POLYCYSTOSIS WA OVARIES (PCOS) NDI KUTHENGA KWA INSULIN

Lingaliro la kukana insulini limatanthawuza kuchepa kwa chidwi cha maselo pakupanga kwa insulin. Izi anomaly nthawi zambiri zimawonedwa kwa odwala omwe ali ndi matenda osokoneza bongo, koma nthawi zina, kukana insulin kumawonekeranso mwa anthu athanzi kwathunthu.

Matenda monga polycystic ovary syndrome (PCOS) amawonekera nthawi zambiri mwa amayi omwe ali ndi matenda a endocrine. Amadziwika ndi kusintha kwa ntchito ya ovarian (kuchuluka kapena kusakhalitsa kwa ovulation, kuchepetsedwa kwa msambo). Mu 70% ya odwala, PCa akuwonetsa kukhalapo kwa mtundu 2 wa shuga.

Kutsutsana ndi insulin ndi malingaliro amagwirizana kwambiri ndipo pakadali pano, asayansi akuwononga nthawi yawo yambiri akuwerenga za ubale wawo. Pansipa, matendawa pawokha, chithandizo cha matenda a polycystic, kuzindikira ndi mwayi wokhala ndi pakati mwachilengedwe, ubale wapakati pa polycystic ndi insulin ya mahomoni, ndi chithandizo cha zakudya zamatendawa zidzafotokozedwa mwatsatanetsatane.

Polycystic

Matendawa adapezeka kumayambiriro kwa zaka zana zapitazi ndi asayansi awiri aku America - Stein ndi Leventhal, kotero kuti matenda a polycystic amatchedwanso kuti Stein-Leventhal syndrome. The etiology ya matendawa sipadaphunziridwe kwathunthu. Chimodzi mwazizindikiro zazikulu ndikuwonekera kwa katulutsidwe wama mahomoni ogonana achimuna m'thupi la mayi (hyperandrogenism). Izi zimachitika chifukwa cha kusokonezeka kwa ntchito ya adrenal kapena ovarian.

Potengera PCOS, ovary ili ndi gawo lotchulidwa morphological - polycystic, popanda neoplasms iliyonse. Mu thumba losunga mazira, kaphatikizidwe kamapangidwe ka Corpus luteum kumavulala, kupanga kwa progesterone kumatsekedwa, ndipo vuto la ovulation ndi kusamba limakhalapo.

Zizindikiro zoyambirira zomwe zikuonetsa Stein-Leventhal syndrome:

• Kusakhalapo kapena kuchedwa kwa msambo,
• Tsitsi lochulukirapo m'malo osafunikira (nkhope, kumbuyo, chifuwa, ntchafu zamkati),
• Ziphuphu, khungu lamafuta, tsitsi lamafuta,
• Kulemera kolemera mpaka 10 kg pakanthawi kochepa,
• Kuchepetsa tsitsi
• Kukoka pang'ono pang'onopang'ono pamimba pamsana pa msambo (ululu wammbuyo ululu sichimadziwika).

Kusintha kwachilendo kwa ovomerezeka mwa akazi kumayendetsedwa ndi kusintha kwa mahomoni omwe ma pituitary ndi thumba losunga mazira limapanga. Pa msambo, kuvunda kumachitika pafupifupi milungu iwiri isanayambe. Thumba losunga mazira limatulutsa estrogen ya mahomoni, komanso progesterone, yomwe imakonzekeretsa chiberekero kuti dzira loyambitsidwa. Pocheperapo, amapanga testosterone wamwamuna. Ngati kutenga pakati sikuchitika, ndiye kuti kuchuluka kwa mahomoni kumachepetsedwa.

Ndi polycystosis, thumba losunga mazira limatulutsa kuchuluka kwa testosterone. Zonsezi zimatha kuyambitsa kubereka komanso zizindikiro zomwe zili pamwambapa. Ndikofunika kudziwa kuti mahomoni azakugonana achikazi amawoneka mthupi kokha chifukwa cha kupezeka kwa mahomoni achimuna, kuwasintha. Amakhala kuti popanda kukhalapo kwa mahomoni achimuna, chachikazi nawonso sichitha kupangidwa mthupi la mkazi.

Izi ziyenera kumvedwa, popeza zolephera izi zimapangitsa kuti ovary ya polycystic ipangidwe.

PCOS NDI INSULIN RESISTance

Pazaka 20 zapitazi, zidakhazikitsidwa kuti hyperinsulinemia ndiye chifukwa chachikulu cha polycystic ovary syndrome (PCOS) mu gawo lalikulu la azimayi. Odwala awa ali ndi "metabolOS PCOS," yomwe imawerengedwa kuti ndi boma la prediabetes. Nthawi zambiri, atsikana awa amakhala ndi kunenepa kwambiri, kusamba, komanso achibale omwe ali ndi matenda ashuga.

Amayi ambiri omwe ali ndi polycystic ovary syndrome (PCOS) ali ndi insulini ndipo amatha kunenepa kwambiri. Kunenepa kwambiri palokha kumayambitsa kusokonezeka kwa metabolic. Koma kukana insulini kumadziwikanso mwa azimayi omwe ali ndi PCOS omwe si onenepa kwambiri. Izi zimachitika makamaka chifukwa cha milingo ya LH ndi testamu yaulere ya seramu.

Chovuta chachikulu chomwe chimapangitsa azimayi omwe ali ndi ovomerezeka ya polycystic kuti mitundu ina ya maselo mthupi - nthawi zambiri minofu ndi mafuta - imatha kukhala yolimbana ndi insulin, pomwe ma cell ena ndi ziwalo zina sizingatero. Zotsatira zake, gland ya pituitary, thumba losunga mazira ndi ma cell a adrenal mwa mkazi yemwe ali ndi insulin kukana amangoyankha kuchuluka kwakukulu kwa insulin (ndipo osayankha moyenera pazachilendo), zomwe zimapangitsa kuti luteinizing mahomoni ndi androgens. Vutoli limatchedwa "kusankha kukana."

Zifukwa

Amakhulupirira kuti chimodzi mwazinthu zazikuluzikulu za kukana insulini ndikuwonjezeka kwa kuchuluka kwa mafuta. Kafukufuku wambiri akuwonetsa kuti kukhathamira kwamafuta acheya m'magazi kumabweretsa kuti maselo, kuphatikiza minofu ya minyewa, amasiya kuyankha moyenera insulin. Izi zitha kuchitika chifukwa cha mafuta komanso ma metabolites a mafuta achilengedwe omwe amakula mkati mwa minofu yam'mimba (mafuta a mnofu). Chifukwa chachikulu chakuchulukira kwamafuta amafuta ndichakudya chamafuta ambiri komanso kunenepa kwambiri. Kuchuluka kwambiri kwa thupi, kunenepa kwambiri komanso kunenepa kwambiri zimagwirizana kwambiri ndi insulin. Mafuta ochulukirapo pamimba (ozungulira ziwalo) ndi owopsa. Imatha kumasula mafuta ambiri aulere m'magazi komanso kumasula mahomoni otupa omwe amachititsa kuti insulin ikane.

Amayi omwe ali ndi kulemera kwabwinobwino (komanso ngakhale owonda) atha kukhala ndi PCOS ndi insulin, koma vuto ili ndilofala kwambiri pakati pa anthu onenepa kwambiri.

Pali zifukwa zingapo zomwe zimayambitsa vutoli:

Kudya kwambiri kwa fructose (kuchokera kwa shuga m'malo mwa zipatso) kwalumikizidwa ndi insulin.

Kuchuluka kwa oxidative kupsinjika ndi kutupa mthupi kungayambitse insulin kukana.

Kuchita masewera olimbitsa thupi kumawonjezera chidwi cha insulin, pomwe kusachita, m'malo mwake, kumachepa.

Pali umboni kuti kuphwanya chilengedwe cha bakiteriya m'matumbo kungayambitse kutupa, komwe kumakulitsa kulolerana kwa insulin ndi mavuto ena a metabolic.

Kuphatikiza apo, pali zinthu zamtundu komanso zachikhalidwe. Akuti mwina 50% ya anthu ali ndi chibadwa chotengera matendawa. Mzimayi akhoza kukhala mgululi ngati ali ndi mbiri ya banja la matenda ashuga, matenda amtima, matenda oopsa, kapena PCOS. Mwa ena, kukana insulini 50% kumayamba chifukwa cha kudya kopanda thanzi, kunenepa kwambiri komanso kusachita masewera olimbitsa thupi.

Zizindikiro

Ngati ovomerezeka ya polycystic ikukayikira, madokotala nthawi zonse amapereka mayeso okana insulin kwa akazi.

Kusala kwambiri insulin ndi chizindikiro cha kukana.

Kuyesedwa kwa HOMA-IR kumawerengera insulin kukana index, chifukwa glucose ndi insulin yofulumira imaperekedwa. Zikakhala zapamwamba, zimakhala zoipitsitsa.

Kuyesedwa kwa glucose kumayesa kusala shuga ndi maola awiri mutatha kudya shuga.

Glycated hemoglobin (A1C) ndi muyezo wa glycemia m'miyezi itatu yapitayo. Mlingo woyenera ukhale pansi pa 5.7%.

Ngati mayi ali ndi kunenepa kwambiri, kunenepa kwambiri komanso mafuta ochuluka m'chiuno mwake, ndiye kuti mwayi wa kukana insulini ndiwokwera kwambiri. Dokotala amayeneranso kulabadira izi.

1. Acanthosis wakuda (Negroid)

Ili ndiye dzina lachiwonetsero cha khungu lomwe malo amdima amawonedwa m'malo ena, kuphatikiza zikola (khwangwala, khosi, malo omwe ali pansi pa chifuwa). Kupezeka kwake kumasonyezanso kukana insulini.

Low HDL ("yabwino" cholesterol) ndi ma triglycerides apamwamba ndi zilembo zina ziwiri zomwe zimagwilizana kwambiri ndi insulin.

Mkulu insulin ndi shuga ndi zizindikiro zazikuluzikulu za kukana insulini m'mimba lama polycystic. Zizindikiro zina zimaphatikizapo mafuta ambiri am'mimba, ma triglycerides okwera, ndi HDL yotsika.

Momwe Mungadziwe Za Insulin Resistance

Mkazi akhoza kukhala ndi vuto ili ngati ali ndi zitatu kapena zingapo mwa izi:

• kuthamanga kwambiri kwa magazi (kudutsa 140/90),
• Kulemera kwenikweni kumapitilira 7 kg kapena kupitilira,
• triglycerides ndi okwera,
• cholesterol yathunthu ndi yokwera kuposa yachilendo
• "Chabwino" cholesterol (HDL) ndi yochepera 1/4 yonse,
• kuchuluka kwa uric acid ndi glucose,
• kuchuluka kwa glycated hemoglobin,
• ma enzymes okwera (nthawi zina)
• otsika plasma magnesium.

Zotsatira za kuchuluka kwa insulin:

• polycystic ovary syndrome,
• ziphuphu
• hirsutism
• kusabereka
• matenda ashuga
• kulakalaka kwa mashuga ndi chakudya,
• kunenepa kwamtundu wa apulo komanso zovuta kunenepa
• kuthamanga kwa magazi
• matenda amtima
• kutupa
• khansa
• mavuto ena okomoka
• Kuchepetsa chiyembekezo chamoyo.

INSULIN RESISTance, PCOS NDI METABOLIC SYNDROME

Kukana kwa insulin ndi chizindikiro cha zochitika ziwiri zofala kwambiri - kagayidwe ka metabolic ndi matenda a shuga 2. Matenda a metabolism ndi nambala ya ngozi zomwe zimayenderana ndi matenda a shuga 2, matenda a mtima, komanso mavuto ena. Zizindikiro zake zimaphatikizapo ma triglycerides okwera, HDL yotsika, kuthamanga kwa magazi, kunenepa kwambiri (mafuta kuzungulira m'chiuno), ndi shuga wamagazi ambiri. Kukana kwa insulini kumathandizanso kwambiri pakupanga matenda a shuga a mtundu wachiwiri.

Poletsa kupitirira kwa insulin kukaniza, milandu yambiri ya metabolic syndrome ndi mtundu 2 wa shuga imatha kupewedwa.

Kukana kwa insulini kuli pakatikati kagayidwe ka metabolic, matenda a mtima, ndi matenda amtundu wa 2, omwe pakali pano ali m'gulu la zovuta zachipatala padziko lapansi. Matenda ena ambiri amakhudzidwanso ndi insulin. Izi zimaphatikizapo matenda osokoneza bongo a chiwindi osamwa mowa, polycystic ovary syndrome (PCOS), matenda a Alzheimer's ndi khansa.

MUNGATANI KUTI MUKHALE ZINSINSI KUTI MUTHENGE MU POLYCYSTOSIS OF OVARIES

Ngakhale kukana insulini ndikuphwanya kwakukulu komwe kumabweretsa zotsatira zoyipa, zitha kuphatikizidwa. Mankhwala ndi metformin ndiye chithandizo chachikulu chomwe madokotala amapereka. Komabe, azimayi omwe ali ndi mtundu sukulimbana ndi insulin wa PCOS amatha kuthandizidwa posintha moyo wawo.

Mwina iyi ndi njira yosavuta kwambiri yowongolera chidwi cha insulin. Zotsatira zake zidzaonekera posachedwa. Sankhani zolimbitsa thupi zomwe mumakonda kwambiri: kuthamanga, kuyenda, kusambira, kupalasa njinga. Ndibwino kuphatikiza masewera ndi yoga.

Ndikofunikira kutaya mafuta enieni a visceral, omwe amapezeka pamimba ndi chiwindi.

Ndudu za fodya zingayambitse kukana kwa insulini ndikuwonjezera vutoli mwa amayi omwe ali ndi ovary ya polycystic.

1. Dulani shuga

Yesetsani kuchepetsa kudya kwanu shuga, makamaka kuchokera ku zakumwa zotsekemera monga koloko.

1. Idyani Zathanzi

Zakudya za ovary ya polycystic ziyenera kukhazikitsidwa ndi zakudya zomwe sizipezeka. Phatikizaninso mtedza ndi nsomba zamafuta muzakudya zanu.

Kudya mafuta a omega-3 acids amachepetsa triglycerides wamagazi, omwe nthawi zambiri amakhala okwera ndi polycystic ovary matenda ndi insulin kukana.

Tengani zowonjezera zowonjezera insulin kumva komanso kuchepetsa magazi. Izi zimaphatikizapo, mwachitsanzo, magnesium, Berberine, inositol, vitamini D ndi mankhwala wowerengeka monga sinamoni.

Pali umboni kuti kugona pang'ono, kumayambiranso insulin.

Ndikofunikira kuti atsikana omwe ali ndi ovomerezeka ya polycystic aphunzire kuthana ndi nkhawa, mavuto komanso nkhawa. Yoga ndi othandizira okhala ndi mavitamini a B ndi magnesium amathanso kuthandiza pano.

Mitengo yambiri yazitsulo imalumikizidwa ndi insulin kukana. Potere, zopereka zamagazi, zopereka kuchokera ku nyama kupita kuzakudya zamasamba, ndikuphatikizidwa kwa zinthu zina mkaka mu zakudya zitha kuthandiza amayi a postmenopausal.

Kukana kwa insulin mwa amayi omwe ali ndi polycystic ovary kumatha kuchepetsedwa kwambiri komanso kuchiritsidwa kwathunthu ndi kusintha kosavuta kwa moyo, zomwe zimaphatikizapo chakudya chamagulu, zowonjezera, zolimbitsa thupi, kuchepa thupi, kugona tulo komanso kuchepetsa nkhawa.

Wolemba nkhani yasayansi pankhani zamankhwala ndi zaumoyo, wolemba pepala la sayansi ndi Matsneva I.A., Bakhtiyarov K.R., Bogacheva N.A., Golubenko E.O., Pereverzina N.O.

Polycystic ovary syndrome (PCOS) ndi imodzi mwazomwe zimakhala endocrinopathies. Ngakhale kuchuluka kwa PCOS komanso mbiri yayitali yofufuza, etiology, pathogenesis, kuzindikira ndi kuchiza kwa matenda akadali ovuta kwambiri. M'zaka zaposachedwa, chidwi chowonjezeka cha asayansi chakopeka ndi funso la chopereka cha hyperinsulinemia pakukula kwa PCOS. Amadziwika kuti mu 50-70% ya milandu, PCOS imaphatikizidwa ndi kunenepa kwambiri, hyperinsulinemia, ndikusintha kwa magazi a lipid spectrum, zomwe zimawonjezera chiopsezo chokhala ndi matenda amtima, mtundu 2 matenda a shuga ndipo zimayambitsa kutsika kwapafupifupi kwa chiyembekezo chamoyo. Ofufuzawo ambiri amatengera kutsimikiza kwa majini a zovuta za metabolic mu PCOS, mawonetseredwe ake amakulirakulira pamaso pa kunenepa kwambiri kwa thupi. Gawo laposachedwa pakuphunzira kwa pathogenesis ya PCOS imadziwika ndi kafukufuku wozama wa kusokonekera kwa metabolic: insulin kukana, hyperinsulinemia, kunenepa kwambiri, hyperglycemia, dyslipidemia, kuchepa kwamatenda, kuphunzira kwawoko kwazomwe zimayambitsa zovuta zam'mimba, komanso matenda okhudzana ndi matenda osagwirizana ndi insulin komanso matenda osokoneza bongo matenda. Izi zitha kufotokozera kusaka kwawuni yatsopano kudziwa kuti ndi ati mwa omwe angagwiritsidwe ntchito pochita tsiku ndi tsiku monga olosera za metabolic ndi mtima pazovuta za odwala omwe ali ndi PCOS.

KUGWIRA NTCHITO NDIPONSO KUDZIPEREKA MU POLYCYSTIC OVARIAN SYNDROME

Polycystic ovarian syndrome (PCOS) ndi imodzi mwazomwe zimakhala endocrinopathies. Ngakhale kutsika kwakukulu kwa PCOS komanso mbiri yayitali ya kafukufukuyu, nkhani za etiology, pathogenis, kuzindikira ndi kuchiritsa matendawa ndizovuta kwambiri. M'zaka zaposachedwa, chidwi chowonjezeka cha asayansi chakopeka ndi funso la chopereka cha hyperinsulinemia pakukula kwa PCOS. Amadziwika kuti mu 50-70% ya milandu PCOS imaphatikizidwa ndi kunenepa kwambiri, hyperinsulinemia ndikusintha kwa milomo> insulin kukana, hyperinsulinemia, kunenepa kwambiri, hyperglycemia, dyslip> systemic kuvimba thumba losunga mazira, komanso matenda ena monga insulin-Independent shuga mellitus ndi matenda a mtima. Izi zitha kufotokozera kusaka kwazidziwitso zatsopano kuti mudziwe kuti ndi ziti mwa zomwe zingagwiritsidwe ntchito pochita tsiku ndi tsiku monga olosera za metabolic ndi mtima zamavuto omwe ali ndi PCOS.

Zolemba za ntchito yasayansi pamutu wakuti "Kutupa kwamatenda ndi kukokana kwa insulin mu polycystic ovary syndrome"

SYSTEM INFLAMMATION NDIPONSO KUDZIPEREKA MU SYNDROME

Matsneva I.A., Bakhtiyarov K.R., Bogacheva N.A., Golubenko E.O., Pereverzina N.O.

FGAOU VO Yoyamba University State Medical University yotchedwa I.M. Sechenov (Sechenov University), Moscow, Russian Federation

Kuzindikira. Polycystic Ovary Syndrome (PCOS) ndi imodzi mwazomwe zimakhala mtundu wa endocrinopathies. Ngakhale kuchuluka kwa PCOS komanso mbiri yayitali yophunzira, etiology, pathogenesis, kuzindikira ndi kuchiritsa matendawa ndizovuta kwambiri. M'zaka zaposachedwa, chidwi chowonjezeka cha asayansi chakopeka ndi funso la chopereka cha hyperinsulinemia pakukula kwa PCOS. Amadziwika kuti mu 50-70% ya milandu PCOS imaphatikizidwa ndi kunenepa kwambiri, hyperinsulinemia ndi kusintha kwa magazi lipid sipekitiramu, zomwe zimawonjezera chiopsezo chokhala ndi matenda amtima, mtundu 2 matenda a shuga ndipo zimapangitsa kuchepa kwa chiyembekezo chamoyo. Ofufuzawo ambiri amatengera kutsimikiza kwa majini a zovuta za metabolic mu PCOS, mawonetseredwe ake amakulirakulira pamaso pa kunenepa kwambiri kwa thupi. Gawo laposachedwa pakuphunzira kwa pathogenesis ya PCOS imadziwika ndi kafukufuku wozama wa kusokonekera kwa metabolic: insulin kukana, hyperinsulinemia, kunenepa kwambiri, hyperglycemia, dyslipidemia, kuchepa kwamatenda, kuphunzira kwawoko kwazomwe zimayambitsa zovuta zam'mimba, komanso matenda okhudzana ndi matenda osagwirizana ndi insulin komanso matenda osokoneza bongo matenda.

Izi zitha kufotokozera kusaka kwawuni yatsopano kudziwa kuti ndi ati mwa omwe angagwiritsidwe ntchito pochita tsiku ndi tsiku monga olosera za metabolic ndi mtima pazovuta za odwala omwe ali ndi PCOS.

Mawu ofunikira: kukana insulini, kuchepa kwamatenda, polycystic ovary syndrome, hyperinsulinemia, hyperandrogenism.

Mavuto azidziwitso a polycystic ovary syndrome ndiofunika pakadali pano, ngakhale PCOS idayamba kufotokozedwa ndi Stein ndi Leventhal mu 1935. Njira zodziwira bwino za matenda sizinakhalepo mpaka 2003, pomwe njira za Rotterdam zinafunsidwa. Njira izi zikuphatikiza:

1. Zosazungulira / Kutulutsa.

2. Clinical / labotale hyperandrogenism.

3. Thumba losunga mazira la Polycystic.

Koma ngakhale pakali pano, kuzindikira kwa PCOS kumayambitsa zovuta zina, kuzindikira koyenera kumakhazikitsidwa pambuyo pa nthawi yayitali ndipo, nthawi zambiri, kufufuza mosaganizira komanso chithandizo. Izi mpaka pano zitha kufotokozera chidwi cha ofufuza vutoli.

Polycystic ovary syndrome imapezeka mu 2% -20% ya akazi, ndipo ndi endocrinopathy wodziwika bwino mwa azimayi amsinkhu wobereka. Ziwerengero zonse padziko lapansi ndi 3.5%.

M'zaka zaposachedwa, chidwi chowonjezeka cha asayansi chakopeka ndi funso la chopereka cha hyperinsulinemia pakukula kwa PCOS. Amadziwika kuti odwala ambiri omwe ali ndi PCOS sagwirizana ndi insulin, ndipo pafupifupi 50% ya odwala amakwaniritsa njira za metabolic syndrome 2,3. PCOS nthawi zambiri imagwirizanitsidwa ndi vuto la B-cell, lomwe limakulitsa chiopsezo cha matenda ashuga a 2. Mwa azimayi omwe ali ndi PCOS, chiwopsezochi ndi chachikulu poyerekeza ndi azimayi athanzi amalemu omwewo komanso amsinkhu wawo. Insulin imalimbikitsa zochitika za p450c17 m'mimba mwa m'mimba ndi ma adrenal gland, zomwe zimapangitsa kuti pakuwonjezeke kupanga androgen.

Pathogenesis ya PCOS imaphatikizapo hyperandrogenism, kunenepa kwambiri, komanso kukana kwa insulin (hyperinsulinemia). Miyezi yambiri ya testosterone imathandizira kunenepa kwambiri pamimba, komwe kumapangitsa kuti insulin ikane. Kukana kwa insulini kumayambitsa hyperinsulinemia kenako kumapangitsa kuti chiwonetsero cham'mimba chitulutsidwe ndimimba komanso ma adrenal gs, amalepheretsa kupanga kwa mahomoni ogonana omanga globulin (SHBG), ndipo potero amawonjezera ntchito ya testosterone. Komanso insulin kukana

kunenepa kwambiri pakati pazotsatira za hyperandrogenism mu PCOS zimagwirizanitsidwa ndi kuchuluka kwa ntchito yotupa komanso kuchuluka kwa katulutsidwe ka adipokines, ma interleukins ndi chemokines, zomwe zingakulitse chiwopsezo

kukula kwa matenda ashuga ndi mtima.

Zoyipa ndi zosadziwika

Mkuyu 1. Chozungulira chozungulira mu PCOS.

DANISH MEDICAL JOURNAL. Endocrine ndi metabolic mawonekedwe mu polycystic ovary syndrome. Dan med j

Kukana insulini. Kukana kwa insulini kumakhudzana kwambiri ndi index mass body (BMI), komanso kupezeka mwa odwala omwe ali ndi kulemera kwabwino mu PCOS. Makina enieni a insulin kukana mu PCOS sakudziwikabe. Odwala a PCOS ali ndi kuchuluka kofanana komanso kufanana kwa insulin yolandila poyerekeza ndi azimayi athanzi, chifukwa chake, kukana insulini mwina kumakhala kosinthidwa ndikusintha kwa kusintha kwa chizindikiritso cha siginecha cholumikizidwa ndi insulin receptor. Kuphatikiza apo, oxidative ndi non-oxidative glucose metabolism idasokonezeka mwa odwala omwe ali ndi PCOS m'maphunziro pogwiritsa ntchito njira zosalunjika za calorimetry. M'maphunzirowa, insulin-yolimbikitsira ya glucose yopanda mphamvu ya okosijeni imagayidwa kwambiri kuposa oxidative glucose metabolism, yomwe imathandizira kuchepa kwa ntchito ya glycogen synthase mu PCOS. Ntchito yofooka ya glycogen synthase imatsimikiziridwa ndi maphunziro a minofu biopsy mwa odwala. Kafukufukuyu akuwonetsa kuti odwala omwe ali ndi PCOS adaletsa insulin kusaina kudzera mwa Akt ndi AS160, komanso kuwonongeka kwa insulin-induction glycogen synthetase poyerekeza ndi gulu lolamulira. Mwa odwala ena omwe ali ndi PCOS, serine phosphoryl idakulitsidwa.

insulin receptor b, koma madera akutali a insulin receptor cascade 6.7 nawonso adakhudzidwa.

Kukana kwa insulini mwa azimayi omwe ali ndi PCOS kumatha kukhala chifukwa cha majini kapena njira zina monga kunenepa kwambiri ndi hyperandrogenism. Njira izi zidawunikidwanso mu ulusi wopukutidwa wa minofu wopezeka kwa odwala omwe ali ndi insulin kukana PCOS ndi amayi athanzi 8.9. Zofooka pakuchitika kwa insulini, zomwe zimapitilira ma cell omwe amachotsedwa pakati pa vivo, zikusonyeza kuti kusintha kumeneku ndi chifukwa cha masinthidwe amtundu omwe amawongolera njira zotumizira ma sign. Asayansi adapeza kuti kuthamanga kwa glucose ndi oxidation, kaphatikizidwe ka glycogen, ndi milomo ya lipid zinali zofanana pakati pa odwala omwe ali ndi PCOS ndi amayi athanzi, komanso adachitanso zochitika ngati mitochondrial za 6.7. Zotsatira izi zinawonetsa kuti kukana kwa insulini mu PCOS kumakhalanso chifukwa cha njira zama adapter. Pancreatic beta cell insulin secretion imachulukitsidwa kuti ilipirire insulin. Chifukwa chake, hyperinsulinemia mu PCOS imatha kukhala njira yosinthira yolimbana ndi insulin.

Kafukufuku wasonyeza kuti ma insulin receptors amapezeka mu mazira abwinobwino komanso ovomerezeka a polycystic. Pogwirizana ndi LH, insulini imalimbikitsa ntchito ya p450c17 m'mimba mwa m'mimba ndi ma adrenal gland ndikuwonjezera pakuwonjezeka kwa androgens. Kafukufuku akutsimikizira kuti maselo a theca omwe ali ndi odwala omwe ali ndi PCOS amamvera kwambiri zovuta za androgen zomwe zimapangitsa insulini kuposa momwe amapangira mazira abwinobwino. Chifukwa chake, insulin imatha kukhala ngati gonadotropin, ndikuwonjezera kuwonjezeka kwa kapangidwe ka androgens kuchokera ku ma cell a tech. Kuphatikiza apo, hyperinsulinemia imachepetsa kupanga kwa SHBG m'chiwindi. Chifukwa cha njirayi, kuchuluka kwa testosterone yaulere kumawonjezeka. Komanso, magulu ochepa a SHBG adagwiritsidwa ntchito pakuwonetsa PCOS ndikugwirizana ndi insulin sensivivity mu euglycemic hyperinsulinemic test.

Testosterone imatha kupititsa patsogolo kukana kwa insulin mwachindunji kapena m'njira zina. Testosterone yoyendetsedwa pamankhwala akuluakulu a azimayi anali limodzi ndi insulin kukana, kuyesedwa pogwiritsa ntchito mayeso a euglycemic. Kuphatikiza apo, kuchuluka kwambiri kwa testosterone kumatha kuthandizira kunenepa kwambiri kwam'mimba, komwe kungayambitse insulin kukana. PCOS phenotypes okhala ndi hyperandrogenism anali okhudzana kwambiri ndi insulin kuposa phenotypes popanda hyperandrogenism, amenenso adatsimikizira kufunikira kwa hyperandrogenism mu insulin kukana mu PCOS.

Kutupa kwazinthu ndi zolembera. Malinga ndi kafukufuku, pafupifupi 75% ya odwala omwe ali ndi PCOS ndi onenepa kwambiri, ndipo kunenepa kwambiri kwapakati kumawonedwa kwa odwala omwe ali ndi nthawi zonse komanso onenepa kwambiri. Kukula kwa vuto lakudya kunali pafupifupi 40% mwa azimayi omwe ali ndi hirsutism, komanso, mwa azimayi omwe ali ndi PCOS, bulimia inali yofala kwambiri. Kuchuluka kwa metabolic sikunachepetse kwa odwala omwe ali ndi PCOS, ndipo poyeserera mosasinthika panalibe kusiyana kulikonse pakukwaniritsa kuchepetsa pakati pa odwala omwe ali ndi PCOS ndi amayi athanzi muzakudya zomwezo. Komabe, secretion wa ghrelin pakudya itatha kuponderezedwa mu PCOS poyerekeza ndi azimayi athanzi, ndikuwonetsa kuti kusowa chilamulo. Grelin imasungidwa makamaka ndi maselo am'mimba a endocrine. Mitundu ya Ghrelin imawonjezeka panthawi yanjala ndikuchepa panthawi ya chakudya. Grecin katulutsidwe amachepetsa panthawi yolimba mphamvu, monga kunenepa kwambiri. Ghrelin akuwonetsedwa m'maselo a pancreatic beta ndipo akhoza kuletsa katemera wa insulin. Ghrelin yotsika imalumikizidwa ndi insulin kukana ndi matenda a shuga. Ghrelin amalumikizana bwino ndi

adiponectin ndi kumbuyo ndi leptin. Kafukufuku wam'mbuyomu adanenanso zochepera za ghrelin mwa odwala PCOS poyerekeza ndi azimayi athanzi.

Kafukufuku wasonyeza kuti kuchepa kwa moyo wamunthu mu PCOS kumalumikizidwa ndi kuwonjezeka kwa thupi. Kunenepa kwambiri kumagwirizananso ndi insulin kukana komanso kufooka kwa thupi, mwina pang'onopang'ono ndi boma lomwe limayamba kutupa pang'onopang'ono. Tizilombo ta Adipose timatulutsa ndipo timapuloteni tambiri timene timapuloteni tambiri, tambiri totchedwa adipokins. Kupatula leptin ndi adiponectin, ma adipokine samapangidwa kokha ndi adipocytes, amasungidwa makamaka ndi macrophages amafuta. Ndi kunenepa kwambiri, kuchuluka kwama macrophages ochulukirapo kumachulukitsa zonse ziwiri zamkati komanso ma visceral adipose minofu, ndipo ma cell a mononuclear ozungulira amakhala othandiza kwambiri. Kuchulukitsidwa kwachulukidwe kwa adipokines kulosera metabolic syndrome ndikukulitsa mwayi wokhala ndi matenda ashuga.

Adiponectin ndiye mapuloteni otchuka kwambiri ndipo amatulutsidwa ndi minofu ya adipose. Secretion wa Adiponectin amachepetsa kunenepa kwambiri. Dongosolo lozungulira la adiponectin lagwirizanitsidwa ndi chiopsezo chowonjezeka cha insulini komanso kukula kwa matenda a shuga a mtundu 2. Njira zomwe adiponectin amagwiritsa ndi insulin sensitivity sizimamveka bwino. Kafukufuku wa nyama ndi ma vitro awonetsa kuti kuphatikizira kwa adiponectin kumalimbikitsa kuyamwa komanso kupindika kwa glucose, kumachepetsa kuchuluka kwa gluconeogeneis m'chiwindi, komanso kumalimbikitsa kukhathamiritsa kwa mafutulu amafuta am'mafupa. Chifukwa chake, adiponectin amatsitsa misempha ya triglyceride ndikuwonjezera mphamvu ya insulin. Adiponectin imathanso kugwira ntchito mwachindunji. Adiponectin receptors amapezeka m'mimba ndi endometrium. Maselo a Theca omwe ali ndi odwala PCOS anali ndi mawu otsika a adiponectin receptors poyerekeza ndi mazira a amayi athanzi. Mu maphunziro, kukondoweza kwa adiponectin kunalumikizidwa ndi kuchepa kwa kupanga kwa androgen. Zotsatira izi zimatsimikizira ubale wofunikira pakati pa kunenepa kwambiri, adiponectin, ndi hyperandrogenism mu PCOS. Kuwonjezeka kwa testosterone kwa odwala onenepa kwambiri komanso PCOS ikhoza kuphatikizidwa ndi kuchepa kwa adiponectin.

Leptin anali woyamba adipokine wofotokozedwa ndipo ali ndi chofunikira pakuwongolera zakudya komanso kuchuluka kwa mphamvu. Leptin akuonekera

adipocytes, amalepheretsa kudya komanso amalimbikitsa kugwiritsa ntchito mphamvu. Leptin amakhudza hypothalamus ndi pituitary gland ndipo sangakhudze kungoyambira kwa hypothalamic chilimbikitso cha kudya, komanso mantha amanjenje. Mu mbewa, jekeseni wa leptin adasintha chitukuko cha nthochi zolandila za leptin zapezeka m'mazira am'mimba, zomwe zikusonyeza kuti leptin ikhoza kukhala chinthu chofunikira pakuchita kwa gonad. Kafukufuku awonetsanso kuyanjana kwabwino pakati pa leptin ndi BMI, kuyang'ana m'chiwindi komanso misinkhu ya insulin kukana.

Kuti macrophages azitha kuyamwa LDL (otsika kachulukidwe lipoproteins), ayenera kuthira oxidini, ndikupanga oxLDL kukhala atherogenic mawonekedwe a LDL. Milingo ya OxLDL idakulitsidwa mwa odwala PCOS poyerekeza ndi azimayi athanzi. Komanso, milingo ya OxLDL inali yofanana ndi odwala omwe ali ndi PCOS yachibadwa komanso yonenepa kwambiri, motero kuyanjana pang'ono pakati pa kulemera kwa thupi ndi oxLDL ya 25.26 kumaganiziridwa. CD36 imawonetsedwa pamtundu wa monocytes ndi macrophages. Kupangidwe kwa maselo a chithovu kumayambitsidwa ndikuwonjezeredwa ndikumangiriza kwa oxeptL receptors ku CD36, zomwe zimapangitsa kuti ntchito ya CD36 ikhale pachiwopsezo cha matenda amtima. Soluble CD36 (sCD36) imatha kuyezedwa mu plasma ndikugwirizana ndi insulin kukaniza ndi glucose. Mgwirizano wabwino unapezeka pakati pa sCD36 ndi insulin ndi BMI. Odwala a PCOS anali ndi ma sCD36 okwera kuposa azimayi athanzi amalemu yomweyo.

HsCRP imadziwika kuti imasungidwa poyankha ma cytokines, kuphatikizapo IL-6. HsCRP yomwe idakwezedwa inali yolosera mwamphamvu kwambiri yoopsa pamtima. HsCRP sikungokhala chizindikiro cha matenda opatsirana, komanso imathandizira njira yotupa poyambitsanso ma monocytes ndi maselo a endothelial. Odwala a PCOS anali ndi milingo yayikulu kwambiri ya hsCRP poyerekeza ndi azimayi athanzi. Pakufufuza kwaposachedwa kwaposachedwa, milingo ya CRP inali pafupifupi 96% yowonjezeka ku PCOS motsutsana ndi gulu loyang'anira ndipo linapitilira kuwonjezeka pambuyo powongolera BMI. Zinapezeka kuti hsCRP imakhudzana bwino ndi zisonyezo zamafuta zokhazikitsidwa za DEXA

misa, pomwe palibe kulumikizana kwakukulu komwe kunapezeka poyesa testosterone kapena metabolism ya glucose.

Prolactin imasungidwa osati ndi pituitary gland, komanso macrophages a adipose minofu chifukwa cha kutupa ndi kutsika kwa glucose. Mu maphunziro, prolactin yayikulu idalumikizidwa ndi kuchuluka kwa maselo oyera a magazi ndi matenda a autoimmune. Hypothesis yomwe prolactin imatha kuchita ngati adipokine imathandizidwa ndi maphunziro mu odwala omwe ali ndi prolactinomas. Odwala omwe ali ndi prolactinoma anali a insulin, insulin sensitivity imawonjezeka panthawi ya mankhwala ndi dopamine agonist. Mankhwala a Prolactin adapezeka kuti amagwirizana ndi estradiol, testosterone yathunthu, DHEAS, 17-hydroxyprogesterone ndi kuchuluka kwa cortisol mwa odwala omwe ali ndi PCOS. Pakuwunikira kambiri, prolactin idalumikizana bwino ndi estradiol, 17OHP, ndi cortisol atasintha zaka, BMI, komanso kusuta. M'maphunziro a maselo a nyama, prolactin inali ndi mphamvu yolimbikitsa pakuwonjezereka kwa maselo a adrenocortical, omwe adathandizira adrenal hyperplasia 31.6.

Komanso posachedwa, ndi polycystic ovary syndrome, mitundu yambiri yazowonjezera ndi ya metabolic imayeza. Zina mwazolemba ndi monga chemokine migration inhibition factor (MIF), protein ya monocytic chemoattractant (MCP) -1 ndi puloteni yotupa ya macrophage (MIP), visfatin ndi resitin, etc. Zambiri pa izi zolemba zowopsa ndizotsutsana ndikufunika kwawo ku PCOS idayenera kukhazikitsidwa.

Chifukwa chake, zotsatira za kafukufuku wambiri zawonetsa kuti pali maubwenzi ena pakati pa zilembo zingapo zotupa, kukana insulini, ndi polycystic ovary syndrome (Gome 1).

Maphunziro owonjezera amafunikira kuti adziwe kuti ndi ati mwa omwe akuwunika omwe ayenera kuyesedwa pochita tsiku ndi tsiku monga olosera za metabolic ndi mtima wamavuto omwe ali ndi PCOS.

Kuyanjana kotheka pakati pa zikwangwani zotupa ndi chizindikiro cha kuchuluka kwamafuta

misa, insulin ndi testosterone milingo.

Zolemba zotupa mu PCOS.

Zolemba za Chiwopsezo cha PCOS im / fat misa Insulin sensitivity Testosterone

Adiponectin Anachepetsa (0 i,?

Grepn Kuchepetsa ine t- (0

Prolactin Yachepetsa (V) 0) +

SCD36, oh-LDL Kuchuluka (0 + + ayi

CRP Kuchulukitsa + + Ayi

Leptin Pakati pa malire + + (+) ayi

IL-6 Yachilendo + N / A

t t Tili pachiyanjano cholimba, ubale wosagwirizana, (t) (t) maubale ofooka

+ + ubale wopanda cholakwika, + zabwino inter-modulus (t) zolumikizana zabwino ayi: palibe ubale

DANISH MEDICAL JOURNAL. Endocrine ndi metabolic mawonekedwe mu polycystic ovary syndrome. Dan med j

BUKU MUTU. Physiology ndi Pathology ya Kubala Kwachikazi

The Journal of azachipatala endocrinology ndi kagayidwe. Tian, ​​Ye, Zhao, Han, Chen, Haitao, Peng, Yingqian, Cui, Linlin, Du, Yanzhi, Wang, Zhao, Xu, Jianfeng, Chen, Zi-Jiang. Wolemba Meyi 1, 2016

Glintborg D., Andersen M. Ndemanga pa pathogenesis, kutupa, ndi metabolism mu hirsutism ndi polycystic ovary syndrome. Gynecol Endocrinol 2010.4: 281-96

DANISH MEDICAL JOURNAL. Endocrine ndi metabolic mawonekedwe mu polycystic ovary syndrome. Dan Med J 2016.63 (4): B5232

Eriksen M. B., Minet A. D., Glintborg D. et al. Ntchito yoyambirira ya mitochondrial mu myotubes yokhazikitsidwa kuchokera kwa azimayi omwe ali ndi PCOS. J Clin Endocrinol Metab 2011, 8: E1298-E1302.

The Journal of clinical endocrinology ndi metabolism. Broskey, Nicholas T., Klempel, Monica C., Gilmore, L.

Anne, Sutton, Elizabeth F., Altazan, Abby D., Burton, Jeffrey H., Ravussin, Eric, Redman, Leanne M. Wolemba June 1, 2017

Eriksen M., Porneki A.D., Skov V. et al. Kutsutsa kwa insulin sikumasungidwa mu myotubes okhazikitsidwa kwa amayi omwe ali ndi PCOS. PLOS One 2010, 12: e14469.

Cibula D., Skrha J., Hill M. et al. Kuneneratu zamchere wa insulin mwa azimayi omwe si akazi am'mimba mwa polycystic ovary. Juni 2016

Corbould A. Zotsatira za androgens pa insulin zomwe zimachitika mwa amayi: kodi androgen imakhala gawo lalikulu la akazi metabolic syndrome? Diabetes Metab Res Rev 2008, 7: 520-32.

Polycystic Ovarian Disease (Stein-Leventhal Syndrome) Lorena I. Rasquin Leon, Jane V. Mayrin. Einstein Medical Center. Kusintha Komaliza: October 6, 2017

Neuroendocrine Kukula kwa Zakudya Zambiri mu Polycystic Ovary Syndrome. Daniela R., Valentina I., Simona C., Valeria T., Antonio L. Reprod Sci. 2017 Jan 1: 1933719117728803. doi: 10.1177 / 1933719117728803.

Morgan J., Scholtz S., Lacey H. et al. Kuchuluka kwa zovuta zamagulu akudya mwa azimayi omwe ali ndi vuto lodana ndi nkhope: kupweteka kwamaphunziro. Int J Kudya Disord 2008, 5: 427-31.

BIOMECHANICS, OBESity, NDI OSTEOARTHRITIS. MALO A ZOPHUNZITSA: PAMENE LEVEE BULANI. Francisco V., Pérez T., Pino J., López V., Franco E., Alonso A., Gonzalez-Gay M.A., Mera A., Lago F., Gómez R., Gualillo O. J. Orthop Res. 2017 Oct 28.

Ntchito ya adipocyte mitochondria mu kutupa, lipemia ndi insulin kudziwa anthu: zotsatira za pioglitazone

chithandizo. Xie X., Sinha S., Yi Z., Langlais P.R., Madan M., Bowen B.P., Willis W., Meyer C. Int J Obes (Lond). 2017 Aug 14. doi: 10.1038 / ijo.2017.192

Chen X., Jia X., Qiao J. et al. Adipokines mu ntchito yobereka: mgwirizano pakati pa kunenepa kwambiri ndi polycystic ovary syndrome. J Mol Endocrinol 2013, 2: R21-R37.

Li S., Shin H. J., Ding E. L., van Dam R. M. Magulu a Adiponectin ndi chiwopsezo cha matenda a shuga 2: kuwunika mwatsatanetsatane komanso kusanthula kwa meta. JAMA 2009, 2: 179-88.

Chen M.B., McAinch A.J., Macaulay S.L. et al. Kuvuta kwa AMP-kinase ndi mafuta acid oxidation ndi globular adiponectin wolemekezeka wamatumbo wamisempha wa onenepa mtundu 2 matenda ashuga. J Clin Endocrinol Metab 2005, 6: 3665-72.

Comim F.V., Hardy K., Franks S. Adiponectin ndi ma receptor ake mu ovary: umboni wina wolumikizana pakati pa kunenepa kwambiri ndi hyperandrogenism mu polycystic ovary syndrome. PLOS One 2013, 11: e80416.

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SYSTEM INFLAMMATION AND INSULIN RESistance IN POLYCYSTIC

Matsneva I.A., Bakhtiyarov K.R., Bogacheva N.A., Golubenko E.O., Pereverzina N.O.

Yunivesite yoyamba ya boma yaku Moscow idatchedwa I.M. Sechenov, Moscow, Russian Federation

Kuzindikira. Polycystic ovarian syndrome (PCOS) ndi imodzi mwazomwe zimakhala endocrinopathies. Ngakhale kutsika kwakukulu kwa PCOS komanso mbiri yayitali ya kafukufukuyu, nkhani za etiology, pathogenis, kuzindikira ndi kuchiritsa matendawa ndizovuta kwambiri. M'zaka zaposachedwa, chidwi chowonjezeka cha asayansi chakopeka ndi funso la chopereka cha hyperinsulinemia pakukula kwa PCOS. Amadziwika kuti mu 50-70% ya milandu PCOS imaphatikizidwa ndi kunenepa kwambiri, hyperinsulinemia ndikusintha kwa lipid sipekitiramu yamagazi, zomwe zimawonjezera chiopsezo chokhala ndi matenda amtima, mtundu II matenda a shuga ndipo zimayambitsa kuchepa kwa nthawi yayitali ya moyo . Ofufuzawo ambiri amatengera kutsimikiza kwa majini a zovuta za metabolic mu PCOS, mawonetseredwe omwe amapitilira muyeso wa kuchuluka kwambiri kwa thupi. Gawo lamakono pakuphunzira pathogenesis ya PCOS imadziwika ndi kafukufuku wozama wa kusokonekera kwa metabolic: insulin kukana, hyperinsulinemia, kunenepa kwambiri, hyperglycemia, dyslipidemia, kuchepa kwamatenda , komanso matenda ena monga insulin-Independent shuga mellitus ndi matenda a mtima.

Izi zitha kufotokozera kusaka kwazidziwitso zatsopano kuti mudziwe kuti ndi ziti mwa zomwe zingagwiritsidwe ntchito pochita tsiku ndi tsiku monga olosera za metabolic ndi mtima zamavuto omwe ali ndi PCOS.

Mawu ofunikira: kukana insulini, kuchepa kwamatenda, polycystic ovary syndrome, hyperinsulinemia, hyperandrogenia.

BUKU MUTU. Physiology ndi Pathology ya Kubala Kwachikazi

The Journal of clinical endocrinology ndi metabolism. Tian, ​​Ye, Zhao, Han, Chen, Haitao, Peng, Yingqian, Cui, Linlin, Du, Yanzhi, Wang, Zhao, Xu, Jianfeng, Chen, Zi-Jiang. Wolemba Meyi 1, 2016

Glintborg D., Andersen M. Ndemanga pa pathogenesis, kutupa, ndi metabolism mu hirsutism ndi polycystic ovary syndrome. Gynecol Endocrinol 2010.4: 281-96

DANISH MEDICAL JOURNAL. Endocrine ndi metabolic mawonekedwe mu polycystic ovary syndrome. Dan Med J 2016.63 (4): B5232

Eriksen M. B., Minet A. D., Glintborg D. et al. Ntchito yoyambirira ya mitochondrial mu myotubes yokhazikitsidwa kuchokera kwa azimayi omwe ali ndi PCOS. J Clin Endocrinol Metab 2011, 8: E1298-E1302.

The Journal of clinical endocrinology ndi metabolism. Broskey, Nicholas T., Klempel, Monica C., Gilmore, L. Anne, Sutton, Elizabeth F., Altazan, Abby D., Burton, Jeffrey H., Ravussin, Eric, Redman, Leanne M. Wolemba June 1, 2017

Eriksen M., Porneki A.D., Skov V. et al. Kutsutsa kwa insulin sikumasungidwa mu myotubes okhazikitsidwa kwa amayi omwe ali ndi PCOS. PLOS One 2010, 12: e14469.

Cibula D., Skrha J., Hill M. et al. Kuneneratu zamchere wa insulin mwa azimayi omwe si akazi am'mimba mwa polycystic ovary. Juni 2016

Corbould A. Zotsatira za androgens pa insulin zomwe zimachitika mwa amayi: kodi androgen imakhala gawo lalikulu la akazi metabolic syndrome? Diabetes Metab Res Rev 2008, 7: 520-32.

Polycystic Ovarian Disease (Stein-Leventhal Syndrome) Lorena I. Rasquin Leon, Jane V. Mayrin. Einstein Medical Center. Kusintha Komaliza: October 6, 2017

Neuroendocrine Kukula kwa Zakudya Zambiri mu Polycystic Ovary Syndrome. Daniela R., Valentina I., Simona C., Valeria T., Antonio L. Reprod Sci. 2017 Jan 1: 1933719117728803. doi: 10.1177 / 1933719117728803.

Morgan J., Scholtz S., Lacey H. et al. Kuchuluka kwa zovuta zamagulu akudya mwa azimayi omwe ali ndi vuto lodana ndi nkhope: kupweteka kwamaphunziro. Int J Kudya Disord 2008, 5: 427-31.

BIOMECHANICS, OBESity, NDI OSTEOARTHRITIS. MALO A ZOPHUNZITSA: PAMENE LEVEE BULANI. Francisco V., Pérez T., Pino J., López V., Franco E., Alonso A., Gonzalez-Gay M.A., Mera A., Lago F., Gómez R., Gualillo O. J. Orthop Res. 2017 Oct 28.

Ntchito ya adipocyte mitochondria mu kutupa, lipemia ndi insulin kudziwa anthu: zotsatira za pioglitazone chithandizo. Xie X., Sinha S., Yi Z., Langlais P.R., Madan M., Bowen B.P., Willis W., Meyer C. Int J Obes (Lond). 2017 Aug 14. doi: 10.1038 / ijo.2017.192

Chen X., Jia X., Qiao J. et al. Adipokines mu ntchito yobereka: mgwirizano pakati pa kunenepa kwambiri ndi polycystic ovary syndrome. J Mol Endocrinol 2013, 2: R21-R37.

Li S., Shin H. J., Ding E. L., van Dam R. M. Magulu a Adiponectin ndi chiwopsezo cha matenda a shuga 2: kuwunika mwatsatanetsatane komanso kusanthula kwa meta. JAMA 2009, 2: 179-88.

Chen M.B., McAinch A.J., Macaulay S.L. et al. Kuvuta kwa AMP-kinase ndi mafuta acid oxidation ndi globular adiponectin wolemekezeka wamatumbo wamisempha wa onenepa mtundu 2 matenda ashuga. J Clin Endocrinol Metab 2005, 6: 3665-72.

Comim F.V., Hardy K., Franks S. Adiponectin ndi ma receptor ake mu ovary: umboni wina wolumikizana pakati pa kunenepa kwambiri ndi hyperandrogenism mu polycystic ovary syndrome. PLOS One 2013, 11: e80416.

Otto B., Spranger J., Benoit S.C. et al. Nkhope zambiri za ghrelin: malingaliro atsopano a kafukufuku wazakudya? Br J Nutr 2005, 6: 765-71.

Kuchita masewera olimbitsa thupi komanso kuchepa thupi, sikuti nthawi zonse banja losangalala: Mayeso osawona akhungu kamodzi mwa akazi omwe ali ndi BMI yosiyanasiyana. Jackson M., Fatahi F., Alabduljader K., Jelleyman C., Moore J.P., Kubis H.P. Appl Physiol Nutr Metab. 2017 Nov 2.

Barkan D., Hurgin V., Dekel N. et al. Leptin amachititsa ovulation mu mbewa zopanda vuto la GnRH. FASEB J 2005, 1: 133-5.

Jackson M., Fatahi F., Alabduljader K., Jelleyman C., Moore J.P., Kubis H.P. Appl Physiol Nutr Metab. 2017 Nov 2. doi: 10.1139 / apnm-2017-0577.

Gao S., Liu J. Chronic Dis Transl Med. 2017 Meyi 25, 3 (2): 89-94. doi: 10.1016 / j.cdtm.2017.02.02.008. eCollection 2017 Jun 25. Unikani.

Onyango A.N. Oxid Med Cell Longev. 2017, 2017: 8765972. doi: 10.1155 / 2017/8765972. Epub 2017 Sep 7. Kubwereza.

Nakhjavani M., Morteza A., Asgarani F. et al. Metformin imabwezeretsa kuphatikiza pakati pa ma seramu-oxidized LDL ndi leptin m'magulu 2 odwala matenda ashuga. Redox Rep 2011, 5: 193-200.

The Associations of Endotoxemia With Systemic kutupa, Endothelial activation, and Cardiovascular Outcome in Impso Transplantation. Chan W., Bosch J.A., Phillips A.C., Chin S.H., Antonysunil A., Inston N., Moore S., Kaur O., McTernan P.G., Borrows R.J. Ren Nutr. 2017 Oct 28.

Diamanti-Kandarakis E., Paterakis T., Alexandraki K. et al. Zisonyezo za kuchepa kwamkaka koopsa mu polycystic ovary syndrome ndi zotsatira zopindulitsa za metformin. Hum Reprod 2006, 6: 1426-31.

Bouckenooghe T., Sisino G., Aurientis S. et al. Adipose Tissue Macrophages (ATM) ya odwala onenepa akutulutsa milingo yambiri ya prolactin panthawi yovuta yotupa: Udindo wa prolactin mu kusokonezeka? Biochim Biophys Acta 2013, 4: 584-93.

Mtundu woletsa insulin wa PCOS

Ndi mtundu wakale wa PCOS komanso pofala kwambiri. Pamwamba insulin ndi leptin ziletsa ovulation ndikulimbikitsa thumba losunga mazira kuti lipange kwambiri testosterone. Kukana kwa insulini kumayambitsidwa ndi shuga, kusuta, kulera kwa mahomoni, kutulutsa mafuta ndi poizoni wazachilengedwe.

Ambiri Choyambitsa PCOS ndiye vuto lalikulu ndi insulin ndi leptin.Insulin anamasulidwa ku kapamba wanu. Leptin kumasulidwa ku mafuta anu. Pamodzi, mahomoni awiriwa amayendetsa shuga komanso magazi. Amakonzanso mahomoni anu achikazi.

Insulin imadzuka mutangotha ​​kudya, zomwe zimapangitsa kuti maselo anu atenge glucose m'magazi anu ndikusintha kukhala mphamvu. Kenako amagwa. Izi ndizabwinobwino ngati muli ndi "insulin".

Leptin ndiye maholide anu okhathamira. Imadzuka mukatha kudya, komanso mukakhala ndi mafuta ochulukirapo. Leptin amalankhula ndi hypothalamus yanu ndipo amalankhula zochepetsa chilimbikitso chanu ndikuwonjezera kuchuluka kwa metabolic. Leptin amauzanso gland wanu kuti atulutse FSH ndi LH. Izi ndizabwinobwino mukakhala "chidwi ndi leptin."

Mukakhala ndi chidwi ndi insulin, mumakhala ndi shuga wochepa komanso insulin yaying'ono pakukula kwanu kwa magazi. Mukakhala ndi chidwi ndi leptin, mumakhala ndi leptin yochepa.

Pankhani ya PCOS, simumvera insulin ndi leptin. Mumawakana, zomwe zikutanthauza kuti simungathe kuyankha moyenera. Insulin singanene kuti maselo anu amawononga glucose mphamvu, m'malo mwake amasintha glucose kukhala mafuta. Leptin sangauze hypothalamus yanu kuti imachepetsa chilakolako, ndiye kuti mumakhala ndi njala nthawi zonse.

Mukatero kukana insulini, muli ndi misempha yambiri ya insulin. Chakudya kukana leptin, muli ndi leptin wokwanira m'magazi. Ndi mtundu uwu PCOS muli ndi insulin ndi leptin kukana - imangotchedwa insulin kukana.

Kukana kwa insulini kumayambitsa zoposa PCOS yokha. Mkazi amatha kukhala ndi msambo wolemera (kusamba), kutupa, ziphuphu, kusowa kwa progesterone komanso chizolowezi chowonjezera thupi. Kuopsa kotenga matenda ashuga, khansa, mafupa, kuchepa kwa thupi, ndi matenda amtima kukukulira. Ichi ndichifukwa chake PCOS imawonjezera chiopsezo cha izi.

Zimayambitsa Insulin Resistance

Choyambitsa chachikulu chomwe chimapangitsa kuti insulin ikane ndi shuga, chomwe chimanena za fructose yokhazikika mu zakumwa komanso zakumwa za shuga. Fructose yolumikizidwa (koma osati yotsika mlingo) imasintha momwe ubongo wanu umayendera leptin. Izi zimasintha momwe thupi lanu limayendera insulin. Fructose yokhazikika imapangitsanso kuti muzidya zambiri, zomwe zimabweretsa kulemera.
Palinso zifukwa zina zokanira insulin. Mitu ikuluikulu ndi: chibadwa chamtsogolo, kusuta, kutulutsa mafuta, kupsinjika, mapiritsi oteteza kulera, kusowa tulo, kuperewera kwa magnesium (kofotokozedwera pansipa) ndi zoopsa zachilengedwe. Zinthu izi zimayambitsa kukana kwa insulini chifukwa zimawononga insulin yanu, ndipo chifukwa chake, sichingayankhe bwino.

Njira yochepetsera chidwi cha minofu ku insulin

Pogwiritsa ntchito njira za kulera za mahomoni, mahomoni opanga, osiyana ndi kuzungulira kwa mahomoni awo, amaperekedwa pafupipafupi ndi thupi la mkazi wachinyamata muyezo waukulu. Pambuyo pa kulowererapo, mahomoni awo sangakhale ndi vuto lililonse pakugwira ntchito kwa endrogenine. Kudzilamulira kwa dongosolo la endocrine kumadzakhala kovuta.
Kuti thupi lipulumuke, maselo a ziwalo zonse musamvere chisoni mahomoni onse, kuphatikiza ku insulin.

Chifukwa chiyani minofu insulin?

Kuzindikira kwa minofu ndi ziwalo ku insulin ndikofunikira kwambiri. Imatsimikiza kulowa mu khungu la glucose ndi michere ina. M'malo mwake, kufa ndi njala popanda insulin ndi glucose kumachitika chifukwa cha thupi. Wogula wamkulu wa glucose ndi bongo, yemwe sangagwire ntchito bwino popanda iwo.
Mwachitsanzo, mwa odwala omwe ali ndi matenda a shuga, kuchepa kwambiri kwa shuga, matenda am'mimba amatha kufa pankhani ya mphindi (hypoglycemic state). Popewa ngozi yowopsa, odwala matenda ashuga nthawi zonse amanyamula china chake chokoma.
Zikondwererozo zimayamba kupanga insulin mosalekeza komanso pamakampani.kuteteza kufa kwa ubongo. Chifukwa chake chitha kuyamba mtundu 2 shuga - matendawa ndi oopsa komanso oopsa.

Chifukwa chake, mkazi akakhala bwino, ndiye minofu ndikumverera kwa insulin kumachepa. Ichi ndi chimodzi mwamavuto akuluakulu mukamagwiritsa ntchito mahomoni opanga. Kupanga kwa insulin kachulukidwe kumachulukirachulukira. Insulin yowonjezera imayambitsa zovuta zingapo za metabolic ndi endocrine, mpaka kukula kwa matenda ashuga amtundu wa 2. Zimachitika zokha Kusintha kumachitika m'mimba mwake - amakhala hypersensitive kwa insulinndiye zotsatira zake zidzakhala chimodzimodzi - kokha popanda matenda ashuga.

Zambiri Chabwino chimalepheretsa kuwonjezeka kwa minofu mwa akazi achichepere. Izi zimatha kuyambitsa kulemera komanso kuchepa kwa mphamvu ya insulin, motero njira zakulera za mahomoni ndizosankha bwino kwambiri pa PCOS.

Kodi insulin imakhudza bwanji mazira?

M'mimba, ma androjeni amapangidwa, komwe ma estrogen amapangidwa. Mchitidwe womwewo umalimbikitsidwa ndi insulin. Ngati milingo yake ndi yokwera, ndiye kuti mahomoni onse am'mimba amatha "kupangidwa" m'mimba mwake.
Ma estrogens ndiye chinthu chotsiriza cha unyolo wonse wama kemikali. Zogulitsa zapakatikati - progesterone ndi androgens zamitundu yosiyanasiyana. Amapereka zochuluka Zizindikiro zosasangalatsa mu PCOS.

Insulin yambiri - androjeni ambiri mumazira

Kuchuluka kwa insulin kumapangitsa kuti thumba losunga mazira tiziyerekeza ma androjeni mopitirira muyeso. Ndipo mkazi wachichepereyo akupeza zokoma za hyperandrogenism: ziphuphu, kuwonongeka tsitsi, hirsutism.

Testosterone (ma adrenal mahomoni), imatchedwanso mahomoni a "amuna", 99% ili m'thupi la akazi osagwira ntchito, omangidwa ndi mapuloteni ena apadera (SHBG, SHBG). Testosterone imasandulika mawonekedwe - - dihydrotestosterone (DHT, DHT) ndi thandizo insulin ndi 5-alpha reductase enzyme. Nthawi zambiri, DHT siyenera kukhala yoposa 1%.
Dihydrotestosterone imakonda kudzikundikira m'mabowo a tsitsikuyambitsa mavuto ambiri pamaonekedwe a mkaziyo: tsitsilo limakhala lopaka mafuta, lotupa ndipo limayamba kugwa, chifukwa chitha kutsata dazi.
Chiwerengero chachikulu cha DHT m'magazi chimakhudzanso khungu: kuchuluka kwa mafuta, ziphuphu. Komanso kuzungulira kumachoka ndipo kagayidwe kazinthu kamasintha.

Pomaliza, insulin yambiri chimalimbikitsa thumbo lanu kuti liphatikizane ndi mahomoni owonjezera a luteinizing (LH), yomwe imapangitsanso ma androgens ndikuletsa ovulation.

Chifukwa chake, kuchuluka kwambiri kwa insulin m'magazi kumawonjezera zomwe zili ndi androgens yogwira. Androgens samapangidwira osati m'mimba mwake, komanso m'matumbo a adrenal, chiwindi, impso, ndi minofu ya adipose. Koma thumba losunga mazira ndilo gawo lofunikira kwambiri pakukula kwa PCOS.

Kunenepa kwamaonekedwe a Apple

Samalani chizindikiro cha kunenepa kwambiri mu mawonekedwe a apulo (onyamula katundu wolemera m'chiuno mwanu).
Gwiritsani ntchito tepi yoyezera m'chiuno mwanu. Ngati chiuno chanu chazungulira 89 cm, ndiye kuti muli ndi chiwopsezo chokana insulini. Izi zitha kuwerengedwa molondola kwambiri momwe mawonekedwe a chiuno amakhala ofikira: Mchiuno mwanu musakhale ochepera theka kutalika kwanu.
Kunenepa kwambiri kwa Apple ndi chizindikiro chofotokozera cha kukana insulin. Mukakhala ndi gawo lalikulu m'chiwuno chanu, PCOS yanu imakhala yosagwirizana ndi insulin.

Insulin yayikulu imapangitsa kuti muchepetse kuchepa thupindipo izi zimatha kukhala ozungulira: kunenepa kwambiri kumayambitsa kukana kwa insulini, kuyambitsa kunenepa kwambiri, komwe kumakulitsanso kukana kwa insulin. Njira yabwino kwambiri yochepetsera thupi ndi kukonza insulin.

Zofunika! Kutsutsa kwa insulini kumatha kuonekanso mwa anthu ochepa thupi. Kuyesedwa kwa magazi ndikofunikira kuti mudziwe.

Kuyesa kwa magazi kukana insulini

Funsani dokotala wanu kuti akupatseni malangizo amodzi mwazomwe mungachite:

• Kuyesedwa kwa kulolera kwa glucose ndi insulin.
  Ndi kuyesedwa uku, mumapereka zitsanzo zingapo zamagazi (musanamwe ndikumwa chakumwa). Chiyeso chimayeza momwe mumachotseretsa shuga m'magazi (zomwe zikuwonetsa momwe mumayankhira insulini). Mutha kuyesanso leptin, koma ma laboratories ambiri satero.
• Kuyesedwa kwa magazi pansi pa index HOMA-IR.
  Ndiwo pakati pa insulin yosala kudya ndi glucose othamanga. Mkulu insulin imatanthawuza kukana insulin.

Ngati muli ndi kukana insulini, muyenera chithandizo chomwe tikambirana pambuyo pake.

Kukana shuga

Choyambirira kuchita ndikuletsa kudya zakudya komanso zakumwa za shuga. Pepani chifukwa chobweretsa mbiri yabwino, koma ndikutanthauza kusiya. Sizitanthauza kuti nthawi zina zimangobwerera pie zokha. Ngati mukumana ndi insulin, mulibe "mphamvu zamahomoni" kuti muzitha kuzola mchere. Nthawi iliyonse mukadya zakudya zamchere, zimakukanikizirani mwakuya mpaka kukana kwa insulini (ndikuzama mu PCOS).
Ndikudziwa kuti ndizovuta kusiya shuga, makamaka ngati mumagwiritsa ntchito mankhwala osokoneza bongo. Kupereka shuga kumatha kukhala kovuta kapenanso kovuta kuposa kusiya. Kuchotsa shuga m'thupi kumafunikira dongosolo losamala.

Momwe mungathandizire kukana shuga:

• Gona mokwanira (chifukwa kugona tulo kumayambitsa kulakalaka kwa shuga).
• Idyani zakudya zonse kuphatikizapo macronutrients onse atatu: mapuloteni, wowuma, ndi mafuta.
• Osayesa kuchepetsa zakudya zanu mitundu yina ya chakudya mukamaponyera shuga.
• Yambani kudya panthawi yochepetsetsa m'moyo wanu.
• Dziwani kuti kulakalaka kwakukulu kwa maswiti kudzatha mu mphindi 20.
• Dziwani kuti zolakalaka zimangotsalira pakatha milungu iwiri.
• Onjezani magnesium chifukwa imachepetsa kulakalaka kwa shuga.
• Dzikondeni nokha. Dzikhululukireni. Kumbukirani, mumachita nokha!

Kukana shuga ndikosiyana ndi zakudya zamafuta ochepa. M'malo mwake, nthawi zambiri zimakhala zosavuta kupereka shuga ngati simupewa kukhuthala, monga mbatata ndi mpunga, chifukwa wowuma amachepetsa zokhumba. Komabe, ndizovuta kusiya shuga ngati mumadya zakudya zotupa monga tirigu ndi mkaka. Izi ndichifukwa kulakalaka kwa chakudya ndi chizindikiro chofala cha zakudya zotupa.
Idzafika nthawi yomwe insulin yanu ingakhale yabwinobwino ndipo kenako mutha kusangalala ndi mchere wambiri. Nthawi zambiri, ndikutanthauza kamodzi pamwezi.

Zochita zolimbitsa thupi

Kuchita masewera olimbitsa thupi kumathandizanso kuti minofu ikhale ndi insulin. M'malo mwake, masabata ochepa okha ophunzitsidwa mphamvu adawonetsa kuwonjezeka kwa insulin sensitivity ya 24%. Lowani nawo malo ochitira masewera olimbitsa thupi, ngakhale mutayesetsa pang'ono muonabe kusintha. Yendani mozungulira mtunda. Kwerani masitepe. Sankhani mtundu wa masewera olimbitsa thupi omwe mumakonda.

DIAGRAM YOPHUNZITSIRA KUKULA KWAMBIRI

Malamulowa sapangidwa kuti azingowonjezera chidwi cha insulin mwa amayi omwe ali ndi PCOS, koma kwa anthu onse omwe ali pachiwopsezo chachikulu chotenga matenda a shuga.

Magnesium taurate

Berberine *

Inositol Powder, 227 g

GTF Chrome ***

Zolemba pagome

* Berberine musaphatikize ndi mankhwala ena omwe mumalandira: antidepressants, beta blockers, kapena immunosuppressants (chifukwa amatha kusintha kuchuluka kwa magazi amankhwala anu). Contraindicated pa mimba ndi mkaka wa m`mawere.
Musagwiritse ntchito mosalekeza kwa miyezi yopitilira itatu chifukwa imayambitsa matenda osokoneza bongo ndipo imatha kusintha ma bacteria. Masabata atatu ndi Berberine ndi curcumin.

** Alpha Lipoic Acid yotetezeka kwambiri, koma pamlingo wambiri (kuposa 1000 mg) imatha kutsitsa mahomoni a chithokomiro.
Alpha-lipoic acid, pokhala thiol, samaphatikizana ndi vitamini B12, chifukwa Zonsezi zimayamba kukhala ndi antitumor, koma zimakhala zovulaza thupi la munthu wathanzi. Chifukwa chake, timamwa mosiyana ndi mankhwala komwe B12 ilipo, maphunziro osinthika (sitingathe kuwabweretsa pofika tsiku).
Tengani mosiyana ndi magnesium, chitsulo ndi calcium, monga amalowa nawo mu chakudya china, osaphatikiza ndi mowa.

*** Chrome osaphatikiza ndi antidepressants, beta-blockers, H2 blockers, proton pump inhibitors, corticosteroids, NSAIDs.

Progesterone

Kutsutsa kwa insulin kumayambitsanso kuchepa kwa progesterone komanso kuzungulira kolemera.
Vuto lalikulu ndi PCOS ndikusowa kwa kapangidwe ka progesterone kwa masabata awiri muchizungu chilichonse. Kuperewera kwa progesterone kumayambitsa kusalinganika m'mazira, kumalimbikitsa androgen, ndipo kumayambitsa kuzungulira kosasangalatsa. Ndizomveka kukonza izi poyipa ndikubwezeretsanso progesterone (m'malo mwa duphaston), ndikupereka njira ziwiri zoti musankhe:

Tsopano Zakudya, Natural Progesterone Kirimu

• ndi msambo wokhazikika wa msambo - kuyambira masiku 14 mpaka 25 a MC (tsiku loyamba lopaka kirimu liyenera kukhala lofanana ndi tsiku la mazira.)
• Popeza kuzungulira - ntchito 25 masiku yopuma 5 masiku.
• okhala ndi progesterone yotsika kwambiri kapena testosterone yayikulu - gwiritsani ntchito mwezi woyamba mosalekeza, komanso kuyambira lotsatira - mugawo lachiwiri.

GUNA, Potentiated Progesterone Drops

Mphamvu yamuyaya imawonedwa pakatha mwezi umodzi wogwiritsidwa ntchito.
Njira yogwiritsira ntchito:
Mwa 20 akutsikira kawiri pa tsiku pamimba yopanda 20-30 mphindi musanadye kapena ola limodzi mutatha kudya, pogwiritsa ntchito njira iyi:

• ndi msambo wokhazikika wa msambo - kuyambira 14 mpaka 25 masiku a MC (tsiku loyamba lovomerezedwa liyenera kufanana ndi tsiku la ovulation.)
• Popeza kuzungulira - kutenga masiku 25 ndi masiku 5.
• okhala ndi progesterone yotsika kwambiri kapena testosterone yayikulu - gwiritsani ntchito mwezi woyamba mosalekeza, komanso kuyambira lotsatira - mugawo lachiwiri

Proentierone wa potentiated akulimbikitsidwa kuti agwiritsidwe ntchito ndi progesterone synthesis inducer - GUNA REGUCICLE (G3)kotero kuti thupi lokhalo limapitiriza izi.
Mwa 20 akutsikira kawiri pa tsiku pakumwa chopanda kanthu 20-30 mphindi musanadye kapena ola limodzi, tengani mosalekeza kwa mwezi umodzi. Mankhwalawa onse amathanso kukhala osakanizika mu kapu imodzi yamadzi ndikumwa mochedwa.

• Kugula Guna progesterone pa eBay yoperekera padziko lonse lapansi
• Kugula Guna Rugulcycle pa eBay yoperekera padziko lonse lapansi

Kukonzekera kwa progesterone kumayamba ndi mankhwala a insulin kwa miyezi 3-4.

Hyperandrogenism imatha kutsogolera ku hypnotrogenism kapena mosinthanitsa ndi kuchepa kwa estrogen.
Pofuna kuchepa kaphatikizidwe ka estrogen, onjezerani phytoestrogens kapena estrogens omwe amatha kusankha kuchokera.
Phytoestrogens ali mwanjira yofanana ndi estrogen ya anthu, koma, monga lamulo, amakhala ofooka pang'ono. Zitsamba za phytoestrogenic zimakhala ndi mitundu yosiyanasiyana, motero, zimakhudza thupi m'njira zosiyanasiyana. Zitha kubweretsanso maubwino ena mthupi lanu: kukhalabe osatetezeka, kusintha magazi m'matumbo, kuchepetsa kutupa, ndi zina zambiri.

Njira Yachilengedwe, Red Clover

• ndi msambo wofanizira kusamba - kuyambira masiku 5 mpaka 14 a MC
• Ngati endometrium imakula bwino, ndiye kuyambira masiku 5 mpaka 25 MC

GUNA, Potentiated Estradiol Drops

• ndi msambo wokhazikika wa msambo - kuyambira 14 mpaka 25 masiku a MC (tsiku loyamba lovomerezedwa liyenera kufanana ndi tsiku la ovulation.)
• Ngati endometrium sichikula bwino - kuyambira masiku 5 mpaka 25 a MC

Estradiol ya potentiated imalimbikitsidwa kuti izigwiritsidwa ntchito ndi estradiol synthesis inducer - GUNA FEM, yomwe imawunikira dongosolo lonse la endocrine ndipo thupi limapitilizanso njirayi.
Mwa 20 akutsikira kawiri pa tsiku pakumwa chopanda kanthu 20-30 mphindi musanadye kapena ola limodzi, tengani mosalekeza kwa mwezi umodzi. Mankhwalawa onse amathanso kukhala osakanizika mu kapu imodzi yamadzi ndikumwa mochedwa.

Ma Horopathic potentiated mahomoni amapezeka ku Ukraine kokha, mwatsoka samatumizidwa mwachindunji kwa wopanga kuchokera ku Russia. Mankhwala ena adayamba kuwoneka pa Amazon.

• Kugula Guna wachikazi pa eBay yotumiza padziko lonse lapansi.
• Kugula Guna estradiol pa eBay yotumiza padziko lonse lapansi.

Kuti muyike oda mu malo ogulitsa aku Guna aku Ukraine, mufunika satifiketi ya katswiri yemwe adaphunzitsidwa nawo - 1781 (Dzinalo lisasiyidwe). Kutumiza kumachitika ku Ukraine ndi makalata atsopano, ndalama pobweretsa.