Yuav Tiv Thaiv Thiab Kho BK Polyomavirus Tom Qab Hloov Raum Li Cas?
Apr 25, 2024
BK polyomavirus kab mob yog ib qho kev sib tw loj tom qab hloov lub raum thiab tuaj yeem ua rau lub raum tsis ua haujlwm ntxov ntxov. Tam sim no tsis muaj cov tshuaj tiv thaiv hauv tsev kho mob lossis cov tshuaj tiv thaiv kab mob zoo, tab sis kev nce qib tseem ceeb cuam tshuam txog pathophysiology, kev kuaj mob, thiab kev kho mob tuaj yeem txhim kho kev tswj hwm tus kab mob BK polyomavirus tom qab hloov lub raum. Cov kev nce qib no tuaj yeem txhim kho qhov txiaj ntsig kawg rau cov neeg tau txais kev hloov raum.
Lub Plaub Hlis 2024, Lub Koom Haum Hloov Pauv Ntiaj Teb tau tshaj tawm cov lus qhia rau kev kuaj mob thiab kev kho mob ntawm BK polyomavirus tom qab hloov lub raum. Raws li nws cov ntaub ntawv, tsab xov xwm no tau muab faib ua cov lus pom zoo rau kev kuaj mob raum, cov txheej txheem kuaj mob, cov lus qhia ua haujlwm ntawm kev txo cov tshuaj tiv thaiv kab mob, thiab cov lus pom zoo rau kev tswj hwm rau BK polyomavirus. , PK thiab PD kev sib tham, cov lus pom zoo txog tus nqi zoo, thiab lub sij hawm ntawm kev hloov pauv.
Nyem rau Cistanche rau mob raum
Cov lus pom zoo rau lub raum biopsy
Yog tias BK polyomavirus kev soj ntsuam DNA yog qhov zoo, tus neeg mob yuav tsum raug txiav txim seb puas yuav tsum tau mus rau lub raum biopsy raws li tus neeg mob cov ntaub ntawv kho mob (proteinuria, hematuria, thiab lwm yam) (muaj zog, A);
Cov neeg mob uas yog BK polyomavirus DNA-zoo, muaj lub raum ua haujlwm ruaj khov, thiab muaj kev pheej hmoo ntawm kev tiv thaiv kab mob lossis kab mob (xws li DNA titers ntau dua) yuav tsum tau mus rau lub raum biopsy (tsis muaj zog, D);
Txhais cov txiaj ntsig biopsy tam sim no ntawm lub raum hloov pauv nrog rau kev siv tshuaj kho mob, chaw kuaj mob, thiab cov ntaub ntawv kab mob virological, thiab yav dhau los biopsies (tsis muaj zog, C);
BK polyomavirus DNA yuav tsum tau qhab nia ib nrab ntawm ntau thiab cais raws li Banff pawg neeg ua haujlwm txoj kev (muaj zog, C);
Siv American Society of Transplantation (AST) kev faib tawm, tom qab sau cov ntaub ntawv inflammatory thiab tabular, BK polyomavirus cov neeg mob tau muab faib ua tsib pawg: PyVAN-A, -B1, -B2, -B3, thiab -C (muaj zog, C);
Rau cov neeg mob uas kuaj tau BK polyomavirus DNAemia thiab ua tau raws li Banff diagnostic cov txheej txheem, peb pom zoo kom kuaj xyuas cov tshuaj tiv thaiv kab mob sib kho (muaj zog, C);
Peb pom zoo kom tiv thaiv kev kuaj mob sib xyaw ua ke TCMR (Banff qib IA/B) raws li kev mob thiab tubulitis; Hloov chaw, kev sib tham yuav tsum siv txoj hauv kev sib tham (muaj zog, B).
Peb pom zoo rau immunohistology (clonal PAb 416 tiv thaiv SV40 loj t antigen) kom paub meej tias biopsy-proven BK polyomavirus kab mob (muaj zog, A);
BK polyomavirus kab mob yuav tsum raug txiav txim siab hauv SV40-cov neeg mob zoo (muaj zog, B);
Rau cov neeg mob uas BK polyomavirus DNAemia tsis paub tab sis nws lub raum biopsy qhia txog kev hloov pauv, SV40 yuav tsum tau kuaj (tsis muaj zog, D);
Nws raug pom zoo kom tsis txhob niaj hnub siv SV40 (LTag) immunohistochemical staining hauv cov neeg mob uas yog BK polyomavirus DNA tsis zoo (tsis muaj zog, C);
Peb pom zoo kom tsis txhob ua allograft biopsy thaum lub sijhawm kawm lossis kev daws teeb meem ntawm BK polyomavirus DNAemia / nephropathy tshwj tsis yog kev tsis lees paub lossis lwm yam kab mob raum muaj kev txhawj xeeb thiab nws qhov kev kuaj pom yuav hloov kho (tsis muaj zog, D).
kuaj mob
Cov neeg tau txais kev hloov pauv hauv lub raum yuav tsum tau tshuaj xyuas tsis tu ncua rau BK polyomavirus DNA positivity kom kuaj pom tus kab mob BK polyomavirus sai sai (muaj zog, A);
BK polyomavirus kuaj DNA yuav tsum tau ua txhua hli rau thawj 9 lub hlis tom qab hloov lub raum, tom qab ntawd txhua txhua 3 lub hlis txog 2 xyoos tom qab hloov lub raum (Strong, B);
Hauv cov chaw muaj kev txwv, cov zis cytometry tuaj yeem siv los ua qhov kev tshuaj ntsuam xyuas yam tsawg kawg nkaus rau BK polyomavirus (muaj zog, B);
Yog tias tsis tuaj yeem sau cov ntshav lossis kuaj ntshav tsis tuaj yeem siv, txiav txim siab BK polyomavirus DNA load hauv cov zis los ntawm QNAT txoj kev ntawm lub sijhawm sib txuas (tsis muaj zog, D);
Yog tias kuaj pom cov kab mob tso zis los yog cov zis BK polyomavirus DNA load ntau dua lossis sib npaug li 10 lab luam / mL, peb pom zoo kom ntsuas cov ntshav BK polyomavirus DNA load los qhia kev kho mob (muaj zog, B);
Rau kev sib xyaw ua ke ntawm lub raum / cov khoom hloov pauv hauv nruab nrog cev nrog rau txiav txiav, peb pom zoo kom txuas ntxiv BK polyomavirus DNA thauj khoom kuaj txhua 3 lub hlis mus rau 36 lub hlis tom qab hloov pauv (tsis muaj zog, C);
Rau cov neeg tau txais kev hloov pauv hauv lub cev tsis muaj zog, BK polyomavirus DNA thauj khoom kuaj yuav tsis ua raws li niaj zaus (muaj zog, B);
Tib lub chaw kuaj mob siv ib qho kev sib koom ua ke los txiav txim siab BK polyomavirus DNA thauj khoom kom tsis txhob muaj qhov sib txawv ntawm txoj kev kuaj mob (muaj zog, B);
Peb pom zoo kom siv QNAT txhawm rau txheeb xyuas BK polyomavirus genome ib ntus, tso cai rau kev tshawb pom txhua yam genotypes thiab txawv txav (muaj zog, C);
Peb pom zoo kom siv luv amplicons ntawm<150 bp for QNAT detection to avoid significant underquantification (strong, C);
Cov ntsuas ntsuas thiab ntsuas yuav tsum tau ntsuas tsis tu ncua kom ntseeg tau qhov zoo ntawm BK polyomavirus kuaj (muaj zog, C).
Kev taw qhia tswv yim txog kev txo cov tshuaj tiv thaiv kab mob
01 Cov ntsiab lus
Ua ntej paub meej tias cov koob tshuaj thiab qhov ntau ntawm tag nrho cov tshuaj tiv thaiv kab mob yog nyob rau hauv lub hom phiaj (tsis muaj zog, C);
Peb pom zoo saib xyuas BK polyomavirus DNA thauj khoom txhua 2-4 lub lis piam kom txog thaum tshem tawm (muaj zog, B) lossis ruaj khov ntawm cov kab mob ntshav plasma.<1000 copies/mL (or equivalent) (weak, C);
Rau cov neeg mob tsawg uas tau mus txog qhov tshuaj tiv thaiv qis tshaj plaws thiab muaj BK polyomavirus DNA load<1000 copies/mL, it is recommended to follow up the BK polyomavirus DNA load and serum creatinine concentration every 3 months (weak, D).
02 Txo cov tshuaj tiv thaiv metabolite ua ntej
① Ua ntej txo qhov koob tshuaj ntawm cov tshuaj antimetabolite tsawg kawg yog 50%:
Yog tias tom qab 4 lub lis piam ntawm kev kho mob BK polyomavirus DNA load txo qis 10-fold lossis poob qis dua qhov kev kuaj pom qis dua, cov tshuaj tiv thaiv kab mob yuav tsum tau txo ntxiv (tsis muaj zog, C):
② Txiav cov tshuaj antimetabolite thiab maj mam txo cov koob tshuaj corticosteroid rau 5 txog 10 mg / d ntawm prednisone lossis sib npaug (yog tias tsim nyog)
③Peb pom zoo kom ntxiv prednisone (los yog sib npaug) 5-10 mg/d rau cov neeg mob tsis noj corticosteroids kom tsis txhob CNI monotherapy (Tsis muaj zog, C)
Yog tias yuav tsum tau txo qis hauv kev tiv thaiv kab mob ntxiv, peb pom zoo kom txo qis ntawm calcineurin inhibitor (CNI) koob tshuaj (tacrolimus trough lub hom phiaj concentration 5 ng / mL; cyclosporine trough lub hom phiaj concentration 100 ng / mL) (Tsis muaj zog, C).
03 Txo cov koob tshuaj CNI ua ntej
① Txo cov koob tshuaj CNI los ntawm 25% mus rau 50% hauv 1 mus rau 2 kauj ruam. Tshwj xeeb, qhov trough concentration ntawm tacrolimus yog 3 mus rau 5 ng / mL, thiab trough concentration ntawm cyclosporine yog 75 mus rau 125 ng / mL.
Yog tias tom qab 4 lub lis piam ntawm kev kho mob BK polyomavirus DNA load txo qis 10-fold lossis poob qis dua qhov kev kuaj pom qis dua, cov tshuaj tiv thaiv kab mob yuav tsum tau txo ntxiv (tsis muaj zog, C):
② Txo cov tshuaj tiv thaiv metabolites los ntawm 50% thiab corticosteroids rau 5 txog 10 mg / d ntawm prednisone lossis sib npaug (yog tias tsim nyog)
③ Tsis siv tshuaj antimetabolite
Peb pom zoo kom ntxiv prednisone (los yog sib npaug) 5 mus rau 10 mg / hnub rau cov neeg mob tsis noj corticosteroids kom tsis txhob CNI monotherapy (tsis muaj zog, C).
tswv yim tswj
Rau cov neeg mob hloov lub raum uas tsis muaj kev tiv thaiv kab mob siab lossis nyuaj los ntawm kev tsis lees paub, peb pom zoo kom txo qis kev tiv thaiv kab mob raws li kev kho mob tseem ceeb rau kev pheej hmoo BK polyomavirus DNAemia / nephropathy (muaj zog, B);
Thaum BK polyomavirus DNAemia nyob nruab nrab ntawm 1000 thiab 10 000 cov ntawv luam / mL (lossis sib npaug) ntawm ob zaug hauv 2 mus rau 3 lub lis piam, peb pom zoo kom txo qis kev tiv thaiv kab mob (tsis muaj zog, B);
We recommend reducing immunosuppressants in patients with BK polyomavirus DNAemia or biopsy-proven BK polyomavirus nephropathy based on 1 determination of BK polyomavirus DNA >10, 000 daim ntawv luam / mL (los yog sib npaug) (Nruab, B);
Peb pom zoo kom txo qis kev tiv thaiv kab mob hauv biopsy-pov thawj BK polyomavirus nephropathy txawm tias tos BK polyomavirus DNA load cov txiaj ntsig (muaj zog, B);
Peb pom zoo kom txhua lub chaw hloov pauv tsim cov txheej txheem kev ua haujlwm thiab cov txheej txheem kev ua haujlwm rau kev txo qis kev tiv thaiv kab mob hauv cov neeg mob BK polyoma viremia (tsis muaj zog, D);
Tom qab lees paub tias BK polyomavirus DNA kuaj tsis zoo, kev kho tshuaj tiv thaiv kab mob yuav tsum tau rov pib dua raws li tus neeg mob lub cev tiv thaiv kab mob, thiab BK polyomavirus DNA yuav tsum tau tshuaj xyuas kom zoo (tsis muaj zog, D);
Yog tias lub raum tsis ua haujlwm, peb pom zoo kom kuaj de novo pub dawb tshwj xeeb cov tshuaj tiv thaiv kab mob (DSA) hauv cov neeg mob uas muaj tus kab mob BK polyomavirus DNAemia tsis tu ncua ntawm kev siv tshuaj tiv thaiv kab mob tsawg kawg nkaus los pab txiav txim siab txog kev hloov lub raum biopsy (tsis muaj zog, D);
Rau cov neeg tau txais kev cog qoob loo ntau, suav nrog rau cov neeg tau txais kev hloov pauv hauv lub raum lossis cov tsis muaj lub raum tsis ua haujlwm nrog BK polyomavirus DNAemia lossis biopsy-proven BK polyomavirus nephropathy, peb pom zoo kom ua tib zoo txo qis kev tiv thaiv kab mob raws li tau piav qhia saum toj no thiab kaw kev soj ntsuam thiab kuaj xyuas, ntsuas qhov txaus ntshai thiab txiaj ntsig ntawm kev tsis lees paub thiab kev tso nyiaj. poob (Weak, D).
PK thiab PD sib tham
Thaum kho cov neeg mob BK polyomavirus DNAemia / nephropathy, peb pom zoo kom txhais cov tshuaj tiv thaiv kab mob hauv cov ntsiab lus ntawm PK / PD, kev sib cuam tshuam ntawm cov tshuaj yeeb tshuaj (xws li tag nrho lwm cov tshuaj, lwm yam tshuaj ntxiv thiab ntxiv, thiab cov tshuaj tom khw muag khoom), thiab daim siab thiab Lub raum kev ua haujlwm Cov tshuaj noj thiab trough plasma concentration (muaj zog, B).
Peb pom zoo kom ua tib zoo saib xyuas thiab saib xyuas qhov cuam tshuam ntawm PK / PD cuam tshuam ntawm kev tiv thaiv kab mob hauv kev txhawb lossis cuam tshuam cov kab mob sib kis, kinetics, thiab BK polyomavirus DNAemia (tsis muaj zog, C).
Peb pom zoo kom cov neeg mob thiab cov neeg saib xyuas yuav tsum tau muab kev qhia txog tshuaj tsis tu ncua txog kev ua raws li kev noj tshuaj thiab kev ua raws li kev soj ntsuam raws li niaj hnub no (Strong, B).
cov lus qhia txog kev siv nyiaj
Peb pom zoo kom niaj hnub tshuaj ntsuam xyuas BK polyomavirus DNAemia siv lub tswv yim uas tau npaj tseg hauv cov lus qhia tam sim no, vim qhov no cuam tshuam nrog cov txiaj ntsig kho mob tau zoo dua qub thiab muaj txiaj ntsig zoo hauv cov qauv zoo ntawm cov neeg tau txais kev hloov hauv lub raum hnub nyoog qis dua 70 xyoo (Strong, B );
Peb pom zoo kom txo qis kev tshuaj ntsuam xyuas ntau zaus vim tias nws tuaj yeem txo qhov kev cuam tshuam los ntawm kev txo cov tshuaj tiv thaiv kab mob, yog li ua rau tag nrho cov nqi kho mob ncaj qha (tsis muaj zog, B).
Lub sijhawm ntawm retransplantation
Rau cov neeg mob uas lub raum allograft tsis ua hauj lwm vim BK polyomavirus nephropathy, peb pom zoo kom retransplantation (muaj zog, B);
Ua ntej hloov pauv, kev kuaj BK polyomavirus yuav tsum tsis zoo (tsis muaj zog, C);
Rau cov neeg mob uas muaj allograft tsis ua hauj lwm vim BK polyomavirus nephropathy thiab BK polyomavirus DNA-tsis zoo cov neeg mob, peb pom zoo kom allograft nephrectomy tsis tau ua txhua zaus ua ntej retransplantation (tsis muaj zog, C).
Yimaitong yog tus kws tshaj lij kws kho mob hauv online platform nrog lub hom phiaj ntawm "xav txog kev kho mob ntawm lub ntiaj teb thiab pab kev txiav txim siab kho mob hauv Suav teb". Yimaitong muaj cov khoom lag luam xws li "Clinical Guide", "Medication Reference", "Medical Literature King", "Yizhiyuan", "e Yantong" thiab "e Maipiao", uas ua tau raws li qhov xav tau ntawm cov neeg ua haujlwm kho mob rau kev txiav txim siab- ua, tau txais kev paub tshiab thiab txhim kho kev tshawb fawb txog kev tshawb fawb. cov kev xav tau ntawm efficiency.
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 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.