Orlistat yochepetsa thupi - malangizo apadera a odwala omwe ali ndi matenda ashuga

M'zaka zaposachedwa, nkhani yopewa komanso kuchiza kunenepa kwambiri yakhala ikulandiridwa kwambiri. Kunenepa kwambiri kwakhala kukuwoneka kuti sikukuchulukitsa minofu ya adipose mthupi, koma ngati matenda omwe amabwera pafupipafupi, zotsatira za kusowa kwa mphamvu zamagetsi zomwe zimayamba ndi kuwonjezeka kwa chakudya komanso kuchepa kwa mphamvu zamagetsi ndipo zimagwirizanitsidwa kwambiri ndi zovuta zingapo. Orlistat (Xenical), mankhwala ozungulira omwe alibe zotsatira za system 11, 24, 27, amagwiritsidwa ntchito kwambiri ku pharmacotherapy ya kunenepa kwambiri. Xenical ndiye mankhwala ophunziridwa kwambiri a pharmacological a kuwonda. Odwala opitirira 30,000 onenepa kwambiri anali ndi CI, pomwe oposa 2,500 odwala omwe ali ndi matenda a shuga a 2. Mankhwalawa masiku ano amakhalanso othandizira pochita kunenepa kwambiri / kunenepa kwambiri.

ORLISTAT PAKUTHENGA KUTHA KWA KUDZIPEREKA NDI ZINYAMA ZA 2

Kwa zaka zapitazi, cholinga chakhala chikukula pakupewa komanso kuchiza kunenepa kwambiri. Kunenepa kwambiri kwakhala kukuchitika kwa nthawi yayitali> Orlistat (Xenical), wogwiritsa ntchito mankhwala mosachiritsika popanda zotsatira za 11, 24, 27, wakhala akudwala matenda onenepa kwambiri. Xenical ndi mankhwala omwe amaphunziridwa bwino kwambiri ochepetsa thupi. Oposa 30,000 odwala kunenepa kwambiri adachitapo ziyeso zamankhwala, pomwe odwala oposa 2,500 anali ndi matenda a shuga a 2. Mpaka lero, mankhwalawa amakhalabe othandizira pochiza kunenepa kwambiri / kunenepa kwambiri.

Zolemba za asayansi pamutu wakuti "Orlistat mu zovuta zochizira kunenepa kwambiri ndi mtundu wa matenda ashuga a 2"

A.M. MKRTUMYAN, MD, pulofesa, E.V. BIRYUKOVA, MD, pulofesa

Moscow State Medical and Dental University A.I. Evdokimova

ORLISTAT MU COMPLEX THERAPY

KUKHALA NDI ZIWALO ZA 2

M'zaka zaposachedwa, nkhani yopewa komanso kuchiza kunenepa kwambiri yakhala ikulandiridwa kwambiri. Kunenepa kwambiri kwakhala kukuwoneka kuti sikukuchulukitsa minofu ya adipose mthupi, koma ngati matenda omwe amabwera pafupipafupi, zotsatira za kusowa kwa mphamvu zamagetsi zomwe zimayamba ndi kuwonjezeka kwa chakudya komanso kuchepa kwa mphamvu zamagetsi ndipo zimagwirizanitsidwa kwambiri ndi zovuta zingapo. Orlistat (Xenical), mankhwala ozungulira omwe alibe zotsatira za system 11, 24, 27, amagwiritsidwa ntchito kwambiri ku pharmacotherapy ya kunenepa kwambiri. Xenical ndiye mankhwala ophunziridwa kwambiri a pharmacological a kuwonda. Odwala opitirira 30,000 onenepa kwambiri anali ndi CI, pomwe oposa 2,500 odwala omwe ali ndi matenda a shuga a 2. Mankhwalawa masiku ano amakhalanso othandizira pochita kunenepa kwambiri / kunenepa kwambiri.

Mawu ofunikira: lembani matenda ashuga a 2 shuga, kunenepa kwambiri, pharmacotherapy, orlistat.

A.M. MKRTUMYAN, MD, Prof., E.V. BIRYUKOVA, MD, Prof.

Moscow State University of Medicine ndi Dentistry yotchedwa A.I. Evdokimov

ORLISTAT PAKUTHENGA KUTHA KWA KUDZIPEREKA NDI ZINYAMA ZA 2

Kwa zaka zapitazi, cholinga chakhala chikukula pakupewa komanso kuchiza kunenepa kwambiri. Kunenepa kwambiri kwa nthawi yayitali sikuti kumangokhala ngati mafuta ochulukirapo a thupi koma ndi matenda omwe akubwerera m'mbuyo, zotsatira za kuchepa mphamvu kwa mphamvu, komwe kumayamba chifukwa cha kuchuluka kwa chakudya komanso kuchepetsedwa kwa mphamvu zamagetsi ndipo kumalumikizana kwambiri ndi zovuta zingapo. Orlistat (Xenical), wogwiritsa ntchito mosadziletsa popanda zotsatirapo zoyipa za 11, 24, 27, wakhala akugwiritsidwa ntchito kwambiri pochiza matenda a kunenepa kwambiri. Xenical ndi mankhwala omwe amaphunziridwa bwino kwambiri ochepetsa thupi. Oposa 30,000 odwala kunenepa kwambiri adachitapo ziyeso zamankhwala, pomwe odwala oposa 2,500 anali ndi matenda a shuga a 2. Mpaka lero, mankhwalawa amakhalabe othandizira pochiza kunenepa kwambiri / kunenepa kwambiri.

Mawu osakira: mtundu 2 shuga, kunenepa kwambiri, pharmacotherapy, orlistat.

Kunenepa kwambiri kumathandizira kukulira ndikuwonekera kwa matenda osachiritsika monga mtundu 2 shuga mellitus (T2DM), matenda a mtima, matenda a minofu ndi mafupa, kugaya chakudya, mitundu ina yamatumbo oyipa, ndi ena ambiri. ndi zina zambiri, zomwe zimayipitsa mbiri ya moyo. Kunenepa kwambiri kumakhudzanso kuchepa kwa nthawi yamoyo chifukwa chodwala pafupipafupi matenda opatsirana.

WHO imawona kunenepa ngati mliri wapadziko lonse womwe ukukulitsa mamiliyoni aanthu. Mliri wa kunenepa kwambiri ukukula kwambiri: kumayambiriro kwa zaka za XXI. kuchuluka kwa matendawa pakati pa anthu azaka zogwira ntchito kwachulukirachulukirachulukira ndipo pafupifupi hafu ya anthu okalamba padziko lonse yawonjezera kunenepa kwambiri, ndipo pafupifupi theka lawonda 1, 22. manambala sakulimbikitsa m'badwo wachichepere: pali kuchuluka kwamankhwala ambiri onenepa, komanso m'maiko otukuka 15% ya achinyamata. Kunenepa kwambiri paubwana ndikuneneratu kwambiri kunenepa kwambiri mukamakula, kuphatikiza apo, kumathandizira kukulitsa matenda okhudzana ndi imfa, kufa msanga ndi kulumala. Kuwonjezeka kwa kuchuluka kwa kunenepa kwambiri mwa ana ndi achinyamata makamaka kumayendetsedwa ndi kuwonjezeka kwa odwala omwe ali ndi T2DM.

Kunenepa kwambiri komanso kunenepa kwambiri ndizomwe zikuyambitsa kuchuluka kwa kuchuluka kwa matenda amtima wapadera (CVD), matenda ashuga

Mtundu wa 2 3, 12, 14. Kuchulukana kwa T2DM kumawonjezeka ndi kuchuluka kwa mndandanda (BMI): mwa anthu omwe ali ndi BMI ya 25-29.9 kg / m2, ndi 2%, mwa anthu omwe ali ndi BMI ya 30-34.9 kg / m2 - oposa 8% ndi 13% okhala ndi BMI yoposa 35 kg / m2. Malinga ndi IDF, oposa theka la milandu ya T2DM atha kupewedwa bwino bola kuwonjezeka kwa kulemera kukanapeweka.

Tiyenera kukumbukira kuti kuchepa kwa thupi la 5-10% kungachepetse kwambiri mawonetseredwe a

Chithunzi 1. BMI ndi chidziwitso cha moyo

, kusintha kuwongolera ndikuwonjezera mphamvu ya mankhwala a matenda a kunenepa kwambiri. Komabe, kulemera kwa thupi ndi zofunikira zina za anthropometry za odwala (mwachitsanzo, kuzungulira kwamchiuno) sikuti nthawi zonse kumatsimikizika machitidwe, chifukwa, ngati matenda, kunenepa kwambiri sikuwoneka kawirikawiri m'mbiri yachipatala. Chizindikiro chokwanira kwambiri chamafuta amthupi ndi index index (BMI), yomwe imagwirizana kwambiri ndi mafuta okwanira amthupi: BMI = kulemera kwa thupi, (kg) / kutalika, (m2). WHO imagwiritsa ntchito mawu oti "kunenepa kwambiri" kwa odwala omwe ali ndi BMI ya £ 30 kg / m2. Amuna ndi akazi omwe ali ndi BMI ya 25-29.9 kg / m2 amawonedwa kuti ndi onenepa kwambiri. BMI yapakati pa 30.0 mpaka 34.9 kg / m2 imafanana ndi kunenepa kwambiri kwa digiri yoyamba, kuyambira 35.0 mpaka 39.9 kg / m2 - kunenepa kwambiri kwa digiri yachiwiri, BMI yoposa 40 kg / m2 - kunenepa kwambiri kwa digiri yachitatu, kapena kuchepa kwa digiri yachitatu.

Kunenepa kwambiri ndi matenda a multifactorial. Choyambitsa chibadwa chimatsata kukula kwa kunenepa kwambiri, koma chinthu chomwe chimapanga, mosaganizira zaka, jenda, ndi moyo wa munthu. Njira yofala kwambiri yankhanira yotengera kunenepa kwambiri imayamba chifukwa cha kudya kosayenera (kudya zakudya zopatsa mphamvu kwambiri, kosawerengeka, kudya moperewera) komanso kuchepa mphamvu zolimbitsa thupi.

Mliri wa kunenepa kwambiri ukukula kwambiri: kumayambiriro kwa zaka za XXI. kuchuluka kwa matendawa pakati pa anthu azaka zogwira ntchito kwachulukanso kuposa kale ndipo kotala la anthu achikulire padziko lonse lapansi ali ndi kunenepa kwambiri, ndipo pafupifupi theka la onenepa kwambiri

Kunenepa kwambiri kumachitika chifukwa cha kusakhazikika kwa mphamvu zamagetsi ndikukula ndikukula kwa chakudya komanso kuchepa kwa mphamvu zamagetsi. Mulingo watsiku ndi tsiku wopatsa mphamvu zokwanira 100 kcal kokha kumapangitsa kuti thupi lizikula chaka chilichonse ndi makilogalamu atatu. Zaka makumi angapo zapitazi, kapangidwe ka zakudya za anthu asintha kulikonse, ndipo zakudya zama calorie ambiri okhala ndi mafuta ochulukirapo komanso zokhala ndi fiber zochepa zachepa. Kumbukirani kuti mphamvu yonse yogwiritsidwa ntchito mthupi imakhala ndi zinthu zitatu: metabolism yayikulu (60-65%), zochita zenizeni za chakudya (thermogenesis - 10%) ndi zochitika zolimbitsa thupi (20-40%). Monga mafuta amphamvu kwambiri pazonse, mafuta osakhazikika (1 g = 9 kcal) amasungidwa mosavuta mthupi, kusandulika malo osungirako mafuta osawonongeka pang'ono mphamvu. Kuphatikiza apo, mafuta alibe mafuta okwanira monga mapuloteni ndi chakudya, ndipo kugwiritsa ntchito zakudya zamafuta kwambiri kumachepetsa mbali zomwe zimapangitsa kuti munthu azikhala ndi chidwi chofuna kudya, kuchepetsa nkhawa. Kusungidwa kwamafuta kumafuna mphamvu zochepa kuposa kusungidwa kwa chakudya. Pomaliza, zakudya zokhala ndi mafuta zimapangitsa kuti mafuta asamadye kwambiri, sizitengera nthawi yayitali kutafuna -

Chithunzi 2. Lamulo la kudziunjikira kwa Neuroendocrine

Orexigenic zinthu Anorexigenic zinthu

Zotsatira za Orexigenic Neuropeptide Y Melanin-mahomoni ophatikizika a Orexins A ndi B Agouti okhudzana ndi mapuloteni Opioids Galanin

f chakudya kudya f parasympathetic kamvekedwe (f insulin)

F kuchitira ena chisoni (f)

f kumwa ndi mafuta

Proopiomelanocortin Cocaine ndi amphetamine-wolemba Cortico-, tyroliberin Glucone-ngati peptide-1 Serotonin, vasopressin

F chakudya kudya f parasympathetic kamvekedwe (f insulin)

f zomvera chisoni (f mtengo) f fat oxidation

kuposa zakudya zamafuta ndi michere yambiri, zomwe zimathandizanso kuti mudye kwambiri.

Ndi mitundu yonse ya kunenepa kwambiri, pali kuphwanya kwa kayendetsedwe kazinthu zazikulu zomwe zimasintha zochita. Malo ofunikira omwe amayang'anira kudya ndi mphamvu zamagetsi amaphatikiza dera la hypothalamus lomwe limatulutsa, lomwe limayang'anira njala, komanso dera la ventothedial hypothalamus, lomwe limayang'anira satiety. Kuphwanya kulumikizana kulikonse mu kachipangizidwe kameneka kumatha kubweretsa kusintha kwa chakudya komanso kuchuluka kwa mafuta. Ma monoamine ena, okhala ndi zopatsa mphamvu, amakula, ena, amakhala ndi zotsatira za anorexigenic, m'malo mwake, amachepetsa kudya.

Mu pathogenesis ya kunenepa kwambiri ndi matenda omwe amagwirizana nawo, gawo lofunikira limaperekedwa kwa minofu ya adipose ngati gawo loyimira lazinsinsi. Minofu ya Adipose imasiyanitsidwa ndi auto-, para- ndi endocrine ntchito, imasunga chinsinsi chachikulu cha ma cytokines omwe ali ndi zotsatira zosiyanasiyana zachilengedwe zomwe zingayambitse kukula kwa zovuta zomwe zimakhudzana ndi kuchuluka kwambiri kwa thupi, kuphatikiza insulin kukaniza (IR). Kuwonongeka kwa hypothalamic-pituitary-adrenal axis ndikuwonjezereka kwa zochitika zamagulu amanjenje omvera, norepinephrine, insulin imayendetsedwa ndi kuwonjezeka kwa kupanga kwa cortisol, testosterone mwa amayi komanso kuchepa kwa progesterone, testosterone mwa amuna, yomwe imathandizanso kupititsa patsogolo kwa kusokonekera kwa metabolic. Adipose minofu amasinthanso kukonzanso kwa thupi, amathandizira kukulitsa kutupa kwapang'onopang'ono.

IR imadziwika kawirikawiri kwa odwala omwe ali ndi kunenepa kwambiri, omwe ali ndi matenda ena kapena zovuta zina zomwe zimaphatikizidwa ndi lingaliro la "metabolic syndrome" (MS). Ichi ndi chimodzi mwazinthu ziwiri zotsogola kwambiri za T2DM, chilema china ndichinsinsi cha pancreatic p-cell.

Chithunzi 3. Kunenepa kwambiri kwa Visceral kumawonjezera chiopsezo cha T2DM.

96.3 m'chiuno mozungulira (cm)

Nurses 'Health Study Carey VJ et al, 1997

Chiwopsezo chotenga matenda onenepa kwambiri chimakhazikitsidwa makamaka ndi mawonekedwe a kufalikira kwa minyewa ya adipose mthupi. Ntchito yayikulu pakukula ndi kupititsa patsogolo kwa IR imaseweredwa ndi adipose minofu yam'mimba. Ndi index yomweyo ya thupi (BMI), kunenepa kwam'mimba kumalumikizidwa ndi chiwopsezo chachikulu cha CVD ndi T2DM kuposa kunenepa kwambiri kwa mpweya wotumphuka (gynoid). Chizindikiro cha kunenepa kwambiri pamimba ndi kuwonjezeka kwa chiuno mwa amuna opitilira 94 masentimita, ndipo mwa akazi oposa 80 cm.

A mawonekedwe a visceral adipocytes ndi kukhudzika kwakukulu kwa lipolytic zotsatira za catecholamine ndipo otsika kwa antilipolytic zotsatira za insulin. Pafupipafupi komanso kuuma kwa IR ndi kunenepa kwambiri kumawonjezeka ndi kuwonjezeka kwa mafuta ochuluka, makamaka m'chigawo cha visceral. Zotsatira za kafukufuku wam'mbuyomu zawonetsa gawo lalikulu la IR pakukula msanga komanso kuthamanga kwa CVD yolumikizana ndi atherosulinosis, komanso kuwonjezera chiwopsezo cha zovuta za pachimake macrovascular. Kukana kwa insulin, mosasamala kanthu za zifukwa zina zofunika kwambiri za mtima, kuphatikizira hyperglycemia, dyslipidemia, kusuta fodya, kumakulitsa kudziwikiratu kwa chitukuko cha CVD, kumathandizira kukulitsa tsogolo labwino. Kuphatikiza apo, digiri ya IR imangodziyimira pawokha pakukula kwa kuwonongeka kwa impso.

Chimodzi mwamagwiritsidwe omwe amatsogolera kunenepa kwambiri ndikusintha kwa insulin. Hyperinsulinemia imathandizira kuyamwa kwa glucose ndi zotumphukira zimakhala, komanso amachepetsa kupanga kwa chiwindi cha hepatic, komwe kwakanthawi kamakhala ndi shuga wamagazi. Compensatory hyperinsulinemia, yomwe imayamba kuchepa kwamatenda amtundu wa insulin, imakhala ndi cholinga chokhala ndi kagayidwe kazinthu kogwiritsa ntchito magawo oyambira, koma imathandizira kukulira kwa kusokonekera kwa metabolic, hemodynamic ndi ziwalo.Kamodzi, hyperinsulinemia ndiyofunikira kuthana ndi minofu kukana insulin, ndipo mbali inayo, njira ya m'magazi yomwe imathandizira kuti pakhale zovuta komanso zovuta za metabolic, hemodynamic ndi systemic.

Kunenepa kwambiri ndi vuto losakanikirana, ndipo madokotala aliwonse apadera ayenera kuchitira izi, ndikulowerera kwakanthawi, matendawa amasintha. Chithandizo cha kunenepa kwambiri ndi ntchito yovuta, chifukwa ndi matenda osachiritsika omwe amafunikira nthawi yayitali, kuwunika mwatsatanetsatane ndikuchiza 5, 12. Njira zamakono zothandizira kunenepa kwambiri zimaphatikizapo kugwiritsa ntchito njira zosagwiritsa ntchito mankhwala, zomwe ngati, ndizofunikira, zimathandizidwa ndi pharmacotherapy ndi chithandizo chamankhwala opangira opaleshoni (tebulo).

Cholinga chachikulu chothandizira kunenepa kwambiri, komanso kuchepetsa kunenepa kwamthupi, ndikulepheretsa kapena kupititsa patsogolo matendawa, kukulitsa chiwopsezo cha CVD ndi zovuta zawo komanso kukonza moyo wabwino 2, 14. Kuchokera pa malingaliro azachipatala, sikofunikira kuyesetsa kuti mukhale ndi kulemera koyenera kuti mukhale ndi thanzi labwino. Thupi: kuchepa kwakukulu kwakulemera m'thupi ndi osachepera 5% ya kulemera koyambirira, zonse zomwe zimatheka kwa anthu ambiri. Kwa odwala omwe ali ndi BMI yoposa 35 kg / m2, cholinga chamankhwala ndikuchepetsa thupi ndi 10% ya mtengo woyambira.

Zotsatira za kafukufuku wam'mbuyomu zawonetsa gawo lalikulu la IR pakukula msanga komanso kuthamanga kwa CVD yolumikizana ndi atherosulinosis, komanso kuwonjezera chiwopsezo cha zovuta za pachimake macrovascular

Mulingo woyenera amaonedwa ngati kuchepa pang'onopang'ono kulemera kwa thupi - kuyambira 0,5 mpaka 1 makilogalamu pa sabata kwa miyezi 3 mpaka 6 ndi kukhazikika kwake kwa miyezi isanu ndi umodzi. Makamaka, lolani kuti cholinga chanu chichepetse makilogalamu awiri m'mwezi umodzi, ndipo cholinga cha nthawi yayitali - ndi 6-10 kg m'miyezi isanu ndi umodzi. Kutsika kwa kulemera kwa thupi m magulu a 5.0-9.9 makilogalamu kumachepetsa chiopsezo chotenga matenda oopsa chifukwa cha 15%, kutsika kwa 10 kg kapena kupitilira - ndi 26%. Kutsika kwa kulemera kwa thupi kwa 10% kapena kupitirira kumabweretsa kutsika kwa 44% pangozi yakukula kwa T2DM.

Ndikofunika kudziwa kuti kuchepa thupi kumakhala koyenera nthawi zonse poyerekeza ndi zakudya zam'mbuyomu komanso kuwonjezera masewera olimbitsa thupi, omwe amachepetsa chizolowezi chomwa mowa, makamaka olemera m'mafuta. Kuchita masewera olimbitsa thupi tsiku lililonse kuyenera kuchitika mosalephera. Ngakhale kutsimikizika kwa kuphatikiza zakudya zamankhwala ndikulimbitsa thupi kowonjezereka, 20% yokha ya odwala omwe akufuna kuchepetsa thupi amagwiritsa ntchito njira zochiritsira nthawi imodzi. Odwala atha kulimbikitsidwa kuchita masewera olimbitsa thupi nthawi zonse (kuyenda, kusambira, kuchita masewera olimbitsa thupi) mwamphamvu (magawo 4-5 pa sabata kwa mphindi 30-45), chifukwa kumayambiriro kwa chithandizo, odwala nthawi zambiri satha kuchita makalasi atali komanso okhazikika. Tsoka ilo, mwa kuchita izi, odwala onenepa nthawi zambiri amanyalanyaza kudya calorie komanso kudya kwambiri masewera olimbitsa thupi.

Pharmacotherapy ya kunenepa imagwiritsidwa ntchito ngati njira yolumikizira mankhwala osagwiritsa ntchito mankhwala ndipo imalola odwala kuwonjezera kudzipereka kwawo kwa mankhwala osagwiritsa ntchito mankhwala ndikukwaniritsa kuchepetsa kokwanira kwa kulemera kwa thupi ndikusunga kwake kwakanthawi.Kugwiritsa ntchito mankhwala osokoneza bongo kumachitika kwa odwala omwe ali ndi BMI ya £ 30 kg / m2, komanso kukhala ndi BMI ya £ 27 kg / m2 pamaso pa zovuta zokhudzana ndi kunenepa kwambiri komanso zovuta za CVD 1, 22. Chosangalatsa chachikulu ndi mankhwala omwe mankhwala ake a pharmacological samangofunikira kuchepetsa Kulemera kwa thupi, komanso kukonza mahomoni-kagayidwe kachakudya ndi zovuta zam'magazi zomwe zimakhudzana ndi kunenepa kwambiri 5, 22.

Orlistat (Xenical), mankhwala ozungulira omwe alibe zotsatira za dongosolo 11, 24, 27, amagwiritsidwa ntchito kwambiri muchipatala cha kunenepa kwambiri. Xenical ndiye mankhwala ophunziridwa kwambiri a pharmacological a kuwonda, odwala opitirira 30,000 onenepa kwambiri omwe adakhudzidwa ndi CI, ndipo Oposa 2,500 odwala matenda amtundu wa 2. Mankhwalawa masiku ano amakhalanso othandizira pochita kunenepa kwambiri / kunenepa kwambiri.

The pharmacological zotsatira za Xenical ndi chifukwa cha luso la mankhwalawo kuti amangirane

Gome. Kusankha kwa njira zochizira kunenepa kutengera BMI

Chithandizo cha BMI, kg / m2

25.0-26.9 27.0-29.9 30-34.9 35.0-39.9 g 40.0

Zakudya zochepa zopatsa mphamvu Pazolimbitsa thupi Khalidwe kusintha + + + + +

Pharmacotherapy - Mikhalidwe ya Comorbid + +

Mankhwala othandizira - - - Mikhalidwe ya Comorbid +

pakati yogwira lipases ya m'mimba thirakiti (GIT), kukulitsa. Ma digestive tract lipases ndi michere yayikulu yomwe imayendetsa hydrolysis ya chakudya triglycerides kuti monoglycerides ndi mafuta acids. Poletsa matenda a m'mimba a lipase, Xenical imalepheretsa kusweka ndikuyamba kuyamwa pafupifupi 30% yamafuta azakudya. Njira yofananira imayambitsa kuperewera kwa mphamvu, komwe kugwiritsa ntchito nthawi yayitali kumathandizira kuchepetsa thupi.

Kuchokera pamalingaliro azachipatala, sikofunikira kuti muziyesera kuti mukwaniritse bwino thupi kuti mukhale ndi thanzi labwino: kuchepa kwakukulu kwa kulemera kwa thupi kumachepera 5% ya kulemera koyambirira, ndizo zonse. imatheka kwa anthu ambiri

Kuphatikiza apo, mankhwalawa amachepetsa kuchuluka kwamafuta acids ndi monoglycerides m'matumbo a lumen, omwe amachepetsa kusungunuka komanso kuyamwa kwa cholesterol, ndikuthandizira kuchepetsa hypercholesterolemia.

The pharmacological zotsatira zimadalira kupezeka kwa mafuta mu chakudya; odwala omwe amatenga Xenical, zakudya zomwe zili ndi zotsika ndizofunikira. Xenical imayikidwa 120 mg katatu patsiku mkati kapena mkati mwa ola limodzi mutatha kudya, malinga ndi chakudya. Mlingo wothandiza wa mankhwalawa ndi 120 mg katatu patsiku (360 mg / tsiku).

Kulekerera kwa Xenical kumalumikizidwa mosiyanasiyana ndi kuchuluka kwa mafuta mu chakudya. Odwala omwe sataya mafuta ochulukirapo pakudya, chopondacho chimakhala chambiri, chamafuta, chosawoneka bwino cha m'mimba chitha kuchitika, monga kutulutsa magazi, kusefukira. Mawonekedwe am'mimba amachepa ndi kuchepa kwa zakudya zamafuta. Contraindication kugwiritsa ntchito mankhwalawa ndi mal mayamwidwe, cholestasis, hypersensitivity kwa mankhwala kapena zigawo zake.

Zinawonetsedwa kuti kuphatikiza zakudya zamagulu ochepa zopatsa mphamvu, Xenical imachepetsa kwambiri kulemera kwa thupi ndikuwonjezereka mobwerezabwereza, imathandizira mkhalidwe wa matenda omwe amachitika chifukwa cha kunenepa kwambiri komanso kusintha moyo wabwino 15, 18. Izi zimatithandizira kuti tithandizire kugwiritsa ntchito mankhwalawa pakulamulira kwakanthawi kwakanthawi kwa odwala omwe ali ndi kunenepa kwambiri. Lero ndi mankhwala okhawo ochepetsa thupi, ovomerezeka kuti azigwiritsidwa ntchito kwa achinyamata azaka za 12-16. Mankhwalawa amatha kugwiritsidwa ntchito kwa nthawi yayitali kwa zaka 4.

Kafukufuku watsatanetsatane wazidziwitso zamatenda a Xenical mu

Kafukufuku wambiri adapeza mwayi watsopano pothandizira odwala omwe ali ndi kunenepa kwambiri 13, 15, 26. Chosangalatsa ndichoyesa matenda (CI) XXL (XenicaL ExtraLarge Study). XXL ndiye kafukufuku wamkulu kwambiri yemwe adathandizira kuwunika kwa Xenical therapy muzochitika zenizeni zamankhwala, kuphatikizapo odwala 15,549 (zaka zapakati pa 48 zaka) ndi matenda angapo ophatikizika (pafupifupi theka anali ndi 2-3, gawo limodzi mwa magawo atatu a odwala anali ndi matenda a kunenepa kwambiri a 3 kapena kuposa). . Chifukwa chake, matenda oopsa am'mimba amapezeka mu 41%, dyslipidemia mu 34% ndipo amalemba matenda a shuga a 2% mwa 16% ya odwala. Kutalika kwa Xenical mankhwala pafupifupi 7.1 miyezi. Odwala ambiri m'mbuyomu adayeseranso kuchepetsa thupi, koma ochepera 10% adatha kukwaniritsa kutsika kwa 5% kulemera kwa thupi ndikuwonjezeranso zina. Pamapeto pa phunziroli, kuchepa kwapakati kwa kulemera kwa thupi kunali 10,7%, BMI - 3.76 kg / m2. Kuphatikiza apo, 87% ya odwala idataya kuposa 5%, ndi theka la odwala - kuposa 10% ya kulemera koyambirira kwa thupi.

Pamodzi ndi kuchepa thupi, zotsatira zopindulitsa za Xenical zawonedwa mwa odwala omwe ali ndi vuto la kunenepa kwambiri. Makamaka, kuchepa kwa kupanikizika kwa systolic / diastolic pamapeto pamaphunziro anali 8.7 / 5.1 mm RT. Art. Odwala ochepa matenda oopsa, tanthauzo la systolic limatsika ndi 12.9 mmHg. Art., Ndi diastolic - ndi 7.6 mm RT. Art. Kuchepetsa thupi kunayendetsedwa ndi kusintha kwa maselo a metabolic, kuphatikizapo zizindikiro za metabolism ya carbohydrate, kuphatikizapo pamaso pa T2DM. Mwambiri, pomaliza kuwonera, glycemia yachangu idatsika ndi 7.5% mwa odwala onse omwe adatenga nawo mbali phunziroli, komanso mwa odwala T2DM - 15,0%.

Xenical chithandizo chimachepetsa chiopsezo cha mtima. Kuchokera kumbali ya mbiri ya lipid, kuchepa kwa chiŵerengero cha LDL / HDL (-15.4%) kunawonedwa. Mwa odwala omwe ali ndi dyslipidemia, panali kuchepa kwakukulu kwa kuchuluka kwa cholesterol kwathunthu, LDL (14%) ndi triglycerides (18%), pomwe mulingo wa HDL unakwera ndi 13%.

Ndikofunika kudziwa kuti kuchepetsa thupi nthawi zonse kumakhala kothandiza kwambiri poyerekeza ndi momwe zakudya zimayambira komanso kuchuluka kwa zochitika zolimbitsa thupi, zomwe zimachepetsa chizolowezi chomwa mowa, makamaka wamafuta

Chotsatira chofunikira cha kafukufuku wa XXL chinali kusintha kwa chithandizo chamankhwala okhudzana ndi kunenepa kwambiri, kuphatikizapo kusiya kapena kuchepetsa mankhwala ena mwa odwala onenepa omwe adalandira Xenical. Chifukwa chake, 18% ya odwala omwe ali ndi matenda oopsa komanso 31% ya odwala omwe ali ndi dyslipidemia anasiya kumwa mankhwala a antihypertensive ndi hypolipidemic, motero. Kuphatikiza apo, mu 8% ya odwala omwe ali ndi matenda oopsa ndipo

15% ya dyslipidemia yafupika tsiku lililonse mankhwala. Mwa odwala omwe ali ndi T2DM, chithandizo chochepetsa shuga chinathetsedwa mu 16%, ndipo mu 18% mlingo wa tsiku ndi tsiku wa mankhwala unachepetsedwa. Mwa odwala omwe ali ndi kunenepa kwambiri komanso dyslipidemia, m'modzi mwa odwala atatuwa adasiya kugwiritsa ntchito hypolipidemic.

Xenical ndi mankhwala omwe amaphunziridwa kwambiri a mankhwalawa kuti achepetse thupi, odwala oposa 30,000 onenepa kwambiri anali ndi CI, komanso odwala opitilira 2,500 omwe ali ndi matenda a shuga a 2. Mankhwalawa amakhalabe chopinga pochiza kunenepa / kunenepa kwambiri.

Kafukufuku wowerengeka adawunikira kuyesayesa kwamankhwala ndikololera kwa Xenical mwa odwala omwe ali ndi MS. Mu CI Pinkston M. et al. adawunikira zotsatira zakusintha kwa Xenical ndi moyo (poyerekeza ndi zosintha za moyo zokha) mwa azimayi 107 omwe ali ndi MS (wazaka 21-65 zaka). Patatha chaka chowonekera, pagulu la odwala a MS omwe amalandila Xenical, kusintha kwakukulu kuzowonetsa anthropometric kunawonedwa: kuchepa kwa thupi ndipo BMI inali 9.3 ± 7.5 makilogalamu ndi 3.1 ± 3.9 kg / m2, motsatana, pomwe inali inanso gulu - okha 0,2 ± 3,1 kg ndi 0,1 ± 1,2 kg / m2.

Kafukufuku wina adawunika zotsatira za Xenical tiba, kuwunika kuwopsa kwa zaka 10 za CVD pamawonekedwe a Framing mu 181 odwala. Pakutha kwa sabata la 36 la mankhwala a Xenical, BMI yatsika kuchoka pa 35.0 ± 4.2 mpaka 32.6 ± 4.5 kg / m2, malo m'chiuno - kuyambira 108.1 ± 10,1 mpaka 100.5 ± 11.1 cm Ndikofunikira kudziwa kuti kuchepa kwa kulemera kwa thupi kopitilira> 5% kudakwaniritsidwa mwa 64.6% ya odwala. Mwa odwala omwe ali ndi vuto la kulekerera kwa glucose (NTG), 38 mwa 53 (71.7%) adawonetsa kusintha kwa kulolera kwa glucose. Pakutha kwa phunziroli, theka la odwala anali atasamukira kumalo ochepetsa ngozi ya CVD pamlingo wa Framingham. Izi ndi kafukufuku ena angapo awonetsa kuthekera kwa kugwiritsa ntchito Xenical kwa odwala omwe ali ndi kunenepa kwambiri, kuphatikizapo NTG ndi T2DM, pofuna kupewa zovuta zamitsempha.

Chidziwitso china chofunikira ndi zotsatira zabwino za Xenical pazomwe zimapangidwira kulipira kwa T2DM. Si chinsinsi kuti cholepheretsa chithandizo chokwanira cha hyperglycemia ndichakuti odwala ambiri amtundu wa 2 amenepa kwambiri, ndipo pazaka zambiri amatha kuchuluka, makamaka ndi sulfonylurea ndi insulin. Ndiyofunika kukhazikika pazotsatira za CI yokhala ndi makanda awiri, momwe odwala 368 omwe ali ndi T2DM adatenga nawo mbali (BMI kuposa 28 kg / m2, HbA1s 6.5-11.0%). Pambuyo pa chaka 1 chowunikira, kuchepa kwa thupi kwakuposa 5% kudakwaniritsidwa mu 51,5% ya odwala omwe amalandila Xenical kuwonjezera pa mankhwala ochepetsa shuga, ndipo mu 31.6% ya odwala omwe amawalandira ndi placebo. Odwala omwe amalandila Xenical, kusintha kwabwinoko kwambiri pazowonedwa kunawonedwa.

kulipira anthu odwala matenda ashuga poyerekeza ndi odwala omwe akungomwa mankhwala ochepetsa shuga: HbAlc (-0.9% / - 0,4%, p sindikutha kupeza zomwe mukufuna? Yesani ntchito yosankha mabuku.

CHITSITSO CHIYANI

Mankhwala achi Swiss enieni omwe:

Amachepetsa mpaka 16% ya kulemera koyambirira m'chaka choyamba cha mankhwala okhala ndi zotsatira zabwino kwambiri m'miyezi itatu yoyambirira ya tiba1

V Chimalimbikitsa zotsatila

ndipo amalepheretsa kubwereza mobwerezabwereza 2'3

Zimathandizira odwala anu kuwongolera kuchuluka kwa mafuta muzakudya zawo4

Xenical (Orlistat). Nambala yolembetsa: P N014903 / 01. Gulu la Pharmacotherapeutic: gastrointestinal lipase inhibitor. Nambala ya ATX: A08AV01. Zowonetsa kwa nthawi yayitali odwala omwe ali ndi kunenepa kwambiri kapena odwala onenepa kwambiri (MT), kuphatikizapo omwe ali ndi chiopsezo chokhudzana ndi kunenepa kwambiri, osakanikirana ndi zakudya zopatsa mphamvu zama calorie (UHD). Kuphatikiza kwa hyperplasma ndi mankhwala oseketsa kapena UHD mwa odwala omwe ali ndi matenda a shuga 2 a mellitus (DM) omwe ali ndi MT kapena kunenepa kwambiri. Kuphwanya malabsorption syndrome, cholestasis, hypersensitivity mankhwala. Mimba komanso nthawi yoyamwitsa: chifukwa cha kusowa kwa chidziwitso chachipatala, Xenical sayenera kutumizidwa kwa amayi apakati komanso / kapena kutengedwa panthawi yoyamwitsa. Mlingo ndi makonzedwe: mwa akulu ndi ana opitilira zaka 12 onenepa kwambiri kapena MT owonjezera, komanso kuphatikiza mankhwala a hypoglycemic kapena UHD mwa akulu omwe ali ndi matenda a shuga a 2 omwe ali ndi MT kapena kunenepa kwambiri, mlingo woyenera wa orlistat ndi kapisozi 1 120 mg ndi chakudya chachikulu chilichonse 3 pa tsiku. Zosungidwa: Mndandanda B. Sungani kutentha osapitirira +25 ° C pamalo otetezedwa ku chinyezi komanso osavomerezeka kwa ana.

Zambiri zimaperekedwa mu malangizo ogwiritsira ntchito mankhwala a Xenical.

1. Rissanen A et al. INTJ Obes. 2003.27. 103-109, 2. Sjosfrom L et al. Lancet. 1998 ¡ul 18, 3. Torgerson JS pa al. Kusamalira Matenda a shuga 2004, Jan, 4. Zhi J et al. Clin Pharmacol Ther. 1994, Jul, 56 (1>: 82-5

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sindikutha kupeza zomwe mukufuna? Yeserani ntchito yosankha mabuku.

Njira ya placebo + ya Xenical + Kusintha kwa moyo wa Xenical

kuchepetsa kuchepetsa vs placebo

78 104 130 Masabata

Sjostrom et al. 9 ICO. Sao Paulo, 2002

mavuto akulu azachipatala. Mankhwala a kunenepa kwambiri ayenera kuonedwa ngati othandizira pa njira zosagwiritsa ntchito mankhwalawa pochiza matendawa. Kuchiza ndi Xenical sikungangokulitsa mtundu ndi chiyembekezo cha moyo wa odwala, komanso zimachepetsa kwambiri zovuta ndi kufa kwa mavuto a kunenepa kwambiri, ndipo nthawi zina amachotsa polypharmacy, yomwe imakonda kupezeka mwa odwala omwe ali ndi kunenepa kwambiri.

1. Kunenepa kwambiri. Mkonzi. I.I. Agogo. M: Medical News Agency, 2014.

2. Aronne LJ. Zosankha zochizira kusintha kwa cardiometaboLic chiopsezo. Ndine J Med., 2007, 120 (3 SuppL 1): S26-34.

3. Aronne LJ, SegaL RK. Kugwirizana ndi zotsatira zakugawa kwamafuta: kuwunika ndi tanthauzo la cLinicaL Obes Res, 2002, 10 (1): 14S-21S.

4. Zotsatira za Bjorntorp P. Metabolic pakugawa mafuta m'thupi. Chisamaliro cha Mashuga, 1991, 14: 1132-1143.

5. Btay GA, Greenway FL. Mankhwala apano komanso omwe angathe kuthandizira kunenepa. Endocr Rev 1999, 20: 805-75.

6. Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Kunenepa kwambiri, kunenepa kwambiri, komanso kufa chifukwa cha khansa kwa munthu yemwe akuyembekezeka ku Ly adaphunzira cohort ku U.S. akuluakulu. N Engl J Med, 2003, 348 (17): 1625-1638.

7. Deng Y, Scherer PE. Adipokines ngati ma bio-cholembera komanso ma CD a metabolic syndrome. Ann NY Acad Sci, 2010, 1212: E1-E19.

8. Flegal KM, Carroll MD, Kuczmarski RJ, Johnson CL. Kunenepa kwambiri komanso kunenepa kwambiri ku United States: kuchuluka ndi zochitika, 1960-1994. Int J Obes Relat Metab Disord, 1998, 22: 39-47.

9. Galanis DJ, Harris T, Sharp D, Petrovich H. Wothandizila kulemera, kusintha kwa kulemera, komanso chiopsezo cha matenda a mtima mu Honolulu Heart Program. Ndine J Epidemiol, 1998, 147: 379-86.

10. Hanefeld M, Sachse G. Zotsatira za orlistat pa kulemera kwa thupi ndi kayendedwe ka glycemic pakuyang'anira-

odwala kulemera ndi mtundu 2 shuga. Disabetes Obes Metab, 2002, 4: 415-23.

11. Heck AM, Yanovski JA, Calis KA. Orlistat, lipase inhibitor yatsopano pakuwongolera kunenepa kwambiri. Pharmacotherapy, 2000, 20: 270-9.

12. Kahn SE, Hull RL, Utzschneider KM. Njira zophatikiza kunenepa kwambiri ndi kukana kwa insulin ndi matenda a shuga a 2. Zachilengedwe, 2006, 444: 840-846.

13. Pinkston MM, Poston WS, Amabweza RS et al. Kodi metabolic syndrome imachepetsa kuchepa kwa azimayi olemera ku Mexico onenepa kwambiri omwe amathandizidwa chaka chimodzi ndi orlistat ndikusintha kwamachitidwe? Idyani Thupi Lathupi, 2006, 11 (1): 35-41.

14. Rahmouni K, Correia MLG, Haynes WG et al. Matenda ogwirizana ndi kunenepa kwambiri. Matenda oopsa 2005, 45: 9-14.

15. Richelsen B, Tonstad S, Rossner S et al. Zotsatira za orlistat pa kulemetsanso kwa thupi komanso kuwopsa kwa mtima pambuyo pazakudya zopanda mphamvu kwambiri mwa odwala onenepa kwambiri: kafukufuku wazaka zitatu wosasinthika komanso wowerengeka. Chisamaliro cha Mashuga, 2007, 30 (1): 27-32.

16. Rowe R, Cowx M, Poole C et al Zotsatira za orlistat mwa odwala omwe ali ndi matenda ashuga: kusintha kwa kayendetsedwe ka glycemic ndi kuwonda. Curr Med Res Opin, 2005, 21 (11): 1885-90.

17. Sharma AM, Golay A. Zotsatira zakuchepetsa kwa kuthamanga kwa magazi m'thupi komanso kuthamanga kwa mtima mwa odwala. J. Hypertens, 2002, 29: 1873-8.

18. Sjostrom L, Rissanen A, Andersen T et al. Orlistat yovomerezeka mosaloledwa ya orlistat yochepetsa thupi komanso kupewa kunenepetsa kwa odwala onenepa kwambiri. Lancet, 1998, 352: 167-72.

19. Torgerson JS, Hauptman J, Boldrin MN et al. Xenical popewa matenda ashuga mu maphunziro onenepa (XENDOC), kafukufuku wosasankhidwa wa mankhwala osokoneza bongo ngati njira yothana ndi kusintha kwa matenda ashuga a mtundu 2 kwa odwala onenepa. Kusamalira Matenda a shuga, 2004, 27: 155-161.

20. Tounian P, Aggoun Y, Dubern B et al: Kukhalapo kwa kukhazikika kwa zovuta za carotid artery ndi endothelial dysfunction mu ana onenepa kwambiri: kafukufuku woyembekezeka. Lancet.

2001, 385: 1400-04.

21. Tremblay A, Buemann B. Kuchita masewera olimbitsa thupi, kusamalira bwino macronutrient komanso kuwongolera kunenepa kwambiri. Int J Obes Relat Metab Disord, 1995, 19: 79-86.

22. Yanovski SZ, Yanovski JA. Kunenepa kwambiri. N Engl J Med,

2002, 346: 591-602.

23. Wadden TA, Wothandizira GD. Khalidwe kuchitira kunenepa. Med Clin North Am, 2000, 85: 441-61.

24. Kukhathamira A. Kuchepetsa thupi ndi kusakhazikika kwa orlistat: The XXL- primary Health Care Trial. Matenda a shuga, Kunenepa kwambiri ndi Metabolizm, 2005, 7: 21-7.

25. Wolf AM, Colditz GA. Ziwerengero zaposachedwa za mtengo wachuma wa kunenepa kwambiri ku United States. Obes Res., 1998, 6: 97-106.

26. Zanella MT, Uehara MH, Ribeiro AB. Mbiri ya Orlistat ndi mtima wamavuto mumagulu oopsa omwe ali ndi metabolic syndrome: kafukufuku wa ARCOS. Arq Bras Endocrinol Metabol, 2006, 50 (2): 368-76.

Orlistat - kapangidwe ndi mawonekedwe a kumasulidwa

Kunja, makapisozi otsekemera a Orlistat amasiyanitsidwa ndi chipolopolo cha buluu wokhala ndi mthunzi wa pelescent (phale lidzayera podzicheka), mzere wogawika ndi zolemba "f". M'maselo a mabulasitiki a pulasitiki, mankhwalawa amadzazidwa ndi zidutswa 10, m'bokosi mumatha kukhala ma mbale ambiri (kuchokera pa 1 mpaka 9 ma PC.).

Mankhwalawa akupezeka kuti mugulitsidwa, mutha kugula zonse mumafakitale wamba komanso pa intaneti. Ndizopindulitsa kwambiri kugula makapisozi pazonse zonse - phukusi lalikulu limawononga ndalama zochepa. Mtengo wa Orlistrat udzadalira wopanga: mapiritsi apakhomo (21 ma PC. 120 mg iliyonse) muyenera kulipira ruble 1300, analogue ya wopanga wa Switzerland, ofanana kulemera kwake, adzagula ruble 2300.

Alumali moyo wa mankhwala salinso zaka ziwiri. Kusunga zida zothandizira poyamba ndikwabwino kuti musankhe malo ozizira osadetsedwa ndi ana.

Chofunikira chachikulu cha mankhwalawa ndi zotumphukira ndi orlistat. Inhibitor imachepetsa kudya ndipo pafupifupi siyimalowetsedwa kuzungulira dongosolo.

Zomwe zimapangidwira mu formula zimathandizira ndi ma excipients: magnesium stearate, acacia chingamu, sodium lauryl sulfate, crospovidone, mannitol.

Makhalidwe a Pharmacological a Orlistat

Or Oratat, limagwirira ntchito amatengera ndi zoletsa ntchito ya lipases pamimba ndi matumbo. Zotsatira zake zimadziwikiratu m'mimba, komwe kumapangidwa mgwirizano ndi serase lipases. Ma Enzymes amataya mphamvu ya hydrolyze triglycerol kuchokera ku zakudya zamafuta kuti agwetse mamolekyulu kupita ku mafuta acids okhala ndi monoglycerides.

Ma mamolekyulu osadziwika omwe samatengedwa - kusowa kwa zopatsa mphamvu kumathandizira kuchepetsa kunenepa. Kuti mankhwalawa awone kuthekera kwake, safunikira njira yolekeramo magazi: muyezo wokwanira (120 mg / 3 p. / Day) amachepetsa kuyamwa kwamafuta ndi wachitatu.

Zinakhazikitsidwa poyesa kuti kusunthika kwa ndulu ndi kapangidwe kazomwe zili mkati mwake, kuchuluka kwa matumbo ndi kuchuluka kwake kwa acidity sikusintha mukadzaza ndi orlistrist. Mwa 28 ophunzira omwe adatenga Orlistrat pa 120 mg / 3 p. / Day., Ndende ya ziwalo zamkuwa, phosphorous, iron, zinc, magnesium, calcium yachepa.

Kuthekera kwakutali kwa orlistat potengera kupewa matenda awa sikunaphunzire.

Orlystraat ndi ndani

Mankhwalawa amalimbikitsidwa kuti achepetse thupi, komanso kuti azitha kukhazikika, ngati abwerera kale. Kulandila kwa makapisozi kumafunikira kuphatikizidwa ndi minofu yogwira ntchito ndi chakudya chamafuta ochepa.

Aliyense amene ali pachiwopsezo (odwala matenda ashuga omwe ali ndi matenda amtundu wa 2, matenda oopsa oopsa ndi kuchuluka kwa thupi, anthu omwe ali ndi cholesterol yambiri "yoyipa") nthawi ndi nthawi amatha kumwa mankhwalawa pofuna kupewa.

Malangizo ogwiritsira ntchito

Kuchokera pazotsatira zimatsata kuti mphamvu ya mankhwalawo pazomwe zimapangidwa kale mafuta ndizochepa. Ntchito yake imapangidwa ndi ma calories atsopano omwe amalowa m'thupi limodzi ndi zakudya zamafuta. Poletsa kuyamwa kwamafuta, zoletsa zam'madzi zimachepetsa chakudya chama calorie ndikuthandizira kuchepetsa thupi.

Mu mtundu wanthawi zonse, mankhwalawa amawadyedwa 3 r. / Day. 1 kapisozi.

Nthawi yabwino yoyamwa orchidat ndikumwa mapiritsi ndi chakudya kapena mukangomaliza kudya. Njira ya chithandizo ndi miyezi itatu. Pofuna kupewa zovuta, musanayambe chithandizo, muyenera kufunsa dotolo kapena dokotala.

Zachuma komanso Mankhwala Osokoneza bongo

Ndipo, panthawi yosinthira, komanso kugwiritsa ntchito mankhwala kwa nthawi yayitali, zinthu zosafunikira ndizotheka:

1. Kutulutsa kwamafuta kochokera ku anus nthawi zina pomwe matumbo samatenga chakudya konse.
2. Kuphwanya matumbo motility, kumadziwonetsera mu mawonekedwe a m'mimba.
3. Fecal incontinence: rectum amasiya kutanuka chifukwa kuphwanya malangizowo pakumwa mankhwalawo.
4. Vuto lakuchuluka chifukwa chakudya chopanda mphamvu, kuchepa kwa mavitamini osungunuka a mafuta, kuchuluka kwa zinthu zambiri zosagwiritsidwa ntchito pamimba.

Kugwiritsa ntchito kamodzi kwa 800 mg ya mankhwala kapena njira, nthawi zambiri 400 mg / 3r / tsiku. Kupitilira masabata awiri, zotsatira zodabwitsa zomwe sizinachitike sizinaululidwe kwa anthu opanda kulemera kokwanira kapena mwa omwe ali ndi BMI yoposa 30.

Kwa omwe mankhwalawo amakwiriridwa

Zina mwa zotsutsana kwathunthu:

• Mimba komanso kuyamwa
• Matenda am'mimba
• Osakwana zaka 12
• Vephrolithiasis,
• Cholestasis
• Malabsorption syndrome,
• Hyperoxcaluria.

Ndi matumbo oyaka, makapisozi nawonso samapilira, chifukwa mawonekedwe ake, muyenera kusiya kumwa mankhwalawo ndikupita kwa katswiri.

Zotsatira za kuyanjana ndi mankhwala ena

Ndi kugwiritsidwa ntchito mosiyanasiyana kwa Orlistat ndi mowa, pravastin, digoxin (ngati amaperekedwa kamodzi) ndi phenytoin (limodzi mlingo 300 mg), pharmacokinetics yamankhwala samasintha. Nifedipine yokhala ndi mphamvu yayitali imasunga magawo a bioavailability;

Mowa, nawo, sukusintha mawonekedwe a Orlistrat komanso mawonekedwe a mafuta okhala ndi ndowe.

Osatengera Cyclosporin kuphatikiza ndi Orlistrat: zomwe zili kumapeto kwa magazi zidzachepetsedwa. Kutalikirana pakati pa kugwiritsa ntchito mankhwala ndi maola atatu.

Orlistat imatha kuchepetsa kuchepa kwa beta-carotene (mwachitsanzo, kuchokera pazakudya zowonjezera) ndi 30%, vitamini E - ndi 60%. Mphamvu ya mankhwalawa pakamwa mavitamini D ndi A sizinakhazikitsidwe, kuchepa kwa mayamwidwe a vitamini K kwalembedwa.

Kafukufuku wokhala ndi anthu khumi ndi awiri omwe sanatengere kunenepa kwambiri akuwonetsa kuti Orlistrist samalepheretsa magawo a warfarin, koma magawo a coagulation amayang'aniridwa ndi chithandizo cha nthawi yayitali.

Momwe amagwiritsidwira ntchito pamodzi ndi Orlistat ndi levothyroxine sodium hypothyroidism sichili pambali. Muzochitika zotere, chithokomiro cha chithokomiro chikuyenera kuyang'aniridwa ndipo kupatsirana pakati pa Mlingo kuyenera kukulitsidwa mpaka maola 4.

Malangizo apadera

Ndikofunikira kumvetsetsa kuti Orlistat si panacea yolemetsa yonse. Ngati wodwalayo adayamba kale kupanga mafuta olimba ndikuyembekeza kuti athetse popanda zakudya ndi masewera olimbitsa thupi, kupanikizana ndi piritsi lina pabedi lomwe lili kutsogolo kwa TV, ndiye kuti simungathe kudalira zotsatira zomwe wapanga.

Mafuta akakhala 30% kapena ochulukirapo tsiku lililonse muzakudya, mphamvu ya machitidwe a makapisozi amachepa, ndipo chiwopsezo cha zochitika zoyipa chimawonjezeka. Zakudya za tsiku ndi tsiku za mafuta, chakudya komanso mapuloteni ayenera kugawidwa m'magawo atatu.

Kuti mukhale ndi mavitamini ndi michere yambiri, ndikofunikira kutenga zovuta za vitamini zomwe zimayenderana ndi Orlistat, popeza mankhwalawo amalepheretsa kuyamwa kwawo.

Popereka mankhwala, munthu ayenera kuganizira kuthekera kwa organic chifukwa choonjezera kunenepa, mwachitsanzo, hypothyroidism.
Popeza mankhwalawa amaletsa kuyamwa kwa mavitamini angapo osungunuka ndi mafuta, ndizotheka kubwezeretsa bwino mothandizidwa ndi maultivitamini, omwe amaphatikiza mavitamini osungunuka a mafuta. Amatengedwa mosinthana ndi maola a 2 asanachitike kapena atatha Orlistrat.

Ndi zovuta zamanjenje (bulimia, anorexia), kuwotcha mafuta ndikotheka. Kulandila kwa makapisozi mu mulingo woposa 120 mg / 3r / Day. sichimapereka zotsatira zowonjezereka. Mankhwala, maumino a oxalate nthawi zina amalowa mkodzo.

Zomwe zingalowe m'malo mwa Orlistat

Ndi kusalolera kwamunthu payekha, zovuta zake zoyipa kapena zotsutsana zina, dokotala amatha kusankha analogue ya Orlistrat. Ali ndi mitundu ingapo ya mankhwala omwe ali ndi kaphatikizidwe komwe kameneka ndi zinthu zina zothandizira popanga.

• Xenical. Pamtima pa mnzake waku Swiss ndi orlistat yomweyo. Amawonetsedwa kwa chithandizo cha nthawi yayitali odwala omwe ali ndi kunenepa kwambiri osakanikirana ndi zakudya za hypocaloric.
• Orsoten. Mankhwala ochepetsa lipid amathandizana ndi chapamimba komanso kapamba pazakudya zam'mimba, chifukwa chake ma enzymes satenga nawo gawo pakuwonongeka kwamafuta.
• Mndandanda. Chida chimagwiritsidwa ntchito kunenepa. Zotsatira zoyipa zimaphatikizapo mafuta opunthira mafuta, kupweteka kwa epigastric, kusokonezeka kwa phokoso.
• Allie Lipase inhibitor imalimbikitsa kuchepa thupi ndipo sikuti imalowa m'magazi. Ilibe mphamvu yothandizanso. Zizindikiro za bongo: kusokonezeka, kusakhazikika pansi, kuthamanga kwapang'onopang'ono.
• Xenalten. Mankhwala okhazikika pa orlistrist amawonetsedwa kwa odwala matenda ashuga, matenda oopsa, ndi dyslipidemia. Kugwiritsidwa ntchito mosiyanasiyana kwa cyclosporine kumachepetsa kuyika kwake m'magazi.

Ndemanga za Orlistat

Pamabwalo azodzikongoletsa, zolemetsa zonse zimakhudzidwa ndi zovuta zazotsatira zoyipa, koma kuyambitsa kuchepetsa thupi mothandizidwa ndi orlistat kumatha kukhala ndi zotsatira zabwino.

Pambuyo kuchepa thupi, kagayidwe kachakudya kamayenda bwino, ndikuwongolera glycemic mu matenda ashuga. Zikatero, ndikofunikira kusintha mlingo wa mankhwala antidiabetesic ndi insulin.

Vutoli limachulukitsa anthu ambiri, timadziunjikira kwa zaka zambiri, ndipo timalakalaka titachichotsa pakatha masiku. Komabe, madokotala amagogomezera kuti kuchepetsa thupi ndi njira yayitali yomwe imafunikira njira yophatikizira. Ngati mungathe kuthana ndi vuto loyang'aniridwa ndi katswiri, mutha kusankha njira zabwino kwambiri zamankhwala ndikupeza zotsatira zotsimikizika popanda zodabwitsa.

Ndemanga ya wochita masewera othana ndi kutentha kwa owotchera mafuta Xenical ndi Orlistat, onani vidiyo:

Kupereka kwa magazi kwa shuga wokhala ndi katundu

• 1 Kusanthula kwamtundu wanji?
  • 1.1 Zizindikiro
  • 1.2 Kukonzekera
• 2 Momwe mungasinthire: Njira za kafukufuku
• 3 Kuyesedwa kwa shuga m'magazi kumachitika ndi masewera olimbitsa thupi
  • 3.1 shuga
  • 3.2 Zokhala
• 4 Kodi mungathetse bwanji vutoli?

Kwa zaka zambiri osalimbana ndi ma DIABETES?

Mutu wa Bungwe: “Mudzadabwitsidwa kuti kumakhala kovuta motani kuchiritsa matenda a shuga tsiku lililonse.

Shuga ndiye mphamvu yofunikira kwambiri yomwe imapangitsa kuti thupi lonse lizigwira ntchito bwino. Magazi a shuga amaperekedwa ndi katundu kuti athe kuwona kuchuluka kwa thupi lomwe limatha kukhathamiritsa glucose, ndiko kuti, mpaka amathyoledwa mpaka kufika pati. Kuchuluka kwa shuga kumawonetsa kuchuluka kwa kagayidwe kazakudya, amayeza m'magawo a mamililitale pa lita imodzi (mmol / l).

Kusanthula kwamtundu wanji?

Phunziroli limachitika mu labotale yachipatala. Kukonzekera kwake kumakhala kokhazikika komanso kosakwanira kuposa momwe mumawerengera nthawi zonse. Kuyesedwa kwa glucose kumathandizira kuzindikira zovuta zamatenda a carbohydrate metabolism ndikuzindikira matenda ashuga. Phunziroli lilola kuti muzindikire matendawa panthawi yake ndikupeza chithandizo chofunikira.

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Kuyesedwa kwa magazi ndi katundu kumathandizira kuzindikira matendawa. Mafuta ochulukirapo akuwonetsa mwayi wa matenda ashuga. Chitsimikizo ichi chimagwiritsidwanso ntchito kuwunikira momwe chithandizo chikuyendera. Kuyesedwa ndikofunikanso panthawi yomwe muli ndi pakati kapena pamaso paziwopsezo za matendawa:

• lembani 1 ndikulemba matenda ashuga 2
• cheke chowonjezerapo kuti mumveketse bwino za matendawa, kuphatikiza, mwamtundu wa azimayi apakati,
• kugaya chakudya ndimatumbo
• polycystic ovary syndrome,
• zachiwindi mu chiwindi,
• kukhalapo kwa matenda amitsempha,
• khunyu
• matenda amtundu wa endocrine,
• kusokoneza kwa endocrine.

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Kukonzekera

Ndikofunika kwambiri kukumbukira malamulo oyambira kukonzekera kusanthula. Kuti mudziwe zotsatira zolondola kwambiri, kukonzekera kuyenera kuchitika molondola:

Musanapereke magazi kuti muwoneke, kwa masiku angapo muyenera kusiyanitsa zakudya zamafuta ndi mafuta.

masiku atatu kusanachitike, wodwalayo ayenera kuphatikiza muzakudya zomwe zili ndi chakudya chokwanira, kupatula zakudya zokazinga ndi mafuta,

Ngati nkosavomerezeka kuletsa kumwa mankhwalawa, muyenera kudziwitsa dokotala

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Momwe mungasinthire: njira za kafukufuku

Kuyesedwa kwa shuga kokhala ndi katundu kumakupatsani mwayi wolamulira kuchuluka kwa glucose m'magazi komanso kutha kuzipenda. Phunziroli limachitika m'magawo. Kusanthula kumayamba ndi kuyesa shuga pamimba yopanda kanthu, ndipo magazi amatuluka kuchokera m'mitsempha. Kenako wodwalayo amagwiritsa ntchito njira yothetsera shuga (kwa akulu ndi ana, 75 g ya shuga pa kapu imodzi yamadzi, kwa amayi apakati - 100 g). Mukayika, sampuli imachitika theka lililonse la ola. Pambuyo maola 2, magazi amatengedwa komaliza. Popeza njira yothetsera vutoli ndi shuga kwambiri, imatha kuyambitsa nseru komanso kusanza kwa wodwala. Muzochitika izi, kusanthula kumusamutsira tsiku lotsatira. Pa kuyesa kwa shuga, masewera olimbitsa thupi, chakudya, ndi kusuta ndizoletsedwa.

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Zotsatira za mayeso a shuga

Kwezani mayeso.

Mukayesedwa shuga ndi katundu, miyezo iyi ndi yofanana kwa onse: abambo, amayi ndi ana, zimangodalira zaka zawo. Kuchulukitsa kwa shuga kumafuna kuyesedwanso. Wodwala akapezeka ndi matenda ashuga kapena prediabetes, amatengedwa mwachangu. Matenda omwe atapezeka amafunika kuwongolera shuga. Kuphatikiza pa mankhwala, zakudya zamagulu ena zimagwiritsidwa ntchito pochizira, momwe amawerengedwa ndi zopatsa mphamvu.

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Mlingo wa shuga

Kuti apereke kwathunthu ziwalo za anthu ndi machitidwe ake ndi glucose, mulingo wake uyenera kukhala wogwirizana kuyambira 3.5 mpaka 5.5 mmol / L. Kuphatikiza apo, ngati kuyezetsa magazi ndi katundu sikusonyeza kupitirira 7.8 mmol / l, ndiye kuti izi ndizofananso. Zoyesazo zimakhala ndi katundu pomwe mungayang'anire kuchuluka kwa shuga zimaperekedwa pagome.

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Zopatukira

Matenda a shuga ndiye chachikulu, koma osati chokha chomwe chimayambitsa matenda. Shuga wamagazi amatha kukhala ndi zovuta zakanthawi pazifukwa zina:

• kupsinjika m'maganizo ndi m'thupi,
• kudya pamaso pa mtanda
• poizoni wa monoxide
• opareshoni, kuvulala ndi kuwundana,
• kuwotcha matenda
• kumwa mankhwala (mahomoni, okodzetsa),
• kusamba
• chimfine, kupweteka kwamankhwala oyambitsa ndi ma virus kapena kufalikira kwa matenda osachiritsika,
• onenepa kwambiri.

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Kodi mungathetse bwanji vutoli?

Pakulephera koyamba kwa kagayidwe kazachilengedwe, kusintha zingapo kuyenera kuchitika. Poyamba, muyenera kuthana ndi kulemera kwambiri ndikuwasamalira kuti muchepetse kuchuluka kwa shuga m'magazi. Izi zimatheka podziletsa pakudya mothandizidwa ndi zakudya zapadera. Nthawi yomweyo siyani ufa, kusuta, wokazinga ndipo makamaka wokoma. Sinthani njira zophikira: kuwira, kuwiritsa, kuphika. Kuphatikiza apo, zochitika zolimbitsa thupi za tsiku ndi tsiku ndizofunikira: kusambira, kulimbitsa thupi, kuyendetsa ndege, Pilates, kuthamanga ndi kukwera miyendo.

Kunenepa kwambiri Kungayambitse matenda A shuga

Anthu ambiri masiku ano ndi onenepa. Pafupifupi anthu 1.7 biliyoni amapezeka kuti ali ndi kunenepa kwambiri.

Ku Russia, pafupifupi 30% ya anthu ogwira ntchito ali ndi kunenepa kwambiri, ndipo 25% amapezeka kuti ali ndi kunenepa kwambiri.

Kukhala wonenepa kwambiri kumayenderana mwachindunji ndi chiopsezo cha matenda a shuga.

Chifukwa chake, kunenepa kwambiri kwa 1 degree kumakulitsa chiopsezo cha matenda osokoneza bongo 2 times, 2 degree - 5 times, 3 degrees - kupitilira 10 times.

Anthu onenepa kwambiri amakhala ndi insulin yambiri m'magazi awo. Njirayi imagwirizanitsidwa ndi insulin kukana, ndiye kuti, kuchepa kwamphamvu kwa maselo pazotsatira za insulin. Kuchepetsa thupi munthawi yomweyo kumatheka pokhapokha ngati matenda a insulin atha.

Mankhwala ochulukirapo omwe munthu amakhala nawo, okwanira amakana insulini, ndipo insulin yambiri ikamapezeka m'magazi, kunenepa kwambiri kumayamba. Mzere wozungulira wozungulira, womwe umayambitsa matenda a shuga a 2.

Kubwezeretsa kuchuluka kwa insulini pazomwe zimachitika:

• Kutsatira zakudya zamafuta ochepa.
• Maphunziro azolimbitsa thupi.
• Mankhwala omwe ali ndi mankhwala apadera (adokotala okha ndi omwe angawatenge).

Bwanji kuchepetsa thupi ndi matenda ashuga?

Munthu yemwe akudwala kunenepa kwambiri komanso mtundu wachiwiri wa matenda ashuga ayenera kukhala ndi cholinga choti ataye mapaundi owonjezera amenewo.

Zoyeserera ziyenera kuchitidwa kuti muchepetse shuga, koma kuchepetsa thupi kulinso kofunika kwambiri. Izi ndichifukwa choti kuchepa thupi kumapangitsa chidwi cha maselo kulowa insulin, chifukwa chake amachepetsa kukana insulini.

Kutsika pang'onopang'ono kwa kulemera kwa thupi kumathandizira kuchepetsa katundu pa kapamba, kupangitsa kuti gawo lamaselo ake a beta likhale lamoyo. Kuchulukana kwa maselo komwe kumatha kugwira ntchito moyenera, kumakhala kosavuta kwambiri kuti muzitha kuyang'anira matenda ashuga.

Anthu omwe ali ndi matenda a shuga a mtundu wa 2 posachedwa, atachepa thupi, amatha kukhalabe ndi shuga m'magazi, ndipo safunika jakisoni wa insulin.

Zakudya Zabwino Komanso Zakudya

Popeza aganiza zodya, munthu ayenera kufunsa katswiri wa zakudya komanso mankhwala a endocrinologist, popeza thupi la wodwala matenda ashuga limafunikira mkhalidwe wapadera pazinthu zochepetsa thupi mothandizidwa ndi chakudya.

Njira yokhayo yochepetsera kuchuluka kwa insulin popanda mankhwala ena alionse ndi chakudya chomwe chimachepetsa kuchuluka kwa chakudya chamagulu muzakudya. Njira yowonongeka ya minofu ya adipose imayenda bwino, ndipo wodwalayo amachotsa kulemera mopanda kuyesetsa mwapadera komanso popanda kukumana ndi njala nthawi zonse.

Kodi chimayambitsa mavuto ndi chiyani pothana ndi kunenepa kwambiri kapena zakudya zamafuta ochepa? Amayambitsidwa chifukwa chakuti zakudya zotere zimakhala ndi chakudya chokwanira, ndipo izi zimapangitsa kuti insulini isungidwe kwambiri.

Zakudya zama carb zotsika shuga komanso kunenepa kwambiri ndi njira yabwino yochepetsera thupi.

Kwa munthu yemwe ali ndi matenda ashuga, zakudya zowopsa ndizomwe zimakhala ndi chakudya chamafuta pang'ono: zakudya zonse zotsekemera ndi ufa, kupatula izi, mitundu ina ya mpunga, kaloti, mbatata, beets ndi vinyo (werengani apa za zovuta zakumwa za odwala ashuga).

Pambuyo pachakudya, wodwala matenda ashuga sayenera kufa ndi njala - ayenera kukhala ndi zakudya zazikulu zitatu ndi ziwiri.

Ngati mungafune, mutha kuwonjezera masewera olimbitsa thupi ndi mapiritsi apadera pazakudya, zomwe zimakulitsa chidwi cha maselo pakuchita insulin.

Mankhwala Ochepetsa

Chithandizo chodziwika bwino kwambiri ndi Siofor, chomwe chimagwira ntchito kwambiri ndi metformin.

Cholinga cha mtundu uwu wa mankhwalawa ndikuwonjezera chidwi cha maselo kuti apange insulin, yomwe imachepetsa kuchuluka kwa magazi ofunikira kuti mukhale shuga wambiri.

Kugwiritsa ntchito mankhwalawa kumathandizira kuti kuchulukitsa mafuta kuthandizire ndikuchepetsa njira yochepetsera thupi.

Maphunziro akuthupi

Maphunziro olimbitsa thupi amachititsa kuti minofu iwonjezeke, zomwe zimapangitsanso kuti chidwi cha thupi chizindikire insulini, kusunthira kosavuta kwa glucose m'maselo, komanso kuchepa kwa kufunikira kwa insulin kuti thupi likhale ndi shuga nthawi zonse.

Pochizira mafupa, owerenga athu adagwiritsa ntchito DiabeNot bwino. Kuwona kutchuka kwa malonda, tidaganiza zoperekera chidwi chanu.

Kuchuluka kwa insulini, kunenepa kwambiri komanso matenda a shuga kumakhudzana mwachindunji - ndi kuchepa kwamankhwala a insulin, njira yochepetsera thupi imayendetsedwa ndipo chiwopsezo cha matenda a shuga chimachepa.

Zimaphatikizidwa ndi kuchepa kwabwino kwamafuta mwa anthu omwe amaphunzira masewera olimbitsa thupi, osati ndi zopatsa mphamvu zopaka masewera olimbitsa thupi.

Kumbukirani kuti kuchepa thupi kuyenera kukhala kosalala, osapitirira 5 kg pamwezi. Kuchepetsa thupi kwambiri ndi njira yoopsa, makamaka pakati pa odwala matenda ashuga.

Kwa munthu yemwe sanakhalepo nawo pamasewera komanso onenepa kwambiri, poyamba padzakhala katundu wochepa, mwachitsanzo, mphindi 10-15 zakuyenda mwachangu. Pambuyo pake, nthawi iyenera kubweretsedwa mpaka mphindi 30 mpaka 40 ndikuchita zolimbitsa thupi katatu pa sabata. Kuphatikiza apo, mutha kusambira kapena kukwera njinga. Zitsanzo zolimbitsa thupi za odwala matenda ashuga onani apa.

Musanayambe makalasi, muyenera kufunsa dokotala.

Mankhwala othandizira

Njira yaposachedwa komanso yovuta kwambiri yochotsera kunenepa kwambiri mu shuga ndi opaleshoni. Anthu odwala matenda ashuga nthawi zina amatha kuthana ndi vuto la kudya kwambiri, amachepetsa thupi komanso amachepetsa shuga la magazi.

Popeza pali njira zingapo zochitira opaleshoni zomwe zingathandize kuthana ndi kudya kwambiri komanso kuchiza kunenepa kwambiri, wodwalayo ayenera kufunsa dokotala kuti amve zambiri.

Kumbukirani kuti pofuna kuthana ndi matenda a shuga, wodwalayo ayenera kuchepetsa thupi. Kukwaniritsidwa kwa malangizo onse a dokotala kumachepetsa kukula kwa matendawa ndikuchepetsa chiopsezo cha zovuta zake zilizonse.

Orlistat yochepetsa thupi - malangizo apadera a odwala omwe ali ndi matenda ashuga

Orlistat ndi mankhwala a gulu la zoletsa zomwe zimalepheretsa matumbo ndi m'mimba. Mankhwalawa amagwiritsidwa ntchito kukonza zolemetsa; amathandizanso matenda a shuga a 2.

Kwa Orlistat, malangizo ogwiritsira ntchito amalimbikitsa kutenga makapisozi kuti muchepetse kunenepa, kukhazikika pamiyendo, ndikuchepetsa mwayi woyimbanso. Zoletsa zomwe zimapanga mankhwalawa zimalepheretsa kuyamwa kwamafuta m'matumbo ndikuthandizira kuti zithetsedwe ndi ndowe.