Tshawb nrhiav Cov Lus Cog Tseg Ntawm Biomarkers Rau Mob Raum Mob Ⅳ

4. Saib mus rau yav tom ntej: Kev nthuav dav ntawm qhov kev xav tau

AKI yog ib qho kev paub txog kev pheej hmoo rau kev loj hlob ntawm CKD los ntawm txoj hauv kev profibrotic, thiab ob lub raum syndromes txawm tias yog ib qho kev txuas ntxiv ntawm tib txoj kev tshem tawm, ua rau muaj kev pheej hmoo rau cov kab mob plawv. Lub luag haujlwm ntawm biomarkers hauv kev nkag siab qhov txuas ntxiv no tau tshawb nrhiav hauv kev tshawb fawb yav tom ntej ntawm 656 cov neeg mob hauv tsev kho mob nrog AKI, uas tau soj ntsuam cov xwm txheej muaj feem cuam tshuam nrog rau lub raum raug mob, mob, thiab lub raum ua haujlwm ntawm ntau lub sijhawm tom qab AKI txog 12 lub hlis. Ntau lub urinary thiab plasma biomarkers ntawm tubular noj qab haus huv. Cov kws sau ntawv tau pom tias cov ntaub so ntswg tsis tu ncua thiab o, nrog rau kev rov qab qeeb ntawm tubular noj qab haus huv, tau cuam tshuam nrog kev pheej hmoo siab ntawm CKD tshwm sim thiab kev loj hlob. Tshwj xeeb, kev nce hauv cov zis KIM-1, MCP-1, thiab ntshav TNFR1 los ntawm lub hauv paus mus rau 12 lub hlis tau cuam tshuam nrog 2-3-fold nce hauv CKD kev pheej hmoo, thaum nce hauv cov zis uromodulin tau cuam tshuam nrog 40% kev pheej hmoo txo.

Nyem rau ntawm Cistanche rau mob raum

Biomarkers kuj tseem tuaj yeem ua lub luag haujlwm hauv kev kwv yees kab mob plawv thiab kev tuag. 502 tus neeg raug xaiv los ntawm Health ABC pawg, suav nrog cov neeg ua haujlwm zoo hnub nyoog 70 txog 79 xyoo. Ntawm lawv, 245 yog cov neeg mob uas muaj kab mob plawv thiab 220 yog cov neeg mob plawv tsis ua haujlwm. Tag nrho ntawm 776 tus neeg tau txais ib lub sijhawm ntsuas qhov zis 1M, NGAL, thiab hom III procollagen amino-terminal propeptide (PIIINP). Cov kws sau ntawv pom tias 1MG thiab NGAL yog tus kheej cuam tshuam nrog cov kab mob plawv thiab kev tuag, tab sis tsis yog lub plawv tsis ua haujlwm. Ib lub koom haum zoo sib xws tau tshwm sim hauv SPRINT pawg, ib qho piv txwv ntawm 2377 tus neeg mob paub tias muaj CKD. Ib txoj kev tshawb fawb tau tshuaj xyuas peb lub biomarkers ntawm cov zis: 1-microglobulin (1M), 2 microglobulin (2MG), thiab uromodulin, thiab pom tias 1M cuam tshuam nrog kev pheej hmoo ntawm CVD thiab kev tuag ntau dua, thaum uromodulin koom nrog qis dua CVD. Yog li ntawd, ntau AKI biomarkers tej zaum yuav muaj feem cuam tshuam rau kev kwv yees qhov kev pheej hmoo ntawm kev nce mus rau CKD thiab cov xwm txheej hauv plawv tom qab AKI.

5. Txuas qhov sib txawv: Txuas kev tshawb fawb soj ntsuam kom muaj kev pheej hmoo stratification

AKI biomarkers are currently used in several clinical trials as biological indicators designed to modulate clinical interventions and/or measure clinical outcomes such as risk of progression to CKD or mortality. Indeed, AKI biomarkers could play a role in the early identification of at-risk patients and the assessment of specific clinical management and therapeutic interventions at various stages of AKI. These biomarker-guided approaches are being actively tested to enable KDIGO's care bundles. In the PrevAKI study, a single-center randomized trial evaluated the efficacy of the KDIGO guideline in preventing cardiac surgery-related AKI in high-risk patients identified by renal biomarkers. This allows interventions to be initiated before renal function changes. A total of 276 high-risk patients were included in the study, and high-risk was defined as urine [TIMP-2]×[IGFBP-7]>0.3. Cov neeg mob tau muab faib ua pawg tswj hwm uas tau txais kev saib xyuas tus qauv thiab pab pawg cuam tshuam uas ua raws li KDIGO CT phais pob. Cov txiaj ntsig tseem ceeb ntawm pab pawg kev cuam tshuam (nrog rau qhov tshwm sim ntawm AKI hauv 72 teev tom qab kev phais) tau qis dua li ntawm pawg tswj hwm (55.1 vs. 71.7%; ARR 16.6%, 95% CI 5.5-27. 9; p{13}}.004). Hauv kev sim Bigp AK, ib qho kev tshawb fawb zoo sib xws uas siv tib lub biomarkers tau ua los ntsuas qhov cuam tshuam ntawm KDIGO kev saib xyuas pob hauv kev tiv thaiv AKI tom qab kev phais mob loj. Txawm hais tias tsis muaj qhov sib txawv ntawm qhov xwm txheej AKI tag nrho, qhov pib ntawm nruab nrab mus rau hnyav AKI, lub sijhawm ICU, thiab nyob hauv tsev kho mob tau qis dua hauv pawg tswj hwm. Txoj kev tshawb no pib BigpAK-2, ib qho kev sib tw thoob ntiaj teb multicenter prospective randomized tswj kev sim xav kom tso npe rau 1,302 tus neeg mob los kuaj xyuas thawj qhov tshwm sim hauv cov pej xeem dav.

Xyoo 2019, Lub Hom Phiaj Kab Mob Zoo Tshaj Plaws (ADQI) tau tshaj tawm cov lus pom zoo ntawm AKI biomarkers, tsom mus rau kev ntsuam xyuas, kev kwv yees, kev tiv thaiv, kev tswj hwm, thiab kev nce qib ntawm AKI. ADQI hais txog qhov tseem ceeb ntawm kev sib koom ua ke kev raug mob thiab kev ua haujlwm biomarkers nrog cov ntaub ntawv kho mob txhawm rau txhim kho qhov tseeb ntawm AKI thiab nkag siab tob txog cov txheej txheem pathophysiological uas txheeb xyuas qhov ua rau. Tsis tas li ntawd, lawv tau npaj txoj kev faib AKI tshiab, faib KDIGO theem 1 AKI ua peb pawg: Theem 1S, uas lub raum puas tsuas yog kuaj pom los ntawm biomarkers thiab tsis pom tseeb los ntawm creatinine thiab zis tso zis. Cov neeg mob ua tau raws li cov txheej txheem classic theem 1 tom qab ntawd tau sib txawv raws li seb lawv puas muaj biomarkers tsis zoo rau theem 1A lossis zoo biomarkers rau theem 1B. Tsis tas li ntawd, Phase 2 thiab Phase 3 kuj tau muab faib ua A thiab B raws li cov xwm txheej ntawm biomarkers. Ntawm lub rooj sib tham 2019, KDIGO tau hais txog qhov tshwm sim ntawm biomarkers yog ib qho ntawm cov cuab yeej tshiab rau kev kuaj mob thiab tswj AKI. Txawm li cas los xij, lawv tau txiav txim siab tias tam sim no tsis muaj pov thawj txaus los muab cov biomarkers rau hauv cov ntsiab lus uas twb muaj lawm ntawm AKI. Tsis tas li ntawd, kev txwv hauv nws qhov muaj nyob thoob ntiaj teb ua rau txoj haujlwm no nyuaj dua. Txawm hais tias muaj txiaj ntsig zoo ntawm cov kev ntsuam xyuas no muaj, qhov teeb meem ntawm tus nqi-zoo ntawm cov kev sim no tseem tsis meej.

Hauv cov ntsiab lus ntawm kev sim AKI thaum ntxov hauv 2018, kev ntsuas nyiaj txiag ntawm Nephrocheck, cystatin C, thiab NGAL tau kawm dav. Qhov no qhia tau tias txhua qhov kev ntsuam xyuas zoo li yuav tau txais txiaj ntsig zoo thaum ntsuas tus kheej tawm tsam tus qauv kev saib xyuas. Kev soj ntsuam rhiab heev qhia txog Nephrocheck qhov rhiab heev rau cov kev hloov pauv, qhia txog qhov xav tau rau kev tshawb fawb ntxiv thiab kev sib piv nrog cov kev ntsuam xyuas nyiaj txiag yav dhau los, qhia txog qhov tsis paub tseeb thiab qhov sib txawv ntawm cov txiaj ntsig, thiab qhia txog qhov tseem ceeb ntawm kev kho cov kev ntsuam xyuas no. poj niam deev. Tsis tas li ntawd, kev ceev faj yuav tsum tau siv thaum nthuav dav cov txiaj ntsig no rau kev kawm sab nraum ICU lossis NHS hauv tebchaws Askiv.

Qhov kev tsis paub tseeb no tau hais qhia hauv qhov kev tshuaj xyuas thiab kev txheeb xyuas tus nqi kom zoo los ntsuas lub luag haujlwm ntawm biomarkers (xws li Nephrocheck, ARCHITECT Urinary NGAL, thiab BioPorto NGAL) hauv kev tshawb pom AKI thaum ntxov. Txoj kev tshawb fawb no suav nrog 56 qhov kev tshawb fawb nrog 17,967 tus neeg koom thiab qhia txog cov txiaj ntsig zoo ntawm kev kuaj xyuas thiab kwv yees AKI. Txawm li cas los xij, qhov tsis txaus ntseeg tseem ceeb yog qhov tsis muaj kev tshawb fawb txog kev cuam tshuam ntawm biomarker piv nrog cov qauv kev saib xyuas thiab qhov tsis paub meej txog qhov zoo tshaj plaws rau NGAL, uas ua rau muaj kev tsis meej tag nrho. Qhov no qhia txog qhov yuav tsum tau muaj kev tshawb fawb ntxiv los ntsuas tag nrho lub luag haujlwm thiab kev lag luam tus nqi ntawm cov biomarkers no.

Thaum kawg, nws tsim nyog hais tias thaj chaw tau hloov pauv sai sai thaum thev naus laus zis nce qib thiab lwm yam qauv biomarker tshwm sim. Cov cheeb tsam tshiab ntawm kev tshawb fawb yog siv cov proteomics los txheeb xyuas cov kab mob urinary peptide thaum ntxov hauv AKI. extracellular vectors thiab microRNA] kuj tseem raug tshawb xyuas raws li biomarkers thiab muaj peev xwm kho lub hom phiaj rau kev cuam tshuam. Thaum kawg, sib txuas AKI biomarker kev ntsuam xyuas nrog cov ntaub ntawv kho mob cuam tshuam tuaj yeem kho AKI kev tswj hwm thiab kev kho mob rau cov neeg mob thaum ntxov, yog li txhim kho kev kho mob, txuag nqi, thiab txo qhov kev pheej hmoo ntawm kev nce mus rau CKD.

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 ntawmcistancheyogphenylethanoidglycosides, 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 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.