Is Low Birth Weight a Risk Factor for Development of Kidney Disease?-A Systematic Review

出生時體重過低是腎病發生的危險因子嗎？－系統性文獻回顧

蔣榮福(Jung-Fu Chiang) ； Claire Carson

《Acta Nephrologica》 22卷1期 (2008/03) Pp. 31-40

摘要

背景：出生時體重過低者，容易引發糖尿病及腎元數不足以致高血壓。出生日時體重過低被推論是末期腎病致病原因之一。
目標：回顧目標在評估文獻研究方法，及探討糖尿病與非糖尿病族群中，出生時體重過低與腎病發生的關連性。
搜尋方法：在MEDLINE與EMBASE資料庫，不設限日期，搜尋人體研究的英語文獻。在重要腎臟雜誌，與入選回顧文獻的參考資料做手工搜尋。
篩選條件：篩選探究出生時體重過低與腎病發生的橫貫性研究、世代研究、對照研究，但排除個案報告、動物實驗、敘述性回顧文獻。
資料收集分析：摘取並分析入選文獻的研究方法、危險因子、研究結果、未參與率、觀察者及參與者的盲測情形、結果評估及擾亂因子的校正。
主要結果：出生時體重過低與腎病發生，在糖尿病族群關連不明確；在非糖尿病族群則存有關連性。
結論：各論文結果不一致可歸因於不同的研究設計與品質參差不一的研究方法。支持胚胎起源說的證據，須接受方法學上嚴格地檢測。個人推薦問延的世代研究，長期追蹤體重過低的嬰兒群是未來最佳研究；同時以懷胎月數校正胎兒體重：並應用顯微蛋白尿篩檢糖尿病早期腎病變；及以尿液白蛋白肌酐酸比值篩檢非糖尿病早期腎病變。評估關連性時應再加校正社經地位、出生後體重增加值、現今體重等擾亂因子。

關鍵字

出生體重過低 ； 腎元數不足 ； 腎病變

並列摘要

Background: People born with low birth weight are prone to developing diabetes mellitus, low nephron number and subsequent essential hypertension. The cause of end stage renal disease is multifactorial. Low birth weight has been proposed as a risk factor of renal diseased.
Objectives: The aim of this review is to asses the quality of the study methods of the included studies and to discuss evidence for any association between low birth weight and renal disease in diabetic and non-diabetc people.
Search strategy: MEDLINE and EMBASE were searched for related English articles with no date limitation and focused on humans. We also carried out a hand-search of core kidney journals, and the reference lists of theses selected articles were scrutinized. Selection criteria: Cross-sectional studies, cohort studies, and casecontrol studies exploring an association between low birth weight and kidney disease were excluded. Data collection and analysis: Eligible articles were extracted for data regarding the study method, exposure of interest, outcome of interest, non-participation rate, blinding status of observers and participants, outcome assessment, and confounders adjustment.
Main results: Among the studies of diabetic people, the association between low birth weight and renal disease is mixed but among studies of non-diabetic people, low birth weight tends to be inversely associated with renal disease.
Author's conclusions: The causes of inconsistent results may be attributed to the different study designs, and varying methodological quality. Fetal origins hypothesis is plausible, however, evidence should be critically appraised by methodological quality. For future work, a well-designed cohort study to follow up low birth weight babies should be recommended. Further, exposure measurement (birth weight) should be measured adjusting for gestational age. Outcome measurement also must be standardized, that is-using microalbuminuria to identily early diabetic nephropathy in diabetic people and using ruine ACR≥30 mg/mmol to detect early nephropathy in non-diabetic people. Added potential confounders, such as socio-economic level, postnatal growth, and current weight, should be adjusted when assessing the effect of low birth weight on renal disease.

並列關鍵字

low birth weight ； low nephron number ； nephropathy