Matenda ashuga insipidus - zizindikiro ndi zizindikiro, matenda ndi chithandizo

- Inde, muli ndi matenda ashuga, mzanga!
-Kodi mukuganiza?
- Ndipo ntchentche yanu yatseguka, ndipo njuchi imawuluka pafupi!
(nthabwala zamankhwala)

Aliyense amadziwa mawu akuti matenda ashuga. Koma ochepa amadziwa zomwe zimatanthawuza, ndipo ochepa amatha kufotokoza momwe matenda a shuga amasiyana ndi shuga. Nthawi yakwana yoti mudzaze izi. Nthabwala, yomwe inadzakhala phokoso, imatchula njuchi yomwe imawulukira maswiti. Nzeru za anthu zimazindikira chizindikiro cha matenda ashuga: glucosuria (njuchi), ndiye kuti kuchuluka kwa shuga mumkodzo kumakulitsidwa.

Nthawi zambiri, shuga wamagazi amagwiritsidwa ntchito mu minofuyo ndi insulin ya mahomoni, yomwe imapangidwa ndi kapamba. Koma ngati ndikusowa, kapena ayi, kapena tiziwalo timeneti sitigwirizana ndi "ntchito" yake, ndiye kuti magazi amakhala ndi shuga wambiri, kenako zonse zimalowa mkodzo.

Chifukwa chake, mawu akuti "shuga" amatanthauza chidule cha Latin "mellitus", chomwe chimatanthawuza "kudutsa uchi." Kupatula apo, madokotala a Renaissance, nthawi yatsopanoyo, komanso m'zaka za XIX, analibe njira yodziwunikira, ndipo anakakamizidwa kulawa mkodzo wa wodwalayo. Mwina ndichifukwa chake kuyendera kwa dokotala wovomerezeka nthawi zonse kumawononga ndalama zambiri masiku akale.

Koma motani? Ndiye zingatheke bwanji kuti shuga asakhale “wopanda shuga”? Ndiye kuti, mkodzo wokhala ndi glucose mulibe? Kodi zingakhale bwanji M'malo mwake, palibe kutsutsana komveka pano. Chizindikiro chachiwiri cha matenda a shuga ndi polyuria, ndiye kuti, mkodzo wowonjezera, womwe umamasulidwa masana.

Zinali zofanana ndi kufananako komwe amatcha matendawo "matenda a shuga" kapena "matenda a shuga." Kodi matenda ndi chiyani? Kodi zimachitika kangati, ndipo zimathandizidwa bwanji?

Tsamba lofulumira

Matenda a shuga ana

Mwa ana aang'ono, matenda a shuga angayambike ndi zotsatirazi:

kufunikira kosintha pafupipafupi,
mapaipi onyowa
kuyamwa,
mavuto atulo.

Ndi madzi am'mimba (ndipo zimachitika mwa ana mwachangu kwambiri kuposa akuluakulu), malungo, kusanza, ndi kudzimbidwa zimatha kuchitika. Mwana samakula kapena kuchepera thupi komanso kukula bwino.

Zoyambitsa matenda a shuga insipidus

Zifukwa zake ndizosiyanasiyana, motero pali mitundu ingapo ya matenda a shuga:

Insipidus yapakati pa shuga imachitika ndi kuwonongeka kwa hypothalamus ndi / kapena pituitary gland atachitidwa opaleshoni, kuvulala kwambiri, kapena ndi chotupa cha gawo lino laubongo. Pali kuchepa kwa ADH, komwe kumatha kukhala kwakanthawi kapena kokhazikika. Palinso mitundu yamitundu yosakwanira yobisika ya ADH, yomwe imawonekera pobadwa. Chithandizo: kumwa mapangidwe a mapiritsi a mapiritsi a antidiuretic mapiritsi.
Nephrogenic shuga insipidus imachitika ngati aimpso tubules, momwe kuchuluka koyenera kwa madzimadzi kungamwe, sangayankhe kukondoweza kwa vasopressin. Pankhaniyi, palibe kuchepa kwa mahomoni, koma mawonekedwe ake ndi operewera. Matendawa nthawi zambiri amayamba chifukwa cha vuto lobadwa ndipo limadziwonetsa kubadwa, nthawi zambiri anyamata amadwala. Chithandizo - kuchepa kwa mchere wambiri, kuchuluka kwa madzimadzi, nthawi zina mankhwala ochokera ku gulu la okodzetsa kumathandiza (modabwitsa).
Gestational matenda a shuga insipidus amakhudzana ndi pakati. Nthawi zina ma enzyme opangidwa ndi placenta panthawi yoyembekezera amawonongetsa ADH m'magazi a amayi, ndipo matenda a shuga amapezeka. Mwamwayi, njirayi ndiyosowa. Nthawi zina chithandizo chokhala ndi analogue ya ADH chimafunika.

Palinso polydipsia yoyamba - mkhalidwe womwe ntchito yapakati pa ludzu mu hypothalamus imasokonekera. Nthawi yomweyo, munthu amakhala ndi ludzu nthawi zonse, ndipo magawidwe a mkodzo wambiri amalumikizidwa ndimadzi akumwa kwambiri. Ndi vuto ili, kugona usiku sikusokonezeka, ndipo mkodzo wokhazikika umatulutsidwa m'mawa.

Kuwopsa kwa matenda ashuga

Matendawa si owopsa pokhapokha wodwala akamwa. Izi ndizosokoneza - muyenera kumwa nthawi zonse ndipo nthawi zambiri mumapita kuchimbudzi, kuphatikizapo usiku, koma sizowopsa. Komabe, mikhalidwe ya kusowa kwamadzi, munthu yemwe ali ndi matenda a shuga amalumikizika msanga chifukwa kutulutsa mkodzo kumakhalabe kokwanira.

Kuthetsa madzi kumawonetsedwa ndi pakamwa pouma, kuchepa kwa khungu (crease sikuwongola), ludzu lalikulu ndi kufooka. Ngati vutoli silikukonzedwa mu nthawi, kusokonezeka kwa electrolyte kumachitika (kuchuluka kwa sodium ndi potaziyamu m'magazi amasintha). Amawonetsedwa ndi kufooka kwambiri, kunyansidwa komanso kusanza, kukhumudwa komanso kusokonezeka ndipo amafunika kuthandizidwa mwachangu.

Zoyenera kuchita ngati mukukayikira matenda ashuga

Funsani dokotala wodziwa bwino, chifukwa pali zifukwa zambiri zakumwa kwambiri. Matenda a inshuwarasi sikuti ndi zovuta kuti adziwe matenda, koma kukayikakayika kumachitika kawirikawiri kuposa momwe zimachitikira. Kuyesedwa ndi kuchepetsedwa kwa madzimadzi kumathandizira kusiyanitsa ndi zifukwa zina (wodwalayo samamwa kwa maola angapo, motsutsana ndi maziko awa, kuyesa kwamkodzo ndi magazi, kuyeza, ndikuyerekeza kuchuluka kwa mkodzo wambiri) kumachitika. Kuphatikiza apo, pakutsimikizira shuga insipidus, ndikofunikira kupatula zotupa za hypothalamic-pituitary zone.

Matenda a shuga - ndi chiyani?

matenda ashuga odwala matenda a shuga 1

Matenda a shuga ndi matenda amtundu wa endocrine pomwe impso zimalephera kuloza mkodzo. Vutoli limachitika chifukwa chosowa ma antidiuretic mahomoni, ndipo zizindikiro zazikulu za matendawa ndi:

Kupatula mkodzo "wambiri",
Ludzu lalikulu lomwe limakhudzana ndi kuchepa kwamadzi.

Mwachilungamo, ziyenera kunenedwa kuti kuchuluka kwachilendo kwa mapangidwe a mkodzo woyamba (i.e. kusefedwa kwa madzi am'magazi) ndi 100 ml / miniti. Izi zikutanthauza kuti mu ola limodzi malita 6 a mkodzo apangidwe, ndipo patsiku - malita 150, kapena zitini 50-lita imodzi!

Koma 99% ya mkodzo, momwe zinthu zofunika zimakhala, zimabwezeretsedwanso m'malo obanika. Ntchitoyi imayendetsedwanso ndi mahomoni a pituitary, omwe amatenga gawo lalikulu m'madzi - mchere kagayidwe ka thupi. Amatchedwa antidiuretic mahomoni (i.e., kuchepetsa diuresis, kapena kuchuluka kwa mkodzo tsiku ndi tsiku) mwa anthu.

Kukula kwa matendawa kumachitika chimodzimodzi kwa amuna ndi akazi, komanso kwa ana, koma kumakhala kochepa kwambiri poyerekeza ndi matenda a shuga. Nthawi zambiri achinyamata amavutika.

Kodi zimagwira bwanji?

Hormone ya antidiuretic, kapena vasopressin, ndi gawo limodzi la magawidwe ovomerezeka amomwe magazi amayenda, kamvekedwe ka mtima, madzi amthupi ndi sodium zimalumikizana molumikizana mu "node" umodzi wotchedwa renin - angiotensin - aldosterone system (RAAS).

Chifukwa chake, magazi akayamba kuchepa impso (magazi akutsikira, magazi sodium amachepetsa), ndiye kuti mu glomeruli la impso chinthu chapadera chimapangidwa mogwirizana ndi chizindikirocho - renin. Zimayambitsa kusinthika kwa kusintha kwa mapuloteni a plasma, angiotensin amapangidwa, omwe amachepetsa lumen ya mitsempha yamagazi. Zotsatira zake, kupsinjika kumabwezeretseka.

Vasopressin, kapena antidiuretic mahomoni (ADH), amapangidwa mu ubongo kuti athe kuwongolera magwiridwe antchito. Imachepetsa kuchuluka kwa mkodzo, ndikuwonjezera kuyamwa kwa madzi kulowa m'magazi. Kunena mosapeneka, mu timabowo ta impso mumakhala "chipewa", chotsegulidwa, madzi ochokera mkodzo woyamba amabwerera magazi. Ndipo kuti titsegule "ma valve" masauzande ambiri pamatchalitchiwa, ma molekyulu a vasopressin, kapena ADH, amafunikira.

Tsopano tili omveka (mwapadera kwambiri) ntchito ya vasopressin ndi udindo wake pakayendetsedwe ka ntchito ya impso, ndipo titha kumvetsetsa mitundu ya matenda a shuga insipidus omwe alipo. Tsopano ngakhale munthu wamba akhoza kumvetsetsa bwino kuti mitundu iwiri yayikulu ya matendawa ndi yotheka: chapakati komanso cham'mphepete.

Matenda a shuga apakati

Zizindikiro za matenda a shuga a insipidus mwa akazi

Insipidus yapakati pa shuga imapezeka ngati "pakati", ndiye kuti, ubongo, pazifukwa zina satulutsa timadzi mu magazi, kapena ochepa kwambiri. Pali kuperewera kwathunthu kwazinthu izi.

Zomwe zimayambitsa mawonekedwe awa ziyenera kufunidwa m'matenda ndi zinthu zotsatirazi zomwe zimakhudza ubongo:

zotupa ndi chosaopsa cha tchire England ndi hypothalamic dera,
matenda atapita. Zitha kuchitika pambuyo pa chimfine chachikulu komanso ma virus ena.
Mikwingwirima ya ischemic yomwe imasokoneza magazi kupita kwa pituitary ndi hypothalamus,
chitukuko cha zoopsa pambuyo pake.
metastatic zotupa za hypothalamic-pituitary dongosolo.

Nephrogenic shuga insipidus - mawonekedwe akunja

Fomu yotumphukira ndi nephrogenic shuga insipidus. Mawu oti "nephrogenic" amatanthauza "anawonekera impso." Ndiko kuti, ubongo, hypothalamus ndi pituitary gland zimapanga kuchuluka kokwanira kwa timadzi iyi, koma minyewa ya impso sazindikira kulamula kwake, ndipo kuchuluka kwa mkodzo kuchokera pamenepa sikuchepa.

Kuphatikiza apo, pali mtundu wachitatu wa matenda ashuga, womwe umawoneka pakubala, koma, mwamwayi, nthawi zambiri umasowa pawokha pakutha kwa trimester yachitatu, kapena pambuyo pobala. Kupezeka kwake kumachitika chifukwa chakuti michere yapadera yomwe chivundikirocho chimatulutsa imatha kuwononga mamolekyulu, ndikupangitsa kuchepa kwina.

Zomwe zimayambitsa matenda a shuga a nephrogenic insipidus ndi, kuwonongeka kwa impso, komanso matenda ena akulu amwazi:

kobadwa nako komanso zopezeka mu medulla ya impso,
glomerulonephritis,
sickle cell anemia,
amyloidosis ndi polycystic matenda a impso,
CRF, kapena kulephera kwa impso,
kuwonongeka kwa poizoni wa minyewa (ndikugwiritsanso ntchito mankhwala osokoneza bongo, kugwiritsa ntchito mankhwala osokoneza bongo kwa nthawi yayitali, komanso kugwiritsa ntchito mankhwala osokoneza bongo).

Dziwani kuti kuwonongeka kwa impso kuyenera kukhala "kutulutsa", ndikukhudza impso zonse. Kupatula apo, ngati, mwachitsanzo, kusasinthika kwa chitukuko kapena vuto latsoka lomwe lidakhudza impso imodzi, ndipo lachiwiri lidakhalabe lathanzi kwathunthu, ndiye kuti ntchito yake "imayenera" thupi lonse.

Amadziwika kuti kuchotsedwa kwa impso imodzi (ngati yachiwiri ili ndi thanzi, kutuluka kwa magazi ndi kukodza kwake kumasungidwa kwathunthu) kulibe vuto mthupi.

Cryptogenic shuga insipidus ilinso. Izi zikutanthauza kuti chifukwa chenicheni sichinapezeke, ndipo pafupipafupi matendawa ndi okwera kwambiri - pafupifupi 30%. Makamaka nthawi zambiri kuzindikira kumeneku kumachitika kwa odwala okalamba omwe ali ndi ma endocrine ambiri a psychology. Kodi matenda ashuga amayamba bwanji, ndipo ndi zizindikiro ziti zomwe zimachitika?

Zizindikiro ndi matenda a shuga insipidus

matenda ashuga odwala matenda ashuga

Tanena pamwambapa kuti zizindikiro za matenda a shuga insipidus ndi zomwezi mwa akazi ndi amuna. Izi zili choncho chifukwa timadzi timeneti timapezekanso m'magulumagulu onse amodzi ndipo timagwira ntchito yomweyo mthupi. Komabe, zomwe zimachitika chifukwa cha matendawa ndi kuphwanya kwamchiberekero - kusamba kwa msambo, amenorrhea, kenako - kubereka. Kukula kwa chithunzi chachipatala kumadalira zinthu ziwiri izi:

Magazi a mahomoni
Chowopseza chake ndichinthu chachilendo chomwe chimapezeka m'matumbo a impso.

Ngati mukukumbukira, chinthu chomwecho chimadziwika ndi matenda a shuga: kusapezeka kwa insulin kumabweretsa mtundu 1 wa shuga, komanso insulin kukana mtundu 2 shuga. Mwambiri, iyi ndi njira yotchuka yamatenda ambiri a endocrine.

Ngati chilichonse chasweka, mahomoni ndi ochepa, ndipo ma receptor amagwira ntchito molakwika, ndiye kuti chithunzi cha matendawa chimayamba. Zizindikiro zikuluzikulu ndi kuzungulira-nthawi, kunjenjemera kwambiri komanso kugona mozungulira. Mlingo wa mkodzo womwe umapangidwa patsiku umatha kufika 20-25 malita. Mwachilengedwe, thupi silingathe kupirira chifukwa cha nthawi yayitali.

Chifukwa chake, posachedwa mwayi wolipirira umatha, ndipo odwala ali ndi chizindikiro chachiwiri cha matenda ashuga - awa ndi monga:

Zizindikiro za exicosis, kapena kuchepa kwa madzi m'thupi (pakamwa pouma, mucous nembanemba, zilonda zapakhosi, kuchepa kwa khungu turgor),
Matenda, ndi kuchepa thupi,
Gastroptosis (kusokonezeka ndi kuchepetsedwa kwa m'mimba, popeza wodwalayo amamwa pafupifupi tsiku lonse),
Popeza kuperewera kwa madzi m'thupi komanso kupyinjika kwamadzi m'matumbo am'mimba amaphatikizika, kulephera kugaya kumayamba,
Kupanga kwa bile, kapamba wa kapamba amasokonezeka, dysbiosis imakula,
Zizindikiro zakuchepa kwa ureters ndi chikhodzodzo chifukwa cha kupsinjika,
Thukuta limasokonekera
Chifukwa chakusowa kwamadzi, kusokonezeka kwa miyendo kumatha kuchitika, kuthamanga kwa magazi kumachepa,
Chifukwa cha kukulira kwa magazi, kutentha kwa thupi kumachepa, thrombosis ndiyotheka, mpaka kukulitsa matenda a mtima ndi stroko,
Mwinanso kusintha kwa maukonde ausiku, chifukwa cha kutopa kwapang'onopang'ono kwa chikhodzodzo,
Wodwalayo amakhala ndi vuto lolefuka, kufooka komanso kuchepa mphamvu kwa ntchito, kulephera kudya, nseru komanso kusanza.

M'malo mwake, wodwalayo amasandulika kukhala "fakitale" yotsalira yopopera madzi.

About matenda a shuga insipidus

Kuzindikira matenda a shuga a insipidus nthawi zambiri sikovuta. Kutengera madandaulo, ndi chithunzi chachipatala, kuchuluka kwa mahomoni m'mwazi kumatsimikiziridwa, ntchito ya impso imayesedwa. Koma ntchito yovuta kwambiri si kukhazikitsa matenda, koma kupeza zomwe zikuyambitsa.

Kwa izi, MRI ndi angiography ya ubongo, zithunzi za chishalo cha ku Turkey zimachitidwa, maphunziro ochulukitsa a mahomoni amachitidwa. Urology ndi ultrasound ya impso imachitidwa, ma ion m'magazi am'madzi ndi mkodzo amatsimikiza, osmolarity yamagetsi amafufuzidwa.

Pali njira zochulukirapo zozindikirira matenda amtunduwu. Izi zikuphatikiza izi:

Hypernatremia (wopitilira 155),
plasma hyperosmolarity oposa 290 mosm,
mkodzo hypoosmolarity (kutsika) zosakwana 200 mosm,
isohypostenuria, ndiko kuti, kachulukidwe kochepa ka mkodzo, komwe sikapitilira 1010.

Zonsezi zimathandizanso kudziwa matenda a shuga. Nthawi zambiri amasiyanitsa ndi matenda a shuga, komanso neurogenic (psychogenic) polydipsia. Momwe mungagwiritsire ntchito matenda opweteka, ndipo ndizotheka kukwaniritsa zonse zomwe zachitika?

Chithandizo cha matenda a shuga insipidus, mankhwala osokoneza bongo

Nthawi zina kuchotsedwa kwa zomwe zimayambitsa (mwachitsanzo, chithandizo cha glomerulonephritis) kumabweretsa kutha kwa zizindikiro za matenda. Ngati zifukwa sizipezeka, ndipo kuchuluka kwa mkodzo komwe sikudutsa malita 3-4 patsiku, ndiye kuti chithandizo cha matenda obwera chifukwa cha matenda ashuga mwa akazi ndi abambo chimalipidwa ndi zakudya komanso njira zomwe sizovuta kutsatira.

Kukonzekera

Pankhani ya matenda oopsa, kupezeka, kapena kuchepa kwambiri kwa mphamvu ya timadzi m'magazi, kuthandizira mankhwala othandizira ndi desmopressin, analogue ya ADH. Mankhwala amatchedwanso "Minirin", ndipo amagwiritsidwa ntchito papiritsi.

Popeza "kuphatikiza" kwa kupanga kwa mahomoni kumadalira kuchuluka kwa kuchepa kwake, mkati mwa sabata yoyamba kuvomerezedwa, mlingo umasankhidwa, womwe umayamba pang'ono ndi pang'ono mpaka kutha kwa matenda komanso kuthetsa zizindikiro za matendawa. Mankhwalawa amatengedwa katatu patsiku.

Zikachitika kuti ndi mitundu yapakati ya ADH imapangidwabe, ndiye kuti matenda a shuga a insipidus amathandizidwa ndimankhwala omwe amawonjezera katulutsidwe ka ADH. Izi zimaphatikizapo Miskleron ndi anticonvulsant drug carbamazepine.

Mu mawonekedwe aimpso, chithandizo chovuta chimayikidwa. NSAIDs amagwiritsidwa ntchito, amagwiritsa ntchito zakudya, cytostatics (makamaka pochiza matenda a impso a autoimmune).Chepetsani kuchuluka kwa mchere muzakudya, onjezani potaziyamu (mbatata yophika, zipatso zouma). Pofuna kuchepetsa ludzu, ndikofunika kusiya zakudya zotsekemera.

Chithandizo cha matenda

Pankhani yoyambirira komanso yodziwika bwino, matenda a shuga ndi "matenda opatsirana". Ndi mitundu ya magengenic, wodwalayo amathandizidwa moyo wake wonse, mankhwalawa "Minirin" ngati ali ndi vuto losakwanira, amatenga moyo, ndipo nthawi ndi nthawi amayang'anira zizindikiro za kusinthanitsa kwa ion.