Kodi matenda a shuga a LADA ndi chiyani

Amadziwika kuti kumapeto mtundu II matenda ashuga mabodza akukula insulin kukana (minofu yotsutsa insulini) ndi kulipiritsa kwakanthawi kuchuluka kwa insulin ndi kutsika kwotsatira ndi kuwonjezeka kwa shuga m'magazi. Komabe, asayansi sanamvetsetse chifukwa chake mu odwala ena omwe ali ndi matenda amtundu wa II, kuponderezana pang'onopang'ono komanso kufunikira kwa mankhwala a insulin kumachitika pokhapokha m'zaka makumi angapo, pomwe ena (kuchuluka kwawo ndikocheperako) - kale mu zaka zochepa (kuyambira miyezi isanu ndi umodzi mpaka zaka 6) Anayamba kumvetsetsa malamulo a shuga wachiwiri. Pofika pano, ntchito yofunika kwambiri yopanga matendawa ku mtundu wa shuga I inali yodziwika kale (ngati simunawerenge, ndikulimbikitsa kuti muwerenge).

Akatswiri a shuga a ku Australia mu 1993 ntchito yosindikizidwa yokhala ndi zotsatira zaphunziro ma antibodies ndi mayendedwe C peptide poyankha kukondoweza glucagonzomwe zimachulukitsa shuga.

C-peptide ndi chotsalira chochepa cha mapuloteni chomwe chimapangidwa ndi ma enzymes kuti asinthe molekyu ya proinsulin kukhala insulin. Mlingo wa C-peptide umagwirizana mwachindunji ndi msinkhu wa insulin. Mothandizidwa ndi C-peptide, munthu amatha kuyesa kubisika kwa insulin yodwala mkati mwa wodwala pa insulin.

C-peptide imatsala panthawi yopanga insulin kuchokera ku proinsulin.

Kufufuza kwa autoantibodies ndi kutsimikiza kwa kuchuluka kwa zomwe zidapangitsa C-peptide mwa odwala omwe ali ndi matenda amtundu II adapereka zotsatira zosayembekezereka. Zinapezeka kuti odwala kukhalapo kwa ma antibodies ndi secretion yochepa ya C-peptide alibe mtundu wachiwiri wa matenda ashuga (monga momwe amachokera ku chipatala), koma akuyenera kutero Mtundu I shuga (ndi makina a chitukuko). Pambuyo pake zidadziwika kuti amafunikira insulin yoyendetsedwa kale kuposa gulu lonselo. Maphunzirowa adatilola kusiyanitsa mtundu wina wa matenda ashuga - "lembani 1.5 shuga", Yodziwika bwino pansi pa chidule cha Chingerezi Lada (shuga ya autoimmune mu akulu - shuga ya autoimmune mu akulu) Chowoneka - chobisika, chosawoneka.

Kufunika Kwa Kudziwitsa LADA

Zitha kuwoneka, kodi pali kusiyana kwanji komwe asayansi abwera? Chifukwa chiyani mukuvutikira moyo wanu ndi mayeso owonjezera? Koma pali kusiyana. Wodwala akapezeka kuti ali ndi LADA (matenda a shuga a autoimmune mu akulu), amathandizidwa popanda insulini monga yachibadwa mtundu II shuga, kupangira zakudya, maphunziro olimbitsa thupi ndi mapiritsi ochepetsa shuga makamaka ochokera ku gulu la sulfonylurea (glibenclamide, glycidone, glyclazide, glimepiride, glipizide ndi ena). Mankhwalawa, mwa zina, amachititsa kuti insulin itulutsidwe ndikuwonjezera maselo a beta, ndikuwakakamiza kuti azigwira ntchito mpaka pamapeto. A kukwera kwambiri kogwira ntchito kwa maselo, ndizomwe zimawonongeka ndi kutupa kwa autoimmune. Arises bwalo loipa:

autoimmune beta cell kuwonongeka?
Kuchepetsa insulin?
kupereka mankhwala ochepetsa shuga?
kuchuluka kwa maselo a beta otsalira?
kuchuluka kutupa kwa autoimmune ndi kufa kwa maselo onse a beta.

Zonsezi za Zaka 0.5-6 (pafupifupi 1-2 zaka) zimatha ndi kutulutsa kwapa ndi kufunikira kwambiri insulin mankhwala (Mlingo waukulu wa insulini komanso pafupipafupi glycemic control ndi chakudya chamagulu) Mu matenda am'mbuyomu a shuga a II, kufunikira kwa insulin kumadza pambuyo pake.

Kuti muchepetse kuzungulira kwazovuta za autoimmune, milingo yaying'ono ya insulin imayenera kuyikidwa atangopeza matenda a shuga a LADA. Chithandizo cha insulin choyambirira ali ndi zolinga zingapo:

kupatsa kupuma maselo a beta. Mukamagwiritsa ntchito mwachinsinsi zambiri, maselo ambiri amawonongeka mu autoimmune process,
chopinga cha autoimmune kutupa mu kapamba pochepetsa mawu (kuopsa ndi kuchuluka) kwa maantiantiants, omwe ndi "mafiyidwe ofiira" othandizira chitetezo cha mthupi ndipo amayambitsa mwachindunji kayendedwe ka autoimmune, limodzi ndi mawonekedwe a antibodies ofanana. Pazoyesa, zidawonetsedwa kuti kukhazikika kwa insulin nthawi yayitali kumachepetsa kuchuluka kwa ma autoantibodies m'magazi,
kusamalira shuga wabwinobwino. Zakhala zikudziwika kale kuti kuchuluka kwa glucose okwera komanso kwakutali kumakhalabe, komwe kumapangitsa kuti matenda ashuga azikhala osiyanasiyana.

Chithandizo cha insulin choyambirira kwa nthawi yayitali chimapulumutsa chinsinsi chake chotsalira cha pancreatic. Kupulumutsa Chinsinsi chotsalira ndikofunikira pa zifukwa zingapo:

imathandizira kukonzanso shuga ya magazi chifukwa cha gawo la kapamba,
amachepetsa chiopsezo cha hypoglycemia,
zimalepheretsa kukula koyambirira kwa zovuta za matenda ashuga.

M'tsogolo, zachindunji Katemera autoimmune kutupa mu kapamba. Kwa matenda ena a autoimmune, njira zoterezi zilipo kale (onani mankhwala Infliximab).

Momwe mungayikirere LADA?

Usiku woyambira LADA ndi kuyambira 25 mpaka 50. Ngati pazaka izi mwakhala mukukayikira kapena kupezeka ndi matenda amtundu wa II, onetsetsani kuti mwatsimikiza za njira zina zonse za LADA. Za 2-15% ya odwala matenda a shuga a mtundu II khalani ndi shuga ya autoimmune mu akulu. Pakati pa odwala Matenda A II a shuga popanda kunenepa kwambiri LADA ili ndi 50%.

Pali "LADA Clinical Risk Scale", Kuphatikiza zinthu zisanu:

Matenda a shuga amayambira msinkhu zosakwana 50 zaka.
Koyamba (kuchuluka mkodzo> 2 L patsiku, ludzu, kuchepa thupi, kufooka, etc., mosiyana ndi njira ya asymptomatic).
Mndandanda wamkulu wochepera 25 kg / m 2 (m'mawu ena, kusowa kwambiri kwa thupi ndi kunenepa kwambiri).
Matenda a autoimmune tsopano kapena kale (nyamakazi, systemic lupus erythematosus ndi matenda ena amitsemphamultiple sclerosis Hashimoto autoimmune chithokomiro, kuphatikiza poyizoni, autoimmune gastritis, matenda a Crohn, ulcerative colitis, autoimmune pancreatitis, autoimmune bullous dermatosis, matenda a celiac, cardiomyopathy, myasthenia gravis, vasculitis, kusokoneza (B12 - kuperewera kwa folic) kuchepa magazi, alopecia areata (dazi), vitiligo, autoimmune thrombocytopenia, paraproteinemia ndi ena).
Kukhalapo kwa matenda a autoimmune mu abale apamtima (makolo, agogo, ana, abale ndi alongo).

Malinga ndi omwe adapanga sikelo iyi, ngati mayankho abwino kuyambira 0 mpaka 1, kuthekera kokhala ndi LADA sikupitilira 1%. Ngati pali mayankho awiri kapena ochulukirapo, kuwopsa kwa LADA kuli pafupi 90%, Pankhaniyi, kuyezetsa labotale ndikofunikira.

Kodi mungatsimikizire bwanji za matendawo?

Kwa matenda a labotale shuga ya autoimmune mu akulu amagwiritsa ntchito mayeso awiri.

1) Kutsimikiza kwa mulingo anti-gad — glutamate decarboxylase antibodies. Zotsatira zoyipa (i.e., kusowa kwa ma antibodies kuti glutamate decarboxylase m'magazi) kumathetsa LADA. Zotsatira zabwino (makamaka ndi kuchuluka kwa ma antibodies) ambiri (!) Milandu imalankhula mokomera LADA.

Kuphatikiza apo, ndikungoneneratu za kupita patsogolo kwa LADA komwe kumatsimikizika ICA — Ma antibodies kuti ma islet cell kapamba. Kupezeka kwakofanana kwa anti-GAD ndi ICA ndi mawonekedwe amitundu yayikulu kwambiri ya LADA.

2) Tanthauzo mulingo wa peptide (pamimba yopanda kanthu komanso pambuyo kukondoweza) C-peptide ndi chinthu chopangidwa ndi insulin biosynthesis ndipo motero zonse zimagwirizana molingana ndi insulin. Mwa mtundu wa matenda ashuga a mtundu wa Type (komanso a LADA nawonso, popeza LADA ndi mtundu wocheperako wa matenda a shuga I amadziwika nawo) kuchuluka kwa C-peptide.

Poyerekeza: ndi matenda a shuga a mtundu II, oyamba anazindikira insulin kukana (minyewa ya kuketekela ku insulin) ne compensatory hyperinsulinemia (kuti achepetse kuchuluka kwa shuga, kapamba amachititsa kuti inshuwaransi ikhale yogwira kwambiri kuposa momwe zimakhalira), chifukwa chake, matenda amtundu wa II, kuchuluka kwa C-peptide sikuchepetsedwa.

Chifukwa chake, pakalibe anti-GAD, kupezeka kwa LADA kumatha. Pamaso pa anti-GAD + otsika kwambiri a C-peptide, kuwunika kwa LADA kumawerengedwa ngati kutsimikiziridwa. Ngati pali anti-GAD, koma C-peptide ndiyachilendo, kuwunikira kowonjezereka ndikofunikira.

Ndi matenda okangana, LADA imawonetsa kupezeka kwakukulu zolembera mtundu I matenda ashuga (oopsa a HLA), chifukwa kulumikizaku sikupezeka mu mtundu II matenda ashuga. Nthawi zambiri, panali kulumikizana ndi antigen ya B8 HLA, ndipo sipanakhale mgwirizano uliwonse ndi antigen "yoteteza" HLA-B7.

Subtypes zamtundu I shuga

Pali mitundu iwiri yanthete yomwe ndimayikamo:

matenda a shuga ana (ana ndi achinyamata) = subtype 1a,
subtype 1b, izi zikugwiranso ntchito Lada (shuga ya autoimmune mu akulu). Olekanitsa chidziwitso Mtundu I shuga.

Matenda a shuga (subtype 1a) amakhala ndi 80-90% ya milandu ya matenda a shuga am'mbuyomu. Ziyenera chosalimba antiviral chitetezo chokwanira wodwala. Ndi subtype 1a, ma virus angapo (Coxsackie B, nthomba, adenoviruses ndi ena) amawononga ma virus mu ma cell a kapamba. Poyankha, ma cell a chitetezo cha mthupi amawononga ma cell omwe amakhudzidwa ndi ziphuphu za kapamba. Autoantibodies kuti islet minofu ya kapamba (ICA) ndi insulin (IAA) imayenda mu magazi nthawi iyi. Chiwerengero cha ma antibodies (titer) m'magazi pang'onopang'ono amachepetsa (amapezeka mu 85% ya odwala kumayambiriro kwa matenda ashuga komanso mwa 20% patatha chaka). Subtype iyi imachitika masabata angapo atatenga kachilombo ka ana ndi achinyamata ochepera zaka 25. Chiyambicho chimakhala chamkuntho (odwala amalowa mu chisamaliro chochepa mu masiku angapo, komwe amapezeka). Nthawi zambiri pamakhala ma antigen A HLA B15 ndi DR4.

Lada (subtype 1b) amapezeka mu 10-20% ya milandu ya matenda a shuga am'mbuyomu. Izi subtype za matenda ashuga ndi chimodzi mwazinthu zowonetsera njira ya autoimmune m'thupi ndipo chifukwa chake nthawi zambiri zimaphatikizidwa ndi matenda ena a autoimmune. Zimachitika nthawi zambiri mwa akazi. Ma Autoantibodies amayendayenda m'magazi nthawi yonse ya matendawa, gawo lawo (gawo) limakhala lokhazikika. Awa ndi anti-GAD antibodies kuti glutamate decarboxylase, chifukwa IA-2 (antibodies to tyrosine phosphatase) ndi IAA (kuti insulini) ndizosowa kwambiri. Izi subtype za shuga ndi chifukwa kutsika kwa T-suppressors (mtundu wa lymphocyte womwe umachepetsa mayankho a chitetezo mthupi motsutsana ndi ma antijeni a mthupi).

LADA-shuga pogwiritsa ntchito limagwirira limatanthauzira mtundu I shuga, koma zizindikiro zake ndizofanana ndi matenda amtundu II shuga (kuyambira pang'onopang'ono ndi koyerekeza ndi matenda ashuga). Chifukwa chake, matenda a shuga a LADA amawoneka ngati apakatikati pakati pa mtundu woyamba wa matenda a shuga ndi mtundu II. Komabe, kutsimikiza kwa kuchuluka kwa ma autoantibodies ndi C-petid sikuphatikizidwa pamndandanda wanthawi zonse wamatenda a wodwala yemwe ali ndi matenda ashuga, ndipo matenda a LADA ndi osowa kwambiri. Nthawi zambiri, kulumikizana ndi HLA antijeni B8 ndi DR3 kumadziwika.

At chidziwitso mtundu I shuga mellitus palibe kuwonongeka kwa autoimmune kwa maselo a beta, komabe pali kuchepa kwa ntchito yawo ndi kufafaniza katemera wa insulin. Ketoacidosis imayamba. Matenda a shuga a Idiopathic amapezeka makamaka ku Asia ndi ku Africa ndipo ali ndi cholowa chowonekera. Kufunika kwa mankhwala a insulini mwa odwala oterewa kumatha kuwoneka ndikutha pakapita nthawi.

Kuchokera munkhani yonseyi ndikofunikira kukumbukira mfundo zochepa.

Matenda a shuga a LADA sadziwika pakati pa madokotala (mawuwa adapezeka mu 1993) choncho samapezeka kawirikawiri, ngakhale amapezeka 2-15% ya anthu odwala matenda ashuga a mtundu II.
Chithandizo cholakwika ndi mapiritsi ochepetsera shuga amatsogolera mofulumira (pafupifupi zaka 1-2) pancreatic kufooka ndi kusamutsa mokakamiza ku insulin.
Chithandizo chochepa cha insulin choyambirira chimathandizira kuletsa kupitilira kwa njira ya autoimmune ndikusunga chinsinsi chotsalira cha insulin.
Chotsalira cha insulin chobisalira chimafewetsa njira ya matenda a shuga ndikuchinjiriza pamavuto.
Ngati mwapezeka kuti muli ndi matenda a shuga a mtundu II, dzifufuzeni njira zisanu za matenda a shuga a LADA.
Ngati njira ziwiri kapena zingapo zili zabwino, matenda a shuga a LADA ali ndi mwayi komanso C peptide ndi ma antibodies kuti glutamate decarboxylase (anti-GAD) ayesedwe.
Ngati anti-GAD komanso otsika a C-peptide (oyambira komanso oyambitsa) apezeka, muli ndi matenda a shuga a autoimmune akuluakulu (LADA).