Bukaannada Arthritis-ka ah Qaadashada NSAIDs Isticmaal Proton Pump Inhibitors
Dhiirigelinta Dhiig-xirka Kaansarida Jirka ee Nabadgelyada Kansarka
Khatarta sii kordhaysa ee jabta ayaa la xiriirta isticmaalka kontoroolka mashiinka proton, oo ah daroogada daroogada loo isticmaalo si loo daaweeyo xaaladaha acid-ku xiran sida mideeynta iyo GERD (cudurada gastroesophageal reflux). Sida laga soo xigtay natiijooyinka cilmi-baarista ee daabacaadda Diisambar 27-keedii, 2006-da, Ururka cilmi-baadhista ee Mareykanka , cilmi-baarayaashu waxay sheegeen in daaweynta sunta proton-ka ee muddo ka badan hal sano oo ah dadka ka weyn 50 sano ay la xiriirtay 44% jab.
Khatartu waxay ahayd 2.6 dhibcood marka loo eego dadka isticmaala muddada fog ee mashiinka proton-ka ee qadarka sare. Waqtiga iyo qiyaasta isticmaalka badeecada difaacka ee proton ayaa labadoodaba lala xiriiriyay khatarta jabka ee kor u kaca. Khatarta yaraanta, sidoo kale khatarta kor u kaca ee jabta ayaa sidoo kale lala xiriiriyay H2-blockers, oo loo yaqaan 'histamine-2 reset blockers' (tusaale ahaan Tagamet iyo Pepcid).
- 1.262 oo bukaanno waayeel ah ayaa lagu daaweeyaa buste proton in ka badan hal sano, hal jajab oo dheeraad ah sannadkii ayaa lagu xirayaa isticmaalka mashiinka proton-ka.
- 336 bukaan oo da 'walba ah ayaa lagu daaweeyaa in ka badan hal sano oo la qaato qiyaaso badan oo ka mid ah mishiinada difaaca difaaca, hal jajab oo dheeraad ah sannadkii ayaa lagu xirayaa dawooyinka mukhaadaraadka difaaca.
Proton Pump Inhibitors Iyadoo NSAIDs
Bukaanno badan oo arthritis-ka ah ayaa sidoo kale qaata baraha difaaca (sida Nexium , Prevacid, Protonix, iyo Prilosec) oo ay weheliyaan daawooyinka nonsteroid anti-inflammatory (NSAIDs) si loo yareeyo waxyeelada mindhicirka ee la xidhiidha NSAIDs.
Natiijooyinka waxbarasheed ee laga soo sheegay 2003-dii shirkii sanadlaha ee Kuliyadda American Gastroenterology waxay soo jeediyeen in maaddooyinka proton-ka difaacu si weyn u yareeyo halista boogaha ee bukaanka si joogto ah u qaataan NSAIDs. Macluumaadka ayaa ka tagay qaar ka mid ah dhakhaatiirta oo aaminsan in dhammaan bukaanada ku jira NSAIDs inay sidoo kale qaataan bamka sunta difaaca, halka kuwo kale ay dareemeen bukaano calaamado qaba cudurka dyspepsia waa inay qaataan baraha difaaca.
Mar labaad 2004 iyo 2005, marka ay joojiyaan COX-2 (fasal cusub oo NSAIDs ah ayaa lagu dhajiyay iyada oo sababaysa dhibaatooyin yar oo dheef-shiid kiimikaad hooseeya) ayadoo la eegayo arrimaha nabadgelyada wadnaha, dhakhaatiir badan ayaa mar kale kugula taliyey bukaanka arthritis in NSAID-ka dhaqameedka ee isku-xirnaanta mashiinka proton-ka doorka daaweynta ee wanaagsan.
Miyuu bukaanku ka joojinayaa in uu qaato kalluumaysiga tijaabada ah?
Sida laga soo xigtay cilmi-baaraha rheumatologist Scott J. Zashin, MD, "Sababta oo ah NSAIDs waxay kordhin kartaa khatarta dhiig-baxa dheef-shiid kiimikaadka, bukaanno badan oo khatarta ugu jira dhibaatadan si isku mid ah waxay qaataan bambo-nada korontada sida:
- Prilosec (omeprazole)
- Nexium (esomeprazole)
- Aciphex (rabeprazole)
- Ka hortagga (lansoprazole)
- Protonix (pantoprazole)
Waxyaabaha halista ah ee dhiig-baxa waxaa ka mid ah da'da ka weyn 60, sigaar cabbin, qaadashada corticosteroids , Aspirin , Coumadin (warfarin), Plavix (clopidogrel) ama serotonin kor u qaadida daawooyinka, iyo kuwa leh taariikh hore ee boogaha ama dhiig-baxa. Qaadashada mashiinka proton-ka ee difaaca ayaa yarayn kara khatarta ah dhiigbaxa GI ka wanaagsan tan H2 antagonists, oo ay ka mid yihiin:
- Pepcid (famotidine)
- Tagamet (cimetidiin)
- Zantac (ranitidine)
Daraasadani waxay muujineysaa in bukaannada ay qaataan qiyaasta ugu badan ee ka hortagga badeecada difonayaashu ay ku yeesheen khatarta sii kordheysa ee jabka osteoporosis iyo jabto.
Wali waxaa lagugula talinayaa inaad qaadato maalin kasta oo ah 1000-1500 mg oo ah kalsiyum iyo 400 IU oo fitamiin D ah inkastoo dad badani ay ka faa'iideysan karaan illaa 800 IU, gaar ahaan haddii aysan lahayn taariikh dhicis dhagxan ama kalsiyum sare leh.
Iyada oo ku saleysan daraasaddan, waxaan ku talin lahaa in bukaanada u baahan daawooyinkaas ay leeyihiin cufnaanta lafaha la socdo iyo haddii ay hooseeyso, hubi heerka fitamiin D-ga ah oo tixgelinaayo daaweyn dheeraad ah si loo ilaaliyo lafaha. Kala doorashooyinka kale waxaa ka mid ah badalida mashiinka proton-ka ee daawada ee la yiraahdo Cytotec (misoprostol) - daawo siinaysa faa'iidada ugu badan ee ilaalinta caloosha boogaha marka la qaato afar jeer maalin kasta.
Daawada ayaa ka hortageysa (ie aan loo isticmaalin) dumarka da'da ilmaha oo waxay u badan tahay inay sababaan calaamadaha kale ee caloosha. Doorashada kale waa in la helo daaweyn kale sidaasi darteed NSAID loo baahneyn. "
Scott J. Zashin, MD, waa macalin kiliin ah oo ka shaqeeya Jaamacadda Teknoolajiyada ee Columbine Medical School, Qaybta Rheumatology, Dallas, Texas; dhakhtar ku jira Isbitaalka Presbyterian ee Dallas iyo Plano; oo ka mid ah Iskuulada Maraykanka ee Dhakhaatiirta iyo Kulliyadda Maraykanka ee Rheumatology; iyo xubin ka tirsan Ururka Caafimaadka Mareykanka. Dr. Zashin waa qoraaga Arthritis Without Pain - Miracle TNF Blockers . Buuggu wuxuu faa'iido u leeyahay qof kasta oo ka mid ah daroogada bayolojiga (Enbrel, Remicade, Humira) ama tixgelinta daroogooyinka bayoloji.
Ilaha:
1. Yang, Yu-Xiao. "Daawo Muddo Dheerka ah ee Proton Pump Therapy iyo Khatarta Jabka Jabka." JAMA December 27, 2006.
2. "Mindhicirrada jilicsan ee loo xirxiray Khatarta Jabka." MSNBC.com. December 29, 2006. 31 Dec 2006.
3. "Proton Pump Inhibitor May Ayaa Ka Caawin Kara Waxay Ka Hortagaysaa UCariyaha Isticmaalayaasha NSAID-da Dabiiciga ah." Medscape. Oktoobar 15, 2003. 31 Dec 2006.