Qhov Tseeb Version Ntawm Suav Cov Kws Tshaj Lij Pom Zoo Rau Kev Ua Haujlwm ntev ESAs Rau Kev Kho Mob Raum Ntshav Qab Zib raug tso tawm, taw qhia txog kev siv peb hom ESAs

Erythropoiesis stimulating agents (ESAs) feem ntau yog siv cov tshuaj hauv kev kho mob ntawm lub raum anemia. Tam sim no, muaj ESAs luv luv thiab ua haujlwm ntev ESAs muaj rau cov kws kho mob. Kev ua yeeb yam luv luv ESAs tau siv dav hauv kuv lub tebchaws nrog keeb kwm ntev, thiab muaj ntau qhov kev pom zoo hauv tsev thiab txawv teb chaws. Kev ua haujlwm ntev ESAs muaj qhov zoo ntawm qhov ntev ib nrab-lub neej, tsis tshua muaj infusion zaus, thiab ua raws li cov neeg mob zoo. Kev nce qib tseem ceeb tau ua tiav hauv kev tshawb fawb soj ntsuam nyob rau xyoo tas los no, tab sis tseem tsis muaj kev taw qhia txog kev siv tshuaj kho mob ntev ntawm ESAs. Muab qhov no, Pawg Neeg Saib Xyuas Kev Pom Zoo ntawm Lub Raum Dialysis Professional Committee ntawm Tuam Tsev Kho Mob Tsis yog-Public Tsev Kho Mob tau tshaj tawm Suav Cov Kws Tshaj Lij Pom Zoo (2024 Edition) ntawm Kev Ua Haujlwm Ntev ntev ESAs rau Kev Kho Mob Raum Ntshav Qab Zib nyob rau hauv Suav Journal of Nephrology, qhia meej txog rational siv peb qhov ntev-ua yeeb yam ESAs. Ua ke nrog cov xwm txheej pom zoo ntawm cov tshuaj hauv Suav teb, cov ESAs ua haujlwm ntev hauv kab lus no suav nrog 3 cov tshuaj, uas yog darbepoetin, ib qho kev txhawb nqa EPO receptor agonist (CERA), thiab peroxide.

Nyem rau Cistanche rau mob raum

Hauv cov ntsiab lus, tsab xov xwm no luv luv qhia txog cov txheej txheem ntawm kev ua thiab cov tshuaj pharmacodynamic ntawm peb ESAs thiab feem ntau qhia txog kev siv ESAs ntev ntev hauv lub raum ntshav ntshav.

Mechanism of action and pharmacodynamic yam ntxwv ntawm ESAs

ESAs feem ntau muab faib ua rHuEPO thiab tshuaj lom neeg ua ke EPO mimetic peptides raws li lawv cov qauv molecular. Raws li kev pom zoo tshuaj nyob rau hauv Suav teb, peb cov tshuaj yuav tsum tau ua tib zoo saib xyuas cov kws kho mob.

Kev siv cov ESAs ntev ntev hauv lub raum anemia

1 Cov khoom kho mob

Cov lus pom zoo

Kev ua haujlwm ntev ESAs raug pom zoo rau kev kho mob raum mob ntshav qab zib hauv cov neeg mob uas tsis yog dialysis-dependent CKD (1A).

Kev ua haujlwm ntev ESAs raug pom zoo rau kev kho mob raum mob ntshav qab zib hauv cov neeg mob uas muaj dialysis-dependent CKD (1A).

Nws raug pom zoo tias cov neeg mob lub raum tsis zoo uas muaj cov lus teb qis rau ESAs luv luv yuav raug kho nrog ESAs ntev (2C).

2 Lub sijhawm kho

Cov lus pom zoo

Nws raug pom zoo tias lub sijhawm kho mob thawj zaug rau kev ua haujlwm ntev ESAs hauv kev kho mob raum ntshav ntshav yog thaum hemoglobin (Hb) yog.<100g/L (1C).

Nws raug pom zoo tias thaum ESAs ua haujlwm ntev tau siv los kho lub raum tsis ua haujlwm, lub hom phiaj Hb yuav tsum tau khaws cia ntawm ntau dua lossis sib npaug li 110g / L, tab sis tsis pub tshaj 130g / L (1A).

Tsis tas li ntawd, thaum ua haujlwm ntev ESAs tau siv los kho lub raum anemia, lwm yam kab mob uas ua rau muaj ntshav tsis txaus, xws li kev noj zaub mov tsis zoo, hemorrhagic anemia, hemolytic anemia, thiab lwm yam kab mob hauv cov ntshav, yuav tsum tsis suav nrog kev kuaj mob, thiab ua rau lub raum tsis zoo. raug kho kom ntau li ntau tau. Lwm yam ntawm kev sib deev anemia, xws li mob o, mob metabolism hauv hlau, thiab cov khoom siv tsis txaus hematopoietic.

3 Cov kev kho mob

Cov lus pom zoo

Thawj koob tshuaj ntawm ESAs ua haujlwm ntev yog txiav txim siab raws li kev kho mob ua ntej Hb qib thiab kev kho mob hauv cov neeg mob CKD (1D).

Nws raug pom zoo tias rau cov neeg mob uas tshiab rau ESAs kev kho mob, qhov pib koob tshuaj darbepoetin alfa tuaj yeem muab tau raws li cov koob tshuaj tas li (20 ug) lossis suav raws li lub cev hnyav (0.45 ug. / kg), ib zaug ib lub lim tiam, subcutaneously lossis intravenously; koob tshuaj pib ntawm CERA Qhov pib koob tshuaj ntawm pemoxatide yog 0.6 ug/kg, ib zaug txhua 2 lub lis piam, subcutaneous lossis intravenous txhaj; Qhov pib koob tshuaj peroxide yog 0.04 mg / kg, ib zaug txhua 4 lub lis piam, txhaj tshuaj subcutaneous (1A).

Nws raug pom zoo tias cov neeg mob tam sim no raug kho nrog luv-acting ESAs ncaj qha hloov mus rau ESAs ntev hauv kev faib ua feem rau lawv tam sim no siv luv-acting ESAs (1As).

Nws raug nquahu kom hloov kho cov koob tshuaj ib tus neeg raws li qhov nce qib ntawm Hb theem thaum pib kho nrog ESAs ntev thiab kev ruaj ntseg ntawm Hb qib thaum kho. Qib Hb yuav tsum tswj hwm ntawm 110-120g/L, thiab Hb loj hlob yuav tsum tswj ntawm 10-120g/L txhua 4 lub lis piam. Hauv 20g / L (2D).

Kev pib koob tshuaj, koob tshuaj ntau zaus, thiab kev siv tshuaj rau cov neeg mob lub raum tsis zoo uas tau txais kev kho ESA tshiab yog qhia hauv Table 2.

For patients switching from short-acting ESAs to long-acting ESAs, the starting dose can be adjusted based on the dose of short-acting ESAs used before the switch. In addition, the conversion rate of ESAs: darbepoetin α in multiple international phase III clinical studies was 200:1. However, some prospective and observational studies believe that maintaining a conversion ratio of 250:1 to 350:1 may be more beneficial to the stable increase in Hb levels, especially for patients who use short-acting ESAs >5000 IU / lub lis piam.

Cov kev tshawb fawb loj loj tau lees paub tag nrho tias Hb nce nrawm heev thiab / lossis qib siab dhau los muaj feem cuam tshuam rau cov neeg mob CKD tsis zoo. Yog li, qib Hb yuav tsum tau saib xyuas zoo thaum siv ESAs. Nws raug nquahu kom saib xyuas Hb txhua 1 mus rau 2 lub lis piam kom txog thaum nws ruaj khov, thiab tom qab ntawd txhua 4 lub lis piam.

Lus Cim: Qhov kev hloov pauv nce thiab nqis tuaj yeem hloov kho raws li qhov sib npaug ntawm 25% ntawm thawj koob tshuaj, thiab yog tias tsim nyog, qhov kev faib ua feem ntawm 50% tuaj yeem hloov kho. Dareppoetin alfa tuaj yeem hloov kho ib kauj ruam raws li cov koob tshuaj, xws li 10, 20, 30, 40, 50, thiab 60 ug. * Thaum qib Hb ruaj khov, darbepoetin alfa tuaj yeem hloov kho los ntawm ib lub lim tiam mus rau ib zaug txhua 2 lub lis piam. CERA thiab darbepoetin alfa (rau cov neeg mob uas tsis yog lim ntshav) tuaj yeem hloov kho txhua 2 lub lis piam mus rau txhua 4 lub lis piam ntawm ob zaug ntawm cov koob tshuaj tam sim no.

Tsis tas li ntawd, bioavailability thiab kev ua tau zoo ntawm kev tswj cov hlab ntsha thiab kev txhaj tshuaj subcutaneous ntawm darbepoetin alfa thiab CERA yog sib npaug. Yog li, kev kho mob, txoj kev tswj hwm ntawm darbepoetin thiab CERA tuaj yeem xaiv tau dawb raws li tus neeg mob qhov kev xav tau thiab kev kho mob. Raws li peroxide, vim nws cov khoom siv tshuaj, qhov kev xaiv tsuas yog txhaj tshuaj subcutaneous.

4 Kev siv hlau ntxiv

Cov lus pom zoo

Nws raug nquahu kom ntsuas cov ntsuas cov metabolism hauv cov hlau xws li SF thiab TSAT tsis tu ncua ua ntej thiab thaum kho nrog ESAs ntev, tsawg kawg ib hlis ib zaug. Cov neeg mob nyob rau theem kev kho mob ntshav qab zib lossis nrog Hb ruaj khov, yuav tsum tau kuaj tsawg kawg ib zaug txhua 3 lub hlis. x (1C).

Thaum lub sijhawm ua haujlwm ntev ESA, SF yuav tsum tau khaws cia ntawm 200 ~ 500 ug / L thiab TSAT ntawm 20% ~ 50% (2B).

Siv nyob rau hauv cov neeg tshwj xeeb

Cov lus pom zoo

Hauv kev kho mob raum tsis zoo hauv cov pab pawg tshwj xeeb xws li menyuam yaus, cov neeg laus, lub siab tsis txaus, hloov lub raum, thiab cov qog, cov ESAs ntev tuaj yeem raug txiav txim siab (2B).

Kev phiv tshuaj thiab kev kho mob

Cov lus pom zoo

Nws raug pom zoo tias thaum siv ESAs ntev ntev, cov neeg mob yuav tsum raug soj ntsuam rau cov kev tsis zoo xws li kev ua xua, kub siab, thromboembolism, thiab PRCA, thiab yog tias pom, lawv yuav tsum tau kho kom zoo (1, tsis muab qhab nia).

Kev nce ntshav siab yog qhov tshwm sim tsis zoo tshaj plaws thaum siv ESAs, thiab cov ntaub ntawv pov thawj kev kho mob uas twb muaj lawm tsis txaus los txiav txim siab seb hom ESAs twg yog qhov zoo dua rau kev tswj cov ntshav siab. Yog li ntawd, thaum kho nrog ESAs ntev, ntshav siab yuav tsum tau saib xyuas kom zoo, thiab kev noj zaub mov kom tsim nyog lossis tshuaj tiv thaiv ntshav siab yuav tsum tau siv los tswj ntshav siab yog tias tsim nyog. Rau cov neeg mob uas nws cov ntshav siab tswj tau yooj yim, nws raug nquahu kom txo cov tshuaj ESAs lossis ncua lawv cov kev tswj hwm.

Hauv kev xyaum kho mob, thaum siv ESAs ntev ntev, qib Hb yuav tsum tau saib xyuas zoo thiab cov tshuaj kho tau sai sai kom tsis txhob muaj cov kab mob plawv thiab cerebrovascular thromboembolic tshwm sim los ntawm kev nce siab hauv Hb.

Cov neeg mob tsawg heev tuaj yeem ntsib kev ntxhov siab thaum siv cov ESAs ntev, suav nrog anaphylaxis, angioedema, bronchospasm, tawm pob, thiab urticaria; Cov kab mob loj heev ntawm daim tawv nqaij muaj xws li hlwv, tawv nqaij exfoliation tshwm sim, erythema multiforme, thiab Stevens-Johnson syndrome, toxic epidermal necrolysis. Thaum qhov teeb meem saum toj no tshwm sim, kev siv yuav tsum tau nres tam sim ntawd.

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 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.