Ntshav qab zib insipidus (ntshav qab zib insipidus) yog ib yam kab mob endocrine tsawg kawg uas tshwm sim vim yog cov tsis muaj hlwb, hypothalamus, lossis lub raum tsis ua haujlwm. Tus kab mob no yog cim los ntawm polydipsia (zoo nkaus li kev nqhis dej tas mus li) thiab polyuria (nce tso zis ntau lawm - los ntawm 6 txog 50 litres ib hnub).
Tus kab mob no yog mob ntev, nws tuaj yeem tsim kho hauv poj niam thiab txiv neej tsis hais hnub nyoog li cas, tab sis feem ntau mob ntshav qab zib insipidus syndrome tshwm sim rau cov neeg hnub nyoog 18-28 xyoo.
Lub caj pas pituitary thiab hypothalamus yog endocrine qog uas cuam tshuam nrog. Lawv sawv cev rau qee qhov kev tswj hwm vaj huam sib luag uas tswj cov qog endocrine ntawm lub cev.
Ua tib zoo mloog! Cov neurons ntawm cov hypothalamus tsim cov tshuaj hormones - oxytocin thiab vasopressin.
Antidiuretic hormone - vasopressin yog sau nyob rau sab hauv cov hlwv tom qab. Cov tshuaj hormones yog tso tawm yog tias tsim nyog thiab tswj cov thim rov qab nqus ntawm dej hauv lub raum nephrons.
Thaum tsis tshua muaj cov ntsiab lus ntawm antidiuretic hormone hauv cov ntshav hauv lub raum hauv cov txheej txheem ntawm kev rov qab nqus dej - nws tau poob siab, uas yog vim li cas polyuria tsim.
Cov tsos mob thiab ua rau muaj ntshav qab zib insipidus
Ntshav qab zib mellitus syndrome tshwm yog tias pathological hloov hauv lub cev, qhov ua rau muaj nyob hauv:
- txhim kho kev tawg ntawm vasopressin;
- qhov tshwm sim ntawm cov formations hauv lub caj pas pituitary thiab hypothalamus;
- hauv phiaj cov hlwb nyob rau hauv lub raum, qhov mob rhiab heev rau cov tshuaj tiv thaiv kab mob ua rau muaj kev tawm tsam;
- malformations ntawm hypothalamus lossis pituitary caj pas;
- kev muaj keeb muaj keeb (hom kab mob sib xws rau hom autosomal hom);
- lub taub hau puas tsuaj lossis ua tsis tiav qhov kev phais neurosurgical, uas ua rau kev puas tsuaj rau vasopressin neurons;
- oncological metastases uas muaj kev cuam tshuam tsis zoo rau kev ua haujlwm ntawm ob lub qog;
- autoimmune thiab kis kab mob uas rhuav cov neurons ntawm antidiuretic hormone.
Cov tsos mob tseem ceeb ntawm ntshav qab zib mellitus yog polydipsia thiab polyuria, nrog sib txawv ntawm qhov mob hnyav.
Cov tsos mob uas tshwm sim nrog lub caij nyoog ntev ntawm tus kab mob
Ntev ntawm tus kabmob, cov tsos mob xws li nce ntxiv ntawm lub zais zis, prolapse thiab cais ntawm lub plab yog tus yam ntxwv. Cov tsos mob ntawm tus mob ntshav qab zib insipidus syndrome kuj muaj xws li tsis nco qab (nyhav dhau heev lawm), ntuav, thiab xeev siab.
Cov yam ntxwv nram qab no yog cov ntshav siab qis, ua pa nyuaj, thiab hawb pob. Mob ntshav qab zib mellitus tseem nrog cov tsos mob xws li mob taub hau thiab ua kom tsaug zog ntawm thaj chaw pom.
Ntau cov tsos mob ntawm tus mob ntshav qab zib insipidus dag hauv lub cev qhuav dej:
- daim tawv nqaij qhuav thiab atonic;
- tej zaum cramps;
- sunken cheekbones.
Tsis tas li, qee zaus nrog kev hloov pauv siab hauv cov kev qhia hauv lub cev, tus neeg mob tau tsim cov tsos mob xws li orthostatic vau.
Kev kuaj mob
Thaum txiav txim siab txog kev kuaj mob, nws yog ib qho tseem ceeb kom tau tsim kho tus qauv mob kom thiaj li kho tau zoo. Rau kev kuaj mob ntawm tus kab mob, ib qho anamnesis thiab cov tsos mob uas qhia txog polydipsia thiab polyuria (ntau tshaj li ob liv nyob rau ib hnub) yog qhov tseem ceeb.
Yog tias cov kab mob thiab keeb kwm kho mob pom tias muaj ntshav qab zib insipidus syndrome, ces tus kws kho mob tau sau qee yam kev kuaj mob. Hauv qhov no, tus neeg yuav tsum tso dej tawm mus ib ntus.
Tus neeg mob tseem muab cov zis thiab kuaj ntshav los txiav txim:
- zis ceev;
- osmolarity;
- cov ntsiab lus ntawm nitrogen, potassium, qabzib, sodium, calcium hauv cov ntshav;
- glucosuria.
Lwm qhov kev txheeb xyuas yog nqa tawm rau kev noj mov qhuav, nyob rau hauv uas tus neeg mob tsis haus dej ntawm 8 txog 24 teev. Hauv txoj kev kuaj pom, qhov hnyav, qhov ceev thiab ntim ntawm cov zis yog kaw txhua teev thiab cov sodium ntsiab lus hauv cov zis yog ntsuas.
Yog tias tus neeg mob lub cev hnyav li 5%, thiab cov dej sodium ntau dua 3 mmol / l, ces txoj kev tshawb no tau ua tiav. Yog li, nws yog qhov ua tau rau refute lossis paub meej qhov muaj ntshav qab zib insipidus, nyob rau hauv uas tsis muaj antidiuretic hormone, uas ua rau nws muaj peev xwm nqa tawm diffdiagnosis nrog kev mob hlwb thiab mob hlwb polydipsia.
Cov kev kuaj mob sib txawv ntawm nephrogenic thiab hypothalamic ntshav qab zib insipidus syndrome muaj kev tshawb nrhiav siv Minirin: kev sim tiav raws li Zimnitsky ua ntej noj Minirin thiab tom qab siv cov tshuaj no. Yog tias, tom qab noj cov tshuaj, qhov ntau npaum li cas ntawm cov zis txo thiab nws qhov ntom nce ntxiv, qhov no tau lees tias qhov kev kuaj mob ntawm tus mob ntshav qab zib hypothalamic insipidus.
Txhawm rau qhov sib txawv ntawm kev kuaj mob nephrogenic thiab hypothalamic, cov ntsiab lus ntawm vasopressin hauv cov ntshav yog qhov tseem ceeb heev: nrog rau cov ntshav qab zib nephrogenic, qhov nyiaj ntawm cov tshuaj hormone no nce ntxiv, thiab nyob rau kis thib ob nws tsis tau suav cia.
Txhawm rau kuaj mob ntshav qab zib hom mellitus, ib qho MRI ua tiav, uas txiav txim siab qhov muaj cov kab mob pathologies, qhov ci ntsa iab thiab tsim nyob hauv lub caj pas pituitary.
Kev Kho Mob
Nruab nrab hauv ntshav qab zib insipidus
Kev kho rau hom ntshav qab zib ntshav qab zib insipidus koom nrog kev siv cov kev hloov pauv tsis tu ncua. Cov tshuaj tseem ceeb uas cov kev kho mob ua tiav yog nqa tawm yog Desmopressin thiab nws cov ntau yam:
- Minirin (ntsiav tshuaj) - ib qho khoom noj hluav taws xob ua ke ntawm cov tshuaj antidiuretic;
- Adiuretin (ampoules) - rau kev siv sab hauv.
Minirin (vasopressin dag)
Tom qab kev coj noj coj ua, cov tshuaj tuaj yeem kuaj pom hauv cov ntshav tom qab 15-30 feeb, thiab nws cov concentration tau mus txog tom qab 120 feeb.
Tus kws kho mob xaiv cov ntau npaum li cas rau tus kheej, saib xyuas qhov tshwm sim ntawm cov tshuaj thaum kho yog nyob rau theem pib. Qhov koob tshuaj tau teeb tsa, nyob ntawm tus nqi ntawm cov kua dej haus cawv thiab tus naj npawb ntawm tso zis. Raws li txoj cai, nws yog 1-2 ntsiav tshuaj ib hnub.
Cov tshuaj no tshwm sim ib nrab teev ua ntej noj mov lossis tom qab 2 teev tom qab noj mov. Lub sijhawm ntawm Minirin yog los ntawm 8 txog 12 teev, yog li nws yuav tsum tau ua peb zaug ib hnub.
Nyob rau hauv cov ntaub ntawv ntawm overdose, nws yuav tshwm sim:
- o tuaj;
- mob taub hau
- tso zis tsawg dua.
Cov laj thawj ntawm kev noj ntau dua yog feem ntau cuam tshuam nrog kev noj tshuaj tsis zoo, kev hloov pauv huab cua, kub cev thiab kev hloov pauv hauv lub neej.
Kev kho mob ntshav qab zib insipidus nephrogenic
Kev kho ntawm hom mob no koom nrog kev siv tshuaj sib xyaw, muaj ntau yam tshuaj tua kab mob nrog kev noj ntsev tsawg. Qhov no yog qhov tsim nyog los txhim kho cov nyhuv ntawm thiazide diuretics.
Raws li kev kho mob ib ce, prostaglandin inhibitors siv: ibuprofen, tshuaj aspirin, indomethacin.
Ua tib zoo mloog! Nrog rau nephrogenic hom ntshav qab zib insipidus, Desmopressin yog qhov tsis muaj txiaj ntsig.
Kev kho mob ntawm hom dipsogenic ntawm tus kab mob no tsis tas yuav siv tshuaj kho mob. Nws lub hom phiaj tseem ceeb yog txhawm rau txo cov dej haus kom tsawg.
Nrog rau cov ntshav qab zib insipidus syndrome, tus neeg mob yuav tsum tau txwv cov ntsev, cawv thiab zaub mov noj protein ntau. Lub hauv paus tseem ceeb ntawm nws kev noj haus yuav tsum yog cov khoom noj muaj mis, txiv hmab txiv ntoo thiab zaub.
Thiab kom txo qhov nqhis dej, koj yuav tsum haus dej txias nrog kua thiab txiv qaub.
