Kev nce qib hauv kev kuaj mob thiab kev kho mob ntawm CKD ua ke nrog ntshav qab zib
Oct 08, 2024
Mob ntshav qab zib yog ib yam kab mob ntev uas ua rau tib neeg noj qab haus huv thoob ntiaj teb. Tam sim no, muaj 537 lab tus neeg mob ntshav qab zib thoob ntiaj teb, thiab xav tias yuav nce mus rau 783 lab los ntawm 2045. kuv lub tebchaws tau dhau los ua lub tebchaws uas muaj cov neeg mob ntshav qab zib ntau tshaj plaws, thiab xav tias yuav ncav cuag 174 lab los ntawm 2045. Ntshav qab zib yog ib qho ntawm cov ua rau mob raum mob ntev (CKD). Txog li 40% ntawm cov neeg mob ntshav qab zib yuav tsim CKD. Los ntawm 2010 txog 2020, qhov nruab nrab nce ntawm cov kab mob raum kawg uas tshwm sim los ntawm ntshav qab zib hauv kuv lub tebchaws yog kwv yees li 2.3 / lab tus tib neeg. Hauv xyoo 2023, JAMA tau tshaj tawm cov ntaub ntawv tshawb fawb tshiab tshaj plaws ntawm kev nthuav dav ntawm CKD hauv cov neeg Suav. Kev kwv yees ntau ntawm CKD, lub raum tsis ua haujlwm, thiab cov proteinuria yog 8.2%, 2.2%, thiab 6.7% feem. Daim ntawv ntawm CKD ua ke nrog cov ntshav qab zib tseem hnyav, nrog rau qhov muaj feem ntau ntawm 31.3%, thiab kev paub txog tus nqi kho mob, thiab kev tswj hwm tus nqi yog tag nrho tsawg dua 50%. Nyob rau tib lub sijhawm, nws tau ua ke nrog ntau dua ntawm cov ntshav siab, lipid metabolism tsis meej, thiab hyperuricemia.
Nyem rau Cistanche rau mob raum
1. Kev kuaj mob CKD ua ke nrog ntshav qab zib
Xyoo 2024, kuv lub teb chaws tau tshaj tawm "Suav Kev Pom Zoo ntawm Kev Tswj Xyuas Kev Kho Mob Ntshav Qab Zib Ua Ke Nrog Kab Mob Raum Hniav", uas pom zoo tias txhua tus neeg mob ntshav qab zib hom 2 thiab ntshav qab zib hom 1 uas muaj kev kawm ntau dua lossis sib npaug li 5 xyoos yuav tsum muaj lawv cov zis. albumin/creatinine ratio (UACR) thiab kwv yees glomerular filtration rate (eGFR) soj ntsuam tsawg kawg ib xyoos ib zaug. Thaum cov neeg mob ntshav qab zib tau ntsib ib qho ntawm cov xwm txheej hauv qab no thiab tsis suav nrog lwm yam cuam tshuam xws li kev kis kab mob, lawv tuaj yeem kuaj tau nrog CKD hauv kev kho mob: (1) Rov ua dua UACR rau 3 zaug hauv 3 mus rau 6 lub hlis, nrog tsawg kawg 2 zaug ntau dua. los yog sib npaug li 30 mg / g. (2) eGFR<60 ml/(min·1.73m2) and lasting for more than 3 months. Routine renal biopsy and pathological examination are not required. When the patient has the following conditions that are highly suggestive of non-diabetes-related kidney disease, a renal biopsy is recommended to clarify the cause and then provide specific treatment: no combined diabetic retinopathy, rapid decline in eGFR, abnormal active urine sediment, refractory hypertension, rapid increase in urinary albumin or nephrotic syndrome, combined with symptoms and signs of other systemic diseases, and eGFR decrease of >30% hauv 2-3 lub hlis ntawm kev kho mob nrog angiotensin-hloov enzyme inhibitors lossis angiotensin II receptor blockers.
2. Kev nce qib hauv kev kho mob CKD ua ke nrog ntshav qab zib nephropathy
2024 KDIGO "Cov Lus Qhia Txog Kev Kho Mob rau Kev Ntsuam Xyuas thiab Kev Tswj Xyuas Kab Mob Raum Hniav" qhia txog kev siv cov tswv yim kho mob rau cov neeg mob CKD thiab ntshav qab zib, suav nrog cov neeg mob kev kawm, kev ua neej, kev tawm dag zog, kev haus luam yeeb, noj zaub mov thiab tshuaj kho mob, thiab noj. Cov kev ntsuas cuam tshuam ntawm ntau qib los txo qhov kev pheej hmoo ntawm CKD kev loj hlob thiab nws cov hlab plawv thiab lwm yam teeb meem hauv lub cev. Ntawm cov tshuaj kho mob, renin-angiotensin system inhibitors (RASi), sodium-glucose cotransporter 2 inhibitors (SGLT2i), nonsteroidal mineralocorticoid receptor antagonists (nsMRA), thiab glucagon-zoo li peptide 1 receptor agonists (GLP1-RA) qhia qhov tseem ceeb. Lub raum thiab lub plawv tiv thaiv cov teebmeem.
1.SGLT2i
Ntau qhov kev sim loj randomized tswj thiab ntsuas ntsuas tau pom qhov tseeb cov txiaj ntsig ntawm SGLT2i hauv cov pej xeem CKD, suav nrog cov neeg mob uas tsis yog ntshav qab zib. Kev siv SGLT2i hauv cov neeg mob uas muaj hom 2 mob ntshav qab zib mellitus CKD tau pom zoo, thiab cov tshuaj siv tau ntxiv rau ntau qhov ntau ntawm cov neeg CKD. Xyoo 2024 ntawm cov lus qhia ntxiv hais txog lub luag haujlwm ntawm SGLT2i hauv kev txo qis kev pheej hmoo ntawm kev mob raum, kev tuag ntawm cov hlab plawv, mus pw hauv tsev kho mob rau lub plawv tsis ua haujlwm / myocardial infarction, thiab mob raum mob rau cov neeg mob CKD, thaum tswj ntshav siab, uric acid, ntim, thiab ntshav poov tshuaj tsis ua rau muaj kev pheej hmoo ntawm hypoglycemia. Rau cov neeg mob uas siv SGLT2i, ntshav qab zib, ntim, thiab lwm yam teeb meem yuav tsum raug soj ntsuam thaum ua raws. Los ntawm kev kawm tus neeg mob thiab noj cov kev ntsuas sib xws, cov tshuaj hypoglycemic, thiab diuretics yuav tsum tau hloov kho kom tsis txhob muaj kev hloov pauv hauv cov ntshav qab zib thiab ntim ntau dhau.
2. nsMRA
Ob qhov kev sib tw loj randomized tswj, FIDELIO-DKD thiab FIGARO-DKD, tau pom tias kev siv nsMRA txo qis qhov tshwm sim tsis zoo ntawm lub raum thiab cov hlab plawv. nsMRA muaj qhov pom tseeb ntawm lub raum thiab lub plawv tiv thaiv qhov tseem ceeb, thiab kev siv mus sij hawm ntev tuaj yeem txo cov neeg mob 'UACR thiab kev kwv yees. Tsis tas li ntawd, nsMRA ua ke nrog SGLT2i tuaj yeem txo qhov kev pheej hmoo ntawm hyperkalemia. nsMRA thiab SGLT2i muaj ntau txoj hauv kev thiab tshwj xeeb pathophysiological, feem. Kev kho ob zaug nrog ob cov tshuaj yuav txo tau lub raum thiab mob plawv txaus ntshai ntawm CKD cov neeg mob ntshav qab zib ntau dua li kev siv tshuaj ib leeg. CONFIDENCE yog ib qho randomized, tswj, ob-dig muag, ob-dummy thoob ntiaj teb multicenter kawm. Cov txiaj ntsig tau soj ntsuam kev nyab xeeb, kev ua siab ntev, thiab cov txiaj ntsig ntawm kev siv ob npaug ntawm kev siv finerenone thiab SGLT2i hauv cov neeg laus uas muaj CKD thiab hom 2 mob ntshav qab zib, thiab tuaj yeem muab cov txiaj ntsig ntev rau cov neeg mob CKD thiab hom 2 mob ntshav qab zib.
3. GLP1-RA
GLP1-RA tuaj yeem txo cov kev mob plawv tsis zoo (MACE) hauv cov neeg mob ntshav qab zib hom 2. Ib qho kev soj ntsuam ntawm lub raum tau pom tias GLP1-RA txo MACE los ntawm 14%, tag nrho cov neeg tuag los ntawm 12%, pw hauv tsev kho mob rau lub plawv tsis ua hauj lwm los ntawm 11%, thiab cov txiaj ntsig ntawm lub raum sib xyaw los ntawm 21%. Txoj kev tshawb fawb FLOW yog thawj qhov kev mob siab rau lub raum qhov kev sim ntawm GLP1-RA, uas suav nrog cov neeg mob ntshav qab zib hom 2 uas muaj kev pheej hmoo siab lossis muaj kev pheej hmoo siab ntawm CKD thiab xav tias yuav ua tiav thaum kawg ntawm 2024. Tom qab cov txiaj ntsig ntawm FLOW sim raug tso tawm, txoj hauj lwm ntawm GLP1-RA hauv CKD kev kho mob yuav hloov.
Nyob rau hauv luv luv, tus naj npawb ntawm cov neeg mob ntshav qab zib yog nce, thiab kev tiv thaiv thiab kev kho mob ntawm CKD ua ke nrog ntshav qab zib yog hnyav heev thiab ntsib cov teeb meem loj. Kev pom zoo ntawm cov lus qhia rau CKD ua ke nrog ntshav qab zib tau hloov kho tas li, thiab cov ntaub ntawv pov thawj-raws li kev kho mob tau nce zuj zus. Txhawm rau ncua qhov kev mob ntshav qab zib CKD, ntxiv rau peb txoj haujlwm kho mob uas twb muaj lawm (renin-angiotensin system inhibitors, SGLT2i thiab nsMRA), GLP1-RA tej zaum yuav yog "them plaub" txhawm rau txo qis kev poob. ntawm lub raum ua haujlwm.
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.
