Ngaphansi kwegama elithi "isifo sikashukela" kufihla izifo ezimbalwa ezifanayo. Izizathu zecebo labo lokuthuthuka nokwelashwa zihlukile ngokuyisisekelo. Izinga lempilo lesiguli lincike kakhulu ekutholakaleni okuyilo, ngakho-ke, ukuhlukaniswa kwesifo sikashukela kubuyekezwe kaningi futhi kwaba yinkimbinkimbi. Ezinhlotsheni ezaziwa kudala 1 no 2, manje kunezelwa amafomu angaphezu kweshumi nambili, lapho ngamunye kunqunywa khona ukwelashwa okulungile.
Manje bangaphezu kwezigidi ezingama-400 abantu abahlaselwa yisifo sikashukela, ngakho-ke izinkinga zokuhlukaniswa kwezifo, ukuxilongwa kusenesikhathi, kanye nokukhethwa kwendlela yokwelashwa ephumelela kakhulu kube ngenye yezinto ezibaluleke kakhulu kwezokwelapha emhlabeni.
Izinhlobo ezivame kakhulu zesifo sikashukela
Kuzo zonke izinhlobo zesifo sikashukela, thayipha i-1 account cishe cishe i-7% yazo zonke izifo zesifo. Isizathu sokwanda koshukela ukubhujiswa kwamaseli e-beta akhiwe kumanyikwe. Lesi sifo siqhubeka ngokushesha, ekugcineni, ukukhiqizwa kwe-insulin yesiguli kuyeka ngokuphelele. Ushukela wegazi uqala ukukhula lapho kungabikho ngaphezu kwama-20% amangqamuzana asele. Le ndlela yesifo sikashukela ibhekwa njengesifo sentsha, njengoba ikhula kakhulu ezinganeni nasebusheni ngesikhathi sokukhula nokuvuthwa okusheshayo. Ngenxa yokuvama kwesifo, ifa alilandelwa kahle. Iziguli azinazo izimpawu zangaphandle umuntu angasola ngazo ukuthambekela kokuthayipha isifo sikashukela esingu-1.
Manje kukhona izivivinyo ezikhethekile lapho ungathola khona ukuthambekela kofuzo kulolu hlobo lwesifo sikashukela. Kuhlotshaniswa nohlobo oluthile lohlelo lwe-HLA - antigen leukocyte antigen. Ngeshwa, lezi zivivinyo azitholanga uhlelo olusebenzayo, ngoba ngisho nokwazi ukuba khona kwezakhi zofuzo eziyingozi, ososayensi namanje abakwazi ukukuvimba ukubhujiswa kweseli.
Isifo sohlobo 1 sivame ukuhlukaniswa ngama-subtypes ama-2: i-autoimmune ne-idiopathic:
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%
- Isifo Sikashukela se-Autoimmune kuvusa ukungatheleleki komuntu. Ngesikhathi sokubhujiswa kwamangqamuzana nezinyanga eziyisithupha ngemuva kokuqedwa ngokuphelele kokuhlanganiswa kwe-insulin, ama-autoantibodies atholakala egazini asebenza ngokumelene namaseli omzimba wawo. Njengomthetho, ukungavikeleki okunganele kubangelwa yizici zangaphandle. Njengamanje, ezinye zazo sezikhonjwa: inkukhu, isimungumungwane, ingxenye yama-enterovirus, ukutheleleka kweCMV, ezinganeni ezingaphansi konyaka owodwa ubudala - ubisi lwenkomo.
- Isifo sikashukela se-Idiopathic kuvame kakhulu kubamele izinhlanga ze-Asia ne-Negroid. Isimo somtholampilo ezigulini siyefana: Amaseli e-pancreatic nawo ewohloka ngokushesha, ushukela uyakhula, i-insulin iyancipha, kepha amasosha omzimba awatholakali.
Iningi labanesifo sikashukela (ngokusho kokulinganisa okuhlukahlukene kusuka kuma-85 kuye kwangama-95%), kutholakala ukuthi banesifo sikashukela sohlobo 2. Ukuthuthuka kwalesi sifo kuncike nakwifa, futhi kulula ukulandelela: iziguli eziningi zinezihlobo ezisondelene ezinesifo sikashukela. Isici esizuzwe njengefa sikholelwa ukuthi kuwukuthambekela kwezicubu zokulahlekelwa umuzwa we-insulin. Kodwa-ke, izinhlobo ezithile ezibhekene nokuqagelwa kwalolu hlobo sikashukela azikasungulwa.
Izici zangaphandle zibaluleke kakhulu: ubudala (imvamisa bangaphezulu kwama-40), ukukhuluphala, ukuhamba kabi, ukungondleki kahle. Ukufaka ushukela ezicutshini kunzima. Amaseli we-pancreatic ngaphansi kwezimo ezinjalo ayaphoqelelwa ukuba alondoloze ukukhiqizwa kwe-insulin ngezinga eliphakeme njalo. Uma zingaphumeleli, i-glycemia iyanda. Ngokuhamba kwesikhathi, ukukhiqizwa kwe-insulin kuqala ukugcwala, khona-ke ivolumu yokuqalwa kwayo incipha futhi inciphe.
Izinga lokubhujiswa kwamaseli we-beta ngohlobo 2 sikashukela umuntu ngamunye: ezinye iziguli sezivele ziphoqelekile iminyaka eyishumi ukuba zifake insulin, kanti ezinye zikhiqiza i-insulin yazo yonke impilo yazo. Ekuhlukanisweni kwesifo sohlobo 2, lesi simo sabonakaliswa: isifo sikashukela esine-predominance ye-insulin ukumelana noma ne-predominance yokukhubazeka kwe-insulin.
Ukuhlukaniswa okwamukelwa eRussia
Kusukela ngo-1999, umuthi waseRussia ubelokhu usebenzisa ukuhlukaniswa kwezifo okwamukelwa emhlabeni wonke. Amakhodi avela kulokhu kufakwa afakwe kumarekhodi wezokwelapha, ikhefu lokugula, asetshenziswa kumadokhumenti wokubala, ukubikwa kwezibalo. Manje inguqulo yeshumi yokuhlukaniswa iyasebenza - ICD-10. Inamakhodi ayi-6 esifo sikashukela:
- I-E10 inikezwa iziguli ezinesifo sikashukela esincike ku-insulin, okungukuthi, labo, ngenxa yezizathu zezempilo, kufanele bajobe i-insulin. Esebenza, lesi sigaba sifaka uhlobo lweshukela sikashukela.
- I-E11 iyikhodi yesifo sikashukela esinga-insulin, okungukuthi, izinhlobo ezi-2. Noma isiguli sinokugula isikhathi eside, ukwakheka kwe-insulin kuncane, futhi ithola i-insulin ngomjovo, ikhodi yesifo ayishintshiwe.
- I-E12 - lesi sigaba kufanele sabelwe iziguli lapho isifo sikashukela sibangelwa wukudla okungenampilo. Ukuxhumana phakathi kokungondleki kanye noshukela okwamanje kuyangabaza, ngakho-ke le khodi ayisebenzi.
- I-E13 - ezinye izindlela zesifo sikashukela, izinhlobo ezingaziwa ze-Mody zidluliselwa kukhodi.
- I-E14 - isifo sikashukela, uhlobo lwayo olungachazwanga. Ikhodi isetshenziswa lapho uhlobo lokugula lusakungabaza, futhi ukwelashwa kufanele kuqale ngokushesha.
- I-O24 yisifo esakhula ngesikhathi sokukhulelwa (isifo sikashukela sokukhulelwa). Kungokwesigaba esehlukile, kusukela ngemuva kokuzalwa ushukela kuvamile.
Ukuphazamiseka okuncane kwe-metabolic okungakatholakali ngenxa yesifo sikashukela kubhalwe njengo-R73.
Lokhu kuhlukaniswa kwesifo sikashukela kwaqala ukusetshenziswa emhlabeni ngonyaka we-1994. Kuze kube manje, iphelelwe yisikhathi kakhulu. Lesi sifo siveze izinhlobo ezintsha, sekukhona nezindlela zesimanje zokuxilonga. Manje i-WHO isebenza ekuhlukanisweni okusha kwe-ICD-11, ukuguqukela kuyo kulindelwe ngo-2022. Okungenzeka ukuthi, ikhodi yesifo sikashukela izovuselelwa. Amagama athi "kuncike kwe-insulin" kanye "nokuzivikela kwe-insulin" nawo azokhishwa.
Ukuhlukaniswa kwe-WHO
Ukuhlukaniswa okuhambelana kakhulu manje ngokusho kwe-WHO 2017. Yadalwa ngo-1999, ngemuva kwalokho yavuselelwa kaninginingi.
| Thayipha | I-Subtypes |
| 1 | I-Autoimmune (noma i-immuno-mediated). |
| I-Idiopathic. | |
| 2 | Ngokuphikisana ne-insulin ephezulu. |
| Nge-predominance ye-insulin synthesis. | |
| Ezinye izinhlobo ezithile zihlukaniswa imbangela yesifo sikashukela. | Ukulimala kwe-Gene okuholela ekungangeni kahle kwe-insulin synthesis. Lokhu kufaka ama-subtypes e-Mody 1-6. |
| Ukulimala kwe-Gene okuholela ekuphazamisweni kwe-insulin: disendocrinism, Rabson-Mendenhall, ama-syndromes e-Seip-Lawrence, ama-A-Type insulin, njll. | |
| Izifo ze-pancreatic: ukuvuvukala, ama-neoplasms, usizi, i-cystic fibrosis, njll. | |
| Izifo ze-Endocrine. | |
| Izinto zokwelapha, ikakhulukazi ama-hormone. | |
| Ukutheleleka: i-cytomegalovirus, i-rubella kusanda kuzalwa. | |
| Ama-pathologies ezinhlobo zezakhi zofuzo ezivame ukuhlanganiswa nesifo sikashukela: Ama-syndromes ama-Down and Turner, i-porphyria, njll. | |
| Isifo sikashukela sokutholwa kwesisu | Ukuhlukaniswa kuma-subtypes akunikezwanga. |
Kulesi sigaba, isifo sikashukela asiphathwa njengesifo esehlukile, kepha njengesifo. Ushukela omningi uthathwa njengenye yokuboniswa kwanoma iyiphi i-pathology emzimbeni, okuholele ekuphulweni kokukhiqizwa noma isenzo se-insulin. Izizathu zifaka inqubo ye-autoimmune, ukumelana ne-insulin, izifo ze-pancreatic, ukusilela kofuzo.
Ososayensi bakholelwa ukuthi ukuhlukaniswa kwesimanje kuzoshintsha ngaphezu kwesisodwa. Ngokunokwenzeka, indlela yohlobo 2 lwesifo sikashukela iyaguqulwa. Kuzobhekwa kakhulu izimbangela ezinjengokukhuluphala kanye nendlela yokuphila. Ukuhlukaniswa kwesifo sikashukela sohlobo 1 nakho kuzoshintsha. Ngendlela efanayo lapho kubalwa izakhi zofuzo ezibhekene nezinhlobo zeMody 1-6, kuzobhekwa zonke iziphambeko zofuzo ezibhekene nohlobo 1 lwesifo. Ngenxa yalokho, i-idiopathic subtype yesifo sikashukela izonyamalala.
Okunye ukuhlukaniswa
Isifo sikashukela sohlobo 2 siphinde sihlukaniswe ngamadigri ngokushuba kwempilo yalesi sifo:
| Degree ye | Isimo sokugeleza | Incazelo |
| Mina | Easy | Ushukela wokuzila awudluli ku-8, phakathi nosuku ukushintshashintsha kuncane, akukho shukela emchameni noma kukhona ngamanani amancane. Ukulungisa i-glycemia ngokwejwayelekile, ukudla kwanele. Izinkinga zitholakala kwifomu elincane ngesikhathi sokuhlolwa. |
| II | Ibanga eliphakathi | Ukwenza ushukela osheshayo kuhlu lwe-8-14, ngemuva kokudla i-glycemia kukhula ngokuqinile. Emchameni, kutholakala ushukela, i-ketoacidosis kungenzeka. Izinkinga ziya ngokuthuthuka. Ukulungisa ushukela ngokwejwayelekile, kudingeka amaphilisi e-hypoglycemic noma i-insulin edigini lama-unit angama-40. ngosuku. |
| I-III | Isindayo | Ukusheshisa ushukela wegazi okungaphezulu kwe-14, emchameni - ngaphezu kwama-40 g / l. Izidakamizwa zomlomo azanele, kudingeka amayunithi angaphezu kwangama-60. insulin ngosuku. |
Ukuhlukaniswa kwesigaba sesinxephezelo sikashukela kusetshenziselwa ukuhlola impumelelo yokwelashwa. Indlela elula kunazo zonke yokwenza lokhu ukusebenzisa i-glycated hemoglobin (HG) test, ekuvumela ukuthi ubone lonke ushintsho kushukela ngaphezulu kwezinyanga ezi-3.
| Ibanga lesinxephezelo | Izinga le-GG | Incazelo |
| isinxephezelo | ngaphansi kuka-6.5 | Isiguli sizizwa kahle, singahola impilo yomuntu ophilile. |
| ukukhokha okuncane | 6,5-7,5 | Ngesikhathi sokuqunjelwa ushukela, impilo yomuntu iya ngokuya iba nzima, umzimba uthinteka ezifweni, kepha akukho ketoacidosis. |
| ukuncipha | ngaphezu kwe-7.5 | Ubuthakathaka obuhlala buhlala, ingozi enkulu ye-ketoacidosis, ukuguquguquka okungazelelwe koshukela, ukukhohlisa kwesifo sikashukela kungenzeka. |
Isikhathi eside lapho kungenzeka ukugcina isifo sikashukela esigabeni sesinxephezelo, mancane amathuba okuthi kube nezinkinga ezintsha kanye nokuqhubeka kwalokhu okukhona. Isibonelo, ngohlobo oluhlanganisiwe 1, ubungozi be-retinopathy buncane ngama-65%, i-neuropathy ngama-60%. Ubudlelwano obuqondile phakathi kwesinxephezelo kanye nezinkinga butholakala ku-75% wabashukela. Cishe i-20% yalabo abanenhlanhla akuvamile ukuthola izinkinga nganoma yisiphi i-glycemia, odokotela bathi lokhu kubangelwa izakhi zofuzo. E-5% yeziguli, izinkinga ziba khona ngisho nangoshukela onxephezelwe.
Izimo eziphakathi
Phakathi kwesimo esejwayelekile se-carbohydrate metabolism kanye nohlobo 2 sikashukela, kunesimo esithile esiphakathi, esivame ukubizwa ngokuthi yi-prediabetes. Isifo sikashukela yisifo esingalapheki esingalapheki ngokuphelele. Isifo sikashukela siyisimo esiguqukayo. Uma uqala ukwelashwa kulesi sigaba, ezimeni eziphakathi, isifo sikashukela singavinjelwa. Amazwe aphakathi kwe-WHO afaka:
- Ukubekezelelwa kwe-glucose okhubazekile. I-NTG itholakala uma ushukela udonswa kancane yisiguli kunowomuntu ophilile. Ukuhlaziywa kokulawula kwalesi simo ukuhlolwa kokubekezelela ushukela.
- Ukusheshisa i-glycemia. Nge-NGN, ushukela ekuseni uzoba ngaphezulu kwamanani ajwayelekile, kepha ngaphansi komngcele okuvumela ukuthi uxilonge isifo sikashukela. I-NTG ingatholwa kusetshenziswa isivivinyo sokuzila ushukela esivamile.
Lokhu kuphazamiseka akunazimpawu, ukuxilongwa kwenziwa ngemiphumela yokuhlolwa ushukela kuphela. Kuhlolwa kunconyelwa abantu abasengozini enkulu yesifo sohlobo 2. Izici zobungozi zibandakanya ukukhuluphala, ifa elibi, ukuguga, umfutho wegazi ophakeme, umsebenzi ophansi wezimoto, ukudla okungenakulinganiswa ngokweqile okunama-carbohydrate namafutha.
Izindlela zokuhlonza isifo sikashukela
I-WHO yatusa izindlela zokuthola isifo sikashukela:
- Izimpawu ezejwayelekile: ukuchama ngokushesha, ukoma, ukutheleleka njalo, i-ketoacidosis + nokuhlolwa okukodwa koshukela ngaphezulu komngcele wesifo sikashukela. Umngcele manje wamukelwe: ushukela wokuzila ungaphezulu kwe-7; ngemuva kokudla ngaphezulu kwe-11.1 mmol / L.
- Izimpawu azikho, kepha kunedatha evela ezihlolweni ezimbili ngaphezulu kokujwayelekile, ezithathwa ngezikhathi ezihlukile.
Imvamisa kumuntu ophilile yimiphumela yokuhlaziywa ku-6.1 esiswini esingenalutho, kuye ku-7.8 ngemuva kokudla. Uma idatha etholakele ingaphezulu kokujwayelekile, kepha ngaphansi komngcele kashukela, isiguli sitholakala sine-prediabetes. Uma ushukela waqala ukukhula kusukela ku-2nd trimester yokukhulelwa futhi ibanga kusuka ku-6.1 kuya ku-7 esiswini esingenalutho, ngaphezulu kwe-10 ngemuva kokudla, kutholakala isifo sikashukela sokukhulelwa.
Umahluko wezinhlobo 1 no-2, kwethulwa imibandela eyengeziwe:
| Ukuhlwaya | Thayipha | |
| 1 | 2 | |
| I-insulin ne-c-peptide | Ngezansi kwesimo, kunenkambiso yokwehla okuqhubekayo. | Okujwayelekile noma ngaphezulu kokujwayelekile. |
| Ama-Autoantibodies | Kukhona egazini abangama-80-90% eziguli. | Abekho. |
| Ukuphendula izidakamizwa ze-hypoglycemic zomlomo | Ayisebenzi. | Banciphisa ushukela kahle, inqobo nje uma kungekho ketoacidosis. |
Kwezinye izimo, lezi zindlela azanele, futhi odokotela kufanele bazigoqe izingqondo zabo ngaphambi kokuxilongwa okuyikho futhi banikeze nokwelashwa okufanele. Isifo sikashukela saziwa ngokwanda kwezigameko njalo nje. Lo mkhuba ubonakale ikakhulukazi eminyakeni engama-20 eyedlule. Ngaphezu kwalokho, ukuhlukaniswa kohlobo lwesifo sikashukela kuya ngokuya kuba nzima.
Phambilini bekukholelwa ngokuzenzakalelayo ukuthi abantu abasha bangaba nohlobo lwesifo olu-1 kuphela, kanye nabantu abadala ngemuva kohlobo lwe-40 - 2. Manje ukwakheka kwezigameko sekushintshe kakhulu. Iziguli eziningi ezinoshukela omningi kusuka eminyakeni engama-20 kuye kwengama-40 zinezimpawu zohlobo 2. Isibonelo, e-United States eminyakeni engu-8 eyedlule kuleli qembu leminyaka baqala ukuthola uhlobo lwe-2 ngo-21% kaningi. Kunezimo zokwenza lokhu kutholwa ezinganeni. Umkhuba ofanayo ubonakala kuwo wonke amazwe athuthukile, okungukuthi, kukhona ukuvuselelwa okusobala kwe-mellitus yesifo sikashukela.
Izingane nentsha zibonakaliswa ngentuthuko esheshayo yesifo sikashukela. Kubantu abadala, phakathi kokuqala kwe-NTG nokuqala kwesifo sikashukela, isilinganiso seminyaka eyi-10 siyadlula, kubantu abasha cishe ngo-2,5. Ngaphezu kwalokho, i-20% inezindlela ezixubile zesifo sikashukela, ngoba isifo sazo sikhula kancane, kepha kungenzeka ukuthola ama-autoantibodies asezindaweni zohlobo 1 egazini.
Uhlobo lwesifo sikashukela esingu-1 “olumsulwa”, kunalokho, sesimdala. Phambilini, yambulwa yaze yaba yiminyaka engama-35 kuya kwengama-40. Manje kunamacala okuxilonga aze afike eminyakeni engama-50. Isibonakaliso esisobala njengokukhuluphala asikukhuthazi ukuzimisela kohlobo. Phambilini, ngokuba khona noma ukungabikhona kwayo, bekuyinto ebekwazi ukuthola uhlobo lwesifo sikashukela ngokunemba okuphezulu. Manje ukukhuluphala ngokweqile kubantu kuvame kakhulu, ngakho-ke odokotela banaka kuphela ukungabikho kokukhuluphala: uma isisindo sisesimweni esijwayelekile, uhlobo lwesifo sikashukela lwesibili lubizwa ngokuthi umbuzo.
Izinkinga ezijwayelekile
Imbangela enkulu yezinkinga izinqubo ze-glycation ezenzeka kwezicubu lapho zihlangana noshukela wegazi ophezulu. Amaprotheni aboshelwe ngokuqinile ku-molecule ye-glucose; ngenxa yalokho, amaseli awakwazi ukwenza imisebenzi yawo. Izindonga zemithambo yegazi ezixhumana ngqo noshukela zitholakala kalula ku-glycation. Kulokhu, umuntu onesifo sikashukela uhlakulela ama-angiopathies amabanga ahlukahlukene.
Ukuphazamiseka emikhunjini emikhulu enesifo sikashukela kusongela ngezifo zenhliziyo. Ama-Microangiopathies aholela ekwephulweni kokuhlinzekwa kwegazi kwizicubu ezikude nenhliziyo, imvamisa izinyawo zesiguli zihlupheka. Ziphinda zithinte nesimo sezinso, ezihlunga ushukela egazini umzuzu nomzuzu futhi zithambekele ekuwukhipheni umchamo.
Ngenxa ye-glycation ye-hemoglobin, ukulethwa kwe-oksijini kwezicubu kuyaphazamiseka. Ezimweni ezinzima kakhulu, aze afike ku-20% we-hemoglobin eyeka ukusebenza. Ushukela omningi ngesimo se-sorbitol ufakwa emangqamuzaneni, ngenxa yokuthi ingcindezi ye-osmotic ishintsha kuwo, izicubu ziyavuvukala. Ukuqunjelwa kwe-sorbitol kwezicubu zezinzwa, i-retina kanye namalensi kuyingozi ikakhulukazi.
