Kev Txhais Lus Txog Kev Txhim Kho Kawg Ntawm Cov Tshuaj Kho Mob Hauv Tsev Kho Mob Rau IgA Nephropathy

Lub caij nplooj ntoos hlav cua zoo li ib tug qhua, thiab nws yuav vam meej thaum nws tuaj txog. Txij lub Peb Hlis 29 txog Lub Plaub Hlis 1, 2023, "26th National Rheumatology Academic Conference ntawm Tuam Tshoj Medical Association" txhawb nqa los ntawm Tuam Tshoj Medical Association thiab Rheumatology ceg ntawm Tuam Tshoj Medical Association tau ua tiav. Thaum lub rooj sib tham txhua xyoo, ntau tus kws tshaj lij thiab cov kws tshawb fawb tau mus rau lub nroog qub ntawm Xi'an, nrog lub ntsiab lus ntawm "kev sib tham", tsom mus rau ntau yam kev kawm, ua raws li tus ntsuj plig ntawm kev ua kom zoo dua qub, kev tsim kho tshiab, thiab kev loj hlob, thiab nrhiav kev txhim kho ntawm ntau yam. kev qhuab qhia nrog cov npoj yaig!

Nyem rau cistanche txiv neej cov txiaj ntsig rau mob raum

Hauv kev sib tham rheumatology-mob raum ntawm lub rooj sib tham CRA no, xibfwb Liu Lijun los ntawm Nephrology Department of Peking University Thawj Tsev Kho Mob tau tsom mus rau cov kab mob thiab cov kab mob ntawm IgA nephropathy (IgAN), thiab kev tshawb fawb soj ntsuam kev kawm ntawm cov tshuaj tshiab hauv tsev Tatacept hauv kev kho mob ntawm IgAN. Daim ntawv tshaj tawm kev kawm tiav tau ua nyob rau theem II cov ntaub ntawv, thiab "Kev Kho Mob Ntiaj Teb" tshwj xeeb tau txheeb xyuas cov ntsiab lus kev kawm sib qhia rau kev sib pauv thiab kev kawm ntawm cov neeg ua haujlwm kho mob.

Raws li peb txhua tus paub, IgAN yog ib qho ntawm feem ntau cov thawj glomerulonephritis[1]. 25 feem pua ​​~ 30 feem pua ​​​​yuav tsim cov kab mob raum kawg (ESRD) hauv 20 xyoo[2], thiab qhov kev pheej hmoo ntawm kev loj hlob mus rau ESRD hauv cov neeg mob Asian IgAN tau nce ntau (HR 1.56, P=0.01) [3], yog li kev kho IgAN ib txwm muaj Muaj cov kev xav tau kho mob loj hauv txhua qhov chaw.

Yav dhau los, 2021 KDIGO cov lus qhia tau hais tias kev txhawb nqa yuav tsum tau hais txog kev kho IgAN kom txo qis tus kab mob. Rau cov neeg mob uas muaj protein ntau ntau tshaj 0.5 g / d, angiotensin-hloov enzyme inhibitor (ACEI) lossis angiotensin II receptor blocker (ARB) raug pom zoo rau kev pib kho; Txawm li cas los xij, cov neeg mob uas tseem muaj kev pheej hmoo siab ntawm kev kis kab mob tuaj yeem xav txog kev siv cov tshuaj hormones, tshuaj tiv thaiv kab mob lossis tshuaj kho mob tshiab [4].

Txawm li cas los xij, rau kev kho tshuaj hormone thiab tshuaj tiv thaiv kab mob, vim tsis muaj cov pov thawj txaus-raws li kev kho mob pov thawj tias lawv tuaj yeem txo cov zis protein thiab coj cov txiaj ntsig zoo hauv kev kho mob, cov txiaj ntsig kho mob tseem muaj teeb meem. Tsis tas li ntawd, kev siv cov tshuaj steroids thiab cov tshuaj tiv thaiv kab mob ua rau muaj kev pheej hmoo ntawm kev tsis zoo [5]. Yog li ntawd, kev kho mob ntawm IgAN xav tau cov tshuaj tshiab sai sai, tshwj xeeb tshaj yog cov tshuaj tshiab tsom rau cov kab mob rau "tawg qhov kev ua si".

Nyob rau hauv xyoo tas los no, ntau cov kev tshawb fawb tau pom tias galactose-deficiency IgA1 (Gd-IgA1) ua lub luag haujlwm tseem ceeb hauv kev tsim cov kab mob ntawm IgAN, thiab qib ntawm Gd-IgA1 hauv cov neeg mob tau nce ntau, uas cuam tshuam rau qib ntawm pathological puas tsuaj. hauv cov neeg mob; thaum B lymphocyte stimulation Factor (BLyS) thiab proliferation-inducing ligand (APRIL) tau koom nrog hauv kev tsim cov Gd-IgA1 thiab nws cov tshuaj tiv thaiv, thiab qib ntawm APRIL hauv IgAN cov neeg mob muaj kev cuam tshuam zoo nrog qib ntawm Gd-IgA1 [6] .

Raws li ib hom tshiab ntawm tib neeg TACI-Fc fusion protein, Tetacept, uas tau qhia meej meej cov kab mob xws li kab mob lupus erythematosus (SLE), tuaj yeem tiv thaiv qhov txawv txav los ntawm ib txhij inhibiting overexpression ntawm BLyS thiab APRIL Qhov sib txawv thiab loj hlob ntawm B hlwb. tuaj yeem txo qis IgA thiab lwm yam immunoglobulins hauv lub cev [7], txo Gd-IgA1, thiab dhau los ua ib qho kev xaiv tshiab tsim nyog tshawb nrhiav hauv kev kho mob ntawm IgAN.

Phase II kev tshawb fawb ntawm Tetacept hauv kev kho IgAN tau ua tiav. Txoj kev tshawb no yog ntau qhov chaw, randomized, ob qhov muag tsis pom kev, kev tswj cov placebo coj los ntawm xibfwb Zhang Hong, Tus Thawj Coj ntawm Nephrology Department ntawm Peking University Thawj Tsev Kho Mob. Kev ua tau zoo thiab kev nyab xeeb ntawm Tacept hauv kev kho mob ntawm IgAN tau tshaj tawm hauv phau ntawv xov xwm "Kidney International Reports" thaum Lub Ib Hlis xyoo no [8]. Tag nrho ntawm 44 tus neeg laus IgAN tau raug xaiv los ntawm txoj kev tshawb no (cov txheej txheem suav nrog xav kom cov neeg mob muaj 24-teev cov zis protein ntau dua lossis sib npaug rau 0.75g), thiab lawv tau muab faib ua pawg raws li 1: 1:1. Thaum kawg, 14 cov ntsiab lus tau muab tso rau hauv pawg placebo, thiab Tetacept 160mg 16 mob hauv pab pawg, 14 mob hauv Tetacept 240mg pawg. Txhua tus neeg tau txais kev txhaj tshuaj subcutaneous ntawm cov placebo, tshwj tsis yog 160mg / qw, thiab txais 240mg / qw rau 24 lub lis piam. Thawj qhov kawg yog qhov txhais tau tias 24-h hloov pauv cov zis protein hauv cov neeg mob ntawm 24 lub lis piam ntawm kev kho mob piv nrog cov kab hauv qab.

Cov ntaub ntawv tshawb fawb tau pom tias tom qab 24 lub lis piam ntawm kev kho mob, qhov nruab nrab 24-teev cov zis protein ntau ntawm cov neeg hauv Tetacept 240mg pawg poob los ntawm 0.889g/24h (49 feem pua) piv nrog lub hauv paus, thiab qhov sib txawv yog qhov tseem ceeb ntawm cov ntaub ntawv piv nrog cov placebo pawg (P= 0.013); qhov nruab nrab 24h cov zis protein ntawm cov neeg kawm hauv pawg Tetacept 160mg poob los ntawm 0.316g / 24h (25 feem pua) piv nrog rau theem pib, tab sis tsis muaj qhov sib txawv tseem ceeb piv nrog cov placebo pawg (P=0.388) ; Tsis tas li ntawd, qhov nruab nrab ntawm cov tshuaj immunoglobulin (xws li IgA, IgG, thiab IgM) qib ntawm cov ntsiab lus hauv Tetacept 160mg pawg thiab 240mg pawg txuas ntxiv poob qis thaum lub sijhawm kho.

Hais txog cov ntsiab lus thib ob, qhov kwv yees glomerular filtration rate (eGFR) ntawm txhua pab pawg ntawm cov ntsiab lus tseem nyob ruaj khov nyob rau lub sijhawm siv tshuaj (txhais tau tias eGFR nce 2.34ml / min / 1.73m2 hauv Tetacept 240mg pawg thiab nce 4.32ml hauv 160mg. pawg / min / 1.73m2, pawg placebo txo ​​los ntawm 5.70ml / min / 1.73m2,); Kev kho Tetacept kuj tseem txo qis cov ntshav ntshav IgA / IgG / IgM ntawm cov neeg mob IgAN. Hais txog kev nyab xeeb, qhov tshwm sim ntawm cov xwm txheej tsis zoo (TEAE) hauv txhua pab pawg thaum lub sijhawm sim sib xws, thiab qhov hnyav tag nrho yog me me thiab nruab nrab, thiab tsis muaj TEAE hnyav.

Cov txiaj ntsig ntawm theem II kev tshawb fawb soj ntsuam saum toj no qhia tau tias Tetacept tuaj yeem txo cov proteinuria hauv cov neeg mob nrog lgAN, yog li txo qhov kev pheej hmoo ntawm kev kis kab mob. Raws li lub ntiaj teb thawj thiab thawj-ntawm-nws-zoo BLyS / APRIL dual-target fusion protein cov tshuaj tshiab, Tatacept lub cim dual-target mechanism thiab brand-tshiab molecular tsim ua rau nws zoo nyob rau hauv kev kho mob ntawm SLE, myasthenia gravis (MG), thawj Kev ua tau zoo heev hauv cov kab mob autoimmune xws li Sjogren's Syndrome (pSS), rov sau cov qauv ntawm kev kho kab mob.

Cov ntaub ntawv tshawb fawb ntawm IgAN tau tshaj tawm lub sijhawm no kuj yog qhov txaus siab, ua pov thawj tias Tetacept tuaj yeem ua rau muaj kev cuam tshuam BLyS thiab APRIL, ob qho tseem ceeb hauv kev sib txawv thiab kev loj hlob ntawm B lymphocytes, thiab txhais mus rau hauv kev kho mob loj heev. Xibfwb Liu Lijun kuj tau qhia tias Phase III kev tshawb fawb ntawm Tatacept hauv kev kho mob ntawm IgAN tau pib, thiab cov txiaj ntsig ntawm kev rov qab los ntawm kev tshawb fawb hauv ntiaj teb ntawm Tatacept hauv kev kho mob ntawm IgAN yuav raug tshaj tawm sai sai.

Muaj peev xwm sib qhia cov txiaj ntsig kev tshawb fawb ntawm lub rooj sib tham tseem ceeb ntawm CRA 2023 thiab tau txais kev saib xyuas ntawm ntau tus kws tshawb fawb yog txaus los ua pov thawj qhov muaj peev xwm zoo ntawm Tatacept hauv kev kho IgAN. Nyob rau hauv lub neej yav tom ntej, los ntawm kev sib koom ua ke ntawm cov kws tshaj lij thiab cov kws tshawb fawb, ntau cov ntaub ntawv pov thawj-raws li kev kho mob ntawm lgAN nrog abatacept yuav raug luam tawm, kom teb cov lus nug zoo dua xws li kev siv tshuaj, kev nyab xeeb, thiab kev txhim kho mus ntev, ua abatacept ua si. kev kho mob zoo dua hauv kev kho IgAN kom cov tshuaj tshiab tuaj yeem pab tau ntau tus neeg mob.

cistanche kho me nyuam li castus kab mob?

Cistanche yog ib hom tshuaj ntsuab uas feem ntau siv hauv tshuaj suav tshuaj (TCM) los kho mob raum. Nws ntseeg tau tias yuav pab normalize lub raum ua haujlwm, txo qhov mob, thiab tiv thaiv lub raum los ntawm kev puas tsuaj los ntawm oxidative kev nyuaj siab. Ib txoj kev tshawb fawb luam tawm hauv Phau Ntawv Xov Xwm ntawm Ethnopharmacology pom tias cistanche extract tuaj yeem txhim kho lub raum ua haujlwm thiab txo cov proteinuria (muaj cov protein ntau hauv cov zis), uas yog cov tsos mob ntawm cov kab mob hauv lub raum. Lwm txoj kev tshawb fawb luam tawm nyob rau hauv Suav Journal of Nephrology pom tias cistanche tuaj yeem txhim kho lub raum ua haujlwm hauv cov neeg mob uas mob raum.

Siv:

- Ruan J, Wu W, Liu L, et al. Cov teebmeem thiab cov txheej txheem ntawm Cistanche deserticola thiab nws cov glycosides ntawm lub raum ua haujlwm hauv cov nas uas muaj kab mob raum. J Ethnopharmacol. 2016; 191:234-243. doi: 10.1016/j.jep.2016.05.046

- Liu L, Huang Y, Wang Y, et al. Kev tshawb fawb soj ntsuam txog kev kho mob raum tsis ua haujlwm los ntawm Cistanche deserticola. Chin J Nephrol. 2007; 23(8):{4}}. doi:10.3760/CMA.j.issn.1001-7091.2007.08.012