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

Zaka za zana la 21 ndi zaka zamakono zatsopano zamakono zopangira ndi zopangira, komanso zaka zana la ma pathologies atsopano.

Thupi laumunthu limakhala losiyana ndi kapangidwe kake, komanso limapereka zolephera ndi zolakwa.

Mothandizidwa ndi zoyambitsa ndi ma mutagen osiyanasiyana, chibadwa cha anthu chimatha kusinthidwa, zomwe zimayambitsa matenda amtundu.

Matenda a shuga amodzi ndi amodzi mwa amenewo.

Kodi matenda a shuga a modi ndi chiyani

Matenda a shuga ndi kuphwanya dongosolo la endocrine, pomwe maziko ake ndi kuchepa / insulin yokwanira m'thupi la munthu. Izi zimayambitsa zosokoneza mu metabolism yonse. Mwa zovuta zonse za dongosolo la endocrine, iye amatenga malo oyamba. Monga chifukwa cha imfa - malo atatu.

Chifukwa chake pali mitundu:

• wodwala insulin kapena mtundu 1 shuga,
• osagwirizana ndi insulin kapena matenda a shuga a 2,
• Matenda a shuga panthawi yoyembekezera (gestational).

Palinso mitundu yapadera:

• pancreatic beta cell gene kusintha,
• endocrinopathies,
• zopatsirana
• Matenda oyambitsidwa ndi mankhwala ndi mankhwala osokoneza bongo.

IMODI ndi mtundu wovuta wa chibadwa wa matenda ashuga omwe adayamba kuyambira zaka 0 mpaka 25. Kuchulukana kwa anthu ambiri kumakhala pafupifupi 2%, ndipo mwa ana - 4.5%.

MOOD (kukhwima pa matenda a achinyamata) kumamveka ngati "matenda akuluakulu a achinyamata." Imafalikira ndi maubale obadwa nawo, amatengera chikhalidwe (anyamata ndi atsikana nawonso akukhudzidwa). Zolakwika zimachitika ponyamula zokhudzana ndi zofunikira, chifukwa chomwe zolinga za kapamba zimasinthira, ndicho ntchito ya maselo a beta.

Maselo a Beta amatulutsa insulini, yomwe imagwiritsidwa ntchito pokonzanso shuga. Nayo, imagwira ntchito ngati gawo lapansi la thupi. Ndi MODI, zotsatizana zimasokonekera ndipo shuga ya magazi mwa mwana imakwera.

Gulu

Mpaka pano, ofufuza adazindikira mawonetsero 13 a matenda a shuga a MODI. Amafanana ndi masinthidwe amtundu wa 13 omwe amayambitsa matendawa.

Mwa milandu 90%, mitundu iwiri yokha ndi yomwe imapezeka:

• MODY2 - chilema mu gencokinase gene,
• MODY3 - chilema mu jini chifukwa cha nyukiliya ya hepatocytes 1a.

Mitundu yotsalayo imakhala ndi milandu 8-10% yokha.

• MODY1 - chilema mu gene cha nyukiliya ya hepatocytes 4a,
• MODY4 - chilema pamtundu wa promoter factor 1 wa insulin,
• MODY5 - chilema mu jini chifukwa cha nyukiliya ya hepatocytes 1b,
• MODYX.

Koma pali mitundu ina yomwe asayansi sanadziwebe.

Zizindikiro

Matenda a shuga a m'magazi mwa mwana amadziwika kwambiri mwamwayi, chifukwa chithunzi cha chipatala chimasiyana. Choyamba, ndizofanana ndi zomwe zimayambitsa matenda a shuga a mtundu 1 ndi mtundu 2. Matendawa sangathe kuonekera kwa nthawi yayitali kapena angayambitse matenda oopsa a shuga.

Glucokinase ndi isoenzyme ya chiwindi.

• Kutenga kwa glucose ndikusintha kwa glucose-6-phosphate m'maselo a pancreatic beta ndi hepatocytes a chiwindi (pamitsempha yayikulu ya shuga),
• kuwongolera kutulutsidwa kwa insulin.

Pafupifupi 80 masinthidwe osiyanasiyana amtundu wa glucokinase amafotokozedwa m'mabuku asayansi. Zotsatira zake, ntchito ya enzyme imachepa. Kugwiritsa ntchito shuga kosakwanira kumachitika, chifukwa chake, shuga amawuka.

• zomwe zimachitikiranso atsikana ndi anyamata,
• kusala hyperglycemia mpaka 8,0 mmol / l,
• glycosylated hemoglobin pafupifupi 6.5%,
• Asymptomatic maphunziro - omwe amapezeka pafupipafupi ndi mayeso a chipatala,
• zovuta kwambiri (retinopathy, proteinuria) - kawirikawiri,
• Zingakhale zoyipa mukakalamba
• nthawi zambiri palibe kufunika kwa insulini.

Hepatocyte Nuclear Factor 1a ndi mapuloteni ofotokozedwa mu hepatocytes, zilumba za Langerhans, ndi impso. Makina a chitukuko cha ana omwe ali ndi matenda a shuga a modi3 sakudziwika. Pancreatic beta-cell magwiridwe antchito amachitika ndipo insulin yotupa imakhala yolemetsa. Izi zimawonedwa mu impso - kusinthika kwina kwa glucose ndi amino acid kumachepetsedwa.

Imadziwulula mwachangu:

• kuchuluka kwa glucose ambiri,
• pafupipafupi zovuta zazikulu,
• kusowa kwa kunenepa kwambiri
• kuwonongeka kwa nthawi,
• kufanana 1 shuga,
• pafupipafupi makonzedwe a insulin.

Hepatocyte nyukiliya factor 4a ndi chinthu cha protein chomwe chili m'chiwindi, kapamba, impso komanso matumbo. Mtunduwu ndi wofanana ndi mody3, koma palibe kusintha kwa impso. Heredity ndiyosowa, koma ndiyowopsa. Nthawi zambiri amawonetsedwa zaka 10 zapitazo.

Chotsitsimutsa cha insulin1 chimakhudzidwa ndikukula kwa kapamba. Zomwe zimachitika ndizochepa kwambiri. Dziwani matendawa akhanda chifukwa chakukula kwa ziwalo. Pafupifupi kupulumuka kwa ana awa sikudziwika.

Hepatocyte nyukiliya factor 1b - yomwe ili m'magulu ambiri ndipo imakhudza chitukuko cha ziwalo ngakhale utero.

Ndi zowonongeka, kusintha kwa majini, kusintha kukuwoneka kale mwa akhanda:

• kuchepetsa thupi
• kufa kwachi cell
• maliseche.

Mitundu ina ya shuga modi imakhala ndi mawonekedwe ofanana, koma mtundu wina umatha kusiyanitsidwa pokhapokha pofufuza majini.

Zizindikiro

Kudzifufuza moyenera kumakhudza kusankha kwa njira zamavuto azachipatala. Nthawi zambiri, mtundu 1 kapena mtundu wachiwiri wa shuga umapezeka popanda kukayikira china chilichonse. Njira zazikulu zodziwira matenda:

• zaka 10-45,
• zambiri zamagulu a shuga mu 1, 2 mibadwo,
• palibe chifukwa chosowa insulin wokhala ndi zaka 3,
• kuchepa kwambiri
• chizindikiro chama protein C-peptide m'magazi,
• kufooka kwa kapamba,
• kusowa kwa ketoacidosis ndi mawonekedwe akuthwa.

Njira Zowonera Odwala:

• kuwunika kwathunthu kwa anamnesis ndi madandaulo, kujambula mtengo wabanja, ndizotheka kuyang'ana abale,
• mkhalidwe wama glycemic ndi shuga othamanga,
• kuphunzira pakamwa glucose,
• kukhazikitsidwa kwa hemoglobin wa glycated,
• kusanthula kwa zamankhwala amwazi m'magazi (CTF yonse, triglycerides, AST, ALT, urea, uric acid, ndi zina zambiri),
• Ultrasound yam'mimba,
• electrocardiography
• kusanthula kwa majini,
• kukambirana ndi ophthalmologist, neurologist, opaleshoni, othandizira.

Kuzindikira komaliza kumachitika mwa kupenda ma genetic.

Kuyesedwa kwa jini kumachitika ndi polymerase chain reaction (PCR). Magazi amatengedwa kuchokera kwa mwana, ndiye kuti majini ofunikira amakhala okha mu labotale kuti awone kusintha. Njira yolondola komanso yachangu, yotalika kuyambira masiku atatu mpaka 10.

Matendawa amadziwonekera mu mibadwo yosiyana, motero mankhwalawa amayenera kusintha (mwachitsanzo, nthawi yakutha msinkhu). Kodi pali mankhwala a matenda a shuga a modi? Choyamba, muyenera kuchita masewera olimbitsa thupi mokhazikika komanso kudya mokwanira. Nthawi zina izi zimakhala zokwanira ndipo zimabweretsa kulipira kwathunthu.

Zakudya zikuluzikulu ndizomwe zimayang'anira tsiku ndi tsiku:

• mapuloteni 10-20%,
• mafuta osakwana 30%,
• chakudya 55-60%,
• cholesterol yochepera 300 mg / tsiku,
• CHIKWANGWANI 40 g / tsiku
• mchere wa tebulo wochepera 3 g / tsiku.

Koma ndi vuto lomwe likuipiraipira komanso zovuta zina, kulandira chithandizo chamankhwala kumawonjezeredwa.

Ndi MODY2, mankhwala ochepetsa shuga salembedwera, popeza kuti vutoli ndi lofanana ndi 0. Kufunika kwa insulini kumakhala kotsika ndipo kumayikidwa pa chiwonetsero cha matendawa. Pali zakudya zokwanira ndi masewera.

Ndi MODY3, mankhwala oyambira ndi sulfonylurea (Amaryl, Diabeteson). Ndi ukalamba kapena zovuta, kufunikira kwa insulin kumawonetsedwa.

Mitundu yotsalayo imafuna chidwi chochulukirapo kuchokera kwa dokotala. Chithandizo chachikulu chimakhala ndi insulin ndi sulfonylurea. Ndikofunikira kusankha mlingo woyenera komanso kupewa zovuta.

Zodziwikanso kwambiri ndi yoga, masewera olimbitsa thupi, mankhwala achikhalidwe.

Popanda chithandizo choyenera, zovuta zotere ndizotheka:

• kuchepa chitetezo chokwanira,
• mitundu yayikulu ya matenda opatsirana,
• matenda amanjenje ndi minofu
• kusabereka kwa akazi, kusabala kwa amuna,
• zovuta zokhudzana ndi chitukuko cha ziwalo,
• Kutenga mbali pa matenda a shuga m'maso, impso, chiwindi,
• chitukuko cha matenda ashuga.

Popewa izi, kholo lililonse limakakamizidwa kukhala maso ndipo nthawi yomweyo limafunsira katswiri.

Malangizo

Ngati matenda a MODI atapezeka atatsimikiziridwa kuti ndiwotsimikizika, ndiye kuti malamulo otsatirawa ayenera kuonedwa:

• Pitani kwa endocrinologist 1 nthawi / theka la chaka,
• fufuzani glycated hemoglobin 1 nthawi / theka la chaka,
• mayeso ambiri zasayansi 1 nthawi / chaka,
• khalani njira yodzitetezera kuchipatala 1 nthawi / chaka,
• maulendo osakonzekera kupita kuchipatala ndi kuwonjezeka kwa shuga m'magazi tsiku lonse komanso / kapena zizindikiro za matenda ashuga.

Kutsatira malangizowa kungathandize kupewa matenda ashuga.

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. Nthawi zambiri, matendawa amawonekera pakutha msinkhu. 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.

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: m'dera la banja la C (CFTR / MRP) kapena mamembala ake 8 (ABCC8).

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 tingayerekeze 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.

Zachidziwikire, ndipo ngakhale 100%, ndi matenda amtundu wanji omwe amadwala matenda a shuga a mtundu wa MOI mwa ana kapena mtundu 1 wa matenda ashuga, dokotala amatha kokha atayezetsa ma genetic.

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

• ndi mawonekedwe a matendawa, ndipo mtsogolomo, kulibe kudumphadumpha mu shuga, ndipo koposa zonse, kuthamangitsidwa kwa matupi a ketone (zinthu zakuwonongeka kwamafuta ndi ma amino acid) m'magazi sikukula kwambiri, ndipo sikupezeka mu urinalysis,
• kuwunika kwa plasma ya ndende ya C-peptides chikuwonetsa zotsatira pamalire wamba,
• glycated hemoglobin mu seramu yamagazi muli mulingo wa 6.5-8%, ndipo glucose wothamanga wamagazi saposa 8.5 mmol / l,
• palibe zizindikiro zowonongeka kwa autoimmunezimatsimikizidwa ndi kusapezeka kwa ma antibodies a cell a pancreatic beta,
• Matenda a shuga limachitika osati m'miyezi isanu ndi umodzi yokha matendawa atangoyamba kumene, komanso pambuyo pake, komanso mobwerezabwereza, pomwe gawo lowonongeka silikupezeka,
• ngakhale mlingo wochepa wa insulin umapangitsa kuti chikhululukiro chikhazikikeyomwe imatha kukhala 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 ndiwofanana ndi malangizo a matenda a shuga a 2, koma motere:

• 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 holide" 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 zoyenera.

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.

Ndipo pomaliza nkhaniyi, tikufuna kupereka upangiri kwa makolo omwe ana awo akudwala matenda ashuga. Musawalange kwambiri ngati milandu yotsutsana ndi zoletsa chakudya 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.