Mob ntshav qab zib raum rau menyuam yaus thiab cov tub ntxhais hluas: Kev Hloov Kho
Mar 31, 2022
Hu rau:joanna.jia@wecistanche.com/ WhatsApp: 008618081934791
Lauren N. Lopez1 · Weijie Wang2 · Lindsey Loomba3 · Maryam Afkarian1 · Lavjay Butani4
Tau txais: 2 Lub Xya Hli 2021 / Hloov Kho: 16 Lub Kaum Hli 2021 / Txais: 18 Lub Kaum Hli 2021
© Tus sau 2021
Cov txiaj ntsig ntawm desert cistanche:zoo heev rau lub raum ua haujlwm
Abstract
Mob ntshav qab zibraumkab mob(DKD), yav dhau los tau ntsib feem ntau hauv cov neeg mob laus, tau nce siab hauv nruab nrab raws li kev mob me nyuam yaus thiab ib qho uas cov kws kho mob nephrologists yuav ntsib nrog ntau zaus. Qhov no feem ntau yog vim muaj kev rog rog thiab qhov tshwm sim ntawm kev mob ntshav qab zib hom 2 hauv cov menyuam yaus thiab cov tub ntxhais hluas, nrog rau kev mob ntshav qab zib ntau dua phenotype hauv cov hluas niaj hnub no nrog kev poob qis thiab kev loj hlob sai thiab kev loj hlob ntawm cov teeb meem ntshav qab zib. nrog rau kev ua haujlwm qis rau cov kev kho mob siv rau cov neeg laus. DKD, qhov kawg ntawm cov kab mob ntshav qab zib mellitus, yog qhov tsawg kawg yog ib qho cim ntawm, thiab feem ntau yuav ua rau muaj kev cuam tshuam rau, kev loj hlob ntawm cov txiaj ntsig tsis zoo ntawm cov hlab plawv thiab kev tuag ntxov hauv cov menyuam yaus uas muaj ntshav qab zib. Ntawm qhov kev cia siab, ntau txoj kev kho tshiab tam sim no muaj rau kev tswj cov ntshav qab zib hauv cov neeg laus, xws li GLP1 receptor agonists, SGLT2 inhibitors, thiab DPP4 inhibitors, uas kuj tau pom tias muaj kev cuam tshuam zoo rau cov txiaj ntsig cardiorenal. Tsis tas li, kev cog lus yog kev ua tiav ntawm cov khoom noj uas muaj zog tsawg heev hauv kev ua kom tshem tawm cov ntshav qab zib hauv cov neeg laus. Txawm li cas los xij, qhov sib ntxiv ntawm cov tshuaj thiab kev noj zaub mov zoo rau kev tswj cov cuab yeej ntawm ntshav qab zib thiab DKD hauv cov menyuam yaus thiab cov tub ntxhais hluas tseem tos qhov kev ntsuam xyuas zoo ntawm lawv txoj kev nyab xeeb thiab kev ua tau zoo hauv cov neeg no. Qhov kev tshuaj xyuas no piav qhia txog cov kab mob ntshav qab zib thiab DKD, thiab cov kev txhim kho tshiab uas yuav muaj txiaj ntsig zoo rau kev tswj hwm cov menyuam yaus thiab cov hluas uas muaj ntshav qab zib thiab DKD. Cistanche zoo heev rau lub raum ua haujlwm.
Keywords Diabetes · Nephropathy · Microalbuminuria · Metabolic Syndrome
Taw qhia
2] thiab, rau T2D, piv rau qhov nce hauv kev rog rog. Tsis tas li ntawd, piv rau cov neeg laus, ntshav qab zib muaj qhov mob hnyav dua hauv cov menyuam yaus thiab cov tub ntxhais hluas, cim los ntawm cov lus teb tsis zoo rau cov kev cuam tshuam tam sim no [3, 4], nrog rau kev ua haujlwm sai ntawm cov cell, kev ua haujlwm ntawm insulin tsis kam, thiab kev loj hlob. ntawm qhov kawg-organ teeb meem [5, 6]. Raws li qhov tshwm sim, qhov tshwm sim ntawm cov kab mob raum mob ntshav qab zib mellitus (DKD) nce ntxiv hauv cov menyuam yaus thiab cov tub ntxhais hluas, nce ntawm 1.16 mus rau 3.44 feem pua ntawm 2002 thiab 2013 [7], tshwj xeeb tshaj yog rau cov hluas nrog T2D uas, piv rau cov hnub nyoog sib tw, tau tau sau tseg tias muaj 23-fold nce kev pheej hmoo ntawm lub raum tsis ua haujlwm thiab 39-fold nce kev pheej hmoo ntawm kev lim ntshav [8]. Ntawm qhov kev txhawj xeeb sib npaug yog qhov kev soj ntsuam uas DKD kos npe rau ib pawg ntawm cov tib neeg uas muaj kev pheej hmoo siab ntawm cov kab mob plawv thiab kev tuag ntxov ntxov [9, 10]. Xws li, ntshav qab zib thiab nws cov teeb meem, tshwj xeeb yog DKD, txuas ntxiv qhov tseem ceeb ntxiv rau cov kws kho mob nephrologist. Ntawm no, peb tshuaj xyuas qhov hloov tshiab tsis ntev los no rau kev kuaj mob thiab kev tswj hwm ntawm DKD hauv cov menyuam yaus thiab cov tub ntxhais hluas. Cistanche zoo heev rau lub raum ua haujlwm.
Kev kuaj mob
Tam sim no cov cim kev kho mob
Raws li nrog ntau lwm cov kab mob raum ntev (CKD), kev kuaj mob ntawm DKD pob khawm ntawm kev hloov pauv hauv cov zis albumin excretion rate (AER) thiab glomerular filtration rate (GFR). Cov qauv kev hloov pauv tus yam ntxwv ntawm DKD tau pom nyob rau hauv lub raum biopsies thaum ntxov li thawj ob peb xyoos tom qab pib mob ntshav qab zib [11], tab sis tus kab mob no tseem nyob twj ywm hauv tsev kho mob tsawg kawg 10-15 xyoo.
Hyperfiltration txhais tau tias yog GFR ntawm 120–150 mL / min / 1.73m2 lossis> 2 tus qauv sib txawv tshaj qhov nruab nrab GFR [12], hyperfiltration tau tshaj tawm hauv 25-40 feem pua ntawm cov hluas uas muaj ntshav qab zib [6]. Hyperfiltration tau pib ntaus nqi rau thaum ntxov nceraumntshav ntshavntwsthiab intraglomerular siab thiab ntseeg tau tias yog ib qho kev kwv yees muaj zog ntawm GFR poob thiab DKD kev loj hlob [13]. Txawm li cas los xij, cov pov thawj txhawb kev koom tes ntawm hyperfiltration thiab albuminuria tau raug hu mus rau cov lus nug tsis ntev los no, hauv T1D thiab T2D, tau pom hauv qee qhov kev tshawb fawb (T1D, T2D [14]) tab sis tsis nyob hauv lwm tus (T1D [15], T2D. [16]). Hyperfiltration tau cuam tshuam nrog GFR poob hauv ob qho tib si T1D [17] thiab T2D [14], tab sis tsuas yog ib qho kev tshawb fawb tau sau tseg qhov kev poob qis rau GFR < 60="" ml="" min="" 1.73m2="" [18],="" tawm="" hauv="" qhov="" muaj="" peev="" xwm="" pom="" tias="" gfr="" sai="" sai.="" poob="" yog="" qhov="" thim="" rov="" qab="" ntawm="" qhov="" ntxov="" glomerular="" hyperfiltration="" lossis="" regression="" mus="" rau="" qhov="" txhais="" tau="" tias.="" qhov="" tseem="" ceeb,="" hyperfiltration="" thaum="" ntxov="" tsis="" cuam="" tshuam="" nrog="" kev="" pheej="" hmoo="" ntawm="" kev="" nce="" ntxiv="" mus="" rau="" qhov="" kwv="" yees="" gfr="" ntawm=""><60 ml="" min="" 1.73m2="" hauv="" cov="" neeg="" uas="" muaj="" t1d="" hauv="" kev="" kuaj="" mob="" ntshav="" qab="" zib="" mellitus="" thiab="" cov="" teeb="" meem="" sib="" kis="" kab="" mob="" ntawm="" kev="" mob="" ntshav="" qab="" zib="" thiab="" teeb="" meem="" (dcct/edic.="" )="" kev="" kawm="" [19].="" raws="" li="" cov="" kws="" sau="" ntawv="" tau="" taw="" qhia,="" qhov="" kev="" soj="" ntsuam="" no="" tsis="" tawm="" tsam="" qhov="" kev="" sim="" cov="" ntaub="" ntawv="" uas="" qhia="" txog="" kev="" cuam="" tshuam="" ntawm="" ib="" leeg-nephron="" hyperfiltration="" thiab="" ua="" rau="" glomerular="" hypertension.="" raws="" li="" tau="" tham="" tom="" qab,="" cov="" lus="" pom="" zoo="" tam="" sim="" no="" tsis="" txhawb="" nqa="" angiotensin="" blockade="" nkaus="" xwb="" rau="" kev="" tswj="" hwm="" hyperfiltration.="" cistanche="" zoo="" heev="" rau="" lub="" raum="" ua="">
Albuminuria nce hauv cov zis AER siab dua li qub tau piav qhia raws li cov cim ntxov tshaj plaws ntawm DKD. Microalbuminuria, txhais tau tias yog cov zis AER 30–299 mg / hnub (los yog tso zis albumin-to-creatinine piv 30–299 mg / g hauv cov zis zis), tshwm sim hauv 26 feem pua thiab 51 feem pua ntawm cov menyuam yaus thiab cov tub ntxhais hluas tom qab 10 thiab 19 xyoo. mob ntshav qab zib mellitus [20]. Macroalbuminuria, txhais tau tias yog AER tso zis ntau dua lossis sib npaug li 300 mg / hnub (lossis cov zis albumin-to-creatinine piv Ntau dua lossis sib npaug li 300 mg / g hauv cov zis zis), tau tshaj tawm hauv 14 feem pua ntawm cov menyuam yaus uas muaj T1D tom qab qhov nruab nrab ntshav qab zib ntev ntawm 10 xyoo [20]. Cov ntaub ntawv pov thawj qhia tias albuminuria tshwm sim ua ntej thiab nce nrawm dua hauv cov menyuam yaus thiab cov tub ntxhais hluas nrog T2D [21]. Txawm li cas los xij, kev siv micro- lossis macroalbuminuria ua tus cim surrogate rau DKD tau sib tw. Cov neeg koom nrog DCCT / EDIC nrog microalbuminuria muaj feem ntau dua ntawm kev rov qab mus rau normoalbuminuria (10- xyoo sib sau ua ke ntawm 40 feem pua ) dua li ntawm kev nce mus rau macroalbuminuria (28 feem pua), CKD theem 3 lossis siab dua (15 feem pua), lossisraum tsis ua haujlwm (4 feem pua)[22]. Macroalbuminuria tau cuam tshuam nrog kev pheej hmoo ntau dua ntawm DKD kev loj hlob, tab sis txawm tias qib siab dua ntawm albuminuria ua rau ntau zaus rau normoalbuminuria (48 feem pua 10- xyoo kev pheej hmoo) dua li kev nce mus rau CKD theem 3 lossis siab dua (32 feem pua) lossis raum. tsis ua haujlwm (16 feem pua) [23]. Tsis tas li ntawd, thaum feem ntau ntawm GFR poob yog ua ntej los ntawm albuminuria, nyob rau hauv ib tug loj me me (24 feem pua), GFR poob tshwm sim nyob rau hauv tsis muaj albuminuria [24], ntxiv nyuaj rau cov nqi ntawm albuminuria raws li ib tug tseem ceeb kwv yees ntawm DKD kev loj hlob. Txawm hais tias cov lus ceeb toom no, cov kws kho mob pom zoo kom kuaj txhua xyoo txhawm rau txhawm rau kuaj pom albuminuria, siv cov zis tso zis thaum sawv ntxov, pib thaum muaj hnub nyoog laus lossis 10 xyoo (xws li ua ntej) pib 5 xyoos tom qab kuaj T1D, thiab thaum kuaj T2D [25, 26] (saib Table 1).
GFR poob Kuj pom zoo yog saib xyuas GFR, suav los ntawm cov ntshav creatinine siv kwv yees sib npaug,
Table 1 Cov Lus Qhia rau kev tshuaj xyuas thiab kev cuam tshuam tseem ceeb hauv cov menyuam yaus thiab cov tub ntxhais hluas uas muaj ntshav qab zib
nyob rau hauv lub hauv paus thiab tsis tu ncua tom qab ntawd, raws li kev kho mob, hnub nyoog, thiab lub sijhawm thiab kev kho mob ntshav qab zib [27]. Txhua qhov kev kwv yees GFR uas twb muaj lawm yog qhov tsis zoo, tshwj xeeb tshaj yog rau cov menyuam yaus thiab cov tub ntxhais hluas uas muaj T1D thiab cov uas muaj qhov qub lossis siab dua li ib txwm GFRs [28], yuav tsum tau txiav txim siab serial eGFR siv lub tshuab xam zauv, hnub nyoog tsim nyog, thiab siv tau eGFR; rau cov hluas> 18 xyoo, tus neeg laus eGFR lub laij lej yuav tsum tau siv. Hauv cov menyuam yaus uas muaj GFR < 60="" ml="" min="" 1.73m2,="" ib="" qho="" 4-="" qhov="" sib="" txawv="" ntawm="" lub="" raum="" tsis="" ua="" haujlwm="" (xws="" li="" hnub="" nyoog,="" poj="" niam="" txiv="" neej,="" aer,="" thiab="" egfr)="" muaj="" peev="" xwm="" kwv="" yees="" 1–5-xyoo="" lub="" raum="" tsis="" ua="" haujlwm.="" ,="" txhawb="" nqa="" qhov="" tseem="" ceeb="" ntawm="" egfr="" thiab="" albuminuria="" raws="" li="" qhov="" tseem="" ceeb="" ntawm="" kev="" txiav="" txim="" siab="" ntawm="" lub="" raum="" tsis="" ua="" haujlwm="" hauv="" cov="" menyuam="" yaus="" uas="" muaj="" ckd="" siab="" heev="" [29].="" txawm="" li="" cas="" los="" xij,="" theem="" ntawm="" ckd="" tam="" sim="" no="" tau="" pom="" tsawg="" dua="" hauv="" cov="" menyuam="" yaus="" mob="" ntshav="" qab="" zib="" mellitus,="" txawm="" hais="" tias="" nws="" qhov="" kev="" nthuav="" dav="" yuav="" nce="" ntxiv="" nrog="" qhov="" nce="" hauv="">
Hauv cov ntsiab lus, peb qhov kev nkag siab tam sim no ntawm txoj hauv kev ntawm DKD hauv cov menyuam yaus thiab cov tub ntxhais hluas qhia tiassiab CKD thiab raum tsis ua haujlwmsiv sij hawm ntau xyoo los txhim kho tom qab pib / kuaj mob ntshav qab zib, uas txhais tau hais tias cov ntaub ntawv ntawm kev nthuav dav thiab lub sijhawm ntawm cov txiaj ntsig ntawm kev mob ntshav qab zib thaum yau yog feem ntau tau los ntawm cov neeg laus cov kev tshawb fawb [30]. Qhov no nthuav tawm qhov teeb meem rau ib qho kev kawm nruj me ntsis ntawm DKD hauv cov menyuam yaus thiab cov tub ntxhais hluas vim tias nkag siab txhua yam ntawm DKD (biomarkers, kev pheej hmoo rau kev loj hlob, cov lus teb rau kev cuam tshuam, thiab lwm yam) yuav tsum tau tso siab rau cov txiaj ntsig nruab nrab (xws li albuminuria, hyperfiltration) [ 30], uas tsis tuaj yeem ntseeg tau tus neeg sawv cev rau DKD kev nce qib, lossis lwm yam ntxiv ntawm kev tshawb fawb hauv cov neeg laus uas muaj ntshav qab zib.
Novel biomarkers
Qhov tsis muaj cov cim npe uas muaj kev ntseeg siab rau DKD kev loj hlob thaum yau thiab cov hluas ua rau kev txheeb xyuas cov cim tshiab ntawm cov kab mob thaum ntxov hauv cov hluas tseem ceeb dua li cov neeg laus. Feem ntau cov kev tshawb fawb luam tawm qhia txog kev sib koom ua ke ntawm ntau yam urinary / serum protein biomarkers thiab cov txiaj ntsig nruab nrab xws li albuminuria, nrog rau cov kev tshawb fawb tsawg dua los tshuaj xyuas cov koom haum no siv cov ntaub ntawv ntev [31–33]. Cov kev tshawb fawb tsis tshua muaj qhov tseem ceeb hauv kev hla dhau qhov kev cia siab ntawm cov cim tsis zoo no thiab tshuaj xyuas kev sib koom ua ke ntawm cov khoom siv bio-cov cim xws li cov ntshav siab glycation kawg-cov khoom [34] lossis ntshav bradykinin [35] nrog rau kev hloov pauv hauv lub raum thaum ntxov hauv cov hluas nrog T1D. Hauv cov neeg laus, cov qog nqaij hlav necrosis factor receptor 1 (TNFR1) thiab TNFR2 tau pom tias muaj feem cuam tshuam nrog kev hloov pauv thaum ntxov ntawm DKD nrog rau DKD kev loj hlob [36], qhia txog kev koom tes ntawm kev ua tsis zoo rau cov txheej txheem kab mob. Lwm cov biomarkers muaj peev xwm rau DKD, raws li kev tshawb fawb rau cov neeg laus, yog cov zis neutrophil gelatinase-associated lipocalin (NGAL), raum raug mob molecule-1 (KIM-1), N-acetyl- -d-glucosaminidase (NAG), thiab daim siab fatty acid-binding protein (LFABP). Qee lub sij hawm hu ua "mob raum tubular raug mob cov cim," cov urinary proteins tau cuam tshuam nrog DKD kev loj hlob hauv qee qhov [37] tab sis tsis yog hauv lwm qhov [38] kev tshawb fawb. Tsis muaj ib qho ntawm cov cim kos npe tam sim no yog ib feem ntawm kev kho mob niaj hnub hauv cov neeg laus lossis menyuam yaus DKD.
Monogenic hom mob ntshav qab zib
Txawm hais tias muaj kev sib tham dav dav ntawm cov ncauj lus no [39] yog dhau ntawm peb cov ntawv sau, nws tsim nyog hais tias monogenic hom mob ntshav qab zib mellitus, uas sawv cev rau ib pab pawg tsis sib xws ntawm cov noob tsis sib xws uas ua rau muaj kev ua haujlwm tsis zoo ntawm pancreatic-cells, tab tom nce ntxiv. - ingly lees paub los ntawm kev nce qib hauv cov tshuaj genomic. Monogenic hom mob ntshav qab zib mellitus muaj xws li cov mob ntshav qab zib neonatal mellitus, kev loj hlob ntawm cov ntshav qab zib mellitus ntawm cov hluas, thiab mitochondrial diabetes, rau npe rau ob peb tug. Kev hloov pauv hauv ntau dua 30 cov noob sib txawv yog txuam nrog monogenic ntshav qab zib; ib co ntawm no muaj concomitantraumanomalies. Kev paub txog cov kab mob monogenic ntawm ntshav qab zib mellitus ntawm cov kws kho mob yog qhov tseem ceeb vim tias lawv qhov kev tshuaj ntsuam xyuas thiab kev kho mob cuam tshuam, tso cai rau cov tshuaj kho tus kheej. Cistanche zoo heev rau lub raum ua haujlwm.
Mob ntshav qab zib ketoacidosis cuam tshuam nrog mob raum mob
Ib qho tsis ntev los no tau sau tseg ntawm DKD trajectory yog qhov rov tshwm sim ntawm qhov mob hnyavraumraug mob(AKI) thiab lawv txoj kev koom tes rau DKD kev nce qib. Tshwj xeeb, AKI yog qhov tshwm sim tshwm sim ntawm mob ntshav qab zib ketoacidosis (DKA), tshwm sim hauv 43-64 feem pua ntawm cov neeg mob menyuam yaus nrog DKA [40]. Cov xwm txheej txaus ntshai rau DKA-koom nrog AKI suav nrog cov hnub nyoog laus dua, lub plawv dhia siab dua, ntshav siab dua urea nitrogen (BUN), ntau dua cov piam thaj kho cov ntshav sodium concentration, cov piam thaj ntau dua, thiab qis pH, tag nrho ntawm kev nthuav qhia thawj zaug [41]. Tsis tas li ntawd, ib ntu ua ntej ntawm DKA-koom nrog AKI feem ntau ua rau muaj kev pheej hmoo ntawm cov ntu zoo sib xws, qhia tias tus me nyuam sib txawv ntawm lawv txoj kev pheej hmoo rau AKI lossis qhov rov qab los ntawm AKI ua rau lub raum tsis zoo rau kev raug mob tom qab [41]. DKA feem ntau predisposes rau AKI los ntawm qhov ntim depletion thiab lub raum hypoperfusion vim osmotic diuresis thiab qee zaum plab hnyuv, ua rau cov duab ua ntej lub raum. Txawm li cas los xij, qhov hnyav dua ntawm AKI hauv qee cov menyuam yaus (theem 2 lossis 3) qhia tias muaj peev xwm ua rau lub raum raug mob los ntawm tsuas yog ua ntej lub raum mus rau mob tubular raug mob [42].
Hauv cov neeg laus uas muaj ntshav qab zib, AKI cuam tshuam nrog kev pheej hmoo ntau dua ntawm kev tsim DKD, thiab qhov kev pheej hmoo no nce ntxiv nrog rau txhua qhov AKI ntu [43]. Piv nrog rau cov neeg laus nrog DKA uas tsis paub txog AKI, cov neeg uas muaj kev nce qib ntawm DKD sai dua nrog rau kev tuag mus ntev dua [44]. Tsis tas li ntawd, tus nqi ntawm CKD kev nce qib yog proportionate rau qhov hnyav ntawm DKA-koom nrog AKI [44]. Cov cuab yeej tsav tsheb hloov pauv ntawm AKI mus rau CKD tuaj yeem suav nrog kev txhim kho ntawm tubulointerstitial fibrosis tom qab kev raug mob ntawm tubular, glomerular endothelial tsis ua haujlwm, oxidative kev nyuaj siab, tsis tu ncua infammation, thiab cell voj voog ntes [45]. Hauv cov menyuam yaus, cov ntaub ntawv hais txog kev koom tes ntawm DKA-koom nrog AKI thiab DKD kev nce qib tam sim no tsis muaj. Cistanche zoo heev rau lub raum ua haujlwm.
Kev tswj hwm
Hais txog cov xwm txheej txaus ntshai uas txhawb nqa kev txhim kho ntawm DKD
Txoj kev tshawb fawb DCCT / EDIC tau hais qhia txog hyperglycemia yog thawj qhov laj thawj rau kev mob ntshav qab zib mellitus hauv cov menyuam yaus thiab cov tub ntxhais hluas raws li kev txo qis ntawm microvascular teeb meem los ntawm kev kho mob ntshav qab zib hnyav hauv 195 tus neeg koom nrog DCCT, uas muaj hnub nyoog 13-17 xyoo, zoo ib yam. sau nyob rau hauv tag nrho pawg [46] Raws li txoj kev tshawb no, lub hom phiaj HbA1c tau teem rau <7.0–7.5 feem="" pua="" rau="" cov="" neeg="" mob="" t1d="" thiab="" t2d="" los="" ntawm="" lub="" teb="" chaws="" thiab="" thoob="" ntiaj="" teb="" cov="" zej="" zog="" [25,="" 26].="" txawm="" li="" cas="" los="" xij,="" hauv="" kev="" txiav="" txim="" siab="" glycemic="" lub="" hom="" phiaj="" rau="" kev="" kho="" mob="" ntshav="" qab="" zib,="" ib="" qho="" kev="" txiav="" txim="" siab="" yog="" tsim="" nyog="" sau="" cia.="" ntau="" qhov="" kev="" soj="" ntsuam="" loj="" tau="" pom="" tias="" qhov="" glycemic="" pib="" nrog="" qhov="" kev="" pheej="" hmoo="" tsawg="" tshaj="" plaws="" ntawm="" cov="" teeb="" meem="" hauv="" nruab="" nrog="" cev="" yog="" nyob="" ntawm="" hba1c="" nadir="" ntawm="" 5.0-5.5="" feem="" pua="" [47,="" 48].="" txawm="" li="" cas="" los="" xij,="" thaum="" txo="" qis="" hba1c="" mus="" rau="" 7="" feem="" pua="" ua="" rau="" txo="" qis="" cov="" teeb="" meem="" [49],="" tsis="" muaj="" kev="" sim="" cuam="" tshuam="" tau="" pom="" tias="" muaj="" kev="" txhim="" kho="" hauv="" kev="" kho="" mob="" los="" ntawm="" kev="" txo="" hba1c="" qis="" dua="" 7="" (xws="" li="" vadt="" [50],="" advance="" [51])="" thiab="" qee="" qhov="" tau="" pom="" muaj="" kev="" phom="" sij="" (accord="" [52]).="" ib="" qho="" lus="" piav="" qhia="" rau="" qhov="" pom="" tseeb="" dichotomy="" ntawm="" kev="" soj="" ntsuam="" thiab="" kev="" tshawb="" fawb="" kev="" cuam="" tshuam="" yuav="" yog="" qhov="" pom="" zoo="" glycemic="" lub="" hom="" phiaj="" yog="" txiav="" txim="" siab="" los="" ntawm="" qhov="" sib="" npaug="" ntawm="" cov="" txiaj="" ntsig="" vs.="" kev="" pheej="" hmoo="" rau="" ib="" qho="" kev="" cuam="" tshuam.="" thaum="" ib="" txwm="" tshwm="" sim="" hba1c="" ntawm="" 5.0-5.5="" feem="" pua="" yuav="" cuam="" tshuam="" nrog="" qhov="" pheej="" hmoo="" tsawg="" tshaj="" plaws="" ntawm="" cov="" teeb="" meem,="" thaum="" hba1c="" raug="" thawb="" los="" ntawm="" 7="" mus="" rau="" 5.5="" feem="" pua="" ntawm="" kev="" siv="" cov="" kev="" kho="" mob="" ntshav="" qab="" zib="" ntau="" dua,="" cov="" kev="" pheej="" hmoo="" siab="" dua="" (xws="" li="" hypoglycemia,="" qhov="" hnyav="" nce)="" tuaj="" yeem="" cuam="" tshuam="" txog="" kev="" kho="" mob.="" cov="" txiaj="" ntsig="" los="" ntawm="" qhov="" qis="" dua="" hba1c.="" ntawm="" qhov="" tod="" tes,="" kev="" siv="" cov="" kev="" kho="" mob="" uas="" muaj="" kev="" pheej="" hmoo="" tsawg="" dua="" xws="" li="" hypoglycemia="" (piv="" txwv="" li,="" metformin="" lossis="" sglt2="" inhibitors)="" txhawm="" rau="" txhawm="" rau="" txo="" qis="" hba1c="" qhov="" pib="" yuav="" xav="" tau="" kom="" ua="" tiav="" cov="" txiaj="" ntsig="" tau="" zoo.="" yog="" li,="" lub="" hom="" phiaj="" glycemic="" zoo="" tshaj="" plaws="" yuav="" tsis="" yog="" qhov="" pib="" ruaj="" khov,="" tab="" sis="" ib="" qho="" uas="" txawv="" raws="" li="" qhov="" sib="" npaug="" ntawm="" qhov="" kev="" pheej="" hmoo="" vs.="" cov="" txiaj="" ntsig="" ntawm="" txhua="" qhov="" kev="" cuam="" tshuam="" tshwj="" xeeb="" siv="" los="" ua="" kom="" tiav="" qhov="" glycemic="" pib.="" table="" 1="" qhia="" txog="" cov="" lus="" pom="" zoo="" rau="" kev="" tswj="" cov="" menyuam="" yaus="" thiab="" cov="" tub="" ntxhais="" hluas="" nrog="" t1d="" thiab="" t2d.="" yav="" dhau="" los="" tus="" yam="" ntxwv="" ntawm="" t2d,="" tab="" sis="" dhau="" los="" ua="" ntau="" dua="" hauv="" t1d="" thiab="" t2d,="" insulin="" tsis="" kam="" (ir)="" tau="" txuas="" nrog="" kev="" txhim="" kho="" ntawm="" dkd.="" ir="" tuaj="" yeem="" pib="" ua="" rau="" lub="" raum="" raug="" mob="" ntawm="" nws="" tus="" kheej="" ntawm="" [53],="" thiab="" txawm="" tias="" ua="" ntej="" kev="" loj="" hlob="" mus="" rau="" [54]="" frank="" hyperglycemia.="" ir="" yog="" paub="" zoo="" tias="" yuav="" tsum="" tau="" augmented="" los="" ntawm="" kev="" loj="" hlob="" thiab="" hormonal="" hloov="" uas="" tshwm="" sim="" thaum="" lub="" sij="" hawm="" puberty.="" piv="" txwv="" li,="" ir="" yog="" qhov="" tseem="" ceeb="" hauv="" cov="" tub="" ntxhais="" hluas="" nrog="" t1d="" txawm="" tias="" tsis="" muaj="" adiposity="" [55].="" qhov="" nce="" ntawm="" kev="" rog="" rog="" hauv="" cov="" hluas="" tau="" ntxiv="" rau="" kev="" puberty-induced="" nce="" hauv="" ir="" uas="" ua="" rau="" muaj="" kev="" loj="" hlob="" sai="" ntawm="" ir="" rau="" ntshav="" qab="" zib="" hauv="" cov="" pejxeem,="" raws="" li="" qhia="" nyob="" rau="" hnub="" no="" [56]="" thiab="" rise="" [57]="" kev="" tshawb="" fawb.="" cistanche="" zoo="" heev="" rau="" lub="" raum="" ua="">
Ntshav siab, ib qho kev pheej hmoo tsim nyog rau kev loj hlob ntawm DKD [58], nce qhov tshwm sim sai hauv cov hluas uas muaj ntshav qab zib, tshwj xeeb yog T2D [56]. Qhov kev nce no tsis cuam tshuam los ntawm kev tswj glycemic thiab yuav tsum tau siv ntau yam tshuaj hauv ib feem loj ntawm cov neeg mob, qhia tias kev rog thiab ntshav qab zib ua rau muaj txiaj ntsig zoo rau kev kho mob ntshav siab [56]. Cov lus qhia tam sim no [59] pom zoo kom muab tshuaj kho mob sai sai, nrog rau kev ntsuas kev ua neej, rau kev kho mob ntshav siab (BP> 95 feem pua). Cov lus pom zoo kuj tseem hais tias cov kab mob frst-line hauv cov neeg mob ntshav qab zib yog angiotensin-hloov enzyme inhibitors (ACEis) lossis angiotensin receptor blockers (ARBs), tom qab muab kev qhia txog kev yug menyuam rau cov poj niam uas muaj hnub nyoog yug menyuam. Lub hom phiaj BP hauv txhua tus neeg mob yuav tsum tsawg dua li 90 feem pua. Txawm li cas los xij, feem ntau, ntshav siab feem ntau mus kuaj tsis tau hauv cov menyuam yaus, ua qhov no yog lub hom phiaj tseem ceeb rau kev tshawb fawb thiab kev tsim kho tshiab los txhim kho kev paub txog qhov tseem ceeb ntawm qhov kev pheej hmoo rau DKD.
Serum uric acid (SUA) tau ntev tau suav tias yog qhov ua rau muaj feem cuam tshuam rau DKD hauv cov neeg laus thiab cov hluas [60]. Tsis tas li ntawd, SUA txo qis hauv kev sim tshuaj me me tau cuam tshuam nrog kev poob qis hauv GFR hauv cov neeg mob CKD [61], tsa kev cia siab tias kev tsom mus rau SUA tuaj yeem ua rau lub tswv yim tshiab rau kev qeeb DKD. Hmoov tsis zoo, ob qhov kev sim tshuaj tsis ntev los no tsom rau kev txo qis SUA nrog allopurinol (PERL [62]) thiab febuxostat (FEATHER [63]) tsis pom muaj kev cuam tshuam rau DKD / CKD kev nce qib. Cistanche zoo heev rau lub raum ua haujlwm.
Kev noj zaub mov thiab kev ua neej nyob
Cov qauv kev saib xyuas tam sim no suav nrog kev kawm noj zaub mov, piv txwv li, suav cov carbohydrates, nrhiav calories thiab noj cov zaub mov uas tsis muaj glycemic Performance index [25], thiab txhawb kev ua kom lub cev muaj zog, tag nrho cov no cuam tshuam nrog kev txhim kho glycemic tswj [64]. Txawm li cas los xij, cov tswv yim no tseem tsis tau muaj kev vam meej. Piv txwv li, tsuas yog 20 feem pua thiab 30 feem pua ntawm cov tub ntxhais hluas uas muaj T2D txwv cov zaub mov muaj roj ntau thiab siv cov carbohydrate suav, feem [64]. Cov lus pom zoo ntawm kev noj zaub mov hauv cov hluas yuav tsum xav txog qhov muaj feem ntau ntawm kev noj zaub mov tsis zoo hauv cov hluas uas muaj ntshav qab zib mellitus [65], nws tus kheej cuam tshuam nrog kev tswj glycemic tsis zoo thiab cov txiaj ntsig tsis zoo. American Diabetes Association (ADA) cov lus qhia kuj pom zoo kom tswj qhov hnyav, tshwj xeeb tshaj yog rau cov hluas nrog T2D [25]. Txawm li cas los xij, cov kev pabcuam kev noj qab haus huv hnyav uas sib xyaw cov hom phiaj noj zaub mov thiab kev tawm dag zog tau ua tsis tiav hauv kev txhawb nqa qhov hnyav hnyav lossis txhim kho kev tswj glycemic hauv cov tub ntxhais hluas nrog T2D [66].
Tsis ntev los no, qhov kev vam meej tseem ceeb ntawm DiRECT (Diabetes Remission Clinical Trial) tau rov ua kom muaj kev txaus siab rau kev noj zaub mov zoo rau kev tswj ntshav qab zib, tshwj xeeb nrog kev siv cov khoom noj uas tsis muaj zog (VLED). Cov neeg laus rog rog nrog T2D tsis ntev los no, tau noj cov calories tsawg heev (825-835 kcal / hnub) noj zaub mov hloov pauv rau 3-5 lub hlis, ua raws cov txheej txheem rov qhia zaub mov thiab kev txhawb nqa txhua hli, ua tiav 46 feem pua ntawm cov ntshav qab zib remission. ntawm 12 lub hlis, nrog rau kev poob qis rau 36 feem pua ntawm 24 lub hlis [67]. Txawm hais tias cov txiaj ntsig no tau ua rau muaj kev zoo siab heev nrog rau cov lus pom zoo rau kev siv VLED hauv qee cov neeg mob, lawv txoj kev nyab xeeb, thiab kev ua tau zoo ntawm cov tub ntxhais hluas tsis tau kawm zoo txog niaj hnub no. Kev tshuaj xyuas cov txheej txheem tsis ntev los no thiab kev tshuaj ntsuam xyuas VLEDs hauv cov menyuam yaus thiab cov tub ntxhais hluas tau pom qhov poob phaus thiab txhim kho cov txiaj ntsig cardio-metabolic, nrog rau ntau qhov kev ceeb toom [68]: VLED kev nyab xeeb tsis tuaj yeem ntsuas vim tias cov xwm txheej tsis zoo tau piav qhia hauv feem ntau ntawm cov kev tshawb fawb soj ntsuam. Tsis tas li ntawd, ntawm 24 qhov kev tshawb fawb tau txheeb xyuas, tsuas yog plaub tau luam tawm txij li xyoo 2000, tsuas yog ob qho tib si tau raug tswj xyuas kev sim, thiab tsuas yog ob qho tsom rau cov neeg mob uas kuaj mob T2D [68]. Xws li, txawm tias lawv cov txiaj ntsig ntev ntev, kev suav nrog LEDs hauv kev tswj cov ntshav qab zib tam sim no hauv cov menyuam yaus thiab cov tub ntxhais hluas tos txais kev txhawb nqa los ntawm cov kev sim loj thiab kev tswj hwm thiab tsis tuaj yeem pom zoo rau lub sijhawm no vim tias muaj peev xwm ua rau muaj kev cuam tshuam tsis zoo hauv qhov kev pheej hmoo siab heev. cov neeg nyob qhov twg kev loj hlob thiab kev tsim kho neurodevelopmental kev xav yog qhov tseem ceeb tshaj plaws. Cistanche zoo heev rau lub raum ua haujlwm.
Pharmacological kev tswj hwm
Muaj kev nce qib tseem ceeb hauv kev kho tshuaj rau cov neeg laus uas muaj ntshav qab zib hauv ob peb lub xyoo dhau los [69, 70]. Ntau cov tshuaj txo cov piam thaj los ntawm peb chav kawm tshiab tau pom zoo hauv Asmeskas rau kev siv rau cov neeg laus uas muaj ntshav qab zib: glucagon-zoo li peptide-1 (GLP1) receptor agonists, dipeptidyl peptidase-4 (DPP4) inhibitors, thiab sodium-glucose cotransporter-2 (SGLT2) inhibitors [71], ntau yam muaj txiaj ntsig zoo rauraumqhov tshwm sim[69]. Txawm li cas los xij, cov menyuam yaus thiab cov tub ntxhais hluas uas muaj ntshav qab zib mellitus tseem tsis tau txais txiaj ntsig los ntawm cov kev nce qib no nrog kev kho mob ntshav qab zib hauv cov menyuam yaus uas txwv rau metformin thiab insulin [72]. Txawm hais tias metformin yog ib tus neeg ua haujlwm txo qis ntshav qabzib yam tsis muaj kev pheej hmoo ntawm hypoglycemia, nws tsis muaj peev xwm khaws cia -cell ua haujlwm xws li lub sijhawm glycemic ua haujlwm hnyav zuj zus hauv cov neeg mob. Txawm hais tias muaj kev ntshai thaum ntxov ntsig txog kev koom nrog ntawm metformin thiab lactic acidosis hauv cov neeg mob CKD, cov ntaub ntawv los txhawb qhov teeb meem no tau tsis sib haum xws li FDA tau hloov kho nws cov lus ceeb toom txog kev siv metformin hauv cov neeg mob CKD uas muaj eGFR> 45 mL / min. ua 1,73m2;. Kev hloov kho koob tshuaj yuav tsum tau nrog kev poob qis hauv eGFR thiab tam sim no tsis muaj cov ntaub ntawv muaj kev nyab xeeb rau kev siv metformin hauv cov neeg mob uas muaj eGFR <30 ml="" min="" rau="" 1.73="" m2="" lossis="" hauv="" cov="" neeg="" mob="" ntshav="" qab="" zib="" [73].="" txog="" niaj="" hnub="" no,="" tsuas="" yog="" ib="" qho="" tshuaj="" tshiab,="" glp1="" receptor="" agonist,="" tau="" pom="" zoo="" rau="" cov="" menyuam="" yaus="" thiab="" cov="" tub="" ntxhais="" hluas.="" muab="" qhov="" nce="" ntawm="" cov="" ntshav="" qab="" zib="" ntau="" ntxiv="" nrog="" rau="" dkd="" [7,="" 8]="" hauv="" cov="" menyuam="" yaus="" thiab="" cov="" tub="" ntxhais="" hluas,="" qhov="" nce="" hauv="" lub="" neej="" tsis="" zoo="" tshwm="" sim="" thiab="" kev="" tuag="" ntxov="" hauv="" cov="" neeg="" no,="" thiab="" cov="" txiaj="" ntsig="" zoo="" ntawm="" qee="" cov="" tshuaj="" ntshav="" qab="" zib="" tshiab="" ntawm="" cov="" txiaj="" ntsig="" tsis="" zoo="" rau="" cov="" neeg="" laus.="" ,="" nws="" dhau="" los="" ua="" qhov="" tseem="" ceeb="" rau="" qhov="" tseem="" ceeb="" rau="" cov="" kev="" tshawb="" fawb="" uas="" xav="" tau="" los="" muab="" cov="" ntaub="" ntawv="" ntawm="" kev="" nyab="" xeeb="" thiab="" kev="" ua="" tau="" zoo="" ntawm="" cov="" neeg="" ua="" haujlwm="" no="" hauv="" cov="" menyuam="" yaus="" thiab="" cov="" tub="" ntxhais="" hluas.="" cov="" kev="" sim="" me="" me="" tam="" sim="" no="" thiab="" me="" me="" ntawm="" cov="" neeg="" ua="" haujlwm="" no="" tsuas="" yog="" ua="" raws="" li="" txoj="" cai="" ntawm="" cov="" menyuam="" yaus,="" fda="" txoj="" cai="" hais="" tias="" txhua="" cov="" tshuaj="" tau="" pom="" zoo="" rau="" kev="" siv="" rau="" cov="" neeg="" laus="" yuav="" tsum="" tau="" kuaj="" xyuas="" kev="" nyab="" xeeb="" thiab="" ua="" tau="" zoo="" hauv="" cov="" neeg="" mob.="" yog="" li="" ntawd,="" cov="" neeg="" koom="" nrog="" cov="" menyuam="" yaus="" yog="" me="" me="" (tsawg="" dua="" lossis="" sib="" npaug="" li="">
(Table 2 thiab 3), qhov sib txawv me ntsis rau cov neeg laus cov kev sim siab uas tau tso npe ntau txhiab tus neeg tuaj koom. Tsis tas li ntawd, ob peb qhov txiaj ntsig los ntawm cov kev sim me nyuam yaus no tau raug luam tawm hauv cov ntawv txheeb xyuas cov phooj ywg.
GLP1 receptor agonists rau T2D GLP1 receptor agonists ua cov txheej txheem incretin los ntawm kev txhawb nqa cov piam thaj-dependent insulin secretion, inhibiting glucagon secretion thiab gastric emptying, thiab suppressing qab los noj mov, ua rau txo qis hauv cov ntshav qabzib qib [85] thiab qee qhov hnyav. Kev siv GLP1 receptor agonists yog txuam nrog 17 feem pua txo qhov kev pheej hmoo ntawm cov kab mob hauv lub raum nrog rau qhov xwm txheej macroalbuminuria, txo eGFR, kev loj hlob mus rau kev lim ntshav, lossis tuag los ntawm lub raum ua rau, yam tsis muaj qhov tshwm sim ntawm hypoglycemia [85]. Rau GLP1 receptor agonists tau pom zoo hauv Tebchaws Meskas rau kev kho T2D hauv cov neeg laus hauv 5-10 xyoo dhau los; tsuas yog ib qho (liraglutide) tau pom zoo siv rau cov neeg mob hnub nyoog siab dua lossis sib npaug li 10 xyoo nrog T2D. Ib qho me me 5-lub lim tiam kev nce koob tshuaj nyob rau hauv cov hluas tau pom tias liraglutide muaj cov tshuaj pharmacokinetic zoo ib yam li cov neeg laus uas tsis muaj qhov tshwm sim tsis zoo hauv lub sijhawm luv luv ntawd [77]. Nws kuj tau pom tias txhawm rau txhim kho glycemic tswj hauv cov hluas nrog T2D, nrog rau metformin [76], ua rau FDA pom zoo thaum Lub Rau Hli 2019. Kev Ntsuas ntawm Liraglutide hauv Pediatrics with Diabetes (ELLIPSE) sim nyob rau hauv feem ntau dawb, rog cov hluas nrog T2D pom. tias qhov sib ntxiv ntawm liraglutide rau metformin txhim kho glycemic tswj [76]. Ib 3-hloov kev tshawb fawb txog liraglutide efcacy nyob rau hauv 100 dub cov hluas thiab cov hluas nrog T2D (NCT02960659) yuav tsum ua kom tiav thaum kawg ntawm 2022. Nws yog tsim nyog sau cia tias FDA pom zoo ntawm liraglutide hauv cov menyuam yaus thiab cov tub ntxhais hluas yog nyob ntawm ob kev sim uas muaj tag nrho ntawm 156 tus neeg koom, sib piv rau cov neeg laus sim nrog ntau txhiab tus neeg koom (xws li, n=9, 340 rau liraglutide hauv LEADER).
GLP1 receptor agonists rau T1D Tsis muaj GLP1 receptor agonists raug pom zoo siv rau cov menyuam yaus uas muaj T1D. Cov kev tshawb fawb uas tau ua tiav txog tam sim no, thiab ib qho uas tseem tab tom ua, yog txhua yam me me (< 40="" participants)="" and="" have="" largely="" remained="" unpublished="" (table="" 2).="" cistanche="" is="" very="" good="" for="" kidney="">
DPP4 inhibitors rau T2D Zoo li GLP1 receptor agonists, DPP4 inhibitors ua rau lub cev incretin. Txawm li cas los xij, DPP4 inhibitors ua los tiv thaiv kev degradation ntawm incretins los ntawm inhibiting DPP4 enzyme [86]. Qhov no ua rau muaj kev nce ntxiv hauv post-prandial GLP1 uas txhawb kev tsim cov tshuaj insulin, txo qis ntshav qabzib concentration. Tsis zoo li GLP1 receptor agonists, DPP4 inhibitors tsis cuam tshuam rau kev noj qab haus huv lossis kev ua pa hauv plab thiab tau txais kev noj qab haus huv, tsis yog los ntawm txoj kev subcutaneous [86]. DPP4 inhibitors muab kev tswj glycemic zoo hauv cov neeg mob T2D tab sis tsis muaj kev tiv thaiv kab mob plawv thiab cov txiaj ntsig zoo ntawmraumqhov tshwm simmuaj teeb meem [87]. Tseem tsis tau pom zoo siv rau cov menyuam yaus lossis cov hluas.
Kev txo koob tshuaj raws li qhov HbA1c tau sau tseg hauv ib qho me me 12-lub lim tiam txoj kev tshawb fawb ntawm linagliptin, DPP4 inhibitor, hauv 37 cov tub ntxhais hluas uas muaj T2D piv nrog cov placebo, tab sis qhov sib txawv no tsis yog qhov tseem ceeb. Tsis muaj qhov tshwm sim loj heev hauv pab pawg cuam tshuam [80]. Txoj kev tshawb fawb DINAMO tsis tu ncua (NCT03429543) tam sim no tau ntsuas qhov kev nyab xeeb ntev dua thiab kev ua tau zoo ntawm ib hnub linagliptin ib hnub dhau 52 lub lis piam thiab kwv yees yuav ua tiav xyoo 2023. Txoj kev tshawb no tsom mus rau 186 tus neeg koom nrog hnub nyoog 10-17 xyoo nrog T2D thiab BMI. Ntau dua lossis sib npaug li 85 feem pua ntawm cov hnub nyoog thiab poj niam txiv neej uas yuav raug randomized 1: 1: 1 rau cov placebo, linagliptin, lossis empagliflozin (sib tham ntxiv hauv qab no).
Ib yam li ntawd, kev sim nrog lwm tus DPP4 inhibitors tsis tau pom muaj kev txhim kho tseem ceeb hauv HbA1c. Tsis muaj ib qho ntawm cov kev sim no tau ua rau kev tshaj tawm, yuav yog vim muaj cov neeg tsawg heev. Cov kev sim loj ntxiv tseem tab tom pib (Table 3).
DPP4 inhibitors rau T1D Txawm tias nyob rau hauv cov neeg laus, DPP4 inhibitors tam sim no tsuas yog pom zoo los kho T2D, thaum lawv cov kev ua tau zoo ntawm cov neeg laus nrog T1D tab tom tshawb xyuas [88]. Hauv cov tub ntxhais hluas uas muaj T1D, DPP4 inhibitor sitagliptin tsis ua rau muaj kev txhim kho tseem ceeb hauv 2-h c-peptide teb tom qab kev sib tw noj mov [75]. Lwm txoj kev tshawb fawb (NCT01718093) hauv 21 cov tub ntxhais hluas tshawb xyuas cov piam thaj txo qis ntawm kev ntxiv sitagliptin, metformin, lossis ob qho tib si, rau kev tswj hwm insulin, tau ua tiav xyoo 2015 tab sis tseem tsis tau tshaj tawm.Cistanche zoo heev rau lub raum ua haujlwm.
SGLT2 inhibitors rau T2D SGLT2 inhibitors thaiv sodium thiab qabzib reuptake hauv cov tubules ze ntawmraum, ua rau muaj zog tso zis sodium thiab qabzib tso tawm ua rau txhim kho cov metabolism thiab hemodynamic tsis xws li hyperglycemia, lub cev hnyav, adiposity, thiab BP [89]. Tsis tas li ntawd, SGLT2 inhibitors tau pom tias txo qis lub raum hyperfiltration hauv cov neeg mob ntshav qab zib, los ntawm kev cuam tshuam rau tubular-glomerular tawm tswv yim mechanisms. Cov txiaj ntsig cardiorenal ntawm SGLT2 inhibitors hauv cov neeg laus tau tsim muaj txiaj ntsig zoo hauv cov txiaj ntsig ntawm kev mob plawv. Kuj tseem muaj cov ntaub ntawv qhia tias SGLT2 inhibitors ua rau txo qis kev pheej hmoo ntawm lub raum tsis zoo, xws li kev poob qis hauv eGFR, xav tau kev lim ntshav, lossis tuag los ntawm lub raum ua rau cov neeg laus [90, 91]. SGLT2 inhibitors yog txuam nrog kev pheej hmoo ntawm qhov chaw mos [90, 91]. Hauv kaum xyoo dhau los, plaub SGLT2 inhibitors tau pom zoo hauv Asmeskas rau cov neeg laus nrog T2D thiab tau pom zoo rau cov neeg mob T2D thiabmob raumua kom qeeb qeeb rau kev lim ntshav [71]; Txawm li cas los xij, tsis muaj SGLT2 inhibitor tau pom zoo siv rau cov hluas.
Ib txoj kev tshawb fawb (NCT02725593) tau soj ntsuam qhov ua tau zoo ntawm dapagliflozin, ib qho SGLT2 inhibitor, vs. placebo hauv kev txo qis HbA1c hauv 72 cov tub ntxhais hluas thiab cov hluas. Rau peb txoj kev paub, cov txiaj ntsig kev sim tsis tau luam tawm hauv phau ntawv xov xwm sib tham. Txawm li cas los xij, cov ntaub ntawv xa mus rau clinicaltrials.gov qhia tias tsis muaj qhov sib txawv tseem ceeb hauv kev hloov pauv hauv HbA1c lossis yoo ntshav ntshav qabzib los ntawm lub hauv paus rau lub lim tiam 24 ntawm dapagliflozin thiab placebo. Lwm txoj kev tshawb fawb tau soj ntsuam cov tshuaj pharmacokinetic thiab pharmacodynamic profiles ntawm ntau koob tshuaj empagliflozin, lwm SGLT2 inhibitor, nyob rau hauv 27 cov tub ntxhais hluas (txhais tau tias muaj hnub nyoog 14.1 xyoo) thiab pom qhov txo qis hauv cov ntshav qabzib yoo mov, qhov koob tshuaj nce ntxiv hauv cov zis tso zis, thiab tsis muaj mob hnyav. Cov xwm txheej tsis zoo [83]. Cistanche zoo heev rau lub raum ua haujlwm.
Theem 3 kev sim rau dapagliflozin (NCT03199053) thiab empagliflozin (NCT03429543) hauv cov menyuam yaus thiab cov tub ntxhais hluas tseem tab tom ua tiav thiab kwv yees kom tiav hauv 2023. Ob qhov kev sim no ua raws li tus qauv zoo sib xws, randomizing kwv yees li ntawm 243 thiab 181, feem: rau cov placebo, SGLT2 inhibitor (dapagliflozin lossis empaglifozin), lossis DPP4 inhibitor (saxagliptin lossis linagliptin). Ob qhov kev sim no yuav ntsuas qhov ua tau zoo ntawm kev hloov pauv hauv HbA1c los ntawm lub hauv paus pib ntawm lub lim tiam 26 thiab yuav ua raws li cov neeg koom nrog rau lub lim tiam 52. Ntau qhov SGLT2 inhibitors tam sim no nyob rau ntau theem ntawm kev sim tshuaj rau cov neeg laus thiab cov hluas nrog T2D (Table 3).
SGLT2 inhibitors rau T1D Tam sim no, SGLT2 inhibitors tsuas yog pom zoo siv rau cov neeg laus nrog T2D tab sis lawv cov txiaj ntsig zoo hauv kev kho T1D tam sim no tau tshawb xyuas [88]. Tsuas yog ib qho kev sim tam sim no tab tom tshawb xyuas kev siv SGLT2 inhibitor hauv cov tub ntxhais hluas (NCT04333823) thiab, tshwj xeeb, nws tsuas yog qhov kev sim ntawm tus neeg mob ntshav qab zib tshiab hauv cov tub ntxhais hluas uas muaj tus kab mob.mob raum thawj qhov tshwm sim. Cov Hluas Kev Kho Mob Ntshav Qab Zib Hom 1 nrog SGLT2i rau hyperglycEMia thiab hyperfiltration Trial (ATTEMPT) npaj yuav xaiv 100 cov tub ntxhais hluas (hnub nyoog 12-18 xyoo) nrog T1D tsawg kawg yog 1 xyoo; Cov neeg koom nrog yuav raug randomized kom tau txais dapagliflozin lossis placebo ib hnub ib zaug rau 16 lub lis piam. Qhov txiaj ntsig tseem ceeb ntawm qhov kev sim yog qhov hloov pauv hauv kev ntsuas GFR los ntawm lub hauv paus mus rau lub lim tiam 16, nrog rau lub hom phiaj ntawm kev nkag siab txog kev ua kom lub cev muaj zog ntawm SGLT-2 inhibition ntawm cov teeb meem ntshav qab zib thaum ntxov hauv cov hluas. Qhov kev tshawb fawb no kwv yees yuav ua kom tiav hauv 2023.
Kev phais mob
Kev phais Bariatric muaj qhov cuam tshuam loj, nrawm, thiab ntev ntev ntawm kev txhim kho qhov poob phaus, kev pheej hmoo ntawm cov hlab plawv, thiab kev tswj glycemic rau cov neeg laus nrog T2D, ua rau kev tshem tawm cov ntshav qab zib ntau dua ib nrab ntawm txhua tus neeg mob tom qab 2 xyoos [92]; Kev phais kuj tau pom tias txo qis qhov tshwm sim ntawm albuminuria thiab qeeb DKD kev loj hlob [93].Cistanche zoo heev rau lub raum ua haujlwm.
Kev phais Bariatric tau dhau los ua qhov kev xaiv kho mob ntau dua rau cov hluas rog rog. Qhov Kev Ntsuam Xyuas Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) txoj kev tshawb fawb tau tso npe rau 242 cov tub ntxhais hluas uas raug phais bariatric hauv txoj kev tshawb fawb yav tom ntej [94]. Cov txheej txheem phais feem ntau yog Roux-en-Y gastric bypass (66.5 feem pua), ua raws li lub tes tsho gastrectomy (27.7 feem pua) thiab kho lub plab (5.8 feem pua). Teen-LABS qhia tau hais tias kev phais bariatric ua rau txo qis hauv BMI hauv 6 lub hlis thiab qhov kev poob phaus no tau khaws cia ntawm 3 xyoos. Qhov no tau cuam tshuam nrog kev txhim kho tseem ceeb hauv eGFR thiab albuminuria ntawm 3 xyoos [94]. Ib qho kev soj ntsuam thib ob pom tau tias cov tub ntxhais hluas muaj 27 feem pua yuav muaj ntau dua li cov neeg laus kom ua tiav kev tshem tawm ntawm T2D, thiab 51 feem pua yuav muaj ntau dua li cov neeg laus kom ua tiav qhov kev tshem tawm ntawm kev kub siab 5 xyoo tom qab phais bariatric [95].
Cov ntaub ntawv pov thawj ntxiv qhia tias kev phais mob bariatric muaj qhov zoo dua li qhov tam sim no tus qauv ntawm kev saib xyuas txoj kev ua neej thiab kev xaiv tshuaj rau cov tub ntxhais hluas nrog T2D. Ib qho kev soj ntsuam thib ob piv rau kev phais thiab kev tswj xyuas kev kho mob ntawm T2D hauv cov tub ntxhais hluas los ntawm kev sib tw 30 Cov Hluas-LAB koom nrog thaum lub sijhawm phais nrog 63 cov tub ntxhais hluas los ntawm txoj kev tshawb no TODAY. Cov neeg tuaj koom tau raug muab sib piv rau hnub nyoog, poj niam txiv neej, haiv neeg / haiv neeg, thiab lub hauv paus BMI, tsis hais txog pab pawg kho mob hnub no. Tom qab 5 xyoos ntawm kev soj ntsuam, Cov neeg koom nrog Teen-LABS tau qis BMI, txhais tau tias HbA1c, txhais tau tias triglycerides, thiab txhim kho insulin rhiab heev, thaum cov neeg koom nrog niaj hnub no muaj BMI, HbA1c, thiab triglycerides ntau dua, thiab ua rau cov insulin rhiab heev [96]. Kev tswj hwm kev kho mob ntawm T2D hauv cov tub ntxhais hluas kuj tseem cuam tshuam nrog cov neeg pluagraumqhov tshwm sim. Tom qab 5 xyoos tom qab, cov neeg koom nrog hnub no muaj 27-feeb ntau dua ntawm cov zis AER siab dua piv nrog Cov Hluas-LABS cov neeg koom. Txawm li cas los xij, tsis muaj qhov kev sim ntsuas randomized tau ua qhov kev sib piv ntawm lub taub hau ntawm kev ua tau zoo thiab kev nyab xeeb ntawm kev phais rau cov kev kho mob uas tsis yog phais, thiab yog li ntawd, kev txiav txim siab mus nrhiav kev phais yuav tsum tau ua tus kheej thiab kho kom haum rau cov kev xav tau tshwj xeeb. tus neeg mob thiab cov kws tshaj lij muaj nyob hauv lub tsev kho mob. Tsis tas li ntawd, kev phais mob hauv cov tub ntxhais hluas no yuav xav tau kev soj ntsuam zoo ntawm lawv cov kev pheej hmoo thiab cov txiaj ntsig zoo dua li kev soj ntsuam ntev dua. Feem ntau, cov lus qhia siv los ua ib qho kev qhia rau kev phais metabolic hauv cov tub ntxhais hluas muaj xws li BMI> 35 kg / m2 nrog comorbidities lossis BMI> 40 kg / m2 nrog lossis tsis muaj comorbidities.
Kev hloov ntawm kev saib xyuas
Lub sijhawm hloov pauv ntawm tus menyuam mus rau kev saib xyuas neeg laus yog ib qho cuam tshuam nrog kev tsis zoo ntawm kev tswj glycemic; nce tshwm sim ntawm mob hnyav; kev nyuaj siab, kev xav, thiab kev coj cwj pwm; thiab qhov tshwm sim ntawm cov teeb meem mob ntev [97, 98]. Tsis tas li ntawd, cov txheej txheem ntawm kev hloov pauv ntawm tus menyuam mus rau kev saib xyuas neeg laus yog qhov ua rau muaj kev tawg ntawm kev kho mob, uas yuav cuam tshuam rau kev saib xyuas kev noj qab haus huv zoo, nqi, thiab cov txiaj ntsig [99].
ADA cov lus qhia pom zoo kom cov kws kho mob npaj cov tub ntxhais hluas rau kev hloov pauv mus rau kev saib xyuas kev noj qab haus huv rau cov neeg laus thaum ntxov thiab, qhov kawg, tsawg kawg yog 1 xyoo ua ntej qhov kev hloov pauv tshwm sim [25, 98]. Lub sijhawm no, ob tus kws kho mob rau menyuam yaus thiab cov neeg laus mob ntshav qab zib yuav tsum muab kev txhawb nqa thiab kev pabcuam rau kev hloov pauv cov hluas. Muab qhov sib txawv ntawm cov tub ntxhais hluas kom tau txais kev ywj pheej thiab kev tswj xyuas ob qho tib si logistical thiab kev kho mob ntawm kev kho mob ntshav qab zib, kev hloov chaw kho mob yuav tsum tsuas yog tshwm sim thaum nws pom zoo los ntawm tus neeg mob thiab tus kws kho mob.Cistanche zoo heev rau lub raum ua haujlwm.
Cov tswv yim los npaj cov tub ntxhais hluas kom zoo dua rau kev hloov pauv muaj xws li kev tsom mus rau kev tswj tus kheej ntawm ntshav qab zib rau cov neeg laus uas muaj hnub nyoog laus dua nrog kev hloov pauv ntawm kev saib xyuas ntshav qab zib mus rau cov hluas los ntawm niam txiv lossis tus saib xyuas, sib qhia cov ntaub ntawv hais txog qhov sib txawv ntawm cov menyuam yaus thiab cov neeg laus. cov kws kho mob hauv lawv txoj hauv kev rau kev saib xyuas, thiab kev kawm txog kev xaiv pov hwm kev noj qab haus huv thiab yuav ua li cas thiaj li tswj tau qhov kev pov hwm. Qhov zoo tshaj plaws, tus neeg mob thiab tus kws kho mob ntshav qab zib yav tom ntej yuav tsum tau txais cov ntawv sau qhia txog txhua yam cuam tshuam nrog tus neeg mob kev tswj ntshav qab zib [98]. Yog xav paub ntxiv, tus nyeem ntawv raug xa mus rau ADA Transitions Workgroup report [98]. Txawm hais tias tam sim no muaj qee cov pov thawj-raws li cov tswv yim rau kev hloov pauv kev saib xyuas rau cov hluas uas muaj ntshav qab zib, qhov no yog ib qho tseem ceeb thiab ib qho uas tau txais kev saib xyuas ntxiv; peb cia siab tias cov txiaj ntsig ntawm kev sim tshuaj xws li "Kev Ntsuam Xyuas Kev Tsim Kho Tshiab hauv Kev Hloov Los Ntawm Kev Kho Mob Rau Cov Menyuam Yaus mus rau Kev Saib Xyuas Neeg Laus-Kev Hloov Pauv Kev Sib Tw" (NCT03342495) yuav pab muab lub hauv paus ua haujlwm kom tso cai rau kev saib xyuas zoo dua thiab muaj txiaj ntsig zoo. rau cov hluas ntawd. Cistanche zoo heev rau lub raum ua haujlwm.
Cov lus xaus
Hauv cov ntsiab lus, ntshav qab zib thiab DKD tau ntsib ntau dua hauv cov menyuam yaus thiab cov tub ntxhais hluas. Nyob rau tib lub sijhawm, peb txoj kev nkag siab ntawm pathophysiology ntawm tus kab mob kuj tau nce ntxiv, raws li muaj armamentarium ntawm cov tswv yim kho mob muaj rau peb. Feem ntau qhov kev cog lus yog peb qhov tshiab ntawm kev sib kho uas tam sim no tau kawm ntau hauv cov neeg laus: GLP1 receptor agonists, DPP4 inhibitors, thiab SGLT2 inhibitors, nrog rau kev noj zaub mov kom rov qab ntshav qab zib thiab nws cov teeb meem cuam tshuam (xws li, LEDs). Ntau qhov kev cuam tshuam no muaj peev xwm txo qis qhov kawg ntawm lub cev. Xav txog qhov nce ntxiv ntawm cov ntshav qab zib hauv cov menyuam yaus thiab cov neeg laus hluas thiab qhov hnyav dua phenotype ntawm cov ntshav qab zib hauv cov neeg uas muaj kev pheej hmoo siab, nws yog lub sijhawm los rov tsom mus rau peb cov kev siv zog thiab cov peev txheej ntawm thaj chaw no los ntawm kev sim tshuaj loj thiab nruj dua ntawm cov tshuaj kho tshiab no hauv cov menyuam yaus thiab cov hluas uas muaj ntshav qab zib. Cistanche zoo heev rau lub raum ua haujlwm.
Cov ntsiab lus tseem ceeb
(1) Kev mob ntshav qab zib mellitus, tshwj xeeb tshaj yog hom 2 mob ntshav qab zib mellitus, thiab nws cov teeb meem tshwm sim, muaj kev nce ntxiv hauv cov menyuam yaus thiab cov tub ntxhais hluas, cuam tshuam tsis zoo rau cov haiv neeg tsawg.
(2) Lub hauv paus tseem ceeb hauv kev tiv thaiv kab mob ntshav qab zibmob raumNws yog qhov zoo tshaj plaws tswj glycemic, nrog rau kev tshuaj xyuas thiab tswj kev kub siab thiab albuminuria.
(3) GLP1 receptor agonists, ua ke nrog metformin, tau pom tias muaj txiaj ntsig zoo hauv kev txo qis qhov tshwm sim tsis zoo.raumcov txiaj ntsig, thiab tam sim no tau pom zoo siv rau cov menyuam yaus uas muaj ntshav qab zib hom 2.
(4) Txawm hais tias muaj ntau yam kev kho tshiab tau kawm thiab pom zoo siv rau cov neeg laus uas muaj ntshav qab zib thiab ntshav qab zibmob raum, tsis muaj kev vam meej tau ua tiav hauv kev sim tshuaj rau cov menyuam yaus thiab cov neeg laus.
2. Qhov twg hauv qab no qhia txog qhov tshwm sim ntawm CKD theem 5 hauv cov menyuam yaus uas muaj T1D, 30 xyoo tom qab pib mob?
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10-25 feem pua
25-30 feem pua
>30 feem pua
3. Thaum twg yuav tsum kuaj cov albuminuria hauv cov menyuam yaus thiab cov hluas uas muaj T2D?
a) Thaum lub sijhawm kuaj mob
b) Tom qab 1 xyoos ntawm kev kuaj mob
c) Tom qab 5 xyoos ntawm kev kuaj mob
d) Thaum mob ntshav qab zib retinopathy yog frst kuaj
4. Cov nqe lus twg hauv qab no hais txog kev txhim kho AKI thaum lub sij hawm DKA muaj tseeb?
a) AKI yog qhov tshwm sim tsis tshua muaj tshwm sim hauv cov menyuam yaus nrog DKA.
b) Feem ntau ua rau AKI hauv DKA yog nephrotoxic ATN.
c) Cov neeg laus nrog DKA uas tsim AKI muaj kev vam meej ntawm DKD ntau dua.
d) Cov hnub nyoog yau yog txuam nrog kev pheej hmoo siab dua rau cov me nyuam nrog DKA los tsim AKI.
5. Qhov twg hauv qab no yog qhov tseem ceeb tshaj plaws uas cuam tshuam nrog kev loj hlob ntawm DKD hauv cov neeg mob ntshav qab zib?
Ntshav siab
b) Kev tiv thaiv insulin
c) Serum uric acid
Hyperglycemia
Cov lus nug ntau xaiv
1. Cov nqe lus twg hauv qab no qhia meej txog kev sib raug zoo ntawm albuminuria thiab kev loj hlob ntawm DKD?
a) Kev loj hlob ntawm DKD yog universally preceded los ntawm kev loj hlob ntawm albuminuria.
b) Feem ntau cov neeg mob me me nrog microalbuminuria nce mus rau macroalbuminuria.
c) Macroalbuminuria yog txuam nrog kev pheej hmoo siab ntawm CKD.
d) Macroalbuminuria invariably nce mus rau qib siab CKD.
Cistanche zoo heev rau lub raum ua haujlwm.
Cov lus tshaj tawm
Kev tsis sib haum xeeb Cov neeg sau ntawv tshaj tawm tsis muaj kev sib tw cov txiaj ntsig.
Qhib Kev Nkag Mus Kab lus no tau tso cai raws li Creative Commons Attribution 4.0 Daim ntawv tso cai thoob ntiaj teb, uas tso cai siv, sib koom, hloov kho, faib, thiab luam tawm hauv ib qho nruab nrab lossis hom ntawv, tsuav yog koj muab credit tsim nyog rau tus sau thawj (s) thiab qhov chaw, muab qhov txuas mus rau Creative Commons daim ntawv tso cai, thiab qhia seb puas tau hloov pauv. Cov duab lossis lwm yam khoom siv thib peb hauv tsab xov xwm no suav nrog hauv tsab xov xwm Creative Commons daim ntawv tso cai tshwj tsis yog tau qhia lwm yam hauv kab qiv nyiaj rau cov khoom siv. Yog tias cov ntaub ntawv tsis suav nrog hauv tsab xov xwm Creative Commons daim ntawv tso cai thiab koj qhov kev npaj siv tsis raug tso cai los ntawm txoj cai lij choj lossis tshaj qhov kev tso cai siv, koj yuav tsum tau txais kev tso cai ncaj qha los ntawm tus tuav ntaub ntawv. Txhawm rau saib daim ntawv tso cai no, mus saib http://creativecommons.org/licenses/by/4.0/.Cistanche zoo heev rau lub raum ua haujlwm.
