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《Nefrología : publicación oficial de la Sociedad Espa?ola Nefrologia》2022,42(2):186-195
Protein-energy wasting (PEW) and poor health-related quality of life (HRQoL) are independently associated with morbi-mortality in continuous ambulatory peritoneal dialysis (CAPD). PEW may reduce HRQoL; however, we hypothesized HRQoL is affected differentially by PEW degrees or by individual criteria of nutritional status.AimTo evaluate HRQoL according to PEW severity and nutritional status indicators in CAPD.This is a cross-sectional study in 151 patients. Subjective global assessment (SGA) was employed, and nutritional status classified as normal, mild-moderate PEW, and severe PEW. HRQoL was evaluated using Kidney Disease Quality of Life Short Form?, including physical (PCS), mental (MCS) and kidney disease (KDCS) components, and their subscales. Dietary intake, anthropometric and biochemical variables were measured.Forty-six percent of patients were well-nourished, 44% had mild-moderate PEW, and 10% severe PEW. Compared with well-nourished patients, those with mild-moderate (p = 0.06) and severe (p = 0.005) PEW had lower HRQoL score [68 (52–75), 55 (45–72), 46 (43–58), respectively]. PCS, MCS, and KDCS and their subscales had lower values as PEW was more severe. Patients with obesity and hypoalbuminemia had significantly lower HRQoL overall and component scores than their counterparts. Dietary intake was not associated with quality of life. In multivariate analysis obesity, PEW (by SGA), hypoalbuminemia, and low educational level predicted poor HRQoL (χ2 58.2, p < 0.0001).As conclusion, PEW severity was related with worse HRQoL, either as overall score or in every component or subscale in CAPD patients. Poor HRQoL was predicted independently by PEW severity and obesity; additional predictors were hypoalbuminemia and low education. 相似文献
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《Archivos de bronconeumología》2022,58(2):135-141
IntroductionIdiopathic pulmonary fibrosis (IPF) is progressive and irreversible. Some discrepancies about IPF staging exists, especially in mild phases. Forced vital capacity (FVC) higher than 80% has been considered early or mild IPF even for the design of clinical trials.MethodsSpanish multicentre, observational, retrospective study of IPF patients diagnosed between 2012 and 2016, based on the ATS/ERS criteria, which presented FVC greater or equal 80% at diagnosis. Clinical and demographic characteristics, lung function, radiological pattern, treatment, and follow-up were analyzed.Results225 IPF patients were included, 72.9% were men. The mean age was 69.5 years. The predominant high-resolution computed tomography (HRCT) pattern was consistent usual interstitial pneumonia (UIP) (51.6%). 84.7% of patients presented respiratory symptoms (exertional dyspnea and/or cough) and 33.33% showed oxygen desaturation below 90% in the 6 min walking test (6MWT). Anti-fibrotic treatment was initiated at diagnosis in 55.11% of patients. Median FVC was 89.6% (IQR 17) and 58.7% of patients had a decrease of diffusion lung capacity for carbon monoxide (DLCO) below 60% of theoretical value; most of them presented functional progression (61.4%) and higher mortality at 3 years (20.45%). A statistically significant correlation with the 3-years mortality was observed between DLCO <60% and consistent UIP radiological pattern.ConclusionsPatients with preserved FVC but presenting UIP radiological pattern and moderate–severe DLCO decrease at diagnosis associate an increased risk of progression, death or lung transplantation. Therefore, in these cases, preserved FVC would not be representative of early or mild IPF. 相似文献
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目的探讨钆塞酸二钠(Gadolinium ethoxybenzyl diethylene-triamine-pentaacetic-acid,Gd-EOB-DTPA)动态对比增强MRI(dynamic contrast-enhanced magnetic resonance imaging,DCE-MRI)定量评估大鼠中度肝纤维化(hepatic fibrosis,HF)的价值。材料与方法40只雄性Wistar大鼠(对照组10只,实验组30只),腹腔注射CCl4构建不同分期HF模型,并行肝脏轴位T1WI及DCE-MRI扫描,获取以下参数:容量转运常数(Ktrans)、速率常数(Kep)、血管外细胞外间隙体积百分数(Ve)以及初始曲线下面积(iAUC)。所有大鼠扫描前行尾静脉采血,测定血清中透明质酸(hyaluronic acid,HA)、层粘连蛋白(laminin,LN)含量。扫描结束后取大鼠肝脏组织进行HF病理学分期。采用独立样本t检验比较正常组与实验组、正常组及轻度HF组与中度HF组DCE-MRI参数和血清学指标的差异;采用单因素方差分析比较DCE-MRI参数和血清学指标在不同HF分期之间的差异;采用Spearman相关检验分析DCE-MRI参数和血清学指标与HF分期的相关性;利用ROC曲线比较各参数诊断中度HF的价值。结果26只大鼠纳入本次研究,其中病理学分期为正常组6只、轻度HF(F1期)7只、中度HF(F2~F3期)13只,随着HF加重,Ktrans、Kep、Ve及iAUC均降低(r=-0.665,P<0.001;r=-0.395、P=0.046;r=-0.565、P=0.003;r=-0.538、P=0.005),血清LN及HA含量均升高(r=0.606,P=0.001;r=0.601,P=0.001);Ktrans、Ve及iAUC在实验组与正常组、正常组及轻度HF组与中度HF组、正常组与中度HF组、轻度HF与中度HF组间差异均有统计学意义(P<0.05);血清LN及HA含量在对照组与中度HF组之间差异具有统计学意义(P<0.05);ROC曲线显示Ktrans及LN诊断中度HF效能最高。结论Gd-EOB-DTPA DCE-MRI定量评估对中度HF分期具有较好的诊断价值,其中DCE-MRI参数中Ktrans具有最佳的诊断效能。 相似文献
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目的 运用网络药理学方法及分子对接技术探讨黄芪干预腹膜纤维化的可能机制。方法 利用中药系统药理学数据库及分析平台(TCMSP)检索黄芪的主要化学成分及靶点,并补充文献报道相关药理作用的成分作为潜在活性成分。以"peritoneal fibrosis"为关键词分别在OMIM、Genecards获取目前已知的与腹膜纤维化相关的疾病靶点,后取两者的交集靶点;对交集基因通过STRING数据库与Cytoscape 3.7.2软件构建"药物-成分-靶点-疾病"网络及蛋白互作(PPI)网络并筛选核心网络。基于R软件使用Bioconductor生物信息软件对核心靶点进行GO及KEGG富集分析,最终采用AutoDock软件将主要有效成分与核心靶点进行分子对接,得出其结合能力。结果 筛选出20个黄芪活性成分及文献报道有相关药理作用4个, 457药物作用靶点,与674个腹膜纤维化病靶点取交集,得到86个共同靶点。GO功能富集分析提示黄芪拮抗腹膜纤维化主要参与了蛋白激酶B信号转导的调节、细胞对化学的应激反应、炎症反应的调节等通路; KEGG通路富集分析主要涉及调控肿瘤、磷脂酰肌醇-3-羟激酶-蛋白激酶B(PI3K-Akt)、晚期糖基化终末产物/晚期糖基化终末产物受体(AGE-RAGE)、人类巨细胞病毒感染、HIF-1信号通路等;分子对接结果显示关键靶点与活性成分具有较好的结合能力。结论 黄芪治疗腹膜纤维化的分子机制,可能与抑制炎症及氧化应激反应、调节多种信号通路等相关。 相似文献
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目的 通过分析特发性肺纤维化急性加重期(AE-IPF)患者证候与血清生物标志物的关系,为中医辨证治疗提供参考。方法 采用观察性研究设计,收集2019年3月至2019年11月三个中心的AE-IPF患者76例,其中痰热壅肺证26例、痰浊阻肺证50例,并纳入健康志愿者10例作为对照。采用ELISA测定患者血清CCL18、HMGB1、KL-6、MMP-7、SP-A和SP-D水平,分析与中医证候的相关性。结果 AE-IPF患者血清CCL18、HMGB1、KL-6、MMP-7、SP-A和SP-D水平均显著高于健康对照组。血清CCL18、HMGB1、KL-6、MMP-7和SP-D水平在痰热壅肺证和痰浊阻肺证患者间无显著性差异(P>0.05),而血清SP-A水平存在显著性差异(P<0.05)。结论 血清SP-A与AE-IPF证候存在一定的相关性,血清SP-A的浓度升高,与痰热壅肺证关系越密切,反之,血清SP-A浓度降低,则与痰浊阻肺证关系越密切。AE-IPF痰热壅肺证患者的预后可能较痰浊阻肺证患者更差。 相似文献
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《Journal of infection and chemotherapy》2022,28(7):1029-1032
A recent study reported that patients with interstitial lung disease (ILD) are at increased risk of death from coronavirus disease 2019 (COVID-19). However, there are no studies on the outcome of COVID-19 patients with preexisting ILD treated with corticosteroids or antiviral drugs. We extracted 26 patients with preexisting ILD by medical records and HRCT pattern. Of 503 patients with COVID-19, we selected 52 patients as control matched for age and sex. Twenty out of the 26 ILD patients (76.9%) received corticosteroid therapy, and 23 patients (88.5%) also received antiviral treatment with remdesivir or favipiravir. Although no statistical difference was found, the proportion of severe patients in ILD group tended to be higher than in non-ILD group (23.1% vs. 42.3%; p = 0.114). Also, mortality rate in ILD group tended to be higher than in non-ILD patients (11.5% vs. 3.8%; p = 0.326). In univariate analysis to evaluate risk factors for severe condition, diagnosis of idiopathic pulmonary fibrosis, usual interstitial pneumonia pattern, and honeycomb lung were not risk factors of severe disease. Treatment with corticosteroids, antiviral drugs, and immunosuppressive agents may affect the outcome of COVID-19 patients with ILD. 相似文献