Iproton pump inhibitors kungenzeka ixhunywe nesifo sezinso
Muva nje, kuningi okuye kwadonselwa ukunakekelwa kwemidiya ethandwayo emiphumeleni yocwaningo olwanyatheliswa kuyi- Journal of the American Society of Nephrology echaza ukuxhumana okukhona phakathi kokusetshenziswa kwemithi, okuthiwa "i-proton pump inhibitors" nesifo sezinso. I-Proton pump inhibitors (i-PPIs) yizidakamizwa ezivamile, kanti ezinye zenzeka ukuthi zitholakale ngaphezu kwe-counter-you-you may have heard of names like Prilosec, noma Nexium, noma Prevacid.
Ama-proton pump inhibitors aselokhu aqala kusukela ngawo-1980 ngenkathi eqala ukuthuthukiswa, ne-omeprazole ibe enye yezinto zokuqala ezizoqala emakethe ngo-1989.
Ama-PPI asebenza ngokunciphisa ukukhiqizwa kwe-asidi esiswini. Yebo, izidumbu zethu zinama-acid, ikakhulukazi okuthiwa "i-hydrochloric acid," enendima ebalulekile ekugayeni. I-acid eningi kakhulu, noma i-asidi endaweni engafanele (cabanga ngepayipi yakho yokudla, i-esophagus, esikhundleni sesisu), futhi uqala ukubhekana nezinkinga. Ngakho-ke, ama-PPIs asetshenziselwa ukwelapha izifo ezivamile ezifana nesifo se-reflux ye-gastroesophageal (GERD), izilonda zesisu, isisu sokuphuza, nesifo se-Barrett. Ngakho-ke, akumangalisi ukuthi ama-PPI angenye yezidakamizwa ezisetshenziswa kabanzi, kanti i-omeprazole ibe ohlwini lwe- WHO (World Health Organisation) .
Ngeshwa, ingxenye enkulu yeziguli zisebenzisa lezi zidakamizwa ngokungalungile (isibonakaliso esingalungile / umthamo / ubude).
Ngakho-ke, ngokufanelekile, uma isigaba esithandwayo semithi siphawula ukuthi sinesihlobo nesifo (isifo esingenasifo sezinso , kulokhu), kuyomelwe ukuphakamisa amashiya, noma ngabe ingozi incane.
Ama-proton pump inhibitors ahlale enomlando ohlolisisiwe kuze kube yilapho kusebenza khona izinso.
Njengoba inikezwe iphrofayli enhle yokuphepha yalezi zidakamizwa, imiphumela emibi engaba khona ezintsheni ayizange iqokonyiswe ngokukhethekile. Kodwa-ke, njengodokotela wezinso , ezweni le-nephrology, lokhu bekulokhu kuyingxenye yokufundisa okujwayelekile emashumini ambalwa eminyaka manje.
Ikhono le-proton pump inhibitors lokubangela ukusabela okuvuthayo ezinso, okuthiwa i-nephritis yangaphakathi ye-interstitial (AIN), kwaqaphela cishe eminyakeni engu-25 edlule. Ezinye izinkinga ezihlobene nezinso (ama-electrolyte disorders) eziye zahlanganiswa neproton pump inhibitors ziyi-magnesium ephansi namazinga aphansi e-sodium egazini, kanye nezinga eliphezulu le-calcium.
I-Proton Pump Inhibitors Ilimaza Kanjani Izinso?
I-nephritis ephakathi kwe-interstitial, njengoba kukhulunywe ngenhla, ingenye yezindlela ezivamile lapho imithi ye-proton pump inhibitor (njenge-omeprazole / rabeprazole / pantoprazole, isibonelo) ingaba nomthelela ekusebenzeni kwezinso. Cabanga njengendlela yokusabela okwehliswayo yilawa mithi , ngaphandle kokuthi ukungezwani komzimba kuvinjelwe ezintsheni ngakho-ke ungase ungaboni kahle.
Ngendlela, i-proton pump inhibitors akuyona yodwa imithi eyenza i-nephritis ephakathi kwamanye amazwe. Empeleni, noma imuphi imithi ingayenza, kodwa amacala e-classic ayimithi elwa namagciwane, ama-NSAID, i-allopurinol, i-furosemide, njll.
Kodwa okwenza ukuthi le nkinga ibe yinkimbinkimbi nakakhulu uma kuziwa ku-proton pump inhibitors ukuthi kungenzeka ukuthi awunayo izimpawu zakudala noma izimpawu umuntu angalindela ukuzibona ku-nephritis ejwayelekile yomshoshaphansi owenziwe izidakamizwa (lokhu kungukuthi: umkhuhlane, ukuqhuma , izinga eliphakeme lenye uhlobo lwegazi elithi eosinophils, njll).
Ungayibona kanjani i-PPI-Inducedical Nephritis yangaphakathi?
Uma kungekho izibonakaliso noma izimpawu ezinokwethenjelwa, udokotela wakho / udokotela wezinzwa angase abone ukunyuka okungaqondakali kwegazi lakho le-creatinine leve (ikhemikhali elilinganiselwe egazini ukuhlola umsebenzi wezinso zakho).
Yiqiniso, lokho kuyinto ejwayelekile kakhulu engatholakali nephritis yangaphakathi ngenxa yeproton pump inhibitor. Ngakho-ke, uma kungekho enye incazelo efundwayo, indlela kuphela ecacile yokuxilonga le nhlangano impela yi- biopsy yezinso , inqubo ehlanganisa ukufaka inaliti ezinso zakho ukuze uthole ukuhlaziywa kwezicubu ezincane. Njengoba ungase ucabange, iziguli eziningi angeke zibe abalandeli abakhulu bale nqubo, okuyinto ngamanye amagama okusho ukuthi asinayo indlela enokwethenjelwa, engavumelekile yokuqinisekisa i-nephritis ehlobene ne-PPI ephathelene ne-interstitial interstitial interstitial.
Ngakho-ke, cabanga ngalesi simo: Uqala ukuthatha izidakamizwa ze-PPI (njenge-omeprazole) ukuze uthole uphawu olucacile lwe-aclux / uphawu lokushaya inhliziyo. Njengoba uqhubeka ukuthatha imithi, i-nephritis yangaphakathi yegazi ivela ezinso ngemuva kwesikhathi esithile, ngaphandle kokuthi awunayo inkinobho ukuthi iyaqhubeka. Ungase uthole noma ungatholi ukuhlolwa kwegazi, kodwa noma ngabe odokotela abaningi bangase bangayinaki i-PPI njengendlela ebangela ukulimala kwezinso (ikakhulukazi uma imithi oyithatha ingaphezu kwe-counter). Lokhu kuyiqiniso ikakhulukazi lapho ungase wasebenzisa khona i-PPI esikhathini esidlule, kodwa okwamanje ayisebenzisi eyodwa, ngoba ukusetshenziswa kwesikhathi eside ngaphambi kwalokho kungaholela ekulimaleni okuphakade.
Ngamanye amazwi, uma usudlulile iphuzu elithile ekuthuthukiseni nasekuziphendukeni kwe-nephritis yangaphakathi, i- acute (isikhashana esifushane, isikhashana) ukuvuvukala kungashintsha ibe yindabuko (isikhathi eside, isikhathi esihlala njalo) ukuvuvukala ngenxa yokwakheka kwezicubu, ukudala into ebizwa ngokuthi i-chronic interstitial i-nephritis. Lokhu ekugcineni kungaholela ekufweni kwezinsana ezingapheli kanye nengozi ephakeme yokuqhubekela phambili kwi- dialysis endaweni engaphansi kweziguli.
Okushiwo yiDatha
Kuze kube manje, sinezifundo ezingaphezu kweyodwa eziphakamisa amathuba okuba nomphakathi phakathi kwesifo se-proton pump inhibitor kanye nesifo sezinso, yingakho ukucwaninga kwakamuva okushicilelwe kuyi- Journal of American Society of Nephrology ngo-Ephreli 2016 kubalulekile. Okwenza isifundo sibaluleke nakakhulu ukuthi uzama ukuphendula ukuthi i-proton pump inhibitors ngeke ithinte kanjani ukuthuthukiswa kwezinso zezinso, kodwa futhi nokuqhubeka kwayo nokuhlaselwa ekugcineni ekugcineni kwesifo sezinso.
Lolu cwaningo lwasebenzisa uMnyango Wezemidlalo Wase-Veteran Affairs ukuthola abasebenzisi abasha be-proton pump inhibitors, (abantu abangaba ngu-170 000) futhi bawaqhathanisa nabasebenzisi abasha bama-histamine H2 abathintekayo abathintekayo (esinye isigaba esivamile semithi esetshenziselwa ukwelapha izifo ezihlobene nesisu, cishe 20,000 abantu). Lezi ziguli zalandelwa iminyaka emihlanu futhi umsebenzi wabo wezinso ulandelwa. Nazi imiphumela:
Ama-PPIs kanye Nokuthuthukiswa Nokuthuthukiswa Kwezifo Zezinso
Ucwaningo lwathola ukuthi abantu abasebenzisa i-proton pump inhibitors, uma kuqhathaniswa nalabo abasebenzisa i-histamine H2 blockers babe nomngcipheko ophakeme (ingozi isilinganiso 1.22) yentuthuko yesifo esisha sezinso, ngisho noma beqala ngezinso ezijwayelekile (isifo sezinso lesi simo sachazwa ngokuthi i- GFR engaphansi kuka-60 ). Babesengozini enkulu yokuphindaphinda izinga le-serum creatinine kanye nokwehla kwesifo sezinso ekugcineni kwesifo sezinso. Ingozi ibonakala ikhuphuka isikhathi eside kakhulu sokuvezwa kweproton pump inhibitors.
Ngakho-ke, lolu cwaningo luphetha ngokuthi ukusebenzisa i-proton pump inhibitors kungase kwandise ingozi yokuthuthukiswa kwesifo sezinso, futhi kubangele ukuwohloka kwesifo sezinso ekupheleni kwesikhathi.
Ukusebenzisa isikhathi eside kangakanani kuma-PPIs Kungenza umehluko
Njengomphumela wemiphumela yokutadisha, kubonakala sengathi akulona nje ukusetshenziswa kwala mithi, kodwa nokuthi ungayisebenzisa isikhathi esingakanani lokho okubalulekile. Ucwaningo luqhathanise abantu abasebenzisa le mithi izinsuku ezingaphansi kwengu-30 kubasebenzisi besikhathi eside. Kuvele kubonakale sengathi kukhona ubudlelwane obuphakathi phakathi kwesikhathi sokuchayeka kanye nesifo sezinso zezinso, futhi lokhu kwanda kuze kube yizinsuku ezingaba ngu-720 zokuvezwa kwezidakamizwa.
Lokho Konke Kukusho Kanjani Njengomonde?
Imiphumela yesifundo esichazwe ngenhla, kanye nedatha yangaphambili, inikeza ukucabanga okucatshangwayo. Ngifuna ukugcizelela ukuthi lokhu kuyisifundo sokuhlola, okuyinto ngencazelo ayikwazi ukufakazela ukudala. Kungakhathaliseki ukuthi kunjalo, kubonakala sengathi kukhona ubudlelwane phakathi kokusetshenziswa kwe-PPI nesifo sezinso, okumele kuqondwe. Idatha nayo iyahambisana nokubona kwangaphambili.
Kungenzeka ukuthi isibalo esikhulu sezilwane esisebenzisa i-proton pump inhibitors kungenzeka ukuthi singatholakali nephritis ye-interstitial interstitial, okuyinto ekugcineni iqhubekela phambili kwi-nephritis engapheli yindlala, ngakho-ke isifo esingenasifo sezinso. Njengoba kunikezwe izinkinga ezihilelekile ekwenzeni i-nephritis ye-interstitial (ikakhulukazi ne-proton pump inhibitors, njengoba kuchaziwe ngenhla), iziguli eziningi lapho zingase zingazi ukuthi zilimaza izinso zazo nale mithi.
Angifuni ukuzwakala i-alarmist lapha, kodwa kungakhathaliseki ukuthi ingozi ezincane zingase zibe zincane kangakanani, kuphela ukuthi le mithi ithathwa izigidi zeziguli, ngezinye izikhathi ngokungafanele futhi ngokuphindaphindiwe ngaphezulu kwe-counter ngaphandle kokwazi udokotela, kwenza lokhu kuyinto enkulu.
Ngingakukhuthaza ukuba uxoxe ngalokhu okulandelayo nodokotela wakho manje ukuthi uyazi ukuthi kungenzeka ukuthi izixhumanisi phakathi kwama-PPIs kanye nesifo sezinso:
- Qinisekisa ukuthi odokotela bakho bayazi ukuthi uthatha i-proton pump inhibitors, ikakhulukazi uma ubathatha phezu kwe-counter
- Buza udokotela wakho uma ushintshela ku-block ye-H2 receptor (njenge-famotidine, noma i-Pepcid, njll) kungaba yindlela evikelekile
- Qinisekisa ukuthi ngempela uthatha i-PPI ngencazelo efanele. Sivele sinemininingwane emitholampilo ekhombisa ukuthi i-proton pump inhibitors ivame ukushiwo ngendlela engafanele ngaphandle kokubonisa okufanele.
- Uzophinde ufune ukuhlola uma udinga ukuthatha le mizuzu ngokuqhubekayo, noma kuphela ngesisekelo esidingekayo (njengoba imiphumela yocwaningo ngenhla isitshela ukuthi, isikhathi sokuchayeka kuyisici esibalulekile ekunqumeni ingozi yesifo sezinso)
- Uma kufanele uthathe i-proton pump inhibitor, qinisekisa ukuthi umsebenzi wakho wezinso uhlolwa ngudokotela wakho oyinhloko noma nge- nephrologist . Ngingancoma kakhulu lokhu kuziguli ezinezinye izifo ezingezinkinga zesifo sezinso (njengesifo sikashukela, isifo sofuba, isifo senhliziyo, ukukhuluphala, noma labo abasebenzisa ama-NSAID ngokungavamile, njll).
Imithombo:
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