소아 복막투석환자에서 혈관내피성장인자 유전자 다형성이 복막의 용질이동성에 미치는 영향
Influence of VEGF Genetic Polymorphism on Peritoneal Solute Transport in Pediatric Dialysis Patients
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목적:복막투석환자에서 복막의 용질이동성에 영향을 미치는 요인으로 유전적 요인과 임상적 요인이 있다. 복막평형검사는 복막투석환자의 복막 용질이동속도를 평가하는 데에 유용한 검사로, 본 연구에서는 소아 복막투석 환자에서 복막평형검사 결과를 이용하여 혈관내피성장인자(VEGF)의 유전자 다형성과 복막 용질이동성의 상관관계를 연구하였다. 방 법:서울대학교 어린이병원과 삼성서울병원의 소아 복막투석환자 중에서 복막염의 병력이 없고 복막투석 시작한 지 1년 이내에 복막평형검사가 시행된 환자를 대상으로 하였다. VEGF 유전자 -2578 C/A, -14978T/C, -1154G/A, -634G/C, +936 C/T의 단일 유전자 다형성 분석을 시행하였고 VEGF 유전자 다형성의 분포와 복막평형검사 결과간의 상관관계를 분석하였다. 결 과:복막평형검사를 분석한 결과, 4시간 크레아티닌의 투석액/혈장비(D/P creatinine)는 0.56± 0.13였고 4시간 투석액/0시간 투석액 포도당비(D/D0 glucose)는 0.43±0.11였다. 배수체 CTGGC의 이형접합체 또는 동형접합체인 경우가 배수체 CTGGC 를 가지지 않은 경우에 비해 높은 4시간 D/P creatinine (0.67±0.12 vs 0.50±0.09, P=0.007)과 낮은 4시간 D/D0 glucose (0.35±0.12 vs 0.47± 0.08, P=0.037)를 보였다. 결 론:VEGF 유전자 다형성은 복막 용질이동성에 영향을 미칠 수 있다.
Abstract
Purpose:Genetic and clinical factors can influence the permeability of the peritoneal membrane. The peritoneal equilibration test (PET) is helpful in measuring peritoneal permeability in peritoneal dialysis (PD). We investigated the influence of genetic polymorphism of vascular endothelial growth factor (VEGF) on the PET parameters. Methods:Pediatric patients who underwent PET within 12 months of initiating PD at Seoul National University Children’s Hospital and Samsung Medical Center were selected. The patients with positive history of peritonitis before PET were excluded. The VEGF -2578C/ A, -14978T/C, -1154G/A, -634G/C, and +936C/T single-nucleotide polymorphisms were genotyped. Results:The mean 4-hour dialysate-to-plasma ratio for creatinine (D/P creatinine) and the mean 4-hour dialysate glucose to baseline dialysate glucose ratio (D/D0 glucose) were 0.56±0.13 and 0.43±0.11, respectively. The patients with haplotype CTGGC showed higher 4-hour D/P creatinine (0.67±0.12 vs 0.50±0.09, P=0.007) and lower 4-hour D/D0 glucose (0.35±0.12 vs 0.47±0.08, P=0.037) than those without haplotype CTGGC. Conclusion:The VEGF genetic polymorphism may influence the peritoneal solute transport.
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