Isifo sikashukela singokwesigaba sezifo ze-endocrine eziqhamuka usizi noma ukusilela ngokuphelele kwe-insulin ye-hormone. I-Hyperglycemia (ukukhula okuqinile kweglucose yegazi) kungakhula ngenxa yokwephulwa kokuxhumeka kwe-insulin namaseli omzimba.
Lesi sifo sibonisa inkambo engapheli kanye nokwephula zonke izinhlobo ze-metabolism:
- amanoni;
- carbohydrate;
- amaprotheni;
- usawoti wamanzi;
- amaminerali.
Ngokuthabisako, isifo sikashukela asithinti abantu kuphela, kepha futhi nezilwane ezithile, ngokwesibonelo, amakati nawo ahlushwa yilesi sifo.
Lesi sifo singasolwa ngezimpawu zaso ezihlaba umxhwele kakhulu ze-polyuria (ukulahlekelwa uketshezi emchameni) kanye ne-polydipsia (ukoma okunganqobeki). Igama elithi "isifo sikashukela" laqala ukusetshenziswa ngekhulu lesibili leminyaka nguDemetrios wase-Apamania. Igama elihunyushwe lisuselwa esiGrekini lisho "ukungena ngaphakathi."
Lokhu kwakungumqondo wesifo sikashukela: umuntu uhlala elahlekelwa uketshezi, bese kuthi, njengempompo, aqhubeke nokuwuphindaphinda. Lolu uphawu oluphambili lwalesi sifo.
Ukuhlushwa ushukela omkhulu
UThomas Willis ngonyaka we-1675 waveza ukuthi ngokukhuphuka okungaphezulu komchamo (i-polyuria), uketshezi lungaba nobumnandi, noma kungenzeka lube "olunambitheka ngokuphelele". Isifo sikashukela se-Insipid sasibizwa ngokuthi i-insipid ngalezo zinsuku.
Lesi sifo sibangelwa ukuphazamiseka kwe-patological yezinso (isifo sikashukela se-nephrogenic) noma ngesifo se-pituitary gland (neurohypophysis) futhi kubonakaliswa ukwephulwa komphumela wezinto eziphilayo noma ukukhululeka kwe-hormone ye-antidiuretic.
Omunye usosayensi, uMatthew Dobson, ukhombisile umhlaba ukuthi ubumnandi bomchamo negazi lesiguli esinesifo sikashukela kungenxa yokuxineka okukhulu koshukela egazini. AmaNdiya asendulo aqaphela ukuthi umchamo wesifo sikashukela uheha izintuthwane ngobumnandi baso futhi wanikeza lesi sifo igama elithi "isifo esimnandi somchamo".
Ozakwabo baseJapan, abaseChinese nabaseKorea baleli binzana basuselwa kwinhlanganisela yezinhlamvu efanayo futhi basho okufanayo. Lapho abantu befunda ukukala ukugcwala koshukela hhayi emchini kuphela, kodwa nasegazini, basheshe bathola ukuthi okokuqala ushukela ukhuphuka egazini. Futhi kuphela lapho izinga legazi lakhe lidlula umkhawulo owamukelekayo wezinso (cishe ama-9 mmol / l), ushukela uvela emchameni.
Umbono wokuthi ngaphansi kwesifo sikashukela, futhi bekufanele ushintshwe, ngoba kwavela ukuthi indlela yokuboshwa ushukela yizinso ayikaphulwa. Ngakho-ke isiphetho: ayikho into enjengokuthi "ushukela ukungasebenzi."
Noma kunjalo, i-paradigm yakudala yahlala yabelwa isimo esisha se-pathological, esibizwa ngokuthi "isifo sikashukela sezinso." Imbangela enkulu yalesi sifo empeleni bekuwukuncipha komkhawulo wezinso ushukela wegazi. Ngenxa yalokhu, emhlanganweni ojwayelekile we-glucose egazini, ukubonakala kwawo emchameni kwakubonwa.
Ngamanye amagama, njengasoshukela we-insipidus, umqondo wakudala waba semfuno, kodwa hhayi ngesifo sikashukela, kodwa ngesifo esihluke ngokuphelele.
Ngakho-ke, umbono wokuthi i-sukari incontinence yalahlwa ngenxa yomunye umqondo - ukugcwala ushukela egazini.
Lesi sikhundla namuhla siyithuluzi eliyisihluthulelo lokuxilonga nokuhlola ukusebenza kwezokwelapha. Ngasikhathi sinye, umqondo wesimanje wesifo sikashukela awupheli kuphela eqinisweni likashukela ophezulu egazini.
Umuntu angasho futhi ngokuqiniseka ukuthi umbono wokuthi "ushukela wegazi ophezulu" uqeda umlando wokuqanjwa kwesayensi kwalesi sifo, onciphisela imibono mayelana nokuqukethwe ushukela oluketshezi.
Ukuntuleka kwe-insulin
Manje sizokhuluma ngomlando wama-hormone wezimangalo zesayensi mayelana nesifo sikashukela. Ngaphambi kokuthi ososayensi bathole ukuthi ukuntuleka kwe-insulin emzimbeni kuholela ekwandeni kwalesi sifo, bathole okuthile okuhle.
U-Oscar Minkowski noJoseph von Mehring ngonyaka we-1889 bethule isayensi nobufakazi bokuthi ngemuva kokuba inja isuse ama-pancreas, lesi silwane sikhombisa ngokuphelele izimpawu zesifo sikashukela. Ngamanye amagama, i-etiology yesifo ngqo incike ekusebenzeni kwalesi sitho.
Omunye usosayensi, u-Edward Albert Sharpei, ngonyaka we-1910, waveza ukuthi i-pathogenesis yesifo sikashukela ilele ekuntuleni kwamakhemikhali akhiqizwa yizichibi zeLangerhans ezisezinhlwini zamaphaphu. Usosayensi wanikeza le nto igama - i-insulin, elivela ku-Latin "insula", elisho "isiqhingi".
Lokhu kuqonda kwemvelo kanye nemvelo yama-pancreas ngo-1921 kwaqinisekiswa abanye ososayensi ababili uCharles Herbert Best noFrederick Grant Buntingomi.
Isigama namuhla
Igama lesimanje "uhlobo 1 lwesifo sikashukela" lihlanganisa imiqondo emibili ehlukene eyayikhona phambilini:
- isifo sikashukela esincike ku-insulin;
- isifo sikashukela sezingane.
Igama elithi "uhlobo 2 sikashukela mellitus" nalo liqukethe amagama amaningi aphelelwe yisikhathi:
- isifo sikashukela esinga-insulin;
- isifo esihlobene nokukhuluphala;
- Abantu abadala be-AD.
Izindinganiso zomhlaba wonke zisebenzisa kuphela amagama athi "uhlobo 1st" no "2nd". Kweminye imithombo, ungathola umqondo "wesifo sikashukela esingu-3", okusho ukuthi:
- isifo sikashukela sokukhulelwa sabesifazane abakhulelwe;
- "isifo sikashukela esiphindwe kabili" (uhlobo lokuvikela isifo sikashukela esingu-1);
- Thayipha isifo sikashukela esingu-2, esakhula isidingo sokulimala kwe-insulin;
- "Thayipha isifo sikashukela esingu-1.5", i-LADA (i-autoimmune latent sikashukela kubantu abadala).
Ukuhlukaniswa kwezifo
Uhlobo 1 sikashukela, ngenxa yezizathu, ihlukaniswe ngama-idiomatic ne-autoimmune. I-etiology yesifo sikashukela sohlobo 2 isezimbangela zezemvelo. Ezinye izinhlobo zesifo zingavela:
- Isici sofuzo ekusebenzeni kwe-insulin.
- I-genetic pathology yokusebenza kwe-beta cell.
- I-Endocrinopathy.
- Izifo zesifunda se-endocrine yama-pancreas.
- Lesi sifo sicasulwa izifo.
- Lesi sifo sidalwa ukusetshenziswa kwezidakamizwa.
- Izinhlobo ezingezinhle zesifo sikashukela sokulamula.
- Ama-syndromes we-Hereditary ahlanganisa nesifo sikashukela.
I-Etiology yesifo sikashukela sokuthambisa, ukuhlukaniswa ngezinkinga:
- Isifo sikashukela.
- I-Nephropathy
- I-retinopathy
- Isifo sikashukela se-polyneuropathy.
- I-Diabetesic macro kanye ne-microangiopathy.
Ukuxilongwa
Lapho ebhala ukuxilongwa, udokotela ubeka uhlobo lwesifo sikashukela endaweni yokuqala. Uma kwenzeka isifo sikashukela sincike ku-insulin, ikhadi lesiguli libonisa ukuzwela kwesiguli kuma-ejenti omlomo we-hypoglycemic (ukumelana noma cha).
Isikhundla sesibili sithathwa yisimo se-carbohydrate metabolism, kulandelwa uhlu lwezinkinga zesifo ezikhona kulesi siguli.
I-Pathogenesis
I-pathogenesis yesifo sikashukela ihlukaniswa ngamaphuzu amabili amakhulu:
- Amaseli we-pancreatic awunakho ukukhiqizwa kwe-insulin.
- I-pathology yokuhlangana kwe-hormone namaseli womzimba. Ukuphikiswa kwe-insulin kungumphumela wesakhiwo esishintshiwe noma ukwehla kwenani le-receptors sici se-insulin, ukwephulwa kwezindlela ezisetshenziswayo zesiginali kusuka kuma-receptors kuya kuma-cellelles weselula, kanye noshintsho ekwakhiweni kokuhanjiswa kweseli noma i-insulin uqobo.
Uhlobo 1 sikashukela lubonakala ngohlobo lokuqala lokuphazamiseka.
I-pathogenesis yentuthuko yalesi sifo ukubhujiswa okukhulu kwamangqamuzana e-pancreatic beta (islets of Langerhans). Ngenxa yalokhu, ukwehla okubucayi kwamazinga we-insulin yegazi kwenzeka.
Nakani! Ukufa kwenani elikhulu lamaseli e-pancreatic nakho kungavela ngenxa yezimo ezicindezelayo, izifo ezibangelwa amagciwane, izifo ze-autoimmune, lapho amaseli omzimba wokuzivikela komzimba eqala ukukhiqiza khona amasosha omzimba alwa namaseli we-beta.
Lolu hlobo lwesifo sikashukela lubonakala kubantu abasha abangaphansi kweminyaka engama-40 nezingane.
Isifo sikashukela esinga-insulin sibonisa ukuphazamiseka okuchazwe esigabeni 2 ngenhla. Ngale ndlela yalesi sifo, i-insulin ikhiqizwa ngamanani anele, kwesinye isikhathi ngisho nakwezokuphakama.
Kodwa-ke, ukumelana ne-insulin kwenzeka (ukuphazamiseka kokuxhumana kwamangqamuzana omzimba nge-insulin), isizathu esiyinhloko sokungasebenzi kwezakhi zolwelwesi ukuthola i-insulin ngokweqile (ukukhuluphala ngokweqile).
Ukukhuluphala yisici esikhulu esiyingozi sesifo sikashukela sohlobo 2. Ama-Receptors, ngenxa yezinguquko enanini lawo nasendleleni, alahlekelwa amandla abo okusebenzisana ne-insulin.
Kwezinye izinhlobo zesifo sikashukela esingancikileli i-insulin, ukwakheka kwe-hormone ngokwayo kungalandela izinguquko ze-pathological. Ngaphezu kokukhuluphala, kunezinye izici zobungozi zalesi sifo:
- imikhuba emibi;
- ukudla ngokweqile;
- ubudala
- impilo yokuhlala;
- umfutho wegazi ophakeme.
Singasho ukuthi lolu hlobo lwesifo sikashukela luvame ukuthinta abantu ngemuva kweminyaka engama-40. Kepha futhi kunesifiso sokuthola lesi sifo kulesi sici. Uma ingane inesinye sezihlobo ezigulayo, amathuba okuthi umntwana azuze ifa lesifo sikashukela sokuqala asondele ku-10%, futhi isifo sikashukela esingaxhamli nge-insulin singenzeka ngamacala angama-80%.
Kubalulekile! Naphezu kwendlela yokwakhiwa kwalesi sifo, zonke izinhlobo zesifo sikashukela zibonisa ukwanda okuqhubekayo kokuxineka kashukela wegazi nokuphazamiseka kwe-metabolic ezicutshini, ezihluleka ukubamba ushukela egazini.
I-pathology enjalo iholela ku-catabolism ephezulu yamaprotheni namafutha ngokuthuthukiswa kwe-ketoacidosis.
Njengomphumela woshukela wegazi ophakeme, ukwanda kwengcindezi ye-osmotic kwenzeka, umphumela wakho ukulahleka okukhulu kukamanzi nama-electrolyte (polyuria). Ukwanda okuqhubekayo kokuhlushwa ushukela wegazi kuthinta kabi isimo sezicubu eziningi nezitho zomzimba, okuthi, ekugcineni, kuholele ekukhuleni kwezinkinga ezinkulu zesifo:
- unyawo lwesifo sikashukela;
- i-nephropathy;
- i-retinopathy
- i-polyneuropathy;
- i-macro- ne-microangiopathy;
- Isifo sikashukela sikashukela.
Abantu abanesifo sikashukela banenkambo ebabazekayo yezifo ezithathelanayo kanye nokwehla kokuphinda futhi komzimba ukuzivikela.
Izimpawu zokwelashwa zesifo sikashukela
Isimo somtholampilo walesi sifo sivezwa emaqenjini amabili wezimpawu - eyokuqala neyesekondari.
Izimpawu eziphambili
I-Polyuria
Isimo sibonisa umthamo omkhulu womchamo. I-pathogenesis yale nto ukwandisa umfutho we-osmotic we-fluid ngenxa yoshukela oncibilikisiwe kuwo (ngokujwayelekile kufanele kungabikho ushukela emchameni).
I-Polydipsia
Isiguli sihlushwa ukoma okungapheli, okubangelwa ukulahleka okukhulu koketshezi nokukhuphuka kwengcindezi ye-osmotic egazini.
I-Polyphagy
Indlala engaguquki. Lesi sibonakaliso senzeka ngenxa yokuphazamiseka kwe-metabolic, noma kunalokho, ukungakwazi kwamaseli ukubamba nokuqeda i-glucose lapho kungekho i-insulin ye-hormone.
Ukwehla kwesisindo
Lokhu kubonakaliswa kutholakala kakhulu kwisifo sikashukela esincike ku-insulin. Ngaphezu kwalokho, ukunciphisa isisindo kwenzeka ngokuhambisana nesizinda sokudla kwesineke okwandayo.
Ukwehla kwesisindo, futhi kwezinye izimo, ukwehla komzimba kuchazwa ngokwanda kwe-catabolism yamafutha namaprotheni ngenxa yokufakelwa kwe-glucose kusuka kumandla we-metabolism kumaseli.
Izimpawu eziphambili zesifo sikashukela esincike ku-insulin zinamandla. Ngokuvamile, iziguli zingakhombisa ngokunembile isikhathi noma usuku lokuvela kwazo.
Izimpawu ezincane
Lokhu kufaka ukubonakaliswa kwemitholampilo okungacaciswanga okuthuthuka kancane futhi isikhathi eside. Lezi zimpawu zimpawu zazo zombili izinhlobo zesifo sikashukela:
- umlomo owomile
- ikhanda;
- umbono ongalungile;
- ukulunywa kwezicubu zolwelwesi lwe-mucous (ukulunywa kwesitho sangasese sowesifazane sangasese)
- ukulunywa kwesikhumba;
- ubuthakathaka bemisipha obujwayelekile;
- Kunzima ukwelapha izilonda zesikhumba ezivuthayo;
- ngesifo sikashukela esincike ku-insulin, ukuba khona kwe-acetone emchameni.
I-mellitus encike kwisifo sikashukela (uhlobo 1)
I-pathogenesis yalesi sifo ilele ekukhiqizeni okunganele kwe-insulin ngamangqamuzana e-beta pancreas. Amaseli e-Beta anqaba ukwenza umsebenzi wawo ngenxa yokubhujiswa kwawo noma umthelela wanoma iyiphi into ye-pathogenic:
- izifo ze-autoimmune;
- ukucindezela
- ukutheleleka ngegciwane.
Thayipha isifo sikashukela sokuqala esingu-1-15% sazo zonke izimo zesifo sikashukela, futhi isikhathi esiningi lesi sifo senzeka ebuntwaneni noma ebusheni. Izimpawu zalesi sifo zihamba ngokushesha futhi ziholele ezinkingeni ezinkulu ezibucayi:
- ketoacidosis;
- ukoma, ovame ukuphela ekufeni kwesiguli.
I-mellitus engaxuthi ne-insulin (uhlobo 2)
Lesi sifo senzeka ngenxa yokwehla kokuzwela kwezicubu zomzimba kuyi-insulin ye-hormone, yize kukhiqizwa ngamanani aphakeme futhi ngokweqile ezigabeni zokuqala zesifo sikashukela.
Ukudla okulinganiselayo nokuqeda amakhilogremu angeziwe kwesinye isikhathi kusiza ekujwayezeni i-carbohydrate metabolism futhi kunciphise ukukhiqizwa kweglue ngesibindi. Kepha njengoba lesi sifo siqhubeka, ukukhululeka kwe-insulin, okwenzeka kumaseli we-beta, kuyancipha futhi kunesidingo sokwelashwa kwe-insulin.
Uhlobo lwe-2 sikashukela luba ngama-85-90% azo zonke izimo zesifo sikashukela, futhi iningi lesi sifo senzeka ezigulini ezineminyaka engaphezu kwengama-40 futhi ezimweni eziningi sihambisana nokukhuluphala. Lesi sifo sihamba kancane futhi sibonakaliswa yizimpawu zesibili. I-ketoacidosis yesifo sikashukela onesifo sikashukela esingaxhomekeki ku-insulin ayivelakancane kakhulu.
Kepha, ngokuhamba kwesikhathi, kuvela ezinye izindlela:
- i-retinopathy
- i-neuropathy;
- i-nephropathy;
- i-macro ne-microangiopathy.
