I-ursodeoxycholic acid: imiyalo yokusetshenziswa, i-analogues, izibuyekezo

Muva nje, i-ursodeoxycholic acid isetshenziselwa ukuphatha izilonda ezihlukahlukene zesibindi. Imfundo yokusetshenziswa kwalesi sakhi samakhemikhali ibonisa ukusebenza kwayo kwezifo eziningi ezibi kakhulu. Iyini le nto? Iyini i-ursodeoxycholic acid ehloselwe? Kuphi imikhiqizo ekhona?

Incazelo

I-ursodeoxycholic acid, ukusetshenziswa kwayo okusekelwe emvelaphi yayo nasezindaweni zayo, i-powder emhlophe ephuzi elimhlophe. Unomusa omuhlungu. Lesi sitho emzimbeni womuntu osebenza ngokujwayelekile senziwa ngamanani amancane. Ukuvuthwa kwalo okucishe kube ngu-5% we-mass mass we-bile acid. I-hydrophilic futhi ayinayo i-cytotoxicity. Le nhlanganisela yamakhemikhali isetshenziselwa ukuphuza utshwala kanye ne-acetic glacial acid, kancane inomswakama ku-chloroform futhi ingenasifo emanzini. I-ursodeoxycholic acid emikhiqizo ayitholakali. Itholakala ku-gallbladder ibhere elimnyama.

I-ursodeoxycholic acid (UDCA) i-epimer ye-chenodeoxycholic acid. Ekuqaleni, yayisetshenziselwa ukwelapha i-reflux gastritis kanye nokucwiliswa kwama-gallstones. Ngokuhamba kwesikhathi, yaqala ukusetshenziswa kwezinye izifo eziningi. I-UDCA ibhekwa njenge- asidi enesibindi kakhulu .

Isenzo se-ursodeoxycholic acid

Kuze kube manje, ukusetshenziswa kwe-UDCS kuyinqubo yokwelashwa kwezifo ezihlukahlukene ze-chilestatic kwesibindi ngenye ingxenye ye-autoimmune. Indlela yokwenza le nsizakalo ukusimamisa amaseli alesi sitho. Ama-molecule ayo angafakwa emagqumeni amangqamuzana ebindi - ama-hepatocytes. Ngenxa yalokhu bayakwazi ukubenza baphikisane kakhulu nesenzo sezinto ezinonya. Le-agent ye-hepatoprotective inomphumela we-choleretic. Ama-UDCS anciphisa ukushiswa kwe-cholesterol esibindi futhi avimbele ukungena kwawo emathunjini. Lesi sidakamizwa sinciphisa i-lithogenicity ye-bile futhi kwandisa okuqukethwe kwe-asidi kuyo. It ngcono umsebenzi lipase, pancreatic kanye nesisu esiswini. I-ursodeoxycholic acid ine-hypoglycemic effect, igqugquzela ukwakheka nokuhlukaniswa kwe-bile, kunciphisa izinga le-cholesterol kuyo.

Lesi sidakamizwa sinomthelela ekuhlanzeni okuncane noma okuphelele kwamatshe e-cholesterol. Yingakho isetshenziswa kaningi. Ukuxhuma nge-cholesterol, kwandisa ukukhwabanisa kwama-crystals, okusebenza ngokulimazayo emaqenjini. I-UDCA ine-immunomodulatory effect, equkethe ukwandisa umsebenzi we-lymphocyte, iyanciphisa ukuveza ama-antigens ahlukahlukene emagqabeni we-hepatocytes. Lithinta inani lama-T-lymphocytes, linciphisa inani lama-eosinophil.

I-UDCA inciphisa ukuhlushwa kwe-cholesterol nge-bile ngokusabalalisa kwayo kanye nokuguquka kwalesi sigaba esigabeni se-crystalline. Ithinta ukusakaza kwe-enterohepatic ye-bile usawoti. Ngenxa yalokho, ukubuyisela kabusha emathunjini amakhemikhali aphethwe yi-hydrophobic kanye ne-toxic ayancipha. Lesi sidakamizwa sinomphumela oqondile we-hepatoprotective kanye ne-choleretic. I-ursodeoxycholic acid, ebuyekezwe ochwepheshe emkhakheni we-hepatology efakazela ukuthi iyasebenza, iyakwazi ukunciphisa isibindi se-fibrosis nge-degeneration yayo enamafutha.

Isicelo

I-ursodeoxycholic acid, ukusetshenziswa okwenziwa ngaphansi kokuqondiswa odokotela abaya khona, kunqunywe ezimweni ezinjalo zempilo:

• ukutholakala kwamatshe e-cholesterol okutholakala emgodini we-gallbladder noma ovamile;

• Ukungenakwenzeka kokwelashwa ngendlela endoscopic noma yokuhlinzwa;

• I- hepatitis engapheli, e-atypical, elula kanye neyodwa ;

• ukutholakala kwamatshe e-cholesterol emva kokutholwa kwe-mechanical and extracorporeal lithotripsy;

• Ukulimala kwesibindi esinobuthi (ukwelapha, utshwala);

• i-cholangitis ye-sclerosing;

• i-cirrhosis eyinhloko ye-biliary ngaphandle kwezibonakaliso ze-decompensation;

I-Atresia ye-biliary tract;

• i-cystic fibrosis;

• isifo sofuba esingasebenzi esingapheli;

• i-cholestasis ene-parenteral nutrition;

• i-dyskinesia yamabhilidi;

• I-biliary dyspeptic syndrome ene-biliary dyskinesia kanye ne-cholecystopathy;

• i-opisthorchiasis engapheli;

I-atresia ye-congenital ye-bile ducts;

• I-reflux-esophagitis ye-biliary ne-reflux gastritis.

I-ursodeoxycholic acid (UDCA) isetshenziselwa ukuvimbela ukulimala kwesibindi okubangelwa ukuthatha izidakamizwa ze-cytotoxic kanye nokukhulelwa kwe-hormonal. Kunqunywe ezinye izifo ezibangelwa ukuhlanganiswa kwe-bile. I-UDCS inqunyelwe ukwelashwa okusizayo kwesibindi noma ezinye izitho zokufakelwa kwezitho.

Ukungafani

I-ursodeoxycholic acid, okubukezwa kwayo yiyo enhle kakhulu, inezingqinamba ezingathí sina. Lokhu kufaka:

• Izifo ezivuvukalayo ze-gallbladder, amathumbu nama-bucts e-phase esicacile;

• Ama-gallstones anama-ray ane-X anokuqukethwe okuphezulu kwe-calcium;

• ukuvimbela amabhiliyari;

• ukuxoshwa;

• isifo se-cirrhosis sesibindi ngesikhathi sokunciphisa;

• Isifo sikaCrohn;

• ukuphazamiseka okukhulunywa ekusetshenzisweni kwe-pancreas, isibindi nezinso.

Imikhawulo ekusetshenzisweni

I-ursodeoxycholic acid, imfundo yokusetshenziswa kwayo ibonisa ngokucacile ukungabi khona kwemingcele eqinile ekusetshenzisweni kwayo, ayinqunyelwe izingane ezingaphansi kweminyaka emi-3 kwifomu ye-capsule. Ngokwelashwa kwabo, ukumiswa okuqukethe lokhu kusetshenziswa izidakamizwa. Kuze kube manje, ochwepheshe abazange benze izifundo ezifanele ezihloswe ekunqumeni umphumela we-chololitholytic walesi sici kuye ngokuthi uneminyaka yengane. Ngesikhathi esifanayo, izifundo ezinganeni ezine-atresia ze-bile neduct nezinye izifo zesibindi azibonanga izinkinga ezithile zezingane.

Izidakamizwa eziqukethe i-ursodeoxycholic acid zinqunyelwe abesifazane abakhulelwe kuphela uma umphumela olinganiswayo wokwelashwa nalo muthi udlula ingozi engenzeka enganeni engakazalwa. Ngesikhathi esifanayo, akufanele sikhohlwe ukuthi akekho oye wenza ucwaningo lwesayensi olugcwele ngokuphepha kwalesi sigaba salesi sigaba seziguli. Njengoba kungaziwa ukuthi u-UDCA ungena ebisi lwebele, kudingekile ukuqapha lesi sidakamizwa kubesifazane abahlengikazi.

Imiphumela emibi

I-ursodeoxycholic acid, imfundo yokusetshenziswa kwayo ayibonakali ukulinganiselwa kuphela ekusebenziseni kwayo, kodwa futhi emiphumeleni emihle, ingaholela ezinkingeni ezinjalo zokuthi:

• ukuqothulwa, isifo sohudo;

• isicashunwe;

• umsebenzi owandisiwe we-transaminases;

• ubuhlungu ku-hypochondrium kanye nesifunda se-epigastric;

• ukusabela okweqile esikhumbeni (itching, rash);

• Ukubalwa ngamatshe.

Ukwelapha kwe-cirrhosis eyinhloko ye-biliary nalesi sidakamizwa ngezinye izikhathi kuholela ekutheni isiguli sinomsoco ophuthumayo oshabalala ngemva kokuhoxiswa kwalesi sidakamizwa.

Ukuqapha

Ukuze uthole i-litholysis ephumelelayo yamatshe e-cholesterol ngosizo lwe-UDCA, le mibandela elandelayo kufanele icatshangelwe:

• usayizi wabo awudluli 2 cm;

• abanikeli isithunzi emsakazweni;

• i-gallbladder isebenza ngendlela evamile;

• amadoksi agcina ubuciko;

• i-bubble igcwele amatshe angaphansi kwesigamu;

• Umzila we-bile ovamile awuqukethe amatshe.

Yimiphi eminye imikhawulo eyenziwa i-ursodeoxycholic acid? Imfundo yalo mkhiqizo wezokwelapha ibonisa ukuthi ukuhlolwa okuqhubekayo okungaphezu kwenyanga eyodwa kuyadingeka ukuthi kuqhutshwe njalo (kanye ngezinsuku ezingama-30) ukuqapha kwe-transaminase ye-hepatic, phosphatase, bilirubin, gamma-glutamyltransferase. Ukuqhuba ukuhlaziywa okunjalo kubaluleke kakhulu ezinyangeni ezintathu zokuqala zokwelapha nge-UDCS. Ukuphumelela kokwelashwa kuqinisekiswa njalo ezinyangeni eziyisithupha nge-x-ray kanye nokuhlolwa kwe-ultrasound kokungena kwe-biliary. Ukuvimbela ukuhlaselwa kokuphindaphindiwe kwe-cholelithiasis, ukwelashwa kuqhubeka ngemva kokuqedwa kwamatshe. Ingahlala izinyanga eziningi.

Ngesikhathi ukwelashwa kwe-UDCS, abesifazane abaneminyaka yobudala yokubeletha batuswa ukuba basebenzise izindlela ezinokwethenjelwa zokuzivikela ekukhulelwe. Lezi zingaba izidakamizwa ezingekho ze-hormonal noma izakhi zokubeletha ezinenani elincane lezi-estrogen.

Ukukhishwa kwefomu kanye nesilinganiso

I-ursodeoxycholic acid, imfundo yokusetshenziswa kwayo inikeza incazelo eningiliziwe yemigomo yokuphatha kwayo, iyatholakala kumafomu okulinganisa:

• amakhemikhali namaphilisi angu-150 no-250 mg;

• ukumiswa kwezingane.

Isilinganiso se-ursodeoxycholic acid sisungulwe ngokuqondile. Kuncike ekutheni isimo somuntu nesisindo somzimba. Ngokuvamile kunqunywe ku-10-20 mg / kg ngosuku. Leli dosi lithathwa ngesikhathi, kusihlwa. Isikhathi sokwelashwa ngokuqondile sincike ezinkomba. Lesi sidakamizwa sitholakale emathunjini amancane, futhi emva kwamahora amathathu e-plasma yegazi, kukhonjiswe ukuhlushwa okuphezulu kakhulu. Ukudla okuqhubekayo kwemithi equkethe i-ursodeoxycholic acid yenza kube yi-acid enkulu ye-bile emzimbeni womuntu. Lesi sici sibhekene nenani lezinguquko futhi emphumela wokugcina unqunywe njengama-metabolites ngemifino nomchamo.

Isikhathi sokwelapha sinqunywa udokotela oya khona. Ingahlukahluka kuye ngokuthi uhlobo lwesifo. Kwezinye izimo ezinzima kakhulu, ukusetshenziswa kwezidakamizwa ze-UDCA kudlulela iminyaka.

Ukusebenzisana nezinye izidakamizwa

Ngokuphathwa okuhlanganyelwe kwe-UDCA kanye ne "Cyclosporine," ukuxoshwa kwalezi zinsuku kungenwe ngokungazelelwe. Ngesikhathi esifanayo, ukuhlushwa kwe-plasma yegazi kukhulisa kakhulu ukuhlushwa kwezidakamizwa. Ezimweni ezingavamile zokuthatha i-UDCS ngesikhathi esifanayo nesidakamizwa "Ciprofloxacin" ukuhlushwa kwalezi zinsuku kunciphisa.

I-ursodeoxycholic acid (ama-analogs)

I-ursodeoxycholic acid (amakhemikhali, amaphilisi) atholakala ngaphansi kwamagama ahlukene. Izindlela ezinjalo zihlukile phakathi kwazo kanye nezinto ezisizayo ezakha ukwakheka kwazo. Ngakho, ekuthengiseni kungenzeka ukuhlangabezana nemithi elandelayo nge-ursodeoxycholic acid:

• Ama-Capsules "Ursosan", okuhloswe ukwelashwa kwezifo zesibindi, ezithinta i-cholelithiasis, ne-reflux gastritis ye-biliary kanye ne-reflux esophagitis, i-cirrhosis eyinhloko, ukulimala kwesibindi, okweqile, isifo se-alcoholic, sclerosing cholangitis, i-bile duct atresia, engeyona i-steatohepatitis. I-ursodeoxycholic acid ("i-Ursosan") isetshenziselwa ukuvimbela ukulimala kwesibindi.

• Amathebulethi "Ukrliv", athathwa ngokungaqiniseki kahle, isifo sofuba esingapheli, i-cholelithiasis.

• Ama-capsules "Ursofalk", anqunyelwe izifo ezihlukahlukene ze-gallbladder nesibindi, ehambisana ne-cholestasis, ukwehla kwemisebenzi ethile yesibindi, ukwanda kwezinga le-cholesterol. Lokhu kufaka phakathi: i-cirrhosis eyinhloko ye-biliary kanye ne-cholangitis ye-sclerosing, i-reflux gastritis ne-reflux esophagitis, i-hepatitis ye-etiologies ehlukahlukene, amatshe e-cholesterol, i-cystic fibrosis, izilonda ezihlukahlukene zesibindi, i-bile stasis. Lesi sidakamizwa sisetshenziselwa ukuvimbela ukulimala kwesibindi uma uthatha izidakamizwa ezinamandla.

• Amaphilisi e-Ursodex, athathwe nge-cirrhosis ye-biliary ngaphandle kokubonakaliswa kwe-decompensation ne-reflux gastritis. Zisetshenziselwa ukuqothula amatshe amancane okuthiwa yi-cholesterol ekusebenzeni okujwayelekile kwe-gallbladder.

• Ama-capsules "Ursodez", asetshenziselwa ukukhipha amatshe e-cholesterol, ukwelashwa kwe-reflux gastritis, yokwelashwa okuphawulekayo ne-cirrhosis eyinhloko yesibindi ngaphandle kokubonakaliswa kwe-decompensation.

• Ama-capsules "Ursolizin", awenzelwe ukuqeda amatshe e-cholesterol kanye nokwelashwa kwesifo se-cirrhosis ye-biliary, i-gallbladder cholesterosis ne-reflux gastritis. Isidakamizwa sisetshenziselwa ukwelashwa okuyinkimbinkimbi ekwelapheni iziguli ezine-hepatitis ezingapheli kanye nesifo se-chibindi sesibindi.

• Ama-Capsules "Holudexan", asetshenziselwa ukwelapha i-cholelithiasis engahlosiwe, isifo sofuba esingapheli, isibindi soshukela nesibindi esinobuthi, okungewona utshwala obizwa ngokuthi i-steatohepatitis, i-cirrhosis eyinhloko ye-biliary, i-primary sclerosing cholangitis, i-cystic fibrosis, i-bile duct dyskinesia, i-reflux gastritis ne-reflux esophagitis.

• Ama-capsules "Urdoksa", anqunyelwe i-cirrhosis eyinhloko yebhilidi ngaphandle kokubonakaliswa kwe-decompensation, i-reflux gastritis. Isidakamizwa kahle sichitha amatshe amancane kanye naphakathi kwe-cholesterol ngenkathi igcina umsebenzi ojwayelekile we-gallbladder.

• Ama-capsules "Ursoror S", enqunyelwe i-cholelithiasis engathandeki, i-cirrhosis eyinhloko, i-hepatitis enesifo esibucayi, i-sclerosing cholangitis, i-intrahepatic atresia, i-reflux gastritis ne-reflux esophagitis, i-cholestasis, ukondleka kwebele, i-dyskinesia ye-biliary, i-fover pathology, I-cystic fibrosis, i-fatty hepatosis, i-dyspeptic syndrome. Isidakamizwa sisetshenziselwa ukuvimbela ukulimala kwesibindi uma usebenzisa izisu zokuvimbela i-hormonal kanye ne-cytostatics, ukwakheka kwamatshe ekukhulupheni.

I-ursodeoxycholic acid, okufana nalezi zinto zithathwa kuphela ngenhloso yodokotela oya khona.