Rashin ciwon sukari insipidus

Cutar sankara a jiki cuta ce ta jiki wacce take haifar da rashin ruwa da rashin daidaituwa a ma'aunin ruwan gishiri. Cutar ta amsa da kyau ga magani, amma yana iya haifar da rikitarwa. Ciwon sukari mellitus cuta ce da mutane da yawa ke da ɗan sani game da shi. Ainihin, bayanin yana da alaƙa da yadda za a guji wannan mummunan cutar. Wannan yana nufin kawai nau'i ɗaya na ciwon sukari. A aikace, akwai cututtukan da yawa daban-daban masu alaƙa da shaye shaye da kuma amfani da sugars. Ofayansu shine ciwon sukari na koda.

Ciwon sukari

Ayyuka mafi mahimmanci na jiki sun haɗa da excretory, wato, ikon ƙirin don cire samfuran metabolic na ƙarshe daga jini, ruwa mai wuce haddi, ma'adanai a cikin hanyar maganin creatinine, uric acid, phenol, amines da sauran abubuwa. A ketare wannan aikin, abubuwan da za a cire su tara su dawo cikin jini, sannu a hankali suna lalata daukacin kwayoyin, kuma ba wai ƙashin kansa ba.

Muhimmin fasalin kodan shine ikon tattarawa da narke fitsari, gwargwadon bukatun jikin mutum. Saboda haka ne yawan tara abubuwa daban-daban da adadin ruwa ya bambanta da kyau dangane da lokacin rana, aikin da aka yi, zafin jiki, da sauransu. Babu shakka, gazawar aiwatar da wannan aikin yana haifar da nau'ikan maye.

Cutar cututtuka da yawa da ke da alaƙa da hana ƙwaƙwalwar ƙwayar cuta tana da alaƙa da gaskiyar cewa ɗaukarwa da cirewa dangane da wani abu mafi yawanci ana lalata shi. Ga irin wannan cutar ce cututtukan koda suka shafi.

Kwayar cutar ta bayyana ne kawai a lokuta masu tsauri, lokacin da asarar glucose da ruwa ta zama mai mahimmanci. A cikin tsari mai sauƙi, matakin glucose na jini ya kasance al'ada, haƙurin ɗaukar nauyi al'ada ne ko an rage shi, wannan shine cutar ba ta shafar shaƙar glucose daga abinci. Wani lokacin cututtukan koda na koda shine “m” ga sukari. Cututtuka suna da alaƙa, amma a kaikaice, maimakon haka, suna shafar ci gaban juna fiye da tsokani.

Babban haɗarin shine asarar ruwa da haɓaka hypokalemia, wanda, a ƙarshe, ke haifar da lalata ma'aunin ruwan-gishiri. Bugu da kari, rashi na carbohydrates baya bada izinin daidaita ma'aunin makamashi na yau da kullun.

Cutar ba cuta ce ta kowa ba, amma tana iya zama cikin haihuwa - wani nau'in gado ne mai cin gashin kansa. Daga shekaru da jinsi, cutar ba 'a ɗaure ta' ba.

A cikin yara, asalin na haihuwar ya nuna kanta tuni a sati 3-6 na rayuwa. Siffar halayyar ita ce jariri ya zaɓi ruwa zuwa madarar uwa kuma cikin sauri zai rasa nauyi. Tsarin da ba shi haihuwa ba, kamar manya, yana da alamu mara kyau, duk da cewa sakamakon sa yafi lalacewa. Sau da yawa rashin lafiya yana ƙaddara ko da yaro ya fara lalacewa a baya ta haɓaka ta jiki da ta kwakwalwa.

Kyakkyawan tsari mai tsayayyen haske ba ya haifar da raunin haɓakar haɓaka. Marasa lafiya tsofaffi ba za su iya yin tunanin cutar su tsawon shekaru ba.

Idan aka fahimci hanyoyin da cutar take da kanta, to ba a tabbatar da tushen abubuwan da ke haifar da hakan ba.

Ka'idojin yanzu suna bayanin rashin jigilar fasalin glucose kamar haka:

• Tare da glualcin glual na koda, yawan proubual tubules yana raguwa da kusancin su, wanda ke haifar da asarar glucose.
• Rashin daidaituwa na tsarin sufuri da kanta a kan mai tattara hankali a cikin membrane. Shaida ita ce cewa ginin glucose ta cikin membrane yana da alaƙa da jigilar sodium. Wanke na ƙarshen, bi da bi, yana haifar da cire sukari.
• Rage cikakkiyar tasirin waɗannan ƙwayoyin da ke fuskantar ɓarin tubules - glucose ba ta riƙe da membrane.
• Rage aikin jigilar membrane don glucose.

Wani nau'i na ciwon sukari (insipidus na sukari) shine ciwon sukari na gishiri. Yana da alaƙa da shan wahala na sodium, wanda ke kaiwa zuwa haɓakar sa da haɓakar hyponatremia, shine, sake, don keta daidaitaccen ruwan-gishiri.

Ana yin nazarin abubuwanda ke haifar da wannan cutar:

• Cututtukan cututtuka kamar tarin fuka, mura.
• Pathology na hypothalamus, yana haifar da mummunan aiki a cikin kwayar maganin antidiuretic - vasopressin. Yana iya zama a cikin haihuwa ko samu.
• Lalacewa ga kwakwalwa, hanya daya ko wata da ta shafi aikin urination - rauni, ciwace-ciwacen daji, aiki.
• Cututtukan autoimmune wanda aka yiwa tsarin alli.

A cikin bidiyo game da Sanadin ciwon sukari insipidus:

Akwai manyan nau'ikan cututtukan guda biyu na cutar: ciwon sukari da ciwon sukari na koda. Duk da cewa cututtukan cututtukan iri ɗaya ne, bambance-bambancen da ke tsakaninsu na da mahimmanci.

Sugar - glycosuria, wato isasshen isowar ma'adinan glucose, wanda hakan ke haifar da fitowar kansa a cikin fitsari. A cikin tushen ciwon sukari mellitus, cutar ba a gano shi ba kusan, tunda wannan hanyar - cirewar glucose, yana biya da babban abun ciki na sukari a cikin jini. Koyaya, wannan cin zarafin, duk da haka, yana haifar da saurin ƙwayoyin nephrons, tunda suna aiki tare da nauyin wuce kima.

Akwai biyan kuɗi guda biyu:

• nau'in A - wanda ke da alaƙa da asarar taro mai yawa na tubules proximal,
• nau'in B - cin zarafin safarar sukari ana lura dashi kawai a cikin ɓangarorin nephrons, yayin da ɗayan ɓangaren yana aiki tare da karuwa.

Dangane da tsarin kirkirar cutar, keɓaɓɓen ƙwaƙwalwar ƙwayar cuta ya kasu kashi na farko da na biyu:

• na farko - da ke hade da datti da ruwa,
• sakandare - sakamakon samo cutar. Wadannan sun hada da nephrosis, glomerulonephritis, cutar Girke, da sauransu.

Bugu da kari, yi la’akari da renal da extrarenal glucosuria:

• Tsarin rigakafi - yana da alaƙa da raunin glucose mai ƙarancin gaske a matakin ƙodan, a cikin tsarin tubular, kuma saboda rikici na jigilar glucose a cikin sel.
• An kafa extrarenal a ƙarƙashin tasirin abubuwan na waje. Ya bambanta da koda a cikin cewa karuwa a cikin matakan glucose fitsari ya zo daidai da karuwa na sukari jini.

Akwai wasu biyan kuɗi da yawa da ke da alaƙa da sanadin take hakki:

• masu ciwon sukari - ana danganta su da ciwon sukari, yawanci na farkon. Sugar a cikin fitsari ya bayyana koda da ƙima sosai a cikin plasma. Rashin glucose a cikin fitsari alama ce ta mummunar mummunar cuta, saboda yana nuna gazawar jiki wajen tace komai kwata-kwata,
• tsakiya - hade da lalacewar kwakwalwa. Sanadin encephalitis, meningitis, bugun jini, basur saboda rauni da sauransu,
• cututtukan farji - na ɗan lokaci ne, yana haifar da rashin ƙarfi a cikin aikin ƙwayar cutar. Bayan cire kumburi, glucosuria ya ɓace,
• endocrine - ana danganta shi da wuce haddi ko rashin hormones. Dalilin na iya zama duka cuta ta farko - pheochromocytoma, acromegaly, da kuma amfani da kwayoyi - ACTH, cortisol, da dai sauransu.
• hauhawar jini shima yanayin wucin gadi ne sanadiyyar zazzabi, wanda ke haifar da bushewa da hauhawar jini.

Yi la'akari da waɗannan ƙananan hanyoyin:

• Alimentary - shine sakamakon cin abinci tare da adadin kuzari na carbohydrates. Ana lura da minti 30 bayan cin abinci kuma ya ɓace bayan sa'o'i 4-5. Zai iya zama sakamakon ɗaukar glucocorticoids,
• tausayawa - an danganta shi da kwarewa mai ƙarfi sakamakon raunin da ya faru, rawar jiki, zubar jini. Hakanan yana da alaƙa da glucocorticoids, amma daga asali na asali: ana samar da hormone lokacin da jiki ya dace da yanayin damuwa,
• glucosuria yayin daukar ciki - galibi ana yin sa ne a semester na uku kuma yana ɓacewa bayan haihuwa. Idan matakan sukari na fitsari ba su da ƙasa, babu matakan musamman. Idan matakin glucose ya tashi da sauri kuma an lura dashi da kyau, magani ya zama dole.

Daidaitar da gishiri-gishiri a jikin mutum shine mafi yawanci ana samar dashi ta wani sashi na sodium da ions potassium. An kiyaye daidaituwa ta hanyar aikin kodan da kuma tsarin hormonal. Misali, tare da karuwa a yawan tattara sinadarin a cikin jini, samarwa da kwayar halittar a cikin glandon adrenal ya tsaya, kuma sinadarin sodium an kebe shi a cikin fitsari domin dawo da rabon al'ada na potassium da sodium. Tare da raguwa a cikin taro na sodium, aldosterone yana haɓaka aiki sosai.

Sodium reabsorption yana faruwa a cikin tubules na koda. Aldosterone yana shafar masu karɓa na mineralocorticoid, wanda, bi da bi, yana haɓaka haɓakar jigilar sodium. Latterarshen an keɓance ta cikin ƙwayar tubule kuma an cire shi da fitsari.

Saline mai narkewar ƙwayar ƙwayar ƙwayar cuta wanda ke faruwa lokacin da hankalin jijiyoyin jiki ya ragu. Dangane da haka, jikin ba shi da ikon yin isasshen amsa game da maida hankali na abubuwan aldosterone. A sakamakon haka, ana ci gaba da fitar da sodium, maida hankali a fitsari yana ƙaruwa sosai - sau 15-20.

Irin wannan raguwa mai ƙarfi a cikin abubuwan da ke cikin sodium ions suna haifar da asara mai yawa, lalacewar ma'aunin ruwan-gishiri kuma shine sanadin ciwo mai zurfi. A kan wannan - bushewar ruwa, ciwon sukari da haɗuwa da sukari.

Akwai cututtukan mahaifa da cututtukan siga

• haifuwa - yana da alaƙa da cututtukan cuta a cikin haɓakar tsarin tubular, an gano shi yana ɗan ƙarami,
• saya - yana bayyana saboda cututtukan cututtuka - tarin fuka, lalata kwakwalwa - meningitis, rauni, lalata jijiyoyin jiki da sauransu. Za'a iya haɗa kayan aikin tare da duka aldosterone da vasopressin.

Idan ciwon sukari yana da alaƙa da samar da gurbataccen maganin antidiuretic, to ana iya ƙirƙirar shi ta hanyoyin guda biyu.

Haka kuma, akwai nau'ikan cututtukan 2:

• tsakiya - hade da rashi na maganin antidiuretic, wanda saboda wasu dalilai ba a samar da shi a cikin hypothalamus. A wannan halin, ruwa baya sha, saboda kodan basa karbar alamar da ta dace,
• nephrogenic diabetes insipidus - ana danganta shi da asarar hankalin mai karɓar ƙwayoyin sel daga cikin ƙwayoyin koda. A lokaci guda, vasopressin yana daɗaɗɗa, amma sashin jiki bai amsa shi ba.

Ana samun yawancin ciwon sukari a cikin marasa lafiya na matasa - har zuwa shekaru 30. Idan ba a kula da shi ba, cutar tana ci gaba cikin sauri.

A cikin yara, cutar ta bayyana kanta da gaske, wani lokacin a cikin nau'i na seizures. Alamar yau da kullun tana haɗuwa da zazzabi, rudewa.

Bayyanar cututtuka da alamu

Hoton asibiti na ciwon sukari ya dogara da tsananin, dalilin cutar da yanayin ta. Furucin su da tsananin kishirwa da kuma yawan fitar fitsari wadanda suke tasowa a wannan fannin sun zama ruwan dare.

Ofarfin ƙwayar koda na koda don bayyanawa wasu abubuwa abubuwan ana iyakance shi. Don haka, don glucose, al'ada shine 8.9-10 mmol / l a cikin jini. A wannan maida hankali, ana sake farfado da glucose kuma ya koma cikin jini.

Sama da wannan matakin, nauyin da yake kan tubules ya wuce kima, kuma ana fitar da glucose mai yawa. Darajar da glucose ta daina daukar nauyinta gaba daya ana kiranta "bakin ƙofar gida." Ga mutane daban-daban, darajar mahimmancin mahimmanci shine daban, amma yawanci yakan fada cikin kewayon da aka ƙayyade.
A cikin mata masu juna biyu, bakin kofa a cikin zangon karatu na uku yana raguwa, wanda a mafi yawan lokuta yakan haifar da bayyanar sukari a cikin fitsari.

A cikin yaro, "ƙirar ƙirar" shine 10,45-12, 65 mmol / L.

• Ka'idar ilimin halittar jiki don maida hankali a cikin fitsari shine 1.7 mmol / L. Idan kun wuce matakin fiye da 2.8 mmol / l, zaku iya amincewa da magana game da cutar.

Tare da tsari mai laushi, babu alamun cutar. Yaran yara na iya fuskantar wasu nauyin asara, ko kuma, rashin nauyi, rage yawan ci.

Alamun asibiti suna bayyana ne kawai tare da matsanancin rashin ruwa da kuma babban hasara na glucose:

• rauni da danshi,
• yunwar, sau da yawa hade da rashin ci - kuna son ku ci, amma “wani yanki ba zai hau makogwaron ku ba”,
• karancin ƙwaƙwalwar ajiya, raguwar tunani da ke hade da yunƙurin kwakwalwa,
• polyuria - 3-4 a kowace rana.

Waɗannan alamun sun zo daidai da alamun hypoglycemia, wanda ke sa ganewar asali da wahala.

• Yawan urination mai saurin motsa jiki yana nuna cutar sosai - polyuria, wanda ke nuna kanta a cikin matsanancin tsari da matsanancin ƙodin koda.

Keta keta-gishirin ruwa yana da matukar muhimmanci ga rayuwar yau da kullun, don haka canjin sa yana shafar lafiyar da sauri.

Babban fasalin sune kamar haka:

• polyuria - kuma zuwa babban adadin, 5-1 lita,
• kamar yadda jiki yake kokarin maido da wadatar,
• urinary rashin daidaituwa, musamman da dare. A ƙarƙashin rinjayar irin wannan nauyin, mafitsara ya girma kuma yana aiki tare da wahala,
• nauyi asara - wannan cutar an bayyana shi musamman a cikin yara,
• bushe fata, na yau da kullun salivation,
• zazzabi
• tashin zuciya daga amai, amai da hare-hare tare da karancin ci, maƙarƙashiya.

Kwayar cutar ta ci gaba a hankali, amma idan ba a kula da ita ba, za a sami ci gaba cikin sauri. Bugu da kari, irin wannan nauyin da sauri yana shafar ayyukan zuciya, wanda ke haifar da karuwa a karfin jini.
A cikin yara yara, bayyanar cututtuka sun fi m:

• Siffar sananniyar cutar cuta ce mai narkewar urinary sodium - sosai sau 15-20 fiye da ta al'ada. Don tantance shi, ana yin gwajin jini na ƙwayoyin cuta don ware ƙarancin ƙimar ƙirar ƙoda.
• Hakanan alama ce ta alama ta halayyar ƙwayar cutar koda na insipidus tare da tsarinta na tsakiya ƙananan matakan maganin antidiuretic - vasopressin. Hormone yana tarawa a cikin kashin baya na ciki kuma an keɓe shi kamar yadda ake buƙata. Tare da lalacewar kwakwalwa, cututtukan autoimmune ko lalatawar hypothalamic, vasopressin ba a hade cikin adadin da ake buƙata ba. Sakamakon haka, hanyar lalata ruwa ta lalata, wanda ke haifar da polyuria.

Binciki matakin samarwa na vasopressin ta amfani da gwajin bushewa.

Bayyanar cututtuka da magani na insipidus na ciwon sukari

Binciko

Yana da mahimmanci a gudanar da wani bambance bambancen bincike don kafa ingantaccen ganewar asali. Ko da tare da cikakken daidaituwa na bayyanar cututtuka, cututtuka na iya samun yanayi daban da kuma sanadin.

Don yin wannan, an ƙididdige ƙididdiga daban-daban:

• Da farko dai, ƙaddara da yawan zafin fitsari an ƙaddara - wannan shine cikakken binciken kowa da kowa.
• Gwajin gwaji na jini da urinalysis yana ba ku damar kafa matakin potassium, sodium da sauran abubuwa da rabonsu a cikin plasma da fitsari.
• Idan kuna zargin glucosuria, ana yin gwajin jini da fitsari don sukari. Amma idan gwajin haƙuri na glucose ya nuna sakamako na ƙima, to, dole ne a auna matakin sukari a cikin fitsari sau da yawa. Damuwa, aikin jiki, kayan abinci na kwanan wata - duk wannan yana shafar cirewar glucose. Dangane da gwajin fitsari guda ne don glucose, ba za ku iya gano shi ba.
• Idan ana zargin nau'in gishiri na ciwon sukari da banbancin rashi na maganin antidiuretic, ana yin gwajin bushewa. Mai haƙuri a ƙarƙashin kulawar likita na awanni 8 zuwa 24 baya shan ruwa. Kowane sa'a, ana ɗaukar fitsari don bincike: ƙaddarar tana ƙaddara ta matsa lamba ta osmotic da matakin sodium a cikin fitsari. Mai haƙuri yana auna kullun. An gama gwajin bayan lokacin da aka ƙayyade ko kuma idan mai haƙuri ya rasa fiye da 5% na nauyi, matakin sodium a cikin fitsari ya kai 3 mmol / L ko sama da haka, kuma ƙima da osmolarity su ragu.

Wannan sakamakon gwajin yana tabbatar da nau'in tsakiyar cututtukan ƙwayar gishiri na koda, wato, a kan asalin rashin vasopressin.

Idan sakamakon ya bambanta, to ana iya ci gaba da yin la'akari da yiwuwar juyayi ko ƙwaƙwalwar ƙwaƙwalwar ƙwaƙwalwa:

• Gwaji na biyu don raba ciwon sukari na gishiri shine nunawa ta amfani da minirin. Ana yin gwaji bisa ga Zimnitsky kafin amfani da miyagun ƙwayoyi da kuma bayan. Idan magani yana da inganci, shine, yawan fitsari yana ƙaruwa, kuma yawanta bayan gudanarwa ya ragu, to za a iya gano cutar sikari ta hypothalamic lafiya.
• Gwajin jini na kwayoyin halitta a wannan yanayin yana da mahimmanci: gwargwadon matakin vasopressin a cikin jini, an raba ciwon sukari na tsakiya da nau'in nephrogenic. A cikin lamari na farko, an rage matakin vasopressin, a cikin na biyu - an wuce gona da iri.

Sauran gwaje-gwaje na iya wajabta su:

• MRI - don ware ciwan ciki a cikin kwakwalwar da ke sanya matsin lamba a kan hypothalamus,
• renal parenchyma biopsy - tare da ciwon sukari na gishiri babu wasu canje-canje na halittar mutum da bambanci ga ƙarancin na koda.

A cikin bidiyon kan maganin cutar insipidus:

Hanyar kirkiro ciwon sukari da sukari mai gishiri yana da bambanci sosai. Jiyya, a gaskiya, ba shi da abin yi.

Tare da glucosuria

Ciwon sukari mellitus kusan ba cuta ce mai zaman kanta ba. Sau da yawa, an rage hanyar motsa jiki don magance cutar ta farko - rikicewar endocrine, cututtukan cututtukan fata da sauransu.

A cikin tsari mai sauƙi, glucosuria baya buƙatar wani magani, amma dole ne a kula da matakan glucose fitsari.

A cikin mawuyacin hali, sukan koma neman magani. Manufarta ita ce rage matakan glucose zuwa al'ada.

Don yin wannan, nema:

• ACE inhibitors, rage karfin jini - quinapril, captopril,
• masu hana karɓa na angiotensin-2 - valsartan, condesartan. An rubutasu idan an hana masu hana ACE wasu dalilai,
• sulodexide magani ne wanda ke sake dawo da matakin al'ada na permeability na membrane na tushe.

Glucosuria yana buƙatar takamaiman abincin, sau da yawa ana bada shawara ga marasa lafiya da ciwon sukari, amma ba a cikin irin wannan tsari mai tsauri ba.

Ciwon sukari

Harshen warkewa a cikin cututtukan gishiri yana da niyyar dawo da ma'aunin gishiri-ruwa. A zahiri, don mayar da matakin sodium a cikin jini. Don yin wannan, ana gabatar da maganin sodium don cimma burin da ake so.

Sauran abubuwanda aka lura dasu sun dogara ne da diddigin cutar:

• A cikin lura da ciwon sukari na tsakiya, ana amfani da magunguna waɗanda ke da alaƙar mutum-mutumin na vasopressin: desmopressin, minirin, adiuretin.
• Tare da nau'in ciwon sukari na nephrogenic, desmopressin ba shi da tasiri. Don warkarwa, an wajabta maganin hana daukar ciki: ibuprofen, asfirin, indomethacin. Tushen hanyar shine turezide diuretics.

Abincin gaske yana saukowa zuwa ƙuntatawa ko ma cire gishiri. A lokacin jiyya da dawowa, tushen abincin ya zama yayan itace, kayan lambu da kayayyakin kiwo. Yanayin shaye-shaye bai iyakance ba.

Kulawa da yara bai bambanta sosai. Dalili shine aikin canzawa tare da analogues na hormone antidiuretic. Wannan yawanci desmopressin ne.

Matsayin da yanayin amfani shine likita ya ƙaddara dangane da yanayin haƙuri. Babu wasu shawarwari gaba daya a nan.
A cikin bidiyon game da maganin cutar sankara:

Hasashen da fadace-fadace

Hasashen marasa lafiya da ke dauke da cutar sankarar mahaifa yana da kyau, har ma da wani ƙarshen ziyarar likita. Glucosuria, a ma'ana, ba cuta ce mai barazanar rayuwa ba, kodayake yana iya haɓaka ci gaban ciwon sukari.

Cutar sankara na sukari shima ana iya warkar dashi da sauri ta hanyar kawar da cutar.

Lokacin kula da yara, yana da mahimmanci a tantance cutar a kan lokaci, saboda nau'ikansa masu tsauri suna haifar da jinkiri na haɓaka. Hasashen halin yana da fa'ida. Koyaya, lokacin yin irin wannan binciken, yara ya kamata su kasance a ƙarƙashin kulawa na asibiti: sau ɗaya a kowane watanni 3, ana kula da fata, ƙishirwa, ana duba diuresis, kuma ana kula da ci gaban jiki da na kwakwalwa. Tabbatar ziyarci wani likitan fata da likitan ido.

Cutar sankarau cuta cuta ce da za a iya kula da ita sosai kuma ba ta buƙatar sake duba yanayin rayuwa. Koyaya, shawarar likita da mai cin abinci mai gina jiki duk da haka dole ne a bi su.