Insulin irambe - chii? The metabolic chirwere ndiye insulin irambe

Nokuti vanhu vakasiyana dzinoratidzwa kusiyanisa mano jekiseni kumutsa shuga uptake. Zvakakosha kuziva kuti munhu anogona kuva hwandaiva aikanganiswa mumwe kana kupfuura zvinokonzerwa mukomboni uye panguva imwe chete - ive kurwisa kwakakwana kune vamwe. Next, isu kuongorora pfungwa "insulin irambe": chii, sei kunoratidzwa.

tsananguro

Asati kubata pfungwa "insulin irambe", chii uye chii anoti anoita, zvinofanira kutaurwa kuti chirwere ichi kunowanzoitika. Vanopfuura 50% yevanhu vane BP vanotambura ichi. Kakawanda, insulin irambe (chinova achaiswa kurondedzerwa, pazasi) rinowanikwa vakwegura. Asi mune zvimwe zviitiko zvinonzi dzakaonekwa muuduku. insulin irambe chirwere kazhinji haana kuona kare, hazvina kutanga kuratidza kutyora metabolic kwendangariro. Avo pangozi vanosanganisira vanhu vane dyslipidemia kana vakadhakwa shuga kushivirira, kufutisa, BP.

insulin irambe

Chii? Zvii zvinoitwa kukanganisa? Metabolic urwere pakati insulin irambe chinhu zvisiri kwaiita nhengo kusvikira chiito rimwe yeimwe. Pfungwa iri kushandiswawo akasiyana utachiona migumisiro. Izvi, kunyanya anoti kufurirwa jekiseni pamusoro mapuroteni uye lipid muviri, Gene okuti, ari vascular endothelial basa. Havachanyatsogoni mhinduro kunotungamirira nokuwedzera ropa wevasungwa pakati mukomboni hunodiwa kuti hama vhoriyamu iripo shuga. insulin irambe chirwere - kukanganisika yaisanganisa. It kunosanganisira kuchinja shuga kushivirira, mhando 2 cheshuga, dyslipidemia, kufutisa. "Syndrome X" uye Kunosanganisirawo nepfari nemishonga ine shuga (jekiseni-kuzvimiririra).

budiriro mashandiro

kuongorora Fully nyanzvi ayo zvevakomana rakakundikana. Zvirwere kuti kukonzera kukura insulin irambe kunogona kuitika panguva dzinotevera nhanho:

• Kanotokonya. Panyaya iyi, hurumende akanzwirwa sungano kana kuderera kwenhamba receptors.
• Pachiyero shuga zvifambiso. Panyaya iyi, iyo dzakaonekwa kuderera kuti GLUT4 mamorekuru.
• Pre-receptoral. Muchiitiko ichi tinotaura pamusoro mwero jekiseni.
• Postreceptor. Muchiitiko ichi pane kutyora phosphorylation uye nokuvhiringidzirwa chiratidzo hutachiwana.

Abnormalities insulin yakakodzera mamorekuru zvakakwana mashoma uye hatina kunotoda kukosha. Kanotokonya arambe achirema anogona yakaderera varwere nokuda akaipa dzinovaka. Zviri nokuda hyperinsulinemia. Kazhinji, varwere vane kuderera Kanotokonya nhamba zvine mwero. Panyaya iyi, iyo inofambiswa pamwero hakunganzi chinhu chokuratidza naro nayo kwatemwa ndiko dhigirii ane insulin irambe. Zvinokonzera chirwere vari kuderedzwa nyanzvi kuti postreceptor kutyorwa kutapurirwa. By precipitating zvinhu, zvikurukuru, zvinosanganisira:

• Kusvuta.
• Inosimudzira TNF-Alpha mukati.
• Kutapudza kurovedza muviri.
• Kuwedzera kuwanda vasiri esterified mafuta acids.
• Age.

Ndivo huru zvinhu kungamutsawo insulin irambe kakawanda kupfuura vamwe. Treatment inosanganisira kushanda:

• Thiazide diuretics boka.
• Beta-adrenergic blockers.
• Nicotinic acid.
• Corticosteroids.

zvakawedzera insulin irambe

Mugumisiro shuga muviri kunoitika muna zvinyama adipose, tsandanyama, uye chiropa. Skeletal tsandanyama metabolizes anenge 80% of mukomboni. Tsandanyama iyi nyaya anoita sechinhu chinokosha tsime insulin irambe. Capture kuti shuga iri mumasero rinoitwa pachishandiswa chinokosha chokufambisa GLUT4 mapuroteni. Kana Kanotokonya iri kusashanda nokuda jekiseni akaparirwa akatevedzana phosphorylation siyana. Ivo pakupedzisira kuchaguma translocation pamusoro GLUT4 kuti sero Kamudzira kubva cytosol. Sezvo shuga anokwanisa kupinda sero. Insulin irambe (zvazvingava zvichabviswa akaratidza hereinafter) anokonzerwa vasanyanye ukuru translocation pamusoro GLUT4. It rinozivikanwa kuderera Utilisation uye shuga uptake. Pamwe izvi, kunze kufambisa kubatwa kuti shuga iri peripheral nyama, kana hyperinsulinemia iri woutsinye hepatic shuga kugadzirwa. In mhando 2 chirwere cheshuga zvinonzi ndokutangazve.

kufutisa

Zvinonzi pamwe insulin irambe kakawanda. Kana kukuru murwere uremu 35-40% utetsa anodonhedza 40%. Zvinowanikwa iri abdominal rusvingo mafuta rinenge rine wakakwirira metabolic basa pane rimwe riri pazasi. Munguva zvokurapa zvaanorumbidza yakaratidza kuti rakawedzera kusunungurwa kupinda portal riparadzirwe mafuta acids kubva abdominal fibers chinokurwadzai kugadzirwa chiropa triglycerides.

zvekuchipatara zviratidzo

Insulin irambe, izvo zviratidzo chokuita metabolic vachivavhiringidza anogona advantageously kuti vanofungidzirwa pavarwere vane abdominal kufutisa, gestational cheshuga, nhoroondo mhuri mhando 2 cheshuga, dyslipidemia uye BP. Pangozi uye vakadzi polycystic ovary syndrome (PCOS). Nokuda kuti kufutisa mabasa sezvo chiratidzo pakati insulin irambe, zvinokosha kuti vaongorore mamiriro, ine kuparadzira adipose tishu. nzvimbo yayo zvinogona ginekoidnomu - panzvimbo dzapasi chikamu muviri, kana humanoid mhando - pamadziro pamberi peritoneum. Kuunganidza chokumusoro hafu muviri ane zvikuru kuzoita insulin irambe, zvakachinjwa shuga kushivirira uye chirwere cheshuga, kufutisa kupfuura migove rezasi. Kuti kuziva uwandu abdominal mafuta rinenge anogona kushandisa nzira inotevera: kuona nhamba rechiuno sekamufarenzi, hudyu sekamufarenzi uye BMI. At dziine 0,8 vakadzi uye 0.1 varume uye BMI kupfuura 27 vari nechirwere abdominal kufutisa uye insulin irambe. Zviratidzo chirwere akaratidza kunze. Kunyanya paganda muchimucherechedza Enrugado, dzemakwiringwindi hyperpigmented nzvimbo. Kakawanda vanoonekwa vari muhapwa, emaoko, pasi mazamu. Analysis kuti insulin irambe iri kuverenga inonyatsoita. HOMA-neKara rinowanikwa sezvinotevera: kutsanya jekiseni (Mu / L) x shuga achitsanya (mmol / L). The vakawana mugumisiro yakakamurwa 22.5. Chichabudirira insulin irambe indekisi. Norma - <2,77. Kana kutsaudzira yakananga kuwedzera nehanya kunogona akaonekwa nyonganyonga munyama.

Kusagadzikana dzimwe gadziriro: atherosclerosis

Nhasi hapana chete tsanangudzo yokuti mashandiro ose simba insulinorezistenotnosti pokukundwa kumwoyo. Pangave zvakananga kukanganisa atherogenesis. Zvinonzi anokonzerwa mano jekiseni kuti vabatsire kwetunhu lipids uye zvinoumba kuwandisa anotsvedzerera tsandanyama ari mudziyo pamadziro. Pamwe izvi anogona kukonzerwa arteriosclerosis akabatanidza metabolic zvirwere. Somuenzaniso, kungava neBP, dyslipidemia, kuchinja shuga shiviriro. Mune pathogenesis chirwere ndicho chatinonyanya kukoshesa vasingadzoreki kushanda vascular endothelium. Basa racho tiine mataurire migero neropa secreting neurotransmitters vasodilation uye vasoconstriction. In hurumende mitemo jekiseni zvinosimudzira kutandara pamusoro anotsvedzerera tsandanyama fibers ari mudziyo rusvingo noruoko kusunungura nitric oxide (2). Uyezve, kukwanisa kwayo kuwedzera endothelium-zvaanoda vasodilation yekudyidzana akachinjwa pavarwere vane kufutisa. Izvi zvinoshandawo varwere insulin irambe. With kukura coronary tsinga kutadza kupindura kwomuzvarirwo kuitika, uye richikura, unogona kutaura pamusoro Danho rokutanga microcirculatory zvirwere - microangiopathy. Izvi pathological ezvinhu ari kuchengetwa mune ruzhinji varwere cheshuga (chirwere cheshuga mellitus).

Insulin irambe anogona kukonzera atherosclerosis kubudikidza kuvhiringidzika nedanho fibrinolysis. Pai-1 (plasminogen activator inhibitor) ari kumusoro kuwanda Varwere chirwere cheshuga uye vakafutisa nondiabetic. Kwetunhu Pai-1 kwakamutsa proinsulin uye jekiseni. Padanho fibrinogen nezvimwe procoagulant zvinhu rakawedzera.

Kuchinjwa shuga kushivirira uye mhando 2 chirwere cheshuga

Insulin irambe iri chinhu asati kurapwa nokuratidzwa cheshuga. Nokuti kuderedza wevasungwa kuti shuga tichingamidze Beta masero rwatata. Achidzikisa wevasungwa rinoitwa nokuwedzera kugadzirwa jekiseni, izvo zvinozoita zvinotisvitsa hama hyperinsulinemia. Euglycemia hunogona kuchengetedzwa Varwere sokuvapo Beta masero vanokwanisa kuramba tichishandisa yakakwirira kwevari yeplasma jekiseni yokukunda kurwisa. Pakupedzisira, kugona ichi wakarasika, uye wevasungwa kuti shuga kunowedzera yekudyidzana. Chinhu, riri basa hyperglycemia usina chawadya pamusoro yaitwa mhando 2 cheshuga, insulin irambe ndiyo chiropa. Healthy mhinduro iri kuderedza shuga kugadzirwa. Kana insulin irambe, mhinduro akarasika. Somugumisiro, kunyanya chitaka shuga kugadzirwa mberi, zvichiguma kutsanya hyperglycemia. Nokurasikirwa mano Beta masero kugovera jekiseni hypersecretion chinoratidza kuchinja kubva insulin irambe pamwe hyperinsulinemia kune zvakachinjwa shuga shiviriro. Zvadaro, hurumende iri kuva chiremba chirwere cheshuga uye hyperglycemia.

BP

Pane nzira dzakawanda kuti kukonzera kukura kwayo pamusoro pakanyorwa insulin irambe. Zvingaonekwa anoratidza kuti kwakaderera vasodilation uye vasoconstriction activation anogona kukonzera vascular nemishonga. Jekiseni kunoita tsinga kurudziro (tsitsi) hurongwa. Izvi zvinotungamirira kuwedzera yeplasma norepinephrine wevasungwa. In varwere insulin irambe zvakawedzera mukupindura angiotensin. Uyezve, urongwa unogona kutyorwa vasodilation. Mitemo wehurumende jekiseni zvinosimudzira kutandara pamusoro vascular tsandanyama rusvingo. Vasodilatation iyi nyaya iri yairevererwa nokubudiswa / chizvarwa endothelial nitric oxide. In varwere insulin irambe, endothelial nerevane iri vasingadzoreki. Izvi kunoderedza vasodilation kubudikidza 40-50%.

dyslipidemia

Kana insulin irambe kwakakanganiswa chakaipa goho kudzvinyirira nuna vakasununguka acids pashure kudya adipose tishu. Inosimudzira wevasungwa pave substrate nokuda kunowedzera kwetunhu triglycerides. Ichi danho rinokosha VLDL kugadzirwa. Kana hyperinsulinemia kwakaderedza basa rinokosha enzayemu - lipoprotein lipase. Pakati Qualitative kuchinja necheseri chakarondedzera LDL mhando 2 chirwere cheshuga uye insulin irambe zvinofanira kutaurwa rakawedzera mwero oxidation ose LDL inoramba. More kubatwa izvi vanoonekwa glycated apolipoproteins.

kuchirapa matanho

Kuwedzera jekiseni utetsa zvinogona kuitwa nenzira dzakawanda. Zvikuru kukosha ndiyo zvinoderedza uremu uye kurovedza muviri. Diet Zvinokoshawo kuti vanhu vari nechirwere insulin irambe. Diet chinowedzera Kudzikamiswa mumazuva mashomanana. Tiwedzere utetsa zvakawanda achasimudzira uremu. Nokuti vanhu vane akatsunga insulin irambe, kurapwa ine mumatanho anoverengeka. Kudzikamiswa zvataidya uye kurovedza muviri ichaongororwa kuva wokutanga kurapwa rwakazara. Nokuti vanhu vanenge vanozivikanwa jekiseni, zvokudya zvinofanira kuva pasi-mafuta. A mwero kuderera uremu muviri (5-10 makirogiramu) kazhinji zvinobatsira kuvandudza kudzora shuga yomuropa. Macalorie 80-90% iri kuparadzirwa pakati carbohydrate uye mafuta, 10-20% kubva mapurotini.

mishonga

Rinoreva "Metamorfin" rinoreva boka mishonga biguanide. The mushonga anovandudza peripheral uye hepatic jekiseni wanda. Muchiitiko ichi zvinoreva hapana sei ayo secretion. Pasina rokugadzirira jekiseni "Metamorfin" haushandi. Rinoreva "Troglitazone" ndiyo yokutanga medicament boka tiazolidinedionov iyo anobvumirwa kushandisa iri USA. The mushonga kunowedzera chokufambisa kuti shuga. Izvi zvimwe kunokonzerwa activation kuti PPAR-wegamma Kanotokonya. Uye pakudaro kunowedzera GLUT4 okuti, izvo zvinozoita kunotungamirira kuwedzera jekiseni-dzinovhurika shuga kubatwa. Varwere vane insulin irambe, kunokwanisa kupiwa uye zvabatanidzwa. The pamusoro rinoreva anogona ikashandiswa pamwe sulfonylurea, uye dzimwe nguva mumwe kubereka mumwe synergistic nomugumisiro pamusoro yeplasma shuga uye zvimwe zvirwere. The mushonga "Metamorfin" akabatana ane sulfonylurea kunowedzera secretion uye jekiseni wanda. Muchiitiko chino, shuga yomuropa kudukupiswa pashure zvokudya uye usina chawadya. Varwere akapiwa wemishonga kurapwa, vakanga anonyanya kuratidzirwa yomuropa.