혈역학적으로 안정된 혈액투석환자에서 심장 질환 지표로서 B-type Natriuretic Peptide (BNP), N-terminal pro-BNP Cardiac Troponin T 측정

• Published in: Kidney research and clinical practice Vol. 26; no. 2; pp. 212 - 219
• Main Authors: 백현정, Hyun Jeong Baek, 김정아, Jung Ah Kim, 최소연, So Yeon Choi, 도연실, Yeon Sil Do, 장은희, Eun Hee Jang, 김정인, Jung In Kim, 도정호, Jung Ho Do, 최성철, Sung Chul Choi, 이정은, Jung Eun Lee, 허우성, Woo Seong Huh, 김대중, Dae Joong Kim
• Format: Journal Article
• Language: Korean
• Published: 대한신장학회 30.03.2007
• Subjects: Hemodialysis; Natriuretic peptides; Troponin
• ISSN: 2211-9132

목적: 만성 신질환 환자들은 일반인에 비해서 관상 동맥질환과 좌심실 비대가 동반되는 경우가 많다. 일반인에서 Btype Natriuretic Peptide (BNP), N-terminal pro-BNP (NT-proBNP), Cardiac Troponin T (cTnT)가 심질환 진단과 예후 인자로 유용하게 사용되고 있다. 투석 환자에서도 표지자를 이용하여 심질환을 예측할 수 있는지 알아보고자 하였다. 방법: 2004년 9월부터 9개월간 삼성서울병원에서 6개월 이상 투석을 받고 있는 환자 중 급성 심혈관계 질환이 없는 27명을 대상으로 하였다. 같은 날 채혈과 심장초음파 검사를 시행하였다. 결과: BNP, NT-proBNP, cTnT 중앙값 (pg/mL)은 각각 433, 10,598, 0.021이었다. NT-proBNP는 BNP (r= 0.940, p=0.000), cTnT (r=0.504, p=0.009)와 뚜렷한 양의 상관관계를 보였다. BNP, NT-proBNP는 심박출 계수와는 음의 상관관계를 (각각 r=-0.502, p=0.008 vs. r=-0.556, p=0.003), 좌심실 질량 지수와는 양의 상관관계를 보였다 (각각 r=0.619, p=0.001 vs. r=0.718, p=0.000). cTnT는 심박출 계수와 음의 상관관계를 보였으나 (r=-0.513, p=0.007), 좌심실 질량 지수와는 상관관계를 보이지 않았다 (r=0.369, p=0.063). 심박출 계수에 독립적으로 영향을 미치는 인자는 albumin, cholesterol, LDL-cholesterol, NT-proBNP이었고 (R2=0.80), 좌심실 질량 지수에 영향을 미치는 인자는 나이, body mass index, LDL-cholesterol, NT-proBNP, cTnT이었다 (R2=0.78). 결론: 혈액투석을 받고 있는 환자에서도 표지자 측정이 심질환을 예측하는데 도움이 될 것으로 사료된다. Purpose: The prevalence of coronary artery disease and left ventricular hypertrophy (LVH) is higher in patients with chronic kidney disease (CKD) than in the general population. In the general population, BNP, NT-proBNP, and cTnT are useful markers of cardiac disease. Recently, studies on biomarkers in patients with CKD have been reported. However, the effect of renal disease on these markers is still uncertain particularly in hemodialysis patients. We investigated the potential of BNP, NT-proBNP, and cTnT as biomarkers of cardiac disease in hemodialysis patients. Methods: We prospectively studied 27 hemodialysis patients without cardiovascular event within the last 6 months. We performed an echocardiography and blood samples for plasma BNP, NT-proBNP and cTnT. Results: Median BNP, NT-proBNP, and cTnT level (pg/mL) were 433, 10,598, and 0.021, respectively. NT-proBNP was correlated with BNP (r=0.940, p=0.000) and cTnT (r=0.504, p=0.009). There was a negative correlation between BNP and left ventricular ejection fraction (LVEF) (r=-0.502, p=0.008), between NT-proBNP and LVEF (r=-0.556, p=0.003), and between cTnT and LVEF (r=-0.513, p=0.007). There was a positive correlation between BNP and LV mass index (LVMI) (g/m2) (r=0.619, p=0.001). Also, a positive correlation between NT-proBNP and LVMI was shown (r=0.718, p=0.000). There was an insignificant positive correlation between cTnT and LVMI (r=0.369, p=0.063). Albumin, cholesterol, LDL-cholesterol, and NT-proBNP had an independent effect on LVEF (R2=0.80). Age, body mass index, LDL-cholesterol, NT-proBNP, and cTnT had an independent effect on LVMI (R2=0.78). Conclusion: BNP, NT-proBNP, and cTnT may be as a noninvasive diagnostic or prognostic marker of cardiac disease in stable hemodialysis patients.