29 Cov Lus Pom Zoo Tshaj Tawm Txog Kev Ntsuas, Kev Kho Mob Thiab Ua Raws Li Lupus Nephritis
Apr 07, 2023
Lupus nephritis (LN) yog lub raum puas tsuaj los ntawm lub cev lupus erythematosus (SLE). Qhov kev tso tawm tag nrho ntawm cov kev kho mob induction uas twb muaj lawm rau proliferative lupus nephritis yog tsawg, thiab lupus nephritis yog qhov yuav rov qab los. Nws yog ib qho tseem ceeb heev rau kev kuaj mob thiab kho lupus nephritis scientifically thiab standardizedly1. Nyob rau hauv xyoo tas los no, biomarkers tshiab thiab cov tshuaj tshiab rau LN tau tshwm sim, uas tau coj cov kev hloov pauv tseem ceeb hauv kev kuaj mob, kev kho mob, thiab kev soj ntsuam ntawm LN.
Nyem rau cistanche herba rau mob raum
Thaum Lub Peb Hlis 22, 2023, pab pawg kws tshaj lij Spanish glomerular kab mob tau tshaj tawm cov lus qhia LN tshiab kawg, feem ntau piav qhia txog kev kuaj mob, kho, thiab ua raws li LN. Kab lus no nthuav qhia lawv thiab ua 29 cov lus qhia rau cov neeg nyeem.
1. Kev kuaj mob
1) Kev kuaj mob ntawm SLE yuav tsum ua raws li tus yam ntxwv ntawm tus kab mob thiab cov cim qhia, thiab muab faib raws li 2019 EULAR / ACR cov qauv.
2) Ntshav creatinine, kwv yees glomerular filtration rate (eGFR), thiab cov zis yuav tsum tau kuaj tsis tu ncua hauv cov neeg mob SLE, tshwj xeeb tshaj yog cov zis albumin-to-creatinine ratio (UACR) thiab / lossis zis protein-to-creatinine ratio (UPCR). Rau cov neeg mob SLE uas muaj kev ua haujlwm SLE, cov qhab nia zoo, thiab cov neeg tsis yog neeg Caucasian, cov kev ntsuam xyuas saum toj no yuav tsum tau ua ntau zaus, tsawg kawg ib zaug lossis ob zaug hauv ib xyoos.
3) Feem ntau cov neeg mob LN tsis muaj cov tsos mob pom tseeb thiab tsuas tuaj yeem kuaj tau los ntawm kev kuaj sim. Tsis tas li ntawd, cov neeg mob SLE yuav tsum tau them nyiaj tshwj xeeb rau edema thiab / lossis qhov pib mob ntshav siab tshiab.
4) Diagnosis and classification of LN require renal biopsy and evaluation by a nephropathy pathologist. Renal biopsy should be performed in patients with SLE complicated with proteinuria (>0.5g/24h or UPCR>0.5g/g), hematuria, urinary leukocytosis, thiab/los yog lub raum tsis zoo. Hauv cov neeg mob uas tsis muaj proteinuria, tab sis nrog cov zis tso zis thiab / lossis lub raum tsis zoo, txiav tawm lwm yam ua rau lub raum tsis zoo ua ntej ua rau lub raum biopsy.
2. Kev kho mob
1. Cov qauv kev ua tau zoo thiab cov hom phiaj
Cov txheej txheem kev kho mob rau LN yog ua tiav kev tso tawm, kev tso tawm ib nrab, tsis tso cai, thiab rov ua dua, thiab cov ntsiab lus tshwj xeeb ntawm cov qauv no yog raws li hauv qab no:
Kev tshem tawm kom tiav: proteinuria Tsawg dua lossis sib npaug rau {{0}}.5g/24h lossis UPCR Tsawg dua lossis sib npaug rau 0.5g/g; tsis tso zis tso zis (tsawg dua lossis sib npaug rau RBC / hpf); serum albumin Ntau dua lossis sib npaug li 3.5g / dL; ib txwm eGFR lossis tus nqi txo qis dua lossis sib npaug li 10 feem pua ntawm cov hauv paus.
Kev tshem tawm ib nrab: tso zis protein ntawm {{{0}}.6 ~ 3.5g/24h lossis UPCR ntawm 0.6 ~ 3.5g/g; tso zis ib nrab (tsawg dua lossis sib npaug li 10 RBC / hpf), cov ntshav albumin Ntau dua lossis sib npaug li 3.0g / dL; eGFR ib txwm muaj lossis zoo dua li qhov pib poob qis dua lossis sib npaug li 25 feem pua.
Tsis teb: Cov neeg mob uas tsis tsim nyog tau txais cov lus teb ua tiav lossis ib nrab.
Relapse: hematuria, microscopic or macroscopic hematuria, and increased urine deposition (>15 RBC/hpf); urinary protein ntau ntxiv, cov neeg mob uas muaj kev tso tawm tiav: cov zis muaj protein ntau dua lossis sib npaug li 1g / 24h lossis UPCR Ntau dua lossis sib npaug li 1g / g; Cov neeg mob uas muaj kev tso tawm ib nrab, cov zis tso zis ntau dua lossis sib npaug li 50 feem pua ntawm cov hauv paus; Kev txo qis hauv eGFR ntawm Ntau dua lossis sib npaug li 25 feem pua.
Lub hom phiaj ntawm kev kho mob rau txhua tus neeg mob LN yog ua kom tiav.
2. Kev xaiv tshuaj rau ntau hom LN cov neeg mob
Rau kev kho thawj zaug rau cov neeg mob uas muaj hom I / II LN, thiab rau cov neeg mob qib I LN, hydroxychloroquine tuaj yeem siv rau cov tsos mob ntxiv.
Rau cov neeg mob qib II LN nrog cov proteinuria Tsawg dua lossis sib npaug ntawm 1 g / 24h thiab tso zis ib txwm muaj, cov phiaj xwm kho mob rau cov neeg mob qib I LN tuaj yeem raug xa mus rau.
Rau cov neeg mob qib II LN uas tau txais ACEI / ARB kev kho mob tab sis tseem muaj cov proteinuria> 1 g / 24h thiab / lossis cov zis tso zis uas qhia txog hematuria, nws raug nquahu kom mus rau lub raum biopsy dua. Yog tias tus neeg mob tseem muaj qib II LN, steroids thiab mycophenolic acid analogs (MPAA) yuav tsum tau ntxiv raws li kev kho mob ib txwm siv rau 6-12 lub hlis, thiab tus neeg mob yuav tsum tau hloov kho raws li tus neeg mob tus mob, thiab koob tshuaj. yuav tsum maj mam txo.
Kev kho mob pib rau cov neeg mob uas muaj hom III / IV ± V LN
Kev kho mob pib rau txhua tus neeg mob nrog III / IV ± V LN yuav tsum suav nrog cov tshuaj steroids lossis lwm yam tshuaj tiv thaiv kab mob. Kev txhaj tshuaj methylprednisolone ({{0}}} mg/d, rau 3 hnub sib law liag) yog nyiam, thiab tom qab ntawd cov koob tshuaj maj mam txo, thiab qhov ncauj prednisone (0.5-0.6 mg/kg /d) lossis sib npaug cov tshuaj hormones raug xaiv.
Rau cov neeg mob uas muaj proteinuria<3g/24h, good compliance, infertility (or no need for fertility), contraindications or intolerance to cyclophosphamide, hormone + MPAA can be used for dual initial immunosuppressive therapy.
Rau cov neeg mob uas muaj proteinuria<3g/24h, low treatment compliance, MPAA contraindications or intolerance, steroids + intravenous cyclophosphamide can be used for dual initial immunosuppressive therapy. After the sixth dose of cyclophosphamide, treatment with MPAA (or azathioprine if MPAA is not tolerated) can be started.
Cov neeg mob uas muaj proteinuria tsis txo qis rau 25 feem pua ntawm cov hauv paus ntsiab lus tom qab 2-3 lub hlis ntawm corticosteroids ntxiv rau MPAA / cyclophosphamide yuav tsum tau ntxiv rau belimumab (yog tias cov tsos mob tshwm sim ntxiv) lossis calcineurin inhibitors (CNI, yog tias muaj proteinuria siab thiab tsis tu ncua).
Rau cov neeg uas ua tau raws li qhov yuav tsum tau muaj proteinuria<3g/24h, good compliance, infertility (or no need for fertility), or cyclophosphamide contraindications or intolerance, accompanied by strong SLE extrarenal clinical symptoms, or need to be reduced rapidly Patients with glucocorticoid dosage should be treated with corticosteroid + MPAA + belimumab triple therapy.
Rau cov neeg mob uas muaj proteinuria> 3g / 24h lossis mob nephrotic mob hnyav, nyob rau hauv rooj plaub ntawm eGFR Ntau dua lossis sib npaug li 45ml / min / 1.73㎡, cov tshuaj hormone ntxiv MPAA ntxiv rau CNI triple therapy tuaj yeem siv.
Rau cov neeg mob uas lub raum tsis ua haujlwm sai, tag nrho cov txheej txheem saum toj no tuaj yeem siv tau, tab sis thaum tus neeg mob lub eGFR yog<45ml/min/1.73㎡, CNI should be avoided.
Kev kho thawj zaug rau cov neeg mob uas muaj hom V LN
Rau cov neeg mob uas muaj proteinuria<1g/24h, hydroxychloroquine can be used for treatment.
Rau cov neeg mob uas muaj proteinuria ntawm 1.0-3.5g/24h, steroid plus CNI therapy tuaj yeem siv. Yog tias cov proteinuria tsis tau txo qis rau 25 feem pua ntawm cov hauv paus ntsiab lus tom qab 3-4 lub hlis ntawm kev kho mob, MPAA yuav tsum tau ntxiv.
Rau cov neeg mob uas muaj proteinuria> 3.5g / 24h, cov tshuaj hormone ntxiv rau CNI thiab MPAA kev kho yuav tsum tau siv.
Kev kho mob rau cov neeg mob uas muaj hom III / IV ± V thiab hom V
Rau cov neeg mob uas tau ua tiav ib nrab lossis ua tiav kev tshem tawm, cov tshuaj corticosteroids qis (xws li prednisone 2.5-5 mg/d) yuav tsum tau siv rau kev kho mob. Rau cov neeg mob uas tau tshem tawm cov tsos mob thiab cov kev ntsuas serological, nws raug nquahu kom tsis txhob siv lawv tom qab 18-24 lub hlis ntawm cov tshuaj hormones.
Rau cov neeg mob uas tau tshem tawm cov tsos mob thiab kev ntsuas serological, nws raug nquahu kom maj mam txo cov koob tshuaj MPAA tom qab 18-24 lub hlis ntawm kev kho mob, thiab tag nrho cov kev kho MPAA yuav tsum muaj tsawg kawg yog 3-5 xyoo.
Rau cov neeg mob uas tsis tuaj yeem zam MPAA, nws raug nquahu kom siv azathioprine (1.5-2 mg/kg/d) rau kev kho mob, thiab kev txo qis thiab tag nrho cov kev kho mob zoo ib yam li MPAA.
Rau cov neeg mob uas tsis haum rau hydroxychloroquine thiab / lossis cov tshuaj hormones, muaj cov tsos mob tshwm sim tsis tu ncua lossis tsis tu ncua, thiab / lossis cov ntsuas serological txawv txav, belimumab raug pom zoo ua kev kho mob.
Rau cov neeg mob uas muaj hom V LN uas tau kho nrog cov tshuaj hormones ntxiv rau CNI, qhov txo qis ntawm cov tshuaj hormones tuaj yeem xa mus rau 5.1. Rau cov neeg mob uas siv CNI, nws raug pom zoo kom tswj kev kho mob rau 12-18 hli. Yog tias ua tiav kev tshem tawm, maj mam txo cov koob tshuaj hauv 6 mus rau 12 lub hlis; yog hais tias ib feem tshem tawm los yog tseem ceeb proteinuria, ces maj mam txo cov koob tshuaj nyob rau hauv 12 mus rau 18 lub hlis.
Kev kho mob nrog ACEI / ARB yog pom zoo kom tswj ntshav siab thiab proteinuria. Yog tias ACEI/ARB tswj tsis tau cov proteinuria, SGLT{0}} tuaj yeem siv tau.
3. Ua raws
1) Extrarenal kev tshwm sim yog ib qho tseem ceeb heev rau cov neeg mob LN, thiab lub systemic lupus erythematosus kab mob kev ua index (SLEDAI) scoring system yuav tsum raug pom zoo los saib xyuas cov kev mob tshwm sim.
2) Rau cov neeg mob LN, proteinuria, tso zis tso zis, ntshav creatinine, thiab eGFR yog qhov tseem ceeb rau kev ntsuas kev txhim kho kab mob thiab kev kho mob.
3) Qee yam tsis yog SLE (Table 1) tuaj yeem cuam tshuam rau cov proteinuria, tso zis tso zis, thiab lub raum ua haujlwm. Rau cov neeg mob uas muaj SLE rov tshwm sim dua lossis lwm yam kab mob ntev, yuav tsum tau ua tib zoo soj ntsuam.
4) Tam sim no tsis muaj kev pom zoo rau rov ua lub raum biopsy hauv cov neeg mob LN. Rau cov neeg mob uas muaj refractory LN thiab tsis tu ncua proteinuria, rov ua lub raum biopsy yuav raug txiav txim siab. Rov ua dua lub raum biopsy kuj tseem yuav raug txiav txim siab hauv qee cov neeg mob uas xav tias mob raum tsis cuam tshuam nrog SLE thiab ua ntej txiav cov tshuaj tiv thaiv kab mob.
qas cistanche kho mob raum
Cistanche tau ib txwm siv hauv Suav tshuaj los pab txhawb lub raum noj qab haus huv thiab kho mob raum. Nws muaj ob peb lub tebchaw uas tau paub los muab kev tiv thaiv lub raum thiab kev txhawb nqa, xws li echinacoside thiab acteoside. Cov tshuaj no pab txhim kho cov ntshav ncig hauv ob lub raum, txo qhov mob thiab oxidative kev nyuaj siab, thiab txhawb kev tsim kho ntawm lub raum puas hlwb. Tsis tas li ntawd, cistanche muaj cov nyhuv diuretic uas pab ua kom cov zis ntau lawm thiab tshem tawm cov co toxins los ntawm ob lub raum.
cov ntaub ntawv:
1. Zhang Hui, Yang Niansheng, Lu Jing, et al. Cov Qauv rau Kev Ntsuas thiab Kev Kho Mob Lupus Nephritis. Suav Journal of Internal Medicine, 2021,60(9): 784-790
2. Jorge E Rojas-Rivera, Clara García-Carro, Ana I Ávila, et al. Kev kuaj mob thiab kev kho mob ntawm lupus nephritis: Cov ntsiab lus ntawm Daim Ntawv Pom Zoo Pom Zoo ntawm Pawg Spanish rau Kev Tshawb Fawb Txog Kab Mob Glomerular (GLOSEN). Clinical Kidney Journal. Peb 22, 2023. sfad055.
