Isifo sikashukela i-mellitus sivame ukuvela ngendlela engemuva futhi sinezinkinga eziningi. Ukuze uvikele i-pathology, kubalulekile ukwenza izifundo ezithile. Ukuthola izivivinyo ezidingekayo, kufanele ubonane nodokotela futhi uthole ukuthi kungakanani ukuhlolwa kwezimpawu zokuthola ushukela.
Izigaba eziyisithupha zikashukela ziyaziwa ngomuthi. Isisulu sokuqothuka kobuso sithathwa njengenhlanganisela ekhethekile yezakhi zofuzo.
Zonke izinkomba zesifo sohlobo lokuqala zihlukaniswe nge-immunological, genetic and metabolic.
Ukuhlolwa kwesifo sikashukela
Umphakathi wanamuhla wezokwelapha uncoma ukuhlolwa kwesifo sikashukela ezigabeni ezithile zabantu. Okokuqala, kuyadingeka kubantu asebefinyelele eminyakeni engama-45 noma ngaphezulu. Uma umphumela ungathandeki, ukuhlaziya kwenziwa njalo eminyakeni emithathu.
Iziguli zisencane kufanele ziqhubeke nezinqubo:
- ngokweqile
- ifa elihambisanayo,
- ngokobuhlanga noma ngokobuzwe kweqembu elithile,
- isifo sikashukela sokukhulelwa
- umfutho wegazi ophakeme
- ukuzala okunesisindo esingaphezu kwamakhilogremu ayi-4,5,
- i-glycemia ephezulu esiswini esingenalutho.
Ukuhlolwa okwabelwe naphakathi nendawo, kunconyelwa ukuthola inani le-glucose ne-hemoglobin A1c. Le yi-hemoglobin, lapho i-molecule yeglucose ixhunyaniswa khona ne-molecule ye-hemoglobin.
I-Glycosylated hemoglobin ihlangana ne-glucose yegazi. Isebenza njengesibonakaliso sezinga le-carbohydrate metabolism izinyanga ezintathu ngaphambi kokuhlaziywa. Izinga lokwakheka kwe-HbA1c lincike kubukhulu be-hyperglycemia. Ukushintshwa ngokwejwayelekile kwezinga layo egazini kwenzeka emavikini ama-4-5 ngemuva kwe-euglycemia.
Inani le-HbA1c linqunywa uma kuba nesidingo sokulawula i-carbohydrate metabolism futhi kuqinisekiswe isinxephezelo salo kwabanesifo sikashukela abagule isikhathi eside.
Izici Zokuxilonga
Ukwenza ukuxilongwa futhi uqaphele ngokuphelele i-pathology, udinga ukuya ngezinqubo eziningana zokuxilonga.
Okokuqala, le yimibhalo yaselebhu yasendulo, okuwukutadisha i-glucose ngokufaka amasampula umchamo negazi, kanye nokuhlolwa kwama-ketones nokuhlolwa kweglucose.
Ngaphezu kwalokho, ukuhlaziywa kwenziwa:
- HbA1c;
- i-fructosamine;
- i-microalbumin;
- umchamo we-urin;
- iphididi le-lipid.
Kunokuxilongwa okungeziwe kokucwaninga kwesifo sikashukela, okwenza sikwazi ukulawula ukuthuthukiswa kwesifo sikashukela, le ncazelo:
- I-peptide
- ama-insulin antibodies
- ama-antibodies kuma-islets ama-Langengars kanye ne-tyrosine phosphatase,
- ama-antibodies e-glutamic acid decarboxylase,
- i-ghrelin, i-raschistina, i-leptin, i-adiponectin,
- Ukuthayipha kwe-HLA.
Ukuthola i-pathology amashumishumi eminyaka, odokotela batusa ukwenza ukuhlaziya ushukela osheshayo. Eminyakeni yamuva nje, kutholakele ukuthi kunokuxhumana okucacile phakathi kwamazinga kashukela wegazi, ukuhlukunyezwa kwemithambo ekhona kanye nezinga labo lentuthuko; ayitholakali ngenkomba kashukela osheshayo, kepha ngezinga lokukhuphuka kwayo ngemuva kokudla. Lokhu kubizwa nge- postprandial hyperglycemia.
Zonke izimpawu zomhlobo 1 wesifo sikashukela zingahlukaniswa ngokulandelayo:
- ufuzo
- kwezemvelo
- umzimba.
Ukuthayipha kwe-HLA
Isifo sikashukela i-mellitus, ngokuya ngemibono yomuthi wanamuhla, sinokuqala kakhulu, kepha isikhathi eside. Izigaba eziyisithupha ziyaziwa ngokwakhiwa kwalesi sifo. Esokuqala saleso isigaba isigaba sokuphishekelwa ifa noma ukungabikho kwezakhi zofuzo ezihambisana nesifo sikashukela sohlobo 1.
Kuyafaneleka ukuthi uveze ukuthi ukuba khona kwama-antigen we-HLA, ikakhulukazi isigaba sesibili: I-DR 3, DR 4, DQ, kubalulekile. Ingozi yokwakhiwa kwe-pathology kuleli cala inyuka kaningana. Njengamanje, ukubhekelwa phambili kwefa lokuvela kwezinhlobo ezahlukahlukene zohlobo lwesifo kubhekwa njengokuhlanganiswa kwezinhlobo eziningana zofuzo ezivamile.
Izimpawu zokufundisa kakhulu zesifo sohlobo 1 ama-antigen we-HLA. Ama-haplotypes abonakalayo abonakala njengoshukela wohlobo 1 atholakala kubantu abangama-77% abanesifo sikashukela. I-6: inama-haplotypes abhekwa njengokuvikela.
Ama-antibodies kuma-Langerhans Islet Cell
Ngenxa yokukhiqizwa kwama-autoantibodies kumaseli ezinqola zaseLangerhans, lezi zamuva ziyabhujiswa, okuholela ekungeneni kokufakwa kwe-insulin kanye nokuvela kwesithombe esishiwoyo sohlobo 1 sikashukela.
Izindlela ezinjalo zinganqunywa ngofuzo noma zivele ngenxa yezici ezahlukahlukene.
Phakathi kwezinto ezivame kakhulu yilezi:
- amagciwane
- isenzo sezinto ezinobuthi
- izingcindezi ezahlukahlukene.
Uhlobo lokuqala lwesifo lubonakala esigabeni se-prediabetes ngaphandle kwezimpawu, lungahlala iminyaka eminingana. Ukuqamba kanye nokuqhekeka kwe-insulin ngalesi sikhathi kungabonakala kuphela ngokufunda ukubekezelela ushukela.
Emithini, amacala okutholwa kwama-antibodies lawo iminyaka eyisishiyagalombili noma ngaphezulu ngaphambi kokuqala kwesithombe somtholampilo walesi sifo achazwa. Ukuchazwa kwalawa ma-antibodies kufanele kusetshenziswe ekuxilongeni ngokushesha isifo sikashukela sohlobo 1.
Kubantu abane-antibodies enjalo, ukusebenza kwe-islet cell kunciphisa ngokushesha, okukhonjiswa ukwephulwa kokugcinwa kwe-insulin. Uma isigaba sishabalaliswa ngokuphelele, khona-ke isibonakaliso somtholampilo wesifo sikashukela salezi zinhlobonhlobo senzeka.
Ucwaningo oluningi lukhombisa ukuthi ama-antibodies akhona kuma-70% abaphenduli abanesifo sikashukela sokuqala esisanda kutholwa. Eqenjini elingelona isifo sikashukela kukhona kuphela i-0,1,5,5% yamacala okuthola amasosha omzimba.
Lama-antibodies nawo angatholakala ezihlotsheni zabanesifo sikashukela. Leli qembu labantu linamazinga aphezulu ngalesi sifo. Ucwaningo oluningi lukhombisa ukuthi izihlobo ezinama-antibodies zakha isifo sikashukela sohlobo 1 ngokuhamba kwesikhathi.
Amamaki wanoma yiluphi uhlobo lohlobo 2 lwesifo sikashukela i-mellitus nawo afaka lolu cwaningo. Ososayensi sebefakazile ukuthi ukunquma izinga lale antibodies kusifo sikashukela ngohlobo lwesibili lwesifo kuyasiza ukukusichaza kahle ngaphambi kokuthi kubonakale isithombe somtholampilo, futhi kusiza ukusethwa kwemithamo yokwelashwa kwe-insulin. Ngakho-ke, kuma-diabetes kanye nohlobo lwesibili lokugula, kungenzeka ukubikezela ukwakheka okwengeziwe kokuncika kwi-insulin ye-hormone.
Ama-antibodies kuma-insulin atholakala cishe kuma-40% abantu abanesifo sikashukela sohlobo 1. Kunombono mayelana nokuhlangana phakathi kwama-antibodies kuya kuma-insulin nama-antibodies kuma-islet cell.
Ezangaphambili zingaba sesigabeni se-prediabetes kanye nokuqala kwezimpawu zohlobo lwesifo sikashukela 1.
I-Glutamic acid decarboxylase
Muva nje, ososayensi baye bakhomba i-antigen eyinhloko, okuyinkomba yama-autoantibodies ahlotshaniswa nokwakhiwa kwesimo sokuncika kwesifo sikashukela. Kuyi-decarboxylase ye-glutamic acid.
Le asidi iyi-enzyme ye-membrane evikela ukuthi i-biosynthesizing the neurotransmitter CNS-gamma-aminobutyric acid. I-enzyme yaqala ukutholwa kubantu abanokuphazamiseka kohlelo lwezinzwa.
Ama-antibodies kuya ku-GAD yilona lwazi olwakhayo kakhulu lokuhlonza isimo se-prediabetesic. Ngakho-ke, kungenzeka ukubona ingozi enkulu yokuthola isifo sikashukela sohlobo 1. Ngokwakheka kwalesi sifo njenge-asymptomatic yalesi sifo, ama-antibodies ku-GAD angabonakala kubantu eminyakeni eyisikhombisa ngaphambi kokubonakaliswa kwalesi sifo.
Okuthembekile futhi kufundise kakhulu phakathi kososayensi kubhekwa njengokuhlaziywa kanyekanye kwama-marker ambalwa egazini. Umaka ongu-1 umelela ama-20% wolwazi, omaka abathathu bakhombisa ama-44% emininingwane, kuthi abamaki abathathu bamele imininingwane engama-95%.
Ama-Autoimmune Diabetes Markers
Ku-diabetes, iphrofayili ye-autoantibodies incike kubulili nobudala. Ama-antibodies kuma-antigen kanye nama-antibodies ukuya kuma-islet cell, njengomthetho, asezingane kunabantu abadala. Ama-antibodies kuma-glutamic acid decarboxylase, ezimeni eziningi, atholakala kwabesifazane.
Isisungulo sokwakheka kwezinhlobo ngazinye zama-autoantibodies cishe sinqunywa izinhlobo ezihlukile zohlelo lwe-HLA, ngoba ama-autoantibodies kuya ku-insulin, amaseli we-islet ne-islet antigen 2 atholakala kakhulu kubantu abane-HLA - DR 4 / DQ 8 (DQA 1 * 0301 / DQB 1 * 0302). Ngasikhathi sinye, ama-antibodies to glutamic acid decarboxylase akhona kubantu abane-HLA genotypes - DR 3 DQ 2 (DQA 1 * 0501 / DQB 1 * 0201).
Izinhlobo eziningana zama-autoantibodies zivame ukubakhona kwabashukela abancane, kuyilapho abantu abanesifo sikashukela se-autoimmune sinohlobo olulodwa lwe-autoantiever.
Ama-antibodies kuma-glutamic acid decarboxylase aphakathi kwabantu abadala abanesifo sikashukela ngohlobo lokuqala lwe-pathology, kodwa futhi imvamisa iphezulu kubantu abane-phenotypes yohlobo lwesibili lwesifo.
Ukuzimisela kwala ma-antibodies kwenza ukuthi sikwazi ukubona amacala amaningi we-autoimmunity, uma kuwukuphela kophawu lwabantu abadala.
Izindleko zokuhlaziya
Abantu abanesifo sikashukela abasolisayo bavame ukuthakazela ukuthi kubiza kangakanani ukuhlaziya amamaki kashukela. Kunamaphrofayili athile akhonjiswa inombolo yokuhlaziya.
Ukuhlaziywa okujwayelekile okubizwa ngokuthi "ukulawula isifo sikashukela" kufaka i-glucose yegazi nokuhlolwa kwe-creatinine.
Ngaphezu kwalokho, iphrofayli iqukethe:
- Ukuhlaziywa kwe-hemoglobin ye-glycated,
- triglycerides
- i-cholesterol ephelele
- I-cholesterol ye-HDL,
- I-cholesterol ye-LDL,
- i-albhamu yomchamo
- Homocestein,
- Ukuhlolwa kwe-Reberg,
- ushukela emchameni.
Izindleko zokuhlaziywa okunjalo okuphelele cishe ama-ruble ayizinkulungwane ezinhlanu.
Ukuhlola kufaka phakathi:
- ukuhlaziywa kweglucose
- glycated hemoglobin.
Intengo yokuhlaziya imayelana nama-ruble angama-900.
Izimpawu ze-Autoimmune:
- ama-antibodies kuma-insulin
- ama-antibodies kuma-tyrosine phosphatase.
- ama-antibodies e-glutamate ama-decarboxylase,
- ama-antibodies kuma-tyrosine phosphatase.
Ukuhlaziywa okunjalo kuzobiza ama-ruble ayizinkulungwane ezine.
Ukuhlolwa kwe-insulin kuzodla cishe ama-ruble angama-450, ukuhlolwa kwe-C-peptide kuzobiza ama-ruble angama-350.
Ukuxilonga ngesikhathi sokukhulelwa
Ukuhlolwa kweglucose yegazi kuthathwa esiswini esingenalutho. Ukwesaba kuzodalwa yinkomba engu-4.8 mmol / kusuka emunweni no-5.3 - 6.9 mmol / l kusuka emthanjeni. Ngaphambi kokuthatha izivivinyo, umuntu wesifazane akufanele adle ukudla cishe amahora ayishumi.
Lapho uthwala ingane, kungahlolwa ukuhlolwa kweglucose. Kulokhu, umfazi uphuza u-75 g we-glucose engilazini yamanzi. Ngemuva kwamahora ama-2, amasampula egazi ayaphindwa. Ngaphambi kokuhlaziywa, awudingi ukuzikhawulela ekudleni okunempilo. Ukudla kufanele kujwayele.
Uma kutholakala izimpawu zesifo sikashukela, akufanele uhlehlise ukubonisana nodokotela wakho. Ukuhlonza lesi sifo kusenesikhathi kusiza ukumisa ukuqhubeka kwesifo nokukhula kwezinkinga ezisongela impilo. Imiphumela yocwaningo kumele inembe, ngoba lokhu udinga ukulandela yonke imithetho yokulungiselela ukuhlaziywa.
Isifo sikashukela sitholakala kanjani? Isazi sizotshela kule vidiyo ekulesi sihloko.
