말기 신부전 환자에서 좌심실 비대에 대한 호모시스테인과 심장트로포닌-1의 상관관계에 대한 연구 = Correlationship between Homocysteine and Cardiac Troponin-I with Left Ventricular Hypertrophy in End-Stage Renal Disease Patients

국문 초록 (Abstract)

배 경:심혈관계 질환은 말기 신부전증으로 신대체 요법을 시행받는 환자의 가장 흔한 사망원인이며 좌심실 비대는 심혈관계 합병증 및 사망률과 이환율을 결정하는 독립적 위험 인자로 알려져 있다. 본 연구에서는 혈액투석과 복막투석 환자들을 대상으로 호모시스테인과 심장 트로포닌-I를 병합 측정함으로서 좌심실 비대와 상관관계를 밝혀 말기 신부전증 환자의 좌심실 비대에 대한 위험인자를 밝히고자 하였다.
방 법:조선대학교 의과대학 부속병원 신장내과에서 6개월 이상 정기적으로 혈액투석을 시행하고 있는 환자 (58명)와 지속성 외래 복막투석을 시행하고 있는 환자 (32명)를 대상으로 하여 호모시스테인, 심장 트로포닌을 포함한 일반 혈액검사와 심초음파 검사를 실시하였다.
결 과:전체 환자군은 총 90명으로서 이 중 고혈압 환자 82명, 당뇨 환자 32명, 허혈성 심질환 환자 42명을 포함하였다. 전체 환자의 성별은 남성 44명, 여성 46명이었으며, 평균 연령은 52.2±12.46세, 평균 투석기간은 28.4±23.40개월이었다. 원인 질환은 당뇨병성 신병증 32명 (36%), 만성 신장염 29명 (32%), 고혈압성 신증 26명 (29%), 다낭성신증 2명 (2%) 그리고 원인이 불분명한 경우가 1명 (1%)이었다. 좌심실 비대는 76명 (84%)에서 관찰되었으며 좌심실 비대가 없는 군에 비해 나이 (52.8±11.87세 vs 43.6±12.68세, p<0.05), 호모시스테인 (18.58 µmol/L [13.06-21.86 µmol/L] vs 13.12 µmol/L [11.78-13.47], p<0.01), 트로포닌-I (0.1 ng/mL, [0-0.6 ng/mL] vs 0 ng/mL, [0-0.01], p<0.05) 그리고 CRP (2.42±3.54 mg/dL vs 0.56±0.37 mg/dL, p<0.05)는 유의하게 높았다. 좌심실 비대의 위험인자에 대한 다중 분석에서 각각의 위험인자들을 보정시 트로포닌-I와 호모시스테인이 동시 상승시 좌심실 비대에 대한 위험도가 2.91배 상승함을 관찰할 수 있었다 (Odds ratio 2.91, 95% CI 1.14-7.42, p= 0.026). 좌심실 질량지수는 투석 환자군에서 혈중 호모시스테인 (r=0.507, p<0.01), 심장 트로포닌-I (r=0.339, p<0.01) 그리고 CRP (r=0.403, p<0.05)와는 통계적으로 유의한 양의 상관관계를 가졌다.

다국어 초록 (Multilingual Abstract)

Background:Cardiovascular disease is the main cause of death in chronic renal failure patients. Left ventricular hypertrophy (LVH) is an independent risk factor for mortality of patients in ESRD and hemoglobin (Hb), hypercholesterolemia and CRP as associated factors for LVH. This study was conducted to determine weather the total homocysteine and cardiac troponin in ESRD patients is related to the LVH as the independent mortality factor of ESRD.
Methods:We assessed the baseline disease status and laboratory variables including total homocysteine and cardiac troponin in 90 patients (58 hemodialysis and 32 peritoneal dialysis). Also, we analyzed the left ventricular mass index (LVMI) and ejection fraction(EF) on echocardiography.
Results:The causes of renal disease patients were 32 cases (36%) of diabetic nephropathy, 29 cases (32%) of chronic glomerulonephritis, 26 cases (29%) of hypertensive nephropathy, 2 cases (2%) of polycystic kidney disease and 1 case (1%) of unknown cause. Mean age of patients (male/female: 44/46) was 52.2±12.46 years and duration of dialysis was 28.4±23.40 months. The prevalence of LVH was 76 cases (84%). The age (52.8±11.87 years vs 43.6±12.68 years, p<0.05), mean homocysteine levels (18.58 µmol/L, [13.06-21.86 µmol/L] vs 13.12 µmol/L, [11.78-13.47 µmol/L], p<0.01), cardiac troponin-I concentrations (0.1 ng/mL, [0-0.6 ng/mL] vs 0 ng/mL, [0-0.01 ng/mL], p<0.05) and CRP (2.42±3.54 mg/dL vs 0.56±0.37 mg/dL, p<0.05) were higher on LVH patients than normal LV mass patients. In a multiple logistic regression analysis, including age, duration of dialysis, mode of dialysis, diabetes, hypertension, cTn-I, homocysteine and CRP, both elevation of cTn-I and homocysteine were associated with a 2.91 folds increase in the incident risk of LVH (Odds ratio 2.91, 95% CI 1.14-7.42, p=0.026). LVMI positively correlated with homocysteine (r=0.507, p<0.01), cardiac troponin-I (r=0.339, p<0.01) and CRP (r=0.403, p<0.05).
Conclusion:High levels of homocysteine and cardiac troponin-I appear together with increased left ventricular mass in patients with ESRD. Regular study of homocysteine, cardiac trophonin-I and CRP levels on ESRD patients will be predictors of LVH and useful markers on prevention of cardiovascular complication.

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