Daim Duab Ntawm Kev Tswj Tus Kheej Ntawm Lub Raum Anemia

Raws li cov ntaub ntawv sib kis tau kwv yees, tus naj npawb ntawm cov neeg mob raum mob ntev (CKD) thoob ntiaj teb yog ze li ntawm 1 billion, ua rau muaj kev pheej hmoo ntau ntxiv ntawm txhua txoj kev tuag thiab cov hlab plawv, thiab tau dhau los ua qhov teeb meem tseem ceeb ntawm kev noj qab haus huv rau tib neeg kev noj qab haus huv. Anemia yog ib qho kev pheej hmoo txaus ntshai rau kev tuag ntau ntxiv hauv cov neeg mob CKD.

Nyem rau Cistanche rau mob raum

Zuag qhia tag nrho, ntau dua 50% ntawm cov neeg mob CKD yog anemic. Raws li theem ntawm CKD zuj zus, qhov tshwm sim ntawm anemia kuj nce ntxiv, thiab yuav luag txhua tus neeg mob tuaj yeem cuam tshuam los ntawm theem kev lim ntshav. Ntxiv rau qhov ua rau muaj kev pheej hmoo ntawm kev tuag, anemia kuj tseem cuam tshuam nrog kev txo qis ntawm lub neej thiab kev ua kom lub raum tsis zoo hauv cov neeg mob CKD.

Tam sim no, kev ua raws cai ntawm lub raum anemia hauv kuv lub tebchaws tseem nyob rau theem qis. Kev tsim cov phiaj xwm kho mob yuav tsum ua tib zoo xav txog qhov cuam tshuam ntawm ntau yam xws li qhov ua rau, lub raum ua haujlwm, thiab qhov hnyav ntawm cov ntshav liab. Qhov no tej zaum yuav yog ib qho tseem ceeb rau kev txhim kho kev tswj ntshav qab zib hauv cov neeg mob CKD.

1 Vim li cas cov neeg mob lub raum tsis ua haujlwm nrog Hb<100g/L need to initiate anemia treatment promptly?

Anemia ua rau muaj kev pheej hmoo ntawm cov neeg mob CKD los ntawm ntau qhov ntev. Nws tsis tsuas yog ua kom lub raum ua haujlwm tsis zoo xwb, tab sis kuj ua rau tus neeg mob muaj kev pheej hmoo ntawm myocardial infarction, plawv tsis ua hauj lwm, thiab coronary artery revascularization. Hauv kev xyaum kho mob, peb kuj tau pom tias ntau tus neeg mob ntshav qab zib hnyav muaj kev pheej hmoo tuag ntau dua; Tsis tas li ntawd, tag nrho cov kev siv nyiaj kho mob ntawm cov neeg mob ntshav qab zib muaj ntau dua li cov neeg mob uas tsis muaj ntshav qab zib. Qhov no tsis yog tsuas yog xav txog qhov xav tau ntawm cov tshuaj ntxiv rau kev kho mob ntshav qab zib tab sis kuj yog tus nqi ntau dua. Rau kev kho mob ntawm cov teeb meem tshwm sim los ntawm lub raum anemia. Tsis tas li ntawd, anemia txo qhov ua tau zoo ntawm lub neej ntawm cov neeg mob CKD los ntawm kev txo cov pa oxygen rau hauv lub cev thiab cov ntaub so ntswg, ua rau cov tsos mob xws li qaug zog, ua tsis taus pa, insomnia, mob taub hau, thiab txo qis kev puas hlwb.

Nws yog ib nqi sau cia hais tias cov saum toj no-hais kev puas tsuaj ntawm anemia rau cov neeg mob CKD tsis tsuas yog tshwm sim thaum muaj mob hnyav anemia. Cov kev tshawb fawb tau pom tias piv nrog cov neeg mob Hb 110 ~ 120 g / L, cov neeg mob Hb<100 g/L have a 64% increased risk of death and a 34% increased risk of first hospitalization; while patients with Hb 120~130 g/L have a 64% increased risk of death. With a 21% reduction, the risk of death is relatively low. The results of another observational cohort study of peritoneal dialysis patients showed that the risk of all-cause death and cardiovascular death in peritoneal dialysis patients with Hb<100 g/L was significantly increased. Therefore, CKD anemia must be screened, diagnosed, and treated early, and anemia treatment must be initiated promptly for patients with renal anemia with Hb <100g/L.

Cov tshuaj ib txwm siv rau kev kho mob raum ntshav ntshav feem ntau suav nrog erythropoiesis-stimulating agents (ESA) thiab cov tshuaj hlau. Lawv tau pom tias muaj feem xyuam nrog ntau yam kev mob tshwm sim hauv kev kho mob, tshwj xeeb tshaj yog thaum siv tshuaj ntau dua. Tsis tas li ntawd, cov kev xaiv kev kho mob ntshav qab zib ib txwm muaj feem ntau tsis txaus siab rau cov neeg mob uas muaj mob, tsis txaus dialysis, thiab tsis zoo tag nrho. Nrog rau qhov tshwm sim ntawm hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI) tau ua tiav tiav raws li Nobel nqi zog-yeej mechanism, kev kho mob raum ntshav ntshav tau coj mus rau hauv tshooj tshiab. Raws li lub ntiaj teb thawj HIF-PHI tshuaj, roxadustat tau pom zoo rau kev lag luam hauv Suav teb thaum kawg ntawm 2018. Tom qab nws tso tawm, nws tau sau ntau cov ntaub ntawv kho mob hauv ntiaj teb thiab tau pom zoo los ntawm ntau tshaj kaum tawm cov lus qhia lossis cov kws tshaj lij pom zoo. Xyoo 2022, Kuv zoo siab los koom nrog hauv kev sau ntawv "Suav Cov Kws Tshaj Lij Pom Zoo rau Roxadustat hauv Kev Kho Mob Raum Ntshav Qab Zib". Kuv kuj vam tias qhov kev pom zoo ntawm tus kws tshaj lij no yuav muab cov ntaub ntawv siv rau ntau tus kws kho mob thiab ntxiv kev txhim kho cov tswv yim kho mob rau lub raum anemia.

2 Yam dab tsi yuav cuam tshuam rau kev txhim kho cov phiaj xwm kho mob?

Kev xaiv txoj kev kho mob rau lub raum anemia xav kom peb ua tib zoo xav txog tus neeg mob keeb kwm caj ces, etiology, kev kho mob tshwm sim, comorbidities, thiab lwm qhov ntev los muab cov neeg mob nrog kev kuaj mob thiab kev kho mob. Hauv kev kho mob raum mob anemia, cov hauv qab no yuav tsum tau txiav txim siab yam tsawg kawg nkaus:

01 CKD kev ua si

CKD theem cuam tshuam rau kev kuaj mob thiab kev kho mob rau lub raum anemia. Ua ntej CKD theem 3, ob lub raum tseem muaj cov txiaj ntsig zoo, thiab cov neeg mob feem ntau tsis raug mob ntshav qab zib. Yog tias ntshav ntshav tshwm sim nyob rau theem no, cov kab mob tseem ceeb yuav tsum tau txiav txim siab, xws li interstitial nephritis, ntau yam myeloma lub raum puas, thiab lwm yam. Anemia tseem ntxov; cov khoom noj khoom haus, xws li kev noj zaub mov tsis txaus los ntawm kev txwv kev noj haus; comorbidity yam, nrog lossis tsis muaj ntshav plab, thiab lwm yam. Kev kho mob raum ntshav ntshav thaum ntxov CKD yuav tsum yog tus kheej raws li kev noj cov khoom no los txiav txim siab.

02 Micro-inflammatory xeev

Qhov muaj lossis tsis muaj lub xeev microinflammatory yog qhov tseem ceeb hauv kev xaiv hom tshuaj thiab ntau npaum li cas. Cov neeg mob siab CRP feem ntau tsis teb zoo rau ESA thiab tuaj yeem ntsib cov lus teb qeeb, xav tau koob tshuaj ntau dua, thiab tsis ua tiav cov txiaj ntsig Hb. Nyob rau tib lub sijhawm, tus neeg mob lub ferritin qib yuav siab, thiab exogenous hlau supplementation tsis haum. Ntau qhov kev tshawb fawb soj ntsuam tau pom tias txawm tias rau cov neeg mob siab CRP, roxadustat tsis xav tau ntau npaum li cas hauv kev kho mob ntshav qab zib. Yog li ntawd, kev txhim kho ntawm anemia los ntawm roxadustat tsis cuam tshuam los ntawm lub xeev micro-inflammatory. Kev kho mob Roxadustat tuaj yeem muab qhov tseem ceeb hauv cov neeg mob uas muaj lub xeev micro-inflammatory kom tau txais cov txiaj ntsig zoo ntawm kev kho mob ntshav qab zib.

03 Hlau metabolism xwm txheej

Lub xub ntiag ntawm hlau tsis txaus yog lwm yam uas yuav tsum tau xav txog. Hlau deficiency nyob rau hauv cov neeg mob CKD tuaj yeem muab faib ua cov hlau tsis muaj zog thiab tsis muaj hlau tsis txaus. Kev ua haujlwm hlau tsis muaj peev xwm txhais tau hais tias tag nrho cov hlau hauv lub cev txaus, tab sis kev siv hlau raug txo, uas yog tshwm sim los ntawm cov ferritin siab thiab txo qis transferrin saturation. Thaum muaj kev ua haujlwm hlau tsis txaus, kev siv hlau ntxiv yuav tsum tsis txhob dig muag tab sis kev siv hlau yuav tsum tau txhim kho. Cov kev tshawb fawb soj ntsuam yav dhau los tau pom tias roxadustat tuaj yeem txhim kho kev siv hlau los ntawm kev txo cov hepcidin thiab txhim kho cov metabolism hauv cov hlau xws li ferritin thiab transferrin saturation, yog li kho cov ntshav qab zib.

Seb puas muaj ESA hyporesponsiveness. Clinically, EPO hyporesponsiveness feem ntau txhais tau tias yog kev txhaj tshuaj subcutaneous ntawm rHuEPO txog li 300 U / kg hauv ib lub lis piam (20, 000 U / lub lis piam) lossis txhaj tshuaj rHuEPO mus txog 500 U / kg ib lub lis piam (30, {{ 5}} U/lub lim tiam). Tom qab 4 lub hlis ntawm kev kho mob, Hb tseem tsis tuaj yeem ncav cuag lossis tswj tus nqi ntawm lub hom phiaj. Kev tshawb fawb soj ntsuam thiab kev xyaum tau pom tias roxadustat tuaj yeem txhim kho lub hom phiaj hemoglobin hauv qee cov neeg mob uas muaj ESA hyporesponsiveness.

04 laj

Hnub nyoog yog qhov tseem ceeb hauv kev kuaj mob tus kheej thiab cov phiaj xwm kho mob ntshav qab zib. Cov neeg laus muaj cov kab mob ntau dua thiab muaj kev pheej hmoo siab ntawm cov kab mob plawv thiab cerebrovascular. Qhov kev pheej hmoo ntawm cov kev mob tshwm sim thaum kho mob ntshav qab zib kuj tseem nce ntxiv. Roxadustat simulates physiological teb ntawm tib neeg anemia los ntawm activating HIF txoj kev, txhawb zus tau tej cov endogenous EPO thiab EPO receptors, txhawb nqa hlau nqus thiab thauj, thiab comprehensively tswj cov ntshav liab ntau lawm. Tsis tas yuav hloov kho rau cov neeg mob hnub nyoog tshaj 65 xyoo. Thawj koob tshuaj muaj txiaj ntsig zoo hauv kev txhim kho ntshav qab zib, yog li nws tuaj yeem yog qhov kev xaiv tshiab rau pab pawg tshwj xeeb anemia.

05 Dosage method

Txoj kev tswj hwm yuav tsum tau txiav txim siab. ESA xav tau kev txhaj tshuaj, uas feem ntau tsis yooj yim rau kev siv tshuaj kho mob, thaum roxadustat tau noj hauv qhov ncauj, uas ua rau muaj txiaj ntsig zoo ntawm kev noj tshuaj thiab txhim kho kev ua raws li tus neeg mob. Rau cov neeg mob CKD anemia thiab peritoneal dialysis cov neeg mob uas tseem tsis tau kuaj ntshav, cov kws kho mob tuaj yeem txiav txim siab noj cov tshuaj roxadustat thaum pib kho raws li cov yam ntxwv xws li tus yam ntxwv ntawm tus kab mob, kev kho mob zoo, thiab cov neeg mob xav tau.

3 Rau cov neeg mob ntshav qab zib CKD nrog lub hauv paus Hb<90g/L, should they reach the target quickly or steadily?

Rau cov neeg mob ntshav qab zib CKD, txawm tias hemoglobin yuav tsum ncav cuag tus qauv sai lossis tsis tu ncua yeej ib txwm muaj kev txhawj xeeb rau peb cov kws kho mob. Txawm li cas los xij, ob qho tib si tsis yog qhov sib txawv kiag li. Hauv kev xyaum kho mob, cov lus teb ntawm tus kheej yuav tsum tau ua, tsom mus rau kev ntsuas kev sib raug zoo ntawm kev ncav cuag tus qauv sai thiab ruaj khov mus txog tus qauv. Cov txiaj ntsig thiab kev pheej hmoo.

Pib los ntawm kev ntsuas qhov hnyav ntawm cov ntshav liab. Rau cov neeg mob ntshav qab zib hnyav, xws li hemoglobin qis dua 90g / L, lossis txawm tias qis dua 60g / L, hemoglobin yuav tsum tau rov qab mus rau qhov chaw nyab xeeb sai li sai tau. Nyob rau lub sijhawm no, yuav tsum tau nce sai, thiab txawm tias kev hloov ntshav yuav tsum tau nce qib hemoglobin. Rau me me mus rau nruab nrab anemia, hemoglobin yuav tsum tsis tu ncua kom txo tau txoj kev pheej hmoo ntawm cov teeb meem cuam tshuam nrog kev hloov pauv Hb loj lossis nrawm.

Qhov thib ob, tus neeg mob tus mob tag nrho kuj muaj feem cuam tshuam rau kev kho mob ntshav qab zib. Cov neeg laus thiab cov neeg mob CKD tsis tshua muaj zog, feem ntau muaj kev hloov mus rau lub xeev anemia. Nyob rau tib lub sijhawm, yog tias hemoglobin nce nrawm dhau, nws yuav ua rau muaj kev pheej hmoo ntawm thromboembolism. Yog li ntawd, nws yog ib qho tseem ceeb heev rau lawv kom ncav cuag lub hom phiaj smoothly.

Tsis tas li ntawd, yuav tsum tau soj ntsuam comorbidities. Rau cov neeg mob uas muaj keeb kwm ntawm thromboembolism, refractory hypertension, lossis cov qog ua haujlwm, qhov nce sai ntawm hemoglobin yuav ua rau muaj kev pheej hmoo ntawm cov xwm txheej tsis zoo rau cov neeg mob no. Hauv qhov no, stabilizing lub hom phiaj yuav yog qhov kev xaiv zoo dua.

Tag nrho txhua yam, hauv kev kho mob, cov txiaj ntsig thiab kev pheej hmoo ntawm cov neeg mob mus txog lub hom phiaj sai thiab ruaj khov yuav tsum tau soj ntsuam thiab sib npaug, kev kuaj mob tus kheej thiab kev npaj kho mob yuav tsum tau tsim, kev soj ntsuam ntshav yuav tsum tau ntxiv dag zog, thiab ntau npaum li cas ntawm kev kho mob ntshav qab zib. cov tshuaj yuav tsum tau kho raws li lub sijhawm raws li qhov kev xeem tau.

4. Tom qab Hb ntawm CKD cov neeg mob ntshav qab zib nce mus txog lub hom phiaj, yuav ua li cas kom ruaj khov Hb nyob rau thaj tsam ntawm 110-130g/L?

Tom qab Hb ntawm CKD cov neeg mob ntshav qab zib tau ncav cuag lub hom phiaj, nws yog qhov zoo tshaj yog tias nws tuaj yeem ua kom ruaj khov nyob rau hauv qhov ntau ntawm 110-130g/L, vim qhov no tsis yog tsuas yog pom zoo thiab xav tau los ntawm cov lus qhia, tab sis kuj vim Hb. ntawm cov neeg mob CKD yog nyob rau hauv qhov ntau thiab cov xwm txheej ntawm cov hlab plawv thiab qhov kev pheej hmoo ntawm kev tuag yog qhov qis tshaj, thiab tus neeg mob lub neej zoo tau zoo tuaj. Txawm li cas los xij, hauv kev kho mob, nws nyuaj heev kom ua tiav cov qauv zoo ib yam thiab ruaj khov.

Pib nrog kev ntsuam xyuas tsis tu ncua. Kev hloov pauv hauv Hb tsis tuaj yeem pom los ntawm cov neeg mob. Tsuas yog kev saib xyuas tsis tu ncua tuaj yeem tshawb xyuas tam sim seb Hb deviates los ntawm lub hom phiaj ntau. Nws feem ntau pom zoo tias cov neeg mob CKD yuav tsum tau kuaj ntshav niaj hnub txhua lub hlis thiab saib xyuas cov ntsuas hlau metabolism txhua 3 lub hlis. Raws li kev kho mob raug kho, yuav tsum muaj kev saib xyuas ntau ntxiv.

Qhov thib ob, sim xaiv cov tshuaj uas tuaj yeem txhim kho Hb hloov pauv. Hb variability yog cuam tshuam los ntawm ntau yam xws li inflammatory txheej xwm, khoom noj khoom haus, dialysis txaus, thiab comorbidities. Kev hloov pauv Hb hauv cov neeg mob CKD yog qhov siab dua li cov neeg ib txwm muaj. Kev kho mob Roxadustat tsis tshua cuam tshuam los ntawm lub xeev micro-inflammatory thiab qib hlau metabolism. Nws txhawb cov endogenous EPO uas tsim los ntawm lub cev nyob rau hauv lub physiological tswj ntau yam, uas yuav pab tau cov neeg mob CKD kom ruaj khov mus txog Hb lub hom phiaj nyob rau hauv lub sij hawm ntev. Qhov no kuj tau lees paub hauv peb qhov kev kho mob. pom.

Tsis tas li ntawd, txhim kho kev ua raws li tus neeg mob. Qee tus neeg mob xav tias lawv ua tiav tom qab lawv Hb mus txog lub hom phiaj thiab tsis hais kom noj tshuaj ntxiv lawm. Qhov no kuj yog ib qho tseem ceeb rau kev nce Hb hloov pauv. Thaum tus neeg mob lub Hb nce mus txog 110g / L, qhov koob tshuaj yuav tsum tau hloov tam sim ntawd kom sim ua kom tus neeg mob qib Hb nyob ruaj khov nyob rau hauv thaj tsam ntawm 110-130g / L. Kev tswj qhov ncauj ntawm roxadustat ua kom yooj yim dua thiab muaj txiaj ntsig zoo dua rau cov neeg mob uas tsis yog lim ntshav thiab peritoneal dialysis. Tsis tas li ntawd, qib Hb hauv cov neeg mob lim ntshav tau cuam tshuam zoo heev los ntawm cov ntshav ntim. Rau cov neeg mob uas hnyav dhau ntawm kev lim ntshav, ntau dhau ultrafiltration tom qab lim ntshav tuaj yeem ua rau Hb siab dua 130g / L, ua rau muaj kev pheej hmoo ntawm thrombosis. Yog li ntawd, ntxiv dag zog rau kev kawm thiab txhim kho cov neeg mob ua raws cai yog ib qho ntawm cov kev ntsuas tseem ceeb los tswj Hb stability.

5. Roxadustat tuaj yeem siv ua ke nrog ESA?

Txawm hais tias roxadustat tuaj yeem siv ua ke nrog ESA yog lo lus nug ntawm kev txhawj xeeb zoo rau cov kws kho mob. Tam sim no tsis muaj pov thawj los lees paub lossis tsis lees paub cov tswv yim zoo li no. Tab sis peb tuaj yeem txheeb xyuas qhov zoo thiab qhov tsis zoo ntawm kev siv ua ke los ntawm cov txheej txheem ntawm kev ua ntawm ob.

Ntawm qhov tod tes, roxadustat simulates physiological teb ntawm tib neeg anemia los ntawm stabilizing hypoxia-inducible yam, txhawb endogenous EPO synthesis, thiab kev txhim kho ntau yam kev sib txuas hauv cov kab mob ntshav qab zib adaptation mechanism, xws li txhawb EPO receptor synthesis thiab txhim kho cov hlau metabolism. Kev nqus thiab siv, kev tswj hwm ntawm cov ntshav liab tsim tawm. Exogenously txhaj ESA yog qhov sib txawv ntawm endogenous EPO hauv cov qauv thiab cov tshuaj pharmacokinetics, thiab cov koob tshuaj ntau tshaj qhov kev xav ntawm lub cev. Qhov kev tawm dag zog ntau dhau ntawm lub cev ntawm EPO tuaj yeem yog qhov laj thawj tseem ceeb ntawm nws cov kev mob tshwm sim. Yog li ntawd, feem ntau hais lus, kev sib xyaw ntawm ob yog tsis tsim nyog nyob rau hauv cov nqe lus ntawm mechanism, thiab nyob rau hauv cov ntaub ntawv ntawm kev phiv, nws yog ib qhov nyuaj rau txiav txim seb cov tshuaj twg yog lub luag hauj lwm.

Ntawm qhov tod tes, txij li kev sib xyaw ua ke raug txiav txim siab, ob qho tshuaj yuav tsum ua tsis tau raws li qhov xav tau. Los ntawm txoj kev xav, ntxiv rau kev txhawb nqa EPO synthesis, roxadustat tuaj yeem txhim kho ntshav qab zib los ntawm ntau txoj hauv kev. Kev sib xyaw ESA nrog roxadustat yuav theoretically nce qhov ua tau zoo ntawm ESA. Tab sis nyob rau hauv cov ntaub ntawv no, thawj qhov yuav tsum tau xav txog yog seb peb cov kev cia siab rau kev nce Hb puas tsim nyog. Hb yuav tsum tsis txhob nce nrawm dhau, thiab nws yog qhov tsim nyog kom nce nws li 10-20g/L txhua lub hlis. Nws tsis tsim nyog xav tias yuav nce Hb sai sai los ntawm kev yuam cov yub los txhawb kev loj hlob. Qhov thib ob, feem ntau yog vim li cas vim li cas Hb tsis nce raws li qhov xav tau. Cov yam ntxwv no uas cuam tshuam rau kev ua tau zoo ntawm cov tshuaj yuav tsum tau pom thiab tshem tawm ua ntej, tsis yog qhov muag tsis pom kev ntxiv tshuaj.

Kev sib xyaw ua ke ntawm ob kuj tuaj yeem siv los ua kev xaiv thaub qab rau kev kho mob raws li kev xav txog tag nrho ntawm cov xwm txheej saum toj no. Rau cov neeg mob uas roxadustat tsis muaj txiaj ntsig, nws yog ib qho tsim nyog yuav tsum tau ua ntej txiav txim siab txog kev mob ntshav qab zib los ntawm lwm yam kev kho mob tshwm sim (xws li ntshav poob, tsis muaj hlau tsis txaus, lim ntshav tsis txaus, hyperparathyroidism, thiab lwm yam), thiab kho cov laj thawj tam sim ntawd. Yog tias qhov cuam tshuam cuam tshuam rau kev ua tau zoo ntawm cov ntshav ntshav tau raug txiav tawm, koob tshuaj roxadustat tuaj yeem hloov ua ntej. Yog tias qhov kev ua tau zoo tseem tsis txaus, sim nrhiav lwm qhov kev kho mob tsawg uas ua rau lossis ua rau mob hnyav ntxiv, xws li kab mob hematological, qog, thiab lwm yam. Tam sim no, tsis muaj cov ntaub ntawv qhia txog cov lus teb tsis tshua muaj rau kev kho mob roxadustat hauv cov neeg mob uas muaj cov koob tshuaj txaus. ntawm roxadustat thiab tsis muaj lwm yam ua rau mob ntshav qab zib exacerbation. Kev ua tau zoo thiab kev nyab xeeb ntawm kev kho mob ua ke hauv cov neeg mob no tseem yuav tsum tau kawm ntxiv.

Cov ntsiab lus

Anemia yog ib qho teeb meem loj tshaj plaws hauv cov neeg mob CKD, uas muaj qhov tshwm sim siab thiab mob hnyav. Txawm li cas los xij, tus nqi kho mob thiab kev ua raws li lub hom phiaj yuav tsum tau txhim kho ntxiv, yog li kev tswj xyuas ntshav qab zib tseem ntsib cov teeb meem loj. Hauv kev kho mob, nws raug pom zoo tias cov neeg mob CKD nrog Hb<100g/L should initiate anemia assessment and treatment as soon as possible. The treatment of renal anemia should evaluate the impact of multiple factors, including CKD stage, anemia severity, the presence of inflammatory status, iron deficiency, ESA reactivity, Hb hypervariability, etc., as well as the patient's thromboembolism risk and Comorbidity status. On this basis, a reasonable treatment plan should be formulated, and patient education should be strengthened to try to ensure that Hb reaches the target stably and stably in the long term.

Cistanche kho mob raum li cas?

Cistancheyog ib hom tshuaj suav tshuaj ntsuab siv rau ntau pua xyoo los kho ntau yam mob, suav nrograumkab mob. 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 rauraumnoj 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 cov kab mob hauv lub 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 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.