Kodi kukana insulin ndi chiyani? Metabolic Insulin Resistance Syndrome

Metabolic syndrome
Amuna: kutalika - 177 cm, kulemera - 146 kg, BMI - 46 kg / m²
ICD-10-KM	E88.81
ICD-9	277.7 277.7
ICD-9-KM	277.7
Omim	605552
Diseasesdb	31955
Medlineplus	007290
Mesh	D024821

Metabolic syndrome (MS) (masinthidwe: metabolic syndrome X, Reaven syndrome, insulin kukana matenda) - kuchuluka kwa visceral mafuta, kuchepa kwa chidwi cha zotumphukira kuti insulin ndi hyperinsulinemia, zomwe zimasokoneza carbohydrate, lipid, purine metabolism, komanso zimayambitsa matenda oopsa.

Kuyambukira

Mu 1981, a M. Hanefeld ndi W. Leoonardt anaganiza zopanga matenda osakanikirana osiyanasiyana monga "metabolic syndrome" (MS).

Mu 1988, Pulofesa G. Reaven, pokamba nkhani yake ya Bunting, potengera zomwe awerenga ena akuchita mwachidule, adatsogola kunena motengera momwe insulin imakanira, kunenepa kwambiri pamimba, matenda oopsa a arterial hypertension (AH), atherogenic dyslipidemia, ndi matenda a mtima a coronary (CHD) amagwira ntchito ngati chiwonetsero cha matenda, omwe adatcha "Syndrome X". Mu 1989, D. Kaplan analemba mawu akuti "quartet yakufa": kuphatikiza matenda a shuga, kunenepa kwambiri, matenda oopsa, komanso matenda a mtima.

Malinga ndi H. Arnesen (1992), matenda a metabolic amadziwika kuti amatanthauza kuphatikiza chimodzi mwa zovuta zisanu izi:

• insulin kukana ndi kuchepetsedwa kulolerana kwa zakudya ndi hyperinsulinemia,
• dyslipoproteinemia ndi hypertriglyceridemia ndi otsika kwambiri kachulukidwe kolesterol lipoproteins,
• chizolowezi cha thrombosis komanso kuchuluka kwa plasma activator wa plasminogen activator inhibitor,
• ochepa matenda oopsa motsutsana ndi maziko achululi a zochitika za mtima wachisoni,
• kunenepa kwambiri ndi kuchuluka kwachulukidwe zamafuta amafuta am'mafuta mu mitsempha ya portal.

Kuyambukira

Malinga ndi WHO, kuchuluka kwa odwala omwe ali ndi matenda a insulin omwe ali pachiwopsezo chachikulu chokhala ndi matenda a shuga a 2 ndi anthu 40-60 miliyoni ku Europe. M'mayiko olemera, kuchuluka kwa matenda a metabolic pakati pa anthu opitilira 30 ndi 10-20%, ku United States - 34% (44% mwa anthu opitilira 50). Amakhulupirira kuti metabolic syndrome ndi matenda aanthu azaka zapakati komanso (makamaka) azimayi. Komabe, kafukufuku yemwe anachitika motsogozedwa ndi a American Diabetes Association akusonyeza kuti matendawa akuwonetsa kukula pakati pa achinyamata ndi achinyamata. Chifukwa chake, malinga ndi asayansi ochokera ku yunivesite ya Washington, kuyambira 1994 mpaka 2000, kuchuluka kwa matenda a metabolic pakati pa achinyamata kwakula kuchoka pa 4.2 mpaka 6.4%. Padziko lonse lapansi, kuchuluka kwa achinyamata ndi achinyamata omwe akudwala Syndrome X akuyerekeza oposa 2 miliyoni.

Metabolic syndrome ndivuto lalikulu kwambiri lamankhwala amakono lomwe limakhudzana ndi kukhalabe ndi moyo wopanda thanzi. Lingaliro la "kukhala ndi moyo wathanzi" limaphatikizapo kudya mokwanira, kukhala ndi thupi labwino, kuchita zolimbitsa thupi mokwanira komanso zaka zake, komanso kukana kumwa mowa ndi kusuta fodya.

Zambiri

Tisanapange lingaliro la "kukana insulini", chomwe liri komanso zomwe likhale nalo, ziyenera kunenedwa kuti matendawa ndi ofala mokwanira. Anthu opitilira 50% okhala ndi matenda oopsa amatha kudwala matenda amenewa. Nthawi zambiri, kukana insulini (chomwe ndi, kufotokozedwa pansipa) kumapezeka mwa okalamba. Koma nthawi zina, amapezeka ali mwana. Matenda okana insulini nthawi zambiri amakhala osadziwika osasokoneza metabolic asanayambe kuwonekera. Gulu lachiwopsezo limaphatikizapo anthu omwe ali ndi dyslipidemia kapena kulekerera shuga, kunenepa kwambiri, matenda oopsa.

Kukana insulini

Ichi ndi chiyani Kodi kuphwanya kuli ndi chiyani? Kagayidwe kachakudya matenda a insulin kukaniza olakwika thupi zochita za mmodzi wa mankhwala. Lingaliro limagwira ntchito zosiyanasiyana zachilengedwe. Izi, makamaka, zimakhudzana ndi mphamvu ya insulin pa mapuloteni ndi lipid metabolism, mawonekedwe a jini, ndi mtima wa endothelial function. Kuyankha kosavutikaku kumayambitsa kuwonjezeka kwa kuchuluka kwa pawiri m'magazi a magazi mpaka kuchuluka kwa glucose yofunikira kuchuluka kwa voliyumu yomwe ilipo. Insulin resistance syndrome ndi vuto lophatikiza. Zimaphatikizapo kusintha kwa kulolera kwa glucose, mtundu wa 2 shuga, dyslipidemia, ndi kunenepa kwambiri. Syndrome X imatanthauzanso kukana kuyamwa kwa glucose (wodalira insulin).

Njira yopititsira patsogolo

Mpaka pano, akatswiri akhala asakuwerenga. Zovuta zomwe zimatsogolera pakupanga insulin kukana zitha kuchitika zotsatirazi:

• Receptor. Pankhaniyi, mkhalidwe umawonetsedwa ndi ubale kapena kuchepa kwa chiwerengero cha omwe amalandila.
• Pa mulingo wa shuga. Pankhaniyi, kuchepa kwa chiwerengero cha ma molekyulu a GLUT4 apezeka.
• Prereceptor. Poterepa, amalankhula za insulin yachilendo.
• Postreceptor. Pankhaniyi, kuphwanya phospholation ndikuphwanya kufalitsa mawu.

Ma Anomalies a mamolekyulu a insulin ndi osowa kwambiri ndipo alibe kufunika kwachipatala. Mlingo wa Receptor utha kuchepetsedwa mwa odwala chifukwa cha mayankho olakwika. Amayambitsidwa ndi hyperinsulinemia. Nthawi zambiri odwala amachepetsa moyenera kuchuluka kwa ma receptor. Pankhaniyi, mulingo woyankha suwonedwa ngati chitsimikizo chomwe chimatsimikiziridwa kuti mulingo wa insulin uli pati. Zomwe zimayambitsa chisokonezo zimachepetsedwa ndi akatswiri kuti asokoneze ma postreceptor pakufalitsa mawu. Zinthu zopatsa, makamaka, zimaphatikizapo:

• Kusuta.
• Kuwonjezeka kwa zomwe zili mu TNF-alpha.
• Kuchepetsa thupi.
• Kuchulukitsa kwa kuchuluka kwamafuta osagwirizana ndi mafuta.
• M'badwo.

Izi ndi zinthu zazikuluzikulu zomwe nthawi zambiri zimapangitsa kuti insulin ikane. Kuchiza kumaphatikizapo kugwiritsa ntchito:

• Zojambula za gulu la thiazide.
• Beta-adrenoreceptor blockers.
• Nicotinic acid.
• Corticosteroids.

Kuchulukana kwa insulin

Zokhudza kagayidwe kakang'ono ka glucose zimapezeka mu minofu ya adipose, minofu ndi chiwindi. Minofu ya mafupa imapanga pafupifupi 80% ya pawiriyi. Minyewa pamenepa imakhala ngati gwero lofunika kwambiri la insulin. Kulanda kwa glucose m'maselo kumachitika ndi njira yapadera yamapuloteni a GLUT4. Pambuyo kutsegula kwa insulin receptor, mndandanda wa phospholution zimachitika. Mapeto ake amatsogolera pakusamutsidwa kwa GLUT4 mu membrane wa khungu kuchokera ku cytosol. Chifukwa chake glucose amapeza mwayi wolowa mu cell. Kukana kwa insulini (zomwe zikuwonetsedwa pansipa) kumachitika chifukwa cha kuchepa kwa gawo la GLUT4. Nthawi yomweyo, pali kuchepa kwa kugwiritsa ntchito shuga ndi ma cell. Kuphatikiza pa izi, kuwonjezera pakuphatikizira kukoka kwa glucose mu zotumphukira, kupanga kwa shuga ndi chiwindi kumapanikizidwa ndi hyperinsulinemia. Ndi mtundu 2 wa shuga, umayambiranso.

Amaphatikizidwa ndi insulin kukana nthawi zambiri. Ngati wodwalayo achulukitsa kulemera ndi 35-40%, mphamvu yotsika imachepa ndi 40%. Minofu ya adipose yomwe ili kukhoma kwamkati kwa khomo imakhala ndi zochita zambiri zapamwamba kuposa zomwe zili pansipa. Munthawi yowonera zachipatala, zidapezeka kuti kutulutsidwa kwamafuta ochulukirapo kuchokera ku ulusi wam'mimba kulowa m'magazi a portal kumayambitsa kupanga kwa chiwindi cha triglycerides.

Zizindikiro zamankhwala

Kukana kwa insulini, zizindikiro zomwe zimagwirizanitsidwa makamaka ndi kusokonezeka kwa metabolic, zitha kukayikiridwa kwa odwala omwe ali ndi vuto la m'mimba, matenda ashuga, mbiri ya banja yokhala ndi matenda a shuga 2, dyslipidemia, ndi matenda oopsa. Pangozi ndi azimayi omwe ali ndi PCOS (polycystic ovary). Chifukwa chakuti kunenepa kwambiri ndi chizindikiro cha kukana insulini, ndikofunikira kuyesa chikhalidwe chogawa minofu yamafuta. Malo ake amatha kukhala gynecoid - m'munsi mwa thupi, kapena mtundu wa admin - khoma lakutsogolo kwa peritoneum. Kuchulukitsa kumtunda kwa thupi kumazindikiridwa ndi chidziwitso chofunikira kwambiri cha insulin kukana, kusinthasintha kwa glucose komanso kulolera shuga kuposa kunenepa kwambiri m'munsi. Kuti mudziwe kuchuluka kwa minofu yam'mimba yamafuta, mutha kugwiritsa ntchito njira yotsatirayi: kudziwa kuchuluka kwa chiuno, m'chiuno ndi BMI. Amayi 0,8 azimayi ndi 0,1 kwa amuna ndi BMI yoposa 27, am'mimba onenepa kwambiri komanso kutsutsana ndi insulin amapezeka. Zizindikiro za pathology zimadziwonetsa kunja. Makamaka, malo opindika, oyipa amadziwika pakhungu. Nthawi zambiri zimawoneka mikwingwirima, patsinde, pansi pa thumbo ta mammary. Kusanthula kwa insulini kukana kuwerengera pamawonekedwe. HOMA-IR imawerengeredwa motere: kusala insulin (μU / ml) x glucose (mmol / l). Zotsatira zake zagawidwa ndi 22,5. Zotsatira zake ndi cholozera cha insulin. Norma - Januware 18, 2015

Zimayambitsa kagayidwe kachakudya matenda.

Insulin m'thupi imagwira ntchito zambiri. Koma ntchito yake yayikulu ndikulumikizana ndi ma insulin omwe amalumikizana ndi cell iliyonse. Pambuyo pake, zimagwirira zoyendetsa glucose kuchokera kumalo ang'onoang'ono kupita mu cell zimayamba. Chifukwa chake, insulin "imatsegula chitseko" cha khungu la glucose. Ngati ma receptor samayankha insulin, ndiye kuti mahomoni enieniwo ndi glucose amadziunjikira m'magazi.

Maziko a kagayidwe kachakudya matenda ndi insulin insensitivity - insulin kukana. Izi zitha kuchitika pazifukwa zingapo.

1. Makamaka. Anthu ena amakhala ndi insulitivity pamtundu wa majini. Jini, yomwe imayambitsa kukula kwa metabolic syndrome, ili pa chromosome ya 19. Kusintha kwake kungachititse kuti
   • maselo akusowa zolandilira insulin,
   • ma receptor samvera insulin,
   • chitetezo chathupi chimapanga ma antibodies omwe amatseka ma insulin-sensept receptors,
   • kapamba amatulutsa insulin yachilendo.
   
   Pali lingaliro lomwe limatsitsa kuchepa kwa insulin chifukwa cha chisinthiko. Katunduyu amathandizira kuti thupi lizitha kuthana ndi mavuto mosamala. Koma mwa anthu amakono, akamadya zakudya zamafuta ambiri komanso zamafuta, anthu oterewa amayamba kunenepa kwambiri komanso metabolic syndrome.
   
2. Chakudya chamafuta kwambiri komanso chakudya - Chofunikira kwambiri pakukula kwa metabolic syndrome. Mafuta ochulukidwa omwe amabwera ndi mafuta a nyama pamitundu yambiri amathandizira kukulitsa kunenepa kwambiri. Kuphatikiza apo, mafuta acids amachititsa kusintha kwamankhwala m'maselo, kumawapangitsa kuti azikhala osaganizira zochita za insulin. Zakudya zopatsa mphamvu zochulukirapo zimapangitsa kuti shuga wambiri komanso mafuta ambiri alowe m'magazi. Kuchuluka kwawo kumaikidwa m'maselo amafuta m'mafuta amkati, komanso m'misempha ina. Izi zimabweretsa kuchepa kwa chidwi chawo ndi insulin.
   
3. Khalidwe labwino. Kutsika kwa zochitika zolimbitsa thupi kumaphatikizapo kuchepa kwa kuchuluka kwa machitidwe onse a metabolic, kuphatikizapo kusweka ndi mayamwidwe amafuta. Mafuta achilengedwe amatsekera kutulutsa shuga m'magazi ndipo amachepetsa chidwi cha nembanemba yake kuti apange insulini.
   
4. Imakhalitsa kwa matenda oopsa. Zimayambitsa kuphwanya kwazungulira kwa zotumphukira, zomwe zimatsatiridwa ndi kuchepa kwa chidwi cha minofu kupita ku insulin.
   
5. Wosuta zakudya zochepa. Ngati zopatsa mphamvu za zakudya za tsiku ndi tsiku zimakhala zosakwana 300 kcal, izi zimabweretsa mavuto osasintha a metabolic. Thupi "limapulumutsa" ndikumanga malo osungirako, omwe amachititsa kuti mafuta awonjezeke.
   
6. Kupsinjika. Kupsinjika kwakutali kwa m'maganizo kumakwiyitsa magwiridwe amanjenje komanso ziwalo. Zotsatira zake, kupanga kwamahomoni, kuphatikizapo insulin, komanso momwe maselo kwa iwo amasokonezekera.
   
7. Kutenga insulin okonda:
   • glucagon
   • corticosteroids
   • kulera kwamlomo
   • mahomoni a chithokomiro
   
   Mankhwalawa amachepetsa kuyamwa kwa glucose ndi minofu, yomwe imayendetsedwa ndi kuchepa kwa chidwi cha insulin.
   
8. Mankhwala osokoneza bongo a insulin pochiza matenda a shuga. Chithandizo chopanda tanthauzo chimabweretsa insulin yambiri m'magazi. Zimasilira ma receptor. Pankhaniyi, kukana insulini ndi mtundu wa chitetezo chomwe thupi limachita kuchokera ku insulin yambiri.
   
9. Matenda a mahomoni. Adipose minofu ndi gawo la endocrine ndipo imasokoneza mahomoni omwe amachepetsa mphamvu ya insulin. Kuphatikiza apo, kunenepa kwambiri, kumachepetsa mphamvu. Mwa akazi, ndi kuchuluka kwa testosterone ndikuchepetsa estrogen, mafuta amadziunjikira molingana ndi mtundu wa "wamwamuna", mitsempha yamagazi imagwira komanso kusintha kwa matenda oopsa. Kutsika kwa mahomoni a chithokomiro omwe ali ndi hypothyroidism kungayambitsenso kuchuluka kwa lipids (mafuta) m'magazi ndikukula kwa insulin.
   
10. Zosintha zokhudzana ndi zaka. Kupanga kwa testosterone kumachepa ndi ukalamba, komwe kumayambitsa kukana insulini, kunenepa kwambiri, komanso matenda oopsa.
    
11. Apnea m'maloto. Kugwira mpweya m'maloto kumapangitsa kuti mpweya ubwere wa m'maganizo ndikuwonjezera mphamvu ya mahomoni okula. Izi zimathandiza kuti pakhale insulin sensitivity.

Zizindikiro za metabolic syndrome

Limagwirira kukula kwa kagayidwe kachakudya matenda

1. Kuchita masewera olimbitsa thupi ochepa komanso kuperewera kwa zakudya m'thupi kumayambitsa kusokonezeka kwa mphamvu ya zolandirana zomwe zimagwirana ndi insulin.
2. Zikondazo zimatulutsa insulini yambiri kuti athane ndi kusagwirizana kwa maselo ndikuwapatsa shuga.
3. Hyperinsulinemia (kuchuluka kwa insulini m'magazi) kumayamba, komwe kumayambitsa kunenepa kwambiri, kuperewera kwa lipid metabolism, ndi mtima, komanso kuthamanga kwa magazi.
4. Mafuta osaphatikizidwa amakhalabe m'magazi - hyperglycemia imayamba. Kuzungulira kwamphamvu kwa glucose kunja kwa cell ndi kutsika mkati kumapangitsa kuwonongeka kwa mapuloteni ndi mawonekedwe a ma radicals aulere, omwe amawononga cell nembanemba ndikupangitsa kukalamba kwawo msanga.

Matendawa amayamba osadziwika. Zilibe kupweteka, koma sizikhala zoopsa.

Zotsatira zomverera mu metabolic syndrome

• Ziwawa Kutenga kwa shuga m'magazi amtundu wa ubongo kumayambitsa kukwiya, kupsa mtima komanso kuchepa.
• Kutopa. Kusweka kumeneku kumachitika chifukwa chakuti ngakhale pali shuga wambiri, maselo samalandira glucose, amasiyidwa opanda chakudya komanso gwero lamphamvu. Chomwe chimapangitsa "kufa ndi njala" kwa maselo ndikuti mapangidwe omwe amayendetsa glucose kudzera mu membrane wa cell sagwira ntchito.
• Kusankha zakudya. Nyama ndi ndiwo zamasamba sizimayambitsa chidwi, ndikufuna maswiti. Izi ndichifukwa choti maselo aubongo amafunikira shuga. Mukatha kudya chakudya chamagulu, kusintha kumakhalapo kwakanthawi kochepa. Masamba komanso zakudya zama protein (tchizi tchizi, mazira, nyama) zimapangitsa kugona.
• Zowukira zamkati mwachangu zamtima. Momwe ma insulin okwera amathandizira kugunda kwa mtima ndikuwonjezera kutuluka kwa magazi kuchokera mumtima ndi chilichonse. Izi poyamba zimabweretsa kukula kwa makoma a theka lamanzere la mtima, kenako ndikutseka kukhoma kwa minofu.
• Ululu mumtima. Kuchuluka kwa cholesterol m'mitsempha yama coronary kumayambitsa kusokonezeka kwa zakudya za mtima ndi zowawa.
• Mutu zimagwirizanitsidwa ndi kuchepetsa ziwiya zaubongo. Kupsinjika kwa capillary kumawoneka ndi kuwonjezeka kwa kuthamanga kwa magazi kapena chifukwa cha vasoconstriction yokhala ndi zolembera za atherosulinotic.
• Kuchepetsa mseru komanso kusokoneza mgwirizano oyambitsidwa ndi kukhathamira kwa intracranial pokhudzana ndi kuphwanya kutuluka kwa magazi kuchokera mu ubongo.
• W ludzu komanso mkamwa youma. Izi ndi zomwe zimapangitsa kuti ma cell azisangalalo azilepheretsa chidwi chake ndi mitsempha yachisoni yomwe ili ndi magazi ambiri.
• Kuyesa kudzimbidwa. Kunenepa kwambiri kwa ziwalo zamkati komanso kuchuluka kwa insulin kumachepetsa matumbo ndikuchepetsa secretion wa zam'mimba timadziti. Chifukwa chake, zakudya zimakhalapo m'mimba yokumbira kwa nthawi yayitali.
• Kuchulukitsa thukuta, makamaka usiku - chifukwa cha insulin kukondoweza kwa mtima wamanjenje.

Mawonetseredwe akunja a kagayidwe kachakudya

• Kunenepa kwambiri pamimba, mafuta m'mimba ndi lamba. M'mimba mwa “mowa”. Mafuta amadzimadzi samadziunjikira kokha pakhungu, komanso kuzungulira ziwalo zamkati. Imangowafafaniza, kumawumiriza ntchito, komanso imayimba gawo la endocrine. Mafuta amabweza zinthu zomwe zimathandizira kuwoneka ngati kutupa, kuwonjezeka kwa mulingo wa fibrin m'magazi, zomwe zimawonjezera chiopsezo cha kuundana kwa magazi. Kunenepa kwam'mimba kumadziwika ngati chiwopsezo chakupitirira:
  • mwa amuna oposa masentimita 102,
  • mwa azimayi opitirira 88 cm.
• Mawanga ofiira pachifuwa ndi pakhosi. Awa ndi Zizindikiro zakuchulukirachulukira komwe kumakhudzana ndi vasospasm, yomwe imayambitsidwa ndi insulin yambiri.

  Kuthamanga kwa magazi (popanda mankhwala a antihypertensive)

  • Kuthamanga kwa magazi kwa systolic (kumtunda) kumapitilira 130 mm Hg. Art.
  • kuthamanga kwa diastolic (kutsika) kupitirira 85 mm Hg. Art.

Laborator Zizindikiro za metabolic syndrome

Kuyesedwa kwa biochemical kwa anthu omwe ali ndi metabolic syndrome kumawulula kupatuka kwakukulu kuchokera pazizolowezi.

1. Triglycerides - mafuta oletsedwa kwa cholesterol. Odwala omwe ali ndi metabolic syndrome, chiwerengero chawo chimaposa 1,7 mmol / L. Mlingo wa triglycerides umakwera m'magazi chifukwa chakuti mafuta amatulutsidwa m'mitsempha ya portal panthawi yanenepa kwambiri.
   
2. Lipoproteins density high (HDL) kapena "good" cholesterol. Kulimbirana kumachepa chifukwa chosakwanira kudya mafuta a masamba komanso kukhala phee.
   • azimayi - ochepera 1.3 mmol / l
   • amuna - ochepera 1.0 mmol / l
3. Cholesterol, otsika osalimba lipoproteins (LDL) kapena "yoyipa" cholesterol, kuwonjezeka kwa 3.0 mmol / L. Mafuta ochulukirapo amachokera ku minyewa ya adipose yozungulira ziwalo zamkati imalowa m'mitsempha yama portal. Mafuta awa amathandizira chiwindi kuti apange cholesterol.
   
4. Kuthamanga magazi oposa 5.6-6.1 mmol / l. Maselo a thupi samamwa glucose bwino, chifukwa chake magazi ake amakhala okwera kwambiri ngakhale atasala kudya usiku.
   
5. Kulekerera kwa glucose. 75 ga shuga amatengedwa pakamwa ndipo patatha maola 2 mulingo wamagazi wakhazikika. Mwa munthu wathanzi, shuga amayamba nthawi imeneyi, ndipo mulingo wake umabweranso mwakale, osapitirira 6.6 mmol / L. Ndi metabolic syndrome, ndende ya glucose ndi 7.8-11.1 mmol / L. Izi zikusonyeza kuti glucose samayamwa ndi ma cell ndipo amakhalabe m'magazi.
   
6. Uric acid zopitilira 415 micromol / l. Mlingo wake umakwera chifukwa cha kufooka kwa purine metabolism. Ndi kagayidwe kachakudya matenda, uric acid imapangidwa nthawi ya kufa kwa cell ndipo sinafotokozenso bwino ndi impso. Zimawonetsa kunenepa kwambiri komanso chiwopsezo chachikulu chotengera gout.
   
7. Microalbuminuria Maonekedwe a mamolekyulu amkodzo mumkodzo akuwonetsa kusintha kwa magwiridwe antchito oyambitsidwa ndi matenda a shuga kapena matenda oopsa. Impso sizisefa mkodzo mokwanira, chifukwa chake, mamolekyulu a protein amapezekamo.

Ndi dokotala uti yemwe ndiyenera kulumikizana ndi ine ngati wonenepa?

Endocrinologists amathandizira metabolic syndrome. Koma powona kuti kusintha kwamitundu yambiri kumachitika m'thupi la wodwalayo, kufunsira kungafunike: katswiri, wamtima, wazakudya.

Poika dokotala (endocrinologist)

Poll

Pa phwando, dokotala amatenga anamnesis ndikupanga mbiri yachipatala. Kafukufukuyu amathandiza kudziwa zomwe zimayambitsa kunenepa komanso kukula kwa metabolic syndrome:

• malo okhala
• zizolowezi zakudya, kuzolowera zakudya zabwino ndi zamafuta,
• anali ndi zaka zingati onenepa
• Kaya achibale akuvutika ndi kunenepa,
• kupezeka kwa matenda amtima,
• kuthamanga kwa magazi.

Kuyeserera kwa wodwala

• Kudziwitsa za kunenepa kwambiri. Mu metabolic syndrome, mafuta amakhazikika pa khoma lakunja lam'mimba, thunthu, khosi ndi nkhope. Ndi kunenepa kwam'mimba kapena kunenepa kwambiri kwamphongo. Ndi gynoid kapena mtundu wamkazi wa kunenepa kwambiri, mafuta amawaika m'munsi mwa thupi: m'chiuno ndi matako.
  
• Chiyeso chozungulira chozungulira. Zizindikiro zotsatirazi zikutsimikizira kukula kwa metabolic syndrome:
  • mwa amuna oposa masentimita 102,
  • mwa azimayi opitirira 88 cm.
  
  Ngati pali cholowa chamabadwa, ndiye kuti matenda a "kunenepa" amapangidwa pamasamba a 94 cm ndi 80 cm, motero.
  
• Kuyeza kwa chiyerekezo cha chiuno chomazungulira ndi kuzungulira kwa chiuno (OT / OB). Chiwerengero chawo sichiyenera kupitirira
  • mwa amuna oposa 1.0,
  • mwa akazi oposa 0,8.
  
  Mwachitsanzo, chiuno cha mzimayi ndi 85 cm, ndipo m'chiuno mwake ndi 100 cm. 85/100 = 0.85 - chizindikiro ichi chikuwonetsa kunenepa kwambiri komanso kukula kwa metabolic syndrome.
  
• Kuyeza komanso kuyesa kukula. Kuti muchite izi, gwiritsani ntchito muyeso wamankhwala ndi stadiometer.
  
• Kuwerengeredwa kwa index ya umzimba (BMI). Kuti mudziwe cholozera chogwiritsa ntchito formula:

BMI = kulemera (kg) / kutalika (m) 2

Ngati mndandanda uli mgawo la 25-30, izi zikuwonetsa kunenepa kwambiri. Miyezo yazowonjezera yoposa 30 imawonetsa kunenepa kwambiri.

Mwachitsanzo, kulemera kwa mzimayi ndi 90 kg, kutalika kwa 160 cm. 90/160 = 35.16, komwe kumawonetsa kunenepa kwambiri.

Kupezeka kwa striae (matanda otambalala) pakhungu. Ndi kukula kwambiri kwa kulemera kwake, makulidwe amtundu wa pakhungu ndi ma capillaries ang'onoang'ono amwazi amang'ambika. The epermermis amakhalabe athanzi. Zotsatira zake, mizere ofiira 2-5 mm imawoneka pakhungu, lomwe pamapeto pake limadzaza ndi ulusi wolumikizika ndikuwala.

Laboratory matenda a metabolic syndrome

C cholesterol chonse chakwera ≤5.0 mmol / L. Izi zimayambika chifukwa cha kusokonekera kwa lipid metabolism komanso kulephera kwa thupi kuyamwa mafuta moyenera. Cholesterol yayikulu imalumikizidwa ndi kudya kwambiri komanso kuchuluka kwambiri kwa insulin.

Mapuloproteins apamwamba kwambiri (HDL kapena cholesterol yapamwamba) amachepetsedwa ochepera 1 mmol / l mwa amuna komanso ochepera 1.3 mmol / l mwa akazi. HDL ndi "cholesterol" chabwino. Imasungunuka kwambiri, motero, siziikidwa pamakoma amitsempha yamagazi ndipo siyambitsa atherosclerosis. Mkulu wambiri wa glucose ndi methylglyoxal (chinthu chosokonekera cha monosugars) chimatsogolera ku kuwonongeka kwa HDL.

Low mole kulemera lipoproteins (LDL kapena otsika kachulukidwe cholesterol) ndende kumakulitsidwa ≤3.0 mmol / L. "Cholesterol yoyipa" imapangidwa mumikhalidwe ya insulin yowonjezera. Imasungunuka pang'ono, motero, imayikidwa pamakoma amitsempha yamagazi ndi mafomu a atherosulinotic malo.

Triglycerides okwera > 1.7 mmol / L. Mafuta amafuta amafuta omwe amagwiritsidwa ntchito ndi thupi kunyamula mafuta. Amalowa mu venous system kuchokera ku adipose minofu, chifukwa chake, kunenepa kwambiri, kuphatikizira kwawo kumawonjezeka.

Kuthamanga magazi a m'magazi kukwezedwa > 6.1 mmol / L. Thupi silitha kugaya glucose ndipo mulingo wake umakhalabe wokwera ngakhale mutasala kudya usiku.

Insulin inachuluka > 6.5 mmol / L. Mulingo wambiri wa ma pancreatic mahomoni amayamba chifukwa cha insulin ya insulin. Potukula timadzi tating'onoting'ono, thupi limayesetsa kuchita zinthu zolimbitsa thupi za maselo, ndikuonetsetsa kuti glucose imachokera.

Leptin kuchuluka > 15-20 ng / ml. Homoni wopangidwa ndi minofu ya adipose yomwe imayambitsa kukana kwa insulin. Minofu yambiri ya adipose, imakulitsa kuchuluka kwa timadzi timeneti.

Mankhwala mankhwala a metabolic syndrome

Chithandizo cha mankhwala a kagayidwe kachakudya umalimbana ndi mayamwidwe a insulin, kukhazikika misempha ya glucose komanso matenda a metabolism.

Gulu la mankhwala osokoneza bongo	Limagwirira mankhwala	Oimira	Momwe angatenge
Chithandizo cha lipid kagayidwe kachakudya
Hypolipidemic mankhwala (ma statins ndi ma fiber)	Amachepetsa kaphatikizidwe ka cholesterol, amathandizira pakuchotsa "cholesterol yoyipa" m'magazi. Ziphuphu zimachepetsa mulingo wa uric acid chifukwa cha kulowetsedwa kwamchere ndi impso.	Rosuvastatin	Tengani 5-10 mg ya mankhwala 1 kamodzi patsiku. Pambuyo pa milungu 4, adotolo amawerengera kuchuluka kwa cholesterol m'magazi ndipo amatha kuonjezera mlingo.
		Fenofibrate	Imwani mankhwalawa katatu patsiku: makapisozi awiri pakudya cham'mawa komanso 1 kapisozi nthawi yamadzulo.
Chithandizo cha insulin kukaniza ndi kuwongolera shuga
Mankhwala ochepetsa mphamvu ya insulin	Sinthani kutuluka kwa glucose mu cell osalimbikitsa insulin. Chepetsani kupanga mafuta acids, imathandizira kusintha kwa glucose kukhala glycogen. Amasintha kumangiriza kwa insulin ku ma cell receptors, ndikuwonjezera chidwi cha minofu kwa icho.	Metformin	Mlingo umakhazikika malinga ndi kuchuluka kwa shuga m'magazi a mapiritsi a 1-4. Mlingo wa tsiku ndi tsiku umagawidwa mu Mlingo wa 2-3. Gwiritsani ntchito mukatha kudya.
Mankhwala a Insulin Sensitization	Mankhwalawa amachedwetsa kuyamwa kwa glucose m'matumbo, amachepetsa kupanga shuga mu chiwindi ndikuwonjezera chidwi cha maselo kuti apange insulin. Kuchepetsa chilimbikitso ndikuthandizira kuchepa thupi.	Siofor Glucophage	Mlingo woyambirira ndi 500-850 mg katatu patsiku ndi chakudya. Pambuyo pa masabata awiri, kusintha kwa mankhwalawa ndikofunikira poganizira kuchuluka kwa shuga m'magazi.
Mavitamini	Alpha lipoic acid amawongolera chiwindi, amasintha kagayidwe ka cholesterol. Amakulitsa kuyamwa kwa shuga m'matumbo otupa.	Alpha lipon	Tengani piritsi limodzi katatu patsiku masabata atatu.
Mankhwala omwe amatulutsa kagayidwe ka magazi ndi magazi
Angiotensin-Kutembenuza Enzyme Inhibitors	Tsekani zochita za enzyme yomwe imayambitsa vasoconstriction. Amakulitsa kuunikira kwamitsempha yamagazi, amachepetsa kuthamanga kwa magazi, kutsogoza ntchito ya mtima.	Captopril	Mankhwalawa amatengedwa pamimba yopanda kanthu katatu patsiku. Mlingo wa tsiku ndi tsiku umachokera ku 25 mpaka 150 mg.
		Enalapril	0,01 g kamodzi patsiku, ngakhale zakudya.
Ma calcium antagonists kapena calcium blockers	Kuchepetsa kuthamanga kwa magazi, chepetsa kuchepa kwa mpweya m'misempha ya mtima ndipo nthawi yomweyo kukonza zakudya zake. Amakhala ndi ofooka okodzetsa.	Felodipine	Imwani piritsi limodzi (5 mg) kamodzi patsiku. Muzidya mosasamala kanthu za chakudya.
Kunenepa kwambiri
Fat Absorption Inhibitors	Kuchepetsa ntchito ya m'mimba michere ndipo potero kusokoneza kusweka ndi mayamwidwe am'mafuta m'matumbo aang'ono.	Xenical	Tengani kapisozi imodzi (120 mg) pachakudya chilichonse kapena pasanathe ola limodzi mutatha kudya.
		Orlistat	Tengani 120 mg pakudya yayikulu katatu patsiku. Ngati chakudyacho chili ndi mafuta pang'ono, ndiye kuti orlistat siyingatengedwe.
Mankhwala osokoneza bongo omwe amakhudza gawo lamanjenje lamkati komanso amachepetsa kulakalaka	Amatengera chikhalidwe cha kudya, amachepetsa kufunika kwa chakudya, komanso amachepetsa kudya. Amathandizira kuthana ndi njala pakudya.	Fluoxetine	Mankhwala ochepetsa nkhawa amalembedwa mapiritsi 1-3 tsiku lonse chakudya.

Yang'anani! Anorectics (mankhwala omwe amachepetsa chilakolako chofuna kudya) sangathe kugwiritsidwa ntchito pakuchepetsa thupi pochiza matenda a metabolic. Mankhwalawa amathandizanso kuchepetsa kukhudzidwa kwa minofu. Anorectics amaphatikizapo mankhwala otchuka awa: Fluoxetine, Prozac, Meridia, Reduxin.

Metabolic Syndrome

Kuti mubwezeretsenso kagayidwe kachakudya ndikuwonjezera mphamvu ya insulin, zinthu ziwiri ziyenera kukwaniritsidwa:

• zakudya zochepa zamafuta
• zolimbitsa thupi zolimbitsa thupi.

Tikhale tsatanetsatane wa izi.

Maphunziro olimbitsa thupi a metabolic syndrome.

Pa masewera, thupi limawotcha mafuta m'masitolo. Kuphatikiza apo, kagayidwe kamapangidwira, motero, ngakhale pakupuma, thupi limapitilizabe kupangira mafuta kukhala mphamvu.

Chifukwa cha maphunziro, mahomoni achisangalalo - ma endorphin - amapangidwa mu ubongo. Zinthu izi sizimangokhala bwino, komanso zimathandizanso kuti muzilakalaka kudya komanso kuti muchepetse kulakalaka kwa chakudya chamafuta. Chifukwa chake, pakakhala kumverera kwanjala, chakudya chama protein chopatsa thanzi chimathandiza kuthana nacho.

Kusinthika ndikukhala bwino, kuwonjezera chidwi cha insulin ndi chiwonetsero chochepa komanso kuchepa kwa ukalamba, magwiridwe antchito - mabonasi kuchokera pamasewera okhazikika.

Malamulo ochepa okuthandizani kuthana ndi kunenepa kwambiri.

1. Sangalalani. Sankhani masewera omwe ali oyenera. Ngati makalasi amabweretsa chisangalalo, ndiye kuti simudzasiya maphunziro.
   
2. Phunzitsani pafupipafupi. Apatseni nthawi yochita zolimbitsa thupi tsiku ndi tsiku. Muyenera kumvetsetsa kuti thanzi lanu limatengera kulangidwa pankhaniyi. Zabwino kwambiri zimawonedwa ngati zolimbitsa thupi masiku 6 pa sabata kwa mphindi 60.
   
3. Sankhani masewera oyenera.
   • Kwa anthu azaka zopitilira 50 omwe ali ndi vuto lozungulira komanso nthenda ya mtima, kuyenda kapena kuyenda kwa Nordic ndimitanda ya ski kuli koyenera.
   • Kwa anthu ochepera zaka 50, kuthamangitsidwa.
   • Pazaka zilizonse, kusambira, kupalasa njinga, kugwedeza, makina opitilira zingathandize kukonza mtima.
     
4. Osamagwira ntchito kwambiri. Maphunziro sayenera kufooketsa, mwinanso angawononge chitetezo chamthupi kwambiri. Yambitsani ndi katundu wochepa ndipo pang'onopang'ono muwonjezere nthawi ndi kulimba kwamakalasi.
   
5. Yang'anani kukwera kwanu. Mwabwino kwambiri, mafuta amawotchedwa pafupipafupi 110-130 kumenyedwa pamphindi. Mlingo wapamwamba wamtima: Zambiri zosachepera 220 pazaka. Mwachitsanzo, ngati muli ndi zaka 40, ndiye kuti chizindikiro chowopsa kwa inu ndi 22040 = kumenyedwa kwa 180 pamphindi kale. Ndikosavuta kugwiritsa ntchito kuwunika kwa mtima kuti muziwongolera kugunda kwamtima kwanu panthawi yophunzitsira.
   
6. Ganizirani zopinga zomwe zimatengera matenda ophatikizika ndi zovuta zoyambitsidwa ndi metabolic syndrome. Ndikulimbikitsidwa kukana maphunziro ngati:
   • mapuloteni opezeka mu mkodzo
   • kuthamanga kwa magazi ndiokwera kwambiri kuposa chizolowezi chanu,
   • kuchuluka kwa shuga m'magazi kuposa 9,5 mmol / L.

Anthu ambiri ali ndi chidwi ndi funso loti: "Ndimasewera ati omwe ndi othandiza kwambiri kuthana ndi kunenepa kwambiri?" Kuti muwonjezere zolimbitsa thupi zanu, masewera olimbitsa thupi a anaerobic ndi aerobic tsiku lililonse.

Anaerobic zolimbitsa thupi kapena kulimbitsa thupi (pamene minofu imagwira ntchito ndi kuchepa kwa mpweya) amathandizira kukonza kagayidwe ka magazi ndikuchepetsa kukana kwa insulini poonjezera kuchuluka kwa omwe amayendetsa shuga. Masewera olimbitsa thupi amathandizira kuti minofu ikhale yolimba, yowonjezera mafupa ndi mafupa, imakupatsani mphamvu. Kulimbitsa thupi kumakhala koyenera kwa anyamata ndi atsikana.

Zochita zolimbitsa thupi zimachitidwa mwachangu kwambiri ndipo zimafunikira kuyesetsa kwakukulu. Amayambitsa kupweteka kwambiri pam minofu yogwira ntchito. Izi ndichifukwa choti microfractures imawonekera pa ulusi wa minofu ndi lactic acid imadziunjikira mumisempha minofu.

Amakhulupirira kuti kuchita masewera olimbitsa thupi kumawonjezera chidwi cha insulin, koma anthu okhawo omwe ali ndi mtima wathanzi amatha kuwachita. Zochita za anaerobic zimaphatikizapo:

• kupindika
• akusambira mothamanga kwambiri
• kutsika pansi,
• Amphaka
• kukankha mmwamba
• kukweza zolemera (maphunziro opangira ma simulators).

Kuchita masewera olimbitsa thupi kumachitika mu njira za 3-5 zosatha osaposa mphindi 1.5. Njira zina zolimbitsa thupi zogwira ntchito zamagulu osiyanasiyana a minofu.Kutalika konse kwa maphunziro kwa woyamba ndi mphindi 20. Pang'onopang'ono onjezani nthawi yolimbitsa thupi kukhala ola limodzi.

Zochita zolimbitsa thupi za aerobic anachita pang'onopang'ono ndi kutsika kapena kwapakatikati. Potere, minofu imapatsidwa bwino ndi okosijeni, ndipo mafuta osunthika amawotchedwa. Masewera olimbitsa thupi a Aerobic amatchedwanso Cardio kulimbitsa thupi, amateteza matenda a mtima, amasintha ntchito yamapapu komanso amathandiza kuthana ndi kupsinjika. Zochita za Aerobic zimaphatikizapo:

• aerobics
• kuvina
• kuyenda
• kuyendetsa njinga kapena masewera olimbitsa thupi.

Maphunziro oyamba sayenera kupitirira mphindi 15 patsiku. Onjezani nthawi ya kalasi yanu pofika mphindi 5 mpaka 10 pasabata. Pang'onopang'ono, mufika pamlingo wofunikira kupirira, ndipo makalasi anu amatha pafupifupi ola limodzi. Mukapitiliza, mafuta ochulukirapo "amayaka".

Njira yophunzitsira yopepuka. Ngati pali vuto la impso (nephropathy) kapena m'maso (retinopathy), gwiritsani ntchito zovuta zolimbitsa thupi. Sichimayambitsa kuchuluka ndipo sikukweza katundu pazinthu zodwala. Zopepuka zamagetsi zimalimbikitsa kulumikizana, kusintha mgwirizano ndikuthandizira njira za metabolic.

Mukakhala m'makalasi, gwiritsani ntchito dumbbells (kapena mabotolo amadzi a pulasitiki) olemera 300-500 g.

• kusinthasintha ndi kukulira kwa ma biceps,
• kukweza manja mmwamba
• kutsamira kutsogolo
• kufalitsa mikono mmbali momasuka.

Chilichonse cholimbitsa thupi chimachitika pang'onopang'ono komanso bwino 3 magawo 10. Pakati pa seti yopuma ya mphindi 10-15.
Kumbukirani kuti minofu yambiri mthupi lanu komanso mafuta ochepa, ndizochedwa kumva kuti insulin ili ndi mphamvu. Chifukwa chake, ngati muchepa, mawonekedwe a metabolic syndrome amakhala ochepa.

Zakudya zoyenera ndi metabolic syndrome.

Cholinga chachikulu cha zakudya zamatenda a metabolic ndikuchepetsa kudya zamafuta ndi mafuta. Izi zikuthandizira kusiya kunenepa kwambiri komanso kuchepetsa thupi pang'onopang'ono.

Akatswiri azakudya zamasiku ano amadana ndi kusala kudya komanso kudya zakudya zama kalori ochepa. Pankhaniyi, munthu nthawi zambiri amamutsata ndikumverera kwanjala, chifukwa chake anthu okhawo omwe ali ndi mphamvu amatha kutsatira zakudya zotere. Zakudya zopatsa mphamvu zamafuta pang'ono (otsika-carb) ndizosangalatsa komanso zokhutiritsa. Zakudya zosiyanasiyana zimatha kukonzedwa kuchokera kuzinthu zovomerezeka.

Zakudya zama calori ochepetsetsa zimachepetsa chitetezo cha mthupi kuteteza ma virus ndi ma bacteria. Izi ndichifukwa choti thupi limasowa mapuloteni komanso mavitamini ofunikira kuti chitetezo cha mthupi chizigwira ntchito. Zakudya zamafuta ochepa, m'malo mwake, zimalimbitsa chitetezo chathupi komanso kukonza matumbo am'mimba, chifukwa cha mapuloteni komanso zinthu mkaka wowawasa, zipatso ndi ndiwo zamasamba.

Zakudya zama carb zotsika mtengo ziyenera kukhala chakudya cha moyo wonse. Kudya calorie ndi 1600-1900 calories. Muyenera kudya pafupipafupi 4-5 patsiku, koma m'magawo ang'onoang'ono. Zakudya izi zimathandiza kupewa njala.

Mndandanda wazogulitsa:

• mitundu yamafuta ochepa a nyama (nyama yamwana, kalulu, nkhuku yopanda khungu) ndi nkhuku 150-200 g patsiku,
• nsomba ndi nsomba zam'madzi 150 g,
• mazira - 1-2 patsiku mawonekedwe amamu kapena owiritsa kwambiri,
• mafuta amkaka ochepa,
• kanyumba tchizi 100-200 g,
• Mitundu yamafuta ochepa komanso osalimba kwambiri a tchizi cholimba - yochepa mpaka 30 g,
• masoseji amafuta ochepa kapena soseji yophika kawiri pa sabata,
• 25% masamba aliwonse osaphika, ena onse omwe amapatsidwa chakudya, kuwiritsa, kuwotcha, kuwotcha (osachepera 400 g).

Mitengo yobiriwira Yotsimikizika,

• Zipatso zopanda zipatso ndi zipatso mpaka 400 g. Zatsopano, zowuma kapena zamzitini popanda shuga.
• sauerkraut wotsukidwa ndi madzi,
• phala lochokera pa barele, ngale, zipatso za mazira, mpunga wa bulauni. 150-200 g pa ntchito iliyonse, malinga ndi malire a mkate,
• maphunziro oyamba (250-300 g) pamafuta ochepa, nyama, nsomba kapena msuzi wa bowa, msuzi wamasamba.
• buledi wa tirigu wathunthu, zopanga zipatso mpaka 200 g,
• tiyi, zipatso ndi ndiwo zamasamba popanda shuga,
• Mzere wa chokoleti chakuda, odzola ndi shuga m'mousse,
• kudya kwamadzi ndi ochepa malita 1.5. Izi zimayambitsa kuwonongeka kwamafuta mthupi.

Ndikofunikira kukana zinthu ngati izi:

• confectionery: maswiti, makeke, zonona
• kuphika, makamaka makeke owononga komanso puff,
• nyama zamafuta: nkhumba, mwanawankhosa, bakha,
• Zakudya zamzitini, nyama yosuta ndi nsomba, soseji, nyama,
• mpunga, semolina ndi oatmeal, pasitala,
• kirimu, yogurt wokoma, tchizi chamafuta ndi zinthu kuchokera pamenepo,
• margarine, mafuta ophikira,
• zoumba, nthochi, mphesa, madeti ndi zipatso zina zokoma,
• mayonesi, msuzi wazonunkhira wamafuta, zonunkhira,
• zakumwa zoziziritsa kukhosi, timadziti ndi timadzi tokoma ndi shuga.

Kamodzi pakatha masabata 1-2, mutha kudya tsiku limodzi ndikugwiritsa ntchito moyenera zakudya "zosafunikira".

Zosintha zamasiku a tsikulo

Chakudya cham'mawa: phala la buckwheat ndi batala, dzira lowiritsa kapena mazira osenda, tiyi kapena msuzi.

Chakudya cham'mawa chachiwiri: zipatso.

Chakudya chamadzulo: msuzi wamasamba wowawasa wowawasa (wopanda zokazinga komanso wopanda nyama), wowotcha masamba mumafuta a masamba, nyama yophika, zipatso zosapsa.

Chakudya chamadzulo: saladi watsopano wamasamba, nsomba yophika kapena yophika nsomba 150-200 g, tiyi.

Chakudya chachiwiri: kefir kapena yogurt yopanda mafuta.

Zomwe zimayambitsa kukula kwa metabolic syndrome

Ma insulin omwe amapangidwa ndi maselo a minyewa ya pancreatic amagwira ntchito zosiyanasiyana zomwe zimagwirizanitsidwa ndi kayendedwe ka metabolic.

Ntchito yayikulu ya mahormoni ndikupanga ma cell omwe ali ndi ma cell apadera apadera am'mimba mwa maselo otengera insulin. Chifukwa cha kupangidwa kwa zovuta, glucose imayendetsedwa mkati mwa malo, motero, khungu limadyetsedwa.

Pamene insulin receptor chitetezo chachitika, osati glucose yekha komanso insulin imadziunjikira m'magazi, zomwe zimayambitsa zovuta kwambiri pakukonzekera kagayidwe kazinthu.

Matenda a metabolic kwenikweni amakula chifukwa cha maonekedwe a ma cell a chodabwitsa monga kukana insulin. Kukana kwa insulini palokha kumatha kuyambitsidwa ndi zifukwa zosiyanasiyana.

Zomwe zimapangitsa kuti pakhale chitetezo chokwanira cha cell membrane receptors kwa insulin ndi:

1. Makamaka.
2. Kudya zakudya zokhala ndi mafuta ambiri komanso chakudya chamafuta.
3. Kukhala ndi moyo wongokhala.
4. Wodwalayo watalika nthawi yayitali.
5. Kugwiritsa ntchito pafupipafupi zakudya zama calorie otsika.
6. Kumachitika pafupipafupi zinthu zovuta.
7. Kugwiritsa ntchito mankhwala omwe ali ndi insulin antagonists.
8. Mankhwala osokoneza bongo a insulin pochiza matenda a shuga.
9. Matenda a mahomoni.
10. Kukhazikika kwa kugona m'thupi.
11. Sinthani m'thupi la amuna mukadzakula.

Matenda amtundu wa chibadwa amayamba chifukwa cha chibadwa cha insulin pamlingo wamtundu. Mtundu womwe umapangitsa kuti pakhale kusaganiza bwino uli pa chromosome ya 19.

Kusintha kwa mtsogolo kumabweretsa izi:

• maselo ali ndi ziwonetsero zosakwanira padziko
• zolandilira zimakhala insulin,
• chitetezo cha mthupi chimayamba kupanga ma antibodies omwe amatchinga ma cell ku cell membrane,
• kapamba kupanga insulin.

Kugwiritsa ntchito pafupipafupi zakudya zamafuta kwambiri komanso chakudya chamafuta ndizofunikira kwambiri zomwe zimapangitsa kukula kwa matenda a metabolic m'thupi la wodwalayo.

Kukhalapo kwa thupi la mafuta ochulukirapo kumapangitsa kuti kunenepa kwambiri.

Zizindikiro zakukula kwa matendawa

Metabolic syndrome ndimatenda omwe angayambitse matenda owopsa mthupi.

Matendawa ali mthupi amayamba osadziwika.

Mukukula kwake, matendawa samabweretsa kupweteka, koma kukula kotereku sikuyambitsa ngozi kwa anthu.

Kukana kwa insulini kuli ndi magawo a chitukuko mthupi:

1. Kuchepetsa zochitika zolimbitsa thupi ndi vuto lakudya kumayambitsa kuchepa kwa chidwi cha ma membrane receptors kupita ku insulin.
2. Pancreas imapanga insulin yochulukirapo kuti ithane ndi zovuta zomwe zimadza chifukwa cha zolandilira, zomwe zimafunikira kuti magawo athunthu azikhala ndi maselo.
3. Kuchuluka kwa insulin mthupi kumapangitsa kuti thupi likhale ndi vuto loti hyperinsulinemia imayambitsa kukula kwa kunenepa kwambiri, kusokonezeka kwa kagayidwe ka lipid, kusokoneza kayendedwe ka mtima ndi kuwonjezeka kwa magazi.
4. Kuchuluka kwa shuga osagonjetseka m'madzi am'magazi kumatsutsa kukula kwa hyperglycemia m'thupi. Mkulu kuchuluka kwa glucose kumayambitsa kukalamba kwa maselo.

Ndi kupita patsogolo mthupi la kuphwanya monga insulin kukaniza mthupi, zotsatirazi zamalingaliro otsatirawa zimawonedwa:

• nkhondo,
• maonekedwe akunenepa kwambiri,
• chakudya chochuluka,
• kupezeka kwa palpitations,
• kupweteka mumtima,
• kupezeka kwa mutu
• kuwoneka kwa mseru komanso kusagwirizana koyenda,
• ludzu lambiri ndi pakamwa pouma,
• maonekedwe okonda kudzimbidwa,
• maonekedwe a thukuta lochulukitsa.

Mawonekedwe akunja a kagayidwe kachakudya ndi zizindikiro zotsatirazi:

1. Kunenepa kwam'mimba, kuwonetseredwa mawonekedwe a mafuta m'mimba ndi lamba.
2. Maonekedwe ofiira mawanga m'chifuwa ndi khosi. Zizindikiro zoterezi ndi mawonekedwe a kuthamanga kwa magazi komwe kumakhudzana ndi kupezeka kwa mitsempha yamitsempha yama mtima. Kuphipha kwamitsempha kumatheka chifukwa cha kuchuluka kwa insulin m'mwazi.

Mu kafukufuku wa labotale, mawonetseredwe akuluakulu a metabolic syndrome ndi kuchuluka kwa triglycerides, kuchepa kwa lipoproteins, kuchuluka kwa cholesterol, kuwonjezeka kwa kusala kwa magazi ndi ena.

Zimayambitsa Insulin Resistance

Kuchepetsa kuchepa kwa insulin kwa minofu kungayambike chifukwa cha zinthu zambiri - kusintha kokhudzana ndi zaka, kutenga pakati, kulephera kugwira ntchito, kutha msanga, kunenepa kwambiri, matenda, kupsinjika, kuperewera kwa chakudya, uremia, cirrhosis, ketoacidosis, matenda a endocrine. Zomwe zimayambitsa kukana insulini ndizambiri:

• Shuga owonjezera. Mukamadya zakudya zokhala ndi shuga wambiri woyengedwa, thupi limayamba kupanga insulin. Mphamvu ya maselo pazotsatira zake imachepetsedwa, ndipo kuchuluka kwa glucose kumakhalabe kokwezeka.
• Kunenepa kwambiri Adipose minofu ali ndi endocrine ndi paracrine ntchito - imapanga zinthu zomwe zimakhudza kusokonekera kwa ma insulin. Mukunenepa kwambiri, kulumikizana kwa mahomoni ndi ma receptors komanso kayendedwe ka glucose kamasokoneza.
• Katundu wamtundu. Chomwe chimapangitsa kuti insulin ikane kukokana ndi chibadwa. Mavuto a metabolism ya Carbohydrate amapezeka mwa anthu omwe achibale awo mwachindunji amapezeka ndi matenda a shuga, kunenepa kwambiri, kapena matenda oopsa.

Kukana kwa insulini kumayamba pamene ziwopsezo kwambiri za insulin - chiwindi, adipose ndi minofu minofu - zimalephera kuzindikira zochita za timadzi timeneti. Njira zingapo zotsogola za pathological zadziwika: kuwonjezeka kwa mafuta acids aulere, hyperglycemia, kutupa kosafunikira kwamafuta, oxidative metabolic nkhawa, kusintha kwa matanthidwe a gene ndi kusokonekera kwa mitochondrial.

Mafuta aulere acids (FFAs) ndi gawo lapansi la kapangidwe ka triglycerides, omwe ndi insulin antagonists. Momwe kuchuluka kwa FFA kumachulukira komanso kagayidwe ka triglycerides mu myocyte amasintha, kuchuluka kwa omwe amayendetsa glucose amachepetsa, glucose imatsika pang'onopang'ono. Mu chiwindi, kudya kwambiri kwa FFA kumalepheretsa kusamutsidwa ndi phosphorylation ya glucose. Insulin siyiletsa gluconeogeneis, kupanga kwa glucose ndi hepatocytes kumawonjezeka. Ndi kukana kwa insulin, kaphatikizidwe ndi katulutsidwe ka VLDLP kumatheka, ndende ya HDLP yafupika. Chifukwa cha kuchuluka kwa FFA, lipids imadziunjikira mumaselo a kapamba, kusokoneza ntchito yawo ya mahomoni. Mphamvu ya antilipolytic ya insulin imatsitsidwa mu minofu ya adipose. Kunenepa kwambiri kumadziwika ndi njira ya aseptic yotupa mu adipocytes; oxidative nkhawa ndi hyperglycemia amapangidwa.

Gulu

Kuzindikira kwa minofu ya thupi pazotsatira za insulin kumatsimikiziridwa ndi zinthu zosiyanasiyana - zaka, kulemera kwa thupi, kulimbitsa thupi, kukhalapo kwa zizolowezi zoyipa ndi matenda. Kukana kwa insulini kumadziwika ndi mtundu wachiwiri wa matenda a shuga komanso matenda ena angapo komanso zikhalidwe zina, zomwe zimadalira matenda a metabolic. Kutengera izi, mitundu inayi ya insulin yotsutsana imasiyanitsidwa mu endocrinology:

1. Zachilengedwe. Ndi njira imodzi yozolozera kuti pakhale nthawi yosiyanasiyana kudya ndi kutulutsa mphamvu. Zimachitika pakati pa kugona usiku, pakati, kutha msinkhu, ukalamba, kugwiritsa ntchito mafuta pafupipafupi.
2. Zamatsenga. Dziwani ndi vuto la dysmetabolic. Muli matenda a shuga II amtundu wa shuga, matenda a shuga a mtundu woyamba, matenda ashuga a ketoacidosis, kuperewera kwa zakudya m'thupi kwa nthawi yayitali, kuledzera, komanso kunenepa kwambiri.
3. Endocrine. Zimayambitsidwa ndi ma pathologies a gland ya endocrine. Amatsimikizika ndi thyrotooticosis, hypothyroidism, Cushing's syndrome, acromegaly, pheochromocytoma.
4. Pathological non-endocrine. Cholinga chake ndi kusungira homeostasis m'matenda komanso zinthu zina zadzidzidzi. Imayendera limodzi ndi matenda oopsa, matenda aimpso osachiritsika, matenda a khansa, cachexia, matenda owopsa, poyizoni wa magazi, komanso opareshoni.

Zizindikiro za Insulin Resistance

Kukana kwa insulini sikuwonetsedwa bwino, koma kumachitika chifukwa cha zina za thupi, kumayambitsa kusokonekera kwa metabolic, kusintha magwiridwe amkati. Chifukwa chake, pokhudzana ndi kukana insulini, ndikofunikira kuyankhula osati za zizindikiro, koma za zomwe zimayenderana nawo. Mafuta ochuluka amawonedwa, makamaka nthawi zambiri m'chiuno. Mtundu wonenepa kwambiri umatchedwa kuti m'mimba. Mafuta ochulukirapo amadziunjikira mozungulira ziwalo, amakhudza ntchito yawo. Chizindikiro china chodziwika ndi kuthamanga kwa magazi, kuwonetsedwa ndi mutu kumbuyo kwa mutu, chizungulire, chisokonezo, kulumikizana, thukuta, komanso kufiira nkhope.

Kusintha kwa magawo a shuga m'magazi kumayambitsa odwala kutopa, kufooka, kukhumudwa, kusakwiya, kukumana ndi ludzu komanso njala. Khungu limatha kukhala ndi pigmentation yeniyeni - keratosis wakuda (acanthosis). Madera achikhungu pakhosi, m'mbali, m'mikwendo, pansi pa tinthu tating'ono ta m'mimba timachita khungu, timakhala taukali komanso makwinya, nthawi zina timakhazikika. Mwa akazi, kukana insulini nthawi zambiri kumayendera limodzi ndi zizindikiro za hyperandrogenism zochokera ku polycystic ovary syndrome. Zizindikiro zamtunduwu ndi seborrhea wamafuta, ziphuphu zakumaso, kusokonezeka kwa msambo, mawonekedwe a tsitsi lambiri la thupi m'manja, miyendo ndi nkhope.

Mavuto

Zotsatira zoyipa kwambiri za kukana insulini ndi matenda amtima komanso matenda ashuga.Ndi kukana kwa insulini komanso kunenepa kwambiri, ntchito ya insulini imachepetsa kuyambitsa vasodilation, ndipo kulephera kwamitsempha yamagazi kumatha ndikoyamba koyamba pakukonzekera kwa angiopathies (zovuta zamagazi). Komanso, kukana insulini kumathandizira kuti mapangidwe a atherosulinosis asinthe, chifukwa amasintha ntchito ya zinthu zophatikizika ndimagazi ndi njira ya fibrinolysis. Limagwirira kukula kwa mtundu II matenda ashuga monga kuchuluka kwa insulin kukaniza yaitali kukakamiza kwa hyperinsulinemia ndi kutsika kwatha kwa maselo a beta, kuchepa kwa insulin kapangidwe, ndi mapangidwe olimbitsa a hyperglycemia.

Zizindikiro

Kuzindikiritsa kukana kwa insulin ndi ntchito yovuta yodziwikitsa chifukwa chakuti matendawa alibe chiwonetsero chazachipatala ndipo samalimbikitsa odwala kufunsa chithandizo chamankhwala. Monga lamulo, zimapezeka mukamayesedwa ndi endocrinologist wa matenda a shuga kapena kunenepa kwambiri. Njira zofala kwambiri zodziwikitsa matenda ndi izi:

• Mayeso othandizira a insulin. Njira imakhazikika pakukhazikika kwa glucose, pomwe kupondereza zomwe maselo a β amapanga ndikupanga glucose amkati. Kuzindikira kwa insulin kumatsimikiziridwa ndi mulingo wa shuga m'magawo azofanana. Mtengo wa chisonyezo cha MI ndi ≥7.0, kukana insulini kumatsimikiziridwa.
• Mayeso a kulolerana a glucose. Amagwiritsidwa ntchito kwambiri pamakina ojambula, amawunika kukhalapo ndi kuopsa kwa hyperinsulinemia. Mu seramu yamagazi, mulingo wa glucose, C-peptide, insulin pamimba yopanda kanthu ndikatha kumwa chakudya umayezedwa. Maola awiri pambuyo pa carbohydrate katundu mu hyperinsulinemia, index ya insulini imaposa 28,5 μI / ml, ndi metabolic syndrome chizindikiro C-peptide ndi zoposa 1.4 nmol / L, ndipo mu shuga mellitus chizindikiro cha glucose ndioposa 11.1 mmol / L.
• Intravenous glucose kulolerana mayeso. Amakulolani kuti muwerenge gawo la insulin katulutsidwe, kupanga mtundu wa zochita zake. Panthawi ya ndalamayi, shuga ndi insulin zimayendetsedwa molingana ndi chiwembu, zotsatira zake zimawonetsa kusintha kwa glucose, mosasamala kanthu za insulin komanso pansi pa zomwe akuchita. Kukana kwa insulini kumatsimikiziridwa ndi index ya SI -4 min -1.
• HOMA-IR Index. Asanawerenge chitsimikizo, kuyezetsa magazi kumachitika, zikuwonetsa kuchuluka kwa insulin, shuga (glucose) mu plasma yothamanga imagwiritsidwa ntchito. Kukhalapo kwa kukana kwa insulin kumawonetsedwa ndi index pamwamba pa 2.7.

Chithandizo cha insulin

Kusamalira odwala ndi kokwanira. Sicholinga chongokulitsa mayankho a insulin, komanso kukonza matenda a shuga, cholesterol, insulin yamagazi, kuthetsa kunenepa kwambiri, komanso kupewa kunenepa kwambiri, matenda ashuga, mtima ndi matenda amitsempha. Kuchiza kumachitika ndi endocrinologist, katswiri wazakudya, wophunzitsa olimbitsa thupi. Odwala akuwonetsedwa:

• Mankhwala. Mankhwala amathandizira odwala omwe ali ndi nambala ya misa yoposa 30 omwe ali ndi chiopsezo cha matenda amtima. Biguanides, alpha-glucosidase blockers, thiazolidinediones amagwiritsidwa ntchito pochepetsa thupi komanso kuwonjezera insulin sensitivity.
• Zakudya zochepa za carb Anthu omwe ali ndi insulin kukana amawonetsedwa ngati chakudya chamagulu ochepa, koma osasala kudya. Chakudya chopatsidwachi chimachokera pakudya 5 mpaka 7 patsiku m'magawo ang'onoang'ono. Izi zimakuthandizani kuti mukhale ndi shuga wokhazikika, ntchito yofanana ya insulin.
• Kuchita masewera olimbitsa thupi pafupipafupi. Kuchita masewera olimbitsa thupi kumayendetsa mayendedwe a glucose komanso kuthekera kwa insulini kulimbikitsa kaphatikizidwe ka glycogen. Dongosolo la maphunziroli limasankhidwa kwa wodwala payekhapayekha: kuyambira kuyenda pamasewera ndi masewera olimbitsa thupi opepuka mpaka mphamvu ndi masewera olimbitsa thupi. Mkhalidwe waukulu ndikuchitika pafupipafupi kwamakalasi.

Zotsogola ndi kupewa

Mkhalidwe wa kukana insulini ukhoza kuwongoleredwa ndi njira yophatikizidwa, kuphatikizapo zakudya ndi masewera olimbitsa thupi. Ndi madokotala onse omwe amawaika, dokotala amapeza bwino. Pofuna kupewa, ndikofunikira kuwongolera kudya zakudya zamafuta, makamaka ogwira ntchito popanga shuga, kupewa kusachita masewera olimbitsa thupi, kukhalabe ndi moyo, kulowa dala masewera olimbitsa thupi. Ndikofunikira kuti anthu omwe ali ndi kunenepa kwambiri azingoyang'ana kuonda. Ngati pali mbiri ya banja yokhala ndi matenda a shuga, atherosulinosis, kuwunika kwa shuga, insulin, ndi cholesterol yamagazi ndikulimbikitsidwa.

Kuzindikira kagayidwe kachakudya matenda

Kuchiza kwa metabolic syndrome kumachitika ndi endocrinologists.

Mukukonzekera matendawa, zovuta zingapo zimachitika zomwe zingafune kuonana ndi akatswiri ena azachipatala, monga. Mwachitsanzo, wochita zamatsenga, wodwala zamtima komanso wodwala.

Mukapita ku endocrinologist, njira yodziwira matendawa imachitika m'magawo angapo.

Magawo akuluakulu azidziwitso ali motere:

• kafukufuku wodwala
• kuyesa wodwala,
• Laborator diagnostics.

Pochita kafukufuku wodwala, dokotala yemwe amapita amatenga zidziwitso ndikupanga mbiri yachipatala. Kafukufukuyu akufotokozera momveka bwino momwe moyo umakhalira, kudya ndi zosokoneza bongo, kupezeka kwa kunenepa kwambiri mwa abale ake apamtima, kupezeka kwa matenda amtima wodwala komanso kuthamanga kwa magazi.

Mukamayesa wodwala, adokotala amapita:

1. Kudziwitsa za kunenepa kwambiri.
2. Amayeza mbali yodwala.
3. Imazindikira mgwirizano womwe ulipo pakati chiuno ndikuzungulira kozungulira.
4. Amayeza kukula komanso kulemera wodwalayo.

Kuchita kafukufuku wa labotale mukazindikira matenda anu kumaphatikizapo maphunziro awa:

• muyeso wa cholesterol yathunthu m'magazi,
• muyezo wa kuchuluka kwa maselo olemera a lipoprotein ndi cholesterol yambiri m'thupi,
• kudziwa kuchuluka kwa otsika kulemera lipoproteins ndi otsika kolesterol m'thupi,
• kutsimikiza kwa triglycerides m'mwazi,
• kusala kwa plasma glucose,
• kuyeza kuchuluka kwa insulin mthupi,
• kuyeza kuchuluka kwa leptin m'thupi.

Kutengera ndi mayankho a mayankho komanso mayeso a labotale, adotolo akumaliza kuti wodwalayo ali ndi metabolic syndrome.

Chithandizo cha mavuto mthupi

Wodwala aliyense yemwe wapezeka ndi metabolic syndrome amafunikira njira yodziwira yekha chithandizo. Kusankhidwa kwa mankhwalawa kumatengera siteji komanso zomwe zimayambitsa kukula kwa kunenepa kwambiri.

Kuphatikiza apo, kusankha kwa mankhwala kumadalira zotsatira zamaphunziro a biochemical pazomwe zili pazinthu zina za madzi a m'magazi.

Kukhazikitsidwa kwa mankhwala a insulin kukana syndrome kumachitika makamaka pakukonzanso kulowetsedwa kwa insulin, kukhazikitsa index ya glucose m'thupi ndi kusintha njira zamafuta kagayidwe.

Pogwiritsa ntchito mankhwala osokoneza bongo, magulu otsatirawa a mankhwalawa amagwiritsidwa ntchito:

1. Mavitamini Mankhwala abwino amaphatikizapo matenda a shuga a Complivit ndi Oligim.
2. Hypolipidemic mankhwala.
3. Mankhwala ochepetsa mphamvu ya insulin.
4. Mankhwala omwe amalimbikitsa chidwi cha insulin.
5. Mankhwala omwe amatulutsa kagayidwe ka magazi ndi magazi.
6. Mankhwala osokoneza bongo ndi zoletsa zamafuta.
7. Mankhwala osokoneza bongo omwe amakhudza gawo lamanjenje lamkati komanso amachepetsa kulakalaka.

Mankhwala a metabolic syndrome, osavomerezeka kugwiritsa ntchito mankhwala omwe ali m'gulu la anorectics omwe amachepetsa chilakolako cha kudya. Mankhwalawa amathandizira kuchepa kwamphamvu kwa minyewa yamadzi mu insulin.

Mankhwalawa akuphatikiza mankhwala otsatirawa.: Fluoxetine, Prozac, Meridia, Reduxin.

Moyo pamaso pa kagayidwe kachakudya matenda

Kubwezeretsa kagayidwe kachakudya mthupi ndikuwonjezera chidwi cha insulini, pamafunika zinthu zingapo, zomwe zofunika kwambiri ndizopatsa thanzi pogwiritsa ntchito zinthu zomwe zimakhala ndi zochepa zamagalimoto ndipo zimapangitsa kuti thupi lizilimbitsa thupi kwambiri.

Mukamasewera masewera, thupi limawotcha mafuta m'masitolo. Kuphatikiza apo, panthawi ngati izi, njira za metabolic zimathandizira, izi zimathandizira kuti ngakhale thupi litakhala kuti likupuma, limapitilizabe kusinthira mafuta m'masitolo.

Kuchita zolimbitsa thupi pafupipafupi mu matenda a shuga komanso kupereka mphamvu zolimbitsa thupi kumabweretsa chitukuko cha mahomoni achisangalalo, ma endorphin, m'thupi la wodwalayo.

Mankhwala othandizira awa amathandizira kusintha kusintha kwamthupi, amathandizira kuti azilakalaka komanso kuwonjezera zilako zamoto.

Cholinga chachikulu cha zakudya zomwe zimagwiritsidwa ntchito mu metabolic syndrome ndikuchepetsa kudya zamafuta ndi mafuta. Zakudya zoterezi zimakuthandizani kuti muchepetse kunenepa kwambiri ndipo pang'onopang'ono muchotse kuchuluka kwakukulu.

Akatswiri azakudya zamasiku ano amadana kwambiri ndi njala komanso kugwiritsa ntchito zakudya zochepa zama calorie.

Zakudya zomwe zimagwiritsidwa ntchito mu metabolic syndrome ndizopatsa mphamvu zochepa. Ndipo ndi njira yoyenera yopangira menyu, imakhalanso yokoma komanso yokhutiritsa.

Pogwiritsa ntchito zakudya zosiyanasiyana zololedwa, mutha kuphika zakudya zosiyanasiyana.

Kugwiritsa ntchito zakudya zamafuta ochepa kuti muchepetse kunenepa kumapangitsa kuti chitetezo cha mthupi chizigwira ntchito bwino, zomwe zimachepetsa chitetezo cha mthupi motsutsana ndi ma virus ndi mabakiteriya.

Kugwiritsa ntchito zakudya zama carb ochepa kumakupatsani mwayi wolimbitsa thupi komanso kusintha matumbo chifukwa chogwiritsa ntchito zipatso, ndiwo zamasamba komanso zopatsa mkaka muzakudya. Kanema wosangalatsa munkhaniyi akuthandizani kumvetsetsa kuti insulin resistance syndrome ndi chiyani.