STEROID NTSHAV QAB ZIB - NWS YOG DAB TSI? COV TSOS MOB THIAB BIOCHEMISTRY

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Hauv nws cov ntawv soj ntsuam, mob ntshav qab zib steroid yog ntshav qab zib insulin-tiv thaiv kab mob ntshav qab zib mellitus (DM 1), tab sis nws ua ke nrog cov yam ntxwv ntawm hom thawj thiab thib ob.

Qhov laj thawj ntawm qhov tsos yog lub caij nyoog muaj nyob rau hauv cov ntshav ntau ntawm corticosteroids (cov tshuaj hormones tsim los ntawm adrenal cortex), uas ua rau muaj kev ua haujlwm tsis zoo ntawm lub txiav vim kev puas tsuaj rau nws lub hlwb.

Symptomatology

Ib qho yeeb yaj kiab ntawm steroid ntshav qab zib, uas tseem hu ua ntshav qab zib tshuaj, yog qhov tsis tshua mob heev cov tsos mob.

Hauv cov theem thaum ntxov ntawm tus kabmob, ntau tshaj ntawm corticosteroids ua rau kev puas tsuaj rau cov hlwb ntawm endocrine txiav, tab sis kev tsim cov tshuaj insulin tseem tab tom ua. Nov yog qhov nyuaj - tus kab mob no twb dhau mus, tab sis cov tsos mob kuj tseem tsis muaj zog thiab tus neeg mob tsis maj nrawm mus nrhiav kev pab kho mob.

Nrog txoj kev ua tiav ntawm kev tso tawm ntawm cov tshuaj insulin, cov tsos mob ntawm tus mob ntshav qab zib mellitus tshwm sim:

Polyuria
Polydipsia;
Neeg tsis muaj zog
Qaug Zog;
General kev mob tsis zoo.

Kev poob ceeb thawj sai tsis yog ib txwm raug rau cov mob ntshav qab zib mellitus, xws li kev hloov pauv sai hauv glycemia. Cov concentration ntawm cov piam thaj thiab acetone hauv kev kawm txog dej hauv lub cev (ntshav thiab zis) feem ntau nyob ze rau qhov ib txwm muaj. Qhov no ua rau nws nyuaj rau kev kuaj pom tseeb.

Vim li cas rau qhov tsos

Steroid mob ntshav qab zib tshwm sim los ntawm kev txiav tawm ntau dhau ntawm corticosteroids nyob rau hauv tib neeg cov ntshav. Cov laj thawj rau qhov dhau qhov no tuaj yeem ua tsis tau thiab txaus ntshai.

Nrog rau cov teeb meem endogenous, ntau dhau ntawm cov tshuaj hormones tuaj yeem tshwm sim los ntawm cov kab mob ntawm cov kab mob ntawm endocrine. Nrog rau exogenous - ib qho dhau ntawm cov tshuaj hormones tshwm sim tom qab siv ntev ntawm glucocorticosteroid tshuaj.

Exogenous

Steroid ntshav qab zib tuaj yeem ua rau:

Thiazide diuretics (Ezidrex, Hypothiazide).
Cov tshuaj uas siv los kho kev ua xua, tshuaj tiv thaiv mob ntsws, mob qa foob, mob ntsws, mob ntsws, mob mononucleosis thiab ntau lwm yam kab mob, suav nrog autoimmune. Hom tshuaj no suav nrog Betaspan, Dexamethasone, Prednisolone, Dexon, Anaprilin.
Siv tshuaj tiv thaiv kev tiv thaiv siv tom qab phais mob lub raum.
Tshuaj noj tiv thaiv tsis pub muaj menyuam.

Endogenous ua

Kev ua txhaum ntawm lub caj pas pituitary tsis zoo cuam tshuam qhov tsis kam ntawm cov ntaub so ntswg thiab cov hlwb ntawm lub cev mus rau insulin. Ntawm cov mob no pathological, Itsenko-Cushing syndrome feem ntau ntsib, uas yog tus cwj pwm los ntawm kev zais cia ntau dhau ntawm cov keeb cortisol los ntawm adrenal cortex.

Xws li cov tsos mob feem ntau ua rau nws tus kheej tawm tsam keeb kwm ntawm tus kab mob Itsenko-Cushing, uas txawv ntawm cov tsos mob hauv qhov kev cuam tshuam ntawm lub adrenal cortex muaj mob thib ob.

Qhov ua rau mob tseem ceeb yog mob pituitary microadenoma.

Graves 'kab mob (goiter lom), lub cev ua haujlwm rau lub cev cov thyroid uas ua rau cov insulin emissions tsawg thiab cov ntshav qabzib hauv lub ntsej muag ntau ntxiv, tuaj yeem ua rau txoj kev loj hlob ntawm cov ntshav qab zib tshuaj.

Tseem Ceeb! Yog tias thaum lub sijhawm saib xyuas cov tshuaj glucocorticoid hauv cov neeg mob cov roj metabolism hauv lub cev tsis muaj kev ntxhov siab, kev tshaj tawm ntawm homons tuaj yeem tshem tawm los ntawm kev tshem tawm kev siv cov tshuaj thiab hloov nrog cov tshuaj zoo.

Cov pab pawg muaj kev pheej hmoo

Steroid mob ntshav qab zib tsis yog tsim hauv txhua tus neeg mob noj tshuaj corticosteroid. Muaj qee yam uas ua rau muaj feem ntau ntawm kev tsim tus kabmob no:

kev tshuaj ntsuam genetic predisposition;

Lub cev hnyav dhau;
Kev Hypodynamia;
Kev noj haus tsis zoo.

Txoj kev pheej hmoo ntawm kev tsim muaj cov ntshav qab zib ntau ntxiv nyob rau qee lub sijhawm yog tias muaj keeb kwm caj ces hauv tus neeg mob niam txiv muaj keeb kwm muaj tus kab mob.

Tshaj dhau qhov nyhav dhau los, uas tuaj yeem tshwm sim vim yog lub zog ntawm lub cev, ua rau nce ntxiv hauv cov ntshav ntawm cov tshuaj tiv thaiv insulin, lipids, cov roj cholesterol, piam thaj, thiab ua txhaum cov ntshav siab. Nrog rau qhov nce hauv lub cev huab hwm coj qhov ntsuas, uas yog xam los ntawm kev faib qhov hnyav los ntawm cov square ntawm kev loj hlob hauv meters, txog 27 kg / m2, qhov no ua rau txo qis rhiab heev ntawm cov ntaub so ntswg mus rau insulin.

Cov khoom noj dhau los ntawm cov ntshiab, yooj yim nqus tau cov suab thaj (muaj suab thaj, zib ntab), cov carbohydrates yooj yim thiab kev txo cov protein hauv cov zaub mov cuam tshuam cov txheej txheem hauv lub cev hauv lub cev, uas tuaj yeem ua rau kev rog.

Kev kuaj mob

Qhov nyuaj ntawm kev kuaj mob ntawm tus kab mob no yog tias cov ntsuas ntawm cov ntshav thiab cov zis kuaj tau tsuas yog me ntsis dhau qhov tsim tau cov qauv. Ib txoj kev kuaj mob muaj tseeb dua yog kev soj ntsuam kuaj ntshav qabzib, uas yog txiav txim siab muaj cov ntshav qab zib.

Kev kuaj mob ntshav qab zib mellitus tuaj yeem ua tau los ntawm kev nce ntxiv ntshav qab zib los ntawm 6 mmol / L ntawm lub plab tsis txaus mus txog 11 mmol / L tom qab thau khoom nrog kua qabzib. Tom qab ntawd nws hom yog kuaj.

Txhawm rau txiav txim siab cov ntshav qab zib steroid, kev ntsuam xyuas ntxiv yog ua: 17-ketosteroids thiab 17-hydroxycorticosteroids nyob rau hauv cov zis, kuaj ntshav rau theem ntawm cov tshuaj hormones uas ua los ntawm adrenal cortex, pituitary caj pas.

Ib qho tseem ceeb rau kev kuaj mob yog kev kuaj ntshav biochemical, uas yog, xws li ntsuas xws li cov piam thaj, glycated hemoglobin, insulin, C-peptide, lipoproteins, triglycerides, fructosamine, pancreatic peptide.

Kev Kho Mob

Mob ntshav qab zib Steroid kho tau raws li cov kev cai ib yam li mob ntshav qab zib hom 2 thiab cov qauv rau kev them nyiaj yog tib yam.

Kev kho mob kom zoo rau cov ntshav qab zib steroid yog li nram no:

Thim ntawm corticosteroids;
Cov tshuaj insulin;
Kev noj haus;
Noj tshuaj tiv thaiv kab mob;
Kev phais mob.

Nrog rau qhov txawv txav ntawm kev txhim kho tus kab mob (siv cov tshuaj glucocorticoids), nws yog ib qho tsim nyog yuav tsum tso tseg lawv txoj kev tswj hwm thiab xaiv cov qauv zoo dua. Cov theem ntawm kev kho tom ntej yog kev noj haus, kev siv tshuaj hypoglycemic thiab kev kho tshuaj insulin ntau npaum.

Nrog endogenous hypercorticism, thaum ntshav qab zib steroid los ntawm kev ua tsis zoo ntawm lub cev nws tus kheej, kev phais mob tshwm sim feem ntau ua, uas suav nrog tshem tawm cov nqaij ntau ntxiv hauv cov qog adrenal.

Kev siv cov tshuaj tiv thaiv kab mob siab yuav tsum tau ua ke nrog cov tshuaj insulin, txwv tsis pub cov nyhuv tshuaj tsis haum ntawm lawv txoj kev saws me nyuam yuav tsawg heev lossis tsis tuaj kiag li. Qhov no yog vim qhov tseeb tias insulin tso cai rau qee lub sijhawm kom ua haujlwm ntawm cov hlwb ua haujlwm kom zoo thiab pab lawv rov qab ua tiav cov ntaub ntawv tsis pub dhau.

Kev noj zaub mov carbohydrate tsawg yuav txo qis cov carbohydrates noj ib hnub thiab nce cov kev muaj protein thiab zaub mov kom ntau. Raws li kev ua raws li kev noj zaub mov zoo li no, tus neeg lub cev muaj kev noj qab haus huv zoo dua, lub cev xav tau cov tshuaj insulin thiab cov tshuaj txo cov ntshav qab zib tsawg dua, thiab muaj cov ntshav qab zib ntau ntau tom qab noj mov tau tsawg.

Cov tshuaj muaj ntshav qab zib tsis tuaj yeem kho cov ntshav qab zib kom zoo, lawv cov kev nkag mus rau txoj kev noj qab nyob zoo thiab nce ntxiv.

Kev faib tawm tshuaj

Cov tshuaj muaj piam thaj ntau tuaj nyob hauv ntau pawg:

Sulfonylurea derivatives;
Thiazolidinediones;
Alpha glucosidase inhibitors;
Meglitinides;
Incretinomimetics.

Cov khoom siv ntawm sulfonylureas feem ntau siv rau kev kho mob ntshav qab zib hom 2, thiab yog li ntshav qab zib steroid. Lub tshuab ntawm lawv cov kev ua yog los txhawb cov B hlwb ntawm endocrine ib feem ntawm tus txiav, ua tiav los ntawm qhov twg mobilization thiab nce ntau lawm ntawm insulin tshwm sim.

Cov kws kho mob tau mus nqa tshuaj xws li Glycvidon, Chlorpropamide, Maninil, Tolbutamide, Glipizide.

Meglitinides (Nateglinide, Repaglinide) nce insulin ntau lawm thiab qis dua cov piam thaj.

Biguanides (Bagomet, Metformin, Siofor, Glucofage) - cov tshuaj uas lawv ua yog tiv thaiv kev tsim cov piam thaj (gluconeogenesis) thiab txhim kho cov txheej txheem ntawm nws txoj kev siv. Thaum tsis muaj cov tshuaj insulin, cov nyhuv ntawm biguanides tsis pom.

Thiazolidinediones lossis glitazone (Pioglitazone thiab Rosiglitazone) nce rhiab heev ntawm cov leeg, adipose cov nqaij mos thiab mob siab rau insulin, los ntawm kev ua kom lawv cov receptors, thiab tseem txhim kho lipid metabolism.

Alpha-glucosidase inhibitors (Voglibosis, Glucobay, Miglitol) qeeb cov kev puas tsuaj ntawm saccharides, txo qhov tsim thiab nqus ntawm cov piam thaj hauv cov hnyuv.

Cov tshuaj tiv thaiv kabmob ntau ntxiv (Liraglutid, Exenatide, Sitagliptin, Saksagliptin) yog cov chav kawm tshiab ntawm cov tshuaj tiv thaiv kab mob, cov txheej txheem ntawm kev txiav txim ntawm uas yog raws li lub zog ntawm incretins, cov tshuaj hormones zais cia qee yam ntawm cov plab hnyuv me tom qab noj. Lawv cov kev nkag siab ua rau cov kua dej tso tawm ntau dua, txo qis dua cov piam thaj.

Mob ntshav qab zib steroid yog tus cwj pwm kawm los ntawm cov chav kawm nyob ruaj khov thiab muaj benign. Kev kho mob ntawm tus kab mob no yuav tsum muaj txhij txhua thiab suav nrog tsis yog kev txhaj tshuaj insulin thiab kev siv tshuaj txo cov ntshav qab zib, tab sis kuj noj zaub mov thiab ua lub neej muaj sia.

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