Sesosa sa tsoekere e ntseng e eketseha e kanna ea ba li-steroid tse ngata maling. Tabeng ena, ho fumanoa lefu la tsoekere la steroid. Hangata, ho se leka-lekane ho hlaha ka lebaka la meriana e boletsoeng, empa hape e ka ba motsoako oa maloetse o lebisang keketseho ea tokollo ea li-hormone. Maemong a mangata, liphetoho tsa pathological ho metabolism ea lik'habohaedreite lia fetoha, ka mor'a ho tlohela lithethefatsi kapa ho lokisa sesosa sa lefu lena, lia nyamela, empa maemong a mang li ka phehella kamora kalafo.
Li-steroid tse kotsi ka ho fetisisa ke tsa batho ba nang le lefu la tsoekere la mofuta oa 2. Ho latela lipalo-palo, bakuli ba 60% ba tlameha ho khutlisetsa li-hypoglycemic agents ka kalafo ea insulin.
Lefu la tsoekere la steroid - ke eng?
Steroidal, kapa e susumetsoang ke lithethefatsi, lefu la tsoekere ke lefu le lebisang ho hyperglycemia. Lebaka la eona ke litlamorao tse matla tsa lihomone tsa glucocorticoid, tse sebelisoang haholo makaleng ohle a meriana. Ba fokotsa ts'ebetso ea sesole sa 'mele, ho ba le litlamorao tse khahlanong le ho ruruha. Glucocorticosteroids e kenyelletsa Hydrocortisone, Dexamethasone, Betamethasone, Prednisolone.
Haufinyane, ha ho feta matsatsi a 5, kalafo ka meriana ena e fuoe mafu:
Lefu la tsoekere le khatello e matla e tla ba ntho ea khale
- Ts'oarelo ea tsoekere -95%
- Ho felisoa ha vein thrombosis - 70%
- Ho felisa ho otla ha pelo e matla -90%
- Ho tlosa khatello e phahameng ea mali - 92%
- Keketseho ea matla mots'eare, ho ntlafatsa boroko bosiu -97%
- maqeba a mabe
- bactering ea meningitis
- COPD ke lefu le sa foleng la matšoafo
- gout ketsahalo e mpe haholo.
Nako e telele, e fetang likhoeli tse 6, kalafo ea steroid e ka sebelisoa bakeng sa pneumonia ea methapo, mafu a autoimmune, ho ruruha ha mala, mathata a dermatological, le transplantation ea setho. Ho latela lipalo-palo, lefu la tsoekere ka mor'a ts'ebeliso ea lithethefatsi tsena ha le feta 25%. Mohlala, kalafo ea mafu a matšoafong, hyperglycemia e bonoa ho 13%, mathata a letlalo - ho 23,5% ea bakuli.
Kotsi ea lefu la tsoekere la steroid e eketsoa ke:
- tsoalo ea tlhaho ea lefu la tsoekere la 2, ba leloko la pele ba nang le lefu la tsoekere;
- lefu la tsoekere nakong ea boimana bo le bong;
- prediabetes;
- ho nona haholo, haholoholo ka mpeng;
- ovary ea polycystic;
- botsofali.
Ha tekanyetso ea moriana e nooang e phahamela menyetla ea lefu la tsoekere la steroid:
| Motsoako oa hydrocortisone, mg ka letsatsi | Keketseho e eketsehileng ea maloetse, linako |
| < 40 | 1,77 |
| 50 | 3,02 |
| 100 | 5,82 |
| 120 | 10,35 |
Haeba mokuli pele kalafo ea steroid e se na mathata a mantlha a metabolic ea lik'habohaedreite, glycemia hangata e tloaelehile matsatsing a 3 ka mor'a ho hlakoloa. Ha tšebeliso ea lithethefatsi tsena e le tsa nako e telele ebile e na le bothata ba lefu la tsoekere, hyperglycemia e ka ba e sa foleng, e hloka khalemelo ea bophelo bohle.
Matšoao a tšoanang a ka hlaha ho bakuli ba nang le tlhahiso ea lihormone tse sa sebetseng hantle. Hangata, lefu la tsoekere le qala ka lefu la Itsenko-Cushing, hangata le hyperthyroidism, pheochromocytoma, trauma kapa lesapo la mokokotlo.
Mabaka a nts'etsopele
Ho na le kamano e tobileng ea multicomponent pakeng tsa ts'ebeliso ea glucocorticoid le nts'etsopele ea lefu la tsoekere la steroid. Lithethefatsi li fetola biochemistry ea lits'ebetso tse etsahalang 'meleng oa rona, e baka tsitsitseng ea hyperglycemia:
- Li ama ts'ebetso ea lisele tsa beta, tseo ka tsona motsoako oa insulin o fokotsehang, ho ntšoa ha eona maling ho hatelloa ka lebaka la tšebeliso ea tsoekere.
- E ka baka lefu le leholo la lisele tsa beta.
- Ba fokotsa ts'ebetso ea "insulin", 'me ka lebaka leo, ba nyenyefatsa ho fetisoa ha tsoekere liseleng.
- Fokotsa sebopeho sa glycogen kahare ho sebete le mesifa.
- Ts'ebetso ea "enteroglucagon ea" hormone e hatelloa, ka lebaka leo tlhahiso ea insulin e ntseng e fokotseha le ho feta.
- Ba eketsa ho lokolloa ha glucagon, e leng hormone e fokotsang litlamorao tsa insulin.
- Li kenya ts'ebetso ea "gluconeogeneis" ts'ebetso ea ho theha glucose ho tsoa metsoakong ea tlhaho e seng nama ea kolobe.
Kahoo, tlhahiso ea insulin e fokotsehile haholo, kahoo tsoekere e ke ke ea fihlela sepheo sa eona - liseleng tsa 'mele. Ho phalla ha glucose maling, ka lehlakoreng le leng, ho eketseha ka lebaka la gluconeogeneis le ho fokola hoa ho hlahisoa ha tsoekere mabenkeleng.
Ho batho ba nang le metabolism e phetseng hantle, motsoako oa insulin o eketseha ka mor'a matsatsi a 2-5 a ho nka li-steroid ho lefella ts'ebetso ea eona e fokotsehileng. Kamora ho tlohela moriana, makhopho a khutlela morao. Ho bakuli ba nang le kotsi e phahameng ea lefu la tsoekere la steroid, matšeliso a ka 'na a se lekane, hyperglycemia e etsahala. Hangata sehlopha sena se na le "ho phatloha" ho lebisang ho lefu la tsoekere le sa foleng.
Boloetse bona bo fuoa khoutu ea ICD ea 10 E11 haeba ts'ebetso ea pancreatic e bolokiloe ka karolo, mme E10 haeba lisele tsa beta li timetsoa ka ho khetheha.
Litšobotsi le matšoao a lefu la tsoekere la steroid
Bakuli bohle ba nkang li-steroid ba lokela ho tseba matšoao a amanang le lefu la tsoekere:
- polyuria - ho ruruha ho eketsehileng;
- polydipsia - lenyora le matla, hoo e batlang e se ho fokolisa kamora ho noa;
- li-membrane tse ommeng tsa mucous, haholo molomong;
- letlalo le boreleli, le bobebe;
- boemo bo khathetseng ba kamehla, ts'ebetso e fokotsehile;
- ka lebaka la ho haelloa ke insulin haholo - boima ba 'mele bo ke keng ba qojoa.
Haeba matšoao ana a hlaha, ho hlokahala ho tsebahatsa lefu la tsoekere la steroid. Teko e tebileng ka ho fetisisa ntlheng ena ke tlhahlobo ea mamello ea glucose. Maemong a mang, e ka bonts'a liphetoho ho metabolism ea carbohydrate nakong ea lihora tse 8 kamora ho qala ho nka li-steroid. Litekanyetso tsa ho hlahloba li tšoana hantle le mefuta e meng ea lefu la tsoekere: glucose qetellong ea tlhahlobo ha ea lokela ho ba holimo ho 7.8 mmol / l. Ka keketseho ea khatello ea likarolo tsa 11.1, re ka bua ka pherekano e kholo ea metabolic, hangata e ke keng ea fetoloa.
Lapeng, lefu la tsoekere la steroid le ka fumanoa le sebelisa glucometer, boemo bo kaholimo ho 11 kamora ho ja bo bonts'a ho qala ha lefu lena. Tsoekere e potlakisang e hola hamorao, haeba e le ka holimo ho li-unit tsa 6.1, o hloka ho ikopanya le endocrinologist bakeng sa tlhatlhobo le kalafo e eketsehileng.
Matšoao a lefu la tsoekere a ka 'na a se be teng, ka hona ke moetlo oa ho laola tsoekere ea mali matsatsing a mabeli a pele kamora tsamaiso ea li-glucocorticoids. Ka tšebeliso e telele ea lithethefatsi, mohlala, kamora ho fetisoa, liteko li fanoa beke le beke nakong ea khoeli ea pele, ebe kamora likhoeli tse 3 le likhoeli tse tšeletseng, ho sa tsotellehe boteng ba matšoao.
Mokhoa oa ho phekola lefu la tsoekere la steroid
Lefu la tsoekere la Steroid le baka kholo ea tsoekere ka mor'a ho ja. Bosiu le hoseng pele ho lijo, glycemia e tloaelehile ka lekhetlo la pele. Ka hona, kalafo e sebelisitsoeng e lokela ho fokotsa tsoekere motšehare, empa u se ke oa qholotsa hypoglycemia ea bosiu.
Bakeng sa kalafo ea lefu la tsoekere mellitus, ho sebelisoa meriana e tšoanang le mefuta e meng ea lefu lena: li-hypoglycemic agents le insulin. Haeba glycemia e le ka tlase ho 15 mmol / l, kalafo e qala ka lithethefatsi tse sebelisetsoang lefu la tsoekere la mofuta oa 2. Linomoro tse phahameng tsa tsoekere li bontša ho senyeha ho hoholo ha mosebetsi oa pancreatic, bakuli ba joalo ba fuoa ente ea insulin.
Lithethefatsi tse sebetsang:
| Lithethefatsi | Ketso |
| Metformin | E ntlafatsa pono ea insulin, e fokotsa gluconeogeneis. |
| Lits'oaetso tsa sulfanylureas - glyburide, glycoslide, repaglinide | Se ke oa fana ka litlhare tsa ts'ebetso ea nako e telele, ho lekola nako ea phepo e nepahetseng hoa hlokahala. |
| Glitazones | Eketsa kutloisiso ea insulin. |
| Analogs of GLP-1 (enteroglucagon) - exenatide, liraglutide, lixisenatide | E sebetsa hantle ho feta ka lefu la tsoekere la mofuta oa 2, eketsa insulin ha o qeta ho ja. |
| Li-inhibitors tsa DPP-4 - sitagliptin, saxagliptin, alogliptin | Fokotsa maemo a tsoekere, khothaletsa boima ba 'mele. |
| Kalafo ea insulin, ho latela boemo ba insulin ea bona, ho khethoa mofuta oa moetlo kapa o matla | Insulin e sebetsang bohareng hangata e beoa le nako e khuts'oane pele ho lijo. |
Thibelo
Ho thibela le ho lemoha ka nako ea lefu la tsoekere la steroid ke karolo ea bohlokoa ea kalafo e nang le li-glucocorticoids, haholoholo ha ts'ebeliso ea bona ea nako e telele e lebelletsoe. Mehato e ts'oanang e sebelisoang bakeng sa lefu la tsoekere la mofuta oa 2, lijo tse nang le carb e fokolang le ho eketsa mesebetsi ea mmele, li fokotsa kotsi ea tlolo ea metabolism ea carbohydrate.
Ka bomalimabe, prophylaxis ena e thata, hobane li-steroid li eketsa takatso ea lijo, le mafu a mangata a li phekolang a li khetholla kapa a fokotsa lipapali haholo. Ka hona, ts'ebetsong ea ts'oaetso ea lefu la tsoekere la steroid, karolo e ka sehloohong ke ho khetholla mafu le ho lokisa ha bona boemong ba pele ka thuso ea lithethefatsi tse fokotsang tsoekere.
