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사람면역결핍바이러스 감염 환자의 폐동맥 고혈압 발생빈도 및 임상양상
김미현 ( Mi Hyun Kim ),장혁재 ( Hyuk Jae Chang ),양영준 ( Young June Yang ),홍지영 ( Ji Young Hong ),강민경 ( Min Kyoung Kang ),양우인 ( Woo In Yang ),심지영 ( Chi Young Shim ),하종원 ( Jong Won Ha ),정남식 ( Nam Sik Chung ),신소 대한내과학회 2011 대한내과학회지 Vol.81 No.6
Background/Aims: Human immunodeficiency virus-associated pulmonary arterial hypertension (HIV-PAH) is a complication of HIV infection. Due to improvements in HIV survival rates following the introduction of highly active antiretroviral therapy, HIV-PAH has become an important cause of HIV-related morbidity. Thus, the objective of this study was to explore the prevalence and characteristics of HIV-PAH. Methods: Ninety-two patients were enrolled in the study from March to August 2010. We investigated clinical characteristics and performed echocardiography. HIV-PAH was defined as having a mean pulmonary arterial pressure (mPAP)≥25 mmHg based on Mahan`s equation, without lung disease or heart disease. The HIV-PAH-possible group was defined as having a tricuspid regurgitation velocity (TRV) of 2.9-3.4 m/s and a pulmonary arterial systolic pressure (PASP) of 37-50 mmHg. Results: Fifteen patients (16.3%) met the criteria of HIV-PAH based on mPAP. With respect to TRV, six patients met the criteria of the HIV-PAH-possible group. Based on the criteria of mPAP, the duration of HIV infection was not different with or without HIV-PAH. HIV RNA titers and CD4 T cell counts tended to be higher in HIV-PAH patients (8,607±11 vs. 1,067±64 copies/mL, p=0.371; 471±148 vs. 499±252 cells/mm3, p=0.680, respectively). Echocardiographic indices of the right ventricle were significantly deteriorated in the HIV-PAH group as compared with the non-HIV-PAH group (TASPE: 20.52 vs. 23.2, p=0.001; Tei index: 0.42 vs. 0.39, p=0.037). In a multivariate regression analysis, HIV activity factors (HIV duration, HIV RNA titer, and CD4 cell count) were not associated with echocardiographic indices of PAH (mPAP, PASP, and pulmonary vascular resistance). Conclusions: In this study, the prevalence of HIV-PAH was comparable to that of previous studies. (Korean J Med 2011; 81:729-739)
정상 심기능을 보이는 노인 환자에서 정형외과 수술 전 NT-proBNP의 역할
고은정 ( Eun Jung Ko ),문재연 ( Jae Youn Moon ),임영민 ( Yeong Min Lim ),홍원정 ( Won Jung Hong ),신석표 ( Suk Pyo Shin ),김상훈 ( Sang Hoon Kim ),양우인 ( Woo In Yang ),성정훈 ( Jung Hoon Sung ),김인재 ( In Jai Kim ),임상욱 ( San 대한내과학회 2014 대한내과학회지 Vol.87 No.3
Background/Aims: Preoperative N-terminal pro-brain natriuretic peptide (NT-proBNP) is a useful predictor of postoperative cardiovascular complications. The present study investigated whether blood NT-proBNP values are suitable for predicting postoperative cardiovascular complications after non-cardiac surgery in elderly patients showing normal left ventricular (LV) function on preoperative echocardiograms. Methods: This study was performed by analyzing the medical records of elderly patients referred to the cardiology department for the purpose of assessing their cardiac function before orthopedic surgery. Of the patients who underwent echocardiography and NT- proBNP assessment simultaneously, 275 patients aged ≥ 70 years and with an LV ejection fraction of ≥ 55% were included in the study. Results: Major adverse cardiac and cerebrovascular events (MACCEs) occurred in 33 (12%) of the 275 patients, and the NT-proBNP concentration was higher in patients with complications than in those without complications (1,904.20 ± 2,300.23 vs. 530.58 ± 882.27 pg/mL, p < 0.01). The ROC area under the curve was 0.756 (95% confidence interval 0.701-0.805, p < 0.001) with an optimal cutoff of 416.3 pg/mL (69.7% sensitivity, 67.36% specificity). A multivariate analysis showed that a preoperative age of > 80 years (odds ratio, 2.313; p = 0.047) and an increased blood NT-proBNP concentration (odds ratio, 3.189; p = 0.009) were independent risk factors for the prediction of MACCEs. Conclusions: Although elderly patients scheduled to undergo non-cardiac surgery may show normal LV systolic function on echocardiography, measurement of their preoperative blood NT-proBNP concentration is useful for predicting MACCEs occurring after non-cardiac surgery. (Korean J Med 2014;87:302-310)