Yuav Ua Li Cas Kho Aristolochic Acid Nephropathy

Xyoo 1992, muaj kab mob raum txawv txawv hauv Belgium. Cov kab mob raum no txawv ntawm cov kab mob hauv lub raum ua ntej. Cov protein hauv cov zis tsis pom tseeb, cov ntshav creatinine siab, lub raum ua haujlwm txuas ntxiv mus, thiab lub raum atrophy, thiab uremia. Nrog rau hom kab mob no, kwv yees li ib nrab ntawm cov neeg mob yuav tsim cov qog nqaij hlav hauv lub raum pelvis thiab urethra. Kev tshawb nrhiav ua ntej pom tias ntau dua 70 tus neeg mob tau noj tib yam tshuaj poob phaus uas muab los ntawm tib lub tsev kho mob.

Nyem rau Cistanche rau mob raum

Txawm li cas los xij, lub tsev kho mob tau qhib rau 15 xyoo thiab tsis pom muaj teeb meem zoo sib xws ua ntej. Vim li cas lawv tau tshwm sim tsis ntev los no? Tom qab kev tshawb xyuas ntxaws, nws tau pom tias pib xyoo 1990, lub tsev kho mob tau hloov pauv cov mis poob thiab ntxiv ob tsob nroj, Fangchi thiab Magnolia officinalis. Thaum kawg nws tau lees paub tias cov aristolochic acid hauv Fangchi tau ua rau lub raum tsis zoo.

Tshuaj ntsuam xyuas pom tias Stepheniatetrand hauv cov tshuaj poob phaus tau hloov los ntawm Aristolochia fangchi. 10 ntawm 12 pawg ntawm cov hmoov muaj aristolochic acid, nrog rau qhov nruab nrab concentration ntawm 0.609 mg / g.

Kab mob tshwm sim tshwm sim ntawm ib koob tshuaj ntawm 147 mg, thiab koob tshuaj noj yog proportional rau tus nqi ntawm tus kab mob. Nws tuaj yeem txiav txim siab tias lwm cov khoom xyaw hauv cov tshuaj ntsiav tau koom nrog, thiab Aristolochia fangji tsuas yog qhov txaus ntshai xwb [1]. Los ntawm 1998, 70% ntawm 128 tus neeg mob tau kuaj pom thiab kho tau mus rau theem kawg ntawm lub raum kab mob (ESRD) [2, 3].

Tom qab cov xov xwm tawm, nws ua rau muaj kev poob siab loj hauv lub ntiaj teb cov neeg kho mob.

Tom qab xyoo 1956, muaj cov lus ceeb toom ib zaug ntxiv tias muaj kab mob raum txawv txawv nyob hauv qee lub zos hauv Danube River Basin xws li Bulgaria, Croatia, Serbia, Bosnia thiab Herzegovina, thiab Romania. Cov neeg uas muaj tus kab mob no feem ntau tshwm sim mob hnyav ntawm cov hnub nyoog ntawm 40 thiab 60. thiab uremia, uas yog lub raum fibrosis, mob raum atrophy, thiab ureteral malignancy, thiab qhov nruab nrab lub neej expectancy ntawm cov neeg mob tsuas yog 45 xyoo. Qhov ua rau tsis paub thaum lub sijhawm, yog li nws tau hu ua endemic Balkan nephropathy.

Tom qab tus kws kho mob hauv Belgian tau tshaj tawm, qee tus kws kho mob nephrologists sai sai xav tias cov tsos mob ntawm herbal nephropathy thiab endemic nephropathy nyob rau hauv Balkans zoo sib xws. Lawv puas tuaj yeem tshwm sim los ntawm aristolochic acid?

Tom qab ntawd, kev tshawb nrhiav los ntawm cov kws tshaj lij Asmeskas pom tias muaj ntau Aristolochia loj hlob hauv cov nplej hauv Balkans. Thaum sau qoob loo, Aristolochia yuav muab sib xyaw nrog cov nplej thiab tsis txhob noj.

Tom qab ntawd, aristolochic acid-DNA adducts (adducts, complexes tsim los ntawm combining DNA fragments nrog carcinogenic chemicals) tau pom nyob rau hauv lub raum kuaj los ntawm cov neeg mob uas muaj kab mob raum nyob rau hauv lub Balkans, tab sis tsis muaj xws li adducts nyob rau hauv cov neeg mob uas muaj kab mob hauv lub raum. Qhov no tau ua pov thawj tias aristolochic acid yog qhov ua rau muaj kab mob nephropathy nyob rau hauv Balkans, yog li nws yog lub npe hu ua aristolochic acid nephropathy.

Tom qab ntawd, ntau lub tebchaws tau txwv lossis ceeb toom tawm tsam kev noj cov nroj tsuag uas muaj aristolochic acid. Xyoo 2003, Tuam Tshoj kuj tau tso tseg cov qauv tshuaj rau peb Aristolochia tshuaj ntsuab: Guanmutong, Fangji Fangji, thiab Aokixiang.

Muaj ntau pua hom nroj tsuag hauv tsev neeg Aristolochaceae, uas feem ntau muaj aristolochic acid. Cov nroj tsuag muaj aristolochic acid uas raug txwv hauv Hong Kong yog:

1. Aristolochia genus: Aristolochia macrophylla, Aristolochia diannan, Aristolochia nanna, Aristolochia sibirica, Aristolochia bractatum, Aristolochia bractatum, Lotus cinnabar, Aristolochia spp. Aristolochia nplooj, Aristolochia candidum, Tongcheng tiger, Hainan Aristolochia, Hanzhong Fangji, Fujixiang, Nanyue Aristolochia, concave vein Aristolochia, Huaitong, Back Snake, Guannanxiang, Guanmutong, Xugufeng, Leatherleaf Favristolochia, Bloomus Aristolochia y Huab , Platinum Txiv Hmab Txiv Ntoo Olive, Xiaonan Muxiang.

2. Asarum genus: Asarum, Asarum, Asarum, Duheng, Asarum, Golden Earring, Earthen Earring, Wujincao, Hualian Asarum, Taitung Asarum.

Muaj ntau cov pov thawj pom tseeb tias kev noj cov nroj tsuag aristolochic acid txawm tias ib zaug me me tuaj yeem ua rau lub raum tsis zoo thiab ua rau muaj kev pheej hmoo ntawm lub raum tsis ua haujlwm thiab mob qog noj ntshav urothelial yav tom ntej. Qhov ntau koj noj, qhov kev pheej hmoo ntau dua. loj.

Xyoo 2013, cov kws tshawb fawb tau tshawb pom qhov chaw hloov pauv noob los ntawm aristolochic acid, ua pov thawj tias aristolochic acid lub peev xwm ua rau cov noob hloov pauv yog qhov muaj zog tshaj plaws ntawm txhua yam khoom uas paub niaj hnub no: 150 bases ib lab bases Genes tuaj yeem hloov pauv. Nws kuj tau pom thawj zaug ntawm hepatotoxicity ntawm aristolochic acid.

Cov txheej txheem pathogenic ntawm aristolochic acid yog tias ib feem ntawm nws cov metabolite txo qis rau aristolocholactam, uas nkag mus rau hauv lub raum tubular epithelial hlwb thiab accumulates nyob rau hauv lub cytoplasm kom ua rau muaj tshuaj lom; lwm qhov tuaj yeem tsim cov adducts nrog tib neeg DNA, Hloov pauv ntawm RAS gene thiab p53 noob. Kev sim tau pom tias aristolochic acid ua rau muaj kab mob vim tias nws tuaj yeem khi nruj rau DNA thiab hloov T hauv plaub lub hauv paus rau A. Cov kev hloov no ua rau kev txhais ntawm tag nrho lub neej tsis ncaj ncees lawm, ib yam li koj tau sau ntawv rau tus vajtswv poj niam nrog cov ntsiab lus. "WoAi Ni" (Kuv hlub koj), tab sis nws tau cuam tshuam los ntawm aristolochic acid rau hauv "Wo Ti-Ni" (Kuv mam li ncaws koj), qhov kawg tuaj yeem xav txog.

Tsis muaj qhov hu ua kev nyab xeeb rau DNA puas tsuaj los ntawm qhov mutagen no.

Txawm hais tias qee cov nroj tsuag uas tsis yog Aristolochic (xws li Houttuynia cordata) tsis muaj aristolochic acid, lawv muaj aristolochamide, metabolite ntawm aristolochic acid, uas tuaj yeem ua rau mob qog noj ntshav.

Hauv kev sib piv, mob ntsws cancer tshwm sim los ntawm kev haus luam yeeb muaj qhov nruab nrab ntawm 8 kev hloov pauv ntawm 1 lab DNA. Qhov no twb tsis zoo, tab sis nws daj ntseg nyob rau hauv kev sib piv rau 150 ntawm Aristolochic Acid.

1. Kev kho mob tshwm sim ntawm aristolochic acid nephropathy

Aristolochic acid nephropathy tuaj yeem tshwm sim ua rau mob raum raug mob (xws li mob hlab ntsha necrosis), mob raum raug mob (xws li mob tubulointerstitial nephritis), thiab malignancy.

1. Mob raum tubular necrosis

Nws feem ntau tshwm sim tom qab noj tshuaj ntau ntawm aristolochic acid-muaj tshuaj nyob rau lub sijhawm luv luv (txawm tias ib zaug). Qhov pib yog sai, thiab oliguria, anuria, edema, plawv tsis ua hauj lwm, kub siab, thiab lwm yam feem ntau tshwm sim nyob rau hauv ob peb teev tom qab noj cov tshuaj. Nyob rau tib lub sijhawm, cov tsos mob ntawm plab hnyuv xws li xeev siab, ntuav, thiab mob plab plab tuaj yeem tshwm sim.

Kev kuaj zis yuav qhia tau tias microalbuminuria, hematuria, glycosuria, aminoaciduria, hypoosmolar tso zis, nce zis NAG enzyme, thiab lwm yam. Cov ntshav kuaj pom tias creatinine siab, acidosis, anemia, thrombocytopenia, daim siab enzymes, thiab lwm yam. Xim Doppler ultrasound kuaj pom lub raum loj, qhov loj ntawm lub raum. , lwm.

Lub raum pathology manifests li mob tubular necrosis. Nyob rau hauv lub teeb microscopy, loj degeneration, necrosis, thiab disintegration ntawm lub raum tubular epithelial hlwb, ib feem hauv qab daus daim nyias nyias raug, raum interstitial edema, nyob rau hauv tej lub sij hawm tawg infiltration ntawm ib tug me me ntawm lymph thiab mononuclear hlwb, tsis pom tseeb glomerular lesions, thiab o ntawm arteriolar endothelial hlwb. tau pom. Immunofluorescence tsis zoo.

Mob hnyav degeneration thiab necrosis ntawm lub raum tubular epithelial hlwb, raug rau lub raum tubular hauv qab daim nyias nyias, tab sis tsis muaj regeneration ntawm lub raum tubular epithelial hlwb yog cov yam ntxwv pathological hloov ntawm mob aristolochic acid nephropathy.

2. Tus kab mob tubulointerstitial nephritis

Nws yog tshwm sim los ntawm kev siv tshuaj tsawg tsawg ntawm cov tshuaj uas muaj aristolochic acid, thiab qee tus neeg mob tshwm sim los ntawm mob aristolochic acid nephropathy. Tus kab mob no maj mam, nrog rau lub sij hawm los ntawm kev noj tshuaj mus rau qhov pib ntawm cov tsos mob ntawm lub hlis mus rau xyoo. Qhov pib yog insidious thiab cov tsos mob feem ntau yog atypical. Feem ntau tsis muaj tsos mob tshwm sim thaum ntxov. Cov tsos mob xws li nce nocturia, nce ntshav creatinine, anemia, qaug zog, thiab anorexia maj mam tshwm.

Kev kuaj zis yuav qhia tau tias microalbuminuria, glycosuria, aminoaciduria, hypotonic tso zis, nce zis NAG enzyme, thiab lwm yam. Cov ntshav kuaj pom cov ntshav siab creatinine, anemia, thrombocytopenia, thiab lwm yam, uas yuav qhia tau tias lub raum tubular acidosis thiab/los yog Fanconi syndrome. Kev kuaj xim ultrasound qhia tau hais tias lub raum ntim tau qis, lub raum cortex tau dhau los ua nyias, thiab cortical echo tau nce.

Lub pathological tshwm sim ntawm lub raum yog mob ntev tubulointerstitial fibrosis. Nyob rau hauv lub teeb microscopy, multifocal los yog loj-scale oligocellular fibrosis tau pom nyob rau hauv lub raum interstitium, nrog qee zaus ib tug me me ntawm tawg los yog me me focal lymphoid thiab mononuclear cell infiltration, multi-focal los yog loj-scale atrophy ntawm lub raum tubules, thiab glomerular atrophy. . Txawm hais tias tsis muaj qhov pom tseeb, lossis muaj ischemic hauv qab daus membrane shrinkage thiab sclerosis, cov phab ntsa arteriole yog thickened, thiab cov lumen yog nqaim. Immunofluorescence tsis zoo.

Ntev interstitial fibrosis thiab txo tus naj npawb ntawm lub raum tubules nyob rau hauv cortical cheeb tsam los yog corticomedullary hlws ris cheeb tsam, tab sis tsis pom tseeb cellular infiltration, yog cov yam ntxwv pathological manifestations ntawm mob aristolochic acid nephropathy.

Lub raum ua haujlwm puas tsuaj ntawm cov mob aristolochic acid nephropathy mus rau qhov sib txawv. Qee tus neeg mob tau nce sai thiab nkag mus rau theem kawg ntawm lub raum tsis ua haujlwm li ob peb lub hlis mus rau ib xyoos; Qee tus neeg mob tau nce qeeb thiab ncav cuag uremia hauv ntau dua 10 xyoo. Anemia feem ntau tshwm sim ntxov thiab tej zaum yuav tsis sib npaug mus rau qib ntawm lub raum puas.

3. mob qog nqaij hlav

Cov kev sim tsiaj kuj tau lees paub tias aristolochic acid yog cov carcinogenic heev thiab tuaj yeem ua rau muaj kev hloov pauv ntawm cell carcinoma ntawm lub raum pelvis thiab zais zis hauv nas. Kev soj ntsuam soj ntsuam tau pom tias cov neeg mob uas muaj mob ntev aristolochic acid nephropathy muaj qhov tshwm sim ntawm cov qog nqaij hlav, feem ntau yog cov kab mob qog nqaij hlav epithelial cell carcinoma ntawm lub zais zis, lub raum pelvis, thiab ureter.

Yog tias cov neeg mob uas muaj mob ntev aristolochic acid nephropathy muaj qhov pom tseeb ntawm microscopic hematuria lossis tag nrho hematuria, lawv yuav tsum tau ceev faj heev txog cov qog zis.

2. Cov qauv kev kho mob thiab cov phiaj xwm

Tam sim no, lub pathogenesis ntawm aristolochic acid nephropathy tsis meej, yog li tsis muaj qhov tshwj xeeb thiab paub tab kev kho mob.

1. Txhob noj tshuaj kom sai

Thaum aristolochic acid nephropathy raug lees paub, cov nroj tsuag muaj cov aristolochic acid yuav tsum tau txiav tam sim ntawd. Nyob rau tib lub sijhawm, kev paub txog aristolochic acid nephropathy yuav tsum tau nrov, kev phom sij ntawm aristolochic acid yuav tsum tau ntsib xwm txheej, thiab qhov ntau npaum li cas thiab lub sijhawm ntawm kev kho mob yuav tsum tau tswj nruj me ntsis.

2. Kev siv glucocorticoids

Mob aristolochic acid nephropathy tuaj yeem kho nrog glucocorticoids kom txo cov tubular puas thiab pab kho tubules.

Tus mob aristolochic acid nephropathy tuaj yeem kho nrog glucocorticoids. Tus kws kho mob Belgian Vanherweghem thiab lwm tus ib zaug siv prednisone ntawm koob tshuaj 1 mg / kg·d. Tom qab 1 lub hlis ntawm kev kho mob, koob tshuaj tau raug kaw thiab thaum kawg khaws cia ntawm 0.15 mg / kg·d. Nws muaj qee yam cuam tshuam rau ncua kev loj hlob ntawm lub raum ua haujlwm puas. Xib fwb Chen Yipu thiab lwm tus hauv kuv lub tebchaws kuj tau siv glucocorticoids los kho tus mob aristolochic acid nephropathy.

Kev kho glucocorticoid thaum ntxov tuaj yeem pab thim rov qab thiab ncua sijhawm ntawm lub raum kev ua haujlwm thiab muaj qee yam cuam tshuam rau tus kab mob no. Txawm li cas los xij, cov lus qhia thiab cov tshuaj noj tshwj xeeb xws li pib koob tshuaj, yuav txo cov koob tshuaj li cas, thiab lub sijhawm saib xyuas tseem tsis tau txiav txim siab. Kev tshawb nrhiav thiab kev tshuaj xyuas ntau ntxiv yog xav tau. Nws txoj kev kho mob kuj tseem tsis meej.

3. RASi, SGLT2i thiab MRA

Kev thov thaum ntxov ntawm ACEI lossis ARB hauv cov kab mob aristolochic acid nephropathy tsiaj cov qauv tuaj yeem txo qis kev sib txuam ntawm cov cellular matrix thiab fibrosis hauv lub raum interstitium thiab txhim kho lub raum ua haujlwm. Txawm li cas los xij, ntxiv cov ntaub ntawv loj hauv kev soj ntsuam xyuas kev ua tau zoo yog xav tau.

Cov kev tshawb fawb soj ntsuam tau lees paub tias SGLT2i muaj txiaj ntsig zoo rau cov neeg tsis muaj ntshav qab zib CKD thiab tuaj yeem ncua kev ua haujlwm ntawm lub raum tsis zoo. Txawm li cas los xij, nws cov txiaj ntsig tshwj xeeb ntawm tus mob aristolochic acid nephropathy tseem yuav tsum tau lees paub.

Thib peb-tiam aldosterone receptor antagonist fenelinone muaj tseeb los tiv thaiv kab mob thiab tej zaum yuav muaj kev cia siab dav rau kev kho mob ntawm aristolochic acid nephropathy.

4. Cov tsos mob thiab kev txhawb nqa kev kho mob

Ua haujlwm kho mob ntshav qab zib thiab siv HIF-PHIs xws li erythropoietin lossis roxadustat thaum ntxov. Txhim kho acidosis thiab electrolyte imbalance kom muaj kev ruaj ntseg hauv ib puag ncig. Kev kho lub raum hloov yog ib qho kev xaiv rau cov neeg mob uas muaj kab mob raum kawg.

3. Kev kwv yees

Qhov kev kwv yees tsis zoo. Txawm hais tias cov tshuaj uas muaj aristolochic acid raug tso tseg rau lub sijhawm, tsuas yog qee tus neeg mob uas mob aristolochic acid nephropathy tuaj yeem rov qab mus rau lub raum tsis ua haujlwm, thiab feem coob ntawm cov neeg mob mob tsis tuaj yeem rov qab los ntawm lub raum ua haujlwm thiab tig mus rau lub raum tsis ua haujlwm. Hauv cov neeg mob uas mob ntev aristolochic acid nephropathy, lub raum kev ua haujlwm yuav maj mam nce mus rau theem kawg ntawm lub raum tsis ua haujlwm txawm tias tom qab txiav tshuaj.

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. Cov khoom tseem ceeb ntawm cistanche yog phenylethanoid glycosides,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 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.