신장 ; 혈액투석 환자에서 중심동맥 경직도와 대동맥 석회화의 연관성

정안덕 ( An Doc Jung ),김창성 ( Chang Seong Kim ),최준석 ( Joon Seok Choi ),배은희 ( Eun Hui Bae ),김계훈 ( Kye Hun Kim ),안영근 ( Young Keun Ahn ),김수완 ( Soo Wan Kim ) 대한내과학회 2011 대한내과학회지 Vol.81 No.2

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 고혈압치료 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), 당뇨유무(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. Background/Aims: Cardiovascular (CV) disease is the leading cause of death in patients with chronic kidney disease. It may berelated to nontraditional risk factors such as arterial stiffness (AS) and vascular calcification (VC). AS, as evaluated by pulse wavevelocity (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 weresignificantly 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)

40세 이하의 한국인에서 발생한 급성 심근경색증의 임상적 특성

조상철 ( Sang Cheol Cho ),정명호 ( Myung Ho Jeong ),김원 ( Weon Kim ),최옥자 ( Ok Ja Choi ),정안덕 ( An Doc Chung ),강원유 ( Won Yu Kang ),조용찬 ( Yong Chan Cho ),안영근 ( Young Keun Ahn ),김완 ( Wan Kim ) 대한내과학회 2008 대한내과학회지 Vol.74 No.5

목적: 우리나라에서 연령에 따른 급성심근경색증 환자의 동맥경화 위험인자와 기본적 특성, 관상동맥 조영술 소견 및 주요 심장사건 등에 대해 직접적으로 비교한 결과는 많지 않다. 방법: 1997년 6월부터 2006년 2월까지 급성심근경색증으로 관상동맥 조영술을 실시한 환자 중 연령이 40세 미만인 환자 108명을 I 군으로 하였고, 이와 비교된 70세 이상 환자 64명을 II 군으로 하였다. 기본 임상적 특성, 심장초음파, 관상동맥 조영술 및 주요 심장사건 발생 등에 관하여 비교분석 하였다. 주요심장사건은 사망, 표적혈관의 재협착, 급성심근경색증의 재발과 관상동맥 우회술 시행 등으로 정의하였다. 결과: 1) 두 군 모두에서 남성의 빈도가(I군 vs. II군: 94.6% vs. 56.1%) 많았으며, 특히 I 군에서 더 많았다(p<0.001). 2) 동맥경화의 위험인자는 I 군에서 흡연(78.7 vs. 46.9%, p<0.001)과 고지혈증(45.4 vs. 14.1%, p<0.001)이 많았고, II군에서 고혈압(23.1 vs. 40.6%, p=0.01)과 당뇨병(11.6 vs. 34.4%, p<0.001)이 많았다. 3) 심초음파의 좌심실 구혈율은 I군에서 높았다(55.1±14.1% vs. 50.5±14.1%, p=0.042). 4) 혈중 고감도 C반응단백(1.7±2.6 vs. 3.4±4.4 mg/L, p=0.015)과 homocysteine (11.5±7.0 vs. 15.3±9.7 μmol/L, p=0.029) 은 II 군에서 더 높았다. 5) 관상동맥 조영술에서 표적혈관의 경우 II군에서 우관상동맥이 높은 빈도를 보였으며(35.2% vs. 50.0%, p=0.021), 병변 형태의 분류에서 유의한 차이는 없었다. 병변혈관 수에서 단일혈관 질환이 I 군에서 많았으며 (78.7% vs. 59.4%, p=0.007), 시술 전 Thrombolysis in Myocardial Infarction (TIMI) 혈류등급은 I 군에서 grade II-III (58.3% vs. 42.2%, p=0.040)의 빈도가 높아 더 좋은 혈류등급을 보였다. 6) 86.6%의 환자에서 평균 2.5년의 임상추적이 이루어졌으며, 심장사망은 II 군에서 높았으나(2.1% vs. 15.1%, p=0.002), 전체 주요 심장사건 발생률은 양군 사이에 차이는 없었다. 결론: 한국에서 40세 이하에 발생한 급성심근경색증 환자는 남성, 흡연 및 고지혈증 등의 위험인자를 가지고 있었으며, 관상동맥 조영술에서 단일혈관 질환이 많았고, 추적관찰 결과 고령의 환자에 비해 심인성 사망은 적었다. Background/Aims: It is known that mortality increases with age for patients who suffer with acute myocardial infarction (AMI). Yet there isn`t much data on the clinical characteristics and long-term prognosis of young patients with AMI. Methods: We analyzed two groups of patients with AMI who underwent coronary angiogram: 108 patients younger than 40 years as group I and 64 patients over 70 years old as group II. We compared the baseline clinical characteristics, the echocardiographic and coronary angiographic findings, and the major adverse cardiac event (MACE). Results: Male gender (94.4% vs. 56.1%, respectively, p<0.001), smoking (78.7% vs. 46.9%, respectively, p<0.001) and hyperlipidemia (45.4% vs. 14.1%, respectively, p<0.001) were more frequent in group I, whereas hypertension (23.1% vs. 40.6%, respectively, p=0.015) and diabetes (11.6% vs. 34.4%, respectively, p<0.001) were more common in group II. The left ventricular ejection fraction (55.1±12.2% vs. 50.5±14.1%, respectively, p=0.042) was higher in group I. The serum levels of high sensitivity C-reactive protein (1.7±2.6 vs. 3.4±4.4 mg/L, respectively, p=0.015) and homocysteine (11.5±7.0 vs. 15.3±9.7 μg/L, respectively, p=0.029) were higher in group II. One vessel disease (78.7% vs. 59.4%, respectively, p=0.007) and good Thrombolysis In Myocardial Infarction (TIMI) flow (TIMI II-III, 58.3% vs. 41.2%, respectively, p=0.040) were more common in group 1. There were no differences between the two groups for the development of MACE during the 28±21 months of clinical follow-up, but cardiac death was lower in group I than in group II (2.1% vs. 15.4%, respectively, p=0.002). Conclusions: Male gender, smoking and hyperlipidemia were the major risk factors of Korean young AMI patients. In addition, single vessel disease and good TIMI flow were more frequent and cardiac death was less frequent in the younger AMI patients.(Korean J Med 74:515-522, 2008)

원발성 비후형 심근증에서 심근비후 형태에 따른 임상상의 차이

이명곤(Myung Kon Lee),박종수(Jong Su Park),안영근(Young Keun An),박주형(Ju Hyung Park),정명호(Myung Ho Jeong),조정관(Jeong Gwan Cho),박종춘(Jong Chun Park),강정채(Jung Chaee Kang),박옥규(Ock Kyu Park) 대한내과학회 1993 대한내과학회지 Vol.45 No.4

N/A Background; The idipathic hypertrophic cardiomyopathy(HCM) is characterized by inappropriate myocardial hypertrophy of unknown cause. It may presents a variety of clinical and morphologic features according to the site and extent of the hypertrophy. The widespread application of echocardiography has made it possible to diagnose HCM earlier and easier, even in asymptomatic patients. However, clinical reports on the relationship between the distribution of left ventricular hypertrophy (LVH) and the clinical features are few in Korea. Therefore, the present clinical stu4y was performed to characterize more completely the distribution of LVH and to determine whether different patterns of hypertrophy are of particular clinical significance. Methods: The clinical, electrocardiographic and echocardiographic features were reviewed in 32 patients with idipathic HCM of Chonnam National University Hospital from July 1983 to August 1992. Results: 1) There were 23 males and 9 females. The mean age was 45.4±16.5 ranging from 15 to 74 years. There were no significant difference in age distribution according to the patterns of LUH. 2) Based on M-mode and 2-dimensional echocardiographic findings. The 32 patients were divided into 2 groups; 16 patients in the obstructive HCM group and the other 16 patients in the non-obstructive HCM group. Among the 16 patients with non-obstructive HCM, there were 6 patients with asymmetric septal hypertrophy(septal HCM), 7 patients with apical hypertrophy (apical HCM), 3 patients with symmetric (concentric) hypertrophy (symmetric or concentric HCM). 3) The cardinal clinical symptoms were dyspnea (71.9%), chest pain (59.5%), palpitation(37.5%) and syncope (12.5%). There were no significant difference in the frequency of symptoms according to the patterns of LCH. 4) On chest X-ray examination, the enlargement of cardiac silhoutte (C/T ratiok≥0.55) was observed in 32% of the cases. There wedre 4 patients with C/T ratio ≥0.6, and all had obstructive HCM. 5) In conventional 12 leads electrocardiograms, abnormal electrocardiographic findings were obtained in 94% of the cases. Among them repolarization abnormalities and left ventricular hypertrophy were most common, occuring in 80.6% and 64.5%, respectively. This was followed by abnormal Q waves (37.5%), atrial fibrillation (29.0%) and giant T wave inversion (29.0%). Giant T wave inversion was significantly more common in patients with apical HCM than in any other patients. 6) On the M-mode echocardiograms, the ratio of left ventricular septal thickness to left ventricular posterior wall thickness (IVS/LVPW) was 1.58±0.36 in obstructive HCM, 1.55±0.08 in septal HCM, 1.05±0.14 in apical HCM, and 1.13±0.08 in symmetric HCM. 7) On the 2-dimensional echocardiograms, the ventricular septum and anterolateral free wall were significantly thicker compared to left ventricular posterior wall in patients with obstructive and septal HCM (p<0.001, p<0.01 respectively). The apical wall was significantly thicker compared to the other regions in patients with apical HCM. 8) Mital regurgitation was detected by Doppler echocardiography in 13 (40.6%) of the total 32 cases of HCM and especially in 11 (68.8%) of the 16 cases with obstructive HCM. 9) Continuous wave Doppler echocardiography of left ventricular outflow tract was performed in 10 patients with obstructive HCM and revealed a mean peak pressure gradient of 50.1±39.9mmHg (13~130mmHg) between the left ventricular (LV) mid cavity and the LV outflow tract. Conclusion: Clinical features are very similar in every pattterns of LVH. But the above results suggested that depending on the extent and distribution of LVH, the functional and morphologic features of HCM may differ considerably. It is still questionable whether identifiable patterns of hypertrophy are of clinical significance.

급성 하벽 심근 경색증 환자에서 우흉부 유도 심전도와 관동맥 조영술 소견

박종수(Jong Soo Park),이명곤(Myung Kon Lee),안영근(Young Keun An),박주형(Ju Hyung Park),정명호(Myung Ho Jeong),조정관(Jeong Gwan Cho),박종춘(Jong Chun Park),강정채(Jung Chaee Kang),박옥규(Ock Kyu Park) 대한내과학회 1993 대한내과학회지 Vol.45 No.3

N/A Background: The right ventricular infarction is frequently associated with acute inferior myocardial infarction. It is seldom diagnosed by the conventional 12 lead electrocardiogram (EKG). However, right precordial EKG has been proved highly sensitive and specific in diagnosing the right ventricular infarction. The right ventriculr infarction is said to be associated with proximal right coronary lesions. The present study was performed to evaluate the value of the right precordial EKG in predicting the proximal RCA lesion in acute inferior wall myocardial infarction. Methods: In order to observe the relation of the EKG change and coronary angiographic findings in the RV infarction, 40 patients (men 36, women 4, mean age 57±2.4 years) with an acute inferior myocardial infarction were examined. The right precordial electrocardiogram recorded with 10 hours after the onset of chest pain, and coronary angiogram were analysed. Results: 1) The mean amplitudes of r-waves were 1.4±0.9 mm in V3R and 1.2±0.8 mm in V4R. The mean amplitudes of s-waves were 6.6±3.6mm in V3R, 4.2±1.9 mm in V4R, 2.7±1.4 mm in V5R, 1.7±1.6mm in V6R. The mean r/s ratio in right precordial leads was less than 1. The configuration of T-wave was inverted in 40. 8% of the patients in V3R, 38.6% in V4R, 38.5% in V5R and 35.9% in V6R. 2) Of the 40 studied subjects, 22 were one-vessel disease, 14 two-vessel disease, 3 three-vessel disease and one normal coronary artery. 3) Twenty eight patients had ST segment elevation in V3R, V4R and/or V5R, in which 23 had right proximal coronary stenosis and 5 had right middle or distal coronary stenosis. Among twenty three patients who had proximal right coronary stenosis & ST segment elevation in V3R, V4R and/or V5R, 19 had single proximal right coronary stenosis, 4 had left anterior descending or left circumflex coronary stenosis coincidently, All five patients that had middle or distal right coronary stenosis and ST segment elevation in V3R, V4R and/or V5R had associated left anterior descending or left circumflex stenosis. 4) In the diagnosis of proximal right coronary stenosis, the sensitivity of ST segment elevation in V3R, V4R and/or V5R is 92%, the specificity is 83%, and the predictive accuracy is 82%. Conclusion: Above results suggested that right precordial lead electrocardiogram in acute inferior myocardial infarction is a good predictor of the proximal right coronary arterial stenosis.

급성 관상동맥 증후군 후 우울증의 예측인자

박상욱(Sang-Wook Park),배경열(Kyung-Yeol Bae),김선영(Seon-Young Kim),유준안(Joon-An Yoo),양수진(Su-Jin Yang),김성완(Sung-Wan Kim),김재민(Jae-Min Kim),신일선(Il-Seon Shin),홍영준(Young-Joon Hong),안영근(Young-Keun Ahn),정명호(Myung-Ho 대한생물치료정신의학회 2009 생물치료정신의학 Vol.15 No.2

Objectives: Depression after acute coronary artery syndrome(ACS) is common and associated with higher mortality, while little is known about predictors of the onset of depression. This study aimed to investigate the incidence and predictors of depression at the points of first hospitalization and 12 month after ACS. Methods: Eighty one patients with ACS were recruited from the heart center of a university hospital. Depression was categorized using Hamilton Depression Rating Scale(HAMD)>7. Data on sociodemographic characteristics (age, gender, education, marital state, religion, accommodation and occupation), severity of ACS(Global Registry of Acute Coronary Events risk score), disability(World Health Organization Disability Assessment Schedule Ⅱ-12), and personality(Big Five Inventory) were obtained. Results: Incident rates of depression were 25% and 23% at the first hospitalization and at 12 months after ACS, respectively. Predictors of depression were disability at the first hospitalization and neuroticism at 12 months after ACS. Conclusion: Depression was common after ACS in this sample. More intensive psychiatric care and intervention is needed for the high risk groups of depression.

The Stuies on the Influence of Antioxidants on the Toxicity of Polychlorinated Biphenyls(PCBs)(Ⅰ)

An, Young-keun,Kim, Sung-oh,Ock, Eun-seong 圓光大學校 1981 論文集 Vol.15 No.1

PCB의 毒性에 對한 抗酸化劑의 영향을 mice와 rats를 各各 7群으로 나누어 PCB 100ppm, 500ppm과 抗酸化劑로 vitamin C 500ppm과 vitamin E 150ppm을 各各 투여 12週間 사육한 결과 다음과 같은 結論을 얻었다. 1) 투여 한 PCB는 rats의 體重增加를 감소시키고 mice와 rats에서 liver weight/body weight 比를 증가시켰으나 mice에서는 體重增加의 감소보다 오히려 약간의 증가를 보였다. 2) PCB를 투여한 rats의 肝臟의 組織學的 所見으로 clear cytoplasm, vacuolation of hepatocytes, slight sinusoidal congestion, increased numbers of Kupffer cells, hydrophic degeneration이 보였으나 核의 變化는 없었다. PCB를 투여한 rats의 腎臟의 組織學的 所見으로는 약간의 renal papillary degeneration과 congestion이 보였다. 3) 抗酸化劑로 투여 한 vitamin C는 mice와 rats에서 PCB의 毒性에 아무 영향을 주지 못했다. 4) 抗酸化劑로 투여 한 vitamin E는 rats에서 PCB의 毒性인 體重增加의 감소, liver weight/body weight 比의 증가와 肝臟 腎臟의 組織學的 變化를 감소시켰다. The effects of antioxidants on the toxicity of PCBs were studied in 7 groups of mice and 7 groups of rats fed commercial stock diet added with PCBs and antioxidants, vitamin C and vitamin E for 12 weeks. The obtained results are as follows; 1) PCBs decreased the body weight gain in rats and increased the liver weight/body weight ratio in mice and rats, but did not decrease the body weight gain, rather increased very slightly in mice. 2) The liver of PCBs-dosed rats showed clear cytoplasm, vacuolation of hepatocytes, slight' sinusoidal' congestion, increased numbers of Kupffer cell, hydrophic degeneration but dit not show the nuclear changes. The kidney of PCBs-dosed rats showed some renal papillary degeneration and congestion. 3) Antioxidant, vitamin C did not have an influence on the toxicity of PCBs in mice and rats. 4) Antioxidant, vitamin E decreased the toxicity of PCBs, reduction of body weight gain and increase of liver weight/body weight ratio and morphological alterations of liver and kidney of rats The polychlorinated biphenyls(PCBs) have been used extensively for industrial purpose during the past 40 years. These compounds are extremely stable, not hydrolized by water, acid or alkali, and are able to withstand temperature up to 650℃ without disintergrading. These properties make them ideal for commercial usage and also enhance their resistance to degradation in the environment. Due to their extensive industrial use and their resistance to biological degradation, PCBs are one of the most widely dispersed contaminants of the environment. In our country a large amount of PCBs have been imported for industrial purpose until 1976 but now for these reason the import of PCBs is forbidden A wide range of PCBs are absorbed from intestinal mucosa of human and animals and these lipophilic compounds are not excreted at an appreciable rate prior to their metabolism to more polar compounds. For these delayed excretion some quantities of absorbed PCBs are deposited in fatty tissue, liver, kidney, brain etc. and cause the persistent toxic effects such as chloracne, reproductive dysfunction, gastrointestinal distubances, and altered liver function. In 1968 "Yusho" outbreak was produced by the ingestion of K rice oil contaminated with Kanechlor 400 in Fukuoka-Ken, Japan. Many results showed that PCBs act as growth promoting substance in pig, mouse and salmon whereas in mink, monkey, bird and rat PCBs act as growth impeding substance. The physiological reasons for these adverse effects of PCBs are not known. It is well known that PCBs increased the liver weight and the liver weight/body weight ratio arid activity of cytochrome P-450 and drug metabolizing enzymes. Although many studies on the toxicity of PCBs have been conducted, little information was reported regarding to the reduction or the elimination of the toxicity of PCBs. The peroxidation of fatty acid which may be released from the accumulated lipid caused by PCBs may give the damage to the liver. With this hi mind, before the study of the biochemical effects of antioxidants on the toxicity of PCBs we have designed this study to investigate whether anti-oxidants such as vitamin C and vitamin E could reduce or eliminate the common toxicity of PCBs in mice and rats.

종합 건강 진단 센터에서 진단된 고혈압, 고지혈증 및 관상동맥 질환의 빈도

박종철,정명호,여미원,주덕,나혜랑,양훈화,임정란,전해정,이숙자,김안자,김성화,안영근,조정관,박종춘,강정채 대한고혈압학회 1999 대한고혈압학회지 Vol.5 No.2