Kev Tshawb Fawb Txog Kev Tiv Thaiv Kab Mob Nephritis hauv 2023 Ⅰ

IgA nephropathy (IgA)

(1) Ntau haiv neeg genome-wide koom haum meta-analysis qhia ntau tshaj 30 IgAN susceptibility noob

Thaum Lub Xya Hli 2023, "Nature Genetics" tau luam tawm qhov kev tshawb fawb loj tshaj plaws ntawm cov noob caj noob ces ntawm IgAN rau hnub tim. Txoj kev tshawb no tau ua ib qho kev soj ntsuam genome-wide koom haum (GWAS)-meta-analysis ntawm 10 146 IgAN cov neeg mob thiab 28 751 tswj thiab pom 30 tus kheej muaj kev pheej hmoo loj loci, txhawb nqa tias IgAN yog kab mob polygenic. Qhov qhab nia ntau dua polygenic tsis tsuas yog ua rau muaj kab mob ua rau muaj kev phom sij tab sis kuj ua rau muaj kev pheej hmoo ntawm kev loj hlob mus rau uremia. Ntau yam kev soj ntsuam hauv qhov kev tshawb fawb no tau pom tias kev tswj hwm ntawm IgA ntau lawm yog tswj los ntawm caj ces thiab tseem yog txoj hauv kev tseem ceeb ntawm IgAN. Ntau cov kab mob pathogenic ntawm IgAN yog los ntawm kev tiv thaiv cov ntaub so ntswg extrarenal, cov hlwb hematopoietic, thiab cov hnyuv mucosal. Susceptibility genes yog enriched nyob rau hauv ib co interventional cytokine ligand-receptor khub, muab cov ntsiab lus tseem ceeb rau kev kho mob yav tom ntej.

Nyem rau Cistanche rau mob raum

Thaum Lub Kaum Ib Hlis 2023, Phau Ntawv Xov Xwm ntawm American Society of Nephrology tau luam tawm cov koom haum loj hauv kev tsom xam ntawm cov protein-coding cheeb tsam sib txawv raws li exon chips. Txoj kev tshawb no tau ua ib qho kev tshawb fawb peb-theem koom haum nyob rau hauv 8529 cov neeg mob thiab 23,224 kev noj qab haus huv tswj thiab txheeb xyuas ib tug tsawg variant (OR, 1.97) nyob rau hauv lub coding cheeb tsam ntawm vascular endothelial kev loj hlob yam A gene, kwv yees hais tias qhov tsawg variant no yuav ua rau vascular endothelial kev loj hlob. yam A. Kev hloov pauv ntawm A nce nws txoj kev sib txuas nrog rau cov receptor. Ib qho kev sib txawv uas muaj nyob hauv PKD1L3 gene (OR, 1.16) kuj tseem cuam tshuam nrog cov kab mob, nrog rau kev pheej hmoo allele cuam tshuam nrog qis dua haptoglobin. Txoj kev tshawb no pom tias tsis tshua muaj qhov sib txawv muaj kev pheej hmoo ua rau muaj kab mob hauv IgAN, thiab cov txheej txheem tshwj xeeb tseem yuav tau piav qhia ntxiv.

Tseem muaj ntau yam teeb meem uas yuav tsum tau daws hauv GWAS kev tshawb fawb tam sim no. Piv txwv li, cov kab mob pathogenic hloov pauv ntawm cov kab mob ntsig txog cov noob tsis meej, yog li lawv qhov tshwj xeeb ntawm cov kab mob pathogenic tseem tsis tau piav qhia. Piv txwv li, tag nrho cov qauv loj-GWAS kev tshawb fawb ntawm IgAN tau pom tias kev hloov pauv caj ces hauv MTMR3-HORMAD2-LIF cheeb tsam ntawm chromosome 22 yog txuam nrog qhov pib ntawm IgAN, thiab ntawm qib genome-wide. , qhov tseem ceeb ntawm cov gene locus yog thib ob tsuas yog rau thaj tsam HLA. Txawm li cas los xij, cov noob caj noob ces tshwj xeeb thiab cov txheej txheem tseem tsis meej. Thaum lub Cuaj Hlis 2023, phau ntawv xov xwm "Kidney International" tau tshaj tawm txoj kev tshawb fawb txog kev koom tes ntawm MTMR3 genetic variation hauv IgAN los ntawm TLR9-induced IgA tiv thaiv kab mob. Cov kws tshawb fawb thawj zaug tau txheeb xyuas ob qho kev hloov pauv ntawm cov noob caj noob ces nyob rau hauv cov noob caj noob ces MTMR3 koom nrog cov kab mob ntawm IgAN hauv cheeb tsam no los ntawm kev siv cov kev tshawb fawb genetic fine-mapping. Lawv txuas ntxiv siv cov lus qhia ntau qhov kev txheeb xyuas qhov chaw soj ntsuam kev sib koom ua ke hauv cheeb tsam, thiab kab mob sib txawv ntawm cov noob transcriptomics. Kev soj ntsuam, genotype-phenotype correlation tsom xam, thiab lwm yam. pom tau hais tias MTMR3 kev pheej hmoo genotype muaj feem xyuam nrog kev nce qib ntawm MTMR3, thiab tseem muaj kev cuam tshuam zoo nrog cov qib IgA, IgA1, thiab Gd-IgA1 hauv cov ntshav ntawm cov neeg mob IgAN. , qhia tias MTMR3 kev hloov pauv caj ces tuaj yeem dhau los ntawm Upregulates qib qhia ntawm MTMR3 thiab nce qib ntawm cov kab mob IgA, yog li koom nrog cov kab mob ntawm IgAN. Hauv kev sim hauv vitro cell, tom qab overexpression ntawm MTMR3 hauv DAKIKI hlwb, qib IgA hauv cov cell supernatant tau nce ntau, thiab txo qis thaum khob; Cov nas nyob ib txwm muaj sia nyob tom qab lub cev tawm ntawm Mtmr3, tab sis qib IgA tau txo qis, thiab lub raum IgA deposition tseem ceeb. Cov glomerular mesangial hyperplasia tau txo. Cov haujlwm saum toj no tau lees paub qhov tseem ceeb ntawm cov noob caj noob ces ntawm chromosome 22 thiab tau hais ntxiv tias kev tswj hwm ntawm MTMR3 kev qhia / kev ua haujlwm yog cuam tshuam nrog kev nce qib ntawm IgAN IgA / Gd-IgA1. Inhibiting MTMR3 yuav dhau los ua lub hom phiaj tshiab rau kev kho IgAN.

(2) Cov yam ntxwv ntawm IgAN nqa COL4A3-5 kev hloov pauv

Nyob rau hauv xyoo tas los no, cov kab mob raum cuam tshuam nrog COL4A3-5 kev hloov pauv tau txais kev saib xyuas thoob plaws. Ntxiv rau qhov classic Alport syndrome, nws tseem tuaj yeem pom hauv focal segmental glomerulosclerosis, IgAN, cystic nephropathy, thiab lwm yam. Thaum Lub Ib Hlis 2023, Phau Ntawv Xov Xwm ntawm American Society of Nephrology tau luam tawm ib txoj kev tshawb fawb qhia tias diffuse thinning ntawm glomerular qab daus daim nyias nyias hauv. Cov neeg mob uas tsis muaj IgAN muaj feem cuam tshuam nrog kev hloov pauv caj ces hauv COL4A3, COL4A4, thiab COL4A5 noob. Txoj kev tshawb no tau muab piv rau 161 IgAN cov neeg mob uas muaj cov kab mob pathological nrog los ntawm kev nthuav dav ntawm glomerular hauv qab daus daim nyias nyias (tGBM) nrog hnub nyoog- thiab poj niam txiv neej-matched IgAN cov neeg mob uas tsis muaj cov kab mob hauv qab daus thiab cov neeg mob uas muaj cov txheej txheem hauv qab daus membrane nephropathy, thiab pom tias IgAN-tGBM Cov neeg mob. Cov neeg mob tsawg dua li cov neeg mob uas muaj IgAN tsis muaj tGBM, tab sis muaj mob ntau dua li cov neeg mob nyias nyias hauv qab daus nephropathy. Los ntawm tag nrho-exome sequencing ntawm 122 IgAN-tGBM cov neeg mob, nws tau pom tias 38 tus neeg mob (31.1%) muaj 37 kab mob sib txawv hauv COL4A3 / COL4A4 / COL4A5 noob. Cov neeg mob IgAN-tGBM uas muaj cov kab mob pathogenic muaj qhov sib npaug ntau dua ntawm glomerular hauv qab daus daim nyias nyias<250 nm and less glomerular damage, while IgAN-tGBM patients who do not carry pathogenic variants exhibit more IgAN Characteristics, including higher glomerular IgA deposition and higher Gd-IgA1 levels. Studies have shown that COL4A3-5 mutation detection is of great value in the diagnosis and identification of diseases, and has expanded further understanding of Alport syndrome.

(3) Qhov kev xav tias IgAN yog ib qho kab mob tshwj xeeb ntawm cov kab mob autoimmune tau raug thov dua

Thaum Lub Peb Hlis 2023, phau ntawv journal "Advanced Science" luam tawm kev tshawb fawb ntawm IgA autoantibodies tsom rau cov hlwb mesangial uas rov txhais cov txheej txheem pathological ntawm IgAN. Siv gddY nas, tus qauv IgAN tus kheej, cov kws tshawb fawb pom tias cov ntshav IgA yog tsim tawm tsam mesangial antigens, suav nrog II-spectrin. Feem ntau cov neeg mob nrog IgAN kuj pom cov ntshav IgA cov tshuaj tiv thaiv rau II-spectrin protein. Zoo ib yam li cov neeg mob IgAN, IgA + plasma hlwb tau sau rau hauv lub raum ntawm gddY nas. IgA cov tshuaj tiv thaiv uas tsim los ntawm plasma cell clones muaj ntau ntawm V cheeb tsam kev hloov pauv thiab tuaj yeem khi rau II-spectrin protein thiab saum npoo ntawm mesangial hlwb. Cov IgA cov tshuaj tiv thaiv no paub txog kev hloov pauv thiab / lossis endogenous II-spectrin proteins nyob rau saum npoo ntawm embryonic nephrogenic hlwb thiab tuaj yeem xaiv khi rau hauv qhov chaw mus rau thaj tsam glomerular mesangial. Txoj kev tshawb nrhiav kev txheeb xyuas ntawm IgA autoantibodies thiab lawv cov antigens hauv IgAN muab cov kev nkag siab tshiab rau kev nkag siab txog kab mob pathogenesis thiab redefines IgAN raws li cov ntaub so ntswg tshwj xeeb autoimmune kab mob.

(4) Kev siv cov duab kos duab kho qhov muag hauv IgAN

Thaum Lub Ob Hlis 2023, phau ntawv journal "Kidney International" tau luam tawm ib qho kev tshawb fawb txog cov kab mob pathogenesis ntawm galactose-deficient IgA (Gd-IgA) abnormalities qhia los ntawm kev ntsuas qhov muag pom. Cov kws tshawb fawb tau siv thev naus laus zis kho qhov muag kom pom kev ncaj qha IgA tso rau hauv lub raum nrog kev daws teeb meem ntawm lub cev thiab lub cev hauv BALB / c liab qab nas. Cov duab fluorescence tiag tiag tau qhia tias IgA tus neeg mob tau txais IgA hauv lub raum tau yooj yim dua li IgA purified los ntawm cov tib neeg noj qab haus huv. Longitudinal fluorescence imaging qhia tias nce circulating Gd-IgA nyob rau hauv IgAN cov neeg mob nyob rau hauv lub raum rau ntau tshaj ob lub lis piam, thiab ruaj khov deposition ntawm Gd-IgA ua rau lub raum tsis ua hauj lwm, nrog rau albuminuria thiab mesangial proliferation. Txoj kev tshawb no qhia txog kev koom tes ntawm lub raum tsis zoo ntawm lub raum tso ntshav ntawm Gd-IgA hauv cov kab mob ntawm IgAN. Kev ntsuas qhov muag pom thoob plaws qhov ntsuas yuav muaj cov ntawv thov hauv kev ntsuam xyuas lwm cov kab mob hauv lub raum tiv thaiv kab mob thiab nthuav tawm cov kab mob hauv qab.

(5) Tus Hu-like receptor 9 (TLR9) / Tus Hu-like receptor 7 (TLR7) yog koom nrog hauv cov txheej txheem ntawm IgAN

Thaum Lub Kaum Ib Hlis 2023, phau ntawv xov xwm "Kidney International" luam tawm kev tshawb fawb qhia tias nucleotide-sensing TLR9 / TLR7 tuaj yeem yog lub hom phiaj kho mob rau IgAN. Cov kws tshawb fawb tau siv tus qauv IgAN nas thiab tonsil cov ntaub so ntswg los ntawm 53 IgAN cov neeg mob los xyuas seb TLR7 puas koom nrog kev loj hlob ntawm IgAN, thiab lub peev xwm ntawm nucleotide-sensing Toll-like receptors (xws li TLR9 thiab TLR7) raws li IgAN kho lub hom phiaj. TLR9/TLR{11}}MyD88-NF-κB txoj hauv kev ua rau cov cytokines pro-inflammatory, suav nrog interleukin-6. Interleukin -6 upregulates proliferation-inducing ligand (APRIL), downregulates core 1 1, 3-galactosyltransferase, thiab txhawb cov synthesis ntawm txawv txav glycosylated IgA. IgA tsim cov tshuaj tiv thaiv kab mob uas muaj IgA, thiab cov complexes sib sau ua ke hauv glomerulus, thaum kawg ua rau glomerular o. Hydroxychloroquine tuaj yeem cuam tshuam cov synthesis ntawm txawv txav glycosylated IgA los ntawm kev tiv thaiv TLR9 / TLR7 los ntawm kev khi rau ligands hauv endosomes thiab inhibiting downstream signaling.

(6) Cov tswv yim kho tshiab raws li cov txheej txheem pathophysiological tau ua tiav sai hauv IgAN.

Nefecon yog ib qho tshiab ntawm qhov ncauj-tso tawm qauv ntawm budesonide uas feem ntau ua rau cov hnyuv mucosa. Thaum lub Cuaj Hlis 2023, Lub Lancet tau tso tawm qhov kev ntsuam xyuas zaum kawg ntawm 2-xyoo rov qab los ntawm NefIgArd mus sib hais. Qhov no multicenter, randomized, ob-dig muag, placebo-tswj theem III sim suav nrog 364 cov neeg laus nrog IgAN lees paub los ntawm lub raum biopsy. Cov txheej txheem suav nrog suav nrog qhov kwv yees glomerular pom tus nqi (eGFR) ntawm 35 thiab 90 ml. / (min·1.73m2), persistent proteinuria [urinary protein/creatinine ratio (UPCR) Ntau tshaj los yog sib npaug rau 0.8 g/g los yog proteinuria Ntau tshaj los yog sib npaug rau 1 g/24 h], thiab lwm yam. Cov neeg mob tau random muab tso rau hauv ib tug 1: 1 piv rau pawg Nefecon (16 mg / d) lossis pab pawg placebo kom tau txais kev kho tshuaj rau 9 lub hlis thiab tom qab ntawd nkag mus rau 15- lub hlis kev soj ntsuam xyuas. Txoj kev tshawb fawb NefIgArd tau muab faib ua ntu A thiab B: Ntu A suav nrog lub sijhawm 9- lub hlis kho qhov muag tsis pom kev thiab 3- lub hlis tshem tawm cov tshuaj siv tshuaj, nrog UPCR yog thawj qhov kawg; Ntu B suav nrog 12 lub hlis ntxiv ntawm kev tshuaj xyuas ob qhov muag dig muag. lub sij hawm thiab lub sij hawm-hnyav nruab nrab eGFR nyob rau hauv tag nrho 2-lub xyoo tom qab lub sij hawm tau siv los ua thawj qhov kawg. Cov txiaj ntsig ntawm kev soj ntsuam ob xyoos tau pom tias piv nrog cov placebo pab pawg, IgAN cov neeg mob noj Nefecon (16 mg / d, 9-hloov kev kho mob) ncua sij hawm poob ntawm lub raum ua haujlwm ntau dua 60% ntawm nruab nrab thiab txo cov proteinuria li ntawm 30%. Kev nyab xeeb zoo ib yam ntawm ob pawg, tsis muaj kev kho mob ntsig txog kev tuag. Feem ntau tshaj tawm txog kev kho mob-tshuaj tsis zoo tshwm sim thaum kho Nefecon yog peripheral edema, kub siab, mob leeg, thiab pob txuv. Qhov kev ntsuam xyuas zaum kawg ntawm NefIgArd sim tau lees paub tias Nefecon tuaj yeem nqa cov txiaj ntsig mus ntev rau cov neeg mob nrog IgAN los ntawm kev ncua kev poob ntawm eGFR thiab txo cov proteinuria.

Sibeprenlimab yog humanized IgG2 monoclonal antibody uas khi thiab neutralizes lub Plaub Hlis. Thaum Lub Kaum Ib Hlis 2023, New England Journal of Medicine tau luam tawm cov txiaj ntsig ntawm Phase II kev tshawb fawb soj ntsuam ntawm Sibeprenlimab hauv kev kho IgAN. Hauv theem 2 no, multicenter, ob-dig muag, randomized, placebo-tswj kev sim, cov neeg tshawb xyuas tau muab 1: 1: 1: 1 piv rau cov neeg laus uas muaj biopsy-confirmed IgAN uas tau txais kev kho tus qauv tab sis muaj kev pheej hmoo siab rau kev kis kab mob. Cov neeg mob tau raug muab tso tseg kom tau txhaj tshuaj Sibeprenlimab ntawm 2 mg / kg, 4 mg / kg, lossis 8 mg / kg lossis placebo rau 12 lub hlis. Lub ntsiab lus kawg yog qhov kev hloov pauv ntawm lub hauv paus hauv kev hloov pauv UPCR ntawm lub hli 12. Cov ntsiab lus thib ob suav nrog kev hloov pauv hauv eGFR ntawm 12 lub hlis thiab kev nyab xeeb. Cov ntaub ntawv tshawb fawb tau pom tias piv nrog cov placebo, IgAN cov neeg mob uas tau txais sibeprenlimab rau 12 lub hlis tau txo qis cov zis muaj protein ntau. Thaum 12 lub hlis, piv nrog cov hauv paus ntsiab lus, qhov geometric piv txwv qhov txawv ntawm qhov txo qis hauv UPCR yog 47.2%, 58.8%, thiab 62.0 rau cov neeg mob tau txais sibeprenlimab ntawm koob tshuaj 2 mg / kg, 4 mg / kg, thiab 8 mg / kg thiab placebo, raws li. % thiab 20.0%. Piv nrog rau cov placebo pab pawg, eGFR ntawm cov neeg mob hauv pab pawg sibeprenlimab tseem nyob ruaj khov, thaum nyob rau hauv pawg placebo poob li ntawm 7.4 ml / (min·1.73m2). Txoj kev tshawb no tau pom tias hauv cov neeg mob nrog IgAN, kev kho mob nrog sibeprenlimab rau 12 lub hlis ua rau muaj kev txo qis hauv proteinuria ntau dua li cov placebo. Tsis muaj qhov sib txawv tseem ceeb hauv qhov xwm txheej ntawm cov xwm txheej tsis zoo ntawm ob pawg.

Telitacicept yog ib qho fusion protein uas tsom rau B lymphocyte stimulating factor thiab APRIL ntawm B hlwb thiab plasma hlwb. Thaum Lub Peb Hlis 2023, Daim Ntawv Qhia Txog Raum International tau tshaj tawm cov txiaj ntsig ntawm Phase II kev tshawb fawb soj ntsuam ntawm Telitacicept hauv kev kho IgAN. Hauv theem 2 no ob-dig muag, randomized, placebo-tswj sim, cov neeg mob tau muab tso rau hauv qhov sib piv 1: 1: 1 rau subcutaneous Telitacicept 160 mg, 240 mg, lossis placebo rau 24 lub lis piam. Cov ntsiab lus tseem ceeb yog qhov hloov pauv ntawm cov hauv paus hauv 24- teev proteinuria ntawm lub lim tiam 24. Cov ntsiab lus thib ob suav nrog kev hloov pauv hauv 24- teev proteinuria, eGFR, IgA, IgG, thiab IgM qib, thiab kev nyab xeeb. Cov ntaub ntawv tshawb fawb tau pom tias thaum kawg ntawm 24 lub lis piam ntawm kev kho mob, 24-teev proteinuria poob los ntawm 0.889 g / d (49%) los ntawm cov hauv paus hauv cov neeg mob hauv Telitacicept 240 mg pawg, thiab txo qis ntawm 0.316 g / d ( 25%) tau pom nyob rau hauv Telitacicept pawg 160 mg). Qhov nruab nrab eGFR ntawm cov neeg mob hauv Telitacicept 240 mg thiab 160 mg pawg tau nce los ntawm 2.34 ml / (min·1.73m2) thiab 4.32 ml / (min·1.73m2), thaum nyob rau hauv pawg placebo nws txo los ntawm 5.70 ml / (min·· 1.73 m2). Telitacicept serum immunoglobulin qib, suav nrog IgA, IgG, thiab IgM, tau txo qis hauv 160 mg thiab 240 mg pawg piv nrog cov placebo pawg. Tsis muaj qhov sib txawv tseem ceeb hauv qhov xwm txheej ntawm cov xwm txheej tsis zoo ntawm ob pawg.

Iptacopan (LNP023) yog ib qho kev sib txuas sib txuas ntxiv inhibitor uas tshwj xeeb khi rau qhov tseem ceeb B. Thaum Lub Kaum Hli 2023, "Kidney International" tau tshaj tawm cov txiaj ntsig ntawm Phase II kev tshawb fawb soj ntsuam ntawm Iptacopan hauv kev kho IgAN. Hauv theem no 2 multicenter, ob-dig muag, randomized, placebo-tswj sim, cov neeg koom tau txais Iptacopan (10 mg, 50 mg, 100 mg, 200 mg) lossis placebo ob zaug ib hnub rau 3 lub hlis (Part 1) lossis 6 lub hlis (Part 2). ). Lub ntsiab lus kawg yog qhov kev sib raug zoo ntawm koob tshuaj ntawm UPCR ntawm lub hli 3 thiab lub hauv paus. Cov ntsiab lus thib ob suav nrog cov zis tso zis, hloov pauv hauv eGFR, thiab kev nyab xeeb. Ib qho kev txo qis hauv UPCR tau pom nyob rau ntawm 3 thiab 6 lub hlis; ntxiv biomarker qib txuas ntxiv txo qis, thiab nws tau txais txiaj ntsig zoo. Qhov loj tshaj plaws txo qis hauv UPCR piv nrog cov placebo tau pom nyob rau hauv 200 mg pawg ntawm 3 lub hlis, nce mus txog 23%, nrog kev txo qis ntxiv ntawm 6 lub hlis (los ntawm qhov nruab nrab ntawm 1.3 g / g ntawm lub hauv paus rau 0.8 g / g). eGFR ntawm cov neeg mob hauv pab pawg Iptacopan tseem nyob ruaj khov, thaum nyob rau hauv pawg placebo txo ​​qis li ntawm 3.4 ml / (min·1.73m2). Qib ntawm cov cim biomarkers ntxiv (plasma Bb, ntshav ntshav Wieslab lwm txoj hauv kev ntxiv cov cim cim, thiab tso zis C5b-9) txuas ntxiv txo. Tsis muaj qhov sib txawv tseem ceeb hauv qhov xwm txheej ntawm cov xwm txheej tsis zoo ntawm ob pawg.

Spartan is a single-molecule, dual endothelin, and angiotensin receptor antagonist. In November 2023, The Lancet published the results of the PROTECT clinical study. PROTECT is an international, randomized, double-blind, active-controlled study conducted in 134 centers in 18 countries. The study mainly compares parental and irbesartan in the treatment of IgAN with urine protein quantification >1 g/d. cov txiaj ntsig ntawm tus neeg mob. Thawj qhov ua tau zoo kawg ntawm txoj kev tshawb no yog qhov hloov pauv ntawm cov zis albumin / creatinine piv los ntawm qhov pib ntawm lub lim tiam 36; Qhov kev ua tau zoo thib ob suav nrog qhov kev hloov pauv ntawm eGFR ntawm 58 thiab 110 lub lis piam tom qab pib kho randomized. PROTECT sim tso npe rau 404 tus neeg mob nrog IgAN. Hauv 36-lub lim tiam ib ntus kev soj ntsuam, cov zis albumin / creatinine piv tau txo los ntawm 49.8% hauv cov neeg mob spartan, tab sis tsuas yog 15.1% hauv cov neeg mob irbesartan. Cov txiaj ntsig ntawm 2- xyoo tom qab tau pom tias los ntawm kev kho tsis tau mus txog 110 lub lis piam, eGFR poob rau 5.8 ml / (min·1.73m2) hauv pawg spartan thiab 9.5 ml / (min·1.73m2) hauv irbesartan pab pawg. Lub sijhawm ntev eGFR nqes hav txo qis los ntawm 2.7 ml / (min·1.73m2) hauv ib xyoos hauv pawg spartan thiab 3.8 ml / (min·1.73m2) ib xyoos hauv pawg irbesartan, nrog qhov sib txawv tseem ceeb ntawm 1.1 ml / (min 1.73 m2). Kev soj ntsuam mus sij hawm ntev qhia tau tias pawg spartan tuaj yeem txo cov proteinuria zoo dua thiab tiv thaiv lub raum ua haujlwm hauv kev kho IgAN.

Thaum Lub Ob Hlis 2023, "Journal of the American Medical Association·Open Network" tau luam tawm cov kev tshawb fawb ntawm MAIN mus sib hais. Qhov no yog qhov qhib-label randomized tswj kev kawm los ntawm Tuam Tshoj. 170 cov neeg mob uas muaj kev vam meej IgAN uas tau txais kev saib xyuas zoo suav nrog losartan thiab nws cov zis muaj protein ntau dua lossis sib npaug li 0.75 g / d tau muab tso rau mycophenolate hauv 1: 1 piv. Rau cov pab pawg MMF thiab cov txheej txheem kho mob, txoj kev tshawb fawb txog kev kho tshuaj tau ua raws li 3 xyoos ua ntej nkag mus rau theem tom qab kev sim, nrog rau lub sijhawm nruab nrab ntawm 5 xyoo. Cov ntsiab lus tseem ceeb ntawm kev tshawb fawb: (1) Ua ob npaug ntawm cov ntshav creatinine, kab mob hauv lub raum kawg (dialysis, hloov pauv, lossis lub raum tsis ua haujlwm yam tsis muaj lub raum hloov kho), lossis tuag los ntawm lub raum lossis mob plawv. (2) Kev loj hlob ntawm cov kab mob raum ntev. Cov txiaj ntsig kev tshawb fawb tau pom tias ntxiv MMF rau kev kho tus qauv txo qhov kev pheej hmoo ntawm qhov kawg ntawm cov neeg mob IgAN los ntawm 77% piv nrog kev kho tus qauv ib leeg. Kev soj ntsuam tom qab kev sim qhia tau hais tias kev txiav tawm ntawm MMF tuaj yeem ua rau qhov kev poob qis hauv eGFR. Tsis muaj qhov sib txawv ntawm qhov sib txawv ntawm qhov tshwm sim ntawm cov xwm txheej tsis zoo ntawm ob pawg, tab sis qhov tshwm sim ntawm cov tsos mob ntawm plab hnyuv thiab kab mob tau siab dua hauv pawg MMF.

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 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 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.