Zogwirizana ndi matenda a shuga a Impso

Kodi Empagliflozin omwe akudwala matenda a shuga ndi matenda a impso anali kuyembekezera

Pankhani yokhudza matenda a shuga ndi kuchepetsa chiopsezo cha impso kulephera (kufunikira dialysis kapena kupatsirana kwa impso ), sikuli tsiku lomwe timamva za mankhwala omwe amavomereza mawu monga "Holy Grail," "Kusintha kwa masewera", " kupambana " , ndi zina zotero. Chabwino, tikhoza kukhala pa nthawi yosavuta ya mankhwala pamene mankhwala akuwonetsa zotsatira zomwe zimalonjeza zokwanira kuti zivomereze malemba awo.

Pali mankhwala oletsa matenda a shuga, chinachake chotchedwa empagliflozin (chomwe chimadziwika ndi dzina lake, Jardiance). Komabe, kuti mumvetsetse zomwe mphamvu zapadera zimathandiza popewera impso, ndizofunikira kudziwa pang'ono.

Chifukwa Chakugwidwa Ndi Shuga N'kovulaza Kwambiri Impso

Matenda a shuga ndi manja omwe amayamba chifukwa cha matenda a impso ndi impso m'mayiko ambiri otukuka. Kufalikira kwake kumapitirizabe kukula pamene zochitika zake zikupitirizabe kuwonetsa vuto lachipatala. Ndi matenda amtendere, osavuta kunyalanyaza mpaka wodwalayo akuyamba kukhala ndi mavuto.

Impso sizinthu zokha zomwe zawonongeka ndi matendawa. Popeza matenda a shuga amawononga mitsempha ya magazi, mwachidziwitso, lirilonse limasewera. Malingana ndi kukula kwa mitsempha ya magazi, matenda a mitsempha ya magazi omwe amachititsidwa ndi matenda a shuga akhala akugawanika kukhala microvascular (mwachitsanzo.

matenda opatsirana ndi matenda a shuga, matenda a impso kapena matenda a shuga, etc.), komanso matenda aakulu a mtima (monga matenda a mtima omwe amachititsa ngozi kuwonjezeka kwa mtima, matenda osokoneza bongo m'mitsempha ya mitsempha ya ubongo amawonjezera chiopsezo cha kupwetekedwa, etc.).

Chifukwa cha zomwe tatchulazi, ndizomveka kuti nthawi iliyonse yomwe ntchito ikuyendetsedwa ndi matenda a shuga, dziko limayang'anitsitsa.

Madokotala ndi odwala akuyembekezera uthenga wabwino ndi mpweya wabwino. Kodi mankhwala atsopano amachepetsa chiopsezo cha imfa yokhudzana ndi shuga? Nanga bwanji za matenda a mtima kapena stroke? Mwinamwake kuchepetsa chiopsezo cha matenda a shuga kulephera?

Kapena, monga momwe ziliri nthawi zambiri , zingakhale zomvetsa chisoni kuti kumene kuli bwino matenda a shuga sikumasulira zotsatira zabwino zachipatala kwa odwala? Ndipotu, pakhala pali maphunziro omwe amafotokoza za chiopsezo chachikulu cha imfa / matenda ndi mankhwala enaake a shuga. Chifukwa cha izi zikuoneka ngati zovuta kuti FDA ifunike kuti anthu onse opanga mankhwala odwala matenda a shuga akuwonetsetse kuti mankhwala awo atsopano sadzapweteka kwambiri mtima ndi matenda opatsirana.

Kodi mankhwala atsopano angathandize bwanji matenda a shuga ndi Matenda Okhudzana ndi Impso?

Zaka khumi zapitazi zakhala zikuchitika mndandanda watsopano wa mankhwala ovomerezedwa kuti athetse matenda a shuga. Zitsanzo zochepa ndi izi:

• GLP-1 Agonists amachulukitsa insulini kumasulidwa ndi ziphuphu
• DPP-4 Zizindikiro zimayambitsanso ntchito ya GLP-1 ndipo motero mwachindunji zimatsogolera zomwezo pamwambapa
• Magulu a SGLT-2 amaletsa shuga (shuga) kubwezeretsanso mu impso. Mankhwala awa ndilo cholinga cha zokambirana zanga m'nkhaniyi

Kodi DD SGLT-2 Inhibitors Zimakhudza Bwanji Impso?

SGLT imayimira sodium-shuga cotransporter.

Pofotokoza mwachidule, ndi mapuloteni okhudzana ndi kutumiza mitundu iwiri ya zinthu mkati mwa impso, kuchokera mkodzo kupita ku magazi. Mmodzi wa iwo ndi sodium, ndipo winayo ndi shuga yomwe imakhala "nkhumba" pa kayendedwe ka sodium. Chiwerengero cha "2" chikutanthauza mitundu yeniyeni ya mapuloteni omwe amapezeka mu impso zowonongeka, gawo lotchedwa "kupitilira tubula." Palinso SGLT-1 koma ili ndi gawo laling'ono chabe la zoyendetsa izi).

Zomwe zimachitika mu biology zamoyo zimathandiza kumvetsetsa chifukwa chake chilengedwe chokhala ndi matenda osokoneza bongo ndi za nephrology chimachitika chifukwa cha mankhwala atsopanowa, SGLT-2 inhibitors.

Tsopano popeza tikudziwa udindo wa SGLT-2, zingakhale zophweka kumvetsetsa zomwe zikanati zidzachitike ngati mutati muletse "mapuloteni" . Impso sizikanatha kuyamwa shuga yomwe idasindikizidwa kale mu mkodzo (zomwe ndizo zimachita), ndipo makamaka pee yomwe shuga / shuga amalowa m'nyumbamo . Chimene chimatanthauza kuchepa kwa shuga kosungidwa m'magazi anu, ndipo mwinamwake mukudwala matenda a shuga.

Mankhwala omwe tatchulidwa m'nkhani ino ndi chinachake chotchedwa empagliflozin (Jardiance), omwe amagwiritsa ntchito SGLT-2 inhibitor omwe amavomereza ndi FDA kuti adziwe mtundu wa shuga. Ngakhale kuti mankhwala enaake atsopano a shuga akhala akutsatiridwa ndi malonda ochepa omwe akuyamika phindu lawo, mayesero ambiri alephera kuwonetsa chiopsezo chochepa cha zotsatira zovuta zamagetsi (monga kusintha kwa matenda a mtima kapena kuopsa kwa stroke) ndi mankhwala atsopanowa poyerekeza ndi mankhwala ochizira kwa matenda a shuga. Kusintha komabe, pamene mankhwala atsopano amasonyeza lonjezo lolimba lochepetsera mtima, matenda, kapena impso kusokonezeka, ndiye kuti ndizofunika kwambiri.

Kuchiza kwachibadwa kwa matenda a shuga a impso

Mwatsoka, kwa zaka makumi awiri zapitazo, sitinapangepo mbali yaikulu pakuchiritsa odwala matenda a shuga. Masiku ano mankhwala ochizira amachokera pazowonjezereka monga kulamulira magazi, kapena kuchepetsa mapuloteni otaya mu mkodzo (kugwiritsa ntchito mankhwala otchedwa ACE-inhibitors kapena angiotensin receptor blockers). Tikhoza kukangana ndi zofuna zina, monga kukula kwa magazi, matenda a shuga, komanso kuchepetsa uric acid. Komabe, nthawi zambiri machitidwewa sangakhale okwanira kuti apange kusiyana kwakukulu kwa mwayi wa wodwala amene akusowa matenda a impso.

Kodi Magalimoto Angakhale Chozizwitsa Chochiritsa Odwala Matenda a Nthendayi?

Pali zifukwa zokhulupirira kuti mphamvu zingathe kusokoneza zokhumudwitsa "inertia" zaka makumi awiri zapitazo. Epagliflozin yoyamba kugwidwa ndi matenda a shuga kumapeto kwa chaka cha 2015 pamene zotsatira za mayiko otchedwa EMPA-REG anawonetsa kuti zathandiza kwambiri kuchepetsa imfa, matenda osagwirizana ndi mtima, ndi zilonda. Zotsatirazo zinafalitsidwa kenako ku New England Journal of Medicine.

Phunzirolo palokha linali mayesero akuluakulu oposa 7000 odwala matenda a shuga m'mayiko 42 m'madera osiyanasiyana. Ndikofunika kuzindikira kuti oposa 80 peresenti ya ophunzirawo anali kale kale pa chithandizo choyenera cha matenda a shuga (omwe ali pamwamba pa 80 peresenti ali pa ACE inhibitors kapena angiotensin receptor blockers). Pafupifupi odwala onse anali ndi chiopsezo chachikulu cha matenda a mtima. Kukula kwa mayesero ndi chimodzi mwa zinthu zomwe zinapangitsa kuti zikhale zovomerezeka.

Chifukwa cha zotsatirazi zolimbikitsa, kufufuza kwina kwa zotsatira za matendawa pamtundu wa chitukuko ndi kuwonjezereka kwa matenda a impso kudachitidwa. Izi zinayambitsa nkhani yachiŵiri yofalitsidwa mu June 2016, yomwe imagwiritsa ntchito zomwe mankhwalawa amachita ku impso. Mwapang'onopang'ono, kufufuzaku kunayang'ana pa kuchuluka kwa ntchito ya impso yowonjezereka (mwa odwala pa vs osati pa mankhwala). Izi zinachitidwa poyesa kuchuluka kwa mlingo wa creatinine kapena kuperewera kwa mapuloteni mu mkodzo. Zotsatira zomaliza zikuwonetsa kuti odwala matenda a shuga omwe ali ndi chiopsezo chachikulu cha matenda a mtima, ndipo omwe amatenga impagliflozin (kuwonjezera pa "chisamaliro chosamalidwa") akhoza kuona kuchepa kwakukulu mu ntchito ya impso kusiyana ndi omwe sali. Odwala omwe amagwiritsa ntchito mankhwalawa amakhalanso ndi shuga wambiri wa magazi, komanso kuthamanga kwa magazi, chiuno chozungulira, kulemera, ndi uric acid.

Zotsatira Zoipa ndi Mayankho Osayankhidwa

Nthawi iliyonse mankhwala amatchedwa "masewera osintha", kawirikawiri ndibwino kuti mubwerere ndikuyang'ana ndi chidziwitso chabwino cha sayansi. Funsani mafunso okhudza mphamvu yake, mwinamwake? Nazi mafunso ena omwe akufunikanso kuti ayankhidwe moona nthawiyi:

• Kodi pali chinachake chapadera kwambiri pa zamagetsi? Tingawonenso phindu lomweli ndi mankhwala ena omwe ali m'gulu la mankhwala omwewo (SGLT-2 Inhibitors, mwachitsanzo canagliflozin, dapagliflozin)?
• Kodi zomwe mukuganiza kuti zimapindulitsa kwenikweni ndi chifukwa cha kuchepa kwa magazi kapena kulemera kwake, komwe kunawonedwa kwa odwala omwe adatenga zozizwitsa?
• Kodi kupopera shuga m'magazi kungapangitse kufotokozera zapamwamba zamagetsi?

Nkhanizi zapamwamba zimadzutsa zowonjezera zowonjezera komanso zowonjezera. Bwanji ngati ife tikhoza kuwombera shuga wabwino kwambiri wa magazi / kuthamanga kwa magazi pogwiritsa ntchito mankhwala omwe alipo kale ndi kusintha kwa moyo (kulingalira chinachake monga metformin + lisinopril + zakudya / zochita) ? Kodi zimenezo zingatipatse bwenzi lofanana ndi buck, mwina pamtengo wotsika kwambiri? Mafunso awa ndi ambiri adzakhala nkhani za kufufuza kwa zaka zikubwerazi.

Potsirizira pake, kumbukirani zotsatira za zotsatira zoipa zomwe zinayesedwa mu mayesero, ena mwa iwo anali:

• Matenda opatsirana
• Urosepsis
• Ngakhale kuti mayesero achipembedzo sananene izi, a FDA atangom'chenjeza posachedwa za kuwonongeka kwa impso pogwiritsa ntchito "abambo ake" (canagliflozin, dapagliflozin)

Uthenga Wotengera Kwa Odwala

1. Zotsatira za mayesero awiriwa, (pa zotsatira za matenda a mtima, matenda a mitsempha, ndi impso) omwe amafalitsidwa mkati mwa miyezi ingapo mosakayikitsa ndi zochititsa chidwi koma adzafunikira kutsimikiziridwa mtsogolo.
2. Kafukufukuwo amati impagliflozin ingachepetse chiopsezo cha mtima, zilonda, ndi imfa zikawonjezeredwa ku matenda odwala matenda a shuga kwa odwala omwe ali ndi matenda a shuga omwe ali pachiopsezo chachikulu cha matenda a mtima.
3. Empagliflozin mwina ikhoza kuchepetsanso kuchepa kosayembekezereka kwa ntchito ya impso yomwe ikuwoneka pa matenda a shuga oopsa kwambiri. Sitikudziŵa bwinobwino ngati izi zimachokera ku chitetezo pa impso pamwamba pa mliri wa shuga (magazi shuga).
4. Ngati zotsatira zikutsimikiziridwa mu mayesero ena, kwa nthawi yoyamba mwina, tingathe kusuntha njira zowonjezera zomwe zagwiritsidwa ntchito pakadwala matenda a shuga (monga magazi ndi shuga). Izi zikhoza kupereka odwala chinachake chimene chingathe kuchepetsa mwayi wothetsera dialysis.

Tikukhulupirira kuti izi zatsopano sizongowonjezera "mwayi wa oyamba", monga momwe ziliri ndi mankhwala ena a matenda a shuga m'mbuyomu (Bardoxolone ndiyake). Popeza mayesero awiriwa anafalitsidwa, ndawona chiwerengero chokhumudwitsa cha nkhani zopanda malire m'makampani opanga malire ozungulira. Ndemanga yochokera m'nyuzipepala imene inafalitsidwa ku New England Journal of Medicine (yomwe ili magazini yomwe maphunziro oyambirira anafalitsidwa) imatulutsa zomwe tikudziwa panopa:

... "timasiyidwa ndi kusiyana komwe kumawoneka kolimbikitsa, komabe si" kumayendetsa kunyumba "pokhudzana ndi kasamalidwe ka shuga. M'zaka zikubwera, mayesero ogwira ntchito ndi ofanana omwe amagwirizanitsa mawonekedwe atsopano ndi okalamba angathandize Awonetsere njira yothandiza kwambiri ya mankhwala kwa mamiliyoni a anthu omwe miyoyo yawo imakhudzidwa ndi mtundu wa shuga 2 ".

> Zotsatira:

> Empagliflozin ndi Kupitirira kwa Matenda a Impso mu Mtundu Wachiwiri wa shuga .Wanner C, et al; EMPA-REG OTHANDIZA Ofufuza N Engl J Med. 2016 Jun 14

> Impagliflozin, Zotsatira Zamtima, ndi Imfa mu Mtundu Wachiwiri wa shuga. Zinman B, et al; EMPA-REG ZOKHUDZA Ofufuza. Engl J Med.2015 Nov 26