Hoʻomau pinepine ʻia nā maʻi mellitus i kahi hana latent a hoʻopuni ʻia me nā hoʻopiʻi like ʻole. I mea e pale ai i ka palaka, pono ia i lalo i kekahi mau aʻo. I mea e hoʻoholo ai i nā hoʻokolohua kūpono, pono ʻoe e kamaʻilio i ke kauka a ʻike i ka nui o ka hoʻokolokolo no nā māka maʻi o ka maʻi maʻi.
ʻEono mau makahiki o ka maʻi diabetes e ʻike i ka lāʻau lapaʻau. ʻIke ʻia ka predisposition hereditary ʻo ke ʻano ʻokoʻa pū ʻiliʻili o nā ʻano genes.
Hoʻokaʻawale nā mea hōʻailona a pau o nā maʻi o ka ʻano mua i loko o ka immunological, genetic a me ka metabolic.
Hoʻohālikelike huakini
Kuhi ʻia ke kaiāulu hou i ka hoʻāʻo no ka maʻi diabetes i kekahi mau kuʻuna o ka heluna. ʻO ka mea mua, pono ia no nā poʻe i hiki i ka makahiki 45 a ʻoi aʻe paha. Inā maikaʻi ʻole ka hopena, e hoʻopaʻa ʻia ana ka ʻike ma kēlā me kēia mau makahiki ʻekolu.
Pono nā mea maʻi ma ka wā ʻōpio i nā kaʻina hana me:
- momona momona
- laa hiʻona,
- ʻiallelo ʻia a ʻōiwi paha i kekahi hui;
- maʻi maʻi maʻi gestational
- haʻi maʻi
- ʻoi aku ka hānau ʻana ma mua o 4.5 kg,
- glycemia kiʻekiʻe ma ka ʻōpū ʻole.
No ka screening decentralized a me centralized, ʻoi ʻia e hoʻoholo i ke kiʻekiʻe o ka glucose a me ka hemoglobin A1c. ʻO kēia he hemoglobin, kahi e pili ai ka molekui glucose ma kahi moleklo hemoglobin.
Hoʻopili ke Glycosylated hemoglobin me ka glucose koko. Hoʻohana ia e like me kahi hōʻailona o ka pae o nā kaohi kino o ka metabolism no ʻekolu mau mahina ma mua o ka nānāʻana. ʻO ka helu o ka hoʻolālā HbA1c ka mea i hilinaʻi i ka nui o ka hyperglycemia. Ka pae ʻana o kona pae i ke koko e hele i 4-5 mau pule ma hope o ka euglycemia.
Hoʻoholo ʻia ka nui o ka HbA1c inā lilo ia i mea e kaohi ai i ka metabolism momololi a hoʻopaʻa ʻia i kona uku uku i nā maʻi maʻi maʻi i hala.
Nā hiʻohiʻona huakaʻi
No ka hana ʻana i kahi maʻi a hana i kahi kāʻei ʻana i ke ʻano o ka patology, pono ʻoe e hele i kekahi o nā kaʻina diagnostic.
ʻO ka mea mua, he mau palapala hulina maʻi maʻamau, ʻo ia hoʻi ka ʻike ʻana i ka glucose ma o ka hōʻike ʻana i ka urine a me ke koko, me ka hoʻāʻo ʻana no ka ketones a me ka hoʻāʻo ʻana i ka glucose.
Eia kekahi, ua hana ʻia kahi loiloi:
- HbA1c;
- fructosamine;
- microalbumin;
- hana manu;
- lehelehe lipid.
Aia kekahi mahele hou e pili ana i ka noiʻi ʻana i ka maʻi diabetes, kahi e hiki ai ke ʻohi i ka hoʻomohala ʻana i ka maʻi maʻi, i kēia wehewehe:
- C peptide
- Nā halepakena insulin
- mea maʻiʻo i nā mokupuni o Langengars a me ka poulosine phosphatase,
- pololi
- ghrelin, raschistina, leptin, adiponectin,
- Paʻi HLA.
I mea e hoʻoholo ai i ka patolo no kekahi mau makahiki, ua noi nā kauka e hana i kahi loiloi o ke kō. I kēia mau makahiki i hala, ua ʻike ʻia he mea e hoʻākāka ʻia ma waena o ke ana o ke kō koko koko, nā ʻeleʻelima vascular mua a me ko lākou pae i ka ulu ʻana; ʻaʻole i ʻike ʻia me kahi mea hōʻike o ke kōʻai wikiwiki, akā me ke ʻano o kona hoʻonui ma hope o ka ʻai ʻana. Ua kapa ʻia kēia ma ka hyperglycemia postprandial.
Hiki i nā hōʻailona āpau o ke ʻano maʻi maʻi 1 ke hoʻokaʻawale ʻia e like me kēia:
- lawena
- immunological aʻai
- kaʻaloa.
Paʻi HLA
ʻO ka maʻi diabetes mellitus, e like me nā manaʻo o ka lāʻau lapaʻau o kēia wā, aia kahi hoʻomaka koʻikoʻi, akā he lōʻihi lōʻihi. E ʻike ʻia nā pae ʻeono i ka hoʻokumu ʻia ʻana o kēia ʻano pathology. ʻO ka mea mua o kēia ke kumu o ka predisposition hoʻoilina a i ʻole ka haʻalele ʻana i nā ʻano pili i pili i ka maʻi diabetes 1.
He mea pono ke kuhikuhi ʻana i mua o ka HLA antigens, koʻikoʻi ka papa ʻelua: DR 3, DR 4, DQ, nui loa. Loaʻa ka paʻakikī o ka hoʻokumuʻana o ka pathology i kēia hihia i mau manawa. I kēia manawa, kahi predisposition hoʻoilina i ka helehelena o nā ʻano ʻano maʻi mua i manaʻo ʻia he hui pū ʻana o kekahi alelē o nā ʻano maʻamau.
ʻO nā hōʻailona ākeaʻoi loa no nā maʻi ʻano 1 ka HLA antigens. Aia nā hiʻohiʻona haplotypes i kahi ʻano maʻamau o ka maʻi type 1 i ʻike ʻia ma 77% o ka poʻe me ka maʻi maʻi. 6: loaʻa nā haplotypes i manaʻo ʻia he mea pale.
Nā Antibodies a Langerhans Islet Cells
Ma muli o ka hana ʻana o nā autoantibodies i nā sela o nā mokupuni o Langerhans, ua luku ʻia nā mea hope loa, ka mea e alakaʻi ai i ka synthesis o ka insulin a me ke ʻano o kahi kiʻi i hoʻohālikelike ʻia ai i ka maʻi maʻamau.
Kēia mau ʻano hana i koho ʻia a nānā ʻole ma muli o nā ʻano like ʻole.
I waena o nā mea maʻamau ka:
- nā maʻi maʻi
- ka hana a nā mea ʻona
- nā kaumaha like ʻole.
ʻO ke ʻano maʻi mua o ka maʻi kau ʻia e kahi ʻano prediabetes me nā hōʻailona ʻole, hiki iā ia ke mau i nā makahiki he nui. Hiki ke hōʻike ʻia i ka synthesis a me ka huni o ka insulin i kēia manawa ma o ka hoʻopaʻa ʻana o ke kūpaʻa glucose.
I nā lāʻau lapaʻau, nā hihia o ka loaʻa ʻana o nā mea maʻi i ʻewalu a i ʻole paha mau makahiki ma mua o ka wehewehe ʻana o ka hoʻomaka ʻana o ke kiʻi o ka maʻi i ka maʻi. ʻO ka hoʻākāka ʻana o kēia mau antibodies e pono e hoʻohana i kahi maʻi o ka maʻi type o ka maʻi type 1.
I ka poʻe me nā antibodies, e hoʻohaʻahaʻa ka nui o ka cell islet, kahi e hōʻike ʻia ana e ka mea hōʻino o ka huna ʻana o ka insulin. Inā hoʻopau loa ia ka ʻina, a laila hele mai ka tohu maʻi o ka maʻi maʻamau o kēia ʻano like ʻole.
Hōʻike kekahi mau haʻawina aia i kēia mau antibodies i 70% o nā mea pane me nā maʻi maʻi maʻi maʻi hou 1 hou. I ka kaohi hoʻomalu non-maʻi maʻi aia wale nō 0.1-0,5% o nā hihia o ka ʻike i nā antibodies.
Hiki ke loaʻa kēia mau antibodies i nā hoahānau o nā maʻi maʻi maʻi. Loaʻa i kēia pūʻulu o ka poʻe kahi kiʻekiʻe predisposition i ka maʻi. Hōʻike nā haʻawina he nui nā ʻohana me nā antibodies e hoʻomohala i ke ʻano type type 1 i ka manawa lōʻihi.
ʻO nā māka o kekahi ʻano ʻano like ʻole o ka mellitus type 2 ke komo pū ma kēia noiʻi. Ua hōʻike ʻia e nā ʻepekema ʻo ka hoʻoholo ʻana i ke kiʻekiʻe o kēia mau antibodies i ka maʻi maʻi me ka lua o nā maʻi e kōkua pono i ka wehewehe ʻana ma mua o ka puka ʻana o ke kiʻi lapaʻau, a hoʻomaʻamaʻa i ka hoʻonohonoho ʻana o nā dosis o ka lapaʻau insulin. No laila, i ka poʻe maʻi maʻi me ka lua o nā maʻi, hiki ke wānana i ka hoʻonui hou ʻana o ka hilinaʻi i ka insulin hormone.
Loaʻa nā antibodies i ka inika ma kahi o 40% o nā poʻe me ka maʻi diabetes. Aia kekahi manaʻo e pili ana i ka pilina ma waena o nā antibodies i ka insulin a me nā antibodies i nā pūloli islet.
Aia ka mea ma mua o ke ʻano o ka prediabetes a me ka hoʻomaka ʻana i nā hōʻailona o ka maʻi maʻi maʻi 1.
Hoʻopili ka glatamic acid decarboxylase
ʻO ka manawa nei, ua ʻike ka poʻe ʻepekema i ka antigen nui, ʻo ia ka mea i makemake ai no ka autoantibodies e pili pū ana me ka hoʻokumu ʻia ʻana o kahi ʻano hana i kūlia i ka maʻi diabetes. He decarboxylase o ka mana glutamic.
ʻO kēia waikawa he membrane enzyme e koi ana ka biosynthesize i ka neurotransmitter CNS-gamma-aminobutyric acid. I loa ʻike ka hoʻokūkū o ka enzyme i nā poʻe me nā pilikia o ke kinima.
ʻO Antibodies a GAD ka mea maopopo loa no ka hōʻailona ʻana i ka mokuahi prediabetic. No laila, hiki ke kuhikuhi pono i kahi hopena kiʻekiʻe o ka hoʻomohala ʻana i ka maʻi diabetes mika. Me ka hoʻokumuʻana o ka asymptomatic o kēia maʻi, hiki ke ʻike i nā antibodies i GAD i nā kānaka ʻehiku mau makahiki ma mua o nā hōʻike hōʻike mai o ka maʻi.
ʻO ka hilinaʻi nui a ʻike i waena o nā poʻe ʻepekema e noʻonoʻo ʻia ka ʻike like ʻana o kekahi mau māka i ke koko. Hoʻomaopopo ka hōʻailona ma 20% o ka ʻike, ʻelua mau hōʻailona e hōʻike ana i ka 44% o ka ʻike, a he ʻekolu mau hōʻailona hōʻailona ka 95% o ka ʻike.
ʻO nā māka maʻi Autoimmune
I ka maʻi maʻi, ka pili o nā mea pono o ka autoantibodies i ka wahine a me ka makahiki. ʻO nā antibodies i nā antigens a me nā antibodies i nā loko o ka islet, e like me ke kānāwai, aia ka poʻe ma mua o nā pākeke. ʻO nā antibodies i ka glaramic acid decarboxylase, ma ka hapa nui, loaʻa i nā wahine.
ʻO ka predisposition i ka hoʻokumu ʻia ʻana o nā ʻano ʻano like o ka autoantibodies ka ʻike like ʻana o nā ʻano like o nā ʻano o ka HLA, no ka mea, ʻo ka autoantibodies i ka insulin, nā loko o nā islet me islet antigen 2 i ʻike pinepine ʻia i nā kānaka me HLA - DR 4 / DQ 8 (DQA 1 * 0301 / DQB 1 * 0302). I ka manawa like, loaʻa nā antibodies i ka glutamic acid decarboxylase i ka poʻe me nā HLA genotypes - DR 3 DQ 2 (DQA 1 * 0501 / DQB 1 * 0201).
Nui nā ʻano o ka autoantibodies e hele pinepine i ka maʻi maʻi maʻi ʻōpio, aʻo nā poʻe me ka maʻi maʻamau maʻi autoimmune i hoʻokahi ʻano o autoantibody wale nō.
ʻO nā antibodies i ka glaramic acid decarboxylase ma waena o nā maʻi pākeke me nā ʻano pathology mua, akā ke kiʻekiʻe nō hoʻi ke alapine nui i nā poʻe me nā phenotypes o ka ʻano ʻelua o ka maʻi.
ʻO ka hoʻoholo ʻana i kēia mau antibodies e hiki ai ke ʻike i nā hihia he nui o ka autoimmunity, inā ʻo ia wale nō ka māka no ka pākeke pākeke.
Uku kumukūʻai
Manaʻo pinepine ʻia nā poʻe me ka maʻi ʻaʻai maʻi i ka nui o ke kaomi ʻana o nā maʻi maʻi maʻi maʻi. Aia kekahi mau kikoʻī e hōʻike ʻia ana e ka nui o nā kikoʻī.
Kahi palapala loiloi i kapa ʻia ʻo "ka mālama ʻana i ka maʻi diabetes" pili i kahi glucose koko a me ka hōʻike hoʻāʻo ʻana.
Eia kekahi, aia ka ʻike i ke ʻano:
- glycated hemoglobin analahi,
- triglycerides
- huʻeluʻi kolamu
- ʻAlaola HDL
- LDL kolamu,
- albumin urinary
- homocek,
- Hōʻike hōʻike,
- ka glucose i loko o ka urine.
ʻO ke kumukūʻai o ia ʻano nānā loiloi like ka 5 tausani rubles.
Hoʻohui ka palapala:
- ka nānā wailua o ke koko
- hemoglobin glycated.
ʻO ke kumukūʻai loiloi e pili ana i 900 rubles.
Nā hōʻailona hōʻailona Autoimmune:
- nā antibio i ka insulin
- nā antibodies i ka phatase tyrosine.
- palamo decarboxylase olakino,
- nā antibodies i ka phatase tyrosine.
ʻO kēia ʻano kikoʻī e kūʻai ʻoi aku i 4 tausani rubles.
Ma kahi o nā hōʻike insulin e kūʻai i nā 450 rubles, kahi C-peptide test e kūʻai i 350 rubles.
Diagnosis i ka wā hāpai
Lawe ʻia kahi hōʻike holi koko ma luna o ka ʻōpū ʻole. E hoʻomaka ʻia ka weliweli e kahi hōʻailona o ka 4.8 mmol / mai ka manamana lima a me 5.3 - 6.9 mmol / l mai ka pua. Ma mua o ka hoʻopaʻa ʻana i nā hoʻokolohua, ʻaʻole pono nā wahine e ʻai i ka meaʻai no nā hola 10.
Ke lawe nei i kahi fetus, hiki ke hoʻokō ʻia kahi hōʻike hoʻonaninani glucose. No kēia, ua inu kekahi wahine i ka g o ka glucose i loko o kahi aniani o ka wai. Ma hope o 2 mau hola, ua ʻōlelo hou ʻia ka paukū koko. Ma mua o ke ʻano loiloi, ʻaʻole pono ʻoe e kau palena iā ʻoe iho i ka mālama. ʻAle ʻole kaʻai.
Inā loaʻa nā hōʻailona o ka maʻi maʻi, ʻaʻole ʻoe e hoʻopiʻi i ka kūkākūkā ʻana me kāu kauka. ʻO ka hoʻomaopopo ʻana i ka maʻi i ka wā mua e kōkua i ka pani ʻana i ka holomua o ka maʻi a me ka hoʻomohala ʻana i nā ʻōlelo hoʻopilikia hoʻoweliweli. Pono pololei nā hopena noiʻi, no kēia mea pono ʻoe e hahai i nā lula āpau o ka hoʻomākaukau no ka nānā ʻana.
Pehea e hoʻoili ʻia ai ka maʻi maʻi? E haʻi kekahi loea i ke wikiō ma kēia ʻatikala.
