{"id":13298,"date":"2008-11-20T20:00:00","date_gmt":"2008-11-20T20:00:00","guid":{"rendered":""},"modified":"2008-11-20T20:00:00","modified_gmt":"2008-11-20T20:00:00","slug":"nimesulidas-geras-ir-saugus-pasirinkimas-pacientuinetoleruojanciam-kitu-nesteroidiniu-vaistu-nuo-uzdegimo","status":"publish","type":"post","link":"https:\/\/www.pasveik.lt\/lt\/naujausi-medicinos-straipsniai\/nimesulidas-geras-ir-saugus-pasirinkimas-pacientuinetoleruojanciam-kitu-nesteroidiniu-vaistu-nuo-uzdegimo\/13298\/","title":{"rendered":"Nimesulidas – geras ir saugus pasirinkimas pacientui,netoleruojan\u010diam kit\u0173 nesteroidini\u0173 vaist\u0173 nuo u\u017edegimo"},"content":{"rendered":"

ALERGIJOS NESTEROIDINIAMS VAISTAMS NUO U\u017dDEGIMO PATOGENEZ\u0116<\/b><\/p>\n

Nesteroidiniai vaistai nuo u\u017edegimo (NVNU) d\u0117l savo skausm\u0105, u\u017edegim\u0105 ir kar\u0161\u010diavim\u0105 mal\u0161inan\u010dio poveikio yra naudojami daugyb\u0119 b\u016bkli\u0173 ir lig\u0173 gydyti. Pagrindinis \u0161ios grup\u0117s preparat\u0173 veikimo mechanizmas – fermento ciklooksigenaz\u0117s (COX) slopinimas (1–3). COX dalyvauja prostaglandin\u0173 ir tromboksan\u0173 sintez\u0117je i\u0161 arachidono r\u016bg\u0161ties. Yra kelios COX izoformos. COX-1 yra konstitucinis (nuolat organizme veikiantis) fermentas, jis dalyvauja sintezuojant apsauginius prostaglandinus, kurie b\u016btini palaikyti normali\u0105 inkst\u0173 funkcij\u0105, skrand\u017eio gleivin\u0117s vientisum\u0105, hemostaz\u0119 ir autokrinin\u012f atsak\u0105 \u012f kraujyje cirkuliuojan\u010dius hormonus. COX-2 yra indukuojamas fermentas, svarbus u\u017edegimini\u0173 proces\u0173 patogenez\u0117je.<\/div>\n
D\u0117l COX-1 slopinimo sutrinka skrand\u017eio gleivin\u0117s apsaugin\u0117 funkcija bei trombocit\u0173 funkcija. D\u0117l COX-2 slopinimo pasirei\u0161kia u\u017edegim\u0105 ma\u017einantis ir analgezinis NVNU poveikis. Preparatams, stipriai slopinaniems COX-2 ir ma\u017eiau slopinantiems COX-1, b\u016bdingas stiprus u\u017edegim\u0105 ma\u017einantis poveikis, o nepageidaujmas poveikis skrand\u017eio gleivinei ir inkstams yra \u017eymiai ma\u017eesnis.<\/div>\n
Kadangi gydytojai da\u017enai skiria NVNU, be to, jie parduodami be recepto, neretai pacientai netinkamai juos vartoja, \u0161ios grup\u0117s preparatams gali pasireik\u0161ti padid\u0117j\u0119s jautrumas: anafilaksinis \u0161okas<\/a>, bronchospazmas, angioedema<\/a>, dilg\u0117line ir \u012fvair\u016bs odos pa\u017eeidimai.<\/div>\n
Padid\u0117jusio jautrumo NVNU grup\u0117s preparatams patogenez\u0117 n\u0117ra visi\u0161kai ai\u0161ki, svarstomi keli patogeneziniai mechanizmai:<\/div>\n
1.      <\/span>Keletui pacient\u0173 alergin\u0117s reakcijos pasirei\u0161k\u0117 vartojant pirazolonus, aspirin<\/a>\u0105, antranilin\u0117s r\u016bg\u0161ties junginius ir dikofenak\u0105. Reakcijos gali pasireik\u0161ti veikiant l\u0105steliniams alergijos mechanizmams ir IgE. Pirmuoju atveju reakcijos pasirei\u0161kia kaip alerginis kontaktinis ir fotoalerginis dermatitas. IgE sukelt\u0173 reakcij\u0173 spektras – nuo \u016bmin\u0117s dilg\u0117lin\u0117s ar angioedemos iki anafilaksinio \u0161oko (4).<\/div>\n
2.      <\/span>Da\u017eniausiai alergini\u0173 reakcij\u0173 NVNU prie\u017eastimi b\u016bna ne imuninis hiperjautrumas, o nespecifinis bazofil\u0173 bei putli\u0173j\u0173 l\u0105steli\u0173 aktyvinimas ir komplemento komponent\u0173 aktyvinimas, kuris pasirei\u0161kia vis\u0173 pirma d\u0117l COX ferment\u0173 slopinimo. Taip ai\u0161kinama NVNU sukeltos bronchin\u0117s astmos patogenez\u0117. D\u0117l COX ferment\u0173 slopinimo sutrinka ciklooksigenazi\u0173 ir lipooksigenazi\u0173 pusiausvyra arachidono r\u016bg\u0161ties metabolizmo kaskadoje, d\u0117l to ma\u017eiau pagaminama bronchodilataciniu poveikiu pasi\u017eymin\u010dio prostaglandino PGE2<\/sub>,o daugiau – bronchokonstrikciniu poveikiu pasi\u017eymin\u010di\u0173 leukotrien\u0173 C4<\/sub> ir D4<\/sub> (5).<\/div>\n
 <\/div>\n
NIMESULIDO SAUGUMAS ESANT ALERGIJAI KITIEMS NVNU<\/b><\/div>\n
Nimesulidas yra sulfonanilidinis nesteroidinis vaistas nuo u\u017edegimo, kuris selektyviai slopina ciklooksigenaz\u0117s 2 (COX-2) veikim\u0105 (6). Tod\u0117l nimesulidas gal\u0117t\u0173 b\u016bti puikus pasirinkimas pacientams, kurie netoleruja NVNU (7–10). Viename i\u0161 tyrim\u0173 (11) buvo siekta \u012fvertinti, kaip NVNU netoleruojantys suaug\u0119 pacientai toleruoja nimesulid\u0105.<\/div>\n
\u0160iame aklame, placebo kontroliuojamame tyrime dalyvavo 171 pacientas. 130 pacient\u0173 buvo odos alergini\u0173 reakcij\u0105, 58 – kv\u0117pavimo tak\u0173 alergini\u0173 reakcij\u0173, o 17 pacient\u0173 – ir odos, ir kv\u0117pavimo tak\u0173 alergini\u0173 reakcij\u0173. Da\u017eniausiai jas suk\u0117l\u0117 aspirinas (86 proc. atvej\u0173), pirazolonai (61 proc.) ir dikofenakas (30 proc.). Tyrimo metu tris skirtingas dienas (su 7–14 dien\u0173 pertrauka) 2 kartus per dien\u0105 visiems pacientams buvo skiriama: pirm\u0105 dien\u0105 – placebas ir placebas, antr\u0105 dien\u0105 – 5 ir 50 mg nimesulido, tre\u010di\u0105 dien\u0105 – 50 ir 150 mg nimesulido. Ir placebas, ir nimesulidas buvo skiriami geriam\u0173j\u0173 kapsuli\u0173 pavidalu (i\u0161braukti). Doz\u0117s buvo skiriamos su 1 val pertrauka.<\/div>\n
Prie\u0161 geriant vaist\u0173s ir pra\u0117jus 3 val. po doz\u0117s suvartojimo buvo matuojamas arterinis kraujosp\u016bdis, \u0161irdies susitraukim\u0173 da\u017enis (\u0160SD) ir maksimalus i\u0161kv\u0117pimo srov\u0117s greitis (PEF). Astma sergantiems pacientams papildomai buvo tiriamas FEV1<\/sub> ir 24 val. stebimas PEF.<\/div>\n
Laikyta, kad pacientas netoleruoja nimesulido, jei pasirei\u0161k\u0117 dilg\u0117lin\u0117<\/a>, angioedema<\/a>, rinitas, aki\u0173 simptomai ar FEV1<\/sub> suma\u017e\u0117jimas 20 proc. Pacientams buvo nurodyta, kad v\u0117lesnes reakcijas jie registruot\u0173 kaip nepageidaujamus poveikius ir prane\u0161t\u0173 apie juos tyr\u0117jams. Pacientai, kuriems nepasirei\u0161k\u0117 alergini\u0173 reakcij\u0173, buvo stebimi 18 m\u0117n.<\/div>\n
25 pacientai (15 proc.) netoleravo nimesulido (tolerancijos testas<\/a> buvo neigiamas). Da\u017eniausiai preparato netoravimas pasireik\u0161davo dilg\u0117line, angioedema<\/a>, astma, rinitu ir nie\u017euliu. 20 pacient\u0173 (t. y. 80 proc. i\u0161 nimesulido netoleravusi\u0173j\u0173 grup\u0117s) alergini\u0173 reakcij\u0173 pasireik\u0161davo tik po did\u017eiausi\u0173 (150 mg) nimesulido dozi\u0173.<\/i> 14 pacient\u0173 netoleravimo po\u017eymiai pasireik\u0161davo per pirmas 2 val. suvartojus vaisto, 8 pacientams – per 3–6 val., o 4 – po 6 val.<\/div>\n
82 pacientams u\u017edegimui slopinti nimesulido buvo skiriama dar 18 m\u0117n. I\u0161 j\u0173 93 proc. gerai toleravo \u0161\u012f preparat\u0105, o 7 proc. po keli\u0173 nimesulido dozi\u0173 pasirei\u0161k\u0117 dilg\u0117lin\u0117s ir angioedemos epizod\u0173, kurie buvo pana\u0161\u016bs \u012f vartojant kit\u0173 NVNU pasirei\u0161kusius.<\/div>\n
\u0160io tyrimo (11) rezultatai rodo, kad gydym\u0105 nimesulidu gerai toleruoja 85 proc. pacient\u0173, netoleruojan\u010di\u0173 kit\u0173 NVNU. Tai atitinka kit\u0173 autori\u0173 skelbiamus duomenis (7–10).<\/div>\n
\u0160iek tiek ma\u017eiau yra duomen\u0173 apie ilgesnio gydymo nimesulidu toleravim\u0105. Tod\u0117l buvo aliktas kitas tyrimas (12), kuriame dalyvavo 625 pacientai, kuriems d\u0117l vieno ar keli\u0173 NVNU grup\u0117s preparat\u0173 vartojimo pasirei\u0161k\u0117 alergini\u0173 reakcij\u0173 (1 lentel\u0117)<\/i>.<\/div>\n
 <\/div>\n
1 lentel\u0117. NVNU sukeltos alergin\u0117s reakcijos (12).<\/i><\/div>\n

\n\n\n\n\n\n\n\n\n\n\n\n\n
\n
NVNU klas\u0117<\/span><\/div>\n<\/td>\n
\n\n
Astma<\/span><\/div>\n<\/td>\n
\n
Anafilaktinis \u0161okas<\/span><\/div>\n<\/td>\n
\n
Daugiaform\u0117 eritema<\/span><\/div>\n<\/td>\n
\n
B\u0117rimas<\/span><\/div>\n<\/td>\n
\n
I\u0161 viso (proc.)<\/span><\/div>\n<\/td>\n<\/tr>\n
\n
Salicilatai<\/span><\/div>\n<\/td>\n
\n
248<\/span><\/div>\n<\/td>\n
\n
41<\/span><\/div>\n<\/td>\n
\n
1<\/span><\/div>\n<\/td>\n
\n
2<\/span><\/div>\n<\/td>\n
\n
3<\/span><\/div>\n<\/td>\n
\n
295(34,3)<\/span><\/div>\n<\/td>\n<\/tr>\n
\n
Pirazolonai<\/span><\/div>\n<\/td>\n
\n
190<\/span><\/div>\n<\/td>\n
\n
13<\/span><\/div>\n<\/td>\n
\n
4<\/span><\/div>\n<\/td>\n
\n
7<\/span><\/div>\n<\/td>\n
\n
37<\/span><\/div>\n<\/td>\n
\n
251(29,2)<\/span><\/div>\n<\/td>\n<\/tr>\n
\n
Arilpropionai<\/span><\/div>\n<\/td>\n
\n
107<\/span><\/div>\n<\/td>\n
\n
3<\/span><\/div>\n<\/td>\n
\n
1<\/span><\/div>\n<\/td>\n
\n
0<\/span><\/div>\n<\/td>\n
\n
8<\/span><\/div>\n<\/td>\n
\n
119(13,8)<\/span><\/div>\n<\/td>\n<\/tr>\n
\n
Fenetidinai<\/span><\/div>\n<\/td>\n
\n
35<\/span><\/div>\n<\/td>\n
\n
17<\/span><\/div>\n<\/td>\n
\n
5<\/span><\/div>\n<\/td>\n
\n
4<\/span><\/div>\n<\/td>\n
\n
18<\/span><\/div>\n<\/td>\n
\n
80(9,3)<\/span><\/div>\n<\/td>\n<\/tr>\n
\n
Arilacetatai<\/span><\/div>\n<\/td>\n
\n
25<\/span><\/div>\n<\/td>\n
\n
11<\/span><\/div>\n<\/td>\n
\n
4<\/span><\/div>\n<\/td>\n
\n
2<\/span><\/div>\n<\/td>\n
\n
6<\/span><\/div>\n<\/td>\n
\n
48(5,7)<\/span><\/div>\n<\/td>\n<\/tr>\n
\n
Oksikamai<\/span><\/div>\n<\/td>\n
\n
17<\/span><\/div>\n<\/td>\n
\n
10<\/span><\/div>\n<\/td>\n
\n
0<\/span><\/div>\n<\/td>\n
\n
0<\/span><\/div>\n<\/td>\n
\n
4<\/span><\/div>\n<\/td>\n
\n
31(3,6)<\/span><\/div>\n<\/td>\n<\/tr>\n
\n
Fenamatai<\/span><\/div>\n<\/td>\n
\n
11<\/span><\/div>\n<\/td>\n
\n
8<\/span><\/div>\n<\/td>\n
\n
0<\/span><\/div>\n<\/td>\n
\n
0<\/span><\/div>\n<\/td>\n
\n
0<\/span><\/div>\n<\/td>\n
\n
19(2,2)<\/span><\/div>\n<\/td>\n<\/tr>\n
\n
Kiti<\/span><\/div>\n<\/td>\n
\n
16<\/span><\/div>\n<\/td>\n
\n
0<\/span><\/div>\n<\/td>\n
\n
0<\/span><\/div>\n<\/td>\n
\n
0<\/span><\/div>\n<\/td>\n
\n
0<\/span><\/div>\n<\/td>\n
\n
16(1,9)<\/span><\/div>\n<\/td>\n<\/tr>\n
\n
I\u0161 viso<\/span><\/div>\n<\/td>\n
\n
650<\/span><\/div>\n<\/td>\n
\n
103<\/span><\/div>\n<\/td>\n
\n
15<\/span><\/div>\n<\/td>\n
\n
15<\/span><\/div>\n<\/td>\n
\n
76<\/span><\/div>\n<\/td>\n
\n
859<\/span><\/div>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
 <\/div>\n
Visiems pacientams buvo skirtos bandomosios nimesulido doz\u0117s, kurias visi pacientai gerai toleravo. Pirm\u0105 tyrimo dien\u0105 buvo skiriama tiek placebo dozi\u0173, kiek buvo planuojama skirti nimesulido dozi\u0173. Kit\u0105 dien\u0105 didinant dozes iki bendros terapin\u0117s 100 mg dienos doz\u0117s su 30 min. pertraukomis buvo skiriama nimesulido (10 mg, 20 mg, 30 mg ir 40 mg). Tik 2,1 proc. pacient\u0173, vartojusi\u0173j\u0173 nimesulid\u0105, gydymo metu pasirei\u0161k\u0117 dilg\u0117lin\u0117<\/a>. Likusieji 97,9 proc. pacient\u0173 vartojo nimesulid\u0105 nuo 15 d. iki 4 m. po bandomosios doz\u0117s ir jiems nepasirei\u0161k\u0117 joki\u0173 alergini\u0173 reakcij\u0173.<\/div>\n
Pacientams, kuriems vartojant nimesulido pasirei\u0161k\u0117 alergini\u0173 reakcij\u0105 (nors j\u0173 skai\u010dius \u0161iame tyrime buvo labai nedidelis), buvo nustatyti trys reik\u0161mingi rizikos veiksniai: l\u0117tin\u0117 dilg\u0117lin\u0117<\/a> anamnez\u0117je (p<0,05; santykin\u0117 rizika 77,6), padid\u0117j\u0119s jautrumas antibakteriniams preparatams (p<0,05; santykin\u0117 rizika 11,5) ir padid\u0117j\u0119s jautrumas daugiau nei vienam NVNU grup\u0117s preparatui. Tai, kad nimesulidui jautr\u016bs pacientai gali b\u016bti jautr\u016bs ir antibakteriniams preparatams, patvirtina ir ankstesni kit\u0173 autori\u0173 duomenys (13, 14). Tai rei\u0161kia, kad tokie asmenys yra jautr\u016bs daugeliui medikament\u0173; labiausiai tik\u0117tina, kad jautrum\u0105 keletui negimining\u0173 med\u017eiag\u0173 nulemia neimuniniai mechanizmai (15).<\/span><\/div>\n
Jau anks\u010diau buvo \u017einoma, kad esama s\u0105saj\u0173 tarp padid\u0117jusio jautrumo NVNU ir l\u0117tin\u0117s dilg\u0117lin\u0117s (5). O remiantis apra\u0161omo tyrimo rezultatais (12), vienas i\u0161 rizikos veiksni\u0173 jautrumui nimesulidui atsirasti yra l\u0117tin\u0117 dilg\u0117lin\u0117<\/a> anamnez\u0117.<\/div>\n
Galiausiai trims i\u0161 keturi\u0173 nimesulidui jautri\u0173 pacient\u0173 diagnozuota atopija. Kol kas n\u0117ra duomen\u0173, paai\u0161kinan\u010di\u0173 ry\u0161\u012f tarp padid\u0117jusio jautrumo NVNU ir atopijos (16, 17). Pastarosios atveju kaip reakcija \u012f \u012fprastinius alergenus gaminami specifiniai IgE, tuo tarpu padid\u0117j\u0119s jautrumas NVNU da\u017eniausiai ai\u0161kinamas neimuniniais mechanizmais. Viena i\u0161 hipotezi\u0173 ai\u0161kina, kad \u0161i\u0173 pacient\u0173 tarpe atopijos genai ir LTC4 sintetaz\u0117s genai yra tame pa\u010diame chromosos regione (18).<\/div>\n
 <\/b><\/div>\n
APTARIMAS IR APIBENDRINIMAS<\/b><\/div>\n
Nimesulidas (4-nitro-2-fenoksimetansulfonanilidas) daugelyje \u0161ali\u0173 vartojamas jau beveik 10 met\u0173. Tradici\u0161kai NVNU funkcin\u0117 grup\u0117 yra karboksilin\u0117, enolin\u0117 ar hidroksilin\u0117. Nimesulido molekul\u0117s funkcin\u0117 grup\u0117 yra sulfilidin\u0117. Manoma, kad b\u016btent tai u\u017etikrina \u0161io preparato veiksmingum\u0105 bei saugum\u0105, kontroliuojant u\u017edegiminius procesus. Nimesulidas laikomas veiksmingesniu arba bent jau tokiu pat veiksmingu, kaip kiti NVNU, ta\u010diau d\u0117l retesni\u0173 nepageidaujam\u0173 poveiki\u0173 vir\u0161kinimo traktui ir inkstams yra geriau toleruojamas.<\/div>\n
\u012erodyta, kad \u0161is preparatas yra saugus ir veiksmingas, gydant daugel\u012f patologini\u0173 b\u016bkli\u0173, kurioms b\u016bdingas u\u017edegimas ir skausmas: osteoartroz\u0119, psoriazin\u012f artrit\u0105, tendinit\u0105 ir burzit\u0105, pooperacin\u012f skausm\u0105, pirmin\u0119 dismenor\u0117j\u0105 (19, 20). Nimesulido veikimo mechanizmai yra \u0161ie:<\/div>\n
·        <\/span>Nimesulidas silpnai slopina COX-1, bet stipriai COX-2 veikim\u0105; tuo galima paai\u0161kinti ne tik jo u\u017edegim\u0105 ma\u017einant\u012f poveik\u012f, bet ir retus nepageidaujamus poveikius vir\u0161kinimo traktui.<\/div>\n
·        <\/span>Nimesulidas slopina superoksido anijon\u0173 gamyb\u0105 neutrofiluose, nema\u017eindamas j\u0173 fagocitinio ir chemotaksinio aktyvumo.<\/div>\n
·        <\/span>Nimesulidas inaktyvuoja deguonies radikalus, kurie yra citotoksi\u0161ki ir palaiko u\u017edegiminius procesus. Manoma, kad nimesulido u\u017edegim\u0105 slopinantis poveikis yra susij\u0119s ne tiek su COX-2 slopinimu, kiek su deguonies radikal\u0173 inaktyvinimu ir superoksido anijon\u0173 gamybos slopinimu.<\/div>\n
·        <\/span>Nimesulidas slopina trobocitus aktyvinan\u010di\u0173 faktori\u0173 bei leukotrieno C4 gamyb\u0105 eozinofiluose.<\/div>\n
·        <\/span>Nimesulidas pasi\u017eymi antianafilaksiniu ir antihistamininiu poveikiu: jis nekonkurentiniu b\u016bdu slopina histamino poveik\u012f H1<\/sub> receptoriams (21). Antihistamininis ir antianafilaksinis nimesulido poveikis buvo tiriamas alergine astma ir rinitu sergantiems pacientams. Nustatyta, jog \u0161is preparatas gali suma\u017einti i\u0161skyr\u0173 i\u0161 nosies kiek\u012f, \u010diaudul\u012f (22).<\/div>\n
D\u0117l \u0161i\u0173 savybi\u0173 nimesulid\u0105 galima skirti pacientams, alergi\u0161kiems kitiems NVNU (13, 23–26). Visi autoriai, tyr\u0119, kaip pacientai toleruoja gydym\u0105 nimesulidu, nurodo, kad pacientai \u0161\u012f preparat\u0105 toleruoja gerai, o nepageidaujam\u0173 poveiki\u0173 ir alergini\u0173 reakcij\u0173 da\u017enis yra labai nedidelis (24, 27–29).<\/div>\n
Taigi nimesulidas yra veiksminga ir saugi alternatyva, kai pacientas alergi\u0161kas nesteroidiniams vaistams nuo u\u017edegimo. J\u012f reik\u0117t\u0173 atsargiai skirti pacientams, kuriems anamnez\u0117je yra buvusi l\u0117tin\u0117 dilg\u0117lin\u0117<\/a>, nustatytas padid\u0117j\u0119s jautrumas antibakteriniams preparatams ir yra padid\u0117j\u0119s jautrumas daugiau nei vienam NVNU grup\u0117s preparatui.<\/div>\n
 <\/div>\n
Pareng\u0117 gyd. M. RUSTEIKAT\u0116<\/i><\/div>\n
 <\/b><\/div>\n
Literat\u016bra<\/b><\/div>\n
1.      <\/span>Smith, W.L.; DeWitt, D.L. Biochemistry of prostaglandin endoperoxide H synthase-1 and synthase-2 and their differential susceptibility to nonsteroidal antiinflammatory drugs. Semin. Nephrol. 1995, 15, 179–194.<\/div>\n
2.      <\/span>Smith, W.L.; Garavito, R.M.; DeWitt, D.L. Prostaglandin endoperoxide H synthases (Cyclooxygenases)-1 and synthase-2. J. Biol. Chem. 1996, 271, 33157–33160.<\/div>\n
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ALERGIJOS NESTEROIDINIAMS VAISTAMS NUO U\u017dDEGIMO PATOGENEZ\u0116 Nesteroidiniai vaistai nuo u\u017edegimo (NVNU) d\u0117l savo skausm\u0105, u\u017edegim\u0105 ir kar\u0161\u010diavim\u0105 mal\u0161inan\u010dio poveikio yra naudojami daugyb\u0119 b\u016bkli\u0173 ir lig\u0173 gydyti. Pagrindinis \u0161ios grup\u0117s preparat\u0173 veikimo mechanizmas – fermento ciklooksigenaz\u0117s (COX) slopinimas (1–3). COX dalyvauja prostaglandin\u0173 ir tromboksan\u0173 sintez\u0117je i\u0161 arachidono r\u016bg\u0161ties. Yra kelios COX izoformos. COX-1 yra konstitucinis (nuolat…<\/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":[96,832,751,873,771,769,1279,138,55,181,1280],"site":[],"post_item_type":[27345],"class_list":["post-13298","post","type-post","status-publish","format-standard","hentry","tag-alergijos","tag-nvnu","tag-placebo","tag-preparatas","tag-sergantiems-pacientams","tag-toleruoja","tag-uzdegima-mazinantis","tag-vaistai","tag-virskinimo","tag-visiems","tag-visiems-pacientams"],"acf":{"post_sites":false},"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts\/13298","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=13298"}],"version-history":[{"count":0,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts\/13298\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/media?parent=13298"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/categories?post=13298"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/tags?post=13298"},{"taxonomy":"site","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/site?post=13298"},{"taxonomy":"post_item_type","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/post_item_type?post=13298"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}