Proton pump inhibitors zvingave yakabatana nehosha yepfungwa
Munguva pfupi yapfuura, zvakanyanya kufungidzirwa zvakatorwa nemushumo anozivikanwa kumigumisiro yekudzidza yakabudiswa mu Journal of the American Society of Nephrology inotaura nezvekugona kuwirirana pakati pekushandisa mishonga, inonzi "proton pump inhibitors," uye chirwere chepfungwa. Proton pump inhibitors (PPIs) inowanzoshandisa zvinodhaka, uye zvimwe zvinoitika kuti zviwanikwe pamusoro pe-the-counter-ungangodaro wakanzwa nezvezita rakadai sa Prilosec, kana Nexium, kana Prevacid.
Proton pump inhibitors vave varipo kubvira kuma1980 apo ivo vakatanga kutanga, uye omeprazole kuva imwe yekutanga kuiswa mumusika muna 1989.
PPIs inoshanda kuburikidza nekuderedza kushandiswa kweAic acid mudumbu. Hongu, dumbu redu rine asidi, kunyanya chimwe chinhu chinonzi "hydrochloric acid," iyo ine basa rinokosha pakugadzirisa. Izvozvo zvakanyanya asidi, kana kuti asidi munzvimbo isina kururama (funga zvokudya zvako pombi, sophagus, pane dumbu), uye iwe unotanga kupinda mumatambudziko. Nokudaro, maPPIs anoshandiswa pakurapa zvirwere zvinowanzofanana negastroesophageal reflux chirwere (GERD), gastric ulcers, kupisa mwoyo, uye sarudzo yaBarrett. Saka, hazvishamisi kuti PPIs ndeimwe yemishonga yakashandiswa zvikuru, uye omeprazole iri kuWMS (World Health Organization) Essential Medication List .
Zvinosuruvarisa, chikamu chakakura chevarwere vanoshandisa mishonga iyi zvisina kunaka (kuratidza kusina kunaka / murosi / kureba).
Saka zvinonzwisisika zvino, kana kirasi yakakurumbira yemishonga inonzi iine ushamwari nehosha ( chirwere chisingaperi chisinganzwisisiki , munyaya ino), chinofanira kusimudza nheyo, kunyange kana ngozi iri duku.
Proton pump inhibitors vakagara vaine checkered nhoroondo kusvika kuneiyo yepfungwa basa.
Zvichipa huwandu hwakanaka hwekuchengetedzwa kwemishonga iyi, zvinogona kuitika pamakumbo hazvina kunyanya kusimbiswa. Zvisinei, seminetsere yeutsvo , munyika ye nephrology, izvi zvave nguva dzose iri chikamu chekudzidzisa kwakakwana kwemakumi mashoma mashoma ikozvino.
Izvo zvinogona kuita proton pump inhibitors zvinokonzera kupisa kwehupenzi mukati mehvo, inonzi acute interstitial nephritis (AIN), yakaonekwa makore anenge 25 apfuura. Zvimwe zvinetso zvepimpano zvine chokuita neutsvo (electrolyte disorders) izvo zvakabatanidzwa neproton pump inhibitors zvakaderera magesizi uye mazinga ari pasi eropa muropa, pamwe chete nepamusoro ye calcium level.
Proton Pump Inhibitors Inokuvadzai Tsvete?
Acute interstitial nephritis, sezvataurwa pamusoro apa, ndeimwe yenzira dzakajairika iyo proton pump inhibitor mishonga (kufanana ne omeprazole / rabeprazole / pantoprazole, somuenzaniso) inogona kukanganisa maitiro epfungwa. Funga nezvazvo sechirwere chinogadziriswa chinogadziriswa nemishonga iyi , kunze kwekuti kushaya kwepfungwa kunenge kwasungwa kuitsvo saka iwe haugoni kuzvicherechedza.
Nenzira, proton pump inhibitors haisi yega mishonga inokonzera chirwere chinonzi nephritis. Muchidimbu, chero mishonga inogona kuzviita, asi maitiro ekirasi maiva nemishonga inorwisa mabhakitiriya, NSAIDs, allopurinol, furosemide, nezvimwewo.
Asi chii chinoita kuti nyaya yacho iwedzere kuoma kana iri kuuya kune proton pump inhibitors ndeyekuti iwe unogona kunge usingave neyechiGiriki zviratidzo kana zviratidzo izvo munhu angatarisira kuona mune zvinowanzoitwa mushonga-induced acute interstitial nephritis (aya ndeaya: fever, rash , nhamba yakakwirira yeimwe rudzi rwemasero eropa anonzi eosinophils, nezvimwewo).
Unogona Kuziva Sei PPI-Inofungidzirwa Nezvinyorwa Nephritis?
Mukusina kwezviratidzo kana zviratidzo zvinotendeseka, chiremba wako / nephrologist angaona kuwedzera kusina kutsanangurwa muropa rako creatinine leve l (iyo makemikari yakayerwa muropa kuti uongorore basa rako repso).
Zvechokwadi, ihwo ihwo hutsva hunogadziriswa husingaiti zvachose hunopedzana ne interstitial nephritis nekuda kweproton pump inhibitor. Nokudaro, kana pasina imwe tsanangudzo inowanikwa, nzira chete yekutsvaga kuti iyi inhengo ndeyeyiyi yepfungwa yehupi , iyo nzira inosanganisira kusunga tsono muinso rako kuti uwane chiduku chezvinyorwa zvekuongorora. Sezvaunogona kufungidzira, varwere vazhinji havazove vakanaka vatsva vekuita izvi, izvo mune mamwe mazwi zvinoreva kuti hatina nzira yakatendeka, isingasviki yekusimbisa PPI-yakabatana inonzi interstitial nephritis.
Saka, fungidzira mamiriro ezvinhu aya: Unotanga kutora chirongwa chePPI (kufanana ne omeprazole) nokuda kwechinhu chisina kujeka asiri reflux / chirwere chepfungwa. Sezvaunoramba uchitora mushonga, interstitial nephritis inokura muinso mushure mechinguva, kunze kwekuti iwe hauna kumira iyo iri kuitika. Iwe unogona kana kuti usati uwane kuongororwa kweropa, asi nenzira imwe neimwe vanachiremba vangave vasingateereri kuPPI sechinhu chinokonzera chinokonzera kuora kwepvo (kunyanya kana mushonga wauri kutora uri kupfuura-the-counter). Izvi zvinonyanya kuitika pane iwe ungangodaro wakashandisa PPI munguva yakapfuura, asi hausi kushandisa ikozvino, sezvo kushandiswa kwenguva refu kwenguva refu kunogona kutungamirira kukuvadzwa zvachose.
Mune mamwe mazwi, kana iwe ukapfuura pane imwe pfungwa mukukudziridza uye nekushanduka kwekati interstitial nephritis, yakaoma (nguva pfupi, kwenguva pfupi) kuputika kunogona kuchinja kuva kusingaperi (nguva refu, kusingaperi) kuputika nekuda kwechivara chemavara, kugadzira chimwe chinhu chinonzi chronic interstitial nephritis Izvi zvingazopedzisira zvichitungamirira kune chirwere chisingaperi chepfungwa uye mungozi mukuru wekufambira mberi kwe dialysis muchitsetse chevarwere.
Zvinoitwa naData
Kusvika ikozvino, tave nekudzidza kwekudzidzira imwechete kuunza mukana wekubatana pakati peproton pump inhibitor kushandiswa uye chirwere chepfungwa, ndicho chikonzero kuongorora kwechangobva kubudiswa mumutauro weAmerican Society of Nephrology muna April 2016 kwakakosha. Chinoita kuti chidzidzo chacho chive chakanyanya kukosha ndeyekuti yakaedza kupindura kuti sei proton pump inhibitor inenge isingagadziri kukura kwezvirwere zvepfungwa, asiwo kufambira mberi kwayo uye pakupedzisira kunonoka kupera chirwere chepfungwa.
Chidzidzo chacho chakashandisa dhipatimendi reDhipatimendi reVeteran Affairs kuti vatsvake vashandisi vatsva veproton pump inhibitors, (vanopfuura 170 000 vanhu) uye vakazvifananidza nevanoshandisa vatsva ve histamine H2 zvinopesana nevamwe (rimwewo boka rema meds rinoshandiswa kurapa dambudziko rekushaya dumbu reAidoma, vanenge 20 000 vanhu). Ava varwere vakabva vateverwa kwemakore mashanu uye basa ravo reimpso rakateverwa. Heano mhinduro yacho:
PPIs uye Kubudirira uye Kuwedzera kwezvirwere zvepoyi
Chidzidzo chacho chakawana kuti vanhu vakashandisa proton pump inhibitors, kana vachienzanisa nevaya vakashandisa histamine H2 blockers vaiva nehuwandu hwehutano (hazard ratio 1.22) yekuvandudzwa kwezvirwere zvepfungwa itsva, kunyange kana dzakatangwa nemafungiro akakwana zvakakwana (chirwere chepfungwa che iyi mamiriro ezvinhu aitsanangurwa seGFR pasi pe 60 ). Vaivewo vari pangozi yakakura yekupindira sarum creatinine level uye nekuderera kwepfungwa yepfungwa kusvika pakuguma kwepfungwa yepfungwa dzepfungwa. Ngozi inoratidzika kuenderera mberi kwenguva yakareba yekutsvaga proton pump inhibitors.
Nokudaro, chidzidzo ichi chinogumisa kuti kushandisa proton pump inhibitors kunogona kuwedzera njodzi yekuvandudzwa kwezvirwere zvepfungwa, pamwe nekukonzera kukurumidza kuderera kwepfungwa basa rekupedzisira-chirwere chepfungwa chepfungwa.
Inguva Yakadini Unoshandisa PPIs Unogona Kuita Kusiyana
Sezvakaitika pamigumisiro yekudzidza, zvinoratidzika sokuti hazvisi kungoshandiswa kwemishonga iyi, asiwo kwenguva yakareba yaunoshandisa sei icho icho chinhu chinokosha. Icho chidzidzo chaicho chakafananidza vanhu vakashandisa mishonga iyi kwemazuva mashoma makumi matatu nevanoshandisa vashandi venguva refu. Ikoko kwakaratidzika kuva nesangano rakabatanidzwa pakati penguva yekutsvaga uye pangozi yezvirwere zvepfungwa, uye izvi zvakakura kusvikira mazuva anenge 720 ekubudiswa kwemishonga iyi.
Izvo Izvi Zvose Zvinorevei Kwauri Somwoyo Murefu?
Migumisiro yezvinyorwa zvinotsanangurwa pamusoro apa, pamwe chete nedhenda yekare, inopa zvokudya zvekufunga. Ndinoda kusimbisa kuti iyi ndiyo chidzidzo chekucherechedza, iyo inotsanangurwa haigone kuratidza kukonzera. Pasinei nokuti zvakadaro, zvinoratidzika kuva neshamwari pakati pePPI nekushandiswa kwepfungwa, iyo inofanirwa kutarisirwa. Nhoroondo yacho inofananawo nekutarisa kwekutanga.
Zvinokwanisika kuti vanhu vazhinji vevarwere vachishandisa proton pump inhibitors vangave vasina kuongororwa nepistiti inonzi nephritis kutanga, iyo inoguma ichienda kune isingarapiki nephritis uye saka isingaperi zvirwere zvepfungwa. Zvichipa zvinetso zvakabatanidzwa mukugadzirisa kuongororwa kwepakatikati nephritis (zvikurukuru neproton pump inhibitors, sezvinotsanangurwa pamusoro apa), vazhinji varwere kunze uko vangave vasingazivi kuti vari kukuvadzai itsvo dzavo nemishonga iyi.
Handidi kurira mheremhere pano, asi zvisinei kuti zvingangova zvipingamupinyi zvakadini, kungoziva kuti mishonga iyi inotorwa nemamiriyoni evarwere, dzimwe nguva zvisina kunaka uye kazhinji pane-the-counter pasina ruzivo rwechiremba, inoita ichi chinhu chikuru.
Ndinokukurudzira kuti ukurukure zvinotevera nechiremba wako ikozvino kuti iwe unoziva nezvekugona kwehukama pakati pePPIs uye chirwere chepfungwa:
- Iva nechokwadi kuti vanachiremba vako vanoziva kuti iwe unotora proton pump inhibitors, kunyanya kana uri kutora iwo pamusoro pekambani
- Kumbira chiremba wako kana ukashandura kune H2 receptor blocker (kufanana famotidine, kana Pepcid, nezvimwewo) inogona kunge yakachengeteka
- Tarisa kuti iwe uri kutora PPI nenzira yakakodzera. Isu tatove nedzimwe ruzivo rwekliniki inoratidza kuti proton pump inhibitors inowanzomirirwa zvisina kunaka pasina chiratidzo chakakwana.
- Iwe unoda zvakare kutarisa kana iwe uchida kutora mishonga iyi nguva dzose, kana kuti pane imwechete sezvinoda rubatsiro (semigumisiro yekudzidza pamusoro apa inotiudza, nguva yekutsvaga chinhu chinokosha pakusarudza ngozi yezvirwere zvepfungwa)
- Kana iwe uchifanira kutora proton pump inhibitor, iva nechokwadi chekuti basa rako repimpure riri kuongororwa kana iwe chiremba wako wekutanga kana kuti nephrologist . Ndinokurudzira zvikuru izvi kune varwere vane zvimwe zvinokonzerwa nehutachiona (sechirwere cheshuga, hypertension, chirwere chemwoyo, kuneta, kana avo vanoshandisa NSAID zvisingaperi, nezvimwewo).
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