Izitatimende zesifo sikashukela kanye nesifo sikashukela kumanje kufundwa kabanzi futhi kusatshiswa kakhulu ososayensi abavela emhlabeni jikelele. Ucwaningo oluningi olusebenzise umphumela we-placebo lukwazile ukufakazela ukuthi ama-statins anciphisa kakhulu ubungozi bokuthola isifo senhliziyo.
Ngaso leso sikhathi, kunenqwaba yokuqaphela okubonisa iqiniso lokuthi ama-statin ohlobo lwe-2 mellitus wesifo sikashukela angandisa ubungozi bokuthi isifo sibe sibi kakhulu. Ikakhulu, kuma-diabetes, kukhona ukwanda koshukela wegazi, ngenxa yalokho okufanele uthathe i-Metformin noma ushintshe kuma-sartans.
Okwamanje, odokotela abaningi bayaqhubeka nokunquma izidakamizwa zesifo sikashukela. Ziyiqiniso kangakanani lezi zenzo zodokotela futhi kungenzeka yini ukuthi iziguli ezinesifo sikashukela zithathe ama-statin?
Ama-statins awuthinta kanjani umzimba?
I-Cholesterol iyinhlangano yamakhemikhali yemvelo ebandakanyekayo ekwenziweni kwama-hormone ubulili besifazane nabesilisa, ihlinzeka izinga elijwayelekile lokuphuma kwamangqamuzana omzimba.
Kodwa-ke, ngokweqile emzimbeni, isifo esibi - i-atherossteosis singakhula. Lokhu kuholela ekuphazamiseni ukusebenza okujwayelekile kwemithambo yegazi futhi kuvame ukudala imiphumela emibi, ngenxa yokuthi umuntu angahlupheka yini. Isiguli sivame ukuba nomfutho wegazi ophakeme ngenxa yokuqongelelwa kwama-cholesterol plaque.
Izimo ziyimithi yokwelapha esehlisa i-lipids noma i-cholesterol ne-low density lipoprotein - ifomu lokuhambisa cholesterol. Izidakamizwa zokwelapha zingezokwenziwa, zenziwe ngokwedlule, zingokwemvelo, kuye ngohlobo lwazo lwendabuko.
Umphumela ophawuleka kakhulu we-lipid-usetshenziswa yi-atorvastatin ne-rosuvastatin yemvelaphi yokwenziwa. Izidakamizwa ezinjalo zinesisekelo sobufakazi kunazo zonke.
- Okokuqala, ama-statins acindezela ama-enzyme adlala indima enkulu ekusithekeni kwe-cholesterol. Njengoba inani lama-lipids asemuva njengamanje lifinyelela kumaphesenti angama-70, indlela yokusebenza yezidakamizwa ibhekwa njengento ebalulekile ukuqeda le nkinga.
- Futhi, umuthi usiza ukwandisa inani lama-receptors amafomu okuhamba kwe-cholesterol kuma-hepatocytes. Lezi zinto zingabamba ama-lipoproteins ajikeleza egazini azidlulisele kumaseli wesibindi, lapho inqubo ukususwa kwemikhiqizo yokungcola yezinto eziyingozi egazini.
- Kubandakanya ama-statins akuvumeli ukuthi amafutha angeniswe emathunjini, okwehlisa izinga le-cholesterol engaphandle.
Ngaphezu kwemisebenzi ebalulekile ewusizo, ama-statin nawo abe nomphumela omuhle, okungukuthi, angasebenza "kumigomo" eminingana ngesikhathi esisodwa, athuthukise isimo jikelele somuntu. Ikakhulu, isiguli esiphuza le mishanguzo engenhla sithola ukuthuthuka kwezempilo okulandelayo:
- Isimo sokufakwa kwangaphakathi kwemithambo yegazi siyathuthuka;
- Umsebenzi wezinqubo zokuvuvukala uyancipha;
- Ukuvinjwa kwegazi kuyavinjelwa;
- Ama-spasms wemithambo enikezela nge-myocardium ngegazi ayakhishwa;
- Kwi-myocardium, ukukhula kwemithambo yegazi evuselelwe kuyakhuthazeka;
- I-Myocardial hypertrophy iyancipha.
Okusho ukuthi, singasho ngokuphephile ukuthi ama-statin anethonya elihle kakhulu lokwelapha. Udokotela ukhetha umthamo ophumelela kakhulu, ngenkathi noma umthamo omncane ungaba nomphumela wokwelapha.
Ukuhlanganiswa okukhulu yinani lemiphumela emincane ekwelashweni kwama-statin.
Izimo nezinhlobo zazo
Namuhla, odokotela abaningi bakholelwa ukuthi ukwehlisa i-cholesterol yegazi ngohlobo 2 sikashukela kuyisinyathelo esibalulekile sokululama. Ngakho-ke, le mishanguzo, njengamaSartan, inqunywa kanye nezidakamizwa ezifana neMetformin. Kubandakanya ama-statins kuvame ukusetshenziswa ngisho ne-cholesterol ejwayelekile ukuvimbela i-atherosulinosis.
Imithi yaleli qembu ihlukaniswa ukwakheka, umthamo, imiphumela emibi. Odokotela banaka ngokukhethekile isici sokugcina, ngakho-ke, ukwelashwa kwenziwa ngaphansi kokuqondisa kukadokotela. Lokhu okulandelayo yizinhlobo eziningana zezidakamizwa ukwehlisa i-cholesterol yegazi.
- Umuthi iLovastatin ukhiqizwa kusetshenziswa isikhunta esidlula inqubo yokuvutshelwa.
- Umuthi ofanayo yi-simvastatin yomuthi.
- Umuthi uPravastatin naye unokwakheka okufanayo nomphumela.
- Izidakamizwa zokwenziwa ngokuphelele zihlanganisa i-Atorvastatin, iFluvastatin, neRosuvastatin.
Umuthi osebenza kakhulu futhi osetshenziswa kakhulu yi-rosuvastatin. Ngokwezibalo, i-cholesterol esegazini lomuntu ngemuva kokwelashwa ngomuthi onjalo amasonto ayisithupha incishiswa ngamaphesenti angama-45-55. I-Pravastatin ithathwa njengesidakamizwa esisebenzayo esingatheni, sehlisa i-cholesterol ngamaphesenti angama-20 ukuya kwangu-35.
Izindleko zezidakamizwa zihlukile komunye nomunye, kuya ngomkhiqizi. Uma amaphilisi angama-30 eSimvastatin angathengwa ekhemisi cishe ngama-ruble ayi-100, khona-ke intengo yeRosuvastatin iyahlukahluka kusuka kuma-ruble angama-300 kuye kwangama-700.
Umphumela wokuqala wokwelapha ungatholakala kungaphambi kwenyanga yokwelashwa ejwayelekile. Ngokwemiphumela yokwelapha, ukukhiqizwa kwe-cholesterol ngesibindi kuyancishiswa, ukufakwa kwe-cholesterol emathunjini kusuka emikhiqizweni ethathiwe kuyancishiswa, izindawo ezivele zakheka i-cholesterol esembeni yemithambo yegazi ziyaqedwa.
Izimo zikhonjiswa ukusetshenziswa ku:
- isifo sokuqina kwemizwa;
- isifo senhliziyo, usongo lokuhlasela kwenhliziyo;
- isifo sikashukela i-mellitus ukuvimbela noma ukunciphisa izinkinga zokujikeleza kwegazi.
Kwesinye isikhathi ukuvela kwama-atherosselotic plaque kungabukwa ngisho ne-cholesterol ephansi.
Kulokhu, umuthi unganconyelwa nokwelashwa.
Isifo sikashukela kanye nesifo senhliziyo
Isifo sikashukela, kunengozi enkulu yemiphumela emibi emkhakheni wezinhliziyo ezihlangene. Abantu abanesifo sikashukela banamathuba aphindwe kahlanu kuya kweziyishumi okuba nesifo senhliziyo kunabantu abanoshukela wegazi ojwayelekile. Amaphesenti angama-70 alezi ziguli ngenxa yezinkinga anomphumela obulalayo.
Ngokusho kwabameli be-American Heart Association, abantu abanesifo sikashukela nalabo abatholakala benesifo samathambo abanesifo sokuwohloka kwengqondo basengozini efanayo yokufa ngenxa yengozi yenhliziyo. Ngakho-ke, isifo sikashukela asisona isifo esibi kangako kunezifo zenhliziyo ze-ischemic.
Ngokwezibalo, isifo senhliziyo sitholakala kumaphesenti angama-80 abantu abanesifo sikashukela sohlobo 2. Kumaphesenti angama-55 abantu abanjalo, ukufa kwenzeka ngenxa yokufakelwa kwamazinyo futhi ngamaphesenti angama-30 ngenxa yokushaywa unhlangothi. Isizathu salokhu ukuthi iziguli zinezici ezithile zobungozi.
Lezi zici ezisengcupheni yabanesifo sikashukela zifaka:
- Ukwanda ushukela wegazi;
- Ukuvela kokumelana ne-insulin;
- Ukwanda kwe-insulin egazini lomuntu;
- Ukuthuthukiswa kwe-proteinuria;
- Ukwanda kokuguquguquka okukhulu kwezinkomba ze-glycemic.
Ngokuvamile, ingozi yokuba nesifo senhliziyo ikhuphuka nge:
- isindwa ifa;
- iminyaka ethile;
- ukuba khona kwemikhuba emibi;
- ukuntuleka kokuzivocavoca umzimba;
- nge-hypertension ye-arterial;
- hypercholesterolemia;
- dyslipidemia;
- isifo sikashukela mellitus.
Ukwanda kokuhlushwa kwe-cholesterol egazini, ushintsho enanini le-atherogenic ne-antiatherogenic lipids yizici ezizimele ezandisa ingozi yokuthola izifo zesistimu yenhliziyo. Njengoba izifundo ezahlukahlukene zesayensi zibonisa, ngemuva kokujwayelekile kwalezi zinkomba, amathuba we-pathologies anciphisa kakhulu.
Njengoba unikezwe ukuthi isifo sikashukela sinomphumela omubi emithanjeni yegazi, kubonakala kunengqondo ukukhetha ama-statin njengendlela yokwelashwa. Kodwa-ke, ngabe le indlela eyiyo yokwelapha lesi sifo, ingabe iziguli zingazikhetha ama-Metformin noma ama-statin asehlolwe iminyaka kangcono?
Izimo nesifo sikashukela: ukuhambisana kanye nenzuzo
Ucwaningo lwakamuva luveze ukuthi ama-statins kanye nohlobo 2 sikashukela angahambisana. Izidakamizwa ezinjalo zinciphisa hhayi kuphela ukungasebenzi kahle, kepha futhi nokufa ngenxa yesifo senhliziyo kubantu abanesifo sikashukela. I-Metformin, njengama-statins, inomphumela ohlukile emzimbeni - yehlisa ushukela wegazi.
Imvamisa, umuthi obizwa nge-Atorvastatin ufakwa esifundweni sesayensi. Futhi nanamuhla, umuthi i-Rosuvastatin uzuze ukuthandwa okubanzi. Zombili lezi zidakamizwa ama-statins futhi zinemvelaphi yokwenziwa. Ososayensi baqhube izinhlobo eziningana zezifundo, kufaka phakathi i-CARDS, PLANET ne-TNT CHD - DM.
Ucwaningo lwe-CARDS lwenziwe ngokubamba iqhaza kwabanesifo sikashukela sohlobo lwesibili lwesifo, lapho indices ze-lipoprotein ezisezingeni eliphakeme zazingaphakeme kune-4.14 mmol / litre. Futhi phakathi kweziguli kwakudingeka ukhethe labo ababengenayo i-pathologies emkhakheni we-peripheral, cerebral and coronary artery.
Umuntu ngamunye obambe iqhaza ocwaningweni okungenani wayenengxenye eyodwa yobungozi:
- Umfutho wegazi ophakeme;
- I-retinopathy yesifo sikashukela;
- I-Albuminuria
- Ukubhema imikhiqizo kagwayi.
Isiguli ngasinye sasithatha i-atorvastatin ngesilinganiso se-10 mg ngosuku. Iqembu lokulawula bekuzothatha i-placebo.
Ngokusho kwalolucwaningo, phakathi kwabantu abathathe ama-statins, ubungozi bokuthola isifo sohlangothi bunciphe ngamaphesenti angama-50, futhi amathuba okuthi kube ne-myocardial infaration, i-angina engazinzile, ukufa kwe-coronary kungazelelwe kwehle ngamaphesenti angama-35. Njengoba imiphumela emihle yatholakala futhi kwavela izinzuzo ezisobala, izifundo zamiswa eminyakeni emibili edlule kunalokho obekuhleliwe.
Ekuqhubekeni kwesifundo se-PLANET, amakhono we-nephroprotective atorvastatin neRosvvatin anawo aqhathaniswa futhi afundwa. I-PLANET yokuqala engiyivivinyayo yayihilela abaguli abatholakala benesifo sohlobo I nesifo sikashukela sesi-2. Ababambe iqhaza ekuhlolweni kwe-PLANET II kwakungabantu abane-glucose ejwayelekile yegazi.
Isiguli ngasinye esifundiwe sasibonakaliswa yi-cholesterol ephakeme ne-proteinuria elinganiselayo - ukuba khona kwamaprotheni kumchamo. Bonke ababambiqhaza bahlukaniswa ngezikhathi ezithile baba ngamaqembu amabili. Iqembu lokuqala lathatha ama-80 mg e-atorvastatin nsuku zonke, kwathi elesibili lathatha ama-40 mg we-rosuvastatin. Izifundo zenziwa izinyanga eziyi-12.
- Njengoba kuhlolwe isayensi, ezigulini ezinesifo sikashukela ezathatha i-Atorvastatin, amazinga wamaprotheni omchamo ancipha ngamaphesenti ayi-15.
- Iqembu elithatha umuthi wesibili lalinokwehla kwezinga lamaprotheni lamaphesenti angama-20.
- Ngokuvamile, i-proteinuria ayizange inyamalale ngokuthatha iRosuvastatin. Ngaso leso sikhathi, bekunokwehla kwezinga lokuhlunga lomchamo, ngenkathi idatha evela ekusetshenzisweni kwe-Atorvastatin ibonakala ingashintshile.
I-PLANET engiyifundile ithola ngamaphesenti ama-4 abantu okwadingeka bakhethe i-rosuvastatin, ukwehluleka kwe-renal acute, nokuphindeka kabili kwe-serum creatinine. Phakathi kwabantu. ukuthatha i-atorvastatin, ukuphazamiseka kutholakale kumaphesenti angu-1 kuphela eziguli, kanti akukho shintsho olwatholakala kwi-serum creatinine.
Ngakho-ke, kwavela ukuthi umuthi owamukelwe i-Rosuvastatin, ngokuqhathaniswa ne-analogue, awunazo izinto zokuvikela ezinso. Ukufaka umuthi kungaba yingozi kubantu abanesifo sikashukela sanoma yiluphi uhlobo nokuba khona kwe-proteinuria.
Ucwaningo lwesithathu lwe-TNT CD-DM luhlolisise imiphumela ye-atorvastatin engcupheni yokuthola ingozi yemithambo yegazi nesifo se-coronary artery isifo sohlobo 2 sikashukela. Iziguli kwadingeka ziphuze i-80 mg yesidakamizwa ngosuku. Iqembu lokulawula lathatha lo muthi umthamo we-10 mg ngosuku.
Ngokwemiphumela yalolucwaningo, kwavela ukuthi amathuba okuba nezinkinga emkhakheni wohlelo lwezinhliziyo zegazi sehlile ngamaphesenti angama-25.
Yini engaba ama-static ayingozi
Ngaphezu kwalokho, ososayensi baseJapan benza izivivinyo eziningana zesayensi, ngenxa yalokho kwenzeka bathola iziphetho ezinamandla kakhulu. Kulokhu, ososayensi bekufanele bacabange ngokungathi sína yini ngalezi zinhlobo zemithi yesifo sikashukela sohlobo 2.
Lokhu kungenxa yokuthi ngemuva kokuthatha ama-statins, kube nezimo zokuncipha kwesifo sikashukela i-mellitus, okuthe kwaholela ekufundeni okujulile kwezidakamizwa.
Ososayensi baseJapan bazamile ukufunda ukuthi i-Atorvastatin ngesilinganiso se-10 mg iyithinta kanjani i-hemoglobin ye-glycated noshukela wegazi. Isisekelo kwakuyi-glucose esejwayelekile ezinyangeni ezintathu ezedlule.
- Lokhu kuhlolwa kwenziwa izinyanga ezintathu, iziguli ezingama-76 ezitholakale zinesifo sikashukela sohlobo 2 nazo zahlanganyela kukho.
- Ucwaningo lufakazele ukwanda okukhulu kwe-carbohydrate metabolism.
- Ocwaningweni lwesibili, lo muthi waphathwa kumthamo ofanayo kubantu abanesifo sikashukela kanye ne-dyslipidemia.
- Ngesikhathi sokuhlolwa kwezinyanga ezimbili, kuye kwatholakala ukuncipha kokuxineka kwama-atherogenic lipids kanye nokwanda ngesikhathi esifanayo kwe-hemoglobin ye-glycated.
- Futhi, iziguli zabonisa ukwanda kokungahambisani ne-insulin.
Ngemuva kokuthola imiphumela enjalo, ososayensi baseMelika benza ukuhlaziya okubanzi. Umgomo wabo bekuwukuthola ukuthi ama-statins ayithinta kanjani i-carbohydrate metabolism kanye nokuthola ubungozi besifo sikashukela ngesikhathi sokwelashwa ngama-statins. Lokhu kufaka phakathi zonke izifundo zesayensi ezenziwa phambilini ezihlobene nokukhula kwesifo sikashukela sohlobo 2.
Ngokwemiphumela yalokhu kuhlola, kungenzeka ukuthi uthole imininingwane eveza phakathi kwezifundo ezingama-255 icala elilodwa lokuthuthuka kwesifo sikashukela sohlobo 2 ngemuva kokulashwa ngama-statins. Ngenxa yalokho, ososayensi baphakamise ukuthi le mithi ingathinta i-carbohydrate metabolism.
Ngaphezu kwalokho, ukubalwa kwezibalo kutholile ukuthi kukho konke ukuxilongwa kwesifo sikashukela kunamacala ayi-9 okuvimbela inhlekelele yenhliziyo.
Ngakho-ke, okwamanje kunzima ukwahlulela ukuthi alusizo kangakanani noma, ngakolunye uhlangothi, ama-static ayingozi kwabanesifo sikashukela. Okwamanje, odokotela baqinisekile ngokuthuthuka okukhulu ekuqoqweni kwe-lipids yegazi ezigulini ngemuva kokusetshenziswa kwezidakamizwa. Ngakho-ke, uma kunjalo iphathwe ngama-statins, kubalulekile ukubheka ngokucophelela amazinga we-carbohydrate.
Kubalulekile futhi ukwazi ukuthi yiziphi izidakamizwa ezihamba phambili futhi uthathe kuphela umuthi omuhle. Ikakhulu, kunconywa ukukhetha ama-statin ayingxenye yeqembu le-hydrophilic, okungukuthi, angancibilika emanzini.
Phakathi kwazo kukhona iRosvvatin kanye nePravastatin. Ngokusho kodokotela, le mishanguzo inethonya elincane ku-carbohydrate metabolism. Lokhu kuzonyusa ukusebenza kwezokwelapha futhi kugweme ingozi yokuthola imiphumela emibi.
Ukwelashwa nokuvimbela isifo sikashukela kungcono ukusebenzisa izindlela ezifakazelwe. Ukwehlisa i-cholesterol yegazi, kuyadingeka ukulungisa lokho kudla, ngokwenziwa kwesifo sikashukela sohlobo 2, kunconyelwa ukuthatha umuthi iMetformin 850, oye watuswa kakhulu, noma ama-sartans.
Izimo zichaziwe kuvidiyo ekulesi sihloko.
