Ma Statin ndi matenda a shuga a shuga pano akuwerengedwa mofala komanso kutsutsidwa kwambiri ndi asayansi ochokera padziko lonse lapansi. Maphunziro ambiri omwe amagwiritsa ntchito zotsatira za placebo adatha kutsimikizira kuti ma statins amachepetsa kwambiri vuto la matenda amtima.
Nthawi yomweyo, pali zowonera zingapo zomwe zikuwonetsa kuti ma statins a mtundu wa 2 shuga amatha kuwonjezera chiwopsezo cha matenda. Makamaka, mu odwala matenda ashuga, pali kuwonjezeka kwa shuga wamagazi, chifukwa chomwe muyenera kutenga Metformin kapena kusinthana ndi ma sartans.
Pakadali pano, madokotala ambiri akupitiliza kupereka mankhwala a matenda ashuga. Kodi zochita za madotolo ndizowona bwanji ndipo ndizotheka kuti odwala matenda ashuga azitenga ma statins?
Kodi ma statins amakhudza bwanji thupi?
Cholesterol ndi mankhwala achilengedwe omwe amaphatikizidwa ndikupanga mahomoni ogonana achikazi ndi amuna, imapereka mulingo wabwinobwino wamadzi m'maselo a thupi.
Komabe, ndi kuchuluka kwake mthupi, nthenda yayikulu - atherosulinosis imayamba. Izi zimabweretsa kusokonezeka kwa magwiridwe antchito amitsempha yamagazi ndipo nthawi zambiri zimayambitsa zovuta kwambiri, chifukwa cha zomwe munthu amatha kuvutika. Wodwala nthawi zambiri amakhala ndi matenda oopsa chifukwa cha kuchuluka kwa cholesterol plaques.
Ma Statin ndi mankhwala a pharmacological omwe amachepetsa lipids kapena cholesterol ndi lipoproteins yotsika - mawonekedwe a mayendedwe a cholesterol. Mankhwala othandizira ndi opangidwa, opangidwa pang'ono, zachilengedwe, kutengera mtundu wawo.
Chochita chodziwika bwino cha lipid-kutsitsa chimagwiritsidwa ntchito ndi atorvastatin ndi rosuvastatin wazinthu zopangidwa. Mankhwalawa ali ndi umboni kwambiri.
- Choyamba, ma statins amapondereza ma enzyme omwe amathandizira kwambiri pakudziletsa kwa cholesterol. Popeza kuchuluka kwa ma lipids amkati pakadali pano kuli mpaka 70 peresenti, njira yochitira mankhwalawo imawerengedwa kuti ndi yofunika kuthetsa vutoli.
- Komanso, mankhwalawa amathandizira kukulitsa kuchuluka kwa zolandirira mawonekedwe a mayendedwe a cholesterol mu hepatocytes. Zinthu izi zimatha kukoka ma lipoprotein omwe amayendayenda m'magazi ndikuwapatsira ma cell a chiwindi, kumene njira Kuchotsa zinyalala za zinthu zovulaza m'magazi.
- Kuphatikiza ma statins samalola kuti mafuta azilowetsedwa m'matumbo, zomwe zimachepetsa kuchuluka kwa cholesterol yakunja.
Kuphatikiza pa ntchito zofunikira, ma statins amakhalanso ndi zotsatira zokondweretsa, ndiye kuti, amatha kuchita zinthu zingapo "nthawi imodzi", kukonza zomwe munthu amakhala nazo. Makamaka, wodwala yemwe amamwa mankhwalawa pamwambapa amakumana ndi zotsatirazi:
- Mkhalidwe wamkati wamitsempha wamagazi umakhala bwino;
- Zochita za kutupa zimachepa;
- Kugundika kwa magazi kumaletsedwa;
- Spasms yama mitsempha yopereka myocardium ndi magazi imachotsedwa;
- Mu myocardium, kukula kwa mitsempha yatsopano yamagetsi kumakhudzidwa;
- Myocardial hypertrophy imachepa.
Ndiye kuti, titha kunena mosapita m'mbali kuti ma statins ali ndi zabwino kwambiri zochizira. Dokotala amasankha mlingo woyenera kwambiri, ngakhale mlingo wocheperako umatha kukhala ndi zotsatira zochizira.
Kuphatikiza kwakukulu ndikochepa kwambiri pazotsatira zamankhwala a statins.
Ma Statin ndi mitundu yawo
Masiku ano, madokotala ambiri amakhulupirira kuti kutsitsa cholesterol yamagazi m'magulu 2 a shuga ndi gawo lofunikira kwambiri kuti munthu achire. Chifukwa chake, mankhwalawa, monga a Sartan, amawonetsedwa pamodzi ndi mankhwala monga Metformin. Kuphatikiza ma statins nthawi zambiri amagwiritsidwa ntchito ngakhale ndi cholesterol yabwinobwino kuti ateteze matenda a atherosulinosis.
Mankhwala a gululi amasiyanitsidwa ndi kapangidwe, Mlingo, zoyipa. Madokotala amatenga chidwi makamaka ndi chomaliza, chifukwa chake, chithandizo chamankhwala chimachitika moyang'aniridwa ndi dokotala. Izi ndi mitundu ingapo ya mankhwala ochepetsa magazi m'thupi.
- Mankhwala a Lovastatin amapangidwa pogwiritsa ntchito nkhungu zomwe zimayeserera kupesa.
- Mankhwala ofanana ndi manvastatin.
- Pravastatin wa mankhwala amakhalanso ndi mawonekedwe ake komanso momwe amagwirira ntchito.
- Mankhwala opangidwa mokwanira amaphatikizapo Atorvastatin, Fluvastatin, ndi Rosuvastatin.
Chithandizo chothandiza kwambiri komanso chogwiritsidwa ntchito kwambiri ndi rosuvastatin. Malinga ndi ziwerengero, cholesterol m'magazi a munthu atatha kulandira chithandizo chotere kwa masabata asanu ndi limodzi amachepetsedwa ndi 45-55 peresenti. Pravastatin amadziwika kuti ndiwosagwira ntchito kwenikweni, amatsitsa cholesterol ndi 20-35 peresenti yokha.
Mtengo wa mankhwala umasiyana mosiyana ndi mnzake, kutengera wopanga. Ngati mapiritsi 30 a Simvastatin angagulidwe ku pharmacy pafupifupi ma ruble 100, ndiye kuti mtengo wa Rosuvastatin umasiyana kuchokera ku 300 mpaka 700 rubles.
Woyamba achire zotsatira zimatheka palibe kale kuposa mwezi umodzi wokhazikika mankhwala. Malinga ndi zotsatira za mankhwalawa, kupanga cholesterol ndi chiwindi kumachepa, kuyamwa kwa cholesterol m'matumbo kuchokera kuzinthu zomwe zimatengedwa kumachepetsedwa, mapangidwe a cholesterol omwe amapezeka m'mitsempha yamitsempha yamagazi amathetsedwa.
Ma Statin akuwonetsedwa kuti agwiritse ntchito mu:
- atherosulinosis;
- matenda a mtima, chiwopsezo cha matenda a mtima;
- matenda a shuga kupewetsa kapena kuchepetsa magazi.
Nthawi zina maonekedwe a atherosselotic zolembera amatha kuonedwa ngakhale ndi cholesterol yotsika.
Pankhaniyi, mankhwalawa atha kupatsidwanso mankhwala.
Matenda a shuga ndi matenda amtima
Ndi matenda a shuga, pamakhala chiopsezo chachikulu cha zotsatira zoyipa m'magazi a mtima. Anthu odwala matenda ashuga amatha kukhala ndi matenda amtima kuposa kasanu anthu omwe ali ndi shuga. 70% ya odwala chifukwa cha zovuta amakhala ndi zotsatira zakupha.
Malinga ndi oimira bungwe la American Heart Association, anthu omwe ali ndi matenda ashuga komanso omwe apezeka ndi matenda amitsempha yamagazi ali ndi chiwopsezo chofanana cha kufa chifukwa cha ngozi yamtima. Chifukwa chake, matenda ashuga sindiwo matenda oopsa kuposa matenda a mtima wa ischemic.
Malinga ndi ziwerengero, matenda amtima wapezeka ndi 80% ya anthu odwala matenda ashuga a 2. Mwa 55 peresenti ya anthu oterewa, amafa chifukwa cha kuphwanya myocardial and 30% chifukwa cha stroke. Cholinga cha izi ndikuti odwala ali ndi zovuta zowonekera.
Zina zomwe zili pachiwopsezo cha odwala matenda ashuga zimaphatikizapo:
- Kuchuluka kwa shuga;
- Zikamera insulin kukana;
- Kuchulukitsa kwa insulin m'magazi a anthu;
- Kukula kwa proteinuria;
- Kuwonjezeka kwa kusinthasintha kowonekera kwa zizindikiro za glycemic.
Mwambiri, chiopsezo chokhala ndi mtima wamtima chikuwonjezereka ndi:
- olemedwa ndi chibadwa;
- m'badwo wina;
- kukhalapo kwa zizolowezi zoipa;
- kusowa zolimbitsa thupi;
- ndi ochepa matenda oopsa;
- hypercholesterolemia;
- dyslipidemia;
- matenda ashuga.
Kuwonjezeka kwa kuchuluka kwa cholesterol m'magazi, kusintha kwa kuchuluka kwa ma atherogenic ndi antiatherogenic lipids ndizinthu zodziyimira zokha zomwe zimawonjezera chiopsezo cha matenda opatsirana ndi mtima. Monga kafukufuku wasayansi wosiyanasiyana, zitachitika kuti ziwonetserozi zikhale zachilendo, kuthekera kwa ma pathologies kumatsika kwambiri.
Popeza matenda ashuga amakhudza mitsempha yamagazi, zikuwoneka zomveka kusankha ma statins ngati njira yothandizira. Komabe, kodi iyi ndi njira yoyenera yochizira matendawa, kodi odwala amatha kusankha Metformin kapena ma statins omwe ayesedwa kwa zaka zambiri?
Statin ndi matenda ashuga: kuyenderana ndi mwayi
Kafukufuku waposachedwa akuwonetsa kuti ma statins ndi mtundu wa 2 matenda a shuga amatha kukhala ogwirizana. Mankhwalawa amachepetsa osati kuchepa kokha, komanso kufa chifukwa cha matenda amtima pakati pa anthu odwala matenda ashuga. Metformin, monga statins, imakhudzanso thupi - imachepetsa shuga.
Nthawi zambiri, mankhwala otchedwa Atorvastatin amachitidwa kafukufuku wa sayansi. Komanso masiku ano, mankhwala a Rosuvastatin atchuka kwambiri. Mankhwalawa onse ndi ma statin ndipo ali ndi chiyambi chopangidwa. Asayansi apanga mitundu ingapo ya maphunziro, kuphatikizapo ma CARDS, PLANET ndi TNT CHD - DM.
Kafukufukuyu wa CARDS adachitika ndi kutenga matenda ashuga a mtundu wachiwiri wa matenda, momwe ma lipoprotein okhala otsika kwambiri sanali apamwamba kuposa 4.14 mmol / lita. Komanso pakati pa odwala kunali kofunikira kusankha omwe alibe ma pathologies mu gawo la zotumphukira, matenda amitsempha yama cell ndi coronary.
Munthu aliyense amene anachita nawo phunziroli anali ndi choopsa chimodzi.
- Kuthamanga kwa magazi;
- Matenda a shuga a retinopathy;
- Albuminuria
- Kusuta fodya.
Wodwala aliyense amatenga atorvastatin pafupifupi 10 mg pa tsiku. Gulu lolamulira lidayenera kutenga placebo.
Malinga ndi kuyesera kumeneku, mwa anthu omwe adatenga ma statins, chiopsezo chokhala ndi matenda am'mimba chatsika ndi 50 peresenti, ndipo mwayi wokhala ndi myocardial infaration, angina wosakhazikika, kufa kwadzidzidzi kwamwamuna kutsika ndi 35 peresenti. Popeza zotsatira zabwino zidapezeka ndikuwonekeratu zopindulitsa, maphunzirowa adayimitsidwa zaka ziwiri izi zisanachitike.
Mu kuphunzira kwa PLANET, maluso a nephroprotective omwe Atorvastatin ndi Rosuvastatin ali nawo adayerekezedwa ndikuphunzira. Njira yoyamba ya PLANET yomwe ndimayesa idakhudza odwala omwe adapezeka ndi matenda a mtundu woyamba a II. Otenga nawo mbali pazoyeserera za PLANET II anali anthu omwe ali ndi magazi abwinobwino.
Aliyense mwa odwala omwe adaphunzira adadziwika ndi cholesterol yokwezeka komanso zolimbitsa mapuloteni - kukhalapo kwa mapuloteni mumkodzo. Ophunzira onse adagawidwa mosagawika m'magulu awiri. Gulu loyamba limatenga 80 mg ya atorvastatin tsiku lililonse, ndipo lachiwiri limatenga 40 mg wa rosuvastatin. Maphunziro adachitidwa kwa miyezi 12.
- Monga kuyesa kwa asayansi kunawonetsa, mwa odwala matenda ashuga omwe adatenga Atorvastatin, kuchuluka kwa mapuloteni a mkodzo kunachepa ndi 15 peresenti.
- Gulu lomwe limamwa mankhwala achiwiri lidachepa ndi mapuloteni 20%.
- Mwambiri, proteinuria sinatheretu pakutenga Rosuvastatin. Nthawi yomweyo, panali kutsika kwamkodzo pang'onopang'ono, pomwe ma data omwe amagwiritsidwa ntchito ndi Atorvastatin amawoneka kuti sanasinthe.
Kafukufuku wa PLANET yemwe ndidapeza mu 4 peresenti ya anthu omwe amayenera kusankha rosuvastatin, kulephera kwaimpso, komanso kuchuluka kwa serum creatinine. Pakati pa anthu. kutenga atorvastatin, zovuta zimapezeka mwa 1 peresenti ya odwala, pomwe palibe kusintha kwa serum creatinine komwe kunapezeka.
Chifukwa chake, zidapezeka kuti mankhwala omwe adagwiritsidwa ntchito ndi Rosuvastatin, poyerekeza ndi analogue, ilibe chitetezo cha impso. Kuphatikiza mankhwala kumatha kukhala koopsa kwa anthu omwe ali ndi matenda amtundu uliwonse komanso kupezeka kwa proteinuria.
Kafukufuku wachitatu wa TNT CD-DM adawunika zotsatira za atorvastatin pachiwopsezo chokhala ndi ngozi yamtima mu matenda amitsempha yamagazi ndi matenda a shuga a 2. Odwala amayenera kumwa 80 mg ya mankhwalawa patsiku. Gulu lowongolera lidatenga mankhwalawa pa mlingo wa 10 mg patsiku.
Malinga ndi zotsatira za kuyesako, zidapezeka kuti chiwopsezo chazovuta pamunda wamtima chatsika ndi 25 peresenti.
Zitha kukhala zowopsa ma statins
Kuphatikiza apo, asayansi aku Japan adayesera zingapo zasayansi, zomwe zidatheka kuti athe kupeza zidziwitso zovuta kwambiri. Pankhaniyi, asayansi amayenera kuganiza mozama ngati atenge mankhwalawa mtundu wa matenda ashuga a 2.
Izi ndichifukwa choti mutatenga ma statins, panali milandu ya matenda a shuga, omwe amachititsa kuti ayambe kuphunzira mozama za mankhwala.
Asayansi aku Japan adayesa kuphunzira momwe Atorvastatin kuchuluka kwa 10 mg amakhudzira kuchuluka kwa hemoglobin wa glycated ndi shuga m'magazi. Maziko anali pafupifupi shuga m'miyezi itatu yapitayo.
- Kuyesaku kunachitika miyezi itatu, odwala 76 omwe anapezeka ndi matenda a shuga a 2 adachitapo kanthu.
- Phunziroli lidawonetsa kuwonjezeka kowopsa kwa kagayidwe kazakudya.
- Mu kafukufuku wachiwiri, mankhwalawa adaperekedwa muyezo womwewo kwa anthu omwe ali ndi matenda ashuga komanso dyslipidemia.
- Pa kuyesa kwa miyezi iwiri, kuchepa kwa kuchuluka kwa ma atherogenic lipids komanso kuwonjezeka kwakofanana kwa hemoglobin ya glycated kunapezeka.
- Komanso, odwala adawonetsa kuwonjezeka kwa insulin.
Atapeza izi, asayansi aku America adachita kafukufuku wa meta kwambiri. Cholinga chawo chinali choti adziwe momwe ma statins amakhudzira kagayidwe kazakudya ndikuwonetsetsa kuti chiwopsezo cha matenda ashuga chimatha kuchitika ndi ma statins. Izi zidaphatikizapo maphunziro onse asayansi omwe adachitidwa kale omwe akukhudzana ndi chitukuko cha matenda ashuga a mtundu 2.
Malinga ndi zotsatira za kuyesaku, zinali zotheka kupeza deta yomwe idawulula pakati pa maphunziro 255 milandu imodzi ya chitukuko cha mtundu wachiwiri wa shuga pambuyo pakuchiritsidwa kwa ma statins. Zotsatira zake, asayansi akuganiza kuti mankhwalawa angakhudze kagayidwe kazachilengedwe.
Kuphatikiza apo, kuwerengetsa masamu kunapezeka kuti pakuzindikira matenda aliwonse a shuga pali milandu 9 yoletsa ngozi zamatenda.
Chifukwa chake, pakadali pano ndizovuta kudziwa kuti ndizothandiza kapena, momwemonso ma statins ndi owopsa kwa odwala matenda ashuga. Pakadali pano, madokotala akukhulupirira kwambiri kusintha kwakukulu pakuwonjezereka kwa lipids yamagazi mwa odwala atatha kugwiritsa ntchito mankhwala. Chifukwa chake, ngati atathandizidwa ndi ma statins, ndikofunikira kuyang'anira kuchuluka kwa chakudya.
Ndikofunikanso kudziwa kuti ndi mankhwala ati omwe ali abwino komanso kungomwa mankhwala abwino. Makamaka, tikulimbikitsidwa kusankha ma statins omwe ali m'gulu la hydrophilic, ndiye kuti amatha kusungunuka m'madzi.
Ena mwa iwo ndi Rosuvastatin ndi Pravastatin. Malinga ndi madotolo, mankhwalawa samakhudza kagayidwe kazachilengedwe. Izi zidzakulitsa chithandizocho ndikuti mupewe chiopsezo chokhala ndi mavuto.
Pazithandizo ndi kupewa matenda a shuga ndibwino kugwiritsa ntchito njira zotsimikiziridwa. Kuchepetsa cholesterol yamagazi, ndikofunikira kusintha zakudya, ndikupanga mtundu wa 2 shuga mellitus, tikulimbikitsidwa kumwa mankhwala Metformin 850, omwe amalimbikitsidwa kwambiri, kapena sartan.
Statins akufotokozedwa mu kanema munkhaniyi.
