Obesityanddisease(讲师-高铭聪)教程分析.ppt

慢性腎臟疾病的危險因素 Taal, Kidney Int 2006;70:1694 NSAIDS Antibiotics/anti-virals Radiological contrast Urological disorders Obstruction Recurrent urinary infections 台灣尿毒症五大常見病因: 病因 機制 1. 糖尿病 ? 代謝異常 2. 腎絲球腎炎 ?免疫異常 3. 高血壓 ? 血管傷害 4. 尿路阻塞、結石、感染， 毒藥物傷害 ? 感染、毒藥害 5. 多囊性腎病 ? 遺傳 SURVEY OF MORTALITY ASSOCIATED RISK FACTORS OF CKD IN TAIWAN Wen CP, Lancet 2008;371:2173–82 Total CKD Prevalence: 11.93% (1/8) Awareness: 3.54% All causes death: 10.3% 相關危險因子 糖尿病(3.8X) 高血壓(2.5X) 貧血(1.5X) 高血脂(1.74X) 肥胖(2.29X) 吸菸(1.44X) 中草藥(1.2X) 低社經階層(2.71X) ALL-CAUSE MORTALITY ATTRIBUTABLE TO CHRONIC KIDNEY DISEASE: A PROSPECTIVE COHORT STUDY BASED ON 462,293 ADULTS IN TAIWAN WEN CP ET AL, LANCET 2008 年紀愈大盛行愈高 FIGURE 1. LINEAR REGRESSION ANALYSES OF RELATIONSHIP BETWEEN EGFR AND BMI IN THE MALE A) AND FEMALE B) RESIDENTS. REGRESSION LINES AND 95% CONFIDENCE LIMITS ARE SHOWN IN EACH GRAPH. Ikuo Nomura, Vasc Health Risk Manag. 2009 TABLE 1.BASAL PROFILES OF MALE AND FEMALE RESIDENTS WITH OR WITHOUT CKD Abbreviations: BMI, body mass index; SBP and DBP, systolic and diastolic blood pressure; HDL, high-density lipoprotein; FBG, fasting blood glucose; eGFR, estimated GFR; CVD, cardiovascular disease. Definition of obesity, BMI = 25.0 Kg/m2; Mean+/?SD; aP 0.05, Ikuo Nomura, Vasc Health Risk Manag. 2009 HIGHER BASELINE BMI AS AN INDEPENDENT PREDICTOR FOR ESRD Hsu C, Ann Intern Med? 2006?144:1:21-28 18.5, 18.5-24.9, 25-29.9, 30-34.9, 35-39.9, 40 BMI ESRD=end-stage renal disease 320,252 adult members of Kaiser Permanente who volunteered for screening health checkups between 1964 and 1985 and who had height and weight measured 肥胖造成腎臟傷害的機轉 cc 內科學誌　　2012：23：98-105 肥胖造成腎臟傷害的機轉 肥胖對腎絲球的影響 肥胖改變腎臟血行動力學 活化腎素- 血管收縮素- 醛固酮系統(reninangiotensin-aldosterone system, RAAS) 發炎反應和發炎細胞激素(proinflammatory cytokines) 的角色 瘦體素 (Leptin) 的角色 肥胖對腎絲球的影響 肥胖是否會對腎絲球造成損害呢？ 首先發現肥胖與腎病症候群的關聯，蛋白尿在減重後改善，而在復胖後蛋白尿加重。 Weisinger JR. Ann Intern Med 1974. 肥胖患者的腎臟