4. Kev sib tham

Qhov kev tshawb pom tseem ceeb ntawm txoj kev tshawb fawb yog: (1) Lub ntim ntawm CM tau tswj hwm thaum lub sijhawm TAVI thiab cov ntim ntim ntawm CM tau tswj hwm hauv xya hnub lossis 30 hnub ntawm TAVI tsis cuam tshuam nrog AKI tom qab TAVI; thiab (2) Tsis muaj ib qho ntawm cov qauv ntsuas kev pheej hmoo uas suav nrog CM module, nws tus kheej cuam tshuam nrog tom qab TAVI AKI. (3) eGFR tsuas yog tus kws tshaj lij ywj pheej rau AKI.

Raws li cov kev tshawb fawb muaj feem xyuam, cistanche yog ib txwm suav tshuaj ntsuab uas tau siv rau ntau pua xyoo los kho ntau yam kab mob. Nws tau raug pov thawj scientific kom muaj cov tshuaj tiv thaiv kab mob, tiv thaiv kev laus, thiab antioxidant zog. Cov kev tshawb fawb tau pom tias cistanche muaj txiaj ntsig zoo rau cov neeg mob uas muaj kab mob raum. Cov khoom xyaw nquag ntawm cistanche paub tias txo qhov mob, txhim kho lub raum ua haujlwm thiab rov ua kom lub raum tsis zoo. Yog li, kev sib koom ua ke cistanche hauv txoj kev npaj kho mob raum tuaj yeem muab txiaj ntsig zoo rau cov neeg mob hauv kev tswj hwm lawv tus mob. Cistanche pab txo qis proteinuria, txo qis BUN thiab creatinine qib, thiab txo qhov kev pheej hmoo ntawm lub raum puas. Tsis tas li ntawd, cistanche kuj pab txo cov roj cholesterol thiab triglyceride uas tuaj yeem ua rau muaj kev phom sij rau cov neeg mob uas muaj kab mob raum.

Nyem rau ntawm Cistanche Tubulosa Ntxiv

【Yog xav paub ntxiv: david.deng@wecistanche.com / WhatApp:86 13632399501 】

AKI yog ib qho teeb meem loj, feem ntau ntsib tom qab TAVI nrog qhov tshwm sim ntawm txhua theem ntawm AKI, tshaj tawm los ntawm cov npe loj thiab cov metanalyses, nyob ib ncig ntawm 20 feem pua ​​[1,3]. Txoj kev loj hlob ntawm AKI, tom qab TAVI, ua rau muaj kev pheej hmoo ntawm cov teeb meem luv luv thiab ntev ntev, xws li myocardial infarction, ua rau lub neej los ntshav, lub raum tsis ua haujlwm tas li yuav tsum tau kho lub raum hloov, thiab kev tuag [1,3-5. , 20–23] ib. Ntau tus yam ntxwv hauv paus, co-morbidities, thiab peri-procedural yam tau txuas nrog TAVI-txog AKI. Qee qhov kev tshaj tawm tshaj plaws yog qhov txo qis ntawm hemoglobin, lub raum tsis ua haujlwm ntev, mob ntshav siab, thiab hemodynamic instability thaum lub sijhawm ua haujlwm [2,5,22,24,25]. Txawm li cas los xij, muaj ntau qhov tsis paub meej nrog ntau qhov kev pheej hmoo uas tau hais tseg yav dhau los cuam tshuam nrog AKI tom qab lwm cov txheej txheem uas CM tau siv thiab lub luag haujlwm uas lawv ua hauv kev txhim kho AKI tom qab TAVI nrog cov lus qhia tsis sib haum xeeb. Piv txwv li, thaum qee qhov kev tshawb fawb pom tias muaj kev sib raug zoo ntawm lub hnub nyoog nce thiab AKI kev loj hlob tom qab TAVI, lwm cov kev tshawb fawb tsis tau [3,6,7,10,25]. Thaum nyob rau hauv qee qhov kev tshawb fawb LVEF tsis sib haum xeeb nrog post-TAVI AKI, hauv lwm cov ntawv luam tawm nws tsis yog [6,7,10,23,25,26]. Txawm tias txo qis hauv paus eGFR thiab lub raum tsis ua haujlwm ntev muaj qhov tsis paub meej ntawm cov teebmeem ntawm post-TAVI AKI [3,6–8,10,25–27]. Kev sib raug zoo ntawm CM ntim thiab TAVI-txog AKI kuj tseem muaj teeb meem. Hauv ntau qhov kev tshawb fawb yav dhau los, tsis muaj qhov sib txawv tseem ceeb ntawm qhov ntim ntawm CM xa tawm thaum lub sijhawm TAVI, nruab nrab ntawm AKI ntxiv rau cov neeg mob thiab AKI- cov neeg mob, lossis ntawm CM koob tshuaj thiab tom qab txheej txheem AKI [2,4,5,8,16]. Hloov pauv, lwm cov kev tshawb fawb tau piav qhia ntau dua ntawm CM hauv AKI ntxiv rau cov neeg mob piv rau AKI, thiab kev sib koom ua ke ntawm qhov ntim ntawm CM xa tawm thaum TAVI thiab kev txhim kho tom qab ntawm AKI [6,9,10,25,26].

Lub koom haum tsis paub meej ntawm kev tswj hwm CM ntim thiab AKI tau piav qhia nrog lwm cov txheej txheem kho mob uas siv hluav taws xob CM. Hauv cov neeg mob uas muaj eGFR siab dua 30 mL / min / 1.73 m2 uas tau kuaj CT, tsis muaj qhov sib txawv tseem ceeb ntawm qhov tshwm sim ntawm AKI ntawm cov neeg uas tau txais cov hlab ntsha CM thiab cov uas tsis tau, thiab cov txiaj ntsig rau cov neeg mob eGFR tsawg dua 30 mL. /min/1.73 m2 tau tsis sib haum xeeb [28,29]. Kev soj ntsuam ntawm kev soj ntsuam kev tshawb fawb tau xaus lus tias kev siv xov tooj cua sib txawv hauv CT scanning tsis cuam tshuam rau kev hloov pauv hauv lub raum [30]. Cov txiaj ntsig no tau hais nyob rau hauv qhov kev hloov tshiab tsis ntev los no ntawm American College of Radiology cov lus pom zoo nyob rau hauv uas nws tau tshaj tawm tias qhov kev pheej hmoo ntawm AKI txhim kho tom qab raug rau cov kab mob iodinated CM tau dhau los ua qhov tseeb thiab qhov txaus ntshai ntawm AKI, ntsig txog CM kev tswj hwm, tseem tsis paub meej txawm rau cov neeg mob mob raum mob hnyav [31]. Nws tau raug qhia tias kev tswj hwm ntawm CM, zoo li nrog CT angiography, tuaj yeem ua rau muaj kev pheej hmoo sib txawv ntawm AKI dua li qhov cuam tshuam nrog kev tswj hwm ntawm CM, zoo li PCI thiab TAVI; Txawm li cas los xij, cov ntaub ntawv tsis suav nrog [32–37].

CM-txog AKI tau kawm ntau yam hauv cov ntsiab lus ntawm PCI. Txawm li cas los xij, kev ntsuam xyuas qhov cuam tshuam tiag tiag ntawm CM ntawm kev txhim kho AKI, tom qab PCI, tau ua pov thawj tias yog ib txoj haujlwm nyuaj. Cov kev tshawb fawb uas ntsuas qhov sib txuas ntawm CM thiab AKI dav sib txawv ntawm hom, tshuaj lom neeg yam ntxwv, pharmacokinetics, thiab ntim ntawm CM, txoj kev nws tau tswj hwm, cov txheej txheem kho mob nws tau muab, thiab, lub ntsiab lus siv los kuaj mob AKI [38]. Qhov tseem ceeb, ntau qhov sib txawv ntawm qhov sib txawv (los ntawm qis dua 100 mL mus rau saum 800 mL) tau cuam tshuam nrog post-PCI nephropathy [12,13,39–41]. Muaj ntau qhov sib txawv nruab nrab ntawm cov neeg mob kho nrog TAVI thiab cov neeg mob kho nrog PCI uas, muaj peev xwm, ua rau yav dhau los muaj kev pheej hmoo siab dua los tsim AKI dua li yav tas los. Cov neeg mob uas tau txais TAVI feem ntau yog cov laus, tsis muaj zog, feem ntau raug kev txom nyem los ntawm ntau yam kab mob sib kis thiab tau txo GFR [7,42]. Tsis tas li ntawd, cov neeg mob kho PCI feem ntau raug rau CM ib zaug thaum lawv cov txheej txheem ntsuas. TAVI-kho cov neeg mob, txawm li cas los xij, feem ntau raug rau qhov ntim loj ntawm CM thaum lub sijhawm kuaj mob thiab kev cuam tshuam thiab ntau lub sijhawm luv luv. Interestingly, txawm tias qhov sib txawv no, Venturi li al. pom tias AKI tshwm sim tsawg zaus hauv cov neeg mob uas tau txais TAVI dua li cov neeg mob uas tau txais PCI, txawm tias tom qab cov qhab nia zoo sib xws [7]. Ua raws li TAVI, tsis zoo li lwm cov txheej txheem uas siv CM, muaj kev txhim kho tam sim ntawd thiab txhawb nqa hauv hemodynamics ua rau lub plawv tso zis thiab cov kab mob perfusion [43–45]. Txawm li cas los xij, txawm tias qhov no tuaj yeem txhais ua qhov txo qis ntawm AKI tom qab TAVI, tus nqi ntawm lub raum ua haujlwm tam sim ntawd tom qab TAVI tau pom tias me me hauv kev tshaj tawm tsis ntev los no (5 feem pua) [46].

Kev kuaj mob ntawm AKI zoo li lag luam tom qab qhov ntsuas tau raug rau CM, nrog rau kev ua haujlwm ntawm lub raum tsis zoo nyob rau hnub tom ntej. Yog li, qhov kev ntsuam xyuas rau CM-txuas nrog nephrotoxicity yog ib txwm ua nyob rau hauv 48 mus rau 72 teev ntawm kev raug thiab raws li VARC-3 cov lus pom zoo, lub sijhawm no tau txuas ntxiv mus rau xya hnub [13,17,39]. Txog tam sim no, cov txiaj ntsig ntawm CM ntawm lub raum ua haujlwm tau sim rau CM xa tawm thaum lub sijhawm TAVI ib leeg, thaum qhov ua tau tshwm sim los ntawm ze li yav dhau los raug rau CM tau saib tsis pom. Qhov no coj peb mus sim rau qhov muaj txiaj ntsig ntxiv ntawm kev nthuav tawm ua ntej rau CM ntawm qhov tshwm sim ntawm AKI tom qab TAVI. Hauv txoj kev tshawb no, qhov ntim ntawm CM tau tswj hwm thaum lub sijhawm TAVI ib leeg, thaum 7 hnub, lossis 30 hnub, tsis sib txawv ntawm AKI ntxiv rau cov neeg mob thiab AKI- cov neeg mob, thiab tsis tau nws tus kheej kwv yees kev loj hlob ntawm AKI. Ib yam li ntawd, hauv ib txoj kev tshawb fawb tsis ntev los no, kev ntsuam xyuas qhov tshwm sim ntawm ntau qhov tshwm sim rau CM thaum rov tshwm sim thiab kev cuam tshuam cov txheej txheem coronary, txawm tias ntau xyoo, kev ua haujlwm ntawm lub raum tsis zoo cuam tshuam nrog kev paub txog kev pheej hmoo rau kev mob raum tab sis tsis suav nrog CM ntim. [47].

Cov teeb meem hauv kev kwv yees AKI tom qab TAVI coj mus rau kev txhim kho cov qauv ntsuas kev pheej hmoo. Kev sib koom ua ke ntau qhov tsis sib xws los tsim cov qauv kev pheej hmoo, tuaj yeem txhim kho lub zog kwv yees tshaj li ntawm tus kheej cov modules suav nrog hauv nws. AKI cov qauv kev kwv yees kev pheej hmoo tau raug tsim, sim, thiab siv tau rau cov txheej txheem coronary [11–14,48,49]. Tu siab, tsuas yog ob peb ntawm cov qauv no tau tsim tshwj xeeb los ntsuas qhov kev pheej hmoo ntawm post-TAVI AKI. Piv txwv li, Zivcovic et al. tau qhia txog AKI lub laij lej pheej hmoo uas txhais tau tias yuav tsum tau siv ua ntej TAVI thiab yog li tsis suav nrog CM tivthaiv [27]. Ib yam li hauv txoj kev tshawb no, ntau qhov kev tshawb fawb yav dhau los tau sim qhov ua tau zoo ntawm CMbased, tsis yog-TAVI mob siab rau cov qauv kev pheej hmoo hauv kev kwv yees AKI tom qab TAVI [6,15,16,24,26,50]. Hauv peb txoj kev tshawb fawb, tsis muaj ib qho ntawm CM-raws li cov qauv kev pheej hmoo peb tau sim nws tus kheej kwv yees postTAVI AKI. Mach et al. tau tshaj tawm tias tsis muaj ib qho ntawm rau qhov kev sim CM-raws li cov qauv kev pheej hmoo (xws li Mehran tus qauv kev pheej hmoo) yog qhov sib txawv ntawm AKI ntxiv thiab AKI- cov neeg mob lossis, zoo ib yam li peb cov txiaj ntsig, nws tus kheej kwv yees AKI [16]. Rosa et al. piav qhia tias tag nrho lawv cov qauv kev pheej hmoo raug sim, ntawm plaub qhov suav nrog CM module thiab ob qho tsis tau, muaj qhov tsis zoo ntawm kev kwv yees qhov tshwm sim ntawm AKI. Txawm li cas los xij, muaj kev txhim kho hauv AKI qhov kev kwv yees qhov kev pheej hmoo rau ntau theem ntawm AKI. Los ntawm univariable logistic regression tsom xam, tsuas yog cov qauv pheej hmoo nrog CM module tau txuam nrog AKI. Cov txiaj ntsig ntawm ntau qhov sib txawv logistic regression coefficients ntawm kev pheej hmoo rau ib qho AKI lossis ntau theem ntawm AKI tsis tau tshaj tawm [15]. Hauv qhov sib piv, ib qho kev kawm me me ntawm 93 tus neeg mob, uas AKI tau kuaj pom hauv 24 ntawm lawv, pom nyob rau hauv ib qho kev soj ntsuam tsis txawv txav uas Mehran tus qauv pheej hmoo, nrog rau CM ntim, kwv yees tom qab TAVI AKI. Cov kws sau ntawv kuj tau tshaj tawm tias hauv kev txheeb xyuas ntau yam sib txawv, CM ntim, Mehran qhab nia, SCr, thiab eGFR yog txhua tus ntawm nws tus kheej cuam tshuam nrog AKI [6]. Txawm li cas los xij, txoj kev tshawb fawb no muaj tsawg tus qauv me me thiab, muab qhov tsawg kawg ntawm cov ntsiab lus kawg tau ua tiav, tsis muaj zog los tshawb xyuas qhov tseeb ntawm cov ntsiab lus saum toj no.

Hauv peb txoj kev tshawb fawb, kev txo qis eGFR, raws li yav dhau los tau piav qhia los ntawm lwm tus, yog qhov tseem ceeb thiab nws tus kheej cuam tshuam nrog AKI hla kev tshuaj ntsuam feem ntau [5,8]. Nws tsuas yog tus kws tshaj lij ywj pheej rau AKI. Yog li ntawd, nrog kev ceev faj, peb xav tias AKI kwv yees lub zog ntawm cov qauv kev pheej hmoo uas muaj CM ntim module yuav luag tag nrho rau cov txheej txheem ua ntej eGFR.

Kev txwv: Qhov no yog ib daim ntawv tshaj tawm hauv ib tus neeg thiab muaj cov kev txwv cuam tshuam nrog kev txheeb xyuas rov qab. Muab cov xwm txheej AKI tsawg tsawg, peb txoj kev tshawb fawb tsis muaj zog los ntsuas cov theem hnyav tshaj plaws ntawm AKI. Qhov kev ntsuam xyuas ntawm lub hauv paus sCr tau ua ua ntej TAVI thiab tsis yog ua ntej thawj zaug raug rau CM nyob rau hauv lub sij hawm ntsuam xyuas. Tsis tas li ntawd, cov neeg mob feem ntau raug tso tawm ua ntej xya hnub tau dhau los ntawm lawv cov txheej txheem, thiab yog li ntawd, txawm tias nws yog peb lub koom haum kev coj ua kom tso tawm tus neeg mob tom qab lub raum ua haujlwm tau ruaj khov, nws muaj peev xwm ua rau lub raum tsis zoo ntxiv tom qab tso tawm yam tsis tau sau tseg. . Kev siv cov tshuaj uas muaj cov tshuaj nephrotoxic nyob ze rau qhov sib piv ntawm cov xov xwm tawm kuj tseem tsis tau sau tseg.

5. Cov lus xaus

Tsis yog qhov ntim ntawm CM xa tawm thaum lub sijhawm TAVI lossis qhov sib npaug ntawm CM xa tuaj rau lub sijhawm uas pib xya hnub lossis 30 hnub ua ntej TAVI thiab xaus nrog TAVI cuam tshuam nrog AKI. Lub zog ntawm cov tsis-TAVI mob siab rau CM-raws li cov qauv kev pheej hmoo, hauv kev kwv yees AKI, tsuas yog txwv rau cov txheej txheem ua ntej lub raum tsis ua haujlwm.

Tus sau kev koom tes:Conceptualization, DS thiab IM; Methodology, DS, LG-R., EYB, thiab IM; Validation, DS, LG-R., AL, thiab IM; Kev Tshawb Fawb Kev Tshawb Fawb, DS, LG-R., thiab IM; Kev Tshawb Fawb, DS, YD, FK, AL, MG, WK, thiab IM; Resources, DS, WK, EH, MG, thiab IM; Data Curation, DS thiab AL; Kev Sau Ntawv—Kev Npaj Ua Ntej, DS; Kev Sau Ntawv—Saib xyuas thiab Hloov Kho, DS, LG-R., EYB, AL, thiab IM; Visualization, DS, LG-R., AL, thiab EYB; Kev saib xyuas, EYB, thiab IM; Project Administration, DS; Txhua tus kws sau ntawv tau pab npaj cov ntawv sau los ntawm International Committee of Medical Journal Editors (ICMJE) cov txheej txheem rau kev sau ntawv. Txhua tus kws sau ntawv tau nyeem thiab pom zoo rau cov ntawv luam tawm ntawm cov ntawv sau.

Nyiaj txiag:Qhov kev tshawb fawb no tsis tau txais nyiaj txiag sab nraud.

Institutional Review Board Statement:Txoj kev tshawb no tau ua raws li cov lus qhia ntawm Kev Tshaj Tawm ntawm Helsinki, thiab tau pom zoo los ntawm Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv ntawm Padeh Medical Center (Txoj Cai Cai POR-0099-14; Hnub pom zoo: 30 Kaum Ob Hlis 2019).

Cov Lus Qhia Txog Kev Pom Zoo:Cov ntaub ntawv tso cai tau txais los ntawm txhua yam kev koom tes hauv txoj kev tshawb fawb.

Cov ntaub ntawv muaj nyob:Cov ntaub ntawv qhia nyob rau hauv txoj kev tshawb no yog tau los ntawm PMC lub zos TAVI lub npe yav tom ntej thiab muaj nyob rau ntawm kev thov los ntawm tus sau sau.

Kev tsis sib haum xeeb ntawm kev txaus siab:DS tau txais tus nqi hais lus los ntawm Abbott Medical Laboratories, Sanofi, Novartis, thiab Novo Nordisk; EYB tau txais ib tus neeg hais lus 'honouraria los ntawm CTS, thiab Novo Nordisk tau txais kev tshawb fawb txhawb nqa rau University of Pennsylvania los ntawm Medtronic Inc. thiab Impulse Dynamics Ltd.

Cov ntaub ntawv

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