Ilori Titilayo O, Wang Xiao, Huang Morong, Gutierrez Orlando M, Narayan K M Venkat, Goodman Michael, McClellan William, Plantinga Laura, Ojo Akinlolu O
Emory University School of Medicine, Atlanta, GA, USA.
Am J Nephrol. 2017;45(4):338-345. doi: 10.1159/000464257. Epub 2017 Mar 11.
Oxidative balance score (OBS) is a composite measure of oxidative stress-related exposures. The aim of this study was to investigate the association between OBS, end-stage renal disease (ESRD), and cardiovascular disease (CVD).
Using data from the Chronic Renal Insufficiency Cohort, we calculated the main exposure OBS by summing up 12 apriori-defined pro- and antioxidant factors obtained from the diet history questionnaire and lifestyle assessment. We divided OBS into quartiles (Q1-Q4), with Q1 (predominance of pro-oxidants) as the reference. We analyzed OBS quartiles as an ordinal variable. Crude and adjusted hazards ratios (HRs) and 95% CIs were estimated using Cox proportional hazards models for time to ESRD and CVD.
Compared to Q1, Q4 (high antioxidant) was associated with ESRD in the crude model (HR 1.35, 95% CI 1.08-1.69) and adjusting for age, sex, and race (HR 1.36, 95% CI 1.09-1.71) but not in the fully adjusted model (HR 1.12, 95% CI 0.84-1.51). HR of ESRD increased as the OBS quartiles increased in the crude model (ptrend < 0.05) but not in the fully adjusted model (ptrend = 0.30). Compared to Q1, Q4 was associated with CVD in the crude (HR 1.33, 95% CI 1.06-1.68) but not adjusted models. The HR of CVD increased with an increase in OBS quartiles in the crude model (ptrend < 0.05).
The reverse association between OBS and progression to ESRD suggests that perhaps the effect of oxidative balance-related exposure is different in the setting of established chronic kidney disease.
氧化平衡评分（OBS）是氧化应激相关暴露的综合指标。本研究旨在探讨OBS与终末期肾病（ESRD）及心血管疾病（CVD）之间的关联。
利用慢性肾功能不全队列研究的数据，我们通过汇总从饮食史问卷和生活方式评估中获得的12个先验定义的促氧化剂和抗氧化剂因素来计算主要暴露指标OBS。我们将OBS分为四分位数（Q1-Q4），以Q1（促氧化剂占优势）作为参照。我们将OBS四分位数作为有序变量进行分析。使用Cox比例风险模型估计ESRD和CVD发生时间的粗风险比（HR）和调整后风险比以及95%置信区间（CI）。
与Q1相比，在粗模型中Q4（高抗氧化剂）与ESRD相关（HR 1.35，95%CI 1.08-1.69），在调整年龄、性别和种族后（HR 1.36，95%CI 1.09-1.71），但在完全调整模型中不相关（HR 1.12，95%CI 0.84-1.51）。在粗模型中，ESRD的HR随OBS四分位数的增加而升高（趋势P<0.05），但在完全调整模型中并非如此（趋势P=0.30）。与Q1相比，在粗模型中Q4与CVD相关（HR 1.33，95%CI 1.06-1.68），但在未调整模型中不相关。在粗模型中，CVD的HR随OBS四分位数的增加而升高（趋势P<0.05）。
OBS与进展至ESRD之间的反向关联表明，在已确诊的慢性肾脏病背景下，氧化平衡相关暴露的影响可能有所不同。
