혈액투석 환자에서 중심동맥 경직도와 대동맥 석회화의 연관성
The Relationship between Central Arterial Stiffness and Aortic Calcification in a Cross-Sectional Study of Patients Undergoing Hemodialysis
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목적: 만성 신질환 환자에서 심혈관 질환은 주요 사망원인으로 전통적인 위험인자뿐만 아니라 비전통적인 위험인자인 대동맥 경화증, 혈관 석회화와도 연관되어 있을 것으로 생각된다. 그리고 이 위험인자는 측정방법에 따라 각 상관관계에 차이가 있었다. 혈액투석 환자군에서 맥파속도와 석회화 측정을 통해 각각의 상관관계 및 기여인자를 확인하고자 단면연구를 시행하였다. 방법: 2009년 1월부터 10월까지 관상동맥 조영술에서 협착이 관찰되지 않고 정상 크레아티닌 범위를 보이며 고혈압 치료 중인 환자를 고혈압군으로, 6개월 이상 유지 혈액투석 중인 자를 투석군으로 하였다. 각 군의 심혈관, 동반 질환 여부, 약제 복용력 등을 조사하였고 자동 파형 분석기를 통해 맥파속도를 투석 환자에서 non-contrast CT를 이용하여 혈관 석회화 여부를 측정하였다. 결과: 투석군에서 고혈압군에 비해 평균연령이 54.0 ± 13.7세로 낮았고 여성이 더 많았으며 흡연자가 27.9%로 적었음에도 동반 질환은 제 2형 당뇨병이 42.6%로 많고 수축기 혈압(145.3 ± 27.7 vs. 123.3 ± 17.5 mmHg, p < 0.05) 및 맥압(59.3 ± 19.4 vs. 50.7 ± 12.3 mmHg, p < 0.01)이 더 높았다. 투석군에서 hfPWV (11.3 ± 3.20 vs. 9.72 ± 2.16 m/s, p < 0.01), baPWV (17.76 ± 4.79 vs. 13.80 ± 2.95 m/s, p < 0.01)로 모두 증가되었다. 또한 투석군의 73.6%에서 석회화가 동반되었으며 최고 HU는 평균 387.4 ± 295.2 HU였고, 2.69 ± 2.43개의 석회화가 관찰되었다. 분절에 따른 동맥 경직도 및 혈관 석회화와 각 요인들간의 단변량 회귀분석에서 hf가 좋은 상관관계를 보였으며 연령(r = 0.613, p < 0.01), 맥압(r = 0.540, p < 0.01), 혈관 석회화의 HU 값(r = 0.483, p < 0.01), 성별(r = 0.354, p < 0.05), 당뇨 유무(r = 0.331, p < 0.05) 순으로 양의 상관관계를 보여주었다. 최고 HU 정도에 따른 혈관 석회화는 맥압(r = 0.483, p < 0.01), 연령(r = 0.392, p < 0.01) 이외에 투석기간(r = 0.389, p < 0.05)과도 상관관계가 있었으나 성별(r = 0.230, p = NS) 및 당뇨여부(r = -0.052, p = NS)에서는 관계를 보여주지 못했다. 맥파속도는 연령이 많고, 당뇨, 남성에서, 맥압이 높을수록(β = 0.454, p < 0.001, β = 0.250, p < 0.05, β = 0.239, p < 0.05, β = 0.217, p < 0.05) 혈관 석회화 정도는 맥압, 투석기간, 연령(β = 0.401, p < 0.001, β = 0.390, p < 0.05, β = 0.282, p < 0.05) 순으로 기여도가 높았다. 결론: 투석 환자에서 혈관경직도 증가의 위험인자로 고령, 당뇨, 남성 및 높은 맥압이 관여하며, 혈관 석회화의 위험인자는 고령, 투석기간 및 높은 맥압이 연관되어 있었다. 당뇨를 동반한 투석군에서 비당뇨군에 비교하여 혈관경직도가 증가되었다.
Abstract
Background/Aims: Cardiovascular (CV) disease is the leading cause of death in patients with chronic kidney disease. It may be related to nontraditional risk factors such as arterial stiffness (AS) and vascular calcification (VC). AS, as evaluated by pulse wave velocity (PWV), has been established to be an independent predictor of CV mortality. This study investigated the relationship between AS and VC, and contributing risk factors in patients with hypertension undergoing hemodialysis (HD). Methods: Cross-sectional data are reported on 65 patients with hypertension and 61 patients undergoing HD. PWV, abdominal computed tomography (CT) scans, and serum markers of mineral metabolism were measured. Results: Mean heart-femoral (hf) PWV and brachial-ankle (ba) PWV were higher in the HD group than in the hypertensive group. In a univariate linear regression analysis, hfPWV was positively correlated with age (r = 0.613, p < 0.01), pulse pressure (r = 0.540, p < 0.01), highest aortic VC (HU) (r = 0.483, p < 0.01), gender (r = 0.354, p < 0.05), and diabetes (r = 0.331, p < 0.05). Aortic VC was also positively correlated with pulse pressure (r = 0.483, p < 0.01), age (r = 0.392, p < 0.01), and dialysis duration (r = 0.389, p < 0.05). In a multivariate regression analysis, old age, diabetes, male gender, high pulse pressure, and dialysis duration were significantly associated with PWV in that order, whereas high pulse pressure, dialysis duration, and age were significant factors for aortic VC. Arterial stiffness was more prevalent and advanced in the diabetic HD group than that in the nondiabetic HD group. Conclusions: A high prevalence of arterial stiffness was noted in patients undergoing HD, which was closely related with old age, diabetes, male gender, and high pulse pressure. Patients with diabetes undergoing HD may be at risk for vascular stiffness. (Korean J Med 2011;81:215-222)
참고문헌 (17)
- Foley RN, "Clinical epidemiology of cardiovascular disease in chronic renal disease", Am J Kidney Dis, 32(5 Suppl 3), pp.S112~S119 (1998)
- Drüeke TB, "Aspects of cardiovascular burden in pre-dialysis patients", Nephron, 85(Suppl 1), pp.9~14 (2000)
- Levin A, "Clinical epidemiology of cardiovascular disease in chronic kidney disease prior to dialysis", Semin Dial, 16, pp.101~105 (2003)
- Cheung AK, "Atherosclerotic cardiovascular disease risks in chronic hemodialysis patients", Kidney Int, 58, pp.353~362 (2000)
- London GM, "Cardiovascular calcifications in uremic patients: clinical impact on cardiovascular function", J Am Soc Nephrol, 14(9 Suppl 4), pp.S305~S309 (2003)
- Blacher J, "Arterial calcifications, arterial stiffness, and cardiovascular risk in end-stage renal disease", Hypertension, 38, pp.938~942 (2001)
- London GM, "Arterial media calcification in end-stage renal disease: impact on all-cause and cardiovascular mortality", Nephrol Dial Transplant, 18, pp.1731~1740 (2003)
- 신영신, "The Relation of Arterial Stiffness with Vascular Calcification and BMD in Chronic Kidney Disease", Kidney Research and Clinical Practice, 28(5), pp.433~443 (2009), 대한신장학회
- Chobanian AV, "Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure", Hypertension, 42, pp.1206~1252 (2003)
- Toussaint ND, "Relationship between vascular calcification, arterial stiffness and bone mineral density in a cross-sectional study of prevalent Australian haemodialysis patients", Nephrology (Carlton), 14, pp.105~112 (2009)
- Toussaint ND, "Associations between vascular calcification, arterial stiffness and bone mineral density in chronic kidney disease", Nephrol Dial Transplant, 23, pp.586~593 (2008)
- Daugirdas JT, "Second generation logarithmic estimates of single-pool variable volume Kt", V: an analysis of error, 1993, pp.4, 1205~1213
- Jono S, "Phosphate regulation of vascular smooth muscle cell calcification", Circ Res, 87, pp.E10~E17 (2000)
- Giachelli CM, "Vascular calcification and inorganic phosphate", Am J Kidney Dis, 38(4 Suppl 1), pp.S34~S37 (2001)
- Guérin AP, "Arterial stiffening and vascularcalcifications in end-stage renal disease", Nephrol Dial Transplant, 15, pp.1014~1021 (2000)
- Kimoto E, "Preferential stiffening of central over peripheral arteries in type 2 diabetes", Diabetes, 52, pp.448~452 (2003)
- Taniwaki H, "Aortic calcification in haemodialysis patients with diabetes mellitus", Nephrol Dial Transplant, 20, pp.2472~2478 (2005)