Kev nce qib hauv kev kuaj mob thiab kev kho mob ntawm cov kab mob tsis xws luag thiab pob txha metabolism hauv kab mob raum ntev hauv 2023Ⅱ

3. Osteoporosis

Pib los ntawm CKD theem 3, qhov tshwm sim ntawm osteoporosis hauv cov neeg mob maj mam nce. Qhov tshwm sim ntawm cov pob txha mob thiab pob txha pob txha hauv cov neeg mob dialysis yog ntau dua li cov neeg mob uas tsis tau lim ntshav. Kev xyuam xim rau kev tiv thaiv thiab kev kho mob pob txha hauv cov neeg mob CKD tau dhau los ua ib feem tseem ceeb ntawm kev tswj hwm CKD-MBD.

Nyem rau Cistanche rau mob raum

1. Kev kho Etecatide tuaj yeem txhim kho pob txha zoo

Cov kws tshawb fawb ntawm Baylor University hauv Tebchaws Meskas tau tshawb fawb txog qhov cuam tshuam ntawm kev kho exenatide ntawm cov pob txha zoo hauv cov neeg mob hemodialysis nrog SHPT. Txoj kev tshawb no tau siv sijhawm li 36 lub lis piam, thiab tag nrho ntawm 22 tus neeg mob tau suav nrog, 13 tus neeg ua tiav qhov kev soj ntsuam. Cov txiaj ntsig ntawm txoj kev tshawb fawb pom tau tias tom qab 36 lub lis piam ntawm kev kho mob, tus neeg mob PTH qib tau txo qis los ntawm 67%, thaum cov pob txha ceev ntawm tus txha nraub qaum, femoral caj dab, thiab tag nrho lub duav nce los ntawm 3%, 7%, thiab 3%. Spinal cancellous pob txha qhab nia nce 10%, raws li tau ua radial pob txha txhav thiab tsis ua hauj lwm load. Txawm li cas los xij, pob txha biopsies qhia tau tias txo cov pob txha tsim. Zuag qhia tag nrho, txoj kev tshawb fawb pom tau hais tias kev kho exenatide tuaj yeem txhim kho cov pob txha pob txha pob txha pob txha pob txha thiab cov pob txha trabecular zoo ntawm cov neeg mob tom qab 36 lub lis piam ntawm kev kho mob thaum txo cov pob txha rov qab yam tsis muaj kev cuam tshuam cov khoom ntawm cov pob txha. Qhov kev tshawb pom no muab cov ntaub ntawv soj ntsuam tseem ceeb rau seb kev kho tshuaj ntawm SHPT tuaj yeem txhim kho pob txha ceev hauv cov neeg mob SHPT ntau npaum li kev phais parathyroidectomy.

2. Desosumab (dialysis + nephropathy)

Denosumab yog tib neeg monoclonal antibody uas ua rau RANKL los tiv thaiv kev tsim osteoclast, txo cov pob txha resorption, nce pob txha ceev, thiab txo qhov kev pheej hmoo ntawm pob txha. Nws tau tsim tawm hauv EU hauv xyoo 2010 rau kev kho mob pob txha, tshwj xeeb tshaj yog rau cov poj niam postmenopausal thiab cov txiv neej uas muaj kev pheej hmoo siab ntawm pob txha. Nws tau tsim tawm hauv Suav teb thaum Lub Rau Hli 2020 thiab tau txhaj tshuaj subcutaneously txhua 6 lub hlis. Nws yog ib qho kev kho mob zoo rau cov neeg mob uas muaj mob osteoporosis thiab malignant qog pob txha metastasis, tshwj xeeb tshaj yog cov neeg uas muaj hypercalcemia, txhim kho cov neeg mob lub neej zoo thiab txo txoj kev pheej hmoo ntawm pob txha.

Vim hais tias denosumab tuaj yeem siv los kho cov pob txha hauv cov neeg mob uas muaj qhov sib txawv ntawm qhov ntsuas glomerular pom, thiab txawm tias hauv kev kho mob ntawm cov pob txha qis, nws kuj tseem siv tau rau cov neeg mob lim ntshav, tsis zoo li lwm cov tshuaj tiv thaiv kab mob hauv cov neeg mob uas muaj lub raum tsis ua haujlwm. txwv tsis pub. Thaum Lub Ib Hlis 19, 2024, US Food and Drug Administration (FDA) tau tshaj tawm lub thawv dub ceeb toom txog "cov tshuaj tiv thaiv kab mob osteoporosis denosumab ua rau muaj kev pheej hmoo ntawm hypocalcemia hauv qib siab CKD" thiab ntseeg tias denosumab tuaj yeem ua rau muaj kev pheej hmoo ntawm hypocalcemia hnyav hauv qib siab. CKD. Sumumab ua rau muaj kev pheej hmoo ntawm hypocalcemia hnyav hauv cov neeg mob uas muaj CKD siab heev, tshwj xeeb tshaj yog cov neeg mob ntshav qab zib. Cov kws kho mob yuav tsum muab qhov tseem ceeb rau nws. Tom qab siv tshuaj, cov ntshav calcium concentration yuav tsum tau saib xyuas kom zoo, thiab kev kho calcium thiab vitamin D yuav tsum tau ntxiv yog tias tsim nyog.

4. Kev tiv thaiv thiab kho vascular calcification (VC)

1. VC yog qhov tseem ceeb ntawm kev pheej hmoo rau CKD kev loj hlob

Tam sim no muaj cov ntaub ntawv pov thawj kev kho mob tsawg tsawg ntawm VC. Tuam Tshoj Dialysis Calcification Study (CDCS) coj los ntawm Academician Liu Zhihong luam tawm ib qho kev kawm tseem ceeb hauv JAMA Netw Open journal hauv 2023 [3]. Txoj kev tshawb no tau ua raws li 1,489 Suav cov neeg mob ntshav lim ntshav mus txog 4 xyoos thiab pom tias VC muaj ntau heev thiab muaj kev loj hlob sai hauv cov neeg no, nrog rau kev loj hlob ntawm calcification hauv cov hlab ntsha, plab aorta, thiab lub plawv li qub tau ntau dua. Cov txiaj ntsig ntawm kev tshawb fawb tau taw qhia tias cov hnub nyoog siab tshaj thiab nce qib fibroblast kev loj hlob 23 qib yog ib qho tseem ceeb ntawm kev pheej hmoo rau kev loj hlob ntawm VC. Tsis tas li ntawd, kev tswj cov ntshav calcium, phosphorus, thiab PTH qib ntawm lub hom phiaj txo qhov kev pheej hmoo ntawm cov hlab ntsha calcification, uas cuam tshuam nrog kev pheej hmoo ntawm cov hlab plawv thiab kev tuag. Cov txiaj ntsig kev tshawb fawb no muab cov ntaub ntawv tseem ceeb rau kev txhim kho kev tswj hwm ntawm cov neeg mob lim ntshav, tshwj xeeb tshaj yog hauv kev cuam tshuam nrog CKD-MBD, thiab pab tsim cov kev kuaj mob tsim nyog thiab cov tswv yim kho mob txhawm rau txhim kho kev noj qab haus huv ntawm cov neeg mob lim ntshav.

2. Magnesium txhim kho VC hauv cov neeg mob CKD

Magnesium, raws li ib qho ntawm cov kab tseem ceeb rau tib neeg lub cev, ua lub luag haujlwm tseem ceeb hauv kev tiv thaiv kab mob plawv. Hauv ntau hom tsiaj ntawm CKD VC, nws tau raug lees paub tias magnesium supplementation tuaj yeem ncua sijhawm lossis thim rov qab qhov kev loj hlob ntawm VC, tab sis tseem tsis muaj pov thawj txaus hauv kev tshawb fawb soj ntsuam.

Nyob rau lub Tsib Hlis 2023, pab pawg Danish Lain Bressendorff [4] tau luam tawm ib qho kev sib tw, ob qhov muag tsis pom kev, cov placebo, pawg tswj hwm kev sib tham hauv JASN phau ntawv xov xwm los ntsuas qhov cuam tshuam ntawm qhov ncauj magnesium supplementation ntawm kev nce qib ntawm CKD VC. Cov ntsiab lus tau muab tso rau qhov ncauj magnesium hydroxide lossis placebo ob zaug ib hnub rau 12 lub hlis. Cov txiaj ntsig ntawm txoj kev tshawb fawb tau pom tias txawm hais tias plasma magnesium tau nce ntxiv hauv pawg magnesium ntxiv piv nrog cov placebo pab pawg, tsis muaj kev txhim kho tseem ceeb hauv VC kev loj hlob. Txoj kev tshawb no qhia tau hais tias kev kho mob, magnesium supplementation ib leeg tsis tuaj yeem ncua kev loj hlob ntawm VC, thiab lwm cov tswv yim kho mob yuav tsum tau ua ke nrog kev cuam tshuam rau CKD ntsig txog kab mob plawv. Intracellular magnesium ua hauj lwm pab raws li ib tug cofactor rau ATP thiab ntau enzymes thiab transporters thiab yog ib qho tseem ceeb rau lub cev lub cev lub zog metabolism, uas yog reflected nyob rau hauv kev loj hlob ntawm cov kab mob txuam nrog imbalances nyob rau hauv magnesium homeostasis. Cov kab ke tswj hwm ntawm magnesium homeostasis suav nrog kev tswj cov plab hnyuv magnesium nqus, khaws pob txha, thiab lub raum magnesium excretion. Ib txoj kev tshawb fawb luam tawm nyob rau hauv NDT nyob rau tib lub xyoo raws li US NHANES database [5] pom tias magnesium noj cov qhab nia uas suav nrog magnesium metabolism hauv (xws li haus cawv, noj PPI proton twj tso kua mis inhibitors, diuretics, thiab lub raum tsis txaus) yog txuam nrog kev pheej hmoo ntawm plab aortic calcification. Hais txog, kev cuam tshuam ntawm lub raum magnesium metabolism thiab magnesium noj yam tseem ceeb ntawm magnesium homeostasis yog hais txog. Yog li ntawd, nyob rau hauv lub neej yav tom ntej tus kheej kev kuaj mob thiab kev kho mob, ntau yam ntawm magnesium noj nyob rau hauv cov neeg mob yuav tsum tau soj ntsuam tag nrho, tshwj xeeb tshaj yog rau cov neeg laus nrog CKD. Thaum ntxiv magnesium, qhov cuam tshuam ntawm magnesium noj yam xws li proton twj tso kua mis inhibitors thiab diuretics yuav tsum tau txiav txim siab. Tseem muaj ntau yam tsis paub nyob rau hauv cheeb tsam no uas tsim nyog kawm ntxiv.

3. Cov nyhuv ntawm vitamin K supplementation ntawm CKD VC

Ntau qhov kev tshawb fawb yav dhau los tau pom tias qib ntawm cov tsis-phosphorylated-uncarboxylated stromal gla protein (dp-ucMGP) yog ib qho kev kwv yees ntawm kev nce VC hauv cov neeg mob CKD. stromal gla protein / stromal -carboxyglutamate protein (MGP) Nws yog ib qho inhibitor ntawm cov ntaub so ntswg calcification thiab muaj peev xwm khi thiab inhibit qhov kev loj hlob ntawm calcium crystals. Tsis muaj vitamin K2 yuav ua rau txo qis hauv carboxylated MGP protein, nce dp-ucMGP, thiab tom qab ntawd qhov tshwm sim ntawm VC. Cov kev tshawb fawb hauv chav kuaj thiab tsiaj txhu tau pom tias vitamin K tuaj yeem ua kom cov matrix -carboxyglutamate protein (MGP) tau los ntawm vascular du leeg hlwb thiab chondrocytes los ntawm carboxylation, yog li inhibiting qhov tshwm sim thiab kev loj hlob ntawm VC, qhov uas tsis yog-activated lub xeev ntawm dp-ucMGP yog. cuam ​​tshuam nrog rau kev nce qib ntawm VC [6].

Txhawm rau txheeb xyuas seb qhov ncauj vitamin K2 ntxiv tuaj yeem ua rau qeeb ntawm CKD VC, Sabrina Haroon li al [7] tau ua ib lub chaw, kev cia siab, thiab kev sim tshuaj loj tshaj plaws hauv cov neeg Esxias mus txog rau niaj hnub no. Txoj kev tshawb no pom tau hais tias txawm tias qhov txo qis hauv dp-ucMGP, vitamin K2 supplementation tsis tau txo VC kev loj hlob raws li ntsuas los ntawm coronary artery calcium qhab nia. Ib qho kev ntsuam xyuas meta-tshaj tawm los ntawm CKJ tau pom [8] tias kev ntxiv cov vitamin K tsis muaj txiaj ntsig rau kev tuag hauv cov neeg mob lim ntshav thiab tsis pom muaj txiaj ntsig zoo hauv kev thim cov qhab nia calcium. Piv nrog cov vitamin K2, vitamin K1 tau pom tias muaj txiaj ntsig zoo dua hauv kev txo cov qib dp-ucMGP.

Hauv cov ntsiab lus, txawm hais tias cov ntaub ntawv tseem ceeb thiab cov kab mob sib kis tau txhawb nqa lub luag haujlwm ntawm magnesium thiab vitamin K hauv VC, tam sim no tsis muaj pov thawj zoo rau kev siv cov vitamin K niaj hnub hauv CKD. thiab qhov tsim nyog ntawm magnesium supplementation. Nws tuaj yeem piav qhia tau tias VC hauv CKD, tshwj xeeb tshaj yog nyob rau hauv cov neeg mob hemodialysis, tej zaum nyob rau hauv lub xeev irreversible. Yog li ntawd, nws yog ib qho tseem ceeb heev los cuam tshuam rau theem pib ntawm CKD los tiv thaiv qhov tshwm sim ntawm VC. Tsis tas li ntawd, tam sim no muaj qee qhov kev tsis sib haum xeeb txog kev siv VC qhab nia raws li qhov tshwm sim ntawm kev kho mob. Txawm hais tias muaj lwm yam kev muaj peev xwm los txhais cov kev nce qib VC tsim nyog tau txais kev tshawb fawb ntxiv thiab kev pom zoo. Xav txog qhov nyuaj ntawm pathogenesis ntawm VC nyob rau hauv qhov chaw ntawm uremia thiab lub luag hauj lwm txwv ntawm magnesium thiab vitamin K, compound noj kev pab txhawb nqa kev kho mob thiab cov phiaj xwm kev kho mob tshiab tej zaum yuav yog yav tom ntej kev tshawb fawb cov lus qhia rau kev tiv thaiv ntawm VC hauv CKD.

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 rau lub raum kev noj 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.