成人男性における健康體力水準の評價に關する硏究

국문 초록 (Abstract)

본 연구에서는 "successful aging", "healthy aging"을 위해서는, 무엇보다 도 자신의 체력수준을 파악하는 것과 일정한 체력수준을 유지하는 것이 중요 하다라는 전제 하에, "종합적인 체력수준", "건강체력수준"을 평가하기 위한 하나의 지표를 구축함과 동시에, 건강체력수준이 다른 집단간의 횡단적 비교 와 운동 습관에 따른 종단적 추적을 통해서 그 지표의 타당성 및 유용성을 검토하는 것을 목적으로 하였다. 구체적인 검토과제는, 1) 성인 남성의 체력수준의 종합적인 평가방법을 확 립하는 것, 2) 체력을 건강관련체력과 기능관련체력으로 나누는 것에 대한 합 리성을 검토하고, 체력연령추정식을 작성하는 것, 3) 작성한 체력연령(건강 관련체력연령) 추정식이 건강도가 다른 복수집단 간의 변별에 활용가능한 가 를 평가하는 것, 4) life style의 개선 (운동의 습관화)에 따른 건강관련체력 연령의 종단적변화를 조사하는 것, 5) 체력연령(건강관련체력연령) 산출의 간 이화에 대한 검토이다. 이와같은 일련의 과제를 검토한 결과, 아래와 같은 지견을 얻었다. 1. 연령의 증가에 따라 현저하게 저하하는 행동체력(전신지구성, 근력, 유 연성, 민첩성, 순발력, 평형성)의 각 측정치로부터 성인남성의 종합적인 체력 수준을 파악할 수가 있고, 체력연령은 다음 추정식에 의해 평가할 수 있다. PFA=_15. 3PFS+48. 0+Z, PFS=-0. 016X₁-0. 008X₂-0. 017X₃-0. 017X₄-0. 024X5-0. 020X6-0. 037X7-0. 021 X8+4. 92 Z=0. 12Age-5. 82. 작성한 체력연령추정식의 적용가능성을 검토한 결과, 추정식 작성에 이 용하지 않은 다른 일반군에게도 유사한 결과를 얻었으므로, 교차타당성(Cross -Validity)이 높음이 증명되었다. 그리고, 일반군과 유질환군, 일반군과 운 동군의 체력수준이 분명하게 식별됨으로써 체력수준 평가 지표로서의 유용성 이 시사되었다.

다국어 초록 (Multilingual Abstract)

Thesis by Mitt Sun Park, 1995, Karolinska Institute, Division of Renal Medicine and Division of Baxter Novum, Department of Clinical Sciences, Huddinge University Hospital, S-141 86 Huddinge, Sweden This study was undertaken to characterize the effect of various osmotic agents on peritoneal transport characteristics (I, III), to assess the numeral values of the convective transport parameter (sieving coefficient) for small solutes (IV) and the effect of acidity in dialysis solution
on the peritoneal transport characteristics (V). The study was initially perfortned in CAPD patients. To evaluate various aspects of peritoneal uansport characteristics which are not easily accessible in clinical studies, an experimental model of peritoneal dialysis in rat was initiated (II). The major findings are: I. Amino acid-based dialysis solutions have a similar effect on ulnatiltration compared with corresponding glucose-based conventional dialysis solutions. The absorption of 72-78 % of instilled amino acids was more than sufficient to compensate for the reported daily loss of amino acids during peritoneal dialysis with glucose containing solutions. Although the peritoneal
transport of investigated solutes, except amino acids and urea, were not different with the amino acid solutions compared with the corresponding eqnimolar glucose solutions, the transport of amino acids and urea, were altered with PDA 2.7% versus PDA l%, suggesting an effect of the hypertonic amino acid solution on the peritoneal membrane fransport properties. II. The experimental model of peritoneal dialysis in the rat yielded consistant and reproducible results which seem to provide an appropriate basis for comparisons with peritoneal transport data in CAPD patients. However, substantial differences in peritoneal fluid and solute transport
were also noted. Understanding of similarities and differences of peritoneal transport properties in an experimental peritoneal dialysis compared with data obtained from CAPD patients could be of value to interpret experimental data.
III. The uanscapillsry ultrafiltration with the approximately isotonic 7.5 % albumin solution was maintained for at least for 4 hours during peritoneal dialysis in rats, although the transcapillary ultrafiltration rate was not big enough to compensate for the peritoneal fluid reabsorption rate. A dialysis solution which contained both albumin and glucose resulted in higher and more prolonged ultrafiltration than that with the equimolsr glucose-based dialysis solution without albumin. After 4-hour dialysis with the two albumin solutions, approximately 20-25 % of the initial amount of albumin was absorbed (whereas approximately 85 % of the initial amount of glucose was absorbed with Dianeal 1.36 % solution). The present study shows the beneficial effect of a large molecular solute with or without a small molecular solute as osmotic agents in the same solution for prolonged uluafiltration and prevention of glucose load
during peritoneal dialysis. IV. The net sieving coefficients (S) for urea and sodium were between 0 and 1 in the rats, and did not differ from the previously reported S values measured in CAPD patients for an isochratic solution, except S for glucose which appeared to be lower. S for potassium was negative and thus ant of physical range. The finding of anomalous transport of potassium may indicate that the transport of potassium from the peritoneal cavity is not only by simple passive diffusion but also by other transport mechanisms such as active transport of potassium into cells. V. The findings that transport of fluid, glucose, sodium and potassium during the dialysis with neutral dialysis solutions was different from the values with conventional dialysis solutions suggest that the acidity of the conventional dialysis solution may influence the peritoneal transport characteristics of the investigated small solutes with exception for urea.
Key words: peritoneal dialysis, experimental model of peritoneal dialysis, peritoneal nansport, kinetic modelling, ultrafiltration, diffusive uansport, convective transport, sieving coefficient, osmotic agent, acidity of dialysis solution, amino acid, albumin