Cov Teeb Meem Ntawm Lub Raum Nyob Hauv Kev Pub Dawb Ntawm Arterial Stiffness: Ib Txheej Txheem Ntsuam Xyuas Txheej Txheem
Feb 28, 2022
thov hu rau Tinatina.xiang@wecistanche.comyog xav paub ntxiv
TSAB NTAWV
Taw qhia Cov neeg mob raum tau raug tshaj tawm tias muaj kev nce qib ntawm aortic txhav thiab txo qis glomerular pom piv nrog cov neeg tsis noj qab haus huv. Qhov no yog ib qho kev txhawj xeeb vim tias muaj zog aortic nce ntxiv yog ib qho kev kwv yees tus kheej ntawm tag nrho cov kab mob plawv thiab tag nrho-ua rau kev tuag ntawm cov pejxeem. Txhawm rau kom paub tseeb tias cov hlab ntsha tawv nce ntxiv tom qab pub dawb, peb yuav soj ntsuam tag nrho cov kev tshawb fawb uas ntsuas qhov ntsuas ntawm cov hlab ntsha hauv cov neeg noj qab haus huv uas tau txais unilateral nephrectomy rau lub raum pub dawb piv nrog cov hnub nyoog sib txuam nrog kev noj qab haus huv uas tsis yog nephrectomized tswj.
Methods/analysis Peb yuav ua tiav tshawb nrhiav cov kev tshawb fawb luam tawm ntawm 1 Lub Ib Hlis 1960 thiab 15 Lub Peb Hlis 2021 hauv MEDLINE, EMBASE, Cochrane Central, OVID, thiab EBM tshuaj xyuas. Tag nrho cov yav tom ntej (cohort, case-control, case series, thiab ua ntej-thiab-tom qab kev tshawb fawb) thiab retrospective non-randomized kev tshawb fawb qhia indices ntawm arterial stiffness nyob rau hauv nephrectomized thiab non-nephrectomized noj qab haus huv cov neeg koom yuav suav nrog. Cov txiaj ntsig tseem ceeb yuav yog qhov sib txawv ntawm qhov kev ntsuas kev ua haujlwm ntawm cov hlab ntsha tawv nqaij ntawm cov neeg pub dawb thiab cov tsis pub dawb. Secondary
Cov txiaj ntsig yuav yog qhov sib txawv ntawm cov ntshav siab systolic / diastolic, ntshav creatinine, glomerular filtration, carotid artery intima-media thickness, thiab vascular calcification.
Kev tshawb nrhiav, kev xaiv, thiab kev rho tawm cov ntaub ntawv yuav ua los ntawm ob tus neeg saib xyuas ywj pheej. Kev pheej hmoo ntawm
Kev tsis ncaj ncees yuav raug soj ntsuam ntawm tus kheej nrog cov cuab yeej ROBINS-I thiab kev ntseeg siab hauv cov pov thawj los ntawm Kev Ntsuas Kev Ntsuas Kev Pom Zoo, Kev Txhim Kho, thiab Kev Ntsuas Kev Pom Zoo. Cov ntaub ntawv zoo thiab ntau cov ntaub ntawv sib txuas, nrog rau kev soj ntsuam thiab kev txheeb cais sib txawv (Forest plots, I2 thiab Cochran's Q statistics), yuav raug soj ntsuam. Yog tias qhov kev soj ntsuam thiab txheeb xyuas heterogeneity tau txais, qhov cuam tshuam ntawm qhov sib txawv ntawm qhov hnyav yuav raug tshuaj xyuas los ntawm cov qauv siv random.
Kev ncaj ncees thiab kev tshaj tawmTsis muaj kev pom zoo rau kev ncaj ncees yog qhov tsim nyog. Peb cov txiaj ntsig yuav raug tshaj tawm los ntawm kev txheeb xyuas cov ntawv tshaj tawm thiab kev nthuav qhia los qhia cov neeg muaj feem cuam tshuam txog kev ntsuam xyuas thiab kev saib xyuas cov neeg mob raum.
PROSPERO tus lej sau npe CRD42020185551.
Taw qhia
Nyob pubraumhloov pauvyog qhov kev kho mob zoo tshaj plaws rau cov neeg mob uas muaj kab mob raum kawg (ESRD); nws muab cov neeg mob ntau ntxiv thiab graft muaj sia nyob thiab lub neej zoo dua li kev lim ntshav lossis tus neeg pub dawb tuaghloov pauv. yuav tsum txo lawv txoj kev pheej hmoo thiab ua kom muaj kev nyab xeeb siab tshaj plaws thaum lub sijhawm thiab tom qabraum pub dawb. Txawm hais tias ob peb qhov kev tshawb fawb 2 5 6 tau qhia tias qhov txaus ntshai rau kev noj qab haus huvraum pubTom qab nephrectomy tsawg heev, qee tus tau tshaj tawm tias unilateral nephrectomy yog txuam nrog kev nce ntxiv ntawm aortic txhav, txhim kho sab laug ventricular loj, interventricular septum thickness thiab txo glomerular pom piv nrog cov neeg noj qab haus huv uas tsis yog pub dawb los ntawm hnub nyoog thiab poj niam txiv neej.7-11 Hauv feem ntau ntawm cov ntawv ceeb toom no, ntshav siab ntawm kev soj ntsuam tsis sib txawv ntawm cov neeg pub dawb thiab cov tsis pub dawb. Kev pom tus nqi (GFR) tom qab pub dawb tuaj yeem yog qhov ua rau muaj kev pheej hmoo ua rau muaj zog aortic, tsis muaj ntshav siab.7 13 Cov kev tshawb pom no muaj feem cuam tshuam rau kev kho mob vim tias muaj zog aortic nce ntxiv raws li ntsuas los ntawm carotid-femoral pulse yoj velocity (cf-PWV) yog qhov muaj zog ywj pheej kwv yees ntawm tag nrho cov kab mob plawv thiab tag nrho-ua rau kev tuag ntawm cov pejxeem.14 Kev nce ntawm 1 m / s hauv cf-PWV hauv lwm tus neeg noj qab haus huv tau cuam tshuam nrog kev hloov pauv kev pheej hmoo nce 14 feem pua thiab 15 feem pua ntawm tag nrho cov kab mob plawv thiab tag nrho cov neeg tuag.14 Txawm hais tias kev them nyiaj rau lub raum hypertrophy thiab glomerular hyperfiltration tshwm sim tom qab unilateral nephrectomy, qhov txo qis hauv tag nrho GFR feem ntau ua raws li, thiab qhov no ua rau muaj kev pheej hmoo ntawm cov kab mob plawv tom qab pub dawb tuaj yeem sib piv rau cov kev pheej hmoo ntawm cov neeg mob mob me me mus rau nruab nrab.kab mob raum.15–17 Kev txo qis hauv lub raum ua haujlwm ntawm qhov loj npaum li no yuav yog qhov tseem ceeb tshwj xeeb rau cov hluas nyobraumCov neeg pub dawb uas muaj lub sijhawm ntev tshaj plaws ntawm kev pheej hmoo raug cuam tshuam los ntawm kev txo lub raum loj. Txhawm rau txiav txim siab seb cov neeg pub raum puas muaj kev pheej hmoo rau kev mob aortic ntxiv, kev ntsuam xyuas cov kev tshawb fawb uas twb muaj lawm ntawm cov hlab ntsha hauv cov neeg pub dawb piv nrog cov hnub nyoog sib txuam nrog kev noj qab haus huv yog tsim nyog. Qhov kev tshuaj xyuas no txawv ntawm cov kev tshuaj xyuas uas twb muaj lawm thiab cov tshuaj ntsuam xyuas meta uas tau soj ntsuam cov kev cuam tshuam cuam tshuam ntawmhloov raumntawm arterial stiffness nyob rau hauv cov neeg tau txais lub raum nrog ESRD.18 19 Cov txiaj ntsig ntawm qhov kev tshuaj xyuas tshiab no tuaj yeem hais txog qhov muaj zog thiab qhov tsis muaj zog hauv cov kev tshawb fawb yav dhau los nrog rau cov neeg pub rau lub raum thiab txiav txim siab seb puas xav tau kev tshawb nrhiav zoo ntxiv.
Nyem qhov no kom paub ntau ntxiv txog lub raum ua haujlwm
Lub hom phiaj
Nyob rau hauv txoj kev tshawb no, peb yuav soj ntsuam tag nrho cov kev tshawb fawb uas tsis yog-randomized uas ntsuam xyuas lub hauv paus los yog peripheral arterial txhav nyob rau hauv cov neeg noj qab haus huv uas underwent unilateral nephrectomy tom qab ua tiav cov txheej txheem rau lub raum pub dawb thiab cov uas muaj kev ntsuas ntawm lub functional los yog structural Cheebtsam ntawm arterial txhav, raws li tau hais tseg. by validated metrics including cf-PWV, brachial-ankle pulse wave velocity (PWV), pulse wave analysis, femoral-tibial PWV, ankle-brachial index, aortic distensibility, carotid artery intima-media thickness, thiab vascular calcification. Lub hom phiaj tseem ceeb ntawm qhov kev tshuaj xyuas no yuav yog los muab cov pov thawj zoo tshaj plaws ntawm seb puas muaj cov hlab ntsha tuaj yeem nce ntxiv tom qab nyob rau hauv lub raum pub dawb tshaj li qhov xav tau rau hnub nyoog sib tw noj qab haus huv uas tsis yog nephrectomized tswj. Peb feem ntau yuav txiav txim siab qhov sib txawv ntawm cov cim kev ua haujlwm ntawm cov hlab ntsha ntawm lub raum pub dawb thiab lawv cov kev sib piv kev noj qab haus huv uas tsis yog pub dawb tswj hwm. Txij li thaum kev nce qib ntawm arterial txhav nyob rau hauv lub raum pub dawb yuav yog ib qho kev txiav txim ntawm cov hlab plawv, peb tseem yuav sib piv arterial txhav nyob rau hauv pub ua ntej thiab tom qab nephrectomy. Thib ob, peb yuav sau qhov sib txawv ntawm cov ntshav siab systolic thiab diastolic (SBP, DBP), ntshav creatinine, kwv yees GFR (eGFR), thiab cov cim cim ntawm cov hlab ntsha tawv nqaij (carotid intima-media thickness, arterial calcification qhab nia) ntawm ob pawg neeg no.
METHODS THIAB SAIB
Peb yuav ua qhov kev tshuaj xyuas no ua raws li Cochrane Collaboration cov hauv paus ntsiab lus rau Kev Ntsuam Xyuas Txheej Txheem20thiab cov txheej txheem no tau sau npe hauv PROSPERO rau npe rau kev tshuaj xyuas.21Cov khoom tshaj tawm uas nyiam tshaj plaws rau Kev Ntsuam Xyuas Txheej Txheem piav qhia los ntawm Cov Lus Qhia Tshaj Lij Tshaj Lij rau Kev Ntsuam Xyuas Txheej Txheem thiab Meta-Analyses cov lus qhia22yuav ua raws li thiab daim ntawv teev npe rau cov lus pom zoo no yuav suav nrog(online ntxiv cov ntawv ntxiv1).23
Cov pej xeem thiab cov qauv tsim nyog
Raum pub
Peb yuav suav nrog cov neeg laus noj qab haus huv (³18 xyoo) ntawm txhua lub hnub nyoog uas tau txais unilateral nephrectomy tom qab ua tau raws li cov qauv kev tshuaj ntsuam xyuas rau kev pub khoom nruab nrog cev thiab nws cov hlab ntsha tau ntsuas tsis tau ua ntej thiab / lossis tom qab nephrectomy nrog ib qho ntawm cov kev ntsuas hauv qab no ntawm cov hlab ntsha. : cf-PWV, brachial-ankle PWV, femoral-tibial PWV, ankle-brachial index, pulse wave analysis (augmentation index and central pulse pressure) and aortic distensibility.24 25 Raws li cov cim qhia ntawm kev hloov pauv hauv cov hlab ntsha, kev ntsuas ntawm carotid artery intima-media thickness thiab vascular calcification cov qhab nia kuj yuav raug sau tseg.26
Tswj kev noj qab haus huv
Raws li kev tswj hwm, peb yuav suav nrog cov neeg laus (³18 xyoo) nrog kev ntsuas cov ntsuas ntsuas ntawm cov hlab ntsha uas tau koom nrog kev tswj hwm kev noj qab haus huv hauv cov kev tshawb fawb raum pub dawb.7 8
Kev cuam tshuam
Hauv qhov kev tshuaj xyuas no, unilateral nephrectomy tsis zoo rau lub raum pub dawb ntawm txoj kev phais (laparoscopic thiab qhib nephrectomy) yuav suav tias yog qhov kev cuam tshuam loj.
Cov txiaj ntsig
Cov txiaj ntsig tseem ceeb yuav yog qhov sib txawv ntawm kev ntsuas kev ua haujlwm ntawm cov hlab ntsha tawv nqaij ntawm cov neeg noj qab haus huv nephrectomized thiab cov neeg uas tsis yog nephrectomized nrog rau qhov sib txawv ntawm cov neeg pub dawb ua ntej thiab tom qab nephrectomy. Cov txiaj ntsig zoo ntxiv rau qhov sib txawv ntawm pab pawg txhais tau tias yuav raug sau tseg hauv lawv qhov ntsuas ntsuas. Cov txiaj ntsig thib ob yuav yog qhov sib txawv ntawm SBP thiab DBP (mm Hg), mem tes siab (mm Hg), qib ntshav creatinine (µmol/L), eGFR (ml / min / 1.73 m)2), carotid artery intima-media thickness (mm), thiab vascular calcification (cov qhab nia).16 24 26 27Cov txiaj ntsig kho mob thiab ib qho kev ntsuas ntxiv ntawm kev ua haujlwm endothelial yuav raug sau tseg thiab tshaj tawm raws li.17 28
cf-PWV reference group
Ntxiv rau qhov kev sib piv thawj zaug, peb yuav tshawb nrhiav cov kev tshawb fawb uas ntsuas cf-PWV hauv cov neeg noj qab haus huv sib txawv thoob ntiaj teb thiab leej twg tau tshaj tawm cov txiaj ntsig ntawm cf-PWV tus qauv raws hnub nyoog.29 Peb cia siab tias
tias qhov kev tshuaj ntsuam no yuav txhim kho qhov kev pom dav dav ntawm qhov kev tshuaj xyuas no. Kawm tsim qauv
Txij li thaum yav tom ntej randomized soj ntsuam kev sim ntawm pub dawb yuav tsis muaj peev xwm ua tau rau kev coj ncaj ncees, tsuas yog yav tom ntej uas tsis yog-randomized (cohort, case-control, case series, thiab ua ntej-thiab-tom qab kev tshawb fawb) thiab cov kev tshawb fawb rov qab yuav suav nrog, muab tias 10 lossis ntau dua cov kev kawm tau koom nrog hauv qhov kev ntsuam xyuas thawj zaug.
Nrhiav tswv yim
Peb lub tswv yim tshawb nrhiav yuav yog siv MEDLINE, EMBASE, Cochrane Central databases, CADTH's 'Grey matters light', OVID, EBM Reviews, Health Technology Assessment Database, thiab lwm cov ntaub ntawv grey ntawm kev tshawb fawb suav nrog tsoomfwv cov lus ceeb toom thiab cov lus tshaj tawm txoj cai luam tawm tom qab 1 Lub Ib Hlis 1960. Ib lub tswv yim tshawb fawb zoo yuav raug tsim thiab siv los ntawm tus kws tshaj lij cov ntaub ntawv kho mob (RS) nrog kev tshuaj xyuas kev ua haujlwm, hauv kev koom tes nrog pab pawg tshawb fawb. Cov ntsiab lus MeSH yuav raug siv los ntes cov ntsiab lus tseem ceeb ntawm cov lus nug tshawb fawb thiab cov ntaub ntawv txheeb xyuas yuav raug xa tawm mus rau ib daim ntawv tshaj tawm rau kev tshawb xyuas thiab xaiv. Peb lub tswv yim tshawb nrhiav cov ntaub ntawv tau hais tseg nyob rau hauv cov ntawv txuas ntxiv hauv online 2. Peb qhov kev tshawb fawb tau npaj tseg yuav ua mus txog rau thaum Lub Peb Hlis 15, 2021. Kev tshuaj xyuas phau ntawv ntawm cov npe siv rau txhua qhov kev tshawb fawb yuav ua raws li cov txheej txheem tshuaj ntsuam ua ntej (table 1).
Kev tshawb nrhiav cov ntaub ntawv grey zaum kawg yuav yog siv 'Google Scholar's thiab tshuaj xyuas ntawm ClinicalTrials.gov rau ib qho kev kawm tam sim no. Tsis muaj kev txwv hom lus yuav raug siv nyob rau hauv ib qho ntawm kev tshawb nrhiav thawj zaug, tab sis peb qhov kev ntsuam xyuas zaum kawg yuav txwv rau cov ntawv tshaj tawm ua lus Askiv, Fabkis, Italian, Portuguese thiab lus Spanish. Cov ntawv luam theej tawm yuav raug tshem tawm thiab cov tswv yim tshawb nrhiav yuav raug khaws cia txog lub sijhawm kawg ntawm qhov kev tshuaj xyuas no.
Kawm kev tshuaj ntsuam, cais tawm, thiab xaiv
Thaum lub sijhawm tshuaj ntsuam xyuas, peb yuav suav tag nrho cov kev tshawb fawb yav tom ntej thiab rov qab los ntawm cov kev tshawb fawb uas tsis yog-randomized qhia txog kev ntsuas cov hlab ntsha hauv cov neeg mob nephrectomized thiab tsis yog nephrectomized noj qab nyob zoo. Ib qho txheej txheem ntawm kev xaiv txoj kev kawm yuav raug ua raws li kev suav nrog thiab tsis suav nrog cov txheej txheem teev tseg hauv cov lus 1. Peb yuav tsis suav nrog cov kev tshawb fawb qhia txog kev tshawb nrhiav hauv cov menyuam yaus (hnub nyoog<18 years),="" non-human="" studies,="" narrative="" reviews,="" in="" vitro="" or="" mathematical="" modeling="" reports,="" abstracts="" or="" conference="" proceedings,="" and="" any="" duplicate="" or="" substudy="" of="" previously="" published="" investigations.="" all="" review="" processes="" will="" be="" independently="" performed="" by="" two="" individuals,="" with="" a="" third="" person="" available="" for="" consensus="" in="" cases="" of="">
Tag nrho cov ntaub ntawv pov thawj yuav raug tshuaj xyuas los ntawm lub npe thiab paub daws teeb meem. Tom qab xaiv los ntawm lub npe / cov lus piav qhia thiab nrog lub hom phiaj ntawm kev ua kom yooj yim rau kev txiav txim siab zaum kawg ntawm cov kev kawm tsim nyog, ib qho kev ntsuam xyuas nruab nrab ntawm cov khoom siv thiab cov txheej txheem
yuav raug muab coj los siv rau hauv kev sib tw kom paub meej tias hom kev ua haujlwm rau kev ntsuas cov hlab ntsha. Kev txiav txim siab txiav txim siab xaiv ua ntej kev rho tawm cov ntaub ntawv yuav ua tiav los ntawm cov neeg saib xyuas ywj pheej ntawm cov ntawv sau tag nrho. Nyob rau hauv cov ntaub ntawv uas ploj lawm, peb yuav txiav txim siab hu rau cov kws sau ntawv kawm. Ob tus kws sau ntawv tshuaj xyuas yuav tsis pom qhov muag rau cov npe sau ntawv lossis rau cov kws sau ntawv lossis cov tsev kawm.
Kev rho tawm cov ntaub ntawv
Daim ntawv rho tawm cov ntaub ntawv yuav raug npaj ua ntej nrog kev pom zoo los ntawm txhua tus neeg tshawb xyuas thiab ua kom zoo dua siv cov txheej txheem ntawm 4 cov kev tshawb fawb randomly xaiv ua ntej muab rho tawm los ntawm ob tus neeg saib xyuas ywj pheej. Thaum ntau qhov kev tshaj tawm tshwm sim los ntawm ib qho kev tshawb fawb, cov ntaub ntawv cuam tshuam yuav raug muab rho tawm rau hauv ib daim ntawv. Kev rho tawm cov ntaub ntawv yuav suav nrog (1) cov yam ntxwv ntawm kev kawm, kev tsim, thiab cov txheej txheem: lub npe, cov kws sau ntawv, phau ntawv xov xwm / qhov chaw / xyoo, cov lus tshaj tawm, lub teb chaws, hom kev kawm tsim, lub sijhawm kawm, kev tshaj tawm, tag nrho cov neeg pub dawb thiab tsis -cov neeg pub dawb, suav nrog thiab cais tawm, thiab cov ntsiab lus ntawm kev ntsuas; (2) cov yam ntxwv piv txwv: hnub nyoog, poj niam txiv neej, hnub nyoog thaum lub sij hawm ntawm nephrectomy, hnub nyoog ntawm lub sij hawm ntawm kev ntsuam xyuas, lub sij hawm ntawm kev soj ntsuam thiab hom arterial stiffness instrumentation;( 3) cov txiaj ntsig: kev hloov pauv hauv arterial stiffness raws li kev ntsuas ntsuas: cfPWV, brachial-ankle PWV, femoral-tibial PWV, ankle-brachial index, augmentation index, central pulse pressure, aortic distensibility, carotid artery intima-media thickness; Cov qhab nia ntawm arterial calcification, ntshav creatinine qib, eGFR. SBP, DBP, thiab mem tes ntshav siab. Peb yuav ua ntaub ntawv yog tias qhov ntsuas qhov tawv nqaij tawv tau raug tshaj tawm raws li kev kho lossis tsis kho raws li kev hloov pauv hauv cov ntshav siab thiab / lossis lub plawv dhia. Yog tias tau tshaj tawm, peb yuav sau cov hom thiab tus naj npawb ntawm cov tshuaj rau kev tswj ntshav siab.
Kev soj ntsuam kev pheej hmoo ntawm kev tsis ncaj ncees
Qhov kev pheej hmoo ntawm kev tsis ncaj ncees rau cov kev tshawb fawb uas tsis yog randomized yuav raug soj ntsuam siv qhov Risk of Bias hauv Non-randomised studies (ROBINS-I) tool. Xya lub ntsiab lus los ntawm qhov kev tsis ncaj ncees tuaj yeem raug qhia yuav raug ntsuas ntawm tus kheej thiab sib tham los ntawm ob tus neeg tshuaj xyuas, suav nrog kev tsis sib haum xeeb, xaiv cov neeg koom (nephrectomized thiab non-nephrectomies), kev faib tawm ntawm kev cuam tshuam (ie, unilateral nephrectomy), sib txawv ntawm qhov kev cuam tshuam, ploj lawm. cov ntaub ntawv, ntsuas cov txiaj ntsig thiab kev xaiv cov txiaj ntsig tau tshaj tawm. Txhua tus sau npe yuav raug txiav txim raws li qhov qis, nruab nrab, loj, lossis tseem ceeb txaus ntshai ntawm kev tsis ncaj ncees lossis tsis muaj ntaub ntawv muaj. Tom qab kev sib tham ntawm cov neeg soj ntsuam, kev ntsuam xyuas tag nrho ntawm kev tsis ncaj ncees ntawm kev kawm nrog kev suav nrog txhua tus thawj coj yuav raug tabulated. Cov kev tsis sib haum xeeb yuav raug daws nrog kev koom tes ntawm tus neeg soj ntsuam thib peb.
nruab nrab thiab interquartile ntau yam rau qhov sib txawv tsis tu ncua thiab cov lej thiab feem pua rau cov hloov pauv categorical. Ib daim ntawv qhia piav qhia txog cov yam ntxwv ntawm kev kawm yuav raug muab. Peb yuav txheeb xyuas qhov muaj peev xwm ntawm kev kho mob heterogeneity raws li qhov sib txawv hauv kev kawm tsim cov yam ntxwv, txheej txheem kev ua tau zoo, cov yam ntxwv ntawm lub hauv paus nruab nrab ntawm cov pab pawg nephrectomized thiab lawv cov kev tswj hwm, thiab lub sijhawm ua raws sijhawm. Yog tias tsawg kawg yog ob txoj kev tshawb fawb qhia txog qhov tshwm sim tib yam, kev tshuaj xyuas ntau (ie, meta-analysis) yuav raug sim rau cov kev tshawb fawb no. Statistical heterogeneity yuav yog tus cwj pwm nrog Forest plots, I², thiab Cochran's Q cov txheeb cais (p<0.10）. if="" both="" clinical="" and="" statistical="" heterogeneity="" is="" acceptable,="" inverse="" variance-weighted="" effects="" meta-analysis="" will="" be="" performed.="" ani'valueless="" than="" 60%="" with="" anon-significant="" x'="" statistic(p="">0.10) yuav qhia txog qhov nruab nrab ntawm kev txheeb cais sib txawv. Peb feem ntau yuav xaiv tus qauv cuam tshuam raws li cov txheej txheem ntawm DerSimonian thiab Laird, tab sis qhov kev cuam tshuam ruaj khov meta-kev tshuaj ntsuam kuj tseem yuav ua qauv ua ib feem ntawm peb qhov kev soj ntsuam rhiab heev. Raws li qhov ntsuas ntsuas, peb tuaj yeem xaiv los suav cov txiaj ntsig kev kwv yees siv cov qauv lossis qhov sib txawv ntawm qhov sib txawv thiab lawv qhov sib thooj 95 feem pua ntawm kev ntseeg siab. Txhawm rau txo qhov 'ob npaug suav qhov yuam kev hauv ua ntej thiab tom qab kev tshawb fawb, ib nrab ntawm tag nrho cov neeg koom nrog kev kawm yuav raug faib rau txhua qhov kev kawm. Txhua qhov kev ntsuam xyuas yuav ua tiav siv RevMan V.5.3(Lub Nordic Cochrane Center, The Cochrane Collaboration, 2014. Copenhagen).
Kev tsom xam rhiab heev
Nyob ntawm tus naj npawb ntawm cov kev tshawb fawb tsim nyog, kev soj ntsuam rhiab heev tuaj yeem ua los ntsuas qhov cuam tshuam ntawm qhov muaj txiaj ntsig loj, muaj kev pheej hmoo siab ntawm kev kawm tsis ncaj ncees, thiab muaj kev cuam tshuam tsis zoo cuam tshuam nrog qhov sib txawv hauv kev tshaj tawm txog kev hloov kho lossis tsis kho qhov tseem ceeb ntawm cov hlab ntsha nruj raws li kev hloov pauv. nyob rau hauv txhais tau tias arterial siab thiab/los yog lub plawv dhia. Kev soj ntsuam ntawm qhov sib txawv ntawm qhov sib txawv ntawm cov qauv kev teeb tsa thiab qhov tshwm sim tsis zoo ntawm cov kev kwv yees sib xyaw ua ke kuj tseem yuav raug soj ntsuam.
Kev tsom xam pab pawg
Cov kev tshawb fawb soj ntsuam 32 tau sau tseg tias cov neeg pub nyiaj muaj sia nyob muaj feem cuam tshuam nrog lawv cov neeg tau txais ESRD feem ntau yuav tsim cov kab mob hauv lub raum. Yog li, nws yog ib qho tseem ceeb rau kev sib txawv ntawm qhov cuam tshuam ntawm unilateral nephrectomy ntawm arterial txhav ntawm cov neeg tau txais kev noj qab haus huv tswj hwm thiab cov uas tsis cuam tshuam nrog tus neeg txais. Txhawm rau txo qis kev tsis ncaj ncees hauv peb qhov kev tshuaj xyuas thiab nyob ntawm seb muaj pes tsawg qhov kev kawm tsim nyog, xwm txheej, thiab nthuav dav ntawm cov ntaub ntawv tshaj tawm, peb yuav sim txiav txim siab qhov cuam tshuam ntawm cov neeg muaj peev xwm confounders los ntawm kev ua cov pab pawg neeg soj ntsuam raws hnub nyoog, txheej txheem phais (qhib vs laparoscopic nephrectomy) , lub sijhawm ua raws li kev soj ntsuam tom qab nephrectomy (luv luv vs ntev), hom kev sib piv (tus neeg tau txais txiaj ntsig vs tsis yog tus neeg tau txais txiaj ntsig), tus naj npawb thiab hom tshuaj siv rau kev tswj ntshav siab thiab kev sib deev raws li txiv neej sib txawv piv. Intergroup qhov sib txawv yuav raug tshuaj xyuas siv Cochran's Q cov txheeb cais nrog p Tsawg dua lossis sib npaug rau 0.10.
Cov ntaub ntawv synthesis thiab tsom xam cov phiaj xwm
Cov kev tshawb fawb yuav suav nrog hauv cov khoom sib xyaw zoo thiab ntau yog tias lawv ua tiav txhua yam kev tsim nyog. Cov yam ntxwv ntawm kev kawm yuav raug suav hais tias siv txhais tau tias thiab SD lossis
thiab hom tshuaj siv rau kev tswj ntshav
siab thiab kev sib deev raws li tus txiv neej sib txawv rau poj niam
piv. Intergroup sib txawv yuav raug tshuaj xyuas siv Cochran's Q cov txheeb cais nrog p Tsawg dua lossis sib npaug rau 0.10.
Kev ntseeg siab ntawm cov ntaub ntawv pov thawj
Txhawm rau ntsuas qhov tseeb ntawm cov pov thawj thiab lub zog ntawm cov lus pom zoo ntawm qhov cuam tshuam ntawm unilateral nephrectomy nyob rau hauv lub raum pub dawb, ob tus neeg saib xyuas yuav tshuaj xyuas cov pov thawj zoo rau txhua qhov txiaj ntsig ntsuas raws li tsib lub ntsiab lus ntawm Kev Ntsuas Kev Ntsuas, Kev Txhim Kho, thiab Kev Ntsuam Xyuas Kev Pom Zoo.
Kev hloov kho
Txhua qhov kev hloov kho raws tu qauv yuav raug sau tseg hauv daim ntawv ntawm lub rooj, qhov twg hnub hloov kho, piav qhia txog kev hloov pauv, thiab qhov laj thawj yuav raug muab.
Tus neeg mob thiab pej xeem kev koom tes
Cov neeg mob thiab / lossis cov pej xeem tsis tau koom nrog hauv kev tsim cov txheej txheem.
Kev sib tham
Vim tias cov neeg muaj lub raum nyob tau raug xaiv los ntawm cov neeg noj qab haus huv, qhov kev pheej hmoo mus sij hawm ntev ntawm ESRD, kab mob plawv lossis kev tuag tau raug tshaj tawm tias zoo ib yam lossis qis dua li cov pej xeem. " nephrectomy feem ntau ua rau txo lub raum ua haujlwm thiab nce qib ntawm cov ntshav creatinine.1516 Txawm hais tias qhov nruab nrab-lub sij hawm thiab ntev-ntev kev phiv los ntawm hyperfiltration thiab compensatory hypertrophy tom qab pub dawb tseem tsis meej, endothelial dysfunction cuam tshuam nrog txo brachial artery reactivity thiab nce qib ntawm uremic. Tsis ntev los no, qee cov kev tshawb fawb tau tshaj tawm tias cov tshuaj nephrectomy unilateral ua rau muaj zog aortic, sab laug ventricle pawg, thiab txo GFR thaum ntxov li ib xyoos tom qab phais.- Txawm hais tias cov ntshav siab tsis muaj kev cuam tshuam loj heev hauv lub raum. Cov kev tshawb fawb no, cov txiaj ntsig thawj zaug qhia tias txo GFR tuaj yeem yog ib qho kev pheej hmoo ntawm kev ywj pheej tor kom nce aortic txhav thiab tsis zoo sab laug ventricle remodeling, ywj siab ntawm ntshav siab.811 12
Txhawm rau txheeb xyuas qhov cuam tshuam ntawm hemodynamic ntawm unilateral nephrectomy hauv cov neeg pub raum, peb xav kom txheeb xyuas qhov systematically txheeb xyuas, ntsuas thiab sau tag nrho cov kev tshawb fawb uas tsis yog-randomized uas tau tshawb xyuas qhov ntsuas ntawm arterial txhav ua ntej thiab tom qab nephrectomy hauv cov neeg pub dawb los txiav txim siab txog kev nce qib ntawm arterial stiffness piv. nrog rau cov neeg noj qab nyob zoo nrog hnub nyoog. Ntxiv nrog rau kev txhim kho peb txoj kev nkag siab ntawm kev sib raug zoo ntawm lub raum tsis ua haujlwm tom qab pub dawb thiab lub plawv ua haujlwm, peb cov kev tshawb pom yuav txiav txim siab seb unilateral nephrectomy yog qhov muaj feem cuam tshuam rau cov hlab ntsha ntxiv rau cov neeg pub dawb thiab seb qhov ntsuas tsis cuam tshuam ntawm cov hlab ntsha tuaj yeem muaj txiaj ntsig zoo rau kev pheej hmoo. stratification.
Cov kev tshawb fawb tsiaj tau pom tias kev hloov pauv hauv lub raum kev loj hlob ua rau txo qis nephron tus lej hauv cov xeeb ntxwv ua rau cov ntshav siab nce siab, txo qis.
cardiac functional reserve and left ventricle hypertrophy in adulthood."Although alterations of the reninangio tensin-aldosterone system and changes in vascular tone are frequently present after unilateral nephrectomy,"'kidney donation is not considered a risk factor for hypertension post-donation. Kasiske et al followed living kidney donors for a 3-year period and identified an increase in blood pressure over time, but differences between donors and controls were non-significant. Kim et al found that there was an increase in blood pressure after donation with 21%ofdonors requiring medication for control of hypertension. Thiel et al" reported that the risk of developing hypertension(defined as >140/90mm Hg) nce 3. Vim tias cov ntshav siab hauv lub cev tuaj yeem yog qhov txiav txim siab ntawm cov hlab ntsha, peb yuav suav nrog SBP thiab DBP ua qhov txiaj ntsig thib ob. Qhov no yuav ntxiv rau kev nkag siab txog kev sib raug zoo ntawm cov ntshav siab thiab arterial txhav tom qab
7-39
khoom pub dawb.—
Txhawm rau lees txais tias qhov nce ntawm cov hlab ntsha tuaj yeem cuam tshuam nrog kev cuam tshuam ntawm unilateral nephrectomy, ntseeg cov pov thawj raws li kev tshawb fawb zoo thiab tsim qauv tsim nyog yog qhov tseem ceeb. Txawm hais tias qhov zoo ntawm cov pov thawj thiab qhov sib txawv ntawm kev tsim qauv yog cov yam ntxwv uas tuaj yeem txwv lub zog ntawm peb cov koom haum, kev siv cov ntsuas ntsuas tau zoo hauv peb txoj kev tshawb fawb rau kev ntsuam xyuas qhov kev pheej hmoo ntawm kev tsis ncaj ncees thiab qhov tseeb ntawm cov pov thawj yuav txo qis kev txhais lus tsis raug.3ss Nyob rau hauv rooj plaub uas cov ntaub ntawv yog tsis muaj, peb yuav ua txhua yam ua tau los tiv tauj tus thawj kws sau ntawv kom tau txais cov ntaub ntawv uas ploj lawm.
Cov neeg nyob hauv lub raum tsis tau txais txiaj ntsig kho mob los ntawm kev pub dawb, nthuav tawm lawv tus kheej rau kev noj qab haus huv cuam tshuam nrog txoj kev phais thiab qhov cuam tshuam ntawm lub raum loj rau cov txiaj ntsig ntawm lwm tus tib neeg. Kev txhawb nqa ntawm tus neeg pub dawb txoj kev ywj pheej hauv cov txheej txheem kev txiav txim siab kho mob yuav tsum muaj qhov tseeb ntawm qhov kev pheej hmoo ntawm nruab nrab thiab mus sij hawm ntev tom qab pub dawb. Qhov no yog qhov tseem ceeb tshwj xeeb tshaj yog rau cov tub ntxhais hluas uas muaj sia nyob pub dawb uas muaj feem cuam tshuam ntev tshaj plaws. Peb qhov kev tshuaj xyuas yuav muab qhov kev kwv yees tseeb dua ntawm 'kev pheej hmoo luv-rau-nruab nrab ntawm cov kab mob plawv tom qab pub dawb los ntawm kev tshuaj xyuas qhov kev mob ntawm arterial txhav tom qab nephrectomy.- Cov txiaj ntsig zoo li no tuaj yeem qhia rau cov neeg muaj peev xwm pub dawb thiab tuaj yeem coj lawv txoj kev saib xyuas tom qab. thiab khaws cia kev noj qab nyob zoo nyob rau lub sijhawm ntev.
Kev ncaj ncees thiab kev tshaj tawm
Tsis xav tau kev pom zoo rau kev coj ncaj ncees rau qhov kev tshuaj xyuas no. Peb qhov kev tshawb pom yuav raug tshaj tawm los ntawm kev txheeb xyuas cov ntawv tshaj tawm thiab kev nthuav qhia, uas tuaj yeem qhia txog cov txheej txheem kho mob thiab kev tswj xyuas cov neeg muaj peev xwm raum.
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