Kev Ntsuas Thiab Kev Kho Ntawm ANCA-Associated VasculitisⅣ

Kev kho mob: Induction ntawm remission

Cyclophosphamide-based regimen

Kev taw qhia ntawm cyclophosphamide, tus neeg sawv cev alkylating, tau hloov pauv ANCA-koom nrog vasculitis los ntawm cov kab mob uas yuav luag thoob plaws ntiaj teb ua rau tuag taus rau ib qho uas, thaum tseem niaj hnub ua rau tuag taus ntev, tau thim rov qab rau feem ntau. Thawj qhov kev paub nrog cyclophosphamide cuam tshuam nrog kev noj tshuaj txhua hnub ntawm qhov ncauj (ua ke nrog cov koob tshuaj glucocorticoids siab), xws li rituximab thiab cyclophosphamide hauv ANCA-koom nrog vasculitis (RAVE2016 Cov txiaj ntsig ntawm kev kho mob ntawm cov tshuaj tiv thaiv neutrophil cytoplasmic antibody (ANCA) raws li CA-associated vasculitis ) .pdf), tab sis cov tshuaj tua kab mob hauv cov hlab ntsha cyclophosphamide (ua ke nrog glucocorticoids) kuj muaj qhov ua tau zoo ntawm kev ua tiav ntawm kev tshem tawm.

Nyem rau Cistanche rau mob raum

CYCLOPS txoj kev tshawb no (2009 Pulse piv rau txhua hnub qhov ncauj cyclophosphamide rau induction ntawm remission nyob rau hauv antineutrophil cytoplasmic antibody-associated vasculitis ib randomized sim) piv intravenous thiab qhov ncauj cyclophosphamide nyob rau hauv kev kho mob ntawm generalized ANCA-koom nrog vasculitis thiab pom tias nyob rau hauv ib qho kev txhaj tshuaj. kwv yees li 50% txo qis hauv cyclophosphamide raug. Txawm li cas los xij, yuav luag 88% ntawm cov neeg mob hauv ob pawg tau nkag mus rau kev tso cai tsis pub dhau 9 lub hlis tom qab pib kho. Ob pawg ntawm cov neeg mob tau txais kwv yees li 7.6 g ntawm kev kho glucocorticoid sib npaug rau prednisone thaum lub sijhawm no, sib npaug rau qhov nruab nrab txhua hnub prednisone koob tshuaj ze li 28 mg / d. Thaum lub sijhawm 4.3 xyoo ntawm kev ua raws li txoj cai, feem ntau cov neeg mob tau txais kev kho mob tsis tu ncua nrog azathioprine thiab glucocorticoids txog 18 lub hlis tom qab pib kho thiab tom qab ntawd ntxiv kev tiv thaiv kab mob ntawm tus neeg tshawb xyuas qhov kev txiav txim siab. Nyob rau tag nrho lub sijhawm ua raws, 40% ntawm cov neeg mob hauv cov tshuaj tua kab mob cyclophosphamide tau ntsib cov kab mob rov qab, piv nrog 21% ntawm cov neeg mob hauv qhov ncauj pawg cyclophosphamide.

Yog li, txawm hais tias cyclophosphamide-raws li kev tswj hwm tau hloov kho cov kab mob tuag ntau hauv cov neeg mob uas muaj ANCA-txog vasculitis, kab mob rov tshwm sim tseem muaj thiab lub nra ntawm kev kho glucocorticoid tseem siab. Glucocorticoid toxicity tsis tau ntsuas ua ntej thiab thaum lub sijhawm xyoo 2000s vim tias kev ntsuas kev ntsuas tsis muaj thiab kev txhawj xeeb loj dua rau kev siv cyclophosphamide. Qhov kev xaiv tam sim no ntawm cyclophosphamide raws li qhov kev tso cai tso tawm induction tus neeg saib xyuas suav nrog qhov zoo thiab qhov tsis zoo ntawm ob txoj hauv kev ntawm kev tswj hwm, tab sis rituximab tau nyiam ntau dua li cyclophosphamide. Yog tias siv cyclophosphamide txhua, nws yuav tsum siv sijhawm luv luv (piv txwv li, 3 lub hlis) kev tswj hwm, thaum lub sijhawm ntev (txog 10 pulses) siv hauv CYCLOPS kev sim tsis pom zoo vim muaj teeb meem toxicity (xws li. , malignancy), Txawm hais tias txoj kev ntawm kev tswj hwm siv.

Rituximab-based regimen

Kev siv tau zoo ntawm rituximab, chimeric monoclonal antibody targeting CD20+ hlwb, hauv kev kho mob ntawm ANCA-associated vasculitis tau tshaj tawm thawj zaug hauv xyoo 2001. Hauv kev sim RAVE, kev tswj hwm ntawm rituximab ntxiv rau glucocorticoids tau muab piv nrog kev tswj hwm ntawm txhua hnub ntawm qhov ncauj cyclophosphamide ntxiv rau glucocorticoids los txhawb kev tso tawm kom pom tias cov kev tswj hwm rituximab tsis yog qis dua. RAVE raws tu qauv qhia tias cov neeg mob 'ua ke nrog kev kho mob prednisone yuav tsum tau maj mam tapered kom txiav tawm rau ntau tshaj 5.5 lub hlis. Rau caum-plaub feem pua ​​​​ntawm cov pab pawg rituximab thiab 53% ntawm cyclophosphamide (induction) thiab azathioprine (kev saib xyuas) pawg tau nkag mus rau kev tso cai yam tsis tau siv cov glucocorticoids, thawj qhov kawg. Tsis tas li ntawd, pawg rituximab tsis yog qis dua rau pawg cyclophosphamide thiab azathioprine hauv kev txhawb nqa kev zam txim (p<0.001), but the advantage was not statistically significant (p=0.09). In patients with PR3 ANCA-associated vasculitis, rituximab was superior in inducing remission and had a higher rate of disease relapse, a finding that has been consistently observed across multiple studies.

Kev sib xyaw ntawm glucocorticoid tshwm sim thaum lub sijhawm 18- lub hlis tom qab tsis muaj qhov sib txawv ntawm ob pawg (4.6 g raug nyob rau hauv pawg rituximab thiab 5.1 g raug hauv pawg cyclophosphamide), sib npaug rau qhov nruab nrab koob tshuaj txhua hnub ntawm 8.4 mg. , raws. thiab 9.3 mg, tseem yog ib qho loj loj. Cov neeg mob hauv qhov kev sim RAVE tsis tau noj rituximab (lossis rituximab placebo) dua li ntawm 6 lub hlis, thiab tus kab mob rov tshwm sim tau tshwm sim los ntawm 18- hli sim. Kaum yim lub hlis tom qab pib kev kho mob, 39% ntawm pawg rituximab thiab 33% ntawm pawg cyclophosphamide tau txais kev tso cai, yog li ib chav kawm ntawm rituximab ntxiv rau corticosteroids tsis txaus los tswj kev tshem tawm mus sij hawm ntev hauv cov neeg mob feem ntau.

Hauv cov neeg mob uas muaj MPO-ANCA-txuas nrog vasculitis thiab khaws cia lub raum ua haujlwm, LoVAS (2021 LoVAS Cov nyhuv ntawm kev txo koob tshuaj thiab koob tshuaj glucocorticoids ntxiv rau rituximab ntawm kev tso tawm induction hauv ANCA-koom nrog vasculitis ib qho kev sim tshuaj ntsuam xyuas..pdf) sim Rituximab ntxiv rau cov tshuaj glucocorticoid qis qis tau pom tias yuav ua rau txo qis kev tso tawm zoo ib yam li cov qauv-dose glucocorticoid regimens (71% vs. 69%), thiab cov tshuaj noj qis tau cuam tshuam nrog cov kab mob hnyav tsawg: 5 vs. 13. Tshaj li 2 lub lis piam, Cov neeg mob nyob rau hauv cov txheej txheem koob tshuaj glucocorticoid tau txais 4.2 g ntawm glucocorticoids, thiab cov neeg mob nyob rau hauv cov koob tshuaj qis tau txais 1.3 g ntawm glucocorticoids, sib npaug rau qhov nruab nrab koob tshuaj txhua hnub ntawm 22.8 mg thiab 7.2 mg, raws li.

Kev sim cov ntaub ntawv ntawm kev ua tau zoo ntawm rituximab hauv cov neeg mob uas muaj cov ntshav creatinine ntau dua 352 µmol / L (4 mg / dL) nyob qis qis, feem ntau vim tias RAVE Cov Ntaub Ntawv thiab Pawg Saib Xyuas Kev Nyab Xeeb tau thov qhov kev cais tawm no ntau dua vim tias muaj pov thawj tias Rituximab tsis yog. siv tau rau hauv qhov xwm txheej no. Txawm li cas los xij, qee tus kws kho mob pom zoo kom sib xyaw rituximab nrog ob lub pulses ntawm cyclophosphamide hauv qhov chaw no raws li lub tswv yim los pab cov neeg mob nkag mus rau kev zam txim. Txoj hauv kev no tsis tau raug rau kev sim siab, ob qhov muag tsis pom kev, thiab muaj kev txhawj xeeb tias qhov kev tswj hwm no tuaj yeem ua rau muaj kev sib kis tsis zoo.

Cistanche kho mob raum li cas?

Cistancheyog ib hom tshuaj suav tshuaj ntsuab siv rau ntau pua xyoo los kho ntau yam mob, suav nrograumkab mob. 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 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 cov kab mob hauv lub 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 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.