Tshaj Tawm Txoj Kev Kho Mob Rau Rituximab Induction Treatment Ntawm MCD

Kev tshawb fawb keeb kwm

Kev hloov pauv nephropathy tsawg tsawg (MCD) yog ib hom kab mob nephrotic syndrome thiab feem ntau tshwm sim hauv cov menyuam yaus. Cov kev tshawb fawb yav dhau los tau pom tias MCD feem ntau rov tshwm sim tom qab kis kab mob, tiv thaiv kab mob lossis ua xua, qhia tias T hlwb thiab B hlwb ua lub luag haujlwm tseem ceeb hauv kev tshwm sim thiab kev loj hlob ntawm MCD. Tam sim no, KDIGO cov lus qhia pom zoo tias thawj kab kev kho mob rau MCD yog glucocorticoids, tab sis txog li 33% ntawm cov neeg mob yuav rov qab los yog dhau los ua glucocorticoid-dependent MCD. Rituximab tuaj yeem txo qhov rov tshwm sim ntawm MCD thiab tuaj yeem siv tau tshwj xeeb hauv cov neeg mob uas muaj kev pheej hmoo siab ntawm kev tsis zoo rau glucocorticoids. Txawm li cas los xij, rituximab puas tuaj yeem siv rau kev kho mob ntawm MCD thiab tsis yog rau kev kho induction?

Nyem rau Cistanche rau mob raum

Kev tshawb fawb tsim

The inclusion criteria for this study were patients with newly treated or relapsed MCD confirmed by renal biopsy and electron microscopy (including previous cases), and who presented with nephrotic syndrome, that is, 24h urine protein >3.5g / 24h, thiab ntshav albumin<30g/L . Divided into 3 groups according to different treatment plans.

Pab pawg A

There were 9 patients in Group A, including 4 patients with initial treatment and 5 patients with complete relapse. They were only treated with a sufficient amount of rituximab. The patients' estimated glomerular filtration rate (eGFR) was >90ml/min/1.73㎡. Urine output >800ml, tsis muaj mob raum mob (AKI).

Pab pawg B

There were 4 patients in Group B, all of whom were completely relapsed. They were treated with short-term low-dose glucocorticoids combined with sufficient rituximab. Their eGFR was >90 ml/min/1.73㎡, urine output was >800ml, thiab lawv tsis muaj AKI.

Pawg C

There were 8 patients in group C, all of whom had complete recurrence. After short-term and sufficient glucocorticoid induction for remission and rituximab maintenance therapy, all patients had severe proteinuria (>10g / 24h), ntshav albumin<20g/L or developed AKI.

Qhov kawg ntawm txoj kev tshawb no yog qhov ua tau zoo thiab kev nyab xeeb ntawm rituximab hauv kev txhawb nqa MCD. Cov txiaj ntsig muaj xws li: tus neeg mob kev kho mob tus nqi, lub sij hawm rau kev tshem tawm, thiab kev kho mob rov qab. Kev nyab xeeb feem ntau tshuaj xyuas qhov kev pheej hmoo ntawm kev tsis zoo tshwm sim.

Kev tshawb fawb tshwm sim

01 Cov ntaub ntawv tseem ceeb

Tag nrho ntawm 21 tus neeg laus MCD tau cuv npe, nrog rau hnub nyoog nruab nrab ntawm 34.67 ± 14.92 xyoo. Ua ntej kev kho mob, tus neeg mob qhov nruab nrab 24- teev proteinuria yog 11.36±6.08g, ntshav albumin qib yog 19.50 (17.70 ~ 27.85) g/L, nruab nrab cov ntshav creatinine yog 76.60 ± 22.19µmol / L, thiab nruab nrab eGFR.4 yog 102. ± 30.46ml. /min/1.73㎡. Qhov nruab nrab CD19+B cell suav yog 500.67 ± 275.34/µl.

02 Txhua tus neeg mob tau ua tiav kev kho mob

Tom qab 12 lub hlis ntawm kev soj ntsuam, tag nrho cov neeg mob tau ua tiav kev kho mob, nrog rau 19 tus neeg mob (90.48%) ua tiav kev tshem tawm, 2 tus neeg mob (9.52%) tau txais kev tso tawm ib nrab, thiab lub sijhawm tshem tawm nruab nrab yog 4 (2.5-12 ) lis. Hauv 1 xyoos tom qab kev soj ntsuam, 2 tus neeg mob rov qab los, nrog tus nqi rov ua dua ntawm 9.52%.

Pab pawg A

Pawg A tau cuv npe 9 tus neeg mob, 3 tus neeg mob tau txais ib koob tshuaj rituximab 6 lub hlis tom qab ua tiav kev kho mob rituximab puv nkaus, 8 ntawm lawv (88.89%) tau ua tiav kev tshem tawm, 1 Ib tus neeg mob (11.11%) tau teb ib feem, thiab cov lus teb nruab nrab. lub sij hawm yog 3 (2.25-14) lub lis piam. Ib tus neeg mob rov ua dua ob zaug hauv 1 xyoos tom qab kev soj ntsuam.

Pab pawg B

Pab pawg B tau cuv npe rau 4 tus neeg mob, 3 tus neeg mob (75.00%) tau ua tiav kev tso cai, thiab lub sijhawm teb nruab nrab yog 4 (4-10) lub lis piam. Ib kis tau txais kev tso cai ib nrab (25.00%). Tus neeg mob tseem muaj proteinuria tom qab ua tiav kev kho mob rituximab puv nkaus. Tom qab 6 lub hlis ntawm kev soj ntsuam, rov txhaj tshuaj rituximab (375 mg / ㎡) tsis tshwm sim. Nws tuaj yeem txhim kho nws qib proteinuria. Txhua tus neeg mob tau tso tseg tsis noj tshuaj steroids hauv 4 lub hlis, thiab 1 tus neeg mob rov qab ua dua li ntawm 1 xyoos tom qab kev tshuaj xyuas.

Pawg C

Pawg C tau tso npe rau 8 tus neeg mob, tag nrho (100%) tau ua tiav cov lus teb, thiab lub sijhawm teb nruab nrab yog 3.5 (2-4) lub lis piam. Peb tus neeg mob tau txais ib koob tshuaj rituximab 6 lub hlis tom qab ua tiav kev kho mob rituximab puv nkaus. Txhua tus neeg mob tau tso tseg tsis noj tshuaj steroids hauv 3 lub hlis thiab tsis pom qhov tshwm sim.

03 Tag nrho cov neeg mob 'lab ntsuas ntsuas tau zoo dua

Piv nrog rau cov ntaub ntawv ua ntej kev kho mob rituximab, nyob rau hauv 12 lub hlis tom qab kev kho mob, tus nqi ntawm cov urinary protein tau txo qis thiab serum albumin tau nce ntau hauv txhua tus neeg mob.

Tsis tas li ntawd, lipid thiab protein metabolism tsis txaus tau txo qis, qhov ntau npaum li cas ntawm cov tshuaj hormones tau txo qis, thiab CD19 suav pom qhov poob qis.

04 Rituximab + cov tshuaj hormones tau txais txiaj ntsig zoo

Cov xwm txheej tsis zoo tshwm sim hauv 6 tus neeg mob (28.57%) thaum lub sijhawm kho rituximab thiab ua raws, thiab 1 tus neeg mob (4.76%) tau ntsib qhov xwm txheej tsis zoo, tshwj xeeb yog mus pw hauv tsev kho mob rau kev mob ntsws ntsws interstitial.

Cov ntsiab lus tshawb fawb

Hauv kev xaus, kev kho mob nrog rituximab txaus ib leeg lossis siv sijhawm luv luv ntawm cov koob tshuaj glucocorticoids ua ke nrog cov rituximab txaus tuaj yeem ua rau muaj txiaj ntsig zoo thiab tswj kev tshem tawm hauv cov neeg mob MCD yam tsis muaj AKI. Rau cov neeg mob MCD nrog AKI, luv luv thiab txaus glucocorticoids yog siv los txhawb kev tshem tawm thiab tom qab ntawd kev kho mob nrog rituximab kuj zoo.

Kws tshuaj xyuas

Ntawm cov kev xaiv kho mob uas twb muaj lawm, rituximab feem ntau yog siv los txo qhov rov qab los ntawm cov neeg mob MCD. Ntawm cov neeg mob no, rituximab tuaj yeem pab cov neeg mob feem ntau txo lossis txiav tawm cov tshuaj tiv thaiv kab mob thiab corticosteroids, nrog rau txo qhov kev pheej hmoo ntawm cov kab mob raum. Txoj kev tshawb no yog thawj zaug tshaj tawm tias kev siv cov rituximab txaus ib leeg lossis ua ke nrog cov tshuaj glucocorticoids qis tuaj yeem ua rau muaj txiaj ntsig zoo ntawm MCD. Rau cov neeg mob AKI, rituximab tuaj yeem siv tau tom qab lub sijhawm luv luv ntawm kev tso tawm nrog cov glucocorticoids txaus. Kev kho mob tseem siv tau. Peb cov txheej txheem induction yog tag nrho cov txiaj ntsig zoo rau cov neeg mob MCD uas muaj keeb kwm sib txawv, tuaj yeem txo qhov ntau npaum li cas thiab kev vam khom ntawm glucocorticoids, thiab tuaj yeem ua tiav cov tshuaj tsis muaj tshuaj hormones, yog li txo qis cov kev mob tshwm sim ntawm cov tshuaj hormones.

Piv nrog rau cov kev tshawb fawb yav dhau los, kev kho hormonal ib leeg ua rau cov lus teb zoo sib xws rau kev kho rituximab. Tsis tas li ntawd, piv nrog cov kev tshawb fawb yav dhau los uas siv rituximab ib leeg los kho MCD, qhov rov tshwm sim ntawm qhov kev tshawb fawb no tau qis dua. Qhov no yuav cuam tshuam rau kev siv rituximab kom txaus nyob rau theem pib thiab kev kho mob rituximab ntxiv tom qab 6 lub hlis tom qab.

Tsis tas li ntawd, cov neeg mob feem ntau zam tau zoo, tsuas yog ib tus neeg mob tau ntsib cov xwm txheej tsis zoo, thiab qhov kev pheej hmoo ntawm cov xwm txheej tsis zoo tau qis dua li yav dhau los qhia txog kev kho mob prednisolone thiab tshuaj hormone ua ke nrog kev kho mob tacrolimus. Ib qho kev phiv tshwm sim ntawm kev kho mob rituximab yog cov tshuaj tiv thaiv infusion, uas tuaj yeem kho tau los ntawm kev kho tus nqi infusion.

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 tshuab.

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.