Tus Tshiab Calcimimetic Agent Etecatide tuaj yeem yog Kev Cia Siab Tshiab Rau Kev Tswj Xyuas CKD-MBD!

Thaum Lub Xya Hli 5-8, 2023, tau txhawb nqa los ntawm Tuam Tshoj Medical Association thiab Nephrology ceg ntawm Tuam Tshoj Medical Association, thiab tsim los ntawm Hunan Medical Association, Nephrology Professional Committee ntawm Hunan Medical Association, thiab Cov Ntshav Purification Professional Committee ntawm Hunan Medical Association Lub Rooj Sib Tham Txog Ntshav Ntshav 2023 ntawm Lub Tuam Txhab Nephrology ntawm Tuam Tsev Kho Mob Suav tau muaj nyob hauv Changsha, Hunan. Lub hom phiaj ntawm lub rooj sab laj yog los qhia thiab txhawb cov kev xav tshiab, cov thev naus laus zis tshiab, thiab cov kev vam meej tshiab, ntxiv cov txheej txheem kho ntshav kom huv, thiab ua kom tiav qib kev kho ntshav purification hauv kuv lub teb chaws, hloov mus rau kev hloov kho cov ntshav purification, kev kho mob. thiab tswj hom nyob rau hauv qhov xwm txheej tshiab.

Nyem rau cistanche koob tshuaj rau mob raum

Thaum Lub Xya Hli 8, 2023, lub rooj sab laj tau tuav lub rooj sib tham satellite ntawm Fosun Pharma. Lub rooj sib tham tau tsom mus rau kev qhia txog Etecaride hauv Suav teb thiab tsom mus rau kev siv Etecaride nyob rau hauv Chronic Kidney Disease-Mineral and Bone Metabolism Abnormalities (CKD- Cov txiaj ntsig kho mob tau txais los ntawm kev tswj hwm ntawm MBD) tau tham txog qhov tob.

Lub rooj sib tham tau ua tus thawj coj los ntawm xibfwb Zhao Minghui los ntawm Lub Tsev Haujlwm ntawm Nephrology ntawm Peking University, thiab xibfwb Liu Hong los ntawm Lub Tsev Kho Mob Thib Ob Xiangya ntawm Central South University tau qhia lub ntsiab lus ntawm "Etecartide rau CKD-MBD kev tswj hwm kom ua tiav cov txiaj ntsig ntau".

Nyob rau hauv xyoo tas los no, nrog rau kev kho mob siv cov tshuaj calcimimetic, kev vam meej tau ua tiav hauv kev kho CKD-MBD. Secondary hyperparathyroidism (SHPT), raws li ib qho ntawm cov tseem ceeb hauv kev loj hlob ntawm CKD-MBD, kho qhov chaw kho mob thiab cov tsos mob ntawm ntau lub cev puas tsuaj rau cov neeg mob, tshwj xeeb tshaj yog mob plawv. Xib fwb Liu Hong tau taw qhia tias kev kho mob thiab kev tswj hwm ntawm CKD-MBD yog qhov dav, thiab yuav tsum tau saib cov ntsuas ntawm cov neeg mob ntev. Txoj kev kho mob mus rau hauv tes kom ua tiav kev kho mob ntawm SHPT [1].

Etecartide yog ib tiam tshiab ntawm cov neeg ua haujlwm calcimimetic, nws cov txheej txheem ntawm kev ua haujlwm yog qhib los ntawm kev khi rau cov qauv extramembrane ntawm calcium-sensing receptors, thiab nws tuaj yeem nthuav tawm nws cov haujlwm yam tsis muaj kev vam khom ntawm extracellular Ca2 ntxiv. Hais txog kev siv tshuaj kho mob, ntau qhov kev sim tau pom tias etecartide tuaj yeem txo qis qib ntawm parathyroid hormone (PTH).

Ib txoj kev tshawb fawb Nyij Pooj tau taw qhia [2] tias tom qab peb lub hlis ntawm kev kho mob etekatide, tus neeg mob PTH pom qhov txo qis, thiab nws tuaj yeem tswj tau qhov kev poob qis. ua haujlwm ntev. Lwm qhov kev tshawb fawb taub hau [3] muab piv rau kev kho cov teebmeem ntawm etecartide thiab cinacalcet, thiab cov txiaj ntsig tau pom tias txij li 16 lub lis piam mus txog, cov neeg mob hauv pawg etecartide tau txo qis PTH txog li 50 feem pua, thiab txuas ntxiv tswj ntawm qib no. , thaum qhov txo qis hauv PTH hauv pawg cinacalcet tau khaws cia ntawm 30 feem pua ​​-40 feem pua ​​. Lwm cov ntaub ntawv qhia [4] tias ntawm cov theem pib PTH sib txawv, qhov txo qis hauv cov hauv paus PTH hauv pab pawg kho mob etecartide yog tsawg kawg yog 14 feem pua ​​​​siab dua li hauv pawg cinacalcet, thiab rau cov neeg mob kho nrog cinacalcet, hloov mus siv Etecartide kev kho mob ntxiv. txo PTH qib los ntawm 50 feem pua ​​[5].

Etecartide tau qhia nws qhov zoo ntawm cov txiaj ntsig ntawm cov hlab plawv thiab kev tiv thaiv pob txha. Cov kev tshawb fawb tau taw qhia tias piv nrog cov placebo, etekatide tuaj yeem txo cov qib ntawm fibroblast loj hlob zoo (FGF23) hauv cov neeg mob los ntawm 56 feem pua ​​[6]. Feem ntau ntawm cov neeg mob tau poob qis (-68 feem pua ​​vs -41 feem pua ​​, P<0.001), and a significantly greater proportion of patients had a ≥30% decline. A previous article pointed out [7] that a decrease in FGF23 level ≥ 30% can reduce the risk of the primary composite endpoint (mortality and major cardiovascular events) by 18%, reduce the risk of cardiovascular death by 34%, reduce the risk of sudden death by 43%, and reduce the risk of heart failure. 31% reduction. Another study suggested that during the 12-month follow-up, the left ventricular mass index (LVMI) of patients in the etecartide group was slightly reversed compared with the baseline [8]. risk, to achieve cardiovascular benefits.

Raws li kev pheej hmoo siab ntawm pob txha hauv cov neeg mob nrog CKD-MBD, cov kev tshawb fawb tau soj ntsuam cov qib ntawm cov pob txha hloov pauv cov cim hauv cov neeg mob kho nrog etecartide thiab pom tias nws tuaj yeem txo cov pob txha tsim cov pob txha tshwj xeeb alkaline phosphatase hauv cov neeg mob ntawm 27 lub lis piam ( bALP), pob txha resorption marker hom I collagen cross-linked c-telopeptide (CTX-I), thiab cov nyhuv zoo dua li ntawm cinacalcet[3]. Lwm txoj kev tshawb fawb EVOLVE tau pom tias tom qab hloov kho cov ntaub ntawv, cov tshuaj calcimimetic tuaj yeem txo qhov kev pheej hmoo ntawm pob txha los ntawm 16 feem pua ​​-29 feem pua ​​​​piv rau cov placebo [9]. Cov ntaub ntawv no qhia tias daim ntawv thov ntawm etecartide yuav tsum txhim kho txoj kev pheej hmoo ntawm pob txha hauv cov neeg mob SHPT.

Xib fwb Liu Hong tau taw qhia tias rau kev kho mob thiab kev tswj hwm ntawm CKD-MBD, kev saib xyuas cov ntshav calcium tseem ceeb heev, thiab qhov tshwm sim ntawm hypocalcemia yuav tsum tau saib xyuas. Tam sim no, ntau cov kev tshawb fawb tau taw qhia tias qhov tsis zoo tshwm sim thiab hypocalcemia tshwm sim los ntawm etecartide feem ntau tsom rau hauv cov theem pib ntawm kev kho mob, nws yuav maj mam ruaj khov nyob rau theem tom qab ntawm kev kho mob. Cov kev tshawb fawb hauv ntiaj teb no tseem qhia tau tias qhov tshwm sim ntawm kev mob plab hnyuv ntawm etecartide tsuas yog 3 feem pua ​​-4 feem pua, uas yog qis dua li ntawm cinacalcet (53 feem pua) [10], qhia txog nws txoj kev nyab xeeb zoo.

Tsis tas li ntawd, kev tswj xyuas cov tshuaj tua kab mob tuaj yeem txhim kho cov neeg mob ua raws li 20 feem pua ​​[11], txo lub nra ntawm cov ntsiav tshuaj rau cov neeg mob hemodialysis. Qhov txiaj ntsig ntawm etecartide kuj tseem cuam tshuam rau hauv txoj kev metabolic. Vim tias nws tuaj yeem raug tshem tawm los ntawm hemodialysis, nws feem ntau tsis tsim nyog los xav txog cov teeb meem tshwm sim los ntawm kev siv tshuaj ntau hauv kev kho mob; thiab cov kws kho mob feem ntau yuav tsum xav txog kev sib cuam tshuam tshuaj thaum siv tshuaj. Cinacalcet yuav tsum tau siv tib lub sijhawm nrog cov tshuaj metabolized los ntawm CYP450 system, tab sis etecartide tsis metabolized los ntawm CYP450 system, yog li tsis muaj teeb meem zoo li no hauv kev siv tshuaj kho mob.

Cov ntsiab lus

Lub rooj sib tham no tau qhia tag nrho cov txiaj ntsig zoo ntawm etecartide hauv kev kho mob ntawm SHPT thiab nws qhov zoo dua piv nrog lwm cov tshuaj calcimimetic. vam!

Cistanche kho mob raum li cas?

Cistanche yog cov tshuaj suav tshuaj ntsuab siv rau ntau pua xyoo los kho ntau yam mob, suav nrog kab mob raum. Nws yog muab los ntawm cov stems qhuav ntawm Cistanche deserticola, ib tsob nroj nyob rau hauv cov suab puam ntawm Tuam Tshoj thiab Mongolia. Cov khoom tseem ceeb ntawm cistanche yog phenylethanoid glycosides, echinacoside, thiab acteoside, uas tau pom tias muaj txiaj ntsig zoo rau lub raum 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.

Cov ntaub ntawv:

[1] Liu Zhihong, Li Guisen. Cov lus qhia rau kev kuaj mob thiab kev kho mob pob zeb thiab pob txha txawv txav hauv cov kab mob raum tsis zoo hauv Suav teb [M]. Beijing: People's Medical Publishing House, 2019: 9-72.

[2] Keitaro Yokoyama, et al. Clin Exp Nephrol. 2021 Jan; 25(1):66-79.

[3]Geoffrey A Block, et al. JAMA. 2017 Jan 10; 317(2):156-164.

[4]Stephens JM, et al. Hemodial Int. 2022; 26(2): 243-254

[5] Marc Xipell, et al. Ntshav Purif. 2019;48(2):{4}}.

[6] Wolf M, et al. Clin Kidney J. 2019 Lub Plaub Hlis 26; 13(1):75-84.

[7] Sharon M Moe, et al. Kev ncig. 2015 Jul 7;132(1):27-39.

[8] Katharina Dörr, et al. Kev Tshawb Fawb Kev Tshaj Tawm. 2021; 128:1616–1625

[9] Bernardo J, et al. Curr Osteoporos Rep. 2023 Lub Ob Hlis 27.

[10]Russo D, et al. J Clin Med. 2019 Lub Xya Hli 20; 8(7): 1066.

[11]Valentina Perrone, et al. Kev kho mob (Basel). 2022 Plaub Hlis 11; 10(4): 709.