{"id":13131,"date":"2008-12-21T20:00:00","date_gmt":"2008-12-21T20:00:00","guid":{"rendered":""},"modified":"2008-12-21T20:00:00","modified_gmt":"2008-12-21T20:00:00","slug":"protonu-pompos-inhibitoriai-svarbi-virskinimo-trakto-infekcijas-skatinanti-priezastis","status":"publish","type":"post","link":"https:\/\/www.pasveik.lt\/lt\/naujausi-medicinos-straipsniai\/protonu-pompos-inhibitoriai-svarbi-virskinimo-trakto-infekcijas-skatinanti-priezastis\/13131\/","title":{"rendered":"Proton\u0173 pompos inhibitoriai – svarbi vir\u0161kinimo trakto infekcijas skatinanti prie\u017eastis"},"content":{"rendered":"

\u012eVADAS<\/span><\/b><\/p>\n

Proton\u0173 pompos inhibitoriai (PPI) ir H2 receptori\u0173 blokatoriai yra pagrindiniai ir stipriausiai skrand\u017eio r\u016bg\u0161ties sekrecij\u0105 ma\u017einantys vaistai. Tod\u0117l jie pla\u010diai vartojami padid\u0117jusio r\u016bg\u0161tingumo sukeltoms ligoms (opaligei, gastroezofaginiam refliuksui ir kitoms) gydyti. Vien 2006 m. i\u0161laidos \u0161iems vaistams sudar\u0117 595 mln. EUR Anglijoje (1) ir 7 mlrd. Britanijos svar\u0173 visame pasaulyje (2). Ta\u010diau tyrimai rodo, kad pasaulyje PPI pirmin\u0117s ir antrin\u0117s sveikatos prie\u017ei\u016bros grandyse skiriami pernelyg da\u017enai (3\u20139).<\/span><\/div>\n
Australijos ligonin\u0117se net 63 proc. pacient\u0173 vartojo PPI nesant reikiam\u0173 indikacij\u0173 (3), Airijoje 33 proc. (4), o Jungtin\u0117je Karalyst\u0117je 67 proc. (5). JAV atliktu tyrimu nustatyta, kad hospitalizuojami PPI vartojo apie 20 proc. pacient\u0173, 40 proc. i\u0161 j\u0173 ligonin\u0117je \u0161i\u0173 vaist\u0173 vartojo profilakti\u0161kai, o i\u0161ra\u0161ant PPI vartojo jau apie pus\u0119 pacient\u0173 (6). Be to, paai\u0161k\u0117jo, kad net 90 proc. ligoni\u0173 j\u0173 vartojo nesant reikiam\u0173 indikacij\u0173, nebent kada nors anamnez\u0117je buv\u0119s gastroezofaginis refliuksas b\u016bt\u0173 laikomas pagr\u012fsta indikacija (6). Taigi, 25\u201370 proc. pacient\u0173 \u0161i\u0173 vaist\u0173 vartojo nepagr\u012fstai. Tai rei\u0161kia, kad pasaulyje net 2 mlrd. Britanijos svar\u0173 proton\u0173 pompos inhibitoriams kasmet i\u0161leid\u017eiama be reikalo.<\/span><\/div>\n
PPI yra gana saug\u016bs ir tikrai veiksmingi vaistai, o rim\u010diausias nepageidaujamas poveikis \u2013 galvos skausmas ir viduriavimas<\/a>. Visgi veiksmingas skrand\u017eio r\u016bg\u0161ties sekrecijos slopinimas gali skatinti vir\u0161utinio vir\u0161kinimo trakto dalies bakterin\u0117s floros ve\u0161\u0117jim\u0105, o tod\u0117l \u2013 ir malabsorbcijos, \u017earnyno bei kit\u0173 organ\u0173 infekcij\u0105. Tad pastaraisiais metais nema\u017eai tyrim\u0173 siek\u0117 \u012fvertinti \u017earnyno infekcij\u0173 rizikos ir PPI vartojimo ry\u0161\u012f.<\/span><\/div>\n
\u00a0<\/div>\n
PROTON\u0172 POMPOS INHIBITORIAI IR GASTROENTERITAS<\/a><\/span><\/b><\/div>\n
Skrand\u017eio r\u016bg\u0161tis \u2013 svarbus veiksnys, \u0161alinantis \u012f vir\u0161kinimo trakt\u0105 patekusias bakterijas, tod\u0117l padid\u0117j\u0119s skrand\u017eio pH gali lemti patogenini\u0173 mikroorganizm\u0173 gaus\u0117jim\u0105. \u017darnyno infekcij\u0173 ir skrand\u017eio r\u016bg\u0161tingumo ma\u017einimo, vartojant PPI ir H2 blokatorius, ry\u0161iui nustatyti atlikta metaanaliz\u0117 (10), \u012f kuri\u0105 buvo \u012ftraukti 25 perspektyviniai tyrimai (juose dalyvavo 29\u00a0748 pacientai) (11\u201335). 19 i\u0161 \u0161i\u0173 tyrim\u0173, kuriuose dalyvavo 18\u00a0468 pacientai, analizavo skrand\u017eio r\u016bg\u0161tingumo \u012ftak\u0105 C.\u00a0difficile<\/i> infekcijos atsiradimui, o 6 (11\u00a0280 pacient\u0173) \u2013 kit\u0173 \u017earnyno infekcij\u0173 rizik\u0105.<\/span><\/div>\n
I\u0161analizavus duomenis paai\u0161k\u0117jo, kad vartojant skrand\u017eio r\u016bg\u0161ties sekrecij\u0105 slopinan\u010di\u0173 vaist\u0173 kit\u0173 \u017earnyno infekcij\u0173, sukelt\u0173 ne C.\u00a0difficile<\/i>, rizika padid\u0117ja 2,55 karto, t. y. santykin\u0117 rizika (SR) yra 2,55 (95\u00a0proc. PI 1,53\u20134,26). I\u0161 6 tyrim\u0173 keturi vertino PPI \u012ftak\u0105 gastroenterito rizikai (12, 19, 22, 27). Juose gastroenterito SR buvo 3,33 (95\u00a0proc. PI 1,84\u20136,02) (1 pav.)<\/i>. Lyginant su H2 blokatori\u0173 \u012ftaka \u017earnyno infekcijoms, PPI \u012ftaka buvo stipresn\u0117, ta\u010diau patikimumas ribinis (p=0,08).<\/span><\/div>\n



\n\u00a0<\/p>\n

1 pav. Ne C.\u00a0difficile sukelt\u0173 \u017earnyno infekcij\u0173 rizika vartojant PPI<\/b><\/span><\/i><\/div>\n
Odds ratio (95\u00a0proc. confidence interval)\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Santykin\u0117 rizika (95\u00a0proc. PI)<\/span><\/div>\n
\"Proton\u0173<\/span><\/div>\n
Control at high risk\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Didel\u0117s rizikos kontrolin\u0117 grup\u0117<\/span><\/div>\n
PPI at high risk\u00a0\u00a0\u00a0\u00a0 Didel\u0117s rizikos PPI vartotoj\u0173 grup\u0117<\/span><\/div>\n
Combined (random)\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Bendras rezultatas<\/span><\/div>\n
\u00a0<\/div>\n
Analogi\u0161ki rezultatai gauti ir atliekant kit\u0105, perspektyvin\u012f, atvejo bei kontrol\u0117s tyrim\u0105, kuriame dalyvavo 56\u00a0414 pacient\u0173 nuo 20 iki 74 met\u0173. 6414 pacient\u0173 buvo diagnozuotas infekcinis gastroenteritas<\/a>, atsi\u017evelgiant \u012f prad\u0117t\u0105 viduriavim\u0105 slopinan\u010di\u0173 vaist\u0173 vartojim\u0105 (36). \u012e tyrim\u0105 nebuvo \u012ftraukti pacientai, sergantys onkologin\u0117mis ligomis, \u017earn\u0173 u\u017edegimu ar piktnaud\u017eiaujantys alkoholiu, nes jiems gastroenterito rizika jau savaime didesn\u0117. Viduriuojantiems pacientams i\u0161matose tur\u0117jo b\u016bti nustatyta specifin\u0117 bakterija (Salmonella<\/i>, Campylobacter<\/i>, Shigella<\/i>, Clostridium<\/i> ar kita).<\/span><\/div>\n
I\u0161analizavus duomenis paai\u0161k\u0117jo, kad skrand\u017eio r\u016bg\u0161ties sekrecijos slopinimas padidino rizik\u0105 susirgti \u017earnyno infekcijomis. Gastroenterito rizika vartojusiems PPI pacientams buvo 2,9 (95\u00a0proc. PI 2,8\u20133,5) ir did\u0117jo priklausomai nuo PPI doz\u0117s. Didel\u0119 PPI doz\u0119 kart\u0105 per dien\u0105 vartojusiems pacientams gastroenterito SR padid\u0117jo iki 3,2 (95\u00a0proc. PI 0,5\u201319,4), o du kartus vartojusiems \u2013 net iki 5,3 (95\u00a0proc. PI 2,81\u201310,3). Paai\u0161k\u0117jo, kad rizika nepriklaus\u0117 nuo gydymo trukm\u0117s, o vartojant H2 blokatorius gastroenterito SR buvo 1,1 (95\u00a0proc. PI 0,9\u20131,4), nepriklaus\u0117 nuo gydymo trukm\u0117s ir vaist\u0173 doz\u0117s. <\/span><\/div>\n
Da\u017eniausiai pacient\u0173, susirgusi\u0173 gastroenteritu, i\u0161matose buvo nustatytos Campylobacter<\/i> (N=4124) ir Salmonella<\/i> (N=1885), re\u010diau Shigella<\/i> (N=312) ir Clostridium<\/i> (N=31) genties bakterijos.<\/span><\/div>\n
Taigi, akivaizdu, kad PPI vartojimas statisti\u0161kai reik\u0161mingai padidina \u017earnyno infekcij\u0173 rizik\u0105 (36), o vartojant H2 blokatori\u0173 bakterini\u0173 infekcij\u0173 rizika taip ry\u0161kiai nepadid\u0117ja.<\/span><\/div>\n
\u00a0<\/div>\n
PROTON\u0172 POMPOS INHIBITORIAI PADIDINA CLOSTRIDIUM DIFFICILE <\/i>SUKELTO KOLITO RIZIK\u0104<\/span><\/b><\/div>\n
Analizuojant anks\u010diau min\u0117tai metaanalizei (10) naudot\u0173 tyrim\u0173 duomenis (18\u00a0468 pacientai) (11, 13\u201318, 23\u201326, 28\u201335) nustatytas statisti\u0161kai reik\u0161mingas skrand\u017eio r\u016bg\u0161ties sekrecijos ma\u017einimo ir C.\u00a0difficile<\/i> sukelto kolito ry\u0161ys \u2013 SR 1,95 (95\u00a0proc. PI 1,48\u20132,58). Vartojant H2 blokatori\u0173, C.\u00a0difficile<\/i> infekcijos rizika buvo 1,48 (95\u00a0proc. PI 1,06\u20132,06). Vartojant PPI \u0161ios infekcijos rizika buvo didesn\u0117 \u2013 SR 2,05 (95\u00a0proc. PI 1,47\u20132,85) (2 pav.).<\/i><\/span><\/div>\n


<\/span><\/i><\/p>\n

2 pav. C.\u00a0difficile <\/b><\/span><\/i>infekcijosrizika vartojant proton\u0173 pompos inhibitori\u0173<\/span><\/b>

\n\u00a0<\/div>\n
Odds ratio (95\u00a0proc. confidence interval)\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Santykin\u0117 rizika (95\u00a0proc. PI)<\/span><\/div>\n
\u00a0<\/div>\n
\"Proton\u0173<\/span><\/div>\n
Control at high risk\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Didel\u0117s rizikos kontrolin\u0117 grup\u0117<\/span><\/div>\n
PPI at high risk\u00a0\u00a0\u00a0\u00a0 Didel\u0117s rizikos PPI vartotoj\u0173 grup\u0117<\/span><\/div>\n
Combined (random)\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Bendras rezultatas<\/span><\/div>\n
\u00a0<\/div>\n
C.\u00a0difficile<\/span><\/i> rizika vartojant PPI buvo ma\u017eesn\u0117 nei kit\u0173 \u017earnyno infekcij\u0173 rizika, ta\u010diau skirtumo patikimumas ribinis (p=0,09).<\/span><\/div>\n
Pana\u0161\u016bs duomenys gauti atlikus perspektyvin\u012f atvejo ir kontrol\u0117s tyrim\u0105: buvo tiriama C.\u00a0difficile<\/i> infekcijos rizika pacientams, nesigyd\u017eiusiems ir vartojantiems PPI stacionare (37). Tyrime dalyvavo 481 pacientas, atrinktas pagal gaut\u0105 informacij\u0105 apie skirt\u0105 gydym\u0105 geriamuoju vankomicinu. I\u0161 j\u0173 317 (65,9\u00a0proc.) iki tol metus nebuvo gydyti jokiame stacionare. PPI vartojimas reik\u0161mingai padidino sergamum\u0105 C.\u00a0difficile<\/i> infekcija \u2013 SR 3,5 (95\u00a0proc. PI 2,3\u20135,2); vartojan\u010di\u0173 H2 blokatori\u0173 SR buvo ma\u017eesn\u0117, tik 1,4 (95\u00a0proc. PI 0,8\u20132,5; skirtumas statisti\u0161kai nereik\u0161mingas). Be abejo, svarbiausias vaidmuo didinant infekcijos C.\u00a0difficile<\/i> rizik\u0105 teko antibiotikams, ta\u010diau net 45 proc. tirt\u0173 asmen\u0173 90 dien\u0173 iki viduriavimo nebuvo vartoj\u0119 joki\u0173 antibiotik\u0173.<\/span><\/div>\n
Taigi, \u0161iuo tyrimu nustatyta statisti\u0161kai reik\u0161mingai didesn\u0117 infekcijos C.\u00a0difficile<\/i> rizika PPI vartojusiems pacientams. Kita vertus, \u017einoma, kad C.\u00a0difficile <\/i>spor\u0173 didesnis atsparumas skrand\u017eio r\u016bg\u0161\u010diai pagerina \u0161io mikroorganizmo kolonizacijos galimybes (38), tod\u0117l skrand\u017eio r\u016bg\u0161tingum\u0105 ma\u017einan\u010di\u0173 vaist\u0173 vartojimas ma\u017eiau lemia C.\u00a0difficile<\/i> infekcijos vystym\u0105si, palyginti su kit\u0173 patogen\u0173 (kurie jautr\u016bs skrand\u017eio r\u016bg\u0161ties poveikiui) sukeltos infekcijos rizika.<\/span><\/div>\n
\u00a0<\/b><\/div>\n
APTARIMAS<\/span><\/b><\/div>\n
\u017darnyno infekcij\u0173 rizikos did\u0117jim\u0105, vartojant skirting\u0173 skrand\u017eio r\u016bg\u0161ties sekrecij\u0105 ma\u017einan\u010di\u0173 vaist\u0173, galima paai\u0161kinti tam tikrais vaist\u0173 veikimo ypatumais. Pirmiausia tai gali b\u016bti susij\u0119 su skrand\u017eio r\u016bg\u0161ties sekrecijos slopinimo lygiu: H2 blokatoriai j\u0105 slopina silpniau nei PPI, o bakterij\u0173 dauginimuisi svarbu, kad pH>4 i\u0161likt\u0173 kuo ilgiau. Jeigu pH<4 b\u016bna bent kelias valandas per par\u0105, bakterij\u0173 dauginimasis nuslopinamas (40). Tyrim\u0173 duomenimis, pH>3 ir pH>4 gydomiems terapin\u0117mis PPI doz\u0117mis pacientams b\u016bna ilgesn\u012f laik\u0105 nei gydomiems H2 blokatoriais (41). Skirting\u0105 PPI ir H2 blokatori\u0173 skrand\u017eio r\u016bg\u0161ties sekrecijos slopinimo veiksmingum\u0105 \u012frodo ir duomenys apie bakterij\u0173 kolonizacij\u0105: net 53 proc. omeprazolio vartojusi\u0173 asmen\u0173 rasta patogenini\u0173 \u017earnyno bakterij\u0173, o tarp vartojan\u010di\u0173 cimetidino toki\u0173 asmen\u0173 buvo tik 17 proc. (42). Taigi skrand\u017eio r\u016bg\u0161ties sekrecijos slopinimas sutrikdo pirm\u0105 apsaugos nuo patekusi\u0173 \u012f vir\u0161kinimo trakt\u0105 mikroorganizm\u0173 grand\u012f. Ta\u010diau gastroenteritui vystytis svarbiausia ne vaist\u0173 gal\u0117jimas slopinti skrand\u017eio r\u016bg\u0161ties sekrecij\u0105, o \u0161io poveikio trukm\u0117 (43, 44).<\/span><\/div>\n
Tai, kad didesn\u0117 PPI doz\u0117 susijusi su didesne \u017earnyno infekcij\u0173 rizika, taip pat remia id\u0117j\u0105, kad svarbiausi\u0105 vaidmen\u012f vystantis Salmonella<\/i> ir Campylobacter<\/i> sukeltam gastroenteritui atlieka b\u016btent stipresnis skrand\u017eio r\u016bg\u0161ties sekrecijos slopinimas, ta\u010diau apie H2 blokatori\u0173 didesni\u0173 dozi\u0173 \u012ftak\u0105 infekcij\u0173 rizikai duomen\u0173 nepakanka.<\/span><\/div>\n
Yra duomen\u0173 ir apie PPI poveik\u012f leukocit\u0173 funkcijoms. Vienkartin\u0117 40 mg omeprazolio doz\u0117 didina neutrofil\u0173 laisv\u0173j\u0173 radikal\u0173 gamyb\u0105 ir slopina baktericidin\u012f j\u0173 poveik\u012f Escherichia coli<\/i> apie 30 proc. (45). Ranitidinas neveikia laisv\u0173j\u0173 radikal\u0173 gamybos, cimetidinas ir famotidinas tik ne\u017eymiai slopina neutrofil\u0173 aktyvum\u0105 (46). PPI taip pat veikia pagrindin\u012f u\u017edegimo proceso etap\u0105 \u2013 u\u017edegimo l\u0105steli\u0173 migracij\u0105 \u012f u\u017edegimo \u017eidin\u012f. Cirkuliuojantys leukocitai \u012f infekcijos \u017eidin\u012f patenka dalyvaujant endotelio l\u0105steli\u0173 ir leukocit\u0173 adhezijos molekul\u0117ms (47), o PPI, bet ne H2 blokatoriai slopina kai kuri\u0173 i\u0161 j\u0173 rai\u0161k\u0105 leukocit\u0173 membranos pavir\u0161iuje, tod\u0117l silpn\u0117ja adhezijos procesas ir endotelio l\u0105steli\u0173 aktyvinimas (48). <\/span><\/div>\n
\u00a0<\/div>\n
APIBENDRINIMAS<\/span><\/b><\/div>\n
Padid\u0117jusio skrand\u017eio sul\u010di\u0173 r\u016bg\u0161tingumo sukelt\u0173 lig\u0173 gydymas proton\u0173 pompos inhibitoriais (PPI)\u00a0ir H2 blokatoriais yra veiksmingas ir gana saugus. Ta\u010diau PPI vartojimas pastaraisiais metais dramati\u0161kai did\u0117ja, o tyrimai rodo, kad 25\u201370 proc. pacient\u0173 \u0161i\u0173 vaist\u0173 vartoja nepagr\u012fstai. Skrand\u017eio r\u016bg\u0161ties sekrecij\u0105 slopinan\u010di\u0173 vaist\u0173 empirin\u012f skyrim\u0105 pacientams skatina dispepsijos gydymo gair\u0117s (49). Vir\u0161utinio vir\u0161kinimo trakto simptomus junta labai daug pacient\u0173 (50), jie reik\u0161mingai pablogina gyvenimo kokyb\u0119, o prad\u0117jus vartoti PPI ar H2 blokatori\u0173 savijauta greitai pager\u0117ja (39).<\/span><\/div>\n
Nepaisant neabejotinos skrand\u017eio r\u016bg\u0161ties sekrecij\u0105 slopinan\u010di\u0173 vaist\u0173 naudos, rekomenduojama prie\u0161 skiriant vien\u0105 i\u0161 j\u0173, ar tai PPI, ar H2 blokatorius, \u012fvertinti rizikos ir naudos santyk\u012f. Tai ypa\u010d aktualu didesn\u0117s \u017earnyno infekcij\u0173 rizikos asmenims, pvz., keliaujantiems \u012f padid\u0117jusios rizikos kra\u0161tus, stacionare gydomiems ir ypa\u010d antibiotik\u0173 vartojantiems pacientams, ne\u012fgaliems, vyresnio am\u017eiaus, inkst\u0173 funkcijos nepakankamumu, piktybiniais navikais ir\/ar sergantiems \u017earn\u0173 u\u017edegimu. \u0160i rekomendacija susijusi su padid\u0117jusia infekcinio gastroenterito ir C. difficile<\/i> sukeltos \u017earnyno infekcijos rizika, ypa\u010d vartojant PPI.<\/span><\/div>\n
\u00a0<\/div>\n
Pareng\u0117 gyd. L.\u00a0VAITKEVI\u010cI\u016aT\u0116<\/span><\/i><\/div>\n
Gauta: 2008-12-12<\/span><\/i><\/div>\n
Pateikta spaudai: 2008-12-23<\/span><\/i><\/div>\n
\u00a0<\/div>\n
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\u012eVADAS Proton\u0173 pompos inhibitoriai (PPI) ir H2 receptori\u0173 blokatoriai yra pagrindiniai ir stipriausiai skrand\u017eio r\u016bg\u0161ties sekrecij\u0105 ma\u017einantys vaistai. Tod\u0117l jie pla\u010diai vartojami padid\u0117jusio r\u016bg\u0161tingumo sukeltoms ligoms (opaligei, gastroezofaginiam refliuksui ir kitoms) gydyti. Vien 2006 m. i\u0161laidos \u0161iems vaistams sudar\u0117 595 mln. EUR Anglijoje (1) ir 7 mlrd. Britanijos svar\u0173 visame pasaulyje (2). Ta\u010diau tyrimai rodo,…<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[],"tags":[],"site":[],"post_item_type":[27345],"class_list":["post-13131","post","type-post","status-publish","format-standard","hentry"],"acf":{"post_sites":false},"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts\/13131","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/comments?post=13131"}],"version-history":[{"count":0,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts\/13131\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/media?parent=13131"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/categories?post=13131"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/tags?post=13131"},{"taxonomy":"site","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/site?post=13131"},{"taxonomy":"post_item_type","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/post_item_type?post=13131"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}