Superiority ntawm Cystatin C dhau Creatinine Rau Kev Tshawb Fawb Txog Thaum Ntxov Ntawm Lub raum Kev Kho Mob Hauv Cov Menyuam Mob Mob Lymphoblastic Leukemia / Lymphoblastic Lymphoma Ⅱ

Cov txiaj ntsig

Qhov xwm txheej thiab qhov hnyav ntawm AKI

Peb tau tshuaj xyuas 16 tus neeg tau txais tag nrho of 75 chav kawm ntawm kws khomob. Ntawm cov no, 12 yog txiv neej thiab hnub nyoog nruab nrab yog 9.4 xyoo nrog qhov sib txawv (IQR) ntawm 7.2 txog 13.1 xyoo. Qhov nruab nrab qhov siab yog 132.5 cm (IQR, 117.8 txog 153.4 cm), thiab nruab nrab lub cev hnyav yog 28.7 kg (IQR, 19.1 txog 42.4 kg). Lub cev qhov hnyav yog 16.3 (IQR, 15.7 txog 18.4) kg / m2. Qhov nruab nrab Z-cov qhab nia rau qhov siab thiab qhov hnyav raws li Japanese cov qauv kev loj hlob (Isojima li al. 2016) yog −0.3 (IQR, −1.0 rau {{ 34}}.5) thiab −{38}}.6 (IQR, −1.1 txog 0.3), ntsig txog (Table 1).

Raws li qhia hauv Table 3, tag nrho 16 tus neeg mob tau tsim AKI thaum siv tshuaj khomob (100% tshwm sim) thiab thaum kawg rov zoo. Thaum lub sijhawm 75 chav kawm, AKI tau kuaj pom hauv 58 chav kawm los ntawm CysC-based eGFR (77%: "Risk" 72%, "Injury" 4.0%, "Failure" 1.3%, "Poob" 0%) thiab nyob rau hauv 49 chav kawm los ntawm Cr-based eGFR (65%: "Risk" 61%, "Injury" 2.7%, "Failure" 1.3%, "Poob" 0%). AKI tau kuaj pom hauv 42 chav kawm los ntawm CysC-based eGFR thiab Cr-based eGFR (56%) txawm tias tsis muajtsim cov qog lysis syndromethaum chemotherapy.

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Txij li thaum glucocorticoids tuaj yeem cuam tshuam cov ntshav CysC qib (Bardi li al. 2010; Nakamura li al. 2018; Cimerman li al. 2000), qhov tshwm sim ntawm AKI raws li CysC-based eGFR tau muab piv los ntawm kev kho mob glucocorticoid. Tsis muaj qhov sib txawv tseem ceeb hauv qhov tshwm sim ntawm AKI: 77.4% thaum lub sij hawm kho mob nrog glucocorticoids thiab 77.3% thaum siv tshuaj kho mob tsis muaj glucocorticoids. Qhov tshwm sim ntawm AKI los ntawm hom kev siv tshuaj khomob yog qhia hauv Table 4. AKI tau tshwm sim ntau zaus hauv cov chav kawm sib sau uas suav nrog methotrexate. AKI tau kuaj pom hauv 24 ntawm 25 chav kawm sib koom ua ke (96%) raws li CysC-based eGFR thiab 22 ntawm 25 chav kawm sib sau ua ke (88%) raws li Cr-based eGFR (Table 4).

Qhov tsis sib xws tau pom nyob rau hauv 23 chav kawm hais txog qhov tshwm sim ntawm AKI kuaj pom los ntawm CysC-based eGFR thiab Cr-based eGFR: 7 chav kawm tau kuaj pom tias muaj AKI nkaus xwb los ntawm Cr-based eGFR, thaum 16 chav kawm tau kuaj pom tias muaj AKI nkaus xwb los ntawm CysC- raws li eGFR (Table 3). Txawm li cas los xij, tsis muaj qhov sib txawv tseem ceeb hauv qhov tshwm sim ntawm AKI tsis hais seb CysC-based eGFR lossis Cr-based eGFR tau siv rau kev kuaj mob (p=0.104).

Hnub mus txog rau qhov pib ntawm AKI

Ntxiv mus, rau 42 chav kawm uas AKI tau kuaj pom los ntawm ob qho tib si CysC- thiab Cr-based eGFR, peb piv cov hnub txij li pib ntawm txhua chav kho mob mus rauAKI kuaj mob. Lub sijhawm nruab nrab ntawm AKI kuaj pom tau luv luv rau CysC-based eGFR (8 hnub [IQR, 4 txog 21 hnub]) dua li Cr-based eGFR (17 hnub [IQR, 10 txog 31 hnub], p <0.001) (Fig. 1). Ntawm 42 chav kawm uas AKI tau tsim, muaj cov kev hloov pauv hauv qhov txo qis ntawm CysC- thiab Cr-based eGFR nyob rau 2 lub lis piam txij li pib siv tshuaj khomob (Fig. 2). CysC-raws li eGFR tau pom qhov poob qis dua li Cr-based eGFR.

Kev soj ntsuam mus sij hawm ntev Ntawm 16 tus neeg mob, 13 tau ua raws li lub Peb Hlis 2021.

Peb tus neeg mob tau ploj mus tom qab lawv tsiv mus rau ib qho

Table 3. Kev tshwm sim ntawm mob raum raug mob (AKI) thaum lub sij hawm cov kev kawm ntawm chemotherapy nyob rau hauv me nyuam mob mob lymphoblastic leukemia/ lymphoblastic lymphoma (ALL/LBL) nyob deb qhov chaw. Lub sijhawm ua raws li kev kho mob rov qab siv dua li ntawm 18 txog 57 lub hlis (qhov nruab nrab, 29 lub hlis; IQR, 18-45 hli). Tsis muaj cov neeg mob uas muaj proteinuria tseem ceeb lossis muaj CysC-based eGFR < 90 mL / min / 1.73m2 .

Post hoc fais fab kev soj ntsuam Kev soj ntsuam tom qab hoc fais fab tuag tau ua los siv G*Power 3.1.9.4 (Heinrich-Heine University, Düsseldorf, Lub teb chaws Yelemees) los soj ntsuam thawj qhov tshwm sim ntawm lub sijhawm rauAKI kuaj mob(Faul et al. 2007). Cov nyhuv loj ntawm peb cov ntaub ntawv yog 0.609. Thaum qhov tseem ceeb theem tau teem rau 0.05, lub zog yog 0.855, uas yog ntau dua 0.80. Yog li, qhov kev tshuaj xyuas tau lees paub tias tus qauv loj txaus rau kev txheeb xyuas kev txheeb xyuas (Cohen 1992).

Fig. 1. Sib piv cov hnub txij li pib ntawm kev kho mob mus rau mob raum raug mob (AKI) kuaj mob. Cov hnub nruab nrab rau AKI (tsawg dua lossis sib npaug li 25% ntawm kev txo qis hauv CysC-based eGFR) yog 8 hnub (interquartile range, 4 txog 21 hnub), piv nrog 17 hnub (interquartile range, 10 mus txog 31 hnub) hauv Cr-based eGFR (p <0.001). Cov kab kab rov tav nyob rau hauv lub thawv sawv cev rau qhov nruab nrab qhov tseem ceeb, thiab hauv qab thiab sab saum toj ntawm lub thawv sawv cev rau 25th thiab 75th feem pua, feem. Cov kab ntsug txuas ntxiv los ntawm lub thawv rau 5 thiab 95 feem pua. AKI, mob raum raug mob; Cr, creatinine; CysC, cystatin C; eGFR, kwv yees glomerular filtration rate.

Kev sib tham

Peb txoj kev tshawb fawb tau qhia tias txhua tus neeg mob tau ntsib AKI tsawg kawg ib zaug thaum ALL / LBL kho thiab AKI tau kuaj pom hauv 77% ntawm tag nrho.Cov chav kawm chemotherapysiv CysC-based eGFR. Ib txoj kev tshawb fawb tau tshaj tawm txog 16.2% qhov tshwm sim hauv ib pawg ntawm 831 tus neeg mob tau txais tshuaj kho mob rau cov menyuam yaus mob ntshav qab zib mellitus tshiab (Fisher et al. 2010). Lwm daim ntawv tshaj tawm qhia pom qhov tshwm sim ntawm 39% ntawm AKI hauv kev tshawb fawb ntawm 23 tus menyuam yaus uas muaj qog nqaij hlav (McMahon li al. 2018). Rau peb txoj kev paub, tsis muaj kev tshawb fawb tau soj ntsuam qhov tshwm sim ntawm AKI ntawm cov neeg mob ALL / LBL. Hauv txoj kev tshawb fawb tam sim no, qhov tshwm sim ntawm AKI thaum siv tshuaj khomob yuav siab dua qhov kev cia siab ntawm cov kws kho mob oncologist lossis lwm yam kev tshwm sim yav dhau los hauv cov neeg mob qog noj ntshav. Qhov tsis sib xws ntawm qhov tshwm sim ntawm AKI tuaj yeem piav qhia los ntawm ntau qhov laj thawj. Ua ntej, nquag ntsuam xyuas ntawm lub raum ua haujlwm nyob rau hauv lubcov lus qhia ntawm pediatric nephrologists, kev kuaj ntshav tsawg kawg 3 zaug hauv ib lub lis piam, ua rau muaj kev soj ntsuam ntau dua, thiab peb tuaj yeem kuaj tau AKI me me. Qhov thib ob, cov qauv sib txawv tau siv hauv cov kev tshawb fawb yav dhau los. Rau kev kuaj mob ntawm AKI, qee qhov kev tshawb fawb tau siv Cov Kab Mob Raum: Txhim Kho Cov Txheej Txheem Thoob Ntiaj Teb (Sutherland li al. 2015; Meersch li al. 2017) lossis cov qauv pRIFLE (Sethi li al. 2015; Sutherland et al. al. 2015), thaum lwm tus tau siv International Statistical Classification of Diseases thiab Related Health Problems codes (Ko et al. 2018). Thib peb, cov tshuaj siv hauv cov txheej txheem sib txawv tuaj yeem cuam tshuam cov txiaj ntsig. Plaub, Cr-based eGFR tau siv los ntsuas lub raum ua haujlwm hauv kev tshawb fawb feem ntau (McMahon li al. 2018), thiab CysC-based eGFR tsis tshua siv (Yong et al. 2017; Nakamura li al. 2018). Kev txhim kho hauv kev kuaj mob thiab kev kho mob ntawm cov neeg mob qog noj ntshav hauv menyuam yaus tau ua rau muaj cov neeg mob qog noj ntshav nce ntxiv. Txawm li cas los xij, ntau tus neeg mob qog noj ntshav thaum yau muaj teeb meem kev noj qab haus huv ntau xyoo tom qab vim lawv txoj kev kho mob qog noj ntshav. Koojmans et al. (2019) tshuaj xyuas cov kev tshawb fawb yav dhau los ntawm lub raum tsis ua haujlwm hauv cov menyuam yaus uas muaj mob qog noj ntshav. Lawv tau tshaj tawm tias feem ntau ntawm CKD yog li ntawm 2.4% mus rau 32%. Lwm txoj kev tshawb fawb tau tshaj tawm tias 0.5% ntawm ntau dua 10,{18}} cov neeg mob qog noj ntshav thaum yau tau kho hauv xyoo 1970 thiab 1980s tau tsim lub raum tsis ua haujlwm lossis xav tau kev lim ntshav los ntawm 18 xyoo tom qab kuaj mob qog noj ntshav thawj zaug. Lawv muaj cuaj npaug siab dua lawv cov kwv tij uas tsis muaj mob qog noj ntshav (Oeffinger li al. 2006). Chemotherapy-induced AKI yog tus cwj pwm los ntawm ntau lub xeev pathological xws li podocytopathy, mob tubular raug mob, thiab siv lead ua nephropathy (Perazella 2012). Txawm hais tias AKI rov zoo, kho tsis zoo, thiab rov raug mob ntau zaus tuaj yeem ua rau tubulointerstitial fibrosis thiab glomerulosclerosis uas ua rau CKD (Venkatachalam li al. 2015; Basile li al. 2016), peb qhov kev tshawb pom qhia tias cov kws kho mob yuav tau saib xyuas me ntsis AKIs. Cov neeg mob qog noj ntshav feem ntau tau kawm ntau yam kev kho mob chemotherapy, uas tuaj yeem ua rau rov ua rau lub raum raug mob thiab ib qhonce kev pheej hmoo ntawm CKD. Yog li, oncologists ua ke nrog nephrologists yuav tsum ua tib zoo xyuas txawm tias mob AKI thaum siv tshuaj khomob.

Hauv kev kawm tam sim no, thaum 75 chav kawm, AKI tau kuaj pom hauv 58 chav kawm los ntawm CysC-based eGFR (77%) thiab 49 chav kawm los ntawm Cr-based eGFR (65%). Ntawm cov xwm txheej no, kev kuaj mob ntawm AKI tau pom zoo pom zoo siv ob qhov kev ntsuas ntsuas hauv 42 chav kawm. Los ntawm qhov sib txawv, muaj qhov sib txawv ntawm qhov tshwm sim ntawm AKI kuaj pom los ntawm CysC-based eGFR thiab Cr-based eGFR hauv 23 chav kawm, txawm hais tias tsis muaj qhov sib txawv tseem ceeb hauv qhov xwm txheej ntawm AKI tsis hais seb CysC-based eGFR lossis Cr-based eGFR. tau siv rau kev kuaj mob (p=0.104). Peb xav kom cov txheej txheem hauv qab no ua rau muaj qhov tsis sib xws: Ntawm xya qhov kev kuaj mob AKI tsuas yog los ntawm Cr-based eGFR, rau tus neeg mob (86%) tau txais asparaginase tam sim ua ntej kev txhim kho AKI. Txij li thaum asparaginase tuaj yeem txo cov ntshav CysC los ntawm kev txo qis cov ntshav triiodothyronine, uas txhawb nqa CysC tso tawm ntawm cov leeg nqaij los ntawm kev hloov pauv kev loj hlob-beta 1, AKI soj ntsuam siv CysC-based eGFR yuav raug saib xyuas vim qhov txo qis hauv cov ntshav CysC hauv cov neeg mob tau txais asparaginase ( Ferster et al. 1992; Kotajima et al. 2010). Lub caij no, ntawm 16 chav kawm kuaj mob AKI los ntawm kev siv CysC-based eGFR ib leeg, feem ntau muaj tus qhab nia Z tsis zoo rau lub cev qhov hnyav, qhia tias lawv tau txo cov leeg nqaij. Txij li cov ntshav Cr qib feem ntau cuam tshuam los ntawm cov leeg nqaij, qhov no yuav ua rau muaj qhov tsis tseeb-nega tiv thaiv cov txiaj ntsig hauv kev kuaj mob ntawm AKI tso siab rau Cr-based eGFR. Qhov tseem ceeb, Rayar et al. (2013) tau tshaj tawm tias cov menyuam yaus uas muaj TAG NRHO muaj cov leeg pob txha qis (txhais tau tias Z tus qhab nia ntawm −0.18) dua li cov menyuam noj qab haus huv thaum lub sijhawm kuaj mob.

Fig. 2. Tus nqi ntawm CysC-based eGFR thiab Cr-based eGFR txo qis thaum cov kev kho mob nrog rau mob raum raug mob (AKI). Qhov nruab nrab txo tus nqi ntawm CysC-raws li eGFR (khoom khov kab) thiab Cr-based eGFR (dashed kab) txij li thaum pib ntawm chemotherapy ntawm 42 chav kawm nrog AKI tau qhia. Cov kab kab rov tav nyob rau hauv lub thawv sawv cev rau qhov nruab nrab qhov tseem ceeb, thiab hauv qab thiab sab saum toj ntawm lub thawv sawv cev rau 25th thiab 75th feem pua, feem. Cov kab ntsug txuas ntxiv los ntawm lub thawv rau 5 thiab 95 feem pua. AKI, mob raum raug mob; Cr, creatinine; CysC, cystatin C; eGFR, kwv yees glomerular fi ltration tus nqi.

Serum Cr feem ntau yog siv rau hauv kev kuaj mob ntawm AKI thiab kev saib xyuas ntawmlub raum ua haujlwm. Txawm li cas los xij, nws cov qib yuav tsis hloov mus txog thaum kwv yees li 50% ntawm lub raum ua haujlwm tau ploj lawm (Nguyen thiab Devarajan 2008). CysC yog cov protein uas tsis muaj molecular hnyav tas li tsim thiab zais los ntawm cov hlwb nucleated thoob plaws lub cev. Nws yog lim dej dawb los ntawm glomerulus thiab tag nrho reabsorbed thiab metabolized los ntawm lub raum proximal tubules; nws muaj qhov sib cuam tshuam nrog GFR raws li ntsuas siv cov xov tooj cua isotopes (Coll li al. 2000). Vim yog cov yam ntxwv lom neeg, CysC tuaj yeem tsim nyog rau kev soj ntsuam ntawm lub raum ua haujlwm hauv cov menyuam yaus (Lankisch li al. 2006; Nakhjavan Shahraki et al. 2017). Ib qho kev ntsuam xyuas meta tsis ntev los no tau pom qhov zoo tshaj ntawm CysC tshaj Cr hauv kev kuaj mob AKI (Nakhjavan Shahraki li al. 2017), uas nthuav tawm lwm txoj hauv kev rau kev kuaj mob ib txwm muaj hauv nephrology. Txawm li cas los xij, kev tswj hwm glucocorticoid hauv cov neeg laus uas muaj mob hawb pob thiab cov qog nqaij hlav tuaj yeem ua rau cov ntshav CysC nce qib ntawm lub raum tsis ua haujlwm, txawm tias qhov tseeb mechanism tseem tsis paub (Bjarnadottir li al. 1995; Manetti li al. 2005). Qhov no tuaj yeem ua rau muaj qhov tsis tseeb ntawm AKI yog kev soj ntsuam los ntawm CysC-based eGFR. Hauv qhov sib piv, muaj kev sib cav txog seb glucocorticoids puas cuam tshuam rau cov ntshav CysC hauv cov neeg mob menyuam yaus (Bokenkamp li al. 2002; Foster et al. 2006; Bokenkamp et al. 2007; Bardi et al. 2010; Slort et al. 2010). Yog li, hauv txoj kev tshawb fawb tam sim no, qhov tshwm sim ntawm AKI tau muab sib piv los ntawm kev kho mob khaub thuas glucocorti. Cov txiaj ntsig tau pom tsis muaj qhov sib txawv tseem ceeb ntawm ob txoj kev tswj hwm ntawm AKI: qhov qub yog 77.4%, thaum tom kawg yog 77.3% (Table 3). Tsis tas li ntawd, cov kev hloov pauv nyob rau hauv tus nqi ntawm CysC-based eGFR txo qis thaum lub sijhawm 42 chav kawm ntawm AKI, uas suav nrog 28 chav kawm nrog glucocorticoids, pom kev txhim kho hauv lub raum ua haujlwm hauv 12 hnub txawm hais tias kev tswj hwm glucocorticoid txuas ntxiv 2 lub lis piam. Ua ke, peb ntseeg tias glucocorticoids muaj qhov cuam tshuam tsis zoo ntawm cov ntshav CysC qib thiab CysC-based eGFR thiab cov txiaj ntsig ntawm peb txoj kev tshawb fawb qhia tias CysC-based eGFR yog qhov rhiab dua li Cr-based eGFR rau kev ntsuas lub raum ua haujlwm hauv cov neeg mob TAG NRHO / LBL. Peb kuj tau sib piv AKI qhov xwm txheej los ntawm hom kev kho tshuaj khomob. AKI feem ntau tshwm sim thaum cov chav kawm sib sau ua ke, tej zaum yog vim kev siv cov tshuaj methotrexate siab. Txawm hais tias tsis yog qhov tseem ceeb, hauv txhua plaub hom kev kawm, AKI tau kuaj pom ntau dua thaum txhais tau tias siv CysC-based eGFR piv rau Cr-based eGFR, uas qhia tau hais tias muaj txiaj ntsig ntawm CysC-based eGFR hauv kev kuaj mob AKI thaum siv tshuaj khomob.

Txawm hais tias ob qho tib si CysC- thiab Cr-based eGFR muaj qhov zoo thiab qhov tsis zoo, peb pom qhov txiaj ntsig ntawm CysC-based eGFR dhau Cr-based eGFR rau covkev kuaj mob ntxovntawm AKI hauv cov neeg mob menyuam yaus uas muaj TAG NRHO / LBL tau txais kev kho mob. Tshawb xyuas AKI thaum ntxov yuav tso cai rau kev tiv thaiv tsim nyog los tiv thaiv lub raum tsis zoo ntxiv. Muaj peev xwm tiv thaiv kev kho mob nrog rau kev txo cov tshuaj noj, kev haus dej, kev tswj hwm cov tshuaj diuretics (Horie li al. 2018), thiab lwm yam tshuaj tiv thaiv raum yuav pab txhawb kev tiv thaiv CKD yav tom ntej. Hauv txoj kev tshawb no, peb tau ua raws li cov neeg mob rau qhov nruab nrab ntawm 29 lub hlis tom qab rov ua cov kev kawm kom paub meej txog kev txhim kho ntawm CKD; tsis muaj neeg mob tau txo eGFR. Txij li cov neeg mob uas tau ntsib AKI muaj kev pheej hmoo ntawm CKD yav tom ntej, peb yuav txuas ntxiv mus ntxiv.

Txoj kev tshawb no muaj qee qhov kev txwv uas yuav tsum tau xav txog. Ua ntej, raws li tag nrho cov kev tshawb fawb cov neeg mob tau zoo lawm, tsis muaj kev cuam tshuam los ntawm AKI. Cov kev tshawb fawb ntxiv yog xav tau los txiav txim siab seb puas tuaj yeem rov qab tau nrawm nrog kev cuam tshuam, xws li txo cov tshuaj tiv thaiv kab mob, cov kua dej ntau ntau, lossis alkaliza tion. Ntxiv mus, cov kev tshawb fawb yav tom ntej yuav tsum tau txiav txim siab seb qhov kev cuam tshuam thaum ntxov tuaj yeem txo qhov kev pheej hmoo ntawm kev loj hlob ntawm CKD. Qhov thib ob, cov tshuaj los ntawm cov kev kho mob yav dhau los yuav muaj qhov cuam tshuam rau cov kev kawm tom ntej. Txawm li cas los xij, vim tias qhov nruab nrab CysC-based eGFR thaum pib ntawm txhua chav kho mob yog 160 (IQR, 135 txog 181), peb ntseeg tias qhov muaj peev xwm no tsawg heev. Thib peb, tus qauv loj me me. Txawm li cas los xij, tus qauv loj txaus rau kev ntsuam xyuas thawj qhov tshwm sim ntawm lub sijhawm rau kev kuaj mob AKI. Cov nyhuv loj hauv peb txoj kev tshawb fawb yog 0.609, uas yog txaus rau cov ntaub ntawv tsis yog parametric. Cov qauv me me txwv tsis pub muaj kev tshawb fawb ntxiv txog qhov cuam tshuam ntawm tus kheej cov txheej txheem kho lossis tshuaj. Cov kev tshawb fawb ntxaws ntxiv nrog cov neeg mob ntau dua yog tsim nyog

Hauv kev xaus, cov txiaj ntsig ntawm peb txoj kev tshawb fawb tau hais txog ob qho tseem ceeb ntsig txog AKI hauv cov neeg mob uas tau txais tshuaj kho mob rau menyuam yaus ALL / LBL. Ua ntej, peb tau pom qhov muaj peev xwm ntawm AKI siab ntawm cov neeg mob. Txawm hais tias nephrotoxicity paub zoo nrog kev siv tshuaj khomob siv qee cov tshuaj tshwj xeeb, tsis muaj daim ntawv tshaj tawm tam sim no tau ntsuas nephrotoxicity vim ALL / LBL kev kho mob hauv menyuam yaus. Kev soj ntsuam tsis tu ncua ua rau peb pom txawm tias mob AKI. Thib ob, CysC-raws li eGFR tso cai kuaj pom ua ntej ntawm AKI dua li Cr-based eGFR. Yog li, txiav txim siab txog qhov nws thiab qhov tsis zoo ntawm CysC-based eGFR thiab Cr-based eGFR hauv kev kuaj mob me nyuam yaus AKI thaum siv tshuaj khomob, peb xav kom nquag ua haujlwm rau lub raum los ntawm ob qho kev ntsuas.

Kev lees paub Peb xav ua tsaug Editage (https://www.editage. com) rau kev kho lus Askiv.

Sau Kev Pabcuam SA, ST, thiab KK tsim qhov kev kawm; TY, SA, thiab YA tau sau cov ntaub ntawv; TY, SA, YA, thiab SY txheeb xyuas cov ntaub ntawv; TY, SA, MR, thiab YA tau sau cov ntawv sau; thiab SY, TO, TK, thiab ST tau muab kev txhawb nqa thiab tshuaj xyuas cov ntawv sau. KK saib xyuas tag nrho cov txheej txheem kawm. Txhua tus kws sau ntawv tau nyeem thiab pom zoo cov ntawv sau kawg.

Cov ntaub ntawv

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