Kev cuam tshuam los ntawm leeg

Kev faib tawm cov tshuaj: thawj thawj thiab tiam thib ob, thiab lub thawj tiam yog tsis siv niaj hnub no vim muaj qhov loj ntawm cov kev mob tshwm sim tsis zoo, thaum qhov tseeb tshaj plaws muaj cov tshuaj kho tau zoo tshaj plaws thiab tsis tshua pom cov tsos mob tshwm sim.

Txoj kev sib xyaw thiab cov tshuab ntawm kev txiav txim

Sulfonylurea derivatives, tshuaj uas qhib cov hlwb noj qab nyob zoo xwb. Lawv cov kev ua ntawm kev ua yog pib ua kom muaj kev zais ntawm cov kua dej los ntawm cov qog. Txhawm rau ua qhov no, nws yog qhov tsim nyog los thaiv cov channel uas tsis pub cov calcium tuaj rau hauv lub cell thiab inhibit nws qhov depolarization. Thaum tau txais cov calcium, lub cell tau zoo siab heev thiab pib zais insulin, uas nyob rau hauv ntshav qab zib mellitus yog nyob rau hauv cov ntshav hauv cov ntshav ntau vim tias txo qis cov ntaub so ntswg ntxig rau insulin.

Ntawm cov ntshav qab zib, piam thaj nkag mus rau hauv cov ntshav thiab cov plab hnyuv siab raum, tab sis cov qib insulin tsis txaus yuav nqus tsis tau. Cov tshuaj uas muaj sulfonylurea nyob rau hauv lawv cov muaj pes tsawg leeg nres lub caij nyoog tsis zoo no.

Yog li, qhov tseem ceeb los ntawm cov tshuaj tsim los ntawm sulfonylurea yog:

• Pancreatic cell stimulation
• Tiv thaiv cov tshuaj insulin los ntawm cov enzymes thiab cov tshuaj tiv thaiv uas ua kom tawg,
• Pab txhawb tsim ntawm receptors rau insulin thiab rhiab ntawm cov hlwb rau nws,
• Lawv inhibit gluconeogenesis, uas yog, kev sib txuas ntawm cov piam thaj los ntawm lwm yam tshuaj, thiab kuj txo cov ketone lub cev,
• Txwv tsis pub rhuav tshem cov rog,
• Nyob rau hauv parallel, lub tso pa tawm ntawm pancreatic glucagon thiab somatostatin yog sim,
• Muab lub cev nrog zinc, hlau.

Daim ntawv teev cov tshuaj 1 tiam:

• Carbutamide
• Tolbutamide
• Chlorpropamide
• Tolazamide

Tshuaj ntawm cov pab pawg no tau sau tseg rau kev kho mob ntawm hom 2 mob ntshav qab zib mellitus nkaus xwb, qhov twg rhiab ntawm cov hlwb rau cov tshuaj insulin tsis muaj zog. Tus mob ntshav qab zib hom 1, tus txiav tsis tuaj yeem ua tag nrho nws cov haujlwm.

Tseem Ceeb! Nws tuaj yeem raug kho raws li kev kho mob monotherapy, lossis kev sib xyaw nrog cov tshuaj ntawm lwm pab pawg, tab sis nws yog kiag li contraindicated yuav siv ntau cov tshuaj los ntawm tib pab pawg ntawm ib zaug.

Nws ntseeg tau hais tias tus kab mob tsis tuaj yeem tswj tau, nrog txoj kev kawm tau ntev, tsis muaj kev tawm tsam ntawm kev kho mob nrog lwm cov tshuaj ntshav qab zib, yog qhov qhia tau rau kev teem caij cov tshuaj tau piav qhia hauv tsab xov xwm no.

Cov kev thaiv tsis zoo thiab cov tshwm sim

Vim tias qhov tseeb tias cov tshuaj yog metabolized los ntawm daim siab thiab qee yam los ntawm ob lub raum, kev kho yog contraindicated nyob rau hauv cov kab mob mus ntev ntawm cov zis thiab cov kab mob nrog qhov tshwm sim ntawm qhov tsis muaj txhij txhua.

Tsis tas li, koj tsis tuaj yeem sau cov tshuaj no:

• Cov menyuam yaus hnub nyoog qis dua 18 xyoo, txij li qhov ntxim rau cov menyuam yaus lub cev tsis tau hais meej,
• Cov poj niam cev xeeb tub thiab thaum lactation (raws li nws tau raug pov thawj tsis zoo rau cov xwm txheej ntawm tus me nyuam hauv plab thiab tus menyuam),
• Yam 1 ntshav qab zib.

Tsuas tshuaj thiab tswj hwm

Cov tshuaj muaj nyob hauv ntsiav tshuaj, noj ntawm qhov ncauj. Qhov ntau npaum li cas yog nyob ntawm daim ntawv ntawm kev tso tawm ib qho tshuaj tshwj xeeb, nws muaj pes tsawg leeg thiab mob ntawm tus neeg mob, cov txiaj ntsig ntawm nws cov tshuaj ntsuam, kab mob concomitant thiab lwm yam xwm txheej.

Kev tiv thaiv kev nyab xeeb

Nws yog ib qho tseem ceeb tshwj xeeb los mus saib xyuas tsis yog txoj haujlwm tau zoo xwb, tabsis tseem ceeb toom rau kev kho ntshav qab zib rau cov neeg muaj kab mob siab thiab mob raum. Vim tias tsis muaj detoxification kev ua haujlwm ntawm cov kabmob no, qib ntawm cov tshuaj hauv ntshav tuaj yeem nce ntxiv thiab ua rau muaj kev phiv loj heev.

Cov poj niam cev tsis tab seeb yuav tsum tsis txhob siv cov ntaub ntawv pab pawg ntawm hypoglycemic tus neeg sawv cev thiab hloov mus rau insulin rau lub sijhawm ntawm kev coj tus kheej thiab pub mis rau tus menyuam.

Ntxiv rau cov ntshav qab zib, cov neeg laus thiab cov neeg mob uas mob nyhav ntev yuav tsum tau ceev faj los sau pawg tshuaj no vim tias qhov kev pheej hmoo siab ntshav qab zib thiab qhov nyuaj ntawm kev tsim cov tshuaj tiv thaiv.

Kev sib cuam tshuam ntawm PSM nrog lwm yam tshuaj

Nws yog ib qho tseem ceeb uas yuav tau ua tib zoo saib xyuas kev sib koom ua ke ntawm kev kho nrog lwm cov tshuaj, tshwj xeeb tshaj yog thaum kho cov tshuaj rau ob peb tus kab mob sib kis.

Qee pawg ntawm cov tshuaj tuaj yeem ua rau qhov kev nqis tes ua ntawm sulfonylurea derivatives lossis rov qab sab nraud, tiv thaiv lawv cov kev txiav txim siab, uas yuav tsum tsis muaj kev txiav tawm ntawm lawv txoj kev siv.

Txhawm rau tsim txoj kev tseeb ntawm kev kho tshuaj, nws yog qhov tsim nyog rau tus kws kho mob endocrinologist kom ua tib zoo kawm cov tshuaj ntawm lwm tus kws tshaj lij thiab cov npe tshuaj uas tus neeg mob tau noj tas mus li.

Lwm cov kab mob hypoglycemic, ntxiv rau sulfonylurea derivatives, yog cov pab pawg ntawm cov tshuaj hluavtaws uas tseem cuam tshuam rau insulin secretion.

“Dmitry, 67 xyoo. Tsis ntev los no, ntshav qab zib tau tsim mus rau qhov muaj mob ntau heev, yuav tsum tau mus pw hauv tsev kho mob nrog cov ntshav qab zib thiab cov ntshav siab, pom kev. Tus kws kho mob tseem tau ntxiv glibenclamide rau metformin. Kuv tau noj nws rau ntau tshaj peb lub hlis. Qab zib tau poob, xeev siab yog qhov kev txhawj xeeb me ntsis, tab sis tsis zoo li yuav tsum tshem tawm txoj kev kho mob. Kuv zoo siab tias ntshav qab zib tau poob qis. "

“Andrey, 48 xyoo. Kuv tau muaj mob ntau dua tsib xyoos. Tau ntev, txawm tias muaj ntau npaum li cas ntawm "metformin" tshem tawm kom tsis muaj piam thaj hauv qhov qub. Kuv yuav tsum tau ntxiv glimepiride, nws tau yooj yim dua. Qab zib tau poob thiab tseem nyob ntawm qhov ntau ntawm 7-7.5, tsis muaj kev phiv tshuaj. Kuv tsis tu ncua kuaj kuv tus mob, xeem kev sib tham thiab sab laj nrog kuv tus kws kho mob, uas lees tias kuv ua haujlwm tau zoo. "

“Elena, 41 xyoo. Kuv tau mob ntev heev, Kuv tau sim siv tshuaj ntau thaum lub sijhawm no, tab sis thaum kuv hloov mus rau "glyclazide", kev nyob ruaj khov tuaj. Txhua qhov kev ntsuam xyuas tau rov qab zoo li qub, thiab tam sim no nws tau tuaj yeem txo qhov koob tshuaj kom tsawg kawg nkaus thiab ua rau cov piam thaj ib txwm dhau los ntawm kev noj haus thiab tawm dag zog. "

Ntau yam analogues thiab hloov pauv yuav txawv. Tus nqi muaj li ntawm 60-350 rubles rau ib pob. Lub chav kawm ntawm kev kho mob yuav tsum tau siv ntau yam nqi thiab ntau yam kev noj tshuaj ntawm kev noj tshuaj. Muag los ntawm cov tshuaj nkaus xwb. Ua ntej kev teem sij hawm, tus kws kho mob endocrinologist ua ib qho kev kuaj mob kom zoo nrog kev kuaj mob, kev kuaj ntshav kuaj mob los tsim kom muaj qhov xav tau ntawm kev teem sij hawm ntawm sulfonylurea derivatives.

Hauv thawj theem, mob ntshav qab zib tuaj yeem nres los ntawm kev noj haus nruj thiab qoj ib ce. Yog tias tus neeg mob tsis tuaj yeem tswj qib ntshav qabzib hauv txoj kev no, kev noj tshuaj yog raug kho. Lawv pib nrog kev txhaj tshuaj me, tus neeg mob lub neej thiab cov txiaj ntsig ntawm kev kho tau kuaj xyuas.

Yog tias kev kho mob tseem tsis tau tso tseg qhov mob, ces tus kws kho mob siv tshuaj kho mob hnyav, "tolbutamide" thiab cov tshuaj zoo sib xws muaj nyob hauv lawv pawg. Ua ntej yuav teem caij, nws yog ib qho tseem ceeb los txiav txim siab lub xeev kev ua haujlwm ntawm tus kws mob siab, mob siab thiab lub raum. Vim tias qhov tseeb tias kev tsim kho kom ntev ntev ntawm insulin secretion pib, qhov kev ua txhaum ntawm kev ua haujlwm ntawm beta hlwb yog ua tau. Tsis tas li ntawd, nws yog ib qho tseem ceeb kom tswj lub luag haujlwm ntawm cov kabmob uas cov metabolism hauv cov tshuaj tau nyaij.

Tus txheej txheem ntawm kev txiav txim ntawm sulfonylurea derivatives.

1. Txhim kho beta hlwb ntawm cov txiav (uas tswj cov theem ntawm cov kua dej hauv cov ntshav, xyuas kom meej sai ntawm kev tsim thiab kev ua haujlwm ntawm cov tshuaj insulin) thiab ua rau muaj kev cuam tshuam rau cov kua nplaum ntev.

2. Ua kom muaj zog ntawm kev ua haujlwm ntawm insulin, txwv qhov kev ua ntawm insulinase (ib qho enzyme uas tawg rau insulin), ua kom tsis muaj zog txuas ntawm insulin nrog cov protein, txo qhov khi ntawm insulin los ntawm cov tshuaj tiv thaiv.

3. Ua kom qhov mob rhiab heev ntawm cov leeg thiab cov nplawm adipose cov nqaij txais rau cov insulin, ua kom cov insulin ntau ntxiv rau ntawm cov nqaij mos.

4. Txhim kho cov piam thaj kev siv hauv cov leeg thiab nplooj siab los ntawm kev siv ua lub zog insulin endogenous.

5. Txwv tsis pub tso tawm cov piam thaj hauv lub siab, inhibit gluconeogenesis (kev tsim cov piam thaj hauv lub cev los ntawm cov protein, cov rog thiab lwm yam khoom tsis-carbohydrate), ketosis (cov ntsiab lus ntxiv ntawm ketone lub cev) hauv lub siab.

6. Hauv cov ntaub so ntswg adipose: inhibit lipolysis (qhov tawg ntawm cov rog), cov kev ua ntawm triglyceride lipase ntau lawm (ib qho enzyme uas zom triglycerides rau glycerol thiab dawb fatty acids), txhim kho qhov nqus thiab oxidation ntawm qabzib.

7. Txo kev ua haujlwm ntawm alpha hlwb ntawm islets ntawm Langerhans (alpha cells secrete glucagon, insulin antagonist).

8. Kev txwv tsis pub noj somatostatin secretion (somatostatin inhibits insulin secretion).

9. Tshaj tawm cov ntsiab lus hauv cov ntshav plasma ntawm zinc, hlau, magnesium.

Lawv inhibit qhov nyhuv hypoglycemic.

• Niacin thiab nws cov derivatives, saluretics (thiazides), tshuaj laxatives,
• indomethacin, cov thyroid hormones, glucocorticoids, sympathomimetics,
• barbiturates, estrogens, chlorpromazine, diazoxide, acetazolamide, rifampicin,
• isoniazid, tshuaj tiv thaiv hormonal, ntsev lithium, calcium channel blockers.

Sulfonylureas rau kev kho mob hom 2 ntshav qab zib

Sulfonylurea tshuaj mechanism ntawm kev txiav txim

Txhua yam tshuaj nyob rau hauv pab pawg no ua rau feem ntau beta hlwb ntawm cov txiav.

• Cov tshuaj no yog tsim nyob rau hauv hlwb pancreatic (lub npe thiaj li hu ua SUR1 receptor) thiab yog li txhawb cov tshuaj insulin zais cia. Qhov no ua rau muaj kev nce ntxiv hauv cov ntshav insulin, uas ua rau txo qis cov ntshav qab zib.
• Qhov no tsuas yog ua tau yog tias cov hlwb pancreatic muaj peev xwm tsim thiab tso tawm cov tshuaj insulin.
• Yog li, cov tshuaj no tsis ua haujlwm thiab tsis ua kom muaj kev cuam tshuam hauv hom ntshav qab zib 1.
• Raws li koj paub, muaj tus mob ntshav qab zib hom 2, cov hlwb beta "tsis tiav" thiab tsis muaj peev xwm tsim cov tshuaj insulin rau lub sijhawm. Hauv qhov no, nws twb yuav tsim nyog los ntxiv cov tshuaj insulin rau hauv lub cev hauv daim ntawv ntawm txhaj tshuaj subcutaneous, thiab kev siv sulfonylurea ua tsis tau zoo.
• Tsis tas li ntawd, kev tshawb fawb pom tau tias cov tshuaj no tuaj yeem nce qhov rhiab ntawm daim siab, cov leeg thiab cov rog ua rau insulin.

Sulfonylureas tshuaj rau leej twg yog kws kho

Cov tshuaj tau pom zoo yog tias koj muaj ntshav qab zib hom 2 thiab koj siv tsis tau Metformin vim yog qhov tsis sib xws lossis yog tias koj muaj kev phiv loj heev.

Txawm li cas los xij, hauv qhov xwm txheej no (tshwj xeeb yog tias koj rog dhau lossis rog dhau), tej zaum yuav muaj cov tshuaj pab tau zoo dua los ntawm cov pab pawg ntawm DPP-4 inhibitors (Trajenta, Onglyza, Kombolyze, Januvia, Galvus) lossis SGLT-2 inhibitors (Forxiga, Invokana) - vim tias lawv tsis txhob nce phaus, tsis zoo li sulfonylureas.

Hauv cov ntshav qab zib mellitus, yog tias koj noj cov tshuaj metformin, saib xyuas koj kev noj zaub mov kom zoo thiab tawm dag zog kom tsis tu ncua, thiab tseem tsis tau koj cov ntshav qab zib cov ntshav siab siab tshaj theem tau txais, sulfonylurea derivatives kuj yuav raug txiav txim raws li cov kauj ruam kho tom ntej.

Cov Yuav Tsum Tau Ua

Sulfonylurea derivatives yuav tsum tsis txhob siv rau cov xwm txheej hauv qab no:

• Kev tsis haum rau sulfonylurea lossis tshuaj tua kab mob los ntawm sulfonamide pawg (yog tias koj muaj kev fab tshuaj rau cov tshuaj tua kab mob xws li Bactrim, Biseptol, Trimesan, Uroprim - koj yuav tsum qhia koj tus kws kho mob)
• Yam 1 ntshav qab zib
• Ketoacidosis
• Cov mob ntshav siab thiab / lossis lub raum ua haujlwm tsis zoo (tshwj tsis yog glycidone, uas yog muab tau los ntawm cov kua tsib, yog li nws tuaj yeem siv yog tias muaj mob raum tsis ua haujlwm),
• Cev xeeb tub thiab lactation.

Cov tshuaj saum toj saud yuav tsum tsis txhob siv nyob rau hauv cov xwm txheej uas qhov xav tau ntawm lub cev insulin nce siab - piv txwv, muaj mob hnyav lossis phais txheej txheem. Hauv cov xwm txheej zoo li no, koj tus kws kho mob yuav qhia kom siv cov insulin ib ntus.

Derivatives ntawm sulfonylureas yuav ua li cas

Txhua yam tshuaj hauv pab pawg no tau noj ntawm qhov ncauj.

• Lawv yuav tsum tau noj ua ntej ua ntej los yog nrog noj mov.
• Glimepiride thiab Gliclazide txhawb kev tso tawm (piv txwv li, Diaprel MR) noj 1 zaug hauv ib hnub thaum sawv ntxov thaum noj tshais.
• Gliclazide siv ob zaug ib hnub.
• Cov qauv ntawm kev siv glycidone thiab glipizide nyob ntawm qhov koob tshuaj pom zoo - noj me me tuaj yeem siv ntau dua 2 lossis 3 zaug hauv ib hnub.
• Feem ntau, tus kws kho mob ua ntej pom zoo kom txo qis dua ntawm cov tshuaj, uas tom qab ntawd tuaj yeem nce ntxiv yog tias qhov ua tau zoo ntawm cov tshuaj muaj zog dhau (i.e. lub suab thaj tseem muaj ntau).
• Yog tias koj tsis nco qab noj tshuaj, tsis txhob nce qib ntxiv. Qhov no yog cuam tshuam nrog kev phom sij ntawm lub qog ntshav qab zib.
• Tsis txhob muab tshuaj rau tus kheej. Cov koob tshuaj yog tshuaj tshwj xeeb los ntawm koj tus kws kho mob.

Cov txiaj ntsig ntawm kev siv tshuaj pab pawg no:

• txo cov piam thaj
• cov txiaj ntsig zoo rau kev them nyiaj ntshav qab zib - qis dua glycated hemoglobin ntau ntau los ntawm 1-2% (zoo ib yam li metformin),
• ntxiv cuam tshuam los ntawm cov tshuaj cuam tshuam nrog nce cov nqaij mos rhiab rau insulin,
• yooj yim ntau npaum txoj kev
• tus nqi tsim nyog.

Sab Sij Huam ntawm Sulfonylurea Derivatives

Lub ntsiab cuam tshuam yog qhov phom sij ntawm hypoglycemia. Txoj kev pheej hmoo ntawm cov ntshav qog ntshav nce siab yog tias koj noj tshuaj ntxiv, xws li acenocumarol lossis warfarin, qee yam tshuaj tua kab mob, tshuaj aspirin, lossis lwm yam tshuaj uas tsis yog tshuaj steroidal, xws li ibuprofen.

Ntxiv rau, qhov kev pheej hmoo no nce ntxiv tom qab kev tawm dag zog lub cev, haus cawv thiab muaj kev cuam tshuam ntawm cov thyroid kab mob lossis kev noj zaub mov tsis zoo.

Lwm qhov kev tsis zoo tshwm sim ntau ntawm kev siv sulfonylurea yog qhov nce hauv lub cev hnyav, uas yog qhov tsis xav txog tus mob ntshav qab zib, txij li nws nce insulin tsis kam.