말기 신부전증으로 투석을 시작하는 당뇨병과 비당뇨병환자에서 99mTc-sestamibi SPECT (MIBI) 및 심초음파 소견의 비교 = The Comparison of 99mTc-sestamibi SPECT (MIBI) and Echocardiographic Findings between Diabetic and Non-diabetic Patients Starting Dialysis Treatment

다국어 초록 (Multilingual Abstract)

Background:Cardiovascular disease is known as an important predictor of mortality, not only in patients undergoing dialysis treatment but also in those who are starting dialysis treatment. In addition, it is well known that cardiovascular morbidity is about twice higher in diabetic patients. In this study, MIBI and echocardiography were performed in patients starting dialysis treatment, and a comparison of these findings between diabetic (DM) and non-diabetic (Non-DM) patients was done.
Methods:Among the patients diagnosed as end- stage renal disease (ESRD) and started dialysis treatment at Severance Hospital, 77 patients underwent MIBI and echocardiography when they were clinically stable within 4 weeks after the initiation of dialysis. Clinical characteristics, laboratory findings, MIBI and echocardiographic findings of the 77 patients were analyzed.
Results:The mean age of the patients was 58.4±10.8 years with sex ratio of 1.1:1. Of the 77 patients, 52 were DM and 25 were Non-DM. There were 30 patients (39.0%) with abnormal findings on MIBI scan, 26 with reversible and 4 with fixed defects, and 69 patients (89.6%) with left ventricular hypertrophy (LVH) on echocardiography. DM group showed higher prevalence of myocardial perfusion defect than Non-DM group (48.1% vs. 20.0%, p< 0.05). There were no differences in the prevalence of LVH (92.3% vs. 84.0%) and in left ventricular ejection fraction (LVEF) (56.1±13.1% vs. 57.5±11.8%) between DM and Non-DM groups. LVEF was significantly lower in patients with abnormal findings on MIBI scan than those with normal MIBI finding.
Conclusion:The majority of ESRD patients starting dialysis treatment accompanied LVH and myocardial perfusion defect was present in many cases especially in diabetic patients. Therefore, early evaluation and treatment of ischemic heart disease are mandatory in diabetic patients starting dialysis treatment for ESRD.

국문 초록 (Abstract)

배 경 : 심혈관계 질환은 말기 신부전증 환자에서 사망률에 영향을 주는 중요한 예후 인자이며, 이러한 심혈관계 질환의 유병률은 당뇨병 환자에서 특히 높은 것으로 알려져 있다. 투석 중인 말기 신부전증 환자를 대상으로 원인 질환에 따른 심혈관계 질환의 차이를 비교한 연구는 종종 보고되어 온 반면, 투석을 처음 시작하는 환자를 대상으로 한 연구는 아직까지 보고된 바가 없다. 이에 저자 등은 투석을 처음 시작하는 말기 신부전증 환자를 대상으로 MIBI와 심초음파 소견을 분석하였으며, 대상 환자를 말기 신부전증의 원인에 따라 당뇨병성 신병증군 (DM)과 비당뇨병성 신질환군 (Non-DM)으로 나누어서도 비교하였다.방 법 : 연세의료원에서 투석을 처음 시작한 말기 신부전증 환자 중, 투석 시작 4주내에 MIBI와 심초음파 검사를 모두 시행한 77명 (DM 52명, Non-DM 25명)을 대상으로 임상적 특성, 혈청생화학 검사, MIBI 및 심초음파 소견을 분석하였다. 결 과 : 대상 환자의 평균 연령은 58.4±10.8세, 남녀 비는 1.1 : 1이었다. 전체 환자 중 MIBI 검사상 비정상 소견은 30명 (39.0%)에서 동반되었는데, 이중 가역 관류 결손 26명, 지속 관류 결손 4명이었다. 심초음파 검사상 좌심실 비후 소견은 69명 (89.6%)에서 관찰되었다. DM군과 Non-DM군 사이의 MIBI 소견을 비교한 결과, 심근 관류 이상 소견은 DM군에서 의미있게 많았다 (48.1% vs. 20.0%, p<0.05). 심초음파 검사상 DM군과 Non-DM군 사이에 좌심실 비후 동반 여부와 좌심실 구혈율에는 차이가 없었다. MIBI 검사상 심근 관류 이상 소견이 없었던 환자군에서의 좌심실 구혈율은 심근 관류 이상 소견이 있었던 환자군에 비해 유의하게 높았다 (59.4±12.8% vs. 52.1±11.2%, p<0.05).

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