Matenda a shuga: ziwerengero zofala padziko lonse lapansi

Vutoli limadziwika ndi kuchuluka kwa milandu yamatendawa, pafupipafupi komanso kufa kwa odwala matenda ashuga.

Chizindikiro chilichonse mwatsatanetsatane chimatsimikiziridwa ndi zinthu zambiri zomwe zimatha kusintha kufunikira kwawo ndikuwunika patsogolo pa nthawi. Njira yothetsera kuthetsa mavuto angapo okhudzana ndi matenda ashuga imakhazikika pam mfundo zomwezi monga matenda ena osagonjetseka (a mtima, oncological, ndi zina).

Zomwe zikuluzikulu ndizakuti chinthu chomwe amaphunzirachi ndi kuchuluka kwa anthu (kuchuluka kwa anthu), matendawa amawerengedwa momwe zinthu zimakhalira ndikukhazikika kwake, wophunzirayo ayenera kuganizira za kuchuluka kwa zinthu zomwe zimatha kuphatikizidwa ndi chitukuko cha matendawa - zachilengedwe, zachikhalidwe, zachilengedwe, nyengo komanso nyengo ena

Epidemiology ya insulin-wodwala matenda a shuga a mellitus (IDDM). IDDM yakhala ikudziwika kuti ndi imodzi mwazovuta kwambiri za matenda ashuga, ndikumawatcha, mwachitsanzo, mwana, mwana. Gawo lake laling'ono m'gulu la odwala matenda ashuga (osapitirira 10-15%) komanso kuchepa kwa thupi, lojambulidwa makamaka mwa ana osaposa zaka 15 ndi osapitirira 30,

Chidwi mu maphunziro apadera a IDDM chinawonjezeka m'ma 70s. Choyamba, zidapezeka kuti odwala omwe ali ndi matenda ashuga, kupatsirana kwa insulin sikungathandize kapena kulibe, pomwe odwala omwe ali ndi matenda akuluakulu a shuga amasungidwa.

Kachiwiri, zidapezeka kuti izi ndi zosiyana kwambiri ndi miliri. Chachitatu, odwala matenda ashuga, kuyanjana kwa matendawa ndi HLA antijeni (Ag) sikunapezeke mwa odwala matenda ashuga.

Zotsatira za ma regista a IDDM m'maiko 40 apadziko lapansi zidapangitsa kuyerekezera kwakutukuka kwa magawo osiyanasiyana ndikudziwuza zinthu zofunika kwambiri zomwe zikuwakhudza chizindikirochi. Zolembedwa:

1) kuchuluka kwakukulu kwa IDDM kudalembedwa kumpoto kwa Europe, koma kumasiyana m'maiko osiyanasiyana (mwachitsanzo, ku Iceland ndi 50% yaomwe ku Norway ndi Sweden komanso pafupipafupi matenda ku Finland),

2) kuchuluka kwa IDDM pakati pa anthu okhala kumpoto ndi kum'mwera kwa dziko lapansi ndi kosiyana (m'maiko omwe ali pansi pa equator, sikupitirira 20: kuchuluka kwa anthu, pomwe ali kumayiko omwe ali pamwamba pa equator, ndi ochuluka kwambiri).

Nthawi yomweyo, pafupipafupi IDDM imakhala yopanda malire kapena kutentha kwapakati pachaka. Mwachidziwikire, kusiyanasiyana kwadongosolo la IDDM makamaka kumatsimikiziridwa ndi ma genetic.

Zowonadi, anthu okhala m'mikhalidwe yosiyanasiyana, koma okhala ndi chibadwa wamba (mwachitsanzo, anthu aku Britain Isles, Australia ndi New Zealand) ali ndi chiopsezo chofanana ndi kukhala ndi IDDM. Komabe, kuti matendawo apezekenso, zinthu zachilengedwe ndizofunikira.

Epidemiology ya odwala matenda a shuga osagwirizana ndi insulin (NIDDM). Kugwirizana kwa maphunziro ofufuza a NIDDM makamaka chifukwa ndi chifukwa cha 85-90% cha mitundu ina ya matenda ashuga.

Kuphatikiza apo, kuchuluka kwa NIDDM ndi kokwera kwambiri kuposa kawiri konse. Zinthu zonsezi zimazindikira kufunika kwa NIDDM, osati pakati pa mitundu ina ya matenda ashuga, komanso pakati pa matenda ena osachiritsika.

Kuyambira 1988, WHO yakhala ikutenga zambiri zokhudzana ndi kufala kwa matenda a shuga komanso kulekerera kwa glucose (NTG) pakati pa anthu padziko lapansi azaka 30-64. Zoyambirira zikusonyeza kuti NIDDM kulibe kwathunthu kapena osowa kwambiri pakati pa anthu ena a ku Melanesia, East Africa ndi South America, komanso pakati pa anthu achilengedwe aku North.

M'madera ambiri ochokera ku Europe, kuchuluka kwa NIDDM kuli mitundu 3-15%. M'magulu a anthu ochokera ku India, China komanso ku America ochokera ku Spain, amakhala apamwamba (15- 20%).

Pofika kumayambiriro kwa zaka za 70s, maphunziro ochepa okha ndi omwe adachitika ku Russia (Leningrad, Moscow, Rostov-on-Don ndi madera ena). Adagwiritsa ntchito njira zosiyanasiyana - kudziwa kuchuluka kwa shuga mumkodzo, magazi - pamimba yopanda kanthu ndikatha kutsitsa shuga (mayeso a kulolera glucose - GTT), komanso zida zofotokozera zamankhwala.

Zosagwirizana ndi glucose kapena njira zowunikira zotsatira za GTT sizinali zofanana. Zonsezi zidawonjezera kupenda koyerekeza, koma zidapangitsa kuti zidziwike kuti kuchuluka kwa matenda ashuga m'magawo osiyanasiyana komanso m'magulu azanthu aku Russia kumasiyana kwambiri ndipo kumapitilira zizindikiro zake kutengera kudandaula kwa anthu kuchipatala.

Kusiyana komwe kunawululidwa kunali kokhudzana kwambiri ndi mgwirizano wapadziko lonse komanso chikhalidwe cha anthu omwe amaphunzira. Chifukwa chake kuchuluka kwambiri kwa matenda ashuga kudadziwika ku Moscow, komwe kumafikira azimayi 4.58%, ndi 11.68% m'magulu azaka zopitilira 60.

M'madera ena, kuchuluka kumachokera ku 1 mpaka 2.8%. Mwinanso kafukufuku wofalitsa matenda adzawonetsa amitundu omwe ali ndi matenda ambiri a shuga, koma Russia imadziwika ndi anthu omwe ali ndi vuto lalikulu.

Choyamba, anthu angapo a Kumpoto Kakutali ndi awo. Chifukwa chake, pakati pa Nanai, Chukchi, Koryak, Nenets, matenda a shuga samachitika, pakati pa Yakuts kuchuluka kwake kumafika ku 0,5-0.75%.

Poganizira kuti kudziwiratu kwa chibadwa ndikofunikira pakukula kwa matenda ashuga (mosasamala mtundu wake), ziyenera kuganiziridwa kuti kuchuluka kwake m'dera lililonse kumatengera kuchuluka kwa magulu amitundu omwe amakhala kumeneko.

Kuphatikiza pa kubadwa kwamtundu, zinthu zambiri zimathandizira kukhazikitsidwa kwa NIDDM. Zina mwazomwe zimakhudzana ndi chitukuko cha matenda osokoneza bongo mwanjira zina, ena mwachindunji, makamaka ndikumazindikira kuopsa kwa matendawa.

Posachedwa, zomwe zimatchedwa metabolic syndrome zakopa chidwi chambiri cha ofufuza: kukana insulini, hyperinsulinemia, dyslipidemia, kulolerana kwa glucose kapena NIDDM, mtundu wamtundu wa kunenepa kwambiri, matenda oopsa.

Mu anthu omwe ali ndi metabolic syndrome, hyperuricemia, microalbuminemia, kuchuluka kwa kuphatikiza kwa maselo ambiri amapezeka kawirikawiri, mwa akazi - hyperandrogenemia. Udindo waukulu pakukula kwa matendawa ukhoza kuseweredwa ndi insulin kukana komanso kulipiritsa hyperinsulinemia.

Anthu ambiri omwe ali ndi vuto lolephereka la glucose ali kale ndi insulin kukana. Mwinanso izi zisanachitike kukhazikitsidwa kwa NIDDM. Zovuta zazikulu za NIDDM ndi dyslipidemia, matenda oopsa ndipo kunenepa kwambiri.

Kuyanjana pakati pa chitukuko cha NIDDM ndi zinthu zachilengedwe kumatsimikiziridwa ndikuti pafupipafupi pakukula kwake kumasintha ndikusintha kwa moyo wa anthu. Kufalikira kwa kuchuluka kwa matendawa komanso kufalikira kwa matendawa sikokwanira kuti kungofotokozedwa mwakubadwa kwa majini.

Kufalikira kwa NIDDM kumadalira jenda. M'mayiko ambiri, pakati pa akazi ndi apamwamba kuposa amuna. Kufalikira kwa NIDDM kumawonjezeka ndi zaka.

Chifukwa cha nkhondo yopambana yolimbana ndi matenda opatsirana ambiri komanso kuchuluka kwa moyo, kuwonjezereka kwa kufalikira kwa NIDDM kungayembekezeredwe.

Zakhazikitsidwa kuti zochitika zolimbitsa thupi zimakhudza kagayidwe ka glucose ndipo zimakhala ndi phindu linalake pakukula kwa NIDDM. Chifukwa chake, kufalikira kwa NIDDM pakati pa anthu okhala ndi moyo wongokhala ndiwosirikiza kawiri kuposa pakati pa anthu omwe amachita nawo masewera.

Pali maphunziro ochepa chabe pa mgwirizano womwe umachitika pakati pa NIDDM ndi mtundu wa zakudya. Kuchuluka kwa chakudya chamafuta ndi kuchuluka kwa chakudya moyenera komanso pafupipafupi ndi NIDDM. Komabe, kuphunzira udindo wa zakudya pakupanga NIDDM si vuto lophweka.

Maubwenzi ovuta pakati pa zakudya, kunenepa kwambiri komanso kuwononga mphamvu, zomwe pamlingo wina kapena zina zimakhudzidwa ndi pathogenesis ya NIDDM, ikuwonetsa kuti sangakhale ofunika kwambiri pakukula kwake komanso maphunziro ena amafunikira.

Njira zoyenera kudziwa matenda ashuga

Mu 1999, WHO idavomereza njira zatsopano zodziwonera za matenda ashuga, zomwe zidatsimikizidwa mu 1997 ndi ADA.

Anafotokoza mosamala njira zodziwitsira zosiyanasiyana zamatenda a carbohydrate metabolism

NTG - kulolerana kwa glucose, GN - kusala koopsa kwa hyperglycemia (m'magazi a capillary)

Kusiyana kwakukulu pakati pa njira zatsopano zopezera matenda ashuga mu 1999 ndi njira zomwe zidalipo mu 1985 ndikuchepa kwa kuchuluka kwa matenda a shuga (6) mpaka 6.1 mmol / l (m'magazi a capillary) kapena kuchokera pa 7.8 mpaka 7.0 mmol / l (mu plasma yamagazi venous).

Mlingo wodziwitsa za glycemia maola 2 atatha kudya anakhalabe chimodzimodzi - 11.1 mmol / L. Zolinga zakukulira njira zodziwira matendawa ndizodziwikiratu: kudziwitsidwa koyambirira kwa matenda ashuga kumathandizira kuti mankhwalawa ayambe munthawi yake komanso kupewa zovuta za matenda ashuga.

Kuphatikiza apo, mu njira yatsopano yodziwira, lingaliro linanso lakhala likuwonetsa kuphwanya kwa kagayidwe kazakudya zam'thupi - kusala kwa hyperglycemia. NTG ndi hyperglycemia yosala kudya ndi magawo a shuga, omwe amatha kusinthika kukhala shuga pokhapokha atakumana ndi zovuta.

Zomwe zimayambitsa kusintha kwa matenda ashuga asanafike pasadakhale kuti akhale shuga:
• onenepa kwambiri (BMI> 25 kg / m2),
• kumangokhala
• yapezeka kale NTG kapena kusala hyperglycemia,

• ochepa matenda oopsa (BP> 140/90 mm Hg),
• kwambiri osalimba lipoprotein cholesterol (HDL cholesterol) 1.7 mmol / l,
• Kuyika pachiwopsezo kwa mayi kubereka mwana wambiri> 4.5 kg,
• ovary ya polycystic.

Mphamvu ya chithandizo cha matenda ashuga imawunikidwa ndi zizindikiro zingapo zomwe zikuwonetsa mtundu wa metabolism ya carbohydrate. Izi zimaphatikizira kusala kudya kwa glycemia, glycemia patatha maola awiri atatha kumeza ndi glycated hemoglobin HbAlc - chofunikira kwambiri pakubwezeretsanso kwa kagayidwe kazakudya m'miyezi iwiri yapitayi.

Epidemiology ndi pafupipafupi matenda a shuga komanso matenda ashuga a retinopathy

Mapeto a XX ndi chiyambi cha zaka za XXI cholembedwa ndi kufalikira kwakukulu kwa matenda ashuga mellitus (DM). Kuwonjezeka kwa ziwopsezo zomwe zapangitsa kuti zitheke kunena za mliri wapadziko lonse wa matenda osokoneza bongo. Pofotokoza zomwe akatswiri anapeza, mkulu wa Center for Diabetes ku World Health Organisation (WHO) ndi International Institute for the Study of Diabetes ku Australia P.

Zimmet adati: "Tsunami padziko lonse la anthu obwera ndi matenda ashuga akubwera, tsoka lomwe likhala vuto laumoyo m'zaka za m'ma 2000 zino, izi zitha kuchepetsa chiyembekezo chokhala padziko lonse lapansi kwanthawi yoyamba m'zaka 200."

Matenda a shuga ndi amodzi mwa matenda omwe amafala kwambiri, amakhala m'malo akuluakulu osati pakapangidwe ka matenda a endocrine, komanso pakati pa matenda osagonjetseka (malo achitatu pambuyo pa mtima ndi oncopathology).

Kulumala koyambirira pakati pa matenda onse, kufa kwakukulu pakati pa odwala kumawonetsa matenda ashuga ngati zofunika kwambiri pamagulu azachipatala amayiko onse padziko lapansi, omwe adalembedwa mu Saint Vincent Declaration.

ku Europe kokha - ma euro oposa 33 miliyoni ndi enanso 3 miliyoni - posachedwa. Malinga ndi Purezidenti wa European Association for the Study of matenda ashuga, Pulofesa Ferannini, kafukufuku yemwe akupitilizidwa, mwachitsanzo, makina osokonekera a β cell atha kupangitsa kuti mankhwalawa apezeke.

M'mayiko otukuka ku Europe, kuchuluka kwa anthu odwala matenda ashuga ndi 3-10% kawirikawiri, ndipo pakati pa anthu omwe ali pachiwopsezo ndi okalamba amafika 30% ya anthu onse, omwe adapezeka ndi matenda osokoneza bongo a 58-60% ya odwala onse.

Chifukwa chake, malinga ndi akatswiri a WHO, mu 1995 panali odwala 135 miliyoni omwe ali ndi matenda ashuga, ndipo mu 2001 chiwerengero chawo chidafika 175.4 miliyoni, pofika 2005–2010 adzakhala anthu 200-239.4 miliyoni, ndipo pofika 2025 chiwerengerochi achuluke mpaka 300 miliyoni ndipo podzafika 2030 adzafika anthu 366 miliyoni.

Izi zimachitika makamaka chifukwa cha kuchuluka kwa odwala matenda ashuga amtundu wa 2, omwe ndi pafupifupi 6-7% yaanthu onse. Mphindi 20 zilizonse, vuto latsopano la matenda ashuga limanenedwa ku United States, ndi mphindi makumi anayi zilizonse ku Europe. Ndi mitundu yochepa chabe yomwe ikusankha (malinga ndi WHO).

Kuwerengetsa kukuwonetsa kuti pakuwonjezeka kwa zaka zapakati pazaka pafupifupi 80, kuchuluka kwa odwala matenda amtundu wa 2 kupitilira 17% yaanthu. Mwa anthu azaka zopitilira 60, odwala matenda a shuga ndi 16%, ndipo patatha zaka 80, 20-24%.

Chiwopsezo cha matenda ashuga chikuwonjezeka chaka chilichonse m'maiko onse padziko lapansi ndi 5-7%, koma kuchuluka kwambiri kwa matenda ashuga 2 kumayembekezeredwa ku Middle East, Africa ndi India, Asia, makamaka m'magulu azaka zopitilira zaka 25 mpaka 40, ndi aliyense 10 Zaka khumi ndi zisanu ziwonjezereka.

Pasanathe zaka 20, kuchuluka kwa odwala matenda ashuga padziko lapansi kwawonjezeka kasanu ndi kamodzi. Malinga ndi kuneneratu, tikusunga kuchuluka kwamtunduwu pofika chaka cha 2025, kuchuluka kwa anthu odwala matenda ashuga kumayiko otukuka kudzakhala 7,6%, m'maiko omwe akutukuka - 4,9%, ndipo kuchuluka kwambiri kwa anthu m'maiko otukuka kumachitika zaka makumi 65 zikadatha, m'maiko otukuka - -64 zaka.

Amakhulupilira kuti mtundu 1 wa shuga m'mayiko otukuka amapezeka mu 10-15% ya odwala, ndipo amalemba matenda ashuga 2 mu 85-90%. Koma m'zaka zaposachedwa, kuchuluka kwa matenda ashuga a mtundu wachiwiri m'maiko otukuka kwakula kwambiri (chifukwa cha kuperewera kwa zakudya m'thupi ndi zina), ndipo kuchuluka kwa odwala matenda amtundu wa 1 sikunasinthe kwenikweni.

Chiwerengero cha anthu omwe ali ndi vuto losakhazikika pakati pa odwala omwe ali ndi matenda a 2 amachokera ku 30 mpaka 90%. Mwambiri, zosowa kuchokera kumaiko osiyanasiyana monga Mongolia ndi Australia zimawonetsa kuti kwa munthu aliyense amene wapezeka ndi matenda a shuga, pamakhala wodwala m'modzi wodwala matenda ashuga osazindikira.

M'mayiko ena, kuchuluka kwa anthu odwala matenda ashuga ndiwabwino kwambiri: mwachitsanzo, mpaka 60-90% ku Africa. Komabe, ku USA kuli 30% okha a iwo. Kafukufuku wa ku Australia wa matenda ashuga a ku Australia, Obesity and Lamoyoyle (AusDiab) adawonetsa kuti pamavuto onse omwe apezeka ndi matenda amtundu wa 2, pamakhala vuto limodzi.

The National National Health and Nutrition Survey (NHANES III), yopangidwa ku USA, idawonekeranso kuchuluka kwa matenda ashuga a mtundu 2 omwe sanadziwike kwa anthu ambiri: pafupifupi, ndi 2.7%, ndipo mwa amuna ndi akazi azaka zapakati pa 50-59 3.3 ndi 5.8%, motsatana.

Ofufuza ambiri akuwonetsa kuchuluka kwa azimayi ambiri omwe ali ndi matenda ashuga, gawo lomwe limachokera ku 57 mpaka 65%.

Kuchokera pa Januware 1, 2006, ku Ukraine, chiwerengero cha odwala omwe adalembetsa matenda ashuga kwa nthawi yoyamba amaposa kuchuluka kwa miliyoni ndikufika pa anthu, omwe ndi 2137.2 pa anthu zana (pafupifupi 2% ya anthu onse).

Kukula kwa matenda ashuga pakati pa ana osakwana zaka 14 ndi 0,66 pa ana 1000, pakati pa achinyamata - 15.1 a otsutsana. Pali kuwonjezeka kwa odwala omwe ali ndi matenda ashuga omwe amafunikira chithandizo cha insulin: kuyambira 1998 mpaka 2005. Kuchulukana kwapachaka kwa odwala otere kumafika pa 8%.

Kuchuluka kwa chiwopsezo cha anthu odwala matenda ashuga ku Ukraine kufika 3,9% mchaka cha 2005. Matenda a shuga amawonjezereka pakati pa anthu okhala m'magawo otukuka, makamaka, kuchuluka kwa izi kumadalira kuchuluka kwa njira zopewera kudziwitsidwa koyambirira kwa odwala omwe ali ndi matenda a shuga a 2.

Kuwonjezeka kwakukulu kwa kuchuluka kwa odwala ku Ukraine odwala matenda ashuga kuchoka pa 115.6 pa anthu zana limodzi mu 1993 mpaka 214.6 mu 2005. Tiyenera kudziwa kuti kuchuluka kwa odwala kumawonjezeka makamaka chifukwa cha matenda ashuga a 2.

Komanso mitengo ya ziwopsezo imakwera kwambiri komwe malo ogwiritsira ntchito chitetezo amayikidwa bwino. Chifukwa chake, mdera la Kharkov, chisonyezo chodziwikirachi chikufika 351.7, mumzinda wa Kiev - 288.7. Nthawi yomweyo, kupezeka koyambirira kwa matenda ashuga m'magawo a Chernihiv (chizindikiro 154.3) ndi Volyn (137.0) sikugwira ntchito mokwanira.

M'madera osiyanasiyana ku Ukraine, odwala 2-2.5 omwe ali ndi vuto losautsa la shuga kwa wodwala aliyense wovomerezeka. Kutengera ndi izi, titha kuganiza kuti ku Ukraine kuli odwala pafupifupi 2 miliyoni omwe ali ndi matenda ashuga.

Kukula kwenikweni kwa matenda ashuga kumapitilira zomwe zalembedwa, zotsatira zomwezo pokhudzana ndi kuchuluka kwa zovuta zam'mimba. Izi zimachitika ku Ukraine komanso m'maiko onse otukuka padziko lapansi.

Pamenepa, bungwe la American Diabetes Association lakonza njira zatsopano zodziwitsira za matenda ashuga, omwe angakupatseni mwayi wofufuzira matenda atangoyamba kumene ndipo potero mutha kupewa kukula kwa zovuta za matenda ashuga.

Tiyenera kudziwa kuti pazaka khumi zapitazi, kusintha kwina kwachitika mu nthawi ya matenda ashuga, chiyembekezo cha moyo wa odwala, komanso zomwe zimayambitsa kufa. Kutalika kwa moyo wa odwala kwachulukira, koma kudwala matenda ashuga ndi chimodzi mwazomwe zimapangitsa kuti anthu azigwira ntchito m'maiko osatukuka.

Nthawi yayitali yomwe odwala amakhala ndi matenda ashuga ndi 6-12% yochepera kuposa m'magulu ena a anthu. Kulakwitsa kwa odwala matenda ashuga kumachitika ka 25 pafupipafupi kuposa anthu ambiri, ndipo kuwonongeka kowonekera kumawonedwa mwaoposa 10% ya odwala matenda ashuga.

Mpaka pano, pali umboni wosonyeza kuti kupitiliza kulipira shuga kwa nthawi yayitali komanso kwakanthawi pazaka zambiri kumatha kuchepetsa kwambiri (mwa 40-60%) ndikuyimitsa kukula kwa zovuta zambiri za matenda ashuga.

DM ndi matenda otengera zovuta za mitundu yonse ya kagayidwe kachakudya ndi kukula kwa pang'onopang'ono kwa microangiopathy yapadziko lonse. Nthawi zomwe zimachitika kuti masinthidwe osinthika am'magazi asungunuke, ataganiziridwa zaka 5 mpaka 10 kuchokera pa chiyambi cha matenda ashuga, sizikukula, ngakhale atapita patsogolo kwambiri muyezo wa mankhwala a carbohydrate kagayidwe mu mitundu yonse ya 1 ya shuga ndi matenda a shuga a 2. .

Diabetesic retinopathy (DR) ndi imodzi mwazovuta zovuta zamatenda a shuga. Komabe, DR singaganiziridwe ngati vuto, koma chifukwa chachilengedwe chakukula kwa kusintha kwa ma pathological mu microvascular network ya retina mwa odwala matenda ashuga.

Kutchulidwa koyamba kwa DR kumapezeka mu Chipangano Chakale ndi Talmud. Amakhala ndi mafotokozedwe a maso ndi matenda awo. Chifukwa chake, Isake anali ndi matenda ashuga a m'mimba, Jacob anali ndi vuto lalikulu, ndipo Eliya anali ndi glaucoma.

Pafupipafupi chitukuko cha kuchuluka kwa DR ndi: kutalika kwa shuga mpaka zaka 10 - 3-5%, zaka 10-15 - 20-30%, zaka 20-30 - 60%, kutalika kwa zaka zopitilira 35-40, kufalikira kwa prinifosicosis kumachepa pang'onopang'ono chifukwa ndi kufa kwamphamvu chifukwa cha nthawi yayitali ya matenda ashuga, ndipo ngati DR sikunayambike, mwayi woti umapezeka ndiwotsika.

/ Zipangizo za Endocrine / Mazovian / Epidemiology

KULIMBITSA NDI EPIDEMIOLOGY YA DIABETES MellITUS

Matanthauzidwe apamwamba kwambiri a shuga ndi "mkhalidwe wa hyperglycemia wokhazikika womwe ungakhalepo chifukwa chodziwitsidwa kwazinthu zambiri zakunja ndi majini omwe nthawi zambiri amathandizana wina ndi mnzake" (Ripoti la WHO Expert Committee on Diabetes, 1981).

Dzinali "shuga" (kuchokera ku Greek "diabaio" - ndimadutsa) monga momwe mawu adayambira mu nthawi yakale (Areteus of Cappadocia, 138-81 BC), tanthauzo la "shuga" (kuchokera ku Latin "mellitus" - uchi , lokoma) anawonjezera m'zaka za zana la 17 (Thomas Willis, 1674).

Pakukula kwa chiphunzitso cha matenda ashuga, nthawi zitatu zazikuluzikulu zimatha kusiyanitsidwa: 1) asanafufuze insulin, 2) kuchokera pakupezeka kwa insulin mu 1921 mpaka ma 1950, 3) nthawi yamakono, yodziwika ndi chidziwitso chambiri chokhudza matenda a shuga, kuphatikizapo kukwaniritsa maselo biology, genetics, immunology, tekinoloje yatsopano ya kukonzekera kwa insulini komanso njira zothandizira, zotsatira za maphunziro a miliri.

Munthawi imeneyi, mapangidwe a molekyulu ya insulin adapangidwa, kapangidwe kake adachitika, njira zakukonzekera kwake kuchokera kuubwino wa genetic zinapangidwa, deta yatsopano inapezeka pa gawo la majini ndi ma autoimmune njira mu pathogenesis ya matenda ashuga, ndipo matenda a heterogeneity adatsimikizika.

Izi zawonjezera kwambiri kumvetsetsa kwa matenda ashuga, omwe amadziwika ngati matenda osatha a endocrine-metabolic, ophatikizidwa mwachilengedwe. Ofufuza ambiri amawonjezera liwu loti "cholowa" mu tanthauzo ili, ena amawonjezera tanthauzo la "mtima", potero amafuna kudziwa kuchuluka kwa zotupa zam'magazi kwa odwala matenda ashuga.

Komabe, palibe amene angavomerezane ndi izi, popeza cholowa chovuta chifukwa cha matendawa sichimawululidwa nthawi zonse kwa odwala matenda ashuga, komanso, zotupa zam'mimba sizipezeka nthawi zonse.

Matendawa amatchulidwa kuti ndi endocrine, izi zimatsimikiziridwa osati pafupipafupi kuwonongeka kwa zida zam'mimba za kapamba, komanso kutengapo gawo kwa zotengera zina za endocrine mu pathogeneis ya matenda osokoneza bongo a shuga ndi zotupa zamafupa.

Vuto la metabolic (makamaka glucose metabolism) limawonetsedwa kwambiri ndi matenda a shuga, chifukwa chake tanthauzo lake ngati "metabolic" matenda ndilachilengedwe.

Njira yodwalayo, ngakhale idaperekedwa mobwerezabwereza komanso kuyambiranso matenda a shuga, ndipamanso matenda. Udindo wobadwira m'matenda a shuga umatsimikiziridwa ndi kafukufuku wazachipatala wazaka zambiri (chizindikiro choyamba cha matenda am'banja chinayamba zaka za zana la 17).

Kukula kwa matenda ashuga kumatsimikiziridwa ndi zinthu zingapo za etiological ndi pathogenetic. M'magulu amakono, potengera miliri yamaphunziro, zamankhwala, maphunziro a labotale komanso pazomwe zaposachedwa kwambiri kuchokera ku genetics ndi immunology, heterogeneity ya shuga imayimiriridwa kwathunthu.

Matenda a matenda a shuga mellitus pakadali pano ali m'gulu la malo apakati pakuphunzira kusinthika kwachilengedwe, pathogeneis, gulu komanso kakonzedwe ka njira zopewera sayansi.

Ngakhale zambiri zakhala zikuchitika m'zaka 65 kuyambira pomwe apeza komanso kugwiritsa ntchito mankhwala a insulin kuti amvetsetse za etiology, pathogeneis, komanso kusintha kwachipatala kwa matenda ashuga, njira yofikira kumaphunziro ake pazaka 20 zapitazi yakulitsa kwambiri ndikuwonjezera kuphunzira kwa matenda ashuga.

Kuyesedwa kwa magulu amtundu wa anthu kumatilola kuti tiganizire za matenda a shuga osati modzipatula (poyeserera poyeserera kapena mu chipinda cha chipatala), koma mu vivo ndikuwunika kwa zomwe zimachitika zingapo zakunja ndi zakunja.

Maphunziro onse am'mapapo, kuphatikizapo matenda ashuga, amatha kugawidwa m'maphunziro a: 1) omwe amathandizira kutsimikiza kwa matenda ashuga kapena mawonekedwe ake.

2) mafotokozedwe ofotokozera - kafukufuku wa kuchuluka, kusinthasintha ndi kusinthika kwachilengedwe kwa matenda ashuga, 3) kusanthula kwamatsenga - maphunziro amgwirizano wa zina zomwe zimayambitsa ngozi komanso mikhalidwe yawo malinga ndi etiology.

), mapulogalamu osiyanasiyana othandizira, njira yodziyang'anira yokha odwala omwe ali ndi matenda ashuga.

Pakufufuza koyambirira kofotokozera komwe kumachitika mu 1950s, kusiyana sikunawonekere pakuwonjezereka, komanso kuwonetsa kwa matenda ashuga m'modzi ndi mayiko.

Adanenanso kuti kuchuluka kwa matenda ashuga kumalumikizidwa ndi kusiyanasiyana kwa chilengedwe, mawonekedwe a kuchuluka kwa anthu (ma genetic, demographic), kuchuluka kwa ziwopsezo za matenda a shuga m'mankhwala ambiri (onenepa kwambiri, matenda oopsa, kuchuluka kwa matenda amtima, matenda oopsa, zina zambiri).

Pamodzi ndi njira yodziwika ndi kuchuluka kwa anthu, matenda am'magazi amagwiritsa ntchito mawerengero osiyanasiyana komanso masamu, zamankhwala, zakuthupi komanso zantchito, labotale ndi njira zina kukhazikitsa malamulo a chitukuko cha matenda ashuga.

Maphunziro a Epidemiological amatha kupitiliza komanso kusankha. Pakufufuza kosalekeza, anthu onse okhala mdera linalake lazachuma ndi malo amawunika; m'maphunziro osankha, gawo lokhalo lomwe limayimira kuchuluka kwa chizindikiro cha chiwerengero chonse chimayesedwa.

Kukula kwachitsanzo kumatsimikiziridwa ndi njira yapadera. Njira yosankhayi imalola kuti pakhale zotsatira zodalirika zomwe zitha kuperekedwa kwa anthu onse. Maphunziro ambiri amatsenga amagwiritsa ntchito njira yosankhira, yomwe ndiyachuma kwambiri kuposa njira yophunzirira yopitilira.

Maphunziro a Epidemiological amagawidwanso munthawi imodzi komanso oyembekezera. Amodzi munthawi yomweyo amakulolani kuti mudziwe momwe matenda awonongera panthawiyo, ndi omwe akuyembekezerawa - kuti awone kusinthika kwake.

Zowopsa, njira zingapo zodzitetezera, etc. Njira ya matenda osokoneza bongo imagwiritsidwanso ntchito, zomwe zimathandiza kudziwa kuchuluka kwa milandu yatsopano komanso zovuta za matenda ashuga. Kuphatikiza apo, njira za miliri zimagwiritsidwanso ntchito pophunzira zovuta za matenda ashuga (makamaka, mtima), kufa ndi zomwe zimayambitsa kufa kwa odwala.

Pa tebulo. 1 imapereka chidule cha kufalikira kwa IDDM, kutengera kuphunzira kolemba. Kuchuluka kwa mtundu uwu wa matenda ashuga mwa anthu 1000 aliwonse ku England sikupita 3.4.

Gome 1. Kufalikira kwa IDDM pagulu la anthu, zaka (malinga ndi Zimmet, 1982)

Mu anthu aku Japan, gawo la ma antibodies kuma cell a islet pancreas silipezeka kawirikawiri, mawonekedwe osiyana pang'ono a histocompatibility antigen (HLA). Ngakhale ma haplotypes HLA B8, DW3, DRW3 ndi ma helotypes HLA B15, DW4, DRW4 ndizodziwika bwino kwa azungu ndi U.S. omwe amakhala ku United States, Japan haplotype BW54, ndipo pafupipafupi ma loc a B40 ndi otsika kwambiri kuposa anthu aku Europe. Zikuwoneka kuti, kusiyana kumeneku kumatsimikiziridwa ndi zina, makamaka zochitika zachilengedwe.

Kuunikira kwa ma genetic kutengera kutsimikiza kwa ma antigen a HLA omwe ali pachiwopsezo cha IDDM, kochitikira ku UK, adawonetsa kuti pafupifupi 60%

omwe adawunikawa ali ndi ma antijeni a HLA DR3 ndi DR4, omwe nthawi zambiri amalemba IDDM, ndipo ndi 6% okha omwe ali ndi ma antigen. Kuwona anthu 6% awa a matenda ashuga sikunawonetse kuchuluka pagululi.

Komabe, kupezeka kwa IDDM kwatulutsa kusintha kwakanthawi, komwe kumalumikizidwa ndi kukopa kwa ma virus. Chifukwa chake, malinga ndi kulembetsa kwa Britain Diabetes Association, kuchuluka kwa anthu odwala matenda ashuga kumawonjezera miyezi itatu pambuyo pa mliri wa mumps.

Pali malipoti a ubale wamtundu wa pathogenetic pakati pa kubadwa kwa rubella ndi matenda ashuga. Pafupipafupi matenda a shuga mellitus mwa odwala obadwa nako rubella amachokera ku 0,13 mpaka 40%. Izi ndichifukwa choti kachilombo ka rubella kakapangidwira ndipo kamachulukana mu kapamba.

Pali umboni wa zomwe chiwopsezo cha virus cha Coxsackie B4 chikukula mu IDDM. Komabe, ma virus okhudzana ndiubwana ali ponseponse kuposa IDDM, ndipo ubale wapakati pawo umafunanso kutsimikizika. M'malo mwake, zimapangitsa ana kukhala ndi vuto lotengera kubadwa kwa makolo.

Zaka zaposachedwa, mphamvu ya zophatikizira poizoni pa IDDM (N-nitrosamines yomwe ili mu nyama yam'chitini ndi fodya, rodenticides, makamaka katemera, wogwiritsidwa ntchito ku USA monga chosungira chakudya), komanso mphamvu ya zakudya, yakhazikitsidwa.

Ponena za zinthu zopatsa thanzi pakukula kwa matenda a shuga, ndikofunikira kudziwa udindo wa mkaka. Ana omwe amadyetsedwa mkaka wa m'mawere omwe ali ndi zinthu zoteteza pakuwonongeka kwa cell ya beta sangakhale ndi vuto la shuga kuposa omwe adalandira mkaka wa ng'ombe.

Chifukwa chake, kafukufuku wokhudzana ndi matenda a IDDM awonetsa kuti zinthu zachilengedwe zimathandiza kwambiri pakukula kwake. M'mayiko angapo (Norway, Sweden, Finland) pali chizolowezi chowonjezera kuchuluka kwa IDDM.

Kafukufuku wochitidwa ndi Department of Diabetes Epidemiology IEEiHG AMS USSR ndi mabungwe ena mdziko lathu sananene izi. Matenda a shuga ndi matenda ochulukitsa, omwe amayamba kuchuluka, chifukwa chake kuchuluka kwa IDDM ndi kwakukulu kuposa

Vuto ndi miliri ya matenda ashuga ku Russia komanso padziko lapansi

Ngati mchaka cha 1980 panali odwala 153 miliyoni omwe ali ndi matenda ashuga padziko lapansi, kumapeto kwa chaka cha 2015 chiwerengero chawo chidawonjezeka nthawi 2.7 ndikufika pa 415 miliyoni.

Titha kunena bwinobwino kuti matenda ashuga ndi mliri wazaka za 21, zomwe zimatsimikiziridwa ndi ziwerengero zokhumudwitsa kwathunthu. Kafukufuku wa WHO akusonyeza kuti masekondi 7 aliwonse pamafunika odwala awiri pomwe wodwala m'modzi amwalira chifukwa cha zovuta za matendawa. Asayansi amati pofika chaka cha 2030, matenda ashuga ndi omwe azitsogolera.

M'mayiko otukuka lero, pafupifupi 12% ya anthu akuvutika, ndipo chiwerengerochi chidzawonjezeka chaka chilichonse. Mwachitsanzo, ku United States zaka 20 zapitazi, kuchuluka kwa odwala kwawonjezeka. Ndipo mtengo wa chithandizo, phindu laumoyo, kugonekedwa kuchipatala kwa odwala matenda ashuga kuposa $ 250 biliyoni.

Mliri wa matenda ashuga sunatheretu ku Russia. Mwa mayiko onse adziko lapansi, zimatenga malo 5 pa chiwerengero cha anthu omwe ali ndi matendawa. China chokha, chomwe chikuyambirira, India, USA ndi Brazil, ndi omwe anali patsogolo pawo.

The mliri wa matenda osokoneza bongo umakhala wonyadira malo pakati pa oncological ndi mtima matenda. Anthu ambiri amafa chaka chilichonse, ndipo anthu ambiri amaphunzira za matendawa. Kulemedwa ndi kunenepa kwambiri ndi ziwopsezo ziwiri zomwe zimayambitsa matendawa.

Zakudya zoyipa. Mwachitsanzo, kudya kwambiri zakudya zotsekemera kapena zamafuta kumatha kusokoneza kapamba. Mapeto ake, izi zidzabweretsa kukula kwa matenda ovutikawa monga matenda a shuga.

Zowopsa ndi Kuzindikira

Tsoka ilo, aliyense akhoza kukhala pachiwopsezo. Mwa awa, pafupifupi 90% ya anthu ali ndi matenda a shuga a 2, nthawi zina osadziwa za izi. Mosiyana ndi mtundu 1, momwe odwala amadalira insulin, matenda amtundu 2 - osadalira insulini, pafupifupi asymptomatic.

Koma, ngakhale akumva bwino, munthu asayiwale za kuopsa kwa matenda ashuga. Chifukwa chake, wodwala matenda ashuga ayenera kufunsa dokotala ndikuyesa magazi kuti adziwe kuchuluka kwa shuga.

Muyenera kudziwa kuti shuga yayikulu imayambitsa kuwonongeka kwa makoma a m'maso, miyendo, impso, ubongo ndi mtima. Masiku ano, khungu, kulephera kwa impso ndi zina zomwe zimatchedwa zopanda vuto zimayamba kuchitika chifukwa cha matenda ashuga. Madokotala amalimbikitsa kuyezetsa magazi kamodzi kamodzi pachaka kuti adziwe kuchuluka kwa shuga.

Izi ndizowona makamaka kwa anthu okulirapo wazaka zopitilira 45 ndi onenepa kwambiri.

Kuteteza Matenda

Nthawi zambiri, odwala matenda ashuga sazindikira kapena kunyalanyaza zizindikiro zoyambirira. Koma ngati zina mwazizindikiro zingapo zotsatirazi zikuwonedwa, ndikofunikira kuwomba alarm. Kufunika kopita kwa dokotala ndikuwunikira kuchuluka kwa shuga m'magazi.

Chizolowezi chimatengedwa ngati chizindikiro kuyambira 3.3 mpaka 5.5 mmol / L. Kupitilira muyeso uwu kumawonetsa kuti wodwala ali ndi matenda a shuga.

Izi ndi zizindikiro zofala kwambiri za matendawa.

Wodwala matenda ashuga nthawi zambiri amamva ludzu losatha ndipo amadandaula kukoka pafupipafupi.
Ngakhale odwala matenda ashuga amakhala ndi chidwi chofuna kudya, kuchepa thupi kumachitika.
Kutopa, kutopa mosalekeza, chizungulire, kulemera m'miyendo ndi malaise ambiri ndizizindikiro za matenda ashuga.
Zochita zogonana ndi potency zimachepetsedwa.
Kuchiritsidwa kwamankhwala kumakhala pang'onopang'ono.
Nthawi zambiri kutentha kwa odwala matenda ashuga kumakhala kosakwana - 36.6-36.7 ° C.
Wodwalayo amatha kudandaula kuti ali ndi dzanzi komanso amanunkha m'miyendo, ndipo nthawi zina amakokana m'matumbo a ng'ombe.
Njira ya matenda opatsirana, ngakhale ndi chithandizo cha nthawi yake, ndikutalika.
Odwala matenda a shuga amadandaula za kuwonongeka kwa mawonekedwe.

Nthabwala zoyipa ndi matendawa, chifukwa chake, mutazindikira momwemo mwa inu nokha, muyenera kulankhulana ndi dokotala nthawi yomweyo.

Nthawi zina, pakumva za matendawa, odwala matenda ashuga ambiri amakwiya ndikuyambitsa matendawa. Pakumvetsetsa kwawo, matenda ashuga ndi matenda osachiritsika, ndiye angatani kuti athane ndi izi? Koma musataye mtima, chifukwa awa si sentensi.

Pozindikira matendawa panthawi yake, chithandizo choyenera, zakudya, odwala matenda ashuga amakhalanso ngati anthu wamba.Amakhulupirira kuti anthu odwala matenda ashuga amakhala kwambiri kuposa anthu athanzi.

Izi zitha kufotokozedwa ndikuti ali ndi udindo komanso amawonetsetsa kuti ali ndi thanzi labwino, mwachitsanzo, kuwunika shuga, magazi, kuwona magazi ndi zina zambiri zofunika.

Ngakhale kuti aliyense akhoza kudwala matenda a shuga, mutha kuchepetsa mwayi wake wopezeka mosavuta mwa kutsatira zotsatirazi:

Kusungabe thupi labwinobwino. Kuti muchite izi, mutha kuwerengera mndandanda wamasamba a thupi monga kuchuluka kwa kulemera (kg) kufika msinkhu (m). Ngati chizindikiro ichi chatha kupitirira 30, ndiye kuti pali vuto la kunenepa kwambiri lomwe likufunika kuthana ndi mavuto. Kuti muchite izi, muyenera kuchita masewera olimbitsa thupi osati kudya kwambiri. Maswiti, mafuta a nyama sayenera kupatula pachakudyacho, ndipo mosiyanasiyana amadya zipatso ndi ndiwo zamasamba zambiri.
Kutsatira moyo wokangalika. Ngati mulibe nthawi yochita masewera olimbitsa thupi ndikuchita masewera olimbitsa thupi ndi matenda ashuga, ndikokwanira kuti muziyenda osachepera mphindi 30 patsiku.
Osadzilimbitsa nokha ndipo musayendetse nokha matendawa, ngati kuli koyenera, funsani kwa dokotala panthawi yake ndikutsatira malingaliro ake onse
Siyani kusuta fodya basi,
Ngakhale patakhala kuti palibe chizindikiro chilichonse, kuyezetsa magazi kamodzi pachaka sikudzapweteka konse, makamaka ngati munthu ali ndi zaka zopitilira 40.
Chitani kuyesedwa kwa cholesterol kamodzi pachaka, ngati zotsatira zake ndizoposa 5 mmol / l, funsani dokotala wanu.
Penyani kuthamanga kwa magazi anu.

Zizindikiro zoyambirira za matenda a shuga zikawoneka, muyenera kulumikizana ndi akatswiri a zamankhwala kapena a endocrinologist.

Ngati muli ndi matenda ashuga, musachepetse manja anu. Njira zamakono zamankhwala zimakupatsani mwayi wokhala limodzi ndi anthu athanzi.

Ndikofunikira kwambiri pa matenda a shuga kuti azitsatira zakudya zapadera ndikuwonetsetsa kuti kunenepa kwambiri sikuwoneka. Komanso musaiwale za mayeso azachipatala omwe amafunikira kupitilizidwa. Zachidziwikire, nthawi zonse muzikumbukira kuti matenda aliwonse ndi bwino kupewa kuposa kuchiza pambuyo pake.

Mu kanema munkhaniyi, zoyambira Kuzindikira matendawa ndi zizindikiro zazikulu zimaperekedwa.

Insulin - Mbiri ndi Kugwiritsa Ntchito

Mu 1922, insulin idapezeka ndikuyamba kudziwitsa anthu, kuyesera sikunakhale kopambana: insulin idayeretsedwa bwino ndipo idayambitsa kuyanjana. Pambuyo pa izi, maphunziro adayimitsidwa kwakanthawi. Zinapangidwa kuchokera ku kapamba a agalu ndi nkhumba.

Kapangidwe ka genetic aphunzira kutulutsa "insulin" yaanthu. Pamene insulin imaperekedwa kwa wodwala, zotsatira zoyipa zimatha - hypoglycemia, momwe kuchuluka kwa glucose m'magazi kumatsika ndikukhala otsika kuposa kwazonse.

Insulin yosadziwika bwino, chifukwa chake, izi sizigwirizana kalekale. Insulin yamakono kwenikweni sikuyambitsa ziwengo ndipo ndiotetezeka kwathunthu.

M'mayambiriro oyamba a matenda ashuga a 2, thupi la munthu limatha kutulutsa insulin, motero sipafunikanso jakisoni wapadera. Pankhaniyi, ndikokwanira kumwa mankhwala omwe amalimbikitsa kupanga insulin.

Tsoka ilo, gawo la matendawa liyenera kusinthidwa kuti jakisoni ndi insulin. Nthawi zambiri, anthu amadwala matenda amtundu wa 2 ndipo samadziwa za izi, ndipo atazindikira kuti amakakamizidwa amapeza jekeseni wa insulin nthawi yomweyo.

Kupezeka kwa matenda a shuga 1 amtundu wa ana ndichinthu chofala kwambiri, chifukwa chake amatchedwa matenda aunyamata. Matenda amtunduwu amapezeka mu 15% ya odwala matenda ashuga. Wodwala wa mtundu woyamba akapanda kulowetsedwa ndi insulin, amwalira.

Masiku ano, mankhwala ndi jakisoni wa insulin ndi njira yodalirika komanso yotetezeka yochizira matenda ashuga.

Kusungabe moyo wokangalika ndi wathanzi, kutsatira kadyedwe koyenera, komanso kudziyang'anira nokha ndiye chinsinsi cha nkhondo yolimbana bwino ndi matendawa.

Wotsutsa nkhani yasayansi pankhani zamankhwala ndi zaumoyo, wolemba pepala lasayansi ndi A. A. Tanirbergenova, K. A. Tulebaev, Zh. A. Akanov

Pakadali pano matenda a shuga ndi vuto lalikulu padziko lonse lapansi. Matenda a shuga amadziwika ndi World Health Organisation ngati amodzi mwa matenda ofunika kwambiri padziko lonse lapansi kwa anthu. DM ikufalikira mwachangu, ikukhudza anthu ochulukirachulukira. Pofika chaka cha 2025, kuchuluka kwa matendawa kumaiko otukuka kwambiri kudzakhala 7.6%, ndipo m'maiko akutukuka 4.9%.

ҚANT DIABETININ ZHҺANDYҚ TARALUY

Diabetesазіргі таңда үні жүзі бойнша қant shuga mellitus әанесі алғашқы орында тұр. Дүниежүзілін densaulasa saқtau ұyymy dant shuga auruyn қoғamdyқ mankhwala үшін әлемдік маңызы bar bіrden-bіr aura dep myyndaldy. Kant diabetesimen auyratyn adamdar sany jyldam өsude. 2025 zhylқa қaray қant diabetesinің economicқ ladiesғan vakurude - 7.6%, azimayi azimayi akulu-4.9% akukwera.

Ndime ya ntchito yasayansi pamutu wakuti "Kufalikira kwa matenda ashuga amakono"

1P.A. Makhanbetzhanova, 2 A.N. Nurbatsyt

1K, Kazakhstan, Azerbaijan University of Medicine "KSZHM" 2S.Zh. Asfendiyarov atyndagi K, az ¥ MU, Almaty tsalasy

EMHANA JAFDAYINDA K0RSET1LET1N MEDICAL K0MEK SAPASYN SHASHYRANDS OF SCLEROSIS BAR EMDELUSH1LERDSHF BALALAUI

TYYin: Bul Mak, Alada, Almaty Kalasinda Shashyranda Sclerosis Bar ScienceStardin, Emhana Jagdyynda Kersetilgen Meditsalyk, Kemek Sapasyn Bagalauy Boynsha medali, -eleumetzh Zertteu Natzheleri Berilgen. TYYindi sesder: glanders, ndizanalyk, kemek, shashyranda sclerosis.

1R.A. Mahanbetzhanova, 2A.N. Nurbakyt

Yunivesite yachipatala ya Kazakhstan "KSPH" 2Asfendiyarov Kazakh National Medical University, Almaty

KUTHANDIZA KWA KUSINTHA KWA KUSINTHA KWAULERE KWA AMAKHALA NDI ASITSI MU

Kuyambiranso: Nkhaniyi ikuwonetsa zotsatira za kafukufuku wamankhwala komanso wokhudzana ndi chikhalidwe cha odwala omwe amapezeka ndi matenda a polyclinic. Mawu osakira: Makhalidwe, chisamaliro cha polyclinic, sclerosis yambiri.

A.A. Tanirbergenova, K.A. Tulebaev, J.A. Akanov

Kazakh National Medical University yotchedwa S.D. Asfendiyarova

KUSINTHA KWA ZIWANDA MU DZIKO LAPANSI

Kugwirizana. Matenda osagwiritsidwa ntchito posachedwa (NCD), omwe amadziwikanso kuti matenda osachiritsika, samatengeka kuchokera kwa munthu wina kupita kwa munthu. Amakhala nthawi yayitali ndipo amapita patsogolo pang'onopang'ono. Mitundu inayi yayikulu yamatenda osaneneka ndi matenda amtima, khansa, matenda opuma komanso matenda ashuga. Matenda amtima amachititsa kuti anthu ambiri amafa kuchokera ku NCD - anthu 17,5 miliyoni amafa chaka chilichonse. Amatsatiridwa ndi khansa (8.2 miliyoni), matenda a kupuma (mamiliyoni 4) ndi matenda a shuga (1.5 miliyoni).

Matenda a shuga ndi matenda a metabolic a etiology osiyanasiyana, omwe amadziwika ndi matenda a hyperglycemia omwe amayamba chifukwa cha kubisala kapena kanthu ka insulin, kapena zinthu zonse ziwiri, 2, 3, 4,5.

Kuchuluka kwa matenda ashuga padziko lonse lapansi pakati pa anthu azaka zopitilira 18 kwachulukira kuchoka pa 4.7% mu 1980 kufika pa 8.5% mchaka cha 2014. Malinga ndi zidziwitso za boma kuchokera ku World Health Organisation (WHO), chiwerengero cha anthu odwala matenda ashuga chakwera kuchoka pa 108 miliyoni mu 1980 kufika pa 422 miliyoni mchaka cha 2014, ndipo pofika chaka cha 2035

Malinga ndi deta yomwe yaperekedwa ndi International Diabetes Federation (IDF), kuchuluka kwa odwala matenda ashuga kudzachuluka mpaka kufika pa anthu 592 miliyoni, omwe ndi gawo limodzi mwa khumi padziko lonse lapansi 6.7.

Kukula kwenikweni kwa matenda ashuga amtundu wa 2 ndi kukwera kuchulukirapo kawiri kuposa kumene kunalembedwa ndi

kusintha. Mu theka la milandu, matenda a shuga a 2 amapezeka zaka zisanu ndi ziwiri kuyambira nthawi yoyamba matendawa, chifukwa chake, 20-30% ya odwala panthawi ya matenda a shuga amapezeka kuti ali ndi zovuta zake. Zonsezi zimatsimikizira kufunika kwake kwachipatala komanso chikhalidwe osati pakati pa mitundu ina ya matenda ashuga, komanso pakati pa matenda onse osachiritsika 8, 9, 10. . Chifukwa chake, matenda a shuga amafalikira mofulumira, akukhudza anthu ochulukirachulukira. Pofika chaka cha 2025, kuchuluka kwa matendawa kumaiko otukuka kwambiri kudzakhala 7.6%, ndipo m'maiko akutukuka 4.9%. Kuchulukana kwa matenda ashuga ngati kuchuluka kwa anthu m'maiko osiyanasiyana kumawonetsedwa pagome 1.

Bulletin of KazNMU No. 2-2017

Gome 1 - Kugawidwa kwa matenda ashuga m'maiko osiyanasiyana

Maiko aku Western Europe 4-5%

Mayiko aku Latin America 14-15%

Makamaka kutchulidwa kukuwonjezereka kwa chiwopsezo cha matenda ashuga pakati pa achinyamata m'maiko osatukuka. Zowonadi, kuchuluka kwa odwala omwe ali ndi matenda a shuga a 2 akukhala ku Asia-Pacific, odwala pafupifupi 50 miliyoni amakhala ku India ndi China, poyerekeza ndi 18 miliyoni ku United States.

Chiwerengero chachikulu cha odwala chikuyembekezeredwa ku USA, China, India, koma kufalikira kwambiri kwamatenda kulembedwa ku Mediterranean. Malinga ndikuwonetseratu kwa WHO, pofika chaka cha 2030, Israeli ikhala ndi odwala miliyoni miliyoni omwe ali ndi matenda ashuga. Kwa United States, zonenedweratu zikuwoneka zowopsa kwambiri: ngati m'mbuyomu, madokotala adaneneratu kuti pofika chaka cha 2050 anthu odwala matenda ashuga adzakhala 29 miliyoni, tsopano odwala 30 miliyoni akuyembekezeredwa ndi 2030. Amadziwika kuti anthu omwe ali ndi matenda ashuga a 2 amapezeka m'maiko onse apadziko lonse lapansi .. Ngakhale kuti m'malo osiyanasiyana chiwopsezo chotenga matendawa sichofanana, mitundu ingapo ili pachiwopsezo chachikulu. Kusintha kwa moyo wogwirizana ndi kukula kwachuma m'maiko osatukuka kwawonjezera kuchuluka kwa matenda ashuga amtundu wa 2. Pamenepa, kuwonjezeka kwa moyo wamayiko akutukuka kumayendera limodzi ndi kuchuluka kwa anthu odwala matenda ashuga a 2. Zinkakhala kuti mtundu wa 2 umakhudza anthu akuluakulu okha, koma masiku ano mtundu uwu wa shuga ukukhudza achinyamata, ngakhale ana. Chifukwa chake, ku Japan, kuchuluka kwa matenda ashuga amtundu wa 2 kwa ana pazaka 20 zapitazi kwachulukanso. M'mayiko aku Asia, matenda ashuga a 2 mwa ana amakula pafupipafupi kanayi kuposa mtundu 1. Ku Russian Federation, matenda a shuga a 2 amalembedwa mu 3% ya anthu, ndipo zowona zikuwonekeratu chifukwa chakuti kuchuluka kwakukulu kwa odwala omwe ali ndi matenda ashuga sikupezeka kuyambira matendawa atadwala. Ku Russia mchaka cha 2000, anthu 2 miliyoni. 100 miliyoni odwala matenda a shuga adalembetsa, mwa iwo

1 miliyoni 800,000 - odwala omwe ali ndi matenda a shuga a 2. Zowonadi zake, chiwerengerochi chikuyerekeza odwala 8 miliyoni (5%), ndipo pofika 2025 chiwerengerochi chitha kufikira 12 miliyoni.

Kuchuluka kwa anthu odwala matenda ashuga ku Republic of Kazakhstan mu 2002 kunali anthu 93.7 pa anthu zana limodzi, mu 2015 adakwera ndi 54.3%, ndipo adafika pa 172.7 pa anthu zana limodzi onse 17, 18.

Mu 2015, kuchuluka kwa anthu odwala matenda ashuga kunali motere: kuchuluka kwambiri kunalembedwa m'dera la North Kazakhstan (260,5), Kostanay (244.3), East Kazakhstan (220.3), Akmola (200.7), Pavlodar (191, 4), Karaganda (189.3), komanso ku Astana, Almaty, Zhambyl ndi

Ma alaty amatero akuti chiwonetserochi chikufanana ndi boma la Republican. Chizindikiro chotsika kwambiri chili ku Mangistau (143.6), Aktobe (140.8), Atyrau (140.6), Kzylorda (136.6), South Kazakhstan (132.9), West Kazakhstan (132.2) . Mwa makumi mamiliyoni a anthu, matenda ashuga samadziwikabe, kuchulukanso, chiyembekezo chobadwa nacho cha matendawa chimatheka, chifukwa ali ndi abale ake apamtima omwe akudwala matendawa.

Chifukwa chake, kufulumira kwavuto kumatsimikiziridwa ndi kufunikira kwakazachipatala ndi chikhalidwe cha anthu odwala matenda ashuga, omwe amadziwika ndi

kuchuluka kwa kuwonongeka kwa antchito ndi kuwonongeka kwachuma chifukwa chakuchepa, kulumala ndi kufa kwa anthu, ndalama zomwe boma limagwiritsa ntchito pochiza matenda ndi zovuta zake, zomwe zikufuna kuwongoleredwa ndi kuyenera kwa dongosolo la chisamaliro chapadera, choyenera.

1 LimSS, VosT, FlaxmanAD, DanaeiG, ShibuyaK, Adair-RohaniHetal. Kuyerekeza kowopsa kwa kulemera kwa matenda ndi kuvulala komwe kumachitika chifukwa cha zovuta 67 ndi masango opezeka pachiwopsezo m'magawo 21, 1990-2010: kusanthula kwadongosolo kwa Global Burden of Disease Study 2010 // Lancet. - 2012. - Na. 380 (9859). - R. 2224-2260.

2 Balabolkin M.I. Matenda a shuga mellitus // Mankhwala. - 2005. - Na. 2. - R. 114-118.

3 Dedov I.I., Lebedev N.B., Yu.S. Suntsov et al. Pa National Register of matenda ashuga. Kulankhulana 2. Mliri wa matenda a shuga ogwirizana ndi insulin komanso pafupipafupi zovuta zake mu ana aku Moscow. // Probl. Endocrinol. - 2006. - T.42. - Na. 5. - S. 3-9.

4 Defronzo R.A. Pathogenesis wa NIDDM: Kuwunika mwachidule // Matenda a shuga. - 2002. - Vol. 19. - P. 15-21.

5 Mazze R.S. Njira zomwe zimayendera chisamaliro cha matenda a shuga // Matenda a shuga. - 2000. - Vol. 31. - P. 17-22.

6 WHO Global Diabetes Report. - June 2016 .-- 45 p.

7 Agogo aamuna I.I. Matenda a endocrine dongosolo. - M.: Mankhwala, 2000 .-- 208 p.

8 Dedov I.I., Suntsov Yu.D. Mliri wamatenda a shuga mellitus // Probl. endocrinology. - 2007. - Na. 2. - S. 42-47.

9 Drash A. A shuga a Mellitus mwa Mwana ndi Wachinyamata. M'mavuto Omwe Akumachitika mu Chipatala. - Chicago: Book Book, 2001 .-- 254 p.

10 King H., Aubert R., Herman W. Global katundu wa matenda ashuga 1995-2025 // Matenda a shuga. - 1998. - Ayi. 21. - P. 14-31.

11 Zimmet P. Kuletsa Matenda A shuga a 2 komanso matenda a dysmetabolicsyndrome mu zenizeni: lingaliro loona // Diabetes Med. -2003. - Ayi. 20. - P. 693-702.

12 Dedov I.I., Shestakova M.V. Ma algorithms othandizira chithandizo chapadera cha odwala omwe ali ndi matenda a shuga. -M.: Mankhwala, 2006. - 30 p.

13 CefaIuW. Diabetesic ketoacidosis // Crit Care Clin. - 2006. - Vol. 32. - P. 7-14.

14 Shestakova M.V. Kuthana ndi insulin kukaniza ndiye maziko othandizira komanso kupewa mtundu wa 2 shuga mellitus // Russian Medical Journal. - 2004. - Na. 12. - S. 88-96.

15 Mkrtumyan A.M. Kugwiritsa ntchito bwino glycemic pogwiritsa ntchito mankhwala ophatikizira // Russian Medical Journal. - 2003. - Gawo 11 -. 12. - S. 104-112.

16 Muratalina A.N. Matenda a shuga ku megalopolis: pafupipafupi, njira zamankhwala, zovuta (mwachitsanzo, Almaty): Abstract. Chisi. . Woyankha wa Sayansi ya Zachipatala - Almaty, 2010 .-- 51 p.

17 Zowerengera za Statistical. Astana, 2016. Zaumoyo wa anthu aku Republic of Kazakhstan ndi zomwe mabungwe azaumoyo amachita mu 2015. - S. 56-57.

A.A. Tanirbergenova, K.A. Tulebaev, J.A. Akanov

S.Zh. Asfendiyarov atyndagi K, azats ¥ lttytsmeditsyna yrneepcumemi

KANT DIABETES1NSC JAJANDSCH TARALUA

Tushn: K ^ rp tan, yes blow Dzhi zi boyynsha, antabetes meselae algash, s orynda tour. Duniyezhuzshsk densaulshch sa, tau uyymy, ant matenda auruyn, ogamdy, mankhwala Yoshin elemzh munthu, yzy bar birden-bir auru dep myyindaldy. Kant diabetman ayyratin adamdar sany jyldam esude. 2025 zhylga, arai, akatswiri azachuma achitetezo a matenda ashuga, Damigan vakurude - 7.6%, Damushi vakurude - 4,9%, ma mantha.

TYYindi sesder: Zhu, Pali emes aurular ,, ant matenda ashuga taraluy, Kazakhstan Republicy.

A.A. Tanirbergenova, K.A. Tulebayev, Zh.A. Akanov

Asfendiyarov Kazakh National Medical University

KULIMA KWA ZIWANDA MU DZIKO LAPANSI

Endaninso: Pakadali pano matenda a shuga ndi vuto lalikulu padziko lonse lapansi. Matenda a shuga amadziwika ndi bungwe azaumoyo padziko lonse lapansi ngati amodzi mwa matenda omwe ali ndi tanthauzo padziko lonse lapansi kwa anthu. Matenda a shuga amakhalapo msanga, akumenya kwambiri komanso

anthu ochulukirapo. Pofika chaka cha 2025 kuchuluka kwa matendawa kumaiko otukuka bwino kudzakhala 7.6% ndikukula - 4.9%.

Mawu osakira: Matenda osagonana, kufalitsa matenda a shuga, Republic of Kazakhstan.

UDC 613.227: 612.392.6 (574)

G. Khasenova, A.B. Chuenbekova, S.T. Alliyarova, A. Seitmanova

Kazakh National Medical University. S.D. Asfendiyarova, Department of Nutrition, KMU "VSHOZ"

KUSINTHA KWAULERE NDIPONSO ZOFUNIKIRA ZA MBALI YA BONE TISSUE MINERAL Density YEMWE AKUKHALA NDI CHIPHUNZITSO CHA ALMATY

Nkhaniyi ikuwonetsa kufalikira kwa mafupa ndi kusanthula kwamayiko osowa m'mafupa m'dera la Almaty. Mukamaphunzira zakudya, zidapezeka kuti mkaka ndi mkaka osakwanira, komanso kuperewera kwa micronutrients. Malinga ndi zotsatira za kafukufukuyu, zakudya zomwe zimalepheretsa kuyamwa kwa calcium ndizofunikira kwambiri muzakudya. Osteoporosis pakati pa akulu okalamba mdera la Almaty ndi 42%, osteopenia ndi 50%, mulingo wamba ndi 8% yokha. Mawu ofunika: kufooka kwa mafupa, kuchuluka, kufalikira kwam'mafupa, kuwunika kwa thanzi.

Kuyamba Osteoporosis (OP) ndi matenda a mafupa amatsenga omwe amadziwika ndi kuchepa kwa mafupa komanso kuphwanya kwa microarchitectonics ya minofu yam'mafupa, zomwe zimayambitsa kuwonjezeka kwa mafupa komanso chiwopsezo chowonjezeka. Kuchuluka kwa mafupa am'mimba kumachitika pamalo achi 5 pakati pa matenda omwe sanayambitse matenda, chifukwa choyambitsa kufa ndi kulumala, ndi ena mwa matenda 10 osafunikira kwambiri opatsirana mwa anthu. Mwa anthu azaka zopitilira 50 ndi kupitilira, m'modzi mwa akazi atatu ndi m'modzi mwa abambo 5 amadwala OP. Malinga ndi kafukufuku wokhudza kukhazikitsa pulogalamuyi komanso kafukufuku wapadera

pankhani yopewa matenda a mafupa ku Republic of Kazakhstan, kuchepa kwa mafupa a mineral (BMD) mwa anthu omwe awerengedwa ndi 75% ya milandu. OP yapezeka mwa anthu 450 (22.2%), osteopenia - 1176 (53.2%) anthu. Sonographic densitometry indices yofanana ndi yachibadwa minofu mafupa anapezeka republic mu 24,6% milandu.

Kuneneratu kwa WHO kwa mafupa am'madzi padziko lonse lapansi - podzafika 2050, kuchuluka kwa mafupa olowa m'chiuno kudzafika pa miliyoni 6.2 miliyoni (mu 1990 - 1.66 miliyoni milandu). Chiwerengero cha anthu padziko lonse lapansi chikuwonjezeka tsiku lililonse ndi anthu 250,000, anthu opitilira 60 ndi omwe ali ambiri

Zizindikiro zakukula kwa matendawa

Chizolowezi chimatengedwa ngati chizindikiro kuyambira 3.3 mpaka 5.5 mmol / L. Kupitilira muyeso uwu kumawonetsa kuti wodwala ali ndi matenda a shuga.

Izi ndi zizindikiro zofala kwambiri za matendawa.

Wodwala matenda ashuga nthawi zambiri amamva ludzu losatha ndipo amadandaula kukoka pafupipafupi.
Ngakhale odwala matenda ashuga amakhala ndi chidwi chofuna kudya, kuchepa thupi kumachitika.
Kutopa, kutopa mosalekeza, chizungulire, kulemera m'miyendo ndi malaise ambiri ndizizindikiro za matenda ashuga.
Zochita zogonana ndi potency zimachepetsedwa.
Kuchiritsidwa kwamankhwala kumakhala pang'onopang'ono.
Nthawi zambiri kutentha kwa odwala matenda ashuga kumakhala kosakwana - 36.6-36.7 ° C.
Wodwalayo amatha kudandaula kuti ali ndi dzanzi komanso amanunkha m'miyendo, ndipo nthawi zina amakokana m'matumbo a ng'ombe.
Njira ya matenda opatsirana, ngakhale ndi chithandizo cha nthawi yake, ndikutalika.
Odwala matenda a shuga amadandaula za kuwonongeka kwa mawonekedwe.

Nthabwala zoyipa ndi matendawa, chifukwa chake, mutazindikira momwemo mwa inu nokha, muyenera kulankhulana ndi dokotala nthawi yomweyo.

Shuga mellitus - gulu, chipatala, matenda

Nthawi "Matenda a shuga" kuphatikiza matenda a metabolic a etiology osiyanasiyana omwe amayamba chifukwa chazovuta mu insulin secretion komanso / kapena insulin, zomwe zimayambitsa kusokonezeka kwa mitundu yonse ya kagayidwe, koma makamaka chakudya, chomwe chimawonetsedwa ndi matenda a hyperglycemia.

Matenda a shuga a shuga amadziwika ndi kuwonongeka kwa mtima kwakukulu - yaying'ono- ndi macroangiopathies, omwe angayambitse kusintha kwamatenda am'mimba komanso minofu yomwe imakhala yangozi ku thanzi ndi moyo wa odwala (odwala matenda a shuga, khungu losawonongeka, nephrosselosis yodwala matenda aimpso.

Amabala

Kuyambukira shuga mellitus (shuga) mwa anthu achikulire omwe ali m'madera ambiri padziko lapansi ndi 4-6%. Ziwerengero zowerengera zikuwonetsa kuwonjezeka kosasunthika kwa odwala omwe ali ndi matenda ashuga, kupeza chilengedwe. Pakadali pano, anthu opitilira miliyoni miliyoni akudwala matenda ashuga padziko lapansi, ndipo malinga ndi kulosera, pofika chaka cha 2010 chiwerengero chawo chidzakwera kufika pa 230, ndipo pofika 2025 mpaka 300. Chaka chilichonse chiwerengero cha odwala matenda a shuga chikuwonjezeka ndi 5-7%, ndipo aliyense Zaka 12 mpaka 15.

Ku Russia, mchaka cha 2000, pafupifupi 8 miliyoni odwala matenda ashuga kapena 5% yaanthu adalembetsa; pofika 2025, akuneneratu kuchuluka kwa odwala kufika mamiliyoni 12. Kafukufuku wosankhidwa akuwonetsa kuti chiwerengero chenicheni cha odwala, makamaka odwala mtundu 2 shuga(SD-2), Katatu katatu kuchuluka kwa zojambulidwa.

Tiyenera kudziwa kufunikira kwa matendawa komanso chikhalidwe cha anthu chifukwa cha matendawa ndi kuchuluka kwa moyo wa odwala omwe ali ndi zovuta zake za m'mbuyomu (nephropathy, retinopathy, gangren of the m'mphepete, polyneuropathy). Chifukwa chake, chiyembekezo cha moyo mwa odwala lembani matenda ashuga 1SD-1) kufupikitsidwa ndi gawo limodzi.

Chochititsa chachikulu kwambiri cha kufa msanga kwa odwala omwe ali ndi matenda ashuga kuyambira ali mwana kuwonongeka kwa impso - matenda ashuga nephropathy ndi kukula kwa aimpso kulephera. Mwa odwala onse omwe akudwala hemodialysis, 30% amadwala matenda ashuga. Imfa yochokera ku uremia yokhala ndi matenda a shuga 1 amachokera pa 30 mpaka 50%.

Matenda a shuga ndi omwe amachititsa kwambiri kuti azichita khungu pakati pa anthu azaka zapakati. Chiwopsezo chotenga khungu kwa odwala omwe ali ndi matenda ashuga ndiwowonjezereka maulendo 25 kuposa omwe alipo ambiri.

Kukula kwa matenda ashuga kumabweretsa kulumala, ndipo nthawi zina kufa kwa wodwala. Kupitilira theka lamadulidwe azinthu zosakhudzana ndi kuvulala kumachitika mwa odwala matenda a shuga. Malinga ndi Unduna wa Zaumoyo ku Russia, mdziko lathu anthu ochulukitsa 11,000 am'madera ochepa omwe ali ndi matenda a shuga amachitika chaka chilichonse.

Matenda a shuga amatsimikizira kukula kwa atherosulinosis, chifukwa, kuwonjezera pazowopsa zomwe zimachitika, monga hyperlipidemia, ochepa matenda oopsa, kusuta, kutulutsa thupi, kunenepa kwambiri, kutengera kwa majini, kuperewera kwa matenda ashuga pali zina zowonjezera zovuta za atherogenic - hyperglycemia, hyperinsulinosiacycyosisosia. .

Chifukwa chake, chiopsezo chotenga matenda a mtima, omwe amachokera ku atherosclerosis, amakhala okwanira katatu kwa odwala matenda ashuga kuposa ambiri. Chiwopsezo cha matenda amtima chambiri zimachulukitsa kanayi ngati matenda a shuga akuphatikizidwa ndi matenda oopsa, komanso maulendo 10 ngati matenda ashuga a m'mimba nawonso atenga nawo matenda amenewa.

M'mayiko otukuka, matenda a mtima m'mitsempha 30-50% amachititsa kufa kwa odwala omwe ali ndi matenda osokoneza bongo a zaka zopitilira 40. Matenda a shuga amaphatikizidwanso ndi kuwonjezeka kwa matenda a matenda a matenda a chithokomiro nthawi 2-3.

Chifukwa chake, matenda a shuga angayambitse kudwala komanso kufa msanga kwa wodwalayo. Mu kapangidwe kaimfa, matenda ashuga amachitika mwachangu pambuyo pamatenda amtima komanso a oncological.

Ngati tiwonjezera pamwambapa kuti odwala matenda ashuga amafunikira kugwiritsa ntchito mankhwala ochepetsa shuga, komanso tikufuna kuchipatala kuwirikiza kawiri kuposa kuchuluka kwa anthu, ndiye kufunikira kwachipatala ndi chikhalidwe cha anthu kumawonekeratu.

Epidemiology ya matenda ashuga komanso kudalirika kwa kuchuluka kwake mu Russian Federation

Suntsov Yu.I., Bolotskaya L.L., Maslova O.V., Kazakov I.V.

Federal State Institution Endocrinology Research Center, Moscow (Director - Wophunzira wa Russian Academy of Science ndi RAMS II Dedov)

Kufalikira kwa matenda a shuga mellitus (DM) mdziko lonse komanso ku Russia ndi mliri. Kupanga mayina a odwala omwe ali ndi matenda ashuga, kuchititsa maphunziro a miliri kumakuthandizani kuti mupeze chidziwitso chokhudza matenda omwe amadza chifukwa cha matenda ashuga komanso zovuta zake, kulosera kuchuluka kwake. Monga gawo la ntchito ya zaka 5 komanso kafukufuku yemwe akuyembekezeredwa pambuyo pake, deta idapezeka yomwe ikuwonetsa kuchuluka kwa matenda ashuga ku Russia. Chiwerengero cha odwala matenda a shuga kuyambira pa 01.01.2010 ndi anthu 3163.3 miliyoni, malinga ndi zomwe zanenedwazo, odwala 5.81 miliyoni adzalembetsedwa zaka makumi awiri zikubwerazi, pomwe chiwerengero chomwecho cha odwala sichidzapezeka. Kuchuluka kwa zovuta za matenda ashuga kumapitilira zomwe zalembedwa, ndipo mu 40-55% ya odwala sapezeka. Kafukufuku woyembekezeredwa wawonetsa kuti kuchuluka kwa odwala omwe ali ndi matenda amtundu wa 1 omwe ali ndi HbAlc glycogemoglobin

Matenda a shuga: miliri ndi njira zake

Julayi 31 pa 15:16 3758

Pafupifupi 90% ya chiwerengero chonse cha odwala omwe ali ndi matenda ashuga ndi odwala matenda a shuga 2 ndipo pafupifupi 10% ndi odwala matenda amtundu wa 1. M'mbuyomu, matenda awiriwa adasiyanitsidwa ndi zaka: mtundu 1 wa matenda ashuga adadwala akadali achichepere (kuyambira miyezi ingapo ya moyo kufika zaka 40), ndipo matenda a shuga a 2 - atakula komanso ukalamba. Tsopano, chifukwa cha vuto lalikulu la kunenepa kwambiri, kuopsa kwa matenda ashuga a 2 kukukhalanso ana. Malinga ndi kafukufuku wosiyanasiyana, ku United States kale 15% ya ana azaka 4 mpaka 10 ali onenepa kwambiri, 25% yaiwo adalephera kulolera glucose (NTG), mu 4% ya omwe adapezeka kuti ali ndi mtundu wachiwiri wa matenda a shuga awonekeranso. ku Russia. Kuyambira mu 1996, Russian Federation yakhala ikugwira ntchito mwakhama popanga State Record of Diabetes, ntchito zomwe zimaphatikizapo kulembetsa pachaka kwa milandu yonse ya matenda ashuga, kuwunika kwa kuchuluka ndi zochitika za matenda a shuga 1, 2, kusanthula kwa matenda aposachedwa a matenda ashuga, kusanthula kwa kufa kwa matenda ashuga. Gosregister of matenda ashuga, mu 2004 ku Russia analembetsa odwala osapitirira 270,000 omwe ali ndi matenda amtundu wa 1. Zotsatira za matenda amtundu wa shuga m'zaka zaposachedwa zatsalirabe pa anthu khumi ndi ziwiri pa anthu 100,000, kutengera dera. Kuchuluka kwa matenda ashuga a mtundu 2 ku Russia kwathunthu ndi pafupifupi 4,5%, komwe sikapitilira kuchuluka kwa mayiko otukuka, koma zomwe zikuwonjezera chiwopsezo cha matenda ashuga amtundu wa 2, wamba padziko lonse lapansi, sizidutsa ku Russia. Kuchuluka kwa matenda ashuga a mtundu wachiwiri mdziko lonse lapansi Mu 1999, WHO idavomereza njira zatsopano zodziwonera za matenda ashuga, zomwe zidatsimikizidwa mchaka cha 1997 ndi ADA. Kuzindikira njira za matenda ashuga .Anafotokoza mwachindunji njira zopezeka zosiyanasiyana zamatenda a carbohydrate metabolism. Diagnosticamu yokhudza kuphatikiza kagayidwe kazakudya zam'mimba: NTG - kusungunuka kwa glucose, GN - kusala kudya kwa hyperglycemia (m'magazi a capillary) Kusiyana kwakukulu pakati pa njira zatsopano zopezera matenda ashuga mu 1999 ndi njira zam'mbuyomu mu 1985 - kutsitsa kuzindikira kwa kusala kwa glycemia kuyambira 6.7 mpaka 6 , 1 mmol / l (m'magazi a capillary) kapena kuchokera 7.8 mpaka 7.0 mmol / l (mu plasma yamagazi a venous). Mlingo wodziwitsa za glycemia maola 2 atatha kudya anakhalabe chimodzimodzi - 11.1 mmol / L. Zolinga zakukulira njira zodziwira matendawa ndizodziwikiratu: kudziwitsidwa koyambirira kwa matenda ashuga kumathandizira kuti mankhwalawa ayambe munthawi yake komanso kupewa zovuta za matenda ashuga. Kuphatikiza apo, mu njira yatsopano yodziwira, lingaliro linanso lakhala likuwonetsa kuphwanya kwa kagayidwe kazakudya zam'thupi - kusala kwa hyperglycemia. NTG ndi hyperglycemia yosala kudya ndi magawo a shuga, omwe amatha kusinthika kukhala shuga pokhapokha atakumana ndi zovuta.

Zowopsa zomwe zimapangitsa kuti matenda ashuga akhale ndi matenda ashuga ndi monga:

• katundu wochotsa matenda amtundu wa 2 shuga, • wonenepa kwambiri (BMI> 25 kg / m2), • wokhala m'magazi, • yemwe adazindikira NTG kapena hyperglycemia yoyambirira, • matenda oopsa (kuthamanga kwa magazi (kuthamanga kwa magazi> 140/90 mm Hg), • cholesterol level of high density lipoproteins (HDL cholesterol) 1.7 mmol / l, • chiopsezo kwa mayi yemwe wabereka mwana ndi thupi lolemera> 4.5 kg, • polycystic ovary. Mphamvu ya chithandizo cha matenda ashuga imawunikidwa ndi zizindikiro zingapo zomwe zikuwonetsa mtundu wa metabolism ya carbohydrate. Izi zimaphatikizira kusala kudya kwa glycemia, glycemia patatha maola awiri atatha kumeza ndi glycated hemoglobin HbAlc - chofunikira kwambiri pakubwezeretsanso kwa kagayidwe kazakudya m'miyezi iwiri yapitayi. Zolinga zakuwongolera glycemia kwa odwala omwe ali ndi matenda ashuga. Pali chikomokere pamaziko a hyperglycemia: ketoacidotic, hyperosmolar ndi lactacidotic. Ngati mankhwala osokoneza bongo a hypoglycemic, kukomoka kwa hypoglycemic ndikotheka. Pakadali pano, monga tekinoloje yochizira matenda a shuga ipita patsogolo, kuchuluka kwa chikomokere kwa hyperglycemic kwachepa kwambiri, ndipo chiyembekezo cha moyo wa odwala chakwera. Komabe, limodzi ndi kuchuluka kwa nthawi ya moyo, vuto lakachedwa kwa zovuta za shuga zomwe zimakhudza kama wam'kati mwa minyewa ndi minyewa yamitsempha idawonekera. Izi zimaphatikizapo matenda ashuga a michereopathies (zotupa zamagetsi zazing'ono zowerengeka), macroangiopathies (zotupa zam'mimba zokhala ndi caligathy yayikulu) komanso matenda a shuga. Kugawika kwa zovuta zamatenda a shuga. Ndizovuta zam'mimba zomwe zimayambitsa kulumala kwakukulu ndi kufa kwa odwala matenda ashuga. Dedov I.I., Shestakova M.V.

Mitundu ya Aducin (ADD1, ADD2 ndi ADD3)

Ma adducins ndi mapuloteni a cytoskeleton a khungu. Amaganiza kuti, mbali inayi, mauctuctins amapatsira ma cell mkati mwa khungu, ndipo, akalumikizana ndi mapuloteni ena a cytoskeletal, amayendetsa ma ion kudzera mu membrane wa cell. Mwa anthu, ma aducins onse amapangidwa nthawi ziwiri.

Matenda a shuga ndi matenda oopsa

Matenda a shuga: gulu

Shuga mellitus ndi gulu la matenda a metabolic (metabolic) omwe amadziwika ndi hyperglycemia, omwe amachitika chifukwa cha kusokonezeka kwa katemera wa insulin, zotsatira za insulin, kapena zonsezi. Matenda a hyperglycemia omwe ali ndi matenda ashuga amaphatikizidwa ndi kuwonongeka, kusowa kwa ntchito osati chitukuko.

Matenda a shuga ndi matenda oopsa

Makhalidwe Abwino kwa matenda a shuga

Cholinga chachikulu pakuperekera odwala omwe ali ndi matenda ashuga ndi kupewa kutukuka kapena kupitirira msanga kwa zovuta zamavuto amtunduwu (DN, DR, kuwonongeka kwa ziwiya zamtima, bongo, ndi mitsempha ina yayikulu). Ndizosatsutsika kuti zomwe zimatsogolera zikuwonetsedwa.