Izidakamizwa eziphikisana nezidakamizwa - i-panacea noma i-killer kancane?

Ngokuvamile, izidakamizwa ezingekho-steroidal anti-inflammatory, noma i-NSAID, zisetshenziselwa ukwenza umtholampilo. Zibekiwe ngezinqubo zokuvuvukala ezihlukahlukene zokuqapha ukukhishwa kwesibindi, ukukhishwa kwesifo sobuhlungu, umkhuhlane, ukunciphisa ingozi ye-thrombosis (evamile i-aspirin). Ngokwezibalo ze-WHO, lezi zilungiselelo zidla cishe abantu abayizigidi ezingu-30 nsuku zonke, futhi ingxenye eyodwa kuphela kwezintathu zazo zibekwe udokotela. Izibalo ezithakazelisayo nakakhulu, ikakhulukazi, ngezifo ze-rheumatic. Kwakukhona ukuthi izidakamizwa eziphikisanayo zokuvuvukala zamalunga zibekiwe ngamaphesenti angama-80 ama-rheumatologists.

Kodwa ingabe lemithi ayinalutho njengoba idume? Ukusebenza komtholampilo akukabuzwa, kodwa kunomkhawulo wokulinganiselwa, ngoba ngisho nokulinganisa amancane kungabangela imiphumela emibi ekutholeni okwesikhashana kuma-25% weziguli, futhi kuma-5% wamacala, abe yisongo ekuphileni. Ikakhulukazi, liphathelene nabantu asebekhulile, futhi ngemva kwakho konke, balinganiselwa ku-60% kubo bonke abasebenzisi be-NSAID.

Ngesikhathi se-70s isimiso sesenzo salezi zidakamizwa sitholwa (ukuvimbela umsebenzi we-cyclooxygenase, i-enzyme eyinhloko ehilelekile ekusetshenzisweni komzimba kwe-prostaglandins), kwacaca ukuthi umphumela ohlangothini uzoba ukuthuthukiswa kwamathambo wokujikeleza kwe-renal kanye nomgudu wamathumbu. Phela, i-prostaglandins (PG) idlala indima enkulu lapha. Ngawo-1990, kwavela amaqiniso amasha mayelana nendima ye-PG phakathi nezinqubo ezibaluleke kakhulu emzimbeni womuntu. Ngakho-ke, izidakamizwa ezilwa nokuvuvukala ziphakamisa yonke inqubo yokubaluleka okubalulekile, ikakhulukazi, i- blood coagulation kanye nezwi le-vascular, bone metabolism, embryogenesis, ukukhula kwamaseli wesimiso sezinzwa, ukulungisa izicubu nezinye eziningi.

Ngesikhathi esifanayo, kwatholakala ukuthi kune-isoforms ezimbili ye-cyclooxygenase: COX-1 ne-COX-2. Ngaphezu kwalokho, owokuqala unomthwalo wokusebenza okujwayelekile kwezitho ezingeni leselula, futhi ukuvinjelwa kwesibili kubonisa umphumela wokwelapha. Ngakho-ke, ukhiqiza izidakamizwa ezilwa nokuvuvukala ezingahle zithinte i-COX-2, unganciphisa ukutholakala kwemiphumela emibi kakhulu kanye nokwelashwa okuphephile.

Enye ye-ejenti ekhethiwe yi-ibuprofen. Ngokusho cishe konke ukucwaninga, ingozi yokukhubazeka kwezinsikeni lapho uyithatha ayifani uma kuqhathaniswa ne, isibonelo, i-piroxicam.

Muva nje, omunye umphumela wecala utholakele obangela izidakamizwa ezingezangezokwelapha ezilwa nokuvuvukala. Zinciphisa kakhulu ithoni yemikhumbi, eyingozi kakhulu kubantu ababhekene ne-pathologies yenhliziyo. Ngemuva ye-NSAID, ngokuvamile kuvame ukwanda kwegazi, futhi empeleni iningi labantu asebekhulile elibekwe la mithi yokwelapha i-rheumatic ngokuvamile ivele ibe ne-anamnesis yesifo somfutho wegazi.

Ngaphezu kwalokho, ama-NSAID anciphisa ukuphumelela komthelela wokudonswa kwemithi eminingi yezidakamizwa ezinamandla. Ngokuyinhloko, isilinganiso semithi yokwelapha e-indomethacin, i-piroxicam ne-naproxen ayinqamuli ukudliwa kwezidakamizwa eziqukethe i-furosemide ne-hypothiazide, njengezidakamizwa ze-prazosin noma i-captopril. Kodwa-ke, kwabuye kwaziwa ukuthi amalungiselelo okwenza okukhethiwe kwi-isoforms ehlukene ye-COX, okukhulunywe ngenhla, ayithinti kakhulu isimo senhliziyo. Ngakho-ke, kusekhona insimu enkulu yomsebenzi wokwakha izidakamizwa ezikhethiwe kakhulu ezinomthelela omncane ekucindezelekeni kwegazi, futhi ezifanele kakhulu kubantu asebekhulile. Futhi izidakamizwa ezinjalo sezivele zivele zivele. Isibonelo, ngokuphathelene ne-COX-2, i-meloxicam, i-celecoxib, inokukhetha okuphawulekayo.

Ngeshwa, akubona abantu asebekhulile kuphela abahlinzeka ngezidakamizwa ezingezona izifo ezivutha ukuvuvukala emakhazeni, isibonelo, hhayi ukuqonda yonke imiphumela engenzeka. I-NSAID inzima ngempela ukufaka esikhundleni, kodwa udokotela oqeqeshiwe kuphela ongakwazi ukuhlola ukusebenza komuthi owanikwa kuzo zonke izingozi ezingenzeka.