Background Coronary artery calcification(CAC)is common in end-stage renal disease(ESRD)patients,and the extent of CAC is closely related to cardiovascular outcomes in ESRD patients.Cartilage oligomeric matrix protein(...Background Coronary artery calcification(CAC)is common in end-stage renal disease(ESRD)patients,and the extent of CAC is closely related to cardiovascular outcomes in ESRD patients.Cartilage oligomeric matrix protein(COMP),as a component of the vascular matrix,has been found to be an inhibitor of arterial calcification in basic studies.However,there is no clinical research on the correlation between COMP and CAC in maintenance hemodialysis(MHD)patients.The aim of this study was to explore the relationship between serum COMP levels and CAC and cardiovascular events in MHD patients.Methods Serum COMP levels were compared between 54 MHD patients and 66 healthy people.MHD patients were then divided into three groups according to the tertiles of the concentration of COMP level and were followed up for major adverse cardiac events(MACEs),which were defined as a combined end point of new onset angina pectoris,nonfatal myocardial infarction,heart failure,coronary artery revascularization,hospitalization due to angina pectoris and all-cause deaths.The CAC score was calculated based on computed tomography scans.Results The serum COMP level in MHD patients was significantly higher than that in the general population[984.23(248.43-1902.61)ng/mL vs.219.01(97.26-821.92)ng/mL,P<0.01].Serum COMP levels were positively correlated with CAC(r=0.313,P=0.021)and serum parathyroid hormone in MHD patients(r=0.359,P<0.01).Linear regression suggested that after adjusting for age,fasting blood glucose(Glu)and glycosylated hemoglobin(HbAlc),CAC score was an independent predictor in the final model for COMP level(β=0.424,t=3.130,P<0.01).The receiver operating characteristic(ROC)curve showed that COMP≥994 mg/mL had 68.0%sensitivity and 72.4%specificity for the prediction of severe CAC[area under the curve(AUC):0.674,P=0.030,95%CI:0.526-0.882].After a median follow-up of 16 months(8-24 months),there was no difference in the incidence rate of MACEs between the upper,middle and lower serum COMP groups.Conclusions Our study found that MHD patients have higher levels of circulating COMP than controls.The serum COMP level is positively correlated with CAC score and could be used as a biomarker of severe CAC in MHD patients.However,there is no obvious correlation between serum COMP levels and the incidence of cardiovascular events.展开更多
目的检索并汇总维持性血液透析(maintenance hemodialysis,MHD)患者不宁腿综合征(restless legs syndrome,RLS)症状管理的最佳证据,为临床实践提供循证依据。方法系统检索国内外数据库及指南网站中有关MHD患者RLS症状管理的临床决策、...目的检索并汇总维持性血液透析(maintenance hemodialysis,MHD)患者不宁腿综合征(restless legs syndrome,RLS)症状管理的最佳证据,为临床实践提供循证依据。方法系统检索国内外数据库及指南网站中有关MHD患者RLS症状管理的临床决策、指南、证据总结、系统评价、专家共识及随机对照试验,检索时限为建库至2024年5月30日。结果共纳入14篇文献,包括4篇临床决策、2篇指南、1篇证据总结和7篇系统评价,汇总出29条最佳证据,包括管理受益、诊断与管理、危险/加重因素、评估与监测、透析优化、补充替代疗法、药物治疗和健康教育8个方面。结论本研究汇总了MHD患者RLS症状管理的最佳证据,为医护人员临床实践提供了循证依据。展开更多
目的研究维持性血液透析(maintenance hemodialysis,MHD)患者血浆致动脉硬化指数(atherogenic index of plasma,AIP)、淋巴细胞与单核细胞比值(lymphocyte/monocyte ratio,LMR)与腹主动脉钙化(abdominal aortic calcification,AAC)的相...目的研究维持性血液透析(maintenance hemodialysis,MHD)患者血浆致动脉硬化指数(atherogenic index of plasma,AIP)、淋巴细胞与单核细胞比值(lymphocyte/monocyte ratio,LMR)与腹主动脉钙化(abdominal aortic calcification,AAC)的相关性,并构建风险预测模型。方法选取2023年5月1日─2024年4月30日在首都医科大学附属北京潞河医院郎府院区血液净化中心接受MHD治疗的患者。通过单因素及多因素Logistic回归分析来确定ACC的危险因素,建立列线图,并进行内部验证。结果共纳入158例MHD患者,分为AAC组(n=106)和非AAC组(n=52);AAC组的年龄(F=1.325,P<0.001)、校正钙(F=0.343,P=0.016)、AIP(F=8.726,P=0.003)、合并糖尿病(F=9.287,P=0.002)高于非AAC组;透析时长(F=3.681,P=0.007)、血白蛋白(F=3.287,P=0.002)、血磷(F=0.344,P=0.018)、LMR(F=1.824,P=0.022)低于非AAC组。多因素Logistic回归分析发现高龄(OR=1.071,95%CI:1.034~1.108,P<0.001)、合并糖尿病(OR=3.346,95%CI:1.428~7.843,P=0.005)、高AIP(OR=1.176,95%CI:1.041~1.33,P=0.009)、低LMR(OR=0.777,95%CI:0.614~0.983,P=0.036)是MHD患者发生AAC的独立危险因素。绘制列线图,计算C-index为0.834(95%CI:0.769~0.899),说明该列线图模型的区分能力较好。绘制校准曲线,模拟曲线和实际曲线绝对误差为0.029,说明模型具有较强的一致性。结论对于MHD患者来说,高龄、合并糖尿病、高AIP、低LMR是MHD患者发生AAC的独立危险因素。依据年龄、糖尿病、AIP、LMR构建的风险预测模型有很好的预测效能。展开更多
目的通过Meta分析构建维持性血液透析(maintenance hemodialysis,MHD)患者肌少症风险预测模型,同时验证其预测效能。方法计算机检索中国知网、中国生物医学文献数据库、维普、万方、PubMed、Embase、Web of Science等发表的关于MHD肌少...目的通过Meta分析构建维持性血液透析(maintenance hemodialysis,MHD)患者肌少症风险预测模型,同时验证其预测效能。方法计算机检索中国知网、中国生物医学文献数据库、维普、万方、PubMed、Embase、Web of Science等发表的关于MHD肌少症影响因素的文献,检索时限为2010年1月—2022年4月。按照纳排标准筛选文献并进行Meta分析,构建MHD患者肌少症风险预测模型。回顾性选取2022年3月—2023年3月南通市海门区人民医院血液净化中心收治的血液透析患者作为验证集,采用ROC曲线、Hosmer-Lemeshow检验评估风险预测模型的效能。结果共纳入20篇文献。Meta分析结果显示:年龄≥60岁(RR=1.781,95%CI:1.661~4.623,P<0.001)、C反应蛋白增高(RR=1.663,95%CI:1.234~4.923,P<0.001)、低活动水平(RR=1.488,95%CI:1.214~3.853,P<0.001)、糖尿病史(RR=1.559,95%CI:1.222~2.732,P<0.001)、透析龄长(RR=1.101,95%CI:1.041~1.161,P<0.001)、男性(RR=1.354,95%CI:1.142~2.958,P<0.001)、改良主观综合性营养评估(modified quantitative subjective global assessment,MQSGA)评分高(RR=1.523,95%CI:1.323~3.266,P<0.001)是MHD患者发生肌少症的危险因素,高体质量指数(body mass index,BMI)(RR=0.553,95%CI:0.122~0.986,P<0.001)和高血磷(RR=0.586,95%CI:0.443~0.777,P<0.001)是其保护因素。根据Meta分析结果构建MHD肌少症发生风险的预测模型,风险预测模型预测验证集发生肌少症的AUC为0.849(95%CI:0.768~0.930),最佳截断值为35分,灵敏度为70.0%、特异度为93.7%,Hosmer-Lemeshow检验结果显示χ^(2)=8.971,P=0.201。结论本研究构建的风险预测模型对MHD患者发生肌少症具有良好的预测效能和区分度,具有一定的临床应用和推广价值。展开更多
基金supported by the National Natural Science Foundation of China(81400262)the Backbone Fund of Peking University Third Hospital(Y72497-04)
文摘Background Coronary artery calcification(CAC)is common in end-stage renal disease(ESRD)patients,and the extent of CAC is closely related to cardiovascular outcomes in ESRD patients.Cartilage oligomeric matrix protein(COMP),as a component of the vascular matrix,has been found to be an inhibitor of arterial calcification in basic studies.However,there is no clinical research on the correlation between COMP and CAC in maintenance hemodialysis(MHD)patients.The aim of this study was to explore the relationship between serum COMP levels and CAC and cardiovascular events in MHD patients.Methods Serum COMP levels were compared between 54 MHD patients and 66 healthy people.MHD patients were then divided into three groups according to the tertiles of the concentration of COMP level and were followed up for major adverse cardiac events(MACEs),which were defined as a combined end point of new onset angina pectoris,nonfatal myocardial infarction,heart failure,coronary artery revascularization,hospitalization due to angina pectoris and all-cause deaths.The CAC score was calculated based on computed tomography scans.Results The serum COMP level in MHD patients was significantly higher than that in the general population[984.23(248.43-1902.61)ng/mL vs.219.01(97.26-821.92)ng/mL,P<0.01].Serum COMP levels were positively correlated with CAC(r=0.313,P=0.021)and serum parathyroid hormone in MHD patients(r=0.359,P<0.01).Linear regression suggested that after adjusting for age,fasting blood glucose(Glu)and glycosylated hemoglobin(HbAlc),CAC score was an independent predictor in the final model for COMP level(β=0.424,t=3.130,P<0.01).The receiver operating characteristic(ROC)curve showed that COMP≥994 mg/mL had 68.0%sensitivity and 72.4%specificity for the prediction of severe CAC[area under the curve(AUC):0.674,P=0.030,95%CI:0.526-0.882].After a median follow-up of 16 months(8-24 months),there was no difference in the incidence rate of MACEs between the upper,middle and lower serum COMP groups.Conclusions Our study found that MHD patients have higher levels of circulating COMP than controls.The serum COMP level is positively correlated with CAC score and could be used as a biomarker of severe CAC in MHD patients.However,there is no obvious correlation between serum COMP levels and the incidence of cardiovascular events.
文摘目的检索并汇总维持性血液透析(maintenance hemodialysis,MHD)患者不宁腿综合征(restless legs syndrome,RLS)症状管理的最佳证据,为临床实践提供循证依据。方法系统检索国内外数据库及指南网站中有关MHD患者RLS症状管理的临床决策、指南、证据总结、系统评价、专家共识及随机对照试验,检索时限为建库至2024年5月30日。结果共纳入14篇文献,包括4篇临床决策、2篇指南、1篇证据总结和7篇系统评价,汇总出29条最佳证据,包括管理受益、诊断与管理、危险/加重因素、评估与监测、透析优化、补充替代疗法、药物治疗和健康教育8个方面。结论本研究汇总了MHD患者RLS症状管理的最佳证据,为医护人员临床实践提供了循证依据。
文摘目的研究维持性血液透析(maintenance hemodialysis,MHD)患者血浆致动脉硬化指数(atherogenic index of plasma,AIP)、淋巴细胞与单核细胞比值(lymphocyte/monocyte ratio,LMR)与腹主动脉钙化(abdominal aortic calcification,AAC)的相关性,并构建风险预测模型。方法选取2023年5月1日─2024年4月30日在首都医科大学附属北京潞河医院郎府院区血液净化中心接受MHD治疗的患者。通过单因素及多因素Logistic回归分析来确定ACC的危险因素,建立列线图,并进行内部验证。结果共纳入158例MHD患者,分为AAC组(n=106)和非AAC组(n=52);AAC组的年龄(F=1.325,P<0.001)、校正钙(F=0.343,P=0.016)、AIP(F=8.726,P=0.003)、合并糖尿病(F=9.287,P=0.002)高于非AAC组;透析时长(F=3.681,P=0.007)、血白蛋白(F=3.287,P=0.002)、血磷(F=0.344,P=0.018)、LMR(F=1.824,P=0.022)低于非AAC组。多因素Logistic回归分析发现高龄(OR=1.071,95%CI:1.034~1.108,P<0.001)、合并糖尿病(OR=3.346,95%CI:1.428~7.843,P=0.005)、高AIP(OR=1.176,95%CI:1.041~1.33,P=0.009)、低LMR(OR=0.777,95%CI:0.614~0.983,P=0.036)是MHD患者发生AAC的独立危险因素。绘制列线图,计算C-index为0.834(95%CI:0.769~0.899),说明该列线图模型的区分能力较好。绘制校准曲线,模拟曲线和实际曲线绝对误差为0.029,说明模型具有较强的一致性。结论对于MHD患者来说,高龄、合并糖尿病、高AIP、低LMR是MHD患者发生AAC的独立危险因素。依据年龄、糖尿病、AIP、LMR构建的风险预测模型有很好的预测效能。
文摘目的通过Meta分析构建维持性血液透析(maintenance hemodialysis,MHD)患者肌少症风险预测模型,同时验证其预测效能。方法计算机检索中国知网、中国生物医学文献数据库、维普、万方、PubMed、Embase、Web of Science等发表的关于MHD肌少症影响因素的文献,检索时限为2010年1月—2022年4月。按照纳排标准筛选文献并进行Meta分析,构建MHD患者肌少症风险预测模型。回顾性选取2022年3月—2023年3月南通市海门区人民医院血液净化中心收治的血液透析患者作为验证集,采用ROC曲线、Hosmer-Lemeshow检验评估风险预测模型的效能。结果共纳入20篇文献。Meta分析结果显示:年龄≥60岁(RR=1.781,95%CI:1.661~4.623,P<0.001)、C反应蛋白增高(RR=1.663,95%CI:1.234~4.923,P<0.001)、低活动水平(RR=1.488,95%CI:1.214~3.853,P<0.001)、糖尿病史(RR=1.559,95%CI:1.222~2.732,P<0.001)、透析龄长(RR=1.101,95%CI:1.041~1.161,P<0.001)、男性(RR=1.354,95%CI:1.142~2.958,P<0.001)、改良主观综合性营养评估(modified quantitative subjective global assessment,MQSGA)评分高(RR=1.523,95%CI:1.323~3.266,P<0.001)是MHD患者发生肌少症的危险因素,高体质量指数(body mass index,BMI)(RR=0.553,95%CI:0.122~0.986,P<0.001)和高血磷(RR=0.586,95%CI:0.443~0.777,P<0.001)是其保护因素。根据Meta分析结果构建MHD肌少症发生风险的预测模型,风险预测模型预测验证集发生肌少症的AUC为0.849(95%CI:0.768~0.930),最佳截断值为35分,灵敏度为70.0%、特异度为93.7%,Hosmer-Lemeshow检验结果显示χ^(2)=8.971,P=0.201。结论本研究构建的风险预测模型对MHD患者发生肌少症具有良好的预测效能和区分度,具有一定的临床应用和推广价值。
