Kev nce qib tshiab hauv kev kuaj mob thiab kev kho mob ntshav qab zib nephropathy

Mob ntshav qab zib nephropathy, ib qho kev kho mob uas tshwm sim los ntawm cov proteinuria tsis tu ncua thiab kev poob qis hauv lub raum ua haujlwm, yog qhov ua rau mob raum raum kawg thoob ntiaj teb. Multifactorial kev cuam tshuam xws li renin-angiotensin-aldosterone system inhibitors, tswj ntshav siab thiab ntshav qab zib, kev tawm dag zog tsim nyog, thiab kev haus luam yeeb tuaj yeem txhim kho qhov kev mob tshwm sim ntawm cov neeg mob ntshav qab zib nephropathy. Tam sim no, ntau cov tshuaj tshiab rau kev tiv thaiv thiab kev kho mob ntshav qab zib nephropathy tau siv rau hauv kev kho mob, uas tuaj yeem tiv thaiv lub raum ua haujlwm zoo dua thiab txhim kho cov kev mob tshwm sim ntawm cov neeg mob, tab sis tseem xav tau kev tshawb fawb ntxiv los ntsuas cov txiaj ntsig kev kho mob ntev ntawm cov no. tshuaj tshiab. Tsab ntawv no tsom mus rau kev kuaj mob rau ntshav qab zib nephropathy thiab cov kev pabcuam kho mob tam sim no.

Nyem rau cov txiaj ntsig ntawm cistanche rau mob raum

Mob ntshav qab zib nephropathy (DN) yog ib qho teeb meem loj thiab mob hnyav ntawm ntshav qab zib mellitus (DM) thiab ua rau muaj kab mob raum kawg (ESRD), uas tuaj yeem ua rau cov neeg mob DN tuag ntau ntxiv. Hauv cov tebchaws tsim, DN tshwm sim los ntawm hom 2 mob ntshav qab zib mellitus (T2DM) yog qhov ua rau ESRD. Hauv cov teb chaws tsim, qhov xwm txheej ntawm DN tau nce zuj zus txhua xyoo, thiab nws tau dhau los ua ib qho tseem ceeb ntawm ESRD.

Txawm hais tias tam sim no txoj kev kho mob rau DN tuaj yeem txo qhov mob ntawm cov neeg mob mus rau qee qhov, lawv tseem tsis tuaj yeem tiv thaiv qhov kev loj hlob ntawm DN mus rau ESRD. Yog li ntawd, kev kuaj mob raws sij hawm thiab kev kho tus qauv yog qhov tseem ceeb heev.

1 kev kuaj mob

1.1 Diagnosis of DN

DN yog ib qho ntawm cov kab mob microvascular tseem ceeb tshaj plaws hauv cov neeg mob DM. Kev lig kev cai, DN yog ib qho kev kho mob uas tshwm sim los ntawm kev pheej hmoo ntawm cov proteinuria thiab kev poob qis hauv lub raum ua haujlwm, nrog rau kev hloov pauv ntawm glomerular pathological. Tab sis maj mam pom tias qhov kev kho mob tshwm sim thiab chav kawm ntawm DN muaj ntau haiv neeg. Lub sij hawm mob ntshav qab zib mellitus (DKD) yog tam sim no feem ntau siv los piav qhia cov neeg mob ntshav qab zib nrog cov proteinuria lossis txo lub raum ua haujlwm.

Hauv xyoo 2007, Cov Kev Pab Cuam Rau Cov Kab Mob Raum Ua Tau Zoo (KDOQI) cov txheej txheem tsim los ntawm Lub Raum Foundation (NKF) tau qhia tias yuav siv DKD es tsis yog DN. Xyoo 2014, American Diabetes Association (ADA) thiab NKF tau txais kev pom zoo tias DKD hais txog kab mob raum mob los ntawm DM. DKD feem ntau yog kev kuaj mob raws li cov proteinuria thiab txo qis glomerular filtration rate (eGFR), thiab nws tuaj yeem hais tias qhov kev kuaj mob ntawm DKD feem ntau yog hais txog cov proteinuria tsis tu ncua lossis txo eGFR hauv cov ntsiab lus ntawm DM, deviating los ntawm lub raum pathological connotation.

DN tsis tshua muaj nyob rau hauv 10 xyoo tom qab kuaj T1DM, thiab 95 feem pua ​​​​ntawm cov neeg mob T1DM nrog DN kuj nyuaj rau ntshav qab zib retinopathy. 10 xyoo tom qab kuaj pom, proteinuria thiab ntshav qab zib retinopathy tuaj yeem kuaj tau tias yog DN, tab sis nws tshwm sim tom qab 25 txog 30 xyoo tom qab kuaj pom. Qhov ua tau ntawm DN yog qhov tsawg [1].

Cov keeb kwm ntawm T2DM tsis muaj txiaj ntsig rau kev kuaj mob DN. Cov neeg mob feem ntau tsis tuaj yeem txhais lub sijhawm pib ntawm DN kom raug, thiab tsuas yog 60 feem pua ​​-65 feem pua ​​​​ntawm cov neeg mob tau kuaj pom muaj ntshav qab zib retinopathy tib lub sijhawm[1]. Lub ntsiab pathological hloov ntawm DN yog glomerular lesions, nrog rau glomerular qab daus daim nyias nyias nyias, mesangial widening, nodular sclerosis (KW nodules), thiab advanced mob ntshav qab zib glomerulosclerosis.

Tsis tas li ntawd, interstitial fibrosis thiab tubular atrophy (IFTA), interstitial fibrosis, arteriolar hyalinosis, thiab arteriosclerosis feem ntau tshwm sim.

1.2 Kev kuaj mob ntawm ib txwm muaj proteinuric

DN (nonproteinuric DN, NP-DN) Hauv classic DN, proteinuria thawj zaug tshwm, tom qab ntawd los ntawm kev poob qis hauv lub raum ua haujlwm. Txawm li cas los xij, ib feem ntawm cov neeg mob DN nthuav tawm nrog lub raum tsis ua haujlwm thiab cov teeb meem vascular tsis muaj proteinuria, hu ua NPDN [2]. Xyoo 1994, Tsalamandris et al tau tshaj tawm thawj zaug tias cov neeg mob DM tsis muaj proteinuria, tab sis lub raum ua haujlwm tsis zoo.

Cov kev tshawb fawb tsis ntev los no tau pom tias qhov tshwm sim ntawm proteinuria hauv DM thiab qhov poob ntawm eGFR muaj qhov sib txawv, uas yog hais tias, qhov tshwm sim ntawm microalbuminuria tau txo qis, tab sis qhov tshwm sim ntawm eGFR poob tau nce [3]. Qhov no qhia tau hais tias qhov pib thiab kev loj hlob ntawm lub raum poob yuav tsis muaj kev ywj pheej ntawm kev tsim cov proteinuria. Hauv 2019, cov lus sib koom ntawm Italian Society of Diabetes thiab Italian Society of Nephrology tau taw qhia tias ntxiv rau cov classic proteinuric phenotype, DN kuj muaj ob hom proteinuric-yeej ywj pheej phenotypes, uas yog "tsis-proteinuric raum puas" thiab "kev loj hlob. lub raum puas". Kev poob qis", qhia tias kev nce qib ntawm DN mus rau ESRD tuaj yeem tshwm sim los ntawm ob txoj hauv kev sib txawv, xws li proteinuria thiab tsis yog proteinuria [4].

2 kev kho mob

2.1 Kev cuam tshuam kev ua neej

Kev cuam tshuam hauv kev ua neej yog ib lub tswv yim tseem ceeb los txhim kho qhov kev tshwm sim ntawm DN, suav nrog kev poob phaus, qhov tsim nyog nce hauv kev ua si lub cev, noj zaub mov tsis muaj ntsev thiab rog tsawg, thiab haus luam yeeb. Cov neeg mob raug txhawb kom koom nrog hauv kev tswj tus kheej. KDIGO cov lus qhia pom zoo tias kev noj zaub mov yuav tsum muaj zaub, txiv hmab txiv ntoo, cov nplej, fiber ntau, legumes, cov zaub mov muaj protein ntau, cov roj tsis muaj roj, thiab cov txiv ntoo, nrog rau cov nqaij ua tiav tsawg, cov carbohydrates ua kom zoo, thiab cov dej qab zib; tsawg kawg yog 150 feeb hauv ib lub lis piam ua haujlwm nruab nrab siv lub cev, lossis mus txog qib uas sib haum nrog nws tus kheej lub plawv thiab lub cev kam rau ua [5].

2.2 Tswj cov ntshav qab zib

Qhov tsim nyog hypoglycemia tuaj yeem tsis tsuas yog tswj cov ntshav qab zib kom zoo tab sis kuj tseem ncua sijhawm tshwm sim thiab kev loj hlob ntawm cov proteinuria rau qee yam thiab tiv thaiv lub raum ua haujlwm. DCCT, UKPDS, ADVANCE, thiab lwm yam kev tshawb fawb tau pom tias kev mob ntshav qab zib tsis txaus tuaj yeem txo cov zis protein, ncua eGFR poob qis, thiab txo qis kev pheej hmoo ntawm cov teeb meem microvascular suav nrog DN.

Hauv qhov sib piv, ACCORD txoj kev tshawb fawb tau raug txiav tawm vim tias nws qhia tias muaj kev pheej hmoo siab ntawm kev tuag ntau dua hauv cov pab pawg hypoglycemic hnyav. Lub hypoglycemia yuav tsum tau txo qis kom tsim nyog raws li tus neeg mob tus mob kom tsis txhob muaj qhov tshwm sim ntawm hypoglycemia. 2019 ADA pom zoo tias glycated hemoglobin (HbA1c) ntawm cov neeg laus tsis cev xeeb tub yuav tsum yog<7%, and it can be used appropriately for patients with T2DM who have a short course of DM, only receive lifestyle intervention or metformin treatment, have a long life expectancy, or have no obvious cardiovascular disease A more stringent HbA1c target, such as 6.5%.

2020 KDIGO cov lus qhia pom zoo tias HbA1c tus kheej lub hom phiaj rau cov neeg mob tsis lim ntshav DM nrog CKD yog 6.5 feem pua ​​-8 feem pua ​​[5]. Rau DN nrog creatinine siab, thaum siv cov tshuaj hypoglycemic ntawm qhov ncauj, yuav tsum tau them nyiaj rau kev kho hom thiab koob tshuaj raws li eGFR. Lub sijhawm lig ntawm DM feem ntau nrog kev puas tsuaj rau lwm yam kabmob. Kev saib xyuas yuav tsum tau ua thaum xaiv cov tshuaj hypoglycemic kom tsis txhob cuam tshuam rau lwm yam hauv nruab nrog cev. Thiazolidinediones yog contraindicated nyob rau hauv cov neeg mob uas muaj los yog muaj kev pheej hmoo ntawm lub plawv tsis ua hauj lwm. Tam sim no cov tshuaj hypoglycemic zoo dua qub suav nrog sodium-glucose transporter 2 inhibitors (SGLT2i), glucagon-zoo li peptide-1 (glucagon-zoo li peptide-1, GLP-1) receptor agonists, dipeptidyl peptide Enzyme -4 (dipeptidyl peptidase-4, DPP{17}}) inhibitors, thiab lwm yam.

2.2.1 TSI SGLT2i

SGLT2i yog ib yam tshuaj tshiab ntawm qhov ncauj hypoglycemic uas inhibits SGLT2 nyob rau hauv lub raum raum tubule, thaiv cov reabsorption ntawm sodium ions thiab qabzib los ntawm cov tubule proximal, ua rau kom cov kua nplaum tso zis, thiab txo cov ntshav qab zib. Glucose reabsorption los ntawm cov tubules proximal yog linearly ntsig txog cov ntshav qabzib thiab cov piam thaj lim los ntawm lub raum, yog li SGLT2i tsis ua rau cov ntshav qabzib ntau, tab sis cov neeg mob uas tsis tshua muaj eGFR tuaj yeem ua rau muaj kev cuam tshuam tsis txaus. Lub raum kev tiv thaiv mechanism ntawm SGLT2i tsis nyob ntawm seb cov ntshav qab zib tswj, thiab yog ywj siab ntawm cov txiaj ntsig plawv; SGLT2i constricts afferent arterioles los ntawm tubule tawm tswv yim, txo glomerular sab hauv siab, thiab relieves hyperfiltration; Nyob rau tib lub sijhawm, nws tseem tuaj yeem txo cov vascular tsis kam, Kev poob phaus thiab biomarkers ntawm kev raug mob ntawm tubular raug txo qis, yog li txo cov proteinuria thiab ncua kev loj hlob ntawm cov kab mob raum.

EMPA-REG (empagliflozin) thiab DAPA-CKD (dapagliflozin) cov kev tshawb fawb qhia tias SGLT2i tuaj yeem ncua kev mob raum, txhim kho lub raum, thiab muaj txiaj ntsig zoo hauv ob qho tib si DM thiab cov neeg tsis yog DM. Txoj kev tshawb no DECLARE-TIMI 58 tau ua pov thawj tias dapagliflozin ncua kev loj hlob ntawm lub raum kab mob hauv cov neeg mob T2DM, tsis hais seb nws puas muaj teeb meem nrog cov kab mob plawv atherosclerotic [6]; thiab txo qis cov zis albumin-to-creatinine ratio (UACR) thiab ESRD txaus ntshai [7]. Txoj kev tshawb fawb CREDENCE kuj tau qhia tias pawg canagliflozin muaj 30 feem pua ​​​​txo qis ntawm ESRD cov xwm txheej sib xyaw, ob npaug ntawm creatinine, thiab tuag los ntawm lub raum lossis cov hlab plawv ua rau piv nrog cov placebo pawg [8].

2.2.2 GLP-1 receptor agonists

GLP-1 receptor agonists (xws li exenatide, liraglutide, thiab lixisenatide) siv lawv cov teebmeem los ntawm kev txhawb nqa GLP-1 receptor. GLP-1 yog cov tshuaj endocrine uas tso tawm los ntawm L hlwb hauv cov hnyuv, uas txhawb kev tso tawm ntawm insulin los ntawm pancreatic islet cells, inhibits glucagon secretion, qeeb plab hnyuv, thiab induces satiety. GLP-1 tuaj yeem cuam tshuam cov nyhuv inflammatory ntawm angiotensin Ⅱ, inhibit oxidative stress thiab proteinuria, thiab txhim kho proteinuria, glomerular hyperfiltration, glomerular hypertrophy, thiab mesangial matrix expansion hauv tsiaj qauv [9]. Txoj kev tshawb fawb LEADER pom tias liraglutide tuaj yeem txo qhov kev pheej hmoo ntawm qhov tshwm sim tsis tu ncua loj heev ntawm proteinuria, ob npaug ntawm creatinine, ESRD, thiab tuag los ntawm lub raum ua rau thaum muaj txiaj ntsig los ntawm cov kab mob plawv [10-11].

Txoj kev tshawb fawb SUSTAIN{{0}} kuj tau lees paub tias semaglutide txo qhov kev pheej hmoo ntawm cov kab mob raum tshiab los yog ua rau cov neeg mob T2DM [12]. Txoj kev tshawb fawb AWARD-7 tau pom tias hauv cov neeg mob T2DM thiab nruab nrab mus rau CKD hnyav, dulaglutide ib zaug ib lub lim tiam muaj cov nyhuv hypoglycemic zoo sib xws rau insulin glargine, tab sis qhov poob ntawm eGFR tsawg dua, qhia tias dulaglutide yog ib qho kev nyab xeeb thiab siv tau zoo. Cov neeg mob hnyav CKD [13]. Txoj kev tshawb nrhiav REWIND tau lees paub tias dulaglutide tuaj yeem txo qhov kev pheej hmoo ntawm lub raum sib xyaw qhov kawg ntawm cov xwm txheej (tshiab proteinuria loj, kev poob qis hauv eGFR Ntau dua lossis sib npaug li 30 feem pua, thiab kho lub raum hloov), qhia tias nws muaj cov txiaj ntsig rau lub raum thaum txo cov ntshav qab zib [14-15]. Kev tshuaj ntsuam meta tsis ntev los no kuj tau qhia tias GLP-1 receptor agonists tuaj yeem txo qhov kev pheej hmoo ntawm lub raum ua haujlwm tau los ntawm 17 feem pua ​​(HR 0.83, 95 feem pua ​​​​CI 0.78-0.89) [16].

2.2.3 DPP-4 inhibitors

DPP-4 inhibitors (xws li sitagliptin, linagliptin, saxagliptin, thiab alogliptin, thiab lwm yam) nce qib ntawm GLP-1 los ntawm inhibiting DPP-4, yog li txo cov ntshav qab zib. Linagliptin feem ntau yog tawm los ntawm enterohepatic ncig thiab tsis cuam tshuam los ntawm lub raum ua haujlwm. Lwm yam DPP-4 inhibitors feem ntau yog tawm los ntawm ob lub raum, thiab qhov ntau npaum li cas yuav tsum raug txo rau cov neeg mob uas muaj lub raum tsis zoo rau lub raum tsis txaus[4]. DPP-4 inhibitors kuj inhibited siab glucose-induced transforming growth factor (TGF) 1 nyob rau hauv proximal tubular cells, ua rau kom txo qis hauv qab dej Smad2 phosphorylation, yog li ameliorating raum fibrosis [17].

SAVOR-TIMI 53 txoj kev tshawb nrhiav pom tias saxagliptin tuaj yeem txo cov proteinuria hauv cov neeg mob T2DM, thiab nws cov txiaj ntsig ntawm kev txo cov proteinuria yog ywj siab ntawm cov nyhuv hypoglycemic, thiab cov kev hloov hauv eGFR, lub sijhawm pib lim ntshav, hloov lub raum, thiab lwm yam kev mob raum txawv. dua li cov hauv pawg placebo Tsis muaj qhov tseem ceeb ntawm cov ntaub ntawv [18-19]. MARLINA txoj kev tshawb fawb tau faib T2DM cov neeg mob uas muaj kev pheej hmoo siab plawv thiab lub raum rau hauv linagliptin lossis placebo kho thiab pom tias linagliptin tsis muaj qhov sib txawv tseem ceeb hauv cov hlab plawv thiab lub raum tshwm sim piv nrog cov placebo pawg [20]. Tseem muaj cov pov thawj tsis txaus-raws li kev kho mob pov thawj ntawm cov nyhuv renoprotective ntawm cov tshuaj no.

2.3 Tswj ntshav siab

Kev tswj cov ntshav siab tau zoo tuaj yeem txo cov qib proteinuria hauv cov neeg mob uas muaj DN, ncua kev ua haujlwm ntawm lub raum tsis zoo, thiab txo qis kev pheej hmoo ntawm cov teeb meem plawv [1]. Hauv xyoo 2019, ADA tau qhia tias rau cov neeg mob ntshav qab zib mellitus thiab ntshav siab uas muaj kev pheej hmoo siab plawv, lub hom phiaj tswj ntshav siab yuav tsum yog 130/80 mmHg (1 mmHg=0.133 kPa). Xyoo 2021 "Suav Cov Lus Qhia rau Kev Kho Mob thiab Kev Kho Mob Ntshav Qab Zib Kab Mob" pom zoo kom ntshav siab.<140/90 mmHg for patients over 65 years old, and <130/80 mmHg for patients under 65 years old, and blood pressure should be controlled at ≤130 when 24-hour urine albumin is ≥30 mg /80mmHg.

Angiotensin-hloov enzyme inhibitor (ACEI) lossis angiotensin receptor blocker (ARB) cov tshuaj tau pom zoo rau cov poj niam cev xeeb tub kom txo qis ntshav siab, txo cov proteinuria hauv cov neeg mob DN, thiab ncua sijhawm rau lub raum kev ua haujlwm. IRMA-2 (Irbesa Tan), INNOVATION (telmisartan), IDNT (irbesartan), RENAAL (losartan) thiab lwm yam kev tshawb fawb classic tuaj yeem lees paub. Tib lub sijhawm, nws tuaj yeem txo qhov kev pheej hmoo ntawm cov kab mob plawv hauv cov neeg mob DN. ACEI thiab ARB tshuaj yog tib yam hauv kev txo cov proteinuria, ncua kev ua haujlwm ntawm lub raum thiab tus nqi. Lub raum ua haujlwm, cov poov tshuaj ions, thiab ntshav siab yuav tsum tau saib xyuas hauv 2 mus rau 4 lub lis piam ntawm kev pib lossis hloov kho [5]. Kev siv ua ke ntawm ACEI thiab ARB tsis cuam tshuam nrog kev txhim kho kev mob tshwm sim, tab sis cov xwm txheej tsis zoo xws li hypotension, syncope, thiab lub raum puas tsuaj nce ntxiv, yog li tsis pom zoo siv tib lub sijhawm.

Ib yam li ntawd, kev siv cov renin inhibitors ncaj qha nrog ACE inhibitors thiab ARBs tsis pom zoo vim tias muaj kev pheej hmoo siab ntawm cov hlab plawv thiab lub raum. Qib ntawm proteinuria nyob rau hauv cov pej xeem DN yog txuam nrog kev pheej hmoo ntawm lub raum tsis ua hauj lwm, thiab ACEI thiab ARB tshuaj yuav txo tau cov qib ntawm proteinuria, yog li KDIGO cov lus qhia ntseeg hais tias ACEI thiab ARB kev kho mob tej zaum yuav muaj txiaj ntsig zoo rau cov neeg mob DN tsis muaj ntshav siab. Txawm li cas los xij, cov ntaub ntawv uas twb muaj lawm qhia tau tias, rau cov neeg mob uas tsis muaj proteinuria lossis ntshav siab, ACEI thiab ARB kev kho mob tsis muaj txiaj ntsig zoo [5].

Calcium channel blockers yog ib chav kawm ntawm cov tshuaj antihypertensive uas tsis muaj lub raum tsis ua haujlwm. ACEI thiab ARB tuaj yeem siv ua ke nrog cov neeg mob uas tsis tswj hwm ntshav siab. Raws li cov txiaj ntsig ntawm kev sim kev tshawb fawb thiab kev sim tshuaj me me, diltiazem, ib qho uas tsis yog-dihydropyridine calcium channel blocker, tuaj yeem txo cov proteinuria thiab txo qhov kev loj hlob ntawm DN[1].

Mineralocorticoid receptor antagonists (mineralocorticoid receptor antagonists, MRA) suav nrog spironolactone, eplerenone, thiab finerenone (them peb). Nyob rau hauv physiological tej yam kev mob, mineralocorticoids khi rau receptors los tswj ntshav siab thiab tswj qhov sib npaug ntawm dej thiab electrolytes nyob rau hauv tib neeg lub cev. Txawm li cas los xij, nyob rau hauv qhov txawv txav plasma aldosterone ntau ntau lossis lwm yam kab mob pathological, mineralocorticoid receptors yog overactivated, ua rau cov kev qhia ntawm pro-inflammatory thiab pro-fibrotic gene transcription kom nce ntau lub hlwb, yog li ua rau mob thiab fibrosis.

Ntau cov kev tshawb fawb tau pom tias kev sib xyaw ua ke ntawm MRA thiab ACEI lossis ARB tuaj yeem tswj cov ntshav siab, thiab txo cov proteinuria thiab cov xwm txheej ntawm cov hlab plawv, tab sis hyperkalemia yuav tsum zam thaum siv. Piv nrog rau spironolactone thiab eplerenone, qhov kev pheej hmoo ntawm hyperkalemia nyob rau hauv lub thib peb-tiam MRA finerenone yog ho txo ​​qis, thiab kev faib nyob rau hauv lub plawv thiab lub raum yog sib npaug, uas yuav txo tau txoj kev pheej hmoo ntawm mob raum kev loj hlob thiab mob plawv nyob rau hauv cov neeg mob hom 2 DM. thiab CKD [21].

2.4 Vitamin D (Vitamin D, VD)

VD tuaj yeem cuam tshuam qhov kev puas tsuaj ntawm podocytes, tswj qhov zoo li qub ntawm podocytes, thiab muaj kev tswj tsis zoo ntawm renin-angiotensin (RAS) system. VD muaj zog tiv thaiv proteinuria thiab podocyte Tiv thaiv cov teebmeem. Cov nyhuv lom ntawm VD yog ua tiav los ntawm kev khi rau VD receptor (vitamin D receptor, VDR). VDR tau nthuav tawm hauv podocytes, thiab VD / VDR txoj kev taw qhia muaj ntau yam kev tiv thaiv rau lub raum xws li tiv thaiv cov proteinuria, tiv thaiv fibrosis, tiv thaiv kab mob, kev tswj lub raum tiv thaiv, thiab tiv thaiv kev raug mob podocyte hauv DN cov neeg mob. Paricalcitol yog ib qho vitamin D analogue. Kev tshuaj xyuas zoo ntawm paricalcitol hauv kev kho mob ntawm DN tau qhia tias nws tuaj yeem txo qis cov protein ntau hauv cov zis, tab sis tsis muaj pov thawj ntseeg tias nws tuaj yeem tiv thaiv lub raum ua haujlwm [22].

2.5 Sulodexide

Sulodexide yog ib qho kev ua kom huv heev dextran sib xyaw uas tuaj yeem txo TGF 1 thiab proteinuria qib hauv cov tsiaj qauv ntawm DM glomerulosclerosis [23]. Txawm li cas los xij, cov txiaj ntsig ntawm qhov loj-scale randomized soj ntsuam sim (Sun-MACRO txoj kev tshawb no) qhia tau hais tias sulodexide ua tsis tau tejyam los qhia kev txhim kho nyob rau hauv proteinuria thiab lub raum muaj nuj nqi [24]. Ib qho kev soj ntsuam meta tsis ntev los no tau pom tias sulodexide txo qis cov zis tawm hauv cov zis thiab muaj cov teebmeem renoprotective hauv cov neeg mob DM, microalbuminuria, thiab macroalbuminuria [25].

2.6 Pentoxifylline (PTF)

PTF ncua kev loj hlob ntawm lub raum fibrosis los ntawm inhibiting cell proliferation, txo lub raum mob, thiab txo cov tsub zuj zuj ntawm extracellular matrix. Cov kev tshawb fawb tau pom tias ACEI thiab ARB ua ke nrog PTF tuaj yeem txo qis ntawm eGFR thiab txo cov zis albumin excretion [26].

2.7 Endothelin receptor antagonists

Endothelin receptor antagonists tuaj yeem txo cov proteinuria thiab ntshav siab, tab sis tuaj yeem ua rau sodium ion tuav. Avosentan, uas tsis yog-xaiv endothelin receptor antagonist, tuaj yeem txo cov zis protein, tab sis nws cov koob tshuaj ntau hauv kev kho mob DM nrog CKD raug txiav tawm vim muaj kev mob plawv ntau ntxiv [27]. Txawm li cas los xij, kev siv tshuaj tsawg tsawg ntawm cov kev xaiv endothelin receptor antagonist atrasentan tuaj yeem txo cov zis protein yam tsis ua rau cov kua dej tseem ceeb [28]. SONAR txoj kev tshawb nrhiav pom tias atrasentan tuaj yeem txo qhov kev pheej hmoo ntawm lub raum cov xwm txheej hauv cov neeg mob DM thiab CKD, qhia tias xaiv cov endothelin receptor antagonists muaj peev xwm tiv thaiv lub raum ua haujlwm ntawm T2DM cov neeg mob uas muaj ESRD siab [29].

2.8 Bardoxolone methyl hmoov

Bardoxolone methyl txo oxidative kev nyuaj siab cov khoom los ntawm activating Nrf2 thiab inhibiting txoj kev NF-κB. Cov kev tshawb fawb luv luv tau pom tias nws tuaj yeem nce eGFR hauv cov neeg mob T2DM tab sis tsis cuam tshuam rau cov proteinuria [30]. Txawm li cas los xij, BEACON txoj kev tshawb fawb pom tias bardoxolone methyl tsis tuaj yeem txo qhov tshwm sim ntawm ESRD lossis kev pheej hmoo ntawm cov hlab plawv tuag, tab sis ua rau muaj kev cuam tshuam loj heev ntawm cov hlab plawv, yog li txoj kev tshawb no raug txiav tawm vim muaj kev txhawj xeeb txog kev nyab xeeb [31]. Kev soj ntsuam ntxiv pom tias bardoxolone methyl tuaj yeem nce eGFR thiab UACR tib lub sijhawm. Piv nrog rau cov placebo pawg, bardoxolone methyl pawg UACR tau nce ntau heev; tom qab 6 lub hlis, qhov nce ntawm UACR tsis muaj zog; Regression tsom xam ntawm qhov sib txawv tau txheeb xyuas cov hauv paus ntsiab lus eGFR thiab eGFR lub sijhawm dhau los ua cov ntsiab lus tseem ceeb cuam tshuam nrog kev hloov pauv hauv UACR, tsis zoo li cov kev pom ib txwm muaj uas nce proteinuria feem ntau cuam tshuam rau lub raum raug mob [32].

2.9 Pyridoxamine ua

Pyridoxamine belongs rau tsev neeg vitamin B6. Nws tuaj yeem tshem tawm cov dawb radicals thiab cov khoom carbonyl, thiab thaiv cov synthesis ntawm glycosylation khoom. Ib qho randomized ob-dig muag placebo-tswj sim nrog rau 238 tus neeg mob nrog DN tau lees paub tias eGFR qis dua rau cov neeg mob noj cov vitamin B (P=0.02) [33]. Nws txoj kev tiv thaiv ntawm DN tseem yuav tsum tau lees paub los ntawm qhov loj dua randomized tswj kev sim.

2.10 Hypoxia-inducible factor-proline hydroxylase inhibitor (hypoxia-inducible factor-proline hydroxylase inhibitor, HIF-PHI)

DM cov ntaub so ntswg vim yog hypoxia-inducible factor-1 (hypoxia-inducible factor-1, HIF-1) Hypoxia vim qhov ua kom tsis txaus thiab qhov tsis zoo ntawm cov lus teb rau hypoxia yog qhov tseem ceeb pathogenesis ntawm DM thiab nws cov teeb meem. . Yog li ntawd, nce HIF-1 kev taw qhia tej zaum yuav yog ib txoj kev kho mob zoo rau DM thiab nws cov teeb meem. Tsis ntev los no DM kev tshawb fawb tsiaj tau pom tias HIF-PHI tuaj yeem tiv thaiv thiab kho DN [34].

Ntawm qhov tod tes, piv nrog rau lub raum anemia tshwm sim los ntawm lwm yam etiologies, DN anemia tshwm sim ua ntej, muaj qhov tshwm sim ntau dua, hnyav dua, thiab nyuaj rau kho. Tsis txaus EPO hauv DN ntshav ntshav yog qhov tseem ceeb hauv kev tiv thaiv, tsis muaj hlau tsis txaus, thiab micro-o, thiab tseem cuam tshuam nrog kev siv tshuaj hypoglycemic thiab autoimmune tsis ua haujlwm. HIF-PHI cov tshuaj uas sawv cev los ntawm roxadustat yog yooj yim, nyab xeeb, thiab siv tau qhov ncauj, thiab tuaj yeem txhim kho cov metabolism hauv hlau, thiab cov nyhuv curative tsis cuam tshuam los ntawm lub xeev micro-inflammatory. Yog li, nws raug pom zoo tias cov tshuaj HIF-PHI yog thawj qhov kev xaiv hauv kev kho DN anemia[35].

3 Kev xaus

DN yog ib qho teeb meem loj thiab loj ntawm DM, uas ua rau muaj teeb meem loj rau kev kho mob thiab tseem yog qhov tseem ceeb ntawm ESRD. DN kuj tseem muaj feem cuam tshuam nrog cov xwm txheej ntawm cov hlab plawv thiab ua rau cov neeg mob plawv thiab cov neeg mob tuag tag nrho. Nws qhov kev nthuav qhia kho mob thiab kev kwv yees yuav txawv, xws li NPDN. Qhov hnyav ntawm proteinuria, txawm li cas los xij, tseem yog ib qho tseem ceeb ntawm kev pheej hmoo ntawm kev loj hlob. Kev tswj hwm zoo tau tawm tswv yim rau DN, uas ua ke nrog cov yam ntxwv uas txo qis kev pheej hmoo ntawm cov hlab plawv thiab ua rau qeeb ntawm kev mob raum, uas yog tswj cov ntshav qab zib thiab ntshav siab, inhibition ntawm renin-angiotensin-aldosterone system, kev tawm dag zog kom zoo, thiab kev haus luam yeeb. Kev sib xyaw ua ke zoo ntawm cov kev cuam tshuam no tuaj yeem txo qhov kev pheej hmoo ntawm DN kev loj hlob thiab lwm yam teeb meem microvascular, cov xwm txheej hauv plawv, thiab kev tuag. Txoj kev npaj kho mob tus kheej yuav tsum tau tsim raws li qhov tseeb ntawm tus neeg mob.

Yog xav paub ntxiv:ali.ma@wecistanche.com