Thaum xaiv cov tshuaj hypoglycemic rau ob lub raum ntawm cov neeg mob ntshav qab zib mellitus (DKD), tsis yog lawv yuav tsum xav txog yuav ua li cas txo cov ntshav qab zib kom zoo, tab sis kuj tseem them nyiaj rau kev tiv thaiv lub raum. Yog li, cov neeg mob DKD yuav tsum tau ceev faj ntau dua hauv kev xaiv cov tshuaj hypoglycemic kom tsis txhob ua rau lub nra hnyav ntxiv. Kab lus no tsom mus rau kev tswj hwm cov neeg mob DKD kom pab ntau tus neeg mob DKD txo cov ntshav qab zib kom zoo thiab tiv thaiv ob lub raum kom nyab xeeb.

Nyem rau cistanche pab rau mob raum

Raws li xyoo 2021, tus naj npawb ntawm cov neeg mob ntshav qab zib laus hauv ntiaj teb tau nce mus txog 537 lab, thiab tus naj npawb ntawm cov neeg mob ntshav qab zib hauv Suav teb tau tshaj 120 lab, ntawm 20 feem pua ​​​​rau 40 feem pua ​​​​ntawm cov neeg mob ntshav qab zib muaj DKD.

DKD yog qhov teeb meem mob microvascular feem ntau ntawm cov ntshav qab zib mellitus, thiab nws kuj yog ib qho ntawm cov ua rau tuag rau cov neeg mob ntshav qab zib thiab tau dhau los ua cov kab mob hauv lub raum kawg.

Kev kuaj mob ntawm DKD

DKD yog ib hom kab mob raum ntev uas tshwm sim los ntawm ntshav qab zib, feem ntau tshwm sim los ntawm cov zis albumin / creatinine piv ntau dua lossis sib npaug li 30 mg / g thiab / lossis kwv yees glomerular filtration rate (eGFR) < 60 ml / (min·1.73 m²), thiab txuas ntxiv. rau ntau tshaj 3 lub hlis, thaum tsis suav nrog lwm cov kab mob raum mob.

Lub raum biopsy pathological kev kuaj mob yog lub hauv paus tseem ceeb rau kev kuaj mob, thiab lub raum biopsy pathological kuaj tau ua tau thaum lub etiology nyuaj los txheeb xyuas.

Kev tshuaj ntsuam rau DKD

Nws raug pom zoo tias cov neeg mob ntshav qab zib hom 1 uas muaj kab mob ntau dua 5 xyoos thiab cov neeg mob ntshav qab zib hom 2 thaum lub sijhawm kuaj mob yuav tsum tau kuaj pom cov zis albumin / creatinine piv thiab eGFR kev ntsuas txhawm rau kuaj DKD ntxov. Kev tshuaj xyuas yuav tsum tau ua tsawg kawg ib xyoos ib zaug tom qab ntawd.

Kev soj ntsuam ntawm DKD

Tom qab kuaj pom DKD, eGFR staging thiab urinary albumin grading yuav tsum tau ua tam sim ntawd.

KDIGO pom zoo kom sib txuas cov kab mob raum mob ntev thiab albuminuria staging los ntsuas qhov kev pheej hmoo ntawm DKD kev loj hlob thiab qhov zaus ntawm kev rov kuaj dua.

Kev kho DKD

Kev kho mob ntawm DKD yog ib txheej txheem ntawm kev tswj hwm kev sib koom ua ke. Los ntawm kev tswj hwm ntawm DKD cov neeg mob suav nrog kev hloov pauv kev ua neej tsis zoo, muaj feem cuam tshuam (hyperglycemia, kub siab, lipid metabolism, thiab lwm yam) kev pheej hmoo ntawm lub raum tsis zoo thiab kev tuag.

1. Hloov kev ua neej tsis zoo

Xws li kev tswj qhov hnyav kom tsim nyog, noj zaub mov ntshav qab zib, kev haus luam yeeb thiab kev tawm dag zog kom raug. Nws raug nquahu kom cov neeg mob ua 5 zaug hauv ib lub lis piam, 30 feeb ntawm kev tawm dag zog uas cuam tshuam rau kev ua haujlwm cardiopulmonary.

2. Kev tswj kev noj haus

Kev noj cov protein ntau ntau yuav ua rau cov protein ntau metabolites (creatinine, urea nitrogen, thiab lwm yam) hauv cov ntshav, ua kom lub nra hnyav rau tus neeg mob lub raum, thiab ua kom cov zis tso zis ntau ntxiv. Yog li ntawd, cov neeg mob DKD yuav tsum tau noj cov zaub mov uas tsis muaj protein ntau thiab siv cov tsiaj protein zoo (mis nyuj, qe, nqaij ntshiv, ntses, thiab lwm yam) kom ntseeg tau tias cov khoom noj "tseem ceeb amino acids" thiab txo cov zaub protein tsawg (cov ntsiab lus siab dua " tsis tseem ceeb amino acids ").

●Rau cov neeg mob DKD uas tsis tau pib lim ntshav, qhov pom zoo kom noj cov protein ntau yog {{0}}.8 g/(kg d). Thaum cov creatinine tshem tawm txo qis thiab lub raum ua haujlwm poob qis, kev txwv tsis pub muaj protein ntau, thiab kev noj cov protein txhua hnub yog tswj hwm ntawm 0.6 g / kg.

●Rau cov neeg mob lim ntshav, nws tuaj yeem tsim nyog nce mus rau 1.0~ 1.2 g/(kg·d).

Cov protein ntau yuav tsum yog cov tsiaj muaj protein ntau, thiab cov khoom sib xyaw -keto acid tuaj yeem ntxiv yog tias tsim nyog. Thaum ua raws li kev noj zaub mov tsis muaj protein ntau, nws yuav tsum ua kom muaj calories txaus (30-35 kal / kg ib hnub) kom tsis txhob muaj cov protein thiab rog ntau ntxiv, uas yuav ua rau lub raum hnyav ntxiv thiab ua rau tsis muaj zaub mov noj.

Tsis tas li ntawd, cov neeg mob DKD kuj xav tau cov khoom noj uas tsis muaj ntsev (nqaij 3-6 g/d), tshwj xeeb tshaj yog thaum nrog nephrotic syndrome. Rau cov neeg mob hyperkalemia, kev noj cov poov tshuaj ntsev kuj yuav tsum tau txwv.

3. Tswj cov ntshav qab zib

Kev kho hypoglycemic tsim nyog raug pom zoo rau txhua tus neeg mob DKD. Lub sijhawm ntev hyperglycemia yog qhov tseem ceeb ua rau muaj kev puas tsuaj rau microvascular hauv ntshav qab zib. Thaum tsim cov hom phiaj tswj ntshav qabzib rau cov neeg mob DKD, cov hom phiaj tswj tus kheej yuav tsum tau tsim raws li hnub nyoog, lub sijhawm muaj ntshav qab zib, lub neej expectancy, comorbidities, teeb meem, kev pheej hmoo ntawm hypoglycemia, thiab lwm yam.

Lub hom phiaj zoo tshaj plaws rau kev tswj ntshav qab zib yog ceev cov ntshav qab zib qis dua 6.1 mmol / L, 2- teev tom qab cov ntshav qab zib qis dua 8.0 mmol / L, thiab glycosylated hemoglobin qis dua 6.5 feem pua. Cov neeg laus tuaj yeem so tus qauv tswj kom tsim nyog.

Cov neeg mob lub raum tsis txaus tuaj yeem xaiv cov tshuaj hypoglycemic uas tsis tshua tawm ntawm lub raum, thiab cov neeg mob lub raum tsis txaus yuav tsum tau kho nrog insulin.

● Cov kev tshawb fawb tau pom tias sodium-glucose cotransporter 2 inhibitors tuaj yeem txo qis cov ntshav qab zib nkaus xwb tab sis kuj muaj kev tiv thaiv rau lub raum. Rau cov neeg mob ntshav qab zib hom 2 nrog DKD, nws raug nquahu kom siv sodium-glucose cotransporter 2 inhibitors hauv cov neeg mob nrog eGFR Ntau dua lossis sib npaug li 45 ml / (min·1.73 m²) txhawm rau txo qhov kev pheej hmoo ntawm DKD kev loj hlob thiab / lossis cov xwm txheej hauv plawv.

● Cov kev tshawb fawb tau pom tias glucagon-zoo li peptide-1 receptor agonists tuaj yeem txo qhov kev pheej hmoo ntawm albuminuria tshiab hauv cov neeg mob ntshav qab zib, thiab tuaj yeem txiav txim siab hauv cov neeg mob uas muaj eGFR Ntau dua lossis sib npaug li 30 ml / (min·1.73 m²) .

● Cov neeg mob DKD thaum ntxov tuaj yeem xaiv gliquidone thiab repaglinide, ob cov tshuaj no feem ntau yog metabolized nyob rau hauv daim siab, 95 feem pua ​​​​ntawm cov metabolites raug tso tawm ntawm cov quav los ntawm cov kua tsib, thiab tsawg dua 5 feem pua ​​​​yog tawm los ntawm lub raum. Yog li ntawd, nws yuav tsis nce lub nra ntawm ob lub raum thiab tsis tshua muaj kev cuam tshuam rau lub raum.

●Alpha-glucosidase inhibitors tsis tshua nkag mus rau hauv cov ntshav los ntawm txoj hnyuv thiab tsis cuam tshuam rau lub raum, yog li lawv tuaj yeem siv tau.

●Rau cov neeg mob ntshav qab zib uas tsis noj cov tshuaj hypoglycemic ntawm qhov ncauj lossis tau tsim lub raum tsis txaus, tag nrho cov tshuaj hypoglycemic ntawm qhov ncauj yuav tsum raug tso tseg thiab yuav tsum siv cov tshuaj insulin los tswj cov ntshav qab zib.

4. Tswj ntshav siab

Kev kho mob antihypertensive tsim nyog tuaj yeem ncua qhov tshwm sim thiab kev loj hlob ntawm DKD. Cov ntshav siab tsis yog tsuas yog ib qho tseem ceeb ntawm qhov tshwm sim thiab kev loj hlob ntawm DKD tab sis kuj yog ib qho kev pheej hmoo tseem ceeb uas txiav txim siab txog kev mob plawv hauv cov neeg mob.

Rau cov neeg mob DKD, tshwj xeeb tshaj yog albuminuria, cov ntshav siab yuav tsum tau tswj qis dua 130/80 mmHg, tab sis cov ntshav siab diastolic yuav tsum tsis txhob qis dua 70 mmHg, thiab cov ntshav siab diastolic yuav tsum tsis txhob qis dua 60 mmHg rau cov neeg laus.

Angiotensin-hloov enzyme inhibitors (ACEI) lossis angiotensin II receptor blockers (ARBs) yog cov tshuaj tiv thaiv ntshav siab nyiam rau cov neeg mob ntshav qab zib, thiab qhov ntau npaum li cas tuaj yeem yog ob npaug ntawm cov tshuaj tiv thaiv ib txwm muaj.

ACEI/ARB tsis tuaj yeem txo cov ntshav siab xwb, tab sis kuj tseem tiv thaiv lub raum, txo qhov siab hauv glomerular capillaries, txo qis albumin excretion, thiab ncua kev kawm ntawm DKD. Txawm li cas los xij, kev saib xyuas yuav tsum tau them nyiaj rau kev kuaj xyuas lub raum ua haujlwm tsis tu ncua thiab cov kua dej poov tshuaj thaum noj tshuaj.

Nws tsis tuaj yeem siv thaum lub raum tsis txaus thiab cov ntshav creatinine ntau dua 3 mg / dl (los yog 265 μmol / L). ACEI / ARB yog contraindicated nyob rau hauv cov neeg mob uas muaj ob lub raum hlab ntsha stenosis.

Thaum tus neeg mob ntshav siab siab, feem ntau yuav tsum tau noj cov tshuaj sib xyaw ua ke, xws li ACEI / ARB ua ke nrog cov tshuaj calcium ions antagonists ntev xws li nifedipine tswj-tso ntsiav tshuaj, thiab me me ntawm diuretics (hydrochlorothiazide, spironolactone, thiab lwm yam. ) tos).

5. Kho dyslipidemia

Lub hom phiaj tseem ceeb yog txhawm rau txo qis lipoprotein cholesterol (LDL-C), thiab LDL-C yuav tsum tau txo qis rau lub hom phiaj tus nqi raws li kev pheej hmoo ntawm atherosclerotic kab mob plawv hauv cov neeg mob. Cov tshuaj statins lipid-txo qis yog thawj qhov kev xaiv rau txoj kev npaj kho mob, thiab cov tshuaj statins yuav tsum tau siv thaum pib, thiab cov koob tshuaj yuav tsum raug kho kom haum raws li tus neeg mob lipid-txo cov txiaj ntsig thiab kev ua siab ntev.

Lub hom phiaj kho ntshav lipid pom zoo rau cov neeg mob DKD yog: qib LDL-C tsawg dua 1.8 mmol / L hauv cov neeg mob uas muaj keeb kwm ntawm atherosclerotic kab mob plawv lossis eGFR<60 ml/(min·1.73 m²), and less than 2.6 mmol/L in other patients /L.

6. Yam kom tsis txhob muaj lub raum puas

Kev kis kab mob, tshwj xeeb tshaj yog cov kab mob urinary, tuaj yeem ua rau kev loj hlob ntawm DKD. Yog li ntawd, thaum muaj pov thawj ntawm tus kab mob, active anti-inflammatory kev kho mob yuav tsum tau muab. Sim zam kom tsis txhob siv cov tshuaj uas tsim kev puas tsuaj rau lub raum, xws li cov tshuaj tua kab mob aminoglycoside (streptomycin, gentamicin, thiab lwm yam), tshuaj tua kab mob thiab tshuaj tua kab mob, thiab txo qis kev siv ntau yam sib txawv, xws li cov tshuaj tua kab mob hauv lub cev. Cov neeg mob yuav tsum tau rov qab dej kom sai li sai tau thaum lawv lub cev qhuav dej vim ntau yam

Cistanche kho mob raum li cas?

Cistanche yog ib hom tshuaj suav tshuaj uas feem ntau siv hauv Suav tshuaj los kho mob raum. Cov kev tshawb fawb tshawb fawb tau pom tias cistanche muaj ntau yam tshuaj uas ua rau nws muaj txiaj ntsig zoo hauv kev kho mob raum.

Ua ntej, cistanche muaj cov teebmeem immunomodulatory uas tuaj yeem pab ntxiv dag zog rau lub cev tiv thaiv kab mob, uas yog qhov tseem ceeb hauv kev kho mob raum vim nws feem ntau cuam tshuam cov lus teb.

Thib ob, cistanche muaj ib pab pawg ntawm cov khoom xyaw ntuj hu ua phenylethanoid glycosides (PEGs) uas muaj cov tshuaj tiv thaiv antioxidant thiab tiv thaiv kab mob. Cov khoom no pab tiv thaiv ob lub raum tiv thaiv oxidative kev nyuaj siab thiab o, uas yog ob qho tseem ceeb ua rau lub raum puas.

Thaum kawg, cistanche tau pom tias yuav ua rau kom cov cytokines thiab chemokines txhawb kev loj hlob ntawm tes thiab rov tsim dua tshiab hauv ob lub raum, uas tuaj yeem pab txhim kho lub raum ua haujlwm.

Zuag qhia tag nrho, cistanche tuaj yeem ua tau zoo rau kev kho mob raum los ntawm kev txo qhov mob, tiv thaiv oxidative kev nyuaj siab, thiab txhawb kev loj hlob ntawm tes thiab rov tsim dua tshiab hauv lub raum.

Cov ntaub ntawv:

[1] Mob Ntshav Qab Zib ntawm Tuam Tshoj Medical Association, Cov Lus Qhia rau Kev Tiv Thaiv thiab Kev Kho Mob Ntshav Qab Zib Hom 2 hauv Suav Teb (2020 Edition) [J]. Suav Journal of Diabetes, 2021, 13 (4): 315-409.

[2] 2021 "Cov Lus Qhia rau Kev Tiv Thaiv thiab Kev Kho Mob Ntshav Qab Zib Nephropathy hauv Suav Teb", Suav Journal of Diabetes, 2021,13(8): 762-784.

[3] American Diabetes Association. Standards of Medical Care in Diabetes2022［J］ Diabetes Care, 2022, 45 (Suppl 1): S1-S264