지속성 외래복막투석 환자에서 Celecoxib 투여에 따른 High Sensitivity C-reactive Protein, D-dimer, von Willebrand Factor 및 Troponin-T의 변화 = The Effects of Celecoxib on High-sensitivity C-reactive Protein, D-dimer, von Willebrand Factor and Troponin-T in Continuous Ambulatory Peritoneal Dialysis Patients

다국어 초록 (Multilingual Abstract)

Background:It has become clear that inflammation is an important process in the pathogenesis of atherosclerosis. Cyclooxygenase (COX)-2 inhibitors, such as rofecoxib or celecoxib, are new nonsteroidal anti-inflammatory drugs. Some reports that COX-2 inhibitors decreased inflammatory markers in animals and humans. In this study, we evaluated the effects of celecoxib on the level of high-sensitivity C-reactive protein (hs-CRP), D-dimer, von Willebrand factor (vWF) and troponin-T in continuous ambulatory peritoneal dialysis (CAPD) patients.
Methods:From June 2002 to December 2002, 46 CAPD patients with hs-CRP equal or greater than 0.25 mg/dL were included in this prospective study. The 46 patients were randomized to the treatment group who took 200 mg of celecoxib daily for 4 weeks or to the control group who did not take the medication. Of the 46 patients, 43 patients completed this study.
Results:Baseline values of all the parameters were not significantly different between the two group. In the control group (N=22), the levels of hs- CRP, albumin, D-dimer, vWF and troponin-T did not change. In the treatment group (N=21), administration of celecoxib for 4 weeks significantly reduced hs-CRP from 0.77 (range 0.25-7.08) to 0.39 mg/dL (range 0.11-5.22, p<0.05). The level of albumin, D- dimer, vWF and troponin-T levels were not affected by the administration of celecoxib.
Conclusion:Our preliminary short-term study shows that celecoxib decreased hs-CRP and not changed the level of vWF, D-dimer and torponin-T in CAPD patients. We suggest that celecoxib has an anti-inflammatory effect in usual dosage in CAPD patients

국문 초록 (Abstract)

배 경 : 염증 (inflammation)은 동맥경화증의 병인에 중요한 역할을 한다고 알려져 있다. 말기 신부전 환자들은 동맥경화증의 고위험군이며 심혈관계질환에 의한 사망이 50%에 달한다고 보고되고 있다. C-reactive protein (CRP)은 염증의 대표적인 표지자이며 atherogenesis에 직접적으로 연관되고 말기 신부전 환자에게서 CRP가 증가된 환자들이 심혈관계 질환의 사망률이 높다고 알려져 있다. Cyclooxygenase-2 (COX-2) 선택적 억제제가 염증의 표지자를 감소시킨다는 여러 보고가 있으나 복막투석 치료를 하는 말기신부전 환자에게서 염증에 대한 효과를 평가한 보고는 없었다. 이에 저자들은 지속성 외래복막투석 환자들에서 COX-2 선택적 억제제의 하나인 celecoxib 투여 후 high-sensitivity CRP (hs-CRP), D-dimer, von Willebrand factor, Troponin-T를 검사하였다.방 법 : 본원에서 복막투석을 시행 받고 있는 환자들 중 hs-CRP가 0.25 mg/dL 이상인 46명의 환자를 대상으로 2002년 6월과 12월 사이에 시행되었고, 복막투석 치료를 지속한 평균기간은 37개월이었다. 46명의 환자 중 23명은 4주 동안 celecoxib 200 mg 하루 1회 경구 복용하였고, 대조군 23명은 celecoxib를 복용하지 않았다. 본 연구의 시작전과 celecoxib 복용 4주 후에 hs-CRP, albumin, D-dimer, vWF와 troponin-T를 측정하였다.결 과 : 46명의 환자 중 43명이 본 연구를 마쳤다. 치료군 중 2명은 치료 도중 celecoxib를 복용하지 않았고, 대조군 중 1명은 복막염이 발생하여 분석에서 제외되었다. 치료 시작 전 모든 표지자는 양군에 통계학적 차이가 없었다. 대조군에서 hs-CRP, albumin, D-dimer, vWF와 troponin-T는 치료 전과 치료 후에 차이가 없었다. 치료군에서 celecoxib 4주 치료 후 hs- CRP가 치료시작 전 0.77 mg/dL (0.25-7.08)에서 0.39 mg/dL (0.11-5.22)로 통계학적으로 의미있게 감소되었다. 그러나 albumin, D-dimer, vWF와 troponin-T는 celecoxib 치료 후 변화가 없었다.

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