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Liu DF, Zhang XY, Zhou RF, Cai L, Yan DM, Lan LJ, He SH, Tang H. Glucose metabolism continuous deteriorating in male patients with human immunodeficiency virus accepted antiretroviral therapy for 156 weeks. World J Diabetes 2023; 14:299-312. [PMID: 37035225 PMCID: PMC10075030 DOI: 10.4239/wjd.v14.i3.299] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 12/21/2022] [Accepted: 02/28/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND The dynamic characteristics of glucose metabolism and its risk factors in patients living with human immunodeficiency virus (PLWH) who accepted primary treatment with the efavirenz (EFV) plus lamivudine (3TC) plus tenofovir (TDF) (EFV + 3TC + TDF) regimen are unclear and warrant investigation.
AIM To study the long-term dynamic characteristics of glucose metabolism and its contributing factors in male PLWH who accepted primary treatment with the EFV + 3TC + TDF regimen for 156 wk.
METHODS This study was designed using a follow-up design. Sixty-one male treatment-naive PLWH, including 50 cases with normal glucose tolerance and 11 cases with prediabetes, were treated with the EFV + 3TC + TDF regimen for 156 wk. The glucose metabolism dynamic characteristics, the main risk factors and the differences among the three CD4+ count groups were analyzed.
RESULTS In treatment-naive male PLWH, regardless of whether glucose metabolism disorder was present at baseline, who accepted treatment with the EFV + 3TC + TDF regimen for 156 wk, a continuous increase in the fasting plasma glucose (FPG) level, the rate of impaired fasting glucose (IFG) and the glycosylated hemoglobin (HbA1c) level were found. These changes were not due to insulin resistance but rather to significantly reduced islet β cell function, according to the homeostasis model assessment of β cell function (HOMA-β). Moreover, the lower the baseline CD4+ T-cell count was, the higher the FPG level and the lower the HOMA-β value. Furthermore, the main risk factors for the FPG levels were the CD3+CD8+ cell count and viral load (VL), and the factors contributing to the HOMA-β values were the alanine aminotransferase level, VL and CD3+CD8+ cell count.
CONCLUSION These findings provide guidance to clinicians who are monitoring FPG levels closely and are concerned about IFG and decreased islet β cell function during antiretroviral therapy with the EFV + 3TC + TDF regimen for long-term application.
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Affiliation(s)
- Da-Feng Liu
- Department of Internal Medicine, Public Health and Clinical Center of Chengdu, Chengdu 610061, Sichuan Province, China
| | - Xin-Yi Zhang
- Department of Endocrinology and Metabolism, Sichuan University West China Hoapital, Chengdu 610041, Sichuan Province, China
| | - Rui-Feng Zhou
- Department of Infectious Disease, Public Health and Clinical Center of Chengdu, Chengdu 610061, Sichuan Province, China
| | - Lin Cai
- Department of Infectious Disease, Public Health and Clinical Center of Chengdu, Chengdu 610061, Sichuan Province, China
| | - Dong-Mei Yan
- Department of Infectious Disease, Public Health and Clinical Center of Chengdu, Chengdu 610061, Sichuan Province, China
| | - Li-Juan Lan
- Department of Internal Medicine, Public Health and Clinical Center of Chengdu, Chengdu 610061, Sichuan Province, China
| | - Sheng-Hua He
- Department of Infectious Disease, Public Health and Clinical Center of Chengdu, Chengdu 610061, Sichuan Province, China
| | - Hong Tang
- Center of Infectious Disease, Sichuan University West China Hoapital, Chengdu 610041, Sichuan Province, China
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Sun CY, Zhou LF, Song L, Lan LJ, Han XW, Zhang GR, Mo YW, Zheng SQ, Chen YG, Fu X. How to Reduce the Risk of Arteriovenous Fistula Dysfunction by Observing Prepump Arterial Pressure during Hemodialysis: A Multicenter Retrospective Study. Blood Purif 2021; 50:800-807. [PMID: 33530090 DOI: 10.1159/000512352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/14/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Prepump arterial (Pa) pressure indicates the ease or difficulty with which the blood pump can draw blood from the vascular access (VA) during hemodialysis. Some studies have suggested that the absolute value of the Pa pressure to the extracorporeal blood pump flow (Qb) ratio set on the machine (|Pa/Qb|) can reflect the dysfunction of VA. This study was conducted to explore the impact of arteriovenous fistula (AVF) dysfunction and to explore the clinical reference value of |Pa/Qb|. METHODS We retrospectively identified adults who underwent hemodialysis at 3 hospitals. Data were acquired from electronic health records. We evaluated the pattern of the association between |Pa/Qb| and AVF dysfunction during 1 year using a Cox proportional hazards regression model with restricted cubic splines. Then, the patients were grouped based on the results, and hazard ratios were compared for different intervals of |Pa/Qb|. RESULTS A total of 490 patients were analyzed, with an average age of 55 (44, 66) years. There were a total of 85 cases of AVF dysfunction, of which 50 cases were stenosis and 35 cases were thrombosis. There was a U-shaped association between |Pa/Qb| and the risk of AVF dysfunction (p for nonlinearity <0.001). |Pa/Qb| values <0.30 and >0.52 increased the risk of AVF dysfunction. Compared with the group with a |Pa/Qb| value between 0.30 and 0.52, the groups with |Pa/Qb| <0.30 and |Pa/Qb| >0.52 had a 4.04-fold (p = 0.002) and 3.41-fold (p < 0.001) greater risk of AVF dysfunction, respectively. CONCLUSIONS The appropriate range of |Pa/Qb| is between 0.30 and 0.52. When |Pa/Qb| is <0.30 or >0.52, the patient's AVF function or Qb setting should be reevaluated to prevent subsequent failure.
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Affiliation(s)
- Chun-Yan Sun
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,School of Nursing, Southern Medical University, Guangzhou, China
| | - Li-Fang Zhou
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Li Song
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Li-Juan Lan
- Blood Purification Center, Shenzhen People's Hospital, Shenzhen, China
| | - Xiao-Wei Han
- Division of Nephrology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Guan-Rong Zhang
- Information and Statistical Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ya-Wen Mo
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shu-Qian Zheng
- Division of Nephrology, Guangzhou Nansha Central Hospital, Guangzhou, China
| | - Ying-Gui Chen
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xia Fu
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China, .,School of Nursing, Southern Medical University, Guangzhou, China,
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Sun CY, Mo YW, Lan LJ, Han XW, Song L, Zhang GR, Zhou LF, Zheng SQ, Chen YG, Liu SX, Liang XL, Fu X. It is time to implement prepump arterial pressure monitoring during hemodialysis: A retrospective multicenter study. J Vasc Access 2020; 21:938-944. [PMID: 32345102 DOI: 10.1177/1129729820917266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Prepump arterial pressure (Pa) indicates the ease or difficulty with which the blood pump can draw blood from vascular access (inflow) during hemodialysis. The absolute prepump arterial pressure to blood pump speed (Qb) ratio (|Pa/Qb|) may reflect the dysfunction of other vascular accesses. There is no consensus on the impact of |Pa/Qb| on arteriovenous fistula dysfunction. This study aimed to demonstrate the impact of |Pa/Qb| on arteriovenous fistula dysfunction. METHODS In this retrospective analysis, 490 hemodialysis patients with arteriovenous fistula from three hospitals were enrolled. Data were extracted from the I-Diapro database and hospital case systems. The absolute values for |Pa/Qb| and other data collected in the first month of enrollment were used to predict arteriovenous fistula dysfunction and determine the |Pa/Qb| cutoff value. Based on this value, patients were grouped, and 1-year arteriovenous fistula function was analyzed. Patients were followed until arteriovenous fistula dysfunction, until access type replacement, or for 12 months. RESULTS The area under the receiver operating characteristic curve for fistula dysfunction over 1 year was 0.65, with an optimal |Pa/Qb| value, sensitivity, and specificity of 0.499, 60.7%, and 72.6%, respectively. |Pa/Qb| > 0.499 was associated with earlier intervention (317.37 ± 7.68 vs 345.96 ± 3.64 days), lower survival (p < 0.001), and a 3.26-fold greater risk of arteriovenous fistula dysfunction (p < 0.001) than |Pa/Qb| ⩽ 0.499. CONCLUSIONS |Pa/Qb| was an independent risk factor for arteriovenous fistula dysfunction. Nurses should emphasize |Pa/Qb| monitoring and properly set blood pump speed according to this ratio to protect arteriovenous fistula function. |Pa/Qb| > 0.499 might be a predictive measure of arteriovenous fistula dysfunction.
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Affiliation(s)
- Chun-Yan Sun
- School of Nursing, Southern Medical University, Guangzhou, China.,Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ya-Wen Mo
- School of Nursing, Southern Medical University, Guangzhou, China.,Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Li-Juan Lan
- Blood Purification Center, Shenzhen People's Hospital, Shenzhen, China
| | - Xiao-Wei Han
- Division of Nephrology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Li Song
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Guan-Rong Zhang
- Information and Statistical Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Li-Fang Zhou
- School of Nursing, Southern Medical University, Guangzhou, China.,Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shu-Qian Zheng
- School of Nursing, Southern Medical University, Guangzhou, China.,Division of Nephrology, Guangzhou Nansha Central Hospital, Guangzhou, China
| | - Ying-Gui Chen
- School of Nursing, Southern Medical University, Guangzhou, China.,Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shuang-Xin Liu
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xin-Ling Liang
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xia Fu
- School of Nursing, Southern Medical University, Guangzhou, China.,Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Liu DF, Chen Z, Zeng YL, Zhao BN, Lan LJ, Liu YL, Wang Y, Bao L, Xin Y, Hu XH, Luo C. [Difference of Liver Enzymes in Different Metabolism States of Chronic Hepatitis B]. Sichuan Da Xue Xue Bao Yi Xue Ban 2017; 48:570-574. [PMID: 28752976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To analyze the difference of liver enzymes in different metabolism state groups of chronic hepatitis B (CHB). METHODS We use prospective cross-sectional study to analyze the difference of liver enzymes in different metabolism state groups in 110 cases of CHB, including alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and glutamyl transferase (GGT). RESULTS Regardless of the presence or absence of fatty liver, the levels of ALP and GGT were increased along with the deterioration of glucose metabolism (P<0.05).The levels of ALP and GGT in the presence of fatty liver group were higher than those in the absence of fatty liver group (P<0.05). The levels of AST, ALP and GGT showed the trend of increasing along with the increase of HOMA-IR and the decrease of HOMA-β. There was no difference of liver enzymes among the groups with or without other metabolism disorder (P>0.05). CONCLUSION In CHB, abnormal glucose metabolism and fatty liver can lead to the increase of ALP and GGT. The increase of HOMA-IR and the decrease of HOMA-β may lead to the increase of AST, ALP and GGT. Other metabolism disorder did not show any effect on the level of liver enzymes.
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Affiliation(s)
- Da-Feng Liu
- Department of Internal Medicine, the Public and Health Clinic Centre of Chengdu, Chengdu 610061, China
| | - Zhu Chen
- Department of Infectional Inpatient Ward Two, the Public and Health Clinic Centre of Chengdu, Chengdu 610061, China
| | - Yi-Lan Zeng
- The Public and Health Clinic Centre of Chengdu, Chengdu 610061, China
| | - Ben-Nan Zhao
- Department of Internal Medicine, the Public and Health Clinic Centre of Chengdu, Chengdu 610061, China
| | - Li-Juan Lan
- Department of Internal Medicine, the Public and Health Clinic Centre of Chengdu, Chengdu 610061, China
| | - Ya-Ling Liu
- Department of Internal Medicine, the Public and Health Clinic Centre of Chengdu, Chengdu 610061, China
| | - Yong Wang
- Department of Internal Medicine, the Public and Health Clinic Centre of Chengdu, Chengdu 610061, China
| | - Lei Bao
- Department of Internal Medicine, the Public and Health Clinic Centre of Chengdu, Chengdu 610061, China
| | - Yi Xin
- Department of Internal Medicine, the Public and Health Clinic Centre of Chengdu, Chengdu 610061, China
| | - Xin-Hua Hu
- Department of Internal Medicine, the Public and Health Clinic Centre of Chengdu, Chengdu 610061, China
| | - Chuan Luo
- Department of Internal Medicine, the Public and Health Clinic Centre of Chengdu, Chengdu 610061, China
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