혈액투석중인 만성신부전 환자의 사망률에 영향을 미치는 요인부석

김경석(K . S . Kim),김진구(J . G . Kim),우상태(S . T . Woo),서상렬(S . Y . Suh),김향(H . Kim),권영주(Y . J . Kwon),표희정(H . J . Pyo),김용섭(Y . S . Kim),차대룡(D . R . Cha),조원용(W . Y . Jo),김형규(H . K . Kim),김창수(C . S . Kim),박 대한내과학회 1998 대한내과학회지 Vol.54 No.3

N/A Background: Several factors have been influenced to mortality of patients with end-stage renal disease treated with hemodialysis. We performed this study to evaluate the factors influencing to mortality in chronic hemodialysis patients in eight hemodialysis centers. Method: We analyzed retrospectively the demographic characteristics, risk stratification, Kamofsky scale, regularly tested laboratory finding(CBC, Blood chemistry), hospitalization rate, and gross mortality among 150 patients from June, 1994 to June 1996. Results: 1) A total of 150 patients were enrolled, male 91 and female 59 and mean age was about 53 years. 43 patients had diabetes and 107 patients had nondiabetes. The mean duration of hemodialysis was 48.2±24.7 months(range, 9-123months), 2) 82 patients(54.7%) required hospitalization during the 2 year follow-up period and the most common cause of hospitalization was cardiovascular disease. 3) A total of 43 patients(28.7%) had been died during the 2 year follow-up period and the most common cause of death was cerebrovascular disease. 4) In univariate analysis, advancing age, Kamofsky scale(<80 points), diabetic nephropathy as the underlying cause of ESRD, comorbid illness, high risk group in risk stratification, total HD duration, HD length per week, low serum albumin and creatitine concentration were all associated with significantly increased risk of death. In multivariate analysis, diabetic nephropathy as the underlying cause of ESRD and low serum albumin concentration were more highly associated with death probability. Conclusion: We conclude that diabetic nephropathy as underlying cause of ESRD and serum albumin concentration are more important elements in determining patient mortality.

유지혈액투석 환자에 있어 영양상태와 염증지표의 관계에 대한 연구

한상엽(S. Y. Han),조상경(S. K. Jo),윤종우(J. W. Yoon),신진호(J. H. Shin),이소영(S. Y. Lee),차대룡(D. R. Cha),권영주(Y. J. Kwon),조원용(W. Y. Cho),표희정(H. J. Pyo),정태시(T. S. Jung) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.2

N/A Malnutrition is known to be an independent risk factor of morbidity and mortality in hemodialysis patients. The causes of malnutrition were obsucure. Several catabolic cytokines such as interleukin-1β(IL-1β), interleukin-6(IL-6), and tumar necrosis fac-tor-α(TNF-α) were reported to be elevated in hemo-dialysis patients with malnutrition, To evaluate the nutritrional status and relationship among cytokines IL-1β, TNF-α, and various parameters, we performed a cross-sectional study in maintenance hemodialysis patients who have undergone for six months at least. Patients who were taking steroid. showed any sign of infection, or had residual renal function were excluded from the study. Nutritional status was classified into well nourished(A), mild to moderate malnutrition(B), and severe malnutrition(C) by using subjective global assessment(SGA). Patients were divided into two groups (I: A, II: B and C) based on SGA. The level of IL-10, TNF-a were estimated by ELISA. Total patients were 23(M/F:15/8 mean age 52.0±1.56yrs). There were significant differences in weight changes for 6 months, CRP, and SGA between two groups based on the level of serum albumin(using 4.0g/dL as a cutoff value). Moreover, based on SGA, there were significant differences in age, BMI, CRP, and albumin between the group I and IL Serum albumin levels was directly correlated with transferrin(r=0.302, p=0.04), and was inversly correlated with age(r=-0.329, p=0.007). TNF- u was inversly correlated with Kt/Vueea(r=-0.291, p= 0.047), and directly correlated with the duration of maintenance hemodialysis(r=0,346, p=0.036), BMI(r-0.453, p<0.05). These data support the fact that albumin and CRP can be a good marker of nutritional status in maintenance hemodialysis patient. However cytokines and transferrin might not be related to nutritional status.

만성신부전증에서 혈청 CEA치에 관한 연구

이정상,신영태,정순일,고창순,김성권,표희정,권인순 대한핵의학회 1980 핵의학 분자영상 Vol.14 No.2

저자들은 1979년 3월부터 1980년 10월까지 서울대학교병원내과에 입원하여 만성신부전증으로 진단받고 혈액투석요법을 받지 않은 환자 15예, 혈액투석요법을 시행중인 환자 39예 및 신장이식술을 받고 신장능이 호전된 환자 23예에서 혈청 CEA치를 방사면역측정법으로 측정하여 정상대조군과 비교하여 다음과 같은 결과를 얻었다. 1) 정상 성인 65명의 혈청 CEA치의 범위는 1.0∼4.3 ng/ml이었으며 평균은 1.6±0.66 ng이었다. 2) 혈액투석요법을 시행치 않은 만성신부전증 환자 15예의 혈청 CEA치는 0.3∼8.3 ng/ml이었고 평균은 3.6±2.10 ng/ml로써 정상대조군에 비하여 유의하게 증가되어 있었다(p$lt;0.001). 3) 혈액투석요법으로 치료중인 만성신부전증 환자 39예의 혈청 CEA치는 0.7∼6.7 ng/ml로 평균이 3.0±1.52 ng/ml이며, 정상대조군에 비하여 유의하게 상승되어 있으나(p$lt;0.001), 혈액투석을 받지 않은 환자군과는 유의한 차이가 없었다. 4) 신이식 환자 23예의 혈청 CEA치의 분포는 1.8∼10.8 ng/ml이고 평균은 3.8±1.96 ng/ml로 역시 정상대조군에 비하여 유의하게 증가되어 있으나(p$lt;0.001), 만성신부전증 환자군과는 유의한 차이가 없었다. 5) 이상의 혈청 CEA치가 정상범위 이상으로 상승된 49명��환자중 이학적 소견이나 검사소견상 악성종양은 발견되지 않았다. The serum CEA levels were measured by radioimmunoassay technique in 15 patients with chronic renal failure, who were not treated with hemodialysis, in 39 patients under hemodialysis and in 23 patients who received renal transplantation. The results were compared with those in 65 normal adults and the following results were obtained. 1) Serum CEA concentrations in 65 normal adults were in the range of 1.0 to 4.3 ng/ml with a mean value of 1.6±0.66 ng/ml. 2) Serum CEA concentrations in 15 chronic renal failure patients who were not treated with hemodialysis, were in the range of 0.3 to 8.3 ng/ml with a mean value of 3.6±2.10 ng/m1 which was significantly higher than those of normal controls(P$lt;0.001). 3) Serum CEA concentrations in 39 chronic renal failure patients under hemodialysis were also much higher than normal controls(p$lt;0.001), but not significantly different from those of the patients who were not under hemodialysis(P$gt;0.05). 4) In 23 patients who received renal transplantation, serum CEA levels were snificantly higher than normal controls(P$lt;0.001), but not significantly different from those of chronic renal failure patients.

당뇨병에서의 혈장 Renin 활성에 관한 연구

이정상,이문호,김성권,최강원,표희정,박정식 대한핵의학회 1979 핵의학 분자영상 Vol.13 No.1

당뇨병에서의 고혈압 및 신합병증에 따른 Renin Angiotensin-Aldosterone계의 동태를 밝히기 위하여 40예의 당뇨병 환자에서 기저 및 furosemide 정주 2시간 후의 PRA를 측정하였다. 1) 40예의 당뇨병 환자는 신합병증과 고혈압의 유무에 따라 4군으로 분류하였으며, 임상적인 합병증이 없는 Ⅰ군에는 15명, 신합병증이 있는 Ⅱ군에는 7명, 신합병증과 고혈압이 같이 있는 Ⅲ군에는 8명, 고혈압만 있는 Ⅳ군에는 10명의 환자가 속하였다. 2) 각 군의 24시간 요중 Na배설량의 평균치 사이에는 유의한 차이가 없었다. 3) 기저 PRA치는 Ⅰ군이 1.53±1.09ng/ml/hr(Mean±S.D), Ⅱ군이 0.63±0.59ng/ml/hr, Ⅲ군이 0.79±0.62ng/ml/hr, Ⅳ군이 1.11±0.80ng/ml/hr로서 Ⅱ군과 Ⅲ군은 Ⅰ군에 비하여 유의하게 저하되어 있으나(P$lt;0.05), 다른 군들 간에는 유의한 차를 볼 수 없었다. 4) furosemide 정주 2시간 후의 PRA치는 Ⅰ군이 2.72±1.96ng/ml/hr, Ⅱ군이 0.92±0.78ng/ml/hr, Ⅲ군은 1.03±0.76ng/ml/hr, Ⅳ군은 1.73±1.39ng/ml/hr로써 Ⅰ군과 Ⅱ군사이에서만 유의한 차이를 보이고(P$lt;0.05), 다른 당뇨병 환자군 사이에서는 유의한 차를 볼 수 없었다. 5) furosemide 정주에 의한 Renin 분필 자극시험에 대한 반응도 Ⅱ군과 Ⅲ군에서는 둔화되어 있는 양상을 보이나, 시험대상도 적고하여 통계적 유의성에는 미치지 못하였다. 이상의 성적에서 신합병증이 있는 당뇨병에서는 혈장 Renin활성이 저하되며 furosemide 정주에 의한 Renin 분필자극시험에 대한 반응도 둔화됨을 알 수 있었다. 또한 당뇨병성 신합병증에 의한 고혈압에서도 혈장 Renin활성은 저하되는 경향을 보여서 이 경우의 고혈압은 Renin이외의 다른 요인이 작용할 것으로 보인다. To evaluate the renin-angiotensin-aldosterone system in diabetes mellitus, basal plasma renin activity(PRA) and its response to intravenous furosemide were determined in 40 diabetic subjects. The diabetics were divided into 4 groups according to the pressence of nephropathy and/or hypertension. Uncomplicated diabetics(Group I) were taken as control group and the results of the other groups were compared to this group. In diabetics viith nephropathy alone(Group Ⅱ), and with nephropathy and hypertension (Group Ⅲ), basal PRA values were 0.63±0.59ng/ml/hr., and 0.79±0.62ng/ml/hr., respectively, both significantly lower than control group. (1.53±1.09ng/ml/hr.). (P$lt;0.05) In both of the above groups, the responses to intravenous furosemide tended to be blunted. On the other hand, in diabetics, with hypertension only (Group Ⅳ), the basal and stimulated PRA were not significantly different from control. Above results suggests that nephropathy may be one of the factors which suppress renin activity in diabetes me.