Theem Mob Gout: Them Nyiaj Rau Anti-inflammatory Thiab Analgesic

Nws kwv yees tias muaj 1-3 tus neeg mob gout rau 100 tus neeg Suav, thiab tus naj npawb ntawm cov neeg mob hyperuricemia tuaj yeem ncav cuag 14, uas qhia tau tias muaj kev nce zuj zus txhua xyoo. Ntxiv nrog rau kev txhim kho txoj kev ua neej, kev noj tshuaj kuj tseem ua lub luag haujlwm tseem ceeb hauv kev tswj tus mob gout. Cov kev kho mob sib txawv ntawm ntau theem ntawm gout. Niaj hnub no, tus editor tau sau qee cov ntsiab lus ntawm cov tshuaj tiv thaiv kab mob thiab tshuaj tua kab mob nyob rau theem mob ntawm gout, nrog rau cov tshuaj lom neeg muaj peev xwm kho tau, vam tias yuav pab tau koj hauv koj qhov kev kuaj mob thiab kev kho mob.

Nyem rau Cistanche rau mob raum

Lub hauv paus ntsiab lus ntawm kev kho mob nyob rau theem mob yog kom ceev nrooj tswj kev sib koom ua ke thiab mob. Nyob rau theem mob hnyav, koj yuav tsum tau so hauv txaj thiab txhawb nqa cov ceg tawv. Nws yog qhov zoo tshaj plaws los pib siv tshuaj los tswj tus mob o nyob rau hauv 24 teev ntawm qhov pib.

Cov tshuaj kho thawj kab muaj xws li colchicine thiab non-steroidal anti-inflammatory tshuaj. Thaum muaj contraindications rau kev kho mob los yog kev kho mob cov nyhuv tsis zoo, glucocorticoid anti-inflammatory kev kho mob kuj raug txiav txim siab. Nws feem ntau yog siv rau hauv cov koob tshuaj me me thiab cov kev kawm luv luv. Thaum cov pob qij txha o thiab mob ploj mus, Nws yog ib qho tsim nyog yuav tsum maj mam txo cov tshuaj thiab nres cov tshuaj. Yog tias kev kho mob ib leeg tsis zoo, kev kho mob ua ke nrog cov tshuaj saum toj no tuaj yeem xaiv. Tam sim no tsis muaj pov thawj los txhawb kev ua tau zoo ntawm cov tshuaj tsis muaj zog opioids thiab opioid analgesics rau kev tawm tsam ntawm gout.

01 colchicine ua

Nws raug nquahu kom siv cov tshuaj colchicine qis, thawj koob tshuaj yog 1 mg, nce los ntawm 0.5 mg tom qab 1 teev, thiab 0.5 mg tom qab 12 teev, 1 txog 3 zaug / d . Nws yog qhov zoo tshaj plaws los pib noj tshuaj tsis pub dhau 12 teev tom qab tus mob gout nres. Cov nyhuv yuav txo qis tom qab 36 teev.

Cov neeg mob lub raum tsis txaus yuav tsum tau txo qhov koob tshuaj lossis ncua sijhawm noj tshuaj raws li qhov tsim nyog. Thaum eGFR yog 30~60ml/min, qhov siab tshaj plaws ntawm colchicine yog 0.5mg/d; thaum eGFR yog 15 ~ 30ml / min, qhov siab tshaj plaws ntawm colchicine yog 0.5mg txhua ob hnub; Nws yog contraindicated nyob rau hauv cov neeg mob nrog eGFR<15ml/min or dialysis patients.

Cov tshuaj no tuaj yeem ua rau mob plab hnyuv, xws li raws plab, mob plab, xeev siab, thiab ntuav. Nws kuj tseem tuaj yeem ua rau lub siab thiab lub raum puas thiab pob txha pob txha. Lub siab thiab lub raum ua haujlwm thiab cov ntshav yuav tsum tau saib xyuas tsis tu ncua. Colchicine yog contraindicated nyob rau hauv cov neeg mob noj muaj zog P-glycoprotein thiab / los yog CYP3A4 inhibitors (xws li cyclosporine A los yog clarithromycin).

02 NSAIDs

Rau kev tawm tsam ntawm gout, qhov txaus ntawm cov NSAIDs ceev ceev yuav tsum tau siv sai li sai tau, feem ntau suav nrog cov tshuaj tsis tshwj xeeb cyclooxygenase (COX) inhibitors thiab COX⁃2 inhibitors tshwj xeeb. Feem ntau siv tshuaj muaj xws li celecoxib, etoricoxib, diclofenac sodium, thiab meloxicam.

Tsis yog tshwj xeeb COX inhibitors yuav tsum tau them sai sai rau kev pheej hmoo ntawm plab hnyuv xws li plab hnyuv, los ntshav, thiab perforation; Cov kev pheej hmoo ntawm plab hnyuv ntawm cov COX tshwj xeeb-2 inhibitors yog kwv yees li 50% qis dua li cov uas tsis yog cov tshuaj COX inhibitors, tab sis cov plab hnyuv los ntshav thiab perforation tseem yog qhov txwv tsis pub noj tshuaj.

Tsis tas li ntawd, NSAIDs tuaj yeem ua rau lub raum puas, yog li ua tib zoo saib xyuas lub raum ua haujlwm; Cov neeg uas muaj lub raum tsis ua haujlwm yuav tsum tau muaj dej txaus thiab saib xyuas lawv lub raum ua haujlwm. Cov nrog eGFR<30ml/min and who are not undergoing dialysis should not use them.

Tshwj xeeb COX-2 inhibitors kuj tseem tuaj yeem ua rau muaj kev pheej hmoo ntawm cov kab mob plawv thiab yuav tsum tau siv nrog ceev faj hauv pab pawg muaj kev pheej hmoo siab.

03 Glucocorticoids

1. Prednisone

Nws yog tsuas yog siv rau cov neeg mob uas muaj mob gout tawm tsam nrog rau cov tsos mob ntawm lub cev, los yog cov neeg mob uas muaj colchicine thiab non-steroidal anti-inflammatory tshuaj uas tsis zoo los yog contraindicated, los yog lub raum insufficiency.

Feem ntau pom zoo tias prednisone 0.5 mg·kg-1·d-1 yuav tsum tau siv tsis tu ncua rau 5 mus rau 10 hnub thiab tom qab ntawd txiav tawm, lossis cov koob tshuaj yuav tsum maj mam txo tom qab 2. mus rau 5 hnub ntawm kev siv. Tag nrho cov kev kho mob yog 7 mus rau 10 hnub. Nws tsis haum rau kev siv mus ntev.

Thaum siv glucocorticoids, ua tib zoo saib xyuas cov kev tsis zoo xws li kub siab, hyperglycemia, hyperlipidemia, dej thiab sodium retention, kab mob, plab hnyuv los ntshav, thiab osteoporosis. Vim tias cov tshuaj hormones tuaj yeem cuam tshuam kev loj hlob thiab kev loj hlob ntawm cov menyuam yaus, kev siv sijhawm ntev yuav tsum tau ua nrog ceev faj.

2. Kev txhaj tshuaj betamethasone

Yog tias qhov mob hnyav ntawm gout cuam tshuam nrog pob qij txha loj, lossis kev kho qhov ncauj tsis zoo, glucocorticoids tuaj yeem txhaj rau hauv cov kab noj hniav sib koom ua ke lossis intramuscularly, tab sis kev sib koom ua ke yuav tsum raug txiav tawm thiab rov txhaj tshuaj dua hauv lub sijhawm luv yuav tsum zam.

(1) Cov Neeg Laus: ① Intramuscular txhaj: Rau kev tswj hwm lub cev, pib nrog 1.00~2.00 ml. Kev tswj xyuas rov qab tuaj yeem siv yog tias tsim nyog. Qhov ntau npaum li cas thiab tus naj npawb ntawm txhaj tshuaj nyob ntawm tus mob thiab tus neeg mob cov lus teb. Kev siv mus sij hawm ntev yog zam. ② Intra-articular txhaj: Cov koob txhaj tshuaj hauv zos yog 0.25 ~ 2.{{10}} ml (nyob ntawm qhov loj ntawm qhov sib koom lossis qhov chaw txhaj tshuaj). Siv 1.00~2.00 ml rau pob qij txha loj (lub hauv caug, duav, xub pwg); siv 0.50~1.00 ml rau nruab nrab pob qij txha (lub luj tshib, dab teg, pob taws); siv 0.25 ~ 0.50 ml rau pob qij txha me (ko taw, tes, hauv siab); tsis txhob rov siv dua nyob rau lub sijhawm luv.

(2) Cov menyuam yaus: Cov khoom no muaj benzyl cawv thiab txwv tsis pub txhaj tshuaj intramuscular rau menyuam yaus.

Lus Cim: Cov tshuaj tua kab mob tsis tuaj yeem siv los tswj kev mob gout

Thaum muaj mob hnyav tshwm sim, cov pob qij txha raug nthuav tawm sai sai, o, kub, mob, thiab ua haujlwm tsis zoo. Feem ntau cov neeg mob tau nce erythrocyte sedimentation tus nqi thiab C-reactive protein. Lawv raug kuaj pom tau yooj yim raws li kab mob hauv zos, thiab ntau cov tshuaj tua kab mob xws li penicillin siv tsis raug rau kev kho mob. Tsis muaj txiaj ntsig rau tus neeg mob los ntawm kev kho mob.

04 Cov tshuaj lom neeg

Rau qee cov neeg mob uas muaj refractory gout, vim qhov mob hnyav, ntau qhov sib koom ua ke, lossis kev koom tes loj, monotherapy tsis txo qhov mob thiab yuav tsum tau siv tshuaj ua ke.

Cov tshuaj pom zoo ua ke suav nrog colchicine thiab NSAID, colchicine thiab qhov ncauj corticosteroids, thiab intraarticular corticosteroids thiab NSAID, colchicine, lossis qhov ncauj corticosteroid.

Kev siv ib txhij ntawm NSAIDs thiab qhov ncauj corticosteroids yuav tsum tau zam kom txo tau cov kev sib koom ua ke ntawm lub plab zom mov. Tsis tas li ntawd, cov neeg mob uas muaj refractory gout feem ntau nrog cov hlab plawv, lub raum, plab hnyuv thiab lwm yam teeb meem hauv ntau lub cev. Cov teeb meem no tuaj yeem ua rau muaj qhov tshwm sim tsis zoo lossis contraindications rau cov kev kho mob saum toj no, xws li colchicine ua rau raws plab, cov tshuaj uas tsis yog steroidal Anti-inflammatory hauv lub cev tuaj yeem ua rau mob plab hnyuv, mob plawv, mob raum, thiab lwm yam.

Yog li ntawd, lwm txoj kev kho mob yog xav tau rau cov neeg mob intolerance los yog tsis ua hauj lwm los teb rau cov thawj kab tshuaj no. Nyob rau hauv xyoo tas los no, cov tshuaj lom neeg ua rau cov tshuaj tua kab mob tshiab tau pib siv los kho thiab tiv thaiv gout.

Interleukin (IL) -1 inhibitors

MSU tuaj yeem cuam tshuam IL-1 qhib rau hauv cov pob qij txha thiab cov ntaub so ntswg kom txo tau cov lus teb inflammatory. Nws txoj kev ua tau zoo tau raug txheeb xyuas tau zoo hauv kev sim tshuaj, suav nrog anakinra, canakinumab, thiab rilonacept. Canakinumab tau pom zoo los ntawm European Medicines Agency (EMA) rau kev kho mob ntawm gout nyob rau hauv cov neeg mob uas intolerant los yog contraindicated nrog cov pa anti-inflammatory analgesics.

Tumor necrosis factor (TNF)-alpha inhibitors

Cov kev tshawb fawb tau pom tias kev siv etanercept tuaj yeem txhim kho qhov mob ntawm cov neeg mob gout uas tsis zoo rau kev kho thawj kab. Tsis tas li ntawd, ntau thiab ntau cov pov thawj qhia tau hais tias etanercept tuaj yeem siv rau cov neeg mob uas muaj kab mob ntev ntev, ntau qhov kev koom tes sib koom ua ke, muaj cov tophi, cov tshuaj tiv thaiv kab mob ib txwm siv tsis tau thiab nrog rau lwm yam kev koom tes hauv lub cev. Nws tuaj yeem tswj tau qhov mob thiab ua kom uric acid txo qis kom sai li sai tau. Tshuaj nteg lub hauv paus. Yog li, etanercept yuav yog ib txoj hauv kev zoo rau cov neeg mob no.

IL -6 inhibitor

Los ntawm kev thaiv kev sib kis ntawm IL-6 tsav tsheb teeb liab, cov tshuaj tiv thaiv kab mob yog inhibited. Cov ntaub ntawv qhia tau hais tias cov neeg mob refractory gout muaj kev txhim kho tseem ceeb hauv cov qhab nia mob thiab kev ua neej nyob tom qab kev kho mob nrog tocilizumab, thiab cov qib uric acid thiab cov kab mob gout raug txo qis tom qab ua ke nrog urate-txo cov tshuaj; Txawm tias nyob rau hauv thawj kab kev kho mob, anakinra yog ineffective. Hauv cov neeg mob uas muaj tus kab mob ntev zuj zus los ntawm kev rog dhau, kev vam khom lossis kev tsis haum, tocilizumab tuaj yeem ua tiav cov txiaj ntsig zoo thiab tsis pom muaj qhov tsis zoo tshwm sim.

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 cov zus tau tej cov pro-inflammatory cytokines thiab inhibit qhov ua kom o yuav tsum tau txoj kev, 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.