잠시만 기다려 주세요. 로딩중입니다.

말기신질환자에서 호모시스테인농도에 따른 엽산의 치료효과 및 Pulse wave velocity (PWV) 의 변화

Changes of pulse wave velocity findings and the effects of folic acid treatment on homocysteine levels in End Stage Renal Disease

대한내과학회지
2007년 72권 6호 p.607 ~ p.615
고재기 ( Koh Jae-Ki ) - 서울의료원 내과

김수현 ( Kim Su-Hyun ) - 서울의료원 내과
신석호 ( Shin Suk-Ho ) - 서울의료원 내과
전관선 ( Chun Kwan-Sun ) - 서울의료원 내과
최준혁 ( Choi Jun-Hyouck ) - 서울의료원 내과
임지환 ( Lim Ji-Hwan ) - 서울의료원 내과
윤수진 ( Yoon Su-Jin ) - 서울의료원 내과

Abstract

Backgroudn: In end-stage renal disease (ESRD) patients, cardiovascular disease (CVD) is a major cause of morbidity and mortality. These patients frequently have hyperhomocysteinemia, a putative risk factor for cardiovascular disease. Several studies suggest that lowering plasma homocysteine may improve endothelial dysfunction, a marker of atherothrombotic risk. Pulse wave velocity (PWV) is a useful diagnostic tool to access endothelial dysfunction, and is widely used screening test for atherosclerosis.

Methods:We measured fasting total plasma homocysteine (tHcy) in 84 hemodialysis patients and 21 peritoneal dialysis patients. Subjects were assigned to two groups. Group I (tHcy <20 umol/L) consisted of 74 ESRD patients who have taken continual usual dose folate (1 mg/day). Group II (tHcy> or =20 umol/L) consisted of 26 ESRD patients who have taken high dose folate (5 mg/day). For 15 Group I patients and 5 Group II patients, pulse wave doppler velocity (PWV) measurements were taken before and after 3 months of folate treatment.

Results:The mean tHcy concentration was higher in the ESRD patients (82 HD: 16.9+/-6.4 mol/L, 20 PD: 18.0+/-16.7 mol/L). The pulse wave velocity (PWV) was faster in ESRD patients-19 HD: Aorta (Ao)-PWV 8.98+/-1.4, lower extremities (LE)-PWV 10.15+/-1.3, upper extremities (UE)-PWV 8.80+/-0.8 (m/s); 8 PD: Ao-PWV 9.32+/-1.8, LE-PWV 10.64+/-1.4, UE-PWV 9.24+/-0.7 (m/s). The PWV increased in ESRD patients with coronary heart disease and who had a history of angioplasty because of thrombosis or stenosis of vascular access. There was a significant reduction in hyperhomocysteinemia after 3 months in the high dose folate supplement group as compared to the usual dose folate supplement group with a significant statistical difference between the two groups. (15 Group I patients: 13.9+/-4.9 mol/L->13.5+/-6.1 for 5 Group II patients: 34.3+/-27.5 mol/L->23.0+/-5.9 mol/L (p<0.05, paired t-test). No difference in the PWV was found before and after folic acid supplementation for the two groups (p>0.05, paired t-test).

Conclusions:We assume that PWV and homocysteine concentration have some correlation and both studies are available as part of screening tests for atherosclerosis in ESRD. Although no significant interval change was detected for the PWV, this finding suggests that high-dose folate supplementation was helpful to minimize the risk of cardiovascular disease associated with hyperhomocysteinemia in ESRD patients.

키워드

원문 및 링크아웃 정보
 
등재저널 정보
학술진흥재단(KCI) KoreaMed 대한의학회 회원 
주제코드
주제명
(Target field)
연구대상
(Population)
연구참여
(Sample size)
대상성별
(Gender)
질병특성
(Condition Category)
연구환경
(Setting)
연구설계
(Study Design)
연구기간
(Period)
중재방법
(Intervention Type)
중재명칭
(Intervention Name)
키워드
(Keyword)
유효성결과
(Recomendation)
연구비지원
(Fund Source)
근거수준평가
(Evidence Hierarchy)
출판년도
(Year)
참여저자수
(Authors)
대표저자
(1st Authors)
Doi
KCD코드
ICD 03
건강보험코드