Puas yog Tus Kab Mob Raum Kab Mob Kab Mob Sib Kis Sib Koom Tes Creatinine-cystatin C Equation Muaj txiaj ntsig rau Glomerular Filtration Rate Kev kwv yees hauv cov neeg laus?
Mar 10, 2022
Yog xav paub ntxiv:ali.ma@wecistanche.com
Keeb kwm:
Peb tsom los ntsuas qhov kev ua tau zoo ntawm covMob raum mob Kab mob sib kisKev sib koom tes (CKD-EPI) creatinine-cystatin C sib npaug hauv ib pawg ntawm cov neeg laus suav nrog.
Cov ntaub ntawv thiab cov txheej txheem:
Glomerular filtration rate (GFR) tau ntsuas nyob rau hauv 431 cov neeg laus Suav koom nrog technetium-99m diethylene-triamine-penta-acetic acids (99mTc-DTPA) lub raum dynamic imaging txoj kev thiab tau calibrated sib npaug zos rau cov ntshav plasma piv 99mTc- DTPA-GFR. Kev ua haujlwm ntawm CKD-EPI(CMob raum mob Epidemiology)creatinine-cystatin C kab zauv tau muab piv nrog rau qhov sib npaug ntawm Cockcroft-Gault, qhov rov hais dua 4- hloov pauv hloov pauv ntawm Kev Noj Qab Haus Huv Hauv Lub Raum Kab Mob (MDRD) kab zauv, thiab CKD-EPI creatinine sib npaug.
Cov txiaj ntsig:
Txawm hais tias qhov kev tsis ncaj ncees ntawm CKD-EPI(CMob raum mob Epidemiology)creatinine-cystatin C sib npaug ntau dua nrog rau lwm qhov sib npaug (qhov nruab nrab qhov sib txawv, 5.7 mL / feeb / 1.73 m2 piv rau thaj tsam ntawm 0.4-2.5 mL / feeb / 1.73 m2; P, 0 . {54}}–23.6 mL/minute/1.73 m2; P, 0.001 rau txhua qhov kev sib piv), ua rau muaj kev txhim kho me ntsis ntawm qhov raug (qhov nruab nrab qhov sib txawv kiag li, 1 0.5 mL/minute/1.73 m2 nqe 12.2 thiab 11.4 mL/minute/1.73 m2 rau qhov sib npaug Cockcroft–Gault thiab rov hais dua 4-variable MDRD kab zauv, P=0. 04 rau ob qho tib si; 11.6 mL/minute/1.73 m2 rau CKD-EPI creatinine equation, P=0.11), raws li cov qhab nia zoo ntawm kev ua tau zoo (6.0 piv rau thaj tsam ntawm 1.0–2.0 rau lwm qhov sib npaug). GFR qeb duas thiab ntshav qab zib mellitus yog cov yam ntxwv tsis zoo uas cuam tshuam nrog qhov tseeb ntawm CKD-EPI creatinine-cystatin C sib npaug (=−0.184 thiab −0.113, P,0.001 thiab P=0.02, ntsig txog. ).
Xaus:
Piv nrog rau creatinine-based sib npaug, CKD-EPI(CMob raum mob Epidemiology)creatinine-cystatin C sib npaug yog tsim nyog rau cov neeg laus Suav. Txawm li cas los xij, qhov txiaj ntsig zoo ntawm CKD-EPI creatinine-cystatin C sib npaug rau kev siv tshuaj kho mob yuav tsum raug txiav txim siab.
Ntsiab lus:Cov neeg laus, sib npaug, glomerular filtration rate, serum creatinine, cystatin C
cistanche rau kev kho mobmob raum
Nyem rau cistanche deserticola ma thiab Cistanche khoom rau mob raum
Taw qhia
Mob raum mob (CKD)(Chronic raum mob)muaj ntau nyob rau hauv cov neeg laus.1 Glomerular filtration rate (GFR) yog qhov zoo tshaj plaws Performance index ntawm tag nrho lub raum kev ua haujlwm.2 Hauv ob txoj kev tshawb fawb dhau los, 3,4 peb pom tias creatinine-based GFR kwv yees sib npaug tsis haum rau cov neeg laus suav nrog CKD.(Chronic raum mob). Hauv qhov kev tshawb fawb tam sim no, ntau qhov kev txhim kho rau kev kawm tsim qauv tau ua. Ua ntej, cystatin C tau ntxiv los ua qhov kev kwv yees tshiab hloov pauv thiab tau taug qab mus rau cov qauv siv rau kev ntsuas cystatin C. Thib ob, GFR tau ntsuas los ntawm technetium-99m diethylene-triamine-penta-acetic acids (99mTc-DTPA) lub raum dynamic imaging txoj kev thiab tau calibrated sib npaug zos rau cov piv txwv dual plasma 99mTc-DTPA-GFR. Thib peb, tus qauv loj tau nce. Peb tsom los ntsuas qhov ua tau zoo ntawm CKD tshiab(Chronic raum mob)Epidemiology Collaboration (CKD-EPI)(CMob raum mob Epidemiology)creatinine-cystatin C equation5 nyob rau hauv ib pawg ntawm cov neeg laus Suav koom, piv nrog cov creatinine-raws li sib npaug.
Cov ntaub ntawv thiab cov txheej txheem
Cov neeg koom nrog
Cov neeg koom nrog hnub nyoog 60 xyoo lossis laus dua hauv Tsev Kho Mob Thib Peb ntawm Sun Yat-sen University, Tib Neeg Lub Tebchaws ntawm Tuam Tshoj tau tso npe rau thaum Lub Ib Hlis 2010 thiab Kaum Ob Hlis 2012. Cov txheej txheem tsis suav nrog: 1) mob raum tsis zoo, edema, cov leeg pob txha atrophy, pleural fusion los yog ascites, malnutrition, amputation, lub plawv tsis ua hauj lwm, thiab ketoacidosis, los yog 2) ntawm cimetidine los yog trimethoprim, los yog 3) raug kho nrog dialysis thaum lub sij hawm txoj kev tshawb no. Kev pom zoo kawm tau txais los ntawm lub koom haum tshuaj xyuas pawg thawj coj ntawm Lub Tsev Kho Mob Thib Peb ntawm Sun Yat-sen University. Kev pom zoo ntawm cov ncauj lus tau txais ua ntej pib qhov kev kawm.
cistanche rau kev kho mobmob raum
Laboratory txoj kev
GFR tau ntsuas los ntawm 99mTc-DTPA lub raum dynamic imaging txoj kev, 6,7 raws li tau piav yav dhau los.8 Raws li txoj kev tsim los ntawm Ma li al,9 peb txiav txim siab qhov tsawg kawg nkaus tus qauv loj yog 36 (95 feem pua ntawm kev ntseeg siab thiab 8{{ 53}} feem pua fais fab), siv Qhib Epi Version 2 10 los sib piv txhais tau tias (kom paub meej tias peb qhov ntsuas GFR [mGFR] qhov tseem ceeb tau ntsuas qhov sib npaug ntawm cov qauv ntshav dual 99mTc-DTPA-GFR). Kev suav yog raws li qhov kev tshawb pom hauv Suav yav dhau los.11 Peb tau xaiv 36 qhov xwm txheej (GFR ntsuas los ntawm DTPA lub raum dynamic imaging method, thaj tsam 15.6–106.3 mL / feeb / 1.73 m2) thiab ua ob txoj kev kuaj ntshav plasma 99mTc- DTPA clearance ib txhij nrog lub raum dynamic dluab. Tom qab tau txais cov ntshav, kuaj ntshav tau coj 2 thiab 4 teev tom qab txhaj tshuaj los ntawm lub puab tsaig rov qab. Lub plasma tau muab cais tawm, thiab cov xov tooj cua raug suav rau hauv ntau lub tshuab ua haujlwm zoo (ZD-6000 cov cuab yeej siv ntau yam; Zhida Technology Company, Xian, Tib Neeg Lub Tebchaws ntawm Tuam Tshoj).12 Lub 99mTc-DTPA lub raum dynamic imaging GFR ntsuas Hauv peb txoj kev tshawb fawb tuaj yeem ntsuas tau rau ob lub plasma kuaj 99mTc-DTPA clearance GFR siv cov kab rov tav kab rov tav: Dual plasma qauv 99mTc-DTPA-GFR (mL/minute/1.73 m2)=-2.586 ntxiv rau 1.106 × 99. lub raum dynamic imaging-GFR (mL/minute/1.73 m2) (R2 =0.872, P,0.001)
Ntshav creatinine qib tau ntsuas los ntawm txoj kev enzymatic ntawm Hitachi 7180 AutoAnalyzer (Hitachi Ltd, Tokyo, Nyiv; reagents los ntawm Roche Diagnostics, Mannheim, Lub teb chaws Yelemees), thiab recalibrated rau isotope dilution mass spectrometry. Serum cystatin C assays tau taug qab mus rau cov ntaub ntawv pov thawj (ERM-DA471). Kev ua haujlwm ntawm CKD-EPI(CMob raum mob Epidemiology)creatinine-cystatin C kab zauv tau muab piv nrog rau Cockcroft-Gault kab zauv, 13 qhov rov hais dua 4- hloov pauv hloov pauv ntawm Kev Noj Qab Haus Huv Hauv Lub Raum Kab Mob (MDRD) kab zauv, 14 thiab CKD-EPI(CMob raum mob Epidemiology)creatinine sib npaug 15 (Table 1).
Kev txheeb cais
Bias tau txhais raws li qhov nruab nrab ntawm qhov sib txawv ntawm mGFR thiab kwv yees GFR, thiab qhov tseeb tau ntsuas los ntawm qhov sib txawv ntawm qhov sib txawv (IQR) rau qhov sib txawv. Qhov tseeb tau txhais los ntawm ob qho tib si nruab nrab ntawm qhov sib txawv kiag li thiab qhov feem pua ntawm kev kwv yees GFR tsis sib txawv ntau dua 30 feem pua ntawm mGFR. Wilcoxon kos npe-qib xeem tau siv rau qhov sib txawv, bootstrap method16 rau IQR, thiab McNemar xeem rau 30 feem pua qhov tseeb. Kev ua tau zoo ntawm GFR kwv yees qhov sib npaug raug ntsuas los ntawm peb yam, suav nrog kev tsis ncaj ncees, qhov tseeb, thiab qhov tseeb. Cov qhab nia zoo tshaj plaws 4 tau tsim. Qhov sib npaug uas ua tau zoo tshaj plaws nyob rau hauv txhua yam hauv tag nrho pawg tau qhab nia li 1, thiab hauv txhua pawg GFR pawg li 0.5. Qhov ntau dua tag nrho cov qhab nia, qhov zoo ntawm cov khoom siv hluavtaws. Txhua qhov kev suav thiab txheeb cais tau ua tiav siv SPSS software (version 11.0; IBM Corporation, Armonk, NY, USA) thiab Matlab software (version 2011b; The Mathworks, Boston, MA, USA).
Cov txiaj ntsig
Tag nrho ntawm 431 tus neeg koom nrog hnub nyoog 60 xyoo lossis tshaj saud tau cuv npe. Qhov nruab nrab hnub nyoog yog 69.9 ± 6.8 xyoo thiab qhov nruab nrab mGFR yog 53.4 ± 26.9 mL / feeb / 1.73 m2. Cov yam ntxwv ntxaws ntxaws tau teev tseg hauv Table 2.
Txawm hais tias qhov kev tsis ncaj ncees ntawm CKD-EPI(CMob raum mob Epidemiology)creatinine-cystatin C sib npaug ntau dua nrog rau lwm qhov sib npaug (qhov nruab nrab qhov sib txawv, 5.7 mL / feeb / 1.73 m2 piv rau 0.4-2.5mL / feeb / 1.73m2, P, 0.001 rau Txhua qhov kev sib piv), qhov tseeb tau txhim kho nrog CKD-EPI(CMob raum mob Epidemiology)creatinine-cystatin C sib npaug (IQR rau qhov sib txawv, 19.5 mL / feeb / 1.73 m2 piv rau 23.0-23.6 mL / feeb / 1.73 m2, P, 0.001 rau txhua qhov sib piv), ua rau kev txhim kho me ntsis ntawm qhov raug (qhov nruab nrab qhov sib txawv, 10.5 mL / feeb / 1.73 m2 nqe 12.2 thiab 11.4 mL / feeb / 1.73 m2 rau Cockcroft-Gault equation thiab re-expressed 4-variable MD{RD{ sib npaug, P 28}}.04 rau ob qho tib si; thiab 11.6 mL / feeb / 1.73 m2 rau CKD-EPI(CMob raum mob Epidemiology)creatinine sib npaug, P{{0}}.11); 30 feem pua qhov tseeb, 59.9 feem pua vim 55.5 feem pua -57.5 feem pua, P.0.05 rau tag nrho (Table 3). Qhov kev ua tau zoo tshaj plaws tau tsim los ntsuas qhov ua tau zoo ntawm qhov sib npaug sib txawv (Table 4). Lub CKD-EPI(CMob raum mob Epidemiology)creatinine–cystatin C sib npaug ua tiav cov qhab nia zoo (6.0 piv rau ntau yam ntawm 1.0–2.0 rau lwm qhov sib npaug).
Peb tau siv ntau qhov kev ntsuam xyuas rov qab los txiav txim siab txog qhov cuam tshuam rau qhov tseeb ntawm CKD-EPI(CMob raum mob Epidemiology)creatinine-cystatin C sib npaug, nrog 30 feem pua qhov tseeb ntawm CKD-EPI creatinine-cystatin C sib npaug raws li qhov sib txawv thiab GFR pawg (qib 1: 1; qeb 2; 2: qeb 3; 3: qeb 4; 4: qeb 5 ; 5), hnub nyoog (#65 xyoo: 1; .65 xyoo: 2), poj niam txiv neej (txiv neej: 1; poj niam: 2), ntshav qab zib (tsis yog ntshav qab zib: 1; ntshav qab zib: 2), lub cev qhov hnyav (,20 kg / m2: 1; $ 20 kg / m2 thiab , 25 kg / m2: 2; $ 25 kg / m2 thiab # 30 kg / m2: 3; .30 kg / m2: 4) raws li cov kev hloov pauv ywj pheej rau kev ntsuas kev rov qab. Peb pom tias ob hom GFR siab dua thiab ntshav qab zib yog qhov muaj kev ywj pheej uas cuam tshuam tsis zoo nrog 30 feem pua qhov tseeb ntawm CKD-EPI.(CMob raum mob Epidemiology)creatinine-cystatin C equation ({0}}}−0.184 thiab −0.113, P,0.001 thiab P=0.02, ntsig txog).
Kev sib tham
Tsis ntev los no, kev ntsuas ntawm cov ntshav cystatin C tau tawm tswv yim raws li ib qho yooj yim, txhim khu kev qha, thiab yog tus cim ntawm GFR.17Cystatin C yog cov protein uas tsis muaj molecular hnyav uas tau lim dawb thoob plaws glomerular barrier thiab yuav luag tag reabsorbed thiab catabolized los ntawm tubular cells.17 Ib qho kev sib npaug cystatin-C-raws li muaj ntau yam zoo dua li creatinine-raws li ib qho hauv kev ntsuam xyuas ntawm lub raum ua haujlwm hauv cov neeg laus vim tias creatinine-raws li ib qho tuaj yeem cuam tshuam los ntawm kev txo cov leeg nqaij thiab lwm yam teeb meem xws li hnub nyoog, haiv neeg, poj niam txiv neej. , ntshav qab zib , thiab kev hloov pauv txhua hnub. Txawm li cas los xij, tseem tsis tau muaj pov thawj qhia meej txog qhov ua tau zoo tshaj plaws hauv cov neeg no hauv kev kho mob.18,19 Tsis tas li ntawd, kev kwv yees cystatin-C-raws li GFR kuj tau pom tsuas yog kev txhim kho tsuas yog qhov sib piv rau creatinine-based formula.18 Hauv 2012, a new CKD-EPI(CMob raum mob Epidemiology)Kev sib npaug ntawm creatinine-cystatin C tau tsim los ntawm cov ntshav cystatin C thiab creatinine. Qhov sib npaug ua ke ua tau zoo dua qhov sib npaug raws li tus cim ib leeg.5 Txawm li cas los xij, CKD-EPI creatinine-cystatin C sib npaug tsis tau lees paub rau cov neeg laus. Txoj kev tshawb fawb tam sim no tau tsim los ntsuas nws qhov kev ua tau zoo hauv kev kwv yees GFR rau cov neeg laus Suav.
Hauv txoj kev tshawb no, peb pom tias txawm tias qhov kev tsis ncaj ncees ntawm CKD-EPI(CMob raum mob Epidemiology)creatinine-cystatin C sib npaug yog ntau dua li lwm qhov sib npaug creatinine-raws li, qhov tseeb tau txhim kho nrog CKD-EPI.(CMob raum mob Epidemiology)creatinine-cystatin C sib npaug, ua rau kev txhim kho me ntsis ntawm qhov raug thiab cov qhab nia zoo ntawm kev ua tau zoo ib yam. Ob pawg GFR siab dua thiab ntshav qab zib yog qhov muaj kev ywj pheej tsis zoo cuam tshuam nrog 30 feem pua qhov tseeb ntawm CKD-EPI creatinine-cystatin C sib npaug. Cov txiaj ntsig no tau lees paub tias kev sib xyaw ua ke ntawm cov cim pom tshiab, xws li cystatin C thiab ntshav creatinine, rau hauv GFR kwv yees mis, yuav yog tus yuam sij rau kev txhim kho qhov raug.
Muaj qee qhov kev txwv rau txoj kev tshawb no. Ua ntej, cov kev kawm tau sawv cev rau pawg neeg laus tshwj xeeb hauv Cov Neeg Sawv Cev ntawm Tuam Tshoj; xav tau kev lees paub ntxiv rau lwm lub hnub nyoog lossis haiv neeg. Thib ob, qhov sib txawv ntawm qhov ntsuas ntawm GFR qhia txog kev tsis ncaj ncees.20 Thib peb, GFR kwv yees qhov sib npaug tuaj yeem cuam tshuam los ntawm qhov sib txawv ntawm mGFR kev faib tawm thiab qhov ua rau muaj kab mob hauv cov pejxeem.21
Hauv cov ntsiab lus, piv cov creatinine-raws li kev sib npaug, CKD-EPI(CMob raum mob Epidemiology)creatinine-cystatin C sib npaug yog tsim nyog rau cov neeg laus Suav. Txawm li cas los xij, tus nqi-zoo ntawm CKD-EPI(CMob raum mob Epidemiology)creatinine-cystatin C sib npaug rau kev siv tshuaj kho mob yuav tsum xav txog.
cistanche rau kev kho mobmob raum
Kev lees paub
Txoj haujlwm no tau txais kev txhawb nqa los ntawm National Natural Science Foundation ntawm Tuam Tshoj (tus lej nyiaj 81370866 thiab tus lej 81070612), Tuam Tshoj Postdoctoral Science Foundation (tus lej nyiaj 201104335), Guangdong Science thiab Technology Plan (tus lej nyiaj 2011B031800084), Cov Nyiaj Tshawb Fawb Txog Kev Tshawb Fawb rau Central Universities (tus lej nyiaj pub dawb 11ykpy38), thiab National Project of Scientific thiab Technical Supporting Programs Funded los ntawm Ministry of Science thiab Technology ntawm Tuam Tshoj (grant tooj 2011BAI10B00). Txoj haujlwm no kuj tau txais kev txhawb nqa los ntawm National Natural Science Foundation ntawm Tuam Tshoj (tus lej nyiaj 91029742, 81170647, thiab 81370837 rau Hui Huang).
Qhia tawm
Cov neeg sau ntawv tshaj tawm tsis muaj qhov tsis sib haum xeeb ntawm kev txaus siab hauv txoj haujlwm no.
Cov ntaub ntawv
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