Ukuxhatshazwa kwe-Insulin - yintoni na? I-insulin resistant syndrome

Abantu abahlukeneyo babonakaliswa ngamandla ahlukeneyo e-insulin ukwenzela ukuvuselela i-glucose. Kubalulekile ukwazi ukuba umntu unokukwazi ukubonisa uvakalelo oluqhelekileyo kwimpembelelo enye okanye ngaphezulu yale nxalenye kwaye ngexesha elifanayo - ukuxhathisa ngokupheleleyo kwabanye. Emva koko, siza kuhlalutya ingcamango "yokukhuseleka kwe-insulin": oko kukuthi, kubonakala njani.

Ulwazi jikelele

Ngaphambi kokuba uhlalutye ingcamango yokuba "ukukhushulwa kwe-insulin", yintoni na kwaye yiziphi iimpawu, kufuneka kuthiwa le ntlupheko ivela rhoqo. Abantu abangaphezu kwama-50% abanomdla wokuxinzelela kwegazi abahluphekileyo kule nkalo. Ngokuqhelekileyo, ukuxhatshazwa kwe-insulin (oko kukuthi, kuya kuchazwa ngezantsi) kufumaneka kubantu abadala. Kodwa kwiimeko ezininzi kubonakaliswe ebuntwaneni. Isifo soxinzelelo lwe-insulin sisoloko singabonakali ngaphambi kokuba kuphazamiseke ukuphazamiseka kwemizimba. Iqela lomngcipheko liquka abantu abane-dyslipidemia okanye abanokukhubazeka kwe-glucose, ukukhuluphala, uxinzelelo lwegazi.

Ukuxhathisa kwe-insulin

Yintoni na? Ziziphi iimpawu ukuphula umthetho? I-syndrome yesifo se- insulin ukumelana nokunyamezela komzimba kukungalunganga komzimba kwisenzo senye yezinto ezikhoyo. Ingcamango iyasebenza kwimiphumo eyahlukeneyo yezinto eziphilayo. Oku, ngokukodwa, kubhekisela kwimpembelelo ye-insulin kwiprotheni kunye ne- lipid metabolism, intetho yomzimba, umsebenzi we-endothelial we-vascular. Impendulo engavumelekanga ikhokelela ekunyuseni kwenkomfa yenkomfa kwisondlo segazi kwinto efunekayo kwimiqulu ekhoyo ye-glucose. I-insulin syndrome isifo esihlangeneyo. Kuquka utshintsho kwi-glucose tolerance, uhlobo lwesifo sikashukela, i-dyslipidemia, ukukhuluphala. "I-Syndrome X" iphinda ibonise ukunganyangeki kwe-glucose (i-dependul-dependent-dependant).

Indlela yo phuhliso

Ngokugqibeleleyo ukufundela iingcali zanamhlanje kwakungenakwenzeka. Iziphazamiso ezikhokelela ekuphuhliseni ukukhushulwa kwe-insulin zingaqatshelwa kumanqanaba alandelayo:

• Ummkeli. Kule meko, le meko ibonakaliswe ngokubambisana okanye ukuncipha kwinani labalamkeli.
• Kwinqanaba lokuthutha i-glucose. Kule meko, inani le-molecule ye-GLUT4 linciphisa.
• Pre-receptor. Kule meko, bathetha nge-insulin engaqhelekanga.
• Ukuvalelwa. Kule meko, kukho ukuphulwa kwe-phospholysis kunye nokuphulwa kwe-signal transmission.

Iimali ze-molecule ze-insulin aziqabile kwaye ayinayo intsingiselo yekliniki. Ubuninzi beemitholampi ziyancitshiswa kwizigulane ngokubhekiselele kwingxelo engalunganga. Kubangelwa yi-hyperinsulinemia. Ngokuqhelekileyo, izigulane zinokuhla kweyantoni kwinani labalamkeli. Kule meko, izinga leempendulo alithathwa njengoluhlu olumiselweyo ukuba luphi na umlinganiselo wokumelana no-insulin. Izizathu zengxaki ziyancitshiswa ngabachwephesha ukuphazamiseka kwe-post-receptor ye-transmission signal. Imiba echukumisayo, ngokukodwa, ibandakanya:

• Ukutshaya.
• Ukwandiswa kumxholo we-TNF-alpha.
• Umsebenzi owenziwe owenziwe ngomzimba.
• Ukwandisa kwiinkcenkceshelo zamanqatha, ezingekho eziqinisekisiwe.
• Ubudala.

Ezi zizinto eziphambili ezivame ukukhupha i-insulin. Unyango lubandakanya ukusetyenziswa:

• I-Diuretics yeqela le-thiazide.
• Abagcini be-beta-adrenergic receptors.
• Nicotinic acid.
• Corticosteroids.

Ukwanda kwe-insulin

Isiphumo kwi-glucose metabolism senzeka kwi-adipose tissue, muscle kunye nesibindi. Izisipha ze-squelette zidibanisa malunga ne-80% yale ngqungquthela. Imisipha kulo mzekelo yenza njengomthombo obalulekileyo wokunyanzelwa kwe-insulin. Ukuthathwa kwe-glucose kwiiseli kwenziwa ngeprotheni ekhethekileyo yezothutho GLUT4. Xa i-receptor isebenze kwi-insulin, i-series of phospholysis reactions ishukumisa. Ekugqibeleni zikhokelela ekutshintsheni i-GLUT4 kwisalathisi seesistim kwi-cytosol. Ngoko i-glucose ifumana ithuba lokungena kwikheji. Ukuxhatshazwa kwe-insulin (okuqhelekileyo kuya kuboniswa ngezantsi) kubangelwa ukuhla kwezinga lokuthunyelwa kwe-GLUT4. Ngaloo nto kukho ukwehla kokusetyenziswa kunye nokuthathwa kwe-glucose ngamaseli. Ngaloo nto, ngaphezu kokuququzelela i-glucose yokufunyanwa kwimizimba ye-peripheral, i-hyperinsulinemia igxotha imveliso ye-glucose ngesibindi. Ngohlobo lwe-2 lweswekile, luyaqala kwakhona.

Ukunyanya

Idibaniswe nokuxhatshazwa kwe-insulin kaninzi. Xa isigulane sidlula ubunzima ngo-35-40%, uvelwano luyehla ngo-40%. Iisitidi ze-adipose kwindonga yangasemva yangasese inomsebenzi ophezulu wesondlo kunomnye ongezantsi. Ngethuba lokuqwalaselwa kwezokwelapha, kwafunyanwa ukuba ukukhululwa kwama-acid acids kwi-fibers esiswini kwi-portal bloodstream kubangela ukuveliswa kwe-triglycerides ngesibindi.

Izimpawu zonyango

Ukuxhatshazwa kwe-insulin, iimpawu zazo ezinxulumene nengxaki yokuxhatshazwa, ngokukodwa, kunokukhankanywa kwizigulane ezinesisu esiswini, isifo sikashukela sesifo sikashukela, imbali yentsapho yohlobo lwe-2 lweswekile, i-dyslipidemia kunye nomfutho wegazi ophezulu. Kwiqela leengozi, abafazi abane-PCOS (i-polycystic ovary). Ngenxa yokuba ukunyanya kunommakishi wokunyanzelwa kwe-insulin, kuyimfuneko ukuvavanya uhlobo lokusabalalisa izicubu ezinamafutha. Indawo yayo ingaba kwi-gynecoid - kwicandelo elingaphantsi kwe-trunk, okanye kwindawo ye-android-kwindonga yangaphambili ye-peritoneum. Ukuqokelela kwisigxina esiphezulu somzimba kubonakala ngento ebalulekileyo yokuxhomekeka kwe-insulin, ukuguqulwa kwe-glucose kunye nesifo sikashukela kunokugqithisa kwiindawo eziphantsi. Ukugqiba inani lempahla yesisu esiswini, ungasebenzisa le ndlela elandelayo: misela umlinganiselo wesikhumba, i-hip ne-BMI. Kwimivuzo ye-0.8 yabasetyhini kunye ne-0.1 yamadoda kunye ne-BMI engaphezu kwe-27, bayifumanisa ukukhuluphala kwesisu nokukhushulwa kwe-insulin. Iimpawu zokugula zibonakaliswa ngaphandle. Ngokukodwa, isikhumba sibonisa indawo enobungozi, iindawo ezinobungozi. Ininzi idla ngokubonakalayo kwiingqungquthela, kwiingqungquthela, phantsi kweengcambu zamathambo. Uhlalutyo lokuxhaswa kwe-insulin kukubala nge-formula. I-HOMA-IR ibalwa ngolu hlobo lulandelayo: ukuzila ukudla kwe-insulin (μU / ml) x ukutya kwe-glucose (mmol / l). Isiphumo sihlulwe sibe ngama-22.5. Isiphumo sisicatshulwa sokukhuseleka kwe-insulin. Isiqhelo kuyinto <2.77. Xa kwenzeka ukuphambuka kwinqanaba lokunyuka, ingxaki yesifo ingafunyanwa.

Ukugqithiswa kwezinye iisistim: i-atherosclerosis yemithwalo yegazi

Namhlanje, akukho nkcazo enye yendlela yokwenza ukunganyangeki kwe-insulin kumonakalo kwinkqubo ye-cardiovascular system. Ku nokuba nefuthe ngqo kwi-atherogenesis. Yibangelwa amandla e-insulin ukukhuthaza ukuhlanganiswa kwe-lipids kunye nokunyuka kwezinto ezisisigxina ze-muscle kwi-wall wall. Kanye nale nto, i-atherosclerosis ingabangelwa ukuphazamiseka kwamanzi. Umzekelo, unokuba ngumfutho wegazi, i-dyslipidemia, utshintsho kwi-glucose tolerance. Kwi-pathogenesis yesifo, umsebenzi ophazamisayo we-endothelium ye-vascular ibaluleke kakhulu. Umsebenzi wakhe kukugcina ithoni yeendlela zegazi ngenxa yokufihlalwa kwababhalisi be-vasodilation kunye ne-vasoconstriction. Kwimeko eqhelekileyo , i- insulin ivuselela ukuphumla kwemibhobho evulekileyo yodonga lwe-vascular ekukhululweni kwe-nitric oxide (2). Ngexesha elifanayo, amandla akhe okwandisa i-endothelium-depend on vasodilation iyahluka kakhulu kwizigulane ezinobunene. Kuyafana nangezigulane zokuxhathisa i-insulin. Ngokuphuhliswa kokungakwazi kwamathambo e-coronary ukuphendula kwisistim esivamile kunye nokwandisa kunokwenzeka ukuthetha malunga nesigaba sokuqala sokuphazamiseka kwe-microcirculation kunye ne-microangiopathy. Isi simo sengqondo esichaphazelekayo sichazwa kwininzi yezigulane ezine-diabetes mellitus (i-diabetes mellitus).

Ukunganyangeki kwe-insulin kunokunyusa i-atherosclerosis ngokungaqhelekanga kwinkqubo ye-fibrinolysis. IAP-1 (i-inhibitor ye-activminogen activator) inxininkulu ephezulu kwizigulane ezineesifo seswekile kunye nokukhuluphala ngaphandle kwesifo sikashukela. I-synthesis ye-IAP-1 ivuselelwa ngumproinsulini kunye ne-insulin. Iqondo le-fibrinogen kunye nezinye izinto eziqhubekayo zandisiwe.

Ukutshintsha i-glucose ukunyamezela kunye nohlobo lwesibini lweswekile

Ukuxhatshazwa kwe-insulin yindlela engaphambili yokubonakaliswa kwekliniki yesifo sikashukela. Iiseli zeBeta kwi-pancreas ziphendula ukuhla kwe-glucose concentration. Ukunciphisa uxinzelelo kubangelwa ukunyuka kwemveliso ye-insulin, leyo nto leyo ibangela ukuba i-hyperinsulinemia esondeleyo. I-Euglycemia iqhubekeka kwizigulane njengoko nje iiseli ze-beta ziyakwazi ukugcina izinga eliphezulu le-insulin kwi-plasma ukunqoba ukunqandwa. Ekugqibeleni, oku kukwazi ukulahleka, kwaye ukuxinwa kwe-glucose kwandisa kakhulu. Into ebalulekileyo ejongene nokuzila ukutya kwe-hyperglycemia kwimvelaphi yesifo sikashukela kukuxhathisa kwe-insulin yesibindi. Impendulo enempilo kukunciphisa umkhiqizo we-glucose. Ngoxinzelelo lwe-insulin, le mpendulo ilahleka. Ngenxa yoko, isibindi siyaqhubeka nokuvelisa i-glucose, ekhokelela ekuzileni ukutya kwe-hyperglycaemia. Ngenxa yokulahlekelwa amandla okwenziwa kweeseli ze-beta ukubonelela nge-insulin ye-hypersecretion, kukho ukuguquka kokungabikho kokuxhaswa kwe-insulin kwi-hyperinsulinemia ukutshintsha i-glucose tolerance. Emva koko, imeko iguqulwa ibe yikliniki yesifo sikashukela kunye ne-hyperglycemia.

U xinzelelo

Kukho iindlela ezininzi ezinokuqulunqa ukuphuhliswa kwayo malunga nemvelaphi yokungqinanga kwe-insulin. Njengoko kuboniswa ukuboniswa, ukunyanzeliswa kwe-vasodilation kunye nokusetyenziswa kwe-vasoconstriction kunokubangela ukwanda kwindlela yokuxhatshazwa kwemisipha. I-insulin ikhuthaza ukuvuselelwa kwenkqubo yobubele (enobubele). Oku kubangela ukwanda kwenkxalabo ye-noradrenaline eplasma. Kwizigulane zokuxhathisa i-insulin, impendulo ku-angiotensin yanda. Ukongezelela, iindlela ze-vasodilation zingaphazamiseka. Kwimeko yokuqhelekileyo, ukungeniswa kwe-insulin kubangela ukuphumula kwindonga ye-muscular vascular. I-Vasodilation kule meko idibanisa ngokukhutshwa / ukuveliswa kwe-nitric oxide kwi-endothelium. Kwizigulane ezinokuxhatshazwa kwe-insulin, umsebenzi wokuphela kwexesha ungasebenzi. Oku kukhokelela ekunciphiseni kwe-vasodilatation ngama-40-50%.

Dyslipidemia

Ngokuxhatshazwa kwe-insulin, ukunyanzeliswa ngokuqhelekileyo kwesivuno samafutha e-fatty free after eating from adipose tissue kuphazamiseka. Ukugxininiswa kweengcamango kuyifomathi yesondlo sokwandisa i-triglyceride synthesis. Le ngongoma ebalulekileyo kwimveliso ye-VLDL. Nge-hyperinsulinemia, umsebenzi we-enzyme ebalulekileyo, i-lipoprotein lipase, iyancitshiswa. Phakathi kokuguqulwa kwekhwalithi kwi-LDL ebonakalayo malunga nesimo sesibini sikashukela kunye nokunyanzelwa kwe-insulin, ku funeka kuqatshelwe ukuba i-oxidation eyandisiweyo yeengqungquthela ze-LDL. Eyona nto ingenakuyithintela kule nkqubo i-apolipoproteins.

I zi ganeko

Ukwanda kwe-insulin ukuzwela kungenziwa ngeendlela eziliqela. Kubaluleke kakhulu ukulahleka kwesisindo kunye nokusebenza ngokomzimba. I-regimen yesondlo ibalulekile nakubantu abafunyaniswa ukuba bane-insulin ukumelana. Ukutya kukuncedisa ukuzinza kwemeko iintsuku eziliqela. Ukwanda kwengqondo kuya kuqhutyelwa ngakumbi ngokulahlekelwa kwesisindo. Kubantu abanokuxhatshazwa kwe-insulin, unyango lunamanqanaba ambalwa. Ukuzinza kokutya kunye nokusebenza ngokomzimba kuthathwa njengesigaba sokuqala sonyango. Kubantu abanoxinzelelo lwe-insulin, ukutya kufuneka kube yi-calori ephantsi. Ukunciphisa ngokulinganisela kwisisindo somzimba (ngo-5-10 kilogram) kaninzi kuncedisa ekuphuculeni ukulawulwa kwamanqanaba e-glucose. I-calories yama-80-90% isasazwa phakathi kwe-carbohydrates kunye namafutha, i-10-20% iiprotheni.

Mayeza

Ithetha "iMetamorfin" ibhekisela kumayeza eqela elikhulu. Isilwanyana siphucula umgangatho wentsholongwane kunye nobuzwe obuthakathaka obuya ku-insulin. Kule meko, i-arhente ayinasiphumo kwi-secretion yayo. Ukungabikho kwe-insulin, isilwanyana "i-Metamorfin" ayinakwenzeka. Isilwanyana "iTroglitazone" yileyilisi yokuqala yeqela le-thiazolidine-adiones, elivunyiwe ukuba lisetyenziswe e-USA. Isiza lenza ngcono ukuthuthwa kwe-glucose. Oku mhlawumbi ngenxa yokusetyenziswa kwe-PPAR ye-gamma receptor. Yaye indleko yolu yandisa intetho ye-GLUT4, leyo leyo, eyakhokelela ekunyuseni kwe-gulcose-insulated-insulated glucose. Kwiigulane ezinokuxhatshazwa kwe-insulin, unyango lunokumiselwa kwaye ludibene. Amaziko angentla angasetyenziselwa ukudibanisa ne-sulfonylurea, kwaye ngamanye amaxesha omnye nomnye kunye nokufumana isistim somzimba kwizinga le-glucose kwi-plasma nakweminye ingxaki. Isilwanyana "iMetamorfin" kunye kunye ne-sulfonylurea sandisa ukugcinwa kwemfihlo kunye novelwano kwi-insulin. Ngelo xesha, izinga le-glucose linciphisa emva kokutya kunye nesisu esingenalutho. Kwizigulane ezibekwe unyango oluhlangeneyo, i-hypoglycemia yayivame kakhulu.