Tshuaj tua kab mob rau cov tshuaj insulin

Antibodies rau cov tshuaj insulin yog tsim tawm tsam lawv cov insulin sab hauv. Ntawm cov tshuaj insulin yog qhov raug ntaus cim tshwj xeeb tshaj plaws rau ntshav qab zib hom 1. Cov kev tshawb fawb yuav tsum tau muab coj los soj ntsuam tus kab mob.

Hom I mob ntshav qab zib mellitus tshwm vim yog autoimmune kev puas tsuaj rau cov islets ntawm Langerhans caj pas. Xws li lub pathology ua rau muaj kev ua tiav ntawm insulin hauv tib neeg lub cev.

Yog li, ntshav qab zib hom 1 tau tawm tsam rau hom 2 mob ntshav qab zib, tom kawg tsis txuas ntau qhov tseem ceeb rau kev tiv thaiv kab mob. Nrog kev pab los ntawm kev kuaj mob sib txawv ntawm cov mob ntshav qab zib, kev soj ntsuam tuaj yeem ua kom zoo thiab txoj kev kho mob zoo tuaj yeem kho tau.

Kev txiav txim ntawm cov tshuaj tiv thaiv rau cov insulin

Qhov no yog qhov cim ntawm qhov txhab autoimmune ntawm cov tawv nqaij ntawm pancreatic beta hlwb uas ua cov tshuaj insulin.

Autoantibodies rau kev siv tshuaj insulin yog cov tshuaj tiv thaiv kab mob uas tuaj yeem raug kuaj hauv cov ntshav ntshav ntawm cov ntshav qab zib hom 1 ua ntej kho cov tshuaj insulin.

Kev qhia rau kev siv yog:

• kuaj mob ntshav qab zib
• kev kho cov tshuaj insulin,
• kuaj mob ntawm thawj theem pib ntawm ntshav qab zib,
• kuaj mob ntshav qab zib.

Cov tsos mob ntawm cov tshuaj tiv thaiv ua rau cuam tshuam nrog tus neeg lub hnub nyoog. Yuav kuaj pom cov tshuaj tiv thaiv no yuav luag txhua qhov mob yog tias mob ntshav qab zib tshwm rau cov menyuam yaus hnub nyoog qis dua tsib xyoos. Hauv 20% ntawm cov neeg mob, qhov tshuaj tiv thaiv yog pom hauv cov neeg muaj ntshav qab zib hom 1.

Yog tias tsis muaj hyperglycemia, tab sis muaj cov tshuaj tiv thaiv, tom qab ntawd kev kuaj mob ntshav qab zib hom 1 tsis tau lees paub. Thaum lub caij ua haujlwm ntawm tus kabmob, qib ntawm cov tshuaj tiv thaiv rau cov insulin tsawg dua, nce mus txog lawv qhov kev ploj tag.

Cov neeg mob ntshav qab zib feem ntau muaj cov HLA-DR3 thiab HLA-DR4 noob. Yog tias cov txheeb ze muaj mob ntshav qab zib hom 1, qhov yuav tshwm sim muaj mob ntau dua 15 zaug. Cov tsos mob ntawm autoantibodies rau insulin yog sau ntev ua ntej thawj cov tsos mob ntawm tus mob ntshav qab zib.

Rau cov tsos mob, nce txog 85% ntawm cov hlwb hlwb yuav tsum tau muab pov tseg. Kev soj ntsuam ntawm cov tshuaj tiv thaiv no ntsuas qhov kev pheej hmoo ntawm cov ntshav qab zib yav tom ntej hauv cov neeg muaj mob predisposition.

Yog tias tus menyuam muaj lub caj ces roj ntsha muaj lub cev tiv thaiv kab mob rau cov tshuaj insulin, qhov kev pheej hmoo ntawm kev tsim cov ntshav qab zib hom 1 hauv kaum xyoo tom ntej nce ntxiv li 20%.

Yog tias ob lossis ntau dua cov tshuaj tiv thaiv tau pom tias tshwj xeeb rau hom 1 mob ntshav qab zib mellitus, tom qab ntawd qhov tshwm sim ntawm kev muaj mob nce ntxiv rau 90%. Yog tias ib tus neeg tau txais cov tshuaj insulin (ua kom zoo, ua kom rov zoo ntxiv) hauv kev kho ntshav qab zib, tom qab ntawd lub sijhawm pib lub cev pib tsim cov tshuaj tiv thaiv rau nws.

Kev tsom xam hauv qhov no yuav zoo. Txawm li cas los xij, kev tshuaj ntsuam tsis ua rau nws muaj peev xwm nkag siab hais tias cov tshuaj tiv thaiv yog tsim ntawm insulin sab hauv lossis sab nraud.

Raws li cov tshuaj insulin kho rau cov neeg mob ntshav qab zib, cov naj npawb ntawm cov tshuaj tiv thaiv rau cov insulin sab nraud hauv cov ntshav nce siab, uas tuaj yeem ua rau insulin tsis kam thiab cuam tshuam kev kho mob.

Nws yuav tsum tau yug hauv siab tias qhov tshuaj tiv thaiv insulin tuaj yeem tshwm sim thaum lub sij hawm kho nrog qhov tsis muaj peev xwm txaus ntxhua cov tshuaj insulin.

Kev kho mob ntawm cov neeg mob uas muaj hom 1 mob ntshav qab zib mellitus nrog cov tshuaj tiv thaiv rau cov tshuaj insulin

Qib ntawm cov tshuaj tiv thaiv rau cov tshuaj insulin hauv cov ntshav yog qhov tseem ceeb rau kev kuaj mob. Nws tso cai rau tus kws kho mob kho txoj kev kho, nres qhov kev txhim kho kom tsis txhob cuam tshuam nrog cov tshuaj uas yuav pab tswj ntshav qabzib hauv cov ntshav kom txaus. Kev tawm tsam pom nrog qhov qhia txog kev ua haujlwm tsis zoo hauv kev ua kom huv, nyob rau hauv uas muaj ntxiv proinsulin, glucagon thiab lwm yam.

Yog tias tsim nyog, muab cov tshuaj ntxuav tau zoo (feem ntau yog nqaij npuas) yog kws kho. Lawv tsis ua rau lub cev tsim cov tshuaj tiv thaiv.
Qee zaum cov tshuaj tiv thaiv tau tshawb pom nyob rau hauv cov ntshav ntawm cov neeg mob uas tau kho nrog hypoglycemic tshuaj.

Lub cim ntawm cov txheej txheem autoimmune ua rau muaj kev tawm tsam thiab kev tsis haum rau exulinous insulin thaum kho insulin.

Lub cev tiv thaiv kab mob rau insulin yog ib qho ntawm cov kab mob autoantibodies tau pom nyob rau hauv qhov txhab txhab ntawm lub islet pancreatic apparatus yam ntxwv ntawm insulin-dependant type I diabetes.

Kev txhim kho ntawm autoimmune pathology ntawm pancreatic beta hlwb yog txuam nrog kev mob caj ces (nrog cov qauv ntawm cov teeb meem ib puag ncig). Cov cim ntawm cov txheej txheem autoimmune muaj nyob rau hauv 85 - 90% ntawm cov neeg mob ntshav qab zib insulin-nrog kev pib nrhiav kev mob sai sai, suav nrog cov tshuaj tiv thaiv rau insulin - hauv kwv yees li 37% ntawm cov neeg mob. Ntawm cov neeg txheeb ze nyob ze ntawm cov neeg mob uas muaj ntshav qab zib hom 1, cov tshuaj tiv thaiv tau pom nyob hauv 4% ntawm tus neeg mob, ntawm cov neeg nyob ntawm cov neeg noj qab haus huv - nyob rau hauv 1.5% ntawm cov neeg mob. Rau cov neeg txheeb ze ntawm cov neeg mob ntshav qab zib hom 1, qhov pheej hmoo ntawm tus kab mob no yog 15 npaug ntau dua li ntawm cov pej xeem.

Kev soj ntsuam cov tshuaj tiv thaiv kabmob rau lub cev tiv thaiv kab mob pancreatic islet cell antigens tuaj yeem txheeb xyuas cov tib neeg uas muaj feem ntau ntawm cov kabmob no. Cov tshuaj tiv thaiv kev tiv thaiv kab mob tuaj yeem paub txog ntau lub hlis, thiab qee kis, txawm tias ntau xyoo ua ntej qhov pib ntawm kev kho mob ntawm cov tsos mob. Tib lub sijhawm, vim tias tam sim no tsis muaj txoj hauv kev los tiv thaiv kev loj hlob ntawm hom 1 ntshav qab zib, thiab ntxiv rau, nws muaj peev xwm kuaj pom cov tshuaj tiv thaiv kab mob rau insulin hauv cov neeg muaj kev noj qab haus huv, cov kev tshawb fawb no tsis tshua muaj siv nyob rau hauv kev kho mob niaj hnub ua hauv kev kuaj mob ntshav qab zib thiab kev kuaj ntshav Cov.

Kev tiv thaiv cov tshuaj insulin autoantibodies tau qhia qhov tseeb ntawm cov tshuaj tiv thaiv kab mob uas yuav tsum muaj qhov sib txawv ntawm cov tshuaj tiv thaiv uas tshwm sim hauv cov neeg mob ntshav qab zib insulin-raws kev kho mob nrog insulin npaj ntawm tsiaj keeb kwm. Qhov kawg yog cuam tshuam nrog cov tsos ntawm kev phiv tshuaj thaum kho (cov tawv nqaij hauv zos, kev tsim cov tshuaj insulin, kev sim tawm ntawm kev tawm tsam cov tshuaj tiv thaiv hormonal nrog insulin npaj ntawm ib hom tsiaj).

Kev tshawb nrhiav kom paub cov tshuaj endogenous insulin autoantibodies hauv cov ntshav, uas yog siv rau qhov txawv txav ntawm tus mob ntshav qab zib hom 1 hauv cov neeg mob uas tsis tau txais kev kho mob nrog insulin npaj.

Txhais Lavxias

Txhais Lus Askiv

Cov tshuaj insulin Autoantibodies, IAA.

Kev tshawb fawb qauv

Enzyme-txuas immunosorbent assay (ELISA).

Chav Nyob

U / ml (chav nyob rau ib milliliter).

Dab tsi biomaterial siv tau rau kev tshawb fawb?

Yuav npaj li cas rau txoj kev kawm?

Tsis txhob haus luam yeeb rau 30 feeb ua ntej muab cov ntshav.

Kawm Txog Ib Zaug Ntxiv

Cov tshuaj tua kab mob rau insulin (AT rau insulin) yog cov tshuaj tiv thaiv kab mob ua rau lub cev tiv thaiv nws cov insulin. Lawv yog cov cim tshwj xeeb tshaj plaws ntawm hom 1 ntshav qab zib mellitus (hom 1 mob ntshav qab zib) thiab tseem raug tshawb fawb txog kev kuaj mob sib txawv ntawm tus kab mob no. Mob ntshav qab zib Hom 1 (ntshav qab zib-insulin-tiv thaiv ntshav qab zib) tshwm sim los ntawm lub cev ua rau lub cev puas tsuaj rau lub hlwb ntawm tus txiav, ua rau muaj qhov tsis txaus insulin nyob rau hauv lub cev. Qhov no cais cov ntshav qab zib hom 1 los ntawm ntshav qab zib hom 2, uas cov tshuaj tiv thaiv kab mob ua rau lub luag haujlwm me dua. Kev kuaj pom ntau hom ntshav qab zib yog qhov tseem ceeb tshaj plaws rau kev soj ntsuam thiab kho cov teeb meem.

Txog rau cov kev kuaj mob ntshav qab zib ua kom txawv txav, tus kab mob autoantibodies tau taw qhia tawm tsam? Cov islets ntawm Langerhans tau kuaj xyuas. Feem coob ntawm cov neeg mob ntshav qab zib hom 1 muaj cov tshuaj tiv thaiv cov tshuaj tiv thaiv lawv tus kheej lub txiav ua ke. Thiab, ntawm qhov tsis sib xws, cov autoantibodies zoo li tsis pom zoo rau cov neeg mob uas muaj ntshav qab zib hom 2.

Qhov tshuaj insulin yog ib qho autoantigen hauv kev txhim kho hom ntshav qab zib hom 1. Tsis zoo li lwm yam kab mob autoantigens pom nyob hauv tus kab mob no (glutamate decarboxylase thiab cov protein ntau ntawm cov islets ntawm Langerhans), cov tshuaj insulin yog qhov tsuas yog tshwj xeeb ntawm pancreatic autoantigen. Yog li, kev soj ntsuam zoo ntawm cov tshuaj tiv thaiv rau cov tshuaj insulin yog suav tias yog qhov cim tshwj xeeb tshaj plaws ntawm kev tiv thaiv kab mob autoimmune rau cov kab mob ntshav qab zib hauv cov ntshav qab zib hom 1 (hauv cov ntshav 50% ntawm cov neeg mob uas muaj ntshav qab zib hom 1, autoantibodies rau insulin raug kuaj). Lwm yam autoantibodies kuj tseem pom nyob hauv cov ntshav ntawm cov neeg mob ntshav qab zib hom 1 suav nrog cov tshuaj tiv thaiv rau islet hlwb ntawm tus txiav, tiv thaiv kom glutamate decarboxylase, thiab qee yam. Thaum lub sijhawm kuaj mob, 70% ntawm cov neeg mob muaj 3 lossis ntau hom tshuaj tiv thaiv, tsawg dua 10% muaj tsuas yog ib hom, thiab 2-4% tsis muaj kev tiv thaiv kabmob tshwj xeeb. Tib lub sijhawm, autoantibodies uas muaj ntshav qab zib hom 1 tsis yog qhov ncaj qha ua rau kev loj hlob ntawm tus kab mob, tab sis tsuas yog xav txog kev puas tsuaj ntawm cov kab mob pancreatic.

AT ntawm cov tshuaj insulin yog cov yam ntxwv ntawm cov menyuam yaus muaj ntshav qab zib hom 1 ntau dua thiab muaj tsawg dua rau cov neeg laus. Raws li txoj cai, hauv cov kws kho mob hauv cov menyuam yaus, lawv pom thawj zaug hauv titer siab heev (cov qauv no tshwj xeeb tshaj yog cov menyuam yaus hnub nyoog qis dua 3 xyoos). Muab cov ntsej muag zoo li no, kev ntsuam xyuas ntawm cov tshuaj tiv thaiv rau cov tshuaj insulin yog suav tias yog qhov kev sim zoo tshaj plaws kom paub meej tias kev kuaj mob ntshav qab zib hom 1 hauv cov menyuam yaus uas muaj hyperglycemia. Txawm li cas los xij, nws yuav tsum raug sau tseg tias qhov kev tshwm sim tsis zoo tsis suav nrog qhov muaj tus mob ntshav qab zib hom 1. Yuav kom tau txais cov ntaub ntawv tiav ntau thaum lub sijhawm kuaj mob, nws raug nquahu kom soj ntsuam tsis yog cov tshuaj tiv thaiv rau cov tshuaj insulin, tab sis kuj tseem muaj lwm cov tshuaj tiv thaiv kab mob ntshav qab zib hom 1 ntshav qab zib. Kev kuaj mob ntawm cov tshuaj tiv thaiv rau insulin hauv tus menyuam tsis muaj hyperglycemia tsis suav tias yog kev pom ntawm kev kuaj mob ntshav qab zib hom 1. Nrog rau chav kawm ntawm tus kab mob, cov theem ntawm cov tshuaj tiv thaiv rau cov tshuaj insulin poob rau ib qho kev ua tsis tau, uas cais cov tshuaj tiv thaiv no los ntawm lwm cov tshuaj tiv thaiv tshwj xeeb rau hom ntshav qab zib hom 1, qhov siab ntawm uas tseem nyob ruaj khov lossis nce ntxiv.

Txawm hais tias qhov tseeb hais tias tshuaj tiv thaiv rau cov tshuaj insulin raug suav hais tias yog qhov cim tshwj xeeb ntawm ntshav qab zib hom 1, cov neeg mob ntshav qab zib hom 2 tau piav qhia, uas cov kab mob autoantibodies kuj tau kuaj pom.

Ntshav Qab Zib Hom 1 muaj cov lus qhia kom meej raws caj ces. Cov neeg mob feem ntau uas muaj tus kab mob no yog cov nqa HLA-DR3 thiab HLA-DR4 cov pa. Txoj kev pheej hmoo ntawm kev tsim cov ntshav qab zib hom 1 hauv cov neeg txheeb ze ntawm tus neeg mob uas muaj tus kab mob no nce 15 zaug thiab nce mus txog 1:20. Raws li txoj cai, cov tshuaj tiv thaiv kab mob hauv daim ntawv ntawm kev tsim cov autoantibodies mus rau cov khoom xyaw ntawm cov txiav ua tiav ntev ua ntej pib ntawm ntshav qab zib hom 1. Qhov no yog vim qhov tseeb tias kev txhim kho ntawm cov kev soj ntsuam nthuav dav ntawm ntshav qab zib hom 1 xav tau kev puas tsuaj ntawm 80-90% ntawm cov hlwb ntawm islets ntawm Langerhans. Yog li, kev ntsuam xyuas cov tshuaj tiv thaiv rau cov tshuaj insulin tuaj yeem siv los ntsuas kev pheej hmoo ntawm kev muaj ntshav qab zib yav tom ntej hauv cov neeg mob uas muaj keeb kwm muaj keeb ntawm tus kab mob no. Muaj cov tshuaj tiv thaiv rau cov tshuaj insulin hauv cov ntshav ntawm cov neeg mob li no tau cuam tshuam txog 20 feem pua ​​ntawm kev pheej hmoo ntawm mob ntshav qab zib hom 1 nyob rau 10 xyoo tom ntej. Kev tshawb pom ntawm 2 lossis ntau dua cov kabmob autoantibodies tshwj xeeb rau cov ntshav qab zib hom 1 ntau qhov kev pheej hmoo ntawm kev txhim kho tus kabmob 90% nyob rau 10 xyoo tom ntej.

Txawm hais tias kev soj ntsuam rau cov tshuaj tiv thaiv rau cov tshuaj insulin (ntxiv rau lwm qhov kev sim ntsuas) tsis pom zoo los ua kev soj ntsuam rau cov ntshav qab zib hom 1, txoj kev tshawb no yuav pab tau zoo rau kev kuaj xyuas cov menyuam yaus uas muaj keeb kwm muaj keeb kwm ntawm tus mob ntshav qab zib hom 1. Ua ke nrog kev ntsuas ntshav qabzib, nws tso cai rau koj kuaj ntshav qab zib hom 1 ua ntej txhim kho cov kev mob hnyav, nrog rau ketoacidosis uas mob ntshav qab zib. Qib C-peptide thaum lub sijhawm kuaj mob tseem siab dua, uas yog ntsuas qhov ntsuas zoo tshaj plaws ntawm kev ua haujlwm ntawm? - Cov cai tau pom nrog cov cai no ntawm kev tswj cov neeg mob uas muaj kev pheej hmoo. Nws yuav tsum raug sau tseg tias qhov kev pheej hmoo ntawm kev tsim kab mob rau tus neeg mob uas muaj txiaj ntsig zoo los ntawm kev kuaj mob AT rau insulin thiab qhov tsis muaj keeb kwm keeb kwm ntawm tus kabmob ntshav qab zib hom 1 tsis txawv ntawm kev pheej hmoo ntawm kev tsim tus kabmob no hauv cov pejxeem.

Feem ntau cov neeg mob tau txais cov tshuaj insulin (exogenous, tso tshuaj insulin) pib tsim cov tshuaj tiv thaiv rau nws lub sijhawm. Lawv yuav muaj cov txiaj ntsig kev sim zoo, tsis hais seb lawv tsim cov tshuaj tiv thaiv kab mob rau cov tshuaj insulin endogenous lossis tsis tau. Vim tias qhov no, txoj kev tshawb nrhiav tsis yog npaj rau qhov kev kuaj ntshav sib txawv ntawm tus mob ntshav qab zib hom 1 hauv cov neeg mob uas twb tau txais insulin npaj lawm. Cov xwm txheej zoo li no tuaj yeem tshwm sim thaum tus mob ntshav qab zib hom 1 raug xav tias nyob hauv tus neeg mob uas tau kuaj pom tus mob ntshav qab zib hom 2 uas tau txais kev kho mob exogenous insulin los kho hyperglycemia.

Feem ntau ntawm cov neeg mob uas muaj ntshav qab zib hom 1 muaj ib lossis ntau dua cov kab mob autoimmune. Cov neeg feem ntau kuaj pom cov kab mob autoimmune thyroid (Hashimoto's thyroiditis lossis Graves disease), thawj cov kab mob adrenal tsis txaus (Addison's disease), celiac enteropathy (kab mob celiac) thiab pernicious anemia. Yog li, nrog txoj kev soj ntsuam zoo los ntawm kev tso tshuaj tiv thaiv rau cov tshuaj insulin thiab kev paub tseeb ntawm kev kuaj mob ntshav qab zib hom 1, kev kuaj ntshav ntxiv yog tsim nyog kom cais cov kab mob no.

Dab tsi yog qhov kev tshawb fawb tau siv rau?

• Txog rau kev kuaj mob ntau yam ntawm yam 1 thiab hom 2 mob ntshav qab zib mellitus.
• Txhawm rau ua kom raug kwv yees ntawm kev loj hlob ntawm hom 1 mob ntshav qab zib hauv cov neeg mob uas muaj keeb kwm muaj keeb kwm ntawm tus kab mob no, tshwj xeeb yog rau cov menyuam yaus.

Thaum kawm tiav thaum twg?

• Thaum kuaj xyuas tus neeg mob uas muaj cov tsos mob ntawm tus mob hyperglycemia: nqhis dej, nce ntxiv ntawm cov zis txhua hnub, qab los noj mov, yuag yuag, ploj zuj zus ntawm lub zeem muag, txo qhov rhiab ntawm daim tawv nqaij, thiab tsim kom ntev ntev tsis kho ko taw thiab txhais ceg tawv nqaij.
• Thaum kuaj xyuas tus neeg mob uas muaj keeb kwm muaj keeb kwm mob ntshav qab zib hom 1, tshwj xeeb yog tias nws yog menyuam yaus.

Cov txiaj ntsig li cas?

Kev siv cov nqi: 0 - 10 U / ml.

• ntshav qab zib hom 1
• autoimmune insulin syndrome (Hirat's mob),
• Cov mob polyimocrine syndrome,
• yog tias cov tshuaj insulin npaj (exogenous, tso tshuaj insulin) tau raug sau tseg - muaj cov tshuaj tiv thaiv rau cov tshuaj insulin npaj.

• kev cai
• nyob rau hauv qhov muaj cov tsos mob ntawm hyperglycemia, kev kuaj mob ntawm tus mob ntshav qab zib hom 2 feem ntau yuav tshwm sim.

Dab tsi tuaj yeem cuam tshuam rau qhov txiaj ntsig?

• AT rau cov tshuaj insulin yog cov yam ntxwv ntau dua rau cov menyuam yaus uas muaj ntshav qab zib hom 1 (tshwj xeeb txog 3 xyoos) thiab tsis tshua pom muaj hauv cov neeg laus.
• Qhov kev tso siab ntawm cov tshuaj tiv thaiv rau cov tshuaj insulin poob qis kom txog thaum tus kab mob tsis tuaj yeem tshawb pom nyob rau thawj 6 lub hlis.
• Hauv cov neeg mob uas tau txais cov tshuaj insulin, qhov txiaj ntsig ntawm txoj kev tshawb no yuav muaj qhov zoo, tsis hais seb lawv ua cov tshuaj tiv thaiv kab mob rau cov tshuaj insulin endogenous lossis tsis tau.

Cov ntawv tseem ceeb

• Txoj kev tshawb no tsis tso cai rau qhov txawv ntawm cov tshuaj tiv thaiv kab mob autoantibodies rau lawv tus kheej cov tshuaj insulin thiab cov tshuaj tiv thaiv ua rau cov kab mob insulin rau (exogenous (injectable, recombinant) insulin.
• Cov txiaj ntsig ntawm kev tsom xam yuav tsum raug ntsuas nrog rau cov ntaub ntawv ntsuas rau lwm cov tshuaj tiv thaiv kab mob ntshav qab zib hom 1 rau cov ntshav qab zib hom 1 thiab cov txiaj ntsig ntawm kev kuaj pom dav dav.

Kuj pom zoo

Leej twg yog tus sau daim ntawv qhia?

Endocrinologist, tus kws kho mob feem ntau, tus kws kho menyuam yaus, tus sawv rov qab los kho qhov muag, kws kho qhov muag, kws kho qhov muag, kws kho qhov muag, kws kho plawv.

Ntaub Ntawv

1. Franke B, Galloway TS, Wilkin TJ. Kev tsim kho hauv kev twv ua ntej ntawm hom 1 mob ntshav qab zib mellitus, nrog rau kev siv tshwj xeeb rau cov tshuaj insulin autoantibodies. Ntshav Qab Zib Metab Res Rev. 2005 Sep-Oct, 21 (5): 395-415.
2. Bingley PJ. Cov chaw kho mob soj ntsuam kuaj cov ntshav qab zib soj ntsuam. J Clin Endocrinol Metab. 2010 Lub Ib Hlis, 95 (1): 25-33.
3. Kronenberg H li al. Williams ntawv qhia txog Endocrinology / H.M. Kronenberg, S. Melmed, K.S. Polonsky, P.R. Larsen, 11 ed. - Saunder Elsevier, 2008.
4. Felig P, Frohman L. A. Endocrinology & Metabolism / P. Felig, L. A. Frohman, 4 th ed. - McGraw-Toj, 2001.

Tawm koj tus E-mail thiab tau txais xov xwm, nrog rau kev qhia tshwj xeeb los ntawm KDLmed chav kuaj

1. 
   Neumyvakin, I.P. Mob Ntshav Qab Zib / I.P. Neumyvakin. - M .: Dilya, 2006 .-- 256 p.
2. 
   Skorobogatova, E.S., Kev pom kev puas vim yog ntshav qab zib / E.S. Skorobogatova. - M.: Tshuaj, 2003. - 208 p.
3. 
   Gressor M. Ntshav Qab Zib. Ntau yam yog nyob ntawm koj (tau txhais los ntawm Lus Askiv: M. Gressor. "Mob ntshav qab zib, tawm qhov sib luag", 1994).SPb., Lub tsev luam tawm "Norint", 2000, 62 nplooj ntawv, ncig 6000 daim qauv.

Cia kuv qhia kuv tus kheej. Kuv lub npe yog Elena. Kuv tau ua haujlwm li endocrinologist rau ntau tshaj 10 xyoo. Kuv ntseeg hais tias tam sim no kuv yog tus kws tshaj lij hauv kuv daim teb thiab kuv xav pab txhua tus neeg tuaj xyuas lub vev xaib kom daws qhov nyuaj thiab tsis yog li cov haujlwm. Txhua cov ntaub ntawv rau lub xaib tau sau thiab ua tib zoo ua kom tiav thiaj li xa ntau li ntau tau cov ntaub ntawv tsim nyog. Ua ntej thov cov ntaub ntawv uas tau piav qhia hauv lub vev xaib, yuav tsum tau sab laj nrog tus kws kho mob tshwj xeeb.

Tshuaj insulin yog dab tsi

Cov tshuaj uas ua los ntawm cov hlwb sib txawv ntawm cov roj ntsha pancreatic ntawm Langerhans

Cov tshuaj Insulin yog hom tshuaj hormonal ntawm polypeptide xwm. Nws yog cov tshuaj los ntawm cov ntshav c-hlwb nyob hauv cov tuab ntawm cov islets ntawm Langerhans.

Tus kws tswj lub ntsiab ntawm nws cov ntau lawm yog ntshav qab zib. Qhov ntau dua ntawm cov piam thaj hauv qab ntshav, qhov ntau dua yog qhov xav tau ntawm cov tshuaj insulin.

Dua li ntawm qhov tseeb tias cov synthesis ntawm cov tshuaj hormones insulin, glucagon thiab somatostatin tshwm sim hauv cov hlwb nyob sib ze, lawv yog antagonists. Antagonists ntawm insulin suav nrog cov tshuaj hormones ntawm adrenal cortex - adrenaline, norepinephrine thiab dopamine.

Cov haujlwm ntawm cov tshuaj insulin

Lub hom phiaj tseem ceeb ntawm cov tshuaj insulin yog txoj cai ntawm cov metabolism hauv kev ua noj. Nws yog nrog nws cov kev pab uas lub zog siv - cov piam thaj, nyob hauv cov ntshav ntshav, nkag mus rau cov hlwb ntawm cov leeg nqaij thiab cov qog nqaij adipose.

Cov roj ntsha insulin yog cov sib xyaw ntawm 16 amino acids thiab 51 amino acid residues

Ntxiv rau, insulin hormone ua cov haujlwm hauv lub cev, uas tau muab faib ua 3 pawg, nyob ntawm qhov tshwm sim:

• Anticatabolic:
  1. txo cov protein hydrolysis kev ua kom tsis zoo,
  2. kev txwv tsis pub ntev dhau ntawm cov ntshav nrog cov roj ntsha.
• Kev ntsuas pib:
  1. rov ua haujlwm ntawm glycogen nyob rau hauv daim siab thiab cov hlwb ntawm pob txha pob txha los ntawm kev ua kom sai nws cov polymerization los ntawm cov piam thaj hauv cov ntshav,
  2. kev ua haujlwm ntawm cov enzymes lub ntsiab muab cov pa oxygen-free oxidation ntawm cov lwg piam ntawm cov nplais thiab lwm yam carbohydrates,
  3. tiv thaiv kev tsim cov glycogen hauv lub siab los ntawm cov protein thiab cov rog,
  4. kev loj hlob ntawm kev ua ke ntawm cov tshuaj hormones thiab enzymes ntawm lub plab zom mov - gastrin, ib qho inhibitory gastric polypeptide, secretin, cholecystokinin.
• Anabolic:
  1. tsheb thauj mus los ntawm magnesium, potassium thiab phosphorus sib txuas rau hauv hlwb,
  2. ntxiv kev nqus ntawm cov amino acids, tshwj xeeb yog valine thiab leucine,
  3. txhim kho cov protein biosynthesis, ua rau kom txo DNA ceev ceev (ob npaug ua ntej faib),
  4. kev ua kom nrawm ntawm kev sib txuas ntawm triglycerides los ntawm cov piam thaj.

Rau ib daim ntawv. Cov tshuaj insulin, ua ke nrog kev loj hlob hormone thiab anabolic steroids, yog hais txog qhov thiaj li hu ua cov tshuaj hormones anabolic. Lawv tau txais lub npe no vim tias nrog lawv cov kev pab ua rau lub cev nce tus naj npawb thiab ntau dua ntawm cov leeg nqaij. Yog li, cov tshuaj insulin yog qhov lees paub tias yog kev ncaws pob kis las thiab nws qhov kev siv yog txwv rau kev ncaws pob ntawm cov kis las feem ntau.

Kev tsom xam ntawm cov kua dej thiab nws cov ntsiab lus nyob hauv ntshav

Rau kev ntsuas ntshav rau cov tshuaj insulin, cov ntshav tau los ntawm cov leeg ntshav

Hauv cov neeg muaj kev noj qab haus huv, cov theem ntawm cov insulin hormone cuam tshuam nrog cov piam thaj hauv cov ntshav, yog li, txhawm rau txiav txim siab tseeb nws, ntsuas kev tshaib plab rau insulin (yoo mov) tau muab. Cov kev cai tswjfwm kev npaj rau kev ntsuas cov ntshav rau kev kuaj ntshav insulin yog tus qauv.

Cov lus qhia luv luv muaj raws li nram no:

• tsis txhob noj haus lossis tsis haus kua ntau dua li dej huv - rau 8 teev,
• tsis suav cov khoom noj muaj roj thiab lub cev ua haujlwm dhau, tsis txhob ua kom txaj muag thiab tsis txhob txaj muag - hauv 24 teev,
• tsis txhob haus luam yeeb - 1 teev ua ntej kuaj ntshav.

Txawm li cas los xij, muaj cov nuances uas koj xav paub thiab nco ntsoov:

1. Beta-adreno-blockers, metformin, furosemide calcitonin thiab ib tug xov tooj ntawm lwm yam tshuaj txo qis tsim cov tshuaj insulin.
2. Noj qhov ncauj noj kom tsis txhob muaj menyuam yaus, quinidine, albuterol, chlorpropamide thiab ntau lwm yam tshuaj yuav cuam tshuam rau cov txiaj ntsig ntawm kev tshuaj ntsuam, overestimating lawv. Yog li, thaum tau txais cov lus qhia rau kev kuaj ntshav insulin, koj yuav tsum sab laj nrog koj tus kws kho mob txog kev siv cov tshuaj twg uas yuav tsum tau txiav thiab ntev npaum li cas ua ntej tso ntshav tawm.

Yog tias cov kev cai tau ua raws, tom qab ntawd muab tias txoj cai ntawm tus kws kho mob kom ua haujlwm kom zoo, koj tuaj yeem xav kom ua tiav hauv qab no:

Lus khaws xav Yog tias tsim nyog, rov ua dua cov ntsuas ntawm cov ntsuas siab hauv pmol / l, cov mis μU / ml x 6.945 yog siv.

Cov kws tshawb fawb piav qhia qhov txawv ntawm qhov muaj nuj nqis raws li nram no:

1. Cov kab mob loj hlob tas li xav tau lub zog, yog li ntawd, hauv menyuam yaus thiab tub ntxhais hluas, qhov sib txuas ntawm cov tshuaj insulin yog qis dua me ntsis nws yuav yog tom qab tiav nkauj tiav nraug, thaum pib uas muab lub zog cuam tshuam rau qhov nce zuj zus.
2. Cov txheej txheem siab ntawm cov tshuaj insulin nyob rau hauv cov ntshav ntawm cov poj niam cev xeeb tub ntawm lub plab khoob, tshwj xeeb tshaj yog nyob rau lub sijhawm peb lub hlis thib peb, vim yog qhov tseeb tias nws nqus tau qeeb qeeb los ntawm cov hlwb, thaum tseem ua rau pom kev ua haujlwm tsis muaj txiaj ntsig hauv kev txo qis cov ntshav qab zib.
3. Hauv cov txiv neej thiab poj niam laus tom qab hnub nyoog 60 xyoo, kev tsim kho lub cev ploj mus, kev ua kom lub cev tsawg zuj zus, lub cev tsis xav tau lub zog ntau, piv txwv, xws li thaum muaj 30 xyoo, yog li qhov ntau ntawm qhov tsim tawm cov tshuaj insulin yog qhov qub.

Kev txiav txim siab lub ntsuas qhov ntsuas kev tshaib plab insulin

Kev tsom xam tsis tau muab ib qho ntawm lub plab khoob, tab sis tom qab noj mov - qhov nce ntawm cov tshuaj insulin yog qhov lav

Kev sib txawv ntawm kev ntsuam xyuas tshwm sim los ntawm kev siv qhov tseem ceeb, tshwj xeeb tshaj yog thaum insulin qhov tseem ceeb qis dua ib txwm, tsis zoo.

Qib qis yog ib qho ntawm qhov kev lees paub ntawm kev kuaj mob:

• ntshav qab zib hom 1
• ntshav qab zib hom 2
• Kev Ntsuas Ncaj.

Daim ntawv teev cov mob thiab pathologies nyob rau hauv uas insulin yog siab dua li ib txwm yog ntau dav:

• tshuaj insulinoma
• ntshav qab zib uas muaj cov kev txhim kho ntawm hom 2,
• daim siab mob
• polycystic lub zes qe menyuam,
• Itsenko-Cushing's syndrome,
• metabolic mob
• dystrophy fibre leeg,
• muaj keeb rau intolerance rau fructose thiab galactose,
• acromegaly.

NOMA Index

Qhov ntsuas uas qhia tau cov tshuaj tiv thaiv insulin - ib qho mob uas cov leeg tsis nco qab txog cov tshuaj insulin lawm, yog hu ua NOMA Index. Txhawm rau txiav txim siab nws, ntshav tseem nqa tawm ntawm lub plab tas. Cov piam thaj thiab cov tshuaj insulin yog tsim los, tom qab uas ua lej kev xam zauv yog nqa los ntawm cov mis: (mmol / l x μU / ml) / 22.5

Cov cai ntawm NOMA yog qhov tshwm sim - ≤3.

Qhov ntsuas tau ntawm HOMA Performance index & gt, 3 qhia tias muaj ib lossis ntau pathologies:

• tsis hnov ​​lus qabzib zoo,
• metabolic mob
• yam 2 mob ntshav qab zib,
• polycystic lub zes qe menyuam,
• kev cuam tshuam ntawm cov metabolism-lipid metabolism,
• dyslipidemia, atherosclerosis, kub siab.

Rau cov ntaub ntawv. Cov neeg uas nyuam qhuav kuaj mob ntshav qab zib hom 2 mob ntshav qab zib mellitus yuav tsum tau kuaj qhov mob no ntau zaus, vim tias nws yuav tsum tau soj qab xyuas qhov ua tau zoo ntawm kev kho mob raws li tau hais tseg.

Kev ntxhov siab ua haujlwm tsis tu ncua thiab ib qho kev ua neej nyob qis qis yuav ua rau muaj ntshav qab zib

Tsis tas li ntawd, kev sib piv ntawm cov ntsuas ntawm cov tshuaj insulin thiab cov piam thaj pab tus kws kho mob kom paub meej txog qhov tseem ceeb thiab ua rau muaj kev hloov pauv hauv lub cev:

• Siab insulin nrog cov piam thaj ib txwm yog lub cim:

1. muaj cov txheej txheem ntawm cov qog ntshav hauv cov ntaub so ntswg ntawm tus txiav, ua ntej ntawm lub hlwb los yog qog nqaij hlav,
2. daim siab ua haujlwm thiab qee qhov siab mob siab,
3. cuam ​​tshuam ntawm lub caj pas pituitary,
4. txo qis glucagon tso pa tawm.

• Qes insulin nrog piam thaj ib txwm ua tau nrog:

1. ntau dhau lawm ntau lawm lossis kev kho mob nrog contra-hormones cov tshuaj hormones,
2. pathology ntawm lub caj pas pituitary - hypopituitarism,
3. muaj cov muaj pathologies ntev,
4. nyob rau lub sij hawm mob kis tau yooj yim,
5. qhov xwm txheej ntxhov siab
6. mob siab rau qab zib thiab cov zaub mov muaj roj,
7. kev muab lub cev ua haujlwm dhau los lossis rov ua dua, ua haujlwm ntev ntawm lub cev.

Rau ib daim ntawv. Feem ntau ntawm cov neeg mob feem ntau, cov tshuaj insulin tsawg nrog cov ntshav qabzib tsis yog qhov kuaj mob ntshav qab zib, tab sis koj yuav tsum tsis txhob so. Yog tias tus mob no tseem ruaj khov, ces nws yuav ua rau muaj kev tiv thaiv ntshav qab zib ntau ntxiv.

Siv tshuaj Insulin Antibody (Insulin AT)

Yam 1 ntshav qab zib ua ntej feem ntau tshwm sim thaum menyuam yaus thiab thaum tiav hluas

Hom kev kuaj ntshav ntawm lub cev yog qhov cim ntawm lub hlwb ua rau lub cev puas tsuaj rau insulin-cells-cells ntawm cov txiav. Nws tau tsim rau cov menyuam yaus uas muaj keeb kwm mob ntshav qab zib hom 1 ntshav qab zib.

Nrog kev pab ntawm txoj kev tshawb no, nws tseem muaj peev xwm:

• kev sib txawv kawg ntawm kev kuaj mob tus mob 1 lossis ntshav qab zib hom 2,
• kev txiav txim siab ntawm kev xav rau hom 1 mob ntshav qab zib,
• kev qhia meej ntawm cov laj thawj ntawm hypoglycemia hauv cov neeg uas tsis muaj ntshav qab zib,
• kev txheeb xyuas ntawm kev tsis kam thiab ua kom zoo dua ntawm kev fab tshuaj rau cov tshuaj insulin exogenous,
• kev txiav txim siab ntawm theem ntawm anansulin tshuaj tiv thaiv thaum lub sij hawm kho nrog insulin ntawm tsiaj keeb kwm.

Tshuaj tua kab mob rau cov tshuaj insulin - 0.0-0.4 U / ml. Hauv qhov xwm txheej uas qhov kev cai no dhau los, nws raug nquahu kom ua ib qho kev soj ntsuam ntxiv rau cov tshuaj tiv thaiv IgG.

Saib xyuas Qhov nce ntxiv ntawm cov tshuaj tiv thaiv qib siab yog qhov ib txwm muaj hauv 1% ntawm cov neeg noj qab haus huv.

Glucose kam rau ua ncua kev ntsuas rau qabzib, insulin, c-peptide (GTGS)

Qhov kev kuaj ntshav hom ntshav no siv sijhawm ntev li 2 teev. Thawj qhov hnoos qeev yog coj los rau ntawm lub plab khoob. Tom qab qhov no, muab cov piam thaj tso rau hauv, muab, lub khob ntawm cov kua dej (200 ml) kua dej qab zib (75 g) yog qaug cawv. Tom qab thau khoom, cov ntawv yuav tsum zaum ntsiag to li 2 teev, uas yog qhov tseem ceeb tshaj plaws rau kev ntseeg tau ntawm cov txiaj ntsig kev tshuaj xyuas. Tom qab ntawv muaj qhov rov ua ntshav ntxiv.

Cov cai ntawm cov tshuaj insulin tom qab kev qoj ib ce yog 17.8-173 mkU / ml.

Tseem Ceeb! Ua ntej dhau qhov kev xeem GTG, yuav tsum kuaj ntshav sai sai nrog lub glucometer yog qhov yuav tsum tau ua. Yog tias kev nyeem qab zib yog ≥ 6.7 mmol / L, tsis muaj kev kuaj seb puas muaj kab. Luag pub ntshav pub rau ib qho kev cais txawv ntawm tsuas yog c-peptide nkaus xwb.

Qhov kev mob siab ntawm c-peptide hauv cov ntshav yog ruaj khov dua li qib ntawm cov tshuaj insulin. Cov cai ntawm c-peptide hauv cov ntshav yog 0.9-7.10 ng / ml.

Kev ntsuas rau kev kuaj ntshav c-peptide yog:

• kev sib txawv ntawm hom 1 thiab ntshav qab zib hom 2, nrog rau cov xwm txheej tshwm sim los ntawm cov ntshav qog ntshav qab zib,
• kev xaiv ntawm kev tawm tsam thiab kev kho mob ntshav qab zib,
• polycystic zes qe menyuam syndrome,
• tau muaj kev cuam tshuam los yog tsis kam lees ntawm kev kho mob nrog cov tshuaj insulin,
• daim siab pathology
• tswj tom qab kev phais kom tshem tawm cov txiav.

Cov txiaj ntsig kev xeem los ntawm chav sib txawv yuav txawv.

Yog tias c-peptide ntau dua qhov qub, ces nws muaj peev xwm ua tau:

• ntshav qab zib hom 2
• lub raum tsis ua hauj lwm
• tshuaj insulinoma
• malignant qog ntawm endocrine qog, cov qauv ntawm lub paj hlwb lossis hauv nruab nrog cev,
• muaj cov tshuaj tiv thaiv rau cov tshuaj insulin,
• somatotropinoma.

Yog tias muaj c-peptide qib qis dua ib txwm, kev xaiv muaj peev xwm:

• ntshav qab zib hom 1
• lub xeev ntawm lub caij nyoog kev nyuaj siab
• quav cawv
• muaj cov tshuaj tiv thaiv rau insulin hormone receptors nrog kev twb tau tsim kev kuaj mob ntawm tus mob ntshav qab zib hom 2.

Yog tias tus neeg raug kho nrog cov tshuaj insulin, tom qab ntawd txo qis ntawm c-peptide yog tus qauv.

Thiab hauv kev xaus, peb hais kom saib ib qho yeeb yaj kiab luv luv uas yuav pab koj npaj rau kev kuaj ntshav thiab zis, txuag lub sijhawm, txuag cov leeg thiab tsev neeg pob nyiaj, vim hais tias tus nqi ntawm qee qhov kev tshawb fawb saum toj no zoo nkauj heev.