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Tahlili qandi khun

Boyad har yak nafar odam, bazan vaqt az tahlili qandi khun guzarad. Hatto agar shumo khudatonro khele khub his kuned ham. Hej guna tashvish va noqulayi nadorad, ammo manfiatash ba hama ayon ast. Testho baroi sanjidani darajai qandi khun khele ziyodand: jamovarii khun az vena, az nugi angusht, bo sarbori (kori jismoni) va be sarbori va hatto chunin «darrandai » tamoman nomalume ba misli gemoglobini glikogeni. CHi guna va baroi kiho in zarur ast va natijahoi onhoro chi khel fahmidan mumkin ast?

AZ RUI KADOM ALOMATHO BALANDSHAVII DARAJAI QANDI HUNRO MUAYYAN KARDAN MUMKIN AST?

Diabetic patient doing glucose level blood test using ultra mini glucometer and small drop of blood from finger and test strips isolated on a white background. Device shows 115  mg/dL which is normal
Diabetic patient doing glucose level blood test using ultra mini glucometer and small drop of blood from finger and test strips isolated on a white background. Device shows 115 mg/dL which is normal

Nishonai klassiki – tashnagii doimi. Ziyodshavii miqdori peshob niz kasro ba tahluka meandozad (az hisobi dar on paydo shudani glyukoza), beokhir khushk mondani dahon, khorishi pust va pardahoi luobi (aksar vaqt dar uzvhoi tanosul), bequvvatii umumi, mondashavi, dammalho. Agar shumo hatto yak nishonaro pay burda  boshed, makhsusan agar yakjoyagii yakchandtoi onhoro – pas behtar ast, ki fol dida nashinedu zudtar ba nazdi dukhtur raved. YO in ki hamtu pagohi bo shikami gurusna baroi tahlili qandi khun, az nugi angushtaton khun supored.

SIRRI PANJ MILLION

Dar Rossiya ba tavri rasmi ziyoda az 2,6 million odam bo diabeti qand ba qayd girifta shudaand, dar barobari in 90% -i onho ba  diabeti namudi 2-yum giriftor hastand. Az rui malumothoi tadqiqothoi nazorati-epidemiologi, miqdori in guna bemoron hatto 8 millionro tashkil medihad. Az hama noguvorash on ast, ki – az se du hissai odamoni ba diabet giriftor buda (ziyoda az 5 million) oidi in mushkiloti khud pay namebarand (namedonand).

Hangomi ba diabeti qandi namudi 2-yum giriftor budan dar nisfi odamoni bemor nishonahoi khosi in bemori ba nazar namerasand. Az in mebaroyad, ki baroi hama zarur ast, ki bazan vaqt ba tavri davri darajai qandi khunashonro bisanjand?

Bale. Tashkiloti Umumijahonii Tandurusti (VOZ) tavsiya medihad, ki badi  40 solagi, pas az har yak se sola baroi tahlili qand, khun suporida shavad. Agar shumo ba guruhi khavfnok taalluq doshta boshed (vazni barziyod, kheshovandoni giriftori diabet dored) on goh boyad har sol khun supored. In imkoniyat medihad, ki ba khuruji bemori roh nadihed va onro to darajai orizaho ovarda narasoned.

CHI GUNA NISHONDIHANDAHOI DARAJAI QANDI HUN MEYORI SHUMORIDA MESHAVAND?

Agar shumo az nugi angusht khun suporida boshed  (dar dili nahor/bo shikami  gurusna): 3,3–5,5 mmol/l – meyori ast, novobasta az sinnu sol; 5,5–6,0 mmol/l – prediabet (sarshavii diabet), holati mobayni/muttavassit.  Onro inchunin vayronshavii bardoshtkunii glyukoza (narusheniem tolerantnosti k glyukoze (NTG)) yo glikemiyai vayronshuda dar dili nahor niz menomand  (narushennoy glikemiey natoshak (NGN)); 6,1 mmol/l va az on bolotar – diabeti qand. Agar khunro az vena girifta boshand (inchunin dar dili nahor), meyor takhminan 12% ziyodtar ast – to 6,1 mmol/l (agar az 7,0 mmol/l  bolotar boshad – pas kas diabeti qand dorad).

Kadom tahlil daqiqtar ast – ekspressi yo laboratori?

Dar yak qator markazhoi tibbi tahlili qandi khun  bo usuli ekspressi (bo glyukometr) ijro karda meshavad. Ba gayr az in bo glyukometr chen kardani qandi khun dar sharoiti khona niz khele qullay meboshad. Ammo natijahoi tahlili ekspressi takhmini shumorida meshavand, onho nazar ba tahlilhoi dar tajhizothoi laboratori guzaronidashuda kamtar daqiq hastand. Baroi hamin hangomi az meyor berun budani on zarur ast, ki boz baroi tahlili laboratori az nav khun suporida shavad (odatan baroi in kor khuni vena istifoda burda meshavad). 

Oyo natijaho hamesha daqiq hastand?

Bale. Agar nishonahoi nazarrasi diabet malum boshand, sanjishi yakmartagi kifoya ast. Ammo agar nishonaho mavjud naboshand, tashkhisi «diabet» dar on holate guzoshta meshavad, ki darajai qand 2 marotiba (dar ruzhoi gunogun) ziyoda az meyor malum shuda boshad.

BA TASHHISI GUZOSHTASHUDA BOVAR KARDA NAMETAVONAM, OYO YAGON USULI ANIQ KARDANI ON MAVJUD AST?

Boz yak testi digar hast, ki dar yak qator holatho baroi tashkhisi diabet guzaronida meshavad: namunai sanjishi bo «sarborii (vazninii) qandi». Darajai qandi khunro dar dili nahor (bo shikami gurusna) muayyan mekunand, badan shumo 75 g glyukozaro dar shakli sirop menushed va pas az 2 soat boz az nav baroi tahlili qand khun mesupored va natijaashro mesanjed, to 7,8 mmol/l meyor, 7,8  – 11,00 mmol/l – sarshavii diabet, bolotar az 11,1 mmol/l – diabet. Pesh az test ba misli muqarrari khurok khurdan mumkin ast. Dar davomi 2 soati bayni tahlili yakum va duyum khurdan, sigor kashidan, nushidan mumkin nest; sayru gasht kardan (sarbori (kori jismoni)/mashguliyathoi jismoni darajai qandro past mefarorand) yo baraks  khob raftan yo daroz kashidan dar rui kat niz  nomatlub ast (zarurat nadorad) – chunki hamai inho natijahoro bargalat karda metavonand.

KAM KARDANI VAZN –  BOZDOSHTANI DIABET AST

Baroi to kadom daraja kam kardani vazn, formulai takhmini chunin talqin mekunad: — qad (bo sm) – 100 kg. Tajribai amali nishon medihad, ki baroi behtar kardani ahvoli salomati ba miqdori 10-15% kam kardani vazn basanda ast.

Formulai boz ham daqiqtar:
Nishondihandai (indeksi) Massai Badan (IMT) = massai badan (kg) : qad dar  kvadrat (m2).
18,5–24,9 – meyor;
25,0 –29,9 – vazni barziyod  (zinai 1-umi farbehshavi);
30,0–34,9 – zinai 2-yumi farbehshavi; khavfi (riski) giriftorshavi ba diabet;
35,0–44,9 – zinai 3-yum; khavfi giriftorshavi ba diabet.

CHiho ba natijai tahlil tasir merasonand?

Hama guna tahqiqu muoinahoi darajai qand boyad dar hoshiyai khurokhoi muqarrari guzaronida shavand. Rioya kardani hej guna parhezkunii (dietai) makhsus, az shiriniho dast kashidan zarurat nadorad, durust ast, ki albatta pas az shabnishinii purdabdabae niz dar pagohiruzi ba laboratoriya raftan kori khub (lozim)  nest. Naboyad tahlilho dar hoshiyai yagon holati vaznin, az qabili  shamolkhuri/ (khunukzadagi), jarohat  (travma) yo  infarkti miokarda guzaronida shavand. Hangomi homiladori niz kriteriyahoi tashkhisguzori digar khel khohand bud.

Baroi chi tahlili gemoglobini glikogeni (agishtobagi) zarur ast (HbA1c)?

Nishondihandai HbA1c darajai miyonai shabonaruzii qandi khunro dar 2-3 mohi okhir inikos mekunad. Holo in tahlilro az sababi mushkilothoi standartigardonii usulho baroi tashkhisi diabet istifoda namekunand. Ba buzurgii nishondihandai HbA1c illatnokii gurdaho, darajai lipidhoi khun, mavjudiyati gemoglobini anomali va gayra tasir karda metavonand. Nishondihandai az meyor balandshudai  gemoglobini glikogeni  metavonad na faqat diabet va balandshavii bardoshtkuni ba glyukozaro nishon dihad, balki masalan anemiyai kamchinii ohanro niz nishon dihad. Binobar in testi HbA1c baroi onhoe zarur ast, ki dar onho allakay diabet daryoft shudaast. Tavsiya doda meshavad, ki in guna tahlil pas az guzoshtani tashkhis suporida shavad va badan dar har yak 3-4 moh (tavassuti dar shikami gurusna az vena khun suporidan) az nav suporida shavad. In yak namudi bahodihii on meshavad, ki shumo chi tavr darajai qandi khunatonro nazorat mekuned. Zimnan (dar omadi gap) natijai tahlil az usuli istifodashavanda vobastagi dorad, baroi hamin baroi on ki tagyiryobii gemoglobin nazorat karda shavad, shumo boyad doned, ki dar laboratoriya az kadom usul istifoda kardaand.

CHI BOYAD KARD, AGAR DAR MAN SARSHAVII DIABET (PREDIABET) PAYDO SHUDA BOSHAD?

Sarshavii diabet – in sarshavii vayronshavii mubodilai karbogidratho meboshad, signal dar borai on ki shumo ba mintaqai khavfnok vorid shudaed. Pesh az hama boyad favran az vazni barziyod khalos shaved (odatan dar hamin khel  bemoron in guna mushkili hast), duvvum boyad oidi past kardani darajai qand chorajuyi namoned. Vagarna boz kamtari digaru – on goh der shuda memonad. Hurokvoriatonro to ba 1500 – 1800 kkal dar yak shabonaruz mahdud namoed (vobasta ba vazni avvali va khuroki muqarrari), az kulchaqandho, qonfetho, sambusaho dast kashed; khurokhoro bo bug pazed, obpaz kuned va beravgan pazed. Tanho tavassuti ivaz kardani hasibchaho — ba hamon miqdori barobari gushti obpazshuda yo gushti lahmi murg, ivaz kardani mayonez va qaymoqi seravgan bo salat – ba yogurti shirturush (jurgot) yo qaymoqi beravgan, va ba joi ravgani maska – ba non guzoshtani bodiring yo pomidor, vazn partoftan mumkin ast. Dar yak ruz 5-6 marotiba khurok khured. Maslihat kardan bo dietolog – endokrinolog oidi khurokkhurii durust niz khele foidanok ast.

Fitnesi haruzaro niz ba in ilova kuned: shinovari, akvaaerobika, pilates… Baroi odamone, ki khavfi bemorii irsi, fishori balandi arteriali yo  darajai balandi kholesterin dorand, hatto dar zinai sarshavii diabet doruhoi pastkunandai darajai qand tain mekunand.

Ba savolho Oleg UDOVICHENKO, nomzadi ilmhoi tibbi, dukhur-endokrinologi Markazi tibbiii «Prima Medika» posukh gardonid.

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