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新研究探討心腎代謝綜合症（CKM），強調肥胖、糖尿病、心血管疾病和慢性腎病之間的複雜關聯。隨著這些疾病的共存成為全球性挑戰，研究呼籲加強預防和管理策略，並強調早期篩檢的重要性。透過探索病理機制與現有療法，這項綜述旨在改善患者健康結果，並促進跨學科合作。
Cardiovascular-Kidney-Metabolic (CKM) syndrome: A state-of-the-art review
心血管-腎臟-代謝 (CKM) 綜合症：最前沿的綜述
Sebastian SA, Padda I, Johal G. Cardiovascular-Kidney-Metabolic (CKM) syndrome: A state-of-the-art review. Curr Probl Cardiol. 2024;49(2):102344. doi:10.1016/j.cpcardiol.2023.102344
https://pubmed.ncbi.nlm.nih.gov/38103820/
Abstract
The correlation between obesity, type 2 diabetes mellitus (DM), cardiovascular disease (CVD), and chronic kidney disease (CKD) is an escalating and widely acknowledged epidemic in industrialized nations. Recently, this complex web of interrelated health conditions has been collectively defined as the Cardiovascular-Kidney-Metabolic (CKM) syndrome by the American Heart Association (AHA). The molecular mechanisms underlying CKM disease contain a spectrum of interconnected factors, including hyperglycemia, insulin resistance, heightened activity of the renin-angiotensin-aldosterone system (RAAS), the generation of advanced glycation end-products, oxidative stress, lipotoxicity, endoplasmic reticulum stress, abnormalities in calcium handling, malfunctioning of mitochondria and impaired energy production, as well as persistent chronic inflammation. Addressing their prevention, management, and treatment is of paramount importance to promote better patient health outcomes. The objective of this review is to provide a comprehensive and critical examination of the current state-of-the-art regarding the recently defined CKM syndrome. This includes an exploration of epidemiological evidence establishing connections between cardio-renal-metabolic diseases, an examination of the underlying pathophysiological mechanisms, and a comprehensive overview of existing treatment modalities.
摘要
肥胖、2型糖尿病 (DM)、心血管疾病 (CVD) 與慢性腎臟疾病 (CKD) 之間的相關性在工業化國家中已成為一種不斷上升且廣泛認可的流行病。最近，美國心臟協會 (AHA) 將這一複雜的健康狀況網絡統稱為心血管-腎臟-代謝 (CKM) 綜合症。CKM 疾病的分子機制包含一系列相互關聯的因素，包括高血糖、胰島素抵抗、腎素-血管緊張素-醛固酮系統 (RAAS) 的活性增強、糖化終產物的生成、氧化壓力、脂毒性、內質網壓力、鈣處理異常、線粒體功能失常及能量產生受損，以及持續的慢性炎症。解決這些問題的預防、管理與治療對於促進患者健康結果至關重要。本綜述的目的是對新近定義的 CKM 綜合症進行全面而批判的檢視，包括探討流行病學證據以建立心腎代謝疾病之間的聯繫，檢視潛在的病理生理機制，以及對現有治療方式的全面概述。
引言
根據大量證據，2型糖尿病 (DM)、心血管疾病 (CVD) 和慢性腎臟疾病 (CKD) 是三大主要健康挑戰，與顯著的發病率和死亡率相關。這些疾病通常會共同存在。根據 2017 年至 2020 年 3 月的全國健康與營養檢查調查 (NHANES) 數據，20 歲及以上成年人中，CVD 的整體盛行率為 48.6%，相當於 2020 年 1.279 億人。這一盛行率在男性和女性中隨著年齡增長而增加。在美國心臟協會 (AHA) 2023 年的心臟病和中風統計更新中，CVD 在 2020 年導致了大約 1905 萬例全球死亡。國際合作者對全球 CKD 負擔的報告顯示，1990 年至 2017 年間，CKD 的全齡死亡率顯著增加了 41.5%（95% 不確定區間為 35.2 至 46.5）。此外，2021 年 20 至 79 歲人群中的糖尿病全球盛行率估計為 10.5%，相當於 5.366 億人，預計到 2045 年將上升至 12.2%，涵蓋 7.832 億人。
來自觀察性研究和臨床試驗的流行病學數據提供了關於代謝、心血管和腎臟疾病之間存在顯著重疊的充分證據。為認識這種複雜的關係，美國心臟協會 (AHA) 最近引入了心血管-腎臟-代謝綜合症 (CKM) 的概念，強調這三個健康領域 (CVD、CKD 和 2 型 DM) 之間的密切關聯與相互作用。在 AHA 最近的總統諮詢報告中，討論了 CKM 的不同階段，特別強調篩查的重要性和社會健康決定因素對 CKM 患者整體健康的影響。許多其他機制也與 CKM 密切相關，這為這一新興病症的治療管理奠定了基礎。本綜述深入分析了 CKM 相關的潛在機制，探討了有效應對這一複雜綜合症的治療方法。此外，我們強調跨學科合作在主動預防 CKM 綜合症和促進受影響個體整體健康與福祉方面的重要性。
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