Kev Koom Tes Nruab Nrab Nruab Nrab Hnub Nyoog Sodium Excretion, Qhov Sib Txawv Ntawm Cov Dej Extracellular Dej-rau-tag Nrho Lub Cev Dej Qhov Sib Txawv, Thiab Cov Kev Pom Zoo Rau Raum Hauv Cov Neeg Mob Raum Kab Mob
Mar 25, 2022
Kaori Kohatsu1, Sayaka Shimizu2,3, Yugo Shibagaki1thiab Tsutomu Sakurada1,*
Abstract:Seb kev noj ntsev kom tsawg cuam tshuammob raum mob(CKD) kev nce qib tseem tsis meej. Peb tau ua ib qho kev tshawb fawb rov qab los txheeb xyuas qhov cuam tshuam ntawm ob qho tib si kev noj ntsev txhua hnub (DSI) thiab ntim cov xwm txheej ntawmlub raumCov txiaj ntsig tau tshwm sim hauv 197 tus neeg mob CKD. DSI tau kwv yees los ntawm 24-h urinary sodium excretion thiab ntim raws li txoj cai tau soj ntsuam los ntawm qhov piv ntawm cov dej extracellular (ECW) rau tag nrho lub cev dej (TBW) ntsuas los ntawm bioelectrical impedance tsom xam (BIA). Peb faib cov neeg mob ua ob pawg raws li DSI (6 g / hnub) lossis nruab nrab ECW/TBW (0.475) thiab pivlub raumcov txiaj ntsig ntawm txhua pawg. Tsis tas li ntawd, peb tau faib thiab txheeb xyuas plaub pawg raws li DSI thiab ECW/TBW. Cov pab pawg DSI siab dua tau pom 1.69-fold (95 feem pua kev ntseeg siab lub sijhawm (CI) 1.12–2.57, p=0.01) ntau dua qhov kev pheej hmoo ntawm qhov tshwm sim tshwm sim piv rau pawg qis. Ntawm plaub pawg, piv nrog Pawg 1 (tsawg DSI thiab qis ECW/TBW), Pawg 3 (siab DSI thiab qis ECW/TBW) tau pom 1.84-fold (95 feem pua CI 1.03–3.30, p { {18}}.04) Kev pheej hmoo ntau dhau ntawm qhov tshwm sim tshwm sim; Txawm li cas los xij, Pawg 2 (DSI qis thiab siab ECW/TBW) tsis pom qhov txawv txav. Kev noj ntsev ntau zoo li yuav cuam tshuam nrog cov neeg pluaglub raumCov txiaj ntsig tsis muaj ntshav siab (BP), proteinuria, thiab ntim raws li txoj cai.
Ntsiab lus: mob raum mob; noj ntsev txhua hnub;dej ntau dhau; lub raum tshwm sim
Hu rau:joanna.jia@wecistanche.com
echinacoside cov tshuajkom txo tau qhov mobraumkab mob
1. Taw qhia
Kev noj zaub mov ntau ntsev tau tshaj tawm tias muaj feem cuam tshuam nrog ntau yam kev noj qab haus huv, xws li mob plab [1], osteoporosis [2], thiabraumpob zeb [3]. Txawm li cas los xij, ntau qhov teeb meem tseem ceeb yog qhov tsis ntseeg qhov pib tshiab lossis ua rau mob ntshav siab thiab tshwm sim ntawm cov xwm txheej hauv plawv. Kev noj ntsev ntau yog qhov paub txog kev pheej hmoo rau tsis yog kab mob plawv nkaus xwb, tab sis kuj rau lub raum tsis ua haujlwm, thiab kev txwv ntsev ua lub luag haujlwm tseem ceeb hauv kev noj zaub mov raumob raum mob(CKD) cov neeg mob [4]. Qhov tseeb, kev txwv ntsev nruj tau cuam tshuam nrog kev txhim kho hauv kev kub siab thiab txo cov zis protein [5,6].
Ntau qhov kev tshawb fawb tau tshaj tawm tias kev noj ntsev ntau raws li suav los ntawm kev ntsuas 24-h tso zis sodium los yog kwv yees los ntawm cov zis tso zis tau cuam tshuam nrog kub siab, nce zis protein ntau, thiab tshwm sim ntawm kab mob plawv (CVD) [7–9] . Txawm li cas los xij, qhov cuam tshuam ntawm kev noj ntsev ntawm CKD kev loj hlob tseem tsis meej. Txawm hais tias qee qhov kev tshawb fawb tau qhia tias muaj kev sib raug zoo ntawm cov zis sodium excretion thiab CKD kev loj hlob [10,11], lwm tus tau pom tias tsis muaj kev koom tes zoo li no [12–14]. Tsis tas li ntawd, ob peb txoj kev tshawb fawb tau soj ntsuam qhov cuam tshuam ntev ntawm kev txwv ntsev ntawm lub raum.
Tsis tas li ntawd, kev noj zaub mov muaj ntsev ntau ua rau muaj sodium retention hauv cov neeg mob CKD, ua rau cov kua dej ntau dhau uas ua rau muaj ntshav siab. Tsis tas li ntawd, cov kua dej ntau dhau ntawm nws tus kheej tau raug qhia los sawv cev rau qhov muaj txiaj ntsig zoo rau kev mob plawv lossis kev tuag tag nrho, txawm tias tom qab kho cov ntshav siab (BP) tswj lossis proteinuria [15–17].
Cov kua dej ntau dhau kuj tau tshaj tawm tias cuam tshuam nrog cov neeg pluaglub raumcov txiaj ntsig [18–20]. Hauv cov kev tshawb fawb no, txawm li cas los xij, yuav ua li cas ntsev kom tsawg thiab cov dej ntau dhau cuam tshuam hauv lawv txoj kev koom tes nrog rau lub raum cov txiaj ntsig tsis tau ntsuas txaus.
Peb, yog li ntawd, txhawm rau txheeb xyuas qhov cuam tshuam ntawm kev noj ntsev txhua hnub (DSI) raws li kwv yees los ntawm 24-h tso zis sodium thiab ntim raws li kev ntsuas los ntawm qhov piv ntawm cov dej ntxiv ntawm tes (ECW) rau tag nrho cov dej hauv lub cev ( TBW) ntsuas siv bioelectrical impedance tsom xam (BIA) ntawmlub raumCov txiaj ntsig tau tshwm sim hauv cov neeg mob uas muaj theem 3-5 CKD (CKD staging yog raws li KDIGO 2012 kev soj ntsuam cov lus qhia rau kev soj ntsuam thiab kev tswj hwm ntawmmob raum mob).
2. Cov neeg mob thiab cov txheej txheem
2.1. Kawm Tsim thiab Teeb
Txoj kev tshawb fawb tam sim no tau siv ib qho chaw nruab nrab, rov qab tsim kev sib koom ua ke. Txoj kev tshawb fawb no tau pom zoo los ntawm Pawg Neeg Saib Xyuas Kev Ncaj Ncees ntawm St. Marianna University Tsev Kawm Ntawv Tshuaj Kho Mob (kev pom zoo no. 4942). Qhov xav tau kev tso cai pom zoo raug zam vim yog qhov rov qab los ntawm txoj kev tshawb fawb. Txoj kev tshawb no tau ua raws li cov hauv paus ntsiab lus ntawm Kev Tshaj Tawm ntawm Helsinki (raws li hloov kho hauv Fortaleza, Brazil, Lub Kaum Hli 2013). Tsis tas li ntawd, cov ntaub ntawv kawm tau tshaj tawm hauv internet, muab cov neeg mob siv sijhawm los siv lub vev xaib ntawm lub tuam tsev haujlwm los xaiv tawm ntawm txoj kev kawm yog tias lawv tsis xav kom lawv cov ntaub ntawv siv rau kev tshawb fawb.
2.2. Kawm Pej Xeem
Tag nrho ntawm 464 tus neeg mob nrog theem 3-5 CKD uas tau mus pw hauv tsev kho mob ntawm St. Marianna University Tsev Kawm Ntawv Kho Mob rau kev kawm txog CKD txij lub Ib Hlis 2011 txog Lub Plaub Hlis 2019 tau suav nrog. Cov neeg mob uas tsis muaj qhov hloov pauv uas xav tau rau kev tshuaj xyuas ntau yam, los ntawm leej twg txaus 24-h cov zis tsis tuaj yeem sau tau (tag nrho cov zis ntim<400 ml/day,="" as="" the="" definition="" of="" oliguria),="" or="" for="" whom="" egfr="" was="" not="" followed="" up="" after="" discharge="" were="" excluded.="" all="" of="" the="" required="" data="" were="" available="" from="" 204="" of="" the="" 464="" patients.="" among="" these="" 204="" patients,="" 3="" patients="" who="" met="" the="" definition="" of="" oliguria="" and="" 4="" patients="" whose="" egfr="" could="" not="" be="" followed="" after="" discharge="" were="" excluded.="" this="" resulted="" in="" a="" total="" of="" 194="" participants="" enrolled="" in="" this="">
2.3. Kev ntsuas
2.3.1. Cov yam ntxwv ntawm tus neeg mob
Peb tau txais cov ntaub ntawv rau cov neeg mob ntawm kev nkag los ntawm cov ntaub ntawv kho mob, suav nrog hnub nyoog, poj niam txiv neej, lub cev qhov hnyav (BMI), etiology ntawm CKD, comorbidities (diabetes mellitus (DM) lossis CVD xws li ischemic heart disease, cerebrovascular disease, lossis peripheral arterial disease. ), siv renin-angiotensin system (RAS) inhibitors lossis diuretics, thiab txhais tau tias systolic ntshav siab (SBP) raws li ntsuas los ntawm kev ntsuas ntshav siab (ABPM). Cov nqi rau 24-h ABPM tau txais los ntawm kev siv lub tshuab ABPM tsis siv neeg (TM-2431; A&D, Tokyo, Nyiv) thaum nruab hnub. Peb kuj tau txais kev kuaj pom, suav nrog albumin, hemoglobin, eGFR, zis protein, thiab DSI kwv yees los ntawm 24-h tso zis sodium. eGFR raug xam los ntawm cov ntshav creatinine qib, hnub nyoog, thiab poj niam txiv neej siv cov mis pom zoo los ntawm Nyiv Society of Nephrology [21]. Tag nrho cov 24-h cov zis tau sau los ntawm hnub nkag mus rau tag kis sawv ntxov.
2.3.2. Kev nthuav tawm
(a) Division raws li DSI
DSI tau kwv yees los ntawm 24-h urinary sodium excretion [22,23]. Peb siv cov qauv hauv qab no:
DSI (g/day)=24-h urinary sodium excretion (mEq/L) x cov zis txhua hnub (L)/17
Cov neeg mob tau muab faib ua ob pawg raws li DSI nrog kev txiav tawm ntawm 6 g / hnub raws li pom zoo hauv cov ntaub ntawv pov thawj-raws li kev soj ntsuam kev coj ua rau CKD [24].
(b) Division raws li ECW/TBW
Peb ntsuas TBW, ECW, thiab ECW/TBW los ntawm BIA. Tom qab ntawd cov neeg mob tau muab faib ua ob pawg raws li qhov nruab nrab ECW/TBW.
Txoj kev tshawb no siv BioScan 920-II multifrequency bioelectrical impedance analyzer (Maltron Bioscan, Rayleigh, UK). Lub yim tactile electrodes tau txuas mus rau dorsum ntawm lub dab teg thiab thib peb metacarpi ntawm ob txhais tes, thiab qhov chaw sab hauv ntawm pob taws thiab thib peb metacarpi ntawm ob txhais taw nrog tus neeg mob supine rau ntawm lub txaj, tsis muaj kev cuam tshuam. Bioscan analyzer tso cai rau kev ntsuas ntau zaus (5, 50, 100, thiab 200 kHz) nrog rau qhov tsawg-amplitude tam sim no (700 μA). Cov ntaub ntawv tau txais suav nrog cov kua dej hauv lub cev, sib cais rau hauv cov dej tsis muaj dej uas muaj cov protein, rog, thiab cov zaub mov, TBW, dej intracellular (ICW), thiab ECW. Cov kev ntsuas no tau ua los ntawm cov kws paub txog kev kuaj xyuas cov kws tshaj lij ua qhov muag tsis pom rau keeb kwm ntawm cov neeg mob cuv npe.
(c) Division raws li DSI thiab ECW/TBW
Ntxiv mus, peb tau faib plaub pawg raws li DSI thiab ECW/TBW: Pawg 1, qis DSI thiab qis ECW/TBW; Pawg 2, qis DSI thiab siab ECW/TBW; Pawg 3, siab DSI thiab qis ECW/TBW; thiab Pawg 4, siab DSI thiab siab ECW/TBW.
2.3.3. Cov txiaj ntsig
The primary outcome was defined as a >30 feem pua kev poob qis hauv eGFR los ntawm lub hauv paus (ntawm kev nkag) lossis tshwm sim ntawm cov kab mob hauv lub raum kawg (ESRD, coj los ua qhov pib ntawm kev kho lub raum (hemodialysis, peritoneal dialysis, lossis hloov raum)) lossis tuag. Lub sijhawm muaj sia nyob tau suav txij li kev tso npe nkag (hnub nkag) mus rau qhov tshwm sim ntawm qhov tshwm sim. Cov ntsiab lus poob rau kev rov qab los vim yog kev tshem tawm lossis hloov tsev kho mob raug censored thaum lub sijhawm mus ntsib zaum kawg, thiab cov neeg uas tsis tau qhia ib qho xwm txheej li ntawm 30 Lub Plaub Hlis 2020 tau censored nyob rau hnub ntawd.
2.3.4. Kev txheeb cais
Cov txiaj ntsig ntsuas tau qhia tias qhov nruab nrab (interquartile range (IQR)) lossis txhais tau tias (SD), raws li qhov tsim nyog. Categorical variables yog piav raws li zaus (n) thiab piv (%). Kev sib raug zoo ntawm DSI thiab ob qho tib si ECW / TBW thiab SBP tau txiav txim siab los ntawm Pearson's correlation coefficients. Qhov sib txawv ntawm plaub pawg tau muab faib raws li DSI thiab ECW / TBW tau muab piv los ntawm kev txheeb xyuas qhov sib txawv ntawm qhov sib txawv ntawm qhov sib txawv thiab siv cov Kruskal-Wallis test rau qhov sib txawv asymmetrically faib. Categorical variables uas xav tau frequencies hauv qab 10 tau soj ntsuam siv Fisher's test, thiab tag nrho lwm tus tau soj ntsuam los ntawm chi-squared tsom xam. Txoj kev ciaj sia nyob tau raug kos siv txoj kev Kaplan–Meier thiab qhov kev ntsuas ntsuas tau raug siv rau kev sib piv ntawm pab pawg. Qhov kev xav tias muaj kev phom sij tau raug lees paub los ntawm kev sim raws li Schoenfeld residuals. Kev sib piv ntawm cov txiaj ntsig ntawm cov pab pawg tau qhia hauv Tshooj 2.3.2. raug soj ntsuam siv qhov phom sij piv (HR) xam los ntawm Cox proportional hazards analysis. Ntau qhov sib txawv tau hloov kho rau hnub nyoog, poj niam txiv neej, eGFR, hemoglobin, albumin, log urinary protein (UP), SBP, muaj lossis tsis muaj DM, thiab CVD. Txhua qhov kev txheeb cais tau ua tiav siv Stata/MP version 16.1 software (StataCorp, College Station, TX, USA). Tus nqi ntawm p <0.05 tau="" suav="" tias="" yog="" qhov="" tseem="">
cistanchetshuaj tiv thaiv kab mob raum
3. Cov txiaj ntsig
3.1. Cov yam ntxwv tseem ceeb
Cov yam ntxwv ntawm pej xeem thiab kev kho mob ntawm tag nrho 194 tus neeg mob tau sau tseg hauv Table 1. Qhov nruab nrab hnub nyoog yog 70.5 (SD 12.1) xyoo, thiab 75.6 feem pua yog txiv neej. Feem coob ntawm cov neeg mob (94.4 feem pua) muaj ntshav siab, thiab 46.7 feem pua muaj DM. Feem ntau ua rau CKD yog mob ntshav qab zib nephropathy (31.5 feem pua), tom qab ntawd los ntawm nephrosclerosis (27.9 feem pua). RAS inhibitors tau siv hauv 67.5 feem pua ntawm cov neeg mob, thiab diuretics hauv 31.5 feem pua. DSI kwv yees los ntawm {{20}}h urinary sodium excretion yog 5.88 g (IQR 4.35–8.24 g), thiab txhais tau tias ECW/TBW yog 0.48 (SD 0.04). Qhov nruab nrab ECW/TBW ntawm 0.475 tau siv los faib cov neeg mob ua ob pawg. Cov kev faib tawm no tau piav qhia hauv histograms hauv daim duab 1
Raws li DSI kwv yees los ntawm 24-h urinary sodium excretion thiab ECW/TBW, 62 tus neeg mob tau categorized li Pab Pawg 1, 42 tus neeg mob ua pab pawg 2, 37 tus neeg mob ua pab pawg 3, thiab 56 tus neeg mob ua pab pawg 4. Cov neeg mob hauv Pawg 1 yog cov laus dua thiab feem ntau poj niam thiab pom tias muaj BMI thiab UP qis dua li peb pawg (Table 1).
Tsis tas li ntawd, etiologies ntawm CKD nyob rau hauv pab pawg 1 yog ntau zaus nephrosclerosis thiab mob glomerulonephritis thiab tsis tshua muaj ntshav qab zib nephropathy. Tsis tas li ntawd, cov neeg tsawg tsawg tau mob ntshav siab hauv pawg 1. Meanwhile, cov neeg mob hauv pab pawg 4 yog cov hluas thiab nquag txiv neej thiab muaj BMI ntau dua thiab zaus ntawm DM. Ntxiv mus, lawv tau pom qhov tseem ceeb tshaj UP thiab DSI dua li lwm pab pawg. Tsis hais txog ntawm DSI, cov neeg mob uas muaj ECW / TBW saum toj no qhov nruab nrab pom qhov tseem ceeb BMI siab dua, UP, feem ntau ntawm cov ntshav qab zib mellitus nephropathy, qis albumin, thiab nquag siv RAS inhibitors thiab diuretics piv rau cov neeg muaj ECW / TBW hauv qab nruab nrab.
3.2. Cov txiaj ntsig ntawm tus neeg mob
During follow-up (median, 1.4 years; IQR 0.7–2.4 years), 107 patients (54.3%) showed an outcome, namely, a >30 feem pua qis qis hauv eGFR hauv 49.7 feem pua, induction ntawm ESRD hauv 3.0 feem pua, thiab tuag hauv 1.5 feem pua. Qhov tshwm sim ntawm qhov tshwm sim ntawm kev kho mob yog 29.8 rau 100 tus neeg-xyoo (Table 2).
3.3. Kev sib raug zoo ntawm DSI thiab Txhua ntawm ECW/TBW thiab SBP
DSI tau pom muaj kev sib raug zoo heev nrog txhais tau tias SBP hauv ABPM (r {{0}}}.24, p < 0.01) thiab ECW/TBW (r=0.21, p < 0.01) (Daim duab 2).
3.4. Kev sib piv ntawm cov txiaj ntsig ntawm Ob Pawg Raws li ECW/TBW lossis DSI
Higher DSI (>6 g / hnub) tau cuam tshuam nrog cov txiaj ntsig zoo piv nrog qis DSI (s6 g / hnub) (HR 1.69, 95 feem pua CI 1.12–2.57; p=0.01). Hloov pauv, tsis muaj kev koom tes tseem ceeb nrog cov txiaj ntsig kho mob tau pom ntawm pawg ECW/TBW.
3.5. Kev sib piv ntawm kev soj ntsuam keeb kwm yav dhau thiab cov txiaj ntsig ntawm plaub pawg raws li Ob leeg ECW/TBW and DSI
Ciaj sia taus nkhaus rau plaub pawg muaj nyob rau hauv daim duab 3. Nrog rau kev soj ntsuam xyuas, p-value yog 0.22. Cox proportional hazards analysis los sib piv cov txiaj ntsig ntawm plaub pawg pom Pawg 3 (siab DSI thiab qis ECW/TBW) muaj 1.84-fold (95 feem pua CI 1.03–3.{12}}fold; p { {13}}.04) ntau qhov kev pheej hmoo ntawm qhov tshwm sim tshwm sim piv nrog Pawg 1 (tsawg DSI thiab qis ECW/TBW). Txawm li cas los xij, Pawg 2 thiab 4 tsis pom qhov sib txawv tseem ceeb piv nrog Pawg 1 (Daim duab 4).
4. Kev sib tham
The present study investigated the effects of both DSI and volume status on renal outcome in patients with stage 3–5 CKD. Among two groups divided by DSI, higher DSI (>6 g / hnub) tau cuam tshuam nrog lub raum tshwm sim piv rau qis dua DSI (s6 g / hnub) (HR 1.69, 95 feem pua CI 1.12–2.57; p=0.01). Ntawm qhov tod tes, tsis muaj kev koom tes tseem ceeb tau txheeb xyuas ntawm cov pab pawg uas tau faib los ntawm ECW/TBW. Tom qab ntawd peb tau faib plaub pawg raws li DSI thiab ECW/TBW. Ntawm cov pab pawg no, piv nrog Pawg 1 (tsawg DSI thiab qis ECW/TBW), Pawg 3 (siab DSI thiab qis ECW/TBW) tau pom 1.84-fold (95 feem pua CI 1.03–3.30; p {{ 20}}.04) tshaj qhov kev pheej hmoo ntawm qhov tshwm sim tshwm sim. Interestingly, Pawg 2 (tsawg DSI thiab siab ECW/TBW) tsis pom qhov txawv qhov txawv piv nrog rau Pawg 1.
Several studies have demonstrated positive correlations between a high-salt diet and CKD progression [10,25,26]. In contrast, some studies have suggested no such association [12–14]. However, those studies showed limitations with specific subgroups such as non-diabetic patients [12], type 1 DM [13], and advanced CKD patients [14], which could not sufficiently cover the general CKD population. In addition, some studies used spot urine samples to evaluate salt intake, which might have resulted in inaccurate estimations. He et al. [10] recently reported the association of 24-h urinary sodium excretion with CKD progression and all-cause mortality among 3757 patients with CKD in the Chronic Renal Insufficiency Cohort Study. In that study, the highest quartile of urinary sodium excretion (>194.6 mmol/24 h) qhia tau tias 1. . Txawm li cas los xij, lub koom haum ntawd tau ploj mus tom qab kho cov proteinuria, uas qhia tias cov proteinuria tuaj yeem sawv cev rau lub luag haujlwm tseem ceeb hauv qab CKD kev loj hlob cuam tshuam nrog kev noj ntsev ntau. Proteinuria paub tias yog ib qho kev pheej hmoo tseem ceeb rau lub raum tsis zoo, thiab cov kev tshawb fawb yav dhau los tau qhia tias kev noj ntsev ntau tuaj yeem txhim kho angiotensin-hloov enzyme kev ua haujlwm hauv lub raum cov ntaub so ntswg, uas tuaj yeem txo cov txiaj ntsig ntawm RAS blockers thiab ua rau nce UP thiab cov neeg pluag tom ntej. Cov txiaj ntsig ntawm lub cev [25] Ntawm qhov tod tes, Kang et al. [26] tshaj tawm 24-h urinary sodium excretion yog txuam nrog CKD kev vam meej ntawm BP lossis proteinuria, txhawb cov txiaj ntsig tam sim no. Cov txheej txheem los ntawm kev noj ntsev ntau ua rau lub raum puas yog maj mam nthuav tawm. Qhov cuam tshuam ncaj qha ntawm kev noj ntsev ntau rau lub raum puas tau raug tshawb xyuas hauv ntau yam kev tshawb fawb hauv paus. Cov kev tshawb fawb tshawb fawb tau pom tias kev noj ntsev ntau ua rau intrarenal zus tau tej cov angiotensin II [27], nkoos lub synthesis ntawm pro-inflammatory cytokines [28], thiab tsub kom oxidative kev nyuaj siab [29] thiab inflammation, uas yuav ua rau kom cov hlab ntsha thiab/los yog endothelial. kev ua haujlwm tsis zoo. Cov kev tshawb fawb tsis ntev los no kuj tau tshaj tawm tias Rac1, ib tus tswv cuab ntawm Rho tsev neeg GTPases tau qhib los ntawm kev noj ntsev ntau, ua kom cov mineralocorticoid receptors tsis muaj aldosterone, ua rau muaj ntsev-rhiab siab, proteinuria, thiab glomerulosclerosis [28,29].
Txoj kev tshawb fawb tam sim no tau qhia tias DSI siab raws li tau hais los ntawm kev tso zis ntau ntxiv tuaj yeem sawv cev rau qhov muaj kev pheej hmoo ntawm kev ywj pheej rau CKD kev vam meej ib sab ntawm SBP thiab proteinuria, zoo ib yam nrog cov txiaj ntsig ntawm kev tshawb fawb soj ntsuam yav dhau los [26–31].
Hauv cov ntawv tshaj tawm tsis ntev los no, cov kua dej ntau dhau tau qhia tias muaj feem cuam tshuam rau lub raum hauv cov neeg mob CKD tsis tau txais kev lim ntshav [18–20]. Cov kev tshawb fawb no tau siv ntau yam cim ntawm cov xwm txheej ntim, xws li ECW / TBW ntsuas los ntawm BIA thiab qib ntawm overhydration (OH) xam los ntawm qhov sib txawv ntawm qhov ntsuas ECW thiab ib txwm xav tau ECW kwv yees siv cov qauv physiological nyob rau hauv cov xwm txheej euvolemic [32]. Hung et al. kuj tau tshaj tawm tias cov kua dej ntau dhau raws li kev soj ntsuam los ntawm OH / ECW tau cuam tshuam nrog rau lub raum tshwm sim tsis muaj BP [19]. Cov txheej txheem los ntawm cov kua dej ntau dhau ua rau muaj kab mob raum tau tshwm sim suav nrog kev txo qis hauv lub raum cov ntshav vim yog nce lub raum siab [33], arterial txhav, endothelial activation, thiab o [19,34]. Hung et al. [19] qhia tias cov neeg mob lossis cov tsiaj uas muaj qhov ntim ntau dhau tau muaj qhov tseem ceeb ntawm cov cytokines proinflammatory cytokines xws li interleukin 6 thiab qog necrosis piv rau cov uas tsis muaj dej ntau dhau. Lwm cov kev tshawb fawb tau qhia tias lub plab phab ntsa edema hauv cov neeg mob uas muaj dej ntau dhau tuaj yeem ua rau cov kab mob endotoxin translocation [35].
Previous studies about associations between fluid overload and renal outcome do not appear to have sufficiently considered how salt intake influences the effects of excess volume on the renal outcome. In our study, no significant difference in renal outcome was seen among Groups 1 and 2. Such findings suggest that fluid overload is unrelated to renal outcome in the absence of high DSI. Although ECW/TBW could also be increased in lean, elderly patients with low ICW [36], patients in Groups 2 and 4 with ECW/TBW above the median were younger and showed relatively higher BMI compared with patients in Groups 1 and 3 with ECW/TBW at or below the median and were thus unlikely to be considered frail. Based on our results that the higher DSI group (>6 g/day) had a higher risk of outcomes than the lower-intake group (s6 g/day) despite no significant difference according to ECW/TBW, and that patients in Group 3 had the highest risk of all groups, DSI could be considered to be associated with renal outcome independent of volume status. Differences in outcomes among Groups 3 and 4 despite similar DSI >6 g / hnub sawv cev rau qhov teeb meem nthuav. Qhov tseeb, qhov sib txawv hauv DSI tau pom ntawm Pawg 3 thiab 4, nrog rau qhov nruab nrab ntawm 7.76 thiab 9.15 g / hnub, raws li. Txawm li cas los xij, DSI, raws li kwv yees los ntawm 24-h tso zis sodium, tej zaum yuav overestimated, nyob rau hauv lub hauv paus ntawm kev siv ntau diuretic nyob rau hauv pab pawg neeg 4 ntau dua li nyob rau hauv pab pawg neeg 3. Nyob rau hauv luv luv, cov neeg mob nyob rau hauv pab pawg neeg 4 tej zaum yuav tsis muaj kev txom nyem. Lub raum tshwm sim vim DSI tej zaum yuav tsawg dua li qhov kwv yees. Txhawm rau txiav txim siab qhov txiaj ntsig ntawm kev siv diuretics, peb tau soj ntsuam pab pawg hauv cov neeg mob uas tsis muaj diuretics. Txawm hais tias muaj kev txwv rau kev txhais cov txiaj ntsig hauv qhov kev ntsuas me me ntawm 135 tus neeg mob, qhov nruab nrab DSI ntawm Pawg 4 tau qis dua (9.2 txog 8.2 g / hnub), thiab qhov kwv yees ntawm HR tau siab dua (1.14 rau 1.26). Nws tau pom tias cov neeg mob uas tsis ncaj ncees lawm siab DSI nrog kev siv tshuaj diuretics yuav txo qis HR hauv pab pawg 4. Tsis tas li ntawd, kev noj zaub mov tsis zoo lossis tsis muaj ntsev tsawg tuaj yeem ua rau cov txiaj ntsig ntawm kev koom tes tseem ceeb nrog rau lub raum tshwm sim hauv Pawg 3, txawm tias peb tuaj yeem ua tau. tsis tshawb nrhiav lawv hauv txoj kev tshawb fawb tam sim no. Tsis tas li ntawd, cov kev tshawb fawb tsis ntev los no qhia tau hais tias sodium tshuav nyiaj li cas yog tswj hwm los ntawm lwm yam ntxiv rau lub raum, thiab daim tawv nqaij tuaj yeem ua haujlwm raws li lub pas dej ntawm sodium, ywj siab ntawm lub raum tswj [37]. Yog li ntawd, txawm tias muaj ntsev ntau, qee cov neeg tuaj yeem khaws cov sodium hauv daim tawv nqaij yam tsis muaj qhov ntim ntau ntxiv. Cov neeg mob hauv pab pawg 3 tuaj yeem suav nrog cov neeg no. Hauv ntau qhov kev tshawb fawb siv 23Na-magnetic resonance imaging, sodium cia nyob rau hauv daim tawv nqaij tau kuaj pom, thiab cov ntsiab lus ntawm cov sodium ntawm daim tawv nqaij muaj kev cuam tshuam nrog sab laug ventricular huab hwm coj ywj siab ntawm BP los yog ntim raws li txoj cai, txawm tias cov ncauj lus kom ntxaws mechanisms tseem tsis meej [38]. Txawm hais tias kev sib raug zoo ntawm sodium cia hauv daim tawv nqaij thiab lub raum qhov tshwm sim tseem tsis tau paub ntau, peb cov txiaj ntsig ntawm kev koom tes tseem ceeb nrog rau lub raum tshwm sim hauv Pab Pawg 3 yuav cuam tshuam nrog khaws sodium hauv daim tawv nqaij. Txawm li cas los xij, qhov no tseem yog kev kwv yees rau tam sim no. Ntxiv cov txiaj ntsig ntxiv yog xav tau los qhia meej txog kev sib koom ua ke ntawm sodium cia hauv daim tawv nqaij thiab cov txiaj ntsig rau lub raum.
5. Cov kev txwv
Qee qhov kev txwv ntawm qhov kev tshawb fawb no yuav tsum tau xav txog. Cov kev txwv loj tshaj plaws yog kev soj ntsuam ntawm DSI los ntawm ib zaug 24-h cov zis sau thiab lub sijhawm luv luv. Qee cov ntawv ceeb toom tau pom tias ib zaug 24-h tso zis tsis txaus los kwv yees tus kheej-qib mus ntev DSI [39]. Nrog rau kev sib koom ua ke ntawm qhov raug raws li ntau yam 24-h cov zis sau, peb tuaj yeem faib cov neeg mob kom raug ntau dua nrog kev sib cais tsis zoo dua li siv ib qho kev sau. Ntxiv mus, DSI kev kwv yees los ntawm ib zaug 24-h tso zis thaum nkag tsis tuaj yeem cuam tshuam qhov kev kwv yees thaum lub sijhawm soj ntsuam txawm tias nws raug ntsuas raug. DSI yuav hloov tau, tshwj xeeb tshaj yog nyob rau hauv cov kev kawm hauv tsev kho mob. Txawm li cas los xij, nws tau xav tias tseem ceeb tias qhov sib txawv tseem ceeb tseem nyob txawm tias txhua tus neeg koom tau txais kev kawm noj zaub mov hauv peb txoj kev tshawb fawb. Cov kev tshawb fawb ntxiv los tshawb xyuas ntau cov zis tso zis thiab xav tau lub sijhawm rov qab mus ntev dua. Tsis tas li ntawd, urinary sodium excretion tej zaum yuav cuam tshuam los ntawm lwm yam ua rau xws li kev siv diuretic thiab txo eGFR. Ib txoj kev tshawb nrhiav qhov chaw dav hlau simulation kuj tau tshaj tawm tias nyob rau hauv cov kev noj qab haus huv raws li kev tswj hwm sodium kom tsawg, tso zis sodium hloov pauv ib ntus [40]. Kev tshawb xyuas kev sib koom ua ke ntawm kev noj ntsev "yog" thiab cov txiaj ntsig rau lub raum tau suav tias yog qhov nyuaj tshwj tsis yog ua raws li kev tshawb fawb txog kev cuam tshuam. Cov cuab yeej tshiab los ntsuas kev noj ntsev yog xav tau.
Tsis tas li ntawd, qhov kev tshawb fawb tam sim no rov qab tshuaj xyuas ib pawg me me los ntawm ib lub koom haum. Tsis tas li ntawd, nws kuj tau xav tias yog ib qho kev txwv uas cov pej xeem no yuav muaj kev paub txog kev noj qab haus huv zoo, vim lawv yeem nrhiav kev kawm rau CKD. Qhov tseeb, qhov nruab nrab DSI yog 5.88 g / hnub, raws li qhov pom zoo ntawm 6 g / hnub. Txawm li cas los xij, qhov tseem ceeb, qhov sib txawv ntawm lub raum tshwm sim raws li DSI tseem tseem nyob hauv cov neeg muaj peev xwm paub txog kev noj qab haus huv no. Hais txog qhov tsis muaj kev koom tes ntawm ECW / TBW thiab lub raum qhov tshwm sim, cov kua dej ntau dua hauv txoj kev tshawb no yuav tsis txaus los cuam tshuam rau lub raum tshwm sim vim tias cov neeg mob no tsis tau txais cov xwm txheej tseem ceeb. Kev tshawb nrhiav ntxiv nyob rau hauv cov neeg mob uas muaj ntau qhov ntau ntawm cov xwm txheej ntim yog xav tau.
Thaum kawg, seb ECW/TBW puas muaj cov cim tsim nyog ntawm cov xwm txheej ntim tseem tsis sib haum xeeb. Tus nqi no tuaj yeem cuam tshuam los ntawm hnub nyoog thiab cov leeg nqaij. Txawm li cas los xij, tsis muaj ib qho parameter tuaj yeem ntsuas qhov ntim qhov xwm txheej. Peb siv ECW / TBW ua ib qho tsis muaj kev cuam tshuam, rov tsim dua, thiab yooj yim cim ntawm ntim raws li txoj cai. Kev tshawb nrhiav ntxiv yog xav tau los txheeb xyuas qhov tseeb dua, cov cuab yeej yooj yim dua rau kev ntsuas qhov ntim.
Txawm hais tias cov kev txwv no, nws zoo li muaj txiaj ntsig zoo uas cov txiaj ntsig tau qhia tias cov neeg mob uas muaj ntsev kom tsim nyog tau cuam tshuam nrog cov txiaj ntsig zoo rau lub raum txawm tias muaj qhov ntim siab, siv 24-h cov ntaub ntawv tso zis los ntawm 197 tus neeg mob. Cov kev tshawb fawb ntxiv nrog ntau qhov kev sau tso zis thiab lub sijhawm txuas ntxiv nyob rau hauv cov neeg coob dua yuav xav tau yav tom ntej.
cistanche yog qhov zoo rau choric raum kab mob, nyem qhov no kom paub ntau ntxiv
6. Cov lus xaus
Kev noj ntsev ntau tuaj yeem cuam tshuam nrog kev ua rau lub raum tsis zoo ntawm BP, proteinuria, thiab ntim xwm txheej.
Tus sau kev koom tes:Conceptualization, KK, TS, SS, thiab YS; methodology, KK, SS, thiab TS; software, SS; validation, SS thiab KK; kev soj ntsuam, SS thiab KK; kev tshawb nrhiav, KK; cov ntaub ntawv curation, KK thiab SS; sau ntawv—kev npaj ua ntej, KK; kev sau ntawv - tshuaj xyuas thiab kho, SS, TS, thiab YS; kev pom, KK, thiab SS; saib xyuas, TS; kev tswj xyuas qhov project, TS, thiab YS Txhua tus kws sau ntawv tau nyeem thiab pom zoo rau cov ntawv luam tawm ntawm cov ntawv sau.
Nyiaj txiag:Qhov kev tshawb fawb no tsis tau txais nyiaj txiag sab nraud.
Institutional Review Board Statement: Txoj kev tshawb no tau ua raws li cov lus qhia ntawm Kev Tshaj Tawm ntawm Helsinki, thiab tau pom zoo los ntawm Pawg Neeg Saib Xyuas Kev Ncaj Ncees ntawm St. Marianna University Tsev Kawm Ntawv Tshuaj (kev pom zoo no. 4942).
Cov Lus Qhia Txog Kev Pom Zoo: Cov neeg mob pom zoo raug zam vim yog qhov rov qab los ntawm txoj kev tshawb no.
Cov ntaub ntawv muaj nyob:Cov ntaub ntawv nthuav tawm hauv qhov kev tshawb fawb no muaj nyob rau ntawm kev thov los ntawm tus kws sau ntawv.
Kev lees paub:Peb zoo siab lees paub qhov kev pab ntawm Yoshiko Ono, Mie Tagaya, thiab Mami Oohori hauv kev sau cov ntaub ntawv rau txoj kev tshawb no. Qhov kev tshawb fawb no tau txais kev txhawb nqa los ntawm AMED nyob rau hauv Grant Numbers JP20ek0310010h0003.
Kev tsis sib haum xeeb ntawm kev txaus siab:Cov kws sau ntawv tshaj tawm tsis muaj kev cuam tshuam ntawm kev txaus siab.
kuaj rau flavonoids
Cov ntaub ntawv
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