{"id":2413,"date":"2021-01-26T13:37:44","date_gmt":"2021-01-26T05:37:44","guid":{"rendered":"http:\/\/43.207.1.148\/?p=2413"},"modified":"2021-01-26T13:37:44","modified_gmt":"2021-01-26T05:37:44","slug":"%e8%aa%8d%e8%ad%98%e5%a4%9a%e5%9b%8a%e8%85%8e","status":"publish","type":"post","link":"https:\/\/adpkdtw.org\/?p=2413","title":{"rendered":"\u8a8d\u8b58\u591a\u56ca\u814e"},"content":{"rendered":"\n\n\n

\u8a8d\u8b58\u591a\u56ca\u814e<\/strong>
<\/h2>\n\n\n\n

\u793e\u5718\u6cd5\u4eba\u4e2d\u83ef\u6c11\u570b\u591a\u56ca\u814e\u814e\u53cb\u5354\u6703\u7406\u4e8b\u9577
\u8f14\u5927\u91ab\u9662\u814e\u81df\u79d1\u4e3b\u6cbb\u91ab\u5e2b
\u9ad8\u82b7\u83ef<\/p>\n\n\n\n

\u524d\u8a00<\/strong><\/h3>\n\n\n\n


\u591a\u56ca\u814e\u7684\u5168\u540d\u662f\u591a\u56ca\u6027\u814e\u81df\u75c5(polycystic kidney disease, PKD)\uff0c\u53ef\u5206\u70ba\u81ea\u9ad4\u986f\u6027\u907a\u50b3\u591a\u56ca\u6027\u814e\u81df\u75c5(ADPKD)\u548c\u81ea\u9ad4\u96b1\u6027\u907a\u50b3\u591a\u56ca\u6027\u814e\u81df\u75c5(ARPKD)\u5169\u5927\u985e\uff0c\u524d\u8005\u901a\u5e38\u5728\u6210\u4eba\u6642\u671f\u767c\u75c5\uff0c\u5f8c\u8005\u5247\u5728\u5b30\u5152\u6642\u671f\u767c\u75c5\u3002\u4f46\u4e5f\u6709\u5c11\u90e8\u5206\u7684\u75c5\u4eba\u975e\u907a\u50b3\u5f97\u75c5\uff0c\u4e43\u662f\u81ea\u8eab\u57fa\u56e0\u5076\u767c\uff08sporadic\uff09\u7a81\u8b8a\u6240\u81f4\u3002
\u672c\u6587\u5c07\u4ecb\u7d39\u81ea\u9ad4\u986f\u6027\u907a\u50b3\u591a\u56ca\u6027\u814e\u81df\u75c5(\u4ee5\u4e0b\u7c21\u7a31\u300c\u591a\u56ca\u814e\u300d)\u7684\u6d41\u884c\u75c5\u5b78\u3001\u57fa\u56e0\u7570\u5e38\u3001\u75be\u75c5\u81ea\u7136\u53f2\u3001\u75c7\u72c0\u3001\u8a3a\u65b7\u548c\u6cbb\u7642\u3002<\/p>\n\n\n\n

\u591a\u56ca\u814e\u7684\u6d41\u884c\u75c5\u5b78<\/strong><\/h3>\n\n\n\n


\u6bcf400\u81f31000\u4eba\u4e2d\u5c31\u53ef\u80fd\u6709\u4e00\u4eba\u60a3\u6709\u591a\u56ca\u814e\uff0c\u4e0d\u540c\u7a2e\u65cf\u7684\u76db\u884c\u7387\u5dee\u4e0d\u591a\u3002\u5728\u7f8e\u570b\uff0c\u591a\u56ca\u814e\u662f\u5c0e\u81f4\u672b\u671f\u814e\u75c5\uff08end-stage renal disease, ESRD\uff09\u7684\u5176\u4e2d\u4e00\u500b\u91cd\u8981\u539f\u56e0\u3002<\/p>\n\n\n\n

\u591a\u56ca\u814e\u7684\u57fa\u56e0\u7570\u5e38<\/strong><\/h3>\n\n\n\n


\u591a\u56ca\u814e\u662f\u4e00\u7a2e\u6700\u5e38\u898b\u7684\u55ae\u4e00\u57fa\u56e0\u7a81\u8b8a\u5f15\u8d77\u7684\u907a\u50b3\u6027\u814e\u81df\u75c5\uff0c\u76ee\u524d\u78ba\u5b9a\u6703\u5f15\u767c\u591a\u56ca\u814e\u7684\u7a81\u8b8a\u57fa\u56e0\u6709\u5169\u7a2e\u3002\u7b2c\u4e00\u7a2e\u662fPKD1\uff0c\u4f4d\u65bc\u7b2c16\u5c0d\u67d3\u8272\u9ad4\u4e0a\uff1b\u7b2c\u4e8c\u7a2e\u662fPKD2\uff0c\u4f4d\u65bc\u7b2c4\u5c0d\u67d3\u8272\u9ad4\u4e0a\u3002PKD1\u7d04\u4f54\u6240\u6709\u60a3\u8005\u768485%\uff0c\u901a\u5e38\u75c5\u60c5\u6bd4\u8f03\u56b4\u91cd\uff0c\u65e9\u81f3\u56db\u3001\u4e94\u5341\u6b72\u5373\u53ef\u80fd\u9032\u5165\u900f\u6790\uff08\u6d17\u814e\uff09\u968e\u6bb5\u3002\u53e6\u5916\uff0c\u7d0415%\u7684\u591a\u56ca\u814e\u60a3\u8005\u7684\u7a81\u8b8a\u57fa\u56e0\u70baPKD2\uff0c\u901a\u5e38\u75c5\u60c5\u6bd4\u8f03\u8f15\u5fae\uff0c\u4e0d\u4e00\u5b9a\u6703\u9032\u5c55\u5230\u900f\u6790\u968e\u6bb5\uff0c\u82e5\u9700\u900f\u6790\uff0c\u901a\u5e38\u5e74\u9f61\u70ba\u4e94\u3001\u516d\u5341\u6b72\u4ee5\u5f8c\u3002\u8ddf\u5176\u5b83\u570b\u5bb6\u76f8\u6bd4\uff0c\u5728\u53f0\u7063\u5e36\u6709PKD2\u7a81\u8b8a\u57fa\u56e0\u7684\u60a3\u8005\u8d85\u904e15%\u3002<\/p><\/blockquote>\n\n\n\n

\u591a\u56ca\u814e\u7684\u75be\u75c5\u81ea\u7136\u53f2<\/strong><\/h3>\n\n\n\n


\u591a\u56ca\u814e\u60a3\u8005\u7684\u5169\u5074\u814e\u81df\u6703\u4e0d\u65b7\u7522\u751f\u5927\u5c0f\u4e0d\u4e00\u7684\u56ca\u816b\uff0c\u814e\u81df\u4e5f\u6703\u9010\u6f38\u8b8a\u5927\u3002\u6b63\u5e38\u7684\u814e\u81df\u7d44\u7e54\u6703\u88ab\u4e0d\u65b7\u751f\u9577\u7684\u56ca\u816b\u4f54\u64da\u53ca\u58d3\u58de\uff0c\u5c0e\u81f4\u814e\u529f\u80fd\u9010\u6f38\u4e0b\u964d\uff0c\u6700\u5f8c\u9020\u6210\u814e\u8870\u7aed\uff0c\u751a\u81f3\u9700\u8981\u900f\u6790\uff08\u6d17\u814e\uff09\u3002<\/p>\n\n\n\n

\u591a\u56ca\u814e\u7684\u75c7\u72c0<\/h3>\n\n\n\n


\u591a\u56ca\u814e\u7684\u81e8\u5e8a\u8868\u73fe\u4e3b\u8981\u5206\u70ba\u814e\u81df\u672c\u8eab\u4ee5\u53ca\u814e\u81df\u4ee5\u5916\u5169\u5927\u90e8\u5206\u3002
\u814e\u81df\u65b9\u9762\u7684\u75c7\u72c0\u5305\u62ec\u8179\u75db\u3001\u8170\u75db\u3001\u80cc\u75db\u3001\u8840\u5c3f\u3001\u86cb\u767d\u5c3f\u3001\u591c\u5c3f\u3001\u814e\u7d50\u77f3\u3001\u5c3f\u8def\u611f\u67d3\u3001\u56ca\u816b\u51fa\u8840\u3001\u56ca\u816b\u611f\u67d3\u3001\u6fc3\u7e2e\u5c3f\u6db2\u80fd\u529b\u4e0b\u964d\u3001\u9ad8\u8840\u58d3\u548c\u814e\u529f\u80fd\u8870\u9000\u7b49\u3002
\u814e\u81df\u4ee5\u5916\u7684\u75c7\u72c0\u773e\u591a\uff0c\u5217\u8209\u5982\u4e0b\uff1a
\uff081\uff09 \u809d\u81df\u56ca\u816b\uff1a\u6e90\u65bc\u64f4\u5f35\u7684\u81bd\u7ba1\uff0c\u5176\u6578\u76ee\u96a8\u5e74\u9f61\u589e\u52a0\uff0c\u809d\u529f\u80fd\u4e00\u822c\u6b63\u5e38\u4e0d\u53d7\u5f71\u97ff\uff0c\u6703\u5f15\u8d77\u809d\u81df\u816b\u5927\u4e26\u9020\u6210\u75bc\u75db\u8207\u8179\u8139\u3002
\uff082\uff09 \u80c3\u8178\u9053\u88ab\u56ca\u816b\u58d3\u8feb\u5f15\u8d77\u80c3\u98df\u9053\u9006\u6d41\u3001\u4fbf\u79d8\u548c\u98df\u617e\u4e0d\u632f\u7b49\u3002
\uff083\uff09 \u5927\u8178\u61a9\u5ba4
\uff084\uff09 \u8179\u58c1\u6216\u9f20\u8e4a\u90e8\u759d\u6c23
\uff085\uff09 \u4e0b\u8154\u975c\u8108\u53d7\u5230\u58d3\u8feb\u9020\u6210\u4e0b\u80a2\u6c34\u816b
\uff086\uff09 \u56e0\u8179\u8154\u5167\u56ca\u816b\u6975\u591a\u4f7f\u8179\u58d3\u4e0a\u5347\uff0c\u751a\u81f3\u4f7f\u6a6b\u9694\u819c\u4e0a\u79fb\u9020\u6210\u547c\u5438\u56f0\u96e3\u3002
\uff087\uff09 \u8166\u5167\u8840\u7ba1\u7624\uff1a\u7d0410%\u7684\u75c5\u4eba\u6703\u7522\u751f\u8166\u5167\u52d5\u8108\u7624\uff0c\u7576\u52d5\u8108\u7624\u76f4\u5f91\u9054\u4e00\u516c\u5206\u6642\uff0c\u7834\u88c2\u4e26\u6ea2\u8840\u7684\u5371\u96aa\u6027\u5927\u589e\u3002
\uff088\uff09 \u8166\u5167\u5fae\u5c0f\u51fa\u8840\uff08microbleeds\uff09
\uff089\uff09 \u5fc3\u81df\u74e3\u819c\u9589\u9396\u4e0d\u5168\u3001\u4e8c\u5c16\u74e3\u74e3\u819c\u812b\u5782\u3001\u80ba\u52d5\u8108\u9ad8\u58d3\u7b49
\uff0810\uff09 \u52d5\u8108\u7624\u3001\u4e3b\u52d5\u8108\u525d\u96e2\u7b49
\uff0811\uff09\u5176\u4ed6\u53ef\u80fd\u6703\u767c\u751f\u56ca\u816b\u7684\u5668\u5b98\u5305\u62ec\uff1a\u86db\u7db2\u819c\u3001\u80ba\u90e8\u3001\u80f0\u81df\u3001\u813e\u81df\u3001\u5375\u5de2\u3001\u776a\u4e38\u53ca\u651d\u8b77\u817a\u7b49\uff0c\u4f46\u9019\u4e9b\u56ca\u816b\u4e00\u822c\u4e0d\u6703\u9020\u6210\u56b4\u91cd\u7684\u554f\u984c\u3002<\/p>\n\n\n\n

\u591a\u56ca\u814e\u7684\u8a3a\u65b7<\/strong><\/h3>\n\n\n\n


\uff081\uff09 \u57fa\u56e0\u6aa2\u6e2c(\u9a57\u8840)
\uff082\uff09 \u5bb6\u65cf\u53f2\uff1a\u7d04\u670915%\u7684\u75c5\u4eba\u5176\u7236\u6bcd\u90fd\u6c92\u6709\u591a\u56ca\u814e\u75c5\u53f2\uff0c\u4e43\u500b\u4eba\u57fa\u56e0\u7a81\u8b8a\u9020\u6210\u3002<\/p>\n\n\n\n


\uff08\u4e09\uff09\u5f71\u50cf\u5b78\u7684\u6aa2\u67e5<\/h3>\n\n\n\n
  1. \u814e\u81df\u8d85\u97f3\u6ce2\u2015\u65b9\u4fbf\u3001\u4fbf\u5b9c\u3001\u6c92\u6709\u8f3b\u5c04\u3001\u4e0d\u5177\u4fb5\u8972\u6027\u3002<\/li>
  2. \u8179\u90e8\u53ca\u9aa8\u76c6\u8154\u96fb\u8166\u65b7\u5c64\u2014\u6602\u8cb4\u3001\u5177\u6709\u8f3b\u5c04\u3001\u9700\u986f\u5f71\u5291\u3002<\/li>
  3. \u8179\u90e8\u53ca\u9aa8\u76c6\u8154\u6838\u78c1\u5171\u632f\u2014\u6602\u8cb4\u3001\u6c92\u6709\u8f3b\u5c04\u3001\u4e0d\u9700\u986f\u5f71\u5291\u3002<\/li><\/ol>\n\n\n\n

    \u814e\u529f\u80fd\u5feb\u901f\u60e1\u5316\u7684\u5b9a\u7fa9<\/h3>\n\n\n\n


    \u814e\u529f\u80fd\u5feb\u901f\u60e1\u5316\u662f\u6307\uff1a\uff08\u4e00\uff09\u814e\u7d72\u7403\u904e\u6ffe\u7387\u4f30\u8a08\u503c\uff08eGFR\uff09\u5728\u4e94\u5e74\u5167\u6bcf\u5e74\u4e0b\u964d \u2265 2.5 mL\/min\/1.73m2\u6216eGFR\u5728\u4e00\u5e74\u5167\u4e0b\u964d \u2265 5 mL\/min\/1.73m2\u3002\uff08\u4e8c\uff09\u6885\u7d04\u5206\u985e\uff08Mayo Class\uff09\u70ba1C\u30011D\u62161E\u3002\uff08\u4e09\uff09\u814e\u81df\u7e3d\u5bb9\u7a4d\uff08Total kidney volume\uff09\u6bcf\u5e74\u589e\u52a0\u5927\u65bc5%\u3002<\/p>\n\n\n\n

    \u591a\u56ca\u814e\u7684\u6cbb\u7642<\/h3>\n\n\n\n


    \u82e5\u56ca\u816b\u9ad4\u7a4d\u592a\u5927\uff0c\u9020\u6210\u75bc\u75db\u6216\u58d3\u8feb\u6642\uff0c\u53ef\u8003\u616e\u63a5\u53d7\u5f15\u6d41\u6216\u624b\u8853\u6cbb\u7642\u3002\u5c0d\u5feb\u901f\u589e\u5927\u7684\u55ae\u4e00\u56ca\u816b\uff0c\u5f15\u6d41\u5f8c\u6ce8\u5c04\u9152\u7cbe\u81f3\u56ca\u816b\u5167\uff0c\u6216\u8a31\u53ef\u9632\u6b62\u5176\u7e7c\u7e8c\u589e\u5927\u3002
    \u76ee\u524d\u5df2\u6709\u53ef\u6291\u5236\u56ca\u816b\u8b8a\u5927\u3001\u6e1b\u7de9\u814e\u529f\u80fd\u8870\u9000\u7684\u85e5\u7269\uff08tolvaptan\uff09\u9762\u4e16\u3002\u5728\u4e94\u5341\u6b72\u4ee5\u4e0b\u7684\u6210\u4eba\uff0c\u82e5\u6709\u814e\u529f\u80fd\u5feb\u901f\u60e1\u5316\u7684\u60c5\u5f62\u3001\u6162\u6027\u814e\u81df\u75c5\u5c6c\u7b2c\u4e09\u671f\uff0c\u4e14\u809d\u529f\u80fd\u6b63\u5e38\uff0c\u53ef\u5728\u814e\u81df\u79d1\u91ab\u5e2b\u7684\u5354\u52a9\u4e0b\u7533\u8acb\u4ee5\u5065\u4fdd\u7d66\u4ed8\u65b9\u5f0f\u7528\u85e5\u3002\u9664tolvaptan\u5916\uff0c\u9084\u6709\u85e5\u5ee0\u6b63\u5728\u9032\u884c\u4e16\u754c\u6027\u7684\u65b0\u85e5\u81e8\u5e8a\u8a66\u9a57\uff0c\u5e0c\u671b\u70ba\u591a\u56ca\u814e\u75c5\u4eba\u7684\u6cbb\u7642\u5e36\u4f86\u66f4\u591a\u9078\u64c7\u3002
    \u82e5\u814e\u81df\u529f\u80fd\u5df2\u9032\u5165\u672b\u671f\u968e\u6bb5\uff0c\u53ef\u8003\u616e\u63a5\u53d7\u8840\u6db2\u900f\u6790\u6216\u8179\u819c\u900f\u6790\u6cbb\u7642\u3002\u82e5\u672c\u8eab\u62b5\u6297\u529b\u4e0d\u932f\uff0c\u4e5f\u53ef\u8003\u616e\u814e\u81df\u79fb\u690d\u3002\u65b0\u79fb\u690d\u7684\u814e\u81df\uff0c\u4e0d\u6703\u767c\u751f\u591a\u56ca\u814e\u75c5\u8b8a\u3002
    \u5728\u7121\u5c3f\u4e14\u814e\u81df\u5f88\u5927\u7684\u900f\u6790\u75c5\u4eba\uff0c\u82e5\u816b\u5927\u7684\u814e\u81df\u9020\u6210\u75bc\u75db\u3001\u547c\u5438\u56f0\u96e3\u3001\u6216\u56e0\u58d3\u8feb\u5230\u80c3\u8178\u9020\u6210\u98df\u617e\u4e0d\u632f\u6216\u56b4\u91cd\u4fbf\u79d8\u6642\uff0c\u53ef\u8003\u616e\u63a5\u53d7\u96d9\u5074\u814e\u52d5\u8108\u6813\u585e\u624b\u8853\u3002<\/p>\n\n\n\n

    Tolvaptan\u7684\u6548\u7528<\/h3>\n\n\n\n


    Tolvaptan\u53ef\u963b\u65b7\u8840\u7ba1\u589e\u58d3\u7d20(vasopressin)\u5c0d\u814e\u81df\u4e2dV2\u53d7\u9ad4\u7684\u4f5c\u7528\uff0c\u5f9e\u800c\u6291\u5236\u56ca\u816b\u8b8a\u5927\uff0c\u751a\u81f3\u4f7f\u56ca\u816b\u8b8a\u5c0f\uff0c\u6700\u91cd\u8981\u7684\u662f\uff0c\u6b64\u85e5\u53ef\u6e1b\u7de9\u814e\u529f\u80fd\u8870\u9000\u3002\u6839\u64da\u672c\u4eba\u7684\u7d93\u9a57\uff0c\u7d04\u767e\u5206\u4e4b\u4e03\u5341\u4e94\u7684\u7528\u85e5\u75c5\u4eba\u5176\u814e\u529f\u80fd\u6703\u4fdd\u6301\u7a69\u5b9a\u6216\u7a0d\u70ba\u6539\u5584\u3002<\/p>\n\n\n\n

    \u4f7f\u7528Tolvaptan\u6642\u8981\u6ce8\u610f\u7684\u4e8b\u9805<\/strong><\/h3>\n\n\n\n


    \uff081\uff09\u809d\u529f\u80fd\u6b63\u5e38
    \uff082\uff09\u8840\u6e05\u5c3f\u9178\u6fc3\u5ea6\u63a7\u5236\u826f\u597d\uff08\u5118\u91cf\u63a7\u5236\u57287 mg\/dL\u6216\u4ee5\u4e0b\uff09
    \uff083\uff09 \u8840\u7cd6\u63a7\u5236\u826f\u597d
    \uff084\uff09 \u6c92\u6709\u9752\u5149\u773c\u6216\u7d93\u773c\u79d1\u91ab\u5e2b\u8b49\u660e\u773c\u58d3\u63a7\u5236\u826f\u597d
    \uff085\uff09 \u8840\u9209\u6b63\u5e38
    \uff086\uff09 \u9858\u610f\u5728\u670d\u85e5\u671f\u9593\u63a5\u53d7\u5b9a\u671f\u8eab\u9ad4\u8a3a\u5bdf\u53ca\u6aa2\u9a57\u8ffd\u8e64
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