Matenda a shuga ndi akazi, amuna ndi ana

Mawu oti "shuga" amachokera ku Greek "leak", m'mbuyomu anthu amakhulupirira kuti madzimadzi omwe amalowa mthupi, ndi matenda, thupi limadutsa osamwetsa. Matenda a shuga ndi njira zina zosowa zomwe zimagwirizana ndi tanthauzo lakale. Cholinga chake ndikuchepa kwa timadzi timene timayendetsa madzi ndi impso. Zotsatira zake, kutuluka kwa mkodzo kumakonzedwa kwambiri, kuchititsa munthu kukhala ndi moyo wabwinobwino.

Wodwalayo amakhala ndi ludzu ndipo amakakamizidwa kumwa malita amadzi kuti apewe madzi. Mosiyana ndi shuga, matenda ashuga a shuga samayambitsa kuchuluka kwa shuga m'magazi, samayenderana ndi kugwira ntchito kwa kapamba, ndipo samayambitsa zovuta za matenda ashuga. Matenda awiriwa amagwirizana ndi chizindikiro chodziwika bwino - chotchedwa polyuria.

Matenda a shuga - ndi chiyani?

Sikuti madzimadzi onse omwe amalowa impso zathu amakhala mkodzo. Pambuyo pakuchita kusefa, pafupifupi kuchuluka konse kwamkodzo koyamba kamabwezedwa m'mwazi kudzera m'misempha ya impso, njira yotchedwa reabsorption. Mwa malita 150 omwe impso zimayendetsa okha, 1% yokha ndi yomwe imayikidwa mkodzo wachiwiri. Kubwezeretsanso kumatha kuchitika chifukwa cha ma aquaporins - zinthu za mapuloteni zomwe zimapanga ma pores muma cell cell. Imodzi mwa mitundu ya ma aquaporin omwe ali mu impso, imagwira ntchito yake pamaso pa vasopressin.

Matenda a shuga ndi kupsinjika kudzakhala chinthu chakale

• Matenda a shuga -95%
• Kuthetsa kwa mitsempha thrombosis - 70%
• Kuthetsa kwa kugunda kwamtima kwamphamvu -90%
• Kuthana ndi kuthamanga kwa magazi - 92%
• Kuwonjezeka kwa mphamvu masana, kukonza kugona usiku -97%

Vasopressin ndi timadzi tomwe timapangidwa mu hypothalamus (gawo laubongo) ndipo timadziunjikira mu gitu (gland yapadera yomwe ili kumapeto kwa ubongo). Ntchito yake yayikulu ndikukhazikitsa madzi kagayidwe. Ngati kupsinjika kwa magazi kukwera, kapena kulibe madzi okwanira mthupi, kumasulidwa kwa vasopressin kumakulanso.

Ngati pazifukwa zina mahomoni atachepa, kapena maselo a impso asiya kumwa vasopressin, matenda a shuga atuluka. Chizindikiro chake choyamba ndi polyuria, mkodzo wambiri. Impso zimatha kuchotsa malita 20 a madzi tsiku lililonse. Wodwalayo amangokhalira kumwa madzi ndi kukodza. Mpweya woterewu umatopetsa munthu, kumakulitsa moyo wake. Dzina lina la matendawa ndi matenda a shuga. Anthu omwe ali ndi matenda a shuga insipidus amatenga magulu atatu olumala, mwayi wowalandira kwaulere ndikupeza mankhwalawo.

Matendawa ndi osowa, kuchokera pa 1 miliyoni, anthu awiri omwe akudwala matendawa. Nthawi zambiri, matendawa amayamba munthu wamkulu, kuyambira zaka 25 mpaka 40 - anthu 6 pa 1 miliyoni miliyoni. Nthawi zambiri, matenda ashuga amayamba mwa ana.

Zomwe zimasiyanitsa mitundu ndi mitundu ya ND

Kutengera zomwe zimayambitsa polyuria, insipidus ya shuga imagawidwa m'mitundu:

1. Matenda a shuga apakati - Zimayamba ubongo ukawonongeka ndikutulutsidwa kwa vasopressin m'magazi kukasiya. Fomuyi imatha kuchitika pambuyo pochita opaleshoni yamitsempha, kuvulala, zotupa, meningitis ndi kutupa kwina kwa ubongo. Mu ana, mawonekedwe apakati nthawi zambiri amayamba chifukwa cha matenda owopsa kapena osachiritsika, matenda amtundu. Zizindikiro zazikulu mwa odwala zimawoneka pamene pafupifupi 80% ya maukala a hypothalamus atasiya kugwira ntchito, izi zisanachitike, kuphatikiza kwa mahomoni kumalandidwa ndi madera osapezekanso.
2. Nephrogenic shuga insipidus - amakula pamene aimpso tubule receptors amasiya kuyankha vasopressin. Ndi mtundu uwu wa matenda ashuga, mkodzo nthawi zambiri umatulutsidwa zochepa kuposa pakati. Kusokonezeka kotere mu impso kumatha chifukwa cha kukoka kwa mkodzo mwa iwo, mawonekedwe a chotupa ndi zotupa, komanso njira yayitali yotupa. Palinso mtundu wina wobadwa nawo wa matenda a impso a m'mimba chifukwa cha kusokonekera kwa impso mu mwana wosabadwayo.
3. Idiopathic matenda a shuga insipidus - kudziwikako kumapangidwa nthawi zambiri ngati vasopressin sikokwanira, koma choyambitsa kusowa kwake sichingadziwike pakadali pano. Izi nthawi zambiri zimakhala chotupa chaching'ono. Ikamakula, maphunziro amapezeka pogwiritsa ntchito njira zamakono zowonera: MRI kapena CT. Idiopathic shuga insipidus imatha kuzindikira ngakhale kuchuluka kwa mahomoni, koma kusintha kwa impso sikupezeka. Nthawi zambiri imafotokozedwa ndi kusintha kwa majini. Zizindikiro zimawonedwa mwa amuna okha. Amayi amakhala onyamula jini yowonongeka, zizindikiro za matendawa zimatha kuwonekera pokhapokha njira zasayansi, yomwe ikuwoneka kuti polyuria palibe.
4. Matenda a shuga okakamiza - imatheka mwa amayi apakati, chifukwa chomwe chimapangitsa ndi vasopressinase ya mahomoni yopangidwa ndi placenta, yomwe imawononga vasopressin. Matenda amtunduwu amazimiririka pambuyo pobadwa - nkhani yathu yokhudza matenda ashuga.

Kuphatikiza pa kukhalapo kwa vasopressin m'mwazi, insipidus ya shuga imayang'aniridwa molingana ndi zizindikiro zina:

Zifukwa zachitukuko cha ND

Njira yayikulu ya matenda a shuga imatha kupezeka munthawi zotsatirazi:

• kuvulala kwa hypothalamus ndi pituitary gland - kuwonongeka kwa madera awa, edema m'dera lapafupi, kuponderezedwa ndi minofu ina;
• zotupa ndi ma metastases mu ubongo;
• Chifukwa cha opaleshoni kapena radiotherapeutic kulowerera mu ubongo ziwalo zoyandikana ndi hypothalamus ndi pituitary gland. Ntchito zotere zimapulumutsa moyo wa wodwala, koma nthawi zina (20% ya kuchuluka kwa matenda ashuga) zimakhudza kapangidwe ka timadzi tambiri. Pali milandu yodziwika yokhudza matenda omwe amadzichiritsa okha, omwe amayamba atangopanga opereshoni ndikusowa m'masiku ochepa;
• radiation mankhwala zochizira zotupa mu ubongo;
• kufalikira kwamitsempha yamagazi m'matumbo amutu chifukwa cha thrombosis, aneurysm kapena stroke;
• matenda a neuroinfpat - encephalitis, meningitis;
• matenda pachimake - kuchulukitsa chifuwa, chimfine. Mu ana, matenda opatsirana amatsogolera ku insipidus ya shuga nthawi zambiri kuposa akuluakulu. Ichi ndi chifukwa cha kuchepa kwa ubongo muubwana: kukula kwamitsempha yatsopano, kutsekeka kwa zotengera zomwe zilipo, chotchinga chotchinga magazi;
• granulomatosis yamapapu, chifuwa chachikulu;
• kumwa clonidine;
• kusinthika kwatsopano - microcephaly, chitukuko cha zigawo zaubongo;
• kuwonongeka kwa hypothalamus intrauterine matenda. Zizindikiro za matenda a shuga pankhaniyi zimatha kuonekera patapita zaka zambiri, mothandizidwa ndi kupsinjika, kupsinjika kapena kusintha kwa ma horoni.
• vuto la jini lopangitsa kapangidwe ka vasopressin kukhala kosatheka;
• Matenda a Tungsten ndimavuto ovomerezeka obadwa nawo, kuphatikizapo matenda ashuga ndi matenda ashuga, kuperewera kwa maso ndi kumva.

Zoyambitsa za nephrogenic mawonekedwe a shuga:

• kukula kwa aimpso kulephera chifukwa cha matenda a impso, polycystic matenda, matenda ashuga nephropathy, urolithiasis;
• kuphwanya mapuloteni kagayidwe kachakudya ndi amyloid mu minofu ya impso;
• myeloma impso kapena sarcoma;
• vasopressin receptor kuchepa kwa majini mu impso;
• zotsatira za poizoni wa mankhwala ena:

Zizindikiro za matenda a shuga

Chizindikiro choyamba cha matenda a shuga insipidus amtundu uliwonse ndikuwonjezereka kwa kukodza (kuyambira malita 4), omwe saima usiku. Wodwalayo amatha kugona mokwanira, pang'onopang'ono amayamba kutopa. Mu ana, usiku ndi nthawi ya nthawi ya enursis imayamba. Mkodzo ndi wowonekera, pafupifupi wopanda mchere, magawo ake ndi akulu, kuchokera theka la lita. Popanda chithandizo, chifukwa cha kuchuluka kwa mkodzo, mafupa a impso ndi chikhodzodzo pang'onopang'ono amakula.

Poyankha kuchotsedwa kwa madzimadzi m'thupi, ludzu lamphamvu limayamba, odwala omwe amamwa malita amamwa. Nthawi zambiri amakonda kwambiri zakumwa zoziziritsa kukhosi, chifukwa zakumwa zoziziritsa kukhosi zimathetsa ludzu kwambiri. Kudzimbidwa kumakulirakulira, m'mimba mwake kumatambasulidwa ndikugwa, kupweteka kumachitika m'matumbo.

Poyamba, madzi omwe amamwa amakhala okwanira kukwaniritsa kuchepa kwake mthupi, ndiye kuti kuchepa kwamadzi kumayamba. Zizindikiro zake ndi kutopa, kupweteka mutu komanso chizungulire, kuthamanga kwa magazi, arrhythmias. Wodwala yemwe ali ndi matenda a shuga insipidus, kuchuluka kwa malovu amachepetsa, khungu limawuma, ndipo palibe madzi amadzimadzi otuluka.

Kuzindikira ndi kuyesa

Odwala onse omwe ali ndi polyuria ayenera kuyang'aniridwa ndi matenda a shuga. Njira yoyambira:

1. Mbiri yazachipatala - kufufuza kwa wodwala za nthawi yayitali ya matendawa, kuchuluka kwa mkodzo kumasulidwa, Zizindikiro zina, milandu ya matenda a shuga achibale apafupi, opaleshoni yam'mbuyomu kapena kuvulala kwa ubongo. Kutsata kwa chikhalidwe cha ludzu: ngati kulibe usiku kapena wodwala atakhala wotanganidwa ndi chinthu chosangalatsa, chifukwa cha polyuria sichingakhale shuga insipidus, koma psychogenic polydipsia.
2. Kudziwa shuga wamagazi kupatula shuga ndi chizolowezi cha shuga wamagazi ndi momwe mungaperekere magazi kwa shuga.
3. Kusanthula mkodzo ndi kuwerengera kachulukidwe ndi osmolarity. Pokomera matenda a shuga a insipidus, osachulukitsa ndi ochepera 1005, ndipo osmolarity ndi ochepera 300.
4. Kuyesedwa kwamadzi - wodwalayo samalandidwa chakumwa chilichonse kapena chakumwa chamadzimadzi kwa maola 8. Nthawi yonseyi amayang'aniridwa ndi madotolo. Ngati kuchepa kwa madzi m'thupi kumachitika, mayesowo amatha. Matenda a shuga a insipidus amawaganizira kuti amatsimikizira ngati kulemera kwa wodwala kwatsika ndi 5% kapena kupitilira panthawiyi, ndipo osmolarity ndi kachulukidwe ka mkodzo sikunachulukenso.
5. Kusanthula kuchuluka kwa vasopressin m'magazi atangoyesedwa kuti adziwe mawonekedwe a matendawa. Ndi matenda apakati a shuga, mulingo wake umakhala wotsika, wokhala ndi mawonekedwe a nephrogenic amakula kwambiri.
6. MRI yokhala ndi kachilombo ka shuga komwe amaganiza kuti ipeza ma neoplasms mu ubongo.
7. Ultrasound a impso ndi mkulu Mwina wa nephrogenic mawonekedwe.
8. Kuwona za ma genetic kwa anthu omwe akuwaganizira kuti ali ndi matenda obadwa nawo.

Chithandizo cha matenda a shuga insipidus

Atazindikira chomwe chimayambitsa matendawa, kuyesayesa konse kwa madokotala kuli ndi cholinga chowathetsa: amachotsa ma neoplasms, amachepetsa kutupa m'm impso. Ngati mawonekedwe apakati apezeka, ndipo matenda ashuga samatha atatha kulandira chithandizo chazomwe zimayambitsa, mankhwala amaloledwa. Amakhala ndikulowetsa m'magazi ma analogue opanga mahomoni omwe alibe mwa wodwala - desopressin (mapiritsi Minirin, Nourem, Nativa). Mlingo umasankhidwa payekha kutengera kupezeka kwa kapangidwe ka vasopressin ndi kufunikira kwake. Mlingo umatengedwa ngati wokwanira ngati zizindikiro za matenda a shuga insipidus zimatha.

Ma mahomoni ake akapangidwa, koma osakwanira, clofibrate, carbamazepine, kapena chlorpropamide akhoza kukhazikitsidwa. Mwa odwala ena, amatha kuyambitsa kaphatikizidwe kakang'ono ka vasopressin. Ana omwe amamwa mankhwalawa amaloledwa chlorpropamide pokhapokha, koma akamagwiritsa ntchito, ndikofunikira kuyendetsa shuga m'magazi, chifukwa amakhala ndi vuto la hypoglycemic.

Njira ya nephrogenic ya matenda a shuga ilibe njira zochiritsira mwamphamvu. Kuchepetsa kuchepa kwamadzi ndi 25-50% kumatha kukodzetsa kuchokera pagulu la thiazides. Ndi matenda a shuga a insipidus, samalimbikitsa kutulutsa mkodzo, monga anthu athanzi, koma amawonjezera kubwezeretsanso.

Kuphatikiza pa mankhwala, odwala amapatsidwa zakudya zokhala ndi mapuloteni ochepa kuti asadzaze kwambiri impso. Popewa kuchepa madzi m'thupi, muyenera kumwa madzi okwanira, timadziti kapena ma compotes, kubwezeretsa mavitamini ndi michere.

Ngati mankhwalawa athandizira kufikira kubwezera kulipidwa kwa matenda a shuga, wodwalayo amatha kukhala ndi moyo wabwinobwino akugwirabe ntchito. Kuchira kwathunthu ndikotheka ngati choyambitsa matendicho chitha. Nthawi zambiri, matenda ashuga amatha ngati adayamba chifukwa cha kuvulala, zotupa komanso njira zopangira opereshoni. Nthawi zina, odwala amafunikira chithandizo cha moyo wonse.