Menene cutar LADA

Sanin haka a cibiyar nau'in ciwon sukari na II qarya girma insulin juriya (rashin kulawar nama zuwa insulin) da rama na dan lokaci kara yawan insulin tare da m depletion da karuwa a cikin jini sukari. Koyaya, masana kimiyya basu iya fahimtar dalilin da yasa a cikin wasu marasa lafiya da ke dauke da ciwon sukari na II, raguwar cututtukan fata da kuma buƙatar insulin far kawai yana faruwa a cikin 'yan shekarun da suka gabata, yayin da wasu (adadinsu ya fi ƙanƙanta) - riga a cikin 'yan shekaru (daga watanni 6 zuwa shekaru 6) Sun fara fahimtar dokokin nau'in ciwon sukari na II. A wannan lokacin, an riga an san mahimmancin aikin autoantibodies a cikin haɓaka nau'in I ciwon sukari (idan baku karanta shi ba, ina bayar da shawarar ku karanta shi).

Ma'aikatan Diabetologists na Australiya a shekarar 1993 aikin da aka buga tare da sakamakon binciken matakin kwayoyin rigakafi da kuma rufin asiri C peptide a cikin amsawa ga karawa glucagonwanda ke kara matakan sukari.

C-peptide shine karamin ragowar furotin wanda enzymes yake fitarwa don canza wani kwayar ta proinsulin zuwa insulin. Matsayi na C-peptide daidai yake da matsayin insulin na ciki. Ta hanyar maida hankali ne na C-peptide, yana yiwuwa a kimanta ruɓaɓɓen insulin a cikin haƙuri a kan maganin insulin.

C-peptide ya wanzu yayin haɓakar insulin daga proinsulin.

Binciken autoantibodies da ƙuduri na matakin motsa jiki na C-peptide a cikin marasa lafiya da ke da nau'in ciwon sukari na II ya ba da sakamakon da ba a tsammani ba. Ya juya cewa marasa lafiya tare da kasancewar ƙwayoyin cuta da ƙarancin ɓoyewar C-peptide ba su da nau'in ciwon sukari na II (kamar haka daga asibiti na cutar), amma ya kamata a danganta shi da shi Type I ciwon sukari (ta hanyar ci gaba). Daga baya dai an gano cewa suna bukatar gudanar da aikin insulin tun da wuri fiye da sauran rukunin. Wadannan karatuttukan sun ba mu damar bambanta wani matsakaicin nau'in ciwon sukari - “nau'in ciwon sukari guda 1.5", Wanne ne sananne a ƙarƙashin raguwa na Ingilishi Lada (latent autoimmune ciwon sukari a cikin manya - latent autoimmune ciwon sukari a cikin manya) Latent - mai ɓoye, marar ganuwa.

Mahimmancin Cutar da LADA

Zai yi kama, wane bambanci ne abin da masana kimiyya suka haɗu da shi? Me yasa rikita rayuwar ku da ƙarin gwaje-gwaje? Amma akwai bambanci. Idan ba a gano mai haƙuri da cutar LADA (latent autoimmune diabetes a cikin manya), ana kula dashi ba tare da insulin a matsayin al'ada II ciwon sukari ba, sarrafa tsarin abinci, ilimin jiki da allunan rage sukari da yawa daga ƙungiyar sulfonylurea (glibenclamide, glycidone, glyclazide, glimepiride, glipizide da sauransu). Wadannan kwayoyi, a tsakanin sauran tasirin, suna tayar da ɓoye insulin da haɓaka ƙwayoyin beta, tilasta su yin aiki zuwa iyaka. A mafi girman aikin aikin sel, ƙari sun lalace tare da kumburi autoimmune. Arises mummunan da'ira:

1. lalacewar cell cell lalacewa?
2. rage insulin insulin?
3. sarrafa magungunan rage sukari?
4. arin aiki mai saura sel
5. increasedara yawan kumburin autoimmune da mutuwar duk ƙwayoyin beta.

Duk wannan don 0.5-6 shekaru (matsakaita shekaru 1-2) yana ƙare da ƙoshin hanji da buƙata m insulin far (babban allurai na insulin da kuma yawan sarrafa glycemic tare da tsaftataccen abinci) A cikin nau'in ciwon sukari irin na II, buƙatar insulin ya taso daga baya.

Don katse mummunan yanayin kumburi na autoimmune, ƙananan allurai na insulin suna buƙatar wajabta shi nan da nan bayan bayyanar cutar ta LADA. Farjin insulin da wuri yana da manufofi da yawa:

• bayarwa hutawa sel. Yayin da aka sami ƙarin aiki mai ma'ana, yawancin ƙwayoyin sun lalace a cikin tsarin aikin kwayar halitta,
• hanawa daga kumburi autoimmune a cikin farji da ragewa magana (tsananin da yawa) na autoantigens, waɗanda sune “jan rag” don tsarin rigakafi kuma yana haifar da tsarin aikin kai tsaye, tare da bayyanar cututtukan da zasu dace. A cikin gwaje-gwajen, an nuna cewa gudanar da insulin na tsawon lokaci a cikin mafi yawan lokuta yana rage adadin autoantibodies a cikin jini,
• rike al'ada sukari. An daɗe da sanin cewa matakan glucose na jini mafi girma da tsayi kuma suna wanzuwa, cikin sauri da wahala mawuyacin hali na ciwon sukari.

Farjin insulin da wuri na dogon lokaci zai adana sauran abubuwan da ke jikinsa. Adanawa saura bayanan sirri yana da mahimmanci saboda dalilai da yawa:

• yana sauƙaƙe aikin kula da sukari na jini saboda wani ɓangaren aikin jijiyoyin jiki,
• rage hadarin rashin karfin jini,
• yana hana farkon haɓakar cututtukan ciwon sukari.

Nan gaba, takamaiman immunological jiyya kumburin autoimmune a cikin farji. Ga wasu autoimmune cututtuka irin hanyoyin riga zama (a duba. A miyagun ƙwayoyi Infliximab).

Yadda ake zargin LADA?

Nau'in farkon farawa na LADA shine daga shekara 25 zuwa 50. Idan a wannan shekarun ana zargin ku ko kuma ku kamu da cutar sankara ta II, to ku duba sauran abubuwan LADA. Game da 2-15% na marasa lafiya masu fama da ciwon sukari na II da latent autoimmune ciwon sukari a cikin manya. Daga cikin marasa lafiya Nau'in ciwon siga na II ba tare da kiba ba LADA suna da kusan 50%.

Akwai "LADA Clinical Risk Clinical”, Ciki har da sharudda 5:

1. Ciwon sukari lokacin tsufa kasa da shekara 50.
2. M farko (ƙara yawan fitsari> lita 2 a kowace rana, ƙishirwa, asarar nauyi, rauni, da sauransu, da bambanci da asymptomatic Hakika).
3. Indexididdigar yawan jiki na ƙasa da kilogiram 25 / m 2 (a takaice dai, rashi yawan nauyin jiki da kiba).
4. Cututtukan autoimmune yanzu ko a da (rheumatoid arthritis, na jiki lupus erythematosus da sauran cututtuka na rheumaticmahara sclerosis Hashimoto autoimmune thyroiditis, yadawa mai guba goiter, cututtukan autoimmune, cututtukan Crohn, ulcerative colitis, autoimmune pancreatitis, autoimmune bullous dermatosis, celiac cuta, cardiomyopathy, myasthenia gravis, wasu vasculitis, pernicious (B12 - rashi mai rauni) anaemia, alopecia areata (aski), vitiligo, autoimmune thrombocytopenia, paraproteinemia da sauransu).
5. Kasancewar cututtukan autoimmune a dangi na kusa (iyaye, kakaninki, yara, 'yan'uwa maza da mata).

A cewar masu kirkirar wannan sikelin, idan amsoshi masu kyau daga 0 zuwa 1, da yiwuwar samun LADA bai wuce 1% ba. Idan akwai 2 ko fiye da irin waɗannan amsoshin, haɗarin LADA ya kusan 90%, a wannan yanayin, ana buƙatar jarrabawar dakin gwaje-gwaje.

Yaya za a tabbatar da cutar?

Don maganin gwaji latent autoimmune ciwon sukari a cikin manya yana amfani da 2 manyan gwaje-gwaje.

1) Matsayin matakin anti-gad — maganin glutamate decarboxylase. Sakamakon mara kyau (i.e., kasancewar rigakafin ƙwayar cuta don hana ƙwayoyin jini a cikin jini) yana kawar da LADA. Sakamakon tabbatacce (musamman tare da babban matakin rigakafi) a cikin mafi yawan (!) Cases yana magana cikin yarda da LADA.

Bugu da ƙari, kawai don yin hasashen ci gaban LADA ne kawai za'a iya ƙaddara ICA — maganin rigakafi zuwa sel islet koda. Matsayi na anti-GAD da ICA lokaci guda shine halayen mafi girman nau'ikan LADA.

2) Ma'anar matakin peptide (a kan komai a ciki da bayan tashin hankali) C-peptide wani samfuri ne na insulin biosynthesis sabili da haka abun cikin sa yana daidaita daidai da matakin endogenous (ƙoshin) insulin. Wani nau'in ciwon sukari I (kuma ga LADA kuma, tunda LADA nau'in nau'in nau'in ciwon sukari ne) halayyar mutum ne rage matakin C-peptide.

Don kwatantawa: tare da nau'in ciwon sukari na II, an lura da farko insulin juriya (rashin kulawar nama zuwa insulin) da raunin hyperinsulinemia (don rage matakan glucose, pancreas na ɓoye insulin da ƙwazo fiye da al'ada), saboda haka, tare da nau'in ciwon sukari na II, ba a rage matakin C-peptide ba.

Don haka, in babu anti-GAD, an yanke hukuncin cutar LADA. A gaban anti-GAD + low matakan C-peptide, bayyanar cututtuka na LADA ana ɗauka an tabbatar dashi. Idan akwai anti-GAD, amma C-peptide al'ada ce, ana buƙatar ƙarin kallo.

Tare da bincike mai rikitarwa, LADA yana nuna babban yiwuwar ganowa Alamar kwayoyin nau'in ciwon sukari I (mai haɗarin HLA alleles), tunda ba a samo irin wannan haɗin ba a cikin nau'in ciwon sukari na II. Mafi sau da yawa, akwai haɗin tare da maganin antigram B8 HLA, kuma kusan babu wata ƙungiya tare da "kariya" HLA-B7 antigen.

Abubuwan nau'ikan nau'in I ciwon sukari

Akwai nau'ikan nau'ikan nau'ikan nau'ikan nau'ikan nau'ikan cuta 2 na:

• matasa masu ciwon sukari (yara da matasa) = keɓaɓɓu 1a,
• santin 1b, wannan ya shafi Lada (latent autoimmune ciwon sukari a cikin manya). Raba idiopathic Type I ciwon sukari.

Ciwon sukari (ƙaramin abu mai 1a) yakai kashi 80-90% na nau'ikan nau'in ciwon sukari. Ya kamata lahani na rigakafi mai haƙuri. Tare da subtype 1a, adadin ƙwayoyin cuta (Coxsackie B, kadin, adenoviruses da sauransu) suna haifar da lalacewar hoto ko ƙwayoyin cuta daga sel. A cikin amsa, sel na tsarin rigakafi suna lalata ƙwayoyin da abin ya shafa na tsibirin pancreatic. Autoantibodies zuwa islet nama na pancreas (ICA) kuma zuwa insulin (IAA) kewaya cikin jini a wannan lokacin. Yawan rigakafin (titer) a cikin jini a hankali ya ragu (an gano su a cikin 85% na marasa lafiya a farkon ciwon sukari kuma kawai a cikin 20% bayan shekara guda). Wannan nau'in halitta yana faruwa 'yan makonni bayan kamuwa da kwayar cuta a cikin yara da matasa a ƙarƙashin shekara 25. Farkon yana da hadari (marasa lafiya suna shiga cikin kulawa mai zurfi a cikin 'yan kwanaki, inda aka gano su). Mafi yawan lokuta akwai maganin antigens na HLA B15 da DR4.

Lada (nau'in 1b) yana faruwa a cikin 10-20% na lokuta na nau'in ciwon sukari na nau'in. Wannan nau'in ciwon sukari guda ɗaya ne kawai daga cikin bayyanar da hanyoyin sarrafa kansa a cikin jiki saboda haka yawanci ana haɗuwa da wasu cututtukan autoimmune. Yana faruwa mafi yawan lokuta a cikin mata. Autoantibodies suna yaduwa cikin jini a duk tsawon lokacin cutar, titer (matakin) a kullun yake. Wadannan sune magungunan rigakafin anti-GAD don maganin glatamate decarboxylase, tunda IA-2 (kwayoyin zuwa tyrosine phosphatase) da IAA (zuwa insulin) suna da matuƙar wuya. Wannan nau'in ciwon sukari shine saboda karancin T-suppressors (wani nau'in lymphocyte wanda ke dakatar da amsawar rigakafi daga maganin antigens na jiki).

LADA-ciwon sukari ta hanyar abubuwanda ke faruwa yana nufin nau'in ciwon sukari na I, amma a cikin alamominsa ya fi kama da ciwon sukari na II (jinkirin farawa kuma idan aka kwatanta shi da ciwon sukari na yara). Saboda haka, cutar LADA-ana daukar matsakaici ne tsakanin nau'in I da nau'in ciwon sukari na II. Koyaya, ƙudurin matakin autoantibodies da C-petid ba a haɗa shi a cikin jerin gwaje-gwajen al'ada na mai haƙuri da sabon ciwon sukari ba, kuma cutar ta LADA ke da wuya. Mafi sau da yawa, haɗin da HLA antigens B8 da DR3 an lura.

A idiopathic nau'in ciwon sukari mellitus babu wani lalataccen autoimmune na kwayoyin sel, amma har yanzu akwai raguwa a aikin su tare da dakatar da lalata insulin. Ketoacidosis yana haɓaka. Ana samun cutar ta Idiopathic galibi a cikin Asiya da Afirka kuma tana da gado na fili. Bukatar ilimin insulin a cikin irin waɗannan marasa lafiya na iya bayyana kuma ya ɓace a kan lokaci.

Daga cikin labarin yana da amfani a tuna factsan bayanai.

1. Cutar sankarar LADA ba a santa sosai tsakanin likitoci (kalmar ta bayyana a shekara ta 1993) sabili da haka ba kasafai ake gano shi ba, kodayake ana samun shi a cikin 2-15% na cututtukan cututtukan II.
2. Jiyya maras kyau tare da allunan rage sukari yana haifar da saurin (a matsakaici na shekaru 1-2) nakasa ƙwayar ƙwayar cuta da canzawa zuwa insulin.
3. Therapyarancin ƙwaƙwalwar insulin na yau da kullun yana taimakawa dakatar da ci gaban yanayin sarrafa kansa da kuma kula da ɓoye insulin nasa na tsawon lokaci.
4. Ruwan insulin mai saura wanda yake sanya kwantar da hankali zai iya magance ciwon sukari da kuma kariya daga rikicewa.
5. Idan ana kamuwa da ciwon sukari irin na II, sai a duba kanku don ka'idoji 5 na cututtukan LADA.
6. Idan sharuɗɗa 2 ko sama da haka suna da inganci, za a iya gwada cutar ta LADA kuma C peptide da ƙwayoyin cuta don maganin glutamate decarboxylase (anti-GAD).
7. Idan an gano anti-GAD da ƙananan matakan C-peptide (basal da haɓaka), kuna da ciwon sukari mai lalacewa na latent autoimmune (LADA).