Group-based trajectory modeling

基于群的轨迹建模
  • 文章类型: Journal Article
    脓毒症引发强烈的炎症反应,常导致器官衰竭和高死亡率。血清白蛋白水平在脓毒症中的作用至关重要,但尚未完全了解。特别是关于白蛋白水平随时间变化的重要性。这项研究利用基于群体的轨迹建模(GBTM)来研究血清白蛋白变化的模式及其对脓毒症结局的影响。
    我们对华西医院(2015-2022年)的ICU患者进行了回顾性分析,使用GBTM研究ICU入院第一周内的血清白蛋白波动。这项研究考虑了人口统计,临床参数,和合并症,通过多重插补处理缺失的数据。评估的结果包括28天死亡率,整体医院死亡率,和继发性并发症,如AKI和需要机械通气。
    来自1,950名患者的数据显示了四种血清白蛋白轨迹,显示出明显的持续低模式,增加,中度,和一贯的高水平。这些群体的死亡率差异很大,持续低水平组的死亡率最高。在其他组之间没有观察到28天死亡率的显著差异。亚组分析并没有改变这些发现。
    该研究确定了败血症患者的四个白蛋白轨迹组,强调那些持续低水平的人有最坏的结果,而那些水平越来越高的人最好。稳定的高水平高于30g/L并没有显着改变结果。这些发现可以为临床决策提供信息,帮助早期识别高风险患者并定制治疗方法。
    UNASSIGNED: Sepsis triggers a strong inflammatory response, often leading to organ failure and high mortality. The role of serum albumin levels in sepsis is critical but not fully understood, particularly regarding the significance of albumin level changes over time. This study utilized Group-based Trajectory Modeling (GBTM) to investigate the patterns of serum albumin changes and their impact on sepsis outcomes.
    UNASSIGNED: We conducted a retrospective analysis on ICU patients from West China Hospital (2015-2022), employing GBTM to study serum albumin fluctuations within the first week of ICU admission. The study factored in demographics, clinical parameters, and comorbidities, handling missing data through multiple imputation. Outcomes assessed included 28-day mortality, overall hospital mortality, and secondary complications such as AKI and the need for mechanical ventilation.
    UNASSIGNED: Data from 1,950 patients revealed four serum albumin trajectories, showing distinct patterns of consistently low, increasing, moderate, and consistently high levels. These groups differed significantly in mortality, with the consistently low level group experiencing the highest mortality. No significant difference in 28-day mortality was observed among the other groups. Subgroup analysis did not alter these findings.
    UNASSIGNED: The study identified four albumin trajectory groups in sepsis patients, highlighting that those with persistently low levels had the worst outcomes, while those with increasing levels had the best. Stable high levels above 30 g/L did not change outcomes significantly. These findings can inform clinical decisions, helping to identify high-risk patients early and tailor treatment approaches.
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  • 文章类型: Journal Article
    我们旨在表征整个成年期的体力活动(PA)轨迹,并估计其与高血压事件风险的关联。
    数据来自2004-2011年进行的中国健康与营养调查(CHNS)。基于组的轨迹建模(GBTM)用于识别不同组的PA轨迹。采用Cox比例风险模型进行相关性研究。
    我们的研究包括了11,162名参与者,他们的PA在CHNS中通过两次至四次的自我报告重复评估。在5.4年的随访中,确定了3824例高血压事件。在男性中发现了五种不同的PA轨迹:轻度和轻度下降,轻度逐渐下降,然后急剧上升,轻到中重,然后下降,中重和逐渐下降,严重而急剧的下降。在女性中发现了两种不同的PA轨迹:轻和稳定,中等和逐渐下降。PA的中重度和逐渐下降的轨迹与男性高血压风险的降低显著相关,风险比和95%置信区间(CI)为0.80(0.63,0.99),0.74(0.59,0.93),0.76(0.60,0.96),和模型1-4中的0.70(0.55、0.88)。
    我们的研究确定了男性的五种不同的长期PA轨迹和女性的两种不同的轨迹。发现成年早期中重PA的PA轨迹随后逐渐下降与男性晚年高血压风险降低显着相关。
    UNASSIGNED: We aimed to characterize physical activity (PA) trajectories across adulthood and to estimate their association with incident hypertension risk.
    UNASSIGNED: Data were obtained from the China Health and Nutrition Survey (CHNS) conducted during 2004-2011. Group-based trajectory modeling (GBTM) was used to identify distinct groups of PA trajectories. The Cox proportional hazards model was used to investigate the association.
    UNASSIGNED: A total of 11,162 participants whose PA was repeatedly estimated by self-report from questionnaires two to four times in the CHNS were included in our study. During the 5.4 years of follow-up, 3824 incident hypertension cases were identified. Five distinct PA trajectories were identified in men: light and slight decline, light and gradual decline then sharp rise, light to medium-heavy then decline, medium-heavy and gradual decline, and heavy and sharp decline. Two distinct PA trajectories were identified in women: light and stable, and medium and gradual decline. The PA trajectory of medium-heavy and gradual decline was significantly associated with decreased risk of hypertension in men, with the hazard ratios and 95% confidence intervals (CI) being 0.80 (0.63, 0.99), 0.74 (0.59, 0.93), 0.76 (0.60, 0.96), and 0.70 (0.55, 0.88) in models 1-4, respectively.
    UNASSIGNED: Our study identified five distinct long-term PA trajectories in men and two distinct trajectories in women. The PA trajectory of medium-heavy PA in early adulthood followed by gradual decline was found to be significantly associated with a decreased risk of hypertension in later life in men.
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  • 文章类型: Journal Article
    目的:探讨儿科重症监护病房(PICU)不同急性胃肠道损伤(AGI)分级轨迹的特征及其对预后的影响。
    方法:本回顾性队列研究在中国一家大型儿童医院进行。包括入住PICU的儿童。在PICU入院后的最初九天内,每隔一天评估一次AGI等级。
    结果:共纳入642名儿童,其中364例(56.7%)患儿出现不同程度的胃肠功能障碍(AGI等级≥2级)。根据AGI分级随时间变化的模式,确定了六组:低稳定组,低波动组,中等递减组,中等增长组,高递减组,高持久性组。高持久性组约占所有记录死亡的90%。与低稳定组相比,中等增长组和高持续组均与PICU住院时间(PICULOS)和住院时间(LOS)呈正相关.与低稳定组相比,五组与肠内营养(EN)接受的能量百分比呈负相关,以及EN收到的蛋白质。
    结论:本研究在危重患儿中确定了6个不同的AGI分级轨迹组。随着时间的推移,AGI等级轨迹的模式与EN递送比例和临床结果相关。
    OBJECTIVE: To investigate the characteristics of different Acute Gastrointestinal Injury (AGI) grading trajectories and examine their impact on prognosis in the Pediatric Intensive Care Unit (PICU).
    METHODS: This retrospective cohort study was conducted at a large children\'s hospital in China. The children admitted to the PICU were included. AGI grade was assessed every other day during the initial nine days following PICU admission.
    RESULTS: A total of 642 children were included, of which 364 children (56.7%) exhibited varying degrees of gastrointestinal dysfunction (AGI grade ≥ 2). Based on the patterns of AGI grading over time, six groups were identified: low-stable group, low-fluctuating group, medium-decreasing group, medium-increasing group, high-decreasing group, high-persistent group. The high-persistent group accounted for approximately 90% of all recorded deaths. Compared to low-stable group, both the medium-increasing and high-persistent groups exhibited positive correlations with length of stay in PICU (PICU LOS) and length of stay (LOS). Compared to low-stable group, the five groups exhibited a negative correlation with the percentage of energy received by enteral nutrition (EN), as well as the protein received by EN.
    CONCLUSIONS: This study identified six distinct trajectory groups of AGI grade in critically ill children. The pattern of AGI grade trajectories over time were associated with EN delivery proportions and clinical outcomes.
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  • 文章类型: Journal Article
    将父母监控(父母驱动的行为)与父母知识区分开来的研究通常无法找到监控对青少年行为问题的保护作用。为了回答父母监控是否与最需要的青少年中的青少年行为问题更密切相关,本研究应用基于群体的轨迹模型来改变青少年早期至中期攻击行为问题,并研究了父母监护与不同亚组之间的关联.发现了三个潜在的青少年群体:低攻击性,中等程度的侵略,和高度增加的侵略。结果表明,仅在高增长组中的青少年中,更多的母亲和父亲监测与更少的青少年攻击行为问题相关。此结果表明,对于青少年亚组来说,父母的监护是防止青少年攻击行为问题的保护因素,这些青少年可能最需要它,而对其他青少年的影响较小。
    Studies that distinguish parental monitoring (parent-driven behaviors) from parental knowledge often fail to find protective effects of monitoring on adolescent behavior problems. To answer whether parental monitoring is more strongly associated with adolescent behavior problems among adolescents who may need it most, this study applied group-based trajectory modeling to change in early- to mid-adolescent aggressive behavior problems and examined associations between parental monitoring with different subgroups. Three latent groups of adolescents were found: Low Aggression, Medium-Increasing Aggression, and High-Increasing Aggression. Results show that more maternal and paternal monitoring were associated with fewer adolescent aggressive behavior problems only for adolescents in the High-Increasing Group. This result suggests that parental monitoring is a protective factor against adolescent aggressive behavior problems for subgroups of adolescents who may need it most and less impactful for other adolescents.
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  • 文章类型: Journal Article
    目的:本研究调查了痴呆症患者在口腔保健期间所表现出的抗护理行为(CRB)的日常变化,以及一天中的时间对CRB轨迹的潜在影响。
    方法:对75位在口腔护理活动中表现出CRB的老年痴呆症患者的样本进行了二次分析。超过21天,在上午和下午的口腔护理期间,使用修订的护理抵抗能力量表(RTC-r)测量CRB。基于组的轨迹建模用于识别轨迹模式并评估上午和下午CRB模式之间的差异。
    结果:确定了三种轨迹模式:早晨CRB轨迹模式显示,50.6%的痴呆症患者的RTC-r评分始终较低,37.5%的痴呆症患者表现出波动,中等RTC-r分数,11.9%的人表现出RTC-r分数开始较高,然后随着时间的推移而下降。同样,下午口腔护理期间的CRB轨迹模式显示,54.5%的RTC-r得分持续较低,38.6%的痴呆症患者的RTC-r得分波动适中。然而,第三个CRB轨迹组遵循一个高增长的轨迹,对于6.9%的痴呆症患者,RTC-r评分开始较高,并继续增加。
    结论:CRB是动态的,并且在几天和一段时间内变化;但是,在管理CRB的干预措施中通常不考虑一天中的时间。因此,重要的是要考虑为痴呆症患者提供口腔护理的时机。根据轨迹的特征,我们建议早上的口腔活动可能更有效。
    OBJECTIVE: This study examined day-to-day variation in care-resistant behaviors (CRBs) exhibited by persons living with dementia during mouth health care and the potential influence of time-of-day on CRB trajectories.
    METHODS: A secondary analysis was conducted on a sample of 75 nursing home-dwelling persons living with dementia who exhibited CRBs during mouth care activities. Over 21 days, CRBs were measured using the revised Resistiveness to Care Scale (RTC-r) during morning and afternoon mouth care sessions. Group-based Trajectory Modeling was used to identify trajectory patterns and assess differences between morning and afternoon CRB patterns.
    RESULTS: Three trajectory patterns were identified: morning CRB trajectory patterns showed 50.6% of persons living with dementia had consistently low RTC-r scores, 37.5% of persons living with dementia exhibited fluctuating, moderate RTC-r scores, and 11.9% exhibited RTC-r scores that started high and then decreased over time. Similarly, CRB trajectory patterns during afternoon mouth care showed a consistently low RTC-r score for 54.5% and a fluctuating moderate RTC-r score for 38.6% of persons living with dementia. However, the third CRB trajectory group followed a high-increasing trajectory, with RTC-r scores starting high and continuing to increase for 6.9% of persons living with dementia.
    CONCLUSIONS: CRBs are dynamic and vary within days and over time; however, the time of the day is often not considered in interventions to manage CRBs. Thus, it is important to consider the timing of providing mouth care for persons living with dementia. Based on the characteristics of the trajectories, we suggest that morning mouth activities may be more efficient.
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  • 文章类型: Journal Article
    背景:了解不同模式的依从依瑞德茶林治疗对确定帕金森病(PD)患者可能受益于有针对性的干预措施至关重要。
    目的:这项描述性研究的目的是确定纵向依从模式并表征与之相关的因素。
    方法:我们在日本医院管理数据库中确定了21-99岁的PD患者,这些患者开始使用istradefyline治疗。基于组的轨迹建模用于对一段时间内覆盖的每月天数比例进行建模,以识别不同的360天依从性模式。使用单变量多项逻辑回归模型评估与每种依从性模式相关的因素。
    结果:在2088名符合条件的PD患者中,确定了4个不同的依从性组:始终高依从性(56.8%);依从性迅速下降(25.8%);依从性逐渐下降(8.5%);然后逐渐下降,然后恢复依从性(9.0%)。与一贯的高依从性组相比,其他组有以下特征与较低的依从性相关的可能性:快速下降的依从性组接受较少的多巴胺激动剂(63.8%vs.69.4%),单胺氧化酶B(MAO-B)抑制剂(26.8%vs.31.6%),和儿茶酚-O-甲基转移酶抑制剂(31.6%vs.37.0%),焦虑/情绪障碍患病率较高(29.9%vs.24.6%);逐渐下降的依从性组接受的MAO-B抑制剂较少(22.5%vs.31.6%)和金刚烷胺(8.4%与16.1%),轻度认知障碍/痴呆患病率较高(27.0%vs.18.8%);依从性下降然后恢复组的焦虑/情绪障碍患病率较高(34.2%vs.24.6%)。
    结论:临床医生应该意识到依从依瑞德韦林的异质性模式。
    BACKGROUND: Understanding the different patterns of adherence to istradefylline treatment is essential to identifying Parkinson\'s disease (PD) patients who might benefit from targeted interventions.
    OBJECTIVE: This descriptive study aimed to identify longitudinal istradefylline adherence patterns and to characterize factors associated with them.
    METHODS: We identified PD patients aged 21-99 years who initiated istradefylline treatment in a Japanese hospital administrative database. Group-based trajectory modeling was used to model the monthly proportion of days covered over time to identify distinct 360-day adherence patterns. Factors associated with each adherence pattern were assessed using univariable multinomial logistic regression models.
    RESULTS: Of 2088 eligible PD patients, 4 distinct adherence groups were identified: consistently high adherence (56.8%); rapidly declining adherence (25.8%); gradually declining adherence (8.5%); and gradually declining and then recovering adherence (9.0%). Compared to the consistently high adherence group, the other groups had the following characteristics associated with a likelihood of lower adherence: the rapidly declining adherence group received fewer dopamine agonists (63.8% vs. 69.4%), monoamine oxidase B (MAO-B) inhibitors (26.8% vs. 31.6%), and catechol-O-methyl transferase inhibitors (31.6% vs. 37.0%) and had a higher prevalence of anxiety/mood disorders (29.9% vs. 24.6%); the gradually declining adherence group received fewer MAO-B inhibitors (22.5% vs. 31.6%) and amantadine (8.4% vs. 16.1%) and had a higher prevalence of mild cognitive impairment/dementia (27.0% vs. 18.8%); and the declining and then recovering adherence group had a higher prevalence of anxiety/mood disorders (34.2% vs. 24.6%).
    CONCLUSIONS: Clinicians should be aware of the heterogeneous patterns of adherence to istradefylline.
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  • 文章类型: Journal Article
    背景:保持较高水平的功能能力对于老年人的独立生活很重要。东京都老年学能力指数研究所(TMIG-IC)的老化轨迹有三种模式;然而,子尺度模式尚不清楚。
    目的:本研究旨在阐明社区居住的老年日本人的TMIG-IC分量表的衰老轨迹模式。
    方法:参与者是3,169名社区居住的日本老年人,他们参加了Otassha研究的2012-2022邮件调查。使用基于组的轨迹建模确定了65-90岁人群的TMIG-IC总分和子量表得分的老化轨迹模式。Further,确定子尺度轨迹模式的组合频率。
    结果:确定了三种模式:早发减少,迟发性下降,和高度稳定。
    结论:日常生活工具活动(IADL)的轨迹一直维持到大约80岁;然而,慢性病在早发性减少模式中占主导地位。25%的参与者存在智力活动(IA)的早发性下降模式,从65岁开始显示IA受损。30%的参与者存在迟发性社会角色(SR)下降的模式,与其他量表相比,显示出急剧下降。对很多人来说,SR和IA的减少模式重叠。
    结论:为了保持更高水平的功能能力,应实施干预措施,包括疾病管理和预防IADL下降,提高对整个老年期间提供的社会支持的认识,以及对IA早期下降人群的干预措施.
    BACKGROUND: Maintaining higher-level functional capacity is important for independent living in older age. The aging trajectory of the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) has three patterns; however, the subscale patterns are unclear.
    OBJECTIVE: This study aimed to clarify the aging trajectory patterns of the TMIG-IC subscales among community-dwelling older Japanese.
    METHODS: Participants were 3,169 community-dwelling older Japanese who participated in the 2012-2022 mail survey of the Otassha study. The aging trajectory patterns of the TMIG-IC total and subscale scores for those aged 65-90 years were identified using group-based trajectory modeling. Further, the combination frequency of the subscale trajectory patterns was determined.
    RESULTS: Three patterns were identified: early-onset decreasing, late-onset decreasing, and high-stable.
    CONCLUSIONS: The instrumental activities of daily living (IADL) trajectory was maintained until approximately 80 years of age; however, chronic disease prevailed the most in the early-onset decreasing pattern. The early-onset decreasing pattern of intellectual activity (IA) was present in 25% of participants, showing impaired IA from 65 years of age. The late-onset decreasing pattern of social roles (SR) was present in 30% of participants, showing a sharp decline compared to other subscales. For many people, the patterns of decrease in SR and IA overlapped.
    CONCLUSIONS: To maintain higher-level functional capacity, interventions that include disease management and prevention of decline in IADL and increase the awareness of the social support provided throughout old age and interventions for people with an early decline in IA should be implemented.
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  • 文章类型: Journal Article
    先前的研究表明中性粒细胞与淋巴细胞比率(NLR)和空腹血糖受损(IFG)之间存在联系,但是调查结果有争议。通过进行现实世界的后续研究,我们可以监测疾病的发展,并确认NLR和IFG之间的联系。共1168例无IFG或T2DM患者随访6年。在基线,参与者\'NLR级别,记录空腹血糖和其他临床特征.在后续期间,记录NLR水平和IFG患病率。最终,45人失去了随访,留下1,123名参与者进行分析。使用基于组的轨迹建模(GBTM),样本分为三组。IFG在三组中的患病率为12.1%,19.4%,和20.85%,分别。与低水平NLR组相比,中等水平NLR组和高水平NLR组IFG的危险比分别为1.628(1.109-2.390)和1.575(1.001-2.497),分别。BMI和NLR对IFG风险有显著的交互作用(P<0.001)。在这个现实世界的后续研究中,我们观察到NLR与IFG风险之间存在正相关,肥胖状况加剧了这种关系。
    Previous studies have indicated a link between neutrophil to lymphocyte ratio (NLR) and impaired fasting glucose (IFG), but the findings have been disputed. By conducting a real-world follow-up study, we can monitor the development of diseases and confirm the connection between NLR and IFG. A total of 1168 patients without IFG or T2DM were followed up for six years. At baseline, participants\' NLR levels, fasting plasma glucose and other clinical characteristics were recorded. During the follow-up period, NLR levels and the prevalence of IFG were recorded. Ultimately, 45 individuals were lost to follow-up, leaving 1,123 participants for analysis. Using Group-Based Trajectory Modeling (GBTM), the sample was divided into three groups. The prevalence of IFG in the three groups was 12.1%, 19.4%, and 20.85%, respectively. Compared with the low-level NLR group, the hazard ratio of IFG in the moderate-level NLR group and high-level NLR group were 1.628 (1.109-2.390) and 1.575 (1.001-2.497), respectively. There was a significant interaction effect of BMI and NLR on the risk of IFG (P < 0.001). In this real-world follow-up study, we observed a positive association between NLR and the risk of IFG, with this relationship being exacerbated by obesity status.
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  • 文章类型: Journal Article
    背景:在重症监护病房(ICU)患者中,尚未很好地确定急性肾损伤(AKI)生物标志物随时间变化的轨迹的临床价值。
    方法:这是一个单中心,前瞻性观察研究,在东京一所教学医学院的混合ICU演出,日本。2014年9月至2015年3月纳入成人ICU动脉导管和尿道导管患者。在ICU中停留少于48小时的患者和已知终末期肾病的患者被排除在研究之外。在ICU入院后0、12、24和48小时收集血液和尿液样品用于AKI生物标志物的测量。主要结果是出院时的主要不良肾脏事件(MAKE),定义为死亡的复合物,透析依赖性,和持续肾功能丧失(eGFR下降≥25%)。
    结果:该研究包括156名患者。基于血清肌酐的估计肾小球滤过率(eGFR),血浆中性粒细胞明胶酶相关脂质运载蛋白(NGAL),和尿肝型脂肪酸结合蛋白(uL-FABP)进行连续测量,并根据基于组的轨迹建模分析将每个变量分为三组.当轨迹曲线彼此平行移动时(即,\"低,\"\"中间,\"和\"高\")对于eGFR和血浆NGAL,uL-FABP曲线显示出不同的轨迹模式,并在不同的方向上移动(“低和恒定,“\”高和指数下降,\"和\"高和指数增长\")。这些轨迹模式与MAKE显著相关。MAKE发生在16(18%),16(40%),和9名(100%)患者在低和恒定,“\”高和指数下降,\"和\"高和指数增长\"组,分别,基于uL-FABP水平(p值<0.001)。uL-FABP的初始值和12小时变化均与MAKE显著相关,即使在调整了eGFR[赔率比(95%置信区间)之后:1.45(1.17-1.83)和1.43(1.12-1.88)对于初始值的增加和对数转换的uL-FABP的12小时变化1点,分别]。
    结论:ICU患者连续测量尿L-FABP的轨迹模式与MAKE显著相关。
    BACKGROUND: The clinical value of the trajectory of temporal changes in acute kidney injury (AKI) biomarkers has not been well established among intensive care unit (ICU) patients.
    METHODS: This is a single-center, prospective observational study, performed at a mixed ICU in a teaching medical institute in Tokyo, Japan. Adult ICU patients with an arterial line and urethral catheter were enrolled from September 2014 to March 2015. Patients who stayed in the ICU for less than 48 h and patients with known end-stage renal disease were excluded from the study. Blood and urine samples were collected for measurement of AKI biomarkers at 0, 12, 24, and 48 h after ICU admission. The primary outcome was major adverse kidney events (MAKE) at discharge, defined as a composite of death, dialysis dependency, and persistent loss of kidney function (≥ 25% decline in eGFR).
    RESULTS: The study included 156 patients. Serum creatinine-based estimated glomerular filtration rate (eGFR), plasma neutrophil gelatinase-associated lipocalin (NGAL), and urinary liver-type fatty acid-binding protein (uL-FABP) were serially measured and each variable was classified into three groups based on group-based trajectory modeling analysis. While the trajectory curves moved parallel to each other (i.e., \"low,\" \"middle,\" and \"high\") for eGFR and plasma NGAL, the uL-FABP curves showed distinct trajectory patterns and moved in different directions (\"low and constant,\" \"high and exponential decrease,\" and \"high and exponential increase\"). These trajectory patterns were significantly associated with MAKE. MAKE occurred in 16 (18%), 16 (40%), and 9 (100%) patients in the \"low and constant,\" \"high and exponential decrease,\" and \"high and exponential increase\" groups, respectively, based on uL-FABP levels (p-value < 0.001). The initial value and the 12-h change in uL-FABP were both significantly associated with MAKE, even after adjusting for eGFR [Odds ratio (95% confidence interval): 1.45 (1.17-1.83) and 1.43 (1.12-1.88) for increase of initial value and 12-h change of log-transformed uL-FABP by 1 point, respectively].
    CONCLUSIONS: Trajectory pattern of serially measured urinary L-FABP was significantly associated with MAKE in ICU patients.
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  • 文章类型: Journal Article
    背景:先前的研究表明,在被诊断为帕金森病(PD)的个体中,嗅觉功能受损与快速眼动睡眠行为障碍(RBD)的风险增加之间存在联系。然而,关于嗅觉功能障碍对早期PD患者睡眠障碍的长期模式的潜在影响的知识存在差距.
    方法:来自帕金森进展标志物倡议计划的数据包括589名参与者,他们使用Epworth嗜睡量表(ESS)和RBD筛查问卷(RBDSQ)评估睡眠障碍。使用宾夕法尼亚大学气味鉴定测试测量基线时的嗅觉功能障碍。使用基于组的轨迹模型确定5年随访期间睡眠障碍的轨迹,通过二项逻辑回归分析嗅觉功能障碍与睡眠障碍轨迹之间的关系。
    结果:在5年的随访期内确定了两种不同的睡眠障碍轨迹,其特征在于保持低或高ESS评分和低或高RBDSQ评分。嗅觉功能测量值与白天过度嗜睡(EDS)的轨迹之间存在反转关联(比值比[OR]=0.97,95%置信区间[CI]0.95,1.00,P=0.038),在控制潜在协变量后。同样,在早期PD个体中,嗅觉功能与可能的RBD(pRBD)的较低轨迹显着相关(OR=0.96,95%CI0.94,0.98,P=0.001)。在替代分析模型中重复了一致的发现。
    结论:我们的研究结果表明,在早期帕金森病中,嗅觉功能障碍与睡眠障碍的长期不良轨迹相关。
    BACKGROUND: Previous studies have suggested a connection between impaired olfactory function and an increased risk of rapid eye movement sleep behavior disorder (RBD) in individuals diagnosed with Parkinson\'s disease (PD). However, there is a gap in knowledge regarding the potential impact of olfactory dysfunction on the long-term patterns of sleep disorders among early PD patients.
    METHODS: Data from the Parkinson\'s Progression Markers Initiative program included 589 participants with assessments of sleep disorders using the Epworth Sleepiness Scale (ESS) and RBD Screening Questionnaire (RBDSQ). Olfactory dysfunction at baseline was measured using the University of Pennsylvania Smell Identification Test. Trajectories of sleep disorders over a 5-year follow-up were identified using group-based trajectory modeling, and the relationship between olfactory dysfunction and sleep disorder trajectories was examined through binomial logistic regression.
    RESULTS: Two distinct trajectories of sleep disorders over the 5-year follow-up period were identified, characterized by maintaining a low or high ESS score and a low or high RBDSQ score. An inversion association was observed between olfactory function measures and trajectories of excessive daytime sleepiness (odds ratio [OR] = 0.97, 95% confidence interval [CI] 0.95, 1.00, p = 0.038), after controlling for potential covariates. Similarly, olfactory function showed a significant association with lower trajectories of probable RBD (OR = 0.96, 95% CI 0.94, 0.98, p = 0.001) among early PD individuals. Consistent findings were replicated across alternative analytical models.
    CONCLUSIONS: Our findings indicated that olfactory dysfunction was associated with unfavorable long-term trajectories of sleep disorders among early PD.
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