Ciwon sukari mellitus a cikin mata, maza da yara

Kalmar "ciwon sukari" ta fito ne daga Girkanci "leak", a zamanin da an yi imani cewa ruwan da ke shiga jiki, tare da wannan cuta, jikin yana wucewa ba tare da shan ruwa ba. Ciwon sukari insipidus wata cuta ce mai saurin kamuwa da cuta wacce ke da alaƙa da ma'anar tsohuwar. Dalilinsa shine rashin kyawun kwayoyin wanda ke daidaita fitarwar ruwa da kodan. A sakamakon haka, haɓakar fitsari yana haɓaka da haɓaka, da gangan hana mutum rayuwa ta al'ada.

Mai haƙuri koyaushe yana jin ƙishirwa kuma yana tilasta shan ruwa na ruwa don hana bushewa. Ba kamar sukari ba, insipidus na ciwon sukari baya haifar da karuwa a cikin glucose na jini, baya da alaƙa da aikin ƙwayar cutar, kuma baya haifar da rikicewar aladu. Wadannan cututtukan guda biyu suna da alaƙa ne da cutar alama ta gama gari - polyuria da aka ɗauka.

Ciwon sukari insipidus - menene?

Ba duk ruwan da ke shiga cikin hanjin mu ya zama fitsari ba. Bayan yin tacewa, kusan dukkan adadin fitsari na farko ana dibar su cikin jini ta cikin tubules din, tsari da ake kira reabsorption. Daga cikin lita 150 da kodan ke fitarwa da kansu, kashi 1% ne kacal da ke fitowa daga wani nau'in fitsari na hanzari. Sake ɗaukar abu mai yiwuwa ne saboda aquaporins - abubuwa masu gina jiki waɗanda suke girke girke-girke a cikin ƙwayoyin sel. Ofaya daga cikin nau'in aquaporins da ke cikin kodan, yana yin ayyukanta kawai a gaban vasopressin.

Ciwon sukari da hauhawar jini zai zama abin da ya wuce

• Normalization na sukari -95%
• Cirewa kan jijiyoyin mara wuya - 70%
• Cire zuciyar mai karfin zuciya -90%
• Rabu da cutar hawan jini - 92%
• Increasearuwar kuzarin rana, inganta bacci da dare -97%

Vasopressin wani hormone ne wanda aka kera shi a cikin hypothalamus (wani bangare na kwakwalwa) kuma ya tattara a cikin glandin pituitary (gland shine yake a cikin kasan kwakwalwa). Babban aikinta shine tsari na tafiyar da ruwa. Idan yawan jini ya tashi, ko kuma babu isasshen ruwa a jiki, sakin vasopressin yana ƙaruwa.

Idan saboda wasu dalilai ana iya rage ƙwayar hormone, ko ƙwayoyin koda suka daina shan vasopressin, ciwon insipidus na haɓaka. Alamar ta farko ita ce polyuria, ƙwayar fitsari. Kodan na iya cire ruwa mai kimanin lita 20. Mai haƙuri koyaushe yana shan ruwa da urinates. Irin wannan yanayin rayuwa yana takura wa mutum, yana matukar bata yanayin rayuwarsa. Wani sunan cutar shine insipidus masu ciwon sukari. Mutanen da ke da ciwon sukari insipidus suna samun rukunin nakasassu guda 3, damar da za a kula da ita kyauta kuma ta sami magunguna.

Cutar tana da wuya, daga cikin miliyan 1, mutane 2-3 suna fama da ita. Mafi sau da yawa, cutar ta fara ne a cikin balagaggu, daga shekaru 25 zuwa 40 - mutane 6 cikin yawan miliyan 1. Mafi yawan lokuta ba a cika amfani da su ba, cututtukan insipidus na haɓaka cikin yara.

Abin da ke bambanta siffofin da nau'ikan ND

Ya danganta da dalilin polyuria, insipidus na ciwon sukari ya kasu kashi biyu:

1. Cutar sankara ta tsakiya - Yana farawa lokacin da kwakwalwa ta lalace kuma sakin vasopressin cikin jini ya daina aiki. Wannan nau'i na iya haɓaka bayan ayyukan neurosurgical, raunin da ya faru, tare da ciwace-ciwacen daji, meningitis da sauran raunin kwakwalwa. A cikin yara, tsari na tsakiya shine yawanci sakamakon ciwo ko kamuwa da cuta, rikicewar ƙwayoyin cuta. Bayyanar bayyanar cututtuka a cikin marasa lafiya suna bayyana lokacin da kusan kashi 80% na nuclei na hypothalamus sun daina aiki, kafin wannan, ana amfani da kwayar halittar hormone ta yankuna masu fa'ida.
2. Ciwon ƙwaƙwalwar ƙwayar mahaifa insipidus - yana haɓaka lokacin da masu karɓa na tubule masu karɓa suka daina amsawa ga vasopressin. Tare da wannan nau'in ciwon sukari, yawanci ana fitar da fitsari ƙasa da na tsakiya. Irin wannan rikice-rikice a cikin kodan na iya lalacewa ta hanyar stagnation fitsari a cikinsu, cystic formations da ciwace-ciwacen daji, da kuma tsawan tsari mai kumburi. Haka kuma akwai wani nau'in haihuwan yara na cututtukan ƙwayar cuta na yara wanda ke haifar da cutar ƙwaƙwalwar ƙwayar cuta a cikin mahaifa.
3. Idiopathic ciwon sukari insipidus - ana yin gwajin cutar sau da yawa lokacin da vasopressin bai isa ba, amma ba a iya gano musabbabin rashinsa a halin yanzu. Wannan yawanci ƙari ne. Yayinda yake girma, ana samun ilimi ta amfani da hanyoyin gani na zamani: MRI ko CT. Za'a iya gano cutar ta Idiopathic insipidus koda kuwa matakin hormone yana da girma, amma ba a gano canje-canje a kodan. Ana yin bayanin shi sau da yawa ta hanyar maye gurbi. Ana lura da cututtukan ne kawai a cikin maza. Mata suna ɗaukar jigon halittar da aka lalata, ana iya gano alamun cutar a cikin su ta hanyar dakin gwaje-gwaje, polyuria da aka bayyana ba ya nan.
4. Insipidus na ciwon suga - Zai yuwu ne kawai a cikin mata masu juna biyu, tunda sanadinsa shine hormone vasopressinase wanda mahaifa ke lalata, wanda ke lalata vasopressin. Wannan nau'in cutar ya ɓace nan da nan bayan haihuwa - labarinmu game da ciwon sukari na gestational.

Baya ga kasancewar vasopressin a cikin jini, an rarraba insipidus na sukari bisa ga wasu alamun:

Dalilai don ci gaban ND

Tsarin tsakiya na ciwon sukari na iya haɓakawa cikin yanayi masu zuwa:

• raunin da hypothalamus da pituitary gland shine yake - lalacewar waɗannan yankuna, edema a cikin yankin da ke kusa, matsawa ta sauran kyallen takarda;
• ciwace-ciwacen daji da metastases a cikin kwakwalwa;
• Sakamakon tiyata ko aikin rediyo a cikin tsarin kwakwalwa kusa da hypothalamus da pituitary gland shine yake. Irin waɗannan ayyukan suna adana rayuwar mai haƙuri, amma a lokuta mafi ƙaranci (20% na yawan haɗarin ciwon insipidus) suna shafar haɓakar hormone. Akwai sanannun lokuta na ciwon kai na warkarwa, wanda ke farawa nan da nan bayan tiyata kuma ya ɓace cikin fewan kwanaki.
• radiation wajabta don maganin cututtukan kwakwalwa;
• ƙarancin jijiyoyin jini a cikin tasoshin kai a sakamakon thrombosis, aneurysm ko bugun jini;
• cututtukan neuroinfectious - encephalitis, meningitis;
• m cututtuka - whooping tari, mura, chickenpox. A cikin yara, cututtukan cututtukan suna haifar da ciwon insipidus sau da yawa fiye da na manya. Wannan ya faru ne sakamakon rarrabewar halittar kwakwalwa a cikin yarinta: saurin haɓakar sabbin tasoshin jini, cikar tasoshin da ke gudana, wani shinge na jini-kwakwalwa da ba ta dace ba;
• granulomatosis na huhu, tarin fuka;
• shan clonidine;
• rikice-rikice a cikin haihuwar haihuwa - microcephaly, rashin ci gaba na yankunan kwakwalwa;
• lalacewar kamuwa da cututtukan cikin zuciya na hypothalamus. Kwayar cutar sankarau a cikin wannan yanayin na iya bayyana bayan shekaru, a ƙarƙashin rinjayar damuwa, rauni ko canje-canje na hormonal.
• lahani na halittar yin vasopressin ba zai yiwu ba;
• Cutar Tungsten wata cuta ce mai tazarar haihuwa, gami da ciwon sukari da ciwon insipidus, mummunan gani da ji.

Matsaloli da ka iya haddasawa na nau'in cutar nephrogenic:

• ci gaban lalacewa na koda saboda cututtukan koda na koda, cututtukan polycystic, cututtukan cututtukan cututtukan zuciya, urolithiasis;
• take hakkin metabolism tare da sanya amyloid a cikin kyallen da kodan;
• koda myeloma ko sarcoma;
• vasopressin mai ƙarancin ƙwayoyin cuta a cikin kodan;
• illa mai guba a ƙodan wasu ƙwayoyi:

Bayyanar cututtuka na ciwon insipidus

Alamar farko ta rashin ciwon sukari na kowane nau'i shine karuwa mai yawa a cikin urination (daga lita 4), wanda baya tsayawa da daddare. Mai haƙuri ya rasa bacci na al'ada, sannu a hankali sai ya sami ciwan ciki. A cikin yara, dare da rana sannan rana ta waye. Fitsari a bayyane yake, kusan ba tare da salma ba, sassanta suna da yawa, daga rabin lita. Ba tare da magani ba, saboda irin wannan yawan fitsari, ƙashin ƙugu da ƙwanƙwasa a hankali suna faɗaɗawa.

Don amsa cire ruwa daga jikin mutum, ƙishirwa mai ƙarfi ya fara, marasa lafiya waɗanda ke da ruwa suna shan ruwa. Yawancin lokaci ana shayar da abin sha mai sanyi sosai, tun da abin sha mai zafi yana saka ƙishirwa mara kyau. Cutar narkewa tayi rauni, ciki ya shimfiɗa ya faɗi, haushi yana faruwa a cikin hanji.

Da farko, ruwan da aka cinye ya isa ya gamsar da rashi a jiki, sannan a hankali ruwa ya fara aiki. Alamar ta shine gajiya, ciwon kai da tsananin rauni, hauhawar jini, arrhythmias. A cikin mai haƙuri da ciwon insipidus na sukari, yawan ƙwayar rana yana raguwa, fatar jiki ta bushe, kuma ba a fitar da wani ruwa mai lacrimal ba.

Bayyanar cututtuka da jarrabawa

Dukkanin marasa lafiya da ke cikin polyuria ya kamata a bincika su don insipidus na ciwon sukari. Tsarin bincike:

1. Tarihin likita - bincike na mara lafiya game da tsawon lokacin cutar, yawan fitsari da aka saki, wasu alamomin, maganganun cututtukan ƙwayar insipidus a cikin dangi na kusa, ayyukan da suka gabata ko raunin kwakwalwa. Bayani game da yanayin ƙishirwa: idan ba ta cikin dare ko kuma idan mai haƙuri yana aiki da wani abu mai ban sha'awa, dalilin polyuria na iya zama rashin ciwon sukari insipidus, amma polygenpsia na psychogenic.
2. Eterayyade glucose na jini don ware ciwon sukari shine ka'idodin sukari na jini da yadda ake bayar da gudummawar jini don sukari.
3. Binciken fitsari tare da lissafin yawanta da ƙoshinta. A cikin yarda da ciwon sukari insipidus, yawa ba kasa da 1005, kuma osmolarity kasa da 300.
4. Gwajin rashin ruwa - marassa lafiyar daga hana shan abin sha ko abincin ruwa na tsawon awanni 8. Duk wannan lokacin yana karkashin kulawar likitoci. Idan gubar ruwa mai haɗari ya faru, gwajin yana karewa da wuri. Ana la'akari da ciwon insipidus na ciwon sukari idan nauyin mai haƙuri ya ragu da 5% ko fiye a wannan lokacin, kuma osmolarity da yawa na fitsari bai ƙaru ba.
5. Binciken adadin vasopressin a cikin jini kai tsaye bayan gwajin don tantance nau'in cutar. Tare da ciwon sukari na tsakiya, matakinsa ya ragu, tare da wani nau'in nephrogenic yana ƙaruwa sosai.
6. MRI tare da zargin ciwon sukari na tsakiya don gano neoplasms a cikin kwakwalwa.
7. Duban dan tayi na kodan tare da babban yiwuwar kamannin nephrogenic.
8. Gwajin ƙwayar halittar ƙwayar cuta don cututtukan cututtukan cututtukan jini.

Jiyya da ciwon sukari insipidus

Bayan gano dalilin cutar, duk kokarin likitocin suna da niyyar kawar da shi: suna cire neoplasms, suna rage kumburi a cikin kodan. Idan aka gano wani tsari na tsakiya, kuma ciwon sukari baya tsayawa bayan lura da mai yuwuwar cutar, an wajabta maganin canzawa. Ya ƙunshi gabatarwa cikin jini kamar analog na roba na kwayar halitta a cikin mara haƙuri - desopressin (Allunan, Minurem, Nourem, Nativa). An zabi sashi daban-daban gwargwadon kasancewar sinadarin vasopressin da kuma buƙatar hakan. Ana ɗaukar kashi ɗaya cikakke idan alamun cututtukan insipidus na sukari sun shuɗe.

Lokacin da aka samar da kwayar halitta kansa, amma bai isa ba, ana iya yin saitin Clofibrate, carbamazepine, ko chlorpropamide. A cikin wasu marasa lafiya, zasu iya haifar da karuwar haɗarin vasopressin. Area thesean waɗannan magungunan ana ba da izinin Chlorpropamide ne kawai, amma lokacin amfani da shi, ya zama dole don sarrafa glucose na jini, tunda yana da tasirin hypoglycemic.

Tsarin nephrogenic na ciwon sukari bashi da hanyoyin magani tare da ingantaccen tasiri. Don rage asarar ruwa ta 25-50% na iya diuretics daga rukunin thiazides. Tare da ciwon sukari insipidus, basa motsa motsawar fitsari, kamar yadda yake a cikin mutane masu lafiya, sai dai su ƙara yawan farfadowarsa.

Baya ga magunguna, an wajabta wa marasa lafiya abinci mai ƙarancin furotin don kada su cika kodan. Don hana bushewar ruwa, kuna buƙatar shan isasshen ruwa, da zai fi dacewa ruwan 'ya'yan itace ko abubuwan sarrafawa, don mayar da bitamin da za'a iya samarwa da ma'adanai.

Idan magani ya taimaka har zuwa matakin ladabtar da cututtukan ƙwaƙwalwar ƙwayar cuta, mai haƙuri zai iya yin rayuwa ta al'ada yayin riƙe ƙarfin aiki. Cikakke murmurewa mai yiwuwa ne idan an kawar da dalilin cutar. Mafi sau da yawa, ciwon sukari yana ɓacewa idan ya haifar da raunin da ya faru, ciwace-ciwace da kuma aikin tiyata. A wasu halayen, marasa lafiya suna buƙatar magani na tsawon rai.