Kev pheej hmoo rau ntshav siab tom qab thiab kab mob plawv tom qab nyob rau hauv lub raum pub dawb: Puas muaj feem cuam tshuam rau kev kho mob? Ntu 2
Apr 20, 2023
UREMIC CARDIOMYOPATHY
Lub sij hawm uraemic cardiomyopathy tau tsim nyob rau xyoo 1980 nrog cov lus ceeb toom ntawm qhov tsis txaus ntseeg ntawm kev ua haujlwm ntawm lub plawv thiab cov qauv hauv cov neeg mob nrog CKD / ESKD: uas yog nce sab laug ventricular (LV) pawg thiab sab laug ventricular hypertrophy (LVH); diastolic thiab systolic tsis ua haujlwm; ua ke nrog, feem ntau heev myocardial fibrosis ntawm histology [107-114]. Txawm li cas los xij, LV hypertrophy tau raug sau tseg nrog rau kab mob raum thaum ntxov li 1827 los ntawm Richard Bright ntawm Guys Tsev Kho Mob hauv London [115]. Lub etiology ntawm uraemic cardiomyopathy zoo li yuav ua tau ntau yam thiab suav nrog lub siab thiab ntim ntau dhau, ntshav tsis txaus, nce oxidative kev nyuaj siab, thiab ua kom lub zog ntawm renin-angiotensin-aldosterone, nrog rau kev nce siab ntawm cardiotonic steroids, uric acid, parathyroid hormone, fibroblast. kev loj hlob zoo-23 (FGF-23) thiab lwm yam uraemic toxins [112, 113, 116, 117]. Ntau yam ntawm cov no suav nrog uric acid, parathyroid hormone, thiab FGF-23 nce kev pub raum tom qab [36, 37, 40, 118]. Qhov hnyav ntawm uremic cardiomyopathy raws li ntsuas los ntawm LV pawg yog ib qho kev kwv yees muaj zog ntawm cov hlab plawv tuag [119–131]. Uraemic cardiomyopathy tej zaum tsis yog tsuas yog muaj nyob rau hauv yuav luag txhua tus neeg mob nrog ESKD ntawm kev lim ntshav tab sis kuj zoo li nthuav tawm rau cov neeg mob uas muaj mob me me ntawm CKD [109-111]. Kev tshawb fawb ntawm cov kev kawm nrog theem 2 thiab 3 CKD tau tshaj tawm txog qhov ntau zaus ntawm kev mob plawv tsis zoo raws li uraemic cardiomyopathy [43, 111, 116].
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Raws li uraemic cardiomyopathy zoo nkaus li pib ntxov rau cov neeg mob CKD, nws yuav xav tias qee qhov nta yuav muaj nyob rau hauv cov neeg mob raum, tshwj xeeb tshaj yog cov uas muaj qis dua tom qab pub rau lub raum ua haujlwm. Txog thaum tsis ntev los no, cov ntaub ntawv raug txwv rau qee qhov me me, ntu ntu, lossis tsis tswj xyuas cov kev tshawb fawb uas tau tshaj tawm cov txiaj ntsig tsis sib haum xeeb tom qab pub raum. Ib qho me me hla ntu echocardiographic thiab cardiac magnetic resonance imaging (CMR) txoj kev tshawb fawb ntawm 15 Italian tus neeg pub dawb piv nrog hnub nyoog thiab kev sib deev kev noj qab haus huv los ntawm Tebchaws Meskas ntawm qhov nruab nrab ntawm 8.4 xyoo (tsawg kawg ntawm 5 xyoos) los ntawm kev pub dawb pom tias feem ntau ntawm kev ntsuas ntawm LV geometry thiab kev ua haujlwm tsis txawv ntawm cov neeg pub dawb thiab kev tswj hwm, tab sis cov neeg pub dawb tau pom qhov txawv txav ntawm LV apical rotation thiab torsion [132]. Hauv kev tshawb nrhiav tsis muaj kev tswj hwm ntawm 23 lub raum pub dawb siv CMR, LV pawg tau nce ntawm 12 lub hlis yam tsis muaj kev hloov pauv hauv chaw ua haujlwm ntshav siab [133]. Los ntawm qhov sib txawv, ob qho tib si speckle taug qab echocardiographic txoj kev tshawb fawb ntawm 30 lub raum pub rau hauv lub hauv paus thiab 12 lub hlis tom qab pub dawb pom tsis muaj qhov sib txawv tseem ceeb hauv sab laug lossis txoj cai ventricular [134].
Ib tug UK yav tom ntej, tswj kev kawm txog cov qauv myocardial thiab kev ua haujlwm hauv lub raum pub dawb tau muab {{0}} thiab 5- cov ntaub ntawv xyoo. Hauv 68 tus neeg pub dawb thiab 56 qhov kev tswj hwm kev noj qab haus huv sib npaug (feem ntau ntawm cov neeg tau ua haujlwm pub dawb tab sis tsis pub dawb), nrog rau kev tsom xam qhov muag tsis pom ntawm 12 lub hlis, muaj qhov nce hauv LV pawg ntsuas los ntawm CMR hauv cov neeg pub dawb tab sis tsis tswj [36] . Lub ntiaj teb ncig ncig kuj tseem txo qis, qhia txog kev hloov pauv thaum ntxov hauv systolic tsis ua haujlwm. Tsis muaj kev hloov pauv ntawm cov ntshav siab ntsuas los ntawm 24-h kev saib xyuas lub tsheb thauj neeg mob thiab tsis muaj kev cuam tshuam ntawm kev hloov pauv hauv LV huab hwm coj thiab kev hloov ntshav siab. Txawm li cas los xij, tom qab 5 xyoos tom qab pub dawb, 50 tus neeg pub dawb thiab 45 kev tswj hwm los ntawm thawj pawg neeg tau rov qab los siv CMR duab [37]. Hauv pawg pab pawg no, qhov nce hauv LV pawg ntawm 1- xyoo tom qab pub dawb tseem pom. Txawm li cas los xij, qhov kev hloov pauv ntawm LV loj hauv cov raum pub rau 5 xyoos tsis txawv ntawm kev tswj hwm kev noj qab haus huv [0.40 (95 feem pua CI 4.68–5.49 g)]. Tsis muaj qhov sib txawv tseem ceeb hauv cov kev hloov pauv hauv LV lossis sab laug atrial tagnrho, LV geometry, lub ntiaj teb ntev ntev, lossis lub ntiaj teb ncig ncig ntawm 5 xyoos [37]. Tsis tas li ntawd, ntawm 5 xyoos, tsis muaj qhov sib txawv ntawm cov neeg pub dawb thiab kev tswj hwm hauv tus neeg sawv cev CMR cov cim ntawm LV fibrosis (T1 mapping thiab lig gadolinium li) [37]. Muaj kev nce siab hauv siab C-reactive protein, siab-rhiab heev troponin T thiab vitamin D dhau sij hawm hauv ob qho tib si pub thiab tswj. Thaum 12 lub hlis, qhov tshwm sim ntawm kev kuaj pom troponin T tau ntau dua hauv cov neeg pub dawb ntau dua li kev tswj hwm; ntawm 5 xyoos, qhov kev nthuav dav tau nce hauv ob pawg, txo qhov sib txawv ntawm pawg [37].
Muaj ntau qhov kev piav qhia txog qhov sib txawv ntawm qhov kev tshawb pom ntawm 1 xyoo thiab 5 xyoo hauv cov neeg mob raum piv nrog kev tswj hwm. Qhov cuam tshuam los ntawm random muaj feem cuam tshuam rau cov neeg koom nrog tsawg yog ib qho ua tau. Lwm qhov ua tau yog qhov nqaim ntawm qhov sib txawv ntawm lub raum ua haujlwm ntawm cov neeg pub dawb thiab tswj 1-5 xyoo tom qab pub dawb. Thaum nyob rau hauv cov neeg pub dawb qhov txhais tau tias GFR nce los ntawm 2 mL / min / 1.73 m2 nyob rau lub sijhawm no, GFR hauv kev tswj tsis zoo los ntawm 1 mL / min / 1.73 m2 toj xyoo. Muab qhov kev sib raug zoo ntawm GFR thiab LV huab hwm coj hauv kev soj ntsuam kev tshawb fawb [125, 131, 135], qhov txo qis qhov sib txawv ntawm GFR ntawm cov neeg pub dawb thiab kev tswj hwm yuav xav tias yuav cuam tshuam nrog qhov sib txawv ntawm LV pawg. Tsis tas li ntawd, lwm yam cuam tshuam nrog nce LV pawg xws li ntshav ntshav, nce erythropoietin, thiab C-reactive protein ntau tsis tshua muaj tshwm sim tom qab 12 lub hlis hauv cov neeg pub nyiaj [136].
Coronary microvascular dysfunction, raws li ntsuas los ntawm coronary txaus ceev ceev ceev, muaj ntau heev nyob rau hauv cov neeg mob nrog CKD thiab yog txuam nrog ib tug adverse prognosis [137]. Nws kuj tau xav tias yog tus pab txhawb rau kev txhim kho ntawm uraemic cardiomyopathy [137]. Hauv kev tshawb fawb me me ntawm 23 tus neeg pub dawb nrog qhov nruab nrab ntawm 30 lub hlis tom qab pub dawb thiab 25 qhov kev tswj hwm zoo sib xws, cov neeg pub nyiaj tau pom tias muaj qhov qis qis qis qis qis dua li kev tswj hwm [138]. Cov kev tshawb pom no yuav tsum tau rov ua dua hauv cov kev tshawb fawb loj dua, yav tom ntej, ntev.
Hauv cov ntsiab lus, muaj ob peb txoj kev tshawb fawb tshawb xyuas cov txheej txheem plawv thiab kev ua haujlwm hloov pauv tom qab pub raum. Cov kev tshawb fawb uas muaj nyob no muaj cov qauv me me thiab tau muab cov txiaj ntsig tsis sib haum. Cov pov thawj tam sim no qhia tau hais tias txawm tias kev pub rau lub raum yuav ua rau muaj kev hloov pauv me me hauv cov qauv plawv thiab kev ua haujlwm hauv 1 xyoos, cov no tsis tshwm sim rau lub sijhawm ntev dua. Kev tswj xyuas tau zoo thiab kev tshawb nrhiav ntev ntev nrog kev tshawb xyuas lub plawv yuav tsum tau ua.
TEEB MEEM
Ronald yeej tsis muaj kev khuv xim txog kev pub lub raum rau nws tus kwv. Tom qab ntawd, raws li tam sim no, nyob rau lub raum pub dawb pub rau cov neeg mob nrog ESKD txoj hauv kev zoo tshaj plaws rau lub sijhawm ntev, tsis muaj kev lim ntshav [58, 139]. Cov neeg pub dawb tsis tau txais txiaj ntsig ncaj qha rau lawv txoj kev siv zog. Txawm li cas los xij, ua ntej kev pub dawb, cov neeg muaj peev xwm xav tau thiab tsim nyog, kom muaj cov ntaub ntawv zoo txog kev pheej hmoo yav tom ntej rau lawv txoj kev noj qab haus huv tag nrho, kev ua neej zoo, thiab muaj feem cuam tshuam rau lub neej expectancy. Muab kev sib raug zoo ntawm cov kab mob plawv thiab CKD, cov ntaub ntawv hais txog kev pheej hmoo ntawm cov kab mob plawv thiab ntshav siab yav tom ntej yog qhov tshwj xeeb. Qhov no yog qhov tseeb tshwj xeeb tshaj yog vim qhov kev so tsis tu ncua ntawm cov txheej txheem xaiv, raws li qhov cuam tshuam ncaj qha ntawm qhov xav tau ntau ntxiv rau kev hloov hauv lub raum, suav nrog cov neeg pub dawb nrog cov mob metabolic, ntshav qab zib, thiab ntshav siab [140–143]. Raws li qhov kev tshuaj xyuas no tseem ceeb, cov pov thawj xav tau tseem tu siab tsis muaj. Yog li tej zaum nws tsis yog qhov xav tsis thoob tias muaj qhov sib txawv loj npaum li cas (los ntawm ib txwm mus rau ib txwm tsis tau) txawv qhov kev pheej hmoo mus sij hawm ntev tau tham nrog cov neeg muaj peev xwm pub dawb [144].
Lub sijhawm ntev (tsawg kawg 20 xyoo) cov kev tshawb fawb yav tom ntej thiab kev sau npe, nrog cov pab pawg tswj hwm kev noj qab haus huv, nrog rau cov neeg sawv cev tsim nyog ntawm pawg neeg sib txawv thiab kev sib txawv, yuav tsum tau ua kom muaj kev pheej hmoo pub dawb tuaj yeem suav tau raws li xav tau [140]. Tej zaum nws yog ib qho kev nplij siab uas muaj pov thawj ntxiv tias kev ua siab dawb thiab kev ua haujlwm pub dawb tau cuam tshuam nrog kev cia siab rau lub neej ntev thiab txo kev siv kev noj qab haus huv [145–147]. Txawm li cas los xij, vim tias lawv qhov kev ua tau zoo tsis yog tsuas yog cov neeg tau txais txiaj ntsig xwb tab sis kuj tseem muaj ntau lub zej zog thoob plaws lub ntiaj teb, cov neeg pub nyiaj nyob tsim nyog tau txais txiaj ntsig ntau dua li qhov xav tau. Xav txog qhov tsis paub tseeb tam sim no txog kev pheej hmoo cuam tshuam nrog rau lub raum pub dawb, cov chaw hloov pauv yuav tsum tsim kom muaj kev sib raug zoo mus ntev nrog cov neeg pub dawb uas tso cai saib xyuas txhua yam cuam tshuam txog kev pheej hmoo ntawm cov hlab plawv. Txog tam sim no, nws zoo li tsim nyog los muab kev tawm tswv yim, saib xyuas, thiab kho cov kev pheej hmoo ntawm cov hlab plawv, thiab rov ua kom ntseeg tau tias txawm hais tias cov pov thawj hauv paus tsis zoo, tsis muaj kev tshawb fawb tau muab pov thawj muaj txiaj ntsig ntawm kev pheej hmoo ntawm cov hlab plawv tuag lossis kab mob.
TXOJ CAI NTAWM INTEREST STATEMENT
Tsis muaj leej twg tshaj tawm.
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