{"id":21606,"date":"2023-04-15T21:20:16","date_gmt":"2023-04-15T14:20:16","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=21606"},"modified":"2023-04-18T15:26:42","modified_gmt":"2023-04-18T08:26:42","slug":"uc-che-nhom-sglt2-va-nhung-dieu-can-biet","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/15\/uc-che-nhom-sglt2-va-nhung-dieu-can-biet\/","title":{"rendered":"Thu\u1ed1c \u1ee9c ch\u1ebf nh\u00f3m SGLT2 v\u00e0 nh\u1eefng \u0111i\u1ec1u c\u1ea7n bi\u1ebft"},"content":{"rendered":"

Thu\u1ed1c \u1ee9c ch\u1ebf nh\u00f3m SGLT2 \u0111\u01b0\u1ee3c x\u1ebfp v\u00e0o nh\u00f3m thu\u1ed1c \u0111i\u1ec1u tr\u1ecb \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng nh\u01b0ng c\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng \u0111\u1ed3ng th\u1eddi th\u1ea3i \u0111\u01b0\u1eddng v\u00e0 th\u1ea3i natri g\u00e2y l\u1ee3i ti\u1ec3u n\u00ean g\u00e2y c\u00f3 t\u00e1c d\u1ee5ng gi\u1ea3m c\u00e2n v\u00e0 h\u1ea1 huy\u1ebft \u00e1p. Ba thu\u1ed1c \u1ee9c ch\u1ebfnh\u00f3m SGLT2: dapagliozin, canagliozin, empagliozin \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb m\u1edbi nh\u1ea5t hi\u1ec7n nay v\u00e0 hi\u1ec7n \u0111ang \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong l\u00e2m s\u00e0ng<\/strong><\/p>\n

1.C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng<\/strong><\/h2>\n

\u1ede ng\u01b0\u1eddi b\u00ecnh th\u01b0\u1eddng, \u1ed1ng l\u01b0\u1ee3n g\u1ea7n h\u1ea7u nh\u01b0 t\u00e1i h\u1ea5p thu t\u1ea5t c\u1ea3 glucose \u0111\u01b0\u1ee3c l\u1ecdc b\u1edfi c\u1ea7u th\u1eadn. Kho\u1ea3ng 90% qu\u00e1 tr\u00ecnh t\u00e1i h\u1ea5p thu glucose x\u1ea3y ra t\u1ea1i m\u1ed9t protein c\u00f3 t\u00ean l\u00e0 SGLT2. \u0110\u00e2y l\u00e0 m\u1ed9t protein \u1edf \u1ed1ng l\u01b0\u1ee3n g\u1ea7n cho ph\u00e9p v\u1eadn chuy\u1ec3n glucose qua m\u00e0ng b\u00e0o t\u01b0\u01a1ng c\u00f9ng v\u1edbi natri. \u1ee8c ch\u1ebf k\u00eanh v\u1eadn chuy\u1ec3n n\u00e0y b\u1eb1ng c\u00e1c thu\u1ed1c hi\u1ec7n t\u1ea1i s\u1ebd d\u1eabn \u0111\u1ebfn b\u00e0i ti\u1ebft kho\u1ea3ng 30-50% l\u01b0\u1ee3ng glucose \u0111\u01b0\u1ee3c l\u1ecdc. M\u1eb7c d\u00f9 k\u00eanh \u0111\u1ed3ng v\u1eadn natri\/glucose c\u1ee7a \u1ed1ng l\u01b0\u1ee3n g\u1ea7n \u0111\u00e3 \u0111\u01b0\u1ee3c bi\u1ebft t\u1eeb l\u00e2u nh\u01b0ng c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf k\u00eanh n\u00e0y m\u1edbi \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u v\u00e0 ph\u00e1t tri\u1ec3n trong th\u1eddi gian g\u1ea7n \u0111\u00e2y.<\/p>\n

Ba thu\u1ed1c \u1ee9c ch\u1ebf SGLT2: dapagliozin, canagliozin, empagliozin \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb m\u1edbi nh\u1ea5t hi\u1ec7n nay v\u00e0 hi\u1ec7n \u0111ang \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong l\u00e2m s\u00e0ng. Tuy thu\u1ed1c \u1ee9c ch\u1ebf nh\u00f3m SGLT2 \u0111\u01b0\u1ee3c x\u1ebfp v\u00e0o nh\u00f3m thu\u1ed1c \u0111i\u1ec1u tr\u1ecb \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng nh\u01b0ng c\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng \u0111\u1ed3ng th\u1eddi th\u1ea3i \u0111\u01b0\u1eddng v\u00e0 th\u1ea3i natri g\u00e2y l\u1ee3i ti\u1ec3u n\u00ean g\u00e2y c\u00f3 t\u00e1c d\u1ee5ng gi\u1ea3m c\u00e2n v\u00e0 h\u1ea1 huy\u1ebft \u00e1p.<\/p>\n

2.D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc v\u00e0 d\u01b0\u1ee3c l\u1ef1c h\u1ecdc<\/strong><\/h2>\n

C\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf SGLT2 \u0111\u01b0\u1ee3c h\u1ea5p thu nhanh qua \u0111\u01b0\u1eddng ti\u00eau h\u00f3a. Th\u1eddi gian b\u00e1n th\u1ea3i c\u1ee7a dapagliozin l\u00e0 10-12h, v\u00e0 t\u1edbi 70% li\u1ec1u thu\u1ed1c \u0111\u01b0\u1ee3c b\u00e0i ti\u1ebft qua n\u01b0\u1edbc ti\u1ec3u \u1edf d\u1ea1ng 3-Oglucuronide (ch\u1ec9 kho\u1ea3ng 2% thu\u1ed1c \u0111\u01b0\u1ee3c b\u00e0i ti\u1ebft d\u01b0\u1edbi d\u1ea1ng kh\u00f4ng \u0111\u1ed5i qua n\u01b0\u1edbc ti\u1ec3u). M\u1eb7c d\u00f9 n\u1ed3ng \u0111\u1ed9 thu\u1ed1c cao h\u01a1n \u1edf b\u1ec7nh nh\u00e2n suy th\u1eadn n\u1eb7ng, b\u00e0i ti\u1ebft glucose n\u01b0\u1edbc ti\u1ec3u c\u0169ng s\u1ebd gi\u1ea3m khi b\u1ec7nh th\u1eadn m\u1ea1n t\u00ednh x\u1ea5u \u0111i. Li\u1ec1u c\u1ee7a canagliozin \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o kh\u00f4ng v\u01b0\u1ee3t qu\u00e1 100 mg\/24h v\u1edbi MLCT \u01b0\u1edbc t\u00ednh t\u1eeb 45-59 mL\/ph\u00fat. Thu\u1ed1c kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u00ean d\u00f9ng \u1edf b\u1ec7nh nh\u00e2n suy th\u1eadn n\u1eb7ng ho\u1eb7c b\u1ec7nh gan ti\u1ebfn tri\u1ec3n. T\u01b0\u01a1ng t\u00e1c thu\u1ed1c c\u1ea7n \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc khi s\u1eed d\u1ee5ng c\u00e1c lo\u1ea1i thu\u1ed1c n\u00e0y. V\u00ed d\u1ee5, d\u00f9ng \u0111\u1ed3ng th\u1eddi rifampicin l\u00e0m gi\u1ea3m t\u00e1c d\u1ee5ng c\u1ee7a dapagliozin kho\u1ea3ng 22%.<\/p>\n

3.Ch\u1ec9 \u0111\u1ecbnh<\/strong><\/h2>\n

Hi\u1ec7n t\u1ea1i, ch\u1ec9 \u0111\u1ecbnh c\u1ee7a c\u00e1c lo\u1ea1i thu\u1ed1c n\u00e0y l\u00e0 cho b\u1ec7nh \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2. Hi\u1ec7n nay thu\u1ed1c \u0111\u00e3 \u0111\u01b0\u1ee3c c\u00e1c hi\u1ec7p H\u1ed9i tim m\u1ea1ch M\u1ef9 v\u00e0 ch\u00e2u \u00c2u 2018 khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng cho c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng c\u00f3 b\u1ec7nh l\u00fd m\u1ea1ch m\u00e1u x\u01a1 v\u1eefa nh\u1eb1m l\u00e0m gi\u1ea3m c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch. C\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf SGLT2 s\u1ebd l\u00e0m gi\u1ea3m HbA1C 0,5-1%, t\u01b0\u01a1ng t\u1ef1 nh\u01b0 c\u00e1c thu\u1ed1c h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft u\u1ed1ng kh\u00e1c.<\/p>\n

C\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf SGLT2 c\u00f3 m\u1ed9t s\u1ed1 t\u00e1c d\u1ee5ng kh\u00e1c \u0111\u00e3 \u0111\u01b0\u1ee3c ghi nh\u1eadn, thu\u1ed1c g\u00e2y gi\u1ea3m c\u00e2n trung b\u00ecnh 3,2 kg so v\u1edbi m\u1ee9c t\u0103ng 1,2 kg c\u1ee7a glipizide. M\u1ed9t ph\u1ea7n trong s\u1ed1 n\u00e0y l\u00e0 do t\u00e1c d\u1ee5ng l\u1ee3i ti\u1ec3u, d\u00f9 t\u00e1c d\u1ee5ng l\u1ee3i ti\u1ec3u c\u1ee7a nh\u00f3m SGLT2 th\u01b0\u1eddng y\u1ebfu. C\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf SGLT2 c\u0169ng g\u00e2y ra gi\u1ea3m huy\u1ebft \u00e1p t\u00e2m thu trung b\u00ecnh 5,1 mmHg, so v\u1edbi m\u1ee9c t\u0103ng huy\u1ebft \u00e1p t\u00e2m thu kho\u1ea3ng 1 mmHg sau khi b\u1eaft \u0111\u1ea7u u\u1ed1ng sitagliptin.<\/p>\n

Trong m\u1ed9t nghi\u00ean c\u1ee9u v\u1ec1 ipragliozin l\u00e0 thu\u1ed1c \u1ee9c ch\u1ebf SGLT2 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng t\u1ea1i Nh\u1eadt cho th\u1ea5y, ipragliozin \u0111\u00e3 l\u00e0m t\u0103ng l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u t\u1eeb ng\u00e0y 1 \u0111\u1ebfn ng\u00e0y 3 v\u00e0 gi\u1ea3m 0,7 kg tr\u1ecdng l\u01b0\u1ee3ng c\u01a1 th\u1ec3 \u1edf ng\u00e0y th\u1ee9 ba so v\u1edbi ng\u00e0y \u0111\u1ea7u. C\u1ea3 b\u00e0i ti\u1ebft natri v\u00e0 kali n\u01b0\u1edbc ti\u1ec3u t\u0103ng khi s\u1eed d\u1ee5ng ipragliozin nh\u01b0ng n\u1ed3ng \u0111\u1ed9 trong huy\u1ebft thanh c\u1ee7a c\u1ea3 hai ch\u1ea5t \u0111i\u1ec7n gi\u1ea3i n\u00e0y v\u1eabn \u1ed5n \u0111\u1ecbnh. V\u00ec v\u1eady, t\u00e1c d\u1ee5ng m\u1ed9t ph\u1ea7n c\u1ee7a vi\u1ec7c gi\u1ea3m c\u00e2n l\u00e0 do t\u00e1c d\u1ee5ng l\u1ee3i ti\u1ec3u c\u1ee7a thu\u1ed1c.<\/p>\n

4.Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh<\/strong><\/h2>\n

Thu\u1ed1c kh\u00f4ng s\u1eed d\u1ee5ng cho b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 1 ho\u1eb7c c\u00f3 t\u00ecnh tr\u1ea1ng nhi\u1ec5m toan ceton.<\/p>\n

Trong tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed d\u1ecb \u1ee9ng ho\u1eb7c qu\u00e1 m\u1eabn v\u1edbi b\u1ea5t k\u1ef3 th\u00e0nh ph\u1ea7n n\u00e0o c\u1ee7a thu\u1ed1c, SGLT2 kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng. Ngo\u00e0i ra, b\u1ec7nh nh\u00e2n m\u1eafc c\u00e1c b\u1ec7nh l\u00fd th\u1eadn n\u1eb7ng c\u1ea7n th\u1eadn tr\u1ecdng khi s\u1eed d\u1ee5ng SGLT2 v\u00ec thu\u1ed1c c\u00f3 th\u1ec3 t\u0103ng nguy c\u01a1 vi\u00eam th\u1eadn v\u00e0 suy th\u1eadn. B\u1ec7nh nh\u00e2n c\u0169ng c\u1ea7n th\u1eadn tr\u1ecdng khi s\u1eed d\u1ee5ng SGLT2 n\u1ebfu c\u00f3 ti\u1ec1n s\u1eed b\u1ec7nh tim m\u1ea1ch ho\u1eb7c \u0111ang s\u1eed d\u1ee5ng c\u00e1c lo\u1ea1i thu\u1ed1c kh\u00e1c \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng.<\/p>\n

Thu\u1ed1c \u1ee9c ch\u1ebf nh\u00f3m SGLT2 c\u0169ng kh\u00f4ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong nh\u1eefng t\u00ecnh hu\u1ed1ng \u0111\u1eb7c bi\u1ec7t nh\u01b0 ph\u1ee5 n\u1eef c\u00f3 thai ho\u1eb7c \u0111ang cho con b\u00fa, tr\u1ebb em d\u01b0\u1edbi 18 tu\u1ed5i, b\u1ec7nh nh\u00e2n \u0111ang trong giai \u0111o\u1ea1n h\u1ed3i ph\u1ee5c sau ph\u1eabu thu\u1eadt ho\u1eb7c b\u1ecb s\u1ed1c.<\/p>\n

5.T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n<\/strong><\/h2>\n

\u0110i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c \u1ee9c ch\u1ebf SGLT2 c\u00f3 li\u00ean quan \u0111\u1ebfn t\u1ef7 l\u1ec7 h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft th\u1ea5p (3,5% so v\u1edbi 40,8% v\u1edbi glipizide). C\u00f3 s\u1ef1 gia t\u0103ng g\u1ea5p s\u00e1u l\u1ea7n t\u1ef7 l\u1ec7 nhi\u1ec5m n\u1ea5m sinh d\u1ee5c \u1edf ph\u1ee5 n\u1eef v\u00e0 nguy c\u01a1 nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u cao h\u01a1n m\u1ed9t ch\u00fat (8,8% so v\u1edbi 6,1%). T\u1ea5t c\u1ea3 c\u00e1c thu\u1ed1c n\u00e0y \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 kh\u00f4ng c\u00f3 ho\u1eb7c \u1ea3nh h\u01b0\u1edfng t\u1ed1i thi\u1ec3u \u0111\u1ebfn n\u1ed3ng \u0111\u1ed9 \u0111i\u1ec7n gi\u1ea3i trong huy\u1ebft thanh.<\/p>\n

M\u1ed9t trong nh\u1eefng t\u00e1c d\u1ee5ng ph\u1ed5 bi\u1ebfn c\u1ee7a SGLT2 l\u00e0 ti\u1ec3u nhi\u1ec1u h\u01a1n b\u00ecnh th\u01b0\u1eddng, c\u00f3 th\u1ec3 g\u00e2y m\u1ea5t n\u01b0\u1edbc v\u00e0 ch\u1ea5t \u0111i\u1ec7n gi\u1ea3i trong c\u01a1 th\u1ec3, v\u00e0 d\u1eabn \u0111\u1ebfn t\u00ecnh tr\u1ea1ng kh\u00f4 mi\u1ec7ng v\u00e0 kh\u00e1t n\u01b0\u1edbc. Ngo\u00e0i ra, SGLT2 c\u0169ng c\u00f3 th\u1ec3 g\u00e2y ra vi\u00eam \u0111\u01b0\u1eddng ti\u1ec3u, vi\u00eam b\u00e0ng quang v\u00e0 nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng ti\u1ec3u.<\/p>\n

M\u1ed9t s\u1ed1 t\u00e1c d\u1ee5ng kh\u00e1c c\u1ee7a SGLT2 bao g\u1ed3m t\u0103ng nguy c\u01a1 vi\u00eam th\u1eadn v\u00e0 suy th\u1eadn, t\u0103ng nguy c\u01a1 ketoacidosis (t\u00ecnh tr\u1ea1ng t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft v\u00e0 t\u0103ng n\u1ed3ng \u0111\u1ed9 acid trong m\u00e1u), t\u0103ng nguy c\u01a1 \u0111\u1ed9t qu\u1ef5 v\u00e0 b\u1ec7nh tim m\u1ea1ch, v\u00e0 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn ch\u1ee9c n\u0103ng gan.<\/p>\n

B\u1ec7nh vi\u1ec7n \u0110a khoa Qu\u1ed1c t\u1ebf Vinmec<\/b><\/a>\u00a0 c\u00f3 \u0111\u1ed9i ng\u0169 D\u01b0\u1ee3c s\u0129 d\u01b0\u1ee3c l\u00e2m s\u00e0ng v\u00e0 \u0111\u01b0a h\u1ec7 th\u1ed1ng m\u00e1y m\u00f3c, thi\u1ebft b\u1ecb hi\u1ec7n \u0111\u1ea1i \u0111\u1ea1t chu\u1ea9n v\u00e0o c\u00f4ng t\u00e1c th\u0103m kh\u00e1m, ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3 c\u00e1c b\u1ec7nh l\u00fd tim m\u1ea1ch.<\/p>\n","protected":false},"excerpt":{"rendered":"

Thu\u1ed1c \u1ee9c ch\u1ebf nh\u00f3m SGLT2 \u0111\u01b0\u1ee3c x\u1ebfp v\u00e0o nh\u00f3m thu\u1ed1c \u0111i\u1ec1u tr\u1ecb \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng nh\u01b0ng c\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng \u0111\u1ed3ng th\u1eddi th\u1ea3i \u0111\u01b0\u1eddng v\u00e0 th\u1ea3i natri g\u00e2y l\u1ee3i ti\u1ec3u n\u00ean g\u00e2y c\u00f3 t\u00e1c d\u1ee5ng gi\u1ea3m c\u00e2n v\u00e0 h\u1ea1 huy\u1ebft \u00e1p. Ba thu\u1ed1c \u1ee9c ch\u1ebfnh\u00f3m SGLT2: dapagliozin, canagliozin, empagliozin \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o h\u01b0\u1edbng d\u1eabn […]<\/p>\n","protected":false},"author":7,"featured_media":21609,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[12,33],"tags":[3],"yoast_head":"\nThu\u1ed1c \u1ee9c ch\u1ebf nh\u00f3m SGLT2 v\u00e0 nh\u1eefng \u0111i\u1ec1u c\u1ea7n bi\u1ebft - Vinmec<\/title>\n<meta name=\"description\" content=\"\u1ee8c ch\u1ebf nh\u00f3m SGLT2 v\u00e0 nh\u1eefng \u0111i\u1ec1u c\u1ea7n bi\u1ebft s\u1ebd \u0111\u01b0\u1ee3c cung c\u1ea5p trong b\u00e0i vi\u1ebft d\u01b0\u1edbi \u0111\u00e2y. 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