Cov txiaj ntsig cuam tshuam thiab kev tuag ntawm cov neeg tau txais kev hloov pauv hauv lub raum thaum lub sijhawm COVID-19 Tus Kab Mob Sib Kis Ⅱ
Nov 30, 2023
Kev sib tham
Txoj kev tshawb no qhia tau hais tias 17% poob rau hauv tsev kho mob nkag tsis muaj qhov cuam tshuam raucov neeg tau txais kev hloov raum mus ntevmuaj kev ua haujlwm grafts thaum ntxovCOVID-19 kis thoob qhov txhia chawnyob rau hauv lub teb chaws Yelemees. Cov kev hloov pauv tseem ceeb hauv cov tshuaj tiv thaiv kab mob tsis tshua muaj tab sis tau cuam tshuam nrog kev pheej hmoo ntawm allograft rejection. Txhua qhov ua rau tuag tseem tsis hloov pauv thaum muaj kev sib kis.
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Qhov pom qhov txo qis hauv kev nkag mus rau qhov sib txawv ntawm cov pej xeem (5,6). Qhov kev txo qis no feem ntau cuam tshuam tsis yog-COVID-19- cuam tshuam cov kab mob sib kis, uas tej zaum yuav yog vim muaj kev tu cev zoo dua, hnav lub npog ntsej muag, thiab kev nyob sib nrug deb (23). Kev nkag mus rau cov kab mob plawv thiab allograft rejections tseem nyob ruaj khov, qhia txog kev pheej hmoo siab ntawmcov kab mob no rau cov neeg tau txais kev hloov raum. Txawm li cas los xij, qhov tsis muaj qhov rov qab los rau ib qho ntawm cov kab mob tshawb fawb tom qab kev kaw tseg qhia tias tsis muaj qhov tshwm sim tsis zoo ntawm kev poob qis hauv kev nkag. Qhov no tau hais ntxiv los ntawm cov teeb meem hauv tsev kho mob ruaj khov, txawm tias thaum lub sijhawm kaw. Muab hais tias feem ntau mob los yog subacute graft tsis ua hauj lwm thiab kev kho mob dialysis raucov neeg tau txais kev hloov lub raumraug kho raws li cov neeg mob nyob hauv lub tebchaws Yelemes, peb qhov kev tshawb pom qhia tias kev poob qis kuj tseem nyob ruaj khov thaum muaj kev sib kis. Ua ke, qhov txo qis hauv kev nkag mus ib ntus zoo li muaj kev nyab xeeb. Qhov no kuj tseem tuaj yeem cuam tshuam rau kev saib xyuas dav dav ntawm cov neeg tau txais lub raum mus sij hawm ntev vim tias cov neeg mob tau txais txiaj ntsig yuav raug kho raws li cov neeg mob sab nraud.
Raws li qhov sib txawv ntawm qhov cuam tshuam ntawm kev nkag mus, tsuas muaj kev hloov maj mam hloov hauv kev saib xyuas tshuaj. Txawm hais tias muaj kev sib cav txog nws txoj kev cuam tshuam ntawm COVID-19 (24), tsis muaj kev poob qis hauv kev txhiv cov angiotensin-hloov pauv enzyme inhibitors. Statins tau siv ntau zaus hauv xyoo 2020, uas yuav yog vim muaj cov lus qhia nruj dualipid-txo txoj kev kho(25). Txawm hais tias kev txo koob tshuaj yog tag nrho me me, qhov kev txo qis ntawm cov tshuaj tiv thaiv kab mob piv nrog cov tshuaj mob plawv sib cav rau cov teebmeem tshwj xeeb. Raws li peb qhov kev tshuaj xyuas tau txwv rau cov neeg mob uas tsis tau pw hauv tsev kho mob nrog COVID-19 thiab rau cov neeg mob sab nraud, kev kho mob COVID-19 feem ntau tsis tshua muaj nyob hauv cov neeg tau txais kev hloov pauv (26). Qhov kev tshawb pom no yuav tshwm sim los ntawm kev cuam tshuam nyiaj txiag. Txawm hais tias peb txoj kev tshawb fawb tsis tuaj yeem txheeb xyuas qhov tseeb ntawm qhov laj thawj ntawm qhov kev soj ntsuam no, kev ceeb toom dav dav thaum muaj kev sib kis thoob ntiaj teb, yav dhau los COVID-19 kev sib cuag, thiab kev saib xyuas kev noj qab haus huv ntau dua nrog tsawg dua CNI-theem tswj yuav pab tau. Qhov kev nyiam rau kev hloov pauv hauv CNI koob tshuaj tuaj yeem piav qhia los ntawm qhov yooj yim tuaj yeem hloov kho lub hom phiaj trough theem, thiab kev txo qis steroid tuaj yeem piav qhia los ntawm kev koom tes ntawm kev siv cov tshuaj steroid mus ntev nrog cov txiaj ntsig zoo ntawm COVID-19 (26,27). Cov teebmeem me me ntawm cov tshuaj no yog vim ib feem peb ntawm cov neeg mob txo cov koob tshuaj tsawg kawg yog 25%. Rau CNI, qhov kev txo qis no ua rau muaj kev pheej hmoo ntawm kev tsis lees paub ntau ntxiv, txawm tias tom qab hloov kho rau qhov paub txog kev pheej hmoo. Qhov kev tshawb pom no yog ua raws li cov ntaub ntawv vim hais tias qhov tsim nyog CNI lub hom phiaj yog qhov tseem ceeb los tiv thaiv kev tsis lees paub ntawm allograft (28). Raws li cov ntaub ntawv qhia tias tsis muaj lossis tsuas yog me ntsis nce qhov kev tsis lees paub tom qab kev tshem tawm steroid lig, lub koom haum ntawm kev txo qis steroid nrog allograft rejections pom qhov tsis tseem ceeb thiab tsis muaj kev cuam tshuam ntxiv rau CNI txo (29).
Daim duab 3.|Tus nqi piv rau tag nrho tag nrho cov kev ua rau tuag nyob rau hauv 2020 piv nrog rau 2019. Tag nrho yog hais txog lub sijhawm txij lub Peb Hlis 15 txog Lub Cuaj Hli 30, thaum lub sijhawm kaw yog txij lub Peb Hlis 15 txog rau Lub Rau Hli 15 thiab theem tom qab kaw txij lub Rau Hli 16 txog Lub Cuaj Hli 30. Kev tshuaj xyuas tau ua rau txhua tus neeg mob thiab cov neeg mob uas tsis tau pw hauv tsev kho mob COVID-19 (tsis yog-COVID-19).COVID-19, kab mob khaus laus nas vais lav2019; RR, tus nqi piv txwv.
Txawm hais tias cov ntaub ntawv tau tshwm sim, nws tseem tsis tau paub meej tias cov neeg tau txais kev hloov pauv lub raum puas muaj kev pheej hmoo ntau ntxiv rau COVID{{0}} cov kab mob thiab cov kab mob tsis zoo (30–32). Cov ntaub ntawv tseem me me, tshwj xeeb tshaj yog hais txog qhov xwm txheej. Thaum lub sijhawm kawm, Lub Tebchaws Yelemees tau tshaj tawm qhov xwm txheej dav dav ntawm COVID-19 tshwm sim ntawm 0.35% (19) nrog 17% tus nqi pw hauv tsev kho mob (33). Piv nrog rau peb pawg, qhov no txhais tau tias yog 28-ntau ntxiv ntawm cov neeg tau txais lub raum hloov pauv mus pw hauv tsev kho mob nrog COVID-19 piv nrog cov pej xeem. Ib txoj kev tshawb fawb tsis ntev los no tau tshawb xyuas hauv tsev kho mob COVID-19 cov kev kawm hauv cov pej xeem ntawm cov ntaub ntawv pov hwm tib yam hauv lub sijhawm sib tshooj, tso cai sib piv ncaj qha (34). Kev tuag hauv tsev kho mob hauv qhov kev tshawb fawb no yog 22% thiab yog li yuav luag ob npaug piv nrog peb pawg. Hauv qhov sib piv, tus nqi lim ntshav tsuas yog 6%, txhais tau tias muaj kev pheej hmoo siab dua ob zaug hauv cov neeg tau txais kev hloov hauv lub raum. Qhov tsis tshua sib xws ntawm kev tsis lees paub allograft thiab COVID-19 tau pom nyob rau hauv peb txoj kev tshawb fawb tau tawm tsam qhov laj thawj ntawm kev tiv thaiv kab mob rau cov neeg mob ntshav qab zib ntau dua hauv cov neeg tau txais kev hloov hauv lub raum. Qhov tseeb, qhov kev pheej hmoo siab dua rau AKI hnyav yog tej zaum tshwm sim los ntawm ib qho kev xav rau cov txheej txheem sib txawv ntawmCOVID-19- cuam tshuam rau lub raum raug mobxws li kev puas tsuaj ncaj qha lossis tsis ncaj (35). Qhov qis dua rau kev nkag mus rau cov neeg tau txais kev hloov hauv lub raum, raws li qhia hauv cov ntaub ntawv tsis ntev los no, tuaj yeem piav qhia txog qhov sib txawv ntawm kev tuag (26). Paub cov xwm txheej txaus ntshai rau COVID-19 xws li hnub nyoog, ntshav qab zib, kab mob ntsws ntev, dementia, thiab kab mob plawv thiab daim siab kuj tau siv rau peb pawg (36). Tsis tas li ntawd, kev saib xyuas cov tshuaj nrog cov tshuaj steroids cuam tshuam nrog kev pheej hmoo mus pw hauv tsev kho mob nrog COVID-19. Qhov no txhawb nqa kev tshawb pom cuam tshuam txog kev siv steroid mus sij hawm ntev kom ua rau COVID-19 tshwm sim (26,27). Txawm hais tias qee qhov kev tshawb fawb tau txheeb xyuas qhov koob tshuaj ntau ntawm mycophenolate yog qhov muaj feem pheej hmoo rau COVID-19 hauv cov neeg tau txais kev hloov pauv hauv nruab nrog cev, feem ntau pom tsis muaj kev sib raug zoo (26,37–39). Hauv qhov sib piv, peb txoj kev tshawb fawb tau sib cav txog qhov tsis zoo ntawm mycophenolate nrog COVID-19. Qhov kev tiv thaiv no yog txhawb nqa los ntawm cov ntaub ntawv hauv vitro uas qhia txog kev tiv thaiv tus kabmob coronaviruses los ntawm mycophenolate (40). Thaum kawg, nws yuav ua rau muaj kev cuam tshuam ntawm cov koob tshuaj qis dua yog kev tiv thaiv thiab koob tshuaj ntau dua ua rau muaj kev pheej hmoo rau COVID-19.
Txawm hais tias COVID-19 muaj tus neeg tuag coob thiab suav txog 17% ntawm tag nrho cov neeg tuag tau pom hauv peb pawg, txhua qhov kev tuag tseem nyob ruaj khov. Qhov no kuj tau siv rau cov neeg mob uas tsis muaj COVID-19 cov chav kawm hnyav, qhia tias tsis muaj kev cuam tshuam rau kev tuag.
Rau qhov zoo tshaj plaws ntawm peb txoj kev paub, qhov no yog thawj qhov kev tshawb fawb soj ntsuam cov txiaj ntsig ntawm tus kab mob COVID-19 kis thoob qhov txhia chaw piv rau COVID-19- muaj feem cuam tshuam rau cov neeg tau txais kev hloov raum. Cov pej xeem txoj kev tshawb no yog ib qho ntawm cov kev hloov pauv loj tshaj plaws uas tau tshawb xyuas thaum lub sijhawm muaj kev sib kis thoob ntiaj teb thiab suav nrog kwv yees li 30% ntawm kwv yees tag nrho cov neeg tau txais kev hloov raum nrog kev ua haujlwm ntawm lub cev hauv lub tebchaws Yelemes (41,42). Hais txog cov yam ntxwv ntawm tus neeg mob feem ntau, peb cov kev sib koom ua ke zoo ib yam li lwm cov kev tshawb fawb txog kev hloov raum mus sij hawm ntev hauv lub teb chaws Yelemees thiab lwm lub teb chaws (43,44).
Txawm hais tias nws muaj zog, peb txoj kev tshawb fawb muaj ntau yam kev txwv. Peb txoj kev tshawb fawb tshawb xyuas cov neeg mob nyob rau lub sijhawm ntev tom qab hloov lub raum thaum lub sijhawm COVID-19 kis thoob lub tebchaws Yelemes. Nws tseem yuav raug tshuaj xyuas seb qhov kev soj ntsuam pom muaj feem cuam tshuam rau cov neeg mob uas tsis muaj kev cuam tshuam kev ua haujlwm ruaj khov lossis lwm lub tebchaws uas muaj qhov sib txawv ntawm COVID-19 tshwm sim. Tsis tas li ntawd, cov ntaub ntawv hais txog kev kho mob sab nraud raug txwv rau kev txhiv tshuaj. Cov teebmeem ntawm tus mob me thiab mob sab nraud-kho COVID-19 yog li tsis tuaj yeem tshawb xyuas. Txawm li cas los xij, qhov kev tsis ncaj ncees no yog qhov me me vim tias cov ntawv ceeb toom tau pom tias ,10% ntawm SARS-CoV-2- cov neeg tau txais lub raum zoo tau raug kho raws li cov neeg mob sab nraud (26). Cov ntaub ntawv ntawm cov txiaj ntsig kev sim kuj tsis muaj nyob hauv peb cov ntaub ntawv. Yog li peb tsis tuaj yeem qhia meej seb puas muaj kev tswj xyuas cov ntaub ntawv hauv chav kuaj tau yooj yim dua, suav nrog CNI qib, pab txhawb rau cov kev hloov pauv. Kev khaws cia thaum pib ntawm kev sib kis kuj tsis tuaj yeem raug cais tawm. Cov kev tshawb fawb rov qab yav tom ntej suav nrog cov ntaub ntawv kuaj mob thiab cov neeg mob sab nraud yuav pab tau ib feem kom kov yeej cov kev txwv no. Tsis tas li ntawd, cov kev tshawb fawb yav tom ntej yuav tsum muaj nyob rau yav tom ntej nthwv dej los qhia meej txog qhov kev hloov pauv thaum muaj kev sib kis.
Hauv kev xaus, txawm hais tias muaj kev hloov pauv ntau hauv cov nqi nkag, cov txiaj ntsig ntawm cov khoom lag luam thaum ntxov COVID-19 muaj kev sib kis tsis muaj kev cuam tshuam rau kev tuag lossis kev poob nyiaj poob haujlwm. Yog li, qhov txo qis ntawm kev nkag mus hauv tsev kho mob ib ntus zoo li muaj kev nyab xeeb. Txawm li cas los xij, txo cov tshuaj tiv thaiv kab mob tiv thaiv kab mob ua rau muaj kev pheej hmoo cuam tshuam rau allograft rejections thiab yuav tsum tau txwv rau cov xwm txheej tshwj xeeb. COVID-19 kev tuag yog siab tab sis tsis muaj feem cuam tshuam rau txhua qhov kev tuag.
Qhia tawm
TB Huber muaj kev sib tham nrog AstraZeneca, Boehringer-Ingelheim, DaVita, Deerfield, Fresenius Medical Care, GoldfinchBio, MantraBio, Novartis, thiab Retrophin, thiab tau txais kev tshawb fawb nyiaj txiag los ntawm Amicus thiab Fresenius Medical Care.
Tag nrho cov neeg sau ntawv tseem tshuav tsis muaj dab tsi los qhia tawm. Cov nyiaj F. Grahammer tau txais kev txhawb nqa los ntawm DFG (CRC 1192 thiab GR 3933/1-1). TB Huber tau txais kev txhawb nqa los ntawm DFG (CRC1192, HU 1016/8-2, HU 1016/11-1, thiab HU 1016/12-1), BMBF (STOPFSGS{10}}GM1901C thiab NephrESA-031L0191E), thiab DEFEAT PANDEMICs (01KX2021) uas yog ib feem ntawm National Network University Medicine (NUM).
Cov ntaub ntawv
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