Cov tshuaj Insulin txhim kho qhov kev sib txuas ntawm fatty acids los ntawm cov piam thaj hauv hepato- thiab lipocytes. Nyob rau hauv nws lub zog, cov carboxylation cov tshuaj tiv thaiv ntawm acetyl-CoA yog ua haujlwm nrog kev tsim tom qab ntawm malonyl-CoA, uas txuas ntxiv FFA cov qauv, cov phiaj ntawm cov tshuaj no yog enzyme acetyl-CoA-carboxylase (acetyl-CoA CO2 ligase).

Cov tshuaj insulin tawm qhov cuam tshuam ntawm txhua qhov lipolytic cov tshuaj hormones (adrenaline, glucagon, STH, glucocorticoils), thiab kuj tsim ib qho dhau ntawm isocitrate thiab -ketoglutarate - cov ua haujlwm ntawm acetyl-CoA-carboxylase.

Nws paub tias fatty acids yog thauj los ntawm daim siab mus rau adipose cov ntaub so ntswg uas yog ib feem ntawm cov lipoproteins tsawg kawg (VLDL) zais cia los ntawm daim siab. Cov tshuaj insulin txhim kho cov haujlwm ntawm lipoprotein lipase, uas nqa tawm VLDL tshem tawm nrog kev hloov ntawm fatty acids mus rau hauv adipocytes.

Cov tshuaj Insulin ua kom nrawm rau thauj cov piam thaj rau hauv adipocytes thiab inhibits lub ntsiab lipolytic enzyme ntawm adipose cov nqaij mos - cov tshuaj tiv thaiv lipase.

Raws li kev ua haujlwm ntawm insulin, kev ua haujlwm ntawm glycolysis muab lipogenesis plastically (alpha-glycerophosphate), thiab kev ua kom pentose txoj hauv kev - nquag (los ntawm NADPH₂). 4,2000

Insulin kuj

Insulin tsis kam yog lub cev metabolic teb rau cov tshuaj insulin endogenous lossis exogenous. Hauv qhov no, kev tiv thaiv kab mob tuaj yeem tshwm sim nws tus kheej txog ntawm ib qho ntawm cov teebmeem ntawm insulin, lossis rau ob peb.

Qhov tshuaj insulin yog peptide hormone uas tsim nyob hauv cov hlwb beta ntawm cov kab mob pancreatic islets ntawm Langerhans. Nws muaj ntau qhov kev cuam tshuam ntawm cov txheej txheem hauv kev zom zaub mov hauv yuav luag txhua lub cev nqaij. Kev ua haujlwm tseem ceeb ntawm insulin yog kev siv cov piam thaj los ntawm cov cell - lub cev ua kom cov glycolysis enzymes tseem ceeb, nce permeability ntawm qabzib mus rau lub cell cell, txhawb kev tsim cov glycogen los ntawm cov piam thaj hauv cov leeg thiab lub siab, thiab tseem txhim kho lub zog ntawm cov protein thiab cov rog. Tus txheej txheem uas ua rau cov ntshav tawm hauv insulin yog ua kom cov ntshav qabzib ntau hauv cov ntshav. Tsis tas li ntawd, kev tsim thiab kev zais ntawm cov kua dej insulin yog tsa los ntawm kev noj zaub mov (tsis tsuas yog muaj cov carbohydrate). Kev tshem tawm ntawm cov tshuaj hormone los ntawm cov hlab ntshav yog tsuas yog ua rau daim siab thiab lub raum. Kev ua txhaum ntawm kev nqis tes ua ntawm cov tshuaj insulin rau ntawm daim ntaub (mob ntshav insulin txheeb ze) yog qhov tseem ceeb hauv kev txhim kho ntshav qab zib hom 2.

Cov tshuaj tiv thaiv kabmob ntshav yog siv rau cov neeg mob uas muaj ntshav qab zib hom 2 mellitus, uas txhim kho kev siv ntawm cov kua nplaum los ntawm cov ntaub so ntswg thiab ua rau lub cev ntau ntxiv rau cov tshuaj insulin.

Hauv cov teb chaws industrialized, insulin tsis kam yog kaw hauv 10-20% ntawm cov pej xeem. Nyob rau hauv xyoo tas los no, qhov nce ntawm cov neeg mob tiv thaiv insulin ntawm cov neeg hluas thiab cov tub ntxhais hluas tau raug sau tseg.

Cov tshuaj insulin tuaj yeem txhim kho nws tus kheej lossis tshwm sim los ntawm tus kab mob. Raws li kev tshawb fawb, insulin tsis kam yog sau tseg hauv 10-25% ntawm cov tib neeg tsis muaj teeb meem ntawm lub cev thiab rog rog, hauv 60% ntawm cov neeg mob ntshav liab (nrog ntshav siab 160/95 hli Hg. Art. Thiab saum toj no), hauv 60% ntawm cov neeg mob hyperuricemia, nyob rau hauv 85% ntawm cov neeg mob hyperlipidemia, hauv 84% ntawm cov neeg mob uas muaj ntshav qab zib hom 2, nrog rau hauv 65% ntawm cov neeg uas muaj kev tiv thaiv tsis qabzib.

Cov Neeg Ua thiab Teeb Meem Qhov Tseeb

Lub tshuab ntawm kev txhim kho ntawm cov tshuaj tiv thaiv insulin tsis paub tag nrho. Nws lub ntsiab tseem ceeb tau txiav txim siab ua txhaum ntawm qib ntawm postreceptor. Nws tsis tau meej meej tias qhov kev mob caj ces cuam tshuam qhov kev loj hlob ntawm cov txheej txheem pathological, txawm hais tias muaj tseeb tias muaj kev paub tseeb keeb kwm los mus txhim kho cov tshuaj tiv thaiv kab mob.

Qhov tshwm sim ntawm kev tiv thaiv insulin tuaj yeem yog los ntawm kev ua txhaum ntawm nws lub peev xwm los tawm tsam kev tsim cov piam thaj hauv lub siab thiab / lossis txhawb kev noj qog ntshav qab zib los ntawm cov ntaub so ntswg. Txij li ib feem tseem ceeb ntawm cov piam thaj tau siv los ntawm cov leeg, nws tau qhia tias qhov ua rau kev txhim kho ntawm insulin kuj yuav cuam tshuam kev siv ntshav qabzib los ntawm cov leeg nqaij, uas yog tsim kho los ntawm insulin.

Hauv kev txhim kho cov tshuaj tiv thaiv insulin nyob rau hauv cov ntshav qab zib mellitus ntawm yam thib ob, cov kab mob ua ntej thiab tau kis tau los ua ke. Hauv monozygotic menyuam ntxaib nrog hom 2 mob ntshav qab zib mellitus, muaj peev xwm tiv thaiv insulin ntau dua yog pom nyob hauv kev sib piv nrog menyuam ntxaib tsis raug kev mob ntshav qab zib mellitus. Tau txais cov khoom tiv thaiv ntawm kev tiv thaiv cov tshuaj insulin nws tus kheej thaum ua kom paub tus kab mob.

Kev tswj tsis zoo ntawm lipid metabolism nrog insulin tsis kam ua rau txoj kev loj hlob ntawm cov rog rog (ob leeg thiab mob hnyav) nrog kev pheej hmoo mob ntshav siab lossis mob qog nqaij hlav.

Cov laj thawj rau kev tshwm sim ntawm theem nrab insulin kuj nyob rau hauv hom 2 mob ntshav qab zib mellitus muaj xws li lub xeev ntawm hyperglycemia ntev, uas ua rau kev txo qis hauv kev lom neeg ntawm insulin (glucose-vim insulin resistance).

Ntawm cov ntshav qab zib mellitus ntawm thawj hom, insulin tsis kam tshwm sim vim tswj tsis tau cov ntshav qab zib, thaum txhim kho cov nyiaj them rau cov khoom noj uas muaj cov kab mob carbohydrate, insulin rhiab heev tshwm sim. Hauv cov neeg mob uas muaj hom 1 ntshav qab zib mellitus, insulin tsis kam yog qhov thim rov qab thiab correlates nrog glycosylated hemoglobin ntshav cov ntsiab lus.

Qhov txaus ntshai rau kev tsim cov tshuaj insulin muaj xws li:

kev tshuaj ntsuam genetic predisposition
lub cev nyhav dhau heev lawm (thaum tshaj lub cev qhov zoo tshaj los ntawm 35-40%, cov ntaub so ntswg rhiab rau insulin tsawg dua li 40%),
leeg ntshav siab
kis kab mob
metabolic ntshawv siab
cev xeeb tub lub sijhawm
kev raug mob thiab phais mob,
tsis muaj kev tawm dag zog
cwj pwm tsis zoo
noj ib tug xov tooj ntawm cov tshuaj
Khoom noj khoom haus tsis zoo (feem ntau yog siv cov ua kom zoo zoo carbohydrates),
pw tsis txaus hmo ntuj
xwm txheej ntxhov siab heev
hnub nyoog siab heev
teej tug rau qee haiv neeg (Cov Neeg Mev, Neeg Asmeskas Dub, Neeg Asmeskas Dub).

Cov qauv ntawm tus kabmob

Insulin tsis kam tuaj yeem yog thawj thiab theem nrab.

Kev kho tshuaj kho mob ntawm cov tshuaj tiv thaiv insulin yam tsis muaj kev kho qhov hnyav dhau yog tsis ua haujlwm.

Los ntawm keeb kwm, nws muab faib ua cov ntawv hauv qab no:

muaj sia - tuaj yeem tshwm sim hauv tus pub dawb, thaum cev xeeb tub, thaum pw tsaug zog hmo ntuj, nrog cov rog ntau dhau los ntawm cov khoom noj,
metabolic - nws yog sau tseg nrog hom 2 mob ntshav qab zib mellitus, decompensation ntawm hom 1 mob ntshav qab zib mellitus, mob ntshav qab zib ketoacidosis, rog rog, hyperuricemia, noj tsis txaus, haus dej cawv,
endocrine - pom nrog hypothyroidism, thyrotoxicosis, pheochromocytoma, Itsenko-Cushing's syndrome, acromegaly,
non-endocrine - tshwm sim nrog mob qog ntawm lub siab, mob raum tsis ua haujlwm, mob rheumatoid, mob plawv tsis ua haujlwm, mob cancer cachexia, mob hlab ntsha hauv pob txha, raug mob, phais mob, hlawv roj, mob sepsis.

Cov tsos mob ntawm Insulin Kuj

Nws tsis muaj cov cim tshwj xeeb ntawm cov tshuaj tiv thaiv insulin.

Feem ntau muaj ntshav siab - nws tau tsim hais tias qhov ntau dua ntawm cov ntshav siab, nws muaj peev xwm tiv thaiv cov tshuaj insulin ntau dua. Tsis tas li, hauv cov neeg mob insulin tsis kam, qab los noj mov feem ntau tau nce, lub plab rog rog rog yog qhov tshwm sim, kev tsim cov roj tuaj yeem nce ntxiv.

Lwm yam cim ntawm insulin tsis kam suav nrog nyuaj ua kom hnov qab, plooj plooj nco qab, tsis muaj zog, nkees, pw tsaug zog nruab hnub (tshwj xeeb yog tom qab noj mov), muaj kev ntxhov siab.

Kev kuaj mob

Txhawm rau kuaj mob insulin tsis kam, qhov sau ntawm kev tsis txaus siab thiab anamnesis (suav nrog tsev neeg keeb kwm), kev tshuaj xyuas lub hom phiaj, kev tshuaj ntsuam lub zog ntawm cov tshuaj insulin kuj ua tiav.

Thaum sau cov anamnesis, kev saib xyuas yog them rau qhov muaj ntshav qab zib mellitus, kub siab, mob plawv rau cov neeg nyob ze, thiab hauv cov neeg mob yug, mob ntshav qab zib hauv lub cev thaum muaj menyuam hauv plab.

Lub luag haujlwm tseem ceeb hauv kev kho yog ua si los ntawm kev txhim kho ntawm kev ua neej, feem ntau khoom noj khoom haus thiab kev tawm dag zog.

Kev kuaj kab mob ntawm cov xav tias insulin tsis kam suav nrog kev kuaj ntshav thiab tso zis, kuaj ntshav biochemical, thiab kev txiav txim siab hauv chav ntawm cov tshuaj insulin thiab C-peptide hauv cov ntshav.

Ua raws li kev kuaj mob rau kev tawm tsam insulin tsis kam los ntawm Lub Koom Haum Ntiaj Teb Kev Noj Qab Haus Huv, nws muaj peev xwm xav tias nws muaj nyob rau hauv tus neeg mob raws li cov qauv hauv qab no:

lub plab rog rog rog,
txhawb cov ntshav triglycerides (siab tshaj 1.7 mmol / l),
txo qib ntawm qhov siab lipoproteins (qis dua 1.0 mmol / l hauv cov txiv neej thiab 1.28 mmol / l hauv cov poj niam),
qhov ua rau cov suab thaj tsis txaus lossis nce siab nrawm ntawm cov piam thaj (ceev ceev cov piam thaj ntau dua 6.7 mmol / l, cov ntshav qabzib nyob ob teev tom qab ntsuas cov suab thaj hauv qhov ncauj 7.8–11.1 mmol / l),
kev tshem tawm cov albumin hauv cov zis (microalbuminuria saum toj 20 mg / min).

Txhawm rau txiav txim siab txaus ntshai ntawm insulin tsis kam thiab cuam tshuam txog hlab plawv cov teeb meem, ib lub cev ntawm lub cev qhov ntsuas tau raug txiav txim siab:

tsawg dua 18.5 kg / m 2 - tsis muaj lub cev hnyav, tsis muaj kev pheej hmoo,
18.5-24.9 kg / m 2 - lub cev nyhav, cov kev pheej hmoo,
25.0–29.9 kg / m 2 - rog dhau, qhov phom sij dua,
30.0–34.9 kg / m 2 - rog ntawm 1 degree, muaj kev pheej hmoo siab,
35.0–39.9 kg / m 2 - Kev rog rog 2 degrees, muaj kev pheej hmoo siab heev,
40 kg / m 2 - Kev rog dhau 3 qib, muaj kev pheej hmoo siab heev.

Kev kho mob insulin

Kev noj tshuaj rau tshuaj insulin kuj yog noj tshuaj hauv qhov ncauj hypoglycemic. Cov neeg mob uas muaj hom 2 mob ntshav qab zib mellitus yog cov tshuaj hypoglycemic uas txhim kho kev siv ntawm cov kua nplaum los ntawm cov ntaub so ntswg thiab ntxiv qhov mob ntawm cov ntaub so ntswg mus rau insulin, uas ua rau kom them nyiaj ntawm cov metabolism metabolism hauv cov neeg mob ntawd. Txhawm rau kom tsis txhob ua rau lub siab ua haujlwm tsis zoo thaum lub sijhawm siv tshuaj kho mob, tshuaj xyuas cov tshuaj muaj zog ntawm cov ntshav hauv cov ntshav cov neeg mob pom zoo tsawg kawg ib zaug txhua peb lub hlis.

Hauv cov teb chaws industrialized, insulin tsis kam yog kaw hauv 10-20% ntawm cov pej xeem.

Hauv kev kub siab, kev kho mob antihypertensive yog kev kho mob. Nrog rau cov roj (cholesterol) hauv cov ntshav, lipid-txo cov tshuaj yog qhia.

Nws yuav tsum tau yug hauv siab tias kev siv tshuaj kho mob ntawm cov tshuaj insulin tsis muaj kev txhim kho ntawm lub cev nyhav dhau los yog qhov ua tsis tau zoo. Lub luag haujlwm tseem ceeb hauv kev kho yog ua si los ntawm kev txhim kho ntawm kev ua neej, feem ntau khoom noj khoom haus thiab kev tawm dag zog. Ib qho ntxiv, nws yog qhov tsim nyog los tsim kom muaj kab mob kev noj qab haus huv txhua hnub txhawm rau txhawm rau txhawm rau kom muaj kev pw txaus.

Kev kawm tawm dag zog lub dag zog ua rau koj ua suab nrov ntawm cov leeg nqaij, nrog rau nce cov leeg nqaij thiab yog li txo qis cov ntsiab lus ntawm cov piam thaj hauv cov ntshav yam tsis muaj cov tshuaj insulin ntxiv. Cov neeg mob uas muaj tshuaj insulin kuj pom zoo kom siv dag zog tawm dag zog kom tsawg 30 feeb nyob rau ib hnub.

Txo tus nqi ntawm adipose daim ntaub uas muaj lub cev muaj roj heev tuaj yeem ua phais mob. Kev phais liposuction tuaj yeem yog laser, dej-dav hlau, radiofrequency, ultrasound, nws tau ua nyob rau hauv kev siv tshuaj loog thiab tso cai rau koj kom tshem tau 5-6 liv ntawm cov rog hauv ib txoj kev ua. Kev phais liposuction tsis yog qhov ua kom mob qis dua, tuaj yeem ua raws li cov tshuaj loog hauv zos thiab muaj lub sijhawm luv dua. Lub ntsiab tseem ceeb ntawm cov kev phais mob liposuction yog cryolipolysis, ultrasonic cavitation, thiab kev txhaj tshuaj liposuction.

Hauv kev rog rog morbid, qhov teeb meem ntawm kev kho mob nrog kev phais tus mob phais plab me me yuav raug txiav txim siab.

Noj rau insulin kuj

Qhov yuav tsum tau kawm uantej rau qhov ua tau zoo ntawm kev tiv thaiv insulin yog kev noj haus. Kev noj haus yuav tsum yog protein-zaub, carbohydrates yuav tsum tau sawv cev los ntawm cov khoom lag luam nrog qis glycemic index.

Insulin tsis kam yog kaw hauv 10-25% ntawm cov tib neeg tsis muaj teeb meem ntawm lub cev thiab rog dhau.

Cov zaub mov muaj zaub mov thiab zaub mov muaj fiber ntau, nqaij ntshiv, nqaij ntses thiab nqaij ntses, khoom noj siv mis thiab khoom noj muaj roj, buckwheat tais diav, thiab cov zaub mov muaj roj omega-3 fatty acids, potassium, calcium, thiab magnesium pom zoo.

Txwv txiav cov zaub uas muaj cov hmoov txhuv nplej siab ntau (qos yaj ywm, pob kws, taub dag), tsis suav cov qhob cij dawb thiab ncuav qab zib, mov, nplej zom, mis nyuj tag nrho, butter, qab zib thiab ncuav qab zib, cov kua txiv qab, cawv, thiab kib thiab zaub mov muaj roj. Cov.

Rau cov neeg mob uas muaj cov tshuaj insulin, ib qho kev noj haus Mediterranean yog qhov pom zoo, nyob rau hauv uas txiv roj roj yog qhov tseem ceeb ntawm kev noj haus lipids. Cov zaub uas tsis muaj hmoov nplej thiab txiv hmab txiv ntoo, cawv liab liab (tsis muaj pathologies ntawm cov hlab plawv thiab lwm yam kev sib kis), cov khoom noj muaj mis (kua mis nyeem yog ntuj, feta cheese) tuaj yeem suav nrog kev noj haus. Cov txiv ntoo qhuav, txiv ntoo, noob, txiv ntseej tuaj yeem siv tsis ntau tshaj ib zaug ib hnub. Koj yuav tsum txwv kev siv cov nqaij liab, nqaij qaib, tsiaj rog, qe, ntsev.

Yuav muaj teeb meem thiab tshwm sim

Insulin tsis kam tuaj yeem ua rau atherosclerosis los ntawm kev ua txhaum fibrinolysis. Tsis tas li ntawd, tawm tsam nws cov keeb kwm yav dhau los, hom 2 mob ntshav qab zib mellitus, kab mob plawv, tawv nqaij pathologies (daim tawv dub mob, acrochordon), polycystic ovary syndrome, hyperandrogenism, kev loj hlob anomalies (nthuav dav ntawm lub ntsej muag, kev loj hlob sai) tuaj yeem tsim kho. Kev tswj tsis zoo ntawm lipid metabolism nrog insulin tsis kam ua rau txoj kev loj hlob ntawm daim siab rog (ob qho tib si me thiab mob hnyav) nrog kev pheej hmoo mob ntshav siab lossis mob qog nqaij hlav.

Muaj cov ntshiab keeb kwm kev suav nrog kev txhim kho ntawm kev tiv thaiv cov tshuaj insulin.

Nrog kev kuaj mob kom raws sij hawm thiab kev kho mob kom raug, kev mob tshwm sim yog qhov muaj txiaj ntsig.

Kev Tiv Thaiv

Txhawm rau tiv thaiv kev txhim kho ntawm insulin tsis kam, nws raug pom zoo:

kho cov rog dhau,
zaub mov zoo
meej pem hom ntawm kev ua hauj lwm thiab so,
kev siv lub cev kom txaus
kev zam ntawm qhov xwm txheej ntxhov siab
muab mus rau qhov tsis zoo,
kev kho mob raws sij hawm uas muaj peev xwm ua rau kev txhim kho ntawm insulin tsis kam,
thov kev pab kho mob thiab kev soj ntsuam ntawm insulin tsis kam nyob rau hauv rooj plaub yog xav tias tsam tau ua txhaum ntawm cov carbohydrate metabolism,
Zam txhob siv tshuaj tsis raug cai.

Symptomatology

Kev kuaj mob ntawm cov txheej txheem pathological no nyuaj, vim tias ntev ntev nws tuaj yeem ua rau tag nrho asymptomatic. Ib qho ntxiv, tam sim no cov kev soj ntsuam mob yog qhov tsis tseem ceeb ntawm cov xwm txheej, yog li ntau tus neeg mob tsis nrhiav kev kho mob raws sij hawm, suav tias kev noj qab haus huv tsis zoo rau kev ua kom rog lossis muaj hnub nyoog.

Txawm li cas los xij, ib qho kev ua txhaum cai hauv kev ua haujlwm ntawm lub cev yuav ua ke nrog cov cim hauv qab no:

lub qhov ncauj qhuav, txawm tias qhov nqhis dej tas mus li thiab siv cov kua ntau,
xaiv hauv cov khoom noj - feem ntau, nyob rau hauv cov neeg mob zoo li tus nyiam hloov pauv, lawv tau "kos" rau cov zaub mov qab,
mob taub hau yam tsis muaj ib qho laj thawj, qee zaus kiv taub hau,
qaug zog, txawm tias tom qab so so ntev,
kev paub tsis txaus siab, kev txhoj puab heev, uas yuav yog vim cov piam thaj hauv lub hlwb tsis txaus,
lub plawv dhia
nquag cem quav uas tsis yog los ntawm kev yoo mov
nce hws, tshwj xeeb tshaj yog thaum tsaus ntuj,
rau cov poj niam - coj khaub ncaws tsis xwm yeem,
rog rog plab - tsub zuj zuj ntawm cov rog nyob ib ncig ntawm lub xwb pwg thiab hauv plab,
liab tawm ntawm lub hauv siab thiab caj dab, uas tuaj yeem nrog nrog khaus. Peeling thiab zoo li cov tsos mob dermatological yog tsis tuaj.

Ntxiv nrog rau daim duab sab nrauv etiological sab nraud, qhov muaj cov tsos mob zoo li no yuav raug qhia los ntawm qhov tsis txawv ntawm cov cai ntawm cov ntsuas hauv LHC:

qhov concentration ntawm cov roj "zoo" yog txo,
tus nqi ntawm triglycerides saum toj ib txwm los ntawm 1.7 mmol / l,
tus nqi ntawm cov "phem" cov cholesterol yog siab dua li ib txwm los ntawm 3.0 mmol / l,
cov tsos ntawm cov protein nyob hauv cov zis,
tus nqi ntawm cov ntshav ceev ceev nyob rau hauv qhov ntau tshaj qhov tso cai los ntawm 5.6-6.1 mmol / l.

Yog tias koj muaj daim duab kho mob saum toj saud, koj yuav tsum nrhiav kev kho mob sai sai. Kev muab tshuaj rau tus kheej, qhov no, tsis yog tsuas yog tsis tsim nyog xwb, tab sis kuj tseem ua kom txaus ntshai txoj sia.