Daratumumab, Ib txoj hauv kev tshiab rau Kev Kho Mob Ntawm Kev Loj Hlob Glomerulonephritis Nrog Monoclonal IgG Deposition

Proliferative glomerulonephritis nrog monoclonal immunoglobulin deposition (PGNMID) yog ib yam kab mob uas tuaj yeem cuam tshuam rau lub raum. Hauv xyoo 2004, Nasr tau hais tias PGNMID yuav tsum tau muab cais ua monoclonal gammopathy (MGRS). Hauv cov kab mob no, monoclonal immunoglobulins tso rau hauv glomeruli, ua rau muaj kev ua kom ntxiv, glomerulonephritis, thiab kev loj hlob. Cov tsos mob ntawm PGNMID suav nrog cov proteinuria, hematuria, lub raum tsis txaus, thiab peripheral edema, uas tsis yog tshwj xeeb piv nrog rau lwm cov kab mob raum.

Nyem rau Cistanche rau mob raum

Hmoov tsis zoo, tsis muaj cov txheej txheem kev kho mob rau kev tswj hwm PGNMID. Cov kev xaiv kho mob ib txwm muaj yog renin-angiotensin receptor system antagonists (RASi) thiab cov tshuaj tiv thaiv kab mob, thiab lawv cov txiaj ntsig tseem muaj teeb meem. Yog li ntawd, cov kev kho mob tshiab yog qhov yuav tsum tau ceev nrooj los ua kom tiav qhov sib thooj.

Daratumumab yog Ameslikas pom zoo rau kev kho mob ntawm ntau yam myeloma, thiab nws kuj tau nyiam nyob rau hauv lub raum kab mob vim nws cov txheej txheem ntawm kev txiav txim ntawm lub hom phiaj CD38- qhia plasma hlwb. Tsis ntev los no, ib rooj plaub los ntawm Tsev Kho Mob Guizhou hauv kuv lub tebchaws tau qhia tias daratumumab tuaj yeem kho PGNMID nrog IgG deposition.

Lub raum biopsy thiab hematological kuaj

Lub raum biopsy pom sclerosis nyob rau hauv 2 ntawm 8 glomeruli, thiab 6 glomeruli pom muaj nruab nrab diffuse proliferation ntawm mesangial hlwb thiab interstitium nrog endothelial cell proliferation. Immunofluorescence pom pom clump-zoo li thiab diffuse C3, Clq, IgG, thiab x lub teeb saw nyob rau hauv glomerular mesangial cheeb tsam. IgG subclass staining pom muaj zog zoo IgG3, tsis muaj zog rau qhov tsis zoo staining ntawm IgG1, IgG2, IgG4, thiab Ib lub teeb chains. Cov txiaj ntsig saum toj no zoo ib yam nrog IgG3 PGNMID.

Tsis muaj cov tshuaj tiv thaiv kab mob monoclonal tau kuaj pom nyob rau hauv thawj cov pob txha pob txha biopsy, thiab cov pob txha pob txha ntws cytometry qhia tias cov plasma hlwb suav txog li 0.15% ntawm tag nrho cov nucleated hlwb, thiab cov immunophenotypes CD38, CD138, thiab CD19 yog tag nrho cov zoo. . Cov txiaj ntsig ntawm serum protein electrophoresis, serum-free light chain test, thiab zis protein electrophoresis yog txhua yam.

B cell subsets thiab immunophenotypes

B cell subsets thiab immunophenotypes raug soj ntsuam ntawm 2, 6, thiab 12 lub lis piam ntawm kev kho mob. Cov txiaj ntsig tau pom tias cov naj npawb tsis zoo ntawm B hlwb (CD19+, CD27-, thiab IgD+), marginal zone B hlwb (CD19+, CD27-, thiab IgD+), nco B cells (CD19+, CD27+, thiab CD{11}}), transitional B hlwb (CD19+, CD24+, thiab CD 38+), thiab plasmablasts (CD{15}} thiab CD{16}}) poob qis. Nco ntsoov, qhov tseeb suav ntawm kev hloov pauv B hlwb (CD19+, CD24+, thiab CD{19}}) thiab plasmablasts (CD19+ thiab CD{21}}) yog qhov ntsuas tsis tau ntawm qhov kev ntsuas thib ob thiab thib peb.

Kev kho mob

Tus neeg mob muaj keeb kwm mob ntshav siab ntau dua 10 xyoo thiab tau kho nrog qhov ncauj valsartan (80 mg / d). Thaum nkag, tus neeg mob cov ntshav creatinine thiab proteinuria yog 0.81 mg / dL thiab 1.07 g / d, raws li qhia, qhia txog theem 2 mob raum (CKD), yog li tus neeg mob tau kho nrog valsartan (80 mg / d) thiab prednisone (50 mg. /d). Txawm li cas los xij, tom qab 1 lub hlis ntawm kev kho mob, tus neeg mob cov proteinuria thiab ntshav creatinine qib tseem yuav luag tsis hloov. Yog li, tus neeg mob tau kho nrog daratumumab (400 mg / d, rau 2 hnub sib law liag), nrog rau tag nrho ntawm 800 mg. Tom qab tau txais kev kho mob daratumumab, koob tshuaj ntawm prednisone yog halved (25 mg / d), thiab valsartan tseem tsis hloov. Methylprednisolone sodium succinate 20 mg thiab calcium gluconate 1 g tau muab tso rau hauv txoj hlab ntshav ua ntej txhua qhov infusion, thiab promethazine hydrochloride 25 mg tau txhaj tshuaj intramuscularly tib lub sijhawm. Kev kho Daratumumab tau ua tiav yam tsis muaj kev fab tshuaj. Txawm li cas los xij, 2 lub lis piam tom qab kev kho mob, tus neeg mob tau tsim mob ntsws thiab raug tso tawm tom qab siv tshuaj tiv thaiv kab mob.

No.4 Follow-up

Ib lub hlis ua ntej kev kho daratumumab (xws li, kev kho tshuaj hormone + valsartan), tus neeg mob cov zis ntshav liab tau nce mus rau 3+ thiab cov zis protein ntau ntxiv rau 2.27g / d. Tom qab kev kho mob daratumumab, tus neeg mob cov zis ntshav liab poob mus rau 2+, thiab ntawm 16 lub lis piam, nws tsis muaj zog. Ib lub hlis tom qab kev kho mob daratumumab, tus neeg mob lub edema tau ploj mus, proteinuria yog 0.55g / d, thiab cov ntshav creatinine yog 1.26mg / dL. Tom qab 3 lub hlis ntawm kev kho mob, tus neeg mob tus mob zoo dua, proteinuria poob mus rau 0.18g/d, thiab cov ntshav creatinine poob mus rau 0.86mg/dL.

Hmoov tsis zoo, tom qab tso tawm, tus neeg mob tau ploj mus rau kev soj ntsuam thiab rov kuaj xyuas hauv peb lub tsev kho mob thaum lub Tsib Hlis 2024. Lub sijhawm no, nws tau kuaj pom lub ntsej muag thiab qis qis qis. Kev kuaj kuaj pom pom cov ntshav creatinine ntawm 1.28mg / dL, proteinuria ntawm 1.24g / d, ntshav albumin qib 33.2g / L, thiab kuaj zis pom cov qe ntshav liab 3+. Tus neeg mob tus kab mob PGNMID yog thawj zaug xav tias.

Case kev sib tham

PGNMID yog ib qho tshwj xeeb glomerular raug mob, thiab feem ntau IgG deposition subtype yog IgG3. Tsis zoo li lwm yam subtypes, IgG3 muaj tus nqi siab dua thiab kev kho molecular, tuaj yeem sib sau tus kheej los ntawm FC-C, thiab muaj peev xwm ua kom muaj zog ntxiv.

Tam sim no, PGNMID cov neeg mob tau txais cov kev kho mob ib txwm muaj muaj cov kab mob raum tsis zoo thiab cov kab mob tsis zoo. Ib txoj kev tshawb nrhiav rov qab hauv xyoo 2009 tau qhia tias ntawm 9 PGNMID cov neeg mob, tsuas yog 2 tau ua tiav kev tshem tawm, 2 tau ua tiav ib feem ntawm kev tshem tawm, thiab 1 tus neeg mob tau nce mus rau theem kawg ntawm lub raum kab mob (ESRD.) Ntawm cov neeg mob PGNMID tau txais cov tshuaj tiv thaiv kab mob, 11% ntawm cov neeg mob tau ua tiav kev tshem tawm. thiab 33% tau ua tiav ib nrab kev zam txim. 1/6 cov neeg mob yuav nce mus rau ESRD.

Tsis ntev los no, Gumber et al. pom tias cov tshuaj tiv thaiv monoclonal tuaj yeem muaj peev xwm kho PGNMID thiab txhim kho cov tsos mob ntawm cov neeg mob. Txawm li cas los xij, qhov kev sib tw tam sim no ntawm kev siv cov kev kho no hauv kev kho mob yog tias nws tsis tuaj yeem saib xyuas cov kab mob biomarkers los coj cov neeg mob xaiv cov tshuaj tiv thaiv monoclonal tshwj xeeb thiab siv lawv li cas. Cov kev tshawb fawb yav dhau los tau pom tias tsuas yog 35% txog 40% ntawm cov tshuaj tiv thaiv kab mob tau kuaj pom hauv cov pob txha pob txha biopsies ntawm PGNMID cov neeg mob, uas tuaj yeem muab kev taw qhia rau kev xaiv thiab ntau npaum li cas ntawm cov tshuaj tiv thaiv monoclonal tshwj xeeb. Cov neeg mob uas tsis tuaj yeem kuaj xyuas cov pob txha pob txha los yog tsis pom cov tshuaj tua kab mob hauv cov pob txha pob txha, tuaj yeem tso siab rau kev siv tshuaj khomob rau kev siv tshuaj. Muab hais tias IgG yog hom kev tso nyiaj ntau tshaj plaws, cov tshuaj tiv thaiv plasma cell raug pom zoo.

Qee cov kws tshaj lij pom zoo tias cov tshuaj khomob yuav tsum tau ua rau PGNMID cov neeg mob nrog CKD Ntau dua lossis sib npaug li 3, thiab cov kev kho mob ib leeg yuav tsum raug xaiv kom ntau li ntau tau. Guard et al. pom tias kev kho rituximab zoo dua hauv CD20-cov neeg mob PGNMID zoo. Cov kev tshawb fawb yav dhau los tau pom tias 5 ntawm 7 tus neeg mob zoo li no tau ua tiav kev tshem tawm thiab 2 tau ua tiav ib feem ntawm kev tshem tawm tom qab tau txais kev kho mob rituximab, thiab cov txiaj ntsig tau zoo dua li lwm cov tshuaj uas twb muaj lawm.

Daratumumab kuj yog lwm txoj kev kho mob tsim nyog. Hauv kev tshawb fawb theem 2, 10 tus neeg mob nrog PGNMID tau txais tsawg kawg ib koob tshuaj (16 mg / kg) ntawm daratumumab. Tom qab 12 lub hlis ntawm kev soj ntsuam, cov txiaj ntsig tau pom tias txhua tus neeg mob tau txhim kho lub raum ua haujlwm, ntawm 4 tus neeg mob tau ua tiav kev tshem tawm thiab 6 tau ua tiav kev tshem tawm ib nrab. Kev nyab xeeb tau txais, thiab qhov tshwm sim tseem ceeb ntawm qhov tsis zoo yog kev kis mob hnyav. Nws yog ib qho tsim nyog sau cia tias ib tus neeg mob tau muaj kev txhim kho tseem ceeb hauv cov proteinuria thiab ntshav creatinine tom qab tsuas yog ib qho kev txhaj tshuaj ntawm daratumumab, uas tau kav ntev li 12 lub hlis. Zuag qhia tag nrho, daratumumab yog ib qho ntawm lwm txoj kev xaiv rau kev kho mob ntawm PGNMID.

Rau tus neeg mob no, raws li cov txiaj ntsig ntawm B cell subsets thiab kev kuaj kab mob tiv thaiv kab mob, peb xaiv daratumumab rau kev kho mob, saib xyuas cov cim sib xws xws li CD38, thiab tsim lub sijhawm ntawm kev txiav tawm daratumumab. Nyob rau hauv lub neej yav tom ntej, kev soj ntsuam kev tshawb fawb ntawm daratumumab rau kev kho mob ntawm PGNMID yuav tsum tau ua kom zoo rau kev siv lub tswv yim ntawm daratumumab.

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 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 tshuaj tiv thaiv kab mob. 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 qhov tsim ntawm pro-inflammatory cytokines thiab inhibit qhov kev ua ntawm txoj kev yuav tsum tau rau o, 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.