Insulin - kuyini? I syndrome umzimba kuyinto insulin

Kubantu ezahlukene libhekene ikhono insulin ukuze sikhuthaze abatholako glucose obuhlukahlukene. Kubalulekile ukwazi ukuthi umuntu ungaba ukuzwela evamile ukuba okukodwa noma ngaphezulu imiphumela lemagalagala ngesikhathi esifanayo - i ukumelana ngokuphelele kuze kube komunye. Ngokulandelayo, sihlaziya welithi "insulin": ukuthi kuyini, it is indlela kuboniswe.

Uhlolojikelele

Ngaphambi ekubhekaneni welithi "insulin", lokho oyikho nalokho izingxenye enza, kufanele kusho ukuthi lesi sifo akuyona into engavamile. Bangaphezu kuka-50% wabantu abane nomfutho wegazi ophezulu yilesi sifo. Ngokuvamile, insulin (kuyo, uzobe kuchaziwe ngezansi) itholakala asebekhulile. Kodwa kwezinye izimo itholwa ebuntwaneni. insulin syndrome ngokuvamile akuyona Kutholwe ngaphambi, ke kungaqali ukukhombisa kuphula umthetho we izinqubo umzimba. Labo abasengozini bahlanganisa abantu dyslipidemia noma kahle glucose ukubekezelelana, ukukhuluphala nomfutho wegazi ophezulu.

insulin

Kuyini lokhu? Iziphi izici enza ukuhlukumeza? syndrome umzimba ka-insulin yimpendulo ayilungile umzimba ukuze isenzo esisodwa zezakhi. Umqondo isebenza imiphumela ezihlukahlukene zezinto eziphilayo. Lokhu, ikakhulukazi, iphathelene ithonya insulini ku protein ne lipid umzimba, isakhi sofuzo ngekukhululeka, semithambo umsebenzi endothelial. Ukusabela Ukuphazamiseka kuholela ekwandeni in the lokuhlushwa igazi kwakwakhe edingekayo ukuze ivolumu isihlobo glucose etholakalayo. insulin syndrome - ukuphazamiseka elihlangene. It kuhilela ukushintsha ukubekezelelana glucose, sikashukela sohlobo 2, dyslipidemia, ukukhuluphala. "Syndrome X" futhi kuhilela ukumelana kokuquleka glucose (insulin-kuncike).

ukuthuthukiswa indlela

ukuhlola ngokugcwele ochwepheshe yayo kuze kube manje kuhlulekile. Ukungasebenzi eziholela ukuthuthukiswa insulin kungenzeka kumazinga alandelayo:

• Yokwamukela. Kulokhu, isimo kuboniswe ziyezwana noma ukwehla inani receptor.
• Ezingeni ezokuthutha glucose. Kulokhu, bekubona Ukwehla GLUT4 molecule.
• Oku-receptoral. Kulokhu sikhuluma insulin ongaphilile.
• Postreceptor. Kulokhu kukhona phosphorylation ukuhlukumeza kanye ukuphazamiseka ukudluliswa isignali.

Ukukhubazeka zishintshe insulini kukhona ngokwanele ezingavamile futhi ayinakho ukubaluleka emtholampilo. yokwamukela kwabantu kungase kwehle ngo iziguli ngenxa impendulo engeyinhle. Kuyinto ngenxa hyperinsulinemia. Ngokuvamile, iziguli ukwehla yokwamukela izinombolo ngokulinganisela. Kulokhu, ezingeni impendulo akubhekwa ukufanelekela ngalo kunqunywa elingangani has insulin. Izimbangela sifo ziyancipha ngochwepheshe ukuze postreceptor ukwephulwa yokudlulisela. Ngu ayeke ukunisa izici, ngokukhethekile, zihlanganisa:

• Ukubhema.
• Ukwandiswa okuqukethwe TNF-alpha.
• Nciphisa umzimba.
• Ukwandisa lokuhlala non-esterified fatty acid.
• Ubudala.

Lawa izici eziyinhloko engabangela insulin njalo uma ziqhathaniswa nezinye. Ukwelashwa kuhlanganisa isicelo:

• Thiazide isisu iqembu.
• beta blocker-adrenergic.
• Nicotinic acid.
• Corticosteroids.

anda insulin

Ithonya Lako umzimba glucose kwenzeka kwezicubu adipose, imisipha, futhi isibindi. imisipha yohlaka agaya cishe 80% kwakwakhe. Imisipha kuleli cala uba mbo obalulekile insulin. Capture glucose kumaseli Kwenziwa esebenzisa ekhethekile ezokuthutha GLUT4 amaprotheni. Lapho yokwamukela ivuswe ngu-insulini kwabangela uchungechunge phosphorylation ukusabela. Bagcina nomphumela translocation ka GLUT4 ukuze ulwelwesi cell kusukela cytosol. Njengoba i-glucose uyakwazi ukungena cell. Insulin (isilinganiso uzobe kuboniswe ngemuva kwalokhu) kubangelwa ukwehla degree of translocation ka GLUT4. Kuyaqapheleka ukwehla ukusetshenziswa kanye abatholako glucose. Njengoba sihambisana nale, ngaphandle lula bamba glucose in kwezicubu neuropathy, lapho hyperinsulinemia is bebengaphuzile ukukhiqizwa glucose hepatic. Ngo sikashukela sohlobo 2 it is yaphinde yaqhubeka.

ukukhuluphala

It is kuhlangene insulin njalo ngokwanele. Lapho esingeqile nesineke isisindo 35-40% ukuzwela sehla ngo-40%. Akhiwe besisu odongeni amafutha kwezicubu has a umsebenzi ephakeme umzimba kunaleyo esemgwaqweni ngezansi. Phakathi kokuma kwezokwelapha kwembula nokuthi ukukhishwa kakhudlwana ku nokusakazwa portal fatty acid esuka Imicu yotshani besisu kuphakamisa ukukhiqizwa triglyceride isibindi.

izimpawu zokwelapha

Insulin, okuyinto izimpawu ezihlobene ukuqeda iziphazamiso ezazingase umzimba kungase advantageously zixwaywe in iziguli ukukhuluphala besisu, sikashukela sokukhulelwa, umlando womndeni ohlobo 2 sikashukela, dyslipidemia kanye nomfutho wegazi ophezulu. Engozini nabesifazane polycystic syndrome esibelethweni (PCOS). Ngenxa yokuthi ukukhuluphala izenzo njengendlela marker insulin, kubalulekile ukuhlola isimo, lapho kukhona ukusatshalaliswa izicubu adipose. indawo yayo kungenziwa ginekoidnomu - engxenyeni engezansi yomzimba, noma uhlobo humanoid - ogangeni phambi peritoneum. Ukuthola engxenyeni engaphezulu kuphela yomzimba has awuphawu ebalulekile yokusebenzelana insulin, ezishintshwe glucose ukubekezelelana sikashukela, ukukhuluphala ngaphandle izingxenye engezansi. Ukuze abone inani besisu izicubu fat ungasebenzisa indlela elandelayo: ukucacisa ratio okhalweni selilonke, hip selilonke kanye BMI. Ngezinye amazinga 0.8 kwabesifazane 0.1 abesilisa BMI mkhulu kunezinhliziyo 27 uxilongwe ukukhuluphala besisu futhi insulin. Izimpawu isifo wabonakaliswa olubonakalayo. Ikakhulukazi esikhumbeni imakwe ukushwabana, anolaka izindawo hyperpigmented. Ngokuvamile zivela emakhwapheni, izindololwane, ngaphansi amabele. Ukuhlaziya insulin kuyinto ifomula ukubala. Homa-IR ibalwa kanje: kokuzila insulini (mu / L) x ngokuzila ukudla glucose (mmol / L). Umphumela etholwe lihlukaniswe by 22.5. Lokho kuzodingeka insulin Inkomba. Norma - <2,77. Lapho ukuphambuka bebheke ukuzwela okwandisa Kungahlonzwa ngomshini disorder kwezicubu.

Ukungasebenzi kahle kwezinye izinhlelo: isifo sokuqina kwemithambo yegazi

Namuhla ayikho incazelo yinye indlela ithonya insulinorezistenotnosti kokunqotshwa yisimiso senhliziyo nemithambo yegazi. Kungase kube nomthelela nqgo atherogenesis. Sibangelwa ikhono insulin ukuze sikhuthaze synthesis lipids futhi izingxenye ekwandeni imisipha bushelelezi ogangeni isitsha. Njengoba sihambisana nale kungahle kubangelwe ukuqina kwemithambo yegazi ezihlobene umzimba iziyaluyalu. Ngokwesibonelo, kungase kube umfutho wegazi ophakeme, dyslipidemia, izinguquko ukubekezelelana glucose. Esikhathini pathogenesis ka lesi sifo kwemiphumela ethile eyisiSekelo ukubaluleka kahle umsebenzi endothelium semithambo. abangababi bemisebenzi yaso iwukuhlale ithoni iziteshi igazi ngokukhipha neurotransmitters vasodilation futhi vasoconstriction. In the state imithetho insulini kuvusa ukuphumula olubushelelezi imisipha Imicu yotshani odongeni isitsha ukukhulula oxide nitric (2). Ngaphezu kwalokho, amandla abo okuphila umlilo ukuthuthukisa vasodilation endothelium ancike kakhulu okushintshiwe iziguli ukukhuluphala. Kuyefana nasendleleni iziguli insulin. With ukuthuthukiswa yenhliziyo Umthambo ukwehluleka nokusabela ezintweni ezivamile, futhi wanda, ungakwazi ukukhuluma esigabeni sokuqala microcirculatory iziyaluyalu - microangiopathy. Lesi simo sokugembula is ebonwe iningi iziguli sikashukela (ngifundise ngesifo sikashukela).

Insulin kungabangela isifo sokuqina kwemithambo yegazi ngu yokuphazamiseka inqubo fibrinolysis. PAI-1 (plasminogen Activator inhibitor) ungaphakathi lokuhlala eliphezulu in iziguli sikashukela kanye nondiabetic okhuluphele. Synthesis PAI-1 kwavusa proinsulin futhi nge-insulini. Izinga fibrinogen nezinye izinto procoagulant nakho kuyanda.

Eshintshile glucose ukubekezelelana sikashukela sohlobo 2

Insulin kuyisici ngaphambi ukubonakaliswa basemtholampilo sikashukela. Ukwehlisa lokuhlushwa glucose ukuhlangabezana amaseli beta ku amanyikwe. Ukunciphisa lokuhlushwa Kwenziwa ngokwandisa ukukhiqizwa insulin, nakho kuholela hyperinsulinemia isihlobo. Euglycemia zigcinwe ezigulini nje amaseli beta bayakwazi ukulondoloza amazinga kuqhathaniswa eliphezulu plasma insulini izithathe ukuze ixazulule leyo ukumelana. Ekugcineni, leli khono elahlekile, futhi lokuhlushwa glucose kwandisa kakhulu. Isihluthulelo esiyinhloko, okuyinto unomthwalo Hyperglycemia esiswini esingenalutho on isizinda abanesifo sikashukela sohlobo 2, insulin iyona isibindi. Ukusabela okunempilo ukwehlisa ukukhiqizwa glucose. Lapho-insulin, impendulo kulahleka. Ngenxa yalokho, ngokweqile ukukhiqizwa isibindi glucose uyaqhubeka, okuholela kokuzila Hyperglycemia. Nokulahlekelwa ikhono beta amaseli ukunikeza insulini hypersecretion kumaka aphuma insulin nge hyperinsulinemia ukuze ezishintshwe glucose ukubekezelelana. Ngemva kwalokho, isimo uguqulwe ube sikashukela emitholampilo Hyperglycemia.

nomfutho wegazi ophezulu

Kukhona izindlela eziningana eziholela ekuthuthukisweni yayo phezu zangokwasemuva zezinhlelo insulin. Ukuqaphelwa abonisa ukuthi buthakathaka vasodilation futhi vasoconstriction kusebenze kungase kube nomthelela ukumelana semithambo. Insulin ikhuthaza nerve stimulation (nozwela) uhlelo. Lokhu kuholela ekwandeni plasma norepinephrine okuhlushwa. In iziguli nge-insulin anda ekuphenduleni angiotensin. Ngaphezu kwalokho, amalungiselelo kungenziwa i- vasodilation. I-insulini imithetho isimo kuvusa ukuphumula semithambo imisipha udonga. Vasodilatation kulesi simo waba umlamuleli lapho kukhululwa / isizukulwane endothelial oxide nitric. In iziguli nge-insulin, umsebenzi endothelial kuphazamisekile. Lokhu kunciphisa vasodilation by 40-50%.

dyslipidemia

Lapho insulin iphazamiseke evamile okukhipha ukucindezelwa fatty acid khulula emva kokudla kusuka izicubu adipose. okuhlushwa Ukwandiswa ukhiqiza substrate for the zamagama ngcono triglyceride. Lokhu kuyisinyathelo esibalulekile e VLDL ukukhiqizwa. Lapho hyperinsulinemia encishisiwe umsebenzi obalulekile-enzyme - Esilula lipase. Phakathi kwezinguquko qualitative ngemuva spectrum LDL sikashukela sohlobo 2 futhi insulin kufanele ukhulume degree lelitfutfukile namachibi of LDL izinhlayiya. Okuningi singangena kule nqubo ezibhekwa apolipoproteins glycated.

izinyathelo zokwelapha

Ukwandisa insulini ukuzwela ingafinyelelwa ngezindlela eziningana. Okubaluleke kakhulu yiyona ukunciphisa isisindo umzimba. Ukudla Kubalulekile futhi abantu uxilongwe insulin. Ukudla kunomthelela sinjalo ezinsukwini ezimbalwa. Thuthukisa ukuzwela ngaphezulu uzokhuthaza kwesisindo. Kubantu abanalesi uzimisele insulin, impatho unezigaba eziningana. Ukuqina lokudla ukudla okufanele nokuvivinya umzimba ubhekwa ngowokuqala ukwelashwa esiteji. Kubantu ziye zakhomba insulini, ekudleni kufanele kube-kilojoule amaningi. A ukwehla alinganiselayo esisindo (5-10 amakhilogramu) ngokuvamile kusiza ukwenza ngcono ukulawula namazinga kashukela egazini. Calories 80-90% isakazwa phakathi carbohydrate namafutha, 10-20% kusuka amaprotheni.

imithi

Kusho "Metamorfin" libhekisela eqenjini kwemithi biguanide. Umuthi ngcono neuropathy hepatic insulini ukuzwela. Kulokhu-ke kusho akunamthelela uketshezi yayo. In the ukungabikho ukulungiselela insulini "Metamorfin" ayizwakali. Kusho "Troglitazone" ungowokuqala nomuthi tiazolidinedionov iqembu okuyinto ovunyelwe ukusebenzisa e-USA. Umuthi kwandisa ezokuthutha glucose. Lokhu kungenzeka kudalwe ukusebenza PPAR-gamma yokwamukela. Futhi kanjalo sithuthukiswe GLUT4 inkulumo, nakho kuholela ekwandeni e-insulin-inkanuko yobulili-glucose bamba. Ezigulini abangenawo ukumelana insulin, yokwelashwa ingatholakala iqondiswa futhi kuhlanganiswe. Izindlela ngenhla ingasetshenziswa lihambisana sulfonylurea, futhi ngezinye izikhathi nomunye ukukhiqiza umphumela synergistic ku-plasma-glucose nezinye izifo. Umuthi 'Metamorfin "lihambisana sulfonylurea kwandisa uketshezi futhi insulini ukuzwela. Kulokhu, namazinga kashukela egazini wehlise ngemva kokudla futhi esiswini esingenalutho. Iziguli aye abelwa ukuphathwa inhlanganisela, Zaziwukubonakaliswa evame kakhulu yokusebenzisa kahle kungakhuphula izinga likashukela.