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혈액투석 환자에서 저알부민혈증이 진행성 좌심실 비대에 미치는 영향
송인숙,박종하,박정식,문경협,신영태,채동완,홍창기,장혜숙 대한신장학회 1999 Kidney Research and Clinical Practice Vol.18 No.2
Cardiac disease is a major cause of mortality and morbidity in hemodial ysis patients. Left ventricular hypertrophy(LVH) is an independent cardiac risk factor in these patients. To evaluate the prevalence and risk factors of echocardiographic LVH at the time of starting hemodialysis and its progression, we performed a prospective study. From Jun. 1994 to Feb. 1997, 111 patients with ESRD on starting hemodialysis were included. They received baseline echocardiography within six months from the initiation of hemodialysis. LVH was highly prevalent in ESRD patients at the time of starting hemodialysis (82% of 111 ESRD patients). Among them, 32 patients, who had LVH on baseline echocardiography, received follow-up echocardiography. At the time of second echocardiography, they had no clinical events such as angina, myocardial infarction, congestive heart failure and cerebrovascular accident. Follow-up echocardiography was done after 15 months(range; 9-24 months). LVH was defined as the left ventricular mass index(LVMI) greater than 131g/m2 in male, and 100g/m2 in female. Progressive LVH was defined as the follow-up LVMI larger than 105% of the baseline LVMI. We measured hemoglobin, blood urea nitrogen, creatinine, cholesterol, albumin, prealbumin, parathyroid hormone, Kt/V, nPCR, fibrinogen, homocysteine and ACE gene polymorphism. The median age was 55 years old(range; 19-78) and 50% of the patients had diabetes mellitus. Progressive LVH occurred in 19 patients(M:F= 12:7). Progressive LVH was associated with lower diastolic blood pressure(81±11 vs. 90?12mmHg, P= 0.036) and lower serum albumin level(3.5±0.4 vs. 3.9±0.4g/dl, P=0.009). Serum albumin level was well correlated to ?LVMI(follow-up LVMI minus baseline LVMI) negatively(r=-0.4198, P=0.017). Hypoalbuminemia was an independent risk factor for progressive LVH using multiple logistic regression analysis(R.R.=1.288, P=0.046). Progressive LVH was not associated with age, gender, diabetes mellitus, smoking history and other laboratory parameters. In conclusion, LV highly prevalent in hemodialysis patients on starting hemodialysis. Progressive LVH occurred in 59% of hemodialysis patients, and hypoalbuminemia was a risk factor for progressive LVH in these patients.
송인숙,이미숙,박정식,정시정,문경협,신영태,채동완,홍창기 대한신장학회 1999 Kidney Research and Clinical Practice Vol.18 No.2
To evaluate the prevalence of cardiac disease and its risk factors at the start of dialysis, we analyzed the demographic, clinical, echocardiographic, and laboratory data including ACE gene polymorphism of 111 end-stage renal disease(ESRD) patients who survived at least 6 months and had an echocardiogram within 6 months from the initiation of hemodialysis Clinically, 24% of the patients had congestive heart failure and 14% had ischemic heart disease. Congestive heart failure was associated with diabetes(56% vs. 32%, P=0.03), higher plasma homocysteine(24.5μmol/l vs. 20.7μmol/l, P=0.01), and lower parathyroid hormone($lt;60pg/ml; 46% vs. 14%, P= 0.004). Ischemic heart disease was associated with older age(62 vs. 48, P=0.001), diabetes(67% vs. 33%, P=0.01), hypoalbuminemia(3.1g/dl vs. 3.4g/dl, P=0.03) and lower parathyroid hormone($lt;60pg/ml; 47% vs. 18%, P=0.04). Echocardiographically, left ventricular hypertrophy (LVH) was present in 89% of the patients of whom in detail 70% had concentric left ventricular hyptrophy(CLVH), 18% had left ventricular dilatation (LD), and 12% had systolic dysfunction(SD). The following associates were found:LVH group-diabetes(41% vs. 9%, P=0.04) and smoking(34% vs. 2%, P=0.01), CLVH group-hypoalbuminemia(3.3g/dl vs. 3.6g/dl, P=0.08), and diabetes(45% vs. 26%, P=0.048), SD group-high cholesterolemia(205mg/dl vs. 168mg/ dl, P=0.01). High diastolic blood pressure was an independent predictor of severe LVH in multivariate logistic analysis(relative risk=1.46, P=0.05). In conclusion, LVH was highly prevalent in ESRD patients starting hemodialysis. Diastolic hypertension was independently associated with severe LVH and there was no association between ACE gene polymorphism and cardiovascular disease.
A Case of Paracentric Inversion of Chromosome 18 (q21.1q22.1)
( Gh An ),( Kh Choi ),( My Kim ),( Jy Han ),( Hk Ahn ),( Jh Chung ),( Mh Kim ),( Sw Lee ),( Yj Han ),( Dw Kwak ),( Yh Chae ),( Sy Park ),( Hm Ryu ) 대한산부인과학회 2012 대한산부인과학회 학술대회 Vol.98 No.-
We report on a case with a paracentric inversion of the long arm of chromosome 18: 46,XX,inv(18)(q21.1q22.1). A karyotype 46.XX.add(18) was found during antenatal diagnosis (amniocentesis) performed at local clinic because of advanced maternal age (38 years). And the pregnant woman visited our hospital at 18.4 weeks to confirm the result. We performed the amniocentesis and found the karyotype 46,XX,inv(18)(q21.1q22.1). The inversion was also found in the mother and the maternal grandmother of the fetus by chromosome studies from peripheral blood . The high resolution ultrasonography performed at 20.5 weeks showed normal findings. The diagnosis of paracentric inversion can be difficult and might be incorrect because of the variety of unpredictable unbalanced chromosome products that can result from a paracentric inversion. The vast majority of paracentric inversions are likely to be harmless. The risk of having an abnormal child for carriers of paracentric inversions is expected to be low. but sometimes by the variation of breakpoint or recombination process, various clinical phenotype can be seen : 18q- syndrome including: microcephaly, epicanthal folds, midface hypoplasia, and abnormally modeled ears, dermatoglyphic whorls on fingertips, clubfeet, hearing loss, and developmental delay. The mother is now ongoing pregnant state and the baby needs long term follow up after birth. This report underlines the importance of careful antenatal diagnosis and genetic counseling for parental and fetal paracentric inversion.