Kev nce qib hauv kev kuaj mob thiab kev kho mob ntshav qab zib nephropathy
Apr 08, 2024
Thaum Lub Peb Hlis 30, Xib Fwb Wang Rong los ntawm Lub Tsev Kho Mob Shandong Provincial Tsev Kho Mob tau hais lus qhuab qhia txog "Kev nce qib hauv kev kuaj mob thiab kev kho mob ntshav qab zib nephropathy" ntawm 11th West Lake Forum ntawm Kev Txhim Kho Tshiab hauv Nephrology.
1. Kev nkag siab zoo ntawm DN mus rau DKD
Xib fwb Wang Rong tau hais tias nyob rau xyoo tas los no, vim muaj coob tus neeg mob ntshav qab zib nce ntxiv thoob ntiaj teb, ntshav qab zib tau dhau los ua qhov tseem ceeb ntawm cov kab mob raum ntshav qab zib (DKD), ua rau muaj kev phom sij loj. Txawm li cas los xij, vim yog qhov nyuaj pathogenesis ntawm DKD thiab tsis muaj lub hom phiaj tshwj xeeb cuam tshuam, kev kho mob tsis zoo, thiab nws ntsib teeb meem loj hauv kev tiv thaiv thiab kev kho mob. Lub tswv yim ib txwm muaj yog tias ntshav qab zib nephropathy (DN) yog ib qho teeb meem microvascular tshwm sim los ntawm ntshav qab zib, tab sis nrog kev tshawb fawb tob tob, 2007 National Kidney Foundation / KDOQI Cov Lus Qhia ntseeg tias DKD hais txog cov kab mob raum mob los ntawm cov ntshav qab zib; Mob ntshav qab zib Glomerular kab mob hais txog kev hloov pauv hauv glomeruli los ntawm ntshav qab zib uas tau lees paub los ntawm lub raum biopsy. Hauv xyoo 2014, American Diabetes Association thiab National Kidney Foundation tau txais kev pom zoo, hais tias qhov kev kuaj mob ntawm DKD suav nrog kwv yees li glomerular filtration rate (eGFR)<60 ml/(min·1.732) or a urinary albumin-to-creatinine ratio higher than 30 mg. /g lasts for more than 3 months.
Nyem rau Cistanche rau mob raum
Kev kuaj mob ntawm DN feem ntau yog ua raws li cov yam ntxwv ntawm cov kab mob pathological thiab txhais tau tias muaj proteinuria nrog retinopathy hauv cov neeg mob ntshav qab zib hom 1. Lub xub ntiag ntawm proteinuria yog suav hais tias yog ib qho kev qhia ntxov ntawm cov mob ntshav qab zib glomerulopathy, uas yog tus cwj pwm los ntawm glomerular basal Membrane thickening, endothelial raug mob, mesangial hyperplasia thiab nodules, thiab podocyte poob. Kev kuaj mob ntawm DKD yog nyob ntawm cov yam ntxwv kho mob thiab kuaj pom los ntawm albuminuria thiab / lossis eGFR raws li ntshav qab zib. Raws li qhov tseeb txhais ntawm 2020 KDIGO cov lus qhia kev kho mob, DKD tsis hais tshwj xeeb rau cov kab mob phenotypes, suav nrog cov kab mob glomerular uas tsis yog classical. thiab tubulointerstitial kab mob. Nws tuaj yeem pom tias DKD yog thawj theem kev nkag siab ntawm DN hloov tshiab.
2. Kev nkag siab ntawm irreversible mus rau reversible urinary microprotein
Lub sijhawm ncua sij hawm yog qhov zoo rau cov ntshav qab zib hom 1; rau hom 2 mob ntshav qab zib mellitus, ncua sij hawm tuaj yeem sib txawv. Nws tau ntseeg yav dhau los tias qhov nce siab ntawm cov zis albumin yog qhov ntxov tshaj plaws kuaj pom biomarker ntawm cov ntshav qab zib glomerulopathy. Cov kev tshawb fawb tom qab tau pom tias qhov poob qis hauv eGFR muaj txiaj ntsig ntau dua, vim tias eGFR tuaj yeem txo qis ua ntej lossis tsis muaj albuminuria thiab txawm tias mus rau theem kawg ntawm lub raum kab mob.
Tam sim no, txoj kev loj hlob ntawm microalbuminuria tsis suav tias yog ib qho kev hloov pauv tsis tau ntawm DKD, thiab kev tso tawm ntawm microalbuminuria tshwm sim raws li qhov tshwm sim tshwm sim. Cov kev tshawb fawb tau pom tias qhov tso tawm ntawm microalbuminuria hauv cov neeg mob uas muaj hom 1 lossis hom 2 mob ntshav qab zib mellitus yog li ntawm 21% txog 64%. Txawm li cas los xij, kev thim rov qab ntawm cov proteinuria hauv hom 1 thiab hom 2 mob ntshav qab zib yog txawv. Hauv hom 1 mob ntshav qab zib mellitus, qhov nce nruab nrab ntawm cov zis microalbumin mus rau qib ib txwm yog ib qho tshwm sim. Qhov tshwm sim no kuj tshwm sim hauv hom 2 mob ntshav qab zib, tab sis qhov tshwm sim qis dua li hom 1. Nyob rau hauv ib pawg ntawm 386 cov neeg mob ntshav qab zib hom 1 uas tau nce qib ntawm cov zis albumin, 59% tau txiav txim siab me me ntawm albuminuria tom qab 6 xyoo, thiab Tsuas yog 19% tau nce mus rau qib siab ntawm cov zis albumin.
Cov laj thawj cuam tshuam rau kev tso zis tso zis muaj xws li hypoglycemia: glycated hemoglobin<8%; hypotension: systolic blood pressure <115 mmHg (1 mmHg=0.133 kPa); hypolipidemia: total cholesterol <5.12 mmol/L, triacylglycerol <1.64 mmol/ L, Urinary protein excretion rates can be consistently reduced in patients receiving medications such as renin-angiotensin system blockers. In addition, the remission of proteinuria is also related to the reduction of eGFR decline, and controlling blood pressure and improving blood sugar are independent predictors of proteinuria remission.
3. Tsis yog-albuminuric DKD thiab albuminuric DKD
Kev txiav txim siab los ntawm cov ntaub ntawv kho mob tam sim no, albuminuric DKD thiab albuminuric DKD qhia cov yam ntxwv hauv qab no: (1) Piv nrog albuminuric DKD, qhov feem ntau ntawm cov ntshav qab zib retinopathy hauv cov neeg mob uas tsis yog-albuminuric qis dua (10 feem) %-43% thiab 22 %-62%), qhov tshwm sim ntawm cov hlab ntsha loj zoo sib xws. (2) Ib txoj kev tshawb fawb tau ua rau lub raum biopsy ntawm cov neeg mob ntshav qab zib mellitus nrog kev tso tawm albumin ib txwm thiab pom tias cov kab mob tshwm sim muaj xws li mob ntshav qab zib glomerular lesions, cov kab mob feem ntau cuam tshuam nrog cov hlab ntsha thiab lub raum tubulointerstitium, thiab cov kab mob uas tsis yog tshwj xeeb. (3) DKD zoo li ua tau qeeb qeeb hauv cov neeg mob ntshav qab zib yam tsis muaj albuminuria. Tsis tas li ntawd, cov neeg mob uas tsis yog-albuminuric DKD thiab albuminuric DKD muaj kev pheej hmoo siab ntawm cov kab mob plawv.
4. Kev kuaj mob thiab kev nce qib ntawm DKD
1. Tswj kev kuaj mob
Diabetes combined with kidney damage cannot be defined as DKD. If any of the following conditions occur, other causes should be considered. (1) Severe albuminuria (i.e. >300 mg/d or mg/g) within 5 years of the onset of type 1 diabetes. (2) eGFR decreases rapidly [eGFR decreases >5 ml / (min·1.73m2) ib xyoos]. (3) Proteinuria nce sharply los yog nephrotic syndrome tshwm sim. (4) Cov zis tso zis qhia tau tias muaj kev ua haujlwm xws li cov qe ntshav liab txawv txav thiab cov qe ntshav dawb pov tseg. (5) Cov tsos mob lossis cov tsos mob ntawm lwm yam kab mob, xws li kab mob lupus erythematosus.
2. Cov txheej txheem kuaj mob
Persistent urinary microalbumin and/or persistent decrease in eGFR includes: (1) If regular urine sample collection and measurement are used, albuminuria is defined as urinary albumin ≥ 30 mg/d. (2) If the random urine albumin/creatinine ratio is used to estimate the excretion rate, it is defined as a ratio >30 mg/g. (3) Txo eGFR txhais tau tias yog eGFR<60 ml/(min·1.73m2) measured using a creatinine-based formula. (4) Albuminuria or reduced eGFR persists for at least 3 months.
3. Kev nce qib hauv kev kuaj mob ntawm DKD
Albuminuria thiab qis eGFR muaj qhov tsis zoo hauv kev kuaj pom DKD thaum ntxov, cuam tshuam kev kuaj mob thiab kev kwv yees ntawm DKD thaum ntxov thiab cuam tshuam rau kev txhim kho kev tshawb fawb tshiab ntawm kev kho mob ntxov thiab kev tiv thaiv kab mob. Ob peb lub voj voog thiab cov zis biomarkers tam sim no nyob rau hauv kev kho mob raws li kev kuaj mob thiab cov cuab yeej prognostic, tab sis tam sim no tsis muaj nyob rau hauv kev kho mob siv. Kev nce qib hauv kev kuaj mob ntawm DKD suav nrog cov hauv qab no: (1) Ntxiv rau cov zis albumin, cov cim kev raug mob glomerular kuj suav nrog cov zis hloov pauv, zis IgG, thiab zis hom IV collagen. (2) Cov cim kab mob thiab cov kab mob fibrosis yog cov neeg ua pov thawj ywj pheej ntawm CKD kev loj hlob hauv hom 1 mob ntshav qab zib thiab hom 2 mob ntshav qab zib. (3) Cov qhab nia siab CKD273 muaj feem cuam tshuam nrog qhov tshwm sim ntawm albuminuria hauv hom 2 mob ntshav qab zib. (4) Serum galectin -3 qib, uas koom nrog hauv kev txhawb nqa lub raum thiab lub plawv fibrosis, nws tus kheej cuam tshuam nrog ob npaug ntawm cov ntshav creatinine thiab proteinuria tshwm sim hauv hom 2 mob ntshav qab zib. (5) Cov kab mob sib kis tau koom nrog qhov tshwm sim thiab kev txhim kho ntawm DKD mus rau qib sib txawv, xws li TNF-a, IL-1, IL-6, thiab IL-18. (6) Fibrosis mediators xws li TGF- 1 yog tus yuam sij rau fibrosis hauv ntshav qab zib raum raug mob.
5. Kev kho mob ntawm DKD
Hais txog kev kho DKD, xibfwb Wang Rong tau qhia cov ntsiab lus hauv qab no:
(1) Kev tswj hwm hypoglycemic ntawm DKD. Cov neeg mob uas tsis tau lim ntshav: Qhia txog kev tswj tus kheej. Cov neeg mob uas tsis tau lim ntshav yuav tsum tswj glycated hemoglobin (HbA1c). Rau cov neeg uas muaj kev pheej hmoo ntawm hypoglycemia, nws tsis pom zoo kom HbA1c qis dua 7.0%, vim lawv lub neej expectancy luv dua. Rau cov neeg uas muaj comorbidities thiab txaus ntshai ntawm hypoglycemia, lub hom phiaj tswj HbA1c yuav tsum tau so kom tsim nyog, tsis pub ntau tshaj 7% mus rau 9%. Cov neeg mob dialysis: Qhov zoo tshaj plaws HbA1c cuam tshuam nrog kev ntsuas ntawm cov neeg mob lim ntshav tseem tsis tau txiav txim siab. Nws raug pom zoo kom teem lub hom phiaj HbA1c ntawm 7% mus rau 8%; rau cov neeg mob uas tseem hluas (<50 years old) and have no obvious comorbidities, an HbA1c close to 7% is recommended. Goal: In older patients with multiple comorbidities, HbA1c targets approach 8%.
(2) Kev kho tshuaj. Renin-angiotensin system blockers tau ua lub hauv paus ntawm DKD tswj tau ntau xyoo lawm, raws li cov kev tshawb fawb zoo randomized. Rau cov neeg mob uas muaj hom 1 lossis hom 2 mob ntshav qab zib mellitus nrog DKD thiab hnyav hnyav albumin, nws raug pom zoo tias cov tshuaj tiv thaiv kev mob ntshav siab suav nrog angiotensin-hloov enzyme inhibitors (ACEI) lossis angiotensin II receptor blockers (ARB). Tsis txhob sib koom ua ke ntawm ACE inhibitors thiab ARBs, thiab yuav tsum tsis txhob siv cov tshuaj no nrog renin-angiotensin system blocker. Rau cov neeg mob uas muaj ntshav qab zib hom 2 uas tseem muaj DKD thiab hnyav hnyav albumin txawm tias angiotensin suppression, sodium-glucose cotransporter 2 raug pom zoo. Hauv DKD cov neeg mob uas txo eGFR, glucagon-zoo li peptide{11}} receptor agonists tuaj yeem txhim kho cov hlab plawv thiab lub raum tau zoo thaum tswj cov ntshav qabzib. Nyob rau hauv lub neej yav tom ntej, yuav muaj qee qhov kev nce qib hauv kev tshawb fawb tshuaj kho mob, suav nrog cov tsis xaiv phosphodiesterase inhibitors, vitamin D analogs, qib siab glycation end-product inhibitors, endothelin receptor inhibitors, thiab lwm yam, thiab yav tom ntej yuav tsum tau siv tshuaj kho mob. .
6. Cov ntsiab lus
Thaum kawg, xibfwb Wang Rong tau xaus lus li no: (1) Cov txiaj ntsig kev kho mob ntawm DKD sib txawv heev, thiab cov txheej txheem ntawm tus kab mob tsis yog ib leeg lossis ib leeg. (2) Cov yam ntxwv uas ua rau muaj kev daws teeb meem ntawm albuminuria hauv DKD: tswj cov ntshav qab zib kom zoo, txo cov ntshav siab, txo qis tag nrho cov cholesterol thiab triacylglycerol. (3) Tsawg dua yuav tsum tau muab tso rau hauv cov txheej txheem ntawm cov proteinuria, thiab yuav tsum tau saib xyuas ntau dua rau cov txheej txheem uas pib thiab txhawb kev poob qis hauv lub raum ua haujlwm thiab thaum kawg ua rau mob raum kawg. (4) Rau cov neeg mob uas muaj hom 1 lossis hom 2 mob ntshav qab zib mellitus nrog DKD thiab hnyav hnyav hnyav albumin, nws raug pom zoo tias cov tshuaj tiv thaiv ntshav siab suav nrog ACEI lossis ARB. Kev sib xyaw ua ke ntawm ACEI lossis ARB yuav tsum zam, thiab ib qho ntawm cov tshuaj no yuav tsum tsis txhob siv nrog renin-angiotensin. ua ke nrog cov tshuaj hormones system blockers. (5) Rau cov neeg mob uas muaj hom 2 mob ntshav qab zib mellitus uas tseem muaj DKD thiab ua rau mob hnyav hnyav tom qab siv angiotensin inhibitors, sodium-glucose cotransporter 2 raug pom zoo. (6) Hauv DKD cov neeg mob uas txo eGFR, glucagon-zoo li peptide -1 receptor agonists tuaj yeem txhim kho cov hlab plawv thiab lub raum tau zoo thaum tswj ntshav qab zib.
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 cov stems qhuav ntawm Cistanche deserticola, 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 tswv yim.
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 cov kab mob hauv lub 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 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.
