1. curs 1-dz

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FP METABOLISMULUI INTERMEDIARGLUCIDIC

• HIPERGLICEMII - DZ

• HIPOGLICEMII

• GLICOGENOZE

8/15/2019 1. CURS 1-DZ

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DIABETUL ZAHARAT - DZ

DIABETES MELLITUS - DM

• GRUP DE

AFECTIUNIMETABOLICE HIPERGLICEMIA

MECANISMEFIZIOPATOLOGICE

DIFERITE

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PRODUCTIA DEGLUCOZA

UTILIZAREA GLUCOZEI

ECHILIBRU METABOLIC

EUGLICEMIE

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DIABETUL ZAHARAT - DZ

DIABETES MELLITUS - DM

ETIOLOGIE COMPLEXA

FACTORI • GENETICI

• DE MEDIU

• STIL DE VIATA

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PRODUCTIA DE

GLUCOZA ↑

UTILIZAREAGLUCOZEI ↓

DEZECHILIBRU METABOLIC - DZ

HIPERGLICEMIE

8/15/2019 1. CURS 1-DZ

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DEZECHILIBRU METABOLIC - DZ

• Multiple mo i!i"#$i FP %e"u& #$e

• Multiple o$'#&e %i %i%teme

Imp#"t i& i(i u#lImp#"t %o"i#l ) AS

DZ * CAUZA PRINCIPALA

• # #!e"tiu&ilo$ $ele te$mile

• # #mput#tiilo$ &o&-t$#um#ti"e e

e+t$emit#ti i&!e$io#$e• # o$,i$ii l# # ulti

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DZ - CLASIFICARE

• Ve" e# "l#%i!i"#$e

• (#$%t# e,utului• tipul e te$#pie

NOUA CLASIFICARE REVIZUITA

• American Diabetes Association . /000 - 1222

• MECANISMUL FP "#$e ete$miHIPERGLICEMIA

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8/15/2019 1. CURS 1-DZ

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DZ - CLASIFICARE

I3 DZ DE TIP / ( distr !"r"# $"% %"%&rβ → DEFICIT ABSOLUT

DE INSULINA '

A Me i#t imu&olo'i" B I iop#ti"

8/15/2019 1. CURS 1-DZ

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DZ - CLASIFICARE

II3 DZ DE TIP 1- po#te (#$i#

• e l# REZISTENTA LA INSULINAPREDOMINANTA "u e!i"it $el#ti( e i&%uli

• l# DEFECT SECRETOR DE INSULINAPREDOMINANT "u $e4i%te&t# l# i&%uli

8/15/2019 1. CURS 1-DZ

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DZ - CLASIFICAREIII. ALTE TIPURI SPECIFICE DE DZ

A53 DEFECTE GENETICE ALE FUNCTIEICELULELOR . "#$#"te$i4#te p$i& MUTATII #le

1. F#$t&r % i ")#t&$it#r d" tr#*s$ri)ti" * $%"#r# (HNF' + α , MOD- 1

2. G% $& i*#/"i , MOD- 2

0. HNF 1 α , MOD- 0

+. F#$t&r % i )r& &t&r #% i*s %i*"i (IPF' 1 , MOD- +

3. HNF 1 β , MOD- 3

4. ADN % i it&$&*dri#%

5. C&*6"rsi"i i*s %i*"i s# r&i*s %i*"i

8/15/2019 1. CURS 1-DZ

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8/15/2019 1. CURS 1-DZ

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DZ - CLASIFICARE

III. ALTE TIPURI SPECIFICE DE DZ

B53 DEFECTE GENETICE ALE EXERCITARII

EFECTELOR INSULINEI1. Ti) % A d" r"/ist"*t# %# i*s %i*#

2. L")r"$ # *is %

0. Sd. R#7s&* M"*d"* #%%

+. Di#7"t % %i)tr&8i$

8/15/2019 1. CURS 1-DZ

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DZ - CLASIFICARE


C53 AFECTIUNI ALE PANCREASULUIEXOCRIN

• )#*$r"#tit"9 )#*$r"#t"$t& ii9 *"&)%#/ii9 8i7r&/# $ isti$#9

" &$r& #t&/#9 )#*$r"#t&)#ti# 8i7r&$#%$ %s#

8/15/2019 1. CURS 1-DZ

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DZ - CLASIFICARE

III. ALTE TIPURI SPECIFICE DE DZD53 ENDOCRINOPATII

• A$r& "!#%i"• S& #t&st#ti*&• Hi)"rtir&idis

• G% $#!&*&• Sd. C s i*!• A%d&st"r&*&• F"&$r& &$it&

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E53 INDUS MEDICAMENTOS SAU CHIMIC• V#$&r• P"*t# idi*#• A$id *i$&ti*i$• Glu"o"o$ti"oi4i• H&r &*i tir&idi"*i• Di#/&:id• A'o&i%ti ) A&t#'o&i%ti -#$e&e$'i"i• Ti#4i e• Fe&itoi&• α i*t"r8"r&*• I* i7it&ri d" )r&t"#/"

• C%&/#)i*

8/15/2019 1. CURS 1-DZ

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DZ - CLASIFICARE


F53 INFECTII

• R 7"&%# $&*!"*it#%#

• Cit& "!#%&6ir s• C&:s#$ i"

8/15/2019 1. CURS 1-DZ

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DZ - CLASIFICARE


G53 FORME NEOBISNUITE ) RARE DE DZ

MEDIAT IMUNOLOGIC • AC. #*tir"$")t&ri i*s %i*i$i• ;Stiff-man“ sy.

8/15/2019 1. CURS 1-DZ

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H53 ALTE SINDROAME GENETICE ASOCIATEUNEORI CU DZ

• Sd. D&&%8r#• At#:i# Fri"dr"i$• C &r""# H *ti*!t&*• Sd. L# r"*$" M&&* Bi"d%• Distr&8i# i&t&*i$#• P&r8iri#• Sd Pr#d"r >i%%i

8/15/2019 1. CURS 1-DZ

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DZ - CLASIFICARE

IV. DIABETUL ZAHARAT

GESTATIONAL ? DE SARCINA(GDM'

8/15/2019 1. CURS 1-DZ

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DIABETUL ZAHARAT GESTATIONAL ) DE SARCINA(GDM = Gestational Diabetes Mellitus '

- C& )%i$# )#*# %# 1@ di* t&t#% % s#r$i*i%&r

I* R& #*i# 3

• D"8i*iti"

&ri$" !r#d d" i*t&%"r#*t# %# !% $id"9 $ d"7 t s# )ri #r"$ *st"r" * ti ) % s#r$i*ii

di#7"t % $ d"7 t * ti ) % s#r$i*ii

di#7"t % )r"":ist"*t s#r$i*ii9 d#r *"di#!*&sti$#t #*t"ri&r

(i*di8"r"*t d#$# )"rsist# s# * d )# *#st"r" s# d#$#

)"*tr "$ i%i7r#r" "st" s 8i$i"*t# di"t# &ri *"$"sit#

i*s %i*&t"r#)i"'

8/15/2019 1. CURS 1-DZ

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DZ - EPIDEMIOLOGIE• p$e(#le&t# i& ↑ $#m#ti"# i& ultimele ou# e"# e → %ep$e"o&i4e#4# me&ti&e$e# #"e%tei te& i&te i& (iito$ul #p$opi#t

i* USA (1 54 1 +'

)r"6#%"*t# DZ %# #d %ti , 9 1290 )r"6#%"*t# IFG %# #d %ti , 493 95

• t$e& e+pe"t#t 6 p$e(#le&t# 7 DZ 1. p$i& 6

- ↑ i&"i e&tei %i p$e(#le&tei o,e4it#tii- te& i&t# l# %e e&t#$i%m

• "#4u$i &e i#'&o%ti"#te 8

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DZ - EPIDEMIOLOGIE 1 9 )r"6#%"*t# DZ i* USA 14 i%. I*di6i/i , 4 di* )&) %#ti"

i*$id"*t# , @@.@@@ ? #* s"*si7i% "!#%# %# B si F i* &ri$#r"i*t"r6#% d" 6#rst#9 8ii*d s&r %# B 4@ #*i

@ , DZ 2

)r"6#%"*t# DZ i* )&) %#ti"

↑ $ 6#rst# ( 193 %# 2@ 0 #*i → 2@ %# 53 #*i '

2 : %# #8r& # "ri$#*i9 is)#*i$ii # "ri$#*i si # "ri$#*ii*#ti6i 8.d. $# $#/i"*ii *&* is)#*i$i

d"7 t % DZ 2 %# & 6#rst# #i %# $"i %# $#r" )r"6#%"*t# " #i

i*$id"*t# %# #$"st" !r ) ri d" ris$ " i* $r"st"r" r#)id#

r#ti *i *"$ *&s$ t"

8/15/2019 1. CURS 1-DZ

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DZ - DIAGNOSTIC

Crit"rii%" r"6i/ it"9 st#7i%it" )ri* $&*s"*s % #i %t&r $& it"t" d"":)"rti

• National Diabetes Data Group

• WHO

8/15/2019 1. CURS 1-DZ

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ABREVIERI

• RPG , Random Plasma Glucose = !%i$" i# #%"#tr"9 i*t# )%#tr"

• FPG , Fasting Plasma Glucose = !%i$" i# 7#/#%#9 á jeun

• IFG , Im ai!ed Fasting Glucose , !%i$" i" 7#/#%# #%t"r#t#

• IG" , Im ai!ed Glucose "ole!ance = t&%"r#*t# #%t"r#t# (s$#/ t#' %# !% $&/#

• H7A 1C , H" &!%&7i*# !%i$#t# J i/&8&r # A 1C

• #G"" = #!al Glucose "ole!ance "est = t"st % d" t&%"r#*t# %# !% $&/# )" $#%"&r#%# (TTGO'

8/15/2019 1. CURS 1-DZ

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DZ – DIAGNOSTIC (criterii ADA)Oricare dintre :

• Simptomatologie clinica + RPG ≥ 11,1 mmol !("## mg $!) sau

• 1% &aloare a 'PG ≥ , # mmol ! (1" mg $!) sau

• "* PG ≥ 11,1 mmol ! ("## mg $!) in timp lTTGO

sau

• -.A1c (-. glicata) / ,0 ("#11)

8/15/2019 1. CURS 1-DZ

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DZ - DIAGNOSTIC

• I,%e&t# HIPERGLICEMIEI u&ie" i(o"e%#u #

• DECOMPENSARII METABOLICE ACUTE .

→ #"e%te "$ite$ii #$ t$e,ui "o&!i$m#te p$i&

$epet#$e# te%telo$ i&t$-u& #lt mome&t

9#lt# 4i - "u $e(i4ui$e# "o& itiilo$ e p$e'#ti$e #p#"ie&tului %i $elu#$e# p$oto"olului5

Sursa : American Diabetes Association, 2000

CLASIFICAREA TOLERANTEI LA GLUCOZA

8/15/2019 1. CURS 1-DZ

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CLASIFICAREA TOLERANTEI LA GLUCOZA

PE BAZA FPG/3 TOLERANTA NORMALA LA GLUCOZA

FPG : ;./ mmol)L 9/22 m') l5

9/22m') L5 ;./ mmol)L ≤ IFG :

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• C$ite$iile $e(i4uite e i#'&o%ti" # DZ

- $e!le"t# &oile o(e4i epi emiolo'i"e %i met#,oli"e

- %e ,#4e#4# pe u$m#to#$ele p$emi%e 6

• 9/5 Spe"t$ul FPG %i $#%pu&%ul l# o i&"#$"#$e p3o3 "u G

(#$i#4# l# i& i(i4ii &o$m#li• 915 Di#'&o%ti"ul DZ e %t#,ilit pe ,#4# #"elo$ (#lo$i #le G l#"#$e %e "o&%t#t# "ompli"#tii %pe"i!i"e DZ %i &u pe ,#4#tole$#&tei l# G %t#,ilite p$i& %tu ii popul#tiole

• e+3 6 p$e(#le&t# $eti&op#tiei l# #me$i"#&ii ti(i9popul#tie i& i# Pim#5 i&"epe %# "$e#%"# e l# o(#lo#$e # FPG 7 ;.= mmol)L 9//; m') L5

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• Cel m#i $e"om#& #t te%t 6 FPG

te%t e screenin l# #%imptom#ti"i→ %t#& #$ i4#t→ i%po&i,il→ cost-e!!ecti"e

• L# %imptom#ti"i 6 RPG ≥ //./ mmol)L 9122 m') L5 %em&e "li&i"e "l#%i"e e DZ 9poliu$ie. poli ip%ie.pie$ e$e i& '$eut#te et"35 * "e$t DZ

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• pl#%m# (e&o#%# * %#&'e "#pil#$ tot#l

• meto # e&4im#ti"#• FPG * l# mi&im > po%tp$#& i#l

• SI * C + CF

mmol)L * m') L + 2.2 /

• #te p$e"i%e. e(e&tu#l $epet#$e# te%telo$ ii&te#u&ui '3 !il

8/15/2019 1. CURS 1-DZ

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DZ - S#$EENING

• Utili4#$e# pe %"#$# l#$'# # FPG "# te%t escreenin pe&t$u DZ 1 e $e"om#& #t# %i i&"u$# #t#(1' * #r" *r. d" i*di6i/i $#r" i*tr *"s$ $rit"rii%" d" d!. * sti $## DZ (#si )t& #ti$i'

(2' st dii%" ")id" i&%&!i$" s !"r"#/# $# DZ d" ti) 2 #r ) t"# 8i

)r"/"*t $ )#*# %# & d"$#d# i*#i*t"# st#7i%irii d!.

(0' 3@ di* i*di6i/ii $ DZ 2 # *# s# #i %t" $& )%i$#tiis)"$i8i$" DZ i* & "*t % di#!*&sti$#rii DZ

DZ 1 S#$EENING

FR pe&t$u DZ 1

8/15/2019 1. CURS 1-DZ

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DZ 1 - S#$EENING Re"om#& #$ile Comitetului e E+pe$ti

i& Di#'&o%ti"ul %i Cl#%i!i"#$e# DZ

• screenin - ul tutu$o$ i& i(i4ilo$ 7 = #&i) "el puti& o#t# l# !ie"#$e ? #&i

• screenin - ul

→ i&"ep#& "u o (#$%t# m#i ↓

→ m#i !$e"(e&t #l tutu$o$ i& i(i4ilo$ #%imptom#ti"i "u FR pt3 DZ

FR pe&t$u DZ 1 • Ist&ri$ 8# i%i#% d" DZ

• S )r#)&d"r#%it#t" s# O7"/it#t" ( G ≥ 2@ 8.d. id"#% sau $MI ≥ 23!? 2

• V#rst# ≥ +3 #*i• S"d"*t#ris (I*#$ti6it#t" 8i/i$# #7it #%#'

• R#s#?Et*i# (#8r& # "ri$#*9 is)#*& # "ri$#*9 # "ri$#* *#ti69 #si#ti$# "ri$#*9 i*s %#r P#$i8i$'

• IFG s# IGT s# H7A1$ K 395 i* #*t"$"d"*t"

• Ist&ri$ d" GDM s# 8#t #$r&s& ( ≥ +@@@ !'

• HTA (TA ≥ 1+@ ? @ H! '• HDL C&%≤ @9 &%?L (03 !?dL' si%sau TGL ≥ 29 2 &%?L (23@

!?dL'

• Sd. &6#r("' )&%i$ isti$("' s# #$#*t &sis *i!ri$#*s

• Ist&ri$ d" 7%# 6#s$ %#r#

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S#$EENING DZ /

• !3 $#$ %i &eo,i%&uit %# #i,# o pe$io# # lu&'# e HG#%imptom#ti"# ii&te# '3 DZ

• ":ist# i* )r"/"*t )&si7i%it#t"# id"*ti8i$#rii *&r ma!&e! ii *&%&!i$i )t. DZ 1A

→ ti%i/#r"# %&r $ r"*t# "st" e%"u$# #t# ()#*# %#id"*ti8i$#r"# *&r i*t"r6"*tii 7"*"8i$" i* #$"st s$&)9 %#i*di6i/ii $ ris$ ↑ )t. DZ 1'

8/15/2019 1. CURS 1-DZ

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S#$EENING -UL DIABETULUI GESTATIONALRis$ % )"*tr DG tr"7 i" #)r"$i#t d" %# )ri # 6i/it# )r"*#t#%#

RISC SCAZUT

r#s# #%7# si 6#rst# 23 #*i si !r" t#t" N i*#i*t"# s#r$i*ii si #7s"*t# #*t"$"d. HCL )t.

di#7"t si #7s"*t# DG i* #*t"$"d"*t"%"

)"rs&*#%" si #7s"*t# $& )%i$#tii%&r

&7st"tri$#%" i* #*t"$"d"*t"

RISC CRESCUT

&7"/it#t" sau 6#rst# 0@ #*i sau Ist&ri$ )"rs&*#% d" DG s#

t&%"r#*t# #%t"r#t# %# !% $&/#sau #*t"$"d. HCL (r d" !r#d I' )t.

di#7"t sau #)#rt"*"*t# %# !r ) "t*i$ $

ris$ ( is)#*i$i9 #8r&' sau S#r$i*i $ 8"ti #$r&s& i s##%8&r #tii s# rt"

i*tr# t"ri*# i*":)%i$#7i%# #8#t % isau

!% $&/ ri"

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S#$EENING -UL DIABETULUI GESTATIONALL# 8" "i%" $&*sid"r#t" $ $i%" "$e%"ut )"*tr DG tr"7 i" "8"$t #t#

t"st#r"# !%i$" i$# $ t #i $ r *d )&si7i%

& !%i$" i" # " * 124 !?dLs#

& !%i$" i" i*t# )%#tr"( * &ri$" & "*t #% /i%"i' 2@@ !?dLr"$&*8ir #t" d" & d"t"r i*#r" %t"rir#

i#'&o%ti" e DG 9i& p$imul t$ime%t$u5

Te%t#$e# i& %#pt3 1=-1> e %#$"i # !r#6id"%&r $ $i%" me iu 8" "i%&r $ ris$ $r"s$ t $#r" * # #6 t DG %# sc!eening %

i*iti#%F" "i%" $ $i%" %"#4ut )"*tr DG nu *"$"sit# s$r""*i*! J d#r * )r"#

":ist# 8" "i $ ris$ s$#/ t

testarea tuturor ra"i%elor & obli atorie

8/15/2019 1. CURS 1-DZ

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S#$EENING -UL %i DIAGNOSTICULDIABETULUI GESTATIONAL

•TTGO $ 53 ! !% $&/#9 #s r#r"# !%i$" i"i 7#/#%9 1 si 2 • di i*"#t#9 d )# )&st #%i "*t#r d" i*i

•I* s#)t. 2+ 2 d" s#r$i*#9 %# 8" "i%" *"di#!*&sti$#t" #*t"ri&r $

di#7"t $%i*i$ #*i8"st (i* $#/ % !r#6id"%&r $ ris$ $r"s$ t9r"t"st#r"'

• d!. d" DIABET GESTATIONAL , i* $#/ % i* $#r" 8i" si & si*! r#

6#%r" # !%i$" i"i (&ri$#r" di* $"%" tr"i' d")#s"st" 6#%r"#*&r #%#9 #di$#7#/#% K 2 !?dL (3.1 &%?L' 1 K 1 @ !?dL (1@.@ &%?L' 2 K 130 !?dL ( .3 &%?L'

PATOGENEZA DZ

8/15/2019 1. CURS 1-DZ

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PATOGENEZA DZ

TIPUL I A• E!e"t %i&e$'i" #l !#"to$ilo$ 6

- 'e&eti"i

- e me iu

- imu&olo'i"i

MASA

CELULELOR

PANCREATICE

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PATOGENEZA DZ /

• FACTORI GENETICI

s *t i )%i$#t" !"*" %ti)%" → d"/6&%t#r"# DZ )#r" s#*"$"sit" &st"*ir"# * i $& )%": d" !"*" s 8i$i"*t )t.# $&*8"ri s s$")ti7i%it#t"# %# DZ

$&*$&rd#*t# DZ 1A %# !" "*ii &*&/i!&ti , 0@ 5@→ ":ist# si #%ti 8#$t&ri #diti&*#%i9 &di8i$#t&ri d" $#r"d")i*d" s s$")ti7i%it#t"# %# DZ

PATOGENEZA DZ /

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PATOGENEZA DZ /• FACTORI GENETICI

!"*# # &r# s s$")ti7i%# # 8i i )%i$#t# i* d"t"r i*#r"# DZ 1A"st" %&$#%i/#t# i* r"!i *"# HLA # $r.4

)&%i &r8is % $& )%": % i HLA )#r" s# $&*8"r" * ris$ !"*"ti$

d" +@ 3@ d" # d"/6&%t# DZ ti) 1A r"!i *"# HLA # $r.4 $&*ti*" !"*" $#r" $&di8i$# &%"$ %"%" d"

$%#s# # II # #%" MHC9 &%"$ %" $#r" )r"/i*t# AG L8 T H → i*iti#/# RI

#7i%it#t"# &%"$ %"%&r MHC d" $%#s# # II # d" # )r"/"*t# AGd")i*d" d" $& )&/iti# i* AA # situs % i d" %"!#r" # AG → s 7stit tii #%" s"$6"*t"i N # AA #r ) t"# i*8% "*t# s)"$i8i$it#t"# RI9)ri* #%t"r#r"# #8i*it#tii d" %"!#r" # di8"riti AG %# #$"st" &%"$ %"

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PATOGENEZA DZ /

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PATOGENEZA DZ /• FACTORI GENETICI

":ist# $"% ) ti* #%t" 15 #%t" locus ri !"*"ti$" $#r" #r ) t"#$&*tri7 i %# s s$")ti7i%it#t"# %# ti) % 1A d" DZ

• )&%i &r8is % r"!i *ii !omote! # !"*"i $" $&di8i$#s"$6"*t# i*s %i*"i )#r" s# $&*8"r" & )r"dis)&/iti" d" 1@)"*tr #)#riti# DZ 1A

s # ) s i* "6id"*t# si !"*" $#r" #r ) t"# $&*8"ri )r&t"$ti" 8#t# d" DZ 1A

• #)%&ti) ri%" D A1Q@1@29 D B1Q@4@2 s *t )r"/"*t" %#2@ di* )&) %#ti"9 8ii*d i*s# ":tr" d" r#r" %# i*di6i/ii $DZ 1A ( 1 '

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PATOGENEZA DZ /

• FACTORI GENETICI

d"si ti) % 1A d" DZ "st" $%#r #s&$i#t $ #* it" !"*&ti) ri)r"dis)&/#*t"9 %ti i*di6i/i $ #st8"% d" !"*&ti) ri * d"/6&%t#*i$i&d#t# DZ

i* )% s9 %ti i*di6i/i $ DZ ti) 1A * # *i$i & r d# d" !r#d % I $#$"#st# #8"$ti *"

t&t si9 8#r# *i$i & i*d&i#%#9 ris$ % r d"%&r i*di6i/i%&r $ DZ 1A d" 8#$" 7%# " $&*sid"r#7i% 8.d. ris$ % )&) %#ti"i !"*"r#%"

8/15/2019 1. CURS 1-DZ

48/57

PATOGENEZA DZ /

• FACTORI AUTOIMUNI

i* $i d# 8#)t % i $# si #%t" $"% %" i*s %#r" )#*$r"#ti$"

• α → !% $#!&*• δ → s& #t&st#ti*#• PP → )&%i)")tid % )#*$r"#ti$

s *t d.).d.6. " 7ri&%&!i$ si 8 *$ti&*#% si i%#r" $"% %"%&r → #$"st"# s *t i& mo i&e+pli"#,il p$ote #te d" 8"*& "*"%"# t&i *"

8/15/2019 1. CURS 1-DZ

49/57

PATOGENEZA DZ /

• FACTORI AUTOIMUNI- i&%ulit# , i*8i%tr#t i*8%# #t&r (L8' i* r % i*s %"%&r → distr $ti"$"% %#r#9 #tr&8i"→ ii s" sti*!"9 #r "r ii i *&%&!i$i dis)#r

st dii%" )" &d"%" #*i #%" # d" &*str#t #*& #%ii #%" RI &r#%si $"% %#r

• # t& AC #*ti $"% %" i*s %#r"

• L8 #$ti6#t" i* i*s %"9 !!%. %8. )"ri)#*$r"#ti$i si sist" i$

• L8 T $" )r&%i8"r"#/# %# sti %#r"# $ )r&t"i*" i*s %#r"

• "%i7"r#r"# d" C= )r& i i* 8&$#r → $"% )#r # 8i i* &d)#rti$ %#r s s$")ti7i%" %# "8"$t % t&:i$ #% *&r C= (TNFα9 IFN γ 9

IL 1'

8/15/2019 1. CURS 1-DZ

50/57

PATOGENEZA DZ /

• FACTORI AUTOIMUNI- i%t$u"ti# "el3 → "$#*is " ( '

• "t#7&%iti d" NO

• #)&)t&/#• $it&t&:i$it#t" dir"$t# # CD T

# t& AC #*tii*s %#ri * )#r # 8i i )%i$#ti9 )t. $#

• #$"sti AC * r"#$ti&*"#/#9 i* !"*"r#%9 $ $"% %"%" i*s %#r"d" s )r#8#t#

• * tr#*s it DZ %# #*i #%"%" d" ":)"ri"*t#

8/15/2019 1. CURS 1-DZ

51/57

PATOGENEZA DZ /

• FACTORI AUTOIMUNI- Mole"ule #le i&%ulelo$ p#&"$e#ti"e - ti&te #le p$o"e%ului#utoimu& 6

• i*s %i*#• d"$#r7&:i%#/# #$. !% t# i$ (GAD'

• ICA 312?IA 29 & &%&! #% tir&/i* 8&s8#t#/"%&r

• ) &!ri*# ()r&t"i*# # !r#* %"%&r s"$r"t#*t" d" i*s %i*#'• ( * !#*!%i&/id i*s %#r'

• ($#r7&:i)")tid#/# H'

8/15/2019 1. CURS 1-DZ

52/57

PATOGENEZA DZ /

• FACTORI AUTOIMUNI- C#$e e%te %u,%t$#tul i%t$u'e$ii %ele"ti(e # "elulelo$ 8

• I*iti"r"# * i )r&$"s # t&i * dir"$ti&*#t i )&tri6# 1 Q

&%"$ %" → r#s)#*dir" s)r" #%t" &%"$ %"9 )" #s r# $")r&$"s % i * distr !" $"% %" si $r""#/# & s"ri" d" # t& AG s"$ *d#r"

C"% %"%" #%" i*di6i/i%&r $ DZ 1A * di8"r# d" $"%" #%" i*di6i/i%N9 d" 6r" " $" $"% %"%" tr#*s)%#*t#t" s *t distr s" d" & r"$ r"*t## )r&$"s % i # t&i * di* $#dr % DZ 1A

8/15/2019 1. CURS 1-DZ

53/57

PATOGENEZA DZ /

• MA$'E$ I IMUNOLOGICI- Auto-AC #&ti "elule i&%ul#$e 9 I#As( & mar)er i #i p$o"e%ului#utoimu&

T"st#r"# i* 6"d"r"# id"*ti8i$#rii I'(s " ti%# i*

• $%#si8i$#r"# DZ d" ti) 1 $# 8ii*d d" ti) 1A (i *&%&!i$'

• id"*ti8i$#r"# i*di6i/i%&r *&*di#7"ti$i $ ris$ )"*tr d"/6&%t#r"#ti) % i 1A d" DZ

8/15/2019 1. CURS 1-DZ

54/57

PATOGENEZA DZ /

• MAR ERI IMUNOLOGICI

- I#As s *t )r"/"*ti

• %# # &rit#t"# i*di6i/i%&r *& d!. $ DZ 1A ( 53 '

• i*tr & s" *i8i$#ti6# i*&rit#t" %# i*di6i/ii *& d!. $ DZ 2

• &$#/i&*#% %# i*di6id"%" $ GDM ( 3 '

• i* d" 0 + %# r d"%" d" !r#d % I #%" i*di6i/i%&r $ DZ 1A

PATOGENEZA DZ /

8/15/2019 1. CURS 1-DZ

55/57

PATOGENEZA DZ /• MA$'E$ I IMUNOLOGICI

- I#As )r"/"*ti

• i* $&* *$ti" $ ↓ s"$r"ti"i d" I %# TTi69 "i )r"/i$ * ris$ 3@ d" # d"/6&%t# DZ 1A i* 3 #*i

• d#$# s"$r"ti# d" I " N9 ris$ % )r"/is %# 3 #*i 23

• ris$ % r d"%&r d" !r#d % I #%" i*di6i/i%&rI'(s ( ' " r"%#ti6 ↓• $ i#r i*di6i/ii I'(s ( ' * 8#$ i*t&td"# *# 7%#

i* )r"/"*t9 ICAs s *t ti%i/#ti i* $"r$"t#r"9 * i* )r#$ti$# $%i*i$#

• d&t#r" ? dis)&*i7i%it#t"

• i* ti% $# si $&*s"$i*t# t"r#)" ti$#

PATOGENEZA DZ /

8/15/2019 1. CURS 1-DZ

56/57

PATOGENEZA DZ /

• FACTORI DE MEDIU

- Multi !#"to$i #u !o%t p$opu%i "# tri er -i #i p$o"e%ului#utoimu& l# i& i(i4ii %u%"epti,ili)p$e i%pu%i 'e&eti" - &i"i

u&ul p$e# "o&"lu e&t 6• id"*ti8i$#r"# " di8i$i%# )t. $# "6"*i "*t % #r ) t"# )r"$"d"d"7 t % DZ $ $#ti6# #*i

• 6ir s ri (C&:s#$ i"9 r 7"&%i$'

• ":) *"r"# ti ) ri" %# )r&t"i*"%" di* %#)t"%" d" 6#$#

• ": *"r"# %# *ii $& ) si *itr&/ r"i$i

PREVENTIA DZ /

8/15/2019 1. CURS 1-DZ

57/57

PREVENTIA DZ /- E+i%t# i&te$(e&tii e+pe$ime&t#le pe mo ele #&im#le "#$e #u$eu%it "u %u""e% %# i&t#$4ie %#u " i#$ %# p$e(i #p#$iti# DZ 6

• i *&s )r"si"

• d"%"ti" s"%"$ti6# # *&r s 7ti) ri d" $"% %" T

• i*d $"r"# t&%"r#*t"i i *" %# )r&t"i*" i*s %#r"• 7%&$#r"# #$ti *ii $itit&:i$" # *&r C=

• $r"st"r"# r"/ist"*t"i i*s %#r" %# )r&$"s % # t&i *

- Diabetes *re"ention Trial - t+pe , #d i*istr#r"# d" I %#i*di6i/ii $ ris$ $r"s$ t )t. DZ 1A → i*d $"r"# t&%"r#*t"i i *" si#%t"r#r"# )r&$"s % i d" distr $ti" # t&i *# # $"% %"%&r

1. curs 1-dz

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