Theem Ntawm Ib Tus Qauv Transtheoretical Raws li kev kwv yees ntawm qhov poob qis hauv kwv yees Glomerular pom tus nqi: Kev Tshawb Fawb Txog Kev Tshawb Fawb

TSAB NTAWV

Keeb kwm:Covqauv transtheoretical(TTM) yog tsim los ntawm ntau theem raws li tus neeg mob's nco qab thiab ntseeg tias yuav coj tib neeg kom paub txog qhov tseem ceeb ntawm kev noj qab haus huv tus cwj pwm. Peb tau soj ntsuam kev koom tes ntawm TTM theem nrog kev poob qis ntawm qhov kwv yees glomerularfi ualtration rate (eGFR).Txoj kev:Peb tau siv cov ntaub ntawv tshuaj xyuas kev noj qab haus huv txhua xyoo thiab cov ntaub ntawv pov hwm kev noj qab haus huv ntawm Nyiv Lub Koom Haum Saib Xyuas Kev Noj Qab Haus Huv hauv Kyoto Prefecture thaum lub Plaub Hlis 2012 thiab Lub Peb Hlis 2016. TTM theem ntawm kev hloov pauv tau txais los ntawm cov lus nug ntawm lubfi uarst kev kuaj mob thiab muab faib ua rau pawg. Thawj qhov tshwm sim yog defi uaned raws li ntau dua 30% poob hauv eGFR los ntawmfi uarst kev kuaj mob. Pebfi uatted ib tug multivariable Cox proportional-hazards qauv rau lub sij hawm-rau-kev soj ntsuam kev kho rau lub hnub nyoog, poj niam txiv neej, eGFR, lub cev loj Performance index, ntshav siab, ntshav qab zib, dyslipidemia, uric acid, urinary protein, thiab muaj nyob rau hauv lub raum kab mob ntawmfi uarst kev kuaj mob.Cov txiaj ntsig:Peb tau txheeb xyuas 239,755 tus neeg ua haujlwm thiab qhov ntsuas qhov nruab nrab yog 2.9 (tus qauv sib txawv, 1.2) xyoo. Raws li piv nrog rau theem 1 pawg, qhov kev pheej hmoo ntawm eGFR poob qis yog signifi uacantly qis nyob rau theem 3 pawg (kev phom sij piv [HR] 0.77; 95% confi uadence interval [CI], 0.65–{{0}}.91); theem 4 pawg (HR 0.80; 95% CI, 0.65–{{0}}.98); thiab theem 5 pawg (HR 0.79; 95% CI, 0.66–0.95). 

Kev xaus: Piv nrog rau theem ua ntej xav txog (theem 1), qhov kev npaj, ua, thiab kev saib xyuas theem (theem 3, 4, thiab 5), tau txuam nrog qis dua.kev pheej hmoo ntawm eGFR poob.

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Taw qhia

Mob raum mob(CKD) tau uateeb meem kev noj qab haus huv thoob ntiaj teb tau ntau xyoo, thiab nws qhov kev nthuav dav tau mus txog kwv yees li 10-15% thoob ntiaj teb ntawm 500 lab tus tib neeg.1 CKD kev loj hlob yog tshwm sim los ntawm ntau yam kev pheej hmoo ntawm pathophysiological xws lintshav qab zib, ntshav siab, thiabkev tiv thaiv kab mob.1 Tsis ntev los no, kev noj zaub mov thiab kev ua neej hloov pauv tau pomcuam ​​tshuam rau lub raum ua haujlwm, yog li ntawdKab mob raum: Txhim kho cov txiaj ntsig thoob ntiaj teb(KDIGO) cov lus qhia tam sim no tau pom zoo tias cov neeg mob CKD yuav tsum saib xyuas thiab hloov lawv tus cwj pwm, suav nrog kev haus luam yeeb, lawv qhov hnyav, thiab kev ua ub ua no txhua hnub. Kev pheej hmoo ntawm CKD kev loj hlob 3 qhia tias kev hloov pauv tus cwj pwm tuaj yeem ua rau tus kab mob qeeb zuj zus. Txawm li cas los xij, qhov teeb meem yuav yog tias kev hloov tus cwj pwm noj qab haus huv zoo li tsis yooj yim hauv chaw kho mob. Tsis ntev los no, qee qhov kev xav sib koom ua ke ntawm psychotherapies tau hloov kho los daws qhov teeb meem no.

Tus qauv transtheoretical (TTM) ntawm kev hloov tus cwj pwm yog ib qho kev sib koom ua ke uas faib cov tib neeg rau hauv tsib pawg raws li qhov ntev ntawm lub cev.4 Feem ntau, tib neeg txav mus txog tsib theem los ntawm kev xav ua ntej mus rau kev xav, thiab tom qab ntawd npaj, ua raws li kev txiav txim. thiab cov theem txij nkawm thaum lawv hloov lawv tus cwj pwm. Cov kev tshawb fawb tsis ntev los no tau sau tseg tias TTM-raws li kev cuam tshuam txhim kho kev ua raws li lipid-txo lossis tshuaj tiv thaiv hypertensive, 5,6 thiab txhawb nqa kev noj qab haus huv, kev tawm dag zog, thiab lwm yam kev coj noj coj ua hauv kev sib tw randomized.7

Txawm li cas los xij, nws yog ib qho tseem ceeb kom nkag siab txog cov txheej txheem meej uas cov cwj pwm cuam tshuam rau lub raum ua haujlwm. Thawj kauj ruam yuav txiav txim siab seb txhua theem puas cuam tshuam nrog CKD kev nce qib. Ntawm no, peb tshuaj xyuas sebCKD kev nce qibyog txuam nrog TTM theem siv kev kuaj xyuas kev noj qab haus huv Japanese database.

Txoj kev

Cov ntaub ntawv pov thawj thiab cov phiaj xwm Peb tau ua qhov kev tshuaj xyuas rov qab siv cov ntaub ntawv tshuaj xyuas kev noj qab haus huv txhua xyoo thiab kev pov hwm kev noj qab haus huv cov ntaub ntawv ntawm cov tswv ntiav hauv cov tuam txhab tuav pov hwm los ntawm Nyiv Health Insurance Association hauv Kyoto prefecture, Nyiv. Kev kuaj xyuas kev noj qab haus huv txhua xyoo ntawm cov neeg ua haujlwm hnub nyoog tshaj 35 xyoo yog qhov yuav tsum tau ua kom txog thaum lawv poob lawv qhov kev tsim nyog (xws li, hloov haujlwm, txav mus rau lwm qhov chaw, lossis tuag).

Cov txheej txheem suav nrog thiab cais tawm ntawm cov neeg koom

Peb tau xaiv cov neeg ua haujlwm uas muaj hnub nyoog ntawm 35 txog 75 xyoo thiab tau kuaj xyuas ob lossis ntau dua txij lub Plaub Hlis 2012 txog Lub Peb Hlis 2016. Peb tsis suav cov neeg uas muaj mob raum lossis cov ntaub ntawv ploj lawm hauv thawj qhov kev kuaj mob. Cov lus nug tau txais los ntawm txhua qhov kev kuaj mob thiab muaj cov ntaub ntawv qhia txog cov tshuaj kho mob, kev coj tus cwj pwm noj qab haus huv, thiab haus cawv. Kab mob raum tau txhais los ntawm Lub Ntiaj Teb Kev faib tawm ntawm Kab Mob, 10th Revision codes, xws li N00-08, I70, thiab Q61, hauv cov ntaub ntawv thov.

Kev hloov pauv hauv paus

TTM theem ntawm kev hloov pauv tau los ntawm cov lus nug ntawm thawj qhov kev kuaj mob tau muab faib ua rau pawg los ntawm cov lus nug: "Koj puas npaj siab los txhim kho koj txoj kev noj qab haus huv ntawm kev noj haus thiab kev tawm dag zog? theem 1; npaj siab hloov pauv hauv 6 lub hlis tom ntej, suav tias yog theem 2; npaj siab yuav nqis tes ua tam sim ntawd mus txog rau lub hlis tom ntej, suav tias yog theem 3; ua qhov kev hloov kho tshwj xeeb hauv lawv txoj kev ua neej nyob rau hauv 6 lub hlis dhau los, suav tias yog theem 4; kev tiv thaiv kev rov qab los, tab sis lawv tsis siv cov txheej txheem hloov pauv ntau npaum li cov neeg ua haujlwm, suav tias yog theem 5; tsis muaj lus teb rau lo lus nug (cov ntaub ntawv ploj lawm), suav tias yog "tsis muaj kev txhawj xeeb". Kev txiav tawm, ua kom lub cev ua haujlwm, thiab ua kom muaj kev noj qab haus huv 1 xyoos tom qab kuaj xyuas thawj zaug, tau txais los ntawm cov lus nug ntawm kev kuaj xyuas kev noj qab haus huv tom ntej: Cov neeg uas "tsis haus luam yeeb" txhais tau tias cov neeg teb tias "Yog" yav dhau los xyoo thiab teb tias "Tsis yog" xyoo tam sim no rau lo lus nug, "Koj puas yog haus luam yeeb hnyav? (Ib tug neeg haus luam yeeb hnyav yog hais txog cov uas tau haus luam yeeb ntau tshaj 100 tus luam yeeb lossis haus luam yeeb tau 6 lub hlis thiab tau haus luam yeeb thaum lub hli dhau los.)". xyoo dhau los thiab teb tias "Yog" xyoo tam sim no rau lo lus nug, "Koj puas yog ib tus cwj pwm ua kom tawm hws maj mam dhau 30 feeb ib zaug, ob zaug hauv ib lub lis piam, ntau tshaj ib xyoos?". Kev haus dej ntau npaum li cas yog txiav txim siab raws li cov lus nug, "Koj haus dej ntau npaum li cas hauv ib hnub?". "Kev haus dej ntau npaum li cas" txhais tau tias cov lus teb rau lo lus nug "Koj haus dej ntau npaum li cas? (sake, shochu, npias, cawv, cawv, los yog brandy, thiab lwm yam) "Cov ntsiab lus ntawm cov lus nug tau tsim los ntawm kev siv rau "Kev kuaj mob thiab kev qhia txog kev noj qab haus huv" los ntawm tsoomfwv Nyij Pooj: Ministry of Health, Labor, thiab Welfare .8

The covariates were classified into groups as follows: four groups based on age (35–45, 46–55, 56–65, and 66 or more years); four groups based on body mass index (BMI; thin: ≤18.5 kg=m2 , normal: 18.5–25 kg=m2 , pre-obesity: 25–30 kg=m2 , and obesity: >30 kg=m2 ) according to the World Health Organization; five groups based on eGFR (≤15, 30–15, 45–30, 60–45, and >60 mL=min=1.73 m2 ); Peb pawg raws li cov zis tso zis (siv cov dipsticks: zoo (Ntau dua lossis sib npaug rau 1+), kab (±), thiab tsis zoo), lub plab ncig (yog tias txiv neej siab dua lossis sib npaug li 85 cm, poj niam Loj dua lossis sib npaug mus txog 90 cm); tsib pawg raws li ntshav siab (systolic ntshav siab [SBP] Ntau dua lossis sib npaug ntawm 180 mm Hg lossis diastolic ntshav siab [DBP] Ntau dua lossis sib npaug li 110 mm Hg yam tsis muaj tshuaj, SBP Ntau dua lossis sib npaug li 160 mm Hg lossis DBP Ntau dua lossis sib npaug ntawm 100 mm Hg yam tsis muaj tshuaj, SBP Ntau dua lossis sib npaug ntawm 140 mm Hg lossis DBP Ntau dua lossis sib npaug li 90 mm Hg yam tsis muaj tshuaj, ib txwm tsis muaj tshuaj, thiab nrog tshuaj); thiab plaub pawg raws li dyslipidemia (triglyceride ntau dua lossis sib npaug ntawm 150 mg=dL lossis cov roj lipo protein ntau ntom ntom<40 mg=dL was defined to be abnormal with hypolipidemic drugs, abnormality without hypolipidemic drugs, normal with hypolipidemic drugs, normal without hypolipidemic drugs), diabetes (fasting blood sugar ≥110 mg=dL or hemoglobin A1c ≥5.6% was defined to be as abnormality with antidiabetic drugs, abnormality without antidiabetic drugs, normal with antidiabetic drugs, normal without antidiabetic drugs), and hyperuricemia (defined uric acid ≥8 mg=dL without drugs or with use of anti-hyperuricemias). The information for each medication use was extracted from questionnaires.

Kev txheeb cais

Cov txiaj ntsig tseem ceeb rau kev soj ntsuam kev ciaj sia tau txhais tias yog qhov txo qis ntawm 30% lossis ntau dua hauv eGFR.9 Lub eGFR tau suav los ntawm kev sib npaug siv los ntawm Nyiv Society of Nephrology.10 Cov neeg mob tau ua raws li cov txiaj ntsig lossis censored.

Tus qauv Cox proportional-hazards yog siv rau lub sij hawm-rau-kev soj ntsuam los kwv yees qhov txaus ntshai piv (HRs); 95% kev ntseeg siab lub sijhawm (CI) tau siv rau thawj qhov tshwm sim. Cov ntaub ntawv ncua sij hawm rau cov neeg mob tau censored nyob rau hnub ntawm kev kuaj mob zaum kawg. Qhov kev tshuaj ntsuam tau siv ob hom qauv: qauv 1 (tsis muaj tshuaj yam tseem ceeb), kho lub hnub nyoog, poj niam txiv neej, BMI, lub plab ncig, eGFR, thiab cov zis tso zis; thiab qauv 2 (nrog rau cov tshuaj noj), kho rau hnub nyoog, poj niam txiv neej, BMI, plab ncig, eGFR, urinary protein, ntshav siab, ntshav qab zib, dyslipidemia, thiab uric acid. Txhua qhov kev kuaj mob tau kuaj pom ntawm thawj zaug kuaj mob. Schoenfeld residuals tau siv los txheeb xyuas qhov kev xav tias muaj kev phom sij. Ib theem tseem ceeb ntawm ob sab ntawm 0.05 tau siv, thiab txhua qhov kev ntsuam xyuas tau ua los ntawm R version 3.4.1 (R Foundation for Statistical Computing, Vienna, Austria).

Subgroup analyses were performed for the model 2 condition, where the analysis population was stratified by employees 1) whose eGFR categorized as >60, 60–45, lossis Tsawg dua lossis sib npaug li 45 mL=min=1.73 m2 thiab 2) uas tsis tau mus pw hauv tsev kho mob vim mob ntshav qab zib (tsis muaj tshuaj los txo cov ntshav qab zib lossis txhaj tshuaj insulin) , thiab 3) uas tau ntsib 1 lossis ntau dua cov qauv rau Japanese metabolic syndrome.11

Kev soj ntsuam rhiab heev kuj tau ua rau tus qauv 2 qhov xwm txheej, uas peb tsis suav nrog cov neeg soj ntsuam 1) cov neeg ua haujlwm hnub nyoog 60 xyoo lossis ntau dua xyoo lossis 2) cov neeg ua haujlwm uas tau noj tshuaj rau ntshav siab, ntshav qab zib, lossis dyslipidemia. Cov neeg ua haujlwm yav dhau los raug cais tawm vim tias cov nyiaj laus tuaj yeem tshwm sim ntau dua 60-65 xyoo hauv Nyij Pooj, uas tuaj yeem ua rau cov neeg ua haujlwm noj qab haus huv tsis zoo, thiab peb txo qis qhov cuam tshuam ntawm cov neeg ua haujlwm poob rau kev soj ntsuam.