Matenda a shuga - maupangiri ndi zidule

Matenda a shuga mellitus (DM) ndivuto lalikulu lazachipatala komanso chikhalidwe chokhudzana ndi zoyambira za machitidwe azachipatala m'dziko lililonse pafupifupi mayiko onse, otetezedwa ndi malamulo a WHO.

Kaseweredwe komanso kufulumira kwa vuto la matenda ashuga kumatsimikiziridwa ndi kufalikira kwa matenda ashuga, kufa kwakukulu ndi kulumala koyambirira kwa odwala.

Kuchuluka kwa matenda ashuga mmaiko a Azungu ndi 2-5% ya anthu, ndipo m'maiko osatukuka akufika pa 10-15%. Zaka 15 zilizonse kuchuluka kwa odwala kumawirikiza. Ngati mu 1994 panali odwala 120.4 miliyoni omwe ali ndi matenda ashuga padziko lapansi, ndiye pofika chaka cha 2010 kuchuluka kwawo, malinga ndi akatswiri, adzakhala 239.3 miliyoni. Ku Russia, anthu pafupifupi 8 miliyoni ali ndi matenda a shuga.

Matenda a shuga a Mtundu Wachiwiri amapezeka pang'onopang'ono poyerekeza ndi kuchuluka kwa odwala, omwe amakhala 80% ya odwala onse. Mawonetseredwe azachipatala a mtundu I ndi mtundu wachiwiri wa shuga ali osiyana kwambiri. Ngati mtundu wa matenda a shuga a mellitus (wodalira insulini) umapangitsa kuti ziwonekere kukhala pachimake-matenda ashuga ketoacidosis, ndipo odwala oterowo nthawi zambiri amagonekedwa m'madipatimenti apadera a endocrinology (diabetes), ndiye kuti mtundu wa II wodwala mellitus (osagwirizana ndi insulin) umadziwikiridwa mwachidziwikire mwatsatanetsatane: pakufunsidwa kwa udokotala, kulandira ma komisheni, etc. d. Zowonadi, mdziko lapansi, pali anthu awiri omwe samakayikira za kudwala kwawo pamtundu wa II wodwala wodwala yemwe wapempha thandizo. Komanso, iwo, osachepera 40% ya milandu, ali kale ndi vuto lotchedwa mochedwa zovuta: matenda a mtima, retinopathy, nephropathy, polyneuropathy.

Matenda a shuga ndi matenda omwe amayeserera adokotala mwanjira iliyonse.

I. Dedev, B. Fadeev

Zovuta za matenda ashuga
Pezani yankho laibulale yachipatala

Kufunika kwa mwambowu

Matenda a shuga ndi limodzi mwa matenda atatu omwe nthawi zambiri amabweretsa kulumala ndi kufa (atherosulinosis, khansa ndi matenda a shuga).

Malinga ndi WHO, matenda a shuga amawonjezereka kufa ndi anthu katatu ndipo amachepetsa chiyembekezo chokhala ndi moyo.

Kufunika kwa vutoli kumachitika chifukwa cha kufalikira kwa matenda ashuga. Mpaka pano, milandu pafupifupi 200 miliyoni yalembedwa padziko lonse lapansi, koma kuchuluka kweniko kuli pafupifupi 2 times (anthu omwe ali ndi mawonekedwe osalala, osalandira mankhwala sawaganiziridwa). Kuphatikiza apo, ziwerengero zimachulukana chaka chilichonse m'maiko onse ndi 5 ... 7%, ndipo zimachulukanso zaka 12 ... zaka 15. Zotsatira zake, kuchuluka kwakuopsa kwambiri pamilandu kumabweretsa mkhalidwe wosavulaza.

Matenda a shuga amadziwika kuti kuchuluka kwa shuga m'magazi, kumatha kuchitika zaka zilizonse ndipo kumatenga moyo. Kukonzekera kwa cholowa kumadziwika bwino, komabe, kuzindikira kwangozi kumadalira zochita za zinthu zambiri, zomwe kunenepa kwambiri komanso kusachita zolimbitsa thupi kukuwatsogolera. Kusiyanitsa pakati pa matenda a shuga 1 kapena osadalira insulini ndi mtundu wa matenda ashuga 2 kapena osadalira insulini. Kuchuluka kowopsa kwa chiwopsezo kumayenderana ndi mtundu 2 wa shuga, womwe umakhala woposa 85% ya milandu yonse.

Pa Januware 11, 1922, Bunting ndi Best woyamba adalowetsa insulin kwa achinyamata omwe ali ndi matenda ashuga - nthawi ya mankhwala a insulin idayamba - kupezeka kwa insulini kunali kopambana kwakukulu mu mankhwala a zana la 20 ndipo adalandira Mphotho ya Nobel mu 1923.

Mu Okutobala 1989, chilengezo cha Saint Vincent chokhudza kusintha kwa chisamaliro cha anthu omwe ali ndi matenda ashuga chidakhazikitsidwa ndipo pulogalamu yakhazikitsidwe ku Europe idapangidwa. Mapulogalamu ngati amenewa amakhalanso m'maiko ambiri.

Miyoyo ya odwala idatha, adasiya kufa mwachindunji ndi matenda ashuga. Kupita patsogolo kwa matenda ashuga m'zaka makumi angapo zapitazi kwatipangitsa kuti tiziyembekeza bwino kwambiri kuthetsa mavuto obwera chifukwa cha matenda ashuga.

Kuyesa kwa glycemia pakupezeka kwa matenda ashuga: mavuto ndi mayankho ake

A.V. Indutny, MD,

Omsk State Medical Academy

Magazi a m'magazi ndi umboni wofunikira pakupezeka ndi matenda a shuga a mellitus syndrome a hyperglycemia. Kutanthauzira kolondola kwachipatala pazotsatira zodziwira glycemia ndipo, chifukwa chake, kupezeka koyenera kwa matenda a shuga kumadalira mtundu wa ntchito ya labotale. Makhalidwe abwino owunikira njira zamakono zantchito zothandizira kudziwa shuga, kukhazikitsidwa kwa kuyesa kwa kafukufuku wamkati ndi kunja kumapereka chidziwitso chodalirika cha magwiridwe antchito. Koma izi sizithetsa mavuto ofananitsa magawo a glucose omwe amapezeka pakuwunika mitundu yosiyanasiyana ya sampuli zamagazi (magazi athunthu, plasma yake kapena seramu), komanso mavuto omwe amayamba chifukwa cha kuchepa kwa glucose pakasungidwa zitsanzozi.

Pochita izi, shuga amatsimikizika m'magazi onse a capillary kapena venous, komanso m'magawo a plasma ogwirizana. Komabe, malire a kusinthasintha kwa kuchuluka kwa shuga m'magazi amasiyana kwambiri kutengera mtundu wa magazi omwe amaphunziridwa, omwe atha kukhala matanthauzidwe olakwika omwe amatsogolera ku hyper- kapena hypodiagnosis ya matenda a shuga.

M'magazi athunthu, kuchuluka kwa shuga kumakhala kochepa poyerekeza ndi madzi am'madzi. Chomwe chimapangitsa izi kukhala chosiyana ndi madzi am'munsi m'magazi athunthu. Gawo losakhala lamadzimadzi lonse la magazi (16%) limayimiridwa makamaka ndi mapuloteni, komanso ma plasma lipid-protein complexes (4%) ndi zinthu zofanana (12%). M'magazi am'magazi, kuchuluka kwa osagwiritsa ntchito madzi ndi 7% yokha. Chifukwa chake, kuchuluka kwa madzi m'magazi athunthu, pafupifupi 84%, mu plasma 93%. Ndizachidziwikire kuti glucose m'magazi imangopezeka yankho lamadzi, chifukwa imagawidwa kokha mwa madzi apakati. Chifukwa chake, malingaliro a kuchuluka kwa glucose pakuwerengera kuchuluka kwa magazi athunthu ndi kuchuluka kwa plasma (wodwala yemweyo) zidzasiyana nthawi 1.11 (93/84 = 1.11). Kusiyana kumeneku kwathandizidwa ndi World Health Organisation (WHO) mu machitidwe omwe aperekedwa a glycemic. Kwanthawi yayitali, sizinali zoyambitsa kusamvetsetsa komanso zolakwika zodziwikitsa, popeza m'gawo la dziko linalake, magazi a capillary onse (malo omwe anakhalapo pambuyo pa Soviet ndi mayiko ambiri akutukuka) kapena plasma yamagazi (mayiko ambiri aku Europe) anali kugwiritsa ntchito posankha shuga.

Zinthu zinasintha kwambiri ndikubwera kwa glucometer am'modzi ndi a labotale omwe ali ndi zida zowerengera mwachindunji komanso kuyeza kuchuluka kwa glucose potengera kuchuluka kwa madzi a m'magazi. Zachidziwikire, kutsimikiza kwa shuga mwachindunji m'madzi a m'magazi ndikofunikira kwambiri, chifukwa sizitengera hematocrit ndipo zimawonetsa zenizeni za metabolism ya carbohydrate. Koma kugwiritsidwa ntchito paliponse pakuchitika kwa matenda a glycemic kwa plasma komanso magazi athunthu kunadzetsa mkhalidwe wazowirikiza kawiri poyerekeza zotsatira za kafukufukuyu ndi njira zodziwira matenda osokoneza bongo. Izi zidapangitsa kuti pakhale kusamvetsetsana kosiyanasiyana komwe kumakhudza kuyendetsa bwino glycemic ndipo nthawi zambiri kumalepheretsa kugwiritsa ntchito akatswiri azachipatala omwe amadziwika ndi odwala omwe amadziletsa glycemia.

Kuti athetse mavutowa, International Federation of Clinical Chemistry (IFCC) yapanga malingaliro ofotokozera zotsatira za shuga m'magazi. Chikalatachi chikufunsanso kusintha kwa kuchuluka kwa shuga m'magazi athunthu kukhala mtengo wofanana ndi kuphatikizika kwake m'madzi a m'magazi mwa kuchulukitsa zakale ndi chinthu cha 1.11, chomwe chikufanana ndi kuchuluka kwa kutsikira kwa madzi m'mitundu iwiriyi. Kugwiritsa ntchito chizindikiro chimodzi cha kuchuluka kwa glucose m'magazi (mosasamala kanthu ndi njira yodziwira) kumapangidwira kuti muchepetse kuchuluka kwa zolakwika zachipatala pofufuza zotsatira za kusanthula ndikuchotsa kusamvetsetsa kwa odwala pazomwe zimasiyana pakati pa kuwerengera kwa glucometer ndi data yoyesa labotale.

Kutengera ndi malingaliro a akatswiri a IFCC, WHO yalongosola kuyesa kwa glycemia pakupezeka kwa matenda ashuga. Ndikofunikira kudziwa kuti mu mtundu watsopano wa njira zodziwunikira za matenda a shuga, chidziwitso cha kuchuluka kwa shuga m'magazi athunthu sichimaphatikizidwa pamagawo amtundu wa glycemia. Mwachidziwikire, ntchito yothandizira ma labotale iyenera kuwonetsetsa kuti zidziwitso zomwe zimaperekedwa ponena za kuchuluka kwa glucose zikukwana ndi njira zodziwira matenda ashuga. Malingaliro a WHO omwe akufuna kuti athetse ntchito yofunikayi atha kuchepetsedwa ndikuyamba kutsatira:

1. Poonetsa zotsatira za phunziroli ndikuwunika glycemia, ndikofunikira kugwiritsa ntchito deta yokha pamlingo wa glucose m'magazi a m'magazi.

2. Kudziwitsa kuchuluka kwa glucose mu venous magazi am'magazi (glucose oxidase colorimetric njira, glucose oxidase njira yodziwunikira, hexokinase ndi njira ya glucose dehydrogenase) ziyenera kuchitika pokhapokha pakulowera magazi mu chubu choyesedwa ndi glycolysis inhibitor ndi anticoagulant. Popewa kuchepa kwa magazi m'chilengedwe, ndikofunikira kuonetsetsa kuti magazi akusungidwa chubu ndi magazi mu ayezi mpaka madziwo atalekanitsidwa, koma osapitilira mphindi 30 kuchokera nthawi yomwe amasamba magazi.

3. Kuphatikizika kwa shuga m'magazi a m'magazi a capillary kumatsimikiziridwa ndikupenda magazi onse a capillary (popanda kuchepetsedwa) pazida zomwe zili ndi gawo lopanga zopangira mawonekedwe (Reflotron) kapena kutembenuka kophatikizidwa kwa muyezo kumapangitsa kuchuluka kwa shuga m'magazi am'magazi (ma glucometer).

4. Pa kafukufuku wa kuchepetsedwa kwa maselo a magazi a capillary magazi onse (hemolysates) omwe ali ndi zida zowonera za amperometric (EcoTwenty, EcoMatic, EcoBasic, Biosen, SuperGL, AGKM, etc.) komanso pa biochemical Analysers (glucose oxidase, hexokinase ndi glucose dehydrogenase odzipereka) magazi athunthu. Zomwe zimapezedwa motere ziyenera kuchepetsedwa ku plasma glycemia yamagazi a capillary, ndikuwachulukitsa ndi chinthu cha 1.11, chomwe chimatembenuza muyeso mu gawo la glucose la plillma yamagazi. Nthawi yayitali kwambiri yovomerezeka kuyambira panthawi yomwe magazi akusungidwa (mpaka kugwiritsa ntchito njira ndi mawonekedwe a amperometric) kapena centrifugation (mukamagwiritsa ntchito mitundu ya colorimetric kapena spectrophotometric) ndi mphindi 30, kusungidwa kwa zitsanzo mu ayezi (0 - + 4 C).

5. Mwanjira yazotsatira zakusaka, ndikofunikira kuwonetsa mtundu wa magazi omwe mulingo wa glucose unayesedwa (mu mawonekedwe a dzina la chisonyezo): mulingo wa plasma glucose m'magazi a capillary kapena plasma glucose magazi a venous. Mitsempha yamagazi ndi ya venous m'magazi a glucose imagwirizana pamene wodwala amupima pamimba yopanda kanthu. Mitundu yamatchulidwe (yachilendo) yosala kudya shuga m'magazi am'magazi: kuyambira 3,8 mpaka 6.1 mmol / L.

6. Tiyenera kudziwa kuti pambuyo pobaya kapena kulongedza shuga, kuchuluka kwa shuga m'magazi a m'magazi a capillary kumakhala kwapamwamba kuposa plasma ya magazi a venous (pafupifupi, 1.0 mmol / l) 1 3. Chifukwa chake, mukamayesa mayeso a glucose mu Mtundu wazotsatira za phunziroli uyenera kuwonetsa chidziwitso cha mtundu wamwazi wamagazi ndikuwapatsanso matanthauzidwe ofananirako (tebulo).

Kutanthauzira kwa zotsatira za kuyesedwa kwa glucose koyenera 1, 3

Mtundu
magazi a m'magazi

Magawo a Zipatala a Hyperglycemia
(shuga glucose amasonyezedwa mmol / l)

Mawu a ntchito yasayansi pamutu wakuti "Matenda a shuga mu Russian Federation: mavuto ndi mayankho"

■ Matenda a shuga ku Russian Federation: mavuto ndi mayankho

Federal Diabetes Center M3 ya Russian Federation. ■ 'Endocrinological Research Center RAMS Ж (dir. - Acad. RAMS II Dedov), Moscow I

Kugwirizana kwa matenda a shuga mellitus (DM) kumatsimikiziridwa ndikuwonjezereka kwaposachedwa kwambiri kwa anthu. Chifukwa chake, malinga ndi akatswiri, chiwerengero cha odwala padziko lapansi pofika 2000 chidzakhala 175.4 miliyoni .. ndipo pofika chaka cha 2010 chiwonjezeka kufika pa 239.4 miliyoni. Zikuwonekeratu kuti zakutsogolo kwa akatswiri kuti kuchuluka kwa odwala omwe ali ndi matenda ashuga pazaka zilizonse 12-15 kudzakhala kolungamitsidwa. Mu mkuyu. Chithunzi 2 ndi 3 chikuwonetsa kuchuluka kwa insulin-kudalira (IDDM) komanso osadalira insulin (IDDM) matenda a shuga m'mayiko osiyanasiyana padziko lapansi. Maiko aku Scandinavia, ndi Finland poyambilira, ali ndi udindo waukulu pakukula kwa matenda ashuga a I, pomwe pafupipafupi IDDM ku Russia (data ya ku Moscow) ndi yotsika kasanu ndi katatu kuposa ku Finland ndipo ili pamlingo uwu pakati pa Poland ndi Germany.

Mexico> 0,6 Japan ■ 7 Israel .i Poland G 5.5

Russia (Mosca) I. 5.4

■, 15 20 25 30 35 40%

Mkuyu. 1. Zochitika za anthu odwala matenda ashuga padziko lapansi komanso zoneneratu za chitukuko chake (anthu miliyoni).

Mkuyu. Kufalikira kwa IDDM m'maiko padziko lonse lapansi.

NIDDM imalamulira pakati pa Amwenye a Pima (USA), mtundu wa Nauru (Micronesia). Russia imatenga pakati pa China ndi Poland.

Mu kapangidwe ka shuga mellitus, nthawi zambiri 80-90g amapangidwa ndi odwala omwe ali ndi matenda amtundu II, ndipo mitundu yokhayo yamayiko osiyanasiyana ndiyomwe imakonda. Chifukwa chake, okhala ku Papua New Guinea alibe shuga wachiwiri, ndipo ku Russia, nzika za Kumpoto sizikhala ndi matenda a shuga a mtundu.

Ku Russia mu 1997 pafupifupi 3,000,000 odwala omwe ali ndi matenda ashuga adalembetsa, mwa omwe 252 410 anthu anali ndi matenda a shuga a I, ana 14 367 ndi anyamata 6494. Koma zizindikirozi zikuwonetsa kusakhazikika kwanyengo, i.e. pamene odwala adakakamizidwa kufunafuna thandizo. Pakufunika kopima mayeso a kuchipatala, kuzindikira kwa odwala, kuchuluka kwa omwe akudwala NIDDM kumakhalabe kosalembedwa. Anthu omwe ali ndi glycemia kuyambira 7 mpaka 15 mmol / L (pafupipafupi 3.3 - 5.5 mmol / L) amakhala, amagwira ntchito, inde, okhala ndi mawonekedwe azizindikiro. osati za

Papua N. Guinea ■ - Ndi China ^ 1,3

Mkuyu. 3. Kufalikira kwa NIDDM m'maiko padziko lonse lapansi.

pitani kuchipatala, khalani osaperekedwa. Amapanga gawo la pansi pa shuga - "madzi oundana", omwe nthawi zonse "amadyetsa" pansi, ndikuti, gawo laling'ono la odwala matenda ashuga omwe amapezeka kuti ali ndi matenda am'miyendo. Coronary mtima kapena matenda aubongo, matenda ashuga retinopathy, nephro

Kugwirizana kwa zenizeni (A) ndi kulembetsa “(B) kufalikira kwa NIDDM pakati pa anthu aku Moscow

Magulu azaka A / B

Zaka 30-39 3.00 3.05

Zaka 40-49 3,50 4,52

Zaka 50-59 2.00 2.43

patia. polyneuropathy, etc. Kafukufuku wosankhidwa adawonetsa kuti m'maiko otukuka padziko lapansi kwa wodwala m'modzi yemwe amayendera dokotala pali anthu 3-4 omwe ali ndi shuga wamagazi a 7-15 mmol / l, omwe sakudziwa za matendawa.

Kafukufuku wofanana omwe adachitika pakati pa anthu aku Moscow adapeza kuchuluka kwa (A) ndikujambulidwa (B) kufalikira kwa NIDDM (Table 1). Zambiri, makamaka zamagulu azaka za 30-39 ndi 40-49, zimagwirizana kwathunthu ndi zakunja.

Munthawi yoyamba ya odwala omwe ali ndi mtundu woyamba wa II komanso mtundu II, tinapeza kuchuluka kwambiri kwa zovuta za matenda ashuga. Zinapezeka kuti kuchuluka kwamavuto omwe amadziwika ndi odwala matenda ashuga ndiokwera kwambiri kuposa kutsutsana komwe kumadziwika kuti kumatanthauza (mkuyu. 4, 5) Izi ndi zomwe zimapangitsa kulumala ndi kufa kwa odwala.

Macroangiopathy yam'munsi

Myocardial infarction G matenda oopsa Stroke

60 80 100 “Wolembetsa C Okhazikika

Mkuyu. 4.Kukula kwenikweni ndi zolembedwa za zovuta za IDDM mwa odwala azaka 18 ndi akulu.

Macroangiopathy | miyendo yotsika

| Wolembetsedwa ■ _ Zoona

Mkuyu. 5. Kukula kwenikweni ndi zolembedwa za zovuta za NIDDM mwa odwala azaka zapakati pa 18 ndi akulu.

Izi ndizomwe zimapangitsa kuti pakhale kuyesa kwakukulu, kapena, kwathunthu, kuyezetsa matenda ashuga pambuyo pazaka 40, kukhazikitsa mfundo zowunikira thanzi la anthu. yalimbikitsidwa ndi WHO. Njira zothetsera izi ndi njira yeniyeni yodziwira PNSD ndi zovuta zake, kupewa kwawo. Tsopano, munthawi ya chithandizo choyambirira cha wodwala yemwe ali ndi matenda osokoneza bongo kupita kwa adotolo, ndikuwunika koyenera pafupifupi 40 gf milandu, IHD yapezeka. retinopathy, nephropathy, polyneuropathy. odwala matenda ashuga phazi. Kuyimitsa njirayi ndikuvuta kwambiri, ngati kuli kotheka, ndipo kumawononga ndalama zambiri kwa anthu ambiri. Ichi ndichifukwa chake mchaka cha 1997 United States idatengera pulogalamu yowunika anthu kuti adziwe matenda a shuga II. Zachidziwikire, pulogalamu yotere imafuna ndalama zambiri, koma zimabwera bwino. Kuneneratu kuchuluka kwa IDDM ku Russia mpaka 2005 kukuwonetsedwa ku mkuyu. 6. Ntchito ya matenda ashuga iyenera kukhala yokonzekera kupatsa mamiliyoni ambiri odwala omwe ali ndi matenda ashuga ndi mankhwala amakono ndi chisamaliro choyenera.

Mkuyu. 6. Zowonetseratu zakukula kwa IDDM ku Russia mpaka 2005.

Kalata ya boma la odwala matenda ashuga iyenera kutenga gawo lalikulu pakuphunzira kuchuluka kwa matenda ashuga, malo ake m'magawo osiyanasiyana, m'mizinda, m'mizinda ndi kumidzi, kumpoto ndi kumwera, kutengera nyengo ndi nyengo, chikhalidwe cha chakudya, ndi zina zambiri.

Miyezo ya ku Europe ndi yokhazikitsidwa ndi mbiri yaku Russia, yomwe ingalole kufananizira magawo onse a shuga ndi maiko akunja, kuneneratu kuchuluka konse, kuwerengera ndalama zowonekera mwachindunji komanso zosadziwika, ndi zina zambiri.

Tsoka ilo, kusakhazikika kwachuma ku Russian Federation kumalepheretsa kukhazikitsidwa kwa Boma-

Kulembetsa matenda a shuga chofunikira kwa Russia.

Kupatsa odwala mankhwala ndi zowongolera

Vuto lopatsa odwala matenda ashuga ndi mankhwala abwino ndi njira zowongolera lakhala likuchitika paliponse ndipo likukulirabe, ndipo zokambiranazi zikupitilira pakusankhidwa kwa njira zomwe zingakwaniritsidwe, mbali imodzi, komanso yothandiza kwambiri inayo.

Mu media athu nthawi ndi nthawi pamakhala kukambirana kwamkati pankhani yofunikira kwambiri ya insulini ya nyama. makamaka nkhumba insulin. zomwe amati sizotsika kuposa anthu komanso zotsika mtengo kuposa izi. Izi, kunena mwachidule, zosakwanira mawu, mokulira, zikukulimbikitsa mwachangu kwa opanga nyama a insulin, omwe ndi matenda ashuga a dzulo.

Mapulogalamu amtundu wa anthu omwe amapezeka pogwiritsa ntchito ukadaulo wa DNA womwe umadziwikanso padziko lonse lapansi amadziwika kuti ndiye insulin yosankha pamsika wapadziko lonse. Kufalikira kwake kofalikira, kuyambira 1982, kunachotsa zovuta zonse zomwe zimafanana ndi nyama.

Zambiri zathu zaka zambiri zawonetsa kuti kufunika kwa insulin kwa odwala omwe ali ndi IDDM. kulandira insulin ya anthu, amakhala ndi mlingo wokhazikika, pomwe Mlingo wa porcine monocomponent insulin panthawi imodzimodziyo umachulukitsidwa.

Mitundu yosiyanasiyana ya insulin imadziwika. Porcine insulin yawonjezera immunogenicity, motero antier titer mu odwala IDDM. analandila mkati

Woyang'anira Nguluwe Yaanthu

Mkuyu. 7. Kufunika kwa insulin kwa odwala omwe ali ndi IDDM omwe adalandira insulin yaumunthu ndi porcine.

Pakupita kwa chaka, insulin ya anthu sinasinthe, ndipo mwa anthu omwe amalandira insulin ya nkhumba yoposa kuwirikiza. Pankhaniyi, kusintha kwa chitetezo cha mthupi mwa odwala matenda a shuga omwe amalandiridwa ndi insulin yaumunthu kumawonetseratu. Chizindikiro cha

18 16 ndi 12 U 8 6 L 2

Mkuyu. 8. gawo la antibodies kwa insulin mwa odwala IDDM omwe adalandira

monocompitute wa anthu ndi nkhumba

mkhalidwe wa chitetezo chamthupi ndikutsimikiza kwa immunoregulatory index (chiyerekezo cha othandizira a T-assist

- oyambitsa T-suppressors-cytotoxic). Mwa anthu athanzi, ndi 1.8 ± 0.3. Odwala omwe ali ndi IDDM omwe alandila insulin, ndi yocheperako. Miyezi 6 mutatha kusintha mankhwalawa ndi insulin ya anthu, chizindikirochi chimafika mulingo woyenera. Zomwe zafotokozedwazo ndi mfundo zina zambiri zokhuza phindu la insulin ya munthu pa nkhumba iyenera kukhala nkhani yosatheka pogula insulin.

Ma pathogenesis a IDDM ndi zovuta zake zomaliza zimatengera njira zovuta. Pakati pawo, matenda a chitetezo chamthupi amatsogolera. Kukhazikitsidwa kwa insulin yaumunthu kumathandizira kulimbana ndi matendawa, kuikidwa kwa nkhumba kapena insulin ina kumapangitsa kuti vutoli lithe.

Chifukwa chake, insulin ya anthu ndi mankhwala osankha osati kwa ana, achinyamata, amayi oyembekezera, anthu opuwala, odwala matenda a shuga omwe ali ndi "matenda a shuga", koma lero tiyenera kutsatira mfundo yotsatirayi: odwala onse omwe adapezeka ndi matenda a shuga a mtundu woyamba, ngakhale ali ndi zaka zingati. Ayenera kuyamba kulandira mankhwala a insulin aanthu. Sizikungochitika kuti Federal Program "Diabetes Mellitus" imasinthira kuti odwala onse asinthane ndi insulin ya anthu mu 2000.

Nkhumba monocomponent insulin

Ine nditatha kulandira chithandizo

Kuwongolera ■ O 'ISDM

Mkuyu. 9. Mphamvu ya infunoregulatory index (yogwirizana, mayunitsi) mwa odwala IDDM kwa miyezi 6 atasinthira ku insulin yaumunthu.

Nsulin ya anthu sikuti chithandizo chokhacho chothandiza kwambiri kwa matenda ashuga, komanso kupewa matendawo a mtima.

Njira ya insulin yaumunthu, njira yothandiza kwambiri yolamulira (glucometer, strips) ndi njira yochitira insulin (syringes, zolembera ndi zolembera) yalola kukhazikitsidwa kwa zomwe zimatchedwa insulin Therapy kuzichita m'zaka khumi zapitazi.

Kafukufuku wodziyerekeza wa asayansi aku America (BSST) wopitilira zaka 10 awonetsa kuti insulin yokwanira ya odwala omwe ali ndi IDDM amachepetsa chiopsezo cha proliferative retinopathy ndi 50-70 g (nephropathy - 40 g, neuropathy

- 80g (, macroangiopathies - 40gg, nthawi kasanu ndi kawiri amachepetsa zizindikiro za kupunduka kwakanthawi, kuphatikizapo nthawi yolandila chithandizo: imakulitsa ntchito zaka zosachepera 10.

Ndikosavuta kulimbikitsa chikhalidwe komanso zolimba zamankhwala olimbitsa thupi a odwala omwe ali ndi matenda a shuga mothandizidwa ndi zolembera ndi zolembera. Tikakumana ndi zoyeserera zazovuta pamasamba a media kuti tipewe zolembera ndi zolembera komanso makampani opanga maopanga omwe amapanga mabotolo ndi ma syringe wamba. kuteteza zokonda za odwala, ayenera kupulumutsa "ma swoops" awa ndi mfundo zodziwika bwino zadziko lapansi. kuti mankhwala a insulin othandizira kwambiri mothandizidwa ndi zolembera za syringe ndiye njira yabwino kwambiri komanso yofunika kwambiri yothandizira anthu odwala IDDM.

Odwala omwe ali ndi cholembera cha syringe ndi insulin yoyenera, zofunika zofunika zimagwirizana ndi zaumoyo. Mwana, wachinyamata, wachikulire yemwe ali ndi IDDM amatha kuphunzira, kugwira ntchito, kukhala kwathunthu wathanzi, osakhala "omangidwa ku firiji", momwe mbale za insulin zimasungidwira.

Vuto limodzi lalikulu lomwe M3 wa ku Russia wakonza ndi opanga ma insulin omwe atayika ndikuganiza kwa WHO ndi IDF (International Diabetes Federation) pofika 2000 kuti asinthane ndi dongosolo logwirizana popanga insulini pokhapokha 100 PIECES / ml ndi syringes yoyenera kukula. Mbale za 40 ndi 80 mayunitsi / ml ndi ma syringe omwe amafananira amasiya.

Ili ndi vuto lalikulu kwa opanga, akatswiri azaumoyo, madokotala a shuga ndi odwala, omwe akuyenera kuthana nawo lero.

Cholinga chachikulu cha dokotala komanso wodwala pochiza matenda ashuga ndikukwaniritsa msanga pafupi ndi zabwinobwino. Njira yeniyeni yokwaniritsira cholinga ichi ndikugwiritsa ntchito chisamaliro chambiri.

Chithandizo chachikulu cha insulin chimatheka pokhapokha pogwiritsa ntchito njira zamakono zowongolera glycemic komanso kudziyang'anira pawokha.

Mu mkuyu. 10 ikuwonetsa zambiri kuchokera ku pulogalamu ya American DCCT yakuwongolera kwamatenda a chiwopsezo cha matenda ashuga. Kuchuluka kwa retinopathy kumawonjezeka kwambiri ndi milingo ya glycogemoglobin (Hb Ale) pamwamba pa 7.8g. Ndikofunika kuti kuwonjezeka kwa glycohemoglobin mwa lrf kumawonjezera mwayi wokhala ndi matenda ashuga retinopathy 2 times! Pali kudalira kokhazikika kwa kulowetsedwa kwa myocardial mwa odwala NIDDM pamlingo wa glycogemoglobin komanso kutalika kwa matendawa. Mokulira kuchuluka kwa glycogemoglobin ndi kutalika kwa matendawa, kumakhala pachiwopsezo cha kuchepa kwa myocardial. Kuchokera pamenepa tikutsimikiza kuti ndalama zikuyenera kuyang'aniridwa pokonza zowongolera, kukulira kakang'ono kwamakono, ma glucometer odalirika ndi mikwingwirima yodziwira shuga ndi mkodzo. Tiyenera kudziwa kuti glucometer-

HbA1c (mulingo wa hemoglobin wa glycated,%)

Mkuyu. 10. Mphamvu ya kayendetsedwe ka glycemic pazochitika za matenda ashuga retinopathy mosamala

Zithunzi ndi zingwe zimakwaniritsa zofunikira zamakono, koma kusintha kwawo kumafuna kuthandizidwa ndi boma. Kampani yakunyumba "Phosphosorb" yakwanitsa kupanga zida zodziwira glycogemoglobin, yomwe ndi gawo lofunikira pakukweza kwa matenda ashuga, kuphatikizapo njira yothandizira.

P1 Chifukwa chake, chinsinsi chowunikira thanzi la odwala omwe ali ndi matenda ashuga ndikuwunika kwambiri glycemia. Chidziwitso chothandiza kwambiri pakubwezeretsanso kwa shuga masiku ano ndi kuchuluka kwa hemoglobin ya glycated. Omaliza amalola osati kungoyesa kuchuluka kwa kubwezerera kwa chakudya cha m'mimba kwa miyezi iwiri yapitayi, komanso, komwe ndikofunikira kwambiri, kulosera kukula kwa zovuta zamankhwala.

Mwa kuchuluka kwa hlcphemoglobin m'magulu osankhidwa a anthu ena, ndizotheka kuwunika bwino ntchito ya chithandizo cha matenda am'magawo a dera, mzinda, ndi zina, kuphatikizapo zida zowongolera, kupezeka kwa mankhwala, komanso kuchuluka kwa maphunziro a odwala. kudziletsa, kuphunzitsa akatswiri.

Kafukufuku wa ana ku Moscow ndi ku dera la Moscow lotsogozedwa ndi gulu la ESC RAMS mkati mwa dongosolo la State Record adawonetsa kuchuluka kosakwaniritsa kopereka chindapusa cha shuga pakati pa ana: 18.1 g ku Moscow (m'chigawo cha Moscow, ndi 4,6 g yokha yomwe inali ndi HLA1 osakwana 10 g pamlingo wa 6-89 s. ana ambiri ali pamavuto oyipa.

Nthawi yomweyo, monga momwe tinkayembekezera, pafupipafupi zovuta za mtima zimawululidwa, zomwe zimatengera mwachindunji kuchuluka kwa kubwezeredwa kwa shuga ndi chododometsa monga glycemic hemoglobin. Ana oterewa akuyenera kupitiriza msanga zovuta za mochedwa komanso kulumala kwambiri koyambirira. Izi zikuwonetsa kumapeto kosamveka: ntchito za anthu odwala matenda ashuga a mzindawo ndi chigawo amafunika kusintha mosamalitsa pantchito yake, kulimbitsa maphunziro a akatswiri, kupereka ana ndi insulin yaumunthu ndi zida zowongolera, kukonza bungwe la "sukulu" zophunzitsira ana ndi / kapena makolo awo, ndiye kuti konzani zowunikira zamakono zaumoyo wa ana ndi ma algorithms odziwika otengedwa ndi WHO. Inde, njira zoterezi ndizofunikira pafupifupi madera onse a Russian Federation.

Tikuyenera kunena kuti zaka 2 zapitazi, azaumoyo ku Moscow adachita nawo nkhondo yolimbana ndi matenda ashuga, kupereka ndalama zambiri ku pulogalamu ya matenda a shuga.

Mochedwa Vuto la Matenda a shuga

Pulogalamu ya Congress imaphatikizapo misonkhano ingapo. odzipereka pakuwunika mwakuya kwamalingaliro amakono ndi zowona zokhudzana ndi

zamchere pathogeneis, matenda, mankhwala ndi kupewa matenda a shuga.

Njira ya masiku ano yothana ndi zovuta ndiz njira zopewetsa, i.e. mwanjira iliyonse yofunikira popewa kapena kusiya ntchito yomwe yayamba kale. Kupanda kutero, tsoka silitha.

Mu pepala ili, mwachitsanzo cha nephropathy ndi "diabetesic foot" syndrome, timangokhala mwachidule pazoyang'anira odwala otere. Zowopsa zazikulu zomwe zimapangitsa kuti munthu akhale ndi diabetesic nephropathy (DN) ndi:

- chindapusa cholakwika cha matenda a shuga (HBA1c),

- Matenda a shuga

M'zaka zaposachedwa, kufufuza kwakukulu kwa sayansi kwachitika pa majini - omwe akufuna kuchita nawo DN. Pa tebulo. 2 ikuwonetsa magulu awiri akuluakulu amitundu: yoyamba imaphatikizapo majini omwe akufuna kudziwa kuchuluka kwa matenda oopsa, ndipo chachiwiri - iwo omwe ali ndi vuto la kuchulukitsa kwa mesangioma ndi sclerosis yotsatira yokhudzana ndi kukula kwa nodular glomerulossteosis.

Zomwe zimatha kukhala zamtundu (majini ochita kusankha) pakulimbikitsa matenda a shuga

Kuphatikizidwa ndi chitukuko cha matenda oopsa ogwirizana Ndi kuchuluka kwa mesangium komanso kufalitsa kwa matrix

- Mtundu wa renin - Mtundu wa angiotensinogen - Mtundu wa angiotensin - mtundu wa angiotensin receptor jini (mtundu 1) - Mtundu wa Na / Li - ■ jini wotsutsa - Mtundu wa Na / H - mtundu wa - Y-deacetylases - Gene1E-1 - Gene I-1p - Gene receptors 11.-1

Sakani ma genes omwe ali ndi vuto pazinthu zina pakupanga DN. zolonjeza kwambiri. Zotsatira za maphunziro awa, tikuyembekeza, zibwera ndi matenda ashuga posachedwa. Masiku ano, hemodynamic con yokhazikika komanso yomveka bwino

Kusamalira Kachitidwe

Arteriope ochepa magazi

Mkuyu. 11. Chiwembu cha aimpso glomerulus ndi zinthu zomwe zimachepetsa efferent arteriole.

unyolo wa chitukuko cha DN. Mu mkuyu. Chithunzi 11 chikuwonetsa modekha glomerulus ndi zinthu zachilengedwe zomwe zimachepetsa arteriole (constriersors) omwe amatuluka mu glomerulus. Ngati zinthu zomwe zimachepetsa zimachulukitsa magazi kupita ku glomerulus, ndiye kuti othandizira amachepetsa mphamvu yake kudzera mu mphamvu ya arteriole, i.e. Kupanikizika kwa intracubule kumawonjezeka kwambiri, kupanikizika kwa zipinda zapansi za glomerular capillary network kumawonjezeka. Ngati njirayi imakhala yodwala, ndiye mothandizidwa ndi "hydrodynamic" zotere zomwe zimasinthidwa pansi, zimasunthika, zimatopa, zimayamba kunenepa, kapangidwe kake kamene kamasinthasintha kamunthu kamatha, ndipo ntchito ya maapozi omwe amathandizira mbali zamkati movutikira. Kapangidwe kazinsinsi ka maselo a endothelial amasokonekera: amayamba kugwira mwachangu endothelium 1-chinthu, chomwe chimapangitsa kuti magazi azikhala mwamphamvu kwambiri. Ngati njirayi sinalowererepo, ndiye kuti albumin ndi lipids zimayamba kulowa mwachangu kudzera pa khoma la glillerular capillaries. Kuwonekera kwa albumin ngakhale m'magawo ochepera (oposa 300 mcg / tsiku), omwe amatchedwa microalbuminuria, ndiwopseza kwambiri kwa dokotala komanso woleza, chizindikiritso cha chiyambi cha zochita zamphamvu kwambiri! Microalbuminuria ndiwonetseratu. wokonda tsikulo. Ndi nthawi iyi yomwe chitukuko cha DN chikuyimitsidwa. Pali njira zina zoyambirira za DN, koma microalbuminuria ndiye chizindikiro chofunikira, ndipo chilipo kuti atsimikizire madokotala ndi odwala omwe ali kunja kapena malo okhala. Kugwiritsa ntchito Mzere wapadera,

Glucose glucagon kukula kwa hormone prostacyclin nitric oxide

Angiotensin II Catecholamines Thromboxane A2 Endothelium 1

kutsitsidwa mumtsuko ndi mkodzo, kwenikweni mkati mwa miniti imodzi kukhalapo kwa microalbuminuria kumadziwika. Chithunzichi chikuwonetsa zojambula za ma DN. Chilichonse ndichopepuka: kuwongolera kuthamanga kwa magazi. Kutsimikiza kwa mapuloteni mu mkodzo ndi microalbuminuria.

| Kusanthula kwa Matenda a shuga

NGATI POPANDA PROTEINURIA MWA OKHALA

• Kamodzi pachaka patatha zaka 5 kuchokera

fufuzani matenda a shuga

(pa kudutsa pambuyo

■ Kamodzi pachaka kuyambira pano

kupezeka kwa matenda ashuga (mukamayamba kutha msinkhu)

miyezi 3-4 iliyonse kuyambira tsiku la matenda ashuga

kuchuluka kwa proteinuria (mkodzo wa tsiku ndi tsiku), kuchepa kwa kuchuluka kwa kusefedwa (molingana ndi chilolezo cha creatinine), kuthamanga kwa magazi (tsiku ndi tsiku)

NGATI PROTEINURIA NDI

kuwongolera 1 nthawi m'miyezi 4-6

Chithandizo ndi kupewa matenda ashuga nephropathy

Gawo lachitukuko cha zoyeserera za NAM

Hyperfunction - Malipiro a matenda a shuga (HBA1c sindikutha kupeza zomwe mukufuna? Yesani ntchito yosankha mabuku.

Zomwe takumana nazo zikuwonetsa kuti kusankha kwa renitek kumatsogolera ku kutha kwa albinuria komanso kufalikira kwa magazi. Ma inhibitors a ACE amawonetsedwa kwa microalbuminuria komanso kuthamanga kwa magazi, omaliza osasinthika panthawi yamankhwala.

Ngati "timayang'anitsitsa" gawo la microalbuminuria, ndiye kuti panthawi ya proteinuria ndizosatheka kuyimitsa chitukuko cha DN. Ndi masamu mwatsatanetsatane, nthawi ya kupitirira kwa glomerulosulinosis ndi kukula kwa aimpso kulephera ndi zotsatira zakupha kutha kuwerengera.

Ndikofunikira pa ndalama zonse kuti musaphonye gawo loyambirira la NAM komanso. Chofunika koposa, gawo lomwe limapezeka mosavuta la microalbuminuria. Mtengo wochizira odwala matenda ashuga

Mkuyu. 12. Zotsatira za renitek pa albuminuria (1) ndi kuthamanga kwa magazi (2) pamagawo osiyanasiyana a matenda ashuga.

voliyumu koyambirira kwa NAM ndi madola 1.7 miliyoni ndi moyo wathunthu ndi madola zikwi zana limodzi ndi zisanu pamlingo wa uremia ndipo wodwalayo wagona. Ndemanga za izi, tikuganiza, sizofunikira.

Diabetesic Foot Syndrome (VDS)

Mu Russian Federation, zopitilira zikuluzikulu zoposa 10 mpaka 10,000 zimachitika chaka chilichonse. Zomwe zidachitika mdipatimenti yodwala matenda ashuga ku ESC RAMS zidawonetsa kuti nthawi zambiri opaleshoni yodwala mwanjira imeneyi amakhala opanda chifukwa.Akadwala 98 kuchokera kumadera osiyanasiyana a Russian Federation omwe abwera ku ESC RAMS atapezeka kuti ali ndi vuto la neuropathic kapena mtundu wosakanikirana wa VDS, kupewedwa kwa malekezero apansi kunapewedwa. zilonda zam'mapazi zamapazi, ma phlegmons, ngati lamulo, amagwera m'manja mwa madokotala ochita opaleshoni omwe sadziwa kwenikweni za zovuta za zotupa za matenda ashuga. akatswiri Ibetologists, i.e. bungwe la chisamaliro chapadera cha odwala otere.

Congress ilingalira zazikuluzikulu za VTS. Apa timangopereka malingaliro angapo oyenera kwa adotolo ndi odwala kuti tipewe SDS.

Choyamba, mfundo zotsatirazi zowunikira odwala omwe atumizidwa kupewa ziyenera kumveka bwino: kuyezetsa miyendo paulendo uliwonse wopita kwa dokotala, kuyezetsa mitsempha kamodzi pachaka kwa odwala onse omwe ali ndi matenda ashuga, kuwunika kwa magazi m'magawo otsika kwambiri kwa odwala omwe ali ndi IDDM -1 pachaka pambuyo pa zaka 5-7 kuyambira kumayambiriro kwa matendawa, odwala omwe ali ndi NIDDM - 1 nthawi pachaka kuyambira nthawi yodziwika bwino.

Pamodzi ndi zofunikira kuti pakubwezeretsedwe kwa matenda ashuga pofuna kupewa matenda ashuga, ndizovuta kuzindikira kufunika kwa maphunziro a shuga mu pulogalamu yapadera.

Malingana ndi deta yathu, maphunziro amachepetsa kuyimbira kwa wodwala chifukwa cha 5-7. koposa zonse, chiwopsezo cha kuwonongeka kwa phazi chimachepetsedwa.

Pamagulu omwe ali pachiwopsezo, maphunziro amachepetsa pafupipafupi zilonda zam'mapazi: amachepetsa pafupipafupi kukadulidwa kambiri ndi nthawi 5-6.

Tsoka ilo, ku Russian Federation, pali zipinda zochepa za CDS zomwe odwala angaphunzitsidwe, kuyang'aniridwa, njira zingapo zodzitetezera ndikugwiritsa ntchito matekinoloje amakono pakupezeka ndi kupatsirana mitundu yosiyanasiyana yazachipatala ya CDS. Pepani. nthawi zambiri mumamva za kuchepa kwa ndalama kapena mtengo wokwanira wokonza zipinda zapadera za SDS. Pankhaniyi, ndizoyenera kupereka deta pamitengo yomwe ikukhudzana ndi njira zosalekeza zosungira miyendo ya wodwalayo.

Mtengo wa nduna "odwala matenda ashuga"

2-6 madola zikwi (kutengera makonzedwe)

Mtengo wa maphunziro ndi madola 115.

Ndalama Zowonera Zamphamvu

(Wodwala 1 pachaka) - $ 300

Mtengo wa chithandizo pa wodwala aliyense

Fomu la Neuropathic - $ 900 - $ 2 zikwi

Fomu ya Neuroischemic - madola 3,000,5 madola.

Mtengo wa opaleshoni

Kukonzanso kwamasamba - madola 10-13 miliyoni

Kudulidwa kwa dzanja - madola 9-12 miliyoni.

Chifukwa chake, mtengo wa kudula mwendo umodzi umagwirizana ndi mtengo wodziyang'anira wodwala wina kwa zaka 25 za bungweli komanso kugwira ntchito kwa maofesi a 5 Diabetesic Foot kwa zaka 5.

Ndizachidziwikire kuti gulu la zipinda zapadera "phazi la Diabetes" ndiyo njira yokhayo yothandiza kwambiri kupewa komanso kuchiza odwala matenda ashuga omwe ali ndi SDS.

Chowongolera chogwira ntchito komanso chachuma kwambiri mu diabetesology, monga gawo lililonse lazachipatala, ndikupewa. Pali magawo atatu a kupewa. Kupewa koyambirira kumakhudzanso kupezeka kwa magulu omwe ali pachiwopsezo cha IDDM kapena NIDDM ndi njira zopewera kukula kwa matendawa.

Njira zodzitchinjiriza zimaphatikizidwa m'chilengedwe, koma ndi mitundu yawo yonse, maphunziro a odwala amatenganso mbali ina. Posachedwa, utsogoleri wathu wophatikizana, "Sukulu," ukutuluka, pomwe tikuwona mbali zosiyanasiyana zakukonza "masukulu" (malo) ophunzitsira odwala omwe ali ndi matenda ashuga, mapulogalamu osiyanasiyana, maphunziro a odwala omwe angopezeka kumene ndi maphunziro a odwala pofuna kupewa ndi / kapena kuchiza zovuta, ndi zina zambiri. .

Zomwe takumana nazo zaka 10 mu maphunziro a odwala zawonetsa motsimikiza kuti popanda kuphunzitsa ndizosatheka kupeza zotsatira zabwino komanso zazitali. Kukwaniritsidwa kwa njira zoperekera chithandizo ndi maphunziro kwa odwala omwe ali ndi matenda ashuga kumapereka zotsatira zabwino: mtengo wokhala ndikusamalira wodwala umachepetsedwa kanayi! Nthawi yomweyo, ndalama sizisunga ndalama zokha zochizira matenda a shuga komanso zovuta zake, koma, zomwe ndizofunikira kwambiri, chifukwa cha mtengo wosadziwika, i.e. chifukwa cha kupewa, choyambirira, cha zovuta, kupewa kulumala, kufa, komwe kumafunikira ndalama zazikulu osati kungobwezeretsa zachipatala, komanso kutetezera odwala ndi olumala.

Mu mkuyu. 13 ikuwonetsa kusuntha kwa glycogemoglobin mulingo waophunzira odwala IDDM patatha chaka chimodzi ndi zaka 7. Mitundu yosiyanasiyana ndi mapulogalamu ophunzitsira amapereka zotsatira zapamwamba komanso zosatha kwa nthawi yayitali kwambiri -

Zaka 1 zoyambirira

Anthu ophunzitsa □ Ophunzira

Mkuyu. 13. Mphamvu ya gawo la glycogemoglobin mwa odwala IDDM ataphunzitsidwa.

Nthawi, monga zikuwonekera ndi kuchepa kwakukulu kwa HbA1. Nthawi yomweyo, ndikofunikira kukumbukira kuti kuchepa kwa glycogemoglobin kokha ndi 1 g kumachepetsa chiopsezo chokhala ndi vuto la mtima ndi 2 times!

Kuphunzitsidwa kwa odwala omwe ali ndi PND ndi matenda oopsa kunapangitsa kuti pakhale njira yotsimikizika yotsimikizika yothandizira antihypertensive ndipo pambuyo pa miyezi 6 adaloledwa kupeza kuchepa kodalirika kwa magazi a systolic ndi diastolic.

Zotsatira za kusankha njira ndi mankhwala ochizira odwala a NIDDM asana n ataphunzitsidwa ku Center yathu ndizowonetsa. Onse mothandizidwa ndi odwala komanso kuchipatala, asanaphunzitsidwe, 75 g ya odwala adalandira pakamwa mankhwala a hypoglycemic. 25gg amangogwiritsa ntchito chakudya. Pambuyo pa miyezi 12, kuchuluka kwa odwala omwe adalipidwa ndi chakudya chokha kudakwera mpaka 53 g sindikutha kupeza zomwe mukufuna? Yeserani ntchito yosankha mabuku.

Kupewa matendawa kumatheka pokhapokha gawo 1. Kodi ma genetics amakono komanso immunology zimaperekanji kwa wodwala matenda ashuga?

Njira yotanthauzira yomwe idapangidwa ndi ESC RAMS limodzi ndi SSC "Institute of Immunology" imalola:

1) kudziwa mitundu ya kutsimikiza ndi kukana IDDM mwa anthu amitundu yosiyanasiyana,

2) kuzindikira mitundu yatsopano, yosadziwika yomwe imalumikizidwa ndi IDDM:

3) kukhazikitsa machitidwe oyesera oyesera kulosera za chitukuko cha matenda ashuga komanso / kapena kuzindikira odwala omwe ali m'gulu linalake,

4) kuwerengera zochitika ndi zachuma (mtengo mwachindunji komanso wosadziwika).

Kafukufuku m'mabanja a nyukiliya, i.e. M'mabanja mwa odwala, akuwonetsa chiopsezo chotenga IDDM, kupanga magulu omwe ali pachiwopsezo ndikuyambitsa pulogalamu yothandizira kupewa matenda ashuga komanso a sekondale.

Kuneneratu kukula kwa vuto la mtima - kudziwika kwa majini - ofuna kuphatikizidwa, amakupatsani mwayi wokhala ndi njira zodzitetezera komanso / kapena kusankha njira yoyenera ya algorithm.

Pulogalamu ya Congress imaphatikizapo malipoti onse pamatenda ovuta kwambiri a kafukufuku wamakono wamtundu wa matenda ashuga, koma pantchito iyi timangoyang'ana pa zotulukapo zokha. Chifukwa chake mu mkuyu. Chithunzi 15 chikuwonetsa kugawa kwa ma proquentians a locus B0B1 omwe amaphatikizidwa ndi IDDM pakati pa anthu m'maiko osiyanasiyana padziko lapansi. Ndizofunikira kudziwa kuti ziwonjezerazi zikuchuluka kuchokera kummawa kupita kumadzulo komanso kuchokera kumwera kupita kumpoto: chitetezo Bole1-04 ndiye wolamulira pakati pa anthu ku Asia, pomwe ogwirizana nawo, i.e. mavomerezi a BOV 1-0301 ndi BOV 1-0201 akuwopseza matendawa. amalamulira kuchuluka kwa mayiko a Scandinavia. maiko angapo ku Central Africa komwe kuli kuchuluka kwa IDDM. Anazindikira. kuti ma supples otsogola amagwira ntchito mwamphamvu pamalingaliro okonzekereratu ku IDDM. Zomwe takumana nazo pakufufuza kwamtundu wa anthu m'mitundu ya Russia, Buryats, ndi Uzbek zatilola kudziwa zikhalidwe zomwe sizimadziwika kale m'mitundu iyi. Adaloleza koyamba kuti apereke njira zomveka zodziwikiratu

Mkuyu. 15. Kugawa kwa ma DQB1 nkhani mu IDDM.

ISDM m'fuko linalake ndipo. Chifukwa chake, adatsegula chiyembekezo chodziwitsira anthu kuti azitha kupeza upangiri wa zachuma.

Mu mkuyu. Chithunzi 16 chikuwonetsa chiopsezo chokhala ndi IDDM mwa anthu kutengera ndi chibadwa (allele kapena genotype). Kuphatikizidwa kwa zinayi zoyeserera za SS / SS kumapereka chiopsezo chachikulu cha IDDM.

DQB1 DR4 B16 DQB1 DQA1 DR3 / 4 SS / SS * 0201 -0302 * 0301

Mkuyu. 16. Chiwopsezo chokhala ndi IDDM mwa anthu, kutengera ndi chibadwa.

Malinga ndi zomwe tapeza, zomwe zimapangitsa kuti IDDM ipangidwe 80 amatenga 80 g (otsalawo 20 (sindingapeze zomwe mukufuna? Yesani ntchito yosankha mabuku.)

Wofunsidwa ndi Gene Yemwe Angayanjane ndi Vascular Pathology

Angiotensinogen (AGN) matenda ashuga a shuga a Nephropathy Aakulu

Angiotensin I-kutembenuza enzyme (ACE) matenda ashuga nephropathy Akuluakulu matenda oopsa a ischemic matenda a mtima ndi myocardial infarction

Mtima Chymase (СambalaА1) matenda ashuga nephropathy a ischemic matenda a mtima ndi myocardial infarction

Vascular angiotensin II receptor (AGTR1) matenda a shuga a nephropathy Aakulu a matenda oopsa a ischemic mtima matenda ndi myocardial infarction

Catalase (CAT) Diabetes Nephropathy Diabetesic Retinopathy wa IHD ndi Myocardial infarction

Mu mkuyu. Chithunzi 17 chikuwonetsa zambiri zomwe zapezeka ku ESC RAMS pakugawidwa kwa jini la angiotensin-kutembenuza enzyme (ACE) m'magulu a odwala omwe ali ndi IDDM omwe ali ndi popanda diabetesic nephropathy ("DN +") ("DN -") kusiyana kosadalirika pakati pa genotypes II ndi BB a geni genesypes ndi AB m'magulu "DN +" ndi "DN-" akuwonetsa kuyanjana kwa chikhomo cha polymorphic ndi nephropathy ya matenda ashuga odwala IDDM aanthu aku Moscow.

Ma Alleles ndi genotypes amtundu wa ACE amagwirizanitsidwa ndi kulowetsedwa kwa myocardial kwa odwala omwe ali ndi matenda a shuga II (Table 5). Odwala a NIDDM. atatha kulowetsedwa myocardial, kudziwika kwa B allele ndi BB genotype kwapezeka. Mu gulu la odwala opanda myocardial infarction, allele I ndi genotype II ndizofala kwambiri. Izi zimawonetsa gawo la ACE gene polymorphism pamtundu wakudziwikanso kwa kukula kwa myocardial infarction.

Kupezeka kwakukulu (%) kwa ma genes ndi ma genotypes amtundu wa ACE mwa odwala omwe ali ndi matenda amtundu II pambuyo poyambitsa myocardial

Odwala omwe ali ndi DM II Pop

Kuteteza kwamtundu wa mtima

cholembera myocardial (Moscow)

Allele I 23.0 32.6

Allele D 76.3 67.4

Genotype II 0 16.1

ID ya Genotype 47.4 33.1

Genotype DD 52.6 50.8

Ponena za matenda ashuga retinopathy (DR). ndiye, molingana ndi deta yoyambira, mtundu wa catalase umakhala ndi zoteteza (mkuyu. 18). Mphamvu zoteteza za 167 allele zimawonetsedwa mokhudzana ndi DR ku NIDDM: odwala osakhala ndi DR okhala ndi nthawi yayitali yoposa zaka 10, pafupipafupi zomwe zimachitika mwanjira imeneyi zimakhala zapamwamba kwambiri poyerekeza ndi odwala omwe ali ndi nthawi yakuyamba ya DR omwe amakhala nthawi yayitali ya NIDDM.

W Gulu "DR +" (n = 11) Kuti Gulu "DR-" (n = 5)

Mkuyu. 18. Alleles of the catalase gene (CAT) odwala NIDDM odwala matenda ashuga retinopathy (DR +) ndipo popanda iwo (DR-).

Zomwe zimachitika kuti ziwonekere zamtundu wamtundu wa ntchofu zachilengedwe zimafunikira mosakayikira, zikufunanso kafukufuku wina wazakafukufuku, koma kale lero amalimbikitsa chiyembekezo kwa odwala ndi madokotala.

1. Kuzindikira chibadwa cha mtundu wa matenda ashuga nephropathy komanso kuzindikira mtundu wa polymorphism wa angiotensin-1-kutembenuza enzyme ngati gawo la chiopsezo cha angiopathy komanso ngati gawo lochita bwino pa antiproteinuric therapy.

2. Kukhazikitsa chitetezo chamtundu umodzi mwazomwe zimayambitsa matenda amtundu wa 2 monga matenda a shuga ndi matenda ashuga nephro- ndi retinopathies.

3. Kupanga njira yabwino yophunzirira kusinthaku kapena kutsutsana ndi matenda ashuga opanga matenda a shuga ndikupanga maziko oti ntchito ina ichitike.

Powunikira mfundo pamwambapa, timalandira ufulu woyankha mafunso ofunikira a matenda ashuga monga awa.

Kodi ndizotheka kuyang'ana kuopsa kwa IDDM ndikulosera YES

Kodi ndizotheka kuti muchepetse kukula kwa IDDM ndikuchepetsa mawonekedwe ake achipatala?

Kodi ndizotheka kulosera za zovuta za matenda ashuga, komanso kuwongolera kwawo pochiza komanso kupewa?

Pomaliza, ziyenera kukumbukiridwa kuti yankho la matenda a shuga lili ngati. Komabe, nkhani ina iliyonse imatengera zinthu zitatu izi:

Malingaliro: anthu omwe ali okonzeka komanso okonzeka kugwiritsa ntchito malingaliro awa: zakuthupi ndi luso lakumisiri. Malingaliro, kuwonjezera apo. pali pulogalamu yonse, pali anthu (akatswiri amatanthauza), koma sizikwanira, maphunziro ophunziridwa bwino amafunikira, ndipo pamapeto pake, maziko ndi zida zamakono zopangira chithandizo chamakono kwa odwala matenda ashuga ndi ofooka kwambiri.

Pamafunika ndalama zokwanira, choyambirira, m'gulu la anthu odwala matenda ashuga ku Russia, zomwe zimaphatikizapo kumanga malo opangira matenda ashuga, masukulu, mabungwe apadera omwe ali ndi zida zamakono, ophunzitsira ogwira ntchito, ndi ena. Pokha pamenepa ndi pomwe tingathe kufikira magawo omwe a WHO. ndipo sitingathe kuwonongeka. koma kwenikweni kuzindikira ku Russia mawu odabwitsa: "Matenda a shuga si matenda, koma moyo wapadera chabe."

Ntchito yathu ndikugwira ntchito limodzi, aliyense m'malo mwake, m'chigawo chake, kukulitsa moyo wa odwala omwe ali ndi matenda ashuga.