Rau 6 hom kab mob raum no, Flunomide tuaj yeem siv los txo cov zis tso zis!
Apr 09, 2024
Leflunomide yog ib qho ntawm cov khoom siv tshuaj fluorine uas muaj cov qauv tsim los ntawm German tuam txhab Hoeschst thaum xyoo 1970s thaum lub sijhawm tsim cov tshuaj tua kab ua liaj ua teb. Leflunomide muaj kev tiv thaiv kev loj hlob thiab kev tiv thaiv kab mob thiab tau ua ntau yam kev pab cuam hauv kev kho mob rheumatology thiab kev tiv thaiv kab mob, xws li kev txhim kho cov neeg laus mob caj dab, thiab tuaj yeem siv rau cov neeg mob lupus nephritis.
Nyem rau Cistanche rau mob raum
Nyob rau hauv xyoo tas los no, Leflutide kuj tau paub zoo thiab siv hauv kev kho mob nephrology. Cov kev tshawb fawb soj ntsuam tau pom tias nws tuaj yeem siv los kho cov kab mob tiv thaiv kab mob hauv lub raum, xws li cov hlab ntsha me me vasculitis raum puas, IgA nephropathy, refractory nephrotic syndrome, thiab lub raum hloov pauv. cov tshuaj tiv thaiv thiab lwm yam hauv xyoo 1999, National Medical Products Administration (NMPA) tau pom zoo leflunomide rau kev lag luam hauv Suav teb [1].
Lub mechanism ntawm leflunomide
Nws yog ib qho prodrug uas tuaj yeem hloov pauv sai thiab ua tiav rau hauv cov tshuaj metabolite malonitramide tom qab noj nws. Nws tuaj yeem cuam tshuam cov kev ua ntawm dihydrolactate dehydrogenase hauv mitochondria, nres lymphocyte proliferation, thiab txwv cell membrane synthesis. Lub synthesis thiab secretion ntawm cov tshuaj tiv thaiv thiab lymphokines yog inhibited. Leflunomide nres qhov kev loj hlob ntawm B lymphocytes thiab T lymphocytes nyob rau theem Gl, yog li inhibiting lymphocyte-mediated cellular thiab humoral tiv thaiv kab mob.
Kev siv rau hauv kev tiv thaiv kab mob raum
1 Lupus nephritis
Thaum kho cov neeg mob uas muaj hom III thiab hom IV nquag lupus nephritis, leflunomide thiab glucocorticoids tuaj yeem siv ua ke los tswj tus kab mob. Cov kev tshawb fawb tau pom tias thaum kho mob lupus nephritis, kev siv cov leflunomide los ntawm kev kho mob nrog cyclophosphamide + prednisone tuaj yeem txo cov raum puas tsuaj [2].
Lub sijhawm induction: 20mg / d ~ 40mg / d, feem ntau xaiv 30mg / d, thiab lub sijhawm kho yog 6 ~ 9 lub hlis.
Lub sijhawm tu: 20mg / d. Yog tias kev tshem tawm tau khaws cia ntev ntev, qhov koob tshuaj tuaj yeem raug txo mus rau 10mg / d raws li qhov tsim nyog. Kev kho mob yog tsawg kawg yog 2 xyoos.
Rau cov neeg mob lub raum tsis ua haujlwm uas nws cov ntshav creatinine ntau dua 1.5 npaug ntawm qhov txwv tsis pub dhau, cov koob tshuaj yuav raug txo kom tsawg raws li qhov tsim nyog.
2 Primary me hlab ntsha vasculitis nephritis
Rau cov neeg mob uas tsis muaj txiaj ntsig lossis tsis haum rau cyclophosphamide, leflunomide tuaj yeem siv.
Induction remission lub sij hawm: Leflunomide 20mg / d ~ 30mg / d tuaj yeem hloov tau azathioprine lossis methotrexate, thiab tsim nyog rau cov neeg mob uas muaj ANCA-txog vasculitis nyob rau lub sijhawm saib xyuas uas muaj kev ua haujlwm tsis zoo lossis ua tsis haum rau thawj ob.
3 IgA nephropathy
Kev sib xyaw ua ke ntawm leflunomide thiab koob tshuaj nruab nrab glucocorticoids tuaj yeem txo cov proteinuria hauv cov neeg mob uas muaj IgA nephropathy, txo cov tshuaj hormones ua ke, nce ntshav albumin, thiab ua kom lub raum ua haujlwm tsis tu ncua. Rau cov neeg mob uas noj cov tshuaj renin-angiotensin-aldosterone (RAAS) cov tshuaj uas tsis muaj txiaj ntsig hauv kev txhim kho cov proteinuria, lawv tuaj yeem hloov mus rau leflunomide, nrog kev pib koob tshuaj ntawm 20mg / d ~ 30mg / d. Tom qab ua tiav kev kho mob tag, leflunomide tuaj yeem siv tau. Hloov mus rau 10mg / d kev kho mob, nrog rau kev kho mob tsawg kawg yog 6 lub hlis.
4 Refractory nephrotic Syndrome
Cov neeg mob uas muaj tus mob nephrotic tam sim no nrog cov proteinuria loj heev thiab dyslipidemia, thiab qee cov neeg mob kuj tseem muaj hematuria. Leflunomide ua ke nrog glucocorticoids tuaj yeem txhim kho cov tsos mob saum toj no. Nws raug nquahu kom siv leflunomide ua ke nrog glucocorticoids los kho tus mob refractory nephrotic syndrome, nrog kev pib koob tshuaj ntawm 20 mg / d ~ 30 mg / d thiab kev kho mob tsawg kawg yog 6 lub hlis.
5 Purpura nephritis
Leflunomide thiab koob tshuaj me me rau nruab nrab ntawm glucocorticoids tuaj yeem txo cov zis protein ntau thiab txhim kho hematuria hauv cov neeg mob purpura nephritis. Qhov pom zoo pib koob tshuaj rau kev siv ua ke yog 10mg / d ~ 20mg / d. Tom qab ua tiav kev kho mob tiav lawm, cov tshuaj tuaj yeem hloov pauv. Kev kho mob yog 5mg / d ~ 10mg / d, thiab chav kho mob tsawg kawg yog 6 lub hlis.
6 lub raum hloov
Muaj ntau cov tshuaj tiv thaiv kab mob siv tom qab hloov lub raum, xws li cyclosporine A, tacrolimus, glucocorticoids, thiab lwm yam. Leflunomide kuj tseem siv tau rau cov neeg mob tom qab hloov pauv, thiab cov metabolism hauv lub cev yuav tsum tau tswj xyuas thaum noj nws. Cov ntshav concentration ntawm cov khoom yog 50 ug / ml, yog li yuav tsum tau soj ntsuam ntshav concentration.
Daim ntawv thov
1. Thaum noj Leflunomide, koj yuav tsum kuaj xyuas koj lub siab thiab lub raum ua haujlwm tsis tu ncua. Leflunomide tsis cuam tshuam los ntawm hemodialysis thiab lub raum ua haujlwm puas tsuaj, thiab tsis ua mob rau lub siab. Txawm li cas los xij, vim tias nws cuam tshuam rau daim siab metabolism thiab cov kua tsib, nws tuaj yeem ua rau mob siab heev. Leflunomide yog contraindicated nyob rau hauv cov neeg mob, tshwj xeeb tshaj yog cov neeg uas muaj kab mob siab B thiab kab mob siab C.
2. Lub voj voog soj ntsuam pom zoo yog: hauv 3 lub hlis ntawm kev siv tshuaj, sim txhua 2 mus rau 4 lub lis piam; thaum lub sij hawm 3 mus rau 6 lub hlis ntawm cov tshuaj, sim txhua txhua 8 mus rau 12 lub lis piam; yog tias noj tshuaj ntau dua 6 lub hlis, sim txhua 12 lub lis piam.
3. Cov tshuaj tiv thaiv kab mob muaj sia tsis tuaj yeem muab tshuaj thaum noj tshuaj.
4. Leflunomide tuaj yeem noj rau ntawm lub plab khoob lossis nrog zaub mov.
Cov ntsiab lus
Leflunomide tsis yog tsuas yog siv dav hauv cov kab mob autoimmune, xws li mob caj dab rheumatoid (RA), kab mob lupus erythematosus (SLE), granulomatous vasculitis (GPA), Sjogren's syndrome (SS), ntau yam Dermatomyositis (PM), ankylosing spondylitis (AS), thiab Nrog rau kev txhim kho txuas ntxiv ntawm leflunomide, nws kuj tau siv dav hauv nephrology. Qhov no yog ib qho tshuaj pheej yig thiab ua tau sai, tab sis nws kuj yog ib qho tshuaj noj thiab yuav tsum tau siv rationally raws li kev qhia ntawm tus kws kho mob [3].
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 cov stems qhuav ntawm Cistanche deserticola, 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.
