No aneane 50 mau makahiki, ua hoʻohana nā kauka i nā lāʻau sulfanilamide e mālama i ka mellitus type type 2, ʻoiai ka paʻakikī o kā lākou hoʻohaʻa ʻana i ke kō.
Hoʻomoe nui ka hoʻomākaukau o ka pūʻulu sulfonamide i nā hua beta o nā pancreas, ma laila e hoʻomaikaʻi i ka nui a me ka hana mua o ka insulin.
Loaʻa nā mākau Sulfanilamide i kahi hopena liʻiliʻi-pancreatic. Me kēia, ʻo ka mālama lōʻihi glycemic nānā i ka wā o ka maʻi me ka sulfonamides:
- e hōʻemi ana i ka nui o ka glucose hana e ka ate;
- hoʻomaikaʻi i ka pane ʻana i ka huna i ka huna i ka ʻaina meaʻai;
- hoʻomaikaʻi i ka hopena o ka insulin ma ka uaua a me ka kiko adipose.
Ua kākau ʻia ʻo Sulfanilamides i nā lāʻau lapaʻau mua (ʻaʻole lākou i hoʻohana pono ʻia i Rusia) a me nā lāʻau lapaʻau lua, ʻo ia hoʻi ka papa inoa:
- pili pili
- gliclazide
- glycidone
- huiloli,
ka mea nui no ka mālama ʻana i ka maʻi maʻi.
ʻO ka hoʻomākaukau ʻana o ka glimepiride pūʻulu sulfonamide, ma muli o kona mau ʻano kūʻokoʻa, e pili ana i nā waihona hōʻemi i ka hilo o ka hanauna ʻekolu.
Nā hana hana i ka hana
ʻO ka hana o ke ʻano o nā lāʻau o ka huina sulfanilamide, e kōkua ana e hoʻohaʻahaʻa i ka nui o ke kō, ua hoʻokumu ʻia i ka hoʻoulu ʻia ʻana o ka huna ʻana i ka insulin, i hoʻoponopono ʻia e nā hāmeʻa pākīpeka o ATP i ka membrane plasma o ka papa beta.
Loaʻa nā hāmeʻa pāloli hāpana ATP i nā 2 subunits. ʻO kekahi o kēia mau subunite ka mea i loaʻa i kahi sulfonamide receptor, a ʻo nā mea ʻē aʻe ke kūlike o ka kahawai. I ka poʻe maʻi me ka diabetes mellitus type 2, nona ka hana o nā cell beta e mālama i kahi nui, e hoʻopaʻa ʻia e ka receptor sulfonamide, kahi e hiki ai i ka pani ʻana o ka pāheona potassium ATP-sensitive.
A ʻo kahi hopena, hōʻiliʻili ka paʻakai i loko o nā pū beta, kahi i hoʻohemo ʻia, a makemake i ka hoʻopiʻi ʻana o ka kalima ma loko o ka beta beta. Ka hoʻonui ʻia ʻana o ka nui o ka calcium i loko o nā pū beta e hoʻowalewale i ka halihali o nā granule insulin i ka membrane cytoplasmic o nā puna e hui ai, a me ka pūna intercellular piha me ka insulin.
Pono e hoʻolilo i ka hoʻouluʻana o ka inikini insulin i ka secretogens ʻaʻole i hilinaʻi i ka pae o ka glucose i loko o ke koko, a ke piʻi nei ka piʻi ʻana o ka plasma insulin e kahe ana i ka hōʻea o ka glycemia wā a me ka wikiwiki.
I kēia hihia, ua loaʻa i ka sulfanilamide secretogens-HbA1 i kahi hopena hōʻemi a hoʻohiolo i ke kō, ua hōʻemi ʻia ke kōpaʻa ma o 1-2%. Ke mālama ʻia me ka lāʻau lapaʻau non-sulfanelamide, hoʻemi wale ke kōpaʻa ma o 0.5-1% wale nō. ʻO kēia ma muli o ka hopena wikiwiki o ka hope.
ʻO Sulfanilamide nā lāʻau lapaʻau paha i loaʻa kekahi hopena hou aʻe-pancreatic i nā ʻōnaehana hilinaʻi i ka insulin a me ka puʻuwai. Eia naʻe, aia ka hana maoli o nā hana i hāpai i ka hōʻemi o ka hyperglycemia akā ʻaʻole i hoʻokū ʻia a hiki i kēia lā.
He mea hiki ke sulfanilamide hyperstimulation o ka mea huna o ka hormone-insulin i loko o ka papa waihona inoa hoʻohui i ka hopena o ka insulin ma ka ate a hōʻemi i ka wikiwiki hyperglycemia.
ʻO ka hoʻololi ʻana i ka glycemia e hōʻemi i ka hoʻoneʻe o ka glucose a laila e hoʻonui i ka naʻau o ka insulin e waiho ana ma nā wahi o ka nui o ke kūpaʻa i ka insulin (adipose, Muse).
Sulfanilamide gliclazide i ke ʻano diabetes mellitus type 2 e hoʻihoʻi hou i ka mea i hoʻopilikia ʻia (3-5 min) o ka hilo ʻana o ka inikini, a, ʻo ia hoʻi, e hoʻomaikaʻi ai i nā hana hoʻopulapula o ka lua lōʻihi (1-2 hola), ka ʻano o ka maʻi mellitus type 2.
Leka i ka pharmacokinetics o sulfa nā hopena i ke kiʻekiʻe o ke adsorption, metabolism a me ka pāʻina excretion. ʻAʻole paʻa nā lāʻau lapaʻau i ka papa inoa o ka lua a me ke kolamu o nā protein plasma ikaika, e hoʻokaʻawale ana iā lākou mai nā lāʻau lapaʻau ma ka papa inoa o ka hanauna mua.
ʻO nā mākau ʻaʻala sulfanilamide pau loa e hoʻopili ʻia e nā ʻili. Eia nō naʻe, ka hoʻomaka ʻana o kā lākou hana a me kona mau lōʻihi ma luna o nā hiʻohiʻona pharmacokinetic o kēlā me kēia, i hoʻoholo ʻia e ka ʻano o ka lāʻau lapaʻau.
ʻO ka hapa nui o sulfa he hapa pōkole wale nō ka hapa, lōʻihi ka lōʻihi ma mua o 4-10 hola. Ma muli o ka hapa nui o ka sulfonamides e hoʻohana ʻia ʻelua, ʻoiai ke kahe o ka hapa hapa mai ke kahawai, ʻoiai paha i loko o nā beta beta ma ke ʻano o ke ake, e hoʻohaʻahaʻa ʻia kā lākou haehae ma mua o ke koko.
Loaʻa ka lāʻau lapaʻau Glyclazide sulfanilamide i ka wā lōʻihi a hāʻawi i kahi kiʻekiʻe kiʻekiʻe i ka plasma no nā hola 24 (diabetes diabetes.) Ua papa nui ka papa inoa o nā lāʻau sulfa i loko o ka puʻuwai, a me kā lākou mau metabolites i hoʻokaʻawale ʻia e nā keiki a me kekahi hapa e ka gastrointestinal tract.
Nā hoʻoponopono a me ka hoʻoponopono ʻana
ʻO ka maʻamau, hoʻomaka ka mālama me sulfonamides me kahi liʻiliʻi haʻahaʻa a hoʻonui ʻia me ka manawa o 4-7 mau lā a hiki i ka hopena makemake. ʻO nā mea maʻi e pili paʻa ana i ka meaʻai, a me ka poʻe e ʻimi e hōʻemi i ke kaumaha, hiki ke hōʻemi i ka nui o nā sulfonamides a haʻalele iā lākou āpau.
Eia nō naʻe, aia kahi hōʻike e hiki i ka hoʻohana 'ana i kahi liʻiliʻi liʻiliʻi o sulfonamides no ka manawa lōʻihi e mālama i kahi pae glucose maikaʻi.
Loaʻa ka hapa nui o ka poʻe maʻi i kā lākou glycemic pae i ka wā e hoʻohana ai i ka 1/3, 1/2 o ke ana nui. Akā inā i ka wā o ka mālamaʻana me ka sulfonamides i ʻole ka hopena o ka glucose makemake i makemake ʻia, a laila e hui pū ʻia nā lāʻau lapaʻau me nā ʻaina hypoglycemic non-insulin a i ʻole hoʻi me ka insulin.
Ke koho i ka sulfonamides, pono e noʻonoʻo ʻia nā mea nui:
- ka wa a me ka lōʻihi o ka hana;
- ikaika;
- ke ʻano o ka hana o ka ʻaina;
- nā hopena maikaʻiʻole.
Kālana ka hana o ka hana o sulfonamide ma ke ʻano o ka pilina me ka sulfonamide receptor. No kēia mea, ʻo glyclazide, glimepiride, glibenclamide ua ʻike ʻia ʻo ia ka mea ʻoi a maikaʻi.
He mea nui ia e pili ana i ka lāʻau sulfanilamide e pili ana i ka hana ʻana o nā kalima kalepa i nā ʻili like ʻole a me nā moku, e pili ana i ka hana o ka vasodilation. ʻAʻole maopopo ana paha inā he koʻikoʻi paha ka hana a kēia kaʻina.
Inā lawa ʻole ka lawa o nā lāʻau lapaʻau i loko o ka papa inoa o sulfonamides, hiki iā ʻoe ke hoʻohana i kā lākou hui pū me nā mea hoʻohaʻahaʻa i nā kō. ʻO ka meaʻokoʻa ka mea huna - meglitinides, kahi e nakinaki ai i nā ʻeleʻele sulfonamide.
ʻO ka hui hoʻohui me nā lāʻau lapaʻau e komo pū ana me ka papa inoa o nā sulfonamides o ka hana hoʻohui e hoʻohui ʻia i nā lāʻau e loaʻa kahi ʻano ʻokoʻa ka sulfanilamides.
ʻO ka hui pū ʻana o ka lāʻau sulfonamide me ka metformin e hōʻoiaʻiʻo i ka mea, ʻaʻole i ka hopena o ka hopena i ka mea huna o ka insulin hormon, akā ke hoʻonui nei i ka hoʻowalewale o ka puʻuwai ma ia mea, ma muli o ka hoʻonui ʻana o ka hoʻōla wai o ka sulfanilamides.
Kahi like pū me nā mea lapaʻau e pili pono ana i ka mālama ʻana i nā maʻi maʻi type 2. Me ka hui pūʻana o nā lāʻau sulfa me nā alpha glucosidase inhibitors, ka liʻiliʻi o ka glucose e hele mai i ka ʻōpū liʻiliʻi ma hope o ka ʻai ʻana, no laila ua hoʻemi ʻia ka postprandial glycemia.
Hoʻonui ka Glitazones i ka hoʻowalewale o ka ate a me nā ʻōnaehana hilinaʻi-like o ka insulin i ka hormone-insulin, e hoʻoikaika ana i ka kahe o ka hana kuhi-sulia ʻo ka wānana o sulfanilamide. Inā mākou e noʻonoʻo i ka hui pū ʻana o nā lāʻau lapaʻau i komo pū ʻia i ka papa inoa o sulfonamides me ka insulin, a he mea hoʻomau nā manaʻo o nā kauka i kēia mea.
Ma kahi lihi, inā pono ia ke kahakaha ʻana i ka insulin, ua manaʻo ʻia ua hōʻole ʻia kona waiwai i loko o ke kino, no laila, ʻo ka hopena ke kuhi hou ʻia me ka huina sulfonamide me ka maikaʻi ʻole.
I ka manawa like, inā mālama ʻia kahi mea maʻi i ka mea huna o ka insulin i ka wahi liʻiliʻi e hōʻole i ka hoʻohana ʻana iā sulfanilamide, pono kēia e hoʻonui i ka nui o ka nui o ka insulin.
Hāʻawi ʻia i kēia ʻike, ʻoi aku ka lula ʻana o ka metabolism ma o ka ʻimi endogenous ʻoi aku ka maikaʻi ma mua o nā lāʻau insulin ʻē aʻe. ʻOiai me ka mea kau palena iki o nā pū beta, hoʻowahāwahā ʻole ʻana i ka hoʻoponopono pono ʻole ʻana.
ʻO ka papa inoa o nā lāʻau sulfonamide o ka lua o ka hanauna o ka mea kaulana loa ma Rūsia:
- glycidone;
- gliclazide MV;
- pili pili;
- glimepiride;
- glibenclamide.
Nā Hōʻike
Ke lawe nei i ka sulfonamides, pono ke emi o ka pae o HbA1c ma loko o 1-2%. ʻO nā huina Sulfanilamide, e like me nā lāʻau lapaʻau haʻahaʻa, e ʻoi aku ka maikaʻi i nā mea maʻi me ka hoʻomohala glycemic maikaʻi ma mua o nā mea maʻi e pili kokoke ana nā hōʻailona iā lākou (HbA1c 7%).
ʻO ka hoʻomākaukau e pili ana i ka sulfanilamide pono no ka poʻe maʻi me ka diabetes mellitus type 2, ka mea i hōʻole ʻia ka hana i ka hana ʻana i ka insulin, akā naʻe, ʻaʻole i pau nā hale i nā insulin i loko o nā pū o beta a ua lawa ia a ua lawa lākou e hoʻoulu hou i ka sulfonamides.
Kahi papa inoa o nā maʻi me nā hopena maikaʻi loa:
- Ua hoʻomohala ʻia ke maʻi maʻi ma hope o 30 mau makahiki.
- ʻOi aku ka lōʻihi o ka maʻi i ka 5 mau makahiki.
- ʻO ka wā hoʻomaha i ka hyperglycemia ma mua o 17 mmol / L.
- ʻO nā maʻi maʻi maʻamau a kaupaona.
- ʻO ka poʻe maʻi e pili ana i nā ʻōlelo hōʻike a kahi mea ʻai, a me ka hana kino kiʻekiʻe.
- ʻO nā mea maʻi me ka nele ʻole o ka insulin.
ʻO ka ha o ka poʻe maʻi i hōʻike mua ʻia me ka maʻi diabetes mellitus type 2 ʻaʻole i pane aku i ka mālama ʻana me sulfonamides. No lākou, he mea pono e koho i nā lāʻau lapaʻau e hoʻohaʻahaʻa maikaʻi i ke kō.
I waena o nā poʻe maʻi e pane maikaʻi ana i ka hoʻōla, 3-4% hōʻalo i ka hoʻoweliweli ʻana i ka sulfonamides i loko o hoʻokahi makahiki (tachyphylaxis, kūʻokoʻa ʻelua).
ʻO ka mea mua, loaʻa kēia ma muli o ka emi ʻana o ka hoʻokahe ʻia o nā ʻāpana beta a ma muli o ka momona kaumaha (ke piʻi ʻana o ka pale ʻana o ka insulin).
Hiki ke hōʻalo ʻia nā hopena hopena maikaʻi ʻole e nā kumu aʻe i luna aʻe, akā nā nā kumu ʻē aʻe:
- hana kino kino;
- ka maikaʻi ʻole
- manaʻo kaumaha
- nā maʻi hakakā (stroke, attack heart, infection);
- ka koho ʻana i nā lāʻau lapaʻau e hōʻemi i ka hopena o nā sulfonamides.
I kekahi mau mea maʻi me ka diabetes mellitus type 2, i ka wā e mālama ai me ka sulfonamides (glibenclamide), ua ʻike ʻia kahi "syndrome looping", like me ko ka maʻi maʻi o Somogy i nā maʻi maʻi maʻi āpau.
Ke hoʻololi nei i ka glibenclamide me ka lāʻau lapaʻau me ka hopena hypoglycemic emi i ka hopena (glimepiride) e uku ʻia no ka maʻi mellitus.
He mea hiki ke neʻe i ka hypoglycemia nocturnal me ka hoʻohana ʻana o glibenclamide i hoʻonāukiuki i ka hyperglycemia kakahiaka i kēia mau maʻi, ka mea e hoʻoikaika i ke kauka e hoʻonui i ka nui o ka lāʻau i ka lōʻihi. A i ka pō hypoglycemia i kēia hihia ua luhi a alakaʻi i kahi hala nui o ka maʻi diabetes i ke kakahiaka a me ke ahiahi.
ʻO kēia ka mea o "syndrome looping" i ka mālamaʻana o ka mellitus type type 2 me nā sulfonamide lāʻau. I kēia lā, ʻo metformin (biguanide) ke koho mua ʻana i nā lāʻau lapaʻau mua no ka maʻi mellitus type type 2 mua loa.
ʻO Sulfanilamides e kuhikuhi pinepine ʻia no ka hana lapaʻau ʻana me kēia lāʻau lapaʻau. Inā hoʻomanawanui ka mea maʻi i ka hoʻomākaukau ʻana i ka metformin a hōʻole ʻole iā ia no nā kumu ʻē aʻe, e hiki ke hoʻohana ʻia ka sulfonamides ma ke ʻano ʻo ka maʻi mellitus type 2.
Nā Hoʻohui
ʻO Sulfanilamide ka lāʻau lapaʻau e contraindicated ma nā hihia o ke ʻano o ka hypersensitivity iā lākou, a hiki i ka ketoacidosis maʻi maʻi, i hui pū ʻia me koma a i ʻole ia. Inā ua ulu ke ʻano ma muli o ka mālama ʻana o ka mellitus type type 2 me ka lālani i hoʻokomo ʻia i loko o ka papa inoa o nā lāʻau sulfonamide, a laila pono lākou e hōʻole ʻia a kauoha ʻia ka insulin DKA.
Ma kekahi mau hōʻike hoʻokolohua ʻaʻole i hoʻokō maikaʻi loa i nā kiʻekiʻe kiʻekiʻe o ka ʻepekema ʻepekema, loaʻa kahi pilikia nui o ka make ma nā maʻi cardiovascular i ulu pū me ka sulfonamide therapy.
Akā i kahi hoʻomohala ākea ākea o nā poʻe ʻepekema Pelekane, ʻaʻole paʻa kēia ʻoiaʻiʻo. No laila, i kēia lā, ʻaʻole i hōʻoia ʻia ka hopena o nā maʻi o ka maʻi cardiovascular e nā sulfa sulfa.
Nui! ʻO ka hoʻopiʻi koʻikoʻi koʻikoʻi hiki ke ulu me ka terapi sulfanilamide ka hypoglycemia a me nā puka koʻikoʻi. No laila, pono e hoʻomaopopo ʻia nā mea maʻi e pili ana i ka hiki o kēia ʻano!
He mea paʻakikī ka hypoglycemia e hoʻohālikelike i nā mea maʻi a me nā mea maʻi beta-blocker. ʻO ka maʻa ʻana i ka wā e lawe ai i ka sulfonamides:
- ʻO nā mea maʻi pau loa me nā hōʻailona o ka maʻi hōʻino.
- ʻO ka poʻe maʻi e loaʻa ana i ka pituitary, adrenal a i ʻole kaʻohi ʻana i ka nuku.
- ʻO nā mea maʻi me ka ʻōlelo hoʻopiʻi ʻana o ka hoʻokomo caloric.
- ʻO nā mea maʻi ma hope o ka inu wai.
- ʻO ka poʻe me ka maʻi maʻi ma hope o ka hoʻoikaika kino kino.
ʻO nā mea maʻi ma lalo o ke kaumaha, ma hope o ka trauma, maʻi o ka hōʻeha ʻana, a e nalo paha i kā lākou glycemic control me ka sulfanilamide hoʻomākaukau. I kēia hihia, pono ka uku no nā dosis he nui, ʻo ka liʻiliʻi loa e like me ka hana ʻana. Akā ʻo ka hopena o ka uluʻana i ka hypoglycemia, me ka hoʻoweliweli ʻana e loaʻa ka hypoglycemic coma, hoʻonui.
