Qhov ua rau cov piam thaj ntau ntxiv tuaj yeem yog lub caij nyoog ntev tshaj ntawm cov tshuaj steroid hauv cov ntshav. Hauv qhov no, kev kuaj mob ntawm cov ntshav qab zib steroid yog tsim. Feem ntau feem ntau, qhov tsis txaus ntseeg tshwm sim vim cov tshuaj kho mob, tab sis nws kuj tseem tuaj yeem ua qhov kev mob uas cuam tshuam ntawm cov kabmob ua rau muaj kev nce ntxiv hauv kev tso tawm cov tshuaj hormones. Feem ntau, pathological kev hloov pauv hauv cov metabolism ntawm cov roj carbohydrates yog qhov thim rov qab, tom qab kev tshem tawm yeeb tshuaj lossis kho ntawm tus kab mob-ua rau, lawv ploj, tab sis qee qhov lawv tuaj yeem mob tom qab kev kho mob.
Qhov tshuaj phom sij tshaj plaws yog rau cov neeg muaj ntshav qab zib hom 2. Raws li kev txheeb cais, 60% ntawm cov neeg mob yuav tsum hloov cov tshuaj hypoglycemic nrog kev kho insulin.
Steroid ntshav qab zib - nws yog dab tsi?
Steroidal, lossis kev quav yeeb tshuaj, ntshav qab zib yog kab mob uas ua rau hyperglycemia. Qhov laj thawj rau nws yog qhov tshwm sim ntawm glucocorticoid cov tshuaj hormones, uas tau siv dav hauv txhua ceg ntawm cov tshuaj. Lawv txo qis cov haujlwm ntawm lub cev tsis muaj zog, muaj cov khoom ua rau lub cev tiv thaiv. Glucocorticosteroids muaj xws li Hydrocortisone, Dexamethasone, Betamethasone, Prednisolone.
Tsis ntev, tsis pub dhau 5 hnub, kev kho nrog cov tshuaj no tau sau tseg rau cov kab mob:
Mob ntshav qab zib thiab siab surges yuav yog ib yam dhau los
- Li qub ntawm qab zib -95%
- Kev tshem tawm ntawm cov hlab ntsha thrombosis - 70%
- Ntaus tau ntawm lub plawv dhia muaj zog -90%
- Kev tshem tawm ntshav siab - 92%
- Qhov nce hauv lub zog nruab hnub, txhim kho pw tsaug zog thaum hmo ntuj -97%
- malignant hlav
- cov kab mob rau daim tawv hlwb
- COPD yog mob ntsws ntev ntev
- gout nyob rau theem mob huam tuaj.
Lub sijhawm ntev, ntau dua 6 lub hlis, kev kho kab mob steroid tuaj yeem siv rau kev mob ntsws, mob plab, mob plab hnyuv, mob caj dab, mob caj dab thiab hloov khoom nruab nrog cev. Raws li kev txheeb cais, qhov tshwm sim muaj ntshav qab zib tom qab siv cov tshuaj no tsis ntau tshaj 25%. Piv txwv, hauv kev kho mob ntsws, hyperglycemia yog pom hauv 13%, teeb meem ntawm daim tawv nqaij - hauv 23,5% ntawm cov neeg mob.
Kev pheej hmoo ntawm cov ntshav qab zib steroid nce ntxiv los ntawm:
- mob ntxiv rau hom kab mob ntshav qab zib hom 2 ntshav qab zib, thawj cov txheeb ze muaj ntshav qab zib;
- Mob ntshav qab zib hauv lub cev thaum muaj tsawg kawg ib zaug cev xeeb tub;
- ntshav qab zib;
- kev rog, tshwj xeeb tshaj yog lub plab;
- polycystic ovary;
- hnub nyoog siab heev.
Kev txhaj tshuaj ntau dua yog siv ntau dua, qhov muaj feem yuav ntau dua ntawm cov ntshav qab zib steroid:
| Koob tshuaj ntawm hydrocortisone, mg rau ib hnub | Muaj kev pheej hmoo ntawm kab mob, lub sijhawm |
| < 40 | 1,77 |
| 50 | 3,02 |
| 100 | 5,82 |
| 120 | 10,35 |
Yog tias tus neeg mob ua ntej kev kho mob steroid tsis muaj qhov pib ua kom tsis haum metabolic ntawm carbohydrates, glycemia feem ntau li qub tsis pub dhau 3 hnub tom qab lawv tshem tawm. Nrog lub sijhawm ntev ntawm kev siv cov tshuaj no thiab nrog lub siab xav rau ntshav qab zib, hyperglycemia tuaj yeem dhau los ua mob ntev, uas yuav tsum tau kho lub neej ntev.
Cov tsos mob zoo li no tuaj yeem tshwm sim hauv cov neeg mob uas tsis muaj peev xwm tsim cov tshuaj hormones. Feem ntau, mob ntshav qab zib pib nrog Itsenko-Cushing's disease, tsawg dua - nrog hyperthyroidism, pheochromocytoma, mob plig lossis mob hlwb.
Cov laj thawj kev tsim kho
Muaj kev sib txuam ncaj qha multicomponent ntawm kev siv glucocorticoid thiab kev txhim kho cov ntshav qab zib steroid. Tshuaj hloov lub biochemistry ntawm cov txheej txheem noj nyob rau hauv peb lub cev, provoking ruaj khov hyperglycemia:
- Lawv cuam tshuam rau kev ua haujlwm ntawm beta hlwb, vim tias cov tshuaj tua kab mob insulin tsawg dua, nws tso tawm rau hauv cov ntshav tau los ntawm cov lus teb rau cov ntshav qabzib.
- Tej zaum yuav ua rau muaj kev tuag ntau ntawm cov beta hlwb.
- Lawv txo qis cov kev ua haujlwm ntawm insulin thiab, vim li ntawd, cuam tshuam qhov hloov ntawm cov piam thaj rau hauv cov ntaub so ntswg.
- Txo cov glycogen tsim sab hauv lub siab thiab cov leeg.
- Cov kev ua ntawm cov tshuaj hormone enteroglucagon yog suppressed, vim tias qhov twg cov kua dej ntau lawm ntxiv txo qis.
- Lawv nce nce ntawm kev tso tawm ntawm glucagon, ib qho tshuaj hormones uas ua rau tsis muaj zog ntawm insulin.
- Lawv ua rau gluconeogenesis, txheej txheem ntawm kev ua kom qabzib los ntawm cov sib txuas ntawm lub ntiaj teb tsis-carbohydrate.
Yog li, insulin ntau lawm txo qis, yog li cov piam thaj tsis tuaj yeem nkag mus rau nws lub hom phiaj - hauv cov hlwb ntawm lub cev. Qhov khiav ntawm cov piam thaj mus rau hauv cov ntshav, ntawm qhov tsis sib xws, nce vim gluconeogenesis thiab qhov ua kom tsis muaj zog ntawm cov ntshav qab zib ntawm cov suab thaj hauv khw.
Hauv cov neeg muaj kev noj qab haus huv metabolism, insulin synthes nce ntxiv tom qab 2-5 hnub ntawm kev noj tshuaj steroids los them rau nws txoj haujlwm txo qis. Tom qab kev txiav tawm ntawm cov tshuaj, cov txiav quav rov qab rau hauv lub hauv paus. Hauv cov neeg mob uas muaj kev pheej hmoo siab ntawm kev mob ntshav qab zib steroid, kev them nyiaj yuav tsis txaus, hyperglycemia tshwm sim. Pab pawg neeg no feem ntau muaj "kev rhuav tshem" ua rau muaj ntshav qab zib mob ntshav qab zib.
Tus kab mob no tau muab ICD code ntawm 10 E11 yog tias pancreatic muaj nuj nqi qee yam khaws cia, thiab E10 yog tias cov beta hlwb cov pov thawj feem ntau tau rhuav tshem.
Nta thiab cov tsos mob ntawm cov ntshav qab zib steroid
Txhua tus neeg mob uas siv cov tshuaj steroids yuav tsum paub cov tsos mob tshwj xeeb rau ntshav qab zib:
- polyuria - tso zis nce ntxiv;
- polydipsia - lub zog nqhis dej, yuav luag tsis muaj zog tom qab haus dej;
- qhuav mucous daim nyias nyias, tshwj xeeb tshaj yog nyob rau hauv lub qhov ncauj;
- rhiab, flaky tawv nqaij;
- nkees tas li lub xeev, txo kev ua tau zoo;
- nrog rau qhov tseem ceeb vim tsis muaj cov tshuaj insulin - cov khoom hnyav poob zoo.
Yog tias cov tsos mob no tshwm sim, nws yog ib qhov tsim nyog los kuaj ntshav qab zib steroid. Kev ntsuam xyuas tshwj xeeb tshaj plaws hauv qhov no yog kev kuaj ntshav qabzib. Qee qhov xwm txheej, nws tuaj yeem qhia cov kev hloov pauv hauv cov metabolism hauv cov metabolism hauv 8 teev tom qab pib noj cov tshuaj steroids. Kev kuaj mob tib yam nkaus rau lwm yam mob ntshav qab zib: cov piam thaj ntawm qhov kawg ntawm kev sim yuav tsum tsis pub ntau dua 7.8 mmol / l. Nrog rau kev nce siab ntxiv rau 11,1 units, peb tuaj yeem tham txog kev cuam tshuam ntawm cov metabolism hauv lub cev, feem ntau cuam tshuam tsis tau.
Hauv tsev, mob ntshav qab zib steroid tuaj yeem raug kuaj pom siv cov glucometer, qib theem 11 tom qab noj mov qhia qhov pib ntawm tus kab mob. Fasting qab zib yoo hlob tuaj tom qab, yog tias nws siab dua 6.1 units, koj yuav tsum hu rau tus kws endocrinologist mus kuaj ntxiv thiab kho ntxiv.
Cov tsos mob ntawm tus mob ntshav qab zib tej zaum yuav tsis muaj, yog li nws yog ib qho kev coj los tswj ntshav qabzib hauv thawj ob hnub tom qab tshuaj glucocorticoids. Nrog kev siv sijhawm ntev ntawm cov tshuaj, piv txwv li, tom qab hloov chaw, kev kuaj tau muab txhua lub limtiam rau thawj lub hlis, tom qab ntawd tom qab 3 hlis thiab rau lub hlis, tsis hais muaj nyob ntawm cov tsos mob.
Yuav kho kab mob ntshav qab zib steroid li cas
Mob ntshav qab zib sterter ua rau muaj suab thaj ntau ntxiv tom qab noj mov. Thaum tsaus ntuj thiab sawv ntxov ua ntej noj mov, glycemia yog qhov nyob hauv thawj thawj zaug. Yog li, kev kho mob siv yuav tsum txo cov suab thaj thaum nruab hnub, tab sis tsis txhob ua kom tsis muaj mob rau cov ntshav ib hnub dhau hnub.
Rau kev kho mob ntshav qab zib mellitus, tib cov tshuaj siv yog siv rau lwm hom kabmob: hypoglycemic agents thiab insulin. Yog tias glycemia tsawg dua 15 mmol / l, kev kho mob pib nrog cov tshuaj siv rau ntshav qab zib hom 2. Cov piam thaj ntau dua qhia tias muaj teeb meem loj ntxiv hauv pancreatic muaj nuj nqi, cov neeg mob li no tau raug sau tshuaj insulin.
Tshuaj zoo:
| Tshuaj | Nkaus |
| Metformin | Txhim kho kev xav ntawm insulin, txo qis gluconeogenesis. |
| Derivatives ntawm sulfanylureas - glyburide, glycoslide, repaglinide | Tsis txhob xaj tshuaj rau ntawm kev nqis tes ua lub sijhawm ntev, saib xyuas kev noj zaub mov xwm yeem. |
| Glitazones | Nce insulin rhiab heev. |
| Cov qauv ntawm GLP-1 (enteroglucagon) - exenatide, liraglutide, lixisenatide | Ua tau zoo dua nrog mob ntshav qab zib hom 2, ntxiv cov insulin tso tawm tom qab noj mov. |
| DPP-4 inhibitors - sitagliptin, saxagliptin, alogliptin | Txo cov piam thaj hauv qab, txhawb nqa poob phaus. |
| Kev kho tshuaj Insulin, nyob ntawm theem ntawm lawv tus kheej insulin, kev coj noj coj ua tshuaj lossis qhov hnyav yog xaiv | Nruab nrab lub cev insulin feem ntau yog hais tawm thiab luv luv ua ntej noj mov. |
Kev Tiv Thaiv
Kev tiv thaiv thiab tshawb pom lub sijhawm mob ntshav qab zib steroid yog qhov tseem ceeb ntawm kev kho mob nrog glucocorticoids, tshwj xeeb tshaj yog thaum lawv siv ntev yuav tsum. Tib yam kev ntsuas uas siv rau hom ntshav qab zib hom 2, kev noj zaub mov kom tsawg thiab ua kom lub cev muaj zog, txo kev pheej hmoo ntawm kev ua txhaum ntawm cov metabolism hauv cov metabolism.
Hmoov tsis zoo, cov prophylaxis tsis yooj yim rau kev siv, txij li cov tshuaj steroids ua rau kom qab los noj mov, thiab ntau yam kab mob uas kho lawv tshem tawm lossis txo kev ua kis las. Yog li, hauv kev tiv thaiv cov kab mob ntshav qab zib steroid, lub luag haujlwm tseem ceeb rau kev kuaj mob ntawm kev tsis sib haum xeeb thiab lawv txoj kev txhim kho ntawm theem pib nrog kev pab los ntawm cov tshuaj muaj suab thaj.
