Cov Insulin Kuj thiab HOMA-IR Index

kwv yees (qhov profile muaj xws li kev kawm txog kev yoo kua nplaum thiab tshuaj insulin.

Cov qauv siv feem ntau rau kev ntsuam xyuas cov tshuaj insulin cuam tshuam nrog kev txiav txim siab ntawm qhov pib ntawm qhov nrawm (nrawm) ntawm cov piam thaj thiab insulin qib.

Txoj kev tshawb no yog nqa tawm ntawm lub plab khoob, tom qab 8-12 teev sijhawm tsaus ntuj yoo mov. Qhov profile muaj xws li ntsuas:

1. piam thaj
2. tshuaj insulin
3. HOMA-IR laij cov insulin resistance index.

Insulin tsis kam cuam tshuam nrog kev pheej hmoo ntawm kev tsim muaj cov ntshav qab zib thiab cov kab mob plawv thiab, pom tseeb, yog cov khoom xyaw ntawm cov kab mob pathophysiological hauv kev koom ua ke ntawm kev rog nrog cov kab mob no (suav nrog metabolic syndrome). Txoj kev yooj yim tshaj plaws rau kev ntsuam xyuas cov tshuaj insulin kuj yog HOMA-IR Insulin Resistance Index, qhov ntsuas tau los ntawm Matthews D.R. et al., 1985, muaj feem xyuam rau kev txhim kho ntawm tus qauv evostatic rau kev tshuaj xyuas qhov tsis taus insulin (HOMA-IR - Homeostasis Kev Ntsuam Xyuas Qauv ntawm Insulin Resistance). Raws li tau qhia, qhov piv ntawm basal (yoo mov) insulin thiab ntshav qabzib cov qib, xav txog lawv cov kev cuam tshuam hauv lub voj kev tawm tswv yim, feem ntau cuam tshuam nrog kev txheeb xyuas cov tshuaj insulin nyob rau hauv cov txheej txheem ncaj qha rau kev txheeb xyuas cov teebmeem ntawm insulin rau glucose metabolism - hyperinsulinemic euglycemic clamp method.

HOMA-IR qhov ntsuas yog suav siv cov mis: HOMA-IR = yoo qab zib (mmol / L) x yoo insulin (μU / ml) / 22.5.

Nrog kev nce ntawm kev yoo kua nplaum lossis insulin, HOMA-IR index, feem, nce ntxiv. Piv txwv li, yog tias cov kua nplaum ceev yog 4,5 mmol / L thiab cov tshuaj insulin yog 5.0 μU / ml, HOMA-IR = 1.0, yog tias cov piam thaj sai yog 6.0 mmol / L thiab insulin yog 15 μU / ml, HOMA- IR = 4.0.

Qhov pib ntsuas tus nqi ntawm cov tshuaj insulin kuj nyob rau hauv HOMA-IR feem ntau txhais tau tias yog 75 feem pua ​​ntawm nws cov pej xeem kev faib tawm. Lub HOMA-IR qhov ntsuas yog nyob ntawm tus qauv rau kev txiav txim siab insulin; nws tsis yooj yim rau qauv. Cov kev xaiv ntawm qhov pib tus nqi, ntxiv rau, yuav yog nyob ntawm lub hom phiaj ntawm qhov kev tshawb fawb thiab cov pab pawg xaiv raug xaiv.

HOMA-IR qhov ntsuas tsis suav nrog cov qauv tseem ceeb hauv kev kuaj mob ntawm tus mob metabolic syndrome, tab sis nws tau siv los ua kev tshawb nrhiav ntxiv ntawm cov ntaub ntawv no. Hauv kev txheeb xyuas qhov kev pheej hmoo ntawm kev tsim muaj cov ntshav qab zib hauv ib pawg neeg cov ntshav qabzib qis dua 7 mmol / L, HOMA-IR paub ntau dua li sai dua cov piam thaj lossis insulin per se. Kev siv hauv kev kho mob rau kev soj ntsuam lub hom phiaj ntawm cov qauv ua qauv rau kev ntsuas kev txhim kho cov tshuaj insulin raws li kev txiav txim siab ntawm kev yoo ntshav plasma thiab cov kua nplaum muaj ntau qhov kev txwv thiab tsis yog ib txwm lees rau kev txiav txim siab txog kev teem sijhawm kho ntshav qabzib, tab sis tuaj yeem siv rau kev soj ntsuam lub zog. Muaj zog insulin tsis kam nrog nce ntau zaus tau sau tseg hauv kev muaj kab mob siab C (phaj 1). Kev nce ntxiv ntawm HOMA-IR ntawm cov neeg mob no tau cuam tshuam nrog cov lus teb tsis zoo rau kev kho dua li cov neeg mob tiv thaiv insulin li qub, thiab yog li, kev kho ntawm insulin tsis kam yog suav tias yog ib qho ntawm cov hom phiaj tshiab hauv kev kho mob ntawm daim siab C. Ib qho kev nce ntawm insulin tsis kam (HOMA-IR) yog pom nrog cov tsis muaj cawv tsis ua rau lub siab Cov.

Ntaub Ntawv

1. Matthews DR li al. Qhov kev ntsuas tus qauv hauv tsev: insulin tsis kam thiab beta-cell ua haujlwm los ntawm kev yoo plasma ntshav qab zib thiab cov tshuaj insulin nyob hauv tus txiv neej. Diabetologia, 1985, 28 (7), 412-419.

2. Dolgov VV li al. Kev kuaj pom ntawm cov roj ntsha metabolism hauv cov teeb meem no. Cov kab mob metabolic, mob ntshav qab zib mellitus. M. 2006.

3. Romero-Gomez M. li al. Kev siv tshuaj insulin ua kom tsis txhob mob ntxiv rau peginterferon ntxiv rau ribavirin hauv cov neeg muaj kab mob siab C ntev ntev. Gastroenterology, 2006, 128 (3), 636-641.

4. Mayorov Alexander Yuryevich Lub xeev muaj cov tshuaj tua kab mob hauv kev hloov pauv ntawm cov ntshav qab zib hom 2. Abstract. diss. d. M.N., 2009

5. O.O. Hafisova, T.S. Polikarpova, N.V. Mazurchik, P.P. Dib lauj Cov nyhuv ntawm metformin txog kev tsim cov tshuaj tiv thaiv kab mob ua kom lub sij hawm sib xyaw ua ke los kho tus kab mob siab nrog Peg-IFN-2b thiab ribavirin nyob rau hauv cov neeg mob thaum pib insulin tsis kam. Cov ntawv qhia los ntawm RUDN University. Ser. Tshuaj 2011, No.2.

Cov ntaub ntawv dav dav

Kev tawm tsam (txo qis qhov tsis haum xeeb) ntawm insulin-tiv thaiv cov kab mob rau cov kua dej los ntawm cov kua dej los ntawm cov kev hloov pauv hauv lub cev thiab lwm cov txheej txheem hemodynamic. Qhov ua rau ntawm kev ua tsis ua hauj lwm yog feem ntau cov caj ces los yog tus txheej txheem ua mob. Raws li qhov tshwm sim, ib tus neeg muaj kev pheej hmoo ntau los tsim cov ntshav qab zib mellitus, kev mob metabolic syndrome, lub plawv plawv pathologies, thiab ua haujlwm ntawm cov nruab nrog sab hauv (mob siab, raum).

Kev kawm ntawm cov tshuaj insulin yog qhov kev soj ntsuam ntawm cov ntsuas hauv qab no:

Cov tshuaj insulin yog tsim los ntawm cov hlwb pancreatic (beta hlwb ntawm islets ntawm Langerhans). Nws koom nrog ntau yam kev qhia hauv lub cev hauv lub cev. Tab sis kev ua haujlwm tseem ceeb ntawm cov tshuaj insulin yog:

• piam thaj xa mus rau cov nqaij mos,
• kev cai ntawm lipid thiab carbohydrate metabolism,
• normalization ntawm ntshav qab zib theem, thiab lwm yam.

Hauv qab ntawm qee yam vim li cas, ib tus neeg pib txhim kho tawm tsam insulin lossis nws txoj haujlwm tshwj xeeb. Nrog rau kev txhim kho ntawm kev tawm tsam ntawm cov hlwb thiab cov ntaub so ntswg mus rau insulin, nws cov ntsiab lus hauv cov ntshav nce ntxiv, uas ua rau muaj kev nce siab ntxiv hauv cov piam thaj. Raws li qhov tshwm sim ntawm no, txoj kev loj hlob ntawm hom 2 mob ntshav qab zib, mob metabolic syndrome, thiab kev rog yog qhov ua tau. Kev mob ntshav siab los thaum kawg yuav ua rau lub plawv nres thiab mob ntshav nce hlwb. Txawm li cas los xij, muaj lub tswv yim ntawm "lub cev mob insulin tsis kam", nws tuaj yeem tshwm sim nrog kev xav tau lub zog hauv lub cev (thaum cev xeeb tub, mob nyhav lub cev).

Nco tseg: feem ntau, cov insulin tsis kam yog sau tseg rau hauv cov neeg rog dhau los. Yog tias lub cev qhov hnyav nce txog ntau dua 35%, tom qab ntawd cov tshuaj insulin nws raug txo los ntawm 40%.

HOMA-IR qhov ntsuas yog suav tias yog qhov kev ntsuas xov xwm hauv kev txheeb xyuas qhov muaj peev xwm tiv thaiv cov tshuaj insulin.

Txoj kev tshawb fawb ntsuas qhov sib piv ntawm cov hauv qab (yoo) cov piam thaj thiab insulin qib. Kev nce qib hauv HOMA-IR cov cim qhia tau nce nce ntawm cov piam thaj lossis insulin ntau dua. Nov yog qhia kom meej tias tus mob ntshav qab zib.

Tsis tas li, qhov ntsuas no tuaj yeem siv rau thaum raug kev txhim kho ntawm insulin tsis kam rau cov poj niam mob polycystic ovary syndrome, mob ntshav qab zib hauv lub cev xeeb tub, mob raum tsis ua haujlwm, mob siab B thiab C, thiab mob siab rau lub siab.

Kev ntsuas rau kev tsom xam

• Txheeb xyuas qhov tseeb ntawm insulin tsis kam, nws qhov kev ntsuas hauv kev puab,
• Kev twv ua ntej ntawm kev pheej hmoo ntawm kev tsim muaj cov ntshav qab zib mellitus thiab kev paub tseeb ntawm kev txheeb xyuas pom nyob hauv nws qhov chaw kuaj mob,
• Xav tias kuaj ntshav qabzib tsis kam txais,
• Kev kawm zoo tshaj ntawm cov hlab plawv pathologies - kev mob plawv hauv lub plawv, atherosclerosis, lub plawv tsis ua haujlwm, thiab lwm yam,
• Saib xyuas qhov mob ntawm cov neeg mob nyhav dhau los,
• Cov kev sim ntau rau cov kab mob ntawm cov kab mob endocrine, kab mob metabolic tsis txaus,
• Kev kuaj mob ntawm tus mob polycystic ovary syndrome (ntawm zes qe menyuam tsis nyob ntawm keeb kwm ntawm endocrine pathologies),
• Kev kuaj thiab kho cov neeg mob uas muaj kab mob siab B lossis C hauv daim ntawv ntev,
• Kev kuaj mob ntawm lub siab ua rau lub siab tsis muaj cawv, lub raum tsis ua haujlwm (mob thiab mob ntev),
• Txheeb xyuas txoj kev pheej hmoo ntawm kev tsim kev kub siab thiab lwm yam mob cuam tshuam nrog ntshav siab,
• Kev kuaj mob ntshav qab zib hauv poj niam cev xeeb tub,
• Kev paub ntau ntawm kev kis kab mob, kev teem kho kom zoo.

Txiav txim siab qhov txiaj ntsig ntawm qhov kev ntsuam xyuas rau insulin tsis tuaj yeem tuaj yeem tshwj xeeb: tus kws kho mob, kws kho menyuam yaus, kws phais neeg, kev ntsuas tus kws kho mob, tus kws kho qhov muag, kws kho plawv, kws kho mob hlwb, kws kho mob tshwj xeeb.

Kev siv qhov tseem ceeb

• Cov ciam nram qab no tau txhais rau qhov qabzib:
  • 3.9 - 5.5 mmol / L (70-99 mg / dl) - qub,
  • 5.6 - 6.9 mmol / L (100-125 mg / dl) - mob ntshav qab zib,
  • ntau tshaj 7 mmol / l (mob ntshav qab zib mellitus).
• Qhov ntau ntawm 2.6 - 24.9 mcED rau 1 ml yog suav tias yog kev cai ntawm insulin.
• NOMA-IR insulin resistance index (coefficient) rau cov laus (20 txog 60 xyoo) tsis muaj ntshav qab zib: 0 - 2.7.

Hauv chav kawm ntawm qhov kev tshawb fawb, cov ntsuas tau kawm: qhov kev xav ntawm cov piam thaj thiab insulin hauv cov ntshav, nrog rau qhov ntsuas cov tshuaj insulin kuj. Cov tom kawg yog xam los ntawm cov mis:

NOMA-IR = "cov suab thaj (mmol ib" 1 l) * tshuaj insulin (perED ib 1 ml) / 22.5

Cov mis no yog xav kom siv rau tshwj xeeb yog thaum yoo ntshav.

Qhov tseeb ntawm kev cuam tshuam ntawm qhov tshwm sim

• Lub sijhawm tsis raws qauv ntawm cov ntshav coj mus kuaj,
• Ua txhaum ntawm cov cai ntawm kev npaj rau txoj kev tshawb no,
• Noj qee yam tshuaj
• Cev xeeb tub
• Hemolysis (nyob rau hauv kev ua haujlwm ntawm kev rhuav tshem cov ntshav liab, cov enzymes uas tua cov tshuaj insulin raug tso tawm),
• Kev kho mob Biotin (kev sim tshuaj rau cov tshuaj insulin kuj ua tiav tsis dhau 8 teev tom qab qhia tias muaj tshuaj ntau heev),
• Kev kho tshuaj insulin.

Nce nuj nqis

• Kev tsim tawm ntawm kev tiv thaiv (tiv thaiv, kev tiv thaiv kab mob) rau insulin,
• Nce mob ntshav qab zib
• Mob ntshav qab zib Gestational
• Kab mob plawv
• Cov paib mob (ua txhaum kev ua kom tau cov carbohydrate, rog thiab purine metabolism),
• Polycystic zes qe menyuam mob
• Kev pham ntawm ntau hom,
• Cov kab mob siab (muaj tsis txaus, kab mob ua npaws, steatosis, mob ntsws thiab lwm yam),
• Mob raum tsis ua hauj lwm
• Kev cuam tshuam ntawm cov nruab nrog ntawm cov endocrine system (adrenal caj pas, pituitary, lub qog thiab hlab ntsws, thiab lwm yam),
• Kis tau tus kab mob pathologies
• Oncological kev, thiab lwm yam.

Ib HOMA-IR qis qhia tias tsis muaj cov tshuaj insulin tsis ua haujlwm thiab yog suav tias yog qhov qub.

Kev tsom xam kev npaj

Tshawb nrhiav biomaterial: mob ntshav hauv ntshav.

Biomaterial sampling method: venipuncture ntawm pob ntseg hlab ntsha.

Obligatory mob ntawm lub laj kab: nruj me ntsis ntawm ib npliag plab!

• Cov menyuam yaus hnub nyoog qis dua 1 xyoos yuav tsum tsis txhob noj 30-40 feeb ua ntej kev kawm.
• Cov menyuam hnub nyoog 1 txog 5 xyoos tsis tau noj 2-3 teev ua ntej kev kawm.

Cov kev xav kawm ntxiv

• Nyob rau hnub ntawm tus txheej txheem (tam sim ntawd ua ntej kev tswj hwm) koj tuaj yeem haus dej tsuas yog dej tsis muaj roj thiab ntsev.
• Hmo ua ntej ntawm kev sim, cov rog, kib thiab ntsim tais diav, txuj lom, thiab cov khoom noj uas haus luam yeeb yuav tsum muab tshem tawm ntawm cov khoom noj. Nws yog txwv tsis pub haus dej, tonic dej haus cawv, cawv.
• Thaum nruab hnub, tsis suav lub nra (lub cev thiab / lossis lub paj hlwb-kev xav). 30 feeb ua ntej tso ntshav pub, ib qho kev tsis txaus ntshai, dhia sab nraud, nqa khoom hnyav, thiab lwm yam yog sib kis.
• Ib teev ua ntej kuaj insulin tsis kam, koj yuav tsum tsis txhob haus luam yeeb (suav nrog luam yeeb hauv hluav taws xob).
• Txhua yam kev qhia ntawm kev kho tshuaj lossis kev pabcuam ntxiv, cov vitamins yuav tsum ceeb toom rau tus kws kho mob ua ntej.

Koj tseem yuav tau muab haujlwm: