Imagliflozin yakazara nehutachiona hwevanhu vane chirwere cheshuga vane chirwere chetsvo chakanga chakamirira
Kana zvichitaura mukurapa chirwere cheshuga chepfungwa uye kuderedza dambudziko rehupi kusakundikana (zvinoda dialysis kana kupora kwepyiyo ), hazvisi zuva rega roga ratinonzwa pamusoro pemishonga inoruramisa mazwi akadai, "Holy Grail,", "Mutambo wekuchinja", " kuputsika " , nezvimwewo. Zvakanaka, tinogona kunge tiri pane imwe nguva dzisinganzwisisiki mumishonga apo mishonga yakaratidza zviitiko zvinopikira zvakakwana kuti zvigadzirise mazita iwayo.
Pane mishonga yekudzora chirwere cheshuga, chimwe chinhu chinonzi empagliflozin (inozivikanwawo nezita rayo, Jardiance). Zvisinei, kuitira kuti unzwisise zvaanogona kuita zvekudzivirira mafungiro asina hanya, zvinokosha kuti uzive zvishoma zvemashure.
Sei Chirwere Cheshuga Chichikuvadza Zviyo?
Chirwere cheshuga mellitus maoko pasi chikonzero chikuru chikuru chepfungwa yepfungwa uye yeutsvo kusakundikana munyika dzakawanda dzakabudirira. Kupararira kwaro kunoramba kuchikwira asi zvarinoreva zvinopfuurira kuisa hurumende yehutano hwehutano. Iyo chirwere chisingaregi, zvose zvakare nyore kuregeredza kusvikira murwere atanga kukura matambudziko.
Itsvo haisi ivo chete nhengo dzakaparadzwa nedambudziko iri. Sezvo chirwere cheshuga chinokuvadza mishonga yeropa, technically, nhengo yese yakanaka. Zvichienderana nehukuru hwemidziyo yeropa inobatanidzwa, chirwere cheropa chinokonzerwa nechirwere cheshuga chakagara chakaparadzaniswa kuva microvascular (semuenzaniso.
chirwere cheshuga chinonzi retinopathy mumaziso, chirwere chepfungwa kana chirwere cheshuga nephropathy, nezvimwewo), uye macrovascular complications (eg coronary heart disease inoita kuti pave nengozi yekurwadziwa kwepfungwa, chirwere cheperebrovascular mujinga reropa muuropi chinowedzera dambudziko rekurohwa, kana zvakadaro).
Sezvo zvataurwa pamusoro apa, zvinonzwisisika kuti chero nguva nguva yekugadzirisa kunoitwa mundima yekuchengetedza chirwere cheshuga, nyika inocherechedza.
Vanachiremba uye varwere vanomirira mashoko akanaka ne bhed breath. Ndiyo mushonga mutsva unozogadzirisa dambudziko rekushaya chirwere cheshuga chakafanana nerufu here? Zvakadini nekumhanya kwemwoyo kana kurohwa? Zvichida kuderedza dambudziko rekushaya chirwere cheshuga kukanganisa?
Kana, sezvinowanzoitika , zvingava zvose zvinogumbura here kana chirwere cheshuga chakagadziriswa hachirevi muchibereko chinowanikwa mumakirini kune varwere? Ichokwadi, pane zvidzidzo zvakashuma njodzi yakakura yekufa / chirwere nechimwe chirwere cheshuga cheshuga. Izvo ndezvekuita kwekuita sekunyadzisa kuti FDA ikozvino inoda kuti vese vatsva vanorwara nehutachiona hwemishonga yehutachiona varatidze kuti mishonga yavo mitsva haingazoipisidzi nengozi yemwoyo uye zvirwere zvevascular.
Mishonga Mitsva inogona Kuvandudza Chirwere Cheshuga uye Kurwara Kwemweya Akafanana Here?
Imakore gumi apfuura yakaona zvikamu zvitsva zvese zvemishonga inobvumirwa kutarisa chirwere cheshuga. Mienzaniso mishomanana ndeyi:
- GLP-1 Agonist inowedzera insulini yakasunungurwa ne pancreas
- DPP-4 Inhibitors inowedzera chiito che GLP-1 uye naizvozvo nenzira isiri iyo inotungamirira kune zvakafanana nepamusoro
- SGLT-2 Inhibitor inodzivisa glucose (shuga) kudzoka zvakare muinso. Iyi mishonga ndiyo yekukurukurirana kwangu munyaya ino
Ko DD SGLT-2 Inhibitor Inobata Sei Iroyi?
SGLT inomirira sodium-glucose cotransporter.
Kuti rive nemashoko akajeka, iprotini inobatanidzwa mukutakura zvinhu zviviri zvezvinhu mukati meevo, kubva mumuginho kusvika muropa. Imwe yeiyo sodium, uye imwe iyo glucose iyo inoshandiswa "piggybacks" pane zvekutakura kwe sodium. Nhamba ye "2" inoreva rudzi rwepuroteni inowanika muitsvo dzekushambadzira, imwe chikamu chinonzi "proximal tubule." Ikoko kunewo SGLT-1 asi iyo inotarisira chete chikamu chiduku chekutakura uku).
Mamiriro ezvinhu mu molecular biology inobatsira kunzwisisa kuti nei endocrinology uye nephrology yose iri kuenda gaga pamusoro pemishonga iyi mitsva, SGLT-2 inhibitors.
Iye zvino zvatinoziva kuti chii chinoitwa neSGLT-2, zvingava nyore nyore kunzwisisa chii chaizoitika kana iwe "uchidzivisa" chiito cheproteni iyi . Iso haizogoni kukwanisa kuisa glucose yakanga yatotonyorwa mumuginhi (ndiyo iyo inowanzoita), uye inonyanya kuisa kuti shuga / glucose kunze kwose kuenda muimba yega . Icho chinoreva kuderedza glucose kuchengetwa muropa rako, uye zvichida kutarisa chirwere cheshuga.
Mishonga inokurukurwa munyaya ino chimwe chinhu chinonzi empagliflozin (Jardiance), iSGLT-2 inhibitor inobvumirwa naDDA mukurapa rudzi rwechipiri chirwere cheshuga. Kunyange zvazvo vamwe vezvechirwere cheshuga mutsva vave vachiendeswa nekushambadzira kwakaderera kunorumbidza kubatsirwa kwavo, miedzo yakawanda yakakundikana kuratidzira panjodzi yakaderera yematambudziko emakiriniki akaoma (kufanana nekuvandudzwa kwepfungwa yepfungwa kana chirwere chepachikwere) nemishonga iyi mitsva, zvichienzaniswa nemishonga yemagariro yekudzivirira chirwere cheshuga. Nokuda kwekuchinja, zvakadaro, apo mishonga mutsva inonyatsoratidza chivimbiso chakasimba chokuderedza mwoyo yekurwisa, kurohwa, kana kuti kusaputsika kwepvo, inofanira kunge iri pakati pekucherechedza.
Kurapa Kwechirwere Chechirwere Chirwere Chirwere
Zvinosuruvarisa, kwemakumi maviri emakore apfuura, hatina kuita chero chinhu chipi zvacho chakakosha pakuvandudza kurapwa kwevarwere vane chirwere cheshuga chepfungwa. Mazuva ano maitiro ekurapa anonyanya kushandiswa pamigiramuro yakadai sekudzora ropa, kana kuderedza mapuroteni kurasika mumuguta (uchishandisa mishonga inonzi ACE-inhibitors kana angiotensin receptor blockers). Isu tinokwanisa kubatanidza kupindira uku pamwe nedzimwe zvinangwa, sekuwedzera kwemazinga earkali muropa, chirwere chinorwara cheshuga, nekuderedza uric acid mazinga. Zvisinei, mumatambudziko akawanda izvi zvinogona kunge zvisingakwanisi kuti zvive nechinopesana zvakanakira kune mikana yemurwere anokonzera kusagadzikana kwepso.
Zvingaita Here Kuti Zviratidzo Zvishamiso Zvirwere Zvechirwere Cheshuga Nefropathy?
Pane zvikonzero zvekutenda kuti empagliflozin inogona kuputsa kukanganiswa kwe "inerpeutic inertia" yemakore makumi maviri ekupedzisira. Empagliflozin kutanga kupararira pane chirwere cheshuga chekuisa chirwere cheshuga kunopera 2015 apo migumisiro yeiyo inonzi EMPA-REG yakaedzwa yakaratidza kuti yakabatsira zvikuru kuderedza moyo yevashuga kufa, kusagadzikana kwemwoyo, uye kurohwa. Zvigumisiro zvakazobudiswa gare gare muNew England Journal of Medicine.
Chidzidzo chacho chaive chiedza chikuru chinosanganisira vanopfuura 7000 vane chirwere cheshuga munyika 42 mune dzimwe nzvimbo. Zvakakosha kucherechedza kuti vanopfuura makumi mapfumbamwe nezana kubva muzana vevatori vechikamu vakanga vatotanga kurapwa kwakakwana kwechirwere cheshuga chepfungwa (uye pamusoro pe80 muzana iri paACE inhibitors kana angiotensin receptor blockers). Inenge vose varwere vakanga vari pangozi yepamusoro yehutano hwepfungwa. Ukuru hwekuedzwa kwaive chimwe chezvinhu zvakasimbisa kuvimbika kune zvarinosarudza.
Zvichipa migumisiro ino inokurudzira, kutsvakurudza kwakawedzerwa kwemigumisiro yepagliflozin pachiyero chekukura nekuwedzerwa kwezvirwere zvepfungwa zvakaitwa. Izvi zvakaita kuti nyaya yechipiri ibudiswe muna June 2016, iyo inotarisa pane izvo zvinodhaka zvinoshandiswa kuitsvo. Kunyanya, kuongororwa kwakatarisa kuwedzera kwekuwedzerwa kwepimpumu basa (mune varwere vese kwete pamushonga). Izvi zvakaitwa kuburikidza nekuyera kukura kwe creatinine level kana kuti mapuroteni kurasika mumuguta. Zvigumisiro zvekupedzisira zvinoratidza kuti chirwere cheshuga cheshuga chirwere chakakonzerwa nehutano hwehutano, uye ndiani anotora empagliflozin (akawedzerwa ku "kutarisirwa kwepamusoro") angangodaro achiona kunonoka kunonoka kudarika muhupano basa kupfuura avo vasingaiti. Varwere vachitora iyi med uyewo vaiva nehuwandu hwehuga hwekugadzirisa shuga, pamwe nekuderera kwemuropa, chiuno chakasvibirira, uremu, uye uric acid mazinga.
Migumisiro yakaipa uye isina kupindurwa Mibvunzo
Chero nguva apo mushonga unonzi "mutambo unoshandura", kazhinji kacho pfungwa yakanaka kudzokera shure uye kutarisa nehutano hwakanaka hwekusava nechokwadi kwesayenzi. Bvunza mibvunzo pamusoro pekushanda kwayo, zvichida? Heano mimwe mibvunzo inenge ichiri kudikanwa kuti ipindurwe nenzira yakarurama panguva ino:
- Pane chimwe chinhu chaicho chakasiyana nezvepagliflozin? Tingaona zvikomborero zvakafanana kubva kune mamwe madhiragi ayo ari ekirasi imwechete yemishonga (SGLT-2 Inhibitors, eg canagliflozin, dapagliflozin)?
- Ndizvo zvinonzi zvikomborero chaizvoizvo zvakaguma nekuderera kweropa kana kuyerwa, izvo zvakaonekwa kune varwere vakatora empagliflozin?
- Kunogona here kutarisa kusanganiswa kwemashuga eropa kunotsanangura hukuru hweempagliflozin?
Nyaya dziri pamusoro apa dzinomutsa tsvina yepamusoro-pikiso uye hype. Ko kana tikakwanisa kupfura shuga yeropa iri nani / kudzvinyirira kwekutonga kushandisa kushandisa mishonga uye mararamiro emararamiro (funga chimwe chinhu chakafanana ne metformin + lisinopril + kudya / kurovedza muviri) ? Izvozvo zvingatipa bhudzi rakafanana kune buck, zvichida pane mari yakaderera? Iyi mibvunzo nemimwe inenge iri nyaya yekutsvakurudza kwemakore anotevera.
Pakupedzisira, ramba uchifunga nezvemagliflozin migumisiro yakaipa yakataurwa mukutongwa, mamwe acho aiva:
- Zvirwere zvirwere
- Urosepsis
- Kunyange zvazvo kuedza kwepagliflozin kusina kureva izvi, FDA ichangobva kupa nyevero pamusoro pengozi yekutsva kwepvo kubva kune "vakoma" vavo (canagliflozin, dapagliflozin)
Mharidzo Yotora-Musha kune Murwere
- Migumisiro yezviedzo zviviri izvi, (pamigumisiro yezvagliflozin pangozi yemwoyo, vascula, uye zvirwere zvepfungwa) yakabudiswa mukati memakore mashomanana pasina mubvunzo zvinoshamisa asi zvichida inoda kuzoratidzwa mune ramangwana.
- Zvidzidzo zvinoratidza kuti empagliflozin inogona kuderedza njodzi yekurwadziwa kwepfungwa, kurohwa, uye rufu paunowedzera kune chirwere cheshuga chechirwere chevanhu vane chirwere cheshuga chechirwere cheshuga avo vari pangozi yehutano hwehutano.
- Empagliflozin inogona kupedzisira ichidzikisa nguva inowanzodzivirirwa yehupenzi inowanikwa muhutachiona hwehutachiona hwakanyanya. Isu hatichizive zvizere kana izvi zvichikonzerwa nekudzivirirwa kwepfungwa pamusoro pemafuta pamusoro peglycemic (shuga yeropa).
- Kana zvakaguma zvave zvichiratidzwa mune mamwe mimwe miedzo, kwekutanga kokutanga, tinokwanisa kukwanisa kutora matanho emagetsi anowanzoshandiswa kurapwa chirwere cheshuga chetsvo (sekuda kweropa uye shuga yekudzivirira). Izvi zvinogona kupa vashandi chimwe chinhu chinogona kuderedza mukana wekuti vapedze dialysis.
Tariro, izvi zviitiko zvitsva / kubudirira hakusi nyaya ye "mutangi wekutanga", sezvakave zvakadaro nedzimwe mishonga yehutachiona hwetsva hwepabhesi munguva yakapfuura (Bardoxolone inowanikwa munharaunda). Sezvo miedzo miviri ichibudiswa, ndakaona nhamba inonyadzisa yezvisingabatsiri zvinyorwa muzvinyorwa zvisiri pamiganhu ye hyperbole. Chirevo kubva muhurukuro yakabudiswa muNew England Journal of Medicine (iyo magazini chaiyo apo zvidzidzo zvepakutanga zvakadhindwa) zvinodzidzisa chinangwa chezvatinoziva kusvika zvino:
... "isu takasiiwa nekusiyana kunoonekwa kuchikurudzira, asi haisi" kumhanya kumusha "maererano nehutungamiri hwehuga hwehuga.makore anotevera, kutonga uye kuenzanisa miedzo inoshandiswa zvakafanana nekubatanidza vashandi vatsva vane vakuru vanogona kubatsira shandisa zvirongwa zvekurapa kwemamiriyoni evanhu vane hupenyu hwehutachiona hwechirwere cheshuga ".
> Sources:
> Empagliflozin uye Kuwedzera kwezvirwere zvepoyi muTsika 2 Chirwere cheshuga .Aanner C, et al; EMPA-REG OUTCOME Investigators. N Engl J Med. 2016 Jun 14
> Empagliflozin, Matambudziko emwoyo, uye Kufa muChirwere chechirwere cheshuga. Zinman B, et al; EMPA-REG OUTCOME Investigators.N Engl J Med.2015 Nov 26