The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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The relationship between aortic distensibility and serologic markers of atherosclerosis

대동맥 탄성도와 동맥경화증의 혈액학적 인자의 관계

Kim, Hyun-Kuk;Park, Jong-Chun;Kim, Sung-Soo;Choi, Hong-Sang;Sim, Doo-Sun;Yoon, Nam-Sik;Yoon, Hyun-Ju;Hong, Young-Joon;Park, Hyung-Wook;Kim, Ju-Han;Ahn, Young-Keun;Jeong, Myung-Ho;Cho, Jeong-Gwan;Kang, Jung-Chaee
김현국;박종춘;김성수;최홍상;심두선;윤남식;윤현주;홍영준;박형욱;김주한;안영근;정명호;조정관;강정채

  • Published : 20090700
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Abstract

Background/Aims: The elasticity of the aorta modulates the entire cardiovascular system. Increasing arterial stiffness with the loss of aortic elasticity is not only a surrogate marker for early atherosclerosis, but also a predictor of cardiovascular events. Methods: This study included 203 patients (57.6${\pm}$14.7 years, 117 male) who underwent diagnostic transesophageal echocardiography. We investigated the correlation between the arterial stiffness index (${\beta}$ stiffness index), which is calculated from the distensibility of the descending thoracic aorta and blood pressure, and known serologic markers of atherosclerosis and cardiovascular events. Results: The ${\beta}$ stiffness index correlated significantly with the brachial-ankle pulse wave velocity ($R^2$=0.243, p<0.001) and intima-media thickness of the descending thoracic aorta ($R^2$= 0.470, p<0.001). It also correlated with age (r=0.465, p<0.001) and the presence of diabetes mellitus (r=0.250, p<0.001). The ${\beta}$ stiffness index was significantly positively correlated with the levels of N-terminal pro-brain natriuretic peptide (NT- proBNP), high-sensitivity C-reactive protein (hsCRP), glucose, HbA1c, apolipoprotein (Apo) A-I, and erythrocyte sediment rate. A multivariate regression analysis demonstrated that the ${\beta}$ stiffness index was associated with the levels of NT-proBNP, hsCRP, HbA1c, and Apo A-I. Conclusions: The ${\beta}$ stiffness index for the distensibility of the descending thoracic aorta significantly correlates with other parameters of arterial stiffness and serologic markers for atherosclerosis. Therefore, the ${\beta}$ stiffness index can be used as a parameter of cardiovascular events in diseases requiring transesophageal echocardiography, such as atrial fibrillation and mitral stenosis.

목적: 동맥은 탄력성이 있어 전체 심혈관계에서 조정자의 역할을 담당하고 있다. 탄력성의 감소로 인한 동맥 경직도의 증가는 조기 동맥 경화의 지표일 뿐 아니라 차후 심혈관 사건과 관련이 있는 것으로 알려져 있다. 본 연구에서 하행 흉부대동맥 탄성도와 혈압을 이용하여 계산한 동맥 경직도 지수(${\beta}$ stiffness index)와 동맥경화증과 관련이 있는 혈액학적 인자와의 관계를 규명하고자 하였다. 방법: 2007년 1월부터 2008년 3월까지 전남대학교병원에서 경식도 초음파를 시행한 203명(57.4${\pm}$14.8세, 남자 117명)을 대상으로 시행하였다. ${\beta}$ stiffness index와 동맥 경직도에 공인된 지표인 상완발목 맥파속도 및 하행 흉부 대동맥 내중막 두께의 관련성을 분석하였으며, 다중 회귀 분석을 이용하여 ${\beta}$ stiffness index와 관련있는 혈액학적 인자를 조사하였다. 결과: ${\beta}$ stiffness index와 상완-발목 맥파속도 및 하행 흉부 대동맥의 내중막 두께는 유의한 양의 상관관계를 보였다($R^2$=0.243, p<0.001;$R^2$=0.470, p<0.001). 또한 나이(r=0.465, p<0.001), 당뇨병(r=0.250, p<0.001), N-terminal pro-B type natriuretic peptide (NT pro-BNP) (r=0.225, p=0043), high-sensitivity C-reactive protein (hs CRP) (r=0.381, p<0.001), 혈청 당(r=0.189, p=0.012), 당화 혈색소(r=0.209, p=0.013), 아포지단백 A-1 (r=-0.241, p=0.004) 및 적혈구 침강속도(r=0.185, p=0.049) 등과 양의 상관관계가 있었다. 다중 회귀 분석에서 NT-proBNP와 hsCRP, 당화 혈색소 및 아포지단백 A-I 등이 상관관계를 보였다. 결론: 하행 흉부 대동맥의 탄성도를 이용한 ${\beta}$ stiffness index는 동맥 경직도를 측정하는 다른 측정 방법과 상관관계가 있으며, NT-proBNP와 hsCRP, 혈청 당 수치, 당화 혈색소 및 아포지단백 A-I과 같은 동맥경화증과 관련된 혈액학적 인자와도 관련성이 있어 심방세동이나 승모판 협착증 등 경식도 심초음파를 이용하는 질환에서 심혈관 사건의 위험도 평가나 치료 강도의 결정에 이용될 수 있을 것으로 기대된다. 또한 심장 전산화 단층촬영에서도 칼슘 점수와 같이 심혈관 사건의 예측인자로 이용할 수 있을 것으로 기대된다.

Keywords

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