Yuav Ua Li Cas Txheeb Xyuas Thiab Tswj Cov Neeg Mob CKD Tom Qab Ua Tau Zoo Li Cas?

Tam sim no, ntau tus neeg mob uas muaj kab mob raum ntev (CKD) yog rog lossis rog dhau, thiab glucagon-zoo li peptide 1 receptor agonists (GLP-1RA) thiab GLP/gastric inhibitory peptide (GIP) dual receptor agonists tau zoo hauv hom 2. Lawv siv hauv kev kho mob ntshav qab zib thiab rog rog tau nce ntau, thiab lawv tsis tuaj yeem txo qhov hnyav xwb tab sis kuj tseem txhim kho lub raum cov txiaj ntsig hauv cov neeg mob rog CKD. Txawm li cas los xij, kev poob phaus tseem ceeb hauv lub sijhawm luv luv yuav cuam tshuam rau qhov kev ntsuas ntawm kwv yees glomerular filtration rate (eGFR) thiab urinary albumin excretion (UAE), yog li muaj qee qhov cuam tshuam rau kev tswj hwm cov neeg mob CKD.

Nyem rau Cistanche rau mob raum

Thaum Lub Ib Hlis 31, 2024, NDT tau tshaj tawm cov ntawv sau los ntawm University of Michigan hauv Tebchaws Meskas, uas tau taw qhia tias muaj 4 lub ntsiab lus tseem ceeb uas yuav tsum tau saib xyuas thaum ntsuas cov neeg mob CKD uas tau ua tiav qhov hnyav!

4 yam yuav tsum nco ntsoov

① Kev ntsuas lub raum yuav tsum ntsuas GFR (mGFR) lossis eGFR ntsuas los ntawm creatinine + cystatin C;

② Vim muaj kev hloov pauv loj hauv lub cev thiab thaj chaw ntawm lub cev, eGFR ntawm tus neeg mob no yuav tsum raug tshem tawm ntawm lub cev qhov chaw thiab tsuas yog ntsuas los ntawm GFR (ml / min);

③ Kev ntsuam xyuas yuav tsum tau ua nyob rau hauv cov pab pawg raws li seb cov neeg mob puas nyob rau hauv ib qho ultrafiltration xeev ntawm lub hauv paus;

④ Thaum ntsuas cov neeg mob cov proteinuria thiab lub raum ua haujlwm, kev hloov pauv hauv cov ntshav siab, ntshav qab zib, thiab cov cim inflammatory yuav tsum ua ke.

Kev soj ntsuam ntawm GFR

Tam sim no, muaj ob txoj hauv kev tseem ceeb los ntsuas GFR. Thawj txoj kev yog exogenous biomarkers, xws li iohexol. Lub glomerulus dawb lim lim Iohexol thiab tsis yog secreted los yog reabsorbed, tab sis ntsuas GFR siv exogenous filtration markers yog kim dua thiab siv tau tsawg dua. Qhov thib ob mus kom ze yog endogenous biomarkers xws li creatinine thiab cystatin C.

Nco ntsoov, endogenous biomarkers tsis tshua muaj kev ntseeg siab hauv kev ntsuas lub raum ua haujlwm hauv cov neeg mob uas lub cev hnyav lossis hnyav hnyav. Creatinine yog cov khoom pov tseg uas tsim los ntawm kev tawg ntawm cov leeg thiab raug lim los ntawm ob lub raum. Cov kev tshawb fawb pom tau hais tias hauv cov neeg mob uas tag nrho lub cev hnyav thiab poob phaus, cov leeg nqaij yuav txo qis thiab creatinine ntau lawm, ua rau cov ntshav qis thiab creatinine hauv cov zis. Qhov no yuav ua rau muaj kev nce ntxiv hauv creatinine eGFR hauv cov neeg rog rog uas poob phaus. Cystatin C yog ib qho endogenous protein uas tsim los ntawm tus nqi tas mus li los ntawm tag nrho cov nucleated hlwb thiab tuaj yeem siv los ua tus neeg sawv cev lossis lwm tus biomarker rau creatinine los kwv yees GFR. Tsis zoo li creatinine, cystatin C tsis cuam tshuam los ntawm cov leeg nqaij, noj cov protein noj, lossis kev tawm dag zog, tab sis kev tshawb fawb txog kev kis mob tau pom tias nws cuam tshuam nrog lub cev qhov ntsuas (BMI). Yog li, cov neeg mob uas txo BMI yuav muaj qhov txo qis hauv cystatin C thiab nce ntxiv hauv eGFR.

Chang li al pom tias creatinine thiab cystatin c kev ntsuam xyuas ntawm GFR tuaj yeem ua rau cov neeg mob rog dhau los uas tau ua tiav qhov hnyav. Hauv kev tshawb fawb ntawm cov neeg mob uas raug phais bariatric, cov kws tshawb fawb siv iohexol los ntsuas GFR (mGFR) thiab creatinine, cystatin c, thiab CKD-EPI cov mis los xam eGFR. Ua ntej kev phais, qhov nruab nrab BMI ntawm cov neeg mob cuv npe yog 49.5kg / ㎡, uas poob rau 35.6kg / ㎡ tom qab kev phais. Tom qab kev phais, mGFR nce me ntsis, tab sis eGFR ntawm creatinine, cystatin c, thiab creatinine + cystatin C txhua tus tau nce ntau. Nws tsim nyog sau cia tias eGFR ntawm creatinine + cystatin C yog ze rau mGFR. Nws tau pom zoo tias eGFR thiab mGFR ntawm creatinine + cystatin C yog qhov tsim nyog rau kev ntsuas lub raum ua haujlwm hauv CKD cov neeg mob uas muaj kev poob phaus thiab kev rog dhau los.

lub cev nto qhov chaw hloov

Tam sim no, chav tsev feem ntau siv rau eGFR kev qhia yog ml / min / 1.73㎡, qhov twg 1.73㎡ yog thaj tsam ntawm lub cev (BSA). GFR yog niaj zaus normalized rau BSA thiab tom qab ntawd qhia kom paub cov lej tuaj yeem qhia hauv tus neeg lub cev qhov hnyav ntawm ntau hom lub cev. Txawm li cas los xij, txoj kev ntsuas no zoo li tsis tsim nyog rau cov neeg rog niaj hnub no thiab cov neeg uas tau ua tiav qhov hnyav. Muaj ob qho laj thawj. Ua ntej, BSA ntawm 1.73㎡ yog qhov nruab nrab BSA ntawm cov neeg Amelikas ze li 100 xyoo dhau los, thaum BSA ntawm cov pejxeem niaj hnub tau hloov pauv loj. Raws li cov ntaub ntawv cuam tshuam los ntawm US National Health thiab Nutrition Database los ntawm 2015 txog 2018, qhov nruab nrab BSA ntawm cov poj niam Asmeskas yog 1.78㎡ (IQR: 1.64 ~ 1.94), thiab qhov nruab nrab BSA ntawm cov txiv neej yog 2.03㎡ (IQR: 1.88 ~ 2.20) . Yog li ntawd, nws zoo li tsis tsim nyog siv cov qauv ntawm ze li ntawm 100 xyoo dhau los los ntsuas eGFR ntawm cov neeg niaj hnub, tshwj xeeb tshaj yog cov neeg rog.

Qhov thib ob, BSA hloov nrog kev hloov pauv tseem ceeb hauv BMI. Piv txwv li, ib tug txiv neej nrog BMI ntawm 40kg / ㎡ thiab BSA ntawm 2.41. Yog tias nws GFR yog 90ml / min, nws eGFR yog 65ml / min / 1.73㎡. Thaum nws ua tiav qhov hnyav nws qhov siab tseem tsis hloov pauv, thiab nws BMI yog 20kg / ㎡, yog tias nws GFR tseem yog 90ml / min, nws eGFR yog 87ml / min / 1.73㎡. Nws tuaj yeem pom tias yog BSA tsis raug tshem tawm, tsuas yog qhov poob phaus tuaj yeem ua rau tus neeg mob eGFR nce 22 ml / min / 1.73㎡, uas yuav cuam tshuam rau tus kws kho mob qhov kev ntsuas ntawm nws lub raum ua haujlwm.

Yog li, yuav ua li cas tshem tawm qhov cuam tshuam ntawm BSA ntawm GFR? Cov kws tshaj lij hais tias qhov no tuaj yeem ua tiav los ntawm kev sib faib eGFR los ntawm tus neeg mob qhov tseeb BSA thiab faib los ntawm 1.73. Qhov no zam qhov cuam tshuam loj ntawm kev hloov pauv hauv cov neeg mob 'BSA ua ntej thiab tom qab poob phaus ntawm lawv cov eGFR, tso cai rau kev soj ntsuam kom raug ntau dua ntawm kev hloov pauv ntev hauv lub raum ua haujlwm hauv cov neeg mob CKD.

Subgroup tsom xam ntawm ultrafiltration

It is well known that both obesity and diabetes may lead to glomerular hyperfiltration. Ultrafiltration and eGFR generally decrease with weight loss, and because BSA also decreases with weight loss, there is usually no significant difference in eGFR in patients after weight loss. However, when eGFR is not indexed by the BSA of 1.73㎡, it is particularly important whether there is high filtration at the baseline. It is worth noting that if the patient's eGFR is >120ml / min / 1.73㎡ los yog<60ml/min/1.73㎡ before successful weight loss, the reasons for the change in eGFR before and after weight loss may be completely different. If the two are confused, It may be difficult to correctly interpret the cause of changes in a patient's eGFR, leading to different management options. Therefore, the best solution is to separately analyze eGFR changes in patients with and without hyperfiltration at baseline.

Kev sib raug zoo ntawm kev hloov pauv hauv proteinuria thiab lwm yam ntsuas

Ntau cov kev tshawb fawb tau pom tias tsis hais txog txoj kev poob phaus, UAE thiab cov zis albumin rau creatinine piv (UACR) yuav txo qis tom qab poob phaus. Tsis tas li ntawd, txo UACR tshwm sim txawm tias poob ntawm cov leeg nqaij thiab qis cov zis creatinine. Ib txoj kev tshawb nrhiav kev tswj hwm tau muab piv rau kev sib raug zoo ntawm kev phais bariatric thiab kev kho tshuaj (xws li sodium-glucose co-transporter 2 inhibitors, GLP-1RA, thiab lwm yam) thiab cov neeg mob albuminuria remission rate (UACR)<30mg/g). The results found that bariatric surgery can also successfully reduce patients' UACR, and there is no significant difference from drug treatment. In addition, weight loss reduced proteinuria levels regardless of whether patients had diabetes at baseline. Therefore, the effects of weight loss on blood glucose and blood pressure can only explain part of the reduction in proteinuria. Studies have found that an important reason for the reduction in proteinuria caused by weight loss may be related to the reduction of inflammatory markers, such as high-sensitivity C-reactive protein. It is suggested that weight loss itself can reduce vascular inflammation and thereby reduce proteinuria.

Hauv luv luv, thaum ntsuas cov proteinuria hauv cov neeg mob uas tau ua tiav qhov hnyav, ntshav qabzib, ntshav siab, thiab cov cim inflammatory yuav tsum tau muab tso ua ke kom paub meej cov laj thawj ntawm kev txo qis hauv proteinuria, yog li kev txiav txim siab tswj tau raug.

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 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 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.