Mob ntshav qab zib mellitus feem ntau tau nyaij nyob rau hauv daim ntawv latent thiab yog fraught nrog ntau cov teeb meem. Txhawm rau tiv thaiv pathology, nws yog ib qhov tsim nyog los yauv kev soj ntsuam ntawm qee qhov kev tshawb fawb. Txhawm rau txiav txim siab tsim nyog kev kuaj mob, koj yuav tsum sab laj nrog tus kws kho mob thiab nrhiav seb qhov ntsuas ntau npaum li cas rau cov cim ntsuas cov ntshav qab zib cov nqi.
Rau rau theem ntawm ntshav qab zib tau paub txog tshuaj. Cov kab mob muaj keeb yog pom raws li kev sib xyaw tshwj xeeb ntawm cov noob.
Txhua txhua cov cim ntawm tus kab mob ntawm thawj hom tau muab faib ua tshuaj tiv thaiv kab mob, caj ces thiab metabolic.
Kuaj ntshav Qab zib
Cov zej zog kev kho mob niaj hnub pom zoo kom kuaj ntshav qab zib hauv qee pawg neeg. Ua ntej tshaj plaws, nws yog qhov tsim nyog rau cov neeg uas tau nce mus txog 45 xyoos lossis ntau dua. Yog tias qhov txiaj ntsig tsis zoo, kev ntsuam xyuas yog nqa tawm txhua peb lub xyoos.
Cov neeg mob uas hnub nyoog yau yuav tsum ua cov txheej txheem nrog:
- thawj
- coj muaj keeb,
- haiv neeg lossis pawg neeg hauv ib pab pawg,
- mob ntshav qab zib gestational
- ntshav siab
- cov me nyuam yug hnyav dua 4.5 kg,
- siab glycemia ntawm lub plab khoob.
Txog kev soj ntsuam kev ua haujlwm nruab nrab thiab hauv nruab nrab, nws raug pom zoo los txiav txim siab txog qib piam thaj thiab hemoglobin A1c. Qhov no yog hemoglobin, qhov uas cov kua nplaum nyob hauv qab nrog cuam tshuam nrog hemoglobin molecule.
Glycosylated hemoglobin cuam tshuam nrog cov ntshav piam thaj. Nws ua raws li qhov taw qhia ntawm theem ntawm cov khoom noj metabolism hauv peb lub hlis ua ntej kev txheeb xyuas. Tus nqi ntawm HbA1c tsim yog nyob ntawm lub siab ntawm hyperglycemia. Kev kho kom yooj yim ntawm nws qib hauv cov ntshav tshwm sim 4-5 lub lis piam tom qab euglycemia.
Tus nqi ntawm HbA1c yog txiav txim siab yog tias nws yuav tsim nyog los tswj cov metabolism hauv kev ua kom yuag thiab paub meej tias nws cov nyiaj them rov qab rau cov neeg mob ntshav qab zib uas tau mob ntev.
Kev kuaj mob nta
Txhawm rau txhawm rau txheeb xyuas thiab ua tiav kev soj ntsuam ntawm tus kab mob pathology, koj yuav tsum dhau los ntawm ntau cov txheej txheem kuaj mob.
Ua ntej tshaj plaws, cov no yog cov ntawv tshawb pom nyob hauv cov laus, uas yog kawm txog ntshav qabzib los ntawm kev kuaj cov zis thiab ntshav, nrog rau kev sim rau ketones thiab ntshav qabzib kam kuaj.
Ib qho ntxiv, kev tshuaj ntsuam yog kwv rau:
- HbA1c;
- fructosamine;
- microalbumin;
- kev tso zis tso zis;
- lipid profile.
Muaj ib qho kev soj ntsuam ntxiv ntawm kev tshawb fawb txog ntshav qab zib, uas ua rau nws tuaj yeem tswj hwm kev txhim kho ntshav qab zib, cov lus txhais no:
- C peptide
- tshuaj tua kab mob insulin
- tshuaj tiv thaiv rau islets ntawm Langengars thiab tyrosine phosphatase,
- glutamic acid decarboxylase cov tshuaj tiv thaiv,
- ghrelin, raschistina, leptin, adiponectin,
- HLA ntaus ntawv.
Txhawm rau txiav txim siab pathology rau ob peb xyoo lawm, cov kws kho mob pom zoo ua ib qho kev soj ntsuam ntawm cov piam thaj sai. Nyob rau hauv xyoo tas los no, nws tau pom tias muaj kev sib txuam ntau dua ntawm cov ntshav qab zib cov ntshav, kev muaj peev xwm ntawm cov vascular uas twb muaj lawm thiab lawv qib kev loj hlob; nws tsis yog kuaj pom nrog qhov ntsuas ntawm cov piam thaj sai, tab sis nrog rau qib ntawm nws nce tom qab noj mov. Qhov no yog hu ua postprandial hyperglycemia.
Txhua tus ntaus cim ntawm ntshav qab zib hom 1 tuaj yeem faib raws li hauv qab no:
- caj ces
- tshuaj tiv thaiv kab mob
- metabolic.
HLA ntaus ntawv
Mob ntshav qab zib mellitus, raws li lub tswv yim ntawm cov tshuaj niaj hnub, muaj qhov pib mob hnyav, tab sis lub sijhawm ntev mus ntev. Rau rau qib paub hauv kev tsim cov kab mob no. Thawj thawj ntawm cov no yog theem ntawm kev mob tshwm sim los yog tsis muaj caj ces cuam tshuam nrog ntshav qab zib hom 1.
Nws yog tsim nyog taw qhia tias qhov muaj ntawm HLA antigens, tshwj xeeb tshaj yog chav thib ob: DR 3, DR 4, DQ, yog qhov tseem ceeb. Txoj kev pheej hmoo ntawm pathology tsim nyob rau hauv cov ntaub ntawv no nce ntau zaus. Tam sim no, cov kab mob muaj keeb tiv thaiv kab mob rau qhov pom ntawm ntau yam ntawm thawj hom mob yog suav tias yog kev sib txuam ntawm ob peb lub cev ntawm cov neeg ib txwm muaj.
Cov cim ntaus cim tshaj plaws rau hom 1 yog HLA antigens. Tus cwj pwm haplotypes uas yog yam ntxwv ntawm tus kabmob ntshav qab zib hom 1 pom nyob hauv 77% ntawm cov neeg mob ntshav qab zib. 6: muaj haplotypes uas pom tau tias tiv thaiv.
Tshuaj tua kab mob rau Langerhans Islet Cell
Vim kev tsim cov khoom ntawm autoantibodies rau lub hlwb ntawm cov islets ntawm Langerhans, tom kawg raug rhuav tshem, uas ua rau cov tshuaj tiv thaiv insulin tsis meej thiab ua kom pom cov duab ntawm cov ntshav qab zib hom 1.
Xws li cov tshuab yuav raug txiav txim caj los sis tshwm sim vim los ntawm ntau yam.
Ntawm cov feem ntau muaj:
- kab mob kis
- kev txiav txim ntawm cov khoom lom
- ntau yam kev ntxhov siab.
Thawj hom mob yog pom los ntawm theem ntawm kev mob ntshav qab zib uas tsis muaj tsos mob, nws tuaj yeem kav mus ntau xyoo. Qhov kev ua kom sib xyaw thiab tso pa tawm ntawm cov kua dej hauv lub sijhawm no tsuas yog tuaj yeem pom los ntawm kev kawm txog cov kua nplaum nyob nruab nrab.
Hauv kev siv tshuaj, muaj mob ntawm kev kuaj pom ntawm cov tshuaj tiv thaiv xws li yim lossis ntau xyoo ua ntej qhov pib ntawm kev siv duab hauv chaw kuaj mob. Lub ntsiab lus ntawm cov tshuaj tiv thaiv kab mob yuav tsum tau siv los ua kev kuaj mob thaum ntxov ntawm hom 1 ntshav qab zib.
Hauv cov neeg muaj cov tshuaj tiv thaiv zoo li no, islet cell ua haujlwm poob qis, uas yog pom los ntawm kev ua txhaum ntawm cov tshuaj insulin zais cia. Yog hais tias lub sij hawm ua tiav pov tseg, tom qab ntawv soj ntsuam symptomatology ntawm ntshav qab zib ntawm ntau yam no tshwm sim.
Ntau cov kev tshawb fawb qhia pom tias cov tshuaj tiv thaiv kab mob muaj nyob rau hauv 70% ntawm cov neeg teb nrog tus mob ntshav qab zib hom 1 tshiab. Hauv kev tswj hwm cov tsis mob ntshav qab zib pawg tsuas muaj 0.1-0.5% ntawm kev kuaj pom ntawm cov tshuaj tiv thaiv.
Cov tshuaj tiv thaiv kab mob no tseem tuaj yeem nrhiav pom hauv cov txheeb ze ntawm tus mob ntshav qab zib. Cov pab pawg ntawm cov neeg no muaj lub siab nrog qhov tshwm sim. Ntau cov kev tshawb fawb qhia pom tias cov txheeb ze uas muaj cov tshuaj tiv thaiv kab mob ntshav qab zib hom 1 nyob rau sijhawm.
Cov cim ntawm qee hom mob ntshav qab zib hom 2 mob ntshav qab zib kuj tseem suav nrog qhov kev kawm no. Cov kws tshawb fawb tau ua pov thawj tias kev txiav txim siab theem ntawm cov tshuaj tiv thaiv kab mob hauv ntshav qab zib nrog hom mob thib ob pab kom pom tseeb nws txawm tias ua ntej cov duab hauv chaw kho mob tshwm sim, thiab pab txhawb kev teeb tsa cov tshuaj tiv thaiv kab mob insulin. Yog li, nyob rau hauv cov neeg mob ntshav qab zib nrog hom mob thib ob, nws muaj peev xwm twv seb kev tsim cov kev vam khom ntxiv ntawm cov tshuaj insulin.
Tshuaj tua kab mob rau cov tshuaj insulin muaj nyob hauv kwv yees li 40% ntawm cov neeg muaj ntshav qab zib hom 1. Muaj kev xav hais txog kev sib txheeb ntawm cov tshuaj tiv thaiv rau cov tshuaj insulin thiab cov tshuaj tiv thaiv rau islet cells.
Lub qub yuav nyob rau theem ntawm kev mob ntshav qab zib thiab nrog rau qhov pib ntawm cov tsos mob ntawm tus mob ntshav qab zib hom 1.
Glutamic acid decarboxylase
Tsis ntev los no, cov kws tshawb fawb tau txheeb xyuas lub ntsiab antigen, uas yog lub hom phiaj rau autoantibodies uas cuam tshuam nrog kev tsim cov tshuaj insulin-tiv thaiv mob ntshav qab zib. Nws yog decarboxylase ntawm glutamic acid.
Cov kua qaub no yog ib qho enzyme membrane uas biosynthesizes tus neurotransmitter CNS-gamma-aminobutyric acid. Qhov enzyme tau pom thawj zaug hauv cov neeg muaj teeb meem ntawm lub paj hlwb poob siab.
Tshuaj tua kab mob rau GAD yog qhov kev ntaus cim tshaj plaws rau kev txheeb xyuas lub xeev cov mob ntshav qab zib. Yog li, nws muaj peev xwm txheeb xyuas qhov kev pheej hmoo siab ntawm kev muaj ntshav qab zib hom 1. Nrog cov asymptomatic tsim ntawm tus kab mob no, cov tshuaj tiv thaiv mus rau GAD tuaj yeem kuaj pom hauv tib neeg xya xyoo ua ntej qhov pom ntawm tus kab mob.
Cov neeg ntseeg siab tshaj plaws thiab cov ncauj lus ntawm cov kws tshawb fawb tau suav hais tias yog kev tsom xam ua ib txhij ntsuas ntawm ntau lub cim hauv cov ntshav. 1 tus cim sawv cev rau 20% ntawm cov ntaub ntawv, ob lub cim taw qhia 44% ntawm cov ntaub ntawv, thiab peb tus cim sawv cev 95% ntawm cov ntaub ntawv.
Cov Cim Ntshav Qab Zib Autoimmune
Hauv cov ntshav qab zib, qhov profile ntawm autoantibodies yog nyob ntawm poj niam txiv neej thiab hnub nyoog. Cov tshuaj tua kab mob ua rau antigens thiab tshuaj tiv thaiv rau islet cells, raws li txoj cai, yog nyob hauv cov menyuam yaus dua li cov neeg laus. Cov tshuaj tua kab mob rau glutamic acid decarboxylase, feem ntau, pom hauv cov poj niam.
Qhov kev xav ua ntej rau kev tsim ntawm qee tus neeg ntawm autoantibodies feem ntau yuav txiav txim siab los ntawm cov caj ces sib txawv ntawm HLA, vim hais tias autoantibodies rau insulin, islet hlwb thiab islet antigen 2 feem ntau pom muaj nyob rau hauv cov neeg uas muaj HLA - DR 4 / DQ 8 (DQA 1 * 0301 / DQB 1 * 0302). Nyob rau tib lub sijhawm, tshuaj tiv thaiv rau glutamic acid decarboxylase muaj nyob hauv cov neeg muaj HLA genotypes - DR 3 DQ 2 (DQA 1 * 0501 / DQB 1 * 0201).
Ntau hom kab mob autoantibodies feem ntau muaj rau cov neeg mob ntshav qab zib, thaum cov neeg muaj tus mob ntshav qab zib ua lub cev muaj ntshav qab zib muaj tsuas yog ib hom mob autoantibody.
Cov tshuaj tua kab mob rau glutamic acid decarboxylase yog ntawm cov neeg mob ntshav qab zib nrog thawj hom pathology, tab sis kuj tseem muaj tus mob siab rau cov neeg uas muaj phenotypes ntawm yam thib ob ntawm tus kab mob.
Kev txiav txim siab ntawm cov tshuaj tiv thaiv kab mob no ua rau nws muaj peev xwm txheeb xyuas ntau qhov xwm txheej ntawm autoimmunity, yog tias qhov no tsuas yog cim rau cov neeg laus.
Kev tsom xam nqi
Cov neeg uas xav tias muaj ntshav qab zib feem ntau txaus siab nyob rau hauv ntau npaum li cas cov kev ntsuas mob ntshav qab zib npiav cim cov nqi. Muaj qee qhov profiles uas qhia los ntawm tus naj npawb ntawm kev tshuaj ntsuam.
Kev ntsuam xyuas dav dav hu ua "tswj ntshav qab zib" suav nrog kev kuaj ntshav qab zib thiab creatinine.
Tsis tas li, cov profile muaj:
- tsom xam hemoglobin,
- triglycerides
- tag nrho cov roj (cholesterol)
- Roj HDL,
- LDL cov roj cholesterol,
- tso zis albumin
- homocestein,
- Reberg xeem,
- piam thaj hauv cov zis.
Tus nqi ntawm xws li cov kev tsom xam muaj kwv yees li 5 txhiab rubles.
Kev soj ntsuam suav nrog:
- ntshav qabzib tsom
- glycated hemoglobin.
Tus nqi tshuaj ntsuam yog kwv yees li 900 rubles.
Cov kab cim autoimmune:
- cov tshuaj tiv thaiv rau cov tshuaj insulin
- tshuaj tiv thaiv kom tus kabmob tyrosine phosphatase.
- glutamate decarboxylase cov tshuaj tiv thaiv,
- tshuaj tiv thaiv kom tus kabmob tyrosine phosphatase.
Qhov kev tshawb xyuas no yuav raug nqi txog li 4 txhiab rubles.
Qhov kev kuaj ntshav ntawm cov tshuaj insulin yuav raug nqi li 450 rubles, kev kuaj C-peptide yuav raug nqi 350 rubles.
Kev kuaj mob thaum cev xeeb tub
Kev kuaj ntshav qab zib yog kuaj hauv plab tas. Kev ntshai yuav tshwm sim los ntawm qhov taw qhia ntawm 4.8 mmol / los ntawm tus ntiv tes thiab 5.3 - 6.9 mmol / l los ntawm cov leeg ntshav. Ua ntej xeem ntsuas, tus poj niam yuav tsum tsis txhob noj zaub mov ntev li 10 teev.
Thaum xeeb tus me nyuam hauv plab, kuaj ntshav qabzib tuaj yeem ua. Rau qhov no, tus poj niam haus 75 g ntawm cov piam thaj hauv ib khob dej. Tom qab 2 teev, kuaj ntshav rov ua dua. Ua ntej kev txheeb xyuas, koj tsis tas yuav txwv koj tus kheej hauv kev noj haus. Cov khoom noj yuav tsum paub txog.
Yog tias pom cov tsos mob ntshav qab zib, koj yuav tsum tsis txhob laug sib tham nrog koj tus kws kho mob. Txheeb xyuas tus kab mob thaum ntxov yuav pab tau tiv thaiv tus mob thiab kev loj hlob ntawm lub neej muaj teeb meem. Cov txiaj ntsig kev tshawb fawb yuav tsum yog qhov tseeb, rau qhov no koj yuav tsum ua raws txhua txoj cai ntawm kev npaj rau kev tsom xam.
Yuav kuaj ntshav qab zib tau li cas? Tus kws tshaj lij yuav qhia hauv cov yeeb yaj kiab hauv tsab xov xwm no.
