Matenda a shuga a insipidus (code malinga ndi ICD-10 - E23.2) ndi matenda oopsa a neuroendocrine, omwe amadziwika ndi kulephera kwa impso kuti amwe madzi ndikubwerera mkodzo. Maziko ndiku kuphwanya kupanga, kutulutsa kapena zochita za vasopressin (mahomoni antidiuretic). Matendawa amawonetsedwa ndi ludzu la pathological komanso kumasulidwa kwamikodzo yambiri. Zambiri pazomwe insipidus ili ndi matenda a shuga, ndi mitundu yanji ya matenda ndi momwe mungathane nayo.
Zambiri za anatomy ndi physiology
Impso ndi chiwalo chophatikizika, chomwe chili kumbuyo kwa khoma lachiberekero kumbuyo kwa gawo lotsika la thoracic ndi chapamwamba cha lumbar vertebrae. Chiwalocho chili ndi nembanemba yotupa, kapisozi wamafuta komanso aimpso. Pali magawo omwe impso zimagawika m'magawo awiri:
- ziwalo parenchyma - ntchito zake ndi zofunikira kusefa magazi ndikupanga mkodzo;
- pelvis - kudziunjikira ndikuchotsa mkodzo m'thupi.
Impso iliyonse imakhala ndi zigawo zambiri za ma nephrons, zomwe zimapereka momwe zimagwirira ntchito. Nefroni ali ndi mawonekedwe awa:
- Glomerulus - yoyimiriridwa ndi plexus yolimba ya ma capillaries omwe magazi amayenda. Glomerulus imamizidwa mu kapamwamba ka Shumlyansky-Bowman.
- Kapsolo ili ndi makoma awiri, ndipo pali mwayi pakati pawo. Kapholo kamadutsa mkati mwa tubules.
- Tubules tupangile mu milimo ya kusambakena mu kishimpi kya mpelo parenchyma.
![](http://img.diabetesentity.com/img/diab-2020/7950/nesaharnij-diabet.jpg)
Nephron ndiye gawo laling'ono kwambiri laling'ono la impso.
Ntchito
Impso zimachotsa madzimadzi owonjezera mthupi la munthu, ma metabolites a metabolism a allergen, poizoni ndi poizoni, komanso mankhwala. Kuphatikiza apo, thupi limakhudzanso kayendetsedwe ka madzi amchere, mkhalidwe wamagazi acid, ndi kuthinikizidwa.
Zofunika! Njira zofananira zimaperekedwa chifukwa cha kupangika kwa mkodzo.
Mkodzo umapangidwa motere. Magazi ankhondo amasefa mu glomeruli la nephrons. Apa, magazi amatuluka pang'onopang'ono chifukwa cha kuthamanga kwa mitsempha ya impso komanso kusiyana kukula kwa ziwiya. Madzi oundana amalowetsedwa mu kapisozi komanso poyizoni, zinthu zosafunikira, shuga, ma amino acid. Zida za impso sizidutsa mapuloteni ndi ma cell ena akuluakulu.
Kuphatikiza apo, m'matumbo am'mimba mumatha kuyamwa madzi ndi zinthu zofunika pathupi. Zinthu zosafunikira zimadziunjikira ndikulowetsa mkodzo wa mkodzo (kutola zisa, pelvis, kenaka kulowa muretta ndi chikhodzodzo).
Kodi vasopressin amatani?
Vasopressin imatchedwa mahomoni a hypothalamic-pituitary system, omwe amathandizira pokodza. Kuchuluka komwe kumapangidwa kumayendetsedwa ndi microelement sodium. Kuchulukitsa kachulukidwe m'thupi kumachulukitsa kaphatikizidwe ka mahomoni, ndipo kochepetsedwa kumachepetsa.
Mothandizidwa ndi vasopressin, pamakhala kuyamwa kwina kwa madzi ndi michere kuchokera mkodzo woyamba.
Horona ntchito:
- Amathandizira kuchepetsa ziwiya za nephrons;
- amakhala ndi mulingo woyenera wopanikizika;
- Amathandizira magazi;
- imawongolera kupanga kwa mahomoni ena angapo;
- amawongolera osmotic ndende za michere;
- imalimbikitsa makoswe.
![](http://img.diabetesentity.com/img/diab-2020/7950/nesaharnij-diabet-2.jpg)
Module wa molekyulu ya vasopressin - mahomoni opatsirana, kulephera kwake komwe kumabweretsa kukula kwa matendawa
Kutanthauzira kwa matenda a mtima
Matenda a Endocrine samamangidwa ndi jenda kapena zaka. Itha kuchitika mwa munthu aliyense, koma nthawi zambiri imakula mukamakula.
Gawoli lotsatirali lilipo:
- Central shuga insipidus - zimachitika chifukwa cha matenda opanga mahomoni omwe amagwiritsa ntchito: mtundu wa cholowa; mtundu wopezeka.
- Nephrogenic shuga insipidus - akufotokozera motsutsana maziko a kuchepa chidwi cha impso kuchitira antidiuretic timadzi: cholowa; kukhala ndi chikhalidwe.
- Polydipsia ya pulayimale - kudya kowonjezera kwamadzimadzi kumakhala chifukwa: mtundu wa psychogenic - kuchuluka kwamadzimadzi pakakhala zovuta zamaganizidwe; Mtundu wa dipsogenic - kutsitsa pakhomo la ma receptors omwe amawona kusintha kwa osmotic ndende yamadzi ozungulira.
Mitundu yosowa shuga
Izi zimaphatikizapo matenda a shuga a gestagen, omwe amalumikizidwa ndi kuchuluka kwa michere ya placental. Pambuyo pobadwa kwa mwana, mkhalidwe wa mayiyo umakhazikika.
![](http://img.diabetesentity.com/img/diab-2020/7950/nesaharnij-diabet-3.jpg)
Gestagenic shuga insipidus - matenda omwe amapezeka pakati pa nthawi yobereka
Mtundu wa ntchito umakula mu makanda. Ndi chifukwa chosakhazikika kwa dongosolo la impso komanso kuchuluka kwa phosphodiesterase-5, komwe kumayambitsa kuchepa kwa chidwi cha ma receptors ku mahomoni ndi mphamvu yake yochepa.
Iatrogenic shuga insipidus ndi mawonekedwe osakhalitsa omwe amayamba ndi okodzetsa.
Zifukwa zachitukuko
Pali zinthu zingapo zokhudzana ndi thupi zomwe zimayambitsa matenda a shuga. Werengani zambiri za chilichonse.
Zabadwa
![](http://img.diabetesentity.com/img/diab-2020/7950/nesaharnij-diabet-4.jpg)
Central cholowa cha matenda a shuga chimayamba chifukwa cha masinthidwe amtundu wa vasopressin kapena chifukwa cha kusiyana pakati pa mapangidwe a midbrain. Zizindikiro za matenda amtunduwu zimadziwika pazaka zisanu zoyambirira za moyo wa mwana. Ndi m'badwo, matenda amapita patsogolo, zizindikiro za vasopressin secretion zimachepa.
Zofunika! Matenda azachipatala a kusintha kwawoko kwambiri momwe amayi ndi odwala omwe ali ndi zaka zopitilira 40 amadziwika.
Kuperewera kwa mahoni kumatha kukhala gawo limodzi la matenda obadwa nawo, omwe, kuphatikiza pa matenda a shuga, amaphatikizanso matenda a shuga, ugonthi, kuwala kwa mitsempha ya maso.
Kuyala kwa bedi
Ana amakhala ndi zinthu zochuluka zama cell usiku, zomwe zimachepetsa mkodzo. Mu makanda odwala ndi oyambira usiku kwamikodzo kusakwana, kuchuluka kwa ma antidiuretic amachepetsa kwambiri usiku, motero, mkodzo wambiri wowumitsidwa umachotsedwa.
Kuvulala kumutu
Kuvulala kambiri (mwachitsanzo, kupindika kwa maziko a chigaza, kuwonongeka kwa chishalo cha ku Turkey) kungayambitse kukula kwa zotupa kuzungulira maselo omwe ali ndi vuto lopanga mahomoni. Kuperewera kwa kaphatikizidwe kungakhale kwakanthawi kapena kupitiliza. Mwa odwala ena, zizindikiro za matendawa sizichitika pasanadutse miyezi 1-1,5 pambuyo povulala.
Opaleshoni
Opaleshoni yochotsa pituitary adenoma, metastases, craniopharyngiomas ndizomwe zimayambitsa matenda a shuga insipidus. Katswiriyu ayenera kusiyanitsa pakati pa kupezeka kwa matenda am'mimba ndi njira yothandizira thupi yochotsa madzimadzi omwe adalowa m'thupi kudzera mwa kulowetsedwa panthawi ya opaleshoni.
Tumors
Chochititsa chachikulu ndi dysgerminoma. Kupangitsa kuyambika kwa matendawa, chotupa chiyenera kukhala chachikulu kapena chokhazikika pamalo omwe maselo akuluakulu kwambiri omwe amapanga chinsinsi cha vasopressin amapezeka. Matenda a shuga angayambitse kuwonongeka kwa hypothalamus ndi metastases pamaso pa khansa ya impso, mapapu, kapena chifuwa.
![](http://img.diabetesentity.com/img/diab-2020/7950/nesaharnij-diabet-5.jpg)
Endocrinologist - wothandizira polimbana ndi matenda
Kulondola
Zomwe zimayambitsa kukula kwa mtundu wopanda matenda a matenda am'mimba ndi meningococcal, matenda a cryptococcal, toxoplasmosis, cytomegalovirus, omwe adakhudzana ndi maziko ndi nembanemba wa ubongo mchitidwewu.
Zizindikiro za matendawa
Chizindikiro choyamba ndi ludzu la m'magazi komanso kukodza pafupipafupi (onse masana ndi usiku). Kuchuluka kwa mkodzo kumatha kufikira malita 13-18 patsiku. Wodwala ali ndi izi:
- khungu louma ndi mucous nembanemba;
- kuwonda;
- kusowa kwa chakudya;
- kudzimbidwa pafupipafupi;
- kuchepetsedwa kwa mavuto, tachycardia;
- kumverera kwa kutopa kosalekeza;
- kupumirana mseru ndi kusanza;
- chisokonezo cha kugona;
- kukwiya, manjenje, misozi.
Kuti mumve zambiri za zomwe zimayambitsa matenda a shuga insipidus, onani nkhaniyi.
Zizindikiro za matenda mu ana zimasiyana. Mwanayo amalemera pang'ono, amakana kuyamwitsa, amakonda madzi osawonekera. Mwana amakhala ndi nkhawa, misozi, misozi ikhoza kusakhalapo kapena ochepa.
![](http://img.diabetesentity.com/img/diab-2020/7950/nesaharnij-diabet-6.jpg)
Achichepere - gulu la anthu lodziwika ndi kukula kwa matenda apakati
Zizindikiro za kuchepa madzi m'thupi zimawonekera: kutentha kwa thupi kumachepa, mawonekedwe amaso akuthwa, maso amatuluka, mphuno imayamba kutchulidwa, ma tubercles akutsogolo amawonekera bwino. Kusintha kumachitika nthawi zambiri. Kuchepa mphamvu kwa thupi kumatha kubweretsa kukokana komanso kusazindikira. Pankhaniyi, thandizo loyenerera ndilofunikira, chifukwa ngakhale zotsatira zakupha zimakhala zotheka.
Werengani zambiri za kuwonetsa kwa matenda ashuga a shuga mwa ana amapezeka munkhaniyi.
Zizindikiro
Ngati deta yonse ya anamnesis ndi mawonetsedwe azachipatala amawonetsa ludzu la m'matumbo ndi kukodza kwambiri, ndikofunikira kuphunzira izi:
- mulingo wazinthu zomwe zimatsata magazi (calcium, sodium, potaziyamu);
- Zizindikiro zam shuga ndi mkodzo (chimodzi mwazosiyana pakati pa matenda ashuga ndi shuga);
- Zizindikiro za urea mu biochemistry;
- kukoka kwapadera kwa mkodzo;
- osmotic ndende ya magazi ndi mkodzo.
Kuyesa kwamadzi
Njirayi imathandizira osati kukhazikitsa kukhalapo kwa matendawa, komanso kusiyanitsa pakati pa nephrogenic shuga insipidus. M'mawa pamimba yopanda kanthu ,ayeza thupi la wodwalayo, kenako asamwe madzi aliwonse. Kutalika kwa nthawi ndi maola 6-8 mpaka 24. Ola lililonse, kulemera, kuchuluka kwake komanso kukoka kwapadera kwa mkodzo, zizindikiro za sodium ndi osmotic ndizojambulidwa.
Mayeso a Desmopressin
Kuchitidwa motsutsana ndi maziko a kuyesedwa kwamadzi kapena kupatula pamenepo. Wodwalayo amapatsidwa Desmopressin piritsi kapena jakisoni. Odwala amayesedwa molingana ndi Zimnitsky, ndende ya osmotic imatsimikiziridwa, zizindikiro za sodium mu mkodzo pamene mukumwa mankhwalawa komanso isanachitike.
Chida chozindikira
Njira zotsatirazi zimagwiritsidwa ntchito:
- MRI yaubongo - imakupatsani mwayi kuti musankhe osati kukhalapo kwa matenda, komanso kukhazikitsa chomwe chimayambitsa matendawa.
- Ultrasound a impso.
- X-ray yamapapu.
- CT sikani ya m'mimba.
- Mbiri
Zochizira
Cholinga cha mankhwalawa ndikuchotsa ludzu la m'magazi komanso kukodza kwambiri, ndikukhalanso moyo wabwino kwa wodwalayo. Choyamba, amachotsa chomwe chinayambitsa matendawa. Chotsatira, mankhwalawa amaperekedwa malinga ndi mtundu wa matenda a shuga a insipidus.
![](http://img.diabetesentity.com/img/diab-2020/7950/nesaharnij-diabet-7.jpg)
Njira yokhazikika yomwera ndi gawo limodzi la mankhwalawa
Chithandizo chapakati
Malangizo a wodwala amatengera kuchuluka kwa madzi omwe amatsika. Ngati kuchuluka kwamkodzo ndi ochepera malita 4 patsiku, mankhwalawa sagwiritsidwa ntchito. Katswiriyu amakupatsirani mankhwala azakudya ndi njira yokwanira yomwera.
Ngati kuchuluka kwa mkodzo kupitilira malita 4, ndiye kuti mungagwiritsidwe ntchito mankhwala othandizira kapena othandizira omwe amapangitsa kuti mahomoni azigwiritsidwa ntchito. Kwa nthawi yayitali, mankhwala adayikidwa omwe adalowetsedwa m'malo amphuno (Desmopressin). Tsopano, pakuthandizira mankhwala, analog ya Minirin imagwiritsidwa ntchito.
Mankhwala omwe amathandizira kupanga mahomoni a antidiuretic: Chlorpropamide, Carbamazepine, Miskleron.
Dziwani zambiri zamalangizo a matenda a shuga omwe alembedwa munkhaniyi.
Chithandizo cha impso
Choyamba, njira yobwezeretsanso madziwo imayendetsedwa. Kenako, mankhwala amathandizidwa ndi mankhwala:
- Liazide diuretics sizodabwitsa, koma ndi matenda a shuga amathandizira kuti madzi asamabwerenso pakapangidwa mkodzo wachiwiri. Oimira gululi - Hydrochlorothiazide, Indapamide.
- NSAIDs - chifukwa cha njira zingapo, othandizira a gululi amawonjezera osmolarity a mkodzo ndikuchepetsa kuchuluka kwake (Indomethacin, Ibuprofen).
![](http://img.diabetesentity.com/img/diab-2020/7950/nesaharnij-diabet-8.jpg)
Mankhwala osokoneza bongo ndi gawo limodzi la chithandizo chachikulu
Kuchiza ndi wowerengeka azitsamba amaloledwa, koma pokhapokha atakambirana ndi endocrinologist.
Chithandizo cha zakudya
Zakudya za matenda a shuga insipidus zimatengera mfundo izi:
- kuchepetsa mchere wambiri mpaka 4 g patsiku;
- kuphika wopanda mchere, kuwonjezera mchere ku mbale yomalizidwa;
- kugwiritsa ntchito zipatso zouma;
- kukana maswiti;
- kupatula zakumwa zoledzeretsa;
- kudya zamasamba atsopano kuchokera ku zipatso, timadziti ndi zakumwa zakumwa zipatso, zopangidwa ndi nsomba, mazira;
- kuletsa kwa mapuloteni, ndipo mafuta ndi chakudya ayenera kukhalapo okwanira;
- zakudya zazing'ono zazing'ono m'magawo ang'onoang'ono.
Ndikofunika kukumbukira kuti matendawa pawokha ali ndi zotsatira zabwino. Mukapita kwa katswiri pa nthawi yake, kutsatira malangizowo ndikuchotsa zomwe zimayambitsa, mutha kukwaniritsa kuchira mwachangu.