Soj ntsuam Cov xwm txheej tam sim no ntawm lub raum kab mob hauv Suav teb
Apr 03, 2023
Txij lub Peb Hlis 30 txog Lub Plaub Hlis 2, 2023, 2023 International Society of Nephrology (ISN) World Congress of Nephrology (WCN) thiab 21st Congress ntawm Asia-Pacific Society of Nephrology (APCN) yuav muaj nyob rau hauv Bangkok, Thaib teb. Nyob rau hauv lub rooj sib tham no, Prof. Zhang Hong thiab Prof. Zhang Luxia los ntawm Peking University Thawj Tsev Kho Mob tau sau tseg cov kab mob sib kis, kev kuaj mob tshwm sim, thiab tam sim no ntawm kev kuaj mob thiab kev kho mob nephropathy hauv Suav teb 1,2.
Nyem rau cistanche tubulosa extract rau mob raum
Prof. Hong Zhang: Cov xwm txheej tam sim no ntawm IgA nephropathy hauv Suav teb
Xib fwb Zhang Hong tau qhia txog qhov xwm txheej tam sim no ntawm immunoglobulin A (IgA) nephropathy hauv Suav teb los ntawm peb yam: kev kis mob, cov tsos mob, thiab kev kho mob. Raws li qhov sib txawv no, xibfwb Zhang Hong ntseeg tias IgA nephropathy tej zaum yuav muaj qee yam heterogeneity, uas yog, nws cov kab mob yuav txawv ntawm cov neeg sib txawv. Nyob rau tib lub sijhawm, tus xibfwb Zhang Hong tau hais tias piv nrog lwm cov pejxeem, cov tshuaj tiv thaiv kab mob zoo dua rau cov neeg mob Suav IgA nephropathy.
01 Epidemiology ntawm IgA nephropathy
IgA nephropathy yog hom kab mob glomerular tshaj plaws hauv ntiaj teb, thiab nws kuj yog kab mob glomerular tshaj plaws hauv Suav teb, tab sis qhov xwm txheej sib txawv heev ntawm ntau lub teb chaws thiab cheeb tsam, thiab qhov tshwm sim ntawm IgA nephropathy hauv Asia yog qhov siab tshaj ( Kwv yees li 40 feem pua ~ 50 feem pua ntawm cov neeg mob uas muaj tus kab mob thawj glomerular).
Qhov sib txawv ntawm qhov tshwm sim kuj ua rau muaj qhov sib txawv ntawm qhov tshwm sim ntawm IgA nephropathy. Hauv Suav teb, 54.3 feem pua ntawm cov neeg mob uas muaj tus kab mob thawj glomerular muaj IgA nephropathy tom qab kev pom zoo los ntawm lub raum biopsy. Lwm lub tebchaws Esxias suav txog ntau dua 28 feem pua, tab sis Tebchaws Meskas, Brazil, thiab lwm lub tebchaws suav txog li 20 feem pua, thaum African Morocco tsuas yog 12.0 feem pua. Nws tuaj yeem pom tau tias qhov tshwm sim ntawm IgA nephropathy nyob rau hauv Suav teb yog siab, tus nqi nce siab, thiab cov neeg mob coob. Nws yog ib hom kab mob raum hauv Suav nephrologists.
02 Kev kho mob tshwm sim ntawm IgA nephropathy
Piv nrog rau lwm lub tebchaws, muaj ob qhov sib txawv tseem ceeb hauv kev kho mob tshwm sim ntawm cov neeg mob IgA nephropathy hauv Suav teb, uas yog kwv yees glomerular filtration rate (eGFR) thiab hom kab mob.
Hais txog eGFR, eGFR ntawm cov neeg mob txawv teb chaws nrog IgA nephropathy feem ntau qis dua li cov neeg mob Suav nrog IgA nephropathy. Nruab nrab ntawm 1.73㎡ (ntau qhov kev tshawb fawb Suav pej xeem).
Ntawm cov kab mob pathological, hom M1 thiab C1 ntxiv rau C2 suav rau feem ntau ntawm Suav IgA nephropathy cov neeg mob. Ntawm lawv, hom M1 suav txog ntau dua 40 feem pua, thiab C1 ntxiv rau C2 suav txog ntawm 37 feem pua thiab 59.5 feem pua. Txawm li cas los xij, hom M1 suav tsuas yog 28 feem pua ntawm cov neeg txawv teb chaws, thiab C1 ntxiv rau C2 suav txog tsuas yog 11 feem pua.
Tsis tas li ntawd, piv nrog cov neeg Caucasians, Suav cov neeg mob nrog IgA nephropathy muaj kev sib raug zoo dua ntawm eGFR poob qis nrog proteinuria. Yog tias qib proteinuria zoo ib yam, eGFR feem ntau yuav txo qis hauv Suav cov neeg mob IgA nephropathy.
Nyob rau tib lub sijhawm, cov kev tshawb fawb tseem tau lees paub tias tom qab hloov kho hnub nyoog, poj niam txiv neej, thiab kev siv tshuaj, piv nrog rau lwm tus neeg, qhov kev poob qis ntawm eGFR hauv cov neeg mob IgA nephropathy hauv thaj av Asia-Pacific yog siab dua, nrog qhov sib txawv kiag li. 1.62ml/min/1.73㎡ (95 feem pua CI, - 3.19~-0.50; P=0.04). Qhov ntawd yog, tom qab hloov kho lub hnub nyoog, poj niam los txiv neej, thiab kev siv tshuaj, cov neeg mob hauv thaj av Asia-Pacific tau muaj feem yuav kis tus kab mob raum kawg (HR=1.56; 95 feem pua CI, 1.{{ 18}}.22; P=0.01) thiab eGFR piv nrog lwm haiv neeg Txo qis dua lossis sib npaug li 50 feem pua (HR=1.81; 95 feem pua CI, 1.25-2 .62; P=0.002).
03 IgA nephropathy txoj kev npaj kho mob
Qhov sib txawv loj tshaj plaws ntawm cov neeg mob uas muaj IgA nephropathy hauv Suav teb thiab cov neeg mob IgA nephropathy hauv lwm lub tebchaws yog kev siv cov tshuaj tiv thaiv kab mob. Feem ntau (19 feem pua -54.7%) cov neeg mob IgA nephropathy hauv Suav teb thiab Nyij Pooj tau txais kev kho tshuaj tiv thaiv kab mob, thaum tsuas yog qee tus neeg mob hauv Canada (15.7 feem pua) thiab Fabkis (19.6 feem pua) tau txais kev kho tshuaj tiv thaiv kab mob. Tam sim no, cov tshuaj tiv thaiv kab mob feem ntau siv rau cov neeg mob IgA nephropathy suav nrog glucocorticoids thiab mycophenolate mofetil (MMF). Yog li, dab tsi yog qhov cuam tshuam ntawm ob cov tshuaj no ntawm IgA nephropathy?
① Glucocorticoids
Hais txog glucocorticoids, Kev Tshawb Fawb Kev Tshawb Fawb thiab Kev Tshawb Fawb STOP IgAN tau muab cov lus teb sib txawv. Txoj kev tshawb fawb soj ntsuam pom tau tias glucocorticoids tuaj yeem txo qhov kev pheej hmoo ntawm lub raum sib xyaw cov ntsiab lus kawg (kawg lub raum kab mob, tuag vim mob raum, lossis eGFR poob qis dua lossis sib npaug li 40 feem pua) hauv cov neeg mob (HR{{2 }}.37; 95 feem pua CI, 0.17-0.85; P=0.019), thaum txoj kev kawm STOP IgAN tsis muaj cov txiaj ntsig zoo sib xws.
Xib Fwb Zhang Hong tau taw qhia tias qhov sib txawv loj tshaj plaws ntawm Kev Tshawb Fawb Kev Tshawb Fawb thiab Kev Kawm STOP IgAN yog qhov sib txawv ntawm cov neeg koom. Cov neeg mob IgA nephropathy koom nrog hauv Kev Tshawb Fawb Kev Tshawb Fawb yog los ntawm Tuam Tshoj, Australia, Is Nrias teb, Canada, thiab Malaysia, ntawm 75.3 feem pua ntawm cov neeg mob yog los ntawm Tuam Tshoj, thaum cov neeg mob hauv STOP IgAN txoj kev tshawb no yog tag nrho los ntawm lub teb chaws Yelemees.
In addition, the inclusion and exclusion criteria of the two studies were somewhat different. The population included in the Testing study was proteinuria > 1g; at the same time, different intervention methods were adopted according to the baseline eGFR. For example, patients with an eGFR of 20-120ml/min/1.73㎡ received full-dose glucocorticoid therapy, while patients with an eGFR of 30-120ml /min/1.73㎡ patients received reduced doses of glucocorticoids. In the STOP-IgAN study, the proteinuria level of the patients was >0.75g, and the eGFR was >30ml / min / 1.73㎡, tab sis tsis muaj qhov sib txawv ntawm qhov ntau npaum ntawm glucocorticoids. Nyob rau tib lub sijhawm, muaj qee qhov sib txawv ntawm cov hom pathological ntawm cov neeg koom hauv ob txoj kev tshawb fawb. Cov kev sib piv saum toj no qhia tias glucocorticoids yuav ua tau zoo dua rau cov neeg mob IgA nephropathy hauv Suav teb lossis thaj tsam Asia-Pacific.
② MMF
Kev tshuaj ntsuam meta (n=347) suav nrog 8 cov kev tshawb fawb pom tias piv nrog cov placebo lossis glucocorticoid ib leeg, MMF monotherapy tau ua haujlwm zoo dua tab sis muaj cov xwm txheej tsis zoo. Piv nrog rau lwm cov tshuaj tiv thaiv kab mob ntxiv rau kev kho glucocorticoid, MMF muaj cov txiaj ntsig zoo dua qub, tuaj yeem txo qhov kev pheej hmoo ntawm creatinine ob npaug thiab kev loj hlob mus rau theem kawg ntawm lub raum kab mob, thiab muaj qhov tshwm sim tsis zoo. Txawm li cas los xij, feem ntau ntawm cov pov thawj uas MMF tau txais txiaj ntsig zoo rau IgA nephropathy los ntawm cov neeg Esxias.
04 Heterogeneity ntawm IgA nephropathy
Tag nrho cov pov thawj saum toj no qhia tau hais tias cov neeg mob IgA nephropathy nyob rau hauv thaj av Asia-Pacific thiab Europe sib txawv ntawm cov kab mob sib kis, kev nthuav qhia kho mob, thiab kev xaiv kho mob. Cov kev tshawb fawb tseem ceeb tau pom tias piv nrog cov neeg Caucasian, Suav IgA nephropathy cov neeg mob tau qis cov ntshav galactose-tsis muaj IgA1 (Gd-IgA1) qib (P<0.0001), and Asian IgA nephropathy patients have unique gene mutation sites, C1GALT1 also exists in different variants.
Hais txog kev qhuas, cov neeg Esxias kuj txawv ntawm cov neeg Caucasian. Los ntawm txoj kev xav ntawm lwm txoj hauv kev (AP), cov noob tiv thaiv ntawm cov pej xeem Suav tau qis dua li cov neeg Caucasian. Nyob rau hauv txoj kev lectin (LP), Neeg Esxias muaj kev pheej hmoo siab ntawm C4d deposition tshaj Caucasians.
Cov kev tshawb fawb uas twb muaj lawm tau pom tias qhov sib txawv ntawm kev ua kom muaj zog ntxiv hauv cov neeg mob uas muaj IgA nephropathy tuaj yeem tshwm sim hauv cov kab mob glomerular vascular lesions thiab Gd-IgA1 lub cev tsis muaj zog, uas yuav ua rau muaj qhov sib txawv hauv kev kho mob thiab cov teebmeem kev kho mob. Vim tias qhov pathogenesis ntawm IgA nephropathy tam sim no tsis paub, nws tsis paub meej tias qhov sib txawv ntawm biomarkers (Gd-IgA1 qib), cov noob caj noob ces, thiab cov kab ke sib txuas yog tag nrho cov hauv paus ntawm heterogeneity hauv cov neeg mob IgA nephropathy.
Feem ntau, cov pej xeem Suav muaj ntau dua rau IgA nephropathy. Suav cov neeg mob uas muaj IgA nephropathy teb zoo dua rau kev tiv thaiv kab mob ntau dua li lwm tus neeg. Nyob rau hauv lub neej yav tom ntej, peb yuav tsum tau them nyiaj mloog ntxiv rau cov txheej txheem pathological ntawm IgA nephropathy thiab ua cov kev pabcuam kho mob ib leeg.
Xib fwb Luxia Zhang: Cov Ntaub Ntawv Loj thiab Kab Mob Raum
Tam sim no, Tuam Tshoj tau nkag mus rau lub hnub nyoog digital, thiab ntau lub lag luam tsim cov ntaub ntawv ntau, thiab kev lag luam kho mob tsis muaj qhov tshwj xeeb. Cov ntaub ntawv loj tuaj yeem sau cov ntaub ntawv los ntawm ntau qhov chaw, tom qab ntawd txheeb xyuas cov ntaub ntawv los nthuav tawm cov ncauj lus, thiab kev nkag siab uas nrhiav tsis tau los ntawm lwm txoj hauv kev, thiab yog li tsim cov kev daws teeb meem.
Xib fwb Zhang Luxia tau qhia txog kev sib koom ua ke ntawm Tuam Tshoj cov ntaub ntawv loj kev lag luam thiab kev kho mob hauv ntau txoj hauv kev los ntawm loj mus rau me me, los ntawm qhov chaw mus rau qhov chaw. Cov kev ua tiav tshiab no yuav txhawb nqa kev nce qib ntawm kev tshawb nrhiav kab mob raum thiab kev tswj hwm.
01 Cov ntaub ntawv loj thiab tshuaj
Tam sim no, kev sib koom ua ke ntawm cov ntaub ntawv loj, AI, thiab lwm yam ntaub ntawv thev naus laus zis nrog kev kho mob tau los ze zog dua. Nws yog tsim nyog sau cia tias "kev pom loj" muab los ntawm cov ntaub ntawv loj tuaj yeem daws qee qhov mob ntawm cov tshuaj uas twb muaj lawm vim tias cov ntaub ntawv loj muaj plaub yam tseem ceeb: ntim, ntau yam, nrawm (Velocity), thiab qhov tseeb (Veracity). Cov yam ntxwv saum toj no ua rau muaj qhov sib txawv ntawm cov ntaub ntawv loj tsom xam thiab cov ntaub ntawv tshuaj ntsuam xyuas thiab kev tshawb fawb. Hauv cov ntsiab lus no, cov ntaub ntawv tshawb fawb tau los ua. Cov ntaub ntawv tshawb fawb yog ib qho kev tshawb fawb uas siv AI, cov ntaub ntawv loj, thiab cov cuab yeej siv hluav taws xob muaj zog (khoom siv) los ua ke thiab ua cov ntaub ntawv los tsim cov ntaub ntawv sib xws thiab kev paub, thiab thaum kawg los tsim cov tswv yim ua tau zoo thiab ua tau.
Txhawm rau muab tshuaj zoo dua, cov ntaub ntawv tshawb fawb tau tsim ib ceg ntawm kev tshawb fawb txog kev noj qab haus huv (HDS). Tam sim no, HDS tab tom ntsib peb qhov kev sib tw tseem ceeb, xws li kev xav-tsav vs cov ntaub ntawv-tsav, lub ntiaj teb tiag tiag vs kev tshawb fawb scenarios, thiab kev sib tw sib tw.
① Hypothesis-tsav vs data-driven
Hypothesis-driven yog ib txoj hauv kev tshawb fawb uas nug cov lus nug, tsim cov phiaj xwm sim, sau cov ntaub ntawv, thiab ua kev tshuaj xyuas thiab ua qauv qhia los ntawm kev xav thiab kev xav. Nws kuj yog ib txoj kev tsim qauv rau kev tshawb fawb soj ntsuam tam sim no.
Cov ntaub ntawv-tsav yog lwm txoj kev xav, thiab nws cov ntsiab lus tau muab faib ua peb kauj ruam:
1) Sau cov ntaub ntawv loj; 2) Cov ntaub ntawv qauv thiab kev txheeb xyuas cov ntaub ntawv; 3) Cov ntaub ntawv tawm tswv yim.
Kev tsim qauv thiab kev txheeb xyuas cov ntaub ntawv yuav muab cov lus qhia thiab kev txiav txim siab cov tswv yim hauv kev siv tshuab, ntse, thiab kev tshawb fawb.
Hauv luv luv, HDS yuav tsis tsim ob txheej txheem ntawm kev tawm tswv yim thiab tsim cov kev sim, tab sis yuav ncaj qha pib los ntawm cov ntaub ntawv uas twb muaj lawm, muab AI thiab suav lub zog, thiab muab cov lus qhia txiav txim ncaj qha rau cov neeg siv (cov kws kho mob) (
② Lub ntiaj teb tiag tiag vs kev tshawb fawb scenarios
Tam sim no, kev tshawb fawb soj ntsuam tsis tuaj yeem sim simulate lub ntiaj teb tiag tiag, thiab muaj qee qhov lag luam hauv kev txiav txim siab, uas yog qhov tsis txaus ntawm cov kev tshawb fawb yav dhau los. Txawm li cas los xij, plaub tus yam ntxwv ntawm cov ntaub ntawv loj tuaj yeem sau cov ntaub ntawv kho mob hauv lub ntiaj teb tiag tiag, nrawm, ntau yam, thiab nthuav dav, ua rau HDS sai sai muab cov lus pom zoo uas muaj kev qhia dav thiab ua raws li kev kho mob.
③ Cov kev sib tw sib tw
Tam sim no, qhov kev sib tw loj tshaj plaws rau HDS yog yuav ua li cas koom nrog cov kws kho mob, cov kws tshaj lij hluav taws xob, thiab cov neeg tsim cai. Txij li HDS yog ib qho kev kawm tshiab, lwm cov kev lag luam paub me ntsis txog nws, thiab qee cov ntsiab lus thiab cov ntsiab lus tsim nyog yuav tsum tau nrov. Yog li ntawd yog qhov kev sib tw tam sim no.
02 HDS thiab mob raum
① Cov ntaub ntawv dav dav
Cov ntaub ntawv rau HDS muaj ntau haiv neeg thiab cov peev txheej tshiab tau tsim los tas li. Tam sim no, cov peev txheej ntawm HDS cov ntaub ntawv feem ntau cuam tshuam rau nephrologists thiab cov kws tshawb fawb yog:
Kev tshawb fawb txog kab mob sib kis (xws li kev tshawb fawb NHANES);
Cov kev tshawb fawb loj (piv txwv li, DOPPS txoj kev kawm, iNet-CKD);
Cov ntaub ntawv sau npe tus neeg mob (xws li USRD, UK Renal Registry); kev tshawb fawb soj ntsuam.
Tsis tas li ntawd, cov ntaub ntawv kho mob hauv hluav taws xob thiab cov ntaub ntawv pov hwm kho mob kuj yog qhov tseem ceeb ntawm HDS. Lawv tsis yog Ameslikas tsim rau kev tshawb fawb lub hom phiaj, thiab yog li ntawd, cov ntaub ntawv yog loj thiab ntau yam. Thaum lawv cuam tshuam nrog lwm cov ntaub ntawv, lawv tuaj yeem ua haujlwm zoo dua rau kev txiav txim siab kho mob, uas yog ib qho ntawm cov lus qhia rau kev tshawb fawb yav tom ntej. Txawm li cas los xij, vim qhov tsis zoo ntawm cov ntaub ntawv kho mob hauv hluav taws xob thiab cov ntaub ntawv pov hwm kho mob, cov kev xav tau ntawm cov ntaub ntawv txheeb xyuas thiab kev tswj hwm yog qhov siab. Qee qhov kev tshawb fawb hauv xyoo tas los no tau pom tias cov ntaub ntawv ntsig txog molecular biology, xov tooj ntawm tes, thiab kev tshaj xov xwm tuaj yeem yog qhov zoo ntawm HDS.
② Muaj kev ua tiav ntawm HDS
Hauv Suav teb, HDS tab tom txhim kho sai, thiab Kab Mob Raum Cov Ntaub Ntawv Network (CK-NET; Txuas: www.chinakidney.net) yog ib qho ua tau zoo tshaj plaws. Lub hom phiaj ntawm CK-NET yog txhawm rau sib koom ua ke ntau yam ntaub ntawv ntawm cov kab mob raum hauv Suav teb thiab siv cov cuab yeej siv thev naus laus zis los muab cov ntaub ntawv pov thawj rau kev txiav txim siab txoj cai, ntxiv dag zog rau kev tshawb fawb, thiab txhawb kev tswj hwm kab mob zoo hauv lub raum.
CK-Net tsis tu ncua nthuav tawm cov ntaub ntawv tshawb fawb txog kab mob raum hauv Suav teb, suav nrog peb tshooj, kab mob raum tsis zoo (CKD), kab mob raum kawg (ESKD), thiab cov neeg mob tshwj xeeb, suav nrog feem ntau ntawm cov neeg mob raum thiab qhia meej txog qhov xwm txheej. kab mob raum yog pab tau rau kev txhim kho tshuaj, tsim txoj cai thiab tsim kom muaj kev tiv thaiv thiab tswj cov kev pab cuam.
Tsis tas li ntawd, HDS ua lub luag haujlwm tseem ceeb hauv kev kwv yees ntawm kev mob raum kev loj hlob thiab kev tshawb fawb ntawm lub raum pathology. Kev kawm tshuab thiab lwm txoj hauv kev tuaj yeem siv los kwv yees qhov kev loj hlob ntawm cov kab mob raum hauv cov neeg mob thiab txhawm rau kuaj pom lub raum biopsy kuaj thiab kos cov lus xaus.
Hais txog kev tshawb fawb, HDS tuaj yeem tshawb fawb hauv ntiaj teb tiag. Piv nrog rau kev tshawb fawb ib txwm muaj, kev tshawb fawb hauv ntiaj teb muaj peev xwm suav nrog ntau tus neeg, cov ntaub ntawv muaj ntau dua lub sijhawm, thiab nws yog ze rau kev kho mob. Tsis tas li ntawd, HDS tuaj yeem ua rau muaj kev pheej hmoo stratification, kev pom kev siv tshuab tshiab, thiab cov phiaj xwm kev kho mob ntawm cov neeg hauv zos yooj yim dua.
HDS twb hloov txoj kev kuaj mob thiab kho. Siv Minuteful raum ua piv txwv. Qhov no yog ib lub xov tooj app ntxiv rau kev kuaj tus kheej cov khoom siv uas tso cai rau cov neeg mob kuaj xyuas qib proteinuria hauv tsev. Qhov no yuav hloov qhov kev tshuaj ntsuam xyuas, kev kuaj mob, thiab kev soj ntsuam ntawm cov neeg mob CKD thiab pab txhawb rau qhov kawg ntawm cov neeg mob. Nws tau tshaj tawm tias cov khoom tau raug tso tawm hauv Tebchaws Meskas.
Cistanche puas tuaj yeem kho mob raum?
Cistanche tau ib txwm siv hauv Suav tshuaj los kho mob raum tsis zoo xws li lub raum tsis ua haujlwm, lub raum tsis muaj zog, thiab tso zis tsis txaus. Cov kev tshawb fawb tsis ntev los no kuj tau pom tias cistanche tuaj yeem muaj txiaj ntsig zoo rau lub raum noj qab haus huv. Cistanche ntseeg tau tias muaj cov tshuaj tiv thaiv kab mob, tiv thaiv kab mob, thiab tshuaj tua kab mob antioxidant uas yuav pab tiv thaiv lub raum los ntawm kev puas tsuaj los ntawm oxidative kev nyuaj siab thiab mob. Nws kuj tseem tuaj yeem txhim kho lub raum ua haujlwm los ntawm kev txhawb cov ntshav ntws mus rau ob lub raum thiab ua kom cov zis tso zis ntau ntxiv. Txawm li cas los xij, xav tau kev tshawb fawb ntxiv kom nkag siab txog qhov cuam tshuam ntawm cistanche ntawm cov kab mob raum thiab nws txoj kev nyab xeeb thiab kev ua tau zoo. Nws yog ib qho tseem ceeb uas yuav tau sab laj nrog tus kws kho mob ua ntej noj tshuaj ntsuab, tshwj xeeb tshaj yog tias koj muaj mob raum.
Cov ntaub ntawv:
1. Hong Zhang, IgA Nephrology epidemiology, soj ntsuam pathological nta, thiab kev kho mob nyob rau hauv Tuam Tshoj Mar 30, 2022. WCN Virtual Congress.
2. Luxia Zhang. Txhim kho raum Kev Noj Qab Haus Huv Los Ntawm Cov Ntaub Ntawv Loj thiab Cov Ntaub Ntawv Tshawb Fawb. Lub Peb Hlis 30, 2022. WCN Virtual Congress.
