Kev hloov pauv ntawm Lub Cev Cov Ntsuas Lub Cev Thiab Lub Raum Ua Haujlwm Ntawm Cov Tshuaj Insulin rhiab heev ntawm cov neeg mob uas muaj CKD thiab tswj kev noj qab haus huv
Mar 16, 2022
Hu rau: Audrey Hu Whatsapp / hp: 0086 13880143964 Email:audrey.hu@wecistanche.com
Elvis A. Aw1,2,3,6, Melis Sahinoz4,6, Aseel Alsouqi4, Edward D. Siew1,2,3 , T. Alp Ikizler1,2,3,7thiab Adriana M. Hung1,2,3,5,7
1Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA;2Vanderbilt Center rau Kab Mob Raum, Nashville, Tennessee, USA;3Tennessee Valley Healthcare System, Nashville VA Medical Center, Nashville, Tennessee, USA;4Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; thiab5Vanderbilt Precision Nephrology Program, Nashville, Tennessee, Tebchaws USA
Kev Taw Qhia: Insulin tsis kam thiab rog rog muaj ntau nyob hauvmob raum mob(CKD) cov neeg mob. Kev sib cuam tshuam ntawmlub cev index(BMI) thiabraummuaj nuj nqithoob plaws qhov txuas ntxiv ntawm kwv yees glomerular filtration rate (eGFR) tsis paub. Txoj Kev: Hauv kev tshawb nrhiav ntu ntu ntawm 139 tus neeg mob, 52 nrog CKD (mob raum mob) theem 3 thiab 4 thiab 87 cov neeg mob uas muaj eGFR ib txwm, peb ntsuas qhovinsulin rhiab heevindex (ISI) using the hyperinsulinemic-euglycemic clamp and homeostasis model assessment of insulin resistance (HOMA-IR). We investigated the interaction between eGFR and BMI in their association with ISI and HOMA-IR using linear models with robust standard errors. Results: Median age was 56 (42, 66) years, 50.4% were female, and 36% were African American. Patients with low eGFR (w30 ml/min per 1.73 ㎡ ) had low ISI (2.3 mg/min per mU/ml) regardless of BMI. Among patients with preserved eGFR (>90 ml / min ib 1.73㎡), BMI muaj qhov cuam tshuam ntau dua ntawm ISI (6.3 mg / min ib mU / ml ntawm BMI ntawm 20 kg / ㎡ vs. 4.6 mg / min ib mU / ml ntawm ib BMI ntawm 30 kg/㎡ ) (P rau kev sib cuam tshuam =0.046). Hauv cov qauv hloov kho rau cov pej xeem thiab kev hloov pauv ntawm cov interleukin -6, high-rhiab heev C-reactive protein, leptin, thiab adiponectin, ib tug 1-SD (28 ml / min ib 1.73 ㎡) qis eGFR yog txuam nrog ib qho tseem ceeb statistical 1.14-unit poob hauv ISI (95 feem pua ntawm kev ntseeg siab ib ntus=1.80, -0.48) ntawm cov neeg mob uas tsis muaj mob hnyav. Ntawm cov neeg mob rog, qhov txiaj ntsig kwv yees yog -0.25 (95 feem pua ntawm kev ntseeg siab =- 0.88, 0.39). Kev sib raug zoo ntawm BMI thiab HOMA-IR muaj zog dua rau cov neeg mob uas qis dua eGFR (P rau kev sib cuam tshuam =0.005). Xaus: Ob leeg eGFR thiab BMI yog nws tus kheej cuam tshuam nroginsulin rhiab heev, tab sis lub zog ntawm kev sib koom ua ke ntawm BMI thiabinsulin rhiab heevNws txawv ntawm eGFR.
Raum Int Rep (2021) 6, 2811–2820; https://doi.org/10.1016/j.ekir.2021.08.031
KEYWORDS:mob raum mob; insulin tsis kam; kev sib cuam tshuam;lub raum ua haujlwm; Kev rog rog Tshaj tawm los ntawm Elsevier Inc. sawv cev ntawm International Society of Nephrology. Qhov no yog ib tsab xov xwm qhib-access nyob rau hauv daim ntawv tso cai CC BY-NC-ND
Cistanche tuaj yeem khomob raum mob& txhim kho lub raum ua haujlwm
Insulin kuj muaj nyob rau hauv cov neeg mobmob raum mob(CKD) thiab tej zaum yuav sawv cev rau kev sib txuas tseem ceeb ntawm CKD(mob raum mob)thiab cov kab mob plawv ntxiv (CVD) raug pom nyob rau hauv cov pej xeem no. Cov ntaub ntawv ua ntej qhia tias hauv CKD, insulin tsis kam tuaj yeem cuam tshuam feem ntau rau kev sib txuas ntawm cov tshuaj insulin hauv cov leeg pob txha 1; Txawm li cas los xij, nws cov metabolic correlates yog multifactorial, xws li ib tug txo nyob rau hauv clearance thiab dysregulation ntawm adipocytokines, hyperinsulinemia, systemic o, thiab muaj zog oxidative kev nyuaj siab. tiv thaiv thiab sib txuas cov kev pheej hmoo ntawm downstream cardio-metabolic cuam tshuam nrog rau cov piam thaj metabolism tsis zoo, endothelial dysfunction, thiab CVD. Qhov muaj peev xwm sib cuam tshuam ntawm qhov cuam tshuam ntawm kev puas tsuajlub raum ua haujlwmthiab rog rog ntawm insulin kuj yuav cuam tshuam nrog lub luag haujlwm ua los ntawm adipocytokines leptin thiab adiponectin, zais los ntawm cov ntaub so ntswg adipose thiab feem ntau tshem tawm los ntawm lub raum. Leptin thiab adiponectin sib sau ua kelub raum ua haujlwmrov 7,8;. Hauv kev saib xyuas cov neeg mob hemodialysis, qhov sib piv ntawm leptin-rau-adiponectin tau pom tias yog qhov zoo tshaj plaws sib cuam tshuam ntawm cov tshuaj insulin tsis kam lees tiv thaiv tus qauv kub hyperinsulinemic-euglycemic clamp, thaum piv rau ntau qhov kev siv cov ntsuas ntsuas ntawm insulin tsis kam xws li kev ntsuas tus qauv homeostasis. Cov tshuaj insulin tsis kam (HOMA-IR) thiab qhov ntsuas qhov ntsuas qhov ntsuas qhov ntsuas ntawm qhov ntsuas (QUICKI).
Qhov muaj peev xwm sib cuam tshuam ntawmlub raum ua haujlwmthiab ntsuas kev rog - suav nrog adipocytokines - raws li kev kwv yees ntawminsulin rhiab heevntawm cov neeg tsis muaj ntshav qab zib nrog lossis tsis muaj CKD(mob raum mob)tsis tau kawm kom ntxaws. Lub hom phiaj ntawm txoj kev tshawb no yog los tshawb xyuas qhov kev sib cuam tshuam ntawm kwv yees glomerular filtration rate (eGFR) thiab kev ntsuas tus nqi ntawm adiposity (lub cev indexthiab serum leptin) nyob rau hauv lawv cov koom haum nrog (i) peripheralinsulin rhiab heevntsuas los ntawm clamp derived insulin rhiab heev index (ISI), thiab (ii) hepaticinsulin rhiab heevntsuas siv HOMA-IR Performance index, nyob rau hauv ib qho piv txwv ntawm nondiabetic cov ntsiab lus nrog khaws cialub raum ua haujlwmthiab CKD theem 3 thiab 4.
Cov khoom siv thiab cov txheej txheem
Tsim thiab Kawm Qauv
Insulin Resistance nyob rau hauvMob raum mob(IRCKD) txoj kev tshawb fawb yog kev tshawb nrhiav chaw kho mob hla ntu uas tau tso npe rau 140 yam: 52 tus neeg mob CKD(mob raum mob)theem 3 thiab 4 thiab 88 tswj (eGFR> 60 ml / min ib 1.73 ㎡). Cov neeg mob CKD tau raug xaiv los ntawm Nashville Veterans Affairs (VA) chaw kho mob. Kev tswj hwm tau raug xaiv los ntawm Researchmatch.org, Vanderbilt University Medical Center e-mail faib cov npe, thiab cov ntawv tshaj tawm hauv cov chaw kho mob sab nraud. Txhua tus neeg koom nrog kev tshawb fawb tsis yog mob ntshav qab zib hauv kev tso npe thiab muaj ib qholub cev index (BMI) >18 kg / ㎡. Ntshav qab zib cov xwm txheej tau txheeb xyuas los ntawm keeb kwm kev kho mob, daim ntawv tshuaj xyuas, kev siv tshuaj tiv thaiv kab mob ntshav qab zib, glycated hemoglobin, lossis ceev cov piam thaj. Hauv pab pawg CKD, peb suav nrog cov neeg mob $ 18 xyoo nrog eGFR<60 ml/min="" per="" 1.73="" ㎡="" without="" proteinuria="">5 g / 24 h, leej twg muaj ntshav siab<160 00="" mm="" hg,="" with="" no="" change="" in="" their="" blood="" pressure="" medications="" 1="" month="" prior="" to="" enrollment.="" controls="" were="" 50="" to="" 80="" years="" of="" age="" and="" prehypertensive="" (systolic="" blood="" pressures="" 120-139="" mm="" hg="" and/or="" diastolic="" blood="" pressure="" 80-89="" mm="" hg)="" who="" had="" an="" egfr="" $60="" ml/min="" per="" 1.73="" ㎡="" with="" no="" proteinuria.="" controls="" on="" antihypertensive="" therapy="" were="" excluded.="" given="" our="" focus="" on="" investigating="" patterns="" of="">insulin rhiab heevntawm cov neeg rog rog thiab ib txwm-yuag cov neeg mob raws lilub raum ua haujlwmNtxiv mus, peb tsis suav cov neeg mob uas muaj BMI<18 kg/㎡="" (considered="" to="" be="">
Hauv ob pawg, peb tsis suav nrog cov poj niam cev xeeb tub lossis pub niam mis, cov neeg mob ntawm cov tshuaj insulin rhiab heev rau kev kho mob ntawm metabolic syndrome, cov neeg mob uas muaj lub plawv tsis ua haujlwm, lossis cov neeg uas muaj qhov mob CVD hauv 6 lub hlis dhau los. Peb kuj tsis suav nrog cov neeg mob uas tau txais cov kab mob glucocorticoids / immunomodulators hauv 1 lub hlis ntawm kev tso npe lossis muaj cov kab mob hnyav / mob hnyav. Txoj kev tshawb fawb no tau pom zoo los ntawm Vanderbilt University Medical Center thiab VA lub koom haum saib xyuas, thiab tau txais kev pom zoo los ntawm txhua tus neeg koom.
Cov txheej txheem kawm
Ntshav kuaj
Cov qauv siv los ntsuas cov piam thaj tau ua tiav siv GM9 glucose analyzer (Analox Instruments, Atlanta, GA). Cov qauv rau cov tshuaj insulin, adiponectin, thiab leptin tau kos rau hauv ethylenediaminetetraacetic acid (EDTA) hlab, centrifuged li ntawm 10 mus rau 15 feeb ntawm 3000 RPM, thiab khaws cia ntawm -800. Cov tshuaj insulin thiab leptin tau soj ntsuam ntawm Vanderbilt's Hormonal Lab Core. Lub siab molecular-yuag adiponectin thiab interleukin 6 (IL-6) tau ntsuas los ntawm enzyme-linked immunosorbent assay (R&D Systems, Minneapolis, MN) thiab high-rhiab heev C-reactive protein (hsCRP) tau ntsuas ntawm Vanderbilt Clinical laboratory. los ntawm txoj kev immunoturbidimetric.
Hyperinsulinemic Euglycemic Clamp
Lub clamp tau ua los soj ntsuam tag nrho lub cev cov piam thaj pov tseg hauv txhua tus neeg koom nrog kev kawm tom qab 8- teev ib hmos ceev ceev siv cov txheej txheem qabzib uas tau piav qhia los ntawm DeFronzo li al.10 Luv luv, 2 peripheral iv catheters tau muab tso rau hauv lub sab sauv, thiab cov ntshav yoo mov tau kos. Ib qho iv infusion ntawm tib neeg cov tshuaj insulin (50 units / 50 ml ntawm 0.9 feem pua cov kua qaub ib txwm siv) tau pib ntawm tus nqi tas li ntawm 80 mU / m2 ib min rau cov neeg mob CKD thiab 40 mU / m2 ib min rau kev tswj kom ua tiav hyperinsulinemia, inhibits hepatic qabzib ntau lawm, thiab ua kom cov piam thaj pov tseg hauv cov leeg pob txha. Vim tias muaj zog tiv thaiv cov tshuaj insulin hauv CKD(mob raum mob)Cov neeg mob piv rau kev tswj hwm, kev siv tshuaj insulin ntau dua yuav tsum tau ua kom tiav cov piam thaj hauv siab. Raws li qhov tshwm sim, kev txhaj tshuaj ntawm 20 feem pua dextrose tau muab tso rau ntawm tus nqi sib txawv txhawm rau txhawm rau "clamp" cov ntshav qabzib ntau hauv euglycemic ntau yam (90-105} mg / dl), thiab lub ntsuas ntshav qab zib tau siv los ntsuas ntshav qabzib txhua. 5 feeb. Ib qho kev txhaj tshuaj ntawm potassium phosphate kuj tau muab los tiv thaiv hypokalemia uas tshwm sim los ntawm hyperinsulinemia. Tsis pub dhau 150 feeb ntawm kev pib ntawm cov tshuaj insulin, ib qho chaw ruaj khov ntawm euglycemia, txhais tau tias yog<10% variation="" in="" blood="" glucose="" readings="" for="" $30="" minutes="" at="" a="" constant="" infusion="" of="" 20%="" dextrose,="" was="">
Piv txwv tias kev tsim cov piam thaj hauv siab tau raug txwv los ntawm lub xeev hyperinsulinemic thiab tsis muaj qhov hloov pauv hauv cov ntshav qabzib hauv cov ntshav qabzib nyob rau hauv cov xwm txheej tsis tu ncua, peb kwv yees cov piam thaj pov tseg (M), uas yog sib npaug rau qhov nruab nrab qabzib infusion tus nqi thaum lub sijhawm khov kho. - xeev. Qhov kwv yees M tus nqi yog normalized rau lub cev hnyav thiab siv los xam cov clamp-derived ISI.
Cistanche tuaj yeem kho mob raum mob
Cov txiaj ntsig kawm
Cov kev hloov pauv tseem ceeb rau txoj kev tshawb no yog cov leeg thiab lub siabinsulin rhiab heevntsuas siv clamp-derived ISI thiab HOMA-IR, feem. Tus qauv kub rau kev ntsuas peripheral insulin rhiab heev yog qhov hyperinsulinemic-euglycemic clamp, uas ntsuas tag nrho lub cev.insulin rhiab heevnyob rau hauv vivo raws li nws ncaj qha ntsuas cov piam thaj pov tseg tom qab kev tawm tsam ntawm cov piam thaj hauv siab nyob rau hauv cov xwm txheej tsis tu ncua.10 HOMA-IR yog cov khoom lag luam ntawm cov ntshav plasma insulin sai thiab qabzib, uas yog qhov ntsuas ntawm lub siab insulin tsis kam11.
ISI=M/(G × DI), 12 qhov twg M yog cov piam thaj pov tseg hauv mg/kg/min thiab suav ua M= (dextrose infusion tus nqi ntawm lub xeev khov kho hauv ml / h × 184) / (qhov hnyav hauv kg × 60); G yog qhov nruab nrab-lub xeev cov piam thaj hauv mg / dl; thiab DI yog qhov sib txawv ntawm cov tshuaj insulin plasma thaum pib thiab qhov kawg ntawm lub sijhawm tsis tu ncua ntsuas hauv mU / ml. HOMA-IR=fasting serum insulin (mU/ml) × fasting plasma glucose (mg/dl)/405.5,11,13,14
Covariates
Lub ntsiab kev ywj pheej hloov pauv rau txoj kev tshawb no yog eGFR, BMI (qhov hnyav [kg] / qhov siab [m]2), thiab serum leptin. Lub eGFR tau suav nrogMob raum mobEpidemiology Collaboration (CKD-EPI) equation.15 Cov neeg koom tau raug cais raws li kev rog raws li Lub Koom Haum Saib Xyuas Kev Noj Qab Haus Huv Ntiaj Teb txiav cov ntsiab lus raws li BMI $ 30 kg / m2, thiab CKD tau txhais tias yog eGFR<60 ml/="" min="" per="" 1.73="">2. Covariates suav nrog cov pej xeem, cov cim kab mob (IL-6 thiab hsCRP), thiab adipocytokines (adiponectin thiab leptin).
Kev txheeb cais
Kev sib cuam tshuam ntawm eGFR thiab Nruam BMI raws li kev txiav txim ntawm ISI thiab HOMA-IR
Ib tus qauv sib txawv ntawm cov kab rov ua dua qub tau haum nrog ISI raws li qhov sib txawv ntawm qhov sib txawv; eGFR thiab BMI raws li qhov tseem ceeb ntawm kev ywj pheej sib txawv ( qauv linearly), thiab suav nrog eGFR BMI cov sij hawm sib cuam tshuam. Kev kwv yees ntawm txhais tau tias ISI tau txais rau qhov ntau ntawm qhov tseem ceeb ntawm eGFR thiab BMI uas peb muaj cov ntaub ntawv tshaj plaws (2.5th rau 97.5th feem pua). Tus qauv-raws li kev kwv yees ntawm txhais tau tias ISI tau npaj tawm tsam ob qho tib si eGFR thiab BMI siv cov phiaj xwm contour los qhia cov qauv kev sib cuam tshuam. Qhov kev soj ntsuam no tau rov ua dua siv log leptin nyob rau hauv qhov chaw ntawm BMI raws li kev ntsuas ntawm cov rog ua haujlwm. Tag nrho cov kev ntsuam xyuas saum toj no tau rov ua dua rau HOMA-IR raws li qhov sib txawv ntawm qhov sib txawv
Kev sib raug zoo ntawm eGFR thiab Kev Ntsuas ntawmInsulin rhiab heevHla BMI Pawg
Txhawm rau tshawb xyuas qhov muaj peev xwm hloov pauv ntawm kev koom tes ntawm eGFR nrog ISI los ntawm kev rog rog, ib qho qauv kab nrog ISI raws li qhov sib txawv ntawm qhov sib txawv tau haum nrog cov kev txwv hauv qab no: eGFR, BMI qeb (obese vs. nonobese), thiab eGFR × BMI qeb kev sib cuam tshuam lub sij hawm (model 1). Cov kab sib txawv tau siv los ua kom tau qhov sib txawv nruab nrab (b) hauv ISI ib qho kev hloov pauv SD hauv eGFR ntawm cov neeg rog rog thiab tsis muaj rog. Qhov kev tshuaj ntsuam no tau rov qab siv HOMA-IR qhov ntsuas raws li qhov sib txawv ntawm qhov sib txawv. Cov qauv tom qab tau hloov kho rau cov qib plasma ntawm cov cim inflammatory (IL-6 thiab hsCRP) thiab adipocytokines (leptin thiab adiponectin) hauv cov qauv 2. Cov kev hloov pauv no (IL-6, hsCRP, adiponectin, thiab leptin) tau teev tseg. -hloov thiab ua qauv siv txwv cubic splines nrog 4 knots. Knots tau muab tso rau ntawm qhov ntau ntawm cov kev faib tawm, sib npaug sib npaug hauv cov qauv loj.16 Cov txiaj ntsig tsis txaus ntseeg tau raug tshuaj xyuas los ntawm kev hloov kho ntxiv rau hnub nyoog, poj niam txiv neej, thiab haiv neeg hauv cov qauv 3. Kev soj ntsuam txwv rau kev tswj kev noj qab haus huv kuj tau ua.
Hauv kev ntsuam xyuas tag nrho, kho qhov sib txawv ntawm HOMA-IR cov qhab nia tau suav nrog 4 pawg (CKD / rog, CKD / nonobese, non-CKD / rog, nonobese / non-CKD) siv cov qauv linear, nrog cov pab pawg nonobese / non-CKD raws li cov qeb hais.
Tag nrho cov qauv tau tsim los siv cov txheej txheem tsis zoo los ua kom cov kev xav ntawm homoscedasticity. A 2- ib sab 5 feem pua qhov tseem ceeb theem tau siv rau kev txheeb cais, thiab txhua qhov kev tshuaj ntsuam tau ua tiav siv Stata version 15.1 (StataCorp LLC, College Station, TX). Muaj 6 qhov tseem ceeb uas ploj lawm rau hsCRP, 2 rau serum adiponectin, thiab 1 rau ntshav IL-6. Ua tiav cov ntaub ntawv txheeb xyuas tau ua tiav.
Cistanche tuaj yeem kho mob raum mob
TSEEM CEEB
Cov yam ntxwv tseem ceeb ntawm Cov Qauv Kawm
Cov yam ntxwv hauv paus ntawm 139 tus neeg koom (52 CKD cov neeg mob thiab 87 kev tswj hwm) suav nrog hauv cov kev tshuaj ntsuam no tau nthuav tawm hauv Table 1. Cov hnub nyoog nruab nrab yog 56 xyoo (interquartile range [IQR]=42, 66); 49.6 feem pua yog txiv neej thiab 36 feem pua yog African American. Median (IQR) eGFR ntawm CKD(mob raum mob)Cov neeg mob thiab kev tswj hwm yog 46.1 (40.4, 52.6) thiab 94.3 (84.9, 107.0) ml / min ib 1.73 m2, raws. Piv rau kev tswj hwm, CKD(mob raum mob)Cov neeg mob laus dua, feem ntau yuav rog, thiab muaj ntshav siab systolic. Cov neeg mob CKD kuj tseem muaj cov piam thaj ntau dua nruab nrab, yoo mov insulin, HOMA-IR, thiab cov ntshav leptin, tab sis muaj qis dua adiponectin, M qhov tseem ceeb, thiab ISI piv rau cov tswj (Table 1).
Table 1. Cov yam ntxwv tseem ceeb ntawm cov neeg koom nrog kev kawm
cov ntaub ntawv rau qhov sib txawv tsis tu ncua yog nthuav tawm raws li qhov nruab nrab (interquartile range). boost ntawm-pab pawg sib piv yog qhov tseem ceeb (P=0.005 rau SBP, P=0.02 rau BMI, thiab P <0.001 rau="" qhov="" sib="" txawv)="" tshwj="" tsis="" yog="" haiv="" neeg,="" leptin,="" thiab="" adiponectin.="" cckd=""><60 ml/min="" per="" 1.73="">2. Thaum lub sij hawm cov protein thiab creatinine qib tau ntsuas nyob rau hauv cov zis kuaj.
Kev sib raug zoo ntawm eGFR, BMI, thiab ISI
Log ISI tau zoo sib raug zoo nrog eGFR (r=0.39) thiab inversely correlated nrog BMI (r= -0.30) thiab log leptin (r= -0.42). Cov phiaj xwm contour hauv daim duab 1a qhia txog kev koom tes ntawm ISI nrog eGFR thiab BMI. Cov neeg mob uas tau concurrently qhov qis tshaj eGFR thiab siab tshaj BMI qhov tseem ceeb muaj qhov qis tshaj ISI (2.3 mg / min ib mU ib ml; piav qhia nyob rau sab sauv-sab laug ntawm daim phiaj), thaum cov neeg koom nrog kev kawm nrog ob qho tib si siab tshaj eGFR thiab qis BMI qhov tseem ceeb. muaj qhov siab tshaj plaws txhais tau tias ISI (7.4 mg / min ib mU ib ml; piav qhia hauv qab sab xis ntawm cov phiaj xwm). Lub accentuated curvature ntawm cov kab contour yog qhia txog kev sib cuam tshuam ntawm BMI thiab eGFR hauv kev koom tes nrog ISI. Hauv daim duab 1a, cov neeg mob uas tsis tshua muaj eGFR (tshwj xeeb, cov paj qis ntawm CKD(mob raum mob)theem 3, w30 ml / min rau 1.73 m2) muaj ISI qis (2.9 mg / min ib mU ib ml, thiab yog li insulin resistant) txawm tias BMI nyob rau hauv ib txwm muaj ({2}}.9 kg / m2). Thaum siab dua eGFR, muaj kev hloov pauv ntau dua hauv ISI ib chav hloov pauv hauv BMI. Piv txwv li, ntawm eGFR ntawm 90 ml / min rau 1.73 m2, qhov nruab nrab ISI yog 6.3 ntawm BMI ntawm 20 kg / m2thiab tsuas yog 4.6 ntawm BMI ntawm 30 kg / m2, qhov sib txawv ntawm 1.7 units. P-tus nqi rau kev sib cuam tshuam yog 0.046, qhia qhov sib txawv ntawm kev koom tes ntawm BMI thiab ISI ntawm qis dua eGFR siab dua. Cov qauv kev sib cuam tshuam zoo sib xws tau pom hauv kev txheeb xyuas kev sib cuam tshuam siv log leptin nyob rau hauv qhov chaw ntawm BMI (Cov Duab Ntxiv S1). Ntawm qhov qis eGFR ntawm 30 ml / min rau 1.73 m2, txhais tau tias ISI tseem qis ntawm 3.0 mg/min ib mU ib ml, nrog nce nqi ntawm log leptin los ntawm 1.4 mus rau 2.9. Ntawm qhov siab dua eGFR ntawm 90 ml / min rau 1.73 m2, qhov zoo sib xws hauv log leptin (los ntawm 1.4 txog 2.9) tau cuam tshuam nrog kev poob qis hauv qhov ntsuas ISI los ntawm 7.8 mus rau 5.4 mg / min ib mU ib ml. P-tus nqi rau kev sib cuam tshuam yog 0.01, qhia qhov sib txawv tseem ceeb hauv kev koom tes ntawm cov log leptin thiab ISI qis dua piv rau siab dua eGFR.
Daim duab 1b qhia qhov chaw sib txawv rau txoj kab sib txuas ntawm ISI thiab eGFR hla BMI cate gories. Qhov kev rov qab nqes hav rau kev koom tes ntawm eGFR thiab ISI tau ntau dua hauv cov neeg tsis muaj rog piv rau cov neeg rog rog. A 1-SD (28 ml/min ib 1.73 m2) eGFR qis dua tau cuam tshuam nrog qhov tseem ceeb 1.33-unit qis (95 feem pua ntawm kev ntseeg siab [CI]=-1.97, -0.70) ISI ntawm cov neeg koom nrog tsis muaj rog thiab tsuas yog ib qho {{30}} xwb. ) ISI ntawm cov neeg rog rog (P rau kev sib cuam tshuam =0.04). Ntawm cov kev kawm uas tsis yog neeg laus, tom qab kev hloov kho rau lub log IL-6, log hsCRP, log leptin, thiab log adiponectin, qis eGFR tseem cuam tshuam nrog ISI qis dua (b=-1}.36; 95 feem pua CI {{20. }}.02, - 0.70) (Table 2). Hauv cov neeg rog rog, muaj qhov cuam tshuam loj heev ntawm txoj kab nqes rov qab ntawm eGFR thiab ISI (b=-0.40; 95 feem pua CI=-0.83, 0.04), uas tsis muaj qhov tseem ceeb ntxiv lawm. Hauv cov qauv hloov kho ntxiv rau cov pej xeem (hnub nyoog, poj niam txiv neej, thiab haiv neeg), cov qauv zoo sib xws tau raug soj ntsuam rau cov tsis muaj mob (b=-1.14; 95 feem pua CI=-1.80, -0.48) thiab rog (b=-0.25; 95 feem pua CI=-0.88, 0.39) cov neeg mob. Peb pom cov qauv zoo sib xws hauv kev tsom xam txwv rau kev tswj cov ntsiab lus. Tom qab kev hloov pauv tag nrho rau cov pej xeem (hnub nyoog, poj niam txiv neej, thiab haiv neeg), log IL-6, log hsCRP, log leptin, thiab log adiponectin, ib qho 1-SD qis eGFR tseem cuam tshuam nrog qhov tseem ceeb 2.{{ 50}}unit qis (95 feem pua CI=-3.96, -0.15) ISI hauv cov ntsiab lus tsis muaj neeg coob tab sis tsuas yog qhov tsis tseem ceeb 0.80-unit qis (95 feem pua CI=-2 }.01, 0.41) ISI ntawm cov neeg rog rog. Daim duab 1c qhia tau hais tias qhov kev sib hloov ntawm txoj kab nqes qis dua rau kev koom tes ntawm 1-SD siab dua BMI nrog ISI ntawm cov neeg koom nrog eGFR $ 60 (b=-0.97; 95 feem pua CI=-1.55, {{71 }}.38) piv rau cov neeg mob nrog eGFR<60 (b="-0.43;" 95%="" ci="-0.82," -="">
Cistanche tuaj yeem txhim kho lub raum ua haujlwm
Kev sib raug zoo ntawm eGFR, BMI, thiab HOMA-IR
Log HOMA-IR tau inversely correlated nrog eGFR (r=-0.49) thiab zoo correlated nrog BMI (r=0.52) thiab log leptin (r=0.46). Daim duab 2a qhia txog kev koom tes ntawm HOMA-IR nrog eGFR thiab BMI. HOMA-IR cov qhab nia qis dua rau cov neeg uas muaj eGFR siab dua piv rau qis eGFR, ntawm txhua tus nqi BMI. Piv txwv li, ntawm BMI ntawm 30 kg / m2HOMA-IR yog 2.1 rau cov neeg uas muaj eGFR ntawm 120 ml / min rau 1.73 m2piv rau 4.8 rau cov neeg uas muaj eGFR ntawm 30 ml / min ib 1.73 m2. Yog li, cov neeg uas muaj eGFR siab dua (120 ml / min ib 1.73 m2) yog cov insulin rhiab heev (tsawg HOMA-IR) txawm tias muaj BMI hauv cov rog rog. Qhov tseem ceeb tshaj, qhov kev hloov pauv hauv HOMA-IR ib chav hloov pauv hauv BMI tau ntau dua ntawm eGFR qis dua piv rau siab dua eGFR (raws li pov thawj los ntawm qhov ntau dua gradient ntawm contours ntawm qis dua vs. siab dua eGFR). Ntawm cov neeg uas muaj eGFR siab dua (120 ml / min ib 1.73 m2), HOMA-IR cov qhab nia tseem qis ntawm 2.1 nrog nce BMI qhov tseem ceeb ntawm 20 txog 30 kg / m2. Ntawm qhov qis eGFR ntawm 30 ml / min rau 1.73 m2, zoo li gradient hauv BMI (20 txog 30 kg / m2) tau cuam tshuam nrog kev nce ntxiv ntawm HOMA-IR los ntawm 2.1 txog 4.8. P-tus nqi rau kev sib cuam tshuam yog 0.005, qhia qhov sib txawv tseem ceeb hauv kev koom tes ntawm BMI thiab HOMA-IR ntawm qis dua piv rau siab dua eGFR. Cov qauv kev sib cuam tshuam zoo sib xws tau pom nyob rau hauv kev txheeb xyuas kev sib cuam tshuam siv log leptin es tsis txhob siv BMI (Cov Duab Ntxiv S2) rau kev koom tes nrog HOMA-IR.
Table 3 qhia tau hais tias hloov pauv qhov sib txawv hauv HOMA-IR cov qhab nia rau cov neeg koom nrog cais raws li CKD / nonobese, rog / tsis yog CKD(mob raum mob), thiab cov neeg koom nrog CKD / rog piv rau pawg neeg tsis yog CKD / nonobese. Hauv qauv 1, qhov sib txawv nruab nrab (b=4.39) hauv HOMA-IR cov qhab nia rau pawg CKD / rog tau ntau dua qhov sib txawv ntawm qhov sib txawv rau CKD / nonobese (b=1. 91) thiab cov pab pawg uas tsis yog-CKD/ rog rog (b=1.78), qhia txog kev sib koom ua ke tseem ceeb (P rau kev sib cuam tshuam < 0.001)="" ntawm="" ckd="" thiab="" rog="" rog="" nrog="" rau="" qhov="" siab="" dua="" homa-ir="" cov="" qhab="" nias.="" tom="" qab="" tag="" nrho="" cov="" kev="" hloov="" kho="" rau="" cov="" pej="" xeem,="" cov="" cim="" inflammatory,="" thiab="" adipocytokines,="" cov="" neeg="" mob="" ckd="" (ob="" leeg="" rog="" thiab="" nonobese)="" tseem="" muaj="" homa-ir="" cov="" qhab="" nia="" siab="" dua="" piv="" rau="" pawg="" neeg="" tsis="" yog-ckd="" nonobese,="" thaum="" cov="" neeg="" rog="" rog="" nrog="" egfr="" tsis="" muaj="" homa="" qis="" dua.="" -="" ir="" cov="" qhab="" nia.="" kev="" sib="" tham="" peb="" tau="" tshawb="" xyuas="" cov="" koom="" haum="" ntawm="" egfr="" thiab="" kev="" ntsuas="" ntawm="" adiposity="" (bmi="" thiab="" serum="" leptin)="" nrog="" cov="" leeg="" nqaij="" thiab="" mob="">insulin rhiab heevHauv cov neeg tsis muaj ntshav qab zib suav nrog cov neeg mob CKD(mob raum mob)theem 3 thiab 4 thiab cov neeg uas tau khaws cia eGFR. Peb qhov kev tshawb pom qhia tias eGFR thiab BMI yog ob qho tib si ntawm nws tus kheej cuam tshuam nrog insulin rhiab heev, tab sis hais tias lub zog ntawm kev koom tes ntawm BMI thiabinsulin rhiab heevNws txawv ntawm cov qib eGFR thiab insulin rhiab heev phenotype.
Skeletal leeginsulin rhiab heevlos yog clamp-derived ISI raug txo kom tsawg ntawm eGFR tsawg thiab tsis tshua muaj txuam nrog BMI (los yog leptin) ntawm qis eGFR. Lub caij no, kev sib koom ua ke ntawm BMI nrog rau cov tshuaj insulin rhiab heev (HOMA-IR) tau tshaj tawm ntawm cov qib eGFR qis dua, nrog cov qib BMI siab dua uas cuam tshuam nrog cov tshuaj insulin siab dua (nce HOMA-IR). Yog li ntawd, cov neeg mob rog rog nrog CKD tau pom tau hais tias cov tshuaj insulin tsis kam (siab HOMA-IR) dhau qhov xav tau los ntawm kev ywj pheej ntawm kev txo qis eGFR thiab siab BMI, qhia txog kev sib koom ua ke ntawm kev rog thiab CKD.(mob raum mob).
Cov neeg mob nrog CKD muaj kev pheej hmoo siab rau kev mob plawv (CV) kev tuag, uas tsis tau piav qhia tag nrho los ntawm cov xwm txheej CV. 17 Insulin tsis kam yog cuam tshuam nrog nce CVD kev pheej hmoo txawm tias tsis muaj ntshav qab zib 18 thiab suav tias yog "kev pheej hmoo" CV hauv CKD.(mob raum mob)19 los ntawm nws cov teebmeem ntawm o, endothelial muaj nuj nqi, thiab oxidative kev nyuaj siab. Lub luag haujlwm ntawm cov protein-zog nkim hauv CKD, tshwj xeeb tshaj yog nyob rau hauv kev saib xyuas cov neeg mob hemodialysis.27 Kev qhia txog cov txheej txheem hauv qab yog qhov tseem ceeb rau kev tsim cov kev cuam tshuam uas tuaj yeem txhim kho cov tshuaj insulin thiab nws cov txiaj ntsig hauv CKD.
Cov tshuaj insulin kuj tseem muaj nyob hauv cov theem ua ntej ntawm CKD(mob raum mob), 28, thiab nws qhov kev nthuav dav nce ntxiv nrog kev poob qis ntxiv hauvlub raum ua haujlwm.29 Txawm hais tias pathophysiology ntawm insulin tsis kam nyob rau hauv uremia tau raug lees paub thiab tshawb nrhiav ntau xyoo dhau los, cov pov thawj muaj feem cuam tshuam txog kev cuam tshuam ntawm CKD nruab nrab thiab adiposity hauv insulin kuj tseem tsis tau daws. Fliser et al. qhia tias tsis muaj kev sib raug zoo ntawm eGFR thiabinsulin rhiab heevntsuas los ntawm iv glucose tolerance test.28 Cov kev tshawb fawb tau pom tias BMI yog thawj qhov kev txiav txim siab ntawm insulin tsis kam hla CKD.(mob raum mob)spectrum hauv cov neeg mob uas tsis muaj ntshav qab zib nrog CKD theem 3 thiab 4, ntsuas los ntawm hyperinsulinemic-euglycemic clamp30 thiab HOMA-IR.5 Hauv qhov sib piv, zoo ib yam li peb cov txiaj ntsig, Kobayashi li al. qhia txog kev sib txheeb ntawmlub raum ua haujlwmthiab insulin rhiab heev ntsuas los ntawm qhov clamp hauv cov neeg mob uas tsis muaj ntshav qab zib nrog ntau theem ntawm CKD(mob raum mob).24 In addition, data from the Uppsala Longitudinal Study of Adult Men study, which included a cohort of elderly men with baseline eGFR >50 ml / min rau 1.73 m2, qhia tau tias muaj kev sib raug zoo ntawm eGFR thiabinsulin rhiab heevntsuas los ntawm cov txheej txheem clamp.31
Cistanche tuaj yeem txhim kho lub raum ua haujlwm
Peb qhov kev tshawb pom tam sim no qhia txog qhov kev xav uas txo qislub raum ua haujlwmcuam tshuam nrog BMI hauv cov ntsiab lus ntawm peripheralinsulin rhiab heev. Thaum qis eGFR qib, kab mob hauv lub raum zoo li yog tus tsav tsheb ntawm peripheral insulin tsis kam, qhov siab dua eGFR, BMI tuaj yeem yog tus thawj tswj hwm ntawm peripheral insulin tsis kam ywj pheej ntawm eGFR. Lub pathophysiology ntawm qis eGFR- txuam nrog peripheral insulin tsis kam yog qhov nyuaj thiab yuav ua rau muaj ntau yam. Muaj peev xwm cuam tshuam nrog suav nrog txo qis kev tshem tawm ntawm insulin thiab adipocytokines, mob mob ntev, metabolic acidosis, nce oxidative kev nyuaj siab, uremic toxins, vitamin D tsis txaus, tsis muaj kev tswj hwm theem nrab hyperparathyroidism, thiab ntshav qab zib.32 Peb xav tias adipocytokine dysregulation yuav yog qhov tseem ceeb tshaj plaws uas txhawb kev tiv thaiv insulin. thiab cov qauv kev sib tshuam tau pom hauv qhov kev tshawb fawb no.
Peb txoj kev tshawb fawb ntxiv qhia txog cov qauv sib txawv rau ISI thiab HOMA-IR. Txawm hais tias BMI siab dua yog txuam nrog txo ISI ntawm txhua qib eGFR, qhov loj ntawm lub koom haum no qis dua li eGFR poob. Ntawm eGFR ntawm w30 ml / min rau 1.73 m2, cov neeg kawm pom tau tias cov tshuaj insulin tsis kam tsis hais lawv cov BMI. Hauv qhov sib piv, qhov sib txheeb ntawm BMI nrog rau cov tshuaj insulin tiv thaiv kab mob siab, ntsuas los ntawm HOMA-IR, yog ntau dua ntawm qis Fr qib. Qhov kev sib txawv no hauv cov txiaj ntsig ntawm peripheral thiab hepatic insulin tsis kam yog zoo ib yam nrog cov ntaub ntawv hais txog lub neej ntawm peripheral insulin tsis kam hauv CKD.(mob raum mob).
Peb cov txiaj ntsig tseem qhia tau tias kev mob o thiab adipocytokine dysregulation muaj peev xwm ua lub luag haujlwm tseem ceeb hauv peripheral insulin tsis kam hauv cov neeg mob rog, uas yog raws li cov ntaub ntawv tam sim no. Cov ntaub ntawv pov thawj tau muab kev sib txuas ncaj qha ntawm kev mob thiab kev rog-vim insulin tsis kam nyob rau ntau xyoo dhau los. Adipose cov ntaub so ntswg-derived pro-inflammatory cytokines xws li qog necrosis factor-a (TNF-a) tau pom los ua lub luag haujlwm hauv kev rog-txuas insulin tsis kam.33 Inflammatory cytokines (TNF-a, IL-6) thiab nuclear factor-kB (NF-kB) paub tias ua rau cov tshuaj insulin tsis kam los ntawm kev nce serine phosphorylation ntawm insulin receptor substrate 1 (IRS-1).34–36.Mob raum mobinduces systemic o los ntawm adipose cov ntaub so ntswg tsis ua hauj lwm, uas, thaum ua ke nrog txo clearance ntawm adipocytokines, exacerbates insensitivity rau cov metabolic kev ua ntawm insulin.
Cov pov thawj tam sim no hais txog kev ua rau lub siab insulin hauv CKD(mob raum mob)tseem tsis meej. Cov kev tshawb fawb yav dhau los los ntawm DeFronzo et al.29 thiab Friedman et al.37 tau sau tseg tias hloov pauv cov tshuaj insulin hauv CKD feem ntau yog vim qhov tsis ua haujlwm ntawm cov piam thaj nkag mus rau hauv cov leeg pob txha. Txawm li cas los xij, Rubenfeld thiab Garber38 tau tshaj tawm cov piam thaj ntau ntxiv hauv CKD(mob raum mob)Cov neeg mob feem ntau los ntawm kev nce gluconeogenesis ntsuas siv radiolabeled alanine, qhia ob qho tib si peripheral thiab hepatic insulin tsis kam. Hauv txoj kev tshawb fawb tam sim no, peb tshaj tawm tias HOMA-IR cov qhab nia yog qhov loj tshaj ntawm qib eGFR qis. Cov kev tshawb fawb tau pom tias qhov txo qis ntawm eGFR ua rau hyperinsulinemia (vim txo qhov kev tshem tawm), uas cuam tshuam nrog kev txo qis ntawm GLUT4, tsis muaj cov cim qhia ntawm insulin, thiab peripheral insulin tsis kam. Hloov chaw ntawm cov tshuaj insulin txo qis kom rov ua tau homeostasis, cov lus teb tsis zoo tshwm sim uas tshwm sim los ntawm kev tsim cov tshuaj insulin ntau ntxiv kom kov yeej cov tshuaj insulin, uas nws tus kheej ua rau cov tshuaj insulin tsis kam. Yog li ntawd, nyob rau hauv cov ntsiab lus ntawm concurrently txo eGFR, txo qis insulin thiab adipocytokine clearance, thiab hyperinsulinemia, nce BMI ntau dua los yog nce adiposity cuam tshuam nrog cov insulin tsis kam. Qhov no yuav piav qhia ib feem yog vim li cas kev sib koom ua ke ntawm kev sib koom ua ke qis eGFR thiab siab BMI cuam tshuam nrog ntau dua HOMA-IR cov qhab nia ntau dua li qhov xav tau los ntawm qhov kev koom tes ntawm eGFR qis lossis siab BMI, raws li pom hauv Table 3.
Cov kev txwv ntawm txoj kev tshawb fawb no suav nrog kev tsim cov ntu ntu, uas ua rau muaj qhov cuam tshuam rov qab thiab txwv tsis pub muaj kev cuam tshuam ntawm CKD(mob raum mob)thiab insulin tsis kam. Tsis tas li ntawd, peb txoj kev tshawb fawb muaj ib qho piv txwv me me nrog kev tswj tsis txaus. Cov ntaub ntawv los ntawm cov kev tshawb fawb loj dua yuav ntxiv dag zog rau qhov muaj peev xwm ua rau muaj kev cuam tshuam. Tsis tas li ntawd, peb cov neeg kawm ntawv feem ntau yog cov neeg mob CKD(mob raum mob)theem 3, uas txwv qhov dav dav rau cov neeg mob uas muaj ntau dua CKD. Lwm qhov kev txwv yog kev siv BMI ua ib tus neeg sawv cev ntawm adiposity hauv CKD cov pej xeem. Qhov tseeb tias BMI tsis suav nrog cov protein-zog nkim rau cov neeg mob nrog CKD tuaj yeem ua rau tsis zoo rau cov neeg mob uas muaj kev rog rog sarcopenic li qub thaum lawv lub cev rog feem pua qhov tseeb yuav faib lawv li rog. Qhov no feem ntau hu ua "obesity paradox." 39 Lub zog ntawm peb txoj kev tshawb fawb suav nrog kev siv tus qauv kub hyperinsulinemic-euglycemic clamp los ntsuas peripheral.insulin rhiab heevthiab tso npe rau cov neeg koom nrog ntau yam txaus ntawm eGFR los tshawb xyuas kev koom tes nrog insulin rhiab heev nyob rau theem BMI.
Hauv kev xaus, txawm hais tias kab mob raum thiab adiposity yog ob qho tib si ywj pheej ua rau cov tshuaj insulin tsis kam hauv CKD(mob raum mob), kev koom tes ntawm BMI rau insulin kuj nyob ntawm theem ntawm cov kab mob raum. eGFR qis dua yog cuam tshuam nrog kev ua haujlwm tsis zoo ntawm cov tshuaj insulin hauv cov ntaub so ntswg peripheral, tsis hais txog adiposity. Lub koom haum no ntawm eGFR nroginsulin rhiab heevzoo li yuav tsum tau kho feem ntau los ntawm o thiab adipocytokine dysregulation ntawm cov neeg rog rog tab sis tsis nyob rau hauv cov neeg mob nonobese. Tsawg eGFR thiab rog rog yog txuam nrog kev tawm tsam insulin hauv lub siab, qhia txog kev sib koom ua ke ntawm lub raum ua haujlwm thiab rog rog hauv cov tshuaj insulin tsis kam. Cov kev tshawb fawb ntxiv yog xav tau los tshawb txog cov txheej txheem hauv qab ntawm insulin tsis kam hauv CKD(mob raum mob).
Cistanche tuaj yeem txhim kho lub raum ua haujlwm
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