Te Tikanga Mahi a ngā Paturopi ki te Whakangaro i ngā Huakita
Ko ngā paturopi tētahi o ngā kitenga tino nui i roto i te hītori o te rongoā hou. Ka whakamahia ēnei rongoā hei rongoā i ngā mate i puta mai i ngā huakita, ahakoa e pā ana ki te kiri, ki te ara manawa, ki te ara mimi, ki ētahi atu okana rānei. Ahakoa e kiia ana he "kaipatu huakita", kāore ngā paturopi e mahi rite tonu ki ngā huakita katoa, kāore hoki e whai hua ki ngā mate huaketo pērā i te rewharewha, i te COVID-19 rānei. Kia mārama ai tātou he aha te hiranga o te whakamahinga o ngā paturopi, me mārama tātou ki te mahi a ngā paturopi ki te whakangaro i ngā huakita.
Paturopi: whakamate, ārai rānei i ngā huakita
I te nuinga o te wā, e rua ngā huarahi matua o te mahi a ngā paturopi. Tuatahi, he patu huakita, arā, ka patua tika ngā huakita. Tuarua, he patu huakita, arā, ka ārai i te tipu me te whakaputa uri o ngā huakita, ka wātea ai te pūnaha ārai mate o te tinana ki te whakakore i te mate. He mea nui tēnei rerekētanga nā te mea i roto i ētahi āhuatanga (pēnei i ngā mate kino, i ngā tūroro rānei he ngoikore te pūnaha ārai mate), he maha ngā wā ka pai ake ngā paturopi patu huakita hei whakakore wawe i ngā huakita.
Heoi, ahakoa te kāwai, ka mahi noa ngā paturopi mā te kimi i te "ngoikoretanga" o te huakita. Ko tēnei ngoikore he hanganga, he tukanga koiora rānei e motuhake ana ki ngā huakita, kāore i roto i ngā pūtau tangata. Koia te take ka taea e ngā paturopi te whakaeke i ngā huakita me te kore e tino kino ki ngā pūtau tinana.
1. Ārai i te hanganga o ngā pakitara pūtau huakita
Ko tētahi o ngā pūtake rongonui mō ngā paturopi ko te pakitara pūtau huakita. He maha ngā huakita he pakitara pūtau kei roto i te peptidoglycan, he hanganga rite ki te mata e whakarato ana i te āhua me te kaha. Kāore he pakitara pūtau o ngā pūtau tangata, nā reira he tino motuhake tēnei pūtake ki ngā huakita.
Kei roto i te rōpū beta-lactam ngā paturopi pērā i ngā penicillin, ngā cephalosporin, ngā carbapenem, me ngā monobactam. Ka mahi rātou mā te aukati i te whākōkī e kawenga ana mō te hanga hononga whakawhiti i roto i te peptidoglycan. Ka ngoikore te pakitara pūtau, ā, ka pakaru pea ngā huakita (lysis), inā koa i te wā e tipu ana, e wehea ana hoki.
Haunga ngā beta-lactam, kei reira anō hoki ngā glycopeptides pērā i te vancomycin e mahi ana i tētahi huarahi rerekē: ka herea ki te wāhanga peptidoglycan, ka whakararuraru i te huihuinga o te pakitara pūtau. He tino whai hua tēnei tikanga ki ngā huakita Gram-pai.
2. Ka kino i ngā kiriuhi pūtau huakita
Ko te whāinga e whai ake nei ko te kiriuhi pūtau, te paparanga e pupuri ana i te taurite o ngā mea kei roto i te pūtau. Mēnā ka pakaru te kiriuhi, ka turuturu ngā wāhanga nui o roto i te pūtau , ā, kāore e ora ngā huakita.
Ko ngā tauira o ngā paturopi whakahohe-kirikiri ko ngā polymyxins (hei tauira, te colistin), e whakamahia whānuitia ana ki ētahi huakita Gram-negative ātete. Ka taunekeneke ngā polymyxins me ngā wāhanga o te kiriuhi o waho me te kiriuhi cytoplasmic, ka puta he turuturu. Ka taea hoki e te daptomycin te kino i te kiriuhi pūtau o ngā huakita Gram-positive mā te whakaputa i te depolarization o te kiriuhi, ā, ka mutu te whakaputa pūngao o ngā huakita.
Nā te mea kei roto i te tangata ngā kiriuhi pūtau, he nui ake te mōrearea o tēnei momo paturopi ki ngā pānga taha, ā, me nui ake te tūpato i te whakamahinga.
3. Ārai i te hanganga pūmua huakita
Me whai pūmua ngā huakita hei oranga, hei tipu, hei whakatika i ngā kino, me te mahi i ngā mahi pākia. Ka hangaia ngā pūmua e ngā mīhini e kiia nei ko ngā ribosome. He rerekē te hanganga o ngā ribosome huakita i ngā ribosome tangata, ā, ka taea e ngā paturopi te aro motuhake ki a rātou.
Ko ētahi rōpū paturopi e aukati ana i te hanganga pūmua ko:
– Ngā aminoglycosides (hei tauira, gentamicin, amikacin): ka whakararuraru i te pānui o te waehere ira, ka puta ai he pūmua hapa i roto i ngā huakita. He maha ngā aminoglycosides he patu huakita.
– Tetracycline (hei tauira, te doxycycline): ka ārai i te urunga o ngā "rauemi mata" mō te hanganga pūmua ki roto i ngā ribosome, ā, ka mutu te hanga pūmua.
– Ngā Macrolide (hei tauira, erythromycin, azithromycin): ka aukati i te nekehanga o te ribosome i te taha o te mRNA, ka mutu te tukanga whakaroa i te mekameka pūmua.
– Chloramphenicol me ngā lincosamides (hei tauira, clindamycin): ka whakararuraru i te hanganga here peptide, i ētahi atu mahi nui rānei o te hanganga pūmua.
Ki te kore e hangaia ngā pūmua nui, e kore e taea e ngā huakita te tupu, te mate rānei, i runga i te momo paturopi me te āhua o te mate.
4. Ārai i te hanganga DNA me te RNA
Ko ngā rauemi ira kitakita, arā, ko te DNA me te RNA, te pūwāhi whakahaere matua mō te oranga kitakita. Ko ētahi paturopi e aro ana ki ngā tukanga o te tāruaruatanga DNA (te tāruaruatanga) te tuhi RNA rānei (te hanga tārua o ngā mōhiohio ira mō te hanga pūmua).
Ka āraihia e ngā fluoroquinolones (hei tauira, ciprofloxacin, levofloxacin) te whākōkī DNA gyrase, te topoisomerase rānei, e hiahiatia ana hei wetewete me te whakahoki i te DNA i te wā whakaputarua. Mēnā ka whakararuhia tēnei tukanga, kāore e taea e ngā huakita te wehewehe, ā, ka mate i te mutunga.
I taua wā tonu, ka aukati te rifampin i te whākōkī RNA polymerase huakita, ka ārai i te hanga RNA e ngā huakita. He mea nui tēnei rongoā i roto i te rongoā mate kohi nā te mea ka ārai pai i te hanga o ngā wāhanga nui e ngā huakita.
5. Ka whakararuraru i te pākia o te folate (antimetabolite)
Me whai folate ngā huakita hei hanga i te DNA me ētahi atu wāhanga nui. He mea whakamīharo, ka whiwhi te tangata i te folate mai i te kai, engari he maha ngā huakita me whakaputa i ā rātou ake folate. Mā tēnei rerekētanga ka puta he wā mō ngā paturopi.
Hei tauira, ko te huinga trimethoprim-sulfamethoxazole. Ka ārai te sulfamethoxazole i te taahiraa tuatahi o te hanganga folate, ko te trimethoprim ia ka ārai i te taahiraa e whai ake nei. Mā te aukati i ngā taahiraa e rua i te wā kotahi, ka tino heke te hanga folate, ka kore ngā huakita i ngā rauemi mata mō te hanganga DNA, ā, ka mutu tō rātou tipu, ka mate rānei.
He aha te take kāore e mahi tonu ai ngā paturopi?
Ahakoa he whai hua ngā tikanga o ngā paturopi, kei reira ētahi āhuatanga e kore ai e taea e rātou te patu i ngā huakita. Ko tētahi o ngā tino take ko te ātete ki ngā paturopi. Ka puta te ātete ina huri ngā huakita ki te taumata kāore e whai hua ngā paturopi. He rerekē ngā tikanga, hei tauira:
1. Whakaputa i ngā whākōkī whakangaro paturopi, pērā i te beta-lactamase e whakangaro ana i te mowhiti beta-lactam i roto i te penicillin.
2. Te whakarerekē i te whāinga o te paturopi, kia kore ai e piri, e mahi rānei te rongoā.
3. Ka whakaiti i te urunga mai o ngā paturopi mā roto i ngā panonitanga o ngā pūwero kiriuhi i roto i ngā huakita Gram-negative.
4. Te pupuhi i ngā paturopi mā te whakamahi i te papu pupuhi, kia kore ai e ranea te kukū o te rongoā i roto i te huakita hei whakamate.
5. Ka hanga he kiriata koiora, he paparanga tiaki e uaua ai te toro atu o ngā paturopi ki ngā huakita.
Ka piki ake te ātete nā te whakamahinga hē o ngā paturopi, hei tauira, te tango i ngā paturopi me te kore he tohutoro, te kore e whakaoti i te rongoā e ai ki ngā tohutohu, te whakamahi rānei i ngā paturopi mō ngā mate huaketo.
Te Katinga
Ko te tikanga mahi a ngā paturopi ki te whakangaro i ngā huakita e aro ana ki te whakaeke i ngā wāhanga matua motuhake o ngā huakita: te pakitara pūtau, te kiriuhi pūtau, ngā ribosome, te hanganga DNA/RNA, me ngā ara pākia o te folate. Mā te arotahi ki ēnei "ngoikoretanga," ka taea e ngā paturopi te patu, te aukati rānei i ngā huakita. Heoi, ko te angitu o te rongoā e whakawhirinaki ana ki te whiriwhiri i te paturopi tika, te horopeta tika, me te whakarongo o te tūroro ki ngā tohutohu. I tēnei wā e piki haere ana te ātete, he mea nui te mārama ki te mahi a ngā paturopi, ehara i te mea mō ngā tohunga hauora anake, engari mō te marea hoki, kia tika ake ai te whakamahinga o ngā paturopi, kia taea ai te rongoā haumaru me te whai hua i ngā mate huakita.
