SGLT2 Inhibitors tuaj yeem tiv thaiv lub raum thiab lub plawv zoo
Jul 31, 2023
Thaum Lub Xya Hli 20-23, 2023, nyob rau hauv lub nroog ntug dej hiav txwv nto moo ntawm Qingdao, lub rooj sib tham kev kawm loj hauv thaj tsam kab mob raum tau tshwm sim loj heev. Pib los ntawm lub nra ntawm tus kab mob, cov kws tshaj lij hauv cov kab mob raum (CKD) tau nthuav tawm txog qhov tsim nyog ntawm kev tswj xyuas kev kho mob ntawm CKD, txheeb xyuas cov kab mob ntawm CKD, txhawb kev nkag siab thiab kev xav ntawm cov voj voog kev kawm ntawm kev tswj xyuas kev kho mob ntawm CKD, thiab nthuav tawm. ib qho chaw rau ntau tus kws tshaj lij koom nrog. Cov ntsiab lus zoo heev los qhia!
Nyem rau ntawm cov organic cistanche rau mob raum
CKD kev tswj xyuas kev kho mob muaj txoj hauv kev mus ntev, kev tiv thaiv ntxov thiab kev kho mob ntxov yog qhov tseem ceeb
CKD tau txais kev saib xyuas ntau ntxiv raws li qhov teeb meem kev noj qab haus huv tseem ceeb rau pej xeem. Saib ib ncig ntawm lub ntiaj teb no, lub ntiaj teb no prevalence ntawm CKD yog 11.1 feem pua, thiab tus naj npawb ntawm cov neeg mob yog hais txog 850 lab 1. Saib rov qab rau kuv lub teb chaws, qhov kev nthuav dav ntawm CKD yog 8.2 feem pua, thiab cov neeg mob muaj ze li ntawm 130 lab 2,3 lab. Nrog rau kev nce ntxiv ntawm cov neeg mob raum kawg (ESRD), nws kwv yees tias los ntawm 2030, tus naj npawb ntawm cov neeg mob tau txais kev kho lub raum hloov thoob ntiaj teb yuav nce 5 lab4. Cov ntaub ntawv ceeb toom no qhia qhov sib txawv loj hauv kev tiv thaiv thiab kho CKD.
Raws li CKD vam meej, lub hnub nyoog-tus qauv kev mus pw hauv tsev kho mob tus nqi, cov kab mob plawv, thiab tag nrho-ua rau kev tuag ntawm cov neeg mob CKD ob npaug. Yog li, kev tshawb pom ntxov ntawm CKD muab lub sijhawm zoo dua los txo qis kev mob, thiab kev kho mob thaum ntxov tuaj yeem ncua kev kis tus kab mob mus rau ESRD, tiv thaiv lub raum ua haujlwm, thiab txhim kho cov neeg mob prognosis. Kev Ntsuam Xyuas thiab Kev Tswj Xyuas Cov Txheej Txheem Kev Cai Hu Rau Cov Tswv Yim (tom qab no hu ua 2023 KDIGO Cov Lus Qhia Hu rau Cov Kev Xav), thov kom siv cov tswv yim kev tswj hwm zoo rau cov neeg mob CKD kom txo tau txoj kev pheej hmoo ntawm CKD kev nce qib thiab cov teeb meem ntsig txog 7, thiab qhib "kev txhim kho lub hom phiaj. ntawm lub raum thiab lub plawv. " "Lub sijhawm tswj hwm.
Tus qauv "Kidney and Heart Outcome Management" tus qauv pab CKD cov neeg mob zoo tswj cov kab mob
Daim ntawv qhia 2023 KDIGO pom zoo kom sodium-glucose cotransporter 2 (SGLT2) inhibitors rau kev kho mob ntawm hom 2 mob ntshav qab zib mellitus (T2DM), CKD, thiab cov neeg mob uas kwv yees glomerular filtration rate (eGFR) Ntau dua lossis sib npaug li 20ml / min / 1.73㎡ , thiab CKD nrog lub plawv tsis ua haujlwm, eGFR Ntau dua lossis sib npaug ntawm 20ml / min / 1.73㎡ nrog cov zis albumin-creatinine piv (UACR) Ntau dua lossis sib npaug rau 200mg / g, eGFR Ntau dua lossis sib npaug rau 20-45ml/ min/1.73㎡ nrog UACR <200mg/g7. "Cov Lus Qhia rau Kev Ntsuas Thaum Ntxov thiab Kev Tswj Xyuas Kab Mob Raum Raum Hauv Tuam Tshoj" kuj tau lees paub tag nrho cov kev tiv thaiv lub raum ntawm SGLT2 inhibitors, pom zoo tias SGLT2 inhibitors siv rau cov neeg mob CKD uas muaj lossis tsis muaj ntshav qab zib, thiab hauv cov neeg mob CKD nrog cov tsos mob plawv tsis ua haujlwm. (tsis hais txog qib ntawm ejection feem). Kev kho mob nrog SGLT2 inhibitors, thiab thaum SGLT2 inhibitors tau siv los ncua kev loj hlob ntawm lub raum kab mob lossis kev pheej hmoo ntawm lub plawv tsis ua haujlwm, tuaj yeem siv txuas ntxiv mus txog thaum cov neeg mob nkag mus rau kev lim ntshav lossis tau txais lub raum hloov 8. SGLT2 inhibitors tau txais kev pom zoo los ntawm cov txheej txheem tso cai vim lawv cov ntaub ntawv pov thawj zoo heev thiab cov txheej txheem tshwj xeeb ntawm kev ua.
SGLT2 Inhibitor Leads CKD Kev Txhim Kho Kev Tswj Xyuas thiab Paub Txog Kev Kho Mob raum thiab Lub Plawv
Kev tshawb fawb thawj lub raum ntawm SGLT2 inhibitors hauv CKD cov neeg mob uas muaj lossis tsis muaj T2MD - DAPA-CKD txoj kev tshawb fawb yog ib qho kev tshawb fawb randomized, ob qhov muag tsis pom kev, cov placebo-tswj cov kev tshawb fawb loj hauv 21 lub teb chaws thiab 386 lub chaw thoob ntiaj teb nthuav dav, tag nrho ntawm 4304 CKD cov neeg mob uas muaj lossis tsis muaj T2DM (eGFR Ntau dua lossis sib npaug li 25 thiab Tsawg dua lossis sib npaug li 75mL / min / 1.73㎡, UACR Ntau dua lossis sib npaug 200 thiab Tsawg dua lossis sib npaug rau 5000mg / g) 9 suav nrog. Lub hom phiaj ntawm txoj kev tshawb no yog los soj ntsuam cov txiaj ntsig ntawm kev ntxiv Dapagliflozin 10mg / d raws li kev kho tus qauv. Cov ntsiab lus tseem ceeb ntawm qhov kawg yog qhov ua rau lub raum tsis zoo lossis kev pheej hmoo ntawm kev tuag (txhais tias yog qhov sib xyaw ntawm Ntau dua lossis sib npaug li 50 feem pua ntawm eGFR poob, kev loj hlob mus rau theem kawg ntawm lub raum kab mob, lossis tuag los ntawm cov hlab plawv lossis lub raum ua rau). Cov ntsiab lus thib ob suav nrog qhov kawg ntawm lub raum (kev poob qis hauv eGFR Ntau dua lossis sib npaug li 50 feem pua, kev loj hlob mus rau theem kawg ntawm lub raum kab mob, lossis kev tuag los ntawm lub raum ua rau), qhov kawg ntawm cov hlab plawv tuag lossis pw hauv tsev kho mob rau lub plawv tsis ua haujlwm, thiab tag nrho- ua rau tuag.
Cov txiaj ntsig tau pom tias raws li RAS inhibitor kev kho mob, piv nrog cov placebo, dapagliflozin txo qis cov ntsiab lus kawg ntawm CKD cov neeg mob uas muaj lossis tsis muaj T2DM (txo qis hauv eGFR Ntau dua lossis sib npaug li 50 feem pua, kev nce mus rau ESRD, lub raum tuag lossis cov hlab plawv tuag) Kev pheej hmoo tshwm sim yog 39 feem pua, qhov kev pheej hmoo ntawm lub raum tshwj xeeb cov ntsiab lus kawg (eGFR poob qis dua lossis sib npaug li 50 feem pua, kev nce mus rau ESRD, lub raum tuag) tau txo qis los ntawm 44 feem pua (P<0.001), and the risk of cardiovascular death/heart failure hospitalization significantly reduced by 29% (P=0.009), and the risk of all-cause mortality was significantly reduced by 31% (P=0.004)9. It can be seen that the DAPA-CKD study has confirmed that regardless of whether T2DM is present, dapagliflozin can reduce the risk of renal failure and prolong the survival of patients with CKD stage 2~4, which has brought a breakthrough option for the treatment of CKD patients and has important milestone.
Los ntawm cov neeg mob ntshav qab zib mus rau cov neeg mob raum, SGLT2 inhibitors tau xa cov lus teb kho mob zoo, hloov kho cov qauv ntawm CKD nrog lub zog hardcore, thiab tuaj yeem ua tiav ob lub raum thiab lub plawv.
SGLT2 inhibitors txo lub nra ntawm ob lub raum los ntawm qhov chaw thiab txhim kho cov neeg mob CKD
Kev nkag siab tob txog cov txheej txheem ntawm lub raum raug mob yog qhov tseem ceeb tshwj xeeb los tiv thaiv kev kis kab mob. Ntawm lawv, glomerular hyperfiltration yog suav tias yog ib qho ntawm cov laj thawj ncaj qha uas yuav ua rau muaj kev loj hlob ntawm CKD10. Hyperfiltration ntawm glomeruli ua rau muaj qhov nce ntawm qhov ntim ntawm lub glomerulus, dhau ntawm qhov chaw pib ntawm hypertrophy, thiab qhov ua haujlwm tsis zoo ntawm lub filtration barrier thawj zaug tshwm sim raws li cov proteinuria me me, thiab nce shear quab yuam ntawm cov podocytes yuav ua rau cov podocytes detach, kom lub raum ntsws ntsws, tsim lub voj voog vicious, ntxiv txo nephrons11. Tsis tas li ntawd, hypoxia kuj tuaj yeem ua rau lub raum puas. Glomerular hyperfiltration thiab oxidative kev nyuaj siab nce oxygen thov, ua rau glomerular hypoxia thiab tubulointerstitial hypoxia. Hypoxia ua rau poob ntawm peritubular capillaries, uas tuaj yeem txhawb nqa CKD kev loj hlob los ntawm exacerbating hypoxia12.
SGLT2 inhibitors cog lus afferent arterioles los ntawm adenosine-mediated pathways, txhim kho glomerular hyperfiltration, txo glomerular siab siab, inhibit lub raum tubular reabsorption, txo ATP oxygen noj los ntawm Na plus / K ntxiv twj, thiab alleviate Hypoxic xeev, yog li txo lub nra ntawm lub raum { {2}}.
Nws tuaj yeem pom tias SGLT2 inhibitors tuaj yeem ua rau lub raum muaj zog tiv thaiv los ntawm kev txo qis glomerular hyperfiltration thiab txhim kho hypoxia, thiab yog ib qho ntawm cov kev daws teeb meem tseem ceeb los pab "txhim kho lub raum thiab lub plawv".
Epilogue
Lub rooj sab laj kev kawm no tau ua tiav tiav, thiab kev nkag siab thiab kev xav tau qhia los ntawm cov kws tshaj lij ntawm CKD kev soj ntsuam kev soj ntsuam kev tswj xyuas yog kev xav. Kev tsom mus rau qhov xwm txheej tam sim no, tsab ntawv KDIGO cov lus qhia rau cov lus hais qhia tias CKD yuav tsum tau kuaj xyuas thiab kho ntxov thiab cuam tshuam sai li sai tau. Raws li cov pov thawj tseeb ntawm cov txiaj ntsig ntawm SGLT2 inhibitors, SGLT2 inhibitors tau pom zoo los ntawm cov lus pom zoo hauv tsev thiab txawv teb chaws kom ncua kev kis kab mob thiab txhim kho lub raum thiab mob plawv hauv cov neeg mob CKD. Raws li cov txheej txheem, SGLT2 inhibitors muaj cov txiaj ntsig zoo rau lub raum thiab cov hlab plawv los ntawm kev txo qis glomerular hyperfiltration thiab txhim kho hypoxic, txo lub nra ntawm lub raum los ntawm qhov chaw, thiab noj CKD kev kho mob mus rau qib siab dua. Txawm hais tias tus kab mob lub nra hnyav ntawm CKD yog qhov hnyav thiab cov teeb meem kev kho mob hnyav, txoj hauv kev tom ntej yog ntev thiab txoj kev mus txog. Nyob rau hauv txoj kab nrog lub hom phiaj tseem ceeb ntawm "txhawb txoj kev loj hlob zoo ntawm nephrology los ntawm kev sib koom ua ke", peb txuas ntxiv tshuaj xyuas cov xwm txheej hauv ntej, cov teeb meem pos, thiab cov teeb meem hauv thaj tsam ntawm CKD. Nrog rau qhov xwm txheej tam sim no ntawm kev kuaj mob thiab kev kho mob, kuv ntseeg tias kev txhim kho kev kawm ntawm CKD yuav ruaj khov dua, muaj zog dua, thiab zoo dua, thiab yuav ua rau muaj txiaj ntsig zoo ntawm kev kos duab rau Tuam Tshoj noj qab haus huv hauv xyoo 2030!
Kev siv
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