![\"\"](\"http:\/\/lkksb.lv\/wp-content\/uploads\/2020\/04\/arstesana_825x310.jpg\")
<\/figure><\/div>\n\n\n\nAminosalicil\u0101ti<\/h3>\n\n\n\n
Mesalam\u012bns, olsalaz\u012bns, balsalaz\u012bns un sulfasalaz\u012bns ir z\u0101les, kuru akt\u012bv\u0101 viela ir 5-aminosalicilsk\u0101be (5-ASS), un t\u0101s bie\u017ei lieto k\u0101 pirm\u0101s rindas \u0101rst\u0113\u0161anu, lai maz l\u012bdz vid\u0113ji izteiktam \u010d\u016blainajam kol\u012btam (\u010cK) ierosin\u0101tu simptomu remisiju un saglab\u0101tu to. To efektivit\u0101te remisijas ierosin\u0101\u0161anai un saglab\u0101\u0161anai akt\u012bvas Krona slim\u012bbas (KS) gad\u012bjum\u0101 nav skaidri pier\u0101d\u012bta, jo dom\u0101jams, ka medikamenti iedarbojas tikai uz resn\u0101s zarnas g\u013cot\u0101das virsk\u0101rtu, bet tie var b\u016bt noder\u012bgi, lai p\u0113c oper\u0101cijas nov\u0113rstu KS recid\u012bvu. Sulfasalaz\u012bnu izmanto ar\u012b loc\u012btavu iekaisuma \u0101rst\u0113\u0161anai IZS \u0101rpuszarnu izpausmju gad\u012bjum\u0101.<\/p>\n\n\n\n
Rakstur\u012bgas 5-ASS z\u0101\u013cu blakuspar\u0101d\u012bbas ir galvass\u0101pes, anoreksija, slikta d\u016b\u0161a, vem\u0161ana, dedzin\u0101\u0161ana, aizku\u0146\u0123a dziedzera iekaisums un vair\u0101kas paaugstin\u0101tas jut\u012bbas reakcijas. Retos gad\u012bjumos zi\u0146ots, ka t\u0101s var boj\u0101t nieru funkciju un ietekm\u0113t asins \u0161\u016bnu ra\u017eo\u0161anu.<\/p>\n\n\n\n
Lai mazin\u0101tu blakuspar\u0101d\u012bbas, 5-ASS z\u0101les pieejamas da\u017e\u0101d\u0101s form\u0101s, tostarp, ar zarn\u0101s \u0161\u0137\u012bsto\u0161u apvalku (kas iz\u0161\u0137\u012bst, tikai izejot cauri ku\u0146\u0123im), klizmas un svec\u012btes.<\/p>\n\n\n\n
Kortikostero\u012bdi<\/h3>\n\n\n\n
Kortikostero\u012bdi (piem., budeson\u012bds, prednizolons, prednizons, deksametazons, hidrokortizons un metilprednizolons) mazina iekaisumu un apspie\u017e organisma im\u016bnsist\u0113mu. Vid\u0113ji izteikta l\u012bdz smaga un zibensveida (fulminanta) \u010cK un vid\u0113ji izteiktas l\u012bdz smagas KS uzliesmojumu \u0101rst\u0113\u0161an\u0101 tie tiek uzskat\u012bti par prim\u0101ro terapiju. Tom\u0113r \u0161\u012bs z\u0101les nav efekt\u012bvas, lai saglab\u0101tu ilgtermi\u0146a remisiju, un t\u0101s j\u0101lieto tikai pl\u0101notu \u012bsu kursu veid\u0101.5 Kortikostero\u012bdu blakuspar\u0101d\u012bbas p\u0113c ilg\u0101kas lieto\u0161anas ir bie\u017eas: t\u016bska, svara pieaugums, akne, bezmiegs, tr\u012bces, sv\u012b\u0161ana nakt\u012b un emocion\u0101li trauc\u0113jumi. Citas noz\u012bm\u012bgas blakuspar\u0101d\u012bbas ir palielin\u0101ts asinsspiediens, samazin\u0101ts kaulu bl\u012bvums (osteoporoze) un gar\u012bg\u0101s vesel\u012bbas trauc\u0113jumi (psihoze). Ilgtermi\u0146a lieto\u0161ana var izrais\u012bt acs l\u0113cas apdu\u013c\u0137o\u0161anos (kataraktu) un acs \u0101bola spiediena pieaugumu (glaukomu). Blakuspar\u0101d\u012bbu profila d\u0113\u013c ne ilg\u0101k k\u0101 4 ned\u0113\u013cas p\u0113c \u0101rst\u0113\u0161anas s\u0101kuma kortikostero\u012bdu deva pak\u0101peniski j\u0101samazina un kad sasniegta kl\u012bnisk\u0101 remisija \u2014 z\u0101\u013cu lieto\u0161ana j\u0101p\u0101rtrauc.<\/p>\n\n\n\n
Atkar\u012bb\u0101 no iekaisuma atra\u0161an\u0101s vietas un smaguma, kortikostero\u012bdus var lietot iek\u0161\u0137\u012bgi, intravenozi vai rekt\u0101li.<\/p>\n\n\n\n
Im\u016bnmodulatori<\/h3>\n\n\n\n
Im\u016bnmodulatori, piem\u0113ram, azatiopr\u012bns (AZA) un 6-merkaptopur\u012bns (6-MP), apspie\u017e im\u016bnsist\u0113mu\/imunit\u0101ti un tos lieto, lai pacientiem ar \u010cK saglab\u0101tu remisiju un pacientiem ar KS \u2014 ierosin\u0101tu un saglab\u0101tu remisiju. KS gad\u012bjum\u0101 tos var lietot kombin\u0101cij\u0101 ar anti-tumora nekrozes faktora (TNF) z\u0101l\u0113m, lai palielin\u0101tu atbildes reakciju un paildzin\u0101tu ieguvuma ilgumu.9,10 (skat\u012bt ar\u012b sada\u013cu par anti-TNF z\u0101l\u0113m).<\/p>\n\n\n\n
AZA un 6-MP bie\u017ei sastopam\u0101s blakuspar\u0101d\u012bbas ir slikta d\u016b\u0161a, vem\u0161ana, nogurums, aknu iekaisums un palielin\u0101ts \u0101das jut\u012bgums pret saules gaismu. Atsevi\u0161\u0137os gad\u012bjumos \u0161ie medikamenti var izrais\u012bt pankreat\u012btu, un \u0161\u0101d\u0101 gad\u012bjum\u0101 z\u0101\u013cu lieto\u0161ana j\u0101p\u0101rtrauc. \u0160\u012b iemesla d\u0113\u013c un t\u0101 k\u0101, samazinot cirkul\u0113jo\u0161os leikoc\u012btus, iesp\u0113jama im\u016bnsupresija, visiem pacientiem, kuri lieto \u0161\u012bs z\u0101les, regul\u0101ri j\u0101veic asins p\u0101rbaudes. T\u0101pat j\u0101atz\u012bm\u0113, ka \u0161\u012bs z\u0101les tiek saist\u012btas ar nelielu bet noteiktu \u0101das v\u0113\u017eu un palielin\u0101tu limfomas risku.<\/p>\n\n\n\n
Pacientiem ar KS, alternat\u012bvs im\u016bnmodulators lieto\u0161anai AZA un 6-MP viet\u0101, ir metotreks\u0101ts. Tiek veikti p\u0113t\u012bjumi, lai izv\u0113rt\u0113tu ieguvumus to lietojot \u010cK gad\u012bjumos. T\u0101 k\u0101 metotreks\u0101ts var izrais\u012bt aknu iekaisumu un saistaudu veido\u0161anos plau\u0161\u0101s (plau\u0161u fibrozi), pacientiem ir nepiecie\u0161ama r\u016bp\u012bga nov\u0113ro\u0161ana. Citi im\u016bnmodulatori, ko reiz\u0113m lieto IZS \u0101rst\u0113\u0161an\u0101, ir ciklospor\u012bns, takrol\u012bms un mikofenol\u0101ta mofetils.<\/p>\n\n\n\n
Antibiotikas<\/h3>\n\n\n\n
KS gad\u012bjum\u0101 antibiotikas lieto, lai \u0101rst\u0113tu p\u0101rm\u0113r\u012bgu bakt\u0113riju aug\u0161anu tievaj\u0101s zarn\u0101s, abscesus un fistulas. T\u0101s reiz\u0113m var lietot, lai \u0101rst\u0113tu zarnu iekaisumu pa\u0161u par sevi, tom\u0113r pier\u0101d\u012bjumi, kas atbalsta to atsevi\u0161\u0137u lieto\u0161anu \u0161\u0101dam m\u0113r\u0137im ir v\u0101ji. Bie\u017e\u0101k lietot\u0101s antibiotikas ir metronidazols, ciprofloksac\u012bns un rifaksimins.<\/p>\n\n\n\n
Antibiotikas netiek lietotas \u010cK p\u0101rvald\u012bb\u0101, ja vien nav infekcijas, piem\u0113ram, Clostridium difficile<\/em>.<\/p>\n\n\n\n \u0160iem medikamenti (adalimumabs un infliksimabs) ir vielas, kas organism\u0101 blo\u0137\u0113 olbaltumu, ko sauc par TNF-alfa. \u0160\u012b olbaltumviela ir svar\u012bga da\u013ca reakciju \u0137\u0113d\u0113, kas nodro\u0161ina iekaisuma att\u012bst\u012bbu organism\u0101, un, blo\u0137\u0113jot \u0161o molekulu, tiek p\u0101rtraukta ar\u012b iekaisuma att\u012bst\u012bba. \u0160\u012bs z\u0101les ir apstiprin\u0101tas lieto\u0161anai vid\u0113ji izteikta l\u012bdz smaga KS un \u010cK gad\u012bjum\u0101 pacientiem, kuriem \u0101rst\u0113\u0161ana ar parastajiem im\u016bnmodulatoriem, piem., azattiopr\u012bnu un kortikostero\u012bdiem nav bijusi veiksm\u012bga.<\/p>\n\n\n\n Anti-TNF z\u0101les ir saist\u012btas ar paaugstin\u0101tu smagu infekciju risku, piem\u0113ram, tuberkuloze vai citas organism\u0101 izplat\u012bju\u0161os v\u012brusu, s\u0113n\u012b\u0161u vai bakt\u0113riju izrais\u012bt\u0101s infekcijas. Ar anti-TNF z\u0101l\u0113m saist\u0101mas ar\u012b citas smagas blakuspar\u0101d\u012bbas. Lai piln\u012bb\u0101 saprastu anti-TNF ieguvumu un risku profilu, pacientiem ir j\u0101konsult\u0113jas ar \u0101rstu. Pier\u0101d\u012bts, ka anti-TNF z\u0101les ierosina simptomu remisiju un \u0101rst\u0113 zarnu trakta sieni\u0146as KS un \u010cK gad\u012bjumos. T\u0101s samazina oper\u0101cijas un hospitaliz\u0101cijas nepiecie\u0161am\u012bbu, k\u0101 ar\u012b uzlabo pacienta dz\u012bves kvalit\u0101ti.<\/p>\n\n\n\n Anti-TNF z\u0101les ir iedarb\u012bg\u0101kas, ja t\u0101s lieto agr\u012bni slim\u012bbas gait\u0101 pirms s\u0101ku\u0161\u0101s komplik\u0101cijas, piem\u0113ram, stenozes un abscesi. Turkl\u0101t t\u0101s var b\u016bt iedarb\u012bg\u0101kas, ja tiek lietotas kop\u0101 ar AZA vai 6-MP terapiju. Adalimumabu ievada k\u0101 zem\u0101das injekciju un infliksimabu ievada k\u0101 intravenozu inf\u016bziju. T\u0101s j\u0101lieto pl\u0101nota kursa veid\u0101, nevis vienk\u0101r\u0161i k\u0101 atbildes reakcija uz simptomiem. Tom\u0113r j\u0101atceras, ka anti-TNF z\u0101les neiz\u0101rst\u0113 IZS, un daudziem pacientiem p\u0113c \u0161o z\u0101\u013cu lieto\u0161anas p\u0101rtrauk\u0161anas slim\u012bbas izpausmes atjaunojas.<\/p>\n\n\n\n Infliksimabs ir him\u0113riska cilv\u0113ka un peles IgG1 monoklon\u0101la antiviela, kas specifiski saist\u0101s ar cilv\u0113ka TNF\u03b1. Eiropas Savien\u012bb\u0101 infliksimabs re\u0123istr\u0113ts reimato\u012bd\u0101 artr\u012bta, Krona slim\u012bbas (pieaugu\u0161ajiem un b\u0113rniem), \u010d\u016blain\u0101 kol\u012bta (pieaugu\u0161ajiem un b\u0113rniem), ankiloz\u0113jo\u0161a spondil\u012bta, psori\u0101tisk\u0101 artr\u012bta un psori\u0101zes \u0101rst\u0113\u0161anai.<\/p>\n\n\n\n Infliksimabs \u0161\u0137\u0113rso placentu un ir konstat\u0113ts in utero<\/em> pak\u013cautu z\u012bdai\u0146u serum\u0101 l\u012bdz 12 m\u0113ne\u0161iem p\u0113c dzim\u0161anas (Julsgaard et al, 2016). \u0160iem z\u012bdai\u0146iem var b\u016bt paaugstin\u0101ts infekcijas, taj\u0101 skait\u0101 nopietnas disemin\u0113tas infekcijas risks, kas var izrais\u012bt let\u0101lu izn\u0101kumu, piem\u0113ram, disemin\u0113ta Bacillus Calmette-Gu\u00e9rin (BCG) infekcija, par ko zi\u0146ots p\u0113c dz\u012bvas BCG vakc\u012bnas ievad\u012b\u0161anas p\u0113c dzim\u0161anas.<\/p>\n\n\n\n Ieteicams divpadsmit m\u0113ne\u0161us p\u0113c dzim\u0161anas nogaid\u012bt ar dz\u012bvu vakc\u012bnu ievad\u012b\u0161anu z\u012bdai\u0146iem, kuri in utero<\/em> biju\u0161i pak\u013cauti infliksimaba ietekmei. Ja z\u012bdainim infliksimaba l\u012bmenis serum\u0101 nav nosak\u0101ms vai infliksimabs lietots tikai gr\u016btniec\u012bbas pirmaj\u0101 trimestr\u012b (kad tiek uzskat\u012bts, ka IgG minim\u0101li \u0161\u0137\u0113rso placentu), dz\u012bvas vakc\u012bnas ievad\u012b\u0161anu var apsv\u0113rt agr\u0101k, ja skaidri paredzams kl\u012bniskais ieguvums konkr\u0113tajam z\u012bdainim.<\/p>\n\n\n\n Ierobe\u017eoti publik\u0101ciju dati liecina, ka atkl\u0101tais infliksimaba l\u012bmenis cilv\u0113ka kr\u016bts pien\u0101 ir zems un ir koncentr\u0101cij\u0101s l\u012bdz 5% no l\u012bme\u0146a m\u0101tes serum\u0101 (Fritzsche et al, 2012). Infliksimabs ir noteikts ar\u012b z\u012bdai\u0146a serum\u0101 p\u0113c infliksimaba uz\u0146em\u0161anas ar kr\u016bts pienu. Ir sagaid\u0101ms, ka sist\u0113misk\u0101 iedarb\u012bba ar kr\u016bti barotiem z\u012bdai\u0146iem b\u016bs v\u0101ja, jo infliksimabs liel\u0101 m\u0113r\u0101 sadal\u0101s gremo\u0161anas trakt\u0101.<\/p>\n\n\n\n Dz\u012bvu vakc\u012bnu ievad\u012b\u0161ana ar kr\u016bti barotam z\u012bdainim, kam\u0113r vi\u0146a m\u0101te lieto infliksimabu, nav ieteicama, iz\u0146emot gad\u012bjumus, ja infliksimaba l\u012bmenis z\u012bdai\u0146a serum\u0101 nav nosak\u0101ms.<\/p>\n","protected":false},"excerpt":{"rendered":" IZS \u0101rst\u0113\u0161an\u0101 izmanto vair\u0101kas medikamentu klases. Zem\u0101k aprakst\u012btas bie\u017e\u0101k lietot\u0101s z\u0101les. Aminosalicil\u0101ti Mesalam\u012bns, olsalaz\u012bns, balsalaz\u012bns un sulfasalaz\u012bns ir z\u0101les, kuru akt\u012bv\u0101 viela ir 5-aminosalicilsk\u0101be (5-ASS), un t\u0101s bie\u017ei lieto k\u0101 pirm\u0101s rindas \u0101rst\u0113\u0161anu, lai maz l\u012bdz vid\u0113ji izteiktam \u010d\u016blainajam kol\u012btam […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":9,"menu_order":10,"comment_status":"closed","ping_status":"open","template":"","meta":{"_themeisle_gutenberg_block_has_review":false,"footnotes":""},"class_list":["post-33","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/lkksb.lv\/index.php?rest_route=\/wp\/v2\/pages\/33","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/lkksb.lv\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/lkksb.lv\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/lkksb.lv\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/lkksb.lv\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=33"}],"version-history":[{"count":13,"href":"https:\/\/lkksb.lv\/index.php?rest_route=\/wp\/v2\/pages\/33\/revisions"}],"predecessor-version":[{"id":1669,"href":"https:\/\/lkksb.lv\/index.php?rest_route=\/wp\/v2\/pages\/33\/revisions\/1669"}],"up":[{"embeddable":true,"href":"https:\/\/lkksb.lv\/index.php?rest_route=\/wp\/v2\/pages\/9"}],"wp:attachment":[{"href":"https:\/\/lkksb.lv\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=33"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}Anti-TNF z\u0101les (biolo\u0123iskas z\u0101les)<\/h3>\n\n\n\n
Infliximab (Remicade, Flixabi, Inflectra, Remsima un Zessly): Dz\u012bvu vakc\u012bnu ievad\u012b\u0161ana z\u012bdai\u0146iem, kuri in utero<\/em> vai baro\u0161anas ar kr\u016bti laik\u0101 biju\u0161i pak\u013cauti infliksimaba ietekmei<\/h4>\n\n\n\n
Z\u012bdai\u0146i, kuri in utero<\/em> (gr\u016btniec\u012bbas) laik\u0101 biju\u0161i pak\u013cauti infliksimaba ietekmei<\/h5>\n\n\n\n
Z\u012bdai\u0146i, kuri baro\u0161anas ar kr\u016bti laik\u0101 pak\u013cauti infliksimaba ietekmei<\/h5>\n\n\n\n
S\u012bk\u0101ka inform\u0101cija par dro\u0161uma apsv\u0113rumiem un rekomend\u0101cij\u0101m<\/h5>\n\n\n\n
Dz\u012bvu vakc\u012bnu ievad\u012b\u0161ana z\u012bdai\u0146iem, kuri in utero<\/em> biju\u0161i pak\u013cauti infliksimaba ietekmei<\/h5>\n\n\n\n
Dz\u012bvu vakc\u012bnu ievad\u012b\u0161ana z\u012bdai\u0146iem, kuri baro\u0161anas ar kr\u016bti laik\u0101 pak\u013cauti infliksimaba ietekmei<\/h5>\n\n\n\n