Glucoza serica _ Synevo

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  • Synevohttp://www.synevo.ro

    GlucozasericaPostedBySynevoOnaugust13,2009@3:43pmInBiochimiegeneraldinsngeiurin,Testedebiochimie|NoComments

    Informatiigenerale

    Glucozaestecelmaiimportantmonozahariddinsange.Rezultadindigestiacarbohidratilorsidinconversiahepaticaaglicogenuluiinglucoza.Glucozaesteunfurnizorindispensabildeenergiecaresustineactivitateacelulara.Ceidoihormonicareregleazainmoddirectnivelulglucozeiinsangesuntglucagonulsiinsulina.Glucagonulaccelereazaconversiaglicogenuluiinglucozasideterminaastfelcrestereaglicemiei.Insulinacrestepermeabilitateamembranelorcelularelaglucoza,transportaglucozaincelule(pentrumetabolism),stimuleazaformareaglicogenuluisireduceconcentratiaglucozeidinsange.Altihormonicaredetinunrolimportantinmetabolismulglucozeisunt:ACTHul,glucocorticoizii,adrenalina,tiroxina.Degradareaglucozeiserealizeazaprinprocesuldeglicoliza.

    Metabolismulglucozeipoatefialteratprinmaimultemecanisme:incapacitateacelulelorpancreaticebetadeasecretainsulina,reducereanumaruluireceptorilorinsulinici,malabsorbtiaintestinalaaglucozei,incapacitateaficatuluideametabolizaglicogenul,

    modificareaconcentratieihormonilorimplicatiinmetabolismulglucozei246.

    Diabetulzaharatesteoconditiedefinitaprinnivelulhiperglicemieicaregenereazarisculdeafectareamicrocirculatiei(retinopatie,nefropatiesineuropatie).Seasociazacuosperantadeviataredusa,omorbiditatesemnificativadatoratacomplicatiilormicrovascularespecifice,unrisccrescutdecomplicatiimacrovasculare(boalacoronariana,accidentvascularcerebral,arteriopatieobliterantaamembrelorinferioare)siocalitateavietiidiminuata.

    Inabsentaunuimarkerbiologicmaispecificpentruadefinidiabetuldeterminareaglucozeiplasmaticearamaselementuldebazaalcriteriilordediagnostic.Stabilireavalorilorcutoffpentrudiagnosticuldiabetuluiafostconsecintaanalizeiadouaseturideinformatii:

    nivelurileglucozeiplasmaticeasociatecuriscdecomplicatiimicrovascularespecifice,inspecialretinopatie

  • distributiainpopulatieavalorilorglucozeiplasmatice.

    Din1965OrganizatiaMondialaaSanatatii(OMS)ainitiatpublicareadeghiduripentrudiagnosticulsiclasificareadiabetului.Acesteaaufostrevizuitein1998sipublicatesubdenumireadeGhidpentruDefinitia,DiagnosticulsiClasificareaDiabetuluiZaharat.CaurmareacresteriiinformatieidisponibileprivindaceastaafectiuneADA(AmericanDiabetesAssociation)amodificatin2003criteriile

    pentrudiagnosticulhiperglicemiilorintermediare8.

    CriteriileADA(AmericanDiabetesAssociation)pentrudiagnosticuldiabetuluizaharatinclud:

    Simptomesugestive(poliurie,polidipsie,scadereponderalainexplicabila),lacareseadaugaovaloareaglucozeirandom>=200mg/dL(>=11.1mmol/L)sauValoareaglicemieibazale>=126mg/dL(>=6.99mmol/L)sau

    Valoareaglicemiei>=200mg/dLla2oredupaadministrareaa75gglucoza(incadrultestuluidetolerantalaglucoza)1.Inabsentauneihiperglicemiicudecompensaremetabolicaacuta,criteriile2si3trebuieconfirmateprinrepetareatestariiinzilediferite.LaacesteaseadaugarecomandarearecentaADA(2010)deaincludeHbA1cindiagnosticuldiabetuluilaovaloarecutoffde6.5%(testultrebuiesafieefectuatprintrometodastandardizataDCCT:DiabetesControlandComplicationsTrialsicertificataNGSP:NationalGlycohemoglobinStandardizationProgram).

    Criteriiledediagnosticseaplicaatatadultilorcatsicopiilor17.

    Recomandaripentrudeterminareaglucozeiserice/plasmatice

    screeningul,diagnosticulsimonitorizareadiabetuluizaharat

    diagnosticulhipoglicemiei.

    Sepotrecolta4tipurideprobe:

    Glucozaplasmatica/sericadeterminatajeun(bazala).Glucozasericadeterminatala2orepostprandial.Glucozaplasmatica/sericadeterminatadintroprobadesangerecoltataintrunmomentoarecarealzilei,indiferentdeintervalulde

  • laultimamasa(random).

    Glucozaplasmatica/sericadeterminataincadrultestuluidetolerantalaglucoza(la2oredupaadministrareaa75gglucoza)12.Screeningulpentrudiabetalpersoaneloradulteasimptomaticevafiluatinconsiderarelacategoriilesupraponderalesauobeze(BMI25kg/m2)indiferentdevarsta,precumsilaceicareprezintaunulsaumaimultifactorideriscpentrudiabet:

    sedentarism

    rudedegradul1cuDZ

    antecedentedediabetzaharatgestationalsaunasteredefetimacrosomi(>4000g)

    apartenentalarasesaugrupurietnicecurisc(afroamericani,asiaticiamericani,nativiamericani,hispaniciamericanietc.)

    HTA(140/90mmHg)

    nivelscazutdeHDLcolesterol(250mg/dL)

    femeicusindromulovarelorpolichistice

    istoricdeafectiunicardiovasculare

    scadereatoleranteilaglucozalatesteanterioare

    alteconditiicliniceasociatecurezistentalainsulina(ex:acanthosisnigricans).

    Inabsentaacestorcriteriitestareapentrudiabetvafiinitiatalavarstade45ani.Dacaseobtinrezultate[2]normalelascreening,testareavafirepetatalaintervaledemaximum3ani(testareamaifrecventavafiluatainconsiderareinfunctiedefactoriide

    risc)17.

    PorninddelafaptulcaincidentaDZtip2acrescutdramaticlaadolescentiinultimadecada,recomandarileADAdin2010includsicriteriidetestareacopiilorasimptomatici:supraponderalitate,lacareseadaugadoidinurmatoriifactori:

    istoricfamilialdeDZtip2larudedegradul1sau2

  • apartenentalarasesaugrupurietnicecurisc(afroamericani,asiaticiamericani,nativiamericani,hispaniciamericanietc.)

    semnederezistentalainsulinasauconditiiasociatecurezistentalainsulina(ex:acanthosisnigricans,HTA,dislipidemie,sindromulovarelorpolichistice,dismaturitate)

    istoricdediabetzaharatmaternsaudiabetgestationalintimpulsarciniicucopilulincauza.

    Screeningulvafiinitiatlavarstade10anisauladebutulpubertatii(dacaaceastasedezvoltalavarstesub10ani).Testareavafirepetatalaintervalede3ani.

    Pentrumulteafectiuniexistaodeosebiresemnificativaintretesteledescreeningsiceledediagnostic.Diabetulconstituieoexceptie:

    aceleasitestesuntfolositeatatpentruscreeningulcatsipentrudiagnosticuldiabetului7.

    Lanoiintaratestulrecomandatpentruscreeninguldiabetuluiesteglicemiajeundinsangevenos(plasmasauser).Acesttest

    estepreferatpentrucaesterapid,usordeefectuatsiarecosturiscazute1.

    Pregatireapacientuluiinfunctiedetipulprobei

    A.jeun(absentaaportuluicaloricinultimele8ore)3.

    B.Farapregatirespecialaprobasevarecoltala2oredupamasa3.

    C.Farapregatirespecialapacientulvamentionatimpulscursdelaultimamasa3.

    D.VezirecomandarileprecizatelaTestuldetolerantalaglucozaperos.

    Ladiabeticiicunoscutirecoltareasefaceinainteaadministrariiinsulineisaumedicatieihipoglicemiante4.

    Specimenrecoltatsangevenos4.

    Recipientderecoltarea)vacutainerfaraanticoagulantcu/faragelseparatorsau,depreferat,b)vacutainercufluorurade

    sodiu/Na2EDTA4.

  • Prelucrareanecesaraduparecoltarea)seseparaserulprincentrifugareintruninterval=126

    Nota:Diagnosticuldediabetzaharatsevastabilipebazaacelputin2valoricrescute>=126aleglicemieibazaleobtinuteinzilediferite.

  • Persoanelecuglicemiebazalamodificata(impairedfastingglucoseIFG)casicelecucelecuintolerantalaglucoza(impairedglucosetoleranceIGT,valoricuprinseintre140si199mg/dLla2oredupaadministrareadeglucoza)facpartedintrungrupintermediar,care,desinuindeplinestecriteriiledediagnosticalediabetuluizaharat,prezintanivelurialeglucozeipreamaripentruaficonsideratenormale.Acestepersoaneaufostincadrateanteriorcaavandprediabet.ConformnoilorrecomandariADA(2010),IFGsiIGTnutrebuieconsiderateentitaticlinicedesinestatoarecimaidegrabacategoriiderisccrescutpentrudiabetsiafectiunicardiovasculare.IFGsiIGTseasociazacuobezitate(inspecialabdominala),hipertensiunearterialasidislipidemie(trigliceridecrescutesiHDLcolesterolscazut).Crestereaactivitatiifizice,scadereaponderalasiadministrareaanumitoragentifarmacologiciprevinsauintarziedezvoltareadiabetuluilapersoanelecuintolerantalaglucoza.

    Trebuiementionatfaptulcain2003ADAaredusvaloareacutoffpentruIFGdela110mg/dLla100mg/dL,unuldintrescopurifiindacelacaprevalentaIFGsaseapropiedeceaaIGT.OMSsialteorganizatiipreocupatedediabetnuauadoptataceasta

    modificare7.

    Monitorizareapacientilorcudiabetzaharat

    Uncontrolglicemicoptimreducerisculdeinstalareacomplicatiilormicrosimacrovasculare.

    Tintelecontroluluiglicemiclapacientiidiabeticiestementionataintabeluldemaijos1.

    Optimal Lalimita Suboptimal

    HbA1c% 8.5

    Glicemiebazala 70126 126144 >144

    Glicemiela2orepostprandial

    180

    Factordeconversie:mg/dlx0.0555=mmol/L4.

    Valoricritice2nivelscazut:

  • Interpretarearezultatelor

    Cresteri

    diabetzaharat,boalaCushing,acromegalie/gigantism,feocromocitom,adenomhipofizar(secretordehormondecrestere),hemocromatoza,pancreatitaacuta/cronica,neoplasmdepancreas,glucagonom,afectiunirenalecronice,boalahepaticaavansata,deficientadevitaminaB1[3](encefalopatiaWernicke),stresacut

    emotionalsaufizic(infarctmiocardic,AVC,convulsii)25.

    Scaderi

    insulinom,tumoriextrapancreatice(ex.hepatom),boalaAddison,hipopituitarism,malabsorbtie,necrozahepaticafuminanta(hepatita,intoxicatii),prematuri,nounascutidinmamediabetice,deficienteenzimatice(ex.galactozemie),supradozajinsulinic,hipoglicemiereactiva(hiperinsulinismindusalimentar,tulburariendocrine),hipoglicemiepostprandiala(dupainterventiichirurgicalegastrointestinale,intolerantaereditaralafructoza,galactozemie)25.

    Limitesiinterferente

    Potsaaparacresteriusoarealeglicemieiinsarcinanormala,lamariifumatori,obezisipersoanelesedentare.Efortulfizicintenspoategenerahipoglicemie.Cresterialeglicemeipotsaaparadupaanestezie,interventiichirurgicalesidupaadministrarei.v.deglucoza.

    Scaderialeglucozeisericesepotinregistralapacientiicueritrocitoza(hematocrit>55%)sauleucocitozamarcata(leucemii).

    Medicamente:

    Cresteri:ACTH,asparaginaza,agonistibetaadrenergici(ex.albuterol,isoproterenol,terbutalina),cafeina,calcitonina,corticosteroizi,diazoxid,diuretice(acetazolamida,clortalidona,acidetacrinic,furosemid,tiazide,triamteren),dopamina,epinefrina,estrogeni,fructoza,glucagon,indometacin,carbonatdelitiu,morfina,acidnicotinic(dozemari),octreotid

  • (somatostatin),contraceptiveorale,fenotiazine,fenitoin,rifampin,streptozotocin,teofilina,tiabendazol,Dtiroxina3.

    Scaderi:acetominofen(dozetoxice),blocantibetaadrenergici,steroizianabolizanti(ladiabetici),antihistaminice,aspirina(dozetoxice),bezafibrat,captopril,ciproteron,disopiramid,etanol,fenfluramina(ladiabetici),analogiaiguanetidinei,indometacin(efectevariabile),marijuana,inhibitoriMAO,nifedipina(neconcludent),pentamidina(dupacatevazile),pivampicilina,

    protionamida,spironolactona,trometamina3.

    Bibliografie

    1.Diabetulzaharattip2.Ghiddepracticapentrumediciidefamilie.EdituraInfomedica,2005.

    2.FrancesFischbach.Chemistrystudies.InAManualofLaboratoryandDiagnosticTests.LippincottWilliams&Wilkins,USA,8Ed.2009,

    324330.

    3.FrancesFischbach.EffectsoftheMostCommonlyUsedDrugsonFrequentlyOrderedLaboratoryTests.InAManualofLaboratoryand

    DiagnosticTests.LippincottWilliams&Wilkins,USA,8Ed.2009,12391240.

    4.LaboratorSynevo.Referintelespecificetehnologieidelucruutilizate2010.RefType:Catalog.

    5.LaboratoryCorporationofAmerica.DirectoryofServicesandInterpretiveGuide.Glucose,Serum.www.labcorp.com2010.RefType:

    InternetCommunication.

    6.LotharThomas.Bloodglucose.InClinicalLaboratoryDiagnosticsUseandAssessmentofClinicalLaboratoryResults.THBooks

    VerlagsgesellschaftmbH,Frankfurt/Main,Germany,1Ed.1998,131139.

    7.StandardsofMedicalCareinDiabetes2010.AmericanDiabetesAssociation.

    8.WHO2006.DefinitionandDiagnosisofDiabetesMellitusandIntermediateHyperglycaemia.

  • ArticleprintedfromSynevo:http://www.synevo.ro

    URLtoarticle:http://www.synevo.ro/glucozaserica/

    URLsinthispost:

    [1]trigliceride:http://www.synevo.ro/trigliceride/[2]rezultate:http://www.synevo.ro/spitale/rezultate/[3]vitaminaB1:http://www.synevo.ro/vitaminab1/

    Copyright2009Synevo.Toatedrepturilerezervate.

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