zochitika zina ndi ma syndromes:

a) matenda kapamba,

b) matenda a endocrine,

c) Zinthu zomwe zimayambitsidwa chifukwa cha kumwa mankhwala kapena kukhudzana ndi mankhwala,

d) zovuta za insulin kapena zolandilira,

e) ma syndromes ena amitundu,

e) mayiko osakanikirana.

II. Kulekerera kwa shuga

a) mwa anthu omwe ali ndi thupi labwinobwino

b) mwa anthu onenepa kwambiri

c) Zogwirizana ndi zochitika zina (syndr 4)

B. Makalasi oopsa (omwe ali ndi vuto lofanana ndi shuga koma ali ndi chiwopsezo chachikulu chotenga matenda ashuga)

a) Kuleza mtima kwa shuga m'mbuyomu

b) kulolera kusokoneza shuga.

Ngati m'gulu la bungwe la WHO lomwe likupanga matenda ashuga mellitus (1980), mawu oti "DIA - mtundu wa matenda ashuga" ndi "DIA - mtundu II matenda ashuga" adagwiritsidwa ntchito pagululi pamwambapa. "Pamaganizidwe kuti akuwonetsa kukhalapo kwa zida zogwirira ntchito za pathogenetic zomwe zayambitsa matenda amtunduwu (zida za autoimmune za mtundu wa matenda a shuga a shuga ndikuwonetsa kuteteza matenda a shuga kapena kuchitapo kwake kwa matenda a shuga II). Popeza siamakliniki onse omwe ali ndi kuthekera kudziwa zomwe zimayambitsa matenda amtunduwu komanso ma genetic amitundu iyi ya shuga, ndiye, malinga ndi akatswiri a WHO, muzochitika izi ndizoyenera kugwiritsa ntchito mawu akuti IZD ndi IZND. Komabe, chifukwa chakuti mawu oti "Type Iabetes mellitus" ndi "mtundu II shuga mellitus" akugwiritsidwa ntchito pano m'maiko onse, tikulimbikitsidwa kuwawona ngati mawu amodzimodzi a mawu a IZD ndi IZND popewa chisokonezo, chomwe timagwirizana kwathunthu .

Monga mtundu wodziimira payekha wofunikira (pulayimale) matenda, shuga mellitus imagwirizanitsidwa ndi kuperewera kwa zakudya m'thupi. Matendawa nthawi zambiri amapezeka m'maiko otentha mwa anthu osakwanitsa zaka 30, kuchuluka kwa amuna kwa azimayi omwe ali ndi matenda amtunduwu ndi 2: 1 - 3: 1. Pazonse, pali odwala 20 miliyoni omwe ali ndi mtundu uwu wa matenda ashuga.

Zodziwika kwambiri ndi izi zochepa zamagulu a shuga. Yoyamba ndi matenda a shuga a fibrocalculeous pancreatic. Imapezeka ku India, Indonesia, Bangladesh, Brazil, Nigeria, Uganda. Zizindikiro za matendawa ndi kupangidwa kwa miyala pamkono waukulu wa kapamba ndi kukhalapo kwa mapapo ambiri a kapamba. Mu chithunzi cha chipatala, zimachitika mobwerezabwereza kupweteka kwam'mimba, kuwonda kwambiri komanso zizindikiro zina za kuperewera kwa zakudya zimadziwika. Zapakati, komanso nthawi zambiri zapamwamba, hyperglycemia ndi glucosuria zimatha kuchotsedwa mothandizidwa ndi insulin. Kusowa kwa ketoacidosis ndi khalidwe, lomwe limafotokozedwa ndi kuchepa kwa insulini ndikupanga shuga m'matumbo a islet zida za kapamba. Kupezeka kwa miyala m'makola a kapamba kumatsimikiziridwa ndi zotsatira za x-ray, kubwezeretsa cholangiopancreatography, ultrasound kapena complication tomography. Amakhulupirira kuti chomwe chimayambitsa matenda a shuga a fibrocalculeous pancreatic ndi kumwa mizu yamapala (tapioca, chinangwa) yomwe imakhala ndi cyanogenic glycosides, kuphatikizapo linamarine, pomwe hydrocyanic acid imamasulidwa panthawi ya hydrolysis. Sizimagwirizana ndi kutenga gawo la amino acid, komanso kusowa kwa zakudya zama protein, zomwe zimapezeka kawirikawiri m'mayiko awa, zimapangitsa kuti cyanide ikhale mthupi, chomwe ndi chifukwa cha fibrocalculosis.

Subtype yachiwiri ndi shuga ya kapamba yomwe imalumikizidwa ndi kuchepa kwa mapuloteni, koma palibe calcization kapena pancreatic fibrosis. Amadziwika ndi kukana kukula kwa ketoacidosis komanso zolimbitsa insulin. Monga lamulo, odwala amatopa. Katemera wa insulin amachepetsedwa, koma osati pamlingo wotere (malinga ndi kubisala kwa C-peptide) monga mwa odwala matenda a shuga, omwe amafotokozera kusowa kwa ketoacidosis.

Palibe gawo lachitatu la shuga mu gulu lino la WHO - omwe amatchedwa matenda a shuga a J (omwe amapezeka ku Jamaica), omwe amagawana zinthu zambiri zomwe zimachitika ndi matenda a shuga a pancreatic omwe amaphatikizidwa ndi kuchepa kwa protein.

Zoyipa zomwe magulu a WHO adakhazikitsidwa mu 1980 ndi 1985 ndikuti sizikuwonetsa maphunziro azachipatala komanso kusintha kwa matenda ashuga. Malinga ndi miyambo ya matenda ashuga oweta, kuwunika kwa matenda a shuga kungakhale, m'malingaliro athu, kuperekedwa motere.

I. Matenda a matenda ashuga

1. shuga wodalira insulini (mtundu woyamba wa shuga)

kachiromboka kapena kachiromboka (mtundu IA)

autoimmune (mtundu IB)

2. Matenda a shuga osadalira insulini (mtundu II matenda ashuga)

mwa anthu omwe ali ndi thupi labwinobwino

mwa anthu onenepa kwambiri

mwa achinyamata - MODZI mtundu

3. Matenda a shuga omwe amaphatikizidwa ndi kuperewera kwa zakudya m'thupi

fibrocalcule pancreatic shuga

kuchepa kwa protein protein

4. Mitundu ina ya matenda ashuga (yachiwiri, kapena yodziwika bwino, matenda ashuga):

a) endocrine genesis (Itsenko-Cushing's syndrome, acromegaly, kuphatikiza zakumwa zoledzeretsa, pheochromocytoma, etc.)

b) matenda a kapamba (chotupa, kutupa, kutulutsa, hemochromatosis, etc.)

c) Matenda oyambitsidwa ndi zifukwa zosowa zina (kumwa mankhwala osiyanasiyana, ma genetital obadwa nawo, kupezeka kwa insulin, matenda a insulin receptor, ndi ena otero.)

5. Matenda Abereki

A. Kuopsa kwa matenda ashuga

B. Mkhalidwe wolipirira

B. Zovuta zamankhwala

1. Mankhwala a insulin - momwe thupi lawo siligwirizana, kukhumudwa kwa anaphylactic, lipoatrophy

2. Mankhwala a Oral hypoglycemic - thupi lawo siligwirizana, nseru, kusowa kwa m'mimba, etc.

G. zovuta za matenda ashuga (nthawi zambiri chifukwa chamankhwala osakwanira)

a) ketoacidotic chikomokere

b) Hyperosmolar chikomokere

c) lactic acidosis chikomokere

g) hypoglycemic chikomokere

D. Mavuto obwera chifukwa cha matenda ashuga

1. Microangiopathy (retinopathy, nephropathy)

2. Macroangiopathy (myocardial infarction, stroko, mwendo gangrene)

G. Zilonda za ziwalo zina ndi machitidwe - enteropathy, hepatopathy, cataralog, osteoarthropathy, dermopathy, etc.

II. Kulolerana kwa shuga - shuga yotsalira kapena yam'mbuyo

a) mwa anthu omwe ali ndi thupi labwinobwino

b) mwa anthu onenepa kwambiri

c) Zogwirizana ndi zochitika zina (syndr 4)

III. Makalasi kapena magulu omwe ali pachiwopsezo cha ziwerengero, kapena prediabetes (anthu omwe ali ndi vuto labwino la shuga, koma ali ndi chiopsezo chotenga matenda a shuga):

a) anthu omwe m'mbuyomu adasokoneza kulolera kwa glucose

b) anthu omwe ali ndi vuto la shuga lotha kulolera.

Magawo atatu ali odziwika mu chipatala cha matenda a shuga: 1) kulolerana kwa glucose, kapena prediabetes, i.e. magulu a anthu omwe ali ndi chiopsezo chowerengera, 2) kulolerana kwa glucose, kapena latent kapena latent shuga, 3) kuwonetsa kapena kuwonetsa matenda ashuga a mellitus, EDI ndi ADI, omwe amatha kukhala ofatsa, odziletsa komanso owopsa.

Chofunikira cha matenda osokoneza bongo ndi gulu lalikulu la ma syndromes ochokera kumayendedwe osiyanasiyana, omwe nthawi zambiri amawonekera muzochitika zamankhwala a matenda ashuga. Kusiyana kwa patathogenetic pakati pa IDD ndi IDD kwaperekedwa pansipa.

Kusiyana kwakukulu pakati pa EDI ndi ADI

Chizindikiro cha mtundu I mtundu wa II mtundu II waumboni

Zaka zoyambira Achichepere, nthawi zambiri Kupitirira 40

Matenda mpaka zaka 30

Zowonjezera Pang'onopang'ono

Kuchepetsa Thupi Lathupi Mwambiri

Okwatirana: Mwinanso, amuna amadwala. Nthawi zambiri, amayi amadwala.

Kusalala Kwambiri

Matenda a shuga Nthawi zina, osakhazikika

Matenda a Ketoacidosis ku ketoacidosis nthawi zambiri samakula

Miyezo ya Ketone nthawi zambiri imakwezedwa.

Urinalysis Glucose ndipo Nthawi zambiri Glucose

Nthawi Yoyambira Nthawi zambiri yophukira-yozizira Palibe

Insulin ndi C-peptide Insulinopenia ndi Normal kapena Hyper

kuchepa kwa plasma mu C-peptide insulinemia (insulin

kuyimba pafupipafupi, nthawi zambiri ndi

Kuchepetsa Mkhalidwe Chiwerengero Cha Islets

ma cell a pancreatic b, kuchepa kwawo, ndi kuchuluka

kuchepa kapena kusowa kwa ma b-, a-, d- ndi PP-maselo mkati

ali ndi insulini, malo ochepa pakati pa zaka

lili ndi a-, d- ndi PP-maselo abwinobwino

Lymphocyte ndi ena Amapezeka koyamba Nthawi zambiri palibe

maselo otupa m'milungu yodwala

Ma antibodies ku ma islets. Pafupifupi amatha kuzindikirika.

kapamba muzochitika zonse koyamba

Ma genetic chizindikiro Kuphatikiza ndi HLA-B8, B15, mitundu ya HLA sichoncho

DR3, DR4, Dw4 ndi osiyana ndi athanzi

Concordance Yocheperako 50% Kuposa 90%

Matenda a shuga Kuchepera 10% Oposa 20%

Ine digiri ya ubale

Chithandizo cha zakudya, zakudya za insulin (kuchepetsa),

Mavuto apambuyo Pakanthawi Makamaka

Matenda a shuga a insulin (EDI, mtundu wa matenda a shuga a mellitus) amadziwika ndi kuyamba kwambiri, insulinopenia, chizolowezi chomakula ketoacidosis. Nthawi zambiri, matenda amtundu wa shuga amapezeka mwa ana ndi achinyamata, omwe m'mbuyomu ankadziwika kuti "ana a shuga", koma anthu azaka zilizonse amadwala. Moyo wa odwala omwe ali ndi matenda amtunduwu amayenderana ndi insulin, popanda pomwe ketoacidotic chikomacho chimakula msanga. Matendawa amaphatikizidwa ndi mitundu ina ya HLA, ndipo ma antibodies opita ku ma Langerhans islet antigen nthawi zambiri amapezeka mu seramu yamagazi. Nthawi zambiri kuphatikizidwa ndi macro- ndi microangiopathy (retinopathy, nephropathy), neuropathy.

Matenda a shuga omwe amadalira insulin ali ndi chibadwa. Zina zakunja zomwe zimathandizira kubadwa kwa matenda obwera chifukwa cha matenda ashuga ndizosiyanasiyana matenda opatsirana ndimatenda a autoimmune, omwe afotokozeredwe mwatsatanetsatane pansipa.

Matenda osagwirizana ndi insulin (NIDA, mtundu II shuga mellitus) kumachitika ndi zochepa kagayidwe kachakudya matenda a shuga. Monga lamulo, odwala samachita kunja kwa insulin, komanso mankhwala othandizira pakudya kapena mankhwala apakamwa omwe shuga yotsika mtengo amafunika kulipira kagayidwe kazakudya. Komabe, nthawi zina, kulipira kwathunthu kwa chakudya cha carbohydrate kumatha kupezeka pokhapokha ngati kulumikizidwa kwina kwa insulini kwachiritsidwe. Kuphatikiza apo, ziyenera kukumbukiridwa kuti panthawi zovuta zosiyanasiyana (matenda, zoopsa, opaleshoni), odwalawa amayenera kulandira insulin.Mu mtundu uwu wa matenda ashuga, zomwe zimapezeka mu insulinopenia yamwazi ndizokhazikika, zokwezeka kapena (zosowa) insulinopenia zimawonedwa. Odwala ambiri, hyperglycemia yachangu imatha kusakhalapo, ndipo kwa zaka zambiri mwina sazindikira matenda awo a shuga.

Mu mtundu II shuga mellitus, macro- ndi microangiopathies, amphaka ndi ma neuropathies apezekanso. Matendawa amakula pafupipafupi patatha zaka 40 (kuchuluka kwa mankhwalawa kumachitika zaka 60), komanso kumatha kuchitika ali aang'ono. Uwu ndiye mtundu wotchedwa AMODZI (mtundu wa ashuga achikulire), womwe umadziwika ndi cholowa chachikulu cha cholowa. Odwala omwe ali ndi matenda a shuga a mtundu wachi II, kagayidwe kazakudya kamene kamapatsidwa chakudya kumalipidwa ndi zakudya komanso mankhwala apakamwa omwe amachepetsa shuga. IDD, monga IDD, ili ndi mtundu wakubadwa, womwe umatchulidwa kwambiri (mitundu yambiri ya mabanja a matenda ashuga) kuposa ndi IDD, ndipo imadziwika ndi cholowa chodziwika bwino kwambiri. Chochititsa china chakunja chomwe chikuthandizira kuti chibadwa cha matenda amtunduwu chikhale chodwala kwambiri, zomwe zimayambitsa kukula kwa kunenepa kwambiri, komwe kumawonedwa mu 80-90% ya odwala omwe ali ndi ADHD. Kulekerera kwa Hyperglycemia ndi glucose mwa odwala kumayenda bwino ndi kuchepa kwa thupi. Ma antibodies a ma antibodies a islets a Langerhans mu mtundu uwu wa shuga kulibe.

Mitundu ina ya matenda ashuga. Gululi limaphatikizapo matenda ashuga, omwe amapezeka mu chipatala china, chomwe sichingaphatikizidwe ndi shuga.

1. Matenda a kapamba

a) mu makanda - kubereka kwatsopano kwa ma isco mu kapamba, shuga wocheperapo wa akhanda, magwiridwe antchito osagwirizana ndi njira za insulin zotulutsira,

b) kuvulala, matenda ndi zilonda zakumwa za kapamba zomwe zimachitika pambuyo pa nthawi ya neonatal, zotupa zoyipa, cystic fibrosis ya kapamba, hemochromatosis.

2. Matenda a chikhalidwe cha mahomoni: pheochromocytoma, somastatinoma, aldosteroma, glucagonoma, matenda a Itsenko-Cushing, acromegaly, chakumwa choizoni, kuchuluka kwazithunzithunzi za progestins ndi estrogens.

3. Mikhalidwe yoyambitsidwa ndi kugwiritsa ntchito mankhwala ndi mankhwala

a) Zinthu zomwe zimagwira ntchito muthupi: ACTH, glucocorticoids, glucagon, chithokomiro cha chithokomiro, timadzi timene timatulutsa kukula, njira zakulera zamkati, calcitonin, medroxyprogesterone

b) okodzetsa ndi othandizira antihypertensive: furosemide, thiazides, gigroton, clonidine, clopamide (brinaldix), ethacosterone acid (uregite),

c) Zinthu zama psychoactive: haloperidol, chlorprotixen, chlorpromazine, tridclic antidepressants - amitriptyline (tryptisol), imizin (melipramine, imipramine, tofranil),

d) adrenaline, diphenin, isadrine (novodrin, isoproterenol), propranolol (anaprilin, obzidan, inderal),

e) analgesics, antipyretics, anti-yotupa zinthu: indomethacin (methindole), acetylsalicylic acid okwanira Mlingo.

e) mankhwala a chemotherapeutic: L-asparaginase, cyclophosphamide (cytoxin), megestrol acetate, etc.

4. Kuphwanya insulin zolandilira

a) chilema mu insulin receptors - kobadwa nako lipodystrophy, kuphatikiza virilization, ndi pigment-papillary dystrophy khungu (acantosis nigricans),

b) Ma antibodies kuma insulin receptors, kuphatikiza ndi zovuta zina za chitetezo cha mthupi.

5. Ma gennd syndromes: mtundu I glycogenosis, pachimake porphyria, Down syndrome, Shereshevsky-Turner, Klinefelter, etc.