I-glycated (glycosylated) hemoglobin iyingxenye ye-hemoglobin egcwele egazini eboshelwe glucose. Le nkomba ilinganiswa ngo-%. Ushukela owengeziwe wegazi, amaphesenti amakhulu we-hemoglobin azotholakala glycated. Lokhu kuhlolwa kwegazi okubalulekile koshukela noma ushukela osolwayo. Kukhombisa ngokunembayo izinga eliphakathi le-glucose ku-plasma yegazi ezinyangeni ezi-3 ezedlule. Ikuvumela ukuthi uthole isifo sikashukela ngesikhathi bese uqala ukwelashwa. Noma qinisekisa umuntu uma engenaso isifo sikashukela.
IGlycated hemoglobin (HbA1C) - konke odinga ukukwazi:
- Ungalungisa futhi uluthathe kanjani lolu vivinyo lwegazi;
- Izinhlobo ze-hemoglobin ye-glycated - itafula elula;
- I-Glycated hemoglobin kwabesifazane abakhulelwe
- Okufanele ukwenze uma umphumela uphakanyisiwe;
- Ukuxilongwa kwe-prediabetes, uhlobo 1 nohlobo 2 sikashukela;
- Ukuqapha ukusebenza ngempumelelo kokwelashwa kwesifo sikashukela.
Funda i-athikili!
Sizocacisa ngokushesha ukuthi amazinga we-HbA1C wezingane ayalingana nawabantu abadala. Lokhu kuhlaziya kungasetshenziselwa ukuthola isifo sikashukela ezinganeni, futhi okubaluleke kakhulu, ukubheka ukusebenza kahle kokwelashwa. Intsha enesifo sikashukela ivame ukucabanga izingqondo zayo ngaphambi kokuhlolwa njalo, ithuthukise ushukela wegazi, futhi ngaleyo ndlela ihlobise imiphumela yayo yokulawulwa sikashukela. Nge-hemoglobin ye-glycated, inani elinjalo alisebenzi kubo. Lokhu kuhlaziya kukhombisa ngokunembile ukuthi ngabe onesifo sikashukela "wona" yini ezinyangeni ezi-3 ezedlule noma wahola indlela yokuphila "elungileyo". Bheka futhi isihloko esithi “Uhlobo 1 sikashukela ezinganeni nasebusheni.”
Amanye amagama ale nkomba:
- i-glycosylated hemoglobin;
- i-hemoglobin A1C;
- HbA1C;
- noma i-A1C nje.
Ukuhlolwa kwegazi kwe-glycated hemoglobin kulungele iziguli nodokotela. Inezinzuzo ngaphezu kokuhlolwa okushukela okusheshayo kwegazi nokuhlolwa okubekezeleleka kwamahora amabili. Yiziphi lezi zinzuzo:
- ukuhlaziywa kwe-hemoglobin ye-glycated ingathathwa nganoma yisiphi isikhathi, hhayi ngesisu esingenalutho;
- inembe kakhulu kunokuhlolwa kwegazi kokushukela okusheshayo, ikuvumela ukuthi uthole isifo sikashukela ngaphambili;
- kushesha futhi kube lula ukwedlula isivivinyo sokukhuthazelela i-glucose samahora amabili;
- ikuvumela ukuthi uphendule ngokusobala umbuzo wokuthi umuntu unesifo sikashukela noma cha;
- kusiza ukuthola ukuthi umuntu onesifo sikashukela ulawule kahle kangakanani ushukela wegazi ezinyangeni ezi-3 ezedlule;
- i-glycated hemoglobin ayithintwa ama-nuances wesikhathi esifushane njengamakhaza noma izimo ezicindezelayo.
Iseluleko esihle: lapho uya ukuyokwenza ukuhlolwa kwegazi - ngasikhathi sinye hlola izinga le-hemoglobin HbA1C yakho.
Lokhu kuhlaziywa kunconywe yi-WHO kusukela ngo-2009 ukutholakala kwesifo sikashukela sohlobo 1 nohlobo 2, kanye nokubheka ukusebenza ngempumelelo kwezindlela zokwelashwa.
Umphumela walokhu kuhlaziya AKUSUSA:
- isikhathi sosuku lapho benikela ngegazi;
- ukuzila ukudla noma ngemuva kokudla;
- ukuthatha imishanguzo ngaphandle kwamaphilisi kashukela;
- ukusebenza komzimba;
- isimo esingokomzwelo sesiguli;
- amakhaza nezinye izifo.
Kungani kuhlolwa igazi nge-glycated hemoglobin
Okokuqala, ukuthola isifo sikashukela noma ukuhlola ubungozi bomuntu ukuthola isifo sikashukela. Okwesibili, ukuze kuhlolwe nesifo sikashukela ukuthi isiguli sikwazi kahle kanjani ukulawula lesi sifo futhi sigcine noshukela wegazi usondele kokujwayelekile.
Mayelana nokuxilongwa kwesifo sikashukela, le nkomba isetshenziswe ngokusemthethweni (ekuncomeni kwe-World Health Organisation) kusukela ngo-2011, futhi seyilungele iziguli nodokotela.
Izinhlobo ze-hemoglobin ye-glycated
Umphumela wokuhlaziywa,% | Kusho ukuthini |
|---|---|
< 5,7 | Ngama-carbohydrate metabolism ulungile, ubungozi besifo sikashukela buncane |
5,7-6,0 | Asisekho isifo sikashukela okwamanje, kepha ubungozi bakhe buyanda. Isikhathi sokushintshela ekudleni okuphansi kwe-carb ukuvimbela. Kuyafaneleka futhi ukubuza ukuthi iyini i-metabolic syndrome kanye nokumelana ne-insulin. |
6,1-6,4 | Ingozi yesifo sikashukela iphezulu. Shintshela kwindlela yokuphila enempilo futhi, ikakhulukazi, ekudleni okuphansi kwe-carbohydrate. Akukho lapho ungabeka khona. |
≥ 6,5 | Ukuxilongwa kokuqala kwenziwa ngesifo sikashukela i-mellitus. Kuyadingeka ukwenza ezinye izivivinyo ukuze uqinisekise noma uziphikise. Funda isihloko esithi “Ukuxilongwa Uhlobo 1 nesifo sikashukela sohlobo 2.” |
Izinga eliphansi le-hemoglobin le-glycated esigulini, okungcono ukuthi ushukela abuyiselwe ezinyangeni ezi-3 ezedlule.
Ukuxhumana kwe-HbA1C kufinyelela isilinganiso se-glucose ku-plasma yegazi izinyanga ezintathu
| I-HbA1C,% | IGlucose, mmol / L | I-HbA1C,% | IGlucose, mmol / L |
|---|---|---|---|
| 4 | 3,8 | 8 | 10,2 |
| 4,5 | 4,6 | 8,5 | 11,0 |
| 5 | 5,4 | 9 | 11,8 |
| 5,5 | 6,5 | 9,5 | 12,6 |
| 6 | 7,0 | 10 | 13,4 |
| 6,5 | 7,8 | 10,5 | 14,2 |
| 7 | 8,6 | 11 | 14,9 |
| 7,5 | 9,4 | 11,5 | 15,7 |
Ukuhlolwa kwegazi kwe-hemoglobin ye-glycated: izinzuzo nobubi
Ukuhlolwa kwegazi kwe-HbA1C, kuqhathaniswa nokuhlaziywa kashukela wokuzila, kunezinzuzo eziningi:
- umuntu akadingeki ukuba nesisu esingenalutho;
- igazi ligcinwa kalula kwi -hubhu yokuhlola kuze kube yilapho kuhlaziywa ngokushesha (ukuzinza kwangaphambi kokuqina);
- ushukela we-plasma glucose ungahluka kakhulu ngenxa yengcindezi nezifo ezithathelwanayo, futhi i-hemoglobin ye-glycated iqinile
Ukuhlolwa kwegazi kwe-hemoglobin ye-glycated kukuvumela ukuthi uthole ushukela kusenesikhathi, lapho ukuhlaziya ushukela wokuzila kusakhombisa ukuthi konke kuvamile.
Ubunzima bokuhlolwa kwegazi kwe-hemoglobin glycated:
- izindleko eziphakeme uma ziqhathaniswa nokuhlolwa kweglucose yegazi ku-plasma (kodwa ngokushesha futhi ngokufanele!);
- kwabanye abantu, ukuhlangana phakathi kwezinga le-HbA1C kanye ne-glucose esezingeni eliphansi kuncishisiwe;
- ezigulini ezine-anemia kanye ne-hemoglobinopathies, imiphumela yokuhlaziywa ihlanekezelwa;
- kwezinye izifunda zezwe, iziguli zingase zingabi nakho ndawo yakuhlola lokhu;
- kucatshangwa ukuthi uma umuntu ethatha imithamo ephezulu yamavithamini C no / noma u-E, khona-ke isilinganiso sakhe se-glycated hemoglobin sisezingeni eliphansi ngokukhohlisa (akufakazelwe!);
- amazinga aphansi ama-hormone egilo angadala ukuthi iHbA1C inyuke, kepha ushukela wegazi empeleni awukhuphuki.
Uma wehlisela i-HbA1C okungenani i-1%, ubungozi bezinkinga zesifo sikashukela luzokwehla kangakanani:
| Thayipha isifo sikashukela sokuqala | I-retinopathy (umbono) | 35% ↓ |
| I-Neuropathy (uhlelo lwezinzwa, imilenze) | 30% ↓ | |
| I-Nephropathy (izinso) | 24-44% ↓ | |
| Thayipha isifo sikashukela sesi-2 | Zonke izingqinamba ze-micro-vascular | 35% ↓ |
| Ukufa okuhlobene nesifo sikashukela | 25% ↓ | |
| I-Myocardial infarction | 18% ↓ | |
| Ukufa okuphelele | 7% ↓ |
I-hemoglobin ye-Glycated ngesikhathi sokukhulelwa
I-Glycated hemoglobin ngesikhathi sokukhulelwa ingenye yokuhlolwa okungenzeka kokulawula ushukela wegazi. Kodwa-ke, lesi yisinqumo esibi. Ngesikhathi sokukhulelwa, kungcono ukunganikeli i-glycated hemoglobin, kepha ukuhlola ushukela wegazi lowesifazane ngezinye izindlela. Ake sichaze ukuthi kungani kunjalo, bese sixoxa ngezinketho ezilungile.
Yini ingozi yokwanda ushukela kwabesifazane abakhulelwe? Okokuqala, iqiniso lokuthi umbungu lukhula likhulu kakhulu, futhi ngenxa yalokhu kuzoba nokuzalwa okunzima. Ingozi kubo bobabili umama nengane iyanda. Ukungasho ukuthi imiphumela emibi yesikhathi eside yabo bobabili. Ukwanda ushukela wegazi ngesikhathi sokukhulelwa kubhubhisa imithambo yegazi, izinso, ukubona kwamehlo, njll. Umphumela walokhu uzovela ngokuhamba kwesikhathi. Ukuba nomntwana kuyingxenye yempi. Kuyadingeka ukuthi wayesenempilo eyenele ukumkhulisa ...
Ushukela wegazi ngesikhathi sokukhulelwa ungakhuphuka nakwabesifazane abangakaze bakhononde ngempilo yabo phambilini. Kunemicimbi emibili ebalulekile lapha:
- Ushukela ophakeme awubangeli zimpawu. Imvamisa umuntu wesifazane akasoli lutho, yize enesithelo esikhulu - isiqhwaga esinesisindo esingu-4-4,5 kg.
- Ushukela awukhuphuki esiswini esingenalutho, kodwa ngemuva kokudla. Ngemuva kokudla, ugcina ephakeme amahora angu-1-4. Ngalesi sikhathi, wenza umsebenzi wakhe wokubhubhisa. Ukushukela okusheshayo kuvamile. Uma ushukela luphakanyiswa esiswini esingenalutho, khona-ke udaba lubi kakhulu.
Kungani ukuhlolwa kwegazi kwe-glycated hemoglobin nakho kungafanele? Ngoba usabela sekwephuze kakhulu. I-hemoglobin ye-Glycated ikhula kuphela ngemuva kokuba ushukela wegazi ugcine ukugcotshwa izinyanga ezimbili. Uma owesifazane evusa ushukela, khona-ke lokhu ngokuvamile akwenzeki ngaphambi kokuba kube ngenyanga engu-6 yokukhulelwa. Kulokhu, i-hemoglobin ye-glycated izokwandiswa kuphela ezinyangeni eziyi-8-9, sekuvele ngaphambi nje kokulethwa. Uma owesifazane okhulelwe engalawulwa ushukela wakhe ngaphambili, khona-ke kuzoba nemiphumela emibi kuye nakwengane yakhe.
Uma i-glycated hemoglobin nokuhlolwa okusheshayo kwegazi glucose kungafanele, khona-ke ungahlola kanjani ushukela kwabesifazane abakhulelwe? Impendulo: kufanele ihlolwe ngemuva kokudla njalo emavikini angama-1-2. Ukuze wenze lokhu, ungathatha isivivinyo sokukhuthazelela i-glucose esisebenza amahora amabili endaweni yokucwaninga. Kepha lo ngumcimbi omude futhi okhathazayo. Kulula ukuthenga imitha kashukela weglue futhi ulinganise ushukela 30, 60 no-120 imizuzu ngemuva kokudla. Uma umphumela ungekho ngaphezulu kuka-6.5 mmol / l - kuhle kakhulu. Ebangeni le-6.5-7.9 mmol / l - elibekezelayo. Ukusuka ku-8.0 mmol / l nangaphezulu - kubi, udinga ukuthatha izinyathelo zokunciphisa ushukela.
Gcina ukudla okune-carbohydrate ephansi, kepha yidla izithelo, izaqathe, kanye nama-beet nsuku zonke ukuvikela i-ketosis. Ngasikhathi sinye, ukukhulelwa akusona isizathu sokuzivumela ukuba udle amaswidi nemikhiqizo kafulawa. Ngeminye imininingwane, bheka izindatshana zesifo sikashukela esikhulelwe kanye nesifo sikashukela.
Izinjongo zesifo sikashukela se-HbA1C
Ukuncoma okusemthethweni kwabanesifo sikashukela ukufezekisa kanye nokugcina izinga le-HbA1C le <7%. Kulokhu, isifo sikashukela sibhekwa njengonxephezelwe kahle, futhi amathuba okuba nezinkinga mancane. Vele, kungcono kakhulu uma inkomba ye-hemoglobin ye-glycated ingaphakathi kobubanzi obujwayelekile kubantu abanempilo, isb., HbA1C <6.5%. Noma kunjalo, uDkt Bernstein ukholelwa ukuthi noma ene-hemoglobin ene-glycated ye-6.5%, isifo sikashukela asinxephezeli kahle, futhi ubunzima baso bukhula ngokushesha. Kubantu abaphilile, abanciphile abane-metabolism ejwayelekile ye-carbohydrate, i-hemoglobin ye-glycated imvamisa ingu-4.2-4.6%. Lokhu kulingana nezinga le-glucose eliphakathi kuka-4-4.8 mmol / L. Lona umgomo esidinga ukuwulwela ekwelapheni isifo sikashukela, futhi empeleni akunzima ukuwufinyelela uma ushintshela ekudleni okune-carbohydrate yohlobo 1 noma uhlobo 2 sikashukela.
Inkinga ukuthi lapho ushukela ongculisiwe enxephezelwa kangcono, kuphakama amathuba okuba ne-hypoglycemia ne-hypoglycemic coma. Ezama ukulawula isifo sakhe sikashukela, isiguli kufanele silinganisele phakathi kwesidingo sokugcina ushukela wegazi ophansi nosongo lwe-hypoglycemia. Lona ubuciko obuyinkimbinkimbi obufundwa yisifo sikashukela kuyo yonke impilo yakhe. Kepha uma ulandela ukudla okwehla esiphundu futhi okunempilo okune-carbohydrate, khona-ke impilo iba lula. Ngoba ama-carbohydrate amancane owadlayo, okuncane uzodinga amaphilisi we-insulin noma amashukela anciphisa ushukela. Futhi i-insulin encane, yehlisa ingozi ye-hypoglycemia. Ilula futhi iyasebenza.
Kubantu asebekhulile abanesifiso sokuphila isikhathi esingaphansi kweminyaka emi-5, izinga le-hemoglobin ye-glycated libhekwa njengejwayelekile 7.5%, 8% noma ngaphezulu. Kuleli qembu leziguli, ubungozi be-hypoglycemia buyingozi ukwedlula amathuba okuba nesifo sikashukela sekwephuzile. Ngasikhathi sinye, izingane, intsha, abesifazane abakhulelwe kanye nentsha belulekwa ngokuqinile ukuba bazame ukugcina inani labo le-HbA1C <6.5%, noma okungcono, lingaphansi kuka-5%, njengoba uDkt Bernstein efundisa.
I-Algorithm yokukhethwa komuntu ngamunye kwezinhloso zokwelapha ushukela ngokuya nge-HbA1C
| Ukuhlwaya | Iminyaka | ||
|---|---|---|---|
| omncane | isilinganiso | ukuguga kanye / noma isikhathi sokuphila * <iminyaka emi-5 | |
| Akunazinkinga ezinzima noma ingozi yokuba ne-hypoglycemia | < 6,5% | < 7,0% | < 7,5% |
| Izinkinga ezinkulu noma ingozi yokuba ne-hypoglycemia | < 7,0% | < 7,5% | < 8,0% |
* Isikhathi sokuphila - isikhathi sokuphila.
La mazinga kashukela we-plasma osheshayo kanye namahora ama-2 ngemuva kokudla (i-postprandial) azohambisana nalawa ma-glycated hemoglobin amanani:
| I-HbA1C,% | Ukuzila ushukela we-plasma / ngaphambi kokudla, mmol / l | Ushukela we-plasma emahoreni ama-2 ngemuva kokudla, mmol / l |
|---|---|---|
| < 6,5 | < 6,5 | < 8,0 |
| < 7,0 | < 7,0 | < 9,0 |
| < 7,5 | < 7,5 | <10,0 |
| < 8,0 | < 8,0 | <11,0 |
Izifundo ezenziwa esikhathini eside ngawo-1990s kanye no-2000 zikufakazele ngokukholisayo ukuthi ukuhlolwa kwegazi kwe-hemoglobin ene-glycated kuvumela ukubikezela amathuba okuba nezinkinga zesifo sikashukela kungabi kubi futhi kube ngcono kunokuzila ushukela we-plasma glucose.
Kukangaki uvivinya igazi nge-glycosylated hemoglobin:
- Uma i-hemoglobin HbA1C yakho ingaphansi kuka-5.7%, kusho ukuthi awunasifo sikashukela futhi ingozi yayo ayincani, ngakho-ke udinga kuphela ukulawula le nkomba kanye njalo eminyakeni emithathu.
- Izinga le-hemoglobin yakho ye-glycosylated iphakathi kuka-5.7% - 6.4% - uyithathe futhi minyaka yonke ngoba kunengozi enkulu yesifo sikashukela. Isikhathi sokuthi ushintshele ekudleni okune-carbohydrate ephansi ukuvikela isifo sikashukela.
- Unesifo sikashukela, kepha usilawula kahle, i.e. I-HbA1C ayidluli kuma-7%, - kulesi simo, odokotela bacebisa ukuthi benze i-reanalysis njalo ezinyangeni eziyisithupha.
- Uma usanda kuqala ukwelapha ushukela wakho noma ushintshe irejimeni yakho yokwelashwa, noma ungasakwazi ukulawula ushukela wegazi kahle, kufanele uhlole i-HbA1C ngokucophelela njalo ezinyangeni ezintathu.
Sincoma ukuthi iziguli zihlole igazi nge-glycosylated hemoglobin nakho konke okunye ukuhlolwa kwegazi nomchamo - hhayi ezikhungweni zomphakathi, kodwa ezindaweni zokucwaninga ezizimele. Kuyinto efiselekayo kumafemu "wenethiwekhi", okungukuthi, ezindlini ezinkulu zelizwe noma zamazwe omhlaba. Ngoba kunethuba elikhulu lokuthi ukuhlaziya kuzokwenziwa kuwe, kunokuba ubhale umphumela “ophuma ophahleni”.
