Cov cuab yeej txiav txim siab kho mob tshiab tuaj yeem pab cov kws kho mob tswj tsis tau cov ntshav siab hauv cov neeg mob CKD
Apr 26, 2024
Nws yog qhov paub zoo tias ntshav siab tuaj yeem txo cov raum ua haujlwm thiab txawm tias hloov lub microstructure ntawm lub raum, ua rau tsis muaj kev puas tsuaj rau lub glomerulus. Rau cov neeg mob uas muaj kab mob raum ntev (CKD), ntshav siab yog qhov teeb meem ntau dua thiab muaj feem cuam tshuam nrog ntau yam tshwm sim tsis zoo, xws li lub raum tsis ua haujlwm, mob plawv, thiab tuag.
Nyem rau Cistanche rau mob raum
Tam sim no, ib txoj kev tshawb nrhiav pom tias qhov ntau ntawm cov kab mob ntshav dawb hauv cov neeg mob CKD yog 10.21% txog 16.60%, thiab qhov tshwm sim ntawm H-hom ntshav siab yog 44.14%. Suav cov lus qhia pom zoo rau cov neeg mob CKD uas tso zis albumin tawm<30 mg/24 h, the recommended blood pressure control target is <140/90 mmHg. For CKD patients with urinary albumin excretion ≥30 mg/24 h, the recommended blood pressure control target is <130/80 mmHg1. In short, Chinese guidelines attach great importance to hypertension in CKD patients and recommend different blood pressure targets for different groups of people. However, existing data show that a large number of Chinese CKD patients have high blood pressure. So, how can we better control high blood pressure in CKD patients?
Thaum Lub Peb Hlis 11, 2024, JAMA Network tau tshaj tawm txoj kev tshawb fawb tshiab, uas qhia tau hais tias qhov kev txiav txim siab tshiab hauv chaw kho mob tuaj yeem pab cov kws kho mob tswj kev kub siab hauv cov neeg mob CKD, thaum tseem txo cov kws kho mob cov kev ntxhov siab ua haujlwm.
Kev tshawb fawb tsim
This is a multicenter, randomized clinical study involving hospitals, outpatient clinics, and health service centers, including all adult patients with CKD and hypertension from 2021 to 2022. Specifically, the CKD patients in this study were in CKD stages 3 to 4. The last two estimated glomerular filtration rate (eGFR) levels were between 16 and 59ml/min/1.73㎡, and the urine in the past two years was Albumin to creatinine ratio (UACR) exceeds 30 mg/g (interval >90 days). Hypertension is uncontrolled high blood pressure, with systolic blood pressure (SBP) >140 mmHg hauv ob qhov ntsuas ntshav siab.
Txoj kev tshawb no tau muab faib ua ob pawg kev cuam tshuam. Cov kws kho mob hauv pab pawg cuam tshuam tau siv lub khoos phis tawj kev txiav txim siab kho mob (CDS) system. CDS system yog ib qho kev txiav txim siab txhawb nqa raws li cov qauv kev lag luam thiab kev tsim qauv tib neeg. Nws tuaj yeem nkag siab tias yog cov ntaub ntawv kho mob tau zoo dua qub (EHR). Thaum lub khoos phis tawj pom tias tus neeg mob eGFR, UACR, thiab ntshav siab nyob rau hauv qhov sib thooj, nws yuav ua rau tus kws kho mob sau cov kev kuaj mob sib xws. nrog tshuaj. Pawg tswj hwm yog ib txwm muaj EHR, thiab lub khoos phis tawj tsis tau hais kom tus kws kho mob sau cov tshuaj ntsuam xyuas thiab tshuaj.
Nco tseg: Thaum tus kws kho mob nkag mus lossis lub kaw lus cia li tau txais cov neeg mob cov txiaj ntsig kev xeem thiab cov ntawv sau los ntawm lub tsev kho mob EHR, tus kws kho mob yuav raug ceeb toom kom sau cov tshuaj sib xws, nrog rau cov ntshav siab tshiab, eGFR, thiab cov txiaj ntsig ntawm cov tshuaj poov tshuaj.
Lub ntsiab lus kawg ntawm txoj kev tshawb no yog qhov kev hloov pauv ntawm SBP los ntawm qhov pib mus rau 180 hnub. Qhov thib ob qhov kawg yog qhov feem pua ntawm cov neeg mob uas nws cov ntshav siab tswj tau (txhais tau tias yog ntshav siab<140/90mmHg) on day 180. At the same time, the researchers also compared the similarities and differences in drug prescriptions issued by the two groups of doctors, such as the type of medication, the order of medication, the starting dose, and the maintenance dose.
Kev tshawb fawb tshwm sim
Tag nrho ntawm 174 tus kws kho mob koom nrog hauv txoj kev tshawb no, thiab 2,{11}}26 tus neeg mob CKD thiab ntshav siab tau suav nrog, suav nrog 1,{22}}29 hauv pab pawg cuam tshuam thiab 997 hauv pawg tswj hwm. Qhov nruab nrab hnub nyoog ntawm tag nrho cov neeg mob yog 75.3 xyoo, thiab 39.6% yog txiv neej. Baseline SBP (SD) yog 154.0 (14.3) mmHg. Tsis tas li ntawd, tsis muaj qhov sib txawv tseem ceeb hauv lub hauv paus SBP ntawm ob pawg (154.3 vs 153.7 mmHg). Kev faib ua feem ntawm hom 2 mob ntshav qab zib mellitus, hyperlipidemia, thiab cov neeg tau txais kev hloov hauv lub raum yog 66.1%, 84.0% thiab 0.7% feem. Ntawm qhov ceeb thawj, 84.6% ntawm cov neeg mob tau txais kev kho mob antihypertensive.
1 Thawj qhov kawg
Nws yog ib qho tsim nyog sau cia tias qhov kev hloov pauv hauv SBP ntawm cov neeg mob hauv pab pawg cuam tshuam tau nce siab dua li hauv pawg tswj hwm. Tshwj xeeb, SBP hauv pab pawg cuam tshuam tau txo qis los ntawm 14.6 (95% CI, 13.1 ~ 16.0) mmHg, piv nrog 11.7 (95% CI, 10.2 ~ 13.1) hauv pawg tswj hwm. ) mmHg (P=0.005).
2 cov ntsiab lus thib ob
Nyob rau hnub 180, qhov nruab nrab ntawm SBP (SD) ntawm pab pawg cuam tshuam thiab pawg tswj hwm yog 139.5 (19.7) thiab 142.1 (19.9) raws li, thiab pab pawg kev cuam tshuam tau qis dua pawg tswj hwm (P=0). 09). Txawm li cas los xij, nyob rau hauv cov nqe lus ntawm cov ntshav siab lub hom phiaj ua raws, txawm hais tias pab pawg neeg cuam tshuam muaj lub hom phiaj ua tau zoo dua, tsis muaj qhov sib txawv tseem ceeb (50.4% vs 47.1%; P=0.23).
Nyob rau hauv cov nqe lus ntawm cov tshuaj, qhov feem pua ntawm cov neeg mob nyob rau hauv lub intervention pab pawg neeg uas tau txais angiotensin-hloov enzyme inhibitors (ACEi), angiotensin-hloov enzyme inhibitors (ARB) los yog thiazide diuretics yog ho siab dua li nyob rau hauv pawg tswj (24.8% vs 1{ {5}}.0%;<0.001).
kev sib tham tshawb fawb
Hauv ntau lub tsev kho mob no, kws kho mob koom nrog, kev sim tshuaj ntsuam xyuas randomized, CDS system tuaj yeem pab cov kws kho mob kom tswj tau cov ntshav siab hauv cov neeg mob CKD, xws li txo cov neeg mob SBP. Txawm li cas los xij, txoj kev tshawb fawb kuj pom tias CDS tsis muaj kev cuam tshuam loj rau kev tswj ntshav siab.
Ib xyoo 2020 Meta-kev tshuaj ntsuam pom tau tias rau cov kab mob sib txawv, CDS tuaj yeem pab cov kws kho mob hauv lawv txoj haujlwm tiag tiag, xws li ua tiav cov ntaub ntawv kho mob, tshuaj xyuas daim ntawv kho mob, thiab pab muab cov ntawv sau tshuaj. Txawm li cas los xij, tsis muaj kev txhim kho tseem ceeb hauv cov txiaj ntsig kho mob. Txawm li cas los xij, txoj kev tshawb no pom tias CDS muaj feem cuam tshuam rau cov ntshav siab hauv cov neeg mob CKD.
Tsis tas li ntawd, CDS tuaj yeem pab cov kws kho mob tswj xyuas kev siv tshuaj zoo dua. Txoj kev tshawb no pom tias ntawm cov kws kho mob lossis cov kws kho mob me, sodium-glucose cotransporter 2 inhibitors (SGLT-2i), uas tau pom zoo tshiab hauv cov lus qhia, tsis tshua muaj tshuaj rau cov neeg mob CKD. Txawm li cas los xij, CDS tuaj yeem hais kom cov kws kho mob sau cov tshuaj saum toj no thiab kho cov koob tshuaj ACEi lossis ARB kom ncav cuag lawv cov koob tshuaj ntau tshaj plaws kom ua tau zoo.
Hauv luv luv, CDS tuaj yeem ceeb toom rau cov kws kho mob txog qhov txawv txav ntawm tus neeg mob cov cim qhia, xws li eGFR, UACR, cov tshuaj poov tshuaj, thiab lwm yam. Nws kuj tseem tuaj yeem pab cov kws kho mob hauv kev sau tshuaj thiab optimizing ntau npaum li cas, hom, thiab lwm yam raws li cov lus qhia tseeb thiab kev pom zoo.
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 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.