Part 1: Yam ntxwv Thiab Kev Ntsuas Ntawm Stroke nyob rau hauv Cov Neeg Pab Cuam Raum Hloov Cov Neeg Tau Txais

Hu rau: emily.li@wecistanche.com

Takafumi Mizuno, Takao Hoshino, Kentaro Ishizuka, Sono Toi, Ayako Nishimura, Shuntaro Takahashi. Sho Wako thiab Kazuo Kitagawa

Department of Neurology, Tokyo Women's Medical University Tsev Kho Mob

Hom phiaj: Peb tsom los txiav txim cov yam ntxwv thiab vascular tshwm sim ntawm mob stroke hauvlub raumhloov pauv(RT) cov neeg tau txais kev pab thiab muab piv rau cov neeg mob ntawm hemodialysis (HD) thiab cov uas tsis muaj lub raum hloov kho (RRT).

Cov txheej txheem: Hauv qhov kev soj ntsuam yav tom ntej no, 717 tus neeg mob (txhais tau tias muaj hnub nyoog.70.8 xyoo; txiv neej, 60.5 feem pua) nrog mob stroke ischemic nyob rau hauv ib lub lis piam ntawm qhov pib tau txais kev tso npe sib law liag thiab ua raws li ib xyoos. Cov neeg mob tau muab faib ua peb pawg: (1) cov neeg nyob hauv RT cov neeg tau txais (n=27); (2) cov neeg mob ntawm kev saib xyuas HD ua ntej qhov ntsuas stroke (n=39); thiab (3) cov uas tsis muaj keeb kwm ntawm RRT(n{10}}). Thawj qhov tshwm sim yog qhov sib xyaw ntawm cov xwm txheej tsis zoo hauv plawv (MACE).

Cov txiaj ntsig: Ntshav qab zib nephropathy yog qhov laj thawj tshaj plaws rau RRT hauv ob tus neeg mob RT thiab HD. Cov neeg mob RT feem ntau yuav muaj mob stroke ntawm qhov tsis paub tseeb (33.3 feem pua) dua li lwm tus, thaum HD cov neeg mob feem ntau muaj cardioembolism (51.3 feem pua). Tsis muaj qhov sib txawv ntawm MACE qhov kev pheej hmoo ntawm cov neeg mob hauv RIand non-RRTgroups (ib xyoos twg, 11.3 feem pua ys, 13.1 feem pua ; log-rank P{{10}}}.82: kev phom sij piv [95 feem pua kev ntseeg siab interval],0.92 [0.29-2.98]). Hauv qhov sib piv, HD cov neeg mob muaj kev pheej hmoo ntawm MACE ntau dua li cov uas tsis muaj RRT (ib xyoos twg, 28.2 feem pua vs.13.1 feem pua ; log-rank P=0.019; qhov phom sij piv [95 feem pua ntawm kev ntseeg siab], 2.24[ 1. 16-4.3]). Cov lus xaus: Cov hauv paus ntsiab lus ntawm kev mob stroke sib txawv hauv cov neeg mob RT thiab HD. Qhov kev pheej hmoo ib xyoos ntawm MACE rau cov neeg mob stroke uas tau txais RT yog qis dua li cov neeg mob uas tau txais HD thiab piv nrog cov neeg mob uas tsis muaj RRT.

Ntsiab lus:Embolic stroke ntawm qhov chaw tsis paub meej,End-stage mob raum,Hemodialysis,

Cistanche tuaj yeem pab kho mob raum

Taw qhia

Lub raumKev hloov kho (RRT), suav nroglub raumKev hloov pauv (RT), thiab hemodialysis (HD), zoo kawg li ua rau lub neej expectancy ntawm cov neeg mob thaum kawg.raumkab mob. 2). Txawm li cas los xij, cov neeg mob RRT muaj kev pheej hmoo loj heev ntawm cerebral- thiab mob plawv, uas yuav tsum yog qhov tseem ceeb rau kev tswj hwm lub neej tom qab RRT Raws li cov ntaub ntawv los ntawm Tebchaws Meskas.Lub raumData Systems3), qhov tshwm sim ntawm kev mob stroke thiab kab mob plawv yog 26 feem pua , thiab 9 feem pua ntawm cov neeg mob uas ua haujlwm RT. Rau cov neeg mob uas tau txais HD, qhov ntau dua yog siab dua; 44 feem pua thiab 17 feem pua tau ntsib cov xwm txheej mob stroke thiab coronary, feem. Tsis tas li ntawd, qhov ua rau tuag taus yog vascular xwm txheej rau RT thiab HD cov neeg mob 3. Yog li, yuav tsum tau tsim txoj hauv kev zoo dua los tiv thaiv thiab kho cov kab mob vascular hauv cov neeg mob uas tau txais RRT

Txog rau tam sim no, mob stroke hauv HD cov neeg mob tau kawm zoo nyob rau hauv cov nqe lus ntawm kev kho mob thiab kev kwv yees 4-8 Ntawm qhov tod tes, cov ntaub ntawv tsawg muaj nyob rau hauv cov neeg tau txais RT. Muab qhov tsis ntev los no nce ntawm cov neeg mob nroglub raumtsis tau txais RT3, kev nkag siab zoo dua ntawm kev mob stroke tom qab RT yog qhov tseem ceeb tshaj plaws. Kev nyob pub dawb RT muaj ntau dua li cadaveric RT hauv Nyij Pooj, thiab nws suav txog kwv yees li 85.9 feem pua ntawm tag nrho cov mob RT, thaum cadaveric RT muaj ntau dua nyob rau hauv feem ntau ntawm lub teb chaws). Hauv txoj kev tshawb fawb tam sim no, peb tsom mus rau tus cwj pwm mob stroke nyob rau hauv cov neeg pub dawb RT cov neeg tau txais kev pab raws li cov ntaub ntawv kho mob, chaw kuaj mob, thiab cov duab kos duab thiab txiav txim siab lawv qhov kev mob tshwm sim ib xyoos piv nrog cov neeg tau txais HD thiab cov uas tsis muaj keeb kwm ntawm RRT.

Cov txheej txheem

Kawm Tsim thiab Cov Neeg Mob

Tokyo Women's Medical University (TWMU) Stroke Registry yog ib lub chaw saib xyuas kev soj ntsuam ib leeg, uas cov neeg mob uas muaj mob stroke lossis ischemic nres tau mus pw hauv tsev kho mob ntawm peb lub chaw hauv ib lub lis piam ntawm qhov pib tau cuv npe sib law liag. Txoj kev tshawb no tau ua raws li kev coj ncaj ncees ntawm 1975 Kev Tshaj Tawm ntawm Helsinki, nrog rau Cov Txheej Txheem Kev Ncaj Ncees rau Kev Tshawb Fawb Txog Kab Mob los ntawm tsoomfwv Nyij Pooj thiab Kev Txhim Kho Kev Tshaj Tawm Txog Kev Tshawb Fawb Kev Tshawb Fawb Hauv Kab Mob Kab Mob (STROBE) cov lus qhia. Cov txheej txheem kev tshawb fawb tau pom zoo los ntawm Pawg Neeg Saib Xyuas Kev Ncaj Ncees ntawm Tokyo Women's Medical University Tsev Kho Mob (kev pom zoo tsis muaj.2955-R2). Sau ntawv tso cai tau txais los ntawm txhua tus neeg mob.

cistanche for kidney disease

Thaum Lub Kaum Ob Hlis 2013 txog Lub Cuaj Hli 2019, 806 tus neeg mob tau tso npe rau hauv txoj kev tshawb no. Tom qab tsis suav nrog 7 tus neeg mob uas tau ntsib cov txheej txheem cais tawm (xws li, mob stroke mimics raws li kev kuaj mob zaum kawg lossis ntau tshaj li ib lub lis piam tom qab mob stroke) thiab 82 cov neeg mob uas muaj kev mob ischemic nres, cov ntaub ntawv ntawm 717 cov neeg mob uas mob stroke ischemic tau suav nrog rau qhov kev tshuaj ntsuam tam sim no. (Ntxiv Fig.1).

Tag nrho cov mob stroke raug kuaj los ntawm pawg thawj coj saib xyuas mob stroke neurologists raws li kev tshawb pom neurological thiab radiological. Thaum nkag mus, cov tsos mob ntawm lub paj hlwb raug soj ntsuam los ntawm National Institutes of Health Stroke Scale (NIHSS) cov qhab nia. Cov neeg mob cov ntaub ntawv khaws tseg suav nrog cov ntaub ntawv pej xeem, cov tsos mob tshwm sim thaum lub sijhawm tsim nyog, keeb kwm kev kho mob, tshuaj, kev tshawb nrhiav (nrog rau kev kuaj ntshav, lub hlwb, thiab kev kuaj ntshav hauv hlwb,24- teev Holter electrocardiogram, thiab ultrasonic echocardiography), kev tswj hwm (kev kho mob kev kho mob, cov txheej txheem revascularization, thiab kev phais), thiab qhov tshwm sim ntawm cov xwm txheej kho mob tom qab qhov kev tshwm sim tsim nyog siv daim ntawv qhia txog cov teeb meem.Lub raumKab mob

Peb tau txheeb xyuas cov neeg mob uas muaj keeb kwm ntawm kev muaj sia nyob pub dawb RTor tau kho HD ua ntej qhov ntsuas ntsuas (RT thiab HD pawg, raws li). Cov ntaub ntawv tseem ceebraumCov kab mob uas tsim nyog RRT tau txais los ntawm cov ntaub ntawv kho mob yav dhau los. Tsis muaj ib tus neeg mob hauv peb pawg neeg tau txais cadaveric RT. Qhov kwv yees glomerular filtration tus nqi tau suav nrog Kev Hloov Kho Kev Noj Qab Haus Huv hauvLub raumKab mobformula nrog Japanese coefficient; mob ntevraumkab mob (CKD) tau txhais tias yog kwv yees glomerular pom tus nqi ntawm<60 ml/min/1.73="">

Kev ntsuam xyuas ntawm Atherosclerotic Disease

The intracranial arteries were examined using time-of-flight magnetic resonance angiography (n=686) and/or computed tomography angiography (n=146). The narrowest diameter of each stenosed vessel was measured and divided by the diameter of the normal vessel proximal to the lesion or distal to the lesion if the proximal artery was diseased. Significant intracranial artery stenosis was defined as >50 feem pua stenosis lossis occlusion.

Extracranial carotid atherosclerosis was evaluated using ultrasonography (n=675) and/or computed tomography angiography (n=81)and/or time-of-flight magnetic resonance angiography(n=66). We defined significant extracranial artery stenosis as the presence of atherosclerotic stenosis of >50 feem pua los yog lub sijhawm raws li European Carotid Surgery Trial 9.

Aortic atherosclerosis tau soj ntsuam siv transesophageal echocardiography (n=226). Cov plaques txawb tau raug kuaj pom tias yog cov khoom siv mobile uas swung ntawm lawv cov peduncles. Cov plaque ulcerative tau kuaj pom tias yog qhov sib txawv ntawm qhov luminal ntawm cov quav hniav nrog lub hauv paus dav, nrog rau qhov siab tshaj plaws, tsawg kawg yog 2 hli. Complex aortic atheroma tau txhais tias yog cov quav hniav nrog lub thickness ntawm ntau dua los yog sib npaug li 4 hli los yog ulceration los yog mobile Cheebtsam 10.

Ischemic Stroke Subtly

Lub etiologies ntawm ischemic stroke tau muab faib ua atherothrombosis, cardioembolism, kab mob me me, lwm yam kev txiav txim siab ua rau, thiab tsis muaj kev txiav txim siab, raws li Kev Txiav Txim ntawm Org 10172 hauv Kev Kho Mob Stroke (TOAST) kev faib tawm). Strokes ntawm undetermined ua rau tau muab faib mus rau hauv ib tug embolic stroke ntawm undetermined qhov chaw (ESUS), stroke nrog coexisting etiologies, thiab tsis tiav.

kev tshawb nrhiav. ESUS tau kuaj pom raws li cov txheej txheem tau hais los ntawm cryptogenic mob stroke / ESUS thoob ntiaj teb ua haujlwm pab pawg (piv txwv li, mob stroke kuaj pom los ntawm kev suav tomography lossis magnetic resonance imaging uas tsis yog lacunar; tsis muaj extracranial lossis intracranial atherosclerosis ua rau 50 feem pua ntawm luminal stenosis hauv cov hlab ntsha muab cov cheeb tsam. ntawm ischemia; tsis muaj kev pheej hmoo loj ntawm cardioembolic qhov chaw ntawm embolism lossis tsis muaj lwm yam ua rau mob stroke pom) 12).

Ua raws li thiab Cov Tau Txais

Cov neeg mob tuaj xyuas peb lub chaw tom qab 3 lub hlis thiab tom qab ntawd txhua 1 xyoos rau 3 xyoos tom qab tso npe kawm. Txoj kev tshawb no qhia txog qhov tshwm sim ib xyoos. Thaum rov qab mus ntsib, kev tshawb pom los ntawm kev kuaj lub cev, kev kho mob, txhua qhov tshwm sim ntawm cov xwm txheej kho mob, thiab cov qhab nia hloov kho Rankin Scale (MRS) raug kaw. Yog tias tus neeg mob tsis tuaj yeem hu mus rau kev soj ntsuam, ib tus txheeb ze lossis tus neeg saib xyuas raug xam phaj hauv xov tooj. Cov txiaj ntsig tseem ceeb yog qhov sib xyaw ntawm cov xwm txheej tsis zoo ntawm cov hlab plawv (MACE), suav nrog mob stroke tsis txaus ntshai (ischemic lossis hemorrhagic), nonfatal acute coronary syndrome, kab mob loj peripheral artery, thiab vascular tuag. Kev tuag ntawm cov hlab ntsha tau txhais tau tias yog mob plawv mob plawv, mob hlab ntsha tawg, thiab lwm yam mob plawv. Cov txiaj ntsig thib ob suav nrog kev mob stroke subtype thiab txhua qhov ua rau tuag. Cov txiaj ntsig cuam tshuam txog kev ua haujlwm tau raug soj ntsuam los ntawm Mrs tus qhab nia ntawm ib xyoos. Qhov txiaj ntsig ua haujlwm tsis zoo tau txhais tias yog mRS tus qhab nia ntawm 23.

cistanche-kidney disease

Cistanche tuaj yeem pab kho mob raum

Kev txheeb cais

Quantitative variables tau qhia tias txhais tau tias (tus qauv sib txawv) rau ib txwm faib cov ntaub ntawv los yog nruab nrab (interquartile range). Cov kev hloov pauv tau zoo tau nthuav tawm ua ntau zaus (feem pua). Cov neeg mob tau muab faib ua pawg RT, HD, thiab tsis yog RRT. Peb ntxiv faib cov neeg mob uas tsis yog RRT rau cov uas muaj thiab tsis muaj CKD. Cov kev sib piv ntawm cov pab pawg tau ua tiav siv t-test, Mann-Whitney U test, ib-txoj kev tsom xam ntawm qhov sib txawv, los yog Kruskal-Wallis test rau ntau qhov sib txawv thiab x2 xeem rau qhov zoo sib xws, raws li qhov tsim nyog. Cov xwm txheej tau kwv yees siv txoj hauv kev Kaplan-Meier, thiab qhov sib txawv ntawm pab pawg tau raug soj ntsuam los ntawm kev ntsuas ntsuas qib. Cox proportional hazard regression model tau siv los xam cov hnub nyoog- thiab kev sib deev-hloov kev phom sij thiab 95 feem pua ntawm kev ntseeg siab rau cov neeg mob RT thiab HD, piv nrog cov tsis muaj RRT. Cov ntaub ntawv rau cov neeg mob uas tsis muaj ntaub ntawv nyob rau hauv ib lub xyoo tau censored nyob rau lub sij hawm ntawm lub xeem muaj kev soj ntsuam. Rau qhov tshwm sim, cov neeg mob uas tuag ntawm qhov ua rau lwm yam tsis yog qhov tshwm sim tau raug censored thaum lub sijhawm tuag. Cov xwm txheej uas tshwm sim tom qab ib xyoos tom qab tsis suav nrog hauv kev tshuaj ntsuam tam sim no. Txhawm rau txheeb xyuas cov kev kwv yees ntawm cov txiaj ntsig ua haujlwm tsis zoo, peb tau ua ntau qhov kev soj ntsuam kev rov qab los nrog kev hloov kho rau hnub nyoog, poj niam txiv neej, RRT modality, thiab nkag NIHSS qhab nia. Rau txhua qhov kev ntsuam xyuas, qhov tseem ceeb ntawm cov ntaub ntawv tau teeb tsa ntawm P<>

Cov txiaj ntsig

Ntawm 717 tus neeg mob (lub hnub nyoog nruab nrab, 70.8 xyoo; txiv neej, 60.5 feem pua), 27 cov neeg mob (3.8 feem pua) tau txais cov neeg mob RT thiab 39 tus neeg mob (5.4 feem pua) tau kho HD; qhov seem 651 tus neeg mob (90.8 feem pua) tsis muaj keeb kwm ntawm RRT. Lub sijhawm nruab nrab ntawm RT kev phais mus rau qhov pib mob stroke yog 33 lub hlis (interquartile range,{15}} hli) hauv pawg RT. Lub sijhawm nruab nrab ntawm HD pib mus rau qhov pib mob stroke yog 124 lub hlis (interquartile range,{17}} hli) hauv cov neeg mob HD. Mob ntshav qab zib nephropathy yog qhov laj thawj feem ntau rau RRT hauv ob pawg RT thiab HD (Table 1). Cov nqi siv ntawm

Cov tshuaj tiv thaiv kab mob hauv cov neeg mob RT muaj nyob rau hauv Daim Ntawv Ntxiv 1. Cov tshuaj tiv thaiv kab mob tiv thaiv tsis tau hloov tom qab qhov Performance index stroke. Table 2 qhia txog cov yam ntxwv hauv paus ntawm cov neeg mob. Cov neeg mob hauv pawg RT tseem hluas, thiab cov neeg hauv pawg HD feem ntau muaj mob plawv tsis ua hauj lwm thiab kab mob peripheral artery dua lwm tus. Tsis muaj qhov sib txawv ntawm qhov sib txawv ntawm cov kab mob atherosclerotic nyob rau hauv cov hlab ntsha thiab cov hlab ntsha extracranial thiab aortas ntawm 3 pawg. Qhov tsawg-density lipoprotein concentrations qis dua, thiab homocysteine concentrations siab dua, nyob rau hauv RT thiab HD pawg dua li nyob rau hauv cov pab pawg neeg uas tsis yog-RRT.Lub hlwb natriuretic peptide theem yog siab tshaj nyob rau hauv cov pab pawg neeg HD. Kev sib piv ntawm cov yam ntxwv hauv paus ntawm cov neeg mob nrog RT, HD, tsis muaj RRT nrog CKD, thiab tsis muaj RRT yam tsis muaj CKD pawg tau qhia nyob rau hauv Daim Ntawv Ntxiv 2. Hais txog etiologic subtype (Fig.1 thiab Supplementary Fig.2), ESUS yog Ntau zaus hauv cov neeg mob RT ntau dua li lwm tus. Raws li pom nyob rau hauv Cov Lus Qhia Ntxiv 3, tsis muaj kev sib raug zoo ntawm cov tshuaj tiv thaiv kab mob tshwj xeeb nrog kev txhim kho ntawm ESUS. Ntawm qhov tod tes, cardioembolism ntau zaus hauv cov neeg mob HD. Hauv pab pawg HD, unfractionated heparin thiab low-molecular-weight heparin tau siv hauv 32.

thiab 6 tus neeg mob, raws li, rau kev tiv thaiv kev coagulation ntawm extracorporeal circuit. Tsis muaj cov koom haum tseem ceeb ntawm hom anticoagulant rau HD nrog rau cov subtype ntawm ischemic stroke.

Cov ntaub ntawv hais txog kev siv tshuaj thaum tso tawm thiab phais yog nthuav tawm hauv Daim Ntawv Ntxiv 4. Kev siv cov tshuaj antiplatelet thiab anticoagulant yog 74.1 feem pua thiab 32.1 feem pua hauv pawg RT thiab 59. Ntawm cov neeg mob RT thiab HD nrog 74.1 feem pua thiab 87.2 feem pua ntawm cov ntshav siab, Ntau dua lossis sib npaug rau 1 cov tshuaj tiv thaiv kab mob ntshav siab tau siv 61.5 feem pua thiab 82.1 feem pua , raws li kev tso tawm.

cistanche-kidney function

Cistanche tuaj yeem pab kho mob raum

Ib Lub Xyoo Txhaum Cai

Ntawm 717 tus neeg mob, 96 muaj tsawg kawg yog ib qho kev tshwm sim vascular hauv ib xyoos, muab qhov xwm txheej ntawm 13.4 feem pua (95 feem pua ntawm kev ntseeg siab, 11.1 feem pua -16.1 feem pua). Raws li pom nyob rau hauv Fig.2 thiab Table 3, cov neeg mob hauv pawg HD muaj kev pheej hmoo siab ntawm MACE ntau dua li cov neeg uas tsis yog RRT. Tsis muaj qhov sib txawv ntawm MACE cov kev pheej hmoo ntawm cov neeg mob hauv RT thiab tsis yog RRT pawg. Cov txiaj ntsig no tau zoo ib yam thaum cov neeg mob uas tsis muaj keeb kwm RRT tau muab faib ntxiv raws li qhov muaj lossis tsis muaj CKD (Ntxiv Fig.3). Tsis muaj qhov sib txawv ntawm qhov kev pheej hmoo ntawm kev tuag tag nrho ntawm peb pawg.

Muaj 3 thiab 5 tus neeg mob uas tau hnov mob rov qab mob stroke hauv pawg RT thiab HD, feem. Subtypes ntawm qhov Performance index thiab recurrent strokes yog coincident, tshwj tsis yog rau 1 tus neeg mob nyob rau hauv lub HD pab pawg neeg uas muaj atherothrombosis thaum xub thawj thiab ces tsim cardioembolism thaum lub sij hawm rov qab (Cov Lus Ntxiv 5). Cov Lus Qhia Ntxiv 6 qhia txog kev sib piv ntawm 1-xyoo MACE kev pheej hmoo ntawm txhua tus neeg siv tshuaj tiv thaiv kab mob thiab cov neeg tsis siv ntawm cov neeg mob RT. Cyclosporine thiab mizoribine nyiam ua rau muaj kev pheej hmoo ntawm MACE uas tsis muaj qhov sib txawv ntawm qhov sib txawv, thaum tacrolimus thiab mycophenolate mofetil cuam tshuam nrog qis dua. Hauv pawg HD, 32 (84.2 feem pua) thiab 6 (15.8 feem pua) cov neeg mob tau siv cov tshuaj heparin uas tsis muaj qhov hnyav thiab qis-molecular-hnyav heparin thaum lub sijhawm HD txheej txheem, feem. Raws li qhia hauv Cov Lus Ntxiv 7, qhov xwm txheej ntawm MACE thiab ischemic stroke tsis sib txawv ntawm cov tshuaj tiv thaiv coagulant.

Ib Xyoo Kev Ua Haujlwm Ua Haujlwm Zoo

Fig.3 qhia txog kev faib tawm ntawm Mrs cov qhab nia ntawm ib xyoos ua raws. Cov feem pua ntawm cov neeg mob uas ua haujlwm tsis zoo yuav ua rau qis dua hauv pawg RT, txawm hais tias qhov sib txawv tsis yog qhov tseem ceeb. Qhov sib txawv ntawm pawg neeg sib txawv yog qhov tseem ceeb thaum cov neeg mob uas tsis muaj RRT tau muab faib rau cov neeg uas muaj CKD thiab cov tsis muaj CKD (Ntxiv Fig.4). Kev txheeb xyuas ntau qhov sib txawv tau pom tias RT lossis HD tsis yog tus kheej cuam tshuam nrog kev ua haujlwm tsis zoo ntawm ib xyoos; hnub nyoog thiab NIHSS yog qhov kev txiav txim siab ntawm kev tsis taus (Table4).