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NDT:新的蛋白质组学标记识别早期CKD进展

2016-07-18 Mechront 译 MedSci原创

慢性肾脏病(CKD)的诊断常常很晚,因为在早期疾病中,它不会引起疼痛或其他特定的症状。有时患者甚至没有意识到他们的肾功能受损了,直到他们需要进行肾脏替代疗法(透析或移植),此时诊断已为时已晚,因为各种干预措施(比如饮食、药物)都可能会延迟,甚至阻止终末期肾脏疾病的进展。 目前对CKD进展的评估主要基于肾小球滤过率(eGFR)的下降和尿白蛋白排泄率(UAE)的增加。但是存在一个主要的问题:全科

慢性肾脏病(CKD)的诊断常常很晚,因为在早期疾病中,它不会引起疼痛或其他特定的症状。有时患者甚至没有意识到他们的肾功能受损了,直到他们需要进行肾脏替代疗法(透析或移植),此时诊断已为时已晚,因为各种干预措施(比如饮食、药物)都可能会延迟,甚至阻止终末期肾脏疾病的进展。

目前对CKD进展的评估主要基于肾小球滤过率(eGFR)的下降和尿白蛋白排泄率(UAE)的增加。但是存在一个主要的问题:全科医生并不会对患者经常测量这些“肾参数”。此外,这些标记被认为是晚期标志物,具有低的灵敏度、特异性。它预测早期CKD患者几乎是不可能的。

对于eGFR > 60 ml/min/1.73 m2、UAE在30 - 300 mg/g之间的患者,可能发生GFR快速下降超过15 ml/min/1.73 m2;但是对eGFR保持稳定的患者,疾病不进展。NDT主编Carmine Zoccali教授说:“为了识别疾病进展迅速的高风险患者,我们必须等待至少一年。然后我们进行评估,如果eGFR在过去12个月下降超过15%,则可以开始治疗。当前我们迫切的需要更好更快的CKD标志物,所以当前Pontillo等人发表的论文是十分重要的。”

该研究纳入了2672例不同分期的CKD患者,其中,394名患者eGFR每年下降超过5 mL/min/1.73 m2(进展),其余的人被认为无进展。研究者获得了所有患者的UAE值和CKD273分类评分。根据基线eGFRs值参与者被分为≥80、70–79、60–69、50–59、40–49、30–39、<29 mL/min/1.73 m2等各组。

对于早期CKD,检测疾病进展方面,基于尿蛋白质组的分类表现显着优于UAE;但是对于晚期CKD,UAE则更有优。中度肾功能下降的患者中,没有发现CKD273 和UAE的预测差异。

这些结果表明,尿肽结合CKD273分类,可以对早期CKD的进展进行检测,可能更早得识别可能更有效的干预治疗时间点。

原始出处:

A urinary proteome-based classifier for the early detection of decline in glomerular filtration
, Pontillo C, Jacobs L, Staessen JA et al. Nephrol. Dial. Transplant. (2016) doi: 10.1093/ndt/gfw239

New proteome-based marker classifies chronic kidney disease progression at early stage.MNT.Friday 15 July 2016


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    2016-07-18 doctorJiangchao

    好文章 值得阅读

    0

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在一项新的研究中,来自美国西北太平洋国家实验室(PNNL)和约翰霍普金斯大学(JHU)等机构的研究人员研究了169名卵巢癌患者的肿瘤蛋白质组以便鉴定她们所患肿瘤中存在的关键性蛋白。 通过将这些卵巢癌蛋白质组方面的发现与已知的这些肿瘤的基因组数据整合在一起,研究人员报道了对最为恶性的卵巢癌---浆液性卵巢癌(serous ovarian cancer)---的潜在新认识。相关研究结果于2016

SLEEP 2016:体重和饮食会影响不同睡眠阶段的时间

根据在SLEEP 2016年会上发表的研究结果,体重状况和蛋白质摄入量可以预测不同睡眠阶段的长度。宾夕法尼亚大学博士后研究员Andrea M. Spaeth博士和他的同事们评估了各种能量平衡参数及其对睡眠结构的影响。根据摘要,36名健康的成年人在宾夕法尼亚大学的医院的床上睡了2个连续10小时的时间,研究人员记录多导睡眠、睡眠阶段的时间、体重、身体成分、静息能量消耗、食物和饮料的摄入量等。结果表明,

J Am Soc Nephrol:多吃红肉易肾衰

人们通常将红肉如牛肉、羊肉、猪肉等作为健康饮食的一部分。但是研究人员认为,红肉不可食用过多。美国癌症协会建议,民众红肉的摄入量应少于18盎司/月,因为它会增加民众患某些癌症如胃癌等的风险。 2012年发表在JAMA的一项研究中,研究人员通过对23926例死亡病例进行研究后得出结论:食用红肉会增加民众患心血管疾病和癌症的风险。 Duke-NUS医学院和新加坡国立大学公共卫生学院的的研究人员针对这一问

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