Dhau li ntawm Penicillin, Cov Tshuaj Kho Mob no tuaj yeem ua rau mob raum mob hnyav
Feb 08, 2023
Clinically, peb yuav ntsib mob raum raug mob (mob raum raug mob, AKI) tshwm sim los ntawm penicillin. Niaj hnub no peb siv ib rooj plaub kom nkag siab txog AKI tshwm sim los ntawm lwm cov tshuaj kho mob.
Case tshuaj xyuas
Tus neeg mob, ib tug txiv neej, 52 xyoo, tau mus pw hauv tsev kho mob vim ntuav thiab quav dub. Nws tau kuaj pom tias muaj cov ntshav los ntawm plab hnyuv siab rau hauv kev nkag mus thiab tau txais omeprazole 40mg twv. Tom qab noj nws rau 10 hnub, tus neeg mob tsis ntuav lawm, thiab tsis muaj cov ntshav occult nyob rau hauv cov quav niaj hnub kuaj, thiab nws tus mob zoo tuaj. Txawm li cas los xij, pob khaus thiab khaus tshwm sim hauv tus neeg mob lub plab, thiab cov ntshav creatinine yog 211umol / L (cov ntshav creatinine yog 98umol / L thaum tus neeg mob tau txais).
Nyem rau cistanche deserticola extract rau mob raum raug mob
Xav txog kev siv cov tshuaj proton twj tso kua mis inhibitors (proton twj tso kua mis inhibitors, PPIs) hauv cov neeg mob lub raum raug mob, cov tshuaj yuav tsum tau txiav, thiab cov kev hloov hauv cov ntshav creatinine yuav tsum tau saib xyuas kom zoo. Cov ntshav creatinine tau rov kuaj dua ntawm 150umol / L 3 hnub tom qab thiab 110umol / L tom qab 5 hnub. Tus neeg mob kho tau zoo thiab raug tso tawm.
PPIs feem ntau yog siv los kho ntau yam kab mob gastric acid, xws li gastroesophageal reflux, duodenal ulcer, gastric ulcer, gastrointestinal los ntshav, thiab lwm yam. Tam sim no, feem ntau siv PPIs muaj xws li omeprazole, pantoprazole, tshem tawm Larazole thiab Rabeprazole.
Mechanism ntawm kev ua ntawm PPIs
PPIs feem ntau tsis muaj zog benzimidazole derivatives, uas yog thauj sai sai mus rau parietal hlwb ntawm lub plab mucosa tom qab absorbed nyob rau hauv txoj hnyuv. PPIs ua ke nrog H ntxiv rau hauv qhov chaw acidic ntawm cov tubules secretory thiab vesicles, thiab tom qab protonation, lawv muaj cov nqi zoo, uas tsis tuaj yeem rov qab mus rau hauv cov cell membrane thiab sib sau hauv zos, thiab thaum kawg tsim cov khoom siv ntawm sulfenic acid thiab sulfenamide.
Sulphenamide tuaj yeem tsim ib daim ntawv cog lus sib koom ua ke nrog cov pab pawg sulfhydryl ntawm cov cysteine residue nyob rau hauv lub subunit ntawm H ntxiv, K ntxiv -ATPase (proton twj tso kua mis) rau irreversibly inactivate H plus, K ntxiv -ATPase, yog li inhibit gastric acid secretion kom txog thaum tshiab proton. Cov twj tso kua mis yog tsim, thiab cov parietal hlwb rov pib acid secretion.
PPIs tuaj yeem cuam tshuam qhov nruab nrab lossis peripheral gastric acid secretion thiab tuaj yeem tsim cov teebmeem inhibitory ntawm ob qho tib si basal gastric acid secretion thiab ntau hom kev ntxhov siab gastric acid secretion.
Nws tau raug tshaj tawm nyob rau hauv cov ntaub ntawv hais tias PPIs tuaj yeem ua rau lub raum raug mob, thiab PPIs tuaj yeem ua rau AKI, thiab cov kab mob tshwm sim yog mob nephritis (AIN), uas yog, PPIs cuam tshuam nrog mob nephritis (PPIs-AIN). PPIs tuaj yeem ua rau PPIs-AIN hloov mus rau cov kab mob nephritis ntev thiab tom qab ntawd hloov mus rau cov kab mob raum ntev (mob raum, CKD) thiab lub raum tsis ua haujlwm.
Pathogenesis ntawm PPIs-AIN
Tam sim no, qhov tshwj xeeb pathogenesis ntawm PPIs-induced AIN tsis meej. Nws ntseeg tau tias PPIs thiab / lossis lawv cov metabolites tso rau hauv lub raum tubules thiab lub raum interstitium, thiab ua ke nrog cov khoom qub ntawm lub raum tubular hauv qab daim nyias nyias li haptens, inducing cov tshuaj tiv thaiv antigen tshwj xeeb. kev tiv thaiv kab mob, ua rau muaj kev puas tsuaj rau lub raum tubules thiab interstitium.
Tsis tas li ntawd, activated macrophages nyob rau hauv lub interstitium tuaj yeem ua puas lub hauv paus hauv qab daim nyias nyias los ntawm kev tso cov enzymes proteolytic, hom reactive oxygen, hom reactive nitrogen, thiab inducible nitric oxide synthase, uas tuaj yeem ua rau tus kab mob hnyav dua. Qee qhov adhesion molecules thiab cytokines tuaj yeem koom ncaj qha rau hauv kev raug mob ntawm lub raum interstitium, lossis ua rau muaj kev raug mob ntawm lub raum interstitium los ntawm kev tiv thaiv cellular thiab humoral, thiab ua lub luag haujlwm tseem ceeb hauv qhov tshwm sim thiab kev hloov pauv ntawm tus kabmob. Txawm hais tias cov lus teb no yog cov noob tshwj xeeb lossis yog tias muaj lwm cov txheej txheem cuam tshuam tsis meej.
Clinical Manifestations of PPIs-AIN
Tom qab tus neeg mob tau mus rau hauv tsev kho mob, tsuas yog omeprazole tau siv ua ke nrog cov tshuaj hemostatic, thiab cov tshuaj hemostatic raug tso tseg nyob rau hnub thib tsib ntawm kev nkag, tab sis tus neeg mob cov ntshav creatinine tau nce ntxiv tom qab txhaj tshuaj omeprazole, uas tau txiav txim siab zoo sib xws. rau omeprazole. Tom qab tso tseg kev txhaj tshuaj omeprazole, tus neeg mob cov ntshav creatinine tau zoo tuaj. Raws li tus neeg mob qhov tshwm sim, nws tuaj yeem kwv yees tias tus neeg mob qhov kev txhaj tshuaj omeprazole tuaj yeem ua rau cov ntshav creatinine nce ntxiv.
Cov kev kho mob tshwm sim ntawm PPIs-AIN tsis raug. Kev raug mob raum mob yog ib hom tshuaj tiv thaiv kab mob siab, uas feem ntau tshwm sim 10-14 hnub tom qab noj tshuaj. Cov tsos mob tshwm sim muaj xws li pob liab liab, kub taub hau, hematuria, azotemia, thiab eosinophilia.
Clinically, penicillin yog cov tshuaj classic uas ua rau AIN. Qhov sib txawv ntawm cov tshuaj classic hais txog AIN, PPIs-AIN muaj qhov sib txawv ntawm tus kheej hauv lub sijhawm ntawm kev noj PPIs rau AIN. Txawm li cas los xij, feem ntau PPIs-AIN tsis yog nrog los ntawm kev ua xua tshwm sim xws li ua npaws thiab ua pob liab liab, tab sis tsuas yog cov tsos mob tsis tshwj xeeb xws li qaug zog, qaug zog, xeev siab, thiab tsis qab los noj mov, thiab tsis muaj qhov pom tseeb tshwj xeeb hauv kev sim kuaj, thiab ib txhia ntawm lawv tsuas pom cov ntshav creatinine nce zuj zus. Tus neeg mob hauv qhov no kuj tsis muaj qhov tshwm sim tshwj xeeb, tsuas yog rov kuaj xyuas cov ntshav creatinine pom qhov nce ntxiv.
Kev kho ntawm PPIs-AIN
Tam sim no, tsis muaj cov lus qhia cuam tshuam txog kev kho mob ntawm PPIs-AIN, thiab nws zoo ib yam li lwm yam tshuaj ntsig txog AIN. Thaum xav tias PPIs-AIN, PPIs yuav tsum raug tso tseg tam sim ntawd, cov tsos mob thiab kev txhawb nqa yuav tsum tau muab, thiab kev hloov pauv hauv creatinine yuav tsum tau saib xyuas zoo.
Cov hauv paus ntsiab lus ntawm kev kho mob rau cov tshuaj tua kab mob AKI yog kev txheeb xyuas sai thiab tshem tawm cov tshuaj raws sij hawm; tswj dej thiab electrolyte tshuav nyiaj li cas, tswj kev ruaj khov nyob hauv ib puag ncig, thiab pab txhawb kev rov ua haujlwm ntawm lub raum. Nyob rau tib lub sijhawm, kev txhawb nqa zaub mov thiab nws cov kev kho mob kuj tseem ceeb. Feem ntau, tom qab cov tshuaj raug tso tseg raws sijhawm, feem ntau ntawm lub raum ua haujlwm tuaj yeem rov qab los.
Yuav tiv thaiv kev raug mob raum li cas?
Ua ntej tshaj plaws, koj yuav tsum nug txog keeb kwm ntawm kev tsis haum tshuaj ua ntej siv cov tshuaj, thiab koj yuav tsum tswj hwm cov lus qhia ntawm ntau yam tshuaj kom tsis txhob muaj kev tsim txom. Ua tib zoo saib xyuas cov koob tshuaj thiab kev kho mob hauv daim ntawv thov tshuaj, thiab ua tib zoo saib xyuas cov zis enzyme, cov zis protein, cov zis sediment, thiab lub raum ua haujlwm thaum siv tshuaj.
Rau cov neeg uas muaj lub raum tsis ua haujlwm, sim xaiv cov tshuaj uas muaj nephrotoxicity tsawg dua. Rau qee tus neeg mob, cov tshuaj muaj feem ntau yuav ua rau lub raum puas, xws li cov neeg laus (hnub nyoog> 60 xyoo), cov neeg mob uas muaj lub raum tsis txaus [glomerular filtration rate GFR<60ml/(min·1.73m2)], hypovolemia, combined use of multiple nephrotoxic drugs, diabetes, heart failure, and sepsis. Renal function should be evaluated before the above-mentioned patients are administered, and the dosage and interval of administration should be adjusted according to the creatinine clearance rate.
Tsis tas li ntawd, qee cov tshuaj muaj nyob rau hauv nephrotoxic, thaum lwm tus ua rau lub raum puas nyob rau hauv ib koob tshuaj los yog nyob ntawm lub sij hawm. Kev siv ua ke ntawm ntau yam tshuaj nephrotoxic tuaj yeem ua rau muaj kev sib koom ua ke thiab ua rau muaj kev pheej hmoo ntawm lub raum raug mob. Thaum siv ob peb yam tshuaj ua ke, yuav tsum tau them nyiaj mloog rau kev cuam tshuam ntawm ib leeg, thiab kev thov ib txhij ntawm ntau tshaj ob yam tshuaj lom neeg raug txwv.
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