Txhawm rau kom tshem tawm cov ntshav qab zib thiab nws cov tsos mob, cov tshuaj tshwj xeeb tau siv uas tau txhawm rau txhawm rau txo qis qis cov ntshav qab zib hauv cov ntshav ntawm tus neeg mob. Cov kab mob antidiabetic (hypoglycemic) yuav yog rau kev siv niam txiv, nrog rau lub qhov ncauj.
Cov tshuaj hypoglycemic qhov ncauj hypoglycemic feem ntau tau muab cais raws li nram no:
- sulfonylurea derivatives (cov no yog Glibenclamide, Glikvidon, Gliklazid, Glimepirid, Glipizid, Chlorpropamide);
- alpha glucosidase inhibitors ("Acarbose", "Miglitol");
- meglitinides ("Nateglinide", "Repaglinide");
- cov lag luam loj ("Metformin", "Buformin", "Fenformin");
- thiazolidinediones (Pioglitazone, Rosiglitazon, Tsiglitazon, Englitazon, Troglitazon);
- ncetinomimetics.
Cov yam ntxwv thiab kev ua ntawm sulfonylurea derivatives
Cov khoom siv ntawm sulfonylureas tau pom los ntawm kev sib tsoo heev nyob rau hauv nruab nrab ntawm lub xyoo pua xeem. Lub peev xwm ntawm cov tebchaw tau tsim nyob rau lub sijhawm thaum nws muab tawm tias cov neeg mob uas tau siv tshuaj sulfa kom tshem tawm cov mob sib kis tseem tau txais txo qis hauv lawv cov piam thaj hauv ntshav. Yog li, cov tshuaj yeeb dej caw no tseem muaj lub suab hypoglycemic zoo rau cov neeg mob.
Vim li no, tam sim ntawd pib nrhiav kev xum xaim ntawm sulfonamides nrog lub peev xwm los txo qis dua theem ntawm cov piam thaj hauv lub cev. Txoj haujlwm no tau ua rau muaj kev sib txuas ntawm lub ntiaj teb thawj sulfonylurea derivatives, uas muaj peev xwm ua tau zoo los daws cov teeb meem ntshav qab zib.
Raug rau sulfonylurea derivatives yog txuam nrog kev ua kom muaj qee yam ntawm cov hlwb ua rau pancreatic beta hlwb, uas cuam tshuam nrog kev tsim kho thiab nce ntau ntxiv ntawm cov tshuaj insulin endogenous. Ib qho tseem ceeb ua ntej rau qhov muaj txiaj ntsig zoo yog qhov muaj nyob ntawm kev txiav txim siab ntawm ciaj sia thiab tag nrho cov roj ntsha hlwb.
Nws yog qhov tsim nyog tias nrog kev siv lub sijhawm ntev ntawm sulfonylurea derivatives, lawv cov txiaj ntsig zoo kawg yog ploj tag nrho. Cov tshuaj tsis haum rau cuam tshuam rau cov kua dej hauv kev zais. Cov kws tshawb fawb ntseeg tias qhov no yog vim qhov tsawg ntawm cov neeg tau txais ntawm beta hlwb. Nws kuj tau tshaj tawm tias tom qab so ib zaug hauv kev kho mob, qhov tshuaj tiv thaiv ntawm cov hlwb no rau cov tshuaj tuaj yeem kho rov qab los.
Qee qhov sulfonylureas tseem yuav muab cov nyhuv ua kom zoo li qub-ntxiv. Xws li qhov kev nqis tes ua tsis muaj qhov tseem ceeb kho mob. Cov teebmeem ntxiv-pancreatic muaj xws li:
- ua rau muaj peev xwm ntau ntxiv ntawm cov insulin-cov nqaij ua rau insulin ntawm qhov endogenous;
- tsawg zus tau tej cov piam thaj hauv lub siab.
Lub tswv yim tag nrho ntawm kev txhim kho cov kev cuam tshuam no rau lub cev yog vim qhov tseeb tias cov tshuaj ("Glimepiride" hauv kev tshwj xeeb):
- nce tus naj npawb ntawm receptors rhiab rau insulin ntawm lub phiaj xov tooj;
- kev tsim nyog txhim kho kev cuam tshuam insulin-receptor;
- normalize kev sib hloov ntawm postreceptor teeb liab.
Tsis tas li ntawd, muaj pov thawj tias sulfonylurea derivatives tuaj yeem dhau los ua lub zog ua haujlwm rau kev tso tawm somatostatin, uas yuav ua rau nws muaj peev xwm txhawm rau txhim kho glucagon ntau lawm.
Sulfonylureas
Muaj ntau ntau tiam neeg ntawm cov khoom no:
- Lub Cim Thib 1: "Tolazamide", "Tolbutamide", "Carbutamide", "Acetohexamide", "Chlorpropamide";
- Lub Cim Thib 2: Glibenclamide, Glikvidon, Gliksoksid, Glibornuril, Gliklazid, Glipizid;
- Lub Cim Thib 3: Glimepiride.
Txog hnub, hauv peb lub tebchaws, cov tshuaj ntawm 1st tiam yuav luag tsis siv rau hauv kev coj ua.
Qhov sib txawv tseem ceeb ntawm cov tshuaj ntawm 1st thiab 2nd tiam nyob hauv kev sib txawv ntawm lawv cov kev ua ub no. 2nd tiam sulfonylurea tuaj yeem siv rau hauv cov tshuaj noj kom qis, uas pab ua kom zoo tsim nyog txo qhov muaj peev xwm ntawm ntau cov kev mob tshwm sim.
Hais lus nyob hauv lej, lawv qhov haujlwm yuav yog 50 lossis tseem 100 zaus dua. Yog li, yog tias qhov xav tau qhov nruab nrab yuav tsum tau noj ntau npaum li cas ntawm 1 tiam tshuaj yuav tsum yog los ntawm 0.75 txog 2 g, ces koob thib 2 tiam twb muab ib koob tshuaj 0.02-0.012 g.
Qee qhov hypoglycemic derivatives kuj tseem yuav sib txawv hauv kev thev taus.
Cov tshuaj uas nrov tshaj plaws
Gliclazide - Qhov no yog ib qho ntawm cov tshuaj uas tau muab tshuaj feem ntau. Cov tshuaj tsis yog tsuas yog ua tau zoo ntawm hypoglycemic nyhuv, tab sis kuj tseem muaj txiaj ntsig zoo rau kev txhim kho:
- hematological ntsuas;
- rheological cov yam ntxwv ntawm cov ntshav;
- tshuab ua pa kho mob, microcirculation ntawm cov ntshav;
- kev ua haujlwm heparin thiab fibrinolytic;
- heparin ua siab ntev.
Ntxiv rau, Glyclazide muaj peev xwm tiv thaiv kev txhim kho ntawm microvasculitis (kev mob puas tsuaj), tiv thaiv txhua yam kev txhoj puab heev ntawm platelets, ua rau muaj kev sib cais ntau thiab ua rau pom cov khoom ntawm cov antioxidant zoo.
Glycvidon - Cov tshuaj uas tuaj yeem kho nyob rau cov pab pawg ntawm cov neeg mob uas muaj ntsis tsis pom kev ua haujlwm. Hauv lwm lo lus, muab tias ob lub raum ua kom poob 5 feem pua ntawm cov khoom noj sib txuas, thiab tshuav 95 - txoj hnyuv
Glipizide Nws muaj cov lus tshaj tawm thiab tuaj yeem sawv cev tau qhov kev coj tsawg kawg hauv kev phom sij hauv kev ua kom lub plawv tsis haum. Qhov no ua rau nws tsis tuaj yeem mus sib sau thiab tsis muaj cov metabolites.
Cov yam ntxwv ntawm kev siv cov tshuaj tiv thaiv qhov ncauj
Cov tshuaj tiv thaiv kab mob tuaj yeem yog qhov kev kho mob tseem ceeb rau hom ntshav qab zib 2, uas yog ywj siab ntawm cov tshuaj insulin. Cov tshuaj no raug pom zoo rau cov neeg mob uas dhau 35 xyoo thiab tsis muaj kev cuam tshuam ntau yam ntawm nws txoj kev kawm:
- ketoacidosis;
- kev tsis zoo noj;
- ailments xav tau kev kho mob sai insulin.
Kev npaj Sulfonylurea tsis yog qhia rau cov neeg mob uas, txawm tias muaj zaub mov noj txaus, qhov xav tau txhua hnub rau cov tshuaj insulin ntau dua lub cim ntawm 40 units. Tsis tas li, tus kws kho mob yuav tsis sau ntawv rau lawv yog tias muaj mob hnyav ntshav qab zib mellitus, keeb kwm ntawm kev mob ntshav qab zib tsis ua hauj lwm zoo thiab muaj ntshav qabzib ntau dhau los tiv thaiv keeb kwm ntawm kev noj zaub mov zoo.
Hloov mus rau kev kho mob nrog sulfonylurea yog ua tau nyob rau hauv qhov xwm txheej ntawm qhov tsis hnov lus carbohydrate metabolism, nyiaj tau los ntawm kev txhaj tshuaj ntxiv ntawm cov tshuaj insulin hauv tsawg dua 40 units. Yog tias tsim nyog, txog 10 PIECES, qhov kev hloov pauv yuav raug coj mus rau lub zog ntawm cov tshuaj no.
Lub caij nyoog siv ntawm sulfonylurea derivatives tuaj yeem ua rau txhim kho kev tiv thaiv, uas tuaj yeem kov yeej tsuas yog kev sib txuam nrog kev kho nrog insulin npaj. Hom ntshav qab zib hom 1, cov kev tawm tsam no yuav ua rau pom qhov txiaj ntsig tau sai txaus thiab yuav pab txo qis cov tshuaj insulin txhua hnub, ntxiv rau txhim kho txoj kev muaj kabmob.
Kev qeeb ntawm qhov muaj mob ntawm retinopathy vim sulfonylurea tau sau tseg, thiab cov kab mob ntshav qab zib retinopathy yog ib qho kev mob hnyav. Qhov no tuaj yeem yog vim muaj cov haujlwm angioprotective ntawm nws cov derivatives, tshwj xeeb tshaj yog cov uas zwm rau tiam 2 tiam. Txawm li cas los xij, muaj qee qhov tshwm sim ntawm lawv cov nyhuv atherogenic.
Nws yuav tsum raug sau tseg tias derivatives ntawm cov tshuaj no tuaj yeem ua ke nrog cov tshuaj insulin, nrog rau cov biguanides thiab "Acarbose". Qhov no ua tau rau cov neeg mob txoj kev noj qab haus huv tsis zoo txawm tias muaj 100 qhov tshuaj tiv thaiv ib hnub twg.
Siv cov tshuaj sulfonamide qab zib-txo cov tshuaj, nws yuav tsum nco ntsoov tias lawv cov haujlwm tuaj yeem ua kom qeeb:
- anticoagulants tsis ncaj ncees;
- salicylates;
- "Butadion";
- Kev Ncaj Ncees;
- Cyclophosphamide;
- tetracyclines;
- Chloramphenicol.
Thaum siv cov nyiaj no ntxiv rau cov tshuaj sulfa, cov metabolism kuj yuav tsis muaj peev xwm, uas yuav ua rau kev loj hlob ntawm hyperglycemia.
Yog tias koj sib xyaw sulfonylurea derivatives nrog thiazide diuretics (piv txwv li, "Hydrochlorothiazod") thiab BKK ("Nifedipine", "Diltiazem") hauv kev txhaj tshuaj loj, ces kev tawm tsam tuaj yeem pib tsim. Thiazides thaiv qhov kev ua tau zoo ntawm sulfonylurea derivatives los ntawm kev qhib cov kab mob potassium. LBCs ua rau muaj kev cuam tshuam hauv kev muab cov calcium ions rau beta hlwb ntawm cov txiav.
Derivatives los ntawm sulfonylureas zoo heev txhim kho cov nyhuv thiab kam rau ntawm cov dej cawv. Qhov no yog vim qhov kev ncua hauv cov txheej txheem oxidation ntawm acetaldehyde. Qhov kev nthuav tawm ntawm antabuse-zoo li cov tshuaj tiv thaiv kuj ua tau.
Ntxiv rau cov ntshav qog ntshav qab zib, qhov tsis zoo xav tuaj yeem yog:
- mob dyspeptic;
- cholestatic jaundice;
- hnyav;
- aplastic lossis hemolytic anemia;
- kev txhim kho kev ua xua;
- thim rov qab leukopenia;
- thrombocytopenia;
- agranulocytosis.
Meglitinides
Nyob rau hauv meglitinides yuav tsum to taub txog kev pom zoo.
"Repaglinide" yog ib qho kev sib txuas ntawm benzoic acid. Cov tshuaj sib txawv hauv cov qauv hauv tshuaj los ntawm sulfonylurea derivatives, tab sis lawv muaj tib yam hauv lub cev. Repaglinide thaiv ATP-dependant cov kab mob tso rau hauv cov roj ntsha nquag thiab txhawb kev tsim cov tshuaj insulin.
Lub cev cov lus teb los ib nrab teev tom qab noj mov thiab pom los ntawm kev txo qis hauv cov ntshav qab zib. Nruab nrab ntawm pluas noj, qhov concentration ntawm insulin tsis hloov pauv.
Zoo li cov tshuaj raws li sulfonylurea derivatives, qhov tshwm sim cuam tshuam loj tshwm sim yog hypoglycemia. Ua tib zoo saib, cov tshuaj tuaj yeem pom zoo rau cov neeg mob uas lub raum lossis lub siab tsis ua haujlwm.
Nateglinide yog ib qho kev sib txuas ntawm D-phenylalanine. Cov tshuaj nws txawv ntawm lwm yam zoo sib xws hauv kev ua kom sai dua, tab sis tsis tshua ruaj khov. Nws yog ib qho tsim nyog yuav tau siv cov tshuaj rau hom 2 mob ntshav qab zib mellitus kom zoo tsim nyog txo postprandial hyperglycemia.
Biguanides tau paub txij li 70s ntawm lub xyoo pua xeem thiab tau raug tshaj tawm rau cov tshuaj insulin los ntawm beta cells ntawm cov txiav. Lawv lub zog yog txiav txim siab los ntawm kev cuam tshuam ntawm gluconeogenesis nyob rau hauv daim siab thiab nce ntxiv ntawm kev muaj peev xwm ua kom cov kua nplaum nyob hauv qab. Tsis tas li ntawd, cov cuab yeej tuaj yeem ua kom qeeb qeeb ntawm kev ua haujlwm ntawm insulin thiab nce nws cov lus khi rau cov tshuaj insulin. Hauv cov txheej txheem no, cov metabolism thiab nqus ntawm cov piam thaj nce.
Biguanides tsis txo qis cov ntshav qab zib cov ntshav ntawm cov neeg noj qab haus huv thiab cov neeg txom nyem los ntawm hom 2 mob ntshav qab zib mellitus (muab hmo yoo).
Hypoglycemic biguanides tuaj yeem siv rau hauv kev txhim kho ntshav qab zib hom 2. Ntxiv nrog rau kev txo cov piam thaj, cov tshuaj no nrog rau lawv siv ntev txhawb cov cuam tshuam cov rog rog.
Raws li qhov ua tiav ntawm kev siv tshuaj ntawm pawg no:
- lipolysis yog tshuab txais (cov txheej txheem ntawm kev sib cais cov rog);
- tsis qab los noj mov;
- hnyav maj mam rov zoo li qub.
Qee qhov xwm txheej, lawv txoj kev siv nrog nrog qhov txo qis hauv cov ntsiab lus ntawm triglycerides thiab cov roj cholesterol hauv cov ntshav, nws tuaj yeem hais tau tias biguanides yog cov ntsiav tshuaj rau txo cov ntshav qab zib.
Ntawm hom 2 mob ntshav qab zib mellitus, cov metabolism hauv kev ua tsis tau zoo kuj tseem tuaj yeem cuam tshuam cov teeb meem hauv cov rog metabolism. Hauv thaj tsam li 90 feem pua ntawm cov neeg mob, cov neeg mob rog dhau. Vim li no, nrog kev txhim kho ntshav qab zib, nrog rau kev rog rog, nws yog qhov tsim nyog siv cov tshuaj uas ua rau cov lipid metabolism hauv lub cev tsis ua haujlwm zoo.
Qhov tseem ceeb qhia tias kev siv tshuaj loj yog hom 2 mob ntshav qab zib. Cov tshuaj yog qhov tshwj xeeb tshaj tawm tiv thaiv keeb kwm ntawm cov hnyav dhau los thiab ua tsis tau zoo ntawm kev noj haus lossis tsis muaj txiaj ntsig ntawm sulfonylurea npaj. Kev nqis tes ntawm biguanides tsis tau pom tias tsis muaj cov tshuaj insulin hauv cov ntshav.
Alpha glucose inhibitors inhibit qhov tawg ntawm polysaccharides thiab oligosaccharides. Qhov nqus thiab tsim cov piam thaj txo thiab yog li muaj kev ceeb toom ntawm kev txhim kho ntawm postprandial hyperglycemia. Tag nrho cov carbohydrates uas tau noj nrog zaub mov, hauv lawv lub xeev tsis hloov, nkag mus hauv ntu qis hauv txoj hnyuv thiab qhov loj. Qhov nqus ntawm monosaccharides kav ntev txog 4 teev.
Tsis zoo li cov tshuaj sulfa, alpha glucose inhibitors tsis nce insulin tso tawm thiab tsis tuaj yeem ua rau mob ntshav qab zib tsawg.
Raws li kev tshawb pom, nws tau ua pov thawj tias kev kho nrog kev pab ntawm "Acarbose" tej zaum yuav nrog kev txo qis hauv txoj kev loj hlob ntawm txoj kev hnyav ntawm atherosclerosis.
Kev siv cov tshuaj tiv thaiv kab mob no tuaj yeem ua hom kev kho mob monotherapy, thiab tseem txuas lawv nrog lwm cov tshuaj noj hauv qhov ncauj uas txo cov ntshav qab zib. Qhov muab tshuaj thawj zaug feem ntau yog 25 txog 50 mg tam sim ua ntej lossis thaum noj mov. Nrog rau kev kho mob tom qab, qhov ntau npaum no tuaj yeem raug nce mus txog qhov siab tshaj plaws (tab sis tsis ntau tshaj 600 mg).
Cov cim tseem ceeb rau kev teem caij alpha-glucosidase inhibitors yog: hom 2 mob ntshav qab zib mellitus nrog kev noj zaub mov tsis zoo, hom 1 mob ntshav qab zib mellitus, tab sis yuav muaj kev sib txuam nrog kev kho mob.
