혈액투석 환자의 우울 증상과 염증반응 및 심혈관 질환 위험 인자의 연관성 = Association of Depression with Inflammation and Cardiovascular Risk Factors in End Stage Renal Disease Patients on Hemodialysis

국문 초록 (Abstract)

목적: 우울증 환자에서 염증 반응의 증가가 관찰되며, 심혈관계 합병증이 증가한다는 것이 알려져 있다. 또한 만성신부전 환자의 주된 사망 원인은 심혈관계 합병증이며, 우울 증상은 만성신부전 환자에서 흔히 관찰되는 증상이다. 이 연구의 목적은 유지 혈액투석을 받고 있는 만성신부전 환자에서 우울 증상과 다양한 염증 표지자 및 심혈관계 합병증의 위험 요소들과의 연관 관계를 밝히는 것이다. 방법: 고려대학교 안암 병원에서 유지 혈액투석을 받고 있는 53명의 환자들을 대상으로 연구하였다. Beck 우울증 척도(BDI)가 11 이상인 환자들을 우울 증상군으로, 10 이하인 환자들을 대조군으로 정의하였다. 의무기록을 통해 각 군의 환자들의 특성과 검사소견을 수집하였으며, 각 환자군에서 혈중 IL-10, TNF-α 농도를 측정하고, IL-10 과 TNF-α 프로모터 영역의 유전형 변이를 분석하였다. 결과: TNF-α, CRP 및 ferritin의 농도는 우울 증상군에서 유의하게 높았으며 (p=0.001, 0.04, 0.02), IL-10의 농도는 우울 증상군에서 낮게 관찰되었다 (p=0.05). 좌심실 비대의 빈도는 대조군에 비해 우울 증상군에서 높았다 (44% vs 9%, p=0.01). 프로모터 영역의 유전형 변이 분석에선, IL-10을 더 많이 생산하는 것으로 알려진 GG 유전형 변이가 대조군에 비해 우울 증상군에서 더 적게 관찰되었다 (8% vs 35.7%, p=0.039). 결론: 우울 증상을 보이는 혈액투석 환자에서 염증 반응의 증가 및 좌심실비대, 좌심실 구혈률 감소 등 심혈관계 질환 위험 인자의 증가가 관찰되며, 향후 이들 간의 인과 관계를 밝히기 위한 후향적 연구가 필요할 것으로 생각된다.

다국어 초록 (Multilingual Abstract)

Purpose: Depression is associated with increased inflammation and cardiovascular disease. And in patients with end stage renal disease (ESRD), depression is a common problem and cardiovascular disease is the main cause of death. The aim of this study is to investigate the association of depression with various inflammatory markers and with some cardiovascular risk factors in ESRD patients on hemodialysis. Methods: 53 patients with ESRD on maintenance hemodialysis were divided into depressive symptom (BDI≥11) group and control (BDI<11) group by the 21-items Becks depression inventory (BDI). We collected patients characteristics and laboratory measurements by medical records. And then, we measured the levels of IL-10 and TNF-αaand analyzed the genotype of IL-10 and TNF-αapromoter area. Results: The levels of TNF-α, CRP and ferritin were significantly higher in depressive symptom group (p=0.001, 0.04, 0.02) and IL-10 concentration tended to be lower in depressive symptom group (p= 0.05). The prevalence of left ventricular hypertrophy was higher in depressive symptom group than in the control group (44% vs 9%, p=0.01). GG genotype known as high IL-10 producer was less common in depressive symptom group than in control group (8% vs 36%, p=0.039). Conclusion: Increased inflammation, high left ventricular hypertrophy prevalence and low ejection fraction were observed in depressive hemodialysis patients. Further prospective study is needed to clarify the role of depression in the development of inflammation and cardiovascular disease in ESRD patients.

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