Qhov tseem ceeb

· Magnesium preloading regimen yuav txo qis qhov tshwm sim ntawm cisplatin-uas cuam tshuam rau lub raum raug mob (cis-AKI).

· Cov teebmeem ntawm cisplatin ntawm lub raum ua haujlwm feem ntau yog subacute, yog li cov kws kho mob yuav tsum ua tib zoo saib xyuas tsis yog rau cis-AKI nkaus xwb tab sis kuj cis-AKD.

Keeb kwm

Cisplatin yog ib qho tshuaj tua kab mob uas muaj zog tshaj plaws uas siv rau hauv kev kho mob qog noj ntshav taub hau thiab caj dab; Txawm li cas los xij, nephrotoxicity yog qhov cuam tshuam loj uas txwv kev siv. Magnesium supplementation tau raug tshaj tawm los txo cov kev pheej hmoo hauv cov kev tshawb fawb tsis tswj. Peb tau tshawb xyuas seb qhov preloading nrog magnesium tiv thaiv nephrotoxicity nrog cov tshuaj cisplatin tsawg txhua lub lim tiam.

Raws li cov kev tshawb fawb muaj feem xyuam, cistanche yog ib txwm suav tshuaj ntsuab uas tau siv rau ntau pua xyoo los kho ntau yam kab mob. Nws tau raug pov thawj scientific kom muaj cov tshuaj tiv thaiv kab mob, tiv thaiv kev laus, thiab antioxidant zog. Cov kev tshawb fawb tau pom tias cistanche muaj txiaj ntsig zoo rau cov neeg mob uas muaj kab mob raum. Cov khoom xyaw nquag ntawm cistanche paub tias txo qhov mob, txhim kho lub raum ua haujlwm thiab rov ua kom lub raum tsis zoo. Yog li, kev sib koom ua ke cistanche hauv txoj kev npaj kho mob raum tuaj yeem muab txiaj ntsig zoo rau cov neeg mob hauv kev tswj hwm lawv tus mob. Cistanche pab txo qis proteinuria, txo qis BUN thiab creatinine qib, thiab txo qhov kev pheej hmoo ntawm lub raum puas. Tsis tas li ntawd, cistanche kuj pab txo cov roj cholesterol thiab triglyceride uas tuaj yeem ua rau muaj kev phom sij rau cov neeg mob uas muaj kab mob raum.

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Cov txheej txheem

Peb tau ua ib tus neeg tsav tsheb yav tom ntej, ib leeg-dig muag, randomized tswj kev sim los sib piv cov cisplatin-uas cuam tshuam rau lub raum raug mob (cis-AKI) thiab mob raum mob (cis-AKD) ntawm ob pawg: cov hlab ntsha 0.9 feem pua ​​NaCl 500 ml ntxiv rau KCL 20 mEq tshaj 4 h pre-cisplatin 40 mg/m2 txhua lub lim tiam rau 7-8 lub lis piam (tswj pab pawg) piv nrog ntxiv 16 mEq magnesium ntxiv rau saline infusion ( Mg pawg) hauv 30 tus neeg mob qog noj ntshav taub hau thiab caj dab. Cis-AKI tau txhais tias yog ib qho kev nce ntshav creatinine (SCr) Ntau dua lossis sib npaug rau 0.3 mg / dl hauv 7 hnub thiab cis-AKD yog qhov nce SCr Ntau dua lossis sib npaug rau 0.3 mg / dl ntawm SCr kawg thiab cov hauv paus ua ntej. Tshuaj kho mob SCr.

Cov txiaj ntsig

Zuag qhia tag nrho cisplatin qog teb tus nqi thiab ciaj sia taus yog sib piv ntawm pab pawg. Cov yam ntxwv hauv paus tau sib piv ntawm cov pab pawg, txawm tias SCr qis dua hauv kev tswj hwm ({{0}}.70 ± 0.17 piv rau 0.87 ± 0.17 mg/dl, P=0.01). Qhov tshwm sim ntawm cis-AKI zoo sib xws (4.6 feem pua ​​​​piv rau 1.3 feem pua); Txawm li cas los xij, qhov tshwm sim ntawm cis-AKD tau siab dua rau pawg tswj hwm (46.7 feem pua ​​​​vim 6.7 feem pua ​​, kev phom sij piv=0.082, 95 feem pua ​​​​kev ntseeg siab lub sijhawm 0.008-0.79, P {{26} }.03). Lub sijhawm los tsim cis-AKD tau luv luv hauv pawg tswj hwm (P=0.007).

cov lus xaus

Magnesium-preloading regimen muaj kev nyab xeeb thiab pom tau tias qhov txo qis ntawm cis-AKD. Cov txiaj ntsig txhawb nqa ntawm peb txoj kev tshawb nrhiav kev sim yuav tsum tau lees paub hauv qhov loj-scale randomized tswj mus sib hais.

Ntsiab lus

Taw qhia

Cisplatin-raws li kev kho mob tseem yog tus qauv ntawm kev saib xyuas rau cov neeg mob qog nqaij hlav taub hau thiab caj dab; Txawm li cas los xij, qhov mob, subacute, thiab ntev-ntev toxicities ntawm cisplatin txwv kev siv. Nephrotoxicity yog ib qho teeb meem uas tshwm sim ntau tshaj plaws, suav txog 20 feem pua ​​-50 feem pua, nyob ntawm cov ntsiab lus ntawm nephrotoxicity thiab cumulative cisplatin ntau npaum li cas. Cov kab mob tab sis kuj muaj cov kab mob electrolyte txawv txav, uas yog hypokalemia thiab hypomagnesemia.5 Lub pathogenesis ntawm nephrotoxicity tej zaum yuav tshwm sim los ntawm ib tug ncaj qha toxic nyhuv ntawm cisplatin tsub zuj zuj nyob rau hauv lub proximal tubular epithelial hlwb (PTEC), raws li zoo raws li theem nrab ntawm inflammatory teebmeem ntawm cisplatin, nrog rau nce kev tsim ntawm cov pa oxygen reactive thiab inflammatory mediators ua rau PTEC necrosis thiab apoptosis, ua rau hypomagnesemia, hypokalemia thiab txo qis hauv lub raum ua haujlwm.5

Cov qauv tsiaj sim tau pom tias magnesium depletion ua rau lub raum tubular platinum tsub zuj zuj, oxidative kev nyuaj siab, thiab tubular raug mob ua rau txo qis hauv lub raum ua haujlwm. Ntxiv mus, nyob rau hauv tus qauv nas ntawm magnesium depletion, magnesium supplementation tau pom tias yuav txo tau lub raum tubular raug mob tom qab ob koob tshuaj ib zaug thiab kuj ntau koob ntawm cisplatin.6-8 Qhov tseem ceeb tshaj, magnesium supplementation tsis txo cov nyhuv kho ntawm cisplatin ntawm qog cell.7,9

A retrospective analysis of cancer registry data has suggested that magnesium supplementation has a  protective effect on kidney function compared to pre-treatment with 0.9% NaCl alone.1,2,4,10 Studies have varied in the amount of magnesium given, and the timing of magnesium administration about cisplatin, and forced diuresis protocols. For example, one study gave magnesium in an oral replacement fluid after cisplatin  administration11 and another regular oral magnesium supplementation.12 Although these studies reported that magnesium supplementation reduced kidney injury in the short term, the definition of kidney injury varied. To overcome the variability in definitions of kidney injury,  three categories have been proposed according to the time between baseline serum creatinine (SCr) and subsequent increase in SCr  0.3 mg/dl, defining acute kidney injury (AKI) with the increase in SCr within 7 days, acute kidney disease (AKD) with the increase in SCr between 7 and 90  days and chronic kidney disease (CKD) with the increase in SCr persisting for >90d 13

Vim tias muaj peev xwm toxicity ntawm cisplatin, cov sij hawm noj tshuaj sib txawv tau raug tshawb xyuas hauv cov mob qog noj ntshav hauv lub taub hau thiab caj dab ob qho tib si nasopharyngeal cancer (NPC) thiab tsis yog NPC. Chemoradiation nrog cisplatin 100 mg / m2 muab ib zaug txhua 3 lub lis piam yog tus qauv kev saib xyuas hauv ntau xyoo dhau los. Txawm li cas los xij, kev siv tshuaj tsawg ib zaug ib lub lim tiam cisplatin (30-40} mg / m2 ) tau hloov zuj zus ntxiv vim tias pom tias muaj tshuaj lom tsawg dua, yooj yim, thiab tshem tawm hauv tsev kho mob hauv cov neeg mob. Ob peb randomized theem II thiab theem III kev tshawb fawb hauv Is Nrias teb, Nyiv, thiab Kaus Lim Kauslim tau pom tias tsis muaj qhov ua tau zoo ntawm cov tshuaj qis qis ib zaug ib lub lim tiam ntawm cisplatin piv rau 3-cisplatin txhua lub lim tiam hauv ob qho tib si tom qab kev ua haujlwm sib xyaw ua ke chemoradiation therapy (CCRT ) lossis qhov tseeb CCRT hauv NPC thiab tsis yog NPC. ciaj sia taus thiab tag nrho cov ciaj sia taus (OS) zoo ib yam ntawm cov sib txawv dos teem sij hawm.15

Kev tshuaj xyuas ntawm cov kev tshawb fawb qhia txog nephrotoxicity nrog cov txheej txheem siab koob tshuaj cisplatin tau coj mus rau cov txheej txheem kev kho mob pom zoo tias 8-20 mEq ntawm magnesium yuav tsum tau muab tso rau hauv cov hlab ntsha ua ntej kev tswj hwm qib siab cisplatin.1,3,17-19 Minzi et al.17 tau tshaj tawm tias 8 mEq ntawm cov tshuaj magnesium txo qis qhov tshwm sim ntawm nephrotoxicity yam tsis muaj kev phiv loj. Tsis tas li ntawd, Hase thiab cov npoj yaig19 tau qhia txog kev nyab xeeb thiab kev ua tau zoo ntawm qhov ntxiv 2{{10}} mEq magnesium piv rau 0.9 feem pua ​​NaCl thiab mannitol rau cov txheej txheem siab koob tshuaj cisplatin (60 mg. /m2 txhua 3-4 lis piam). Ntxiv mus, Willox et al.20 tau tshaj tawm tias 16 mEq ntawm magnesium tau siv los ntawm qhov ncauj lossis tso rau hauv lub raum kom txo qis lub raum tubular cov cim kev puas tsuaj nrog cov koob tshuaj qis ntawm cisplatin (20 mg / m2), thiab Yamamoto thiab cov npoj yaig2 tau tshaj tawm txo qis raum ua haujlwm nrog 0.9 feem pua ​​NaCl hydration. piv rau 15 mEq magnesium nrog cov koob tshuaj qis cisplatin (40 mg / m2) txhua lub lim tiam rau 6 lub lis piam. Raws li peb qhov kev tshuaj xyuas ntawm cov ntawv luam tawm, peb tau txiav txim siab los kawm txog cov txiaj ntsig ntawm qhov ntxiv 16 mEq magnesium rau 0.9 feem pua ​​NaCl 500 ml vim tau tshaj tawm cov ntaub ntawv kev nyab xeeb thiab muaj 10 feem pua ​​​​MgSO4 kev npaj hauv peb lub tsev kho mob.

Xws li peb tau ua ib qho kev tshawb nrhiav los txiav txim siab txog qhov cuam tshuam ntawm kev thauj khoom ua ntej nrog magnesium ntxiv 16 mEq piv rau cov qauv kev saib xyuas nrog 0.9 feem pua ​​NaCl ntawm qhov tshwm sim ntawm AKI thiab AKD hauv cov neeg mob qog noj ntshav taub hau thiab caj dab tau txais {{3} } lub lis piam ntawm kev noj tshuaj cisplatin tsawg (40 mg / m2 ).

Cov khoom siv thiab cov txheej txheem

Kawm cov pej xeem

Txoj kev tshawb no yog ib tug yav tom ntej randomized (1: 1), ib leeg-dig muag (cov neeg mob dig muag), parallel tswj, ib leeg-chaw kawm. Cov neeg mob qog noj ntshav hauv taub hau thiab caj dab uas tau txais kev kho mob ib txhij nrog cisplatin 40 mg / m2 txhua lub lim tiam rau 7-8 lub lis piam ntawm Tsev Kho Mob Ramathibodi, Bangkok, Thaib teb, txij lub Plaub Hlis 2015 txog Lub Peb Hlis 2016 tau cuv npe hauv qhov kev sim tshuaj no. Cov txheej txheem suav nrog yog hnub nyoog 18 xyoo, Eastern Cooperative Oncology Pawg kev ua tau zoo 0-2, ntshav creatinine Tsawg dua lossis sib npaug li 1.5 mg / dl lossis kwv yees glomerular filtration rate (eGFR) siv cov kab mob raum mob sib kis (CKD EPI) 60 ml / min rau 1.73 m2. Cov txheej txheem kev cais tawm yog kev kho cisplatin yav dhau los, kev tswj tsis tau kev mob tshwm sim, thiab cev xeeb tub.

Peb qhov piv txwv loj xam rau qhov kev sim no yog ua raws li cov txiaj ntsig ntawm magnesium preloading txo AKI (cov txiaj ntsig thawj zaug) los ntawm 20 feem pua ​​​​piv rau 0.9 feem pua ​​NaCl pab pawg. Qhov no tau muab tag nrho cov neeg mob ntawm 100, nrog lub zog los kuaj pom qhov sib txawv ntawm ob pawg (ob tog ib ¼ 0.05).

Kev kawm raws tu qauv thiab sau cov ntaub ntawv

After study enrollment, patients were assigned to their ground control saline group and magnesium-supplemented (Mg group) group using sealed opaque envelopes that had a randomization number of block sizes of two. The study was single-blinded, with patients blinded, whereas the investigating physicians and oncologists were not. Patients were randomly assigned in a 1: 1 ratio to either the 0.9% NaCl group (control group) who had 0.9% NaCl 500 ml þ KCL 20 mEq administered intravenously over 4 h (125 ml/h) before every cisplatin dose or the Mg group who were given an additional 10% MgSO4 16 mEq (8 mmol) with the 0.9% NaCl 500 ml þ KCL 20 mEq. At every visit, blood was collected for blood count, serum sodium, potassium,  magnesium, creatinine, blood urea nitrogen and, if there were abnormal values, then toxicity was graded and managed according to the Common Terminology Criteria for Adverse Events (CTCAE version 5). The oncologists switched cisplatin to carboplatin if patients could not tolerate cisplatin toxicitiesdnausea and vomiting grade 2-3  which did not resolve despite treatment with appropriate anti-nausea and vomiting medications, persistent increase in serum creatinine >1.5 × sab sauv ib txwm txwv, thiab tsis tu ncua electrolyte tsis txaus (qib 2-3) txawm tias cov kev kho mob tsim los kho cov electrolytes uas tau muab los ntawm nephrologists.

Cov txiaj ntsig

Peb qhov txiaj ntsig tseem ceeb yog qhov tshwm sim ntawm cisplatin-associated AKI (cis-AKI), txhais tau tias yog qhov nce ntxiv hauv cov ntshav creatinine (SCr) 0.3 piv rau cov hauv paus SCr los ntawm lub lim tiam dhau los, nrog cov txiaj ntsig thib ob ntawm Qhov tshwm sim ntawm cisplatin-associated AKD (cis-AKD), txhais tau tias yog qhov nce hauv cov ntshav creatinine 0.3 nruab nrab ntawm pre-cisplatin hauv paus SCr thiab SCr kawg. Qhov kawg SCr tau txhais tias yog SCr 1-4 lub lis piam tom qab ua tiav cov kev kho mob ntawm cisplatin lossis SCr zaum kawg thaum cov neeg mob tawm ntawm kev kho cisplatin.

Kev ncaj ncees

Txhua tus neeg mob tau txais kev tso cai sau ntawv tso cai thiab cov txheej txheem kev tshawb fawb tau pom zoo los ntawm Pawg Neeg Saib Xyuas Kev Ncaj Ncees, Tsev Kho Mob Ramathibodi (MURA 2015/172) thiab ua raws li cov hauv paus ntsiab lus ntawm Kev Tshaj Tawm ntawm Helsinki. Txoj kev tshawb no tau sau npe nrog ClinicalTrials.gov nrog rau tus lej sim ntawm NCT02481518.

Kev txheeb cais

Peb tau sau thiab txheeb xyuas tag nrho cov ntaub ntawv kawg los ntawm lub hom phiaj-to-kho. Rau cov yam ntxwv hauv paus, cov ntaub ntawv txuas ntxiv tau nthuav tawm raws li qhov txhais tau tias ± tus qauv sib txawv rau cov ntaub ntawv ib txwm faib thiab nruab nrab (interquartile ntau) rau cov ntaub ntawv tsis yog parametric. Cov qauv ywj pheej t-test thiab Mann-Whitney U xeem tau siv los txiav txim qhov sib txawv ntawm pawg. Categorical cov ntaub ntawv tau nthuav tawm raws li tus lej (feem pua), thiab Pearson's chi-square test tau siv los sib piv cov ntaub ntawv categorical. Cov qauv sib xyaw linear tau siv los txiav txim siab qhov sib txawv ntawm cov kab hauv qab thiab cov txiaj ntsig tom qab hauv tib pab pawg. Qhov xwm txheej tshwm sim ntawm AKD tau npaj siv Kaplan-Meier nkhaus. Kev ciaj sia tag nrho yog suav nrog Kaplan-Meier txoj kev ciaj sia, siv hnub kuaj mob thiab hnub tuag los ntawm ib qho laj thawj. Cov ntaub ntawv raug txheeb xyuas thiab npaj siv cov kev txheeb xyuas hauv kev tshawb fawb txog kev sib raug zoo (SPSS version 25, IBM, Armonk, NY). AP tus nqi<0.05 was considered statistically significant.

TSEEM CEEB

Kev tso npe kawm

Nyob nruab nrab ntawm lub Plaub Hlis 2015 thiab Lub Peb Hlis 2016, 34 tus neeg mob tau tsim nyog rau txoj kev tshawb no thiab 4 tus neeg mob tsis kam koom nrog; yog li 30 tus neeg mob tau cuv npe. Consolidated Standards of Reporting Trials (CONSORT) flow diagram yog nthuav tawm hauv daim duab 1.

Cov yam ntxwv ntawm lub hauv paus

Feem ntau ntawm cov yam ntxwv ntawm cov neeg mob hauv ob pawg tau sib piv (Table 1). Cov pab pawg Mg tau qis qis dua, thiab muaj cov poj niam cov neeg mob tsawg dua, tab sis qhov sib txawv no tsis tseem ceeb. Baseline pre-cisplatin SCr tau siab dua hauv pawg Mg, thaum eGFR tsis txawv. Txawm hais tias cov pab pawg Mg muaj qis dua hauv cov ntshav qab zib bicarbonate thiab cov ntshav chloride ntau dua, thiab txo cov ntshav siab diastolic, cov kev sib txawv no tau dhau los ua qhov tsis tseem ceeb tom qab kev hloov kho rau ntau qhov kev ntsuam xyuas.

Kawm kev kho mob

Thaum txoj kev tshawb no, cuaj (30 feem pua) cov neeg mob tsis tuaj yeem ua tiav tag nrho cov kev kho mob cisplatin. Kev kho cisplatin tsis tiav los ntawm tsib tus neeg mob hauv pawg tswj hwm vim qib 3 mucositis (n=1), qib 3 neutropenia (n =2), thiab AKI (n =2) , thiab los ntawm plaub tus neeg mob hauv pawg magnesium vim qib 3 neutropenia (n =3) thiab AKI (n =1) ​​(Daim duab 1). Tus naj npawb nruab nrab ntawm cisplatin cycles ua tiav yog rau thiab zoo sib xws rau ob pawg thiab yog li qhov sib xyaw cisplatin ntau npaum li cas sib piv (Table 1).

Kev ntsuas txhua lub limtiam SCr, eGFR, serum potassium, thiab serum magnesium ntsuas tau pom hauv daim duab 2. Piv nrog rau pawg Mg, tau tshwm sim los ntawm lub lis piam 5 thiab 6 rau lub caij nplooj zeeg hauv eGFR thiab ntshav magnesium thiab nce hauv cov ntshav creatinine. nyob rau hauv pab pawg tswj, whereas tsis muaj qhov sib txawv ntawm cov poov tshuaj hauv cov ntshav.

Kev kawm tau tshwm sim

Muaj tsib ntu (3 feem pua) ntawm cis-AKI hauv 164 kev kho mob, txawm hais tias siab dua hauv pawg tswj hwm (4.6 feem pua ​​​​rau 1.3 feem pua), thiab qhov no tsis yog qhov tseem ceeb. Tus nqi txaus ntshai (HR) rau cis-AKI hauv pawg Mg yog 0.19 [95 feem pua ​​​​ntawm kev ntseeg siab (CI) =0.02-2.02, P=0.2] (Table 2). Qhov tshwm sim ntawm cis-AKD yog 26.7 feem pua ​​​​uas siab dua hauv pawg tswj hwm (46.7 feem pua ​​​​vim 6.7 feem pua) thiab HR rau cis-AKD hauv pawg Mg yog 0.082 (95 feem pua ​​​​CI =0.{{29 }}.79, P=0.03).

Thaum xav txog qhov sib txawv hauv SCr ntawm qhov ntsuas hauv qab thiab qhov kawg ntsuas (Daim duab 3), muaj kev nce ntxiv hauv pawg tswj hwm (txhais tau tias SCr nce 0.36, 95 feem pua ​​​​CI=0.{{5 }}.52, P < 0. pawg tswj hwm (txhais tau tias hloov pauv hauv eGFR- 24.7 ml/min ib 1.73 m2, 95 feem pua ​​​​CI =-36.8 rau - 12.6, P =0.001) Nyob rau hauv sib piv rau tsis muaj kev hloov nyob rau hauv pawg Mg. Lub sij hawm los tsim cis-AKD yog luv luv nyob rau hauv pawg tswj (P ¼ 0.007), (Cov duab ntxiv S1, muaj nyob rau ntawm lub website.)

Qhov tseem ceeb, qhov ua tau zoo ntawm kev kho cisplatin zoo ib yam, ob qho tib si ntawm cov lus teb ua tiav (tswj 60 piv rau Mg pawg 64.7 feem pua) thiab nruab nrab OS (mOS) rau ob pawg tom qab CCRT. Lub mOS tau ntev dua nyob rau hauv pawg Mg piv rau cov tswj. [57.6 piv rau 47.6 lub hlis, HR=0.98, 95 feem pua ​​CI=0.36-2.71, P =0.97], tab sis tsis zoo li ntawd.

Cov xwm txheej tsis zoo

Qhov tshwm sim ntawm mucositis thiab neutropenia tsis yog qhov tseem ceeb hauv pawg tswj hwm piv rau pawg Mg (14.1 feem pua ​​​​vim 26.6 feem pua, P =0.12 thiab 2.3 feem pua ​​​​rau 5.1 feem pua ​​, P =0.31 ), raws.

Kev sib tham

Txoj kev tshawb fawb no yog thawj qhov kev sim tshuaj ntsuam xyuas, nrog rau qhov sib piv ntawm kev ntxiv nrog magnesium piv rau cov txheej txheem preloading regimen nyob rau hauv qis-dose txhua lub lim tiam cisplatin chemotherapy rau cov neeg mob uas muaj mob qog noj ntshav thiab lub caj dab. Txawm hais tias qhov tshwm sim ntawm cis-AKI tsis txawv raws li kev txheeb cais, pawg Mg-ntxiv tau muaj qhov tshwm sim ntawm cis-AKD qis dua. Peb thawj qhov txiaj ntsig tau tshwm sim yog qhov tshwm sim ntawm cis-AKI, thiab peb tau kwv yees cov qauv kev tshawb fawb me me raws li cov ntaub ntawv ua ntej tias qhov kev pheej hmoo ntawm magnesium ntxiv rau kev tiv thaiv nephrotoxicity yog w0.2, yog li muab kev tshawb fawb pej xeem. ntawm 100 tus neeg mob. Txawm li cas los xij, tom qab thawj 12 lub hlis kev soj ntsuam ua ntej ntawm thawj 30 tus neeg mob tau pom tias txawm hais tias qhov tshwm sim ntawm cis-AKI (qhov tshwm sim thawj zaug) tsis txawv, muaj qhov sib txawv ntawm qhov tshwm sim ntawm cis-AKD, peb cov txiaj ntsig thib ob. Cov txiaj ntsig no tau raug tshuaj xyuas los ntawm cov kws tshawb nrhiav thiab pab pawg kho mob oncology, thiab txiav txim siab txiav tawm txoj kev tshawb no vim tias muaj kev pheej hmoo siab dua ntawm cis-AKD hauv pawg tswj hwm.

Platinum-based chemotherapy yog dav lees paub tias yog thawj kab kev kho mob rau ntau hom mob qog noj ntshav. Txawm li cas los xij, qhov tsis zoo tshwm sim ntawm cisplatin thiab nws txoj kev tiv thaiv tsis tau kawm zoo. Cisplatin tau tshaj tawm tias yuav ua rau muaj ntau yam ntawm lub raum tsis ua haujlwm xws li AKI mus rau subacute toxicity nrog rau AKD, CKD, raum tubular acidosis, lub raum tubular sodium nkim thiab ua kom pom qhov tsis xws luag thiab electrolyte abnormalities, typified los ntawm hypomagnesemia, thiab hypokalemia. Ntawm qhov tod tes, cisplatin tuaj yeem ua rau cov tubular ua haujlwm tsis zoo nrog Fanconi-zoo li syndrome, tab sis ntawm qhov tod tes, hypomagnesemia potentiates cisplatin tsub zuj zuj hauv tubular hlwb ua rau lub raum raug mob ntau dua.7,9 Lub luag haujlwm ntawm magnesium tseem ua kom tiav. elucidated, raws li uptake ntawm cisplatin rau hauv thiab tawm ntawm lub raum tubular cell yog tswj los ntawm cov tooj liab transporter (Ctr1) thiab cov organic cation transporter (Oct2). Txawm li cas los xij, magnesium ions raug lees paub los sib tw nrog cov organic cations rau qhov chaw sib khi hauv cov channel pore ntawm Oct2. Yog li, yog tias muaj magnesium tsawg, ces cisplatin ntau tuaj yeem tuaj yeem nkag mus rau hauv lub cell mus txog Lub Kaum Hli 2, qhov ntau magnesium nyob rau hauv lub raum tubule, ces qhov kev sib tw ntau dua rau kev thauj mus los thiab txo qis hauv cellular uptake ntawm cisplatin.

Ib qho kev soj ntsuam yav dhau los ntawm cov neeg mob uas mob qog noj ntshav taub hau thiab caj dab kho nrog cov koob tshuaj qis txhua lub lim tiam cisplatin qhia hypomagnesemia tom qab thib rau ntawm kev kho cisplatin txawm tias muaj magnesium supplementation.2 Hauv peb txoj kev tshawb fawb, peb pom tias cov ntshav magnesium tau qis dua tom qab lub lim tiam thib tsib hauv pab pawg tswj, whereas magnesium concentrations tau tuav hauv pawg Mg. Ib yam li ntawd, muaj kev poob qis hauv eGFR tom qab lub lim tiam thib tsib hauv pawg tswj hwm, tab sis tsis yog nyob rau hauv pawg Mg, qhia tias tsawg dua lub raum tubular puas los ntawm cisplatin ua rau cov tubular magnesium nkoos tsawg thiab lub raum tsis zoo. Qhov tshwm sim ntawm cis-AKI tsis txawv ntawm pawg; Txawm li cas los xij, qhov tshwm sim ntawm cis-AKD tau siab dua thiab lub sijhawm rau cis-AKD luv dua hauv pawg tswj hwm. Thaum xav txog kev hloov pauv hauv SCr los ntawm cov hauv paus ntsiab lus, qhov nce ntau dua hauv pawg tswj hwm. Txawm li cas los xij, ib qho yuav tsum xav txog tias lwm yam xws li kev noj haus thiab kev tawm dag zog lub cev tuaj yeem cuam tshuam rau cov ntshav creatinine. Ib tus neeg mob hauv pawg tswj hwm tau tsim cov mucositis hnyav, uas tuaj yeem txo qis kev noj zaub mov noj, thaum tsis muaj tus neeg mob tau sau tseg tias muaj kev txom nyem los ntawm mucositis loj hauv pawg Mg.

Peb cov kev tshawb fawb cov ntaub ntawv qhia txog qhov cuam tshuam ntawm cisplatin ntawm lub raum ua haujlwm uas feem ntau yog subacute, yog li cov kws kho mob yuav tsum ua tib zoo saib xyuas tsis yog rau cis-AKI piv ua ntej thiab tom qab koob tshuaj SCr tab sis kuj rau cis-AKD sib piv tom qab koob tshuaj SCr nrog thawj zaug ua ntej. - Cov kws khomob hauv paus SCr.

Qhov tseem ceeb tshaj, tau muaj kev txhawj xeeb tias kev kho mob uas txo cov cisplatin nephrotoxicity kuj tseem tuaj yeem txo cov cisplatin nkag mus rau hauv cov qog hlwb ua rau txo qis kev ua haujlwm ntawm cisplatin. Raws li magnesium nyob rau hauv peb txoj kev tshawb fawb tau muab tau sai heev raws li ib feem ntawm cov hlab ntim load, qhov no yuav ua rau yuam diuresis nrog nce raum tubular magnesium poob, yog li tsis zoo li yuav muaj kev cuam tshuam sab nraum lub raum. Reassuringly, cov qauv tsiaj tau pom tias magnesium supplementation tsis cuam tshuam cov qog cell tua cov haujlwm, 7,9, thiab cov ntaub ntawv soj ntsuam los ntawm cov kev tshawb fawb qhia txog kev txo qis cisplatin nephrotoxicity tsis tau pom tias txo cov kev siv tshuaj khomob hauv cov neeg mob ntsws thiab zes qe menyuam.11,12 Peb kuj tshaj tawm hais tias ib tug magnesium-preloading regimen txo qhov tshwm sim ntawm cis-AKD yam tsis tau txo cov tshuaj chemotherapeutic nyhuv ntawm rov qab koob tshuaj tsawg nyob rau hauv cov neeg mob kho mob cancer taub hau thiab caj dab. Tsis tas li ntawd, qhov cuam tshuam ntev ntawm cisplatin ntawm lub raum ua haujlwm xws li CKD yuav tsum tau piav qhia hauv kev tshawb fawb ntxiv.

Cov lus xaus

Peb txoj kev tshawb fawb ntawm kev siv tshuaj magnesium-preloading nrog 16 mEq txo qis cis-AKD yam tsis tau txo qis kev kho mob mus sij hawm ntev ntawm cov tshuaj tua kab mob qis cisplatin hauv cov neeg mob qog noj ntshav thiab lub caj dab. Ntxiv qhov loj-loj randomized tswj kev sim yog xav tau kom paub meej tias cov txiaj ntsig txhawb nqa.

TXOJ CAI

Peb lees paub qhov kev pab cuam tseem ceeb los ntawm cov kws tshawb fawb thiab kws muag tshuaj hauv tsev kho mob sab nraud, Lub Tsev Haujlwm Saib Xyuas Tshuaj, Kws Kho Mob, Tsev Kho Mob Ramathibodi, Mahidol University, Bangkok, Thaib teb.

NYIAJ

Kws Qhia Tshuaj, Tsev Kho Mob Ramathibodi, Mahidol University, Bangkok, Thaib teb (piv txwv li IO R11059028). Cov nyiaj tau los tsis muaj lub luag haujlwm hauv kev tsim cov kev tshawb fawb no thiab yuav tsis muaj lub luag haujlwm thaum nws ua tiav, tshuaj xyuas, txhais cov ntaub ntawv, lossis kev txiav txim siab xa cov txiaj ntsig.

Qhia tawm

Cov kws sau ntawv tau tshaj tawm tias tsis muaj kev cuam tshuam ntawm kev txaus siab.

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