Proton pump inhibitors amatha kugwirizana ndi matenda a impso
Posachedwapa, anthu ambiri atulutsa chidwi pa zotsatira za kafukufuku amene anafalitsidwa mu Journal of the American Society of Nephrology posonyeza kugwirizana komwe kulipo pakati pa kugwiritsa ntchito mankhwala, otchedwa "proton pump inhibitors," ndi matenda a impso. Proton pump inhibitors (PPIs) ndi mankhwala osokoneza bongo, ndipo zina zimapezeka kupezeka pamtanda-mwina mumamva mayina monga Prilosec, kapena Nexium, kapena Prevacid.
Proton pump inhibitors akhala akuyambira kuyambira m'ma 1980 pamene iwo anayamba kukonzedwa, ndi omeprazole kukhala imodzi mwa yoyamba kuyambitsidwa pamsika mu 1989.
Mapulogalamu a PPI amagwira ntchito pochepetsa kuchepa kwa asidi m'mimba. Inde, m'mimba mwathu muli asidi, makamaka chinthu chotchedwa "hydrochloric acid," chomwe chili ndi gawo lofunika kwambiri mu chimbudzi. Kuchuluka kwa asidi, kapena asidi m'malo olakwika (ganizirani chakudya chanu, chitofu, m'malo mmimba), ndipo mumayamba kukhala ndi mavuto. Choncho, ma PPI amagwiritsidwa ntchito pofuna kuthana ndi matenda omwe ali nawo monga matenda a reflux a gastroesophageal (GERD), zilonda za m'mimba, kupweteka kwa mtima, ndi chiwonetsero cha Barrett. Nzosadabwitsa kuti PPI ndi imodzi mwa mankhwala ogwiritsidwa ntchito kwambiri, ndi omeprazole pokhala pa WHO (World Health Organisation) Mndandanda wa Ma ARV Ofunika .
Mwatsoka, odwala ambiri amagwiritsira ntchito mankhwalawa mosayenera (chiwonetsero cholakwika / mlingo / nthawi yaitali).
Ndizomveka kuti, ngati mankhwala ambiri amadziwika kuti ali ndi matenda ( matenda aakulu a impso , panopa), ayenera kukweza ziso, ngakhale kuti chiopsezo chili chochepa.
Proton pump inhibitors nthawi zonse akhala ndi mbiri yakale monga momwe ntchito ya impso ikuyendera.
Chifukwa cha ubwino wodzitetezera wa mankhwalawa, zotsatira zowopsa pa impso sizinawonetsedwe makamaka. Komabe, monga dokotala wa impso , mu dziko la nephrology, izi zakhala nthawi zonse ziphunzitso zofunikira kwa zaka makumi angapo tsopano.
Mphamvu za proton pump inhibitors zimayambitsa kupweteka kwa impso, yotchedwa acute interstitial nephritis (AIN), inadziwika pafupifupi zaka 25 zapitazo. Matenda ena omwe ali ndi impso (electrolyte disorders) omwe agwiritsidwa ntchito ndi proton pump inhibitors ndi otsika kwambiri a magnesium ndi ma sodium otsika m'magazi, komanso mchere wa calcium.
Kodi Mavitamini a Proton Amapweteka Bwanji Impso?
Nthendayi yamakono, monga tafotokozera pamwambapa, ndi imodzi mwa njira zomwe anthu ambiri amagwiritsira ntchito mankhwala a proton pump inhibitor (monga omeprazole / rabeprazole / pantoprazole). Ganizirani za mankhwalawa, ngati mankhwalawa asagwiritsidwe ntchito ndi mankhwalawa , kupatula kuti zovuta zimakhala pamphongo.
Mwa njira, proton pump inhibitors si mankhwala okha omwe amachititsa kuti thupi likhale lopweteka kwambiri. Momwemo, mankhwala alionse angakhoze kuchita, koma zoyamba zapachiyambi ndi mankhwala opha tizilombo, NSAIDs, allopurinol, furosemide, ndi zina zotero.
Koma chomwe chimapangitsa kuti vutoli likhale lovuta kwambiri ponena za proton pump inhibitors ndi chakuti mwina simungakhale ndi zizindikiro zachikale zomwe munthu angayembekezere kuziwona mu mankhwala omwe amachititsa mankhwala osokoneza bongo aphatiki (awa ndi: malungo, kuthamanga , mlingo wokwera wa maselo a magazi omwe amatchedwa eosinophils, ndi zina zotero).
Kodi Mungadziwe Bwanji Pulogalamu ya PPI-Yopeka Kwambiri ya Nephritis?
Ngati mulibe zizindikiro zodalirika, dokotala wanu / katswiri wazinthu akhoza kuona kuwonjezereka kwapadera kwa magazi anu creatinine leve l (mankhwala omwe amayeza mu magazi kuti ayese ntchito ya impso zanu).
Zoonadi, izi ndizopeza zowonjezera kwambiri zomwe sizikugwirizana ndi interstitial nephritis chifukwa cha proton pump inhibitor. Choncho, ngati palibe tsatanetsatane yowonjezera, njira yokhayo yodziwira kuti izi ndizopangitsa kuti tizitha kufufuza. Monga momwe mungaganizire, odwala ambiri sangakhale abwino mafanizidwe a njirayi, zomwe zikutanthauza kuti tilibe njira yodalirika, yosavomerezeka yotsimikiziranso za PPI zokhudzana ndi matenda a nephritis.
Choncho, taganizirani izi: Mukuyamba kumwa mankhwala a PPI (monga omeprazole) kuti mukhale ndi mankhwala osakanikirana omwe amatsutsa. Pamene mukupitiriza kumwa mankhwala, mphulupiti imayamba mu impso patapita nthawi, kupatula kuti simukudziwa kuti zikuchitika. Mukhoza kapena musayambe kuyesedwa magazi, koma mwina madokotala ambiri sangamvere PPI monga momwe zingayambitsire matenda a impso (makamaka ngati mankhwala omwe mukuwatengawa ndi oposa). Izi ndi zoona makamaka kumene mungagwiritse ntchito PPI m'mbuyomu, koma panopa simukugwiritsa ntchito imodzi, popeza ntchito yanthaŵi yayitali ingayambitse kuwonongeka kwamuyaya.
Mwa kuyankhula kwina, mutapitapo patsogolo pa chitukuko ndi kusinthika kwa interstitial nephritis, kutupa kochepa (kanthawi kochepa, kanthawi kochepa) kutupa kungasinthe kukhala nthawi yaitali (yotalika, yosatha) kutupa chifukwa cha minofu yofiira, kupanga chinthu chotchedwa chronic interstitial nephritis. Izi zikhoza kutsitsa matenda aakulu a impso ndi chiopsezo chachikulu cha kupita patsogolo kwa dialysis mu gawo la odwala.
Zimene Deta Zimatiuza
Pakalipano, taphunzira mobwerezabwereza kuti pakhale mgwirizano pakati pa proton pump inhibitor ndikugwiritsa ntchito matenda a impso, chifukwa chake kufufuza kwaposachedwa kumene kunafalitsidwa mu Journal of American Society of Nephrology mu April 2016 ndi kofunikira. Chomwe chimapangitsa phunzirolo kukhala lofunika kwambiri ndi chakuti linayesa kuyankha momwe proton pump inhibitors sichidzakhudzira osati chitukuko cha matenda a impso, komanso kuti chiwongolero chake chidzatsikira ku matenda a impso.
Phunzirolo linagwiritsira ntchito Dipatimenti ya Veteran Affairs kuti ipeze atsopano a proton pump inhibitors, (anthu opitirira 170,000) ndipo amawayerekezera ndi atsopano omwe amagwiritsa ntchito histamine H2 antchito (omwe amagwiritsa ntchito mankhwala ochizira matenda a m'mimba, pafupifupi 20,000 anthu). Odwalawa amatsatiridwa kwa zaka zisanu ndipo ntchito yawo ya impso ikuwonekera. Nazi zotsatira:
Ma PPI ndi Kukula ndi Kukula kwa Matenda a Impso
Kafukufukuyu anapeza kuti anthu omwe amagwiritsa ntchito proton pump inhibitors, poyerekeza ndi omwe amagwiritsa ntchito histamine H2 blockers anali ndi chiopsezo chachikulu (chiwopsezo chiwerengero 1.22) cha chitukuko cha matenda atsopano, ngakhale atayamba ndi impso zangwiro (matenda a impso kwa izi zinafotokozedwa ngati GFR zosakwana 60 ). Amakhalanso ndi chiopsezo chochulukitsa kawiri kawiri serum creatinine komanso kuchepa kwa impso kumapeto kwa matenda a impso. Ngoziyi imawoneka ngati ikupita nthawi yaitali yowonekera kwa proton pump inhibitors.
Choncho, phunziroli limatsimikizira kuti kugwiritsa ntchito proton pump inhibitors kungapangitse chiopsezo cha chitukuko cha matenda a impso, komanso kumayambitsa matenda a impso mofulumira kwa matenda a impso otsiriza.
Momwe Mungagwiritsire Ntchito Mapulogalamu a PPI Kwambiri Mungapange Kusiyana Kwambiri
Malingana ndi zotsatira za phunziroli, zikuwoneka ngati sizongogwiritsira ntchito mankhwalawa, komanso kuti muwagwiritsa ntchito nthawi yayitali bwanji. Kafukufukuyu anafanizira anthu omwe amagwiritsira ntchito mankhwalawa kwa masiku osachepera 30 kutsutsana ndi ogwiritsa ntchito nthawi yayitali. Zinaoneka ngati pali mgwirizano pakati pa nthawi ya kutsekula komanso chiwopsezo cha matenda a impso, ndipo izi zinapitirira mpaka masiku 720 kuchokera ku mankhwalawa.
Kodi Zonsezi Zimakukhudzani Bwanji Ngati Woleza Mtima?
Zotsatira za momwe tafotokozera pamwambapa, komanso deta yapadela, zimapereka chakudya cha kuganiza. Ndikufuna kutsindika kuti izi ndi phunziro lophunzirira, lomwe mwakutanthawuza sikungathe kutsimikizira kuti ndiyomwe. Ngakhale zili choncho, zikuwoneka kuti pali mgwirizano pakati pa PPI ndi matenda a impso, omwe amafunikira chidwi. Detayi ikugwirizananso ndi zomwe zisanachitike.
N'zotheka kuti odwala ambiri amagwiritsira ntchito proton pump inhibitors angayambe kukhala ndi matenda osokoneza ubongo a nephritis, omwe pamapeto pake amayamba kukhala odwala matenda a nephritis komanso matenda aakulu a impso. Chifukwa cha mavuto omwe amachititsa kuti azindikire bwino za interstitial nephritis (makamaka ndi proton pump inhibitors, monga tafotokozera pamwambapa), odwala ambiri kumeneko sadziwa ngakhale kuti akupweteka impso zawo ndi mankhwalawa.
Sindikufuna kumveketsa apa, koma ziribe kanthu kuti zingakhale zochepa bwanji, chifukwa chakuti mankhwalawa amatengedwa ndi odwala mamiliyoni ambiri, nthawi zina moyenera komanso mobwerezabwereza popanda chidziwitso cha dokotala, ichi chachikulu.
Ndikukulimbikitsani kuti mukambirane zazotsatira ndi adokotala tsopano kuti mukudziwa kuti mungathe kugwirizana pakati pa PPIs ndi matenda a impso:
- Onetsetsani kuti madokotala akudziwa kuti mumatenga proton pump inhibitors, makamaka ngati mukuwatenga pa pepala
- Funsani dokotala wanu ngati akusintha kupita ku H2 receptor blocker (monga famotidine, kapena Pepcid, etc.) angakhale njira yabwino
- Onetsetsani kuti mutenga PPI kuti mukhale ndi chisonyezo choyenera. Tili ndi ma data ena omwe amasonyeza kuti proton pump inhibitors nthawi zambiri amalembedwa mosayenera popanda chizindikiro chokwanira.
- Mufunanso kufufuza ngati mukufunikira kutenga mankhwalawa nthawi zonse, kapena pokhapokha ngati mukufunikira (monga zotsatira za phunziroli zikutiuza, nthawi yowonekera ndi chinthu chofunika kwambiri chodziwitsa chiopsezo cha matenda a impso)
- Ngati mukufuna kutenga proton pump inhibitor, onetsetsani kuti ntchito yanu ya impso ikuyang'aniridwa ndi dokotala wanu wamkulu kapena ndi nephrologist . Ndikanalimbikitsa kwambiri izi kwa odwala omwe ali ndi zifukwa zina zoopsa za matenda a impso (monga matenda a shuga, matenda oopsa, matenda a mtima, kunenepa kwambiri, kapena omwe amagwiritsa ntchito NSAID mosalekeza, ndi zina).
Zotsatira:
Al-Aly Z, Xie Y, Bowe B, Li T, Xian H, Balasubramanian S. Proton Pump Ziwalo zoopsa ndi Kuopsa kwa CKD Yachilengedwe ndi Kupititsa patsogolo kwa ESRD. Journal ya American Society of Nephrology . 2016; lembani: 10.1681 / ASN.2015121377.
Brewster UC, Perazella MA. Proton pump inhibitors ndi impso: ndemanga yofunikira. Clinical Nephrology . 2007; 68 (2): 65-72.
Florentin M, Elisaf MS. Proton pump inhibitor-inachititsa hypomagnesemia: Vuto latsopano. World Journal of Nephrology . 2012; do: 10.5527 / wjn.v1.i6.151.
Ruffenach SJ, Siskind MS, Liwu YH H. Mphati zovuta zapadera chifukwa cha omeprazole. The American Journal of Medicine . 1992; do: http://dx.doi.org/10.1016/0002-9343(92)90181-A.
Wall CAM, Gaffney EF, Mellotte GJ. Matenda a hypercalcaemia ndi acphisisitis ophatikizapo omeprazole mankhwala. Nephrology Dialysis Transplantation . 2000; 15 (9): 1450-1452.