srcyrlTil
Bosh sahifa / Bilim / Kontent

Bilim

O‘zgartirilgan surunkali buyrak kasalligi epidemiologiyasi bo‘yicha taxminiy glomerulyar filtratsiya tezligi uchun hamkorlik tenglamasi Yaponiyadagi tirik buyrak donorlaridagi boshqa tenglamalarga qaraganda komorbid kasalliklar bilan yaxshiroq bog‘langan Ⅱ

Jan 30, 2024

Natijalar

Dastlabki ma'lumotlar 1-jadvalda keltirilgan. Biz o'rtacha qiymatni solishtirdikeGFR for the three types of equations between the elderly (age >70 yosh) va keksa bo'lmagan guruhlar va komorbidite-ijobiy va qo'shma kasalliklar-salbiy guruhlar o'rtasida (2-jadval) va barcha uchta eGFR uchun keksa va keksa bo'lmagan guruhlar o'rtasida sezilarli farqlar kuzatildi. O'rtacha eGFR/Jm-eGFRni solishtirganda,semizlik, gipertoniya, vaCVD namoyish etildisezilarli farqlar. O'rtacha eGFR / Jm-MDRDni solishtirganda, sezilarli farqlar faqat semirishda aniqlandi. O'rtacha eGFR/Jm-CKD-EPI ni solishtirganda,semizlik, gipertoniya, qandli diabet, va CVD sezilarli farqlarni ko'rsatdi. Har bir tenglamadan foydalangan holda insult uchun o'rtacha eGFRda sezilarli farqlar kuzatilmadi.

The positive rates of the 5 comorbidities in the elderly (age >70 yosh) va keksa bo'lmagan guruhlar 2-rasmda ko'rsatilgan. uchun ijobiy ko'rsatkichlargipertoniya, diabetes, stroke, and CVD were two to three times higher in the elderly than in the non-elderly group. Chi-square tests for an older age (>70 yosh) va qo'shma kasalliklar darajasi sezilarli farqlarni ko'rsatdi (p<0.001).

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    Yosh va o'rtasidagi bog'liqliklareGFR hisoblangan3 ta tenglamadan foydalanish muhim edi (p<0.001). The R2 of the eGFR/Jm-CKD-EPI (R2 =0.509) was larger than that of the eGFR/Jm-eGFR (R2 =0.150) and eGFR/Jm-MDRD (R2 = 0.083).

    3a-rasmda uchta tenglama yordamida hisoblangan eGFR o'rtasidagi ROC tahlili ko'rsatilgan.Semizlikning beshta komorbidiyasi, gipertoniya, qandli diabet, CVD, and stroke. The ROC curves of the eGFR/Jm-CKD-EPI exhibited a leftward shift compared with those of the eGFR/Jm-eGFR and eGFR/ Jm-MDRD about the comorbidities. In particular, regarding the relationship with older age (>70 years old), the area under the ROC curve (AUROC) for the eGFR/JmCKD-EPI was much larger, (0.859) than that for the eGFR/ Jm-eGFR (0.674) and eGFR/Jm-MDRD (0.636). Fig. 3b shows the results of the ROC analysis between the eGFR calculated using the 3 equations and the 5 comorbidities, excluding an older age (>70 yoshda), (n=798). eGFR/Jm-CKD-EPI ning ROC egri chiziqlari birgalikda kasalliklar bo'yicha eGFR/Jm-eGFR va eGFR/Jm MDRD bilan solishtirganda chapga siljishni ko'rsatdi. Qo'shma kasalliklar ko'rsatkichlari, ya'ni<70 mL/min/1.73 m2, 70- 80 mL/min/1.73 m2, and  80 mL/min/1.73 m2, in the 3 eGFR groups are presented in Table 3. All five comorbidities showed significant differences only in the group with eGFR/Jm-CKD-EPI, and the comorbidity rates in the group with eGFR/Jm-CKD-EPI <70 mL/min/1.73 m2 were higher than those in the group with eGFR - 70 mL/min/1.73 m2.

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    Uchta eGFRdan eGFR/Jm-CKD-EPI komorbid kasalliklar bilan eng sezgir korrelyatsiya qildi. eGFR/Jm-CKD-EPI, eGFR/Jm-eGFR va eGFR/Jm-MDRD mos ravishda to'rtta, uchta va beshta komorbidiyalardan birida sezilarli farqlarni aniqladi (2-jadval). ROC tahlillarida (3-rasm) eGFR/Jm-CKD-EPI komorbidiyalar o'rtasidagi munosabatlar nuqtai nazaridan ustun edi. Trend tahlili (3-jadval) eGFR ning pasayishida eGFR/Jm-CKD-EPI ning ustunligini aniqladi (3-rasm).

    Transplantatsiyadan oldin donor nomzodini baholash paytida eGFR/CKD-EPI dastlabki baholash uchun ishlatilishi mumkin. eGFR/CKD-EPI past bo'lgan donorlardan xayriya olgan bemorlarga qo'shimcha yordam ko'rsatilishi kerak (<70 mL/min/1.73 m2 ), which is most strongly associated with the five comorbidities and an older age (Table 3). Compared to donations from healthy living donors, those from living donors with medical conditions (so-called expanded criteria donors) exhibited a high incidence of overall and death-censored graft loss according to multivariable Cox proportional hazards analyses (hazard ratios=2.16 and 3.25, p= 0.015 and 0.004, respectively) (7).

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    Figure 3. a: The AUROC using the ROC analysis for the relationship with comorbidities calculated by the eGFR using the three equations of Jm-eGFR, Jm-MDRD, and Jm-CKD-EPI. The AUROC is shown graphically for each ROC analysis between the eGFR and comorbidities. n=8,176. b: The AUROC using the ROC analysis for the relationship with comorbidities calculated by the eGFR using the three equations of Jm-eGFR, Jm-MDRD, and Jm-CKD-EPI, excluding the elderly (age >70 yoshda). n=7,378. AUROC: qabul qiluvchining ishlash xususiyatlari egri chizig'i ostidagi maydon, ROC: qabul qiluvchining ishlash xususiyatlari, AUC: egri chiziq ostidagi maydon, BMI: tana massasi indeksi, eGFR: taxminiy glomerulyar filtratsiya tezligi, HT: gipertenziya, DM: diabet, yurak-qon tomir kasalliklari, Jm : Yaponiya o'zgartirilgan, MDRD: Buyrak kasalliklarida dietani o'zgartirish, CKD-EPI: Surunkali buyrak kasalligi epidemiologiyasi bilan hamkorlik. Qizil chiziq Jm-CKD-EPI, ko'k chiziq Jm-eGFR va yashil chiziq Jm-MDRD.

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    Kesma tadqiqotlarda eGFR/CKD-EPIning pastligi Kavkaz jamiyatida yashovchi populyatsiyalarda eGFR/MDRDga qaraganda komorbid kasalliklarning tarqalishi bilan yaxshiroq bog'liqligini ko'rsatdi. Tarantini va boshqalar. (4) CVD bilan og'rigan bemorlarda eGFR / CKD-EPI ni baholashda CVD tarqalishi past eGFR guruhidagi eGFR / MDRDni baholashdan ko'ra yuqori ekanligini xabar qildi. Juutilainen va boshqalar. (13) CKD bilan og'rigan bemorlarda gipertenziya, semizlik, diabet va yurak-qon tomir kasalliklarining ko'rsatkichlarini baholadi va baholash eGFR / CKD-EPI yordamida amalga oshirilgandan ko'ra o'tkazilganda qo'shma kasalliklarga chalingan bemorlarning sezilarli darajada yuqori tarqalishini kuzatdi. eGFR/MDRD yordamida.

    Biz adabiyotda eGFR/Jm-CKD-EPI ning aniqligini tasdiqladik. Rule va boshqalar. (14) CKD-EPI tenglamasi past xavfli populyatsiyalarda, jumladan, donorlikdan oldingi va donorlikdan keyingi buyrak donorlarida MDRDga qaraganda aniqroq ekanligini xabar qildi. Murata va boshqalar. (15) kreatininga asoslangan eGFR/CKD-EPI potentsial LKT donorlarida eGFR/MDRDga qaraganda kamroq tarafkashlik ko'rsatganligini xabar qildi (-8% va -18%). Burballa va boshqalar. (16) va Gaillard va boshqalar. (17) kreatininga asoslangan eGFR/CKD-EPI, eGFR/MDRD va mGFR qiymatlarini operatsiyadan oldingi LKT donorlaridagi izotoplar bilan solishtirdi va eGFR/CKD-EPI mGFR bilan eGFR/MDRDga qaraganda yaxshiroq korrelyatsiya qilish degan xulosaga keldi. Horio va boshqalar. (18) eGFR/Jm-CKD-EPI va eGFR/Jm-MDRD aniqligini Yaponiyada tibbiy ko'rikdan o'tkazilgan populyatsiyada o'lchangan inulin GFR bilan solishtirdi. O'lchangan inulin GFR 60 ml / min / 1,73 m2 g'azabida, eGFR / Jm-CKD-EPI da noto'g'ri ko'rsatkichlar (mGFR-eGFR) 7,3 ± 20,6 ml / min / 1,73 m2 va 7,8 ± 22,2 m / 7,2 m2 ni tashkil etdi. eGFR/Jm-MDRD da mos ravishda m2 (p<0.001). Horio et al. (19) evaluated the accuracy of the eGFR/Jm-eGFR in potential LKT donors in Japan who received the inulin clearance test and observed a bias (mGFReGFR) of 18.3±16.4 mL/min/1.73 m2. Thus, the eGFR/JmeGFR underestimated the true GFR of LKT donors. Based on the two studies of Horio et al. (18, 19), the eGFR/JmCKD-EPI appears accurate for comparing measured inulin GFR values.

    We explored why the eGFR/Jm-CKD-EPI was superior regarding its relationship with the five evaluated comorbidties, as the reasons have not been examined in-depth in previous reports. The comorbidity rates were 2 to 3 times higher in the elderly group (age >70 years old) than in the non-elderly group (age  70 years old) among the LKT donors (Fig. 3). An ROC analysis revealed that the eGFR/JmCKD-EPI was better associated with older age (>70 yoshda) eGFR/Jm-eGFR va eGFR/Jm MDRD bilan solishtirganda (3a-rasm). Shunday qilib, biz yosh sezgirligining tenglamasi eGFR / Jm-CKD-EPI ning ustunligi uchun javobgar ekanligiga ishonamiz.

    Ji va boshqalar. ROC tahlili yordamida gipertenziyada eGFR va klinikadan oldingi maqsadli organ shikastlanishi o'rtasidagi munosabatni o'rganib chiqdi va eGFR / Xitoy CKD-EPI tenglamasi eGFR / Xitoy va Osiyoda o'zgartirilgan MDRD tenglamalariga qaraganda gipertonik asoratlar bilan yaxshiroq bog'langanligini xabar qildi (20). eGFR/CKD-EPI eGFR/MDRDga qaraganda intra-media qalinligi, oyoq Bilagi zo'r ko'rsatkichi, chap qorincha massa indeksi, siydik albumini-kreatinin nisbati va aorta puls to'lqinining tezligi bilan yaxshiroq bog'langan. Bizning tadqiqotimizda, keksa yoshdagi holatlarni hisobga olgan holda, eGFR / CKD-EPI, eGFR / Jm-eGFR va eGFR / Jm-MDRD ga qaraganda LKT donorlarida komorbidiyalar bilan yaxshiroq bog'langan (3b-rasm). Shunday qilib, eGFR / CKD-EPI, yoshi kattaroq omil bundan mustasno, gipertenziv yoki aterosklerotik asoratlarga sezgir bo'lishi mumkin. eGFR/Jm-CKD-EPI nafaqat buyrak shikastlanishi, balki LKT donorlarida gipertenziv asoratlarni aks ettiruvchi tizimli organlarning shikastlanishi uchun ham xavfni baholashda foydalanish uchun tavsiya etiladi.

    eGFR/CKD-EPI Kavkaz ishtirokchilarida yurak xuruji hodisalari yoki o'lim darajasini bashorat qilishda eGFR/MDRDdan ustun ekanligi xabar qilingan (1-3). Xitoylik ishtirokchilarda eGFR/CKD-EPI eGFR/MDRD (21) ga qaraganda insultning takrorlanishi va o'limini yaxshiroq bashorat qilgan. Consis tent, Matsushita va boshqalar. (22) eGFR/Jm CKD-EPI eGFR 60 ml/min/1,73 oralig'ida eGFR/Jm-MDRDga qaraganda barcha sabablarga ko'ra va yurak-qon tomir kasalliklaridan o'lim xavfini yaxshiroq bashorat qiluvchi ekanligini xabar qildi. m2 yapon ishtirokchilarida. Terawaki va boshqalar. (3) eGFR/Jm-CKD-EPI va eGFR/Jm-MDRD o'rtasidagi CVD va insult uchun bashoratli qiymatlarni solishtirish uchun ROC tahlilidan foydalangan va eGFR/Jm-CKD-EPI va eGFRdagi CVD hodisalari uchun AUROClar haqida xabar bergan. /Jm-eGFR mos ravishda 0.596 va 0.562 edi. eGFR/CKD-EPI umumiy salomatlik tekshiruvidan o'tayotgan 241 159 yapon ishtirokchisida (o'rtacha yosh, 64 yosh) yurak-qon tomir kasalliklari bilan chambarchas bog'liq edi. Ohsawa va boshqalar. (23) eGFR/Jm-CKD-EPI bilan barcha sabablarga ko'ra o'lim, miyokard infarkti va insultni eGFR/Jm-MDRD bilan solishtirganda salomatlik tekshiruvi kohortiga qaraganda yaxshiroq prognozlash haqida xabar berdi. Shunday qilib, eGFR/CKD-EPI jamiyatda yashovchi populyatsiyalarda KVH hodisalari va o'limni bashorat qilish uchun ustundir. Transplantatsiyadan keyin eGFR/CKD-EPI past bo'lgan donorlarni diqqat bilan kuzatib borishimiz kerak.

    cistanche-kidney disease-4(52)

    Several limitations associated with the present study warrant mention. The registry data had no data on the measured GFR, so we could not directly compare the accuracy of the three eGFR equations. We unfortunately had to exclude many cases with missing data from the analysis. These limitations might have resulted in the data being misclassified; however, our study has some important insights derived from its involvement of a large cohort of LKT donors (>8,{1}} holat).


    Xulosa

    eGFR/Jm-CKD-EPI, yapon LKT donorlari kabi past xavfli populyatsiyalarda eGFR/Jm-eGFR va eGFR/Jm MDRDga qaraganda, semizlik, gipertoniya, diabet, KVH va insultni o'z ichiga olgan komorbidliklar bilan yaxshiroq bog'langan. LKT donor nomzodlarining buyrak funktsiyasini dastlabki baholash uchun eGFR/Jm-CKD-EPI tavsiya etiladi, ayniqsa, komorbidiyalari bo'lgan kengaytirilgan donorlar uchun.


    Sizga ham yoqishi mumkin