Dab tsi yog Qhov Kev Kho Mob Zoo Ntawm Cov Hlau Hlau Ntxiv Rau Cov Neeg Mob Tsis Ntshav Qab Zib Nrog CKD Theem 3-5

Hlau ua lub luag haujlwm tseem ceeb hauv kev tsim cov hemoglobin, thiab cov hlau tsis muaj peev xwm yog ib qho ua rau mob ntshav qab zib hauv cov neeg mob uas tsis yog mob ntshav qab zib mellitus (ND-CKD), tab sis qhov ua rau cov hlau tsis txaus yuav muaj ntau yam, xws li los ntshav los ntawm uremia. -related platelet tsis ua hauj lwm, kev noj haus Hlau nqus yog cuam tshuam, thiab lwm yam. Cov mob ntev kuj plays lub luag haujlwm tseem ceeb hauv cov metabolism ntawm hlau. Los ntawm kev cuam tshuam rau qib ntawm hepcidin, nws ua rau txo qis kev nqus hlau thiab cov hlau cia hauv lub plab zom mov, uas ua rau muaj kev cuam tshuam erythropoiesis thiab nce qib ferritin hauv cov ntshav.

Nyem rau yuav Cistanche rau CKD

Cov neeg mob uas muaj ND-CKD tuaj yeem noj cov hlau ntxiv hauv qhov ncauj lossis tso rau hauv lub cev, tab sis kev siv cov hlau tso rau hauv cov hlab ntsha ntau dhau tuaj yeem ua rau cov hlau tsis muaj cov ntsiab lus ntxiv, uas ua rau cov kab mob loj hlob sai thiab ua rau muaj kab mob ntau ntxiv (hlau yog ib qho tseem ceeb ntawm cov kab mob microorganisms). Nws tseem tuaj yeem ua rau cov hlwb endothelial puas tsuaj, tsim oxidative kev nyuaj siab, ua rau kom muaj peev xwm ua kom muaj peev xwm ntawm cov monocytes, thiab ua kom txoj kev loj hlob ntawm atherosclerosis. Nws tuaj yeem pom tau tias kev siv cov hlau tso rau hauv cov hlab ntsha ntau dhau yuav ua rau muaj kev phom sij rau cov neeg mob. Tsis tas li ntawd, qhov cuam tshuam ntawm kev siv cov hlau tso rau hauv cov hlab ntsha ntawm kev mus pw hauv tsev kho mob, tus nqi kis mob, kev tuag, thiab lwm yam kev ntsuas tsis zoo ib yam hauv cov kev tshawb fawb yav dhau los.

Ali AlSahow et al. los ntawm Kuwait tau ua ib qho kev tshawb fawb rov qab los ntsuam xyuas seb puas muaj cov tshuaj ntxiv hauv cov hlab ntsha tuaj yeem ua rau muaj kev cuam tshuam tsis zoo hauv cov neeg mob tsis lim ntshav nrog CKD theem 3-5. Cov txiaj ntsig ntawm txoj kev tshawb fawb pom tau tias: Rau cov neeg mob uas tsis tau lim ntshav nrog CKD theem 3-5, kev siv cov hlau tso rau hauv cov hlab ntsha tuaj yeem ua rau nce qib ntawm hemoglobin thiab transferrin saturation. Cov neeg mob uas tsis tau lim ntshav, cov neeg mob uas muaj CKD siab heev (CKD theem 5) muaj kev pheej hmoo siab mus pw hauv tsev kho mob thiab kis kab mob.

Txoj kev

Txoj kev tshawb no suav nrog cov neeg mob uas tsis yog lim ntshav nrog CKD theem 3-5 uas tau txais cov tshuaj txhaj tshuaj hauv cov hlab ntsha hauv peb lub tsev kho mob pej xeem hauv Kuwait thaum Lub Ib Hlis 1, 2013, thiab Lub Ib Hlis 1, 2018. Raws li lub raum ua haujlwm, cov neeg mob tau muab faib ua peb pawg. : Pawg 1 pawg, 30 Tsawg dua lossis sib npaug rau eGFR Tsawg dua lossis sib npaug li 59 ml / min / 1.73m2; pawg 2, 15 Tsawg dua lossis sib npaug rau eGFR Tsawg dua lossis sib npaug li 29 ml / min / 1.73m2; pawg 3, eGFR<15 ml/min/1.73m2, and had not received dialysis treatment patient. In the 12-month follow-up, the primary endpoints were the rate of all-cause hospitalization, the rate of infection-related hospitalization, and the decline in eGFR within 12 months after intravenous iron supplementation.

Kev tshwm sim

Tag nrho ntawm 738 tus neeg mob tau suav nrog hauv txoj kev tshawb no, 289 (39 feem pua) hauv pawg 1, 270 (37 feem pua) hauv pawg 2, thiab 179 (24 feem pua) hauv pawg 3. Lub sijhawm nruab nrab ntawm kev soj ntsuam yog 79 lub hlis (IQR 55-108). Kev sib deev muaj pes tsawg leeg ntawm cov neeg mob hauv peb pawg yog cov poj niam feem ntau, thiab cov neeg mob hauv pawg 1 yog tus yau tshaj, nrog rau hnub nyoog nruab nrab ntawm 55.3 xyoo.

32 feem pua ​​​​ntawm cov neeg mob tau txais RAAS blockers, feem ntau yog nyob rau hauv pawg 1, thiab 52 feem pua ​​​​ntawm cov neeg mob tau txais erythropoietin stimulating agents, feem ntau yog nyob rau hauv pawg 3. 76.6 feem pua ​​​​ntawm cov neeg mob tau kho nrog hlau sucrose, thiab 23.4 feem pua ​​​​tau kho nrog hlau carboxymaltose.

94 feem pua ​​​​ntawm cov neeg mob ntshav siab, thiab 65 feem pua ​​​​ntawm cov neeg mob muaj ntshav qab zib. Qhov nruab nrab tus nqi ntawm lub hauv paus hemoglobin hauv pawg 3 yog qhov qis tshaj ntawm 99.4g / L. Qhov nruab nrab pib hloov pauv saturation (TSAT) rau txhua tus neeg mob yog 16.2 feem pua.

Sib piv cov hemoglobin thiab TSAT ntawm lub hauv paus thiab tom qab 12 lub hlis ntawm kev txhaj tshuaj hlau ntxiv, nws tau pom tias tom qab txhaj tshuaj ntxiv, qhov nruab nrab hemoglobin thiab TSAT ntawm tag nrho peb pawg tau nce ntau (tag nrho P.<0.001). After 12 months of intravenous iron supplementation, the risk of hospitalization and infection is substantially increased in patients with CKD stage 5.

Ntawm peb pawg ntawm cov neeg mob, tag nrho-ua rau tsev kho mob tus nqi ntawm CKD theem 5 cov neeg mob (45.8 feem pua) yog siab tshaj (P<0.001), followed by CKD stage 4 group (33%), and the lowest in CKD stage 3 group (19.7%). The infection-related hospitalization rate (chest infection/urinary tract infection/diabetic foot) was also the highest in the CKD stage 5 group (27.4%, P<0.001), followed by the CKD stage 4 group (18%), and the lowest in the CKD stage 3 group (12%).

Tom qab 12 lub hlis ntawm kev txhaj tshuaj ntxiv rau hauv cov neeg mob CKD theem 5, qhov kev pheej hmoo ntawm kev mus pw hauv tsev kho mob tau nce ntau dua piv nrog cov neeg mob CKD theem 3 (aOR, 2.12; 95 feem pua ​​​​Cl, 1.32, 3.41; P=0.002), thiab Qhov kev pheej hmoo ntawm kev kis kab mob kuj tau nce ntxiv piv nrog CKD theem 3 cov neeg mob (aOR, 2.02; 95 feem pua ​​Cl, 1.15, 3.55; P=0.014).

Sib tham

Tsis muaj kev tuag tau pom thaum lub sijhawm kawm, tab sis kev mus pw hauv tsev kho mob tau pom hauv 31 feem pua ​​​​ntawm cov neeg mob, feem ntau yog vim tsis muaj kev sib kis (82 feem pua), thiab cov neeg mob noj RAAS blockers tsis tshua mus pw hauv tsev kho mob. Nws yuav tsum raug sau tseg tias qhov kev mus pw hauv tsev kho mob siab dua kuj tseem tuaj yeem cuam tshuam los ntawm cov hauv paus qis eGFR, qis hemoglobin qib, thiab comorbidities.

Hais txog cov txiaj ntsig ntawm kev txhaj tshuaj hlau ntxiv rau eGFR hauv cov neeg mob ND-CKD, cov txiaj ntsig ntawm cov kev sim tshuaj ntsuam xyuas muaj feem cuam tshuam tau pom tias qhov ncauj thiab cov hlab ntsha hlau ntxiv muaj cov txiaj ntsig zoo sib xws ntawm eGFR, tab sis lub teb chaws cov ntaub ntawv txheeb xyuas ntawm cov neeg Esxias pom tau hais tias cov tshuaj ntxiv rau hauv cov hlab ntsha. tau txuam nrog ceev ceev nrog kev pheej hmoo siab ntawm kev loj hlob mus rau theem kawg ntawm lub raum kab mob. Hauv txoj kev tshawb no, kev poob qis hauv eGFR yog qhov me me tab sis tseem muaj qhov tseem ceeb hauv peb pawg neeg mob.

Xaus

Txoj kev tshawb no qhia tau hais tias kev siv cov hlau tso rau hauv cov hlab ntsha tuaj yeem txhim kho qib ntawm hemoglobin thiab TSAT hauv cov neeg mob uas tsis yog lim ntshav nrog CKD theem 3-5. Kev nkag mus hauv tsev kho mob tau nce ntxiv tom qab IV hlau tau tshwm sim muaj feem cuam tshuam rau cov neeg mob qis eGFR qib thiab kev kho mob (kev haus luam yeeb, dyslipidemia, thiab qib hemoglobin qis hauv qhov pib), tab sis tsis yog rau IV hlau. Tsis tas li ntawd, cov neeg mob tau txais RAAS blockers tau pw hauv tsev kho mob tsawg dua li cov neeg mob tsis siv RAAS blockers. Intravenous iron supplementation tsis cuam tshuam nrog kev tuag ntau ntxiv hauv cov neeg mob.

Yog xav paub ntxiv:ali.ma@wecistanche.com