39 research outputs found
The effects of periodontitis on the metabolic syndrome and cancer
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ผ๋ฌธ (๋ฐ์ฌ)-- ์์ธ๋ํ๊ต ๋ํ์ : ์น์๊ณผํ๊ณผ, 2014. 2. ๋ฐฐ๊ดํ.๋ณธ ์ฐ๊ตฌ๋ ๊ตญ๊ฐ ๋ํํ๋ณธ ์กฐ์ฌ์ธ ์ 4์ฐจ ๊ตญ๋ฏผ๊ฑด๊ฐ์์์กฐ์ฌ(KNHANES)์ ์ฐธ์ฌํ ๋ํ๋ฏผ๊ตญ ์ฑ์ธ์์ ๋์ฌ์ฆํ๊ตฐ๊ณผ ์น์ฃผ์ผ ์ฌ์ด์ ์ฐ๊ด์ฑ์ ํ์ธํ๊ณ , ์ข
ํฉ๋ณ์์ ๋ด์ํ ์ํ์์ ์น์ฃผ์งํ์ ํ๊ฐํ์ฌ ์๊ณผ ์น์ฃผ์งํ๊ณผ์ ์ฐ๊ด์ฑ ์ฌ๋ถ๋ฅผ ์กฐ์ฌํ๊ธฐ ์ํ ๋ชฉ์ ์ผ๋ก ์ํ๋์๋ค.
๊ตญ๋ฏผ๊ฑด๊ฐ์์์กฐ์ฌ์ ์ฐธ์ฌํ 19์ธ ์ด์์ ์ฑ์ธ ์ด 7,178๋ช
์ ๋์์ผ๋ก ๋์ฌ์ฆํ๊ตฐ ์ฐ๊ตฌ๋ฅผ ์ํํ์๋ค. ๋์ฌ์ฆํ๊ตฐ์ NCEP ATP III (National Cholesterol Education Program Adult Treatment Panel III) ์ ์๋ฅผ ๋ฐ๋์ผ๋ฉฐ, ๋ณต๋ถ๋น๋ง์ ๊ธฐ์ค์ ๋ํ๋น๋งํํ์ ์ ์์ ๊ธฐ์ด๋ก ํ์๋ค. ์น์ฃผ์ํ๋ ์ง์ญ์ฌํ์น์ฃผ์ง์(Community Periodontal Index)๋ฅผ ์ด์ฉํ์ฌ ํ๊ฐํ๊ณ , ์ฌํ์ธ๊ตฌํ์ ์์ธ๊ณผ ๊ตฌ๊ฐ๊ฑด๊ฐ์ํ, ๋ณด๊ฑดํํ ๋ฐ ๊ตฌ๊ฐ๋ณด๊ฑดํํ๋ฅผ ๋ณด์ ํ์ฌ ๋ค๋ณ๋ ๋ก์ง์คํฑ ํ๊ท๋ถ์์ ์ํํ์๋ค. ๋ชจ๋ ๋ถ์์ ๋ณตํฉํ๋ณธ์ค๊ณ๋ฅผ ๊ณ ๋ คํ์๊ณ , ์ฐ๋ น, ์ฑ๋ณ, ํ์ฌํก์ฐ์ํ์ ๋ฐ๋ฅธ ํ์์ง๋จ๋ถ์์ ์ํํ์๋ค.
๋ค๋ณ๋ ๋ก์ง์คํฑ ํ๊ท๋ถ์ ๊ฒฐ๊ณผ ๋์ฌ์ฆํ๊ตฐ๊ณผ ์น์ฃผ์ผ ๊ฐ ์ ์ํ ์ฐ๊ด์ฑ์ ๋ณด์๋ค. ๋ชจ๋ ํผ๋๋ณ์๋ฅผ ๋ณด์ ํ ํ ์ง์ญ์ฌํ์น์ฃผ์ง์ 3 ์ด์์ ๋ณด์ธ ์น์ฃผ์ผ ๊ทธ๋ฃน๊ณผ ๋์ฌ์ฆํ๊ตฐ ๊ทธ๋ฃน ์ฌ์ด์ ์ค์ฆ๋น(odds ratio)๋ 1.55(1.32โ1.83)์๋ค. ํ์์ง๋จ๋ถ์ ๊ฒฐ๊ณผ 40์ธ ์ด์์ ๋์์์ ๋์ฌ์ฆํ๊ตฐ๊ณผ ์น์ฃผ์ผ์ด ์ ์ํ ์ฐ๊ด์ฑ์ ๋ณด์๊ณ , ๋ณด์ ๋ ์ค์ฆ๋น๋ ์ฌ์ฑ๊ณผ ํก์ฐ์๊ตฐ์์ ๋จ์ฑ ๋ฐ ๋นํก์ฐ์๊ตฐ์ ๋นํด ๋ ํฌ๊ฒ ๋ํ๋ฌ๋ค.
2010๋
5์๋ถํฐ 2012๋
2์๊น์ง ํ๊ตญ์์๋ ฅ์ํ์์ ๋ด์ํ, ์์ผ๋ก ์ง๋จ๋ฐ์ ํ ์ ์น๋ฃ๋ฅผ ์ํํ๊ธฐ ์ด์ ์ด๋ฉฐ, ๋ณธ ์ฐ๊ตฌ์ ๋ํ ์ค๋ช
์ ๋ฃ๊ณ ์ฐธ์ฌ์ ๋์ํ 57๋ช
์ ํ์๋ฅผ ๋์์ผ๋ก ์๊ธฐ๊ธฐ์
์ ์ค๋ฌธ์กฐ์ฌ์ ์๋ฌด๊ธฐ๋ก์ง ์กฐ์ฌ, ์น์ฃผ์กฐ์ง ๊ฒ์ฌ๋ฅผ ์ค์ํ๊ณ , ์์์ ์น์ฃผ์กฐ์ง ๋ถ์ฐฉ์์ค ์ ๋๊ฐ ๊ฐ์ฅ ํฐ ๋ถ์์์ ์น์์ด๊ตฌ์ก์ ์ฑ์ทจํ์ฌ ์ฌ์ฏ ๊ฐ์ง ์น์ฃผ์งํ ๋ณ์๊ท ๋ถ์์ ์ํํ์๋ค. ํ์๊ณผ ์๋์ ๋ฐ ๊ธฐํ๋ถ์ ์์ ์ธ ๊ตฐ์ผ๋ก ์์ข
์ ๋ถ๋ฅํ์ฌ, ์์ข
๋ณ ์น์ฃผ์ผ ์ ๋์ ์ฐจ์ด๋ ์นด์ด์ ๊ณฑ ๊ฒ์ ๋ฒ์ผ๋ก ๋ถ์ํ์๊ณ , 3.0 mm ์ด์์ ์น์ฃผ๋ญ ๊น์ด๋ฅผ ๊ฐ์ง ๋ถ์์ ์น์ฃผ๋ญ ๊น์ด ํ๊ท ๋ฐ ๊ฐ ๋ณ์๊ท ๋์ ์์ข
๊ฐ ์ฐจ์ด๋ Kruskal-Wallis ๋น๋ชจ์ ๊ฒ์ ์ผ๋ก ๋ถ์ํ ๊ฒฐ๊ณผ, ์น์ฃผ์ผ ์ฌ๋๋ ์์ข
๊ฐ ์ ์ํ ์ฐจ์ด๊ฐ ์์์ผ๋(p>0.05), ์๋์ ํ์๊ตฐ์์ Treponema denticola์ ์์ด ๋ค๋ฅธ ์์ข
์ ๋นํ์ฌ ๋ ๋ง์ด ๊ด์ฐฐ๋์๋ค(p=0.042).
๊ฒฐ๋ก ์ ์ผ๋ก, NCEP-ATP III ์ง๋จ๊ธฐ์ค์ ์ฌ์ฉํ ๋์ฌ์ฆํ๊ตฐ๊ณผ ์น์ฃผ์ผ์ ์ ์ํ๊ฒ ์ฐ๊ด๋์ด ์์๊ณ , ์น์ฃผ์ผ ์ฌ๋๋ ์์ข
๊ฐ ์ ์ํ ์ฐจ์ด๊ฐ ์์์ผ๋, ์๋์ ํ์๊ตฐ์์ Treponema denticola์ ์์ด ๋ ๋ง์ด ๊ด์ฐฐ๋์๋ค.I. ์ ๋ก
II. ์ฐ๊ตฌ๋ฐฐ๊ฒฝ
III. ์ฐ๊ตฌ๋ฐฉ๋ฒ
IV. ์ฐ๊ตฌ์ฑ์
V. ๊ณ ์
VI. ๊ฒฐ ๋ก
์ฐธ๊ณ ๋ฌธํ
์๋ฌธ์ด๋กDocto
Cystatin C is Better than Serum Creatinine for Estimating Glomerular Filtration Rate to Detect Osteopenia in Chronic Kidney Disease Patients
PURPOSE: Recent studies have reported that loss of bone mass is associated with renal function decline and increased fracture risks in chronic kidney disease (CKD) patients. The aim of this study was to investigate the best estimated glomerular filtration rate (eGFR) equation to detect osteopenia in CKD patients.
MATERIALS AND METHODS: This was a cross-sectional study, and 780 patients aged 50 years or above were classified into normal bone mass or osteopenia groups according to the -1.0 of T-scores at total hip and femur neck. Comparisons of area under the receiver operating characteristic (ROC) curves (AUC) were performed to investigate significant differences among three eGFR formulas: Modification of Diet in Renal Disease, CKD-Epidemiology Collaboration (EPI) creatinine, and CKD-EPI cystatin C (CKD-EPI-Cys).
RESULTS: The mean age was 61 years old and the proportion of females was 37.3%. The total hip osteopenia group showed lower CKD-EPI-Cys eGFR levels (osteopenia group, 33.3ยฑ19.0 mL/min/1.73 mยฒ; normal group, 48.1ยฑ26.2 mL/min/1.73 mยฒ, p<0.001). In multiple logistic regression analysis, CKD-EPI-Cys eGFR was independently associated with osteopenia at the total hip (per 1 mL/min/1.73 mยฒ increase, odds ratio 0.98, 95% confidence interval 0.97-0.99, p=0.004) after adjusting for confounding variables. ROC curve analyses indicated that CKD-EPI-Cys shows the largest AUC for osteopenia at the total hip (AUC=0.678, all p<0.01) and the femur neck (AUC=0.665, all p<0.05).
CONCLUSION: Decreased renal function assessed by CKD-EPI-Cys equation correlates with osteopenia better than creatinine-based methods in CKD patients, and the CKD-EPI-Cys formula might be a useful tool to assess skeletal-related event risks.ope
Periostin-Binding DNA Aptamer Treatment Ameliorates Peritoneal Dialysis-Induced Peritoneal Fibrosis
Peritoneal fibrosis is a major complication in peritoneal dialysis (PD) patients, which leads to dialysis discontinuation. Periostin, increased by transforming growth factor ฮฒ1 (TGF-ฮฒ1) stimulation, induces the expression of extracellular matrix (ECM) genes. Aberrant periostin expression has been demonstrated to be associated with PD-related peritoneal fibrosis. Therefore, the effect of periostin inhibition by an aptamer-based inhibitor on peritoneal fibrosis was evaluated. In vitro, TGF-ฮฒ1 treatment upregulated periostin, fibronectin, ฮฑ-smooth muscle actin (ฮฑ-SMA), and Snail expression and reduced E-cadherin expression in human peritoneal mesothelial cells (HPMCs). Periostin small interfering RNA (siRNA) treatment ameliorated the TGF-ฮฒ1-induced periostin, fibronectin, ฮฑ-SMA, and Snail expression and restored E-cadherin expression in HPMCs. Similarly, the periostin-binding DNA aptamer (PA) also attenuated fibronectin, ฮฑ-SMA, and Snail upregulation and E-cadherin downregulation in TGF-ฮฒ1-stimulated HPMCs. In mice treated with PD solution for 4 weeks, the expression of periostin, fibronectin, ฮฑ-SMA, and Snail was significantly increased in the peritoneum, whereas E-cadherin expression was significantly decreased. The thickness of the submesothelial layer and the intensity of Masson's trichrome staining in the PD group were significantly increased compared to the untreated group. These changes were significantly abrogated by the intraperitoneal administration of PA. These findings suggest that PA can be a potential therapeutic strategy for peritoneal fibrosis in PD patients.ope
Change of Nutritional Status Assessed Using Subjective Global Assessment Is Associated With All-Cause Mortality in Incident Dialysis Patients
Subjective global assessment (SGA) is associated with mortality in end-stage renal disease (ESRD) patients. However, little is known whether improvement or deterioration of nutritional status after dialysis initiation influences the clinical outcome. We aimed to elucidate the association between changes in nutritional status determined by SGA during the first year of dialysis and all-cause mortality in incident ESRD patients. This was a multicenter, prospective cohort study. Incident dialysis patients with available SGA data at both baseline and 12 months after dialysis commencement (nโ=โ914) were analyzed. Nutritional status was defined as well nourished (WN, SGA A) or malnourished (MN, SGA B or C). The patients were divided into 4 groups according to the change in nutritional status between baseline and 12 months after dialysis commencement: group 1, WN to WN; group 2, MN to WN; group 3, WN to MN; and group 4, MN to MN. Cox proportional hazard analysis was performed to clarify the association between changes in nutritional status and mortality. Being in the MN group at 12 months after dialysis initiation, but not at baseline, was a significant risk factor for mortality. There was a significant difference in the 3-year survival rates among the groups (group 1, 92.2%; group 2, 86.0%; group 3, 78.2%; and group 4, 63.5%; log-rank test, Pโ<โ0.001). Multivariate Cox regression analysis revealed that the mortality risk was significantly higher in group 3 than in group 1 (hazard ratio [HR] 2.77, 95% confidence interval [CI] 1.27-6.03, Pโ=โ0.01) whereas the mortality risk was significantly lower in group 2 compared with group 4 (HR 0.35, 95% CI 0.17-0.71, Pโ<โ0.01) even after adjustment for confounding factors. Moreover, mortality risk of group 3 was significantly higher than in group 2 (HR 2.89, 95% CI 1.22-6.81, Pโ=โ0.02); there was no significant difference between groups 1 and 2. The changes in nutritional status assessed by SGA during the first year of dialysis were associated with all-cause mortality in incident ESRD patients.ope
Delta neutrophil index is an independent predictor of mortality in septic acute kidney injury patients treated with continuous renal replacement therapy
BACKGROUND: Delta neutrophil index (DNI), representing an elevated fraction of circulating immature granulocytes in acute infection, has been reported as a useful marker for predicting mortality in patients with sepsis. The aim of this study was to evaluate the prognostic value of DNI in predicting mortality in septic acute kidney injury (S-AKI) patients treated with continuous renal replacement therapy (CRRT).
METHOD: This is a retrospective analysis of consecutively CRRT treated patients. We enrolled 286 S-AKI patients who underwent CRRT and divided them into three groups based on the tertiles of DNI at CRRT initiation (high, DNIโ>โ12.0%; intermediate, 3.6-12.0%; low, < 3.6%). Patient survival was estimated with the Kaplan-Meier method and Cox proportional hazards models to determine the effect of DNI on the mortality of S-AKI patients.
RESULTS: Patients in the highest tertile of DNI showed higher Acute Physiology and Chronic Health Evaluation II score (highest tertile, 27.9โยฑโ7.0; lowest tertile, 24.6โยฑโ8.3; Pโ=โ0.003) and Sequential Organ Failure Assessment score (highest tertile, 14.1โยฑโ3.0; lowest tertile, 12.1โยฑโ4.0; Pโ=โ0.001). The 28-day mortality rate was significantly higher in the highest tertile group than in the lower two tertile groups (Pโ<โ0.001). In the multiple Cox proportional hazard model, DNI was an independent predictor for mortality after adjusting multiple confounding factors (hazard ratio, 1.010; 95% confidence interval, 1.001-1.019; Pโ=โ0.036).
CONCLUSION: This study suggests that DNI is independently associated with mortality of S-AKI patients on CRRT.ope
Glycemic Control Modifies Difference in Mortality Risk Between Hemodialysis and Peritoneal Dialysis in Incident Dialysis Patients With Diabetes: Results From a Nationwide Prospective Cohort in Korea
Although numerous studies have tried to elucidate the best dialysis modality in end-stage renal disease patients with diabetes, results were inconsistent and varied with the baseline characteristics of patients. Furthermore, none of the previous studies on diabetic dialysis patients accounted for the impact of glycemic control. We explored whether glycemic control had modifying effect on mortality between hemodialysis (HD) and peritoneal dialysis (PD) in incident dialysis patients with diabetes. A total of 902 diabetic patients who started dialysis between August 2008 and December 2013 were included from a nationwide prospective cohort in Korea. Based on the interaction analysis between hemoglobin A1c (HbA1c) and dialysis modalities for patient survival (P for interactionโ=โ0.004), subjects were stratified into good and poor glycemic control groups (HbA1c< or โฅ8.0%). Differences in survival rates according to dialysis modalities were ascertained in each glycemic control group after propensity score matching. During a median follow-up duration of 28 months, the relative risk of death was significantly lower in PD compared with HD in the whole cohort and unmatched patients (whole cohort, hazard ratio [HR]โ=โ0.65, 95% confidence interval [CI]โ=โ0.47-0.90, Pโ=โ0.01; patients with available HbA1c [nโ=โ773], HRโ=โ0.64, 95% CIโ=โ0.46-0.91, Pโ=โ0.01). In the good glycemic control group, there was a significant survival advantage of PD (HbA1c <8.0%, HRโ=โ0.59, 95% CIโ=โ0.37-0.94, Pโ=โ0.03). However, there was no significant difference in survival rates between PD and HD in the poor glycemic control group (HbA1c โฅ8.0%, HRโ=โ1.21, 95% CIโ=โ0.46-2.76, Pโ=โ0.80). This study demonstrated that the degree of glycemic control modified the mortality risk between dialysis modalities, suggesting that glycemic control might partly contribute to better survival of PD in incident dialysis patients with diabetes.ope
Low Mitochondrial DNA Copy Number is Associated With Adverse Clinical Outcomes in Peritoneal Dialysis Patients
Mitochondrial dysfunction may play an important role in abnormal glucose metabolism and systemic inflammation. We aimed to investigate the relationship between mitochondrial DNA (mtDNA) copy number and clinical outcomes in peritoneal dialysis (PD) patients. We recruited 120 prevalent PD patients and determined mtDNA copy number by PCR. Primary outcome was all-cause mortality, whereas secondary outcomes included cardiovascular events, technical PD failure, and incident malignancy. Cox proportional hazards analysis determined the independent association of mtDNA copy number with outcomes. The mean patient age was 52.3 years; 42.5% were men. The mean log mtDNA copy number was 3.30โยฑโ0.50. During a follow-up period of 35.4โยฑโ19.3 months, all-cause mortality and secondary outcomes were observed in 20.0% and 59.2% of patients, respectively. Secondary outcomes were significantly lower in the highest mtDNA copy number group than in the lower groups. In multiple Cox analysis, the mtDNA copy number was not associated with all-cause mortality (lower two vs highest tertile: hazard ratio [HR]โ=โ1.208, 95% confidence interval [CI]โ=โ0.477-3.061). However, the highest tertile group was significantly associated with lower incidences of secondary outcomes (lower two vs highest tertile: HR [95% CI]โ=โ0.494 [0.277-0.882]) after adjusting for confounding factors. The decreased mtDNA copy number was significantly associated with adverse clinical outcomes in PD patients.ope
Which Biomarker is the Best for Predicting Mortality in Incident Peritoneal Dialysis Patients: NT-ProBNP, Cardiac TnT, or hsCRP?: A Prospective Observational Study
Although numerous previous studies have explored various biomarkers for their ability to predict mortality in end-stage renal disease (ESRD) patients, these studies have been limited by retrospective analyses, mostly prevalent dialysis patients, and the measurement of only 1 or 2 biomarkers. This prospective study was aimed to evaluate the association between 3 biomarkers and mortality in incident 335 ESRD patients starting continuous ambulatory peritoneal dialysis (CAPD) in Korea. According to the baseline NT-proBNP, cTnT, and hsCRP levels, the patients were stratified into tertiles, and cardiovascular (CV) and all-cause mortalities were compared. Additionally, time-dependent ROC curves were constructed, and the net reclassification index (NRI) and integrated discrimination improvement (IDI) of the models with various biomarkers were calculated. We found the upper tertile of NT-proBNP was significantly associated with increased risk of both CV and all-cause mortalities. However, the upper tertile of hsCRP was significantly related only to the high risk of all-cause mortality even after adjustment for age, sex, and white blood cell counts. Moreover, NT-proBNP had the highest predictive power for CV mortality, whereas hsCRP was the best prognostic marker for all-cause mortality among these biomarkers. In conclusions, NT-proBNP is a more significant prognostic factor for CV mortality than cTnT and hsCRP, whereas hsCRP is a more significant predictor than NT-proBNP and cTnT for all-cause mortality in incident peritoneal dialysis patients.ope
Vitamin D deficiency is an independent risk factor for urinary tract infections after renal transplants
Vitamin D deficiency is frequently found in patients with renal transplants (RTxs). Because vitamin D plays indispensable roles in the immune system, there may be an association between vitamin D deficiency and infection in these patients, but this has not been fully elucidated. Therefore, this study investigated the impact of pre-RTx vitamin D deficiency on urinary tract infection (UTI) development after RTx.We measured 25-hydroxyvitamin D3 (25(OH)D3) levels in 410 patients 2 weeks before they underwent RTx. Vitamin D deficiency was defined as 25(OH)D3 <10โng/mL. The primary outcome was UTI occurrence after RTx. Cox proportional hazard analysis determined whether vitamin D deficiency was independently associated with UTI.The mean 25(OH)D3 level was 12.8โยฑโ6.9โng/mL, and 171 patients (41.7%) were vitamin D deficient. During a median follow-up duration of 7.3 years, the UTI incidence was significantly higher in vitamin D-deficient patients (52 patients, 30.4%) compared with vitamin D-nondeficient patients (40 patients, 16.7%) (Pโ=โ0.001). Moreover, multivariate Cox proportional hazard analysis showed that vitamin D deficiency was an independent predictor of UTI after RTx (hazard ratio 1.81, 95% confidence interval 1.11-2.97, Pโ=โ0.02).Vitamin D deficiency was an independent risk factor for UTI after RTx; hence, determining 25(OH)D3 levels might help to predict infectious complications after RTx.ope
Preoperative Low Serum Bicarbonate Levels Predict Acute Kidney Injury After Cardiac Surgery
Acute kidney injury (AKI) after cardiac surgery is a common and serious complication. Although lower than normal serum bicarbonate levels are known to be associated with consecutive renal function deterioration in patients with chronic kidney injury, it is not well-known whether preoperative low serum bicarbonate levels are associated with the development of AKI in patients who undergo cardiac surgery. Therefore, the clinical implication of preoperative serum bicarbonate levels on AKI occurrence after cardiac surgery was investigated. Patients who underwent coronary artery bypass or valve surgery at Yonsei University Health System from January 2013 to December 2014 were enrolled. The patients were divided into 3 groups based on preoperative serum bicarbonate levels, which represented group 1 (below normal levels) 24โmEq/L. The primary outcome was the predicated incidence of AKI 48โhours after cardiac surgery. AKI was defined according to Acute Kidney Injury Network criteria. Among 875 patients, 228 (26.1%) developed AKI within 48โhours after cardiac surgery. The incidence of AKI was higher in group 1 (40.9%) than in group 2 (26.5%) and group 3 (19.5%) (Pโ<โ0.001). In addition, the duration of postoperative stay in a hospital intensive care unit (ICU) was longer for AKI patients and for those in the low-preoperative-serum-bicarbonate-level groups. A multivariate logistic regression analysis showed that low preoperative serum bicarbonate levels were significantly associated with AKI even after adjustment for age, sex, hypertension, diabetes mellitus, operation type, preoperative hemoglobin, and estimated glomerular filtration rate. In conclusion, low serum bicarbonate levels were associated with higher incidence of AKI and prolonged ICU stay. Further studies are needed to clarify whether strict correction of bicarbonate levels close to normal limits may have a protective role in preventing further AKI development.ope