Cov txiaj ntsig ntawm Kev Pabcuam Kev Kho Mob rau Secondary Hyperparathyroidism (lub raum Hyperparathyroidism)

Txij li thaum cov kev taw qhia ntawm cinacalcet nyob rau hauv 2008, kev kho mob ntawmtheem nrab hyperparathyroidism(SHPT) tau hloov los ntawm tag nrho cov parathyroidectomy (PTx), uas tau ua qhov tseem ceeb, mus rau kev kho mob. Kev ua tau zoo ntawm PTx tau raug tshaj tawm rau qee lub sijhawm, thiab kev ua haujlwm ntawm cinacalcet kuj tau tshaj tawm hauv ntau yam kev tshawb fawb. Raws li qhov tshwm sim, tus naj npawb ntawm cov kev phais PTx tau poob qis heev, nrog rau cov ntaub ntawv hauv tebchaws tam sim no qhia tsawg dua 100 qhov kev phais ib xyoos. Cov tsos mob ntawm plab hnyuv los ntawm cinacalcet kuj tau tshaj tawm, tab sis tsis ntev los no, evocalcet, uas ua rau tsawg dua.cov tsos mob plab, tau tshwm sim. Cov kev kho mob no yuav tsum tau mus ntxivtxo tus naj npawb ntawm PTx kev phais yav tom ntej. Txawm li cas los xij, muaj ntau tus neeg mob uas xav tau PTx vim lawv tsis tuaj yeem lossis tiv taus kev kho mob. Yog li, PTx yuav txuas ntxiv yog ib qho ntawm cov txheej txheem phais tseem ceeb rau cov kws phais endocrine. Hauv kev tshuaj xyuas no, peb xav tham txog cov txiaj ntsig ntawm kev kho mob thiab kev phais.

Cov lus tseem ceeb:theem nrab hyperparathyroidism, calciimetics,parathyroidectomy kev kho mob, kev tuag

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Taw qhia

Txog niaj hnub no, ntau yam teeb meem tau raug tshaj tawm vim yog theem nrabhyperparathyroidism(SHPT), nrog rau kev txawv txav hauv cov pob txha metabolism, nrog rau kev nce ntxiv hauvkab mob plawvthiab tag nrho kev tuag vim nws txoj kev vam meej [ 1-3]. Hauv Nyij Pooj, nyob ib ncig ntawm 2008, cinacalcet, kev kho mob rau SHPT, tau qhia, ua rau muaj kev hloov pauv loj hauv kev kho mob los ntawm kev phais mob, uas yog txoj kev kho mob tseem ceeb mus txog thaum ntawd, mus rau kev kho mob, thiab tag nrho parathyroidectomy (tag nrho parathyroidectomy) rau SHPT. PTx) txo qis heev. Raws li lub teb chaws cov ntaub ntawv los ntawm PTx Study Group rau Hyperparathyroidism, PTx tau ua nyob rau hauv 1,754 kis nyob rau hauv 2007 (suav nrog rau cov ntaub ntawv rov ua hauj lwm), tab sis nyob rau hauv 2019 tus naj npawb tau nce mus rau 90 tus neeg mob (nrog rau cov ntaub ntawv rov ua dua). Nws tau pom tias qhov no tau txo qis rau (Daim duab 1 thiab 2) [4]. Tsis tas li ntawd, nrog rau qhov tshwm sim ntawm calcimimetics tshiab, nws yog ib qho yooj yim los twv seb PTx yuav poob mus ntxiv. Qhov kev tshuaj xyuas no tshuaj xyuas cov txiaj ntsig ntawm kev kho mob rau theem nrab hyperparathyroidism.

① Cov txheej txheem kho mob rau SHPT

② Kev kho mob rau SHPT (a. kev kho mob, b. kev kho mob phais)

③ Piav qhia cov txiaj ntsig ntawm txhua txoj kev kho mob rau SHPT raws li kev txiav txim.

1 . Txhua xyoo tus naj npawb ntawm parathyroidectomy rau lub raum hyperparathyroidism hauv Nyiv.* Cov lus qhia ntawm Japanese Society rau Dialysis Therapy Guideline.

Daim duab 2. Cov ntsiab lus ntawm qhov sib txawv ntawm tus naj npawb ntawm PTx rooj plaub hauv PSSJ daim ntawv ntsuam xyuas

PSSJ: PTx Study Group for Hyperparathyroidism PTx Study Group for Hyperparathyroidism (PSSJ) Ua Haujlwm Pab Pawg: Cov xwm txheej tam sim no ntawm PTx rau SHPT hauv PSSJ daim ntawv ntsuam xyuas 2019 http://2hpt-japs.jp/pdf/genkyo_v210107.pdf Reference Peb Hlis 6, 2021

① Cov txheej txheem kho mob rau SHPT

Muaj ntau cov txheej txheem kev kho mob rau cov pob txha pob txha pob txha tsis zoo, xws li K / DOQI thiab KIDIGO cov lus qhia, tab sis hauv Nyij Pooj, Nyiv Lub Koom Haum rau Kev Kho Mob Ntshav Qab Zib tau luam tawm cov "Cov Lus Qhia rau Kev Kho Mob ntawm Secondary Hyperparathyroidism hauv Dialysis Patients" hauv 2006. Hauv xyoo 2012, cov ``Clinical Guidelines for Bone and Mineral Metabolism Abnormalities Associated withMob raum mob'' tau luam tawm. Hais txog kev kho mob ntawm SHPT, 2012 "Clinical Guidelines for Bone and Mineral Metabolism Abnormalities Associated withMob raum mob" npe Tshooj 2: Kev tswj hwm lub hom phiaj tseem ceeb rau P thiab Ca, Tshooj 3: Kev ntsuam xyuas thiab tswj kev ua haujlwm ntawm cov kab mob parathyroid, thiab Tshooj 4: Tshooj ""Cov lus qhia thiab cov txheej txheem ntawm kev cuam tshuam parathyroid" muab cov ncauj lus kom ntxaws, thiab tsim nyog ua raws li cov lus qhia. "Cov txheej txheem kho mob rau cov pob txha thiab cov ntxhia hauv metabolic txawv txav cuam tshuam nrog cov kab mob raum tsis zoo" rau cov txheej txheem kho mob thiab xaiv cov kev kho mob rau SHPT.

② Txoj kev kho mob rau SHPT

a. Txoj kev kho mob

Cov no suav nrog cov tshuaj phosphate binders, vitamin D receptor agonists (VDRAs), thiab calcimimetics. Calcimimetics tam sim no suav nrog cov tshuaj hauv qhov ncauj cinacalcet thiab evocalcet, thiab cov tshuaj txhaj tshuaj etelcalcetide.

b. kev kho mob phais

Tag nrho parathyroidectomy, tag nrho parathyroidectomy + autotransplantation, thiab subtotal parathyroidectomy feem ntau ua. Hauv Nyij Pooj, tag nrho parathyroidectomy + autotransplantation yog txoj kev phais feem ntau ua.

③ Cov txiaj ntsig rau txhua txoj kev kho mob rau SHPT

a. Cov txiaj ntsig ntawm txoj kev kho mob (calcimimetics) 1. Cov txiaj ntsig ntawm kev kho mob nrog cinacalcetCinacalcet yog thawj calcimimetic muaj. Cinacalcet suppresses PTH ntau lawm los ntawm kev ua allo sterically ntawm Ca receptors hauv cov qog parathyroid [5]. MBD-5D txoj kev tshawb fawb hauv Nyij Pooj tau pom tias kev sib xyaw ntawm cinacalcet thiab txo cov tshuaj vitamin D npaj tsis tsuas yog ua kom cov nyhuv ntawm cov ntshav qab zib PTH, tab sis kuj qhia tau tias muaj peev xwm tswj tau cov ntshav Ca thiab ntshav P [6 ]. Raws li cov txiaj ntsig ncaj qha ntawm cinacalcet ntawm cov qog parathyroid, nws tau pom tias nws tuaj yeem ua rau muaj kev hloov pauv hauv cov qog parathyroid thiab txo qhov ntim ntawm cov qog qog nqaij hlav loj [7, 8].

Cov teebmeem kev kho mob histological ntawm cinacalcet ntawm cov pob txha tau pom nyob rau hauv Kev Tshawb Fawb Pob Txha Rau Cov Neeg Mob Dialysis nrog Secondary Hyperparathyroidism ntawm End Stage Renal Disease (BONAFIDE). Hauv cov neeg mob uas muaj kab mob siab dhau ntawm cov pob txha, kev tswj xyuas ntev ntev ntawm cinacalcet tau pom tias yuav ua kom cov pob txha tsim kom zoo dua qub, thiab tseem txhim kho cov cim ntawm kev hloov pauv ntawm cov pob txha thiab cov pob txha pom [9]. . Hais txog cov xwm txheej kho mob pob txha, qhov kawg thib ob ntawm Kev Ntsuas ntawmCinacalcet Hydrochloride Kev Kho Mobmus rau Lower Cardiovascular Events (EVOLVE) sim, kev xav-rau-kho tsom xam pom tsis muaj qhov sib txawv tseem ceeb ntawm pawg cinacalcet thiab cov placebo, tab sis qhov prespecified lag-cen soring tsom xam pom tias cinacalcet txo qis kev pheej hmoo ntawm pob txha [10]. Hais txog cov txiaj ntsig ntawm kev tuag thiab cov kab mob plawv, uas yog lub ntsiab lus kawg ntawm EVOLVE mus sib hais, kev tsom mus rau kev kho mob tsis tau qhia tias cinacalcet muaj txiaj ntsig, tab sis lag-censoring tsom xam pom tias cinacalcet txhim kho kev tuag. [11] Tsis tas li ntawd, nyob rau hauv kev soj ntsuam me me ntawm EVOLVE mus sib hais, tsis muaj qhov sib txawv tseem ceeb hauv cov xwm txheej atherosclerotic plawv, tab sis cinacalcet tau pom tias muaj txiaj ntsig zoo hauv kev txhim kho cov xwm txheej uas tsis yog atherosclerotic cardiovascular xws li kev tuag sai thiab lub plawv tsis ua haujlwm [12]. Ntawm qhov tod tes, txoj kev tshawb fawb ADAVNCE kuj tau qhia tias cinacalcet ntxiv rau cov tshuaj vitamin D sterols tsawg tuaj yeem txo qis cov hlab plawv calcification piv rau kev kho mob nrog cov tshuaj tsawg vitamin D sterols los ntawm kev hloov pauv [13]. Kev tshawb fawb hauv Nyij Pooj thiab Australia kuj tau pom tias nws txo qis kev tuag thiab kev mob plawv tuag [14, 15]. Kuj tseem muaj cov lus ceeb toom tias cinacalcet muajanemia-kev txhim kho cov nyhuv[16]. Txawm li cas los xij, thaum pom cov teebmeem no, muaj ntau cov tsos mob ntawm plab hnyuv xws li xeev siab thiab ntuav, thiab nws tau taw qhia tias cov tshuaj yuav tsis tau noj tag nrho thaum kawg [11, 13, 17].

2. Cov txiaj ntsig ntawm kev kho mob nrog etelcalcetide

Ua raws li cov tshuaj hauv qhov ncauj cinacalcet, etelcalcetide tau qhia ua cov tshuaj hauv cov hlab ntsha. Ib qho randomized, ob-dig muag, ob-dummy soj ntsuam kev sim sib piv cinacalcet thiab etelcalcetide tau ua rau cov neeg mob SHPT hauv Tebchaws Meskas, Canada, Europe, Russia, thiab New Zealand. Kev ua tiav ntawm kev txo qisSerum PTHlos ntawm 30% lossis ntau dua

Ntxiv rau qhov tsis muaj qhov tsis zoo ntawm etelcalcetide, qhov zoo tshaj ntawm etelcalcetide kuj tau pom nyob rau hauv nws qhov kev ua tau zoo ntawm kev txo cov ntshav PTH los ntawm 30% lossis ntau dua thiab 50% lossis ntau dua [18]. Etelcalcetide kuj tau pom tias txo qis FGF23 ntau dua li cinacalcet [19]. SHPT tuaj yeem tswj tau txawm tias nyob hauv cov neeg mob cov neeg mob uas tsis zoo rau kev noj tshuaj rau cinacalcet.

Kev ua tau zoo ntawm etelcalcetide kuj tau pom [20].

Txawm li cas los xij, zoo ib yam li cinacalcet, cov tsos mob ntawm plab hnyuv tau pom, thiab qhov zaus yuav luag zoo ib yam li nrog cinacalcet [18].

3. Cov txiaj ntsig ntawm kev kho mob nrog evocalcet

Evocalcet yog qhov thib peb qhov ncauj calcimimetics tshwm sim tom qab etelcalcetide, uas tuaj yeem muab tso rau hauv cov hlab ntsha. Evocalcet tau tsim nrog lub hom phiaj ntawm kev txo cov tsos mob ntawm plab hnyuv los ntawm cinacalcet thiab etelcalcetide.

Kev sib piv ntawm lub taub hau ntawm cinacalcet thiab evocalcet tau pom tias evocalcet tsis yog qhov qis dua rau cinacalcet hauv kev ua tiav kev tswj hwm ntawm PTH tsis zoo hauv lub hom phiaj, thiabcov tsos mob plabyog 32.8% nrog cinacalcet. Evocalcet pom qhov txo qis ntawm 18.6% [21]. Tsis tas li ntawd, kev sib piv txo qis hauv FGF23, ntshav kho Ca, ntshav qab zib P, thiab cov pob txha metabolic cov cim tau pom nrog cinacalcet thiab evocalcet, thiab cov txiaj ntsig kho mob tau zoo nyob rau yav tom ntej [21]. Hloov los ntawm cinacalcet mus rau evocalcet thiab kev siv lub sij hawm ntev ntawm evocalcet kuj xav tias yuav muaj kev nyab xeeb thiab siv tau [22].

Supportive Service Ntawm Wecistanche-Qhov loj tshaj plaws cistanche exporter nyob rau hauv Tuam Tshoj:

Email: wallence.suen@wecistanche.com

Whatsapp / Tel: +86 15292862950

Khw Muag Khoom Kom Paub Ntxiv Specifications:

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Nyem qhov no kom tau txais Natural organic CISTANCHE EXTRACT nrog 25% ECHINACOSIDE thiab 9% ACTEOSIDE rau lub raum ua haujlwm