http://chineseinput.net/에서 pinyin(병음)방식으로 중국어를 변환할 수 있습니다.
변환된 중국어를 복사하여 사용하시면 됩니다.
본태성 고혈압 환자와 만성신부전증 환자에서 심초음파를 이용한 좌심실 비대에 대한 연구
김동일(Dong Il Kim),송종훈(Jong Hoon Song),임상욱(Sang Wook Im),박성곤(Sung Gon Park),정은미(En Mee Chung),차동훈(Dong Hoon Cha),박필원(Pil Weon Park),안재형(Jae Hyung Ahn) 대한내과학회 1998 대한내과학회지 Vol.55 No.6
N/A Objectives: Left ventricular hypertrophy(LVH) is one of the most common echocardiographic findings and an important prognostic factor for cardiovascular mortality in hypertensives and chronic renal failure patients. To evaluate the prevalence and the types of LVH, and left ventricular systolic and diastolic functions as worsening of renal function, and to elucidate the risk factors for LVH, we performed this study retrospectively in normal populations, hypertensives, and renal failure with or without hemodialysis. Methods and Subjects: We recruited the study population among the patients who had taken echocardiography at Pun-Dang CHA Hospital from July, 1995 to June, 1997. They are consisted of 54 patients for normal control, 53 patients of hypertensives, 31 patients of mild renal failure with less than 4.5 mg/dl of serum creatinine(Group I), 29 patients of moderate renal failure with more than 4.5 mg/dl of serum creatinine(Group II), and 47 patients of end stage renal disease with hemodialysis(Group III). The echocardiography was performed with all standard strategies including 2 dimension, M mode, and Doppler signals. Results: 1) Among the baseline characteristics, the body mass index only significantly increased in hypertensives compared with group II and III. 2) The prevalences of LVH in each groups were 5.6% in control group, 49.1% in hypertensives, 83.8% in group I, 89.7% in group II, and 100% in group III respectively. And the pevalences of concentric LVH were 5.6%, 43.3%, 41.9%, 34.5%, and 25.5% and those of the eccentric hypertrophy were 0.0%, 5.7%, 41.9%, 55.2%, and 74.5% respectively. The prevalence of eccentric hypertrophy increased according to deterioration of renal function. 3) The left ventricular mass index was significantly higher in hypertensives, Group I, Group U, and Group III than normal control and the left ventricular volume index was greater in all renal failure patients compared with controls and hypertensives. 4) In pre-hemodialysis renal failure patients, the types of LVH were consisted of 8 of normal heart(Group A), 23 of concentric LVH(Group H), and 29 of eccentric LVH(Group C). The systolic blood pressure and mean arterial pressure were significantly higher in group C than group A but there was no significant difference between group C and B. The RRC volume was significantly decreased in group B and C compared with group A. The echocardiographic end diastolic interventricular septal thickness and posterior wall thickness were significantly thicker in group B than others but end diastolic LV dimension, LV mass index, and LV volume index were significantly increased in group C than group B and A. The LV ejection fraction and fractional shortening as markers of LV systolic function in group C revealed the lowest level among three groups. The E velocity among the Doppler study profiles was significantly higher in group C than others. 5) In hemodialysis group, all the patients had any types of LV hypertrophic changes. The concentric LVH group(group B) had significantly higher systolic blood pressure and mean arterial pressure than eccentric LVH(group C) but there was no difference in diastolic blood pressure between two groups. The echocardiographic interventricular septum and posterior wall were thicker in group B than group C hut end diastolic LV dimension and LV volume were significantly higher in group C than group B. 6) The I.V mass index in pre-hemodialysis group had positive relationship with blood pressure and serum urea nitrogen level and the LV volume index was positively correlated with systolic blood pressure and mean blood pressure. 7) The LV mass index in hemodialysis group had positive relationship with age and systolic blood pressure and LV volume index was positively correlated with serum urea nitrogen level but negatively correlated with blood pressure. Conclusion: The prevalence of LVH was much higher in renal failure group than hypertenssives and the proportion of eccentric LVH was
새롭게 진단된 제 2 형 당뇨병 환자에서의 좌심실 이완기 기능 장애
차영수(Young Soo Cha),최홍엽(Hong Yup Choi),박진경(Jin Kyoung Park),이준(Jun Lee),임상욱(Sang Wook Lim),차동훈(Dong Hoon Cha),홍은경(Eun Kyoung Hong),박석원(Seok Won Park),김유리(Yu Lee Kim),조용욱(Yong Wook Cho),이상종(Sang Jong Le 대한내과학회 2002 대한내과학회지 Vol.62 No.4
목적 : 심부전증은 당뇨병 환자에서의 중요한 사망 원인이며 자율신경병증, 고인슐린 혈증, 고지방 혈증 등에 의해 유발될 수 있는 좌심실 이완기 기능 장애는 심부전증의 위험 요인으로 알려져 있다. 또한 유병 기간이 1년 이내인 제2형 당뇨병 환자에서도 이러한 변화가 있다는 보고가 있다. 이에 저자들은 처음 제2형 당뇨병을 진단 받은 환자를 대상으로 심초음파를 시행하여 좌심실 이완기 기능 장애 여부를 평가하였다. 방법 : 1996년 12월부터 1998년 6월까지 분당 차병원에 내원하여 처음으로 제2형 당뇨병을 진단 받은 환자들을 대상으로 하였다 (n=20, 당뇨병 환자군). 대상 환자들은 어떠한 치료도 받지 않은 상태에서 심초음파를 시행하였다. 대조군은 분당 차병원 건강 검진에 내원한 환자 중 아무런 질환이 없는 20명의 환자를 대상으로 하여 당뇨병 환자군과 같은 방법으로 심초음파를 시행하였다. 모든 대상 환자들의 혈압, 심박수, 혈중 콜레스테롤, 중성지방, 고밀도 지단백, 저밀도 지단백을 측정하였다. 결과 : 연령, 혈압, 심박수, 혈중 콜레스테롤, 중성지방, 고밀도 지단백, 저밀도 지단백 등의 임상적 특징은 양군간에 유의한 차이를 보이지 않았다. 심초음파 검사 결과에서 심구혈율, 좌심실 질량 지표, 좌심실 이완기말 직경도 양군간에 유의한 차이를 보이지 않았다. 그러나 E/A ratio는 당뇨병 환자군에서 1.06±0.28로 대조군의 1.60±0.27에 비해 유의하게 감소되어 있었으며 (p<0.01) 등용성 이완 시간도 당뇨병 환자군과 대조군이 각각 90.8±18.7 ms, 75.0±15.2 ms로 당뇨병 환자군에서 유의하게 증가되어 있었다 (p<0.01). 마지막으로 감속 기간은 양군간에 유의한 차이를 보이지 않았다. 결론 : 제2형 당뇨병 환자에서 진단 당시에 자율신경병증, 고지혈증, 고인슐린 혈증에 의한 좌심실 질량의 증가에 선행하여 좌심실 이완기 기능의 장애가 나타날 수 있다고 생각되므로 당뇨병 환자에서 동반될 수 있는 당뇨병성 심근증은 당뇨병의 초기부터 특별한 관심과 추적 관찰이 필요하다고 생각된다. Background : Heart failure is one of the major cause of premature mortality and morbidity in diabetes mellitus. It has been well recognized that left ventricular diastolic dysfunction caused by autonomic neuropathy, hyperinsulinemia, hyperlipidemia might be a preceding underlying mechanism of heart failure in diabetes. Also, an impairment of diastolic function in early diabetic patients has been reported in some literature. So, we evaluated the diastolic function in newly diagnosed diabetics with echocardiography. Methods : All patients with newly diagnosed NIDDM in Pundang Cha general hospital from December 1996 to June 1998 were enrolled (n=20). The 20 healthy volunteers comparable for age, sex, body surface area were enrolled as a control group. The echocardiography was performed in all patients before any treatment. Blood pressure, pulse rate, fasting and postprandial sugar and insulin level, serum total cholesterol, triglyceride, HDL-cholesterol, LDL-cholesterol were also checked in all patients. Results : There were no significant difference in blood pressure, pulse rate, total cholesterol, triglyceride, HDL-cholesterol and LDL-cholesterol level between both groups. E and A ratio of mitral inflow and peak diastolic velocity of pulmonary vein flow were significantly decreased in NIDDM group compared with control group (p<0.01). But there were no significant difference in left ventricular mass index, isovolumic relaxation time, deceleration time and peak atrial reversal velocity. Conclusion : This study demonstrates that an impairment of left ventricular diastolic function occurs early in the NIDDM and investigation of diastolic function should be performed in the clinical evaluation of early diabetic patients.(Korean J Med 62:422-429, 2002)