Iproton pump inhibitors mhlawumbi inxulumene nesifo sezintso
Kungekudala, uninzi oluthatywayo luye lwafunyanwa yimidiya eyaziwayo kwiziphumo zophando olwanyatheliswa kwiNcwadi yoMbutho we-American Society of Nephrology echaza ingqamaniso ekhoyo phakathi kokusetyenziswa kwemithi, ebizwa ngokuthi "iproton pump inhibitors," kunye nesifo seengtso. Iproton pump inhibitors (i-PPIs) yiziyobisi eziqhelekileyo, kwaye ezinye zenzeka ukuba zifumaneke ngaphezu kwe-counter-you-you have heard of names like Prilosec, okanye Nexium, okanye Prevacid.
Iproton pump inhibitors sele ijikeleze ukususela ngo-1980 xa iqala ukuphuhliswa, kunye ne-omeprazole ibe yenye yeyokuqala ukuqaliswa kwimarike ngo-1989.
I-PPIs isebenza ngokunciphisa ukuveliswa kwe-asidi kwisisu. Ewe, isisu sine-asidi, ngokukhethekileyo into ebizwa ngokuthi "i-hydrochloric acid," enendima ebalulekileyo ekutyeni. I-asidi eninzi, okanye i-asidi endaweni engafanelekanga (cinga umbhobho wakho wokutya, isisu, endaweni yesisu), kwaye uqala ukuqhuba iingxaki. Ngenxa yoko, ii-PPIs zisetyenziselwa ukunyangwa kwezifo eziqhelekileyo ezifana nesifo se-reflux ye-gastroesophageal (GERD), izilonda zesisu, isisu, kunye ne-Barrett. Ngoko-ke, akumangalisi ukuba i-PPIs enye yezilwanyana ezisetyenziswa kakhulu, kunye ne-omeprazole kwi- WHO (World Health Organisation) .
Ngelishwa, inxalenye enkulu yezigulane zisebenzisa ezi zi yobisi ngokungalunganga (uphawu olungalunganga / umthamo / ubude).
Kuyacaca ukuba ke, ukuba iqela elidumileyo lemithi liye laziwa ukuba linxulumana nesifo ( isifo esingasasigxina sesifo , kule meko), kuya kuphakanyiswa iinki, nokuba ingozi iyinto encinci.
Iproton pump inhibitors baye bahlala benembali ye-checkered ngokubhekiselele kumsebenzi wezintso.
Njengoko iprogram esebenzayo yokuphepha yilezi yobisi, iimiphumo ezingasenokwenzeka kwizintso azange zigqitywe ngokukodwa. Nangona kunjalo, njengogqirha wezintso , kwihlabathi le-nephrology, oku bekusoloko kuyingxenye yokufundisa okuqhelekileyo kwiminyaka embalwa ngoku.
Ubungakanani beproton pump inhibitors bangela ukuba impatho yokuvuvukala kwizintso, ebizwa ngokuba yi-nephritis yangaphakathi ye-interstitial (AIN), yabonwa malunga nama-25 edlulileyo. Ezinye iingxaki ezinxulumene neengtso (i-electrolyte disorders) eziye zadibaniswa neproton pump inhibitors ziphantsi kwe-magnesium kunye namazinga e-sodium aphantsi egazini, kunye nezinga eliphezulu le-calcium.
I-Proton Pump Inhibitors ibuhlungu njani iiNtso?
I-nephritis eqhelekileyo ye-interstitial, njengoko ikhankanywe ngasentla, enye yeendlela eziqhelekileyo apho iproton pump inhibitor imithi (njenge-omeprazole / rabeprazole / pantoprazole, ngokomzekelo) inokuchaphazela umsebenzi wezintso. Cinga ngolu hlobo lweempembelelo ezichaseneyo ngala mayeza , ngaphandle kokuba i-allergies igcinwe kwizintso kwaye ngoko ungaziqapheli.
Ngendlela, iproton pump inhibitors ayilona yodwa imithi eyenza i-nephritis ye-interstitial acute. Ngokomgaqo, nayiphi na imithi inokuyenza, kodwa iiklasi zobudala ziyi-antibiotics, ii-NSAID, i-allopurinol, i-furosemide, njl.
Kodwa yintoni eyenza ingxaki ibe yinkimbinkimbi xa ifika kwiproton pump inhibitors yinyaniso yokuba unokungenazo iimpawu zeklasiki okanye iimpawu umntu angalindela ukuzibona kwi-nephritis ye-interstitial acoustic-induced acoustic drug (oku: i-fever, u-rash , izinga eliphakamileyo lohlobo oluthile lweeseli zegazi ezibizwa nge-eosinophils, njl).
Unokuyifumanisa njani i-PPI-Incedited Nephritis?
Ukungabikho kwempawu okanye iimpawu ezinokwethenjelwa, ugqirha / unogqirha wakho unokubona ukwanda okungachazwanga kwi- creatinine leve l yakho (ikhemikhali elinganiswe egazini ukuhlola umsebenzi wakho wezintso).
Ngokuqinisekileyo, oko kukufumanisa okuqhelekileyo okungekho ndlela epheleleyo ye-nephritis ye-interstitial ngenxa ye-proton pump inhibitor. Ngenxa yoko, ukuba akukho nanye inkcazo ifunyenwe, indlela ecacileyo kuphela yokufumanisa le nto iyinkozo ye- kidney , inkqubo equka ukubethela inaliti kwiintsholongwane zakho ukuze ufumane isicatshulwa esincinci sokuhlalutya. Njengoko unokucinga, ezininzi izigulana aziyi kuba ngabafundi abalandeli bale nkqubo, oko ngamanye amagama kubonisa ukuba asinayo indlela enokwethenjelwayo, engeyona intshayo yokuqinisekisa i-nephritis enxulumene ne-PPI.
Ngoko, cinga nje ngolu hlobo: Uqala ukuthatha isilwanyana sePPI (njenge-omeprazole) ngenca ye-acid engacacanga ye-aclux / i-heartburn symptom. Njengoko uqhubeka uthabatha amayeza, i-nephritis ye-interstitial ikhula kwiintliziyo emva kwexesha elithile, ngaphandle kokuba unganayo inkqubela ukuba iyaqhubeka. Unako okanye ungenakufumana iimvavanyo zegazi, kodwa mhlawumbi indlela abaninzi oogqirha abanakho ukunyamekela i-PPI njengokuba kunokubangela umonakalo wezintso (ngokukodwa ukuba unyango othabathayo luphezu kwe-counter-counter). Oku kuyinyani ngakumbi apho unokusebenzisa i-PPI ngexesha elidlulileyo, kodwa akalisebenzisi ngoku, kuba ukusetyenziswa kwexesha elide kunokubangela ukuba umonakalo ongunaphakade.
Ngamanye amagama, xa usuke udlulile kwinqanaba elithile ekuphuhliseni nasekuziphendukeni kwe-nephritis ye-interstitial, ixesha elifutshane (elifutshane, elifutshane) ukuvuvukala kungashintsha kwisiguli (ixesha elide, isigxina) ukuvuvukala ngenxa yokubunjwa kwamathambo, ukudala into ebizwa ngokuba yi-interstitial nephritis. Oku ekugqibeleni kukukhokelela kwizifo zesifo esingasigxina kunye nomngcipheko ophezulu wokuqhubela phambili kwi- dialysis kwi-subset yezigulane.
Oko iDatha ekusixelela yona
Kuze kube ngoku, siye safunda ngokuphindaphindiweyo ukuba kunokwenzeka ukuba umbutho phakathi kokusetyenziswa kweproton pump inhibitor kunye nesifo seengtso, yingakho uphando olutsha olupapashwe kwiNcwadi yeMerika Society of Nephrology ngo-Apreli 2016 lufanelekileyo. Yintoni eyenza isifundo sibaluleke nakakhulu kukuba lizama ukuphendula indlela i-proton pump inhibitors engayi kuthintela ngayo kuphela ukuphuhliswa kwesifo seengtso, kodwa kunye nenkqubela yayo kunye nokunyuka kwayo ekugqibeleni ukuphela kwesifo sesifo sesifo.
Isifundo esetyenzisiweyo seSebe leNgcaciso yeMicimbi yezoLutsha ukuchonga abasebenzisi abatsha beproton pump inhibitors, (abantu abangaphezu kwe-170,000) kwaye bafanisa nabasebenzisi abatsha be-histamine H2 abaphikisana nabo (enye iklasi eqhelekileyo yee-meds ezisetyenziselwa ukunyanga izifo ezinxulumene nesisu, malunga ne-20,000 abantu). Ezi zi gulane zandelwa emva kweminyaka emihlanu kwaye umsebenzi wabo wezintso ulandelwe. Nazi iziphumo:
Ii-PPIs kunye nophuhliso kunye nokuqhubela phambili kwezifo zengqondo
Uphando lufumene ukuba abantu abasebenzisa iproton pump inhibitors, xa kuthelekiswa nalabo basebenzisa i-histamine H2 blockers babenomngcipheko ophezulu (ingozi ye-1.22) yokuphuhliswa kwezifo zesifo esitsha, nokuba ngaba baqaliswe ngeentso eziqhelekileyo (isifo seengtso le meko ichazwe njengeGFR ngaphantsi kwama-60 ). Kwakhona babekho mngcipheko ophezulu wokuphinda kabini izinga le-serum creatinine kunye nokunciphisa umsebenzi wezintso ukuphelisa isifo sesifo sesifo. Umngcipheko ubonakala ukhuphuka ixesha elide lokukhutshwa kweproton pump inhibitors.
Ngenxa yoko, olu cwaningo luphetha ngokuthi ukusebenzisa i-proton pump inhibitors kunokunyusa ingozi yokuphuhliswa kwesifo seengso, kunye nokubangela ukuhla kwangoko kweentso zesifo sokuphela kwesifo sesifo.
Ukude usebenzise iiPPIs Kungenza umehluko
Njengokuba kukho iziphumo zophando, kubonakala ngathi akusebenzi nje la mayeza, kodwa nokuba ungayisebenzisa ixesha elide le nto ibalulekileyo. Ngokuqinisekileyo isifundo sifanisa abantu basebenzisa la mayeza ngeentsuku ezingaphantsi kweentsuku ezingama-30 kubasebenzisi bexesha elide. Kukho kubonakala ngathi lidibaniselwano phakathi kwexesha lokungcola kunye nomngcipheko wesifo sesifo, kwaye oku kwanda ukuya kwiintsuku ezili-720 zokuchasana kwezi zonyango.
Yintoni Yonke Ethetha Ngayo Njengomonde?
Iziphumo zezifundo ezichazwe ngasentla, kunye nedatha yangaphambili, zinikeza ukutya okucingayo. Ndifuna ukugxininisa ukuba lo luhlolisiso lokuqwalasela, olwenziwe ngcaciso alubonakaliswanga ukuba luyiyo. Kungakhathaliseki ukuba kunjalo, kubonakala sengathi kukho ubudlelwane phakathi kokusetyenziswa kwePPI nesifo seengtso, esiluncedo. Idata nayo iyahambelana nokuqwalaselwa kwangaphambili.
Kunokwenzeka ukuba ininzi yezigulane zisebenzisa i-proton pump inhibitors ingaba ne-nephritis eqaqambileyo ye-interstitial to begin with, ekugqibeleni iqhubekela phambili kwi-nephritis engapheliyo yesifo kunye nesifo esingasasigxina sesifo. Ukubonelelwa ngeengxaki ezibandakanyekileyo ekuqinisekiseni ukuba i-nephritis ye-interstitial (ikakhulukazi ne-proton pump inhibitors, njengoko ichazwe ngasentla), ezininzi izigulane ngaphandle apho zikwazi nokuba zilimaza iintso zabo nale myeza.
Andifuni ukulila i-alarmist apha, kodwa kungakhathaliseki ukuba ingakanani imingcipheko engathandabuzekiyo, ingaba loo mayeza athatyathwa zizigidi zezigulane, ngamanye amaxesha ngokungafanelekanga kwaye ngokuphindaphindiweyo ngaphandle kwe-counter without the knowledge of a doctor, le nto inkulu.
Ndiyakukukhuthaza ukuba uxoxe ngale nto kunye nogqirha wakho ngoku ukuba uyazi ukuba unxibelelwano phakathi kwe-PPIs kunye nesifo sesifo:
- Qinisekisa ukuba oogqirha bakho bayazi ukuba uthatha i-proton pump inhibitors, ngokukodwa xa ubathatha kwi-counter
- Buza ugqirha wakho ukuba uguqula kwi-block receptor blocker (njengefamotidine, okanye i-Pepcid, njl njl
- Qinisekisa ukuba ngokwenene uthabatha i-PPI malunga nesalathiso esifanelekileyo. Sivele sineenkcukacha zeklinikhi ezibonisa ukuba ama-proton pump inhibitors amaninzi akhankanywe ngokungalunganga ngaphandle kwesalathiso esaneleyo.
- Uyakufuna kwakhona ukuba ukhangele ukuba kufuneka uthabathe le ngcamango ngokuqhelekileyo, okanye kuphela kwisiseko esifanelekileyo (njengoko iziphumo zophando apha ngasentla zisitshilo, ubude bokubhenca kubaluleke kakhulu ekufumaneni ingozi yesifo seengtso)
- Ukuba kufuneka uthathe iprot pump inhibitor, qinisekisa ukuba umsebenzi wakho wezintso uhlolwe ngunyango wakho oyintloko okanye nge- nephrologist . Ndiya kuphakamisa kakhulu oku kwizigulane ezinezinye iingozi ezinesifo sesifo (njengesifo sikashukela, umfutho wegazi, isifo senhliziyo, ukukhuluphala, okanye abo basebenzisa ii-NSAID ngokungapheliyo, njl.
Imithombo:
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I-Brewster UC, iPerazella MA. Iproton pump inhibitors kunye neentso: ukuhlaziywa okubalulekileyo. Clinical Nephrology . 2007; 68 (2): 65-72.
U-Florentin M, uElisaf MS. Iproton pump inhibitor-induced hypomagnesemia: Umngeni omtsha. I-World Journal yeNefrology . 2012; i-doi: 10.5527 / wjn.v1.i6.151.
URuffenach SJ, uSiskind MS, inyaniso YH H. I-nephritis eqhelekileyo ye-interstitial ngenxa ye-omeprazole. I-American Journal of Medicine . 1992; i-doi: http://dx.doi.org/10.1016/0002-9343(92)90181-A.
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