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 zis protein tsis pom tseeb, cov ntshav creatinine siab, lub raum ua haujlwm tsis zoo, lub raum atrophy, thiab uremia. Tsis tas li ntawd, kwv yees li ib nrab ntawm cov neeg mob uas muaj kab mob raum no yuav loj hlob 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 muaj teeb meem zoo sib xws tau pom ua ntej. Vim li cas lawv tau tshwm sim tsis ntev los no? Tom qab kev tshawb xyuas ntxaws, nws tau pom tias txij li xyoo 1990, lub tsev kho mob tau hloov pauv cov mis hnyav thiab ntxiv ob tsob nroj, Stephania tetraanda thiab Magnolia officinalis. Thaum kawg, nws tau lees paub tias aristolochic acid nyob rau hauv Stephania tetraanda ua rau lub raum tsis zoo.

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

Qhov koob tshuaj ntawm 147 mg ua rau muaj tus kab mob, thiab kev noj tshuaj yog proportional rau tus nqi ntawm tus kab mob. Lwm cov khoom xyaw hauv cov tshuaj ntsiav tuaj yeem txiav tawm raws li qhov kev pheej hmoo nkaus xwb. [1] Los ntawm 1998, 70% ntawm 128 tus neeg mob tau kuaj pom muaj kab mob raum kawg (ESRD) [2, 3].

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

Tom qab xyoo 1956, muaj cov ntawv ceeb toom tias muaj kab mob raum txawv txawv hauv qee lub zos hauv Danube River Basin hauv Bulgaria, Croatia, Serbia, Bosnia thiab Herzegovina, Romania, thiab lwm yam. Cov neeg mob feem ntau tshwm sim mob ntshav qab zib thiab uremia thaum muaj hnub nyoog 40 mus rau 60. Cov tsos mob yog lub raum fibrosis, lub raum atrophy loj heev, ureteral malignant qog, 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 Balkan endemic nephropathy.

Tom qab tus kws kho mob Belgian tau tshaj tawm, qee tus kws kho mob nephrologist sai sai xav tias cov tsos mob ntawm herbal nephropathy thiab Balkan endemic nephropathy zoo ib yam. Lawv puas tuaj yeem tshwm sim los ntawm aristolochic acid?

Tom qab ntawd, cov kws tshaj lij Asmeskas pom tias muaj ntau cov nroj tsuag Aristolochic acid loj hlob nyob rau hauv cov nplej teb nyob rau hauv lub Balkans. Thaum cov nplej tau sau, Aristolochic acid cov nroj tsuag yuav muab sib xyaw nrog cov nplej thiab noj yuam kev.

Tom qab ntawd, aristolochic acid-DNA adducts (adducts, ib qho nyuaj tsim los ntawm kev sib xyaw ntawm DNA tawg thiab cov tshuaj carcinogenic) tau pom nyob rau hauv cov kab mob raum ntawm cov neeg mob Balkan endemic nephropathy, thaum tsis muaj cov adducts hauv cov neeg mob raum zoo tib yam. Qhov no tau ua pov thawj tias aristolochic acid yog qhov ua rau Balkan endemic nephropathy, yog li nws tau muaj npe hu ua aristolochic acid nephropathy.

Tom qab ntawd, ntau lub teb chaws txwv tsis pub muag lossis ceeb toom tawm tsam kev noj cov nroj tsuag uas muaj aristolochic acid. Xyoo 2003, kuv lub teb chaws kuj tau tshem tawm cov qauv tshuaj rau peb cov tshuaj Aristolochic acid: Aristolochic acid, Aristolochic acid thiab Aristolochic acid.

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

1. Aristolochia: loj-nplooj ntsuab ntoo ntxhiab, yav qab teb Yunnan Aristolochia, yav qab teb ntoo fragrance, raj sab qab teb fragrance, peb lub raj yeeb nkab, bract nplooj Aristolochia, cinnabar lotus, Aristolochia, Tianxianteng, ntsuab tshuaj tsw qab, gourd nplooj Aristolochia, Guangfeng, , Hainan Aristolochia, Hanzhong Fangji, Tengxiang, Nanyue Aristolochia, concave vein Aristolochia, Huaitong, nraub qaum nab, raj sab qab teb fragrance, Guan Mutong, Xungufeng, tawv nplooj Aristolochia, dag loj qos yaj ywm, npauj npaim tsaus ploj, dawb cinnabars ntshav ntau, dawb kub txiv ntoo txiv ntseej, me me yav qab teb ntoo ntxhiab.

2. Asarum: ntiaj teb asarum, loj asarum, lwm yam asarum, Duheng, asarum, kub tsej, ntiaj teb kub tsej, dub kub nyom, paj ntsej muag asarum, Taitung asarum.

Muaj ntau cov ntaub ntawv pov thawj tias txawm tias koj tsuas yog noj me me ntawm cov nroj tsuag uas muaj aristolochic acid ib zaug, nws yuav ua rau lub raum tsis zoo thiab ua rau muaj kev pheej hmoo ntawm kev mob raum tsis ua haujlwm thiab mob qog noj ntshav urothelial yav tom ntej. Qhov ntau koj noj, qhov ntau dua qhov tshwm sim.

Hauv xyoo 2013, cov kws tshawb fawb tau tshawb pom cov noob hloov pauv qhov chaw tshwm sim los ntawm aristolochic acid, ua pov thawj tias aristolochic acid muaj peev xwm ua rau cov noob hloov pauv ntawm txhua yam tshuaj uas paub niaj hnub no: 150 cov noob caj noob ces yuav hloov pauv hauv txhua lab lub hauv paus. Nws kuj yog thawj zaug uas aristolochic acid tau ua pov thawj tias yog hepatotoxic.

Cov txheej txheem pathogenic ntawm aristolochic acid yog ib feem ntawm nws cov metabolites raug txo kom aristolochic acid lactam, nkag mus rau lub raum tubular epithelial hlwb, tsub zuj zuj nyob rau hauv lub cytoplasm thiab exert cov nyhuv; lwm qhov tuaj yeem tsim cov adducts nrog tib neeg DNA, ua rau muaj kev hloov pauv hauv RAS gene thiab p53 gene. 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 lub neej tsis ncaj ncees lawm, ib yam li koj tau sau ib tsab ntawv rau tus vajtswv poj niam, cov ntsiab lus yog "WoAi Ni. " (Kuv hlub koj), tab sis nws tau raug cuam tshuam los ntawm aristolochic acid rau hauv "Wo Ti Ni" (Kuv ncaws koj), qhov kawg tuaj yeem xav txog.

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

Txawm hais tias qee cov nroj tsuag tsis-Aristolochicaceae xws li Houttuynia cordata tsis muaj aristolochic acid, lawv muaj aristolochic acid metabolite aristolochic acid amide, uas tuaj yeem ua rau mob qog noj ntshav.

Hais txog kev hais lus, 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 yog qhov phem heev, tab sis piv nrog 150 ntawm aristolochic acid, nws tsuas yog ib qho teeb meem me me xwb.

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 tubular necrosis), mob raum raug mob (xws li mob ntsws tubulointerstitial nephritis) thiab qog nqaij hlav malignant.

1. Mob tubular necrosis

Nws feem ntau tshwm sim tom qab noj tshuaj ntau ntawm aristolochic acid-muaj tshuaj nyob rau lub sijhawm luv luv (txawm 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 zom mov xws li xeev siab, ntuav, thiab mob plab plab tuaj yeem tshwm sim.

Kev kuaj zis tuaj yeem pom cov proteinuria, hematuria, glycosuria, amino acid zis, hypoosmotic tso zis, thiab nce zis NAG enzyme. Kev kuaj ntshav qhia tias ntshav creatinine nce ntxiv, acidosis, anemia, thrombocytopenia, thiab nce siab enzymes. Xim Doppler ultrasound kuaj pom lub raum loj ntim thiab perinephric edema.

Lub raum pathology yog mob tubular necrosis. Nyob rau hauv lub teeb microscope, lub raum tubular epithelial hlwb yog heev degenerated, necrotic, thiab disintegrated, ib feem ntawm lub qab daus daim nyias nyias yog nthuav, raum interstitial edema, thiab qee zaus ib tug me me ntawm lymphocytes thiab monocytes yog tawg infiltrates. Tsis muaj qhov pom tseeb qhov txhab nyob rau hauv glomerulus, thiab cov hlab ntsha endothelial yog o. Immunofluorescence tsis zoo.

Mob hnyav degeneration thiab necrosis ntawm lub raum tubular epithelial hlwb, nthuav tawm tubular hauv qab daim nyias nyias, tab sis tsis muaj kev tsim kho ntawm tubular epithelial hlwb, yog cov yam ntxwv hloov pauv ntawm cov 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 qhov tshwm sim los ntawm mob aristolochic acid nephropathy. Tus kab mob no maj mam zuj zus, txij li lub hli mus rau xyoo los ntawm kev noj cov tshuaj mus rau qhov pib ntawm cov tsos mob. Qhov pib yog insidious, thiab cov tsos mob feem ntau yog atypical. Feem ntau tsis muaj cov tsos mob tshwm sim thaum ntxov, thiab cov tsos mob xws li nce nocturia, nce ntshav creatinine, anemia, qaug zog, thiab tsis qab los noj mov maj mam tshwm sim.

Kev kuaj zis tuaj yeem pom cov kab proteinuria, glycosuria, amino aciduria, hypoosmotic tso zis, thiab nce zis NAG enzyme. Kev kuaj ntshav qhia tau tias ntshav creatinine nce ntxiv, ntshav ntshav, thrombocytopenia, thiab lwm yam, thiab tshwm sim ntawm lub raum tubular acidosis thiab / lossis Fanconi syndrome yuav tshwm sim. Kev kuaj xim Doppler ultrasound qhia tau hais tias txo lub raum ntim, thinning ntawm lub raum cortex, thiab nce cortical echoes.

Lub pathological tshwm sim ntawm lub raum yog mob ntev tubulointerstitial fibrosis. Nyob rau hauv lub teeb microscope, lub raum interstitium qhia tau hais tias multifocal los yog loj-scale oligocellular fibrosis, nrog tej lub sij hawm tawg los yog me me-scale lymphocyte thiab mononuclear cell infiltration, multifocal los yog loj-scale atrophy ntawm lub raum tubules, thiab tsis muaj teeb meem nyob rau hauv lub glomeruli, los yog ischemic. Lub hauv paus txheej txheem shrinkage thiab sclerosis, thickening ntawm arteriolar phab ntsa, thiab nqaim ntawm lub lumen. 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, tab sis tsis pom tseeb cell infiltration, yog cov yam ntxwv pathological tshwm sim ntawm mob aristolochic acid nephropathy.

Qhov kev nce qib ntawm lub raum ua haujlwm puas tsuaj nyob rau hauv cov mob aristolochic acid nephropathy txawv. Qee tus neeg mob tau nce sai thiab nkag mus rau lub raum tsis ua haujlwm hauv 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 thaum ntxov thiab tej zaum yuav tsis sib npaug rau qib ntawm lub raum ua haujlwm puas tsuaj.

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. Cov kev soj ntsuam soj ntsuam tau pom tias qhov tshwm sim ntawm malignant qog nyob rau hauv cov neeg mob uas mob aristolochic acid nephropathy yog siab heev, feem ntau yog transitional epithelial carcinoma ntawm lub zais zis, lub raum pelvis thiab ureter.

Yog hais tias cov neeg mob uas muaj mob ntev aristolochic acid nephropathy muaj pom tseeb microscopic hematuria los yog macroscopic hematuria, lawv yuav tsum tau ceev faj heev rau cov qog zis.

2. Cov qauv kev kho mob thiab cov phiaj xwm

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

1. Txhob noj tshuaj raws sijhawm

Thaum nws tau lees paub tias nws yog aristolochic acid nephropathy, cov nroj tsuag thiab cov tshuaj uas muaj aristolochic acid yuav tsum tau nres rau lub sijhawm. Nyob rau tib lub sijhawm, kev paub txog kev paub txog aristolochic acid nephropathy yuav tsum tau nrov, kev raug mob ntawm aristolochic acid yuav tsum tau ntsib xwm txheej, thiab kev noj tshuaj thiab cov tshuaj 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 siv cov tshuaj prednisone rau kev kho mob, nrog rau ntau npaum li 1 mg / kg•d. Tom qab ib lub hlis ntawm kev kho mob, cov koob tshuaj tau maj mam txo thiab thaum kawg khaws cia ntawm 0.15 mg/kg•d, uas muaj qee yam cuam tshuam rau kev ncua sijhawm ntawm lub raum ua haujlwm puas tsuaj. Xib fwb Chen Yipu thiab lwm tus hauv kuv lub teb chaws kuj tau siv glucocorticoids los kho mob aristolochic acid nephropathy.

Kev kho mob glucocorticoid thaum ntxov pab txhawb kev thim rov qab thiab ncua sijhawm ntawm lub raum kev ua haujlwm thiab muaj qee yam cuam tshuam rau tus kab mob no, tab sis cov lus qhia rau kev kho mob thiab cov tshuaj noj tshwj xeeb xws li pib koob tshuaj, yuav ua li cas txo cov koob tshuaj, thiab lub sijhawm saib xyuas tseem tsis tau lees paub. thiab yuav tsum tau tshawb nrhiav thiab tshuaj xyuas ntau dua. Nws txoj kev kho mob kuj tseem tsis meej.

3. RASi, SGLT2i thiab MRA

Kev thov thaum ntxov ntawm ACEI lossis ARB hauv cov tsiaj ua qauv ntawm cov mob aristolochic acid nephropathy tuaj yeem txo qhov tsub zuj zuj ntawm extracellular matrix thiab fibrosis hauv lub raum interstitial hlwb thiab txhim kho lub raum ua haujlwm. Txawm li cas los xij, kev kuaj xyuas kev ua tau zoo ntxiv nrog cov ntaub ntawv loj yog xav tau.

Cov kev tshawb fawb soj ntsuam tau lees paub tias SGLT2i cov tshuaj hypoglycemic muaj cov txiaj ntsig zoo rau cov tsis muaj ntshav qab zib CKD thiab tuaj yeem ncua kev ua haujlwm ntawm lub raum tsis zoo, tab sis cov txiaj ntsig tshwj xeeb ntawm tus mob aristolochic acid nephropathy tseem tsis tau lees paub meej.

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

4. Cov tsos mob txhawb nqa kev kho mob

Kev kho mob ntshav qab zib nquag thiab siv HIF-PHI xws li erythropoietin lossis roxadustat thaum ntxov. Ua haujlwm kho cov kab mob acidosis thiab electrolyte tsis zoo kom tswj tau qhov chaw nyob ruaj khov. Cov neeg mob uas muaj kab mob raum kawg tuaj yeem xaiv txoj kev kho lub raum hloov.

3. Kev kwv yees

Qhov kev kwv yees tsis zoo. Txawm hais tias cov tshuaj uas muaj aristolochic acid raug txiav tawm hauv lub sijhawm, tsuas yog ob peb tus neeg mob uas mob aristolochic acid nephropathy tuaj yeem ua rau lawv lub raum ua haujlwm zoo li qub, thiab feem coob ntawm cov neeg mob mob tsis tuaj yeem kho lawv lub raum ua haujlwm thiab tig mus rau lub raum tsis ua haujlwm. Txawm tias tom qab tso tseg cov tshuaj, cov neeg mob uas mob ntev aristolochic acid nephropathy tseem yuav maj mam nce mus rau theem kawg ntawm lub raum tsis ua haujlwm.

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 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 lub cev thiab lub cev, ua rau nws txoj hauv kev zoo rau kev kho mob raum.