Uremic Toxins cuam tshuam ncaj qha rau tus neeg mob lub neej ncua! Yuav Ua Li Cas Tshem Tawm Lawv Zoo Dua?
Jun 11, 2024
Muaj ntau cov tsos mob tsis xis nyob ntawm cov neeg mob uremia, xws li qaug zog, tsis qab los noj mov, khaus tawv nqaij, thiab kev puas tsuaj rau cov hlab plawv, kev tiv thaiv kab mob, thiab lwm yam kab mob, feem ntau yog vim muaj kev cuam tshuam ntawm uremic toxins hauv kev kho mob.
Niaj hnub no peb yuav kawm txog cov uremic co toxins thiab cov ntshav purification tshem tawm lawv li cas.
Nyem rau Cistanche rau mob raum
Uremic toxins hais txog cov khoom uas sib sau hauv lub cev cov ntaub so ntswg thiab cov ntshav raws li lub raum ua haujlwm tsis zoo thiab ua rau cov tsos mob ntawm uremic, cell thiab cov ntaub so ntswg ntawm lub cev puas tsuaj thiab ua haujlwm tsis zoo, thiab lub cev metabolic.
Tam sim no, muaj ntau dua 200 paub txog uremic toxins, thiab txog 30 yam khoom yuav muaj uremic toxicity. Tus naj npawb ntawm cov co toxins uas tau lees paub tshiab tseem nce ntxiv [1].
Tam sim no, raws li lawv cov khoom thiab qhov hnyav molecular, feem ntau lawv tuaj yeem muab faib ua peb pawg:
① Me me molecule dej-soluble solutes: txheeb ze molecular hnyav<500Da, such as urea, creatinine, uric acid, etc.
② Nruab nrab thiab loj molecular co toxins: txheeb ze molecular hnyav Ntau dua los yog sib npaug rau 500Da, xws li 2 microglobulin, leptin, parathyroid hormone (PTH), thiab lwm yam.
③ Protein-bound toxins: sawv cev los ntawm p-cresol sulfate, indoxyl sulfate, indole-3-acetic acid, hippuric acid, thiab lwm yam. Txawm hais tias tus txheeb ze molecular hnyav ntawm hom tshuaj lom no feem ntau tsawg dua 500Da, feem ntau cov ntshav purification hom muaj kev cuam tshuam tsis zoo rau nws vim nws tuaj yeem khi rau cov ntshav albumin. Yog tias nws raug tshem tawm los ntawm kev lim ntshav, qhov kev tshem tawm txhua lub lim tiam yog tsawg dua 1/10 ntawm lub raum [1].
Kev puas tsuaj ntawm uremic toxins rau tib neeg lub cev
Me me molecule co toxins
Cov tshuaj molecule me me yog urea, creatinine, uric acid, thiab lwm yam uas peb pom hauv daim ntawv qhia txog kev ua haujlwm rau lub raum. Vim lawv qhov hnyav molecular me me, lawv tau yooj yim tshem tawm los ntawm cov pa hemodialysis. Ib qho hemodialysis tuaj yeem txo cov ntshav concentration ntawm urea ntau dua lossis sib npaug li 70%. Yog li ntawd, hom tshuaj lom no tsis tshua muaj teeb meem rau tib neeg lub cev thiab yuav tsis tham txog qhov no.
Hauv kev sib piv, tom kawg ob hom co toxins yog qhov nyuaj rau kev tshem tawm los ntawm cov pa hemodialysis vim lawv qhov hnyav molecular loj thiab yooj yim khaws cia hauv lub cev. Cov kev tshawb fawb nyob rau hauv xyoo tas los no tau pom tias ob qho tib si muaj feem xyuam nrog cov xwm txheej ntawm cov hlab plawv, qhov tseem ceeb ntawm kev tuag ntawm cov neeg mob uremic.
Yog li ntawd, peb tsuas yog qhia txog kev tshawb fawb thiab kev tshem tawm ntawm qee qhov nruab nrab-molecule co toxins thiab protein-bound toxins.
Nruab nrab molecular co toxins
2 microglobulin yog tsim los ntawm lymphocytes, platelets, thiab polymorphonuclear leukocytes, nrog rau qhov hnyav molecular ntawm 11800 Da. Nws tsuas yog metabolized los ntawm ob lub raum, thiab 99% yog reabsorbed thiab decomposed los ntawm lub raum tubules.
Cov yam ntxwv xws li acidosis, micro-inflammatory ib puag ncig, thiab hom kev lim ntshav hauv cov neeg mob uremia nce 2 microglobulin. Hauv cov neeg mob uas muaj cov kab mob hauv lub raum kawg (ESRD), 2 microglobulin accumulates hauv lub cev, tsim cov amyloid fibers hauv cov pob txha, pob qij txha, thiab cov kab mob hauv nruab nrog cev, uas ua rau lub cev puas tsuaj, hu ua dialysis-related amyloidosis, uas yog ib qho teeb meem tshwm sim. ntawm ESRD.
2 microglobulin, ua tus sawv cev ntawm nruab nrab molecular co toxins, yog siv los txiav txim qhov txaus ntawm kev lim ntshav. Cov kev tshawb fawb tau pom tias 2 microglobulin cuam tshuam nrog txhua qhov ua rau tuag hauv cov neeg mob ESRD, thiab qhov concentration tsawg dua 27.5 mg / L tuaj yeem ua tiav qhov kev ciaj sia zoo tshaj plaws.
PTH
PTH yog secreted los ntawm parathyroid thawj cov hlwb nrog ib qho hnyav molecular ntawm kwv yees li 9400 Da. Nce PTH tuaj yeem ua rau cov pob txha thiab cov ntxhia hauv cov metabolism, xws li mob raum kab mob mineral thiab pob txha metabolism tsis zoo (CKD-MBD). Ntxiv nrog rau lub cev pob txha, PTH muaj tshuaj lom rau ntau lub cev thoob plaws lub cev.
Cov ntsiab lus siab ntawm PTH hauv cov ntshav tuaj yeem ua rau cov ntsiab lus calcium ntxiv hauv cov qe ntshav liab, yog li cuam tshuam rau lawv txoj kev ncaj ncees thiab ua rau cov ntshav liab puas. PTH tseem tuaj yeem ua rau cov qe ntshav dawb los tiv thaiv kev tiv thaiv kab mob. Qhov siab ntawm PTH tuaj yeem cuam tshuam ncaj qha rau myocardial cell zog metabolism, ua rau myocardial hypertrophy thiab lub plawv tsis ua haujlwm.
Leptin
Leptin yog cov khoom lag luam protein uas tau sau los ntawm cov noob rog rog, feem ntau yog zais los ntawm cov ntaub so ntswg adipose. Nws lub luag haujlwm tseem ceeb hauv lub cev muaj xws li: txo qis qab los noj mov, tswj kev noj qab haus huv thiab lub cev noj, ncaj qha inhibiting rog synthesis, cuam tshuam rau endocrine, koom nrog kev tswj hwm ntawm hematopoiesis thiab lub cev tsis muaj zog, txhawb kev loj hlob thiab cuam tshuam rau kev yug me nyuam, thiab lwm yam kab mob peripheral lom.
Leptin feem ntau yog metabolized los ntawm ob lub raum, thiab qib leptin tau nce siab hauv cov neeg mob ESRD.
Ntau qhov kev tshawb fawb hauv tsev thiab txawv teb chaws tau pom tias leptin cuam tshuam nrog kev noj zaub mov tsis zoo hauv cov neeg mob hemodialysis. Cov qib leptin kuj tseem cuam tshuam rau hemodialysis-txog cov leeg nqaij cramps.
Protein-bound co toxins
Siab homocysteine :
Nws paub zoo tias hyperhomocysteineemia yog ib qho kev pheej hmoo ywj pheej rau cov xwm txheej hauv plawv. Cov kev tshawb fawb tau pom tias hyperhomocysteineemia tuaj yeem ua rau cov hlwb endothelial puas tsuaj thiab cuam tshuam kev kho thiab rov tsim cov hlab ntsha. Nyob rau tib lub sijhawm, nws muaj kev cuam tshuam zoo rau cov hlab plawv thiab txhua qhov kev tuag ntawm cov neeg mob uremia.
Paracresol sulfate
Ib txoj kev tshawb fawb yav tom ntej ntawm cov neeg laus hemodialysis tau pom tias cov neeg mob uas muaj cov tshuaj paracresol sulfate hauv cov ntshav qis qis dua txhua qhov ua rau thiab cov kab mob plawv tuag ntau dua li cov neeg uas muaj paracresol sulfate ntau dua. Tom qab hloov kho rau cov yam ntxwv cuam tshuam xws li hnub nyoog, poj niam txiv neej, albumin, thiab qib hemoglobin, paracresol sulfate tseem cuam tshuam rau txhua qhov ua rau thiab mob plawv.
Indoxyl sulfate (IS)
Indole yog ib qho metabolite ntawm tryptophan los ntawm cov kab mob hauv plab hnyuv, uas ntxiv hloov mus rau hauv indoxyl sulfate hauv daim siab. IS muaj ob qho tib si vascular toxicity thiab nephrotoxicity.
Cov kev tshawb fawb tau pom tias IS-induced systemic oxidative kev nyuaj siab yog qhov txuas tseem ceeb hauv nws cov hlab plawv. IS tuaj yeem ua rau oxidative kev ntxhov siab hauv lub raum tubular hlwb, interstitial hlwb, vascular du leeg hlwb, cardiomyocytes, thiab osteoblasts. Tsis tas li ntawd, nws tuaj yeem ua rau endothelial puas thiab inhibit endothelial proliferation thiab kho. Nws koom nrog hauv kev loj hlob ntawm cov kab mob plawv thiab osteodystrophy hauv cov neeg mob uas mob raum mob.
Cov kev tshawb fawb tsis ntev los no tau pom tias IS tuaj yeem txhim kho qhov kev qhia ntawm epithelial txoj kev loj hlob receptors, yog li txhim kho angiotensin II teeb liab hloov, thiab thaum kawg ua rau atherosclerosis. IS txhawb kev nkag mus ntawm lub raum interstitial monocytes / macrophages, tsim ntau yam profibrotic yam, thiab induces raum interstitial fibrosis.
Cov teebmeem ntawm cov ntshav purification sib txawv ntawm kev tshem tawm ntawm uremic toxins
Tam sim no, feem ntau siv cov ntshav purification txoj kev hauv kev kho mob muaj xws li cov pa hemodialysis, high-flux hemodialysis, hemofiltration, thiab hemoperfusion. Raws li tau hais hauv tsab xov xwm dhau los, cov pa hemodialysis tuaj yeem yooj yim tshem tawm cov co toxins me me, tab sis nws yog ib qho nyuaj rau tshem tawm cov khoom nruab nrab ntawm cov molecule thiab cov protein-bound toxins, uas yuav tsum tau siv lwm txoj hauv kev los pab tshem tawm cov ntshav.
High-flux hemodialysis yog ib txoj kev lim ntshav uas siv cov membrane pore loj thiab siab molecular hnyav polymer dialysis membrane. Nws muaj zoo diffusivity thiab permeability. Nws tuaj yeem tsis tsuas yog tshem tawm cov co toxins me me los ntawm kev nthuav dav thiab convection tab sis kuj tshem tawm cov co toxins loj los ntawm adsorption. Nyob rau tib lub sijhawm, nws tuaj yeem txo qhov kev ntxhov siab inflammatory teb [3].
Hemodiafiltration muab cov txiaj ntsig zoo ntawm hemodialysis thiab hemofiltration thiab ua raws li cov hauv paus ntsiab lus ntawm tubular reabsorption thiab glomerular filtration kom tshem tawm qhov nruab nrab thiab loj molecular co toxins los ntawm cov ntshav ntawm cov neeg mob uremia.
Hemoperfusion yog hom adsorption ntxov tshaj plaws siv hauv kev kho mob tshem tawm cov protein-bound toxins. Txij li thaum hemoperfusion nws tus kheej tsis tuaj yeem tshem tawm dej lossis tswj cov electrolyte thiab acid-base tshuav nyiaj li cas, nws feem ntau yog siv ua ke nrog cov pa hemodialysis.
Ib txoj kev tshawb fawb hauv tsev tau pom tias cov txiaj ntsig ntawm hemoperfusion ua ke nrog hemodialysis hauv kev tshem tawm cov protein-bound toxins yog qhov zoo dua li cov ntshav siab hemodialysis thiab hemodialysis [4].
Txawm li cas los xij, nws nyuaj rau hais tias peb tus twg yog qhov muaj zog dua lossis tsis muaj zog, thiab seb lawv puas tuaj yeem hloov tau los ntawm ib leeg.
Vim tias muaj ntau hom uremic toxins, tam sim no muaj cov co toxins tsawg dua uas tuaj yeem siv los ua tus qauv rau kev txiav txim siab tshem tawm cov co toxins. Piv txwv li, peb feem ntau siv 2 microglobulin ua qhov taw qhia rau kev txiav txim siab txaus ntawm kev lim ntshav. Txawm li cas los xij, ntau lwm yam co toxins yog qhov nyuaj rau kev ntsuas, yog li nws tsis tuaj yeem txiav txim siab seb cov ntshav lim ntshav sib txawv li cas hauv kev tshem tawm cov co toxins, thiab txoj kev twg zoo dua.
Piv txwv li, ib txoj kev tshawb nrhiav pom tias ob qho tib si high-flux hemodialysis thiab hemodiafiltration tuaj yeem tshem tawm cov co toxins loj, nruab nrab thiab me me ntawm cov ntshav. Cov qub tuaj yeem tshem tawm PTH tau zoo, thaum lub sijhawm tom kawg tuaj yeem tshem tawm 2 microglobulin zoo dua.
Yog li ntawd, hauv kev kho mob, txhawm rau pab cov neeg mob uremia zoo tshem tawm cov co toxins, cov txheej txheem saum toj no feem ntau ua ke kom ua tiav cov txiaj ntsig kev tshem tawm cov co toxins ntau dua.
Txawm hais tias cov ntshav purification txoj kev xaiv, tsim nyog anticoagulation yog yuav tsum tau. Noj hemoperfusion ua ke nrog hemodialysis ua piv txwv, yuav ua li cas kho cov tshuaj anticoagulant?
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 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 lub cev thiab lub cev, ua rau nws txoj hauv kev zoo rau kev kho mob raum.
