Mob ntshav qab zib insipidus yog dab tsi? Ua ntej ntawm tag nrho cov, qhov no yog kab mob endocrinological, qhov tseem ceeb ntawm kev uas muaj nqhis dej tsis tu ncua thiab tso zis heev dhau lawm.
Tshwm sim feem ntau hauv cov tub ntxhais hluas 25-30 xyoo, tab sis tuaj yeem tshwm sim thaum muaj hnub nyoog li cas, suav txij thaum yug los.
Hom mob ntshav qab zib insipidus thiab ua rau
Qhov tseem ceeb ua rau cov ntshav qab zib insipidus yog qhov tsis muaj cov tshuaj tiv thaiv kab mob ua kom tsis haum tshuaj (ADH lossis vasopressin), txoj haujlwm tseem ceeb uas yuav tsum tau khi rau lub raum tubular cell receptors thiab ua kom rov qab nqus tau cov kua los ntawm thawj cov zis. Vasopressin yog tsim nyob rau hauv hypothalamus ntawm lub paj hlwb, los ntawm qhov chaw uas nws nkag mus rau hauv cov hlab ntshav los ntawm hypothalamic-pituitary system.
Yog li, qhov kev ua txhaum ntawm ADH tuaj yeem tshwm sim nyob rau theem ntawm lub hlwb (nws cov khoom tsis txaus lossis ib qho kev txwv tsis pub nkag mus rau cov ntshav ntshav), lossis nyob rau theem ntawm lub raum (ua tiav lossis ib feem ntawm kev tiv thaiv ntawm lub raum.
Hauv kev hais txog, cov ntawv hauv qab no cov ntshav qab zib insulin raug cais tshwj xeeb:
1. Cov kab mob ntshav qab zib feem ntau insipidus
Tej zaum yuav tshwm sim rau cov xwm txheej hauv qab no:
- Volumetric formations ntawm hypothalamus lossis pituitary caj pas;
- Cov kab mob hauv cov qauv no;
- Tus mob viral thiab kab mob encephalitis, mob hlwb, nrog rau mob ntsws, mob syphilitic thiab lwm tus;
- Kev raug mob rau lub hlwb: mob hlwb, txhaws ntawm lub hlwb;
- Cov ntshav kev cuam tshuam: cov hlab ntsha tawg, mob ntshav txhaws;
- Qhov tshwm sim ntawm kev phais mob neurosurgical;
- Congenital malformations ntawm lub diencephalon thiab midbrain.
Nruab nrab ntawm ntshav qab zib insipidus yog ntau zaus tsawg dua li mob ntshav qab zib mellitus, tab sis nyob hauv Lavxias tus naj npawb ntawm cov neeg mob los ntawm tus mob no muaj txog 21 txhiab tus neeg.
2. Lub raum mob ntshav qab zib insipidus
Vim li cas:
- Kev kho raws caj ces ntawm receptors rau ADH;
- Cov mob raum mob (pyelonephritis, glomerulonephritis);
- Tawg siab
- Tus hliav amyloidosis;
- Ntau tus qog;
- Mob raum tsis ua hauj lwm;
- Sickle cell anemia;
- Lub sijhawm siv ntev siv qee cov tshuaj.
3. Daim ntawv psychogenic
Nws feem ntau tshwm sim thaum muaj kev ntxhov siab.
4. Cev xeeb tub ntshav qab zib insipidus
Cov kab mob tsis tshua muaj tshwm sim, tshwm sim ntau dua nyob rau hauv cev xeeb tub lig, cuam tshuam nrog kev rhuav tshem ntawm cov placenta ntawm ADH lwg me me. Tom qab yug menyuam tas, cov tsos mob ploj mus.
Yuav luag ib feem peb ntawm cov xwm txheej, cov kev qhia tseem tsis meej.
Cov chaw kho mob tshwm sim ntawm ntshav qab zib insipidus
Tus kab mob feem ntau yog pib ntau zuj zus, kev ua kom zoo tuaj ntawm lub ntsej muag yog yam ntxwv tsawg dua.
- Qhov cim ntawm tus cwj pwm tshaj plaws yog qhov nce ntxiv ntawm qhov tso zis ntau zaus, cov neeg mob tso zis ntau zaus thaum hmo ntuj (mob nocturia tshwm sim), enuresis tuaj yeem txhim kho. Cov zis tso tawm rau ib hnub feem ntau tsis pub tshaj li 3-4 liv, tab sis nyob rau hauv rooj plaub hnyav, tshwj xeeb tshaj yog nrog cov mob muaj keeb ntawm cov kab mob, nws tuaj yeem ncav cuag 25-30 litres.
- Qee lub sij hawm muaj qhov kub nce ntxiv. Vim tias cov kua hauv lub cev ntau dhau hauv cov zis, daim tawv nqaij ua kom tsawg, nws ua nyias, yooj yim rau qhov quav, uas tsis ncaj rau lub sijhawm ntev.
- Qhuav ntawm daim tawv nqaij thiab cov qog ua kua pom tshwm, uas ua rau kom mob rwj thiab muaj zog ntxiv. Stomatitis, mob plab, mob plab.
- Cov neeg mob raug mob los ntawm kev nqhis dej tas li. Vim tias haus cawv ntau thiab nquag tso zis, cuam tshuam ntawm lub plab thiab lub zais zis yog yam ntxwv.
Vim qhov loj ntawm cov kua dej, cov tawv nqaij qhuav dhau los. - Tsis muaj kev pw tsaug zog, cov kua dej tas li ua rau cov tsos ntawm cov neurotic, tsis muaj zog ntawm cov neeg mob, poob ceeb thawj. Cov yam ntxwv tshwm sim yog qhov tsis txaus siab, npau taws, hloov pauv hloov mus los.
- Hauv cov txheej txheem oncological ntawm lub paj hlwb, lwm qhov kev cuam tshuam cov leeg hlwb thiab cov hlwb endocrine feem ntau tshwm sim. Cov no feem ntau tuaj yeem yog lub cev muaj zog, hnov, pom kev txawv txav, cuam tshuam ntawm kev sib koom tes thiab sib npaug.
- Cov txheej txheem kis tau nrog hyperthermia, ib qho kev nce ntxiv ntawm cov qe ntshav dawb thiab ESR hauv cov ntshav. Kev hnov mob los yog rub cov kev xav hauv thaj av lumbar yuav tshwm sim.
- Ntxiv rau cov tsos mob saum toj no mob ntshav qab zib insipidus, txiv neej feem ntau muaj teeb meem nrog libido thiab potency.
- Cov tsos mob hauv qab no yog cov xeeb ceem ntawm cov duab hauv chaw soj ntsuam hauv cov poj niam: kev coj khaub ncaws tsis xwm yeem, teeb meem ntawm ovulation thiab xeeb tub. Miscarriages ua tau nyob rau ntau theem ntawm cev xeeb tub.
Hauv cov menyuam yaus tom qab peb xyoos, kev tshwm sim ntawm tus kabmob yog zoo ib yam li cov laus. Cov mis feem ntau tso zis, poob ceeb thawj, quaj, nyiam haus cov dej ntshiab hloov mis, ntsib kev tso quav. Feem ntau, cov mob hauv cov menyuam yaus tseem tsis tau paub txog lub sijhawm thiab tuaj yeem ua rau tuag.
Yuav ua li cas paub txog cov ntshav qab zib insipidus
- Qhov tseem ceeb tshaj plaws kuaj mob ntshav qab zib insipidus yog urinalysis dav dav, raws li tau tso zis raws li Zimnitsky. Cov yam ntxwv yog qhov nce ntxiv ntawm cov ntim ntawm cov zis txhua hnub, kev cia siab ntawm ib hmo, thiab qhov poob qis hauv nws qhov txheeb ze ntom. Hauv cov zis, yuav kuaj ntshav thiab cov protein. Qhov muaj nyob ntawm qabzib, acetone, tsis zoo li ntshav qab zib, yog qhov tsis tshua muaj, feem ntau tshwm sim thaum ob txoj kev sib xyaw ua ke.
- Hauv kev ntsuas ntshav, cov dej qab ntsev ntau dua ntxiv, creatinine, urea, thiab cov pa nitrogen yuav nce ntxiv.
- Ib qho kim, tab sis cov lus pom kev kuaj mob ntau yog txhawm rau txiav txim siab theem ntawm antidiuretic hormone hauv ntshav. Nquag, tus lej no yog siab dua 6 mmol ib litre.
- Kuaj qhuav. Tus neeg mob raug caw kom txo qis ntawm kev haus dej kom txog thaum nws tus mob pib kom meej meej. Txoj hau kev no tseem siv tau thaum nws tseem xav tau qhov sib txawv ntawm qhov nruab nrab thiab lub raum ua kom cov ntshav qab zib insipidus. Kev ntsuas cov kev hloov pauv hauv lub cev zoo, txoj kev tshawb fawb ntawm cov zis tso zis.
- Txhawm rau tshem tawm lub raum pathology, kev kuaj mob ultrasound ntawm lub hauv nruab nrog cev thiab lub txaj viav vias, excretory urography yog siv;
- Tsis tshua muaj qee qhov, nws yog qhov yuav tsum tau coj cov ntaub ntawv keeb kwm los ntawm kev siv tshuab;
- Kev xoo hluav taws xob ntawm lub pob txha taub hau pab ua kom pom qhov kev txiav txim siab ntawm cov pob txha pob txha ntawm "Turkish", lub xub ntiag ntawm pob txha tawg ntawm lub hauv paus lossis hauv koov;
- Kev suav thiab cov duab hluav taws xob resonance imaging yog qhov tsim nyog txhawm rau txhawm rau txhawm rau txham los yog qog, nrog rau cov duab tshwm hauv lub hlwb;
- Hauv muaj tsev neeg keeb kwm, kev tshuaj ntsuam keeb siv;
Nyob rau hauv txhua rooj plaub, xav tias ntshav qab zib insipidus yog qhia los ntawm kev sib tham ntawm tus kws kho mob nephrologist, neurologist, endocrinologist thiab neurosurgeon.
Kev Kho Mob
Qhov loj ntawm cov kev pom ntawm tus kab mob feem ntau ncaj qha nyob ntawm qhov ntim ntawm cov kua dej ua kom rov zoo.
Kev kho mob ntshav qab zib insipidus pib nrog kev teem caij rau kev noj zaub mov nrog kev ua kom tsawg ntawm cov dej dawb, kua txiv, kev sib piv, kua zaub. Txwv txiav cov txiaj ntsig ntawm lub rooj ntsev rau ob gram ib hnub twg, cov dej qab zib thiab dej cawv. Nws raug nquahu kom tsis suav cov zaub mov muaj protein ntau, nqaij nqaij tau haus, thiab khoom kib kom txo qhov ua rau lub raum. Khoom noj muaj txiaj ntsig nplua nuj nyob hauv cov poov tshuaj: zaub, txiv hmab txiv ntoo. Feem ntau, cov kab mob ntshav qab zib insipidus sib raug rau lub rooj xya lossis kaum.
Raws li hloov kev kho mob, hluavtaws analogues ntawm antidiuretic hormone siv. Lawv muaj nyob rau hauv daim ntawv ntawm cov ntsiav tshuaj los yog tee ntswg.
Qee qhov xwm txheej, cov diuretics zoo li spironolactone qhia rau kev tswj hwm cov ntshav sodium ntau ntau.
Nyob rau hauv cov ntaub ntawv ntawm oncological ntawm lub hypothalamus lossis pituitary caj pas, cov lus nug ntawm kev phais mob, kev siv tshuaj kho mob lossis radiological kho tau daws.
Hauv cov kis kab mob, kev kho tshuaj tiv thaiv kab mob los yog tshuaj tua kab mob kho tau raug kho. Siv tshuaj tiv thaiv, tshuaj uas ua rau kom muaj zog tiv thaiv kab mob yog siv.
Txawm hais tias tus kab mob ntshav qab zib insipidus yog ib tus mob uas tsis tshua pom muaj tsawg thiab muaj tsawg dua li cov piam thaj, nws tseem tuaj yeem yog cov tsos mob ntawm cov kab mob tuag taus thiab ua rau muaj kev rau txim loj. Yog li, nws yog ib qho tseem ceeb heev kom raws sij hawm sai sai rau cov xeeb ceem ntawm cov ntshav qab zib insipidus, ua kev kuaj mob thiab pib kho mob.
