Kunzima ukucabanga ukuthi eminyakeni eyikhulu edlule kwakungekho i-insulin, futhi abanesifo sikashukela babeqinisekiswa ukuthi bazofa ngokushesha. Izidakamizwa ezinciphisa ushukela wohlobo 2 sikashukela zivele maphakathi nekhulu leminyaka elidlule, futhi ngaphambi kwalokho, lezi ziguli nazo zashona, yize kungenjalo ngokushesha okukhulu.
Namuhla ku-Intanethi kunolwazi oluningi ngemithi emisha, izindlela zokwelashwa, amadivaysi okuphatha kanye nokuzibamba kwe-glycemia efinyeleleka kubo bonke abantu abanesifo sikashukela, ukuthi umuntu ovilapha futhi ongakhathaleli kuphela oyozivumela ukuba anganaki konke, alinde izinkinga ezibulalayo.
Elinye lamakilasi amasha wezidakamizwa ze-antidiabetic yi-incretinomimetics (exenatide, liraglutide, sitagliptin, vildagliptin, saxagliptin). Yiziphi izinzuzo zesifo sikashukela?
Izindlela zesenzo sama -retretins
Ama-incretin angama-hormone abantu. Ipheshana labo esiswini likhiqiza ngemuva kokudla kakhulu, ukugcinwa kwe-insulin ngalesi sikhathi kunyuka ngo-80%. Izinhlobo ezimbili zazo zikhonjwe emzimbeni - i-GLP-1 (glucone-like peptide-1) kanye ne-HIP (insulinotropic polypeptide). Ama-receptors wokugcina atholakala kumaseli e-b-cell, futhi ku-GLP-1 angatholakala ezithweni ezahlukahlukene, ngakho-ke umphumela womsebenzi wawo u-multivariate.
- I-GLP-1 ithuthukisa ukukhiqizwa kwe-insulin endulin ngama-b-cell;
- I-hormone ivimbela ukukhululeka kwe-glucagon ngama-b-cell;
- I-Incretin yehlisa isisu;
- Iyanciphisa isifiso sokudla futhi idale umuzwa wokugcwala;
- Umphumela omuhle ohlelweni lwezinzwa oluphakathi, inhliziyo, imithambo yegazi.
IGlucagon, ekhiqizwa esibindini sama-b-cell, ihluke ngqo kwe-insulin. Kwenyusa ukugcwala koshukela egazini ngokumkhulula esibindini.
Imisipha idinga i-glucose ukuze iphinde ibuyele lapho kulondolozwa khona amandla, lapho ikhona ngesimo se-glycogen. Ngokuvimbela ukuvela kwe-glucagon, ama-hormone ama-incretin avimba ukukhishwa kwe-glucose esibindini, okwandisa ngokuzenzakalelayo ukukhishwa kwe-insulin.
Yiziphi izinzuzo zokushiywa yisisu esisibambele isifo sikashukela? Umzimba udonsa kakhulu ushukela osemathunjini. Uma izothunyelwa lapho ngemithamo emincane, ngeke kube khona amaconsi abalulekile ushukela wegazi. Lokhu kusiza ukuxazulula inkinga ye-postprandial (ntambama) glycemia. Akunakwenzeka ukucindezelwa kwesifiso sokudla ngokweqile kuhlobo 2 sikashukela: I-GLP-1 ithinta ngqo isikhungo sendlala kwi-hypothalamus.
Izinzuzo zama-incretins zenhliziyo nemithambo yegazi manje sezifundelwa ngenkuthalo. Ehholo lokucwaninga, kutholakale ukuthi i-GLP-1 ivuselela ukwenziwa kabusha kwamaseli we-pancreatic futhi ivikele amaseli e-b ekubhujisweni.Yini evimbela ukusetshenziswa kwama-hormone emvelo esikhundleni sezidakamizwa? I-GLP-1 ibhujiswa yi-DPP-4 (uhlobo 4 dipeptidyl peptidase) ngemizuzu emi-2, ne-HIP - emizuzwini eyi-6.
Ososayensi beze namaqembu ama-2 wezidakamizwa ezifanayo nama -retretin:
- Ukulingisa indlela yokusebenza ye-GLP-1;
- Ukuvinjwa komsebenzi we-enzyme DPP-4 nokwelula impilo yama-hormone.
Uhlobo lokuqala lwethulwa emakethe yasekhaya yiBayeta (ngokususelwa kwi-exenatide) neViktoza (ngokususelwa ku-liraglutide) - izifaniso ze-GLP-1, eziphindaphinda ngokuphelele amandla ayo, kepha kube nomphumela wesikhathi eside. Izinzuzo zingangezwa futhi unciphise isisindo esingu-4 kg izinyanga eziyisithupha kanye nokwehla kwe-hemoglobin ye-glycated ngo-1.8%.
Uhlobo lwesibili lumelwe ezweni lethu ngemithi emithathu - iGalvus (esekelwe ku-vildagliptin), i-Yanuviya (ngokusekelwe kwi-sitagliptin), i-Ongliza (ekwakhiweni kwayo - i-saxagliptin). Umsebenzi wabo oyinhloko ukuvimba i-enzyme DPP-4, ebhubhisa ama-insretin. Umsebenzi wama-hormone ukhuphuka ngokungaphezulu kwezikhathi ezi-2, ngakho-ke i-glycemia ayisongeli umuntu. Ama-Inhibitors anemiphumela emibi embalwa, ngoba ama-hormone akhula kuhlu lomzimba.
Umphumela wesisindo sabo ungathathi hlangothi, i-glycated hemoglobin incishiswa ngendlela efanayo neqembu lokuqala.
Ifomu lokukhipha umkhiqizo
ISaxagliptin isidakamizwa sakamuva sesigaba se-DPP-4 inhibitors. Igama layo lokuhweba lingu-Onglisa. Badedela umuthi ngemithamo ka-2,5 no-5 mg, bathengise amaphilisi kadokotela. Impilo ye-Shelf yesidakamizwa yiminyaka emi-3, izimo zokugcina zisezingeni.
ISaxagliptin ayifakiwe kuhlu lwenhlangano lwemithi ethandelayo, yize kwezinye izifunda ichazwa ngesisekelo serejista yesifunda kusuka kwisabelomali sendawo. Ukwelashwa kwe-Onglisa ngamanani emithi ekhemisi online, udinga ukusebenzisa ama-ruble ayi-1700. ngenyanga (amaphilisi ama-5 mg). Ukuqhathanisa, inkambo yanyanga zonke kaJanuvia (umthamo we-100 mg) izobiza ama-ruble angama-2, 400, ama-ruble angama-900.
Iziphakamiso zokusetshenziswa
Imiyalo yeSaksagliptin yokusetshenziswa itusa ukuthatha i-1p. / Usuku., Isheduli ayixhunyiwe ekudleni kokudla. Ungasebenzisa ithuluzi le-monotherapy noma ngendlela eyinkimbinkimbi.
Imithi ehlanganisa i-saxagliptin ne-metformin ayikakakhiwa, njenge-analogues YanuMeta neGalvusMeta.
Izinkinga zezinso ezincane, awudingi ukulungisa umthamo; ezimweni ezibucayi, isilinganiso sincishiswa amahlandla ama-2.
Ngubani onqunywe iSaxagliptin
Izidakamizwa ezenziwa nge-Saxagliptin (isichazamazwi - i-Onglisa) zingabekwa esiteji se-prediabetes yohlobo lwe-2, lapho ukuguqulwa kwendlela yokuphila (ukudla okune-carb ephansi, ukusebenza ngokomzimba okwanele, ukulawulwa kwesimo somzwelo) akunikezeli ukulingana kwe-glucose egazini.
I-Saxagliptin nayo ilungele ukwelashwa okuyinkimbinkimbi, ukuthi ungakanani umuthi ozonqunywa ngasikhathi sinye ngemuva kokuxilongwa, kuzoncika ekusebenzeni kwe-glycated hemoglobin. Ngokuhambisana ne-Ongliza, kunqunywa i-metformin, futhi uma kungekho kulawulwa okwanele kwe-glycemic, amalungiselelo we-sulfonylurea kanye ne-thiazolidinediones anqunyelwe.
Contraindication
Nge
Uhlu oluphelele:
- Isikhathi sokukhulelwa nokuncelisa;
- Iminyaka: ngaphambi kweminyaka eyi-18 nangemva kweminyaka engama-75;
- Ngama-glucose-galactose malabsorption azalwe nawo;
- Uhlobo 1 sikashukela;
- Isifo sikashukela sikashukela;
- Ngokungabekezeleli kwe-galactose, ukuntuleka kwe-lactase;
- Hypersensitivity ezingxenyeni zefomula.
Ngokungeziwe ku-contraindication efakwe kuhlu, lapho enza irejimeni yokwelashwa, udokotela ubheka ukusebenzisana kwe-saxagliptin nezinye izidakamizwa ezithathwa yisifo sikashukela ngezifo ezihlangene. Kubalulekile ukwazisa i-endocrinologist ngakho konke ukuqokwa okwengeziwe ngesikhathi.
Imiphumela emibi kanye ne-overdose
I-Saxagliptin yi-ejenti ephephe kakhulu ye-hypoglycemic, ngoba ayivukeli i-hypoglycemia, kepha, njenganoma yimuphi umuthi wokwenziwa, ingaba nemiphumela engathandeki. Uma lezi zimpawu noma okunye ukuvela kungaqhamuki, kufanele uthintane nodokotela: uzolungisa umthamo noma ukhethe okunye.
Phakathi kwemiphumela engaziwa kakhulu engaziwa:
- Izifo zokuphefumula;
- Izinqubo zokuvuvukala zohlelo lwe-genitourinary;
- Ukuphazamiseka kwe-dyspeptic;
- Ubuhlungu bekhanda;
- I-Sinusitis
- I-Gastroenteritis
Umyalo awuzisho izimpawu zokuphuza ngokweqile, ngoba izifundo zomtholampilo lapho umuthi wanikezwa khona amavolontiya anempilo ngamazinga okwedlula okujwayelekile izikhathi ezingama-80 azibonisanga zimpawu zokuphuza.
Yini engathatha isikhundla saxagliptin
Ngokubekezelela okungalungile noma ama-contraindication, udokotela uzokhetha ama-analogues we-saxagliptin. Akukho okunye okungahluka ku-Onglise ngesici esifanayo esisebenzayo, kepha ngokuya ngomshini wokusebenza, ulaka lwe-enzyme ye-DPP-4 luzovinjwa:
- UJanuvia ungumuthi wokuqala walesi sigaba, owawusetshenziswa okokuqala e-USA kuphela, bese wase-Europe. Isigamu sehora ngemuva kokudla, umuthi uzovimba i-enzyme yosuku. Ungathenga amaphilisi ku-25,50 no-100 mg. Umthamo ojwayelekile ngu-100 mg / ngosuku. Umphumela uboniswa kungakapheli inyanga. Ukuze kube lula ukwelashwa okuyinkimbinkimbi, umuthi ukhiqizwa uhlanganiswa ne-metformin - i-YanuMet.
- UGalvus ungumuthi waseSwitzerland osebenzayo, ofanele ukwelashwa okuyinkimbinkimbi, kubandakanya ne-insulin. Umuthi ohlanganisiwe weGalvusMet nawo uyakhishwa, ukwakhiwa kwawo kuhlanganiswe ne-metformin. Okokuqala, amaphilisi athathwa ngo-50 mg / ngosuku.Uma kunesidingo, isilinganiso siphindwa kabili, ukusabalalisa ngemithamo emibili.
Ukusebenza nokuphepha kwazo zonke izidakamizwa kuleli qembu kuyafana, ukukhethwa kwesidakamizwa esithile kuzoncika emandleni wezezimali wesiguli kanye nesipiliyoni se-endocrinologist ngomuthi. Kwi-saxagliptin, inani lentengo lihle uma liqhathaniswa ne-analogues.
I-Saxagliptin esekwe phezu kwe -lagis, ukuthuthukiswa kwakamuva kosokhemisi baseYurophu emkhakheni we-diabetesology, akuyona i-hypoglycemic kuphela, kodwa futhi kunemiphumela eyengeziwe emnandi: kunciphisa isifiso sokudla nesisindo, kuvikela ama-pancreas, kusiza ukulawula umfutho wegazi, futhi inamandla okuthwala inhliziyo.
Ungafunda kabanzi ngama -retretins kanye namathuba wezidakamizwa ezilwa nesifo sikashukela ngokusekelwe kuwebhusayithi yesazi se-endocrinologist uDilyara Lebedeva kule vidiyo.
