Matenda a shuga a mellitus MODZI: Zizindikiro ndi kuchiza kwa matenda amisempha

Nthawi zina zimakhala zovuta kudziwa mtundu wa matenda a shuga, chifukwa pali mitundu yosiyanasiyana ya matendawa, zomwe zimadziwika chifukwa cha mitundu yoyamba komanso yachiwiri. Kuwonjezeka kwamphamvu kwa glucose ali aang'ono, monga mtundu 1, wokhala ndi mtundu wachiwiri wa 2, amatchedwa matenda a shuga a Modi.

MODI ndichidule cha "kukhwima koyambirira matenda a shuga kwa achichepere", omwe atanthauziridwa kuti "matenda akulu a shuga kwa achinyamata." M'badwo womwe matendawa amalephera kupitirira zaka 25. Matenda a shuga a m'mankhwala amaphatikiza mitundu ingapo. Ena mwa iwo ali ndi zizindikiritso zoonekera zowonjezera shuga - ludzu ndi kuchuluka kwamkodzo, koma ambiri a iwo ndi asymptomatic ndipo amadziwika pokhapokha atawoneka dokotala.

Kusiyana kwa matenda a shuga a Modi kuchokera ku mitundu ina

Matenda a shuga a m'magazi ndi matenda osowa kwambiri. Malinga ndi kuyerekezera kosiyanasiyana, gawo la odwala limachokera ku 2 mpaka 5% ya onse odwala matenda ashuga. Choyambitsa matendawa ndi kusintha kwa majini, chifukwa chomwe magwiridwe antchito a ma Langerhans amasokonekera. Awa ndi magulu a maselo apadera mu kapamba, momwe amapangidwira insulin.

Matenda a shuga am'mimba amapatsirana m'njira zodziwika bwino. Ngati mwana alandila jini losalongosoka kuchokera kwa makolo ake, matendawo amayambira 95% ya milandu. Kuthekera kwa kusintha kwa majini ndi 50%. Wodwala m'mibadwo yam'mbuyomu ayenera kukhala ndi abale ake enieni omwe ali ndi matenda a shuga a Mody, kupezeka kwa matendawa kumatha kumveka ngati matenda amtundu 1 kapena 2, ngati matenda sanawonekere.

Matenda a shuga a Mody amatha kukayikiridwa ngati shuga wa magazi amatuluka nthawi ndi nthawi, kuwonjezeka kumene kumasungidwa nthawi yayitali, sikuyambitsa kwambiri hyperglycemia ndi ketoacidosis. Mbali yodziwika ndi momwe mankhwala a insulin amachitikira: kukondwerera kwachikondwerero chikayamba sikukhala miyezi 1-3, monga momwe amachitira ndi matenda ashuga 1, koma motalikirapo. Kukonzekera kwa insulini ngakhale muyezo wowerengeka nthawi zambiri kumayambitsa hypoglycemia yosadziwika.

Njira zoyenera kudziwa kusiyanitsa matenda a shuga a Mody ndi mitundu yambiri ya matenda:

Mtundu 1Modymatenda ashuga
Kuthekera kwa cholowa ndi kotsika, osapitilira 5%.Mkhalidwe wodziphimba, kuthekera kwakukulu kwa kufalikira.
Ketoacidosis imadziwika ndi mtundu wa zoyipa.Kumayambiriro kwa matendawa, kumasulidwa kwa matupi a ketone sikuchitika.
Kafukufuku wa Laborator akuwonetsa kutsika kwa C-peptide.Kuchuluka kwachilengedwe kwa C-peptide, komwe kumawonetsa kubisika kwa insulin.
Poyamba, ma antibodies atsimikiza.Ma antibodies palibe.
Chisangalalo nditayamba mankhwala a insulin ndi ochepera miyezi itatu.Glucose wabwinobwino amatha kukhala zaka zingapo.
Mlingo wa insulin ukuwonjezeka utatha kugwira ntchito kwa maselo a beta.Kufunika kwa insulini ndizochepa, glycated hemoglobin siyapamwamba kuposa 8%.

Mtundu 2Matenda a shuga
Imapezeka mu ukalamba, nthawi zambiri itatha zaka 50.Zimayamba ubwana kapena unyamata, nthawi zambiri zaka 9-13.
Nthawi zambiri, kunenepa kwambiri komanso kulakalaka kwa maswiti kumawonedwa.Odwala amakhala ndi moyo wabwinobwino, palibe onenepa kwambiri.

Mitundu ya Matenda a Mody

Matendawa amagawidwa malinga ndi jini losinthidwa. Pazonse, pali mitundu 13 yosinthika yomwe imapangitsa shuga wamagazi, mpaka pano mitundu yofanana ya matenda a shuga a Mody. Milandu yonse ya anthu odwala matenda ashuga omwe samachita bwino sakhala pansi pawo, chifukwa chake maphunziro amachitika nthawi zonse kufufuza mitundu yatsopano yolakwika. Pang'onopang'ono, kuchuluka kwa mitundu yodziwika yamatendawa kuchulukana.

Lembani ziwerengero za mpikisano wa ku Caucasus:

Pafupifupi ma Asia

10 peresenti yokha ya odwala amtundu wa Mongoloid tsopano amatha kufalitsa matenda amtundu wamtunduwu, chifukwa chake, kafukufuku wofufuza majini atsopano amachitika m'gulu la anthu lino.

Makhalidwe amitundu wamba:

MtunduMtundu wolakwikaZolemba zotayikira
Modi 1HNF4A imayang'anira ntchito za majini angapo omwe amachititsa kuti kagayidwe kazachilengedwe kakonzedwe komanso kusamutsa shuga kuchokera m'magazi kupita ku minofu.Mapangidwe a insulini akuchulukitsidwa, palibe shuga mumkodzo, cholesterol yamagazi ndi triglycerides nthawi zambiri amakhala wabwinobwino. Kuthamanga shuga kungakhale kwabwinobwino kapena kukwezedwa pang'ono, koma mayeso ololera a glucose amawonetsa kukwera kwakukulu (pafupifupi magawo 5). Kukhazikika kwa matendawa ndi kofatsa, pomwe zovuta za matenda ashuga zimayamba kupita patsogolo.
Modi 2GCK ndi mtundu wa glucokinase womwe umalimbikitsa kutembenuka kwa glucose owonjezera kuti akhale glycogen, amawongolera kutulutsidwa kwa insulini poyankha kuwonjezeka kwa shuga.Ndiwofatsa kuposa mitundu ina, nthawi zambiri safuna chithandizo. Kukula pang'ono kwa shuga osala kudya kumawonedwa kuyambira ubadwa, ndi zaka, kuchuluka kwa glycemic kumawonjezeka pang'ono. Zizindikiro zake kulibe; zovuta kwambiri ndizosowa. Glycated hemoglobin pamwambamwamba pamwambo wabwinobwino, kuchuluka kwa shuga panthawi ya kuyeserera kwa glucose kosakwana magawo 3.5.
Modi 3Kusintha kwa HNF1A kumabweretsa kusokonezeka kwapang'onopang'ono kwa maselo a beta.Matenda a shuga nthawi zambiri amayambira zaka 25 (63% ya milandu), mwina pambuyo pake, mpaka zaka 55. Kumayambiriro, hyperglycemia yoopsa ndiyotheka, kotero Modi-3 imasokonezedwa ndi matenda amtundu 1. Ketoacidosis kulibe, kuyesa kwa glucose kumawonetsa kuchuluka kwa shuga kwamagulu opitilira 5. Chotupa cha impso chasweka, kotero shuga mkodzo umatha kuwonekanso ngakhale pamlingo wamba. Popita nthawi, matendawa amapita patsogolo, odwala matenda ashuga amafunika kuwongolera kwambiri glycemic. Popeza kulibe, zovuta zimapita patsogolo.
Modi 5TCF2 kapena HNF1B, zimakhudza kukula kwa maselo a beta mu nthawi ya embryonic.Pali nephropathy yomwe ikupita patsogolo posachokera ku matenda ashuga, pancreatic atrophy, ziwalo zitha kuphatikizidwa. Masinthidwe ongodziwika, osakhala obadwa mwatsopano ndi otheka. Matenda a shuga amayambira 50% ya anthu omwe ali ndi vutoli.

Kodi ndi ziti zina mwazokayikitsa?

Ndikosavuta kuzindikira matenda a Mody -abetes kumayambiriro kwa matendawa, chifukwa nthawi zambiri zovuta zimayamba pang'onopang'ono, ndipo zizindikiro zowoneka sizikupezeka konse. Mwa zizindikilo zopanda tanthauzo, mavuto amawonedwe amatha kuonedwa (chophimba chakanthawi pamaso, zovuta kuyang'ana pamutu). Chiwopsezo cha matenda oyamba ndi fungus chikuwonjezeka, akazi amadziwika ndi kubwereza pafupipafupi kwa thrush.

Pamene shuga wamagazi akwera, zizindikiritso za matenda ashuga zimayamba:

  • ludzu
  • kukodza pafupipafupi
  • kulakalaka
  • kufooka chitetezo chokwanira
  • kuchiritsa bwino khungu,
  • kusintha kwa thupi, kutengera mtundu wa matenda a shuga a Mody, wodwala amatha kuchepa thupi komanso kukhala bwino.

Ndikofunika kuunika matenda a shuga a Modi ngati mwana kapena wachichepere wapeza glycemia kangapo kuposa 5.6 mmol / l, koma palibe zizindikiro za matenda ashuga. Chizindikiro chowopsa ndi shuga kuposa 7.8 mmol / L kumapeto kwa kuyesa kwa glucose. Mu ana, kusowa kwa kuwonda kumayambiriro kwa matendawa komanso shuga atatha kudya osaposa magawo 10 kumasonyezanso matenda a shuga a Mody.

Doctor of Medical Science, Mutu wa Institute of Diabetesology - Tatyana Yakovleva

Ndakhala ndikuphunzira matenda a shuga kwa zaka zambiri. Zimakhala zowopsa anthu ambiri akamwalira, ndipo makamaka amakhala olumala chifukwa cha matenda ashuga.

Ndithamangira kunena mbiri yabwino - Endocrinological Research Center ya Russian Academy of Medical Sayansi yakwanitsa kupanga mankhwala omwe amachiritsa odwala matenda ashuga mellitus. Pakadali pano, kugwiritsa ntchito bwino kwa mankhwalawa kuyandikira 98%.

Nkhani ina yabwino: Unduna wa Zaumoyo wateteza kukhazikitsidwa kwa pulogalamu yapadera yomwe imalipira mtengo wa mankhwalawo. Ku Russia, odwala matenda ashuga mpaka Meyi 18 (kuphatikiza) nditha kuipeza - Kwa ma ruble 147 okha!

Chitsimikizo cha Laboratory cha matenda a shuga a Mody

Ngakhale zovuta zakutsimikizira kwa labotale ya Mody -abetes, maphunziro amtundu ndi ofunika kwambiri, chifukwa amakulolani kuti mupeze njira zoyenera za chithandizo osati mwa wodwala, komanso abale ake okalamba.

Kulemba kwathunthu kumaphatikizapo:

  • shuga m'magazi
  • shuga ndi mapuloteni mumkodzo,
  • C peptide
  • kuyeserera kwa shuga
  • antibodies a autoimmune kupita ku insulin,
  • glycated hemoglobin,
  • magazi lipids
  • Ultrasound wa kapamba,
  • magazi ndi mkodzo,
  • fecal trypsin,
  • kufufuza mozama.

Mayeso 10 oyambilira akhoza kutengedwa komwe akukhala. Kafukufuku waposachedwa amakulolani kudziwa mtundu wa matenda a shuga a Mody, amachitidwa. ku Moscow ndi Novosibirsk kokha. Kuzindikira kumatengera malo ofufuza a endocrinological. Pofufuza, magazi amatengedwa, DNA imatengedwa mu cell, imagawidwa m'magawo ndipo zidutswa zimayesedwa, zolakwika zomwe zimatha kwambiri.

Mankhwala omwe mumalandira mumatengera mtunduModymatenda ashuga:

MtunduChithandizo
Modi 1Zothandizira kuchokera ku sulfanylureas - Glucobene, Glidanil, kukonzekera kwa Glidiab kumapereka zotsatira zabwino. Amachulukitsa kaphatikizidwe ka insulin ndipo amalola shuga kukhalawabwinobwino kwa nthawi yayitali. Kukonzekera kwa insulin kumagwiritsidwa ntchito mwapadera.
Modi 2Chithandizo chokwanira sichothandiza, chifukwa, kuti muchepetse shuga, muyenera kutsatira zakudya zomwe zimachepetsa ndipo mumalandira zolimbitsa thupi pafupipafupi. Pofuna kupewa macrosomia yayikulu (kukula kwakukulu) pa nthawi yomwe ali ndi pakati, mayiyo amapatsidwa jakisoni wa insulin.
Modi 3Mitundu 3 ya matenda a shuga ikalephera, mankhwala osokoneza bongo a sulfa ndiwo mankhwala osankhidwa, ndipo zakudya zamagulu ochepa zimakhala zothandiza. Kupita patsogolo komwe kumachitika, chithandizo chotere chimasinthidwa ndi insulin.
Modi 5Insulin imayikidwa akangopezeka matendawa.

Kuchiza ndikothandiza kwambiri pakalibe kunenepa kwambiri. Chifukwa chake, odwala omwe ali ndi kunenepa kwambiri amapatsidwa zakudya zowonjezera zomwe zili ndi zochepa zopatsa mphamvu.

Zolemba zina zothandiza:

Onetsetsani kuti mwaphunzira! Kodi mukuganiza kuti kuyamwa kwa mapiritsi ndi insulini kwa nthawi yonse yokhayo ndi njira yokhayo yothanirana ndi shuga? Sichowona! Mutha kutsimikizira izi nokha ndikuyamba kuzigwiritsa ntchito. werengani zambiri >>

Kodi matenda a shuga a MODI ndi ati

Matenda A shuga ambiri ndi gulu lomwe limapanga chibadwa chimodzi chomwe chimayambitsa matenda osokoneza bongo ndipo zimasokoneza kugwiritsa ntchito shuga mwa magazi ndi minyewa ya thupi. Kwambiri, matendawa amawonekera pa kutha. Pali mtundu wina woti 50% ya matenda amiseche opatsirana ndi amodzi mwa mitundu ya MODI.

Mitundu yoyamba yamatenda a matenda amtunduwu idapezeka koyamba mu 1974, ndipo mkati mwa zaka za 90s, chifukwa cha kupita patsogolo kwa majini am'maselo ndi mwayi wopititsa kuyesa kwa majini, izi zinadziwika.

Masiku ano mitundu 13 ya MODZI imadziwika. Iliyonse imakhala ndi vuto lakelo.

MutuKusokonezeka kwa fukoMutuKusokonezeka kwa fukoMutuKusokonezeka kwa fuko
MODZI 1HNF4AMODZI 5TCF2, HNF1BMODZI 9PAX4
MODZI 2GckMODZI 6NEUROD1MODZI 10Ins
MODZI 3HNF1AMODZI 7KLF11MODZI 11BLK
MODZI 4PDX1MODZI 8CelMODZI 12KCNJ11

Zomwe zimafotokozera zomwe zikusonyeza kachidutswa komwe kabisalira gawo la hepatocytes, mamolekyu a insulini komanso magawo a cell omwe ali ndi vuto la kusiyana kwa neurogenic, komanso kusindikiza kwa maselo omwewo ndi kapangidwe kazinthu.

Pomaliza pamndandanda, matenda a shuga a MODI 13 ndi omwe amabwera chifukwa cha masinthidwe obadwa nawo m'makaseti omanga a ATP: mdera la banja la C (CFTR / MRP) kapena membala wake 8 (ABCC8).

Chiwopsezo cha matenda a shuga

Zambiri. Asayansi akutsimikiza kuti awa sindiwo mndandanda wathunthu wazolakwika, popeza zochitika za matenda ashuga azaka za achinyamata zomwe zikupezekabe, zomwe zimawonetsedwa "modekha" mwa mtundu wachikulire, sizikuwonetsa zolakwika pamwambapa zikudutsa mayeso amtundu wa chibadwa, ndipo mwina sizingachitike chifukwa cha oyamba komanso oyamba kapena mtundu wachiwiri wa matenda, kapena mawonekedwe apakatikati a Lada.

Mawonetseredwe azachipatala

Ngati tiyerekeza matenda a shuga a mtundu wa shuga ndi matenda a shuga omwe amadalira insulin 1 kapena mtundu wa 2, ndiye kuti matendawa amapezeka bwino komanso modekha, nchifukwa chake:

  • mosiyana ndi DM1, pamene kuchuluka kwa ma cell a beta omwe amapanga insulini yofunikira kuti glucose ayambe kumachepa, zomwe zikutanthauza kuti kaphatikizidwe ka timadzi tating'onoting'ono timene timatsitsidwanso, ndi matenda a shuga a MODI kuchuluka kwa maselo okhala ndi majini "osweka" nthawi zonse
  • Kusagwiritsa ntchito mankhwala a DM 2 mosavutikira kumayambitsa kuwukira kwa hyperglycemia ndikukula kwamatenda minofu ya insulin, yomwe mwa njira imapangidwa pachiwonetsero muyeso, ndipo pokhapokha patapita nthawi yayitali matendawo amatsogolera kuchepa kwake, matenda a shuga a mtundu wa MOI, kuphatikiza "okalamba" odwala, kuphwanya kulolera kwa shuga pang'onopang'ono ndipo nthawi zambiri sizimapangitsa kusintha kwa kulemera kwa thupi, ludzu lalikulu, kusokonekera pafupipafupi komanso kukodza.

Sizikudziwika chifukwa chake, koma matenda a shuga a MODI amapezeka kawirikawiri mwa akazi kuposa amuna

Zachidziwikire, ndipo ngakhale osatero 100%, kodi ndi matenda amtundu wanji omwe amadwala matenda a shuga a mtundu wa MOI mwa ana kapena mtundu 1 wa matenda ashuga, adokotala amatha kuyesedwa kwa majini.

Chizindikiro cha phunziroli, mtengo wake udakali wowoneka bwino (ma ruble 30 000), izi ndi zizindikiro za matenda a shuga a MODI:

  • pakuwonekera kwa matendawa, komanso mtsogolomo, palibe kulumpha kowopsa mu shuga m'magazi, ndipo koposa zonse, kuchuluka kwa matupi a ketone (zinthu zakuwonongeka kwa mafuta ndi ma amino acid ena) m'magazi sikuchulukanso, ndipo sikupezeka mu urinalysis,
  • kuwunika kwa plasma ya ndende ya C-peptides kumawonetsa zotsatira malinga ndi malire ake,
  • glycated hemoglobin mu seramu yamagazi ili m'magulu 6.5-8%, ndipo magazi othamanga osapitirira 8.5 mmol / l,
  • palibe zizindikiro zakuwonongeka kwa autoimmune, komwe kumatsimikiziridwa ndi kusapezeka kwa ma antibodies ku cell ya beta ya kapamba,
  • "Maholide" a shuga amapezeka osati m'miyezi isanu ndi umodzi yokha matendawa atangoyamba kumene, komanso pambuyo pake, komanso kangapo kamodzi, pomwe gawo labodza silikupezeka,
  • ngakhale mlingo wocheperako wa insulin umayambitsa kukhululuka kokhazikika, komwe kumatha mpaka miyezi 10 mpaka 14.

Njira zamankhwala othandizira

Ngakhale kuti matenda a shuga a MOI mu mwana kapena wachichepere amapita patsogolo pang'onopang'ono, kugwira ntchito kwa ziwalo zamkati ndi mkhalidwe wamagulu amthupi kumadwalirabe, ndipo kusapezeka kwa mankhwalawa kumapangitsa kuti matenda azachipatala ayambe kukhala ovuta ndikupita gawo lovuta la T1DM kapena T2DM.

Zakudya zamankhwala ndi masewera olimbitsa thupi ndizofunikira pazamankhwala amitundu iliyonse

Malangizo a matenda a shuga a MODI ndi ofanana ndi malangizo a mtundu wa 2 wa matenda ashuga, koma amatsatizana mosiyanasiyana:

  • pa chiyambi - jakisoni wa insulini waletsedwa ndipo kuchuluka kwa mankhwala ochepetsa shuga, tsiku ndi tsiku mumakhala zosankha, zikuchitidwa kuti mufotokozere kufunika kochepetsa zakudya zamafuta,
  • ndiye kuti pakutha pang'onopang'ono mankhwala ochepetsa shuga komanso kukonza zowonjezera zolimbitsa thupi,
  • ndikotheka kuti kuwongolera shuga m'magazi a seramu kumakhala kokwanira kusankha njira yoyenera komanso mtundu wakuchita zolimbitsa thupi, koma ndikumachepetsa shuga ndi mankhwala pambuyo pa "kutonzedwa kwa tchuthi" maswiti.

Kwa mawu. Kusiyana kwake ndi MODZI 4 ndi 5. Njira zawo zamankhwala ndizofanana ndi kasamalidwe ka odwala omwe ali ndi matenda ashuga a mtundu woyamba. Mwa mitundu ina yonse ya MODI DM, insulini jab imayambiranso pokhapokha kuyesa kuyendetsa shuga m'magazi ndikuphatikizana ndi mankhwala ochepetsa shuga + zakudya + zolimbitsa thupi + zolimbitsa thupi sizinabweretse zotsatira zomwe mukufuna.

Muli mitundu ya SD Modi

Pano pali chidule chachidule cha mitundu ya MODI ndi chisonyezo cha njira yeniyeni yolamulirira glucose wamagazi, kuwonjezera pa zakudya zomwe zimadziwika pang'onopang'ono zamatumbo komanso zakudya zina zolimbitsa thupi.

Gome limagwiritsa ntchito SSP - mankhwala ochepetsa shuga.

Nambala ya ModIMawonekedweZoyenera kuchitira
1Zimatha kuchitika kamodzi pakubadwa, kapena pambuyo pake, mwa anthu obadwa ndi thupi lolemera kuposa 4 kg.BSC.
2Ndi asymptomatic, palibe zovuta. Anazindikira mwangozi kapena matenda a gestational, pomwe tikulimbikitsidwa kupaka insulin.Chitani masewera olimbitsa thupi.
3Amawoneka zaka 20-30. Ulamuliro wa glycemic watsiku ndi tsiku umasonyezedwa. Maphunzirowa atha kukulira, zomwe zimapangitsa kukula kwa mitsempha ya mitsempha komanso matenda a shuga.MTP, insulin.
4Pancreatic underdevelopment imatha kuwoneka nthawi yomweyo, monga matenda osatha a shuga kwa akhanda.Insulin
5Pobadwa, kulemera kwa thupi kumakhala kochepera 2.7 kg. Mavuto omwe angakhalepo ndi nephropathy, kupanikizika kwapang'onopang'ono, zonyansa pakupanga thumba losunga mazira ndi ma testicles.Insulin
6Imatha kuonekera muubwana, koma makamaka ikusintha pambuyo pa zaka 25. Ndi mawonekedwe amtsogolo, zovuta za masomphenya ndi kumva zimatha kuchitika mtsogolo.MTP, insulin.
7Ndi zosowa kwambiri. Zizindikiro zake ndizofanana ndi matenda amtundu wa 2 shuga.BSC.
8Imadziwoneka yokha zaka 25-30 chifukwa cha atrophy ndi pancreatic fibrosis yomwe ikupita patsogolo.MTP, insulin.
9Mosiyana ndi mitundu ina, imakhala ndi ketoacidosis. Pamafunika zakudya zopatsa thanzi, zopanda chakudya.MTP, insulin.
10Imadziwonekera yokha pambuyo pobadwa. Pafupifupi sizimachitika ubwana kapena unyamata, komanso mwa akulu.MTP, insulin.
11Atha kukhala limodzi ndi kunenepa kwambiri.Zakudya, MTP.
12Zimawonekera mukangobadwa.BSC.
13Kugwira ntchito kuyambira wazaka 13 mpaka 60. Pamafunika chithandizo mosamala komanso chokwanira, chifukwa zimatha kubweretsa zotsatirapo zonse zokhala ndi matenda ashuga.MTP, insulin.

Ndipo pomaliza nkhaniyi, tikufuna kupereka upangiri kwa makolo omwe ana awo akudwala matenda ashuga. Musawalange kwambiri ngati milandu yotsutsana ndi zoletsedwa ikadziwika, ndipo musawakakamize kuchita maphunziro akuthupi mokakamiza.

Pamodzi ndi dokotala wanu, pezani mawu othandizira ndi zikhulupiriro zomwe zingakulimbikitseni kuti muzitsatira zakudya. Inde, wopanga mankhwala olimbitsa thupi ayenera kuyesa kuganizira zomwe amakonda za mwanayo, ndi kusiyanitsa mitundu ya zochitika za tsiku ndi tsiku, kupangitsa makalasiwo kukhala osangothandiza, komanso osangalatsa.

Kusiya Ndemanga Yanu