Suav Cov Kws Tshaj Lij Pom Zoo Rau PG Tshuaj Rau Kev Kho Mob CKD tau raug tso tawm, Thiab 4 qhov kev txiav txim siab loj tsim nyog tau txais kev saib xyuas!
Sep 20, 2024
Cov tshuaj Prostaglandin (PG) tuaj yeem inhibit platelet aggregation, txo platelet hyperreactivity thiab thromboxane A2 qib; dilate microvessels thiab txhim kho lub raum cov ntshav khiav; thiab txhawb nqa vascular endothelial hlwb los tsim cov ntaub so ntswg plasminogen activator, uas muaj cov nyhuv thrombolytic. Tam sim no, PG tshuaj feem ntau yog tsim los ntawm PGE1 thiab prostacyclin (PGI2) analogs, thiab feem ntau yog siv hauv tsev kho mob los kho mob ntshav siab, kab mob plawv thiab cerebrovascular, pulmonary hypertension thiab arterial occlusive kab mob. Ntau cov kev tshawb fawb hauv tsev kuj qhia tias PGE1 thiab PGI2 tuaj yeem txo cov zis protein, txhim kho lub raum microcirculation, thiab txo cov kev mob hauv zos. Raws li qhov no, ntau tus kws tshawb fawb ntseeg tias PGE1 thiab PGI2 tuaj yeem kho cov neeg mob raum mob ntev (CKD) nrog hom 2 mob ntshav qab zib. Txawm li cas los xij, hauv kev kho mob, qee tus kws kho mob nephrologist tsis paub ntau txog PGE1 thiab PGI2.
Raws li cov laj thawj saum toj no, lub Cuaj Hlis 13, 2024, Tuam Tshoj Medical Association Journal Nephrology Expert Committee tau tshaj tawm thawj tus kws tshaj lij Suav pom zoo rau PG tshuaj rau kev kho mob ntshav qab zib hom 2 CKD, tshuaj xyuas cov txheej txheem ntawm PG tshuaj rau kev kho mob CKD cov neeg mob. , thiab tau npaj 11 qhov kev ceev faj uas yuav tsum tau ua tib zoo saib hauv kev kho mob.
Tshuaj mechanism
Txhim kho lub raum hemodynamics thiab txo cov vascular endothelial cell puas;
Txhim kho lub raum hypoxia thiab tiv thaiv thiab kho lub raum interstitial fibrosis;
Txo cov theem ntawm lub raum inflammatory yam thiab txo cov oxidative kev nyuaj siab teb;
Inhibit glomerular mesangial cell proliferation thiab txo cov extracellular matrix tsub zuj zuj
Txo kev puas tsuaj los ntawm glomerular immune complexes
Tshuaj mechanism
1 Cov lus pom zoo ntawm daim ntawv thov kev kho mob
① Nws raug nquahu kom siv cov tshuaj PGE1 lossis PGI2 rau kev kho mob tag nrho, nrog rau cov zis albumin excretion tus nqi thiab glomerular filtration tus nqi raws li kev soj ntsuam thiab kev txiav txim siab ua tau zoo:
Nws raug nquahu kom siv nws thaum ntxov, thiab cov tshuaj PGE1 lossis PGI2 tuaj yeem siv rau kev kho mob thaum muaj kab mob proteinuria thiab lub raum ua haujlwm. Thaum ua ke nrog raum tsis txaus, nws raug pom zoo tias cov tshuaj PGE1 lossis PGI2 tuaj yeem siv txuas ntxiv mus txog thaum lub raum lim ntshav lossis hloov lub raum.
② Raws li kev kho tus qauv rau CKD hauv cov neeg mob ntshav qab zib hom 2, cov tshuaj PGE1 lossis PGI2 tuaj yeem ua ke raws li qhov tsim nyog, lossis PGE1 ua ke nrog cov tshuaj PGI2 tuaj yeem siv ua ntu zus los txhim kho kev ua tau zoo. Raws li tus neeg mob cov zis protein, lub raum ua haujlwm thiab ntshav siab, kev sib xyaw ua ke ntawm PGE1 lossis PGI2 cov tshuaj siv los ntawm tus kheej siv cov tshuaj angiotensin-hloov enzyme inhibitors (ACEI) lossis angiotensin II receptor antagonists (ARB), sodium-glucose cotransporter 2 inhibitors (SGLT-2i), mineralocorticoid receptor antagonists thiab lwm yam tshuaj tuaj yeem txo qhov kev pheej hmoo ntawm cov hlab plawv thiab cov hlab ntsha, txo cov zis protein ntau tawm, thiab ncua kev poob qis hauv glomerular pom tus nqi.
③ PGE1 lossis PGI2 cov tshuaj tuaj yeem txhim kho tus neeg mob lub xeev hypercoagulable, thiab saib xyuas kev hloov pauv hauv coagulation muaj nuj nqi thaum siv: Clinically, kev hloov pauv hauv coagulation yuav tsum tau saib xyuas hauv cov neeg mob ntshav qab zib hom 2 CKD. Thaum muab tshuaj antiplatelet aggregation, anticoagulation thiab thrombolysis tshuaj, yuav tsum tau them nyiaj mloog mus rau kev pheej hmoo ntawm los ntshav rau cov neeg mob. PGE1 lossis PGI2 cov tshuaj tuaj yeem txhim kho tus neeg mob lub xeev hypercoagulable thiab muaj cov yam ntxwv ntawm kev pheej hmoo los ntshav tsawg.
④ Rau cov neeg mob uas tau noj tshuaj antiplatelet hauv qhov ncauj lossis tshuaj tiv thaiv coagulants thiab lwm yam tshuaj uas cuam tshuam rau kev ua haujlwm ntawm coagulation ntev, kev pheej hmoo los ntshav yuav tsum tau soj ntsuam tag nrho ua ntej siv cov tshuaj PGE1 lossis PGI2. Cov neeg mob uas muaj kev pheej hmoo los ntshav siab tsis pom zoo siv cov tshuaj PGE1 lossis PGI2 ua ke nrog ceev faj.
⑤ Kev siv cov tshuaj PGE1 lossis PGI2 rau cov neeg mob uas muaj cov kab mob plawv thiab cov hlab plawv (xws li kab mob plawv, ntshav siab, plawv tsis ua hauj lwm, cor pulmonale, cerebral infarction, thiab lwm yam) tuaj yeem pab txhim kho cov hlab plawv thiab cerebrovascular prognosis. PG tshuaj muaj cov teebmeem ntawm kev tiv thaiv platelet aggregation, tiv thaiv thrombosis, vasodilation ntawm vascular du leeg hlwb, thiab kev txhim kho ntawm lub cev microcirculation, thiab tau siv dav hauv cov kab mob plawv. Cov kab mob plawv thiab cerebrovascular yog qhov ua rau tuag ntawm cov neeg mob CKD. Rau hom 2 mob ntshav qab zib CKD cov neeg mob uas muaj cov kab mob plawv thiab paj hlwb ua ke, cov tshuaj PGE1 lossis PGI2 raug pom zoo rau kev kho mob.
2 Cov tshuaj ib leeg
Hauv kev siv tshuaj kho mob, ntau npaum li cas thiab chav kawm ntawm cov tshuaj PGE1 lossis PGI2 tus kheej yuav tsum tau tsim ua ke nrog tus neeg mob cov kab mob thiab kev kho tshuaj:
① Cov koob tshuaj pom zoo ntawm kev txhaj tshuaj alprostadil rau cov neeg laus mob ntshav qab zib hom 2 CKD yog 5-10 ug/d, thiab 7-14 hnub yog kev kho mob.
②Txawm li cas los xij, kuj tseem muaj cov ntaub ntawv siv tshuaj ntau hauv cov ntaub ntawv kho mob tiag tiag: Hauv kev tshawb fawb soj ntsuam hauv tsev, cov koob tshuaj alprostadil feem ntau yog 10 ~ 20ug / d, thiab 7 ~ 14 hnub yog ib qho kev kho mob; nyob rau hauv "Cov Kws Paub Pom Zoo ntawm Kev Ntsuas thiab Kev Kho Mob rau Hom 2 Ntshav Qab Zib Hauv Cov Neeg Laus hauv Suav Teb (2018 Tsab)", rau cov neeg mob uas muaj cov hlab ntsha loj atherosclerotic plaque tsim, tshwj xeeb tshaj yog cov neeg uas muaj cov kab mob qis qis hauv cov hlab ntsha occlusive, nws raug nquahu kom tsis tu ncua. infuse PGE1 tshuaj ntawm 10 ~ 20ug / d, thiab 10 ~ 20 hnub yog ib qho kev kho mob; Hauv kev tshawb fawb soj ntsuam ntawm alprostadil hauv kev kho mob ntshav qab zib ko taw, alprostadil tau siv ntawm koob tshuaj 40ug / d, tso dej tso rau hauv 3 lub lis piam sib law liag, thiab ua tiav cov txiaj ntsig zoo.
③ Cov neeg mob sab nrauv raug pom zoo kom siv beraprost sodium (BPS) rau kev kho qhov ncauj. Qhov pom zoo koob tshuaj BPS yog 40 ug / sijhawm, 3 zaug / d. Cov neeg mob yuav tsum noj nws qhov ncauj tom qab noj mov. Yog tias tsis muaj kev phiv xws li mob taub hau, nws tuaj yeem siv tau ntev.
3 Kev tsis zoo tshwm sim
① Kev tsis zoo tshwm sim dav dav:
Phlebitis ntawm qhov chaw txhaj tshuaj ntawm alprostadil; tawm pob, subcutaneous hemorrhage; mob taub hau, kiv taub hau, tinnitus; cov tsos mob ntawm digestive system ( nqhis dej, kub siab, xeev siab, ntuav, raws plab, mob plab, tsis qab los noj mov); kub taub hau, palpitations, daim tawv nqaij tawm. Kev kho mob tuaj yeem muab tau, thiab cov tshuaj tuaj yeem raug tso tseg yog tias tsim nyog.
② Cov kev phiv loj heev
Tej yam tshwm sim tshwm sim tshwm sim, xws li: los ntshav, poob siab; interstitial pneumonia; daim siab puas; angina pectoris; myocardial infarction. Thaum muaj kev phiv loj heev tshwm sim, tshuaj yuav tsum raug tso tseg thiab yuav tsum tau muab kev kho mob tsim nyog.
4 Lwm yam kev ceev faj
Cov xwm txheej hauv qab no raug txwv:
① Cov poj niam cev xeeb tub lossis cov poj niam cev xeeb tub raug txwv;
② Cov neeg mob los ntshav;
③ Cov neeg uas muaj keeb kwm tsis haum rau hom tshuaj no.
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 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.
