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유지 혈액투석 환자에서 영양실조-염증 점수와 동맥경화의 연관성
이현영 ( Hyun Young Lhee ),이규백 ( Kyu Beck Lee ),김향 ( Hyang Kim ),정찬희 ( Chan Hee Jung ),이은정 ( Eun Jung Rhee ),이원영 ( Won Young Lee ),김선우 ( Sun Woo Kim ),이영래 ( Young Rea Lee ),최경 ( Kyung Choi ) 대한내과학회 2006 대한내과학회지 Vol.71 No.6
목적: 유지 혈액투석 환자에서 영양실조-염증 복합 증후군(malnutrition-inflammation complex syndrome, MIC 증후군)은 흔하며, 나쁜 예후와 연관되어 있다. 그러나 MIC 증후군이 동맥경화의 위험인자로 작용하는지는 충분한 증거가 없다. 본 연구의 목적은 MIC 증후군을 정량적 평가하여 대동맥 석회화 정도(AAC) 및 맥파속도(PWV)와 같은 동맥경화 지표와 연관성이 있는지 알아보고자 하였다. 방법: 강북삼성병원에서 유지 혈액투석 중인 80명(남자:여자=50:30, 평균연령 58±14세)의 환자를 대상으로 하였다. 주관적 총체적 평가법(SGA), 혈청학 검사, nPNA에 기초하여 영양상태를 평가하였다 염증 지표로서 C-reactive protein (CHP)을 측정하였다. MIC 증후군의 정량적 평가를 위해 영양실조 염증 점수(Malnutrition-Inflammation Score, MIS)를 구하였다. 동맥경화 정도를 측정하기 위하여 요추 측부 단순촬영을 시행하여 AAC를 평가하였고, 상완-발목 PWV(baPWV)를 측정하였다. 결과: 영양실조군에서 정상영양군보다 MIS가 높았다(8.7±3.6 vs. 4.0±1.8, p=0.001). 염증군(CRP가 3 mg/L 이상)에서 정상군보다 MIS가 높았다(7.6±4.6 vs. 5.7±3.3, p=0.045). MIS는 동맥경화도의 지표인 AAC 지수(r=0.157, p=0.191) 및 baPWV (r=0.144, p=0.323)외 유의한 상관관계를 보이지 않았다. 결론: 본 연구에서는 MIS는 영양실조 염증반응을 잘 반영하여, MIC 증후군의 지표로 사용할 수 있다. MIS와 동맥경화 지표로서 AAC 지수 및 baPWV와 유의한 상관관계를 보이지 않았다. 혈액투석 환자에서 영양실조, 염증 및 동맥경화를 쉽고, 정확히 평가하는 지표개발이 필요하며, MIC 증후군을 치료의 목표로서 치료에 따른 동맥경화와 사망률에 대한 연구를 하여야 할 것으로 생각한다. Background: Malnutrition-inflammation complex syndrome (MICS) is common in maintenance hemodialysis (MHD) patients and may be related to a poor outcome. However, there is little evidence showing MICS to be a risk factor for all1erosclerosis. The aim of this study was to determine if MICS is associated will, the atherosclerotic markers such as abdominal aortic calcification (AAC) and pulse wave velocity (PWV) in MHD patients. Methods: Eighty MHD patients were selected in Kangbuk Samsung Hospital (male:female=50:30, age 58±14 years). The nutritional status was assessed by the Subjective Global Assessment (SGA), biochemical measurement and the normalized protein equivalent of the total nitrogen appearance (nPNA). The presence of inflammatory reaction was assessed by the C-reactive protein (CRP). The malnutrition-Inflammation Score (MIS) was used to assess MICS. A lateral lumbar radiogram was used to evaluate the AAC index. Brachial-ankle (ba) PWV using automatic device was performed. Results: Malnourished patients had a higher MIS than the well nourished patients (8.7±3.6 vs. 4.0±1.8, p<0.001). Patients with inflammation (CRP3 mg/L) showed a higher MIS than patients without inflammation (7.6±4.6 vs. 5.7±3.3, p=0.045). There was no correlation between the MIS and the AAC index (r=0.157 p=0.191) and baPWV (r=0.144, p=0.323). Conclusion: These results suggest that the MIS is a useful marker of MICS in MHD patients. However, the MIS was not directly related to the AAC index and baPWV. This report highlights the importance of assessing the MICS and atherosclerosis in MHD patients. (Korean J Med 71:635-645, 2006)
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김형규,권영주,박상은,차대룡,신진호,조원용,김향,이규백,표희정,이영래,조상경,김용섭,서상열 대한신장학회 1999 Kidney Research and Clinical Practice Vol.18 No.5
Autosomal dominant polycystic kidney disease (ADPKD) is one of most common hereditary disorders that is potentially fatal. To elucidate clinical and genetic characteristics of ADPKD in Korea, 166 patients were analyzed retrospectively. The results were as follows ; 1) The male-to-female ratio was 83: 83, and age of patients was 4813(meanSD) years. 6496 of patients have a family history of the ADPKD. 2) Most common symptom was flank and abdominal pain. In urinalysis, proteinuria(42%), hematuria(18%) were found. Other organ involvement included hepatic cysts(58%), pancreatic cysts(8%) and splenic cyst(296). 3) The age at diagnosis was 44% 12 years. Hypertension was observed in 65%, the age of detection was 45% 11 years. Azotemia was observed in 36%, the age of detection was 52±11 years. 4) Echocardiography showed left ventricular hypertrophy 5896(19/33), valve regurgitation 1596(5/33) and mitral valve prolapse 3%(1/33). Cerebrovascular events occurred in 14 patients(8.4%), and 6 patients confirmed cerebral aneurysm rupture. 5) 29 patients(17%) reached end stage renal failure(ESRD), the age was 53±10 years. The provability of being alive and not having ESRD was 88% by age 50, 76% by age 58, and 48% by age 65. Sex and hepatic cyst were not associated significantly with the course of renal function(p$gt;0.05). 6) 15 patients(9%) died, the age of death was 55±12 years. 6 patients died after reaching ESRD. The cause of death were was cancer(4), cerebrovascular event(3), cessation of dialysis(2), sudden death (2), liver cirrhosis(1), sepsis(1), suicide(1) and unknown(1). Results of our study revealed the complications of ADPKD in Korea, hypertension 6596, ESRD 17% and cerebrovascular event 8%. Functional survival was 88M by age 50, 76% by age 58, and 48M by age 65. The extrarenal manifestations are more important contributors to mortality than renal manifestations of ADPKD.
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