The Journal of Korean Diabetes (당뇨병)

Korean Diabetes Association (대한당뇨병학회)
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Utility of Brachial-ankle Pulse Wave Velocity as a Severity Marker of Coronary Artery Occlusive Disease in Patients with Diabetes Mellitus

당뇨병환자의 관상동맥질환 중증도 평가지표로서의 상완발목동맥파속도의 유용성

Kim, Hai-Jin;Kim, Chul-Sik;Park, Jong-Suk;Park, Ji-Na;Noh, Tae-Woong;Nam, Ji-Sun;Ahn, Chul-Woo;Cha, Bong-Soo;Lim, Sung-Kil;Kim, Kyung-Rae;Lee, Hyun-Chul
김혜진;김철식;박종숙;박진아;노태웅;남지선;안철우;차봉수;임승길;김경래;이현철

  • Published : 20060000
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Abstract

Background: Atherosclerosis is the underlying pathophysiology of coronary artery occlusive disease. As arterial stiffness reflects degree of systemic atherosclerosis and severity of peripheral artery occlusive disease, by measuring arterial stiffness, one can estimate severity of coronary artery occlusive disease in early stage. In this study we want to show the relationship of arterial stiffness and coronary artery occlusive disease, comparing in diabetes and non-diabetes group and decide the cutoff point of arterial stiffness to predict multivessel disease in diabetes group. Methods: Total 443 of 181 diabetes and 262 non-diabetes patients were enrolled in the study with informed consent. We performed percutaneous coronary angiography and measured AI, ABI, baPWV with a new device, noninvasive pulse wave analyzer. We also checked anthropometric, serologic data and demonstrated the extent of coronary artery occlusion by Gensini score. Results: There were significant differences in baPWV, Gensini score, pulse rate, pulse pressure, serum c-reactive protein (CRP), B-type natriuretic peptide (BNP) and fasting plasma glucose level, all higher in DM patient group. Gensini score was positively related to baPWV, fasting plasma sugar, serum CRP, BNP level and among these, baPWV was the independent predictor of multivessel disease (MVD) in both groups. Furthermore with ROC curve, we could set the cutoff value of baPWV at 1.635 cm/sec to screen MVD with 64.6% sensitivity and 63.5% specificity. With this set point, odds ratio to develop MVD was 3.08 in the group above 1.635 cm/sec compared to that below and DM patients showed higher sensitivity to this cutoff value. Conclusion: We suggest baPWV to be routinely checked in all diabetes patients to detect coronary artery occlusive disease and those who belong to the range above 1.635 cm/sec should take prompt interventional measures to prevent further complication.

연구배경: 관상동맥질환은 당뇨병환자의 주요 사망 원인이지만 감각의 둔화로 인해 무통성 관상동맥질환을 일으키는 경우가 많아 조기에 발견되기 어려운 점이 있다. 이러한 이유로 예방과 조기 치료가 중요한 당뇨병환자의 관상동맥질환을 조기에 예측할 수 있는 비침습적인 지표의 확립이 필요한 실정이며, 이에 대한 많은 연구들이 진행되고 있다. 본 연구는 혈관경직도를 측정함으로 동맥경화증의 평가지표로 알려진 상완발목동맥파속도 (brachial-ankle pulse wave velocity, baPWV), ankle-brachial pressure index (ABI) 및 augmentation index (AI)가 제2형 당뇨병환자에 있어서 관상동맥질환의 중증도 및 조기 위험인자로서의 유용성에 대하여 알아보고자 하였다. 방법: 181명의 당뇨병환자와 262명의 비당뇨병환자 총 443명을 대상으로 동맥경화증과 관련된 인체계측학적 지표와 생화학적 검사를 시행하였고 동맥파 분석기를 이용하여 동맥경화증의 지표로 알려진 baPWV, ABI및 AI를 측정하였다. 또한, 관상동맥조영술로 확인된 관상동맥질환의 중증도는 Gensini score를 이용하여 표기하였다. 결과: 당뇨병환자군과 비당뇨병환자군 간의 연령, 성별, 혈압, 체중, 신장, ABI, AI, 지질 수치의 차이는 없었으나 맥박, 맥압, baPWV, Gensini score, 혈청 c-reactive protein (CRP), B type natriuretic peptide (BNP), 공복 혈당 등은 당뇨병환자군에서 유의하게 증가되어 있었다. 특히 baPWV, 공복혈당, 혈청 CRP 및 BNP 는 Gensini score와 연관이 있었고, 이들은 양의 상관관계를 보였다. 이들 중 baPWV는 다혈관질환의 독립적인 위험인자였다. 한편 ROC (Receiver operation characteristic) curve를 이용하여 다혈관질환을 가려내는 결정값 (cutoff value)을 구한 결과, baPWV 1.635 cm/sec에서 가장 적정한 값을 구하였다 (예민도 64.6%, 특이도 63.5%, AUC 0.65). 또한 baPWV가 그 이상으로 증가할 경우 다혈관질환의 발생률은 3.08배 더 증가하였으며 (95% C.I. 1.06~5.54, P < 0.01), 특히 이러한 결정값은 비당뇨병환자군에 비해 당뇨병환자군에서 더 높은 예민도를 보여 (비당뇨병: 예민도 55%, 특이도 66.5%, AUC 0.63, 당뇨병: 예민도 69%, 특이도 55%, AUC 0.69) 당뇨병환자군에서 관상동맥질환, 특히 다혈관질환의 조기평가 지표로서 유용할 것으로 판단된다. 결론: 이상의 연구결과, 제2형 당뇨병이 있는 관상동맥질환자는 비 당뇨병 관상동맥질환자에 비해 혈관 경직도가 더 증가되어 있고, 이와 더불어 관상동맥질환 및 다혈관질환의 위험도도 증가된다. 이에 저자는 모든 당뇨병환자에서 baPWV를 측정하여 조기에 동맥경화증의 상태을 평가하고, 심혈관계 합병증을 철저히 예방하는 것이 바람직할 것으로 생각된다.

Keywords

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