Cov Neeg Mob Nrog Advanced CKD puas tuaj yeem txaus siab rau Kev Noj Qab Haus Huv Dawb?

Cov kev tshawb fawb yav dhau los tau lees paub tias kev noj zaub mov tsis muaj protein ntau tuaj yeem ncua kev loj hlob ntawm cov kab mob raum hauv cov neeg mob uas muaj kab mob raum (CKD). Cov qauv kev noj haus muaj xws li Mediterranean noj, DASH noj, thiab lwm yam. Feem ntau cov lus qhia pom zoo rau cov qauv kev noj haus saum toj no. Txawm li cas los xij, ib qho teeb meem nrog kev cog qoob loo raws li kev noj zaub mov yog kev noj cov poov tshuaj ntau ntxiv. Qhov no nyob rau hauv lem muaj feem xyuam rau cov kev pheej hmoo ntawm hyperkalemia nyob rau hauv cov neeg mob CKD. Rau cov neeg mob uas muaj CKD siab heev, kev noj zaub mov ntau dua cov poov tshuaj ntau ntxiv ua rau muaj kev pheej hmoo ntawm hyperkalemia. Yog li, yuav ua li cas txo qhov kev pheej hmoo ntawm hyperkalemia hauv cov neeg mob uas muaj cov protein tsawg CKD?

Nyem rau Cistanche rau mob raum

Tsis ntev los no, American Journal of Clinical Nutrition tau luam tawm ib qho kev tshawb fawb soj ntsuam, uas qhia tias sodium zirconium cyclosilicate (SZC) tuaj yeem txo cov ntshav potassium ntawm cov neeg mob nrog CKD ua ke nrog hyperkalemia (5.1 ~ 6.5mEq / L), kom ntseeg tau tias tus neeg mob noj zaub mov kom tsawg. lawv kom txaus siab rau cov zaub mov noj dawb thiab noj qab nyob zoo, ua kom tus neeg mob tau txais txiaj ntsig mus ntev.

kev tshawb fawb tsim

Qhov no yog 6- lub lim tiam ua tau, ib sab caj npab, qhib-label kev tshawb fawb soj ntsuam tsim los ntsuas seb SZC puas tuaj yeem tso cai rau cov neeg mob uas muaj CKD theem 4 txog 5 kom muaj kev nyab xeeb rau kev noj qab haus huv, cog qoob loo, nplua nuj nyob hauv cov zaub mov zoo. Cov txheej txheem suav nrog rau txoj kev tshawb no yog: ①Cov neeg mob uas muaj CKD theem 4 txog 5, kwv yees glomerular filtration rate (eGFR)<29ml/min/1.73㎡; not receiving dialysis treatment; combined with hyperkalemia at baseline (5.1~6.5mEq/L) , or are normokalemic but receive sodium polystyrene sulfonate (SPS) to treat hyperkalemia. For patients receiving SPS treatment, they need to stop taking the drug for 1 week before enrolling, and they can only be enrolled after hyperkalemia occurs. Exclusion criteria for the study were severe hyperkalemia (>6.5 mEq / L), comorbid inflammatory plob tsis so tswj syndrome, keeb kwm ntawm hypokalemia, thiab tsis muaj peev xwm sib txuas lus.

Txoj kev tshawb no kav ntev li 6 lub lis piam, thiab cov neeg mob tau txais cov protein tsawg

({0}}.6 ~ 0.8g/kg/d) noj zaub mov thiab sodium tsawg (<2.3g/d) diet. The only change is that in weeks 3 to 6, the diet will be switched to a high potassium diet (potassium ion intake of at least 3700 mg/d), while in weeks 0 to 2 it will be a low potassium diet (<2300 mg/d). During the entire study period, patients received SZC treatment to control serum potassium between 3.5 and 5.0 mEq/L.

Nws yog ib nqi sau cia hais tias qhov sib txawv ntawm lub lis piam 2 thiab 3 yog hais tias ntau cov nroj tsuag noj zaub mov ntxiv rau cov zaub mov, xws li zaub, txiv hmab txiv ntoo, taum, txiv ntseej, thiab lwm yam.

Cov ntsiab lus tseem ceeb ntawm txoj kev tshawb no yog kev tswj cov poov tshuaj hauv cov ntshav, thiab cov ntsiab lus thib ob yog kev noj zaub mov kom zoo, lub neej zoo, kev mob plab hnyuv, cuam tshuam rau cov tshuaj, thiab kev tshawb fawb txog kev nyab xeeb.

Cov txiaj ntsig tshawb fawb

Tag nrho ntawm 26 tus neeg mob tau suav nrog hauv txoj kev tshawb no, thiab txhua tus neeg mob ua tiav 6- txoj kev tshawb fawb lub lim tiam. Nyob rau hauv lub hauv paus, lub hnub nyoog nruab nrab yog 61 ± 13 xyoo, 65.4% yog txiv neej, 17 cov neeg mob muaj CKD theem 4, thiab 9 cov neeg mob muaj CKD theem 5. Feem ntau ua rau CKD yog immunoglobulin A (IgA) nephropathy, mob ntshav qab zib nephropathy, thiab glomerulonephritis. . Cov neeg mob feem ntau muaj kev noj zaub mov zoo ntawm lub hauv paus, thiab lub cev qhov hnyav qhia tau tias qee cov neeg mob hnyav dua.

Thaum pib ntawm txoj kev tshawb no, nyob nruab nrab ntawm 48 thiab 72 teev tom qab tus neeg mob coj SZC, tus neeg mob qhov nruab nrab cov ntshav cov poov tshuaj poob los ntawm lub hauv paus thiab tseem nyob rau hauv cov ntshav cov ntshav poov tshuaj (Daim duab 2a), tab sis qee cov neeg mob nyob rau hauv cov kab mob hyperkalemia. (Fig. 2b). Tom qab lub lim tiam thib 3, tus neeg mob cov ntshav cov ntshav tau pib maj mam nce ntxiv, tshwj xeeb tshaj yog nyob rau 5 thiab 6 lub lis piam (Daim duab 2 c). Raws li kev soj ntsuam los ntawm 24-h potassium ion excretion, poov tshuaj kom tsawg ntawm 0 mus rau 3 lub lis piam thiab nce los ntawm 3 mus rau 6 lub lis piam. Thaum lub sijhawm kawm, qhov koob tshuaj ntau tshaj ntawm SZC yog 10 g / d.

Hais txog kev noj zaub mov noj, piv nrog rau 0-3 lub lis piam, cov neeg mob noj cov fiber ntau thiab 11 cov as-ham tau nce ntau thaum lub sijhawm 4-6 lub lis piam, thiab cov txiv hmab txiv ntoo, zaub, thiab txiv ntoo tau nce ntxiv, thaum kev noj cov nqaij liab nce. Muaj qhov txo qis hauv kev noj haus thiab kev noj nqaij qaib thiab ntses ntau ntxiv, tsis muaj kev hloov pauv tseem ceeb ntawm tus neeg mob zaus lossis hom kev zom zaub mov. Hais txog qhov ntsuas ntsuas ntsuas, tsis muaj qhov sib txawv tseem ceeb.

Thaum kawg ntawm txoj kev tshawb no, cov neeg mob tau txhim kho lub neej zoo thiab kev ua si lub cev piv nrog cov hauv paus ntsiab lus, thiab tau tshaj tawm kev txaus siab nrog kev kho mob txuas ntxiv. Hais txog cov tsos mob ntawm plab hnyuv, cem quav yog feem ntau tab sis tsis tshua muaj txuam nrog SZC. Ib tus neeg mob tau tshaj tawm txog kev mob gout, tab sis nws tsis raug ntsuas raws li kev siv tshuaj raws li kev tshuaj xyuas kws kho mob.

Renin-angiotensin system inhibitors (RASi) yog ib qho ua rau muaj ntshav siab poov tshuaj hauv cov neeg mob CKD, thiab hauv txoj kev tshawb no, koob tshuaj thiab hom RASi tseem tsis hloov pauv.

During the 48 to 72 hours after SZC treatment, the patient's serum potassium remained within the normal range. In case of hyperkalemia, there was no serum potassium >6.5 mEq/L os<3.0 mEq/L during the follow-up period. In addition, echocardiography The picture does not show the situation of QTc>550ms ib.

kev sib tham tshawb fawb

Cov kev tshawb fawb yav dhau los tau qhia tias cov tshuaj potassium binders tshiab xws li SZC tuaj yeem tswj hwm hyperkalemia, tab sis cov neeg mob no yuav tsum tau xyuam xim rau lawv cov poov tshuaj ion kom tsawg. Txawm li cas los xij, txoj kev tshawb fawb no qhia tias txawm tias cov neeg mob hyperkalemia tuaj yeem noj zaub mov zoo dua thiab noj qab haus huv, uas tsis tau pom dua ua ntej. Hauv lwm lo lus, txawm tias cov neeg mob hyperkalemia hauv CKD theem 4 txog 5 tuaj yeem xaiv qhov kev noj zaub mov zoo dua thiab noj qab nyob zoo thaum tau txais kev kho mob SZC, yog li txhim kho tus neeg mob lub sijhawm ntev.

Kev noj cov poov tshuaj ion feem ntau yog los ntawm kev noj zaub mov, tshwj xeeb tshaj yog cov zaub mov cog. Hauv txoj kev tshawb no, cov neeg mob tau txais cov zaub mov txhua hnub raws li cov zaub mov noj uas suav nrog lawv cov txiv hmab txiv ntoo nyiam, zaub, legumes, txiv ntseej, nplej, nqaij, thiab / lossis qe thiab tsis cuam tshuam los ntawm cov ntsiab lus potassium. Thiab tswj hom lossis tag nrho cov zaub mov noj los ntawm tus neeg mob. Cov kws tshawb fawb tau lees paub cov neeg mob ua raws li kev noj zaub mov tshwj xeeb los ntawm kev soj ntsuam kev noj cov poov tshuaj los ntawm 24-h cov ntaub ntawv noj zaub mov thiab 24-h tso zis potassium.

Cov kev tshawb fawb yav dhau los tau pom tias kev noj cov poov tshuaj ion zoo li tsis cuam tshuam lossis tsis muaj zog cuam tshuam rau cov ntshav cov poov tshuaj; rau cov neeg mob uas muaj CKD theem 3 txog 4, mus sij hawm ntev (3 xyoos lossis 26 lub lis piam) kev noj cov txiv hmab txiv ntoo thiab zaub ntau yuav tsis ua rau lawv cov poov tshuaj ntau ntxiv. Ntshav potassium. Txawm li cas los xij, thaum cov neeg mob uas muaj cov poov tshuaj ntau dhau los lossis hyperkalemia noj cov poov tshuaj ntau dhau, tus neeg mob cov ntshav potassium yuav nce ntxiv. Piv nrog rau pawg tsawg poov tshuaj tsawg, qhov kev pheej hmoo ntawm hyperkalemia nyob rau hauv pab pawg neeg noj cov poov tshuaj siab tau nce ntxiv los ntawm 2.5 (95% CI, 1.04 ~ 6.{11}}; P=0.04).

Tsis tas li ntawd, txoj kev tshawb fawb no pom tau tias RASi tuaj yeem tswj cov neeg mob cov ntshav cov poov tshuaj tsis tau tso tseg cov tshuaj, tawm tswv yim tias hauv kev kho mob tiag tiag, kev noj zaub mov dawb + kev kho tshuaj yuav tsis dhau los ua qhov teeb meem tseem ceeb rau kev tswj cov poov tshuaj hauv SZC.

Hauv kev xaus, txoj kev tshawb no qhia tias cov neeg mob CKD siab heev uas tau txais kev kho mob SZC tuaj yeem txaus siab rau kev noj zaub mov zoo dua thiab noj qab haus huv, uas yuav pab lawv tau txais txiaj ntsig mus ntev.

Cistanche kho mob raum li cas?

Cistanche yog cov tshuaj suav tshuaj ntsuab siv rau ntau pua xyoo los kho ntau yam mob, suav nrog kab mob raum. Nws yog muab los ntawm cov stems qhuav ntawm Cistanche deserticola, ib tsob nroj nyob rau hauv cov suab puam ntawm Tuam Tshoj thiab Mongolia. Cov khoom tseem ceeb ntawm cistanche yog phenylethanoid glycosides, echinacoside, thiab acteoside, uas tau pom tias muaj txiaj ntsig zoo rau lub raum noj 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 nyhuv anti-inflammatory. 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 lub cev thiab lub cev, ua rau nws txoj hauv kev zoo rau kev kho mob raum.