Clinical Effects of Traditional Chinese Medicine nyob rau hauv ncua kev loj hlob ntawm lub raum tsis ua hauj lwm

2 Kev soj ntsuam cov txiaj ntsig ntawm cov tshuaj suav tshuaj hauv kev ncua kev loj hlob ntawm lub raum tsis ua haujlwm

Clinically, muaj ob theem tseem ceeb ntawmlub raum tsis ua haujlwmhauv cov neeg mob uas muaj CRF. Thaum ntxov ntawm mob melub raum ua haujlwmkev poob qis yog sib npaug rau CKD theem 3, uas yog, tusglomerular pom tus nqi(GFR) poob rau 30-59 mL/(min·1.73 m2). Nyob rau theem no, cov neeg mob feem ntau tsis muaj cov tsos mob pom tseeb, tab sis tsuas yog nce me ntsis xwbntshav creatinine(Scr) thiab ntshav urea nitrogen (BUN). Qee cov neeg mob tuaj yeem nrog cov nocturia thiab qaug zog ntawm lub hlwb. Cov tsos mob xws li lub zog, mob nraub qaum thiab lub hauv caug tsis muaj zog. Kev xyaum kho mob qhia tau hais tias nyob rau theem no, cov tshuaj suav tshuaj tuaj yeem txhim kho glomerular filtration muaj nuj nqi thiab ncua kev loj hlob ntawm CRF. Lwm theem yog theem ntawm kev poob qis rau hauv lub raum, uas yog sib npaug rau CKD theem 4 thiab 5.

Yog xav paub ntxiv txog Cistanche Txhim Kho raum Ua Haujlwm

Vim muaj ntau yam nitrogen metabolism toxins hauv tus neeg mob lub cev thiab kev cuam tshuam ntawm dej, electrolyte, thiab acid-base tshuav nyiaj li cas, qhov chaw kho mob tshwm sim ntawm kev ua haujlwm puas tsuaj rau ntau yam kabmob thiab lub cev ntawm lub cev. Nyob rau theem no, lub luag haujlwm ntawm cov tshuaj suav tshuaj yog qhov tseem ceeb hauv kev txhim kho cov teeb meem xws li "kab mob plab, mob plawv, calcium / phosphorus metabolism, tsis muaj zaub mov noj, endocrine abnormality, thiab kev tiv thaiv qis" hauv CRF cov neeg mob. Raws li rau cov co toxins rau uremia, tshwj tsis yog cov tshuaj organic me me molecular, xws li BUN, Scr, uric acid (UA), guanidine, thiab lwm yam, cov tshuaj suav tshuaj tseem muaj qee yam kev tshem tawm rau "cov tshuaj nruab nrab molecular thiab cov tshuaj hormone macromolecular" cov nyhuv. .

2.1 Cov nyhuv ntawm cov tshuaj suav tshuaj rau lub raum ua haujlwm

Tus kws tshawb fawb Nyij Pooj Mizuma Zhongdao tau siv Wenpi Decoction (rhubarb, aconite, ginger qhuav, ginseng, licorice) los kho 8 CRF azotemia cov neeg mob thiab tau ua 5- xyoo tom qab tus neeg mob sab nraud. Ntawm lawv, 5 tus neeg mob tau txais tag nrho cov kev kho mob. Wenpi Decoction tau muab tshuaj raws li ib qho tshuaj rau (207. 0 ± 110. 5) lub lis piam, thaum tus neeg mob tau txais cov tshuaj antihypertensive thawj zaug, diuretics, thiab tshuaj antiplatelet aggregation, ntshav uric acid-txo. tshuaj, thiab tshuaj kho electrolyte. Cov khoom soj ntsuam muaj xws li Scr, BUN, UA, serum potassium (K plus), serum calcium (Ca2 plus), serum phosphorus (P3 plus) thiab lwm yam. Tus sau tau siv txoj kev Mitch ib txwm siv los suav 1/Scr los txiav txim tus nqi ntawm lub raum puas, thiab qhov kawg yog Scr 880.4 μmol·L -1.

Cov txiaj ntsig tau pom tias Wenpi Decoction txhim kho 1 / Scr, lub sijhawm nkag mus rau kev lim ntshav hauv cov neeg mob CRF tau ntev mus rau (262. 0 ± 145. 8) lub lis piam, thiab Scr nce los ntawm (397. 8 ± 212. 16) μmol·L - 1 ua ntej kev kho mob To (742. 56 ± 318. 24 ) μmol·L - 1 , BUN nce los ntawm ( 13. 57 ± 4. 11) mol · L - 1 rau (31. 09 ± 10. 89) mmol · L - 1 ua ntej kho 1. Ntshav P3 ntxiv los ntawm (1. 39 ± 0. 25) mmol·L {{ 31}} rau (1. 71 ± 0. 35) mmol · L - 1 ua ntej kho, thaum ntshav

K plus , blood Ca2 plus , UA tsis hloov loj. Cov kws sau ntawv ntseeg tias kev siv lub sijhawm ntev ntawm Wenpi Decoction tuaj yeem ncua kev loj hlob ntawm CRF cov neeg mob mus rau theem kawg ntawm lub raum kab mob [37].

Guo Zhaoan et al. randomly faib 194 CRF cov neeg mob nrog Scr ntawm 177 thiab 707 μmol·L - 1 rau hauv ib pawg kho mob (128 tus neeg mob) thiab pawg tswj hwm (66 tus neeg mob). Cov neeg mob hauv pab pawg kho mob tau kho nrog nitrogen-clearing enema tov (rhubarb, dandelion, raw peony, siav aconite, salvia, thiab lwm yam), thiab cov neeg mob hauv pawg tswj tau kho nrog aldehyde-oxidized starch.

Tus kws sau ntawv tau soj ntsuam cov tsos mob, cov cim qhia, thiab lub raum kev ua haujlwm ntsig txog qhov ntsuas ntawm ob pawg ntawm cov neeg mob ua ntej thiab tom qab kev kho mob, thiab tseem tsom mus rau kev sib piv ntawm cov tshuaj hauv nruab nrab molecular (MMS), parathyroid hormone (PTH), ntshav Ca2 ntxiv, Ntshav Hloov hauv cov ntsuas xws li P3 ntxiv. Cov txiaj ntsig tau pom tias hauv pab pawg kho mob, 74 tus neeg mob tau txais txiaj ntsig zoo, 38 tau ua haujlwm tau zoo, 16 tau ua haujlwm tsis zoo, nrog rau tag nrho cov txiaj ntsig ntawm 87.5 feem pua; nyob rau hauv pawg tswj hwm, 18 tau txais txiaj ntsig zoo, 26 tau txais txiaj ntsig, thiab 22 tau ua haujlwm tsis zoo, nrog rau tag nrho cov txiaj ntsig ntawm 66.5 feem pua. 7 feem pua; qhov sib txawv ntawm tag nrho cov txiaj ntsig ntawm ob pawg tseem ceeb heev (P ＜ 0.01); Tom qab kev kho mob nrog cov nitrogen-clearing enema, cov tsos mob thiab cov qhab nia ntawm cov neeg mob hauv pab pawg kho mob poob qis, thiab piv nrog cov pab pawg tswj, qhov sib txawv tseem ceeb (P ＜ 0. 05 ), thiab cov ntshav MMS, PTH, Ca2 ntxiv, P3 ntxiv yog tag nrho qis dua cov ua ntej kev kho mob (P ＜ 0. 05 lossis P ＜ 0. 01), piv nrog rau pawg tswj hwm, qhov sib txawv tseem ceeb ( P <>

Cov kws sau ntawv ntseeg tias raucov neeg mob uas tsis tau lim ntshavNrog CRF, nitrogen-clearing enema tuaj yeem txhim kho lub raum ua haujlwm thiab tswj cov calcium / phosphorus metabolism tsis zoo [34]. Cov kev tshawb fawb pom tau hais tias cov tshuaj ntsuam xyuas uas tuaj yeem cuam tshuam lub raum tsis ua haujlwm thaum ntxov tseem yog cov tshuaj cystatin protease inhibitors [xa mus rau cystatin C (CysC)] [38]. Cov kws tshawb fawb hauv tsev Dong et al. tau pom 68 tus neeg mob CRF nrog rau lub raum ua haujlwm them nyiaj rau theem (sib npaug rau CKD theem 2). Cov neeg mob tau muab faib ua pawg kho mob thiab pawg tswj hwm nrog 34 tus neeg mob hauv txhua tus. Cov neeg mob hauv pawg tswj hwm tau txais kev kho mob yooj yim nrog kev noj zaub mov tsis tshua muaj protein thiab phosphorus tsawg, thaum cov neeg hauv pab pawg kho mob tau muab Guben Qudu Yishen Decoction (Sheng Astragalus,Cistanchedeserticola, Eucommia ulmoides, Suav yam, Poria, Polyporus, Alisma, Danshen, Ji Snow nyom, Lub rau hli ntuj daus, rhubarb, dogwood, thiab lwm yam) hais lus.

Thaum lub sijhawm 48 lub hlis, CysC, Scr, BUN, thiab GFR ntawm 2 pawg neeg mob tau soj ntsuam txhua 3 lub hlis. Cov kws sau ntawv pom tias CysC, Scr, thiab BUN ntawm pawg tswj hwm tsis hloov pauv ntau ua ntej thiab tom qab kev kho mob, thiab GFR poob ntawm (66. 86 ± 6. 43) mL·min - 1 rau (42. 34 ± 3. 28) mL ua ntej kev kho mob ·min - 1, thaum cov neeg mob hauv pab pawg kho mob tau txais Guben Qudu Yishen Decoction ua ke nrog kev noj zaub mov tsis tshua muaj protein ntau thiab kev kho mob tsawg-phosphorus rau 48 lub hlis, lawv CysC, Scr, thiab BUN txhua tus tau pom qhov kev poob qis, tshwj xeeb tshaj yog CysC, Scr txhim kho pom tseeb, CysC Los ntawm ua ntej kev kho mob (3. 85 ± 1. 23) g · L {{20}} rau (2. 13 ± 0. 83) g·L - 1, Scr txo los ntawm ua ntej kev kho mob (135. 28 ± 39. 88) μmol · L -1 txo mus rau (95.26 ± 14.69) μmol·L {{35 }}. Yog li ntawd, cov kws sau ntawv ntseeg tias rau cov neeg mob CKD2 nrog rau lub raum ua haujlwm them nyiaj, txoj cai hloov pauv ntawm CysC yog tib yam li ntawm Scr, uas tuaj yeem cuam tshuam txog kev ua haujlwm ntau dhau ntawm glomerulus; Guben Qudu Yishen Decoction ua ke nrog cov khoom noj muaj protein tsawg thiab tsawg-phosphorus tuaj yeem ncua sijhawm ntxov CRF. Txo glomerular filtration muaj nuj nqi hauv cov neeg mob [39].

Cov kev tshawb fawb tsis ntev los no tau pom tias txoj hnyuv plab ua ke nrog cov tshuaj suav tshuaj-Cistancheretention enema yog ib txoj hauv kev tseem ceeb los txhim kho kev ua tau zoo ntawm cov tshuaj suav tshuaj hauv kev kho CRF.

Muaj 72 tus neeg mob tsis-dialysis CRF (sib npaug rau CKD theem 3 txog 5), 36 hauv pab pawg kho mob thiab 36 hauv pawg tswj.

Cov neeg mob nyob rau hauv ob pawg tau kho nrog txoj hnyuv dialysis ua ke nrog cov tshuaj suav suav tshuaj retention enema lossis tshuaj suav tshuaj suav tshuaj khaws cia ib leeg thaum tau txais kev kho mob yooj yim (xws li kho cov dej, electrolyte, acid-base tshuav nyiaj li cas, txhim kho ntshav qab zib, thiab qis- zoo protein noj, thiab lwm yam). Cov neeg mob hauv pab pawg kho mob thawj zaug tau txais kev ntxuav cov hnyuv tag nrho, thiab tom qab ntawd txoj hnyuv plab rau 40 feeb. Tom qab kev lim ntshav, lawv tau muab Jiedu Xiezhuo No. Ⅱ tshuaj suav tshuaj suav tshuaj (raw rhubarb, calcined keel, calcined oyster, sophora japonica, Junexue, tuckahoe, tag nrho Scorpion, Dilong, thiab lwm yam) retention enema (2 mus rau 3 h); Cov neeg mob hauv pawg tswj hwm tsuas yog tau txais kev tuav pov hwm enema nrog tib cov tshuaj suav tshuaj. Lub sijhawm kho yog 2 lub lis piam.

Cov kws sau ntawv piv cov kev hloov pauv ntawm TCM syndromes, BUN, Scr, creatinine clearance rate (Ccr), UA ntawm ob pawg neeg mob ua ntej thiab tom qab kho. Cov txiaj ntsig tau pom tias tag nrho cov txiaj ntsig zoo ntawm pab pawg kho mob yog 88.9 feem pua, uas yog qhov zoo dua li ntawm pawg tswj hwm (69.4 feem pua) (P < 0.05).="" cov="" kws="" sau="" ntawv="" ntseeg="" tias="" txoj="" hnyuv="" plab="" tuaj="" yeem="" tso="" zis="" toxins="" hauv="" txoj="" hnyuv="" loj="" los="" ntawm="" kev="" sib="" pauv="" thiab="" nqus="" ntawm="" dialysate="" hauv="" txoj="" hnyuv="" lumen.="" cov="" kua="" dej="" ncaj="" qha="" mus="" txog="" qhov="" qis="" qis,="" uas="" tsis="" yog="" tsuas="" yog="" nthuav="" dav="" qhov="" chaw="" sib="" cuag="" ntawm="" cov="" hnyuv="" mucosa="" thiab="" cov="" tshuaj="" suav="" tshuaj,="" tab="" sis="" kuj="" tseem="" khaws="" cov="" tshuaj="" suav="" tshuaj="" hauv="" cov="" hnyuv="" rau="" lub="" sijhawm="" ntev,="" yog="" li="" ua="" rau="" kev="" nqus="" ntawm="" cov="" tshuaj="" suav="" tshuaj.="" .="" yog="" li="" ntawd,="" txoj="">

Nws tau raug tshuaj xyuas tias kev sib xyaw ua ke ntawm cov tshuaj suav tshuaj suav tshuaj khaws cia tuaj yeem txhim kho cov txiaj ntsig ntawm cov tshuaj suav tshuaj hauv kev kho CRF [40].

2.2 Cov txiaj ntsig ntawm cov tshuaj suav tshuaj hauv cov teeb meem ntawm uremia

Kev xyaum qhia tau hais tias suav tshuaj muaj qee yam kev txhim kho ntawm daim tawv nqaij khaus thiab cov leeg pob txha cuam tshuam nrog hemodialysis hauv cov neeg mob uas muaj CRF (uremia). Cov tawv nqaij khaus yog ib qho mob tshwm sim hauv cov neeg mob uremia, thiab nws cov txheej txheem yuav cuam tshuam nrog kev tso tawm histamine lossis calcium / phosphorus metabolism cuam tshuam. Huang Xiaoqin et al siv auricular acupuncture ntxiv rau cov tshuaj suav suav tshuaj da dej los kho cov tawv nqaij khaus hauv cov neeg mob CRF. Cov kws sau ntawv tau muab faib ua 104 cov neeg mob uremia uas khaus tawv nqaij mus rau hauv pab pawg niaj hnub, pab pawg da dej, thiab acupuncture ntxiv rau pab pawg da dej. , qus chrysanthemum, thiab lwm yam), acupuncture (pob ntseg ntsiab lus xws li lub siab, spleen, endocrine, adrenal caj pas, diaphragm, Shenmen, Fengxi, thiab lwm yam) ntxiv rau cov tshuaj da dej kho. Cov txiaj ntsig tau pom tias qhov degree ntawm pruritus hauv ob pab pawg da dej thiab cov tshuaj acupuncture ntxiv rau cov tshuaj da dej tau txo qis tom qab kev kho mob, thiab muaj qhov sib txawv tseem ceeb ntawm cov qhab nia ntawm cov pab pawg (P ＜ 0). {{ 5}}5 or P ＜ 0. 01). Cov nyhuv ntawm cov tshuaj acupuncture ntxiv rau pab pawg da dej tau zoo dua li cov tshuaj da dej thiab pab pawg niaj hnub (P ＜ 0. 01). Cov kws sau ntawv ntseeg tias auricular acupuncture ntxiv rau cov tshuaj suav suav da dej muaj txiaj ntsig zoo rau cov tawv nqaij khaus hauv cov neeg mob uremia [41]. Hinoshita thiab al xaiv 5 tus neeg mob uas muaj cov leeg mob hnyav ntawm kev saib xyuas hemodialysis thiab kho lawv nrog shakuyaku-kanzo-rau granules (6 g ib hnub) rau 4 lub lis piam. Cov kws sau ntawv pom tias cov leeg nqaij spasms tau ploj mus hauv 2 tus neeg mob, thiab qhov zaus ntawm cov leeg nqaij spasms hauv 3 tus neeg mob tau qis dua qhov ua ntej kev kho mob, thiab cov degree kuj pom tseeb. alleviated, thiab, thaum lub sij hawm kho, tsis muaj kev phiv tshuaj. Yog li, cov kws sau ntawv ntseeg tias Shaoyao Gancao Decoction tuaj yeem tiv thaiv thiab kho cov leeg nqaij hauv cov neeg mob hemodialysis [42].

Yuav kom suav tau, cov txheej txheem ntawm Suav tshuaj ncua kev nce qib ntawm CRF feem ntau yog hais txog cov txiaj ntsig ntawm Suav tshuaj ntawm kev txhim kho glomerular sclerosis thiab lub raum interstitial fibrosis, piv txwv li, los ntawm kev cuam tshuam glomerular hemodynamics, txo cov podocyte puas, thiab inhibiting TGF- qhia. , kho lipid metabolism tsis meej los txhim kho glomerular sclerosis; txhim kho lub raum interstitial fibrosis los ntawm kev txo cov macrophage infiltration, inhibiting lub raum tubular epithelial cell transdifferentiation, thiab txo cov urinary protein toxicity. Kev kho mob ntawm cov tshuaj suav tshuaj hauv kev ncua sijhawm ntawm CRF yog qhov tseem ceeb hauv kev txhim kho lub raum ua haujlwm thiab qee yam teeb meem. Tsis tas li ntawd, cov tshuaj suav kuj muaj qee yam kev txhim kho ntawm calcium / phosphorus metabolism tsis txaus, micro-inflammatory xeev, thiab uremic toxin tsub zuj zuj hauv cov neeg mob uas muaj CRF siab heev. Cov kws tshawb fawb Nyij Pooj kuj pom qhov ntawdCistanchetuaj yeem hloov cov tshuaj hormones los kho peritoneal fibrosis (retroperitoneal fibrosis, RF) hauv CRF cov neeg mob uas tau kuaj xyuas peritoneal [43].

Tus kws sau ntawv ntseeg tias theem azotemia yog theem kab mob ruaj khov thaum lub sij hawm kev loj hlob ntawm CRF, uas feem ntau kav ntev dua 5 txog 10 xyoo. Nyob rau theem no, tus neeg mob tseem tsis tau tsim muaj kab mob ntau yam kab mob hnyav, thiab cov yam ntxwv ntawm kev kho mob kuj pom tseeb. Yog li ntawd, theem azotemia yog theem zoo tshaj plaws los qhia meej txog kev kho mob ntawm cov tshuaj suav tshuaj hauv kev ncua sijhawm ntawm CRF. Cov kws tshawb fawb hauv tsev yuav tsum sau cov qauv loj ntawm cov ntaub ntawv kho mob raws li qhov ua tau los nthuav tawm cov cai ntawm TCM syndromes thiab xaiv cov phiaj xwm kho mob thiab cov tshuaj kom paub meej txog qhov tshwm sim tiag tiag ntawm TCM hauv kev txhim kho lub raum kev ua haujlwm. Raws li kev tshawb fawb ntawm pharmacological mechanism, nws tseem yuav tsum tau tsom mus rau glomerulosclerosis thiab lub raum interstitial fibrosis. Yog li ntawd, nws yog ib qho tseem ceeb heev los tsim kom muaj tus qauv ua neej nyob ntawm kev loj hlob glomerulosclerosis nrog raum tsis ua haujlwm. Txawm hais tias tus qauv 5/6 nephrectomy tsis muaj cov tshuaj tiv thaiv kab mob sib kis, tseem tsis muaj kev cuam tshuam tsis zoo rau kev kuaj pom hyperfiltration hauv cov nephrons nyob hauv cov qauv, txawm li cas los xij, tus qauv no muaj cov kab mob glomerulosclerosis, yog li ntawd, nws tau raug lees paub los ntawm cov kws tshawb fawb. hauv tsev thiab txawv teb chaws.

Tsis tas li ntawd, lwm tus qauv glomerulosclerosis tau tsim los ntawm Lub Tsev Haujlwm ntawm Nephrology, Niigata University, Nyiv [44]. Munich Wistar nas thawj zaug tau txais unilateral nephrectomy, thiab tom qab ntawd, ib zaug txhaj tshuaj tiv thaiv Thy-1.1 monoclonal antibody, cov nas qauv tsim kev loj hlob. glomerulosclerosis thiab lub raum tsis txaus nyob rau lub lim tiam thib 2 tom qab ua qauv; nyob rau lub lim tiam 7, Lub 24- teev tso zis protein ntau thiab BUN ntawm cov qauv nas nce mus rau 229.3 mg thiab 2 171 mg·L - 1, raws li. Ntawm lawv, glomerular hemodynamics cuam tshuam (glomerular hemodynamics turbulence) yog qhov tseem ceeb ua rau kev loj hlob ntawm glomerular sclerosis hauv cov qauv nas. Tus kws sau ntawv ntseeg tias nrog kev pab ntawm tus qauv no, cov nyhuv thiab cov txheej txheem ntawm cov tshuaj suav tshuaj hauv kev ncua sijhawm ntawm CRF tuaj yeem qhia ncaj qha hauv vivo.

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