COVID-19 Muaj feem cuam tshuam rau Kab mob raum. 4 Txoj Kev Kawm no qhia koj txog kev daws cov tswv yim

Tus kab mob COVID-19 thaum kawg ntawm 2019 zoo li tau ploj mus, tab sis muaj ntau tus neeg muaj keeb kwm ntawm tus kab mob COVID-19 hauv peb lub tebchaws. Yog li, cov neeg mob uas muaj keeb kwm ntawm tus kab mob COVID-19 puas yuav muaj kab mob raum ntau dua li cov neeg mob uas tsis tau kis tus kab mob COVID-19? Puas yog tus qauv kev loj hlob ntawm cov kab mob raum txawv ntawm cov neeg tsis muaj kab mob? Ntxiv rau, yuav tiv thaiv thiab kho lub raum puas los ntawm COVID-19?

Los ntawm lub Plaub Hlis 13 txog 16, 2024, 2024 World Congress on Nephrology (WCN) tau qhib hauv Argentina, lub tebchaws nyob deb tshaj ntawm peb lub tebchaws. Hauv lub rooj sib tham no, tag nrho ntau dua 1,000 abstracts tau nthuav tawm. Ntawm cov lus piav qhia no, 4 cov lus piav qhia qhia txog kev sib raug zoo ntawm COVID-19 thiab kab mob raum.

Nyem rau Cistanche rau mob raum

Cov ntaub ntawv tseem ceeb

① COVID-19 cov neeg mob muaj kev pheej hmoo ntawm kev tsim lub raum tsis txaus;

② Cov neeg mob rog rog COVID-19 muaj kev puas tsuaj rau glomerular ntau dua, uas tej zaum yuav cuam tshuam rau kev pheej hmoo ntawm mob raum;

③ COVID-19 tuaj yeem ua rau muaj kev ua kom ntau dhau ntawm cov kab ke ntxiv hauv cov neeg mob IgA nephropathy;

Rau cov neeg mob hemodialysis, tixagevimab thiab cilgavima tuaj yeem tiv thaiv kev kis kab mob thiab txo qhov kev pheej hmoo ntawm cov neeg mob mob hnyav tom qab kis tus kab mob COVID-19.

1 COVID-19 thiab lub raum tsis txaus 1

Kev tshawb fawb keeb kwm yav dhau los: Cov kev tshawb fawb yav dhau los tau pom tias thaum lub sij hawm kis tus kab mob COVID-19, cov neeg mob qhov kev pheej hmoo ntawm lub raum tsis ua haujlwm nce siab, suav nrog mob raum raug mob (AKI), kab mob glomerular, thiab mob raum mob (CKD). Txawm li cas los xij, cov txiaj ntsig mus ntev ntawm cov neeg uas tau zoo los ntawm COVID-19/ leej twg muaj tus kab mob COVID-19 mus ntev tseem yuav tau tshawb nrhiav ntxiv. Txhawm rau ntsuas qhov cuam tshuam ntawm COVID-19 rau tib neeg lub raum, cov kws tshawb fawb los ntawm Brazil tau ua qhov kev tshawb fawb no.

Kev tshawb fawb tsim: Txij Lub Xya Hli 2021 txog Lub Kaum Hli 2022, 45 tus neeg mob COVID-19 raug xa mus rau kev soj ntsuam hauv lub tsev kho mob nephrology. Cov yam ntxwv ntawm tus neeg mob lub hauv paus, cov ntaub ntawv nkag, thiab cov txiaj ntsig ntawm lub raum ua haujlwm tau raug kaw.

Research results: 31 patients were hospitalized due to COVID-19 complications, and the remaining patients were transferred to the Department of Nephrology after COVID-19 outpatient treatment. The main reasons for referral include COVID-19-related AKI, renal insufficiency after COVID-19 infection, and/or urinary system abnormalities (hematuria and proteinuria). The median age of patients was 61 (IQR 23 ~ 86) years, and 53.5% were male. The most common comorbidities were hypertension (80%), obesity (55.6%), and diabetes (42.2%). Among the hospitalized patients, 17 (54.8%) developed severe AKI requiring dialysis, and their renal function recovered before discharge. The median hospital stay was 32 days (IQR: 16-55 days), and the serum creatinine level at discharge was 1.32 (IQR: 1.05-1.70 mg/dL). Among all patients, hematuria occurred in 26.2% and proteinuria (>{{0}}.5g/g creatinine) hauv 21.2%. Ib tus neeg mob uas muaj nephrotic-ntau proteinuria (4.7 g / g creatinine) tau mus rau lub raum biopsy rau kev hloov pauv nephropathy tsawg. Tom qab kev soj ntsuam nruab nrab ntawm 164 hnub (IQR: 38 txog 458 hnub), qhov nruab nrab creatinine yog 1.4 mg / dL (IQR 0.6 txog 4.3), thiab qhov nruab nrab kwv yees glomerular pom tus nqi yog 49.7 mL / min / 1.73㎡ (IQR : 12.2 ~ 118.5). 26 tus neeg mob (57.8%) muaj eGFR <60 mL/min/1.73㎡. Hnub nyoog> 65 xyoo (RR=3.65; 95% CI, 1.21 ~ 10.46) thiab muaj ntau dua 3 comorbidities (RR=2.93; 95% CI, 1.27 ~ 6.76) cuam tshuam nrog eGFR <60ml/min/1.73㎡. Ib tus neeg mob thaum kawg xav tau kev lim ntshav peritoneal.

Kev tshawb fawb xaus: Zoo ib yam li qee cov ntawv tshaj tawm, ntau tus neeg mob yuav ua rau lub raum tsis ua haujlwm tom qab COVID-19 kis. Qhov no qhia txog qhov tseem ceeb ntawm kev saib xyuas lub raum hauv kev tswj hwm tus kab mob COVID-19. Ib txoj hauv kev muaj ntau txoj hauv kev suav nrog kev xa mus rau nephrology thaum ntxov, kev saib xyuas lub raum ua haujlwm tsis tu ncua, thiab cov tswv yim kho tus kheej tuaj yeem pab txo qis lub raum sequelae thiab txhim kho lub neej zoo hauv cov neeg mob no. Cov kev tshawb fawb ntxiv nrog cov pab pawg loj dua thiab kev soj ntsuam mus sij hawm ntev tau raug pom zoo kom nthuav tawm cov txiaj ntsig mus sij hawm ntev ntawm COVID-19 ntawm lub raum.

Yog li, cov neeg mob COVID-19 leej twg yuav muaj feem ntau yuav ua rau lub raum puas? Kev kawm tom ntej yuav qhia rau koj

2. Cov neeg mob rog rog COVID-19 thiab glomerular puas 2

Kev tshawb fawb keeb kwm yav dhau los: Cov kev tshawb fawb yav dhau los tau lees paub tias qhov kev cia siab ntawm cov neeg mob rog rog COVID-19 yog qhov phem dua li cov neeg mob tsis rog COVID-19, thiab tej zaum yuav cuam tshuam nrog ntau yam teeb meem, xws li lub raum tsis ua haujlwm. Cov kab mob hauv lub cev, kev sib raug zoo sib xws, lub raum hemodynamics, thiab kev kis mob nrog COVID-19 hauv cov neeg mob rog tuaj yeem ua rau tus neeg mob lub glomerulus puas. Puas yog qhov no tiag tiag?

Kev tshawb fawb tsim: Txoj kev tshawb no suav nrog 91 tus neeg mob uas tsis tau txhaj tshuaj tiv thaiv kab mob COVID{1}} los ntawm 2020 txog 2021, thiab tau sau cov neeg mob cov ntaub ntawv kho mob, cov ntsuas ntsuas, ntsuas lub raum (proteinuria, albuminuria, creatinine, thiab urea), nrog rau qhov xav tau rau kev lim ntshav thiab cov tsos mob tshwm sim nrog rau kev txhawb nqa lub tshuab ua pa thiab kev tuag. Txoj kev ELISA tau siv los kuaj xyuas lub raum biomarkers (NGAL, KIM-1, MCP-1, thiab Nephrin) thiab endothelial biomarkers (VCAM-1, angiopoietin, syndecan-1).

Cov txiaj ntsig tshawb fawb: Ntawm 91 tus neeg mob COVID-19 hnyav, 23 (25%) yog rog. Kev rog rog yog txuam nrog cov hnub nyoog yau, comorbidities, thiab xav tau kev lim ntshav. Tsis muaj kev koom tes nrog kev tuag. Kev soj ntsuam ntawm cov ntaub ntawv kuaj mob feem ntau, suav nrog cov tshuaj rau lub raum biomarkers, hematology, daim siab, thiab coagulation tsis pom, tsis muaj kev sib koom ua ke tseem ceeb. Ntawm qhov tod tes, cov zis MCP-1 thiab VCAM-1 tau nce ntxiv hauv kev koom nrog pawg rog rog. Hauv kev txheeb xyuas ntau yam, hnub nyoog yog qhov muaj kev ywj pheej cuam tshuam rau qhov xav tau kev lim ntshav, thaum lub zis MCP-1 thiab hnub nyoog yog qhov muaj feem cuam tshuam rau kev tuag.

Kev tshawb fawb xaus: Piv nrog rau cov neeg mob uas tsis rog rog, hnyav COVID-19 cov neeg mob rog rog tau nce qib ntawm glomerular puas biomarkers, qhia txog kev puas tsuaj glomerular.

Yog li, tus kab mob COVID-19 puas yuav cuam tshuam rau kev kho mob lossis kev tshwm sim ntawm tus kab mob raum? Saib kev kawm tom ntej.

3. COVID-19 thiab IgA nephropathy 3

Kev tshawb fawb keeb kwm yav dhau los: Tus kab mob coronavirus tshiab tuaj yeem ua rau muaj qhov tshwm sim sai ntawm cov kab mob tiv thaiv kab mob, ua rau lub cev tsis muaj zog, uas muaj kev cuam tshuam loj rau tus neeg mob lub cev. Qee qhov xwm txheej qhia tias tus kab mob COVID-19 zoo li yuav ua rau muaj kev pheej hmoo ntawm IgA nephropathy vim tias IgA nephropathy yog kab mob autoimmune-mediated. Yog li, qhov no puas muaj tseeb? Ntxiv mus, piv nrog rau cov neeg mob uas tsis tau kis tus kab mob COVID-19, puas muaj qhov sib txawv tseem ceeb hauv cov kab mob pathological ntawm IgA nephropathy cov neeg mob uas tau kis tus kab mob COVID-19?

Kev tshawb fawb tsim: 33 tus neeg mob tau kuaj pom tias muaj IgAN los ntawm lub raum biopsy ntawm Beijing Anzhen Tsev Kho Mob txij lub Kaum Ob Hlis 2022 txog Lub Plaub Hlis 2023 thiab nrog KEVID-19 kab mob ua ntej lub raum biopsy raug suav nrog (Pab A). Nyob rau tib lub sijhawm, 44 tus neeg mob IgAN (pab pawg B) kuaj xyuas txij lub Kaum Ob Hlis 2018 txog Lub Plaub Hlis 2019 (tib lub sijhawm hauv xyoo dhau los) raug xaiv los tswj. Enzyme-linked immunosorbent assay tau siv los kuaj ntshav plasma FHR-5, MBL, C5a, soluble C5b-9, thiab ntshav Gd-IgA1 thiab IgA cov tshuaj tiv thaiv kab mob. Txoj kev immunofluorescence tau siv los txheeb xyuas qhov qhia ntawm glomerular FHR-5, C3c, MAC, thiab Gd-IgA1. Immunohistochemistry tau siv los kuaj pom SARS-COV-2 nucleocapsid thiab RNA hauv cov qog nqaij hlav hauv lub raum.

Txoj kev tshawb no feem ntau txheeb xyuas cov clincopathological thiab immunological yam ntxwv ntawm ob pawg neeg mob.

Cov txiaj ntsig tshawb fawb: Lub sijhawm nruab nrab ntawm qhov pib ntawm COVID-19 cov tsos mob mus rau lub raum biopsy yog 12 (6, 18) lub lis piam, nrog rau thaj tsam li 1 txog 26 lub lis piam. 30 tus neeg mob (90.9%) tau txhaj tshuaj tiv thaiv ua ntej kis tus kab mob COVID-19. SARS-COV-2 nucleocapsid antigen qhia tau pom nyob rau hauv lub raum tubular epithelial hlwb hauv 11 tus neeg mob (33.3%). Piv nrog rau pawg B, pawg A tau qis dua eGFR qib (p=0.010). Histologically, piv nrog rau pawg B, cov neeg mob uas muaj IgA nephropathy nyob rau hauv pawg A muaj ntau dua ntawm segmental glomerulosclerosis/adhesions (p=0.003) thiab qis dua ntawm mesangial cell hyperplasia (p{19}}.017 ). Plasma C5a (p<0.001), soluble C5b-9 (p=0.018), and FHR5 (p<0.001) levels in group A were significantly higher than those in group B. Even though plasma MBL levels did not differ between groups A and B (p=0.318), we found that more patients in group A presented high-level MBL expression (p=0.025). Compared with group B, patients with IgA nephropathy in group A had stronger MAC deposition intensity (p=0.246). There was no statistically significant difference in serum IgA (p=0.129), Gd-IgA1 (p=0.734), and IgA immune complex (p=0.524) levels between groups A and B, but the glomerular mesangium of patients with IgA nephropathy in group A The Gd-IgA1 deposition intensity in the area and capillary area was higher than that in group B (p=0.005).

Kev tshawb fawb xaus: Txhim kho qhov ua kom muaj zog ntxiv tau pom nyob rau hauv cov neeg mob kuaj pom tias muaj IgA nephropathy tom qab COVID-19 kab mob. Tsis tas li ntawd, piv nrog IgA nephropathy cov neeg mob uas tsis muaj COVID-19, cov kab mob tso tawm ntawm Gd-IgA1 hauv thaj chaw glomerular mesangial ntawm IgA nephropathy cov neeg mob nrog COVID-19 tau pom tseeb dua. Kev ua kom ntau dhau ntawm cov txheej txheem ntxiv thiab kev tso tawm ntawm cov kab mob Gd-IgA1 tuaj yeem yog ib qho laj thawj rau kev mob raum hauv cov neeg mob nrog COVID-19 ua ke nrog IgA nephropathy.

Txij li thaum COVID-19 muaj kev phom sij heev rau cov neeg mob lub raum, cov kws kho mob tuaj yeem tswj cov neeg mob raum thiab txo COVID-19- muaj feem cuam tshuam li cas? Saib kev kawm tom ntej.

4 Cov neeg mob hemodialysis thiab ob lub monoclonal antibodies 4

Kev tshawb fawb keeb kwm yav dhau los: Tom qab cov neeg mob hemodialysis tau kis tus kab mob COVID-19, lawv yog cov kab mob hnyav heev, thiab lawv qhov kev mob ntev ntev yuav phem dua li cov neeg noj qab haus huv. Ntxiv mus, vim muaj kev tiv thaiv qis ntawm cov neeg mob hemodialysis, qee cov tshuaj tiv thaiv COVID-19 tsis tuaj yeem tiv thaiv cov neeg mob hemodialysis tiv thaiv tus kab mob COVID-19. Ntxiv mus, txawm tias cov neeg mob hemodialysis uas tau kis tus kab mob COVID-19 kuj tseem yuav kis tau ntxiv. Yog li, cov tshuaj monoclonal antibodies tixagevimab thiab cilgavimab tuaj yeem tiv thaiv cov kab mob SARS-Cov-2 sib txawv tuaj yeem tiv thaiv cov neeg mob hemodialysis kom tsis txhob kis tus kabmob tshiab no lossis txo qis kev loj hlob ntawm tus kabmob hnyav hauv cov neeg mob?

Kev tshawb fawb tsim: Txoj kev tshawb no yog ib txoj kev tshawb fawb qhib, suav nrog tag nrho ntawm 26 tus neeg mob hemodialysis ntev, nrog rau hnub nyoog nruab nrab ntawm (57.4 ± 19.6) xyoo, 10 tus poj niam thiab 16 tus txiv neej. Txhua tus neeg mob muaj lwm yam kev pheej hmoo rau tus kab mob COVID-19 hnyav (16 tus neeg mob plawv, 6 tus mob ntshav qab zib, thiab 4 tus neeg rog rog). Txhua tus neeg koom tau txais koob tshuaj GAMCOVID-Vac (Sputnik V) 1 xyoo ± 4 lub hlis dhau los. 12 tus neeg mob tau kis tus kab mob COVID{16}} xyoo dhau los. Muaj 144 tus neeg mob hemodialysis ntev nyob rau hauv pawg tswj hwm, nrog rau hnub nyoog nruab nrab ntawm (56.2 ± 18.3) xyoo, suav nrog 68 tus poj niam thiab 76 tus txiv neej. Hauv txoj kev tshawb no, 300 mg txhua ntawm tixagevimab thiab cilgavimab tau txhaj tshuaj intramuscularly tom qab hemodialysis.

Txoj kev tshawb no tau ua los ntawm Lub Ob Hlis 2023 txog Lub Yim Hli 2023. Tag nrho titer ntawm RBD-specific IgG cov tshuaj tiv thaiv tau kwv yees siv SARS-CoV-2-RBD-ELISA cov khoom siv. SARS-CoV-2 virus-specific IgG-negative serum samples with dilutions of 1:50 to 1:1638400 tau pib npaj ua kev tswj. Siv "tus kab mob tas mus li-ntau cov ntshav ntau ntxiv" tsim, tus kab mob-neutralizing antibodies (VNA) qib tau txiav txim siab los ntawm kev cuam tshuam tsis zoo. Npaj 2-fold dilutions of control serum and test serum in DMEM medium containing 2% inactivated fetal calf serum, mix with 100 TCID50 SARS-CoV-2 virus, incubate at 37 degree for 1 hour, and then add Vero E6 hlwb. Cells tau loj hlob ntawm 37 degree nyob rau hauv ib puag ncig carbon dioxide nplua nuj. Tom qab 96 teev, cov teebmeem cytopathic ntawm tus kab mob ntawm cov kab lis kev cai ntawm tes raug soj ntsuam pom los ntawm kev txheeb xyuas qhov cuam tshuam ntawm cell monolayer. SPSS -20 qhov kev pab cuam tau siv los xam cov txiaj ntsig tsis yog parametric Wilcoxon kev ntsuas ntsuas, thiab qhov kev ntseeg tau ntawm cov txheej txheem yog p<0.05 (95%).

Cov txiaj ntsig kev tshawb fawb: Txoj kev tshawb fawb pom tias tag nrho cov nyiaj IgG hauv cov neeg mob tau nce ntau tom qab 90 hnub. Cov kev hloov pauv hloov pauv hauv cov kab mob-nruab nrab kev ua haujlwm titers ntawm cov kab ntawm tes qhia tau tias ob qho tib si tixagevimab thiab cilgavimab tuaj yeem txhim kho lub cev cov lus teb rau ntau hom SARS-Cov-2 hom.

Kev tshawb fawb xaus: Txawm hais tias tixagevimab thiab cilgavimab tsis muaj cov tshuaj tiv thaiv kab mob tshwj xeeb tiv thaiv tus kab mob coronavirus tshiab, tshwj xeeb tshaj yog cov kab mob tshiab, lawv tuaj yeem tiv thaiv cov neeg mob hemodialysis kom tsis txhob muaj kab mob hnyav.

Cistanche kho mob raum li cas?

Cistancheyog ib hom tshuaj suav tshuaj ntsuab siv rau ntau pua xyoo los kho ntau yam mob, suav nrog kab mob raum. 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 rau lub raum kev 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 tshuab.

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 yam kabmob thiab lub cev, ua rau nws txoj hauv kev zoo rau kev kho mob raum.