혈액투석 중인 말기 신부전증 환자에서 관상동맥혈관 석회화와 혈청 Osteoprotegerin 및 Fetuin-A 농도의 상관관계 = Serum osteoprotegerin and fetuin-A Level is associated with coronary artery calcification score in the patients with end-stage renal disease

국문 초록 (Abstract)

목적: 투석을 받고 있는 말기 신부전증 환자에서 관상동맥혈관 석회화 점수(coronary artery calcification score, CACs)와 혈청 OPG 농도 및 혈청 fetuin-A 농도의 상관관계를 알아보았다. 방법: 51명의 말기 신부전증 환자를 대상으로 MSCT를 촬영하여 CACs를 구하였으며, 혈청 OPG 농도와 fetuin-A 농도를 측정하였다. 모든 환자에서 체중, 신장, 혈압을 측정하였으며 심혈관 질환 병력과 투석기간을 조사하였다. 환자의 혈액을 채취하여 hs-CRP, 혈청 인, 혈청 CaxP, 혈청 지질 농도를 측정하였다. 결과: 대상 환자에서 혈청 OPG 농도의 평균값은 3,561±1,160 pg/mL, fetuin-A 농도의 평균값은 28.5±4.1 mg/dL이었다. 대상군의 연령, 성별, 체질량지수 (BMI), 흡연력, 당뇨병 유무를 보정하였을 때, 투석기간(p=0.0225), hs-CRP (p=0.0392), 혈청 인(p=0.0341), Ca x P(p=0.0434), 혈청 OPG 농도(p=0.0026), LDL 콜레스테롤(p=0.0438)이 관상동맥혈관 석회화 점수와 유의한 양의 상관관계를 나타내었다. 다변량 회귀분석에서는 혈청 OPG 농도(p<0.0001)와 혈청 인 농도(p=0.0003)가 CACs에 유의한 독립변수로 나타났다. CACs에 따라 3군으로 분류하여 비교한 결과, 혈청 OPG 농도는 CACs가 400 이상인 중증인 군에서 최소 또는 경미한 군 또는 중등도의 군과 비교하여 유의하게 높게 나타났으며 혈청 fetuin-A 농도는 CACs가 400 이상인 군에서 최소 또는 경미한 군과 비교하여 유의하게 낮게 나타났다. 결론: 유지 혈액투석을 받고 있는 말기 신부전증 환자에서 관상동맥혈관 석회화는 무기 인 대사의 장애, 혈청 OPG 농도의 증가와 밀접한 상관관계가 있었으며 혈청 fetuin-A 농도는 특히 관상동맥혈관 석회화가 심한 경우 저하되어 있음을 알 수 있었다.

다국어 초록 (Multilingual Abstract)

Background: Coronary artery calcification is frequently seen in hemodialysis patients. The development and progression of coronary artery calcification is similar to osteogenesis, and a naturally occurring serum inhibitor of calcification may be involved. The aim of this study was to evaluate the relationship between coronary artery calcification, bone remodeling related factor, serum osteoprotegerin (OPG), calcification inhibitor and the serum fetuin-A levels in hemodialysis patients. Methods: A total of 51 hemodialysis patient were assessed for their coronary artery calcium (CAC) scores with using multirow spiral computed tomography and measuring the serum OPG level, the serum fetuin-A level, the biochemical markers of inflammation, the lipid profile and the mineral metabolism. Results: The mean serum OPG level was 3,561±1,160 pg/mL and the mean serum fetuin-A level was 28.5±4.1 mg/dL. The CAC scores were significantly correlated with the duration of dialysis (p=0.0225), hs-CRP (p=0.0392), serum phosphate (p=0.0341), Ca x P (p=0.0434), the serum OPG level (p=0.0026) and LDL-cholesterol (p=0.0438), after adjusting for age, gender, BMI, smoking history and the presence of diabetes. Multiple regression analysis showed that the CAC scores were significantly associated with the serum OPG level (p<0.0001) and the serum phosphate level (p=0.0003). The subgroup of the patients with a CAC score greater than 400 (the severe CAC group) had significantly higher OPG levels and lower fetuin-A levels than the groups of the patients with lower CAC scores. Conclusions: Our data suggest that the CAC scores in the patients undergoing hemodialysis were related with higher serum OPG and higher serum phosphate levels. The serum fetuin-A level was significantly lower in the patients with severe coronary artery calcification. (Korean J Med 72:451-458, 2007)

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