Kungani kufanele uhlolwe i-hemoglobin ye-glycated, ungayenza kanjani kanye nokujwayelekile kwayo

Ungafunda ngokuqala kwesifo sikashukela noma ukuvivinya izinga lokwelashwa kwalo hhayi ngokuba khona kwezimpawu ezithile noma amazinga eglucose egazi. Enye yezinkomba ezithembeke kakhulu yi-glycated hemoglobin. Izimpawu zesifo sikashukela zivame ukubonakala kakhulu lapho izinga likashukela lingaphezu kwe-13 mmol / L. Leli izinga eliphakeme impela, eligcwele ukuthuthukiswa okusheshayo kwezinkinga.

Ushukela wegazi uyinani eliguquguqukayo, elihlala liguquka, ukuhlaziya kudinga ukulungiswa kwesikhashana kanye nesimo sempilo esivamile sesiguli. Ngakho-ke, incazelo ye-glycated hemoglobin (GH) ibhekwa njengethuluzi lokuhlonza isifo se "golide". Igazi lokuhlaziywa linganikelwa ngesikhathi esikahle, ngaphandle kokulungiselela okuningi, uhlu lwe-contraindication lincane kakhulu kune-glucose. Ngosizo locwaningo nge-GG, izifo ezandulelayo isifo sikashukela zingabonakala futhi: ukungalawuleki kwe-glycemia noma ukubekezelelwa kweglucose.

Indlela i-hemoglobin etholakala glycated

IHemoglobin itholakala kumaseli abomvu egazi, amaseli abomvu egazi, kuyiprotheni lesakhiwo esiyinkimbinkimbi. Indima yawo eyinhloko ukuhambisa umoya-mpilo emikhunjini, kusuka kuma-capillaries amaphaphu kuya kwezicubu, lapho akwanele. Njengamanye amaprotheni, i-hemoglobin ingasabela nge-monosaccharides - glycate. Igama elithi "glycation" lanconyelwa ukusetshenziswa kungekudala, ngaphambi kokuba i-candog hemin ibizwe ngokuthi yi-glycosylated. Njengamanje, zombili lezi zincazelo zingatholakala.

Umnyombo we-glycation ukudalwa kwezibopho eziqinile phakathi kwama-glucose nama-molecule we-hemoglobin. Ukusabela okufanayo kwenzeka ngamaprotheni aqukethe esivivinyweni, lapho uqweqwe lwegolide luba ngaphezulu kwepayi. Ijubane lokuphendula lihambisana nokushisa kanye nenani likashukela egazini. Lapho kuvela khona, ingxenye enkulu ye-hemoglobin i-glycated.

Isifo sikashukela nokucindezela kuzoba yinto yesikhathi esedlule

• Ukwehlela ushukela -95%
• Ukuqedwa kwe-vein thrombosis - 70%
• Ukuqedwa kokushaya kwenhliziyo okuqinile -90%
• Ukuqeda umfutho wegazi ophakeme - 92%
• Ukwanda kwamandla ngesikhathi sosuku, ngcono ukulala ebusuku -97%

Kubantu abadala abanempilo, ukwakheka kwe-hemoglobin kusondele: okungenani ama-97% asefomini A. Kungafakwa ushukela ukwakha izakhi ezintathu ezihlukene: a, b no c. I-HbA1a ne-HbA1b akuvamile, isabelo sabo singaphansi kwe-1%. I-HbA1c itholakala kaningi kakhulu. Lapho bekhuluma ngokunqunywa kwelabhoramu kwezinga le-hemoglobin ye-glycated, ezimeni eziningi basho ifomu le-A1c.

Uma i-glucose yegazi ingeqi ku-6 mmol / l, izinga lale hemoglobin emadodeni, abesifazane nezingane ngemuva konyaka lizoba cishe ama-6%. Ukhuphuka okunamandla kakhudlwana futhi ushukela, futhi isikhathi eside lapho kugxilwa kakhulu kubanjwa egazini, kuphakama umphumela we-GH.

Ukuhlaziywa kwe-GH

I-GH ikhona egazini lanoma yisiphi isilwane esibuhlungu, kufaka phakathi abantu. Isizathu esiyinhloko sokubukeka kwayo i-glucose, eyakhiwa kuma-carbohydrate avela ekudleni. Izinga le-glucose kubantu abane-metabolism ejwayelekile lizinzile futhi liphansi, wonke ama-carbohydrate acutshungulwa ngesikhathi futhi achithwa ezidingweni zamandla zomzimba. Ku-mellitus yesifo sikashukela, okuyingxenye noma lonke ushukela kuyayeka ukungena kwezicubu, ngakho-ke izinga lazo lenyuka lize lande. Ngesifo sohlobo 1, isiguli sifaka i-insulin emangqamuzaneni ukuze iqhube ushukela, efana naleyo ekhiqizwa amanyikwe. Ngesifo sohlobo 2, ukulethwa kweglue emisipha kuvuselelwa yimithi ekhethekile. Uma ngokwelashwa okunjalo kungenzeka ukuthi kulondolozwe izinga loshukela eliseduze nokujwayelekile, isifo sikashukela sibhekwa njengesihlawulelwayo.

Ukuthola ukweqa ushukela kushukela, kuzofanela kukalwe njalo emahoreni ama-2. Ukuhlaziywa kwe-hemoglobin ye-glycated kukuvumela ukwahlulela ngokunembile ushukela wegazi ojwayelekile. Ukunikela ngegazi elilodwa kwanele ukuthola ukuthi isifo sikashukela sakhokhelwa yini ezinyangeni ezi-3 ngaphambi kokuhlolwa.

IHemoglobin, kufaka phakathi i-glycated, ihlala emalanga langu-60-120. Ngenxa yalokho, ukuhlolwa kwegazi kwe-GG kanye ngekota kuzohlanganisa konke ukwanda okubalulekile koshukela ngonyaka.

Ukulethwa kwezidingo

Ngenxa yokuguquguquka kwayo nokunemba okuphezulu, lokhu kuhlaziya kusetshenziswa kabanzi ekuhlolweni kwesifo sikashukela. Iphinde iveze ukwenyuka okufihliwe kushukela (ngokwesibonelo, ebusuku noma ngokushesha nje ngemuva kokudla), okungeke kube khona isivivinyo se-glucose esivamile noma isivivinyo sokubekezelela ushukela.

Umphumela awuthintwa izifo ezithathelwanayo, izimo ezicindezelayo, ukusebenza ngokomzimba, utshwala nogwayi, izidakamizwa, kufaka phakathi ama-hormone.

Ungakuhlaziya kanjani:

1. Thola okudluliselwa ekunqumeni kwe-glycosylated hemoglobin kusuka kudokotela noma ku-endocrinologist. Lokhu kungenzeka uma unezimpawu ezithize ezinesifo sikashukela noma ukwanda kweglucose yegazi, ngisho eyodwa, kutholakala.
2. Thintana nelabhoretri yakho eseduze yokuthengisa bese uthatha isivivinyo se-GH ukuthola imali. Ukuqondisa kukadokotela akudingeki, ngoba ucwaningo alubeki ingozi encane empilweni.
3. Abakhiqizi bamakhemikhali ekubalweni kwe-glycated hemoglobin abanazo izidingo ezikhethekile zoshukela wegazi ngesikhathi sokubeletha, okungukuthi, ukulungiselela kokuqala akudingekile. Kodwa-ke, amanye ama-laboratories athanda ukuthatha igazi esiswini esingenalutho. Ngakho-ke, bafuna ukunciphisa amathuba wephutha ngenxa yezinga elikhulayo le-lipid ezintweni zokuhlola. Ukuze uhlaziyo luthembeke, kwanele ngosuku lokulethwa kwalo ungadli ukudla okunamafutha.
4. Ngemuva kwezinsuku ezi-3, umphumela wokuhlolwa kwegazi uzobe usulungile bese udluliselwa kudokotela oya khona. Kumalabhoratri akhokhelwayo, imininingwane esesimweni sakho sempilo ingatholakala ngosuku olulandelayo.

Lapho umphumela ungangathembeki

Umphumela wokuhlaziywa ungahle uhambisane nenqanaba langempela loshukela ezimweni ezilandelayo:

1. Ukuhanjiswa kwegazi elinikelwe noma izakhi zalo ezinyangeni ezi-3 ezedlule kunikeza umphumela ongathandeki.
2. Nge-anemia, i-hemoglobin ye-glycated ikhuphuka. Uma usola ukuntuleka kwensimbi, kufanele udlulise i-KLA ngasikhathi sinye ngokuhlaziywa kwe-GG.
3. Ubuthi, izifo ezibangelwa ukuqaqanjelwa, uma zibangele i-hemolysis - ukufa kwe-seli okwenziwa ngamangqamuzana abomvu egazi, kuholela ekungazithembi ngokweqile kwe-GH.
4. Ukususwa komgogodla nomdlavuza wegazi kugcwala izinga le-hemoglobin ye-glycosylated.
5. Ukuhlaziywa kuzobe kungaphansi kwesijwayelekile kwabesifazane abanokwehla kwegazi okuphezulu ngesikhathi sokuya esikhathini.
6. Ukwanda kwengxenye ye-fetus hemoglobin (HbF) inyusa i-GH uma isetshenziswa ku-ion chromatography ekuhlaziyeni, futhi kuyehla uma kusetshenziswa indlela ye-immunochemical. Kubantu abadala, ifomu F kufanele libe ngaphansi kwe-1% yomthamo ophelele, imvamisa ye-fetus hemoglobin ezinganeni ukuya ezinyangeni eziyisithupha iphakeme. Le nkomba ingakhula ngesikhathi sokukhulelwa, izifo zamaphaphu, i-leukemia. I-hemoglobin ehlala igcwele glycated iphakanyiswa ku-thalassemia, isifo esiyifa.

Ukunemba kwabahlaziyi be-compact kokusetshenziswa kwasekhaya, okungezelela i-glucose enganquma i-glycated hemoglobin, kuphansi impela, umenzi uvumela ukuphambuka okufika ku-20%. Akunakwenzeka ukuthola i-mellitus yesifo sikashukela ngokususelwa kwimininingwane enjalo.

Enye indlela yokuhlaziya

Uma izifo ezikhona zingaholela ekuhlolweni kwe-GH okungalungile, ukuhlolwa kwe-fructosamine kungasetshenziswa ukulawula isifo sikashukela. Iprotheni ye-Whey ye-glycated, okuyi-glucose ene-albhamuin. Ayihlobene namaseli abomvu egazi, ngakho-ke ukunemba kwayo akuphathelene nezifo ze-anemia kanye nezifo ezinemithambo - izimbangela ezivame kakhulu zemiphumela yamanga ye-glycated hemoglobin.

Ukuhlolwa kwegazi kwe-fructosamine kushibhile kakhulu, kepha ukubhekelwa ngokuqhubekayo kwesifo sikashukela, kuzodingeka kuphindwe kaningi kakhulu, ngoba isikhathi se-albhamuin se-glycated cishe amasonto ama-2. Kepha kuhle ukuthi kuhlolwe ukusebenza ngempumelelo kokwelashwa okusha lapho ukhetha isidlo noma umthamo wezidakamizwa.

Ukuhlaziya imvamisa yokuhlaziya

Kukangaki kunconywa ukunikela ngegazi nge-glycated hemoglobin:

1. Abantu abanempilo emva kweminyaka engama-40 - kanye njalo eminyakeni emi-3.
2. Abantu abane-prediabetes etholakele - njalo ngekota ngesikhathi sokulashwa, bese kuba njalo ngonyaka.
3. Kanye nesifo sikashukela - njalo ngekota.
4. Uma ukunxeshezelwa kwesifo sikashukela okuhlala isikhathi eside kutholakala, kanye ezinyangeni eziyisithupha.
5. Ngokukhulelwa, ukudlulisela ukuhlaziywa akunakwenzeka ngoba ukuqoqwa kwe-hemoglobin ye-glycosylated akugcini ngokuhambisana nezinguquko emzimbeni. Isifo sikashukela sokuzivocavoca sivame ukuqala ezinyangeni ezingama-4-7, ngakho-ke ukwanda kwe-GH kuzobonakala ngqo ekuzalweni kwengane, lapho ukwelashwa sekephuze kakhulu ukuqala.

Imvelo yeziguli ezinempilo ezinesifo sikashukela

Izinga le-hemoglobin elivezwe ushukela liyefana kubo bobabili ubulili. Izinga likashukela lenyuka kancane ngeminyaka: umkhawulo ophezulu ukhuphuka ngeminyaka yobudala kusuka ku-5.9 kuya ku-6.7 mmol / l. Ngenani lokuqala eligcinwe ngokuqinile, i-GG izoba ngu-5.2%. Uma ushukela ungu-6,7, i-hemoglobin yegazi izoba ngaphansi kancane kuka-6. Kunoma yikuphi, umuntu onempilo akufanele abe nomphumela ongaphezulu kuka-6%.

Ukususa kabusha ukuhlaziywa, kusetshenziswa imibandela elandelayo:

Imvamisa yesifo sikashukela iphakeme kancane kunabantu abaphilile. Lokhu kungenxa yengozi ye-hypoglycemia, ekhuphuka ngokuncipha kwengxenye ye-GH. Kuyingozi ebuchosheni futhi kungaholela ku-hypoglycemic coma. Kubantu abanesifo sikashukela abanesifo se-hypoglycemia esivamile noma esivame ukwehla ngokushesha kushukela, izinga le-glycosylated hemoglobin likhulu kakhulu.

Azikho izidingo eziqinile zabashukela asebekhulile. Izinkinga zesifo sikashukela esingamahlalakhona ziqongelela iminyaka edlule. Lapho isikhathi sokuvela kwezinkinga sidlula isikhathi ebesilindelwe sokuphila (isilinganiso sempilo), isifo sikashukela singalawulwa kancane kunasebancane.

Kubantu abasebasha, izinga eliqondiswe kwi-GH lingaphansi kakhulu, kufanele baphile impilo ende futhi bahlale bekhuthele futhi besebenza sonke isikhathi. Ushukela kulesi sigaba sabantu kufanele usondele ngangokunokwenzeka ngezindlela zabantu abaphilile.

Ukwehla okusheshayo kwe-hemoglobin ye-glycated kusuka kumanani aphakeme kakhulu (ngaphezu kwe-10%) kuya kwesejwayelekile kungaba yingozi kwi-retina, eye yavumelanisa iminyaka noshukela ophezulu. Ukuze kungonakalisi umbono, iziguli zinconywa ukuthi zinciphise kancane i-GH, 1% ngonyaka.

Umthelela wamazinga aphezulu we-GH emzimbeni

Uma izifo ezithinta ukuthembeka kokuhlaziywa zingafakwa eceleni, iphesenti elikhulu le-hemoglobin ye-glycated lisho ukuthi ushukela wegazi ophakeme noma ukujuluka kwaso ngezikhathi ezithile.

Izimbangela zokunyuka kwe-GH:

1. Isifo sikashukela mellitus: Izinhlobo 1, 2, LADA, gestational - imbangela evame kakhulu ye-hyperglycemia.
2. Izifo zeHormonal lapho kudedelwa khona ukukhipha ama-hormone aphazamisa ukungena kwe-glucose kwizicubu ngenxa yokuvinjwa kwe-insulin.
3. Ama-tumors ahlanganisa ama-hormone anjalo.
4. Izifo ezinkulu ze-pancreatic - ukuvuvukala okungapheli noma umdlavuza.

Esikhathini sikashukela i-mellitus, kunobudlelwano obucacile phakathi kwesilinganiso sokuphila esiphakathi nendawo kanye ne-hemoglobin ye-glycosylated. Esigulini esingabhemi eneminyaka engama-55 ubudala, esine-cholesterol ejwayelekile (<4) nengcindezi efanelekile (120/80), lobu budlelwano buzobukeka kanjena:

Ngokwale mininingwane, kuyacaca ukuthi i-glycated hemoglobin inyuke yaba ama-10% entshontsha isiguli okungenani unyaka wokuphila. Uma umuntu onesifo sikashukela ebhema futhi, engabheki ingcindezi futhi ehlukumeza amafutha ezilwane, impilo yakhe ifinyezwa iminyaka engama-7-8.

Ingozi yokwehlisa i-glycated hemoglobin

Izifo ezihambisana nokulahleka kwegazi okukhulu noma ukubhujiswa kwamangqamuzana abomvu egazi zinganikeza ukwehla okungamanga kwe-GH. Ukwehla kwangempela kungenzeka kuphela ngamazinga kashukela aqinile ngezansi kwe-hypoglycemia ejwayelekile noma evamile. Ukuhlaziywa kwe-GH nakho kubalulekile ekutholakaleni kwe-hypentlyogemia ye-latent. Ushukela ungahle uwele ephusheni, kusondele kakhulu ekuseni, noma isiguli singase singazizwa izimpawu zesici futhi ngenxa yalokho ungalinganisi ushukela ngalesi sikhathi.

Ku-mellitus yesifo sikashukela, ingxenye ye-GH incishiswa lapho umthamo womuthi ukhethwe ngokungafanele, ukudla okune-carb ephansi kanye nokuzivocavoca okukhulu komzimba. Ukuqeda i-hypoglycemia futhi wandise amaphesenti we-hemoglobin ye-glycated, udinga ukuxhumana nodokotela we-endocrinologist ukuze ulungise ukwelashwa.

Kubantu abangenaso isifo sikashukela, i-hemoglobin yegazi ephansi inganqunywa uma kwenzeka imalabsorption emathunjini, ukukhathala, izifo ezinzima zesibindi nezinso, ukubonakala kwezimila ezikhiqiza i-insulin (funda nge-insulin), notshwala.

Ukwehla kwe-GH kanye nezinga le-glucose eliphakathi

Izifundo zemitholampilo ziveze ubudlelwano phakathi kwenqanaba leshukela lansuku zonke kanye nemiphumela yokuhlaziywa kwe-GH. Ukunyuka okungu-1% engxenyeni ye-hemoglobin e-candied kungenxa yokwanda kwenani eliphakeme leshukela cishe nge-1.6 mmol / L noma i-28.8 mg / dl.

Isifinyezo Sokuhlaziya