Hoʻomākaukau Thiazolidinedione - nā hiʻohiʻona a me nā hiʻohiʻona noi

Ke hoʻohana nei nā lāʻau lapaʻau hou i kahi ʻano lāʻau like ʻole e mālama ai i ka maʻi diabetes type 2.

ʻO kekahi o kēia mau pūʻulu he thiazolidinediones, kahi hopena like me ka metformin.

Ua manaʻoʻiʻo ia, i hoʻohālikelike ʻia me ka waiwai ikaika o luna, ʻoi aku ka palekana o thiazolidinediones.

Pehea e mālama ʻia ai ka holoholo?

ʻO ke ʻano o ka maʻi maʻi o kēia wā he paʻakikī nā ana.

Hoʻokomo ʻia nā hana Therapeutic i kahi papa lāʻau lapaʻau, ma hope o ka meaʻai paʻa, ka mālama kino ʻana, ka mālama ʻole ʻana i ka lāʻau lapaʻau a me ka hoʻohana ʻana i nā ʻano lāʻau lapaʻau maʻamau.

ʻO ka mālamaʻana i ka maʻi diabetes e hoʻohana i nā lāʻau lapaʻau kūikawā e hoʻokō i kekahi pahuhopu therapeutic.

ʻO kēia mau pahuhopu mālama ʻia:

• ka mālama ʻana i ka nui o ka insulin o ka nui i ka pae i koi ʻia,
• ka hoʻohanohano ʻana o ka nui o ka glucose i loko o ke koko,
• he mea pilikia i ka hoʻonui hou ʻana o ke kaʻina pili,
• ka pani ʻana i nā hōʻike o nā hoʻopiʻi a me nā hopena maikaʻi ʻole.

Hoʻopili ka papa lāʻau therapeutic i ka hoʻohana ʻia ʻana o nā pūʻulu o kēia mau lāʻau.

1. Hoʻomākaukau Sulfonylurea, kahi e hana ai i ka hapaʻumi mau hapa kaila o nā lāʻau lapaʻau āpau. Hoʻopili maikaʻi kēia mau papa i ka pale ʻana i ka insulin.
2. ʻO Biguanides nā lāʻau me kahi mea ikaika e like me ka metformin. Loaʻa i ka māhele i ka hopena maikaʻi i ka pohō kaumaha, a kōkua pū i ka hoʻemi ʻana i ke kō koko. Ma ke ʻano he kānāwai, ʻaʻole i hoʻohana ʻia ma ka hihia o nā maʻi like ʻole a me ka hana o ka puʻuwai, ʻoiai e hōʻuluʻulu koke ʻia i loko o kēia mau kino.
3. Hoʻohana ka poʻe Alpha-glycosidase prophylactically i mea e pale ai i ka hoʻomohala ʻana i ka maʻi type 2. ʻO ka pōmaikaʻi nui o nā lāʻau lapaʻau o kēia hui, ʻaʻole lākou e alakaʻi i ka hōʻike ʻana o ka hypoglycemia. ʻO ka lāʻau i hoʻōla ʻia ka hopena he hopena maikaʻi ma ka maʻamau o ka paona, kaomi inā ukali ka mālama ʻana i nā lāʻauʻai.
4. Hiki ke hoʻohana ʻia nā Thiazolidinediones ma ke ʻano nui no ka mālama ʻana i nā pathology a i ʻole me nā lāʻau lapaʻau e hoʻohaʻahaʻa ana. ʻO ka hopena nui o nā papa i ka hoʻonui ʻana i ke ʻano o ka naʻau i ka insulin, a laila e pale ai i ka pale ʻana. ʻAʻole hoʻohana ʻia nā lāʻau lapaʻau i ka hoʻomohala ʻana o ke ʻano maʻi mellitus type 1, no ka mea hiki wale iā lākou ke hana i ke kaona o ka insulin, ka mea i kūkulu ʻia e ka pancreas.

Hoʻohuiʻia, hoʻohana ʻia nā meglitinides - nā lāʻau lapaʻau e hoʻonui ai i ka huna ʻana i ka insulin, no laila e hoʻopiʻi ana i nā ʻāpana beta pancreatic.

ʻO ka emi ʻana o nā pae i ka glucose i nānā ʻia he ʻumikumamālima mau minuke ma hope o ka lawe ʻana i ka paila.

Ke kūloko

Hoʻokomo ʻia ʻo Thiazolidinediones i ka hopena ma o ka hoʻemi ʻana i ka pale ʻana i ka insulin. Aia nā 2 thiazolidinediones i loaʻa ma ka mākeke - rosiglitazone (Avandia) a me ka pioglitazone (Actos). ʻO Troglitazone ka mea mua i loko o kāna papa, akā ua hoʻopau ʻia no ka mea ma kahi o ka pīpī paʻū. Hiki ke hoʻohana ʻia nā lāʻau lapaʻau e like me monotherapy, a i hui pū ʻia me nā lāʻau lapaʻau ʻē aʻe.

Nā hana hana i ka hana. Hoʻonui ka Thiazolidinediones i ka naʻau o ka insulin ma o ka hana ʻana i ka kiko adipose, nā ʻōpū a me nā puʻuwai, kahi e hoʻonui ai i ka hoʻohana o ka glucose a hōʻemi i kona synthes (1,2). ʻAʻole maopopo i ka ʻaoʻao o ka hana. Hoʻonohonoho lākou i hoʻokahi a i ʻole kekahi o nā mea taliaina o ka mea hoʻonaninani i ka hoʻomaʻamaʻa peroxisome (RAPP) e hāpai ana i ka hoʻomaʻamaʻa peroxisome, ka mea, e hoʻoponopono ai i ka hōʻike gen (3).

Loaʻa ʻO Pioglitazone a me rosiglitazone ka like i ka like a i ʻole ka haʻahaʻa haʻahaʻa e like me nā mea āpau hypoglycemic ʻē aʻe. ʻO ka awelika o ka hemoglobin glycosylated i ka wā e lawe ai i ka rosiglitazone e hōʻemi ana i ka 1.2-1.5%, a me ka piʻi ʻana o ka kiʻekiʻe a me ka haʻahaʻa lipoproteins kiʻekiʻe. Ma muli o ka ʻikepili, hiki ke manaʻo ʻia i ka hopena me ka thiazolidinediones, ʻaʻole i haʻahaʻa ma muli o ka hopena o ka hiki ʻana o ka metformin therapy, akā no ka uku nui a me nā hopena hopena, ʻaʻole i hoʻohana ʻia kēia mau lāʻau no ka mālama mua ʻana i ka maʻi maʻi.

ʻO ka hopena o ka thiazolidinediones ma ke ʻano o ka pūnaehana cardiovascular. Hiki i nā lāʻau hōʻalu ma kēia pūʻulu ke hana anti-inflammatory, antithrombotic, a me nā hana anti-atherogen, akā naʻe, i kēia, nā hōʻike i hōʻike ʻia i kahi hōʻemi o ka maʻi cardiovascular ʻaʻole mea mahalo, a ʻo ka nui o nā hopena pākuhi ka pīhoihoi (4,5,6,7). Hōʻike nā hopena o nā loiloi e pili ana i ka pono o ka mālama ʻana ma ka hoʻohana ʻana i ka thiazolidinediones a me rosiglitazone ma kahi kūikawā, ʻoiai nā ʻikepili hou ʻaʻole i hōʻoia a i ʻole hōʻole i ka hōʻike cardiotoxicity. Eia kekahi, pono e noʻonoʻo pono i ka hiki ke hoʻomohala ʻana i ka naʻau ulu ʻole. I kēia kūlana, ʻaʻole pono e hoʻohana i ka rosiglitazone inā hiki ke hoʻohana i nā lāʻau palekana (metformin, sulfonylureas, insulin).

Nā lipopole. I ka wā o ka terapi me ka pioglitazone, ke loli nei ka lohi o nā lipid haʻahaʻa haʻahaʻa, a me ka maʻi me ka rosiglitazone, kahi piʻi i ka neʻe o kēia palaki lipid i ʻike ʻia e ka awelika o 8-16%. (3)

Hoʻopuka palekana |Nā hiʻohiʻona o thiazolidinediones

ʻO Thiazolidinediones, i nā huaʻōlelo glitazones kekahi ʻano o nā lāʻau o ke koena haʻahaʻa i makemake e hoʻonui i ka hopena olakino o ka insulin. No ka mālama ʻana i ka maʻi mellitus no ka hoʻomaka ʻana no ka maʻi maʻamau - mai ka makahiki 1996. Hoʻokuʻu loa ʻia e like me ka papa kuhikuhi.

ʻO Glitazones, ma ka hana o ka hana hypoglycemic he hopena kūpono ma ka ʻōnaehana cardiovascular. ʻO ka hana aʻe i nānā ʻia: antithrombotic, antiatherogenic, anti-inflammatory. Ke lawe nei i ka thiazolidinediones, e emi ana ka pae o ka hemoglobin glycated ma ka awelika o 1.5%, a hoʻonui ka kiʻekiʻe o ka HDL.

ʻO ka hopena me nā lāʻau lapaʻau o kēia papaʻaina ʻaʻole mea emi iki ma mua o ka lāʻau me ka Metformin. Akā ʻaʻole lākou i hoʻohana i ka hana mua me ka maʻi diabetes type 2. ʻO kēia ke kumu o ka paʻakikī o nā hopena ʻaoʻao a me ke kumukūʻai kiʻekiʻe. I kēia lā, hoʻohana nā glitazones e hoʻohaʻahaʻa i ka glycemia me nā derivatives a me ka metformin. Hiki iā lākou ke hoʻokaʻawale ʻia a me nā mea hoʻokaʻawale i kēlā me kēia lāʻau lapaʻau, a i hui pū ʻia.

Loaʻa a me nā ponoʻole

I waena o nā hiʻohiʻona o nā lāʻau lapaʻau ke kūpono a maikaʻi ʻole:

• hoʻonui i ke kaupaona kino ma 2 kg ma ka awelika,
• ʻO kahi papa nui o nā hopena pili
• Hoʻomaikaʻi i ka ʻōlelo lipid
• Hoʻomaʻa maikaʻi ka hopena i ka pale ʻana i ka insulin
• ka hana haʻahaʻa haʻahaʻa haʻahaʻa hoʻohālikelike i ka metformin, sulfonylurea derivatives,
• kahe koko koko
• ho'ēmi i nā mea e pili ana i ka hoʻomohala ʻana o ka atherosclerosis,
• kaomi wai, a ma muli o ia, ʻo ka piʻi ʻana o nā pilikia o ka hoʻopiʻi ʻana o ka naʻau,
• hoʻemi i ka kūloko o ka iwi, hoʻonui i ka nui o ka puʻuwai,
• hepatotoxicity.

Nā hana hana i ka hana

Hana ʻia nā Thiazolidinediones i nā mea hoʻopiʻi, e hoʻonui ai i ka hoʻoili ʻana a me ka hāpai ʻana o ka glucose i nā puna. ʻO ka hana o nā hāmeʻe i ka palani, a me nā iwi adipose a hoʻomaikaʻi. Eia kekahi, ʻoi aku ka nui o ka hopena ma ke kiʻekiʻe o nā hōʻailona ʻelua.

ʻAʻole hoʻonā ʻia nā Glitazones i ka hana ʻana i ka insulin e ka pancreatic β-cells. ʻO ka hōʻemi o ka hana e loaʻa i ka hoʻemi ʻana i ka pale o ka insulin i nā kiko peripheral a me ka hoʻonui ʻana i ka hoʻohana ʻana i nā glucose i nā kino. ʻO ka hopena hoʻohaʻahaʻa gula ma ke ʻano, e like me ke kānāwai, e hele malie. ʻIke ʻia ka pae liʻiliʻi o ka ʻaihue ʻai wikiwiki ʻana ma hope o kahi hana o ʻelua mahina. Kau pū ʻia ka ʻohana me ka loaʻa ʻana o ka paona.

Loaʻa kahi holomua i ka kaohi metabolila ma o ka hoʻohaʻahaʻa ʻana i ke kō. Ke hui pū ʻia me nā derivatives metformin a me sulfonylurea, ua hoʻomaikaʻi ʻia ka mana glycemic i nā mea maʻi me ka maʻi maʻamau 2, a me nā pae nui o ka plasma nui. Hoʻokumu ka Glitazones i ke alo o ka insulin.

Lapa loli nā ʻano ʻoiacacininetic ma muli o ka lāʻau. ʻAʻole e pili i ka kāne a me nā makahiki o ka mea maʻi. Me ka pōʻino o ka maʻi i nā maʻi, e loli ia i ka pharmacokinetics.

Nā hōʻailona a me nā contraindications

Thiazolidinediones e kuhikuhi ʻia no ka non-insulin-dependant type (type 2 diabetes):

• like monotherapy no kēlā poʻe maʻi e kāohi i ke kiʻekiʻe o ka glycemia me ka lāʻau ʻole (kaʻai a me ka hana kino),
• ʻoiai, he mau mea ʻelua e hui pū ana me ka hoʻomākaukau ʻana o ka sulfonylurea,
• ʻoi aku ka lawelawe ʻana i ka metformin no ka ʻoluʻolu o ka glycemic control,
• me he lā triple lapaʻau o "glitazone + metformin + sulfonylurea",
• hui me ka insulin
• hui me insulin a me metformin.

I waena o nā contraindications i ka lawe ʻana i nā lāʻau lapaʻau:

• holomua ʻole,
• hapai / lactation
• makahiki i 18 makahiki
• huni kūlohelohe - koʻikoʻi a me ke kaumaha
• hōʻeha paʻa ka naʻau
• pilikia nui ʻole ʻo ia.

Haʻawina wikiō e pili ana i ka hoʻomākaukau ʻana o ka pūʻulu thiazolidinedione:

Nā hopena hopena

Ma waena o nā hopena hopena ma hope o ka lawe ʻana i ka thiazolidinediones ʻo ia ka:

• i nā kāne - kūlohelohe kāne.
• ka ulu naʻau,
• ka haʻalele ʻana o ke kūlana hormonal,
• ua hoʻonui nui ʻia o nā ate o nā ate,
• anemia
• huahuʻi,
• hipololeka,
• keiki a me ka ʻōpū,
• loaʻa ka paona
• hoʻonui nui momona
• ʻeha ka ʻōpū, hoʻāla,
• nā ʻūlū ʻili, kūwili hoʻi, ka urticaria,
• ka māla ʻana
• hoʻonui nui momona
• ʻike maka
• nā kuhi maikaʻi ʻana - polyps and cysts,
• nā maʻi ʻeha hanu kiʻekiʻe.

I ka wā e mālama ʻia ai ka mālama ʻana, mālama ʻia ke kaupaona a me nā hōʻailona e hōʻike ana i ka mālama ʻana o ka wai. Hoʻohana ʻia nō hoʻi ka nānā ʻana o ka naʻau. ʻO ka hoʻohana ʻana i nā pahuhopu māmā o ka waiʻona ʻaʻole ia e hoʻopilikia i ka mana glycemic.

Dosage, ʻano o ka hoʻokele

Lawe ʻia nā Glitazones me ka ʻole e mālama i ka meaʻai. ʻAʻole hana ʻia ka hoʻoponopono ʻia ʻana no ka poʻe ʻelemakule me nā kekeʻe liʻiliʻi i loko o ke akea. Kahi ʻia ka ʻaoʻao o nā mea maʻi e kuhikuhi i kahi haʻahaʻa o kēlā lā i kēia lā i ka lāʻau. Hoʻoholo ʻia ka Doseage e ke kauka hoʻokahi.

Hoʻomaka ka hoʻomaka ʻana o nā lāʻau me kahi hōʻemi haʻahaʻa haʻahaʻa. Inā kūpono, hoʻonui ʻia i nā kukū ʻana ma luna o ka lāʻau lapaʻau. Ke hui pū ʻia me ka insulin, e loli ʻole kona ʻano o ke ʻano me ka ʻole o nā hōʻike o nā kūlana hypoglycemic.

Thiazolidinedione ʻAuhala Kauka

Loaʻa nā ʻelua inoa o glitazone ma ka mākeke lāʻau i kēia lā - rosiglitazone a me pioglitazone. ʻO ka mea mua i ka hui he troglitazone - ua hoʻopau koke ʻia ia ma muli o ka hoʻomohala ʻana o ka hōʻeha kino o ka pūpū.

Ke loaʻa nei nā lāʻau lapaʻau e pili ana i ka rosiglitazone:

• 4 mg avandia - Sepania,
• 4 mg Diagnitazone - Ukraine,
• Roglit ma ka 2 mg lāua ʻo 4 mg - ʻo Hūlani.

ʻO nā lāʻau lapaʻau Piogitazone e loaʻa:

• Glutazone 15 mg, 30 mg, 45 mg - Ukraine,
• Nilgar 15 mg, 30 mg - India,
• Dropia-Sanovel 15 mg, 30 mg - Turkey,
• Pioglar 15 mg, 30 mg - India,
• Pyosis 15 mg lāuaʻo 30 mg - India.

Hoʻopili me nā lāʻau lapaʻau ʻē aʻe

1. Rosiglitazone. ^ E Ha yM. ʻAʻole pili ka hoʻohana ʻana i ka waiʻona i ka mana glycemic. ʻAʻohe ʻano nui o ka hui me nā tablet contaceptives, Nifedipine, Digoxin, Warfarin.
2. Pioglitazone. ^ E Ha yM. Ke hoʻohui a me ka rifampicin, hoʻemi ʻia ka hopena o ka pioglitazone. Malia paha kahi emi iki o ka hopena o ka contraception aʻo ka lawe ʻana i nā mea papa papa. Ke hoʻohana ʻana i ka ketoconazole, pono nui ka mālama glycemic.

ʻAʻole nā ​​Thiazolidinediones e hōʻemi wale i nā pae koko, akā hoʻopilikia maikaʻi hoʻi i ka ʻōnaehana cardiovascular. Ma waho aʻe o nā pono, loaʻa iā lākou kahi nui o nā hiʻohiʻona maikaʻi, ʻo ia ka mea maʻamau ka nui o ka hoʻokumu ʻana o ka puʻuwai naʻau a me ka emi ʻana o ka hana ʻana o ka iwi.

Hoʻohana pinepine ʻia lākou i loko o ka maʻi paʻakikī, ka hoʻohana ʻana i thiazolidinediones no ka pale ʻana i ka hoʻomohala ʻia o ka maʻi e pono ai ka noiʻi hou aku.

Na rula o ke koho ana

1. ʻO nā lāʻau koho mua no ka maʻi type 2 i nā mea momona keu he metformin a i nā lāʻau mai ka pūʻulu thiazolidinediones.
   
2. I nā mea maʻi me ke kaumaha kino kino, hāʻawi ʻia ka makemake i ka hoʻomākaukau ʻana o ka sulfonylurea a i ʻole ka meglitinides.
   
3. Me ka hana ʻole o ka hoʻohana ʻana i hoʻokahi papa, ma ke ʻano he lula, ua kau ʻia ka hui ʻana o nā mea ʻelua (ʻokoʻa pinepine ʻekolu). ʻO nā hui hui maʻamau:
   
   • olioola +
   • metformin + thiazolidinedione,
   • metformin + thiazolidinedione + sulfonylurea.
     

Hoʻomākaukau Sulfonylurea

ʻO nā mea kaulana loa nā lāʻau lapaʻau e pili ana i nā derivatives o ka sulfonylurea (a hiki i ka 90% o nā lāʻau lapaʻau āpau. Ke manaʻoʻiʻo ʻia nei ka hoʻonui ʻia ʻana o ka mea huna i ka hana huna ʻana e nā lāʻau lapaʻau o kēia papaʻaina i mea e pono ai ke kūpaʻa i ka pale ʻana i ka insulin.

Hoʻopilikia ka 2 mau makahiki sulfonylurea:

• Gliclazide - he hopena kūpono i ka microcirculation, kahe koko, ke loaʻa ka hopena maikaʻi loa i nā hoʻopiʻi microvascular i ka maʻi maʻi.
• ʻO Glibenclamide - ka hopena ikaika loa o ka hypoglycemic. I kēia manawa, nui a me nā mea hou e kamaʻilio e pili ana i ka hopena maikaʻi o kēia lāʻau lāʻau ma ke ala o nā maʻi cardiovascular.
• Hoʻolālā - ua hoʻolaha ʻia he hopena hoʻemi i ka gula, akā ʻoi aku ka lōʻihi o ka hana ma mua o ka glibenclamide.
• Glycidone - ka mea kanu wale nō mai kēia hui, kahi i kuhikuhi ʻia ai i nā mea maʻi me ka maʻi liʻiliʻi o ka maʻi. He pōkole loa ia o ka hana.

Hoʻolālā ʻia nā hanana hanauna 3 o ka wā o ka sulfonylurea Glimeprimide:

• Hoʻomaka i ka hana ma mua a loaʻa ke manawa lōʻihi loa (a hiki i 24 mau hola) ma nā haʻahaʻa haʻahaʻa,
• ka loaʻa ʻana o ka lāʻau lapaʻau wale nō 1 manawa i kēlā me kēia lā,
• ʻaʻole e hōʻemi i ka neʻe ʻana o ka insulin i ka wā e hoʻomaʻamaʻa ai,
• kumu e hoʻokuʻu wikiwiki ai ka insulin i ka pane ʻana i ka meaʻai i ka meaʻai,
• hiki ke hoʻohana ʻia no ka hala ʻole ʻana o ka māmā.
• aia ka palena haʻahaʻa o ka hypoglycemia i hoʻohālikelike ʻia me nā lāʻau lapaʻau ʻē aʻe i kēia papa.

Loaʻa ka nui o ka hoʻomākaukau ʻana i ka hoʻomākaukau o ka sulfonylurea i nā mea maʻi me ka maʻi maʻamau 2, akā me ke kaumaha kino kino.

Kūkulu i nā lāʻau lapaʻau sulfonylurea no ke ʻano maʻi type 2, ke ʻano ʻole ka meaʻai a me ka hana kino kino.

Ua hoʻoulu ʻia ka hoʻomākaukau ʻana o ka Sulfonylurea: no nā mea maʻi me ka maʻi type type 1, hapai a i ka wā lactation, me ka maʻi nui o ke akeʻa a me nā ʻōpū, me ka gangrene maʻi maʻi. Pono ka mālama mālama pono ʻana i ka ʻōpū o ka ʻōpū a me ka duodenal ulia, me ka hihia o ka maʻi febrile i loko o ka maʻi maʻamau.

Wahi a nā helu helu, akā wale nō, ʻo ka hapakolu wale nō o nā mea maʻi e loaʻa i ka uku ʻoi loa no ka maʻi mellitus me ka hoʻohana ʻana i ka sulfonylureas. Hoʻomaopopo ʻia nā maʻi ʻē aʻe e hoʻohui i kēia mau lāʻau me nā lāʻau lapaʻau ʻē aʻe, a i ʻole ia e hoʻololi i ka maʻi insulin.

ʻO ka lāʻau lapaʻau wale nō i kēia hui metformin, e hōʻalo i ka hana a hoʻokuʻu i nā glucose i ka ate, hoʻomaikaʻi i ka hoʻohana ʻana i ka glucose i nā kōʻai peripheral, hoʻomaikaʻi i ke kahe koko, a hoʻomaʻamaʻa i ka lipid metabolism. Hoʻokumu ka hopena hypoglycemic 2-3 mau lā ma hope o ka hoʻomaka ʻana o ka lāʻau lapaʻau.I ka manawa like, hōʻemi ka nui o ka wikiwiki o ka glycemia, a hoʻemi ka momona.

ʻO kahi hiʻohiʻona kūikawā o ka metformin ka stabilization, a me ka lilo nui ʻana - ʻaʻole kekahi o nā mea hana hypoglycemic āpau i kēia hopena.

Ke hōʻike nei i ka hoʻohana ʻana o ka metformin: type 2 diabetes mellitus i nā mea maʻi me ka momona nui, prediabetes, intolerance no ka hoʻomākaukau ʻana o ka sulfonylurea.

Ua hoʻohālikelike ʻia ka Metformin: no nā mea maʻi me ka diabetes type type 1 mellitus, hāpai ʻia a i ka wā e hānai ai, me ka pathology koʻikoʻi o nā pēpē a me nā ʻōpū, me nā hoʻopiʻi o nā maʻi maʻi, me nā maʻi pākuhi, me nā maʻi āpau i mālama ʻia e ka lawa ʻole o ka oxygen i nā kino.

Nā Kahu Inoa o Glycosidase Alpha

Ke komo pū me nā lāʻau o kēia pūʻulu acarbose a miglitol, e hoʻokaʻī i ka ʻemi ʻana o nā kaola i loko o nā wahi i loko, e hoʻomaikaʻi ai i ke kau ʻana o ka glucose i loko o ke koko. Ma muli o kēia, ua hoʻoneʻe ʻia ka piʻi ʻana o ke kō o ke koko i ka wā e ʻai ai, ʻaʻohe pilikia o ka hypoglycemia.

ʻO kahi hiʻohiʻona o kēia mau lāʻau lapaʻau ka mea kūpono i ka hoʻopau ʻana i nā waihona he nui o nā palakū. Inā lanakila nā paʻaleka maʻalahi i ka meaʻai o ka mea maʻi, ʻo ka mālama ʻana me nā inhibits alpha-glycosidase e hāʻawi i kahi hopena maikaʻi. Ka hopena i hōʻike ʻia e hana ai i nā lāʻau o kēia pūʻulu i ʻoi loa ka maikaʻi no ka maʻi glycemia maʻamau a ke piʻi ikaika ʻia ma hope o ka ʻai. Eia kekahi, pono e hoʻonui nā lāʻau lapaʻau i ke paona kino.

Hōʻike ʻia nā inhibitors Alpha-glycosidase no nā mea maʻi me ka maʻi diabetes mellitus type 2 me kaʻai a me ka hoʻomaʻamaʻa ʻana me ka hoʻoulu ʻana o ka hyperglycemia ma hope o ka ʻai ʻana.

ʻO nā ʻōhumu no ka hoʻohana ʻana o nā inhibitors o alpha-glycosidase ka: ketoacidosis maʻi maʻi, cirrhosis, ʻeha a me ke ake ʻana o ka ʻōpū o ka maʻi, a me nā maʻi o ka gastrointestinal me ka hoʻonui ʻana i ka hau, colitis ulcerative, ʻōpū o ka huina, nui hernias, ʻeha hana ʻole i ka maʻi renal, ʻeha a me ka lactation.

Thiazolidinediones

Hoʻokomo ʻia nā lāʻau lapaʻau i kēia hui pioglitazone, rosiglitazone, troglitazonee hōʻemi ana i ka kūleʻa o ka insulin, e hōʻemi ana i ka hoʻokuʻu o ka glucose i ka ate, mālama i ka hana o nā ʻāpana a me ka hana i ka insulin.

ʻO ka hana a kēia lāʻau lapaʻau ka like ʻana me ka hana a ka metformin, akā ua hōʻole ʻia lākou i kona mau ʻano maikaʻi - ʻo ka hoʻēmi ʻana i ka pale ʻana i ka insulin, hiki i nā lāʻau hōʻalo o kēia pūʻulu ke hoʻomoe i ka hoʻomohala ʻana i nā hoʻopiʻi o nā renal a me nā hypertension arterial, ʻoluʻolu i ka lipid metabolism. Akā, ma ka ʻaoʻao ʻē aʻe, i ka wā e lawe ai i nā glitazones, pono ʻoe e kiaʻi mau i ka hana o ka ate. I kēia manawa, aia kahi hōʻike e hoʻonui ai ka hoʻohana ʻana i ka rosiglitazone i ka nui o ka hoʻoulu ʻana i ka myocardial infarction a me ka hāʻule ʻana o cardiovascular.

Hōʻike ʻia nā Glitazones no nā mea maʻi me ka diabetes type 2 i nā hihia o kaʻai ʻole o ka meaʻai a me ka hana kino me kahi mea nui o ka kū ʻana o ka insulin.

ʻO nā kumuhana nā: type 1 diabetes mellitus, ketoacidosis maʻi, ʻeha a me ka lactation, maʻi ʻeha palā, nā puʻuwai puʻuwai.

Meglitinides

Hoʻokomo ʻia nā lāʻau lapaʻau i kēia hui hele hou a nateglinideka loaʻa ʻana o ka manawa hoʻohaʻahaʻa kōmao pōkole. Ke hoʻoponopono nei ʻo Meglitinides i ka pae o ka glucose i hope o ka ʻai ʻana, i hiki ai ke ʻae i ka mālama ʻana i ka ʻai, no ka mea hoʻohana ʻia ka lāʻau ma mua o ka ʻai.

ʻO kahi hiʻohiʻona hiʻohiʻona o ka meglitinides ke emi nui o ka glucose: ma kahi ʻōpū ʻole e 4 mmol / l, ma hope o ka ʻai - e 6 mmol / l. ʻO ke kauʻana o ka hemoglobin HbA1c e hoʻoemi ʻia e 2%. Me ka hoʻohana mau ʻana ʻaʻole e kumu i ka loaʻa ʻana o ka paona a ʻaʻole pono e koho i ka wī. Hoʻonui ʻia ka hoʻonui ʻana i ka hopena hypoglycemic ke lawe nei i ka waiʻona a me kekahi mau lāʻau lapaʻau.

Hōʻike ka hoʻohanaʻana o ka meglitinides ka maʻi type 2 i nā hihia o kaʻai ʻana i ka meaʻai a me ka hana kino.

Ua hoʻohālikelike ʻia ka Miglitinides: no nā mea maʻi me ka maʻi diabetes mellitus type 1, me ka ketoacidosis maʻi maʻi, nā wahine hāpai a me nā umauma, me ka hoʻonui nui ʻana i ka lāʻau.

NĀHUI! ʻO ka ʻike e hāʻawi ʻia e ka pūnaewele DIABET-GIPERTONIA.RU no ke kumuhana wale no. ʻAʻole kuleana ka luna o ka pūnaewele no nā hopena maikaʻi ʻole inā e lawe ʻoe i nā lāʻau lapaʻau a me nā kaʻina ʻole me ke kauka ʻana o kahi kauka.

ʻO ka lāʻau hypoglycemic a antidiabetic i nā lāʻau lapaʻau e hoʻohaʻahaʻa i ka glucose koko a hoʻohana ʻia no ka mālama ʻana i ka maʻi diabetes.

Me ka insulin, ʻo ka hoʻomākaukau o ka mea kūpono wale nō no ka hoʻohana makua, aia kekahi mau mea synthetic syntense e loaʻa ana ka hopena hypoglycemic a maikaʻi ka wā e lawe ʻia ai. ʻO ka hoʻohana nuiʻana o kēia mau lāʻau i ka maʻi diabetes type 2.

Hiki i nā mea āpau ke hoʻopaʻa waha (hypoglycemic) aiko ʻole:

— ololilurea derivatives (glibenclamide, glycidone, glyclazide, glimepiride, glipizide, chlorpropamide),

— Nā meglitinides (nateglinide, repaglinide),

— nā biguanides (buformin, metformin, fenformin),

— lihuiʻanui (pioglitazone, rosiglitazone, ciglitazone, englitazone, troglitazone),

— nā mea paʻa alpha glucosidase (acarbose, miglitol),

Ua loaʻa ka waiwai Hypoglycemic i loko o ka hua palapala sulfonylurea. ʻO ka hiki i nā pūhui hoʻohui o kēia pūʻulu e hana i kahi hopena hypoglycemic i loaʻa i ka 50s, i ka manawa i ʻike ʻia ai ke emi ʻana o ka glucose o ke koko i nā mea maʻi e loaʻa ana i nā lāʻau antibacterial sulfonamide no ka mālama ʻana i nā maʻi maʻi. Ma kēia hana, hoʻomaka kahi hulina no nā mea hili o ka sulfonamides me kahi hopena hypoglycemic i haʻi ʻia i ka 50s. Ua lawe ʻia ka hana o ke ʻano o ka derony o ka sulfonylurea i hiki ke hoʻohana i ka mālama ʻana i ka maʻi mellitus. ʻO nā lāʻau lapaʻau mua loa ʻo ka carbutamide (Kelemānia, 1955) a me tolbutamide (USA, 1956). I ke kumu kanakolu. ua hoʻomaka kēia mau mea neʻe i kēia mau makana sulfonylurea. I nā 60-70s. hele mai ka lua o ka lua o ka wā o nā keikiʻawa. Ua hoʻomaka ka hoʻohana mua ʻana o ka hui mua o ka lua o ka holony o ka sulfonylurea, glibenclamide i ka hoʻohana ʻana i ka maʻi maʻi i ka makahiki 1969, i ka makahiki 1970, ua hoʻomaka ʻia nā glibornuride e hoʻohana, a i 1972, glipizide. Ua hele like aku ʻo Gliclazide a me glycidone.

I ka makahiki 1997, ua ʻae ʻia ʻo repaglinide (kahi hui o meglitinides) no ka mālama ʻana i ka maʻi maʻi.

ʻO ka mōʻaukala o ka hoʻohana ʻana o biguanides e hoʻi hou i ka makahiki waena, i ka wā i hoʻohana ʻia ai kahi mea kanu e mālama ai i ka maʻi maʻi Galega officinalis (Lili palani).

Ua komo ʻo Thiazolidinediones (glitazones) i ka hana kulekele i ka makahiki 1997. ʻO ka lāʻau lapaʻau mua i ʻae ʻia no ka hoʻohana ʻana i ka lawena hypoglycemic he troglitazone, akā ma 2000 ua hoʻohana ʻia kona hoʻohana ʻana ma muli o ka hepatotoxicity kiʻekiʻe. I kēia lā, ʻelua mau lāʻau mai kēia pūʻulu - pioglitazone a me rosiglitazone.

Hoʻolaha huikaʻi pili pū me ka hoʻoulu ʻia o nā ʻāpana beta pancreatic, i ukali ʻia e ka hoʻoneʻe ʻana a me ka hoʻonui ʻana o ka insulin endogenous.

Me ka lōʻihi o ka mālama ʻana me nā derivatives sulfonylurea, ua pau ko lākou hopena hoʻōla mua i ka huna ʻana o ka insulin. Ke manaʻoʻiʻo ia nei kēia ma muli o ka emi ʻana o ka nui o nā mea i hōʻea i nā cell beta. Ma hope o ka hoʻomaha ʻana i ka mālama ʻana, ua hoʻihoʻi ka hopena o nā lāʻau beta i ka lawe ʻana i nā lāʻau lapaʻau o kēia hui.

Loaʻa kekahi mau sulfonylureas i nā hopena extra-pancreatic. ʻAʻole ʻike nui nā hopena Extrapancreatic i loko o ka maʻi koʻikoʻi nui, ua kau lākou i ka hoʻonui ʻana i ke ʻano o nā kinona e hilinaʻi nei i ka insulin i ka endogenous insulin a me ka hoʻēmi ʻana i ka hana o ka glucose i loko o ka ate. ʻO ka hoʻokūkū o ka hoʻomohala o kēia mau hopena ma muli o ka loaʻaʻana o kēia mau lāʻau (ʻoi aku ka glimepiride) i ka nui o nā mea i hōʻea i ka naʻau o ka insulin i nā cell target, hoʻomaikaʻi i ka pilina o ka insulin-receptor, a e hoʻihoʻi i ka transduction o ka hōʻailona postreceptor.

Eia kekahi, aia kekahi hōʻike e hoʻowalewale ka prizvodnye sulfonylureas i ka hoʻokuʻu ʻana o somatostatin a no laila hoʻoweliweli i ka huna ʻana o ka glucagon.

ʻO wau ka hanauna: tolbutamide, carbamide, tolazamide, acetohexamide, chlorpropamide.

II ka hanauna: glibenclamide, glisoxepide, glibornuril, glycidone, glyclazide, glipizide.

III hanauna: glimepiride.

I kēia manawa, ʻaʻole maʻa Russia, ʻo ka hoʻomākaukau ʻana o ka sulfonylurea o ka hanauna mua.

ʻO ka ʻokoʻa nui ma waena o nā lāʻau lapaʻau lua a me nā derivatives o sulfonylurea o ka hanauna mua he ʻoi aku ka hana nui (50-100 mau manawa), hiki iā lākou ke hoʻohana ʻia ma nā haʻahaʻa haʻahaʻa a, ma muli o ia, e hoʻemi i ka hopena o nā hopena ʻaoʻao. ʻO nā ʻelele o nā kūmole hypoglycemic derivatives o ka sulfonylureas o ka hanauna 1 a me ka 2 i ʻokoʻa i ka hana a me ka hoʻomanawanui. No laila, ʻo nā lā o kēlā me kēia lā nā lāʻau lapaʻau mua - tolbutamide a me chlorpropamide - 2 a me 0.75 g, kēlā me kēia, a me nā lāʻau lapaʻau hou ʻelua - glibenclamide - 0,02 g, glycvidone - 0,06-0.12 g. . ^ E Ha yM.

ʻO ka Sulfonylurea hoʻomākaukau e pili ana i ka paʻakikī a me ka lōʻihi o ka hana, kahi e hoʻoholo ai i ke koho o nā lāʻau lapaʻau i ka wā i kuhikuhi ʻia ai. ʻO Glibenclamide ka hopena o ka hopena hypoglycemic ākea o nā derivatives sulfonylurea. Hoʻohana ia e like me ke kuhikuhi no ka loiloi ʻana i ka hopena hypoglycemic o nā lāʻau hou synthesized hou. ʻO ka hopena hypoglycemic ikaika o ka glibenclamide ma muli o ka hana i ka pilina kiʻekiʻe loa no nā papa pākuʻi o ATP-hilinaʻi o nā papa beta pancreatic. I kēia manawa, hana ʻia ka glibenclamide ma ke ʻano o ka palapala hana kuʻuna a ma ke ʻano he ʻano micronized - kahi ʻano glibenclamide kikoʻī e hoʻolako ana i kahi pālahalaha pharmacokinetic a me ka maʻi pharmacodynamic ma muli o ka hoʻopuka piha a me ka hoʻopiha piha (bioavailability 100 100%) a hiki iā ia ke hoʻohana i nā lāʻau lapaʻau ma ʻoi aku ka liʻiliʻi.

ʻO Gliclazide ka lua o ka hoʻohana ʻia ʻana o ka lua hypoglycemic waha ma hope o ka glibenclamide. Eia ka mea i ka hopena o ka gliclazide i ka hopena hypoglycemic, e hoʻomaikaʻi ana i nā ʻāpana hematological, nā ʻāpana rheological o ke koko, kahi hopena kūpono ma ka hemostatic system a me ka microcirculation, a pale i ka hoʻomohala ʻana o ka microvasculitis, a komo hana ʻino i ka retina, pale i ka hoʻohui o platelet, e hoʻonui nui ana i ka pālahalaha kuleana ʻole, ka hoʻonui ʻana i ka heparin a me ka hana fibrinolytic, hoʻonui i ka hoʻohaʻahaʻa heparin, a hōʻike pū i nā mea antioxidant.

ʻO ka Glycvidone kahi lāʻau lapaʻau i hiki ke kuhikuhi i nā poʻe maʻi me ka maʻi koʻikoʻi o ka renal, no ka mea ʻO ka 5% wale nō o nā metabolites ka hoʻopio ʻia ma o nā ʻōpū, ke koena (95%) - ma o nā ʻōpū.

ʻO Glipizide, ka hopena i hoʻopio ʻia, e hoʻopilikia i kahi pōpilikia o ka hopena o ka hopena hypoglycemic, no ka mea, ʻaʻole ia e hoʻopalike a ʻaʻohe ona metabolites.

ʻO nā lāʻau antidiabetic oral he mea nui ia no ka mālama ʻana o ka maʻi mellitus type type 2 (non-insulin-dependant) a e kuhikuhi pinepine ʻia i nā mea maʻi i ʻoi aku o 35 a ʻoi ʻole ka ketoacidosis, nā meaʻai meaʻai, nā mea hoʻopiʻi a i nā maʻi concomitant e koi ana i ka hoʻomehana insulin like ʻole.

ʻAʻole ʻōlelo ʻia nā hoʻomākaukau ʻana o ka pūʻulu sulfonylurea no nā maʻi nā mea, me ka meaʻai kūpono, pono ka lā maʻamau no ka insulin ma mua o 40 papa. ʻAʻole pū kekahi, ʻaʻole i kuhikuhi ʻia no ka poʻe maʻi me nā maʻi koʻikoʻi o ka maʻi mellitus (me ka nui o ka beta-cell insufficiency), me ka mōʻaukala o ka ketosis a i ʻole coma coma, me ka hyperglycemia ma luna o 13.9 mmol / L (250 mg%) ma kahi ʻōpū piha a me nā glucosuria kiʻekiʻe i ka wā mālama kai.

Hoʻololi i ka mālama ʻia me ka lāʻau lapaʻau sulfonylurea no nā mea maʻi me ka maʻi maʻi ma ka maʻi kūlohelohe i hiki ke kōpae ʻia nā maʻi o ka haʻalulu a me nā haʻahaʻa o ka haʻahaʻa o ka insulin i ka haʻahaʻa o 40 mau lā / lā. ʻO nā wai ʻai o ka insulin a hiki i ka 10 mau pūʻulu / lā, hiki iā ʻoe ke hoʻololi koke i ka mālama ʻana me nā derivatives sulfonylurea.

ʻO ka hoʻohana lōʻihi ʻana o nā derivatives o sulfonylurea hiki ke hoʻoulu i ka hoʻomohala ʻana, hiki ke neʻe ʻia e ka hui pū ʻana me ka hoʻomākaukau o ka insulin. Ma ka type 1 diabetes mellitus, ka hui pū ʻana o ka hoʻomākaukau ʻana i ka insulin me nā sulfonylurea derivatives e hiki ai ke hōʻemi i ka pono o kēlā me kēia lā no ka insulin a kōkua i ka hoʻomaikaʻi ʻana i ke ala o ka maʻi, me ka hoʻoluhi ʻana i ka holomua o ka retinopathy, kahi i pili i ka hana angioprotective o ka derivatives sulfonylurea (ma mua o ka hanauna II). I ka manawa like, aia kahi mau hōʻailona o kā lākou hopena atherogenic hiki.

Hoʻohui ia, ua hui pū ʻia nā derivatives sulfonylurea me ka insulin (e like me ke ʻano he hui like ʻole inā maikaʻi ʻole ke ʻano o ka mea maʻi me ka 100 IU o ka insulin i ka lā), i kekahi manawa hoʻohui pū lākou me biguanides a me acarbose.

Ke hoʻohana nei i nā lāʻau huemai hypoglycemic sulfonamide, pono e noʻonoʻo i ka sulfonamides antibakteri, kūlohelohe anticoagulants, butadion, salicylates, ethionamide, tetracyclines, chloramphenicol, cyclophosphamide hoʻomehana i kā lākou metabolism a hoʻonui i ka hoʻoikaika (hypoglycemia e ulu). I ka hoʻohui ʻia o nā derivatives sulfonylurea me thiazide diuretics (hydrochlorothiazide, etc.) a me BKK (nifedipine, diltiazem, etc.), nā antagonism i ka nui o nā dosis - nā thiazides hoʻopiʻi i ka hopena o nā derivatives sulfonylurea ma muli o ka weheʻana o nā kahe pālima, a me BKK ka hōʻuluʻulu i ka kahe ʻana o nā calcium hāpana. nā hui aloha.

Hoʻonui ka huaʻala o ka sulfonylureas i ka hopena a me ka hoʻomehana ʻole o ka ʻawaʻawa, paha ma muli o ke lohi ʻana o ka hopena o ka acetaldehyde. ʻO nā mea kūlike e like me ka Antabuse.

ʻAno ʻia nā lāʻau huakaʻi sulfonamide hypoglycemic āpau e lawe ʻia i ka hola 1 ma mua o ka pāʻina, kahi i hāʻawi ʻia ai ke emi ʻana o ka maʻi postprandial (ma hope o ka ʻai) ka glycemia. Ma kahi o ka hōʻeha koʻikoʻi o nā hanana dyspeptic, ua manaʻo ʻia e hoʻohana i kēia mau lāʻau ma hope o ka ʻai ʻana.

ʻO nā hopena maikaʻi ʻole o nā derivatives o ka sulfonylurea, i ka hoʻohui ʻana i ka hypoglycemia, he dyspeptic disorders (me ka nausea, ka luaʻi, ka ʻōpū), ʻo ka jaundice cholestatic, nā kaupaona hōʻemi, ka hiki ʻana aku i ka leukopenia, thrombocytopenia, agranulocytosis, aplastic a me hemolytic anemia, ʻomaʻama kūwaho ( minamina, ʻaina, dermatitis).

ʻAʻole mālama ʻia ka hoʻohana ʻana o ka hoʻomākaukau ʻana o ka sulfonylurea i ka wā hapai, no ka ʻO ka hapa nui o lākou ka papa C e like me ka FDA (Food and Drug Administration), insulin therapy i hoʻokaʻawale ʻia.

ʻAʻole i ʻōlelo ʻia nā poʻe maʻi kahiko e hoʻohana i nā lāʻau lapaʻau lōʻihi (glibenclamide) ma muli o ka hoʻonui nui o ka hypoglycemia. I kēia manawa, ʻoi aku ka maikaʻi o ka hoʻohana ʻana i nā kiʻi pōkole pōkole - gliclazide, glycidone.

Meglitinides - nā mea hoʻoponopono prandial (repaglinide, nateglinide).

ʻO ka repaglinide kahi huaʻala o ka acid benzoic. ʻOiai ka ʻokoʻa o ka hana kemika mai nā derebatives sulfonylurea, ke kālai ʻia nei hoʻi ia i nā kaola paʻuhina o ke kūpaʻa ʻana o ka ATP i nā membranes o nā pona beta functionally hoʻoikaika o nā islet pancreatic apparatus, ka mea no ka hoʻohemo ʻana a me ka wehe i nā kanalula o nā calcium, ma ia mea e hoʻokomo ai i ka hoʻohui ʻana o ka insulin. Hoʻokomo kahi insulinotropic i kahi papaʻai i loko o 30 mau minuke ma hope o ke noi a ua hele pū ʻia me ka hoʻemi ʻana o ka glucose koko i ka wā o kahi pāʻina (ʻaʻole i hoʻonui nui aʻe ka manaʻo o ka insulin ma waena o ka ʻai). E like me ka derivatives o sulfonylurea, ʻo ka hopena nui ka hypoglycemia. Me ka mālama aka, ua kau ʻia ka repaglinide i nā poʻe maʻi me ka maʻi hepatic a / a i ʻole ke aloha ʻole.

ʻO Nateglinide kahi mea iʻike o D-phenylalanine.ʻAʻole like me nā ʻaihue hypoglycemic waha, ʻoi aku ka wikiwiki o ka nateglinide ma ka mea huna o ka insulin, akā he hoʻomau ka hoʻomau. Hoʻohana nui ʻia ka Nateglinide e hōʻemi i ka hyperglycemia postprandial i nā maʻi maʻi type 2.

Biguanides, ka mea i hoʻomaka e hoʻohana i ka mālama ʻana i ka maʻi type 2 i nā makahiki 70, mai hoʻowalewale i ka huna ʻana o ka insulin e nā pancreatic beta cells. Ua hoʻoholo ʻia ka hopena o ka hopena e ka pale ʻana o ka gluconeogenesis i loko o ka puhilohi (me ka glycogenolysis) a me ka hoʻonui nui o ka glucose e nā kōpili peripheral. Hoʻopili lākou i ka hana ʻole o ka insulin a hoʻomaikaʻi aku i kona kū ʻana i nā ʻenehana insulin (ʻoi aku ka hoʻonui ʻana o ka kao o ka glucose a me ka metabolism).

ʻO ka Biguanides (ʻaʻole e like me derony o ka sulfonylurea) ʻaʻole e hōʻemi i ke kahe koko i loko o ka poʻe olakino a me nā mea maʻi me ka maʻi type type 2 ma hope o ka pōʻaiʻai pōkole, akā kau palena ka nui o kona hoʻonui ma hope o ka ʻai ʻana, me ka ʻole ka kumu hypoglycemia.

ʻO ka biguanides hypoglycemic - metformin a me nā mea ʻē aʻe - e hoʻohana ʻia no ka mellitus type type 2. Ma ka hoʻohui ʻana i ka hopena o ke kōkōlohi, ʻo biguanides, me ka hoʻohana lōʻihi, he hopena maikaʻi i ka metabolise lipid. Hōʻalo ka lāʻau o kēia pūʻulu i ka lipogenesis (ka hana i hoʻohuli ai ka glucose a me nā mea waiwai ʻē aʻe i loko o nā momona momona i loko o ke kino), hoʻāla i ka lipolysis (ke kaʻina hana o nā lipids, ka nui o nā triglycerides i loaʻa ka momona, i loko o ko lākou mau momona momona papa e ka hana a ka lipase enzyme), hoʻemi i ka momona, a e hoʻolauleʻa mea kaumaha. I kekahi mau hihia, ua hoʻohana ʻia ko lākou hoʻohana me ka hoʻokaʻawale ʻana o nā kiko o ka triglycerides, cholesterol a me LDL (i hoʻoholo ʻia ma ka ʻōpū ʻole) i ka serum koko. Ma ka maʻi mellitus type 2, ua hui pū ʻia nā pilikia o ka hoʻoneʻe ʻana me nā loli iki i ka lipid metabolism. No laila, ʻo 85-90% o nā mea maʻi me ka diabetes type 2 he hoʻonui i ke kaumaha o ke kino. No laila, me ka hui pū ʻana o ka maʻi mellitus type 2 me ka nui loa, ke hōʻike ʻia nā lāʻau lapaʻau e hoʻoliʻiliʻi ana i ka hana lipid.

Ke hōʻike nei no ka hoʻokō ʻana o ka biguanides ʻo ka momo diabetes mellitus type 2 (ʻoi aku hoʻi i nā hihia i hele pū me ka obesity) me ka maikaʻi ʻole o ka mālama ʻana i ka ʻai, a me ka like ʻole o ka hoʻomākaukau ʻana o ka hoʻomākaukau ʻana o ka sulfonylurea.

I ka loaʻa ʻole o ka insulin, ʻaʻole i ʻike ʻia ka hopena o ka biguanides.

Hiki ke hoʻohana pū ʻia ʻo Biguanides i ka hoʻohui me ka insulin i mua o ke kū kūʻē ʻana iā ia. ʻO ka hui pū ʻana o nā lāʻau lapaʻau me nā derivatives sulfonamide i hōʻike ʻia i nā hihia ʻaʻole e hāʻawi ka mea hope i ka hoʻoponopono piha ʻana i ka maʻi metabol. Hiki i Biguanides ke kumu i ka hoʻomohala ʻana o ka acidact lactic (lactic acidosis), ka mea e palena i ka hoʻohana ʻana i nā lāʻau lapaʻau ma kēia hui.

Hiki ke hoʻohana pū ʻia ʻo Biguanides i ka hoʻohui me ka insulin i mua o ke kū kūʻē ʻana iā ia. ʻO ka hui pū ʻana o nā lāʻau lapaʻau me nā derivatives sulfonamide i hōʻike ʻia i nā hihia ʻaʻole e hāʻawi ka mea hope i ka hoʻoponopono piha ʻana i ka maʻi metabol. Hiki i Biguanides ke kumu i ka hoʻomohala ʻana o ka acidact lactic (lactic acidosis), ka mea e palena i ka hoʻohana ʻana i kekahi mau lāʻau lapaʻau i kēia hui.

ʻO Biguanides ka contraindicated ma ke alo o ka acidosis a me ke ʻano he (hoʻonāukiuki a hoʻonui i ka hōʻemi o ka lactate), i nā kūlana i hele pū me ka hypoxia (me ka puʻuwai o ka naʻau a me ka hanu, ka wili o ka myocardial infarction, akene cerebrovascular insufficiency, anemia), etc.

Hoʻomaʻamaʻa pinepine ʻia nā hopena o ka biguanides ma mua o nā derivatives sulfonylurea (20% kūkaʻi 4%), ka mea mua loa, ka hopena ʻeha o ka gastrointestinal: ka ʻaha metallic i loko o ka waha, nā hōʻailona dyspeptic, a me nā mea like ʻole i ka derivatives sulfonylurea, hypoglycemia i ka wā e hoʻohana ai i ka biguanides (e.g. metformin ) e loaʻa pinepine ai ʻole.

ʻO ka acidactact lactic, ka mea i ʻikeia i ka wā e lawe ai i ka metformin, ka mea i manaʻo ʻia he hoʻopiʻi koʻikoʻi, no laila ʻaʻole pono ke ʻano o ka metformin no ka pohō ʻana o ka pilikia a me nā kūlana e wānana i kona hoʻomohala - hana i ka mālamalama a me / a i ʻole hana i ka puʻuwai, hōʻemi puʻuwai, pathology lung.

ʻAʻole hiki ke kuhikuhi ʻia ʻo Biguanides i ka manawa like me ka cimetidine, no ka mea ke hoʻokūkū nei lākou me kēlā me kēia ma ke ʻano o ka honi tubular i loko o nā keiki, hiki ke alakaʻi i ka kumulima o ka biguanides, a me ka manawa, hoʻemi ʻo cimetidine i ka biotransformation o biguanides i loko o ka ate.

ʻO ka hui pū ʻana o ka glibenclamide (kahi derivative o ka sulfonylurea o ka lua o ka hanauna) a me ka metformin (biguanide) i hoʻohui pū ʻia i ko lākou mau waiwai, e ʻae iā ʻoe e hoʻokō i ka hopena hypoglycemic makemake i kahi haʻahaʻa haʻahaʻa o kēlā me kēia lāʻau lapaʻau a laila hōʻemi i ka hopena o nā hopena ʻaoʻao.

Mai ka makahiki 1997, ua komo ʻoe i ka hana lapaʻau hoʻomokuʻu ʻia (glitazones), ke kumu o ke kūmole kula o ke kahe thiazolidine. ʻO kēia pūʻulu hou o nā hui antidiabetic e pili pū me ka pioglitazone a me rosiglitazone. Hoʻonui ka mea hōʻeu o kēia pūʻulu i ka ʻike ʻana o nā ʻōpala kiko (kūpū, pili adipose, ate) i ka insulin, hoʻohaʻahaʻa ka lipid synthes i nā ʻāʻī a me nā momona. ʻO Thiazolidinediones kahi poʻe agonist koho o nā receptor nuklea PPARγ (peroxisome proliferator-activated receptor-gamma). Aia i loko o nā kānaka, aia kēia mau mea i loko o ka "ʻōpala kiko" nui e pono ai no ka hana insulin: i ka pili adipose, ma ka ʻāwili a me nā puʻuwai. Hoʻomaʻamaʻa nā ʻona kaulike o ka PPARγ i ka hoʻololi ʻana i nā hua i ka hoʻonā i nā insulin e pili ana i ka mālama ʻana i ka hana o ka glucose, ka lawe ʻana a me ka hoʻohana ʻana. Eia kekahi, ʻo ka genARγ-isens kino pili i ka hana o ka aila o nā momona momona.

I mea e hoʻohana ai i nā thiazolidinediones i kā lākou hopena, pono ka loaʻa ʻana o ka insulin. Ke hōʻemi nei kēia mau lāʻau i ka pale ʻana o ka insulin i nā kinipona peripheral a me ka leʻa, hoʻonui i ka ʻai o nā glucose i hilinaʻi ʻia o ka insulin a hōʻemi i ka hoʻokuʻu ʻana o ka glucose mai ka ate, hoʻohaʻahaʻa hoʻi i ka triglycerides kiʻekiʻe, hoʻonui i ka ʻike o HDL a me ka kolamu, a pale aku i ka wikiwiki hyperglycemia ma hope o ka ʻai ʻana, me ka hemoglobin glycosylation.

Nā Kuhi Inoa o Alpha Glucosidase (acarbose, miglitol) pale i ka wāwahi i ka poly- a me oligosaccharides, e hōʻemi ana i ka hana a me ka lawe ʻana o ka glucose i loko o ka ʻāpana a pale i ke kūkulu ʻana i ka hyperglycemia postprandial. Lawe ʻia nā kalaiwa i ka ʻai o ka ʻai i nā wahi i lalo o nā ʻōpū liʻiliʻi a me nā koina nui, aʻo ka lilo ʻana o nā monosaccharides i ka lōʻihi o nā hola 3-4. ʻAʻole e like me nā ageneke hypoglycemic sulfonamide, ʻaʻole lākou e hoʻonui i ka hoʻokuʻu ʻana i ka insulin a, no laila, mai kumu i ka hypoglycemia.

Ua hōʻike ʻia ka lōʻihi o ka acarbose therapy me ka hoʻokaʻawale nui ʻana i ka pilikia o ka hoʻomohala ʻana i nā hoʻopiʻi cardiac o kahi ʻano atherosclerotic. Hoʻohana ʻia nā inhibitors alpha glucosidase e like me ka monotherapy a i ʻole pū me nā mania hypoglycemic waha. ʻO ka dosis mua ka 25-50 mg koke ma mua o i ka manawa o ka ʻai, a ma hope e hiki ke hoʻonui pinepine ʻia (ʻoi ʻia ka nui o kēlā me kēia lā he 600 mg).

ʻO nā ʻōmaka no ka hoʻohana ʻana o nā inhibitors alpha-glucosidase ʻo ka type 2 diabetes mellitus me ka hui ʻole o kaʻai ʻana i ka meaʻai (ʻo ka papa o ia mea e liʻiliʻi ai ma 6 mau mahina), ʻo ia hoʻi ka type 1 diabetes mellitus (ma ke ʻano o ka hoʻohui hui).

Hiki i nā mākaukau o kēia pūʻulu e nā mea iʻike ʻia i nā dyspeptic i hoʻoneʻe ʻia e ka hoʻowalewua a me ka hoʻopili ʻana ʻana o nā ʻaina, i hana ʻia i ka ʻōpū me ka hoʻokumu ʻana i nā momona momona, carbon dioxide a me ka hydrogen. No laila, i ke koho ʻana i nā mea paʻa o alpha-glucosidase, pili pono i ka ʻai me ke ʻano o ka nui o nā mea laʻa paʻakikī, a me ke ʻano huehue

Hiki ke hoʻohui ʻia ka Acarbose me nā mea hana āpau antidiabetic. Hoʻonui ka neomycin a me ka colestyramine i ka hopena o ka acarbose, ʻoiai ke neʻe a me ka paʻakikī o nā hopena ʻaoʻao mai ka gastrointestinal tract hoʻonui. Ke hui pū me nā antacids, adsorbents a me nā enzyme e hoʻomaikaʻi i ka hoʻowalewale ʻana, hōʻemi ʻia ka hopena o ka acarbose.

I kēia manawa, ua puka mai kahi papa hou o nā mea lawelawe hypoglycemic hou - incretinomimetics. ʻO nā increcins he mau hormon ka mea i hūnā ʻia e kekahi ʻano o nā pūnao liʻiliʻi i pane mai i ka ʻaina meaʻai a hoʻoulu i ka huna ʻana o ka insulin. Ua hoʻokaʻawale ʻia nā mau lua ʻelua: nā polipuleida-like polipona (GLP-1) a me nā glucose-e hilinaʻi nei i ka insulinotropic polypeptide (HIP).

E hoʻolōʻihi i ka addetinomimetics 2 mau hui o nā lāʻau lapaʻau.

- nā mea e hoʻopalike ai i ka hopena o GLP-1 - nā mea kikoʻī o GLP-1 (liraglutide, exenatide, lixisenatide),

- nā mea e hoʻolalelale ana i ka hana o ka endogenous GLP-1 ma muli o ka polaka o ka dipeptidyl peptidase-4 (DPP-4) - kahi huaheima e hoʻopau ai i ka GLP-1 - DPP-4 inhibitors (sitagliptin, vildagliptin, saxagliptin, linagliptin, alogliptin).

No laila, ʻo ka pūʻulu o nā loio hypoglycemic helu i nā helu lapaʻau kūpono. He ʻokoʻa ʻē kā lākou hana o ka hana, ʻokoʻa nā mea hoʻohālike pharmacokinetic a me nā pākaʻi pharmacodynamic. Ka ʻike i kēia mau hiʻohiʻona e hiki i ke kauka ke hana i kahi mea pilikino loa a me ke koho kūpono o ka lāʻau.

Nā Hoʻohui

• 1. ʻAno maʻi type 1.
• 2. Dietic ketoacidosis (he keu ka nui o ke koko o nā ketone mau kino), coma.
• 3. ʻōpū a me ka lactation.
• 4. Nā maʻi maʻi māhā a me nā huelo o ka hana paʻa ʻole.
• 5. Haumaha puʻuwai.
• 6. ʻO ka maʻi o ka maʻi lapaʻau.

Hoʻom hoʻomākaukau a Thiazolidinedione

ʻO Troglitazone (Rezulin) ka lāʻau o ka hanauna mua o kēia hui. Hoʻomau ʻia ʻo ia mai ke kūʻai aku ʻana, ʻoiai he hopena maikaʻi loa kona hopena i ka ate.

ʻO Rosiglitazone (Avandia) kahi lāʻau lapaʻau hanana kolu i kēia pūʻulu. Ua paʻa i ka hoʻohana ʻia ma ka 2010 (ua pāpā ʻia i loko o ka European Union) ma hope o kona hōʻoia ʻia ʻana e hoʻonui i ka nui o ka maʻi o ka maʻi maʻi.

Hoʻohana ikaika

Eia kekahi, ua hōʻike ʻia he lāʻau lapaʻau kekahi mau mea pōmaikaʻi hou.

• Hoemi ke koko
• Hoʻopilikia i ka pae o ka cholesterol (hoʻonui i ke alo o ka "cholesterol maikaʻi", ʻo ia hoʻi, HDL, a ʻaʻole e hoʻonui i ka "kino kino" - LDL),
• Mālama i ka hoʻokumu a me ka ulu ʻana o ka atherosclerosis,
• Hoʻemi i ka hōʻeha o ka maʻi naʻau (e.g., hōʻeha ka naʻau, ka ʻoka).

E heluhelu hou: E mālama ʻo Jardins i ka naʻau

ʻO nā pioglitazone e kuhikuhi ʻia

Hiki ke hoʻohana ʻia Pioglitazone ma ke ʻano he lāʻau ʻai hoʻokahi, i.e. monotherapy. Eia kekahi, inā ʻoe i ka maʻi mellitus type 2, ʻo kou mau loli i ke ola e hāʻawi i nā hopena i manaʻo ʻia a aia nō nā contraindications to metformin, ʻo kona palaka maikaʻi ʻole a me nā hopena hopena paha.

Hiki ke hoʻohana ʻia ka pioglitazone me ka hoʻohui i nā lāʻau antidiabetic e like me ka laʻana, ka acarbose) a me ka metformin inā ʻaʻole i lawe ʻia nā hana ʻē i ka kūleʻa.

Hiki ke hoʻohana ʻia ʻo Pioglitazone me ka insulin, e ʻike pū i nā poʻe e kūleʻa ke kino i ka metformin.

E heluhelu hou: Pehea e lawe ai i ka metformin

Pehea e lawe ai i ka pioglitazone

Pono ka lāʻau lapaʻau ʻia i hoʻokahi manawa i ka lā, ma ke ʻano, i ka manawa paʻa. Hiki i kēia ke hana ma mua a ma hope o ka ʻai, no ka mea ʻaʻole i pili ka meaʻai i ka hoʻopili ʻana o ka lāʻau. ʻO ka maʻamau, hoʻomaka ka hoʻomaʻamaʻa me ka liʻiliʻi haʻahaʻa. I nā wahi i loaʻa ʻole ka hopena o ka mālama ʻana, hiki ke hoʻonui iki ʻia.

Hoʻohana ʻia ka hopena o ka lāʻau i nā hihia i kahi e pono ai e mālama i ka maʻi diabetes type 2, akā ʻaʻole hiki ke hoʻohana ʻia ka metformin, monotherapy me hoʻokahi lāʻau lapaʻau i ʻae ʻia.

I ka ʻoi aʻe o ka pioglitazone e hōʻemi i ka glycemia postprandial, ka glucose o ka plasma a hoʻopaʻa hou i ka hemoglobin glycated, he hopena hou nō hoʻi ia ma ke kaʻe o ke koko a me ka kolamu koko. Eia kekahi, ʻaʻole ia e hoʻomaka i nā anomalies.

Hoʻom hoʻomākaukau a Thiazolidinedione

Thiazolidinediones (TZD) - kahi papa hou o ka lāʻau antidiabetic no ka hoʻohana waha. ʻO nā lāʻau lapaʻau Thiazolidinedione (pioglitazone, rosiglitazone) i komo i ka hana lapaʻau i nā makahiki wale nō. E like me biguanides, ʻaʻole i hoʻonāuki ʻia kēia mau lāʻau i ka huna ʻana o ka insulin, akā e hoʻonui i ka naʻau o nā ʻiʻo peripheral iā ia. ʻO nā hoʻohālikelike o kēia papa e hana i ka poʻe agonists o nā mea hoʻokipa nukini PPAR-y nole (receptor peroxisome proliferator-activated). ʻIke ʻia kēia mau mea kākau i nā momona, nā uaua a me nā pili o ke akeo. Hoʻololi i ka hoʻonāukiuki ʻana o ka poʻe PPAR-y i ka hoʻolilo ʻana i kahi nui o nā huaʻōlelo i pili me ka hoʻouna ʻana i nā hopena o ka insulin no ka komo ʻana o ka glucose a me nā lipids i loko o nā hale. Hoʻohui i ka hoʻohaʻahaʻa i ka pae o ka glycemia, hoʻomaikaʻi i ka hoʻonaninani ʻana i nā kiko i ka insulin ʻoluʻolu e hoʻopilikia i ka profile lipid (ka nui o ka kiʻekiʻe o ka lipoproteins kiʻekiʻe, e emi ana ka ʻike o ka triglycerides). Hāʻawi ʻia i kēia mau lāʻau me ka hoʻoulu ʻana i ka gen transkrip, e hoʻopau i 2-3 mau mahina e loaʻa ai ka hopena kiʻekiʻe. Ma nā haʻawina loiloi, ua hāʻawi kēia mau lāʻau i ka hōʻemi ma o ka pae o HbAc me ka hoʻokalakupua i ka manawa o 0.5 i ka 2%.

Hiki i nā mea hōʻemi o kēia papa ka hoʻohui i ka PSM, insulin a me ka metformin paha. Hoʻohui ʻia ka hui me ka metformin ma muli o ka hana o ka biguanides e kuhikuhi nui ʻia i ka hoʻopaʻa ʻana i ka gluconeogenesis, a me ke hana o ka thiazolidinediones e kuhikuhi ana i ka hoʻonui ʻana i ka hoʻohana ʻana i peripheral glucose. Hoʻohana lākou lākou ʻaʻole i ka hypoglycemia (akā, e like me ka biguanides, hiki iā lākou ke hoʻonui i ka nui o ka hypoglycemia i hui pū me nā lāʻau lapaʻau e hoʻoikaika i ka hana huna ʻana o ka insulin). ʻO ka hopena nui ʻo ka hoʻohana ʻana i ka glucose o peripheral a me ka hoʻohaʻahaʻa ʻana i ka glycogenesis ma o ka hoʻōlaʻana o nā ʻano pehu o insulin (hoʻemi i ka pale ʻana i ka insulin). ʻO Thiazolidinediones e like me ka mea hoʻohana i ka hoʻopau ʻana i ka pale o ka insulin, ke kumu alakaʻi o ka hoʻomohala ʻana i ke ʻano type type 2, ʻo ia ka hui e hoʻohala ʻia nei i nā lāʻau lapaʻau no ka pale ʻana i ka maʻi diabetes type 2. ʻO ka hopena pale o ka thiazolidinediones e hoʻomau i nā manawa he 8 mau mahina ma hope o kona hoʻohemo ʻana. Aia kekahi manaʻo hoʻohiki ka glitazones i hiki ke hoʻoponopono pololei i ka genetic defect o ka pakanā o ka glucose, ka mea e ʻae ʻole i ke kau i ka hoʻomohala ʻana o ka maʻi type 2, akā ke hoʻopau pono loa i kona hoʻomohala ʻana.

Akā, ma kēia manawa, ʻo kahi maʻi maʻi wale nō.

ʻO ka hoʻohana ʻana o thiazolidinediones i nā mea maʻi me ka maʻi diabetes type 2 e wehe i nā kuʻuna no ka pale ʻana i nā hoʻopiʻi cardiovascular, nā hana hoʻomohala i ka nui o ka pale ʻana i ka insulin. Loaʻa nā ʻikepili mua e pili ana i ka hopena angioprotective o thiazolidinediones i loko o kekahi mau hoʻokolohua hoʻokolohua. ʻAʻole nō ke ʻano hana me nā haʻawina like like.

ʻEkolu mau makahiki o ka thiazolidinediones ma ka honua:
- "huaʻohana" hanauna mua - troglitazone (hōʻike i kahi hopena hepatotoxic a me ka hopena cardiotoxic, i pili pū me ka mea i pāpā ʻia e hoʻohana ʻia),
- ka lāʻau lapaʻau o ka "lua lua" - pioglitazone,
- ka hua ʻōpio "ʻekolu kuʻuna" - rosiglitazone.

I kēia manawa, kahi lāʻau mai ka lua o nā hanauna thiazolidinediones - actos (pioglitazone hydrochloride) mai Eli Lilly (USA) a me ka hanauna ʻekolu - avandium (rosiglitazone) i hoʻopaʻa ʻia ma Russia. Loaʻa nā Actos i ke ʻano o nā papa i loaʻa he 15.30 a me 45 mg o ka wai hoʻāno pioglitazone hydrochloride, hoʻokahi manawa i ka lā, me ke ʻano o ka komo ʻana o ka meaʻai.

ʻO ka lā helu o kēlā me kēia lā he 30-45 mg. Loaʻa ka avandium o Glaxo SmithKJine (GSK) i loko o nā papa pākau e loaʻa ai ka 4 a me 8 mg o ka waiwai ikaika o rosiglitazone, hoʻokahi a ʻelua paha lā i kēlā me kēia lā, no ka mālama o ka meaʻai. ʻO kēlā me kēia lā o 8 mg. Ua hoʻolālā ʻia e hoʻokau like ʻo ka hui ʻo ia hui pū ʻia - Avandamet (kahi hui o avandia a me metformin).

Hoʻohana ʻia nā Thiazolidinediones ma ke ʻano monotherapy, akā ʻoi aku ka maikaʻi ma ka hui ʻana me biguanides, acarbose, PSM, insulin i nā mea maʻi me nā maʻi type 2. ʻO ka hoʻohana palena wale ʻana o kēia pūʻulu o nā lāʻau lapaʻau ma muli o kā lākou kumu kūʻai nui.ʻO ka lāʻau lapaʻau, nona nā hua lua o ka thiazolidinediones, ʻaʻole i hōʻike i ka hopena hepatotoxic. Hoʻōla ʻole ʻo Pioglitazone i ka puʻuwai, hana i nā metabolites ikaika, hoʻopiʻi nui ʻia me ka bile. Hiki i kekahi o nā hopena hopena ke hiʻohiʻona o ka edema, a me ka loaʻa ʻana o ka paona. E kūlike i ka mea pili i ka mālama ʻana, ua pono e hoʻomalu i ka pae o ke alanine a me aspartic aminotransferase a kāpae i ka lawe ʻana i ka lāʻau i ka pae o ka enzyme ʻelua ʻelua o ke ʻano. He mea loiloi e loiloi i ka hopena o ka lāʻau lapaʻau me ka hoʻomehana lōʻihi (3-mahina). Nā pālua:
- momo type diabetes
- ketoacidosis me kekahi ʻano maʻi o ka maʻi maʻi,
- ka hāpaiʻana, lactation,
- keu aku o ke ano o ka alanine transferase 3 manawa,
- ka maʻi viral, huʻipiʻi maʻiʻole,
- ka maʻi maʻi maʻi hepatitis.

Hōʻalo ʻia o ka Diabetes Type 2

Ua hōʻike ka hoʻokolohua lapaʻau DREAM i kahi hōʻemi o ka hoʻomohala ʻana i ka maʻi diabetes i ka poʻe maʻi me ka hoʻomanawanui i ka hoʻohaʻahaʻa glucose a me ka hoʻonui ʻana o ka wikiwiki o ka glucose i ka poʻe maʻi e lawe ana i ka rosiglitazone (11, ʻike pū kekahi). Ua hōʻike ʻia kēia noiʻi hiki ke loli i ka hoʻomohala ʻana o ka maʻi diabetes ma nā makahiki he 1.5, akā ke piʻi aʻe ka nui o ka ulu ʻana a lilo ia like me ka hui plasebo.