Qib ntawm cov zis Dipstick Proteinuria Thiab Nws Kev Sib Raug Zoo rau Kev Phem Txhaum Cai Cholelithiasis Ⅱ

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Thaum 904,360 tus neeg-xyoo ntawm kev soj ntsuam, 2,919 (1.41%) qhov xwm txheej ntawm tus mob cholelithiasis tsim los ntawm 2009 txog 2013. Table1 piav qhia txog cov yam ntxwv hauv paus ntawm cov neeg koom nrog hauv peb pawg ntawmcov zis protein ntau ntau. Muaj signifi uatsi diua fferences ntawm peb pawg nyob rau hauv tag nrho cov hauv paus yam ntxwv tshwj tsis yogLDL-cholesterolthiab kev ua si lub cev. Cov pab pawg uas muaj proteinuria ntau dua yuav muaj mob hnyav dua li cov tsis muajproteinuria, uas yog qhov tseem ceeb tshaj hauv qhov txiaj ntsig ntawm kev yoo mov qabzib, triglyceride, eGFR, thiab SCr dua li lwm qhov sib txawv. Txawm li cas los xij, txawm tias tus lej kos npefi uatsi diua fference hauvP-rau qhov sib txawv, qee qhov sib txawv tsis qhia qhov tseem ceeb hauv kev kho mob diua fferences ntawm pab pawg. Tshwj xeeb, qhov nofi uanding yog txawv nyob rau hauv cov variables hais txogrog rog thiab lub siab ua haujlwm,suav nrog BMI, AST, ALT, thiab GGT, uas nyob rau hauv ib txwm muaj nyob rau hauv txhua pab pawg. Muaj 2,919 tus neeg ntawm qhov xwm txheej cholelithiasis thaum taug qab, thiab cov yam ntxwv ntawm cov tib neeg no piv nrog cov seem ntawm pawg neeg tau nthuav tawm hauv Table2. Nyob rau hauv sib piv rau cov koom tsis muajqhov tshwm sim cholelithiasis, cov neeg muaj teeb meem cholelithiasis laus dua (60.8 [SD, 9.4] vs 57.7 [SD, 8.6] xyoo) thiab muaj cov yam ntxwv tsis zoo hauv BMI, systolicBP, TG, HDL-cholesterol, eGFR, AST, ALT, GGT, thiab haus luam yeeb ntau npaum li cas. Tshwj xeeb, ib pab pawg uas muaj xwm txheej cholelithiasis muaj qib siab dua hauv cov yam ntxwv tseem ceeb ntsig txog kev rog thiab lub siab ua haujlwm xws li BMI, AST, ALT, thiab GGT. Txawm li cas los xij, txhua qhov kev hloov pauv tsis tau qhia qhov tshwj xeebfi uac kev taw qhia, thiab cov pab pawg tsis muaj cho cholelithiasis muaj cov ntsiab lus siab dua hauv diastolic BP, tag nrho cov roj cholesterol, LDL-cholesterol, SCr,haus cawv, thiab kev tawm dag zog lub cev. Rooj3 qhia HRs thiab 95% CIs rau cholelithiasis raws li peb pawg. Hauv cov qauv tsis hloov kho, HRs rau cholelithiasis sib piv me me thiab hnyav proteinuria pawg piv rau pawg tsis zoo yog 1.12 (95% CI, 0.87–1.45) thiab 1.77 (95% CI, 1.33–2.34), raws li (P rau trend<0.001). Adjustment for covariates attenuated this association, but statistical signifi uaCance tau khaws cia hauv pawg proteinuria hnyav (HR 1.46; 95% CI, 1.09–1.96). Tom qab kho covariates, cholelithiasis yog signifi uaCantly txuam nrog BMI, hnub nyoog, haus cawv, haus luam yeeb, thiab GGT. Kev soj ntsuam ntawm poj niam txiv neej subgroup qhia tias hnyav proteinuria hauv cov poj niam yog signifi uacantly txuam nrog kev pheej hmoo ntawm qhov teeb meem cholelithiasis (HR 1.68; 95% CI, 1.06–2.65) Nwskho covariates (rooj 1). Cov txiv neej kuj pom ib lub cimfi uaCant koom haum nyob rau hauv cov qauv unadjusted (HR 1.65; 95% CI, 1.15–2.37), uas ploj lawm tom qab hloov kho covariates (HR 1.31; 95% CI, 0.89–1.92). Nyob rau hauv hnub nyoog subgroup tsom xam (rooj 2), pawg hnub nyoogNtau dua lossis sib npaug56 xyoo pom ib lub cimfi uaCant koom nrog hnyav proteinuria thiab teeb meem cholelithiasis (HR 1.44; 95% CI, 1.01–2.03), tab sis pab pawg hnub nyoogTsawg dua los yog sib npaug55 xyoo tsis tau qhia ib lub cimfi uaKev sib koom ua ke tom qab hloov kho rau covariates (HR 1.47; 95% CI, 0.85–2.55).

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AST, aspartate aminotransferase; ALT, alanine aminotransferase; BMI, lub cev hnyav index; BP, ntshav siab; eGFR, kwv yees glomerular pom tus nqi; GGT, gamma-glutamyl transferase; HDL, high-density lipoprotein; LDL, qis lipoprotein tsawg; SCr, ntshav creatinine. Cov ntaub ntawv yog txhais tau tias (tus qauv sib txawv), nruab nrab (interquartile range), lossis feem pua. P-tus nqi los ntawm ANOVA-test rau qhov sib txawv tsis tu ncua thiab Chi-square test rau categorical variables.

BP, TG, HDL-cholesterol, eGFR, AST, ALT, GGT, thiab haus luam yeeb ntau npaum li cas. Tshwj xeeb, ib pab pawg uas muaj xwm txheej cholelithiasis muaj qib siab dua hauv cov yam ntxwv tseem ceeb ntsig txog kev rog thiab lub siab ua haujlwm xws li BMI, AST, ALT, thiab GGT. Txawm li cas los xij, txhua qhov kev hloov pauv tsis tau qhia txog cov kev taw qhia tshwj xeeb, thiab cov pab pawg uas tsis muaj tus mob cholelithiasis muaj cov ntsiab lus siab dua hauv diastolic BP, tag nrho cov roj cholesterol, LDL-cholesterol, SCr, haus cawv, thiab kev ua si lub cev. Table 3 qhia txog HRs thiab 95% CIs rau cholelithiasis raws li peb pawg. Hauv cov qauv tsis hloov kho, HRs rau cholelithiasis sib piv cov proteinuria me me thiab hnyav pab pawg piv rau pawg tsis zoo yog 1.12 (95% CI, 0.87–1.45) thiab 1.77 (95% CI, 1.33–2.34), feem ( P rau trend<0.001). Adjustment for covariates attenuated this association, but statistical significance was maintained in the heavy proteinuria group (HR 1.46; 95% CI, 1.09–1.96). After adjusting for covariates, cholelithiasis was significantly associated with BMI, age, alcohol intake, smoking, and GGT. Gender subgroup analysis indicated that heavy proteinuria in women was significantly associated with an increased risk of incident cholelithiasis (HR 1.68; 95% CI, 1.06–2.65) even after adjusting for covariates (table 1). Men also showed a significant association in the unadjusted model (HR 1.65; 95% CI, 1.15–2.37), which disappeared after adjustment for covariates (HR 1.31; 95% CI, 0.89–1.92). In age subgroup analysis (table 2), the group age ≥56 years showed a significant association between heavy proteinuria and incident cholelithiasis (HR 1.44; 95% CI, 1.01–2.03), but the group age ≤55 years did not show a significant association after adjustment for covariates (HR 1.47; 95% CI, 0.85–2.55).

AST, aspartate aminotransferase; ALT, alanine aminotransferase; BMI, lub cev hnyav index; BP, ntshav siab; eGFR, kwv yees glomerular pom tus nqi; GGT, gamma-glutamyl transferase; HDL, high-density lipoprotein; LDL, qis lipoprotein tsawg; SCr, ntshav creatinine. Cov ntaub ntawv raug qhia raws li txhais tau tias (tus qauv sib txawv) lossis feem pua. P-tus nqi los ntawm t-test rau qhov sib txawv tsis tu ncua thiab Chi-square test rau categorical variables.

Kev sib tham

Hauv kev soj ntsuam ntev ntawm cov ntaub ntawv thoob tebchaws, peb tau ntsuas qhov kev pheej hmoo ntawm qhov xwm txheej cholelithiasis raws li qib ntawm cov zis dipstick proteinuria. Peb cov txiaj ntsig tau qhia tias cov zis dipstick proteinuria ntawm {{0}}} lossis ntau dua tau cuam tshuam nrog kev pheej hmoo ntawm cholelithiasis. Kev soj ntsuam ntawm cov yam ntxwv hauv paus ntawm cov kev kawm muaj peev xwm ua rau qhov kev tshawb pom no. Cov neeg mob uas muaj cov zis ntau dua dipstick proteinuria feem ntau ua rau muaj cov kab mob metabolic thiab lub raum tsis zoo, uas tau pom zoo sib xws hauv cov neeg mob cholelithiasis. Cov kev tshawb pom no qhia tias cov kev kho mob tsis zoo muaj lub luag haujlwm hauv kev txhim kho cov pob zeb hauv lub gallstone. Qhov kev xav no tau txais kev txhawb nqa los ntawm cov kev tshawb fawb yav dhau los uas qhia txog lub luag haujlwm ntawm metabolic derangements xws li insulin tsis kam, rog, thiab dyslipidemia ntawm kev loj hlob ntawm gallstones, proteinuria, thiab CKD.14-16 Yog li, nws tau kwv yees tias cov metabolic milieu uas ua rau cov proteinuria ua rau lub plab zom mov. Cov txheej txheem pathophysiological koom nrog hauv kev loj hlob ntawm gallstones. Txawm li cas los xij, nws yog qhov nthuav tias peb cov txiaj ntsig tau muaj txiaj ntsig tseem ceeb txawm tias tom qab hloov kho covariates, suav nrog cov xwm txheej pheej hmoo rau cov kab mob gallstones xws li hnub nyoog, poj niam txiv neej, BMI, systolic BP, yoo mov qabzib, tag nrho cov roj cholesterol, GGT, haus cawv, thiab kev ua si lub cev. Cov txiaj ntsig no qhia tau hais tias cov proteinuria tuaj yeem yog qhov muaj feem cuam tshuam rau lub gallstones. Cov kev tshawb fawb yav dhau los kuj tau pom tias cov kab mob hauv lub raum cuam tshuam nrog cov proteinuria muaj feem cuam tshuam nrog lub gallstones. Hauv kev tshawb nrhiav ntu ntu ntawm 2,686 tus txiv neej thiab 2,087 tus poj niam hauv Taiwan, 11 feem ntau ntawm cov pob zeb hauv lub plab yog 13.1% hauv cov pab pawg neeg mob CKD, thiab 4.9% ntawm cov neeg mob tsis muaj CKD (P <0.001). Tsis tas li ntawd, nws tau ua pov thawj tias feem ntau ntawm cov pob zeb hauv lub gallstones muaj ntau dua rau cov neeg mob uas muaj kab mob hauv lub raum kawg (ESRD) kho nrog kev lim ntshav piv nrog cov pab pawg uas tsis yog uremic.17,18 Cov kev tshawb fawb soj ntsuam tau pom tias muaj kev sib koom ua ke ntawm cov pob zeb thiab lub raum. pob zeb.19,20 Cov txiaj ntsig no ua rau muaj qhov kev xav tias kev sib tshooj loj heev tuaj yeem tshwm sim ntawm cov txheej txheem pathophysiological ntawm lub raum kab mob thiab kab mob gallstone. Ntxiv mus, xav tias proteinuria yog ib qho kev kho mob ntawm cov kab mob hauv lub raum, suav nrog CKD thiab lub raum pob zeb, cov txiaj ntsig no tuaj yeem txuas cov proteinuria rau cov pob zeb. Txawm li cas los xij, cov kev tshawb fawb yav dhau los raug txwv hauv kev nthuav qhia ncaj qha ntawm cov proteinuria ntawm qhov tshwm sim gallstones. Lawv cov kev txwv yog tshwm sim los ntawm kev tsim cov ntu ntu, 10,11 tsawg dua qhov kev nthuav dav ntawm cov txiaj ntsig tau los ntawm cov neeg mob ESRD nkaus xwb, 17,18 thiab tsis muaj zog ua rau muaj kev sib raug zoo ntawm lub raum pob zeb thiab proteinuria.19,20 Tsis tas li ntawd, ntau qhov kev tshawb fawb tau tshaj tawm tias qhov kev nthuav dav ntawm gallstones tsis txawv ntawm cov neeg mob lim ntshav thiab tswj kev noj qab haus huv.21–23 Hauv qhov sib piv, peb tau txheeb xyuas qhov ntev ntawm kev sib raug zoo ntawm qib ntawm cov zis dipstick proteinuria thiab qhov kev pheej hmoo ntawm qhov tshwm sim gallstone, uas tej zaum yuav muaj txiaj ntsig zoo hauv kev txheeb xyuas qhov cuam tshuam ntawm cov kab mob raum. rau proteinuria ua ib qho kev pheej hmoo rau gallstone.

Hauv peb qhov kev txheeb xyuas, hnyav proteinuria (Ntau dua lossis sib npaug rau {{0}}}) tau cuam tshuam nrog kev pheej hmoo ntawm gallstone, thaum cov proteinuria me me (1+) tsis tau qhia txog kev sib raug zoo nrog rau gallstone. Cov kev tshawb fawb yav dhau los tau pom tias qib ntawm cov proteinuria yog ib qho kev txhim khu kev qha hauv paus muaj kev sib raug zoo nrog tus nqi ntawm eGFR poob qis thiab kev nce qib CKD.24,25 Yog li, nws tau tshaj tawm tias pawg proteinuria hnyav muaj feem ntau ntawm cov qib siab CKD nrog uremia ntau dua. pab pawg me proteinuria nyob rau lub sijhawm ua raws. Lub xeev uremic tuaj yeem cuam tshuam cov txheej txheem nyuaj ntawm neural thiab hormonal yam uas tswj lub gallbladder motility.26–28 Lub neural thiab hormonal tsis txaus yuav hloov lub gallbladder motility, txhawb lub gallstone tsim los ntawm stasis ntawm gallbladder nyob rau hauv cov neeg mob CKD.26–28 Txawm li cas los xij, peb tsis tuaj yeem lav. tias lub xeev uremic raug ntxias los ntawm CKD yog ib qho tseem ceeb rau kev koom tes ntawm proteinuria thiab cholelithiasis hauv peb txoj kev tshawb fawb. Peb tsis tuaj yeem ntsuas qhov hloov pauv ntawm lub raum ua haujlwm thaum rov qab los vim tsis ua raws li kev ntsuas ntawm SCr thiab eGFR. Cov kev tshawb fawb ntxiv yuav tsum tshawb xyuas cov koom haum mus sij hawm ntev ntawm cov hauv paus proteinuria, kev hloov ntawm lub raum ua haujlwm, thiab kev pheej hmoo ntawm cholelithiasis. Cov txiaj ntsig zoo ntawm txoj kev tshawb fawb no yog cov ntaub ntawv kawm tau zoo, cov ntaub ntawv kho mob tau zoo (nrog rau kev kuaj mob cholelithiasis), thiab kev ntsuas ntsuas raws li cov ntaub ntawv pov thawj thoob tebchaws. Cov txiaj ntsig zoo no ua rau peb ntsuas qhov kev pheej hmoo ntawm qhov xwm txheej cholelithiasis raws li qib ntawm cov zis dipstick proteinuria. Txawm li cas los xij, peb lees paub qhov kev txwv ntawm kev kawm. Ua ntej, qib ntawm proteinuria tsuas yog ntsuas los ntawm kev kuaj zis dipstick. Txawm hais tias qhov kev kuaj zis dipstick yog dav muaj nyob rau hauv kev tshuaj ntsuam xyuas proteinuria, nws tsis txaus kom muaj nuj nqis proteinuria. Qhov thib ob, lub sijhawm rov qab los ntawm 4.36 xyoo nyob rau nruab nrab yog luv luv. Qhov tshwm sim ntau ntawm cholelithiasis yog 2.5% hauv peb txoj kev tshawb fawb, tab sis kev soj ntsuam ntev dua tuaj yeem ua rau ob qho tib si qis dua thiab ntau dua qhov tshwm sim rau cholelithiasis. Qhov thib peb, peb txoj kev tshawb fawb tsuas yog ua rau cov neeg laus laus Kauslim uas muaj hnub nyoog nruab nrab ntawm 57.8 (SD, 8.6) xyoo. Peb txoj kev tshawb fawb tau pom tias qhov muaj ntau ntawm +1 proteinuria thiab ntau dua lossis sib npaug ntawm 2+ proteinuria yog 1.8% thiab 1.0%, feem. Txawm li cas los xij, hauv kev tshawb fawb ntawm 18,201,275 Koreans nrog lub hnub nyoog nruab nrab ntawm 45.3 (SD, 14.6) xyoo raws li NHID, qhov ntau ntawm 1+ proteinuria thiab ntau dua lossis sib npaug rau 2+ proteinuria yog 1.18% ( n=214,883) thiab 0.56% (n=103,745), feem.29 Qhov ntau dua ntawm cov proteinuria hauv peb txoj kev tshawb fawb yuav yog vim muaj hnub nyoog laus dua ntawm peb cov kev kawm. Plaub, peb tsis tuaj yeem txheeb xyuas qhov tseeb ntawm qhov tshwm sim ntawm cholelithiasis hauv txoj kev tshawb no vim tsis muaj kev lees paub ntawm qhov tshwm sim ntawm cholelithiasis los ntawm kev txheeb xyuas yav dhau los los ntawm NHID. Thib tsib, txawm tias muaj peev xwm poob rau kev rov qab los thaum rov qab los, peb tsis tuaj yeem ua qhov kev soj ntsuam rhiab heev vim qhov kev txwv ntawm peb cov ntaub ntawv nyoos. NHID tsis yog tsim los rau kev tshawb fawb, tab sis yog rau kev tshawb nrhiav txog kev noj qab haus huv ntawm cov neeg Kauslim. Yog li ntawd, peb tsis tuaj yeem txheeb xyuas cov ntaub ntawv xav tau rau kev tshuaj xyuas rhiab heev.

Cov kev txwv no tau lees paub qhov tsim nyog ntawm kev tshawb fawb ntxiv nrog cov txheej txheem meej meej kom ntsuas cov proteinuria, kev soj ntsuam ntev dua, thiab ntau yam kev kawm, suav nrog cov hnub nyoog qis dua. Hauv kev xaus, cov tib neeg uas muaj proteinuria ntau dua muaj qhov tshwm sim ntau dua ntawm cholelithiasis, thiab cov zis dipstick proteinuria ntawm 2+ lossis ntau dua tau cuam tshuam nrog kev pheej hmoo ntawm cholelithiasis. Cov txiaj ntsig no ntxiv rau cov pov thawj rau qhov kev xav tias muaj cov kab mob raum cuam tshuam los ntawm cov proteinuria yog ib qho kev pheej hmoo ntawm tus kab mob gallstone.

TXOJ CAI

Peb siv National Health Insurance Service–National Sample Cohort database thiab cov ntaub ntawv tau txais los ntawm National Health Insurance Service. Peb qhov kev tshawb nrhiav pom tsis muaj feem cuam tshuam nrog National Health Insurance Service. Tus sau kev koom tes: Jae-Hong Ryoo yog tus lav ntawm txoj haujlwm no thiab, yog li, muaj kev nkag mus rau tag nrho cov ntaub ntawv hauv txoj kev tshawb fawb thiab ua lub luag haujlwm rau kev ncaj ncees ntawm cov ntaub ntawv thiab qhov tseeb ntawm cov ntaub ntawv tsom xam. Sung Keun Park tau pab txhawb rau kev kawm tsim qauv, npaj cov ntawv sau, thiab sau cov ntawv sau thiab sau cov ntawv sau ua thawj tus sau. Chang-Mo Oh tau pab txhawb rau kev kawm tsim thiab kev npaj sau ntawv. Dong-Young Lee thiab Jung Wook Kim tau koom nrog kev txheeb xyuas cov ntaub ntawv txhais lus thiab tshuaj xyuas cov ntawv sau. Min-Ho Kim thiab Hee Yong Kang tau pab txhawb kom tau txais cov ntaub ntawv, kev tswj xyuas cov ntaub ntawv zoo thiab cov txheej txheem, kev txheeb xyuas cov ntaub ntawv thiab kev txhais lus, thiab kev txheeb xyuas cov ntaub ntawv. Eunhee Ha tau pab txhawb kom tau txais cov ntaub ntawv thiab tshuaj xyuas cov ntawv sau. Ju Young Jung pab txhawb rau kev sau ntawv. Kev tsis sib haum xeeb ntawm kev txaus siab: Tsis muaj leej twg tshaj tawm.

APPENDIX A. Cov ntaub ntawv ntxiv

Cov ntaub ntawv ntxiv ntsig txog tsab xov xwm no tuaj yeem nrhiav tau ntawm https:== doi.org=10.2188=jea.JE20190223.

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