만성 신질환에서 혈중납량 및 골중납량과 신기능 저하의 관련성 = Association of Blood and Bone Lead with a Decrease in Renal Function Indices in Patients with Chronic Kidney Disease

다국어 초록 (Multilingual Abstract)

Purpose: This study assessed the environmental lead exposure in patients with chronic kidney disease (CKD) and the relationship between lead exposure and renal function indices.
Methods: Seventy-one patients with CKD and 40 control subjects without known renal disease were included. Blood lead was measured by atomic absorption spectrophotometry and tibial lead was measured via 109Cd-based K-shell X-ray fluorescence. Blood urea nitrogen (BUN), serum creatinine, urine creatinine and urine N-acetyl-beta glucosaminidase (NAG) were also measured. Blood lead was corrected with hematocrit (female: 35%, male: 42%) to adjust for differences in anemic status of patients compared with control subjects.
Results: The mean level of hematocrit-adjusted blood lead was significantly higher in patients with CKD (4.18±1.74 μg/dL) compared with that in control subjects (3.00±0.92 μg/dL); the mean tibial lead level tended to be higher in patients with CKD (3.38±9.93 μg/g) than that in control subjects (1.28±7.92 μg/g), but no statistical significance was observed. In a multivariate regression analysis after adjusting for gender, age, and drinking and smoking status, adjusted blood lead was a significant predictor of increases in BUN and serum creatinine, but not of the level of urine NAG or creatinine. In contrast, no significant association between tibial lead and renal indices was observed in the multivariate regression analysis.
Conclusion: These results suggest that environmental lead exposure may compromise renal function.

국문 초록 (Abstract)

목 적: 만성 신질환 환자에서 혈중 및 골중납량이 신기능과의관련성을 조사하기 위하여 본 연구를 시행하였다.
방 법: 납을 직업적으로 취급한적이 없는 말기신부전환자를포함한 만성 신질환 환자 71명과 동일지역에 사는 직업적 납 노출이 없는 대조군 40명을 연구 대상으로 선정하였다. 혈중납량과 골중납량으로서 경골의 납량을 측정하였으며, 신기능 조기 지표로서 NAG와 임상신기능지표로서 BUN 및 혈청 creatinine 그리고 요중 creatinine을 측정하였으며, 혈구용적치와 혈색소를 측정하였다. 만성 신질환 환자와 대조군의 혈구용적치의 차이가 커서, 이를 보정하기 위하여 혈구용적치로 보정 (여: 35%,남: 42%)한 보정 혈중납량을 산정하여 사용하였다.
결 과: 만성 신질환 환자들의 혈구용적치로 보정한 혈중납량은 대조군보다 유의하게 높았으나, 골중납량은 대조군보다 높았으나 통계적으로 유의하지 않았다. 성별, 연령, 음주 및 흡연 등의 공변수를 통제한 후의 중회귀분석에서 보정 혈중납량은 BUN 및 혈청 creatinine의 증가에는 유의한 영향을 준 반면 요중NAG 및 요중 creatinine에는 유의한 영향을 주지 못했다. 한편 중회귀분석에서 골중납량은 신기능지표에 아무런 영향을 주지 못했다.
결 론: 본 연구는 환경 중의 납 노출이 신기능 손상에 영향을미칠 수 있다고 제안한다.

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