产前皮质类固醇与极低出生体重早产儿青少年肾功能的关系。
Association of antenatal corticosteroids with kidney function in adolescents born preterm with very low birth weight.
机构信息
Wake Forest University School of Medicine, Winston-Salem, NC, 27101, USA.
Department of Statistical Sciences, Wake Forest University, Winston-Salem, NC, 27101, USA.
出版信息
J Perinatol. 2023 Aug;43(8):1038-1044. doi: 10.1038/s41372-023-01688-3. Epub 2023 May 9.
OBJECTIVE
Investigate if antenatal corticosteroids (ANCS) are associated with worse kidney function in adolescence and if greater adiposity magnifies this association.
STUDY DESIGN
Prospective cohort of 162 14-year-olds born preterm with very low birth weight (<1500 g). Outcomes were estimated glomerular filtration rate (eGFR) and first-morning urine albumin-to-creatinine ratio (UACR). We used adjusted generalized linear models, stratified by waist-to-height ratio (WHR) ≥ 0.5.
RESULTS
Fifty-five percent had ANCS exposure and 31.3% had WHR ≥ 0.5. In adjusted analyses of the entire cohort, ANCS was not significantly associated with eGFR or UACR. However, the ANCS-eGFR association was greater in those with WHR ≥ 0.5 (β -16.8 ml/min/1.73 m, 95% CL -31.5 to -2.1) vs. WHR < 0.5: (β 13.9 ml/min/1.73 m, 95% CL -0.4 to 28.1), interaction term p = 0.02.
CONCLUSION
ANCS exposure was not associated with worse kidney function in adolescence, though ANCS may be associated with lower eGFR if children develop obesity by adolescence.
目的
探究产前皮质类固醇（ANCS）是否与青少年时期肾功能恶化有关，以及肥胖程度是否会加剧这种关联。
研究设计
这是一项对 162 名 14 岁早产儿极低出生体重（<1500g）的前瞻性队列研究。结局指标为估计肾小球滤过率（eGFR）和晨尿白蛋白/肌酐比值（UACR）。我们使用调整后的广义线性模型，按腰高比（WHR）≥0.5 分层。
结果
55%的参与者接受了 ANCS 暴露，31.3%的参与者的 WHR≥0.5。在整个队列的调整分析中，ANCS 与 eGFR 或 UACR 无显著相关性。然而，在 WHR≥0.5 的参与者中，ANCS 与 eGFR 的相关性更强（β-16.8ml/min/1.73m，95%可信区间-31.5 至-2.1），而 WHR<0.5 的参与者中则没有这种相关性（β 13.9ml/min/1.73m，95%可信区间-0.4 至 28.1），交互项 p=0.02。
结论
在青少年时期，ANCS 暴露与肾功能恶化无关，但如果儿童在青少年时期发展为肥胖，ANCS 可能与较低的 eGFR 相关。
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