Dab tsi yog Kev Sib Raug Zoo Ntawm Lub Cev Lub Cev Pleev Pleev Thiab Lub Raum Ua Haujlwm Zoo Tshaj Plaws?
Mar 18, 2022
Hu rau: Audrey Huaudrey.hu@wecistanche.com
Lub cev nyhav hloov pauv yog txuam nrog rau lub raum ua haujlwm poob sai
Young Su Joo, et al
AbstractObjective:Txoj kev tshawb no tsom los ntsuas qhov cuam tshuam ntawm lub cev qhov hnyav hloov ntawmlub raum ua haujlwmdeterioration nyob rau hauv ib tug yav tom ntej cohort ntawm cov tib neeg nrog ib txwmlub raum ua haujlwm.
Txoj kev: Data were obtained from the Korean Genome and Epidemiology Study. Bodyweight fluctuations were determined using average successive variability (ASV), which was defined as the average absolute body weight change using repeated measurements for all participants. The decline of the estimated glomerular filtration rate (eGFR) over time was calculated using linear regression analysis of serial eGFR measurements for each patient. Rapid eGFR decline was defined as an average eGFR decline>3 mL / min / 1.73 m2 toj ib xyoo.
Cov txiaj ntsig:Tag nrho ntawm 6,790 tus neeg koom tau txheeb xyuas. Thaum lub sijhawm ua raws li qhov nruab nrab ntawm 11.7 xyoo, eGFR poob sai tau pom hauv 913 (13.4 feem pua) cov neeg koom. Thaum cov neeg koom nrog tau muab faib ua tertiles raws li ASV, eGFR poob sai yog qhov tshwm sim ntau dua hauv pawg ASV tertile siab tshaj qhov qis tshaj. Kev tshuaj xyuas siv ntau cov qauv logistic regression tau qhia tias qhov kev pheej hmoo ntawm eGFR poob sai tau nce hauv pawg ASV tertile siab tshaj plaws piv nrog qhov qis tshaj (qhov sib txawv: 1.66).
Cov lus xaus:Lub cev nyhav hloov pauv tau cuam tshuam nrog kev pheej hmoo siab sailub raum ua haujlwmpoob rau cov neeg koom nrog ib txwm muajlub raum ua haujlwm.
Cistanche yog qhov zoo raulub raum ua haujlwm
Taw qhia
Cov kab mob raum ntev (CKD) yog ib qho kev txhawj xeeb loj rau pej xeem kev noj qab haus huv vim tias nws cuam tshuam rau kev ua rau muaj mob hnyav ntxiv thiab kev pheej hmoo tuag (1). Txawm hais tias kev tswj ntshav qabzib thiab kev tswj ntshav siab, uas yog yam tseem ceeb cuam tshuamlub raum ua haujlwm,CKD thoob plaws ntiaj teb tau nce zuj zus (2). Kev txiav txim siab tias tsim CKD yog qhov tsis tuaj yeem thim rov qab, txheeb xyuas cov kev pheej hmoo hloov tau thiab hloov kho kev ua neej tsis zoo cuam tshuam nrog kev txhim kho CKD yog qhov tseem ceeb pib cov ntsiab lus los txo CKD lub nra.
Kev rog rog yog qhov tseem ceeb ntawm kev pheej hmoo rau CKD (3,4). Hauv cov neeg koom nrog ib txwm muajlub raum ua haujlwm, BMI yog ib qho kev pheej hmoo ywj pheej rau cov kab mob raum tshiab (5). Tsis tas li ntawd, kev rog rog yog txuam nrog kev loj hlob sai rau cov kab mob raum kawg hauv cov neeg mob uas muaj ntau yam kab mob raum, suav nrog immunoglobin A (IgA) nephropathy thiab focal segmental glomerulosclerosis (6,7). Raws li cov kev tshawb pom no, kev txo qhov hnyav feem ntau pom zoo tias yog kev cuam tshuam zoo los txo CKD kev pheej hmoo rau cov tib neeg uas rog rog (8). Txawm li cas los xij, kev poob phaus yog feem ntau nrog los ntawm qhov hnyav rov qab, xws li hu ua hnyav cycling lossis 'yo-yo' nyhuv.
Lub cev hnyavCov kev hloov pauv tau rov ua dua qhia tias muaj feem cuam tshuam nrog kev cuam tshuam ntawm metabolic lossis cov txiaj ntsig tsis zoo ntawm cov hlab plawv (9,10). Ib qho kev soj ntsuam ntawm Framingham Heart Study cov ntaub ntawv taug qab tau qhia tias qhov hloov pauv ntawm lub cev qhov hnyav tau cuam tshuam nrog kev tuag ntau dua thiab mob vim muaj kab mob plawv ntxiv (11). Tsis tas li ntawd, qhov hnyav caij tsheb kauj vab kuj tau tshaj tawm tias yog ib qho kev pheej hmoo tseem ceeb rau kev txhim kho ntshav qab zib (12). Txawm li cas los xij, kev sib raug zoo ntawm lub cev hnyav hloov pauv thiablub raum ua haujlwmtseem tsis paub. Yog li ntawd, txoj kev tshawb no tsom los ntsuas qhov kev sib koom ua ke ntawm lub cev qhov hnyav thiab nrawmlub raum ua haujlwmpoob nyob rau hauv ib tug yav tom ntej, nyob rau hauv lub zej zog raws li cov neeg koom nrog ib txwmlub raum ua haujlwm.
Txoj kev
Kawm cov pej xeem
Cov ntaub ntawv raug muab rho tawm los ntawm Kauslim Genome thiab Epidemiology Study (KoGES), kev kawm yav tom ntej, kev kawm hauv zej zog. Cov ncauj lus qhia ntxaws ntxaws thiab cov txheej txheem hais txog kev txhim kho KoGES tau piav qhia lwm qhov (13). Cov pab pawg tshawb fawb tau tsim los ntawm cov neeg koom nrog hnub nyoog 40 txog 69 xyoo uas yog cov neeg nyob hauv Ansan (nroog nroog) lossis Ansung (nyob deb nroog), koom pheej Kauslim. Cov neeg tuaj koom tau soj ntsuam xyuas kev noj qab haus huv thiab ntau yam kev soj ntsuam txog kev noj qab haus huv ntawm lub hauv paus thiab biannally los ntawm 2001 txog 2014. Cov neeg koom nrog kev ntsuas lub cev hnyav los ntawm lub hauv paus thiab ob lossis ntau qhov kev soj ntsuam tau pib tshuaj xyuas. Cov neeg koom nrog cov kab mob hauv lub raum, cov uas muaj kwv yees li glomerular filtration rate (eGFR) < 60="" ml="" min="" 1.73="" m2="" los="" yog="" proteinuria="" ntawm="" lub="" hauv="" paus,="" cov="" neeg="" uas="" muaj="" kev="" soj="" ntsuam="" tom="" qab=""> 4 xyoos, lossis cov neeg mob qog noj ntshav thaum lub sij hawm kawm tau raug cais tawm. Thaum kawg, tag nrho ntawm 6,790 tus neeg koom nrog. Hauv kev soj ntsuam rhiab heev uas siv cov calibrated Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation, tag nrho ntawm 6,954 tus neeg koom tau suav nrog tom qab tsis suav cov neeg koom nrog siv tib cov txheej txheem raws li tau siv hauv kev tsom xam (Daim duab 1). Txhua tus neeg tuaj koom tau yeem tso npe kawm thiab tau sau ntawv tso cai, uas suav nrog kev pom zoo dav dav hais txog kev siv cov ntaub ntawv rau pej xeem thiab kev kawm siv. Txoj kev tshawb no tau ua raws li Kev Tshaj Tawm ntawm Helsinki thiab tau pom zoo los ntawm Pawg Saib Xyuas Kev Tshawb Fawb ntawm Yonsei University Health System Clinical Trial Center.
Echinacoside ntawm cistanche tuaj yeem txhim kholub raum ua haujlwm
Cov ntaub ntawv khaws tseg
Txhua tus neeg tuaj koom tau txais kev tshuaj xyuas kev noj qab haus huv thiab ua tiav daim ntawv nug txog lawv txoj kev noj qab haus huv thiab kev ua neej nyob thaum mus kawm. Cov ntaub ntawv pej xeem thiab kev noj qab haus huv thiab keeb kwm kho mob tau txais ntawm lawv qhov kev mus ntsib. Kev soj ntsuam comorbidity, kev ntsuas anthropometric, thiab kev soj ntsuam kuaj tau ua txhua xyoo.Lub cev hnyav and height were measured by trained researchers using a calibrated scale or an automated scale with a stadiometer. All anthropometric measurements were performed following specific protocols in which the participants took off their shoes, wore light clothing, and stood on the scale on an even surface while measurements were taken. Participants with blood pressures > 140/90 mm Hg or those taking antihypertensive medications were considered hypertensive. Those with glycated hemoglobin levels > 6.5%, fasting blood glucose concentrations > 126 mg/dL after >8 hours fasting, post-load glucose concentrations >200 mg/dL hauv 75-g qhov ncauj qhov ncauj qhov ncauj qhov ncauj qhov ncauj, lossis cov uas tau txais kev kho mob ntshav qab zib tau suav tias yog ntshav qab zib mellitus. Kab mob plawv (CVD) tau txhais tias muaj keeb kwm ntawm myocardial infarction, kab mob plawv, mob plawv tsis ua haujlwm, kab mob peripheral artery, lossis kab mob cerebrovascular. Cov leeg nqaij tau raug soj ntsuam siv ntau zaus bioelectrical impedance tsom xam (InBody 3.0, BioSpace). Cov ntaub ntawv noj zaub mov ib hnub rau tag nrho cov khoom siv hluav taws xob (hauv kilocalories) tau kwv yees siv ib nrab-quantitative dietary recalls food-frequency questionnaire (FFQ). FFQ cov ntsiab lus, nrog rau kev siv tau thiab rov tsim dua tshiab ntawm FFQ, tau tshaj tawm yav dhau los (14).
Blood samples were obtained after >8 teev ntawm kev yoo mov thiab tau txheeb xyuas hauv lub chaw kuaj mob hauv nruab nrab. Cov zis kuaj tau raug sau thaum sawv ntxov tom qab thawj zaug ntuav. Kev kuaj zis tau ua tiav ntawm cov qauv tso zis tshiab nrog cov zis reagent strips thiab ua tiav siv cov tshuaj ntsuas cov zis semi-automatic, uas tau ntsuas tsis tu ncua. Cov zis muaj protein ntau tau txiav txim siab tias tsis muaj, kab, 1 ntxiv, 2 ntxiv, lossis 3 ntxiv, uas kwv yees li cuam tshuam nrog cov zis protein ntau ntawm cov zis.<10, 10="" to="" 20,="">30, >100, and >500 mg / dL, feem. Lub xub ntiag ntawm cov proteinuria tau txiav txim siab rau qhov txiaj ntsig urinalysis siab dua li qib kab. Cov ntshav creatinine qib tau ntsuas los ntawm Jaffe assay. eGFR tau suav nrog siv plaub qhov hloov pauv ntawm Kev Noj Qab Haus Huv Hauv Lub Raum Kab Mob (MDRD) qhov sib npaug (15). Rau kev soj ntsuam rhiab heev, cov qib creatinine raug txo los ntawm qhov ntsuas qhov ntsuas ntawm 5 feem pua rau cov qauv rau isotope dilution mass spectrometry reference method (16). Cov nqi creatinine no tau siv los kwv yees eGFR nrog CKD-EPI creatinine sib npaug (17).
Kev ntsuas qhov hnyav sib txawv
Qhov hnyav sib txawv, piv txwv li, qhov sib txawv ntawm txhua tus neeg koom nrog qhov hnyav ntawm kev mus ntsib, tau suav los ntawm qhov nruab nrab qhov sib txawv ntawm qhov hnyav thiab txhais tau tias yog qhov nruab nrab qhov sib txawv ntawm qhov sib txawv (ASV). Tshwj xeeb, ASV tau suav nrog sivlub cev hnyavntawm txhua qhov kev rov qab los (Bwtn) siv cov qauv hauv qab no: ([|Bwthauv paus– Bwt1| plus ·· plus|Bwtn-1– Bwtn|]/ mus ntsib zaus [n]). Cov lus qhia ntawm lub cev qhov hnyav hloov pauv kuj tau txiav txim siab hauv kev tshuaj ntsuam. Cov no tau suav los ntawm kev rho tawm tus neeg koom nrog qhov ntsuas qhov hnyav thaum lub sijhawm saib tag nrho los ntawm qhov kev mus ntsib qhov hnyav thiab txhais tau tias yog qhov ruaj khov (hloov pauv <5 feem="" pua),="" nce="" (qhov="" hnyav="" hloov="" pauv="" ntau="" dua="" lossis="" sib="" npaug="" li="" 5="" feem="" pua),="" lossis="" txo="" qis="" (="" qhov="" hnyav="" tsis="" zoo="" hloov="" ntau="" dua="" lossis="" sib="" npaug="" li="" 5="" feem="" pua="" )="">
Kev ntsuas qhov ntsuas
The annual eGFR decline for each participant was calculated using linear least-squares regression models, as previously reported (19). Individual eGFR measurements during the entire follow-up duration were included in the models. In order to estimate the annual eGFR decline, the regression line that was closest to the patient's eGFR measurements, in the sense of minimizing the sum of the squared deviations of the individual eGFR measurements from the line, was determined. Annual eGFR decline, described in units of "milliliters per minutes per 1.73 m2 per year," was defined as the slope of the least-squares regression line of the eGFR versus time data for each patient. Rapid eGFR decline was defined as a calculated annual eGFR decline>3 mL / min / 1.73 m2 thaum lub sijhawm ua raws (19).
Cistanche tuaj yeem txhim kholub raum ua haujlwm
Kev txheeb cais
Cov kev ntsuam xyuas tau ua tiav siv ASV raws li qhov sib txawv tsis tu ncua thiab cov tertiles ntawm ASV raws li qhov sib txawv ntawm categorical. Multivariable linear regressions siv plaub tus qauv tau siv los ntsuas cov kev sib raug zoo ntawm eGFR poob tus nqi thiab ASV thiab sib piv cov kev hloov kho txhua xyoo eGFR poob qis raws li ASV pawg. Txhais tau hais tias thiab 95 feem pua ntawm kev ntseeg siab tau tshaj tawm. Qauv 1 hloov kho qhov hnyav, hnub nyoog, thiab poj niam txiv neej. Qauv 2 hloov kho Model 1 rau kev txij nkawm, kev kawm, kev haus cawv, kev haus luam yeeb, thiab qhov hnyav hloov pauv. Qauv 3 kho Model 2 rau systolic ntshav siab (SBP), high-density lipoprotein cholesterol (HDL-C), C-reactive protein (CRP), albumin, homeostatic qauv ntsuam xyuas rau insulin resistance score (HOMA-IR), lub cev ua si, cov leeg nqaij, tag nrho lub zog noj txhua hnub, thiab eGFR. Qauv 4 hloov kho rau hnub nyoog, poj niam txiv neej, qhov chaw kawm, kev kawm, ntshav qab zib, ntshav siab, haus luam yeeb, thiab BMI hauv qab. Logistic regression tsom xam tau siv los ntsuas qhov kev sib raug zoo ntawm lub cev qhov hnyav hloov pauv thiab eGFR poob sai. Hauv kev txheeb xyuas qhov sib txawv ntawm lub cev qhov hnyav tau siv los ua qhov sib txawv tsis tu ncua, cov qauv tau tsim nyob rau hauv qhov kev ntsuas qhov sib txawv tau nkag mus rau kev xam qhov sib txawv ntawm qhov sib txawv (OR) rau cov txiaj ntsig ntawm qhov nce ntawm ASV qhov tseem ceeb. Cov kev hloov pauv uas tau siv nyob rau hauv cov qauv sib txawv ntawm cov kab sib txawv ntawm cov kab sib txawv kuj tau siv hauv cov qauv logistic regression. Rau kev soj ntsuam rhiab heev, qhov cuam tshuam ntawm lub cev qhov hnyav hloov pauv tau raug tshuaj xyuas ntxiv siv tus qauv sib txawv, coefficient ntawm kev hloov pauv, qhov seem ntawm tus qauv sib txawv, feem pua ntawm kev hloov pauv ntawm lub cev qhov hnyav tag nrho piv nrog lub cev qhov hnyav (ASV feem pua), thiab qhov nruab nrab ntawm BMI hloov pauv (ASBMIV). ). ASV feem pua yog xam los ntawm kev faib txhua tus neeg koom nrog ASV los ntawm lawv lub cev qhov hnyav. ASBMIVs raug xam raws li qhov nruab nrab ntawm tus nqi hloov pauv hauv BMI qhov tseem ceeb ntawm txhua qhov kev mus ntsib. Tsis tas li ntawd, cov qauv latent chav kawm trajectory tau siv los tshawb xyuas kev sib koom ua ke ntawm ASV thiab cov kev sib txawv ntawm eGFR (20). Qhov zoo tshaj plaws ntawm cov chav kawm latent tau txiav txim siab siv cov hauv qab no: 1) Bayesian cov ntaub ntawv ntsuas; 2) txhais tau tias tom qab qhov tshwm sim ntawm kev ua tswv cuab hauv chav kawm; 3) tus naj npawb ntawm cov neeg koom hauv txhua txoj kev, thiab 4) kev txhais lus (21). Logistic regression tau siv los ntsuas qhov kev sib raug zoo ntawm ASV thiab cov chav kawm trajectory nrog eGFR poob qis tshaj plaws. Txhua qhov kev ntsuam xyuas tau ua tiav siv STATA software (version 16.1, StataCorp) thiab R hom lus software (version 3.4.3, R Foundation for Statistical Computing). p <0.05 tau="" suav="" tias="" yog="" qhov="" tseem="">
TSEEM CEEB
Cov yam ntxwv ntawm lub hauv paus
Cov yam ntxwv tseem ceeb ntawm cov neeg tuaj koom tau qhia hauv Table 1. Qhov nruab nrab hnub nyoog yog 52.0 (8.7) xyoo, thiab 48.8 feem pua yog txiv neej. Qhov nruab nrab eGFR yog 91.9 (15.9) mL / min / 1.73 m2. Lub cev hnyav txhais tau tias thiab qhov ntau yog 63.2 (10.1) kg thiab 32.1 txog 105 kg, raws li. Qhov ntau ntawm cov hauv paus eGFR yog 60 txog 155 mL / min / 1.73 m2. Ntawm cov neeg koom, tag nrho ntawm 5,852 (86.2 feem pua) cov neeg tuaj koom tau mus xyuas thiab ntsuas lub cev hnyav tshaj tsib zaug thaum lub sijhawm ua raws (Cov Ntaub Ntawv Txhawb Nqa S1). Tsis tas li ntawd, qhov ntsuas qhov tsawg kawg nkaus yog 2 xyoos, qhov ntev tshaj plaws ntawm kev mus ntsib yog 4 xyoo. Kev ntsuas tau ua nyob rau txhua txhua 2-xyoo ib ntus hauv 58.0 feem pua ntawm cov neeg koom (Cov Ntaub Ntawv Txhawb Nqa S2). Qhov nruab nrab ASV ntawm cov neeg koom yog 1.9 kg (Cov ntaub ntawv txhawb nqa daim duab S3). Tsis muaj kev sib raug zoo ntawm ASV thiab cov hauv paus ntsiab lus eGFR (Pearson correlation, ρ=−0.0115, p=0.34; Cov ntaub ntawv txhawb nqa daim duab S4).
Ib xyoos twg eGFR poob qis koom nrog lub cev qhov hnyav
Thaum lub sijhawm ua raws li qhov nruab nrab ntawm 11.7 xyoo (ntau: 5.2-12.7), tag nrho qhov nruab nrab eGFR poob qis ntawm cov neeg tuaj koom yog −1.57 mL/min/1.73 m2 toj xyoo. Tag nrho txhua xyoo eGFR poob tus nqi tau pom muaj kev sib raug zoo nrog ASV (ib xyoos twg eGFR poob tus nqi ib 1-kg nce hauv ASV: −0.10 mL/min/1/73 m2 ib xyoos twg; 95 feem pua CI: −0.14 txog −0.06; Cov Ntaub Ntawv Txhawb Nqa S1). Thaum cov eGFR poob qis tau muab piv nrog cov ASV tertiles, tus nqi ntawm eGFR poob yog sai dua nyob rau hauv thib peb ASV tertiles piv nrog thawj tertiles. Qhov sib txawv no hauv ib xyoos twg eGFR poob tseem tseem ceeb txawm tias tom qab kev hloov kho tau ua rau qhov tsis sib haum xeeb (Table 2). Ib qho tseem ceeb txhua xyoo eGFR poob qhov sib txawv tsis pom ntawm thawj thiab thib ob ASV tertiles.
eGFR poob sai
Kev poob qis eGFR nrawm, txhais tau tias yog ib xyoos twg eGFR poob> 3 mL / min / 1.72 m2 hauv ib xyoos, tau pom hauv 913 (13.4 feem pua) cov neeg koom. Kev poob qis ntawm eGFR nrawm yog ntau dua nyob rau hauv tertile nrog qhov siab est ASV piv nrog qis tshaj (Tertile 1: 283 [12.5 feem pua]; Tertile 2: 261 [11.5 feem pua]; Tertile 3: 369 [16.3 feem pua]; p rau kev sib txawv<0.001). the="" proportion="" of="" participants="" with="" rapid="" egfr="" decline="" was="" comparable="" between="" the="" first="" and="" second="" asv="" tertile="">
Kev cuam tshuam ntawm lub cev qhov hnyav hloov pauv ntawm eGFR poob sai
Thaum qhov kev pheej hmoo ntawm eGFR poob qis yog stratified ntawm ASV tertiles siv cov qauv sib txawv logistic regression (Table 3), LOSSIS tau nce ntxiv hauv cov neeg koom hauv pawg ASV tertile siab tshaj piv nrog cov qis tshaj (OR: 1.48; 95 feem pua CI: 1. 24-1.76). Lub koom haum no tseem ceeb heev tom qab hloov kho rau qhov sib txawv ntawm qhov sib txawv (LOSSIS: 1.66; 95 feem pua CI: 1.29-2.14). Tom qab ntawd, cov kev koom tes ntawm eGFR poob sai thiab ASV, kho raws li qhov sib txawv tsis tu ncua, kuj tau soj ntsuam (Table 4). Txhua 1-kg nce hauv ASV muaj feem xyuam rau 24 feem pua nce hauv qhov kev pheej hmoo ntawm eGFR poob sai (OR: 1.24; 95 feem pua CI, 1.16-1.33). Qhov kev sib raug zoo ntawm eGFR poob sai thiab ASV tau muaj zog txawm tias tom qab kev hloov kho rau cov teeb meem tsis txaus ntseeg, suav nrog cov hauv paus eGFRs thiab tag nrho cov kev hloov pauv qhov hnyav (los yog: 1.29; 95 feem pua CI: 1.17-1.42).
Kev tsom xam pab pawg
Kev sib raug zoo ntawm lub cev qhov hnyav thiab qhov poob qis sai sai tau tshawb xyuas ntxiv hauv cov pab pawg sib cais raws hnub nyoog (<60 or≥60="" y),="" sex="" (male="" or="" female),="" bmi=""><24.5 kg/m2="" and="" ≥24.5="" kg/m2="" ),="" smoking="" habits,="" body="" weight="" directions="" (decreasing,="" stable,="" and="" increasing="" direction),="" diabetes="" (with="" or="" without),="" and="" hypertension="" (with="" or="" without).="" no="" significant="" interactions="" were="" found="" in="" any="" of="" the="" subgroups,="" suggesting="" that="" the="" relationship="" between="" increased="" body="" weight="" variabilities="" and="" the="" risk="" of="" rapid="" egfr="" declines="" were="" consistently="" significant="" across="" these="" subgroups="" (figure="">
Kev tsom xam rhiab heev
Several subsequent evaluations were performed for sensitivity analyses. First, assessments were performed excluding participants with a follow-up duration < 5 years, those with CVD, or those with a BMI >35 (Cov ntaub ntawv txhawb nqa S2-S4). Kev ntsuam xyuas kuj tau ua tiav suav nrog cov neeg koom nrog lub sijhawm rov qab los ntau dua 4 xyoo (Cov Ntaub Ntawv Txhawb Nqa S5). Qhov thib ob, kev ntsuam xyuas tau ua ntxiv nrog rau lwm qhov kev ntsuas ntawm qhov sib txawv, suav nrog ASV feem pua, ASBMIV, tus qauv sib txawv, coefficient ntawm kev hloov pauv, thiab qhov seem seem sib txawv (Supporting Information Table S6). Cov kev ntsuam xyuas no tau txais txiaj ntsig zoo ib yam nrog cov kev ntsuas tseem ceeb. Thib peb, thaum eGFR poob qis dua tau txhais tau nruj dua li eGFR poob qis> 5 mL / min / 1.73 m2 hauv ib xyoos, cov txiaj ntsig kuj tau sib haum nrog cov kev tshawb pom tseem ceeb (Supporting Information Table S7). Plaub, kev tshuaj xyuas siv CKD-EPI-derived eGFR qhov tseem ceeb kuj tau nthuav tawm cov kev tshawb pom zoo sib xws rau cov txiaj ntsig tseem ceeb (Supporting Information Table S8). Thaum kawg, thaum lub trajectory ntawm eGFR tau muab faib ua peb tus qauv sib txawv (Supporting Information Table S9, Supporting Information Figure S6), ntau dua ASV qhov tseem ceeb tau pom tias muaj feem cuam tshuam rau cov chav kawm uas poob qis tshaj plaws (Supporting Information Table S10).
Kev sib tham
Nyob rau hauv txoj kev tshawb no, lub cev qhov hnyav hloov pauv tau tshwm sim ntawm cov pej xeem nrog ib txwm muajlub raum ua haujlwm. Lawv tau cuam tshuam nrog kev pheej hmoo ntawm eGFR poob sai, uas tsis muaj kev ywj pheej ntawm lub cev qhov hnyav thiab ib txwm muaj kev pheej hmoo. Lub koom haum kuj tseem ceeb txawm tias tag nrho qhov hnyav nce lossis poob thaum lub sijhawm ua raws.
Kev rog rog yog qhov muaj feem cuam tshuam rau CKD kev loj hlob thiab kev loj hlob. Cov kev tshawb fawb raws li pej xeem tau rov sau dua ib lub koom haum ywj pheej ntawm BMI thiab kev pheej hmoo ntawm qhov xwm txheej CKD (22,23). Tsis tas li ntawd, ntau lub cev hnyav thiab adiposity tau pom tias muaj feem cuam tshuam nrog kev mob sai sai ntawm CKD uas tshwm sim los ntawm ntau yam etiologies (24). Tsis ntev los no, qhov hnyav poob vim yog kev phais mob hauv cov neeg mob rog rog thiab hloov pauvlub raum ua haujlwmtau pom tias normalize eGFR (25). Txawm li cas los xij, cov kev tshawb fawb uas tsis muaj kev cuam tshuam rau kev poob phaus tau tshaj tawm cov txiaj ntsig tsis sib haum (6,26). Hauv kev cuam tshuam yav tom ntej ntawm cov neeg mob ntshav qab zib, rog rog, thiab CKD, kev noj zaub mov hypocaloric rau 1 xyoos ua rau poob phaus thiab txhim kho eGFR (27). Txawm li cas los xij, hauv kev tshawb fawb ntawm cov poj niam uas tsis muaj ntshav qab zib nrog kev rog, txawm hais tias kev hloov pauv txoj kev ua neej ua rau BMI txo qis, eGFRs tseem nyob ruaj khov (28). Hauv lwm txoj kev tshawb fawb, ib qho 1-xyoo kev ua haujlwm poob phaus tau ua rau poob ceeb thawj nrog rau qhov tseem ceeb eGFR txo (29). Ib qho ua tau piav qhia rau ntau yam kev poob phaus los ntawmlub raum ua haujlwmtej zaum yuav yog vim qhov tseeb tias qhov hnyav hloov pauv thaum rov qab los tsis tau txiav txim siab hauv cov kev tshawb fawb yav dhau los no. Qhov muaj peev xwm no tau txais kev txhawb nqa los ntawm kev tshawb pom ntawm txoj kev tshawb fawb tam sim no, uas qhia tau hais tias cov neeg koom tau faib rau qhov siab tshaj plaws ASV tertile tau cuam tshuam nrog kev pheej hmoo siab ntawm eGFR poob sai, txawm hais tias tag nrho qhov hnyav ntawm lub cev thaum ua raws li tau sau tseg hauv tsuas yog 7. feem pua ntawm cov neeg koom no. Qhov tshwm sim ntawm txoj kev tshawb no qhia tau hais tias, ntxiv rau qhov paub zoo txog kev pheej hmoo ntawm kev rog, kev hloov pauv ntawm lub cev hnyav kuj tuaj yeem yog qhov ua kom nrawm dua.lub raum ua haujlwmpoob. Yog li ntawd, yav dhau los tiam sis ntawm lub cev hnyav yuav tsum tau coj mus rau hauv tus account nrog rau tam sim no lub cev hnyav thaum stratifying CKD kev pheej hmoo. Ntxiv mus, thaum kev poob phaus raug pom zoo kom txo qis kev pheej hmoo ntawm CKD, nws yuav tsum tau ua cov kauj ruam los tiv thaiv qhov hnyav rov qab los ntawm qhov tshwm sim. Txawm li cas los xij, kev tshawb fawb soj ntsuam ntxiv yuav xav tau los soj ntsuam seb puas txo qis qhov kev hloov pauv ntawm qhov hnyav pab kom tsis txhob ua rau lub raum poob sai.
Cistanche txhim kholub raum ua haujlwm
Lub cev hnyav tau nce siab dua hauv cov tib neeg uas muaj lub cev hnyav dua qhov hloov pauv thaum rov qab los. Qhov no tuaj yeem cuam tshuam qhov kev pheej hmoo siab ceevlub raum ua haujlwmpoob pom nyob rau hauv cov neeg uas muaj zog lub cev hnyav variability nyob rau hauv ntau txoj kev. Ua ntej, muaj qhov ua tau tias qhov rog nws tus kheej, ntau dua li qhov hnyav dua qhov sib txawv, tuaj yeem yog qhov tseem ceeb ntawm qhov kev pheej hmoo ntawm kev nce nrawm.lub raum ua haujlwmpoob. Txawm li cas los xij, txiav txim siab tias qhov kev pheej hmoo nce siab tseem tseem ceeb txawm tias tom qab kev hloov kho rau lub cev qhov hnyav, qhov tshwm sim ntawm qhov muaj feem cuam tshuam tseem ceeb yog tsawg dua. Lwm lub ntsiab lus los xav txog yog tias qhov cuam tshuam ntawm ASV yuav txawv raws li cov hauv paus ntsiab luslub cev hnyavntawm tus kheej. Tib qhov kev hloov pauv ntawm qhov hnyav yuav ua rau muaj kev cuam tshuam ntau dua rau cov neeg koom nrog lub cev qhov hnyav dua li cov uas muaj lub cev hnyav dua. Yog li ntawd, qhov cuam tshuam ntawm lub cev qhov hnyav hloov pauv raws li qhov feem pua ntawm kev hloov pauv ntawm lub hauv paus qhov hnyav tau raug soj ntsuam hauv kev tshuaj ntsuam rhiab heev. Cov kev soj ntsuam rhiab heev no tau txais txiaj ntsig zoo sib xws rau qhov kev ntsuam xyuas tseem ceeb, qhia tias qhov hnyav hloov pauv nws tus kheej, tsis yog lub hauv paus ntawm lub cev qhov hnyav, ua lub luag haujlwm tseem ceeb hauv kev txiav txim siab qhov kev pheej hmoo ntawm lub raum ua haujlwm poob sai.
Preexisting comorbidities tuaj yeem yog lwm qhov ua rau pom lub cev qhov hnyav hloov pauv. Comorbidities, nrog rau kev kub siab, ntshav qab zib, thiab CVDs, muaj ntau dua rau cov neeg koom nrog cov txiaj ntsig ASV siab dua. Tsis tas li ntawd, kev ua neej nyob uas cuam tshuam rau kev noj qab haus huv tag nrho, suav nrog keeb kwm kev haus luam yeeb zoo thiab kev ua kom lub cev qis dua txhua hnub, muaj ntau dua ntawm cov neeg muaj txiaj ntsig ASV siab dua. Cov kev tshawb pom no tawm qhib qhov ua tau tias qhov poob phaus pom hauv cov neeg koom no yog qhov tshwm sim ntawm kev mob. Txawm li cas los xij, qhov tseeb tias qhov hnyav tag nrho, ntau dua li qhov poob phaus, muaj ntau dua nyob rau hauv cov pab pawg uas muaj kev sib txuam ntau dua ua rau muaj feem cuam tshuam nrog kev poob phaus.lub cev hnyavfluctuations, yog vim muaj mob. Tsis tas li ntawd, kev sib koom ua ke ntawm lub cev qhov hnyav thiab qhov poob qis ntawm eGFR sai yog qhov tseem ceeb txawm tias tom qab kev hloov kho rau cov teeb meem hauv qab thiab kev ua neej, qhia tias qhov hloov pauv ntawm lub cev hnyav tuaj yeem cuam tshuam.lub raum ua haujlwmtsis hais txog lawv qhov kev noj qab haus huv tag nrho.
Feem ntau, nrog rau qhov tshwm sim ntawm kev kub siab thiab ntshav qab zib, pom me ntsis tab sis maj mam nce nrog qhov nce hauv ASV. Qhov kev tshawb pom no yog ua raws li cov ntaub ntawv dhau los uas tau pom muaj kev koom tes tseem ceeb ntawm lub cev qhov hnyav thiab ntshav qab zib, ntshav siab, lossis metabolic syndromes (30-32). Kev muaj ntshav siab thiab ntshav qab zib tuaj yeem muaj qee yam cuam tshuam raulub raum ua haujlwmdeterioration cuam tshuam nrog lub cev qhov hnyav hloov pauv. Ntshav siab thiab ntshav qab zib yog qhov paub zoo uas cuam tshuam rau lub raum ua haujlwm (23). Yog li ntawd, kev sib raug zoo nyob rau hauv uas lub cev qhov hnyav nce qhov kev pheej hmoo ntawm lub raum kev ua haujlwm poob qis los ntawm qhov muaj ntshav siab thiab ntshav qab zib tuaj yeem tshwm sim. Txawm li cas los xij, kev sib raug zoo tseem ceeb ntawm ASV thiab lub raum tsis ua haujlwm sai tau khaws cia txawm tias tom qab hloov kho rau SBP thiab HOMA-IR. Yog li ntawd, muaj peev xwm ntawm hypertension- thiab ntshav qab zib-yuav ua li cas cuam tshuam ntawm lub cev qhov hnyav hloov ntawmlub raum ua haujlwmyuav tsum tau xav txog.
Lub luag hauj lwm rau lub luag hauj lwm rau cov nyhuv ntawm lub cev qhov hnyav hloov ntawm ceevlub raum ua haujlwmkev poob qis yog qhov tsis meej, tab sis ntau qhov yuav tsum tau xav txog.Lub cev hnyavKev hloov pauv nce qib insulin sai thiab ua rau cov insulin tsis kam (30,33). Insulin tsis kam activates renin-angiotensin-aldosterone system, tsub kom oxidative kev nyuaj siab, thiab txo endothelial nitric oxide ntau lawm, uas yog zoo-paub yam tseem ceeb inducing raum pathology (34,35). Yog li, insulin tsis kam tuaj yeem yog qhov nruab nrab ntawm lub cev qhov hnyav thiablub raum ua haujlwmde-TABLE 2 cline. Lwm qhov yuav tau xav txog yog kev koom tes nrog ntshav siab. Cov kev tshawb fawb tsiaj tau pom tias lub cev qhov hnyav hloov pauv qhov sib txawv nruab hnub hmo ntuj hauv cov ntshav siab, ua rau "tsis-dipping" qauv (36,37), uas cuam tshuam nrog kev ua rau lub raum tsis txaus (38). Kev tshawb nrhiav ntxiv nrog 24- teev ambulatory ntshav ntsuas ntshav hauv cov tib neeg uas muaj lub cev hnyav hloov pauv yog tsim nyog los ntsuas qhov ua tau no. Rov qab overshoots hauv glomerular siab kuj tuaj yeem ua lub luag haujlwm. Xav tias glomerular filtration rate yog modulated los ntawm kev noj zaub mov, kev hloov pauv hauv kev noj zaub mov cuam tshuam nroglub cev hnyavkev caij tsheb kauj vab yuav ua rau glomerular pom tus nqi hloov pauv (39). Qhov kev puas tsuaj ntev ntev ntawm qhov nce glomerular siab tau piav qhia zoo (40). Tsis tas li ntawd, nce glomerular siab thaum lub sij hawm hnyav-nce tuaj yeem ua rau lub raum hnyav dua, ua rau muaj kev cuam tshuam ntau dua rau cov xwm txheej pheej hmoo. Daim ntawv tshaj tawm yav dhau los qhia tias hyperlipidemia synergistically ua rau glomerular sclerosis thaum glomerular hypertension yog tam sim no txhawb qhov muaj peev xwm (41).
Txoj kev tshawb no muaj ob peb lub zog. Ua ntej, cov ntaub ntawv tau txais los ntawm cov neeg sib tw yav tom ntej nrog txog li 12 xyoo ntawm kev soj ntsuam. Qhov thib ob, ntau yam tsis meej pem uas cuam tshuamlub raum ua haujlwm, suav nrog kev ua neej nyob thiab kev hloov pauv hauv zej zog, tau suav nrog hauv kev tshuaj ntsuam. Thib peb, lub cev hnyav tau ntsuas nrog ntsuas ntsuas ntawm txhua qhov kev mus ntsib, thiab tsis siv tus kheej qhia qhov tseem ceeb. Txawm li cas los xij, qhov kev tshawb fawb no tseem muaj ntau yam kev txwv. Ua ntej, sib txawv txhob txwm poob phaus los ntawm kev poob phaus tsis tau. Kev poob phaus sai tuaj yeem yog los ntawm lwm yam mob uas cuam tshuam rau lub raum ua haujlwm. Txawm li cas los xij, cov neeg koom nrog xwm txheej mob qog noj ntshav lossis keeb kwm ntawm malignancies, uas feem ntau yuav ua rau poob phaus, tsis suav nrog kev tshuaj xyuas. Tsis tas li ntawd, qhov kev xav poob phaus tuaj yeem tshwm sim los ntawm kev rog rog, cov neeg koom nrog hauv pawg ASV tertile siab dua muaj qib BMI siab dua thiab muaj ntshav qab zib thiab kub siab ntau dua. Qhov thib ob, txawm tias qhov kev tsim qauv yav tom ntej, tsuas yog kev koom ua ke, tsis yog qhov ua rau, tuaj yeem raug txiav txim siab vim qhov kev soj ntsuam ntawm txoj kev tshawb fawb. Qhov thib peb, muaj qhov ua tau tias cov caj ces lossis ib puag ncig tej zaum yuav ua haujlwm raws li kev ntsuas tsis txaus ntseeg thiab cov xwm txheej no tsis tuaj yeem suav nrog. Thaum kawg, tsis hais txog ntawm cov ntaub ntawv ntau zaus, uas txo qis txoj hauv kev tsis ncaj ncees, lub sijhawm nruab nrab ntawm kev ntsuas, nrog rau tus lej ntawm kev ntsuas, yuav tsis muaj kev cuam tshuam rau kev sib raug zoo ntawm ASV thiab eGFR poob qis, vim muaj qhov tsis sib xws. xwm ntawm cov ntaub ntawv.
Nyob rau hauv xaus, nyob rau hauv lub zej zog-raws li cohort nrog ib txwmlub raum ua haujlwm, lub cev hnyav hloov pauv tau cuam tshuam nrog kev nce ntxiv hauv kev pheej hmoo ntawm kev nrawmlub raum ua haujlwmpoob. Qhov kev pheej hmoo nce no yog ywj siab ntawm cov kev pheej hmoo ib txwm muaj thiab tag nrho lub cev hnyav nce lossis poob thaum lub sijhawm. Cov kev tshawb fawb ntxiv tau lees paub los piav qhia cov txheej txheem hauv qab ntawm kev sib raug zoo ntawm lub cev qhov hnyav thiab nrawmlub raum ua haujlwmkev puas tsuaj.
TXOJ CAI
Cov ntaub ntawv kab mob sib kis tau siv hauv txoj kev tshawb no tau txais los ntawm Korean Genome thiab Epidemiology Study (KoGES; 4851-302) ntawm National Research Institute of Health, Centers for Disease Control and Prevention, Ministry of Health thiab Welfare, Republic of Kauslim.
Kev tsis sib haum xeeb ntawm kev txaus siab
Cov kws sau ntawv tshaj tawm tias tsis muaj kev cuam tshuam ntawm kev txaus siab.
AUTHOR CONTRIBUTIONSYSJ thiab JTP tau xeeb thiab tsim txoj kev kawm; YSJ, KHN, HRY, SL, JHJ, thiab JTP tau txais cov ntaub ntawv; YSJ, KHN, HRY, SL, JHJ, SHH, THY, JTP, thiab SWK txheeb xyuas cov ntaub ntawv; YSJ thiab KHN tsim cov duab; YSJ, KHN, thiab JTP tau sau cov ntawv sau; SHH, THY, thiab SWK saib xyuas qhov kev kawm. Txhua tus kws sau ntawv tau pab txhawb rau cov ntsiab lus tseem ceeb ntawm kev txawj ntse thaum lub sijhawm sau ntawv sau los yog kho dua tshiab thiab lees txais kev lav phib xaub rau kev ua haujlwm tag nrho los ntawm kev ua kom ntseeg tau tias cov lus nug ntsig txog qhov raug lossis kev ncaj ncees ntawm ib feem ntawm txoj haujlwm raug tshawb xyuas thiab daws kom raug.
Los ntawm: 'Lub cev hloov pauv yog txuam nrog rau lub raum ua haujlwm poob sai' los ntawmYoung Su Joo, et al
---Obesity (Silver Spring). 2022; 30:257–267.
DOI: 10.1002/oby.23326
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