SGLT-2Kuv Tseem Muaj Qhov Zoo Rau Cov Neeg Mob CKD

Hyperuricemia thiab nce qib uric acid yog cov teeb meem tshwm sim hauv cov neeg mob uas muaj kab mob raum ntev (CKD). Cov kev tshawb fawb yav dhau los tau pom tias kwv yees li 60% ntawm cov neeg mob CKD raug kev txom nyem los ntawm asymptomatic hyperuricemia. Cov kev tshawb fawb kuj tau pom tias hyperuricemia yog ib qho kev ywj pheej uas ua rau kom muaj kev loj hlob ntawm CKD thiab cuam tshuam rau qhov kawg ntawm CKD. Qhov tseem ceeb tshaj, hyperuricemia ua rau muaj kev pheej hmoo ntawm cov kab mob plawv hauv cov neeg mob CKD, yog li ua rau tus neeg mob txoj kev pheej hmoo tuag. Yog li ntawd, yuav ua li cas txo qis uric acid yog ib qho kev txhawj xeeb rau cov kws kho mob.

Nyem rau Cistanche rau mob raum

Cov kws tshawb fawb yav dhau los tau pom tias sodium-glucose cotransporter 2 inhibitors (SGLT-2i) tuaj yeem txo cov qib uric acid hauv cov neeg mob uas lub raum ua haujlwm tsis zoo, tab sis seb nws puas tuaj yeem txo cov qib uric acid hauv cov neeg mob CKD tseem muaj teeb meem. Qee qhov kev tshawb fawb hauv tsev kho mob tau pom tias qib ntawm uric acid txo los ntawm SGLT-2i muaj feem xyuam rau lub raum ua haujlwm. Nws tau pom zoo tias SGLT-2Kuv yuav tsis muaj qhov txo qis uric acid hauv cov neeg mob CKD. Puas yog qhov no?

Tsis ntev los no, BMJ tau luam tawm Meta-analysis, uas qhia tau tias SGLT-2Kuv tuaj yeem txo qis uric acid hauv cov neeg mob CKD. Qhov tseem ceeb tshaj, txoj kev tshawb nrhiav pom tias dapagliflozin thiab ipragliflozin zoo li ua tau zoo dua ntawm kev txo qis uric acid hauv cov neeg mob CKD.

Kev tshawb fawb tsim

Qhov no yog ib qho kev tshuaj ntsuam meta raws li PRISMA cov lus qhia. Cov ntaub ntawv los ntawm Emabase, PubMed, Scopus, thiab Web of Science. Cov kev tshawb fawb suav nrog hauv kev tshuaj ntsuam yog randomized tswj kev sim (RCT) thiab tau ntsib plaub lub ntsiab lus hauv qab no:

① Cov neeg laus CKD (Ntau dua lossis sib npaug li 18 xyoo), suav nrog kev lim ntshav ua ntej, lim ntshav peritoneal, hemodialysis, thiab cov neeg tau txais kev hloov raum;

② Pab pawg cuam tshuam tau txais SGLT-2Kuv ib leeg lossis ua ke nrog lwm yam tshuaj;

③ Pab pawg tswj hwm lossis pab pawg placebo tau txais kev kho mob ib txwm thaum tau txais cov placebo;

④ Cov ntsiab lus tshawb fawb yuav tsum suav nrog qib uric acid thiab cov xwm txheej tsis zoo.

Kev hloov pauv hauv cov ntshav uric acid tau qhia raws li tus qauv ntsuas qhov sib txawv (SMD). Nco ntsoov, txoj kev tshawb no tsis txwv hom lossis koob tshuaj SGLT-2i. Yog li, cov kws tshawb fawb tau txheeb xyuas qhov ua tau zoo ntawm uric acid-txo cov txiaj ntsig ntawm ntau txoj hauv kev cuam tshuam los ntawm qhov nyiam qhov yuav ua tau qeb duas nkhaus (SUCRA).

Kev tshawb fawb tshwm sim

Tag nrho ntawm 8 RCTs, 9290 cov neeg mob tau ntsib cov txheej txheem suav nrog thiab thaum kawg tau suav nrog hauv qhov kev tshuaj ntsuam meta no. Muaj 6 hom SGLT-2i suav nrog, uas yog dapagliflozin, empagliflozin, canagliflozin, sotagliflozin, ipragliflozin, thiab tofogliflozin. Ntxiv nrog rau kev sib piv cov txiaj ntsig thiab kev nyab xeeb ntawm cov tshuaj no nrog cov placebo, kuj tseem muaj kev sib piv ntawm cov pab pawg ntau npaum li cas. Piv txwv li, dapagliflozin muaj kev sib piv ntawm pawg 5 mg koob tshuaj thiab pawg tshuaj 10 mg.

Cov kev tshawb fawb tau pom tias SGLT-2Kuv tuaj yeem txo qis uric acid ntau hauv cov neeg mob CKD.

Hauv kev txheeb xyuas pawg pawg, nws tau pom tias 10 mg dapagliflozin thiab 50 mg ipragliflozin muaj zog uric acid-txo qis, nrog SMD mus txog -0.88 (95% CI, -2). 12 ~ 0.22) thiab -0.67 raws.

Raws li tus nqi SUCRA, qhov zoo tshaj plaws SGLT-2i hom thiab koob tshuaj txo cov ntshav uric acid nyob rau hauv cov neeg mob CKD tau qeb raws li hauv qab no:

Qib ntawm uric acid-txo cov txiaj ntsig

① Dapagliflozin 10mg (SUCRA=18.11%)

②Dapagliflozin 5mg (SUCRA=31.29%)

③ipragliflozin 50mg (SUCRA= 31.54%)

④tofogliflozin 20mg (SUCRA=44.56%)

⑤ Empagliflozin 10mg (SUCAR=52.30%)

Hais txog kev nyab xeeb, 6 ntawm 8 qhov kev tshawb fawb tau tshaj tawm cov xwm txheej tsis zoo, thiab 2 qhov kev tshawb fawb tsis tau tshaj tawm cov xwm txheej tsis zoo. Qhov tshwm sim ntawm cov xwm txheej tsis zoo yog 87.6% hauv SGLT-2i pawg thiab 87.6% hauv pawg placebo (RR=0.99; 95% CI, 0.97~1.{ {14}}; P=0.147).

kev sib tham tshawb fawb

Previous studies have shown that SGLT-2i has a uric acid-lowering effect in people with estimated glomerular filtration rate (eGFR) >60ml / min / 1.73㎡, tab sis tsis muaj qhov cuam tshuam zoo sib xws rau cov neeg mob CKD nrog eGFR<60ml/min/1.73㎡. Discover. Some meta-analyses show that only in patients with type 2 diabetes, SGLT-2i can significantly reduce serum uric acid levels (MD= -0.965mg/dL; 95% CI, -1.029~0.901; I²=98.7%). Therefore, whether SGLT-2i can affect serum uric acid levels in CKD patients is still controversial.

Tam sim no, KDIGO's CKD cov lus qhia pom zoo tias SGLT{0}}Kuv yuav tsum tau siv rau cov neeg laus CKD cov neeg mob plawv lossis eGFR Ntau dua lossis sib npaug li 20 ml / min / 1.73 m2 thiab tso zis albumin rau creatinine ratio (UACR) Ntau dua lossis sib npaug rau 200 mg / g (1A). Qhov kev pom zoo no qhia tias SGLT-2i yog thawj kab tshuaj rau CKD. Yog li, tshawb nrhiav ntau yam teebmeem ntawm SGLT-2i ntawm cov neeg mob CKD muaj qhov tseem ceeb hauv kev kho mob. Kev tshawb fawb los ntawm Chino et al. pom tias SGLT-2Kuv tuaj yeem ua kom uric acid tshem tawm thiab txo cov ntshav uric acid. Rau cov tib neeg uas muaj ntshav qab zib uric acid nyob nruab nrab ntawm 3.3 thiab 6.7 mg / dL, SGLT-2 feem ntau kuv tuaj yeem txo lawv cov ntshav uric acid los ntawm kwv yees li 0.60 txog 0.75 mg / dL.

Ntawm qib molecular, Nokikov et al. qhia tias uric acid transporter 1 (URAT 1) thiab qabzib cotransporter 9 (GLUT9) muaj feem xyuam rau uric acid excretion. Chino et al. pom tias SGLT-2Kuv tuaj yeem cuam tshuam GLUT9 kev ua haujlwm, cuam tshuam rau lub raum tubular reabsorption ntawm uric acid, thiab yog li nce uric acid excretion. Yog li, lub hauv paus physiological rau SGLT-2i kom nce uric acid excretion yog lub raum muaj nuj nqi, uas yuav piav qhia yog vim li cas uric acid-txo cov nyhuv ntawm SGLT-2i txo qis raws li lub raum ua haujlwm poob. Txawm li cas los xij, qhov kev tshuaj ntsuam meta no pom tias txawm tias rau cov neeg mob CKD uas muaj lub raum tsis ua haujlwm, SGLT-2Kuv tseem muaj cov txiaj ntsig ntawm kev txo qis uric acid.

Hauv kev xaus, rau cov neeg mob CKD, SGLT-2Kuv tseem tuaj yeem txo cov ntshav uric acid tau zoo, thiab dapagliflozin thiab ipragliflozin zoo li zoo dua.

Cistanche kho mob raum li cas?

Cistancheyog ib hom tshuaj suav tshuaj ntsuab siv rau ntau pua xyoo los kho ntau yam mob, suav nrog kab mob raum. 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.