Glycated (glycosylated) hemoglobin ke karolo ea hemoglobin e pharalletseng maling e tlameletsoeng ho glucose. Letšoao lena le lekantsoe ka%. Ha tsoekere e eketsehileng ea mali,% e kholo ea hemoglobin e tla glycated. Ena ke tlhahlobo ea bohlokoa ea mali bakeng sa lefu la tsoekere kapa lefu la tsoekere le belaetsang. E bontša ka nepo tekanyo ea tsoekere e maling ka har'a plasma ea mali likhoeling tse 3 tse fetileng. E u lumella ho fumana lefu la tsoekere ka nako 'me u qale ho phekoloa. Kapa khothatsa motho haeba a sena lefu la tsoekere.
Glycated hemoglobin (HbA1C) - sohle seo u hlokang ho se tseba:
- Mokhoa oa ho lokisa le ho nka tlhahlobo ea mali;
- Mefuta ea hemoglobin ea glycated - tafole e bonolo;
- Glycated hemoglobin ho basali baimana
- Seo u lokelang ho se etsa haeba sephetho se phahame;
- Tlhahlobo ea lefu la tsoekere pele, mofuta oa 1 le lefu la tsoekere la mofuta oa 2;
- Ho beha leihlo katleho ea kalafo ea lefu la tsoekere.
Bala sengoloa!
Re tla hlakisa hanghang hore litekanyetso tsa HbA1C bakeng sa bana li tšoana le ho batho ba baholo. Tlhatlhobo ena e ka sebelisoa ho khetholla lefu la tsoekere ho bana, mme ka ho fetisisa, ho lekola katleho ea kalafo. Bacha ba nang le lefu la tsoekere hangata ba loanya likelello tsa bona pele ho litlhahlobo tse tloaelehileng, ba ntlafatsa tsoekere ea bona ea mali, 'me ka hona ba kopanya liphetho tsa bona tsa taolo ea lefu la tsoekere. Ka hemoglobin ea glycated, palo e joalo ha e ba sebeletse. Tlhahlobo ena e bontša ka nepo hore na lefu la tsoekere "o ile a etsa sebe" likhoeling tse 3 tse fetileng kapa a phela ka tsela e "lokileng". Bona le sehlooho se reng "Mofuta oa 1 oa lefu la tsoekere ho bana le bacha."
Mabitso a mang bakeng sa letšoao lena:
- glycosylated hemoglobin;
- hemoglobin A1C;
- HbA1C;
- kapa A1C feela.
Teko ea mali bakeng sa hemoglobin ea glycated e loketse bakuli le lingaka kaofela. E na le melemo ho feta teko ea tsoekere ea mali e potlakileng le tlhahlobo e matla ea tsoekere ea lihora tse peli. Melemo ke ena:
- ho hlahlojoa ha hemoglobin ea glycated ho ka nkoa ka nako efe kapa efe, eseng hakaalo ka mpeng e se nang letho;
- e nepahetse haholo ho feta tlhahlobo ea mali bakeng sa tsoekere e potlakileng, e u lumella ho bona lefu la tsoekere kapele;
- e potlakile ebile e bonolo ho feta teko ea mamello ea glucose ea lihora tse peli;
- e o lumella ho araba potso e hlakileng ea hore na motho o na le lefu la tsoekere kapa che;
- e thusa ho tseba hore na lefu la tsoekere le ile la laola tsoekere ea hae hantle hakae likhoeling tse 3 tse fetileng;
- hemoglobin ea glycated ha e angoe ke liphetoho tse sa feleng tsa nakoana joalo ka sefuba kapa maemo a sithabetsang.
Keletso e ntle: ha u il'o etsa liteko tsa mali - ka nako e tšoanang hlahloba boemo ba hau ba hemoglobin HbA1C.
Tlhahlobo ena e khothalelitsoe ke WHO ho tloha ka 2009 bakeng sa tlhahlobo ea lefu la tsoekere la mofuta oa 1 le mofuta oa 2, le bakeng sa ho lekola katleho ea kalafo.
Seo sephetho sa tlhatlhobo ena SE SE SEBETE ho:
- nako ea letsatsi ha ba nehelana ka mali;
- ho e fepa kapa ka mor'a ho ja;
- ho sebelisa meriana e meng ntle le lipilisi tsa lefu la tsoekere;
- ho ikoetlisa;
- boemo ba maikutlo ba mokuli;
- sefuba le tšoaetso e 'ngoe.
Hobaneng u etsa tlhahlobo ea mali bakeng sa hemoglobin ea glycated
Taba ea pele, ho fumana lefu la tsoekere kapa ho hlahloba kotsi ea motho ea ho ba le lefu la tsoekere. Taba ea bobeli, ho hlahloba le lefu la tsoekere hore na mokuli o khona ho laola lefu lena joang le ho boloka tsoekere ea mali e le haufi le e tloaelehileng.
Bakeng sa tlhahlobo ea lefu la tsoekere, letšoao lena le 'nile la sebelisoa ka molao (ka khothaletso ea Mokhatlo oa Lefatše oa Bophelo) ho tloha ka 2011, mme e se e le loketseng bakuli le lingaka.
Mefuta ea hemoglobin e glycated
Liphetho tsa bohlahlobo,% | Ho bolelang |
|---|---|
< 5,7 | Ka metabolism ea carbohydrate o phetse hantle, menyetla ea lefu la tsoekere ha e lekane |
5,7-6,0 | Ha ho na lefu la tsoekere hona joale, empa kotsi ea hae e eketsehile. Ke nako ea ho fetohela lijong tsa carb tse tlase bakeng sa thibelo. Ho boetse ho bohlokoa ho botsa hore na metabolism syndrome le ho hanyetsa insulin ke eng. |
6,1-6,4 | Kotsi ea lefu la tsoekere e phahame haholo. Fetohela bophelong bo phetseng hantle, 'me, haholo-holo, ho ja lijo tse nang le lik'habohaedreite tse tlase. Ha ho kae kapa kae moo u ka qalang. |
≥ 6,5 | Tlhahlobo ea mantlha e entsoe ka lefu la tsoekere. Hoa hlokahala ho etsa liteko tse eketsehileng ho e tiisa kapa ho e hana. Bala sehlooho se reng, "Tlhahlobo ea lefu la tsoekere la mofuta oa 1 le mofuta oa 2". |
Ha a le tlase tlase hemoglobin ea glycated ho mokuli, lefu la tsoekere la hae le ile la putsoa likhoeling tse 3 tse fetileng.
Tokomane ea HbA1C ho tekanyo ea glucose e tloaelehileng ho plasma ea mali bakeng sa likhoeli tse 3
| HbA1C,% | Glucose, mmol / L | HbA1C,% | Glucose, mmol / L |
|---|---|---|---|
| 4 | 3,8 | 8 | 10,2 |
| 4,5 | 4,6 | 8,5 | 11,0 |
| 5 | 5,4 | 9 | 11,8 |
| 5,5 | 6,5 | 9,5 | 12,6 |
| 6 | 7,0 | 10 | 13,4 |
| 6,5 | 7,8 | 10,5 | 14,2 |
| 7 | 8,6 | 11 | 14,9 |
| 7,5 | 9,4 | 11,5 | 15,7 |
Teko ea mali bakeng sa hemoglobin ea glycated: melemo le likotsi
Teko ea mali bakeng sa HbA1C, ha e bapisoa le tlhahlobo ea tsoekere e potlakileng, e na le melemo e 'maloa:
- motho ha a qobelloe ho ba le mpa e se nang letho;
- mali a bolokiloe ka bonolo ka mothong oa liteko ho fihlela tlhahlobo ea hang-hang (botsitso ba preanalytical);
- glucose e potlakileng ea plasma e ka fapana haholo ka lebaka la khatello ea maikutlo le mafu a tšoaetsanoang, mme hemoglobin e tsitsitseng haholoanyane.
Teko ea mali bakeng sa hemoglobin ea glycated e u lumella ho bona lefu la tsoekere ho tloha qalong, ha tlhahlobo ea tsoekere e potlakileng e ntse e bonts'a hore tsohle li tloaelehile.
Mathata a tlhahlobo ea mali ea hemoglobin e glycated:
- theko e phahameng haholo ha e bapisoa le tlhahlobo ea tsoekere ea mali ho plasma (empa ka potlako le ka mokhoa o bonolo!);
- bathong ba bang, khokahano lipakeng tsa HbA1C le boemo ba glucose bo itekanetseng;
- ho bakuli ba nang le phokolo ea mali le hemoglobinopathies, liphetho tsa tlhahlobo lia sotha;
- libakeng tse ling tsa naha, bakuli ba ka ba ha ba na kae kapa kae ho etsa tlhahlobo ena;
- ho nahanoa hore haeba motho a nka tekanyetso e phahameng ea livithamini C le / kapa E, joale tekanyo ea hemoglobin ea hae e tlaase ka thetso (ha e netefatsoe!);
- Litekanyetso tse tlaase tsa lihomone tsa qoqotho li ka etsa hore HbA1C e eketsehe, empa tsoekere ea mali ha e hlile ha e eketsehe.
Haeba o fokotsa HbA1C bonyane 1%, menyetla ea mathata a lefu la tsoekere e tla fokotseha hakae:
| Type 1 lefu la tsoekere | Retinopathy (pono) | 35% ↓ |
| Neuropathy (tsamaiso ea methapo, maoto) | 30% ↓ | |
| Nephropathy (liphio) | 24-44% ↓ | |
| Type 2 lefu la tsoekere | Liphetoho tsohle tsa methapo e metona | 35% ↓ |
| Lefu le amanang le lefu la tsoekere | 25% ↓ | |
| Myocardial infarction | 18% ↓ | |
| Kakaretso ea batho ba shoang | 7% ↓ |
Glycated hemoglobin nakong ea kemolo
Hlycated hemoglobin nakong ea kemolo ke e 'ngoe ea liteko tse ka etsoang ho laola tsoekere ea mali. Leha ho le joalo, hona ke khetho e mpe. Nakong ea kemolo, ho molemo ho se fane ka hemoglobin ea glycated, empa ho hlahloba tsoekere ea mali ea mosali ka litsela tse ling. Ha re hlalose hore na hobaneng ho le joalo, 'me re bue ka likhetho tse nepahetseng haholoanyane.
Kotsi ea tsoekere e eketsehileng ho basali baimana ke efe? Pele ho tsohle, taba ea hore ngoana o hlaha e kholo haholo, mme ka lebaka lena ho tla ba le tsoalo e boima. Kotsi ea ho bo-mme le ea ngoana ea eketseha. Re sa bue ka litlamorao tse telele tsa nako e telele ho bona ka bobeli. Ho eketsa tsoekere ea mali nakong ea kemolo ho senya methapo ea mali, liphio, mahlo a mahlo, joalo-joalo liphetho tsa sena li tla hlaha hamorao. Ho ba le ngoana ke halofo ea ntoa. Hoa hlokahala hore o ne a ntse a e-na le bophelo bo botle bo lekaneng ho mo holisa ...
Tsoekere ea mali nakong ea kemolo e ka eketseha esita le ho basali bao ho seng mohla ba kileng ba tletleba ka bophelo bo botle ba bona. Ho na le lintlha tse peli tsa bohlokoa mona:
- Tsoekere e phahameng ha e bake matšoao. Hangata mosali ha a belaelle letho, leha a e-na le tholoana e kholo - senatla se boima ba 4-4,5 kg.
- Tsoekere ha e tsoele ka mpeng e se nang letho, empa ka mor'a lijo. Kamora ho ja, o lula a phahamisitse lihora tse 1-4. Lekhetlong lena, o etsa mosebetsi oa hae oa ho senya. Ho noka tsoekere hangata ho tloaelehile. Haeba tsoekere e phahamisitsoe ka mpeng e se nang letho, taba eo e mpe haholo.
Hobaneng ha tlhahlobo ea mali bakeng sa hemoglobin ea glycated le eona e sa lokela? Hobane o amohela morao haholo. Hemoglobin ea Glycated e hola feela ka mor'a hore tsoekere ea mali e bolokoe e le telele ka likhoeli tse 2-3. Haeba mosali a nyolla tsoekere, joale hangata sena ha se etsahale pejana ho tloha khoeling ea 6 ea kemolo. Tabeng ena, hemoglobin ea glycated e tla eketseha feela ka likhoeli tse 8-9, e se e le nakoana pele e tsamaisoa. Haeba mosali oa moimana a sa laole tsoekere ea hae pele, ho tla ba le litlamorao tse mpe ho eena le ho lesea la hae.
Haeba hemoglobin ea glycated le tlhahlobo ea mali e potlakileng ea tsoekere e sa lokela, joale u ka hlahloba tsoekere ho basali baimana joang? Karabo: e lokela ho hlahlojoa kamora ho ja khafetsa libeke tse ling le tse ling tse 1-2. Ho etsa sena, o ka nka tlhahlobo ea glucose ea lihora tse peli ka laboratoring. Empa ke ketsahalo e telele le e khathatsang. Ho bonolo ho reka mitha ea glucose e nepahetseng ea lapeng le ho lekanya tsoekere 30, 60 le 120 metsotso ka mor'a lijo. Haeba sephetho se sa phahame ho feta 6.5 mmol / l - se nepahetse. Ka boholo ba 6.5-7.9 mmol / l - mamello. Ho tloha ho 8,0 mmol / l le ho feta - e mpe, o hloka ho nka mehato ea ho fokotsa tsoekere.
Boloka lijo tse nang le lik'habohaedreite tse tlase, empa u je litholoana, lihoete le lihoete letsatsi le leng le le leng ho thibela ketosis. Ka nako e ts'oanang, ho ima ha se lebaka la ho itlohella ho ja ho feta ka liswiti le lihlahisoa tsa phofo. Bakeng sa tlhaiso-leseling e batsi, bona lingoloa tsa Pregants Diabetes and Gestational Diabetes.
Lipheo tsa lefu la tsoekere la HbA1C
Keletso ea semolao ea lefu la tsoekere ke ho fihlela le ho boloka boemo ba HbA1C ba <7%. Tabeng ena, lefu la tsoekere le nkoa le koahetsoe hantle, 'me menyetla ea mathata ha e nyane. Ho joalo, ho molemo le ho feta haeba index ea hemoglobin ea glycated e ka har'a bongata bo tloaelehileng bakeng sa batho ba phetseng hantle, i.e., HbA1C <6.5%. Leha ho le joalo, Dr. Bernstein o lumela hore le ha a na le hemoglobin e glycated ea 6.5%, lefu la tsoekere ha le koahetsoe hantle, 'me mathata a lona a eketseha ka potlako. Ho batho ba phetseng hantle, ba masesaane ba nang le metabolism e tloaelehileng ea carbohydrate, hemoglobin ea glycated hangata ke 4.2-4.6%. Sena se tsamaisana le tekanyo ea glucose e tloaelehileng ea 4-4.8 mmol / L. Ke seo re hlokang ho se loanela kalafo ea lefu la tsoekere, mme ha e le hantle ha ho thata ho se fihlela haeba o fetohela ho ja lijo tse nang le lik'habohaedreite tsa mofuta oa 1 kapa mofuta oa 2 lefu la tsoekere.
Bothata ke hore ha lefu la tsoekere la mokuli le buseletsoe, le ba le menyetla ea ho ba le khatello ea maikutlo ka tšohanyetso le hypoglycemic coma. Ho leka ho laola lefu la hae la tsoekere, mokuli o tlameha ho boloka tekano pakeng tsa tlhokahalo ea ho boloka tsoekere e tlase ea mali le ts'okelo ea hypoglycemia. Ena ke bonono bo rarahaneng boo motho ea nang le lefu la tsoekere a ithutang le ho bo etsa bophelong bohle ba hae. Empa haeba u latela lijo tse nang le phepo e ntle le tse nang le phepo e ntle, joale bophelo bo tla ba bonolo. Hobane lik'habohaedreite tse nyane tseo u li jang, ha u fokola u tla hloka lipilisi tsa insulin kapa tse theolelang tsoekere. Ha insulin e le tlase haholo, e fokotsa menyetla ea ho ba le hypoglycemia. E bonolo ebile e sebetsa.
Bakeng sa batho ba baholo ba nang le tebello ea bophelo e sa lebelloang ea lilemo tse ka tlase ho 5, tekanyo ea hemoglobin ea glycated e nkoa e tloaelehile 7.5%, 8% kapa esita le e phahameng haholo. Sehlopheng sena sa bakuli, kotsi ea hypoglycemia e kotsi haholo ho feta monyetla oa ho ba le mathata a lefu la tsoekere kapele. Ka nako e ts'oanang, bana, bacha, basali baimana, batho ba banyane - ho kgothaletsoa ka matla ho leka le ho boloka boleng ba bona ba HbA1C <6.5%, kapa ho feta, ka tlase ho 5%, joalo ka ha Dr. Bernstein a ruta.
Algorithm bakeng sa khetho ea motho ka mong ea lipheo tsa kalafo ea lefu la tsoekere ho latela HbA1C
| Bofetoheli | Mongoaha | ||
|---|---|---|---|
| nyane | ka karolelano | botsofe le / kapa tebello ea bophelo * <lilemo tse 5 | |
| Ha ho na mathata a tebileng kapa kotsi ea hypoglycemia e matla | < 6,5% | < 7,0% | < 7,5% |
| Mathata a tebileng kapa kotsi ea ho ba le hypoglycemia e matla | < 7,0% | < 7,5% | < 8,0% |
* Nako ea bophelo - tebello ea bophelo.
Mefuta e latelang ea glucose e latelang ea ho itima lijo le lihora tse peli ka mor'a lijo (postprandial) e tla lumellana le litekanyetso tsena tsa hemoglobin e glycated:
| HbA1C,% | Pheha lero la plasma / pele ho lijo, mmol / l | Glucose ea plasma lihora tse peli ka mor'a lijo, mmol / l |
|---|---|---|
| < 6,5 | < 6,5 | < 8,0 |
| < 7,0 | < 7,0 | < 9,0 |
| < 7,5 | < 7,5 | <10,0 |
| < 8,0 | < 8,0 | <11,0 |
Boithuto ba nako e telele bolemong ba bo-1990 le bo-2000 bo pakile ka mokhoa o kholisang hore tlhahlobo ea mali bakeng sa hemoglobin e glycated e lumella ho bolela monyetla oa ho ba le mathata a lefu la tsoekere ho se hobe le ho bile ho le betere ho feta ho itima lijo ka lero la plasma.
Ke hangata hakae ho etsa tlhahlobo ea mali bakeng sa hemoglobin ea glycosylated:
- Haeba hemoglobin HbA1C ea hau e le tlase ho 5.7%, ho bolela hore ha u na lefu la tsoekere mme kotsi ea eona ha e na bohlokoa, ka hona, o hloka feela ho laola letšoao lena hanngoe ka mor'a lilemo tse tharo.
- Tekanyo ea hau ea hemoglobin ea glycosylated e pakeng tsa 5.7% - 6.4% - e nke hape selemo se seng le se seng hobane ho na le kotsi e eketsehileng ea lefu la tsoekere. Ke nako ea hore o fetole lijo tse nang le lik'habohaedreite tse fokolang bakeng sa ho thibela lefu la tsoekere.
- U na le lefu la tsoekere, empa u le laola hantle, i.e. HbA1C ha e fete 7%, - maemong ana, lingaka li khothaletsa ho etsa boithuto bocha ka likhoeli tse ling le tse ling tse tšeletseng.
- Haeba u sa tsoa qala ho phekola lefu la hau la tsoekere kapa u fetotse mofuta oa hau oa kalafo, kapa o ntse o sa khone ho laola tsoekere e maling, o lokela ho hlahloba HbA1C ka hloko likhoeli tse ling le tse ling tse tharo.
Re khothaletsa bakuli ho etsa tlhahlobo ea mali bakeng sa hemoglobin ea glycosylated le liteko tsohle tsa mali le tsa urine - eseng litsing tsa sechaba, empa ka laboratoring e ikemetseng. E lakatseha lifeme tsa "marang-rang", ke hore, lihlopheng tse kholo tsa naha kapa esita le tsa machabeng. Hobane ho na le monyetla o moholo oa hore tlhahlobo eo e hlile e tla etsoa ho uena, ho e-na le ho ngola sephetho “ho tsoa siling”.
