Baseline Urinary Angiotensinogen Excretion Predicts Deterioration ntawm lub raum ua hauj lwm nyob rau hauv cov neeg mob uas muaj mob raum kab mob

Abstract:

Lub hom phiajLub intrarenal renin-angiotensin system (RAS) yog qhib rau cov neeg mob uas muaj kab mob raum ntev (CKD), thiab cov qib urinary angiotensinogen (AGT), tus cim surrogate ntawm intrarenal RAS activation, yog txuam nrog ntshav siab (BP) thiab tso zis albumin. . Tsis tas li ntawd, nws tau pom tias cov kev hloov pauv hauv cov zis AGT cuam tshuam nrog cov kev hloov pauv txhua xyoo hauv kev kwv yees glomerular filtration rate (eGFR) hauv cov neeg mob ntshav qab zib hom 2 thiab qhov nce qib ntawm cov zis AGT hauv hom 2 mob ntshav qab zib cov neeg mob uas muaj albuminuria yog qhov siab. pheej hmoo ua rau mob raum thiab mob plawv. Txawm li cas los xij, txawm hais tias los yog tsis yog theem pib ntawm cov zis AGT kwv yees qhov kev puas tsuajlub raum ua haujlwmnyob rau hauv tag nrhocov neeg mob nrog CKDtsis meej.

Cov txheej txheemWe recruited 62 patients with CKD whose eGFR was >15 mL / min / 1.73 m2. Peb tau ua 24- teev ambulatory BP soj ntsuam ntawm 30- feeb ib ntus thiab khaws cov zis txhua hnub los tshuaj xyuas cov qib AGT urinary thiab albumin excretion thiab ntsuas cov qib ntawm plasma angiotensin II (Ang II), ib qho cim npe ntawm kev ncig. RAS. Tsis tas li ntawd, kev hloov pauv txhua xyoo hauv eGFR tau ua raws li 3.4 ± 1.5 xyoo.

Cov txiaj ntsig Kev hloov pauv txhua xyoo hauv eGFR tau cuam tshuam loj heev thiab cuam tshuam nrog cov zis AGT (r=-0.31, p=0.015) nrog rau hnub nyoog, systolic BP, thiab qib zis albumin. Hauv qhov sib piv, kev hloov pauv txhua xyoo hauv eGFR tsis cuam tshuam nrog plasma Ang II qib. Tsis tas li ntawd, thaum faib cov neeg mob mus rau hauv quartiles raws li qib urinary AGT, cov neeg mob uas muaj qib AGT siab tshaj plaws tau pom tias muaj kev poob qis hauv eGFR.

XausCov txiaj ntsig no qhia tau hais tias kev nce qib hauv cov zis AGT tuaj yeem kwv yees lub raum tsis ua haujlwm hauv cov neeg mob CKD.

Ntsiab lus:mob raum mobintrarenal renin-angiotensin system, lub raum prognosis,tso zis

Nyem qhov no kom tau txais Natural organic CISTANCHE EXTRACT nrog 25% ECHINACOSIDE thiab 9% ACTEOSIDE rau lub raum ua haujlwm

Taw qhia

Lub circulatingrenin-angiotensin system ua haujlwm(RAS) ua lub luag haujlwm tseem ceeb hauv kev tswj cov hlab ntshav siab thiab sodium homeostasis (1). Ib cov ntaub so ntswg tshwj xeeb RAS, ywj siab ntawm RAS circulating, tau muaj nyob hauv ntau lub cev. Cov kws tshawb fawb tau tshaj tawm tias qhov intrarenal RAS tau qhib rau hauv qee cov qauv tsiaj thiab cov neeg mobmob raum mob(CKD) los yog kub siab thiab qhov ua kom lub hauv siab RAS yog intimately koom nrog hauv pathophysiology ntawmlub raum puas (2-6).

Angiotensinogen (AGT) yog tib lub npe hu ua substrate rau renin, tus nqi txwv enzyme hauv RAS. AGT theem hauv fluence RAS ua kom, txij li lawv nyob ze rau Michaelis-Menten tas li rau renin (7, 8), thiab urinary AGT, tau tshaj tawm tias yog ib qho txiaj ntsig biomarker uas qhia txog kev ua haujlwm hauv lub cev RAS thiab CKD qhov hnyav (2, 5, 6, 9-13).

Tsis ntev los no, Lee et al. nrhiav 91 tus neeg mob uas muaj ntshav qab zib hom 2 uas tau ua raws li 52 lub hlis thiab pom tias kev hloov pauv ntawm cov zis AGT cuam tshuam nrog rau lub raum tsis ua haujlwm (14). Tsis tas li ntawd, Sawaguchi et al. qhia tias qib siab ntawm cov zis AGT hauv hom 2 mob ntshav qab zib mellitus nrog albuminuria yog qhov muaj feem yuav ua rau mob raum thiab mob plawv (15). Txawm li cas los xij, txawm hais tias los yog tsis yog cov theem pib ntawm cov zis AGT kwv yees kev ua haujlwm ntawm lub raum tsis zoo hauv txhua tus neeg mob CKD, txawm tias qhov ua rau CKD, tsis paub meej.

Yog li, hauv txoj kev tshawb fawb tam sim no, peb tau tshuaj xyuas cov kev sib raug zoo ntawm cov theem pib ntawm cov zis AGT thiab cov kev hloov pauv txhua xyoo hauv qhov kwv yees glomerular filtration rate (eGFR) hauv cov quartiles raws li theem pib ntawm cov zis AGT.

Cov ntaub ntawv thiab cov txheej txheem

Cov neeg mob

Txoj kev tshawb no tau pom zoo los ntawm Pawg Neeg Saib Xyuas Kev Ncaj Ncees ntawm Hamamatsu University Tsev Kawm Ntawv Tshuaj Kho Mob thiab ua raws li cov hauv paus ntsiab lus ntawm Kev Tshaj Tawm ntawm Helsinki. Peb tau txais 111 sib law liagcov neeg mob nrog CKD20-80 xyoo uas tau mus rau hauv peb lub tsev kho mob kom ze rau kev soj ntsuam los ntawm lub raum biopsy thiab nws lub hauv paus urinary AGT excretion tau raug ntsuas los ntsuas RAS kev ua haujlwm hauv lub raum thaum Lub Ib Hlis 2012 txog Lub Kaum Ob Hlis 2016. Peb tsis suav nrog 25 tus neeg mob CKD nws eGFR<15 mL/min/1.73 m2 (CKD stage 5) because those patients were introduced to dialysis or underwent a kidney transplant within less than 1 year and annual follow-up was not expected. In addition, we excluded 24 patients with CKD whose 1-year follow-up data were not obtained for reasons such as switching hospitals. We ultimately evaluated 62 patients with CKD in this study (Fig. 1). The patients were followed up annually in our outpatient department until December 2018. Written informed consent was obtained from all patients. 

Kawm cov txheej txheem

Thaum nkag mus, kev soj ntsuam ntshav siab (ABPM) siv lub tshuab tsis siv neeg (TM-2431; A thiab D, Tokyo, Nyiv) tau ua tiav rau 24 teev nrog 30-min ntu, thiab kuaj ntshav tau sau thaum 6:00 AM thaum kawg ntawm ABPM tom qab cov neeg mob uas muaj CKD tau so nyob rau hauv lub supine txoj hauj lwm tsawg kawg yog 15 feeb. Cov qauv zis kuj tau txais txhua hnub nyob rau hnub ua ABPM. Cov ntshav kuaj tau centrifuged ntawm 3, 000 rpm ntawm 4 degree rau 10 feeb, thaum cov zis kuaj tau centrifuged ntawm 1,500 rpm ntawm 4 degree rau 5 feeb. Ob qho piv txwv tau muab khaws cia rau ntawm -80 degree kom txog thaum kev soj ntsuam tau ua tiav. Cov kev sim no tau ua raws li tau piav qhia dhau los (2, 16-18). Tom qab ntawd, cov neeg mob tau soj ntsuam txhua xyoo ntawm peb lub chaw kho mob sab nraud.

Cov ntaub ntawv kho mob

Tus neeg mob cov ntaub ntawv kho mob, suav nrog lawv lub hnub nyoog, poj niam txiv neej, thiab lub cev qhov hnyav (BMI), raug kaw thaum lub sijhawm nkag. Thaum lub sijhawm 24-teev ABPM, BP tau ntsuas tsis muaj kev cuam tshuam txhua 30 feeb, raws li tau piav qhia saum toj no. Cov ntshav thiab cov zis creatinine concentrations tau ntsuas nyob rau hauv qhov chaw kuaj mob ntawm Hamamatsu University School of Medicine, University Hospital. Cov theem ntawm urinary AGT, uas paub tias yog tus cim surrogate ntawm intrarenal RAS kev ua (2, 5, 6, 9-13), raug ntsuas los ntawm kev ntsuas enzyme-txuas immunosorbent assay raws li tau piav ua ntej (19). Cov theem ntawm cov zis albumin thiab ntshav plasma angiotensin II (Ang II) tau txiav txim siab siv lub xov tooj cua immunoassay (SRL, Tokyo, Nyiv). Serum creatinine concentrations raug ntsuas nyob rau hauv cov ntshav kos ntawm 6:{10}} AM, thiab eGFR raug xam los ntawm cov ntshav creatinine concentrations hauv Japanese eGFR sib npaug (20). Kev sib piv ntawm cov zis AGT / creatinine (AGT / Cr) tau raug xam. Tus nqi txhua xyoo ntawm kev hloov pauv hauv eGFR (mL / min / 1.73 m2 / xyoo) tau txiav txim siab los ntawm txoj kab nqes los ntawm kev txheeb xyuas kab rov tav ntawm eGFR ntsuas rau txhua tus neeg txhua xyoo thaum rov qab los, raws li tau piav qhia yav dhau los (14, 15) .

Kev txheeb cais

Cov txiaj ntsig tau qhia raws li tus qauv sib txawv. Qhov kev xeem Shapiro-Wilk tau ua los tshuaj xyuas seb puas muaj qhov hloov pauv tau ib txwm faib. Vim hais tias cov theem ntawm cov zis txhua hnub albumin excretion thiab zis AGT / Cr tsis nquag faib, logarithmic transformation tau siv. Kev sib raug zoo ntawm kev hloov pauv txhua xyoo hauv eGFR thiab hnub nyoog, poj niam txiv neej, BMI, systolic thiab diastolic BPs, lub plawv dhia, thiab theem pib ntawm eGFR, txhua hnub tso zis albumin excretion, ntshav Ang II, thiab tso zis AGT / Cr ntawm kev nkag tau raug soj ntsuam. siv Pearson's product-moment correlation test. Ntau qhov kev ntsuam xyuas kab rov tav tau ua los ntsuas qhov kev sib raug zoo ntawm kev hloov pauv txhua xyoo hauv eGFR thiab cov theem pib ntawm cov zis AGT / Cr. Lub hnub nyoog, poj niam txiv neej, BMI, thiab cov hauv paus ntsiab lus eGFR tau raug xaiv los ua tus hloov pauv ywj pheej, vim tias cov kev txwv no feem ntau suav nrog hauv ntau qhov kev ntsuam xyuas kab rov tav.

Tom qab ntawd peb faib tag nrho cov neeg mob rau hauv quartiles raws li lub hauv paus urinary AGT / Cr excretion. Tom qab ntawd, kev sib piv ntawm plaub pawg no tau ua los ntawm kev tshuaj xyuas qhov sib txawv (ANOVA) nrog Tukey-Kramer HSD test lossis Games Howell test. Kev soj ntsuam Covariance tau ua los tshuaj xyuas kev sib koom ua ke ntawm cov quartiles ntawm lub hauv paus urinary AGT / Cr excretion thiab kev hloov pauv txhua xyoo hauv eGFR kho rau hnub nyoog, poj niam txiv neej, BMI, thiab lub hauv paus eGFR. Peb suav tias muaj nuj nqis ntawm p<0.05 to indicate statistical significance. Statistical analyses were performed using the IBMⓇSPSSⓇ software program, version 25 (IBM, Armonk, USA).

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