Qhov thib ob Cardiac Biomarkers nyob rau hauv Pediatric CKD—Kev Tshawb Fawb Txog Kev Tshawb Fawb

Cov txiaj ntsig

1. Cov yam ntxwv kho mob ntawm lub hauv paus

Cov yam ntxwv ntawm lub hauv paus kev kho mob ntawm 22 CKD thiab 26 CKD-T cov neeg mob tau sau tseg hauv Table 1. Tsis muaj qhov sib txawv tseem ceeb ntawm lub sijhawm ua raws li CKD (3.3 ± 0.4 xyoo) thiab CKD-T cov neeg mob (3.2 ± 0.6 xyoo); p=0.42. Tsis muaj kev tso tseg thaum lub sijhawm kawm ntawm cov neeg mob CKD-T, tab sis tag nrho, 7 (32 feem pua) cov neeg mob CKD tau hloov pauv thaum lub sijhawm ua raws. Cov ntaub ntawv tau txais tom qab hloov pauv hauv pawg neeg mob no tau txheeb xyuas nyias.

2. Cov cim qhia txog kev pheej hmoo plawv thiab mob plawv ntawm lub hauv paus

Kev pheej hmoo plawv tau raug soj ntsuam raws li qhov muaj ntshav qab zib, o, thiab deranged calcium-phosphorus tshuav raws li qhia hauv Table 2. Raws li qhov xav tau, ntshav ntshav thiab hyperparathyroidism tau tshwm sim hauv ob pawg, thaum qis qis qis thiab nce calcium-phosphorus qib tsawg dua. nthuav dav. Cardiac biomarkers thiab echocardiographic tshawb pom tau nthuav tawm hauv Table 3. Qhov feem ntau ntawm NT-pro-BNP siab yog 27 feem pua ​​​​hauv CKD thiab 11 feem pua ​​​​ntawm cov neeg mob CKD-T, thiab zoo sib xws, nce hs-cTnT muaj nyob hauv 32 feem pua ​​​​ntawm CKD thiab 8. feem pua ​​ntawm cov neeg mob CKD-T. Ob leeg NT-proBNP (median 155.1 vs. 78.0 ng/L; p=0.02) thiab hs-cTnT (median 5.0 vs. 3.0 ; p=0.02) tau siab dua hauv CKD piv nrog cov neeg mob CKD-T. Hauv qhov sib piv, thaum GFR-hloov qib feem ntau qis dua hauv ob pawg, GFR-hloov kho hs-cTnT hloov pauv siab dua ntawm cov neeg mob CKD-T dua li cov neeg mob CKD (qhov nruab nrab 2.5 vs. 1.6 ng / L; p=0. 001), thaum GFR-hloov NT-proBNP qib tau zoo sib xws hauv ob pawg neeg mob (p=0.47). Cov qib rau hs-cTnI (Architect thiab DxI) tau qis dua rau hs-cTnT, thiab tsis muaj tus neeg mob muaj hs-cTnI (Tswj Vaj Huam Sib Luag lossis DxI) qib siab tshaj qhov kev siv sab saud.

Cov ntaub ntawv mob plawv ntawm lub hauv paus qhia tau hais tias feem ntau ntawm LVH ntawm 21 feem pua ​​​​hauv CKD thiab 28 feem pua ​​​​hauv cov neeg mob CKD-T (Table 3). Txawm hais tias tsis muaj tus neeg mob tau hais tawm nrog sab laug ventricular systolic dysfunction (EF<50%), diastolic dysfunction defined as TDI e´ z-score<5th percentile was present in 6% of CKD and 17% of CKD-T patients.

3. Cov qauv ntev

Hauv kev txheeb xyuas qhov tsis sib xws ntawm kev hloov pauv thaum rov qab los, txhais tau tias GFR ruaj khov nyob rau lub sijhawm hauv pawg CKD ( =1 01, p=0.3{{30 }}), thaum txhais tau tias GFR tsis kam nrog tus nqi txhua xyoo ntawm 2.4 mL / min / 1.73 m2 hauv cov neeg mob CKD-T (p=0.002). Systolic thiab diastolic ntshav siab z-cov qhab nia, nrog rau BMI z-score, inflammatory profile, thiab qib hemoglobin, tseem tsis tau hloov pauv thaum lub sijhawm 3- xyoo rov qab los ntawm txhua tus neeg koom nrog (cov ntaub ntawv tsis qhia). Calcium–phosphorus tshuav nyiaj li cas tau hloov pauv hauv ob pawg, qhov twg phosphate (=−0.07, p=0.005) thiab i-PTH (=−11.8, p=0. 05) txo qis hauv cov neeg mob CKD thiab albumin-adjusted calcium (=−0.01, p=0.01) thiab phosphate (=−0.05, p=0.002) txo hauv cov neeg mob CKD-T dhau sijhawm.

Tsuas yog teev hs-cTnI (Architect, =0.15, p=0). . Tsis muaj kev hloov pauv tseem ceeb hauv cov kab mob plawv hauv pawg CKD-T (cov ntaub ntawv tsis qhia). Hais txog kev mob plawv, tsis muaj qhov ntsuas echocardiographic cim hloov lub sijhawm hauv CKD-T cov neeg mob thiab tsuas yog PWD E / cc-TDI é poob qis hauv CKD pawg;=−0.17, p=0.05.

4. Kev sib koom ua ke ntawm lub raum ua haujlwm thiab lub plawv biomarkers

Kev txheeb xyuas ntau yam ntawm cov ntaub ntawv rov qab qhia txog kev sib raug zoo ntawm lub raum ua haujlwm thiab ob lub log NT-proBNP (=− 0.01, p=0.{{17 }}1) thiab log hs-cTnT (=− 0.007, p=0.01) (Table 4). Txhawm rau pom qhov kev sib raug zoo no, cov cim kab mob plawv no tau piav qhia txog kev ua haujlwm ntawm lub raum hauv ob pawg neeg mob (Fig. 1a–b). Ob lub log NTproBNP thiab log hs-cTnT tau inversely txuam nrog GFR nyob rau hauv ib tug linear zam nyob rau hauv ob qho tib si CKD (=−0.01, p<0.001 and β= −0.01, p=0.001) and CKD-T patients (β= −0.02, p=0.004 and β= −0.007, p=0.009). In contrast, log hscTnI was not associated with GFR (p=0.78 for DxI and p=0.18 for Architect).

Fig. 1 a–b Longitudinal theem ntawm cov log NT-proBNP thiab log hs-cTnT piv rau GFR tau soj ntsuam siv cov kab rov ua dua nrog cov pawg robust variance–covariance matrix. Cov ntaub ntawv raug nthuav tawm rau cov neeg mob CKD thiab cov neeg mob CKD-T nyias nyias. Ob lub log NT-proBNP thiab log hs-cTnT tau inversely txuam nrog GFR nyob rau hauv ib tug linear zam nyob rau hauv ob qho tib si CKD (=−0.01, p<0.001 and β= −0.01, p=0.001) and CKD-T patients (β= −0.02, p=0.004 and β= −0.007, p=0.009)

Fig. 2 a–c Kev hloov pauv hauv NTproBNP, hs-cTnT, thiab GFR qib hauv 7 CKD cov neeg mob uas tau hloov pauv thaum rov qab los. Qhov sib txawv tau sim ua ntej thiab tom qab hloov lub raum siv Mann-Whitney U test; NT-proBNP *p<0.05, hs-cTnT *p<0.05, and GFR ***p<0.001. The median posttransplant time was 1.1 years (range 0.5–1.1 years)

Cardiac biomarkers thiab GFR kuj raug soj ntsuam hauv 7 CKD cov neeg mob uas tau hloov pauv thaum rov qab los, piv rau qib ua ntej thiab tom qab hloov pauv (Fig. 2a–c). Qhov kev tshuaj ntsuam no qhia txog qhov poob qis hauv hs-cTnT (p=0.02) thiab qib NT-proBNP (p=0.01) tom qab hloov lub raum, sib xws rau qhov nce hauv GFR (p <0.001). Thaum cov qauv no tsis hloov pauv rau GFR-hloov kho NT-proBNP uas txo qis tom qab hloov pauv (p=0.03), GFR-hloov hs-cTnT nce ntxiv (p=0.002), (Fig. 3a -b). Tsis muaj qhov hloov pauv tseem ceeb hauv cav hs-cTnI (Dxl lossis Tus Kws Tsim Kho) ua ntej thiab tom qab hloov lub raum (p=0.24 thiab p=0.47).

Fig. 3 a–b Kev hloov pauv hauv GFR-hloov kho NT-proBNP thiab GFR-hloov qib hs-cTnT hauv 7 CKD cov neeg mob uas tau hloov pauv thaum taug qab. Qhov sib txawv tau kuaj ua ntej thiab tom qab hloov lub raum siv Mann-Whitney U test; GFR-adjusted NT-proBNP *p<0.05, GFR-adjusted hs-cTnT **p<0.01. The median post-transplant time was 1.1 years (range 0.5–1.1 years)

5. Longitudinal koom haum ntawm cov hlab plawv biomarkers thiab echocardiographic cov ntaub ntawv

Multivariate analyses ntawm longitudinal koom haum rau cardiac biomarkers qhia tau hais tias elevated log NT-proBNP yog txuam nrog nce LVMI ( =0.02, p=0.05) (Table 4). Tseeb tiag, cov neeg mob uas muaj LVH ntawm lub hauv paus pib muaj ntau dua NT-proBNP (235 [146–301] ng/L) piv nrog cov neeg mob uas tsis muaj LVH (86 [11–477] ng/L), p=0 .02, (Fig. 4). Txhawm rau hloov kho ntxiv rau kev sib koom ua ke muaj zog ntawm lub raum ua haujlwm thiab NT-proBNP uas tau hais los saum toj no, GFR-kho NTproBNP [29] kuj tau raug soj ntsuam raws li kev ntsuas qhov tshwm sim hauv kev tshuaj xyuas me me. GFR-adjusted NT-proBNP tau muaj kev cuam tshuam nrog LVMI hauv kev tshuaj ntsuam univariate; =0.02, p=0.01, thiab qhov kev sib raug zoo tseem ceeb no tseem nyob tom qab kev hloov kho hauv ntau hom qauv ( =0.02, p=0.02).

Lub log siab hs-cTnT dhau sijhawm tau cuam tshuam nrog LV diastolic muaj nuj nqi ntsuas qis qis cc-TDI e´/a´ (=−0.09, p{{5 }} 05). Raws li NT-proBNP, peb kuj tau soj ntsuam kev sib raug zoo rau GFR-hloov qib ntawm cov log hs-cTnT. Hauv cov qauv sib txawv no, qhov tseem ceeb rau TDI e´/a´ sau tseg yav dhau los ploj lawm (=−0.05, p=0.26). Raws li cov log hscTnI (Dxl), ib qho kev koom tes tseem ceeb tau pom rau ob qho tib si siab LVMI (=0.02, p=0.03) thiab qis cc-TDI e´/a´ ( {{20} } −0.19, p=0.03) nyob rau hauv univariate analyses, tab sis qhov no tsis nyob twj ywm tom qab hloov nyob rau hauv lub multivariate qauv (Table 4). Hs-cTnI (Architect) tsis cuam tshuam nrog kev ntsuas plawv.

Kev sib tham

Lub nra ntawm CVD hauv CKD yog siab, thiab kev txhawb siab los nrhiav cov kab mob plawv ruaj khov uas yuav kwv yees yav tom ntej CVD muaj zog. Ob qho tib si cTn thiab NT-proBNP yog txuam nrog kev pheej hmoo siab ntawm lub plawv tsis ua hauj lwm thiab cov hlab plawv tuag hauv ntau tus neeg [6, 37]. Nws kuj tseem pom tau tias cov biomarkers no cuam tshuam nrog cov cim subclinical ntxov ntawm CVD hauv cov neeg mob CKD [38]. Kev txheeb xyuas cov biomarkers uas tuaj yeem txhim kho qhov tseeb ntawm kev kuaj mob uas cuam tshuam txog kev hloov pauv hauv plawv thaum ntxov xws li LV kho thiab ua haujlwm tsis zoo tuaj yeem txhim kho cov txiaj ntsig rau cov neeg mob no [15]. Txawm li cas los xij, cov ntaub ntawv ntev ntawm CKD yog txwv, tshwj xeeb tshaj yog hais txog kev tshawb fawb txog menyuam yaus.

Txoj kev tshawb fawb tam sim no txheeb xyuas cov koom haum nruab nrab ntawm cov theem ntev ntawm qhov siab-rhiab heev plawv-tshwj xeeb troponin T (hs-cTnT), troponin I (hs-cTnI), thiab NT-proBNP thiab thaum ntxov subclinical pathological hloov hauv cov qauv plawv thiab kev ua haujlwm hauv cov menyuam yaus. Cov neeg mob CKD thiab CKD-T. Echocardiography tau siv los txheeb xyuas qhov muaj LVMI nce ntxiv thiab cuam tshuam LV diastolic muaj nuj nqi raws li cov cim ntxov ntawm cov kab mob plawv.

Nyem qhov no kom paub tias Cistanche yog dab tsi thiab yuav Cistanche extract

Cov txiaj ntsig ntawm txoj kev tshawb no qhia tias qib ntawm NT-proBNP thiab hs-cTnT tau nce siab hauv cov neeg mob CKD thiab CKD-T thiab txhawb nqa cov kev tshawb fawb yav dhau los qhia txog kev sib raug zoo nrog GFR [19, 39]. Qhov tseeb, qib siab tuaj yeem tsis tsuas yog cuam tshuam txog kev tso tawm ntawm lub plawv, tab sis kuj txo qis tso zis uas ua rau nyuaj rau kev txhais cov biomarkers hauv CKD. Yog li ntawd nws tau raug pom zoo tias kev kho cov qib ntawm cov hlab plawv biomarkers rau lub raum kev ua haujlwm yuav ua rau muaj txiaj ntsig zoo dua [29, 30, 37]. Siv cov txheej txheem kho NT-proBNP thiab hs-cTnT rau GFR raws li cov ntaub ntawv neeg laus [29, 30], ob qho tib si GFR-hloov qib, nrog rau cov ntaub ntawv tsis raug kho, tau txheeb xyuas hauv txoj kev tshawb no. Tom qab kev hloov pauv ntau yam, GFR-kho kho NT-proBNP thiab NT-proBNP tau cuam tshuam nrog nce LVMI, qhia nws lub luag haujlwm tseem ceeb hauv kev mob plawv thaum ntxov uas twb muaj lawm hauv cov neeg mob menyuam yaus. Ib yam li ntawd, cov neeg mob uas muaj LVH ntawm lub hauv paus pib muaj ntau dua NT-proBNP piv nrog cov neeg mob uas tsis muaj LVH. Cov kev tshawb pom no yog ua raws li lwm cov kev tshawb fawb ntawm cov menyuam yaus thiab cov neeg laus qhia txog kev sib koom ua ke ntawm NTproBNP, LVMI, thiab LVH [17, 19, 40].

Hs-cTnT nyob rau hauv txoj kev tshawb no tsis cuam tshuam rau LVMI tab sis nrog qhov txo qis LV diastolic muaj nuj nqi qhia tau tias qis TDI e'/a'. Cov kev tshawb pom zoo sib xws tau raug tshaj tawm nyob rau hauv cov kev tshawb fawb loj loj thiab cov kev tshawb fawb ntev ntawm cov neeg laus noj qab haus huv nrog rau cov neeg mob CKD [15, 41], tab sis ob peb cov kev tshawb fawb me nyuam yaus yav dhau los tau nthuav tawm cov ntaub ntawv ntawm kev sib raug zoo ntawm cov kab mob tshwj xeeb troponins thiab cov txiaj ntsig ntawm lub plawv. Kev tshawb fawb menyuam yaus ntawm cov menyuam yaus nrog CKD qib 3-5 tau pom tias cTnT cuam tshuam nrog LVH thiab systolic dysfunction [16], nrog rau qis LV contractility [18]. Raws li GFR-hloov kho hs-cTnT tsis cuam tshuam nrog ib qho kev ntsuas plawv hauv peb txoj kev tshawb fawb, nws yog nyob rau theem no nyuaj los qhia qhov tseeb qhov tseeb ntawm kev koom tes ntawm hs-cTnT thiab LV diastolic muaj nuj nqi hauv menyuam yaus CKD. Tsis tas li ntawd, GFRadjusted hs-cTnT tau siab dua ntawm cov neeg mob CKD-T piv nrog cov neeg mob CKD, thaum qhov kev sib raug zoo tau pom rau qhov tsis hloov kho hs-cTnT. Qhov no tuaj yeem piav qhia los ntawm qhov cuam tshuam loj ntawm GFR, tab sis GFR kho qhov sib npaug uas tau siv los kuj yog ib qho laj thawj. Tseeb, raws li cov algorithm siv yog muab los ntawm cov kev tshawb fawb soj ntsuam ua rau cov neeg laus cov neeg mob [30], nws tseem tsis tau muaj pov thawj tias yuav rov tsim dua nyob rau hauv cov me nyuam hnub nyoog. Tsis tas li ntawd, qhov zoo sib xws tsis tau pom rau NT-proBNP qhov twg lwm qhov kev hloov kho GFR tau siv [29]. Lwm qhov tseem ceeb yog tias GFR-hloov kho hs-cTnT nce hauv cov neeg mob CKD uas tau hloov pauv thaum kawm, uas qhia tau hais tias tsis muaj feem cuam tshuam nrog kev hloov pauv nws tus kheej tuaj yeem yog qhov tseem ceeb. Tseeb tiag, cov tshuaj cardiotoxic siv nyob rau hauv cov neeg mob CKD-T tau pom tias cuam tshuam rau cov kab mob plawv txawv [42]. Nws yog qhov tsim nyog xav tias hs-cTnT hauv CKD thiab CKD-T cov neeg mob tau cuam tshuam los ntawm kev sib cuam tshuam ntawm ob lub plawv thiab lub raum, nrog rau kev kho mob sib txawv.

Cistanche tubulosa

Nyob rau hauv txoj kab nrog kev tshawb fawb menyuam yaus yav dhau los thiab sib piv rau lwm cov kab mob plawv, hs-cTnI tsis cuam tshuam nrog raum ua haujlwm [43]. Ib yam li ntawd, qib hs-cTnI tsis siab li NT-ProBNP thiab hs-cTnT. Qhov sib txawv ntawm qhov tseem ceeb ntawm hs-cTnT thiab hs-cTnI hauv pawg neeg mob no tau nthuav tawm yav dhau los [18]. Tseem, muaj kev tsis sib haum xeeb raws li qee qhov kev tshawb fawb qhia tias cTnT tab sis tsis yog cTnI yog qhov tseem ceeb ntawm cov kab mob plawv thiab kev tuag [18, 44], thaum lwm cov ntawv ceeb toom qhia tias cTnI yog qhov tseeb rau qhov muaj kev cuam tshuam rau cov kab mob plawv hauv cov neeg mob CKD [45] .

Qhov kev tshawb pom sib txawv rau peb lub plawv biomarkers soj ntsuam hauv txoj kev tshawb no tuaj yeem piav qhia los ntawm cov neeg mob tsawg tsawg, uas cuam tshuam rau qhov muaj peev xwm ncav cuag lub zog thiab qhov tseem ceeb hauv txhua qhov kev tshuaj ntsuam. Lwm qhov laj thawj tuaj yeem piav qhia los ntawm lawv cov kev ua physiological sib txawv. Piv txwv li, lub plawv tshwj xeeb troponins yog peptides tso tawm los ntawm cov hlab plawv cov leeg hlwb tau qhib thaum lub sij hawm cov leeg nqaij contraction, thaum BNP yog ib yam tshuaj uas secreted los ntawm cardiomyocytes teb rau stretching ntawm lub ventricles vim muaj zog intravascular ntim. Kev nce qib troponin raug kuaj pom nyob rau hauv cov neeg mob uas muaj kev puas tsuaj rau cardiomyocyte xws li myocardial ischemia thiab necrosis hauv cov mob plawv mob plawv [2, 46], thiab NT-proBNP yog suav tias yog ib qho tseem ceeb biomarker ntawm lub plawv tsis ua hauj lwm [3, 14]. Ntau qhov kev tshawb fawb loj tau pom tias muaj kev sib koom ua ke ntawm kev nce qib ntawm hs-cTnT thiab NT-proBNP nrog kev pheej hmoo ntawm CV thiab tag nrho cov neeg tuag tag nrho hauv cov pej xeem [47-49]. Cov biomarkers no tseem cuam tshuam nrog cov qauv thiab kev ua haujlwm ntawm lub plawv tsis zoo hauv cov neeg mob CKD [14, 15, 40], tab sis cov ntaub ntawv ntev tau txwv [6] tshwj xeeb tshaj yog nyob rau hauv cov menyuam yaus [16, 18]. Los ntawm cov txiaj ntsig ntawm txoj kev tshawb fawb tam sim no, peb xaus lus tias NTproBNP, hs-cTnT, thiab hs-cTnI tuaj yeem muab cov ntaub ntawv biochemical ntxiv hauv cov menyuam yaus CKD thiab lawv tsis tuaj yeem hloov ib leeg.

Muaj qee qhov kev txwv tseem ceeb rau txoj kev tshawb no. Ua ntej, thaum peb tsuas muaj 3 feem pua ​​​​cov ntaub ntawv ploj lawm rau hs-cTnT thiab hs-cTnI, peb muaj 25 feem pua ​​​​tsis muaj qhov tseem ceeb rau NT-proBNP dhau kev soj ntsuam. Peb kuj muaj 13 feem pua ​​​​tsis muaj qhov tseem ceeb rau kev ntsuas echocardiographic, uas tej zaum yuav cuam tshuam rau cov txiaj ntsig ntawm kev txheeb xyuas qhov tshwm sim. Thaum kawg, peb muaj qhov tsis ncaj ncees tseem ceeb hauv pawg CKD raws li xya (32 feem pua) cov neeg mob tau hloov pauv thaum rov qab los, yog cov uas muaj lub raum ua haujlwm tsis zoo uas tau tso tawm.

Cistanche hmoov

Hauv cov ntsiab lus, peb tshaj tawm tias NT-proBNP thiab hs-cTnT muaj kev cuam tshuam nrog GFR nrog nce qib thaum lub raum ua haujlwm tsis zoo. Ob lub plawv biomarkers yog ze ze rau qhov txawv txav ntawm sab laug ventricular qauv (nce LVMI) los yog muaj nuj nqi (tso TDI e'/a') hauv cov neeg mob CKD thiab CKD-T, tab sis kev sib raug zoo tsuas yog nyob rau NT-proBNP tom qab hloov kho rau GFR. Qhov tseem ceeb, cov kab mob plawv no yuav yog cov cim ntawm cov kab mob ntau dua li ua rau muaj kev cuam tshuam rau CVD hauv cov neeg mob no. Yog li ntawd, cov kev tshawb fawb yav tom ntej yuav tsum tau soj ntsuam seb thiab qhov twg GFR-hloov qhov tseem ceeb yuav tsum tau siv thaum txhais cov hlab plawv biomarkers hauv kev tshawb fawb menyuam yaus nephrology. Tsis tas li ntawd, nws yog ib qho tseem ceeb kom paub ntau ntxiv txog cov txheej txheem lom neeg hauv qab thiab tshawb xyuas seb qhov kev tsom mus rau cov biomarkers nrog kev kho yuav txo tau qhov kev pheej hmoo ntawm CVD yav tom ntej.

Cistanche ntsiav tshuaj

Cov ntaub ntawv

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Ylva Tranæus Lindblad1,2,3 · Georgios Vavilis4,5 · Milan Chromek1,2 · Abdul Rashid Quershi6 · Christian Löwbeer7,8 · Peter Bárány2,6

1 Division of Pediatrics, CLINTEC, Karolinska Institutet, Stockholm, Sweden

2 Department of Pediatrics, Karolinska University Tsev Kho Mob, Stockholm, Sweden

3 Huddinge BUMM, Paradistorget 4, 5tr, S-141 47 Huddinge, Sweden

4 Department of Medicine, Karolinska Institutet, Stockholm, Sweden

5 Division of Coronary and Valvular Heart Disease, Karolinska University Hospital, Stockholm, Sweden

6 Renal Medicine, CLINTEC, Karolinska Institutet, Stockholm, Sweden

7 Division of Clinical Chemistry, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden

8 Department of Clinical Chemistry ntawm SYNLAB Medilab, Täby, Sweden