Kev Tshawb Fawb Kev Txhim Kho hauv Kev Kho Mob Ntshav Qab Zib nephropathy
Feb 21, 2022
Hu rau: Audrey Huaudrey.hu@wecistanche.com
Qhov xwm txheej thiab kev muaj ntshav qab zib ntau zuj zus txhua xyoo thoob ntiaj teb, thiab mob ntshav qab zib nephropathy (DKD), uas yog ib qho mob hnyav ntawm cov ntshav qab zib mellitus, kuj yog qhov tseem ceeb ntawm cov kab mob raum kawg (ESRD). Kev tiv thaiv ntxov ntxov, kev tswj hwm cov zis tso zis ntau ntxiv, thiab ncua sijhawm ntawm kev loj hlob ntawm DKD yog qhov tseem ceeb los txhim kho cov ciaj sia taus thiab lub neej zoo ntawm cov neeg mob ntshav qab zib.
Kev tshwm sim thiab kev puas tsuaj ntawm ntshav qab zib nephropathy
Txawm hais tias hom 1 lossis hom 2 mob ntshav qab zib mellitus, proteinuria tshwm sim li ntawm 30 feem pua ntawm cov neeg mob, thiab lub raum tsis zoo tshwm sim hauv ntau dua 20 feem pua ntawm cov neeg mob. Mob ntshav qab zib nephropathy (DKD) yog qhov ua rau mob raum kawg (ESKD) hauv ntau lub tebchaws hauv ntiaj teb, kwv yees li 47 feem pua hauv Tebchaws Meskas, thiab ntau dua 60 feem pua hauv Malaysia, Singapore thiab lwm lub tebchaws.
Nyob rau hauv xyoo tas los no, qhov kev faib ua feem ntawm uremic catheterization vim ntshav qab zib hauv kuv lub teb chaws tau maj mam nce. Tsis tas li ntawd, kev txom nyem los ntawm ntshav qab zib nephropathy tseem ua rau muaj kev pheej hmoo ntawm cov hlab plawv thiab cerebrovascular cov xwm txheej (kab mob plawv, myocardial infarction, cerebral infarction, thiab lwm yam). Yog li, kev tiv thaiv thiab kho mob ntshav qab zib nephropathy (DKD) yog qhov tseem ceeb heev rau cov neeg mob ntshav qab zib!
Tswj thiab txhim kho lub raum ua haujlwm:cistanche tubulosa extract
Kev kuaj mob ntshav qab zib nephropathy
Xyoo 2020, American Diabetes Association (ADA) tau hloov kho "Cov Qauv Kev Kho Mob Ntshav Qab Zib", uas tau taw qhia tias kab mob raum mob ntshav qab zib mellitus (DKD) yog ib qho mob hnyav ntawm cov neeg mob ntshav qab zib, uas hais txog kab mob raum mob (CKD) tshwm sim los ntawm ntshav qab zib. Kev tshwm sim los ntawm kev nce qib urinary protein ntau (urinary albumin-to-creatinine ratio Ntau dua lossis sib npaug li 30 mg / g) thiab / lossis kwv yees glomerular filtration rate (eGFR)<60ml·min-1·(1.73m2)-1 for="" more="" than="" 3="" consecutive="" days="" month,="" and="" a="" clinical="" diagnosis="" made="" by="" excluding="" other="" causes="" of="">
Kev saib xyuas mob ntshav qab zib nephropathy thiab glycemic tswj cov hom phiaj
Urinary albumin/creatinine ratio (UACR) thiab eGFR kev soj ntsuam yog pom zoo rau cov neeg mob ntshav qab zib. Cov neeg mob mob yuav tsum tau saib xyuas cov zis protein thiab eGFR tsawg kawg ob zaug hauv ib xyoos los coj kev kho mob. Cov neeg mob uas muaj proteinuria ua ke thiab lub raum tsis txaus yuav tsum tau tshuaj xyuas txhua peb lub hlis.
Cov neeg mob uas muaj ntshav qab zib thaum ntxov yuav tsum muaj zog tswj ntshav qab zib, thiab lub hom phiaj ntawm kev tswj glycated hemoglobin yuav tsum yog 7. Kev kho mob hnyav hypoglycemic tau txhim kho lub raum cov txiaj ntsig hauv cov neeg mob ntshav qab zib, nrog rau 30 feem pua txo qis hauv cov kab mob albuminuria tshiab thiab 65 feem pua txo cov kab mob raum kawg.
Kev kho mob ua ntej ntawm ntshav qab zib nephropathy
SGLT2 inhibitors coj kev cia siab tshiab rau kev kho mob:Lub npe tag nrho ntawm SGLT2 inhibitors yog "sodium-glucose co-transporter 2 inhibitor (SGLT2i)", uas yog ib qho tseem ceeb tshaj plaws hauv kev kho mob ntshav qab zib hauv 20 xyoo dhau los. Nws ua haujlwm los ntawm reabsorbing qabzib thiab ua kom yooj yim tshem tawm cov piam thaj los ntawm cov zis.
Cov kev tshawb fawb tau pom tias nws muaj ntau yam cuam tshuam xws li txo cov ntshav qab zib, txo cov ntshav siab, txo lub cev hnyav, txo cov uric acid, thiab txo cov hlab plawv thiab cerebrovascular thiab lub raum.
Hauv kev tshawb fawb luam tawm tsis ntev los no, ob qho tib si dapagliflozin (DAPA-CKD theem III txoj kev tshawb fawb), empagliflozin (EMPA-REG txoj kev tshawb fawb), thiab canagliflozin (CANVAS txoj kev tshawb fawb) tau pom tias txo cov proteinuria hauv ntshav qab zib mellitus Cov neeg mob 'kev pheej hmoo ntawm lub raum ua haujlwm tsis zoo thiab cov kab mob plawv. txo los ntawm ntau tshaj 40 feem pua.
Tsis tas li ntawd, txoj kev tshawb fawb DAPA-CKD kuj tau qhia tias dapagliflozin tuaj yeem txo qhov kev pheej hmoo ntawm lub raum ua haujlwm tsis zoo thiab tuag rau cov neeg mob CKD, txawm tias lawv muaj ntshav qab zib. Cov lus qhia tshiab pom zoo kom siv SGLT2 inhibitors ua thawj tus neeg saib xyuas hypoglycemic hauv cov neeg mob uas muaj ntshav qab zib nephropathy (theem 3 lossis qis dua lub raum ua haujlwm, microalbuminuria lossis proteinuria). cov neeg mob vim qhov nce hauv cov zis qab zib tom qab noj cov tshuaj no. Txawm li cas los xij, cov kev tshawb fawb tsis ntev los no tau pom tias feem ntau cov neeg mob uas noj SGLT2i tsis muaj kev pheej hmoo rau cov kab mob urinary.
Tam sim no, cov tshuaj no tsis pom zoo rau cov neeg mob CKD3b-5 theem.
Cistanche ntxivrau kev txhim kho lub raum ua haujlwm
GLP-1RA muab kev xaiv tshiab rau cov neeg mob rog:1 GLP-1RA, nws lub npe puv yog "glucagon-zoo li peptide-1 receptor agonist", yog ib chav kawm ntawm cov tshuaj tiv thaiv kab mob uas tuaj yeem tiv thaiv ntshav qab zib nephropathy. GLP-1 yog ib qho tshuaj incretin uas ua rau cov tshuaj insulin tso tawm thaum noj zaub mov, thiab nws cov analogues tau siv los kho cov ntshav qab zib.
Hauv kev tshawb fawb soj ntsuam, cov neeg mob kho nrog GLP-1RA tau pom qhov txo qis (22-36 feem pua ) hauv kev pheej hmoo ntawm cov kab mob plawv, kev pheej hmoo ntawm kev tuag, thiab kev cuam tshuam rau lub raum (tshiab-pib tsis tu ncua macroalbuminuria), thiab raws li kev txo qis hauv lub cev hnyav tom qab siv tshuaj. txo.
Lwm cov kev tshawb fawb tau pom tias muaj ntau dua lossis sib npaug li 40 feem pua txo qis hauv eGFR lossis ib nrab ntawm kev pheej hmoo ntawm ESRD hauv cov neeg mob kho nrog GLP-1RA piv nrog insulin.
Cov lus qhia tshiab tshaj plaws tau pom zoo: Cov neeg mob ntshav qab zib uas muaj kev pheej hmoo siab lossis tsim muaj kab mob atherosclerotic plawv, kab mob raum ntev lossis mob plawv tsis ua haujlwm, tshwj xeeb tshaj yog cov neeg mob rog, tuaj yeem muab qhov tseem ceeb rau GLP-1RA tshuaj, thiab GLP-1RA tuaj yeem suav hais tias nyiam rau kev txhaj tshuaj.
Most GLP-1RAs can be used in patients with mild to moderate renal insufficiency; liraglutide can be used in patients before dialysis. (GFR>15 ml / min / 1.73 / m2
Cov xwm txheej ntawm RASi tsis tuaj yeem shaken:RASi yog cov ntawv luv ntawm "renin-angiotensin system inhibitor", thiab cov tshuaj siv tshuaj feem ntau yog sartans (ARBs) thiab prilins (ACEi). Cov tshuaj no tiv thaiv lub raum los ntawm kev txo qis glomerular siab thiab glomerular ultrafiltration, txo oxidative kev nyuaj siab, o, thiab fibrosis.
Ntau qhov kev tshawb fawb tau pom tias RASi tuaj yeem txo qis proteinuria thiab txo qhov kev pheej hmoo ntawm lub raum ua haujlwm tsis zoo, tuag, thiab ESKD hauv cov neeg mob ntshav qab zib.
Rau cov neeg mob uas muaj DKD, tshwj xeeb tshaj yog albuminuria, RASi yuav tsum yog thawj qhov kev xaiv ua cov tshuaj tiv thaiv kab mob siab, thiab RASi tsis tas yuav tsum tau txiav tawm txawm tias creatinine nce me ntsis (<>
Txhawm rau kom tau txais txiaj ntsig zoo tshaj plaws, cov lus qhia tau pom zoo tias koob tshuaj RASi yuav tsum tau maj mam nce mus rau qhov siab tshaj plaws uas tus neeg mob tuaj yeem zam tau yam tsis muaj kev cuam tshuam tsis zoo (hyperkalemia lossis mob raum tsis txaus).
Hauv cov neeg mob ntshav qab zib uas muaj proteinuria, koob tshuaj RASi yuav tsum tau maj mam nce kom tau txais cov txiaj ntsig kho tau zoo dua txawm tias cov ntshav siab zoo li qub lossis cov ntshav siab tswj tau zoo tom qab siv cov tshuaj RASi tsawg.
Txawm li cas los xij, nws yuav tsum tau muab sau tseg tias kev sib xyaw ntawm ACEi thiab ARB tsis pom zoo tam sim no vim tias muaj kev pheej hmoo ntau ntxiv ntawm cov xwm txheej tsis zoo, xws li hyperkalemia thiab mob raum raug mob. Thaum noj tshuaj xws li RASi, lub raum ua haujlwm yuav tsum tau kuaj xyuas tsis tu ncua, thiab cov tshuaj yuav tsum tau txiav tawm nyob rau lub sijhawm thaum mob plab hnyav. Tsis tas li ntawd, cov tshuaj no yuav tsum tau txiav tawm hauv cov neeg mob uas muaj creatinine ntau dua 3 mg / dL.
Kev tswj hwm ntawm cov ntshav lipids yuav tsum nruj dua:Cov kab mob plawv (CVD) yog qhov ua rau tuag rau cov neeg mob ntshav qab zib nephropathy, thiab dyslipidemia yog qhov tseem ceeb rau cov xwm txheej CVD hauv cov neeg mob ntshav qab zib.
Cov lus qhia pom zoo tias cov neeg mob ntshav qab zib muaj keeb kwm ntawm atherosclerotic kab mob plawv lossis eGFR<60 ml/min-/1.73="" m2="" are="" extremely="" high="" populations="" and="" should="" control="" low-density="" lipoprotein="" (ldl-c)="" levels="" to=""><1.8 mmol/l="" .="" the="" european="" diabetes="" treatment="" guidelines="" even="" recommend="" that="" patients="" with="" diabetes="" or="" stage="" 3-4="" ckd="" should="" control="" ldl-c="" below="" 1.4="">
Kev siv statin lossis statin ua ke nrog ezetimibe los tswj cov ntshav lipids hauv cov neeg mob tau pom zoo hauv cov lus qhia tseem ceeb hauv tsev thiab txawv teb chaws. Vim tias qhov kev ntsuas no tsawg, yuav luag txhua tus neeg mob ntshav qab zib thiab CKD yuav tsum tau txais kev kho mob statin ntev.
Kev noj zaub mov tsis muaj protein ntau thiab kev ua neej nyob yog qhov tseem ceeb heev:cov txheej txheem kho mob ntshav qab zib tshiab tau pom zoo tias cov neeg mob ntshav qab zib thiab mob raum mob yuav tsum tswj hwm cov protein kom tsawg, txog li {{0}}.8 g/kg/d, ntxiv nrog alpha keto acid npaj. Hauv cov neeg mob uas muaj CKD hnyav, kev noj cov protein yuav tsum tau txwv ntxiv (0.4 g / kg / d). Piv nrog rau qib siab ntawm kev noj cov protein ntau, qhov kev ntsuas no muaj txiaj ntsig zoo hauv kev ncua kev poob ntawm GFR thiab ncua kev loj hlob ntawm cov neeg mob mus rau theem kawg ntawm lub raum kab mob (uremia).
Cov neeg mob yuav tsum txwv tsis pub noj ntsev,<6g per="" day,="" and="" even="" more="" stringent="" requirements="" for="" patients="" with="" hypertension,="" heart="" failure,="" and="" edema.="" it="" is="" encouraged="" to="" increase="" the="" intake="" of="" dietary="" fiber,="" and="" patients="" with="" conditions="" can="" properly="" consume="" fish="" oil="" rich="" in="" unsaturated="" fatty="" acids="" and="">
raum tiv thaiv cov nyhuv cistanche
Lwm yam kev cuam tshuam kev ua neej muaj xws li kev tawm dag zog tsim nyog, haus luam yeeb, thiab poob phaus. Ntawm lawv, kev tswj qhov hnyav yog qhov tseem ceeb heev rau kev tswj cov ntshav qab zib, ntshav siab, txo cov hlab plawv thiab cerebrovascular teeb meem, thiab ncua kev mob raum.
Cov lus qhia pom zoo tias cov neeg mob rog rog yuav tsum tau txhawb kom poob phaus thiab siv cov tshuaj uas tuaj yeem pab txo qhov hnyav, xws li metformin, SGLT2 inhibitors (glitatins), GLP-1RAs (liraglutide, thiab lwm yam).
Cov ntsiab lus
Nyob rau hauv xyoo tas los no, ntau qhov kev ua tiav tau ua tiav hauv kev kho mob ntshav qab zib nephropathy, thiab ntau cov tshuaj tau tshwm sim uas tuaj yeem txhim kho tag nrho cov kev mob tshwm sim ntawm cov neeg mob thiab txo qis kev pheej hmoo ntawm plawv, hlwb thiab lub raum teeb meem. Nrog rau kev hloov kho tas mus li thiab kev nce qib ntawm kev tshawb fawb soj ntsuam tshiab, cov tshuaj tshiab, thiab cov lus qhia tshiab, kev kuaj mob ntshav qab zib thiab kev tswj cov kab mob hauv lub raum yuav ua kom zoo dua ntxiv kom tau txais txiaj ntsig ntau dua rau cov neeg mob.
Tshuaj ntsuab Cistanchekho mob raum zoo
Lus Cim: Cov tshuaj suav tshuaj suav tshuajcistanche(tseem hu ua "daj tshuaj ntsuab" thiab "dej suab puam ginseng"), loj hlob tsuas yog nyob rau hauv cov suab puam arid thiab sov. Raws li ib qho ntawm cuaj cov tshuaj tsis txawj tuag, Cistanche (cistanche tubulosa / cistanche deserticola / desertliving cistanche / cistanche salsa) cov ntsiab lus nrog cov khoom xyaw nplua nuj xws li echinacoside, acteoside, tag nrho phenylethanoid glycosides, flavonoids, polysaccharides, thiab lwm yam.cistancheCov tshuaj ntsuab muaj txiaj ntsig zoo thiab khoom noj khoom haus rau tib neeg lub cev tiv thaiv kab mob, cov kab mob hauv nruab nrog cev, thiab cov hlwb hlwb thiab cov neurons, thiab lwm yam. Cov kev tshawb fawb tshuaj niaj hnub no tau lees paub cov teebmeem hauv qab no ntawm cistanche (cov txiaj ntsig ntawm cistanche): txhim kho kev tiv thaiv; txhim kho kev ua haujlwm ntawm kev sib deev thiab lub raum ua haujlwm; tiv thaiv qaug zog; anti-aging; txhim kho kev nco; anti-Parkinson tus kab mob; anti-Alzheimer tus kab mob; antioxidation; yooj yim- cem quav; anti-inflammatory; txhawb cov pob txha loj hlob, ua kom tawv nqaij dawb; tiv thaiv daim siab; lwm.
