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혈액투석 환자에서 활동중혈압을 이용한 투석간 혈압과 수시혈압과의 관계 및 일중 변동에 관한 연구
김혜영(Hye Young Kim),곽남주(Nam Ju Kwack),박남규(Nam Kyu Park),최기원(Ki Won Choi),김동운(Dong Woon Kim),조명찬(Myeong Chan Cho),이상도(Sang Do Lee),윤세진(Sei Jin Yoon),김승택(Seung Taik Kim),엄재호(Jae Ho Earm),남기병(Kee Byung Na 대한내과학회 1996 대한내과학회지 Vol.50 No.4
N/A Objectives: The pre, post and intradialytic blood pressure are used as the criteria of antihypertensive medication in hemodialysis patients but extracellular volume expansion, vasoactive substances released during ultrafiltration and removal of catecholamine make casual blood pressure inaccurate. Furthermore there are reports of the loss of normal diumal blood pressure variation in hemodialysia patients. So we performed this study to evaluate the relationship between interdialytic blood pressure and casual blood pressure measured during dialysis and to find the most representative casual blood pressure in hemodialysis patients. In addition the diurnal blood pressure variations of hemodialysis patients were observed. Methods : We measured interdialytic blood pressure using 24 hour ambulatory blood pressure monitoring(AHPM) and casual blood pressure in the day of dialysis in 21 hemodialysis patients. The increase of body weight during interdialytic period was also recorded. Blood pressure was monitored every 15 min for 24 hours in 21 hemodialysis patients and 50 age and sex matched normal controls. The day-night blood pressure difference was compared between hemodialysis patients and normal controls. Results: 1) The casual pre, intra, postdialytic systolic blood pressure(165.2±26.7 mmHg, 152.7±21.2 mmHg, 160.9±22.5 mmHg, respectively) were significantly higher than interdialytic ambulatory systolic blood pressure (147.9±19.4 mmHg)(p<0.05). 2) The casual pre, intra, postdialytic diastolic blood pressure(94.5±14.8 mmHg, 89.5±15.4 mmHg, 92.4±14.8 mmHg, respectively) were significantly higher than interdialytic ambulatory diastolic blood pressure(77.8±12.2 mmHg)(p<0.05). 3) There were significant relationship between casual pre, intra, postdialytic systolic pressure and interdialytic ambulatory systolic pressure(p<0.01). Correlation coefficients were ranged from 0.67 to 0.78. Hut the only casual postdialytic diastolic pressure was significantly correlated with interdialytic ambulatory diastolic pressure(p<0.01). Correlation coefficients were ranged from 0.56 to 0.58. 4) In normal controls, the daytime blood pressure was significantly higher than nighttime blood pressure(p<0,01) and the day-night difference was 7.1±9.6 mmHg in systolic pressure, and 2.2±6.3 mmHg in diastolic pressure. Hut in hemodialysis patients, that was reversed (p<0.01) and the day- night difference was -4.5±11.7 mmHg in systolic pressure and -1.8±10.2 mmHg in diastolic pressure. Conclusion: The blood pressure measured in the day dialysis was significantly higher than interdialytic ambulatory blood pressure. And the postdialytic blood pressure was significantly related to interdialytic ambulatory blood pressure in both systolic and diastolic pressure. Normal diurnal blood pressure variation was lost in hemodialysis patients.
혈뇨의 감별에서 요중 적혈구 위상차현미경 검사와 탐호스팔 단백의 면역염색법 검사의 비교
김동욱,김혜영,김원재,이도훈,김도형,신경섭,배장환,전현정,엄재호,고병성,곽남주 대한신장학회 1998 Kidney Research and Clinical Practice Vol.17 No.1
Differentiation of renal(RH) and non-renal(NRH) hematuria is important in the diagnosis and treatment of the patients with hematuria. Recently, urine RBC immunoperoxidase(Ipx) staining method was developed, but there was no report on the usefulness of Ipx in Korea. We validated the usefulness of Ipx by comparing with the PCM. Both PCM and Ipx were performed at the same time in 26 patients with RH confirmed by renal biopsy and 23 patients with NRH confirmed by radiologic and/or pathologic studies who were admitted to Chungbuk National University Hospital from January 1996 to December 1996. The age of RH and NRH group were 36.6?15.0 and 56.5±22.2 years. 35.7±30.4% of urine RBC were stained by Ipx in RH group and only 1.6±4.4% were stained in NRH group(P$lt;0.001), 23.4±29.9% of urine RBC by PCM were counted as dysmorphic RBC in RH group and 5.7±13.6% were counted in NRH group(P$lt;0.05). At the cut-off value of 20%, the sensitivity and specificity of Ipx were 57.7% and 100%. At the cut-off value of 30%, thosM were 30.9% and 95.7%, respectively. When comparing overall test performance by calculating AUCs of ROC(receiver operating characteristics) curve, Ipx was better than PCM. Ipx was better than PCM in localizing the origin of hematuria. The NRH might be excluded when Ipx(+) cells are more than 20% of total urine RBC.
고혈압 임부에서 24 시간 활동 중 혈압 측정의 임상적 유용성
전현정(Hyeon Jeong Jeon),고병성(Byeong Seong Ko),곽남주(Nam Ju Kawk),김도형(Do Hyeong Kim),배장환(Jang Hwan Bae),김동운(Dong Woon Kim),남기병(Gi Byoung Nam),조명찬(Myeong Chan Cho),정은환(Eun Hawn Jeong) 대한내과학회 1998 대한내과학회지 Vol.55 No.1
N/A Objectives: In the third trimester hypertensive pregnancies, we would like to evaluate effects of white coat hypertension, severity of hypertension and diurnal variation of blood pressure on the fetal outcome by using 24-hour ambulatory blood pressure monitoring. Methods: Hypertensives(n=50) and normotensives (n=14) in the third trimester of the pregnancy underwent 24-hour ambulatory blood pressure monitoring. We excluded hypertensives(n=5) who became pre-eclampsia patients. Hypertensives(n=45) were classified as white coat hypertensives(n=14, mean ambulatory blood pressure <139/87mmHg) and sustained hyprtensives(n=31). Sustained hypertensives(n=31) were divided as moderate to severe hypertensives(n=5, systolic blood pressure ≥160 mmHg or diastolic blood pressure ≥100mmHg ) and mild hypertensives(n=26). Sustained hypertensives were also divided into two grwps which had diurnal variation of blood pressure or not. To exclude effects of hypertension severity, effects of diurnal variation wane evaluated in hypertensives with similar mean arterial blood pressure. Gestational age, body weight, body weight for gestational age were used as parametars of the fetal outcome. Results : 1) The prevalence of white coat hypertension was 28%(14/50). 2) There were no significant differences in the fetal outcome between normotensives(n=14) and white coat hypertensives(n=14). 3) Body weight of fetus and body weight for gestational age in moderate to severe hypertensives(n=5) were less than those of mild hypertensives(n=26), but gestational age was not significantly different between two groups. 4) Body weight of fetus and body weight for gestational age in sustained hypertensives without diurnal variation(n=10) were less than those with diurnal variation(n=8), but gestational age was not significantly different between two groups. 5) All hypertensives who became pre-eclampsia (n=5) were severe hypertensives and had no diurnal variation of blood pressure. Conclusion: White coat hypertension in the third trimester was quite often and did not affect on the fetal outcome. The more severe hypertension and/or absence of diurnal variation of blood sure caused poor fetal outcome. Patients who became pre-eclampsia were severe hypertensives and had no diurnal variation of blood pressure. Ambulatory blood pressure monitoring may have several roles in the antenatal management of hypertenison.