Lefu la tsoekere khafetsa le hlaha ka mokhoa o iphemisang mme le na le mathata a mangata. Bakeng sa ho thibela ts'ebetso ea methapo ea mafu, ho bohlokoa ho feta lithuto tse ling. Ho fumana liteko tse hlokahalang, o lokela ho bona ngaka le ho fumana hore na tlhahlobo ea matšoao a lefu la tsoekere e bokae.
Mehato e tšeletseng ea lefu la tsoekere e tsebahala ho tsa bongaka. Bohloeki ba moea oa bongoana bo bonoa e le motsoako o ikhethang oa liphatsa tsa lefutso.
Matšoao ohle a lefu la mofuta oa pele a arotsoe ho immunological, genetic le metabolic.
Tlhatlhobo ea lefu la tsoekere
Sechaba sa morao tjena sa bongaka se khothaletsa tlhahlobo ea lefu la tsoekere mefuteng e meng ea baahi. Pele ho tsohle, ho hlokahala bakeng sa batho ba seng ba fihlile lilemo tse 45 kapa ho feta. Haeba sephetho se le seng, tlhahlobo e etsoa lilemo tse ling le tse ling tse tharo.
Bakuli ba sa le banyenyane ba lokela ho latela lits'ebetso le:
- ho nona haholo
- lefa le ts'oanang
- morabe kapa morabe oa sehlopha se itseng,
- lefu la tsoekere
- khatello ea mali
- malinyane a boima bo fetang kilo tse 4,5,
- glycemia e phahameng ka mpeng e se nang letho.
Bakeng sa tlhahlobo e arotsoeng le e bohareng, ho khothaletsoa ho tseba boemo ba glucose le hemoglobin A1c. Ena ke hemoglobin, moo molek'hule ea glucose e hokahaneng le molek'hule ea hemoglobin.
Glycosylated hemoglobin e lumellana le tsoekere ea mali. E sebetsa e le sesupo sa boemo ba metabolism ea carbohydrate bakeng sa likhoeli tse tharo pele ho tlhahlobo. Tekanyo ea sebopeho sa HbA1c e itšetlehile ka boholo ba hyperglycemia. Tsamaiso e tloaelehileng ea boemo ba eona maling e hlaha libeke tse 4-5 kamora ho euglycemia.
Palo ea HbA1c e khethiloe haeba ho hlokahala hore e laole metabolism ea carbohydrate mme e netefatse puseletso ea eona ho bakuli ba lefu la tsoekere ba neng ba kula ka nako e telele.
Lits'oants'o tsa Tlhahlobo
Ho etsa tlhahlobo le ho etsa tlhahlobo e felletseng ea methapo, o hloka ho latela lits'ebetso tse 'maloa tsa tlhahlobo ea mafu.
Pele ho tsohle ke litemana tsa khale tsa laboratori, e leng lipatlisiso tsa tsoekere ka sampole ea moroto le mali, hammoho le tlhahlobo ea liteko tsa li-ketone le tsoekere ea glucose.
Ntle le moo, tlhahlobo e etsoa ho:
- HbA1c;
- fructosamine;
- microalbumin;
- urinine e hlahisang metsi;
- lipid profil.
Ho na le tlhahlobo e 'ngoe ea lipatlisiso tsa lefu la tsoekere, e etsang hore ho khonehe ho laola nts'etsopele ea lefu la tsoekere, tlhaloso ena:
- C peptide
- li-antibodies tsa insulin
- antibodies to islets of Langengars le tyrosine phosphatase,
- li-antibodies tsa glutamic acid decarboxylase,
- ghrelin, raschistina, leptin, adiponectin,
- HLA thaepa.
Ho tseba lefu la tsoalo ea kelello ka mashome a lilemo, lingaka li khothalelitse ho etsa tlhahlobo ea tsoekere e potlakileng. Lilemong tsa morao tjena, ho fumanoe hore ho na le khokahano e hlakileng haholoanyane pakeng tsa maemo a tsoekere ea mali, tlhekefetso ea methapo le boemo ba bona ba nts'etsopele; ha e fumanoe ka matšoao a tsoekere e potlakileng, empa ka tekanyo ea keketseho ea eona kamora ho ja. Sena se bitsoa postprandial hyperglycemia.
Matšoao ohle a lefu la tsoekere la 1 a ka aroloa ka tsela e latelang:
- liphatsa tsa lefutso
- immunological
- metabolic.
HLA thaepa
Lefu la tsoekere la lefu la tsoekere, ho ea ka maikutlo a bongaka ba sejoale-joale, le tšimoloho e mpe, empa ke nako e telele ea morao. Mehato e tšeletseng e tsejoa ho thehoeng ha Psychology ena. Ea pele ho tsena ke boemo ba lefutso kapa lefutso la lefutso le amanang le lefu la tsoekere la mofuta oa 1.
Re lokela ho supa hore boteng ba li-antigen tsa HLA, haholo sehlopha sa bobeli: DR 3, DR 4, DQ, e bohlokoa. Kotsi ea ho etsoa ha methapo ea methapo ea methapo ntlheng ena e eketsa makhetlo a 'maloa. Hajoale, sepheo sa lefutso ho ponahalo ea mofuta o fapaneng oa lefu la pele se nkuoa e le motsoako oa mefuta e 'maloa ea mefuta e tloaelehileng.
Matšoao a nang le tlhaiso-leseling ka ho fetisisa bakeng sa lefu la 1 ke li-antigen tsa HLA. Li-haplotypes tse nang le tšobotsi ea mofuta oa lefu la tsoekere la 1 li fumanoa ho batho ba mashome a robeli a metso e robeli (78) ba nang le lefu la tsoekere. 6: e na le li-haplotypes tse nkoang li sirelletsa
Li-antibodies ho Langerhans Islet Cell
Ka lebaka la tlhahiso ea li-autoantibodies ho lisele tsa lihlekehleke tsa Langerhans, tse qetellang li senngoe, e leng se lebisang ho kenngoeng ka mokhoa oa insulin le ponahalo ea setšoantšo se boletsoeng sa lefu la tsoekere la mofuta oa 1.
Mechine e joalo e ka khethoa ka liphatsa tsa lefutso kapa ea hlaha ka lebaka la lintlha tse fapaneng.
Har'a tse atileng haholo ke:
- likokoana-hloko
- ketso ya dintho tse nang le chefo
- likhatello tse fapaneng.
Mofuta oa pele oa lefu o tšoauoa ka karolo ea prediabetes ntle le matšoao, e ka nka lilemo tse 'maloa. Motsoako le secretion ea "insulin" ka nako ena e ka bonahatsoa feela ke ho ithuta ho mamella tsoekere.
Ho tsa bongaka, linyeoe tsa ho fumanoa ha li-antibodies joalo ka lilemo tse robeli kapa ho feta pele ho qaleho ea setšoantšo sa lefu lena le hlalosoa. Tlhaloso ea li-antibodies tsena e lokela ho sebelisoa e le tlhahlobo ea lefu la tsoekere la mofuta oa pele.
Ho batho ba nang le li-antibodies, ts'ebetso ea sele ea islet e fokotseha ka potlako, e bonahatsoang ke tlolo ea secretion ea insulin. Haeba karolo e felisitsoe ka botlalo, joale matšoao a lefu la tsoekere a mefuta ena a hlaha.
Boithuto bo bongata bo bonts'a hore li-antibodies tsena li teng ho 70% ea ba arabelang ba nang le lefu la tsoekere la mofuta o sa tsoa fumanoa. Sehlopheng sa taolo e se nang lefu la tsoekere ho na le menyetla ea 0,1,5,5% feela ea linyeoe tsa thibelo ea mali.
Li-antibodies tsena li ka fumanoa le ho beng ka batho ba lefu la tsoekere. Sehlopha sena sa batho se na le ts'oaetso e phahameng ea lefu lena. Boithuto bo bongata bo bonts'a hore ba leloko ba nang le li-antibodies ba theha mofuta oa 1 oa lefu la tsoekere ka nako.
Matšoao a mofuta ofe kapa ofe oa mofuta oa 2 mellitus oa lefu la tsoekere le ona o kenyeletsa thuto ena. Bo-rasaense ba netefalitse hore ho khetholla boemo ba li-antibodies tsena ho lefu la tsoekere le mofuta oa bobeli oa lefu ho thusa ho le hlalosa ka botlalo le pele ho hlaha setšoantšo sa kliniki, le ho thusa ho hlophisoa ha litekanyetso tsa kalafo ea insulin. Kahoo, ho batho ba nang le lefu la tsoekere le mofuta oa bobeli oa bokuli, hoa khoneha ho bolela esale pele sebopeho sa ho itšetleha ka insulin.
Li-antibodies ho insulin li fumanoa ho batho ba ka bang 40% ba nang le lefu la tsoekere la mofuta oa 1. Ho na le maikutlo a mabapi le kamano pakeng tsa li-antibodies ho insulin le li-antibodies ho lisele tsa islet.
Pele e ka ba sethaleng sa lefu la tsoekere le ka ho qala matšoao a lefu la tsoekere la mofuta oa 1.
Glutamic acid decarboxylase
Haufinyane tjena, bo-rasaense ba hlokometse antigen ea mantlha, e leng sepheo sa li-autoantibodies tse amanang le ho theha mofuta oa lefu la tsoekere le itšetlehileng ka insulin. Ke decarboxylase ea glutamic acid.
Asiti ena ke enzyme ea membrane e thusang li-neurotransmitter CNS-gamma-aminobutyric acid. Enzyme e qalile ho fumanoa ho batho ba nang le mathata a tsamaiso ea methapo.
Li-antibodies ho GAD ke letšoao le nang le tsebo ho feta la ho tsebahatsa boemo ba prediabetesic. Kahoo, hoa khoneha ho khetholla kotsi e kholo ea ho ba le lefu la tsoekere la mofuta oa 1. Ka sebopeho sa lefu lena, li-antibodies ho GAD li ka fumanoa bathong lilemo tse supileng pele liponahatso tsa lefu lena.
Tse tšepahalang ka ho fetisisa ebile li na le tsebo ho bo-rasaense li nkuoa e le tlhahlobo e ts'oanang ea matšoao a 'maloa maling. Letšoao le le 1 le emela 20% ea tlhaiso-leseling, matšoao a mabeli a bonts'a 44% ea lintlha, mme matšoao a mararo a emetse 95% ea tlhahisoleseling.
Basebelisi ba lefu la tsoekere la Autoimmune
Ho diabetes, profil ea autoantibodies e itšetlehile ka bong le lilemo. Li-antibodies ho li-antigen le li-antibodies ho lisele tsa islet, joalo ka molao, li ho bana ho feta ho batho ba baholo. Li-antibodies ho glutamic acid decarboxylase, maemong a mangata, li fumanoa ho basali.
Bokapele ba sebopeho sa mefuta e fapaneng ea autoantibodies bo ka khethoa haholo ke mefuta e fapaneng ea sistimi ea HLA, hobane li-insulin antips, li-islet cell le islet antigen 2 li fumanoa hangata ho batho ba nang le HLA - DR 4 / DQ 8 (DQA 1 * 0301 / DQB 1 * 0302). Ka nako e ts'oanang, li-antibodies ho glutamic acid decarboxylase li teng bathong ba nang le geno ea HLA - DR 3 DQ 2 (DQA 1 * 0501 / DQB 1 * 0201).
Mefuta e mengata ea li-autoantibodies ka tloaelo e ba teng ho batho ba tsoekere ba bacha, athe batho ba nang le lefu la tsoekere la autoimmune ba na le mofuta o le mong feela oa autoantiever.
Li-antibodies ho glutamic acid decarboxylase li har'a batho ba baholo ba nang le lefu la tsoekere ka mofuta oa pele oa lefu la tsoekere, empa le khafetsa le teng le holimo ho batho ba nang le phenotypes ea mofuta oa bobeli oa lefu.
Boikemisetso ba li-antibodies tsena bo etsa hore ho khonehe ho bona linyeoe tse ngata tsa autoimmunity, haeba sena e le letšoao feela bakeng sa batho ba baholo.
Litšenyehelo tsa tlhahlobo
Batho ba nang le lefu la tsoekere ba belaelloang hangata ba thahasella hore na ho hlahlojoa matšoao a lefu la tsoekere ho patala hakae. Ho na le lintlha tse ling tse profetiloeng tse hlahisitsoeng ke lipatlisiso tse 'maloa.
Tlhahlobo e akaretsang e bitsoang "taolo ea lefu la tsoekere" e kenyeletsa "glucose ea mali" le tlhahlobo ea "acid".
Ntle le moo, boemo ba litaba bo na le:
- glycated hemoglobin
- triglycerides
- k'holeseterole e felletseng
- HDL k'holeseterole,
- LDL k'holeseterole,
- urin albin
- homocestein,
- Teko ea Reberg,
- tsoekere moriring.
Litsenyehelo tsa tlhahlobo e joalo e felletseng li ka ba li-ruble tse likete tse 5.
Screening e kenyelletsa:
- tlhahlobo ea tsoekere ea mali
- glycated hemoglobin.
Theko ea ho sekaseka e ka ba li-ruble tse 900.
Matšoao a Autoimmune:
- li-antibodies ho insulin
- li-antibodies ho tyrosine phosphatase.
- li-antibodies tsa glutamate decarboxylase,
- li-antibodies ho tyrosine phosphatase.
Tlhahlobo e joalo e tla bitsa li-ruble tse likete tse 4.
Teko ea insulin e tla bitsa li-ruble tse 450, tlhahlobo ea C-peptide e tla bitsa li-ruble tse 350.
Ho hlahloba nakong ea kemolo
Teko ea tsoekere ea mali e nkeloa mpeng e se nang letho. Tšabo e tla bakoa ke letšoao la 4,8 mmol / ho tloha monoaneng le 5.3 - 6.9 mmol / l ho tsoa mothapong. Pele a nka liteko, mosali ha a lokela ho ja lijo tse ka bang lihora tse 10.
Ha o tsoala lesea, ho ka etsoa tlhahlobo ea mamello ea tsoekere. Bakeng sa sena, mosali o noa li-glucose tse 75 tsa khalase ea metsi. Kamora lihora tse peli, sampole ea mali e ea phetoa. Pele ho tlhahlobo, ha ho hlokahale hore u ipehe molemong oa phepo e nepahetseng. Lijo li lokela ho tloaela.
Haeba matšoao a lefu la tsoekere a fumanoa, ha ua lokela ho chechisa tlhahlobo le ngaka ea hau. Ho tseba lefu lena ho tloha qalong ho thusa ho emisa ho ata ha lefu lena le nts'etsopele ea mathata a behang bophelo kotsing. Liphetho tsa lipatlisiso li tlameha ho nepahala, hobane sena o hloka ho latela melao eohle ea ho itokisetsa tlhahlobo.
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