Lefu la tsoekere mellitus (lefu la tsoekere insipidus) ke lefu le sa tloaelehang la endocrine le hlahang ka lebaka la ho senyeha ha pituitary, hypothalamus, kapa tšebetso ea liphio. Lefu lena le tšoauoa ka polydipsia (maikutlo a ho nyoriloe kamehla) le polyuria (tlhahiso ea moroto e eketsehileng - ho tloha ho lilithara tse 6 ho isa ho tse 50 ka letsatsi).
Lefu lena ha le fole, le ka ba teng ho basali le ho banna neng kapa neng, empa hangata lefu la tsoekere la tsoekere le hlaha ho batho ba lilemo li 18 ho isa ho tse 28.
Letšoele la tlhaho le hypothalamus ke litšoelesa tsa endocrine tse hokahaneng. Li emela karolo e itseng ea taolo e laolang litšoelesa tsa 'mele oa endocrine.
Ela hloko! Li-neurons tsa Sector tsa hypothalamus li hlahisa lihormone - oxytocin le vasopressin.
Hormone ea antidiuretic - vasopressin e bokelloa ka har'a mokokotlo oa "pituitary" gland. Hormone eo ea lokoloha haeba ho hlokahala ebile e laola ho kenngoa ha metsi ka mpeng ea bana.
Tabeng ea ha lekhalo le tlase la li-antidiuretic li le maling maling a liphio lipakeng tsa mokhoa oa ho khutlisetsa metsi - lea ferekana, ke ka lebaka leo mefuta ea polyuria e leng teng.
Matšoao le lisosa tsa lefu la tsoekere
Lefu la tsoekere le hlaha haeba liphetoho tsa 'mele li hlaha' meleng, lisosa tsa:
- ho phatloha ho matla ha vasopressin;
- ho ba teng hoa liforomo ho pituitary gland le hypothalamus;
- ka har'a lisele tse reretsoeng ho a liphio, ho ba le bothata ba ho hlaseloa ha kutloisiso ho "antidiuretic hormone";
- ho se sebetse hantle ha hypothalamus kapa gland
- ntho ea lefutso (tsoalo-pele ea mofuta o hlahelletseng oa autosomal);
- ho senyeha ha hlooho kapa ts'ebetso ea opereishene ea methapo e sa atleheng, e bakang tšenyo ho vasopressin neurons;
- metastases ea oncological e nang le phello e mpe mosebetsing oa litšoelesa ka bobeli;
- autoimmune le mafu a tšoaetsanoang a felisang li-neurons tsa li-hormone tsa antidiuretic.
Matšoao a mantlha a lefu la tsoekere ke lefu la ho fokola ha mmele le polyuria, le maemo a fapaneng a boima.
Matšoao a hlahang ka nako e telele ea lefu lena
Bakeng sa nako e telele ea lefu lena, matšoao a joalo ka keketseho ea lesapo la mokokotlo, ho hlohlona le ho satalla ha mpa ke litšobotsi. Matšoao a lefu la tsoekere la lefu la tsoekere a kenyeletsa ho ipolaisa tlala (ho theola boima ba 'mele haholo), ho hlatsa le ho nyekeloa hoa pelo.
Matšoao a latelang a sebopeho ke khatello e tlase ea mali, lethargy le asthenia. Lefu la tsoekere le boetse le tsamaisana le matšoao a kang migraine le ho nyehla ha lebala la pono.
Matšoao a eketsehileng a lefu la tsoekere le fumanehang ho feliseng metsi:
- letlalo le omeletseng le la atonic;
- makhopho a khonehang;
- mahlaseli a letsatsi.
Hape, ka linako tse ling ka phetoho e matla maemong a 'mele, mokuli o ba le matšoao a kang ho oa ha orthostatic.
Ts'oaetso
Ha u lekola lefu lena, ho bohlokoa ho theha mofuta oa lefu lena hantle hore kalafo e be e phethahetseng. Bakeng sa ts'oaetso ea lefu lena, li-anamnesis le matšoao a bontšang polydipsia le polyuria (ho feta lithara tse peli ka letsatsi) li bohlokoa.
Haeba nalane ea bongaka le ea bongaka e bontša lefu la tsoekere la lefu la tsoekere, ngaka e beha tlhahlobo e itseng. Boemong bona, motho o hloka ho tlohela metsi ka nakoana.
Mokuli o boetse o fana ka liteko tsa moroto le tsa mali ho tseba:
- letsoalo la moroto;
- osmolarity;
- mahloriso a naetrojene, potasiamo, tsoekere, sodium, calcium maling;
- glucosuria
Tlhahlobo e 'ngoe e etsoa bakeng sa lijo tse omileng, tseo ho tsona mokuli a sa noeng metsi ho tloha lihora tse 8 ho isa ho tse 24. Nakong ea tlhahlobo, boima, segalo le bophahamo ba moroto li tlalehiloe hora e 'ngoe le e' ngoe 'me sodium ea moroto e lekantsoe.
Haeba boima ba mokuli bo fokotseha ka 5%, mme palo ea sodium e feta 3 mmol / l, joale thuto e phethetsoe. Kahoo, hoa khoneha ho hanyetsa kapa ho netefatsa ho ba teng ha lefu la tsoekere "insulin" moo ho se nang li-hormone tsa antidiuretiki, tse etsang hore ho khonehe ho etsa disdiagnosis ka polydipsia ea methapo le ea kelello.
Tlhahlobo e khethollang ea nephrogenic le hypothalamic lefu la tsoekere la insipidus e kenyelletsa thuto e sebelisoang Minirin: tlhahlobo e etsoa ho latela Zimnitsky pele u nka Minirin le kamora ho sebelisa moriana ona. Haeba, kamora ho sebelisa moriana, bophahamo ba urine bo ea fokotseha le letsoalo la bona le eketseha, hona ho tiisa tlhahlobo ea lefu la tsoekere le lefu la hypothalamic.
Bakeng sa tlhahlobo e khethollang ea nephrogenic le mofuta oa hypothalamic, litaba tsa vasopressin maling li bohlokoa haholo: ka lefu la tsoekere la nephrojene, palo ea lihormone tsena e eketsehile, mme maemong a bobeli ha e nyenyefatsoe.
Bakeng sa ho khetholla mofuta oa tsoekere ea lefu la tsoekere mellitus, ho etsoa MRI, e khethollang boteng ba methapo ea methapo, matheba a khanyang le sebopeho sa gland.
Phekolo
Boloetse ba lefu la tsoekere bohareng
Phekolo ea mofuta ona oa lefu la tsoekere e kenyelletsa tšebeliso ea kalafo e sa khaotseng ea pheko. Sesebelisoa se ka sehloohong se sebelisang kalafo e atlehileng ke Desmopressin le mefuta ea tsona:
- Minirin (matlapa) - analog ea maiketsetso ea hormone ea antidiuretic;
- Adiuretin (ampoules) - bakeng sa ts'ebeliso ea intranasal.
Minirin (vasopressin ea maiketsetso)
Kamora ho tsamaisoa, moriana o ka fumanoa maling kamora metsotso e 15-30, mme ho kenella hoa oona kamora metsotso e 120.
Ngaka e khetha litekanyetso ka bonngoe, e lekola liphetho tsa sethethefatsi ha kalafo e le sethaleng sa pele. Tekanyetso e behiloe, ho latela palo ea mokelikeli o nooang le palo ea urination. Joaloka molao, ke matlapa a 1-2 ka letsatsi.
Moriana o nooa halofo ea hora pele ho lijo kapa ka mor'a lihora tse peli ka mor'a ho ja. Nako ea Minirin e tsoa lihora tse 8 ho isa ho tse 12, ka hona e lokela ho nkuoa makhetlo a mararo ka letsatsi.
Haeba ho na le overdose e ka hlaha:
- ho ruruha;
- hlooho e bohloko
- ho theoha ha moroto.
Lisosa tsa overdose hangata li amahanngoa le tekanyetso e fosahetseng, phetoho ea maemo a leholimo, feberu le liphetoho tsa mokhoa oa bophelo.
Phekolo ea mofuta oa lefu la tsoekere la insipidus nephrogenic
Phekolo ea mofuta ona oa lefu lena e kenyelletsa tšebeliso ea litlhare tse kopaneng, tse nang le mefuta e fapakaneng ea li-diuretics tse nang le tšebeliso e fokolang ea letsoai. Sena se hlokahala ho matlafatsa phello ea thiazide diuretics.
Joaloka kalafo ea adjunct, ho sebelisoa li-inhibitors tsa prostaglandin: ibuprofen, aspirin, indomethacin.
Ela hloko! Ka mofuta oa nephrogenic oa lefu la tsoekere, Desmopressin ha e na thuso.
Phekolo ea mofuta oa lefu lena la dipsogenic ha e hloke meriana. Morero oa eona o ka sehloohong ke ho fokotsa bongata ba metsi a sebelisoang.
Ka lefu la tsoekere la insipidus syndrome, mokuli o lokela ho fokotsa palo ea letsoai, joala le lijo tsa protheine tse ling. Karolo e ka sehloohong ea lijo tsa hae e lokela ho ba lihlahisoa tsa lebese, litholoana le meroho.
'Me ho fokotsa lenyora, o noe lino tse pholileng ka apole le linoko.
