HOMILADORLIKDAGI METABOLIK VA GORMONAL O'ZGARISHLARNING POSTPARTUM DAVRDAGI QANDLI DIABET RIVOJLANISHIGA TA'SIRI INSULIN REZISTENTLIGI, GORMONAL DISBALANS VA YOG' TO'QIMALARI FAOLLIGINING O'RNI
Keywords:
Postpartum qandli diabet, Gestatsion qandli diabet, Insulin rezistentligi, Yog' to'qimasi, Yallig'lanish, Leptin, Adiponektin, Beta-hujayra disfunksiyasi, Metabolik sindrom, Bashorat.Abstract
Homiladorlik davri onaning metabolizmi va gormonal muhitida sezilarli o'zgarishlarni keltirib chiqaradi, bu fiziologik jarayon homiladorlik davomida paydo bo'ladigan gestatsion qandli diabet (GQDi) va keyinchalik, ayniqsa postpartum davrda, turli II xil qandli diabet (QDi II) rivojlanish xavfi bilan chambarchas bog'liq [1]. GQDi bilan og'rigan ayollarning deyarli yarmi hayotining keyingi davrida QDi II rivojlanadi, bu esa ushbu populyatsiya uchun jiddiy sog'liqni saqlash muammosini anglatadi [2]. Ushbu sharhli maqolaning maqsadi 2015-2025-yillar oralig'ida e'lon qilingan ilmiy ma'lumotlarni tahli qilish asosida homiladorlikdan keyingi davrda QDi II ning paydo bo'lish mexanizmlarini, ayniqsa homiladorlik davrida kuchaygan insulin rezistentligining (IR) tuzalishsiz qolishi, gormonal disbalansning davom etishi va yog' to'qimasining faollashuvining asosiy rolini chuqur o'rganishdan iborat [3]. Homiladorlik fiziologik insulin rezistentlikni kuchaytiradi, bu esa beta-hujayralarning funksional imkoniyatlarini sinab ko'radi. GQDi bo'lgan ayollarda bu kompensator mexanizm yetarli darajada ishlamaydi, homiladorlikdan keyin esa insulin rezistentligi ko'pincha to'liq regressiyaga uchramaydi, aksincha, turli omillar ta'sirida davom etadi [4]. Ushbu jarayonda yog' to'qimasi, ayniqsa visseral yog', faol endokrin a'zoga aylanib, adiponektin kabi foydali sitokinlarning ishlab chiqarilishini kamaytirib va leptin va pro-yallig'lanish sitokinlari (masalan, TNF-α va IL-6) kabi zararli moddalarni ko'paytirib, insulin signalizatsiyasiga putur yetkazadi [5, 6]. Shuningdek, homiladorlik davridagi gormonal o'zgarishlar (xoriogonadotropin, laktogen, kortizol) va ularning postpartum davrdagi holati, shuningdek, laktatsiya darajasi ham metabolik muvozanatni sezilarli darajada ta'sir qiladi [7]. Maqolada ushbu patofiziologik yo'llarning o'zaro bog'liqligi va ularning postpartum diabetogenezga qo'shgan hissasi muhokama qilinadi. Shuningdek, GQDi anamnezi bo'lgan ayollarda QDi II rivojlanish xavfini bashorat qilish va oldini olish strategiyalarini ishlab chiqish uchun ushbu mexanizmlarni tushunishning ahamiyati ta'kidlanadi. Xulosa qilib aytganda, homiladorlikdan keyingi davr metabolik salomatlikni tiklash va kelajakdagi surunkali kasalliklarning oldini olish uchun hal qiluvchi ahamiyatga ega bo'lgan "terga oynasi" vazifasini bajaradi [8].
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