{"id":8434,"date":"2013-06-18T14:49:58","date_gmt":"2013-06-18T14:49:58","guid":{"rendered":""},"modified":"2013-06-18T14:49:58","modified_gmt":"2013-06-18T14:49:58","slug":"cukrinis-diabeto-gydymas-sergant-sirdies-ir-kraujagysliu-ir-inkstu-ligomis-i","status":"publish","type":"post","link":"https:\/\/www.pasveik.lt\/lt\/naujausi-medicinos-straipsniai\/cukrinis-diabeto-gydymas-sergant-sirdies-ir-kraujagysliu-ir-inkstu-ligomis-i\/8434\/","title":{"rendered":"Cukrinis diabeto gydymas, sergant \u0161irdies ir kraujagysli\u0173 ir inkst\u0173 ligomis (I)"},"content":{"rendered":"

<\/p>\n

<\/p>\n

Lina Zabulien\u0117<\/span><\/strong><\/p>\n

Vilniaus Universitetas, Reumatologijos, traumatologijos-ortopedijos ir rekonstrukcin\u0117s chirurgijos klinika<\/span><\/p>\n

Cukrinis diabetas spar\u010diai plinta, o jo sukeltos l\u0117tin\u0117s mikrovaskulin\u0117s ir makrovaskulin\u0117s komplikacijos didina sergamum\u0105, negali\u0105 ir trumpina gyvenimo trukm\u0119 [1<\/span>, 2<\/span>, 3<\/span>]. Smulki\u0173j\u0173 kraujagysli\u0173 pa\u017eeidimas siejamas su hiperglikemija, o stambi\u0173j\u0173 kraujagysli\u0173 ateroskleroz\u0119 lemia lipid\u0173 ir hemostaz\u0117s pakitimai, arterin\u0117 hipertenzija ir daugelis kit\u0173 \u017einom\u0173 veiksni\u0173 [4<\/span>, 5<\/span>, 6<\/span>, 7<\/span>]. Diabetu sergantiems pacientams \u016bm\u016bs i\u0161eminiai sindromai (d\u0117l vainikini\u0173, miego ar koj\u0173 arterij\u0173 aterotrombotini\u0173 \u012fvyki\u0173) yra 2\u20135 kartus da\u017enesni nei nesergantiems juo, tai lemia lytis, diabeto trukm\u0117, metabolin\u0117 kontrol\u0117, arterinio kraujo spaudimas, pilvinis nutukimas<\/a> ir r\u016bkymas [4<\/span>]. Tyrim\u0173 duomenimis, sergan\u010di\u0173j\u0173 diabetu miokardo infarkto rizika yra tokia pati didel\u0117 kaip ir nesergan\u010di\u0173 diabetu asmen\u0173, jau persirgusi\u0173 miokardo infarkt\u0105 [8<\/span>]. Nustatyta, kad siekiant suma\u017einti \u0161irdies ir kraujagysli\u0173 lig\u0173 pavoj\u0173 sergantiesiems diabetu, b\u016btina grie\u017eta glikemijos kontrol\u0117 ir vis\u0173 \u017einom\u0173 rizikos veiksni\u0173 \u0161alinimas. Jungtin\u0117s Karalyst\u0117s prospektyvinis diabeto tyrimas (angl. \u2013 United Kingdom Prospective Diabetes Study, <\/em>UKPDS) parod\u0117, kad nutukusiems sergantiems antrojo tipo diabetu asmenims, vartojusiems metformin\u0105, rizika susirgti miokardo infarktu buvo ma\u017eesn\u0117 nei vartojusiems sulfanilkarbamidus ar insulin\u0105, tad ir pirmo pasirinkimo vaistas tur\u0117t\u0173 b\u016bti metforminas [9<\/span>].<\/span><\/p>\n

Metformino veikimo ypatumai<\/span><\/strong><\/p>\n

Antrojo tipo cukrinis diabetas metforminu gydomas daugiau nei 50 met\u0173, ta\u010diau kai kurie \u0161io vaisto molekulinio veikimo mechanizmai iki \u0161iol dar n\u0117ra gerai suprasti. Nustatyta, kad gydant metforminu gliukoz\u0117s kiekis kraujyje suma\u017e\u0117ja, nes ma\u017e\u0117ja atsparumas insulinui kepenyse (slopinama gliukoneogenez\u0117), geriau \u012fsisavinama gliukoz\u0117 raumenyse ir ger\u0117ja insulino jungimasis prie insulino receptori\u0173, did\u0117jant insulino receptori\u0173 fosforilinimui ir tirozinkinaz\u0117s aktyvumui\u00a0 <\/span>[10<\/span>,11<\/span>]. \u00a0<\/span>Metforminas aktyvuoja AMF-aktyvuot\u0105 proteinkinaz\u0119 ir taip slopina gliukoz\u0117s gamyb\u0105 kepenyse, gerina jautrum\u0105 insulinui ir gliukoz\u0117s \u012fsisavinim\u0105 raumenyse, taip pat skatina ir riebi\u0173j\u0173 r\u016bg\u0161\u010di\u0173 oksidacij\u0105 [12<\/span>, 13<\/span>]. Tyrim\u0173 duomenimis, metforminas gali didinti inkretin\u0173 (\u012f gliukagon\u0105 pana\u0161aus peptido, GLP-1) kiek\u012f, ma\u017eina skrand\u017eio i\u0161situ\u0161tinim\u0105, gerina suvalgytos gliukoz\u0117s toleravim\u0105 [14<\/span>; 15<\/span>] ir gali slopinti net dipeptidilpeptidaz\u0119-4 (DPP-4) [16<\/span>]. \u017dinoma, kad metforminas kei\u010dia tul\u017eies r\u016bg\u0161\u010di\u0173 apykait\u0105, t. y. slopina j\u0173 absorbcij\u0105 (aktyv\u0173 transport\u0105) klubin\u0117je \u017earnoje, tod\u0117l gali rastis vir\u0161kinamojo trakto rei\u0161kiniai, tuo pa\u010diu ma\u017e\u0117ja ir lipid\u0173 kiekis kraujyje, be to, tul\u017eies r\u016bg\u0161tys gali stimuliuoti GLP-1 atsipalaidavim\u0105 L- l\u0105stel\u0117se, tod\u0117l netiesiogiai did\u0117ja GLP-1 kiekis [17<\/span>; 18<\/span>]. \u00a0<\/span>Pasteb\u0117ta, kad metforminas veikia amiloido susidarym\u0105 ir taip netiesiogiai ma\u017eina progresuojant\u012f kasos beta-l\u0105steli\u0173 netekim\u0105, sergant diabetu [19<\/span>].<\/span><\/p>\n

Vartojant vidutin\u0119 metformino doz\u0119 (500\u20131500 mg), jis \u012fsisavinimas 50\u201360 proc. [20<\/span>,\u00a0 <\/span>21<\/span>], nesijungia su baltymais, daugiausia kaupiasi plonosios \u017earnos sienel\u0117je, organizme n\u0117ra metabolizuojamas ir nepakit\u0119s i\u0161siskiria d\u0117l glomeruli\u0173 filtracijos ir tubulin\u0117s sekrecijos. Sutrikus inkst\u0173 funkcijai metformino i\u0161skyrimas l\u0117t\u0117ja ir gal\u0117t\u0173 lemti jo kaupim\u0105si ir laktatin\u0117s acidoz\u0117s pavoj\u0173, ta\u010diau pastar\u0173j\u0173 met\u0173 tyrimai \u0161\u012f pavoj\u0173 paneigia [21<\/span>, 22<\/span>, 23<\/span>, 24<\/span>, 25<\/span>]. <\/span><\/p>\n

\u0160irdies ir kraujagysli\u0173 lig\u0173 rizika ir diabetas<\/span><\/strong><\/p>\n

Atsparumas insulinui yra pagrindin\u0117 metabolinio sindromo grandis ir da\u017enai susij\u0119s su hipertenzija, pilviniu nutukimu, suma\u017e\u0117jusia inkst\u0173 veikla ir aterogenine dislipidemija, kraujagysli\u0173 endotelio disfunkcija, sutrikusia insulino lemiama vazorelaksacija ir padid\u0117jusia kraujagysli\u0173 rezistencija ir greitesne ateroskleroz\u0117s raida [26<\/span>, 27<\/span>, 28<\/span>, 29<\/span>, 30<\/span>]. Riebalinio audinio sankaupos pilvo ertm\u0117je lemia atsparum\u0105 insulinui ir surado s\u0105lygas metabolinio sindromo (pastaruoju metu vadinamo kardiorenaliniu metaboliniu sindromu) raidai, tod\u0117l suma\u017e\u0117jus \u0161ioms sankaupoms ma\u017e\u0117t\u0173 atsparumas insulinui, \u0161irdies ir kraujagysli\u0173, inkst\u0173 lig\u0173 pavojus [26<\/span>, 27<\/span>]. Padid\u0117jus laisv\u0173j\u0173 r\u016bg\u0161\u010di\u0173 kiekiui ne tik ma\u017e\u0117ja jautrumas insulinui, bet did\u0117ja ir labai ma\u017eo tankio lipoprotein\u0173 gamyba ir sekrecija [27<\/span>]. Padid\u0117j\u0119s triacilgliceroli\u0173 kiekis slopina apolipoproteino B skylim\u0105 kepenyse, tod\u0117l kaupiasi ma\u017eo tankio lipoprotein\u0173 dalel\u0117s [27<\/span>, 28<\/span>, 29<\/span>]. <\/span><\/p>\n

Sergantiesiems cukriniu diabetu ir turintiems antsvor\u012f gydymo metforminu nauda yra neabejotina, be to, vartojant metformin\u0105 neauga svoris ir neb\u016bna hipoglikemij\u0173 [21<\/span>, 30<\/span>]. Gydant \u00a0<\/span>metforminu nutukusias policistini\u0173 kiau\u0161id\u017ei\u0173 sindromu sergan\u010dias moterims, kurios buvo suma\u017e\u0117ja bendro ir pilvinio riebalinio audinio kiekis [31<\/span>]. <\/span><\/p>\n

UKPDS 35 tyrimo duomenimis, \u0161irdies ir kraujagysli\u0173 lig\u0173, insulto ir vis\u0173 mirties prie\u017eas\u010di\u0173 da\u017enis glaud\u017eiai siejasi su glikemija, o suma\u017e\u0117jus 1 proc. glikozilinto hemoglobino A1c (Hb A1c) ir \u0161i\u0173 padarini\u0173 da\u017enis ma\u017e\u0117ja, o gydymas metforminu yra ypa\u010d veiksmingas d\u0117l papildomo apsauginio poveikio \u0161irdies ir kraujagysli\u0173 ligoms [25<\/span>]. Nustatyta, kad metforminas apsaugo kraujagysles \u012fvairiais b\u016bdais \u2013 veikdamas lipidus, u\u017edegim\u0105, hemostaz\u0119, endotel\u012f ir trombocit\u0173 funkcij\u0105, kraujagysli\u0173 sienel\u0117s pakitimus, aktyvuodamas AMF-aktyvuot\u0105 proteinkinaz\u0119 ir kt. [21<\/span>, 32<\/span>, 33<\/span>].<\/span><\/p>\n

Atlikus \u012fvairi\u0173 tyrim\u0173 metaanaliz\u0119 paai\u0161k\u0117jo, kad gydant metforminu ma\u017eo tankio lipoprotein\u0173 (MTL) cholesterolio kiekis suma\u017e\u0117ja daugiau nei vartojant kitus vaistus: tiazolidinedionus (pioglitazon\u0105) (vidutinis skirtumas 0,37 mmol\/l), sulfanilkarbamidus (vidutinis skirtumas 0,26 mmol\/l) ar dipeptidilpeptidaz\u0117s-4 (DPP-4) inhibitorius (vidutinis skirtumas \u2013 0,15 mmol\/l) [34<\/span>].\u00a0 <\/span>Be to, vartojant metformin\u0105 ir triacilgliceroli\u0173 (TG) kiekis ma\u017e\u0117ja daugiau nei vartojant sulfanilkarbamidus (vidutinis skirtumas 0,1 mmol\/l), ta\u010diau pioglitazonas TG ma\u017eina daugiau nei metforminas (vidutinis skirtumas 0,31 mmol\/l) [34<\/span>].<\/span><\/p>\n

Diabetu sergantiems pacientams, ypa\u010d turintiems atsparum\u0105 insulinui, did\u0117ja ir \u0161irdies nepakankamumo rizika [36<\/span>], d\u0117l hipertenzini\u0173, miopatini\u0173 ir i\u0161emini\u0173 poky\u010di\u0173 miokarde. JAV mokslinink\u0173 atliktas tyrimas parod\u0117, kad net penktadalis pacient\u0173, kuriems pirm\u0105 kart\u0105 nustatomas \u0161irdies nepakankamumas, serga ir cukriniu diabetu, o diabeto da\u017enis auga apie 3,8 proc. per metus\u00a0 <\/span>[35<\/span>]. Tarp hospitalizuot\u0173 d\u0117l dekompensuoto \u0161irdies nepakankamumo pacient\u0173 diabetas yra dar da\u017enesnis (apie 44 proc.) [36<\/span>]. Tyrim\u0173 duomenimis pacientams, turintiems \u0161irdies nepakankamum\u0105 ir sergantiems diabetu, mirtingumo rizika didesn\u0117 nei nesergantiems diabetu [35<\/span>; 37<\/span>]. <\/span><\/p>\n

Diabetinei kardiomiopatijai b\u016bdinga miokardo fibroz\u0117, sistolin\u0117 ir diastolin\u0117 disfunkcija, \u0161irdies autonomin\u0117 neuropatija ir smulki\u0173j\u0173 kraujagysli\u0173 liga [38<\/span>, 39<\/span>, 40<\/span>]. Diastolin\u0117 disfunkcija, sergant diabetu, siejasi su suma\u017e\u0117jusiu intral\u0105stelinio jonizuoto kalcio \u0161alinimu i\u0161 kardiomiocit\u0173 po sistol\u0117s [39<\/span>, 40<\/span>]. Gydant metforminu diabetu sergan\u010dias peles \u0161ie funkciniai \u0161irdies poky\u010diai atsistato [40<\/span>, 41<\/span>, 42<\/span>], galb\u016bt d\u0117l didesnio nuo tirozinkinaz\u0117s priklausomo jonizuoto kalcio \u0161alinimo po sistol\u0117s [40<\/span>]. \u012erodyta, kad \u0161is apsauginis metformino poveikis nepriklauso nuo insulino. Be to, gydant metforminu hipertenzij\u0105 turin\u010dias peles j\u0173 \u0161irdies susitraukim\u0173 da\u017enis ret\u0117ja daugiau nei gydant placebo (manoma, kad d\u0117l simpatin\u0119 nerv\u0173 sistem\u0105 slopinan\u010dio poveikis) [42<\/span>]. <\/span><\/p>\n

Penki\u0173 steb\u0117jimo tyrim\u0173 rezultat\u0173 ap\u017evalga parod\u0117, kad vartoti metformin\u0105 sergant \u0161irdies nepakankamumu yra saugiau nei sulfanilkarbamidus [34<\/span>]. \u00a0<\/span>\u012evertinus 16 (5 randomizuot\u0173 ir 11 steb\u0117jimo) tyrim\u0173 rezultatus, paai\u0161k\u0117jo, kad monoterapija metforminu siejosi su ma\u017eesniu bendru mirtingumu, sergamumu ir mirtingumu nuo \u0161irdies ir kraujagysli\u0173 lig\u0173 nei monoterapija sulfanilkarbamidais [34<\/span>]. Nustatyta, kad metforminas yra saugus diabetu sergantiems ir turintiems \u0161irdies nepakankamum\u0105 pacientams ir siejasi su ma\u017eesniu sergamumo ir mirtingumo da\u017eniu nei vartojant kitus vaistus diabetui gydyti [43<\/span>, 44<\/span>, 45<\/span>].<\/span><\/p>\n

Inkst\u0173 veikla ir cukrinis diabetas<\/span><\/strong><\/p>\n

Metforminas \u0161alinamas su \u0161lapimu, tod\u0117l kartais b\u016bk\u0161taujama, ar suma\u017e\u0117jusi inkst\u0173 veikla gali lemti toksin\u012f metformino kiek\u012f [46<\/span>, 47<\/span>]. Dauguma gydytoj\u0173 nutraukia metformino skyrim\u0105, jei kreatinino kiekis yra didesnis nei 124 mkmol\/l moterims ir didesnis nei 133 mkmol\/l vyrams [47<\/span>]. Nustatyta, kad metforminas slopindamas gliukoneogenez\u0119, nekei\u010dia laktato apykaitos ar oksidacijos, tod\u0117l laktato kiekis kraujyje nedid\u0117ja [48<\/span>, 49<\/span>, 50<\/span>]. Cochrane duomen\u0173 baz\u0117s analiz\u0117 parod\u0117, kad metforminas susij\u0119s su laktatine acidoze (kraujo pH yra ma\u017eesnis nei 7,37 ir (ar) laktato kiekis plazmoje didesnis nei 4 mmol\/l) tik tuomet, jei yra lydin\u010dios b\u016bkl\u0117s \u2013 hipotenzija, hipoksemija, \u016bmus inkst\u0173 nepakankamumas ar ciroz\u0117 [48<\/span>, 49<\/span>], o laktatin\u0117s acidoz\u0117s da\u017enis svyruoja nuo 1 iki 16,7 atvej\u0173 100 000 pacient\u0173 met\u0173 [51<\/span>, 52<\/span>]. <\/span><\/p>\n

Pranc\u016bzijos mokslininkai nustat\u0117, kad vyresni\u0173 (70\u201388 met\u0173 am\u017eiaus) asmen\u0173 metformino \u0161alinimas, esant normaliai inkst\u0173 veiklai (glomeruli\u0173 filtracijos greitis (GFG) didesnis nei 60 ml\/min\/1,73 m\u00b2) ar esant lengvo laipsnio inkst\u0173 veiklos nepakankamumui (GFG yra 60\u201330 ml\/min\/1,73 m\u00b2)\u00a0 <\/span>nesiskiria [53<\/span>]. Kitas JAV mokslinink\u0173 1995 m. atliktas tyrimas aptiko, kad metformino \u0161alinimas per inkstus vyresniems asmenims gali suma\u017e\u0117ti 35\u201340 proc., esant lengvo laipsnio inkst\u0173 funkcijos nepakankamumui \u2013 23\u201333 proc., o esant vidutinio ir sunkaus laipsnio inkst\u0173 funkcijos nepakankamumui \u2013 74\u201378 proc. [54<\/span>]. Pagal Jungtin\u0117s Karalyst\u0117s Nacionalinio sveikatos ir klinikin\u0117s kompetencijos instituto (angl. \u2013 National Institute for Health and Clinical Excellence, <\/em>NICE) nuorodas rekomenduojama metformino doz\u0119 ma\u017einti, jei GFG yra ma\u017eesnis nei 45 ml\/min\/1,73 m\u00b2 ar yra \u016bmaus inkst\u0173 nepakankamumo rizika, ir tik esant ma\u017eesniam nei 30 ml\/min\/1,73 m\u00b2 GFG nutraukti gydym\u0105 metforminu (1 lentel\u0117)[47<\/span>, 55<\/span>].<\/span><\/p>\n

1 lentel\u0117. Metformino doz\u0117s keitimas, pagal inkst\u0173 veikl\u0105<\/span><\/p>\n\n\n\n\n\n\n\n\n
\n

eGFG (ml\/min\/1,73 m\u00b2)<\/span><\/p>\n<\/td>\n

\n

Rekomenduojama metformino doz\u0117<\/span><\/p>\n<\/td>\n

\n

Proc. nuo maksimalios metformino doz\u0117s <\/span><\/p>\n<\/td>\n<\/tr>\n

\n

\u2265 90<\/span><\/p>\n<\/td>\n

\n

2500 mg\/dien\u0105<\/span><\/p>\n<\/td>\n

\n

100<\/span><\/p>\n<\/td>\n<\/tr>\n

\n

\u2265 60<\/span><\/p>\n<\/td>\n

\n

2000 mg\/dien\u0105<\/span><\/p>\n<\/td>\n

\n

80<\/span><\/p>\n<\/td>\n<\/tr>\n

\n

\u2265 45<\/span><\/p>\n<\/td>\n

\n

1000 mg\/dien\u0105<\/span><\/p>\n<\/td>\n

\n

40<\/span><\/p>\n<\/td>\n<\/tr>\n

\n

\u2265 30<\/span><\/p>\n<\/td>\n

\n

500 mg\/dien\u0105<\/span><\/p>\n<\/td>\n

\n

20<\/span><\/p>\n<\/td>\n<\/tr>\n

\n

<30<\/span><\/p>\n<\/td>\n

\n

0<\/span><\/p>\n<\/td>\n

\n

0<\/span><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

\u00a0<\/span><\/p>\n

D\u0117l \u012fvairiapusio veikimo ma\u017einant glikemij\u0105, metabolinius ir kitus \u0161irdies ir kraujagysli\u0173 lig\u0173 rizikos veiksnius, metforminas i\u0161lieka pirmo pasirinkimo vaistas, tiek prad\u0117jus diabeto gydym\u0105, tiek ir v\u0117liau derinant j\u012f su kitais vaistais, veikian\u010diais skirtingas diabeto patogenez\u0117s grandis ir yra saugus pacientams, turintiems \u0161irdies nepakankamum\u0105 ar lengvo ir vidutinio laipsnio inkst\u0173 funkcijos nepakankamum\u0105. <\/span><\/p>\n

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      \n
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    6. <\/a><\/a>Lalau JD, Vermersch A, Hary L, Andrejak M, Isnard F, Quichaud J. Type 2 diabetes in the elderly: an assessment of metformin (metformin in the elderly). Intl J Clin Pharmacol Ther Toxicol 1990; 28: 329\u201332.<\/span><\/span><\/li>\n
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    8. <\/a>National Institute for Health and Clinical Excellence. NICE Clinical Guidelines CG87 (May 2009): Type 2 diabetes \u2013 newer agents (partial update of CG66) (http:\/\/www.nice.org.uk\/CG87).<\/span><\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

      <\/p>\n

      Cukrinis diabetas spar\u010diai plinta, o jo sukeltos l\u0117tin\u0117s mikrovaskulin\u0117s ir makrovaskulin\u0117s komplikacijos didina sergamum\u0105, negali\u0105 ir trumpina gyvenimo trukm\u0119 [1<\/span>, 2<\/span>, 3<\/span>]. Smulki\u0173j\u0173 kraujagysli\u0173 pa\u017eeidimas siejamas su hiperglikemija, o stambi\u0173j\u0173 kraujagysli\u0173 ateroskleroz\u0119 lemia lipid\u0173 ir hemostaz\u0117s pakitimai, arterin\u0117 hipertenzija ir daugelis kit\u0173 \u017einom\u0173 veiksni\u0173.
      <\/span><\/p>\n","protected":false},"author":1,"featured_media":8435,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[27313],"tags":[715,400,571,1012,840,411,431,1036,328,157,125,265,1539,110,1042],"site":[],"post_item_type":[27345],"class_list":["post-8434","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-gydymo-naujienos","tag-atliktas-tyrimas","tag-diabetas","tag-diabetes","tag-disfunkcija","tag-filtracijos","tag-health","tag-hipertenzija","tag-metforminas","tag-nepakankamumas","tag-nutukimas","tag-rukymas","tag-saugus","tag-sergant-diabetu","tag-sergantiesiems","tag-ukpds"],"acf":{"post_sites":false},"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts\/8434","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=8434"}],"version-history":[{"count":0,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts\/8434\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/media\/8435"}],"wp:attachment":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/media?parent=8434"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/categories?post=8434"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/tags?post=8434"},{"taxonomy":"site","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/site?post=8434"},{"taxonomy":"post_item_type","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/post_item_type?post=8434"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}