32 Cov Lus Nug Txog Kev Kho Mob thiab Cov Lus Teb Ntawm Cov Kab Mob Biological hauv Kev Kho Mob Ntawm Cov Kab Mob Glomerular Ⅰ

Kev hloov pauv ntawm cov tshuaj rau kev kho cov kab mob hauv lub cev tsis muaj zog tau dhau los ntawm peb theem: (1) cov tshuaj hormones hauv xyoo 1950; (2) immunosuppressant era ntawm azathioprine hauv xyoo 1960, cyclophosphamide thiab tripterygium wilfordii hauv xyoo 1970, cyclosporine A hauv xyoo 1980, mycophenolate mofetil, tacrolimus, thiab leflunomide hauv 1990s; (3) lub sijhawm ntawm kev npaj tshuaj lom neeg hauv lub xyoo pua 21st. Txog niaj hnub no, kev npaj tshuaj lom neeg tau dhau los ua cov tshuaj kho mob tseem ceeb rau kev tiv thaiv kab mob glomerular.

Nyem rau Cistanche rau mob raum

Tam sim no, kev siv cov tshuaj lom neeg hauv thaj chaw ntawm nephrology tau dhau los ua ntau thiab ntau dua. Feem ntau siv cov tshuaj lom neeg npaj thiab lawv lub hom phiaj rau kev tiv thaiv kab mob glomerular yog (1) B lymphocyte stimulating yam tshwj xeeb inhibitors, anti-APRIL antibodies (belimumab, tadalafil); (2) anti-CD20 antibodies [rituximab (RTX)]; (3) plasma cell CD38 antibodies (daratumumab); (4) anti-complement C5 antibodies (eculizumab). Ntawm lawv, RTX yog qhov siv dav tshaj plaws.

Thaum lub Cuaj Hlis 2022, "Suav Cov Kws Tshaj Lij Pom Zoo rau Kev Kho Mob Kho Mob ntawm Cov Kab Mob Ntshav Qab Zib" tau luam tawm hauv "Suav Phau Ntawv Teev Npe ntawm Nephrology", uas muab qee yam kev siv thiab siv rau cov kws kho mob siv cov tshuaj lom neeg. Txawm li cas los xij, hauv cov txheej txheem ntawm kev siv RTX los kho ntau yam kab mob hauv lub cev, cov kws kho mob feem ntau tsa qee cov lus nug uas yuav tsum tau teb. Txhawm rau teb cov lus nug no kom raug thiab sib npaug, xibfwb Mei Changlin thiab lwm tus tau sau thiab txheeb tawm 50 cov lus nug hauv chaw kho mob, thiab thaum kawg tau txheeb xyuas "50 Cov Lus Nug Txog Kev Kho Mob Rituximab ntawm Kev Tiv Thaiv Kab Mob Glomerular", uas xav tias yuav raug luam tawm hauv lub Cuaj Hli xyoo no. . Hauv lub rooj sib tham no, xibfwb Mei Changlin tau qhia ntxaws ntxaws txog plaub yam ntawm 50 cov lus nug uas tau txais kev saib xyuas ntxiv, xws li: Kev kho RTX ntawm membranous nephropathy; Kev kho RTX ntawm kev kuaj mob tsawg kawg nkaus hloov nephropathy (MCD), thawj focal segmental glomerulosclerosis (FSGS) thiab IgA nephropathy; RTX kev kho mob ntawm ANCA-associated vasculitis (AAV) raum puas; Kev siv RTX, kev kho mob thiab ceev faj.

1. Txoj kev npaj kho mob rau membranous nephropathy yuav tsum tau txiav txim siab raws li kev pheej hmoo stratification. Muaj plaub qhov ntsuas rau kev pheej hmoo stratification, uas yog: (1) qib proteinuria; (2) qib albumin; (3) kwv yees glomerular filtration rate (eGFR).

2. Lub hom phiaj ntawm kev pheej hmoo stratification yog ua kom muaj kev kho mob qib thiab kev kho mob zoo dua. Yog li, dab tsi yog qhov tam sim no pom zoo cov kev kho mob immunotherapy rau membranous nephropathy? Saib daim duab 1 kom paub meej.

3. Cov neeg mob membranous nephropathy twg tuaj yeem muab qhov tseem ceeb rau kev kho RTX?

(1) Initial treatment patients with medium/high risk; (2) Patients who have no remission or cannot tolerate CNI/CTX after 6 months of initial treatment; (3) For relapse of membranous nephropathy after remission, RTX combined with or without CNI treatment can be considered; (4) Special populations: such as patients with diabetes, obesity (BMI>28 kg / m2), peptic rwj, tsis tswj kev puas siab puas ntsws, thiab lwm yam, uas yog contraindicated rau kev siv ntawm glucocorticoids; (5) Cov neeg mob rov qab ua dua tom qab hloov lub raum.

4. Cov phiaj xwm kho mob tau pom zoo rau cov neeg mob membranous nephropathy nrog RTX yog dab tsi?

(1) Scheme 1: RTX intravenous drip, 375 mg / m2 lub cev saum npoo av, ib zaug ib lub lim tiam, 4 zaug ua ke raws li kev kho mob; (2) Scheme 2: RTX intravenous drip, 1000 mg rau 1st thiab 15th hnub raws li kev kho mob.

Nws raug nquahu kom txiav txim siab seb puas yuav rov qab los rau hauv lub hlis thib 6 tom qab kev kho mob raws li tus neeg mob B cell rov qab, qib anti-PLA2R antibody, thiab kev kho mob. Tom qab ntawd, rov ntsuas qhov ntsuas txhua rau lub hlis txhawm rau txiav txim siab seb puas yuav tsum muaj lwm qhov dej.

5. Puas yog kev siv RTX hauv cov neeg mob membranous nephropathy ua rau muaj kev pheej hmoo kis mob?

(1) Cov tshuaj lom neeg muaj peev xwm muaj kev cuam tshuam tsis zoo rau kev tiv thaiv kab mob, ua rau lub cev tsis muaj zog tiv thaiv kab mob thiab ua rau muaj mob hnyav; (2) Immunosuppressive therapy (RTX) rau cov neeg mob uas muaj membranous nephropathy yuav ua rau muaj kev pheej hmoo kis mob; (3) Piv nrog rau lwm cov tshuaj tiv thaiv kab mob, RTX muaj tsawg dua qhov kis kab mob thiab kev tuag; (4) Qhov tshwm sim ntawm cov xwm txheej kis mob hnyav yog li 3.7%, feem ntau tshwm sim hauv thawj 6 lub hlis tom qab pib ntawm RTX; (5) Qhov kev pheej hmoo ntawm kev kis tus kab mob hauv cov neeg mob tau txais kev kho RTX nyob ntawm ntau tus neeg mob tus yam ntxwv hauv paus, tus kab mob tseem ceeb, txawm tias nws koom nrog glucocorticoids lossis lwm yam tshuaj tiv thaiv kab mob, tsis yog tsuas yog cov koob tshuaj RTX nkaus xwb.

6. Puas yog nws tsim nyog rau infuse immunoglobulin tib lub sijhawm thaum siv RTX los kho membranous nephropathy?

30% ntawm cov neeg mob tau txais kev kho mob RTX yuav muaj hypogammaglobulinemia (IgG<3-5 g/L), which is related to previous CTX exposure, hormone use, and low baseline IgG level. Serum immunoglobulins need to be monitored during RTX treatment. Patients with hypogammaglobulinemia and high risk of infection can be given immunoglobulin treatment at the same time when receiving RTX treatment.

7. Yog tias qhov kev kho mob RTX thawj zaug tsis zoo rau cov neeg mob uas muaj membranous nephropathy, yuav hloov kho li cas?

Tom qab 6 lub hlis ntawm kev kho RTX thawj zaug rau cov neeg mob uas muaj membranous nephropathy, anti-PLA2R cov tshuaj tiv thaiv tsis zoo los yog cov titer txo qis, tab sis cov proteinuria tsis tau txo qis (txo los ntawm<25%), it is recommended to give 500-1000 mg RTX treatment depending on the situation.

Yog tias cov proteinuria tsis txo qis thiab cov tshuaj tiv thaiv PLA2R tsis txo qis tom qab 6 lub hlis ntawm kev kho RTX thawj zaug, cov kev kho mob tom ntej yuav tsum tau kho raws li qib eGFR. Yog tias eGFR ruaj khov (qis los ntawm<25% from the baseline), it can be adjusted to CNI combined with RTX treatment; if the eGFR is significantly reduced (decreased by >25% los ntawm cov hauv paus ntsiab lus), nws yog ib qho tsim nyog los kho cov tshuaj hormone ua ke nrog kev kho CTX.

8. Yuav ua li cas tswj kev kho mob tom qab tshem tawm ntawm membranous nephropathy nrog RTX?

Rau cov neeg mob uas muaj membranous nephropathy, nws raug nquahu kom txiav txim siab seb puas yuav ntxiv RTX raws li kev hloov pauv hauv cov tsos mob thiab cov ntsuas kev tiv thaiv kab mob.

Rau cov neeg mob uas nws cov B hlwb tsis depleted tom qab "plaub koob tshuaj" los yog "ob koob tshuaj regimen" ntawm RTX, yog hais tias tus anti-PLA2R cov tshuaj tiv thaiv txo qis heev nyob rau hauv 3 mus rau 6 lub hlis, los yog muaj ib qho kev kho mob ntawm kev tso cai, ntxiv. RTX tej zaum yuav tsis xav tau; Yog tias tsis muaj qhov pom tseeb poob qis ntawm cov tshuaj tiv thaiv PLA2R thiab tsis muaj kev kho mob, nws raug nquahu kom ntxiv 500 txog 1000 mg ntawm RTX raws li qhov tsim nyog hauv 3 mus rau 6 lub hlis.

Cistanche kho mob raum li cas?

Cistancheyog ib hom tshuaj suav tshuaj ntsuab siv rau ntau pua xyoo los kho ntau yam mob, suav nrograumkab mob. Nws yog muab los ntawm qhuav stems ntawmCistanchedeserticola, ib tsob nroj nyob rau hauv cov suab puam ntawm Tuam Tshoj thiab Mongolia. Lub ntsiab active Cheebtsam ntawm cistanche yogphenylethanoidglycosides, echinacoside cov tshuaj, thiabacteoside, uas tau pom tias muaj txiaj ntsig zoo rauraumnoj qab haus huv.

Kab mob raum, tseem hu ua kab mob raum, hais txog ib yam mob uas lub raum ua haujlwm tsis zoo. Qhov no tuaj yeem ua rau muaj cov khoom pov tseg thiab cov co toxins hauv lub cev, ua rau muaj ntau yam tsos mob thiab teeb meem. Cistanche tuaj yeem pab kho mob raum ase los ntawm ntau lub tswv yim.

Ua ntej, cistanche tau pom tias muaj cov nyhuv diuretic, txhais tau tias nws tuaj yeem ua rau cov zis ntau ntxiv thiab pab tshem tawm cov khoom pov tseg ntawm lub cev. Qhov no tuaj yeem pab txo lub nra ntawm lub raum thiab tiv thaiv kev tsim cov co toxins. Los ntawm kev txhawb nqa diuresis, cistanche kuj tseem tuaj yeem pab txo qis ntshav siab, ib qho teeb meem ntawm cov kab mob raum.

Ntxiv mus, cistanche tau pom tias muaj cov teebmeem antioxidant. Kev ntxhov siab oxidative, tshwm sim los ntawm qhov tsis sib xws ntawm kev tsim cov dawb radicals thiab lub cev tiv thaiv antioxidant, ua lub luag haujlwm tseem ceeb hauv kev mob raum. ies pab neutralize dawb radicals thiab txo Oxidative kev nyuaj siab, yog li tiv thaiv lub raum los ntawm kev puas tsuaj. Cov phenylethanoid glycosides pom hauv cistanche tau tshwj xeeb hauv kev tshem tawm cov dawb radicals thiab inhibiting lipid peroxidation.

Tsis tas li ntawd, cistanche tau pom tias muaj cov tshuaj tiv thaiv kab mob. Kev mob yog lwm yam tseem ceeb hauv kev loj hlob thiab kev loj hlob ntawm cov kab mob raum. Cistanche's anti-inflammatory zog pab txo qhov tsim ntawm pro-inflammatory cytokines thiab inhibit qhov kev ua ntawm txoj kev yuav tsum tau rau o, yog li alleviating o nyob rau hauv lub raum.

Tsis tas li ntawd, cistanche tau pom tias muaj cov teebmeem immunomodulatory. Hauv kab mob raum, lub cev tiv thaiv kab mob tuaj yeem ua rau tsis zoo, ua rau muaj kev mob ntau dhau thiab cov ntaub so ntswg puas. Cistanche pab tswj lub cev tiv thaiv kab mob los ntawm kev hloov kho kev tsim khoom thiab kev ua haujlwm ntawm lub cev tiv thaiv kab mob, xws li T hlwb thiab macrophages. Txoj cai tiv thaiv kab mob no pab txo qhov mob thiab tiv thaiv kev puas tsuaj ntxiv rau lub raum.

Ntxiv mus, cistanche tau pom los txhim kho lub raum kev ua haujlwm los ntawm kev txhawb nqa kev tsim kho ntawm lub raum hlab nrog cov hlwb. Lub raum tubular epithelial hlwb ua lub luag haujlwm tseem ceeb hauv kev pom thiab rov nqus cov khoom pov tseg thiab electrolytes. Hauv kab mob raum, cov hlwb no tuaj yeem raug puas tsuaj, ua rau lub raum ua haujlwm puas. Cistanche lub peev xwm los txhawb kev tsim kho ntawm cov hlwb no pab kho lub raum kom zoo thiab txhim kho lub raum tag nrho.

Ntxiv nrog rau cov kev cuam tshuam ncaj qha rau lub raum, cistanche tau pom tias muaj txiaj ntsig zoo rau lwm yam kabmob thiab lub cev hauv lub cev. Txoj hauv kev zoo rau kev noj qab haus huv no tseem ceeb tshwj xeeb hauv cov kab mob raum, vim tias tus mob feem ntau cuam tshuam rau ntau lub cev thiab lub cev. che tau pom tias muaj kev tiv thaiv rau lub siab, lub plawv, thiab cov hlab ntsha, uas feem ntau cuam tshuam los ntawm kab mob raum. Los ntawm kev txhawb nqa kev noj qab haus huv ntawm cov kabmob no, cistanche pab txhim kho lub raum tag nrho thiab tiv thaiv kev mob ntxiv.

Hauv kev xaus, cistanche yog cov tshuaj suav tshuaj ntsuab siv rau ntau pua xyoo los kho mob raum. Nws cov active Cheebtsam muaj diuretic, antioxidant, anti-inflammatory, immunomodulatory, thiab regenerative teebmeem, uas pab txhim kho lub raum ua haujlwm thiab tiv thaiv ob lub raum los ntawm kev puas tsuaj ntxiv. , cistanche muaj txiaj ntsig zoo rau lwm yam kabmob thiab lub cev, ua rau nws txoj hauv kev zoo rau kev kho mob raum.